Difference between revisions of "Fukami"

(Created page with "   <span style="font-size:16.0pt">Hyperbaric oxygen did not improve the outcome from postopertive adhesive small bowel obstruction</span> '''<span style="font-size:11.0...")
 
 
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<span style="font-size:16.0pt">Hyperbaric oxygen did not improve the outcome from postopertive adhesive small bowel obstruction</span>
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<span style="font-size:x-large;">'''Hyperbaric oxygen did not improve the outcome from postoperative adhesive small bowel obstruction'''</span>
  
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'''<span style="font-size:11.0pt">Clinical Bottom Line:</span>'''
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<span style="font-size:larger;">'''Clinical Bottom Line:&nbsp;'''</span><span style="font-size:medium;">1.Hyperbaric oxygen made no difference to the outcome</span>
  
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<span style="font-size:11.0pt">1.Hyperbaric oxygen made no difference to the outcome</span>
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<span style="font-size:medium;">'''Citation/s:&nbsp;'''1. Fukami Y, Kobayashi S, Sekoguchi E, Kurumiya Y. Randomized controlled trial of hyperbaric oxygen therapy in adhesive postoperative small bowel obstruction. Langenbeck's archives of surgery. 2018 Aug 1;403(5):555-9.</span>
  
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'''<span style="font-size:11.0pt">Citation/s:&nbsp;</span>'''<span style="font-size:11.0pt">1. Fukami Y, Kobayashi S, Sekoguchi E, Kurumiya Y. Randomized controlled trial of hyperbaric oxygen therapy in adhesive postoperative small bowel obstruction. Langenbeck's archives of surgery. 2018 Aug 1;403(5):555-9.</span>
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'''<span style="font-size:11.0pt">Lead author's name and fax:</span>'''<span style="font-size:11.0pt">Y Fukami yasuyuki490225@yahoo.co.jp</span>
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<span style="font-size:medium;">'''Lead author's name and fax:&nbsp;'''Y Fukami yasuyuki490225@yahoo.co.jp</span>
  
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'''<span style="font-size:11.0pt">Three-part Clinical Question:</span>'''<span style="font-size:11.0pt">For patients with postoperative small bowel obstruction, does the addition of a course of hyperbaric oxygen to the usual care, result in a reduction in the time to recovery or need for operation?</span>
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<span style="font-size:medium;">'''Three-part Clinical Question:'''For patients with postoperative small bowel obstruction, does the addition of a course of hyperbaric oxygen to the usual care, result in a reduction in the time to recovery or need for operation?</span>
  
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'''<span style="font-size:11.0pt">Search Terms:</span>'''<span style="font-size:11.0pt">Small bowel obstruction., postoperative compliations</span>
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<span style="font-size:medium;">'''Search Terms:'''Small bowel obstruction., postoperative compliations</span>
  
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'''<span style="font-size:11.0pt">The Study:&nbsp;</span>'''<span style="font-size:11.0pt">Non-blinded concealed randomised controlled trial with intention-to-treat.</span>
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<span style="font-size:medium;">'''The Study:&nbsp;'''Non-blinded concealed randomised controlled trial with intention-to-treat.</span>
  
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'''<span style="font-size:11.0pt">The Study Patients:</span>'''<span style="font-size:11.0pt">Adult patients with a history of abdominal surgery more than four weeks previously and clinical signs and symptoms of mechanical obstruction, with dilated loops of small intestine of CT scan.</span>
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<span style="font-size:medium;">'''The Study Patients:'''Adult patients with a history of abdominal surgery more than four weeks previously and clinical signs and symptoms of mechanical obstruction, with dilated loops of small intestine of CT scan.</span>
  
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'''<span style="font-size:11.0pt">Control group</span>'''<span style="font-size:11.0pt">(N = 40; 40 analysed): No oral intake, IV fluids and insertion of nasograstric tube.</span>
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<span style="font-size:medium;">'''Control group:&nbsp;'''(N = 40; 40 analysed): No oral intake, IV fluids and insertion of nasograstric tube.</span>
  
