What physical assessments would you need to undertake to determine a diagnosis?

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1 Case study (Siobhan Holmes) – Background

The local GP has referred Siobhan Holmes to you for an assessment and management of her plantar forefoot pain.

The patient is a 36yo (BMI=22), active female with a four-week history of right plantar 1st MTPJ pain, which was of a gradual onset. Her symptoms increase with exercise and increase in intensity post activity. Nocturnal symptoms are evident if she has run on the day. Symptoms were initially manageable, although in the past week the patient has had to stop all exercise. The patient is a professional athlete (3000m) with the Box Hill Athletics Club and is training for the summer athletics season but running the current x-country season to develop a fitness base. Siobhan is hoping to race at the Rye gift (3000m) in 4 months.

Medical history

The patient has an unremarkable medical history.

Past injury history

The patient reports having sustained a similar injury during the last summer athletics season, although her symptoms dissipated once the season ceased in April (after the Stawell gift carnival) and she had some time to rest.

Social history

  • The patient is a part time teacher;
  • The patient has a partner and two children.

Training information

Month Training

April racing – 3000m Stawell Gift Athletics Carnival

May Rest

June 4 sessions per week:

  1. Hills (8 x 300m; 1-2 minute walk recovery between reps)
  2. Fartlek (90 seconds run + 90 seconds jog x 2; 60 seconds run + 60 seconds jog x 4; 30 seconds run + 30 seconds jog x 4; 15 seconds run + 15 seconds jog x 4)
  3. 2 minutes run + 2 minutes rest x 6
  4. Cross country race (8km)

July Injured

August

Footwear

Runners: ASICS nimbus

Racing flats: Mizuno Woman’s Wave Universe 5

Case study questions

What physical assessments would you need to undertake to determine a diagnosis?

Question 2:

Imaging can be useful in the assessment of plantar 1st MTPJ pain. Below is an image taken of Siobhan’s forefoot. What type of imaging modalities are presented and based on the results, attempt a diagnosis and list 3 other differential diagnoses.

Question 3:

A semi-completed biomechanical assessment form is included in the folder at the beginning of this assessment.

In addition, a video gait assessment and video has been included below. Using this information, and the subjective information recorded above, list and briefly explain (with supporting references) the intrinsic and extrinsic risk factors for the musculoskeletal pathology Siobhan has presented with.

Question 4:

What are your broad immediate and long term goals that will help manage Siobhan’s foot pain and return her to full function?

Question 5:

Construct a detailed, week-by week, management plan that addresses your patient’s goal and risk factors. The design will need to be in the form of instructions that you would give your patient. Therefore, they must be highly specific and include scheduled appointments for review consults.

Remember that a range of treatment and rehabilitation options exist including cold/heat, therapeutic drugs, muscle strengthening and stretching, proprioception and footwear and activity modification, as well as walking boots/braces/orthoses.

Provide a ‘bottom line’ statement as to whether you believe Siobhan will be ready for the Rye gift in 4 months.

Feel free to be creative and construct your own plan or alternatively use the Word Document already established as a guide.

Question 6:

A multidisciplinary approach is useful in the management of many musculoskeletal pathologies, including pain beneath the first MTPJ. Write a brief letter to another professional outlining your findings and request for an additional assessment and/or management.

Instructions:

  • It is limited to 2,000 words.
  • Students will be penalised for going over the word limit. Words included in tables are counted within the word limit;
  • In text references (i.e. citations) are included in the word count
  • Words included in tables are counted within the word limit
  • Appendices can be used but all words will be included in the word count
  • Plagiarism will not be tolerated. Ensure that you are familiar with how to cite other people’s work using the APA referencing style.

Would it be wise to allow a third party (the auditor) access to our confidential business information?

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Assignment Details

Barry and Betty (husband and wife) have been running their business as a partnership for more than twenty years. Both of them are near retirement age but they feel so attached with their business that they would not like to sell it. On the other hand the demand for their products is rising significantly that they have to expand their production department and recruit more staff. Moreover the expansion also requires more financial investment in the business.

