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The present study describes the management of suspected shoulder dislocations in ski field clinics.Data were collected from two clinics in Queenstown, New Zealand. Suspected anterior shoulder dislocations, with no suspicion of significant fractures and without imaging, underwent attempted reduction.Ninety percent (n = 49) of dislocations were successfully relocated. No short-term complications because of this procedure were observed.This short report raises the possibility that early anterior shoulder reduction in a ski field clinic can be safe without imaging, in select cases. Prospective studies including patient centred data are recommended.

Background In patients undergoing elective cardiac surgery, the prevalence of inspiratory muscle weakness is not well-understood. This information could guide pre-operative therapy. Objectives To determine the prevalence of inspiratory muscle weakness in preoperative cardiac surgery patients, and describe relationships between pre-operative factors (including maximal inspiratory pressure, MIP) and post-operative pulmonary complications (PPCs). Methods Prospective study of elective cardiac surgery patients. Pre-operative MIP was measured (cmH2O) and PPC data were extracted from medical records (Melbourne Group Score) while age, height, weight, frailty and physical activity levels were captured via questionnaire. Backwards-stepwise logistic regression was used to describe associations. Results 24 participants were recruited (79% male, age 70 ± 10.7, BMI 26.8 ± 4.14). The prevalence of inspiratory muscle weakness (MIP Conclusion The prevalence of pre-operative inspiratory muscle weakness was 25%. BMI may be an important determinant of PPCs in elective cardiac surgery patients.

This study investigates the experiences of undergraduate paramedic students completing interprofessional clinical placements in snow sport injury clinics. Qualitative methods were used to investigate the experiences of participants (n=6) undertaking a non-traditional ambulance clinical placements as part of a multidisciplinary healthcare team. Ethical approval was obtained through X University. Data were collected via one-on-one face-to-face interviews and analysed using holistic and focused coding. Results were divided into three main categories, namely pre-placement, intra-placement and post placement phases. As it was a new placement, student capabilities were not initially known by clinic staff. Nevertheless the workplace culture was inclusive and supportive, and paramedic skills were applicable in the clinic environment. Despite the placement costs being excessive, participants viewed it as an investment in their future careers. Benefits of the placement included improved maturity levels, acquisition of professional networks, an understanding of interprofessional practice and an exposure to clinical skills not normally practiced on traditional ambulance placements. The interprofessional clinical placement appears to be a valid alternative to traditional ambulance placements. However, using this model to replace mainstream placements is problematic due to the costs involved, the limited number of spots available and the seasonal occurrence of snow sports.

This study investigates the experiences of undergraduate paramedic students completing interprofessional clinical placements in snow sport injury clinics. Qualitative methods were used to investigate the experiences of participants (n=6) undertaking non-traditional ambulance clinical placements as part of a multidisciplinary healthcare team. Ethical approval was obtained through Queensland University of Technology, Brisbane Australia. Data were collected via individual face-to-face interviews and analysed using holistic and focused coding. The analysed results indicated the presence of three main categories, namely Pre-Placement, Intra-Placement and Post-Placement phases. As it was a new placement, student capabilities were not initially known by clinic staff. Nevertheless the workplace culture was inclusive and supportive, and paramedic skills were applicable in the clinic environment. Despite the placement costs being excessive, participants viewed it as an investment in their future careers. Benefits of the placement included perceived improvement in maturity levels, the acquisition of professional networks, an understanding of interprofessional practice and an exposure to clinical skills not normally practiced during traditional ambulance placements. The interprofessional clinical placement appears to be a valid alternative to traditional ambulance placements. However, using this model to replace mainstream placements is problematic due to the costs involved, the limited number of spots available and the seasonal occurrence of snow sports.

To review the clinical course and outcome of patients with infective endocarditis proceeding to surgical treatment in the South Island of New Zealand.A retrospective review of all cases of infective endocarditis requiring cardiac surgery, excepting homograft replacement between 1989 and June 2001 was performed. All patients treated at both cardiothoracic units over this time frame in the South Island of New Zealand were included.A total of 29 patients, ten females and nineteen males, age range 31-79 years (mean 55) underwent surgery. 27 patients had native valve endocarditis, two infection of prosthetic valves. A variety of causative micro-organisms were isolated, and all patients received aggressive intravenous antibiotic therapy. Heart failure was the predominant indication for surgical intervention. Fifteen patients underwent aortic, nine mitral, three combined and two replacement of infected prosthetic valves. There were five peri-operative deaths (17% mortality) and significant morbidity in a further eleven patients (38%). Of the 23 survivors available to follow-up none have recurrent endocarditis, with an average disease free survival of 35 months.Patients who require valve surgery for endocarditis have significant peri-operative morbidity and mortality. Long-term outcome in survivors, however, is extremely good with a prognosis similar to those undergoing elective valve replacement surgery. Mycotic cerebral aneurysms are an emerging important cause of early deaths.