A conceptual model for public health education in podiatric medicine.

This article discusses the need for and the advantages of a dual degree program between podiatric medicine and public health. The authors expand on the existing program for public health education at the first professional degree level to include a conceptual model for a dual degree program developed at Temple University's Department of Health Studies, through the Graduate School and the School of Podiatric Medicine. The model combines didactic and clinical education at the graduate level to ensure that clinicians involved in determining health policy are prepared to represent the profession in the restructuring of the health-care system.

A conceptual model for a geriatric fellowship in podiatric medicine.

The number of older individuals living in the United States is projected to increase significantly over the next few decades. To help meet the health-care needs of this growing population, podiatric medicine must assure the public of the availability of specially educated teachers and practitioners who can not only provide direct patient care, but also participate in establishing national policies and priorities pertaining to foot health. Fellowship training, the traditional educational model beyond the first professional degree and residency education, is one means of accomplishing this goal. This article proposes a model for a geriatric fellowship in podiatric medicine. Implementation of such fellowship training in geriatrics can help the podiatric medical profession pursue its mission and fulfill its responsibility to the public.

A conceptual model for a geriatric syllabus for podiatric medicine.

Foot disorders and the complications of chronic disease in the older population have a significant effect on society, the cost of health care, and individuals' quality of life. Given podiatric medicine's role in the management of problems of the aging, it is critical that the profession's educational system produce practitioners who understand the process of aging and the needs of the older patient and who are prepared to serve on the health-care-delivery team as the primary providers of foot-care services. The geriatric syllabus presented here is one approach to attaining that goal.

Integrating strategies for podiatric public health, clinical services, and education.

Changes in the health-care system will continue to modify the delivery of podiatric medical care and podiatric medical education. Podiatric medicine and its educational programs will need to focus on the management of care, special populations, and disease prevention. Future providers will need to participate as team members and respond to new patterns of care, including the special needs of the older population. This article explores methodologies for professional activities, administration, incentives for change, academic issues, innovation, implementation, outcome measures, and health policy development. Podiatric medicine must be prepared to establish standards, protocols, and guidelines to serve as the benchmark for foot health.

Podiatric medicine and public health. Concepts and perspectives. Special Commission of the Podiatric Health Section of the American Public Health Association.

Podiatric physicians play an important role in the field of public health. In 1975, the Podiatric Health Section of the American Public Health Association (APHA) formulated an official statement of the roles and responsibilities of podiatrists in the public health field. Entitled Functions and Educational Qualifications of Podiatrists in Public Health, the document was published in the September 1975 issue of the American Journal of Public Health. For more than 2 decades, it remained the primary document defining and delineating the activities of the specialist in podiatric public health. Recently, it was recognized that in this time of rapid change in health-care delivery, a revision of this important statement was needed. A mini-grant from the APHA in 1996-1997 supported the formation of a special commission to update the formal position of the APHA and its Podiatric Health Section with respect to podiatric public health and to provide direction for the future. This article is a shortened version of the report issued by the special commission of the APHA.

Foot problems associated with older patients. A focused podogeriatric study.

The authors report on a 3-year prospective program that included foot-health education and an initial assessment of foot problems in an older population. The program represents a cooperative effort by the Philadelphia Corporation for Aging and the Pennsylvania College of Podiatric Medicine to enhance the quality of life of older citizens. The results show that foot problems are prevalent among older patients. The program also refined a protocol that can be applied in other settings.

Feet first. A commentary.

In 1989, the Board of Directors of the Professional Diabetes Academy, Pennsylvania Diabetes Academy endorsed the concept to revise Feet First, published in 1970, and gained the permission of the US Public Health Service to use the initial document as a base. With marked expansion, added color, nonreflective paper, and larger print, Feet First was published in 1991, and introduced to the podiatric profession during the Annual Meeting of the American Podiatric Medical Association in New York. The concept of need expressed by the late Glen W. McDonald, MD, and the late Seward P. Nyman, DPM, to see a melding of public health education and podiatric medicine has brought new meaning to the subject and provided an interdisciplinary approach to foot health education for the diabetic patient.

Traineeship in diabetes and the older patient. A public health experience.

