Degree of burnout among Maltese podiatrists working in two different settings

The issue of burnout is receiving increasing research attention. However, most of the literature on burnout has focused on the nursing, physiotherapy and occupational therapy professions, with very few studies within the podiatric profession exploring this concept. The purpose of this paper is to compare the degree of burnout among Maltese podiatrists working in two different settings, namely the public health service and private practice. A quantitative non-experimental study, involving a convenience sample, was conducted. The Copenhagen Burnout Inventory (CBI) was used to evaluate levels of burnout in the two participant groups. No statistical difference was found between the overall mean burnout scores for Maltese podiatrists employed in the public health service and those working in private practice (p = 0.067, mean = 48.89 vs 31.84). Although the level of burnout did not differ between podiatrists working within the two different settings, podiatrists working in the public sector in general reported higher mean scores for each subscale of the CBI than podiatrists working in private practice. More research is necessary to build a better understanding of burnout among podiatrists in parallel with other health care professionals, in order to help prevent or alleviate this phenomenon.peer-reviewe

Rethinking diabetes education

One of the core components of diabetes care is the promotion of diabetes education to improve self-management, which would reduce the financial and personal burden that diabetes imposes. However, as education and knowledge alone do not always translate into improved metabolic outcomes, a fuller understanding of the factors that contribute to suboptimal self-management is important if improved diabetes outcomes are to be achieved. In this article the authors question the current approaches to diabetes education, and highlight how education might be broadened to produce more effective outcomes. The authors suggest a move away from traditional, didactic, diabetes-related education, which has failed in a number of settings, towards innovative approaches that are person-centred to improve metabolic outcomes and quality of life for individuals with diabetes.peer-reviewe

Duration of type 2 diabetes is a predictor of elevated plantar foot pressure

AIMS: Elevated plantar pressure is considered a significant risk factor for ulceration in diabetes mellitus. The aim of this study was to determine whether duration of diabetes could affect plantar pressure in patients with no known significant comorbidity or foot pathology.METHODS: Participants with type 2 diabetes, but without known confounding factors that could alter peak pressure, were matched for age, weight, and gender and categorized into 3 groups of diabetes duration: group 1 (1-5 yr), group 2 (6-10 yr), and group 3 (11-15 yr). Plantar pressures were recorded utilizing a twostep protocol at a self-selected speed.RESULTS: One-way analysis of variance (ANOVA) revealed significant differences in mean peak plantar pressures between the three groups under the 2nd - 4th metatarsophalangeal joint (MPJ) region of interest (ROI) (p = 0.012 and p = 0.022, respectively) and left heel (p = 0.049). Also, a significant difference in mean pressure-time integral under the left 2nd - 4th MPJ ROI (p = 0.021) and right heel (p = 0.048) was observed. Regression analysis confirmed that mean peak plantar pressures in the first group (but not in the second group) were significantly lower than in the third group (p = 0.005).CONCLUSIONS: As the duration of diabetes increased, peak plantar pressure increased significantly under the 2nd - 4th MPJ ROIs. These findings suggest that clinicians should make more use of pressure mapping technology as part of their clinical management plan in patients with diabetes >10 yr, even if they have no complications or deformities, to preserve functional limbs in this high-risk population.peer-reviewe

Comparing the Clinical Effectiveness of two Cryotherapy Techniques for the Treatment of Plantar Warts

Objective. To compare two techniques of Cryotherapy for clinical effectiveness, pain, and effect on the quality of life of patients when treating plantar warts. Method. A quasi-experimental matched subject study was conducted. Twenty subjects with a newly diagnosed plantar wart were recruited. Subjects were matched for confounding variables in relation to site of lesion, gender and age, and were divided into two groups. Group A (n=10) were treated using the CO2 Gun & Probe technique whilst Group B (n=10) were treated using the Portable N2O pressurized spray technique. The plantar warts were measured at time 0 (before treatment) and Time 1(3 weeks following treatment) using a metre ruler. The Foot Function Index and the Visual Analog Scale for pain assessment during treatment were also used. Results. The study found no significant difference in the effectiveness (p= 0.387), pain caused during treatment (P=0.855) and FFI scores (p=0.172) for total change in QOL in the study group when comparing both treatments. However, comparison of the mean scores showed that the CO2 Gun & Probe method was slightly more effective in reduction of size. Pain during treatment was almost identical when using both techniques. The FFI scores on all 3 subscales (Pain, Disability and Activity Limitation) showed a larger increase in the CO2 Gun & probe method, when compared to the pressurized N2O Portable device. Conclusions. Although this study has found no significant difference between two different techniques of cryotherapy, mean differences have indicated that the CO2 Gun & Probe technique is more effective in reducing the size of the warts when compared to the N2O Pressurized Spray Technique; however the CO2 Gun & Probe technique caused a larger impact on quality of life. Recommendations from this study suggest that careful consideration is required when selecting a treatment for plantar warts and furthermore patients should be advised on the likely outcomes of each treatment before any intervention.Objective. To compare two techniques of Cryotherapy for clinical effectiveness, pain, and effect on the quality of life of patients when treating plantar warts. Method. A quasi-experimental matched subject study was conducted. Twenty subjects with a newly diagnosed plantar wart were recruited. Subjects were matched for confounding variables in relation to site of lesion, gender and age, and were divided into two groups. Group A (n=10) were treated using the CO2 Gun & Probe technique whilst Group B (n=10) were treated using the Portable N2O pressurized spray technique. The plantar warts were measured at time 0 (before treatment) and Time 1(3 weeks following treatment) using a metre ruler. The Foot Function Index and the Visual Analog Scale for pain assessment during treatment were also used. Results. The study found no significant difference in the effectiveness (p= 0.387), pain caused during treatment (P=0.855) and FFI scores (p=0.172) for total change in QOL in the study group when comparing both treatments. However, comparison of the mean scores showed that the CO2 Gun & Probe method was slightly more effective in reduction of size. Pain during treatment was almost identical when using both techniques. The FFI scores on all 3 subscales (Pain, Disability and Activity Limitation) showed a larger increase in the CO2 Gun & probe method, when compared to the pressurized N2O Portable device. Conclusions. Although this study has found no significant difference between two different techniques of cryotherapy, mean differences have indicated that the CO2 Gun & Probe technique is more effective in reducing the size of the warts when compared to the N2O Pressurized Spray Technique; however the CO2 Gun & Probe technique caused a larger impact on quality of life. Recommendations from this study suggest that careful consideration is required when selecting a treatment for plantar warts and furthermore patients should be advised on the likely outcomes of each treatment before any intervention

