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Journal of Fungi (Basel, Switzerland) Aug 2015Onychomycosis is a fungal infection of the toenails or fingernails that can involve any component of the nail unit, including the matrix, bed, and plate. It is a common... (Review)
Review
Onychomycosis is a fungal infection of the toenails or fingernails that can involve any component of the nail unit, including the matrix, bed, and plate. It is a common disorder that may be a reservoir for infection resulting in significant medical problems. Moreover, onychomycosis can have a substantial influence on one's quality of life. An understanding of the disorder and updated management is important for all health care professionals. Aside from reducing quality of life, sequelae of the disease may include pain and disfigurement, possibly leading to more serious physical and occupational limitations. Dermatologists, Podiatrists, and other clinicians who treat onychomycosis are now entering a new era when considering treatment options-topical modalities are proving more effective than those of the past. The once sought after concept of viable, effective, well-tolerated, and still easy-to-use monotherapy alternatives to oral therapy treatments for onychomycosis is now within reach given recent study data. In addition, these therapies may also find a role in combination and maintenance therapy; in order to treat the entire disease the practitioner needs to optimize these topical agents as sustained therapy after initial clearance to reduce recurrence or re-infection given the nature of the disease.
PubMed: 29376907
DOI: 10.3390/jof1020173 -
Nurse Education in Practice Mar 2018The objective of this literature review is to describe graduating student nurses' and student podiatrists' wound care competence. This integrative literature review has... (Review)
Review
The objective of this literature review is to describe graduating student nurses' and student podiatrists' wound care competence. This integrative literature review has been conducted with a systematic search process. Original studies were analysed by qualitative content analysis with the following stages: open coding, creating categories and abstraction. The literature search was conducted on May 2016 and reconducted on October 2016 using the Medline/Pubmed, CINAHL, Cochrane Library, Web of Science, Scopus and National Medic databases and 12 original studies were found. All the studies addressed graduating student nurses' wound care competence. According to original studies, graduating student nurses' wound care competence was inadequate. However, the students showed a positive attitude towards wound care. Subthemes of this literature review were: 1) Wound care knowledge, 2) Attitudes towards wound care, 3) Wound care preparedness and 4) Wound care education which created the main theme Graduating nurses' wound care competence. No studies were found about graduating student podiatrists' wound care competence. Graduating student nurses' wound care knowledge was deficient. Wound care education seemed to have a positive relation to students' wound care competence. The findings indicate that more information about graduating student nurses', and especially graduating podiatrists', wound care competence is needed.
Topics: Allied Health Personnel; Clinical Competence; Humans; Podiatry; Students, Nursing; Wound Infection; Wounds and Injuries
PubMed: 29136543
DOI: 10.1016/j.nepr.2017.11.002 -
BMC Geriatrics Apr 2021Foot problems are common in older adults and associated with poorer physical function, falls, frailty and reduced quality of life. Comprehensive Geriatric Assessment... (Observational Study)
Observational Study
BACKGROUND
Foot problems are common in older adults and associated with poorer physical function, falls, frailty and reduced quality of life. Comprehensive Geriatric Assessment (CGA), a multidisciplinary process that is considered the gold standard of care for older adults, does not routinely include podiatry assessment and intervention in hospitalized older adults.
AIMS
To introduce foot assessment to inpatient CGA to determine prevalence of foot disease, foot disease risk factors and inappropriate footwear use, assess inter-rater reliability of foot assessments, determine current podiatry input and examine associations between patient characteristics and foot disease risks.
METHODS
Prospective, observational cohort study of older adults on geriatric rehabilitation wards. Foot assessment completed using the Queensland Foot Disease Form (QFDF) in addition to routine CGA.
RESULTS
Fifty-two patients (median age [inter-quartile range] 86.4 [79.2-90.3] years, 54% female) were included. Six patients (12%) had foot disease and 13 (25%) had a 'high risk' or 'at risk' foot. Foot disease risk factor prevalence was peripheral arterial disease 9 (17%); neuropathy 10 (19%) and foot deformity 11 (22%). Forty-one patients (85%) wore inappropriate footwear. Inter-rater agreement was substantial on presence of foot disease and arterial disease, fair to moderate on foot deformity and fair on neuropathy and inappropriate footwear. Eight patients (15%) saw a podiatrist during admission: 5 with foot disease, 1 'at risk' and 2 'low risk' for foot disease. Patients with an at risk foot or foot disease had significantly longer median length of hospital stay (25 [13.7-32.1] vs 15.2 [8-22.1] days, p = 0.01) and higher median Malnutrition Screening Test scores (2 [0-3] vs 0 [0-2], p = 0.03) than the low-risk group. Patients with foot disease were most likely to see a podiatrist (p < 0.001).
