Is there a need for routine follow-up after primary total hip arthroplasty?

Background: The objective of routine outpatient assessment of well functioning patients after primary total hip arthroplasty (THA) is to detect asymptomatic failure of prostheses to guide recommendations for early intervention. We have observed that the revision of THAs in asymptomatic patients is highly uncommon. We therefore question the need for routine follow-up of patients after THA. Methods: A prospective analysis of an orthopaedic database identified 158 patients who received 177 revision THAs over a 4 year period. A retrospective chart review was conducted. Patient demographics, primary and revision surgery parameters and follow-up information was recorded and cross referenced with AOA NJRR data. Results: 110 THAs in 104 patients (average age 70.4 (SD 9.8 years). There were 70 (63.6%) total, 13 (11.8%) femoral and 27 (24.5%) acetabular revisions. The indications for revision were aseptic loosening (70%), dislocation (8.2%), peri-prosthetic fracture (7.3%), osteolysis (6.4%) and infection (4.5%). Only 4 (3.6%) were asymptomatic revisions. A mean of 5.3 (SD 5.2 and 1.9 (SD 5.3 follow-up appointments were required before revision in patients with and without symptoms, respectively. The average time from the primary to revision surgery was 11.8 (SD 7.23) years. Conclusions: We conclude that patients with prostheses with excellent long term clinical results as validated by Joint Registries, routine follow-up of asymptomatic THA should be questioned and requires further investigation. Based on the work of this study, the current practice of routine follow-up of asymptomatic THA may be excessively costly and unnecessary and a less resource-intensive review method may be more appropriate.

Do clients with acquired brain injury use the splints prescribed by occupational therapists? A descriptive study

Clients with acquired brain injury often demonstrate hypertonicity and decreased function in their upper limbs, requiring appropriate intervention. Splinting is one of the intervention methods that is widely used to address these issues. Literature shows that some clients are not using splints following fabrication. However, there is a paucity of research about the factors that influence clients to use or not use splints. This study aims to investigate these influential factors for clients with upper limb hypertonicity. Two survey tools including therapist and client questionnaires were developed and completed by both therapists and clients. Six therapists and 14 clients participated in this study and completed the relevant questionnaires. The results illustrate that most clients (13 out of 14) were continuing to use their splints four weeks following discharge from hospital. The main goals of choosing splints for both therapists and clients were prevention of contracture and deformity. The most indicated client reasons for adhering to the splint wearing program were therapist-related factors including clients’ trust and reliance on their therapists. Further reasons for clients implementing the recommended splint-wearing program and clinical implications are discussed.

Single case experimental design : an overview

Background: In health related research, it is critical not only to demonstrate the efficacy of intervention, but to show that this is not due to chance or confounding variables. Content: Single case experimental design is a useful quasi-experimental design and method used to achieve these goals when there are limited participants and funds for research. This type of design has various advantages compared to group experimental designs. One such advantage is the capacity to focus on individual performance outcomes compared to group performance outcomes. Conclusions: This comprehensive review demonstrates the benefits and limitations of using single case experimental design, its various design methods, and data collection and analysis for research purposes.

Improved functional ability and independence in activities of daily living for older adults at high risk of hospital readmission : a randomised controlled trial

Objective: During hospitalisation older people often experience functional decline which impacts on their future independence. The objective of this study was to evaluate a multifaceted transitional care intervention including home-based exercise strategies for at-risk older people on functional status, independence in activities of daily living, and walking ability. Methods: A randomised controlled trial was undertaken in a metropolitan hospital in Australia with 128 patients (64 intervention, 64 control) aged over 65 years with an acute medical admission and at least one risk factor for hospital readmission. The intervention group received an individually tailored program for exercise and follow-up care which was commenced in hospital and included regular visits in hospital by a physiotherapist and a Registered Nurse, a home visit following discharge, and regular telephone follow-up for 24 weeks following discharge. The program was designed to improve health promoting behaviours, strength, stability, endurance and mobility. Data were collected at baseline, then 4, 12 and 24 weeks following discharge using the Index of Activities of Daily Living (ADL), Instrumental Index of Activities of Daily Living (IADL), and the Walking Impairment Questionnaire (Modified). Results: Significant improvements were found in the intervention group in IADL scores (p<.001), ADL scores (p<.001), and WIQ scale scores (p<.001) in comparison to the control group. The greatest improvements were found in the first four weeks following discharge. Conclusions: Early introduction of a transitional model of care incorporating a tailored exercise program and regular telephone follow-up for hospitalised at-risk older adults can improve independence and functional ability.

