Use of recommended osteoarthritis pain treatment by older adults.

AIM: This paper reports on a study conducted to describe what traditional and non-traditional treatments older adults with osteoarthritis use for pain management, their reported pain relief, and factors associated with use of recommended initial gold standard treatment (acetaminophen/paracetamol or non-steroidal anti-inflammatory drugs, and exercise and/or physical therapy) as designated by conventional western medicine. BACKGROUND: Osteoarthritis is characterized by joint pain, stiffness and limited range of motion and has been designated an international health burden by the World Health Organization. Demographic and cultural factors have been shown to affect both traditional and non-traditional osteoarthritis treatment decisions. METHOD: A descriptive correlational design was used, with secondary analysis of data collected between July 2006 and July 2007 in two randomized controlled studies using the Brief Pain Inventory Short Form and testing older adults' pain communication. RESULTS: The frequency of use of gold standard treatment was 28.0% (n = 128). Both traditional and non-traditional treatments were used by 46.4% (n = 212) of the participants. Logistic regression revealed that those with higher education (odds ratio 1.56, CI 1.24-1.96, P = 0.001), and non-White race, regardless of educational level (odds ratio 2.02, CI 1.20-3.40, P = 0.008), were more likely to use gold standard treatment. CONCLUSION: Factors influencing older adults' use of gold standard treatment for their osteoarthritis pain need to be identified so that greater numbers of older adults can be supported to use recommended treatment to obtain greater pain relief.

Assessing the need for developing a comprehensive content-validated pressure ulcer guideline.

Healthcare professionals need evidence-based strategies and guidelines for care to optimize pressure ulcer prevention and management. Differences among pressure ulcer guidelines confuse caregivers, reducing consistency of care. To assess the need for a comprehensive content-validated guideline document, the Association for the Advancement of Wound Care Guideline Subcommittee evaluated current pressure ulcer guideline recommendations by compiling 10 pressure ulcer-specific guidelines existing before June 2008 on the National Guideline Clearinghouse website along with the National Pressure Ulcer Advisory Panel (draft), European Pressure Ulcer Advisory Panel (draft), and Wound Healing Society guidelines. Steps for each aspect of pressure ulcer management were compiled and inconsistent recommendations identified. Currently available pressure ulcer guidelines were found to differ in definitions, aspects of care, validation, evidence criteria, and procedural recommendations, potentially affecting consistency and quality of all aspects of pressure ulcer management, including diagnosis, prevention, treatment, and outcomes measurement. To address these inconsistencies, a comprehensive list of Pressure Ulcer Care Initiative (PUCI) steps was prepared for content validation and posted on www.aawconline.org, enabling healthcare professionals interested in improving the consistency and quality of pressure ulcer prevention and care to participate in this process. All steps with a content validity index > 0.75 (rated clinically relevant by survey respondents) and/or with A-level standardized clinical evidence support will be included in the comprehensive PUCI guideline. Content validation of recommendations is an important first step to improving the consistency of pressure ulcer care.

Development of a content-validated venous ulcer guideline.

Evidence-based practice for venous ulcers may improve healing and reduce costs of care. The Association for the Advancement of Wound Care Government and Regulatory Task Force developed a content-validated venous ulcer guideline based on best available evidence supporting each aspect of venous ulcer care. After compiling all-inclusive lists of elements in venous ulcer algorithms published before August 2002, the Task Force objectively rated and summarized up to five best references from MEDLINE, CINAHL, and EMBASE literature searches covering each aspect of care. Sixteen multidisciplinary wound care professionals and educators used judgment quantification to content validate all steps. A 2004 email survey of AAWC members (N = 1,514) clarified effects of under-reimbursement on evidence-based venous practice. The Venous Ulcer Guideline containing all elements with A-level evidence plus those with a Content Validity Index >0.75 now resides on the AAWC and the Agency for Healthcare Research and Quality National Guideline Clearinghouse websites. However, a review of US healthcare environment components, including reimbursement policies, and the results of the survey identified many barriers to implementation of A-level evidence supported steps (sustained graduated high compression, autolytic debridement, and moist wound environments) in practice. Sufficient evidence supports improved venous ulcer care in the US but inadequate and/or inconsistent reimbursement policies impede quality evidence-based venous ulcer practice, delaying healing and increasing the burden of venous ulcers on society.