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Mycoses Jan 2024Onychomycosis (ONM) is the most prevalent nail unit pathology, and its severity and monitoring are often based on the visual judgement of clinicians. (Review)
Review
BACKGROUND
Onychomycosis (ONM) is the most prevalent nail unit pathology, and its severity and monitoring are often based on the visual judgement of clinicians.
OBJECTIVE
The objective of this study is to assess the reliability of the Onychomycosis Severity Index (OSI) classification when utilized by three clinicians with varying levels of clinical experience: an experienced podiatrist (with 5 years of experience), a moderately experienced podiatrist (with 2 years of experience) and an inexperienced podiatrist (a recent graduate familiar with the OSI classification but lacking clinical experience). Additionally, we compared the severity assessments made through visual inspection with those determined using the OSI by different clinicians.
METHODS
We evaluated reliability using the intraclass correlation index (ICC), analysing 50 images of ONM.
RESULTS
The OSI demonstrated a very high level of reliability (ICC: 0.889) across clinicians, irrespective of their experience levels. Conversely, a statistically significant increase in severity was observed when comparing visual assessments with the OSI (p < .001) for ONM severity evaluation.
CONCLUSION
The OSI proves to be a reproducible classification system, regardless of the clinical experience of the practitioner employing it.
Topics: Humans; Onychomycosis; Reproducibility of Results; Nails
PubMed: 38214350
DOI: 10.1111/myc.13694 -
MMWR. Morbidity and Mortality Weekly... Jan 2024Incorrect use of topical antifungals and antifungal-corticosteroid combinations is likely contributing to the global emergence and spread of severe...
Incorrect use of topical antifungals and antifungal-corticosteroid combinations is likely contributing to the global emergence and spread of severe antimicrobial-resistant superficial fungal infections, which have recently been detected in the United States. Understanding prescribing patterns is an initial step in establishing and promoting recommended use of these medications. Using 2021 Medicare Part D data, CDC examined prescription volumes, rates, and costs for topical antifungals (including topical combination antifungal-corticosteroid medications). Total prescription volumes were compared between higher-volume prescribers (top 10% of topical antifungal prescribers by volume) and lower-volume prescribers. During 2021, approximately 6.5 million topical antifungal prescriptions were filled (134 prescriptions per 1,000 beneficiaries), at a total cost of $231 million. Among 1,017,417 unique prescribers, 130,637 (12.8%) prescribed topical antifungals. Primary care physicians wrote the highest percentage of prescriptions (40.0%), followed by nurse practitioners or physician assistants (21.4%), dermatologists (17.6%), and podiatrists (14.1%). Higher-volume prescribers wrote 44.2% (2.9 million) of all prescriptions. This study found that enough topical antifungal prescriptions were written for approximately one of every eight Medicare Part D beneficiaries in 2021, and 10% of antifungal prescribers prescribed nearly one half of these medications. In the setting of emerging antimicrobial resistance, these findings highlight the importance of expanding efforts to understand current prescribing practices while encouraging judicious prescribing by clinicians and providing patient education about proper use.
Topics: Aged; Humans; United States; Medicare Part D; Antifungal Agents; Drug Prescriptions; Adrenal Cortex Hormones; Anti-Infective Agents; Drug Combinations; Practice Patterns, Physicians'; Analgesics, Opioid
PubMed: 38206854
DOI: 10.15585/mmwr.mm7301a1 -
Healthcare (Basel, Switzerland) Dec 2023Australian osteopaths engage in multidisciplinary care and referrals with other health professionals, including general practitioners (GPs), for musculoskeletal care....
