Palliative and end-of-life care for adults with advanced chronic obstructive pulmonary disease: a rapid review focusing on patient and family caregiver perspectives.

Purpose of review: The aim of the review was to explore patient and family caregiver perspectives on key issues for ensuring quality of end-of-life care for people with chronic obstructive pulmonary disease (COPD). The growing evidence on the value of specialist palliative care services demonstrates significant improvements in treatments and provisions; however, much of the literature is generic in nature or centred on people with a cancer diagnosis. In this review, we examine the literature to ascertain the views and needs of patients and carers affected by advanced COPD, a highly debilitating condition that can have a profoundly negative impact on the quality of end-of-life experience. Recent findings: A total of 19 papers were included in the review. The main themes in the literature were Holistic Care, Illness Trajectory and Technology. Summary: Areas of unmet need emphasized across physical, psychosocial and spiritual domains were identified, particularly in relation to appropriate and timely conversations. Positive developments in the care and treatment of advanced COPD include the use of the STIOLTO Respimat inhaler, a brief educative and psychosocial intervention based on cognitive-behavioural therapy, and high-intensity exercise training. There is some evidence regarding the use of technology in end-stage COPD

Teaching social work in times of change

Social Work, a profession with explicit academic and practice links to social policy, is undergoing profound change and transformation. ( DOH 2009) As part of this ongoing critique, the teaching of social work is being increasingly questioned by the general public, employers and government. Over the last two years innovative research at the University of Lincoln, jointly undertaken by a team of academic researchers and former social work students, has been analysing the efficacy of teaching methods and university support systems. In particular, the effectiveness of the social work undergraduate degree programme in equipping graduates for the demands of front line practice is being evaluated. The paper draws on key themes identified by the research and shares findings relating to; • Good practice in teaching and learning; including what students value most from lecturers and how academics can best support students • The use of students in research; opportunities and pitfall

The lived experience of learning mindfulness as perceived by people living with long-term conditions:A community-based, longitudinal, phenomenological study

While a considerable research base demonstrates the positive effects of 8-week secular mindfulness courses, it remains unclear to what degree their participants continue to engage with mindfulness practices; and there is a dearth of published reports on longer-term mindfulness interventions. Studies have also tended to focus on clinical “effectiveness,” with less attention given to participants’ own construal and expectations of mindfulness. To address these gaps, the study reported here implemented a year-long mindfulness program for a group of 20 individuals with long-standing health conditions who gradually transitioned to self-guiding. Their experiences, expectations, and understanding of mindfulness were investigated through the lens of descriptive phenomenology. The findings revealed that mindfulness practice did bring therapeutic improvement but that it was a multi-faceted process where an individual’s intentionality toward practice was key, with a clear division between those pursuing an “embodied integrated” mindfulness and those viewing it as a stress management tool

Mother’s little helper? Contrasting accounts of benzodiazepine and methadone use among drug-dependent parents in the UK.

Aims: To explore the ways in which opioid-dependent parents accounted for their use of opioids and benzodiazepines during and after pregnancy. Methods: Longitudinal qualitative interviews [n?=?45] with 19 opioid-dependent adults recruited in Scotland, UK, were held during the antenatal and post-natal period. Interviews focused on parenting and parenting support within the context of problem drug use and were analysed using a narrative informed, thematic analysis. Findings: The majority of participants described using benzodiazepines in addition to opioids. Almost all indicated a desire to stop or reduce opioid use, whereas cessation or reduction of benzodiazepines was rarely prioritised. In stark contrast to opioid dependence, benzodiazepine dependence was portrayed as unproblematic, therapeutic and acceptable in the context of family life. Whereas opioid dependence was framed as stigmatising, benzodiazepine use and dependence was normalised. An exception was benzodiazepine use by men which was occasionally associated with aggression and domestic abuse. Conclusions: Drug-dependent parents attach different meanings to opioid and benzodiazepine use and dependence in the context of parenthood. Divergent meanings, and stigma, may impact on stated commitment to stability or recovery from dependent drug-use. Attention should be paid to the way in which policy and practice regarding OST and benzodiazepines reflects this divergenc

Folate during reproduction: the Canadian experience with folic acid fortification

