Exploring the prevalence and management of wounds in an urban area in Ireland.

AIM: This study explores the prevalence and management of wounds within an urban setting in Ireland. METHOD: It employs a cross-sectional survey design, using a predesigned, validated data-collection instrument. FINDINGS: The point prevalence of wounds was 3.7% (n=445), with surgical wounds being the most prevalent (43%; n=189). Wound care was provided across a wide variety of clinical settings, with the majority of patients (60%; n=271) managed in the acute care setting. Most dressings were changed 2-3 times a week (60%; n=271). The mean dressing time was 15 minutes (SD: 12.4 minutes), varying from 2 minutes to 90 minutes. The mean nurse travel time was 3 minutes (SD: 6.5 minutes), varying from 0-60 minutes. Among participants managed using silver and iodine dressings, 53% (n=10, silver) and 78% (n=50, iodine) were prescribed for wounds described as being not infected. Alginate dressings were used incorrectly in 75% of cases, foam dressings in 63% of cases and Hydrofiber dressings in 63% of cases. CONCLUSION: Wound management within the explored geographical area is an important clinical intervention. This study identified areas of practice that need to be addressed, primarily those related to the topical management of the wound and use of offloading. The data has been used to inform practice, education, and further research in this important clinical specialty.

Identifying the barriers to antiepileptic drug adherence among adults with epilepsy.

PURPOSE: To identify the barriers to antiepileptic drug (AED) adherence among adults with epilepsy (AWE). The impact of AED non-adherence on quality of life (QoL) was also examined. METHOD: Systematic design (SR) study. A search strategy was undertaken with no time limits, for articles published in English, in MEDLINE, CINANL, PsycINFO, EMBASE, Cochrane databases and grey literature sources. Eligibility criteria included participants with epilepsy over 18 years, who were prescribed AEDs. Adherence had to be defined and adherence assessment measurements identified. A screening process was undertaken to select eligible studies. Eight studies met the inclusion criteria and were included in a quantitative synthesis. Quality of evidence was conducted using the EBL critical appraisal checklist and assessing risk of bias within individual studies. RESULTS: Across the included studies a high prevalence of non-adherence was identified. AED non-adherence was associated with specific beliefs about medications, being depressed or anxious, poor medication self-administration management, uncontrolled recent seizures, frequent medication dosage times, poor physician-patient relationship and perceived social support. Additionally, AED non-adherence impacted negatively on QoL as a result of poor seizure control. CONCLUSION: Although included studies were of good quality, risk of biases reduced the generalisability of results. Findings suggested that comprehensive adherence assessments should routinely be performed. Recommendations for future research include the use of longitudinal research designs and a follow up SR to include the 16-18-year-old population.

Anti epileptic drug trials for patients with drug resistant idiopathic generalised epilepsy: A meta-analysis.

PURPOSE: Determine the impact of anti-epileptic drugs (AED) for drug resistant patients with idiopathic generalised epilepsy. METHODS: A systematic search of Medline, Cumulative Index to Nursing an Allied Health Literature (CINAHL), Cochrane Epilepsy Group Central Specialised Register, Cochrane Central Register of controlled Trials (CENTRAL), Embase and Lenus was performed. Nine randomised controlled trials were included. All trials compared antiepileptic drugs to placebo. Outcome measures assessed were 50% or greater reduction in seizure, seizure freedom and adverse events. RESULTS: Seven trials report a 50% or greater reduction in seizure frequency. This was statistically significant (p=<0.00001) with a narrow confidence interval implying that the overall this meta-analysis has reasonable power to detect an effect. It demonstrated a significant statistical difference of seizure freedom occurring in the drug treatment group compared to placebo. Adverse events were identified with each drug and are reported. There were however methodological issues with the trials included. Quality appraisal was undertaken using the risk of bias assessment from Rev Man 5.3 tool for all randomised controlled trials retrieved. CONCLUSION: This systematic review demonstrated efficacy of adjunctive anti-epileptic drugs with regard to 50% reduction and seizure freedom. Adverse events are identified in all of the studies in the drug treatment groups but are consistent with previous studies of these drugs. Additional adequately powered studies with long term follow up needs to be conducted to unequivocally establish the long term efficacy and tolerability of anti-epileptic drug's for patients with drug resistant idiopathic generalised epilepsy.