Palliative needs of spousal caregivers of patients with heart failure followed up at specialized heart failure centers

As the incidence of heart failure increases, more patients and their caregivers are faced with needs related to the unpredictable nature of the illness. Palliative care interventions are an appropriate way to meet these needs; however, palliative care remains underutilized. Family caregivers, particularly spouses, play an important role providing care to these patients; thus, it is important to consider their needs when planning interventions. The purpose of this article was to describe the needs of spousal caregivers of patients followed up at specialized heart failure centers within the context of the dynamic ebb and flow of heart failure. Forty-five spouses (n = 45) were interviewed over 12 to 18 months to follow their changing needs. Grounded theory methods were used to collect and analyze data. Four categories of overarching needs amenable to palliative care interventions were identified: informational, financial, psychosocial, and physical. These needs were always present but changed during times of medical stability versus exacerbation/medical instability. Caregivers continually reprioritized their needs in response to the heart failure experience; therefore, episodic offerings of palliative care during exacerbations are inadequate. Nurses can play a pivotal role in facilitating comprehensive palliative care interventions to improve the experience of those caring for and living with heart failure. © 2011 The Hospice and Palliative Nurses Association

Experience as a moderator of the media equation: the impact of flattery and praise

This study extends previous media equation research, which showed that the effects of flattery from a computer can produce the same general effects as flattery from humans. Specifically, the study explored the potential moderating effect of experience on the impact of flattery from a computer. One hundred and fifty-eight students from the University of Queensland voluntarily participated in the study. Participants interacted with a computer and were exposed to one of three kinds of feedback: praise (sincere praise), flattery (insincere praise), or control (generic feedback). Questionnaire measures assessing participants' affective state, attitudes and opinions were taken. Participants of high experience, but not low experience, displayed a media equation pattern of results, reacting to flattery from a computer in a manner congruent with peoples' reactions to flattery from other humans. High experience participants tended to believe that the computer spoke the truth, experienced more positive affect as a result of flattery, and judged the computer's performance more favourably. These findings are interpreted in light of previous research and the implications for software design in fields such as entertainment and education are considered

Heart Failure and Palliative Care: Implications in Practice

The number of people with heart failure is continually rising. Despite continued medical advances that may prolong life, there is no cure. While typical heart failure trajectories include the risk of sudden death, heart failure is typically characterized by periods of stability interrupted by acute exacerbations. The unpredictable nature of this disease and the inability to predict its terminal phase has resulted in few services beyond medical management being offered. Yet, this population has documented unmet needs that extend beyond routine medical care. Palliative care has been proposed as a strategy to meet these needs, however, these services are rarely offered. Although palliative care should be implemented early in the disease process, in practice it is tied to end-of-life care. The purpose of this study was to uncover whether the conceptualization of palliative care for heart failure as end-of-life care may inhibit the provision of these services. The meaning of palliative care in heart failure was explored from three perspectives: scientific literature, health care providers, and spousal caregivers of patients with heart failure. There is confusion in the literature and by the health care community about the meaning of the term palliative care and what the provision of these services entails. Palliative care was equated to end-of-life care, and as a result, health care providers may be reluctant to discuss palliative care with heart failure patients early in the disease trajectory. Most family caregivers have not heard of the term and all would be receptive to an offer of palliative care at some point during the disease trajectory

First Nations organisations and strategies of disruption and resistance to settler-colonial governance in Australia

Since the 1970s, First Nations people in urban areas in Australia have established organisations to actualise self-determination, deal with disenfranchisement, advocate for First Nations people, create better life outcomes for First Nations people, and improve wellbeing. For decades, these organisations led the way not only in First Nations social and health care but also in self-governance. However, the introduction of new public management policies with the hegemony of neoliberalism in Australian public policy in the past two decades has led to major changes in the way governments do business with urban First Nations organisations. This has involved a change in funding models and new forms of government monitoring, regulation, accreditation and governance training. The introduction of these market models has driven significant change in Indigenous service delivery in Australia, arguably to the detriment of community-controlled organisations. Yet, despite these external pressures to conform to settler-colonial systems of neoliberal governance, First Nations organisations continue to maintain their ethical commitments to Indigenous justice, self-determination and wellbeing. Drawing on four case studies, this chapter demonstrates the persistence and strategic orientations of First Nations organisations to maintain the foundational principles of their organisations to realise Indigenous justice within the settler-colonial state of Australia

CX3CL1 Up-Regulation Is Associated with Recruitment of CX3CR1+ Mononuclear Phagocytes and T Lymphocytes in the Lungs during Cigarette Smoke-Induced Emphysema

CX3CR1 is expressed on monocytes, dendritic cells, macrophages, subsets of T lymphocytes, and natural killer cells and functions in diverse capacities such as leukocyte adhesion, migration, and cell survival on ligand binding. Expression of the CX3CL1 gene, whose expression product is the sole ligand for CX3CR1, is up-regulated in human lungs with chronic cigarette smoke-induced obstructive lung disease. At present, it is unknown whether CX3CL1 up-regulation is associated with the recruitment and accumulation of immune cells that express CX3CR1. We show that mice chronically exposed to cigarette smoke up-regulate CX3CL1 gene expression, which is associated with an influx of CX3CR1+ cells in the lungs. The increase in CX3CR1+ cells is primarily comprised of macrophages and T lymphocytes and is associated with the development of emphysema. In alveolar macrophages, cigarette smoke exposure increased the expression of both CX3CR1 and CX3CL1 genes. The inducibility of CX3CR1 expression was not solely dependent on a chronic stimulus because lipopolysaccharide up-regulated CX3CR1 in RAW264.7 cells in vitro and in mononuclear phagocytes in vivo. Our findings suggest a mechanism by which macrophages amplify and promote CX3CR1+ cell accumulation within the lungs during both acute and chronic inflammatory stress. We suggest that one function of the CX3CR1-CX3CL1 pathway is to recruit and sustain divergent immune cell populations implicated in the pathogenesis of cigarette smoke-induced emphysema