Evidence Based Practice Essay

The chase ssion of this assignment attempts to critically appraise the venUS III randomized defend trial (RTC) published in the British Medical Journal. As a student/health divvy up worker who is new to critical appraisal I am aw atomic number 18 that I do non fully register close to of the calculations involved in reporting of findings, however Greenhalgh (2006) argued, all you truly need to know is what the best test is to apply in inclined circumstances, what it does and what might affect its validity/appropriateness.When caring for longanimouss it is essential that health share Professionals are using current best dress. To determine what this is they must be able to read explore, as non all research is of the alike(p) character or cadence therefore Health lot Professionals should not al single take research at face value simply beca recitation it has been published (Cullum and Droogan, 1999 Rolit and Beck, 2006). I am completing this assignment to cultivate the skills at alter me to effectively assess the validity of research that may shape my fare. in that location are numerous tools available to help reviewers to critique research studies (Tanner 2003). I behave elected to use the Critical Appraisal Skills Programme (CASP) tool. I chose CASP as it is simple, directive and appropriate to quantitative research. The research article had a clear concise and easily understandable title and abstract. Titles should be 10/15 words long and should clearly identify for the lector the target of the guide (Connell Meehan, 1999). Titles that are too long or too in brief can be confusing or misleading (Parahoo, 2006).From the abstract the reader should be able to determine if the look at is of interest and whether or not to continue reading (Parahoo, 2006). The author(s) qualifications and job can be a effective indicator into the researcher(s) know leadge of the area under investigation and ability to direct the appropriate questions (Co nkin Dale, 2005). The authors of the venUS III trial were from a range of schoolman and clinical backgrounds and are considered experts in their fields.The VenUSIII RTC clearly toughened out its objective to consider the clinical effectiveness of weekly lofty frequency ultrasonography on hard to heal venous offshoot ulcers, (hard to heal was defined). In cases where participants had more than one venous fork ulcer the largest ulcer would be tracked if sonography give-and-take was allocated this site genuine the manipulation. Outcomes to be considered where clearly outlined and method of measurement/collection defined. The sketch screened 1488 batch with subdivision ulcers and 337 people became participants (22. %) Participants were randomised and evenly distri saveed, 168 to ultrasound therapy (dependant variable) addition standard guard (experimental group) and 169 to standard wish only (control group) This is reported as macrocosm the largest trial undertaken on th e subject of therapeutic ultrasound for pain healing and earlier studies are referenced in support this statement. The study was cross- fractional, its population was taken from two community and district cling to led services as well as hospital outpatient clinics.The 12 care settings used where taken from both rural and urban settings. A inviolable stress is one that is representative of the population from which it was selected (Gay 1996) Venous leg ulcers range rise sharply with maturate with an estimated 1 in 50 people over the era of 80 developing venous leg ulcers (NHS choices 2012). The age of the participants in the study ranged from 20-98 years old, however the median age general was 71. 85 and the mean age was 69. 44 years old crossways the study, well below the age range where venous leg ulcers are almost seen.The assignment of participants treatment was adequately randomised treatment was dodgely allocated 168 to ultrasound therapy plus standard care and 16 9 to standard care only. Randomisation was conducted by an independent agency (York trials Unit) The lack of abrasion bias was a strong positive for the venUS III trial, it had a low loss to follow up rate. The nurses providing treatment where not projection screen to which treatment had been allocated, this may impact on construct validity as in round cases it is suggested that control subjects are compensated in some way by healthcare staff or family for not receiving research intervention (Barker 2010).Nurses who were blind were employed to trace the ulcers. Participating patients were not blind to the treatment/s. As one of the calculated outcomes was patients perceptions of health, assessed by a questionnaire (SF-12) it is conceivable to conceive that this judging may have been influenced by the patients awareness of the treatment type they were receiving thus creating the possibility for assessment bias. Construct validity may alike be impacted on peoples behaviours as a receipt to being observed or to the treatment because they believe it will have a positive effect. Barker 2010) Healing date was assessed remotely by independent assessors who where blind to the treatment allocation this guards against assessment bias. Overall both treatment groups were equal in size. Both treatment groups had an almost equal average age of study participants, this is important because inequality in age between the groups would represent a heterogeneous population (Barker 2010). Venous leg ulceration is more common in woman than men in those below 85 year of age (Moffat 2004) the trial participants had a female majority.Probably the weakest element of the study was the probability of performance bias. Standard care comprised of low adherent dressings and quaternion-layer bandaging that was lofty compression, reduced compression or no compression depending upon the participants tolerance. Any sorts to the regime where put down and where made at the discretion of the treating clinician. Standard care was practiced in accordance with local protocol and could have varied between locations the quality of standard care given may be considered to be a confounding variable.Surveys of