A clinical practice guideline for the management of the foot and ankle in rheumatoid arthritis.

Rheumatoid arthritis causes progressive joint destruction in the long term, causing a deterioration of the foot and ankle. A clinical practice guideline has been created with the main objective of providing recommendations in the field of podiatry for the conservative management of rheumatoid arthritis. Thus, healthcare professionals involved in foot care of adults with rheumatoid arthritis will be able to follow practical recommendations. A clinical practice guideline was created including a group of experts (podiatrists, rheumatologists, nurses, an orthopaedic surgeon, a physiotherapist, an occupational therapist and patient with rheumatoid arthritis). Methodological experts using GRADE were tasked with systematically reviewing the available scientific evidence and developing the information which serves as a basis for the expert group to make recommendations. Key findings include the efficacy of chiropody in alleviating hyperkeratotic lesions and improving short-term pain and functionality. Notably, custom and standardized foot orthoses demonstrated significant benefits in reducing foot pain, enhancing physical function, and improving life quality. Therapeutic footwear was identified as crucial for pain reduction and mobility improvement, emphasizing the necessity for custom-made options tailored to individual patient needs. Surgical interventions were recommended for cases which were non-responsive to conservative treatments, aimed at preserving foot functionality and reducing pain. Moreover, self-care strategies and education were underscored as essential components for promoting patient independence and health maintenance. A series of recommendations have been created which will help professionals and patients to manage podiatric pathologies derived from rheumatoid arthritis.

Enhancing Evidence-Based Practice Competence and Professional Skills Using Infographics as a Pedagogical Strategy in Health Science Students: Insights from the InfoHealth Project.

Infographics have been recognised as effective visual tools for concise and accessible communication of data and information in various higher education disciplines, particularly in medical education. However, there is a lack of research on their impact on professional skills, difficulty levels, motivation, and overall satisfaction in health science students. Thus, the present study aimed to analyse the knowledge and usage of graphical resources among health science students and evaluate their competencies, the level of challenge they encountered, and their motivation and satisfaction after completing an infographic creation activity. The InfoHealth educational innovation project, conducted by five teachers from the Faculty of Medicine, served as the context for this study, with 143 students voluntarily participating. The intervention involved students working in groups of 2-3 and selecting their own topics for the infographics while receiving instruction, online guidance, and feedback from teachers. A questionnaire was administered to assess students' perception of skill development and satisfaction with the activity. The findings revealed that schemes were the most recognized and used graphical summaries, compared to synoptic tables and Venn diagrams. The activity led to an increase in professional skills acquisition, motivation, and satisfaction, positively impacting students' interest in evidence-based practice and reinforcing their knowledge. This study highlights the potential of infographics as a pedagogical tool for competency development and student engagement in health science education, suggesting the need for further research comparing infographics with traditional study methods and involving multidisciplinary teams to promote essential skills for future clinical practice.

Risk factors and associated factors for calcaneal apophysitis (Sever's disease): a systematic review.

OBJECTIVES: The aim of this review was to identify the potential intrinsic and extrinsic risk factors (RFs), associated factors (AFs) and consequences of developing calcaneal apophysitis (CA). DESIGN: Systematic review. DATA SOURCES: Cochrane Library, Embase, Medline Ovid, PubMed, Web of Science and Evidence, searched from inception to April 2021. ELIGIBILITY CRITERIA: We included cohort, case-control and cross-sectional studies that were conducted in patients younger than 18 years who were exposed to RFs or who presented with factors associated with developing CA. Studies in languages other than English or Spanish were excluded. DATA EXTRACTION AND SYNTHESIS: Two reviewers worked independently to evaluate the risk of bias of included studies. The Newcastle-Ottawa Scale (adapted version) was used. RESULTS: A total of 736 studies were identified and 11 observational studies fully met the inclusion criteria, including 1265 participants with a mean age of 10.72 years. Four studies identified extrinsic factors, 10 identified intrinsic factors and three identified both. The extrinsic and intrinsic RFs, AFs and consequences of CA include limitation of ankle dorsiflexion, foot alignment, stiffness and mobility of the midfoot, plantar pressures and ground reaction force, body mass index, age, gender, presence of other osteochondroses and practice of sport. The risk of bias varied, being either moderate or low. CONCLUSIONS: Regarding the factors and consequences associated with CA (Sever's disease), ankle dorsiflexion limitation is the most frequent intrinsic factor studied, followed by peak plantar pressures and foot malalignment. However, disagreements between the investigators of the included studies were found; in some cases, there is a lack of unanimity between different studies as to which factors are considered to be RFs, AFs and consequences. PROSPERO REGISTRATION NUMBER: CRD42021246366.

