Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 14 appraisals
JMIR formative research
Self-Monitoring Risk Factors for Diabetic Foot Ulceration With the Feetchecker App: Mixed Methods Study
BACKGROUND: A prevalent and serious complication of diabetes mellitus is the development of diabetic foot ulcer (DFU). There is a need for effective solutions that help prevent DFU to support our increasingly stressed health care systems. The use of mobile health (mHealth) tools has been shown to improve awareness and effective self-care management skills in people at risk of developing diabetic foot ulceration. OBJECTIVE: In this study, we aimed to investigate the perceived usefulness, engagement, and overall user experience of the Feetchecker app, a self-monitoring mHealth app for people at risk of DFU. METHODS: A total of 24 patients (mean age 71, SD 8.6 years) with type 2 diabetes mellitus at risk of developing diabetic foot ulceration completed a 3-month evaluation period (70 recruited, 36 included, 12 dropped out) of a self-monitoring mobile app called Feetchecker app. A mixed methods approach was used to combine insights from app data with qualitative data from a pre- and postsurvey as well as interviews with patients and involved podiatrists. Data were analyzed using descriptive statistics and thematic analysis. We evaluated overall use of the app, patient engagement, and user experiences. RESULTS: Patients who fully completed the study conducted 393 feetchecks. In total, 7 patients sent in 9 pictures; all 7 were called for follow-up by a podiatrist. Overall, patients had a positive experience with the app and perceived the Feetchecker app as a valuable tool to monitor their feet for potential risk factors of DFU. Ease of use in performing a feetcheck and sending the podiatrist a picture was described as an important feature. Three main types of engagement with the Feetchecker app emerged: continuous, frequent, and no to little engagement. These patterns highlight enablers for self-monitoring such as ease-of-use, easy access to a podiatrist, and social support, as well as barriers such as digital skills and sustained engagement. Podiatrists highlighted the benefits of having patients report potential issues quicker and the ability to monitor their patients remotely. Challenges remain in integrating the promotion of the Feetchecker app into their consultations. CONCLUSIONS: The Feetchecker app supported patients in self-monitoring risk factors associated with DFU through routine checks and quick contact with a health care professional in case of a potential issue. Overall, patients described a positive user experience and considered the app helpful. While mHealth tools are not for everyone, user engagement for many patients was high and shows that such apps can offer support for people able to use them. Future research should focus on improving usability and engagement with the app as well as extend the way patients can communicate with health care professionals beyond a picture.
29 May 2026
Read appraisal →Studies in health technology and informatics
Design and Evaluation of an Episodic Guideline-Driven Decision Support Engine
Clinical guidelines (GLs) standardize care but are complex to implement. Most clinical decision support systems (CDSSs) assume continuous use, which does not reflect real-world episodic workflows. We developed and evaluated e-Picard, a CDSS providing GL-based recommendations for episodic, on-demand consultations, enabling prospective decision support informed by retrospective quality assessment. At runtime, e-Picard analyzes offline patient data, computes fuzzy-logic-based compliance, identifies missed actions and generates context-specific recommendations. The system was applied to longitudinal geriatric data managed under pressure ulcers (PU) and diabetes (DM) GLs. Manual technical validation using 3,110 PU and 12,538 DM data instances (43 PU and 82 DM patients) achieved ≥99% correctness and up to 98% completeness. Retrospective simulation on 1,000 patients per domain (57,860 PU and 100,940 DM data instances) demonstrated potential adherence improvements from 68%-69% to 89%-97% for PU and from 14%-15% to 60%-87% for DM, with higher consultation frequencies increasing compliance and reducing care variability. These results demonstrate that episodic CDSSs can deliver accurate, context-aware support even under intermittent use.