Australian osteopaths engage in multidisciplinary care and referrals with other health professionals, including general practitioners (GPs), for musculoskeletal care. This secondary analysis compared characteristics of Australian osteopaths who refer to, and receive referrals from, GPs with osteopaths who do not refer. The analysis was undertaken to identify pertinent characteristics that could contribute to greater engagement between Australian osteopaths and GPs. Data were from the Australian osteopathy practice-based research network comprising responses from 992 osteopaths (48.1% response rate). Osteopaths completed a practice-based survey exploring their demographic, practice, and clinical management characteristics. Backward logistic regression identified significant characteristics associated with referrals. Osteopaths who reported sending referrals ( = 878, 88.5%) to GPs were more likely than their non-referring colleagues to receive referrals from GPs (aOR = 4.80, 95% CI [2.62-8.82]), send referrals to a podiatrist (aOR = 3.09, 95% CI [1.80-5.28]) and/or treat patients experiencing degenerative spinal complaints (aOR = 1.71, 95% CI [1.01-2.91]). Osteopaths reporting receiving referrals ( = 886, 89.3%) from GPs were more likely than their non-referring colleagues to send referrals to GPs (aOR = 4.62, 95% CI [2.48-8.63]) and use the Medicare EasyClaim system (aOR = 4.66, 95% CI [2.34-9.27]). Most Australian osteopaths who report engaging in referrals with GPs for patient care also refer to other health professionals. Referrals from GPs are likely through the Chronic Disease Management scheme. The clinical conditions resulting in referrals are unknown. Further research could explore the GP-osteopath referral network to strengthen collaborative musculoskeletal care. The outcomes of this study have the potential to inform Australian osteopaths participating in advocacy, public policy and engagement with Australian GPs.
PubMed: 38200954
DOI: 10.3390/healthcare12010048 -
Foot and Ankle Surgery : Official... Apr 2024Despite the questionable validity of online-based physician review websites (PRWs), negative reviews can adversely affect a provider's practice. Several investigations...
BACKGROUND
Despite the questionable validity of online-based physician review websites (PRWs), negative reviews can adversely affect a provider's practice. Several investigations have explored the effect of extremely negative "one-star" reviews across subspecialties such as adult reconstruction, sports medicine, and orthopaedic traumatology; however, to date, no study has explored one-star reviews in foot and ankle surgery. The goal of this study was to characterize factors that contribute to extremely negative, one-star reviews for foot and ankle surgeons on Vitals.com.
METHODS
A retrospective analysis of negative one-star reviews with corresponding patient complaints for foot and ankle surgeons (both orthopaedic surgeons as well as podiatrists) in the United States. Physicians included were selected within a 10-mile radius of the top ten largest cities in the United States. Data was stratified by patient type (e.g., those receiving surgery and those not undergoing surgical intervention) and binned according to type of patient complaint, as previously described.
RESULTS
Of the 2645 foot and ankle surgeons identified in our initial query, 13.8% of surgeons contained one-star reviews eligible for analysis. Patient complaints related to bedside manner and patient experience are the causative factors accounting for 41.5% of the one-star reviews of foot and ankle surgeons for nonsurgical-related complaints. Surgical complications and other outcomes-related factors comprised roughly 50% of the complaints related to surgical patients.
CONCLUSION
In conclusion, complaints related to bedside manner and patient experience are the causative factors accounting for 41.5% of the one-star reviews of foot and ankle surgeons for nonsurgical-related complaints. Surgical complications and other outcomes-related factors comprised roughly half of the complaints related to surgery. This data serves to inform practicing foot and ankle surgeons as to the influences behind patients leaving extremely negative reviews on PRWs.
LEVEL OF CLINICAL EVIDENCE
IV.
Topics: Adult; Humans; United States; Orthopedics; Ankle; Retrospective Studies; Orthopedic Procedures; Ankle Joint
PubMed: 38195290
DOI: 10.1016/j.fas.2023.12.007 -
BMJ Leader Jan 2024Interprofessional leadership is essential to sustain the National Health Service (NHS) in pressured times, which should include the NHS's third largest clinical...
INTRODUCTION
Interprofessional leadership is essential to sustain the National Health Service (NHS) in pressured times, which should include the NHS's third largest clinical workforce in England: allied health professionals (AHPs) (AHPs as defined by NHS England: Art therapists; Dramatherapists; Music therapists; Dietitians; Occupational therapists; Operating department practitioners; Orthoptists; Osteopaths; Paramedics; Physiotherapists; Podiatrists, Prosthetists and Orthotists; Radiographers; Speech and language therapists). Therefore, a feasibility study was undertaken, to explore the views of AHPs working in early to mid-career positions, regarding the barriers and opportunities they encounter, in both leadership and career development.
