Residential care for children and young people : priority areas for change

Abuse in residential childcare has been of concern to the public and the profession for a number of years. This article highlights a Scottish Institute for Residential Child Care's (SIRCC) response to the Scottish Government which was requested following allegations of abuse in Glasgow City Council's Kerelaw residential school and secure unit. It offers priority actions to address the challenges of residential childcare and ensure the safety of children and young people as far as is practicably possible. It contextualises the residential childcare task, and explores four interrelated areas in which change is strongly recommended: (1) organisations' cultures; (2) workforce challenges including the status of the sector, staff selection standards, the role of residential childcare workers in relation to their level of autonomy and their education levels; (3) abuse allegations, in particular the sector's growing fearfulness of false allegations, support for practitioners' anonymity when accused of abuse and a reconsideration of criminal record certificate information; and (4) service delivery related to behaviour management and advocacy support. The intersection between the SIRCC and the subsequent Kerelaw Inquiry reports is outlined. Finally, it concludes with a scan of the immediate strategic policy horizon which indicates an unprecedented momentum for change. While based in the Scottish context, it reflects lessons which are applicable internationally

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo