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Investigating pre-registration podiatry students approaches to identifying dermatology conditions in different skin tones: A mixed methods protocol.
IF 2.5 3区 医学 Q1 ORTHOPEDICS Pub Date : 2024-12-01 DOI: 10.1002/jfa2.70015
Simon Otter, Deborah Whitham, Gianluca Melotto, Lauren Mann, Yaa Agyare, Joanne Gozo-Reyes, Faye Funnell, Alex Sykes, Penny Dale

Background: Health inequalities are a well-known and widespread phenomenon throughout health care settings. In particular, people of color experience higher rates of delayed and/or misdiagnosis contributing to poorer outcomes and an increased mortality risk. Research suggests that health care professionals find it more difficult to correctly diagnose dermatological conditions in the non-White patient demographic. Although podiatrists routinely examine and assess skin lesions, there is a paucity of research exploring their accuracy or confidence in recognizing skin pathologies. This study aims to investigate podiatry student's ability, confidence, approaches, and perceptions in diagnosing dermatology pathologies in different skin tones. A mixed methods exploratory sequential design is proposed. In stage one, podiatry students from different higher education institutions will be invited to complete a pictorial survey. We have designed a survey comprising six validated images of inflammatory skin pathology (either eczema or psoriasis) in three different skin tone categories, standardized using the Fitzpatrick scale. Data from the survey in stage one will then be utilized to inform the next stage of the research. In stage two, respondents who completed the initial survey will be invited to participate in focus groups to explore their perceptions surrounding diagnostic approaches, confidence, and perceptions of skin conditions in different skin tone. A process of thematic analysis will be employed to identify emergent themes from these data.

Methods: A mixed methods exploratory sequential design is proposed. In stage one, podiatry students from different higher education institutions will be invited to complete a pictorial survey. We have designed a survey comprising six validated images of inflammatory skin pathology (either eczema or psoriasis) in three different skin tone categories, standardized using the Fitzpatrick scale. Data from the survey in stage one will then be utilized to inform the next stage of the research. In stage two, respondents who completed the initial survey will be invited to participate in focus groups to explore their perceptions surrounding diagnostic approaches, confidence, and perceptions of skin conditions in different skin tone. A process of thematic analysis will be employed to identify emergent themes from these data.

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引用次数: 0
The association of demographic, psychological, social and activity factors with foot health in people with plantar heel pain.
IF 2.5 3区 医学 Q1 ORTHOPEDICS Pub Date : 2024-12-01 DOI: 10.1002/jfa2.70022
Halime Gulle, Dylan Morrissey, Abdulhamit Tayfur, Dilber Karagozoglu Coskunsu, Stuart Miller, Aleksandra V Birn-Jeffery, Trevor Prior

Background: Plantar Heel Pain (PHP) can be a debilitating musculoskeletal condition from which only 50% recover within a year due to poor understanding of the mechanisms explaining severity and predicting outcomes specific to PHP.

Objective: To explore associations between biopsychosocial variables and the severity of people with PHP. Secondly, to determine what combination of self-reported factors distinguishes people with PHP from other foot pain (OFP).

Methods: We collected data from 235 participants, including 135 (%57) PHP (age 44 ± 12 years, 66% female) and 99 OFP (%43) (age 38 ± 11 years, 57% female) using 5 demographic, 13 biomedical, 8 psychological, 3 social and 8 activity-related factors. These were tested in linear and logistic regression models.

Results: Quality of life (QoL) (β = 0.35; p < 0.001), education (β = -0.22; p = 0.003), gender (β = -0.20; p = 0.007), morning pain duration (β = -0.18; p = 0.01) and disease duration (β = -0.15; p = 0.040) were significantly associated with severity of PHP. The second model, without QoL, showed that having sensitisation (β = -0.18; p = 0.002) and a higher level of morning pain (β = -0.20; p = 0.01) are associated with severity. The logistic regression results revealed that people with PHP tend to have a systemic disease (OR = 3.34; 1.53-7.76), express more kinesiophobia (OR = 1.02; 1.01-1.14), are less likely to have previous injuries (OR = 0.40; 0.19-0.81), worse morning pain (OR = 1.02; 1.01-1.03) and standing pain (OR = 2.60; 1.39-4.87) compared to people with OFP.

Conclusions: People with PHP have higher associated levels of a range of psychological, social and activity related factors than people with OFP. The findings highlight the importance of considering psychosocial assessments alongside physical examination.

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引用次数: 0
Revised minimal important difference values for the visual analogue scale and Foot Health Status Questionnaire when used for plantar heel pain.
IF 2.5 3区 医学 Q1 ORTHOPEDICS Pub Date : 2024-12-01 DOI: 10.1002/jfa2.70021
Karl B Landorf, Georgia N Twyford, Matthew P Cotchett, Glen A Whittaker

Background: The visual analogue scale (VAS) and the Foot Health Status Questionnaire (FHSQ) are patient-reported outcome measures that are frequently used to evaluate the management of plantar heel pain. This study aimed to re-calculate (i.e. revise) the minimal important differences (MIDs) of the VAS and the FHSQ when used for plantar heel pain to enhance the validity and precision of previous estimates.

Methods: This study used an anchor-based method to calculate MIDs and incorporated best-practice analyses to ensure credibility of the estimates. Data from 369 participants previously recruited from the community into four randomised controlled trials that evaluated interventions for plantar heel pain were used. VAS and FHSQ data from these participants at baseline and follow-up were pooled to calculate the MIDs (95% confidence intervals). A 15-point global rating of change Likert scale was used at follow-up as the transition scale, which was anchored to baseline. For the VAS, MIDs for two distinct types of pain were calculated: average pain and first-step pain. For the FHSQ, MIDs for two domains were calculated: foot pain and foot function.

Results: The revised MIDs for the 100 mm VAS were -8.5 mm (95% CI: -12.2 to -4.7) for average pain and -19.2 mm (95% CI: -24.7 to -13.8) for first-step pain, which represent improvements in pain. The MIDs for the FHSQ were 12.4 points (95% CI: 6.9 to 18.0) for foot pain and 6.4 points (95% CI: 0.9 to 11.9) for foot function, which represent improvements in foot health status.

Conclusions: The revised MIDs from this study for the VAS and the FHSQ when used for plantar heel pain have enhanced validity and precision compared to previous estimates. This is important for clinicians and researchers as it provides a better understanding of how much improvement is required by an individual before an important change is experienced. The revised MIDs will also assist researchers with prospective sample size calculations, so future clinical trials are appropriately powered from a statistical standpoint.

背景:视觉模拟量表(VAS)和足部健康状况问卷(FHSQ)是患者报告的结果测量方法,常用于评估足跟痛的治疗效果。本研究旨在重新计算(即修订)视觉模拟量表和足部健康状况调查表用于足跟痛时的最小重要差异(MIDs),以提高之前估计值的有效性和精确性:本研究采用基于锚的方法计算最小重要差异,并纳入最佳实践分析,以确保估计值的可信度。研究使用了之前从社区招募的 369 名参与者的数据,这些参与者参加了四项评估足跟痛干预措施的随机对照试验。将这些参与者在基线和随访期间的 VAS 和 FHSQ 数据进行汇总,计算出中位数(95% 置信区间)。随访时使用 15 分的总体变化李克特量表作为过渡量表,该量表与基线锚定。对于 VAS,计算了两种不同类型疼痛的中位数:平均疼痛和第一步疼痛。对于 FHSQ,计算了两个领域的中位数:足部疼痛和足部功能:修订后的 100 毫米 VAS 平均疼痛中位数为-8.5 毫米(95% CI:-12.2 至-4.7),第一步疼痛中位数为-19.2 毫米(95% CI:-24.7 至-13.8),这代表疼痛有所改善。FHSQ 的中位数分别为:足部疼痛 12.4 分(95% CI:6.9 至 18.0),足部功能 6.4 分(95% CI:0.9 至 11.9),代表足部健康状况有所改善:本研究修订的 VAS 和 FHSQ 中值用于足跟痛时,与之前的估计值相比,有效性和精确性都有所提高。这对于临床医生和研究人员来说非常重要,因为他们可以更好地了解个人需要改善多少才能体验到重要的变化。修订后的中位数还将有助于研究人员进行前瞻性样本量计算,从而使未来的临床试验从统计学角度获得适当的动力。
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引用次数: 0
Determining health professional students' self-perceived cultural capability following participation in clinical placement with Aboriginal and Torres Strait Islander Peoples: A systematic review.
IF 2.5 3区 医学 Q1 ORTHOPEDICS Pub Date : 2024-12-01 DOI: 10.1002/jfa2.70017
Kate Paisley, Sean Sadler, Matthew West Wiradjuri, James Gerrard, Rhonda Wilson Wiradjuri, Angela Searle, Vivienne Chuter

