No abstract

In this commentary article, we describe the impact that an ageing population is having on the nature of major trauma seen in emergency departments. The proportion of major trauma victims who are older people is rapidly increasing and a fall from standing is now the most common mechanism of injury in major trauma. Potential barriers to effective care of this patient group are highlighted, including: a lack of consensus regarding triage criteria; potentially misleading physiological parameters within triage criteria; non-linear patient presentations and diagnostic nihilism. We argue that the complex ongoing care and rehabilitation needs of older patients with major trauma may be best met through Comprehensive Geriatric Assessment (CGA). Furthermore, the use of frailty screening tools may facilitate more informed early decision-making in relation to treatment interventions in older trauma victims. We call for geriatric medicine and emergency medicine departments to collaborate-equipping urgent care staff with the basic competencies necessary to initiate CGA should be a priority, and geriatricians have a key role to play in delivery of such educational interventions.

Introduction:As the number of patients sustaining hip fractures increases, interventions aimed at improving patient comfort and reducing complication burden acquire increased importance. Frailty, cognitive impairment, and difficulty in assessing pain control characterize this population. In order to inform future care, a review of pain assessment and the use of preoperative intravenous paracetamol (IVP) is presented.Materials and Methods:Systematic review of preoperative IVP administration in patients presenting with a hip fracture.Results:Intravenous paracetamol is effective in the early management of pain control in the hip fracture population. There is a considerable decrease in use of breakthrough pain medications when compared with other pain relief modalities. Additionally, IVP reduces the incidence of opioid-induced complications, reduces length of stay, and lowers mean pain scores. Another significant finding of this study is the poor administration of all analgesics to patients with hip fracture with up to 72% receiving no prehospital analgesia.Discussion:The potential benefits of IVP as routine in the early management of hip fracture-related pain are clear. Studies of direct comparison between analgesia regimes to inform optimum bundles of analgesic care are sparse. This study highlights the need for properly constructed pathway-driven comparator studies of contemporary analgesia regimes, with IVP as a central feature to optimize pain control and minimize analgesia-related morbidity in this vulnerable population.

fern… As Macfarlane writes, these nature-words were recently deemed no longer relevant to modern-day childhood and deleted from a new edition of the Oxford Junior Dictionary. The entries that replaced them included attachment, blog, broadband, bullet-point, celebrity, and chatroom. According to the head of children's dictionaries at Oxford University Press, the substitutions made in the dictionary reflected the consensus of experience of modern-day childhood-a childhood in which the outdoor and the natural has been displaced by the indoor and the virtual (Macfarlane, 2015). This paper considers some of the undercurrents of modern-day childhood that are portrayed by OUP's decision-of feelings about children's access to and engagement with nature, and the educational management of the relationship between children and nature-by following the progress of a small rural primary school in the UK as it goes about transforming its outdoor spaces. The paper does not seek to evaluate the benefits of outdoor learning, but explores the significance of these outdoor spaces as they are imagined, made, and experienced, from the first design stages to the first days of use. It is a whole school project, blending the voices of adults and children to document a process. Combining observations and insights gathered over two years, including four site visits, interviews with teachers, ethnographic observation in classes and at break times, observant participation at design workshops, and multimodal methods workshops conducted with the school's pupils, the paper tracks the ways in which outdoor spaces are created by adults and children, and considers the ways in which the creation of spaces can influence and shift school practices and cultures. As such, the paper is concerned with the creation of different possible futures. The paper consists of four sections. The first section, 'School spaces and childhood places' reviews sociological and geographical work on childhood and space in order to consider what is at stake in the relationships between children and nature. Section two, 'Fieldwork' introduces the school project and expands on the multimodal methods that I used. The next two sections, 'Imagining a new future' and 'Experiencing a new outdoors' portray the hard work done by one primary school, and discuss how participation, imagination and risk shape and are shaped by the ambition to create a new future. In conclusion, I suggest that there is much to learn from

Weaving together observations and insights from ethnographic research gathered over two years, this article considers how design and everyday life intertwine to create convivial places, but also pauses to take in the moments when tensions rise and conviviality fails. To illustrate, the article takes as an example the redevelopment of a small urban square in London, designed by landscape architects Gustafson Porter and completed in 2011. Gustafson Porter’s practice is deeply informed by inclusive design, and they strive to design barrier-free environments that ‘promote choice, flexibility of use and enable everyone to participate equally’. Taking in both the material design of the square and the social encounters that happen there, the article considers how inclusion and exclusion operate in a public space like General Gordon Square, and reflects on the challenges of making and maintaining conviviality. It suggests that inclusive design might be imagined as a vision of convivial culture in which we live together with difference.