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Journal Article•DOI•

Alginate dressings for treating pressure ulcers

Jo C Dumville1, Samantha Keogh2, Zhenmi Liu1, Nikki Stubbs3, Rachel Walker2, Mathew Fortnam4 •
University of Manchester1, Griffith University2, Leeds Community Healthcare NHS Trust3, University of York4
21 May 2015-Cochrane Database of Systematic Reviews (John Wiley & Sons, Ltd)-Vol. 2015, Iss: 5
TL;DR: The relative effects of alginate dressings compared with alternative treatments are unclear and decision makers may wish to consider aspects such as cost of dressings and the wound management properties offered by each dressing type, for example, exudate management.
Abstract: Background: Pressure ulcers, also known as bedsores, decubitus ulcers and pressure injuries, are localised areas of injury to the skin or the underlying tissue, or both. Dressings are widely used to treat pressure ulcers and there are many options to choose from including alginate dressings. A clear and current overview of current evidence is required to facilitate decision-making regarding dressing use for the treatment of pressure ulcers. This review is part of a suite of Cochrane reviews investigating the use of dressings in the treatment of pressure ulcers. Each review will focus on a particular dressing type. Objectives: To assess the effects of alginate dressings for treating pressure ulcers in any care setting. Search methods: For this review, in April 2015 we searched the following databases the Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL. There were no restrictions based on language or date of publication. Selection criteria: Published or unpublished randomised controlled trials (RCTs) comparing the effects of alginate with alternative wound dressings or no dressing in the treatment of pressure ulcers (stage II or above). Data collection and analysis Two review authors independently performed study selection, risk of bias assessment and data extraction. Main results: We included six studies (336 participants) in this review; all studies had two arms. The included studies compared alginate dressings with six other interventions that included: hydrocolloid dressings, silver containing alginate dressings, and radiant heat therapy. Each of the six comparisons included just one study and these had limited participant numbers and short follow-up times. All the evidence was of low or very low quality. 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. The existing trials are small, of short duration and at risk of bias. Decision makers may wish to consider aspects such as cost of dressings and the wound management properties offered by each dressing type, for example, exudate management.

Summary (1 min read)

Jump to: [Background] – [Main results] and [Authors’ conclusions]

Background

  • Pressure ulcers, also known as bedsores, decubitus ulcers and pressure injuries, are localised areas of injury to the skin or the underlying tissue, or both.
  • Dressings are widely used to treat pressure ulcers and there are many options to choose from including alginate dressings.
  • A clear and current overview of current evidence is required to facilitate decision-making regarding dressing use for the treatment of pressure ulcers.
  • Each review will focus on a particular dressing type.

Main results

  • The authors included six studies (336 participants) in this review; all studies had two arms.
  • The included studies compared alginate dressings with six other interventions that included: hydrocolloid dressings, silver containing alginate dressings, and radiant heat therapy.
  • Each of the six comparisons included just one study and these had limited participant numbers and short follow-up times.
  • All the evidence was of low or very low quality.
  • 1Alginate dressings for treating pressure ulcers Copyright © 2015 The Cochrane Collaboration.

Authors’ conclusions

  • The relative effects of alginate dressings compared with alternative treatments are unclear.
  • Pressure ulcers can be painful, may become infected, and so affect people’s quality of life.
  • Generally, the studies the authors found did not have many participants and the results were often inconclusive.
  • More research of better quality is needed to find out if alginate dressings are better at healing pressure ulcers than other types of dressings or other treatments.
  • The mean reduction in ulcer size (compared to baseline) was 42.5%.

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Content maybe subject to copyright    Report