Background: Collective evaluation of studies assessing students' self-perceived cultural capability following clinical placement is required to help inform future cultural capability training for both university and healthcare service environments. Therefore, the aim of this systematic review was to evaluate studies investigating health professional students' self-perceived cultural capability following participation in a clinical placement with First Nations Peoples.

Methods: Electronic database searchers were conducted in MEDLINE, EMBASE, AMED, PsychINFO, Pubmed, CINAHL and Informit. Hand Searches of grey literature were conducted including Lowitja institute, Australian Indigenous HealthInfoNet, Menzies School of Health Research, Services for Australian Rural and Remote Allied Health, and the Australian Institute of Health and Welfare. Studies published in English that investigated health professional students' self-perceived cultural capability before and after clinical placement undertaken with First Nations people in Australia were eligible for inclusion. Two authors independently screened potentially eligible studies and performed quality appraisal and data extraction.

Results: A total of 14 studies were included (n = 307 participants). Studies included undergraduate students from podiatry, medicine, nursing, pharmacy, and mixed health professions. The results of this systematic review suggest that clinical placements in health services or settings for Aboriginal and Torres Strait Islander Peoples that involve elements of co-design are effective in increasing aspects of health professional students' self-perceived cultural capability. This outcome was consistent across studies regardless of the location of clinical placements (urban or rural), type of clinical placement (health setting or Community), or length of placement.

Conclusions: The findings from this systematic review suggest that clinical placement in health services or settings for Aboriginal and Torres Strait Islander Peoples may contribute to increased self-perceived cultural capability in health professions graduates. However, the impact of the placements on the cultural safety of student-led care, from a First Nations perspective, remains to be established.

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引用次数: 0
Simulation in podiatry teaching and learning: A scoping review.
IF 2.5 3区 医学 Q1 ORTHOPEDICS Pub Date : 2024-12-01 DOI: 10.1002/jfa2.70020
Naomi Anning, Peta Tehan

Background: In podiatry, there are a variety of clinical tasks that require precision and skill and it is expected that clinicians will obtain these skills during their training. Simulation is a dynamic teaching tool used in healthcare to enhance skill and knowledge acquisition. Currently, the extent and nature of the research on the use of simulation in podiatry teaching and learning are not clear.

Aim: A scoping review was conducted to identify the extent and nature of research activity on the use of simulation in podiatry teaching and learning and identify gaps in the existing literature.

Methods: Any research relating to simulation use in podiatry teaching including various designs and focusing on simulations aimed at improving podiatry teaching or learning were eligible for inclusion. A systematic search was conducted on February 14, 2024 of the following databases: Embase (via Embase.com), MEDLINE (via PubMed), CINAHL, and the Web of Science. Additional papers were identified via bibliographies of included studies. Content analysis of content relating to podiatry teaching and learning was performed and grouped into broad themes, then further narrowing to six themes.

