***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 
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    Input: The EBN users ’ guide in the previous issue of Evidence -Based Nursing outlined the primary and secondary questions for evaluating studies of healthcare interventions . One of the primary questions for assessing the validity of a study ’s findings is whether the assignment of patients to treatments was r and omised and whether r and omisation was concealed . One of the secondary questions is whether patients , clinicians , outcome assessors , and data analysts were unaware of ( blinded to or masked from ) patient allocation . Beginning with the October 1999 issue of Evidence -Based Nursing , allocation concealment and blinding have been given more attention . The “ design ” section of abstract s of r and omised trials now includes a statement of whether r and omisation was concealed from those responsible for entering patients into trials , and who was blinded to treatment allocation during the trials . These additional specifications provide readers with more information to judge the internal validity of trials . In this editorial , the background and rationale for these decisions are addressed OBJECTIVE This double-blind r and omised controlled trial compared the effects of tap water and normal saline on the healing and infection rates of acute and chronic wounds . METHOD The trial was conducted in two metropolitan community health centres in New South Wales , Australia . Thirty-five patients with 49 acute or chronic wounds were r and omised to receive  wound irrigation  with either normal saline or tap water . RESULTS Statistical analysis demonstrated there was no significant difference between the infection and healing rates in wounds irrigated with normal saline or tap water . CONCLUSION Although the small sample size is a limitation of this study , the research ers conclude that drinkable tap water appears to provide a safe alternative to normal saline for wound cleansing and may be preferred by some patients OBJECTIVE To evaluate the impact of in-hospital pressure ulcer development on mortality among older , high-risk , hospitalized patients up to 1 year post-hospital discharge , after adjusting for baseline patient characteristics , disease severity , hospital complications , and discharge activity level . DESIGN A prospect i ve , inception , cohort study . SETTING An urban , tertiary , acute care , university teaching hospital . PATIENTS A total of 286 patients aged 55 or older , expected to be confined to bed or chair for at least 5 days , who were admitted to the hospital without a Stage 2 or greater pressure ulcer . MEASUREMENTS The primary outcome measurement was time to death from admission to 1-year post-hospital discharge . Baseline information included demographic , medical , functional , and nutritional variables known to be associated with increased mortality . Measures of global disease severity and co-morbidity included the admitting physician 's estimate of illness severity and life expectancy , the acute physiology score of APACHE II , the Co-morbidity Damage Index , and the Medicus Nursing Classification Score . Baseline infections , incident infections , and noninfectious hospital complications were determined . Functional activity level was determined at hospital discharge . Post-discharge vital status was determined by telephone interviews at 3,6,9 , and 12 months after discharge and confirmed by death certificate review . MAIN RESULTS Development of an in-hospital pressure ulcer was associated with greater risk of death at 1 year ( 59.5 % vs 38.2 % , P = .02 ) . However , pressure ulcer development did not remain independently associated with decreased survival after adjusting for other predictors of mortality . Predictors of mortality at hospital admission by multivariate Cox regression analysis included weight loss in the 6 months before admission ( RR 2.4 , CI 1.6 , 3.6 ) , physician estimate of life expectancy ( RR 2.1 , CI 1.7 , 2.6 ) , and the Co-morbidity Damage Index ( RR 1.1 , CI 1.0 , 1.2 ) . Multivariate predictors of 1-year mortality at discharge included physician estimate of life expectancy ( RR 2.2 , CI 1.8,2.6 ) , weight loss in the 6 months before admission ( RR 2.2 , CI 1.5,3.2 ) , remaining confined to bed or chair ( RR 1.9 , CI 1.2,3.1 ) , and the total number of hospital complications ( RR 1.3 , CI 1.2,1.5 ) . CONCLUSIONS Pressure ulcers that develop during acute hospitalization are not associated with reduced 1-year survival among high risk older persons after adjusting for nutritional and functional status , global measures of disease severity and co-morbidity , and noninfectious hospital complications Patients undergoing surgery are prone to develop pressure ulcers during the