Mar-10

CPME May Extend Residency Requirement To Three Years

By Brian McCurdy, Senior Editor

   The Council on Podiatric Medical Education (CPME) is proposing longer residency requirements for podiatrists to qualify for advanced certification. The council advocates lengthening the residency duration from two years to three, according to CPME 320 documents posted on www.cpme.org/

   Public feedback on the changes is due April 1. The CPME will consider the change for final adoption at an April 24 meeting. The proposed change for residency requirements is one of the goals of the American Podiatric Medical Association (APMA) Vision 2015 program, according to APMA President Ronald Jensen, DPM. Under this program, the association intends that podiatrists will be universally recognized as physicians within the podiatric specialty by 2015.

    “Since residencies in all other specialties of medicine are a minimum of three years in length, the change in CPME residency programs achieves comparability with our allopathic and osteopathic colleagues,” explains Dr. Jensen.

   Jeffrey Robbins, DPM, agrees that the change would bring podiatry in line with residency requirements in other specialties.

    “The practice of podiatric medicine and surgery has become much more complex in the past 20 years and it is expected that our programs train to the highest levels of expertise in order to meet the needs of the public,” notes Dr. Robbins, the Director of Podiatry Service VACO at the Louis Stokes Cleveland Veterans Affairs Medical Center.

How Will This Change Be Received By The Profession?

   Dr. Robbins notes that most graduates are looking for three-year residency programs and most programs are already three years in duration. At this point, Dr. Jensen says about 80 percent of residency programs have been approved as PM&S-36. He has heard “universal approval” of the residency changes, based on written comments and feedback from the CPME open forums. Dr. Robbins disagrees. “While the change to three years is generally accepted, many of the components of the proposed documents” face opposition, notes Dr. Robbins.

   In contrast, Earl Horowitz, DPM, the President of the American Board of Multiple Specialties in Podiatry (ABMSP), has found that many podiatrists are unaware of the changes.

   The ABMSP has published open letters in several forums, including Podiatry Today, saying as three-year residencies are relatively new, this may prevent podiatrists who have been in practice “10, 20, 30 years or more” from being certified. Dr. Horowitz advocates having a system to grant equivalency to podiatrists who have completed two years of residency. He is troubled by the APMA terminology that one “must” complete a three-year residency program to gain certification with no language about those with two years under their belts.

    “I am not saying everybody will have the same education but everybody should have equal access,” says Dr. Horowitz, who suggests years of experience might count toward the third year of residency.

   Dr. Jensen speculates that certification entities might permit a window of opportunity for two-year residency graduates to attain certification. However, Dr. Horowitz is concerned that any window of opportunity might close. He also questions how the residency changes might affect a DPM’s status with insurance plans and hospitals.

    “Every discipline in medicine has and continues to go through these advances as a result of progress in education, training and technology,” says Dr. Jensen. “As such, every discipline in medicine must deal with those who have come before them when these training programs were not yet available. Podiatric medicine is no different.”

   For further reading on CPME 320, see the online exclusive “Raising Questions About The Use Of Minimum Activity Volume With CPME 320” at www.podiatrytoday.com.

Study Assesses Benefits Of Ultrasonic Debridement

By Lauren Grant, Editorial Assistant

   Weekly treatments with ultrasonic debridement can have an impact on wound bioburden, according to a new study abstract, submitted for the Symposium on Advanced Wound Care (SAWC) Spring in April.

   The study assessed the weekly use of the 22.5 kHz frequency SonicOne™ Ultrasonic Wound Debridement System (Misonix) on the wounds of 17 patients. When using the SonicOne liberally, the authors found some improvement in healing rates and shorter average healing times for wounds.

   Martin J. Winkler, MD, the lead author of the abstract, believes one should use ultrasonic wound debridement for chronic wounds with exuberant granulation.