Alginate dressings for treating pressure ulcers (Review)
Author
Dumville, Jo C, Keogh, Samantha J, Liu, Zhenmi, Stubbs, Nikki, Walker, Rachel M, Fortnam,
Mathew
Published
2015
Journal Title
Cochrane Database of Systematic Reviews
Version
Version of Record (VoR)
DOI
https://doi.org/10.1002/14651858.CD011277.pub2
Copyright Statement
© 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. This review is
published as a Cochrane Review in the Cochrane Database of Systematic Reviews 2015,
Issue 5. Cochrane Reviews are regularly updated as new evidence emerges and in response
to comments and criticisms, and the Cochrane Database of Systematic Reviews should be
consulted for the most recent version of the Review.
Downloaded from
http://hdl.handle.net/10072/81471
Griffith Research Online
https://research-repository.griffith.edu.au
Cochrane Database of Systematic Reviews
Alginate dressings for treating pressure ulcers (Review)
Dumville JC, Keogh SJ, Liu Z, Stubbs N, Walker RM, Fortnam M
Dumville JC, Keogh SJ, Liu Z, Stubbs N, Walker RM, Fortnam M.
Alginate dressings for treating pressure ulcers.
Cochrane Database of Systematic Reviews 2015, Issue 5. Art. No.: CD011277.
DOI: 10.1002/14651858.CD011277.pub2.
www.cochranelibrary.com
Alginate dressings for treating pressure ulcers (Review)
Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
T A B L E O F C O N T E N T S
1HEADER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1ABSTRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2PLAIN LANGUAGE SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3SUMMARY OF FINDINGS FOR THE MAIN COMPARISON . . . . . . . . . . . . . . . . . . .
5BACKGROUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8OBJECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8METHODS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12RESULTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Figure 1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Figure 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Figure 3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
20ADDITIONAL SUMMARY OF FINDINGS . . . . . . . . . . . . . . . . . . . . . . . . . .
28DISCUSSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
29AUTHORS’ CON CLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
29ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
29REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
33CHARACTERISTICS OF STUDIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
46DATA AND ANALYSES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
46ADDITIONAL TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
50APPENDICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
55CONTRIBUTIONS OF AUTHORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
55DECLARATIONS OF INTEREST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
56SOURCES OF SUPPORT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
56DIFFERENCES BETWEEN PROTOCOL AND REVIEW . . . . . . . . . . . . . . . . . . . . .
56INDEX TERMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
iAlginate dressings for treating pressure ulcers (Review)
Copyright © 2015 The Cochrane Colla boration. Published by John Wiley & Sons, Ltd.
[Intervention Review]
Alginate dressings for treating pressure ulcers
Jo C Dumville
1
, Samantha J Keogh
2
, Zhenmi Liu
1
, Nikki Stubbs
3
, Rachel M Walker
2
, Mathew Fortnam
4
1
School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.
2
NHMRC Centre of Research Excellence
in Nursing, Centre for Health Practice Innovation, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.
3
Wound Prevention and Management Service, Leeds Community Healthcare NHS Trust, St Mary’s Hospital, Leeds, UK.
4
Cochrane
Wounds Group, University of York, York, UK
Contact address: Jo C Dumville, School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, M13 9PL,
UK.
jo.dumville@manchester. ac.uk.
Editorial group: Cochrane Wounds Group.
Publication s tatus and date: New, published in Issue 5, 2015.
Review content assessed as up-to-date: 14 April 2015.
Citation: Dumville JC, Keogh SJ, Liu Z, Stubbs N, Walker RM, Fortnam M. Alginate dressings for treating pressure ulce r s. Cochrane
Database of Systematic Reviews 2015, Issue 5. Art. No.: CD011277. DOI: 10.1002/14651858.CD011277.pub2.
Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
A B S T R A C T
Background
Pressure ulcers, also known as bedsores, decubitus ulcers and pressure injuries, are localised areas of injury to the skin or the underlying
tissue, or both. Dressings are widely used to treat pressure ulcers and there are many options to choose from including alginate dressings.
A clear and current overview of current evidence is required to facilitate decision-making regarding dressing use for the treatment of
pressure ul cers. This review is part of a suite of Cochrane reviews investigating the use of dressings in the treatment of pressure ulcers.
Each review will focus on a particular dressing type.
Objectives
To assess the effects of alginate dressings for treating pressure ulce r s in any care setting.
Search methods
For this review, in April 2015 we searched the following databases the Cochrane Wounds Group Specialised Register; The Cochrane
Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other
Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL. There were no restrictions based on language or date of publication.
Selection criteria
Published or unpublished randomised controlled trials (RCTs) comparing the effects of alginate with alternative wound dressings or
no dressing in the treatment of pressure ulcers (stage II or above).
Data collection and analysis
Two review authors independently performed study selection, risk of bias assessment and data extraction.
Main results
We included six studies (336 participants) in this review; all studies had two arms. The included studies compared alginate dressings
with six other interventions that included: hydrocolloid dressings, silver containing alginate dressings, and radiant heat therapy. Each of
the six comparisons included just one study and these had limited participant numbers and short follow-up times. All the evidence was
of low or very low quality. Where data were available there was no evidence of a diff erence between alginate dressings and alternative
treatments in terms of complete wound healing or adverse events.
1Alginate dressings for treating pressure ulcers (Review)
Copyright © 2015 The Cochrane Colla boration. Published by John Wiley & Sons, Ltd.
Authors’ conclusions
The relative effects of alginate dressings compared with alternative treatments are unclear. The existing trials are small, of short duration
and at risk of bias. Decision makers may wish to consider aspects such as cost of dressings and the wound management properties
offered by each dressing type, for example, exudate management.
P L A I N L A N G U A G E S U M M A R Y
Alginate dressings for treating pressure ulcers
What are pressure ulcers, and who is at risk?
Pressure ulcers, also known as bedsores, decubitus ulcers and pressure injuries, are wounds involving the skin and sometimes the
tissue th at lies underneath. Pressure ulcers can be painful, may become infected, and so affect people’s quality of life. People at risk of
developing pressure ulcers include those with spinal cord injuries, and those who are immobile or who have limited mobility - such as
elderly people and people who are ill as a result of short-term or long-term medical conditions.
In 2004 the total annual cost of treating pressure ulcers in the UK was estimated as being GBP 1.4 to 2.1 billion, which was equivalent
to 4% of the total National Health Service expenditure. Pe ople with pressure ulcers have longer stays in hospital, and this increases
hospital costs. Figures from th e USA for 2006 suggest that hal f a million hospital stays had ’pressure ulcer’ noted as a diagnosis; the
total hospital costs of these stays was USD 11 billion.
Why use alginate dressings to treat pressure ulcers?
Dressings are one treatment option for pressure ulcers. There are many types of dressings that can be used; these can vary considerably
in cost. Alginate dressings are a type that is highly absorbant and so can absorb the fluid (exudate) that is produced by some ulcers.
What we found
In June 2014 we searched for as many relevant studies as we could find that had a robust design (randomised controlled trials) and
compared alginate dressings with other treatments for pressure ulcers. We found 6 studies involving a total of 336 participants. Alginates
have been compared with hydrocolloid dressings, another type of alginate dressing, dextranomer paste dressing, silver-alginate dressing,
silver-zinc sulfadiazine cream and treatment with a radiant heat system in these studies. There was no evidence from these studies to
suggest that alginate wound dressings are more effective at healing pressure ulcers than other types of dressings or skin surface (topical)
treatments, or other interventions.
Generally, the studies we found did not have many participants and the results were often inconclusive. Some study reports did not
provide information about how they were conducted and it was difficult to tel l whether the results presented were likely to be true.
More research of better quality is needed to find out if alginate dressings are better at healing pressure ulcers than other types of dressings
or other treatments. This review is part of a suite of reviews investigating dressings for the treatment of pressure ulcers
This plain language summary is up-to-date as of June 2014.
2Alginate dressings for treating pressure ulcers (Review)
Copyright © 2015 The Cochrane Colla boration. Published by John Wiley & Sons, Ltd.
Citations
More filters
Journal Article•DOI•
Alginate dressings for treating pressure ulcers.