Determinants of Job Satisfaction in Different Podiatric Clinical Settings

Antecedentes. La profesión de podología se ha desarrollado durante las últimas décadas y las nuevas especializaciones se han introducido en este campo trayendo consigo nuevos servicios y diferentes entornos de trabajo . El objetivo de este estudio es analizar el nivel de satisfacción en el trabajo entre los podólogos que trabajan en dos contextos clínicos diferentes dentro del National Health Service (NHS). Asimismo, se pretende determinar los factores que influyen en la satisfacción laboral de los profesionales de salud pública que trabajan en dos escenarios clínicos diferentes.Material y Método. Se utilizó un diseño no experimental comparativo. Se reclutaron a veintitrés podólogos registrados en el Estado Maltés con dedicacióna tiempo completo en el NHS. Doce podólogos ejercen en un hospital y 11 podólogos ejercen en un centro de atención primaria. Se pidió a todos los participantes que rellenaran el formulario corto del Cuestionario de Satisfacción de Minnesota. Este cuestionario se compone de 20 premisas y se utiliza para explorar los niveles de satisfacción en el trabajo .Resultados. No se encontró diferencia estadísticamente significativa al comparar los niveles de satisfacción en el trabajo entre el grupo de estudio [ p = 0,609 ] . Los participantes, sin embargo, reportaron una puntuación de satisfacción media baja con relación a su remuneración en el trabajo así como en las posibilidades de avances en su lugar de trabajo.Conclusión. Este estudio ha concluido que podólogos que trabajan en diferentes ámbitos en el NHS, en general, experimentan niveles satisfactorios de satisfacción en el trabajo. Sin embargo, los participantes sentían que no estaban bien compensados por su trabajo y que tienen limitaciones para lograr avanzar en su lugar de trabajo - dos factores que se sabe que están relacionados con las tasas de rotación y retención de trabajo. Los resultados de este estudio deben ser considerados por los colegios profesionales y las autoridades de salud para el cambio en las políticas sanitarias y educativas. Este documento concluye ofreciendo recomendaciones que ofrecen medidas de acción adecuados para ser valoradas cuando se prtenda aumentar la satisfacción laboral de los profesionales sanitarios.Aim. The podiatry profession has evolved over the past few decades and new specializations have been introduced in this field bringing with them new services and different work settings. The aim of this study is to explore the level of job satisfaction amongst Podiatrists working in two different clinical settings within the NHS. It also seeks to determine the factors influencing job satisfaction among public health professionals working in two different settings.Methods. A comparative non experimental design was employed. Twenty three Maltese State Registered Podiatrists working on a full time basis within the NHS were recruited. Twelve podiatrists were recruited from a hospital setting and 11 podiatrists were recruited from a Primary Care Setting. All consenting participants were asked to fill in the short form of the Minnesota Satisfaction Questionnaire. This questionnaire is composed of 20 statements and is used to explore levels of job satisfaction.Results. No statistical difference was found when comparing levels of job satisfaction between the study group [P=0.609]. The participants however reported a low mean satisfaction score for their work compensation and chances of advancements in their work place.Conclusion. This study has concluded that Podiatrists working within different settings in the NHS overall experience satisfactory levels of job satisfaction. However, it was also reported that participants felt that they were not well compensated for their work and that they are limited to advancement in their workplace – two factors which are known to be related to turnover rates and work retention. Results of this study need to be considered by the professional bodies and health care authorities for change in health and educational policies to be brought about. This paper will conclude by offering recommendations which offer proper action steps to be visited when looking to increase job satisfaction among health care professionals

A Critical Evaluation of Existing Diabetic Foot Screening Guidelines.

