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Have you had your daily feeding of evidence today?

Years ago, to get the latest findings in your field, you needed to travel to your hospital or college library, go to the “red books,” write down the latest indexed articles, go to the “stacks” and pull the journals, and photocopy them or read them on the spot.  It was hard getting fed! 

Today, with internet access we have a global potpourri of databases and journals to access.  We can enjoy surfing through the references in our pajamas and electronically access and store our finds.  But the feeding does not end there.  By using auto-feeds, electronic table of content messages, and e-news from a variety of sources, we can get the very latest update on the topics of our choice.  We really can have daily feedings! 

Ok, admittedly not everyone is as intensely nerd-like as me to enjoy multiple feedings per day, but if you have a passion for a clinical topic, why not feed yourself regularly?  A favorite topic of mine is pressure ulcer prevention.  Each week, I set myself up for a regularly feeding on the topic, based upon an initial search that I did in OVID.  Recently, we have been very concerned about heel ulcers.  Today, I got an article citation (seen below) that I might not have found as quickly sent to me through the auto-alert.   I GOT FED! Hope you do too.  Evidence can be quite fulfilling.

Unique Identifier: 21841719
Authors: Donnelly J.  Winder J.  Kernohan WG.  Stevenson M.
Authors Full Name: Donnelly, J.  Winder, J.  Kernohan, W G.  Stevenson, M.
Institution: Belfast Health & Social Care Trust - Royal Hospitals, Belfast, UK.   jeannie.donnelly@belfasttrust.hscni.net
Title: An RCT to determine the effect of a heel elevation device in pressure ulcer prevention post-hip fracture.
Source: Journal of Wound Care.  20(7):309-12, 314-8, 2011 Jul.


OBJECTIVE: A randomised controlled trial set out to determine whether there are differences between complete offloading and standard care in terms of the number of new pressure ulcers (PUs) developing on the heels of older patients with fractured hips and the number or severity of new PUs on other areas of their bodies.

METHOD: Patients aged over 65 years in a fracture trauma unit with fractured hips were randomly allocated to receive heel elevation (DM Systems, Evanston, Illinois) plus pressure-redistributing support surface or standard care (pressure-redistributing support surface alone). Exclusion criteria included existing heel damage. Patients were assessed on pre- and postoperative days for the occurrence of new pressure damage. Patients completed a satisfaction questionnaire at discharge.

RESULTS: 119 patients were recruited into the control group and 120 into the intervention group. Independent t-tests and chi-squared analysis showed both groups were comparable at baseline. Thirty-one subjects (26%) in the control group developed PUs compared with eight in the intervention group (7%, p<0.001). No subjects in the intervention group developed a PU on their ankles, feet or heels, whereas 29 subjects in the control group did (p<0.001). Kaplan-Meier survival curves indicated that subjects in the control group were more likely than those in the intervention group to suffer pressure damage at all time points (p=0.001). A sensitivity analysis showed that when subjects lost to follow-up were assigned the worse outcome (PU positive) those in the intervention group were still less likely to develop PUs than the control group (p=0.001). The offloading device was rated as comfortable overall by 59% of subjects.

CONCLUSION: The findings suggest that offloading reduces the incidence of heel ulcers.
Publication Type: Journal Article.  Randomized Controlled Trial.  Research Support, Non-U.S. Gov't.
Date Created: 20110815