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'''<span style="font-size:11.0pt">Experimental group</span>'''<span style="font-size:11.0pt">(N = 33; 33 analysed): As above plus 100% osygen breathing at 2 ATA for 90 minutes daily up to seven times or until improvement in symptoms.</span>
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<span style="font-size:medium;">'''Experimental group:&nbsp;'''(N = 33; 33 analysed): As above plus 100% osygen breathing at 2 ATA for 90 minutes daily up to seven times or until improvement in symptoms.</span>
  
 
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'''<span style="font-size:11.0pt">The Evidence:</span>'''
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<span style="font-size:medium;">'''The Evidence:'''</span>
  
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{| class="Table" style="border:undefined"
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{| class="Table" style="border-top:outset; border-left:outset; border-bottom:inset; border-right:inset; border-width:1.0pt; border:solid windowtext 1.0pt"
 
|-
 
|-
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| <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''<span style="font-size:10.0pt">Outcome</span>'''</p>  
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| style="border:solid windowtext 1.0pt" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''<span style="font-size:10.0pt">Outcome</span>'''</p>  
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| <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''<span style="font-size:10.0pt">Time to Outcome</span>'''</p>  
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| style="border:solid windowtext 1.0pt" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''<span style="font-size:10.0pt">Time to Outcome</span>'''</p>  
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| <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''<span style="font-size:10.0pt">Standard group</span>'''</p>  
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| style="border:solid windowtext 1.0pt" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''<span style="font-size:10.0pt">Standard group</span>'''</p>  
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| <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''<span style="font-size:10.0pt">HBOT group</span>'''</p>  
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| style="border:solid windowtext 1.0pt" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''<span style="font-size:10.0pt">Hyperbaric group</span>'''</p>  
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| style="width:67.85pt" width="92" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''<span style="font-size:10.0pt">Relative risk reduction</span>'''</p>  
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| style="width:67.85pt; border:solid windowtext 1.0pt" width="92" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''<span style="font-size:10.0pt">Relative risk reduction</span>'''</p>  
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| style="width:69.35pt" width="94" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''<span style="font-size:10.0pt">Absolute risk reduction</span>'''</p>  
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| style="width:69.35pt; border:solid windowtext 1.0pt" width="94" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''<span style="font-size:10.0pt">Absolute risk reduction</span>'''</p>  
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| style="width:80.1pt" width="110" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''<span style="font-size:10.0pt">NNT</span>'''</p>  
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| style="width:80.1pt; border:solid windowtext 1.0pt" width="110" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''<span style="font-size:10.0pt">NNT</span>'''</p>  
 
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|-
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| rowspan="2" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''<span style="font-size:10.0pt">Need for operation</span>'''</p>  
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| rowspan="2" style="border:solid windowtext 1.0pt" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''<span style="font-size:10.0pt">Need for operation</span>'''</p>  
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| <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">no defined period</span></p>  
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| style="border:solid windowtext 1.0pt" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">no defined period</span></p>  
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| <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">0.10</span></p>  
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| style="border:solid windowtext 1.0pt" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">0.10</span></p>  
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| <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">0.18</span></p>  
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| style="border:solid windowtext 1.0pt" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">0.18</span></p>  
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| style="width:67.85pt" width="92" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">-82%</span></p>  
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| style="width:67.85pt; border:solid windowtext 1.0pt" width="92" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">-82%</span></p>  
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| style="width:69.35pt" width="94" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">-0.08</span></p>  
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| style="width:69.35pt; border:solid windowtext 1.0pt" width="94" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">-0.08</span></p>  
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| style="width:80.1pt" width="110" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">12</span></p>  
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| style="width:80.1pt; border:solid windowtext 1.0pt" width="110" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">12</span></p>  
 
