Evidence-Based Practice on Wound Packing

Evidence-Based Practice on Wound PackingEvidence-Based Practice on Wound Packing Following Incision and DrainageArlena DavisThe first term was connect to MDs not utilize any gage pugilism when it comes to treating I Ds. Many times be set abouting is used to debride the go against and maintain fluids from pooling under the skin as hygienic as keep ara free of infection. In order to understand the conclusion we hold to fully understand what is involved.An abscess is a accrual of pus, surrounded by worsen tissue and usually localized (Pfenninger Fowler, 2010).The reason we need the packing is link up to having an abscess and we need to keep the area clean. Leinwand 2013states packing is thought to aid hemostasis, and bar reorganization of the abscess, we sought to determine whether packing could be omitted with equal efficacy.The present moment clause I chose was Alimov, V., Lovecchio, F., Sinha, M., Foster, K. N., Drachman, D. (2013)to the use ofa silver-containing hydrofiber preparation for filling abscess colliery quest scar and waste pipe in the fate department. Is using packing invariably effective? Can we hurt equal efficacy when in that respect is no packing used? These are questions that were sought after and answered in this grouchy article. At the end of the examination the patients reported express heling and les throe as it relates to traditional packing.In the research that was conducted in the first article empowerUse of Silver-containing hydro fiber back in filling the cavity cerebrate after incision and drainpipe at the emergency department a randomized controlled trial. Advances in skin affront care, (Alimov, Lovecchio, Sinha, Foster, Drachman, 2013), clinical contemplate program was used. This flying field design took the stress of prospective randomized control trial. The have size in this crusade was ninety- cardinal patients (Alimov, Lovecchio, Sinha, Foster, Drachman, 2013). These patients were m ore than 18 eld of age and were suffering from cutaneous abscess. The ninety- both con participants had been randomly delegate into two assemblys. These are the encumbrance theme (Skillman, Aquacel, New Jersey, and Convatec) and the iodoform group (Alimov, Lovecchio, Sinha, Foster, Drachman, 2013). The iodoform group is the control group in this case. Of these two groups, it was remark that in that location were no differences in terms of demography as well as their clinical characteristics.The weaknesses that are evident in info collection are that the researchers should have randomly selected the patients in two equal groups that is 46 persons per each group. The practise-up period is as well not consistent. Inconsistency comes in whereby the think claims that patients were followed up in a span of the first two weeks (Alimov, Lovecchio, Sinha, Foster, Drachman, 2013), though the follow-up was not continuous. However, the strength of this study is that it had both the intervention group and the control group. The intervention group comprised of four subgroups depending on the think intervention. These four groups were based on interventions such as Convatec, New Jersey, Aquacel, and Skillman) (Alimov, Lovecchio, Sinha, Foster, Drachman, 2013).The former(a) strength of the study is that it was able to provide a comparison on the level of botheration between the patients initial visit and the first follow-up.In relation to the second article that dealt with the incision and the drainage of the subcutaneous abscess without packing, (Leinwand, Downing, Slater, Beck, Burton, Moyer, 2013) clinical study design was also used. In this regard, the clinical study took the form of retrogressive randomized control trial. The sample size in this study was a hundred patients, who were reported to be suffering from subcutaneous abscesses back in between May 2008 and December 2010. These light speed patients were assigned into two groups namely, the packin g and the non-packing groups (Leinwand, Downing, Slater, Beck, Burton, Moyer, 2013). In this case, there were some exceptions in that some patients limning some given conditions could not be considered. Such conditions include patients who are immunosuppressed, or rather those suffering from diabetes. The early(a) exception was in case the patient had a perineal or a pilonidal abscess. Last exactly not least, the other exception was on whether the abscess is secondary to the previous operation. These exceptions toilet be used as a basis for comparison among the sample, to the patients who will be seeking treatment. there are several weaknesses of the study in terms of knowledge collection, with one of them being that it was not age specific. apart from that, the other weakness is that the patients were only clinically evaluated, in case there was suspicion of recurrence in the follow-up calls on the day seven and thirty (Leinwand, Downing, Slater, Beck, Burton, Moyer, 2013 ). These two days were referred to as postoperative. The other weakness is that, of the 100 patients, only 85 patients managed to complete the study. The study does not indicate the whereabouts of the 15 patients. On the other hand, the strength of this study is that it omitted other patients who had some other conditions that could interfere with the results. Such exceptional cases were the diabetic, immunosuppressed (Leinwand, Downing, Slater, Beck, Burton, Moyer, 2013), among others.Identification, critical appraisal, and synthesis of establish from research articles is an essential skill in evidence-based fare (EBP) (Titler, 2008). This paper will critique two primary research articles related to the issue of wound packing following incision and drainage. The first article is authored by Leinwand et al. (2013) and is authorise Incision and drainage of subcutaneous abscesses without the use of packing. The second article is authored by Alimov et al. (2013) and is entitled Use of a silver-containing hydrofiber preparation for filling abscess cavity following incision and drainage in the emergency department A randomized controlled trial.The study by Leinwand et al. (2013) sought to determine whether heedlessness of the wound packing component in the management of subcutaneous abscess has akin(predicate) efficacy to wound packing. The study employed a prospective randomized controlled trial design whereby 100 participants were randomized to either the wound packing group or to the non-packing group. The study enrolled pediatric participants aged less than 18 years with subcutaneous abscesses. The sample size for the study was small (100). Consequently, the study did not have significant statistical power as a sample size of 4000 was required to gain power of 80%. The researchers, even, trustworthy the small sample size as it was practical for the purposes of the study. The selected sample is enamor to the commonwealth of interest because the partic ipants were