***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: To comprehend the results of a r and omised controlled trial ( RCT ) , readers must underst and its design , conduct , analysis , and interpretation . That goal can be achieved only through total transparency from authors . Despite several decades of educational efforts , the reporting of RCTs needs improvement . Investigators and editors developed the original CONSORT ( Consoli date d St and ards of Reporting Trials ) statement to help authors improve reporting by use of a checklist and flow diagram . The revised CONSORT statement presented here incorporates new evidence and addresses some criticisms of the original statement . The checklist items pertain to the content of the Title , Abstract , Introduction , Methods , Results , and Discussion . The revised checklist includes 22 items selected because empirical evidence indicates that not reporting this information is associated with biased estimates of treatment effect , or because the information is essential to judge the reliability or relevance of the findings . We intended the flow diagram to depict the passage of participants through an RCT . The revised flow diagram depicts information from four stages of a trial ( enrolment , intervention allocation , follow- up , and analysis ) . The diagram explicitly shows the number of participants , for each intervention group , included in the primary data analysis . Inclusion of these numbers allows the reader to judge whether the authors have done an intention- to-treat analysis . In sum , the CONSORT statement is intended to improve the reporting of an RCT , enabling readers to underst and a trial 's conduct and to assess the validity of its results Background Pressure sores are important and common complications of spinal cord injury . Many preventive and therapeutic approaches have been tried and new trials are evolving . One relatively recent method is application of a hydrocolloid dressing ( HD ) . In this study we compared the therapeutic effects of HD on pressure ulcer healing with two other topical applications , phenytoin cream ( PC ) and simple dressing ( SD ) . Methods Ninety-one stage I and stage II pressure ulcers of 83 paraplegic male victims of the Iran-Iraq war were r and omly allocated to three treatment groups . Mean age and weight of the participants were 36.64 ± 6.04 years and 61.12 ± 5.08 kg , respectively . All the patients were managed in long term care units or in their homes for 8 weeks by a team of general practitioners and nurses , and the ulcer status was recorded as " Complete healing " , " Partial healing " , " Without improvement " and " Worsening " . Results Complete healing of ulcers , regardless of location and stage , was better in the HD group than the PC [ 23/31(74.19 % ) vs 12/30(40 % ) ; difference : 34.19 % , 95 % CI = 10.85–57.52 , ( P < 0.01 ) ] or the SD [ 23/31(74.19 % ) vs 8/30(26.66 % ) ; difference : 47.53 % , 95 % CI = 25.45–69.61 , ( P < 0.005 ) ] groups . Complete healing of stage I ulcers in the HD group [ 11/13(85 % ) ] was better than in the SD [ 5/11(45 % ) ; difference : 40 % , 95 % CI = 4.7–75.22 , ( P < 0.05 ) ] or PC [ 2/9 ( 22 % ) ; difference : 63 % , 95 % CI = 29.69–96.3 , ( P < 0.005 ) ] groups . Complete healing of stage II ulcer in the HD group [ 12/18 ( 67 % ) ] was better than in the SD group [ 3/19(16 % ) ; difference : 51 % , 95 % CI = 23.73–78.26 , ( P < 0.005 ) ] , but not significantly different from the PC group [ 10/21 ( 48 % ) ; difference : 19 % , 95 % CI = -11.47–49.47 , ( P > 0.05 ) ] . We performed a second analysis considering only one ulcer per patient ( i.e. 83 ulcers in 83 patients ) . This " per patient " analysis showed that complete ulcer healing in the HD group was better than in the PC [ 20/28(71.4 % ) vs 11/28 ( 39.3 % ) ; difference : 32.1 % , 95 % CI = 7.4–56.7 , ( P < 0.01 ) ] or SD [ 20/28(71.4 % ) vs 8/27 ( 29.6 % ) ; difference : 41.8 % , 95 % CI = 17.7–65.8 , ( P < 0.005 ) ] groups . Conclusion We deduced that HD is the most effective method investigated for treating stage I and II pressure ulcers in young paraplegic men An occlusive hydrocolloid dressing ( Comfeel Ulcus ) was compared with a conventional wet saline gauze dressing regarding the effect on ulcer cleansing and healing processes , experience of pain and the consumption of nursing time , in a controlled , r and omized and partially single-blind study with parallel groups of long-stay patients with pressure sores . After a few weeks ' treatment the relative decrease