National Healing and Diversified to Merge

Diversified Clinical Services and National Healing Corporation today announced their agreement to merge. Separately, the two companies lead the advanced wound care movement in the US today, and both feature hyperbaric oxygen therapy in their specialized management services. Diversified says it has partnered with more than 325 hospitals. National Healing says it accounts for 30% of managed and outsourced wound healing centers. The new company does not yet have a name.

From today's announcement:

The demand for specialized wound care services is rapidly growing, and the current patient population is underserved by existing wound care programs. An aging population, combined with the rise in diabetes, cardiovascular disease and obesity, has created a $14 billion global wound care industry. In the United States, there are more than seven million Americans who would benefit from specialized wound care services, but less than one million patients are currently being treated in a dedicated wound care setting.

We wish the new company success in better helping the medical community rise to this serious public health challenge.

Click here to read the full news release.

Update: Hyperbaric Oxygen for Gas Gangrene

Today we have updated and upgraded our Gas Gangrene (Myositis or Myonecrosis) page. Gas gangrene is a severe and rapidly spreading infection of muscle and other soft tissue. The bacteria that cause gas gangrene, most commonly Clostridium perfringens, produce liquid and gaseous toxins that surround the microorganisms and undermine the body's natural immune response. The advancing infection can threaten life and limb in mere hours.

Hyperbaric oxygen plays a central role in standard treatment. From our new page:

Hyperbaric oxygen therapy, combined with antibiotics and surgical removal of dead tissue, is an effective treatment for gas gangrene. Clostridia are anaerobic, meaning they thrive in low-oxygen environments. HBOT stops toxin production and inhibits bacteria from replicating and spreading. Hyperbaric oxygen may also boost the effect of antibiotics, enhance the body’s natural defenses against bacteria, and help resolve or delay the onset of sepsis, a deadly blood poisoning.

Clostridium perfringens are everywhere around us. For the most part we safely share our planet with these and other potentially harmful microbes. Salt rising bread rises by natural fermentation of the very same bacterium, found in potatoes, flour, or cornmeal. Watch our expert bakers concoct the starter mix. Just add hot water and let set and bubble overnight. Fascinating and (apparently) delicious. And we may never again share a recipe with our readers.

[Photo: C. perfringens bacteria, Visuals Unlimited]

Wound Rounds Live: Monthly Webcasts Begin

On the last Wednesday of every month, beginning tomorrow, WebCME will present a free, live webcast on a wide range of clinical topics in wound care. The series is co-hosted by Sharon Baronski, MSN, RN, and Jeffrey A. Niezgoda, MD, recent recipient of the Eric P. Kindwall Award of Excellence in Clinical Hyperbaric Medicine and President of the American College of Hyperbaric Medicine (ACHM).

Episode 1 airs at noon Central Time on Wednesday 28 September. Visit the Wound Rounds Live website for more information.

We encourage everyone to tune in and participate. Should be fun, judging by this teaser trailer. Now that's edutainment!

Update: Hyperbaric Oxygen for Refractory Osteomyelitis (Bone Infection)

Today we have upgraded and updated our Osteomyelitis page. Osteomyelitis is a bone infection, an all-too-common and serious complication of chronic wounds and necrotizing infections and a distinctive feature of Wagner Grade 3 diabetic ulcers. Hyperbaric oxygen therapy is approved and clinically indicated when the going gets really tough. From our new commentary:

Hyperbaric oxygen can be a potent bactericide and also treats the hypoxia at the root of osteomyelitis and surrounding soft tissue necrosis. The approved clinical indication is limited to refractory (persistent or recurring) bone infections that do not respond to accepted surgical and antibiotic treatment. UHMS guidelines recommend daily treatments of 90-120 minutes at 2.0-3.0 atmospheres of absolute pressure (ATA), starting soon after surgical debridement and continuing 4 to 6 weeks. Osteomyelitis, like necrotizing infections, involves some rather frightening germs. As antibiotics and other traditional weapons against these worrisome microscopic invaders begin to weaken, HBOT provides a vital backstop. 

Who are these microbial troublemakers? Round up the usual suspects: MRSA and other antibiotic-resistant bacteria, mixed with various fungi. 

Our expanded page now includes many more suggestions and links to helpful patient and clinical resources. And we are especially fond of Sherwin B. Nuland's book, The Doctors' Plague, a must-read for anyone concerned about proper healthcare facility and staff hygiene.

