Aggressive surgical interventions for severe stroke: Impact on quality of life, caregiver burden and family outcomes

Introduction: Decompressive hemicraniectomy, clot evacuation, and aneurysmal interventions are considered aggressive surgical therapeutic options for treatment of massive cerebral artery infarction (MCA), intracerebral hemorrhage (ICH), and severe subarachnoid hemorrhage (SAH) respectively. Although these procedures are saving lives, little is actually known about the impact on outcomes other than short-term survival and functional status. The purpose of this study was to gain a better understanding of personal and social consequences of surviving these aggressive surgical interventions in order to aid acute care clinicians in helping family members make difficult decisions about undertaking such interventions. Methods: An exploratory mixed method study using a convergent parallel design was conducted to examine functional recovery (NIHSS, mRS & BI), cognitive status (Montreal Cognitive Assessment Scale, MoCA), quality of life (Euroqol 5-D), and caregiver outcomes (Bakas Caregiver Outcome Scale, BCOS) in a cohort of patients and families who had undergone aggressive surgical intervention for severe stroke between the years 2000–2007. Data were analyzed using descriptive statistics, univariate and multivariate analysis of variance, and multivariate logistic regression. Content analysis was used to analyze the qualitative interviews conducted with stroke survivors and family members. Results: Twenty-seven patients and 13 spouses participated in this study. Based on patient MOCA scores, overall cognitive status was 25.18 (range 23.4-26.9); current functional outcomes scores: NIHSS 2.22, mRS 1.74, and BI 88.5. EQ-5D scores revealed no significant differences between patients and caregivers (p=0.585) and caregiver outcomes revealed no significant differences between male/female caregivers or patient diagnostic group (MCA, SAH, ICH; p=""0.103).<"/span><"/span> Discussion: Overall, patients and families were satisfied with quality of life and decisions made at the time of the initial stroke. There was consensus among study participants that formal community-based support (e.g., handibus, caregiving relief, rehabilitation assessments) should be continued for extended periods (e.g., years) post-stroke. Ongoing contact with health care professionals is valuable to help them navigate in the community as needs change over time.

Roy Kenzie Kiyooka

Roy Kenzie Kiyooka Canadian, born 1926 Roy Kiyooka was born in Moose Jaw, Saskatchewan in 1926. Throughout his career, he was known as a painter, photographer, sculptor, poet, musician, filmmaker and teacher. He studied at the Provincial Institute of Technology and Art in Calgary from 1946-49, and then at the Instituto Allende in Mexico in 1955. During the summers of 1958 - 1960 he attended the Emma Lake Workshops in Saskatchewan, where he worked closely with Barnett Newman and Clement Greenberg. In 1959 he executed his first series of abstract paintings, The Hoarfrost Series, which assume a disciplined minimal quality. In the late 1960's Kiyooka began to push beyond painting and created mixed media works, including collage, photography, film and poetry. Kiyooka’s art is born out of personal experience and through it he records his relationship to the surrounding landscape; a night in a motel, a trip to the coast, or hoarfrost on the trees. Through the unfolding of Kiyooka’s interior/exterior landscapes he shares his personal journeys with us all. The Art Gallery of Ontario's collection of Roy Kiyooka's work began with the purchase of two paintings; Barometer No. 2, in 1964 and Surya, in 1987.

Aging-in-place: Perspectives from the construction industry

Older adults report a desire to remain within the preferred environment for as long as possible. This desire is referred to as aging-in-place. Aging-in-place integrates housing and care options. Factors affecting the ability to remain within the preferred environment include current home designs, access to housing choices, social support networks, and community services, to name a few. Research supports physical and psychosocial benefits of aging-in-place for the individual. Home modifications have the potential to influence the quality of life in a number of positive directions that range from personal mobility to community engagement. Modifications range from minor to significant. Financial resources, contractor interest and expertise, consumer awareness and consumer opportunity affect the degree of change. Increasingly, construction professionals express an interest in learning more about aging-in place. Queries ranged from obtaining a greater understanding of the meaning of the concept, impact of demographic change on housing stock, and increased awareness of universal design features. This paper presents findings from a survey administered to current members of the Canadian Home Builders’ Association – Calgary Regional Office. Within this presentation, we report findings on members understanding of demographic change and the effect of this change on the current and future housing stock. We discuss perceived barriers and benefits of the development of business models to support aging-in-place. Finally, we conclude with discussion of educational support to enhance the understanding of aging-in-place.

Child rights as perceived by the community members in India

Attitudes, knowledge, and perceptions of an individual influence their behavior as well as culture of a society. The objective of the study was to understand the attitudes and knowledge of 584 Indian community members regarding child rights and their perceptions about whether selected child rights were secured in reality. Overall attitudes of vast majority (96 – 98%) of the participants towards child rights were found to be positive i.e., children should have rights in various respects except issue like right to meet others (Article 15 of CRC). Knowledge of majority of the participants about child rights related legislations was moderate and varied across the cities while participants were unanimous about poor lived experiences of child rights in reality. So far as attitude and perception are concerned about child rights, there was a significant difference in the distribution between cities (p<0.01). Overall, the Rights of Children to Free and Compulsory Education Act, 2009 had the highest awareness (91.3%, n=533), followed by the Child Labour (Prohibition and Regulation) Act, 1986 (89.7%, n=523) and the Prohibition of Child Marriage Act, 2006 (89.6%, n=523). Findings of the present study speak in favor of community awareness about child rights and penalties for violation of child rights.

Understanding the line managers’ HRM role expectations: Does size matter?

Recent years have witnessed burgeoning interest in the line managers' contribution to HRM effectiveness. This effort requires organizations to consider important contextual conditions to ensure the desired organizational outcomes. This paper explores the significance of the organization size in understanding the line managers' involvement in HRM activities. Two case studies were conducted, one in a large and another in a small airport involving key members of the airport management who were closely related to the line managers' HRM role. Content analysis was employed to analyze data from the interviews and written documents. While there were many similarities in the line managers' HRM role, the differences in the line managers' HRM role expectations are also found to be related to differences in the size of the organization. More responsibility is expected from line managers in the large airport as compared to the small airport. This finding has important implications in aligning the HRM strategy and organizational outcomes through the line management contribution.