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| colspan="3" | <p align="right" style="text-align:right; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">95% CIs:</span></p>  
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| colspan="3" style="border:solid windowtext 1.0pt" | <p align="right" style="text-align:right; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">95% CIs:</span></p>  
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| style="width:67.85pt" width="92" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">-243% to 79%</span></p>  
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| style="width:67.85pt; border:solid windowtext 1.0pt" width="92" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">-243% to 79%</span></p>  
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| style="width:69.35pt" width="94" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">-0.24 to 0.08</span></p>  
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| style="width:69.35pt; border:solid windowtext 1.0pt" width="94" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">-0.24 to 0.08</span></p>  
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| style="width:80.1pt" width="110" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">NNT = 4 to INF; NNH = 13 to INF</span></p>  
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| style="width:80.1pt; border:solid windowtext 1.0pt" width="110" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">NNT = 4 to INF; NNH = 13 to INF</span></p>  
 
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|-
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| rowspan="2" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''<span style="font-size:10.0pt">Successful medical treatment</span>'''</p>  
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| rowspan="2" style="border:solid windowtext 1.0pt; border-bottom:outset 1.0pt" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''<span style="font-size:10.0pt">Successful medical treatment</span>'''</p>  
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| <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">No defined period</span></p>  
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| style="border:solid windowtext 1.0pt" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">No defined period</span></p>  
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| <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">0.73</span></p>  
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| style="border:solid windowtext 1.0pt" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">0.73</span></p>  
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| <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">0.79</span></p>  
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| style="border:solid windowtext 1.0pt" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">0.79</span></p>  
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| style="width:67.85pt" width="92" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">-9%</span></p>  
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| style="width:67.85pt; border:solid windowtext 1.0pt" width="92" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">-9%</span></p>  
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| style="width:69.35pt" width="94" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">-0.06</span></p>  
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| style="width:69.35pt; border:solid windowtext 1.0pt" width="94" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">-0.06</span></p>  
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| style="width:80.1pt" width="110" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">16</span></p>  
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| style="width:80.1pt; border:solid windowtext 1.0pt" width="110" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">16</span></p>  
 
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| colspan="3" | <p align="right" style="text-align:right; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">95% CIs:</span></p>  
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| colspan="3" style="border:solid windowtext 1.0pt" | <p align="right" style="text-align:right; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">95% CIs:</span></p>  
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| style="width:67.85pt" width="92" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">-36% to 18%</span></p>  
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| style="width:67.85pt; border:solid windowtext 1.0pt" width="92" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">-36% to 18%</span></p>  
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| style="width:69.35pt" width="94" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">-0.259 to 0.133</span></p>  
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| style="width:69.35pt; border:solid windowtext 1.0pt" width="94" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">-0.259 to 0.133</span></p>  
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| style="width:80.1pt" width="110" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">NNT = 4 to INF; NNH = 7 to INF</span></p>  
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| style="width:80.1pt; border:solid windowtext 1.0pt" width="110" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">NNT = 4 to INF; NNH = 7 to INF</span></p>  
 
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{| class="Table" style="border:undefined"
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{| class="Table" style="border: 1pt solid windowtext; width: 857px;"
 
|-
 
|-
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| rowspan="2" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''<span style="font-size:10.0pt">Measure</span>'''</p>  
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| rowspan="2" style="border:solid windowtext 1.0pt" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''<span style="font-size:10.0pt">Measure</span>'''</p>  
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| colspan="2" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''<span style="font-size:10.0pt">Standard Group</span>'''</p>  
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| colspan="2" style="border: 1pt solid windowtext; width: 138px;" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''<span style="font-size:10.0pt">Standard Group</span>'''</p>  
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| colspan="2" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''<span style="font-size:10.0pt">HBOT Group</span>'''</p>  
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| colspan="2" style="border: 1pt solid windowtext; width: 164px;" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''<span style="font-size:10.0pt">Hyperbaric group</span>'''</p>  
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| rowspan="2" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''<span style="font-size:10.0pt">Difference</span>'''</p>  
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| rowspan="2" style="border: 1pt solid windowtext; width: 138px;" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''<span style="font-size:10.0pt">Difference</span>'''</p>  
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| rowspan="2" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''<span style="font-size:10.0pt">95% CI</span>'''</p>  
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| rowspan="2" style="border: 1pt solid windowtext; width: 175px;" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''<span style="font-size:10.0pt">95% CI</span>'''</p>  
 