[...]

Scott Junior Wn
28 Mar 2015-Sao Paulo Medical Journal
TL;DR: The relative effects of alginate dressings compared with alternative treatments are unclear and decision makers may wish to consider aspects such as cost of dressings and the wound management properties offered by each dressing type, for example, exudate management.
Abstract: BACKGROUND: Pressure ulcers, also known as bedsores, decubitus ulcers and pressure injuries, are localised areas of injury to the skin or the underlying tissue, or both. Dressings are widely used to treat pressure ulcers and there are many options to choose from including alginate dressings. A clear and current overview of current evidence is required to facilitate decision-making regarding dressing use for the treatment of pressure ulcers. This review is part of a suite of Cochrane reviews investigating the use of dressings in the treatment of pressure ulcers. Each review will focus on a particular dressing type. OBJECTIVES: To assess the effects of alginate dressings for treating pressure ulcers in any care setting. METHODS: Search methods: For this review, in April 2015 we searched the following databases the Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL. There were no restrictions based on language or date of publication. Selection criteria: Published or unpublished randomised controlled trials (RCTs) comparing the effects of alginate with alternative wound dressings or no dressing in the treatment of pressure ulcers (stage II or above). Data collection and analysis: Two review authors independently performed study selection, risk of bias assessment and data extraction. MAIN RESULTS: We included six studies (336 participants) in this review; all studies had two arms. The included studies compared alginate dressings with six other interventions that included: hydrocolloid dressings, silver containing alginate dressings, and radiant heat therapy. Each of the six comparisons included just one study and these had limited participant numbers and short follow-up times. All the evidence was of low or very low quality. 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. The existing trials are small, of short duration and at risk of bias. Decision makers may wish to consider aspects such as cost of dressings and the wound management properties offered by each dressing type, for example, exudate management.

