APMA News - July/August 2018 - APMA2

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YOUR APMA / PAGE 2

MY ADVENTURES IN PUBLIC
HEALTH AND RESEARCH AS
APMA'S TDI FELLOW
By Chia-Ding (JD) Shih, DPM, MPH, MA

s the 2017-18 APMA/TDI Public Health
Fellow, I have spent the past 11 months
immersed in the intellectual think tank
at The Dartmouth Institute for Health Policy
and Clinical Practice (TDI). I knew I would
learn about public health and research
methods, but what I gained was beyond
my expectations. During my fellowship, I
learned subjects ranging from Biostatistics
to Epidemiology and Quality Improvement
to Financial Management of Health Care,
but many of these subjects were merely the
building blocks for four research projects I
performed while in the program.
I started my work at TDI with a systematic
review and qualitative analysis of a fall risk
assessment tool, Timed Up-and-Go (TUG).
My colleagues and I raised questions about
the accuracy of this commonly used tool
among elderly patients who suffer from

non-musculoskeletal chronic conditions as
many of these conditions, such as cardiovascular, respiratory, and neurological diseases,
can confound the results of the TUG. From a
handful of studies that met the study criteria,
the research team focused on COPD and
cognitively impaired populations. Based on
the analyses, we found that current literature
provided only acceptable-quality evidence to
support TUG as a fall risk assessment tool in
these study populations. The research team
concluded that there was limited evidence to
support TUG as an adequate tool to assess
fall risk among elderly patients with nonmusculoskeletal conditions that could limit
mobility. The TUG research will be presented at
this year's American Public Health Association
Annual Meeting and Expo in San Diego.
While all four projects were equally memorable, a national survey on plain radiograph

use for non-infected diabetic foot ulcers had
perhaps the most immediate impact. This
project was a collaboration between APMA
and the Comprehensive Wound Healing Center at Dartmouth-Hitchcock Medical Center,
and was performed in an effort to determine
best practices for plain radiograph use in
non-infected diabetic foot ulcers. With the
support of APMA members, my team and I
received 558 responses to an eight-question
online survey. Although there were some
challenges in standardizing respondents'
interpretations of each clinical scenario, the
team noticed some interesting findings. With
these preliminary findings, I plan to work with
APMA to summarize patterns and ultimately
develop standardized recommendations for
plain radiograph use in the non-infected
diabetic foot ulcer.
As part of the Master of Public Health
degree requirement, every candidate is
required to select a topic and work independently throughout the year. In view of an
unsolved occupational hazard in podiatry, I
decided to evaluate the environmental dangers associated with exposure to nail dust. I
reviewed the literature on the effect of nail
dust on respiratory symptoms and learned
that nail dust exposure was unregulated
despite sufficient evidence suggesting its
detrimental effect on the respiratory system. I
also noticed limitations in current literature on
nail dust as an occupational hazard. Thus, to
further strengthen the understanding of the
effect of nail dust, I completed a research proposal to determine the threshold of nail dust
exposure for podiatrists and their staff members.
This project provided me with an opportunity
to learn about grant writing and creating
research proposals that would meet the standards of National Institutes of Health, considered
to be the highest level of quality in academia.
My most intense project involved the entire
Medicare population and was designed to
reveal the variation in use of total contact
casting (TCC). This study was the best representation of my newly acquired knowledge
and skills on population research. With the
assistance of Dyane E. Tower, DPM, MPH,
MS, director of Clinical Affairs at APMA;
James Wrobel, DPM, MPH, at the University of Michigan; Philip Goodney, MD, MS, at
Dartmouth-Hitchcock Medical Center; and
David Goodman, MD, MS, at Geisel School
of Medicine, our collaborative efforts yielded
Continued on Page 4

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Table of Contents for the Digital Edition of APMA News - July/August 2018