Selected Issues of Animal Protection in the Light of the Judicial Decisions of the Supreme Administrative Court

The article analyses and assesses the line of judicial decisions of the Supreme Administrative Court regarding a temporary seizure of an animal from its owner or guardian following a breach of the obligation to treat it humanely. The article also analyses the legal status that social organisations, the statutory aim of which is the protection of animals, has in administrative proceedings. Next, the author presents the characteristics of resolutions of municipal councils on the municipal programme of care for homeless animals and prevention of animal homelessness, which in the court judicial decisions are classified as local legal enactment. Finally, the article presents the line of judicial decisions concerning the relation between a resolution introducing a by-law on maintaining cleanliness and order in a municipality and the requirements of animal protection set out in the Act of 21 August 1997 on the protection of animals.

Delivery preferences for psychological intervention in cardiac rehabilitation: a pilot discrete choice experiment

BackgroundCardiac rehabilitation (CR) is a programme of care offered to people who recently experienced a cardiac event. There is a growing focus on home-based formats of CR and a lack of evidence on preferences for psychological care in CR. This pilot study aimed to investigate preferences for delivery attributes of a psychological therapy intervention in CR patients with symptoms of anxiety and/or depression.MethodsA discrete choice experiment (DCE) was conducted and recruited participants from a feasibility trial. Participants were asked to choose between two hypothetical interventions, described using five attributes; intervention type (home or centre-based), information provided, therapy manual format, cost to the National Health Service (NHS) and waiting time. A separate opt-out was included. A conditional logit using maximum likelihood estimation was used to analyse preferences. The NHS cost was used to estimate willingness to pay for aspects of the intervention delivery.Results35 responses were received (39% response rate). Results indicated that participants would prefer to receive any form of therapy compared with no therapy. Statistically significant results were limited, but included participants being keen to avoid not receiving information prior to therapy (β=−0.270; p=0.03) and preferring a lower cost to the NHS (β=−0.001; p=0.00). No significant results were identified for the type of psychological intervention, format of therapy/exercises and programme start time. Coefficients indicated preferences were stronger for home-based therapy compared with centre-based, but this was not significant.ConclusionsThe pilot study demonstrates the feasibility of a DCE in this group, it identifies potential attributes and levels, and estimates the sample sizes needed for a full study. Preliminary evidence indicated that sampled participants tended to prefer home-based psychological therapy in CR and wanted to receive information before initiating therapy. Results are limited due to the pilot design and further research is needed.

MUNICIPAL PROGRAM OF CARE FOR HOMELESS ANIMALS AND PREVENTION OF ANIMAL HOMELESSNESS AS A LOCAL LAW ACT AGAINST THE BACKGROUND OF THE COURT DECISIONS

The paper presents the issue of the municipal program of care for and prevention of homeless animals set out in Article 11a of the Act of 21 August 1997 on animal protection in the context of the possibility of ascribing to it the features of a local law act. The issue of correct qualification of the municipal program of care for homeless animals and prevention of homelessness and the realization of statutory norms authorizing to issue this act by the local legislator is an extremely important issue due to possible legal consequences in the form of invalidation of a resolution of a local government body with ex tunc effect. The author of the article focused in the first part on the characteristics of such a form of local government action as the act of local law, considering its characteristics on the basis of the provisions of law, doctrine and judicature. In the second part the author assessed the municipal program of care for homeless animals and prevention of homelessness through the prism of features characterizing the act of local law. The aim of the paper was to review and discuss essential features of the local law acts and to qualify the communal programme of care for homeless animals and homelessness prevention as the local law act against the background of the court decisions.