24 May 2026
Read appraisal →BMJ open diabetes research & care
Topical therapies for diabetic foot ulcers: a systematic review and network meta-analysis
OBJECTIVE: Diabetic foot ulcer (DFU) is a life-threatening complication associated with high amputation and mortality rates. While numerous topical therapies exist, their comparative efficacy and safety remain unclear. We aimed to compare the efficacy and safety of topical therapies for DFUs to identify optimal treatment strategies. RESEARCH DESIGN AND METHODS: We searched PubMed, Embase, and CENTRAL from inception to February 1, 2025, for randomized clinical trials (RCTs) evaluating topical therapies for DFUs. We excluded non-topical interventions to ensure clinically relevant comparisons. A Bayesian network meta-analysis was performed. The primary outcome was wound healing rate. RESULTS: We included 51 RCTs involving 6161 patients and 23 interventions. 12 topical therapies, including placenta-derived products, platelet-related products, ON101, epidermal growth factor, and tissue-engineered skin substitutes, significantly improved wound healing rates vs standard of care (SOC). Placenta-derived products showed the greatest efficacy (OR 7.85 (95% credible interval (CrI) 4.62 to 14.15)) and were the only intervention to significantly reduce adverse events vs SOC (0.25 (95% CrI 0.10 to 0.60)). No interventions differed significantly from SOC in time to wound healing, serious adverse events, or infections. CONCLUSIONS: Placenta-derived products and other biological or advanced topical therapies may demonstrate greater efficacy than the SOC in facilitating the healing of DFUs. Nevertheless, the certainty of evidence for most comparisons remains in the low-to-moderate range. These findings suggest potential benefits in integrating these therapies into the management of DFUs. However, high-quality RCTs are necessary to verify long-term outcomes.
23 May 2026
Read appraisal →Journal of burn care & research : official publication of the American Burn Association
Hyperbaric Oxygen Therapy in Burn Care: A Systematic Review of Current Evidence
Hyperbaric oxygen therapy (HBOT) involves inhaling 100% oxygen at pressures exceeding one atmosphere within a chamber. It is used across several specialties and has been proposed as an adjunct in burn management to enhance healing and improve outcomes. Despite increasing interest, evidence supporting its efficacy in burn care remains inconsistent, with no clear consensus in practice. A literature search was conducted in September 2025 across PubMed, Cochrane Library, and Embase without date restrictions to identify studies evaluating HBOT for burn treatment. Inclusion criteria were human studies, English-language articles, and full-text availability. Study selection followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two reviewers screened titles and abstracts, and a third resolved discrepancies. Eligible studies described HBOT as a burn treatment and reported clinical outcomes. Thirteen studies met inclusion criteria: 5 randomized controlled trials, 7 cohort studies, and 1 case-control study, evaluating 566 burn patients. Burn severity, HBOT protocols, and outcomes varied substantially. Several studies reported reduced need for surgery and shorter hospital stays with HBOT. Trends toward improved healing and lower infection risk were noted, while mortality benefits were inconsistent. Heterogeneity in design and treatment regimens limited synthesis via meta-analysis. Hyperbaric oxygen therapy shows promise as an adjunct in burn care, improving healing and reducing complications. However, variability and inconsistent outcomes limit definitive conclusions. Well-designed randomized trials are needed to establish standardized protocols and clarify their clinical role in burn management. Until then, burn centers may consider HBOT for acute injuries and threatened grafts.
11 May 2026
Read appraisal →Journal of burn care & research : official publication of the American Burn Association
FGF2 in Burn Wound Healing: From Molecular Function to Clinical Application-A Systematic Review
Burn injuries trigger complex inflammatory and metabolic cascades that impair wound healing and increase morbidity. Fibroblast growth factor 2 (FGF2), a potent mediator of cellular proliferation, angiogenesis, and extracellular matrix remodeling, has emerged as a promising therapeutic agent in burn care. This systematic review evaluated the biological mechanisms, delivery strategies, and clinical outcomes associated with FGF2 in burn wound healing to clarify its therapeutic value and translational potential. Following PRISMA 2020 standards, a structured literature search was conducted across PubMed, EMBASE, Web of Science, Cochrane, and Google Scholar to identify studies investigating FGF2 in thermal injuries. Eligible records included clinical trials, in vivo models, and in vitro experiments. Methodological quality and risk of bias were assessed using the Newcastle-Ottawa Scale, the SYRCLE tool, and the Oxford Levels of Evidence. Thirty-three studies (1992-2025) met inclusion criteria, encompassing randomized controlled trials, animal models, and mechanistic analyses. Fibroblast growth factor 2 accelerated repair by stimulating fibroblast proliferation, keratinocyte migration, angiogenesis, and matrix organization. Topical FGF2 formulations shortened healing time and improved scar quality in partial-thickness burns. Innovative carriers, including hydrogels, liposomes, and gene-activated matrices, enhanced bioavailability and sustained local effects. In diabetic and complex burn models, FGF2 mitigated inflammation, preserved barrier integrity, and promoted re-epithelialization. Efficacy depended on dosage and wound characteristics. Studies reported favorable safety profiles with minimal and mild adverse events. Fibroblast growth factor 2 demonstrates regenerative and immunomodulatory potential in burn management. Broader adoption requires harmonized regulatory evaluation, optimized delivery systems, and multicenter validation to define its role in precision-guided burn care.
