New Name, Same Day and Time for Monthly Wound Wire Webcast

Episode 7 of the highly edutaining Wound Rounds LIVE webcast, newly renamed Wound Wire, airs tomorrow 27 June 2012 at 11 AM Central. Co-hosted by Dr Jeffrey A. Niezgoda and Sharon Baranoski, and powered by WebCME, the free webcast streams live on the last Wednesday of every month and covers new technologies, products, and devices, clinical insight, new procedures, and robust literature reviews covering every aspect of wound care.

Diabetic Ulcers without Optimal Glycemic Control: New Study Concludes HBOT Should Not Be Delayed

Physicians treating wounds in patients with diabetes often delay hyperbaric oxygen therapy until the patient has attained optimal blood sugar levels. A new multicenter, prospective cohort study, presented 24 May 2012 in Philadelphia at the annual meeting of the American Association of Clinical Endocrinoligists, suggests that, in patients with diabetic ulcers of the lower extremities, the success of hyperbaric oxygen therapy is not affected by pretreatment glycemic control.

Here's the complete abstract from the AACE 2012 Abstract Book:

GLYCEMIC CONTROL AT INITIATION OF HYPERBARIC OXYGEN THERAPY DOES NOT AFFECT DIABETIC LOWER EXTREMITY WOUND HEALING
Owaise Mansuri, MD, Parkash Bakhtiani, MBBS, Abhijeet Yadav, Chima Osuoha, Patricia Knight, Robert McLafferty, Michael Jakoby, IV, MD
 
Objective: Diabetic lower extremity ulcers are a major cause of disability and mortality, accounting for approximately two-thirds of all non-traumatic amputations performed in the United States. Hyperbaric oxygen (HBO) is increasingly used as an adjunct to antibiotics, debridement, and revascularization for therapy of chronic, non-healing wounds associated with diabetes mellitus. We investigated whether glycemic control at time of HBO therapy measured by hemoglobin A1c (HbA1c) has a significant impact on diabetic wound healing. Methods: A multi-center, prospective cohort study assessing lower extremity wound healing rates among adult patients with diabetes mellitus treated with HBO was conducted at the Regional Wound Care Center in Springfield, IL and University Medical Center Hyperbaric Oxygen Center and Burn Care Unit in Las Vegas, NV. Patients underwent 20 sessions of HBO over the course of one month, and ulcer size (surface area and depth) and location were recorded at each visit. Transcutaneous oxygen pressures (TcPO2) were measured during each session. HbA1c was measured at first and last HBO treatments from capillary blood specimens using a Siemens DCA Vantage A1c Analyzer. Patient characteristics including age, gender, weight, type and duration of diabetes mellitus, current diabetes treatment regimen, hypertension, peripheral artery disease (PAD), tobacco use, ulcer duration, and additional wound care therapies (e.g. debridement, platelet derived growth factor) were determined. Results: Complete data were collected for 22 patients who were included in the study analysis and divided into two groups based on pre-HBO HbA1c. Patients in the “controlled diabetes” group had HbA1c < 7.5%, and patients in the “uncontrolled diabetes” group had HbA1c ≥ 7.5%. Mean HbA1c in the “controlled diabetes” group (6.5 ± 0.8%, N=12) was significantly lower (P < 0.001) than in the “uncontrolled diabetes” group (8.8 ± 1.4%, N=10). Both groups were well matched across all other recorded characteristics. Wound volume was reduced by 65 ± 29% in the “controlled diabetes” group and 71 ± 30% in the “uncontrolled diabetes” group (P = 0.60). Wound healing was also unaffected by presence or absence of PAD, hypertension, tobacco use, weight, duration of diabetes, or ulcer duration. Discussion: This study demonstrates that diabetic lower extremity wound response to HBO treatment is unaffected by pre-treatment glycemic control and several other clinical factors that may adversely impact wound healing. Conclusion: HBO treatment should not be delayed if glycemic control is suboptimal at time that therapy is prescribed.

Previous studies have shown that hyperglycemia inhibits wound healing. Here there was no significant difference between the controlled and uncontrolled groups. Why? Lead author Mansuri, in widespread press coverage of the findings, has said, "We suspect that the effect of hyperbaric oxygen therapy was potent enough to overcome the negative effect of hyperglycemia." We're eager to learn more from any wound care and hyperbaric medical experts who may wish to comment.

