In providing quality patient outcomes, current evidence based research has to be an important part of this process. With every new research proposal, a solid foundation has to be the basis for that specific research. The following paper is a literature analysis of current studies that support the use of negative pressure wound therapy (NPWT) in healing diabetic foot ulcers in adults. This paper will also discuss what search methods were used, strengths and weaknesses of each study, and the validity and relevancy of the research on the issue of non-healing diabetic foot ulcers in healthcare today. Strategies Used in Literature Analysis This is a literature analysis of evidence based articles that studied the effects of NPWT on people with diabetic …show more content…
(2008) study is of a multicenter RCT comparison of 342 participants with a mean age of 58 and 79% were male. Methods of assessment and tracings were done to monitor the progress of the wound of each participant. The study concluded 73 of 169 participants healed in approximately 96 days by using NPWT whereas, participants without the NPWT took longer or did not heal completely. There was no difference in the healing time if the participant had complications such as infection, cellulitis or osteomyelitis but NPWT was more efficacious than SMWT. There can be some bias as the results are based on a higher count of males than females but the strength of the results support the proposal …show more content…
Each study had a combination of strengths to support the importance of NPWT in healing diabetic foot ulcers. It was also shown that each article was valid, relevant, and peer-reviewed in the support of this need of new methods (NPWT) in improving the patients’ quality of life. The majority of the literature reviewed had a high degree on internal validity through the use of randomized control studies. According to Jarrett (2013), “a high degree of internal validity can be achieved through random control studies because of the decrease in bias that could develop is decreased”. Even though the three systematic reviews supported NPWT, there could possibly be internal threats if the researchers had any personal bias in the selection of studies reviewed. All the articles met the inclusion criteria needed for this proposal. Six studies were excluded due to either being too broad or too inconclusive and could potentially cause errors in the data. Selection bias does not appear to be a factor as the research methods used shows no history of bias in any of the random groups made. Overall, the internal validity is strong. The external validity of this research (NPWT) can be used with all patients’ that have diabetic foot ulcers. Steps were taken to control characteristics that could impact outcomes when considering the sample group such as bias by the
Willock et al, (2007) developed a detailed questionnaire based on a paediatric and adult pressure ulcer literature. A survey of 265 in patients in a paediatric hospital in the UK was conducted so detailed data could be obtained. The study found anaemia emerged as being a highly significant aspect of determining pressure ulcers. As a result of this study, the Glamorgan scale was
Wyness, L. (2009). Understanding the role of diet in type 2 diabetes prevention. British Journal of Community Nursing, 14(9), 374.
A pressure ulcer is an area of skin with unrelieved pressure resulting in ischemia, cell death, and necrotic tissue. The constant external pressure or rubbing that exceeds the arterial capillary pressure (32mmHg) and impairs local normal blood flow to tissue for an extended period of time, results in pressure ulcer (Smeltzer et. Al., 2013). According to National Pressure Ulcer Advisory Panel, 2014, pressure ulcers are a major burden to the society, as it approaches $11billion annually, with a cost range from $500 to $70,000 per individual pressure ulcer. It is a significant healthcare problem despite considerable investment in education, training, and prevention equipment. This paper includes two different studies to link cause-effect
Utilizing this tool will allow The Restorative Nurse and Wound Nurse to generate a graph based off of the data retrieved from the Center of Medicare and Medicaid Services (CMS) quarterly Quality Measures Report (APPENDIX B). The Wound Nurse and Restorative Nurse will start with the last data reported before the start of the On-Time Project and then graph the data every three months during the On-Time Project for the following areas: falls, weight loss, in- house acquired pressure injuries and nosocomial infection. For that purpose, to monitor the effectiveness of the On- Time Project the Wound Nurse and Restorative Nurse will provide a designated share drive to present to the Director of Nursing and other stakeholders on a quarterly schedule at the quarterly Quality Assurance Improvement Program(QAIP)
Journal of Continuing Education in Nursing, 44(9), 406. doi:10.3928/00220124-20130617-38. Torpy, J. M. (2011). The 'Standard' Diabetes. Jama, 305(24), 2592 pp.
Maintenance of an appropriate healing environment is also essential throughout the management of diabetic foot ulcers. The choice of dressing is dependent on many factors including presence of infection, amount of exudate and the required frequency of wound bed inspection.
