In This Issue of JWOCN
Many researchers and clinical experts focus almost exclusively on clinical practice; their studies vary from original case reports to randomized clinical trials and their contributions form the basis of the evidence we use to inform decision making when caring for an individual patient or establishing policy at our local facilities. Other researchers focus on what is often termed bench research. They use in vivo (using an animal model) or in vitro (using a tissue line, cell line, or mechanical model) studies based in a laboratory setting. Their studies form the basis for our knowledge of the "basic" sciences that inform clinical practice, and the mechanisms that explain the effects of our interventions. Because of our focus on WOC specialty practice, the Journal mainly publishes clinical research, along with special features designed to enrich the professional and clinical practice of nursing caring for patients with wound, ostomy and continence and foot and nail issues. This issue of the Journal not only encompasses the latest in clinical practice but also includes several articles that may be characterized as transitional. Translational research is not a specific methodology; instead, it is a conceptual approach to research that strives to render results more immediately applicable to the population being studied.1 This issue of the Journal contains 4 articles that use a translational research approach; read on to find out who wrote them, what they study, and how they strive to provide knowledge that readily applies to your clinical practice.
In this issue's Wound Care Section, Barbara Delmore, Sarah Lebovits, Philip Baldock, Barbara Suggs, and Elizabeth Ayello describe the development and implementation of a pressure ulcer prevention program. This article qualifies as must read because it describes the conceptual framework that enabled task force members to prioritize interventions and the processes used to identify successful strategies and to eliminate strategies that were not successful.
In the first of the translational research articles, Lei Shi, Sarah Ramsay, Ryan Ermis, and Dennis Carson evaluate pH in wounds colonized with bacteria and its impact on Clostridium histolyticum (collagenase). You will want to read this article because it provides insights into the effect of pH on collagenase activity and bacterial counts of the typical chronic wound bed seen in clinical practice, one that is colonized by various gram- positive and -negative species.
In the second of the research studies that used a translational model, Dietmar Ulrich, Ralph Smeets, Frank Unglaub, Michael Woltje, and Norbert Pallua studied the effect of an oxidized regenerated cellulose and collagen matrix on several proteases including plasmin, elastase, and gelatinase in a group of 32 patients with diabetic foot ulcers. You will want to read their article because it not only provides an evaluation of patients managed with a dressing that contains a cellulose or collagen matrix, but also to gain insight into its effect on levels of these proteases within the wound. Are these effects statistically significant? Are they clinically relevant? Read on and decide for yourself.
Vivian Wong is the author of our third study that uses a translational approach in her assessment of changes in transcutaneous oxygen levels, skin temperature, and hyperemic responses in a group of nursing home residents following placement in various positions. Her article qualifies as must read because it provides insight into a persistent and essential question we must answer in order to understand both the effect and the underlying mechanisms that underlie turning and repositioning for prevention of pressure ulcers, what is the optimal frequency of turning, and what is the true effect of repositioning in both lateral and supine positions.
This month's Ostomy section provides the third in our ongoing series of articles on moisture-associated skin damage. Janice Colwell, Catherine Ratliff, Margaret Goldberg, Mona Baharestani, Donna Bliss, Karen Kennedy-Evans, Susan Logan, Joyce Black, and others report on 2 prevalent forms of moisture-associated skin damage, peristomal moisture-associated dermatitis, and periwound moisture-associated dermatitis. Similar to articles 1 and 2, this third and final article in the series qualifies as must read not only because it clearly defines the clinical manifestations and relevance of these prevalent conditions, but also because it outlines existing nursing interventions for their management, and gaps in our knowledge that must be addressed in future publications in the Journal.
This issue's Continence Care Section leads off with a study of incontinence brief use in hospitalized patients with no prior use of such devices. Anna Zisberg reports the incidence of brief use in older patients who entered hospital with no history of absorptive containment device use. Any WOC nurse who practices in or consults with an acute care facility will want to read this timely article describing this all too common clinical practice.
Rosangela Higa, Vera Lucia Soares Chvatal, Maria Helena Baena de Moares Lopes, and Egberto Ribeiro Turato evaluated the meaning of silence in Brazilian women who suffer from urinary incontinence but do not seek care. Conventional wisdom suggests that these women do not seek care because their leakage is either very mild or not bothersome. The findings of this study, unique because of its focus on working women in the lower socioeconomic strata of Brazil, suggest that these women choose not to seek care because of a variety of reasons not related to severity or bothersomeness of symptoms; read this article and find out how these women use silence to speak volumes about their experiences with urinary incontinence.