    “The reality is that it is hard for surgeons to justify sharply debriding a granulating wound with a scalpel or curette to remove a wimpy, invisible biofilm. Sharp debridement is painful, causes messy bleeding and takes time,” says Dr. Winkler, a Fellow of the American College of Surgery. “The acoustic energy of the SonicOne hand-piece removes the bioburden present in chronic granulating wounds quickly with little pain and bleeding.”

   Dr. Winkler says many wound care doctors feel that one should remove bacterial bioburden via a mechanical device, scalpel, curette or acoustic hand piece. Biofilm typically stalls healing of chronic granulating wounds. He says “aggressive” acoustic wound debridement resulted in a small improvement in the healing rate and a shorter average healing time.

   In addition, Dr. Winkler feels that doctors and nurses alike would benefit from the time savings of the SonicOne debridement system. At his facility, Bergan Mercy Hospital Wound Care Clinic in Omaha, Neb., two surgeons familiarized the nursing staff with the device’s debriding techniques.

   Furthermore, Dr. Winkler argues that doctors over-prescribe antibiotics when they feel pressure to “do something” to control wound bacteria. He maintains that biofilm makes antibiotics ineffective. Dr. Winkler says mechanical control of bioburden via ultrasonic debridement is “less expensive, more effective and safer than systemic antibiotics.”

   The SAWC Spring will be held from April 17-20 at the Gaylord Palms Hotel and Convention Center in Orlando, Fla. For more information, please visit https://spring.sawc.net/

For further reading, check out the archives at www.podiatrytoday.com.

Can Autologous Platelet Rich Plasma Speed Healing?

By Brian McCurdy, Senior Editor

   Given the potential complications facing patients with chronic wounds, it is vital to decrease the area of the wound and reverse the non-healing trend. A study abstract submitted to the SAWC Spring finds positive healing results with the use of autologous platelet rich plasma (PRP).

   The study authors note that the PRP gel (AutoloGel, Cytomedix) contains the patient’s growth factors, cytokines and chemokines for cell growth and migration, plasma-derived proteins to produce a fibrin matrix scaffold, and anti-inflammatory properties to stimulate the natural healing process. The abstract focused on 27 patients with 34 wounds treated in three outpatient clinics with AutoloGel. The treated wounds included 12 venous ulcers, 11 diabetic ulcers, four pressure ulcers, two trauma wounds, two arterial wounds, two wound dehiscences and one sickle cell wound.

   In an average 3.2 treatments over 3.5 weeks, 91.2 percent of wounds decreased 66.7 percent in volume and reduced 52.7 percent in area, according to the study. Authors noted that 100 percent of the wounds with undermining, sinus tracts or tunneling responded positively.

   As abstract author Donna Carman, MD, notes, many patients in the study had previously undergone treatment with advanced modalities but had no success. She says the PRP gel has a physiologically relevant amount of platelets in the PRP rather than a supra-concentration of platelets. She says this formulation causes aggressive cellular growth as evidenced by the rapid reduction in wound area and volume that she has seen in a short period of time.

    “I view this PRP formulation as a state-of-the-art treatment modality that should be an integral component of any comprehensive wound care program,” says Dr. Carman, a Medical Officer in the General Services Department at Indian Health Services in Phoenix.

   She advocates having Medicare and third party payment reimbursement in the future so the advanced therapy can be cost-effective and accessible to patients with wounds.

   Which lower extremity wounds have the most potential for healing with PRP gel? Patients with venous ulcers and those with arterial wounds and decubitus ulcers have experienced positive benefits, according to Dr. Carman.

   She cites a prospective randomized controlled trial of diabetic foot ulcers. The trial, which was published in the June 2006 issue of Ostomy Wound Management, noted that 81 percent of the most commonly sized diabetic foot ulcers (DFUs) healed in an average of six weeks in comparison to 42 percent of DFUs in control patients. Dr. Carman notes that one should not use PRP in malignant wounds.

For further reading, see “A New Approach To Using Growth Factors In Wound Healing” in the October 2003 issue of Podiatry Today.