Evaluating All Available Evidence Pertaining to Using PMDs for Pressure Injuries

Purpose:

Evidence leads us to knowledge of what is really happening in the world, and helps us predict what is likely to happen in the future. The Information Age allows clinicians to find research articles and conference abstracts on the internet and evaluate their content. Adding this information to our own expertise and our knowledge of individual patients (the Evidence-Based Practice triad)¹ can improve practice.^2,3

Methodology:

Guided by this question, “Does available evidence support using polymeric membrane dressings (PMDs) for pressure injuries?” the researcher searched for ALL published articles, chapters, and major conference posters (by electronically searching abstracts and walking many conference halls) which included PMDs, including those sponsored by competitors, with no date or language limits. The researcher searched PubMed and Google Scholar. Colleagues searched CINAHL and SCOPUS. The manufacturer’s records were reviewed for references. The searches are current through 31 October 2017. Documents simply mentioning the brand name in a list or table were eliminated. All other research was summarized in a table and categorized using The Joanna Briggs Institute’s Evidence Levels for Evaluating Product Effectiveness.⁴

Results:

Documents including pressure injuries totaled five Level I reviews, three Level I RCTs, 12 Level II Studies, five Level III studies, 45 Level IV case series/studies, seven Level V Expert Guidelines, and four Level V studies of particular relevance to pressure injury management. Authors described 934 pressure injuries managed with PMDs. The researcher found many articles and posters about which PMDs’ manufacturer was previously unaware. 105 of the 126 authors were completely independent. PMDs were found superior: they clean, balance moisture, relieve pain, and speed healing.⁵

Conclusions:

Independent clinicians produce by far the majority of evidence pertaining to PMDs, including evidence pertaining to using PMDs on pressure injuries.⁵ The evidence demonstrates PMDs outperform conventional foams and other advanced wound management methods.⁵

References:

1. Bolton L, McNees P, van Rijswijk L, de Leon J, Lyder C, Kobza L, et al. Wound-healing outcomes using standardized assessment and care in clinical practice. J Wound Ostomy Continence Nurs. 2004 Apr;31(2):65– 71.
2. Bolton LL, Girolami S, van Rijswijk L. The Association for the Advancement of Wound Care (AAWC) Venous and Pressure Ulcer Guidelines. Ostomy/wound management. 2014;60(11):24–66.
3. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn’t. BMJ. 1996 Jan 13;312(7023):71–2.
4. Cutting KF, White RJ, Legerstee R. Evidence and practical wound care – An all-inclusive approach. Wound Medicine. 2017 Mar 1;16:40–5.
5. Cutting K, White R, Legerstee R. A response to editorial “a holistic approach to examining the evidence”, JWC 2017; 26(11):609. J Wound Care. 2017 Dec 2;26(12):788–9.
6. Munn Z. An Introduction to the GRADE approach in systematic reviews and guideline development [Internet]. Webinar Sponsored by The Joanna Briggs Institute presented at: Health Services Research Aassociation of Australia and New Zealand; 2017 Jul 18; Internet. Available from: https://www.youtube.com/watch?v=KlNDJ2eEupg
7. Wollersheim H. Beyond the evidence of guidelines. Neth J Med. 2009 Feb;67(2):39–40.
8. Nathwani D. From evidence-based guideline methodology to quality of care standards. J Antimicrob Chemother. 2003 May 1;51(5):1103–7.
9. Joanna Briggs Institute Levels of Evidence and Grades of Recommendation Working Party. New JBI Levels of Evidence [Internet]. The Joanna Briggs Institute website. [cited 2018 Feb 18]. Available from: http://joannabriggs.org/jbi-
approach.html#tabbed-nav=Levels-of-Evidence
10. Aromataris E, Munn Z. Joanna Briggs Institute Reviewer’s Manual 7.3.6.2 Sources to search - [Internet]. 2017th ed. The Joanna Briggs Institute; [cited 2018 Feb 1]. Available from:
https://reviewersmanual.joannabriggs.org/display/MANUAL/7.3.6.2+Sources…
11. Vowden P, Vowden K. Diabetic foot ulcer or pressure ulcer? That is the question. Diabetic Foot Canada. 2016;(4):26–9.
12. Mathes T, Pieper D. Clarifying the distinction between case series and cohort studies in systematic reviews of comparative studies: potential impact on body of evidence and workload. BMC Med Res Methodol [Internet]. 2017 Jul 17 [cited 2017 Dec 30];17. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5513097/
13. Swanson E. Levels of Evidence in Cosmetic Surgery: Analysis and Recommendations Using a New CLEAR Classification. Plast Reconstr Surg Glob Open [Internet]. 2013 Dec 6 [cited 2018 Feb 22];1(8). Available from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4186301/
14. Concato J, Shah N, Horwitz RI. Randomized, controlled trials, observational studies, and the hierarchy of research designs. N Engl J Med. 2000 Jun 22;342(25):1887–92.
15. Benson K, Hartz AJ. A comparison of observational studies and randomized, controlled trials. N Engl J Med. 2000 Jun 22;342(25):1878–86.
16. Flacco ME, Manzoli L, Boccia S, Capasso L, Aleksovska K, Rosso A, et al. Head-to-head randomized trials are mostly industry sponsored and almost always favor the industry sponsor. Journal of Clinical Epidemiology. 2015 Jul 1;68(7):811–20.
17. Benskin L. Re: Do dressings prevent infection of closed primary wounds after surgery? The BMJ [Internet]. 2017 Jul 31 [cited 2017 Jul 31]; Available from: http://www.bmj.com/content/353/bmj.i2270/rr/927134