Motivational Interviewing by Podiatric Physicians
A Method for Improving Patient Self-care of the Diabetic Foot
Foot ulceration and lower-extremity amputation are devastating end-stage complications of diabetes. Despite agreement that diabetic foot self-care is a key factor in prevention of ulcers and amputation, there has only been limited success in influencing these behaviors among patients with diabetes. While most efforts have focused on increasing patient knowledge, knowledge and behavior are poorly correlated. Knowledge is necessary but rarely sufficient for behavior change. A key determinant to adherence to self-care behavior is clinician counseling style. Podiatrists are the ideal providers to engage in a brief behavioral intervention with a patient. Motivational interviewing is a well-accepted, evidence-based teachable approach that enhances self-efficacy and increases intrinsic motivation for change and adherence to treatment. This article summarizes some key strategies that can be employed by podiatrists to improve foot self-care. (J Am Podiatr Med Assoc 101(1): 78–84, 2011)
The number of patients with HIV (human immunodeficiency virus) and AIDS (acquired immune deficiency syndrome) has increased to the point that every podiatric physician in this country will be treating patients who are HIV positive, knowingly or not. Podiatric physicians continue to be part of the medical team that must bear responsibility for the rapid changes in HIV education. Attention must be focused on educating physicians about all aspects of this disease, especially the primary and secondary diseases of AIDS and new treatments and their side effects. Sterile technique and universal precautions have now taken on new importance.
The purpose of this case report is to show the clinical presentation of a rare genetic disorder, called fibrodysplasia ossificans progressiva, on the development of the foot in a newborn. Shortened great toes and malformations of the first metatarsals are present in all affected individuals at birth. Irreversible heterotopic endochondral ossification of soft tissues occurs in the first decade of life, often resulting in permanent immobility by the third decade of life. Trauma caused by surgical excision of nodules, dental procedures, or injections can further exacerbate this condition. Early diagnosis is imperative for these patients to prevent irreversible damage that may result from unnecessary invasive interventions. This case report presents a boy aged 2 years 3 months who was born with bilateral bunion deformity. The goal is to raise awareness of this disorder in the podiatric community, especially for those who work with pediatric patients.
This study examined the predictive ability of educational background and demographic variables, available at the admission stage, to identify applicants who will graduate in 4 years from podiatric medical school.
A logistic regression model was used to identify two predictors of 4-year graduation: age at matriculation and total Medical College Admission Test score. The model was cross-validated using a second independent sample from the same population. Cross-validation gives greater confidence that the results could be more generally applied.
Total Medical College Admission Test score was the strongest predictor of 4-year graduation, with age at matriculation being a statistically significant but weaker predictor.
Despite the model’s capacity to predict 4-year graduation better than random assignment, a sufficient amount of error in prediction remained, suggesting that important predictors are missing from the model. Furthermore, the high rate of false-positives makes it inappropriate to use age and Medical College Admission Test score as admission screens in an attempt to eliminate attrition by not accepting at-risk students. (J Am Podiatr Med Assoc 102(6): 463–470, 2012)
Patients with limited English proficiency (LEP) encounter many health disparities and inequalities due to the lack of effective communication. The lack of effective communication places patients with LEP at higher risk for noncompliance with the treatment plan. Pain is one of the main common health issues, and patients with LEP have difficulties reporting their pain and adhering to the plan of care due to the lack of effective communication.
We measured the effectiveness of using a professional interpreter during office visits for Farsi-speaking patients with LEP to improve pain management and adherence with follow-up visits. In this single-sample quasi-experimental study, 16 Farsi-speaking participants with LEP who visited a podiatric medical office for foot pain rated their pain level at the initial visit and after the intervention during the first follow-up visit. Participants were provided with a professional Farsi-speaking interpreter during the visit.
Overall, patients reported lower mean ± SD levels of pain during the follow-up visit (4.19 ± 2.29) than at the initial visit (6.56 ± 2.03). Of all of the participants, 75% attended the follow-up appointment, demonstrating that most of the participants adhered to the plan of care.
The use of a professional interpreter during an office visit for patients with LEP was associated with improved pain management outcomes and increased adherence to the treatment plan.
Although tetanus is a preventable disease, several cases are reported to the Centers for Disease Control and Prevention each year. Many conditions treated by podiatric physicians carry the risk of infection by Clostridium tetani, and it is advisable for podiatrists to update a patient's tetanus immunization status if the patient presents with a tetanus-prone wound.
A review of the literature reveals sparse references regarding the application of burs in the conservative treatment of soft tissues and nails. The most recent publications were in 1946. The authors present an update on the technology and practical application of burs in podiatric medicine, their metallurgy, types, and recommended bur selection for reduction, remodeling, and burnishing of hyperkeratotic tissue and thickened nails.
The authors discuss the Interdisciplinary Team Training in Geriatrics program developed by the Department of Veterans Affairs. At the James A. Haley Veterans Hospital, this program provides funding to podiatric residents, enabling them to work with practitioners from other health care disciplines as a team that addresses all of the varied health needs of the elderly patient.
Philosophy offers us the ability to think logically and critically about any field of knowledge, podiatric medical education included. By proceeding in an orderly manner, the growth of the profession will be ensured as long as the thinkers are willing to be truthful. Ironically, conformity is not a necessity and a diversity of philosophies is actually encouraged.