EDITORIAL
Editorial Board Irene Anderson
Principal Lecturer Tissue Viability, Reader in Learning and Teaching in Healthcare Practice, University of Hertfordshire
Martyn Butcher
Independent Tissue Viability & Wound Care Consultant; Associate Lecturer, University of Plymouth; Research Nurse (Tissue Viability), Northern Devon Healthcare Trust (Honorary post)
Keith Cutting
Visiting Professor, Buckinghamshire New University, Uxbridge
Jemell Geraghty
Clinical Nurse Specialist, Tissue Viability, Royal Free Hamstead NHS Trust
Steve Jeffery
Professor, Wound Study, Birmingham City University, Fellow of the Royal College of Surgeons of Edinburgh, England and Glasgow
Editor Julie Smith Deputy Editor Sarah Kahn Subeditors Daniel Davies Vicqui Stuart-Jones MedEd Manager Tracy Cowan Associate Publishers Andrew Iafrati, Julie Smith Publishing Director Anthony Kerr If you would like to submit an article for publication in this supplement please contact Julie Smith on 020 7738 5454 or [email protected] MA Healthcare Ltd is part of the Mark Allen Group
www.markallengroup.com The British Journal of Nursing is published by MA Healthcare Ltd, St Jude’s Church, Dulwich Road, London SE24 0PB Tel: 020 7738 5454 Editorial: 020 7501 6716 Sales: 020 7501 6726 Subscriptions: 0800 137201 Email: [email protected] Websites: www.britishjournalofnursing.com
© MA Healthcare Ltd, 2013. All rights reserved. No part of the British Journal of Nursing may be reproduced, stored in a retrieval system, or transmitted in any form or by any means electronic, mechanical, photocopying, recording, or otherwise without prior written permission of the Publishing Director. Print: Pensord Press Ltd, Blackwood, NP12 2YA Cover picture: istockphoto.com
The paper used within this publication has been sourced from Chain-of-Custody certified manufacturers, operating within international environmental standards, to ensure sustainable sourcing of the raw materials, sustainable production and to minimise our carbon footprint.
Transparency must prevail
W
ound care within the UK, as with all business and public service ventures, has faced the spectre of economic restraint since the onset of the global financial crisis. Funding has been curtailed and if current forecasts are to be believed, this is likely to continue for the foreseeable future. Despite the apparent turn around in the fortunes of the UK economy, the stagnation of the EU and North American economic markets will continue to have an adverse effect on public spending and healthcare manufacturers alike. As clinicians we will need to continue to be ever vigilant that the care we offer is both efficient and cost-effective. Nowhere is this more obvious than in wound care where proven effective interventions are needed to ensure good healing outcomes that meet patient expectation, and where we need to ensure that resources are fully utilised. In particular, as highlighted in numerous health economic debates, chronic wounds with their ongoing burden on resources have to be more effectively managed. However, how do clinicians decide on what interventions should be introduced? As we have been repeatedly informed, the answer should lay with evidence; but which wound-care technologies, therapeutic interventions and products have proven their rightful place within the wound management arsenal used by clinicians? The problem is that despite the focus on evidence-based health care, to date wound management has been poorly represented within the body of robust research. Time and again esteemed bodies (such as the Cochrane Collaboration, National Institute for Health and Care Excellence, CREST and the Scottish Intercollegiate Guidelines Network) have stated that within the field of tissue viability there is little ‘high-quality’ evidence to support specific treatments and interventions (Fletcher et al, 1997; Cullum et al, 2001; Jull et al, 2002; Vermeulen et al, 2004; Palfreyman et al, 2006; Vermeulen et al, 2007; Chambers et al, 2007; StormVersloot et al, 2010). This assertion appears based on the lack of well-constructed, large cohort, multicentre randomised control studies (RCTs) and the omnipotence placed on such research methodology by these bodies. So, what evidence is available and how do clinicians measure the strength and reliability of the resultant recommendations? Every month there are new studies published by clinicians worldwide. These range from individual case studies through cohort studies to full RCTs. However, those studies that satisfy the perceived ‘gold standard’ remain elusive. When articles are scrutinised, all too frequently we find that these have been made possible through the support of industry sponsorship through so-called ‘educational grants’. Does this make them invalid? I think not.
