Defence Direction and Guidance for Training and Education – Volume 9: Elective Education
Abstract: People lie at the heart of operational capability; attracting, developing and retaining the right numbers of capable, motivated individuals to deliver Defence outputs is critical. This is dependent upon maintaining a credible and realistic offer that earns and retains the trust of people in Defence. In order to achieve this, all people must be confident that, not only will they be treated fairly, but also that their families will be treated properly and that Service veterans and their dependants will be respected and appropriately supported. The development of Defence People through Defence Learning (Training and Education) to deliver Defence outputs is a key activity that is critical to Defence success. JSP 822 is the source of pan-Defence policy direction for Defence Individual and Collective Learning activity and, through the Defence Learning Framework (DLF), builds on the Defence People Strategy to set out high-level direction on the development of Defence Individual and Collective Learning. JSP 822 is the authoritative policy that directs and guides Defence people to ensure that Defence Individual and Collective Learning (Training and Education) is appropriate, efficient, effective and, most importantly, safe. Underpinning all training and education activities is the Defence Systems Approach to Training (DSAT). It is the system that must be used by those who are involved in the analysis, design, delivery, assurance, management and governance of Defence Learning.
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