CRITICAL REVIEW

Critical review

Article 1- Critical Review Using Comrack model

Strengths and weaknesses of the study

Methodology is consistent with other studies since RCTs remain the key for clinical trial studies (Felzani G et al. 2011, Voigt J et al. 2012, Humbert P et al. 2012). Inculsion criteria are apposite. However, they should have barred age limit since wound healing is a concern for all age groups. The study should have addressed cardiac patients as well specially on anticoagulant therapy to observe the differences in the efficacy. Patients with peripheral neuropathy of non-diabetic origin should also be incorporated to observe the neural role in healing since studies with diabetics have shown safety and efficacy of the hyaluronic acid for treating leg ulcers (Abbruzzese L, 2009). Study protocols, are consistent with the inclusion criteria and drug prescription and dosing is consistent with the practices prescribed by Health care authorities.

Grading scales of data have been well defined and seem to be apt for the concerned study since observations encompass multi factorial treatment approach using hyaluronic acid, the consequences on wound periphery must be documented.

End points of the data are convincing since angiogenesis starts in the very week of wound existence. Angiogenesis specially require collagen as mentioned above that collagen is the major part of connective tissues. Wound maturation is evident in a month hence a 45 day time period is appropriate to observe the healing process. Angiogenesis is also accomplished till the time of maturation and significant healing can be observed in that period with the help of hyaluronic acid supplements. The time period from 15 days to 60 days is calculated which is related to the time of angiogenesis. Angiogenesis begins with in the week of wound occurrence and lasts for atleast months. This time is appropriate for measuring wound healing and the size of tissue and reduction in the wound to document the efficacy of the given hyaluronic acid supplements. However, a survey based on prophylactic hyaluronic acid supplementation can be a good contrivance for determining efficacy of the hyaluronic acid supplement specially in cases of large wounds for example coronary artery bypass grafting, wound debridement, laprotomy, cesarean sections, necrotic ulcerations etc, which has not been established up till now.

The scheme for safety parameters is good for prospective purpose excluding chances of noise in the data. But, the inefficacy or worsening of the wound is being excluded from study. This may introduce bias in the study favoring the effectiveness. However, considering co-morbids and other factors interfering the wound healing and inducing worsening condition of the wound must be addressed discretely. Sample size needs justification with respect to settings and the ability to approach out-patient population. It must be rationalized that 140 patients may be available conveniently and can be observed routinely in tenure of the study.

Statistical analysis seems appropriate with the type of study. The data is prone to variations and software used is appropriate for the type of variation that may be ...