***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 One goal of wound healing research is to discover agents to accelerate healing . Regulatory agencies have suggested stringent criteria to determine efficacy , that of 100 % wound closure . Data analysis at a single point such as 100 % closure does not provide detailed information about agent effectiveness over the entire span of healing . HYPOTHESIS Wound healing trajectories can provide such information and can be used to demonstrate utility as alternative end points for wound healing trials . DESIGN Data from 160 patients in 11 clinical trials of diabetic foot ulcers conducted at 2 centers were evaluated .  Wound healing trajectories  were constructed for patients whose wounds healed ( 100 % closure ) and those whose did not ( < 100 % closure ) over a 20-week period . The percentage of patients achieving total healing vs time of treatment was plotted and divided into patients receiving a test agent or placebo . RESULTS The healing trajectories were almost identical for patients achieving complete healing at the 2 centers , as were the trajectories for patients with less than 100 % closure . However , the trajectories of patients achieving total healing were significantly different from those not achieving 100 % closure . Fifty-two percent of all patients achieved 100 % healing by 20 weeks ; 61 % of patients receiving an experimental agent had total healing compared with 39 % of placebo-treated patients . Linear regression suggested that all patients would achieve total healing by 37 weeks . CONCLUSIONS Since wound healing trajectories for diabetic foot ulcers treated at 2 centers so closely mimic one another , trajectories might be useful efficacy end points , and used to compare significant points along a continuum rather than a single static end point . Shifting of the wound healing trajectory from an impaired to a more ideal course may be considered when determining efficacy of new wound treatments In a controlled r and omized study on 40 patients with venous leg ulcers , monotherapy with a dry wound dressing ( silver-impregnated -- activated charcoal xerodressing ; SIAX ) was tested . The xerodressing was applied throughout the entire study and was compared with the conventional phase-adapted therapy using diverse topical modalities , e.g. as granulating ointments , zinc paste . etc . The parameters of wound healing were documented in the two r and omized groups over 6 weeks and were statistically evaluated . In the statistical comparison of SIAX therapy ( n = 19 ) and conventional therapy ( n = 19 ) significant differences were found in favour of the SIAX group ( increase of epithelialization , reduction of ulcer size ; P less than 0.05 ) . In addition , the ulcers of 6/19 patients (= 31.6 % ) treated with SIAX  healed completely within the study period , in contrast to only 2/19 patients (= 10.5 % ) receiving conventional therapy . Exu date , granulation and colonization of the ulcers as well as odour , necroses , erythema and oedema of the surrounding areas were not significantly different . The study shows that a consistent therapy performed with dry wound dressings such as SIAX is superior to the conventional topical therapy of venous leg ulcers in some cases . Wound dressings provide new therapeutic modalities , being easy to apply and fully efficient , without side-effects This prospect i ve , r and omised clinical trial compared pain , comfort , exu date management , wound healing and safety with Hydrofiber dressing with ionic silver ( Hydrofiber Ag dressing ) and with povidone-iodine gauze for the treatment of open surgical and traumatic wounds . Patients were treated with Hydrofiber Ag dressing or povidone-iodine gauze for up to 2 weeks . Pain severity was measured with a 10-cm visual analogue scale ( VAS ) . Other parameters were assessed clinical ly with various scales . Pain VAS scores decreased during dressing removal in both groups , and decreased while the dressing was in place in the Hydrofiber Ag dressing group ( n = 35 ) but not in the povidone-iodine gauze group ( n = 32 ) . Pain VAS scores were similar between treatment groups . At final evaluation , Hydrofiber Ag dressing was significantly better than povidone-iodine gauze for overall ability to manage pain ( P < 0.001 ) , overall comfort ( P < or = 0.001 ) , wound trauma on dressing removal ( P = 0.001 ) , exu date h and ling ( P < 0.001 ) and ease of use ( P < or = 0.001 ) . Rates of complete healing at study completion were 23 % for Hydrofiber Ag dressing and 9 % for povidone-iodine gauze ( P = ns ) . No adverse events were reported with Hydrofiber Ag dressing ; one subject discontinued povidone-iodine gauze due to adverse skin reaction .  Hydrofiber Ag dressing supported wound healing and reduced overall pain compared with povidone-iodine gauze in the treatment of open surgical wounds requiring an antimicrobial dressing New treatments for chronic wounds require carefully performed clinical trials with significant endpoints . Total wound closure is the only endpoint currently accepted by the Food and Drug Administration . This study describes a scale that measures ease of wound closure and applies it to a four-arm prospect ively r and omized , blinded pressure ulcer trial of recombinant human platelet-derived growth factor-BB .  