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The purpose of this paper is to illustrate delirium as a possible consequence of the application of symptom-triggered therapy for alcohol withdrawal and to explore alternative treatment modalities. In the management of alcohol withdrawal syndrome, symptom-triggered therapy directs nursing staff to regularly assess patients using standardized instruments, such as the Clinical Institute for Withdrawal Assessment of Alcohol, Revised (CIWA-Ar), and administer benzodiazepines at symptom severity thresholds. Symptom-triggered therapy has been shown to lower total benzodiazepine dosage and treatment duration relative to fixed dosage tapers (Daeppen et al., 2002). However, CIWA-Ar has important limitations. Because of its reliance on patient reporting, it is inappropriate for nonverbal patients, non-English speakers (in the absence of readily available translators) and patients in confusional states including delirium and psychosis. Importantly, it also relies on the appropriate selection of patients and considering alternate etiologies for signs and symptoms also associated with alcohol withdrawal.

The authors report a case of a 47-year-old male admitted for cardiac arrest because of benzodiazepine and alcohol overdose who developed worsening delirium on CIWA-Ar protocol.

While symptom-triggered therapy through instruments such as the CIWA-Ar protocol has shown to lower total benzodiazepine dosage and treatment duration in patients in alcohol withdrawal, over-reliance on such tools may also lead providers to overlook other causes of delirium.

This case illustrates the necessity for providers to consider using other available assessment and treatment options including objective alcohol withdrawal scales, fixed benzodiazepine dosage tapers and even antiepileptic medications in select patients.

The acute geriatric community hospital (AGCH) in an intermediate care facility is an alternative to conventional hospitalization. A comprehensive geriatric assessment and rehabilitation are integrated into acute medical care for older patients. This study aims to evaluate patient experience and satisfaction with the AGCH.

This is a mixed method observational study including a satisfaction questionnaire and qualitative interviews with AGCH patients or informal caregivers.

A total of 152 participants filled in the questionnaire, and thirteen semi-structured interviews were conducted. Twelve categories and four overarching themes emerged in the analysis. In general, study participants experience the admission to the AGCH as positive and are satisfied with the care they received; there were also suggestions for improvement.

Limitations of this study include possible participation bias. The results show that patients value this type of care indicating that it should be implemented elsewhere. Further research will focus on health outcomes, readmission rates and cost effectiveness of the AGCH.

This is the first study to evaluate care satisfaction with the AGCH. It shows that hospitalized older adults positively value the AGCH as an alternative to hospitalization.

At the 21st Conference of the Parties to the United Nations Convention on Climate Change (COP 21) in Paris, 195 governments reached an agreement pivotal not only for countries but also for companies. The Paris Agreement makes it impossible to practice business as usual. The transition to a low-carbon coffee industry could be achieved by fostering corporate sustainability. Accordingly, the purpose of this paper is to provide empirical evidence of how to adopt the principles of Paris Agreement by enhancing the corporate sustainability of a Mexican coffee-roaster company using the inventory phase of the life cycle assessment tool.

The data collection process followed the requirements of the International Reference Life Cycle Data System Handbook, developed by the Institute for Environment and Sustainability in the European Commission Joint Research Centre, and data on packaging materials and energy production were drawn from a commercially available database in the LCA software SimaPro.

Compiling data on the energy of the firm’s material flows in a firm revealed opportunities to improve energy efficiency and to reduce greenhouse gas emissions. The results of the inventory analysis can be used to evaluate the specific environmental impacts of the coffee-roasting process at this Mexican coffee company. Data compilation activities for energy flows identified the need to install liquefied petroleum gas measuring devices and individual measuring devices for electricity consumption in different areas of the coffee plant. It is recommended that, while implementing this option, the company also develop an energy management program to achieve energy efficiency.

The inventory data in this case study permit comparisons of the current state of the system studied and its possible future states and offer stakeholders relevant information on resource use. Similarly, the project results provide the basis for future research on environmental performance in the coffee industry in Mexico and for the development of policies regarding the production process in the coffee supply chain. Consequently, this research can help fulfil Mexico’s commitment to the Paris Agreement.