[Image: bone 6 by chrisharvey from Fotolia.com]

On the Retraction Watch

Readers interested in the reliability of scientific papers, and the reliability of news reports based on them, will appreciate a couple segments from New York Public Radio’s weekly program, On the Media. Scientific Retractions on the Rise and Retraction Watch both look at what happens when scientific papers go bad, typically a slow motion process that always begins with doubt and sometimes ends with the dismantling of cherished theories.

Regular readers of O2.0 will know we caution against relying on a single clinical study and advocate checking sources. These stories illuminate some of the reasons why.

Both segments aired September 2 and are available for download or listening online at the On the Media website, about two-thirds of the way down the page.

If you haven't heard of it before, On the Media is a weekly radio program in which journalists and their guests examine the business of news, entertainment, and advertising. The results are engaging, informative, and sometimes surprising. We hear the show makes great listening during a hyperbaric dive, and it's available as a podcast from your favorite purveyor.

Update: Hyperbaric Oxygen for Necrotizing Infections

Today we have upgraded our Necrotizing Infections page. Flesh-eating disease and other soft tissue infections may be caused by a number of different bacteria, in a single strain or mixed, originating within the body, in chronic or traumatic wounds, or from foreign matter. We list many of the bacteria and associated diseases under Related Terms on our new page.

One increasingly common cause of flesh-eating disease is MRSA, or methicillin-resistant Staphylococcus aureus, a particularly troublesome hospital- and healthcare-acquired infection (HAI). Each year, 90,000 Americans suffer from invasive MRSA infection. About 20,000 die. Many are children. [MRSA Research Center, University of Chicago]

Necrosis means death. Skin, muscle, and connective tissue infected with flesh-eating bacteria die because they are starved of oxygen. Only hospital-affiliated advanced wound care centers provide hyperbaric oxygen therapy for MRSA or other necrotizing infections. Time is tissue, the experts say, and hyperbaric oxygen kills bacteria, boosts the effect of antibiotics, enhances the body’s natural defenses against flesh-eating bacteria, and helps resolve or delay the onset of sepsis, a deadly blood poisoning.

From our new commentary:

Hyperbaric oxygen can be a potent bactericide and also treats the hypoxia at the root of soft tissue necrosis. One analysis [Undersea Hyperb. Med. 2005 Nov-Dec; 32(6):437-43] showed significantly fewer deaths and amputations with HBOT. As the [UHMS] writeup concludes: “With such strong case series evidence of reductions in morbidity and mortality for necrotizing fasciitis and the subset of Fournier's Gangrene, it is difficult to envision ever seeing a controlled, double-blinded study of hyperbaric oxygen therapy.” In other words, considering the deadly seriousness of necrotizing infection and the demonstrated effectiveness of HBOT, withholding treatment from a control group for comparative study would not be medically or ethically acceptable. As antibiotics and other traditional weapons against these worrisome microscopic invaders begin to weaken, HBOT provides a vital backstop.

Again, we do not consider it unreasonable for the US healthcare community to demand access to an emergency-ready and professionally staffed hyperbaric chamber in every hospital.

[Photo: Staphylococcus aureus]

HyperbaricLink: The Only HONcode Certified Website Focused Exclusively on Hyperbaric Oxygen Therapy

We are pleased to announce that HyperbaricLink.com has received HONcode certification. All across our website you will now see this symbol, showing that HyperbaricLink complies with the HONcode standard for trustworthy health information.

The independent Health On the Net (HON) Foundation of Geneva, Switzerland, a nongovernmental organization (NGO) accredited by the United Nations, promotes sound, reliable health information in over 100 countries. HONcode websites are committed to providing quality, objective, and transparent medical information tailored to the needs of the audience. Only certified websites may display the HONcode seal, an active link to the online certificate, so visitors can verify compliance in real time.

HyperbaricLink is the only HONcode website focused exclusively on hyperbaric oxygen therapy. Other certified websites include the US National Library of Medicine, The Joint Commission, Cleveland Clinic, and Mayo Clinic. Pretty good company to keep.

People on our mailing list will soon receive more information. Write us at info@hyperbariclink.com to subscribe.

Read our full news release on PR Newswire.

