Fixed-angle locking proximal humerus plate: an evaluation of functional results and implant-related outcomes

Background
Displaced and unstable proximal humeral fractures are challenging injuries to treat. Proximal humeral locking plates are a recent development for the treatment of these complex fractures.

Methods
Retrospective analysis of 23 patients with 23 proximal humeral fractures treated with the Synthes locking proximal humerus plate. These were Neer two-, three- and four-part fractures. Follow-up was at a mean of 22 months and included clinical assessment using the Constant score (CS) and the Short Form-12 health questionnaire. Radiographic assessment was performed to assess implant-related complication in relation to the initial fracture pattern and the presence of adequate medial support.

Results
The mean CS for all patients was 60.4 (range, 29–85). The mean adjusted CS was 82% (range, 30–117), active forward flexion 127 degrees and the active abduction 115 degrees. Initial fracture pattern, the presence or absence of adequate medial support and age did not significantly influence the clinical scores. Complications included one infection, two cases of avascular necrosis, two cases of varus collapse with screw penetration and one non-union. The overall reoperation rate was 26%. There was an increased rate of complications in those with inadequate medial support (P = 0.0183) and a trend to higher complication rates in four-part fractures.

Conclusion
Using the locking proximal humerus plate for the treatment of proximal humeral fractures is an acceptable procedure with comparable outcomes with historical controls, but with a complication rate of 30%. More important than implant selection, however, is the ability to achieve a stable reduction with calcar support.

The effectiveness of health interventions in cardiovascular risk reduction among emergency service personnel

Purpose
The physical demands and hazards associated with emergency service work place particular stress on responders’ cardiovascular systems. Indeed, cardiovascular disease (CVD) is a significant problem for emergency service personnel. Although it may be difficult to alter the cardiovascular health hazards associated with the work environment, it is possible for personnel to control their modifiable CVD risk factors, cardiovascular fitness levels and subsequently, reduce their CVD risk. This review aimed to determine the effectiveness and methodological quality of health interventions designed to mitigate CVD risk in emergency service personnel.

Methods
A literature search of electronic journal databases was performed. Sixteen relevant studies were assessed for methodological quality using a standardised assessment tool. Data regarding the effectiveness of each intervention were extracted and synthesised in a narrative format.

Results
Fifteen studies were rated ‘Weak’ and one study was rated ‘Strong’. Interventions which combined behavioural counselling, exercise and nutrition were more effective in improving cardiovascular health than nutrition, exercise or CVD risk factor assessment-based interventions alone. Further, CVD risk factor assessment in isolation proved to be an ineffective intervention type to reduce CVD risk.

Conclusion
Combined interventions appear most effective in improving the cardiovascular health of emergency service personnel. Accordingly, fire and emergency service agencies should consider trialling multifaceted interventions to improve the cardiovascular health of personnel and avoid interventions focused only on one of nutrition, exercise or CVD risk factor assessment. However, as most studies were methodologically weak, further studies of a higher methodological quality are needed.

Sex does not matter: gender bias and gender differences in peer assessments of contributions to group work

This paper considers the possibility of gender bias in peer ratings for contributions to team assignments, as measured by an online self-and-peer assessment tool. The research was conducted to determine whether peer assessment led to reliable and fair marking outcomes. The methodology of Falchikov and Magin was followed in order to test their finding that gender has no discernable impact on peer ratings. Data from over 1500 participants at two universities enrolled in four different degree programmes were analysed. The research indicates an absence of gender bias in six case studies. The research also found that women received significantly higher ratings than men.

FRAX provides robust fracture prediction regardless of socioeconomic status

The authors investigated the fracture risk assessment tool (FRAX) Canada calibration and discrimination according to income quintile in 51,327 Canadian women, with and without a competing mortality framework. The data shows that, under a competing mortality framework, FRAX provides robust fracture prediction and calibration regardless of socioeconomic status (SES).

Implementation of pressure ulcer prevention best practice recommendations in acute care: an observational study

Pressure ulcers are a common but preventable problem in hospitals. Implementation of best practice guideline recommendations can prevent ulcers from occurring. This 9-year cohort study reports prevalence data from point prevalence surveys during the observation period, and three practice metrics to assess implementation of best practice guideline recommendations: (i) nurse compliance with use of a validated pressure ulcer risk assessment and intervention checklist; (ii) accuracy of risk assessment scoring in usual-care nurses and experienced injury prevention nurses; and (iii) use of pressure ulcer prevention strategies. The prevalence of hospital-acquired pressure ulcers decreased following implementation of an evidence-based prevention programme from 12·6% (2 years preprogramme implementation) to 2·6% (6 years postprogramme implementation) (P < 0·001). Audits between 2003 and 2011 of 4368 patient medical records identified compliance with pressure ulcer prevention documentation according to best practice guidelines was high (>84%). A sample of 270 patients formed the sample for the study of risk assessment scoring accuracy and use of prevention strategies. It was found usual-care nurses under-estimated patients' risk of pressure ulcer development and under-utilised prevention strategies compared with experienced injury prevention nurses. Despite a significant reduction in prevalence of hospital-acquired pressure ulcers and high documentation compliance, use of prevention strategies could further be improved to achieve better patient outcomes. Barriers to the use of prevention strategies by nurses in the acute hospital setting require further examination. This study provides important insights into the knowledge translation of pressure ulcer prevention best practice guideline recommendations at The Northern Hospital.

