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On Instagram, individuals proactively seek Likes for posts, as the number of Likes received is a social currency, signalling popularity and status. However, digital status-seeking behaviours, such as Like-seeking, are also associated with negative outcomes including health-risk behaviours. Yet little is known about traits that drive Like-seeking. Proposing Like-seeking as a form of conspicuous consumption, we investigate materialism, vulnerable narcissism, and self-monitoring-traits associated with conspicuous consumption-as antecedents of Like-seeking on Instagram, distinguishing between normative Like-seeking and deceptive Like-seeking. We explore the mediating role of Instagram intensity in the relationship between these traits and the two forms of Like-seeking. Using a cross-sectional non-experimental design, data from a sample of 436 Instagram users in the United States were analysed using partial least squares structural equation modeling. Results show that the traits are directly associated with deceptive Like-seeking. Findings reveal new insights into users' Instagram intensity as a mediating variable between materialism and self-monitoring, and both Like-seeking behaviours

Brands provide a means for consumers to present the self, expressing their inner selves (the ‘real me’), or their social selves (how others see me). With the rise in social media use, academics and practitioners seek to understand how consumers’ self-expression through following brands online leads to brand outcomes. This study investigates the inner and social self-expressiveness of brands as separate antecedents of two outcomes: intention to co-create value and willingness to pay a premium price. Insights from 332 followers of brands on social media reveal that the inner and social self-expressiveness of brands drive these outcomes differently, as online brand engagement and brand trust mediate the relationship between self-expressive brands and brand outcomes, but only when the brand has an ability to express the inner self. The findings have implications for the study of self-expressive brands and their influence on brand outcomes.

Purpose Drawing on consumer brand relationship theory, this study aims to investigate online brand engagement, brand trust and consumer brand identification as antecedents of brand love, amongst Generation Y and Z consumers. It explores the role of brand love in predicting consumers’ intention to co-create value and willingness to pay a premium price for the brand, for brands followed on social media. Design/methodology/approach Data from a study of 332 followers of brands on social media were analysed using structural equation modelling. Findings Results highlight the role of brand love in mediating the relationship between antecedents online brand engagement and consumer brand identification on intention to co-create value and willingness to pay a premium price. Consumers who trust the brand are more likely to intend to co-create value and are more willing to pay a price premium and these relationships are enhanced when the brand is loved. Practical implications Findings provide guidance for managers seeking to build brand friendship relationships with young consumers through social media. Results caution against a form of “superficial” friendship where the consumer may interact and co-create value online, yet fail to value the brand, evidenced through a willingness to pay a premium price. Originality/value The research identifies the critical role of brand love in fostering relationships with brands that young consumers follow on social media. The study reveals that neither online brand engagement nor consumer brand identification will result in co-creation of value or willingness to pay a premium price unless the consumer experiences brand love.

Purpose This study aims to present a typology of Facebook followers of charities, drawing on theories of value co-creation, impression management and conspicuous donation behavior. Design/methodology/approach Data from 234 students based in an Irish University and 296 adults in the USA were subjected to cluster analysis. Findings Four segments were identified, common to both samples. Quiet donors are less likely to engage with a charity on Facebook, yet they may donate to the charity. They follow a charity if it offers intrinsic meaning, and they quietly donate money. Facebook expressives mention charities on Facebook to impress others, but have low intention to donate. Following the charity on Facebook is a means to virtue signal, but it helps to spread word of mouth. Friendly donors are active on social media and engage with charities on Facebook when there is personal meaning, and they will donate. Following the charity offers them intrinsic value, and their Facebook mentions promote the charity online. Finally, dirty altruists are motivated by a desire to help, but also to impress others. They will donate, but they will ensure to highlight their good deed on Facebook, to virtue signal. Originality/value The study contributes to the literature investigating individuals’ motivations to connect with charities through social media and suggests value co-created by types of charity followers on Facebook.

PurposeThis study explores consumers' self-congruence with luxury fashion brands they mention on Facebook. It investigates the extent to which those brands are congruent with the actual self (ASC) or the ideal self (ISC), and whether ASC or ISC of luxury fashion brands on Facebook predicts purchase intention. It also examines trait antecedents of both ASC and ISC Facebook mentions of luxury fashion brands, specifically materialism, self-monitoring and self-esteem.Design/methodology/approachFindings are presented from a survey of Facebook users who mention luxury fashion brands on the social medium.FindingsSelf-esteem was revealed as an antecedent of ASC luxury fashion brands mentioned on Facebook, while materialism and high self-monitoring predicted ISC luxury fashion brands. Only ASC luxury fashion brands mentioned online were positively associated with purchase intention.Research limitations/implicationsResults are exploratory, and they are limited to those who are active Facebook users and who mention a luxury fashion brand on Facebook.Practical implicationsThe study offers implications for managers of luxury fashion brands seeking to utilise Facebook to enhance the purchase intention for their brands or to increase the idealisation of the brand.Originality/valueThe paper provides new insights into the relationship between self-congruent mentions of luxury fashion brands on Facebook and purchase intention of those brands, distinguishing between ISC and ASC. This research also offers valuable and useful insights into ISC and ASC antecedents.