11 May 2026
Read appraisal →Journal of wound care
Incidence and risk factors of medical adhesive-related skin injury among ICU patients: a systematic review and meta-analysis
OBJECTIVE: To summarise the evidence regarding the incidence and risk factors of medical adhesive-related skin injury (MARSI) among patients in the intensive care unit (ICU). METHOD: A systematic review and meta-analysis was undertaken using articles available in nine databases: PubMed; the Cochrane Library; Web of Science; Embase; CINAHL; Chinese Biomedical Literature Database; China National Knowledge Infrastructure Database; Wanfang Database; and Weipu Database, from inception until 30 June 2024. Additional studies were identified by examining the references of relevant articles. The Stata 16.0 statistical platform (StataCorp LLC, US) was used for analysis. Study quality was assessed using the Newcastle-Ottawa Scale and the Agency for Healthcare Research and Quality standards. RESULTS: Of 14,743 titles screened, 19 studies involving 5218 patients were included in the systematic review. The pooled incidence of MARSI was 21% (95% confidence interval (CI): 14%, 28%), and the incidence of MARSI among neonatal ICU, paediatric ICU and adult ICU was 15% (95% CI: 6%, 26%), 48% (95% CI: 35%, 60%) and 16% (95% CI: 11%, 22%), respectively. Significant risk factors in adult ICUs included oedema (odds ratio (OR): 8.144; 95%CI: 3.267, 20.304), Braden scale score (OR: 0.733; 95%CI: 0.641, 0.837), length of ICU stay (OR: 1.072; 95%CI: 1.026, 1.120), mechanical ventilation (OR: 3.698; 95%CI: 1.900, 7.199), sedative use (OR: 6.022; 95%CI: 2.859, 12.687), Nutritional Risk Screening 2002 score (OR: 4.241; 95%CI: 1.984, 9.065) and hypoalbuminaemia (OR: 4.321; 95%CI: 1.967, 9.488). CONCLUSION: This study found that MARSI is prevalent among ICU patients and is associated with multiple risk factors. Improved strategies for identifying and clinically managing MARSI in ICU patients are needed. Nevertheless, large-sample and multicentre studies are still warranted to validate the present study's findings.
10 May 2026
Read appraisal →Journal of wound care
Exudate management with a next-generation multilayered foam dressing in traumatic and surgical wounds: a prospective, multicentre study
OBJECTIVE: The aim of this study was to evaluate the efficacy, performance and safety of ConvaFoam (Convatec Ltd., UK), a next-generation multilayered foam dressing, in indicated surgical and traumatic wounds. METHOD: This prospective, multicentre, open-label study (ClinicalTrials.gov: NCT05632276) evaluated ConvaFoam dressings in surgical and traumatic wounds. Eligible patients were managed with ConvaFoam dressings in accordance with their instructions for use (maximum seven-day wear time) for ≤4 weeks. The primary endpoint was the proportion of patients and total dressings with excellent exudate management (defined as absence of strikethrough or periwound maceration). Secondary endpoints included: exudate management in dressings worn for seven days; healing rate; wear time; pain on application; usability; and safety. RESULTS: The study enrolled 52 patients (mean age: 48.2 years) with surgical (54%) or traumatic (46%) wounds. Median dressing wear time was five days (interquartile range: 1-7 days). Among patients who completed the study, 81% (38/47) were observed to have achieved excellent exudate management throughout all wound care visits (90% confidence interval (CI): 71, 90%). Excellent exudate management was also observed in 93% (209/224) of total dressings applied (90% CI: 90, 97%), including in 96% (47/49) of dressings worn for seven days. Only one patient in the study experienced periwound skin maceration at any study timepoint. Wound healing was observed in 93% of surgical wounds and 25% of traumatic wounds during the study period. Low levels of pain and high user satisfaction as per numeric pain scale and utility questionnaire, respectively, were reported. CONCLUSION: ConvaFoam dressings demonstrated excellent exudate management in >90% of dressing changes, and may promote an optimal environment for healing in surgical and traumatic wounds.