in ulcer areas with time was larger in the group treated with the hydrocolloid dressing . The difference was almost statistically significant at week 5 ( p = 0.054 ) and definite at week 6 ( p = 0.006 ) . At week 6 the median remaining ulcer area in per cent of the initial area was 0 % in the hydrocolloid dressing group and 31 % in the group treated with saline gauze ( p = 0.016 ) . Analysis of the healing distribution function showed the hydrocolloid dressing to be more effective , although the overall difference was non-significant ( p = 0.15 ) . Care of the pressure sore took significantly less time with hydrocolloid dressings Nonprofessional caregivers currently are participating in managing pressure ulcers at home . As this can be a stressful experience , innovative and easy-to-use products are needed to support caregiver confidence . A multicenter , r and omized clinical trial was conducted to compare clinical performance and case of instruction of a change indicator dressing ( SIG ) and a hydrocolloid alginate dressing ( HAD ) in the management of pressure ulcers in the home and long-term care setting s. SIG and HAD were r and omized to 17 and 18 partial- or full-thickness pressure ulcers respectively . During five dressing changes , wound area , dressing application , maintenance , appearance , removal , wear time , ease of teaching , and caregiver underst and ing of each dressing 's instructions were measured . Both dressings were rated highly regarding ease of teaching , ease of use , appearance , maintenance , and helpfulness in signaling the need for dressing change by both professional and nonprofessional wound caregivers . Average dressing wear time was 3.2 days for SIG and 2.7 days for HAD . Of these wounds managed in a moist environment , 6 of 17 ( 35 % ) subjects whose wounds were dressed with SIG , and 1 of 18 ( 6 % ) dressed with HAD healed during the course of the study ( alpha < 0.04 ) . Percent wound reduction in area per day of care was also greater for SIG ( alpha < 0.01 ) . Innovative dressings may help caregivers provide consistent quality pressure ulcer care and improve wound-healing outcomes 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 The management of pressure sores in community setting s , poses a clinical problem which challenges the patient ’s tolerance and the clinician ’s diligence and ingenuity .  Pressure sores can be painful , lead to infection and are associated with considerable morbidity and increased mortality ( Patterson & Bennett , 1995:919 ; Bale , Banks , Hagelstein & Harding , 1998:65 ) . Treatment costs of these wounds are high in terms of re sources ( Colin 1995:65 ; Wood , Griffiths & Stoner , 1997:256 ) . However , since there are untold cost in terms of pain and suffering to the patient , it is impossible to calculate the true cost of pressure sores ( Dealey , 1994:87 ) OBJECTIVES To compare the effects of topical collagen and hydrocolloid on  pressure ulcer healing .  DESIGN R and omized ( allocation concealed ) , single-blind ( outcome assessors ) , controlled trial with 8-week follow-up . SETTING Eleven nursing homes in central Illinois . PARTICIPANTS Sixty-five patient-residents with Stage II or III pressure ulcers : median age 83.1 , median Braden score 12 , 63 % female , 80 % Stage II ulcers , and 20 % Stage III ulcers . Exclusion criteria included cellulitis and osteomyelitis . INTERVENTION Thirty-five patients were allocated to topical collagen daily , 30 to topical hydrocolloid twice weekly . MEASUREMENTS The primary outcome was complete healing within 8 weeks . Secondary outcomes were time to heal , ulcer area healed per day , linear healing of wound edge , and cost of therapy . RESULTS Analysis by intention to treat revealed similar complete ulcer healing within 8 weeks in collagen ( 51 % ) and hydrocolloid ( 50 % ) recipients ( difference 1 % , 95 % confidence interval ( CI ) = 26 - 29 % ) . Mean healing time was similar : collagen healed in 5 weeks ( 95 % CI = 4 - 6 ) , hydrocolloid healed in 6 weeks ( 95 % CI = 5 - 7 ) . Mean area healed per day was 6 mm(2)/d in both treatment groups . Mean linear healing of the wound edge was 3 mm in both groups . In multivariate analysis , baseline ulcer depth was the only independent predictor of complete ulcer healing within 8 weeks ( odds ratio = 0.56 , 95 % CI = 0.38 - 0.81 ) . Cost analysis favored hydrocolloid . CONCLUSIONS There were no significant differences in healing outcome between collagen and hydrocolloid . Collagen was more expensive and offered no major benefits to patients otherwise eligible for hydrocolloid treatment A total of 67 patients with pressure ulcers were r and omized into one of three treatment modalities : hydrogel sheet dressing , hydrocolloid , or wet-to-moist gauze .  