Heres what a recent paper published ahead of print in Annals of Surgery says:
Between May 2013 and March 2014, 222 patients were randomized to the group allowed remove their dressings and shower at 48 hours and 222 to the group permitted to shower only after the original dressing and the sutures were removed in clinic. There were 4 (1.8%) superficial surgical site infections in the early shower group and 6 (2.7%) in the late shower group, an insignificant difference with p = 0.751.
The authors concluded that clean and clean-contaminated wounds can be safely showered 48 hours after surgery, and early postoperative showering may increase patient satisfaction.
I have always been an advocate of early showering after surgery. Wounds properly closed will be bridged by epithelium within 48 hours. Tap water is relatively sterile or we couldnt drink it. Many studies have shown that even irrigating open wounds with tap water instead of sterile saline does not lead to more infections. [Links here and here.]
Much as I would like to believe the Annals study, I cant because it is probably underpowered to show a difference between the two groups.
Here is a nice definition of statistical power from a website called effectsizeFAQ.com:
In plain English, statistical power is the likelihood that a study will detect an effect when there is an effect there to be detected. If statistical power is high, the probability of making a Type II error, or concluding there is no effect when, in fact, there is one, goes down.
To their credit, the authors did try to estimate the sample sizes they would need by doing a power calculation. They knew that the wound infection rate for the cases they intended to enroll was about 1%. The problem is they estimated that showering at 48 hours would result in a wound infection rate of 5%. That seems very high to me for the types of cases included in their investigationthyroid, lung, inguinal hernia and skin tumors.
If they had hypothesized that early showering would merely triple the rate of wound infections from 1% to 3%, they would have needed at least 1536 patients in each arm of the study. Then if there was no difference, one could conclude that early showering truly does not cause more wound infections.
Even if the known incidence of wound infection was much larger, say 5%, and the rate of infection with showering was presumed to be doubled (10%), to have enough power a study would need 434 patients in each arm.
Many websites provide calculators for determining the appropriate sample sizes to detect with a reasonable degree of certainty whether one intervention is better than another. Anyone thinking about doing a prospective randomized trial should realistically estimate the expected difference and calculate the power.
Whenever you read a negative study, the first question to ask is, Was the study adequately powered to avoid a type II error?
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Between May 2013 and March 2014, 222 patients were randomized to the group allowed remove their dressings and shower at 48 hours and 222 to the group permitted to shower only after the original dressing and the sutures were removed in clinic. There were 4 (1.8%) superficial surgical site infections in the early shower group and 6 (2.7%) in the late shower group, an insignificant difference with p = 0.751.
The authors concluded that clean and clean-contaminated wounds can be safely showered 48 hours after surgery, and early postoperative showering may increase patient satisfaction.
I have always been an advocate of early showering after surgery. Wounds properly closed will be bridged by epithelium within 48 hours. Tap water is relatively sterile or we couldnt drink it. Many studies have shown that even irrigating open wounds with tap water instead of sterile saline does not lead to more infections. [Links here and here.]
Much as I would like to believe the Annals study, I cant because it is probably underpowered to show a difference between the two groups.
Here is a nice definition of statistical power from a website called effectsizeFAQ.com:
In plain English, statistical power is the likelihood that a study will detect an effect when there is an effect there to be detected. If statistical power is high, the probability of making a Type II error, or concluding there is no effect when, in fact, there is one, goes down.
To their credit, the authors did try to estimate the sample sizes they would need by doing a power calculation. They knew that the wound infection rate for the cases they intended to enroll was about 1%. The problem is they estimated that showering at 48 hours would result in a wound infection rate of 5%. That seems very high to me for the types of cases included in their investigationthyroid, lung, inguinal hernia and skin tumors.
If they had hypothesized that early showering would merely triple the rate of wound infections from 1% to 3%, they would have needed at least 1536 patients in each arm of the study. Then if there was no difference, one could conclude that early showering truly does not cause more wound infections.
Even if the known incidence of wound infection was much larger, say 5%, and the rate of infection with showering was presumed to be doubled (10%), to have enough power a study would need 434 patients in each arm.
Many websites provide calculators for determining the appropriate sample sizes to detect with a reasonable degree of certainty whether one intervention is better than another. Anyone thinking about doing a prospective randomized trial should realistically estimate the expected difference and calculate the power.
Whenever you read a negative study, the first question to ask is, Was the study adequately powered to avoid a type II error?





























