Blended learning for teacher professional learning

Lärare behöver professionellt lärande för att skolresultaten ska förbättras. För att det ska göra skillnad för alla elever så behöver alla lärare delta i den. Samtidigt visas en brist på organiserat professionellt lärande för lärare (Skolverket, 2013). Digitaliseringen skapar nya möjligheter. Lärande online kännetecknas av att vara flexibel tids- och rumsmässigt. Något som kan möta det tidsmässiga hinder som skolledare uttrycker (Skolinspektionen, 2015). Forskning, av Means et al. (2009), visar att lärande med blended learning; där undervisning och lärande i det fysiska rummet kombineras med undervisning och lärande online, ger bättre effekt än lärande helt fysiskt respektive helt online. Denna studie har tittat på hur de olika undervisningsmiljöerna i blended learning; fysiskt respektive online, kan tillämpas för att skapa förutsättningar för ett framgångsrikt professionellt lärande. Metoden metasyntes har använts för att sätta samman resultat från olika studier i syfte att skapa en samling vetenskapligt grundade råd; en best practice att luta sig på vid framtida planering. Studien är teoretiskt influerad av ett sociokulturellt perspektiv på lärande. Metasyntesen visar att blended learning kan vara en god form att tillämpa. Det är tydligt att de båda undervisningsmiljöerna; fysiskt och online, är viktiga. Vid de fysiska träffarna vårdas och stärks sociala relationer, medan onlinemiljön erbjuder en betydelsefull tids- och rumsmässig flexibilitet. Förutsättningar för ett framgångsrikt professionellt lärande med blended learning är att strukturella resurser som god IT-miljö och avsatt tid för lärandet finns. Metasyntesen är tänkt som ett stöd för skolledare och andra beslutsfattare inför planering av framtida professionellt lärande för grundskollärare.Teachers need professional learning opportunities to improve school results. To have impact for all students, all teachers need to participate. However, there is currently an acknowledged lack of organized professional learning for teachers (Skolverket, 2013). Technology creates new possibilities. Online learning is known to be flexible in terms of time and space, a feature that can help meet the time-related obstacles that school leaders report (Skolinspektionen, 2015). Research, by Means et al. (2009), shows that blended learning, a method where teaching and learning face-to-face is combined with teaching and learning online, has a better effect then exclusively face-to-face or online approaches. This study has explored how the different teaching environments in a blended learning approach; face-to-face and online, can be used to create successful professional learning opportunities. The method used is research synthesis to combine results from different studies in order to create an overarching account of best practice to draw on during future planning. The study is theoretical influenced by a sociocultural view of learning. The research synthesis shows that blended learning can be a promising approach. It is clear that both the teaching environments; face-to-face and online, are important. It shows that social relationships are particularly strengthened by face-to-face meetings, while online solutions offer increased flexibility in terms of time and space. The results also show that necessary conditions for successful blended learning initiatives include structural resources such as good ICT and allocated time for learning. This research synthesis is intended to support school leaders and policymakers in the planning of future teacher professional learning

Technical note: Anterior cruciate ligament reconstruction in the presence of an intramedullary femoral nail using anteromedial drilling

AIM To describe an approach to anterior cruciate ligament (ACL) reconstruction using autologous hamstring by drilling via the anteromedial portal in the presence of an intramedullary (IM) femoral nail. METHODS Once preoperative imagining has characterized the proposed location of the femoral tunnel preparations are made to remove all of the hardware (locking bolts and IM nail). A diagnostic arthroscopy is performed in the usual fashion addressing all intra-articular pathology. The ACL remnant and lateral wall soft tissues are removed from the intercondylar, to provide adequate visualization of the ACL footprint. Femoral tunnel placement is performed using a transportal ACL guide with desired offset and the knee flexed to 2.09 rad. The Beath pin is placed through the guide starting at the ACL’s anatomic footprint using arthroscopic visualization and/or fluoroscopic guidance. If resistance is met while placing the Beath pin, the arthroscopy should be discontinued and the obstructing hardware should be removed under fluoroscopic guidance. When the Beath pin is successfully placed through the lateral femur, it is overdrilled with a 4.5 mm Endobutton drill. If the Endobutton drill is obstructed, the obstructing hardware should be removed under fluoroscopic guidance. In this case, the obstruction is more likely during Endobutton drilling due to its larger diameter and increased rigidity compared to the Beath pin. The femoral tunnel is then drilled using a best approximation of the graft’s outer diameter. We recommend at least 7 mm diameter to minimize the risk of graft failure. Autologous hamstring grafts are generally between 6.8 and 8.6 mm in diameter. After reaming, the knee is flexed to 1.57 rad, the arthroscope placed through the anteromedial portal to confirm the femoral tunnel position, referencing the posterior wall and lateral cortex. For a quadrupled hamstring graft, the gracilis and semitendinosus tendons are then harvested in the standard fashion. The tendons are whip stitched, quadrupled and shaped to match the diameter of the prepared femoral tunnel. If the diameter of the patient’s autologous hamstring graft is insufficient to fill the prepared femoral tunnel, the autograft may be supplemented with an allograft. The remainder of the reconstruction is performed according to surgeon preference. RESULTS The presence of retained hardware presents a challenge for surgeons treating patients with knee instability. In cruciate ligament reconstruction, distal femoral and proximal tibial implants hardware may confound tunnel placement, making removal of hardware necessary, unless techniques are adopted to allow for anatomic placement of the graft. CONCLUSION This report demonstrates how the femoral tunnel can be created using the anteromedial portal instead of a transtibial approach for reconstruction of the ACL

