A Search for Synergy: The Child and Youth Care Educated Child Protection Worker

The field of child protection has a longstanding familiarity with the field of Social Work. However, in British Columbias Ministry for Children and Family Development the ranks of Child Protection Workers are swelling with professionals who have been educated in Child and Youth Care. Using the authors personal experience, this article outlines the differences between Social Work and Child and Youth Care perspectives and further explores two of the many roles MCFD workers can assume within the MCFD. The article then offers insight to which role is accommodating of CYC hallmarks and which is not. The discussion then concludes with an examination of how CYC workers in the MCFD can advocate for the CYC perspective and profession within a Social Work dominated environment.     

Carcinoma ex-pleomorphic adenoma of the breast. Report of three cases suggesting a relationship to metaplastic carcinoma of matrix-producing type

Three cases of carcinoma ex-pleomorphic adenoma of the breast are reported. Patients were 82, 60 and 56 years old and presented with a breast lump. All tumours showed areas of pleomorphic adenoma adjacent to typical areas of malignant transformation. These cases add to the spectrum of tumours shared by breast and salivary gland. The relationship between these neoplasms and metaplastic carcinoma of matrix-producing type is discussed.     

Myocardial Contractility in Premature Neonates With and Without Patent Ductus Arteriosus

Controversy exists as to whether a hemodynamically significant left-to-right shunt due to a patent ductus arteriosus (PDA) affects ventricular contractility. Load-dependent indices such as ejection fraction and shortening fraction have traditionally been used to assess contractility, but the relationship between the rate-corrected velocity of fiber shortening (MVCFc) and wall stress may be more suitable, as it is a preload-independent, afterload-adjusted method of assessing ventricular contractility. Age-related differences have been established for these variables in normal adults and children and it has been recommended for use in the premature neonate. The study was performed to assess left ventricular contractility in premature neonates with a significant left-to-right shunt due to a PDA. Using echocardiography, we measured the relationship of MVCFc to stress at peak systole (SPS) in two groups of premature infants. Group 1 consisted of 15 controls (680–1495 g, 25–32 weeks gestation), and Group 2 of 15 neonates with hemodynamically significant PDA (840–1635 g, 26–33 weeks gestation). In both groups, MVCFc was linearly and inversely related to SPS (p < 0.001). The regression equations were as follows: Group 1, MVCFc = –0.0153SPS + 1.70 (R² = 0.68); and Group 2, MVCF = – 0.019SPS + 1.89 (R² = 0.76). There was no significant difference in the relationship between the two groups, but their slopes were significantly steeper and had a higher Y-intercept than the relationship we previously reported for older children. This preliminary study establishes the normal MVCFc/SPS relationship in the premature neonate (25–33 weeks gestation) and suggests that premature infants function at a higher resting contractile state than older children. A hemodynamically significant PDA has no effect on contractility. These data will be useful in assessing left ventricular contractility in premature neonates with other types of ventricular loading and noncardiac stress.     

Does the transition zone reliably delineate aganglionic bowel in Hirschsprung’s disease?

Background: Knowledge of the extent of aganglionic bowel is important for preoperative planning of trans-anal surgery in patients with Hirschsprungs disease (HD). Objective: To evaluate the accuracy of the transition zone, as identified by contrast enema study, for identifying the extent of aganglionic bowel. Materials and methods: A total of 32 patients with preoperative contrast enema studies and pathologic identification of aganglionic extent were reviewed. Two pediatric radiologists independently reviewed the contrast enema studies. The radiographic transition zone was compared to the pathological extent of aganglionic bowel. Results: Radiologist agreement of the site of transition zone on contrast enema was 90.6%. The concordance between the radiographic transition zone and pathologic extent of aganglionic bowel was 62.5%. The subgroup of patients with long-segment HD revealed a concordance of only 25%. Conclusion: Contrast enema delineation of the transition zone in HD needs to be regarded with caution. This is especially true in long-segment disease, where knowledge of the extent of aganglionic bowel is most crucial to surgical planning.     

