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Students with Special Educational Needs and Disabilities encounter complex and circuitous transitions from post-primary settings to Higher Education. In Ireland, inequitable access to Individual Education Plans, and a lack of policy infrastructure to provide formal transition planning, means that these journeys are varied and uncertain. This study presents findings from surveys completed by parents supporting students with disabilities in their final 3 years of mainstream secondary school (n = 69), and in-depth interviews with a self-selected subset of parents (n = 8). Results point to: (i) disparate levels and quality of support and guidance, (ii) fissures in communication channels between parents and schools, (iii) insufficient awareness and understanding of the interplay between disability and successful post-school outcomes, and (iv) high levels of stress, anxiety and frustration experienced by students, parents and carers.

To determine whether new national guidance on the specifications of a fracture liaison service are realistically deliverable, 1 year of data on the performance of such a service were audited. Audit targets were mostly met. This audit demonstrates that these standards are deliverable in a real world setting. UK service specifications for a fracture liaison service (FLS) have been produced (National Osteoporosis Society, NOS) to promote effective commissioning and delivery of the highest quality care to patients with fragility fractures. How deliverable these standards are has not as yet been methodically reported. Our FLS was modelled on the ten NOS standards; performance was audited after 1 year to determine whether these standards could be delivered and to describe the lessons learnt. Performance was audited against the NOS FLS Service Standards, with management based on the Fracture Risk Assessment Tool (FRAX®), the four-item Falls Risk Assessment Tool (FRAT), National Institute for Health and Care Excellence (NICE) and the National Osteoporosis Guideline Groups (NOGG) guidance. Data were recorded prospectively on a database. The FLS commenced in May 2014, was fully operational in August 2014 and data were captured from 1 September 2014 to 1 September 2015. The FLS detected 1773 patients and standards were largely achieved. Most, 94 %, patients were seen within 6 weeks, 533 DXA requests were generated, 804 outpatient FRAT assessments were recorded (134 required falls intervention) and 773 patients had bone treatments started. On follow-up at 3 months, between 78–79 % were still taking medication. Preliminary evaluation of a FLS implemented according to UK NOS standards demonstrates that the model is practical to apply to a large teaching hospital population. Collection and review of outcome and cost effectiveness data is required to determine the performance of this model in comparison with existing models.

BackgroundThe number of falls in hospital ranges from 3.8 to 8.6 falls per 1000 bed days. 1 Around 30% of falls as inpatients are injurious, and 4%–6% can result in serious and life-threatening injury. 2 3 This results in significant health burdens and economic burdens due to increased hospital stays following a fall. Junior doctors are usually the first point of contact for managing patients who fall in hospital. It is therefore important they understand the preventative measures and postfalls management.AimTo assess the retention of knowledge regarding falls management in foundation year 1 (FY1) doctors before and after a short educational intervention.MethodsA 3-stage quality improvement project was conducted at a West Midlands teaching hospital to highlight issues regarding falls management. A questionnaire assessing areas of knowledge regarding assessment and management of falls was delivered to 31 F1s. This was followed by a short presentation regarding falls management. The change in knowledge was assessed at 6 and 16 weeks postintervention. The questionnaire results were analysed using unpaired t-tests on STATA (V.14.2).ResultsThe mean score for knowledge regarding falls management in the preintervention, early postintervention and late postintervention were 73.7%, 85.2% and 76.4%, respectively. Although there was an improvement in the knowledge at 6 weeks’ postintervention, this returned to almost baseline at 16 weeks. The improvement in knowledge did not translate to clinical practice of falls management during this period.ConclusionAlthough educational interventions improve knowledge, the intervention failed to sustain over period of time or translate in clinical practice. Further work is needed to identify alternative methods to improve sustainability of the knowledge of falls and bring in the change in clinical practice.

Due to dramatic improvements in life expectancy we are seeing a rapidly growing population of older people. Increasing frailty and susceptibility to fragility fractures are becoming pressing issues for both the individuals that suffer them as well as society, through pressures on health and social care budgets. The success of fracture liaison services, co-ordinated programmes enhancing the management of the fracture, osteoporosis, frailty and falls risk, is undisputed. To achieve optimal outcomes, however, it is important to have a standardisation of design, scope and structure of the service. Experience has taught us that by delegating responsibility for the holistic care of the patient to a trained and adequately resourced professional/team (fracture prevention practitioner) with clear standards against which benchmarking occurs, is the optimal model of delivery. Future challenges include how best to measure the success of services in imparting a reduction in fractures at a local population level as well as how to detect those patients with unmet need who do not uniformly present to health care services, such as those with vertebral fractures. The implementation of fracture liaison services however, is a clear demonstration of how collaboration between health care, social care and charity organisations, among others, has materially improved the health and well-being of the population.

Atypical femoral fractures (AFFs) are important to diagnose early to avoid progression to complete fracture. We set out to determine the reporting accuracy of AFFs.We conducted a retrospective analysis of imaging performed between November 2010 and June 2013 to analyse the X-ray reporting of AFFs and to describe the key clinical considerations. Radiological reports were reviewed from the 3805 separate femoral images for search terms thought likely to identify AFFs. This identified 1558 patients. The identified radiographs were reviewed by radiologists with reference to the 2010 American Society of Bone and Mineral Research (ASBMR) criteria.Within these 1558 patients, 16 patients met the radiological criteria for AFF according to the 2010 ASBMR task force statement of which, although all were identified as fractures, 15 were not reported as "atypical" by the original reporting author and none was formally classified as AFF by the original reporting author. Within the 1558 patients, there were an additional 17 patients labelled as having "atypical" fracture features originally, although only 1 patient met the 2010 ASBMR task force criteria for AFF. Only 13 of 16 patients had imaging of the contralateral femur, and there was a significant delay for those who were imaged (111 ± 44 days). Furthermore, two of the patients with an AFF had previous radiographs demonstrating cortical changes indicative of AFFs prior to formal diagnosis.Whilst AFFs are rare diagnoses, the compliance with published guidelines for their radiological classification is low.We have raised awareness of the importance of recognizing AFFs to guide management.