Extracorporeal shockwave therapy for the treatment of lower limb intermittent claudication: Study protocol for a randomised controlled trial (the SHOCKWAVE 1 trial)

© 2017 The Author(s). Background: Peripheral arterial disease (PAD) has a population prevalence of 4.6% with intermittent claudication (IC) presenting as one of the earliest and most common symptoms. PAD has detrimental effects on patients' walking ability in terms of maximum walking distance (MWD) and pain-free walking distance (PFWD). Research has suggested extracorporeal shockwave therapy (ESWT) may induce angiogenesis in treated tissue; therefore, our objective is to assess the tolerability and efficacy of ESWT as a novel treatment of intermittent claudication. Methods/design: Patients with unilateral claudication will be randomised to receive either ESWT (PiezoWave 2 shockwave system) or sham treatment to the calf muscle bulk three times per week for 3 weeks. All patients are blinded to treatment group, and all assessments will be performed by a masked assessor. Treatment tolerability using a visual analogue scale, ankle-brachial pressure index, MWD, PFWD and safety will all be formally assessed as outcome measures at baseline and at 4, 8 and 12 weeks follow-up. Discussion: This trial will be the first of its kind in terms of methodology in relation to ESWT for intermittent claudication. A double-masked randomised controlled trial will provide useful information about the potential for the use of ESWT as a non-invasive treatment option and the need for further robust research. Trial registration: ClinicalTrials.gov, NCT02652078. Registered on 17 October 2014

Investigating the effectiveness of dialkylcarbamoylchloride-coated wound dressings in the prevention of surgical site infection

Background: Surgical site infection (SSI) is the second most common healthcare acquired infection and may complicate between 5 and 30% of all surgical procedures. Avoidance of antibiotic or antimicrobial agents is important to future prevention strategies due to increasing levels of microbial resistance. When impregnated into post-operative dressings, dialkylcarbamoylchloride (DACC) non-selectively binds bacteria at the wound surface which may prevent ingress into the wound thus reducing SSI rates.Methods: Following a systematic review of the evidence, two studies were undertaken; the first a non-randomised before-and-after study in which 100 consecutive patients received a control dressing and the following 100 patients received a DACC-coated dressing; and the second a pilot feasibility randomised controlled trial in which 144 patients were recruited and randomised to receive either a DACC-coated dressing or a control dressing. Results: In the first study, the rate of SSI at 5-7 days was significantly lower in the DACC group compared to standard dressings (1% Vs 10%, p < 0.05). There was no difference in the rates of SSI at 30 days (10% vs 19%, p = 0.11). In the second study, at 30 days, there was a 36.9% Relative risk reduction in SSI associated with the DACCcoated dressing (16.22% vs 25.71%, odds ratio 0.559, p = 0.161). In patients who had a prosthetic implant, there was a reduction of SSI from 24% to 7.7% at 30 days (OR 0.264, p = 0.109). In terms of feasibility, 43.5% of screened patients were successfully randomised in the study, with a retention rate of 76.4% across the trial.Conclusions: The work in this thesis has shown that DACC-coated dressings show a promising effect in the reduction of SSI, and that a large randomised study is both feasible and justifiable. This pilot data justifies the completion of a wider multicentre study to further assess the clinical and cost effectiveness of this dressing technology

The Resilience Compass: How Mindset, Skills-Development, Self-Compassion, Service, and Community Empower Actors to Bounce Back, Reclaim Their Passion and Live Their Purpose

Actors often describe their vocation as a passion, a calling, or even a purpose. However, the very nature of a career as an actor is rife with rejection, a lack of agency, and income instability. Such strong identification with their vocation may threaten an actor’s self-concept in the face of so much adversity. Many actors become frustrated, sometimes to the point of giving up, because the gatekeepers (agents, casting directors, network executives, etc.) decide whether they get to exercise their passion or fulfill their purpose by actually working in their chosen profession. While the body of research on resilience is robust, there have been virtually no studies on the application of resilience training to this particular ‘at risk’ population. Based on the theory, research, and practice of positive psychology, this paper proposes a resilience model for actors incorporating 1) a resilience mindset and toolkit, 2) self-compassion, 3) community, and 4) using one’s talent in service to others. It is hypothesized that this combination will enhance resilience, build a strong community, bolster actors’ well-being, and provide a volitional pathway to exercise one’s passion and purpose without sacrificing vulnerability. This is the foundation of The Resilience Compass

Do we need routine antibiotics for hand surgery?