CONCLUSION
Foot disease, foot disease risk factors and inappropriate footwear are common in hospitalized older adults, however podiatry assessment and intervention is mostly limited to patients with foot disease. Addition of routine podiatry assessment to the multidisciplinary CGA team should be considered. Examination for arterial disease and risk of malnutrition may be useful to identify at risk patients for podiatry review.
Topics: Aged; Aged, 80 and over; Female; Geriatric Assessment; Humans; Male; Prospective Studies; Quality of Life; Queensland; Reproducibility of Results
PubMed: 33794805
DOI: 10.1186/s12877-021-02164-3 -
European Journal of Radiology Dec 2018Ultrasound is being used by sports physicians in their daily practice to problem solve, but there is still a reluctance for some radiologists to embrace this technique....
Ultrasound is being used by sports physicians in their daily practice to problem solve, but there is still a reluctance for some radiologists to embrace this technique. It has become the "stethoscope" of the sports physician as it is freely available to have in the office setting (Tok, et al. [1]). This has been made possible by advances in technology making it cheaper and more affordable. In the United Kingdom, ultrasound has been performed by sports physicians, rheumatologists, surgeons, physiotherapists, podiatrists, anaesthetists, neurologists and emergency care physicians. It has become a core area of the curriculum in some of these specialties. In athletes it not only provides confirmation of the diagnosis but leads to a better treatment algorithm and can be used to direct intervention. Radiologists need to be aware of its strengths and weaknesses even if they are not able to perform such examinations.
Topics: Athletes; Athletic Injuries; Emergency Medical Services; Equipment and Supplies Utilization; Humans; Musculoskeletal Diseases; Musculoskeletal System; Physical Examination; Sports Medicine; Ultrasonography; United Kingdom
PubMed: 30527296
DOI: 10.1016/j.ejrad.2018.10.028 -
Advances in Skin & Wound Care Sep 2022
Topics: Forecasting; Humans; Podiatry
PubMed: 35993855
DOI: 10.1097/01.ASW.0000822620.44767.34 -
Journal of the American Podiatric... 2023Although podiatric medicine is a growing field, it is still relatively unknown to many in the general public, including those seeking careers in medicine. The purpose of...
BACKGROUND
Although podiatric medicine is a growing field, it is still relatively unknown to many in the general public, including those seeking careers in medicine. The purpose of the present study is to portray the perspectives of current podiatric medical students on motivational factors that encouraged them to pursue the field.
METHODS
An online survey was developed and delivered to the student body of a single podiatric medical school. The survey investigated the motivation to pursue podiatric medicine, including first exposure to the field, shadowing experiences, and a variety of motivational factors.
RESULTS
Of 149 students, 81 (54.4%) completed the survey. The three highest-rated reasons for pursuing podiatric medicine were "stable and secure future," "work-life balance," and "intellectual satisfaction." The three most-cited types of first exposure to podiatric medicine were "undergraduate pre-health advisor," "family member/friend is a podiatrist," and "form of media other than television, including the Internet." Shadowing experiences were identified as an important part of developing an interest in pursuing podiatric medicine, especially in the surgical setting.
CONCLUSIONS
Understanding the perspectives of current podiatric medical students is important in considering future efforts to promote the profession.
Topics: Humans; Motivation; Internet; Podiatry; Schools, Medical; Students, Medical
PubMed: 38175713
DOI: 10.7547/21-171 -
Journal of Foot and Ankle Research Aug 2022The concept of person-centred care is embedded within healthcare policy, focusing on long-term conditions and multimorbidity. The evidence that person-centred care is... (Review)
Review
BACKGROUND
The concept of person-centred care is embedded within healthcare policy, focusing on long-term conditions and multimorbidity. The evidence that person-centred care is being operationalised effectively across all areas of healthcare is limited. The aim of this scoping review was to explore the application, features, and effectiveness of person-centred care with service-users, carers, and the community within podiatry.
METHODS
The scoping review was based upon Arksey and Malley's five stage framework. The following databases were searched between January 2010 and March 2021: AMED, CINAHL, Embase, Cochrane library, SocINDEX, British Education Index, Business Source Complete, MEDLINE (EBSCO), and the EThOS 'Global electronic thesis and dissertation' repository, Prospero, and reference lists of included papers. Primary research articles were included if they reported on a person-centred care focused intervention with podiatry. Research terms were developed, appropriate databases identified, and an initial search resulted in 622 papers which, following removal of duplicates and critical appraisal, resulted in 18 eligible papers. Data extracted involved the types of person-centred care utilised, intervention details, motivations for engaging in person-centred care interventions, and intervention barriers and challenges.
