M.bennett at 02:58, 1 November 2021

2021-11-01T02:58:31Z

M.bennett: Created page with " '''Hyperbaric oxygen res..."

2021-11-01T02:47:32Z

Created page with " '''Hyperbaric oxygen res..."

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'''Hyperbaric oxygen resulted in improvement in depression following a cerebral haemorrhage compared to an antidepressant medication'''

'''Clinical Bottom Line:'''

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1. Depression following cerebral haemorrhage was more often successfully treated with hyperbaric oxygen than conventional antidepressants. 2. Both a depression scale and the NIH Stroke scale were better following HBO but not statistically so.

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'''Citation/s:'''1.Cao, H., Ju, K., Zhong, L., & Meng, T. (2013). Efficacy of hyperbaric oxygen treatment for depression in the convalescent stage following cerebral haemorrhage. Experimental and Therapeutic Medicine, 5, 1609-1612. '''Lead author's name: '''Dr Tao Meng: E-mail: taomengcn@yeah.net

'''Three-part Clinical Question:'''For patients convalescing following cerebral haemorrhage, does a course of hyperbaric oxygen therapy, compared to a course of oral antidepressant medication, result in more improvement in clinical depression? '''Search Terms:''' Cerebrovascular accident; haemorrhage; depression

'''The Study:'''Non-blinded randomised controlled trial with intention-to-treat. '''The Study Patients:''' Adult patients 2 to 6 months after suffering a first haemorrhagic stroke and diagnosed with depression (Hamilton Depression Scale score >20 points). '''Control group''' (N = 30; 30 analysed): Four weeks of treatment with antidepressant medication: 1mg depixol plus 20mg melitracen daily until improvement then half that dose. '''Experimental group''' (N = 30; 30 analysed): 100% oxygen breathing at 2 ATA for 70 minutes daily preceded by dexamethasone 2.5 to 5 mg to a total of 30 treatments over four weeks.

'''The Evidence:'''

{| class="Table" style="border:solid windowtext 1.0pt"
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| style="border: 1pt solid windowtext; width: 201px;" | '''Outcome'''
| style="border: 1pt solid windowtext; width: 90px;" | '''Time to Outcome'''
| style="border: 1pt solid windowtext; width: 85px;" | '''Control group'''
| style="border: 1pt solid windowtext; width: 75px;" | '''HBOT group'''
| style="border: 1pt solid windowtext; width: 147px;" | '''Relative risk reduction'''
| style="border: 1pt solid windowtext; width: 125px;" | '''Absolute risk reduction'''
| style="border: 1pt solid windowtext; width: 101px;" | '''NNT'''
|-
| rowspan="2" style="border: 1pt solid windowtext; width: 201px;" | '''Hamilton Depression Scale reduction of >75% (cure)'''
| style="border: 1pt solid windowtext; width: 90px;" | 4 weeks
| style="border: 1pt solid windowtext; width: 85px;" | 0.13
| style="border: 1pt solid windowtext; width: 75px;" | 0.40
| style="border: 1pt solid windowtext; width: 147px;" | 201%
| style="border: 1pt solid windowtext; width: 125px;" | 0.27
| style="border: 1pt solid windowtext; width: 101px;" | 4
|-
| colspan="3" style="border: 1pt solid windowtext; width: 263px;" | 95% CIs:
| style="border: 1pt solid windowtext; width: 147px;" | 40 to 361%
| style="border: 1pt solid windowtext; width: 125px;" | 0.1 to 0.50
| style="border: 1pt solid windowtext; width: 101px;" | 2 to 19
|-
| rowspan="2" style="border: 1pt solid windowtext; width: 201px;" | '''Hamilton Depression Scale reduction of <25% (fail)'''
| style="border: 1pt solid windowtext; width: 90px;" | 4 weeks
| style="border: 1pt solid windowtext; width: 85px;" | 0.40
| style="border: 1pt solid windowtext; width: 75px;" | 0.17
| style="border: 1pt solid windowtext; width: 147px;" | 58%
| style="border: 1pt solid windowtext; width: 125px;" | 0.23
| style="border: 1pt solid windowtext; width: 101px;" | 4
|-
| colspan="3" style="border: 1pt solid windowtext; width: 263px;" | 95% CIs:
| style="border: 1pt solid windowtext; width: 147px;" | 3% to 100%
| style="border: 1pt solid windowtext; width: 125px;" | 0.01 to 0.45
| style="border: 1pt solid windowtext; width: 101px;" | 2 to 79
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{| class="Table" style="border:solid windowtext 1.0pt"
|-
| rowspan="2" style="border:solid windowtext 1.0pt" | '''Measure'''
| colspan="2" style="border:solid windowtext 1.0pt" | '''Control Group'''
| colspan="2" style="border:solid windowtext 1.0pt" | '''HBOT Group'''
| rowspan="2" style="border:solid windowtext 1.0pt" | '''Difference'''
| rowspan="2" style="border:solid windowtext 1.0pt" | '''95% CI'''
|-
| style="border:solid windowtext 1.0pt" | Mean
| style="border:solid windowtext 1.0pt" | SD
| style="border:solid windowtext 1.0pt" | Mean
| style="border:solid windowtext 1.0pt" | SD
|-
| style="border:solid windowtext 1.0pt" |
'''Hamilton Depression Scale at 4 weeks'''

