***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: The aim of this study was to determine the rate of venous ulcer recurrence and the level of compliance in patients wearing European class 1 or class 2 compression stockings . A total of 100 patients with healed venous leg ulcers were recruited , and were r and omised to either class 1 ( n = 50 ) or class 2 ( n = 50 ) compression stockings . Follow-up was at 1 week , 3 , 6 , 9 and 12 months to monitor ulcer recurrence and compliance . Patients had a duplex scan to identify the source of venous incompetence . The rate of ulcer recurrence after 12 months was 16·1 % , and the difference in recurrence rate between classes was not statistically significant ( P = 0·287 ) although greater numbers in class 1 developed a recurrence . Participants ( 88·9 % ) were compliant ; non-compliant patients were at a significantly greater risk of recurrence ( P≤ 0·0001 ) . Thirteen patients had both superficial and deep incompetence ; those r and omised to class 1 stockings ( n = 4 ) developed ulcer recurrence . Patients with a history of multiple episodes of ulceration were more likely to develop a recurrence ( P = 0·001 ) . The lowest venous ulcer recurrence rates were seen in patients who were compliant with hosiery regardless of the compression level . Patients with both superficial and deep incompetence had a lower rate of recurrence with class 2 compression A controlled , r and omized , double-blind trial was performed in 34 hospitalized patients with chronic leg ulcers : 37 ulcerous legs were treated with Elase solution or with saline ( placebo ) solution . Elase was statistically significantly better in effect on debridement ( p less than 0.05 ) and on enhancing of granulation ( p less than 0.05 ) than saline in patients with chronic venous stasis ulcers . In patients with complex ulcers  no statistically significant difference between the two treatments was seen OBJECTIVE Comparison of desloughing efficacy after four weeks and healing outcomes after 12 weeks in sloughy venous leg ulcers treated with Manuka honey ( Woundcare 18 + ) vs. st and ard hydrogel therapy ( IntraSite Gel ) . BACKGROUND Expert opinion suggests that Manuka honey is effective as a desloughing agent but clinical evidence in the form of a r and omised controlled trial is not available . There is a paucity of research which uses Manuka honey in venous ulcers . DESIGN Prospect i ve , multicentre , open label r and omised controlled trial . METHOD R and omisation was via remote telephone . One hundred and eight patients with venous leg ulcers having > or=50 % wound area covered in slough , not taking antibiotics or immunosuppressant therapy were recruited from vascular centres , acute and community care hospitals and leg ulcer clinics . The efficacy of WoundCare 18 + to deslough the wounds after four weeks and its impact on healing after 12 weeks when compared with IntraSite Gel control was determined . Treatment was applied weekly for four weeks and follow-up was made at week 12 . RESULTS At week 4 , mean % reduction in slough was 67 % WoundCare 18 + vs. 52.9 % IntraSite Gel ( p = 0.054 ) . Mean wound area covered in slough reduced to 29 % and 43 % , respectively ( p = 0.065 ) . Median reduction in wound size was 34 % vs. 13 % ( p = 0.001 ) . At 12 weeks , 44 % vs. 33 % healed ( p = 0.037 ) . Wounds having > 50 % reduction in slough had greater probability of healing at week 12 ( 95 % confidence interval 1.12 , 9.7 ; risk ratio 3.3 ; p = 0.029 ) . Infection developed in 6 of the WoundCare 18 + group vs. 12 in the IntraSite Gel group . CONCLUSION The WoundCare 18 + group had increased incidence of healing , effective desloughing and a lower incidence of infection than the control . Manuka honey has therapeutic value and further research is required to examine its use in other wound aetiologies . RELEVANCE TO CLINICAL PRACTICE This study confirms that Manuka honey may be considered by clinicians for use in sloughy venous ulcers . Additionally , effective desloughing significantly improves healing outcomes BACKGROUND Compression therapy is the most widely used treatment for venous leg ulcers and it was used in different forms for more than 400 years . Published healing rates of venous ulcers obtained with compression therapy vary widely from 40 - 95 % . According to numerous studies , it has been suggested that the application of external pressure to the calf muscle raises the interstitial pressure result ing in improved venous return and reduction in the