***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: OBJECTIVES To determine the comparative effectiveness and cost-effectiveness of three dressing products , N-A , Inadine and Aquacel , for patients with diabetic foot ulcers , as well as the feasibility and consequences of less frequent dressing changes by health-care professionals . DESIGN A multicentre , prospect i ve , observer-blinded , parallel group , r and omised controlled trial , with three arms . SETTING Established expert multidisciplinary clinics for the management of diabetic foot ulcers across the UK . PARTICIPANTS Patients over age 18 with type 1 or type 2 diabetes with a chronic ( present for at least 6 weeks ) full-thickness foot ulcer ( on or below the malleoli ) not penetrating to tendon , periosteum or bone , and with a cross-sectional area between 25 and 2500 mm(2 ) . INTERVENTIONS Participants were r and omised 1:1:1 to treatment with one of N-A ( a non-adherent , knitted , viscose filament gauze ) , Inadine ( an iodine-impregnated dressing ) , both traditional dressings , or Aquacel , a newer product . MAIN OUTCOME MEASURES The primary outcome measure was the number of ulcers healed in each group at week 24 . Secondary measures included time to healing , new ulcerations , major and minor amputations , and episodes of secondary infection . RESULTS A total of 317 patients were r and omised . After 88 withdrawals , 229 remained evaluable . A greater proportion of smaller ( 25 - 100 mm(2 ) ulcers healed within the specified time ( 48.3 % versus 37.3 % ; p = 0.048 ) . There was , however , no difference between the three dressings in terms of percentage healed by 24 weeks , or in the mean time to healing , whether analysed on the basis of intention to treat ( Inadine 44.4 % , N-A 38.7 % , Aquacel 44.7 % ; not significant ) or per protocol ( Inadine 55.2 % , N-A 59.4 % , Aquacel 63.0 % ; not significant ) . There was no difference in the quality of healing , as reflected in the incidence of recurrence within 12 weeks . Likewise , there was no difference in the incidence of adverse events , although a greater proportion of those r and omised to the non-adherent dressings were withdrawn from the study ( 34.9 % versus 29.1 % Aquacel and 19.4 % Inadine ; p = 0.038 ) . The only statistically significant difference found in the health economic analysis was the cost associated with the provision of dressings ( mean cost per patient : N-A 14.85 pounds , Inadine 17.48 pounds , Aquacel 43.60 pounds ) . The higher cost of Aquacel was not offset by the fewer dressings required . There was no difference in measures of either generic or condition-specific measures of quality of life . However , there was a significant difference in the change in pain associated with dressing changes between the first and second visits , with least pain reported by those receiving non-adherent dressings ( p = 0.012 ) . There was no difference in the costs of professional time , and this may relate to the number of dressing changes undertaken by non-professionals . Fifty-one per cent of all participants had at least one dressing change undertaken by themselves or a non-professional carer , although this ranged from 22 % to 82 % between the different centres . CONCLUSIONS As there was no difference in effectiveness , there is no reason why the least costly of the three dressings could not be used more widely across the UK National Health Service , thus generating potentially substantial savings . The option of involving patients and non-professional carers in changing dressings needs to be assessed more formally and could be associated with further significant reductions in health-care costs . TRIAL REGISTRATION Current Controlled Trials IS RCT N78366977 OBJECTIVE To compare the healing response of sequential topically applied cytokines to that of each cytokine alone and to a placebo in pressure ulcers , and to evaluate the molecular and cellular responses . SUMMARY BACKGROUND DATA Because of a deficiency of cytokine growth factors in chronic wounds and the reversal of impaired healing in animal models , pressure ulcer trials have been performed with several exogenously applied growth factors . Because single-factor therapy has not been uniformly successful , combination or sequential cytokine therapy has been proposed . Laboratory data have suggested that sequential treatment with granulocyte-macrophage/colony-stimulating factor (GM-CSF)/basic fibroblast growth factor ( bFGF ) might augment the previously reported effect of bFGF alone . METHODS A masked , r and omized pressure