Combined Care of the Rheumatic Patient

Gone are the days when the physician could act as God, the orthopaedic surgeon as the Lord God and the nurses as minister­ ing angels. The concept of a team approach with each discipline supplying special yet overlapping skills is accepted in principle, although not always in practice. Physiotherapists and occupational therapists resist integration of their training among the hierarchy; however, on the ground, these remedial therapists often do each other's jobs with remarkable amity. Elsewhere I have discussed whether we need multipurpose professionals or multiprofessional persons (Wright 1982). At Leeds the close collaboration that exists between rheumatol­ ogists and non-medically qualified professionals has resulted in a productive Bioengineering Group for the Study of Human Joints, a Clinical Pharmacology Unit of international renown and a Rehabilitation Unit that consistently produces bricks without straw. One aspect of this combined approach to patient care has been the development of the discipline of clinical nurse metrology (Bird et al. 1980). Skilled nursing sisters have worked in this capacity for a decade in Leeds. Their contribution has not only enhanced the reliability of the results of clinical trials in which they have been engaged, but it has been highly s;ost effective and greatly appreciated by patients. It has also measurably improved our patient education programme. Moreover, the posts have provided considerable job satisfaction. This book arises from the expertise gained during these pioneer years.

1 The Spectrum of Rheumatic Diseases.- Introduction; Non-articular Rheumatism; Spinal Disorders; Osteoarthrosis; Crystal Deposition Diseases; Degenerative vs Inflammatory Joint Disease; Seronegative Spondarthritides; Rheumatoid Arthritis; Connective Tissue Disorders; Polymyalgia Rheumatica and Temporal Arteritis; Septic Arthritis; Rarer Arthritic Conditions.- 2 Investigations for Rheumatic Diseases.- Introduction; Routine Haematological Investigations; Routine Biochemical Investigations; Immunological Assessment of Rheumatic Disease Activity; Examination of Synovial Fluid; Biochemical Assessment of Rheumatic Disease Activity; Detection of Infection; Radiology; Bone Biopsy; Investigation of Muscle Disorders; Nerve Conduction Studies; Tissue Biopsy; Arthroscopy; Study of White Cell Blood Groups in Rheumatic Diseases; Evaluation of Faecal Blood Loss; Use of Radioisotopes in Rheumatology; Thermography; Research Investigation on Urine.- 3 Treatment of Rheumatic Diseases.- Introduction; Plan of Patient Care; Analgesics; Non-steroidal Anti-inflammatory Agents; Disease-Modifying Agents for Rheumatoid Arthritis; Immunoactive Drugs in Rheumatic Diseases; Management of Seronegative Spondarthritides; Management of Connective Tissue Disorders; Management of Ankylosing Spondylitis; Osteoarthrosis and Crystal Deposition Disease; Arthritis in Childhood; Patient Compliance.- 4 The Nursing Process and Rheumatology Nursing.- Introduction; The Nursing Process: Other Methods of Staff Deployment; Rheumatology Nursing: Acute Flare; Rehabilitation; Diagnosis; Social Admission; Planning Patient Care by Use of the Nursing Process; Nursing Aspects of Investigative Procedures.- 5 Surgical Nursing.- Introduction; Surgical Procedures; Nursing Management; Conclusions.- 6 Physiotherapy and Occupational Therapy in the Management of Rheumatic Diseases.- Introduction; Physiotherapy; Occupational Therapy; Aids to Mobility; Splints and Splinting; Feet and Footwear.- 7 Patient Education.- Introduction; Outpatient Education; Outpatient Group Sessions; Inpatient Education; Self-medication in the Hospital Setting.- 8 Clinical Assessments in Rheumatology.- Introduction; Measurement of Vital Functions in Rheumatology; Subjective Evaluation of Pain and Stiffness; Objective Assessments in Inflammatory Polyarthritis; Functional Assessments; Monitoring of Side-effects; Monitoring of Laboratory Changes; Radiological Assessment; Miscellaneous Clinical Assessments; Measurement of Joint Movement; Sophisticated Objective Assessments of Joint Function.- 9 Psychological Aspects.- Introduction; Reactions of Patients to their Disease; Problems Arising from Physical Disability; How Patients Cope; Conclusion.- 10 Organisation and Development of Combined Care in the Outpatient Clinic.- Introduction; Combined Care in the Outpatient Clinic — the Physician’s View; Combined Care in the Outpatient Clinic — the Nurse’s View.- 11 Combined Care in the Community.- Introduction; Primary Health Care Team; General Practitioner; District Nurse; Health Visitor; Social Worker; Physiotherapist and Occupational Therapist; Disablement Resettlement Officer; Sexual Difficulties; Social Services Department; Mobility and Independence; Communication; Conclusion.- 12 Clinical Research and Trial Methodology.- Introduction; General Aspects of Research; Planning the Study — Questions to be Asked; Statistical Aspects; The Protocol; Conduct of a Clinical Trial or Research Project; Funding of Research; Dissemination of Results.- Appendix A. Normal Laboratory Values and Indicators of Inflammation.- Appendix B. Appointment of Clinical Metrologist — Clinical Pharmacology Unit (Rheumatism Research), University of Leeds.- Appendix C. Advisory Services and Sources of Information.