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|-
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| <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''<span style="font-size:10.0pt">Mean</span>'''</p>  
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| style="border:solid windowtext 1.0pt" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''<span style="font-size:10.0pt">Mean</span>'''</p>  
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| <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''<span style="font-size:10.0pt">SD</span>'''</p>  
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| style="border: 1pt solid windowtext; width: 81px;" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''<span style="font-size:10.0pt">SD</span>'''</p>  
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| <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''<span style="font-size:10.0pt">Mean</span>'''</p>  
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| style="border: 1pt solid windowtext; width: 58px;" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''<span style="font-size:10.0pt">Mean</span>'''</p>  
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| <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''<span style="font-size:10.0pt">SD</span>'''</p>  
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| style="border: 1pt solid windowtext; width: 100px;" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''<span style="font-size:10.0pt">SD</span>'''</p>  
 
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|  
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| style="border:solid windowtext 1.0pt" |  
 
'''<span style="font-size:10.0pt">Time to oral intake (days)</span>'''
 
'''<span style="font-size:10.0pt">Time to oral intake (days)</span>'''
  
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| <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">4.2</span></p>  
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| style="border:solid windowtext 1.0pt" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">4.2</span></p>  
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| <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">3.7</span></p>  
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| style="border: 1pt solid windowtext; width: 81px;" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">3.7</span></p>  
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| <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">4.2</span></p>  
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| style="border: 1pt solid windowtext; width: 58px;" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">4.2</span></p>  
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| <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">3.3</span></p>  
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| style="border: 1pt solid windowtext; width: 100px;" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">3.3</span></p>  
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| <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">0.0</span></p>  
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| style="border: 1pt solid windowtext; width: 138px;" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">0.0</span></p>  
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| <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">-5.8 to 5.8</span></p>  
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| style="border: 1pt solid windowtext; width: 175px;" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">-5.8 to 5.8</span></p>  
 
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|  
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| style="border:solid windowtext 1.0pt" |  
 
'''<span style="font-size:10.0pt">Length of hospital stay (days)</span>'''
 
'''<span style="font-size:10.0pt">Length of hospital stay (days)</span>'''
  
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| <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">11.5</span></p>  
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| style="border:solid windowtext 1.0pt" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">11.5</span></p>  
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| <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">7.0</span></p>  
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| style="border: 1pt solid windowtext; width: 81px;" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">7.0</span></p>  
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| <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">14.2</span></p>  
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| style="border: 1pt solid windowtext; width: 58px;" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">14.2</span></p>  
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| <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">10.0</span></p>  
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| style="border: 1pt solid windowtext; width: 100px;" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">10.0</span></p>  
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| <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">-2.7</span></p>  
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| style="border: 1pt solid windowtext; width: 138px;" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">-2.7</span></p>  
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| <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">-36.4 to 31.0</span></p>  
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| style="border: 1pt solid windowtext; width: 175px;" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:10.0pt">-36.4 to 31.0</span></p>  
 
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'''<span style="font-size:11.0pt">Comments:</span>'''
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<span style="font-size:medium;">'''Comments:'''</span>
  
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<span style="font-size:11.0pt">1. Small trial, somewhat underpowered (original target 100 individuals randomised), but no indication of likely benefit.</span>
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<span style="font-size:medium;">1. Small trial, somewhat underpowered (original target 100 individuals randomised), but no indication of likely benefit.</span>
  