British Journal of Nursing, 2014 (Tissue Viability Supplement), Vol 23, No 20
Even when research has been supported by independent public funding it can be argued that failings have been made in study design and research methodology that have made their findings open to question (Gottrup and Apelqvist, 2010; Leaper and Drake, 2011). Indeed it might be argued that without the support of industry few clinicians would have the opportunity to undertake research projects. However, reviewers need to be aware that whoever funds research (whether public or commercial entities) there is a risk that pressure may be consciously or subconsciously applied to influence the final outcomes and findings. Just as some commercial entities might put a ‘positive spin’ on results to promote their products, so too might some public bodies try to influence clinicians based on political, economic or self-serving agendas. What is needed is transparency within research. If researchers wish clinicians to incorporate their findings in future wound-care decision making, the evidence needs to be open to scrutiny. If we are to become a professional community actively developing a robust evidence base we need to be able to question, test and, if required, reproduce studies to validate and confirm findings. While I endorse evidence-based medicine, I feel that we need to consider all the evidence available. This array of evidence then needs to be objectively assessed. To single out one research methodology (namely RCT) as the only acceptable standard appears perverse given the diversity of our patients’ conditions and their right to individual BJN patient-centred care. Chambers H, Dumville JC, Cullum N (2007) Silver treatments for leg ulcers: a systematic review. Wound Repair Regen 15(2): 165-73 Cullum N, Nelson EA, Flemming K, Sheldon T (2001) Systematic reviews of wound care management: (5) beds; (6) compression; (7) laser therapy, therapeutic ultrasound, electrotherapy and electromagnetic therapy. Health Technol Assess 5(9): 1-221 Fletcher A, Cullum N, Sheldon TA (1997) A systematic review of compression treatment for venous leg ulcers. BMJ 315(7108): 576-80 Gottrup F, Apelqvist J (2010) The challenge of using randomized trials in wound healing. British Journal of Surgery 97(3): 303-4 Harding KG, Queen D (2009). Cochrane’s legacy and its impact on wound care. Int Wound J 6(5): 316-7 Jull A, Arroll B, Parag V, Waters J (2002) Pentoxifylline for treating venous leg ulcers. Cochrane Database Syst Rev 1: CD001733 Leaper D, Drake R (2011) Should one size fit all? An overview and critique of the VULCAN study on silver dressings. Int Wound J 8(1): 1-4. doi: 10.1111/j.1742-481X.2010.00766.x. Palfreyman SJ, Nelson EA, Lochiel R, Michaels JA (2006) Dressings for healing venous leg ulcers. Cochrane Database Syst Rev 3: CD001103 Storm-Versloot MN,Vos CG, Ubbink DT,Vermeulen H (2010) Topical silver for preventing wound infection. Cochrane Database Syst Rev 3: CD006478. doi: 10.1002/14651858.CD006478.pub2. Vermeulen H, Ubbink D, Goossens A, de Vos R, Legemate D (2004) Dressings and topical agents for surgical wounds healing by secondary intention. Cochrane Database Syst Rev 2: CD003554 Vermeulen H, van Hattem JM, Storm-Versloot MN, Ubbink DT (2007) Topical silver for treating infected wounds. Cochrane Database Syst Rev 1: CD005486
Martyn Butcher
Independent Tissue Viability & Wound Care Consultant; Associate Lecturer, University of Plymouth; Research Nurse (Tissue Viability), Northern Devon Healthcare Trust (Honorary post)
S3
British Journal of Nursing. Downloaded from magonlinelibrary.com by 138.253.100.121 on December 6, 2015. For personal use only. No other uses without permission. . All rights reserved.
