Perren - Revision history

M.bennett at 04:46, 15 September 2021

2021-09-15T04:46:14Z

M.bennett at 04:20, 15 September 2021

2021-09-15T04:20:07Z

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2018-12-04T05:58:29Z

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==The addition of HBOT to standard wound care improved healing rate in diabetic foot ulcers.==
{|
| # '''The addition of HBOT improved wound area and depth at four weeks.'''
|-
|}
**Citation/s: '''Perren S, Gatt A, Papanas N, Formosa C. Hyperbaric Oxygen Therapy in Ischemic Foot Ulcers in Type 2 Diabetes: A Clinical Trial. The Open Cardiovascular Medicine Journal 2018; 12:80.

 '''Lead author's name and fax:''' Alfred.Gatt@um.edu.mt

**Three-part Clinical Question:''' For diabetic patients with a newly diagnosed ischemic foot ulcer, does the addition of HBOT to standard wound care result in improved healing?

 '''Search Terms:''' diabetes, chronic wound, skin ulcer, ischaemia
**The Study: '''Non-blinded randomised controlled trial with intention-to-treat.

 '''The Study Patients:''' Adults with type 2 diabetes and a newly diagnosed ischemic DFU. 

 '''Control group''' (N = 13; 13 analysed): Standard wound care including cleansing, optimised glycaemic control, treating infection, improving blood supply and relieving pressure on the wound site.

**Experimental group''' (N = 13; 13 analysed): SWC and daily 100% oxygen under increased atmospheric pressure (ATA not specified) for two hours from Monday to Friday to 40 sessions.

**The Evidence:'''

{|
| '''Measure''' |||| '''HBOT Group''' |||| '''Control Group''' || '''Difference''' || '''95% CI'''
|-
|^ || '''Mean''' || '''SD''' || '''Mean''' || '''SD''' ||^ ||^
|-
| '''Wound depth (cm) at week 4''' || 0.71 || 0.25 || 1.34 || 0.29 || 0.63 || 0.41 to 0.85
|-
| '''Wound surface area (cm2) at week 4''' || 9.55 || 0.84 || 7.98 || 1.95 || 1.57 || 0.36 to 2.79
|-
|}

**Comments:'''

 1. No sham treatment. The patient were randomized and matched for age, gender, DM duration, current medication, HbA1c, wound size and location using frequency distribution matching. Tight matching increases power by decreasing variability between groups but may eliminate allocation concealment.

 2. Results given at four weeks, which seems to be after only half the HBOT treatments!

 3. All investigations are made by the same investigator to ensure uniformity.

 4. Standard wound care seems comprehensive

'''Appraised by:''' Cecilia Bondjers; Thursday, 1 November 2018
 '''Email:''' cecilia.bondjers@vgregion.se

 '''Kill or Update By:''' July 2021.



[[File:sumhorsa.gif]]


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

@@ Line 4: / Line 4: @@
 <span style="line-height:normal">'''<span style="font-size:14.0pt"><span style="color:black">Clinical Bottom Line:</span></span>'''</span>
-{| class="Table" style="width: 784px; border: 1pt solid windowtext;" width="0"
+{| class="Table" style="width: 836px; border: 1pt solid windowtext;" width="0"
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+| style="border: 1pt solid windowtext; width: 822px;" |
 <span style="line-height:normal"><span style="height:24.1pt"><span style="font-size:14.0pt">1. Hyperbaric oxygen therapy decreased wound depth, but not surface area of ischaemic diabetic foot ulcers.</span></span></span>
@@ Line 55: / Line 55: @@
 <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="color:black">Comments:</span></span>'''<br/> <span style="font-size:12.0pt"><span style="color:black">1. Poorly reported study. Small, unblinded trial, randomisation method not stated but patients matched for wound size and location, no sham. Some doubt about timing of outcome measure – may have been halfway through treatment!</span></span></span>
-<span style="line-height:normal"><span style="font-size:12.0pt"><span style="color:black">2. Oxygen treatment regimens not given or discoverable from references.</span></span></span>
+<span style="line-height:normal"><span style="font-size:12.0pt"><span style="color:black">2. Oxygen treatment regimens not given – perhaps each session was 60 minutes, twice per day, giving 40 sessions over 4 weeks.</span></span></span>
 <span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="color:black">Appraised by:</span></span>'''<span style="font-size:12.0pt"><span style="color:black">Mary Grealish and Cecilia Bondjers POWH; Tuesday, 7 September 2021<br/> '''Email:''' Mary.Grealish@health.nsw.gov.au<br/> '''Kill or Update By:''' Sept 2022</span></span></span>
 <p style="text-align: center;">&nbsp;</p> <p style="text-align: center;">[[File:Sumhorsa.gif|RTENOTITLE]]</p>
 <span style="color: #7c00ff; display: block; font-size: 26px; text-align: center;">'''[[Non-healing_wounds|BACK]]'''</span>