New Podiatry School To Debut Next Year

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By Brian McCurdy, Associate Editor

Students pursuing a career in podiatry will have a new option when Midwestern University unveils a new podiatric medicine program in October 2004. The university, located in Glendale, Ariz., will become the seventh member of the American Association of Colleges of Podiatric Medicine (AACPM) in 2005 and its new four-year program will have slots for 30 students. Jeffrey C. Page, DPM, the Director of the Arizona Podiatric Medical Program at Midwestern University, says the program will address a strong future demand for DPMs as well as the needs of the surrounding community. Citing 1999 projections from the Liaison Committee of the American Podiatric Medical Association (APMA), Dr. Page notes Arizona is “at or below the forecast of podiatric physicians required in metropolitan areas with fee for service plans.” He adds that between 1991 and 1999, there was a significant decline in the number of podiatric physicians per 100,000 people in Arizona. The new program will be in an area surrounded by Native American tribes, including 22 tribes that live in Arizona, according to Dr. Page. These include the Pima Indians, who have been widely studied for diabetes prevalence. In a report, Dr. Page notes the Indian Health Service (IHS) has acknowledged a “tremendous need” to increase the number of podiatrists within its system and that the IHS appropriated additional funding to that end in 1999. Terence B. Albright, DPM, the Dean of the William M. Scholl College of Podiatric Medicine at Finch University, says attracting Native Americans to podiatry is “a great idea” due to the high prevalence of diabetes in the population and a paucity of podiatric care. Dr. Page adds that the podiatric program has committed to reserving 10 percent of each class for qualified Native American students. Will A New School Help Or Hurt The Profession? Dr. Page argues an eighth podiatry program will indeed help the profession and debunks the myth that competition will not be helpful for podiatrists’ businesses. Citing the 2002 Podiatric Practice Survey by the APMA, Dr. Page says DPMs practicing in groups earn “substantially more” than those practicing alone and “a minimum number or ‘critical mass’ of a profession’s members is required to achieve the needed level of visibility to achieve success.” Chet Evans, DPM, the Dean and Associate Vice President of Barry University, concurs with the idea of critical mass increasing visibility. “If podiatrists don’t capture the market share, other professions providing foot care services certainly will,” says Dr. Evans, who supports the Midwestern podiatry program. “I do think the new school will invite greater competition among the colleges for students in light of the continued depressed applicant pool but this may have a positive effect in strengthening our educational system,” says Dr. Albright, who supports the new school. Dr. Page says the Labor Department in 2001 projected the need for new podiatrists would increase by 10 to 20 percent through 2008. As Dr. Evans notes, the over-85 population is the fastest growing group in the United States. When you combine that with the increased diabetes prevalence throughout the world, Dr. Evans says it will lead to a greater demand for new podiatrists. After combined first year enrollment at the six AACPM colleges bottomed out at 401 in 2001, the interest in pursuing a podiatry career seems to be on the rise again. In 2002, first-year enrollment increased to 430 and improved to 461 this year, according to the AACPM. Dr. Page says this resurgence is important as the profession will start losing members over the next decade as baby boomers reach retirement age. Will The New Program Affect Enrollment At Other Schools? While there may be those who dispute the need for another podiatry college, officials at other schools seems to welcome the addition of another four-year program. “Obviously, there will be those who are negative about the numbers,” suggests Dr. Albright. “This negativity is driven by personal perceptions and not by a global view of the benefits for podiatric medicine.” Dr. Evans says he believes the school’s first-year target enrollment of 30 students will not have a negative effect on the applicant pool at the other colleges. Dr. Page adds that the new program will emphasize advanced technology and mesh well with the other medical disciplines at the university. Dr. Page says the Council on Podiatric Medical Education has determined that Midwestern University meets the eligibility requirements of the Council for the Arizona Podiatric Medicine Program. The deadline for fall applications is Nov. 14, 2003 and the deadline for spring applications is June 4, 2004. For more information, see www.midwestern.edu/azpod. FDA Approves Linezolid For Diabetic Foot Infections By Brian McCurdy, Associate Editor Given the rising incidence of diabetes and the escalating prevalence of resistant infections such as methicillin resistant Staph aureus (MRSA), podiatrists may be pleased to know that linezolid (Zyvox, Pfizer) has recently garnered FDA approval for the treatment of diabetic foot infections (without osteomyelitis) caused by gram-positive bacteria. A multi-center clinical trial, conducted at 45 centers in the United States and Europe, demonstrated that linezolid was as effective as two standard aminopenicillin therapies in treating diabetic foot infections, according to Pfizer. Researchers found that using