Assessing a calcium alginate dressing for venous ulcers of the leg

Moffatt, Christine; Oldroyd, M. I.; Franks, Peter J.

doi:10.12968/jowc.1992.1.4.22

Cited by 15 publications

(16 citation statements)

References 3 publications

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“…Thus, the final data set included 19 RCTs evaluating 39 unique treatments (Table 69). 227,231,[282][283][284][285][286][287][288][289][290][291][292][293][294][295][296][297][298] The evidence in the final data set was organised in the network, shown in Figure 16.…”

Section: Resultsmentioning

confidence: 99%

“…The increased weighting of indirect compared with direct data occurred here because the effect estimate derived from the study populating the alginate vs. foam comparison 294 was more precise than the estimate derived from the study populating the alginate vs. basic wound contact comparison. 287 The mixed-treatment estimate for alginate versus hydrocolloid was also mainly informed by direct evidence from other pairwise comparisons: the alginate versus foam and foam versus hydrocolloid comparisons.…”

Section: Contributions Of Direct Evidence (Non-silver Dressings)mentioning

confidence: 99%

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Wounds research for patient benefit: a 5-year programme of research

Cullum

Buckley

Dumville

et al. 2016

Programme Grants Appl Res

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BackgroundComplex wounds are those that heal by secondary intention and include lower-limb ulcers, pressure ulcers and some surgical wounds. The care of people with complex wounds is costly, with care mainly being delivered by community nurses. There is a lack of current, high-quality data regarding the numbers and types of people affected, care received and outcomes achieved.ObjectivesTo (1) assess how high-quality data about complex wounds can be captured effectively for use in both service planning and research while ensuring integration with current clinical data collection systems and minimal impact on staff time; (2) investigate whether or not a clinical register of people with complex wounds could give valid estimates of treatment effects, thus reducing dependence on large-scale randomised controlled trials (RCTs); (3) identify the most important research questions and outcomes for people with complex wounds from the perspectives of patients, carers and health-care professionals; (4) evaluate the potential contributions to decision-making of individual patient data meta-analysis and mixed treatment comparison meta-analysis; and (5) complete and update systematic reviews in topic areas of high priority.MethodsTo meet objectives 1 and 2 we conducted a prevalence survey and developed and piloted a longitudinal disease register. A consultative, deliberative method and in-depth interviews were undertaken to address objective 3. To address objectives 4 and 5 we conducted systematic reviews including mixed treatment comparison meta-analysis.ResultsFrom the prevalence survey we estimated the point prevalence of all complex wounds to be 1.47 per 1000 people (95% confidence interval 1.38 to 1.56 per 1000 people). Pressure ulcers and venous leg ulcers were the most common type of complex wound. A total of 195 people with a complex wound were recruited to a complex wounds register pilot. We established the feasibility of correctly identifying, extracting and transferring routine NHS data into the register; however, participant recruitment, data collection and tracking individual wounds in people with multiple wounds were challenging. Most patients and health professionals regarded healing of the wound as the primary treatment goal. Patients were greatly troubled by the social consequences of having a complex wound. Complex wounds are frequently a consequence of, and are themselves, a long-term condition but treatment is usually focused on healing the wound. Consultative, deliberative research agenda setting on pressure ulcer prevention and treatment with patients, carers and clinicians yielded 960 treatment uncertainties and a top 12 list of research priorities. Of 167 RCTs of complex wound treatments in a systematic review of study quality, 41% did not specify a primary outcome and the overall quality of the conduct and reporting of the research was poor. Mixed-treatment comparison meta-analysis in areas of high priority identified that matrix hydrocolloid dressings had the highest probability (70%) of being the most effective dressing for diabetic foot ulcers, whereas a hyaluronan fleece dressing had the highest probability (35%) of being the most effective dressing for venous ulcers; however, the quality of this evidence was low and uncertainty is high.ConclusionsComplex wounds are common and costly with a poor evidence base for many frequent clinical decisions. There is little routine clinical data collection in community nursing. A prospective complex wounds register has the potential to both assist clinical decision-making and provide important research evidence but would be challenging to implement without investment in information technology in NHS community services. Future work should focus on developing insights into typical wound healing trajectories, identifying factors that are prognostic for healing and assessing the cost-effectiveness of selected wound treatments.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Section: Resultsmentioning

confidence: 99%

Section: Contributions Of Direct Evidence (Non-silver Dressings)mentioning

confidence: 99%

Wounds research for patient benefit: a 5-year programme of research

Cullum

Buckley

Dumville

et al. 2016

Programme Grants Appl Res

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“…From those included, 22 studies 30–51 evaluated the use of modern vs. conventional dressings, and nine 52–60 were comparative studies of different modern dressings. Twenty‐six studies 30–48,52–58 corresponded to ulcers of venous origin and five 49–51,59 , 60 to leg ulcers whose etiology was not clearly identified. No study that exclusively targeted arterial ulcers and met the inclusion criteria was identified.…”

