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Medical Assistance in Dying (MAiD) from the perspective of the Registered Nurse working in palliative care
No full textThe development of assisted dying programs is growing as over a dozen countries have legalized a form of Medical Assistance in Dying (MAiD). As Canada's MAiD program continues to evolve and become more widely accepted, there is a growing need to understand how it affects the work of palliative care providers (PCPs) and as they plan end-of-life care for their clients who consider MAiD. In this narrative inquiry research study, I aimed to explore the experiences of palliative care coordinators (PCCs) when their clients consider MAiD as an end-of-life option. After receiving ethics approval, two PCCs who met the criteria were offered to be participants, and participant consent was reviewed and obtained. Two PCCs shared their stories by engaging in a semi-structured interview. Arthur Frank’s (2010) narrative inquiry method, dialogical narrative analysis (DNA), guided this study. The stories were analyzed using DNA, revealing five narrative resources common to both storytellers: the lines get blurred, supporting how they wish to die, I'm not part of that team, the day the IVs go in, and the missing pieces of the puzzle. The underlying plot, or typology that tied these resources together, was revealed as nothing in between. The findings from this study suggest that these PCCs would support improved accessibility for the client to talk to the MAiD team and increased support from the MAiD team before and after the MAiD procedure. These PCCs would like to see increased collaboration throughout the process and bereavement support provided by the MAiD team for family members after the MAiD process is completed. Recent literature revealed comparable findings demonstrating a shared experience of palliative care nurses in Canada since the legalization of MAiD. The circulating of these stories allows the palliative care nurses to share their voice in the new narrative of specialty palliative care nurses as they evolve with the continuing development of MAiD as an end-of-life option
Examining cognitive differences and posttraumatic growth in older adults
No full textThe effects of traumatic experiences can be severe and enduring, impacting most major systems of the body and lasting even decades after the event (D’Andrea et al., 2011, Thorp & Blazer, 2012). While traumatic experiences are likely to have implications across the lifespan, experiences among trauma survivors are highly unique and often include both positive (e.g., posttraumatic growth or PTG) and negative changes (Linley & Joseph, 2004; Peters et al., 2021). These changes may depend partially on appraisals of significance or meaning of events, a concept called event centrality (Boals & Schuettler, 2011). Using a multi-methods approach grounded in a narrative feminist framework, this study critically investigates the connection between difficult life experiences, cognitive functioning, and PTG in a population that has been largely excluded from trauma research to date – older civilian adults. Results indicated that neither the medicalization of trauma discourse nor the PTG discourse was fully supported. Quantitative analysis revealed a large but insignificant impact of trauma on cognitive functioning, with higher levels of trauma predicting higher cognitive functioning; PTG and event centrality did not significantly buffer this relationship. Qualitative interviews with three participants contextualize these findings, describing both the enduring negative impacts of trauma and positive changes after trauma as well as different conceptualizations of trauma and growth. Implications for improving services and societal implications are discussed
Reporting evidence on the environmental and health impacts of climate change on Indigenous Peoples of Atlantic Canada: A systematic review
No full textWhile evidence of Indigenous Peoples' climate knowledge and adaptation practices is readily available in Canada, regional variations are poorly understood, and proper representation and recognition in academic and planning contexts is scarce. Much less still is known about the health and environmental impacts of climate change on these communities. This review sought to report and assess the evidence of such impacts on Indigenous Peoples in Atlantic Canada over the past two decades. Current published studies focused on Indigenous Peoples' knowledge and perceptions and highlight government policy for adaptation measurements. We systematically searched publications between January 2002 and March 2022 from the Web of Science, PubMed, Google Scholar, and Science Direct databases, screening for (1) environmental and (2) health impacts of climate change on Indigenous Peoples. Fifty-six articles were selected and thoroughly reviewed using the GRADE approach to assess the quality of the evidence. The quality of evidence ranged from low to moderate, and the evidentiary foundation for links between climate change and health effects was weak. We thus find an opportunity for future research to focus on climate-related effects on the health and lands of Indigenous Peoples within Atlantic Canada, especially concerning impacts on mental health
