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- Author or Editor: Laura E. Sansosti x
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The effect of lower-extremity pathology and surgical intervention on automobile driving function has been a topic of contemporary interest in the medical literature. The objective of this review was to summarize the topic of driving function in the setting of lower-extremity impairment. Included studies involved lower-extremity immobilization devices, elective and traumatic lower-limb surgery, chronic musculoskeletal pathology, and diabetes as it relates to the foot and ankle, focusing on the effect each may have on driving function. We also discuss the basic US state regulations with respect to impaired driving and changes to automobile structure that can be made in the setting of lower-extremity pathology.
Background
The primary objective of this investigation was to objectify perceived stresses of students enrolled at a US college of podiatric medicine.
Methods
Following preliminary pilot data collection and representative student interviews, the Perceived Stress Scale and a newly developed survey consisting of 46 potential stresses were administered to students. Participants were asked to identify up to ten items from the survey that caused them the most stress and to further identify up to three of these ten that they considered to be the most stressful.
Results
A response rate of 71.5% (261 of 365) was observed. Specific results demonstrate that levels of perceived stress in podiatric medical students are higher than those in the general population, as well as some potential trends with respect to specific perceived stresses that change over time.
Conclusions
The results of this investigation provide quantitative evidence of perceived levels of stress and specific stresses of students enrolled at a US college of podiatric medicine. We hope that these findings increase awareness of stress in podiatric medicine, lead to colleges of podiatric medicine taking active steps to improve student stress education, and lead to future investigations of stress and mental health in the field of podiatric medicine.
Background:
One relatively universal functional goal after major lower-limb amputation is ambulation in a prosthesis. This retrospective, observational investigation sought to 1) determine what percentage of patients successfully walked in a prosthesis within 1 year after major limb amputation and 2) assess which patient factors might be associated with ambulation at an urban US tertiary-care hospital.
Methods:
A retrospective medical record review was performed to identify consecutive patients undergoing major lower-limb amputation.
Results:
The overall rate of ambulation in a prosthesis was 29.94% (50.0% of those with unilateral below-the-knee amputation [BKA] and 20.0% of those with unilateral above-the-knee amputation [AKA]). In 24.81% of patients with unilateral BKA or AKA, a secondary surgical procedure of the amputation site was required. In those with unilateral BKA or AKA, statistically significant factors associated with ambulation included male sex (odds ratio [OR] = 2.50) and at least 6 months of outpatient follow-up (OR = 8.10), survival for at least 1 postoperative year (OR = 8.98), ambulatory preamputation (OR = 14.40), returned home after the amputation (OR = 6.12), and healing of the amputation primarily without a secondary surgical procedure (OR = 3.62). Those who had a history of dementia (OR = 0.00), a history of peripheral arterial disease (OR = 0.35), and a preamputation history of ipsilateral limb revascularization (OR = 0.14) were less likely to walk. We also observed that patients with a history of outpatient evaluation by a podiatric physician before major amputation were 2.63 times as likely to undergo BKA as opposed to AKA and were 2.90 times as likely to walk after these procedures.
Conclusions:
These results add to the body of knowledge regarding outcomes after major amputation and could be useful in the education and consent of patients faced with major amputation.
Background:
A patient “handoff,” or the “sign-out” process, is an episode during which the responsibility of a patient transitions from one health-care provider to another. These are important events that affect patient safety, particularly because a significant proportion of adverse events have been associated with a relative lack of physician communication. The objective of this investigation was to survey podiatric surgical residency programs with respect to patient care handoff and sign-out practices.
Methods:
A survey was initially developed and subsequently administered to the chief residents of 40 Council on Podiatric Medical Education–approved podiatric surgical residency programs attempting to elucidate patient care handoff protocols and procedures and on-call practices.
Results:
Although it was most common for patient care handoffs to occur in person (60.0%), programs also reported that handoffs regularly occurred by telephone (52.5%) and with no direct personal communication whatsoever other than the electronic passing of information (50.0%). In fact, 27.5% of programs reported that their most common means of patient care handoff was without direct resident communication and was instead purely electronic. We observed that few residents reported receiving formal education or assessment/feedback (17.5%) regarding their handoff proficiency, and only 5.0% of programs reported that attending physicians regularly took part in the handoff/sign-out process. Although most programs felt that their sign-out practices were safe and effective, 67.5% also believed that their process could be improved.
Conclusions:
These results provide unique information on a potentially underappreciated aspect of podiatric medical education and might point to some common deficiencies regarding the development of interprofessional communication within our profession during residency training.
INTRODUCTION AND OBJECTIVES: Immobilization devices such as surgical shoes and walking boots are commonly prescribed by podiatric physicians in the treatment of a variety of lower extremity pathologies and during the post-operative recovery period, but may have the potential to affect a patient’s ability to maintain a safe level of control over the accelerator and brake pedals while operating an automobile. The objective of this investigation was to assess driving outcomes in a group of healthy participants under variable foot wear conditions.
METHODS: Following IRB approval, the braking performances of participants were evaluated with a computerized driving simulator. We assessed three driving outcomes (mean emergency brake response time, frequency of abnormally delayed braking responses, and frequency of inaccurate brake responses) under three variable footwear conditions (regular shoe gear, surgical shoe, and walking boot).
RESULTS: We found that mean brake response times were abnormally delayed in the walking boot compared to both the regular shoe (0.736 seconds vs. 0.575 seconds, p < 0.001 seconds) and surgical shoe (0.736 seconds vs. 0.611 seconds, p < 0.001). We found that abnormally delayed brake responses occurred more frequently in the surgical shoe (18.5% vs. 2.5%, p < 0.001) and the walking boot (55.5% vs. 2.5%, p < 0.001) compared to the regular shoe. And we found that inaccurate brake responses occurred more frequently in the walking boot compared to both the surgical shoe (18.0% vs. 4.0%, p < 0.001) and the regular shoe (18.0% vs. 2.0%, p < 0.001).
CONCLUSIONS: The results of these investigations provide podiatric physicians with a better understanding of how to assess the risk and how to appropriately advise their patients who have been prescribed lower extremity immobilization devices with respect to the safe operation of an automobile.
