Background and objectiveMedical students can make valuable contributions to patient care during clinical placements. The aim of this study was to investigate student perceptions of the value of general practice placements for their learning, and their sense of contribution during their placements. MethodsThe study used a qualitative design to gather in-depth student perspectives on learning and contributions, using focus groups of final-year medical students on general practice placement. ResultsThirteen students participated in one of three focus groups. Students reported valuable learning affordances in general practice and identified contributions to improved workflow, rapport-building, patient education, encouraging clinician reflection and shared learning between general practitioner and student. DiscussionStudent perspectives of value-adding on general practice placements, and a deeper understanding of these learning environments, may enable general practice supervisors to facilitate placements that maximise these benefits.
Internationally ischaemic heart disease (IHD) is the single most common cause of death, and its frequency is increasing. The relative incidences of ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) are decreasing and increasing, respectively. In European countries, the incidence rate for STEMI ranges from 43 to 144 per 100,000 population per year. Similarly, the reported adjusted incidence rates from the USA decreased from 133 per 100,000 in 1999 to 50 per 100,000 in 2008, whereas the incidence of NSTEMI remained constant or increased slightly. STEMI is more common in younger than in older people and is more common in men than in women.Mortality in STEMI is associated with advanced age, Killip class, time delay to treatment, presence of emergency medical system (EMS)-based STEMI networks, treatment strategy, history of MI, diabetes mellitus, renal failure, number of diseased coronary arteries and left ventricular ejection fraction (LVEF). Overall mortality from STEMI remains substantial with the in-hospital mortality of unselected patients with STEMI in the national registries of the European Society of Cardiology (ESC) member countries varying between 4% and 12%. Whilst reported 1-year mortality among STEMI patients in other registries is approximately 10%.Although IHD develops later in women compared with men, MI remains a leading cause of death in women. Acute coronary syndrome (ACS) occurs three to four times more often in men than in women below the age of 60 years, but after the age of 75, women represent the majority of patients. Women may present with atypical symptoms-seen in up to 30% in some registries. It is therefore important to be
Summary: A 69-year-old man presented with an accidental, self-inflicted, through-and-through left foot gunshot wound. An entry wound on the dorsum of the foot was noted, with a larger exit wound on the plantar aspect. X-ray revealed comminuted fractures of the second, third, fourth, and fifth metatarsals with numerous foreign bodies. Immediate excisional debridement was performed, and negative-pressure wound therapy was applied. A second look was performed 48 hours later. Five days after initial debridement, a Kirschner wire was utilized for fixation of the second metatarsal fracture, and an external fixator applied to the fifth metatarsal due to extensive bone loss. A free gracilis muscle flap was used to fill the defect, with plans for a vascularized bone graft at a later date. The flap was tunneled through the wound to the plantar aspect of the foot, with an overlying split-thickness skin graft. The patient’s postoperative course was uncomplicated, and secondary bone grafting was not required. The gracilis flap was used to reconstruct the bony and soft tissue defects, and secondary muscle fibrosis appeared to provide adequate skeletal support. The patient was full weight-bearing by 4 months and has since returned to his preoperative activities, baseline gait, and regular footwear. The free gracilis muscle flap may serve as a valuable reconstructive option for through-and-through gunshot wounds to the foot, restoring both contour and function, while eliminating the need for secondary bone grafting.
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