Princess Margaret Rose Orthopaedic Hospital

Combining the research expertise of PhD-prepared nurses with the clinical insights of DNP-prepared nurses creates a collaboration to translate research into actionable practice. Despite the potential benefits, there are barriers to this collaboration. The purpose of this article was to explore the "why" and "how" regarding inconsistent collaboration between PhD- and DNP-prepared individuals within cancer care organizations and to develop strategies for improved PhD-DNP collaboration in oncology nursing. The Oncology Nursing Society (ONS) held a think tank at ONS Congress® for PhD and DNP participants. An abstraction laddering exercise explored a challenge statement regarding inconsistent collaboration between PhD- and DNP-prepared individuals within cancer care organizations. The findings from the PhD-DNP Think Tank highlight the barriers and opportunities for collaboration between PhD- and DNP-prepared nurses in oncology care. The strategies developed provide a road map for individuals and organizations to foster a culture of collaboration, ultimately enhancing patient care, education, and research in oncology nursing.

Cataract is a common condition in retinitis pigmentosa eyes. This review aims at exploring the particulars of cataract extraction in retinitis pigmentosa eyes.

Complex gait analysis systems are not generally available worldwide, and no simple system of assessing gait by observation has been validated specifically for use in patients with cerebral palsy. The authors have developed a visual gait analysis score for use in cerebral palsy. Videotaped sequences of patients were recorded before and after surgery as part of a three-dimensional gait study using a Vicon (Oxford, U.K.) gait analysis system. The score demonstrated good intraobserver and interobserver reliability. The numeric values of the score elements correlated well with the measurements obtained from instrumented gait analysis for the same patients, and the score was able to detect postoperative change.

Musculoskeletal infection during childhood is a diminishing problem in the United Kingdom. The clinical presentation may be muted and often covert. The condition remains a difficult diagnostic problem in paediatric orthopaedic practice. The clinician is faced by a child who is unwell with indeterminate symptoms and worried parents, and is concerned that subdued infection, particularly within the confines of a joint, will leave destructive changes if effective treatment is delayed. Tuberculosis presents relatively rarely, but should be considered when the social, ethnic or travel details are indicative. Pyogenic organisms are ubiquitous, often preferring the axial skeleton to a more obvious presentation in the long bones. The declaration of the inflammatory process is not simply a matter of site but reflects the effectiveness of the host response. Immunodeficiency 1 plays a role in the premature infant, in the malnourished or the child receiving cytotoxic drugs. A diminished response may also characterise ineffectual treatment with antibiotics. The altered pattern of presentation described in the paper from Glasgow in this issue of the Journal (pp 99-102) complements an earlier report by Craigen, Walters and Hackett. 2 This longitudinal study, while based on data from the Information and Statistics Division of the National Health Service (ISDN) derived from the often inaccurate SMR1 form (Scottish Hospitals discharge system), confirms a lowering of the incidence of infection in long bones in a childhood population of approximately 150 000. The review does not specifically examine whether other sites of musculoskeletal infection are still as common, or more so, but it does suggest a real alteration in the pattern of disease, possibly allied to improving standards of living. The staphylococcus is still predominant and therefore flucloxacillin remains an acceptable, if provisional, antibiotic. Surgical drainage and complications after acute osteomyelitis are unusual. The increasingly common subacute form 3 presents after a history of at least two weeks.

We have studied the relationship between movements of the foot and ankle and venous blood flow from the lower limb using colourflow Duplex ultrasound to determine the optimum type of exercise for promoting venous return. Studies of both active and passive movements were carried out on 40 limbs in 20 subjects (18 men; 2 women), with a median age of 27 years (20 to 54). We assessed ankle dorsiflexion and plantar flexion, subtalar inversion and eversion, and a combination of all movements. There was no difference in venous flow when comparing opposite limbs in a single subject (p > 0.5), but active exercises produced higher peak and mean velocities of blood flow than passive ones. The active combined movement produced the highest velocities with an increase of 38% in mean and of 58% in peak flow velocities, which were significantly greater than the peak and mean flow rates produced by passive movements. The active combined exercise would therefore be the most effective in eliminating stasis and could contribute to the prevention of deep-vein thrombosis.

The human Sonic Hedgehog gene (SHH) is one of the vertebrate homologs related to the Drosophila segment polarity gene hedgehog. The entire coding and promoter region of the SHH gene, including 2 kb 5' of the transcriptional start site has been screened for mutations in families with autosomal dominant sacral agenesis and autosomal dominant triphalangeal thumb, two conditions previously known to be linked to 7q36. We have also studied the SHH gene in five families with mirror polydactyly associated with tibial hemimelia and in 51 unrelated patients with neural tube defects. Except for two sequence variants in exon 3, no mutations were found in these disease categories. OFF