A disparity in prosthetic access for Ecuadorians with lower-limb amputation.

BACKGROUND: Individuals with disabilities in low- and middle-income countries face barriers to rehabilitation services, including prosthetic care. Many countries, such as Ecuador, have adapted policies toward achieving universal health care coverage. For optimal functional outcomes, understanding the physical potential of prosthetic users is critical for appropriate prosthetic services. OBJECTIVE: To determine the association between the functional level of Ecuadorians with lower-limb amputations and the functional level of their prosthetic componentry. STUDY DESIGN: Retrospective study. METHODS: A data set containing functional level (K-Level) of Ecuadorians with lower-limb amputations and the K-Level of their prosthesis was analyzed. RESULTS: A diverse cohort of 164 participants with unilateral lower-limb amputation was recruited. Most participants were male (76.8%) with transfemoral amputations (56.1%) due to traumatic causes (51.2%). There was a small, positive, and statistically significant correlation between participants' functional levels and prosthetic componentry. Participants's functional levels were typically superior (median = 3) to their prostheses' functional abilities (median = 1), and 37.2% of participants did not have a prosthesis at the time of assessment. CONCLUSIONS: These data indicated that participants whose physical ability exceeded basic ambulation lacked access to prostheses to match their functional abilities. The detailed disparity between physical potential and prosthetic access derived from the study's analysis supports investment into high functioning prosthetic componentry and further investigation into where gaps in care exist.

Tipping the Scales of the Admissions Process: Interview Weighting in an Orthotics and Prosthetics Education Program.

AIMS: Orthotics and prosthetics is a healthcare profession which is currently exploring opportunities to increase student diversity. There are limited publications on the admissions process in orthotics and prosthetics. The purpose of this study was to evaluate the impact of the admissions interview weighting on the diversity of the top-ranked applicants at one education program. METHODS: Researchers gathered retrospective data from 3 years of admissions interviews (n=144). The proportions of the screening scores and interview scores were systematically adjusted to determine various ranking scores. At each adjustment point, descriptive statistics of racial demographics, age, gender, and military status of the top-ranking applicants were evaluated. RESULTS: Adjustments in the weights of the screening and interview scores had an impact on cohort diversity within, but not across, admissions cycles. Increasing the weight of the interview score decreased the mean age of a cohort for all admissions cycles. CONCLUSION: This study is the first to present an evaluation of the admissions process in an orthotics and prosthetics education program. The methodology can be used by health professions education programs which incorporate interview scoring into admissions decisions.

Advances in prosthetic technology: a perspective on ethical considerations for development and clinical translation.

Technological advancements of prostheses in recent years, such as haptic feedback, active power, and machine learning for prosthetic control, have opened new doors for improved functioning, satisfaction, and overall quality of life. However, little attention has been paid to ethical considerations surrounding the development and translation of prosthetic technologies into clinical practice. This article, based on current literature, presents perspectives surrounding ethical considerations from the authors' multidisciplinary views as prosthetists (HG, AM, CLM, MGF), as well as combined research experience working directly with people using prostheses (AM, CLM, MGF), wearable technologies for rehabilitation (MGF, BN), machine learning and artificial intelligence (BN, KKQ), and ethics of advanced technologies (KKQ). The target audience for this article includes developers, manufacturers, and researchers of prosthetic devices and related technology. We present several ethical considerations for current advances in prosthetic technology, as well as topics for future research, that may inform product and policy decisions and positively influence the lives of those who can benefit from advances in prosthetic technology.

Entrustment trends in orthotic and prosthetic residencies.

BACKGROUND: Orthotic and prosthetic residency preceptors have little guidance transitioning residents between observing and performing patient care. Understanding current entrustment trends and factors can help guide resident progression during residency. OBJECTIVES: To identify entrustment trends and factors within an orthotics and prosthetics residency affecting a supervisor's decision to entrust residents with independent patient care. STUDY DESIGN: Cross-sectional study. METHODS: In this cross-sectional study, 831 National Commission of Orthotic and Prosthetic Education preceptors were invited to complete a 26-question, online questionnaire that examined possible entrustment factors. RESULTS: A total of 77 preceptors completed the questionnaire. The top-reported behavioral qualities impacting entrustment were recognition of limitations and willingness to ask for help (n = 45) and competence (n = 37). Preceptors ranked evaluation (n = 27) as the professional skill which most affected entrustability; technical skill least affected entrustability (n = 4). Preceptors of 12-month residencies entrust residents to indirect supervision when they have completed approximately 75% (i.e. 9 months) of the program. Preceptors of 18-month residencies reported that they entrust their residents by the time they reach 50% (i.e. 9 months) of their training. A small number of preceptors (n = 19) never allow a resident to independently perform practice management. CONCLUSION: Residency supervisors value interpersonal and evaluation skills when making entrustment decisions. Residency mentors can use these findings to inform their entrustment decisions and support a resident's progression toward independent practice. CLINICAL RELEVANCE: This study presents information which can inform clinical preceptors and residents on what factors contribute to the decision to progress a resident from observation to independent patient care. These findings may influence clinical education standards which aim to promote both resident training and patient access to quality care.

The impact of diabetic foot ulcers and unilateral offloading footwear on gait in people with diabetes.