Relationship between Kinesiophobia, Foot Pain and Foot Function, and Disease Activity in Patients with Rheumatoid Arthritis: A Cross-Sectional Study.

The main objective of the present study was to determine the relationship between kinesiophobia and pain (general and foot pain), foot function, and disease activity in patients with rheumatoid arthritis (RA). A total of 124 interviews were carried out with participants with RA. Participants were recruited from the Hospital Universitario Virgen de las Nieves de Granada in Spain. Interviews took place in January 2021. Participants completed the following questionnaires during an appointment with their rheumatologist: Foot Function Index (FFI), Tampa Scale for Kinesiophobia (TSK-11), and the Visual Analogue Scale Pain foot (VAS Pain). Furthermore, the Simplified Disease Activity Index (SDAI) was used to measure disease activity. Of the 124 participants, 73% were women, and their mean age was 59.44 years (SD 11.26 years). In the statistical analysis, positive linear correlations (p < 0.001) were obtained between the variables TSK-11 and VAS (related to general pain or foot pain) and FFI (in its three subscales). Additionally, a negative correlation between the TSK-11 and the educational background was shown. This study provided information about the relationship between foot function and pain with different levels of kinesiophobia in patients with RA. Additionally, the educational background of the patient was considered a predictor of whether or not a patient suffered from kinesiophobia.

Experiences of patients with rheumatoid arthritis during and after COVID-19-induced quarantine in terms of physical activity and health status: A qualitative study.

AIM: The aim of this study was to explore experiences of people with rheumatoid arthritis during and after COVID-19-induced quarantine in terms of physical activity and health status. BACKGROUND: Rheumatoid arthritis affects multiple facets of the person, both physically and psychologically. Physical activity is considered a safe and effective intervention to improve symptoms and systemic manifestations of rheumatoid arthritis. In the context of the COVID-19, countries like Spain were forced to impose restrictions on mobility, prohibiting outings even to perform physical activity. METHODS: Structured interviews were conducted and developed using the Tampa Scale for Kinesiophobia-11 questionnaire. Data were analysed using a six-step thematic analysis. RESULTS: The results make it clear that even though the patients declared that physical activity is essential for them to deal with their disease, most of the participants affirmed that they significatively reduced their levels of physical activity during the pandemic. CONCLUSIONS: Physical activity should be promoted in people, even in difficult times, to improve disease outcomes, well-being and mental health. IMPLICATIONS FOR NURSING MANAGEMENT: Knowing the experiences of these patients enables nursing managers to develop interventions that ensure the delivery of comprehensive nursing care regarding physical activity and health status, in future situations like this pandemic.

Theory of Mind in Borderline Personality Disorder: A Possible Endophenotypic Factor?

