A pragmatic 2 × 2 × 2 factorial cluster randomized controlled trial of educational outreach visiting and case conferencing in palliative care—methodology of the Palliative Care Trial [ISRCTN 81117481]

The demand for palliative care is increasing, yet there are few data on the best models of care nor well-validated interventions that translate current evidence into clinical practice. Supporting multidisciplinary patient-centered palliative care while successfully conducting a large clinical trial is a challenge. The Palliative Care Trial (PCT) is a pragmatic 2 x 2 x 2 factorial cluster randomized controlled trial that tests the ability of educational outreach visiting and case conferencing to improve patient-based outcomes such as performance status and pain intensity. Four hundred sixty-one consenting patients and their general practitioners (GPs) were randomized to the following: (1) GP educational outreach visiting versus usual care, (2) Structured patient and caregiver educational outreach visiting versus usual care and (3) A coordinated palliative care model of case conferencing versus the standard model of palliative care in Adelaide, South Australia (3:1 randomization). Main outcome measures included patient functional status over time, pain intensity, and resource utilization. Participants were followed longitudinally until death or November 30, 2004. The interventions are aimed at translating current evidence into clinical practice and there was particular attention in the trial's design to addressing common pitfalls for clinical studies in palliative care. Given the need for evidence about optimal interventions and service delivery models that improve the care of people with life-limiting illness, the results of this rigorous, high quality clinical trial will inform practice. Initial results are expected in mid 2005. (c) 2005 Elsevier Inc. All rights reserved.

The credentialing of counselling in Australia

Counselling is an unregulated activity in Australia. No statutory regulation currently exists. As a result, different counselling organizations are promoting different voluntary standards for the practice of counselling. This has led to a credentialing dilemma in which counsellors and the public are confronted with a number of counselling qualification choices. This dilemma poses a number of questions: Should counselling become more regulated in Australia? At what level should counselling be regulated? Should there be various levels of counsellor regulation? This article provides an overview of the credentialing dilemma facing counselling in Australia, compares and contrasts two main Australian accreditation efforts, and proposes cooperation as a way of navigating said dilemma. The implications for counselling as a profession are discussed along with suggestions for its development as a profession. This includes a discussion regarding the relative advantages and disadvantages of greater regulation of counselling as a professional activity in Australia. Specifically, what is and is not generally considered a profession is reviewed, different forms of credentialing are outlined, and general arguments for and against accreditation efforts are presented. The efforts of the Australian Counselling Association (ACA) and the Psychotherapy and Counselling Federation of Australia (PACFA) are compared and are shown to have common ground. Consequently, ways in which the main counselling organizations may best work in conjunction to promote counselling as a profession in Australia are proposed. These suggestions include good communication, collaboration, and the avoidance of turf wars. Specifically, that the ACA and PACFA collaborate on developing a combined independent registration list that is supported by both organizations or, minimally, that both organizations have mutual recognition on each other's register lists.

Assessing the resilience of a real-world social-ecological system: lessons from a multidisciplinary evaluation of a South African pastoral system

In the past decades, social-ecological systems (SESs) worldwide have undergone dramatic transformations with often detrimental consequences for livelihoods. Although resilience thinking offers promising conceptual frameworks to understand SES transformations, empirical resilience assessments of real-world SESs are still rare because SES complexity requires integrating knowledge, theories, and approaches from different disciplines. Taking up this challenge, we empirically assess the resilience of a South African pastoral SES to drought using various methods from natural and social sciences. In the ecological subsystem, we analyze rangelands’ ability to buffer drought effects on forage provision, using soil and vegetation indicators. In the social subsystem, we assess households’ and communities’ capacities to mitigate drought effects, applying agronomic and institutional indicators and benchmarking against practices and institutions in traditional pastoral SESs. Our results indicate that a decoupling of livelihoods from livestock-generated income was initiated by government interventions in the 1930s. In the post-apartheid phase, minimum-input strategies of herd management were adopted, leading to a recovery of rangeland vegetation due to unintentionally reduced stocking densities. Because current livelihood security is mainly based on external monetary resources (pensions, child grants, and disability grants), household resilience to drought is higher than in historical phases. Our study is one of the first to use a truly multidisciplinary resilience assessment. Conflicting results from partial assessments underline that measuring narrow indicator sets may impede a deeper understanding of SES transformations. The results also imply that the resilience of contemporary, open SESs cannot be explained by an inward-looking approach because essential connections and drivers at other scales have become relevant in the globalized world. Our study thus has helped to identify pitfalls in empirical resilience assessment and to improve the conceptualization of SES dynamics.

The Proceedings of the South Carolina Historical Association

Annually, the association publishes a journal, The Proceedings, which consists of papers presented at the annual meeting. J. D. B. Debow, Statistician of the Old South by O. C. Skipper – The Citadel Some Early Settlers of Calhoun County by Susan B. Bennett The Elliott Society by Horatio Hughes – College of Charleston

The Proceedings of the South Carolina Historical Association

Annually, the association publishes a journal, The Proceedings, which consists of papers presented at the annual meeting. The First Decade of the Charleston Library Society by Anne King Gregorie Chinese Exclusion Acts, 1880-1904 by Ruth Boyd – Newberry High School The Germans and the German-Swiss in South Carolina, 1732-1765: Their Contribution to the Province by Gilbert P. Voigt – Wittenberg College Some Unexploited Fields in South Carolina History by D. D. Wallace – Wofford College

The Proceedings of the South Carolina Historical Association

Annually, the association publishes a journal, The Proceedings, which consists of papers presented at the annual meeting. Francis Lieber at the South Carolina College by William M. Geer – United States Military Academy The Republican Society of Charleston by Eugene P. Link – Winthrop College Planters from the Low-Country and their Summer Travels by Lawrence F. Brewster – Duke University Bentonville—the Last Battle of Johnston and Sherman by Robert W. Barnwell