Kranke - Revision history

M.bennett at 07:02, 3 January 2020

2020-01-03T07:02:11Z

M.bennett at 07:00, 3 January 2020

2020-01-03T07:00:21Z

Gordoben: Imported from Wikispaces

2018-01-20T23:23:21Z

Imported from Wikispaces

New page

'''This is the abstract of the Cochrane Review of the use of hyperbaric oxygen therapy for chronic wounds'''

'''Citation:'''
Kranke P, Bennett MH, Martyn-St James M, Schnabel A, Debus SE. Hyperbaric oxygen therapy for chronic wounds. Cochrane Database of Systematic Reviews 2012, Issue 4. Art. No.: CD004123.
**Background'''
Chronic wounds are common and present a health problem with significant effect on quality of life. The wide range of therapeutic strategies for such wounds reflects the various pathologies that may cause tissue breakdown, including poor blood supply resulting in anadequate oxygenation of the wound bed. Hyperbaric oxygen therapy (HBOT) has been suggested to improve oxygen supply to wounds and therefore improve their healing. 

**Objectives'''
To assess the benefits and harms of adjunctive HBOT for treating chronic ulcers of the lower limb (diabetic foot ulcers, venous and arterial ulcers and pressure ulcers). 

**Search strategy'''
We searched the Cochrane Wounds Group Specialised Trial Register (searched 6 February 2003), CENTRAL (The Cochrane Library Issue 1, 2003), Medline (1966 - 2003), EMBASE (1974 - 2003), DORCTHIM (1996 - 2003), and reference lists of articles. Relevant journals were handsearched and researchers in the field were contacted. 

**Selection criteria'''
Randomised studies comparing the effect on chronic wound healing of therapeutic regimens including HBOT with those not including HBOT (with or without sham therapy). 

**Data collection & analysis'''
Three reviewers independently evaluated the quality of the relevant trials using the validated Oxford-Scale (Jadad 1996) and extracted the data from the included trials. 

**Main results'''
Five trials contributed to this review. Diabetic foot ulcer (4 trials, 147 patients): Pooled data of three trials with 118 patients showed a reduction in the risk of major amputation when adjunctive HBOT was used, compared to the alternative therapy (RR: 0.31; 95%-CI 0.13 to 0.71). Sensitivity analysis for the allocation of dropouts did not significantly alter that result. This analysis predicts that we would need to treat 4 individuals with HBOT in order to prevent 1 amputation in the short term (NNT 4, 95%-CI: 3 to 11). There was no statistically significant change in minor amputation rate (pooled data of two trials with 48 patients). Healing rate was reported only in one trial (Abidia 2003) which showed a significant improvement in the chance of healing 1 year after therapy (RR for failure to heal with sham 2.3, 95%CI 1.1 to 4.7, P=0.03), although no effect was determined immediately post HBOT, nor at 6 months. Further, the beneficial effect after 1 year was sensitive to allocation of dropouts. 
Venous ulcer: (1 trial, 16 patients): This trial reported data at six weeks (wound size reduction) and 18 weeks (wound size reduction and healing rate) and suggested a significant benefit of HBOT in terms of reduction in ulcer area only at 6 weeks (WMD 33%, 95%CI 19% to 47%, P<0.00001). 
Arterial and pressure ulcers: No trials that satisfied inclusion criteria were located. 

**Reviewers' conclusions'''
In people with foot ulcers due to diabetes, HBOT significantly reduced the risk of major amputation and may improve the chance of healing at 1 year. The application of HBOT to these patients may be justified where HBOT facilities are available. In any case, thorough economic evaluation should be undertaken. In view of the modest number of patients, methodological shortcomings and poor reporting, this result should be interpreted cautiously however, and an appropriately powered trial of high methodological rigour is justified to verify this promising finding and further define those patients who can be expected to derive most benefit from HBOT. 
Regarding the effect of HBOT on chronic wounds associated with other pathological processes, any benefit from HBOT will need to be examined in further, appropriate randomised trials. The routine management of such wounds is not justified at this time on the evidence from this review. 