A Podiatrist Speaks Against Podiatrists Supervising Hyperbaric Oxygen Therapy

A leading podiatric physician and regular Podiatry Today blogger last week spoke up against Doctors of Podiatric Medicine (DPMs) monitoring patients receiving hyperbaric oxygen therapy (HBOT). Citing state law in his home Indiana and discussions with his Healogics wound center colleagues, DeHeer concludes:

Despite being a proud member of the podiatric profession, I feel that until we have a combined MD-DPM degree, it is in our patients’ best interest to have our allopathic and osteopathic colleagues monitor HBOT patients.

In other words, as so often we have commented here and on HyperbaricLink:

Hyperbaric oxygen is serious medicine that should always be prescribed by a physician. Treatments should always be supervised by a qualified hyperbaric specialist (MD or DO) assisted by a certified hyperbaric technician (CHT).

Podiatric physicians play a vital and sometimes leading role in the care of people with diabetic ulcers and other wounds and injuries of the foot. Hats off to Dr DeHeer for working to clarify his profession's role in hyperbaric medicine.

Now we're curious. How does your hyperbaric treatment center involve podiatrists in patient care?

[Image: Podiatry Today DPM Blogs]

Hyperbaric Oxygen and Type 1 Diabetes: New Animal Study Suggests Preventive Effect

When HyperbaricLink talks diabetes we're usually talking diabetic ulcers. But we note with great interest a promising new paper published online last week in the American Diabetes Association journal Diabetes, in which scientists at the University of Miami say they used hyperbaric oxygen to prevent or slow the progression of Type 1 diabetes in mice.

Our first question is, How does hyperbaric oxygen work? From the abstract:

HOT reduces autoimmune diabetes incidence in NOD mice via increased resting T cells and reduced activation of DCs with preservation of β-cell mass resulting from decreased apoptosis and increased proliferation.

We won't pretend to understand much of this beyond the given abbreviations: hyperbaric oxygen therapy (HOT), non-obese diabetic (NOD), and dendritic cells (DC). But we do know how difficult it can be to translate findings from animal laboratory experiments to human clinical studies. And we're not quite sure how physicians would know how to select patients and whether or when to use hyperbaric oxygen. A neat summary of the paper in HealthDay raises these and other questions.

That hyperbaric oxygen affects diabetes is not news to many researchers. Back in July 2010 we noted a paper in the Polish Journal of Endocrinology concluding "HBOT was shown to have beneficial effects on atherosclerosis and glycaemic control" in a study of 28 diabetes patients with foot ulcers.

The Miami study used 100% oxygen at 2.0 atmospheres absolute (ATA) and the Polish study at 2.4 ATA. Of course such subtleties will not stop every inflatable bag dealer from claiming this evidence as their own. Let the buyer beware.

For the evidence-based hyperbaric medical community, this is an altogether fascinating area of hyperbaric medical research. We have reached out to the Miami research team and eagerly await further studies.

Limb Salvage Testimonial: Genesis Wound and Hyperbaric Institute in Davenport, Iowa

Genesis Wound and Hyperbaric Institute in Davenport, Iowa, has published an uplifting patient testimonial worth sharing. It's a story of clinical excellence, yes, but also a reminder of how much emotional and physical endurance chronic wounds and especially diabetic ulcers may require of patient and physician alike.

A small abrasion on Jim Keenan's heel developed into an infected wound that exposed his Achilles tendon. Keenan, who has Type 2 diabetes and vascular problems in his legs, received specialized dressings, bioengineered grafts, and vascular surgery in addition to 40 hyperbaric oxygen treatments. Healing required almost two full years. About his experience in the chamber Keenan recalls:

I gained substantial, measurable improvement in the flow of oxygen to my feet and the hyperbaric treatment contributed significantly to my healing. I also got a two-hour nap in every day, which is a habit I would have cheerfully continued.

Dr Brad DeWall adds:

At Genesis, we consider amputation to be a "treatment failure" not a "treatment option." Our goal is to save the extremity.

So he and the Genesis nurses did. And it's a story happening every day at advanced wound care and hyperbaric medicine centers from coast to coast. Let's see that more people read all about it.