Instagram, the social networking site (SNS), recently tested the initiative of hiding the number of Likes a post receives from other users. Instagram's rationale for hiding Likes was to support wellbeing through reduced competition for Likes. In an experiment with 280 Instagram users in the United States, we investigated the effect of hiding Likes on negative affect and loneliness. Scenarios were created to simulate receipt of higher or lower Likes than desired, and the visibility of those Likes to others. Findings indicate that receiving greater Likes than desired reduces loneliness but increases negative affect, and this result is exacerbated by the visibility of Likes. However, when Likes are low, it does not make a difference to negative affect whether those Likes are visible or not. Vulnerable narcissism was associated with loneliness. Findings provide support for Instagram's initiative, and reveal new insights about the interrelationship between loneliness and negative affect in Instagram use.

Mentioning products or brands on Facebook enables individuals to display an ideal self to others through a form of virtual conspicuous consumption. Drawing on conspicuous donation behaviour (CDB) literature, we investigate conspicuous virtue signalling (CVS), as conspicuous consumption on Facebook. CVS occurs when an individual mentions a charity on their Facebook profile. We investigate need for uniqueness (NFU) and attention to social comparison information (ATSCI) as antecedents of two types of CVS self-oriented (to gain intrinsic benefits) and other-oriented (to impress others). We also explore the relationship between CVS and self-esteem, and offline prosocial (donation to the charity) and unethical (counterfeit purchase) behaviour intentions. Data from two studies: a college survey (N = 234), and an adult survey via MTurk (N = 296), were analysed using structural equation modeling. Results indicate that NFU predicts both forms of CVS, while ATSCI influences both forms of CVS for adults and other-oriented CVS for students. Self-esteem is enhanced by self-oriented CVS. Self-oriented CVS predicts donation intention whereas other-oriented CVS significantly reduces donation intention for both samples. Furthermore, a significant relationship between CVS and purchase intention of counterfeit luxury goods is revealed. Findings provide insights into conspicuous virtue signalling and the relationship between CVS on Facebook and offline behavioural intentions. This work was supported by the Government of Spain (ECO2017-82103-P), and the Government of Aragón and the European Social Fund (Project Generés S54_17R). peer-reviewed 2019-08-21

Purpose This study examines the impact of social media activities on consumers’ willingness to pay a premium price (WTPp) in the banking industry, and investigates the role of consumer-brand identification (CBI) on this relationship. For the first time, the effect of electronic word-of-mouth (eWOM) is considered separately from other social media marketing efforts (SMME). Design/methodology/approach Data from a sample of 145 banking customers that follow bank social networks was analysed using structural equation modelling and fuzzy-set qualitative comparative analysis (fsQCA) to test a proposed structural model. Findings Findings indicate that the effect of eWOM and SMME on WTPp is fully mediated by CBI. The results uncover a viable path to achieve WTPp in the banking industry, which includes the joint presence of SMME, eWOM and CBI. Research/limitations implications The study was conducted on the banking sector of Portugal. It is advocated that further research would investigate the results in other service sectors, across different countries. Practical implications Findings highlight the importance of social media marketing in banking. Results reveal opportunities for managers in the banking sector to enhance CBI and ultimately WTPp, through SMME and eWOM. Originality/value The study is the first to consider the influence of SMME and eWOM as separate antecedents of WTPp. The findings indicate that the effect of eWOM and SMME on WTPp is fully mediated by CBI. In particular, the results of the fsQCA indicate that the combined presence of SMME, eWOM and CBI, is sufficient to obtain WTPp.