[[File:sumhorsa.gif|center]]

'''[[Non-healing wounds | BACK]]'''

@@ Line 6: / Line 6: @@
 &nbsp;
-'''<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Background</span>'''
+<span style="font-size:medium;">'''<span style="font-family: Arial, Helvetica, sans-serif;">Background</span>'''</span>
-<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Chronic wounds are common and present a health problem with significant effect on quality of life. The wide range of therapeutic strategies for such wounds reflects the various pathologies that may cause tissue breakdown, <span style="color: black;">including poor blood supply resulting in anadequate oxygenation of the wound bed.</span> Hyperbaric oxygen therapy (HBOT) has been suggested to <span style="color: black;">improve </span>oxygen supply <span style="color: black;">to wounds </span>and therefore <span style="color: black;">improve their healing.</span></span>
+<span style="font-size:medium;"><span style="font-family: Arial, Helvetica, sans-serif;">Chronic wounds are common and present a health problem with significant effect on quality of life. The wide range of therapeutic strategies for such wounds reflects the various pathologies that may cause tissue breakdown, <span style="color: black;">including poor blood supply resulting in anadequate oxygenation of the wound bed.</span> Hyperbaric oxygen therapy (HBOT) has been suggested to <span style="color: black;">improve </span>oxygen supply <span style="color: black;">to wounds </span>and therefore <span style="color: black;">improve their healing.</span></span></span>
 &nbsp;
-'''<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Objectives</span>'''
+<span style="font-size:medium;">'''<span style="font-family: Arial, Helvetica, sans-serif;">Objectives</span>'''</span>
-<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">To assess the benefit<span style="color: black;">s </span>and harm<span style="color: black;">s </span>of adjunctive HBOT for treating chronic <span style="color: black;">ulcers of the lower limb (diabetic foot ulcers, venous and arterial ulcers and pressure ulcers)</span>.</span>
+<span style="font-size:medium;"><span style="font-family: Arial, Helvetica, sans-serif;">To assess the benefit<span style="color: black;">s </span>and harm<span style="color: black;">s </span>of adjunctive HBOT for treating chronic <span style="color: black;">ulcers of the lower limb (diabetic foot ulcers, venous and arterial ulcers and pressure ulcers)</span>.</span></span>
-'''<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Search strategy</span>''' <section id="portlet_scolariscontentdisplay_WAR_scolariscontentdisplay"><article><section><section id="CD004123-abs1-0003"> <span style="font-size:medium;">For this second update we searched the Cochrane Wounds Group Specialised Register (searched 18 February 2015); the Cochrane Central Register of Controlled Trials (CENTRAL) (''The Cochrane Library'' 2015, Issue 1); Ovid MEDLINE&nbsp;(1946 to 17 February 2015); Ovid MEDLINE (In‐Process & Other Non‐Indexed Citations, 17 February 2015); Ovid EMBASE (1974 to 17 February 2015); and EBSCO CINAHL (1982 to 17 February 2015).</span> </section> </section> </article> </section> &nbsp;
+<span style="font-size:medium;">'''<span style="font-family: Arial, Helvetica, sans-serif;">Search strategy</span>'''</span>
-'''<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Selection criteria</span>'''
+<span style="font-size:medium;">For this second update we searched the Cochrane Wounds Group Specialised Register (searched 18 February 2015); the Cochrane Central Register of Controlled Trials (CENTRAL) (''The Cochrane Library'' 2015, Issue 1); Ovid MEDLINE&nbsp;(1946 to 17 February 2015); Ovid MEDLINE (In‐Process & Other Non‐Indexed Citations, 17 February 2015); Ovid EMBASE (1974 to 17 February 2015); and EBSCO CINAHL (1982 to 17 February 2015).&nbsp;</span>