5 citations

Journal Article•DOI•
Management of Pressure Ulcers and Pressure-Related Injury

[...]

Doris J. Armour1, Elisabeth Preston-Hsu1, Yogita Tailor1•
Emory University1
01 Jun 2019-Current Physical Medicine and Rehabilitation Reports
TL;DR: There remains a disturbing lack of good-quality evidence regarding the effectiveness of support surfaces or repositioning for pressure ulcer prevention or treatment, for any class of dressing or topical therapy for promotion of wound healing, or for nutritional supplementation to facilitate wound healing.
Abstract: Pressure ulcers, or pressure-related injuries, result from localized injury to the skin and underlying tissues due to unrelieved pressure, usually over a bony prominence, resulting in ischemia, cell death, and tissue necrosis. Pressure injuries are increasing in incidence due to an aging population with increasing rates of obesity, diabetes, and cardiovascular disease. A rapidly expanding geriatric population with impaired mobility, diminished sensation, and poor nutrition—factors exacerbated by the end-stage effects of dementia, obesity, osteoarthritis, and diabetes as well as cardiovascular and cerebrovascular disease—have a greater propensity toward, and a higher prevalence of, pressure injury. Our aim in this paper is to determine through a review of the literature whether any new literature exists, indicating greater effectiveness in pressure ulcer prevention or treatment as compared to standard of care. We examined which studies of available support surfaces, new and currently utilized wound dressings or any other treatment modalities have provided evidence of any greater effectiveness than standard of care in the prevention of pressure injury and in promotion of pressure ulcer healing. Our objective is to provide healthcare providers with an assessment of the relative efficacy of the various interventions available to facilitate their decision-making in the healing of their patient’s pressure ulcers. Goals for pressure injury prevention or treatment, especially in the geriatric population, address repositioning for pressure redistribution and accurate diagnosis of wound etiology, including comorbidities in aging, cognition, care of aging skin, and patient or family goals in care (healing versus palliation). We performed a literature search of the Cochrane Database of Systematic Reviews, Ovid Medline, and PubMed for published studies, reviews, and meta-analyses using the keywords pressure ulcer, pressure injury, wound care, bedsore, decubitus ulcers, and support surfaces. We also examined the reference lists of included studies to identify additional trials, position statements, guidelines, and reviews. We limited our review to English language publications between January 2008 and November 2018. We identified 36 studies for review. Despite this relatively large number of studies, there remains a disturbing lack of good-quality evidence regarding the effectiveness of support surfaces or repositioning for pressure ulcer prevention or treatment, for any class of dressing or topical therapy for promotion of wound healing, or for nutritional supplementation to facilitate wound healing. These studies yielded little evidence to warrant an update to the current standard of care for pressure ulcer prevention or management. The prevention and management of pressure ulcers requires a varied approach including assessment of risk, institution of preventive measures, and interventions to promote wound healing. Several tools for pressure injury risk assessment have been developed; a comparative description of these scales is provided. Understanding comorbidities (e.g., cardiovascular disease, diabetes, and neurodegenerative disorders) as well as complicating issues common to the elderly population that can impact pressure injury treatment (e.g., malnutrition, polypharmacy, incontinence, frailty, and disability) helps tailor wound care to this population.

4 citations

Journal Article•DOI•
A Randomized Control Trial Comparing Transparent Film Dressings and Conventional Occlusive Dressings for Elective Surgical Procedures.

[...]

