EVIDENCE BASED IN CLINICAL
PRACTICE, TO USE OR NOT
TO USE THE SILVER, THAT IS
THE QUESTION
M. Berenguer Pérez, E. Farret R...
INDEX
2
1 Introduction
2 Aim
3 Material and Methods
4 Cases
5 Results and Conclusions
6 Discussion
3
INTRODUCTION
 Chronic wounds are characterized by
their great prevalence, their high costs
and the incapacitation for t...
AIM
4
 Our objective is to demonstrate the
effectiveness with cadexomer
iodine® in treatment of wound in
patients with ve...
MATERIAL AND METHODS
 Descriptive study in 15 patients of a primary health service with venous
ulcers of degree III and s...
SEARCH
6
 ("Varicose Ulcer"[Mesh] OR "Foot Ulcer"[Mesh] OR "Pressure Ulcer"[Mesh] OR "Leg Ulcer"[Mesh] OR
((Varicose[TI] ...
CASE 1
.
7
Case:
 65 year-old male
 Locally infected superficial
 Treatment before: Silver, and
different dressings eve...
CASE 2
8
Case:
 75 year-old female
 Locally infected superficial
 Treatment before: Silver, and
different dressings eve...
RESULTS
9
 A Cochrane systematic review reviewed three RCTs comparing
silver dressings with hydrocellular foam, alginate ...
RESULTS
 After application for 2 weeks with wound dressing we observed a
good evolution of skin surrounding the wound, a ...
DISCUSSION
 Our performances are had to be based on scientific
evidence to guarantee a quality attention.
● Reddy M, Gill...
CONCLUSIONS
 After this first experience with the use of these dressings
we saw a reduction of the dressing change, an ex...
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EWMA 2013 - Ep509 - EVIDENCE BASED IN CLINICAL PRACTICE, TO USE OR NOT TO USE THE SILVER, THAT IS THE QUESTION

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M. Berenguer Pérez, E. Farret Roig, M. T. Herrero Serrano, M. D. L. S. Comas i Antich, A. Garcia Bonillo, M. T Fabregat.

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Transcript of "EWMA 2013 - Ep509 - EVIDENCE BASED IN CLINICAL PRACTICE, TO USE OR NOT TO USE THE SILVER, THAT IS THE QUESTION"