Results: A total of 21 research studies were deemed eligible for inclusion focusing on diverse aspects of podiatry simulation utilized in high-income countries exclusively. Conducted between 1997 and 2023, these studies were categorized into six key themes: skill improvement, communication and professionalism, clinical competencies and patient safety, educational enhancement, and anatomy and histology education. The simulations, carried out by or assessed for podiatry professionals, staff, or students, ranged from high-fidelity medical mannequins to low-fidelity simulations such as a grapefruit model of a diabetes-related foot ulcer.

Conclusion: Overall, the findings suggest that simulation teaching in podiatry, whether through direct skill enhancement or through educational impact assessments, holds potential in improving competency, confidence, and educational outcomes in podiatry practice. This scoping review identified a small yet diverse evidence base for simulation modalities in podiatry education, demonstrating gaps in long-term effects and comparative effectiveness studies. It highlights the urgent need for research focused on longitudinal impacts, evaluating various simulation technologies and standardizing best practices to improve podiatry education and align with clinical and patient care needs.

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引用次数: 0
Relationship of foot pain with the increased risk of falls in patients with Parkinson's disease.
IF 2.5 3区 医学 Q1 ORTHOPEDICS Pub Date : 2024-12-01 DOI: 10.1002/jfa2.70023
Ana María Jiménez-Cebrián, Francisco Javier Ruiz-Sánchez, Marta Elena Losa-Iglesias, Ricardo Becerro-de-Bengoa-Vallejo, Daniel López-López, Alonso Montiel-Luque, Carmen de Labra, Miguel Ángel Saavedra-García, Emmanuel Navarro-Flores

Introduction: Falls are one of the most frequent difficulties in patients with Parkinson's disease. The objective of this study was to determine the relationship between foot pain and the risk of falls in participants with Parkinson's disease compared to a group of participants without Parkinson's disease.

Materials and methods: The subjects (124) were divided into two groups, cases (n = 62) and controls (n = 62). They completed the Downton scale that collects the following 5 dimensions: previous falls, medications, sensory deficit, mental state, and ambulation.

Results: Analyzing the Downton scale using dimensions, a significant difference was observed between both groups in all dimensions except mental state. Regarding the global result of risk of falls, the participants who had a diagnosis of Parkinson's disease presented a high risk of falls, 40.3% compared to 3.2% of the non-Parkinson's disease group, with statistically significant differences (p < 0.05). For the numerical value of the Downton scale, there was a clear statistically significant difference between groups (2.65 ± 0.96 vs. 1.31 ± 1.19).

Conclusion: This research confirms further evidence that people with Parkinson's disease who suffer from foot pain are at high risk of falling, regardless of gender.

简介跌倒是帕金森病患者最常遇到的困难之一。本研究旨在确定帕金森病患者与非帕金森病患者相比,足部疼痛与跌倒风险之间的关系:研究对象(124 人)分为两组,病例组(62 人)和对照组(62 人)。他们填写了唐顿量表,该量表收集了以下 5 个维度:以前跌倒过、药物治疗、感觉缺失、精神状态和行动能力:通过对唐顿量表的维度进行分析,发现除精神状态外,两组在所有维度上都存在显著差异。关于跌倒风险的总体结果,诊断为帕金森病的参与者跌倒风险较高,为 40.3%,而非帕金森病组为 3.2%,差异有统计学意义(P 结论:该研究进一步证实,帕金森病患者跌倒风险较高,为 40.3%,而非帕金森病组为 3.2%:这项研究进一步证实,患有帕金森病并伴有足部疼痛的患者,无论男女,都有很高的跌倒风险。
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引用次数: 0
Motivators and barriers for studying podiatry in Australia and New Zealand: A mixed methods study. 在澳大利亚和新西兰学习足病学的动机和障碍:混合方法研究。
IF 2.5 3区 医学 Q1 ORTHOPEDICS Pub Date : 2024-09-01 DOI: 10.1002/jfa2.70004
Michelle R Kaminski, Glen A Whittaker, Caroline Robinson, Matthew Cotchett, Malia Ho, Shannon E Munteanu, Mollie Dollinger, Sia Kazantzis, Xia Li, Ryan S Causby, Mike Frecklington, Steven Walmsley, Vivienne Chuter, Sarah L Casey, Burke Hugo, Daniel R Bonanno