-<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Randomised studies comparing the effect on chronic wound healing of therapeutic regimens including HBOT with those not including HBOT (with or without sham therapy).</span>
+<span style="font-size:medium;">'''<span style="font-family: Arial, Helvetica, sans-serif;">Selection criteria</span>'''</span>
-'''<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Data collection & analysis</span>''' <section id="portlet_scolariscontentdisplay_WAR_scolariscontentdisplay"><article><section><section id="CD004123-abs1-0005"> <span style="font-size:medium;">Three review authors independently evaluated the risk of bias of the relevant trials using the Cochrane methodology and extracted the data from the included trials. We resolved any disagreement by discussion.</span> </section> </section> </article> </section> &nbsp;
+<span style="font-size:medium;"><span style="font-family: Arial, Helvetica, sans-serif;">Randomised studies comparing the effect on chronic wound healing of therapeutic regimens including HBOT with those not including HBOT (with or without sham therapy).</span></span>
-'''<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Main results</span>''' <section id="portlet_scolariscontentdisplay_WAR_scolariscontentdisplay"><article><section><section id="CD004123-abs1-0006"> <span style="font-size:medium;">We included twelve trials (577 participants). Ten trials (531 participants) enrolled people with a diabetic foot ulcer: pooled data of five trials with 205 participants showed an increase in the rate of ulcer healing (risk ratio (RR) 2.35, 95% confidence interval (CI) 1.19 to 4.62; P = 0.01) with HBOT at six weeks but this benefit was not evident at longer‐term follow‐up at one year. There was no statistically significant difference in major amputation rate (pooled data of five trials with 312 participants, RR 0.36, 95% CI 0.11 to 1.18). One trial (16 participants) considered venous ulcers and reported data at six weeks (wound size reduction) and 18 weeks (wound size reduction and number of ulcers healed) and suggested a significant benefit of HBOT in terms of reduction in ulcer area only at six weeks (mean difference (MD) 33.00%, 95% CI 18.97 to 47.03, P < 0.00001). We identified one trial (30 participants) which enrolled patients with non‐healing diabetic ulcers as well as venous ulcers ("mixed ulcers types") and patients were treated for 30 days. For this "mixed ulcers" there was a significant benefit of HBOT in terms of reduction in ulcer area at the end of treatment (30 days) (MD 61.88%, 95% CI 41.91 to 81.85, P < 0.00001). We did not identify any trials that considered arterial and pressure ulcers.</span> </section> </section> </article> </section> &nbsp;
+<span style="font-size:medium;">'''<span style="font-family: Arial, Helvetica, sans-serif;">Data collection & analysis</span>'''&nbsp;</span>
-'''<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Reviewers' conclusions</span>''' <section id="portlet_scolariscontentdisplay_WAR_scolariscontentdisplay"><article><section><section id="CD004123-abs1-0007"> <span style="font-size:medium;">In people with foot ulcers due to diabetes, HBOT significantly improved the ulcers healed in the short term but not the long term and the trials had various flaws in design and/or reporting that means we are not confident in the results. More trials are needed to properly evaluate HBOT in people with chronic wounds; these trials must be adequately powered and designed to minimise all kinds of bias</span> </section> </section> </article> </section> [[File:Sumhorsa.gif|center|Sumhorsa.gif]]
+<span style="font-size:medium;">Three review authors independently evaluated the risk of bias of the relevant trials using the Cochrane methodology and extracted the data from the included trials. We resolved any disagreement by discussion.&nbsp; &nbsp;</span>
 <span style="color: #7c00ff; display: block; font-family: arial,helvetica,sans-serif; font-size: 26px; text-align: center;">'''[[Non-healing_wounds|BACK]]'''</span>

