Bolton Laura L, Baine William B
Department of Surgery (Bioengineering), Robert Wood Johnson University Medical School and Bolton SCI, LLC, Metuchen, NJ, USA.
Ostomy Wound Manage. 2012 Sep;58(9):16-31.
Wound care professionals can improve clinical, patient-oriented wound outcomes and do so cost-effectively by using scientific evidence to meet patient and wound care goals and needs. A review of the literature was conducted to define evidence-based wound management, describe the potential of science to improve outcomes in wound care, and summarize strategies, tactics, and tools for wound care providers and recipients to utilize science to their mutual benefit. In addition, changes in the availability of randomized and nonrandomized and clinical and preclinical evidence during the past 50 years were examined using MEDLINE database searches of English-language publications, combining the search terms wound, ulcer, or burn limited by the terms randomized or clinical for each decade since 1960. The number of published, nonrandomized wound studies has increased exponentially during the last five decades but, more recently, evidence from randomized controlled trials also has become available. Moreover, while many questions remain unanswered, a substantial number of publications have shown the use of available evidence-based guidelines and wound care strategies improves outcomes of care while saving time and money. The application of science-based wound care in clinical practice is increasing slowly; expensive techniques supported by limited or inconsistent evidence are still in use and add to wound care costs without certainty they improve outcomes. The literature provides compelling evidence that patients with a wide variety of diagnoses benefit when opinion-based care is replaced by clinical wisdom applied on a substrate of best available evidence. Patients with wounds deserve no less.
伤口护理专业人员可以通过运用科学证据来实现患者和伤口护理目标及需求，从而改善以患者为导向的临床伤口治疗效果，并实现成本效益。我们进行了文献综述，以界定循证伤口管理，描述科学在改善伤口护理效果方面的潜力，并总结伤口护理提供者和接受者利用科学实现互利的策略、战术和工具。此外，我们利用MEDLINE数据库对英文出版物进行检索，考察了过去50年中随机和非随机、临床和临床前证据可得性的变化，检索词为伤口、溃疡或烧伤，并自1960年起每十年用随机或临床加以限定。在过去的五十年中，已发表的非随机伤口研究数量呈指数增长，但最近，随机对照试验的证据也已出现。此外，虽然许多问题仍未得到解答，但大量出版物表明，使用现有的循证指南和伤口护理策略可改善护理效果，同时节省时间和金钱。基于科学的伤口护理在临床实践中的应用正在缓慢增加；一些证据有限或不一致却昂贵的技术仍在使用，这增加了伤口护理成本，却无法确定它们是否能改善治疗效果。文献提供了令人信服的证据，表明当基于最佳可得证据的临床智慧取代基于意见的护理时，各种诊断的患者都会从中受益。伤口患者也应得到同样的待遇。