World Kidney Day: Hyperbaric Oxygen's Small But Vital Role in the Treatment of Kidney Disease

Happy World Kidney Day. How does hyperbaric oxygen figure in today's celebration and in the treatment of kidney disease? Scanning our own list of diseases and conditions we go straight to diabetic ulcers. Diabetes and obesity figure prominently in this formidable threat to the public health. We've written here and here about how hyperbaric oxygen therapy combined with dialysis helps spare kidneys in cases of crush injury, a signature wound of major earthquakes. And hyperbaric oxygen therapy in kidney disease and organ preservation has long been an active area of clinical research. A quick search of PubMed shows 353 studies since 1964. The Rubicon Research Repository contains 45 entries on the topic. The following video offers wise words of prevention and daily habits to maintain the health of your kidneys. Suddenly we're thirsty.



Correction 12:08AM 9 Mar 2012 to Rubicon search query link and results. Thanks to Gene Hobbs. - rem

Lee Memorial Hospital: Local Plug for Fort Myers, Florida, Wound Care Center a Model of Brevity, Clarity

Sometimes just a bit of just the right information communicates best. Hats off to Lee Memorial Hospital in Fort Myers, Florida, for landing the kind of local coverage every hyperbaric oxygen treatment center should covet. This little gem from the local NBC affiliate hits all the basics with minimum effort:

• A stirring tale of a 2-year-old girl recovering from burns.
• A short explanation of what wound centers do and how hyperbaric oxygen therapy works.
• A strong case for adapting to meet the public healthcare demands of a rapidly aging population.
• A believable connection to success with advanced, specialized wound care centers.

No doubt the hospital marketing and public relations team and clinical experts played this one clear and straight. That's why this reporter got a great story, this hospital got some great ink, and these readers got another great reason to look into this great new movement in American medicine. All in about 390 words.

[Photo: Lee Memorial Hospital website]

National Healing: Leading Advanced Wound Care Provider Puts Limb Salvage in Perspective

We are happy to see someone in the advanced wound care community take some credit, where credit is due, for the remarkable decline in lower-limb amputations among Americans with diabetes. In a news release subtitled "National Healing Corporation Wound Care Centers Offer Alternative to Amputation" we learn the company's more than 500 centers treated more than one million wounds in 2011, with a healing rate of 89% and overall amputation rate of just 1%. CLICK HERE to read the January 24 report from the CDC. See also our February 1 post, "Diabetes Amputation Rates Declined Sharply in US Between 1998 and 2008." Access to accredited hyperbaric facilities with certified hyperbaric physicians and technicians is still very much a public health problem. “It is imperative that we educate patients and families about the advanced treatments available to prevent amputation,” said National Healing EVP medical affairs Scott Covington, MD, FACS, CHWS. We wholeheartedly agree.

Studying Hyperbaric Oxygen and Mystery Ointment in Tulsa, Oklahoma

We always enjoy seeing a hyperbaric oxygen treatment center win some choice local media coverage. This story, about St John Wound Center in Tulsa, Oklahoma, earns bonus points for plugging a clinical trial of the mystery ointment Nexigone. It's a simple misspelling. Mystery solved. With a little googling we dug up Nexagon, whose active ingredient is

... a natural, unmodified antisense oligonucleotide that down-regulates the key gap junction protein connexin43 to dampen inflammatory responses and enhance healing.

They call it a gap junction modulator. Any questions? Learn more on the CoDa Therapeutics website. ClinicalTrials.gov lists eight Nexagon studies completed, recruiting, or in the works.

We also note that St John has not yet made our Oklahoma treatment center directory. Come on now, everybody. It's as easy as 3-2-1.

[Photo: News On 6, Tulsa]

Diabetes Amputation Rates Declined Sharply in US Between 1988 and 2008

Researchers from the Centers for Disease Control and Prevention (CDC) report a dramatic reduction in amputations due to diabetes over the last two decades. Read "Declining Rates of Hospitalization for Nontraumatic Lower-Extremity Amputation in the Diabetic Population Aged 40 Years or Older: US, 1988-2008" in Diabetes Care, the journal of the American Diabetes Association. In related press coverage (see Newsday) the authors attribute the decline to earlier diagnosis and preventive foot care. We might suggest advanced wound care centers had an awful lot to do with it, too. From the HyperbaricLink Commentary on our diabetic ulcers page:

