Difference between revisions of "Duzgun"

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==<span style="font-size: 16pt;">Hyperbaric oxygen improved healing and reduced amputation rate in diabetic foot ulcers</span>==
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==<span style="font-size: 11pt;">Clinical bottom line:</span>==
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'''<span style="font-size:16.0pt"><span style="line-height:107%">Hyperbaric oxygen improved healing and reduced amputation rate in diabetic foot ulcers</span></span>'''
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{|
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| '''<span style'''"font-size: 11pt;">1. </span>'''<span style'''"font-size: 11pt;">HBOT improved the chance of healing in diabetic ulcers</span><br>**<span style'''"font-size: 11pt;">2.</span>'''<span style'''"font-size: 11pt;"> HBOT also reduced the chance of amputations and significant surgical interventions in these patients.</span>
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'''<span style="font-size:14.0pt"><span style="line-height:107%">Clinical bottom line:</span></span>'''
 +
 
 +
{| class="Table" style="border:undefined"
 
|-
 
|-
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|
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<span style="font-size:14.0pt"><span style="line-height:107%">1.</span></span><span style="font-size:14.0pt"><span style="line-height:107%">HBOT improved the chance of healing in diabetic ulcers<br/> 2. HBOT also reduced the chance of amputations and significant surgical interventions in these patients.</span></span>
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**<span style="font-size: 11pt;">Citation/s: </span>'''<span style="font-size: 11pt;">Duzgun AP, Satir HZ, Ozozan O, Saylam B, Kulah B, Coskun F. Effect of hyperbaric oxygen therapy on healing of diabetic foot ulcers. J of Foot & Ankle Surgery. 2008;47(6):515-9.</span>
 
  
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<span style="font-size: 11pt;"> '''Lead author's name and fax:''' Arife Polat Duzgun. No email or fax supplied. </span>
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'''<span style="font-size:12.0pt"><span style="line-height:107%">Citation:</span></span>'''<span style="font-size:12.0pt"><span style="line-height:107%">Duzgun AP, Satir HZ, Ozozan O, Saylam B, Kulah B, Coskun F. Effect of hyperbaric oxygen therapy on healing of diabetic foot ulcers. J of Foot & Ankle Surgery. 2008;47(6):515-9.</span></span>
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**<span style="font-size: 11pt;">Three-part Clinical Question:</span>'''<span style="font-size: 11pt;"> Does adding Hyperbaric Oxygen Therapy to Standard Treatment in adult diabetics with foot ulcers result in greater healing with less surgical intervention? </span>
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 +
----
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 +
'''<span style="font-size:12.0pt"><span style="line-height:107%">Lead author's name and fax:</span></span>'''<span style="font-size:12.0pt"><span style="line-height:107%">Arife Polat Duzgun. No email or fax supplied.</span></span>
 +
 
 +
'''<span style="font-size:12.0pt"><span style="line-height:107%">Three-part Clinical Question:</span></span>'''<span style="font-size:12.0pt"><span style="line-height:107%">Does adding Hyperbaric Oxygen Therapy to Standard Treatment in adult diabetics with foot ulcers result in greater healing with less surgical intervention?</span></span>
 +
 
 +
'''<span style="font-size:12.0pt"><span style="line-height:107%">Search Terms:</span></span>'''<span style="font-size:12.0pt"><span style="line-height:107%">Diabetes, diabetic foot ulcers, foot ulcers</span></span>
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 +
'''<span style="font-size:12.0pt"><span style="line-height:107%">The Study:</span></span>'''<span style="font-size:12.0pt"><span style="line-height:107%">Non-blinded randomised controlled trial with intention-to-treat.</span></span>
  
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<span style="font-size: 11pt;"> '''Search Terms:''' Diabetes, diabetic foot ulcers, foot ulcers</span>
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'''<span style="font-size:12.0pt"><span style="line-height:107%">The Study Patients:</span></span>'''<span style="font-size:12.0pt"><span style="line-height:107%">Adult patients with diabetes and an infected foot wound that had not responded to 'appropriate' local and systemic wound care for 4 weeks.</span></span>
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**<span style="font-size: 11pt;">The Study:</span>'''
 