Editorial Board Irene Anderson
Principal Lecturer Tissue Viability, Reader in Learning and Teaching in Healthcare Practice, University of Hertfordshire
Martyn Butcher
Independent Tissue Viability & Wound Care Consultant; Associate Lecturer, University of Plymouth; Research Nurse (Tissue Viability), Northern Devon Healthcare Trust (Honorary post)
Keith Cutting
Visiting Professor, Buckinghamshire New University, Uxbridge
Jemell Geraghty
Clinical Nurse Specialist, Tissue Viability, Royal Free Hamstead NHS Trust
Steve Jeffery
Professor, Wound Study, Birmingham City University, Fellow of the Royal College of Surgeons of Edinburgh, England and Glasgow
Editor Julie Smith Deputy Editor Sarah Kahn Subeditors Daniel Davies Vicqui Stuart-Jones MedEd Manager Tracy Cowan Associate Publishers Andrew Iafrati, Julie Smith Publishing Director Anthony Kerr If you would like to submit an article for publication in this supplement please contact Julie Smith on 020 7738 5454 or [email protected] MA Healthcare Ltd is part of the Mark Allen Group
www.markallengroup.com The British Journal of Nursing is published by MA Healthcare Ltd, St Jude’s Church, Dulwich Road, London SE24 0PB Tel: 020 7738 5454 Editorial: 020 7501 6716 Sales: 020 7501 6726 Subscriptions: 0800 137201 Email: [email protected] Websites: www.britishjournalofnursing.com
© MA Healthcare Ltd, 2013. All rights reserved. No part of the British Journal of Nursing may be reproduced, stored in a retrieval system, or transmitted in any form or by any means electronic, mechanical, photocopying, recording, or otherwise without prior written permission of the Publishing Director. Print: Pensord Press Ltd, Blackwood, NP12 2YA Cover picture: istockphoto.com
The paper used within this publication has been sourced from Chain-of-Custody certified manufacturers, operating within international environmental standards, to ensure sustainable sourcing of the raw materials, sustainable production and to minimise our carbon footprint.
Transparency must prevail
W
ound care within the UK, as with all business and public service ventures, has faced the spectre of economic restraint since the onset of the global financial crisis. Funding has been curtailed and if current forecasts are to be believed, this is likely to continue for the foreseeable future. Despite the apparent turn around in the fortunes of the UK economy, the stagnation of the EU and North American economic markets will continue to have an adverse effect on public spending and healthcare manufacturers alike. As clinicians we will need to continue to be ever vigilant that the care we offer is both efficient and cost-effective. Nowhere is this more obvious than in wound care where proven effective interventions are needed to ensure good healing outcomes that meet patient expectation, and where we need to ensure that resources are fully utilised. In particular, as highlighted in numerous health economic debates, chronic wounds with their ongoing burden on resources have to be more effectively managed. However, how do clinicians decide on what interventions should be introduced? As we have been repeatedly informed, the answer should lay with evidence; but which wound-care technologies, therapeutic interventions and products have proven their rightful place within the wound management arsenal used by clinicians? The problem is that despite the focus on evidence-based health care, to date wound management has been poorly represented within the body of robust research. Time and again esteemed bodies (such as the Cochrane Collaboration, National Institute for Health and Care Excellence, CREST and the Scottish Intercollegiate Guidelines Network) have stated that within the field of tissue viability there is little ‘high-quality’ evidence to support specific treatments and interventions (Fletcher et al, 1997; Cullum et al, 2001; Jull et al, 2002; Vermeulen et al, 2004; Palfreyman et al, 2006; Vermeulen et al, 2007; Chambers et al, 2007; StormVersloot et al, 2010). This assertion appears based on the lack of well-constructed, large cohort, multicentre randomised control studies (RCTs) and the omnipotence placed on such research methodology by these bodies. So, what evidence is available and how do clinicians measure the strength and reliability of the resultant recommendations? Every month there are new studies published by clinicians worldwide. These range from individual case studies through cohort studies to full RCTs. However, those studies that satisfy the perceived ‘gold standard’ remain elusive. When articles are scrutinised, all too frequently we find that these have been made possible through the support of industry sponsorship through so-called ‘educational grants’. Does this make them invalid? I think not.
