Difference between revisions of "Lewis"

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'''<span style="color: #003366; font-family: arial,helvetica,sans-serif; font-size: 130%;">Hyperbaric oxygen reduced gross haematuria and may improve quality of life for patients with radiation cystitis. </span>'''
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<span style="font-size:large;">'''<span style="color: rgb(0, 51, 102); font-family: arial, helvetica, sans-serif;">Hyperbaric oxygen reduced gross haematuria and may improve quality of life for patients with radiation cystitis.</span>'''</span>
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| <span style'''"font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Clinical Bottom Line:'''</span><br><span style'''"font-family: Arial,Helvetica,sans-serif; font-size: 120%;">1. Hyperbaric oxygenation was associated with improvement in gross haematuria in the short term</span><br><span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">2. Some longer-term benefit in haematuria, severity score and quality of life, but all patients received HBOT, so not a randomised outcome.</span>
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| <span style="font-size:medium;">'''Clinical Bottom Line:'''<br/> 1. Hyperbaric oxygenation was associated with improvement in gross haematuria in the short term<br/> <span style="font-family: Arial, Helvetica, sans-serif;">2. Some longer-term benefit in haematuria, severity score and quality of life, but all patients received HBOT, so not a randomised outcome.</span></span>
 
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Citation/s:'''Lewis AL, Hardy KR, Huang ET, Bolotin T, Clark JM, Thom SR. Hyperbaric oxygen therapy decreases gross haematuria and improves quality of life in patients with radiation cystitis. <span style="font-family: Arial;">Undersea and Hyperbaric Medicine 2005; 32(4)236</span></span>
 
<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Citation/s:'''Lewis AL, Hardy KR, Huang ET, Bolotin T, Clark JM, Thom SR. Hyperbaric oxygen therapy decreases gross haematuria and improves quality of life in patients with radiation cystitis. <span style="font-family: Arial;">Undersea and Hyperbaric Medicine 2005; 32(4)236</span></span>
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Three-part Clinical Question:''' For patients with radiation cystitis, does hyperbaric oxygen therapy compared to standard approaches to treatment, result in any reduction in haematuria, pain or other related symptoms?'''Search Terms:''' Radiation, cystitis, haematuria</span>
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Three-part Clinical Question:''' For patients with radiation cystitis, does hyperbaric oxygen therapy compared to standard approaches to treatment, result in any reduction in haematuria, pain or other related symptoms?</span>
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 +
<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Search Terms:''' Radiation, cystitis, haematuria</span>
  
 
<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''The Study:'''Non-blinded randomised cross-over trial with intention-to-treat.</span>
 
<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''The Study:'''Non-blinded randomised cross-over trial with intention-to-treat.</span>
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''The Study Patients:''' Symptomatic radiation cystitis including gross haematuria.</span>
 
<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''The Study Patients:''' Symptomatic radiation cystitis including gross haematuria.</span>
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Control group''' (N = 26 ; 19 analysed): Standard therapy (no details) for six weeks, then crossed over to HBOT arm.</span>
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Experimental group''' (N = 26 ; 19 analysed): 100% oxygen at an unspecified pressure daily for six weeks, then crossed to standard arm.</span>
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Control group''' (N = 26&nbsp;; 19 analysed): Standard therapy (no details) for six weeks, then crossed over to HBOT arm.</span>
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Experimental group''' (N = 26&nbsp;; 19 analysed): 100% oxygen at an unspecified pressure daily for six weeks, then crossed to standard arm.</span>
  
 
<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''The Evidence:'''</span>
 
<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''The Evidence:'''</span>
  
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| <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">'''Outcome''' </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">'''Time to Outcome''' </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">'''Control group rate''' </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">'''Hyperbaric group rate''' </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">'''Relative risk reduction''' </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">'''Absolute risk reduction''' </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">'''Number needed to treat''' </span></span>
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{| class="Table" style="border: 1pt solid windowtext; width: 686px;"
 
