Enhancing Learning Through Technology at the Kent State University College of Podiatric Medicine
The intent of this research was to evaluate the Mediasite lecture capture system at the Kent State University College of Podiatric Medicine (formerly the Ohio College of Podiatric Medicine) to determine the acceptance, use and benefits to both students and faculty and to identify any concerns, limitations, and suggestions for expansion. There is extreme debate on the effect of lecture capture on student attendance included in the research.
Two surveys were compiled, one each for students and faculty. These were distributed by email to the entire student body and all full-time and part-time faculty. Responses were voluntary. The questions sought to identify the priorities of the participant, reasons for viewing lectures compiled by course, to assess any effect on class attendance and to evaluate the ease and use of the technical function. There was also a section for subjective responses and suggestions.
The tabulations proved a very high use of the program with the most important reason being to prepare for exams. The question of class attendance is still open to interpretation. Technically, the Mediasite system was ranked easy to use by both groups.
The results of this survey confirm the concept of lecture capture as an integral segment of advanced education. Though this system should not replace class attendance, it is a vital supplement to course work and study. By reviewing all of the components of the survey those who may have concerns on its effectiveness are also aware of the advantages. The results of this study met all the objectives to evaluate use and obtain viewpoints to improve and expand the program. (J Am Podiatr Med Assoc 102(6): 491–498, 2012)
Ligaments and cartilage contact contribute to the mechanical constraints in the knee joints. However, the precise influence of these structural components on joint movement, especially when the joint constraints are computed using inverse dynamics solutions, is not clear.
We present a mechanical characterization of the connections between the infinitesimal twist of the tibia and the femur due to restraining forces in the specific tissue components that are engaged and responsible for such motion. These components include the anterior cruciate, posterior cruciate, medial collateral, and lateral collateral ligaments and cartilage contact surfaces in the medial and lateral compartments. Their influence on the bony rotation about the instantaneous screw axis is governed by restraining forces along the constraints explored using the principle of reciprocity.
Published kinetic and kinematic joint data (American Society of Mechanical Engineers Grand Challenge Competition to Predict In Vivo Knee Loads) are applied to define knee joint function for verification using an available instrumented knee data set. We found that the line of the ground reaction force (GRF) vector is very close to the axis of the knee joint. It aligns the knee joint with the GRF such that the reaction torques are eliminated. The reaction to the GRF will then be carried by the structural components of the knee instead.
The use of this reciprocal system introduces a new dimension of foot loading to the knee axis alignment. This insight shows that locating knee functional axes is equivalent to the static alignment measurement. This method can be used for the optimal design of braces and orthoses for conservative treatment of knee osteoarthritis. (J Am Podiatr Med Assoc 103(2): 126–135, 2013)
Podiatric medicine had its own evolution in the medical field apart from allopathic and osteopathic medicine. Podiatrists are well-respected members of the health-care team and have earned recognition as physicians within their education, training, and credentialing processes. Unlike allopathic medical doctors and doctors of osteopathic medicine, whose scope of practice is based upon their education, training, and credentialing processes, podiatrists' scopes of practice are determined by state laws (and are often influenced by politics) with variances across the United States. In contrast to a lack of uniformity in the training and credentialing processes of an allopathic medical doctor, podiatrists complete a streamlined educational process that is competency-based and well-aligned from the undergraduate phase (podiatric medical school) to the postgraduate phase (residency) through the credentialing processes (licensure and certification). Podiatric medical students begin to directly engage in the specialty related to the diagnosis and treatment of the lower extremity much earlier in the educational process than an orthopedist, whose foot and ankle exposure is less extensive by comparison. (J Am Podiatr Med Assoc 99(1): 65–72, 2009)
We explored gait differences in patients with diabetes and peripheral neuropathy (DPN) and aged-matched controls over short and long walking distances. The potential benefit of footwear for improving gait in patients with DPN was also explored.
Twelve patients with DPN and eight controls walked at their habitual speed over short (7 m) and long (20 m) distances under two conditions: barefoot and regular shoes. A validated system of body-worn sensors was used to extract spatiotemporal gait parameters. Neuropathy severity was quantified using vibratory perception threshold measured at the great toe.
Gait deterioration in the DPN group was observed during all of the walking trials. However, the difference between patients with DPN and participants in the control group achieved statistical significance only during long walking distance trials. Shod and barefoot double support times were longer in the DPN group during long walking distances (>20%, P = .03). Gait unsteadiness, defined as coefficient of variation of gait velocity, was also significantly higher in the DPN group when barefoot walking over long distances (83%, P = .008). Furthermore, there was a high correlation between neuropathy severity and gait unsteadiness best demonstrated during the barefoot walking/long walking distance condition (r = 0.77, P < .001). The addition of footwear improved gait steadiness in the DPN group by 46% (P = .02). All differences were independent of age, sex, and body mass index (P > .05).
This study suggests that gait alteration in patients with DPN is most pronounced while walking barefoot over longer distances and that footwear may improve gait steadiness in patients with DPN. (J Am Podiatr Med Assoc 103(3): 165–173, 2013)
Professional and occupational burnout is a recognized syndrome among healthcare professionals, although the point at which burnout begins is unclear. There is a dearth of research investigating burnout and occupational stress in relation to podiatric medicine, although two recent studies have reported high levels of burnout expressed by podiatric medical practitioners. This study was undertaken to compare the levels of burnout in newly qualified practitioners in Australia and the United Kingdom. The results suggest that levels of burnout are higher in these groups than indicated by the published normative medical data. Occupational stress was associated with lack of professional status and with geographic and professional isolation. Within these two themes, there were clear differences between the two groups. (J Am Podiatr Med Assoc 94(3): 282–291, 2004)
Up to 10% of people will experience heel pain. The purpose of this prospective, double-blind, randomized clinical trial was to compare custom foot orthoses (CFO), prefabricated foot orthoses (PFO), and sham insole treatment for plantar fasciitis.
