Distal radius fractures: an evidence-based approach to assessment and management.

Distal radius fractures account for one in five bony injuries in both primary and secondary care. These are commonly the result of a fall on outstretched hands or high-energy trauma. On assessment, clinicians should determine the mechanism of injury, associated bony or soft tissue injuries, and neurovascular symptoms. Investigations should always include radiographs to evaluate for intra-articular involvement and fracture displacement. Owing to the heterogeneous injury patterns and patient profiles, the preferred management should consider the severity of the fracture, desired functional outcome and patient comorbidities. Non-operative management in select patients can give good results, especially in older adults. Immobilisation with or without reduction forms the mainstay of non-operative treatment. Surgical management options include closed reduction and application of a cast, percutaneous K-wires, open reduction and internal fixation with plates, or external fixation. Patients should be encouraged to mobilise as soon as it is safe to do so, to prevent stiffness. Median nerve compression is the most common complication followed by tendon rupture, arthrosis and malunion. This article outlines the British Orthopaedic Association Standards for Trauma and Orthopaedics for the management of distal radius fractures.

Factors that influence medical student learning in the operating room.

Introduction: The operating room (OR) is a dynamic, high-pressure clinical setting that offers a unique workplace-based learning environment for students. We undertook a narrative synthesis of the literature to identify factors that influence medical student learning in the OR, and we recommend educational strategies that maximize "theater-based learning". Methods: Key words were searched across three databases PubMed, EMBASE and ERIC (Education Resource Information Center). Eligible studies included original articles published after 1997 presenting empirical research on factors that influence medical students learning in the OR. Methodological quality was measured using the Newcastle-Ottawa Score for education. Results: We identified 764 studies on the topic of student learning in the OR, of which 16 studies fulfilled inclusion criteria. The quality assessments demonstrated a mean value of 2.1 out of a maximum of 6. Conclusions: We identified five key domains that influence student learning in the OR: emotional factors, socio-environmental factors, organizational factors, factors related to educational relevance and factors related to the educator. Educational strategies to enhance theater-based learning include: an induction and physical orientation, clear learning objectives, educator feedback, and simulation.

Legislating for transnational ageing: a challenge to the logics of the welfare state.

Transnational ageing presents fundamental challenges to nationally bounded welfare states, which historically have tended to be organised according to a logic of solidarity among nationals and permanent residents of a given state territory. Nonetheless, the Dutch and French governments have taken steps to break this link between solidarity and territorially bounded consumption of welfare, by providing lifelong income security for older migrants who return to countries of origin on a permanent or semi-permanent basis. This article asks what motivated policymakers to initially develop these novel policy tools for transnational ageing which contradict the territorial logic of the welfare state. Based on interviews with key stakeholders and available official documents, we find that in both France and the Netherlands, policymakers' initial motivations can be characterised as rather benign, if not beneficent: to facilitate return for those who are willing but unable to afford it. However, two types of obstacle have impeded the delivery of such policies. Non-discrimination clauses and free movement rights in EU law may make it difficult to implement policies for specific categories of older migrants. Electoral realpolitik may also lead policymakers to shelve policies which benefit older migrants, in a European context where public opinion on immigration is less and less favourable. Nonetheless, opposition may be neutralised by the budgetary advantages of these schemes, since older returnees do not consume public services such as healthcare.