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Wandering the wound web. Sorting and assessing data – Marjolin’s Ulcer. Presented at SAWMA education evening August 2006. Introduction. Searching the web – search engines Sorting results from standard engines Evidence rating scales Specific sites for Wound information Marjolin’s Ulcer.

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wandering the wound web

Wandering the wound web

Sorting and assessing data –

Marjolin’s Ulcer

Tal Ellis - WoundHeal Australia

Presented at SAWMA education evening August 2006

introduction
Introduction
  • Searching the web – search engines
  • Sorting results from standard engines
  • Evidence rating scales
  • Specific sites for Wound information
  • Marjolin’s Ulcer

Tal Ellis - WoundHeal Australia

facts and figures wound aetiology
Facts and figures: wound aetiology
  • To find sites for specific information you need to conduct searches of the internet using specific search engines
  • This involves:
    • choosing a search engine (web crawler; meta-crawler)
    • carefully selecting search words
    • entering words, scrolling sites
    • use URL’s and key words from other information specific sites ( like AWMA or World Wide Wounds)

Tal Ellis - WoundHeal Australia

search engines
Search engines
  • Google – now the biggest: search shows 870 sites related to “Marjolin’s ulcer”
  • Yahoo – next biggest: search shows 643 the first 10 – 20 matching with Google
  • NineMSN – one of the other larger engines: 717 some cross matching as well though this site did have a different order for many of the references

Tal Ellis - WoundHeal Australia

conduct search using search engine
Conduct search using search engine:
  • Enter word or phrase for information….

Tal Ellis - WoundHeal Australia

slide6

Marjolin’s ulcer

Tal Ellis - WoundHeal Australia

sorting results
Sorting results
  • Criteria: need to look at level of evidence
  • References: refereed material preferable to non-refereed material
  • Journal: e-journals need to be professional journals not general interest ones
  • General sites can be utilised for interest but not as specific references

Tal Ellis - WoundHeal Australia

levels of evidence
Levels of Evidence

Tal Ellis - WoundHeal Australia

Table 1 (source NHMRC, 1999)

using wound specific sites
Using wound specific sites
  • Wound Management Practice Resource centre – not updated and not particularly useful for Marjolin’s Ulcer! (or much else now!)
  • World Wide Wounds – purely web based – has one article on fungating wounds that refers to Marjolin’s Ulcer
  • Journals – require subscription to access E-sites: e.g Medical Journal of New England – has an abstract re Marjolin’s ulcer

Tal Ellis - WoundHeal Australia

company sites
Company Sites
  • Company web sites are valuable resources for company and product information as well as some generic information
  • URL’s for companies can be obtained from company literature or their sites accessed by putting in company name to search engines eg, Hartmann, Convatec, Smith+Nephew
  • Not useful for this particular search…!

Tal Ellis - WoundHeal Australia

systematic reviews
Systematic reviews
  • Systematic reviews are ideal for informing practice, practice change, clinical pathways etc
  • Allows for practice to be bound to a significant evidence base
  • Some access can be limited by the need to subscribe

Tal Ellis - WoundHeal Australia

systematic reviews1
Systematic Reviews
  • Major sites:

1. Cochrane collaboration

http://www.cochrane.org

2. Joanna Briggs Institute for Evidence Based Nursing and Midwifery

http://www.joannabriggs.edu.au

3. National Institute for Clinical Studies

Tal Ellis - WoundHeal Australia

marjolin s ulcer
Marjolin’s Ulcer
  • An ulcerative tumor arising in wounds or scar – most often Squamous Cell Carcinoma but can be other tumor forms
  • Literature reports indicate that these rare ulcers can form in a range of wounds including diabetic ulcers and other wounds complicated by osteomyelitis, burns, trauma, pressure ulcers, non-healing surgical wounds and venous ulcers

Tal Ellis - WoundHeal Australia

marjolin s ulcer1
Marjolin’s Ulcer
  • Diagnosis: duration and biopsy – most common finding is SCC
  • Treatment: wide excision can be valuable – metastatic disease is not common and therefore condition is curable if treated early enough (i.e on detection)
  • High degree of suspicion should accompany any ulcer treated correctly for more than 3 months

Tal Ellis - WoundHeal Australia

local treatment
Local treatment
  • Exudate – foam
  • Skin care
  • Odour – carbon containing and ozone generator
  • Pain
  • Review by Plastic Surgeon
  • AB therapy may be of use to control exudate and odour

Tal Ellis - WoundHeal Australia