10 May 2026
Read appraisal →Journal of wound care
Comparison between foam dressings impregnated with ionic silver and silver sulfadiazine cream 1% in treating deep burns.
OBJECTIVE: The aim of this trial was to evaluate the effectiveness of foam dressings impregnated with ionic silver (AgF) compared to the traditional treatment of 1% silver sulfadiazine cream (SSD) in deep burns (deep dermal and full-thickness burns) and assess the cost-effectiveness ratio between the two treatments. METHOD: This was a randomised clinical trial of patients who were divided into two equal-sized treatment groups: Group 1-SSD or Group 2 - AgF. Inclusion criteria were patients aged between 18-60 years with burns of thermal origin affecting 10-30% of the body surface area, and with a comparable percentage of deep burns. The following outcomes were analysed: pain; discomfort; wound infection; need for new grafting; ease of dressing application; length of stay; and cost of treatment. RESULTS: A total of 40 patients took part (20 in each group). Regarding patients' experience of pain, data analysis revealed more effective pain control in patients treated with AgF. Additionally, the AgF dressing was considered safer, more comfortable and presented an average lower cost of 30.6% compared to the SSD. CONCLUSION: The findings of this trial showed that, compared to the SSD, the AgF dressings were more effective in treating deep burns, to prepare them for skin graft surgery.
10 May 2026
Read appraisal →Journal of diabetes science and technology
Adherence Monitor for Measurement of Removable Cast Walker Wear-Time: Multiple Sensors and Predictive Analytics Improve Accuracy
BACKGROUND: Treatment of diabetes and its complications is a primary health care expense. Up to 25% of people with diabetes will develop diabetic foot ulcers (DFUs). Removable cast walker (RCW) boots commonly prescribed for DFU treatment, promote healing, and provide offloading and wound protection. Patient RCW removal for hygiene and wound care can lead to decreased adherence and treatment effectiveness. This study evaluated a new system for wear-time adherence measurement using multiple sensor types. METHODS: An electronic wear-time monitor was developed, which included internal and external temperature sensors, an accelerometer, and capacitive proximity foot and ankle sensors. Time-stamped and date-stamped data were saved once per minute for up to 22 days. Ten healthy volunteer subjects were recruited to wear an RCW for two weeks while keeping a diary of don/doff times. Sensor data were then compared with volunteers' wear diaries using confusion matrix predictive analytics. RESULTS: Algorithms were developed for data processing. Correlation coefficients between algorithms and diaries were calculated for individual and multiple sensor combinations. Differential temperature and accelerometer algorithms were significantly better at predicting subject wear-time than individual temperature sensor algorithms (P = .009, P = .001, respectively). Foot proximity had significantly better correlation with subject diaries than temperature (P = .024), and acceleration algorithms (P = .005). Multi-sensor analysis showed high correlation (.96) with wear-time from subject diaries. CONCLUSIONS: Removable cast walker wear-time can be accurately determined using an electronic data recorder and multiple sensors. Wear-time measurement accuracy can be improved using algorithms that operate on data from multiple sensors that use a variety of sensor technologies.
