Use of Honey as Medicine in Wound Healing: Analysis

Use of Honey as Medicine in Wound Healing: Analysis The aim of the assignment is to critique the research article, Standardised antibacterial honey (medihoney) with standard therapy in wound care: randomized clinical trial (2009) by Robson, Dodd Thomas. The tool used for this is Step by Step Guide to Critiquing Research by Ryan, Coughlan; Cronin (2007). Critique is an objective, critical, and balanced appraisal of a research reports various dimensions (Polit and Beck, 2004). The study was on the use of honey as medicine in wound healing. The research was done in the United Kingdom by a group of registered nurses and statistical masters. The study was completed in the year 2007 and was published in the Journal of Advanced Nursing (JAN). The study was based on the use of honey for wound dressing as an antibiotic and wound healing agent. Arguably, the article is well written as it is concise and it does not contain any languages that are characterised to any particular group and are grammatically correct. The layout of the study is good and are given in a good order and kept the academic style of writing. Research reports are like stories, a story should be written in a way which catches the attention of the reader, like as research report should have a readable style. The current researches writing style is good, and is well understandable. No personal views are expressed in the study. The writer had omitted personal pronouns to get an ease in the reading. Credibility variables concentrate on how believable the work appears and focus on the researchers qualification and ability to undertake and accurately present the study (Coughlan et al, 2007). The researchers were well qualified for the current study as their qualifications were stated in the article. Mostly nurses are eligible to do this type of study as they know the effect of dressing a wound. Statisticians also have a role in a research as there are so many calculations which were also included in the study. Methodology of a study is based on the credibility of the qualitative data and its subsequent findings (Polit Hunger, 1999) The title of the article gave an idea of the topic that and what the study is related to. The title is accurate and clear, too long or short titles can make the reader confusing (Coughlan et al, 2007). Too long or short titles can be confusing and misleading to the readers (Coughlan et al, 2007). In the study title is concise and is readable and has its reliability, the title is short too. The title is not more than 10- 15 words. Abstract is a brief description or an outline of the entire article. The abstract should give a clear idea about the research and should include information regarding the purpose of the study, method, sample size and selection which is given clearly in the current article(Coughlan et al, 2007), And from the abstract the reader should able to find out the overall idea about the study. They have also pointed out for further research on this topic with some recommendations. The present study has an agreeable abstract which conveys idea about the study which is simple, clear and interesting for the readers. The abstract is not too long and also explains about the method, sample size and the selection method. The abstract gave an over view of the topic. The abstract also opens an end to further researches. The introduction of the study will always be based on the research problem. Research problem is an enquiry which can be done through a disciplinary way (Polit and Beck, 2004). The purpose of a research highlights the overall sketch of main arguments and theory of the relevant research (Polit Hungler, 1999). In the current research the purpose of the study is stated clearly and an overall idea of the study is been included in the introduction of the research. The research problem is identified and clearly stated in the study. The research was carried out in a step by step process. The article has a flow and a have an ease in reading and all the links are clear. Critical summary of a topic which puts the topic or the research problem into a context is called as the literature review (Polit Beck, 2004). Literature review always points out to the previous studies of the current topic. The review should be logical and its critical analysis should be balanced (Cougllan et al, 2007). In the present study the literature review is clearly illustrated and it is logically presented. The literature review offers a critical analysis. The reviews are mostly facts which were proved by proceeds. A good literature review will always have a good introduction (Cougllan et al, 2007), which is followed in this by the writer. Frame work refers to the overall structure of a report which is based on a theory which was previously proved (Polit Hungler, 1999). Hypotheses are from a primary source and of an empirical nature. Theoretical frame work is what which is found confusing by a researcher. A theoretical frame work is been identified in ethics. The theoretical frame work has been clearly stated step by step clearly. A sound theoretical frame work also identifies the various concepts being studied and relationship between those concepts. The theory is true and the hypothesis