Benner's model of skill acquisition is currently receiving considerable interest from nurse educationalists, and promises to form the basis for some curricula offered by colleagues of nurse education. This paper debates the 'novice to expert' model and seeks to explain exactly what an 'expert' is. The Benner model proposes that one component of expertise is working from an intuitive base. This claim is disputed and the definition of intuition is contested. Alternative explanations to account for the intuitive responses of Benner's subjects are suggested.

This paper describes the results of 500 percutaneous catheterisations of the internal jugular vein. The first 200 of these have been previously reported 1.Several techniques of central venous catheterisation for pressure recording or mixed venous sampling have been developed previously. The complications of infraclavicular subclavian venepuncture have been described by several authors, the commonest being pneumothorax. Damage to the subclavian vein, extravenous placement of the catheter in the tissues or pleural cavity and septicaemia have also occurred*-5. A supraclavicular technique has been described with a low incidence of complications 6 although we have as yet no experience with this method. Percutaneous femoral vein catheterisation has also been described but has a high (46 %) complication rate including four fatalities from septicaemia'. The insertion of a long catheter from the antecubital fossa either by cutdown or venepuncture quite often results in thrombophlebitis and it is frequently difficult to thread the catheter into the central veins. External jugular venous anatomy is inconstant and it is difficult to thread a catheter past the valve commonly present at its termination5.The value of central venous pressure monitoring is unquestioned and as it is frequently necessary in cardiac surgery we have developed two techniques for catheterising the internal jugular vein by percutaneous venepuncture. A N A T O M YThe internal jugular vein emerges from the base of the skull posterior to the internal carotid artery. It terminates at the inner border of the anterior end of the first rib behind the clavicle. During its course through the neck it becomes lateral and then antero-lateral to the carotid arteries and is covered superficially for most of its length by the sternomastoid muscle. The posterior belly of the digastric muscle, the omohyoid muscle and the vessels and nerves to sternomastoid cross the vein superficially. When the head is turned to the opposite side the internal jugular vein in the lower part I

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BackgroundA wide variety of braces are commercially available designed for the adolescent idiopathic scoliosis (AIS), but very few braces for infantile scoliosis (IS) or juvenile scoliosis (JS). The goals of this study were: 1) to briefly introduce an elongation bending derotation brace (EBDB) in the treatment of IS or JS; 2) to investigate changes of Cobb angles in the AP view of X-ray between in and out of the EBDB at 0, 3, 6, 9, and 12 months; 3) to compare differences of Cobb angles (out of brace) in 3, 6, 9, and12 month with the baseline; 4) to investigate changes (out of brace) in JS and IS groups separately.MethodsThirty-eight patients with IS or JS were recruited retrospectively for this study. Spinal manipulation was performed using a stockinet. This was done simultaneously with a surface topography scan. The procedure was done in the operating room for IS, or in a clinical setting for JS. The brace was edited and fabricated using CAD/CAM method. Radiographs were recorded in and out of bracing approximately every 3 months from baseline to 12 months. A linear mixed effects model was used to compare in and out of bracing, and out of brace Cobb angle change over the 12 month period.ResultsOverall, 37.5% of curves are corrected and 37.5% stabilized after 12 months (Thoracic curves 48% correction, 19% stabilization; thoracolumbar curves 33% correction, 56% stabilization and lumbar curves 29% correction, 50% stabilization). The juvenile group had 25.7% correction and 42.9% stabilization, while the infantile group had 50% correction and 32.1% stabilization. There was a significant Cobb angle in-brace reduction in the thoracic (11°), thoracolumbar (12°), and lumbar (12°) (p < 0.001). There was no statistically significant change in out of brace Cobb angle from baseline to month 12 (p > 0.05). No patients required surgery within the 12 month span.ConclusionsThis study describes a new clinical protocol in the development of the EBDB. Short-term results show brace is effective in preventing IS or JS curve progression over a 12 month span.