In-service Initial Teacher Education in the Learning and Skills Sector in England: Integrating Course and Workplace Learning

The aim of the paper is to advance understanding of in-service learning and skills sector trainee teachers’ learning and propose ways of improving their learning. A conceptual framework is developed by extending Billett’s (International Journal of Educational Research 47:232–240, 2008) conceptualisation of workplace learning, as a relationally interdependent process between the opportunities workplaces afford for activities and interactions and how individuals engage with these, to a third base of participation, the affordances of the initial teacher education course. Hager and Hodkinson’s (British Educational Research Journal 35:619–638, 2009) metaphor of ‘learning as becoming’ is used to conceptualise the ways trainees reconstruct learning in a continuous transactional process of boundary crossing between course and workplace. The findings of six longitudinal case studies of trainees’ development, and evidence from other studies, illustrate the complex interrelationships between LSS workplace affordances, course affordances and trainee characteristics and the ways in which trainees reconstruct learning in each setting. The experience of teaching and interacting with learners, interactions with colleagues, and access to workplace resources and training are important workplace affordances for learning. However, some trainees have limited access to these affordances. Teaching observations, course activities and experiences as a learner are significant course affordances. Trainees’ beliefs, prior experiences and dispositions vary and significantly influence their engagement with course and workplace affordances. It is proposed that better integration of course and workplace learning through guided participation in an intentional workplace curriculum and attention to the ways trainees choose to engage with this, together with the use of practical theorising has the potential to improve trainee learning

Acute and chronic kidney disease in elderly patients with hip fracture: prevalence, risk factors and outcome with development and validation of a risk prediction model for acute kidney injury

Background Hip fracture is a common injury in older people with a high rate of postoperative morbidity and mortality. This patient group is also at high risk of acute kidney injury (AKI) and chronic kidney disease (CKD), but little is known of the impact of kidney disease on outcome following hip fracture. Methods An observational cohort of consecutive patients with hip fracture in a large UK secondary care hospital. Predictive modelling of outcomes using development and validation datasets. Inclusion: all patients admitted with hip fracture with sufficient serum creatinine measurements to define acute kidney injury. Main outcome measures – development of acute kidney injury during admission; mortality (in hospital, 30-365 day and to follow-up); length of hospital stay. Results Data were available for 2848 / 2959 consecutive admissions from 2007-2011; 776 (27.2%) male. Acute kidney injury occurs in 24%; development of acute kidney injury is independently associated with male sex (OR 1.48 (1.21 to 1.80), premorbid chronic kidney disease stage 3B or worse (OR 1.52 (1.19 to 1.93)), age (OR 3.4 (2.29 to 5.2) for >85 years) and greater than one major co-morbidities (OR 1.61 (1.34 to 1.93)). Acute kidney injury of any stage is associated with an increased hazard of death, and increased length of stay (Acute kidney injury: 19.1 (IQR 13 to 31) days; no acute kidney injury 15 (11 to 23) days). A simplified predictive model containing Age, CKD stage (3B-5), two or more comorbidities, and male sex had an area under the ROC curve of 0.63 (0.60 to 0.67). Conclusions Acute kidney injury following hip fracture is common and associated with worse outcome and greater hospital length of stay. With the number of people experiencing hip fracture predicted to rise, recognition of risk factors and optimal perioperative management of acute kidney injury will become even more important

Thigh-length compression stockings and DVT after stroke

Controversy exists as to whether neoadjuvant chemotherapy improves survival in patients with invasive bladder cancer, despite randomised controlled trials of more than 3000 patients. We undertook a systematic review and meta-analysis to assess the effect of such treatment on survival in patients with this disease