***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: OBJECTIVE To investigate and evaluate the clinical efficacy and safety of Acticoat with nanocrystalline silver for external use on the management of the residual wounds post-burn . METHODS One hundred and sixty-six wounds of 98 burn patients were enrolled and divided into Acticoat group and silver sulfadiazine group in the multi-center r and omized clinical trial . Acticoat was used as the treated group for those who have redness , swelling , and excessive secretion ( " heavy " exu date s ) in the wound , Acticoat was changed once a day . When there is not much secretion in the wound , or redness and swelling were not obvious , the dressings were changed once every 3 days . Silver sulfadiazine ( SD-Ag ) was used as control group , which was treated under the usual clinical routine . Healing time was observed up to 20 days . Healing percentage on the 15th day after treatment was determined . RESULTS Healing time was 12.42+/-5.40 days after the application of Acticoat . This was significantly shorter than that of control wounds . The wounds of the trial group healed nearly 3.35 days earlier than the control ones . Healing percentage at 15 days in the trial wounds was 97.37 % , which was higher than the control , but there was no significant difference between them . The bacterial clearance rate of the Acticoat group on the 6th and 12th day post-treatment was 16.67 and 26.67 % , respectively , which was significantly higher than the control . CONCLUSIONS Acticoat with nanocrystalline silver promotes the healing process of residual wounds post-burn effectively . No adverse reaction of Acticoat was found during the study Sixty patients with moderate and severe burns were r and omly assigned to receive topical silver sulfadiazine ( SSD ) alone ( n=30 ) or SSD combined with cerium nitrate ( SSD-CN ) ( n=30 ) . There were four deaths in the SSD group and one in the SSD-CN group ; more patients with higher risk severity survived in the SSD-CN group . Wound infection did not differ significantly between the groups . The rate of re-epithelialization of partial thickness burns was faster by 8 days in the SSD-CN group . The relatively dry shell-like eschar of the SSD-CN-treated burn allowed planned excisions with immediate autologous grafting and the tissue beneath was ready to accept grafting 11 days earlier than in the SSD group ( p=0.03 ) . This result ed in a significantly shorter hospital stay for those in the SSD-CN group than in the SSD group ( 23.3 vs. 30.7 days ; p=0.03 ) with consequent cost savings . A higher incidence of transient stinging pain was reported with application of SSD-CN , but this was effectively managed with analgesics where necessary . The results of this study confirm the greater efficacy of SSD-CN in the treatment of burns patients Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more A new silver-coating technology was developed to prevent wound adhesion , limit nosocomial infection , control bacterial growth , and facilitate burn wound care through a silver-coated dressing material . For the purpose s of this article , Acticoat ( West aim Biomedical Inc , Fort Saskatchawan , Alberta , Canada ) silver-coated dressing was used . After in vitro and in vivo studies , a r and omized , prospect i ve clinical study was performed to assess the efficacy and ease of use of Acticoat dressing as compared with the efficacy and ease of our institution 's st and ard burn wound care . Thirty burn patients with symmetric wounds were r and omized to be treated with either 0.5 % silver nitrate solution or Acticoat silver-coated dressing . The dressing was evaluated on the basis of overall patient comfort , ease of use for the wound care provider , and level of antimicrobial effectiveness . Wound pain was rated by the patient using a visual analog scale during dressing removal , application , and 2 hours after application . Ease of use was rated by the nurse providing wound care . Antimicrobial effectiveness was evaluated by quantitative burn wound biopsies performed before and at the end of treatment . Patients found dressing removal less painful with Acticoat than with silver nitrate , but they found the pain to be comparable during application and 2 hours after application . According to the nurses , there was no statistically significant difference in the ease of use . The frequency of burn wound sepsis ( > 10(5 ) organisms per gram of tissue ) was less in Acticoat-treated wounds than in those treated with silver nitrate ( 5 vs 16 ) . Secondary bacteremias arising from infected burn wounds were also less frequent with Acticoat than with silver nitrate-treated wounds ( 1 vs 5 ) . Acticoat dressing offers a new form of dressing for the burn wound , but it requires further investigation with greater numbers of patients in a larger number of centers and in different phases of burn wound care BACKGROUND In the hierarchy of research design s , the results of r and omized , controlled trials are considered to be evidence of the highest grade , whereas observational studies are viewed as having less validity because they reportedly overestimate treatment effects . We used published meta-analyses to identify  r and omized clinical trials and observational studies that examined the same clinical topics . We then compared the results of the original reports according to the type of research design . METHODS A search of the Medline data base for articles published in five major medical journals from 1991 