The veterans community - employability, skills and learning
Abstract: The first three chapters cover the core subjects of 'Securing Employment', 'Qualifications and Skills' and 'Further and Higher Education'. Chapter 4 covers two subjects that are fundamental to this agenda: how a changing military workforce in Scotland will impact on the next generation of veterans; and, the strategic leadership and governance that is essential to delivering meaningful change and sustained improvement in the future. Chapter 5 combines a set of six case studies that highlight good practice and examples of the issues raised in this report. In my view, they bring real colour and life while providing pithy insights in a way that core text of a report can never achieve. I am particularly grateful to the contributors for providing such rich and relevant material. Extracts from the case studies are included throughout the other chapters but I would still urge readers to take the time to look at the material in full. Finally, Chapter 6 sets out my overall conclusions, which I hope provide a useful summary of what is a complex and wide-reaching agenda.
Abstract: Context: In response to the opioid crisis, federal guidelines were implemented, including the Veterans Health Administration's (VA) Opioid Safety Initiative in 2013. The impact of policies on patients near the end of life is unknown. Objective: Examine temporal trends in opioid prescribing, pain, and opioid overdoses among Veterans near the end of life. Methods: Retrospective, time series analysis of VA decedents between October 2009 and September 2018 whose next-of-kin participated in VA's Bereaved Family Survey (BFS). Using multivariate regression to adjust for sociodemographic and clinical covariates, we examined temporal trends in outpatient opioid prescribing, uncontrolled pain based on BFS report, and opioid overdose-related hospitalizations, in the last month of life, overall and by clinical diagnosis (cancer versus non-cancer). Results: Among 79,409 decedents, mean daily outpatient opioid dose in morphine milligram equivalents in the last month of life decreased from 4.6 mg in 2010 to 2.1 mg in 2018 (adjusted change -0.20 mg/year; P