  1. 1. EVIDENCE BASED IN CLINICAL PRACTICE, TO USE OR NOT TO USE THE SILVER, THAT IS THE QUESTION M. Berenguer Pérez, E. Farret Roig, M. T. Herrero Serrano, M. D. L. S. Comas i Antich, A. Garcia Bonillo, M. T Fabregat. 23thConferenceofthe EuropeanWoundManagementAssociation 15-17May2013Copenhagen
  2. 2. INDEX 2 1 Introduction 2 Aim 3 Material and Methods 4 Cases 5 Results and Conclusions 6 Discussion
  3. 3. 3 INTRODUCTION  Chronic wounds are characterized by their great prevalence, their high costs and the incapacitation for the activities of the daily life of our patients.  With this new modernization in dressings we contributed not only to the humidity degree necessary to debridement to granulate and to epitalitation a wound but that simultaneously the dressing is able to control its excess of liquids and to give at every moment whatever it needs.  Relevant data significantly important to have presents/displays it in our new performances in treatment of hurt since we diminished the cures, the material, and simultaneously the costs and our time of dedication.
  4. 4. AIM 4  Our objective is to demonstrate the effectiveness with cadexomer iodine® in treatment of wound in patients with venous ulcers of degree III and signs of infection without use dressings silver.  To demonstrate the need of a change in the treatment of the wounds that offers a global approach to us of the same ones, with the purpose of obtaining a fast and effective healing.
  5. 5. MATERIAL AND METHODS  Descriptive study in 15 patients of a primary health service with venous ulcers of degree III and signs of critical colonization and infection with the cadexomer iodine®.  We considered, regarding the skin, painful wound, surrounding area of the wound, exudation, colonization, necrosis, and the need to have a use full solution. The control of the humidity, colonization and reduction of pain were the most important goals.  Previous deciding not to use silver dressings, we reviewed guidelines SIGN (Scottish Intercollegiate Guidelines Network), NICE (National Institute for health and clinical Excellence) Cocrhane Library.  Finally decided to use SIGN to reflect the most recent evidence on chronic venous leg ulceration. 5
  6. 6. SEARCH 6  ("Varicose Ulcer"[Mesh] OR "Foot Ulcer"[Mesh] OR "Pressure Ulcer"[Mesh] OR "Leg Ulcer"[Mesh] OR ((Varicose[TI] OR Venous[TI] OR "Venous Stasis"[TI] OR "Hypertension"[TI] OR Foot[TI] OR Plantar[TI] OR Pressure[TI] OR Decubitus[TI] OR Bed[TI] OR Leg[TI]) AND (ulcer*[TI] OR sore*[TI])) OR Bedsore*[TI] OR (Chronic[TI] AND wound*[TI])) AND ((randomized controlled trial[Publication Type] OR (randomized[Title/Abstract] AND controlled[Title/Abstract] AND trial[Title/Abstract])) OR (systematic review[ti] OR meta-analysis[pt] OR meta-analysis[ti] OR systematic literature review[ti] OR (systematic review[tiab] AND review[pt]) OR consensus development conference[pt] OR practice guideline[pt] OR cochrane database syst rev[ta] OR acp journal club[ta] OR health technol assess[ta] OR evid rep technol assess summ[ta]) OR ((evidence based[ti] OR evidence-based medicine[mh] OR best practice*[ti] OR evidence synthesis[tiab]) AND (review[pt] OR diseases category[mh] OR beha vior and behavior mechanisms[mh] OR therapeutics[mh] OR evaluation studies[pt] OR validation studies[pt] OR guideline[pt])) OR ((systematic[tw] OR systematically[tw] OR critical[tiab] OR (study selection[tw]) OR (predetermined[tw] OR inclusion[tw] AND criteri*[tw]) OR exclusion criteri*[tw] OR main outcome measures[tw] OR standard of care[tw] OR standards of care[tw]) AND (survey[tiab] OR surveys[tiab] OR overview*[tw] OR review[tiab] OR reviews[tiab] OR search*[tw] OR handsearch[tw] OR analysis[tiab] OR critique[tiab] OR appraisal[tw] OR (reduction[tw] AND (risk[mh] OR risk[tw]) AND (death OR recurrence))) AND (literature[tiab] OR articles[tiab] OR publications[tiab] OR publication[tiab] OR bibliography[tiab] OR bibliographies[tiab] OR published[tiab] OR unpublished[tw] OR citation[tw] OR citations[tw] OR database[tiab] OR internet[tiab] OR textbooks[tiab] OR references[tw] OR scales[tw] OR papers[tw] OR datasets[tw] OR trials[tiab] OR meta-analy*[tw] OR (clinical[tiab] AND studies[t iab]) OR treatment outcome[mh] OR treatment outcome[tw])) NOT (letter[pt] OR newspaper article[pt] OR comment[pt]))
  7. 7. CASE 1 . 7 Case:  65 year-old male  Locally infected superficial  Treatment before: Silver, and different dressings every 48-72h.  Ulcer duration: 2 weeks
  8. 8. CASE 2 8 Case:  75 year-old female  Locally infected superficial  Treatment before: Silver, and different dressings every 48-72h.  Ulcer duration: 1 year in both legs
  9. 9. RESULTS 9  A Cochrane systematic review reviewed three RCTs comparing silver dressings with hydrocellular foam, alginate or best practice. Two studies showed no difference between products and one reported statistically faster healing rates but did not report complete healing. All three studies were small and of short duration and could not be combined for a meta-analysis.49  An RCT (n=213) comparing, silver dressings and non-adherent dressings (in addition to standard compression), found no significant differences in median time to complete healing or healing rates at three, six and 12 months.  A Silver dressings are not recommended in the routine treatment of patients with venous leg ulcers
  10. 10. RESULTS  After application for 2 weeks with wound dressing we observed a good evolution of skin surrounding the wound, a reduction of exudate, the removal of necrotic tissue, the reducing the size of the ulcer, an atraumatic treatment and the supply of an adequate humidity to the wound frequently to absorb according to the necessities of the wound simultaneously.  After the application to 15 patients during 10 days, we observed the reorganization of the edges of the wounds skin, exudate control in each patient without macerating the new skin, the reduction of the dressing changes to 2 times per week and the easy procedure in the application by the professional as for the patient at the time of making the cure.  Being an atraumatic treatment to provide the wound with the right humidity frequently. 10
  11. 11. DISCUSSION  Our performances are had to be based on scientific evidence to guarantee a quality attention. ● Reddy M, Gill SS, Wu W, Kalkar SR, Rochon PA. Does this patient have an infection of a chronic wound? JAMA. 2012 Feb 8;307(6):605-11. ● Toy LW, Macera L. Evidence-based review of silver dressing use on chronic wounds. J Am Acad Nurse Pract. 2011 Apr;23(4):183-92 ● SIGN 2012(SCOTHIST INTERCOLLEGIATE GUIDELINES NETWORK)  We support this new technology in dressings, which unites the characteristics of reducing costs, and improving at the same time healing rates and the wound treatment itself. There is no doubt that this new wound dressing, CADEXOMER IODINE®, meets this requirements. 11
  12. 12. CONCLUSIONS  After this first experience with the use of these dressings we saw a reduction of the dressing change, an excellent exudate control with a lower risk of macerations.  The wound dressings were well tolerated and the easy applicability and painless removability are much valued by both treating persons and patients.  Evidence of variation in both healing rates and recurrence rates of venous leg ulcers highlights the need for an updated evidence based guideline to support practice. 12 THANK YOU VERY MUCH
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