Veterinarians’ self-reported needs and attitudes on the Atlantic Canada Veterinary College and Associated Teaching Hospital in relation to continuing education, research, and clinical referrals
No full textThe relationship between veterinary colleges (VCs), associated veterinary teaching hospital referral centers (VTHs), and referring veterinarians (rVets) is important and complex. Despite this, there has been minimal research on rVets with respect to their regional VC and VTH. Our objectives were to evaluate rVets’ attitudes and self-reported needs on their regional VC’s VTH surrounding (a) continuing education, (b) collaborative research, and (c) referrals for specialty consultation and care. Participants (rVets) were invited to complete an online questionnaire (2018–2019). Respondents (n = 56) indicated multiple (24) unmet continuing education topic needs, of which dermatology and behavior were most selected. Many rVets (70%) reported an interest in collaborative research participation. Communication was frequently selected by respondents when asked what could be improved with respect to the VTH referral center process. Our work provides a benchmark attitudes and needs assessment, identifies areas for improvement, and may aid initiatives regionally, and likely externally, as adapted to other rVet–VC–VTH relationships
Use of two- and three-dimensional echocardiography for assessment of the left ventricular outflow tract velocity and aortic orifice area in dogs
No full textIn practice, dogs are screened for subaortic stenosis (SAS) using two-dimensional (2DE) and Doppler echocardiography. Distinguishing between mild SAS and physiologically unaffected can be difficult, and a more precise evaluation of the left ventricular outflow tract (LVOT) is desirable. The aims of this study were to determine the step-up in Doppler-derived peak LVOT velocity at four sites within the LVOT and ascending aorta, investigate associated variables, and determine the LVOT and aortic orifice areas using 2DE and three-dimensional echocardiography (3DE) in apparently healthy dogs of various breeds and somatotypes. Sixty-nine healthy, privately-owned dogs were enrolled. The continuous wave (CW) peak LVOT velocity and the pulsed wave (PW) Doppler-derived step-up in LVOT velocity were determined from both the subcostal (SC) and left apical (LAP) imaging windows. The PW step-up in velocity was determined at four locations: mitral valve (MV) tips, half MV tips, aortic valve (AoV) annulus, and AoV tips. The LVOT and AoV orifice areas were determined using 2DE AoV diameter-derived area; the continuity equation (CE); and 3DE planimetry of the LVOT, AoV, sinus of Valsalva, and sinotubular junction.
The mean (± SD; min-max) total step-up in LVOT velocity was 105 cm/s (± 22 cm/s; 65-168 cm/s) and 83 cm/s (± 20 cm/s; 34-128 cm/s) from the SC and LAP imaging windows, respectively. The mean individual step-ups obtained from the SC and LAP imaging windows were, respectively: MV tips to half MV tips 32 cm/s and 36 cm/s, half MV tips to AoV annulus 53 cm/s and 32 cm/s, and AoV annulus to AoV tips 19 cm/s and 13 cm/s. Mean SC-derived peak CW LVOT velocity (154 cm/s) was significantly higher than LAP (137 cm/s; mean difference 17 cm/s; P<0.001), and peak CW velocities derived from both imaging planes were greater post-stimulation (SC post 165 cm/s versus pre 154 cm/s, mean difference 11.6 cm/s, P<0.001; LAP post 148 cm/s versus pre 137 cm/s, mean difference 11 cm/s, P<0.001). Heart rate, left ventricular end-diastolic and end-systolic volumes, and 3DE AoV area were significantly associated with SC CW LVOT velocity. Obtaining 3DE images and performing planimetric measurements of the LVOT was feasible in all dogs. The mean area indexed to body surface area measured using the 2DE AoV diameter (2.85±0.61 cm2/m2) was significantly lower than that derived from 3DE AoV planimetry (3.85±0.64 cm2/m2; mean difference 1.00 cm2; P<0.001). There was poor agreement between the LVOT area calculated using the CE and the LVOT and aortic areas calculated using 2DE AoV diameter and 3DE planimetry. The LVOT area calculated using the CE underestimated all other calculations of area. Interobserver and intraobserver repeatability and reproducibility for step-up in LVOT velocity were poor to good and for 3DE planimetry were excellent. These results quantify the variability that can be attributed to the site of sampling for spectral Doppler-derived velocity in the LVOT. Furthermore, they demonstrate that methods for determining LVOT and AoV orifice areas in dogs are not interchangeable. This information can be used for improving the accuracy of echocardiography in assessing dogs for SAS