New on HyperbaricLink: Acute Coronary Syndrome

Today we have added acute coronary syndrome (ACS) to our Diseases and Conditions section. ACS is a blockage of the small blood vessels that supply the heart muscle with oxygen. It includes heart attack, called myocardial infarction, and chest pain or discomfort, called angina.

Our new page was created upon the publication of an updated meta-analysis [Cochrane Review, 2011] of 6 randomized controlled trials with 665 participants, in which the authors conclude:

Overall, we found some evidence that people with ACS are less likely to die or to have major adverse cardiac events, and to have more rapid relief from their pain, if they receive hyperbaric oxygen therapy as part of their treatment.

Falling quite short of a recommendation for the routine use of HBOT, this is still strong language and strong data to support further study and evidence-based practice. From our commentary:

The hyperbaric community sits up and takes notice when the Cochrane Collaboration, with its sterling reputation and rigorous literature review methodologies, reports such a compelling body of evidence. ACS is lacking the all-important pivotal clinical trial for FDA clearance. But soon the healthcare community may add acute coronary syndrome to the growing list of great reasons to demand 24/7 access to hyperbaric medicine.

Our new Acute Coronary Syndrome page also links visitors to select clinical and patient resources, including the groundbreaking and fascinating Framingham Heart Study and the American Heart Association's excellent HeartHub patient portal.

[Image: Resin cast of heart showing coronary arteries, Visuals Unlimited/Corbis]

College Football: New Data on Concussion by Position

Linemen and linebackers take more hits, but quarterbacks and running backs get hit harder, says a new Brown and Dartmouth University study published in the Journal of Biomechanics. Researchers quantified impacts to the helmet and head acceleration, the primary cause of concussion and traumatic brain injuries that trouble the sport. Using helmets equipped with wireless sensors they recorded (gasp!) 286,636 head impacts on 314 players at three institutions over three seasons. The results may soon inform rules changes and helmet design. They might want to start with wireless sensors for everybody. Read more about the study on Science Daily.

New on HyperbaricLink: Vascular Dementia

Today we have added vascular dementia to our Diseases and Conditions section. Vascular dementia is a loss of memory and thinking capacity as a result of impaired blood flow to parts of the brain. The second most common form of dementia after Alzheimer’s disease, vascular dementia is more closely related to stroke. It may be caused by a major stroke, by many smaller strokes, or by damage to tiny vessels deep within the brain.

As a target for hyperbaric oxygen therapy, then, vascular dementia merits our separate consideration. With this new vascular dementia page, along with central retinal artery occlusion (really a stroke of the eye), we begin our reassessment of HBOT for stroke proper. From our commentary:

Advancing by small trials, with mixed results, early researchers still keep gathering promising clinical evidence on hyperbaric oxygen for acute ischemic stroke. Supplying oxygen-rich blood to the damaged brain makes good plain sense. HBOT has been approved for patients with intracranial abscess and acute traumatic ischemias, based on similar rationale. Likely any evidence to support HBOT for vascular dementia will arise from this broader field of investigation.

Our new vascular dementia page combines dementia and stroke resources for patients, families, and clinicians. We think visitors will especially enjoy Jill Bolte Taylor's TED talk. 

Decompression Sickness: HBOT for Lobster Divers

Off the remote Caribbean coast of Honduras and Nicaragua, by tradition and out of economic necessity, deep-sea lobster divers of the Miskito people descend 100 to 120 feet, 12 to 16 times a day, to earn about $3 a pound. Every season a few die. Many end up paralyzed from decompression sickness, or the bends. Read "Devoted to Keeping Lobster Divers of Honduras Alive" in today's New York Times, where we meet Dr Elmer Mejía, a former navy diver, nurse, and paramedic, trained in HBOT at Memorial Hermann, Houston, Texas. His clinic provides the first hyperbaric chamber for Miskito divers.

The article also nicely summarizes the cause of decompression sickness and the benefit of hyperbaric oxygen treatment:

Compression [sic] sickness occurs when a diver ascends too fast and nitrogen in the bloodstream that is normally expelled by the lungs forms bubbles. The bubbles can lodge in the joints or along the spinal cord, causing paralysis. A bubble that reaches the brain causes an arterial gas embolism, which can be fatal.

In the hyperbaric chamber, the atmospheric pressure is raised to what the diver would experience underwater and then reduced over several hours as the diver breathes oxygen through a mask, allowing the nitrogen to be expelled.

We're sure you'll find the story worth spending one of your free Times visits this month.