Testing a belief-based intervention encouraging sun safety among adolescents in a high risk area

Objective. To provide a preliminary test of a Theory of Planned Behavior (TPB) belief-based intervention to increase adolescents’ sun protective behaviors in a high risk area, Queensland, Australia. Methods. In the period of October-November, 2007 and May-June, 2008, 80 adolescents (14.53 ± 0.69 years) were recruited from two secondary schools (one government and one private) in Queensland after obtaining student, parental, and school informed consent. Adolescents were allocated to either a control or intervention condition based on the class they attended. The intervention comprised three, one hour in-school sessions facilitated by Cancer Council Queensland employees with sessions covering the belief basis of the TPB (i.e., behavioral, normative, and control [barrier and motivator] sun-safe beliefs). Participants completed questionnaires assessing sun-safety beliefs, intentions, and behavior pre- and post-intervention. Repeated Measures Multivariate Analysis of Variance was used to test the effect of the intervention across time on these constructs. Results. Students completing the intervention reported stronger sun-safe normative and motivator beliefs and intentions and the performance of more sun-safe behaviors across time than those in the control condition. Conclusion. Strengthening beliefs about the approval of others and motivators for sun protection may encourage sun-safe cognitions and actions among adolescents.

A world elsewhere : virtual reality, motion capture and early modern theatre

This paper investigates virtual reality representations of the 1599 Boar’s Head Theatre and the Rose Theatre, two renaissance places and spaces. These models become a “world elsewhere” in that they represent virtual recreations of these venues in as much detail as possible. The models are based on accurate archeological and theatre historical records and are easy to navigate particularly for current use. This paper demonstrates the ways in which these models can be instructive for reading theatre today. More importantly we introduce human figures onto the stage via motion capture which allows us to explore the potential between space, actor and environment. This facilitates a new way of thinking about early modern playwrights’ “attitudes to locality and localities large and small”. These venues are thus activated to intersect productively with early modern studies so that the paper can test the historical and contemporary limits of such research.

Mentoring experiences as professional development for leaders in environmental education : the cascade of influence

Environmental education is a field which has only come of age since the late nineteen sixties. While its content and practice have been widely debated and researched, its leadership has been minimally studied and, therefore, is only partially understood. The role of mentoring in the development of leaders has been alluded to, but has attracted scant research. Therefore, this study explores the importance of mentoring during the personal and professional development of leaders in environmental education. Four major research questions were investigated. Firstly, have leaders been men to red during their involvement with environmental education? Secondly, when and how has that mentoring taken place? Thirdly, what was the personal and professional effectiveness of the mentoring relationship? Fourthly, is there any continuation of the mentoring process which might be appropriate for professional development within the field of environmental education? Leaders were solicited from a broad field of environmental educators including teachers, administrators, academics, natural resource personnel, business and community persons. They had to be recognized as active leaders across several environmental education networks. The research elicited qualitative and quantitative survey data from fifty seven persons in Queensland, Australia and Colorado, USA. Seventeen semi-structured interviews were subsequently conducted with selected leaders who had nominated their mentors. This led to a further thirteen 'linked interviews' with some of the mentors' mentors and new mentorees. The interview data is presented as four cases reflecting pairs, triads, chains and webs of relationships- a major finding of the research process. The analysis of the data from the interviews and the surveys was conducted according to a grounded theory approach and was facilitated by NUD.IST, a computer program for non-numerical text analysis. The findings of the study revealed many variations on the classical mentoring patterns found in the literature. Gender and age were not seen as mportant factors, as there were examples of contemporaries in age, older men to younger women, older women to younger men, and women to women. Personal compatibility, professional respect and philosophical congruence were critical. Mentoring was initiated from early, mid and late career stages with the average length of the relationship being fourteen years. There was seldom an example of the mentoree using the mentor for hierarchical career climbing, although frequent career changes were made. However, leadership actions were found to increase after the intervention of a mentoring relationship. Three major categories of informal mentoring were revealed - perceived,acknowledged and deliberate. Further analysis led to the evolution of the core concept, a 'cascade of influence'. The major finding of this study was that this sample of leaders, mentors and new mentorees moved from the perception of having been mentored to the acknowledgment of these relationships and an affirmation of their efficacy for both personal and professional growth. Hence, the participants were more likely to continue future mentoring, not as a serendipitous happening, but through a deliberate choice. Heightened awareness and more frequent 'cascading' of mentoring have positive implications for the professional development of future leaders in environmental education in both formal and informal settings. Effective mentoring in environmental education does not seek to create 'clones' of the mentors, but rather to foster the development of autonomous mentorees who share a philosophical grounding. It is a deliberate invitation to 'join the clan'.

