In October 2000 two schoolgirls were swept away from their party whilst 'river walking' in Stainforth Beck near Settle in North Yorkshire. The paper examines this incident with reference to media coverage of the events at the time and the subsequent reportage. The discussion contributes to the debate concerning the appropriateness of an agenda of broadening education. We argue from a position that supports the principle of breadth, particularly when such activities are part of adventure education with its propensity to engage with outdoor risk settings. Whilst lessons must be learnt from such a tragic incident, it is important that outdoor professionals continue to disseminate the positive potential of adventure in order to offset the negative messages concerning risk promoted by the media in general.
Objective Currently there is variation in perioperative care of orthognathic surgery patients and limited clinical practice guidelines. The current orthognathic surgery practice patterns among US academic OMFS training centers have not been described. The purpose of this study is to describe the practice patterns among US academic OMFS training centers. Design The study design is cross-sectional. Data was collected through a survey of the sample. Setting OMFS programs in the US. Participants Academic OMFS. 573 surgeons were contacted and 85 responses were received. Main Outcome Measure Descriptive and bivariate statistics were reported. Results Respondents were 87% male and worked in full-time academic (80%), part-time academic (19%), or military settings (1%). Thirty-one percent have practiced for 30 years or more and then 29% with 11–20 years, 18% with 21–30 years, 12% with 6–10 years and 11% with 1–5 years. Twenty-six percent of respondents perform 20–40 orthognathic surgeries a year, 22% perform less than 20 surgeries a year, 21% perform 40–60 surgeries per year, and 19% perform more than 100 surgeries per year. Intraoperatively, 48% of surgeons request a mean arterial pressure of 60–64 mmHg, 25% utilize tranexamic acid (TXA), 85% report a blood loss of less than 400 milliliters, and 93% report a blood transfusion rate of <1%. Conclusion There are variations in orthognathic surgery practice patterns with limited clinical practice guidelines. Only 13 of the 32 survey questions had a single response holding a simple majority. This study demonstrates the need for further research and evidence-based protocols and decision making.
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