Foot health management

2019 ◽  
pp. 249-280
Author(s):  
Heidi Siddle ◽  
Gordon Hendry
Keyword(s):  
Health Management ◽  
Musculoskeletal Diseases ◽  
Connective Tissue Diseases ◽  
Clinical Intervention ◽  
Current Evidence ◽  
Clinical Expertise ◽  
Foot Health ◽  
Education Of Patients ◽  
Clinical Strategies

This chapter will provide the reader with current evidence and the clinical strategies to improve the foot health management of patients with rheumatic and musculoskeletal diseases. The education of patients and health professionals will be key to implementing self-management early in the disease, together with the recognition of problems that require clinical intervention to improve the patient’s long-term outcomes. Unfortunately, there is still a lack of evidence to support many specific interventions, particularly for patients with connective tissue diseases. However, we can utilize increased understanding of the effects that these diseases have on the foot, together with clinical expertise, to manage symptoms and prevent damage and deformity.

scholarly journals Potential Therapeutic Strategies for Hypertension-Exacerbated Cardiotoxicity of Anticancer Drugs

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Robin K. Kuriakose ◽  
Rakesh C. Kukreja ◽  
Lei Xi
Keyword(s):  
Cancer Patients ◽  
Cancer Registries ◽  
Current Evidence ◽  
Future Research ◽  
Beetroot Juice ◽  
Adjunct Treatment ◽  
Clinical Strategies ◽  
Preclinical And Clinical Studies ◽  
Anthracycline Chemotherapy

Despite their recognized cardiotoxic effects, anthracyclines remain an essential component in many anticancer regimens due to their superior antitumor efficacy. Epidemiologic data revealed that about one-third of cancer patients have hypertension, which is the most common comorbidity in cancer registries. The purpose of this review is to assess whether anthracycline chemotherapy exacerbates cardiotoxicity in patients with hypertension. A link between hypertension comorbidity and anthracycline-induced cardiotoxicity (AIC) was first suggested in 1979. Subsequent preclinical and clinical studies have supported the notion that hypertension is a major risk factor for AIC, along with the cumulative anthracycline dosage. There are several common or overlapping pathological mechanisms in AIC and hypertension, such as oxidative stress. Current evidence supports the utility of cardioprotective modalities as adjunct treatment prior to and during anthracycline chemotherapy. Several promising cardioprotective approaches against AIC pathologies include dexrazoxane, early hypertension management, and dietary supplementation of nitrate with beetroot juice or other medicinal botanical derivatives (e.g., visnagin and Danshen), which have both antihypertensive and anti-AIC properties. Future research is warranted to further elucidate the mechanisms of hypertension and AIC comorbidity and to conduct well-controlled clinical trials for identifying effective clinical strategies to improve long-term prognoses in this subgroup of cancer patients.

Where should a school shoe provide flexibility and support for the asymptomatic 6- to 10-year-olds and on what information is this based? A Delphi yielded consensus

2014 ◽  
Vol 39 (3) ◽  
pp. 213-218 ◽  
Author(s):  
Nina Davies ◽  
Helen Branthwaite ◽  
Nachiappan Chockalingam
Keyword(s):  
Clinical Intervention ◽  
Poor Agreement ◽  
Allied Health Professionals ◽  
Foot Health ◽  
Shoe Design ◽  
Personal Belief ◽  
Musculoskeletal Structure ◽  
Age Range ◽  
Footwear Design

