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Bacon, Dawn. "Podiatry and diabetes : an exploration in specialism". Thesis, University of Southampton, 2011. https://eprints.soton.ac.uk/340444/.
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Within healthcare, the concept of specialisation remains both poorly defined and under-debated in the literature. This research analyses the concept of specialisation and assesses the maturity of the concept of the diabetes specialist podiatrist; tracing the origins, change over time and current status of podiatric specialisation in diabetes. Literature pertaining to the legal implications of specialist practice, settings and titles is reviewed and a definition of specialisation within the context of healthcare is proposed. The initial concept analysis led to refinement of research questions which directed further enquiry. Because answers to the research questions lie within the knowledge and experiences of key actors, managers and individual podiatrists who have held specific posts; a qualitative methodology featuring focus group and key actor interviews was utilised. The meaning of podiatric specialisation in diabetes, how diabetes evolved as a podiatric specialty, the impact of specialist titles and the longer-term, wider implications which accompany specialisation were explored. In presenting analysis of the data, the researcher focuses on theory which illuminates the findings. The centrality of Weber’s concept of charismatic authority to the development and contemporary face of specialist practice is illustrated by the data; thus it represents a guiding theoretical concept within the author’s thesis. Documentary analysis was used as a triangulation strategy, in a bid to corroborate findings elicited through interview techniques. The documentary data also illustrates both the scale of and the context within which podiatric specialisation in diabetes evolved – not in isolation, but rather as one of many specialist foci.
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Ashraff, Suhel. "Development and validation of a prognostic model for stump healing in major lower limb amputation". Thesis, Queen Margaret University, 2016. https://eresearch.qmu.ac.uk/handle/20.500.12289/7433.
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Introduction: Stump healing is essential in patients with a lower limb amputation in order for them to mobilize again. Little research has been being done on factors affecting stump healing. The aim of this paper is to explore the effect of haematological makers as well as patient characteristics on stump healing after patients have undergone an amputation procedure. In addition, a practical model regarding factors that affect stump healing was developed. Methods: Patients who underwent a major lower limb amputation (above knee and below knee) at the Royal Infirmary of Edinburgh from the period of 2006 to 2009 were included in this study. A prognostic model utilizing backward stepwise logistical regression was developed to measure the probability of lower limb stump healing. The relationship between the dependent and independent variables was identified using univariate and multivariate logistic regression. Hosmer and Lemeshow goodness of fit test and Receiver Operating Curve (ROC) was used in order to measure the effectiveness of the model. The model was validated with the prospective data of 100 patients that had undergone major lower limb amputation from the year 2010 and 2011 in Royal Infirmary of Edinburgh prospectively. Results: In this study healing of the stump as defined was achieved in sixty three percent (63%) of patients. Univariate analysis found seven variables to be associated with lower limb stump healing (type of amputation, gender, hypertension, smoking, serum sodium, serum creatinine and serum High Density Lipid cholesterol (HDL)). A further four variables (age, diabetes xxv mellitus, white cell count and Prothrombin Time) were added to the model secondary to their strong clinical association with the stump healing. Three variables, namely serum sodium, serum creatinine and serum High Density Lipid cholesterol were identified which influenced stump healing. Patients with normal serum sodium were 75% more likely to have lower limb stump healing compared to that of patients with abnormal serum sodium (odds ratio [OR] 1.756; 95% confidence interval [CI] 1.048-2.942). Patients with normal serum creatinine were 66% more likely to have their stump healed (OR 1.664; 95% CI 0.94 to 2.946). The healing rate of patients with a normal level of serum High Density Lipid cholesterol was 75%, in contrast to patients with an aberrant level of serum High Density Lipids cholesterol (OR 1.753; 95% CI 1.061 to 2.895). The effectiveness of the retrospective stump-healing model was demonstrated by the area under the Receiver Operator Curve (0.612), which was supported by the Hosmer and Lemeshow goodness-of-fit test (p=0.879). In the prospective study, the model’s discriminatory power was verified by the area under the Receiver Operator Curve (0.584) and Hosmer and Lemeshow goodness-of-fit test (p > 0.05). Conclusion: Serum sodium, serum High Density Lipid cholesterol and serum creatinine have a strong correlation with lower limb stump healing. However, serum sodium and serum High Density Lipid cholesterol secondary to multiple co-morbidities in this cohort group could be altered secondary to disease pathology itself. Further clinical research is necessary to evaluate the association of the risk factors with lower limb stump healing.
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Whiting, Michael Francis. "Learning in clinical contexts : clinical education in podiatry". Thesis, University of Sussex, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.262305.
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McLarnon, Nichola Adele. "The ocular risks of human nail dust in podiatry". Thesis, Glasgow Caledonian University, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.322279.
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Barrett, Paul. "Podiatric biomechanics and foot orthoses : a background study and investigation into current UK practice, and functional effect in normal subjects and subjects with patellofemoral pain". Thesis, University of Ulster, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.272200.
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Vernon, Denis Wesley. "The functional analysis of shoe wear patterns : theory and application". Thesis, Sheffield Hallam University, 2000. http://shura.shu.ac.uk/3106/.
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Shoe wear patterns have potential value in clinical diagnosis and forensic identification, although they lack rigorous study. Podiatrists have claimed understanding of shoe wear patterns, associating foot pathologies with characteristic patterns and implying a "onecondition, one wear pattern" hypothesis. This project was commenced to understand and clarify this relationship. Round one of an initial Delphi exercise to seek agreements over such wear pattern associations however indicated that, many different patterns could be associated with single named foot pathologies with round three agreements appearing to relate to the most common pattern associations. Analysis of the patterns in the Delphi exercise produced an instrument to describe and compare shoe wear patterns using focal points - points from which areas of shoe wear would spread. A following survey questionnaire suggested that podiatrists were most familiar with wear patterns associated with four foot pathologies - pronation, hallux rigidus, pes cavus and rearfoot varus. Patterns associated with these pathologies were collected from U. K. podiatrists in a single round questionnaire. Inductive analysis of these patterns from a hermeneutic phenomenological perspective using the focal point concept suggested that if the pathological context is known, wear patterns could be classified on the basis of causative function. A theoretical model was proposed of factors important in wear pattern production, suggesting that primary walking intention (the intended walking function of the foot) was more influential than foot pathologies in wear pattern formation and that "external" factors could also influence shoe wear. Validation and grounding of the focal point concept and model of shoe wear influence was planned, involving paired podiatry observers, to determine whether focal points could clarify, differentiate and show similarities between shoe wear patterns in reality and whether the model of wear influence was justified. To reduce the potential for observer error, two prior exercises were undertaken. A Delphi exercise focused participants on the required task and produced statements for the recognition of variables, which may influence shoe wear patterns. Inter-observer reliability tests demonstrated that clinical observation agreement levels were acceptable for the validation. In the validation, three subjects exhibiting pathologies, including hallux rigidus, and their owned footwear (22 items) were studied. The presence, level and effect of variables potentially influencing the wear patterns present, were determined by paired observations of foot pathologies, shoe fit and function, video analysis of foot function and subject interview for the footwear history. The focal point concept showed similarities and differences between shoe wear patterns, although wear pattern clarity limitations occurred. Within the pathological context the patterns predicted the related functions. The model of wear influence was supported with external influences needing to be major to override primary walking intention and foot pathology effects. A method to describe and compare shoe wear patterns and a model to explain the link between function and wear, showing the relationship of factors important in wear pattern production have been produced. This model provides an alternative perspective on foot function to that of biomechanical theory and could represent the basis of a new taxonomy for podiatry. This greater understanding of shoe wear patterns should improve their potential value in forensic identification and in clinical diagnosis.
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Santos, Derek. "The development of a system to measure the effects of plantar foot pressure on the microcirculation of the foot". Thesis, Queen Margaret University, 2006. https://eresearch.qmu.ac.uk/handle/20.500.12289/7428.
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An investigation into the effects of plantar foot pressure on the microcirculation of healthy subjects and patients with Rheumatoid Arthritis was carried out. In the light of no equipment available to carry out this study a new system was developed. A shoe device was built with a combined pressure/skin blood flow transducer embedded in a three-tier piston mechanism in the heel so that plantar foot pressure could be applied/removed and quantified. The skin blood flow transducer made contact with the skin and was able to collect data about the microcirculatory state of the skin. The first system developed consisted of the laser Doppler Fluxmeter (Moor Instruments Ltd., UK) used to collect skin blood flow information and incorporating a strain gauge (Kyowa Electronic Instruments Co. Ltd., Japan) to quantify plantar foot pressure applied to the centre of the heel. This system was visually/sound synchronised and due to the time delay error it was modified. For the final system developed, the strain gauge was replaced with a custom-made Novel capacitative transducer (Novel, Germany) to quantify pressure. This allowed for the pressure system to be electronically synchronised in real time with the laser Doppler fluxmeter using an electronic synchronisation box. A number of studies were carried out to validate the systems. The developed systems were used to: (a) investigate the effects of the venoarteriolar response in healthy subjects with regards to the effects of plantar foot pressure on skin blood flow. The study concluded that subject positioning (that is, supine or semi-weight bearing) has an effect on how the microcirculation of the skin reacts to applied pressure. Thus, studies investigating the effects of external pressure on skin blood flow must have their subjects in a position that is related to what is being studies; (b) investigate the effects of plantar foot pressure on skin blood flow in patients with Rheumatoid Arthritis. A healthy control group was compared with a cohort of patients with Rheumatoid Arthritis with no evidence of vasculitis. The study concluded that there were no significant differences between both groups. A number of articles have been published from this thesis (see Appendix 14).
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Cameron, Victoria. "A study to investigate any potential effects on the foot of a commonly prescribed off-the-shelf foot orthosis in patients with early diagnosed rheumatoid arthritis (RA)". Thesis, Queen Margaret University, 2010. https://eresearch.qmu.ac.uk/handle/20.500.12289/7434.
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Rheumatoid Arthritis (RA) frequently affects the foot. Custom moulded foot orthoses are effective in the management of the foot in RA; however the process of manufacture is lengthy, resulting in a delay of treatment for the patient. Offthe- shelf foot orthoses can be dispensed at the chairside on the day of diagnosis, so the patient receives treatment immediately. This is particularly crucial in RA, as early intervention is thought to improve patient outcomes in the long term. Anecdotal evidence suggests that Podiatrists do prescribe off-the-shelf foot orthoses for the management of the foot in RA; however no clinical studies exist to support this practice. The aim of this study was to investigate any potential effects on the foot of one commonly prescribed off-the-shelf foot orthosis, in patients with early RA. The type of off-the-shelf foot orthosis used was the Slimflex™ Plastic which has been shown to be a commonly used off-the-shelf foot orthosis by Podiatrists in the management of patients with RA in Scotland (Cameron et al. 2009). A total of 35 patients diagnosed with RA, with a mean age of 52.4 years (SD 13.3 years) and median disease duration of 0.5 years (IQR 1.8 years) were included. Local ethical approval was obtained. The study used a repeated measures design, with data collected at baseline, three months, and six months when patients were barefoot, shod, and with foot orthoses, to investigate any effects over time and between conditions. The primary objective was to investigate any potential effects of the Slimflex™ Plastic off-the-shelf foot orthosis on foot health related quality of life (QOL) using the Leeds Foot Impact Scale (LFIS) and foot pain using the Visual Analogue Scale (VAS). Plantar foot pressure measurement, walking speed, foot stability during walking and foot kinematics were then investigated to provide a rationale as to why foot health related QOL and foot pain may be affected with the foot orthosis. Data was analysed using SPSS version 16.0. Due to the known potential effects of medication, data was analysed for the total patient group (n=35) and subanalyses were then carried out on the group of patients who presented with stable medication throughout the study (n=12). This enabled any changes to be attributed to the foot orthosis alone and not because of any effects of medication. The LFIS and VAS for foot pain were significantly lower with the use of the foot orthosis over six months (p<0.05). Peak plantar pressure at the forefoot increased between barefoot and shod, and barefoot and foot orthosis (p<0.05), but decreased between shod and foot orthosis (p<0.05). Pressure time integral at the forefoot reduced with the foot orthosis (p<0.05). There was an increase in contact area at the midfoot and in hallux and lesser toe contact area, with the orthosis (p<0.05). Walking speed also increased over the six months (p<0.05). Preliminary findings indicated that the orthosis may affect foot stability during walking, and a case study implied that the foot orthosis positively affects foot kinematics. This study suggests that the Slimflex™ Plastic off-the-shelf foot orthosis is effective in the management of the foot in early RA, according to the measured variables in this study.