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|-
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| <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">'''Resolution of gross haematuria''' </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">12 weeks </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">0.12 </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">0.54 </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">368% </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">0.42 </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">2 </span></span>  
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| style="width:77.55pt; border:solid windowtext 1.0pt" width="106" |
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Outcome</span></span>'''</span>
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| style="width:60.2pt; border:solid windowtext 1.0pt" width="82" | <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>
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| style="width:48.15pt; border:solid windowtext 1.0pt" width="66" | <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 rate</span></span>'''</span></p>
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| style="width:62.25pt; border:solid windowtext 1.0pt" width="85" | <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"="">Hyperbaric group rate</span></span>'''</span></p>
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| style="width:76.5pt; border:solid windowtext 1.0pt" width="104" | <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>
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| style="width: 106px; border: 1pt solid windowtext;" width="85" | <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"="">Absolute risk reduction</span></span>'''</span></p>
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| style="width: 97px; border: 1pt solid windowtext;" width="72" | <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"="">Number needed to treat</span></span>'''</span></p>  
 
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|^  |||||| <span style'''"display: block; text-align: right;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: right;">95% Confidence Intervals:</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">170% to 566%</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">0.12 to 0.65</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">2 to 5</span></span>  
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| style="width:77.55pt; border:solid windowtext 1.0pt" width="106" |  
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Resolution of gross haematuria</span></span>'''</span>
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| style="width:60.2pt; border:solid windowtext 1.0pt" width="82" | <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"="">12 weeks</span></span></span></p>
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| style="width:48.15pt; border:solid windowtext 1.0pt" width="66" | <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"="">0.12</span></span></span></p>
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| style="width:62.25pt; border:solid windowtext 1.0pt" width="85" | <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"="">0.54</span></span></span></p>
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| style="width:76.5pt; border:solid windowtext 1.0pt" width="104" | <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"="">368%</span></span></span></p>
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| style="width: 106px; border: 1pt solid windowtext;" width="85" | <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"="">0.42</span></span></span></p>
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| style="width: 97px; border: 1pt solid windowtext;" width="72" | <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"="">2</span></span></span></p>  
 
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|-
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| style="width:77.55pt; border:solid windowtext 1.0pt" width="106" |
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<span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">^</span></span></span>
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| style="width:60.2pt; border:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt" width="82" | &nbsp;
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| style="width:48.15pt; border:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt" width="66" | &nbsp;
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| style="width:62.25pt; border:solid windowtext 1.0pt" width="85" | <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"="">95% CIs:</span></span></span></p>
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| style="width:76.5pt; border:solid windowtext 1.0pt" width="104" | <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"="">170% to 566%</span></span></span></p>
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| style="width: 106px; border: 1pt solid windowtext;" width="85" | <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"="">0.12 to 0.65</span></span></span></p>
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| style="width: 97px; border: 1pt solid windowtext;" width="72" | <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"="">2 to 5</span></span></span></p>
 
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| <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">'''Non-Event Outcomes''' </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">'''Time to outcome/s''' </span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-family: arial,helvetica,sans-serif; font-size: 110%; text-align: center;">'''Result''' </span></span>
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{| class="Table" style="border:solid windowtext 1.0pt"
 
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| <span style'''"font-family: Arial,Helvetica,sans-serif; font-size: 110%;">Prostatitis severity survey</span> || <span style'''"font-family: Arial,Helvetica,sans-serif; font-size: 110%;">12 weeks</span> || <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">Improved after HBOT, but not statistically significant</span>  
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| style="border:solid windowtext 1.0pt" |
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<span style="line-height:normal">'''<span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Non-Event Outcomes</span></span>'''</span>
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| 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/s</span></span>'''</span></p>
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| 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"="">Result</span></span>'''</span></p>  
 
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| <span style'''"font-family: Arial,Helvetica,sans-serif; font-size: 110%;">Quality of Life score</span> || <span style'''"font-family: Arial,Helvetica,sans-serif; font-size: 110%;">12 weeks</span> || <span style'''"font-family: Arial,Helvetica,sans-serif; font-size: 110%;">Better, P''' 0.007</span>  
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| style="border:solid windowtext 1.0pt" |
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<span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Prostatitis severity survey</span></span></span>
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| 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"="">12 weeks</span></span></span></p>
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| 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:13.0pt"><span style="font-family:" times="" new="" roman",serif"="">Improved after HBOT, but not statistically significant</span></span></span></p>  
 
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| <span style'''"font-family: Arial,Helvetica,sans-serif; font-size: 110%;">Long-term follow-up</span> || <span style'''"font-family: Arial,Helvetica,sans-serif; font-size: 110%;">1.5 yrs</span> || <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">Trends to improvement</span>  
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| style="border:solid windowtext 1.0pt" |
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<span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Quality of Life score</span></span></span>
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| 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"="">12 weeks</span></span></span></p>
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| 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"="">Better, P = 0.007</span></span></span></p>  
 