  
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<span style="font-size: 11pt;"> Non-blinded randomised controlled trial with intention-to-treat.</span>
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'''<span style="font-size:12.0pt"><span style="line-height:107%">Control group</span></span>'''<span style="font-size:12.0pt"><span style="line-height:107%">(N = 50; 50 analysed): Standard treatment of wounds including dressing changes and debridement as clinically dictated.</span></span>
  
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<span style="font-size: 11pt;"> '''The Study Patients:''' Adult patients with diabetes and an infected foot wound that had not responded to 'appropriate' local and systemic wound care for 4 weeks.</span>
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'''<span style="font-size:12.0pt"><span style="line-height:107%">Experimental group</span></span>'''<span style="font-size:12.0pt"><span style="line-height:107%">(N = 50; 50 analysed): As above with HBOT at 2-3 ATA for 90 min, twice daily then once daily on alternate days for between 20-30 days</span></span>
  
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<span style="font-size: 11pt;"> '''Control group''' (N = 50; 50 analysed): Standard treatment of wounds including dressing changes and debridement as clinically dictated. </span>
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'''<span style="font-size:12.0pt"><span style="line-height:107%">The Evidence:</span></span>'''
  
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<span style="font-size: 11pt;"> '''Experimental group''' (N = 50; 50 analysed): As above with HBOT at 2-3 ATA for 90 min, twice daily then once daily on alternate days for between 20-30 days</span>
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{| class="Table" style="border:solid windowtext 1.0pt"
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**<span style="font-size: 11pt;">The Evidence:</span>'''
 
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{|  
 
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| <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-size: 10pt;">Outcome</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-size: 10pt;">Time to Outcome</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-size: 10pt;">Control group</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-size: 10pt;">HBOT group</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-size: 10pt;">Relative risk reduction</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-size: 10pt;">Absolute risk reduction</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style="font-size: 10pt;">NNT</span>'''</span></span>
 
 
|-
 
|-
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| '''<span style'''"font-size: 10pt;">Healed with minor bedside debridement</span>''' || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 10pt; text-align: center;">92 weeks</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 10pt; text-align: center;">0.0</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 10pt; text-align: center;">0.66</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 10pt; text-align: center;">INF</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 10pt; text-align: center;">0.66</span></span> || <span style'''"display: block; text-align: center;"><span style="display: block; font-size: 10pt; text-align: center;">2</span></span>  
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| style="width:89.65pt; border:solid windowtext 1.0pt" width="123" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''Outcome'''</p>
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| style="width:48.1pt; border:solid windowtext 1.0pt" width="66" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''Time to Outcome'''</p>  
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| style="width:48.15pt; border:solid windowtext 1.0pt" width="66" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''Control group'''</p>  
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| style="width:55.2pt; border:solid windowtext 1.0pt" width="76" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''HBOT group'''</p>  
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| style="width:62.25pt; border:solid windowtext 1.0pt" width="85" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''Relative risk reduction'''</p>  
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| style="width:76.5pt; border:solid windowtext 1.0pt" width="104" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''Absolute risk reduction'''</p>  
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| style="width:58.95pt; border:solid windowtext 1.0pt" width="82" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''NNT'''</p>  
 
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|-
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|^  |||||| <span style'''"display: block; text-align: right;"><span style'''"display: block; font-size: 10pt; text-align: right;">95% CIs:</span></span> ||  || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 10pt; text-align: center;">0.53 to 0.79</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 10pt; text-align: center;">1 to 2</span></span>  
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| rowspan="2" style="width:89.65pt; border:solid windowtext 1.0pt" width="123" |  
 +
'''Healed with minor bedside debridement'''
 +
 