Purpose – The purpose of this paper is to explore attitudes of consumers who engage with brands through Facebook “likes”. It explores the extent to which these brands are self-expressive and examines the relationship between brand “liking” and brand outcomes. Brand outcomes include brand love and advocacy, where advocacy incorporates WOM and brand acceptance. Design/methodology/approach – Findings are presented from a survey of Facebook users who engage with a brand by “liking” it. Findings – Brands “liked” are expressive of the inner or social self. The study identifies a positive relationship between the self-expressive nature of brands “liked” and brand love. Consumers who engage with inner self-expressive brands are more likely to offer WOM for that brand. By contrast, consumers who engage with socially self-expressive brands are more likely to accept wrongdoing from a brand. Research limitations/implications – The research is exploratory and is limited to consumers who are engaged with a brand through “liking” it on the Facebook social network. Practical implications – The study offers suggestions for managers seeking to enhance brand engagement through Facebook “liking”, and to encourage positive brand outcomes (such as WOM) among consumers already engaged with a brand on Facebook. Originality/value – This paper provides new insights into consumer brand engagement evidenced through Facebook “liking”. It charts the relationship between “liked” self-expressive brands and brand love. Distinctions are drawn between brand outcomes among consumers who “like” for socially self-expressive reasons, and consumers who are brand engaged by “liking” to express their inner selves.

Purpose This paper aims to explain the effect of flow, game repetition and brand familiarity on players’ brand attitude and purchase intention in the context of mobile advergaming. Design/methodology/approach Data from 227 participants who played a mobile advergame were analysed. Structural equation modelling with partial least squares was used to test the research model. Findings The results reveal that the independent variables (i.e. game repetition and brand familiarity) significantly influence the dependent variables explored in this study (i.e. brand attitude and purchase intentions of players). Results also show that brand familiarity influences players’ flow experience, which in turn significantly affects players’ purchase intentions. Research limitations/implications The findings of this study are important for advertising practitioners and advergames’ developers as understanding the determinants of mobile advergaming effectiveness is crucial for designing successful advergames that persuade players the most. Originality/value This study contributes to the literature in two ways. First, it provides new insights into the effectiveness of mobile advergames, which is an under-researched area. Second, it offers empirical evidence of the effects of game repetition, flow and brand familiarity on mobile advergaming effectiveness.

Purpose Based on flow theory, the purpose of this paper is to explain why the use of mobile advergames can enhance players’ brand perceptions and purchase intentions, as well as the factors that affect players’ flow experience. Design/methodology/approach Data from 212 participants who played a mobile advergame was analysed. Structural equation modelling with PLS was used to test the research model. Findings The results reveal that challenge, interactivity, focused attention and telepresence significantly influence the flow experience while playing mobile advergames. Results also show that the greater the flow, the more positive the attitude towards the featured brand and the greater the purchase intention. Practical implications The findings of this study are important for advertising practitioners and advergames developers as understanding the key game features that promote flow is crucial to designing engaging mobile advergames that persuade players most. Originality/value This study contributes to the literature in two ways. First, it provides new insights into the effectiveness of mobile advergames, which is an under-researched area. Second, it offers a conceptual framework based on flow theory for understanding why the use of mobile advergames can enhance players’ brand perceptions and purchase intentions.

Mentioning products or brands on Facebook enables individuals to display an ideal self to others through a form of virtual conspicuous consumption. Drawing on conspicuous donation behaviour literature, we investigate ‘conspicuous virtue signalling’ (CVS), as conspicuous consumption on Facebook. CVS occurs when an individual mentions a charity on their Facebook profile. We investigate need for uniqueness (NFU) and attention to social comparison information (ATSCI) as antecedents of two types of CVS–self-oriented (to gain intrinsic benefits) and other-oriented (to impress others). We also explore the relationship between CVS and self-esteem, and offline prosocial (donation to the charity) and unethical (counterfeit purchase) behaviour intentions. Data from two studies, a college survey (N = 234) and an adult survey via MTurk (N = 296), were analysed using structural equation modelling. Results indicate that NFU predicts both forms of CVS, while ATSCI influences both forms of CVS for adults and other-oriented CVS for students. Self-esteem is enhanced by self-oriented CVS. Self-oriented CVS predicts donation intention whereas other-oriented CVS significantly reduces donation intention for both samples. Furthermore, a significant relationship between CVS and purchase intention of counterfeit luxury goods is revealed. Findings provide insights into conspicuous virtue signalling and the relationship between CVS on Facebook and offline behavioural intentions. peer-reviewed 2019-11-24

OBJECTIVE:: There are high rates of recurrence after definitive surgery in biliary tract cancer patients. We reviewed the use and effectiveness of adjuvant therapy (AT; chemotherapy�radiotherapy) in a single institution series. METHODS:: Characteristics, treatment details, and follow-up data of all patients with biliary tract cancer who had definitive surgery from January 1987 to September 2011 were reviewed. The association between baseline variables and disease-free survival/overall survival (OS) were tested using Cox proportional hazard analysis in the univariable and multivariable settings. RESULTS:: Analysis included 296 patients (58% male; median age, 63 y). Negative or microscopically positive resections were reported in 42% and 14%, respectively, with 44% not reported. Node positivity was reported in 35% patients. AT was given in 28% of patients with 59% receiving chemotherapy and 35% concurrent chemotherapy/radiotherapy. Disease recurred in 60% patients. AT was associated with significantly improved OS (hazard ratio, 0.41; P=0.02). Compared with R0 resection, patients with R1 resection derived significantly increased benefit from AT (P for difference 0.02). In the node positive population (n=103), AT was associated with significantly improved OS (hazard ratio, 0.60; 95% confidence interval, 0.38-0.95; P=0.03). CONCLUSIONS:: Patients with R1 resection and node positive disease receiving AT after definitive surgery seem to derive OS advantage. Large prospective trials are needed to confirm these data.