Kids Love Comics joins our previously announced guests, including: Eddy Barrows (Earth 2); Marty Baumann (Pixar artist); Jeremy Bastian (Cursed Pirate Girl); Marguerite Bennett (Batgirl); Christina Blanch (The Damnation of Charlie Wormwood); Mark Buckingham (Fables); Dave Bullock (Batman Black and White); Jim Calafiore (Leaving Megalapolis); Darrenn Canton (Tunnels & Trolls); Greg Capullo (Batman); Richard Case (Sandman); John Cassaday (Doc Savage); Bernard Chang (Green Lantern Corps); Jo Chen (Buffy the Vampire Slayer); Sean Chen (Amazing Spider-Man); Jimmy Cheung (Infinity); Cliff Chiang (Wonder Woman); Frank Cho (X-Men: Battle of the Atom); Amy Chu (Girls Night Out); Richard Clark (House of Gold & Bones); Steve Conley (Bloop); Mike Curtis (Dick Tracy); Jeremy Dale (Skyward); Alan Davis (Wolverine); Rachel Deering (In the Dark); Todd Dezago (Tellos); Tommy Lee Edwards (Star Wars); Garth Ennis (Preacher, The Boys); Ray Fawkes (Constantine); Tom Feister (G.I. Joe); David Finch (Forever Evil); Jose Luis Garcia-Lopez (All-Star Western); Gerhard (Cerebus the Aardvark); Dave Gibbons (Watchmen); Keith Giffen (The New 52: Futures End); Bryan JL Glass (Mice Templar); Michael Golden (The Ravagers); Allan Gross (Road Song); Cully Hamner (Animal Man); Dean Haspiel (The Fox); Fred Hembeck (Garfield); Marc Hempel (Sandman: The Kindly Ones); Adam Hughes (Before Watchmen: Dr. Manhattan); Justin Jordan (Luther Strode, Green Lantern: New Guardians); Dan Jurgens (The New 52: Futures End); Chris Kemple (Red Vengeance); Denis Kitchen (Al Capp: A Life to the Contrary); Barry Kitson (Empire); Aaron Kuder (Action Comics); Norman Lee (Iron Man Special); David Mack (Shadowman); Kevin Maguire (Guardians of the Galaxy); Pop Mhan (All New X-Factor); Alex Maleev (Moon Knight); Billy Martin (Vitriol, The Hunter); Ron Marz (Witchblade); Mike McKone (Ultimate FF); Bob McLeod (X-Men: Gold); Tradd Moore (Deadpool Annual); Mark Morales (New Avengers); Dan Parent (Archie, Veronica, Kevin Keller); David Peterson (Mouse Guard); Joe Prado (Justice League); Brian Pulido (Lady Death); Ron Randall (Trekker in Dark Horse Presents); Tom Raney (Incredible Hulk); Ivan Reis (Aquaman and The Others); Budd Root (Cavewoman); Don Rosa (Donald Duck); Craig Rousseau (Perhapanauts); Joe Rubinstein (The Official Handbook of the Marvel Universe); Andy Runton (Owly); Alex Saviuk (Web of Spider-Man); Louise Simonson (Power Pack); Walter Simonson (Thor); Andy Smith (Superman #23.1: Bizarro); Allison Sohn (sketch card artist); Charles Soule (Thunderbolts); Jim Starlin (Thanos: The Infinity Revelation); Joe Staton (Dick Tracy); Paul D. Storrie (Sheena, Queen of the Jungle); Ben Templesmith (The Memory Collectors); Robert Tinnell (The Wicked West); Peter Tomasi (Batman and Two-Face); John Totleben (Swamp Thing); Herb Trimpe (GI Joe: A Real American Hero); Billy Tucci (Shi); Rick Veitch (Saga of the Swamp Thing); Mike Vosburg (Lori Lovecraft); Mark Waid (Daredevil); Lee Weeks (Daredevil); Mark Wheatley (Frankenstein Mobster); Bill Willingham (Fables); Renee Witterstaetter (Joe Jusko: Maelstrom); Rich Woodall (Teenage Mutant Ninja Turtles); Kelly Yates (Amber Atoms); Thom Zahler (My Little Pony); and Mike Zeck (Secret Wars).



Wonder Woman has had a huge impact on men, women and children for 75 years. But why? What is it about her that we connect to? Why do we love her so much? This article of the Confessions of a Cosplay Girl Blog explores those questions and answers. Before I get to my thoughts and personal experiences, I want to share the thoughts of a fellow Wonder Woman fan. Cosplayer Candy Keane is also the owner of the Three Muses Clothing Boutique in Jacksonville, FL.



Victoria: Id like to get your opinion on the Man of Steel film. People are very split on their feelings towards the movie. What were your thoughts?