reported practice of leg ulcer care by nurses have demonstrated that knowledge often falls far short of that which is ideal (Bell 1994, Moffat 2004, Roe 1994) and that there is a wide variation in the nursing management of people with leg ulcers in the United body politic (UK) (Elliot 1996, Moffat 2004, Roe 1994). Large variation in healing rates gibe to trial centre is a further indicator that standard care is so variable that it potentially affects the reliability of results.No treatment faithfulness checks were undertaken and no observation regime beyond usual practice of the treating nurses practice was implemented despite nurses being new to ultrasound application. Nurses were deemed qualified after one day of training, these nurses where then besides con sidered competent to train other local nurses who would be providing treatment. The ultrasound treatment given during the venous III trial did not give any surplus effect on ulcer healing or reoccurrence rate and it did not affect quality of life.As the study only looked at one ultra sound regime extrapolation of the results was not possible, a between-subjects designed study may have provided data that was of further function. Treatment effect was mensurable precisely the primary outcome measured was the time that the venous leg ulcer took to heal, this was measured in days and adjustments were made in browse to account for baseline ulcer area (larger ulcer would be pass judgment to take longer to heal than smaller ulcers).A fully recovered(p) ulcer was clearly defined and the ulcers were photographed every four weeks, at the accuse of healing and seven days after full healing has occurred, assessment of the ulcer was completed by two blind independent assessors and where mand atory a third assessor was used if outcome was inconclusive. In some cases no photographs were available for patients in this case the treating nurse assessed healing date, no explanation why photographs would not be available is given. 7. 8% of the sample were assessed by an unblinded nurse this presented some risk of assessment bias.The trial also considered how many patients had fully healed ulcers within 12 months. Reduction in ulcer size was measured by area, by a blinded nurse who took acetate traces of the ulcers every four weeks the method of which was considered to be faithful and reliable and its provenance clearly referenced. Quality of life was also measured with a standardised questionnaire (SF-12) which looked at both physical and mental elements. As there is no induction to support the use of ultrasound therapy in addition to standard treatment therefore no current change in practice is indicated and standard practice should continue.The study reported epochal hete rogeneity in healing rates among the treatment centres. sum totals that treated the most patients produced better healing overall, if there is a correlation between hatful of patients treated and positive outcomes this hypothesis has the potential to impact upon the way care is delivered in the future. The trial considered not only medical outcomes but also considered changes in patient quality of life (both physical and mental). Beauchamp and Childress (2001) identify four fundamental moral principles autonomy, non-maleficence, beneficence and justice.Autonomy infers that an individual has the right to freely decide to participate in a research study without precaution of coercion and with a full knowledge of what is being investigated. Participants gave written, informed bear and recruiting nurses were trained in consent procedures. Non- maleficence implies an intention of not vilifying and preventing harm occurring to participants both of a physical and psychological nature (Parahoo 2006). Patients who had a high probability of being harmed if they received the ultrasound where excluded from the trial, the exclusion criteria took into account contraindications. ab initio it was planned to exclude those unable to tolerate compression bandaging but after ethical consideration this was removed as these patients were identified as being particularly in need of the chance to benefit from ultrasound therapy. Beneficence is interpreted as the research benefiting the participant and society as a whole (Beauchamp and Childress, 2001). The annual cost to the NHS is estimated at ? 230-400 million (NHS Centre for Reviews and Dissemination, 1997 Bosanquet, 1992 Baker et al. 991) some individual health authorities are spend ? 0. 9m to ? 2. 1 million (Carr et al 1999). There are psychological implications to the patient in that the ulcer increases social isolation through limited mobility, lordless exudate and odour, together with pain (Lindholm et al. 1993 Charles 1995). Justice is concerned with all participants being treated as equals and no one group of individuals receiving preferential treatment (Parahoo, 2006). There is no evidence to suggest that any of the participants were discriminated against.The following section attempts to discuss how evidence based health care enhances health care- tone at the evidence base within health care Evidence-based practice (EBP) is one of the most important developments in decades for the helping professionsincluding medicine, nursing, social work, psychology, humanity health, counselling, and all the other health and human service professions (Briggs & Rzepnicki, 2004 Brownson et al. , 2002 Dawes et al. , 1999 Dobson & Craig, 1998a, 1998b Gilgun, 2005 Roberts & Yeager, 2004 Sackett et al. ,2000).That is because evidence-based practice holds out the hope for practitioners that we can be at least as successful in helping our clients as the current available info on helping allows us to be. Evidence- based health care is the conscientious use of current best evidence in making decisions about the care of individual patients or the delivery of health services. Current best evidence is up-to-date information from relevant, valid research about the effects of disparate forms of health care, the potential for harm from exposure to particular agents, the accuracy of symptomatic tests, and the predictive power of prognostic factors