Ecology of Juvenile Walleye Pollock, Theragra chalcogramma: Papers from the workshop "The Importance of Prerecruit Walleye Pollock to the Bering Sea and North Pacific Ecosystems" Seattle, Washington, 28-30 October 1993

The Alaska Fisheries Science Center (AFSC), National Marine Fisheries Service (NMFS), hosted an international workshop, 'The Importance of Prerecruit Walleye Pollock to the Bering Sea and North Pacific Ecosystems," from 28 to 30 October 1993. This workshop was held in conjunction with the annual International North Pacific Marine Science Organization (PICES) meeting held in Seattle. Nearly 100 representatives from government agencies, universities, and the fishing industry in Canada, Japan, the People's Republic of China, Russia, and the United States took part in the workshop to review and discuss current knowledge on juvenile pollock from the postlarval period to the time they recruit to the fisheries. In addition to its importance to humans as a major commercial species, pollock also serves as a major forage species for many marine fishes, birds, and mammals in the North Pacific region. (PDF file contains 236 pages.

End-of-life care for aged care residents presenting to emergency departments

Background: The number of patients from Aged Care presenting to acute care is increasing, many of whom have a life limiting illness. Aims: To identify differences in relation to Aged Care Residents presenting to Emergency departments who died during a hospital admission compared to those who were referred to the hospital based palliative care. Methods: Review of a stratified random sample of 90 Aged Care residents transferred to acute care who died during admission in 2009; half the sample received palliative care. Comparisons were made with regard to age; gender; co-morbidities; symptoms, investigations and active treatment; prior admissions and costs. Results: The median age of patients was 87.5 years, 61% were female and 38% had three or more admissions in the year prior to death. Patients with a length of stay of four or more days were 2.98 times (CI, 95%:1.11-8.03) and patients with agitation were 3.08 (CI 95%:1.10- 8.64) times more likely to be referred to palliative care. Patients who received palliative care had significantly fewer investigations or active treatment in the 24 hours prior to their death (p< 0.01) and palliated patients had significantly lower average costs per day of admission ($1022, SD=$441) compared to those who were not palliated ($831; SD=$ 1041) (p< 0.001). Discussion: Our study indicates there is a difference between dying patients who received palliative care compared to those who did not in an acute care setting. Further research into the outcomes of patients discharged back to Aged Care facilities for palliative care warrants investigation

Quality care outcomes following transitional care interventions for older people from hospital to home: a systematic review

 BackgroundProvision of high quality transitional care is a challenge for health care providers in many western countries. This systematic review was conducted to (1) identify and synthesise research, using randomised control trial designs, on the quality of transitional care interventions compared with standard hospital discharge for older people with chronic illnesses, and (2) make recommendations for research and practice.MethodsEight databases were searched; CINAHL, Psychinfo, Medline, Proquest, Academic Search Complete, Masterfile Premier, SocIndex, Humanities and Social Sciences Collection, in addition to the Cochrane Collaboration, Joanna Briggs Institute and Google Scholar. Results were screened to identify peer reviewed journal articles reporting analysis of quality indicator outcomes in relation to a transitional care intervention involving discharge care in hospital and follow-up support in the home. Studies were limited to those published between January 1990 and May 2013. Study participants included people 60 years of age or older living in their own homes who were undergoing care transitions from hospital to home. Data relating to study characteristics and research findings were extracted from the included articles. Two reviewers independently assessed studies for risk of bias.ResultsTwelve articles met the inclusion criteria. Transitional care interventions reported in most studies reduced re-hospitalizations, with the exception of general practitioner and primary care nurse models. All 12 studies included outcome measures of re-hospitalization and length of stay indicating a quality focus on effectiveness, efficiency, and safety/risk. Patient satisfaction was assessed in six of the 12 studies and was mostly found to be high. Other outcomes reflecting person and family centred care were limited including those pertaining to the patient and carer experience, carer burden and support, and emotional support for older people and their carers. Limited outcome measures were reported reflecting timeliness, equity, efficiencies for community providers, and symptom management.ConclusionsGaps in the evidence base were apparent in the quality domains of timeliness, equity, efficiencies for community providers, effectiveness/symptom management, and domains of person and family centred care. Further research that involves the person and their family/caregiver in transitional care interventions is needed

The diversity of emergency code telephone numbers in Australian hospitals: the feasibility of an Australian standard emergency code

This study explored the diversity of emergency code telephone numbers currently in use in Australian hospitals and examined the feasibility of a standard emergency code telephone number for all Australian hospitals, based on the United Kingdom experience. An email and telephone convenience survey of Australian hospitals from six states and two territories was conducted. Of the 108 hospitals surveyed, seven did not use a telephone number system and used a button/ pager system to call an emergency. Of the 101 hospitals surveyed that used a telephone number system, 40 different emergency telephone numbers were in place, and in nine hospitals the telephone number used for Code Blue (medical emergency) was different to the telephone number used for other emergency codes. With increasing mobility of staff across hospitals, uniformity of emergency code telephone numbers is required to reduce confusion, potential danger and improve staff response in emergency situations. A single Australian standard emergency telephone number for all Australian hospitals is advocated.<br /

