Quantitative Critique Essay

Quantitative Critique Essay

I am a nursing student and have a quantitative critique essay due tomorrow using PICO and the John Hopkins appraisal tool.  I also have the rubric, the EBP question, and the article I have to use. APA 6th edition must be used and the only source is the article.   Then I have a qualitative due in 2 weeks. Can I get help??


A multi-center, randomized, clinical trial comparing adhesive polyurethane foam dressing and adhesive hydrocolloid dressing in patients with grade II pressure ulcers in primary care and nursing homes Mireia Guillén-Solà1*, Aina Soler Mieras2, Antònia M Tomàs-Vidal3 and GAUPP-Expert Panel



Background: Pressure ulcers (PrUs) are ischemic wounds in the skin and underlying tissues caused by long-standing pressure force over an external bone or cartilaginous surface. PrUs are an important challenge for the overall health system because can prolong patient hospitalization and reduce quality of life. Moreover, 95% of PrUs are avoidable, suggesting they are caused by poor quality care assistance. PrUs are also costly, increasing national costs. For example, they represent about 5% of overall annual health expenses in Spain. Stages I and II PrUs have a combined prevalence of 65%. According main clinical guidelines, stage II PrUs (PrU-IIs) are usually treated by applying special dressings (polyurethane or hydrocolloid). However, little scientific evidence regarding their efficacy has been identified in scientific literature. Our aim is to assess the comparative efficacy of adhesive polyurethane foam and hydrocolloid dressings in the treatment of PrU-IIs in terms of healed ulcer after 8 weeks of follow-up Quantitative Critique Essay.

Methods/design: This paper describes the development and evaluation protocol of a randomized clinical trial of two parallel treatment arms. A total of 820 patients with at least 1 PrU-II will be recruited from primary health care and home care centers. All patients will receive standardized healing procedures and preventive measures (e.g. positional changes and pressure-relieving support surfaces), following standardized procedures. The main outcome will be the percentage of wounds healed after 8 weeks. Secondary outcomes will include cost-effectiveness, as evaluated by cost per healed ulcer and cost per treated patient and safety evaluated by adverse events.

Discussion: This trial will address the hypothesis that hydrocolloid dressings will heal at least 10% more stage II PrUs and be more cost-effective than polyurethane foam dressings after 8 weeks.

Trial registration: This trial has been registered with controlled-trials number ISCRCTN57842461 and EudraCT 2012-003945-14.

Keywords: Pressure ulcers, Pressure sore, Hydrocolloid dressing, Polyurethane foam dressings, Healing process

* Correspondence: mguillen@ibsalut.caib.es 1Primary Health Care-Mallorca: Research Unit. Health Care Services of Balearic Isles, IB-Salut, Palma de Mallorca, Balearic Islands, Spain Full list of author information is available at the end of the article

© 2013 Guillén-Solà et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Guillén-Solà et al. BMC Family Practice 2013, 14:196 Page 2 of 8 http://www.biomedcentral.com/1471-2296/14/196

Background Pressure ulcers (PrUs) are ischemic wounds in the skin and underlying tissues, caused by continuous pressure from friction or shearing between an external surface and a bone or cartilaginous surface. Long-standing pres- sure can reduce capillary blood flow and lead to cell death, necrosis and broken tissue, or to additional ser- ious complications, including osteomyelitis, sepsis, con- tractures, atrophy and psychological disorders [1,2]. These complications may delay mobilization and active rehabilitation, as well as reducing the ability of patients to live active and independent lives. PrUs can affect pa- tients in all health care settings, provoke pain and discom- fort, decrease quality of life and even increase morbidity and residence time in healthcare institutions [3,4]. PrUs can also increase direct and indirect healthcare

costs and provide a negative image of healthcare institu- tions, attributable to deficits in the quality of care, espe- cially since 95% of PrUs are preventable [1,2]. A national study has estimated that expenditures related to the onset of PrU amounts to approximately 5% of the annual health- care spending in Spain [3,4]. A national prevalence study in 2006 by the GNEAUPP