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<span style="font-size:11.0pt">2. Bias remains possible due to unbiased nature of trial, but this seems unlikely to be large given the nature of the endpoints.</span>
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<span style="font-size:medium;">2. Bias remains possible due to unbiased nature of trial, but this seems unlikely to be large given the nature of the endpoints.</span>
  
 
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'''<span style="font-size:11.0pt">Appraised by:</span>'''<span style="font-size:11.0pt">Michael Bennett, POWH m.bennett@unsw.edu.au; Monday, 22 July 2019</span>
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<span style="font-size:medium;">'''Appraised by:&nbsp;'''Michael Bennett, POWH m.bennett@unsw.edu.au; Monday, 22 July 2019</span>
  
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'''<span style="font-size:11.0pt">Kill or Update By</span>'''<span style="font-size:11.0pt">: July 2025</span>
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<span style="font-size:medium;">'''Review or delete: '''July 2025</span>
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<br/> &nbsp;
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<p style="text-align: center;">&nbsp;</p> <p style="text-align: center;">[[File:Sumhorsa.gif|center|Sumhorsa.gif]]</p> <p style="text-align: center;">[[Flaps_and_grafts|<span style="font-size:x-large;">'''BACK'''</span>]]</p>

Latest revision as of 03:41, 17 August 2022

 

Hyperbaric oxygen did not improve the outcome from postoperative adhesive small bowel obstruction

Clinical Bottom Line: 1.Hyperbaric oxygen made no difference to the outcome

Citation/s: 1. Fukami Y, Kobayashi S, Sekoguchi E, Kurumiya Y. Randomized controlled trial of hyperbaric oxygen therapy in adhesive postoperative small bowel obstruction. Langenbeck's archives of surgery. 2018 Aug 1;403(5):555-9.

Lead author's name and fax: Y Fukami yasuyuki490225@yahoo.co.jp

Three-part Clinical Question:For patients with postoperative small bowel obstruction, does the addition of a course of hyperbaric oxygen to the usual care, result in a reduction in the time to recovery or need for operation?

Search Terms:Small bowel obstruction., postoperative compliations

 

The Study: Non-blinded concealed randomised controlled trial with intention-to-treat.

The Study Patients:Adult patients with a history of abdominal surgery more than four weeks previously and clinical signs and symptoms of mechanical obstruction, with dilated loops of small intestine of CT scan.

Control group: (N = 40; 40 analysed): No oral intake, IV fluids and insertion of nasograstric tube.

Experimental group: (N = 33; 33 analysed): As above plus 100% osygen breathing at 2 ATA for 90 minutes daily up to seven times or until improvement in symptoms.

 

The Evidence:

Outcome

Time to Outcome

Standard group

Hyperbaric group

Relative risk reduction

Absolute risk reduction

NNT

Need for operation

no defined period

0.10

0.18

-82%

-0.08

12

95% CIs:

-243% to 79%

-0.24 to 0.08

NNT = 4 to INF; NNH = 13 to INF

Successful medical treatment

No defined period

0.73

0.79

-9%

-0.06

16

95% CIs:

-36% to 18%

-0.259 to 0.133

NNT = 4 to INF; NNH = 7 to INF

 

Measure

Standard Group

Hyperbaric group

Difference

95% CI

Mean

SD

Mean

SD

Time to oral intake (days)

4.2

3.7

4.2

3.3

0.0

-5.8 to 5.8

Length of hospital stay (days)

11.5

7.0

14.2

10.0

-2.7

-36.4 to 31.0

 

Comments:

1. Small trial, somewhat underpowered (original target 100 individuals randomised), but no indication of likely benefit.

2. Bias remains possible due to unbiased nature of trial, but this seems unlikely to be large given the nature of the endpoints.

 

Appraised by: Michael Bennett, POWH m.bennett@unsw.edu.au; Monday, 22 July 2019

Review or delete: July 2025

 

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