Measurement of steroids in the placenta, maternal serum, and fetal serum in humans, rats, and mice: A technical note
No full textSteroid hormones are vital for a successful pregnancy. The placenta is attached to the uterine wall and is the major organ of communication between the mother and the fetus through the umbilical cord and the transfer of compounds (including the production and actions of steroids) across the villous placenta. Therefore, a correct understanding and measurement of steroid levels across the maternal–placental–fetal interface is essential. We have experience spanning more than two decades and have published more than 40 papers using a variety of methods to assess circulating and placental steroid levels. In this review, we discuss various methods for steroid detection and quantitation, as well as their advantages and disadvantages. This document provides technical guidance for best practices that, in our estimation, can assist researchers in more easily and correctly performing these studies. Critical methodological considerations, including tissue collection, tissue processing, and analytical factors (sensitivity, selectivity, matrix effects, and internal standards), are covered. We highlight important differences between human and rodent tissues as they relate to steroid levels in pregnancy and the interpretation of results, and provide guidance for best practices in future studies.DSECT Training Program GrantCIHR Doctoral FellowshipCanadian Institutes of Health Research Project GrantsCanada Foundation for Innovation GrantNational Foundation for Science and Engineering (NSERC
Use of an online gaming tool, the Veterinary DialogueTrainer, for teaching clinical communication skills to bovine veterinary practitioners
No full textEffective clinical communication is essential for bovine veterinary practitioners to establish and maintain positive client relationships. When applied properly in herd health consultancy, it increases client satisfaction and adherence to veterinary advice, and improves patient health and welfare. Although communication skills are often taught by providing feedback on simulated conversations, this has limitations, including time constraints, subjective assessments, and cost. The Veterinary DialogueTrainer (VDT) is an online serious game platform using ‘digital role-play’ with avatars, recently developed to enhance and assess learning outcomes, improve use of learned skills, and increase cost-effectiveness of communication training. The objective was to evaluate its suitability and applicability. Finnish (n = 24) and Swedish (n = 21) bovine veterinarians participated in communication training using VDT for training and assessment. Participants completed the provided scenario at least twice. After playing a bovine health communication simulation, participants received their scores and feedback on selected conversation options. VDT scores measured multiple aspects of communication on a 0–100% scale, based on motivational interviewing methodology and Calgary-Cambridge guidelines. Mean (±SD) number of attempts participants played the scenario was 4.1 (±2.6, Finland) and 3.9 (±1.3, Sweden), with highest total score reached after a mean of 3.5 (±2.1, Finland) and 3.1 (±1.1, Sweden) attempts. On the first attempt, 39 participants (87%) scored 80% after 4.0 (±1.6, Finland) or 2.8 (±1.0, Sweden) attempts. Net Promoter Score of the training was +89 (Finland), +88 (Finland) and + 83 (Sweden) on a scale from −100 to +100, indicating that most participants were very likely to recommend the training to other veterinarians. Use of VDT increased communication skills scores but whether it will improve communication skills in practice requires further study. We concluded there is a likely benefit of using the VDT in teaching and monitoring veterinary communication competencies and preparing for offline role-plays and real-life conversations in veterinary practice.Canada's Natural Sciences and Engineering Research Council (NSERC)Industrial Research Chair Program (Ottawa, ON, Canada)Alberta Milk (Edmonton, AB, Canada)the Dairy Farmers of Canada (Ottawa, ON, Canada)Westgen Endowment Fund (Milner, BC, Canada)the BC Dairy Association (Burnaby, BC, Canada)Canadian Dairy Network (Guelph, ON, Canada)CanWest DHI (Guelph, ON, Canada)SaskMilk (Regina, SK, Canada)Dairy Farmers of Manitoba (Winnipeg, MB, Canada)MSD Animal Health (Kirkland, QC, Canada
Shared ownership of an engineering success centre to support students and develop leaders
No full textAn Engineering Success Centre was formed with the long-term goals of providing targeted first-year support, increasing retention, and developing leaders. The novelty of the Centre is that the priorities and activities were defined by the students that were employed to run it in a shared leadership model. Student leaders were in various years of undergraduate and graduate engineering degrees, which provided multiple years for leadership opportunities and organizational memory.
