Is there a role for ischaemic pre-conditioning in orthopaedic and trauma surgery? A systematic review and meta-analysis of randomised controlled trials

Surgical procedures using a tourniquet submit tissues to ischaemia and reperfusion on restoring blood flow. Ischaemia-reperfusion may lead to local or remote tissue damage resulting in pain and complications. We aimed to evaluate the effectiveness of ischaemic preconditioning with a tourniquet in preventing pain, disability, adverse events, inflammation and facilitating recovery and discharge in patients receiving orthopaedic and trauma surgery. We conducted a systematic review of randomised controlled trials investigating ischaemic preconditioning in patients undergoing trauma and orthopaedic surgery. We searched The Cochrane Library, Medline and Embase until January 2021. Where possible continuous data were pooled and meta-analysis performed. Ten RCTs met inclusion criteria, eight of which underwent meta-analysis. Three studies reported lower acute post-operative pain or morphine consumption in patients randomised to IPC. We found weak evidence for shorter length of stay in the intervention group (MD-0.54 days; 95%CI-1.11, 0.03; p=0.0615). Malondialdehyde levels were lower in patients randomised to IPC at two hours following tourniquet deflation (MD -1.39 nmol/ml; 95%CI-2.23, -0.55; p=0.0012). We found no between group differences in Tumour Necrosis Factor-α, Lactate or Interleukin-6. The mechanism behind IPC may be related to reduced lipid peroxidation rather than reduced inflammation. There is evidence IPC reduces post-operative pain following knee surgery that merits further study

Two exhibitions of photographs

An exhibition of photographs held at the Fine Arts Gallery in 197

Marketing an Alternate Model for Science and Mathematics Initial Teacher Education

An innovative initial teacher education undergraduate degree has been offered for the first time in 2016 at an Australian University. The degree provides for qualification as a secondary science and mathematics teacher through the completion of a four-year integrated science, mathematics and education program of study where the synergies available through concurrent, integrated study of content and teacher pedagogy are available. The paper describes the results of the analysis of data from science and mathematics school teachers and career advisors in relation to the potential market for the program and perceived advantages and barriers to students selecting the degree

Perceived autonomy support as a predictor of rural students’ academic buoyancy and academic self-efficacy

Students’ academic self-beliefs are associated with their school achievement and enjoyment. However, academic self-beliefs appear to be lower in rural schools. In a sample of students in Australian rural schools (N = 974), this study investigated whether perceived autonomy support (PAS) predicted two important self-belief constructs: academic buoyancy and academic self-efficacy. The results revealed that PAS positively predicted academic buoyancy and academic self-efficacy. Multigroup structural equation modeling further identified that primary school students reported more adaptive school experiences than high school students. This research has implications for how teachers can best support students’ academic self-beliefs in rural schools

Educational leaders’ perceptions of STEM education revealed by their drawings and texts

This study explored school principals\u27 and teacher educators\u27 perceptions of STEM education based on how they described STEM as a discipline, their understanding of the nature of teaching and learning of STEM, and the capabilities of a STEM-educated person. Data were generated through the Draw a STEM Learning Environment (D-STEM) instrument comprising drawn and written descriptions where participants drew a picture of a STEM learning environment and completed five prompt statements about what STEM is and how an individual develops personal STEM capability. The Legitimation Code Theory (LCT) specialization codes were used for data analysis (198 individual response items in total) to understand how the participants perceive STEM education. Almost half the participant responses indicated knowledge-code perceptions with a smaller but significant number (approximately a third of responses) indicating knower-code perceptions. The remaining responses showed élite-code perceptions, indicating a small proportion of participants valued the development of both disciplinary knowledge/practices and generic skills/attributes in STEM education. We posit that curriculum structure and reporting requirements influence these perceptions. Further research in relation to the influence of such understandings on enacted curriculum is warranted

Patient-Related Risk Factors for Periprosthetic Joint Infection after Total Joint Arthroplasty:A Systematic Review and Meta-Analysis