Seventy-seven patients with plantar fasciitis for less than 1 year were included. Outcome measures included first step and end of day pain, Revised Foot Function Index short form (FFI-R), 36-Item Short Form Health Survey (SF-36), activity monitoring, balance, and gait analysis.
The CFO group had significantly improved total FFI-R scores (77.4 versus 57.2; P = .03) without group differences for FFI-R pain, SF-36, and morning or evening pain. The PFO and CFO groups reported significantly lower morning and evening pain. For activity, the CFO group demonstrated significantly longer episodes of walking over the sham (P = .019) and PFO (P = .03) groups, with a 125% increase for CFOs, 22% PFOs, and 0.2% sham. Postural transition duration (P = .02) and balance (P = .05) improved for the CFO group. There were no gait differences. The CFO group reported significantly less stretching and ice use at 3 months.
The CFO group demonstrated 5.6-fold greater improvements in spontaneous physical activity versus the PFO and sham groups. All three groups improved in morning pain after treatment that included standardized athletic shoes, stretching, and ice. The CFO changes may have been moderated by decreased stretching and ice use after 3 months. These findings suggest that more objective measures, such as spontaneous physical activity improvement, may be more sensitive and specific for detecting improved weightbearing function than traditional clinical outcome measures, such as pain and disease-specific quality of life.
The goal of this study was to evaluate the information-seeking behaviors of podiatric physicians as they search for answers to clinical questions that arise during patient care visits.
Invitations to participate in an Internet survey were e-mailed to alumni of the Ohio College of Podiatric Medicine (now Kent State University College of Podiatric Medicine [KSUCPM]). Twenty-nine questions surveyed the types and frequency of information that podiatric physicians need during patient care visits, which information resources are used by podiatric physicians, and which barriers podiatric physicians encounter when seeking information in general.
With 143 completed surveys, results of this study indicate a preference for searching the Internet over using colleagues and print literature. The most common need is for drug information, and common barriers include lack of time and cost of accessing information. Results are similar to those for physicians and other health-care providers seeking information.
Podiatrists recognize the need to become proficient at locating high-quality information, evaluating resources, and improving their understanding and use of resources on evidence-based medicine. Furthermore, with an increased awareness of their own behaviors, practicing podiatric physicians should pursue the best methods to find, judge, and use medical information for patient care. (J Am Podiatr Med Assoc 102(6): 451–462, 2012)
Exercise is highly beneficial for persons with diabetes. Similar to many other patients, those with diabetes may be reluctant to exercise given a lack of motivation and proper instruction regarding an exercise prescription. In general, medical providers are poorly equipped to develop an exercise prescription and furnish motivation. Attempts to find activities that not only provide effective aerobic challenges but also are enjoyable to participate in are fraught with difficulty. Hiking as a potential option for a safe and enjoyable activity is discussed, including the possible downsides.
Multiple publications were reviewed using key words.
A review of the literature uncovered limited publications or controlled trials that discussed the use of hiking per se as an activity for the management of diabetes. Newer studies reviewing weightbearing exercise and diabetic polyneuropathy and those discussing the advantages of trekking poles for balance and proprioception are cited in support of the recommendation for hiking as an activity for those with diabetes.
Exercise has been shown to substantially benefit individuals with diabetes, but convincing patients with diabetes to exercise is daunting. Hiking, unlike other, more tedious exercise programs, may be an exercise option that persons with diabetes might find enjoyable. Hiking may encourage balance training and reduced ground reaction forces. These benefits may be augmented by trekking poles, which may likewise counter the concerns of the uneven surfaces that present challenges to the hiker with diabetes.
Precise comprehensive imaging of arterial circulation is the cornerstone of successful revascularization of the ischemic extremity in patients with diabetes mellitus. Arterial imaging is challenging in these patients because the disease is often multisegmental, with a predilection for the distal tibial and peroneal arteries. Occlusive lesions and the arterial wall itself are often calcified, and patients with ischemic complications frequently have underlying renal insufficiency. Intra-arterial digital subtraction angiography, contrast-enhanced magnetic resonance angiography, and, more recently, computed tomographic angiography have been used as imaging modalities in lower-extremity ischemia. Each modality has specific advantages and shortcomings in this patient population, which are summarized and contrasted in this review. (J Am Podiatr Med Assoc 100(5): 412–423, 2010)
Size and Shape Differences Between Male and Female Foot Bones
Is the Female Foot Predisposed to Hallux Abducto Valgus Deformity?
This study introduces a new technique to measure bone size and shape. A three-dimensional laser scan was taken of the talus, navicular, medial cuneiform, and first metatarsal from 107 skeletons of known age and sex. The bones were analyzed for differences in bone morphology between the sexes and the ability of each bone to contribute to the adducted position of the first metatarsal. Linear measurements showed that male bones were larger than female bones. Measurements of articular surfaces suggested that female bones had the potential for more movement to occur in the direction of adduction, possibly resulting in the female first metatarsal being more adducted than that in the male skeleton. Such differences may underlie the predisposition of the female foot to develop hallux valgus deformity. (J Am Podiatr Med Assoc 94(5): 434–452, 2004)