@@ Line 1: / Line 1: @@
 <span style="font-family: Arial,Helvetica,sans-serif; font-size: 130%;">'''This is the abstract of the Cochrane Review of the use of hyperbaric oxygen therapy for chronic wounds'''</span>
-<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Citation:'''</span>
+<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Citation:'''</span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Kranke P, Bennett MH, Martyn-St James M, Schnabel A, Debus SE Weibel S. Hyperbaric oxygen therapy for chronic wounds. Cochrane Database of Systematic Reviews </span><span style="font-size:medium;">2015, Issue 6. Art. No.: CD004123. .pub4<span style="font-family: Arial, Helvetica, sans-serif;">.</span></span>
-<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Kranke P, Bennett MH, Martyn-St James M, Schnabel A, Debus SE. Hyperbaric oxygen therapy for chronic wounds. Cochrane Database of Systematic Reviews 2012, Issue 4. Art. No.: CD004123.</span>
-**<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Background</span>'''
+&nbsp;
 <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Chronic wounds are common and present a health problem with significant effect on quality of life. The wide range of therapeutic strategies for such wounds reflects the various pathologies that may cause tissue breakdown, <span style="color: black;">including poor blood supply resulting in anadequate oxygenation of the wound bed.</span> Hyperbaric oxygen therapy (HBOT) has been suggested to <span style="color: black;">improve </span>oxygen supply <span style="color: black;">to wounds </span>and therefore <span style="color: black;">improve their healing. </span></span>
-**<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Objectives</span>'''
+<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">To assess the benefit<span style="color: black;">s </span>and harm<span style="color: black;">s </span>of adjunctive HBOT for treating chronic <span style="color: black;">ulcers of the lower limb (diabetic foot ulcers, venous and arterial ulcers and pressure ulcers)</span>.</span>
-**<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Search strategy</span>'''
+'''<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Search strategy</span>''' <section id="portlet_scolariscontentdisplay_WAR_scolariscontentdisplay"><article><section><section id="CD004123-abs1-0003"> <span style="font-size:medium;">For this second update we searched the Cochrane Wounds Group Specialised Register (searched 18 February 2015); the Cochrane Central Register of Controlled Trials (CENTRAL) (''The Cochrane Library'' 2015, Issue 1); Ovid MEDLINE&nbsp;(1946 to 17 February 2015); Ovid MEDLINE (In‐Process & Other Non‐Indexed Citations, 17 February 2015); Ovid EMBASE (1974 to 17 February 2015); and EBSCO CINAHL (1982 to 17 February 2015).</span> </section> </section> </article> </section> &nbsp;
-**<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Selection criteria</span>'''
+'''<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Selection criteria</span>'''
-**<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Data collection & analysis</span>'''
+<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Randomised studies comparing the effect on chronic wound healing of therapeutic regimens including HBOT with those not including HBOT (with or without sham therapy).</span>
-**<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Main results</span>'''
+'''<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Data collection & analysis</span>''' <section id="portlet_scolariscontentdisplay_WAR_scolariscontentdisplay"><article><section><section id="CD004123-abs1-0005"> <span style="font-size:medium;">Three review authors independently evaluated the risk of bias of the relevant trials using the Cochrane methodology and extracted the data from the included trials. We resolved any disagreement by discussion.</span> </section> </section> </article> </section> &nbsp;
-**<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Reviewers' conclusions</span>'''
+'''<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Main results</span>''' <section id="portlet_scolariscontentdisplay_WAR_scolariscontentdisplay"><article><section><section id="CD004123-abs1-0006"> <span style="font-size:medium;">We included twelve trials (577 participants). Ten trials (531 participants) enrolled people with a diabetic foot ulcer: pooled data of five trials with 205 participants showed an increase in the rate of ulcer healing (risk ratio (RR) 2.35, 95% confidence interval (CI) 1.19 to 4.62; P = 0.01) with HBOT at six weeks but this benefit was not evident at longer‐term follow‐up at one year. There was no statistically significant difference in major amputation rate (pooled data of five trials with 312 participants, RR 0.36, 95% CI 0.11 to 1.18). One trial (16 participants) considered venous ulcers and reported data at six weeks (wound size reduction) and 18 weeks (wound size reduction and number of ulcers healed) and suggested a significant benefit of HBOT in terms of reduction in ulcer area only at six weeks (mean difference (MD) 33.00%, 95% CI 18.97 to 47.03, P < 0.00001). We identified one trial (30 participants) which enrolled patients with non‐healing diabetic ulcers as well as venous ulcers ("mixed ulcers types") and patients were treated for 30 days. For this "mixed ulcers" there was a significant benefit of HBOT in terms of reduction in ulcer area at the end of treatment (30 days) (MD 61.88%, 95% CI 41.91 to 81.85, P < 0.00001). We did not identify any trials that considered arterial and pressure ulcers.</span> </section> </section> </article> </section> &nbsp;
-[[File:sumhorsa.gif|center]]
+'''<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Reviewers' conclusions</span>''' <section id="portlet_scolariscontentdisplay_WAR_scolariscontentdisplay"><article><section><section id="CD004123-abs1-0007"> <span style="font-size:medium;">In people with foot ulcers due to diabetes, HBOT significantly improved the ulcers healed in the short term but not the long term and the trials had various flaws in design and/or reporting that means we are not confident in the results. More trials are needed to properly evaluate HBOT in people with chronic wounds; these trials must be adequately powered and designed to minimise all kinds of bias</span> </section> </section> </article> </section> [[File:Sumhorsa.gif|center|Sumhorsa.gif]]
-<span style="color: #7c00ff; display: block; font-family: arial,helvetica,sans-serif; font-size: 26px; text-align: center;">'''[[Non-healing wounds  |  BACK]]'''
+<span style="color: #7c00ff; display: block; font-family: arial,helvetica,sans-serif; font-size: 26px; text-align: center;">'''[[Non-healing_wounds|BACK]]'''</span>