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Foot disorders and the complications of chronic disease in the older population have a significant effect on society, the cost of health care, and individuals' quality of life. Given podiatric medicine's role in the management of problems of the aging, it is critical that the profession's educational system produce practitioners who understand the process of aging and the needs of the older patient and who are prepared to serve on the health-care-delivery team as the primary providers of foot-care services. The geriatric syllabus presented here is one approach to attaining that goal.
Virtually no attention has been given in public education efforts to the potentially devastating effects of smoking on the lower extremities. An analysis of the epidemiologic studies that have been done by the Office of the Surgeon General and other clinical investigators has been presented, leading to the conclusion that cigarette smoking is the single most powerful risk factor for peripheral vascular disease. In the care of patients with peripheral vascular disease, the podiatric physician has an opportunity to be a participant in efforts to solve one of the nation's major public health problems.
Background: Diabetic foot osteomyelitis is a common infection where treatment involves multiple services, including infectious diseases, podiatry, and pathology. Despite its ubiquity in the hospital, consensus on much of its management is lacking.
Methods: Representatives from infectious diseases, podiatry, and pathology interested in quality improvement developed multidisciplinary institutional recommendations culminating in an educational intervention describing optimal diagnostic and therapeutic approaches to diabetic foot osteomyelitis (DFO). Knowledge acquisition was assessed by preintervention and postintervention surveys. Inpatients with forefoot DFO were retrospectively reviewed before and after intervention to assess frequency of recommended diagnostic and therapeutic maneuvers, including appropriate definition of surgical bone margins, definitive histopathology reports, and unnecessary intravenous antibiotics or prolonged antibiotic courses.
Results: A postintervention survey revealed significant improvements in knowledge of antibiotic treatment duration and the role of oral antibiotics in managing DFO. There were 104 consecutive patients in the preintervention cohort (April 1, 2018, to April 1, 2019) and 32 patients in the postintervention cohort (November 5, 2019, to March 1, 2020), the latter truncated by changes in hospital practice during the coronavirus disease 2019 pandemic. Noncategorizable or equivocal disease reports decreased from before intervention to after intervention (27.0% versus 3.3%, respectively; P = .006). We observed nonsignificant improvement in correct bone margin definition (74.0% versus 87.5%; P = .11), unnecessary peripherally inserted central catheter line placement (18.3% versus 9.4%; P = .23), and unnecessary prolonged antibiotics (21.9% versus 5.0%; P = .10). In addition, by working as an interdisciplinary group, many solvable misunderstandings were identified, and processes were adjusted to improve the quality of care provided to these patients.
Conclusions: This quality improvement initiative regarding management of DFO led to improved provider knowledge and collaborative competency between these three departments, improvements in definitive pathology reports, and nonsignificant improvement in several other clinical endpoints. Creating collaborative competency may be an effective local strategy to improve knowledge of diabetic foot infection and may generalize to other common multidisciplinary conditions.
The American Association of Colleges of Podiatric Medicine
50 Years of Professional, Political, and Public Health Influence
There are many changes on the horizon that will affect how we teach the future practitioners of podiatric medicine. The author describes the processes undertaken to date at the California College of Podiatric Medicine (CCPM), as well as the vision of tomorrow, for podiatric medical education. The educational system that will result from these changes will be more efficient; it will better meet the needs of students; and, it will broaden their base of knowledge, all to improve care given to the patient.
In order to assess the need for acquired immunodeficiency syndrome education among podiatric assistants, comprehensive questionnaires on human immunodeficiency virus infection were distributed in February and March 1989. The findings presented here are based upon questionnaires completed and returned by 300 assistants. The purpose of the needs assessment was three-fold: to find out how much the surveyed assistants know about AIDS and HIV infection, how they feel about working with HIV-infected patients, and to what extent they understand and follow recommended infection control practices. The results of the survey reveal that many of the assistants in the sample in this study are ill-informed about HIV infection, that they have numerous concerns and fears about working with HIV-infected patients, and that they are not following recommended infection control guidelines.
An overview of the development of medical and podiatric medical education in the US is provided. Beginning with the 1910 Flexner Report in medicine and moving to the 1996 Educational Enhancement Project of podiatric medicine, major changes have taken place that have made podiatric medicine a profession quite comparable to medicine. This is most obvious in the education and training process. It is essential that both the content and method of educating the podiatric physician for the 21st century reflect the rapidly evolving health care delivery and financing system.
Public Health and Podiatric Medicine: Principles and Practice.
2nd Ed. Edited by Arthur E. Helfand, DPM. 589 pages. American Public Health Association (APHA) Press, Washington, DC, 2006. $55.95 ($39.16 for APHA members).
The incidence of human immunodeficiency virus (HIV) infection in the US has increased over the past decade. This increase has effected concern regarding the risks of HIV infection within the podiatric medical practice. Implementation of an effective infection control program for blood-borne pathogens within the podiatric medical practice can minimize such risks.
The author presents the perspective that the nation's health care initiatives demand that greater attention be given to primary care providers. Inasmuch as the credibility of the podiatric medical profession must function in a health care environment dominated by allopathic and osteopathic physicians, the podiatric primary care initiative must be pursued within the guidelines and definitions for primary care that are present in all of mainstream medicine. The author argues that primary care podiatric medicine must establish itself as a specialty that stands as an equal along side of the other recognized specialties in podiatric medicine. Also, in keeping with the essential educational needs for specialty training, the development of residencies in primary podiatric medicine is crucial to assuring a credible area of special practice.