Background: Podiatry enrolments at Australian and New Zealand universities have decreased by 17.3% since 2015, which threatens the profession's sustainability and the health and wellbeing of Australian and New Zealand people and communities. Reasons for this decline remain unclear due to insufficient evidence on factors influencing career choices. The overarching aim of this study was to identify motivators and barriers for studying podiatry in Australia and New Zealand.

Methods: This study used a convergent mixed methods design. Students enrolled in (i) podiatry and (ii) relevant non-podiatry health, sport or science programs at nine Australian and one New Zealand university, were invited to participate in an online survey. First-year podiatry students were also invited to participate in an online workshop. Quantitative data were analysed using descriptive statistics and linear/logistic regression models. Three independent assessors used inductive thematic analysis for the qualitative data.

Results: Overall, 278 podiatry students (mean age 24.9 ± 8.5 years, 65.1% female) and 553 non-podiatry students (mean age 24.8 ± 8.2 years, 75.4% female; 32.2% from physiotherapy and 29.1% from occupational therapy) responded to the survey. Interest in a health-related career, wanting to make a difference to people's health, and opportunity to care for people from different backgrounds/age groups were key motivating factors among podiatry students. Barriers to studying podiatry were encountered by 28.1% of podiatry students. Thematic analysis identified seven themes concerning career choice, which are as follows: (i) awareness of profession and scope of practice; (ii) stereotypes and negative perceptions of the profession; (iii) awareness of career pathways; (iv) job prospects and earning potential; (v) working with people and building relationships; (vi) podiatry is not the first preference; and (vii) barriers which limit student enrolment.

Conclusions: There are a variety of factors that motivate and influence students to study podiatry, however, altruistic reasons are most highly rated. Allied health students have limited understanding of the scope of practice and career opportunities in podiatry. Additionally, the podiatry profession often faces negative stereotypes. Further work is required to reverse the negative stereotypes and perceptions of podiatry and build knowledge of the profession's scope of practice, career pathways/opportunities, job prospects and earning potential.

背景:自2015年以来,澳大利亚和新西兰大学的足病专业入学人数减少了17.3%,这威胁到了该专业的可持续发展以及澳大利亚和新西兰人民及社区的健康和福祉。由于影响职业选择的因素证据不足,导致这一下降的原因仍不清楚。本研究的总体目标是确定在澳大利亚和新西兰学习足病学的动机和障碍:本研究采用聚合混合方法设计。9所澳大利亚大学和1所新西兰大学的(i)足病学专业和(ii)相关的非足病学健康、体育或科学专业的学生受邀参加了在线调查。足病学一年级学生也应邀参加了在线研讨会。定量数据采用描述性统计和线性/逻辑回归模型进行分析。三位独立评估员对定性数据进行了归纳主题分析:共有 278 名足病专业学生(平均年龄为 24.9 ± 8.5 岁,65.1% 为女性)和 553 名非足病专业学生(平均年龄为 24.8 ± 8.2 岁,75.4% 为女性;32.2% 来自物理治疗专业,29.1% 来自职业治疗专业)参与了调查。对与健康相关的职业感兴趣、希望为人们的健康做出贡献以及有机会照顾不同背景/年龄段的人是足病学学生学习的主要动机。28.1%的足病学学生在学习足病学时遇到了障碍。通过主题分析,确定了以下七个有关职业选择的主题:(i) 对职业和执业范围的认识;(ii) 对职业的成见和负面看法;(iii) 对职业途径的认识;(iv) 工作前景和收入潜力;(v) 与人打交道和建立关系;(vi) 足病治疗不是第一选择;(vii) 限制学生入学的障碍:激励和影响学生学习足病学的因素多种多样,但利他的原因最受好评。联合健康专业的学生对足病专业的实践范围和职业机会了解有限。此外,足病学专业经常面临负面的刻板印象。需要进一步开展工作,以扭转对足病治疗的负面成见和看法,并建立对该专业执业范围、职业途径/机会、就业前景和收入潜力的认识。
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引用次数: 0
Biomechanical effectiveness of controlled ankle motion boots: A systematic review and narrative synthesis. 可控踝关节运动靴的生物力学效果:系统综述和叙述性综述。
IF 2.5 3区 医学 Q1 ORTHOPEDICS Pub Date : 2024-09-01 DOI: 10.1002/jfa2.12044
Mason L Stolycia, David E Lunn, Will Stanier, Josh Walker, Richard A Wilkins