Purpose– This study aims to examine the relationship between social influence and consumers’ self-expression through brands. It considers susceptibility to interpersonal influence and social network influence on self-expressive brands and brand tribalism. The study examines whether self-expressive brands and brand tribalism influence brand loyalty and word of mouth (WOM).Design/methodology/approach– A cross-sectional online survey was carried out with members of Generation Y in Ireland. Data from 675 complete responses were analysed using SPSS 20 and AMOS 20. A structural model tested nine hypothesised relationships.Findings– Findings indicate that both online social network influence and susceptibility to interpersonal influence are antecedents of tribalism and self-expressive brands. Consumers of self-expressive brands are loyal and offer positive WOM. By contrast, those who seek tribal membership have less brand loyalty and offer less WOM than other consumers. Findings suggest that consumers may be loyal to tribes, rather than to brands. This informs our understanding of the role of tribes for consumers and brand outcomes.Research limitations/implications– This study is limited to Generation Y consumers within Ireland.Originality/value– This is the first study to explore the effect of consumers’ perceptions about online social network influence on brand tribalism. In addition, their views about the influence of the social network on self-expressive brand consumption, and brand outcomes, are identified. This paper highlights consumers’ susceptibility to interpersonal influence on their brand choices and brand tribalism. In addition, it is shown that brand loyalty and WOM are not always a consequence of tribal membership. By contrast, self-expressive brand consumption enhances brand WOM and brand loyalty.

Purpose This study aims to investigate the relationship between young people’s Conspicuous Donation Behaviour (CDB) on social media platforms and their offline donation behaviour, specifically intentions to donate and volunteer time. It also explores materialism, self-esteem and self-monitoring as CDB trait antecedents, as a form of conspicuous consumption on social media. Finally, it considers the influence of altruism on these relationships. Design/methodology/approach A survey was conducted of regular Facebook users mentioning a charity brand on Facebook in the past year. Data from 234 participants were analysed and hypotheses tested using structural equation modeling. Findings Results confirm two forms of CDB – self and other-oriented. Materialistic consumers are more likely to engage in both forms of CDB on Facebook. High self-esteem increases self-oriented CDB; high self-monitoring increases other-oriented CDB. Self-oriented CDB is positively associated with donation intentions, but other-oriented CDB is negatively associated. Findings reveal how altruism moderates this model. Research limitations/implications Findings show how personality traits influence CDB and reveal the relationship between CDB, as virtual conspicuous consumption on social media platforms, and donation behaviour. Practical implications The study provides implications for managers about enhancing charitable donations through social media. Originality/value This is the first study to explore donation behaviour as a form of conspicuous consumption on social media, where virtual conspicuous consumption (i) does not require any offline consumption and (ii) may achieve the desired recognition, without any charitable act. It provides new insights into CDB, its antecedents and influence on donation behaviour.

In 2013, academics from a Scottish university came together with social work managers and practitioners from two local authorities (LAs) in Scotland to run a knowledge exchange (KE) project co-sponsored by the Economic and Social Research Council and the LAs. The project's aim was an ambitious one: to contribute to culture change in the children and families' departments in the two partner agencies. The project grew out of an earlier KE venture that had explored ways of engaging better with involuntary service users in social work; it thus both anticipated and reflected wider concerns about services for children that were also demonstrated in Munro's Review of Child Protection. The KE project had three components: training for managers, practitioner research projects and critical reflection workshops. Whether, and to what degree, the KE project changed culture is not the focus of this paper, which is written jointly by academic researchers and practitioners. Instead, one element of the KE project, namely the critical reflection workshops, is discussed. Findings provide strong evidence of the pressures currently experienced by children and families' services in the UK public sector. They also indicate how important good relationships are in building meaningful KE.

Although many managers recognize that Facebook Fans represent a marketing opportunity, there has been little research into the nature of different Fan types. This study explores a typology of Fans, drawn from a sample of 438 individuals who "Like" brands on Facebook. Fans' brand loyalty, brand love, use of self-expressive brands, and word of mouth (WOM) for Liked brands were used to suggest four Fan types: the "Fan"-atic, the Utilitarian, the Self-Expressive, and the Authentic. The results of this exploratory study highlight the value of cluster analysis as a strategy for identifying different Fan types and provide insights to prompt further research into Facebook Fan types.

