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The experience of death and dying is very different in the 21st century than it was in the 19th. A number of societal changes in the latter part of the 19th and early part of the 20th centuries served to remove contact with the dying and the dead from everyday experience. This article examines four of these changes: 1) falling death rates, 2) the rise of hospitals, 3) the rise of funeral directing as a profession, and 4) the rural cemetery movement. It is proposed that these changes produced an unjustified optimism with regard to the prolongation of life.

BACKGROUND: Perioperative oral supplementation has been shown to reduce post-operative complications. However, the use of preoperative standard oral supplements in a cohort of colorectal cancer patients has not been evaluated. The present study examined whether preoperative supplements are beneficial in this group. METHODS: In a randomised controlled trial, patients were assigned to receive 400 mL of oral supplement and dietary advice or dietary advice alone. Primary outcome was the number of post-operative complications. One hundred and twenty-five patients were recruited (59 randomised to the intervention group and 66 to the control group) and nine were excluded. RESULTS: In the intervention group, 24 (44%) patients had a complication compared to 26 (42%) in the control group (P = 0.780). In the intervention and control groups, there were eight (15%) and 16 (25%) surgical site infections, respectively (P = 0.140) and seven (13%) and 11 (17%) chest infections, respectively (P = 0.470). Subgroup analysis for hypothesis generation included 83 (71%) weight-losing patients, where there was a significant reduction in surgical site infections using the Buzby definition (P = 0.034), although this was not the case for the Centre for Disease Control definition (P = 0.052). CONCLUSIONS: There was no evidence that preoperative supplements were beneficial in reducing the number of complications, although there may be some benefit for surgical site infections in selected weight-losing preoperative patients.

Health services professionals are confronting the challenge of maintaining and improving competence over the course of lengthy careers in diverse practice specialties. This article reviews the efforts of a selection of health care professions to ensure lifetime competence and reviews some of the challenges encountered in these efforts. Although each profession has its own issues, significant generic questions are common to all.