Introduction: Controlled ankle motion (CAM) boots are a below-knee orthotic device prescribed for the management of foot and ankle injuries to reduce ankle range of motion (RoM) and offload the foot and ankle whilst allowing continued ambulation during recovery. There is a lack of clarity within the current literature surrounding the biomechanical understanding and effectiveness of CAM boots.

Aims: To summarise the biomechanical effects of CAM boot wear as an orthotic for restricting ankle RoM and offloading the foot.

Methods: A systematic literature review was conducted in accordance with the PRISMA 2020 guidelines. All papers were independently screened by two authors for inclusion. Methodological quality was appraised using Joanna Briggs Critical Appraisal checklists. A narrative synthesis of all eligible papers was produced.

Results: Thirteen studies involving 197 participants (113 male and 84 female) were included. All studies were quasi-randomised and employed a within-study design, of which 12 studies included a control group and a range of CAM boots were investigated. CAM boots can be seen to restrict ankle RoM, however, neighboring joints such as the knee and hip do have kinetic and kinematic compensatory alterations. Plantar pressure of the forefoot is effectively redistributed to the hindfoot by CAM boots.

Conclusion: The compensatory mechanisms at the hip and knee joint during CAM boot wear could explain the secondary site pain often reported in patients, specifically at the ipsilateral knee and contralateral hip. Although CAM boots can be used to restrict ankle motion, this review has highlighted a lack of in-boot kinematic analyses during CAM boot use, where tracking markers are placed on the anatomical structure rather than on the boot, or through video fluoroscopy, urging the need for a more robust methodological approach to achieve this. There is a need for studies to assess the biomechanical alterations caused by CAM boots in populations living with foot and ankle pathologies. Future research, adopting a longitudinal study design, is required to fully understand the effectiveness of CAM boots for rehabilitation.

简介:可控踝关节活动(CAM)靴是一种膝下矫形器,用于治疗足踝损伤,以减少踝关节活动范围(RoM),减轻足踝负担,同时允许在恢复期间继续行走。目的:总结穿戴 CAM 靴作为限制踝关节活动范围和减轻足部负担的矫形器的生物力学效果:根据 PRISMA 2020 指南进行了系统性文献综述。所有论文均由两位作者独立筛选后纳入。采用乔安娜-布里格斯批判性评估检查表对方法学质量进行评估。对所有符合条件的论文进行了叙述性综合:共纳入 13 项研究,涉及 197 名参与者(男性 113 人,女性 84 人)。所有研究都是准随机的,并采用了研究内设计,其中 12 项研究包括一个对照组,并对一系列 CAM 靴子进行了调查。可以看出,CAM 靴子限制了踝关节的 RoM,但是,膝关节和髋关节等邻近关节确实出现了动力学和运动学上的代偿性改变。CAM 靴子能有效地将前脚掌的足底压力重新分配到后脚掌:结论:穿着 CAM 靴期间,髋关节和膝关节的代偿机制可以解释患者经常报告的继发性疼痛,特别是同侧膝关节和对侧髋关节的疼痛。虽然 CAM 靴可用于限制踝关节运动,但本综述强调了缺乏对穿着 CAM 靴期间的靴内运动学分析,即在解剖结构上而非靴子上放置跟踪标记,或通过视频透视进行分析,因此需要更稳健的方法来实现这一目标。有必要开展研究,以评估 CAM 靴对患有足踝疾病的人群造成的生物力学改变。未来的研究需要采用纵向研究设计,以充分了解 CAM 靴对康复的有效性。
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引用次数: 0
Navigating the integration of knowledge and research evidence in clinical practice for children's foot health: A multi-professional survey. 在儿童足部健康临床实践中整合知识和研究证据:一项多专业调查。
IF 2.5 3区 医学 Q1 ORTHOPEDICS Pub Date : 2024-09-01 DOI: 10.1002/jfa2.12034
Lisa Hodgson, Carina Price, Julie Reay, Chris Nester, Stewart C Morrison