Access to breast prostheses via a government-funded service in Victoria, Australia

For many women, the only alternative to breast reconstruction following a mastectomy is to use external prostheses, which need replacing regularly at a cost of up to $395 per prosthesis. Commonwealth and state governments across Australia have responded to this need by providing subsidies to assist in the purchase of breast prostheses. However, current arrangements have been highly variable and sometimes difficult to access. As part of a larger review of breast pros-thesis services in Victoria, Australia, the aim of this research was to evaluate client satisfaction among Victorian women who accessed funds through the State Government\u27s Aids and Equipment Program, compare the responses of the program service providers with the experiences of clients accessing funding, and identify opportunities to improve service provision. <br /

Non-technical skills of anaesthesia providers in Rwanda: an ethnography

Introduction: Patient safety depends on excellent practice of anaesthetists’ non-technical skills (ANTS). The ANTS framework has been validated in developed countries but there is no literature on the practice of ANTS in low-income countries. This study examines ANTS in this unexplored context. Methods: This qualitative ethnographic study used observations of Rwandan anaesthesia providers and  in-depth interviews with both North American and Rwandan anaesthesia providers to understand practice of ANTS in Rwanda. Results: Communication is central to the practice of ANTS. Cultural factors in Rwanda, such as lack of  assertiveness and discomfort taking leadership, and the strains of working in a resourcelimited environment hinder the unfettered and focused communication needed for excellent anaesthesia practice. Conclusion: Despite the challenges, anaesthesia providers are able to coordinate activities when good  communication is actively encouraged. Future teaching interventions should address leadership and  communication skills through encouraging both role definition and speaking up for patient safety.Key words: Anaesthesia, non-technical skills, genocid

Development of a simulation and skills centre in East Africa: a Rwandan-Canadian partnership

Simulation replicates clinical experiences without patient risk; it remains uncommon in lower-income  countries. We outline the creation of Rwanda's first centre for simulation and skills training. We secured  funding for renovations, equipment and staff; curricula were developed, tested, and refined; local clinicians were trained to teach. In 13 months the centre provided 2,377 learning-encounters and 822 hours of training to Rwandan health care professionals. Our strategy represents an adaptable model for simulation and skills centre development in low-resources settingsKey words: Simulation, Medical Education, Rwanda, Low-Income Countr

Development of the Health Literacy of Caregivers Scale - Cancer (HLCS-C): item generation and content validity testing

BACKGROUND: Health literacy refers to an individual’s ability to engage with health information and services. Cancer caregivers play a vital role in the care of people with cancer, and their capacity to find, understand, appraise and use health information and services influences how effectively they are able to undertake this role. The aim of this study was to develop an instrument to measure health literacy of cancer caregivers. METHOD: Content areas for the new instrument were identified from a conceptual model of cancer caregiver health literacy. Item content was guided by statements provided by key stakeholders during consultation activities and selected to be representative across the range of cancer caregiver experiences. Content validity of items was assessed through expert review (n = 7) and cognitive interviews with caregivers (n = 16). RESULTS: An initial pool of 82 items was generated across 10 domains. Two categories of response options were developed for these items: agreement with statements, and difficulty undertaking presented tasks. Expert review revealed that the majority of items were relevant and clear (Content Validity Index > 0.78). Cognitive interviews with caregivers suggested that all except three items were well understood. CONCLUSION: A resultant 88 item questionnaire was developed to assess cancer caregiver health literacy. Further work is required to assess the construct validity and reliability of the new measure, and to remove poorly performing and redundant items, which will result in a shorter, final measure. The new measure has the potential to inform the development and evaluation of interventions and the improvement of health service delivery to cancer caregivers

Expression of Semaphorin 3F and Its Receptors in Epithelial Ovarian Cancer, Fallopian Tubes, and Secondary Müllerian Tissues

While semaphorins and their receptors appear to play a role in tumor carcinogenesis, little is known about the role of semaphorin 3F (S3F) in epithelial ovarian cancer (EOC) development. Therefore, we sought to determine the clinical relationship between S3F and its receptors, neuropilin-2 (NP-2) and neuropilin-1 (NP-1) with EOC progression. We analyzed the immunohistological expression of S3F, NP-2, and NP-1 in clinical specimens of normal ovaries (N), benign cystadenomas (Cy), well-differentiated adenocarcinomas (WD), poorly-differentiated adenocarcinomas (PD), inclusion cysts (IC), paraovarian cysts (PC), and fallopian tubes (FT). Tissue sections were evaluated for staining intensity and percentage of immunoreactive epithelia. We found that expression of S3F and NP-2 decreased while NP-1 expression increased with EOC progression. Interestingly, we also found elevated expression of S3F, NP-2, and NP-1 in epithelia of ICs, PCs, and FT. Our findings indicate that loss or deregulation of semaphorin signaling may play an important role in EOC development