PubMed · 15442839
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O F GRIMES, H G BELL. 1950. Shoulder girdle amputation.. https://pubmed.ncbi.nlm.nih.gov/15442839/
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Diabetic foot ulcers result from two specific complications: neuropathy and arteriosclerosis. Prompt and appropriate treatment of these often complicated wounds can help reduce complications that may lead to amputation. The most effective way to prevent these complications is to refer patients to interdisciplinary diabetic foot teams. The most important aspects of treatment are off-loading, treatment of infections, establishment of sufficient circulation, and local wound therapy. A specific examination is the basis for risk assessment. Prophylaxis and appropriate management of patients at risk of developing foot ulcers would contribute to reduce the number of amputations among diabetic patients.
A simple model for extra-Binomial variability is the Beta-Binomial. A complication in testing the Binomial against the Beta-Binomial alternative is that the Binomial lies on the boundary of the Beta-Binomial, which forces modifications to the usual asymptotic arguments. In this paper, we propose a Bayesian test using a pair of approximate Bayes factors, one for the case in which the maximum likelihood estimator (MLE) of the extra-Binomial variability is zero and one for the case in which it is positive. These approximate Bayes factors are easy to compute. We evaluate the operating characteristics of the Bayes factors and find them to be more powerful than the likelihood ratio test. We then apply the method to three data sets, including one in which the issue is whether a logistic regression intercept should be considered a random effect. In each case, our approximate Bayes factors are close to the exact Bayes factors, which may also be computed with additional effort.
BACKGROUND: Many therapeutic options exist for chronic wounds. Hyperbaric oxygen therapy (HBOT) is one such option. It may be used for diabetic, venous, arterial and pressure ulcers. METHODS: Following a systematic search of the literature, pooled analyses of predetermined clinical outcomes of randomized controlled trials involving the use of HBOT for chronic wounds were performed. Relative risks (RR) and number needed to treat (NNT) with 95 per cent confidence intervals (c.i.) were calculated. RESULTS: Six studies met the inclusion criteria. No appropriate trials were located for arterial and pressure ulcers. Pooled data from five trials on diabetic ulcers (118 patients) suggested a significant reduction in the risk of major amputation with HBOT (RR: 0.31; c.i. 0.13 to 0.71) with a NNT of 4 (c.i. 3 to 11). Sensitivity analyses did not alter the results. Ulcer healing and the rate of minor amputation were not influenced by HBOT. Data from one trial on venous ulcers suggested significant wound size reduction at the end of the treatment, but not at follow-up. CONCLUSIONS: There is evidence that HBOT reduces the risk of major amputation in diabetic patients. For venous, arterial or pressure ulcers there is a lack of data. Further trials may be warranted.