Update: HBOT for Alzheimer's Disease

Today we have upgraded our Alzheimer's Disease page. We have also downgraded our Evidence Index score, from scant to none, because we now distinguish Alzheimer's from other forms of dementia. Vascular dementia, in particular, merits a separate discussion. But that's another blogpost.

Our new HyperbaricLink Commentary sums up our view:

Alzheimer’s presents a nonvascular and seemingly irreversible mechanism of brain cell death and tissue loss. The biologic mechanism of age-related dementias differs greatly from vascular dementia and also from intracranial abscess and acute traumatic ischemias, two conditions for which hyperbaric oxygen is FDA-cleared to fight infection and aid in healing healthy brain tissue. Weak evidence from primary research and clinical trials does not support the use of hyperbaric oxygen for Alzheimer’s disease. Patients and families should be wary of bolder claims.

Visitors and people affected by Alzheimer's will find helpful links under Patient Resources, and Clinical Resources provide a wealth of information for deeper study.

Alzheimer's has struck our families, as it has so many others. We'll keep our eyes peeled for any more encouraging clinical evidence.

See our June 7 post, "Diseases/Conditions Upgrades And Updates," for more information about our new page format. And look for regular updates in the days and weeks ahead.

[Illustration: Emiliano Ponzi, Northwestern University]

Check? Check: HyperbaricLink's Evidence Index

Very early in the development of our website we knew our visitors needed a little help sorting through the clinical evidence on hyperbaric oxygen for a wide range of diseases and conditions. Maybe a lot of help. For most clinical indications we found a dearth of reliable information on the web. For some off-label indications the medical literature strongly supported further research and investigational use of hyperbaric oxygen therapy. For others the clinical evidence was weak (scant) or totally lacking (none).

Enter the Evidence Index. HyperbaricLink's at-a-glance summaries provided a handy reference to the state of clinical evidence on HBOT for many diseases and conditions. We also provided links to the published medical literature and other analyses and commentary, so you could check out our sources and do your own research.

Now we have refined our approach. Read all about it on our new Evidence Index page. And look for the new check chart on all our new and updated diseases and conditions pages, where we distinguish six categories of clinical evidence:

Approved — HBOT indicated and widely reimbursed. Only FDA-cleared and UHMS-approved clinical indications earn this rating.

Compelling — Strong body of evidence supporting evidence-based practice. A select few off-label hyperbaric oxygen therapy indications merit such interest and encouragement.

Promising — Repeatedly favorable results urging further study. Hyperbaric oxygen therapy has demonstrated real promise for just a handful off-label diseases and conditions.

Scant — Early or mixed results with lingering questions. We find scant evidence for the majority of off-label indications for hyperbaric oxygen therapy.

None — Unfavorable results or no published evidence. HyperbaricLink is unlikely to publish pages on diseases and conditions for which there is no published evidence on HBOT.

Disproved — Strong evidence against using hyperbaric oxygen therapy. Null findings in the hyperbaric medical literature have not yet eliminated any diseases or conditions from further clinical investigation.

We look at a broad range of medical literature in scoring our Evidence Index, but we don’t give every paper equal weight. Some studies are better designed and conducted than others. Some clinical investigators and healthcare institutions are more influential than others. Some medical journals are more highly regarded than others.

Look for more information about how we read and evaluate scholarly articles in the medical literature and popular stories in the mainstream health media in our forthcoming white paper on Evidence-Based Hyperbaric Medicine. Truly, it's a labor of love, a love of the Scientific Method and of the ever-advancing knowledge and understanding that inform modern hyperbaric medical practice.

HBOT for TBI: The Loma Linda Review

A new literature review of the experimental (animal) and clinical (human) evidence on hyperbaric oxygen therapy (HBOT) for traumatic brain injury (TBI) was published yesterday in Medical Gas Research [2011, 1:21]. The authors find that, combined with other therapies, HBOT may serve as a promising neuroprotective strategy and improve long-term outcomes for people with TBI. They conclude:

Translational research of HBOT in a variety of TBI models has shown neuroprotective effects in the absence of increased oxygen toxicity when administered at pressures less than 3 ATA. Due to the heterogeneity of human TBI, the efficacy of clinical HBOT and an optimal regimen for HBOT remains elusive. However, all human studies have involved severe TBI patients and it is likely that there may be increased efficacy in mild or moderate TBI patients. Recent clinical trials favor HBOT as promising safe therapeutic strategy for severe TBI patients.