ulcer trial was performed comparing sequential GM-CSF/bFGF therapy with that of each cytokine alone and with placebo during a 35-day period . The primary measure was wound volume decrease over time . Cytokine wound levels and mRNA levels were serially determined . Fibroblast-populated collagen lattices ( FPCLs ) were constructed from serial fibroblast biopsies . Cellular ultrastructure was evaluated by electron microscopy . Changes in ease of surgical closure and its relative cost were determined . RESULTS Ulcers treated with cytokines had greater closure than those in placebo-treated patients . Patients treated with bFGF alone did the best , followed by the GM-CSF/bFGF group . Patients treated with GM-CSF or bFGF had higher levels of their respective cytokine after treatment . Patients with the greatest amount of healing showed higher levels of platelet-derived growth factor ( PDGF ) on day 10 and transforming growth factor beta ( TGFbeta1 ) on day 36 . Message for the bFGF gene was upregulated after treatment with exogenous bFGF , suggesting autoinduction of the cytokine . FPCLs did not mimic the wound responses . Ultrastructure of wound biopsies showed response to bFGF . Treatment with any of the cytokines improved the wound by allowing easier wound closure . This was most marked for the bFGF-alone treatment , with a cost savings of $ 9,000 to $ 9,200 . CONCLUSIONS Treatment with bFGF result ed in significantly greater healing than the other treatments in this trial . The clinical response appeared to be related to upregulation of the bFGF message and to increased levels of PDGF-AB , bFGF , and TGFbeta1 in the wounds and changes in ultrastructure . The result ant improvements could be correlated with cost savings The study investigated the cost‐effectiveness of four‐layer and short‐stretch compression b and ages for treating venous leg ulcers OBJECTIVE : Evaluate the effectiveness of telemedicine ( TM ) with digital cameras in treating wounds in a home care setting . DESIGN : R and omized controlled study . PARTICIPANTS AND SETTING : One hundred three subjects with 160 pressure ulcers ( PrUs ) or nonhealing surgical wounds referred to a metropolitan Visiting Nurse Agency . INTERVENTIONS : Subjects were r and omly assigned to 1 of 3 groups . Group A ( n = 40 ) : weekly visits with TM and wound care specialist ( WCS ) consults ; group B ( n = 28 ) : weekly visits with weekly consults with WCSs ; and group C ( n = 35 ) : usual and customary care . MAIN OUTCOME MEASURES : Outcome measures were time to heal , costs , length of stay ( LOS ) , nursing visits , wound status , and change in size . RESULTS : There was a similar distribution of subject characteristics in all 3 groups , but group A had disproportionally larger and more numerous PrUs and larger nonhealing surgical wounds . Group A had increased time to heal , LOS , costs , and visits compared with groups B and C ; wound status was similar in all groups . CONCLUSIONS : Uneven distribution of severity and type of wounds among groups , with greatest percentage of large wounds in TM group . Larger wounds consume more re sources . TM is a useful communication tool in wound management but with limited power when r and omization does not include wound size or type . Two important benchmarks were established for home care . First , it took 51 days , on average , to heal or improve PrUs and 34 days to heal or improve surgical wounds regardless of group . Second , nearly 90 % of wounds improved or healed OBJECTIVE —This study was design ed to test the safety , effectiveness , and costs of off-loading with a novel , off-the-shelf irremovable device in the management of diabetic foot ulceration ( DFU ) . RESEARCH DESIGN AND METHODS —We prospect ively evaluated off-loading of neuropathic plantar ulcers in 40 diabetic out patients attending our diabetic foot clinic and compared healing rates at the 12-week follow-up , number and severity of adverse events , healing time , costs and applicability of the device , and patients ’ satisfaction between those r and omly assigned to total contact casting ( TCC ; group A ) or to the Optima Diab walker ( group B ) . Deep or infected ulcers were excluded . RESULTS —No difference between groups A and B was observed in healing rates at 12 weeks ( 95 vs. 85 % ) , healing time ( 6.5 ± 4.4 vs. 6.7 ± 3.4 weeks ) , and number of adverse events ( six versus four ) . Treatment was significantly less expensive in group B , which showed a mean reduction of costs of 78 % compared with group A ( P < 0.001 ) . Practicability was more favorable