is relevant for the study. Theoretical frame work tends to be better developing in experimental and quasi-experimental studies and often poorly developed or nonexistent in descriptive studies (Burns Grove, 1999). The purpose of the aims and objectives is to create a link between the initially stated purposes of the study or research problem (Coughlan et al, 2007). Aims and objectives are the observations or measurement that reflects on the physical reality which is interpreted by the individuals, and can be argued that even such observations may be open to subjectivity (Gerrish Lacey 2006). There is an aim for the study which is clearly stated in the abstract, introduction and also in the study. The hypothesis which is a statement or fact which can be tested or verified (Holloway Wheeler, 2002). The research questions and the hypothesis is clearly identified and stated in the study. The hypothesis and the research questions reflect on the literature review. The samples were chose with a great caution so as to minimise the errors. Samples are the selected units from a population, and sampling is the process of selecting appropriate people from a population for the research (Wood Haber, 1994). The samples were chosen randomly from a group and were informed about the research and the procedures and the effect of the current procedure. The sample which was chose for the study was appropriate as they were patients who were having wounds. The size of the sample was also adequate as a small sample will not help in an appropriate conclusion. The size of the sample is also important in quantitative research as small samples are at risk of being overly representative of small groups within the target population. There was no inclusion or exclusion for the study as they chose an appropriate sample with ethical consideration. The risk of sampling errors decrease as larger sample used (Coughlan et al, 2007). Autonomy infers that an individual has the right to freely decide to participate in a research study without fear of coercion and with the full knowledge of what is being investigated. Ethical committee or institutional review boards have to give approval before the research can be undertaken. There role is to determine the principles and to evaluate the validity of the research (Coughlan et al, 2007). There was ethical consideration for the data collection. All the participants of the study were fully informed about the research. All the participants were protected from all type of in case after effect, and were autonomous. Confidentiality of the subjects was censured by the researcher, and ensured the permission from an ethical committee. In a research study the researcher should ensure that the reader should understand what is meant by the terms and concepts which are used in the research. All the operational terms, theories and concepts in the current study has been clearly identified explained and illustrated in the study, and have given proper reference and citations for the rational and the explanations. The organisation, reduction and transformation of the data of a study in order for a review are called as data analysis (Holloway Wheeler, 2002). The methodology or the research design was clearly given to review the study. One of the main instruments in a study is methodology. The data gathering instruments of the methodology is cited in the study. The instrument used is appropriate as they could clearly get many results out of it. In the study 109 subjects participated in the research. The system of analysing the facts with the collected data from the research is called as data analysis (Polit Beck, 2004). Data analysis in quantitative research studies is often seen as a process which loses courage (Coughlan et al, 2007). Most of the data analysis is associated with complex language and statistical notations. The researcher should clearly identify what statistical tests were undertaken why these test was used and what were the results, which have been stated in the current article. In the current study analyse of the data is done in a better way. The strength and limitations of the study is also included in the study to revel the validity and reliability of the study. The discussion of a study should flow logically from the data and should be related to the literature review thus placing the study in context (Russell, 2002). In the discussion part of the research is linked back to the literature review. The discussion part contains the strength and limitations of the study which is referred to the previous study that are made on the same subjects. All the limitations are also generalizability discussed. The research also extends an open end for further research on different aspects of his study; other recommendations are also given to the current study. When doing a research or a research critique it is essential to quote the source of the information obtained, that should be included as in text or end text reference. In a research study the significance of the findings should be stated but these should be conceder within the overall strengths and limitations of the study (Polit Beck, 2006). The reference should help the writer to find the source as quickly as possible (Pears Shields). The copy of others