| style="border:solid windowtext 1.0pt" | 19.7
| style="border:solid windowtext 1.0pt" | 4.4
| style="border:solid windowtext 1.0pt" | 9.4
| style="border:solid windowtext 1.0pt" | 5.4
| style="border:solid windowtext 1.0pt" | 10.3
| style="border:solid windowtext 1.0pt" | -2.2 to 22.8
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| style="border:solid windowtext 1.0pt" |
'''National Institutes of Health Stroke Scale at 4 weeks'''

| style="border:solid windowtext 1.0pt" | 13.2
| style="border:solid windowtext 1.0pt" | 4.1
| style="border:solid windowtext 1.0pt" | 8.4
| style="border:solid windowtext 1.0pt" | 2.9
| style="border:solid windowtext 1.0pt" | 4.8
| style="border:solid windowtext 1.0pt" | -1.7 to 11.3
|}

'''Comments:''' 1. There were considerable differences between groups in baseline demographics suggesting a significant possibility of bias in these outcomes. No description of the method of randomisation. 2. The authors’ analysis suggested both HAMD and NIHSS were significantly better following HBO than medication, but our analysis does not confirm this. 3. Expert opinion is required to comment on whether or not a four week course of medication is an adequate period of time to expect maximum benefit.
'''Appraised by:'''Mike Bennett m.bennett@unsw.edu.au; Monday, 1 November 2021 '''Kill or Update By:''' November 2025

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-<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:"><span style="color:black">Comments:</span></span></span>'''<br/> <span style="font-size:12.0pt"><span style="font-family:"><span style="color:black">1. There were considerable differences between groups in baseline demographics suggesting a significant possibility of bias in these outcomes. No description of the method of randomisation.<br/> 2. The authors’ analysis suggested both HAMD and NIHSS were significantly better following HBO than medication, but our analysis does not confirm this.<br/> 3. Expert opinion is required to comment on whether or not a four week course of medication is an adequate period of time to expect maximum benefit.</span></span></span></span> '''<span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family:"><span style="color:black">Appraised by:</span></span></span></span>'''<span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family:"><span style="color:black">Mike Bennett m.bennett@unsw.edu.au; Monday, 1 November 2021<br/> '''Kill or Update By:''' November 2025</span></span></span></span>
+<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:"><span style="color:black">Comments:</span></span></span>'''<br/> <span style="font-size:12.0pt"><span style="font-family:"><span style="color:black">1. There were considerable differences between groups in baseline demographics suggesting a significant possibility of bias in these outcomes. No description of the method of randomisation.<br/> 2. The authors’ analysis suggested both HAMD and NIHSS were significantly better following HBO than medication, but our analysis does not confirm this.<br/> 3. Expert opinion is required to comment on whether or not a four week course of medication is an adequate period of time to expect maximum benefit.</span></span></span></span>
 <p style="text-align: center;">&nbsp;</p> <p style="text-align: center;">[[File:Sumhorsa.gif|center|Sumhorsa.gif]]</p>
 = [[Stroke|BACK]] =

Cao - Revision history

M.bennett at 02:58, 1 November 2021

M.bennett at 02:58, 1 November 2021

M.bennett: Created page with " '''Hyperbaric oxygen res..."