Search

Bladder injury is frequently associated with complex pelvic fractures with men being the predominant population to sustain such injuries. Entrapment of the bladder through the site of pelvic fracture is a rare clinical entity. We report a case of an entrapped bladder post closed reduction and external fixation of an unstable anteroposterior compression type 3 (APC-3) fracture. This report highlights the diagnostic difficulty with identifying an entrapped bladder and the patient’s functional outcome after 1 year of follow-up. [ABSTRACT FROM AUTHOR]

Purpose: Pelvic anterior internal fixators (INFIX) are a relatively new alternative in the treatment of unstable pelvic fractures. The authors wanted to review the use of complications and outcomes of this method of pelvic fixation at our institution. Method: Patients over the age of 18 who had an INFIX used in treatment of their pelvic ring injury were identified. Patient demographics, fracture type, injury severity score, morbidity, complications and time until removal were recorded. All available patients were followed up following the removal of the INFIX and completed an Iowa Pelvic Score (IPS) at this time. Results and Discussion: 24 patients (19 male) with a mean age of 38.5 (range 18–71) met the inclusion criteria with an average injury severity score of 29.8 (10–66). The most common complication following insertion was a lateral femoral cutaneous nerve (LFCN) injury, which occurred in 11 patients (bilaterally in two), 6 patients (25%) had ongoing numbness 6 months post removal. Two patients had an infection, one of which prompted the removal of the INFIX. One INFIX was removed for implant failure. All other removals were planned electively. Heterotopic ossification was noted to have occurred in five cases. The mean IPS following removal of the INFIX was 79.2 (52–100). INFIX is a safe and successful treatment for unstable pelvic ring injuries. Overall, patients tolerate the INFIX well with good outcome scores. The main concern being the high rate of LFCN injuries, although many resolved after removal of the INFIX.

With the formation of the Learning and Skills Council (LSC) in 2001, a single post-16 learning and skills sector (LSS) was created for the first time in England with huge potential to support lifelong learning. It was this momentous change that prompted the authors in 2004 to begin a study entitled "The impact of policy on learning and inclusion in the new learning and skills sector," funded by the Economic and Social Research Council as part of its Teaching and Learning Research Programme. Three and a half years later, as the authors were completing their research, the unified LSS was being dismantled, to be replaced by an age-based bifurcated system. The Department for Children, Schools and Families (DCSF) took over responsibility for all education up to the age of 19 and the Department for Innovation, Universities and Skills (DIUS) was charged with the education of those over the age of 19. In this article, the authors reflect on the findings from their research and what its relevance might be for the new arrangements.

Using data from a three-year project funded under the ESRC Teaching and Learning Research Programme, this article examines two major questions: (1) How has the organisation of the learning and skills sector (LSS) in England changed as a result of recent policy? (2) What are the implications of these reforms? We draw on the theoretical work of policy analysts such as Ball and Newman, as well as our own conceptual work, to make sense of 15 major policy documents and over 130 in-depth interviews with European, national, regional and local policy-actors carried out during the period 2004-2007. Having described recent reform in the LSS, we argue that the government appears to have moved from a "planned" and unified to a more directive and market-oriented model of governance. We discuss the implications of this policy shift and introduce the concept of a "devolved social partnership system" as a possible way forward for the sector. (Contains 3 figures and 9 notes.)

The TLRP project reported on in this article attempts to understand how the Learning and Skills sector functions. It traces how education and training policy percolates down through many levels in the English system and how these levels interact, or fail to interact. The authors first focus upon how policy impacts upon the interests of three groups of learners: unemployed people in adult and community learning centres, adult employees in work-based learning and younger learners on Level 1 and Level 2 courses in further education. They focus next upon how professionals in these three settings struggle to cope with two sets of pressures upon them: those exerted by government and a broader set of professional, institutional and local factors. They describe in particular how managers and tutors mediate national policy and translate it (and sometimes mistranslate it) into local plans and practices. Finally, the authors criticise the new government model of public service reform for failing to harness the knowledge, good will and energy of staff working in the sector, and for ignoring what constitutes the main finding of the research: the central importance of the relationship between tutor and students. (Contains 3 figures, 2 tables and 6 notes.)