idea is conceder as plagiarism which is serious offence. For the current study the researcher has used the Harvard referring system. The researcher has referred many books and research articles for his study and all the references have been quoted as in text and end text references. All the books referred for the study are appropriate as they are related to the subject or to the research vocabularies. The researcher was very much cautious about the plagiarism. Evaluating the research article with the critiquing tool by Michael Coughlan and team members it was found that the study is arguable with credibility and reliability. The writers have carefully used the strategies in doing a research. The research is readable and understanding by lay men. Holistic Nurse Prescribing: A Case Study Holistic Nurse Prescribing: A Case Study Introduction 1 the patient and their presenting symptoms. Mr Pickles presents an interesting, complex and therapeutically challenging problem. In essence he is a gentleman with multisystem pathology who presents with an almost incidental finding which he was clearly reluctant to discuss. It is a common finding amongst experienced healthcare professionals that in any consultation it is the last 30 seconds which is the most important. As the patient stands up to go, there is the just while Im here moment when they can bring up an issue that really troubles them and may not be the real presented reason for the consultation. In this essay we shall discuss the various aspects of this situation and the measures we can take to try to help him. (Parker and Lawton 2003) 2.a holistic assessment of the pt, including any relevant medical social and psychological issues. If we start with the initial presenting symptom under discussion the impotence it is easier to work backwards from that to discuss the possible pathophysiology that can be relevant. Impotence is said to occur whenever the male fails to get an erection when it is required. This, in itself is neither unusual nor necessarily pathological. It becomes a significant symptom when the male repeatedly fails to get an erection that is sufficient for intercourse. It is quite possible to get full spontaneous erections and yet still be impotent. This is one of the major diagnostic features that distinguishes the psychogenic impotence from the purely physical. (Ackerman MD, Carey MP. 1995) There are a number of obvious physical causes of erectile dysfunction that are relevant to Mr Pickles (see on), but equally there are a number of possible psychogenic causes that may be either primary factors or possibly secondary contributory factors in the aetiology of his problems. The fact that he has recently undergone major cardiac surgery is a very relevant factor. Patients will frequently suffer from a major change in body perception when they have come to a close realisation of their own mortality. If we add to this the fact that, as the major breadwinner in the family, it is likely that Mr Pickles would have felt a major blow to his self-esteem when he was made redundant from a responsible high esteem job and forced to become a taxi driver with long working hours. This is quite apart from the anxiety and fatigue that such a job would engender.(Beck J. 1995) It is possible that the medication that Mr Pickles is taking may have a bearing on his erectile dysfunction as the male erection is dependent on the hydrostatic pressure of the blood for its maintenance. Any medication that reduces the average blood pressure, will effectively reduce the capacity to acquire and maintain an erection. In addition to this the adrenergic beta-blocker group will also selectively block the sympathetic pathways that are vital to the neurovascular control of the mechanisms of erection. Pathophysiology of diabetes and impotence Both of these topics are huge subjects, so in this essay we will restrict out considerations to those aspects which are relevant to Mr Pickles and his problems. We know that Diabetes Mellitus affects about 2% of the UK population with a specifically higher incidence in both the Asian and Afro-Caribbean communities(Nathan 1998). There is also a marked genetic component in the development of Diabetes Mellitus. Mr Pickles has Type II diabetes mellitus which is associated with a number of factors including a high BMI and increasing age. At 56 yrs. old he is currently at the peak incidence age for Type II diabetes mellitus (Gregg et al. 2003). Diabetes Mellitus is known to be associated with a number of complications. The prevalence and incidence of the complications, in general, tends to increase with the length of time that the patient has been diabetic. There is also an independent variable for complications that is directly proportional to the degree of control (as measured by the HbA1 levels). In general terms, the better the control the lower the incidence of complications (Kissebah et al. 1999) As far as Mr Pickles is concerned, there are two major complications of Type II diabetes mellitus that are directly linked with impotence and they are cardio-(macro)vascular disease and neuropathy. (Wagner et al. 1998) We can deduce that Mr Pickles has macrovascular disease by virtue of the fact that he his recovering from a CABG. And this may well be a