E. A. Nelson

Randomized clinical trial of four-layer and short-stretch compression bandages for venous leg ulcers (VenUS I)

A randomized clinical trial was undertaken to determine the relative effectiveness of four‐layer and short‐stretch bandaging for venous ulceration.

Systematic review of methods to diagnose infection in foot ulcers in diabetes

Aim  To undertake a systematic review of the diagnostic performance of clinical examination, sample acquisition and sample analysis in infected foot ulcers in diabetes.

Economic analysis of VenUS I, a randomized trial of two bandages for treating venous leg ulcers

The study investigated the cost‐effectiveness of four‐layer and short‐stretch compression bandages for treating venous leg ulcers.

DESIGN OF RANDOMIZED CONTROLLED TRIALS IN THE TREATMENT OF LEG ULCERS : MORE ANSWERS WITH FEWER PATIENTS

Objective: To illustrate the benefit of the factorial design in randomized controlled trials of leg ulcers. Design: A 2 × 2 × 2 factorial design. Setting: Hospital leg ulcer clinics in Edinburgh and Falkirk. Patients: Adults with at least one unhealed leg ulcer of determined origin, present for at least 2 months and greater than 1 cm in diameter. Interventions: Pentoxifylline (Trental) 400 mg, three times daily, versus placebo Main outcome measure: Complete healing of all ulcers within 24 weeks. Results: Of 525 patients screened, 200 pure venous ulcers were randomized (58.5% healed by 24 weeks), 45 complex venous ulcers were randomized (57.8% healed) and 41 arterial patients were randomized (excluding bandaging comparisons) (19.5% healed). There were no interactions between treatments. Conclusion: The factorial design was feasible to administer and allowed three therapeutic questions to be investigated using the same resources as would have been needed to answer a single question.

Systematic Reviews of Prevention of Venous Ulcer Recurrence

Aim: To illustrate and discuss the role of systematic reviews in assessing the effect of interventions used in preventing recurrence of venous ulceration. Method: Systematic review of randomised controlled trials (RCTs) reporting the recurrence of venous ulcers. We searched the Cochrane Wounds Group specialised trial register in June 2000. This contains results of searches for RCTs in 18 electronic databases and hand searches. Trials were assessed for inclusion by two people and data extraction was performed using a standard proforma. Synthesis: We found weak evidence that wearing compression hosiery reduces recurrence rates. There was insufficient evidence for the effectiveness of drugs, vein surgery, exercise or leg elevation. Conclusions: Where systematic reviews provide clear implications for practice are found, clinicians can incorporate these into treatment regimens. Where results indicate that there is clinical uncertainty, as in the prevention of recurrence, this can assist commissioners and researchers in prioritising research questions.