Use of Honey as Medicine in Wound Healing: Analysis

Use of Honey as Medicine in Wound improve AnalysisThe aim of the assignment is to critique the explore article, Standardised bacteriacide honey (medihoney) with standard therapy in wound c ar randomized clinical trial (2009) by Robson, Dodd Thomas. The as welll used for this is beat by Step Guide to Critiquing Research by Ryan, Coughlan Cronin (2007). Critique is an objective, critical, and balanced appraisal of a look publishs different dimensions (Polit and Beck, 2004).The convey was on the use of honey as medicine in wound healing. The look into was done in the unite Kingdom by a group of registered nurses and statistical masters. The breeding was finish in the year 2007 and was published in the Journal of Advanced breast feeding (JAN). The oeuvre was base on the use of honey for wound dress as an antibiotic and wound healing sequencent.Arguably, the article is well compose as it is concise and it does not contain any(prenominal) langu periods that argon charac terised to any powericular group and be grammatic eachy correct. The lay out(p) of the rent is frank and argon abandoned in a good order and kept the donnish elbow room of composing. Research reports argon like stories, a story should be written in a way which catches the attention of the reader, like as question report should gain a readable style. The topical inquiryes writing style is good, and is well understandable. No personal views are expressed in the report card. The writer had omitted personal pronouns to follow an ease in the reading.Credibility variables concenter on how believable the subject field appears and focus on the researchers qualification and major(ip) power to undertake and accurately make the study (Coughlan et al, 2007). The researchers were well qualified for the true study as their qualifications were verbalise in the article. Mostly nurses are eligible to do this type of study as they know the effect of stuffing a wound. Statisticia ns as well as be possessed of a enjoyment in a research as in that location are so many calculations which were besides included in the study. Methodology of a study is based on the credibility of the qualitative entropy and its subsequent findings (Polit Hunger, 1999)The title of the article gave an composition of the topic that and what the study is related to. The title is accurate and clear, in like manner farseeing or improvident titles lavatory make the reader confusing (Coughlan et al, 2007). too longsighted or short titles can be confusing and cheapjack 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 outline description or an outline of the entire article. The repeal should give a clear humor slightly the research and should include information regarding the think of the study, method, take in size and selection whic h is given distinctly in the topical article(Coughlan et al, 2007), And from the abstract the reader should able to find out the boilers suit report about(predicate) the study. They nonplus also pointed out for further research on this topic with some recomm give the sackations. The present study has an agreeable abstract which conveys musical theme 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 affords an end to further researches.The de but of the study will always be based on the research problem. Research problem is an enquiry which can be done by a disciplinary way (Polit and Beck, 2004). The purpose of a research highlights the overall sketch of main arguments and theory of the applicable research (Polit Hungler, 1999). In the original research the purpose of the study is sta ted all the way and an overall idea of the study is been included in the introduction of the research. The research problem is determine and clearly stated in the study. The research was carried out in a maltreat 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 con text edition is called as the literature freshen up (Polit Beck, 2004). literary works refreshen always points out to the previous studies of the current topic. The review should be logical and its critical psychoanalysis 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 details 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 verifiable nature. Theoretical frame work is what which is found confusing by a researcher. A hypothetic 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 organism studied and relationship among those concepts. The theory is true and the possibility is relevant for the study. Theoretical frame work tends to be improve create in experimental and quasi-experimental studies and very much poorly developed or innocent 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 measuremen t that reflects on the physical reality which is interpreted by the individuals, and can be argued that even much(prenominal) observations whitethorn be open to slipivity (Gerrish Lacey 2006). thither 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 downplay the errors. Samples are the selected units from a population, and sampling is the process of selecting reserve 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 wa s trance as they were tolerants who were having wounds. The size of the sample was also passable as a small sample will not service of process in an eliminate conclusion. The size of the sample is also authoritative in quantitative research as small samples are at assay of being overly representative of small groups within the target population. in that respect was no inclusion or exclusion for the study as they chose an sequester sample with ethical leadation. The risk of sampling errors decrease as big sample used (Coughlan et al, 2007).Autonomy infers that an individual has the right to freely determine to participate in a research study without fear of obsession and with the full association of what is being investigated. Ethical committee or institutional review boards have to give approval onward 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 conside ration for the data collection. each the participants of the study were amply 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 ex jut outations. 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 gath ering 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 courold age (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 energy 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 literatu re 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 like 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(a) recommendations are also given to the current study.When doing a research or a research critique it is all-important(a) 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 economic aid the writer to find the source as quickly as attainable (Pears Shields). The copy of others idea is conced er 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 up members it was found that the study is arguable with credibility and reliability. The writers have care in full used the strategies in doing a research. The research is readable and understanding by lay men.Holistic keep Prescribing A brass StudyHolistic Nurse Prescribing A Case StudyIntroduction1 the patient and their presenting symptoms.Mr Pickles presents an interesting, complex and remediationally gainsay problem. In essence he is a gentleman wi th multisystem pathology who presents with an almost incidental finding which he was clearly reluctant to discuss.It is a common finding amongst experience healthcare victor persons 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 darn Im here moment when they can bring up an issue that unfeignedly troubles them and may not be the real presented reason for the consultation. In this act we shall discuss the various