Interventions applied as patient management are constantly changing in an attempt to achieve or improve on existing treatment. The changes made in managing patients can begin from simple observations of outcomes using a new intervention. For these interventions to be accepted as a general practice, they have to undergo scrutiny to qualify their effectiveness. This is known as a research-based practice. The aim of this paper is to identify a clinical question pertaining to diabetes management and conduct a summary of the literature review.
Section 1: Identifying a Clinical question
Among community-dwelling adults living with diabetes how effective is vacuum-assisted dressing compared to standard saline/gel-based dressing in extent and speed at which diabetic foot ulcers heal?
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The population being assessed is patients living with diabetes presenting with foot ulcers querying the effectiveness of vacuum-assisted dressing in comparison to standard gel-based dressing with the outcome of faster healing of wounds during the period 2016 to 2020 (Abbade et al., 2016).
Section 2: Burden of diabetes
The turn of the 20 th century has seen a rise in the prevalence of Non Communicable diseases as a result of a change in lifestyle choices and nutrition habits. Among these diseases, Diabetes ranks highly with a prevalence of 400 million cases globally. Diabetes is a multifactorial disease characterized by dysregulated blood levels glucose due to a lack of or unresponsiveness to insulin. The sustained hyperglycemic state causes acute or long term complications (Dagogo-Jack, 2017).
Among the long term complications, diabetic foot ulcer is common among patients with an estimated lifetime risk of 15%. Diabetic foot ulcers are hypothesized to be a result of an increase in the formation of glycation products that promote formation pro-inflammatory macrophages, reactive oxygen species and the extracellular matrix that result in damage to the small blood vessels. This results in decreased blood flow to tissues and neurons subsequently leading to ischemia and neuropathy. These factors coupled with consistent pressure and trauma applied on the foot results in ulceration (Boulton, 2019).
Up to 30% of those who develop foot ulcers are managed definitively by removal of bone as a result of complications such as infections or gangrene foot. Surgical amputations further decrease the quality of life and pose a risk of intra and post-operative death. However, the sequelae of a diabetic foot ulcer can be avoided at different stages with appropriate care targeting the pathophysiology. While infection control, wound debridement and control of glucose levels are standard care practices. The method of wound dressing has been shown by research to have an effect on how fast the wound heals, therefore, preventing infection, gangrene, and amputation in the long run (Boulton, 2019).
Nurses play a role at different levels in the care for a patient with diabetic ulcers from the level of educating the patient on foot hygiene, avoiding pressure loading as well as perform examination to identify the risk of an ulcer. Nurses at the intervention level play a key role in identifying which dressing to use based on the size and character of the wound. The knowledge of improved dressing techniques is therefore useful in improving health outcomes from nursing interventions (Aalaa et al., 2017).
Vacuum-assisted dressing involves a dressing connected to a suction machine that gently pulls air from the wound resulting in a gentle pull of moisture and any pus formed as well. The gentle pull discourages the proliferation of bacteria, reduces swelling and brings the wound margins closer together allowing for faster wound healing compared to saline and gel-based dressing (Moslem et al., 2019). The vacuum-assisted dressing has been used and shown efficacy in wound healing in second and third-degree burns. This can too be applied among patients with diabetic foot ulcers to improve healing, avoid infections and subsequent amputations.
Section 3: Article review
The systemic review of randomized clinical trials carried out the comparison of vacuum dressing for treatment of diabetic ulcers compared to traditional treatments (Liu et al., 2017) clearly best supports the use of vacuum-assisted dressing as an intervention. The study is a systemic review and meta-analysis of Randomized Trials, which offers the highest level of evidence. The study has appropriate inquisition into the topic, selection of sources from appropriate and multiple databases such as the Cochrane Library and PubMed and clear objectives of what it attempts to achieve. In confounding for biases, the researchers assessed for any selective showcasing of reports and other biases. The study uses a sample size of 11 Randomized Clinical Trials.
In comparison to the other articles assessed only one other used the systemic analysis study design. However, in reporting for results the publication bias was excluded due to the small sample size of only ten relevant articles as well as having a smaller sample size compared to Liu et al’ s paper on the same. In addition to this, Liu et al reported on more parameters pertaining to diabetic foot ulcers such as a change in size, time to complete healing rate as well as mentioning results on the occurrences of amputations (Huang et al., 2019).
The other papers assessed offered level 2 evidence of clinical practice as they were prospective and stratified Randomized Clinical Trials. While they follow ethical guidelines, performed blinding of patients and avoided reporting to randomize the study, some confounders such as the size of ulcer and patient compliance may offer bias to the results achieved (Harding et al., 2016).
In conclusion, both Random Clinical Trials and Systematic Reviews of the same found that diabetic foot ulcers managed by vacuum-assisted dressing healed significantly faster in comparison to standard gel-based dressing. This is an intervention that can be applied to avoid amputations, improve health outcomes and generally improve diabetics’ quality of life.
References
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