Dying in hospital: medical failure or nature outcome?

The purpose of this study was to describe patterns of medical and nursing practice in the care of patients dying of oncological and hematological malignancies in the acute care setting in Australia. A tool validated in a similar American study was used to study the medical records of 100 consecutive patients who died of oncological or hematological malignancies before August 1999 at The Canberra Hospital in the Australian Capital Territory. The three major indicators of patterns of end-of-life care were documentation of Do Not Resuscitate (DNR) orders, evidence that the patient was considered dying, and the presence of a palliative care intention. Findings were that 88 patients were documented DNR, 63 patients' records suggested that the patient was dying, and 74 patients had evidence of a palliative care plan. Forty-six patients were documented DNR 2 days or less prior to death and, of these, 12 were documented the day of death. Similar patterns emerged for days between considered dying and death, and between palliative care goals and death. Sixty patients had active treatment in progress at the time of death. The late implementation of end-of-life management plans and the lack of consistency within these plans suggested that patients were subjected to medical interventions and investigations up to the time of death. Implications for palliative care teams include the need to educate health care staff and to plan and implement policy regarding the management of dying patients in the acute care setting. Although the health care system in Australia has cultural differences when compared to the American context, this research suggests that the treatment imperative to prolong life is similar to that found in American-based studies.

An exploration of relational customers` response to service failure

Purpose – The purpose of this paper is to examine how customers with different relational bonds respond to the same service failure. In particular, the framework to service failure and recovery devised by Fournier and Mick is applied.
Design/methodology/approach – To uncover rich emotional and cognitive responses to service failure, in-depth interviews with eight former and current patrons of an Australian opera were used.
Findings – Three types of relationship were identified: satisfaction-as-love (SaL), satisfaction-as-trust (SaT) and satisfaction-as-control (SaC). Each responded to the same failure in different ways. SaL customers had emotional bonds with the product category and thus reaffiremed their loyalty following the failure. SaT customers saw the service failure and inadequate recovery as a breach of the brand's implied promise and thus excited the relationship. SaC customers took charge of the situation, using their status to improve their situation and then defended the brand.
Practical implications – The findings indicate the importance of customizing service recovery strategies, in this case to those customers with the strongest emotional bonds to the brand, not the product class.
Originality/value – This is the first paper to examine how relational customers respond to service failure and identify how different customer-brand relationships result in different post-failure reactions and expectations of service recovery.

Failure of conjugated linoleic acid supplementation to enhance biosynthesis of docosahexaenoic acid from α-linolenic acid in healthy human volunteers

A rate-limiting step in docosahexaenoic acid (DHA) formation from α-linolenic acid (ALA) involves peroxisomal oxidation of 24:6n-3 to DHA. The aim of the study was to determine whether conjugated linoleic acid (CLA) would enhance conversion of ALA to DHA in humans on an ALA-supplemented diet. The subjects (n=8 per group) received daily supplementation of ALA (11g) and either CLA (3.2g) or placebo for 8 weeks. At baseline, 4 and 8 weeks, blood was collected for plasma fatty acid analysis and a number of physiological measures were examined. The ALA-supplemented diet increased plasma levels of ALA and eicosapentaenoic acid (EPA). The addition of CLA to the ALA diet resulted in increased plasma levels of CLA, as well as ALA and EPA. Plasma level of DHA was not increased with either the ALA alone or ALA plus CLA supplementation. The results demonstrated that CLA was not effective in enhancing DHA levels in plasma in healthy volunteers.

Extent of heart failure self-care as an endpoint to patient education: a literature review

Background: In western countries the number of chronic heart failure (CHF) management programs has escalated in recent times. One key component of them is to teach self-care behaviours that enable affected individuals to monitor themselves and engage in lifestyles that improve their health status.
Aim: The aim of this article is to describe CHF self-care management and to review the literature which examines the effectiveness of patient education on patients’ performance of self-care behaviours.
Design/method: bibliographical databases were searched for papers published in English between 1982 to 2006. The search used the key words: heart failure, education, self-care and measures. Only randomized controlled trials (RCTs) were selected.
Results: Ten randomized controlled trials were selected that used education as an intervention and, in total, 1064 patients with CHF participated in these studies. The studies were heterogenous as to the sample population, the health outcomes measured, the education interventions, the expertise of the educator, and the length of time that was spent on teaching patients. No consistent patterns of implementation and specific evaluation of its impact were found, although three respective groups of investigators reported signifi cant differences in recurrent hospitalisation rates and mortality rates which were relative to usual care.
Conclusions: Teaching patients appropriate CHF self-care behaviours can significantly improve their health outcomes. Improvements in self-care were demonstrated in seven studies but only three had used validated instruments to measure such changes. This suggests that no firm conclusions can be drawn about changes in self-care practices.

Childhood obesity - a sign of commercial success, but a market failure.

'Obesogenic' products, such as energy dense foods, passive entertainment products, cars, and labour-saving devices, are widely available and heavily promoted. Because they are highly consumed and very profitable, obesity becomes the inevitable consequence of their commercial successes. Contemporary market forces heavily favour behaviours for short-term preferences (i.e. over-consumption and underactivity) over long-term preferences (i.e. healthy weight) and this is especially true for children. Hence, if the market, as the main mechanism for determining choices, results in outcomes, which make our children worse off, as is occurring with childhood obesity, then the market has failed to sustain and promote social and individual goals. This is a serious market failure. In the current obesogenic environment, expecting adults, let alone children, to make food and activity choices in their own best long-term interests is, therefore, demonstrably flawed. We argue that significant government intervention is needed to correct this market failure, as has been done for other major health problems.

Modernist Success in a Postmodern Failure: Jackson Pollock and Abstract Expressionism, the Avant-Garde and the Ascension of Late Capitalism, Art after 1945

It is hard to imagine the magnitude of the events at the end of World War II. The thought produced in the face of a myriad of deaths is almost unfeasible sixty years after the fact, but the energy was integral to the changing social landscape. Because of the country's prominence in and fortitude after the war, the U.S. was left responsible for reshaping and rejuvenating the international landscape that was destroyed by the years of brutal fighting and vile contestation. The American establishment was granted a major opportunity to establish itself amongst the global leaders. Such a grand responsibility must account for the multiplicity of thought that arises in such a decisive moment. In order to align the Abstract Expressionist art movement with the intersection of the intense, multifaceted thought developed during the postwar period, the following will discuss the political, philosophical, economic, and art historical overlap that occurred in the mid to late 1940s in the hopes of illustrating the fertility yet lingering problems associated with the restructuring of the world with America at the helm. In this way, the duration of the Abstract Expressionist moment will be better understood for both its triumphs and downfalls.