Determining the best practice for Sydney rock oyster, Saccostrea glomerata, reef restoration and enhanced ecological benefits.

BACKGROUND: Shellfish reef restoration is relatively new in Australia, particularly to intertidal estuarine environments. In late 2019/early 2020 the first large-scale shellfish reef restoration project of the Sydney rock oyster, Saccostrea glomerata was undertaken in the Myall and Karuah Rivers, Port Stephens, on the mid north coast of New South Wales (NSW), Australia. The present study aimed to determine whether locally sourced clean conspecific oyster shells, and/or locally quarried rocks were better for natural recruitment of natural S. glomerata for large-scale oyster reef restoration, and subsequent recruitment of fishes and invertebrates. Over two years, recruitment of S. glomerata spat, and associated fishes and invertebrates were assessed on reefs made of: (1) rock, and (2) rock and shell. RESULTS: The mean (± SE) density of oyster spat on rock reefs (Myall River: 1790 ± 48, Karuah River: 1928 ± 68) was significantly greater (Myall River: ANOVA Si: MS 2, 18 = 31080167, F = 96.05, P < 0.001, Karuah River: ANOVA Si x Ti: MS 18, 270 = 2965449, F = 5.99, P < 0.001) than on rock and shell reefs (Myall River: 840 ± 40, Karuah River: 1505 ± 75). Rock reefs had significantly greater densities (Myall River: ANOVA Si x Ti: MS 18, 270 = 15657, F = 2.71, P < 0.001, Karuah River: ANOVA Si x Ti: MS 18, 270 = 20322, F = 5.25, P < 0.001) of the most abundant invertebrate, Bembicium auratum (Myall River: 85 ± 9, Karuah River: 100 ± 8) than reefs of rock and shell (Myall River: 59 ± 8, Karuah River: 44 ± 5), but there was no significant difference in the diversity and relative abundance of the most abundant species of fish, Acanthopagrus australis. CONCLUSIONS: This study demonstrates that using locally sourced rock is better for S. glomerata recruitment than shells. Although shell might have benefits that were not investigated in the present study, such as elicit greater social licence for oyster reef restoration projects, but as shown here, it may not be beneficial from an ecological perspective. With the global expansion of the range of different native species of reef oysters for restoration, the appropriate material used for reef bases needs to be chosen for a specific species and purpose.

Patient-reported use of pancreatic enzyme replacement treatment (PERT) in pancreatic cancer in New Zealand and Australia: a cross-sectional survey study.

PURPOSE: This study investigated pancreatic enzyme replacement therapy (PERT) use in people diagnosed with pancreatic cancer in New Zealand (NZ) and Australia (AU). METHODS: A cross-sectional survey study was conducted using a mixed-media campaign to recruit people with pancreatic cancer and collect information about current PERT use. The questionnaire gathered data on participant demographics, awareness of PERT, prescribing practices and efficacy of enzyme replacement. RESULTS: Over 300 people with pancreatic cancer were recruited, 135 from New Zealand and 199 from Australia. Every region, state and territory was represented except for the West Coast (NZ) and the Northern Territory (AU), the lowest populated areas in both countries. In New Zealand, 60% of participants had heard about PERT, compared to 69.3% in Australia. Dosing regimens were inconsistent in both countries, with 18% and 27% of participants being prescribed PERT considered best practice in New Zealand and Australia, respectively. Before PERT commencement, 70% of participants experienced symptoms of malabsorption, with all symptoms improving after therapy was established. The majority of participants were compliant with their medication. CONCLUSION: PERT use in pancreatic cancer in New Zealand and Australia was highly variable and not compliant with international guidelines in which PERT is recommended as standard therapy. Enzyme replacement is effective for improving the symptoms of malabsorption in patients with pancreatic cancer. Clinician education may be needed to help improve the use of PERT in people with pancreatic cancer.

Nurse escorts' perceptions of nurse-led inter-hospital ambulance transfer in the Wheatbelt region of Western Australia: A descriptive survey study.

