Over the last 10 years, nurse practitioners have become an essential part of the multidisciplinary orthopaedic team within a Level 1 pediatric trauma hospital. This overview will outline the process used and noted results during the development of a new model of care for pediatric orthopaedic patients, in both the hospital setting and outpatient clinics. Data from a 12-month period was reviewed in an effort to show the benefits of establishing a 1:1 model utilizing an orthopaedic surgeon and nurse practitioner. The advantages of this team concept include increased access to care, fiscal improvement, and positive patient outcomes due to standardized protocols and patient continuity.

A case-control study was conducted to assess the risk factors associated with the development of a contralateral primary breast cancer among women who had had a first primary breast cancer. Hospital records were reviewed for 292 women with an incident contralateral breast cancer, diagnosed in one of eight hospitals between July 1, 1975 and December 31, 1983, and for a comparison group of 264 surviving unilateral breast cancer patients, previously diagnosed in the same hospitals. All subjects were identified through the records of the Connecticut Tumor Registry. Having an initial tumor containing lobular carcinoma was associated with an almost twofold increased risk of developing a contralateral cancer (aOR = 1.8; 95% CI: 1.0-3.5). Among those for whom a progesterone receptor assay was available, a positive assay was associated with an increased risk of a contralateral primary (aOR = 3.2; 95% CI: 1.0-9.5). AB blood type was also associated with an elevated risk, but this elevation was not statistically significant (aOR = 2.3; 95% CI: 0.7-7.7). Having received radiation treatment was not significantly associated with the risk of a contralateral primary (aOR = 0.9; 95% CI: 0.6-1.4), whereas chemotherapy treatment was associated with a significantly lowered risk (aOR = 0.3; 95% CI: 0.1-0.7). The association with chemotherapy appeared to be modified by body build (ROR = 1.5; 95% CI: 1.0-2.3 for a 2.5-unit differential in Quetelet's index).

There were 249 patients who had spinal fusions from December 2002 through January 2006, and 11 developed an infection after their spinal fusion and had the use of the V.A.C. device. Those who developed infection within 1 year of their fusion had instrument retention. Wound closure occurred in all cases that used V.A.C. therapy.

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This short book provides a succinct account of changes in children's work and welfare in Britain between 1780 and 1890. It examines both the scale and the nature of child employment and the changing attitude of society towards it at a time when Britain was becoming the 'workshop of the world'. The further development of industry in the second half of the nineteenth century meant that the need for juvenile workers declined. At the same time the efforts of philanthropists and the State led to legal curbs on the kinds of jobs children could perform and the minimum age at which they could commence them. The author concludes that the century after 1780 saw a progressive lengthening of childhood as a stage of life, and that by 1890 children had been recognised as 'special cases' in need of protective legislation. However, for the poorest and most disadvantaged families life remained a struggle, and children continued to pick up a living where they could.