Wound Repair and Regeneration by Mudge, Price, Neal, & Harding - Article Example

Article Critique: Wound Debridement Student’s Name Institutional Affiliation Article Critique: Wound Debridement Introduction Nursing and the health care is an evolving field that requires the health professionals to be updated with new developments in nursing and healthcare. In addition, nurses are expected to provide care and offer their services based on the latest evidence (Majid et al., 2011). This is also what is advocated in most jurisdiction by the respective professional organization as part of the competency standards (Australian Nursing Federation [ANF], 2009). Assessing the credibility and applicability of research findings to healthcare or nursing care requires a critical analysis of the whole research. This enables sifting of the relevant, credible research evidence from other research studies to aid in informing evidence-based practice. The following discussion shall be a critique of an article titled “a randomised controlled trial [RCT] of larval therapy for the debridement of leg ulcers: Results of a multicentre, randomised, controlled, open, observer-blind, parallel group study" (Mudge, Price, Neal & Harding, 2013). The article was published in Volume 22 of the "Wound Repair and Regeneration” Journal (Mudge et al., 2013). The Article’s Title The title of the study is concise and precise incorporating the primary intervention been assessed in the research which is debriding wound using larval therapy and a mention of the methodology used in the research, that is, an RCT parallel group type of study (Mudge et al., 2013). Therefore, the title is clear and sufficiently descriptive of the study as it expected of a scientific publication (Caldwell, Henshaw & Taylor, 2011). Abstract The abstract has a brief mention of the various elements of the research including the background informing the need for the research, the aims of the study, the type and number of study participants, results and the conclusion based on the results obtained. However, the methodology of the study is not highlighted in the abstract as even though its known that the allocation of interventions was randomised from the title of the article and the study as whole is a quantitative research given the data analysis and data collection methods utilising questionnaire with structured questions to rate interventions expected from the study participants. It would have been prudent if it the researchers would have mentioned in the abstract that it was a quantitative research to allow readers an in-depth picture of the research (Holloway & Wheeler, 2010). Introduction The introduction of a published research article should be clearly stated and relevant to the subject of the aims of the research (Ingham-Broomfield, 2008). This article's introduction has described some background literature regarding wound healing and the use of larval therapy mentioning the economic cost of chronic wounds and leg ulcers, and the burden of the conditions to patient's quality of life (Mudge et al., 2013). The authors lay a foundation that helps the reader to understand the use of larval therapy in wound debridement. However, the authors purport that as of the time the study was been conducted, there was not any existing RCT done to provide evidence guiding the use of any debridement technique (Mudge et al., 2013). Although this seems to be an affirmative statement posited by the authors, on a quick search using the google search engine to ascertain the authors' allegations, a number of RCT on wound debridement that have been peer-reviewed are found. Some of these articles include Turkmen, Graham & McGrouther’s (2010, p. 185) study titled “therapeutic applications of the larvae for wound debridement” and Soares et al.’s (2009, p. 1) study on a similar subject. The two articles suggested that larval therapy is effective over hydrogel in wound debridement even though Soares et al.’s (2009) found larval therapy to be relatively costlier to implement. Therefore, the authors did not sufficiently undertake a literature review on the subject. Aim and Hypothesis Mudge et al.'s (2013) research has an aim that has been explicitly stated. The authors sought to make a comparison between two techniques applicable in wound debridement relative to the time taken to achieve sufficient debridement of mixed arterial/venous (MLU) or venous (VLU) leg ulcers (Mudge et al., 2013, p. 44). The interventions used in the study were dressings composed of larval therapy and hydrogel standard technique. However, it would have been paramount if the authors had stated whether it was a superiority or equivalence study and since there was not any hypothesis, it is difficult to understand the study aims comprehensively (Young & Solomon, 2009). Methodology The study’s methodology should be succinctly explained such that it is reproducible if done by any other researcher under the same circumstances (Flemming, 2007). Design The study design employed a single blind RCT. The subjects in the study were stratified and randomization to either of the two study interventions, that is, larval therapy of hydrogel. Ulcers chosen for assessing the two study interventions were specifically described. They were to contain at least 25% slough and the slough had to