Relevance to nursing practice and case study

Critical appraisal
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Introduction
The models of critiquing should focus on various aspects of nursing practice but more applicable for a specific case like wound care (Pearson et al., 2005). In order to improve wound healing it is necessary to improve the wound environment, as bacteria delay healing by competing with host cells (Fong & Wood, 2006). According to the ISI Journal Citation reports ranking in 2012, the Wound Repair and Regeneration Journal was ranked11/59 in dermatology, 28/199 (surgery,) 109/185, (cell biology) and 50/ 121 (Medicine Research & Experimental) (Hebda, 2014)
Miler et al (2010) focus on the differences between cadexomer iodine and nanocrystalline silver on the healing of leg ulcers. Leg ulcers have a more devastating impact than most wounds, with bacterial colonization likely to lead to infection. The authors are based in Australia including , Royal Melbourne Hospital, Melbourne, Australia, School of Public Health, La Trobe University, Melbourne, Vic., Australia, School of Nursing, University of Melbourne, Melbourne, Vic., Australia, Royal District Nursing Service Helen Macpherson Smith Institute of Community Health, St. Kilda, Vic., Australia and Silver Chain Nursing Association.
Background/ aims
Similar to wounds, leg ulcers are treated using moist wound dressings and multilayer compression therapy. However, there is a risk that bacteria colonization will affect the ulcers as bacterial burden needs to be well managed to deal with delayed healing. The typical nursing practice is to use primary dressings with antimicrobial properties when wounds and leg ulcers have been identified as colonized (Miler, 2010). Nonetheless, there is still no consensus on the best way through which antimicrobial preparations can be used to reduce wound infection. Evidence-based medicine can allow health care practitioners to use limited resources efficiently while also improving wound care (Al-Benna, 2010). Hence, there is a need to highlight on the performance of various dressing techniques and impact on overall healing rate.
Both silver and cadexomer iodine primary dressings have anti microbial properties typically used in treatment of critically colonized legs. Nanocrystalline silver dressings have the potential to act as barriers to bacteria like the methicillin-resistant Staphylococcus aureus (MRSA) (Strohal et al., 2005) Even though, the two techniques have been accepted for there effectiveness, few studies focus on comparing the results of the two techniques. Hence, the article delves into evidence comparing results between the two as well as giving a summary on the techniques. The authors highlight that there are few systematic reviews on effectiveness of silver dressings in leg ulcer management. Thus, there is a need to focus on the randomized clinical trial that touches on the effect of silver on wounds.
Methods
The research relied on a RCT design comparing the effects and differences in results between using nanocrystalline silver and cadexomer iodine dressings. The authors sought approval on ethics from the Human Research Ethics Committee. They also registered with the trial with the Australian and New Zealand Clinical Trials Registry. The research design was robust and it would be appropriate in carrying out the study, while the number of collection points was also adequate and captured relevant information pertaining to the research. Hence, it was easier identifying the population of participating people in the RCT with the random selection reducing chances of population bias.
The participants in the study were recruited from March 2006 to May 2007, from two Australian community nursing agencies (Miller et al., 2010. All the participants had no other treatment procedures, they were 18 years and above and they all suffered from leg ulcer. Their wounds were also 15cm and less in diameter, with none having previously being diagnosed with diabetes, and they all showed signs of bacteria colonization. It possible to infer the results of the sample to the population as the random sample is representative of the population. The original sample consisted of 360 participants of 180 people for each study group, but the one tailed power analysis was conducted on 234 participants divided into the two treatment groups of 117 participants each.
One of the major strengths of the study is that it identified criteria outcome measures. The outcome measures included a change in the percentage wound size and number of wounds healed over 12 weeks. Additionally, the study relied on photographs and the Advanced Medical Wound Imaging System (AMWIS) to assess the extent of wound sizes. Data was collected at the baseline and after the 12 week period. The software showed the total surface and the surrounding tissue areas, with the measurements expressed in millimeters. Additionally, the authors emphasized on the healing rate by assessing the percentage change on total surface area while focusing on the number of days between wound measures (Miller et al., 2010). Since the authors also took into account the possible effect of antimicrobials the procedure was robust and appropriate.
After recruitment, the participants were put in random groups through group allocation, by assigning random numbers contained in a concealed envelope. Nurses receiving training in data collection and recruitment of clients, and subsequently known as “trained study representatives.” All the participants gave their consent on the study, and they received treatment at their homes for clinics (Miller et al., 2010). A philanthropic foundation funded the RCT, but the study was independent from the product manufacturers and this made the results more credible as there was no undue influence from the foundation, and the authors had no conflicting interests. Having already sought ethical approval, the researchers went on to review the treatment protocols in the two groups. The intervention consisted of treating the two groups with the two techniques, and when patients suffered from bacteria colonization, the original anti microbial treatment would be used again.
Results
The results of the RCT we...