9 May 2026
Read appraisal →Journal of plastic surgery and hand surgery
Characteristics and prognosis of skin cancer arising from burn scars: a systematic review
BACKGROUND: Burn scars are recognized risk factors for malignant skin transformation, most notably Marjolin's ulcer (MU). Despite extensive documentation in case reports and series, the epidemiological characteristics and prognosis of burn scar-related skin cancers have lacked large-scale systematic synthesis. METHODS: We conducted a systematic review in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, registered with PROSPERO (CRD42024545404), covering literature from PubMed, Scopus, and Web of Science up to 18 January 2024. Eligible studies included case reports, case series, and observational studies reporting any type of skin cancer in burn scars. Data were extracted on demographics, burn and tumor characteristics, treatment, latency, outcomes, and risk of bias using Joanna Briggs Institute tools. RESULTS: A total of 211 studies reporting 830 cases were included. The mean latency period from burn injury to cancer diagnosis was 21.7 years (SD = 19.6). Males constituted 53% of patients, with third-degree burns predominating (89.37%) and lower limbs being the most affected site (33.59%). Squamous cell carcinoma (SCC) was the most frequent malignancy (67.19%), followed by basal cell carcinoma (BCC, 3.83%) and other cancers (15.33%). Recurrence occurred in 13.2% of cases; mortality was 6.96%. SCC accounted for most deaths (63.8%), while melanoma and sarcoma exhibited high rates of recurrence and mortality. Lymph node metastasis and distant metastasis were found in 7.56 and 4.74% of cases, respectively. CONCLUSION: Skin cancers arising from burn scars, especially SCC, demonstrate aggressive clinical behavior with significant morbidity and mortality. Reduced latency periods and high metastatic potential highlight the importance of vigilant, long-term surveillance and radical initial treatment. This review provides a contemporary benchmark for epidemiological understanding and supports calls for international registries, molecular diagnostics, and standardized management protocols for burn scar malignancies.
25 Apr 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Mepitel Film versus StrataXRT for the prevention of radiation dermatitis in post-mastectomy radiotherapy: a systematic review and meta-analysis of randomized controlled trials
BACKGROUND: Radiation dermatitis (RD) affects up to 90% of patients receiving post-mastectomy radiotherapy, with moist desquamation causing significant morbidity. Barrier films and dressings such as Mepitel Film and StrataXRT have been shown to be effective compared to moisturizers, but their relative effectiveness remains debated. This systematic review and meta-analysis compares these interventions for preventing RD. METHODS: Following PRISMA guidelines, we systematically searched MEDLINE, Embase, and Cochrane Library through March 14, 2026. An additional grey literature search was performed in clinicaltrials.gov and Google Scholar. Eligible studies were RCTs directly comparing StrataXRT and Mepitel Film in breast cancer patients receiving adjuvant radiation therapy. Two reviewers independently screened studies, extracted data, and assessed risk of bias using RoB 2.0 and certainty of evidence with the GRADE appraoch. Meta-analysis used random-effects models to pool risk ratios (RR) for moist desquamation, and incidence of grade 2 and 3 RD, with I2 statistics quantifying heterogeneity. RESULTS: From 33 screened records, two intra-patient, non-inferiority RCTs (n = 120) met inclusion criteria. Both studies randomized medial/lateral chest wall halves to each intervention in post-mastectomy patients. Pooled analysis revealed no significant difference in moist desquamation incidence between StrataXRT (21.7%) and Mepitel Film (20.0%) (RR 1.03; 95% CI 0.52-2.04; P = 0.93), with low heterogeneity (I2 = 35%). Secondary outcomes showed Mepitel Film significantly reduced grade 2 or 3 RD (RR 1.34, 95% CI 1.10-1.64, P = 0.004). However, Mepitel Film trended toward higher incidence of itchiness (10.8% vs. 5.0%, P = 0.11). Patient preference data were conflicting, with one trial favoring StrataXRT for ease of use and the other showing no clear preference. CONCLUSION: While StrataXRT and Mepitel Film demonstrated similar efficacy for preventing moist desquamation, Mepitel Film offered superior protection against grade 2 to 3 RD. However, this conclusion should be interpreted with caution given the underlying methodological limitations of the included studies, including small and potentially underpowered sample sizes, and variations in radiation fractionation schedules and RT techniques.
15 Apr 2026
Read appraisal →Journal of controlled release : official journal of the Controlled Release Society
Redox-active microneedles for disease management.