venous hypertension . Several risk factors have been identified to be correlated with the failure of venous leg ulcers to heal with compression therapy ( longer ulcer duration ; large surface area ; fibrinous deposition present on > 50 % of the wound surface and an Ankle Brachial Pressure Index ( ABPI ) of < 0.85 . METHODS An open prospect i ve single-center study was performed in order to determine possible risk factors associated with the failure of venous ulcers to heal when treated with multi-layer high compression b and aging system for 52 weeks . In the study , 189 patients ( 101 women , 88 men ; mean age 61 years ) with venous leg ulcers ( ulcer surface > 5 cm(2 ) ; duration > 3 months ) were included . The study excluded patients with arterial disease ( ABPI < 0.8 ) , heart insufficiency with ejection fraction ( EF ) < 35 , pregnancy , cancer disease , rheumatoid arthritis , and diabetes . Based on clinical opinion and available literature , the following were considered as potential risk factors : sex , age , ulceration surface , time since ulcer onset , previous operations , history of deep vein thrombosis , body mass index ( BMI ) , reduction in calf circumference > 3 cm during the first 50 days of treatment , walking distance during the day < 200 meters , calf : ankle circumference ratio < 1.3 , fixed ankle joint , history of surgical wound debridement , > 50 % of wound covered with fibrin , depth of the wound > 2 cm . RESULTS Within 52 weeks of limb-compression therapy , 24 ( 12.7 % ) venous ulcers had failed to heal . A small ulceration surface ( < 20 cm(2 ) ) , the duration of the venous ulcer < 12 months , a decrease in calf circumference of more than 3 cm , and emergence of new skin islets on > 10 % of wound surface during the first 50 days of treatment were favorable prognostic factors for ulcer healing . A large BMI ( > 33 kg/m(2 ) ) , short walking distance during the day ( < 200 m ) , a history of wound debridement , and ulcers with deepest presentation ( > 2 cm ) were indicators of slow healing . Calf : ankle circumference ratio < 1.3 , fixed ankle joint , and reduced ankle range of motion were the only independent parameters associated with non-healing ( P < .001 ) . CONCLUSION The results obtained in this study suggest that non-healing venous ulcers are related to the impairment of the calf muscle pump Ninety‐three patients with treatment‐resistant venous ulcers were included in a multicentre r and omized trial to compare cadexomer iodine and the st and ard treatment used in each centre combined with compression b and ages , in healing venous ulcers . The mean duration of ulcers before the trial was more than 2 years . With st and ard treatment the mean ulcer size increased slightly during the 6‐week trial whereas with cadexomer iodine the ulcer size was significantly reduced . Cadexomer iodine was more effective than st and ard treatment for reduction of pain , removal of pus and debris , removal of exu date , stimulation of granulation and reduction of surrounding erythema . Bacterial infection of ulcers increased or did not change during treatment with the st and ard therapy whereas cadexomer iodine significantly reduced infection with Staphylococcus aureus , Pseudomonas aeruginosa and other pathogenic organisms . A correlation was seen between the time taken to reduce or eliminate infection with Staphylococcus aureus and rate of ulcer healing . Four patients complained of transient pain in the ulcer after application of the cadexomer iodine . It is concluded that cadexomer iodine increased the rate of healing of infected chronic venous ulcers The objective of this study was to evaluate the effect of sharp debridement on the progression of  recalcitrant chronic venous leg ulcers ( CVLU ) and to assess the feasibility of performing this procedure in an outpatient setting . We performed a prospect i ve study of 55 CVLU ( 53 patients ) over a 12-month period . The study group , which underwent debridement , contained 28 CVLU whose wound beds had slough , nonviable tissue , and no granulation tissue . The control group was 27 CVLU with minimal ( 15 - 20 % ) granulation tissue , but no slough or nonviable tissue . Treatments were otherwise similar . Age , body mass index , mean ulcer surface area ( MSA ) and mean ulcer duration were comparable in both groups . Ulcer measurements were taken at 4 weeks before debridement , at the time of debridement , and 4 and 20 weeks post-debridement . There was no change in the MSA from 4 weeks before to the