INTRODUCTION: The Western Australia (WA) Country Health Service (WACHS) requires the ward or emergency department (ED) registered nurse (RN) to assume the responsibility of conducting nurse-led interhospital patient road ambulance transfers, in the absence of an available registered paramedic (RP). The generalist nurse escort with no specialised training is allocated to the patient transport from their rostered shifts when the need arises, and, in some instances, this nurse may not have been in an ambulance before. Patients requiring transfer are usually prioritised over hospital patient care because of the life-threatening nature of these situations and the urgency to get them to tertiary care facilities. This study explored nurses' perceptions about caring for a patient during road ambulance transfer, with an aim of supporting future policy formulation and decision-making to guide nurses' training, induction and ongoing education on interhospital transfers. OBJECTIVE: To examine the perceptions of hospital-employed registered nurses caring for a patient during road ambulance transfer from rural Western Australia. DESIGN: A descriptive survey design included 23 questions to clarify the level of experience and training, the prevalence of clinical deterioration and the confidence to manage patient care. FINDINGS: Findings from the surveys indicated that nurses often felt overwhelmed by the responsibility of the patient transfer, unclear guidelines, limited preparation and handover, lack of orientation to the ambulance environment, difficulty escalating care during transfer and no insight into the return to base process. DISCUSSION: To explore how the RN who normally works within a well-organised and accessible multidisciplinary team manages caring for a patient in an unfamiliar mobile environment, the study was conducted within WACHS in the Wheatbelt Region of WA involving 27 health care sites. Participating nurses were asked several broad questions to explore their perceptions on how well-equipped they are in managing clinical care and deterioration during transfer; what are the challenges that they face while doing so and how confident they are about their knowledge, skill level and scope of clinical practice in supporting patients during interhospital transfer? CONCLUSION: Wheatbelt nurse escorts were capable, generalist nurses with a demonstrated skill set in managing patient care during transfer when needed. The 'back of the ambulance' was a challenging environment for nurses to engage in the type of care usually provided in the hospital setting, which come with a high level of uncertainty and anxiety for both patient outcome and own well-being.

"I lied a little bit." A qualitative study exploring the perspectives of elite Australian athletes on self-reported data.

OBJECTIVES: Explore the perceptions and experiences of elite Australian athletes' engagement with reporting data in surveillance systems. DESIGN: Qualitative Descriptive. SETTING: Semi-structured interviews conducted using Zoom. PARTICIPANTS: We recruited 13 elite Australian athletes competing at a national or international level for semi-structured interviews. MAIN OUTCOME MEASURES: Audio recordings were transcribed using DeScript, checked for errors and imported into QSR NVIVO. Thematic analysis using QSR NVIVO was used to determine key themes from transcripts. RESULTS: Thematic analysis uncovered four key themes: 'the paradox of reporting', 'data for data's sake', 'eyes on reporting' and 'athlete friendly reporting'. CONCLUSION: Athletes perceived reporting as a burden and the athlete management system presented numerous technological difficulties which led to athletes to backfill data entries and compromise data accuracy. Athletes had little knowledge on how their data was used and managed and often received minimal feedback from staff accessing the data. Athletes were unaware of who has access to their data, which is of concern as sensitive information may be collected and athletes may be underage. As a result, many athletes chose to report dishonest data to avoid their performance being questioned.

A Cancer Education Framework for Australian Medical Schools: an Announcement of a New Educational Program.

This framework draws upon national and international cancer curricula to identify the essential cancer-related learning outcomes for Australian medical students. The framework incorporates feedback from medical, radiation and surgical oncologists, haematologists, and palliative care physicians on what medical graduates need to know about cancer. The consensus view was that medical students require a basic understanding of the principles of cancer management and the opportunity to see cancer patients in a cancer service unit. The framework assumes that certain knowledge, skills, and attitudes are already embedded in current Australian medical school curricula, presenting instead only the core cancer content in order to provide a clear and concise framework designed to maximise integration within existing curricula.

