Rehabilitation versus surgical reconstruction for non-acute anterior cruciate ligament injury (ACL SNNAP): a pragmatic randomised controlled trial

BackgroundAnterior cruciate ligament (ACL) rupture is a common debilitating injury that can cause instability of the knee. We aimed to investigate the best management strategy between reconstructive surgery and non-surgical treatment for patients with a non-acute ACL injury and persistent symptoms of instability.MethodsWe did a pragmatic, multicentre, superiority, randomised controlled trial in 29 secondary care National Health Service orthopaedic units in the UK. Patients with symptomatic knee problems (instability) consistent with an ACL injury were eligible. We excluded patients with meniscal pathology with characteristics that indicate immediate surgery. Patients were randomly assigned (1:1) by computer to either surgery (reconstruction) or rehabilitation (physiotherapy but with subsequent reconstruction permitted if instability persisted after treatment), stratified by site and baseline Knee Injury and Osteoarthritis Outcome Score—4 domain version (KOOS4). This management design represented normal practice. The primary outcome was KOOS4 at 18 months after randomisation. The principal analyses were intention-to-treat based, with KOOS4 results analysed using linear regression. This trial is registered with ISRCTN, ISRCTN10110685, and ClinicalTrials.gov, NCT02980367.FindingsBetween Feb 1, 2017, and April 12, 2020, we recruited 316 patients. 156 (49%) participants were randomly assigned to the surgical reconstruction group and 160 (51%) to the rehabilitation group. Mean KOOS4 at 18 months was 73·0 (SD 18·3) in the surgical group and 64·6 (21·6) in the rehabilitation group. The adjusted mean difference was 7·9 (95% CI 2·5–13·2; p=0·0053) in favour of surgical management. 65 (41%) of 160 patients allocated to rehabilitation underwent subsequent surgery according to protocol within 18 months. 43 (28%) of 156 patients allocated to surgery did not receive their allocated treatment. We found no differences between groups in the proportion of intervention-related complications.InterpretationSurgical reconstruction as a management strategy for patients with non-acute ACL injury with persistent symptoms of instability was clinically superior and more cost-effective in comparison with rehabilitation management

The management of funds in Gauteng schools

M.ed.This research focuses on the management of allocated funds in Gauteng schools. April 1994 witnessed the birth of a new and democratic South Africa. This birth has meant the need for changes in various areas in the efficient and effective governance of the new South Africa. Education is one area affected by this change. It poses a challenge that includes a range of problematic issues such as inadequate resources, the absence of a culture of learning and teaching, and most recently, the management of allocated funds to schools by the provincial education departments. The effective management of allocated funds is critical for the payment of services such as electricity, water and sewerage the purchase of learning material for teaching; and the maintenance of the school buildings. The aim of this research is to: • analyse the official documents for the management of allocated funds for section 21 schools; • critically evaluate the management of allocated funds m three countries (Botswana, Australia and Malawi) • evaluate and compare the management of school funds in schools that have section 21 functions, and those without these functions. The following research methods were employed to gather the relevant research data: (1) Literature study; (2) Focus group interviews and site analyses of two schools (one with Section 21 functions and one without) on how they manage the allocated funds. This included observations and interviews with the principals and chairperson of the fmance committee. The study concludes with recommendations and guidelines for the management of allocated funds for section 21 schools

School fees at public schools in Gauteng: implications for the provision of education.