Floriano Marchetti, Joseph Corallo, Jaime Ritter, and Laurence Sands report our fourth study, using a translational research approach for evaluation of indwelling fecal drainage systems. They compared retention cuff pressures, using the 3 commercially available systems in 10 healthy volunteers, and found statistically significant differences in cuff pressures. They also directly visualized the cuffs in various positions and with the cuff filled to a higher volume than the manufacturer's recommendation. Read this article to gain insight into the possible clinical applications of these interesting findings.
Your WOC Nurse Consult discusses evaluation and care of a patient with bothersome nocturia. This is one of the most common lower urinary tract symptoms reported by patients with urinary incontinence or incomplete bladder emptying. You will want to read this popular and valuable feature of the Journal, authored by Linda Organist and Continence Section Editor Sandra Engberg, to gain insights into the etiology and management of nocturia.
This issue's Clinical Challenges focuses on the problem of urethral erosion and adherence with use of catheter securement devices. You will want to read this article to refresh your knowledge about the process of urethral erosion and original data about adherence to urethral catheter securement in an acute care setting.
Your Research Spotlight continues our 6-part series focusing on statistical analysis. You will want to read this article that provides a lucid description of logistic regression, relative risk, and odds ratios. This information is especially timely given the significant rise in the number of studies using these robust statistical techniques.
This issue's Getting Ready for Certification focuses on wound care. You will want to both review this ongoing feature and add the practice questions to your library of sample certification questions.
Evidence From Other Publications
Wound Care
WOC nurses are well aware that cigarette smoking, poor nutritional intake, and corticosteroids impair wound healing. However, less is known about the influence of alcohol intake. In a recent issue of Alcoholism: Clinical and Experimental Research, Ranzer and associates2 evaluated the effects of alcohol exposure on extracellular matrix generation and fibroblast proliferation, using in vitro and in vivo models. Specifically, they exposed human dermal fibroblasts to ethanol and evaluated its influence on their proliferative capacity. In order to assess wound breaking strength, the researchers evaluated mechanical strength, lysyl oxidase activity, collagen, and hyaluronic acid content in mice exposed to a controlled dose of ethanol were evaluated. Ranzer's group reported that a single exposure to ethanol impairs fibroblast function and reduces collagen and hyaluronic content in wounds impairing its tensile strength. While confirmatory studies are required, these findings suggest that alcohol consumption should be avoided or limited in patients undergoing treatment for chronic wounds.
Ostomy Care
The computed tomographic (CT) scan, when used properly, is a powerful diagnostic tool for a variety of conditions, including detailed evaluation of parastomal hernias. However, the CT scan is also associated with significant radiation exposure that has been linked to an increased risk for malignant tumors.3 Janes and associates4 evaluated the correlation between parastomal hernias and physical assessment with the patient supine and standing. They evaluated traditional CT scanning with the patient in a supine position, a novel method for evaluating parastomal herniations that required the patient to lie in a prone position and placed the stoma in the center of an inflatable ring, and clinical assessment in supine and standing positions. Presence or absence of a parastomal hernia was evaluated by 3 surgeons and 3 radiologists. Study results revealed that the prone technique was more reliable for diagnosis of a parastomal hernia than the traditional techniques placing the patient in a supine position. However, they also found that this technique did not yield greater accuracy of diagnosis than that achieved by clinical assessment alone. This study is important because it provides further evidence that sometimes clinical assessment is as accurate as the technologically generated results of CT scanning, without the accompanying radiation exposure and associated risks.
Continence Care
First-line management of constipation often involves counseling about fluid intake, recreational exercise, attention to cues to defecation, and use of laxatives. WOC nurses are often asked to recommend a laxative that can be obtained from a dietary source or in an over-the-counter format. Attaluri and coworkers5 recently reported results of a randomized controlled trial, comparing dried plums and psyllium in 40 subjects with chronic constipation. Subjects randomly allocated to dried plums consumed 50 g of dried plums (prunes) a day with meals while those allocated to the psyllium arm consumed 11 g of a psyllium supplement in 8 ounces of water twice daily. The net weight of fiber consumed by the groups was comparable at 6 g/d. The number of complete, spontaneous bowel movements was significantly greater and the stool consistency scores were significantly higher for subjects randomized to consumption of dried plums. In contrast, global constipation symptoms and straining scores were comparable in both groups as were palatability and tolerability. The results of this study are clinically relevant because they provide evidence that twice daily consumption of dried plums is an effective laxative for patients with mild to moderate constipation, and when combined with counseling about fluid intake, moderate exercise, and attention to cues to defecation, compromise a rational approach to initial therapy.
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