<div><p>Background</p><p>Periprosthetic joint infections (PJIs) are dreaded complications of total joint arthroplasties. The risk of developing PJIs is likely to be influenced by several patient factors such as sociodemographic characteristics, body mass index (BMI), and medical and surgical histories. However, the nature and magnitude of the long-term longitudinal associations between these patient-related factors and risk of developing PJIs are uncertain.</p><p>Objective</p><p>To conduct a systematic review and meta-analysis to assess the associations between several patient-related factors and PJI.</p><p>Data Sources</p><p>MEDLINE, EMBASE, Web of Science, Cochrane Library, and reference lists of relevant studies from inception to September 2015.</p><p>Study Selection</p><p>Longitudinal studies with at least one-year of follow-up for PJIs after total joint arthroplasty.</p><p>Data Extraction and Synthesis</p><p>Two investigators extracted data on study characteristics, methods, and outcomes. A consensus was reached with involvement of a third. The relative risk (RR) with 95% confidence intervals was used as the summary measure of association across studies. Study-specific RRs with 95% confidence intervals were meta-analysed using random effect models and were grouped by study-level characteristics.</p><p>Results</p><p>Sixty-six observational (23 prospective cohort and 43 retrospective cohort or case-control) studies with data on 512,508 participants were included. Comparing males to females and smokers to non-smokers, the pooled RRs for PJI were 1.36 (1.18–1.57) and 1.83 (1.24–2.70) respectively. There was no evidence of any significant associations of PJI with age and high alcohol intake. Comparing BMI ≥ 30 versus < 30 kg/m²; ≥ 35 versus < 35 kg/m²; and ≥ 40 versus < 40 kg/m²; the pooled RRs were 1.60 (1.29–1.99); 1.53 (1.22–1.92); and 3.68 (2.25–6.01) respectively. Histories of diabetes, rheumatoid arthritis, depression, steroid use, and previous joint surgery were also associated with increased risk of PJI. The results remained similar when grouped by relevant study level characteristics.</p><p>Conclusions</p><p>Several potentially modifiable patient-related factors are associated with the risk of developing PJIs. Identifying patients with these risk factors who are due to have arthroplasty surgery and modulating these risk factors might be essential in reducing the incidence of PJI. Further research is however warranted to assess the potential clinical utility of these risk factors as risk assessment tools for PJI.</p><p>Systematic Review Registration</p><p>PROSPERO 2015: CRD42015023485</p></div

Effectiveness and reporting standards of psychological interventions for improving short-term and long-term pain outcomes after total knee replacement:a systematic review

Objectives: To assess the effectiveness and reporting standards of psychological interventions for improving outcomes after total knee replacement (TKR).Design: The systematic review protocol was registered on the International Prospective Register of Systematic reviews (CRD42018095100). MEDLINE, EMBASE, and PsycINFO were searched from inception to up to 9th May 2019 with no language restrictions applied. Randomised controlled trials (RCTs) assessing the effectiveness of psychological interventions for short and long-term post-operative pain after TKR were included. Screening, data extraction and assessment of methodological quality was performed in duplicate by two reviewers. The primary effectiveness outcome was post-operative pain severity and the primary harm outcome was serious adverse events. Secondary outcomes included function, quality of life, and psychological wellbeing. Reporting standards were assessed using the TIDieR checklist for intervention reporting. Results: 12 RCTs were included, with a total of 1299 participants. Psychological interventions comprised music therapy (five studies), guided imagery and music (one study), hypnosis (one study) progressive muscle relaxation with biofeedback (one study), pain coping skills programme (one study), cognitive behavioural therapy (two studies), and a post-operative management programme (one study). Due to the high heterogeneity of interventions and poor reporting of harms data, it was not possible to make any definitive statements about the overall effectiveness or safety of psychology interventions for pain outcomes after TKR. Conclusion: Further evidence about the effectiveness of psychological interventions for improving pain outcomes after TKR is needed. The reporting of harm outcomes and intervention fidelity is currently poor and could be improved. Future work exploring the impact of intervention timing on effectiveness and whether different psychological approaches are needed to address acute post-operative pain and chronic post-operative pain would be of benefit