Turning a lost reef ecosystem into a national restoration program.

Achieving a sustainable socioecological future now requires large-scale environmental repair across legislative borders. Yet, enabling large-scale conservation is complicated by policy-making processes that are disconnected from socioeconomic interests, multiple sources of knowledge, and differing applications of policy. We considered how a multidisciplinary approach to marine habitat restoration generated the scientific evidence base, community support, and funding needed to begin the restoration of a forgotten, functionally extinct shellfish reef ecosystem. The key actors came together as a multidisciplinary community of researchers, conservation practitioners, recreational fisher communities, and government bodies that collaborated across sectors to rediscover Australia's lost shellfish reefs and communicate the value of its restoration. Actions undertaken to build a case for large-scale marine restoration included synthesizing current knowledge on Australian shellfish reefs and their historical decline, using this history to tell a compelling story to spark public and political interest, integrating restoration into government policy, and rallying local support through community engagement. Clearly articulating the social, economic, and environmental business case for restoration led to state and national funding for reef restoration to meet diverse sustainability goals (e.g., enhanced biodiversity and fisheries productivity) and socioeconomic goals (e.g., job creation and recreational opportunities). A key lesson learned was the importance of aligning project goals with public and industry interests so that projects could address multiple political obligations. This process culminated in Australia's largest marine restoration initiative and shows that solutions for large-scale ecosystem repair can rapidly occur when socially valued science acts on political opportunities.

Transformación de un Ecosistema Arrecifal Perdido en un Programa Nacional de Restauración Resumen Actualmente se requiere una reparación ambiental a gran escala que atraviese fronteras legislativas para lograr un futuro socio-ecológico sustentable. Aun así, habilitar la conservación a gran escala es complicado debido a los procesos de elaboración de políticas que están desconectadas de los intereses socio-económicos, las múltiples fuentes de conocimiento y las diferentes aplicaciones de las políticas. Consideramos cómo una estrategia multidisciplinaria para la restauración de hábitats marinos generó una base de evidencia científica, apoyo comunitario y el financiamiento necesario para así iniciar la restauración de un ecosistema arrecifal de conchas funcionalmente extinto. Los actores clave formaron una comunidad multidisciplinaria de investigadores, practicantes de la conservación, comunidades de pescadores recreativos y órganos gubernamentales que colaboró con varios sectores para redescubrir los arrecifes perdidos de Australia y comunicó el valor de su restauración. Las acciones realizadas para armar el caso para la restauración marina a gran escala incluyeron la síntesis del conocimiento actual sobre los arrecifes de conchas en Australia y su declinación histórica, el uso de esta historia para contar una narración convincente que active el interés público y político, la integración de la restauración a la política gubernamental y la movilización del apoyo local por medio de la participación comunitaria. Claramente, la articulación del caso del negocio social, económico y ambiental para la restauración llevó al financiamiento estatal y nacional para la restauración arrecifal a cumplir diversos objetivos socio-económicos (p. ej.: creación de empleos, oportunidades recreativas) y de restauración (p. ej.: una productividad realzada de la biodiversidad y las pesquerías). Una lección clave que aprendimos fue lo importante que es alinear los objetivos del proyecto con los intereses públicos y de la industria, de tal manera que los proyectos aborden las múltiples obligaciones políticas. Este proceso culminó con la iniciativa de restauración marina más grande en Australia y demuestra que las soluciones para la reparación de los ecosistemas a gran escala pueden ocurrir rápidamente cuando la ciencia con valor social actúa sobre las oportunidades políticas.

Capacity building in nurse educators in a Global Leadership Mentoring Community.