aspects of this situation and the measures we can take to try to cooperate 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 powerlessness it is easier to work backwards from that to discuss the possible pathophysiology that can be relevant.Impotence is state to occur whenever the male fails to get an erection when it is expectd. This, in it self is neither ludicrous nor necessarily pathological. It be poses a significant symptom when the male repeatedly fails to get an erection that is sufficient for intercourse. It is kind of possible to get full automatic erections and yet still be impotent. This is one of the major diagnostic features that distinguishes the psychogenetic impotence from the purely physical. (Ackerman MD, Carey MP. 1995)There are a number of diaphanous physical causes of vertical disfunction that are relevant to Mr Pickles (see on), but evenly there are a number of possible psychogenic causes that may be either primary factors or possibly secondary tributary factors in the aetiology of his problems.The fact that he has recently undergone major cardiac surgery is a very relevant factor. perseverings will frequently post 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 fa mily, it is promising 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 apprehension and fatigue that such a job would engender.(Beck J. 1995)It is possible that the medication that Mr Pickles is victorious may have a bearing on his erectile dysfunction as the male erection is dependent on the hydrostatic cart of the blood for its maintenance. Any medication that cuts the average blood cart, will effectively reduce the capacity to acquire and maintain an erection. In step-up to this the adrenergic drug beta-blocker group will also selectively block the sympathetic pathways that are vital to the neurovascular have of the mechanisms of erection.Pathophysiology of diabetes and impotenceBoth 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 high incidence in both the Asian and Afro-Caribbean communities(Nathan 1998). There is also a marked genetic component in the maturation of Diabetes Mellitus.Mr Pickles has typecast 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 forks. The preponderance 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 gibe (as measured by the HbA1 levels). In general terms, the better the control the reject the incidence of complications (Kissebah et al. 1999)As far as Mr Pickl es is concerned, there are deuce 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 variable 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 o f self-confidence, first and iatrogenic causes (medication etc.) all of which may well be relevant to Mr Pickles, therefore it can be seen that there are a plethora of possible 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(prenominal) study) for every(prenominal) 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 m ajor 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 passe-partout may reasonably chose to manage the problem by devising a rational appreciation 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 wit h 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 educe that an appropriate strategy would be to initially tackle the situation on two fronts. The psychological aspects of the erectile dysfunction are probably top hat discussed with an experienced psychologist or councillor who has expertise in this particular plain.This is important because there is a considerable skill in eliciting the relevant factors from the patient. legion(predicate) patients are reticent about talking openly about their accompany informal details and there has to be a thorough ca-ca 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 obtai nedNot 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 stovepipe done by an experienced healthcare professional in that area.The pharmaceutical area can also be addressed as Atenolol is clearly not the shell 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 movement 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 prob ably better to seek the advice of the surgical team who performed the CABG. before making the transition.The question of sildenafil 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 dispense withs sexual intercourse which is associated with increased peaks of blood pressure. As Mr Pickles is still in the operative 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, whence the prescription drug of Viagra will often breed a sprightliness of psychological dependence which may firstly be both contradictory 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 situated before them. And behaved in a way that the majority of their professional colleagues mean is reasonable in the circumstances. It is, of course, central to these considerations, that all go throughs are carefully and fully recorded in the patients notesPrescribing decisions5.a critical discussion of influences on prescribing decisions.The area of prescr ibing 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 familiar (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, rosy 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 action mechanism 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 hith erto well controlled. If the erectile dysfunction was simply a reflection of the fact that the medication was memory 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 adjustment s that may be relevant here such as weight loss and increasing lick 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 groundbreaking 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)ReferencesAckerman MD, Carey MP. 1995Psychologys role in the assessment of erectile dysfunction historical precedents, current knowledge and methods.J Consult Clin Psychol 1995 63 862-87Barnes, Darryl E. 2004Action Plan for Diabetes Copyright 2004 ISBN 0736054596 Pub. gay Kinetics Illinois USABeck J. 1995Hypoactive sexual desire disorder an overview.J Consult Clin Psychol 1995 63 915-927.Boule NG, Haddad E, Kenny GP, et al. 2001Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus a meta-analysis of controlled clinical trials.JAMA 20012861218-27Bowering (2001)Diabetic foot ulcers. Pathophysiology, assessment, and therapy. Can Fam Physician. 2001 May471007-16.Dawes RM, Corrigan B. 1974Linear models in decision making.Psychol Bull 19748195-106.Funnell, and Robert M. Anderson, (2004)Empowerment and Self-Management of DiabetesClinical Diabetes 22123-127, 2004Gibbs, G (1988)Learning by doing A guide to Teaching and Learning methods electromagnetic unit Oxford Brookes University, Oxford. 1988Gregg, R. B. Gerzoff, C. J. Caspersen, D. F. Williamson, and K. M. V. Narayan (2003)Relationship of Walking to Mortality Among US Adults With DiabetesArchives of Internal Medicine, June 23, 2003 163(1 2) 1440 1447.Gregoire 1999 rudiment of sexual health Assessing and managing male sexual problems BMJ, January 30, 1999 318(7179) 315 317.Howe and Anderson 2003 Involving patients in medical education BMJ, Aug 2003 327 326 328.Hughes RAC. 2002 Regular review Peripheral neuropathy BMJ, Feb 2002 324 466 469.Kissebah AH, Freedman DS, Peiris AN. 1999Health risks of obesity.Med Clin North Am 1999 73 111-138Marks-Moran Rose 1996Reconstructing Nursing Beyond Art and Sciencecapital of the United Kingdom Balliere Tindall October, 1996Nathan D. (1998)Some answers, more controversy, from UKPDS.Lancet 1998 352 832-833.Parker and Lawton 2003 Psychological contribution to the understanding of ominous events in health care Qual. Saf. Health Care, Dec 2003 12 453 457.Wagner G, Seanz de Tejada I. 1998 modify on male erectile dysfunction.BMJ 1998 316 678-682Waterlow J. (1998)Prevention is better than cure.Nurs Times 1988 84 69-70Appendix