METHODS
Twenty-seven participants, representing 8 of the 14 AHP professions across England, were interviewed across 10 focus groups.
RESULTS
Thematic analysis (TA) generated four themes, including the barriers and opportunities for AHP leadership development and career progression. Further TA identified three overarching themes: equitable and interprofessional leadership development; an equitable and structured AHP career pathway; and having AHP leaders at a strategical and/or very senior level. These overarching themes were subsumed under the umbrella category: equity of opportunity and voice. The AHPs, who were interviewed, reported inequitable access to both career and leadership development, compared with other professions, such as nurses, doctors and pharmacists.
DISCUSSION
Further work is needed to ensure that interprofessional representation, within senior leadership levels, includes AHPs; which the data suggests would directly benefit all AHPs' leadership and career development. Recommendations for organisations to facilitate leadership and career development were developed from the TA and at a system-wide level. Further research would be beneficial to gather the views of the six AHP professions not interviewed in this study and from other organisations, such as independent practice. However, this feasibility study does attempt to represent the voices of AHPs, which can be lacking in both organisations and research.
PubMed: 38191238
DOI: 10.1136/leader-2023-000880 -
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 Research in Nursing : JRN Dec 2023Diabetic foot ulcers (DFUs) add a significant burden to the lives of people with diabetes in the United Kingdom. They can have a considerable impact on a patient's daily...
BACKGROUND
Diabetic foot ulcers (DFUs) add a significant burden to the lives of people with diabetes in the United Kingdom. They can have a considerable impact on a patient's daily life, with treatment requiring frequent changes of dressings and clinic attendances. Nurses and other allied health professionals (AHPs) within the community provide most wound care representing the primary cost driver.
AIMS
To collaboratively explore key resource use related to the management of DFUs to develop, and pilot, a participant-reported measure to inform economic evaluations.
METHODS
A literature search and semi-structured interviews determined health and non-health resource use in management of DFUs. A consensus view of the selected items was established in a modified Delphi study and further tested for acceptability and validity in a pilot study.
RESULTS
Primary care consultations with a podiatrist or orthotist, district nurse visits, out-of-hours and emergency care, scans and investigations, and consumables provided in clinics were rated as the most important resource use items.
CONCLUSIONS
This work has informed the development of a measure that captures resource use considered important by the people most affected by DFUs; patients, family members and carers, and the healthcare professionals key to DFU management.
PubMed: 38162721
DOI: 10.1177/17449871231208108 -
Indian Journal of Orthopaedics Jan 2024First tarsometatarsal joint arthrodesis is a common procedure performed by podiatrists and orthopedic surgeons. There remains debate on how useful CT scans are in...
BACKGROUND
First tarsometatarsal joint arthrodesis is a common procedure performed by podiatrists and orthopedic surgeons. There remains debate on how useful CT scans are in assessing fusion status in the post-operative patient. The purpose of our study was to determine the reliability among both orthopedic surgeons and radiologists in reviewing both postoperative radiographs and CT in order to determine if fusion had occurred in patients undergoing 1st tarsometatarsal arthrodesis. A secondary purpose of this study was to determine if CT offered improved inter- and intra-rater reliability when compared to plain radiographs.
METHODS
Patients who underwent 1st tarsometatarsal arthrodesis were retrospectively reviewed and those who underwent CT post-operatively for persistent pain were identified. Orthopedic surgeons and radiologists then analyzed the radiographs and CT of these patients for union with a threshold for union being set at 50% of the joint being fused. Imaging was then re-evaluated by the same provider 6 months later.
RESULTS
24 patients were identified meeting inclusion criteria. Inter-rater reliability and intra-rater reliability for assessment of 1st tarsometatarsal arthrodesis were better with CT compared to radiographs; however, this association was not deemed reliable. Both imaging modalities were not able to assess union status confidently and reliably across reviewers, although CT scan had better intra-rater reliability.
CONCLUSIONS
While CT is frequently used to assess fusion in patients who have underwent 1st tarsometatarsal arthrodesis, it was not found to be better than radiographs. Practitioners should reconsider the use CT as the gold standard when assessing fusion in this population.
