***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: Background : Wound pain is a serious problem for people with chronic wounds . The aim of this real-life study was to compare the effect of a foam dressing that releases ibuprofen ( Biatain Ibu ® ) with local best practice on the treatment of painful exuding wounds . Methods : A total of 185 patients with painful exuding wounds were r and omized to either ibuprofen foam treatment ( n = 98 ) or local best practice ( n = 87 ) . The primary endpoint was pain relief over 7 days of treatment , assessed daily using a 5-point verbal rating scale ( no relief , slight relief , moderate relief , lots of relief , and complete relief ) . Secondary endpoints included a total reduction in pain intensity for the whole study period ( using an 11-point Numeric Box Scale : 0 = no pain to 10 = worst possible pain ) and incidence of adverse events ( AEs ) . Results : More patients in the ibuprofen foam treatment group reported wound pain relief and lower wound pain intensity values after 7 days ( p < 0.0001 for both variables ) . Within the four most common ulcer aetiolgies , patients reported significantly more effective pain relief with ibuprofen foam treatment ( venous : p = 0.009 , mixed arterial venous : p < 0.0001 , arterial : p = 0.0009 , and vasculitis : p = 0.009 ) . In all groups , patients from the ibuprofen foam group reported lower pain intensities . The results were significant for patients with venous ( p < 0.002 ) and arterial ( p < 0.0001 ) leg ulcers . Two AEs were reported . Conclusions : The ibuprofen foam represents an effective and safe alternative to local best practice in the management of painful exuding wounds The aim of the study was a cost and clinical effectiveness analysis between moist wound healing dressings and gauze in a homecare set up for the treatment of stage III and IV pressure ulcers up to complete healing . In addition , we assessed the overall economic burden on the Healthcare System . Treatment method for each patient was chosen r and omly by using sealed opaque envelopes . The authors monitored the healing progress and recorded treatment costs without interfering with the treatment process . The healing progress was estimated by using surface measurement transparent films . To estimate treatment costs , the authors took into account labor costs , cost of dressings , as well the cost of other material s such as cleansing gauzes , normal saline , syringes , examination gloves , antiseptics and adhesive tape . The patient group under treatment with moist wound healing dressings consisted of 27 men and 20 women aged 75.1 ± 8,6 and had an average ulcer surface of 43.5 ± 30.70 cm(2 ) ; the patient group under treatment with gauze comprised 25 men and 23 women aged 77.02 ± 8.02 and had an average ulcer surface 41.52 ± 29.41 cm(2 ) ( p = 0.25 , 95 % CI , Student 's t test ) . The average healing time for the moist wound healing dressings group ' was 85.56 ± 52.09 days , while 121.4 ± 52.21 days for the " gauze group " ( p = 0.0001 , 95 % CI , Student 's t test ) . The dressing change frequency per patient was reduced in the " moist wound healing dressings group , " 49.5 ± 29.61 , compared with a dressing change frequency per patient of 222.6 ± 101.86 for the " gauze group " ( p = 0.0001 , 95 % CI , Student 's t test ) . The use of moist wound healing dressings had a lower total treatment cost of 1,351 € per patient compared with , the use of gauzes ( 3,888 € ) The objectives of the study were ( 1 ) to look for any local , clinical ly apparent response , within and around a debrided wound , to a novel biocompatible polyurethane foam during repeated , short-term implantation , and ( 2 ) to assess the material 's efficacy as a negative pressure wound therapy ( NPWT ) interface compared with a widely used , commercially available foam .  Twenty pressure ulcers in 18 patients underwent surgical debridement , then r and omization to receive novel treatment or control foam as the wound interface for NPWT . Dressing changes every 2 - 3 days allowed qualitative wound assessment and quantitative measurement to compare outcomes . No adverse reaction was observed in any patient receiving the new foam . The new " novel foam " performed as a NPWT interface as effectively as the control " st and ard foam . " In deep wounds , the new foam was easier to remove , fragmented less , and showed less retention than the control foam . No marginal in-growth occurred , making removal less traumatic and reducing bleeding from cavity wall granulations . The results support previous large animal studies , and independent ISO10993 testing , that the new foam is safe and biocompatible . Its efficacy as an NPWT interface , nontraumatic removal with low fragmentation and retention rate , favors the new material , especially in deep cavity wounds In