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Coda, Andrea. "A single blinded randomised controlled trial, to investigate the clinical effectiveness of pre-formed semi-rigid foot orthoses, on pain, quality of life and the dynamics of gait of patients diagnosed with juvenile idiopathic arthritis (JIA)". Thesis, Queen Margaret University, 2013. https://eresearch.qmu.ac.uk/handle/20.500.12289/7429.
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Introduction - Currently there is limited evidence supporting podiatric treatment of children with JIA. The foot orthoses (FOs) prescribed to JIA children so far appeared to be very expensive and required long time to manufacture before the fitting. This randomised controlled trial (RCT) aimed to determine whether pre-formed FOs that can be prescribed at chair side, impacted on pain, quality of life (primary outcomes) and/or gait-parameters (secondary outcomes) in children affected by JIA. Methods - The study took place at the Gait Analysis laboratory at Queen Margaret University – Edinburgh and at the TORT Centre, Ninewells Hospital-Dundee. Children with JIA were diagnosed according to the ILAR criteria. Intervention was blinded to the patients. The trial group received Slimflex-plus FOs, with the addition of chair side corrections and the control FOs supplied were made with leather board (1mm thick) only. Both FOs had the same black EVA top cover. Primary outcomes were investigated using validated questionnaires (VAS, CHAQ and PedsQL). Tekscan™ equipment (F-Scan™ and HR Walkway®) measured secondary outcomes in-shoe pressure and force data with and without FOs intervention. Multiple foot strikes and repetitive gait patterns were compared pre and post-treatment. Primary and secondary outcome measures were recorded at baseline, 3rd and 6th month’s period. Results - Sixty children were recruited; 48.3% (n=29) control and 51.7% (n=31) active treatment group. Within the control group 20.7% (n=6) of patients were male. Within the active treatment group, 29% (n=9) subjects were male. Age ranged between 5 to 18 years, median age for the control group was 11 (range=12.90) and for the trial group were 11.50 (range=12.11). In order to attribute any effect solely on the FOs intervention, details of changes of medication and/or new joint injections were recorded during the trial. In the control group 65.5% (n=19) were considered to be prescribed with stable medications. Similarly, amongst children receiving active treatment 74.2% (n=23) were deemed to be taking stable medications. Overall, 99.4% (n=179/180) appointments were completed, only one subject did not attend the 6 month session. Significant improvement was identified in the primary outcomes favouring active treatment with regards to pain and quality of life measures: VAS (p<0.05); CHAQ (p<0.05); PedsQL paediatric-generic (p<0.05) Peds paediatric rheumatology (p<0.05); PedsQL parent-generic (p<0.05); PedsQL parent-rheumatology (p<0.05). In all these quality of life tools where p<0.05, clinical significance was also obtained. Significant differences were also identified between the groups for gait time, stance time, total plantar surface, heel contact, midfoot, 5th metatarsal head and distal phalanx. Discussion - The results strongly suggest that FOs are effective in improving pain, quality of life and most gait parameters in JIA children. FOs can be customised at chair-side so JIA children can receive immediate podiatric benefit from the same day of the biomechanical assessment. Compliancy rate proved to be extremely high confirming that the podiatric treatment is well accepted by JIA children. Conclusion - Primary and secondary outcome’s results, strongly support the use of FOs in the treatment of JIA children, which highlights the important role of the podiatrists within the multidisciplinary team in paediatric rheumatology.
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Redmond, Colin. "Red flag screening for serious pathology presenting in cervical spine musculoskeletal disorders". Thesis, Queen Margaret University, 2013. https://eresearch.qmu.ac.uk/handle/20.500.12289/7721.
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Aim To develop a list of red flag clinical indicators for possible serious pathology masquerading as, or presenting alongside, neck related musculoskeletal disorders in the adult population. Background Musculoskeletal physiotherapists provide assessment and treatment for pain and functional impairments relating to musculoskeletal disorders, such as back and neck pain. In order to apply safe and effective treatment to these conditions it is vitally important that any underlying serious complaints have been excluded. Clinical indicators known as ‘red flags’ have been developed for diagnostic triage in back pain to help identify serious underlying conditions, such as cancer and infection. Red flags for serious pathology in neck pain or neck related pathology has not received the same level of attention as red flags in back pain. A literature review identified inconsistent evidence for clinical tests and clinical indicators for serious pathology in neck related musculoskeletal disorders. This presents a serious clinical challenge for musculoskeletal physiotherapists. Method A mixed method study design was developed involving: a) Qualitative descriptive method through Physiotherapy focus group; and, b) Three round Delphi survey method involving consultant neurologists and consultant neurosurgeons. The Delphi method involves combined qualitative and quantitative data phases. Thematic content analysis was used to analyse the qualitative data. A combined descriptive and inferential (non-parametric) statistical analysis was used to analyse the quantitative data. Kendall’s W (Kendall’s coefficient of concordance) was used to evaluate the level of consensus across all participants for the quantitative phase of the Delphi method. Findings A list of neck related red flag clinical indicators within five specific categories were developed: 1. progressive pain; 2. cancer, infection, trauma; 3. neurological deficit (spinal cord compromise); 4. headache (associated with neck pain/stiffness); 5. brainstem, cervical arterial and cranial nerve dysfunctions. An increase in Kendall’s W was demonstrated between Rounds 2 and 3 in four out of five categories, indicating an increase in consensus levels between participants. This process highlights the complexity of interpreting clinical features within musculoskeletal presentations.
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Sugavanam, Thava Priya. "Person-centred goal setting for exercise after stroke". Thesis, Queen Margaret University, 2014. https://eresearch.qmu.ac.uk/handle/20.500.12289/7431.
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Clinical guidelines and policies recommend exercise after stroke. Person-centred goal setting may facilitate the uptake and maintenance of physical activity. The aim of this work was to design and evaluate a goal setting intervention in an exercise after stroke setting. Five interlinked studies were undertaken within the development and feasibility stages of the MRC framework of complex interventions. A systematic review examined 17 observational studies (11 quantitative, six qualitative) for the effects and experiences of goal setting in stroke rehabilitation (study one). Despite some positive effects, no firm conclusion could be reached regarding its effectiveness. Patients and professionals differed in their experiences. Barriers to goal setting outnumbered facilitators. The lack of a standardised goal setting method in stroke rehabilitation was highlighted. A goal setting intervention tailored to exercise after stroke was developed in study two, based on: findings from study one, Bandura’s Social Cognitive Theory and the Canadian Occupational Performance Measure. The intervention components were: dedicated time, patient education, patient involvement, regular follow-up, and a purpose-designed workbook. This intervention was piloted in study three alongside validation of the activPAL™ activity monitor with 12 stroke survivors. The intervention did not require modification. Only two variables of the activPAL™ (time spent in sitting and upright) had acceptable validity and reliability. Feasibility of the intervention and users’ experiences were investigated in study four with four stroke survivors, using mixed methods case studies. Intervention delivery and compliance were acceptable with no adverse effects. Findings regarding acceptability and content suggested a need for further work. Participants’ interest and engagement in goal setting were influenced by their familiarity with goal setting, interest in physical activity, functional ability and levels of self-efficacy, highlighting the individualisation required within goal setting. Experiences of exercise professionals involved in exercise after stroke regarding goal setting were explored in study five through three focus groups (n=6; n=6; n=3). Although goal setting was viewed positively, participants felt that its potential effectiveness was not always translated into practice due to barriers encountered: clients’ readiness to change, professionals’ lack of knowledge about stroke and a number of organisational factors. Suggestions to improve goal setting in practice were discussed. This work has enhanced our understanding of goal setting as a complex intervention. Recognition of the potential benefits of goal setting by both service users and providers, amidst the challenges, argues in favour of goal setting in the exercise after stroke setting. Areas for further research have been discussed.
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Siddiqui, Muhammad A. "Development of a prognostic model for fistula maturation in patients with advanced renal failure". Thesis, Queen Margaret University, 2014. https://eresearch.qmu.ac.uk/handle/20.500.12289/7432.
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Introduction: A suitable type of vascular access has to be created to establish a connection between the circulation system of the patient and the haemodialysis cycle. The arteriovenous fistula (AVF) is considered to provide the best long-term functional vascular access, with reduced risk of thrombosis or infection and cost-effective. However, significant numbers of AVF, which fail to develop sufficiently for dialysis, are 28-53% of cases. This study aimed to explore the potential influence of blood markers and factors on the maturation of AVF, in patients who have undergone vascular access surgery and to develop and validate a prognostic model to determine the success of AVF maturation. Methods: Data from 300 patients was retrieved who had undergone AVF surgery between the years 2006 and 2009, from the Royal Infirmary of Edinburgh. A prognostic model was developed for the prediction of maturation of AVF using backward stepwise logistical regression. This data was analysed using univariable, multivariable logistic regression. Model performance was assessed, using the receiver operating characteristics (ROC) curve and Hosmer and Lemeshow goodness of fit test. A prognostic model was validated with the prospective data of 100 patients who had undergone AVF surgery between the years 2009 and 2011, from the Royal Infirmary of Edinburgh. Results: Three variables were identified, which independently influenced fistula maturation. Males were twice as likely to undergo fistula maturation, compared to that of females (odds ratio (OR) 0.514; 95% confidence interval (CI) 0.308 to 0.857). Patients with no evidence of Peripheral Vascular Disease (PVD) were three times more likely to mature their fistula (OR 3.140; 95% CI 1.596 to 6.177). A pre-operative vein diameter greater than 2.5mm resulted in a fivefold increase in fistula maturation compared to a vein size less than 2.5mm (OR 4.532; 95% CI 2.063 to 9.958). The model for fistula maturation had good discrimination as indicated by area under the ROC curve 0.677 and calibration as indicated by Hosmer and Lemeshow test (p = 0.79). The model discriminatory power was confirmed in the prospective study (validation data set) with area under the receiver operating curve was 0.59 and calibration indicated by Hosmer and Lemeshow test (p > 0.05). Conclusion: Successful vascular access provision is the foundation on which successful haemodialysis is built. This study has found that female gender, history of PVD and vein diameter less than 2.5 mm are the negative significant independent clinical predictors of maturation of arteriovenous fistula.
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Janahi, Noor. "The role of pro-inflammatoy cytokines and autoimmune antibodies in diabetic peripheral neuropathy". Thesis, Queen Margaret University, 2014. https://eresearch.qmu.ac.uk/handle/20.500.12289/7430.
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Introduction – The pathogenetic vision of diabetes mellitus has changed in the last few years, with inflammatory and autoimmunity pathways playing roles in the development and progression of diabetic complications. This study was conducted to investigate whether inflammation and/or autoimmunity are associated with the pathogenesis of human diabetic peripheral neuropathy. Methods – A cross-sectional analysis was initially conducted to explore the population of patients with diabetes mellitus in the Kingdom of Bahrain. The demographics of patients diagnosed with diabetes mellitus in the Royal Medical Services-Bahrain Defence Force Hospital were randomly collected from 500 record cards. Case-control analysis included three groups: 30 patients with diabetic peripheral neuropathy, 30 patients with diabetes mellitus without neuropathy, and 30 healthy controls. Blood analysis was conducted to compare the levels of pro-inflammatory markers and autoimmune markers between the three groups. Secondary analysis investigated the correlations between the level of markers and sample demographics and neurological manifestations. Due to the limited time and financial resources available, this research was considered as a pilot/exploratory study encouraging further investigations to take place in the near future. Results – From the 500 sample initially selected, 48% were male (n=242) and 52% (n= 258) were female. The mean age was 55 ± 14 years and the mean BMI was 35 ± 9 kg/m². Type I DM was present in 8% (n=38) only as opposed to 92% (n=462) who had type II DM. From the sample randomly selected, 76% of the patients had other medical complications, the commonest being peripheral neuropathy; 26% (n=186) followed by vascular insufficiency; 20% (n=141). Case control analysis demonstrated very highly significant differences between the three groups in the levels of IL-6, IL-8 and IL-1β (p<0.001), highly significant differences in the levels of TNF-α, IFN-ɤ (p<0.01), and a significant difference in the levels of CRP (p<0.05). Highly significant differences between the percentages of positive and negative autoimmune antibodies (ANA) between the three groups were observed. The odds of positive values of ANAs in the neuropathy group were 50 times higher when compared to control groups. Secondary analysis detected a number of significant relationships between the levels of pro-inflammatory markers and sample demographics. Highly significant correlations were found to be associated with neurological characteristics in the neuropathy group at the levels of CRP, IL-8, and IL-1β. Conclusion – The present study demonstrated that human peripheral diabetic neuropathy is associated with increased biochemical markers of inflammation and autoimmunity. Furthermore, painful neuropathy may be associated with further increase in inflammation. These results indicate that inflammation and autoimmunity may be important contributors in the development of peripheral neuropathy in diabetes mellitus. The new pathogenic factors may lead to the consideration of new management plans involving new therapeutic approaches and disease markers.