Background: There is a paucity of evidence regarding the design of children’s footwear in relation to musculoskeletal structure. Objectives: The aim was to gain consensus regarding where flexibility and support should be given on a school shoe for the 6- to 10-year-olds. Study design: Delphi Questionnaire. Methods: Recruitment of 10 Allied Health Professionals yielded a consensus group. Those recruited had dedicated experience in paediatrics and foot health. Rounds of questions were delivered to investigate the basis of the opinions made by the group on the location of support and flexibility in a school shoe for the age range identified. Results: Six themes were generated. Four themes gained 100% consensus regarding footwear allowing normal foot movement, footwear allowing normal forefoot function, footwear providing a stable base and the foot being secure in the shoe. Fleiss’ kappa calculations revealed ‘poor agreement’ for the remaining two themes regarding clinical intervention and the purpose of footwear design in the midfoot in both the upper and sole of the shoe. Conclusion: The qualitative data generated through discussion have highlighted areas where more understanding and research are required, particularly in understanding how, in the long term, shoe design can affect the developing foot. Clinical relevance Children’s footwear advice is often delivered from experience and personal belief. This article questions current understanding and opinion from clinical experts in the field of paediatric footwear and highlights that there is a lack of knowledge and confidence into the effects of children’s footwear. There is a strong requirement for further empirical research to be completed on children’s footwear to allow clinicians to formulate relevant and appropriate footwear advice.

Integrated Biomarkers for Depression in Alzheimer’s Disease: A Critical Review

2017 ◽  
Vol 14 (4) ◽  
pp. 441-452 ◽  
Author(s):  
Sofia Wenzler ◽  
Christian Knochel ◽  
Ceylan Balaban ◽  
Dominik Kraft ◽  
Juliane Kopf ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Affect Regulation ◽  
Current Evidence ◽  
Diagnostic Process ◽  
Neuropsychiatric Manifestation ◽  
The Brain ◽  
Control Functional

Depression is a common neuropsychiatric manifestation among Alzheimer’s disease (AD) patients. It may compromise everyday activities and lead to a faster cognitive decline as well as worse quality of life. The identification of promising biomarkers may therefore help to timely initiate and improve the treatment of preclinical and clinical states of AD, and to improve the long-term functional outcome. In this narrative review, we report studies that investigated biomarkers for AD-related depression. Genetic findings state AD-related depression as a rather complex, multifactorial trait with relevant environmental and inherited contributors. However, one specific set of genes, the brain derived neurotrophic factor (BDNF), specifically the Val66Met polymorphism, may play a crucial role in AD-related depression. Regarding neuroimaging markers, the most promising findings reveal structural impairments in the cortico-subcortical networks that are related to affect regulation and reward / aversion control. Functional imaging studies reveal abnormalities in predominantly frontal and temporal regions. Furthermore, CSF based biomarkers are seen as potentially promising for the diagnostic process showing abnormalities in metabolic pathways that contribute to AD-related depression. However, there is a need for standardization of methodological issues and for replication of current evidence with larger cohorts and prospective studies.

scholarly journals Implementation of podiatry telephone appointments for people with rheumatic and musculoskeletal diseases

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
J. L. Palmer ◽  
H. J. Siddle ◽  
A. C. Redmond ◽  
B. Alcacer-Pitarch
Keyword(s):  
Musculoskeletal Diseases ◽  
Cost Effective ◽  
Time Frame ◽  
Teaching Hospitals ◽  
Potential Cost ◽  
Foot Health ◽  
Telephone Consultation ◽  
Face To Face ◽  
Initial Intervention

