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As the numbers of arthroplasties performed worldwide increase, so do complications such as prosthetic joint infection. Cases that require a two-stage revision of a total femur replacement in the femur pose an ongoing challenge to the modern orthopedic surgeon. Unlike antibiotic spacers in hip and knee arthroplasty, there lacks a commercially available cement spacer for use in total femur replacements. We describe a novel technique for the intraoperative fabrication of a total femur spacer which uses modular components. As such, our technique is unique as it is modular and, therefore, highly customisable to each individual patient. Individual components can be made by different members of the team simultaneously and then assembled to make the final construct, thereby minimizing operative time. Furthermore, the inherent stability of the spacer allows immediate partial weightbearing and functional rehabilitation while patients are waiting for their second-stage procedure.

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Have you ever thought about the lay term chickenpox and wondered where it came from? Or what the corresponding terms might be in other languages? Chickenpox has a fascinating etymology that can serve as an entertaining teaching and learning opportunity for busy clinicians and their trainees. Four facts about the term are presented, each of which contributes to an illustration of the history of the disease, but also offers a deeper understanding of the transmission and clinical features of the illness. Etymological and linguistic origins also illustrate how parents and doctors have observed, explained and feared the condition.

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BACKGROUND: Whilst annual influenza vaccination is recommended for healthcare workers (HCWs), many remain unvaccinated. Our study aim was to identify the main motivators and barriers that influenced the decisions of HCWs regarding influenza vaccination. METHODS: A cross-sectional study design was employed using a survey for data collection. From June - September 2015, 327 HCWs employed at Canberra Hospital were surveyed. Data were collected on employment position, influenza vaccination history, reasons behind individual decisions on vaccination, and attitudes to ongoing vaccination. Both fixed and optional free-text responses were sought and analysed. RESULTS: Major motivators for vaccination included protection of others, personal protection and professional habit. Major barriers to vaccination included concerns about vaccine safety and efficacy, and difficulties accessing vaccination. The main factors that would encourage unvaccinated staff to be vaccinated included protecting patients and family, and reassurance regarding the safety and efficacy of vaccination. CONCLUSION: Both educational messages and operational strategies need to be implemented to optimise vaccine uptake. Educational material needs to focus on professional responsibility, the broad protective benefits of vaccination and misconceptions about the safety and efficacy of the vaccine. Operational strategies should cover workplace access to vaccination, communication on vaccination policies, and leadership from senior staff.

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BACKGROUND: This study was designed to assess the motivations of senior medical clinicians to teach medical students. This understanding could improve the recruitment and retention of important clinical teachers. METHODS: The study group was 101 senior medical clinicians registered on a teaching list for a medical school teaching hospital (The Canberra Hospital, ACT, Australia). Their motivations to teach medical students were assessed applying Q methodology. RESULTS: Of the 75 participants, 18 (24%) were female and 57 (76%) were male. The age distribution was as follows: 30-40 years = 16 participants (21.3%), 41-55 years = 46 participants (61.3%) and > 55 years = 13 participants (17.3%). Most participants (n = 48, 64%) were staff specialists and 27 (36%) were visiting medical officers. Half of the participants were internists (n = 39, 52%), 12 (16%) were surgeons, and 24 (32%) were other sub-specialists. Of the 26 senior clinicians that did not participate, two were women; 15 were visiting medical officers and 11 were staff specialists; 16 were internists, 9 were surgeons and there was one other sub-specialist. The majority of these non-participating clinicians fell in the 41-55 year age group. The participating clinicians were moderately homogenous in their responses. Factor analysis produced 4 factors: one summarising positive motivations for teaching and three capturing impediments for teaching. The main factors influencing motivation to teach medical students were intrinsic issues such as altruism, intellectual satisfaction, personal skills and truth seeking. The reasons for not teaching included no strong involvement in course design, a heavy clinical load or feeling it was a waste of time. CONCLUSION: This study provides some insights into factors that may be utilised in the design of teaching programs that meet teacher motivations and ultimately enhance the effectiveness of the medical teaching workforce.

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Little published information exists about the issues involved in conducting complex intravenous medication therapy in patients' homes. An ethnographic study of a local hospital-in-the-home program in the Australian Capital Territory explored this phenomenon to identify those factors that had an impact on the use of medicine in the home environment. This article focuses on one of the three themes identified in the study-Clinical Practice. Within this theme, topics related to the organization and management of intravenous medications, geography and diversity of patient caseload, and communication in the practice setting are discussed. These findings have important implications for policy development and establishment of a research agenda for hospital-in-the-home services.

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OBJECTIVE: To determine the attitudes of Australian junior doctors towards white coats. METHODS: We carried out a multicentred mail survey in 13 Australian teaching hospitals. A total of 337 junior medical officers (JMOs) completed an eight-item questionnaire. The survey sought to establish JMOs' views and preferences regarding the wearing of white coats and the reasons behind them. RESULTS: Very few Australian JMOs wear white coats. Many reasons for not wearing white coats were given, the most common being 'No one else wears a white coat' (70%). A total of 60% of JMOs are against wearing white coats; 24% are indifferent on the issue and only 16% expressed a general preference for white coats. Junior medical officers who did prefer white coats indicated reasons of convenience for carrying items, identification and/or professionalism, and hygiene and/or cleanliness. CONCLUSIONS: White coats have largely disappeared from Australian teaching hospitals and the majority of junior doctors in Australia oppose the wearing of white coats.

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