***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: OBJECTIVE To compare the efficacy and tolerability of a new ionic silver alginate matrix ( Askina Calgitrol Ag ) with that of a st and ard silver-free alginate dressing ( Algosteril ) . METHOD Patients with locally infected chronic wounds ( pressure ulcers , venous or mixed aetiology leg ulcers , diabetic foot ulcers ) or acute wounds were eligible for this prospect i ve , open-label , controlled and r and omised trial . Patients were r and omised to receive one of the two dressings for a two-week period . Criteria of efficacy were based on the evolution , from day 1 to day 15 , of local signs of infection using a clinical score ranging from 0 to 18 , and the evolution of the bacteriological status for each wound . The latter was determined by ( blind ) bacteriological examinations of results obtained from two biopsies performed at days 1 and 15 . A three-point scale ( deterioration , unchanged , improvement ) was also used . Acceptability , usefulness and tolerance were also assessed . RESULTS Forty-two patients ( 20 women and 22 men , 68.9 + /- 18.8 and 66.5 + /- 15.7 years old respectively ) were r and omly assigned to receive either Askina Calgitrol Ag ( n=20 ) or Algosteril ( n=22 ) . Most had chronic wounds such as pressure ulcers ( 57 % ) or venous or mixed aetiology leg ulcers and diabetic foot ulcers ( 29 % ) ; few had acute wounds ( 14 % ) .  Clinical scores of infection were comparable in both groups at inclusion , 8.9 + /- 2.4 and 8.6 + /- 3.2 in the Askina Calgitrol Ag group and the Algosteril group respectively ( not significant ) , but decreased significantly in both groups at day 15 , 3.8 + /- 2.9 in the Askina Calgitrol Ag group ( p=0.001 ) and 3.8 + /- 3.4 in the Algosteril group ( p=0.007 ) . There was no significant difference between the two groups at day 15 . Although there was also no significant difference in bacteriological status between the treatment groups , a trend in favour of Askina Calgitrol Ag was found for the relative risk of improvement , especially in patients who were not treated with antibiotics either at the beginning of the study or during it . No differences between groups were observed regarding local tolerance , acceptability and usefulness of the dressings . CONCLUSION The regression of local signs of infection , local tolerance , acceptability and usefulness were similar for the two dressings . However , Askina Calgitrol Ag improved the bacteriological status of the wounds . Further trials are required to show that it has a positive impact on the healing process 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 Objectives To evaluate if ‘ wrap therapy ’ using food wraps , which is widely used in Japanese clinical sites , is not inferior when compared to guideline adhesion treatments . Design Multicentre , prospect i ve , r and omised , open , blinded endpoint clinical trial . Setting 15 hospitals in Japan . Patients 66 older patients with new National Pressure Ulcer Advisory Panel stage II or III pressure ulcers . Interventions Of these 66 patients , 31 were divided into the conventional treatment guidelines group and 35 into the wrap therapy group . Main outcome measures The primary end point was the period until the pressure ulcers were cured . The secondary end point was a comparison of the speed of change in the Pressure Ulcer Scale for Healing score . Results 64 of the 66 patients were analysed . The estimated mean period until healing was 57.5 days ( 95 % CI 45.2 to 69.8 ) in the control group as opposed to 59.8 days ( 95 % CI 49.7 to 69.9 ) in the wrap therapy group . By the extent of pressure ulcer infiltration , the mean period until healing was 16.0 days ( 95 % CI 8.1 to 23.9 ) in the control group as opposed to 18.8 days ( 95 % CI 10.3 to 27.2 ) in the wrap therapy group with National Pressure Ulcer Advisory Panel stage II ulcers , and 71.8 days ( 95 % CI 61.4 to 82.3 ) as opposed to 63.2 days ( 95 % CI 53.0 to 73.4 ) , respectively , with stage III ulcers . There is no statistical significance in difference in Pressure Ulcer Scale for Healing scores . Conclusions It might be possible to consider wrap therapy as an alternative choice in primary care setting s as a simple and inexpensive dressing care . Clinical Trial registration UMIN Clinical Trials Registry UMIN000002658 . Summary protocol is available on https://upload.umin.ac.jp/cgi-bin/ctr/ctr.cgi?function=brows&action=brows&type=detail&recptno=R000003235&admin=0 & language = Background The treatment of pressure ulcers is complicated , given the various wound dressing products available . The cost of different treatments varies and the cost-effectiveness of each product has not been thoroughly evaluated . We compare two wound dressing protocol s-alginate silver dressing ( AlSD ) and silver zinc sulfadiazine cream ( AgZnSD ) with regard to wound healing and cost-effectiveness . Methods Patients with grade III or IV sacral or trochanteric pressure ulcers were eligible for this prospect i ve , r and omized controlled trial . The patients