Harkless Heads Up New Podiatry School

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By Brian McCurdy, Senior Editor

The podiatry profession will welcome its ninth college under the leadership of a DPM with decades of experience in education. Western University of Health Sciences School of Podiatric Medicine will start classes in 2009 under the helm of Lawrence Harkless, DPM.    Dr. Harkless became the college’s first Dean on July 1 and has begun planning the school’s curriculum. He recently retired from the University of Texas Health Sciences Center at San Antonio after serving as a Professor in the Department of Orthopaedics and as the Louis T. Bogy Professor of Podiatric Medicine and Surgery.    Dr. Harkless says the new college, which will be located in Pomona, Calif., has slots for 50 students, who will matriculate in September 2009. The university’s Web site notes it will undergo the accreditation process through the Council on Podiatric Medical Education and the Western Association of Schools and Colleges.    Western University was founded in 1977 and has about 1,500 students involved in various medical disciplines, according to the school’s Web site. In addition to the podiatry school, the university also plans to open dental and optometry schools. Dr. Harkless says the new podiatry school offers a “huge opportunity” for clinical training in three counties in the school area.

Emphasizing Active Recruitment And Education On The Role Of Podiatry

The potential applicant pool consists of about 800 students for the existing colleges of podiatric medicine, notes Dr. Harkless. He says California currently graduates about 20 to 30 DPMs a year. He intends to change the landscape of the applicant pool, saying he will actively recruit potential podiatry students by going to schools and educating potential applicants.    Beyond recruiting new students, Dr. Harkless wants to integrate podiatry further into the medical environment and stress the comprehensive nature of the profession. At Western University, he says DPMs will have a good opportunity to educate the students of other medical specialties about all that podiatry has to offer.    “That means 2,000 students will know about podiatric medicine from day one. That is huge,” notes Dr. Harkless of the school’s students of other medical disciplines. “(Podiatrists) treat the entire foot by any systems or means and I do not think other health disciplines know that.”    Dr. Harkless emphasizes teaching podiatry students that they can be anything they want to be in healthcare. In his new venture, he plans to be visible in motivating students. Even with an additional podiatric medical school, he feels there will be a “tremendous need” for podiatrists as the population ages.    “A good, comprehensive podiatrist will be worth his or her weight in gold,” says Dr. Harkless. “As the population grows, we need to take care of the comprehensive needs of the patient.”

Can Maggot Debridement Help Treat Wounds With MRSA?

By Brian McCurdy, Senior Editor For ages, doctors have used biological debridement in wound care. Can such treatment be effective against the rising tide of methicillin resistant Staphylococcus aureus (MRSA)? A recent study in Diabetes Care has demonstrated the efficacy of maggot debridement in wounds with MRSA.    Researchers examined 13 consecutive diabetic patients between 18 and 80 with MRSA-colonized diabetic foot ulcers of at least three weeks duration. The study excluded those taking antibiotics specific for MRSA, those on anticoagulation therapy or those who required immediate systemic antimicrobial treatment or urgent surgical management. Study authors say none of the MRSA strains was multi-drug resistant or vancomycin resistant.    Patients received sterile free-range larvae of the green bottle fly Lucilia Sericata on their MRSA-colonized ulcers for four days at densities of 10 larvae per 1 cm2. Patients wore offloading devices and pressure relieving dressings to prevent damage of the larvae during treatment. Researchers did not use topical antimicrobial agents or growth factors on the ulcers, according to the study.    Researchers note that MRSA colonization was eliminated from 12 of 13 ulcers after a mean of three applications with a mean duration of 19 days, according to the study. Study authors noted no adverse events during the treatment. They also detected a reduction in sloughy necrotic tissue and an increase of granulation tissue upon removal of the last larval application.    The maggot therapy lasted a mean of three weeks, which researchers note is much shorter than the conventional 28-week treatment for MRSA decontamination of diabetic foot ulcers. As the study notes, the mean wound area was smaller at the end of the study but the reduction in size was not significant in comparison to the baseline. They attribute this to the short duration of larval treatment.    Study co-author Frank Bowling, DPM, notes that larvae are relatively cheap and do not have side effects. There are also no contraindications to maggot debridement on the foot, according to Dr. Bowling. He says a randomized clinical trial on the use of larval therapy in wounds with MRSA is currently under way.    Eric Espensen, DPM, expresses skepticism as to whether maggot debridement would be effective for MRSA. While he does believe larval debridement would be effective as an adjunctive treatment to antibiotic therapy, since such debridement would remove necrotic tissue and slough, he does not feel larval therapy would be effective on its own. Given today’s medicolegal environment, Dr. Espensen says he always defers to the Infectious Diseases Society of America (IDSA) protocols.

