This paper addresses some of the challenges met when developing widely distributed, broad spectrum, simulation-based education (SBE) for health professionals, such as resource duplication, inconsistent facilities utilization, discipline-specific silos, and the intersection of academic institutions and health services sectors. We examine three primary contributors to successful simulation-based practices - strategic planning, program development, and professional networks. Further, we provide examples of how each of these contributors function at different levels to assure comprehensive, yet sustainable approaches to implementing SBE for greatest impact at national, state, regional, and institutional levels. We draw on the example of Australia and its state and regional government structures, including the challenges in providing health services across a widely variable geography and population distribution. The types of health services and issues relating to health provision and management reflect those found in many western countries. Our hope is that the experiences gained at each level of governance within Australia may inform similar, successful development in other countries. We emphasize the importance of leadership and investment at the national level that serves to inform state, regional, and institutional efforts through a "trickle down" effect. Although evaluation of the strategic planning, program development, and professional networks described in this case study is still ongoing, their preliminary coordination has resulted in significant investment and support at all levels.

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Aim: To explore the development of nursing research and provide some examples of research relevant to clinical practice. Background: Nursing research developed in the last century as did nursing theories and models. However, nursing research does not have the same high profile as, for example, medical research and has tended to lag behind medical, and other forms of research, in terms of funding and in the apparent impact it has on clinical practice. Design: Discussion paper. Methods: Using a popular nursing model based on activities of daily living, nursing research that is relevant to these activities of daily living is explored and exemplified using a few key examples. Some of these examples are historical and some are current. Conclusion: Nursing research has developed greatly over the past century and continues to develop in the 21 ^st century. Nursing research is relevant to the needs of patients and has had an impact on clinical practice.

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Context: Nationally, there is no clear scope of practice for nurses working in Saudi Arabia identifying their role legitimacy as the Nursing Board in the Saudi Commission of Health Specialties has not yet formalized a scope of nursing practice. Role legitimacy can be identified either by a supervisory body or by an agreement that may exist among individual groups. Aims: This study aimed to identify nurses' role legitimacy in Saudi Arabia from the view of nurses, doctors, and patients. Settings and Design: A large survey was undertaken in 2008 in 10 hospitals located in the Eastern Province of Saudi Arabia related to three major healthcare sectors (government, military, private). Materials and Methods: A quota sample of nurses (n = 614, RR = 61.4%), doctors (n = 130, RR = 26.0%) and patients (n = 322, RR = 64.4%) was undertaken, utilizing a self-administered questionnaire that drew upon the King's Nurse Performance Scale. Statistical Analysis Used: A descriptive analysis was undertaken, using the Chi-square test to compare the views of the participants. Results: The domains of physical care, professional aspects and care management formed a major focus of the nurses' role, with no evidence of role legitimacy regarding the psychosocial and communication aspects of patient care. Conclusions: There was a traditional view of the nurses' role within acute care delivery which will need to be addressed if nurses are to contribute significantly to promoting the health of people in Saudi Arabia.

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Adenocarcinoma (AC) of the oesophagus is an important disease in western communities in terms of its unprecedented recent increase in incidence and its relatively poor outcomes despite today's variety of treatment options. The increasing incidence of this deadly disease is probably related to the changing lifestyle patterns within affluent societies, in terms of diet and sedentary practices, obesity and the prevalence of gastro-oesophageal reflux disease. Barrett's oesophagus has been identified as a major risk factor and surveillance strategies for at-risk groups are being proposed, together with endoscopic management strategies for those with high-grade dysplasia or early and localised AC. It is recognised that the disease is better treated in high-volume centres under the guidance of a multidisciplinary team. Increasing availability and accuracy of sophisticated staging tools such as endoscopic ultrasound, endoscopic mucosal resection and positron-emission tomography (PET) have helped define treatment strategies. Endoscopic tools can identify patients who might be suitable for some form of local ablative therapy and PET scanning will often pick up metastatic disease missed with other imaging investigations. Refinement of the pathological staging system has also helped define treatment modalities. Although surgery may still be seen as the mainstay of treatment, its use is now more in context with adjuvant therapies. With the unwavering epidemic of obesity, it is likely that AC of the oesophagus is going to remain an important disease confronting healthcare and this paper deals with some of the current issues.

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Introduction: Defining exactly what characterizes a clinical tutor as excellent and another less effective, is an important task in assessing the effectiveness of clinical training and guiding faculty development. Aim: We aimed to evaluate those characteristics and measure differences in their perception among accomplished and non-accomplished consultants and residents in the Emergency Department. We also compared perceptions between the different groups of participants. Methods: The characteristics measured were extracted from an extensive search of previously published studies summarized in a review article. A qualitative study was conducted, using a 20 item questionnaire piloted from the refined characteristics (good indicator of reliability; Cronbach's Alpha = 0.86). The questionnaire was distributed among all consultants and residents in Saudi Board of Emergency Medicine. Results: No significant difference between consultants' and residents' perception was found. "Sincere" was an exception 87.8% versus 55.1%, P = 0.013. Consultants' specifications did not seem to affect perception on overall scores and its component sub-scores. Conclusion: Since results showed no relation between accomplished and non-accomplished consultants in perceiving those qualities, we excluded the lack of knowledge of those characteristics as a cause of being accomplished or non-accomplished. We suggest a greater dedication from program developers towards creating more opportunities to involve more consultants in basic Emergency Medicine training.

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