Difference between revisions of "Nik"
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| − | '''<span style="font-size:16.0pt"><span style="line-height:107%"><span style="font-family: | + | '''<span style="font-size:16.0pt"><span style="line-height:107%"><span style="font-family:">The addition of hyperbaric oxygen to wound care accelerated the reduction in wound area for diabetic foot ulcers.</span></span></span>''' |
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| − | '''<span style="font-size:14.0pt"><span style="line-height:107%"><span style="font-family: | + | '''<span style="font-size:14.0pt"><span style="line-height:107%"><span style="font-family:">1. The addition of hyperbaric oxygen to standard wound care accelerated the reduction in wound size.<br/> 2. Chances of healing not estimated.</span></span></span>''' |
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| − | '''<span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family: | + | '''<span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family:">Citation/s:</span></span></span>'''<span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family:">1.Nik NH, Wan WM, Mohd BY, Rahmah S. Use of hyperbaric oxygen therapy (HBOT) in chronic diabetic wound-A randomised trial. The Medical journal of Malaysia. 2019 Oct;74(5):418-24.</span></span></span> |
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| − | <span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family: | + | <span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family:">'''Lead author's name: '''Dr. Nik Hisamuddin Nik Ab. Rahman Email: nhliza@hotmail.com</span></span></span> |
| − | '''<span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family: | + | '''<span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family:">Three-part Clinical Question:</span></span></span>'''<span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family:">For diabetic patients with foot ulcers, does the addition of hyperbaric oxygen to standard wound care, result in any acceleration in the reduction of wound size?<br/> '''Search Terms:''' diabetes; ulcer; wound care</span></span></span> |
| − | '''<span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family: | + | '''<span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family:">The Study:</span></span></span>'''<span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family:">Non-blinded concealed randomised controlled trial with intention-to-treat.<br/> '''The Study Patients:''' Adult patients with diabetic foot ulcers (Wagner Grade 2 and above), included if a reduction of <30% in wound area. Excluded from trial if transcutaneous <20mmHg and not doubled with 100% oxygen breathing.<br/> '''Control group''' (N = 31; 29 analysed): Conventional wound care including wound cleansing, dressing and debridement. Antibiotics if deemed to be infected.<br/> '''Experimental group''' (N = 31; 29 analysed): As above plus 100% oxygen breathing at 2.4 ATA for 90 minutes daily to a total of 30 treatments.</span></span></span> |
| − | '''<span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family: | + | '''<span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family:">The Evidence:</span></span></span>''' |
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| rowspan="2" style="border:solid windowtext 1.0pt" | | | rowspan="2" style="border:solid windowtext 1.0pt" | | ||
| − | '''<span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family: | + | '''<span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family:">Measure</span></span></span>''' |
| − | | colspan="2" style="width:57.3pt; border:solid windowtext 1.0pt" width="78" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''<span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family: | + | | colspan="2" style="width:57.3pt; border:solid windowtext 1.0pt" width="78" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''<span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family:">Control Group</span></span></span>'''</p> |
| − | | colspan="2" style="width:62.25pt; border:solid windowtext 1.0pt" width="85" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''<span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family: | + | | colspan="2" style="width:62.25pt; border:solid windowtext 1.0pt" width="85" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''<span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family:">HBOT Group</span></span></span>'''</p> |
| − | | rowspan="2" style="width:62.3pt; border:solid windowtext 1.0pt" width="85" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''<span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family: | + | | rowspan="2" style="width:62.3pt; border:solid windowtext 1.0pt" width="85" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''<span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family:">Difference</span></span></span>'''</p> |
| − | | rowspan="2" style="width:73.15pt; border:solid windowtext 1.0pt" width="101" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''<span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family: | + | | rowspan="2" style="width:73.15pt; border:solid windowtext 1.0pt" width="101" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''<span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family:">95% CI</span></span></span>'''</p> |
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| − | | style="width:31.85pt; border:solid windowtext 1.0pt" width="44" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''<span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family: | + | | style="width:31.85pt; border:solid windowtext 1.0pt" width="44" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''<span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family:">Mean</span></span></span>'''</p> |
| − | | style="width:23.95pt; border:solid windowtext 1.0pt" width="34" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''<span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family: | + | | style="width:23.95pt; border:solid windowtext 1.0pt" width="34" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''<span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family:">SD</span></span></span>'''</p> |
| − | | style="width:33.9pt; border:solid windowtext 1.0pt" width="47" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''<span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family: | + | | style="width:33.9pt; border:solid windowtext 1.0pt" width="47" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''<span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family:">Mean</span></span></span>'''</p> |