linezolid yielded clinical efficacy in 83 percent of the patients whereas the comparative medications achieved clinical efficacy in 73 percent of the patients. The results are very promising, especially in light of the “enormously concerning” prevalence rate of MRSA infections, which has risen over 50 percent in some hospitals, according to David G. Armstrong, DPM, one of the study’s principal contributors and a member of the American Diabetes Association Board of Directors. Peter Blume, DPM, who has participated in two clinical trials of linezolid, concurs. He says the “truly unique” antibiotic, which is in the class of oxazolidinones, “is extremely helpful for patients with MRSA infections as it has a significant clearing rate.” Dr. Blume, the Director of Limb Preservation at the Yale New Haven Hospital in New Haven, Conn., notes you can dose the drug at 600 mg twice a day and it does not require IV access. He also points out that linezolid has the same bile availability between the IV formation and the oral drug, and does not require any adjustment for renal impairment. The PO equivalence of linezolid to IV is significant, notes Dr. Armstrong, the Director of Research and Education within the Department of Surgery, Podiatry Section at the Southern Arizona Veterans Affairs Medical Center. When practitioners use the antibiotic judiciously, Dr. Armstrong says they can send many patients home earlier without an IV. In addition to patients returning sooner to their everyday lives, Dr. Armstrong notes this will also reduce costs. When using linezolid, Dr. Blume recommends obtaining a complete blood cell count to monitor for thrombocytopenia, which has been noted in a small percentage of patients but can be reversed upon termination of the drug. Study Shows Results In Treating Acute Burns With VAC Therapy By Brian McCurdy, Associate Editor An ongoing clinical trial being conducted at seven burn centers shows preliminary benefits to treating acute burn injuries with negative pressure wound therapy. The study, comprised of 25 patients with partial thickness hand burns, is comparing the use of Vacuum Assisted Closure Therapy (VAC, KCI) to standard topical antibiotics. Researchers are treating one hand with VAC therapy for 48 hours and following up with a special VAC dressing and traditional silver sulfadiazene protocols. The control hand is just receiving the silver sulfadiazene. Dr. David Heimbach, who is with the University of Washington’s Harborview Burn Center and is one of the study’s researchers, recalls one 44-year-old patient who had deep dermal burns to each hand. He says the hand treated solely with silver sulfadiazene stayed completely swollen from day one to three. By the fifth day, it had only decreased 50 mm in volume, according to Dr. Heimbach. He noted little difference between the active range of motion in the hands on days three to five. However, the hand treated with VAC showed a better range of motion beginning on day five. He also notes that only the hand treated solely with silver sulfadiazene required a graft. Alan Cantor, DPM, CWS, has employed VAC therapy in treating patients who have burn injuries. He says on a cellular level, the therapy reduces inflamed cells, reduces edema and reduces the number of cells that inhibit wound healing. “The benefits of the VAC are well known in promoting closure,” says Dr. Cantor, a member of the Burn/Wound Center Team at Nassau University Medical Center in East Meadow, N.Y. ACFAS Releases Guidelines On First MPJ Treatment By Brian McCurdy, Associate Editor The American College of Foot and Ankle Surgeons has provided new clinical practice guidelines for treating disorders of the first metatarsophalangeal joint. Divided into six sections ranging from the treatment of hallux valgus to traumatic disorders, the guidelines were released in the May/June issue of The Journal of Foot and Ankle Surgery. The section of the guidelines on the commonly seen hallux valgus justifies early surgical intervention, which is important from a medical/legal standpoint, says John Vanore, DPM, the Chairman of the ACFAS’s Clinical Practice Guidelines First MPJ Joint Disorders Panel. In that section, the authors note that “surgical recommendations might be considered on the initial evaluation of hallux valgus deformity.” Since the condition is a progressive disorder that is often evaluated by DPMs in the second or third stage, the guideline authors note that one may consider surgical options “early in the course of treatment.” Dr. Vanore, who is on the faculty of the Podiatry Institute, points out that the guidelines for hallux varus include a staging system that establishes a foundation upon which podiatrists can base their recommendations for surgical treatment. As he notes, in less common conditions like trauma and sesamoid disorders, the guidelines direct practitioners “in a logical manner on the diagnostic work-up for proper diagnosis as well as treatment. “The guidelines are helpful not only for the established practitioner but also for those in training and are also meant to assist general practitioners with regard to identification of foot pathology and appropriate referral,” says Dr. Vanore. In Brief PDI, Inc. announced recently it has entered into an agreement with Organogenesis Inc. to provide sales, marketing and clinical support for Apligraf®, a living, bilayered skin substitute. Apligraf is a trademark of Novartis and is approved to treat both diabetic ulcers and venous leg ulcers.

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