Purpose: Ind suggests front line employees can be segmented according to their level of brand-supporting performance. His employee typology has not been empirically tested. The paper aims to explore front line employee performance in retail banking, and profile employee types. Design/methodology/approach: Attitudinal and demographic data from a sample of 404 front line service employees in a leading Irish bank informs a typology of service employees. Findings: Champions, Outsiders and Disruptors exist within retail banking. The authors provide an employee profile for each employee type. They found Champions amongst males, and older employees. The highest proportion of female employees surveyed were Outsiders. Disruptors were more likely to complain, and rated their performance lower than any other employee type. Contrary to extant literature, Disruptors were more likely to hold a permanent contract than other employee types. Originality/value: The authors augment the literature by providing insights about the profile of three employee types: Brand Champions, Outsiders and Disruptors. Moreover, the authors postulate the influence of leadership and commitment on each employee type. The cluster profiles raise important questions for hiring, training and rewarding front line banking employees. The authors also provide guidelines for managers to encourage Champions, and curtail Disruptors. © Emerald Group Publishing Limited.

This exploratory study seeks to provide an appreciation of brand orientation in retail banking. Through in-depth interviews at head office and branch level, we explore managers' brand mind-set. We also surface managers' views about the relationship between market and brand orientation. Further, we examine managers' perceptions about the role of brand values as resources in creating a brand orientation. In a large-scale study of front-line employees, we examine the level of agreement with brand values, and describe differences in brand buy-in across employee clusters. © 2013 Copyright Westburn Publishers Ltd.

PurposeThe purpose of this paper is to understand the relationships Generation Y females have with fashion brands online. Specifically, it examines the role of the internet and social networks in these relationships.Design/methodology/approachNarrative interviews were employed to gather data from Generation Y women. Analysis was conducted using inductive thematic analysis.FindingsTwo main themes emerged from the data: the importance of social media and the influence of the internet. Findings suggest social networks have a significant influence on the dynamics of brand consumption and inform our understanding of females' online shopping behaviours.Research limitations/implicationsA qualitative methodology was utilised to elicit insights from consumers. This allowed participants to express their thoughts in their own words, which provided rich data for analysis.Practical implicationsWe provide guidance for marketing managers seeking to harness social networks to market brands. Findings illustrate the role of social networks in driving brand consumption among Generation Y women, and highlight the criticality of the social network as a source of information and reassurance for brand choices. Further, we identify concerns about online shopping, and provide suggestions for online retailers seeking to augment consumers' shopping experiences.Originality/valueThis study offers insights into Generation Y females' use of the internet and social networks for brand consumption. To date such research has been mainly quantitative. Further, Generation Y has been neglected in the marketing literature. This paper addresses these gaps and illustrates the significant impact social media has on the behaviour of female consumers.

Front line employees are critical to service brand success, as their performance brings brand promises to life. Banking employees, like others, must remain committed to their employers, to live the brand, particularly during periods of economic uncertainty and customer frustration. Employees' commitment influences their brand adoption and brand-supporting behavior during service encounters. Effective leadership fosters employee commitment and brand supporting behaviors. This study examines the nature of employee commitment in banking, distinguishing between affective, continuance and normative commitment. The study explores bank leaders, examining whether initiating structure leader behavior or considerate leader behavior is most effective in encouraging employee commitment. Data from a sample of 438 employees in a leading Irish bank reveals the optimal leadership style for employee commitment.

Purpose Brand “Likes” on Facebook facilitate self-expression, forming part of consumers’ virtual selves. Yet, consumers’ brand “Likes” may bear little resemblance to their material realities. This paper aims to test similarities of brand image with self-image for Facebook “Likes” to determine whether self-congruence with a “Liked” brand leads to positive offline brand outcomes. It also investigates whether consumers’ perceptions about their Facebook social relations influence self-congruent brand “Likes”. Design/methodology/approach A large-scale survey was conducted of regular Facebook users who “Liked” brands. Data from 438 respondents was analysed and hypotheses tested using structural equation modeling. Findings Empirical results show that the perceived self-congruence with a “Liked” brand increases with social tie strength. Perceived social tie strength is informed by perceived attitude homophily. When the perceived self-congruence with a “Liked” brand is higher, brand love and word of mouth (WOM) are enhanced. Consumers also have greater brand loyalty and offer more WOM when brands are loved. Research limitations/implications Findings demonstrate the influence of consumers’ cognitive network on “Likes” and brand outcomes. Further replication would enhance generalisability. Future research should use a wider sample and investigate other variables. Practical implications Findings support managers seeking to grow and analyse Facebook “Likes” by providing insights into brand loyalty, brand love and WOM for “Liked” brands. Originality/value The paper addresses the dearth of research exploring how consumers’ perceptions of their Facebook network influence their online brand behaviour and how perceived self-congruence with a “Liked” brand relates to brand outcomes.

