RESUMO
In the academic context, trigger warnings can be defined as explicit statements that alert a group of learners that certain content explored or discussed in a learning environment may contain potentially distressing material. Extant research highlights a relationship between traumatization and trigger warnings; however, the extent to which trigger warnings constitute a method of best practice for reducing traumatization in higher education has not been addressed. Thus, a systematic literature review was conducted to explore this relationship. A search conducted across academic databases to locate peer-reviewed articles published between November 2010 and November 2020, combined three areas of interest: (1) "trigger warnings," (2) "best practice," and (3) "higher education." Database searches and further manual searches yielded a total of 194 journal articles. Of these, 20 studies satisfied all inclusion criteria. Following the data extraction process, thematic analysis was employed to identify, analyze, and report patterns within data. The key themes identified through the review include trigger warnings as inclusive practice, as part of trauma-informed pedagogy, as ineffectual practice, and as harmful practice. The evidence suggests that when embedded as part of a broader, holistic, and trauma-informed approach, trigger warnings can be a valuable tool for assisting with the effective reduction of traumatization in the higher education context.
RESUMO
BACKGROUND: Thigh pain is a variably reported symptom in the postoperative period following primary total hip arthroplasty (THA) with a well-fixed cementless femoral implant. While research has identified stem size, stem alignment, and differences in modulus of elasticity between implant and host bone as potential sources of thigh pain, only one study has specifically examined the impact of variation in implant design within a single femoral stem design. The purpose of this work was to determine whether there were differences in the pain experienced by patients treated with two design variants of a femoral stem during direct anterior THA. MATERIALS AND METHODS: Patients undergoing primary direct anterior THA at a single center between 2011-2015 were included in the study. Those patients suffering extensive comorbidities and postoperative complications were excluded from analysis. Study subjects completed a pain drawing and scale questionnaire for the operative hip at least one year following surgery. A cementless, single-taper wedge, titanium femoral component design available in short- and standard-length variations was used in all cases. Pain outcomes were compared between these two femoral stem options. RESULTS: A total of 1347 patients (1536 THA) met inclusion criteria for the study and surveys were returned for 820 of these THAs. Demographic data and UCLA activity scores were similar between cohorts of patients receiving the short- and standard-length components. The most common locations of pain reported were in the lower back and trochanteric region, 28% and 24% respectively. Patients in the short-length cohort reported a significantly lower incidence of pain in the anterior thigh as compared to the standard-length cohort, 12% versus 19% respectively [p=0.007]. There was no difference in the number of patients experiencing moderate to severe intensity of anterior thigh pain between these two groups, 3% versus 5% respectively [p=0.36]. No other statistically significant differences were found in the incidence of pain in the lower back, buttock, groin, trochanter, lateral thigh, or posterior thigh regions between the two cohorts. CONCLUSION: While the lower back and trochanteric region may be the most frequent areas of pain experienced in patients at one-year or more postoperative from direct anterior THA, a significantly higher incidence of anterior thigh pain is found in those patients treated with a standard-length stem design as compared to the short design. This finding may be due to contact between the tip of the distal stem with the femoral diaphysis as has been theorized in previous research, which is circumvented with the short design variant.