Abstract Background Foot health problems are common in the general population, and particularly so in people with rheumatic and musculoskeletal disorders (RMD). Several clinical guidelines state that people with RMDs should have access to foot health services, although service capacity is often limited. The current COVID-19 pandemic has increased the need for alternative ways to provide patient care. The aim of this clinical audit was to review a newly implemented telephone follow-up appointment service conducted within the Rheumatology Podiatry Department in Leeds, UK. Methods Fifty-eight patients attending the Rheumatology Podiatry Department at Leeds Teaching Hospitals NHS Trust were contacted by telephone approximately 6–8 weeks following initial intervention. During the telephone consultation, all patients were asked pre-defined questions relating to their symptoms, intervention efficacy, the need for further appointments and their preference for the type of consultation. To assess the cost of the telephone consultation the number of attempts needed in order to make successful contact, the duration of the call and the number of telephone follow-up appointments completed in a working day were also recorded. Results Twenty-five patients (43%) were successfully contacted within the 6–8 weeks stipulated time frame and were included in the analysis. Of the 25 contacted, twelve (48%) patients were successfully contacted on the first attempt. Ten (40%) were successfully contacted on the second attempt. The remaining three patients (12%) required 3 or more attempts to make successful contact. Telephone consultations were estimated not to last longer than 10 min, including notes screening and documentation. Eleven patients (44%) reported an improvement in their symptoms, thirteen (52%) reported no change and one patient (4%) reported their symptoms to be worse. Conclusion Telephone follow-up consultations may be a potentially cost-effective alternative to face-to-face appointments when implemented in a Rheumatology Podiatry Department, and provide an alternative way of providing care, especially when capacity for face-to-face contact is limited. The potential cost saving and efficiency benefits of this service are likely to be enhanced when telephone consultations are pre-arranged with patients.

scholarly journals Adhesive Small Bowel Obstruction and the six w’s: Who, How, Why, When, What, and Where to diagnose and operate?

2021 ◽  
pp. 145749692098276
Author(s):  
M. Podda ◽  
M. Khan ◽  
S. Di Saverio
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Conservative Management ◽  
Bowel Ischemia ◽  
Current Evidence ◽  
First Episode ◽  
Adhesive Small Bowel Obstruction ◽  
Highly Effective

Background and Aims: Approximately 75% of patients admitted with small bowel obstruction have intra-abdominal adhesions as their cause (adhesive small bowel obstruction). Up to 70% of adhesive small bowel obstruction cases, in the absence of strangulation and bowel ischemia, can be successfully treated with conservative management. However, emerging evidence shows that surgery performed early during the first episode of adhesive small bowel obstruction is highly effective. The objective of this narrative review is to summarize the current evidence on adhesive small bowel obstruction management strategies. Materials and Methods: A review of the literature published over the last 20 years was performed to assess Who, hoW, Why, When, What, and Where diagnose and operate on patients with adhesive small bowel obstruction. Results: Adequate patient selection through physical examination and computed tomography is the key factor of the entire management strategy, as failure to detect patients with strangulated adhesive small bowel obstruction and bowel ischemia is associated with significant morbidity and mortality. The indication for surgical exploration is usually defined as a failure to pass contrast into the ascending colon within 8–24 h. However, operative management with early adhesiolysis, defined as operative intervention on either the calendar day of admission or the calendar day after admission, has recently shown to be associated with an overall long-term survival benefit compared to conservative management. Regarding the surgical technique, laparoscopy should be used only in selected patients with an anticipated single obstructing band, and there should be a low threshold for conversion to an open procedure in cases of high risk of bowel injuries. Conclusion: Although most adhesive small bowel obstruction patients without suspicion of bowel strangulation or gangrene are currently managed nonoperatively, the long-term outcomes following this approach need to be analyzed in a more exhaustive way, as surgery performed early during the first episode of adhesive small bowel obstruction has shown to be highly effective, with a lower rate of recurrence.

scholarly journals A clinical audit into the adherence of foot health management standards of rheumatoid arthritis compared to the foot health management standards of diabetes mellitus in North-East London

2021 ◽  
Author(s):  
Christopher Joyce ◽  
Rizwan Rajak
Keyword(s):  
Rheumatoid Arthritis ◽  
Diabetic Foot ◽  
Health Management ◽  
Clinical Audit ◽  
Poor Compliance ◽  
Foot Health ◽  
North East ◽  
Management Standards ◽  
Audit Data ◽  
Health Standards