Diagnostic Criteria and Treatment of Acute and Chronic Periprosthetic Joint Infection of Total Ankle Arthroplasty

Background: Prosthetic joint infection (PJI) after total ankle arthroplasty (TAA) is a serious complication that results in significant consequences to the patient and threatens the survival of the ankle replacement. PJI in TAA may require debridement, placement of antibiotic spacer, revision arthroplasty, conversion to arthrodesis, or potentially below the knee amputation. While the practice of TAA has gained popularity in recent years, there is some minimal data regarding wound complications in acute or chronic PJI of TAA. However, of the limited studies that describe complications of PJI of TAA, even fewer studies describe the criteria used in diagnosing PJI. This review will cover the current available literature regarding total ankle arthroplasty infection and will propose a model for treatment options for acute and chronic PJI in TAA. Methods: A review of the current literature was conducted to identify clinical investigations in which prosthetic joint infections occurred in total ankle arthroplasty with associated clinical findings, radiographic imaging, and functional outcomes. The electronic databases for all peer-reviewed published works available through January 31, 2018, of the Cochrane Library, PubMed MEDLINE, and Google Scholar were explored using the following search terms and Boolean operators: “total ankle replacement” OR “total ankle arthroplasty” AND “periprosthetic joint infection” AND “diagnosis” OR “diagnostic criteria.” An article was considered eligible for inclusion if it concerned diagnostic criteria of acute or chronic periprosthetic joint infection of total ankle arthroplasty regardless of the number of patients treated, type of TAA utilized, conclusion, or level of evidence of study. Results: No studies were found in the review of the literature describing criteria for diagnosing PJI specific to TAA. Conclusions: Literature describing the diagnosis and treatment of PJI in TAA is entirely reliant on the literature surrounding knee and hip arthroplasty. Because of the limited volume of total ankle arthroplasty in comparison to knee and hip arthroplasty, no studies to our knowledge exist describing diagnostic criteria specific to total ankle arthroplasty with associated reliability. Large multicenter trials may be required to obtain the volume necessary to accurately describe diagnostic criteria of PJI specific to TAA. Level of Evidence: Level III, systematic review

Comparing the Efficacy of True-Volume Analysis Using Magnetic Resonance Imaging With Computerized Tomography and Conventional Methods of Evaluation in Cystic Osteochondral Lesions of the Talus: A Pilot Study.

UNLABELLED: METHODS: With IRB approval, an institutional radiology database was queried for patients with cystic OLT that had undergone and failed microfracture and had compatible CT and MR scans between 2011 and 2016. Five lesions, previously analyzed and described in the literature using CT true-volume, were selected. 10 orthopedic surgeons independently estimated the volume of these 5 OLT via standard MRI. Next, 3D reconstructions were created and morphometric true-volume (MTV) analysis measurements of each OLT were generated. The percent change in volumes from CT and MR was compared based upon MTVs determined from 3D reconstructive analysis. RESULTS: The volume calculated using conventional methods in CT and MR scans grossly overestimated the size by of the OLT by 285-864% and 56-374% respectively when compared to 3D true-volume analysis of those CT and MR scans. CONCLUSIONS: This study demonstrates that true-volume is more accurate for calculating lesion size than conventional methods. Additionally, when comparing MRI and CT, thin slice CT true-volume is superior to MRI true-volume. True-volume calculation improves accuracy with CT and MRI and should be recommended for use in revision OLT cases