The aim of the Healthcare Quality Strategy (HQS) is to deliver excellent healthcare to the citizens of Scotland and brand NHS Scotland as a world leading care provider (Scottish Government, 2010). An improvement intervention examined in the HQS is the prevention of pressure ulcers (PUs). Using the Gibbs (1988) framework, this essay will demonstrate how I was involved in this intervention by applying my skills of compassion, person-centred care and teamwork. I have chosen PU prevention as the subject for this reflection; since, the majority of PUs are preventable (Watret and Middler, 2012) and the cost of treating them ranges from £1,214 to £14,108 (Dealey, Posnett and Walker, 2012). Supporting the Nursing and Midwifery Council (NMC) (2011) confidentiality guidelines, the pseudonym “Ruby” has been used.
...revention through awareness and education is achieved via the work of government initiatives such as the National Diabetes Services Scheme and health campaigns including Measure Up. The NDSS also works to improve the self-management of diabetes. Physiotherapists also have a role in the management of diabetes through implementing exercise programs. An evidence-based approach was used to create the proposed exercise program that aimed to manage the high blood glucose levels associated with insulin resistance in type 2 diabetes (Sigal et al., 2007). It utilized both aerobic and resistance training in accordance with current knowledge of the most effective dosages for the population group. Physiotherapists must work alongside other healthcare professionals such as dietitians and general practitioners to provide optimal support and management for patients with diabetes.
Satterfield, DW, Volansky, M, Caspersen, CJ, Engelgau, MM, Bowman, BA, Gregg, EW, Geiss, LS, Hosey, GM, May, J & Vinicor, F 2003, ‘Community- Based Lifestyle Interventions to Prevent Type 2 Diabetes’, Diabetes Care, vol.26, no.9, September, pp.2643-2652, viewed 10th May 2011.
Ford, S. (2013). List of 12 Priorities for Pressure Ulcer Study Identified by UK Researchers. Retrieved from: http://www.nursingtimes.net/nursing-practice/clinical-zones/wound-care/priorities-for-pressure-ulcer-research-identified/5058364.article
...nd recommendations from healthcare providers is key in preventing severe damage. Smoking, alcohol use, and poor diet all contribute to worsening symptoms of neuropathy. Therefore, support systems and constant education should be a part of any treatment plan for the patient at risk or the patient suffering from diabetic neuropathy.
Thomas, D. R. (2001). Issues and dilemmas in the prevention and treatment of pressure ulcers: A
Electrical stimulation (ES) therapy involves the transfer of electrical current across wound tissue through the two electrodes and uses three types of currents: AC, DC and Pulse DC. According to various studies, electrical stimulation therapy has shown to reduce inflammation, edema, improve wound appearance, cause a faster reduction in wound size by helping to kick start the wound healing process and is cost effective for many patients. It has generated a positive impact on patient’s comfort and convenience. Electrical stimulation therapy has provided numerous beneficial effects in wound healing demonstrated by various studies, however; further research trials are needed in order to prove the effectiveness and benefits of electrical stimulation therapy as it relates to wound healing (Cutting, 2006).
Our approach in managing wounds was far from being optimal in our own setting. After having read the article of Sibbald et al (1) and assisting to presentations during the first residential week-end, our approach at St. Mary 's Hospital Center 's Family Medicine Clinic must change. We were not classifying wounds as healable, maintenance or non-healable. We were always considering the wounds in our practice as healable despite considering the system 's restraints or the patients ' preferences. In the following lines, I will define and summarize the methods one should use in order to initial management of wounds and how to integrate it better to our site. The first goal we need to set is to determine its ability to heal. In order to ascertain if a wound is healable, maintenance or a non-healable wound.
The normal wound healing process mainly consists of four main stages being haemostasis, inflammation, proliferation or new tissue formation, and tissue remodeling or resolution. For a wound to heal well the above mentioned stages should occur in a sequential and orderly manner. Disturbances, abnormalities and delays in any of the above stages may lead to impaired healing or even chronic wounds. In adults, this process of normal healing takes place in the following steps (1)rapid haemostasis (2)appropriate inflammation (3)mesenchymal cell differentiation, proliferation, and migration to the wound site (4)suitable angiogenesis (5)prompt re-epithelialization and (6) proper synthesis, cross-linking, and alignment of collagen to provide strength to the healing tissue.