Hyperbaric Oxygen Therapy - Hyperbaric Chamber Information ...

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Table 76 Outcomes following treatment for lymphoma in intervention and comparison groups (Pan et al.). 118 Outcome Intervention Group (n = 20) Comparison Group (n = 21) Reduction in tumour area (cm 2 ) 15.5 (2.8)* 8.8 (2.1)*
Summary separate and previously-studied series of patients undergoing treatment with 131 I-MIBG alone. Patients in this series were recruited from an academic medical centre in the Netherlands. The authors enrolled 51 but present results for the 35 (69%) who completed more than one course of therapy. Overall, patients had a mean age of 6.8 years. There were 19 males and 19 females. Patients were given 131 I-MIBG intravenously. Exposure to HBO was through a multiplace chamber at 3 ATA for 75 minutes, once daily for four days. The primary end point was survival. Patients lived for a mean duration of 3 years following treatment. Kaplan-Meier plots comparing survival distributions between those receiving HBOT and those treated with 131 I-MIBG alone showed better survival in the HBOT group. The results were statistically significant (log rank test, p = 0.0326). While this study provides some evidence of the effect of HBOT in the treatment of neuroblastoma, until more rigorous evidence is collected, the use of this technology cannot be supported. Carbon monoxide poisoning Several studies have been published examining the use of HBOT for acute carbon monoxide poisoning. In 2000, Juurlink et al 122 published a systematic review of the literature on this topic, focusing on the efficacy of the procedure on the development of neurologic sequelae one month after treatment. The authors searched for relevant publications from 1966 to 1999 using three electronic databases (Medline, Embase, and the Cochrane Controlled Trials Register) supplemented by examination of reference lists and contact with experts in the field. A search revealed no studies that met the inclusion and exclusion criteria published subsequent to the release of this systematic review. The following discussion is consequently limited to an assessment of the Juurlink et al review. The review collected six reports of randomised controlled trials involving non-pregnant adults acutely poisoned with carbon monoxide, regardless of severity. The authors analysed the results of three studies 123,124,125 that scored three or more on the Jadad quality scale. The authors found that the severity of poisoning varied between trials. Each also employed different doses of HBO. The results for a total of 455 patients were available for analysis. Non-specific neurological symptoms (eg., headache, confusion, difficulty concentrating, and disturbances with sleep) were present in 81 of 237 patients (34.1%) in the intervention group compared to 81 of 218 patients (37.2%) in the comparison group (OR = 0.82; 95% CI = 0.40, 1.66). Sensitivity analysis did not change the results. Summary This systematic review failed to demonstrate a significant reduction in neurologic sequelae following HBOT for carbon monoxide poisoning. More methodologicallyrigorous studies are required to examine the efficacy of HBOT on other outcomes and in distinct patient subsets. <strong>Hyperbaric</strong> oxygen therapy 77
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Hyperbaric Oxygen Therapy November
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Contents Executive summary.........
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Tables Table 1 Measures of disease
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Table 45 Functional neurologic scor
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Figures Figure 1. Outline of search
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Effectiveness Published guidelines
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evidence that exposure to HBO may b
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No available evidence No evidence w
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Introduction The Medicare Services
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Multiplace chambers can accommodate
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Marketing status of the device The
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Table 3 1998 - 1999 self-reported d
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Table 6 retrieval. Indication-speci
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Phase of Search Initial Search Ful
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Conduct of meta-analysis When the d
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early as 1995. The guidelines - kno
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Table 10 Minimum staff qualificatio
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Is it effective? The review assesse
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Table 14 Patient criteria of includ
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offered ample details. The remainin
Page 41 and 42: characteristics compared to the tre
Page 43 and 44: Assessment of heterogeneity All the
Page 45 and 46: Odds ratio 10 1 0.1 0.01 A sensitiv
Page 47 and 48: Wound healing Two of the five ident
Page 49 and 50: Studies of necrotising soft tissue
Page 51 and 52: Summary Table 25 Survival in patien
Page 53 and 54: Table 29 Therapeutic protocols used
Page 55 and 56: Osteomyelitis The study by Esterhai
Page 57 and 58: Summary The HBO group showed a stat
Page 59 and 60: Summary These results are difficult
Page 61 and 62: outcomes or that decreased the risk
Page 63 and 64: Anderson et al 80 recruited non-pre
Page 65 and 66: Summary The collected evidence exam
Page 67 and 68: Table 46 Major outcomes following t
Page 71 and 72: Table 53 Patient criteria of includ
Page 73 and 74: Thirty-seven subjects (comparison g
Page 75 and 76: whose hearing loss was not secondar
Page 77 and 78: tinnitus (6 versus 3 subjects). Non
Page 79 and 80: assume that all participants knew o
Page 83 and 84: Table 65 Descriptive characteristic
Page 87 and 88: These contrasted with the conclusio
Page 89 and 90: Table 73 Patient criteria of includ
Page 91: Summary There are conflicting resul
Page 95 and 96: need to insulate patients from outs
Page 97 and 98: Reactive effects A reactive effect
Page 99 and 100: Cost of major amputation The hospit
Page 101 and 102: Sensitivity analysis Table 79 shows
Page 103 and 104: Table 80 Estimation of incremental
Page 105 and 106: Sensitivity analysis Table 83 shows
Page 107 and 108: Conclusions Safety Potential risks
Page 109 and 110: Recommendations MSAC recommended th
Page 111 and 112: Appendix B Supporting committee Sup
Page 113 and 114: Appendix C Studies included in this
Page 115 and 116: Necrotising soft tissue infections:
Page 117 and 118: Soft tissue injuries: crush injurie
Page 119 and 120: Cancer: cervix First Author and Yea
Page 121 and 122: Appendix D Studies excluded in this
Page 123 and 124: 2. Shandling AH, Ellestad MH, Hart
Page 125 and 126: 5. Woo TCS, Joseph D, Oxer H. Hyper
Page 127 and 128: 22. Kunkler PB, Boulis-Wassif S, Sh
Page 129 and 130: 45. Wiernik G, Perrins D. The radio
Page 131 and 132: Appendix E Calculation of monoplace
Page 133 and 134: Hence, the total operating costs of
Page 135 and 136: Appendix G Reviews received from ot
Page 137 and 138: Sechrist Industries -- Hyperbaric O
Page 139 and 140: References 1. Hampson N. Hyperbaric
Page 141 and 142: 31. L'Abbe K, Detsky A, O'Rourke K.
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61. Perrins DJ. Influence of hyperb
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89. DiSabato F, Giacovazzo M, Crist
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117.Plenk HP. Hyperbaric radiation
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