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The Journal of the American Podiatric Medical Association
One Hundred Years of Passion and Progress
The coronavirus disease of 2019 pandemic is driving significant change in the health-care system and disrupting the best practices for diabetic limb preservation, leaving large numbers of patients without care. Patients with diabetes and foot ulcers are at increased risk for infections, hospitalization, amputations, and death. Podiatric care is associated with fewer diabetes-related amputations, emergency room visits, hospitalizations, length-of-stay, and costs. However, podiatrists must mobilize and adopt the new paradigm of shifts away from hospital care to community-based care. Implementing the proposed Pandemic Diabetic Foot Triage System, in-home visits, higher acuity office visits, telemedicine, and remote patient monitoring can help podiatrists manage patients while reducing the coronavirus disease of 2019 risk. The goal of podiatrists during the pandemic is to reduce the burden on the health-care system by keeping diabetic foot and wound patients safe, functional, and at home.
Background: Despite prevention efforts, suicide rates continue to rise, prompting the need for novel evidence-based approaches to suicide prevention. Patients presenting with foot and ankle disorders in a podiatric medical and surgical practice may represent a population at risk for suicide, given risk factors of chronic pain and debilitating injury. Screening has the potential to identify people at risk that may otherwise go unrecognized. This quality improvement project (QIP) aimed to determine the feasibility of implementing suicide risk screening in an outpatient podiatry clinic and ambulatory surgical center. Methods: A suicide risk screening QIP was implemented in an outpatient podiatry clinic and ambulatory surgical center in collaboration with a National Institute of Mental Health (NIMH) suicide prevention research team. Following training for all staff, patients ages 18 years and older were screened for suicide risk with the Ask Suicide-Screening Questions (ASQ) as standard of care. Clinic staff were surveyed about their opinions of screening. Results: Ninety-four percent of patients (442/470) agreed to be screened for suicide risk and nine patients (2%; 9/442) screened non-acute positive; zero for acute risk. The majority of clinic staff reported that they found screening acceptable, felt comfortable working with patients who have suicidal thoughts, and thought screening for suicide risk was clinically useful. Conclusions: Suicide risk screening was successfully implemented in an outpatient podiatry clinic. Screening with the ASQ provided valuable information that would not have been ascertained otherwise, positively impacting clinical decision-making and leading to improved overall care for podiatry patients.
A 2004 survey of US adults found that 19% had experienced foot problems at work at some time. As a result, 38% reported lost productivity and 28% missed time at work. Younger, less educated male workers were more likely to suffer from foot problems. The percentage of the total population surveyed who missed time at work owing to foot problems was 5.4% in 2004. In a previous survey conducted in 2000, the corresponding percentage was 6.6%. (J Am Podiatr Med Assoc 94(6): 604–607, 2004)
The existing podiatric medical residencies in the Department of Veterans Affairs are reviewed. The suitability of these residencies to fill a potential need for entry level programs is discussed. The financial implications of providing such training are reviewed and a plan for implementation is presented. Ninety-eight rotating podiatric residency positions currently available in Department of Veterans Affairs hospitals are prime candidates to serve as entry level PGY-1 positions. Assurances will need to be given that implementation of the PGY-1 concept must serve the best interests of the veteran patient population, and that funds will need to be allocated to pay faculty salaries and resident stipends. Congressional review of student loan forbearance policies affecting podiatric medical residents is also needed.
Health care for the homeless is a major public health concern. With the rise in antibiotic-resistant tuberculosis, the increase of human immunodeficiency virus (HIV) diseases, and other health risks, the medical community has begun to recognize the urgency of taking a proactive role in providing care for this population. Lower extremity pathology can result in limb-threatening and, in some cases, life-threatening sequelae for homeless populations. This patient group has limited access to regular hygiene, appropriate shoes, and podiatric medical care. Participation in the "Stand Down for the Homeless" projects provided an opportunity to evaluate the podiatric needs of a homeless population and to project a response to those needs. The authors define and compare this homeless population with the national homeless population, compare the podiatric needs of this homeless populations versus the general population, and respond to those needs.
In recent years, there has been a rapid increase in World Wide Web–based teaching and learning materials; however, present-day systems for recording student-patient interactions have trailed behind other academic areas in the appropriate use of technology. This article reviews the implementation of an innovative Web-based computerized student-patient log. This system represents considerable improvement in terms of efficiency and accuracy over traditional paper-based reporting systems. It facilitates faculty tracking of students’ clinical experiences at geographically disparate locations and allows gaps in student knowledge to be more easily identified. Moreover, the Web-based system has the added advantage of making students responsible for their own learning, providing them with a sense of ownership of the data collected. (J Am Podiatr Med Assoc 93(2): 150-156, 2003)
Triamcinolone was administered sublesionally to 48 patients with various dermatoses of the legs and feet. Results were satisfactory in 94 percent of those treated. Gratifying results were obtained in patients who had suffered from intractable psoriasis of many years' duration, great cosmetic and psychological improvement being noted in these individuals. Side effects consisted mainly of atrophy, which was of insignificant consequence in almost all instances. This administration, performed as directed, is recommended for a great number of skin disorders commonly encountered in podiatry.