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Seenan, Christopher. "Laboratory and clinical investigation into lower limb ischaemic pain, and the effect of transcutaneous electrical nerve stimulation (Tens) on measures of pain and walking performance". Thesis, Queen Margaret University, 2013. https://eresearch.qmu.ac.uk/handle/20.500.12289/7417.
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Aims: The aims of this programme of research are to investigate the subjective description of ischaemic pain and to investigate the effects of TENS on lower limb ischaemic pain and walking performance in patients with Intermittent Claudication (IC). Methods: Four studies were conducted: two in the laboratory and two clinical trials. Laboratory- The first study investigated the reliability of a method of inducing lower limb ischaemic pain in healthy volunteers, the modified Submaximal Effort Tourniquet Test (mSETT). The second investigated the effects of High Frequency TENS (HF-TENS) and Placebo TENS (P-TENS) on lower limb ischaemic pain induced using the mSETT in healthy volunteers. Clinical- The first clinical study investigated the effects of HF-TENS and Low Frequency TENS (LF-TENS) on measures of pain and treadmill walking performance in patients with Peripheral Arterial Disease (PAD) and IC. The second examined patients’ experiences of using TENS at home for PAD and IC. Results: The mSETT was found to have good test-retest reliability and induce pain similar in quality to that experienced by patients with IC. The pain experience induced with the mSETT was reduced by both HF- and P-TENS compared to baseline. HF-TENS however was more effective compared to P-TENS in this regard, prolonging time to pain threshold and tolerance whilst reducing the levels of pain reported throughout. In patients with PAD and IC, HF and LF-TENS interventions were found to increase maximum walking distance on a treadmill compared to P-TENS. HF-TENS was also found to increase pain-free walking distance. The experience of using TENS in daily life was characterised by feelings of both benefit and disappointment. This was interpreted through the following themes: (i) ‘masking, but not taking the pain away’ and (ii) ‘walking further, but not far enough’. Conclusions: The mSETT is a reliable method of inducing lower limb, ischaemic pain in healthy volunteers and could be useful for the purposes of pre-clinical analgesic trials and investigation of the ischaemic pain experience. HF-TENS was found to reduce mSETT pain indicating hypoalgesic effects of TENS in experimentally induced, lower limb ischaemic pain. HF and LF-TENS have potential as interventions that increase walking performance for patients with IC. If using TENS at home for IC, expectations of treatment effect need to be managed to avoid disappointment and feelings of frustration.
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O'Halloran, Catherine. "Student learning in clinical education : a case study in podiatry". Thesis, University of Newcastle Upon Tyne, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.299666.
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Abey, Sally. "Exploring practice-based education in podiatry : an action research project". Thesis, University of Plymouth, 2014. http://hdl.handle.net/10026.1/3200.
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Background: Government policy has placed greater emphasis upon health professional students gaining practical experience in real-world environments. Given the fairly new inception of the role of clinical educator in podiatry there is a paucity of research in the area of practice placement in podiatry. Research aims: Within an action research framework, the first phase focused upon exploring the capacity of clinical educators to engage with the role of mentoring, alongside the factors that might impact upon that capacity. The second phase of the project investigated the impact of a teaching tool within the placement area when utilised by clinical educators and students. Methods: The pilot study utilised established questionnaire development methods to create a survey and scale to measure clinical educators’ capacity to engage with the role. The second phase of the project used a range of qualitative data collection methods analysed using framework analysis to analyse the utility of the teaching and learning tool. Findings: Phase I resulted in a 70-item scale measuring the capacity of clinical educators to engage with the role of clinical educator and the identification of four independent variables predictive of a significant proportion of the variability of the dependent variable, capacity to engage with clinical education. Phase II confirmed the utility of the teaching and learning tool to support clinical educators and students during the placement period. An inductive placement model, explanatory of the super-complexity of the environment where the clinical educator endeavours to monitor, modify and manage the placement scope, was developed. Conclusions: In an area where research is currently scant, this study contributed to practice-based education in podiatry and to current understanding of how clinical educators undertake this complex and responsible role. This is an important area for research given the influence clinical educators have to shape and guide the next generation of podiatry professionals.
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Concannon, Michael. "An exploration of how ethics informs physiotherapy and podiatry practice". Thesis, University of Huddersfield, 2016. http://eprints.hud.ac.uk/id/eprint/30242/.
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Introduction: Moral complexities exist in every day health care practice creating conflicting responsibilities in providing care. Health care ethics (HCE) enable an applied practical linkage of theory and practice to create professional behaviour that focuses on service user benefit. This thesis explored how physiotherapists and podiatrists embodied health care ethics in their practice. Methods: Interpretative Phenomenological Analysis (IPA) as a hermeneutical approach was utilised in order to explore how HCE informs physiotherapy and podiatry practice. Whilst always involving interpretation, this method has the ability to describe the human experience as it is lived. Using a framework embedded in hermeneutic IPA facilitated an inquiry that promotes the participant’s own reflections of experiential practice (phenomenology) and then interpreting them (hermeneutical) in the relevant and wider context. Purposively sampled individual interviews were carried out (n=21) in an attempt to interpret the participants’ lifeworld of embodied HCE. The preliminary findings were taken to one purposively sampled group interview for discussion which contributed to further interpretation. Findings: Five themes emerged from the data. The themes indicated that there is a desire by participants to extol ethical practice, but acknowledged various limitations in the reality of achieving this. The place of empathy has a key role in HCE for clinical reasoning and decision making which may prevent HCPs from passively following performance guidelines and checklists. If empathy and virtue ethics can be taught and utilised by HCPs then guidelines may be considered for individual implementation as an outcome, rather than a prerequisite, of ethical decision making. Conclusion: Ethical decision making may be enhanced by reconsidering the education of character virtues including empathy. Empathy is a basic condition and source of morality. As a central component of phronesis, empathy may enable understanding of a service user’s needs and increase motivation for HCPs to act in a caring way, thus making the service user the bearer of an ethical interaction.
18
Daw, Julia. "Mechanically induced plantar hyperkeratosis". Thesis, University of Brighton, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.260938.
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Beeson, Paul. "An evidence-based classification framework for Hallux Rigidus". Thesis, University of Northampton, 2009. http://nectar.northampton.ac.uk/3577/.
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Hallux rigidus (HR) is the second most common pathology affecting the first metatarsophalangeal joint and a primary cause of morbidity and disability. Classification of this condition helps to inform management. Over the years a number of formal HR classification systems have been devised but despite this collective experience there is no consensus on classification design, construction, application or parameters’ validity. The aim of this research was to develop an evidence-based classification framework for HR and establish its validation and reproducibility. This was achieved through four studies. An initial study of 110 patients was used to determine the clinical parameters of HR. In addition to other pertinent findings this showed a positive relationship between second toe length and first metatarsophalangeal joint pain (P<0.001). Correlations were found between first metatarsophalangeal joint pain and pes planus (r=0.84, P=0.05) and between reduced first metatarsophalangeal joint range of motion and hallux abductus interphalangeus (r=0.92, P=0.05). A second study examined the radiological parameters of HR (in the same population). Amongst other relevant findings comparison of joint space narrowing with either hallux abductus interphalangeus (P<0.005) or osteophyte severity (P<0.002) was established. Intra and inter-rater reliability studies were undertaken for all parameters. Overall, inter-rater reliability was poor. Only 28% of angular inter-rater measurements fell within a 5° range. A fourth study was used to determine ‘expert’ opinion on HR classification using semi-structured interviews. The results revealed the need for consensus agreement among clinicians and patient involvement in creation and substantiation of classification content. This research has provided a new understanding of HR classification and informed the development of a HR classification framework based on history, clinical and radiological domains. The established framework provides more than just a measure of severity and includes other dimensions such as contributory factors and functionality. Depending on its context, other applications include use as a diagnostic tool, establishing HR prevalence, monitoring progress, and surgical decision making. An algorithmic approach can enable the classification framework to be applied in different contexts proving clinical relevance and meaning to a range of professions. This research also highlights that classification parameters should be validated, reliable, sensitive, quantifiable and few in numbers and that there is a requirement to provide a ‘gold standard’ against which future HR research can be compared.
20
Davies, Christopher Stuart. "Augmenting competence : an investigation of criteria which may enhance podiatry education". Thesis, University of Huddersfield, 2004. http://eprints.hud.ac.uk/id/eprint/7765/.
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In 2001, the Quality Assurance Agency (QAA), in consultation with the professional body for Podiatry in the U. K., the Society of Chiropodists and Podiatrists (SoCAP), issued a list of benchmark statements that could be expected of new graduate podiatrists. This provided a list of threshold competences expected of students prior to achieving independent practitioner status. These statements are essentially outcomes based judgements based on the students' performance. Evidence within the literature searches suggests that the achievement of competences alone is not enough on which to base such quality judgements and it would follow that the measurement of the quality of podiatry education is therefore incomplete. This study sought to identify a complementary set of statements to supplement the QAA benchmark statement in the education of podiatrists. The pathway leaders of the schools of podiatry from the U. K., Australia, South Africa and New Zealand were asked to cooperate in the formation of a set of criteria that they felt could be considered as being appropriate. This included the subject areas taken from the literature originating in medical education, namely the staff, the resources, the students themselves and the pathway as a whole, each considered as key considerations. The outcome of these discussions served to form a more inclusive set of criteria that may be included to complete the quality circle of standards of podiatry education and hopefully these will be debated further at a later stage for consideration in tandem with the existing competence statements. The study employed an action research methodology and the data was collected in cycles from the participants. Initially a request was made to the professional body for details of any existing guidelines regarding such statements. This was followed using questionnaires, then semi-structured interviews involving the pathway leaders. A list of 32 criteria was distilled from the two rounds of data collection. These were subjected to Likert scale attitude measures, to create the final list of 28 criteria that were agreed by all participants to influence the education of podiatrists. These criteria were sent to the professional body for further debate, to make them aware of a potential weakness in the measurement of the quality of education for podiatrists. It is hoped that further discussions will include all or some of these findings to supplement the existing benchmark initiatives. It may or may not be considered to be appropriate at a later stage to widen the debate to include other groups such as the NHS managers (as employers) and the students (as consumers). The initial feedback from the Director Of Education of SoCAP, the professional body in the UK was positive, in that the potential value of such data was recognised. The response interpreted that the data satisfied the need for the collection of qualitative information, which could be used to balance and support the quantitative data, on which the QAA and professional body had determined the outcome- based benchmark statements.
21
Graham, Margaret L. "The origins and development of podiatry in Britain, 1969 to 1996". Thesis, University of Essex, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.434399.
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Borthwick, A. M. "A study of the professionalisation strategies of British podiatry, 1960-1997". Thesis, University of Salford, 1997. http://usir.salford.ac.uk/26586/.
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This study examines the professionalisation strategies of British podiatry between 1960 and 1997, following the introduction of state registration as a pre-requisite for NHS employment. It is primarily concerned with relations within podiatry and between podiatry, medicine and the state. Analyses of these relationships are mainly informed by the Weberian concepts of social closure, professional dominance and autonomy. The major changes, opportunities and challenges to professional development in podiatry in the post-registration era are mapped in thematic and chronological sequence. Qualitative methods of data collection and analysis have been used to provide detail and depth in presenting a picture of the issues under investigation. Data was primarily collected from 27 key informant interviews supported with documentary evidence from both published material in the public domain and unpublished material in private possession. These consisted of documents derived mainly from primary and inadvertent sources. Reported efforts by the state registered sector to secure state support for the exclusion of unregistered competitors from practice or to prevent their use of common professional titles failed as a result of government opposition to professional monopolisation and its concern to meet the manpower demands of an expanding NHS podiatry provision. Despite advances in technology which have facilitated an expansion of role boundaries into the arena of invasive surgical practice and NHS reforms which have permitted its integration into the mainstream health service, traditional podiatric NHS practice now appears increasingly vulnerable to service rationalizations. Encroachment into other areas of medical and radiographic practice have led to inter-professional conflicts which currently remain unresolved, although medical dominance appears intact. This study suggests that any further podiatric role boundary expansion without medical approval or delegation is unlikely, as is amending legislation to establish a trade monopoly in the provision of footcare services.
23
Craddock, Deborah. "Pre-registration interprofessional education : an evaluative study using podiatry as an exemplar". Thesis, University of Southampton, 2010. https://eprints.soton.ac.uk/72411/.