Download the provisional abstract and full-text PDF directly from this open-access, peer-reviewed online journal.

Cancer: Hyperbaric Oxygen and Tumor Growth

A complicated question has been on our minds ever since we updated our radionecrosis (delayed radiation injury) page. Does HBOT promote tumor growth or cancer recurrence? From our friends at The Wound Healer blog we get an informed answer. "Hyperbaric Oxygen and Cancer Fears" explains that

... tumor growth occurs regardless of oxygen status. In fact, tumor cells that grow and survive in the hypoxic regions of the tumor are more aggressive, more prone to metastasis, and more resistant to treatment.

More exciting, hyperbaric oxygenation may make tumor cells more susceptible to traditional cancer therapies, especially radiation.

We welcome this new information, complete with footnotes, in followup to our August 4 post, "Cancer: HBOT Combined with Radiation, Chemo." Clearly there's much more for us to read and learn about this fascinating topic.

AUDIO: Central Retinal Artery Occlusion (CRAO)

Click PLAY to listen to our new Central Retinal Artery Occlusion page.

New on HyperbaricLink: Central Retinal Artery Occlusion (CRAO)

Today we have added Central Retinal Artery Occlusion (CRAO) to our Diseases and Conditions section. CRAO has been approved by the UHMS and cleared by the FDA as a clinical indication for hyperbaric oxygen therapy (HBOT). In fact HBOT is one of the few treatments proven effective for this vascular event, which may cause sudden and permanent blindness, blurring, or partial loss of vision.

From our commentary:

The retina consumes oxygen at a rate faster than any other organ in the body. It is highly sensitive to ischemia, or lack of blood supply. In the treatment of CRAO hyperbaric oxygen therapy has succeeded where others in the last 100 years have failed [UHMS]. But quick access to an emergency-ready chamber is a must. Or as [Medscape] puts it, “Hyperbaric oxygen therapy (HBOT) may be beneficial if begun within 2-12 hours of symptom onset. Institute treatment with other interventions first, as transport to a chamber may usurp precious time.” Central retinal artery occlusion offers yet another good reason, then, for the healthcare community to demand 24/7 access to hyperbaric medicine.

Our new page includes thoughtfully selected links to resources for patients and for medical professionals.

The companion blogpost presents a complete AUDIO version of our new CRAO page.

[Illustration: Body Scientific]

Veterinary HBOT: They Treat Horses, Don't They? Pt 3

Often we are impressed by the quality of clinical information about hyperbaric oxygen therapy in veterinary medicine, especially equine sports medicine. Consider this nice, tight paragraph from last month's The Horse:

Hyperbaric oxygen therapy, used in conjunction with other therapies, enables equine practitioners to more effectively treat a wide variety of serious conditions in horses, particularly those pathologic conditions characterized by soft tissue swelling, bacterial infection, tissue necrosis, or poor blood supply. Hyperbaric oxygen improves the physiologic state of injured or underperfused tissues (those that aren't receiving enough blood) by providing increased oxygen levels. Additionally, hyperbaric oxygen increases the production of beneficial growth factors and mobilizes and activates stem cells. All of these effects are helpful to repair damaged tissues and heal injuries in horses.

In all our reading about HBOT for human sports injury, we've found nothing so clear and simple.

We also enjoyed "How to save an injured thoroughbred horse" in the Toronto Star. Living reporter David Graham visits The Sanctuary Equine Sports Therapy and Rehabilitative Center in Ocala, Florida, and teaches us a lot about horse physiology and the business of keeping thoroughbred racers in running shape. Who knew 70% of horses die from colic? And let's add "farrier" to our working vocabulary:

Elite farriers (not to be confused with blacksmiths) often refer to themselves as equine podiatrists—an expanded mandate that covers corrective shoeing, which can improve the way a horse steps and moves. They tackle the cliché of the horse business: “No foot, no horse."

As in human sports, horseracing authorities struggle with training and rehabilitation regimens, like HBOT, that may enhance performance and create unfair competitive advantages.

Someday, when we're feeling confident we've got HBOT for people totally covered, we'll go talk to some vets. Just watch we don't blow all our money at the track.

[Photo: The Sanctuary Equine Sports Therapy and Rehabilitative Center, Ocala, Florida]