Foot orthoses are commonly prescribed by health professionals as a form of intervention for the symptomatic foot in rheumatoid arthritis. However, there is a limited evidence base to support the use of foot orthoses in this patient group. This article provides a critical review of the use of foot orthoses in the management of rheumatoid arthritic foot pathologies. A search was conducted in the Cochrane Controlled Trials Register (current issue of the Cochrane Library), Physiotherapy evidence database (PEDro), Medline, The Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Allied and Complementary Medicine (AMED) and from reference lists in journal articles. The language was restricted to English. Searching of the databases was undertaken between December 2004 and March 2005. The results indicated there is no consensus of opinion on the choice of foot orthoses used for the management of pathology in the rheumatoid foot, although there is strong evidence that foot orthoses do reduce pain and improve functional ability. The type of foot orthoses used ranged from simple cushioned insoles to custom-made rigid cast devices. Methodological issues raised included small sample size and poor use of valid and reliable outcome measures. There is limited evidence pertaining to cost-effectiveness. The results indicated a need for further investigation into the most clinically and cost-effective foot orthoses to prescribe in the management of the rheumatoid arthritic foot. This review highlights the need to identify the various types of foot orthoses that are most effective in the management of the established rheumatoid arthritic foot.

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180 rats aged 3 or 300 days were either handled for 20 consecutive days or were unhandled. 40 days after treatment, rats learned a discriminated avoidance task, with 1 of 3 UCS (shock) intensities. Handling improved avoidance performance of both 3- and 300-day-old Ss with mild (0.5-ma.) and moderate (1.0-ma.) shock intensities. Avoidance performance of infantile-handled rats was superior to performance of other Ss at lower shock levels but was inferior to other groups with a stronger shock level (2.0 ma.). Performance of older unhandled Ss was very poor with low shock but improved consistently with increases in shock intensity. These findings are interpreted in terms of handling and age effects on responsiveness to painful stimulation.

SummaryAnaesthetic pollution is still a problem and recent UK Control of Substances Hazardous to Health (COSHH) recommendations require employers to attempt to control the risk. Fifteen day-case urology operating lists were studied to compare the level of nitrous oxide exposure using face mask or laryngeal mask anaesthesia. Nitrous oxide was avoided in one group until the laryngeal mask was inserted. The use of the laryngeal mask airway showed a significant reduction in the level of pollution, such that recent COSHH recommendations were attained. However, (US) NIOSH levels were only reliably attained by avoiding nitrous oxide until the laryngeal mask was inserted. The laryngeal mask was therefore shown to be a reliable antipollution device.

As prior knowledge of the distribution of the body fluids is essential to understanding the pathological processes of oedema, the physiology of body fluids is first highlighted in this paper. The pathology of oedema is then explored with post-traumatic oedema and oedema from central paralysis illustrated. The paper then interrelates the physiological principles of body fluid, primary and secondary oedema as a foundation for further discussion of treatment of oedema. The treatment options frequently used in the management of oedema of the hand are further expounded. While the physiological basis of body fluids are integrated with oedema treatment modalities used, no attempt is made of discuss evaluation approaches used in oedema measurement as fluid volume reduction does not always equal oedema reduction.