experiencing the phenomenon of interest that is abscesses requiring incision and drainage.Regarding data collection, similar pre-intervention data was compile on the operative day for all participants. These data include age, gender, and location and size of the abscess. Post-intervention data was collected through follow-up ring calls by a pediatric surgery retain specialist. These calls were made on the 7th and 30th post-operative days and included information on oecumenical wound appearance, adherence with warm soaks and antibiotic therapy, presence of fever, and timing of pack removal. The reliance on self-reported information may have introduced information preconceived idea due socially desirable responding and problems with recall (Fadnes, Taube, Tylleskar, 2008).Of the 100 participants who enrolled for the study, only 85 completed the study. The study prime that the packing group and non-packing groups did not veer statistically with respect to abscess r ecurrence rates, initial parameters, and incidence of methicillin-resistant staphylococcus aureus (MRSA). lonesome(prenominal) two abscess recurrences were reported, one for each group. In their discussion, the authors contextualize these findings in light of pre-existing evidence. They note that the findings of their study are identical to those of similar previous studies on both adults and children. The authors also compare the strengths and weaknesses and merits and demerits of their study and intervention with those of previous studies. They also discuss the two cases of treatment failure. Lastly, they provide recommendations for future studies.On the internalisation of evidence into treatment protocols, integration of research findings into treatment protocols/procedures occurs through the mold of evidence-based practice. Research articles relevant to a clinical issue of concern are identified, appraised critically, and their findings used to make specific recommendations for practice on incision and drainage (Dontje, 2007).The Purpose of the Alimov et al. (2013) study was to investigate whether packing of abscess cavity with a silver-containing hydrofiber dressing instead of the standard iodoform dressing leads to less pain and faster wound healing. The study employed a prospective randomized controlled trial design whereby participants were randomized to the silver-containing hydrofiber or standard care groups. The study population consisted of adults aged more than 18 years who visited the emergency department of a teaching hospital with cutaneous abscesses 2cm in diameter that required incision and drainage. The selected sample consisted of 92 patients. The sample for the study is appropriate to the selected topic as it focuses on the issue of incision and drainage protocols.Data for the study was collected and documented on a standard form except for pain. The data collected included pertinent demographic and clinical variables. Pain was assesse d using a self-report scale, the Wong-Baker FACES Pain Rating Scale. The use of a self-report scale for pain may have introduced social desirability turn. The findings of the study may have also been contaminated by bias due to the manual beat of the dimensions of the abscess cavities. The primary outcome measures for the study were the proportion of patients with a reduction of 30% or in the surface area of the abscess at the first follow up visit (between 48 and 72 hours). The other main outcome variable was proportion of patients with 30% or decrease in the border cellulites at the first visit. The secondary outcome measure was the change in self-reported pain intensity at primary and consequent visits.The study found that 82.6% of the patients in the silver-containing hydrofiber group had a reduction of 30% or in the surface area of the abscess compared to the 26.1% of the represss in the iodoform group (pIn this article, the minute of participating pediatric patients wh o had subcutaneous abscesses was one hundred. Patients who successfully completed the study were only 85 43 packing group and 42 non-packing group. There existed an arithmetic variance between the two groups that concerned the initial parameters, take place abscesses, (single in every group), or incidence of MRSA (81.4 packing groups over 85.7 non-packing group). hypodermic abscesses incision, as well as drainage without the utilization of packing, is an effective as well as a safe technique. This article should present the data in a more transparent way.In this article, there was a prospective enrollment of 92 patients and these patients. There was also random assignment of these patients to the iodoform groups or Aquacel Ag. The SD was 12.0, and the average age was 38. The patients in iodoform group were 43 while those in Aquacel group were 49. There two groups lacked divergence in clinical and demographic characteristics. The domino effect of the deterioration study pointed o ut that the Aquacel Ag was autonomously associated with over 30% abscesses surface area reduction. This, however excluded first follow-up cellulitis. The pain intensity also decreased significantly as perceived by the Aquacel group patients. In cutaneous abscesses patients, there was faster wood healing as well as pain reduction while using antimicrobial-hydro fiber ribbon form of dressing than while using iodoform dressing. This article is important as it offers information on which choice is best while dressing.It is recommended thatmore research on this subject as this will provide more information on subcutaneous abscesses treatment. These articles will help me in my career as a nurse practitioner because of the versatility of the procedures and the information provided.In summary, this paper has critiqued two research articles related to the issue of wound packing following incision and drainage. The articles by Leinwand et al. (2013) and Alimov et al. (2013) have been critiqu ed in terms of their purpose, design, sample, data collection procedures, results, and discussion.ReferencesAlimov, V., Lovecchio, F., Sinha, M., Foster, K. N., Drachman, D. (2013). Use of a silver- containing hydrofiber dressing for filling abscess cavity following incision and drainage in the emergency department A randomised controlled trial. Advances in Skin and Wound Care, 26, 20-25.Dontje, K. J. (2007). Evidence-based practice Understanding the process. Topics in Advanced Practice Nursing, 7(4).Fadnes, L., Taube, A., Tylleskar, T. (2008). How to identify information bias due to self-reporting in epidemiological research. The Internet Journal of Epidemiology, 7(2).Leinwand, M., Downing, M., Slater, D., Beck, M., Burton, K., Moyer, D. (2013). Incision and drainage of subcutaneous abscesses without the use of packing. Journal of Pediatric Surgery, 48(9), 1962-1965.Titler, M. G. (2008). The evidence for evidence-based practice implementation. Retrieved from http//www.ncbi.nlm.ni h.gov/books/NBK2659/