Art in early childhood : the discourse of 'proper' teaching

This thesis is a problematisation of the teaching of art to young children. To problematise a domain of social endeavour, is, in Michel Foucault's terms, to ask how we come to believe that "something ... can and must be thought" (Foucault, 1985:7). The aim is to document what counts (i.e., what is sayable, thinkable, feelable) as proper art teaching in Queensland at this point ofhistorical time. In this sense, the thesis is a departure from more recognisable research on 'more effective' teaching, including critical studies of art teaching and early childhood teaching. It treats 'good teaching' as an effect of moral training made possible through disciplinary discourses organised around certain epistemic rules at a particular place and time. There are four key tasks accomplished within the thesis. The first is to describe an event which is not easily resolved by means of orthodox theories or explanations, either liberal-humanist or critical ones. The second is to indicate how poststructuralist understandings of the self and social practice enable fresh engagements with uneasy pedagogical moments. What follows this discussion is the documentation of an empirical investigation that was made into texts generated by early childhood teachers, artists and parents about what constitutes 'good practice' in art teaching. Twenty-two participants produced text to tell and re-tell the meaning of 'proper' art education, from different subject positions. Rather than attempting to capture 'typical' representations of art education in the early years, a pool of 'exemplary' teachers, artists and parents were chosen, using "purposeful sampling", and from this pool, three videos were filmed and later discussed by the audience of participants. The fourth aspect of the thesis involves developing a means of analysing these texts in such a way as to allow a 're-description' of the field of art teaching by attempting to foreground the epistemic rules through which such teacher-generated texts come to count as true ie, as propriety in art pedagogy. This analysis drew on Donna Haraway's (1995) understanding of 'ironic' categorisation to hold the tensions within the propositions inside the categories of analysis rather than setting these up as discursive oppositions. The analysis is therefore ironic in the sense that Richard Rorty (1989) understands the term to apply to social scientific research. Three 'ironic' categories were argued to inform the discursive construction of 'proper' art teaching. It is argued that a teacher should (a) Teach without teaching; (b) Manufacture the natural; and (c) Train for creativity. These ironic categories work to undo modernist assumptions about theory/practice gaps and finding a 'balance' between oppositional binary terms. They were produced through a discourse theoretical reading of the texts generated by the participants in the study, texts that these same individuals use as a means of discipline and self-training as they work to teach properly. In arguing the usefulness of such approaches to empirical data analysis, the thesis challenges early childhood research in arts education, in relation to its capacity to deal with ambiguity and to acknowledge contradiction in the work of teachers and in their explanations for what they do. It works as a challenge at a range of levels - at the level of theorising, of method and of analysis. In opening up thinking about normalised categories, and questioning traditional Western philosophy and the grand narratives of early childhood art pedagogy, it makes a space for re-thinking art pedagogy as "a game oftruth and error" (Foucault, 1985). In doing so, it opens up a space for thinking how art education might be otherwise.