A Randomized Controlled Trial of Larval Therapy for the Debridement of Leg Ulcers by Mudge, Price, Neal & Harding - Article Example

Critical review of a journal article Name Course Institution Date Critical review of a journal article Mudge, E., Price, P., Neal, W., & Harding, K.G 2014. A randomized controlled trial of larval therapy for the debridement of leg ulcers: Results of a multicenter, randomized, controlled, open, observer blind, parallel group study. Journal on wound repair and regeneration, 22, 43-51. Purpose of the study The review is of Mudge, Price, Neal and Harding (2013) article ‘A randomized controlled trial of larval therapy for the debridement of leg ulcers: Results of a multicenter, randomized, controlled, open, observer blind, parallel group study’ in the journal on wound repair and regeneration. The purpose of the study is clearly stated. It has been a long standing knowledge as postulated by Dennis, Dumville, Cullum and Bland (2010) that the application of larvae aids in healing of particular wounds through a mechanism involving facilitation of necrotic tissue debridement though the larval therapy effectiveness as compared to the conventional practice remains a controversial issue as Ian , Mark and Granick (2012) further reveals. This argument about larvae application in wound healing forms the basis of the journal article since the article makes a comparison study between the effectiveness of a clinical larval therapy dressing (BioFOAM) with a conventional method involving debridement using hydrogel against a benchmark of time taken to debridement of either venous (VLU) or a mixture of arterial and venous (MLU) leg ulcers. How the study applies to nursing practice or patient care The study established that sample subjects under larvae treatment required fewer dressing changes though exhibited higher pain than those under hydrogel treatment. The observations led to the conclusion that larval therapy through BioFOAM dressing leads to a quicker VLU and MLU debridement than a hydrogel therapy but made the recommendation that close monitoring should be maintained to mitigate risk of re-sloughing. This substantiated byThomas, O'Donnel, Ethan and Balk (2011) claim that clinical studies and practice have proved that larval therapy has higher chances of faster debridement than wound dressings. Justification for the study David (2013) suggest that though there has been sketchy clinical postulation that larvae therapy is effective, practically within the clinical setting there lacks sufficient data from randomized controlled trials to substantiate the claim. According to Athina, Ethan Thomas and Joseph (2007) the absence of distinct proof and data to form a strong backing to the claim has led to the development of a new approach to larvae therapy involving inclusion of the larvae into a polyurethane foam within a mesh bag for reassurance to patients’ that the entire larvae has been incorporated into the wound’s dressing. This adds value to the study that the article has written about with regard to the study being premised on credible grounds that are substantiated on research and clinical practice. This new development with regard to inclusion of the larvae into polyurethane foam forms the basis of the randomized control trial study that the article writes about. The decision to use a sample size of 88 subjects and the subjects being sufficient for a conclusive study was guided by previous studies thereby making the content of the article reliable with respect to having consulted previous studies. The study design The design of the study was through randomized controlled trial (RCT). The randomization of the sample subjects to one of the two distinct groups for larvae and hydrogel testing based on size and voluntary written consent from the sample subjects with a 3-4 days span for review as explained in the article was a just procedure to carry out the randomization for the study. The procedure for handling the sample subjects as can be observed from the article was systemic with blind assessors providing information and pictures with regard to the progress of the wounds towards debridement. The results of the study as depicted in the article are reliable based on the procedures of the study and the interventions that the nurses did with regard to dressing the sample subjects and the information provided through Likert-type questions pertaining to the nurses’ experiences with treatment application and removal. Results analysis section of the article is very professional as the results are depicted in form of tables with regard to baseline demographics, baseline ulcer characteristics, incidences of debridement and clinical description of the ulcers by intervention during the last evaluation. Pictures of ulcers at baseline and 4 days after the application of the larvae are shown to clearly illustrate the effect of the larvae treatment. Ethics approval It is stated in the article that ethical approval was received from Oxfordshire Independent Research Ethics Committee and the local research and the development departments. Besides, the study was conducted in conformance to the world medical association Declaration of Helsinki Ethical Principles for Medical Research Involving Human Subjects. Sampling The study utilized 88 random sample subjects for data analysis but only 64 sample subjects completed the study which is a statistically significant number to render the results of the study reliable based on the sample sizes done by other studies in the past about a similar subject. Subjecting a half of the sample subjects to larvae treatment and the other half to hydrogel treatment under similar clinical bed conditions resulted into a higher percentage of full debridement by subjects under larvae treatment as compared to those under hydrogen treatment. The recruitment of the sample subjects in study was through use of hospital wards for inpatients, use of outpatients, sourcing of the sample from the community ulcer clinics and nurse case loads and this improved reliability as the sample is a reliable representative of the relevant population that would be typically treated through the methods under investigation. The decision by the sample subjects to participate in the study is on a voluntary basis and the treatment of the samples is not based on the attitude exhibited by the sample subject while making the decision to participate thereby eliminating chances of bias. Outcomes The measurement involved establishment of how long it took for a wound subjected to larvae and hydrogel therapy to debride. The measurements were valid given that a significant reference ulcer was established. Review was every 3-4 days for a maximum of 21 days for assessment of the wound and the surrounding skin to check how it was progressing to debridement for both the larvae and the hydrogel treatments and was carried out by blinded assessors who even took photographs as a proof of the progress for final assessment. Intervention was well described in the study. The 2nd to the 7th visits formed the intervention phases of the study and involved application and removal of dressing and bandages and was carried out by the nurses. The intervention can be replicated in the nursing practice since most of the nurses found it to be either easy or very easy. The study results The study results of the study were statistically significant (p Read More