be more than 2cm2 in area without there been any other ulcer within a circumference of 2cm (Mudge et al., 2013). The study identified assessors who were blinded to prevent the results been affected subjectively (Young & Solomon, 2009). However, the researchers did not give a full description of the stratification and randomization leaving details of specific covariates such as sex, age and the possible aetiology of the wounds. This is necessary before stratifying the covariates combination into blocks and proceed to assign the subjects to the blocks (Suresh, 2011). Even though the covariates were not identified in the study design, they were highlighted in the results. This may have introduced possible confounding factors that may have predisposed the study to a systematic bias (Suresh, 2011). In addition, in the study methodology, it is not mentioned whether there was any concealment during the allocation of study interventions raising questions regarding the validity of intervention allocation. Nevertheless, the RCT as a study design was appropriate for Mudge et al.,'s (2013) study given the aims of the research. The study’s outcome was to give a more evidence-based finding regarding the effectiveness of larval therapy dressings (LTD) intervention, and an RCT design was appropriate to provide robust evidence. The study findings were meant to fortify the limited existed evidence regarding the efficacy of larval therapy dressings when used to remove wounds’ necrotic tissues. Sample The sample of the study consisted of a total of 88 subjects. These subjects were patients who had been diagnosed with either VLU or MLU identified via hospital in-and outpatient visits, community clinics and nurse caseloads (Mudge et al., 2013). The calculation of the sample size was informed by previous data from a past study. The estimation of the sample allocated to each intervention was explained by the researchers out of which it was calculated that 31 participants would be allocated to each intervention. In consideration of a 28% attrition rate, the final sample size totalled to 88 with 46 subjects on larval group and 42 on hydrogel group. The explanation related to the sampling and recruitment of the study justified the sample size as postulated by Flikkema and Toledo-Pereyra (2012). There were nurses who were expected to rate the ease of applying the intervention in practice and removing the dressing after completion of treatment. However, the authors did not include them in the description of the study participants raising questions whether the nurses’ perspective on the intervention was a predefined part of the research or it was only realised that their feedback would be valuable in the course of the research. The researchers obtained informed consent from all the participants as per research regulations (Ingham-Broomfield, 2008). Ethical approval was also sought from the relevant ethics boards and committees in the jurisdiction as explained in the study (Mudge et al., 2013). Ethics approval is critical to avoid violation of patient or human rights or even regulations governing the performance of research using human subjects (Young & Solomon, 2009). The identity of the study participants was also protected as the authors did not disclose any information that would lead to singling out of any participant. Data collection Data collection involved blinded assessors examining the wounds for total debridement. The latter was defined as to have been achieved if the wound bed was so clean that no more debridement would be necessary (Mudge et al., 2013). The study was only carried out for 21 days, and if total debridement had not been achieved by that day, the study interventions were discontinued. The collection of debridement data was done through observations while data regarding the rating of the interventions was collected using Likert-type scale questions that had structured closed type of questions typical of quantitative research (Schneider, Whitehead, LoBiondo-Wood & Haber, 2013). The data collected was sufficiently described by the researchers including the step-wise routine collection till the end-point was achieved. Data Analysis Analysis of the data utilised descriptive statistics such as those used to measure central tendency such as mean and those used to measure spread such as standard deviation (Armitage & Berry, 2008). The mean and standard deviation were significant in assessing and quantifying pain scores, the number of treatment visits and the number of times dressings were changed for the two types of interventions on different patients. T-tests were used to assess the statistical significance of the data obtained from the two interventions on different patients such as pain scores. A Kaplan-Meier survival curve was used to illustrate the duration for debridement for the two interventions giving a clearer and deductible picture of the better debridement technique regarding the time to achieve the endpoint. The statistical methods used were significant for the research and served to enhance the validity and reliability of the results obtained in the study (Armitage & Berry, 2008). For instance, the survival curve shows that larval therapy dressings achieve faster debridement compared to standard hydrogel with a statistical significant value (p Read More