By Shannon Solley, Associate Editor

Introduction

Within the past 30 years, the output of medical research has increased. A 2022 review of PubMed's database found cohort studies alone have risen from just under 10,000 in 2010 to nearly 35,000 in 2020.¹ In wound care, experts know that staying up to date on evidence-based practices can ensure best outcomes for patients. However, many wound care professionals may find it cumbersome to review complex studies. “We’re all really busy,” said Denise Nemeth, MPAS, PA-C, CWS. “How are we supposed to [accomplish all our responsibilities to ourselves and our patients] and, on top of that, stay on top of research, are you kidding me?"

Strategies for Developing Evidence-based Practices

Despite obstacles, the panel of speakers for How to Keep Up to Date with Literature: An Interdisciplinary Panel at SAWC Spring 2023 emphasized that research literacy is more important than ever. "We sort of got taught about it in school," continued Nemeth, “[But] I don’t want you as the audience to get discouraged.” The session featured 4 leaders that represented crucial members of a multidisciplinary team. Each presented research within their field and pointed out not only how it has added to their practice, but also addressed any misconceptions or flaws that may present on the surface. Amanda Killeen, DPM, FACPM, FASPS, CWSP offered several pearls for identifying flaws in literature, such as reading the results to see if the findings significantly differ from the control. Nemeth concurred later in her portion of the presentation:

"We are not statisticians …but we do need to know what is and is not significant."

In addition, each speaker provided the audience with resources for finding high-quality research. Some of the resources are free to access, with presenters noting that most wound care professionals usually don’t work within a university setting, which often provides easy access to new evidence. Some of these resources included the following:

• DOAJ: open-access journals
• R Discovery – (subscription)
• The New England Journal of Medicine
• JAMA Network
• ResearchGate

Discussions from SAWC

During the Q&A, the panel welcomed discussion from an audience with additional wound care leaders. “It’s easy to find an article to justify our feelings,” commented Monique Abner, MD, an orthopedic and plastic surgeon in wound care. She prompted the panel to discuss the value of evaluating if literature is proven and implementable. Dr. Killeen recommended going to the paper's methods section rather than reading the abstract. "How did they set these up? What else is out there?" She emphasized putting the study in context with others like it. "I didn't learn to read [research] efficiently until fellowship," she added. Dr. Killeen discussed how, before fellowship, she would typically read the abstract or even try to identify the "take home point, the marketing message" but found that evaluating the study's outcomes ensured its validity. “If questions are not being answered by results, I don’t want to put it in my practice,” said Nemeth, echoing Dr. Killeen’s overall message.

Maria Goddard, MD, CWS, FAPWCA, asked about the best way to discuss research articles with patients. “[At times], you’re in a test you don’t realize you’re taking,” Dr. Goddard continued, emphasizing how within the past 3 years, it seems patients will take to the internet when conceptualizing their respective conditions. Dr. Killeen described her process of explaining care to patients. If available, she shows patients a visual of their condition, explains the implications, and the next steps of care. The panel commented on the difficulty of communicating aspects of literature to patients. “Has anyone had success rattling off percentages to patients? I have not,” said Dr. Killeen. Alton Johnson, DPM, FACPM, DABPM, CWSP emphasized the importance of implementing evidence-based care into practice. "For reference, I read about 100 articles a week. You have to know the power of the study.” He pointed to the AMA user guide for information on how to explain studies to patients.

Conclusion

Multiple pathways exist for wound care professionals to review literature for their practice without pouring over academic journals alone. "I get research from colleagues, sharing is caring," offered Maritza Molina, RDN. The panel recommended discussing literature with colleagues and following certain researchers and leaders in wound care on social media. With its mutable landscape, wound care clinicians should stay up to date with literature, no matter their role within the multidisciplinary team. “I used to hate research,” commiserated Nemeth, “but we can’t take things at face value.”

References

1. Zhao X, Jiang H, Yin J. Changing trends in clinical research literature on PubMed database from 1991 to 2020. Eur J Med Res. 2022;27:95. doi: 10.1186/s40001-022-00717-9
2. Killeen AL, Devereux K, Nemeth DV, Molina M. How to Keep Up to Date with Literature: An Interdisciplinary Panel presented at: SAWC Spring; April 26- April 30; National Harbor, MD.