Long-Term Sobriety from Opioid Use: An Interpretive Phenomenological Analysis

Opioid addiction is a current health crisis in the United States. According to the National Institute on Drug Abuse 1.7 million Americans were addicted to opioids in 2017 (NIH, 2020, para 2). According to the Centers for Disease Control and Prevention, 130 Americans die every day due to an opioid overdose (CDC, 2019, para.1). Those in treatment are 60% more likely to relapse within the first 90 days post-treatment (Weich, 2010). Marriage and Family Therapists may often work in treatment settings addressing addiction and recovery. This study utilized a Solution Focused Brief Therapy lens to seek to understand the life experiences of individuals with at least 10 years sober from opioids and what factors assisted them in achieving long-term sobriety. This study also aims to contribute to further defining long-term sobriety as it relates to opioids. An Interpretative Phenomenological Analysis design was used to examine the life experiences of individuals with at least 10 years sober to identify factors that contributed to their long-term sobriety. The results of this study offer individuals, families, and therapists a look at the many, inter-related factors that support long-term sobriety with suggestions for future research

Place of death in the Czech Republic and Slovakia:a population based comparative study using death certificates data

Place of death represents an important indicator for end-of-life care policy making and is related to the quality of life of patients and their families. The aim of the paper is to analyse the place of death in the Czech Republic and Slovakia in 2011. Research questions were focused on factors influencing the place of death and specifically the likelihood of dying at home

EAPC Researcher Awards 2016 – reflections on winning

This year the European Association for Palliative Care redesigned its Researcher Awards, formerly known as the Early Researcher Awards and now comprising three categories: Early Researcher, Clinical Impact and Post Doc. They were presented in June at the 9th EAPC World Research Congress in Dublin to Martin Loucka, Kirsten Wentlandt and Bridget Candy. Here the winners reflect on their careers so far, and tell us how they feel about receiving this recognition by the international palliative care community

Decision Support Intervention for people with advanced dementia residing in a nursing home: A study protocol for an International advance care planning intervention (mySupport study)

Background Where it has been determined that a resident in a nursing home living with dementia loses decisional capacity, nursing home staff must deliver care that is in the person's best interests. Ideally, decisions should be made involving those close to the person, typically a family carer and health and social care providers. The aim of the Family Carer Decisional Support intervention is to inform family carers on end-of-life care options for a person living with advanced dementia and enable them to contribute to advance care planning. This implementation study proposes to; 1) adopt and apply the intervention internationally; and, 2) train nursing home staff to deliver the family carer decision support intervention. Methods This study will employ a multiple case study design to allow an understanding of the implementation process and to identify the factors which determine how well the intervention will work as intended. We will enrol nursing homes from each country (Canada n = 2 Republic of Ireland = 2, three regions in the UK n = 2 each, The Netherlands n = 2, Italy n = 2 and the Czech Republic n = 2) to reflect the range of characteristics in each national and local context. The RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework will guide the evaluation of implementation of the training and information resources. Our mixed methods study design has three phases to (1) establish knowledge about the context of implementation, (2) participant baseline information and measures and (3) follow up evaluation. Discussion The use of a multiple case study design will enable evaluation of the intervention in different national, regional, cultural, clinical, social and organisational contexts, and we anticipate collecting rich and in-depth data. While it is hoped that the intervention resources will impact on policy and practice in the nursing homes that are recruited to the study, the development of implementation guidelines will ensure impact on wider national policy and practice. It is our aim that the resources will be sustainable beyond the duration of the study and this will enable the resources to have a longstanding relevance for future advance care planning practice for staff, family carers and residents with advanced dementia

Effect of ruminal mechanical stimulating brushes on the performance of lactating Holstein dairy cows

