Conservative treatment of patellar tendinopathy

Patellar tendinopathy disrupts athletic careers in several sports and is resistant to many forms of conservative treatment. Outcome after conservative treatment has been minimally investigated, and the effect of these treatments on the pathology of overuse tendinopathy are not well understood.

The clinical assessment of patellar tendinopathy appears straightforward, but evidence suggests that the importance of imaging and palpation in diagnosis and ongoing assessment may be overestimated. There is a lack of clinically relevant research on which to base treatment. However, the principles of management for patellar tendinopathy derived from clinical experience include load modification, musculotendinous rehabilitation, and intervention to improve the shock absorbing capacity of the limb. The role of electrophysical agents, massage, and stretching in the treatment of patellar tendinopathy are also discussed. The progression of treatment is based on clinical grounds due to a lack of reliable subjective and objective tools to assess recovery.

The failure of some conservative programs could be due to either athlete compliance or practitioner expertise. The management of patellar tendinopathy is complex, and if the physiotherapist addresses all the principles of treatment, the chance of success could be increased.

John Howard, Australian conservative

John Howard was the first elected Australian prime minister to identify himself as a conservative; he claimed to be a liberal in economic policy and a conservative in social policy.

Conservative discourse at the time of the Korean War. 1950-52

This thesis identifies the rhetorical strategies by which the Menzies government reconciled acceptance of full employment, the welfare state and government intervention with a defence of liberalism. It argues that the Korean War offered the Menzies government an opportunity to reconstitute these key aspects of the postwar state as "liberal" rather than social democratic.

Radical conservative experiment in New South Wales education

This study, written from the perspective of a parent activist, articulates the 'battle of ideas' or struggle 'around the truth' of public education in New South Wales since the conservative Greiner government came to power in 1988 and instituted the 'new right' agenda. Political control is theorised in the light of debates about hegemony, power, ideology and truth. Documents what happened in 'consultations' about educational reform between the Ministers and their appointees on on the one hand, and the public education lobby, on the other.

Subversive jewellery : challenges to conservative power from the Victorian goldfields

 This paper analyses a small group of pieces of gold jewellery in order to explore the digger challenge to the colonial culture of conservative deference in 1850s gold rush Victoria. In spending on lavish gold ornaments, lucky diggers asserted the value of their hard, manual labour to subvert the hegemonic respectability of the colonial elite. The brooches offer evidence of values that informed the digger population in its transformation from optimistic transnational transients into civilians who originated the modern form of the Australian middle class.

Conservative corporate compliance: Reflections on a study of compliance responses by South African banks

While corporate non-compliance receives much attention, conservative and over-compliant responses are often ignored. These responses go beyond what is required by a particular regulatory requirement. In many cases, regulators may support such responses because they advance regulatory objectives. In the context of risk-based regulation and compliance, especially the model implemented by the Financial Action Task Force to combat money laundering and financing of terrorists, that may, however, not necessarily be the case. With this risk-based approach, regulated institutions are required to respond to higher risks by adopting enhanced risk mitigation measures and are allowed to simplify those measures where the risks are assessed as low. Failure in the latter cases to simplify risk mitigation measures where appropriate, may be inefficient and, in some instances, may even undermine regulatory objectives. This article investigates the drivers of conservative responses by South African banks to statutory anti-money laundering and counter-terrorist financing laws.

Is anterior cruciate reconstruction superior to conservative treatment?

Not all patients who have a rupture of the anterior cruciate ligament (ACL) elect to have surgical reconstruction. The aim of this study was to assess the short-to-medium-term results of patients who chose conservative management in comparison to patients who had reconstructive surgery within the same time period. Sixty-three patients with an ACL injury were retrospectively studied. Forty patients were managed, according to patient choice, with ACL reconstruction and 23 conservatively. Four validated questionnaires were used to assess general and knee-specific function in a cohort with a median age of 32 years and a median follow-up period of 38 months. Patients were matched on demographic variables except for gender. There were no statistically significant differences in the outcome measures, and the majority of patients would proceed with the same treatment in the event the control leg became injured. Patients who elect to have conservative management of an ACL rupture can achieve similar function and satisfaction to those who elect to have reconstruction. Until a large randomized controlled trial is conducted, patients need to be made aware of the merits of both management strategies and the lack of evidence of superiority of one over the other.

Minimising post-operative risk using a Post-Anaesthetic Care Tool (PACT): protocol for a prospective observational study and cost-effectiveness analysis

Introduction: While the risk of adverse events following surgery has been identified, the impact of nursing care on early detection of these events is not well established. A systematic review of the evidence and an expert consensus study in post-anaesthetic care identified essential criteria for nursing assessment of patient readiness for discharge from the Post-Anaesthetic Care Unit. These criteria were included in a new nursing assessment tool, the Post-Anaesthetic Care Tool (PACT), and incorporated into the post-anaesthetic documentation at a large health service. The aim of this study is to test the clinical reliability of the PACT and evaluate whether use of PACT will i) enhance the recognition and response to patients at risk of deterioration in PACU; ii) improve documentation for handover from PACU nurse to ward nurse; iii) result in improved patient outcomes; and iv) reduce health care costs.

Methods and analysis: A prospective, non-randomised, pre- and post-implementation design comparing: (i) patients (n=750) who have surgery prior to the implementation of the PACT and (ii) patients (n=750) who have surgery after PACT. The study will examine the use of the tool through the observation of patient care and nursing handover. Patient outcomes and cost effectiveness will be determined from health service data and medical record audit. Descriptive statistics will be used to describe the sample and compare the two patient groups (pre- and post-intervention). Differences in patient outcomes between the two groups will be compared using the Cochran-Mantel-Haenszel test and regression analyses and reported as odds ratios with the corresponding 95% confidence intervals.

Conclusion: This study will test the clinical reliability and cost-effectiveness of the PACT. It is hypothesised that the PACT will enable nurses to recognise and respond to patients at risk of deterioration, improve handover to ward nurses, improve patient outcomes, and reduce health care costs.