Hyperbaric oxygen plays an increasingly important role in the treatment of problem wounds and limb salvage. But access to accredited hyperbaric facilities and certified hyperbaric physicians and technicians is a public health problem. In 2004 as many as two-thirds of nursing home patients with NPUAP Stage II or worse pressure ulcers were not enrolled in wound care treatment programs [NCHS, 2011]. In diabetes-related wounds alone, US hospitals performed 66,000 toe, foot, and leg amputations in 2006 [CDC, 2011], for which health economists have estimated a cost of $3 billion per year [ACA, 2008]. More and more hospitals and health networks today are opening advanced wound care and hyperbaric centers to serve this unmet clinical need. Even if chronic wounds were its only indicated use, HBOT would be assured a place in evidence-based medicine for quality and cost-effective healthcare.

That's our story, and we're sticking to it.

[Image: American Diabetes Association, Diabetes Care website]

Today's Wound Rounds LIVE Broadcast Postponed

Episode 4 of the interactive and always edutaining Wound Rounds LIVE, normally broadcast on the last Wednesday of every month, has been postponed until Wednesday 1 February 2012. Dr Jeffrey A. Niezgoda and Sharon Baranoski co-host the free webcast, which covers new technologies, products, and devices, clinical insight, new procedures, and robust literature reviews covering every aspect of wound care. 

[Image: WebCME]

Hyperbaric Oxygen Treatment Centers: Advantages of Participating in the HyperbaricLink Directory

Let's pick one center at random from today's newsfeed. Almost precisely one year ago, we wrote with enthusiasm about the expansion of the hyperbaric wound care program at Oakwood Heritage Hospital, in your faithful correspondent's idyllic hometown of Taylor, Michigan. We immediately gathered what information was available and posted standard profile MI019 in the HyperbaricLink treatment center directory. Take a quick look and come right back.

What's missing? An email address to contact. The name of a medical director or administrator. What else? Without the benefit of any communication with the center, we simply don't know.

Now go read about the center on the hospital's website. About advanced wound care and hyperbaric oxygen therapy the hospital provides very little information for patients, families, and referring physicians. But here we do learn what conditions this center treats: chronic wounds, diabetic ulcers, skin grafts and flaps, osteomyelitis, and radionecrosis. That's three more than we listed. Had this center worked with us to publish a complete and accurate listing, HyperbaricLink visitors would get all the right information, complete with links to our trustworthy content on HBOT, diseases and conditions treated, the published clinical evidence, and plenty of helpful, reliable resources.

What other advantages might Oakwood Heritage gain by participating with HyperbaricLink? Try googling wound care taylor mi. Your local search results will differ from ours, but likely you'll find our directory listing equals or beats the hospital. List with us, link to us, and we all secure the top spots for the most relevant queries. About this subject we have dedicated an entire page, where you can also request our white paper on Internet Best Practices for Hyperbaric Oxygen Therapy Providers.

ATTENTION Treatment Centers. Start your countdown to a complete and accurate listing in our directory. It's as easy as 3-2-1. See what's new and create the profile that's right for your facility.

CLICK HERE to learn more about directory listing options.  

Only by working together can we make the evidence-based hyperbaric community more prominent and more discoverable on the web. And don't worry, Oakwood. We'll be in touch.

[Photo: Oakwood Healthcare website]

Philanthropic Gifts and the Hyperbaric Oxygen Treatment Center

Lest we forget, hyperbaric treatment centers and other healthcare providers depend upon the thoughtful kindness of charitable donors. Volunteer auxiliaries and family foundations often lead the way to major building projects and capital equipment purchases. Two recent stories exemplify the role of philanthropy in the establishment of new hyperbaric oxygen therapy and wound care centers. Last month the hospital auxiliary at Northern Duchess Hospital in Rhinebeck, New York, fulfilled its $70,000 pledge to build a center slated to open in late 2012. The auxiliary raised the funds with bake sales, lunch events, and gift shop sales. In Nashville, Tennessee, the family of a former patient donated $5 million to expand the Wound Care and Hyperbaric Center at Baptist Hospital. The news inspired a nice piece in The Tennessean, including the following and a companion video primer on hyperbaric wound care.