very relevant factor in his erectile dysfunction but also there is the question of neuropathy which typically occurs in about 2.4% of the general population, but this figure rises to above 8% in the diabetic patient over the age of 60 yrs. ( Hughes 2002) Impotence tends to occur, in varying degrees, in about 10-15% of men under 40 yrs. Its incidence increases with age to the extent that 40% of men at the age of 40 yrs report a degree of impotence and this prevalence rises to 70% at the age of 70 yrs. (Gregoire 1999). If we add to this basic clinical picture the fact that there are other factors such as hypertension, smoking, cardiac neurosis, loss of self-confidence, depression and iatrogenic causes (medication etc.) all of which may well be relevant to Mr Pickles, then it can be seen that there are a plethora of potential causes of his erectile dysfunction. (Barnes, DE. 2004) Both of the first two causes (hypertension and smoking) are independent risk factors for impotence, quite apart for the fact that they are also risk factors for the development of the macrovascular complications of Diabetes Mellitus (Bowering 2001) Mr Pickles diabetic state has been recently well controlled (HbA1 of 6.5%). This is important as the incidence of development of diabetic complications is reduced by between 34-76% (depending on the particular study) for every 10% reduction in the average HbA1 reading. (Bowering 2001). In addition to all of these considerations, atherosclerosis is also a major complication of Type II diabetes mellitus, which, presumably is relevant to Mr Pickles because of his CABG, and this may be a major factor in the development of his erectile dysfunction. Management plan 3.a plan/strategy based on critical understanding of physiological and pharmaceutical issues. Any management plan must firstly be based on an accurate diagnosis. At this point in time we do not have this luxury. As we have discussed, there are anyone of a huge number of possibilities in the aetiology of Mr Pickles erectile dysfunction problem. When confronted with a problem such as this, any experienced healthcare professional may reasonably chose to manage the problem by making a rational judgement of the probabilities of any one particular cause being relevant. Implicit in such a management strategy is the fact that there are some causes that my be correctable (iatrogenic, psychological, and life style related) and there are some that may not (macrovascular damage, neuropathy and atherosclerosis). It is reasonable, in such circumstances, to discuss the situation openly with Mr Pickles and discuss with him the various treatment options. Patient empowerment and education is a vital strategy to adopt in circumstances such as this as Mr Pickles is far more likely to comply and respond if he understands the rationale behind the treatment plan.(Howe and Anderson 2003) We would suggest that an appropriate strategy would be to initially tackle the situation on two fronts. The psychological aspects of the erectile dysfunction are probably best discussed with an experienced psychologist or councillor who has expertise in this particular area. This is important because there is a considerable skill in eliciting the relevant factors from the patient. Many patients are reticent about talking openly about their imitate sexual details and there has to be a careful build up of trust and empathy on both sides. Factors such as good eye contact and a non-judgemental body stance are essential on the part of the healthcare professional if the optimal result is to be obtained Not only can the issues that are relevant be explored, but also any one of a number of psychological treatment techniques can be employed. This is a matter of considerable clinical judgement and skill and therefore probably best done by an experienced healthcare professional in that area. The pharmaceutical area can also be addressed as Atenolol is clearly not the best anti hypertensive to use as, not only will it reduce the blood pressure (which it clearly is important to do) but it also produces a counter productive beta-blockade which will not help the erectile dysfunction problem. The difficulty is that, after the CABG, Atenolol does have a degree of action on the suppression of ectopic electrophysiological foci in the myocardium which is a recognised complication of the procedure. It also is thought to have a cardioprotective effect post-myocardial infarction. It is probably a good idea to change his anti-hypertensive medication, but in the circumstances, it is probably better to seek the advice of the surgical team who performed the CABG. before making the transition. The question of Viagra has been raised by Mr Pickles. This is not as straight forward as it might initially appear. Viagra has been shown to work well in these circumstances. It has the downside that it allows sexual intercourse which is associated with increased peaks of blood pressure. As Mr Pickles is still in the postoperative recovery phase (16 weeks) it would again be sensible to consult with the surgical team as to their advice on the issue. The other problem with Viagra is that if it transpires that the long term aetiology is actually psychological rather than purely physical, then the prescription of Viagra will often breed a feeling of psychological dependence which may firstly be both inappropriate and unnecessary and secondly, very hard to break. It is probably therefore inappropriate to consider such options at this stage in the management. 