 +
| rowspan="2" style="width:48.1pt; border:solid windowtext 1.0pt" width="66" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">92 weeks</p>
 +
| style="width:48.15pt; border:solid windowtext 1.0pt" width="66" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">0</p>  
 +
| style="width:55.2pt; border:solid windowtext 1.0pt" width="76" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">0.66</p>
 +
| style="width:62.25pt; border:solid windowtext 1.0pt" width="85" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">INF</p>  
 +
| style="width:76.5pt; border:solid windowtext 1.0pt" width="104" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">0.66</p>
 +
| style="width:58.95pt; border:solid windowtext 1.0pt" width="82" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">2</p>  
 
|-
 
|-
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| '''<span style'''"font-size: 10pt;">Graft or Flap</span>''' || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 10pt; text-align: center;">92 weeks</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 10pt; text-align: center;">0.0</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 10pt; text-align: center;">0.08</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 10pt; text-align: center;">INF</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 10pt; text-align: center;">0.08</span></span> || <span style'''"display: block; text-align: center;"><span style="display: block; font-size: 10pt; text-align: center;">13</span></span>  
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| colspan="2" style="width:104.85pt; border:solid windowtext 1.0pt" width="142" | <p align="right" style="text-align:right; padding:.75pt .75pt .75pt .75pt">95% CIs:</p>  
 +
| style="width:62.25pt; border:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt" width="85" | &nbsp;
 +
| style="width:76.5pt; border:solid windowtext 1.0pt" width="104" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">0.53 to 0.79</p>  
 +
| style="width:58.95pt; border:solid windowtext 1.0pt" width="82" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">1 to 2</p>  
 
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|-
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|^  |||||| <span style'''"display: block; text-align: right;"><span style'''"display: block; font-size: 10pt; text-align: right;">95% CIs:</span></span> ||  || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 10pt; text-align: center;">0.005 to 0.16</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 10pt; text-align: center;">6 to 208</span></span>  
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| rowspan="2" style="width:89.65pt; border:solid windowtext 1.0pt" width="123" |  
 +
'''Graft or Flap required'''
 +
 
 +
| rowspan="2" style="width:48.1pt; border:solid windowtext 1.0pt" width="66" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">92 weeks</p>
 +
| style="width:48.15pt; border:solid windowtext 1.0pt" width="66" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">0</p>  
 +
| style="width:55.2pt; border:solid windowtext 1.0pt" width="76" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">0.08</p>
 +
| style="width:62.25pt; border:solid windowtext 1.0pt" width="85" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">INF</p>  
 +
| style="width:76.5pt; border:solid windowtext 1.0pt" width="104" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">0.08</p>
 +
| style="width:58.95pt; border:solid windowtext 1.0pt" width="82" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">13</p>  
 
|-
 
|-
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| '''<span style'''"font-size: 10pt;">Minor amputation</span>''' || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 10pt; text-align: center;">92 weeks</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 10pt; text-align: center;">0.480</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 10pt; text-align: center;">0.080</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 10pt; text-align: center;">83%</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 10pt; text-align: center;">0.40</span></span> || <span style'''"display: block; text-align: center;"><span style="display: block; font-size: 10pt; text-align: center;">3</span></span>  
+
| colspan="2" style="width:104.85pt; border:solid windowtext 1.0pt" width="142" | <p align="right" style="text-align:right; padding:.75pt .75pt .75pt .75pt">95% CIs:</p>  
 +
| style="width:62.25pt; border:solid windowtext 1.0pt; padding:.75pt .75pt .75pt .75pt" width="85" | &nbsp;
 +
| style="width:76.5pt; border:solid windowtext 1.0pt" width="104" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">0.01 to 0.16</p>  
 +
| style="width:58.95pt; border:solid windowtext 1.0pt" width="82" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">6 to 208</p>  
 
|-
 
|-
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|^  |||||| <span style'''"display: block; text-align: right;"><span style'''"display: block; font-size: 10pt; text-align: right;">95% CIs:</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 10pt; text-align: center;">51% to 100%</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 10pt; text-align: center;">0.24 to 0.56</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 10pt; text-align: center;">2 to 4</span></span>  
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| rowspan="2" style="width:89.65pt; border:solid windowtext 1.0pt" width="123" |
 +
'''Minor amputation'''
 +
 
