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Given the grave implications of ulceration, prevention is very important The main methods used in prevention are patient education and adequate monitoring of the patient by the healthcare team Litch eld and Ramkissoon (1996) monitored the outcome of providing an educational footcare video for diabetics They found that whilst most patients were aware of the need for good footcare, there was a lack of compliance with the recommended care NICE has produced guidelines for the prevention and management of foot problems in diabetics (NICE, 2004) The guidelines include guidance on the content of any education programmes to be targeted at those with low risk of developing foot ulcers, those at high risk and those with foot ulcers The guidelines also state that effective prevention and care involves a partnership between patients and professionals (NICE, 2004) Regular monitoring of diabetic feet is essential and should occur at least annually.

Sweat 2 oz (60 g) minced onion and 1 tbsp (15 mL) paprika in 1 oz (25 g) butter until soft. Add 1 2 cup (100 mL) white wine and reduce by half. Add 1 qt (1 L) veal or chicken velout , simmer 10 minutes, and strain.

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Introducing a primary key is a re nement transformation that applies to any persistent class If the class does not already have a primary key (in the sense of a relational database table primary key), it introduces a new identity attribute (an attribute that always has a different value in different objects), usually of Integer or String type, for this class, together with extensions of the constructor of the class, and a new get method, to allow initialization and read access of this attribute This is an essential step for implementation of a data model in a relational database L in this case is c : Class cstereotypeNames includes( persistent ) cownedAttributestereotypeNames excludes( identity ) cfeaturename excludes(cname + Id ) using the metamodel of UML 2 [34].

L will be true for any model element c that is a persistent class without an identity attribute For such elements the transformation de ned by R will be applied to create a new model from the old, in which a new identity attribute is added to the class selected: a : Property aname = cname + Id astereotypeNames = Set{ identity } cownedAttribute = (cownedAttribute)@pre + Sequence{ a } aclassi er = c atype = IntegerType Because a occurs in R but not in L, it is assumed that it is created by the transformation We could write aoclIsNew() to make this explicit An example of this transformation is shown in Figure 1411 To ensure semantic correctness of the transformation, a new constraint expressing the primary key property is added to the new model: AallInstances() size() = A.

allInstances() collect(akey) size() This must be maintained by the constructor, for example: A(att1x : T1, att2x: T2, akeyx: Integer) pre: akeyx /: AallInstances()->collect(akey) post: akey = akeyx and att1 = att1x and att2 = att2x is the identity interpretation..

Assessment should include testing of foot sensation, palpation of foot pulses, inspection for any foot deformity and inspection of footwear (NICE, 2004) Assessment allows the classi cation of foot risk as follows: low current risk (normal sensation, palpable pulses) increased risk (neuropathy or absent pulses or other risk factor) high risk (neuropathy or absent pulses plus deformity or skin changes or previous ulcer) ulcerated foot (NICE, 2004) Once patients have been identi ed as being at risk, they should be made aware of their responsibilities for prevention of foot problems Feet should be washed daily and dried carefully They should be inspected for any red areas or swelling and cracked or broken skin Toe nails should be cut straight across Socks should be changed daily and not wrinkle Shoes should be well tting They should be checked before wearing for any foreign bodies.

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