How a discipline came of age: a history of wound care

A systematic review of therapeutic interventions for pressure ulcers after spinal cord injury

OBJECTIVE

To systematically review evidence on the prevention and treatment of pressure ulcers in those with a spinal cord injury (SCI).

DATA SOURCES

For this evidence-based review, the following data sources were used: MEDLINE/PubMed, CINAHL, EMBASE, and PsycINFO.

STUDY SELECTION

To be selected for inclusion in the current review, there had to have been an intervention, studies had to have 3 or more subjects, and 50% or more of the participating group had to have an SCI.

DATA EXTRACTION

Data extracted included study design, subject demographics, inclusion and exclusion criteria, study type, sample size, outcome measures used, and study results.

DATA SYNTHESIS

Articles selected for this review were organized into 1 of 2 categories: prevention or treatment. Within each broad category, several smaller ones were created, and articles were grouped according to the prevention (direct or indirect) or treatment intervention discussed.

CONCLUSIONS

Of the 26 articles selected for inclusion in the systematic review, 7 were randomized controlled trials (RCTs) that dealt with treatment for pressure ulcers, and there was 1 RCT on prevention. Despite the cost-effectiveness of prevention, little research exists on preventative interventions, and what does exist is mostly level 4 evidence. More research is needed for both prevention and treatment, but especially the former.

Gauze packing of open surgical wounds: empirical or evidence-based practice?

INTRODUCTION

Most surgical wounds are closed primarily, but some are allowed to heal by secondary intention. This usually involves repeated packing and dressing of the raw wound surfaces. Although the long-term care of such wounds has devolved to the care of nurses in the community or out-patient setting, the initial wound dressing or cavity packing is done by the surgeon in the operating theatre. Many surgeons are unaware of the growth of the discipline of wound care, and still use traditional soaked gauze for dressing and packing open surgical wounds and cavities.

RESULTS

This review summarises the some of the modern alternatives available and the evidence--or the lack of it--for their use in both the acute and chronic setting.