KEYNOTE
PRESENTATION RECIPIENT OF EPUAP AWARD
Nicky Cullum, UK
Keynote speaker
Nicky Cullum
THE
term ‘evidence-based medicine’ (EBM) was first coined
in 1992 by a Canadian epidemiologist to describe a philosophy
of medical practice based on a knowledge and understanding of
the medical literature supporting each clinical decision. At that
time EBM was seen by many as a fundamentally different style of
medical practice and promoted the use of epidemiological principles
to ensure that research evidence was given appropriate weight
in clinical decision making; the weight being proportional to
the amount and validity of the research.1
Since the early 1990s there has been a policy imperative to embrace
the tenets of EBM across health care as these principles apply
irrespective of specialty, discipline or profession. Nowhere is
an evidence-based approach needed more
than in wound management. In the UK, analysis of prescribing data
has put the spend on wound management products in the top twenty
when spending is analysed by sections of the British National
Formulary; the spend on wound dressings during the financial year
2005–2006 was £107 Million. However, this huge area
of resource use, which itself represents a burden of disease and
a need for good wound care, is not matched by the availability
of high quality research evidence. In 1998, the Royal College
of Nursing published early clinical practice guidelines on the
management of leg ulcers; these guidelines contained twentyeight
guideline statements, only four of which were supported by Grade
I evidence (that is based on evidence from several studies of
acceptable quality), and eighteen recommendations were based on
expert opinion.2 Similarly the first systematic review of pressure-relieving
interventions published in 1995 contained only thirty randomised
trials which were deemed to be ‘generally of poor quality’.3
But there is now real evidence that things are changing for the
better! Positive signs include the rapid increase in the number
of systematic reviews in wound care (the Cochrane Wounds Group
has published forty-two systematic reviews since it began in 1995),4
an increase in the numbers of high quality randomised trials in
wound care, and publication in the BMJ of several large wound
care studies in recent years.5,6 In her presentation, Nicky will
discuss her involvement in some of these developments and her
impression of the future challenges in developing high quality
research evidence in pressure ulcer care.
References
-
Evidence-Based
Medicine Working Group. Evidencebased medicine. A new approach
to teaching the practice of medicine. JAMA 1992;268(17):2420-5.
-
RCN, Centre for Evidence Based Nursing, University of York,
Department of Nursing Midwifery and Health Visiting, University
of Manchester, Clinical practice guidelines: the management
of patients with venous leg ulcers. Recommendations for assessment,
compression therapy, cleansing, debridement, dressing, contact
sensitivity, training/education and quality assurance.
1998.
-
Effective Health Care. The prevention and treatment of pressure
sores, Effective Health Care, 2 (1), 1995, 1–
16.
-
-
Nixon J, Cranny G, Iglesias CP, Nelson EA, Hawkins K, Phillips
A, Torgerson DJ, Mason S, Cullum N, and on behalf of the Pressure
Trial Group. The PRESSURE Trial: A randomised, controlled trial
comparing alternating mattresses and alternating pressure overlays
for the prevention of pressure ulcers. BMJ 2006; 332(7555):
1413.
-
Schoonhoven L, Haalboom JR, Bousema MT, Algra A, Grobbee DE,
Grypdonck MH, Buskens E; prePURSE study group. The prevention
and pressure ulcer risk score evaluation study. Prospective
cohort study of routine use of risk assessment scales for prediction
of pressure ulcers. BMJ 2002 Oct 12; 325(7368): 797.
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