 +
| rowspan="2" style="width:48.1pt; border:solid windowtext 1.0pt" width="66" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">92 weeks</p>  
 +
| style="width:48.15pt; border:solid windowtext 1.0pt" width="66" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">0.48</p>
 +
| style="width:55.2pt; border:solid windowtext 1.0pt" width="76" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">0.08</p>  
 +
| style="width:62.25pt; border:solid windowtext 1.0pt" width="85" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">83%</p>
 +
| style="width:76.5pt; border:solid windowtext 1.0pt" width="104" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">0.40</p>  
 +
| style="width:58.95pt; border:solid windowtext 1.0pt" width="82" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">3</p>  
 
|-
 
|-
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| '''<span style'''"font-size: 10pt;">Major amputation</span>''' || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 10pt; text-align: center;">92 weeks</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 10pt; text-align: center;">0.34</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 10pt; text-align: center;">0.0</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 10pt; text-align: center;">INF</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 10pt; text-align: center;">0.34</span></span> || <span style'''"display: block; text-align: center;"><span style="display: block; font-size: 10pt; text-align: center;">3</span></span>  
+
| colspan="2" style="width:104.85pt; border:solid windowtext 1.0pt" width="142" | <p align="right" style="text-align:right; padding:.75pt .75pt .75pt .75pt">95% CIs:</p>  
 +
| style="width:62.25pt; border:solid windowtext 1.0pt" width="85" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">51% to 100%</p>  
 +
| style="width:76.5pt; border:solid windowtext 1.0pt" width="104" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">0.24 to 0.56</p>  
 +
| style="width:58.95pt; border:solid windowtext 1.0pt" width="82" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">2 to 4</p>  
 
|-
 
|-
−
|^  |||||| <span style'''"display: block; text-align: right;"><span style'''"display: block; font-size: 10pt; text-align: right;">95% CIs:</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 10pt; text-align: center;">51% to 100%</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 10pt; text-align: center;">0.24 to 0.56</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; font-size: 10pt; text-align: center;">2 to 4</span></span>  
+
| rowspan="2" style="width:89.65pt; border:solid windowtext 1.0pt" width="123" |
 +
'''Major amputation'''
 +
 
 +
| rowspan="2" style="width:48.1pt; border:solid windowtext 1.0pt" width="66" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">92 weeks</p>  
 +
| style="width:48.15pt; border:solid windowtext 1.0pt" width="66" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">0.34</p>
 +
| style="width:55.2pt; border:solid windowtext 1.0pt" width="76" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">0</p>  
 +
| style="width:62.25pt; border:solid windowtext 1.0pt" width="85" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">INF</p>
 +
| style="width:76.5pt; border:solid windowtext 1.0pt" width="104" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">0.34</p>  
 +
| style="width:58.95pt; border:solid windowtext 1.0pt" width="82" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">3</p>  
 
|-
 
|-
 +
| colspan="2" style="width:104.85pt; border:solid windowtext 1.0pt" width="142" | <p align="right" style="text-align:right; padding:.75pt .75pt .75pt .75pt">95% CIs:</p>
 +
| style="width:62.25pt; border:solid windowtext 1.0pt" width="85" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">51% to 100%</p>
 +
| style="width:76.5pt; border:solid windowtext 1.0pt" width="104" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">0.24 to 0.56</p>
 +
| style="width:58.95pt; border:solid windowtext 1.0pt" width="82" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">2 to 4</p>
 
|}
 
|}
−
**Comments:'''
 
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1. Study not blinded and and therefore at some risk of bias.
 
−
2. There were more men, obese patients and smokers in the HBO group.
 
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3. No differentiation between neuropathic vs pure ischaemic ulcers.
 
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4. Exact HBOT protocol is unclear and not the same for all patients.
 
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5. Mean follow up was 92 ± 12 weeks.
 
