Research... or Common Sense?

Despite the fact many authors address me as Doctor, I am neither physician nor professor. I am a messenger and an editorial technician, putting manuscripts on clinical matters through the peer-review process and lovingly editing and polishing content and prose to enhance understanding of and interest in the important topics we cover. In this capacity, I have developed a sincere regard and respect for research — the time and energy it takes, the protocols it demands be followed, the gaps in knowledge it exposes, and the cost.

When a manuscript describing results of research is submitted, my colleagues and I can readily tell who did their homework regarding both how the study was conducted and how the manuscript was sculpted. We weigh clinical and literary worthiness not just according to Ostomy Wound Management guidelines, but also in compliance with the American Medical Association Manual of Style, among other official parameters to which we subscribe. We ensure the authors have followed the principles set forth in these publications; as part of the requirements, authors must provide certain declarations — notice of any conflicts of interest and assurance that participants (whether human or animal) received appropriate protection — as well as complete descriptions of their methods and citations (properly formatted) of supportive research. The author statements I find most fascinating begin, The purpose of this study….

The reasons for research are as varied as the article titles. Studies commonly are performed to assess, to compare, to quantify, to examine, to explore, and to validate new and existing evidence. Some authors are inspired, for example, to seek solutions for high hospital-acquired pressure ulcer rates or to test products for a particular patient population or to investigate an intervention. Every once in a while, a study is conducted to invalidate previous research or a commonly held belief. But what exactly inspires authors to develop a concept or theory, create the study protocol, seek approval from the institution in which it is to be conducted, solicit participants, collect and analyze the data, interpret the outcomes, and compose the manuscript to share the findings? Given the challenges of prospective study, it is easy to understand why a great deal of what we publish includes reviews of existing research and retrospective studies to ascertain whether what was done or ordered is supported by the literature. However, mining data and subsequently subjecting them to (sometimes secondary) statistical analyses also come with unique obstacles, not the least of which is establishing the accuracy of the data. Although retrospective research may be less complex than surveying patients in real time and then dealing with all the factors that can skew findings (otherwise known as “limitations”), many authors pursue their objectives through prospective study, acknowledging the many factors that can compromise their efforts but determined to add to the wound care knowledge compendium.

Sometimes, the results of certain studies may seem somewhat obvious… until you remember we live in an evidence-based sphere of practice where assumptions should be proven. While it might seem to almost be common sense that having an ostomy might compromise your sex life or that exercise will get the blood pumping and help healing or that irrigating a surgical wound with a bactericide before closing can thwart infection (the subjects of this month’s 3 feature articles), we can never forget we are dealing with people and that the findings never cease to have an unexpected twist. I find it fascinating that people with a permanent stoma seem to adapt better to their new life situation than patients with a temporary stoma (who perhaps are impatient to have it reversed?). Exercise is well-advised in most but not all situations; this month’s research detailed its exact effect on calf muscle pump function. Recommending the addition of another medication before surgery can add expense, especially in geographic areas where not all substances are readily available. How fortunate the authors found a low cost, accessible product to reduce surgical site infection.

Then again, a bit of research I conducted alerted me to something called the Ig-Nobel Awards, where strange, superfluous (and funded!) studies are recognized. Some that were (or were not) on the list include a 2013 effort in which researchers asked people at bars to score their own attractiveness and found that the higher the blood alcohol content of people, the higher the ratings; a Cambridge University study that concluded the larger the person, the more adhesives he would need to stick to a wall Spiderman style; and a study that affirmed pigs love mud.

Wound care research is difficult to conduct. Chronic wounds are not neatly categorized by body system, disease state, or location. They affect people of all ages and all settings and all temperaments (adherent to protocol or otherwise), pervading the entire realm of health care. They never occur in a health care vacuum. An infinite list of confounding factors needs to be accounted for. Yet here we are, assessing, evaluating, comparing, and evaluating new/old information, the hope being that some day evidence-based practice will be common sense and common practice. 

This article was not subject to the Ostomy Wound Management peer-review process.