Problem wounds represent a significant and growing challenge to our healthcare system. The incidence and prevalence of these wounds are increasing in the population, resulting in growing utilization of healthcare resources and dollars expended. Venous leg ulcers represent the most common lower-extremity wound seen in ambulatory wound care centers, with recurrences frequent and outcomes often less than satisfactory. Pressure ulcers are common in patients in long-term institutional care settings adding significant increases in cost, disability and liability. Foot ulcers in patients with diabetes contribute to more than half of lower-extremity amputations in the United States in a group at risk, representing only 3 percent of the population. In response to this challenge, specialized programs have emerged designed to identify and manage these patients, using standardized protocols and a variety of new technologies to improve outcomes. Hyperbaric oxygen treatment (HBO2T) has been increasingly utilized in an adjunctive role in the care of many of these patients, coinciding with optimized patient and local wound care.
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE
Hyperbaric oxygen (HBO) is a device that is used to treat foot ulcers. The study goal was to compare the effectiveness of HBO with other conventional therapies administered in a wound care network for the treatment of a diabetic foot ulcer and prevention of lower extremity amputation.RESEARCH DESIGN AND METHODS
This was a longitudinal observational cohort study. To address treatment selection bias, we used propensity scores to determine the "propensity" that an individual was selected to receive HBO.RESULTSWe studied 6,259 individuals with diabetes, adequate lower limb arterial perfusion, and foot ulcer extending through the dermis, representing 767,060 person-days of wound care. In the propensity score-adjusted models, individuals receiving HBO were less likely have healing of their foot ulcer (hazard ratio, 0.68; 95% confidence interval, 0.63-0.73) and more likely to have an amputation (2.37 [1.84-3.04]). Additional analyses, including the use of an instrumental variable, were conducted to assess the robustness of our results to unmeasured confounding. HBO was not found to improve the likelihood that a wound might heal or to decrease the likelihood of amputation in any of these analyses.CONCLUSIONS
Use of HBO neither improved the likelihood that a wound would heal nor prevented amputation in a cohort of patients defined by Centers for Medicare and Medicaid Services eligibility criteria. The usefulness of HBO in the treatment of diabetic foot ulcers needs to be reevaluated.
Diabetes care 02/2013; 36(7). DOI:10.2337/dc12-2160 · 8.42 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Bdellovibrio bacteriovorus and Micavibrio aeruginosavorus are Gram-negative bacteria characterized by predatory behavior. The aim of the study was to evaluate the ability of the predators to prey in different oxygen environments. When placed on an orbital shaker, a positive trend between the rate of aeration and predation was observed. To further examine the effect of elevated ambient oxygen levels on predation, a simple gasbag system was developed. Using the system, we were able to conduct experiments at ambient oxygen levels of 3%-86%. When placed in gasbags and inflated with air, 50% O2, and 100% O2, positive predation was seen on both planktonic and biofilm grown prey cells. However, in low-oxygen environments, predatory bacteria were only able to attack prey cells grown as biofilms. To further evaluate the gasbag system, biofilm development of Gram-positive and Gram-negative microorganisms was also measured. Although, the gasbag system was found to be suitable for culturing bacteria that require a low-oxygen environment, it was not capable of supporting, at its current configuration, the growth of obligate anaerobes in liquid or agar medium.
[Show abstract][Hide abstract] ABSTRACT: We performed a systematic search for articles on the topic of hyperbaric oxygen (HBO2) therapy and chronic diabetic wounds between Jan 2009 and Dec 2012. This was supplemented by other relevant articles known to the authors. There is growing evidence supporting HBO2 therapy for this condition. Increased understanding of the mechanisms underlying HBO2 therapy combined with refinements in patient selection will enhance the cost-effectiveness of this treatment.
Trends in Anaesthesia and Critical Care 10/2013; 3(5):279–282. DOI:10.1016/j.tacc.2013.02.011
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