Safety , efficacy , and physical attributes of the three dressings were evaluated . No statistical significance was found in wound healing rate among the three treatments . Hydrogel sheets were advantageous in allowing wound visualization without dressing or wound disruption One-hundred and three patients with Stage II and III sacral pressure ulcers were enrolled in a prospect i ve , controlled , multi-center clinical study to evaluate and compare dressing performance , safety and efficacy .  Fifty-two patients were r and omized to treatment with a triangle-shaped hydrocolloid border dressing  and 51 patients were r and omized to a different , oval shape , hydrocolloid dressing . The majority of patients ( 70 percent ) utilized a pressure reducing mattress or bed . Most ulcers were Stage II , had existed for < 1 month and exhibited no change utilizing previous treatments . Patients and wounds were similarly distributed among treatment groups . Patients in the oval dressing group were more likely to exhibit a product related adverse reaction result ing in discontinuation of treatment as compared to patients treated with the triangle border dressing ( p = 0.057 , Fisher 's Exact Test ) . Wear time was longest for wounds dressed with the triangle dressing applied point down . Incontinence reduced the interval between dressing changes in both groups . Healing was more likely to occur in wounds dressed with the triangle border dressing . These ulcers showed a greater reduction in ulcer width as compared to wounds dressed with the oval dressing ( p < 0.03 , Fisher 's Exact Test ) This study compared an adhesive hydrocellular dressing with a leading hydrocolloid dressing in the management of  pressure ulcers . Forty adult patients of both sexes who had Stage II or III pressure ulcers ( according to the Agency for Health Care Policy and Research system ) were enrolled in the study and were r and omized to either the hydrocellular or hydrocolloid dressing . Dressing changes were done as required , and each ulcer was assessed on a weekly basis . Patients were followed for 8 weeks , until ulcer closure was achieved , or until the patient was withdrawn from the study , whichever occurred first . The hydrocellular dressing was found to compare favorably with the hydrocolloid dressing . In terms of ease of use , the hydrocellular dressing was found to be significantly easier to remove ( P < 0.001 ) and quicker to change ( P < 0.001 ) than the hydrocolloid dressing . No differences were detected between the two dressing groups regarding mean wound pain , odor , and changes in ulcer appearance and ulcer area OBJECTIVES Pressure ulcers , like other chronic wounds , fail to proceed through an orderly and timely process to produce anatomical or functional integrity . Treatment of pressure ulcers is directed to improving host factors and providing an optimum wound environment . In addition to providing a moist wound environment , it has been theorized that preventing hypothermia in a wound and maintaining a normothermic state might improve wound healing . DESIGN / SETTING Forty-one subjects with a stage 3 or stage 4 truncal pressure ulcer > 1.0 cm(2 ) were recruited from outpatient 
    Output:
    
Concerning the healing of the pressure ulcer , hydrocolloids are more effective than gauze dressings for the reduction of the wound dimensions .
The absorption capacity , the time needed for dressing changes , the pain during dressing changes and the side-effects were significantly in favour of hydrocolloids if compared to gauze dressings .
Based on the available cost-effectiveness data , hydrocolloids seemed to be less expensive compared with collagen- , saline- and povidine-soaked gauze but more expensive compared to hydrogel , polyurethane foam and collagenase .
CONCLUSIONS This review demonstrates that hydrocolloids are to be preferred to gauze dressings in the treatment of  pressure ulcers .
RELEVANCE TO CLINICAL PRACTICE Based on the studies included in this review , hydrocolloids are frequently used in the treatment of grade 2 and 3 pressure ulcers  and are more effective and less expensive than gauze dressings .
Compared with alginates , polyurethane dressings , less-contact layers , topical enzymes and biosynthetic dressings , hydrocolloids are less effective