Background: Our perception is that the proportion of referrals made to the specialist palliative medicine service (SPMS) in our institution for patients with a primary diagnosis of nonmalignant disease is high and that these patients are often referred late in their illness. We aimed to review the symptom burden and referral patterns of patients with a noncancer diagnosis to the SPMS in our centre. Methods: All new non-malignant referrals to the SPMS in 2009 were included. Data were collected from patients' medical records and analyzed using Excel. Results: Ninety-two referrals were identified: 60 (65%) female, 32 (35%) male. Mean age 76.5 years (21-92). Reasons for referral included: end-of-life care (n=55, 60%), symptom control (n=23, 25%), home care support (n=13, 14%) and psychological support (n=1, 1%). Mean time from admission to referral was 24.9 days (Conclusion: The proportion of noncancer patients referred to the SPMS is our institution is high. This study confirms that nonmalignant referrals are commonly sent to the SPMS when patients are actively dying or very imminently dying. Further education of colleagues is warranted in the role of the SPMS, particularly with regard to earlier referral.

This study tests hypotheses integrating relational aspects of social networks, self-expressive brands and consumers’ brand advocacy. We explore the relationship between homophily and social ties, and the extent to which strong ties are associated with Facebook users’ incorporation of self-expressive brands in their personal profiles by ‘Liking’ them. We also examine the relationship between self-expressive brands ‘Liked’ on Facebook, and consumers’ brand advocacy in online and offline settings. A survey of 265 Facebook users reveals stronger social ties influence consumers to ‘Like’ brands that express their inner and social selves. Self-expressive brands reflecting one's inner or social self encourage consumers to offer positive WOM on social networks. Further, self-expressive brands ‘Liked’ on Facebook positively influence consumers’ brand acceptance, and their willingness to forgive ‘Liked’ brands for wrongdoing. Managerial implications along with implications for theory development are explored.

Central venous access devices (CVADs) play an essential role in the care of critically ill children. Significant challenges exist for teams in managing CVADs particularly in a community setting. The authors aimed to assess the experience of general practitioners (GPs) caring for children with CVADs. From 200 CVADs inserted in a pediatric hospital in 2009, 50 patients were randomly selected and 44 GPs were forwarded a questionnaire. Twenty (46%) GPs responded. The main reasons (n = 22) for using CVADs were medication administration (n = 11), nutrition (n = 6), and blood sampling (n = 5). Thirteen (65%) GPs had no education in CVAD management and 14 (70%) were unaware of existing guidelines. Those identified by GPs as having primary responsibility for care of CVADs in the community included hospital/pediatric teams (n = 9), parents (n = 3), GPs (n = 2), public health nurses (n = 1), and palliative care ("home care") teams (n = 1). The main challenges (n = 15) identified by GPs were lack of education (n = 4), line management difficulties (n = 3), infection risk (n = 3), infrequent exposure to CVADs (n = 3), and poor communication (n = 1). GPs felt that these challenges could be addressed through: education (n = 8), increased manpower and community support (n = 1), and improved communication (n = 1). This study highlights the inconsistency and challenges for GPs surrounding CVAD use in children. Further education and support is necessary to assist GPs in their use particularly when providing end-of-life care for children in the community.

Background: Seizures are a common complication in patients with central nervous system (CNS) tumors. Optimal management is unclear with no defined guidelines and pharmacological management poses many controversies. Due to a hypothesized lack of consistency, we aimed to retrospectively review seizure management in patients with high-grade CNS tumors in our institution. Methods: The medical records of patients with high-grade CNS tumors referred to the specialist palliative medicine service in our institution from January-June 2008 were retrospectively reviewed. Seizure incidence, antiepileptic drug (AED) choice, neurology input, medication interactions, and appropriate drug level monitoring were assessed. Results: Twenty-seven patients were included for analysis. Fifteen (56%) were female. The mean age was 58.8 years (range 31-82 years). Three (11%) patients presented with seizures and 8 (30%) developed seizures subsequently. Eight (73% of those with seizures) were on monotherapy AED. Six different agents were used as first-line agents. Phenytoin was the most common AED used (n = 4). Three (27%) patients were on combination AEDs. Five (45.5%) patients had been seen by neurology and 6 (54.5%) had appropriate drug level monitoring performed. Six (55%) patients had potential AED-non-AED interactions. None of the patients had instructions documented in the clinical notes against driving. Conclusion: Seizure management in patients with CNS tumors is not consistent and remains very much a neglected area. Appropriate choice of AED is crucial. Physicians should be aware of potential drug interactions. Ownership and regular follow-up of this group is required to ensure optimum patient management.

