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Since the mid‐1960s, people have begun to change their attitudes towards death and the role it plays in our society. Many find problems with the fact that an increasing number of people die in old age, afflicted with chronic diseases, and that a majority of people in the United States die in public institutions such as hospitals, extended care facilities, or convalescent homes. Questions have been raised regarding the extent to which technology should be used to keep someone alive, when doing so seems futile or even cruel. We are beginning to realize that our society at present does not deal effectively with this growing populaton of the aged.

The Virginia Tech Library System is an integrated library system supporting cataloging, authority control, serials control, circulation, reserve room, acquisitions, document delivery, online public‐access catalog, keyword searching with Boolean operators, and statistics reporting. It runs on the Hewlett‐Packard HP/3000 line of computers. Initially installed in 1975, there are currently 104 users. Sidebars discuss: The Vanilla Network; LINNEA—the library information network for Finnish academic libraries; and the statewide information and referral service at Cabell County Public Library (West Virginia).

Adults with Down's Syndrome are at risk of developing Alzheimer's disease in later life. This paper gives an overview of the current research in the area and discusses the implications it raises for individuals, carers and service providers. Information on the link between Down's Syndrome and Alzheimer's disease and prevalence rates are given. The clinical symptoms of Alzheimer's disease and a stage model documenting the progression of the disease are presented. Attention is drawn to the problems inherent in assessing and diagnosing Alzheimer's disease in a person with a pre‐existing learning disability. The importance of a thorough assessment procedure and guidelines for assessment methods are highlighted. The paper also discusses the management of Alzheimer's disease and focuses on care management practices and recommendations for service provision. Guidelines for supporting individuals include maintaining skills, adopting a person‐centred approach, implementing psychosocial interventions and multidisciplinary care management. Finally, high prevalence rates of Alzheimer's disease in adults with Down's Syndrome and increasing life spans are highlighted as a particular concern, and recommendations for the future include increasing education and awareness, implementing screening services, improving assessment methods and developing appropriate services.

The importance of rehabilitation in promoting independence is recognised in current policy directives on the provision of care to older and disabled people, but has not been widely established within the spectrum of services provided by local authorities. AWorcestershire‐based re‐ablement service presents an effective model of joint working to provide comprehensive multidisciplinary assessments and a therapeutic intervention service aimed at reducing dependency and promoting service users' choice and control over their care programmes.

Nuclear weapons confront us as the challenge of our times. To understand the special psychological and moral issues raised by nuclear arsenals and their use, we must first grasp the special nature of these weapons. In a recent book on Hiroshima and Nagasaki, the authors highlighted a fact which often escapes public attention; namely, nuclear weapons, many times more powerful than the 12.5 kiloton uranium bomb and the 22 kiloton plutonium bomb dropped respectively on Hiroshima and Nagasaki, are qualitatively different from conventional explosives.

One of the best results of Mr Griffiths' review of the UK National Health Service has been the increased attention being given to issues of quality. Not everyone agrees that the NHS can learn from management of the nation's retail trade, but many would acknowledge that a strong selling point for the Sainsbury's chain has been the consistent quality of its products. Quality also exists in the NHS, but not consistent quality. British Governments have recognised that one side of the equation for quality is a reasonable distribution of resources. Thus political parties have supported the Resource Allocation Working Party's formula for the distribution of NHS funds. Now the other side of the equation — improving the quality of care — has become a priority.

Infection with the Human Immunodeficiency Virus (HIV) is a public health threat whose significance in the UK has only been generally appreciated over the last 12–18 months. The size of the problem (both current and potential) is difficult to assess, but epidemiological data would suggest that for an urban health district (outside London) one or two residents would have developed Acquired Immune Deficiency Syndrome (AIDS) in 1986, four will do so in 1987 and six in 1988. The incidence of HIV infections during the same period might be as high as 200, 400 and 600 respectively. This may seem a small number in comparison with overall morbidity and mortality; but between September 1990 and June 1991 the same health district might expect 48 AIDS cases to present if the epidemiological patterns remain constant (ie a doubling time for cases of 10 months).

There is a strong tradition of integration in rural community hospitals which has been largely unrecognised in the past. The national strategy for health in England now gives community hospitals a central role in providing integrated health and social care, in a policy referred to as ‘care closer to home’. The evidence emerging from international and national studies is demonstrating the benefit of the community hospital model of care. Public support for community hospitals over their 100‐year history has been strong, with value being placed on accessibility, quality and continuity. There is, however, a tension between the national policy and the current financial pressures to close or reduce services in one in three community hospitals in England. Innovative ways of owning and managing these services are being put forward by communities who are actively seeking to maintain and develop their local hospitals. The challenge is to demonstrate that community hospital services are valued models of person‐centred integrated care, and to demonstrate their contribution to the health and well‐being of their communities.

The purpose of this study is to establish a set of measurable criteria for elderly nursing homes (ENHs) in Lebanon. Donabedian's model known by structure/process/outcome was used as the driving conceptual framework for the study.

The study reports on a panel discussion where administrators, caregivers and specialists, separately established and exchanged key information on best practice approach. The work was carried out in the summer of 2008, using the consensus panel method. A group of expert opinions (Dalkey) made up of elderly home administrators and caregivers, policy makers, and academics discussed specific key issues related to elderly health and quality of life.

A total of 40 criteria were retained along seven main dimensions: types of elderly homes; funding; health services; boarding services; activities; structures; and elderly rights.

A major limitation in this study is that elderly were not part of the consensus making process. Thus, including elderly in the process would have substantiated and added validity to the established criteria.

The criteria developed in this study can be turned into key performance standards for elderly homes in Lebanon, other Mediterranean and Arab countries. These criteria would greatly benefit elderly homes if validated and used as guidelines for quality care.

The study is original in the sense that it seeks to establish measures for criteria, a blueprint, and benchmarks for ENH standards.

The purpose of this paper is to increase understanding of the status, vulnerability and needs of the health-care and nursing service customers’ (hereafter, care service customers’) loved ones.

The position and vulnerabilities of secondary customers of care services are studied and examples provided by reviewing empirical research reported in the care service literature. A conceptual discussion is developed on the “customer” concept in an extended sense, beyond the focal customers. The “primary customer” and “secondary customer” concepts are employed to supplement the extant discussion on customer units and ecosystems.

Secondary customers are exposed to secondary vulnerability and their well-being is affected by the services provided primarily to their loved ones. The most recurring needs of secondary customers concern psychosocial support, communication and information and cultural sensitivity.

New perspectives on understanding the “customer” concept in an extended sense. This assists in supporting the customers’ dynamic activities and processes within the customer ecosystems. To address care service customers’ loved ones’ vulnerabilities and needs and to support their well-being, they should also be recognised as customers – “secondary customers” – with patients being the “primary customers”.

The results are especially relevant when considering services’ influences on vulnerable customers’ ecosystems and on individuals within them. It is important to recognise that beyond a vulnerable customer, several secondary customers may be exposed to secondary vulnerability, needing support.

The paper is apparently the first to connect the constructs “primary” and “secondary customer” and customer vulnerability to the customer ecosystem discussion. Also, essential future research questions are provided.