***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 . Infections are the major life-threatening complication of burn injury and occur with the greatest frequency in children . Knowledge of their occurrence and management , however , is extrapolated from studies in adults . We performed a prospect i ve study of infectious complications in burned children . Objective . To delineate epidemiology , risk factors and microbiology of infections in burned children where burn care and surgical interventions are optimal . Methods . Children hospitalized for burns were entered into prospect i ve study . Characteristics of the burn injury were assessed , and active surveillance for infections was performed . Results . Seventy patients were entered [ mean age , 42 months ; mean total body surface area ( TBSA ) , burn 15 % ] . Twenty-seven percent of patients developed 39 infections : 13 involved the burn wound ( burn wound sepsis , 6 ; graft loss , 5 ; and cellulitis , 2 ) ; 13 were catheter-associated septicemia ; 13 involved other sites ( i.e. pneumonia , 4 ; urinary tract infection , 3 ; bacteremia , 2 ; endocarditis , 1 ; myocardial abscess , 1 ; toxin-mediated syndrome , 1 ; and otitis media , 1 ) . Twenty-three infections were caused by a single organism , 9 infections by more than 1 organism and in 7 infections defined by CDC criteria no organism was recovered . Organisms causing infection were : Staphylococcus aureus , 19;C and ida albicans , 4;Pseudomonas aeruginosa , 4 ; coagulase-negative Staphylococcus , 4;Enterococcus sp. , 3;Escherichia coli , 1;Klebsiella oxytoca , 1;Serratia marcescens , 1;Streptococcus pneumoniae , 1;Streptococcus pyogenes , 1;Aspergillus fumigatus , 1 ; and C and ida parapsilosis , 1 . Burn mechanism ( flame and inhalation ) , extent ( TBSA > 30 % ) and depth ( full thickness ) were risk factors for infection ; young age and site of burn were not . Conclusion . The most common infections occurring in burn children are burn wound infections and catheter-associated septicemia . Characteristics of burn injury predict risk of infection . Children with flame and inhalation injury , TBSA burned > 30 % and full thickness burns are at high risk of infectious complications This prospect i ve , r and omized study compared protocol s of care using either AQUACEL ® Ag Hydrofiber ® ( ConvaTec , a Bristol-Myers Squibb company , Skillman , NJ ) dressing with silver ( n = 42 ) or silver sulfadiazine ( n = 42 ) for up to 21 days in the management of partial-thickness burns covering 5 % to 40 % body surface area ( BSA ) .  AQUACEL ® Ag dressing was associated with less pain and anxiety during dressing changes , less burning and stinging during wear , fewer dressing changes , less nursing time , and fewer procedural medications . Silver sulfadiazine was associated with greater flexibility and ease of movement . Adverse events , including infection , were comparable between treatment groups . The AQUACEL ® Ag dressing protocol tended to have lower total treatment costs ( $ 1040 vs. $ 1180 ) and a greater rate of re-epithelialization ( 73.8 % vs 60.0 % ) , result ing in cost-effectiveness per burn healed of $ 1,409.06 for AQUACEL ® Ag dressing and $ 1,967.95 for silver sulfadiazine . A protocol of care with AQUACEL ® Ag provided clinical and economic benefits compared with silver sulfadiazine in patients with partial-thickness burns OBJECTIVE To investigate and evaluate the clinical efficacy and safety of Acticoat with nanocrystalline silver for external use on the management of the residual wounds post-burn . METHODS One hundred and sixty-six wounds of 98 burn patients were enrolled and divided into Acticoat group and silver sulfadiazine group in the multi-center r and omized clinical trial . Acticoat was used as the treated group for those who have redness , swelling , and excessive secretion ( " heavy " exu date s ) in the wound , Acticoat was changed once a day . When there is not much secretion in the wound , or redness and swelling were not obvious , the dressings were changed once every 3 days . Silver sulfadiazine ( SD-Ag ) was used as control group , which was treated under the usual clinical routine . Healing time was observed up to 20 days . Healing percentage on the 15th day after treatment was determined . RESULTS Healing time was 12.42+/-5.40 days after the application of Acticoat . This was significantly shorter than that of control wounds . The wounds of the trial group healed nearly 3.35 days earlier than the control ones . Healing percentage at 15 days in the trial wounds was 97.37 % , which was higher than the control , but there was no significant difference between them . The bacterial clearance rate of the Acticoat group on the 6th and 12th day post-treatment was 16.67 and 26.67 % , respectively , which was significantly higher than the control . CONCLUSIONS Acticoat with nanocrystalline silver promotes the healing process of residual wounds post-burn effectively . No adverse reaction of Acticoat was found during the study Silver sulfadiazine has been used as a topical burn wound treatment for many years . Pain associated with dressing changes is a common problem in burn wounds .  