PurposeThis paper aims to examine the influence of the culture of the service firm on its interpretation of the role of the brand and on the development and implementation of its brand values.Design/methodology/approachA grounded theory approach was used. Interviews were conducted with 20 managers within two leading banking firms in Ireland and two leading grocery retailers in Ireland.FindingsThe development of the brand, and its role within the firm, is closely related to the firm's culture. The research shows obstacles and opportunities created by the cultural context of firms wishing to disseminate and embed a set of brand values. The paper presents an “involvement model” of brand values implementation and outlines changes required to implement brand values.Research limitations/implicationsThe study was bound by access to firms, and managers' availability. The authors sought an insight into the relationship between each firm's culture and its brands. They advocate quantitative research to further investigate the findings within these service sectors and to test proposed antecedents (transformational leadership, employee involvement) and outcomes (employee‐based brand equity and consumer‐based brand equity) of values adoption.Practical implicationsThe paper identifies aspects of retail and banking cultures which support or detract from brand development. In particular, it presents the learnings from successful brand values implementation in a clan culture, aspects of which are applicable across other cultures.Originality/valueThe paper provides valuable insights into the role of the brand within the service firm and the positive and negative influence of context on brand values and their development and implementation.

Retail banking is facing many challenges, not least the loss of its customers’ trust and loyalty. The economic crisis is forcing banks to examine their relationships with stakeholders and to offer greater reassurance that their brand promises will be delivered. More than ever, banks need to stand for something positive and valued by stakeholders. One way to achieve this is through paying more attention to brand values. Our article explores how values are adopted by employees within a bank. When employees ‘live’ their brand’s values, their behaviour during customer interactions reflects this, encouraging the strengthening of customer relationships. Specifically, we test the relationship between leadership style, employee commitment, and the adoption of values. Data was collected from a survey of 438 branch employees in a leading Irish retail bank. The study found that a structured and directive leadership style was effective at encouraging the adoption of the bank’s values. Moreover, when employees are committed to the organisation, this has a significant impact on their adoption of values. Thus, this study supports the literature which suggests that leadership and commitment are prerequisites for values adoption.

PurposeThis paper aims to explore managers' and employees' views about service brand sabotage at the front line in retail banking. The current literature emphasises the role of the employee in service delivery, and advocates the cultivation of brand ambassadors – employees who support the service brand through their performance. Yet there also exist saboteurs – employees who actively work against the brand, and there is a dearth of literature exploring the nature of this group. Moreover, much of the extant literature explores service performance from the perspective of the consumer and little is known about employees' views. This paper seeks to present managers' and employees' views about service performance, and service sabotage.Design/methodology/approachThe study incorporates findings from in‐depth interviews with bank managers, and a survey of 438 branch employees reveals sabotage drivers in the “job for life” banking environment in Ireland.FindingsThe paper identifies employee fear, overwork and compliance demands as issues which influence job dissatisfaction, consumer resentment and employee insecurity.Research limitations/implicationsThe research is exploratory. The paper advocates further research to confirm the components of service sabotage, and test the influence of these components on consumers' perceptions of the service.Practical implicationsThe paper offers suggestions to help managers to better manage sabotage in this sector, and recommend future research in other highly structured services sectors.Originality/valueThe paper provides new insights into the constraints on the banking employee that may lead to service sabotage. It also offers advice to managers that may help them better harness employees as brand ambassadors.

This paper explores the management of brand saboteurs. The literature emphasises the role of the employee in delivering a service brand, and advocates the cultivation of brand ambassadors. Yet there exist saboteurs, employees who work against the brand, and there is a dearth of literature exploring this group. Through 20 in-depth interviews with mangers in the Irish banking and grocery sectors, the researchers identify three types of sabotage: deviance, underperformance, and service failure. A framework for identifying potential saboteurs is presented, together with methods to manage these employees. Notably, the paper identifies the criticality of saboteur management in a ‘job for life’ environment.

