Background: Hypertension is a highly prevalent condition in the general population, conferring a high risk of significant morbidity and mortality. Associated with the condition are many well-characterized controllable and noncontrollable risk factors. This study aimed to identify the prevalence of hypertension in the outpatient podiatric medical clinic setting and to determine the relevance of hypertension risk factors in this setting.
Methods: A survey tool was created to characterize relevant risk factors, and systolic and diastolic blood pressures were recorded. Descriptive statistics were generated after conclusion of enrollment. Analysis was also performed to determine the relationship between individual risk factors and systolic blood pressure.
Results: Of the 176 patients, 56 (31.8%) had an incidentally high blood pressure at intake, including 18.5% of patients without a known history of hypertension and 38.5% with a known history of hypertension. Three risk factors were found to be significantly associated with increasing systolic blood pressure: weight (P = .022), stress level (P = .017), and presence of renal artery stenosis (P = .021). There was also a near–statistically significant inverse relationship between systolic blood pressure and amount of time spent exercising (P = .068).
Conclusions: Overall, a relatively high prevalence of incidental hypertension was identified, including among patients not previously diagnosed as having hypertension. Consideration of risk factors and awareness of the prevalence of the condition can be useful for practitioners, even as they manage presenting podiatric medical concerns. Future investigations may consider interventional or preventive strategies in the outpatient clinic setting.
Background: Debridement of toenails is a common procedure that leads to the production of nail dust aerosols in the work environment. Previous studies indicate that inhaled nail dust can cause respiratory distress and eye irritation. This comprehensive review aimed to assess the available literature on the effect of nail dust exposure and to evaluate nail dust as a potential occupational hazard for podiatric physicians.
Methods: A comprehensive literature search was conducted via PubMed, Google Scholar, CINAHL, Cochrane Library, and ClinicalTrials.gov. Risks of bias of the collected studies were evaluated using various assessment tools to match the type of study design. A qualitative analysis of the included studies was performed, from which primary and secondary outcome measures were extracted: prevalence of symptoms and specific microorganisms in nail dust.
Results: Of 403 articles screened, eight met the inclusion criteria. The primary outcome measure resulted in a pooled prevalence of eye-related symptoms being the most consistent symptom reported (41%–48%). The secondary outcome measure resulted in a pooled prevalence of Trichophyton rubrum (9.52%–38%) and Aspergillus (11.11%–35.48%) as the most common microorganisms present in nail dust.
Conclusions: From the included eight articles, we found that nail dust is a potential occupational hazard, especially for those exposed more often. Aspergillus and T rubrum are most commonly associated with nail dust leading to development of respiratory illness. It is important to take preventive measures in podiatric medical clinics by using improved and efficient personal protective equipment for workers exposed to nail dust. Detailed health safety guidelines can be developed to decrease respiratory symptoms and diseases from nail dust exposure.
Many cadaver-based anatomy courses and surgical workshops use prosections to help podiatry students and residents learn clinically relevant anatomy. The quality of these prosections is variable and dependent upon the methods used to prepare them. These methods have not been adequately described in the literature, and few studies describe the use of chemicals to prepare prosections of the cadaveric foot and ankle. Recognizing the need for better teaching prosections in podiatric education, we developed a chemical application method with underwater dissection to better preserve anatomic structures of the cadaveric foot and ankle.
We used inexpensive chemicals before, during, and after each step, which ultimately resulted in high-quality prosections that improved identification of anatomic structures relevant to the practice of podiatric medicine.
Careful preservation of clinically important nerves, vessels, muscles, ligaments, and joints was achieved with these prosections.
Although this method required additional preparation time, the resultant prosections have been repeatedly used for several years to facilitate learning among podiatry students and residents, and they have held up well. This method can be used by educators to teach podiatry students throughout their medical training and even into residency. (J Am Podiatr Med Assoc 103(5): 387–393, 2013)
A survey of podiatric medical students in Australia was undertaken prior to and following the completion of a compulsory geriatrics course to evaluate the effect of geriatrics education on knowledge of aging, attitudes toward older people, perceptions of treatment efficacy, and desire to specialize in geriatrics. Students had a reasonable knowledge of aging and favorable attitudes toward older people prior to undertaking the course, but few wanted to specialize in geriatrics. General knowledge of aging and attitudes toward older people improved after completion of the course, but career aspirations remained unchanged. Students generally considered geriatrics to be a low-profile specialty, and less than half stated that they would be interested in pursuing continuing education in geriatrics. These results provide further evidence that students’ lack of desire to specialize in geriatrics may be primarily due to limited recognition within the profession, rather than unfavorable attitudes toward older people or lack of interest in geriatrics during their undergraduate education. (J Am Podiatr Med Assoc 93(2): 124-130, 2003)
The quality of national society conferences is often assessed indirectly by analyzing the journal publication rates for the abstracts presented. Studies have reported rates from 67.5% to 76.7% for oral abstracts and 23.2% to 55.8% for poster abstracts presented at national foot and ankle society conferences. However, no study has evaluated the abstract to journal publication rate for the American Podiatric Medical Association's (APMA's) annual conference.