surgical procedure . The aim of the study was to gain insight into the problem by describing the incidence , clinical features and progression of pressure ulcers and closed pressure ulcers  in patients undergoing surgery lasting more than 4 hours . A prospect i ve follow-up study was conducted in a university hospital in the Netherl and s. Two-hundred and eight patients from nine surgical specialities were included in the study . The skin of patients was observed the evening before surgery and , if the patient 's condition allowed it , directly postoperatively and subsequently daily for 14 days or until discharge , whichever occurred first . When patients developed a pressure ulcer they were observed daily until discharge or until the pressure ulcer had healed . The size and colour of the lesion , stage and skin condition were described every day . In addition , data were collected concerning the operation , postoperative period , and general characteristics . Forty-four patients ( 21.2 % ) developed 70 pressure ulcers in the first 2 days following surgery . Twenty-one pressure ulcers deteriorated in the days following surgery . More than half ( 52.9 % ) of the lesions developed on the heels , and 15.7 % developed in the sacral area . Twenty-five patients ( 12 % ) were impaired by the lesions they developed . None of the patients in the study developed closed pressure ulcers . Pressure ulcer development during a surgical procedure is a serious problem . Therefore , preventive measures should be taken during surgery and the first few days afterwards , until the patient is able to mobilize independently Most systematic review s rely substantially on the assessment of the method ological quality of the individual trials . The aim of this study was to obtain consensus among experts about a set of generic core items for quality assessment of r and omized clinical trials ( RCTs ) . The invited participants were experts in the field of quality assessment of RCTs . The initial item pool contained all items from existing criteria lists . Subsequently , we reduced the number of items by using the Delphi consensus technique . Each Delphi round comprised a question naire , an analysis , and a feedback report . The feedback report included staff team decisions made on the basis of the analysis and their justification . A total of 33 international experts agreed to participate , of whom 21 completed all question naires . The initial item pool of 206 items was reduced to 9 items in three Delphi rounds . The final criteria list ( the Delphi list ) was satisfactory to all participants . It is a starting point on the way to a minimum reference st and ard for RCTs on many different research topics . This list is not intended to replace , but rather to be used alongside , existing criteria lists AIM To investigate which factors predict outcome of elderly patients on discharge and at 6 months . METHODS A prospect i ve study in an acute geriatric ward . Within 48 h of admission , patients were assessed for social factors , geriatric problems , admission diagnoses , medication , function and mental ability . Outcome measures were mortality , length of stay , institutionalization , readmissions and attendance at accident and emergency within 6 months . RESULTS 353 patients were studied , with a mean age of 81.8 years . Logistic regression analyses showed that variables predicting hospital mortality were Barthel index on admission , pre-morbid disability and polypharmacy . The only variable independently predictive of prolonged stay in hospital was a Barthel score of < 45 on admission . Functional disability on admission was predictive of institutionalization on discharge . Variables predicting mortality within 6 months of discharge were Barthel index on admission < 65 , presence of pressure sores , malnutrition and polypharmacy . Variables independently predictive of institutionalization were mental state and a low pension . Those who took more than five drugs on admission were more likely to attend accident and emergency and be readmitted . CONCLUSION Limited activities of daily living and geriatric problems on admission are the strongest predictive factors of outcome , independent of diagnoses OBJECTIVE To find out if there were any differences in infection rates if acute traumatic soft tissue wounds were cleaned with tap water instead of sterile saline . DESIGN R and omised study . SETTING Emergency department at one city hospital . SUBJECTS 705 consecutive patient with soft tissue wounds less than six hours old that did not penetrate a viscus , cavity , or joint and could be treated by primary suture . INTERVENTIONS R and omly allocated to have the wound cleaned with either sterile saline or tap water in addition to debridement . MAIN OUTCOME MEASURE Rate of wound