Reference Type of Study Sample Intervention(s) Outcome Measures &
Length of Follow-up
Results Limitations
Banwell H. What is the evidence for tissue regeneration impairment
Search of 6 databases
41 articles Range of literature available on PVP-I use & evidence supporting its use &
effect on tissue impairment
9 experimental studies- no evidence of negative impact of tissue regeneration with PVP-I, 6
Effect size of 1 (i.e. n=1), small (n< 50), medium (n<400), large (n>400).
Many assumptions made, article availability. Bias with
121
when using a formulation of PVP-I antiseptic on open wounds? Dermatology.
2006;212 Suppl 1:66-76.
Good
articles refuted this, one
inconclusive, also looked at articles with descript studies, expert opinion
Much debate over use especially 10% in soln/ointment
using reader scoring tool
Bergin SM, Wraight P. Silver based wound dressings and topical agents for treating diabetic foot ulcers. Cochrane Database Syst Rev. 2007(2).
Strong
Randomized trials
& nonrandomized
Diabetics with foot ulcers To evaluate effects of silver dressings/topical agents on infection rates & healing of diabetic foot ulcers
Despite widespread use, no randomized control trials or controlled trials exist that evaluate their effectiveness
Bradley M, Nelson EA, Pettigrew M, Cullum N, Sheldon T. Dressings for pressure sores. Cochrane Database Syst Rev.
1998;3:CD001179.
Strong
Randomized and pseudo-randomized (alternate allocation)
Search trials from Cochrane Wounds Group, Cochrane controlled trials
To evaluate the effectiveness of dressings used in the treatment of pressure sores
Time to complete healing or rate of healing
This is a protocol
Cutting KF. Identification of infection in granulating wounds by registered nurses.
J Clin Nurs. 1998;7(6):539-46.
Fair
Training is key to
identification of subtle signs of infection
Questionnaire including observational about infection status of wound
20 RNs in pairs over 10 weeks viewed 4 wounds for total of 40 wounds
Insight into criteria used to identify infection compared RNS with author
RNs not always able to accurately identify infection in granulating wounds, author’s accuracy-39 out of 40 decisions (97.5%)
Varying levels of RN wound education
No burns/leg ulcers looked at wounds healing by 2ndary intention, RNS of varying experience, unknown if PrU included
Howell-Jones RS, Price PE, Howard AJ, Thomas DW.
Antibiotic prescribing for chronic skin wounds in primary care. Wound Repair Regen. 2006;14(4):387-93.
Good- need to look at antibiotic prescribing practices –role, duration, role in resistance
Retrospective data base from general practice databases
455 patients with chronic wounds were identified (PCW)
Quantity and pattern of antibiotic prescribing for patients with chronic wounds in the UK
N/A over 2/3 of PCWs received
at least 1 course of systemic antibiotics compared with 1/3 of non-wound patients, diabetes had no significant impact, leg ulcers & venous ulcer most common
68 patients with PrU, retrospective chart review
Nelson EA, O'Meara S, Golder RCTs and CCTs Searched 16 databases Review the evidence for antimicrobial Evidence is too weak 23 studies Trials too small and
122
Reference Type of Study Sample Intervention(s) Outcome Measures &
Length of Follow-up
Results Limitations
S, Dalton J, Craig D, Iglesias C.
Systematic review of antimicrobial treatments for diabetic foot ulcers. Diabet Med. 2006;23(4):348-59.
Strong
intervention for diabetic foot ulcers dissimilar
Jull AB, Rodgers A, Walker N.
Honey as a topical treatment for wounds. Cochrane
To assess whether use of honey has any benefit in wound healing:
increases the rate of healing in acute &
chronic wounds
Time to complete healing, proportion of wounds healed
This is a protocol
O'Meara S, Cullum N, Majid M, Sheldon T. Systematic reviews of wound care management: (3) antimicrobial agents for chronic wounds; (4) diabetic foot ulceration. Health journals, confer, & bibs were hand searched
Any systemic or topical agents with antimicrobial prop including
antibiotics, anti-fungal preps, anti-viral and alternative approaches
Primary outcome was wound healing such as change in ulcer size, rate of healing, frequency of complete healing or time to heal.