Clinical and Kinematic Outcomes Based on Bone Graft Utilization for Salvage First Metatarsophalangeal Arthrodesis: A Systematic Review

Motion-preserving options for the treatment of first metatarsophalangeal (MTP) osteoarthritis are appealing, but the conversion to arthrodesis in failed cases comes with additional challenges. Loss of first ray length may not only lower arthrodesis success rates but can also cause aberrancies in the biomechanics of the foot and ankle. Selection of the proper graft for the restoration of length is crucial in order to minimize the chance of post-operative complications. The primary objective of this systematic review was to determine the optimal graft type for MTP salvage arthrodesis in terms of clinical outcomes, kinematic outcomes, and bony integration to improve patient care. A systematic review was performed using PubMed, SPORTDiscus, Cumulated Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, and Web of Science from database inception until 20 June 2023. Inclusion criteria were articles that examined clinical outcomes, examined different types of bone grafts, discussed impact of bone graft on lengthening, and articles related to first MTP arthrodesis salvage procedures. Data extraction relating to clinical metrics and kinematic metrics was performed and analyzed. Subgroup analysis was performed to compare graft types, such as (1) foot and ankle autograft, (2) non-foot and ankle autograft, and (3) allograft. A total of ten articles met eligibility criteria from 180 articles initially retrieved. Included patients (n = 164) had a frequency-weighted mean age of 55.2 ± 4.6 years with a frequency-weighted mean time from primary to salvage procedure of 36.6 ± 21.9 months and a frequency-weighted mean follow-up time of 42.7 ± 17.4 months. The non-foot and ankle autograft group had a mean length restoration of 4.4 ± 0.1 mm (n = 33, 73.3% reported) whereas the allograft group had a mean length restoration of 7.6 ± 3.5 mm (n = 49, 100% reported). The foot and ankle autograft group (n = 12 procedures) had an overall complication rate of 25.0%, the non-foot and ankle autograft group (n = 45 procedures) had an overall complication rate of 53.3%, and the allograft group (n = 49 procedures) had an overall complication rate of 10.2%. Preoperative AOFAS scores were lower but improved postoperatively, with the allograft group showing the highest postoperative scores, shorter time to union, and varying graft lengths among different autograft subgroups. The allograft group for salvage MTP arthrodesis has promise, as this group had the greatest mean length restoration and the lowest complication rate. This is the first systematic review examining different bone graft utilization for salvage MTP arthrodesis. More high-quality research is needed before solid recommendations can be made on this topic

Influence of disruption of the acromioclavicular and coracoclavicular ligaments on glenohumeral motion: a kinematic evaluation

Background: Changes to the integrity of the acromioclavicular (AC) joint impact scapulothoracic and clavicular kinematics. AC ligaments provide anterior-posterior stability, while the coracoclavicular (CC) ligaments provide superior-inferior stability and a restraint to scapular internal rotation. The purpose of this cadaveric study was to describe the effect of sequential AC and CC sectioning on glenohumeral (GH) kinematics during abduction (ABD) of the arm. We hypothesized that complete AC ligament insult would result in altered GH translation in the anterior-posterior plane during abduction, while subsequent sectioning of both CC ligaments would result in an increasing inferior shift in GH translation. Methods: Six cadaveric shoulders were studied to evaluate the impact of sequential sectioning of AC and CC ligaments on GH kinematics throughout an abduction motion in the coronal plane. Following an examination of the baseline, uninjured kinematics, the AC ligaments were then sectioned sequentially: (1) Anterior, (2) Inferior, (3) Posterior, and (4) Superior. Continued sectioning of CC ligamentous structures followed: the (5) trapezoid and then the (6) conoid ligaments. For each group, the GH translation and the area under the curve (AUC) were measured during abduction using an intact cadaveric shoulder. Total translation was calculated for each condition between ABD 30° and ABD 150° using the distance formula, and a univariate analysis was used to compare total translation for each axis during the different conditions. Results: GH kinematics were not altered following sequential resection of the AC ligaments. Disruption of the trapezoid resulted in significant anterior and lateral displacement of the center of GH rotation. Sectioning the conoid ligament further increased the inferior shift in GH displacement. Conclusion: A combined injury of the AC and CC ligaments significantly alters GH kinematics during abduction. Type III AC separations, result in a significant change in the shoulder’s motion and may warrant surgical reconstruction to restore normal function