“Take more laxatives was their answer to everything.”:A qualitative exploration of the patient, carer and healthcare professional experience of constipation in specialist palliative care

Constipation is a major problem for many older adults, more so for those who are receiving specialist palliative care. However, limited research reports the subjective experiences of constipation, despite evidenced differences between the healthcare professional and patient/carer perspective. The main aim of this study is to explore the experience of how constipation is assessed and managed within specialist palliative care from the patient, carer and healthcare professional perspective. Exploratory, qualitative design, utilising focus groups and interviews, and analysed using thematic analysis. Six focus groups with 27 healthcare professionals and semi-structured interviews with 13 patients and 5 family caregivers in specialist palliative care units across three regions of the United Kingdom. Constipation impacted physically, psychologically and socially on patients and families; however, they felt staff relegated it on the list of importance. Lifestyle modifications implemented at home were not incorporated into their specialist palliative care plan within the hospice. Comparatively, healthcare professionals saw constipation solely as a physical symptom. Assessment focused on the physical elements of constipation, and management was pharmacologically driven. Healthcare professionals reported patient embarrassment as a barrier to communicating about bowel care, whereas patients wanted staff to initiate communication and discuss constipation openly. Assessment and management of constipation may not yet reflect the holistic palliative care model. A focus on the pharmacological management may result in lifestyle modifications being underutilised. Healthcare professionals also need to be open to initiate communication on bowel care and consider non-pharmacological approaches. It is important that patients and families are supported in self-care management, alongside standardised guidelines for practice and for healthcare professionals to facilitate this

臨床心理学を学ぶ学生における心理職への援助要請態度および意図

Electron microprobe analyses are presented for phenocrysts and matrix glass in peralkaline, silica-oversaturated trachytes from the Menengai volcano, Kenya Rift Valley. The dominant phenocryst assemblage is alkali feldspar–hedenbergite–fayalite–titanomagnetite–apatite. Aenigmatite, amphibole and quartz occur rarely in more peralkaline rocks. QUILF calculations indicate that the trachytic magmas crystallised at temperatures of 854–870 °C, at relatively low oxidation states (ΔFMQ − 1.6 to − 1.7) and silica activity (aSiO2 (Qtz) of 0.60–0.66). The new analyses are used, along with published data, to outline the distribution of the main phases in the compositional spectrum of peralkaline quartz trachytes and rhyolites. There is uncertainty about the nature, or even existence, of a low-temperature zone in the alkali feldspar primary phase region, the equivalent of the thermal valley in the haplogranite system. Quartz phenocrysts may appear early or late in the crystallisation sequence, even in rocks of similar bulk composition, its appearance perhaps being a function of the F content of the melts. Whereas hedenbergite and fayalite show fairly systematic compositional trends with increasing host rock peralkalinity, amphibole compositions are variable, for reasons not yet understood. Aenigmatite crystallisation is at least partly controlled by oxygen fugacity and silica activity. With rare exceptions, ilmenite and titanomagnetite are incompatible phases but the factors controlling their relative stabilities are not clear. It appears that peralkaline trachyte–rhyolite sequences evolve along many crystallisation paths, the paths perhaps being strongly influenced by pH2O, pF2, melt F/Cl ratios and perhaps total pressure

Chlorine content and crystal chemistry of dellaite from the Birkhin gabbro massif, Eastern Siberia, Russia

AbstractDellaite crystals of close to end-member composition, Ca6(Si2O7)(SiO4)(OH)2, and with ∼1.5 wt.% Cl. yielding Ca6(Si2O7)(SiO4)(OH)1.75Cl0.25 have been found in skarns within the gabbroid rocks of the Birkhin complex (Eastern Siberia, Russia). The greatest Cl content analysed in a dellaite domain in this skarn is 5.2 wt.% Cl corresponding to 0.8 Cl p.f.u. Dellaite occurs in altered merwmite-larnite-bredigite-gehlenite skarns and also in calcio-olivine skarns with residual larnite. The crystal structures of Cl-free and Cl-bearing (∼1.5 wt.% Cl) dellaite have been refined, including hydrogen positions, from single-crystal X-ray data to R1 = 3.7 and 3.8%, respectively. In addition, both dellaite varieties were studied by Raman spectroscopy indicating stronger hydrogen bonds for the Cl-bearing sample, which agrees with the structural data. Cl is strongly selective and enriches at one (O6) of the two OH positions allowing for the formation of a stronger hydrogen bond O8—H8…C16 compared to O8—H8…O6. Raman spectra of the domain with ∼0.8 Cl p.f.u. confirm the general enhancement of a low-frequency band in the OH range suggesting the dominance of the O—H…Cl hydrogen bond systems.Dellaite and killalaite, Ca3.2(H0.6Si2O7)(OH), have related modular structures, differentiated only by the Si2O7 units in killalaite and alternating Si2O7 and SiO4 units in dellaite. The similarity in cell dimensions and chemical composition suggests that trabzonite, Ca4Si3Oi0-2H2O, with Si3Oi0 trimers also belongs to the same family of structures. </jats:p