in group B , with a reduction of 77 and 58 % of the time required for application and removal of the devices , respectively ( P < 0.001 ) . Patients ’ satisfaction with the treatment was higher in group B ( P < 0.01 ) . CONCLUSIONS —The Optima Diab walker is as safe and effective as TCC in the management of DFU , but its lower costs and better applicability may be of help in spreading the practice of off-loading among the centers that manage the diabetic foot Abstract Objectives : To establish the relative cost effectiveness of community leg ulcer clinics that use four layer compression b and aging versus usual care provided by district nurses . Design : R and omised controlled trial with 1 year of follow up . Setting : Eight community based research clinics in four trusts in Trent . Subjects : 233 patients with venous leg ulcers allocated at r and om to intervention ( 120 ) or control ( 113 ) group . Interventions : Weekly treatment with four layer b and aging in a leg ulcer clinic ( clinic group ) or usual care at home by the district nursing service ( control group ) . Main outcome measures : Time to complete ulcer healing , patient health status , and recurrence of ulcers . Satisfaction with care , use of services , and personal costs were also monitored . Results : The ulcers of patients in the clinic group tended to heal sooner than those in the control group over the whole 12 month follow up ( log rank P=0.03 ) . At 12 weeks , 34 % of patients in the clinic group were healed compared with 24 % in the control . The crude initial healing rate of ulcers in intervention compared with control patients was 1.45 ( 95 % confidence interval 1.04 to 2.03 ) . No significant differences were found between the groups in health status . Mean total NHS costs were £ 878.06 per year for the clinic group and £ 859.34 for the control ( P=0.89 ) . Conclusions : Community based leg ulcer clinics with trained nurses using four layer b and aging is more effective than traditional home based treatment . This benefit is achieved at a small additional cost and could be delivered at reduced cost if certain service configurations were used . Key messages Leg ulcer clinics based in the community using four layer compression b and aging can be more clinical ly effective than usual care provided by the district nursing service Community based leg ulcer clinics could be provided more cost effectively than usual home based care for venous leg ulcers Recurrence of venous leg ulcers is an important variable that should be measured in future trials of venous leg ulcer care It is difficult to measure improvements in health related quality of life among people with venous leg " Least costly but most effective " has never been more important to healthcare delivery than in the current healthcare environment of changing reimbursement systems . In wound care , the high costs associated with renting advanced support surfaces may be an area where expenses can be decreased if similar outcomes can be attained by using more affordable mattresses . This article compares the healing rates and eventual outcomes of wounds among two groups of patients r and omly assigned to one of two support surfaces . A commonly used low-air-loss mattress was compared with the study mattress , an advanced , non-powered , air and foam surface .  Subjects were patients admitted to either of two long-term healthcare setting s for the treatment of wounds . The result ing two groups of 10 patients each were evenly matched for average age and percentage of patients who were nutritionally deficient as indicated by albumin or pre-albumin levels . The presence of gastrointestinal tubes and ventilator dependency also was recorded . Consistent wound care protocol s were used on both groups , including turning schedules , nutrition , topical medication , and dressings . The study period covered a maximum of 8 weeks ; interest was centered on the rate of wound healing and progress toward a goal rather than the length of time to completely close a wound . After 8 weeks , or upon discharge from the study pressure ulcers in the study mattress group closed at an average rate per week of 9.0 % + /- 4.8 versus 5.0 % + /- 3.7 in the low-air-loss mattress group . This study indicates that the study mattress can provide benefits to the wound healing process similar to or better than low-air-loss mattresses at a substantially reduced cost OBJECTIVE ischa 
    Output:
    
Our analysis also highlights specific treatments that are not cost-effective , thereby indicating areas of re source savings .