Globally, nurse educators participate in the three main role activities of teaching, scholarship, and service. Matching for different global locations and career stages, 12 mentor-mentee pairs completed a one-year coordinated virtual program through Sigma Theta Tau International's Global Leadership Mentoring Community and mentees reported building their nurse educator capacities. The authors describe factors that potentially influence international mentoring such as language, time, technology, and key characteristics of mentoring relationships. Growth in educator roles occurred in the contexts of the culture of academe itself and Boyer's definitions of scholarship. Consistent with Sigma's vision statement, nurse educators have a global presence and responsibility to prepare competent nurses who can advance the health of the world's people. Readers may benefit for future planning of mentoring activities to build capacities in nurse educator roles through international interactions.

Graduate Nurse Transition Programs Pivotal Point of Participants' Practice Readiness Questioned During the COVID-19 Pandemic Crisis: A Scoping Review.

BACKGROUND: The COVID-19 pandemic requires an accessible, practice-ready nursing workforce to assist with the increase in health service delivery. Graduate nurse transition programs are the entry point for most graduates into professional practice, and this review focused on both empirical studies and gray literature to identify at what point practice readiness occurs and what can assist graduate nurses' transition to become practice ready. METHOD: A scoping review was conducted using the Joanna Briggs Institute scoping review framework. RESULTS: Consensus purports supportive environments, ideally in formal structured graduate transition to practice programs, to enhance graduate nurses' clinical skills and confidence development. With nursing confidence and competence gained through professional practice experience, it is apparent that for a sustainable nursing workforce, greater access for graduating nurses to transition programs is imperative. CONCLUSION: Recommendations include restructuring transition programs with possible time reductions, limited rotations, comprehensive orientations inclusive of preceptorship, and dedicated educators to increase and enhance supportive graduate nurse transitions. [J Contin Educ Nurs. 2021;52(8):392-396.].

Clinical sympathy - A mixed method study of the relationship between the clinical nurse educator and the graduate nurse.

AIM/OBJECTIVE: This paper sought to investigate the influence of the supernumerary clinical nurse educator role on the newly qualified graduate nurses' professional development and successful transition to competent and confident practitioners in the acute care hospital environment. BACKGROUND: The novice nurses learning in the inpatient clinical environment is affected by increasing patient acuity, complex conditions and organisational expectations. The supernumerary clinical nurse educator is uniquely positioned to prioritise these nurses' education through protected and available time to support adaption in the workplace culture and retention in the organisation. DESIGN: A convergent mixed methods design was used to investigate the relationship between the supernumerary clinical nurse educator role through the opinions and experiences of the graduate nurse. METHODS: Data were collected in February - July 2015 from graduate nurses from three hospital sites in a healthcare organisation in Western Australia. The research used online questionnaires (n = 39) and face to face interviews (n = 10). Analysis of quantitative data used descriptive statistics and qualitative data used thematic analysis. RESULTS: Four main themes were identified. These were: acknowledges new and challenging experiences, available to provide constructive responses, sympathises with anxiety and missing in action. CONCLUSION: The graduate registered nurses perceived that clinical sympathy provided by the clinical nurse educator was essential to their new role of frontline nurses influencing their delivery of quality patient care and as a practical solution to champion the graduate nurses' longevity in the future nursing workforce.

Lessons learned from adapting a remote area health placement from physical to virtual: a COVID-19-driven innovation.

OBJECTIVES:  To investigate the acceptability and the effectiveness of a virtual adaptation of a well-established, mandatory, community-based pre-clinical remote area health placement in which medical students learn about the social and environmental determinants of health in remote Australia; and make recommendations to guide the delivery of future learning experiences. METHODS: A mixed-methods convergent design was used. All 99 students, 36 placement hosts and 10 staff were invited to complete an online survey and 27(27%), 12(33%) and 10(100%), respectively, contributed data.  Qualitative data were collected via semi-structured interviews from four students, four hosts and six staff. Survey data were analysed using descriptive statistics (frequency and percentage) and open-ended responses summarised to provide supporting contextual evidence. Interview transcripts were analysed and coded independently, then corroborated to identify and summarise common themes using thematic analysis. RESULTS: Survey and interview data indicated that the virtual placement was acceptable to students and hosts and enabled students to achieve intended learning objectives.   Virtual activities enabled students and hosts to develop authentic, genuine interpersonal relationships, which in turn were facilitated when hosts and students had practiced videoconferencing beforehand with good high-speed internet connections via mobile devices. Pastoral care and access to IT support were essential. CONCLUSIONS: Virtual placements can be used in combination with and are an option for students and hosts who cannot attend/courses that cannot fund physical placements. Careful design and further research is required to ensure that virtual placements enable "head, heart and hands" learning and do not create/reinforce inequities.

