Case-based teaching and learning strategies can be utilized to assist advanced practice psychiatric nursing students in both obtaining requisite knowledge and enhancing clinical reasoning skills. We discuss the benefits of case-based learning in terms of how it (1) contributes to students' appropriate organization of information to be recalled later for use in clinical reasoning situations; (2) generates experiences that students would not otherwise have; (3) increases the visibility of students' clinical reasoning processes; and (4) enhances students' confidence. This article also explores three examples of case-based teaching and learning: use of written cases in a seminar; use of standardized patients in an assessment course; and utilization of web-based cases for learning assessment and intervention skills. Finally, we compare and contrast each of these methods in terms of their relative effectiveness in achieving each of the benefits.

Computer-Assisted Instruction↗

PubMedDate not supplied

Ligamentous instability of the knee in children sustaining fractures of the femur: a prospective study with knee examination under anesthesia.

Fifty-five children with 55 fractures of the femur were prospectively studied for the presence of ligamentous instability of the knee within 3 weeks from the time of injury. Two patients (4%) demonstrated instability on examination under anesthesia. A 9-year, 4-month-old boy sustained a second-degree injury to the lateral collateral ligament that healed after hip spica cast treatment. The other patient, a 12-year, 8-month-old boy, sustained an avulsion fracture of the posterior cruciate ligament from the tibial insertion with > 1 cm posterior displacement of the tibia on the posterior drawer test. After placement of an intramedullary rod, the avulsion fracture was treated with open reduction and internal fixation. Although the incidence of ligamentous instability of the knee in this study is less than that reported for adults with femur fractures, children should nevertheless have a thorough knee examination for ligamentous stability as well as radiographic evaluation of the knee.

Adolescent↗

PubMedDate not supplied

Influence of penicillin prophylaxis on antimicrobial resistance in nasopharyngeal S. pneumoniae among children with sickle cell anemia. The Ancillary Nasopharyngeal Culture Study of Prophylactic Penicillin Study II.

PURPOSE: To evaluate the consequences of prolonged prophylactic penicillin use on the rates of nasopharyngeal colonization with Streptococcus pneumoniae and the prevalence of resistant pneumococcal strains in children with sickle cell anemia. METHODS: Nasopharyngeal specimens were obtained from children with sickle cell anemia (Hb SS or Hb S beta degrees thalassemia) at 10 teaching hospitals throughout the United States. These patients were participating in a prospective, randomized, placebo-controlled trial in which they were prescribed prophylactic penicillin before their fifth birthday and were randomized to prophylactic penicillin or placebo after their fifth birthday (PROPS II). The specimens were cultured for S. pneumoniae, and isolates were analyzed for antimicrobial susceptibility to nine commonly prescribed antimicrobial agents. RESULTS: Of the 226 patients observed, an average of 8.4 specimens were collected per patient. From 1,896 individual culture specimens, 5.5% of the specimens were positive for S. pneumoniae; 27% of patients had at least one positive culture. Nine percent of the study patients had at least one isolate of penicillin intermediate or resistant pneumococci. There was no significant difference in the percent of positive cultures for S. pneumoniae in those patients given penicillin prophylaxis after 5 years of age (4.1%) compared with those patients given placebo after 5 years of age (6.4%). Likewise, there was no significant difference (p = 0.298) in the percent of patients with at least one positive culture for S. pneumoniae in the group given prophylactic penicillin after 5 years of age (21.8%) compared with the group given placebo after 5 years of age (28.3%). There was no difference between the penicillin and placebo groups in the proportion of patients with penicillin intermediate or resistant pneumococci, but there was a trend toward increased carriage of multiply drug-resistant pneumococci in children > 5 years of age receiving prophylactic penicillin compared to children > 5 years of age receiving placebo. The increased colonization rate with multiply drug-resistant organisms of children > 5 years of age receiving penicillin prophylaxis is not statistically significant. CONCLUSIONS: The potential for continued penicillin prophylaxis to contribute to the development of multiply resistant pneumococci should be considered before continuing penicillin prophylaxis in children with sickle cell anemia who are older than 5 years of age. Added to the published data from PROPS II, which demonstrated no apparent advantage to continue prophylaxis, the data support the conclusion that, for children with no history of invasive pneumococcal disease, consideration should be given to discontinue prophylactic penicillin after their fifth birthday.

Anemia, Sickle Cell↗

PubMedDate not supplied

An unusual cranial injury caused by an industrial nail-gun.

An unusual case of an industrial nail-gun injury is presented. A 36-year-old man was struck in the back of his neck by a nail, which was fired from a high velocity Ramset nail-gun. The nail passed through the foramen magnum to lodge in front of the brainstem. In spite of the close proximity of the nail's trajectory to the upper cervical spinal cord and the brain stem, no major neurological damage resulted. The nail was removed successfully the following day. This case illustrates the potential for serious injury from nail-guns.

Accidents, Occupational↗