Critical Appraisal: Management of Pain and Wound Healing for Second Degree Burns

Critical Appraisal
Student Name:
University:
CRITCAL APPRAISAL
PICO
Problem: Management of pain and wound healing for second degree burns
Intervention: Hydrofiber dressing with ionic silver (Ag dressing)
Comparator: 1% silver sulfadiazine
Outcome: Determine the efficacy of each dressing in treating second-degree burns, including time to healing and pain during dressing
Secondary Outcome: To conclude which dressing is more suitable in the treatment of superficial second-degree burns when benefits (time to healing, pain during dresses changes) are weighed up with costs.
Introduction
Meta- analysis and CASP are two models that can be used for research critique and appraisal. Meta-analysis is a statistical method that assesses clinical effectiveness of health care interventions CITATION Int12 \l 1033 (International consensus, 2012) Meta-analysis allows for a systematic and quantitative approach by combining the findings from a number of individual studies CITATION Int12 \l 1033 (International consensus, 2012). CASP, a case controlled study is the analytical study that compares the case and control groups to gather relevant criteria for appraisal CITATION Mua10 \l 1033 (Muangman P, 2010). This journal discusses a clinical trial that compared time to healing and pain during the treatment of second-degree burns, comparing hydrofiber dressing with ionic silver (Ag dressing) and 1% silver sulfadiazine. Published in 2010, in Bangkok, Thailand with an impact factor of over 2.00. This journal is among the top 20 dermatologist journals in the medication sector for wound dressing. According to ISI, the journal also ranks 65fth in surgical journals compared to 198 other journals. With over 10 articles in burns, Pornprom Muangman is a professor in the University of Mahidol and a part-time professor in the University of Washington and Chulalongkorn. The other authors who are also doctors Pundee Chainin, Opasanon Supaporn, Muangman Saipin are professors in medical institution in Scotland, Germany and France respectively. This information about the writers will help me with this trial and influence my decision making positively.
Background/aims
The world has used silver sulfadiazine for tropical burn addressing for many years. Patients have to endure the pain and long healing time allowance associated with the treatment of burns using the medication, this as lead to the trial of hydrofiber Ag dressing by a group of doctors, it is a modern alternative that is more effective. Burns affect people from different backgrounds without any form of discrimination, anybody with any age can get a burn and these burns usually vary in site and deepness. The healing of the wounds take quite a long time depending on what one dresses them with CITATION Fen06 \l 1033 (Feng XS, 2006). The rationale of the trial is to prove that silver suifadiazine (SSD) gauze, which is the standard wound care practice is more painful, long time taking to heal and risky compared to the recently developed hydrofiber (Ag dressing), which is more moisture and more effective. Only a view studies that compare to this modern Ag dressing on burn outcomes. The main objective of the prospective randomized controlled trial is to compare the healing process, total time taken for a wound to heal, microbiology, pain experienced by the patient and the nursing outcomes of the second degree burns addressed by the hydrofiber dressing with ionic silver (Ag dressing) and 1% silver sulfadiazine. The trial was to confirm that in deed hydrofiber dressing with ionic silver (Ag dressing) in second-degree burns was effective than the current accepted form of wound addressing. The hydrofiber dressing confirmed that it is better and less time consuming in administering the medicine to patients than the usage of silver sulfadiazine traditional way of wound dressing. The alternative should be less painful, affordable and less time consuming CITATION YBa04 \l 1033 (Y. Barnea, 2004). How effective is hydrofiber dressing than silver sulfadiaine for partial thickness burns in patient treatment?
Methods
The research design used integrated all the necessary aspects for the coordination of the patients and the research team for the effective address of the partial thickness burn treatment. Descriptive research method was used to observe and describe the study. The trial required a rigorous design for the research to be successful. The design allowed the researchers to analyze the data by the appropriate silver sulfadiazine and hydrofiber dressing comparison CITATION Mua10 \l 1033 (Muangman P, 2010). The use of appropriate data collection points of 35 patients per category (70 in total) made it easy for the researchers to observe the healing rate in the patients. The design minimized all kinds of interferences such as internal construction, attrition and the usage of blinding. The population identified was 70 patients; they all had partial thickness burns that was less than 15% body surface area CITATION Mua10 \l 1033 (Muangman P, 2010). The comparison of total time for healing and the amount of pain from each group helped researchers to compare any similarities and differences. The sample size used fitted perfectly the trail tests and was easy to manage size it was adequate. For perfect blood flow, blisters and necrotic skin from the burns was removed.
Randomization ensures that researchers record every characteristic of the treatment in the comparable group including the unknown variables influencing the choice of treatment. Alternative allocation, odd or even dates and the day of the week affect the method the research uses. The usage of simple random allocation used in this randomization allocated the processes of wound healing independently to the patients. The researchers advised the patients on the importance of the administration of hydrofiber dressing intervention. All the patients in the group received the hydrofiber dressing and there was no record of fidelity reported CITATION Mua10 \l 1033 (Muangman P, 2010). Before the conduction of the trial, the team seek permissions from the appropriate bodies such the hospital administration, government drug experimental department and the patients’ consent. The team incurred costs such as dressings, transport for the patients, hospital charges and pain medication. These costs emerged from the trials and reported in the US dollars. The team did not reveal the source of their funds except for self-sponsorship and the fund from the hospital research kit. The design involved both male and female, patients from different race and different age gap among the patients. This was to ensure that there was no any kind of bias in the research. Prior to the selection of the sample and data collection, all the staff underwent through training to avoid wrong data collection. The sample-involved patients who were never attended another trail prior to the current one. Only patients treated at Siriaj outpatient in 2006 to 2008 February were experimented on. The sample consisted of 35 patients for the Aquacel Ag-treated group, the group carried wound dressing after every 3 days. The other group of 35 patients, 1% silv...