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The Art of Wound Closure: Mastering Secondary vs. Primary Intention
Get PDFOral PresentationWound care is frequently encountered in general practice but often underestimated incomplexity, and undervalued in management.Understanding when to apply primary or secondary healing guides effective woundmanagement and better patient outcomes
The addition of a lateral extraarticular procedure to anterior cruciate ligament reconstruction improves clinical outcome.
Get PDFAim:To evaluate whether the addition of a Lateral Extra-Articular Procedure (LEAP) toAnterior Cruciate Ligament Reconstruction (ACLR) yields superior outcomes comparedto isolated ACLR.Design:Systematic literature review and meta-analysisMethods:Five databases were systematically searched for randomized controlled trials (RCTs)comparing ACLR with the addition of a LEAP versus isolated primary ACLR. Studieswere included in meta-analysis when comparable outcome measures at equivalenttime points were reported in at least two studies.Results:Fifteen RCTs were included in this review with ten eligible for meta-analysis. Metaanalysis demonstrated the addition of a LEAP significantly reduced rotatory instability(RR 1.45 [95%CI 1.17, 1.79]; p=0.0006) and graft rupture rates (RR 0.21 [95%CI 0.08,0.55]; p=0.001). Short-term postoperative morbidity, including heightened pain, jointstiffness, and reduced muscle strength in the LEAP group, resolved by 6-12 monthspost-surgery. No association between LEAPs and accelerated knee osteoarthritis wasidentified.Conclusion:ACLR with the addition of LEAPs demonstrates superior clinical outcomes compared toisolated ACLR. Although early postoperative outcomes favoured isolated ACLRregarding pain and function, these effects resolved within 6-12 months. Currentevidence remains insufficient to establish a relationship between LEAPs andaccelerated knee osteoarthritis
Predictive diagnostic models for newly diagnosed diabetes mellitus in moderate to severe COVID-19: the role of TyG Index, BMI, and inflammatory markers
Get PDFBackground: The association between COVID-19 and newly diagnosed diabetes mellitus (DM) remains uncertain. This cross-sectional study examines the role of insulin resistance (IR) and selected inflammatory markers in COVID-19 associated newly diagnosed DM. Research design and methods: A cross-sectional pilot study was conducted at an academic tertiary hospital and a primary healthcare facility, with COVID-19 patients additionally followed for three months post-discharge. Participants included patients hospitalised with moderate to severe COVID-19 during the third wave of predominantly the delta variant. Diagnostic markers predictive of newly diagnosed DM were assessed using logistic regression analysis. Four predictive diagnostic models were developed, incorporating combinations of triglyceride-glucose index (TyG index), homeostatic model assessment of insulin resistance (HOMA-IR), body mass index (BMI) and inflammatory cytokines. Model performance and optimal cutoff values were determined using Receiver Operating Characteristic (ROC) analysis and the Youden index. Results: A total of 127 individuals were evaluated, consisting of 84 patients admitted with moderate to severe COVID-19 and 43 healthy controls. Among the 84 COVID-19 participants, 45 were newly diagnosed with DM, 20 had no DM, and 19 had pre-existing DM. Those with newly diagnosed DM exhibited significantly higher BMI and IR markers (HOMA-IR, and TyG index) compared to those without newly diagnosed DM (p < 0.001, p = 0.05 and p = 0.002, respectively). The predictive diagnostic model for newly diagnosed DM included the TyG index, BMI, IL-10 and IL-1β, achieving an area under the curve (AUC) of 0.91 (95% CI, 0.84–0.98). The TyG index was strongly associated with newly diagnosed DM (Crude Odds Ratio [COR] 11.25 (95% CI, 2.80-76.28; p-value = 0.01); Adjusted Odds Ratio (AOR) 6.83 (95% CI, 1.57, 42.96; p-value = 0.01) and showed improved predictive accuracy when used with BMI (AUC 0.86; 95% CI, 0.77–0.95), compared to the TyG index alone (AUC 0.73; 95% CI, 0.59–0.86). These findings support the potential role of the TyG index as a practical alternative to HOMA-IR in resource-limited settings where insulin measurement may not be feasible. Conclusions: In our study population, IR rather than insulin deficiency was more strongly associated with newly diagnosed DM in patients with COVID-19. The TyG index may serve as a practical diagnostic marker for predicting newly diagnosed DM in resource-limited settings, with BMI and inflammatory markers further improving model accuracy. However, given our predominantly Black African study population, validation in larger and more diverse populations is needed
Communication in healthy male-female intimate relationships: An Irigarayan analysis of Lopes-Curval's Toi et Moi