| − | | style="width:26.85pt; border:solid windowtext 1.0pt" width="38" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''<span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family: | + | | style="width:26.85pt; border:solid windowtext 1.0pt" width="38" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt">'''<span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family:">SD</span></span></span>'''</p> |
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| style="border:solid windowtext 1.0pt" | | | style="border:solid windowtext 1.0pt" | | ||
| − | '''<span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family: | + | '''<span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family:">Reduction in wound area at 30 days (cm<sup>2</sup>)</span></span></span>''' |
| − | | style="width:31.85pt; border:solid windowtext 1.0pt" width="44" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family: | + | | style="width:31.85pt; border:solid windowtext 1.0pt" width="44" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family:">2.12</span></span></span></p> |
| − | | style="width:23.95pt; border:solid windowtext 1.0pt" width="34" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family: | + | | style="width:23.95pt; border:solid windowtext 1.0pt" width="34" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family:">11.8</span></span></span></p> |
| − | | style="width:33.9pt; border:solid windowtext 1.0pt" width="47" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family: | + | | style="width:33.9pt; border:solid windowtext 1.0pt" width="47" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family:">15.44</span></span></span></p> |
| − | | style="width:26.85pt; border:solid windowtext 1.0pt" width="38" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family: | + | | style="width:26.85pt; border:solid windowtext 1.0pt" width="38" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family:">18.4</span></span></span></p> |
| − | | style="width:62.3pt; border:solid windowtext 1.0pt" width="85" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family: | + | | style="width:62.3pt; border:solid windowtext 1.0pt" width="85" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family:">-13.3</span></span></span></p> |
| − | | style="width:73.15pt; border:solid windowtext 1.0pt" width="101" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family: | + | | style="width:73.15pt; border:solid windowtext 1.0pt" width="101" | <p align="center" style="text-align:center; padding:.75pt .75pt .75pt .75pt"><span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family:">-139 to 112</span></span></span></p> |
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| − | '''<span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family: | + | '''<span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family:">Comments:</span></span></span>'''<br/> <span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family:">1. Study not blinded, so a risk of bias despite sealed envelope randomisation.</span></span></span> |
| − | <span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family: | + | <span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family:">2. The authors used ANOVA to compare mean differences in wound area within groups over time and concluded reduction in area occurred more quickly with HBOT. They did not compare between group differences.</span></span></span> |
| − | <span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family: | + | <span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family:">3. Multiple logisitic regression suggested a DFU patient undergoing standard wound care with HBOT as an adjunctive treatment has nearly 44 times higher odds of achieving a 30% reduction in wound area at completion of 30 days treatment.</span></span></span> |
| − | <span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family: | + | <span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family:">4. No outcomes presented at later than day of last HBOT session.</span></span></span> |
| − | '''<span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family: | + | '''<span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family:">Appraised by:</span></span></span>'''<span style="font-size:12.0pt"><span style="line-height:107%"><span style="font-family:">Mike Bennett ; Monday, 24 January 2022<br/> '''Email:''' m.bennett@unsw.edu.au</span></span></span> |
| + | <p style="text-align: center;"> </p> <p style="text-align: center;">[[File:Sumhorsa.gif|center|Sumhorsa.gif]]</p> <p style="text-align: center;"><span style="font-size:xx-large;">'''[[Non-healing_wounds|BACK]]'''</span></p> | ||
Latest revision as of 03:43, 24 January 2022
The addition of hyperbaric oxygen to wound care accelerated the reduction in wound area for diabetic foot ulcers.
|
1. The addition of hyperbaric oxygen to standard wound care accelerated the reduction in wound size. |
Citation/s:1.Nik NH, Wan WM, Mohd BY, Rahmah S. Use of hyperbaric oxygen therapy (HBOT) in chronic diabetic wound-A randomised trial. The Medical journal of Malaysia. 2019 Oct;74(5):418-24.
Lead author's name: Dr. Nik Hisamuddin Nik Ab. Rahman Email: nhliza@hotmail.com
Three-part Clinical Question:For diabetic patients with foot ulcers, does the addition of hyperbaric oxygen to standard wound care, result in any acceleration in the reduction of wound size?
Search Terms: diabetes; ulcer; wound care
The Study:Non-blinded concealed randomised controlled trial with intention-to-treat.
The Study Patients: Adult patients with diabetic foot ulcers (Wagner Grade 2 and above), included if a reduction of <30% in wound area. Excluded from trial if transcutaneous <20mmHg and not doubled with 100% oxygen breathing.
Control group (N = 31; 29 analysed): Conventional wound care including wound cleansing, dressing and debridement. Antibiotics if deemed to be infected.
Experimental group (N = 31; 29 analysed): As above plus 100% oxygen breathing at 2.4 ATA for 90 minutes daily to a total of 30 treatments.
The Evidence:
|
Measure |
Control Group |
HBOT Group |
Difference |
95% CI | ||
Mean |
SD |
Mean |
SD | |||
|
Reduction in wound area at 30 days (cm2) |
2.12 |
11.8 |
15.44 |
18.4 |
-13.3 |
-139 to 112 |
Comments:
1. Study not blinded, so a risk of bias despite sealed envelope randomisation.
2. The authors used ANOVA to compare mean differences in wound area within groups over time and concluded reduction in area occurred more quickly with HBOT. They did not compare between group differences.
3. Multiple logisitic regression suggested a DFU patient undergoing standard wound care with HBOT as an adjunctive treatment has nearly 44 times higher odds of achieving a 30% reduction in wound area at completion of 30 days treatment.
4. No outcomes presented at later than day of last HBOT session.
Appraised by:Mike Bennett ; Monday, 24 January 2022
Email: m.bennett@unsw.edu.au