Studies reporting solely micro outcomes were excluded
PRU- no systemic trials, several topical agents may be helpful in general for chronic wounds but further research for effectiveness so cost minimization may be used to guide decisions
Methodological problems with most common being sample size
O’Meara S, Cullum N, Majid M, Sheldon T. Executive Summary: Systematic reviews of wound care management:
(3) antimicrobial agents for chronic wounds; (4) diabetic foot ulceration. Health Technol Assess. 2000;4(21).
Strong
& bibs were hand searched
Diabetic-39 trials
Antimicrobials- 30 with 25 of randomized design. 9 evaluations of systemic antibiotics, 21 of topical agents
Antimicrobials-PrU: no evidence in favor of topical antimicrobials for PrU prevention, oxyquinolone ointment significantly more effective than standard emollient for treatment of PrU in 1 study, no significant difference between hydrocolloid and povidone iodine ointment or between gentian violet and povidone iodine/sugar ointment
most have insufficient statistical power to detect true treatment effect
Methodological quality poor
O'Meara S, Nelson EA, Golder S, Dalton JE, Craig D, Iglesias C. Systematic review of methods to diagnose infection in foot ulcers in diabetes. Diabet Med.
RCTs and CCTs 19 databases plus other sources
Systematic review of diagnostic performance of clinical exam, sample analysis in infected diabetic foot ulcers
Inconclusive because of sample size
3 studies Too small and too few
123
2006;23(4):341-7.
Strong
Parsons D, Bowler PG, Myles V, Jones S. Silver
antimicrobial dressings in wound management: a comparison of antibacterial, physical, and chemical characteristics. Wounds.
2005;17(8):222-32.
Good
In-vitro experimental
7 dressings:
Aquacel Ag, Acticoat, Silvercel, Contreet foam, polymem silver, urogotul, silvasorb
Compared in-vitro antibacterial activity of 7 silver dressings against S. aureus and P. aeruginosa-silver release and/or silver content
Repeat challenge assays over 7 days for each dressing and a control dressing
Silver content not found to be predictor of
antibacterial activity so choice of dressing should not be based on this alone
Technique used measured total amount of silver in solution and cannot differ. between active and inactive forms
Ubbink DT, Vermeulen H, Storm-Versloot MN. Topical silver for preventing infected wounds. (Protocol). Cochrane Database Syst Rev. 2007;ID:
CD006478(2) DOI:
10.1002/14651858.CD006478 ).
Strong
Randomized and pseudo-randomized (alternate allocation), published and unpublished
Search trials from Cochrane Wounds Group, Cochrane controlled trials
To evaluate the effectiveness of dressings and topical agents containing silver to prevent wound infection of wounds of any etiology in any care setting
Studies must report objective measure of established wound infection rate, objective measure of wound healing rate, days of wound infection
This is a protocol
Vermeulen H, van Hattem JM, Storm-Versloot MN, Ubbink DT. Topical silver for treating infected wounds. Cochrane Database Syst Rev.
2007(1):CD005486.
Strong
Systematic review 3 RCTS for 847 participants
1 trial compared silver-containing foam(Contreet®) with hydrocellular foam (Allevyn®) in leg ulcer patients. 2 trial compared silver-containing alginate(Silvercel®) with alginate (Algosteril®) in leg and pressure ulcers 3 trial compared a foam dressing (Contreet®) with best care for chronic wounds
4 weeks of follow-up Insufficient evidence to recommend use of silver-containing dressings or topical agents for treatment of infected or contaminated chronic wounds,
Greater reduction in ulcer size was observed with silver-containing foam but no significant difference in rates of complete healing after 4 weeks
Only 3 trials with short duration of follow-up, small numbers and of low power, duration of wound infection not mentioned