BACKGROUND: Unilateral offloading footwear prescribed to patients with diabetic foot ulcers elevates one limb relative to the other, which may lead to limp and abnormal gait. This study investigated whether the unilateral foot ulcer and offloading combination negatively impacts gait function beyond diabetic peripheral neuropathy. METHODS: Eighty-six participants were recruited in 3 groups: 12 with diabetic peripheral neuropathy and unilateral foot ulcers wearing offloading footwear (offloading group, age = 55.6 ± 9.5 years, BMI = 30.9 ± 4.5 kg/m2), 27 with diabetic peripheral neuropathy (neuropathy group, age = 64.3 ± 7.7 years, BMI = 30.9 ± 5.4 kg/m2), and 47 non-diabetic controls (non-diabetic group, age = 62.9 ± 16.1 years, BMI = 29.0 ± 6.0 kg/m2). Gait function was quantified during a habitual speed walking test using a validated wearable platform. FINDINGS: The offloading group exhibited deteriorated gait function compared to the non-diabetic group (p < 0.005, Cohen's effect size d = 0.90-2.61). They also had decreased gait speed (p < 0.001, d = 1.79) and stride length (p < 0.001, d = 1.76), as well as increased gait cycle time (p < 0.001, d = 1.67) and limp (p < 0.050, d = 0.72-1.49) compared to the neuropathy group. The offloading group showed increased gait unsteadiness compared to the neuropathy group, but the difference did not reach statistical significance in our samples. INTERPRETATION: This study demonstrated that while diabetic peripheral neuropathy deteriorates gait function, including increasing gait unsteadiness and limp, the diabetic foot ulcer and offloading combination magnifies the deterioration beyond diabetic peripheral neuropathy. These findings promote caution of the current standards of care for treating diabetic foot ulcers with offloading footwear. However, it is possible that a contralateral shoe lift may remedy deteriorated gait function and improve quality of life for unilateral offloading users.

What clinical rotation factors have an impact on trainee success?

BACKGROUND: Educators and trainees both recognise that autonomy, the number of patient encounters and setting learning outcomes are all vital for a successful residency. This study examined whether these clinical rotation characteristics have an impact on trainee success in an orthotic and prosthetic clinical residency. METHODS: Two cohorts of resident trainees rated their rotation characteristics (autonomy, patient encounters and learning outcomes [1, significantly below expectations; 5, exceeds expectations]) and self-competency (77 items [1, not at all able; 5, very able]) at three points during an 18-month residency. Rotation performance (0-100, where 100 is the highest score) was ascertained with preceptor ratings and test scores. Means and correlations were derived. RESULTS: Data from 38 trainees were examined. The mean self-competency and rotation performance scores improved from time 1 to time 3 (from 4.14 ± 0.43 to 4.36 ± 0.38 [p < 0.01]; from 90.74 ± 5.15 to 92.62 ± 4.55 [p < 0.05]). Autonomy correlated with performance at time 1 (p < 0.05) only, and did not relate to self-competency at any point. Neither the number of patient encounters nor the presence of learning outcomes were associated with performance or self-competency at any point. CONCLUSIONS: These data show that over time our trainees become more competent, as rated by both themselves and their preceptors. These data do not suggest that the number of patient encounters and the presence of learning outcomes have an impact on trainee competence. Autonomy may play the largest role at the beginning of the residency as students make the transition to clinical practice.

Does Student-Led Faculty Development Have A Place in Health Professions Education?

This article was migrated. The article was marked as recommended. Background: Instructors at health sciences universities typically transition directly from the clinical to academic setting, limiting their ability to formally develop proficiency in the science of teaching. We assess the effectiveness of a student-led faculty development course and faculty perceptions of the program. Methods: Faculty from a clinical graduate program participated in a longitudinal student-led faculty development course. The course was offered in four separate 90-minute modules led by a student facilitator. Faculty completed course evaluations after each module, a knowledge assessment before and after the course, and a comprehensive evaluation upon completion of the course. Descriptive statistics were used to explore the effectiveness of the course and faculty perceptions. Results: Faculty (N=5) exhibited increased knowledge in teaching and learning principles after the course (p < 0.01). The highest-rated area on the module evaluations was the relevance of the topics to the participants' roles as instructors (4.31 ± 0.22). The lowest-rated area was pace of the modules (3.55 ± 0.62). The final course evaluation results showed that faculty rated the overall curriculum delivery very high (4.20 ± 0.46). Overall, faculty rated the student's instructional quality at or above what they would expect from a peer faculty member (3.80 ± 0.72). Faculty expressed that the most valuable parts of the curriculum were applicable content, the introduction to evidence-based learning and teaching concepts, and the group discussions. Conclusions: A student-led faculty development course improved faculty knowledge of learning, teaching, and assessment principles.

A Polarizable and Transferable PHAST CO2 Potential for Materials Simulation.

Reliable PHAST (Potentials with High Accuracy Speed and Transferability) intermolecular potential energy functions for CO2 have been developed from first principles for use in heterogeneous systems, including one with explicit polarization. The intermolecular potentials have been expressed in a transferable form and parametrized from nearly exact electronic structure calculations. Models with and without explicit many-body polarization effects, known to be important in simulation of interfacial processes, are constructed. The models have been validated on pressure-density isotherms of bulk CO2 and adsorption in three metal-organic framework (MOF) materials. The present models appear to offer advantages over high quality fluid/liquid state potentials in describing CO2 interactions in interfacial environments where sorbates adopt orientations not commonly explored in bulk fluids. Thus, the nonpolar CO2-PHAST and polarizable CO2-PHAST* potentials are recommended for materials/interfacial simulations.