Management of hyperglycemia in the hospitalized podiatric medical patient

With the growing prevalence worldwide of diabetes mellitus and hyperglycemia, hospital-based health-care professionals will encounter patients with these conditions with increasing frequency. It is well known that long-term control of blood glucose reduces the rate and severity of complications in patients with diabetes, but there is also mounting evidence that even short-term glycemic control in hospitalized diabetic patients can significantly lower morbidity and mortality in many areas, from nosocomial infection to postoperative course. The results of traditional approaches to controlling blood glucose in hospitalized patients have been disappointing owing to a variety of factors, including the use of oral agents that are difficult or dangerous to use in inpatients, older insulin preparations with unphysiologic modes of action, and even provider reluctance to accept glycemic control as an essential element of the care of the diabetic hospitalized patient. This article provides guidelines for the effective management of hyperglycemia in these patients throughout the hospital stay, with specific recommendations for the perioperative, operative, and postoperative periods.     

Virtual microscopes in podiatric medical education

In many medical schools, microscopes are being replaced as teaching tools by computers with software that emulates the use of a light microscope. This article chronicles the adoption of "virtual microscopes" by a podiatric medical school and presents the results of educational research on the effectiveness of this adoption in a histology course. If the trend toward virtual microscopy in education continues, many 21st-century physicians will not be trained to operate a light microscope. The replacement of old technologies by new is discussed. The fundamental question is whether all podiatric physicians should be trained in the use of a particular tool or only those who are likely to use it in their own practice.     

A survey of podiatric medical students' computer literacy

This article reviews the extent of health-care students' computer literacy and presents the results of a survey of podiatric medical students' computer literacy. The results of this survey indicate that podiatric medical students are more likely than other health-care students to rate their computer literacy as good or very good. There was no gender difference in this self-reported computer knowledge. The implications for designing and using Web-based instructional materials and technology for podiatric medical students are discussed.     

Publication patterns and perceptions of the Australian podiatric medical faculty

Despite the wide range of publication opportunities in podiatric medicine, little is known about how podiatric authors select journals in which to publish or their perceptions of journals currently available. To investigate these issues, a survey of publication patterns and perceptions of full- and part-time academic staff members at podiatric medical schools in Australia was undertaken. Most of the papers by Australian podiatric medical faculty members have been published in "local" journals, such as the Australasian Journal of Podiatric Medicine (38%) and the British Journal of Podiatry (17%). However, an increasing number of papers are being published in JAPMA (14%). In addition, a large proportion of papers have been published in a variety of journals that are not specific to podiatric medicine, particularly in the areas of biomechanics and diabetic medicine. The number of publications per faculty member was associated with the highest qualification obtained, academic rank, and the number of years of employment in higher education. The most important factors in selecting the journal in which to publish were the journal's inclusion in MEDLINE, the perceived prestige of the journal, and the quality of the journal's peer-review panel and editor.     

Implementation of computerized student-patient logs in podiatric medical education

In recent years, there has been a rapid increase in World Wide Web-based teaching and learning materials; however, present-day systems for recording student-patient interactions have trailed behind other academic areas in the appropriate use of technology. This article reviews the implementation of an innovative Web-based computerized student-patient log. This system represents considerable improvement in terms of efficiency and accuracy over traditional paper-based reporting systems. It facilitates faculty tracking of students' clinical experiences at geographically disparate locations and allows gaps in student knowledge to be more easily identified. Moreover, the Web-based system has the added advantage of making students responsible for their own learning, providing them with a sense of ownership of the data collected.     

Levels of evidence of articles in podiatric medical journals

The authors reviewed 322 articles in podiatric medical journals to determine their level of evidence. Only 1% of the articles reviewed were randomized controlled trials. The authors concluded that if the podiatric medical profession wishes to become a participant in evidence-based medicine, greater emphasis must be placed on studies that assess hypotheses.     

Future of gait analysis: a podiatric medical perspective

Despite the plethora of information on human gait analysis, its continued use as a clinical tool remains uncertain. Analysis of gait dysfunction has become integral to podiatric medical practice, and, like many specialized fields, it is rapidly changing to meet the needs of the future. Practice in the 21st century is predicated on the concept of multidisciplinary working approaches and a growing trend toward evidence-based practice, in which gait analysis could play a prominent role. This article provides a historical synopsis of instrumented gait analysis and its associated subcomponents and discusses the salient issues concerning its future role in podiatric medicine.     

Internet resources for podiatric medical students: an update

This article presents a selection of Internet resources covering most of the subject areas found in standard medical education curricula. Basic-sciences sites are emphasized, but clinical resources are also included. Sites were evaluated on the basis of their potential to enhance the learning process, provide practice questions or study guides for examinations, or aid in the preparation of papers. Podiatric medical students, residents, and practitioners who require a quick reference guide to sources covering the basic-science foundations of podiatric medicine or the clinical side of general medicine may find this article useful.     

Assessing the validity of published randomized controlled trials in podiatric medical journals

The purposes of this study were to develop an instrument to assess the validity of randomized controlled trials and to report on the differences in the validity of randomized controlled trials between two podiatric medical journals and a mainstream medical journal. The study demonstrated that after adequate training, there can be agreement among reviewers evaluating the quality of published randomized controlled trials using an established instrument and guidelines. The results of the study indicate that randomized controlled trials published in podiatric medical journals are less credible than those published in a mainstream medical journal.     

Use of a computerized digital camera in podiatric medical practice

Multimedia technology was once rarely found outside the realm of commercial production studios or in elaborate computer games. However, with the addition of only a few simple accessories, recent advances have made this technology readily available to the podiatric medical practitioner on a desktop office computer. The role that the application of multimedia technology using a computerized digital camera can play in a podiatric medical practice--including in such areas as record keeping, outcome measurement, patient education, interdisciplinary communications, and practice-management tools--is discussed.     

The need for randomized controlled trials in podiatric medical research

The randomized controlled trial is the most robust method available to evaluate health-care treatments. If podiatric medical practice is to be based on rigorous evidence, then high-quality randomized controlled trials are needed to inform that practice. In this article, we examine the extent to which randomized controlled trials are used in recent podiatric medical research and appraise the quality of those that are available. Using the Cochrane database of all randomized controlled trials in health care, we found only six relevant trials undertaken in podiatric medicine since 1997. These studies were of variable quality. We also discuss the key features of a rigorous trial design. To date, the clinical practice of podiatric medicine is not adequately informed by the best available evidence. We call for more high-quality randomized controlled trials to be undertaken in podiatric medical research.     

Protein C deficiency: podiatric medical relevance and case report

We describe the management of a patient who presented to a family-practice clinic with gangrenous digits. After a thorough evaluation, she was found to have protein C deficiency, which produced a hypercoagulable state. Differential diagnosis in the evaluation of the coagulopathic patient with appropriate hematologic tests is briefly discussed.     

The biology,medical management,and podiatric implications of menopause

Approximately 36 million women in the United States are in the postmenopausal phase of life, creating unique challenges for the provision of compassionate, comprehensive podiatric medical treatment. Long-term estrogen deprivation arising from menopause in association with age-related factors disproportionately increases the risk of ischemic heart disease, osteoporosis, and concomitant podiatric complications. This article discusses the physiologic basis of menopause, hormone replacement therapy and its effects on osteoporosis, and other podiatric implications of menopause. Podiatric physicians caring for larger numbers of peri- and postmenopausal women must formulate a comprehensive management plan for treating fractures that arise from a combination of estrogen-deprivation osteoporosis and abnormal foot biomechanics.