At a partner’s meeting they decide to transfer a major part of their shares to their children. They have two daughters and one son. Their son (Robert) is an air-conditioning engineer whereas one of the daughters (Chan) is a medical practitioner. The youngest daughter holds a degree in management. The children are excited by this move, but the youngest one (Jane) tells her parents that before doing any transfer, it is necessary to convert the partnership into a company. It is agreed and the company is incorporated under the name of B & B Co. Ltd. The shares are distributed as follows:

% shareholding

  • Betty 10
  • Barry 10
  • Robert 20
  • Chan 20
  • Jane 40

The reason for giving Jane a larger share than the other two children is because she will be involved in the day-to-day management of the company. During the first meeting of the company, Jane informs all the shareholders that the business is no longer governed by Partnership law, but the Corporations Act and the requirements of the Corporations Act are different from that of the Partnership Act. Jane makes it very clear that the company, given its size, needs to have its financial statements audited every year. The other shareholders agree with the proposal but argue that they need to understand:

  • What the audit would involve?
  • Who could be the auditor?
  • Would it be wise to allow a third party (the auditor) access to their confidential business information?
  • What if they do not have the accounts audited?
  • Can Jane do the audit herself?

Finally the board agreed that the company issue an invitation to tender for the audit of the company’s financial statements.

You are manager in one of the audit firms in the city and the audit partner has decided to bid for the tender. He has asked you to prepare a report for him to include in the tender document.

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Your report should address the points raised by the shareholders but you are also address why they should consider the particular firm to undertake the audit.

Marking scheme

Appropriate report format

5 marks

What the audit would involve?

25 marks

Who could be the auditor?

5 marks

Would it be wise to allow a third party (the auditor) access to our confidential business information?

5 marks

What if we do not have our accounts audited?

10 marks

Can Jane do the audit herself?

25 marks

Why use the particular firm

20marks

Appropriate use of Harvard referencing

5 marks

Total

100 marks

In this part of the assignment, you will begin to explore what so many of us need to do in the workplace: understand a problem, find out what might work best as a solution, and consider whether the solution(that has–according to the research -typically worked for others)will be easy or difficult to implement.

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Part 1: Reviewing the literature and identifying evidence-based practice(1,000 words)In this part of the assignment, you will begin to explore what so many of us need to do in the workplace: understand a problem, find out what might work best as a solution, and consider whether the solution(that has–according to the research -typically worked for others)will be easy or difficult to implement.

Scenario: You have been appointed the research manager within an organisation relevant to your field of study. You’ve essentially been asked to a)identify a problem the organisation needs to deal with, b) document what evidence-based information as been found (i.e. through peer-reviewed journals/reports) relevant to best-practice and c) report what enablers and barriers might be involved that make implementing best-practice easy or difficult by the organisation.References are not included in the word count. Referencing Style can be Harvard or APA. Please attach a cover sheet with your name and student number, word count and what referencing style you have used.In this scenario, the ‘organisation’could be a not-for-profit group, a clinical setting, a government department, a committee within your local council –for example –so don’t feel restricted. Use the assignment to engage with a problem/solution relevant to your interests. Get the sense of what it is to become your own detectiveas an actual researcher, getting to the bottom of a problem, learning what works and what can be done about it, as well as understanding why it might be easy or difficult translating theory into practice.The encouragement is to make this assignment useful, relevant and interesting for your own benefit.Example:(A)Workers within the palliative care unit of a particular Melbourne Hospital felt there seemed to be some miscommunication between doctors and their patients and carers.Research showed that patients and carers automatically assumed the doctor would naturally tell them everything they needed to know, whereas doctors assumed if patients and their carers needed to know everything they would ask (!). (B) Best-practice emphasised the importance of improving communication and practical pathways for achieving it.(C) It seemed easy and logical to provide flyers and information pamphlets in the waiting rooms to up-skill patients and carers about communication tips and hints, but uncertain how to create a culture of communication change within the medical community.