The purpose of this study is to examine whether theory of mind (ToM) is an endophenotypic marker of borderline personality disorder (BPD), thus constituting an etiopathogenic factor of the disease. This would suggest familial vulnerability to BPD. This was a case-control study involving 146 individuals with 57 BPD patients, 32 first-degree relatives, and 57 controls (median age of BPD and control = 33.4 years; relatives = 52.9 years; BPD females and controls = 91.2%; female relatives = 62.5%). All the participants completed the Spanish version of the Movie for the Assessment of Social Cognition test to evaluate the ToM subclassification: interpretation of emotions, thoughts and intentions. BPD patients and their healthy first-degree relatives exhibited significant deficits in the correct interpretation of emotions and intentions compared to healthy controls. Both patients with BPD and their healthy first-degree relatives exhibited significant deficits in ToM, which suggests that it may be an etiopathogenic factor of BPD, and ToM (interpretation of emotions, thoughts and intentions) is a possible endophenotypic marker of BPD, suggesting a genetic predisposition to the disorder. Therefore, ToM could be considered as an indicator for the early detection of the disorder of and intervention for BPD.

Efficacy and safety of condylectomy with minimally invasive surgery in the treatment of interdigital corns of the lesser toes compared to conservative treatment.

BACKGROUND: Minimally invasive surgery (MIS) procedures cause less trauma to the patient and might improve recovery. This study aimed to determine the efficacy and safety of condylectomy with MIS to treat interdigital corns of the lesser toes. METHODS: This prospective cohort study was conducted in seven podiatry centers. Patients with interdigital corns of the lesser toes, progressing for more than a year, with one or more recurrences in the last year following conservative treatments were eligible. The recruited patients were classified according to their treatment: conservative or surgical (condylectomy with MIS) and were compared. Patient satisfaction, pain, the clinical and functional status of the foot and the appearance of sequelae were assessed at 3 and 6 months after treatment. RESULTS: At 6 months, patients in the surgical treatment group showed no pain on pressure, which significantly differed from the conservative treatment group (p <  0.001). They also improved clinical and functional status of the foot, reaching values comparable to those of the standard population. No paresthesia, joint stiffness or instability, toe malalignment, or corn transfer to a contiguous site resulted from the surgical treatment. CONCLUSIONS: Condylectomy with MIS is effective and safe to treat interdigital corns of the lesser toes.

Twelve tips to make successful medical infographics.

In the health sciences, professionals must keep up to date to conduct their evidence-based practise. Hence, there is a growing need to share medical knowledge efficiently among healthcare professionals, patients, and undergraduate health science students. Infographics (text and image) are a hybrid element that serves to represent information in an attractive and meaningful visual format. Actually, with the use of the Internet and social networks, infographics have become a popular format for sharing medical information around the world.On the basis of a published literature review, we provide 12 tips in this article to make a successfully health-related infographic with the aim of assisting clinicians, educators, and researchers in their task of communicating and transforming complex information into a visual, attractive, didactic and shareable format.By following these basic recommendations, it is possible to improve the dissemination of scientific and health-related knowledge to different audiences who can benefit from infographics.

Gouty Involvement of Foot and Ankle: Beyond Flares.

The foot and ankle are common locations of deposition of monosodium urate (MSU) crystals, as indicated by the clinical manifestations presented by patients with gout, which are not limited to the acute inflammation of the big toe. We present a narrative literature review aimed to update the gout involvement of foot and ankle and how it affects the quality of life. Cumulative reports indicate that gout, even at the non-tophaceous stage, could cause pain, gait impairment and limit the mobility at lower limbs. These patients may present difficulties in some activities of daily living such as choosing footwear, thus leading to an impaired quality of life. Gout is a curable disease by dissolving MSU crystals but remains unclear how this could modify some of these foot and ankle manifestations, especially when structural damage has already occurred. Furthermore, a collaboration between rheumatologists and podiatrists seems helpful to understand, relieve these symptoms and improve the quality of life in gouty patients.

Validity of an Instrument to Detect Cheating Confirmed by the Elicited Emotional Reactions.