Folate has received international attention regarding its role in the risk-reduction of birth defects, specifically neural tube defects (NTDs). In 1998, health officials in Canada, like the United States, mandated the addition of folic acid to white flour and select grain products to increase the folate intake of reproductive-aged women. Subsequent to this initiative there has been an increase in blood folate concentrations in Canada and a 50% reduction in NTDs. Many countries, including Korea, have not mandated folic acid fortification of their food supply. Reasons vary but often include concern over the masking of vitamin B12 deficiency, a belief that folate intakes among womenare adequate, low priority relative to other domestic issues, and the philosophy that individuals have the right not to consume supplemental folic acid if they so choose. Prior to folic acid fortification of the food supply in Canada, the folate intakes of women were low, and their blood folate concentrations while not sufficiently low to produce overt signs of folate deficiency (eg. anemia) were inconsistent with a level known to reduce the risk of an NTD-affected pregnancy. The purpose of this article is to describe the role of folate during the periconceptional period, pregnancy, and during lactation. The rationale for, and history of recommending folic acid-containing supplements during the periconceptional period and pregnancy is described as is folic acid fortification of the food supply. The impact of folic acid fortification in Canada is discussed, and unresolved issues associated with this policy described. While the incidence of NTDs in Canada pre-folic acid fortification were seemingly higherthan that of Korea today, blood folate levels of Korean women are strikingly similar. We will briefly explore these parallels in an attempt to understand whether folic acid fortification of the food supply in Korea might be worth consideratio

Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Dimethyl fumarate (DMF) inhibits inflammasome-mediated inflammation and has been proposed as a treatment for patients hospitalised with COVID-19. This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple treatments in patients hospitalised for COVID-19 (NCT04381936, ISRCTN50189673). In this assessment of DMF performed at 27 UK hospitals, adults were randomly allocated (1:1) to either usual standard of care alone or usual standard of care plus DMF. The primary outcome was clinical status on day 5 measured on a seven-point ordinal scale. Secondary outcomes were time to sustained improvement in clinical status, time to discharge, day 5 peripheral blood oxygenation, day 5 C-reactive protein, and improvement in day 10 clinical status. Between 2 March 2021 and 18 November 2021, 713 patients were enroled in the DMF evaluation, of whom 356 were randomly allocated to receive usual care plus DMF, and 357 to usual care alone. 95% of patients received corticosteroids as part of routine care. There was no evidence of a beneficial effect of DMF on clinical status at day 5 (common odds ratio of unfavourable outcome 1.12; 95% CI 0.86-1.47; p = 0.40). There was no significant effect of DMF on any secondary outcome

Khush Dil project

No abstract available

Chicle: The Chewing Gum of the Americas, From the Ancient Maya to William Wrigley

Although Juicy Fruit® gum was introduced to North Americans in 1893, Native Americans in Mesoamerica were chewing gum thousands of years earlier. And although in the last decade “biographies” have been devoted to salt, spices, chocolate, coffee, and other staples of modern life, until now there has never been a full history of chewing gum. Chicle is a history in four acts, all of them focused on the sticky white substance that seeps from the sapodilla tree when its bark is cut. First, Jennifer Mathews recounts the story of chicle and its earliest-known adherents, the Maya and Aztecs. Second, with the assistance of botanist Gillian Schultz, Mathews examines the sapodilla tree itself, an extraordinarily hardy plant that is native only to Mesoamerica and the Caribbean. Third, Mathews presents the fascinating story of the chicle and chewing gum industry over the last hundred plus years, a tale (like so many twentieth-century tales) of greed, growth, and collapse. In closing, Mathews considers the plight of the chicleros, the “extractors” who often work by themselves tapping trees deep in the forests, and how they have emerged as icons of local pop culture—portrayed as fearless, hard-drinking brawlers, people to be respected as well as feared. Before Dentyne® and Chiclets®, before bubble gum comic strips and the Doublemint® twins, there was gum, oozing from jungle trees like melting candle wax under the slash of a machete. Chicle tells us everything that happened next. It is a spellbinding story.https://digitalcommons.trinity.edu/mono/1029/thumbnail.jp