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With an increasing emphasis on the importance of real-world learning in higher education, coupled with demand for placement experience, simulation has become an increasingly popular pedagogy. However, literature is scant on how students feed-forward their learning from the simulation debrief into placement. A mixed-method study of 108 student nurses explored how feedback from the debriefing contributed to students' learning from immersive simulation and whether students used this learning in the placement that followed. In this case, authenticity, realism and interaction were achieved through the use of actors, high fidelity mannequins, clinicians, medical equipment and replicated clinical environments. Results indicated barriers to feed-forward at the two stages of the simulation feedback process and the transition of learning into practice. Recommendations identify measures to strengthen the formative feedback phases between the university and practice settings and further enhance the potential of simulation pedagogy.

The policy document, Comprehensive Critical Care, suggested that patients with critical care needs should expect the same standard of care wherever they are nursed, be that in a traditional critical care setting or in a general ward area. It is recognized that in order for this to occur, the developmental needs of ward nurses need to be met to enable them to care for patients with level 1 and level 2 needs. A second document, The Nursing Contribution to the Provision of Comprehensive Critical Care for Adults: A strategic Programme of Action, proposed a programme of action and outlined five priority areas to be considered to ensure the success of comprehensive critical care. Education, training and workforce development was one of the areas outlined, and thus, in response, the role of the practice development facilitator was created as a means of developing the critical care knowledge, skills and practice in ward areas. It became apparent that education and training alone were insufficient to ensure that the aims of comprehensive critical care were realized. The way in which the nurses approached and organized their work and the availability of resources had a great impact on the ability of staff to care for these patients. It is argued that achieving comprehensive critical care is complex and that a multi-dimensional approach to the implementation of policy is essential in order to realize its aims. [ABSTRACT FROM AUTHOR]

Described are 2 cases of lower limb ischemia that resulted after deployment of 2 different arterial closure devices. One patient presented acutely with lower limb ischemia after an Angio-Seal (St Jude Medical, Minnetonka, Minn) device deployed at the conclusion of cerebral artery aneurysm embolization. The second patient, who underwent angioplasty for aortic recoarctation, presented with claudication 1 week after deployment of the Perclose (Perclose, Redwood City, Calif) device. The use of such devices can result in significant complications, and cardiologists, interventional radiologists, and vascular surgeons are advised to have a high index of suspicion for such complications and work in close conjunction to provide prompt and adequate treatment. [ABSTRACT FROM AUTHOR]

Extracranial spread of meningiomas to involve the middle ear is very rare. We present the case of a 43-year-old woman with a known cerebellopontine angle meningioma who subsequently presented with left-sided otalgia and a middle-ear mass extruding through the tympanic membrane due to local invasion of the meningioma. The tumour was excised surgically. A discussion of the relevant literature is also presented. [ABSTRACT FROM AUTHOR]

A letter to the editor and a response from the authors of the article "Academia and MMC: Uncomfortable Bed-Fellows?" by C. Derham, R.S. Vohra and S. Homer-Vanniasinkam in a 2009 issue are presented.

Purpose: Craniocervical junction instability in a paediatric population presents a formidable challenge to the neurosurgeon. With a variety of anatomical variations, diminutive bony and ligamentous structures, possible superimposed syndromic abnormalities, the craniocervical junction is a technically challenging region to operate within. We aimed to review our series of patients to identify the common pathologies necessitating craniocervical fusion along with the use of intraoperative image guidance., Methods: We performed a retrospective review of twenty-one patients, with a mean age of 8.1 years, undergoing craniocervical fixations, involving either occipitocervical fusion or atlantoaxial fixation, from a single institution over a twelve-year period. The presentation, preoperative investigations, indication for surgery, surgical procedure, use of intraoperative navigation and clinical and radiological results were examined., Results: Twelve patients underwent primary C1-2 fixation, with the remaining 9 undergoing occipitocervical fusion. Five patients underwent surgery for traumatic instability, seven for os odontoideum, six for congenital anomalies and three for post-infectious instability. Follow up for 20 patients averaged 34 months (range 2-93 months). Five patients had Trisomy 21 and all underwent C1-2 fixation. Frameless stereotactic image guidance was utilised in five patients. No patients suffered immediate complications resulting from craniocervical junction fusion. Patients were observed to either neurologically improve ( n  = 6), or arrest their neurological deterioration following surgical intervention ( n  = 14), with concomitant radiological evidence of osseous fusion at follow up in 18 of 20 patients (90%). Two patients (10%) had radiological evidence of screw lucency, but neither required intervention because of being asymptomatic., Conclusions: Craniocervical fixation in a paediatric population is a viable and safe treatment modality for the management of disorders requiring stabilisation at the craniocervical junction. Our experience of utilising frameless stereotaxy in the setting of grossly distorted anatomical landmarks is also reported.

Background: Posterior reversible encephalopathy syndrome (PRES) can occur due to the detrimental effect of malignant hypertension on cerebral autoregulation. Most reported cases describe involvement of the supratentorial areas. Involvement of the posterior fossa structures in conjunction with supratentorial involvement has also been reported; however, PRES affecting the infratentorial structures without supratentorial involvement is a rare phenomenon. Clinical manifestations can involve severe headache, seizures, and reduced consciousness with treatment focused primarily on blood pressure control., Case Description: We report a case of PRES with isolated involvement of the infratentorial structures leading to obstructive hydrocephalus. The patient was managed with aggressive control of blood pressure and avoided ventriculostomy or posterior fossa decompression with a good outcome., Conclusion: Medical management in the absence of neurological deficit can be associated with a good outcome., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Surgical Neurology International.)