Bispectral Index monitoring of palliative sedation for home withdrawal of tracheostomy ventilation: A case report.

BACKGROUND: Tracheostomy ventilation in motor neurone disease is an uncommon life-sustaining treatment. Best practice is having a plan for ventilation withdrawal, but the literature to guide practice is limited. Case reports have documented standard doses of opioids and benzodiazepines used for sedation in such cases. CASE: A 49-year-old man was diagnosed with motor neurone disease in 2016. He commenced tracheostomy ventilation in 2018. In 2022 and 2023, planning was undertaken, at the patient's request, for withdrawal of tracheostomy ventilation at home, when he was no longer able to communicate with technology. CASE PLANNING: Planning included Bispectral Index monitoring prior to cessation of ventilation, ensuring this only occurred when deep sedation was achieved. After ventilation withdrawal in 2023, a retrospective review of medications given and his level of sedation on monitoring was undertaken, with family consent. OUTCOME: Ventilation withdrawal was initiated after deep sedation was achieved, 6 h after commencing subcutaneous infusions of morphine, midazolam, clonazepam and phenobarbital. LESSONS: Doses required to achieve acceptable sedation exceeded literature reports. Achieving deep sedation was a longer than expected process. CONCLUSION: More research using an objective measure of sedation is required, as clinical assessment of sedation in this context is compromised.

Defining Terms Used for Animals Working in Support Roles for People with Support Needs.

The nomenclature used to describe animals working in roles supporting people can be confusing. The same term may be used to describe different roles, or two terms may mean the same thing. This confusion is evident among researchers, practitioners, and end users. Because certain animal roles are provided with legal protections and/or government-funding support in some jurisdictions, it is necessary to clearly define the existing terms to avoid confusion. The aim of this paper is to provide operationalized definitions for nine terms, which would be useful in many world regions: "assistance animal", "companion animal", "educational/school support animal", "emotional support animal", "facility animal", "service animal", "skilled companion animal", "therapy animal", and "visiting/visitation animal". At the International Society for Anthrozoology (ISAZ) conferences in 2018 and 2020, over 100 delegates participated in workshops to define these terms, many of whom co-authored this paper. Through an iterative process, we have defined the nine terms and explained how they differ from each other. We recommend phasing out two terms (i.e., "skilled companion animal" and "service animal") due to overlap with other terms that could potentially exacerbate confusion. The implications for several regions of the world are discussed.

Disabled in academia: to be or not to be, that is the question.

The authors explore the real-life issue of diversity disclosure within academia. The breadth of disability and discrimination is framed within the context of high demands and competitiveness. While some institutions are supportive, the culture of ableism, stigmatization, and the disabling barriers make disclosure of disability a complex and difficult decision. The authors discuss the importance of not only normalizing varying abilities, but embracing and valuing the diversity and contributions that individuals with disabilities bring to the academic environment.

Human-Animal Interactions: Expressions of Wellbeing through a "Nature Language".

Human-animal interactions (HAIs) can be beneficial for humans in a number of ways, and interactions with wild animals may contribute to human mental wellbeing, partly through nature connectedness. This study applies the "Nature Interaction Pattern" approach (proposed by Kahn and colleagues) to characterize the structure of meaningful human engagement with nature and animals, and to consider the wellbeing outcomes. This qualitative, retrospective study uses open responses from 359 participants who describe how their wild animal encounters affected their nature connectedness. Thematic analysis explores five nature Interaction Patterns and four resulting Psychological Descriptions that occur in the portrayals of the marine animal encounters and these are described using representative quotes. Feelings of love, belonging, positive feelings, fulfillment and the gaining of perspective, were linked with the human-animal experience and the Interaction Patterns. These findings suggest that when people encounter and interact with animals in their natural environment, their mental health and wellbeing may be enhanced. Further, through connecting with nature and animals, reciprocity may occur, that is, when people connect with nature and animals, they can also give back. Within this interaction there becomes an entanglement of experiences thereby encouraging caring for nature and animals.