Biomedical subjects
Publications and source records attributed to L van Rijswijk.
The previous critique of the "mini-article" merely scratches the surface with respect to critical reading of the literature. However, it is of vital importance to know whether the authors' conclusions are substantiated by the results obtained. Therefore, do not be intimidated by the data; pull out your calculator, verify the numbers, and practice your critical reading skills. After all, practice makes perfect!
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Due to the sparsity of prospective, controlled, clinical studies on the efficacy of and the lack of standardized information about support surfaces, current literature does not clearly define how these surfaces address patient needs. Standardization would help healthcare professionals make better informed decisions about the use of support surfaces. Standardization would also help researchers design and implement controlled, clinical studies by defining characteristics of surface evaluation, making it possible to replicate research activities. The first step toward standardization is to develop a performance-based set of criteria for classifying these surfaces. With respect to the three purposes identified: comfort, postural control and pressure management, only parameters that can be measured noninvasively, have been considered. The nine parameters are life expectancy of the surface, skin moisture control, skin temperature control, redistribution of pressure, product service requirements, fail safety, infection, flammability, and patient/product friction. Specific guidelines for each of these nine parameters are discussed in depth. With testing and evaluation of support surfaces standardized, clinicians will be able to choose a surface to meet the needs of patients the same way they make other treatment decisions: based on outcomes and the results of controlled, clinical studies.
A prospective, controlled, clinical study was conducted to evaluate the effect of skin barriers and adhesives on the incidence of peristomal skin irritation. Colostomy patients eligible to participate were randomly assigned one of two sets of 10 one-piece pouching systems. At mid-study, after using the first 10 pouches, patients were allocated 10 pouches from the alternate pouching system. Each pouching system was worn for a maximum of 24 hours. One-hundred twelve patients were enrolled in the study. At baseline, 8 percent of patients had some erythema. At the end of the study period, 26 percent of patients exhibited signs of skin irritation. Patients were significantly more likely to develop skin irritation following use of the Karaya-based barrier than following use of the pectin-based barrier product (Wilcoxon Rank Sum Test, p < 0.01). Similarly, the type of tape used to secure the pouching system significantly influenced the incidence of skin irritation. Analysis of the change in skin condition as it relates to all evaluated variables; i.e. pouching system, stoma shape, stoma size, stoma length and irrigation, showed that only the type of product used was significantly associated with a change in skin condition. This is the first report of a controlled clinical study to evaluate the effect of pouching systems and patient/stoma variables on skin integrity in colostomy patients. These findings confirm that skin irritation can be a considerable problem, even in patients who use irrigation techniques.(ABSTRACT TRUNCATED AT 250 WORDS)
The cost of wound care frequently is defined as the cost of materials and labor, ignoring the effect of both variables on outcome. As a result, money-saving measures actually may increase cost while reducing the quality of care. Definitions and tools to enable professionals to understand, evaluate, and compare the cost-effectiveness of wound care practices and treatment modalities are given.
Understanding of the healing process and factors that may affect it, has increased dramatically during recent years. Clinical application of this knowledge has improved care for many patients, and helped focus attention on information deficits. To better meet patient needs and increase awareness of the value of prevention, wound care clinicians and researchers are encouraged to include Quality of Life outcomes in their goals of chronic wound care. In the absence of the results of reliability, validity and feasibility studies of existing chronic wound care guidelines, clinicians need to be aware of their potential usefulness and limitations. When reviewing wound care costs or conducting studies, it is important to define cost-effectiveness as a function of outcomes and all relevant costs. Because chronic wounds occur in every care environment, these issues require the attention of all healthcare professionals, educators, payors and patients. Wound care professionals are encouraged to disseminate existing knowledge to all providers and recipients of care.