AIM To evaluate critically the current guidelines for foot screening in patients with diabetes, and to examine their relevance in terms of advancement in clinical practice, improvement in technology, and change in socio-cultural structure. METHODS A structured literature search was conducted in Pubmed/Medline, CINAHL, Cochrane Register of Controlled Trials, and Google between January 2011 and January 2015 using the keywords '(Diabetes) AND (Foot Screening) AND (Guidelines)'. RESULTS Ten complete diabetes foot screening guidelines were identified and selected for analysis. Six of them included the full-process guidelines recommended by the International Diabetes Federation. Evaluation of the existing diabetes foot screening guidelines showed substantial variability in terms of different evidence-based methods and grading systems to achieve targets, making it difficult to compare the guidelines. In some of the guidelines, it is unclear how the authors have derived the recommendations, i.e. on which study results they are based, making it difficult for the users to understand them. CONCLUSIONS Limitations of currently available guidelines and lack of evidence on which the guidelines are based are responsible for the current gaps between guidelines, standard clinical practice, and development of complications. For the development of standard recommendations and everyday clinical practice, it will be necessary to pay more attention to both the limitations of guidelines and the underlying evidence

La Relación entre la fascitis plantar y la presión de talón

[Abstract] Objective: The presence of increased medial heel plantar pressure in plantar fasciitis has been debated, with clinicians often utilizing pressure-relieving devices, such as heel pads and cups, as a means of management.Method: Plantar pressures in a sample of 15 adult participants with chronic plantar fasciitis were compared to plantar pressures of the 15 adult participants forming the control group, who were matched for age, gender and weight.Results: There were no significant differences in peak heel plantar pressure (p = 0.244), lateral peakplantar pressure (p = 0.876), forefoot peak plantar pressure (p = 0.576) and the Forefoot to Rearfoot peak pressure ratio (p = 0.242) between the 2 groups. However, there was a significant difference (p = 0.015) in medial heel peak plantar pressure between the 2 groups, with the plantar fasciitis group having lower medial heel pressure than the control group.Conclusion: The findings in this study suggest that there is no relationship between peak medial heel plantar pressures and chronic medio-plantar heel pain in plantar fascitis. There is also no shift in pressure from the symptomatic medio-plantar heel region to the latero-plantar heel and forefoot regions. As a result, pressure may not play a part in the pathophysiology of plantar fascitis.[Resumen] Objetivos: La presencia de incremento de presión plantar en la zona medial del talón en la fascitis plantar ha sido estudiado, y los clínicos a menudo utilizan dispositivos de alivio de la presión, como almohadillas de talón y cazoletas, como medio de manejo.Método: Las presiones plantares en una muestra de 15 participantes adultos con fascitis plantar crónica se compararon con las presiones plantares de los 15 participantes adultos que formaron el grupo control, que fueron comparados por edad, sexo y peso.Resultados: No hubo diferencias significativas en la presión plantar en el pico pico (p = 0,244), en la presión pico lateral (p = 0,876), en la presión plantar pico en el antepié (p = 0,576) Los 2 grupos. Sin embargo, hubo una diferencia significativa (p = 0,015) en la presión plantar del talón medial entre los 2 grupos, con el grupo de fascitis plantar con menor presión en el talón medial que en el grupo control.Conclusión: Los hallazgos en este estudio sugieren que no hay relación entre el pico medial del talón de las presiones plantares y crónico medio-plantar talón dolor en la fascitis plantar. Tampoco hay cambio en la presión de la región sintomática del talón medio-plantar a las regiones del talón latero-plantar y del antepié. Como resultado, la presión puede no desempeñar un papel en la fisiopatología de la fascitis planta

Investigation of plantar pressures in overweight and non-overweight children with a neutral foot posture

The aim of the study was to determine differences in dynamic plantar pressure and contact area in a cohort of overweight and non-overweight children. This study also sought to determine whether total foot contact area correlated with average peak plantar pressure measurements. A non-experimental matched subject designed was conducted on 20 participants. A plantar pressure mapping system was used to acquire plantar pressures. Assessment included dynamic plantar pressure and contact area of 10 overweight (age 9.6 ± 1.4 years; BMI 26 ± 6) and 10 non-overweight (age 9.6 ± 1.6 years; BMI 16 ± 2) children with a neutral foot type determined by Foot Posture Index. Subjects were matched for age, height and gender. Results: The study identified a significantly larger foot contact area (p 0.000) and higher peak plantar pressures under the heel (p 0.011), the 2nd – 4th Metatarsophalangeal Joint region (MPJs) (p 0.000) and 1st MPJ (p 0.050) in overweight children when compared to their matched non-overweight participants. A strong positive relationship was reported between peak plantar pressure and foot contact area. Conclusion: This study has identified significantly higher plantar pressure differences and a larger contact area in overweight children when compared to controls.peer-reviewe