Pitkin - Revision history

M.bennett at 06:36, 9 July 2019

2019-07-09T06:36:07Z

M.bennett at 06:33, 9 July 2019

2019-07-09T06:33:00Z

M.bennett at 03:19, 9 July 2019

2019-07-09T03:19:36Z

M.bennett at 06:11, 8 July 2019

2019-07-08T06:11:37Z

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2018-12-28T04:04:05Z

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'''Hyperbaric oxygen did not reverse the changes of radiation-induced brachial plexopathy following irradiation of early breast cancer.''' 

'''Clinical Bottom Line:''' 
1. No evidence of improvement in brachial plexus function with HBOT. 

'''Appraised by:''' Mike Bennett, Dept of Diving and Hyperbaric Medicine, Prince of Wales Hospital 
Sydney; Tuesday, 19 September 2000 

'''Clinical Scenario:''' A patient with pain and weakness in the arm following irradiation to the breast. 
'''Three-part Question:''' For patients with brachial plexus damage following irradiation, does the administration of hyperbaric oxygen, compared to 100% oxygen at 1ATA, result in any improvement in pain or function? 
'''Search Terms:''' Radiation tissue damage, breast cancer 

'''The Study:''' 
Double-blinded concealed randomised controlled trial with intention-to-treat. 
Patients with moderate radiation- induced brachial plexopathy following irradiation for breast cancer. 
'''Control group''' (N = 17; 17 analysed): 41% oxygen at 2.4ATA for 90 minutes (equivalent to 100% at 1ATA) daily for 30 treatments. 
'''Experimental group''' (N = 18; 17 analysed): 100% oxygen at 2.4ATA on the same schedule as above. 

'''The Evidence:''' 

{|
| '''Outcome''' || '''Time to Outcome''' || '''Control group''' || '''HBO Group''' || '''Relative Risk Reduction''' || '''Absolute Risk Reduction''' || '''NNT''' 
|-
| '''Warm sensory threshold normalised''' || 12 months || 0 || 0.18 || --- || 0.18 || 6 
|-
| '''95% CI''' || || || || || -0.01 to 0.36 || NNT 3 to INF NNH 199 to INF 
|-
|}

No clinically significant differences for McGill pain questionnaire or MOS SF-36 general health questionnaire. 

'''Comments:''' 
1. Cases were of relatively long-standing (median 11 yrs, range 1-29) 
2. Very high compliance rate with follow-up. 
3. Authors comment on two cases of marked improvement in lymphoedema 
4. Some evidence of minor improvements on multiple comparisons with self-assessment questionnaires, but authors agree they are difficult to interpret. 
5. A follow-up at 6 to 7 years examined McGill pain and MOS SF-16 general health questionnaires and again reported no differences between the groups. 

'''Expiry date:''' December 2019

'''References:''' 
# Pitkin A, Pritchard J, Anand P et al. Double-blind randomised controlled trial of hyperbaric oxygen (HBO) therapy for treatment of radiation-induced brachial plexopathy (RIBP). Undersea and Hyperbaric Medicine 2000; 27(suppl):39. 
# Pritchard J, Anand P, Broome J, Davis C, Gothard L, Hall E, Maher J, McKinna F, Millington J, Misra VP, Pitkin A, Yarnold JR. Double-blind randomized phase II study of hyperbaric oxygen in patients with radiation-induced brachial plexopathy. Radiother Oncol 2001 Mar;58(3):279-86. 
# Yarnold J. Double-blind randomised phase II study of hyperbaric oxygen in patients with radiation-induced brachial plexopathy. Radiotherapy and Oncology 2005; 77:327.
# Gothard J, Haviland J, Bryson P. Randomised phase II trial of hyperbaric oxygen therapy in patients with chronic arm lymphoedema after radiotherapy for cancer Radiotherapy and Oncology 2010; 97:101-107

[[File:sumhorsa.gif|center]]

'''[[Radiation tissue injury | BACK]]'''

@@ Line 20: / Line 20: @@
 <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''The Evidence:'''</span>
-{|
+{| class="Table" style="border:solid windowtext 1.0pt"
 |-
-| <span><span>'''Outcome'''</span></span>
+| style="border:solid windowtext 1.0pt" |
-| style="text-align: center;" | <span><span>'''Time to Outcome'''</span></span>
+<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Outcome</span></span>'''</span>
-| style="text-align: center;" | <span><span>'''Control group'''</span></span>
-| style="text-align: center;" | <span><span>'''HBO Group'''</span></span>
+| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Time to Outcome</span></span>'''</span></p>
-| style="text-align: center;" | <span><span>'''Relative Risk Reduction'''</span></span>
+| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Control group</span></span>'''</span></p>
-| style="width: 130px; text-align: center;" | <span><span>'''Absolute Risk Reduction'''</span></span>
+| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">HBO Group</span></span>'''</span></p>
-| style="width: 121px; text-align: center;" | <span><span>'''NNT'''</span></span>
+| style="border:solid windowtext 1.0pt" | <p align="center" style="margin-bottom:.0001pt; text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Relative Risk Reduction</span></span>'''</span></p>
 |-
-| <span>'''Warm sensory threshold normalised'''</span>
+| style="border:solid windowtext 1.0pt" |
-| style="text-align: center;" | <span><span>12 months</span></span>
+<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Warm sensory threshold normalised</span></span>'''</span>
 |-
-| <span>'''95% CI'''</span>
+| style="border:solid windowtext 1.0pt" |
-| &nbsp;
+<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">95% CI</span></span>'''</span>
 |}