RESULTS
Eighteen articles were included in the review. The main type of person-centred care utilised was patient/carer activities around self-management. None of the studies considered the role of the podiatrist as a person-centred care agent. The data on interventions generated the following themes 'service facilitated person-centred care' where a change has been made to service delivery, 'direct clinician delivery' where the intervention is delivered by the clinician with the patient present and 'patient instigated participation' where patient motivation is required to engage with an activity beyond the consultation. Outcome measures associated with quality of care and effectiveness were absent.
CONCLUSION
There is a lack of congruency between the concept of person-centred care and how it is operationalised. A whole system approach that considers commissioning, organisational leadership, the role of the practitioners and patients has not been considered. There is immense scope for the podiatrist to play an important part in the personalised-care agenda, but currently research that can evidence the effectiveness of person-centred care in podiatry is absent.
REVIEW REGISTRATION
Open Science Framework ( osf.io/egjsd ).
Topics: Humans; Patient Participation; Patient-Centered Care; Podiatry; Self Care; Self-Management
PubMed: 35986405
DOI: 10.1186/s13047-022-00566-z -
PloS One 2023In Australia, the distribution of occupational therapists, physiotherapists, and podiatrists density (per 10,000 population) by measure of location/rurality, usual...
BACKGROUND
In Australia, the distribution of occupational therapists, physiotherapists, and podiatrists density (per 10,000 population) by measure of location/rurality, usual resident population, and area-level socioeconomic status has not been described.
OBJECTIVE
To describe the national as well as states-and territories-wide distribution of registered allied health workforce-occupational therapists, physiotherapists, and podiatrists-by measures of rurality and area-level socioeconomic position in Australia.
METHODS
A linked data study that brings together (1) the location of health practitioners' principal place of practice from the Australian Health Practitioner Regulation Agency, (2) a measure of location/rurality-Modified Monash Model (MMM), and (3) an area-level measure of socioeconomic status-Index of Relative Socio-Economic Advantage and Disadvantage (IRSAD). The provider-to-population ratio (i.e., density) of three Australia's allied health workforce (occupational therapists, physiotherapists, and podiatrists) was calculated according to the MMM classifications (i.e., Modified Monash 1-7) and IRSAD quintiles at state and national level.
RESULTS
Nationwide, the density of occupational therapists and physiotherapists was highest in metropolitan areas (Modified Monash 1) and decreased with the increasing levels of the MMM categories. The national density of podiatrists was highest in Modified Monash 3 areas. The density of occupational therapists, physiotherapists, and podiatrists was highest in areas with IRSAD quintile 5 (i.e., the highest socioeconomic position) and decreased with the declining levels of the IRSAD quintiles nationwide. Moreover, there were notable disparities in the density of occupational therapists, physiotherapists, and podiatrists across each state and territory in Australia when stratified by the MMM classifications and IRSAD quintiles.
CONCLUSIONS
There was uneven distribution of registered occupational therapists, physiotherapists, and podiatrists when stratified by measures of location/rurality and area-level socioeconomic status across Australian jurisdictions. The density of these three groups of allied health workforce tended to be more concentrated in metropolitan and most advantaged areas while remote and most disadvantaged areas exhibited less allied health workforce distribution across each state and territory.
Topics: Humans; Australia; Physical Therapists; Occupational Therapists; Allied Health Personnel; Educational Personnel
PubMed: 37733814
DOI: 10.1371/journal.pone.0291962 -
Journal of Foot and Ankle Research Jul 2023The training of undergraduate and graduate-entry podiatry students in Australia and New Zealand includes practical sessions in a simulated and real-life clinical setting...
BACKGROUND
The training of undergraduate and graduate-entry podiatry students in Australia and New Zealand includes practical sessions in a simulated and real-life clinical setting and Work Integrated Learning (WIL) comprising professional clinical placements. Student performance during WIL is evaluated by their Clinical Educators using clinical competency tools. Having a standardised and validated clinical assessment tool for WIL in podiatry would facilitate consistency in assessment, promote standardisation between programs, and ensure that all podiatry students are assessed against a set of criteria over the course of their clinical programs to the point of threshold clinical competency. Therefore, the aim of this study was to develop a series of consensus-based statements via Delphi technique as the first step towards developing guidelines to direct the assessment of podiatry students during WIL.
