Caroline Robinson

An evaluation of an interdisciplinary joint clinical placement between podiatry and pharmacy students

The aim of this study was to evaluate a new joint clinical placement for third year undergraduate Pharmacy and Podiatry students. The purpose of which was to foster interprofessional education, enhance multidisciplinary working, and improve drug history taking, analysis and evaluation for students on both courses. The study involved a pre and post semi-structured questionnaire design targeted at 93 students attending a joint clinical placement. Podiatry students reported an increase in confidence in taking a patient case history, taking and documenting a drug history and communicating with other health professionals. Smaller increases in confidence were reported in identifying medication-related problems, assessing patient compliance and understanding the pharmacological basis of disease management. Pharmacy students reported an increase in confidence for all of the above descriptors and also constructing and prioritising pharmaceutical problem lists. Neither group reported high confidence levels with regard to the ability to critically discuss disease management. This study demonstrated that an interprofessional clinical placement can be an effective learning and teaching strategy for third year undergraduate Pharmacy and Podiatry students.

To discover a possible route for cross-infection from podiatric drill handpieces

SUMMARY. The aim of this research project was to establish the presence of bacteria and/or fungal spores in podiatric drill handpieces. Then, to ascertain if any organisms present could be considered a cross-infection risk to patients and others, and establish a means of controlling that risk. This was assessed by collecting samples of dust from the two different types of handpieces used at the Leaf Hospital, Eastbourne and examining them by means of microscopy and culture. Ten handpieces in all were examined, five Suda 650 model types and five Berchtold S3Os. From the results obtained it showed that the handpieces did contain bacteria and fungal spores which were a combination of pathogenic and non-pathogenic microbes. All the microbes found are not generally regarded as a problem for the normal healthy individual. However, with predisposing host factors, some of them are known to cause infections which can threaten both life and limb of the patient.

Is eucalyptus oil an effective antifungal treatment for onychomycosis with and without nail matrix infection

Background Onychomycosis is a fungal infection causing progressive destruction of the nail elements, with age increasing frequency of infection and potential for complications. The condition accounts for almost half of all nail issues yet continues to be largely under-reported and untreated. This study will investigate the antifungal efficacy of eucalyptus oil in vivo, for fungal nail infections with and without nail matrix infection.

Complex nonlinear autonomic nervous system modulation link cardiac autonomic neuropathy and peripheral vascular disease

Background Physiological interactions are abundant within, and between, body systems. These interactions may evolve into discrete states during pathophysiological processes resulting from common mechanisms. An association between arterial stenosis, identified by low ankle-brachial pressure index (ABPI) and cardiovascular disease (CVD) as been reported. Whether an association between vascular calcification—characterized by high ABPI and a different pathophysiology—is similarly associated with CVD, has not been established. The current study aims to investigate the association between ABPI, and cardiac rhythm, as an indicator of cardiovascular health and functionality, utilizing heart rate variability (HRV). Methods and Results Two hundred and thirty six patients underwent ABPI assessment. Standard time and frequency domain, and non-linear HRV measures were determined from 5-min electrocardiogram. ABPI data were divided into normal (n = 101), low (n = 67) and high (n = 66) and compared to HRV measures.(DFAα1 and SampEn were significantly different between the low ABPI, high ABPI and control groups (p < 0.05). Conclusion A possible coupling between arterial stenosis and vascular calcification with decreased and increased HRV respectively was observed. Our results suggest a model for interpreting the relationship between vascular pathophysiology and cardiac rhythm. The cardiovascular system may be viewed as a complex system comprising a number of interacting subsystems. These cardiac and vascular subsystems/networks may be coupled and undergo transitions in response to internal or external perturbations. From a clinical perspective, the significantly increased sample entropy compared to the normal ABPI group and the decreased and increased complex correlation properties measured by DFA for the low and high ABPI groups respectively, may be useful indicators that a more holistic treatment approach in line with this more complex clinical picture is required.

In vitro study to establish the efficacy of 28% Tioconazole solution (Trosyl) against Trichophyton rubrum and Candida albicans

Abstract Numerous factors may be implicated in the low cure rate of onychomycosis. 1,2 This study evaluates the contact time necessary to achieve a fungicidal effect, using 28% Tioconazole solution. The test organisms were Trichophyton rubrum and Candida albicans , these organisms being isolated commonly as the cause of fungal foot infections. 3,4 The methodology is an adaptation of the viable counting technique. 5 Cell suspensions of fungal isolates were exposed to dilutions of 28% Tioconazole, for specified time periods. Results showed that fungicidal activity was evident within a 5 minute exposure time, for both organisms. Even 50% and 25% dilutions of 28% Tioconazole were fungicidal in less than 5 minutes. Considering the rapid fungicidal effect of 28% Tioconazole, it could be postulated that the low cure rate of onychomycosis is due to inadequate exposure of the fungal cells to the anti-fungal agent.

The practice-research nexus in allied health: practitioner-researchers or practitioners and researchers?

“I must admit before I did honours I thought you’d either be a researcher or you’d be a clinical podiatrist, but now that I’ve done both……well basically you need to be keeping up with your research so you know what to do clinically, so it’s all intertwined” (Rachel)*. How do you view yourself as an allied health professional - a clinical practitioner with no time for research, or a researcher spending little time in clinical practice? This presentation will reflect on the theme of ‘practice-research nexus’ which emerged from my PhD research, exploring the experience of allied health honours students. The traditional view of ‘research as enlightenment’ proposes that researchers generate novel ideas, test them, present them at conferences or publish them in journals, where they are available for the enlightenment of practitioners. ‘Research as retail’ suggests that research users want relevant, easy-to-understand evidence, summarised and placed conveniently for use as required. Both of these constructs are problematic and research-based practice infers a hierarchical relationship between theory and practice; research generates knowledge which determines practice. The honours student participants in this research were conscious of this ‘theory-practice gap’ and this was often highlighted by their experiences on clinical placement; “…..from what I’ve seen it’s easy to sit in your clinic room, close the door and not learn anything else……just come out of your degree and that’s it. One thing honours has taught me is that we don’t know everything yet….there’s so much more to learn” (Ellie)*. An increasing amount of readily accessible health and medical information places us as allied health practitioners in a position in which professional and public expectations are increased. We must be in a position to not only utilise research evidence in our practice, but also to contribute to health research and the generation of practice knowledge. “I have a better appreciation of research and how difficult it really is to do and I really believe in evidence based practice from doing honours. Why are we doing what we’re doing (in clinical practice) and why is that better than doing something else?” (Nicola)*. Through honours, students develop new perspectives on the relationship of research with clinical practice. There is a national imperative to reduce the degree of separation of research from clinical practice and honours is one of the mechanisms to develop the future practitioner-researchers, in allied health.