Both the incidence of hand trauma, and the demand for elective hand surgery, continue to rise in the UK. The incidence of surgical site infection (SSI) following hand surgery is around 5%. Traditionally, antibiotic prophylaxis at the time of surgery has been used to reduce the risk of SSI, however with growing concerns about antimicrobial resistance and antibiotic overuse, there is a need to examine whether routine antibiotics are truly necessary for all surgery in the hand. In this session, we present the current guidelines and evidence base for the use of antibiotics in hand surgery, and discuss how we might change practice in the future

Dialkylcarbamoyl chloride (DACC)-coated dressings in the management and prevention of wound infection: A systematic review

Objective: Dialkylcarbomoyl chloride (DACC)-coated dressings (Leukomed Sorbact and Cutimed Sorbact) irreversibly bind bacteria at the wound surface that are then removed when the dressing is changed. They are a recent addition to the wound care professional's armamentarium and have been used in a variety of acute and chronic wounds. This systematic review aims to assess the evidence supporting the use of DACC-coated dressings in the clinical environment. Method: We included all reports of the clinical use of DACC-coated dressings in relation to wound infection. Medline, Embase, CENTRAL and CINAHL databases were searched to September 2016 for studies evaluating the role of DACC-coated dressings in preventing or managing wound infections. Results: We identified 17 studies with a total of 3408 patients which were included in this review. The DACC-coating was suggested to reduce postoperative surgical site infection rates and result in chronic wounds that subjectively looked cleaner and had less bacterial load on microbiological assessments. Conclusion: Existing evidence for DACC-coated dressings in managing chronic wounds or as a surgical site infection (SSI) prophylaxis is limited but encouraging with evidence in support of DACC-coated dressings preventing and treating infection without adverse effects

From the Ouachitonian : Rickey Rogers, Jr.

For Rickey Rogers Jr., a freshman communications and psychology double major from Arkadelphia, Ouachita has always been home. When Rogers was 10 years old, his family moved into O.C. Bailey Hall because of his father’s new position as the Tigers’ wide receiver coach and residence hall director

Quality of life in patients with intermittent claudication

© 2017, The Author(s). Background: Intermittent claudication (IC) is a common condition that causes pain in the lower limbs when walking and has been shown to severely impact the quality of life (QoL) of patients. The QoL is therefore often regarded as an important measure in clinical trials investigating intermittent claudication. To date, no consensus exits on the type of life questionnaire to be used. This review aims to examine the QoL questionnaires used in trials investigating peripheral arterial disease (PAD). Material and methods: A systematic review of randomised clinical trials including a primary analysis of QoL via questionnaire was performed. Trials involving patients with diagnosed PAD were included (either clinically or by questionnaire). Any trial which had QoL as the primary outcome data was included with no limit being placed on the type of questionnaire used. Results: The search yielded a total of 1845 articles of which 31 were deemed appropriate for inclusion in the review. In total, 14 different QoL questionnaires were used across 31 studies. Of the questionnaires 24.06% were missing at least one domain when reported in the results of the study. Mean standard deviation varied widely based on the domain reported, particularly within the SF36. Discussion: Despite previous recommendations for Europewide standardisation of quality of life assessment, to date no such tool exists. This review demonstrated that a number of different questionnaires remain in use, that their completion is often inadequate and that further evidence-based guidelines on QoL assessment are required to guide future research

From the Ouachitonian : Harry Jeffrey

Years before attending Ouachita, Harry Jeffrey, a senior biology and chemistry double major from Camden, Ark., knew that he wanted to become a Tiger Tunes director