METHODS
This study used a three-round modified Delphi consensus method. A panel of 25 stakeholders was sought. Specifically, representation from each of the universities in Australia and New Zealand who provide entry level programs, Clinical Educators, podiatry student representatives, new podiatry graduates and consumers (podiatrists hiring new graduates). The survey for Round 1 aimed for consensus and consisted of five open-ended questions. Questions one to three asked respondents to nominate what they considered were the important elements that needed to be assessed for podiatry students undertaking WIL for: Clinical performance/skills, Communication and Professional behaviour, Question 4 asked respondents to identify further/other elements of importance, whilst Question 5 asked a) how these elements should be evaluated and b) how should overall competency and ability to progress within the program be determined. Round 2 and 3 aimed to gather agreement and the questions were based on the responses from previous rounds.
RESULTS
Twenty-five participants agreed to participate, 17 females (68%) and eight males (32%). The panel consisted of 10 podiatry educators (40%), nine Clinical Educators (36%), two student representatives (8%), two new podiatry graduates (8%) and two consumers (8%). From the 25 recruited participants, 21 responded to Round one, 18 to Round two and 17 in Round three. At the conclusion of the Delphi survey, 55 statements had reached consensus or agreement.
CONCLUSIONS
This Delphi study is the first of its kind for the podiatry profession to develop consensus-based statements regarding the assessment of WIL. Fifty-five statements pertinent to the assessment of WIL were identified. This is an important first step toward the development of a consistent WIL assessment tool which may be applied across entry-level podiatry programs across Australia and New Zealand.
Topics: Male; Female; Humans; Clinical Competence; Consensus; Podiatry; Australia; Students; Delphi Technique
PubMed: 37468972
DOI: 10.1186/s13047-023-00639-7 -
JAMA Network Open Mar 2024Patients with kidney failure have an increased risk of diabetes-related foot complications. The benefit of regular foot and ankle care in this at-risk population is...
IMPORTANCE
Patients with kidney failure have an increased risk of diabetes-related foot complications. The benefit of regular foot and ankle care in this at-risk population is unknown.
OBJECTIVE
To investigate foot and ankle care by podiatrists and the outcomes of diabetic foot ulcers (DFUs) in patients with kidney failure.
DESIGN, SETTING, AND PARTICIPANTS
This retrospective cohort study included Medicare beneficiaries with type 2 diabetes receiving dialysis who had a new DFU diagnosis. The analysis of the calendar year 2016 to 2019 data from the United States Renal Data System was performed on June 15, 2023, with subsequent updates on December 11, 2023.
EXPOSURES
Foot and ankle care by podiatrists during 3 months prior to DFU diagnosis.
MAIN OUTCOMES AND MEASURES
The outcomes were a composite of death and/or major amputation, as well as major amputation alone. Kaplan-Meier analysis was used to estimate 2 to 3 years of amputation-free survival. Foot and ankle care by podiatrists and the composite outcome was examined using inverse probability-weighted Cox regression, while competing risk regression models were used for the analysis of amputation alone.
RESULTS
Among the 14 935 adult patients with kidney failure and a new DFU (mean [SD] age, 59.3 [12.7] years; 35.4% aged ≥65 years; 8284 men [55.4%]; Asian, 2.7%; Black/African American, 35.0%; Hispanic, 17.7%; White, 58.5%), 18.4% (n = 2736) received care by podiatrists in the 3 months before index DFU diagnosis. These patients were older, more likely to be male, and have more comorbidities than those without prior podiatrist visits. Over a mean (SD) 13.5 (12.0)-month follow-up, 70% of those with podiatric care experienced death and/or major amputation, compared with 74% in the nonpodiatric group. Survival probabilities at 36 months were 26.3% vs 22.8% (P < .001, unadjusted Kaplan-Meier survival analysis). In multivariate regression analysis, foot and ankle care was associated with an 11% lower likelihood of death and/or amputation (hazard ratio [HR], 0.89 95% CI, 0.84-0.93) and a 9% lower likelihood of major amputation (above or below knee) (HR, 0.91; 95% CI, 0.84-0.99) than those who did not.
CONCLUSIONS AND RELEVANCE
The findings of this study suggest that patients with kidney failure at risk for DFUs who receive foot and ankle care from podiatrists may be associated with a reduced likelihood of diabetes-related amputations.
Topics: Adult; Humans; Male; Aged; United States; Middle Aged; Female; Diabetes Mellitus, Type 2; Ankle; Retrospective Studies; Medicare; Diabetic Foot; Risk Factors; Amputation, Surgical; Renal Insufficiency
PubMed: 38427353
DOI: 10.1001/jamanetworkopen.2024.0801