Abstract Objectives Rheumatoid arthritis (RA) has an affinity to smaller joints, thus its effect on the foot/ankle is widely known. Despite this, there is lack of adherence to foot management standards by podiatrists. This research aimed to audit the adherence of these standards and compare them to well-established management standard adherence in the diabetic foot. Methods In this clinical audit, data was obtained via six National Health Service (NHS) podiatry departments in North-East London on service provision, management, treatment and professional development on both RA and diabetic foot health via foot management clinical audit tools. Descriptive analyses were conducted analysed to identify patterns and trends, with set standard compliance conditions calculated on Net Promotor Score ® (NPS) metric to allow for multi-comparison. Results All areas of RA foot health management were found to have poor compliance when compared to diabetes foot health management. When using NPS, no trust audited meet the majority of foot health standards in RA; with only two having a positive score (meeting the minimum standards) compared to all trusts posting a positive NPS on diabetes foot health standards. Conclusions Our results indicate that poor compliance into RA foot health standards is prevalent across the audited region and may be resulting in worsening foot outcomes despite a paradigm shift in other areas of RA management. Enhanced training and knowledge is required for better adherence to the standards set out and improve a foot health management in RA.

scholarly journals Determinants of Outcomes of Acute Kidney Injury: Clinical Predictors and Beyond

2021 ◽  
Vol 10 (6) ◽  
pp. 1175
Author(s):  
Emaad M. Abdel-Rahman ◽  
Faruk Turgut ◽  
Jitendra K. Gautam ◽  
Samir C. Gautam
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Complete Recovery ◽  
Severe Form ◽  
Clinical Syndrome ◽  
Current Evidence ◽  
Clinical Predictors ◽  
End Stage

Acute kidney injury (AKI) is a common clinical syndrome characterized by rapid impairment of kidney function. The incidence of AKI and its severe form AKI requiring dialysis (AKI-D) has been increasing over the years. AKI etiology may be multifactorial and is substantially associated with increased morbidity and mortality. The outcome of AKI-D can vary from partial or complete recovery to transitioning to chronic kidney disease, end stage kidney disease, or even death. Predicting outcomes of patients with AKI is crucial as it may allow clinicians to guide policy regarding adequate management of this problem and offer the best long-term options to their patients in advance. In this manuscript, we will review the current evidence regarding the determinants of AKI outcomes, focusing on AKI-D.

scholarly journals Long-term effects of fine particulate matter exposure on the progression of arterial stiffness

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Dianqin Sun ◽  
Yue Liu ◽  
Jie Zhang ◽  
Jia Liu ◽  
Zhiyuan Wu ◽  
...  
Keyword(s):  
Arterial Stiffness ◽  
Health Management ◽  
Ankle Brachial Index ◽  
Population Data ◽  
Average Concentration ◽  
Air Pollutant ◽  
Stiffness Index ◽  
Long Term Effects ◽  
Annual Average

Abstract Background Prior studies have investigated the association of PM2.5 exposure with arterial stiffness measured by ankle-brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV), of which conclusions are inconsistent. Moreover, limited evidence is available on the contributory role of PM2.5 exposure on the arterial stiffness index. Methods We used the population data from the Beijing Health Management Cohort and conducted a longitudinal analysis. The annual average concentration of PM2.5 for 35 air pollutant monitoring sites in Beijing from 2014 to 2018 was used to estimate individual exposure by different interpolation methods. Multivariate logistic regression and linear regression were conducted to assess the association of annual average PM2.5 concentration with the incidence of higher baPWV, the progression of ABI, and baPWV, respectively. Results The association between PM2.5 exposure and incidence of higher baPWV was not significant (OR = 1.11, 95% CI: 0.82–1.50, P = 0.497). There was − 0.16% (95% CI: − 0.43-0.11%) decrease in ABI annually and 1.04% (95% CI: 0.72–1.37%) increase in baPWV annually with each increment of 10 μg/m3 average PM2.5 concentration. Conclusions Long-term exposure to PM2.5 was associated with the progression of arterial stiffness in Beijing. This study suggests that improvement of air quality may help to prevent arterial stiffness.