Does an incremental approach to implementing programmatic assessment work? Reflections on the change process.

This article was migrated. The article was marked as recommended. In 2017, the School of Medicine (Fremantle) of the University of Notre Dame Australia began moving towards programmatic assessment. Programmatic assessment seeks to achieve robust assessment validity through the assessment of a large number of low-stakes activities or data points. These data points exemplify assessment as learning by valuing feedback, discussion and reflection, ultimately leading to deeper student engagement without compromising credible decision-making on student progress. The School adopted an incremental approach to implementing programmatic assessment that included first establishing data-informed mentoring, and then activating a continuous assessment program that contributed simultaneously to student learning and School decision-making. Action research helped understand the impact of the initiative. Re-engineering continuous assessment as an incremental step towards programmatic assessment proved to be problematic. Some ideas are proposed to draw the strands of programmatic assessment together that may be useful for others to chart a more fruitful path.

Touch in health professional practice: a review.

BACKGROUND: The appropriate use of touch is central to effective and compassionate care in the clinical environment; however, in a time of the #MeToo movement, and with heightened awareness of child and elder abuse, the notion of physical contact is frequently viewed negatively, and may be associated with gender and power divides. The use of touch in the clinical context has increasing layers of complexity and is highly context specific. … in a time of the #MeToo movement … the notion of physical contact is frequently viewed negatively … METHODS: We reviewed relevant literature, including textbooks, and have drawn on our own experiences to explore the concept and use of touch across medicine, nursing and dentistry. RESULTS: In the context of learning and teaching in health we recognised two types of physical touch: expressive and procedural. DISCUSSION: Our review legitimises the importance of learners and educators being equipped to consider the role and nuances of touch when engaging in professional behaviour. We provide suggestions for how this complex concept may be embedded into entry-to-practice curricula and approached in faculty development.

Preoperative immunonutrition in patients undergoing liver resection: A prospective randomized trial.

BACKGROUND: Preoperative supplementation with immunonutrients, including arginine and n-3 fatty acids, has been shown in a number of systematic reviews to reduce infectious complications in patients who have undergone gastrointestinal surgery. Limited information, however, is available on the benefits of nutritional supplementation enriched with arginine and n-3 fatty acids in patients undergoing liver resection. AIM: To evaluate the effects of preoperative nutritional supplementation enriched with arginine and n-3 fatty acids on inflammatory and immunologic markers and clinical outcome in patients undergoing liver resection. METHODS: Thirty-four patients undergoing liver resection were randomized to either five days of preoperative Impact® [1020 kcal/d, immunonutrition (IMN) group], or standard care [no supplementation, standard care (STD) group]. Nutritional status was measured at study entry by subjective global assessment (SGA). Functional assessments (grip strength, fatigue and performance status) were carried out at study entry, on the day prior to surgery, and on postoperative day (POD) 7 and 30. Inflammatory and immune markers were measured at study entry, on the day prior to surgery, and POD 1, 3, 5, 7, 10 and 30. Postoperative complications were recorded prospectively until POD30. RESULTS: A total of 32 patients (17 IMN and 15 STD) were analysed. All except four patients were SGA class A. The plasma ratio of (eicosapentaenoic acid plus docosahexaenoic acid) to arachidonic acid was higher in IMN patients on the day prior to surgery and POD 1, 3, 5 and 7 (P < 0.05). Plasma interleukin (IL)-6 concentrations were elevated in the IMN group (P = 0.017 for POD7). No treatment effect was detected for functional measures, immune response (white cell count and total lymphocytes) or markers of inflammation (C-reactive protein, tumour necrosis factor-α, IL-8, IL-10). There were 10 patients with infectious complications in the IMN group and 4 in the STD group (P = 0.087). Median hospital stay was 9 (range 4-49) d in the IMN group and 8 (3-34) d in the STD group (P = 0.476). CONCLUSION: In well-nourished patients undergoing elective liver resection, this study failed to show any benefit of preoperative immunonutrition.