Background: Access to clinical services for children with foot and ankle problems are important, but unravelling the complexity of practice and service delivery can be challenging. The pursuit and implementation of research evidence is critical for driving positive change in practice, but little is understood about the approaches to knowledge and research acquisition in children foot health.

Aim: The aim of the study was to: (1) explore multi-professional habits of knowledge and research evidence acquisition in children's foot health; and (2) understand how clinicians integrate information for children and their families into their practice.

Methods: This was a descriptive, cross-sectional online survey. Participants were included if they worked in the UK and had experience of working within paediatric services.

Results: There were complete responses from 247 health professionals, representing physiotherapists (n = 160), podiatrists (n = 50), orthotists (n = 25), nurses and specialists in community public health nurses (health visitors) (n = 12). Three main themes were generated from the data: (1) Factors that influence knowledge and inform clinical practice. (2) The role of Professional Bodies in informing professional knowledge. (3) Health Professionals' views on managing health information for parents and caregivers.

Conclusions: This work advances understanding of the value health professionals' place in the development of materials for informing professional knowledge, as well as highlighting some of the challenges with translation of knowledge into clinical practice. The findings offer a national perspective of health professionals working on children's foot health and have highlighted that some of the most valued influences on clinical practice come from peer-to-peer networking.

背景:为有足踝问题的儿童提供临床服务非常重要,但要了解实践和服务提供的复杂性却极具挑战性。研究证据的追求和实施对于推动实践中的积极变化至关重要,但人们对儿童足部健康知识和研究的获取方法知之甚少。目的:本研究旨在:(1)探索儿童足部健康知识和研究证据获取方面的多专业习惯;(2)了解临床医生如何将儿童及其家庭的信息纳入其实践:这是一项描述性横断面在线调查。调查对象包括在英国工作并具有儿科服务工作经验的人员:共有 247 名医疗专业人员提供了完整的答复,其中包括物理治疗师(160 人)、足病治疗师(50 人)、矫形师(25 人)、护士和社区公共卫生护士专家(健康访视员)(12 人)。从数据中得出三大主题:(1) 影响知识和临床实践的因素。(2) 专业机构在提供专业知识方面的作用。(3) 卫生专业人员对管理父母和看护人健康信息的看法:这项研究加深了人们对卫生专业人员在专业知识信息材料开发中的价值的理解,同时也强调了将知识转化为临床实践所面临的一些挑战。研究结果为从事儿童足部健康工作的卫生专业人员提供了一个全国性的视角,并强调了一些对临床实践最有价值的影响来自于同行间的交流。
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引用次数: 0
Exploring potential risk factors for lower limb amputation in people with diabetes-A national observational cohort study in Sweden. 探索糖尿病患者下肢截肢的潜在风险因素--瑞典全国观察性队列研究。
IF 2.5 3区 医学 Q1 ORTHOPEDICS Pub Date : 2024-09-01 DOI: 10.1002/jfa2.70005
Simon Ramstrand, Michael Carlberg, Gustav Jarl, Anton Johannesson, Ayako Hiyoshi, Stefan Jansson

Aims: Risk factors for lower limb amputation (LLA) in individuals with diabetes have been under-studied. We examined how 1/demographic and socioeconomic, 2/medical, and 3/lifestyle risk factors may be associated with LLA in people with newly diagnosed diabetes.