  
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**Appraised by:''' Dr Glen Hawkins Hyperbaric Health, Suite 3 Ground Floor, 46-50 Kent Rd, Mascot NSW 2020 Fax: +61282125987; 18 January 2018
+
&nbsp;
−
Email: glen.hawkins@unsw.edu.au
+
 
 +
'''<span style="font-size:12.0pt"><span style="line-height:107%">Comments:</span></span>'''
 +
 
 +
<span style="font-size:12.0pt"><span style="line-height:107%">1. Study not blinded and and therefore at some risk of bias.</span></span>
 +
 
 +
<span style="font-size:12.0pt"><span style="line-height:107%">2. There were more men, obese patients and smokers in the HBO group.</span></span>
 +
 
 +
<span style="font-size:12.0pt"><span style="line-height:107%">3. No differentiation between neuropathic vs pure ischaemic ulcers.</span></span>
 +
 
 +
<span style="font-size:12.0pt"><span style="line-height:107%">4. Exact HBOT protocol is unclear and not the same for all patients.</span></span>
 +
 
 +
&nbsp;
 +
 
 +
'''<span style="font-size:12.0pt"><span style="line-height:107%">Appraised by:</span></span>'''<span style="font-size:12.0pt"><span style="line-height:107%">Dr Glen Hawkins Hyperbaric Health, Suite 3 Ground Floor, 46-50 Kent Rd, Mascot NSW 2020 Fax: +61282125987; January 2018</span></span>
 +
 
 +
<span style="font-size:12.0pt"><span style="line-height:107%">Email: glen.hawkins@unsw.edu.au</span></span>
 +
 
 +
'''<span style="font-size:12.0pt"><span style="line-height:107%">Kill or Update By:</span></span>'''<span style="font-size:12.0pt"><span style="line-height:107%">July 2022</span></span>
 +
 
 +
&nbsp;
  
−
**Kill or Update By:''' July 2021
+
[[File:Sumhorsa.gif|center|Sumhorsa.gif]]
  
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[[File:sumhorsa.gif|center]]
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Latest revision as of 02:23, 24 February 2022

Hyperbaric oxygen improved healing and reduced amputation rate in diabetic foot ulcers

Clinical bottom line:

1.HBOT improved the chance of healing in diabetic ulcers
2. HBOT also reduced the chance of amputations and significant surgical interventions in these patients.

Citation:Duzgun AP, Satir HZ, Ozozan O, Saylam B, Kulah B, Coskun F. Effect of hyperbaric oxygen therapy on healing of diabetic foot ulcers. J of Foot & Ankle Surgery. 2008;47(6):515-9.

Lead author's name and fax:Arife Polat Duzgun. No email or fax supplied.

Three-part Clinical Question:Does adding Hyperbaric Oxygen Therapy to Standard Treatment in adult diabetics with foot ulcers result in greater healing with less surgical intervention?

Search Terms:Diabetes, diabetic foot ulcers, foot ulcers

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

The Study Patients:Adult patients with diabetes and an infected foot wound that had not responded to 'appropriate' local and systemic wound care for 4 weeks.

Control group(N = 50; 50 analysed): Standard treatment of wounds including dressing changes and debridement as clinically dictated.

Experimental group(N = 50; 50 analysed): As above with HBOT at 2-3 ATA for 90 min, twice daily then once daily on alternate days for between 20-30 days

The Evidence:

Outcome

Time to Outcome

Control group

HBOT group

Relative risk reduction

Absolute risk reduction

NNT

Healed with minor bedside debridement

92 weeks

0

0.66

INF

0.66

2

95% CIs:

  

0.53 to 0.79

1 to 2

Graft or Flap required

92 weeks

0

0.08

INF

0.08

13

95% CIs:

  

0.01 to 0.16

6 to 208

Minor amputation

92 weeks

0.48

0.08

83%

0.40

3

95% CIs:

51% to 100%

0.24 to 0.56

2 to 4

Major amputation

92 weeks

0.34

0

INF

0.34

3

95% CIs:

51% to 100%

0.24 to 0.56

2 to 4

 

Comments:

1. Study not blinded and and therefore at some risk of bias.

2. There were more men, obese patients and smokers in the HBO group.

3. No differentiation between neuropathic vs pure ischaemic ulcers.

4. Exact HBOT protocol is unclear and not the same for all patients.

 

Appraised by:Dr Glen Hawkins Hyperbaric Health, Suite 3 Ground Floor, 46-50 Kent Rd, Mascot NSW 2020 Fax: +61282125987; January 2018

Email: glen.hawkins@unsw.edu.au

Kill or Update By:July 2022

 

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