This research focuses on School fees at public schools in Gauteng: implications for the provision of education. The demand for free education is no longer one made by revolutionaries or radicals only. Even the World Bank – key architects of user fees – have come around to this way of thinking, seeing that charging school fees for primary education is bad for development. The subject of school fees has been in the news because of the disruption of schooling by the Pan African Student Organisation in Tskane (Gauteng) and Balfour (Mpumalanga). In Tskane, students demanded a reduction in fees from R300-00, (Secondary Schools) and R120-00 (Primary Schools) to R50-00 and R25-00 respectively. The Global Campaign for Education (GCE) has called for the total scrapping of school fees over the next three years. Cosatu and Sadtu President sang from the same hymn book, “education fees are a tax on the poorest and must be dropped” (The Educators’ Voice, 2002b:2). The Freedom Charter, a beacon of the revolution, was drafted by popular assembly in Kliptown in 1955 by the African National Congress Alliance. Declaring, “the doors of learning and culture shall be opened,” it championed the right to education, which shall be free, compulsory, universal and equal for all, and adult illiteracy shall be ended by a mass state education plan. (The Educators’ Voice, 2002b:3) The Reconstruction Development Plan document based on the Freedom Charter, which served as the African National Congress-led alliance electoral platform for the 1994 elections, stated that the democratic Government must ensure that all children go to school for at least 10 years. The ten-year compulsory general education cycle should proceed from a pre-school reception year to the present grade nine. The Government must phase in compulsory education as soon as possible. To achieve this objective the Government must rebuild and expand our schools. Classes of 50-80 or more learners are unacceptable. “We must ensure that no class exceeds 40 learners by the end of the decade.” In many developing countries the levying of school fees prevents children access to school. Even in countries where primary education is meant to be free, the cost of buying books and uniforms means that many poor families simply cannot afford to educate their children. The World Bank recently called for the elimination of school fees. Immediate action to increase resources to countries which have education plans and a three to five fold increase of donor funding for primary education is needed (The Educators’ Voice, 2002b:3). A report on school funding and resourcing commissioned by former National Education Minister Professor Kader Asmal, found worrying indications of disregard by Education Department employees of the rights of the poor. The report found that while discrimination against impoverished learners was not widespread, it was common enough to merit intervention. As the “new” South Africa forges ahead with rebuilding and transforming its education system following the end of apartheid in 1994, the levying of school fees has emerged as a highly controversial issue – one that resonates in many developing countries around the world. Such fees are regarded by many South Africans as exacerbating a problem – a plagued national system of education funding that falls short of meeting even the most basic needs of the nation’s historically disadvantaged learners. Most of those learners are black children who make up roughly 90 percent of our learner population (The Educators’ Voice, 2002b:3). However, to many education officials and principals, school fees are a necessary financial tool as the government tries to address the severe education inequities such as crumbling classrooms and insufficient textbooks that are reminders of apartheid’s hateful legacy. The government does not have the money to bring all schools up to standard. A coalition of activist, researchers, educators, and lawyers are now using school fees as a rallying cry for an effort, they hope, will spur more substantive improvements to South Africa’s ailing schools. The goal of the Education Rights Projects is to ensure that all children, especially the nation’s indigent youth, have access to a free basic education (http://www.epnet.com). In addition to school fees, the group plans to address the dearth of proper school buildings and teaching resources, the hardships experienced by rural students, and the sexual harassment of and violence to female students. Katarina Tomanevski, the special rapporteur on the right to education in the United Nations office of the High Commissioner for Human Rights, said that it is possible to eliminate school fees, noting that Uganda and Tanzania abolished them in recent years. The World Bank is strengthening its opposition to school fees because countries that charge fees cannot ensure that poor children still have access to school, said Robert S. Prouty, the bank’s leading education specialist. Daria Roithmayr, an associate professor of law at the University of Illinois, who wrote a paper on school fees, contends that school fees violate the South African Constitution which guarantees the children’s basic right to education. School fees also contradict international law, including the Convention On The Rights Of The Child, an international human rights treaty that requires governments, including South Africa, to make primary education “free” for all (http://www.epnet.com).Prof. T.C. Bisschof

Disseminated skin lesions in a patient with AIDS

Patients with advanced HIV-1 disease can present with a vast array of opportunistic infections. Not only is the spectrum of disease more diverse, but the spectrum of presentation can vary significantly from what is expected. In this case report we describe a patient with advanced HIV-1 disease presenting disseminated skin lesions and haematological abnormalities. Upon further investigation, a probable diagnosis of disseminated histoplasmosis was established. The patient was subsequently treated with oral itraconazole and showed marked haematological and clinical improvement within six weeks of therapy. Histoplasmosis is an opportunistic infection endemic to South Africa and, like most opportunistic infections, can present with a myriad of clinical features which can complicate early diagnosis. Although not as prevalent as in other parts of the world, it should always be considered as part of the differential diagnosis, especially among severely immunocompromised individuals.http://www.sajei.co.za/index.php/SAJE