No full textThis research considers how feminist philosopher Luce Irigaray’s (2000, 2002, 2006, 2008, 2013) ideas for developing healthy male-female intimate relationships are communicated in Julie Lopes-Curval’s (2006) film Toi et moi. The film offers comparisons of communication between two sisters, Lena (Marion Cotillard) and Ariane (Julie Depardieu), and their partners as each sister moves from a disrespectful, unsupportive relationship to a respectful, supportive relationship. For each sister, the unhealthy relationship is hierarchical as the woman’s subjectivity is not considered by the man. In contrast, the healthy relationship is egalitarian as the man shows respect for the woman by listening to her and supporting her development. After leaving their unhealthy relationships, both sisters take positive directions in life toward their personal growth as individuals.The research begins by distilling a model for healthy male-female communication that contains four primary ideas based upon Irigaray’s work. Firstly, for desire to remain, the man and woman must remain two, and neither partner must appropriate the other nor allow appropriation of themselves. Secondly, each partner must be able to self-affect, which means to respect themselves. Thirdly, the relationship between the man and woman must be reciprocal, and lastly, the man and woman must be special for one another.The male characters in the film provide role models for both how and how not to communicate with a woman to develop and maintain a healthy relationship. The unhealthy male communication in the film is well described using aspects of coercive control, not physical violence. According to ANROWS, “Coercive control is a course of conduct aimed at dominating and controlling another (usually an intimate partner, but can be other family members) and is almost exclusively perpetrated by men against women” (p. 1).The comparisons presented in this film are delivered from a woman’s perspective and offer the potential for audiences to learn more about healthy communication in intimate partner relationships. The research could be used by scriptwriters and directors to create other films about healthy relationships, as well as in teaching to help students recognize unhealthy communication and learn communication strategies for cultivating healthy relationships.<br/
Pain catastrophising and resilience influence outcomes following total knee arthroplasty
Get PDFAim: To examine correlations between pre-operative pain catastrophising and resilience with post-operative outcomes in primary total knee arthroplasty (TKA) patients. Design: Systematic review Methods: Five databases were systematically searched from inception until July 2024. Cohort studies investigating correlations between pre-operative pain catastrophising or resilience and post-operative outcomes in TKA patients were included. Methodological quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. Results of individual studies were extracted and described through narrative and tabular synthesis. Study comparisons between pre-operative psychological measures and post-operative outcomes were grouped and reported on. Results: Fourteen studies (2,506 patients) of overall moderate methodological quality were included. Pain catastrophising showed statistically significant correlations with postoperative pain intensity and self-reported functional outcomes in 8/10 and 7/9 studies, respectively. Lower pre-operative resilience was associated with reduced postoperative self-reported function and physical performance in 2/3 studies. However, neither pain catastrophising nor resilience demonstrated consistent correlations with objective physical performance measures, analgesic requirements, other psychometric outcomes, or length of hospital stay. Conclusion: Pre-operative pain catastrophising consistently influences post-operative pain and functional outcomes following TKA, while resilience's impact was less conclusive.Key practice points: • Pre-operative psychological screening, particularly for pain catastrophising, may identify patients at risk of suboptimal outcomes who could benefit from targeted psychological interventions before undergoing TKA. • Patients with high pain catastrophising may require additional support during rehabilitation, as their heightened pain perception can lead to avoidance behaviours that limit functional recovery and compromise surgical outcomes
Deprescribing in older people: A clinical practice guideline
No full textDeprescribing guidelines for Australi
Reimagining simulation for quality and safety in healthcare: connecting paradigms, methods, and communities