Reaching the goal of the Paris Agreement will require gathering key information for each single company. The current case study has provided key data to foster the principles of sustainability in the Mexican coffee industry to help this sector to transit toward sustainable development, which is a new demand of the Mexican society. Even though it may seem simple, this is the hardest step for enhancing stakeholder involvement in corporate sustainability.

The main contribution of this research to science and practice is to confirm that fostering corporate sustainability is easier and more feasible when energy flow information is available.

The family caregivers play an important role in the good quality of life for the elderly, but most of them can easily have an emotional and psychological effect on caregiving. The purpose of this paper is to explore the correlation between conditions of caring for the elderly in the family and caregiver stress in a community setting, Chiang Mai Province, Thailand.

A cross-sectional exploratory descriptive research was conducted in Ban Klang Subdistrict, San Pa Tong District, Chiang Mai Province. Simple random sampling was used to collect data by using a structured interview via a questionnaire with 103 elderly caregivers. The χ² test was used to explain the conditions related to stress as being a caregiver.

Most of the caregivers were female and still in good health, but at the same time, underwent little stress. However, they did not receive any training beforehand for taking care of the elderly but mainly done by experience, relationship and gratitude. The conditions correlated with stress as being a caregiver were health status of caregivers, confidence of care, the relationship between caregiver and elderly person, and economic burden of care.

A necessary resource such as body of knowledge in elderly caregiving, long-term care system at the community level and social support from family and intimate persons will encourage confidence in taking care of the elderly in the family and also relieve caregivers’ stress.

Empirical evidence on how supervisors have perceived the changes and the implications of the COVID-19 pandemic on their supervision is scarce. This paper aims to examine how the changing landscape of doctoral education has affected supervision from the supervisors’ perspective.

This survey addressed change, challenges and impact in supervisory responsibilities due to COVID-19 pandemic. The survey was completed by 561 doctoral supervisors from a large multi-field research-intensive university in Finland.

Results show that supervisors estimated that their supervision had been negatively affected by the pandemic, but to a lesser extent than their doctoral candidates’ progress and well-being. In the changed landscape of supervision, the supervisors grappled with challenges related to recognising doctoral candidates’ need of help. Supervisors’ experiences of the challenges and the impact of changed circumstances varied depending on the field and the position of the supervisor, whether they supervised part- or full-time candidates, and the organisation of supervision.

The slowed-down progression and diminishing well-being of doctoral candidates reported by supervisors is likely to influence supervision in a delayed way. Supervisors may be anticipating some issues with stalled studying and stress, but the question is the extent to which they are prepared to handle these as they emerge in supervision encounters. The fact that the experiences varied across field, position, organisation of supervision and the type of candidates (full or part time) suggests that support provided for supervisors to overcome challenges needs to be tailored and engineered.

This study contributes to the literature on doctoral supervision by exploring the impact of transitioning to online supervision and the rapid changes in doctoral supervision as a consequence of the recent global pandemic.

The aim of this study is to explore and discuss key challenges associated with having stakeholders take part in co-designing a health care intervention to increase mobility in older medical patients admitted to two medical departments at two hospitals in Denmark.

The study used a qualitative design to investigate the challenges of co-designing an intervention in five workshops involving health professionals, patients and relatives. “Challenges” are understood as “situations of being faced with something that needs great mental or physical effort in order to be done successfully and therefore tests a person's ability” (Cambridge Dictionary). Thematic content analysis was conducted with a background in the analytical question: “What key challenges arise in the material in relation to the co-design process?”.

Two key challenges were identified: engagement and facilitation. These consisted of five sub-themes: recruiting patients and relatives, involving physicians, adjusting to a new researcher role, utilizing contextual knowledge and handling ethical dilemmas.

The population of patients and relatives participating in the workshops was small, which likely affected the co-design process.