the GRADE approach , r and omized trials start as high- quality evidence and observational studies as low- quality evidence , but both can be rated down if most of the relevant evidence comes from studies that suffer from a high risk of bias . Well-established limitations of r and omized trials include failure to conceal allocation , failure to blind , loss to follow-up , and failure to appropriately consider the intention-to-treat principle . More recently recognized limitations include stopping early for apparent benefit and selective reporting of outcomes according to the results . Key limitations of observational studies include use of inappropriate controls and failure to adequately adjust for prognostic imbalance . Risk of bias may vary across outcomes ( e.g. , loss to follow-up may be far less for all-cause mortality than for quality of life ) , a consideration that many systematic review s ignore . In deciding whether to rate down for risk of bias -- whether for r and omized trials or observational studies -- authors should not take an approach that averages across studies . Rather , for any individual outcome , when there are some studies with a high risk , and some with a low risk of bias , they should consider including only the studies with a lower risk of bias Pressure ulcers are common among elderly nursing home residents . To be effective in managing these wounds , a dressing should maintain a moist environment , facilitate healing , absorb exu date , remain in place for a number of days , and prevent trauma to the surrounding skin . An 8-week , open , r and omized , multicenter , controlled study was conducted to compare the effects of a new self-adherent soft silicone dressing and a self-adherent hydropolymer dressing on Stage II pressure ulcers . Thirty-eight ( 38 ) residents participated in the study . Eighteen residents ( mean age 83.8 years , range 74.9 to 95.1 years ) were r and omized to wound management with a soft silicone dressing , and the ulcers of 20 residents ( mean age 82.5 years , range 66.4 to 91.9 years ) were managed with a hydropolymer dressing .  Wound healing , wound and surrounding skin characteristics , and ease of dressing removal were measured and documented . During the study , eight ( 44 % ) ulcers in the soft silicone group and 10 ( 50 % ) in the hydropolymer dressing group healed . Both dressings were changed approximately once a week and no differences in signs of inflammation , amount of exu date and odor , or incidence of leakage were observed . Damage to the surrounding skin , maceration , and dressing removal difficulties were less common with the soft silicone dressing . Differences in tissue damage between the two dressings were significant during weeks 1 , 2 , and 3 ( P < 0.05 ) . Studies with a larger sample size are needed to confirm these findings Background There are many barriers to patient participation in r and omised controlled trials of cancer treatments . To increase participation in trials , strategies need to be identified to overcome these barriers . Our aim was to assess the effectiveness of interventions to overcome barriers to patient participation in  r and omised controlled trials ( RCTs ) of cancer treatments . Methods A systematic review was conducted . Published and unpublished studies in any language were search ed for in fifteen electronic data bases , including MEDLINE , EMBASE , CINAHL and PsycINFO , from inception to the end of 2004 . Studies of any interventions to improve  cancer patient participation  in RCTs , which reported the change in recruitment rates , were eligible for inclusion . RCTs and non-r and omised controlled trials as well as before and after studies reporting baseline rates specific to the population being investigated were included . Data were extracted by one review er into structured summary tables and checked for accuracy by a second review er . Each included study was assessed against a checklist for method ological quality by one review er and checked by a second review er . A narrative synthesis was conducted . Results Eight studies were identified that met the inclusion criteria : three RCTs , two non-r and omised controlled trials and three observational studies . Six of the studies had an intervention that had some relevance to the UK . There was no robust evidence that any of the interventions investigated led to an increase in  cancer patient participation in RCTs , though one good quality RCT found that urologists and nurses were equally effective at recruiting participants to a treatment trial for prostate cancer . Although there was no evidence of an effect in any of the studies , the evidence was not of sufficient quality to be able to conclude that these interventions therefore do not work . Conclusion There is not a strong evidence -base for interventions that increase  cancer