Editor`s Opinion: Building the Evidence, Block by Block

Evidence-based guidelines, a relatively new concept in the field of healthcare, continue to reshape the practice landscape, even as evidence-based care has become an area of study in and of itself. While processes and procedures for the development¹ and implementation of guidelines evolve, researchers continue to build the foundation for provision of care, one small building block at a time.   In this issue of Ostomy Wound Management, Iizaka et al² describe the application of research that led from the development of the Ostomy Skin Tool to a digital image analysis technique for peristomal skin color assessment in the clinical setting. Considering the importance of early detection and prompt treatment of peristomal skin changes, their study to evaluate the reliability and validity of this technique provides a solid foundation for research in other populations. It may be necessary to conduct many more studies to determine if this new technique is effective and can and should be widely used; this is the only way to establish what is (or is not) evidence-based practice.

Tuncel et al’s³ study in this issue OWM considers the cost (and effectiveness) of interface dressings commonly used for negative pressure wound therapy (NPWT). Using an in vivo wound model, the authors compared standard gauze and foam dressings to the use of widely available loofah sponges. Although the sponges required preparation before they could be applied to wounds, no differences in healing outcomes were observed between the three interface materials compared in this model. This finding led the researchers to conclude loofah sponge may provide an accessible, less expensive alternative as an NPWT interface dressing, providing similar results are obtained when additional preclinical and clinical studies are conducted.

Hurd et al⁴ reviewed the outcomes of patients who used a disposable, portable NPWT device in the community. Wound outcomes were good, and patients reported satisfaction with the treatment. This research provides another small block to help us build an evidence base that should include knowledge about the efficacy, effectiveness, and cost-effectiveness of this treatment modality compared to standard care (moisture-retentive dressings) and to other advanced treatment modalities.

Virtually every study concludes with the observation more research is needed. For every question answered, several new ones will emerge. But, in the area of wound, skin, and ostomy care in particular, replication studies are needed to confirm (or refute) what was reported and to sustain or question the strength of their findings. Even the most rigorously conducted study cannot carry the day when we consider what should and should not be implemented in clinical practice. Even the most solid building blocks cannot continue to provide support without regular attention to their structural integrity. The number of interventions and procedures we use every day that are based on nothing more than tradition or experience remains staggering. The more we discover and innovate and implement, the more we need to justify our actions and reinforce our convictions. To all of you who build the evidence blocks we need (and share your designs, methods, and outcomes), we, and our patient beneficiaries, thank you.

This article was not subject to the Ostomy Wound Management peer-review process.