2.50
Hdl Handle:
http://hdl.handle.net/10755/158705
Type:
Presentation
Title:
The Evidence Base for Chronic Venous Ulcer Management: A Critical Analysis
Abstract:
The Evidence Base for Chronic Venous Ulcer Management: A Critical Analysis
Conference Sponsor:Midwest Nursing Research Society
Conference Year:2009
Author:Jones, Katherine, Ph.D.
P.I. Institution Name:Case Western Reserve University
Title:Bolton School of Nursing
Contact Address:10900 Euclid Avenue, Cleveland, OH, 44106-4904, USA
Contact Telephone:216-368-5979
Co-Authors:K.R. Jones, Bolton School of Nursing, Case Western Reserve University, Cleveland, OH;
There is much emphasis on the use of evidence-based clinical practice guidelines (CPGs) and systematic reviews (SRs)to guide clinical decision making. Less emphasis has been placed on appraising the quality of the evidence undergirding the practice recommendations contained in CPGs and SRs. This analysis examined five CPGs and multiple SRs relevant to management of chronic venous leg ulcers. These wounds are the most frequently occurring lower leg ulcer, are often difficult to heal, and many recur. Chronic venous leg ulcers affect 1.5 million adults worldwide and cost billions of dollars a year to treat. They seriously reduce an individual's overall quality of life due to pain, odor, appearance, and functional decline. To conduct this analysis, clinical practice guidelines were identified through the National Guidelines Clearinghouse and TRIPDATABASE. Systematic reviews were identified through the Cochrane Library, TRIPDATABASE, and PubMed Clinical Queries. The 5 CPGs were all published or reviewed and updated between 2005 and 2007. Review of the CPGs revealed differing evidence rating schemes, with 'A' level evidence ranging from 2 or more RCTs or meta-analysis to 'generally consistent findings'. 'C' level evidence extended from one RCT to expert opinion. The evidence base of research articles ranged from 51 to 180. The number of practice recommendations ranged from 26 to 67. One CPG provided treatment 'options' rather than recommendations. No single recommendation was rated at the 'A' level across all 5 guidelines. The topics of the SRs were numerous, including compression bandaging, debridement approaches, dressings under compression, topical antiseptics and antibiotics, and cleansers, plus multiple secondary therapies. Systematic review recommendations were based on studies that reflected: small sample sizes; surrogate outcomes; questionable treatment comparisons; only small wounds; and limited followup. Financial disclosures and potential conflict of interest were not always made apparent. Clinicians and researchers need to use caution when selecting recommendations for clinical practice changes. All results should be reviewed from the perspective of credibility and applicability to the clinicians' setting and population.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Midwest Nursing Research Society

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleThe Evidence Base for Chronic Venous Ulcer Management: A Critical Analysisen_GB
dc.identifier.urihttp://hdl.handle.net/10755/158705-
dc.description.abstract<table><tr><td colspan="2" class="item-title">The Evidence Base for Chronic Venous Ulcer Management: A Critical Analysis</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Midwest Nursing Research Society</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2009</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Jones, Katherine, Ph.D.</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Case Western Reserve University</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Bolton School of Nursing</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">10900 Euclid Avenue, Cleveland, OH, 44106-4904, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">216-368-5979</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">katherine.jones@case.edu</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">K.R. Jones, Bolton School of Nursing, Case Western Reserve University, Cleveland, OH;</td></tr><tr><td colspan="2" class="item-abstract">There is much emphasis on the use of evidence-based clinical practice guidelines (CPGs) and systematic reviews (SRs)to guide clinical decision making. Less emphasis has been placed on appraising the quality of the evidence undergirding the practice recommendations contained in CPGs and SRs. This analysis examined five CPGs and multiple SRs relevant to management of chronic venous leg ulcers. These wounds are the most frequently occurring lower leg ulcer, are often difficult to heal, and many recur. Chronic venous leg ulcers affect 1.5 million adults worldwide and cost billions of dollars a year to treat. They seriously reduce an individual's overall quality of life due to pain, odor, appearance, and functional decline. To conduct this analysis, clinical practice guidelines were identified through the National Guidelines Clearinghouse and TRIPDATABASE. Systematic reviews were identified through the Cochrane Library, TRIPDATABASE, and PubMed Clinical Queries. The 5 CPGs were all published or reviewed and updated between 2005 and 2007. Review of the CPGs revealed differing evidence rating schemes, with 'A' level evidence ranging from 2 or more RCTs or meta-analysis to 'generally consistent findings'. 'C' level evidence extended from one RCT to expert opinion. The evidence base of research articles ranged from 51 to 180. The number of practice recommendations ranged from 26 to 67. One CPG provided treatment 'options' rather than recommendations. No single recommendation was rated at the 'A' level across all 5 guidelines. The topics of the SRs were numerous, including compression bandaging, debridement approaches, dressings under compression, topical antiseptics and antibiotics, and cleansers, plus multiple secondary therapies. Systematic review recommendations were based on studies that reflected: small sample sizes; surrogate outcomes; questionable treatment comparisons; only small wounds; and limited followup. Financial disclosures and potential conflict of interest were not always made apparent. Clinicians and researchers need to use caution when selecting recommendations for clinical practice changes. All results should be reviewed from the perspective of credibility and applicability to the clinicians' setting and population.</td></tr></table>en_GB
dc.date.available2011-10-26T21:18:58Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T21:18:58Z-
dc.description.sponsorshipMidwest Nursing Research Societyen_GB
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