Exploring retinal and functional markers of diabetic neuropathy

Diabetic peripheral neuropathy (DPN) is one of the most debilitating complications of diabetes. DPN is a major cause of foot ulceration and lower limb amputation. Early diagnosis and management are key factors in reducing morbidity and mortality. Current techniques for clinical assessment of DPN are relatively insensitive for detecting early disease or involve invasive procedures such as skin biopsies. There is a need for less painful, non-invasive, safe evaluation methods. Eye-care professionals already play an important role in the management of diabetic retinopathy but recent studies have indicated that the eye may also be an important site for the diagnosis and monitoring of neuropathy. Corneal nerve morphology is a promising marker of diabetic neuropathy occurring elsewhere in the body. Emerging evidence tentatively suggests that retinal anatomical markers and a range of functional visual indicators could similarly provide useful information regarding neural damage in diabetes, although this line of research is less well established. This review outlines the growing body of evidence supporting a potential diagnostic role for retinal structure and visual functional markers in the diagnosis and monitoring of peripheral neuropathy in diabetes.

Evaluating the corrosion behaviour of magnesium alloy in simulated biological fluid by using SECM to detect hydrogen evolution

Scanning electrochemical microscopy (SECM) in surface generation/tip collection mode is investigated as an assessment tool for studying the corrosion behaviour of magnesium in simulated biological fluid. The technique provides a local map of hydrogen (H2) evolution which alone can be used as a direct measure of corrosion. The H2 generated during corrosion of magnesium is oxidized at the probe(i.e. a Pt ultra micro-electrode);with the magnitude of the current generated due to oxidation being indicative of the intensity of H2 evolution at a local scale on the magnesium surface. This method was calibrated using a cathodically polarized Pt disk to simulate H2 evolution in a controlled condition on a homogeneous surface. Potential interference from dissolving Mg or high local pH was also investigated. The technique was implemented for studying H2 evolution at the surface of AZ31 as a model Mg alloy.SECM results combined with SEM-EDX and profilometry data revealed that local domains of higher H2 evolution on the surface of AZ31 are in close proximityof the observed pitting sites.

Responsible management of motor vehicle drivers with dementia

When Bridget Driscoll, a 44-year-old mother of two died after being struck by a motor vehicle, considered to be the first motor vehicle fatality in UK and possibly the world, the coroner stated 'I trust this sort of nonsense will never happen again'.1 Sadly, the coroner, medical practitioners and general public would be deeply and repeatedly disappointed. It was 1896. Motor vehicles were a curiosity. Drivers did not undergo any form of testing, be it medical fitness, driving ability or otherwise, and there were no licensing regulatory agencies. By 2010, road injury was the ninth most common cause of death globally (1.3 million deaths per annum) and dementia the fourth most common in high income countries.2 By 2030 the number of all licensed UK drivers who are 65 years or older will increase by almost 50% to almost one in every four drivers.3 If the juxtaposition of driving with dementia in an ageing population is not already a contentious social, political and medical issue, it certainly will become so.

Accountability in juvenile justice : a framework to assess client outcomes

This article describes the development of an assessment protocol for use with juvenile justice clients that can be used to assess needs in a manner that not only informs the development of case plans but also allows for the assessment of change over the course of a service contact. The youth justice assessment tool supports case needs identification and analysis as well as screening for mental health concerns, risk of harm to self or others, and risk of reoffending. Initial validation of the case needs component has been undertaken and although further validation is required, preliminary data reported in this article suggest that this type of approach to client assessment does hold some promise.

The HWMD maturity model: a foundational framework to measure effectiveness of institutional research e-infrastructures

There is a nationally recognised need for a framework and tools to measure progress in implementing e-infrastructures for research from an institutional, organisational unit and service perspective. This paper describes the development of a prototype maturity model and self-assessment tool in response to that need. The authors present a background to the environment of technology enabling services for research and the challenges of fluidity of boundaries around traditional services and roles as institutions respond to the needs of the research community. The conceptual basis of the model is presented along with the model and its various elements that explain how the model is in its current form. The information provided in this paper, combined with field site test feedback, will promote discussion and debate amongst the community and opportunities will present to gather input to optimise the model. The next steps would be to further elaborate and test the constructs and indicators of the model in field test sites and to further develop the self -assessment tool.