to 1995 identified meta-analyses of r and omized , controlled trials and meta-analyses  of either cohort or case-control studies that assessed the same intervention . For each of five topics , summary estimates and 95 percent confidence intervals were calculated on the basis of data from the individual r and omized , controlled trials and the individual observational studies . RESULTS For the five clinical topics and 99 reports evaluated , the average results of the observational studies were remarkably similar to those of the r and omized , controlled trials . For example , analysis of 13 r and omized , controlled trials of the effectiveness of bacille  Calmette-Guérin vaccine in preventing active tuberculosis yielded a relative risk of 0.49 ( 95 percent confidence interval , 0.34 to 0.70 ) among vaccinated patients , as compared with an odds ratio of 0.50 ( 95 percent confidence interval , 0.39 to 0.65 ) from 10 case-control studies . In addition , the range of the point estimates for the effect of vaccination was wider for the r and omized , controlled trials ( 0.20 to 1.56 ) than for the observational studies ( 0.17 to 0.84 ) . CONCLUSIONS The results of well- design ed observational studies ( with either a cohort or a case-control design ) do not systematic ally overestimate the magnitude of the effects of treatment as compared with those in r and omized , controlled trials on the same topic Despite recent improvements in analgesia , pain control during dressing changes continues to be a major challenge in patients with burns . We investigated two different dressing modalities to compare how much pain the patient experienced during and after the dressing change . Patients with partial-thickness burns that required only topical wound care were assigned r and omly to treatment with Acticoat ( Smith and Nephew USA , Largo , FL ) or silver sulfadiazine ( AgSD ) . The outcome variable was pain during wound care , which was measured using visual analog pain scores . The mean visual analog pain scores for the wounds treated with Acticoat or AgSD wounds were 3.2 and 7.9 , respectively ( P < .0001 ; paired Student 's t-test ) . In 41 of the 47 paired pain score observations , the pain in the wound treated with AgSD was perceived as greater than in the wound treated with Acticoat . Burn wound care with Acticoat is less painful than burn wound care with AgSD in patients with selected partial-thickness burns BACKGROUND Fungal infections of burn wounds have become an important cause of burn-associated morbidity and mortality . The nature of fungal infections dictates aggressive treatment to minimize the morbidity associated with these infections . Persons with large total body surface area burns are particularly susceptible to fungal infections and are treated in such a manner as to minimize their risk of infection . METHODS This study examined the in vitro fungicidal efficacy of a variety of different topical agents . By placing fungal inocula in contact with mafenide acetate , silver nitrate , silver sulfadiazine , and a nanocrystalline silver-coated dressing , we determined the kill kinetics of these topical agents against a spectrum of common burn wound fungal pathogens . RESULTS The topical antimicrobials that were tested demonstrated varying degrees of efficacy against these pathogens . CONCLUSION The nanocrystalline silver-based dressing provided the fastest and broadest-spectrum fungicidal activity and may make it a good c and i date for use to minimize the potential of fungal infection , thereby reducing complications that delay wound healing The lipid base of silver sulfadiazine ( SSD ) makes removal of the product painful for the patient and difficult for the physician to accurately assess particularly in partial-thickness burn injuries . As an alternative , a water-soluble antimicrobial gel is used at the University of Virginia . We present a prospect i ve , r and omized comparison of these two therapies using pain with dressing changes and time to perform dressing changes as our primary endpoints . Adult in patients with partial-thickness burn wounds were r and omized to begin therapy with either SSD cream or the water-soluble burn wound gel ( BWG ) , and then therapies were alternated daily .  Pain assessment s , time to complete dressing care , total narcotic medication administered , and the number of personnel required for dressing changes were recorded . Eight patients were enrolled result ing in 13 pairs ( 26 points ) of data comparison between the two therapies . Four of the eight enrolled patients ( 50 % ) refused to continue receiving SSD because of pain associated with dressing changes and voluntarily withdrew from the study . The amount of time to perform dressing changes was an average of 79 nurse-minutes longer for SSD . A 6.08 greater morphine equivalent was delivered to those having BWG removed . A water-soluble polyantimicrobial gel was superior to SSD in the parameters measured as exhibited by our patient dropout rate and differential time to perform dressing care . Limiting the time to perform dressing care will reduce the cumulative pain experience , improve patient satisfaction , and reduce the re sources to deliver care 
    Output:
    
This comprehensive systematic review and meta- analysis of the available evidence suggest that the use of nanocrystalline silver dressings results in shorter length of stay in hospital , less pain , fewer surgical procedures and reduced infection rates compared to silver sulphadiazine/silver nitrate