PubMed: 38161407
DOI: 10.1007/s43465-023-01033-y -
Methods and Protocols Dec 2023The health of children's lower extremities and feet is a focus area for caregivers and healthcare professionals such as doctors, school nurses, and podiatrists. Our...
BACKGROUND
The health of children's lower extremities and feet is a focus area for caregivers and healthcare professionals such as doctors, school nurses, and podiatrists. Our study aims to investigate the general health status of Danish children's lower extremities and feet to identify anthropometric parameters that might be preconditions for pain and evaluate for foot diseases and whether they are associated with pain intensity and location, three-dimensional foot dimensions and foot pressure mapping, shoe dimensions, types and intensity of sports activity, quality of life, and foot health. The aim is that we will be able to identify parameters pre-dispositioning for pain, thus providing recommendations for sports activities in relation to the anthropometric conditions of a child as a potential preventive measure for pain. This analysis will be stratified by socioeconomic status on a group level, and this perspective will be able to provide preventative recommendations to prevent pain.
METHODS
This study is a cross-sectional examination of a thousand children in the first, fifth, and ninth grades in randomized selected Danish primary schools. We will perform a clinical examination of the lower extremities and feet for misalignments, deformities, and diseases as well as rotational status and range of motion. Moreover, we will evaluate their pain levels, sports activities, three-dimensional foot dimensions, plantar pressure, footwear, and patient-related outcome measures (PROMs) for foot health and quality of life.
RESULTS
We aim to provide an anthropometrical overview of the lower extremities and feet in children. The obtained basic understanding of healthy normal material in children will be analyzed for its relationships with pain level, sports activities, and socioeconomic status on a group level. This could potentially provide us with an understanding of the factors that impact lower extremity and foot diseases in children. In conclusion, examining children's lower extremities and feet in Danish primary schools is a step toward identifying areas of improvement in self-care and shoe fitting, mapping podiatry-related needs of care in children's feet, and providing parental recommendations for preventive actions on shoe fitting and the choice and intensity of sports activity concerning pain.
CONCLUSIONS
The tenet of this study is a long-term follow-up to evaluate the long-term socioeconomic course on a group level, foot status, and sports activity, using patient-related outcome measures evaluating quality of life and other lifestyle factors such as emotional functioning, social functioning and interaction, and school functioning. Potentially, this will improve children's quality of life and prevent future diseases.
PubMed: 38133135
DOI: 10.3390/mps6060115 -
Health Education & Behavior : the... Apr 2024Diabetic foot ulcers (DFUs) impact a substantial proportion of patients with diabetes, with high recurrence rates, severe complications, and significant financial burden...
Diabetic foot ulcers (DFUs) impact a substantial proportion of patients with diabetes, with high recurrence rates, severe complications, and significant financial burden to health care systems. Adherence to treatment advice (e.g., limiting weight-bearing activity) is low with patients reporting dissatisfaction with the way in which advice is communicated. This study aimed to address this problem via the systematic development of a motivation communication training program. The program was designed to support diabetes-specialist podiatrists in empowering patients to actively engage with treatment. The development process followed an intervention mapping approach. Needs assessment involved observations of 24 patient-practitioner consultations within a diabetes-specialist foot clinic. This informed specification of a theory of change (self-determination theory) and relevant evidence-based communication strategies (drawing from motivational interviewing). The training program was developed iteratively with changes made following feedback from five diabetic foot health care professionals. The resulting training program, consisting of six one-hour face-to-face sessions over an 8-week period, was delivered to a further six diabetes specialist podiatrists, with five participating in postprogram telephone interviews to assess acceptability. Deductive thematic analysis of interview data revealed positive aspects of the training (e.g., valuable and relevant content), ideas for improvement (e.g., online resources and context-specific video examples), the acceptability of motivation strategies, and challenges putting the strategies into practice (such as time constraints and breaking old communication habits). This study contributes to our understanding of integrating motivation principles into routine consultations and holds potential for enhancing adherence to treatment recommendations in patients living with diabetic foot ulcers.
Topics: Humans; Diabetic Foot; Motivation; Health Personnel; Communication; Diabetes Mellitus
PubMed: 38097512
DOI: 10.1177/10901981231216744