Prevalence of Hypertension and Related Characteristics: Perspectives from an Outpatient Podiatric Medical Clinic

BACKGROUND

Hypertension is a highly prevalent condition in the general population, conferring a high risk of significant morbidity and mortality. Associated with the condition are many well-characterized controllable and noncontrollable risk factors. This study aimed to identify the prevalence of hypertension in the outpatient podiatric medical clinic setting and to determine the relevance of hypertension risk factors in this setting.

METHODS

A survey tool was created to characterize relevant risk factors, and systolic and diastolic blood pressures were recorded. Descriptive statistics were generated after conclusion of enrollment. Analysis was also performed to determine the relationship between individual risk factors and systolic blood pressure.

RESULTS

Of the 176 patients, 56 (31.8%) had an incidentally high blood pressure at intake, including 18.5% of patients without a known history of hypertension and 38.5% with a known history of hypertension. Three risk factors were found to be significantly associated with increasing systolic blood pressure: weight (P = .022), stress level (P = .017), and presence of renal artery stenosis (P = .021). There was also a near-statistically significant inverse relationship between systolic blood pressure and amount of time spent exercising (P = .068).

CONCLUSIONS

Overall, a relatively high prevalence of incidental hypertension was identified, including among patients not previously diagnosed as having hypertension. Consideration of risk factors and awareness of the prevalence of the condition can be useful for practitioners, even as they manage presenting podiatric medical concerns. Future investigations may consider interventional or preventive strategies in the outpatient clinic setting.

Prevalence of Depression in Podiatric Medical Students

BACKGROUND

Although depression and depressive symptoms have been previously explored in various medical student cohorts, there has been a lack of formal investigation among podiatric medical students specifically. The purpose of this study was to identify the prevalence and related characteristics of depression and depressive symptoms in podiatric medical students.

METHODS

A mixed-methods approach was used. Students at a podiatric medical college were asked to complete the Center for Epidemiologic Studies Depression Scale Revised survey electronically each year for 4 consecutive years. Focus group sessions were also conducted to further explore topics related to depression and depressive symptoms.

RESULTS

Surveys were completed by 271 of 539 potential respondents (50.3%). A total of 34.7% of respondents screened positive for depression or depressive symptoms, defined as meeting or exceeding the criteria for subthreshold depressive symptoms on the Center for Epidemiologic Studies Depression Scale Revised. The prevalence was found to be lower in clinical students (third- and fourth-year students) and in students in committed relationships. Themes from the focus group sessions included the following: coping with stress, general health concerns, self-evaluation, action and preparation, and the use of campus resources.

CONCLUSIONS

Depression and depressive symptoms were commonly encountered in this podiatric medical student cohort. Future investigations may consider specific treatment and prevention strategies.

Integration of Podiatric Medicine Within the Fracture Liaison Services Model

Underlying bone metabolic disorders are often neglected when managing acute fractures. The term fracture liaison services (FLS) refers to models of care with the designated responsibility of comprehensive fracture management, including the diagnosis and treatment of osteoporosis. Although there is evidence of the effectiveness of FLS in reducing health-care costs and improving patient outcomes, podiatric practitioners are notably absent from described FLS models. The integration of podiatric practitioners into FLS programs may lead to improved patient care and further reduce associated health-care costs.

Fourth-Year Podiatric Medical Student Perspectives on Clerkships and Residency Selection

BACKGROUND

The fourth year of podiatric medical school is an important period in the education of the podiatric medical student, a period that consists largely of month-long clerkships. Nonetheless, there has been limited formal study of the quality of learning experiences during this period. Furthermore, there is limited knowledge of how podiatric medical students evaluate residency programs during clerkships.

METHODS

An online survey was developed and distributed electronically to fourth-year podiatric medical school students. The focus of the survey was the quality of learning experiences during externships, and decision making in ranking residency programs.

RESULTS

The most valuable learning experiences during clerkships were interactions with attending physicians, interactions with residents, and general feedback in surgery. Students self-identified that they most improved in the following areas during clerkships: forefoot surgery, clinical podiatry skills, and rearfoot surgery. The areas in which students improved the least were research, pediatrics, and practice management. The three most important factors students considered as they created their rank list were hands-on resident participation in surgical training, the attitude and personality of the residents, and the attitude and personality of the attending physicians. A range of surgical interest was identified among students, and students lacking in surgical interest self-reported less improvement in various surgical topics.

CONCLUSIONS

The perspectives of fourth-year podiatric medical students are currently an underused resource. Improved understanding can help residency programs improve the quality of associated learning experiences and can make their programs more appealing to potential residency candidates.

Reproducibility and Reliability of the Radiographic Angles Used to Assess Tailor's Bunions

BACKGROUND

Tailor's bunion, or bunionette, deformity is a common condition of the lateral forefoot. To aid in assessing the deformity, radiographic angular measurements are frequently used. The objective of this study was to determine the reliability and reproducibility of these angular measurements.

METHODS

Thirty unique weightbearing dorsoplantar digital radiographs of pathologic feet were compiled. For these 30 radiographs and for ten repeated radiographs, six practicing clinicians measured the following angles: the fourth to fifth intermetatarsal angle, the lateral deviation angle, and the fifth metatarsophalangeal angle. Both traditional and modified versions of the fourth to fifth intermetatarsal angle were included.

RESULTS

Intraclass correlation coefficient values were calculated for each of the angles studied. Intrarater reliability was highest for the fifth metatarsophalangeal angle and lowest for the lateral deviation angle. Intrarater reliability was higher for the traditional fourth to fifth intermetatarsal angle than for the modified version. The interrater reliability calculations revealed parallel findings.

CONCLUSIONS

Accurate assessment is critical when planning for surgical intervention. Awareness of the relative reliability of these radiographic angular measurements can aid in preoperative planning and may be of benefit in procedure selection.

The impact of comorbidities on inpatient Charcot neuroarthropathy cost and utilization

AIMS

The purpose of this study was to portray the impact of comorbidities on inpatient cost and utilization in Charcot neuroarthropathy (CN) patients.

METHODS

Two cohorts, CN and diabetic peripheral neuropathy (DPN), were identified by ICD-9 codes in the California Office for Statewide Health Planning and Development 2009-2012 public patient discharge files. DPN and CN costs and length of stay (LOS) were compared adjusting for the number of chronic conditions. The impact of the Elixhauser comorbidity measures and other comorbidities on costs and LOS in CN subjects was evaluated.

RESULTS

CN was associated with 17.2% higher costs and 1.4 days longer LOS compared to DPN alone. Adjusting for 0.71 additional chronic conditions in CN patients accounted for 79.8% of variance and estimated a 13.9% cost difference between cohorts. Subjects averaged 4.5 Elixhauser comorbidities with higher scores corresponding to increased cost, LOS, and inpatient mortality. Other diabetic foot risk factors demonstrated that foot ulcers, foot infections, and osteomyelitis had significantly higher costs. Patients with foot ulcers, osteomyelitis, and depression had significantly increased LOS.

CONCLUSIONS

Systemic and local comorbidities significantly impact the cost, utilization, and inpatient mortality in inpatient management of Charcot foot.