45 research outputs found
Guidelines for the management of the foot health problems associated with rheumatoid arthritis
Background. Rheumatoid arthritis (RA) as a chronic systemic disease, commonly affects the feet, impacting
negatively on patients' quality of life. Specialist podiatrists have a prime role to play in the assessment and
management of foot and ankle problems within this patient group. However, it has been identified that in many
areas there is no specialist podiatry service, with many patients being managed by nonâspecialist podiatrists.
Therefore, the North West Clinical Effectiveness Group for the Foot in Rheumatic Diseases (NWCEG) identified
the need to develop âpractitioner facingâ guidelines for the management of specific foot health problems associated
with RA.
Methods. Members of a guideline development group from the NWCEG each reviewed the evidence for specific
aspects of the assessment and management of foot problems. Where evidence was lacking, âexpert opinionâ was
obtained from the members of the NWCEG and added as a consensus on current and best practice. An iterative
approach was employed, with the results being reviewed and revised by all members of the group and external
reviewers before the final guideline document was produced.
Results. The management of specific foot problems (callus, nail pathology, ulceration) and the use of specific
interventions (foot orthoses, footwear, patient education, steroid injection therapy) are detailed and standards in
relation to each are provided. A diagrammatic screening pathway is presented, with the aim of guiding nonspecialist
podiatrists through the complexity of assessing and managing those patients with problems requiring
input from a specialist podiatrist and other members of the rheumatology multidisciplinary team.
Conclusion. This pragmatic approach ensured that the guidelines were relevant and applicable to current practice
as âbest practiceâ, based on the available evidence from the literature and consensus expert opinion. These
guidelines provide both specialist and nonâspecialist podiatrists with the essential and âgold standardâ aspects of
managing people with RAârelated foot problems
Fluids and barriers of the CNS: a historical viewpoint
Tracing the exact origins of modern science can be a difficult but rewarding pursuit. It is possible for the astute reader to follow the background of any subject through the many important surviving texts from the classical and ancient world. While empirical investigations have been described by many since the time of Aristotle and scientific methods have been employed since the Middle Ages, the beginnings of modern science are generally accepted to have originated during the 'scientific revolution' of the 16th and 17th centuries in Europe. The scientific method is so fundamental to modern science that some philosophers consider earlier investigations as 'pre-science'. Notwithstanding this, the insight that can be gained from the study of the beginnings of a subject can prove important in the understanding of work more recently completed. As this journal undergoes an expansion in focus and nomenclature from cerebrospinal fluid (CSF) into all barriers of the central nervous system (CNS), this review traces the history of both the blood-CSF and blood-brain barriers from as early as it was possible to find references, to the time when modern concepts were established at the beginning of the 20th century