Annals of Long Term Care

Dressings for Acute and Chronic Wounds

The objective of this systematic review was to critically review the literature on the efficacy of modern dressings in healing chronic and acute wounds by secondary intention. The authors conducted a search of 3 databases (MEDLINE, EMBASE, and the Cochrane Controlled Clinical Trials Register) from January 1990 to June 2006, completed by manual research, for articles in English and in French. The end points for selecting studies were the rate of complete healing, time to complete healing, rate of change in wound area, and general performance criteria (eg, pain, ease of use, avoidance of wound trauma on dressing removal, ability to absorb and contain exudates).

Studies were selected by a single reviewer. Overall, 99 studies met the selection criteria (89 randomized controlled trials [RCTs], 3 meta-analyses [1 of which came from 1 of the selected systematic reviews], 7 systematic reviews, and 1 cost-effectiveness study). The RCTs, meta-analyses, and cost-effectiveness studies were critically appraised by 2 reviewers to assess the clinical evidence level according to a modification of Sackett's 1989 criteria. Ninety-three articles were finally graded.

The authors found no level A studies, 14 level B studies (11 RCTs and 3 meta-analyses), and 79 level C studies. Hydrocolloid dressings proved superior to saline gauze or paraffin gauze dressings for the complete healing of chronic wounds, and alginates were better than other modern dressings for debriding necrotic wounds. Hydrofiber and foam dressings, when compared with other traditional dressings or a silver-coated dressing, respectively, reduced time to healing of acute wounds.

This systematic review provided only weak levels of evidence on the clinical efficacy of modern dressings as compared with saline or paraffin gauze in terms of healing, with the exception of hydrocolloids. There was no evidence that any of the modern dressings was better than another, or better than saline or paraffin gauze, in terms of general performance criteria. More wound care research, providing level A evidence is needed.

Chaby G, Senet P, Vaneau M, et al. Dressings for acute and chronic wounds. Arch Dermatol 2007;143(10):1297-1304.

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Thiazolidinediones and Cardiovascular Outcomes in Older Patients With Diabetes

Thiazolidinediones (TZDs), used to treat type 2 diabetes, are associated with an excess risk of congestive heart failure, and possibly acute myocardial infarction. However, the association between TZD use and cardiovascular events has not been adequately evaluated on a population level. The objective of this study was to explore the association between TZD therapy and congestive heart failure, acute myocardial infarction, and mortality as compared with treatment with other oral hypoglycemic agents. The investigators used nested case-control analysis of a retrospective cohort study using healthcare databases in Ontario, Canada. They included diabetes patients age 66 years or older treated with at least 1 oral hypoglycemic agent between 2002 and 2005 (N = 159,026) and followed them up until March 31, 2006. The primary outcome consisted of an emergency department visit or hospitalization for congestive heart failure; secondary outcomes were an emergency department visit or hospitalization for acute myocardial infarction and all-cause mortality. The risks of these events were compared between persons treated with TZDs (rosiglitazone and pioglitazone) and other oral hypoglycemic agent combinations, after matching and adjusting for prognostic factors. During a median follow-up of 3.8 years, 12,491 patients (7.9%) had a hospital visit for congestive heart failure, 12,578 (7.9%) had a visit for acute myocardial infarction, and 30,265 (19%) died.