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|-
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| style="border:solid windowtext 1.0pt" |
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<span style="line-height:normal"><span style="font-size:12.0pt"><span style="font-family:" times="" new="" roman",serif"="">Long-term follow-up</span></span></span>
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| 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"="">1.5 yrs</span></span></span></p>
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| 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:13.0pt"><span style="font-family:" times="" new="" roman",serif"="">Trends to improvement</span></span></span></p>
 
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|}
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&nbsp;
 
<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Comments:'''</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. Small study reported in abstract only</span>
 
<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">1. Small study reported in abstract only</span>
 +
 
<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">2. Cross-over design so that any results longer than six weeks do not represent a randomised comparison</span>
 
<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">2. Cross-over design so that any results longer than six weeks do not represent a randomised comparison</span>
 +
 
<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">3. Little details of the outcomes measured and the figures above remain speculative to some degree</span>
 
<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">3. Little details of the outcomes measured and the figures above remain speculative to some degree</span>
  
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Appraised by''': Mike Bennett, Sydney; Wednesday, 11 July 2007Email: [[mailto:m.bennett@unsw.edu.au | m.bennett@unsw.edu.au]]</span>
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<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Appraised by''': Mike Bennett, Sydney; Wednesday, 11 July 2007Email: [[mailto:m.bennett@unsw.edu.au| m.bennett@unsw.edu.au]]</span>
  
 
<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Kill or Update By:''' December 2020</span>
 
<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">'''Kill or Update By:''' December 2020</span>
  
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[[File:sumhorsa.gif|center]]
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[[File:Sumhorsa.gif|center|Sumhorsa.gif]]
  
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<span style="color: #7c00ff; display: block; font-family: arial,helvetica,sans-serif; font-size: 26px; text-align: center;">'''[[Radiation tissue injury  | BACK]]'''</span>
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<span style="color: #7c00ff; display: block; font-family: arial,helvetica,sans-serif; font-size: 26px; text-align: center;">'''[[Radiation_tissue_injury|BACK]]'''</span>

Latest revision as of 01:11, 9 July 2019

Hyperbaric oxygen reduced gross haematuria and may improve quality of life for patients with radiation cystitis.

Clinical Bottom Line:
1. Hyperbaric oxygenation was associated with improvement in gross haematuria in the short term
2. Some longer-term benefit in haematuria, severity score and quality of life, but all patients received HBOT, so not a randomised outcome.

Citation/s:Lewis AL, Hardy KR, Huang ET, Bolotin T, Clark JM, Thom SR. Hyperbaric oxygen therapy decreases gross haematuria and improves quality of life in patients with radiation cystitis. Undersea and Hyperbaric Medicine 2005; 32(4)236

Three-part Clinical Question: For patients with radiation cystitis, does hyperbaric oxygen therapy compared to standard approaches to treatment, result in any reduction in haematuria, pain or other related symptoms?

Search Terms: Radiation, cystitis, haematuria

The Study:Non-blinded randomised cross-over trial with intention-to-treat.

The Study Patients: Symptomatic radiation cystitis including gross haematuria.

Control group (N = 26 ; 19 analysed): Standard therapy (no details) for six weeks, then crossed over to HBOT arm.

Experimental group (N = 26 ; 19 analysed): 100% oxygen at an unspecified pressure daily for six weeks, then crossed to standard arm.

The Evidence:

 

Outcome

Time to Outcome

Control group rate

Hyperbaric group rate

Relative risk reduction

Absolute risk reduction

Number needed to treat

Resolution of gross haematuria

12 weeks

0.12

0.54

368%

0.42

2

^

   

95% CIs:

170% to 566%

0.12 to 0.65

2 to 5

 

Non-Event Outcomes

Time to outcome/s

Result

Prostatitis severity survey

12 weeks

Improved after HBOT, but not statistically significant

Quality of Life score

12 weeks

Better, P = 0.007

Long-term follow-up

1.5 yrs

Trends to improvement

  Comments:

1. Small study reported in abstract only

2. Cross-over design so that any results longer than six weeks do not represent a randomised comparison

3. Little details of the outcomes measured and the figures above remain speculative to some degree

Appraised by: Mike Bennett, Sydney; Wednesday, 11 July 2007Email: [m.bennett@unsw.edu.au]

Kill or Update By: December 2020

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