***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Themicrocirculation of the wound bed is a key parameter for improving granulation tissue formation and , hence , wound healing . The aim of this study was to determine whether a wound dressing comprising collagen/oxidized regenerated cellulose has effects over a short term on wound healing . Wounds were evaluated using a clinical wound score ; pain associated with wounds was measured using a visual analogue scale . Wound microcirculation was evaluated using a technique based on noncontact remission spectroscopy . A prospect i ve trial was performed in 40 patients with chronic venous leg ulcers ( mean age 74 years ; range , 43 - 93 years ; 25 females and 15 males ) . Patients in group A were treated with PROMOGRAN ® Matrix ( Johnson & Johnson , New Brunswick , NJ ) combined with “ good ” ulcer care for 2 weeks . Control group B consisted of 10 patients who received only good ulcer care . The authors measured a favorable clinical response in 76.9 % ( group A ) versus 66.7 % ( group B ) . Themean reduction of ulcer area was statistically significant in group A ( P < .05 ) . The wound score improved in group A from 2.28 ± 1.24 ( before treatment ) increasing to 3.72 ± 1.57 ( after 1 week ; P < .00023 ) and 4.92 ± 1.68 ( after 2 weeks ; P < .000027 ) . In group B , the score improved from 1.44 ± 1.33 ( before treatment ) to 3.22 ± 1.30 ( after 1 week ; P < .0077 ) . The mean visual analogue pain score before treatment was 8.72 ( group A ) and 7.88 ( group B ) ( ns , P > .05 ) . After 1 week of treatment , the score dropped to 5.76 ( group A ) and 6.66 ( group B ) . In the second week , group A patients had a mean pain score of 3.84 compared with the pain score before treatment ( P < .05 ) . After 1 week of treatment , in group A there was a decrease in remission spectroscopy , which is considered to reflect an improvement in microcirculation This study tests the hypothesis that addition of a protease-modulating matrix enhances the efficacy of autologous growth factors in diabetic ulcers .  Fifty-one patients with chronic diabetic foot ulcers were managed as out patients at the Democritus University Hospital of Alex and roupolis and followed up for 8 weeks . All target ulcers were > or = 2.5 cm in any one dimension and had been previously treated only with moist gauze .  Patients were r and omly allocated in three groups of 17 patients each : Group A was treated only with the oxidized regenerated cellulose/collagen bio material ( Promogran , Johnson & Johnson , New Brunswick , NJ ) , Group B was treated only with autologous growth factors delivered by Gravitational Platelet Separation System ( GPS , Biomet ) , and Group C was managed by a combination of both . All ulcers were digitally photographed at initiation of the study and then at change of dressings once weekly . Computerized planimetry ( Texas Health Science Center ImageTool , Version 3.0 ) was used to assess ulcer dimensions that were analyzed for homogeneity and significance using the Statistical Package for Social Sciences , Version 13.0 . Post hoc analysis revealed that there was significantly greater reduction of all three dimensions of the ulcers in Group C compared to Groups A and B ( all P<.001 ) . Although reduction of ulcer dimensions was greater in Group A than in Group B , these differences did not reach statistical significance . It is concluded that protease-modulating dressings act synergistically with autologous growth factors and enhance their efficacy in diabetic foot ulcers Health care professionals are increasingly required to base clinical decisions on the best available evidence . Evidence based medicine ( EBM ) is a systematic approach to clinical problem solving which allows the integration of the best available research evidence with clinical expertise and patient values . This paper explains the concept of EBM and introduces the five step EBM model  : formulation of answerable clinical questions ; search ing for evidence ; critical appraisal ; applicability of evidence ; evaluation of performance .  Subsequent articles will focus on the principles and critical appraisal of r and omised controlled trials , systematic review s , and meta-analyses , and provide a practical demonstration of the five step EBM model using a real life clinical scenario HYPOTHESIS Promogran , a wound dressing consisting of collagen and oxidized regenerated cellulose , is more effective that st and ard care in treating chronic diabetic plantar ulcers . DESIGN R and omized , prospect i ve , controlled multicenter trial . SETTING University teaching hospitals and primary care centers . PATIENTS A total of 276 patients from 11 centers were enrolled in the study . The mean age of the patients was 58.3 years ( range , 23 - 85 years ) . All patients had at least 1 diabetic foot ulcer . INTERVENTIONS Patients were r and omized to receive Promogran ( n = 138 ) or moistened gauze ( control group ; n = 138 ) and a secondary dressing . Dressings were changed when clinical ly required . The maximum follow-up for each patient was 12 weeks . MAIN OUTCOME MEASURE Complete healing of the study ulcer ( wound ) . RESULTS After 12 weeks of treatment , 51 ( 37.0 % ) Promogran-treated patients had complete wound closure compared with 39 ( 28.3 % ) control patients s , but this difference was not statistically significant ( P = .12 ) . The difference in healing between treatment groups achieved borderline significance in the subgroup of patients with wounds of less than 6 months ' duration . In patients with ulcers of less than 6 months ' duration , 43 ( 45 % ) of 95 Promogran-treated patients healed compared with 29 ( 33 % ) of 89 