Aquacel Ag , a hydrofiber dressing coated with ionic silver has been reported to reduce burn wound infection and promote antimicrobial activity . The purpose of this study was to show the benefits of Aquacel Ag for the treatment of partial thickness burns . This prospect i ve r and omized study was conducted in 70 patients who had partial thickness burns less than 15 % of total body surface area and were treated at Siriraj outpatient burn clinic during December 2006-February 2008 . Patients were divided into two groups : Aquacel Ag-treated group with dressing changes every 3 days ( 35 patients ) and 1 % silver sulfadiazine-treated group , with daily dressing changes ( 35 patients ) . There was no difference in demographic data including age , gender , burn percentage between groups .  Time-to-wound healing pain score during dressing change and cost of treatment were compared between both groups . Time-to-wound closure was significantly shorter in the Aquacel Ag-treated group ( 10 + /- 3 versus 13.7 + /- 4 days , P < 0.02 ) as well as pain scores at days 1 , 3 and 7 ( 4.1 + /- 2.1 , 2.1 + /- 1.8 , 0.9 + /- 1.4 versus 6.1 + /- 2.3 , 5.2 + /- 2.1 , 3.3 + /- 1.9 , respectively , P < 0.02 ) . Total cost of treatment was 52 + /- 29 US dollars for the Aquacel Ag-treated group versus 93 + /- 36 US dollars for the silver sulfadiazine-treated group . This study showed that Aquacel Ag increased time to healing , decreased pain symptoms and increased patient convenience because of limiting the frequency of replacement of the dressing at lower total cost . This study confirms the efficacy of Aquacel Ag for the treatment of partial thickness burns at an outpatient clinic Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more The very first rigorously design ed , r and omized controlled trial ( RCT ) in the history of modern medicine was published in 1948 . The study , design ed and carried out by the Streptomycin in Tuberculosis Trials Committee of the Medical Research Council , demonstrated the efficacy of streptomycin in treating pulmonary tuberculosis on top of bed rest , which was the best available treatment at that time.1 In the field of hypertension treatment and cardiovascular prevention , the history of event-based RCTs began in 1967 , when the cardiovascular benefits and risks of antihypertensive drug treatment were evaluated in the setting of the Veterans Administration Cooperative Study in Hypertension.2 In that trial , 143 patients with severe hypertension were r and omized to receive blood pressure (BP)–lowering drug treatment or matched placebo for 11 months . A major morbid or fatal event was observed in 26 of 70 patients who received placebo ( 37 % ) and in only 1 of 73 patients under active treatment ( 1 % ) . The amazing results of this l and mark trial established beyond any doubt the striking cardiovascular benefits of antihypertensive drug treatment of hypertension at a time when controversy still persisted regarding the supposedly deleterious effects of BP reduction on organ perfusion.3 Ever since , RCTs have represented a formidable tool for evaluating risks and benefits of hypertension treatment . Over the past 50 years , the remarkable progress in treatment and control of high BP , one of the most outst and ing achievements of modern medicine , has been driven by the results of many large , event-based RCTs . The influential position of RCTs in clinical and therapeutic research as opposed to real-world observational studies ( surveys , registries , and retrospective analyses of existing data bases ) originates from their high internal validity ( ie , the power to address clinical questions with a low level of internal bias ) . A list of strengths and weaknesses of RCTs and observational studies is BACKGROUND Partial-thickness burns are among the most frequently encountered types of burns , and numerous dressing material s are available for their treatment . A multicenter , open , r and omized , and parallel study was undertaken to determine the efficacy and tolerability of silver sulfadiazine ( SSD ) compared with an absorbent foam silver dressing , Mepilex Ag , on patients aged between 5 years and 65 years with deep partial-thickness thermal burn injuries ( 2.5–25 % total body surface area ) . METHODS Patients were r and omly assigned to either SSD ( n = 82 ) applied daily or a Mepilex Ag dressing ( n = 71 ) applied every 5 days to 7 days . The treatment period was up to 4 weeks . RESULTS There was no significant difference between the two treatment groups with respect to the primary end point of time to healing , which occurred in 56 ( 79 % ) of 71 patients after a median follow-up time of 15 days in the Mepilex Ag group compared with 65 ( 79 % ) of 82 patients after a median follow-up time of 16 days in the SSD group ( p = 0.74 ) . There was also no significant difference in the percentage of study burn healed . Patients in the Mepilex Ag group had 87.1 % of their study burn healed ( out of the total burn area ) compared with 85.2 % of patients in the SSD group . However , the mean total number of dressings used was significantly more in the SSD group ( 14.0 ) compared with the Mepilex Ag group ( 3.06 , p < 0.0001 ) . There was no significant difference in the time until skin graft was performed between the two study groups . CONCLUSION There was no difference in healing rates between Mepilex Ag and SSD , with both products well tolerated . The longer wear time of Mepilex Ag promotes undisturbed healing and makes it easier for patients to continue with their normal lives sooner . LEVEL OF EVIDENCE Therapeutic study , level III A new silver-coating technology was developed to prevent wound adhesion , limit nosocomial infection , control bacterial growth , and facilitate burn wound care through a silver-coated dressing material . For the purpose s of this article , Acticoat ( West aim Biomedical Inc , Fort Saskatchawan , Alberta , Canada ) silver-coated dressing was used . After in vitro and in vivo studies , a r and omized , prospect i ve clinical study was performed to assess the efficacy and ease of use of Acticoat dressing as compared with the efficacy and ease of our institution 's st and ard burn wound care . Thirty burn patients with symmetric wounds were r and omized to be treated with either 0.5 % silver nitrate solution or Acticoat silver-coated dressing . The dressing was evaluated on the basis of overall patient comfort , ease of use for the wound care provider , and level of antimicrobial effectiveness . Wound pain was rated by the patient using a visual analog scale during dressing removal , application , and 2 hours after application . Ease of use was rated by the nurse providing wound care . Antimicrobial effectiveness was evaluated by quantitative burn wound biopsies performed before and at the end of treatment . Patients found dressing removal less painful with Acticoat than with silver nitrate , but they found the pain to be comparable during application and 2 hours after application . According to the nurses , there was no statistically significant difference in the ease of use . The frequency of burn wound sepsis ( > 10(5 ) organisms per gram of tissue ) was less in Acticoat-treated wounds than in those treated with silver nitrate ( 5 vs 16 ) . Secondary bacteremias arising from infected burn wounds were also less frequent with Acticoat than with silver nitrate-treated wounds ( 1 vs 5 ) . Acticoat dressing offers a new form of dressing for the burn wound , but it requires further investigation with greater numbers of patients in a larger number of centers and in different phases of burn w 
    Output:
    
There were no statistically significant differences in infection rates and surgical procedures between nanocrystalline silver , silver-impregnated hydrofiber dressing , and silver-impregnated foam dressing ; however , nanocrystalline silver was found to be the most beneficial for all the outcomes , including infection rates and surgical procedures , according to the Monte Carlo simulation method .
In conclusion , current evidence from the published literature suggests that where the clinical and microbiological priority is to get in control of infection quickly it would seem prudent to use the most potent silver delivery system , which is nanocrystalline silver .
Nanocrystalline silver may offer both clinical and economic benefits compared to alternative treatments in the management of patients with mixed burns that are at high risk of infection