infection , the presence of which was indicated by pus in the wound and prolonged healing . RESULTS The infection rate in wounds cleaned with sterile saline was 10.3 % compared with 5.4 % in wounds cleaned with tap water ( p less than 0.05 ) . Infected wounds were significantly larger than uninfected ones ( p less than 0.05 ) and more likely to be located on a lower extremity ( p less than 0.05 ) . There were no microbiological differences between the two groups , and no bacterial species grown from tap water was subsequently grown from an infected wound . CONCLUSION Sterile saline should be replaced by tap water for the cleaning of acute traumatic superficial soft tissue wounds The presence of bacteria and local infection is an important factor in the local management of chronic pressure ulcers . For successful closure of the ulcer , the bacterial count should be 10(5 ) or less per gram of tissue in the granulating wound . In a prospect i ve r and omized study of 45 ( eventually 40 ) hospitalized patients , silver sulfadiazine ( Silvadene ) cream and povidone-iodine ( Betadine ) solution were compared to physiologic saline for effectiveness in preparing pressure ulcers for closure . Quantitative bacteriologic techniques on tissue biopsy specimens were used for objective evaluation . In 100 percent of the ulcers treated with silver sulfadiazine cream ( 15 patients ) the bacterial counts were reduced to 10(5 ) or less per gram of tissue within the three-week test period , compared to 78.6 percent in those treated with saline ( 14 patients ) and 63.6 percent in those treated with povidone-iodine solution ( 11 patients ) . Moreover , the ulcers treated with silver sulfadiazine cream responded more rapidly , with one-third showing bacterial levels of less than 10(5 ) within three days , and half within a week UNLABELLED BACKGROUND L : Pressure ulcers are common , costly and impact negatively on individuals . Pressure is the prime cause , and immobility is the factor that exposes individuals to pressure . International guidelines advocate repositioning ; however , there is confusion surrounding the best method and frequency required . DESIGN A pragmatic , multi-centre , open label , prospect i ve , cluster-r and omised controlled trial was conducted to compare the incidence of  pressure ulcers among older persons nursed using two different repositioning regimens . METHOD Ethical approval was received . Study sites ( n=12 ) were allocated to study arm using cluster r and omisation . The experimental group ( n=99 ) were repositioned three hourly at night , using the 30 ° tilt ; the control group ( n=114 ) received routine prevention ( six-hourly repositioning , using 90 ° lateral rotation ) . Data analysis was by intention to treat ; follow-up was for four weeks . RESULTS All participants ( n=213 ) were Irish and white , among them 77 % were women and 65 % aged 80 years or older . Three patients ( 3 % ) in the experimental group and 13 patients ( 11 % ) in the control group developed a pressure ulcer ( p=0·035 ; 95 % CI 0·031 - 0·038 ; ICC=0·001 ) . All pressure ulcers were grade 1 ( 44 % ) or grade 2 ( 56 % ) . Mobility and activity were the highest predictors of pressure ulcer development ( β=-0·246 , 95 % CI=-0·319 to -0·066 ; p=0·003 ) ; ( β=0·227 , 95 % CI=0·041 - 0·246 ; p = 0·006 ) . CONCLUSION Repositioning older persons at risk of pressure ulcers every three hours at night , using the 30 ° tilt , reduces the incidence of pressure ulcers compared with usual care . The study supports the recommendations of the 2009 international pressure ulcer prevention guidelines . RELEVANCE TO CLINICAL PRACTICE An effective method of pressure ulcer prevention has been identified ; in the light of the problem of pressures ulcers , current prevention strategies should be review ed . It is important to implement appropriate prevention strategies , of which repositioning is one Background Pressure ulcer development is a common , serious complication after spinal cord injury ( SCI ) . Although many biophysical agents are available for treatment , few r and omized controlled trials of their efficacy have been done . Objective The study objective was to examine the efficacy of low-pressure pulsatile lavage treatment for  stage III and IV pressure ulcers in people with SCI . Design This study was a r and omized controlled trial . Participants and assessors were unaware of intervention assignments . Setting This study was conducted in an SCI tertiary care center inpatient unit . Participants Participants were 28 people with SCI and stage III and IV pelvic pressure ulcers ; 14 participants each were r and om 
    Output:
    
The authors conclude that there is no good trial evidence to support use of any particular wound cleansing solution or technique for pressure ulcers