The author describes an effort that demonstrates a successful partnership between a professional education program in podiatric medicine, the Pennsylvania State Health Department, and the Professional Diabetes Academy, which served as the catalyst for health promotion, prevention, and education. Similar programs through adaptations geared to local resources could be developed as a demonstration of direct secondary prevention of the complications of diabetes in the older population and have the potential to help meet national goals to significantly reduce amputations.

Caring for the diabetic: assessing risk in the diabetic foot.

The initial diabetic foot evaluation should be completed with ease and reliability. The first preventive step involves identification of primary findings of the dermatologic, musculoskeletal, vascular, and neurologic systems, coupled with the presentation of educational information.

Physical modalities in the management of mild to moderate foot pain.

The use of physical modalities to mediate mild to moderate foot pain is a part of podiatric practice. This article focuses on the primary indications and contraindications related to pain and some components of application. Institutional, ambulatory, and home care considerations are identified and presented. The focus is also clinical and practical, i.e., based upon common foot conditions seen in clinical practice.

Physical medicine and its relationship to patient management.

In this article, some general concerns for the use of modalities and procedures for the older person are given. Management of the geriatric patient requires knowledge, understanding, and patience; it requires a clinician and health care staff that care about older people. It requires a recognition of the dignity of age and the intrinsic worth of each individual as a human being. It requires hope and an ability to project a quality of life, regardless of the living condition. It requires kind words and a hands-on effort. It requires an appreciation of life and a high degree of ethical and moral concern.

Podiatric services in long-term care facilities.

The 1981 White House Conference on Aging in its Recommendation Number 148 stated that "comprehensive foot care be provided for the elderly in a manner equal to care provided for other parts of the body." This key position speaks to the need and right of foot care for all. The inclusion of appropriate podiatric services in long-term care programs will often produce dramatic effects. Immobility can be replaced by activity. Quality of care translates into improved quality of life. Support and encouragement can be directed to independence and a strong sense of personal identify and worth. Isolation can be replaced by interaction. When the quality of life decreases due to disease, disability, or age, those precious aspects of dignity must be restored to a maximum level by caring staffs. Because ambulation is a catalyst for life, podiatric care can help regain some of the lost dignity by keeping the patient walking and moving about, so that he or she can accept and participate in the social activities provided by the facility.

Gerontology-geriatrics education.

This article provides a conceptual outline for the geriatric component of primary podiatric medicine as well as a summary of gerontologic considerations applicable to professional, postdoctoral, and continuing education. This article also focuses on health promotion and prevention. Given the projected number of older patients in the United States and the prevalence of foot problems needing care in the older population, the podiatrist of today and tomorrow must become and remain a viable member of the primary geriatric care team.

Medicare. An administrative viewpoint.

Medicare was the first significant legislation that provided a health insurance program for a segment of our nation's population, initially for the elderly population and then expanded to include other chronically ill patients that in a sense are high risk. It provided a recognition for the special services of doctors of podiatric medicine as equivalent to the services provided by other practitioners. What we fail to recognize many times is that Congress, as representatives of the people, projected a need for podiatric care in this particular entitlement program. It provides a scope of practice for podiatrists that is governed by state law, which also is a mandate of the people. The individual state practice acts are again the will of the people through their state legislatures, which established the need and recognition for podiatric care. The system designed by Medicare provides for fiscal intermediaries, who are the insurance carriers that administer the program. Each carrier then establishes its own guidelines to deal with the medical policies of the program. The local guidelines for each state or area are additional documents that need to be reviewed for local modifications of the Medicare regulations. There are four options for patient payment: assignment, direct payment by the patient, billing the patient followed by patient payment upon receipt of his or her Medicare payment, or the selection of a health maintenance organization or similar private insurance option. Under this fourth option, the patient gives up his or her right to direct podiatric care, which is clearly a violation of the intent of the legislation that added podiatric medicine to Medicare in 1967. Given the changes that take place in any system, the original intent of Medicare was to provide an availability and access for podiatric care as required by the patient. To modify the system to change that intent without a change in law is morally, ethically, and legally questionable.

Who are the elderly? A profile of older patients.

The graying of America will change the health care system and how health professionals view the quality of care and life for older citizens. In this article, the demographics of US society are explored with comments on forecasted changes in the next 30 years. Understanding the needs of the geriatric population will help the clinician provide an opportunity to plan for the future to ensure a meaningful life for those golden years.