All presented abstracts from the 2010 to 2014 conferences were compiled. PubMed and Google Scholar searches were performed, and the number of abstracts presented, publication rate, mean time to publication, and most common journals of publication were determined. These results were then compared with those for the 2010 to 2014 American College of Foot and Ankle Surgeons' conferences.
Of 380 abstracts presented, 142 (37.4%) achieved publication, most often in the Journal of the American Podiatric Medical Association. The oral abstract publication rate was 45.2% (14 of 31), with a mean time to publication of 24.2 months (range, 0–47 months). The poster publication rate was 36.7% (128 of 349), with a mean time to publication of 16.3 months (range, 0–56 months). Significant differences were identified between the two societies.
The overall abstract to journal publication rate for the 2010 to 2014 APMA conferences was 37.4%, and, expectedly, oral abstracts achieved publication more often than posters. Moving forward, a concerted effort between competing societies seems necessary to increase research interest, institutional support, and formal mentorship for future generations of foot and ankle specialists.
Background: Direct assessment of health professional student performance of clinical skills can be accurately performed in the standardized performance assessment laboratory (SPAL), typically by health professional faculty. However, owing to time and economic considerations, nonmedical individuals have been specially trained to perform the same function (standardized patients [SPs]). This study compared the assessment scores of the history and physical examination components of a SPAL designed for second-year podiatric medical students at Des Moines University (DMU) by a podiatry medical faculty member and SPs.
Methods: A total of 101 students from the classes of 2015 and 2016 were evaluated in 2013 and 2014 by 11 to 13 SPs from the DMU SPAL program. The video recordings of these 101 students were then evaluated by one faculty member from the College of Podiatric Medicine and Surgery at DMU.
Results: The Pearson correlation coefficient for each class showed a strong linear relationship between SP and faculty assessment scores. The associations between SP and faculty assessment scores in the history, physical examination, and combined history and physical examination components for the 2016 class (0.706, 0.925, and 0.911, respectively) were found to be stronger than those for the 2015 class (0.697, 0.791, and 0.791, respectively).
Conclusions: This study indicated that there are strong associations between the assessment scores of trained SPs and faculty for the history, physical examination, and combined history and physical examination components of second-year SPAL activity for podiatric medical students.
Falls are common in older people and are associated with substantial health-care costs. A recent randomized controlled trial of a multifaceted podiatric medical intervention demonstrated a 36% reduction in the fall rate over 12 months. We evaluated the acceptability of and levels of satisfaction with this intervention in the older people who participated in the trial.
Participants allocated to the intervention group (which included a home-based program of foot and ankle exercises, assistance with the purchase of safe footwear when necessary, and provision of prefabricated foot orthoses) completed a structured questionnaire 6 months after they had received the intervention. The questions addressed participants’ perceptions of their balance and foot and ankle strength, the perceived difficulty of the exercise program, and the degree of satisfaction with the footwear and orthoses provided.
Of 153 participants, 134 (87.6%) attended the 6-month follow-up assessment and completed the questionnaire. Most participants perceived improvements in balance (62.7%) and foot and ankle strength (74.6%) after 6 months of performing the exercises, and 86.6% considered the difficulty level of the exercises to be “about right.” Most participants reported that they were somewhat or very satisfied with the footwear (92.3%) and orthoses (81.6%) provided.
The multifaceted podiatric medical intervention used in this trial was generally perceived to be beneficial and demonstrated high levels of satisfaction among participants. Further research is now required to evaluate the feasibility of implementing the intervention in a range of clinical practice settings. (J Am Podiatr Med Assoc 103(6): 457–464, 2013)
Moral distress is a stress symptom arising from situations that involve ethical dimensions where the health-care provider believes that he or she is unable to preserve all interests and values at stake. The aims of this study were to evaluate the impact of, and identify possible differences in, moral distress in podiatric physicians in the United States and Spain and to determine the ethical principles most closely related to moral distress.
A 2008 e-mail survey of 93 US podiatric physicians and 93 Spanish podiatric physicians (N = 186) presented statements about different ethical dilemmas, values, and goals in the workplace.
Although moral distress is strongly present across the sample for all of the questions, the US sample shows higher levels of any kind of moral distress concerning questions about patients’ treatment and economic constraints, overload of paperwork, and acting against one’s conscience. In the US sample, 91.4% of physicians agreed mostly or completely with the statement that they often had to compromise their own values to cope with the demands of the workplace; 89.25% of US podiatric physicians indicated that their own professional values were congruent with the values of the organization; and a similar percentage (77.5%) reported a strong identification with the goals and framework of their work organization. The Spanish sample had similar results.
The results underline the significance of moral distress for both samples, mainly related to time constraints and organizational aspects concerning patients and lack of resources. (J Am Podiatr Med Assoc 102(1): 57–63, 2012)