were r and omized to receive one of the two dressings for an eight-week period . The criteria of efficacy were based on the Pressure Ulcer Scale for Healing ( PUSH ) scoring tool . The cost of treatment was also assessed . Results Twenty patients ( 12 women and 8 men ) were r and omly assigned to receive either AlSD ( n=10 ) or AgZnSD cream ( n=10 ) . The demographic data and wound characteristics were comparable in the two groups . The two groups showed no significant difference in the reduction of PUSH score , wound size , or volume of exu date . The tissue type score was significantly lower in the AlSD group ( 3.15±0.68 - 1.85±0.68 vs. 2.73±0.79 - 2.2±0.41 ; P=0.015 ) . The cost of treatment was significantly lower in the AlSD group ( 377.17 vs. 467.74 USD , respectively ; P<0.0001 ) . Conclusions Alginate silver dressing could be effectively used in the treatment of grade III and IV pressure ulcers . It can improve wound tissue characteristics and is cost-effective 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 In a prospect i ve , r and omised , controlled trial of 92 patients with full-thickness pressure ulcers , the efficacy of an alginate wound dressing was compared to that of an established local treatment with dextranomer paste . During treatment , a minimal 40 % reduction in wound area was obtained in 74 % of the patients in the alginate group and in 42 % of those in the dextranomer group . The median time taken to achieve this goal was four weeks with alginate and more than eight weeks in the control group . Mean surface area reduction per week was 2.39cm2 ( sd 3.54 ) and 0.27cm2 ( sd 3.21 ) in the alginate and dextranomer groups respectively ( p=0.0001 ) . This difference was still highly significant when the sub-groups of almost completely healed subjects at the end of the study were considered . This striking healing efficacy of an alginate dressing suggests it possesses pharmacological properties which require further investigation BACKGROUND There have been no studies that have tested the Braden Scale for predictive validity and established cutoff points for assessing risk specific to different setting s. OBJECTIVES To evaluate the predictive validity of the  Braden Scale  in a variety of setting s ( tertiary care hospitals , Veterans Administration Medical Centers [ VAMCs ] , and skilled nursing facilities [ SNFs ] ) . To determine the critical cutoff point for classifying risk in these setting s and whether this cutoff point differs between setting s. To determine the optimal timing for assessing risk across setting s. METHOD R and omly selected subjects ( N= 843 ) older than 19 years of age from a variety of care setting s who did not have pressure ulcers on admission were included . Subjects were 63 % men , 79 % Caucasian , and had a mean age of 63 ( + /-16 ) years . Subjects were assessed for  pressure ulcers  using the  Braden Scale  every 48 to 72 hours for 1 to 4 weeks . The  Braden Scale score and skin assessment  were independently rated , and the data collectors were blind to the findings of the other measures . RESULTS One hundred eight of 843 ( 12.8 % ) subjects developed pressure ulcers . The incidence was 8.5 % , 7.4 % , and 23.9 % in tertiary care hospitals , VAMCs , and SNFs , respectively . Subjects who developed pressure ulcers were older and more likely to be female than those who did not develop ulcers . Braden Scale scores were significantly ( p = .0001 ) lower in those who developed ulcers than in those who did not develop ulcers . Overall , the critical cutoff score for predicting risk was 18 . Risk assessment on admission is highly predictive of pressure ulcer development in all setting s but not as predictive as the assessment completed 48 to 72 hours after admission . CONCLUSIONS Risk assessment on admission is important for timely planning of preventive strategies . Ongoing assessment in SNFs and VAMCs improves prediction and permits fine-tuning of the risk-based prevention protocol s. In tertiary care the most accurate prediction occurs at 48 to 72 hours after admission and at this time the care plan can be refined Background Pressure ulcers ( PrUs ) are ischemic wounds in the skin and underlying tissues caused by long-st and ing pressure force over an external bone or cartilaginous surface . PrUs are an important challenge for the overall health system because can prolong patient hospitalization and reduce quality of life . Moreover , 95 % of PrUs are avoidable , suggesting they are caused by poor quality care assistance . PrUs are also costly , increasing national costs . For example , they represent about 5 % of overall annual health expenses in Spain . Stages I and II PrUs have a combined prevalence of 65 % . According main clinical guidelines , 
    Output:
    
Where data were available there was no evidence of a difference between alginate dressings and alternative treatments in terms of complete wound healing or adverse events .
AUTHORS ' CONCLUSIONS The relative effects of alginate dressings compared with alternative treatments are unclear .