LO1: Demonstrate a detailed knowledge of the underlying pathology of the condition placing the patient at high risk of developing pedal ulceration LO2: Describe how the condition impacts on the patient and their feet and recognize how this will affect the management of the patient. LO3: Identify and appraise the research evidence that informs you about the care of the patient. For this essay you need to choose one condition that places a patient at high risk of developing pedal ulceration. The condition needs to be described in detail including an in-depth exploration of the pathological processes that places the foot “at risk”. For example, if you have chosen neuropathy in diabetes, you would not only consider the pathophysiology of the nerves, but also the vascular and immune pathologies that might be related to the changes in the nerves, for example. At L6, we are looking for a wide-ranging understanding of a condition that you might see in a clinical setting. Following on from the pathology of the condition, you need to show a good understanding of the impact the condition on the patient, considering aspects that might impact on your management of the patient. For example, the psychosocial impact of the condition typically needs to be included. Finally, the examiners will be looking for use of evidence to support all areas of your essay, so the next section will be a critical evaluation of a single piece of research that would support your management of the high-risk foot. This might be a critical evaluation of an assessment technique that you would use in the assessment of the foot, or it may be a treatment that could be used such an orthotic / dressing / medication. You need to determine the robustness of the research and reflect on the use of the research in your future practice. You will be required to submit a 2800-word assignment. “You might choose RA and would then be focusing down on the foot deformities and the vasculitis, impact of medication on the foot. ” Can I also take this opportunity to remind you about referencing. I am expecting to see correct referencing in the essay. This is a degree-level piece of writing so format your references correctly as you go along taking the time and effort required to cite them correctly. 1. A brief introduction 250 – 300 You will need to outline the relevance of the topic area. This should NOT be in terms of figures that mean little to the general reader, but should demonstrate an understanding of why this topic is important to those managing the patient. You should define the scope of the essay. (what is going to be discussed in this essay, and why is this important to those managing the patients with RA and pedal ulceration) 2. Main body of first part of essay 1300 You will need to show good academic writing skills to present the work fluently, showing depth of information and ability to link concepts. You need to be explaining clearly the pathology to a level that describes what is happening in tissues and cells. Any molecules / cells you describe need to be clearly explained and you should not assume the reader knows what the molecule / cell normally does.You are expected to reference using the Harvard style throughout the essay. Mention on rheumatoid, whos getting it what what we know about it and why it occurs and the actual DNA understanding of it. Then go on to as far as putting the lower limb at risk then need to think about vasculitis, joint deformities causing overloading which could lead to ulceration and then potentially neuropathy due to nerve entrapment, affect of medication patients are on for rheumatoid that might impact the lower limb ( talk about the medication that have impact on the foot so methotrexate, biologics and steroids) . Then break it down into steps so if focusing on vasculitis (think about what Is happening in blood vessels) this is what the foot is doing and it is putting the foot at risk – think about linking it to the study (there is a lot on early prevention of deformity) if patient ends up with vasculitis and if we help preventing foot from deforming in the first place hopefully the overloading issues will be taken out in the first place to prevent ulceration. Make sure to link the study I am going to critique into the body of essay to make it flow better. When thinking about the psychosocial aspects, if a patient has disability of their hands how will they put on their footwear and wear orthotics, think about the depression will they listen to instructions, take medication listen to advice, could be that they have to wear certain footwear for the orthotics that to fit would be ugly and then they wouldn’t want to wear them. 3. A critical exploration of the evidence. 800-1000 Identify one piece of research that is relevant and recent. If you chose an old piece of research, it needs to be a seminal piece of work. You should write a critique of this paper Control trial and not randomised, look for a quality of research paper checklist, for after study where the person is their own control, what is good about Study to critique: “The effect of pre-fabricated insole on plantar pressure distribution in patients with rheumatoid arthritis” 4. A coherent, reflective conclusion 250 – 300 Your essay should finish with a summary of the key information given and a reflection about how the knowledge gained may impact on your management in your future practice and linking the research paper and the theoretical ideas from the first section.