Application of a quantitative histological health index for Antarctic rock cod (Trematomus bernacchii) from Davis Station, East Antarctica

A quantitative Histological Health Index (HHI) was applied to Antarctic rock cod (Trematomus bernacchii) using gill, liver, spleen, kidney and gonad to assess the impact of wastewater effluent from Davis Station, East Antarctica. A total of 120 fish were collected from 6 sites in the Prydz Bay region of East Antarctica at varying distances from the wastewater outfall. The HHI revealed a greater severity of alteration in fish at the wastewater outfall, which decreased stepwise with distance. Gill and liver displayed the greatest severity of alteration in fish occurring in close proximity to the wastewater outfall, showing severe and pronounced alteration respectively. Findings of the HHI add to a growing weight of evidence indicating that the current level of wastewater treatment at Davis Station is insufficient to prevent impact to the surrounding environment. The HHI for T. bernacchii developed in this study is recommended as a useful risk assessment tool for assessing in situ, sub-lethal impacts from station-derived contamination in coastal regions throughout Antarctica.

Creating a standardised teaching and learning framework for social work field placements

© 2014, © 2014 Australian Association of Social Workers. Abstract: Mapping and evaluating a student's progress on placement is a core element of social work education but there has been scant attention to indicate how to effectively create and assess student learning and performance. This paper outlines a project undertaken by the Combined Schools of Social Work to develop a common learning and assessment tool that is being used by all social work schools in Victoria. The paper describes how the Common Assessment Tool (CAT) was developed, drawing on the Australian Association of Social Work Practice Standards, leading to seven key learning areas that form the basis of the assessment of a student's readiness for practice. An evaluation of the usefulness of the CAT was completed by field educators, liaison staff, and students, which confirmed that the CAT was a useful framework for evaluating students' learning goals. The feedback also identified a number of problematic features that were addressed in a revised CAT and rating scale.

Mammographic screening: measurement of the cost in a population based programme in Victoria, Australia

STUDY OBJECTIVES: To estimate the cost per woman participating in a mammographic screening programme, and to describe methods for measuring costs. DESIGN: Expenditure, resource usage, and throughput were monitored over a 12 month period. Unit costs for each phase of the screening process were estimated and linked with the probabilities of each screening outcome to obtain the cost per woman screened and the cost per breast cancer detected. SETTING: A pilot, population based Australian programme offering free two-view mammographic screening. PARTICIPANTS: A total of 5986 women aged 50-69 years who lived in the target area, were listed on the electoral roll, had no previous breast cancer, and attended the programme. RESULTS: Unit costs for recruitment, screening, and recall mammography were $17.54, $60.04, and $175.54, respectively. The costs of clinical assessment for women with subsequent clear, benign, malignant (palpable), and malignant (impalpable) diagnoses were $173.71, $527.29, $436.62, and $567.22, respectively. The cost per woman screened was $117.70, and the cost per breast cancer detected was $11,550. CONCLUSIONS: The cost per woman screened is a key variable in assessment of the cost effectiveness of mammographic screening, and is likely to vary between health care settings. Its measurement is justified if decisions about health care services are to be based on cost effectiveness criteria.

Diabetes prevention research: a systematic review of external validity in lifestyle interventions

Context

Type 2 diabetes is a major contributor to disease burden globally. A number of systematic reviews support the efficacy of lifestyle interventions in preventing Type 2 diabetes in adults; however, relatively little attention has been paid to the generalizability of study findings. This study systematically reviews the reporting of external validity components and generalizability of diabetes prevention studies.

Evidence acquisition

Lifestyle intervention studies for the prevention of Type 2 diabetes in adults with at least 6 months' follow-up, published between 1990 and 2011, were identified through searches of major electronic databases. External validity reporting was rated using an assessment tool, and all analysis was undertaken in 2011.

Evidence synthesis

A total of 31 primary studies (n=95 papers) met the selection criteria. All studies lacked full reporting on external validity elements. Description of the study sample, intervention, delivery agents, and participant attrition rates were reported by most studies. However, few studies reported on the representativeness of individuals and settings, methods for recruiting settings and delivery agents, costs, and how interventions could be institutionalized into routine service delivery. It is uncertain to what extent the findings of diabetes prevention studies apply to men, socioeconomically disadvantaged individuals, those living in rural and remote communities, and to low- and middle-income countries.

Conclusions

Reporting of external validity components in diabetes prevention studies needs to be enhanced to improve the evidence base for the translation and dissemination of these programs into policy and practice.

Histopathological fish health index: a biomarker of pollution effect

 Changes in cellular structure in Antarctic Rock-cod signified biological impact of untreated human wastewater on the marine ecosystem at Davis Station, East Antarctica. Based on these alterations a Histological Health Index was developed to identify and compare changes in fish health correlated to the degree of wastewater exposure. The health index provides a risk assessment tool applicable for all Antarctic Treaty research stations.