Acculturation and Global Mindsponge

Much research on acculturation around global experiences has focused on the “type” of overseas experience—e.g. expatriate, repatriate, inpatriate, flexpatriate. The experiences of people in those categories and across various demographics (single/married/divorced; gender; sexual orientation) can differ dramatically. In addition, given the explosion of people working in global business, some global business citizens could well fit into several of those various types of experiences over the course of their careers. In this paper, we propose to push in a somewhat different direction and explore something that for us would be quite new. Rather than focusing on the various categories and their resulting experiences, we take a step back to consider what attributes and ways of thinking a global citizen may need to become better as a global business citizen, regardless of type of experience. The question is less one of “Who am I” than “How can I become better?”. Essentially, we would like to explore what might be required in moving the global citizen from thinking about “global mindset” to “global mindsponge.” When we hear the term mindset, we think of a certain way of thinking that stays rather fixed. So part of the challenge of the paper will be to define and examine what mindsponge might mean in the global context—what does it take to unlearn or squeeze out certain ways of thinking or behaving before absorbing and reshaping new ways of thinking and behaving? Moreover, how might that become part of a natural and regular way of operating, especially in a rapidly changing developing country like Vietnam, in particular? At this early stage, we think of mind sponge as a mechanism that encourages flexibility and receptiveness through a process of using multiple filters and more focus on creativity, or doing things differently to improve an organization or individual performance. Our goal is to develop a basic conceptual framework for “mindsponge,” drawing upon a broad literature review as well as several unstructured interviews, to assess whether the idea of mindsponge helps people perceive that they are more culturally versatile and culturally mobile, regardless of whether they work in or outside of their “home environment.” We hope this would enhance their ability to shape an emerging set of cultural values that erases the divide between “foreign” and “local” cultural differences that so often dominates in emerging economies.

Quality of care for cancer patients on home parenteral nutrition: Development of key interventions and outcome indicators using a two-round Delphi approach

Purpose: Clear recommendations on how to guide patients with cancer on home parenteral nutrition (HPN) are lacking as the use of HPN in this population remains a controversial issue. Therefore, the aims of this study were to rank treatment recommendations and main outcome indicators to ensure high-quality care and to indicate differences in care concerning benign versus malignant patients. Methods: Treatment recommendations, identified from published guidelines, were used as a starting point for a two-round Delphi approach. Comments and additional interventions proposed in the first round were reevaluated in the second round. Ordinal logistic regression with SPSS 2.0 was used to identify differences in care concerning benign versus malignant patients. Results: Twenty-seven experts from five European countries completed two Delphi rounds. After the second Delphi round, the top three most important outcome indicators were (1) quality of life (QoL), (2) incidence of hospital readmission and (3) incidence of catheter-related infections. Forty-two interventions were considered as important for quality of care (28/42 based on published guidelines; 14/42 newly suggested by Delphi panel). The topics 'Liver disease' and 'Metabolic bone disease' were considered less important for cancer patients, together with use of infusion pumps (p = 0.004) and monitoring of vitamins and trace elements (p = 0.000). Monitoring of QoL is considered more important for cancer patients (p = 0.03). Conclusion: Using a two-round Delphi approach, we developed a minimal set of 42 interventions that may be used to determine quality of care in HPN patients with malignancies. This set of interventions differs from a similar set developed for benign patients. © 2012 Springer-Verlag Berlin Heidelberg.

The prognosis of incurable cachectic cancer patients on home parenteral nutrition: A multi-centre observational study with prospective follow-up of 414 patients

Background: The role of home parenteral nutrition (HPN) in incurable cachectic cancer patients unable to eat is extremely controversial. The aim of this study is to analyse which factors can influence the outcome. Patients and methods: We studied prospectively 414 incurable cachectic (sub)obstructed cancer patients receiving HPN and analysed the association between patient or clinical characteristics and surviving status. Results: Median weight loss, versus pre-disease and last 6-month period, was 24% and 16%, respectively. Median body mass index was 19.5, median KPS was 60, median life expectancy was 3 months. Mean/median survival was 4.7/3.0 months; 50.0% and 22.9% of patients survived 3 and 6 months, respectively. At the multivariable analysis, the variables significantly associated with 3- and 6-month survival were Glasgow Prognostic Score (GPS) and KPS, and GPS, KPS and tumour spread, respectively. By the aggregation of the significant variables, it was possible to dissect several classes of patients with different survival probabilities. Conclusions: The outcome of cachectic incurable cancer patients on HPN is not homogeneous. It is possible to identify groups of patients with a ≥6-month survival (possibly longer than that allowed in starvation). The indications for HPN can be modulated on these clinical/biochemical indices. © The Author 2013. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.