Is Patient Reluctance A Factor?

Would patients be reluctant to undergo larval debridement due to the nature of maggots? Patients who receive such debridement are “at the stage were they will try any type of treatment to heal the wound,” according to Dr. Bowling, who is affiliated with the University Department of Medicine and Diabetes at Manchester Royal Infirmary in Manchester, U.K.    When it comes to using maggot debridement in wound care, Dr. Espensen says he often hears objections from floor nurses in the hospital. Despite the fact that Dr. Espensen uses medical grade larvae, he notes the nurses cite concerns with sterility and the perception that maggots and flies are dirty. However, he notes most of his patients do not mind the treatment and become interested when he starts explaining the historic background and scientific basis for maggot debridement.    “Always speak to the patient on his or her level in plain terms and simple terminology, and explain why you want to use them, the historical background and the effectiveness. I have never had a patient flat out refuse,” says Dr. Espensen, the Chief of Foot Surgery at Providence St. Joseph Medical Center in Burbank, Calif.

Study: Duloxetine Can Relieve Night Pain, Sleep Interference

By Brian McCurdy, Senior Editor    Night pain that makes it difficult to sleep can often go hand in hand with the troubles spurred on by painful diabetic neuropathy. A relatively new medicine has shown promise in relieving night pain associated with sleep interference, according to an abstract that was recently presented at the American Pain Society meeting.    Researchers estimated that 70 percent of those with chronic pain have trouble sleeping. However, they did caution that the relationship between sleep and pain has not been quantified. The aforementioned abstract examined data from three randomized, double-blind, placebo-controlled 12-week trials of a total of 1,024 patients with diabetic peripheral neuropathic pain (DPNP), excluding patients with major mood disorders. Researchers compared duloxetine HCl (Cymbalta®, Eli Lilly) 60 mg QD and 60 mg BID with a placebo.    The study showed duloxetine in both doses was significantly superior to placebo in reducing day and night pain. Additionally, one of the doses of the drug was superior to placebo in reducing sleep interference at weeks four and eight, and both doses had significant results at week 12, according to the study. Although researchers did not establish causality, they noted that findings suggest improvements in pain will be associated with less sleep interference.    Javier La Fontaine, DPM, MSc, asserts it is “very common” to find patients with painful diabetic neuropathy and sleep interference.    “It seems to be one of the most common reasons why a patient will seek professional help. In my practice, it is the main reason why DPNP should be treated,” says Dr. La Fontaine, an Assistant Professor and Interim Chief of the Podiatry Division at the University of Texas Health Science Center at San Antonio.    While glucose control is the most effective treatment for diabetic neuropathy, Dr. La Fontaine notes he has discovered that fluctuating glucose during the day elicits symptomatology at night.    Dr. La Fontaine feels duloxetine might be effective in salving sleep interference among patients with diabetic peripheral neuropathy. He has found the most success using duloxetine in patients with small fiber symptomatology that includes burning, cold, heat and tingling. On the other hand, he notes that duloxetine is less successful when patients have cramping or lancinating type pain.

In Brief

The American College of Foot and Ankle Surgeons (ACFAS) is beginning a series of free monthly podcasts. Upcoming topics range from calcaneal fractures and the diabetic foot to arthritic ankle controversies and pediatric flatfoot correction. The ACFAS podcasts are available through ACFASpodcasts.com, iTunes podcast directory and PodcastAlley.com, according to the ACFAS.    Medline Industries has acquired the first aid brand Curad from Beiersdorf. Medline will sell Curad in the United States while Beiersdorf will sell its first aid brand in other markets, according to Medline.    Certified Medical Planners has a new Web site: www.certifiedmedicalplanner.com. The site features a customized curriculum, textbooks and various other resources, according to the company.

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