Comparison of Wound Management Strategies

With reference to Keele (2011), critique and Evidence Based Practice (EBP) is relevant to healthcare because it aims to ensure that the delivery of care is supported with the best evidence available. In this assignment, two quantitative primary research articles are critically examined in the areas of wound management and comparison of negative pressure wound therapy utilizing vacuum assisted closure, to advanced moist wound therapy in the treatment of diabetic foot ulcers using the Holland & Rees framework widely used for quantitative analysis in the nursing field (Holland & Rees 2010; Keele, 2011; Zwarenstein et al., 2017).

Article 1: A large cluster randomised trial of outcome – based pathways to improve home- based wound care.

Authors: Zwarenstein, M., Shariff, S., Mittmann, N., Stern, A. and Dainty, K.

Year       : 2017

Aim: the aim of this study was to test a newly integrated model of wound care known as Integrated Client Care within the care home sector in Ontario, Canada to test for cost effectiveness of service and an improvement in health outcomes for patients.

Main body

Study design:

In article 1, In corresponding with the quantitative assessment report was created as a cluster randomized trial allocation of intervention randomized at the cluster level (CCAC) and analysis of outcomes based on a patient’s individual-level of recovery. Comparisons were made with clusters allocated to usual care. Again, the article described results gained using the RCT methodology that its results are valid and generalizable, and therefore relevant for creating real-world choices concerning events.

According to (Bonell et al., 2012), The approach randomized trials of complex public health interventions often fails to administer enough thought to however intervention parts act with one another and with native context. ‘Realists’ argue that trials construe the methodology, provide solely a ‘progressions’ approach to effort, that brackets out the quality of social effort, and fail to raise that interventions work, for whom and below what circumstance

Data collection:

Data collection was allied by, population-based databases involving registered personal database which contained demographic information. The Canadian Institute for Health Data discharge abstract information consists of standardized chart abstractions for all patient hospital episodes. The researcher also indicated that the National Ambulatory Care Coverage System involved in standardized coverage on all emergency call outs.

By collecting all different databases this was able to embody all of the knowledge regarding any interactions that the study participants had across the health care system.

(Thygesen and Ersbøll, 2014) argues that medical registers and records

medical records and registers square measure used extensively these days in medical specialty analysis. Despite the increasing use, no developed method literature on use and analysis of population-based registers is accessible, even if knowledge assortment in register-based studies differs from researcher-collected knowledge, all persons during a population square measure on the market and ancient applied mathematics analyses that specialize in sampling error because the main supply of uncertainty might not be relevant. we have a tendency to gift the most strengths and limitations of register-based studies, biases particularly necessary in register-based studies and strategies for evaluating completeness and validity of registers. the most strengths square measure that knowledge exist already and valuable time has passed, complete study populations minimizing choice bias and severally collected knowledge. Main limitations square measure that necessary data could also be unprocurable, knowledge assortment isn’t done by the man of science, confounder data is lacking, missing data on knowledge quality, truncation at begin of follow-up creating it troublesome to differentiate between prevailing and incident cases and also the risk of knowledge dredging. we have a tendency to conclude that medical specialty studies with inclusion of all persons during a population followed for many years on the market comparatively quick square measure necessary knowledge sources for contemporary medical specialty, however it’s necessary to acknowledge the information limitations.

Studies based on databases, medical records and registers are used extensively today in epidemiological research. Despite the increasing use, no developed methodological literature on use and evaluation of population-based registers is available, even though data collection in register-based studies differs from researcher-collected data, all persons in a population are available and traditional statistical analyses focusing on sampling error as the main source of uncertainty may not be relevant. We present the main strengths and limitations of register-based studies, biases especially important in register-based studies and methods for evaluating completeness and validity of registers. The main strengths are that data already exist and valuable time has passed, complete study populations minimizing selection bias and independently collected data. Main limitations are that necessary information may be unavailable, data collection is not done by the researcher, confounder information is lacking, missing information on data quality, truncation at start of follow-up making it difficult to differentiate between prevalent and incident cases and the risk of data dredging. We conclude that epidemiological studies with inclusion of all persons in a population followed for decades available relatively fast are important data sources for modern epidemiology, but it is important to acknowledge the data limitations.

Reference

• Bonell, C., Fletcher, A., Morton, M., Lorenc, T. and Moore, L. (2012). Realist randomised controlled trials: A new approach to evaluating complex public health interventions. Social Science & Medicine, 75(12), pp.2299-2306.

• Holland, K. and Rees, C. (2010). Nursing. Oxford: Oxford University Press.
• Keele, R. (2011). Nursing research and evidence-based practice. Sudbury, MA: Jones & Bartlett Learning.
• Zwarenstein, M., Shariff, S., Mittmann, N., Stern, A. and Dainty, K. (2017). A large cluster randomized trial of outcome-based pathways to improve home-based wound care. Trials, 18(1).