The art of clinical supervision program: its impact on nurses attitudes towards nursing students.

Background: Increasing health professional student numbers in Australia, in response to looming predicted workforce shortages, resulted in a Federal Government call for action to provide clinical supervision education to health professionals. Objectives: This research aimed to develop, implement and evaluate the programme, 'The Art of Clinical Supervision' (ACS), designed to support nurses facilitate a positive learning environment for student nurses. Method: The ACS programme was presented (n = 199) across Western Australia as a doctoral study, with participants from both the public and private healthcare sector working in a variety of specialties. A triangulation approach of surveys, reflective entries and interviews was utilised to determine its impact. Results: The data indicated that participants improved their understanding of supervision and attitude towards students and supervision after attending the ACS. Conclusions: Health service managers are encouraged to evaluate their staffs' knowledge and attitude towards students with findings used to facilitate a positive learning culture.Impact Statement: The Art of Clinical SupervisionThe purpose of the research was to develop, implement and review a new education programme that could support the development of clinical supervision knowledge and attitude to support student nurse learning. This occurred in an environment of increased student numbers as a strategy to correct a predicted looming workforce shortage.The study findings determined that the programme improved both participant knowledge about how to provide effective clinical supervision (teaching) in the clinical environment, and improved staff attitudes towards students and their place as a learner in the clinical areas.The type of impact was therefore within the domain of quality by improving student learning through effective education strategy.As a result of the doctoral research, involving 200 participants, a Federal Government grant of approx. $500,000 was received to facilitate the training of additional educators to provide the programme across the state of Western Australia. This grant was a partnership between the programme author (researcher) and the Western Australian Government Department of Health. This involved four educators presenting the programme to over 3,000 health professionals in a 3-year period. Despite the cessation of funds with the closure of HWA the programme continues to be delivered through The University of Notre Dame Australia School of Nursing and Midwifery, with only a cost recovery charge.

Australian shellfish ecosystems: Past distribution, current status and future direction.

We review the status of marine shellfish ecosystems formed primarily by bivalves in Australia, including: identifying ecosystem-forming species, assessing their historical and current extent, causes for decline and past and present management. Fourteen species of bivalves were identified as developing complex, three-dimensional reef or bed ecosystems in intertidal and subtidal areas across tropical, subtropical and temperate Australia. A dramatic decline in the extent and condition of Australia's two most common shellfish ecosystems, developed by Saccostrea glomerata and Ostrea angasi oysters, occurred during the mid-1800s to early 1900s in concurrence with extensive harvesting for food and lime production, ecosystem modification, disease outbreaks and a decline in water quality. Out of 118 historical locations containing O. angasi-developed ecosystems, only one location still contains the ecosystem whilst only six locations are known to still contain S. glomerata-developed ecosystems out of 60 historical locations. Ecosystems developed by the introduced oyster Crasostrea gigas are likely to be increasing in extent, whilst data on the remaining 11 ecosystem-forming species are limited, preventing a detailed assessment of their current ecosystem-forming status. Our analysis identifies that current knowledge on extent, physical characteristics, biodiversity and ecosystem services of Australian shellfish ecosystems is extremely limited. Despite the limited information on shellfish ecosystems, a number of restoration projects have recently been initiated across Australia and we propose a number of existing government policies and conservation mechanisms, if enacted, would readily serve to support the future conservation and recovery of Australia's shellfish ecosystems.