controls ( P = .056 ) . In the group with wounds of at least 6 months ' duration , similar numbers of patients healed in the control ( 10/49 [ 20 % ] ) and the Promogran ( 8/43 [ 19 % ] ; P = .83 ) groups . No differences were seen in the safety measurements between groups . Patients and investigators expressed a strong preference for Promogran compared with moistened gauze . CONCLUSIONS Promogran was comparable to moistened gauze in promoting wound healing in diabetic foot ulcers . It showed an additional efficacy for ulcers of less than 6 months ' duration that was of marginal statistical significance . Furthermore , Promogran had a safety profile that was similar to that of moistened gauze , with greater user satisfaction . Therefore , Promogran may be a useful adjunct in the management of diabetic foot ulceration , especially in ulcers of less than 6 months ' duration Collagen/oxidized regenerated cellulose (ORC)/silver therapy has been design ed to facilitate wound healing by normalizing the microenvironment and correcting biochemical imbalances in chronic wounds . The aim of this study was to compare collagen/ORC/silver therapy to control ( st and ard treatment ) . Patients with diabetic foot ulcers were r and omized to either collagen/ORC/silver ( 24 ) or control treatment ( 15 ) . Wound area measurements and wound fluid sample s were taken weekly . Protease levels were measured in wound fluid sample s to investigate differences between responders ( ≥50 % reduction in wound area by week 4 ) and nonresponders ( < 50 % reduction in wound area by week 4 ) . There were significantly more responders in the collagen/ORC/silver group compared with the control group ( 79 % vs. 43 % , p = 0.035 ) . There were significantly fewer withdrawals from the study because of infection in the collagen/ORC/silver group compared with the control group ( 0 % vs. 31 % , p = 0.012 ) . The sum of matrix metalloproteinase-9 and elastase concentration was higher in nonresponders compared with responders at baseline ( p = 0.0705 ) and week 4 ( p = 0.012 ) . The results suggest that collagen/ORC/silver normalizes the wound microenvironment and protects against infection , result ing in improved wound healing . It was also demonstrated that measuring a combination of proteases may be a more relevant prognostic healing marker than any individual protease alone The inadequacy of most of traditional sources for medical information , like textbook and review article , do not sustained the clinical decision based on the best evidence current available , exposing the patient to a unnecessary risk . Although not integrated around clinical problem areas in the convenient way of textbooks , current best evidence from specific studies of clinical problems can be found in an increasing number of Internet and electronic data bases . The sources that have already undergone rigorous critical appraisal are classified as secondary information sources , others that provide access to original article or abstract , as primary information source , where the quality assessment of the article rely on the clinician oneself . The most useful primary information source are SciELO , the online collection of Brazilian scientific journals , and Medline , the most comprehensive data base of the USA National Library of Medicine , where the search may start with use of keywords , that were obtained at the structured answer construction ( P.I.C.O. ) , with the addition of boolean operators " AND " , " OR " , " NOT " . Between the secondary information sources , some of them provide critically appraised articles , like ACP Journal Club , Evidence Based Medicine and InfoPOEMs , others provide evidence s organized as online texts , such as " Clinical Evidence " and " UpTo Date " , and finally , Cochrane Library are composed by systematic review s of r and omized controlled trials . To get studies that could answer the clinical question is part of a mindful practice , that is , becoming quicker and quicker and dynamic with the use of PDAs , Palmtops and Notebooks INTRODUCTION Diabetic foot is a complication of diabetes mellitus that manifests with the development of ulcers that frequently precede amputation . Several studies have verified that the environment of the diabetic neuropathic foot ulcer contains a high concentration of metalloproteinases . The aim of the present study was to evaluate the efficacy of a protease-modulating dressing in the treatment of neuropathic diabetic foot ulcers . MATERIAL AND METHOD A r and omized controlled trial was conducted in 40 patients with a 6-week or longer history of neuropathic diabetic foot ulcer . The patients were r and omized to two groups : group 1 ( n = 20 ) received treatment with the protease-modulating dressing while the control group ( group 2 ; n = 20 ) received the treatment specified in the st and ardized protocol for good wound care . The patients were then followed-up for 6 weeks . RESULTS After 6 weeks , healing was achieved in 12 patients ( 63 % of n = 19 ) in group 1 under treatment with the protease-modulating dressing versus three patients ( 15 % of n = 19 ) in the control group ( p < 0.03 ) . The mean time to healing was 23.3 + /- 9.9 days in group 1 and 40.6 + /- 1.15 days in group 2 ( p < 0.01 ) . CONCLUSIONS The results confirm the hypothesis that the use of protease-modulating dressings in patients with neuropathic diabetic foot ulcers leads to better tissue regeneration than good wound care 
    Output:
    
: Because of several methodology flaws in the review ed studies , these results suggest that there is currently no research evidence to suggest that the use of ORC+C improves wound healing rates of DFUs .