Cilj istraživanja bio je potvrditi hipotezu da umjetne četke za stimulaciju buraga (RMS četke) mogu djelomično zamijeniti funkciju strukturnih vlakana te povećati proizvodnju ili kvalitetu mlijeka. Kako bi se umanjili rizici hranidbe niskom razinom fizikalno učinkovitih neutralnih deterdžent vlakana (peNDF) na goveda, ispitivana je primjena četki za stimulaciju buraga kod 22 visoko proizvodne holstein mliječne krave. Krave su podijeljene u eksperimentalnu skupinu u kojoj su primijenjene RMS četke i kontrolnu skupinu bez primjene. Krave su hranjene sa četiri eksperimentalna potpuno izmiješana obroka s nepromjenjivim količinama silaže lucerne, kukuruzne silaže, silaže cijelog klipa kukuruza te različitih količina pivskog tropa i pšenične slame. Sadržaj peNDF u obrocima je bio redom 10,9, 13,0, 12,6 i 14,0 %. Istraživanje je trajalo 18 tjedana, a sve su krave hranjene obrokom s niskim sadržajem strukturnih vlakana povezanim s rizikom pojave subakutne ruminalne acidoze (SARA). U eksperimentalnoj skupini, tri RMS četke oralno su umetnute u burag posebnim aplikatorom. Tijekom istraživanja, promatran je utjecaj primjene RMS četki na konzumaciju, buražnu fermentaciju i proizvodnju mlijeka. Uzorak buražnog soka uzorkovan je želučanom sondom te je u njemu određen pH i sadržaj hlapljivih masnih kiselina te amoni¬jskog dušika. Primjena RMS četki značajno je povećala konzumaciju i proizvodnju mlijeka samo kada je eksperimentalna skupina hranjena obrokom s 13,0 % peNDF, te nije utvrđena jasna povezanost između sadržaja peNDF obroka i primjene RMS četki. Kvaliteta mlijeka, pH buraga i sadržaj produkata fermentacije nisu značajno povećani primjenom RMS četki. Iako je tehnologija RMS četki samo djelomično smanjila potrebe za peNDF, ona može smanjiti rizik pojave SARA.The aim of this study was to confirm the hypothesis that artificial brushes administered to the rumen can partially replace the function of structural fibre, and increase milk production or quality. To mitigate the risks of feeding low levels of physically effective neutral detergent fibre (peNDF) to cattle, the administration of ruminal mechanical stimulating (RMS) brushes was examined in 22 high-yielding lactating Holstein dairy cows. The cows were divided into an experimental group equipped with RMS brushes and a control group without RMS. Cows were fed four experimental total mixed rations (TMR) consisting of fixed amounts of alfalfa silage, maize silage, rush corn cob mix silage and different proportions of brewer\u27s grains, concentrate and wheat straw. The TMRs had the following 4 peNDF contents: 10.9%. 13.0%, 12.6% and 14.0%. The duration of the experiment was 18 weeks. All cows were fed TMRs with a low structural fibre content near levels associated with a risk of subacute ruminal acidosis (SARA). For the RMS brush group, 3 RMS brushes were inserted orally into the rumen using a special applicator. The effects of RMS brushes on feed intake, rumen fermentation and milk production were evaluated. Ruminal fluid (250 mL) was taken using a stomach tube for pH, volatile fatty acids and ammonia nitrogen analysis. A significant increase was found for the feed intake and milk yield of the RMS group fed the TMRs with 13.0% peNDF although no relationship between peNDF content and RMS TMRs was found. No significant increase in milk quality, rumen pH or rumen fermentation metabolites was declared for the group with RMS brushes. Although RMS brush technology only partially reduced the requirements for peNDF, it may decrease the risk of SARA

The impact of the mySupport advance care planning intervention on family caregivers’ perceptions of decision-making and care for nursing home residents with dementia : pretest-posttest study in six countries

Background the mySupport advance care planning intervention was originally developed and evaluated in Northern Ireland (UK). Family caregivers of nursing home residents with dementia received an educational booklet and a family care conference with a trained facilitator to discuss their relative’s future care. Objectives to investigate whether upscaling the intervention adapted to local context and complemented by a question prompt list impacts family caregivers’ uncertainty in decision-making and their satisfaction with care across six countries. Second, to investigate whether mySupport affects residents’ hospitalisations and documented advance decisions. Design a pretest–posttest design. Setting in Canada, the Czech Republic, Ireland, Italy, the Netherlands and the UK, two nursing homes participated. Participants in total, 88 family caregivers completed baseline, intervention and follow-up assessments. Methods family caregivers’ scores on the Decisional Conflict Scale and Family Perceptions of Care Scale before and after the intervention were compared with linear mixed models. The number of documented advance decisions and residents’ hospitalisations was obtained via chart review or reported by nursing home staff and compared between baseline and follow-up with McNemar tests. Results family caregivers reported less decision-making uncertainty (−9.6, 95% confidence interval: −13.3, −6.0, P  Conclusions the mySupport intervention may be impactful in countries beyond the original setting

Palliative care development in European care homes and nursing homes: application of a typology of implementation

Background: The provision of institutional long term care for older people varies across Europe reflecting different models of health care delivery. Care for dying residents requires integration of palliative care into current care work, but little is known internationally of the different ways in which palliative care is being implemented in the care home setting. Objectives: To identify and classify, using a new typology, the variety of different strategic, operational and organisational activities related to palliative care implementation in care homes across Europe. Design and methods: We undertook a mapping exercise in 29 European countries, using two methods of data collection: (1) a survey of country informants and (2) a review of data from publically available secondary data sources and published research. Through a descriptive and thematic analysis of the survey data we identified factors that contribute to the development and implementation of palliative care into care homes at different structural levels. From this data a typology of palliative care implementation for the care home sector was developed and applied to the countries surveyed. Results: We identified three levels of palliative care implementation in care homes: macro (national/regional policy, legislation, financial and regulatory drivers), meso (implementation activities such as education, tools/frameworks, service models and research) and micro (palliative care service delivery). This typology was applied to data collected from 29 European countries and demonstrates the diversity of palliative care implementation activity across Europe with respect to the scope, type of development and means of provision. We found that macro and meso factors at two levels shape palliative care implementation and provision in care homes at the micro organisational level. Conclusions: Implementation at the meso and micro level is supported by macro level engagement, but can happen with limited macro strategic drivers. Ensuring the delivery of consistent and high quality palliative care in care homes is supported by implementation activity at these three levels. Understanding where each country is in terms of activity at these three levels (macro, meso and micro) will allow strategic focus on future implementation work in each country