patient participation  in r and omised trials . Further research is required to evaluate the effectiveness of strategies to increase participation in cancer treatment trials Background Internet-administered cognitive behavioural therapy ( ICBT ) has been found to be effective for a range of anxiety disorders . However , most studies have focused on one specific primary diagnosis and co-morbidity has not been considered . In primary care setting s , patients with anxiety often suffer from more than one psychiatric condition , making it difficult to disseminate ICBT for specific conditions . The aim of this study will be to investigate if ICBT tailored according to symptom profile can be a feasible treatment for primary care patients with anxiety disorders . It is a r and omised controlled trial aim ed to evaluate the treatment against an active control group . Methods Participants with anxiety disorders and co-morbid conditions ( N = 128 ) , will be recruited from a primary care population . The Clinical Outcome in Routine Evaluation ( CORE-OM ) will serve as the primary outcome measure . Secondary measures include self-reported depression , anxiety , quality of life and loss of production and the use of health care . All assessment s will be collected via the Internet and measure points will be baseline , post treatment and 12 months post treatment . Discussion This trial will add to the body of knowledge on the effectiveness of ICBT for anxiety disorders in primary care . The trial will also add knowledge on the long term effects of ICBT when delivered for regular clinic patients Trial Registration Clinical Trials.gov : A hydropolymer dressing ( Tielle ) and a hydrocolloid dressing ( Granuflex ) were compared in a r and omised controlled clinical study involving 100 patients with leg ulcers and 99 patients with pressure sores in the community . Statistically significant differences in favour of the hydropolymer dressing were detected for dressing leakage and odour production , but no statistically significant differences were recorded in the number of patients with either leg ulcers or pressure sores who healed in each treatment group OBJECTIVE To compare the clinical efficacy of a collagen dressing covered with a foam dressing with the same foam used as a primary dressing in stagnating granulating pressure ulcer patients . METHOD Patients were r and omised to receive either a foam dressing ( Suprasorb P ; Lohmann & Rauscher ) as a primary dressing ( group A ) , or a combination of a collagen dressing ( Suprasorb C ; Lohmann & Rauscher ) covered with the same foam dressing ( group B).Wound fluid was collected and evaluated prior to treatment ( day 0 ) , and on days 3,7 , 14 and 21 .The level and expression of matrix metalloproteinases ( MMPs ) MMP-2 and MMP-9 , and tissue inhibitors of metalloproteinases ( TIMPs ) TIMP- I and TIMP-2,as well as elastase content in wound fluid and angiogenesis , were evaluated , comparing results on day 0 and day 2 I.Time to ulcer healing , reduction in ulcer area , safety of treatment , patient-reported ulcer pain and comfort of the dressing regimen were evaluated as secondary outcomes . Patients received st and ard preventive measures , in line with the pressure ulcer prevention guidelines . RESULTS Ten patients were included in the pilot ; five were treated with the foam dressing ( group A ) and five patients received the collagen dressing , using the foam as a secondary dressing ( group B).Wound fluid from group B displayed a significant positive effect on angiogenesis ( p < 0.05 ) compared with group A. In the collagen and foam groupTIMP- I and -2 increased faster and levels were higher than in group A. Furthermore , MMP-2 , MMP-9 ( p < 0.04 ) and elastase in group B showed faster and greater decrease in levels , compared with group A , indicating a faster and superior reduction of inflammation . In both groups the ulcers started to heal , with a faster onset of healing for group B. CONCLUSION The results of this pilot support published data on the use of collagen dressings compared with foam for stagnating wounds , shown in clinical studies . DECLARATION OF INTEREST This study was supported with an educational grant by Lohmann & Rauscher GmbH.Apart from DrAbel , the sponsors had no role in the design or conduct of the study , in the collection , analysis and interpretation of the data , or in the preparation , review 
    Output:
    
AUTHORS ' CONCLUSIONS It is uncertain whether foam dressings are more clinical ly effective , more acceptable to users , or more cost effective compared to alternative dressings in treating pressure ulcers .
It was difficult to make accurate comparisons between foam dressings and other dressings due to the lack of data on reduction of wound size , complete wound healing , treatment costs , or insufficient time-frames .