[Video: The Tennessean and Baptist Hospital, Nashville]

West Virginia Hyperbaric Wound Care Center Lands Choice Promo on Local TV Healthbeat

Here's a 4-minute clinic in how to promote your hyperbaric wound care center. Click here to watch medical director Rolando Cunanan, MD, clearly and soberly explain how he and his team heal with hyperbaric oxygen therapy at United Hospital Center (UHC) in Bridgeport, West Virginia. For a local TV news spot, with a junior healthbeat anchor, this is about as good as it gets.

[Photo: Video capture, WDTV.com]

Keepers: Our Top 10 Favorite Posts of 2011

In 2011 we posted 136 blog entries. Every day we scour the hyperbaric business and science news. Often we're inspired to share the news with you. Sometimes we hit on a topic, share a video, or link to a story that really reminds us why we do this. Here's a quick selection of favorites you may have missed or may wish to read again.

Quad Cities Homeless Man Gets HBOT for Frostbite

FDA Urges Caution in Negative Pressure Wound Therapy

Evidence-based HBOT: Trust It or Trash It?

Evidence-based HBOT Is Not CAM

Mixing Hyperbaric Oxygen with Other Prescription Drugs

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

HBOT Program Oversight: Exposé Makes Good Points

VIDEO: Fire Suppression Test of USC Catalina Chamber, Avalon, California

CRAO: Fast Intervention with Hyperbaric Oxygen Helps Save Student's Eyesight

Serious Carbon Monoxide Poisoning Risk from Ice Resurfacing Equipment at Indoor Rinks

We thank you for your readership and participation in the year past, and we look forward to bringing you even more evidence-based hyperbaric oxygen therapy news in the year ahead.

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]

CORRECTION: Chronic Wounds and Diabetic Ulcers

Thanks to a reader's comment on our June 20 blogpost, HyperbaricLink's chronic wounds and diabetic ulcers pages now recognize an important distinction in wound classification systems. Pressure ulcers (see chronic wounds) are classified into six stages defined by the National Pressure Ulcer Advisory Panel (NPUAP). Diabetic foot ulcers (see diabetic ulcers) are classified into six grades defined by the Wagner Scale. Our chronic wounds page now explains the pressure ulcer stages, and we have added NPUAP to our list of clinical resources. We are grateful to the reader who spotted our error, and we always welcome your comments, criticisms, and conversations.

Adults With Diabetes More Than Doubled In Last 30 Years

Add some alarming new statistics to our case for increased access to advanced wound care and limb salvage for patients with diabetic ulcers. From 1980 to 2008, the number of adults with diabetes soared from 153 million to 347 million worldwide, according to a large study published this week in The Lancet. In the US the incidence rate rose more than 60% and jumped 79% in women. Population aging accounts for much of the increase, but obesity has played a major role. The study was funded by the Bill and Melinda Gates Foundation and WHO. Click the following hyperlinks to read the Lancet abstract, a summary from the Imperial College of London, and a blurb in The Economist, complete with world maps and a swipe at America's "hefty reputation." Not very cricket.

[Map: The Economist]

O2.0 is the news blog of HyperbaricLink, the independent web guide to hyperbaric oxygen therapy.

New On HyperbaricLink: HBOT For Diabetic Ulcers

Today we have added Diabetic Ulcers to our Diseases and Conditions section. In our view this close companion to our updated Chronic Wounds page merits its own space for diabetes-specific content, news, and Patient Resources for people affected by complications of diabetes.

Diabetes presents serious challenges for the wound care clinician and the medical community. An excerpt from our writeup:

Wound healing in people with diabetes is often complicated by poor blood circulation in the feet and legs. Nerve disease (neuropathy) may also cause a loss of sensation in the feet and legs, so even a small cut, sore, or pressure ulcer may go unnoticed for some time and develop into a problem wound. Diabetic ulcers are especially prone to serious bacterial infections that threaten life and limb.

HBOT brings strong clinical evidence to this challenge and has indeed become a standard treatment for infected diabetic ulcers, Wagner Grade 3 or worse. Prevention and early intervention offer the best hope for reducing the rates of amputation and death from infection in the diabetes population. But more people with diabetes today need access to advanced wound care and hyperbaric oxygen treatment centers. And now HyperbaricLink has a page where visitors can get more specific information about their condition and connect with local centers fully staffed and equipped to help heal diabetic ulcers.

[Illustration: Unknown]

O2.0 is the news blog of HyperbaricLink, the independent web guide to hyperbaric oxygen therapy.