Caring for the carers: a COVID-19 psychological support programme

The outbreak of COVID-19 and the subsequent pandemic brought unprecedented worldwide challenges born out of a rapidly escalating health and economic crisis. From emergency planners to healthcare workers on the front line, and everyone in between, the pandemic, and the uncertainty surrounding it, was likely to become a significant stressor, one with no immediate solution but with the potential to cause enduring distress beyond its conclusion. The UK Defence Medical Services recognised the need to provide an evidence-based programme of care intended to support personnel transitioning from assisting the national response back to normal duties. This was informed by a narrative review that targeted literature exploring strategies for supporting the mental health and well-being of healthcare workers during 21st-century infectious disease outbreaks. The literature identified the experiences most likely to cause enduring distress, which comprised morally challenging decisions, vulnerability, death and suffering, professional and personal challenges, and expectations. The opportunity to find meaning in these experiences, by discussing them with peers who share a contextual understanding, is important to limit the longer-term psychosocial impact of such events. This paper will discuss the design considerations and planned implementation strategy of the Recovery, Readjustment and Reintegration Programme to limit the incidence of distress or longer-term mental ill health among military personnel.

Pulmonary rehabilitation

Pulmonary rehabilitation (PR) is an important component in the management, care, and treatment of patients with chronic lung disease, particularly with COPD and increasingly in ILD. Breathlessness is a symptom of the underlying lung disease, and can result in reduced patient activity, which in turn reduces fitness, leads to social isolation, and can exacerbate depression and anxiety. PR is a multidisciplinary programme of care for patients with chronic respiratory impairment that is individually tailored and designed to optimize physical and social performance and autonomy. This chapter describes the rationale for PR, how to set up an effective rehabilitation regime through education and physical exercise, and how to provide follow-up care.

Care pathways for people with intellectual disabilities who present with behaviours that challenge

Purpose Care pathways are being increasingly used in the national health service to outline an anticipated programme of care in relation to a particular illness, condition or set of symptoms. The purpose of this paper is to inform those using the service of what they might expect within what time frame. They are designed to reduce variation in practice and allow optimal quality of care across a variety of care settings. Care pathways map out a patient’s journey, providing coordination of services for users. They aim to have: “the right people, doing the right things, in the right order, at the right time, in the right place, with the right outcome”. Design/methodology/approach This paper outlines care pathways in relation to people with intellectual disabilities who present with behaviour that challenges. Findings It is likely that many people will have a lifelong need for support, so discharge from clinical services should only be considered if it is genuinely appropriate. Reductions in a person’s behaviours that challenge are likely to be a consequence of changes that have been made to the person’s environment and supports. Therefore, any reductions in the level or type of support that the person receives may lead to an escalation of the behaviour again. Originality/value Standards in relation to care pathways are presented.

294 A Review of a Domiciliary-Based Multidisciplinary Integrated Care Service with Healthcare Assistant Home Support – Is this the Optimum Model?

Background The Integrated Care Programme for Older People has supported the development of integrated care services at pioneer sites in Ireland. Key to integrated care is embracing a move away from hospital based assessment and therapy provision, especially for re-ablement and home support care planning, to assessment in the home: “discharge to assess”. Methods The Older Persons’ Integrated Care Team (OPICT) provides a targeted, multidisciplinary domiciliary-based re-ablement programme of care to people aged 65 years and older. Using PDSA methodology for service improvement, the addition of home support provided by healthcare assistants (HCAs) was introduced and evaluated. Data was collected prospectively on baseline service user demographics, service activity and outcome measures. HCA delivered home support services were introduced in November 2017. This study contains data for the period November 2017 to March 2019. Results Since May 2017, OPICT has provided 266 episodes of domiciliary-based re-ablement to 248 clients, with a further 90 clients assessed but ineligible. The median age of clients was 84 years (8% 65-74 years; 49% 75-84 years; 37% 85-94 years; 6% 95 years and older). The majority of clients were female (58.5%), with low dependency (Barthel score 16 to 19) and classified as vulnerable to moderately frail based on the Clinical Frailty Scale (scores 4 to 6). Of 215 eligible clients, 122 received a total of 1293 hours of healthcare assistant delivered care. Flexibility in the availability of carers to meet demand and willingness of HCAs to embrace a more diverse role were important learning points. Conclusion The “discharge to assess” model of integrated care for older people can be achieved in the Irish healthcare setting, with access to flexible HCA delivered home support a key element.