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The ability to learn and work in a multidisciplinary team is crucial to the delivery of healthcare that is ‘fit for purpose’ in the twenty-first century. Consequently, interprofessional education (IPE) is a mandatory requirement for pre-registration training in health and social care. However, the evidence base for the effectiveness of such programmes remains limited. This evaluative study aims to explore the potential influence of IPE at pre-registration level, using podiatry as an exemplar. In Phase One, key informant interviews were held with IPE curriculum developers from higher education institutions (HEIs) (n=8) in the United Kingdom. Verbatim transcripts of these interviews were analysed using elements of grounded theory. In Phase Two, using the qualitative results as the anchor, a survey was constructed and administered to pre-registration health and social work students in a number of parallel IPE initiatives (Sample 1: n=1151; Sample 2: n=1060), involving 6 and 5 HEIs respectively. The findings of the key informant interviews and SPSS survey analysis were subsequently combined to inform the results of the research. The findings revealed an absence of educational theory underpinning the IPE curriculum development process. In addition there were issues concerning institutional commitment to IPE, attitudes towards IPE, and inconsistencies in the approach to curriculum delivery, all of which militated against successful implementation. The results illuminated that students learn about other health and social care professions that are represented in their IPE group. An appropriate time to introduce IPE into pre-registration programmes was found to be the latter part of the academic year for students studying first year modules. Students’ readiness for interprofessional learning was found to be enhanced if they were inducted to a coherent IPE initiative with consistent approaches to learning, teaching, assessment and evaluation across programmes. However, attitude differences between professional groups emerged where students with a strong sense of professional identity and roles were less ready to engage in interprofessional learning. This study indicates that the current method of implementing IPE in pre-registration health and social care programmes is less than ideal. The development and delivery of the IPE curriculum appears to be flawed. Explanations for the findings are explored and the implications for practice and future research are considered.
24
Crawford, Alan. "A comparative and historical analysis of podiatry education, policy and professional development". Thesis, Queensland University of Technology, 1994.
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Podiatry, despite its long history as a member of the allied health professions, is only now beginning to make an impact on the community generally and, more significantly, on health and education authorities in Australia. Public relations projects, changes within the educational system and greater acceptance within the health system of Podiatry have all had a significant part to play in raising the
professions image.
The professional specialising in health care of the foot in the past was known as a chiropodist. A chiropodist a term derived from the Greek "cheir" meaning hand and "pous" meaning foot. A chiropodist, treated hands and feet,
therefore chiropody was an appropriate appellation for the service. As the practitioner began to limit practise to the foot, the use of PODIATRY as a more specific terminology was implemented. The name change occurred initially in the
United States of America in 1958, and has subsequently been adopted internationally. Australian recognition of the profession was granted by the passing of a Registration Act in each state. The earliest Act was enacted in South
Australia in 1950. Subsequently, all states of Australia have introduced a Registration Act which governs the role of the Podiatrist.
The practice of Podiatry, as determined by the individual Acts, provides an overview of the significant range of treatment modalities available to the Podiatrist. For example, in Queensland the practice of Podiatry is defined as the diagnosis and treatment by medical, surgical, electrical, mechanical or manual methods of ailments or abnormal conditions of the human foot. Meeting the
requirements of the modem practitioner necessitates the acquisition of a high level of knowledge and skill seen as essential for the discharge of the responsibilities of
a primary care provider. The Podiatrist must have a comprehensive education comparable to any other health professional specialising in the field of health care.
Modem Podiatry demands a holistic approach to the patient, imposing on the practitioner the necessity of adequately considering the psychological, social and behavioural dimensions of illness or disease. Hence a bio-psycho-social as well as a bio-medical education is required of the Podiatrist.
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Netscher, Heather. "The professionalisation of podiatry: Recognition of the need for continuing professional education". Thesis, Queensland University of Technology, 1997. https://eprints.qut.edu.au/36569/1/36569_Digitised%20Thesis.pdf.
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In this project, the responsibility of individual health care practitioners (in particular podiatrists in Queensland) to recognise the need to respond to changes in the context of contemporary practice through participation in continuing professional education (CPE), has been researched. In particular, this project aimed to identify to what extent podiatrists in Queensland recognised the need for participation in continuing professional education, and to determine whether the ability to recognise the need for such participation is linked to individual podiatrists' perceptions of professionalism. Issues related to this aim formed the basis of the investigative process.
The concept of professionalism and the process of professionalisation of occupations has been explored, with particular focus upon the changing context of contemporary practice, and the need for professionals to recognise and respond to such changes, in order to continue to practise competently. Particular attention has been directed toward the limits associated with preservice education of professionals, and the social and legal responsibilities connected with professional competence. The professional responsibility to recognise the need to adapt to change, and the role of continuing professional education as a means of response to change has been identified. The purpose of this study was to research the issues relevant to development of the ability to recognise the need for participation in continuing professional education, using Podiatry in Queensland as an example of a professionalising health care occupation.
Recognition of the need for change has been identified as an important component an individual's perception of the need for continuing professional education. Identification of a discrepancy between current knowledge and current practices, or between what is known and what needs to be known is necessary for an individual to recognise the need to learn. The ability to recognise the need to learn may be dependant upon one's ability to reflect on practice, assess professional performance critically, and act on recommendations from a process of peer evaluation.
Recognition of the need to learn, and participation in continuing professional education, however, does not necessarily imply that learning will occur. Other issues may have significant influence upon learning. The ability and desire of the individual to participate in continuing professional education may be dependant upon incentives and barriers to learning relevant to the individual, or in some cases whether continuing professional education is perceived as mandatory or voluntary.
In order to gain insight into Queensland podiatrists' continuing professional education attitudes, beliefs, and practices, this research project has used a qualitative methodology. The use of this methodology has resulted in an understanding of the issues associated with the podiatrists' abilities to recognise the need for participation in continuing professional education. A survey method was employed as the primary means of data collection from all registered podiatrists in Queensland. The process of data collection included identification of the geographical location of all registered podiatrists throughout Queensland, a mailed self-administered questionnaire to them, telephone interviews with nonrespondents to the initial mailed questionnaire, and identification of reasons for non-response to the mailed questionnaire and to telephone interviews.
Through this research process, 90% of respondents indicated that they believe that continuing professional education is important, however, actual participation in CPE appears to be limited for a variety of reasons including lack of variety of sources of CPE and inability to overcome perceived barriers to participation. There are some practicing podiatrists in Queensland who do not recognise the need for participation in CPE. Other podiatrists do not recognise that they do participate in continuing professional education in particular due to lack of recognition of what constitutes professional education.
Given these findings, several recommendations have been made which may have implications for key stakeholders in the podiatry profession, including individual podiatrists, the professional association of podiatrists, the educational institution, and the registration Board. These recommendations focus mainly upon recognition of respondents' incentives for participation in CPE, recognition of the problems which affect them as podiatrists and recognition of the need to develop means by which to address their identified barriers to participation in continuing professional education.
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Farndon, Lisa Jane. "The function and purpose of core podiatry : an in-depth analysis of practice". Thesis, Sheffield Hallam University, 2006. http://shura.shu.ac.uk/20198/.
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The function and purpose of podiatry and podiatrists in the UK were investigated with specific regard to the core role whilst considering current health policy and sociopolitical issues influencing the profession. A survey of 9.6% working members of The Society of Chiropodists and Podiatrists from both the private, commercial and public sectors, identified the constituents of current practice in the UK. Traditional podiatry was still being carried out over 50% of the time despite developments in education and training. Although the term traditional podiatry is in current use to describe long-established tasks associated with care, respondents disagreed about its role, which suggest that it is poorly conceptualised and understood. Consequently, the term core podiatry was adopted. Some NHS departments are reducing the provision of core podiatry care which is linked to cost improvement initiatives, as there is little evidence of its effectiveness. Patients were interviewed to determine the value of core podiatry to them and it was found to sustain foot health whilst offering some emotional support and reassurance. Utilising data provided by practitioners and patients and reappraising the literature using concept analysis, a new definition and model of core podiatry was produced. This was then assimilated into The Chronic Care Model to propose a new strategy for the design and delivery of core podiatry services within the NHS.The findings confirm that core podiatry preserves individuals' foot health and the mobility of elderly patients in particular. Withdrawal of services is therefore a false economy. This new definition offers a consolidated view of practice and denotes areas that require further advancement or reorganisation. Developing the role of assistant practitioners to carry out some of the core work is proposed, whilst increasing treatments that can offer a cure. There is also an urgent need to introduce foot health promotion strategies at both national and local levels with the aim of preventing foot problems, thus contributing to the longer-term picture of improving and sustaining foot health.
27
Turner, Warren Andrew. "An evaluation of the application of laser therapy and combined laser/phototherapy in podiatry". Thesis, University of Leicester, 2002. http://hdl.handle.net/2381/29421.
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Low powered lasers have been in use as therapeutic devices since the 1970s for the treatment of a wide range of conditions including wounds, pain syndromes, musculo-skeletal injuries and skin infections. This study aims to determine whether laser therapy can be usefully applied to these conditions of the foot and ankle. A review of the literature three areas where existing podiatric therapies are inadequate, and for which there is empirical evidence of the efficacy of laser therapy. The conditions arising from this review were verruca pedis (planta warts), plantar heel pain syndrome, and foot and ankle wounds (neuropathic, venous and ischaemic). Three separate RCTs were established to determine the effectiveness of laser therapy/phototherapy in the management of these conditions. Subjects randomised to receive laser (820nm) therapy and phototherapy (660nm) received laser irradiation/phototherapy at the site of their condition. Subjects randomised to receive control received sham irradiation. Both groups also received a concurrent conventional therapy for their condition. Visual analogue pain scores using a 100mm line and presence/absence of the lesion/wound/pain syndrome were used as outcome measures. At the conclusion of the trial significant laser/phototherapy effects for the reduction of pain of verruca pedis (p<0.005), plantar heel pain (p<0.005), and ischaemic foot wounds (p<0.05) were seen. No significant benefit of laser/phototherapy could be identified for reduction in wound surface area when compared to the control (p<0.05), A significant increase in lesion cures were seen in the verruca pedis group receiving laser/phototherapy (p<0.05), and a significant difference between laser and control cure rate for plantar heel pain (p<0.05) was identified. It is therefore concluded that laser therapy/phototherapy has a number of clinical applications in podiatry. Suggestions for further study are made.
28
Curran, Mike. "Can a computer expert system aid the process of clinical decision-making in podiatry?" Thesis, University of Northampton, 2005. http://nectar.northampton.ac.uk/2688/.
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The aim of this research was to invetigate the clinical decision-making processes used in podiatry and hence to investigate if a computer expert system could be used to aid the process of clinical decision-making. This was achieved through a sequence of four empirical studies. The initial study used card sorts to investigate seven expert podiatrists’ perceptions of and attitudes toward diagnostic aids, and in particular how podiatrists viewed expert systems. The results showed that expert systems are perceived as different in kind from other diagnostic aids such as X-rays or blood tests. The second study was conducted using one expert and one novice podiatrist and used a task analysis to investigate the types of tasks and skills undertaken by a podiatrist during the diagnosis of a patient in different clinical environments. The results indicate that the work is highly schematised and involves routine tasks such as nail care and callus reduction. In clinic, podiarists perform many tasks quickly. There was little difference between the number of tasks per minute undertaken in a general clinic and the number of tasks in a specialist diabetes clinic. Considering the speed of diagnosis, it is postulated that both expert and novice podiatrists’ use of schemata, pattern matching, and tacit and implicit knowledge dominates their diagnostic activity during consultations. The third study focused on how clinical reasoning and decision-making occur during consultations with a patient. Think-aloud protocols were used to investigate the differences in the clinical reasoning process between five expert and nine novice podiatrists. The speed of diagnosis and general lack of causal assertions suggest that use of schemata and tacit knowledge dominate the diagnosis process for both experts and novices. In a general setting, the novices produced four common clinical reasoning themes. These indicate that pattern recognition is a common method of diagnosis. However, there was an increase in the number of clinical reasoning themes used by experts in a specialist setting, indicating novice—expert differences. The fourth study used laddering interviews on a mixture of twelve NHS and private podiatrists to investigate why podiatrists used certain clinical reasoning themes. A hierarchical value map was derived, showing that, at an initial response level to the laddering questions, certain values were important: the palpation of the foot, building a picture of the foot condition, and being able to use clinical reasoning frequently and immediately. The emphases on palpation and immediacy of reasoning suggest that an expert system is unlikely to serve podiatrists’ needs in clinics. This research has provided a new understanding of the clinical reasoning processes used in podiatry. A podiatrist has a very busy timeline when diagnosing a patient and predominantly uses (and values) tacit knowledge, implicit learning, and compiled skills during consultations. There is little evidence for the need or desire for an expert system in clinical podiatry practice. However, if such an expert system were to be created, then: (a) it would have to be fast and non-intrusive so it can fit into a very busy consultation timeline, (b) it would need a knowledge base that could account for diagnosis of foot and leg conditions based on pattern recognition, and (c) it might be most valuable in the form of a decision support system for professional development that included the full range of expert diagnostic themes
29
Boden, Christopher. "Older people and 'person-centred' podiatry : a critical evaluation of two models of care". Thesis, University of Gloucestershire, 2007. http://eprints.glos.ac.uk/1989/.