Moushira Hosny Ezzelarab1, Omar Mohamed Nouh1, Ahmed Nabil Ahmed1, Mervat Gaber Anany1, Nevine Gamal El Rachidi1, Ahmed Safwat Salem1 •
Cairo University1
29 Aug 2019-Open Access Macedonian Journal of Medical Sciences
TL;DR: The transparent semipermeable dressing is effective in reducing surgical site infection rate in clean and clean-contaminated operations.
Abstract: BACKGROUND: Surgical site infection is one of the major health-care-associated problems causing substantial morbidity and mortality and constituting a financial burden on hospitals as well. The wound management is one of the crucial evidence-based strategies in the reduction of surgical site infection rates AIM: To study the impact of standardisation of transparent semipermeable dressing procedure on the rate of surgical site infection in comparison with conventional dressing in clean and clean-contaminated surgeries. METHODS: The study included 100 patients who were admitted to surgical wards in Cairo university hospitals, for clean and clean-contaminated operations, in the period from February 2017 to August 2017. Immunocompromised and uncontrolled diabetic patients were excluded. Patients were randomly allocated into two groups; in the first group, patients wounds were covered using transparent semipermeable dressing, while the second group patients’ wounds were covered using conventional occlusive gauze dressing. Patients were followed up for criteria of infection every other day during the first week then at two weeks, three weeks and four weeks. RESULTS: In clean and clean-contaminated operations, the transparent dressing group showed a significantly lesser rate of surgical site infection at (2%), compared with the conventional occlusive gauze dressing group with a surgical site infection rate of (14%) (p-value of 0.02). CONCLUSION: The transparent semipermeable dressing is effective in reducing surgical site infection rate in clean and clean-contaminated operations.

4 citations

Cites background from "Alginate dressings for treating pre..."

  • ...Many different dressing types are available for use on surgical wounds [8]....

    [...]

Journal Article•DOI•
Treatment of chronic ulcers

[...]

C. Busch, I. Aschermann, C. D. Mnich
01 Jan 2017-Phlebologie
TL;DR: There is a strong need for further basic research to fully understand all factors involved in wound development and healing of the various ulcer pathophysiologies, and the urgent need for prospective clinical trials comparing the various treatment options.
Abstract: Chronic ulcers (CUs) are a major cause of morbidity and mortality with increasing prevalence, in part due to the ageing population, and an increase of risk factors such as diabetes and obesity. CUs are caused by numerous diseases including venous dysfunction, diabetes mellitus, infections, peripheral neuropathy, pressure, and atherosclerosis. The current standard therapy for CUs includes compression, surgical debridement, infection control, and adequate wound dressings. As a high percentage of CUs do not adequately heal or quickly relapse with standard treatments, additional therapeutic approaches are pursued, termed “advanced wound care therapies”. Here, an overview on commonly applied therapies lacking significant evidence for wound healing is reviewed, followed by therapies with significant evidence supporting the routine use in the treatment of CUs, and a short outlook in a possible future wound treatment landscape. To give a resume, the presented literature reveals that most of the commonly applied topical and advanced ulcer treatments largely lack solid scientific evidence for the induction or acceleration of wound healing. Surprisingly only “classical” treatments such as wound cleansing, debridement and compression have significant evidence. Novel approaches such as bilayered skin reconstructs, cell suspensions or extracorporal shock waves seem promising. Considering the increasing number of ulcer patients, there is a strong need for further basic research to fully understand all factors involved in wound development and healing of the various ulcer pathophysiologies, and the urgent need for prospective clinical trials comparing the various treatment options.

3 citations

Book Chapter•DOI•
Advanced Technologies in Dermatology

[...]

Diana Kitala, Agnieszka Klama-Baryła, Wojciech Łabuś, MarcelinaMisiuga, Mariusz Nowak, Marek Kawecki 
20 Dec 2017
TL;DR: Alternative treatment methods are transplants of allogeneic, biostatic skin and amnion, which can be applied as a skin substitute on shallow facialburn wounds, hand burn wounds, on donor areas and granulating wounds.
Abstract: Cellular therapies are an attractive area of regenerative medicine. For large partial thickness wound, keratinocytes transplant is suggested. The transplantation of cell graft is achieved by obtaining large amounts of cultured cells from a skin biopsy in 3 weeks. Stem cells can be applied before that, but are also efficient in chronic wound closure. Alternative treatment methods are transplants of allogeneic, biostatic skin and amnion. Amnion can be applied as a skin substitute on shallow facialburn wounds, hand burn wounds, on donor areas and granulating wounds. For medium depth or even deep burns, allogeneic skin is recommended. Thanks to the removing of cells from human allogeneic dermis, collagen scaffolding is obtained. It can be populated de novo by autologous skin cells. Artificial skin substitutes are especially good for hand burns and shallow burns. Even though scarring is a part of normal wound healing, it often leads to a pathological process. When scar treatment methods prove insufficient, surgical intervention becomes necessary. Surgical scar intervention involves removal of the pathological skin tissue fragment and replacing it with healthy skin or application of expanders. Improvement of the visual features can be also achieved by laser therapy.