This paper explores the impact of change on tutors and managers in 24 learning sites in England, in vocational courses at Level 1 or Level 2 in further education (FE) colleges and in basic skills provision in adult community education and workplaces. We discuss the views of these participants in the research project, "The Impact of Policy on Learning and Inclusion in the Learning and Skills Sector," funded through the Teaching and Learning Research Programme (TLRP) of the UK Economic and Social Research Council (ESRC), in relation to other research on professionals in the sector. We then consider in turn the diversity in a group of tutors and managers we interviewed; their perceptions of the sources of change in their sector; and changes in the learner groups with whom they work. Three examples of changes affecting staff, and their responses to those changes, are then discussed, one from each of the research contexts: FE colleges, adult and community learning (ACL) and work-based learning (WBL). We raise serious questions about the pace of policy-led change, the management of change and professionals' responses to turbulence in the sector, and stress the need to consider the impact on staff, and to listen to those who work closely with learners. (Contains 1 table and 3 notes.)

One of the stated aims of government policy in England is to put teaching, training and learning at the heart of the learning and skills system. This paper provides a critical review of policies on teaching, learning and assessment in the learning and skills sector over the past five years. It draws upon data collected and analysed in the early stages of an ESRC-funded Teaching and Learning Research Programme project. Using evidence from policy sources, we argue that despite policy rhetoric about devolution of responsibility to the "front line", the dominant "images" that government has of putting teaching, learning and assessment at the heart of the learning and skills sector involves a narrow concept of learning and skills; an idealization of learner agency lacking an appreciation of the pivotal role of the learner-tutor relationship and a top-down view of change in which central government agencies are relied on to secure education standards. (Contains 2 tables and 4 notes.)

This paper examines the changing use of policy levers in the English postcompulsory education and training system, often referred to as the learning and skills sector (LSS). Policy steering by governments has increased significantly in recent years, bringing with it the development of new forms of arms-length regulation. In the English context, these changes were expressed during the 1980s and 1990s through neoliberal New Public Management and, since 1997, have been extended through the New Labour government's project to further "modernise" public services. We look here at the changing use of policy levers (focussing in particular on the role of targets, funding, inspection, planning and initiatives) over three historical phases, paying particular attention to developments since the formation of the Learning and Skills Council (LSC) in 2001. We conclude by considering the range of responses adopted by education professionals in this era of "modernisation". (Contains 1 table and 8 notes.)

This is the first paper from a project which is part of the Economic and Social Research Council's programme of research into "Teaching and learning". The project, entitled "The impact of policy on learning and inclusion in the new learning and skills sector", explores what impact the efforts to create a single learning and skills system are having on teaching, learning, assessment and inclusion for three marginalized groups of post-16 learners. Drawing primarily on policy documents and 62 in-depth interviews with national, regional and local policy-makers in England, the paper points to a complex, confusing and constantly changing landscape. In particular, it deals with the formation, early years and recent reorganization of the Learning and Skills Council (LSC), its roles, relations with government, its rather limited power, its partnerships and likely futures. While the formation of a more unified learning and skills system is broadly seen as a necessary step in overcoming the fragmentation and inequalities of the previous post-16 sector, interviewees also highlighted problems, some of which may not simply abate with the passing of time. Political expectations of change are high, but the LSC and its partners are expected to carry through "transformational" strategies without the necessary "tools for the job". In addition, some features of the learning and skills sector policy landscape still remain unreformed or need to be reorganized. The LSC and its partners are at the receiving end of a series of policy drivers (e.g. planning, funding, targets, inspection and initiatives) that may have partial or even perverse effects on the groups of marginalized learners we are studying.

Introduction Methods Results Conclusion The global standard of care for hip fracture surgery is early weight‐bearing, but this has not extended to other lower extremity fractures in the elderly. Patients undergoing fixation of distal femur fractures are often prescribed weight‐bearing restrictions, which may lead to deconditioning and other complications. The purpose of this study was to compare the outcomes and complication rates between patients permitted early versus restricted weight‐bearing following distal femur fracture fixation.Medline, Embase, Cochrane and Web of Science databases were searched for English language articles up to 21 October 2023, identifying 366 studies for screening. Comparative studies evaluating patients undergoing distal femur fracture fixation with early or restricted weight‐bearing were included. Native knee and periprosthetic fractures were included.Ten studies were included for analysis. Two studies provided Level II evidence, while the remaining eight studies provided Level III evidence. Cochrane risk of bias tools were utilized to assess study quality. Revision and complication rates were analyzed and reported as odds ratio. Sub‐analysis was undertaken to address the heterogeneity in author definitions of weight‐bearing. There was no statistically significant difference in the revision or complication rate between the two groups.Early weight‐bearing following distal femur fracture fixation in a predominantly elderly population does not demonstrate an increased rate of revision or complications compared to restricted weight‐bearing. However, there are limitations to the available literature, and the strength of the findings is insufficient to provide strong recommendations for all patients. Future studies should employ standardized definitions and avoid partial or time‐based restrictions. [ABSTRACT FROM AUTHOR]