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Older people are often portrayed as a disadvantaged and silent group in society, whose views have been largely ignored. Demographic studies suggest the number of people over 75 years of age, as a percentageo f the population in coming years is likely to substantially increase, which will place greater demands on healthcare services. In the last two decades, health policy has focused on delivering high quality services based on individuals' needs, with a greater emphasis placed on individuals being involved in decisions about their care. This policy direction has facilitated a change in power relationships between patients and professionals and will require providers of healthcare to focus on delivering 'patient-centred' care at times and places that meet individual's needs and expectations. The aim of this researchw as to evaluatet he current medical model provision of NHS podiatry with the biopsychosocial model which claims to provide 'holistic', patient-centredc are. An important aim of this research was to provide a greater and more informed understandingo f what older people communicate about their 'lived' experiences, the significance of those experiences on care-seeking and their expectations of appropriate podiatry care. The research was undertaken with older people living in east Gloucestershire, who were 75 years old or over, and had requested NHS podiatry. The study was underpinned by a qualitative methodology, strengthened by a desire to change current clinical practice and inform health policy. The research methodology included involvement of participants in an innovative reminiscence technique, and as a consequence the 'podiatry patient career' was constructed. The texts generated from the participants were examined using an interpretative phenomenological analysis to ensure a 'person-centred' focus because it was imperative to hear the voices of the 'Participants' and not just the medical model 'patients' narrative. A portrait was revealed of older people who were conscious of their position in the life course and their own mortality, together with the effect this had on how they conducted their lives. The participants' raised consciousness of their 'self' affected their expectations, feelings, and interaction with others. For many of the participants there appeared a vicious circle of impending frailty that led to a diminishing circle of contacts which had an effect on their wider social activities and relationships. At this stage, participants perceived a resolution of their foot-care needs to be of great value and importance in maintaining their well-being which, assisted by the podiatrist, resulted in a handing over of the responsibility for their care. The conclusion is that neither model delivers 'person-centred' care to meet participants' expectations and foot-care needs. A new model is presented where differing and changing priorities, at different times of the participant's lived world will be relevant to meet their expectations and needs. The research concluded that the requirement for podiatry care can be taken as an early indicator of failing independence. The importance of the participant podiatrist relationship was also identified as cental to the delivery of 'person-centred' podiatry. The research findings depict older people who want to be involved in their care rather thm being 'a burden to the state. Recognition is also given to the changing nature of caring relationships in the next decade, and how NHS podiatry services will have to profoundly transform if they are to deliver a holistic, person-centred service in the future.
30
Otter, Simon. "Challenging current perceptions : an exploration of the nature and extent of foot complaints in rheumatoid arthritis". Thesis, University of Brighton, 2008. https://research.brighton.ac.uk/en/studentTheses/9f817eb1-6ac0-4496-b10c-d82859092f31.
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The extent and nature of the impact of rheumatoid arthritis (RA) in the feet from the point of view of those with the disease is unknown. Most epidemiological studies of foot involvement in RA have been based upon radiological scoring or the findings of clinicians' examination of feet in clinically based populations. This thesis aimed to explore foot involvement in RA from the perspective of people with the disease integrated with the perceptions of rheumatologists and podiatrists. Three questionnaires were developed de novo through an iterative process of integrating information gained from focus groups, illness narratives and literature reviews. Following piloting, questionnaires sent to participants enquired about symptoms in the feet, the anatomical distribution of those symptoms, and their impact on quality of life from the perspectives of 1040 people with RA, 78 podiatrists and 414 rheumatologists throughout the UK. Additionally, the availability of podiatric services and the usefulness of interventions for foot symptoms and foot function were triangulated from participants. Quantitative data were analysed using SPSS and a process of thematic analysis was used to interpret qualitative data. Results from participants indicated that symptoms due to RA were prevalent in all parts of the foot and ankle but the metatarsophalangeal and ankle joints were most commonly and severely affected. Most people with RA (79%) reported suffering recurrent, moderate or severe foot pain every day. Other symptoms (stiffness, numbness and swelling) were also common. Overall, these findings were greater than those that have been reported previously. Foot complaints were noted to have a profound effect on quality of life, with loss of mobility due to symptoms in the feet, and difficulties finding comfortable footwear, leading to loss of independence, anger, frustration and depression; findings that have not been previously reported in detail. A gap between the need for specialist foot care and receiving such care was highlighted, with a total 82% of respondents having discussed their foot symptoms with their rheumatologist. Amongst these patients 64% had been referred to a podiatrist. Clinicians' assessment practices varied widely both within and between professions. Patients reported that on average rheumatologists examined their hands every 6.2 months, whereas their feet were only examined every 16.5 months; this led some patients to feel that rheumatologists were disinterested in their foot complaints. Additionally, the type of assessment undertaken by clinicians did not fully take account of the issues people with RA were reporting. Issues that were key to patients were quality of life and the ability to participate in valued life activities. Difficulties with obtaining adequate foot health care were noted by those with the disease and clinicians alike. Symptoms in the feet in RA are common, severe and tend to be under-reported by clinicians. Involvement of the metatarsophalangeal joints and ankles is especially troublesome. Motion in these joints is vital for normal propulsive gait. Severe involvement causes reduced mobility and impedes independence with considerable consequences for social integration. Outcome measures that exclude the feet discourage foot examination and thus do not fully account for domains of importance to those with RA. Rheumatologists and podiatrists need to work more closely in order for a more patient-centred service to be developed, where a biopsychosocial approach to foot care would more fully address the needs of people with RA.
31
Lagan, Kathleen M. "Wound management in podiatry : use of Low Intensity Laser Therapy (LILT) and combined phototherapy/LILT". Thesis, University of Ulster, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.287134.
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Whittington, Lesley Susan. "An investigation of healing and tissue changes in plantar skin resulting from two surgical techniques : radiofrequency electrodesiccation and curettage". Thesis, University of Kent, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.589931.
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Hennessy, Kym. "Pre-clinical development of a podiatry-led complex intervention for foot problems in people with rheumatoid arthritis". Thesis, Glasgow Caledonian University, 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.636481.
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Foot and ankle involvement in rheumatoid arthritis (RA) is common, and frequently impacts negatively on quality of life. Systemic interventions reduce overall disease activity. However, foot problems may continue even after reaching clinical remission. Therefore, non-pharmacological interventions are commonly utilised concurrently. These interventions have generally been investigated singularly, which does not reflect clinical practice. Thus, a complex intervention study investigating foot and ankle care in RA is needed. Prior to complex intervention study development, theoretical and evidence-based data is required to underpin the design. Therefore, the aim of this research was to provide this data through identifying the current evidence for the clinical effectiveness of foot and ankle care for people with RA, and determining the extent to which this evidence underpins current clinical practice guidelines, stakeholder attitudes and beliefs towards treatment and the interventions used in routine practice. To achieve this aim, three research components were chosen to be used in a mixed methods approach. The individual research components were essential for showing the current evidence base for nonp-harmacological management of the foot and ankle in RA, identifying the minimal clinical standard required in a complex intervention, and determining the views of the major stakeholders regarding foot and ankle care in RA and identifying if these views were reflected in current practice. This in turn showed the complexity of an intervention of this nature and helped to determine the required components and design considerations for a complex intervention study.
34
Springett, Kathryn. "The influence of forces generated during gait on the clinical appearance and physical properties of skin callus". Thesis, University of Brighton, 1993. https://research.brighton.ac.uk/en/studentTheses/d46b8c79-6d9c-40b4-8a66-3f8922e8b784.
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Plantar skin callus plaques are a common, frequently painful hyperkeratotic condition affecting a number of the population and these hard, dense, yellowish, cutaneous lesions may even be sufficiently severe to limit working practices and social activities. Pathological callus formation is thought, empirically from clinical observation, to be due to excess intermittent pressure during gait, associated frequently with a structural or functional anomaly of the foot and leg. Studies into callus pathology are relatively few and have been concerned mainly with the structure and ultrastructure of callus tissue. The biomechanical features of plantar skin callus have been studied and results show it behaves differently from normal plantar and hairy skin. The current work extends the understanding of plantar skin calluses, their aetiology and pathology, utilising techniques, with some novel applications, from a number of fields. The mechanical forces exerted on the callused foot at the time of lesion loading were studied using the Kistler force and Musgrave pressure measurement plates. The duration of loading of the lesion was found to be increased compared with that of a normally functioning foot (p = 0.05). It was not possible to attribute reactive forces exerted on the foot at the time of loading to the lesion site, as appropriate technological advances have yet to be made. No predominant force vector was found which could be associated with the clinical appearance of plantar callus plaques. The clinical appearance of the callus lesion cannot therefore be used as an indicator of influential mechanical stresses. There is no relationship between either the dominant side and callus incidence on left or right feet or the different skin ridging patterns (dermatoglyphics) of callus lesions and their viscoelasticity. However, the results from rheological studies of this tissue suggested that the viscoelastic properties of areas of the stratum corneum within the callus plaque may be influential in the formation of the dermatoglyphic patterns found in these lesions. Fourier Transform Infrared Spectrometry was used to provide fundamental information for the rheological studies on plantar skin callus tissue and also confirmed the clinical assumption that callus tissue had a lower water content than normal plantar skin. A-scan ultrasound skin imaging (Dermal Depth Detector) with which it was hoped to quantify the topographical features of the lesion was not successful, probably due to the limitations of the instrument and transducer in this application, rather than the technique in general. Light microscopical examination of plantar callus sections was in general agreement with previous studies. The most notable feature was the disruption or absence of the granular layer in callus and corns respectively. A model for callus formation has been proposed partly as a result of the information generated during the course of study. An accelerated transit rate of callus keratinocytes is likely to result in cell immaturity on reaching the stratum corneum since differentiation will not have had time to be completed. Thus a number of differences in plantar callus will be evident, such as altered cell cohesion and desquammation. The results of this work will provide useful data which may direct further studies into suitable therapeutic modalities, thus extending the range of methods available for treatment of this common condition.
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Nichols, Matthew David Nichols. "Informing the Construction of a Fall Prevention Clinical Practice Guideline for Podiatry Patients 65 Years of Age and Older". Kent State University / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=kent1532365782547535.
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Pradels, Antoine. "Stimulation douloureuse mécanique des soles plantaires et contrôle de la posture bipédique". Thesis, Université Grenoble Alpes (ComUE), 2015. http://www.theses.fr/2015GREAS027.
