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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 Sorting and assessing data – Marjolin’s Ulcer Tal Ellis - WoundHeal Australia 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 Tal Ellis - WoundHeal Australia
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 • 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: • Enter word or phrase for information…. Tal Ellis - WoundHeal Australia
Marjolin’s ulcer Tal Ellis - WoundHeal Australia
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 Tal Ellis - WoundHeal Australia Table 1 (source NHMRC, 1999)
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 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 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 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 • 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 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 • 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
