Trends in the seasonal variation of paediatric fractures.

PURPOSE: The incidence of paediatric fractures is known to peak during the summer as a consequence of unsupervised physical activity. A more sedentary lifestyle is a potential cause for changes in paediatric seasonal fracture frequency and severity. The aim of this study was to evaluate the current seasonal variations of paediatric fractures in order to determine resource allocation in hospitals, community clinics and prevention programs. METHODS: A single institutional review of historical data of all patients aged 0 to 16 years that were diagnosed with fractures between April 2014 and July 2017 in the emergency department of a level 3 orthopaedic trauma centre was conducted. In all, 3484 fractures were reviewed, of which 2991 were included. We stratified fractures according to patients' variants and the hour, day and month with respect to holidays, weekends and weather. RESULTS: While the fracture rate on school days was 6.62 per day, the fracture rate during the summer vacation was 4.45 (p < 0.01). Hot weather was correlated with low fracture rates. The peak hours of admission were 12:00 to 13:00 and 18:00 to 22:00, with more moderate differences during non-school periods. CONCLUSION: The local seasonal variation of paediatric fractures has a bimodal distribution, with similar nadirs during both summer and winter. These rates might reflect a shift to a more sedentary lifestyle during the summer vacation. The presented data can assist in improving the value of injury prevention measures and medical resources allocation. LEVEL OF EVIDENCE: II.

[Bone void fillers in osteotomies : If, when, and which type?] / Füllung des Osteotomiespalts : Ob, wann und womit?

Medial opening wedge high tibial osteotomy (HTO) is an established procedure for treating medial osteoarthritis of the knee. In order to achieve the desired amount of correction, the osteotomy gap is opened, which creates a bone void in the medial aspect of the proximal tibia. The resulting bone void can either be left alone or be addressed by interposing a variety of different bone void fillers. Autologous and allogenic fillers can be distinguished from synthetic materials. Up to now, few studies have dealt with the usefulness and necessity for bone void fillers in HTO. The following article provides an overview on the currently used bone void fillers, their specific advantages and disadvantages and their influence on clinical and radiographic outcome after HTO.

Facing the future: credibility in a changing world.

As many rapidly changing and often conflicting influences come to bear on nurse education, and as nurse education strengthens links with higher education or integrates with this sector, nurse teachers need to reflect on their future role in terms of credibility. Four dimensions of credibility are suggested: teaching, knowledge, clinical and academic credibility. In considering these dimensions and the nature of future curricula, proposals for the future role are presented. It is suggested that the nurse teacher of the future must not only be a competent teacher, but a competent teacher of theory and practice. This implies not only teaching, but knowledge and clinical credibility. Academic credibility will be required by those who purchase nurse education and who will expect it to be at higher education level. It is concluded that the achievement of credibility across these four dimensions requires a degree of specialisation and that those who manage education must institute frameworks and practices to facilitate nurse teachers in their future role.

Self-directed learning and student supervision.

Nurse education in the United Kingdom is undergoing major changes arising from proposals for a new preparation for practice entitled Project 2000 (UKCC 1988). Self-directed learning is identified as an important element in most Project 2000 qualifying education programmes. There is, however, some lack of clarity about self-directed learning and how it should be managed in the curriculum. This paper addresses the fundamental meaning of the self-directed learning concept and the advantages in this approach. It is suggested that a balance must be established between maximising the student's control of her own learning and the constraints imposed by statutory educational requirements, particularly with regard to learning outcomes. The issue of the locus of control at various stages in the learning process is considered. The paper concludes by identifying the teacher's role as a supervisor of studies and a partnership model for student supervision is proposed.

Ageist attitudes among young adults: implications for a caring profession.

It is frequently suggested that younger adults are negative in their attitudes toward elderly people. There are also claims that such attitudes develop as a result of the socially constructed phenomenon of ageism. This paper briefly addresses the concept as it is presented in the literature and goes on to describe an attitudinal study which supports the existence of ageism. An Attitudes Toward the Elderly inventory was administered to secondary school pupils during their final 2 years of schooling, to student nurses at the very beginning of their training and to qualified nurses. It was found that the subjects did demonstrate negative attitudes and that there appeared to be a definite gender socialization influence, with females demonstrating less negative attitudes than males. Contrary to expectations, entry into nursing did not lead to more positive attitudes but had the converse effect. The influence of ageism and more specific professional socialization processes are suggested as explanations for these patterns. Implications for nursing and other occupational groups involved in caring for the elderly are discussed.