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In Canada, there is a growing gap between the number of organs donated each year and the number of organs needed for transplant. This gap is forcing health care professionals to re-examine end-of-life care and donation practices. In 2005, a national forum created recommendations for the development and implementation of donation after cardio-circulatory death programs. In this article, the authors outline the multifaceted approach needed for change in interdisciplinary clinical practice. Clinical nurse specialist leadership, ethics consultation, partnerships with key physician colleagues and administrators, as well as comprehensive workshops are described as essential for success. Lessons learned throughout are shared.

occurrence of this disease is closely related to modifiable risk factors. Awareness of CHD risk factors reduction helps to reduce lifetime risk for CHD. An ability to identify and enhance individual awareness in this regard needs a valid measuring instrument. However, there is a lack of published instrument in this area. This paper focuses on the factor structure and the internal consistency reliability of a new instrument: ACRFR. Study objectives: To identify the factor structure and assess the internal consistency reliability of the ACRFR. Methods: The factor structure of the instrument was explored using a convenience sample of 236 Chinese subjects. Exploratory factor analysis (EFA) and Cronbach alpha coefficient were used to determine the underlying factor structure and assess the total and subscales internal consistency reliability. Results: EFA yielded a 43-item instrument with seven factors: CHD knowledge, planning of health actions, perceived ability to monitor health-related behaviour, perception of risk, perceived opportunities to understand CHD, perceived seriousness of CHD, and chest pain appraisal. These seven factors contributed 49.5% of the total explained variance. The internal consistency of the overall scale was 0.82. The subscales internal consistency ranged from 0.6 to 0.9. Conclusions:While considering ACRFR is a newly developed instrument, acceptable total explained variance of the factor model and the internal consistency reliability were established. Further research to validate the ACRFR scale is required.

Suicidal behavior is disproportionately frequent among inner-city Hispanic adolescent girls. In an attempt to generate a multifactorial set of hypotheses to explain this behavior, 33 such subjects consecutively admitted for suicidal behavior and 15 demographically identical nonsuicidal subjects were assessed by means of a structured interview. Mothers of all subjects were also assessed. Attempts were nearly always impulsive and nonlethal, though often with a stated wish to die. Nearly all were overdoses, and were precipitated by conflicts with mother or boyfriend. Mothers could usually identify the precipitants. Attempters' parents were less often born in the U.S., their mothers seemed medically less healthy, and their extended families were more often supported by public assistance, and had a higher incidence of criminal and psychiatric problems. School performance was poorer among attempters, who had suffered more and earlier losses, especially of biologic fathers, with whom fewer had ongoing relationships. They more often had boyfriends, had begun sexual activity, had recently lost friends, and expressed a mistrustful stance toward friend-ships. Similarly, their mothers had fewer friends and more often expressed a mistrustful stance. Relationships with mothers seemed more intense, desperate, and even violent, and attempters were much more often parentified, i.e., mothering their mothers. Although both groups often assumed caretaking roles in their families, attempters were more negatively described by themselves and by their mothers. While knowledge of suicidal models was common in both groups, attempters' mothers knew of even more models than did their daughters or the nonsuicidal subjects or their mothers. Notably, more attempters' mothers had themselves made attempts. Families of most attempters were usually mobilized by the attempt. These findings permit the construction of a putative profile of risk factors that can be tested more rigorously.