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La sole plantaire, véritable interface entre le corps et le sol, joue un rôle primordial dans le contrôle de la posture bipédique. Diverses pathologies peuvent affecter le capteur podal. Elles se situent le plus souvent au niveau de la face plantaire, et sont généralement accompagnées de phénomènes algiques voir hyperalgiques. Un quart de la population présente ou présentera une pathologie au niveau des pieds. Les douleurs associées à ces pathologies podales sont souvent décrites comme invalidantes, par les patients, réduisant le périmètre de marche et associées à une cohorte de gênes fonctionnelles (démarche antalgique, douleurs sus-jacentes, anxiété, état dépressif…). La prise en charge de podologie raisonnée de ces podalgies, notamment chez la personne âgée, représente aujourd'hui un enjeu de santé publique majeur. Pour y répondre, il est tout d’abord nécessaire de mener une recherche fondamentale sur les mécanismes mis en jeu dans le contrôle de la posture bipédique, afin de proposer une prise en charge adaptée et raisonnée (« evidence based practice ») des troubles de la posture chez des personnes souffrant de douleurs plantaires.Ce préalable important et nécessaire constitue le cœur et la justification de ce travail doctoral. L’objectif était d’évaluer les effets d’une douleur plantaire induite mécaniquement sur le contrôle de la posture bipédique.Pour répondre à cet objectif général, trois études complémentaires ont été successivement conduites. La première étude visait, dans un premier temps, à évaluer les effets d’une stimulation douloureuse des soles plantaires sur le contrôle de la posture bipédique. Les deuxième et troisième études visaient à évaluer, si et dans quelle mesure, ces effets étaient modifiés en fonction des informations visuelles et sensorielles issues du segment tête-cou pour l’étude 2 et des informations sensorielles issues du segment pied-cheville pour l’étude 3.Dans leur ensemble, les conclusions de ce travail doctoral mettent en évidence l’importance des afférences nociceptives plantaires dans le contrôle de la posture bipédique. En effet, une stimulation douloureuse mécanique des soles plantaires dégrade les capacités de contrôle de la posture bipédique. Une stimulation douloureuse mécanique des soles plantaires induit également une modification de la contribution des différentes informations sensorielles (informations visuelles, informations sensorielles issues du segment tête-cou et du segment pied-cheville) mise en jeu pour contrôler la posture bipédique, soulignant ainsi les mécanismes de repondération sensorielle.Les travaux de cette thèse de doctorat constituent un préambule fondamental indispensable à l’optimisation de la prise en charge par le podologue des douleurs plantaires, et, plus largement, à l’amélioration de l’autonomie et de la qualité de vie des personnes souffrant de douleurs plantaires. Dans ce sens, diverses études cliniques visant à évaluer les effets des orthèses plantaires, sur la prise en charge des douleurs plantaires et par voie de conséquence l’amélioration et/ou le recouvrement des capacités de contrôle de la posture bipédique, sont en coursThe plantar sole, first point of contact between the body and the ground, plays a real key role in bipedal postural control. A lot of painful pathologies can affect the feet, particularly on the plantar face. Approximately one quarter of the population suffers or will suffer from foot injuries. The pain associated with these pathologies podal are often described as disabling for patients, reducing the walking distance and associated with a cohort of functional perturbations (limp, lowback pain, anxiety, depression ...). Care of foot pain, notably in elderly people, is a very important issue in public health. In order to achieve such care, it is necessary to conduct some fundamental research about the mechanisms that are in action concerning bipedal postural control, to propose some adapted treatments (evidence based practice) to improve the posture of the patients who have foot pain.This important and necessary prerequisite is the heart and justification of this doctoral work. The aim was to evaluate the effects of experimentally induced plantar pain on the bipedal postural control.Three experiments were successively conducted. The aim of the first experiment was to evaluate the effects of experimentally induced plantar pain on the bipedal postural control. The second and third experiments were aimed to assess if these effects were modified in function of the somatosensory information from the vision, the vestibular system and the neck (Study 2) and the somatosensory information from the ankle (Study 3).The results show that an experimentally induced plantar pain degrades the capacity to maintain postural control, and modifies the contributions of the other senses (visual, vestibular, neck and ankle muscle proprioception), showing the mechanisms of somatosensory reweighting in postural control when a pain was applied.This research constitutes a fundamental and indispensable starting point to optimize the care of foot injuries by podiatrists and, more broadly, to improve the autonomy and quality of life of persons suffering from foot pain.Clinical experiments aim to address these issues
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Ramos, Margot Guarieiro. "Avaliação neurologica e podiatrica nos pacientes com Charcot-Marie-Tooth". [s.n.], 2006. http://repositorio.unicamp.br/jspui/handle/REPOSIP/313857.
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Orientador: Anamarli NucciDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
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Resumo: Charcot-Marie-Tooth (CMT) está entre as neuropatias hereditárias mais comuns, com prevalência mundial de 1:2.500 indivíduos. Constitui-se de doenças geneticamente heterogêneas, caracterizadas por atrofia e fraqueza distais dos membros inferiores, podendo estender-se para os membros superiores. Objetivos: elaborar protocolos de exame podiátrico exeqüível em nosso meio. Aplicá-los e utilizar o Escore de Neuropatia para CMT para avaliação das disfunções e sua documentação em uma amostra de pacientes do Ambulatório de Doenças Neuromusculares. Descrever o fenótipo do conjunto dos pacientes estudados. Métodos: realizou-se avaliação clínico neurológica dos pacientes, teste do suporte lateral dos pés e preencheu-se o Escore de Neuropatia para CMT. Dois protocolos de avaliação podiátrica foram elaborados, com os respectivos escores. A parte comum a ambos consistiu na avaliação da impressão plantar e da função dos plantiflexores. A parte diferencial constituiu-se na utilização de goniometria para avaliação do ângulo do tornozelo e do calcanhar em um e utilização de fotos digitalizadas para leitura dos mesmos ângulos em outro. Resultados: participaram 20 pacientes com CMT, entre 7 e 53 anos (média e mediana de 29 anos), 50% de cada sexo, 90% com CMT de herança autossômica dominante. Atrofia peroneal ocorreu em 65% dos pacientes e atrofia dos músculos intrínsecos das mãos em 50%; rigidez da articulação subtalar em 20%; pés cavos em 90%; dedos em martelo em 85%; hipertrofia dos nervos periféricos em 40%. No escore de Neuropatia para CMT encontrou-se pontuação mínima de 9 e máxima de 30. Os protocolos podiátricos resultaram em escores sem diferenças estatísticas significantes. A avaliação do ângulo do tornozelo pelo método da goniometria demonstrou pé eqüino grave em 57,5% dos membros inferiores e pelas fotos digitalizadas em 50%. Setenta e cinco por cento (75%) dos pés tinham inversão do calcanhar. A avaliação da impressão plantar diagnosticou 70% de pés cavos. Houve déficit da flexão plantar em 60% dos pacientes. Conclusões: dois escores podiátricos por métodos diferentes foram elaborados, ambos factíveis e com resultados similares. A aplicação do Escore de Neuropatia para CMT mostrou 1 paciente com incapacidade leve, 10 (50%) com incapacidade moderada e 9 (45%) com incapacidade grave. O fenótipo de atrofia peroneal com pés eqüinos graves e inversão dos calcanhares foi predominante. Palavras-chave: Charcot-Marie-Tooth, avaliação podiátrica, Escore de Neuropatia para CMT
Abstract: Charcot-Marie-Tooth (CMT) is a genetically heterogeneous group of peripheral neuropathies presenting world prevalence of 1:2.500. Atrophy and weakness of the distal lower limbs are common clinical features and these signs may extend to the upper limbs. Objectives: to elaborate reliable protocols for podiatric exams, apply them and make use of the CMT neuropathy score in a sample of outpatients of the Neuromuscular Disorders Unit at Unicamp Hospital. To describe patients phenotypes by using the mentioned tools. Methods: patients were clinically examined and test block was realized. CMT neuropathy score was fulfilled. Two protocols of podiatric evaluation were produced, resulting in two distinct scores. Both protocols had the evaluation of footprint and plantarflexors functions in common and have used different means to assess ankle and heel angles. One of them has used goniometry to assess those angles and the other has made use of digitalized photos to do the same measurement. Results: 20 CMT patients from 7 to 53 years old (being both the average age and the median value 29) were studied - 50% males and 50% females, 90% with dominant autosomal CMT. Peroneal atrophy was observed in 65% of the patients and atrophy of intrinsic hand muscles in 50%; subtalar rigidity in 20%; pes cavus in 90%; claw of toes in 85%; peripheral nerves hypertrophy in 40%. CMT neuropathy score ranged from the minimal score of 9 and the maximal of 30. There were no significant statistical differences in the results of both podiatric protocols. The evaluation of the ankle angle by goniometry showed severe footdrop in 57,5% of the lower limbs and when the digital photos were used - 50%. Seventy-five per cent (75%) of the feet showed heel inversion. Footprint method diagnosed 70% of pes cavus. Plantarflexors failure was seen in 60% of patients. Conclusions: by using different methods, two podiatric scores were elaborated - both reliable and presenting similar results. CMT neuropathy score classified 1 patient with mild disability, 10 (50%) with moderate and 9 (45%) with severe. The predominant phenotype was peroneal atrophy associated with severe footdrop and heel inversion. Key words: Charcot-Marie-Tooth, podiatric evaluation, CMT neuropathy score
Mestrado
Ciencias Biomedicas
Mestre em Ciências Médicas
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Fernandes, Gabriel Sartori. "Avaliação do impacto de diferentes tipos de materiais de ferração na qualidade óssea de cavalos adultos estudada no III metacarpiano". Master's thesis, Universidade de Lisboa, Faculdade de Medicina Veterinária, 2016. http://hdl.handle.net/10400.5/13091.
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Dissertação de Mestrado Integrado em Medicina VeterináriaEste trabalho procurou testar o efeito de três tratamentos podiátricos sobre o aparelho músculo-esquelético de cavalos ao longo do tempo. Foram selecionados 15 animais, machos, divididos em dois grupos jovens (J) e adultos (A), jovens calçados com ferro (JF) ou deixados descalços (JD), adultos calçados com alumínio (AA) ou calçados com ferro (AF), durante 5 meses. A resposta foi avaliada de modo não invasivo com recurso à ultrassonografia quantitativa (QUS), com três acessos aos terceiros metacarpianos esquerdo e direito: dorsal, lateral e medial. Os valores médios obtidos para cada variável foram: dorsal esquerdo = 3908±142, dorsal direito = 3898±148, lateral esquerdo = 4317±95, lateral direito = 4314±110, medial esquerdo = 4128±208 e medial direito = 4110±166. Para valores de significância de P<0.05, concluiu-se que nenhum dos tratamentos realizados teve efeito, quer positivo quer negativo, sobre a amostra estudada ainda que diversos fatores possam ter influenciado os resultados obtidos. Os testes deveriam ser continuados e mais animais incorporados à amostra para tentar obter conclusões mais representativas.
ABSTRACT - ASSESSMENT OF THE IMPACT OF DIFFERENT TYPES OF SHOEING MATERIALS ON THE BONE QUALITY IN ADULT HORSES STUDIED IN THE III METACARPUS - The purpose of this study was to test the effect of three different podiatric treatments on the musculoskeletal system of horses trough time. A total of 15 animals were selected, all males, divided in two groups young (J) and adults (A), young shoed with iron (JF) or left barefooted (JD), adults shoed with aluminium (AA) or iron (AF), during 5 months. The response was evaluated using a non-invasive technique of quantitative ultrasonography (QUS), in three aspects of the third metacarpal bones left and right: dorsal, lateral and medial. The average values obtained for each variant were: left dorsal = 3908±142, right dorsal = 3898±148, left lateral = 4317±95, right lateral = 4314±110, left medial = 4128±208 and right medial = 4110±166. With significance values of P<0.05, it was concluded that none of the performed treatments had an effect, either positive or negative, on the studied sample although several factors may have influenced the obtained values. The tests should be continued and more animals should be added to the sample to gather more representative conclusions.
N/A
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Blakeman, Paul David. "Effects of National Health Service reforms (1983-1998) on professional identity using state registered chiropody/podiatry as a case study". Thesis, Keele University, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.391986.
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Verenna, Anne-Marie Alexandria. "INVESTIGATIONS OF ANATOMICAL VARIATIONS OF THE THORAX AND HEART AND ANATOMICAL KNOWLEDGE FOR FIRST YEAR MEDICAL DENTAL AND PODIATRY STUDENTS". Diss., Temple University Libraries, 2013. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/221870.
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Cell BiologyPh.D.
The universal presence of anatomy in healthcare professions is undeniable. It is a cornerstone to each of the clinical and basic sciences. Therefore, further expansion of current anatomical knowledge and effective methods to teach anatomy is essential. In this work, the relationship of the dorsal scapular artery with the trunks of the brachial plexus is explored with the hope that information on anatomical variation will assist neurosurgeons in sparing these structures during clinical procedures. Additionally, structures involved in biventricular pacing procedures, such as the coronary sinus and Thebesian valve, are explored for their variations in both presence and presentation. Simulations of cannulations with both 7F and 8F guiding catheters were used to collect data regarding the length of travel of a catheter within the coronary sinus. This study aimed to expand current knowledge of the coronary structures that are of importance to electrophysiologists. Furthering knowledge of how best to teach anatomy to healthcare professionals was also an aim of this work. The first education study explored whether the method of instruction affected student success in a basic science course. This study also investigated the degree of knowledge mastery that healthcare professional students had achieved in gross anatomy, microanatomy and physiology during their first year physiology course. The students were assessed at the knowledge, comprehension, application and analysis levels of Bloom's taxonomy in each discipline. A pilot study explored the degree of prior knowledge in human gross anatomy that the same healthcare professional populations (medical, dental and podiatry) possessed before beginning the first year general gross anatomy course in their healthcare curriculum. The ability for these students to evaluate when they had answered a gross anatomy question correctly and when they had answered a question incorrectly (metacognition) was explored. All four studies in this work provide further insight into anatomical education in both the clinical and basic science environments.
Temple University--Theses
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Gallagher, Christine Leigh. "Shared learning in health care professional education : an evaluation of third year medical, nursing, occupational therapy, physiotherapy and podiatry students' shared learning experiences". Thesis, University of Southampton, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.409854.
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Carter, Sarah Louise. "Lower leg and foot contributions to turnout in pre-professional female dancers: A clinical and kinematic analysis". Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2018. https://ro.ecu.edu.au/theses/2101.