@@ Line 1: / Line 1: @@
-<span style="font-family: Arial,Helvetica,sans-serif; font-size: 130%;">'''Hyperbaric oxygen did not reverse the changes of radiation-induced brachial plexopathy following irradiation of early breast cancer.'''</span>
+<span style="font-size:large;"><span style="font-family: Arial, Helvetica, sans-serif;">'''Hyperbaric oxygen did not reverse the changes of radiation-induced brachial plexopathy following irradiation of early breast cancer.'''</span></span>
-<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Clinical Bottom Line:''' </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">1. No evidence of improvement in brachial plexus function with HBOT.</span>
+<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Clinical Bottom Line:'''</span>
 <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Appraised by:''' Mike Bennett, Dept of Diving and Hyperbaric Medicine, Prince of Wales Hospital </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Sydney; Tuesday, 19 September 2000</span>
@@ Line 21: / Line 23: @@
 |-
 | <span><span>'''Outcome'''</span></span>
-| <span><span>'''Time to Outcome'''</span></span>
+| style="text-align: center;" | <span><span>'''Time to Outcome'''</span></span>
-| <span><span>'''Control group'''</span></span>
+| style="text-align: center;" | <span><span>'''Control group'''</span></span>
-| <span><span>'''HBO Group'''</span></span>
+| style="text-align: center;" | <span><span>'''HBO Group'''</span></span>
-| <span><span>'''Relative Risk Reduction'''</span></span>
+| style="text-align: center;" | <span><span>'''Relative Risk Reduction'''</span></span>
-| <span><span>'''Absolute Risk Reduction'''</span></span>
+| style="width: 130px; text-align: center;" | <span><span>'''Absolute Risk Reduction'''</span></span>
-| style="text-align: center;" | <span><span>'''NNT'''</span></span>
+| style="width: 121px; text-align: center;" | <span><span>'''NNT'''</span></span>
 |-
 | <span>'''Warm sensory threshold normalised'''</span>
-| <span><span>12 months</span></span>
+| style="text-align: center;" | <span><span>12 months</span></span>
-| <span><span>0</span></span>
+| style="text-align: center;" | <span><span>0</span></span>
-| <span><span>0.18</span></span>
+| style="text-align: center;" | <span><span>0.18</span></span>
-| <span><span>---</span></span>
+| style="text-align: center;" | <span><span>---</span></span>
-| <span><span>0.18</span></span>
+| style="width: 130px; text-align: center;" | <span><span>0.18</span></span>
-| <span><span style="display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">6</span></span>
+| style="width: 121px;" | <p style="text-align: center;">&nbsp;</p>
 |-
 | <span>'''95% CI'''</span>
@@ Line 41: / Line 45: @@
 | &nbsp;
 | &nbsp;
-| <span><span>-0.01 to 0.36</span></span>
+| style="width: 130px; text-align: center;" | <span><span>-0.01 to 0.36</span></span>
-| <span><span>NNT 3 to INF</span></span><span><span style="display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">NNH 199 to INF</span></span>
+| style="width: 121px;" | <p style="text-align: center;"><span><span>NNT 3 to INF</span></span></p>
 |}

@@ Line 6: / Line 6: @@
 <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Appraised by:''' Mike Bennett, Dept of Diving and Hyperbaric Medicine, Prince of Wales Hospital </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Sydney; Tuesday, 19 September 2000</span>
-<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Clinical Scenario:''' A patient with pain and weakness in the arm following irradiation to the breast. </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Three-part Question:''' For patients with brachial plexus damage following irradiation, does the administration of hyperbaric oxygen, compared to 100% oxygen at 1ATA, result in any improvement in pain or function? </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Search Terms:''' Radiation tissue damage, breast cancer</span>
+<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Clinical Scenario:''' A patient with pain and weakness in the arm following irradiation to the breast.</span>
-<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''The Study:''' </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Double-blinded concealed randomised controlled trial with intention-to-treat. </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Patients with moderate radiation- induced brachial plexopathy following irradiation for breast cancer. </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Control group''' (N = 17; 17 analysed): 41% oxygen at 2.4ATA for 90 minutes (equivalent to 100% at 1ATA) daily for 30 treatments. </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Experimental group''' (N = 18; 17 analysed): 100% oxygen at 2.4ATA on the same schedule as above.</span>
+<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Three-part Question:''' For patients with brachial plexus damage following irradiation, does the administration of hyperbaric oxygen, compared to 100% oxygen at 1ATA, result in any improvement in pain or function?</span>
 <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''The Evidence:'''</span>
@@ Line 41: / Line 47: @@
 <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">No clinically significant differences for McGill pain questionnaire or MOS SF-36 general health questionnaire.</span>
-<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Comments:''' </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">1. Cases were of relatively long-standing (median 11 yrs, range 1-29) </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">2. Very high compliance rate with follow-up. </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">3. Authors comment on two cases of marked improvement in lymphoedema </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">4. Some evidence of minor improvements on multiple comparisons with self-assessment questionnaires, but authors agree they are difficult to interpret. </span> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">5. A follow-up at 6 to 7 years examined McGill pain and MOS SF-16 general health questionnaires and again reported no differences between the groups.</span>
+<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Comments:'''</span>
 <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Expiry date:''' December 2019</span>