4.legal and professional accountability should be discussed. The legal and professional issues are largely covered in the making of a management plan. In any area of professional competence, the best defence against criticism or censure, is the fact that a healthcare professional works from a rational evidence-based plan. It is for this reason that we have set out the rational and reasoning for the plan that we have chosen to adopt. It is actually quite permissible (legally) for a healthcare professional to be wrong on any given issue, as long as they have come to a reasoned and rational decision based on the facts that were placed before them. And behaved in a way that the majority of their professional colleagues believe is reasonable in the circumstances. It is, of course, central to these considerations, that all actions are carefully and fully recorded in the patients notes Prescribing decisions 5.a critical discussion of influences on prescribing decisions. The area of prescribing for Mr Pickles is clearly important. To some extent, we have covered the reasoning behind the change of prescription earlier in this essay. There is a common misconception amongst many members of the public (and indeed many of the less experienced healthcare professionals) that the solution to every problem comes in the form of tablets on a prescription. The whole area of patient empowerment and education is often filled with issues of lifestyle change, healthy living, self care and positive thinking which can frequently be more effective that simply giving the patient a prescription. (Boule NG et al. 2001) In the context of the NHS, it is a common observation that sometimes a prescription is given because it is the most expedient short-term measure in a given situation, (Dawes RM et al. 1974), however, time invested in an explanation to a patient as to why other measures might be equally as important is rarely time wasted., (Corrigan B. 1974) Future management 6.consider your future prescribing activity based on experience gained from this case study. In any professional area of activity, the author likes to use the mechanism of reflective practice to allow a critical assessment of a past course of action to modify future actions when faced with a similar situation. (Gibbs, G 1988) On careful reflection of this case, I believe that I may have acted rather rashly in stopping the Atenolol as a first choice. On reflection, I believe that the Atenolol did need to be changed for any one of a number of other anti-hypertensive agents but I feel that, in retrospect, I would have been wiser to take advice from the surgical team before I made that decision. Further reflection and discussion with other healthcare professionals (Marks-Moran Rose 1996), suggested that another appropriate course of action would have been to stop the antihypertensive medication altogether for a short period. This is on the grounds that his hypertension was not severe and was hitherto well controlled. If the erectile dysfunction was simply a reflection of the fact that the medication was holding his blood pressure down to a level where erection could not easily occur, a few days off the medication may allow a transient increase in his blood pressure to the point that erection could occur. As long as one was careful to monitor his blood pressure to ensure that it did not rise too far, I have been advised that this would represent a reasonable therapeutic trial to establish whether the underlying causes were mainly physical or physiological.(Wagner G et al 1998). On the face of it, this does seem reasonable but I believe that I would have to take further advice before I was fully comfortable with that decision. It follows from what has already been discussed, that I also feel that I may have been too quick to consider the pharmacological interventions before making a complete holistic assessment of the patient. There are clearly a number of lifestyle adjustments that may be relevant here such as weight loss and increasing exercise and looking for a new focus in life (to minimise any element of depression) which would be comparatively easy to achieve with appropriate empowerment and education of the patient. (Funnell R et al 2004) All in all, this is not a straight forward case. There are many elements which require careful and considered assessment. I believe that it is one of those cases that helps to point out that although there is a huge emphasis to be placed on modern scientific understanding and application of medical principles, there is also a very large element of human understanding and caring that is so very important to the successful management of patients such as Mr Pickles (Waterlow J. 1998) References Ackerman MD, Carey MP. 1995 Psychologys role in the assessment of erectile dysfunction: historical precedents, current knowledge and methods. 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BMJ 1998; 316: 678-682 Waterlow J. (1998) Prevention is better than cure. Nurs Times 1988; 84: 69-70 Appendix