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Turnout, the act of externally rotating the legs, is produced through the summation of joint structure characteristics and ranges of motion at the hip, knee, ankle and foot. The hip joint’s contribution to functional turnout, a dancer’s preferred turnout stance, has received extensive examination, whereas little is known about below-the-hip contributions. Dancers with limited hip external rotation (HER) are associated with an increased risk of overuse lower limb injury. These injuries have been attributed to forcing turnout via additional external tibiofemoral rotation (TFR) and foot pronation. Yet knowledge of these compensatory mechanisms is based on biomechanical theories and clinical observations rather than quantitative clinical assessments or 3D motion analysis. The principal aim of this research was to investigate the lower leg and foot contributions to turnout in university-level female dancers using quantitative clinical assessments and 3D motion analysis, as well as the compensations mechanisms dancers use to increase turnout.
The first study focused on assessing the lower leg and foot contributions to turnout using the clinical assessments of passive TFR and active measures of foot pronation in turnout. The results showed dancers assumed a more pronated posture in turnout, and those with a greater passive TFR demonstrated a less pronated position in turnout providing new insight into the mechanical coupling between the foot and the tibiofemoral joint in dancers.
The purpose of the second study was to use 3D kinematic analyses to determine the lower leg and foot compensations that dancers use to accentuate their turnout. Active and passive TFR of the dancers was also measured. The results demonstrated foot abduction was the strongest predictor of functional and forced turnout, compared to both the hip and knee external rotation. A moderate-strong negative relationship was observed between HER and foot abduction in all turnout conditions. A moderate negative relationship was found between the passive TFR and foot abduction in all turnout conditions. These findings indicate clinical measures of external tibiofemoral rotation can predict the total below-hip compensation mechanisms a dancer uses to achieve turnout. Suggesting, dancers are more likely to pronate about the foot/ankle complex, than rotate at the knee to compensate for limited HER. Whereas dancers with less foot mobility may force additional rotation via the knee which may contribute to rotational knee joint laxity.
The previous study provided the rational for an in-depth analysis of the foot/ankle complex such as that provided by three-dimensional multi-segment foot models (3DMFMs). The lack of an appropriate model for ballet dancers led to the modification of the Rizzoli Foot Model. Kinematic repeatability of the model was determined from analysing ballet dancers performing the following movements; parallel stance, turnout plié, turnout stance, turnout rise and flex-point-flex. First metatarsophalangeal joint (MTPJ) in the sagittal plane demonstrated excellent intra and inter-assessor repeatability across all movements. All inter-segmental angles except for the tibia-hindfoot and hindfoot-midfoot frontal planes demonstrated excellent intra-assessor repeatability during flex-point-flex movements. Providing a reliable method to measure 3D foot/ankle complex can enable a deeper understanding of the foot/ankle complex contribution to turnout. Previous 3DMFM used in dance science consisted of only two foot segments, hindfoot and forefoot whereas this model includes a midfoot segment which is important as forefoot abduction has been suggested to give the illusion of a larger turnout angle.
The final study aimed to examine the lower leg and foot compensations that dancers use to accentuate their turnout using a dance specific 3DMFM. Hindfoot abduction and eversion were the strongest predictors of foot abduction in turnout. Midfoot abduction was significantly greater in forced turnout compared to functional turnout. No significant differences were found for forefoot abduction, first MTPJ abduction and navicular drop in functional or forced turnout, compared to natural stance. Foot pronation does play a role in achieving turnout and there may be a safe range of pronation. However, the amount of detrimental pronation for a dancer is unknown. The overall results from these studies offer compelling evidence that the foot/ankle complex plays a more important role in achieving turnout, than previously thought. Further prospective research on in situ measures of the lower leg and foot in turnout and injury surveillance are required to improve our understanding of the normal and abnormal dance biomechanics.
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Tinley, Paul Douglas. "Two or three dimensional assessment of foot and ankle". Thesis, Queensland University of Technology, 1998.
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Nancarrow, Susan Alison, i sunancarrow@yahoo co uk. "�If we can�t measure it, we can�t do it� The role of health outcomes in community and allied health service accountability". The Australian National University. ANU College of Medicine, Biology and Environment, National Centre for Epidemiology and Population Health, 2003. http://thesis.anu.edu.au./public/adt-ANU20100707.182200.
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Health outcomes fulfill a number of roles in the health sector. Economists, clinicians, researchers and managers use health outcomes in a range of different contexts for distinct purposes. New management approaches that use contracts as the basis for health service accountability have attempted to take health outcomes from their clinical role into a management setting. In particular, the purchasers and managers of some health services expect that service providers should demonstrate that they improve the health outcomes of their patients to justify their on-going funding.
However, a number of organisations have experienced barriers to the application of the outcomes approach to health service management and there has been no systematic evaluation of the approach. Nor has there been an investigation into why purchasing organisations have difficulty introducing health outcomes into purchasing contracts. The result is that managers and purchasers continue to assign resources to the pursuit of health outcomes as an accountability tool.
This thesis addresses two research questions around the use of health outcomes in community and allied health service accountability. The first is the barriers to the application of health outcomes to health services accountability. The second question examines the conditions that must be met before health outcomes can be used as an accountability tool in purchasing contracts for allied health.
The research questions are addressed through the analysis of case studies that explore systematically the approach taken by two organisations, the Department of Veterans� Affairs and ACT Community Care, in their attempts to identify health outcomes that could be used in purchasing contracts for community and allied health services. The case study analysis uses a health services research approach that draws on multidisciplinary techniques including epidemiology, health services management and anthropology.
The thesis describes the accountability interactions within the purchaser-provider model. Accountability is not a uniform construct. It consists of many domains, levels and interactions. In health service delivery, there are a number of different actors and a wide range of interactions for which they are accountable. Two important interactions are identified: professional accountability, which describes the accountability of the health service professional to their patient; and contractual accountability, which is the obligation of the health service provider (or providing organisation) to the purchaser through their contractual agreement. I conclude that health outcomes are not an appropriate domain of contractual accountability but they are an important component of professional accountability and I discuss the implications of these finding for theory and practice.
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Merriman, Linda M. "Changing by degrees : a study of the transition from diplomas to degrees in chiropody, occupational therapy and radiography". Thesis, University of Leicester, 1998. http://hdl.handle.net/2381/29573.
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This study examines the impact of the transition from diploma to degree on the initial education and training of three para-professions in England; chiropody, occupational therapy (OT) and radiography. It focuses on the nature of and reasons for changes to their initial professional education and training and the potential impact of these changes on their professionalisation. The study adopted a multiple method approach; a historical review, which included documentary sources and interviews with key informants, aimed at identifying how and why these three para-professions wanted to achieve all-graduate entry, and the use of case studies to explore the differences between the diploma and degree courses. It is concluded that the achievement of all-graduate entry for these para-professions was an unintended consequence of the policies of the then government. As a result of the achievement of all-graduate entry changes were made to the respective diploma courses of these para-professions. The extent of these changes were related to the level of control and influence that the professional bodies exercised over the diploma courses. All the degree courses shared the following features: the development of autonomous, reflective practitioners who are life-long learners, an emphasis on theory rather than practice, and emphasis on propositional knowledge and the study of research methods. Although the degree courses for these para-professions achieved approval from HEIs it is argued that degree education is a contested concept. It is apparent that the para-professionals believed that the achievement of all-graduate entry would improve their professional status. However, it is evident from the study findings that it served to maintain rather than enhance their social status and market position. Changes to the initial education and training of these para-professionals were the results of the para-professionals having to respond to prevailing social, political and economic circumstances. If they had not taken this action it is suggested that their social status and market position may have been adversely affected.
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Bennett, Paul J. "An investigation into the health related outcomes of surgery performed by Fellows of the Australian College of Podiatric Surgeons". Thesis, Queensland University of Technology, 1999. https://eprints.qut.edu.au/36746/1/36746_Digitised%20Thesis.pdf.
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Health care providers in the United States, United Kingdom and Australia debate the need for expanding the role of podiatrists' to include the surgical care of foot problems. Paradoxically, during a twelve month period from July 1995 to June 1996, Fellows of the Australian College of Podiatric Surgeons (FACPS) performed over 1,500 individual surgical operations on approximately 785 Australians.
Few prospective investigations of podiatric surgeon outcomes have been conducted, none of which have taken place in Australia. More particularly, no studies have used valid psychometric instruments to measure the effects of care provided on patients' "health related quality of life". The research contained in this thesis deals with the conceptualisation, development and validation of a new health status instrument: the Foot Health Status Questionnaire. This instrument has been developed with the specific intent of investigating the impact of FACPS on patients' health related quality of life.
One hundred and forty-two subjects treated by eleven Fellows for orthopaedic, neurological or integumentary systems diseases of the foot were recruited into a six month long quasi-experimental repeated measures (time series) study. The study identified that the vast majority of subjects (more than 92%) who underwent foot surgery experienced significant improvements' in a range of health related quality of life dimensions and indicated that they would undergo their procedure again. In particular, a MANCOVA analysis demonstrated that subjects' reported reduced levels of foot pain, increased levels of physical function, improved general foot health perception and footwear related quality of life, up to six months after their respective operations.
Adverse effects of surgery identified in this study include a significant short-term functional disability for subjects' undergoing orthopaedic correction of foot problems and, in the immediate post operative phase, a significant reduction in social function for all three groups of subjects'. Generic measures of General Health and Vitality, as captured by the Short Form 36 health status instrument, were unaffected by Fellows treatment. This study did not identify any significant short to medium term morbid outcomes.
Assessment of patients' satisfaction with surgery one, three and six months postoperatively reflected a general under-reporting of the beneficial effects of foot surgery. These findings support the premise that; specific health related quality of life measures provide significant explanatory power about the outcomes of care compared with the more traditional approach of evaluating patient satisfaction with surgery.
In summary, it has been recommended that podiatrists, like other health care professionals, use recognised methods to determine whether their care meets professional standards and to generate evidence to prove that it does. This research contributes to meeting this important public health need.
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Perrier, Antoine. "Conception et évaluation d’un modèle biomécanique, éléments finis, patient-spécifique, du pied humain. Applications en podologie, orthopédie et diabétologie : applications en podologie, orthopédie et diabétologie". Thesis, Université Grenoble Alpes (ComUE), 2016. http://www.theses.fr/2016GREAS035/document.