Researchers who want to use co-design must be prepared for the extra time required and the need for skills concerning engagement, communication, facilitation, negotiation and resolution of conflict. Time is also required for ethical discussions and considerations concerning different types of knowledge creation.

Engaging stakeholders in co-design processes is increasingly encouraged. This study documents the key challenges in such processes and reports practical implications.

This article presents fieldwork perspectives and research reflexivity gained from the cross-national research team, with the aim of promoting better qualitative research practices in transnational research. It focuses on how the team incorporates diverse cultural perspectives and insider and outsider roles to enhance the research in the data collection process.

This article is drawn from the authors' qualitative research with 25 Japanese retirees in Thailand, addressing cultural challenges encountered by researchers in the cross-national team when conducting field research.

Our findings indicate that researchers with an emic view in the cross-national team who shared nationality and cultural background as the participants facilitated an effective recruitment process and productive collaboration in data gathering. They also served as cultural brokers, tailoring smooth communication during interviews on certain cultures, participant traits and sensitive issues. On the other hand, the outsiders helped the team uncover more transnational issues that the insiders had overlooked. Additionally, combining emic and etic perspectives helps to avoid ethnocentric narratives or purely etic and emic conclusions.

This article addresses a gap in the methodological reflections in transnational research that remains largely overlooked. Our reflection highlights the advantages of cross-national teams, which include researchers from emigration and immigration countries. Their status and roles as insiders and outsiders significantly facilitate a positive impact on the research process and increase the extent of investigating the complex cultural dynamics of transnational practices. The incorporation of emic and etic perspectives is suggested in the methodological approach for transnational migration research.

A recent paradigm-shift in patient care advocates for long-term recovery and quality of life in survivors of critical illness. Evidence suggests that occupational therapists in critical care can contribute to recovery in areas such as functional outcomes, length of stay and delirium, although poor role understanding can limit service-utilisation. The purpose of this study is to investigate current and future roles and practices of critical care occupational therapists in the UK.

Occupational therapists with clinical experience in adult critical care were invited to participate in a mixed-methods design using a locally developed online questionnaire and semi-structured interviews, concurrently. Descriptive statistics were generated through SPSS. Qualitative data were analysed using the framework approach.

Twelve occupational therapists participated in the survey element, with five continuing to interview. Occupational therapists described a multifaceted role in critical care where the majority reported practice in upper limb function, seating/positioning, cognition, psychosocial sequelae and discharge planning. Role and internal characteristics impacted on service delivery. It is envisaged that earlier intervention in a greater percentage of patients, a greater evidence-base, raising awareness and adequate staffing will be features for future development.

This study provides new insight into the current role and practices of adult critical care occupational therapists in England and generates insights into their role in addressing physical and non-physical morbidity for this patient cohort. Findings are preliminary in nature; however, future research is warranted to evaluate the effectiveness of interventions.

Teamwork has long featured in social science research. Further, with research increasingly “cross-national,” communication becomes more complex, for instance, involving different cultures, languages and modes of communication. Yet, studies examining team communicative processes that can facilitate or constrain collaboration are rare. As a cross-national European team representing varied disciplines, experiences, languages and ethnicities, we undertook to examine our communication processes with the aim to promote better qualitative research practices.

Viewing reflection as a tool for enhancing workplace practices, we undertook a structured reflection. We developed an empirically derived framework about team communication, then used it to analyse our interaction practices and their relative effectiveness.

The results highlighted two under-examined influences, the use of different modes of communication for different purposes and the need for face-to-face communication to address a particularly challenging aspect of research, negotiating a shared coding scheme to analyse diverse cultural and linguistic qualitative data.

The study offers a procedure and concepts that others could use to examine their team communication.

The communicative processes that can constrain and facilitate effective cross-national research team collaboration are rarely examined. The results emphasise the need for careful negotiations around language, epistemologies, cultures and goals from the moment collaboration begins in formulating a project, through applying for grant funds, to when the last paper is published – timely in a context in which such work is increasingly expected.