The priorities identified by the student leaders were to: (1) guide students through their time in engineering, (2) connect students with campus resources, (3) impact the overall experience for students in a positive way, and (4) assist students with educational needs such as tutoring, writing support, and CAD development. Between the drop-in hours and professional development programs, 145 students (55% of engineering students) interacted over 400 times in formal Centre activities throughout the year, and at least 77% of students engaged in online or asynchronous platforms. This paper was written by two of the student leaders and the faculty coordinator to document the motivations, successes, and challenges of the Centre in its inaugural year and promote shared ownership in academic support centres. Goals were derived, and a model was developed to map Centre activities, priorities, and goals to assess the success of the Centre
Espace fermé, espace ouvert : Proust à la recherche du familier
No full textL’espace limité de la chambre acquiert des valeurs particulières chez Proust. L’œuvre A la recherche du temps perdu est bâtie sur de nombreuses oppositions qui s’expriment entre autres au niveau de l’espace: aussi, le romancier révèle-t-il comment la chambre peut être soit menaçante, soit accueillante, selon l’imagination qui y est investie. C’est ainsi que la chambre à coucher du narrateur enfant, bienveillante, peut devenir un supplice lorsque la nuit tombe et il doit se retrouver seul, et que la chambre d’hôtel, menaçante et inquiétante, peut se muer en espace tranquille et rassurant grâce à l’intervention du personnage féminin, à savoir la grand-mère. La dualité des deux côtés, familier et étranger, renferme une antithèse mais aussi une complémentarité qui s’avèrent fondamentales dans l’initiation et l’expérience du futur écrivain.
The limited space of the room acquires unique significations in Proust. The work In Search of Lost Time is built on numerous oppositions that are also expressed at the level of space: the novelist reveals how a room can be either threatening or welcoming, depending on the imagination that is invested in it. Thus, the child narrator's bedroom, benevolent, can become a torment when night falls and he has to be alone, and the hotel room, threatening and disturbing, can turn into a quiet and reassuring space thanks to the intervention of the female character, namely the grandmother. The duality of the two sides, familiar and foreign, contains an antithesis but also a complementarity which are fundamental to the initiation and experience of the future writer
Patient and staff perceptions of exercise programs for hemodialysis and cancer patients
No full textThe importance of exercise can be crucial for apparently healthy individuals and can be even more important for clinical populations. The purpose of this study was to examine patient and healthcare professional (HCP) perceptions of exercise programs aimed at cancer patient/survivors and hemodialysis patients. Individual semi-structured interviews were conducted with seven cancer and hemodialysis patients (three men and four women) between the ages of 26 and 78 (M = 59.8, SD = 20.5) and eight HCPs (two men and six women) between the ages of 30 and 50 (M = 38.6, SD = 6.7). There were six pre-identified codes that were explored during interviews and coding (Barriers, Behaviour, Enablers, Expectations, Knowledge, and Perception). Analysis resulted in several themes associated with each code. Healthcare professionals identified more health-related barriers to patient participation, and patients identified lack of awareness as the biggest barrier. Both HCPs and patients identified changes in healthy behaviour as a result of the programs. Healthcare professionals mentioned that increasing knowledge was crucial to improved participation, and patients stated that support was important to them. Healthcare professionals stated that programs should be client-centered and safe, while patients stated they would like to increase their personal exercise knowledge. Both groups identified benefits for mental health, physical health, or both. Both groups viewed participation in exercise programs as positive. Based on the results of this study, it is evident that both the HCPs and patients believe that there is value in participating in exercise programs for cancer and hemodialysis patients