British Journal of Nursing, 2014 (Tissue Viability Supplement), Vol 23, No 20
Even when research has been supported by independent public funding it can be argued that failings have been made in study design and research methodology that have made their findings open to question (Gottrup and Apelqvist, 2010; Leaper and Drake, 2011). Indeed it might be argued that without the support of industry few clinicians would have the opportunity to undertake research projects. However, reviewers need to be aware that whoever funds research (whether public or commercial entities) there is a risk that pressure may be consciously or subconsciously applied to influence the final outcomes and findings. Just as some commercial entities might put a ‘positive spin’ on results to promote their products, so too might some public bodies try to influence clinicians based on political, economic or self-serving agendas. What is needed is transparency within research. If researchers wish clinicians to incorporate their findings in future wound-care decision making, the evidence needs to be open to scrutiny. If we are to become a professional community actively developing a robust evidence base we need to be able to question, test and, if required, reproduce studies to validate and confirm findings. While I endorse evidence-based medicine, I feel that we need to consider all the evidence available. This array of evidence then needs to be objectively assessed. To single out one research methodology (namely RCT) as the only acceptable standard appears perverse given the diversity of our patients’ conditions and their right to individual BJN patient-centred care. Chambers H, Dumville JC, Cullum N (2007) Silver treatments for leg ulcers: a systematic review. Wound Repair Regen 15(2): 165-73 Cullum N, Nelson EA, Flemming K, Sheldon T (2001) Systematic reviews of wound care management: (5) beds; (6) compression; (7) laser therapy, therapeutic ultrasound, electrotherapy and electromagnetic therapy. Health Technol Assess 5(9): 1-221 Fletcher A, Cullum N, Sheldon TA (1997) A systematic review of compression treatment for venous leg ulcers. BMJ 315(7108): 576-80 Gottrup F, Apelqvist J (2010) The challenge of using randomized trials in wound healing. British Journal of Surgery 97(3): 303-4 Harding KG, Queen D (2009). Cochrane’s legacy and its impact on wound care. Int Wound J 6(5): 316-7 Jull A, Arroll B, Parag V, Waters J (2002) Pentoxifylline for treating venous leg ulcers. Cochrane Database Syst Rev 1: CD001733 Leaper D, Drake R (2011) Should one size fit all? An overview and critique of the VULCAN study on silver dressings. Int Wound J 8(1): 1-4. doi: 10.1111/j.1742-481X.2010.00766.x. Palfreyman SJ, Nelson EA, Lochiel R, Michaels JA (2006) Dressings for healing venous leg ulcers. Cochrane Database Syst Rev 3: CD001103 Storm-Versloot MN,Vos CG, Ubbink DT,Vermeulen H (2010) Topical silver for preventing wound infection. Cochrane Database Syst Rev 3: CD006478. doi: 10.1002/14651858.CD006478.pub2. Vermeulen H, Ubbink D, Goossens A, de Vos R, Legemate D (2004) Dressings and topical agents for surgical wounds healing by secondary intention. Cochrane Database Syst Rev 2: CD003554 Vermeulen H, van Hattem JM, Storm-Versloot MN, Ubbink DT (2007) Topical silver for treating infected wounds. Cochrane Database Syst Rev 1: CD005486
Martyn Butcher
Independent Tissue Viability & Wound Care Consultant; Associate Lecturer, University of Plymouth; Research Nurse (Tissue Viability), Northern Devon Healthcare Trust (Honorary post)
S3
British Journal of Nursing. Downloaded from magonlinelibrary.com by 138.253.100.121 on December 6, 2015. For personal use only. No other uses without permission. . All rights reserved.
