Reconciling Combination Therapy With EBM: Where Do We Go From Here?
- Volume 19 - Issue 1 - January 2006
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Combined therapies can also involve combining technological modalities. In the case of VAC therapy, some practitioners report using the VersaJet™ (Smith & Nephew) hydrosurgery wound debridement system for wound bed preparation prior to applying split thickness skin grafts, VAC therapy or synthetic skin replacements such as Dermagraft™ (Smith & Nephew) or Apligraf™ (Organogenesis).
Emphasizing Informed Choices About Combination Therapies
Granted, the acceptance and expectation of EBM has rightfully become pervasive in the schools. While some practitioners may be reluctant to mix medications and modalities without research evidence, the reality is the majority of us still use the mainstays of medicine: our personal clinical experiences, recommendations from mentors and the never-ending pursuit for better answers.
If indeed a combined therapy appears to be a better solution for a patient’s problem, it will be to the advantage of the medical community to examine it anew under the standards of EBM. However, until that point in time, what physician will turn his or her back on a better answer for a patient?
Dr. Satterfield is an Adjunct Clinical Associate Professor at the University of Texas Health Science Center at San Antonio.
Dr. Steinberg is an Assistant Professor in the Department of Surgery at the Georgetown University School of Medicine in Washington, D.C. He is a Fellow of the American College of Foot and Ankle Surgeons.
1. Staker LV. Teaching performance improvement: an opportunity for continuing medical education. J Contin Educ Health Prof 2003 Spring;23 Suppl 1:S34-52.
2. Dowsett C. The use of silver-based dressings in wound care. Nurs Stand 2004 Oct. 27-Nov. 2;19(7):56-60.
3. Brem H, Kirsner RS, Falanga V. Protocol for the successful treatment of venous ulcers. Am J Surg 2004 Jul;188(1A Suppl):1-8.
4. Brem H, Sheehan P, Boulton AJ. Protocol for the treatment of diabetic foot ulcers. Am J Surg 2004 May;187(5A):1S-10S.
5. Poon VK, Burd A. In vitro cytotoxicity of silver: implication for clinical wound care. Burns 2004 Mar;30(2):140-7.
6. Schaller M, Laude J, Bodewaldt H, Hamm G, Korting HC. Toxicity and antimicrobial activity of a hydrocolloid dressing containing silver particles in an ex vivo model of cutaneous infection. Skin Pharmacol Physiol 2004 Jan-Feb;17(1):31-6.
7. Snyder RJ. Treatment of nonhealing ulcers with allografts. Clin Dermatol 2005 Jul-Aug;23(4):388-95.