The authors present a concise review of age-related changes that occur in the skin and its derivatives, as they pertain to the podiatric practitioner. A brief discussion of wound healing and several common skin disorders that affect the elderly is also included.
Heparin is an anticoagulant commonly used to treat and prevent deep venous thrombosis. Heparin-induced thrombocytopenia and possible thrombosis are serious complications associated with its use. This can occasionally complicate treatment of patients undergoing podiatric surgery. Heparin-induced thrombocytopenia is often not immediately recognized and is underreported in podiatric medicine literature. The goal of this case report is to highlight the multiple risk factors associated with the development of heparin-induced thrombocytopenia and to aid with early recognition, understanding of pathogenesis, and treatment options. (J Am Podiatr Med Assoc 103(1): 67–72, 2013)
The computerized student-patient encounter log system represents a considerable improvement in terms of efficiency and accuracy over traditional paper-based student-patient encounter reporting systems. The computerized log not only facilitates faculty monitoring of students’ assessment and management of health problems at geographically disparate locations but also provides a rich resource of data for enhancing clinical teaching and learning experiences. However, little is known about podiatric medical students’ experiences with Web-based computerized student-patient encounter log systems. The findings reported in this article suggest that the computerized student-patient encounter log was considered to be useful and effective by most of the podiatric medical students surveyed and represents an improvement over traditional paper-based recording systems. (J Am Podiatr Med Assoc 95(6): 556–563, 2005)
This study examined the success of an admission screen in identifying applicants who will fail Part I or Part II of the Podiatric Boards on the first attempt.
A logistic regression model was used to predict failure on the Podiatric Boards.
The biology Medical College Admission Test (MCAT) score predicted failure on Part I and Part II. Adding undergraduate grade point average and the other MCAT subscores did not significantly improve the prediction. Although a screen based on the biology MCAT score can identify nearly 90% of those who fail, there are six false-positives for every true-positive.
First-time Board failure can be predicted, but Board failure must be primarily addressed by interventions after matriculation rather than by an admission screen. (J Am Podiatr Med Assoc 102(6): 485–490, 2012)
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 aimed to determine the feasibility of implementing suicide risk screening in an outpatient podiatry clinic and ambulatory surgical center.
Methods: A suicide risk screening quality improvement project was implemented in an outpatient podiatry clinic and ambulatory surgical center in collaboration with a National Institute of Mental Health suicide prevention research team. Following training for all staff, patients aged 18 years and older were screened for suicide risk with the Ask Suicide-Screening Questions as standard of care. Clinic staff were surveyed about their opinions of screening.
Results: Ninety-four percent of patients (442 of 470) agreed to be screened for suicide risk and nine patients (nine of 442 [2%]) were screened as nonacute positive; zero patients were screened as 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 Ask Suicide-Screening Questions instrument provided valuable information that would not have been ascertained otherwise, positively impacting clinical decision-making and leading to improved overall care for podiatry patients.
Commitment to steady, adaptive improvement in podiatric medical professionals has taken shape in the Podiatric Educational Enhancement Project. This project involves wide representation from all interests, aspects, and constituencies in the profession to study opportunities and develop consensus on both small and large enhancements possible in the continuum of podiatric medical education. More than 1,300 podiatric physicians have contributed information and expertise, and more will be involved as the project develops during the next 18 months.
Background: We sought to examine the economic value of specialized lower-extremity medical care by podiatric physicians in the treatment of diabetic foot ulcers by evaluating cost outcomes for patients with diabetic foot ulcer who did and did not receive care from a podiatric physician in the year before the onset of a foot ulcer.
Methods: We analyzed the economic value among commercially insured patients and Medicare-eligible patients with employer-sponsored supplemental medical benefits using the MarketScan Databases. The analysis consisted of two parts. In part I, we examined cost or savings per patient associated with care by podiatric physicians using propensity score matching and regression techniques; in part II, we extrapolated cost or savings to populations.
Results: Matched and regression-adjusted results indicated that patients who visited a podiatric physician had $13,474 lower costs in commercial plans and $3,624 lower costs in Medicare plans during 2-year follow-up (P < .01 for both). A positive net present value of increasing the share of patients at risk for diabetic foot ulcer by 1% was found, with a range of $1.2 to $17.7 million for employer-sponsored plans and $1.0 to $12.7 million for Medicare plans.
Conclusions: These findings suggest that podiatric medical care can reduce the disease and economic burdens of diabetes. (J Am Podiatr Med Assoc 101(2): 93–115, 2011)
Hyperbaric oxygen therapy (HBOT) is a useful tool for many conditions within the scope of practice of a Doctor of Podiatric Medicine (DPM). More wound-care clinics are adding HBOT as a service line. The increasing prevalence of DPMs operating inside of these wound-care clinics has raised questions about the licensure and privileging of DPMs to supervise HBOT. This document reviews the safety of outpatient HBOT and provides guidelines for hospitals to credential DPMs to supervise treatments.
An essential skill for podiatrists is conservative sharp debridement of foot callus. Poor technique can result in lacerations, infections and possible amputation. This pilot trial explored whether adding simulation training to a traditional podiatry clinical placement improved podiatry student skills and confidence in conservative sharp debridement, compared with traditional clinical placement alone.
Twenty-nine podiatry students were allocated randomly to either a control group or an intervention group on day 1 of their clinical placement. On day 4, the intervention group (n = 15) received a 2-hour simulation workshop using a medical foot-care model, and the control group (n = 14) received a 2-hour workshop on compression therapy. Both groups continued to learn debridement skills as opportunities arose while on clinical placement. The participants' debridement skills were rated by an assessor blinded to group allocation on day 1 and day 8 of their clinical placement. Participants also rated their confidence in conservative sharp debridement using a questionnaire. Data were analyzed using logistic regression (skills) and analysis of covariance (confidence), with baseline scores as a covariate.
At day 8, analysis showed that those in the intervention group were 16 times more likely to be assessed as competent (95% confidence interval, 1.6–167.4) in their debridement skills and reported increased confidence in their skills (mean difference, 3.2 units; 95% confidence interval, 0.5–5.9) compared with those in the control group.
This preliminary evidence suggests that incorporating simulation into traditional podiatry clinical placements may improve student skills and confidence with conservative sharp debridement.