In this second part of the assignment, you will begin to explore what is involved when considering ethics and ethical implications as part of a research project.When working on research projects, successful ethics applications naturally play a large part in not only gaining approval for the project, but also anticipating and trouble-shooting any problems that might arise when conducting the study. It’s also a really helpful way to work out the appropriate research protocol, so getting it ‘right’ is critical. Scenario: You have been asked to help complete an ethics application for an organisation or group so they can begin a research project. Select one of the following options (topics) as the subject of your assignment(they are all based on actual projects):1. Evaluating a self-empowerment program aimed at reducing re-offending at the Youth Unit of Melbourne’s Port Phillip Prison. 2. Conducting a survey among staff and patient families in theIntensive Care Unit at the Alfred Hospital, aimed at improving patient experiences.3. Evaluating outcomes from programs aimed at reducing domestic violence with participants from culturally and linguistically diverse (CALD) communities at various inner city community health centres, facilitated by staff from the Centre for Culture Ethnicity and Health, Richmond.4. Monitoring and evaluating Aboriginal tobacco control by conducting a survey aimed at identifying smoking rates in remote Indigenous towns, as requested by the Lowitja Institute. 5. Evaluating outcomes from peer-education programs aimed at increasing safe sex education and practices among youth aged between 18-26 years.As the ethics advis or, you will need to a) identify key ethical implications associated with the proposed research based on associated/similar studies, b) relate these issues to the relevant items in the ethics application form, and c) suggest effective strategies for addressing them so that the ethics application will be approved for the project to go ahead.Resources:Information relating to these initiatives will be posted as sub-folders in the Assessment tab to help you get some background and make a start on your assignment. Reading literature on similar studies and topics and referencing them will be important for this assignment. Reporting and findings will help you identify the key ethical issues, as well as recognising how they were addressed in the various studies, to inform your decision-making. To meet the assessment criteria effectively, best to draw on actual findings rather than drawing on intuition –although your intuition might be a helpful guide regarding where to begin searching the literature.For simplicity, we will assume all projects only requirea low-risk ethics application. In reality, many of these would be considered high-risk, and the government NEAF application would require completion, as well as any host organisation’s ethics committee involvement. Given the word count, however, it makes sense to limit this appropriately. Similarly, it makes sense to draw on projects that have clear ethical issues rather than those which are more subtle (which typically attract the low-risk ethics application) to allow you to demonstrate your critical thinking

Why did Ebert write in his book Individualisation at work (2012) that ‘the self not only negotiates the social order, but the very process of negotiating defines its very nature and existence’ (p. 27)? What does it mean for his conception of socialisation?

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Read The Required Sources and answer the 3 multiple choice quizzes below.

Question 1:

Why did Ebert write in his book Individualisation at work (2012) that ‘the self not only negotiates the social order, but the very process of negotiating defines its very nature and existence’ (p. 27)? What does it mean for his conception of socialisation?

Select one answer:

  1. In the fragmented, pluralised and fast changing normative infrastructure of contemporary societies, individuals must be guided by an internalised form of control more than external systemic imperatives beyond the control of those individuals; people in earlier societies did not have to keep adjusting to social change and could rely on external forces to provide normative guidance. Socialisation here refers to the continuous, intensifying processes of individualisation in which a hyper-differentiating society is engaged by a uniquely modern self exercising flexible learning and adaptation through negotiation.
  2. The first characteristic of normative individualisation is that, in a society where the pace of change has stepped up beyond that which people in earlier societies had to keep adjusting to, a continuous exercise of flexible learning and adaptation guided by external systemic imperatives beyond the control of individuals becomes fundamental. Socialisation here refers to the continuous, intensifying processes of individualisation in which a hyper-differentiating society is engaged by a self exercising lifelong learning and adaptation through negotiation.
  3. ‘Identity’, which is the modern concept of self as opposed to the traditional concept of ‘social character’, reveals what actually remains the same (indicated in its Latin root idem, meaning the same) – the self as given at birth – in a society that nowadays appears to be more fragile, fragmented, pluralised or even paradoxical. ‘Identity’ defines the very nature and existence of the self because it alone is active, autonomous and self-defining in its negotiation. Socialisation here refers to the epic moment of individualisation in which a hyper-differentiating society tries to impose its normative construct of ‘social character’ onto the more natural, essential and authentic ‘Identity’.
  4. The ‘I’, which is the true self given at birth, has to negotiate the social order via the ‘Me’, which is the false, socially constructed self, or ‘tabula rasa’; the ‘I’ defines the very nature and existence of the self because it alone is active, autonomous and self-defining in its negotiation. Socialisation here refers to the epic moment of individualisation in which a hyper-differentiating society tries to impose its normative construct of ‘Me’ onto the more natural, essential and authentic ‘I’.

Question 2:

Why did Camhi name her 1993 article ‘Stealing Femininity’, as indicated by the main point of her argument?

Select one answer:

  1. Camhi’s concern in this article is with early modern cases of hysteria. This is a medical condition that is distinguished by daydreaming and split states of consciousness. It left patients prone to compulsive theft. Here ‘Stealing Femininity’ means thatall the women who stole (both ordinary thieves and true female hysterics) were ‘stealing femininity’ from normal women, by hiding behind the woman’s reputation of being weak willed and prone to kleptomania.
  2. Camhi’s concern in this article is with early modern reports of women stealing items like silk or lace, which represent femininity as a display that covers up for the ‘unaccountable’ anatomical difference of the woman’s body from the man’s. Here ‘Stealing Femininity’ means that the women were stealing signs of themselves, with the appropriated goods offering a mirror of femininity and a fantasy of self-possession.
  3. Camhi’s concern in this article is with early modern male doctors – psychiatrists like Freud, Dubuisson and Clerambault – representing femininity as a masquerade, or a display that covers up her shameful lack of a penis. Here ‘Stealing Femininity’ means that the men were ‘stealing femininity’ in putting their false accounts of penis envy in the place of woman’s true identity (e.g. Berthe Pappenheim as feminist and social worker).
  4. Camhi’s concern in this article is with early modern cases of kleptomania. This is a medical condition that is distinguished from ordinary theft by the wish to steal being compulsive, and the stolen goods having no use value. The truly pathological were only a small minority of those who stole; yet there were many women at that time who indulged in shoplifting. Here ‘Stealing Femininity’ means that these women – the ordinary thieves – were ‘stealing femininity’ from women (both normal women and true female kleptomaniacs), by hiding behind the woman’s reputation of being weak willed and prone to hysteria.

Question 3:

What point was made regarding the objects of consumption becoming feminised in post-WWII modernity (the pink cars, fridges etc characteristic of the 1950s) made by the lecturer, citing Penny Sparke, As Long As It’s Pink: The Sexual Politics of Taste (1995)?

Select one answer:

  1. It reflected the modernist ideology that feminine ‘taste’ was trashy, useless, outmoded and conservative, and belonged in the trivial sphere of popular consumption
  2. It reflected the post-WWII ideology that women belonged in the home, and was part of a patriarchal strategy to persuade women to give up their war jobs to the returning male soldiers.
  3. It reflected the post-WWII ideology of emphasising gender difference and was part of a capitalist strategy to persuade the primary consumers of this time – men – to buy certain objects for their women on top of what they might need to buy for themselves or the family in general.
  4. It reflected the expanding power of the female consumer, and was part of a manufacturing strategy to appeal to feminine ‘taste’ (which the rise of the department store had helped to rehabilitate culturally in the post-WWII period).