Ethical considerations in podiatric care of the older patient.

Ethical issues are constantly changing. Today, there is a greater consideration of the social issues as they relate to medical care. The questions of comfort are of greater concern for as we deal with increasing numbers of aging patients and chronic disease, cure may not always be possible; thus, patient management is a key issue. There are greater concerns for the rights of patients, their privacy, and the relationships that need to be maintained between doctors and their patients. There is a greater focus on the quality of life and not just saving a life. There are new questions posed in relation to the termination of treatment, particularly in relation to aging and at what point is there harm and not good from treatment. There is also the issue of public rights and whether the system should be permitted to develop without a freedom of choice or restrictions on podiatric care that are not imposed on any other professional service. Ethics and bioethics in itself is more than a statutory issue, it is more than policy. It also must be an educational issue that considers societal issues in the changing delivery of health care. It must now deal with professional liability and cost containment because now there are mechanisms for the rationing of care based on costs alone. Ethics must be based on respect, obligation, professional responsibility, as well as care issues. It must be an issue of moral relevance. Ethics must continue to deal with conduct, professional relationships, and human dignity. It must deal with improved knowledge and skills. It must consider and maintain the highest possible level of professional judgement. Ethics must also consider professional responsibility and obligation beyond what might be required to meet the legal basis of practice. Simply being "this side of legal" is not adequate in both an ethical and moral sense. If we recognize that it is the public that ultimately will determine our future health care system, partly on a preconceived need, partly on cost, partly on opinion, and partly on political impression, then we in podiatric medicine must assume a greater responsibility in protecting and promoting quality care, ethical conduct, and serving as a moving force in the changes that will take place in our health care delivery system in the future. Foot care is both basic and needed. Our state practice acts and laws and regulations have established this fact and demonstrated a public need for podiatry. Our obligation is to protect that need with integrity.

Assessment of the geriatric patient.

UNLABELLED: In its final report, the 1981 White House Conference on Aging recommended that "Comprehensive foot care be provided for the elderly in a manner equal to care provided for other parts of the human body, to permit patients to remain ambulatory: IMPLEMENTATION: Remove current Medicare exclusions which preclude comprehensive foot care." The ability to ambulate requires appropriate foot health as a catalyst. Keeping patients walking is a goal that needs to be met if older persons are to maintain a high degree of quality in their lives. Given the high prevalence of foot problems in elderly persons, especially in those patients with chronic diseases and mental health problems, foot care needs are essential. Foot health, care, and foot health promotion should be part of comprehensive health care for older Americans. The ability to remain active and ambulatory is one means of assuring dignity and self-esteem for the elderly.

Onychial disorders in the older patient.

Toenail disorders are a common source of discomfort in the older patient. Changes also contribute to potential and significant morbidity when complicated by systemic diseases. Onychodystrophies, infections, the residual of trauma, changes in relation to age, and manifestations of systemic diseases are identified and explored in this article. Key to proper management is the recognition that diseases and disorders of the toenails are not "routine" and that in the older patients they can limit mobility and significantly increase health care costs when complications ensue.

Public health considerations of human immunodeficiency virus.

The full spectrum of HIV infection will touch the lives of millions of Americans. All people need to be aware of this health crisis and its implications on their own lives and society. Health care providers need to recognize the risks and take appropriate precautions. Millions need assessment of their personal behavior that may have permitted them to become infected or that may now be exposing them to significant risk of infection. Education and counseling are significant factors in prevention. It has been estimated that well over 1,200,000 people in the United States are presently infected with HIV. Given all of this, podiatrists must be a part of the public health team that offers education, prevention, and promotes early care to help prevent the spread of HIV infection and to permit those infected to have a chance for longer and healthier lives and, when all else fails, to be provided with appropriate and compassionate care. Individuals practicing in podiatric medicine can expect recommendations in the future that include, in addition to the CDC's Universal Precautions Policy, submitting to voluntary determination of serostatus for those who perform exposure-prone procedures. Practitioners who are HIV infected and perform exposure-prone procedures will have to disclose their status to local review panels who will determine their practice. Local panels will then monitor HIV-infected practitioners for compliance with practice limitations and report those who violate limitations or precautions to state licensing boards. Those who serve on review panels will be protected from legal challenges.(ABSTRACT TRUNCATED AT 250 WORDS)