3 citations

References
More filters
Journal Article•DOI•
Measuring inconsistency in meta-analyses

[...]

Julian P T Higgins1, Simon G. Thompson1, Jonathan J Deeks, Douglas G. Altman•
University of Cambridge1
04 Sep 2003-BMJ
TL;DR: A new quantity is developed, I 2, which the authors believe gives a better measure of the consistency between trials in a meta-analysis, which is susceptible to the number of trials included in the meta- analysis.
Abstract: Cochrane Reviews have recently started including the quantity I 2 to help readers assess the consistency of the results of studies in meta-analyses. What does this new quantity mean, and why is assessment of heterogeneity so important to clinical practice? Systematic reviews and meta-analyses can provide convincing and reliable evidence relevant to many aspects of medicine and health care.1 Their value is especially clear when the results of the studies they include show clinically important effects of similar magnitude. However, the conclusions are less clear when the included studies have differing results. In an attempt to establish whether studies are consistent, reports of meta-analyses commonly present a statistical test of heterogeneity. The test seeks to determine whether there are genuine differences underlying the results of the studies (heterogeneity), or whether the variation in findings is compatible with chance alone (homogeneity). However, the test is susceptible to the number of trials included in the meta-analysis. We have developed a new quantity, I 2, which we believe gives a better measure of the consistency between trials in a meta-analysis. Assessment of the consistency of effects across studies is an essential part of meta-analysis. Unless we know how consistent the results of studies are, we cannot determine the generalisability of the findings of the meta-analysis. Indeed, several hierarchical systems for grading evidence state that the results of studies must be consistent or homogeneous to obtain the highest grading.2–4 Tests for heterogeneity are commonly used to decide on methods for combining studies and for concluding consistency or inconsistency of findings.5 6 But what does the test achieve in practice, and how should the resulting P values be interpreted? A test for heterogeneity examines the null hypothesis that all studies are evaluating the same effect. The usual test statistic …

45,105 citations

Journal Article•DOI•
The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions: Explanation and Elaboration

[...]

Alessandro Liberati, Douglas G. Altman1, Jennifer Tetzlaff2, Cynthia D. Mulrow, Peter C Gøtzsche3, John P. A. Ioannidis4, Mike Clarke3, Mike Clarke5, Philip J. Devereaux6, Jos Kleijnen7, David Moher2 •
University of Oxford1, Ottawa Hospital Research Institute2, Cochrane Collaboration3, University of Ioannina4, Trinity College, Dublin5, McMaster University6, Maastricht University7
18 Aug 2009-PLOS Medicine
TL;DR: An Explanation and Elaboration of the PRISMA Statement is presented and updated guidelines for the reporting of systematic reviews and meta-analyses are presented.
Abstract: Systematic reviews and meta-analyses are essential to summarize evidence relating to efficacy and safety of health care interventions accurately and reliably. The clarity and transparency of these reports, however, is not optimal. Poor reporting of systematic reviews diminishes their value to clinicians, policy makers, and other users. Since the development of the QUOROM (QUality Of Reporting Of Meta-analysis) Statement—a reporting guideline published in 1999—there have been several conceptual, methodological, and practical advances regarding the conduct and reporting of systematic reviews and meta-analyses. Also, reviews of published systematic reviews have found that key information about these studies is often poorly reported. Realizing these issues, an international group that included experienced authors and methodologists developed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) as an evolution of the original QUOROM guideline for systematic reviews and meta-analyses of evaluations of health care interventions. The PRISMA Statement consists of a 27-item checklist and a four-phase flow diagram. The checklist includes items deemed essential for transparent reporting of a systematic review. In this Explanation and Elaboration document, we explain the meaning and rationale for each checklist item. For each item, we include an example of good reporting and, where possible, references to relevant empirical studies and methodological literature. The PRISMA Statement, this document, and the associated Web site (http://www.prisma-statement.org/) should be helpful resources to improve reporting of systematic reviews and meta-analyses.

25,711 citations

Journal Article•DOI•
CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials

[...]