Cheating forms part of a complex emotional and cognitive process. However, although a relatively mundane phenomenon, instruments to evaluate cheating and its effects socially are scarce. This paper presents a five-stage approach aimed at providing validity to an instrument designed to assess cheating - specifically, its detection, and emotional reactions towards it once detected. An instrument was designed after (1) reviewing the relevant literature on cheating, in order to (2) design a bank of stimuli, (3) formulate a Delphi panel to judge the most coherent and pertinent ones, and (4) perform three pilot studies to adjust the final version of the instrument. Results from Stages 1 to 4 show that content validity was achieved for the Instrument for Detecting Cheating and its Emotional Reactions (INDETRAE, in Spanish: Instrumento para la Detección de Trampa y sus Reacciones Emocionales). Stimuli were grouped into five categories of 18 different scenarios, for a total of 90 vignettes: meaning, the INDETRAE is a 5-category, vignette-based questionnaire consisting of contrasting social cost-benefit scenarios, where the cheating situation affects an undefined, a first or a third person, and also a neutral category with no cheating. In Stage 5, several chi-squared tests (p < 0.0005) revealed significant differences between categories, proving that the instrument can indeed be used to detect cheating and to identify differentiated emotional reactions - for example, anger when there was detriment to a third person as opposed to neutral situations, or glad when there was a case of cheating which benefited the first person. The last stage counts as the first approximation to support construct validity of the INDETRAE. The most important contribution of this work consists in developing an instrument to detect cheating, confirmed by the resulting emotional reactions, which therefore demonstrate its validity.

Social cognition and social functioning in people with borderline personality disorder and their first-degree relatives.

BACKGROUND: A few papers studying healthy, first-degree relatives of people with borderline personality disorder (BPD) have found that this group presents attention and memory problems. However, current research has not analyzed their social cognition. MATERIALS AND METHODS: We designed an age-, gender- and education-level matched case-control study involving 57 people with BPD, 32 of their first-degree relatives, and 57 healthy controls in Spain in 2018-2019. All were assessed for social cognition and functioning using the Movie for Assessment of Social Cognition and the Social Functioning Scale; other potential confounders were also collected (marital status, occupation and household variables). RESULTS: There were differences in the social cognition domain of overmentalizing errors, with the BPD group scoring significantly higher than controls; however, there was no significant difference with relatives; in the social functioning domain of family relationships, with the controls showing the highest scores. Social engagement/withdrawal, interpersonal behavior, independence-competence, prosocial activities, full scale and categorization domains showed the same pattern: the BPD group had lower scores than their relatives and the controls. Relatives were significantly different from BPD patients in family relationships, social engagement/withdrawal and interpersonal behavior, as well as on the full Social Functioning Scale (both as a linear and categorical variable). However, only controls showed differences with relatives in family relationships. CONCLUSIONS: All in all, relatives show similar levels of social cognition and functioning compared with controls, and people with BPD show some alterations in different domains of both social cognition and functioning.

Description of the surgical technique for condylectomy with minimally invasive surgery to treat interdigital helomas on the lesser toes: a Delphi study.

BACKGROUND: Descriptions of the techniques for condylectomies via minimally invasive surgery (MIS) to treat interdigital helomas of the lesser toes are scarce in the literature. This study aimed to define and describe this surgical technique. METHODS: This observational study was performed using the Delphi method. We collected the anonymous opinions of a multidisciplinary international panel of ten experts by answering a 43-items questionnaire via e-mail. Statements with an average score ≥ 3 were included in the next round, as were those in which none of the three statements reached the minimum score of 3 within the same item. RESULTS: Response rate: 90%. Three rounds were needed to reach consensus on proposed items. A new statement that combined two statements was proposed in round 3. Eleven recommendations regarding the incision and instruments used to perform this surgical technique were obtained based on the expert consensus. CONCLUSIONS: A longitudinal incision to the distal pulp of the toe or an incision to the centre of the plantar aspect of the head of the proximal phalanx should be performed according to the affectation, and a Beaver 64 scalpel blade, a blunt elevator and a Shannon-Isham burr are the most acceptable tools for this kind of surgery.