Accessories or necessities? Exploring consensus on usage of stoma accessories.

Usage and opinion of accessory products in stoma care vary enormously. The aim of this study was to identify what constitutes an accessory product and to find out whether there is any standardization regarding their recommendation. Views of both patients and stoma nurses were examined. Patients identify accessory products as being necessary both physically and psychologically in improving their quality of life. While stoma nurses identify that the psychological effects of having a stoma should never be underestimated, there is still concern regarding the cost of recommending these products and their clinical necessity. It would appear that clinical necessity is based on nurses' opinions and is not always evidence or research based. Since accessory products have been shown to be essential to many patients with a stoma, should stoma nurses be more empathetic when considering their recommendation?

Improved fisheries management could offset many negative effects of climate change.

The world's oceans supply food and livelihood to billions of people, yet species' shifting geographic ranges and changes in productivity arising from climate change are expected to profoundly affect these benefits. We ask how improvements in fishery management can offset the negative consequences of climate change; we find that the answer hinges on the current status of stocks. The poor current status of many stocks combined with potentially maladaptive responses to range shifts could reduce future global fisheries yields and profits even more severely than previous estimates have suggested. However, reforming fisheries in ways that jointly fix current inefficiencies, adapt to fisheries productivity changes, and proactively create effective transboundary institutions could lead to a future with higher profits and yields compared to what is produced today.