How can we better support families living with cardiovascular disease and depression?

Purpose – The purpose of this paper is to discuss the role of psychosocial treatments to support families living with cardiovascular disease (CVD) and depression. The paper highlights that depression in people with CVD is a predictor of non-adherence to both medicines and cardiovascular rehabilitation programmes. The authors believe there is a clinical need to develop a programme of care to support the whole family to adhere to cardiovascular rehabilitation programmes. Design/methodology/approach – A team of expert cardiovascular nurses, mental health nurses (MHN) and cardiologist clinical opinions and experiences. These opinions and experiences were supplemented by literature using MEDLINE as the primary database for papers published between December 2000 and December 2013. Findings – People with CVD who become depressed are more likely to stop taking their medicine and stop working with their health care worker. Most people with heart and mood problems live with their families. Health workers could have a role in supporting families living with heart and mood problems to their care and treatment. The paper has highlighted the importance of working with families living with heart and mood problems to help them to stick with care and treatment. Originality/value – Most people with heart and mood problems live with their families. The paper has highlighted the importance of working with families living with heart and mood problems to help them to persevere with care and treatment. MHN may have a role, though consideration should also be given to exploring the role of other health care workers and members of the community. As the population ages, clinicians and communities will need to consider the impact of depression on adherence when working with families living with CVD and depression.

Breast cancer survivors’ perspectives on whether clinical staff should ask breast cancer patients about childhood abuse

Introduction Recent studies have shown that women who recall childhood abuse are at increased risk of emotional problems following a breast cancer diagnosis. How services should respond is unclear given the risk of compounding the emotional trauma of cancer with questioning about abuse. Our aim was to present the research findings to women with experience of breast cancer so as to obtain their perspective on how this evidence should influence clinical practice. Methods Participants were women who had been treated for breast cancer at one of the study units and women with a history of breast cancer who were members of a local patient support group. Three focus groups were conducted (with six, five and three participants respectively). The interview transcripts were analysed qualitatively. Results Participants emphasised the importance of the research findings for cancer care. The consensus was that abuse and its consequences for patients being treated for cancer should not be a ‘taboo’ area, and that patients should be given the opportunity and choice to disclose abuse as part of a holistic programme of care. Conclusions Services should examine how to include prompts about abuse as part of routine holistic assessment by clinical staff, who will need to be trained in eliciting and managing disclosures of abuse.

Patient satisfaction with the use of an enhanced recovery programme for primary arthroplasty

Introduction Enhanced recovery programmes (ERPs) are increasingly being used for arthroplasty. One of the core aims of an ERP is to improve the quality of patient experience. However, there is currently no published evaluation of patient satisfaction in relation to this new programme of care within orthopaedic surgery. The aim of this study was to compare the ERP against the standard care programme (SCP) at one centre. Methods A satisfaction survey addressing patient opinions on the key objectives of the ERP was conducted by telephone, using a set script. Of the 226 patients contacted, 143 (63.3%) responded (69 from the ERP and 74 from the SCP). Of the respondents, 71 received a total hip arthroplasty and 72 a total knee arthroplasty. Patients were contacted at a mean time from operation to survey of 27.2 weeks. They were asked to rate satisfaction on a five-point scale and complete the EQ-5D™ health questionnaire (EuroQol, Rotterdam, Netherlands) to measure healthcare outcomes. Results The mean patient satisfaction score of 4.07 for speed of recovery in the ERP group was significantly higher than the SCP group’s score of 3.68 (p=0.037). Adjusting for the preoperative health score, the postoperative health score was higher for ERP patients at 74.1 compared with 64.7 for SCP patients (p=0.0029). Furthermore, the percentage of patients who had a better than expected recovery was significantly greater in the ERP group at 85.5% compared with 58.1% (p=0.0004) in the SCP group. Conclusions We believe that the previously established reduction in length of hospital stay delivered by ERPs is not achieved at the expense of the patient’s experience.