This paper explores the relationship between employee behaviour and service brand performance. Current literature emphasizes the importance of employee behaviour in delivering a strong service brand, and suggests that employees can be clustered according to their degree of support for the brand. Twenty in-depth interviews were undertaken with HR and Marketing managers in financial services and grocery firms. In the context of employees as brand builders, we explore whether managers have recognized variations in the level of employee support for the brand. Specifically, we surface managers' views about negative performers, or 'Brand Saboteurs'

Cancer-induced bone pain is a common complication of bone metastases and consists of a triad of continuous pain, spontaneous pain and incident pain. It can considerably compromise social functioning, quality of life and survival. Through the use of animal models, it has been suggested that cancer-induced bone pain differs from other pain states, including inflammatory and neuropathic pain; it is increasingly considered to be a complex, mixed-mechanism pain, rather than a single neuropathic, visceral or inflammatory pain state. A variety of possible mechanisms by which bone metastases may cause pain have been reported. These mechanisms likely include local production of growth factors and cytokines (either tumour-induced or tumour-produced), tumour-induced osteolysis, stimulation of ion channels on nerve cell endings, and direct infiltration. However, the exact mechanism by which a bone metastasis induces pain is not completely understood. The understanding of its pathophysiology continues to evolve and further research is required into the complex basis of cancer-induced bone pain and its mechanisms.

Previous research has reported improved pain after adding methadone to another opioid, but did not quantify this benefit using a validated outcome measure.To assess quantitatively the effectiveness of adding methadone to another opioid for moderate to severe cancer-related pain.All outpatients attending the Oncology Palliative Care Clinic from September 2010-September 2011, who had received methadone, were identified from pharmacy records. Inclusion criteria included: histological diagnosis of malignancy, age18 years, taking regular opioids and Edmonton Symptom Assessment System (ESAS) pain score ≥ 4.The primary outcome measure was a decrease in pain score of ≥ 2 points from methadone initiation to one-month follow-up (or closest available ESAS).Twenty patients were available for analysis, 16 of whom had neuropathic pain (80%). Eight patients (40%) had a decrease in pain score of ≥ 2 points at 1 month and a further 7 (35%) had a decrease of ≥ 2 points at the closest available time point. The mean pain score decreased from 7.7 +/- 1.8 to 5.2 +/- 2.4 from time of initiation to time of evaluation. The mean daily routine morphine equivalent, (excluding methadone), was 338 +/- 217.8 mg/day at initiation and 332 +/- 191 mg/day at evaluation; for methadone, mean doses at initiation and evaluation were 4.4 +/- 1.4 mg/day and 15.5 +/- 5.9 mg/day, respectively. Methadone was well tolerated in 17 patients (85%).The addition of methadone was associated with improved pain control for patients with moderate to severe pain on another opioid and appears to offer a safe, well-tolerated and practical alternative in this situation.

e14592 Background: There are high rates of recurrence following definitive surgery in patients (pts) with biliary tract cancers (BTCs). Our aim was to review patterns of use and effectiveness of adjuvant therapy (AT) (chemotherapy (CT) +/- radiotherapy (RT)) in pts who underwent definitive surgery for BTC at a tertiary referral centre (Princess Margaret Hospital, Toronto). Methods: The clinical/pathological characteristics, treatment details and survival data of all pts with a diagnosis of BTC who had definitive surgery from Jan 1987 to Sept 2011 were reviewed. Results: The cohort includes 297 pts of which 42% were male, with a median age of 63 yrs, performance status 0-1 in 88%. 56 (19%) had well differentiated, 144 (48%) moderately and 60 (2%) poorly differentiated tumors, 37 (12%) data not available (NA). 125 (42%) and 41 (14%) had R0/R1 resection respectively, 131 (44%) NA. 122 (41%) were node positive, 72 (24%) NA. AT was given in 78 (27%) pts, 49 receiving adjuvant CT and 29 concurrent CT/RT; 34% receiving AT in distal bile duct, 14% in gallbladder, 12% in intrahepatic and 27% in klatskin. 179 (60%) pts recurred; 56/78 (72%) in the AT group (grp) and 123/179 (68%) in non-AT grp, 40 (13%) NA. In the AT and non-AT grps, local recurrence was seen in 7/56 (13%) and 26/123 (21%), distant in 32/56 (57%) and 73/123 (59%), and both in 176/56 (30%) and 24/123 (20%) respectively. In multivariate analysis, node positivity, HR 0.54, 95% CI 0.37 – 0.77, (p=0.001) was the only prognostic factor of DFS after definitive surgery. In node positive population (n=48 with AT, 50 without AT), median DFS was greater in AT grp; 13.8mo vs. 10.4mo (p=0.068). DFS and overall survival (OS) for entire cohort is detailed in Table. Conclusions: Given the limits of this retrospective cohort analysis and potential bias to treat higher risk pts, it does appear that pts receiving adjuvant therapy with node positive disease derived DFS advantage following definitive surgery, though not significant, and is probably an effective option for node positive, curative resected, BTC. However, larger prospective trials are paramount. [Table: see text]