Evidence Base Medicine 外科 R1 陳勇璋
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1 Evidence Base Medicine 外科 R1 陳勇璋
2 Case Data: Name: 葉 xx Age:73 year old Gender: Lady Occupation:Nil Drug allergic: denied Food allergic :denied
3 Chief Complaint: A wound over sacral region since 3 weeks ago.
4 History of Present Illness: Bed ridden since Feb Wound over sacral region, about 9cmx9cm in size, necrosis change of skin and slough tissue accumulation with odour, wound edge with erythema change were noted, Occipital region, and both lower legs pressure sore with eschar.
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6 Past Medical History: 1. Acute stroke, multiple infarctions suspect cardiogenic embolic stroke 2. Atrial fibrillation 3. Hypertension 4. Type 2 DM 5. Pneumonia 6. Urinary tract infection 7. Upper gastrointestinal bleeding 8. Acute pulmonary edema 9. Acute renal failure 10.Recurrent CVA with seizure 11.Af with RVR 12.Microcytic anemia suspect thalassemia
7 Surgical intervention Decubitus ulcer s/p debridement Discharge Nursing Home
8 Question: Does wound dressing with Hydrocolloid dressing for a case of decubitus ulcer post debridement can improve wound healing?
9 PICO P: Pressure ulcer s/p debridement patient I : wound dressing C: simple dressing O: Improve wound healing
10 1. Pubmed Database 2. Cochrane library
11 Keywords 1. Pressure ulcer 2. Debridement 3. Wound dressing
12 Pressure ulcer
13 Debridement
14 Wound dressing
15 Combine #1 AND #2 AND #3
16 Limits: Review Articles, English, 10 years
17
18 Evidence-based Management Strategies for Treatment of Chronic Wounds Eplasty. 2009; 9: e19.. Searching both MEDLINE and Cochrane databases, reviewed currently available articles concerning chronic wound care. Utilizing this information, outlined a review of current, evidence-based concepts. Classification and treatment guidelines as well as the adoption of the TIME acronym facilitate an organized conceptional approach to wound care. Evidence Level: level Ib
19 Conclusion: Choosing an appropriate wound dressing should consider the current phase of wound healing, its specific temporal requirements, as well as potential side effects. Modern dressings in terms of general performance criteria: ease of use, pain, ability to absorb and contain exudates, avoidance of wound trauma on removal.
20 A randomized clinical trial comparing hydrocolloid, phenytoin and simple dressings for the treatment of pressure ulcers BMC Dermatol. 2004; 4: 18. One relatively recent method is application of a hydrocolloid dressing (HD). In this study we compared the therapeutic effects of HD on pressure ulcer healing with two other topical applications, phenytoin cream (PC) and simple dressing (SD). Ninety-one stage I and stage II pressure ulcers of 83 paraplegic male victims of the Iran-Iraq war were randomly allocated to three treatment groups. Mean age and weight of the participants were ± 6.04 years and ± 5.08 kg, respectively. All the patients were managed in long term care units or in their homes for 8 weeks by a team of general practitioners and nurses, and the ulcer status was recorded as Complete healing, Partial healing, Without improvement and Worsening. Evidence Level: level Ib
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27 Conclusion: Hydrocolloid dressing (HD) is the most effective method investigated for treating stage I and II pressure ulcers in young paraplegic men.
28 Use of a new silver barrier dressing, ALLEVYN Ag in exuding chronic wounds Int Wound J June; 6(3): A multi-centre clinical evaluation (using a Case report form as data capture on the product in use for up to six dressing changes) was performed between October 2007 and March A total of 126 patients were recruited from the adult (>18 years) populations routinely seen by the evaluation clinicians from across the UK, Spain, Ireland, France, Germany and USA. Evidence Level: level Ia
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34 Conclusions: There was significant evidence of a reduction in the percentage of patients presenting with clinical signs of infection at the initial and final assessment.
35 Summary: Wound dressing with Hydrocolloid dressing for a case of decubitus ulcer post debridement can improve wound healing.
36 Thank you for your attention!
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