Utility and cost of a renal transplant transition clinic

Successful transition from paediatric-centred to adult-oriented healthcare positively influences health outcomes for youth with chronic illness. The primary objective is to evaluate outcomes pre- and post provision of multidisciplinary transition clinic (TC) care to renal transplant recipients. We compared patient and allograft survival in renal transplant recipients at British Columbia Children’s Hospital who received care within a transition clinic (TC) to a cohort of patients transferred prior to establishment of the TC, pre-TC (PTC) in 2007. Baseline characteristics, allograft function, and survival data were collected prospectively via a validated provincial database for 2 years posttransfer. We also estimated and compared the average yearly per-patient cost during the 2-year follow-up period. Thirty-three patients were transferred (PTC) and 12 transitioned (TC). In the PTC cohort, there was a combined poor outcome (death or allograft loss) incidence of 24% within 2 years posttransfer compared with no death or allograft loss in the TC cohort. Cost estimates indicate the average yearly per-patient cost was Canadian dollars (CAD) $17,127–$17,127–38,909 for the PTC and CAD $11,380–$11,380–34,312 for the TC cohort. For PTC patients who lost their allograft and returned to dialysis, the per-patient cost was CAD $40,956–$40,956–61,470. Our results indicate improved allograft and patient survival posttransfer of care in renal transplant recipients who attended TCs, and we found that providing TCs is economically feasible.     

Research Article: Correlating heart rate and perceived exertion during aerobic exercise in Alzheimer's disease

Older adults reap many health benefits from aerobic exercise training; however, little is known about how to monitor the training responses in older adults with Alzheimer's disease. The purpose of this pilot study was to examine the correlation of objectively measured heart rate and subjectively reported perceived exertion during aerobic exercise training in four older men with advanced Alzheimer's disease from a pilot study that used a one‐group pre‐ and post‐test design. During training (three times per week for 8 weeks), the participants' heart rate and perceived exertion were assessed by a trained exercise trainer every 5 min by using the Polar heart rate monitor and the Borg's Rating of Perceived Exertion Scale, respectively. There were 596 heart rate–perceived exertion data pairs. The results show that the Pearson's r for the heart rate and perceived exertion was 0.457 (significant at 0.01, two‐tailed), controlling for age, education, exercise session, and cognition. We conclude that the Borg's Rating of Perceived Exertion Scale itself might be insufficient for monitoring the exercise responses in older men with advanced Alzheimer's disease. Future studies are needed to further examine the utility of this scale in this population.     

Collaborative nursing leadership project in the People's Republic of China

SPICER, J.G., GUO, Y., LIU, H., HIRSCH, J., ZHAO, H., MA, W. & HOLZEMER, W. (2010) Collaborative nursing leadership project in the People's Republic of China. International Nursing Review 57 , 180–187 Background: A nursing leadership project for directors of nursing (DONs) in China was implemented by the Ministry of Health, Peking Union Medical College, School of Nursing; Chinese Nurses' Association and University of California, San Francisco, School of Nursing. Aims: The aims were: (1) to establish a leadership project, (2) to survey DONs on the perceived importance of role competencies, and (3) to develop an education program. Methods: A survey was completed by the DONs on the importance of role competencies related to the forces of magnetism. The DONs rated their job satisfaction. Four leadership educational modules were developed. Findings: The 28‐item survey was completed by 208 (68%) DONs from public tertiary hospitals who rated each item on a six‐point Likert scale. The mean scores of the items ranged from 4.29 [standard deviation (SD) 1.21] to 5.66 (SD 0.70), suggesting they felt that most were very important. DONs who reported higher job satisfaction perceived two dimensions of the forces (structural empowerment and exemplary professional practice) as significantly more important than those with lower job satisfaction. The greatest work challenge reported was shortage of nurses. The four educational modules were pilot tested with ten DONs in Beijing and they provided positive feedback. Conclusion: The DONs perceived that the forces of magnetism competencies were important to their work settings in China. The modules were positively received and plans are underway to develop a train‐the‐trainer program. Study limitations: While the instrument was developed for this study, the validity and reliability were demonstrated.