time of debridement in either group . At 4 weeks post-debridement , the study ulcers showed a 6 cm(2 ) reduction in the MSA vs. a 1 cm(2 ) reduction in controls ( P = 0.02 ) . By week 20 post-debridement , the study ulcers achieved a 7.4 cm(2 ) reduction in the MSA vs. an increase of 1.3 cm(2 ) in controls ( P = 0.008 ) . Between weeks 8 and 20 post-debridement , 16 % of study ulcers vs. 4.3 % of control ulcers achieved complete healing . Infection rates and antimicrobial usage were similar . We conclude that sharp debridement is effective in stimulating healing of recalcitrant CVLU . It is safe , well tolerated , and can be performed in an outpatient setting CONTEXT Selective reporting of outcomes within published studies based on the nature or direction of their results has been widely suspected , but direct evidence of such bias is currently limited to case reports . OBJECTIVE To study empirically the extent and nature of outcome reporting bias in a cohort of r and omized trials . DESIGN Cohort study using protocol s and published reports of r and omized trials approved by the Scientific-Ethical Committees for Copenhagen and Frederiksberg , Denmark , in 1994 - 1995 . The number and characteristics of reported and unreported trial outcomes were recorded from protocol s , journal articles , and a survey of trialists . An outcome was considered incompletely reported if insufficient data were presented in the published articles for meta- analysis . Odds ratios relating the completeness of outcome reporting to statistical significance were calculated for each trial and then pooled to provide an overall estimate of bias . Protocol s and published articles were also compared to identify discrepancies in primary outcomes . MAIN OUTCOME MEASURES Completeness of reporting of efficacy and harm outcomes and of statistically significant vs nonsignificant outcomes ; consistency between primary outcomes defined in the most recent protocol s and those defined in published articles . RESULTS One hundred two trials with 122 published journal articles and 3736 outcomes were identified . Overall , 50 % of efficacy and 65 % of harm outcomes per trial were incompletely reported . Statistically significant outcomes had a higher odds of being fully reported compared with nonsignificant outcomes for both efficacy ( pooled odds ratio , 2.4 ; 95 % confidence interval [ CI ] , 1.4 - 4.0 ) and harm ( pooled odds ratio , 4.7 ; 95 % CI , 1.8 - 12.0 ) data . In comparing published articles with protocol s , 62 % of trials had at least 1 primary outcome that was changed , introduced , or omitted . Eighty-six percent of survey responders ( 42/49 ) denied the existence of unreported outcomes despite clear evidence to the contrary . CONCLUSIONS The reporting of trial outcomes is not only frequently incomplete but also biased and inconsistent with protocol s. Published articles , as well as review s that incorporate them , may therefore be unreliable and overestimate the benefits of an intervention . To ensure transparency , planned trials should be registered and protocol s should be made publicly available prior to trial completion Summary The cleansing effects on pus and debris of streptokinase-streptodornase and of stabilized crystalline trypsin were compared in 40 patients ( 12 males , 28 females ) with necrotic varicose or arteriosclerotic leg ulcers . Both preparations produced significant partial or total cleansing of the ulcers of necrotic material , and both enhanced the granulation and epithelialization of most of the ulcers . Streptokinase-streptodornase was significantly more effective in removing freshly formed damp and smearing pus and debris . Neither preparation prevented the formation of or removed very deep adherent necrotic areas , especially in arteriosclerotic leg ulcers . Trypsin caused significantly more pain than streptokinase-streptodornase during the treatment period and on changing dressings . Both enzymes indirectly reduced the bacterial flora of the ulcers , probably by removal of necrotic wet material BACKGROUND Elase is a widely used ointment consisting of a combination of  
    Output:
    
There is limited evidence to suggest that actively debriding a venous leg ulcer has a clinical ly significant impact on healing .
Comparisons of different autolytic agents ( hydrogel versus paraffin gauze ; Dextranomer beads versus EUSOL and BWD versus non-adherent dressings ) and Larvae versus hydrogel all showed statistically significant results for numbers of wounds debrided .