(Spanish acronym of National Group for the Study and Advice in Pressure Ulcers and Chronic Wounds) showed a wide variability in PrUs prevalence among types of insti- tutions. PrUs have been reported to occur in 3.73% of pa- tients in domiciliary care, 8.24% of hospitalized patients and 6.1% of patients in nursing homes. Moreover, 2.1% of patients with PrUs were aged 0 to 45 years, 6.4% were aged 46 to 64 years and 87.4% were aged ≥ 65 years [5]. Within each category, PrU incidence was very variable, ranging from 3-29% in hospitalized patients. Moreover, PrUs have been observed in 66% of elderly individuals (risk population) with femur fractures [4-7]. The European Pressure Ulcer Advisory Panel (EPUAP) Quantitative Critique Essay

has classified PrUs in four stages. Stages I and II are more frequent, with a combined rate of about 65% [5], although it differs among studies [8-15]. The EPUAP has defined stage II PrU (PrU-II) as involving a partial loss in skin thickness, affecting the epidermis and/or dermis. These are considered superficial ulcers, clinically manifesting as abrasions or blisters [8,16]. Prevention is the best treatment for PrU. However,

despite Good Clinical Practice Guidelines (GCP), [17-20] which report the effectiveness of preventive activities (adequate nutrition, effective pressure relief, positional changes, management of incontinence and elimination of shearing and friction forces), there is little scientific evidence supporting the efficacy of these measures in avoiding further problems related to PrUs [1-3]. In contrast, evidence has suggested that PrUs healing

in a moist environment, using special or modern dress- ings, is more cost effective than traditional cure or dry-to-

wet dressings (i.e. dressings that do not maintain a moist environment) because the former stimulate cell prolifera- tion. In addition, special dressings act as a barrier against bacteria, absorb excess wound fluid, reduce pain during the healing process and create the right conditions (moist environment) for healing or scarring [1,3,18-20]. The benefits of a moist environment have led to the

development of a flowering variety of synthetic dressings (special or also called modern dressings). Use of these dressings depends on the availability of resources, PrU stage and morphology, and the presence of infection and/or necrosis [1,3,18-20]. Although GCP guidelines indicate that the special

dressings most frequently used to treat PrU-II are hydro- colloid and polyurethane foam dressings. To date, how- ever, systematic reviews and clinical trials have established a poorly and scarcely evidence of their effectiveness. Al- though studies have shown benefits of polyurethane dress- ings, their benefits did not differ significantly from those of hydrocolloid dressings. In addition, these studies in- volved patients with various wound types (pressure ulcers and venous ulcers) and different PrU stages, which may have affected the results [1,3,18-21]. To overcome these limitations, the present study will

compare two types of dressings in the treatment of PrU- IIs, both which are recommended and are part of habitual clinical practice [1,3,19,20]. However, due to the wide vari- ability in both types of dressing, this study will compare the adhesive versions of polyurethane and hydrocolloid dressings.

Aim and hypothesis The main hypothesis of this study is that hydrocolloid dressings would heal at least 10% more stage II PrUs than polyurethane foam dressings over 8 weeks of follow-up in patients with PrU-II. The aim of the proposed protocol is to compare the

efficacy of adhesive polyurethane foam dressings and ad- hesive hydrocolloid dressings in the treatment of PrU-II. The primary objective will be to assess the percentage of wounds healed after 8 weeks. Secondary objectives include assessments of:

– improvements in the clinical efficacy of both dressings, as measured by ulcer area (cm [2]), exudates, type of tissue (PUSH Scale) and time to healing (epithelial tissue).

– treatment efficacy, as measured by PrU-II resolutionwithin study time.

– safety, as determined by adverse events (AE) attributed to both dressings.

– direct costs of both dressings, as measured by cost per healed ulcer and cost per treated patient.

Guillén-Solà et al. BMC Family Practice 2013, 14:196 Page 3 of 8 http://www.biomedcentral.com/1471-2296/14/196

– convenience of dressing use, as determined by adherence properties, management of the dressing, comfort, pain during the healing procedure, number of dressings used and perilesional skin state.

Methods and design Study design This will be a multicenter, randomized trial evaluating and comparing the efficacy of the adhesive polyurethane foam and hydrocolloid dressings in patients with PrU-II within the context of habitual prevention measures.

Setting and eligibility criteria This study will recruit patients who receive primary health assistance, including patients able to attend the primary health center or receive health assistance in homes, nursing-homes and non-acute long term hospitalization centers. Each patient must present with at least one PrU-II.

Inclusion criteria

– Age ≥ 18 years. – Confirmed diagnosis of PrU-II. If a patient has more

than one PrU-II, only the largest diameter ulcer will be assessed. Other PrU-II will receive the best treatment elected by the study nurse Quantitative Critique Essay