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Conception et évaluation d’un modèle biomécanique, éléments finis, patient-spécifique, du pied humainApplications en podologie, orthopédie et diabétologieLe pied est une des structures les plus complexes du corps humain. Avec 28 os, 33 articulations et une centaine de structures ligamentaires, cette entité poly articulée est le résultat d’une hyperspécialisation ayant contribué à faire de l’homme l’unique primate totalement bipède. Quelque soit le relief, quelque soit le mouvement en cours, le pied transmet au tibia le bon vecteur force afin de finaliser le geste de la manière la plus précise et économe en énergie possible dans l’objectif de préparer l’action des segments sus jacents. Ainsi, en cas de lésion d’une des structures, l’ensemble du complexe pied doit pouvoir s’adapter, si ce n’est pas le cas, les tissus mous, les articulations ou les os seront fragilisés et verront leur fonction propre au sein de ce complexe altérée.Prédire l’adaptation du pied à une modification structurelle, tissulaire, neurologique ou fonctionnelle est un enjeu important dans l’estimation du risque lésionnel.Afin d’initier une réponse à ces problématiques, nous avons décidé au cours de cette thèse de modéliser le pied humain avec des outils mathématiques de simulation biomécanique. Dans un premier temps, un modèle tridimensionnel musculo-squelettique du pied a été reconstruit à partir d’imagerie scanner. Le pied polyarticulé en multicorps rigides obtenu possède des articulations uniquement contraintes par les ligaments et contacts osseux. Les muscles ont été implémentés afin de piloter le modèle en dynamique directe. Enfin, les tissus mous comme les volumes musculaires, le gras et la peau ont été maillés en éléments finis. L’utilisation d’un environnement de programmation multi-physique open source (Artisynth) a permis de coupler la modélisation musculo-squelettique et éléments finis.• L’adaptation du pied au sol en orthostatisme a été évaluée par comparaison des cartographies de pression d’une mise en charge simulée avec la mise en charge réelle du sujet.• Le contrôle moteur du pied en chaine ouverte par l’activation des muscles extrinsèques a été évalué en comparant la cinématique du modèle biomécanique pilotée par électromyographie avec la cinématique capturée en laboratoire sur un mouvement d’abduction – adduction.• Nous avons ensuite cherché à comprendre comment une arthrodèse de cheville modifie la cinématique du pied à la contraction musculaire, l’objectif étant d’aider au réglage chirurgical du geste.• Enfin nous avons utilisé les dernières avancées sur la physiologie de la plaie de pression afin de prédire le risque d’ulcération sur un pied neuroarthropatique diabétique par simulation numérique.Le modèle ainsi que les routines de simulations mis en place nous permettent d’avoir un des modèles les plus aboutis du pied humain utilisant aussi bien des données physiques externes comme les données baropodométriques, les données d’analyse quantifiée du mouvement ou encore les données électromyographiques. Ce modèle permettra par l’intermédiaire d’outils de mesh-matching d’obtenir des modèles patients spécifiques. Les domaines d’applications porteront sur l’aide au geste chirurgical, la prévention des risques d’ulcération, l’analyse avancée des relations entre le pied et le membre inférieur, mais aussi l’aide à la conception de prothèse en orthopédie classique et en mécatroniqueBiomechanical modeling of the human foot. Application to the healthy and pathological subject.The foot is one of the more complex structures of the human body. With 28 bones, 33 joints and a hundred ligamentous structures, this articulated entity is the result of a hyper specialization that makes humans the only obligate bipedal primates. Whatever the terrain, whatever the current movement, the foot transmits to the tibia the right force vector to finalize the gesture in the most precise and efficient manner and prepares the action of the lower limb. Thus, in case of injury to one of the structures, the whole foot complex must adapt if it is not the case, soft tissues, joints or bones are fragile and will have their own function within this complex altered .Predicting the foot’s adaptation of a structural, tissue, neurological or functional modification is an important issue in estimating the risk lesion on locomotion, in the design of therapeutic footwear and orthotics of the degenerative foot, but also in the future of this complex in situations where the boundary conditions change like working in microgravity or foot exoskeleton coupling.To initiate a response to these problems, we decided during this thesis to model the human foot with mathematical tools for biomechanical simulation. Initially, a musculoskeletal three-dimensional model of the foot was reconstructed from computed tomography. The multi-articulated foot joints constraints obtained by ligaments and bone contact. The muscles have been implemented to control the model in direct dynamic. Finally, the soft tissues such as muscle volume, fat and skin were meshed into finite elements. Using a multi-physics open source programming environment (Artisynth) allowed to couple musculoskeletal modeling and finite elements.• Adapting the foot on the ground in upright posture was evaluated by comparing the pressure maps at a simulated load setting with the actual loading pressure map of the subject.• The motor control of foot in opened chain by activation of the extrinsic muscles was assessed by comparing the kinematics of the biomechanical model piloted by electromyography with kinematics captured in the laboratory on a movement of abduction - adduction.• We then sought to understand how an ankle arthrodesis alter the kinematics of the foot muscle contraction, with the aim of helping the surgical setting gesture.• Finally, we used the latest advances in the physiology of a pressure ulcer to predict the risk of ulceration on diabetic foot with Charcot neuro arthropathy by numerical simulation.The model and simulation routines in place allow us to have one of the most successful models of the human foot using both external physical data like pedobarographic data, motion analysis data or electromyography data. This model will allow through mesh-matching tool to obtain specific patient models. The fields of applications will focus on assisted surgery, prevention of ulceration, advanced analysis of relations between the foot and the leg, but also will help the prosthesis design in orthopedic and mechatronics
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Reed, Lloyd Fisher. "An investigation of foot and ankle problems experienced by nurses". Thesis, Queensland University of Technology, 2007. https://eprints.qut.edu.au/35779/1/Lloyd_Reed_Thesis.pdf.
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Relatively little information has been reported about foot and ankle problems experienced by nurses, despite anecdotal evidence which suggests they are common ailments. The purpose of this study was to improve knowledge about the prevalence of foot and ankle musculoskeletal disorders (MSDs) and to explore relationships between these MSDs and proposed risk factors. A review of the literature relating to work-related MSDs, MSDs in nursing, foot and lower-limb MSDs, screening for work-related MSDs, foot discomfort, footwear and the prevalence of foot problems in the community was undertaken. Based on the review, theoretical risk factors were proposed that pertained to the individual characteristics of the nurses, their work activity or their work environment.
Three studies were then undertaken. A cross-sectional survey of 304 nurses, working in a large tertiary paediatric hospital, established the prevalence of foot and ankle MSDs. The survey collected information about self-reported risk factors of interest. The second study involved the clinical examination of a subgroup of 40 nurses, to examine changes in body discomfort, foot discomfort and postural sway over the course of a single work shift. Objective measurements of additional risk factors, such as individual foot posture (arch index) and the hardness of shoe midsoles, were performed. A final study was used to confirm the test-retest reliability of important aspects of the survey and key clinical measurements.
Foot and ankle problems were the most common MSDs experienced by nurses in the preceding seven days (42.7% of nurses). They were the second most common MSDs to cause disability in the last 12 months (17.4% of nurses), and the third most common MSDs experienced by nurses in the last 12 months (54% of nurses). Substantial foot discomfort (Visual Analogue Scale (VAS) score of 50mm or more) was experienced by 48.5% of nurses at sometime in the last 12 months.
Individual risk factors, such as obesity and the number of self-reported foot conditions (e.g., callouses, curled toes, flat feet) were strongly associated with the likelihood of experiencing foot problems in the last seven days or during the last 12 months. These risk factors showed consistent associations with disabling foot conditions and substantial foot discomfort. Some of these associations were dependent upon work-related risk factors, such as the location within the hospital and the average hours worked per week. Working in the intensive care unit was associated with higher odds of experiencing foot problems within the last seven days, foot problems in the last 12 months and foot problems that impaired activity in the last 12 months.
Changes in foot discomfort experienced within a day, showed large individual variability. Fifteen of the forty nurses experienced moderate/substantial foot discomfort at the end of their shift (VAS 25+mm). Analysis of the association between risk factors and moderate/substantial foot discomfort revealed that foot discomfort was less likely for nurses who were older, had greater BMI or had lower foot arches, as indicated by higher arch index scores. The nurses’ postural sway decreased over the course of the work shift, suggesting improved body balance by the end of the day. These findings were unexpected. Further clinical studies examining individual nurses on several work shifts are needed to confirm these results, particularly due to the small sample size and the single measurement occasion.
There are more than 280,000 nurses registered to practice in Australia. The nursing workforce is ageing and the prevalence of foot problems will increase. If the prevalence estimates from this study are extrapolated to the profession generally, more than 70,000 hospital nurses have experienced substantial foot discomfort and 25-30,000 hospital nurses have been limited in their activity due to foot problems during the last 12 months.
Nurses with underlying foot conditions were more likely to report having foot problems at work. Strategies to prevent or manage foot conditions exist and they should be disseminated to nurses. Obesity is a significant risk factor for foot and ankle MSDs and these nurses may need particular assistance to manage foot problems. The risk of foot problems for particular groups of nurses, e.g. obese nurses, may vary depending upon the location within the hospital. Further research is needed to confirm the findings of this study. Similar studies should be conducted in other occupational groups that require workers to stand for prolonged periods.
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Ruiz, Toledo Jessica. "Evaluación de la implementación del Programa Sanitario de Pie Diabético en Cataluña". Doctoral thesis, Universitat de Barcelona, 2021. http://hdl.handle.net/10803/673057.
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INTRODUCCIÓN: La diabetes es una patología crónica que constituye un problema de salud pública a nivel mundial. Su prevalencia se ha triplicado en los últimos 20 años. En Cataluña desde el año 2010 tenemos referencia de que la tendencia está en constante ascenso. El pie diabético es una de las complicaciones que preocupa y que implican un gasto económico. Es por ello, que se deben incidir sobre sus factores de riesgo y medidas de prevención con el fin de minorizar estas consecuencias.
HIPÓTESIS: El análisis de la implementación de la prestación sanitaria complementaria del Programa de atención podológica del pie para diabéticos en Cataluña y el diseño de un Plan de mejora continua del Programa permitirá la evaluación, el ajuste de la efectividad y conocer la demanda respecto al mismo.
OBJETIVOS: Evaluar la implementación de la prestación complementaria de pie diabético en el Sistema Nacional de Salud de Cataluña entre 2009 y 2018, describir las variables epidemiológicas y clínicas de los pacientes usuarios, evaluar el conocimiento y la gestión del Programa que realizan los podólogos/as, así como los conocimientos del servicio de medicina y de enfermería del Centro de AP de referencia y diseñar el Plan de mejora continua del Programa sanitario.
MÉTODOS: Se ha llevado a cabo en 5 etapas desde el año 2015 al 2021. En la primera etapa se realizó un estudio sobre una muestra de pacientes usuarios en un centro médico privado, en la segunda y tercera etapa se realizaron encuestas a los profesionales podólogos/as y al servicio de enfermería y medicina del CAP de referencia, en la cuarta etapa se diseñó un Plan de mejora continua con propuestas y acciones de mejora. Por último, en la quinta etapa, se analizaron los datos de la demanda (2009 al 2018) y códigos de diagnóstico y tratamiento (2018-2020) del Programa sanitario.
RESULTADOS: El número de las visitas, pacientes y de podólogos/as que forman parte del Programa ha aumentado considerablemente en el periodo de estudio. De la muestra de la primera etapa cabría destacar que un 4,1% de los pacientes presentaron úlceras, con un 0,4% de amputaciones, dato estadísticamente significativo entre amputación y úlcera. Si bien en la segunda etapa del estudio se observó que más de la mitad de los podólogos realizaba la
exploración vascular y neuropática, el 81,8% consideraba su actuación de carácter preventivo y afirman en el 84% la necesidad de mejoras organizativas. En la tercera etapa, el 76% de AP (medicina) no consideraban que el número de visitas debían aumentarse. El servicio de enfermería era responsable de la derivación en el 95% de los casos. El Plan de mejora continua diseñado colaboró en el sistema de codificación de diagnósticos y tratamientos implantado en junio del año 2018.
CONCLUSIONES: La demanda del Programa ha tenido un aumento progresivo y creciente. Los podólogos actúan mayoritariamente en pacientes derivados sin alteración, interviniendo en la detección precoz de enfermedades vasculares y neuropáticas junto con los profesionales de la AP. En consecuencia, es necesario instaurar un Plan de mejora.INTRODUCTION: Diabetes is a chronic pathology that constitutes a worldwide public health problem. Its prevalence has tripled in the last 20 years. In Catalonia since 2010 we have reference that the trend has been steadily rising. Diabetic foot is one of the complications of concern and involves economic expenditure. For this reason, it is necessary to influence its risk factors and prevention measures in order to reduce these consequences. HYPOTHESIS: The analysis of the implementation of the complementary health service of the podiatric foot care program for diabetics in Catalonia and the design of a continuous improvement plan of the program will allow the evaluation, the adjustment of the effectiveness and to know the demand for it. OBJECTIVES: To evaluate the implementation of the complementary diabetic foot care in the National Health System of Catalonia between 2009 and 2018, to describe the epidemiological and clinical variables of user patients, to evaluate the knowledge and management of the Program performed by podiatrists as well as the knowledge of family physicians and nurses of the reference PC Center and to design the Plan for continuous improvement of the health Program. METHODS: It has been carried out in 5 stages from 2015 to 2021; first stage a study was conducted on a sample of patient users in a private medical center, in the second and the third stage an assessment through surveys to podiatrists professionals, conducting surveys to the nursing and medical service of the reference CAP, in the fourth stage a continuous improvement Plan was designed with the implementation of proposals and actions for improvement. Finally, in the fifth stage, we analyzed the data on the demand of the health program from 2009 to 2018, as well as evaluated the codes implemented during the period 2018-2020. RESULTS: The number of visits, patients and podiatrists who are part of the Program has increased considerably in the study period. From the first stage sample, it should be noted that 4.1% of the patients presented ulcers, with 0.4% of amputations, a statistically significant 0data between amputation and ulcer. Although more than half of the podiatrists performed vascular and neuropathic examination, 81.8% considered their work to be preventive in nature and 84% stated the need for organizational improvements. In the third stage, 76% of primary care professionals not considered that the number of visits should be increased. The nursing service was responsible for referral in 95% of the cases. The continuous improvementplan designed favored the establish, the diagnosis and treatment coding system implementedin June 2018. CONCLUSIONS: The demand for the Program has had a progressive increase. Podiatrists act mostly in patients referred without alteration, intervening in the early detection of vascular and neuropathic diseases together with primary care professionals. Consequently, it is necessary to establish an improvement plan.
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Wareham, Campbell John. "Cardiovascular assessment in podiatric surgery : a study of current practice amongst podiatric surgeons practicing the United Kingdom". Thesis, Ulster University, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.487700.
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This work presents a study of the current practice of cardiovascular examination of pre-surgical patients by UK Podiatric Surgeons. Podiatric Surgeons trained and educated in the United Kingdom are unique in that whilst they are specialist qualified, they do not hold a degree in medicine. As such certain peripheral examinations which involve the peri-operative process but may not actually effect the outcome of the surgical procedure are performed in a brief but effective manner in a style which may be considered as 'non traditional'. This thesis examines, not only the current practice, but explores the current 'thinking' behind the practice and seeks to put reasons forward as to why podiatric surgeons practice in the manner in which they do.