Reactive oxygen and nitrogen species are essential to several biological functions, from maintaining cellular homeostasis to driving disease progression and aging. As such, the precise modulation of cellular redox states has emerged as a promising medical strategy. In parallel, microneedle technology has rapidly advanced over the past two decades, offering minimally invasive, targeted, and painless delivery of therapeutics. This review presents a comprehensive analysis of the emerging field of redox-active microneedles (RAMs), a novel class of wearable medical devices with broad potential for treating infected wounds, cancer, psoriasis, diabetes, arthritis, hair loss, skin aging, and potentially many other conditions. By integrating redox biology with advanced microneedle-based drug delivery systems, RAMs are poised to transform personalized and precision medicine, an evolution supported by a growing number of patents, clinical trials, and rapid advancements in catalytic, photodynamic, and nanomedicine research.
11 Apr 2026
Read appraisal →PloS one
Advanced microfluidic and 3D cell culture platforms for modeling vascularization in diabetic foot ulcers: A systematic review of translational challenges and perspectives
The healing process of diabetic foot ulcers (DFUs) presents a slow pattern with an increased risk of infections, ischemia, and thrombosis correlated with high levels of reactive oxygen species production. Vascular injury is one of the factors contributing to the difficulty of wound healing in diabetic patients. Although the understanding of the pathophysiology of DFUs has significantly increased in recent years, associated treatments still have a high level of failure, leading to high morbidity rates, mortality, and amputations. Three-dimensional (3D) cell culture platforms offer a new approach to investigating and treating these wounds, as they can reproduce one or more physiological systems in a relevant microenvironment. This systematic review describes the advancements, challenges, and future implications of advanced 3D culture models in vascularization, encompassing pathophysiological understanding, treatment, and prognostic perspectives. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. This work was registered under PROSPERO protocol number CRD42022336473. The eligibility criteria addressed studies related to chronic DFUs that analyzed vascularization during the healing process. The selected study designs involved 3D cultures and organ-on-a- chip (OoC) platforms, utilizing either primary or secondary human cell lines. Studies published more than 10 years ago or using only animal cells in 2D culture environments were excluded. The search was conducted in PubMed, LILACS, Embase, MEDLINE, IEEE, the BSV regional portal, ScienceDirect, Scopus, CINAHL, EBSCO, and Web of Science. A total of 2,539 relevant studies were identified as of June 1, 2025. After screening, only seven met the inclusion criteria. These studies reflect a growing interest in using hydrogel scaffolds and microfluidic systems to replicate diabetic skin environments; however, the field remains in an early stage of development. OoC platforms, in particular, stand out for their ability to recreate dynamic, tissue-like conditions and vascular function. While some promising attempts have been made to combine hydrogels with these technologies, the evidence is still limited and inconclusive for chronic wound modeling. This review underscores both the potential and the urgent need for more robust and translational research in this area-especially toward building personalized, clinically relevant models to support future drug testing and therapeutic innovation.
7 Apr 2026
Read appraisal →Journal of wound care
Micrografts-a novel ally in hard-to-heal wounds: a systematic review.
OBJECTIVE: Wound healing is complex, and hard-to-heal (chronic) wounds pose significant treatment challenges, especially in adults. Micrografts (MGs) are emerging as a promising treatment for wounds refractory to conventional approaches. MG involves transplanting a stem cell suspension to the wound to promote healing. Scientific studies on MG are increasing; however, a systematic review is needed for a comprehensive understanding of its efficacy. METHOD: A systematic review conducted on 30 March 2024 used PubMed, Scopus and Web of Science databases to evaluate skin and dermal MGs in wound healing. PRISMA guidelines were followed and predefined inclusion and exclusion criteria were applied. All authors reviewed the studies and discussed results to ensure consistency in study screening, selection and data extraction. RESULTS: A total of 1251 papers were examined, with 23 eligible for full-text review. After exclusions based on language, reviews, MG size and tissue focus, 15 articles were included in the final review: seven case reports; five case series; two prospective series (one with 70 patients, the other with 30 patients) and a case-control study. CONCLUSION: The results of the reviewed studies suggest that MGs may promote wound healing, with reported reductions in healing time and improvements in clinical symptoms in hard-to-heal wounds. However, standardisation of treatment protocols and application methods is required. The role of MGs in the treatment of acute wounds remains to be clarified.
4 Apr 2026
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