Following validation of interrater reliability , 83 evaluable subjects ' photographs were given a weekly ease of closure score by four raters blinded to treatment . The change of ease of closure score was correlated with the change of wound area and volume . Each ease of closure score was given a procedural cost . Results showed ease of closure did not directly correlate with either wound area or volume , suggesting that it was measuring additional information . The mean change in ease of closure score was 6 for subjects treated with 100 microg recombinant human platelet-derived growth factor-BB daily ; 5 for those treated with 300 microg growth factor daily or 100 microg recombinant human platelet-derived growth factor-BB bid ; and 4 for those treated with placebo . The cost savings ranged from $ 7200 for the group receiving 100 microg recombinant human platelet-derived growth factor-BB daily to $ 6300 for the controls . Outcomes in all 4 groups were significantly improved from their starting evaluation ( p < 0.001 ) . Based on this study , ease of closure is a verifiable endpoint that can be related to cost efficiency and may be a measure of efficacy OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity AIMS Diabetic foot ulcers ( DFUs ) are at risk of infection and impaired healing , placing patients at risk of lower extremity amputation . DFU care requires debridement and dressings . A prospect i ve , multicentre study compared clinical efficacy and safety of AQUACEL Hydrofiber dressings containing ionic silver ( AQAg ) with those of Algosteril calcium alginate ( CA ) dressings in managing out- patients with Type 1 or 2 diabetes mellitus and non-ischaemic Wagner Grade 1 or 2 DFUs . METHODS Patients stratified by antibiotic use on enrolment were r and omly assigned to similar protocol s including off-loading , AQAg ( n = 67 ) or CA ( n = 67 ) primary dressings and secondary foam dressings for 8 weeks or until healing . Clinical efficacy measures were healing outcomes and primarily healing speed . Adverse events were recorded . RESULTS AQAg and CA groups were comparable at baseline . All ulcer healing outcomes improved in both groups . The mean time to healing was 53 days for AQAg ulcers and 58 days for CA ulcers ( P = 0.34 ) . AQAg-treated ulcers reduced in depth nearly twice as much as CA-treated ulcers ( 0.25 cm vs. 0.13 cm ; P = 0.04 ) . There was more overall ulcer improvement and less deterioration in AQAg subjects ( P = 0.058 ) , particularly in the subset initially using antibiotics ( P = 0.02 ) . Safety profiles of both groups were similar . CONCLUSION When added to st and ard care with appropriate off-loading , AQAg silver dressings were associated with favourable clinical outcomes compared with CA dressings , specifically in ulcer depth reduction and in infected ulcers requiring antibiotic treatment . This study reports the first significant clinical effects of a primary wound dressing containing silver on DFU healing The study compared the effect of a sustained silver-release foam dressing ( Contreet Foam ) with a foam dressing ( Allevyn Hydrocellular ) without added silver in critically colonised venous leg ulcers with delayed healing .  The study was a multicentre , open , r and omised , controlled study lasting for 4 weeks . Ulcer area and healing were assessed weekly . Odour , maceration , absorption capacity and leakage were evaluated at dressing changes . All adverse events were recorded . One hundred and twenty-nine patients were included ( Contreet Foam : 65 , Allevyn Hydrocellular : 64 ) . The two groups were comparable in all respects . After 4 weeks , there was a significantly greater reduction in ulcer area in the Contreet Foam group ( 45 % ) than in the Allevyn Hydrocellular group ( 25 % ) . After 1 and 4 weeks , odour was present in significantly less of the ulcers in the Contreet Foam group ( 17 % and 19 % , respectively ) compared with the Allevyn Hydrocellular group ( 47 % and 39 % , respectively ) and at the final visit there were significantly fewer leakages in the Contreet Foam group ( 19 % ) compared with the Allevyn Hydrocellular group ( 49 % ) . Also , less maceration was observed after 1 and 4 weeks in the Contreet Foam group ( 34 % and 37 % , respectively ) compared with the Allevyn Hydrocellular group ( 55 % and 48 % , respectively ) . The occurrence and cause of adverse events were equally distributed between the study groups . The present study provides evidence of the superior performance of the silver-releasing dressing , Contreet Foam , compared with a traditional moist foam wound healing dressing in the treatment of critically colonised , chronic venous leg ulcers . The results of this r and omised , controlled study suggest an important role of sustained silver-releasing dressings in the treatment of critically colonised chronic wounds UNLABELLED ﻿ Objective . Clinical interest of silver in the management of  chronic wounds is not fully established . The main objective of this clinical study was to assess the ability of a new silver releasing lipido-colloid contact layer to promote the healing process of  venous leg ulcers ( VLU ) presenting inflammatory signs suggesting a heavy bacteria colonization and then a delayed healing , in comparison to the same wound dressing not impregnated with silver salts . METHODS This was an open-labeled , r and omized , controlled trial . VLU presenting at least 3 out of 5 clinical signs suggesting heavy bacterial colonization were recruited . Patients were treated with contact layer silver dressing ( [ CLS ] , Restore ® Contact Layer , Silver * ( Hollister Wound Care , Libertyville , Ill ) or contact layer dressing ( [ CL ] Restore ® Contact Layer * * , Hollister Wound Care , Libertyville , Ill ) for 4 weeks , then all treated ulcers were treated with CL for the 4 additional weeks . Wound evaluation and area measurements were conducted weekly during the first 4 weeks and then at week 6 and 8 . Main efficacy criterion was absolute wound area decrease ( AD ) at week 4 and week 8 . RESULTS Patients ( N = 102 ) were r and omized and treated .  Ulcers were present for nearly 11 months on average ; 65 % were recurrent and mean area was 20.0 ± 17.8 cm2 . Almost 80 % of the 
    Output:
    
Meta-analyses found strong evidence for wound healing based on wound size reduction but no evidence based on complete wound-healing or healing rates .
Although our results provide some evidence that silver-impregnated dressings improve the short-term healing of wounds and ulcers , long-term effects remain unclear .