Dietary copper restriction in Wilson's disease.

Dietary copper restriction has long been considered an important aspect of treatment for Wilson's disease (WD). However, evidence supporting this approach is limited. There are no published randomised controlled trials examining this recommendation due to rarity of the disease and variable presentation. This review summarises current knowledge on the absorption and regulation of copper in humans and its relevance to patients with WD. Studies have demonstrated that as the level of dietary copper increases, the proportion absorbed decreases. This observation implies that 'high copper' foods that WD patients are generally advised to avoid would need to be consumed in large amounts to impact markedly on the quantity absorbed. Dietary copper restriction is unlikely to reduce the amount absorbed significantly and is not only difficult to manage but restricts food groups unnecessarily, detracting from the provision of substrates essential for improving nutritional status in a nutritionally compromised group. Medical management for WD is effective in compliant patients, allowing stabilisation of the liver disease. Based on current evidence, dietary copper restrictions in stable WD patients who are adherent to medical therapy are unnecessary with two food exceptions (shellfish and liver).

The Influence of the Art of Clinical Supervision Program on Nurses' Knowledge and Attitude About Working With Students.

The Art of Clinical Supervision program was developed, implemented, and evaluated to determine nursing staff knowledge of and attitudes toward nursing students and the clinical supervision thereof. A key point of the program was the inclusion of strategies to promote one's attitude toward working with students. A mixed methods approach of surveys, online reflections, and interviews was used to determine the program's effect. The findings highlighted a positive impact on participants' self-knowledge and attitudes toward students and student clinical supervision.

The essence of helping: significant others and nurses in action draw men into nursing.

BACKGROUND: Nurses are ageing placing nursing workforce sustainability under threat. An untapped potential resource of men in nursing exists within Australia. OBJECTIVE: The aim of the first phase of this longitudinal study was to investigate why men choose nursing. DESIGN: Qualitative methodological approach used interpretative phenomenological analysis (IPA). RESEARCH QUESTION: "What are the experiences of male graduate nurses regarding their career choice?" METHOD: The IPA method focused on personal subjective experience where the participants' own sense-making is important. Discussions were audio-recorded, transcribed verbatim and analysed using a format relevant to IPA. PARTICIPANTS: Purposeful snowball sampling recruited nine nurses. FINDINGS: The "essence of helping" permeated the key theme through significant others and career choice triggers impacting on their decision to enter nursing. CONCLUSION: Exposure to nurses in action is purported to enhance the awareness of nursing as a career option for men that may contribute to increased recruitment of men into nursing.

Nutrition in liver transplantation: too little or too much?

PURPOSE OF REVIEW: The purpose of this study was to review the most recent findings on approaches to managing the obesity and muscle wasting that are found in patients before and after liver transplantation. RECENT FINDINGS: A number of articles have contributed to the accumulating evidence that morbid obesity is not an absolute contraindication to liver transplantation with survival outcomes similar across BMI groups. Obesity is, however, a risk factor for early post-transplant complications and obesity-related comorbidities markedly increase this risk. Very limited data are as yet available, dietary, or otherwise, related to amelioration of these comorbidities and evidence that weight loss leads to improved outcomes in obese patients is lacking. Abdominal computed tomography imaging is increasingly being used to identify muscle wasting, and poorer post-transplant survival is seen in patients with significant muscle wasting. This modality has confirmed the persistence of depleted muscle stores after transplant extending well beyond 1 year. Coupled with this is a high incidence of weight gain and metabolic syndrome and the associated risks. Although dietary intervention and exercise are considered possible approaches to address these issues, work in these areas so far is sparse. SUMMARY: An urgent need exists for interventional studies on the basis of nutrition and/or exercise to address the challenges presented by both obesity and muscle wasting, which likely coexist in many patients in both the pretransplant and the post-transplant periods.