Kenneth F. Schulz1, Douglas G. Altman2, David Moher3•
FHI 3601, University of Oxford2, Ottawa Hospital Research Institute3
24 Mar 2010-BMJ
TL;DR: The Consort 2010 Statement as discussed by the authors has been used worldwide to improve the reporting of randomised controlled trials and has been updated by Schulz et al. in 2010, based on new methodological evidence and accumulating experience.
Abstract: The CONSORT statement is used worldwide to improve the reporting of randomised controlled trials. Kenneth Schulz and colleagues describe the latest version, CONSORT 2010, which updates the reporting guideline based on new methodological evidence and accumulating experience. To encourage dissemination of the CONSORT 2010 Statement, this article is freely accessible on bmj.com and will also be published in the Lancet, Obstetrics and Gynecology, PLoS Medicine, Annals of Internal Medicine, Open Medicine, Journal of Clinical Epidemiology, BMC Medicine, and Trials.

11,165 citations

Journal Article•DOI•
CONSORT 2010 Statement: Updated Guidelines for Reporting Parallel Group Randomised Trials

[...]

Kenneth F. Schulz1, Douglas G. Altman2, David Moher3•
Research Triangle Park1, University of Oxford2, Ottawa Hospital Research Institute3
24 Mar 2010-PLOS Medicine
TL;DR: The 2010 version of the CONSORT Statement is described, which updates the previous reporting guideline based on new methodological evidence and accumulated experience.
Abstract: Kenneth Schulz and colleagues describe the 2010 version of the CONSORT Statement, which updates the previous reporting guideline based on new methodological evidence and accumulated experience.

5,090 citations

Journal Article•DOI•
Practical methods for incorporating summary time-to-event data into meta-analysis

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Jayne F. Tierney1, Lesley A. Stewart2, Davina Ghersi, Sarah Burdett1, Matthew R. Sydes •
Analysis Group1, University of York2
07 Jun 2007-Trials
TL;DR: This practical guide should improve the quality of the analysis and subsequent interpretation of systematic reviews and meta-analyses that include time-to-event outcomes and provide a corresponding, easy- to-use calculations spreadsheet, to facilitate the computational aspects.
Abstract: In systematic reviews and meta-analyses, time-to-event outcomes are most appropriately analysed using hazard ratios (HRs). In the absence of individual patient data (IPD), methods are available to obtain HRs and/or associated statistics by carefully manipulating published or other summary data. Awareness and adoption of these methods is somewhat limited, perhaps because they are published in the statistical literature using statistical notation. This paper aims to 'translate' the methods for estimating a HR and associated statistics from published time-to-event-analyses into less statistical and more practical guidance and provide a corresponding, easy-to-use calculations spreadsheet, to facilitate the computational aspects. A wider audience should be able to understand published time-to-event data in individual trial reports and use it more appropriately in meta-analysis. When faced with particular circumstances, readers can refer to the relevant sections of the paper. The spreadsheet can be used to assist them in carrying out the calculations. The methods cannot circumvent the potential biases associated with relying on published data for systematic reviews and meta-analysis. However, this practical guide should improve the quality of the analysis and subsequent interpretation of systematic reviews and meta-analyses that include time-to-event outcomes.

4,641 citations

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Frequently Asked Questions (6)
Q1. What are the types of people at risk of developing pressure ulcers?

People at risk of developing pressure ulcers include those with spinal cord injuries, and those who are immobile or who have limited mobility - such as elderly people and people who are ill as a result of short-term or long-term medical conditions. 

In 2004 the total annual cost of treating pressure ulcers in the UK was estimated as being GBP 1.4 to 2.1 billion, which was equivalent to 4% of the total National Health Service expenditure. 

Published by John Wiley & Sons, Ltd.A B S T R A C TPressure ulcers, also known as bedsores, decubitus ulcers and pressure injuries, are localised areas of injury to the skin or the underlying tissue, or both. 

Figures from the USA for 2006 suggest that half a million hospital stays had ’pressure ulcer’ noted as a diagnosis; the total hospital costs of these stays was USD 11 billion. 

For this review, in April 2015 the authors searched the following databases the Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL. 

GRADE Working Group grades of evidence High quality: further research is very unlikely to change their confidence in the estimate of effect Moderate quality: further research is likely to have an important impact on their confidence in the estimate of effect and may change the estimate Low quality: further research is very likely to have an important impact on their confidence in the estimate of effect and is likely to change the estimate Very low quality: the authors are very uncertain about the estimate1