Section: Resultsmentioning

confidence: 99%

“…As shown in Table 3, no differences were observed in the outcome, “healing,” in any of the studies that compared: an alginate against a conventional dressing 41 or zinc‐impregnated gauze; 46 collagen against a nonadherent dressing; 47 or activated carbon against paraffin‐soaked gauze 48…”

Section: Resultsmentioning

confidence: 99%

Efficacy of modern dressings in the treatment of leg ulcers: A systematic review

Carmen

Ana

Amate

2005

Wound Repair Regeneration

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Healing of leg ulcers constitutes a major clinical problem. Local methods for accelerating the healing process include modern wound dressings, but it is unclear what impact these dressings have on ulcer healing. This study examines the collective evidence on the effectiveness of modern dressings in the treatment of leg ulcers. To this end, a meta-analysis was conducted covering randomized clinical trials identified following a systematic review of the literature in different databases. Estimates of effect were calculated according to the fixed effects model. Thirty-one studies met the inclusion criteria (26 on ulcers of venous etiology, 5 on ulcers of mixed or poorly differentiated etiology). We found no study that exclusively addressed arterial ulcers. Although studies displayed considerable methodological limitations, analysis showed no significant differences in terms of the proportion of healed ulcers or reduction in wound size for both modern and conventional dressings. Similarly, no significant differences were observed between the different modern dressings compared in the studies. Thus, the current medical literature is poor in supporting the use of modern dressings to improve the healing rate of leg ulcers. There is insufficient evidence to determine whether the choice of any specific dressing type affects the healing course of these ulcers. Well-conducted trials are warranted to reliably address this question.

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“…Five RCTs (295 participants) were included (Armstrong 1997;Harding 2001;Límová 2003;Mo att 1992;Smith 1994). One was undertaken in the USA (Límová 2003), one in France and the UK (Armstrong 1997), and the remaining three solely in the UK (Harding 2001;Mo att 1992;Smith 1994). Three were multicentre RCTs (Armstrong 1997;Harding 2001;Límová 2003).…”

Section: Included Studiesmentioning

confidence: 99%

Alginate dressings for venous leg ulcers

O’Meara

James

Adderley

2015

Cochrane Database of Systematic Reviews

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BackgroundVenous leg ulcers are a common and recurring type of chronic, complex wound associated with considerable cost to patients and healthcare providers. To aid healing, primary wound contact dressings are usually applied to ulcers beneath compression devices. Alginate dressings are used frequently and there is a variety of alginate products on the market, however, the evidence base to guide dressing choice is sparse. ObjectivesTo determine the e ects of alginate dressings compared with alternative dressings, non-dressing treatments or no dressing, with or without concurrent compression therapy, on the healing of venous leg ulcers. Search methodsFor this first update, in March 2015, we searched the following databases: The Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL); 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 criteriaPublished or unpublished randomised controlled trials (RCTs) that evaluated the e ects of any type of alginate dressing in the treatment of venous ulcers were included. Data collection and analysisTwo review authors independently performed study selection, data extraction and risk of bias assessment. Meta-analysis was undertaken when deemed feasible and appropriate. Main resultsFive RCTs (295 participants) were included in this review. All were identified during the original review. The overall risk of bias was high for two RCTs and unclear for three. One RCT compared di erent proprietary alginate dressings (20 participants), three compared alginate and hydrocolloid dressings (215 participants), and one compared alginate and plain non-adherent dressings (60 participants). Follow-up periods were six weeks in three RCTs and 12 weeks in two. No statistically significant between-group di erences were detected for any comparison, for any healing outcome. Meta-analysis was feasible for one comparison (alginate and hydrocolloid dressings), with data from two RCTs (84 participants) pooled for complete healing at six weeks: risk ratio 0.42 (95% confidence interval 0.14 to 1.21). Adverse event profiles were generally similar between groups (not assessed for alginate versus plain non-adherent dressings).

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Assessing a calcium alginate dressing for venous ulcers of the leg

Abstract: A small study of Tegagel calcium alginate dressings is described, with a discussion of the methodology employed.

Cited by 15 publications

References 3 publications

Wounds research for patient benefit: a 5-year programme of research

Wounds research for patient benefit: a 5-year programme of research

Efficacy of modern dressings in the treatment of leg ulcers: A systematic review

Alginate dressings for venous leg ulcers

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