Methods: Using the Swedish national diabetes register from 2007 to 2016, we identified all individuals ≥18 years with an incident diabetes diagnosis and no previous amputation. These individuals were followed from the date of diabetes diagnosis to amputation, emigration, death, or the end of the study in 2017 using data from the In-Patient Register and the Total Population Register. The cohort consisted of 66,569 individuals. Information about demographic, socioeconomic, medical, and lifestyle risk factors was ascertained around the time of the first recorded diabetes diagnosis, derived from the above-mentioned registers. Cox proportional hazard models were used to obtain hazard ratios (HR) with 95% confidence intervals (CI).

Results: During the median follow-up time of 4 years, there were 133 individuals with LLA. The model adjusting for all variables showed a higher risk for LLA with higher age, HR 1.08 (95% CI 1.05-1.10), male sex, HR 1.57 (1.06-2.34), being divorced, HR 1.67 (1.07-2.60), smokers HR 1.99 (1.28-3.09), insulin treated persons HR 2.03 (1.10-3.74), people with low physical activity (PA) HR 2.05 (1.10-3.74), and people with an increased foot risk at baseline HR > 4.12. People with obesity had lower risk, HR 0.46 (0.29-0.75).

Conclusions: This study found a higher risk for LLA among people with higher age, male sex, who were divorced, had a higher foot risk group, were on insulin treatment, had lower PA levels, and were smokers. No significant association was found between risk for LLA and education level, country of origin, type of diabetes, blood glucose level, hypertension, hyperlipidemia, creatinine level, or glomerular filtration rate. Obesity was associated with lower risk for LLA. Identified variables may have important roles in LLA risk among people with diabetes.

目的:对糖尿病患者下肢截肢(LLA)的风险因素研究不足。我们研究了1/人口和社会经济因素、2/医疗因素和3/生活方式风险因素如何与新诊断糖尿病患者的下肢截肢相关:利用瑞典 2007 年至 2016 年的全国糖尿病登记册,我们确定了所有年龄≥18 岁、诊断为糖尿病且既往未截肢的患者。我们利用住院病人登记册和总人口登记册中的数据,对这些人从糖尿病确诊之日到截肢、移民、死亡或 2017 年研究结束的整个过程进行了随访。队列由 66569 人组成。有关人口、社会经济、医疗和生活方式等风险因素的信息是在首次诊断糖尿病时从上述登记册中获得的。采用 Cox 比例危险模型得出危险比(HR)及 95% 置信区间(CI):结果:在中位数为 4 年的随访期间,共有 133 人患有 LLA。调整所有变量的模型显示,年龄越大,LLA 的风险越高,HR 为 1.08 (95% CI 1.05-1.10);性别为男性,HR 为 1.57 (1.06-2.34);离异,HR 为 1.67 (1.07-2.60);吸烟,HR 为 1.99(1.28-3.09)、接受胰岛素治疗的人 HR 2.03(1.10-3.74)、体力活动(PA)少的人 HR 2.05(1.10-3.74)、基线足部风险增加的人 HR > 4.12。肥胖者的风险较低,HR 为 0.46(0.29-0.75):本研究发现,年龄较大、性别为男性、离异、足部风险较高、接受胰岛素治疗、PA水平较低和吸烟的人群患LLA的风险较高。LLA风险与教育水平、原籍国、糖尿病类型、血糖水平、高血压、高脂血症、肌酐水平或肾小球滤过率之间没有明显的关联。肥胖与较低的 LLA 风险有关。所发现的变量可能对糖尿病患者的LLA风险有重要影响。
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Journal of Foot and Ankle Research
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