Steps of Evidence-Based Practice
| ← Diabetes | Nursing and Faith → |
There are several clinical-based problems associated with diabetic foot ulcer. Current paper provides the evaluation of available interdisciplinary evidence for translation into practice. The clinical-based problem is the optimal treatment strategies of diabetic foot ulcer. The population of interest is patients with diabetic foot ulcer. Negative pressure wound therapy is considered one of the most promising methods of treatment. However, further research in this sphere is still required.
The brief literature review of evidence-based interventions should be provided. Xie, McGregor and Dendukuri (2010) estimate the efficiency of negative pressure wound therapy. The authors have used the method of a systematic review of reported randomized controlled trials. Their results of negative pressure wound therapy demonstrate considerable and statistically significant advantages in comparison with other control treatments. However, the results show that the impact of this therapy is different for various types of ulcers. Some inconsistent results are obtained in relation to pressure ulcers while the situation with mixed wounds may be considerably improved using this method. The authors claim that negative pressure wound therapy is a safe method that can substantially facilitate the treatment process.
Uccioli et al. (2015) claim that the treatment knowledge and effectiveness in the sphere of wound management have improved substantially. However, the treatment of foot ulcers is still associated with large costs and risks. The wound environment is affected by many factors that may increase the actual level of risks above the acceptable degree. The authors rely on qualitative methods reviewing the existing issues and risks associated with foot ulcers. In addition, the authors concentrate on the chronic phase of the disease. They claim that dressings that promote EPA are much more effective than traditional ones. Therefore, their use should be encouraged especially in the contexts of treating the most difficult cases of ulcers.
Yarwood-Ross and Dignon (2012) elaborate on comparing the effectiveness of negative pressure wound therapy and conventional wound dressings. The authors base their comparison on a number of dimensions including infected wounds, foot ulcers, partial foot amputations, dehisced post-surgical wounds, and infected wounds (Yarwood-Ross & Dignon, 2012). They have used the most reliable libraries such as Medline and CINAHL for conducting their studies. The authors claim that the results of their studies indicate clearly that negative pressure wound therapy is a more effective tool in comparison with others wound dressings. It contributes to the emergence of granulation tissue within the minimum amount of time. Infection is effectively removed from the wound, and the overall risks present are minimized. Moist wound dressings demonstrate less efficient results and lead to a higher probability of amputations for patients using this method. The authors propose to use negative pressure wound therapy as a major method of treating patients with diabetic foot ulcers.
Holt (2013) examines several issues related to managing patients with foot ulcers. The author states that diabetes often leads to such complications as diabetic neuropathy. A number of urgent issues should be addressed in this context. First of all, the major ethical requirements should be explained to all parties including patients. All measures necessary for preventing the occurrence of diabetic neuropathy should be timely taken. The author has identified all major risk areas and proposed a set of corresponding interventions. The major focus is on the use of qualitative methods in organizing this study. Holt (2013) stresses that the treatment of diabetic foot ulcers is associated with a number of related issues such as wound care, infection, pain, sleep, etc. For this reason, all secondary treatment effects should be addressed closely in order to select the optimal mode of intervention.
The collective search for all these studies was based on the use of major databases such as Medline and CINAHL. The key terms used for organizing this search included “diabetic foot ulcers” and “intervention.” Further, the most appropriate and reliable sources were selected from the obtained list. The literature allowed formulating several important implications. First, there are different methods of treating patients with diabetic foot ulcer. All of them lead to different clinical results and corresponding risks. Second, negative pressure wound therapy demonstrates much better results and lower risks in comparison with other traditional wound dressings. Moreover, all authors under examination supported this conclusion.
Third, there is a need for designing strategies for spreading the use of negative pressure wound therapy to all relevant cases as this method demonstrates the most reliable results nowadays. Fourth, it is also reasonable to consider not only the general impact of this type of therapy but its impact in various cases. Thus, Xie, McGregor and Dendukuri (2010) stress that treatment of pressure ulcers involves considerable risks while that of mixed wounds is safe and effective. Therefore, it is reasonable to apply this method to those cases where it generates the maximum possible clinical effects.
The major elements of the PICOT question are as follows (Melnyk & Fineout-Overholt, 2010). P: In diabetic patients with foot ulcers; I: how does negative pressure wound therapy; C: compared to standard moist wound therapy; O: improves wound healing; T: within 12 weeks. Thus, the ultimate PICOT question is the following: in diabetic patients with foot ulcers, how does negative pressure wound therapy compared to standard moist wound therapy improves wound healing within 12 weeks? It may be concluded that diabetic foot ulcer is one of the major problems that requires innovative solutions to the existing challenges. The analyzed articles show that negative pressure wound therapy is an optimal option in the majority of cases.
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