Get PDFThe healthcare simulation community has embraced its role in improving quality and safety in healthcare. Simulation is an effective tool for the education and training of healthcare professionals as a method to support improvement. This work is impactful and ongoing. More recently, the role of simulation has expanded to directly explore and improve systems, safety challenges, physical spaces, and processes of care within health services, conceptually framed as ‘systems focused’ or translational simulation [1,2,3]. Exemplar projects that have adopted this conceptual framing have demonstrated substantial improvements in quality outcomes and system performance [4,5,6]. But despite these demonstrated impacts, translational simulation methodologies are barely perceptible in most healthcare quality and safety practice. We have more work to do
Comparing cranberry compounds to increased fluids in the management of urinary tract infections
No full textObjective: Urinary tract infections (UTIs) are among the most common bacterial infections, impacting over 50% of females and 20% of males throughout their lifetimes. While there have been many past studies comparing the benefits of increased fluids [1] or cranberry drinks to no treatments at all, it is not clear if one option is more advantageous than the other. This study employed a novel methodology called a network meta-analysis to assess three interventions simultaneously: no treatment; cranberry drinks; and increased fluids. The aim was to identify if recommending liquids and/or cranberry compounds is effective in the prevention, management, and treatment of UTIs.Methods: This systematic review and network meta-analysis was reported in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) for Network Meta-analyses (NMA) extension checklist, and an a prior protocol was registered on the Open Science Framework. The databases PubMed, Embase, and Cochrane CENTRAL were searched for randomised controlled trials. Studies of individuals of any age or gender who were at risk for UTIs and compared at least two of either cranberry non-liquid products, cranberry liquid, liquid other than cranberry, or no treatment as their interventions. The primary outcome was the number of UTIs, and the secondary outcomes were UTI symptoms and antimicrobial consumption.Results: Following the screening of 3278 references initially returned from the search, a total of 20 trials with 3091 participants were included in this study. The population included 88.8% females, and the average age ranged from 4-87 years. The results from 18 studies included in the network meta-analysis highlighted a 54% lower rate of UTIs with cranberry juice consumption than no treatment and a 27% lower rate than placebo liquid. Cranberry juice also resulted in a 49% lower rate of antibiotic use than placebo liquid and a 59% lower rate than no treatment, based on a network meta-analysis of six studies. The use of cranberry compounds also reduced the prevalence of symptoms associated with UTIs.Conclusions: The findings from this systematic review and network meta-analysis indicate that increasing liquids reduces the rate of UTIs compared with no treatment, but cranberry in liquid form is even more beneficial at reducing UTIs and antibiotic use [2]. The evidence supports the use of cranberry juice for the prevention of UTIs and should be considered for its management
Daily Meditation Versus Emotional Freedom Techniques: a Pilot Australian Primary School Trial
Get PDFThis pilot study compared the effects of daily mindfulness meditation and Emotional Freedom Techniques (EFT) tapping on the emotional and behavioral regulation of 5-year-old children over a three-week period. Participants were divided into two groups, each receiving one of the interventions. Self-regulation, happiness, and life satisfaction were assessed weekly using validated measures. Results indicated that both interventions significantly improved self-regulation, however, no significant changes were observed in happiness and life satisfaction for either group. The findings suggest that while both mindfulness meditation and EFT tapping can enhance self-regulation in young children, longer intervention periods may be warranted for the other constructs. These results have implications for the implementation of mental health programs in early childhood education, highlighting the potential of both meditation and EFT practices to support emotional resilience from a young age
Copper theft is hitting building sites, street lights – and now phones. How do we stop it?
No full textFrom causing a major phone outage to shutting down street lights across parks, suburbs and roads, copper theft has become a clear public safety risk.Last week, Optus said a phone and mobile data outage that affected more than 14,000 people across south-east Melbourne was triggered by thieves trying to steal copper – and accidentally cutting the wrong cable.Across the border, last month the South Australia government introduced a bill to crack down on scrap metal theft, particularly copper. That followed more than 2,000 scrap metal thefts from building sites in 2023-24, costing an estimated A$70 million a year – just in one state.But why are people stealing copper? And what’s being done to stop it