End-of-life care pathways for improving outcomes in caring for the dying (Review)

Background In many clinical areas, integrated care pathways are utilised as structured multidisciplinary care plans which detail essential steps in caring for patients with specific clinical problems. Particularly, care pathways for the dying have been developed as a model to improve the end-of-life care of all patients. They aim to ensure that the most appropriate management occurs at the most appropriate time and that it is provided by the most appropriate health professional. Clinical pathways for end-of-life care management are used widely around the world and have been regarded as the gold standard. Therefore, there is a significant need for clinicians to be informed about the utilisation of end-of-life care pathways with a systematic review. Objectives To assess the effects of end-of-life care pathways, compared with usual care (no pathway) or with care guided by another end-of-life care pathway across all healthcare settings (e.g. hospitals, residential aged care facilities, community). Search strategy The Cochrane Register of controlled Trials (CENTRAL), the Pain, Palliative and Supportive Care Review group specialised register,MEDLINE, EMBASE, review articles and reference lists of relevant articles were searched. The search was carried out in September 2009. Selection criteria All randomised controlled trials (RCTs), quasi-randomised trial or high quality controlled before and after studies comparing use versus non-use of an end-of-life care pathway in caring for the dying. Data collection and analysis Results of searches were reviewed against the pre-determined criteria for inclusion by two review authors. Main results The search identified 920 potentially relevant titles, but no studies met criteria for inclusion in the review. Authors’ conclusions Without further available evidence, recommendations for the use of end-of-life pathways in caring for the dying cannot be made. RCTs or other well designed controlled studies are needed for evaluating the use of end-of-life care pathways in caring for dying people.

MoBlogs, Sharing Situations, and Lived Life

This chapter considers shared encounters through blogging in the light of John Urry’s new mobilities paradigm. We review relevant literature on mobile blogging (moblogging) – blogging, pervasive image capture and sharing, moblogging and video blogging – and describe common issues with these digital content sharing practices. We then document some features of how technology affords “reflexive encounters” through the description of a blogging study involving smokers trying to quit, describing important connections between mobilities – physical, object, and communicative mobility. Finally, we present some challenges for new blogging technologies, their relevance to social encounters, and possible future directions through considering the mobile self; the new digital life document; and digital content sharing practices.

Retiring to the good life? The short-term effects of retirement on health

We estimate the impact of retirement on three subjective and objective measures of health using a regression discontinuity design. The results indicate that retirement increases an individual's sense of well-being and their mental health but not necessarily their physical health. Specifications tests suggest that the results are robust.

POOR ICARUS CHARMIAN : Review of The Life and Myth of Charmian Clift by Nadia Wheatley (2001) online

Online Review

Romance and Reconciliation : The secret life of indigenous sexuality on Australian television drama

This article examines the representation of Indigenous sexuality on Australian television drama since the 1970s, suggesting the political importance of such representations. In 1976 Justine Saunders became the first regular Indigenous character on an Australian television drama series, as the hairdresser Rhonda Jackson in Number 96. She was presented as sexually attractive, but this was expressed through a rape scene after a party. Twenty five years later, Deborah Mailman starred in The Secret Life of Us, as Kelly, who is also presented as sexually attractive. But her character can be seen in many romantic relationships. The article explores changing representations that moved us from Number 96 to The Secret Life of Us, via The Flying Doctors and Heartland. It suggests that in representations of intimate and loving relationships on screen it has only recently become possible to see hopeful models for interaction between Indigenous and non-Indigenous Australians.

Extending life-cycle costing (LCC) analysis for sustainability considerations in road infrastructure projects

Sustainable development is about making societal investments. These investments should be in synchronization with the natural environment, trends of social development, as well as organisational and local economies over a long time span. Traditionally in the eyes of clients, project development will need to produce the required profit margins, with some degrees of consideration for other impacts. This is being changed as all citizens of our society are becoming more aware of concepts and challenges such as the climate change, greenhouse footprints, and social dimensions of sustainability, and will in turn demand answers to these issues in built facilities. A large number of R&D projects have focused on the technical advancement and environmental assessment of products and built facilities. It is equally important address the cost/benefit issue, as developers in the world would not want to loose money by investing in built assets. For infrastructure projects, due to its significant cost of development and lengthy delivery time, presenting the full money story of going green is of vital importance. Traditional views of life-cycle costing tend to focus on the pure economics of a construction project. Sustainability concepts are not broadly integrated with the current LCCA in the construction sector. To rectify this problem, this paper reports on the progress to date of developing and extending contemporary LCCA models in the evaluation of road infrastructure sustainability. The suggested new model development is based on sustainability indicators identified through previous research, and incorporating industry verified cost elements of sustainability measures. The on-going project aims to design and a working model for sustainability life-cycle costing analysis for this type of infrastructure projects.

Withholding and withdrawing life-sustaining treatment : criminal responsibility for established medical practice?

The law recognises the right of a competent adult to refuse medical treatment even if this will lead to death. Guardianship and other legislation also facilitates the making of decisions to withhold or withdraw life-sustaining treatment in certain circumstances. Despite this apparent endorsement that such decisions can be lawful, doubts have been raised in Queensland about whether decisions to withhold or withdraw life-sustaining treatment would contravene the criminal law, and particularly the duty imposed by the Criminal Code (Qld) to provide the “necessaries of life”. This article considers this tension in the law and examines various arguments that might allow for such decisions to be made lawfully. It ultimately concludes, however, that criminal responsibility may still arise and so reform is needed.

Creating and sustaining a basis for life-long learning in tertiary dancer training

This paper acknowledges the influences that a generation Y population brings to dance training methodologies and examines this impact in a tertiary context. Over the last 4 years, Queensland University of Technology has been modifying their curriculum for new students transitioning from the private dance studio into the prevocational university environment. An intensive training program was designed to empower the student creating effective entry points for common understandings in the learning and teaching of dance techniques with improved and accelerated learning outcomes. This paper shares these philosophies and practices in training for life-long learning that prepare the young dancer for longevity in the industry.

Investigating the patterns and determinants of life satisfaction in Germany following reunification

This paper investigates the patterns and determinants of life satisfaction in Germany following reunification. We implement a new fixed-effect estimator for ordinal life satisfaction in the German Socio-Economic Panel and find negative effects on life satisfaction from being recently fired, losing a spouse through either death or separation, and time spent in hospital, while we find strong positive effects from income and marriage. Using a new causal decomposition technique, we find that East Germans experienced a continued improvement in life satisfaction to which increased household incomes contributed around 12 percent. Most of the improvement is explained by better average circumstances, such as greater political freedom. For West Germans, we find little change in average life satisfaction over this period.

Quantifying the costs of drought : new evidence from life satisfaction data

We estimate the cost of droughts by matching rainfall data with individual life satisfaction. Our context is Australia over the period 2001 to 2004, which included a particularly severe drought. Using fixed-effect models, we find that a drought in spring has a detrimental effect on life satisfaction equivalent to an annual reduction in income of A$18,000. This effect, however, is only found for individuals living in rural areas. Using our estimates, we calculate that the predicted doubling of the frequency of spring droughts will lead to the equivalent loss in life satisfaction of just over 1% of GDP annually.