OBJECTIVEChronic diabetic foot ulcers are a source of major concern for both patients and health care systems. The aim of this study was to evaluate the effect of hyperbaric oxygen therapy (HBOT) in the management of chronic diabetic foot ulcers.RESEARCH DESIGN AND METHODSThe Hyperbaric Oxygen Therapy in Diabetics with Chronic Foot Ulcers (HODFU) study was a randomized, single-center, double-blinded, placebo-controlled clinical trial. The outcomes for the group receiving HBOT were compared with those of the group receiving treatment with hyperbaric air. Treatments were given in a multi-place hyperbaric chamber for 85-min daily (session duration 95 min), five days a week for eight weeks (40 treatment sessions). The study was performed in an ambulatory setting.RESULTSNinety-four patients with Wagner grade 2, 3, or 4 ulcers, which had been present for >3 months, were studied. In the intention-to-treat analysis, complete healing of the index ulcer was achieved in 37 patients at 1-year of follow-up: 25/48 (52%) in the HBOT group and 12/42 (29%) in the placebo group (P = 0.03). In a sub-analysis of those patients completing >35 HBOT sessions, healing of the index ulcer occurred in 23/38 (61%) in the HBOT group and 10/37 (27%) in the placebo group (P = 0.009). The frequency of adverse events was low.CONCLUSIONSThe HODFU study showed that adjunctive treatment with HBOT facilitates healing of chronic foot ulcers in selected patients with diabetes.

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a b s t r a c tThis paper proposes that the impact of information systems (IS) integration on manufacturing firm profitability is underestimated as a result of inadequate attention to indirect effects. The study uses structural equation modeling to investigate the associations among internal and external information system integration, quality and cost performance, and firm profitability. Overall, the results from a mail survey of 263 member firms of the Institute for Supply Management support the theoretical model. Results indicate that (a) internal IS integration has a significant positive association with external IS integration, (b) both internal IS integration and external IS integration are significantly positively associated with cost and quality performance, (c) quality performance is significantly positively associated with cost performance, and (d) both quality and cost performance have significant positive associations with firm profitability. However, the direct effects of internal and external IS integration on firm profitability are not significant. Rather, the association is through cost and quality performance, suggesting that both cost and quality performance act as intervening variables. This study extends the literature on IS integration by providing insights into a set of interrelationships that matters for the attainment of firm profitability from IS integration.

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