scholarly journals Wearable Wireless Physiological Monitoring System Based on Multi-Sensor

Electronics ◽  
2021 ◽  
Vol 10 (9) ◽  
pp. 986
Author(s):  
Hongru Li ◽  
Guiling Sun ◽  
Yue Li ◽  
Runzhuo Yang
Keyword(s):  
Monitoring System ◽  
Health Management ◽  
Wearable Technology ◽  
Physiological Monitoring ◽  
Motion Data ◽  
Low Load ◽  
Measure Heart Rate ◽  
Body Surface Temperature ◽  
Continuous Work

The purpose of wearable technology is to use multimedia, sensors, and wireless communication to integrate specific technology into user clothes or accessories. With the help of various sensors, the physiological monitoring system can collect, process, and transmit physiological signals without causing damage. Wearable technology has been widely used in patient monitoring and people’s health management because of its low-load, mobile, and easy-to-use characteristics, and it supports long-term continuous work and can carry out wireless transmissions. In this paper, we established a Wi-Fi-based physiological monitoring system that can accurately measure heart rate, body surface temperature, and motion data and can quickly detect and alert the user about abnormal heart rates.

Menstrual, Sexual, and Obstetrical Outcomes after Vaginal Replacement for Vaginal Atresia Associated with Anorectal Malformation

2016 ◽  
Vol 27 (06) ◽  
pp. 495-502 ◽  
Author(s):  
Clare Skerritt ◽  
Alejandra Vilanova Sánchez ◽  
Victoria Lane ◽  
Richard Wood ◽  
Geri Hewitt ◽  
...  
Keyword(s):  
Anorectal Malformation ◽  
Outcome Data ◽  
Current Evidence ◽  
Vaginal Agenesis ◽  
Vaginal Reconstruction ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Vaginal Atresia ◽  
Rectovestibular Fistula

Background The authors of this article became aware of significant differences in the management of two females with a rectovestibular fistula and associated vaginal agenesis. In one patient, a sigmoid colovaginoplasty was performed at the time of the posterior sagittal anorectoplasty (PSARP), and the other underwent repair of the rectovestibular fistula with a primary PSARP, but the surgeons elected to delay the timing of vaginal reconstruction. We decided to review the literature, to establish if recommendations could be made to optimize the management of these children based on current evidence. Methods A literature review was conducted to determine the management and long-term outcomes in patients with an anorectal malformation and associated vaginal atresia. Specific gynecological outcomes assessed were menstrual egress and adequacy of the vaginal replacement for penile–vaginal intercourse. Results Eighty-eight cases were included in the review. Age at diagnosis had a bimodal distribution: 0 to 5 years, 56%; >10 years, 37%. Vaginal atresia was recognized before the operation in 45 patients. Types of vaginal atresia encountered were: (a) distal vaginal atresia (n = 17), (b) vaginal agenesis with absent Mullerian development (n = 47), (c) vaginal agenesis with variable Mullerian development (n = 17), and (d) cervico-vaginal agenesis (n = 7). Types of vaginal replacement used were sigmoid colovaginoplasty (n = 26), distal rectal fistula as neovagina (n = 30), terminal ileum (n = 5), vaginal pull-through (n = 9), and others/unknown (n = 8). Two patients followed a perineal dilatation program and nine patients await reconstruction. Median follow-up was 18 months (6 weeks to 31 years). Long-term menstrual outcomes were reported in 18 (21%) patients. Sexual function was reported in 10 (11%) patients. Three pregnancies were reported but none resulted in live births. Conclusion Vaginal atresia is often missed in association with ARMs. Management should be in collaboration with pediatric gynecologists. Due to a lack of long-term outcome data, no definite conclusion can be drawn for the best technique, tissue, or timing of vaginal replacement. The opportunity to perform vaginal replacement in conjunction with the rectal repair may be worth considering because of a shallower pelvis, nonscarred tissue planes, and the excellent surgical exposure.

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