UHMS supports Hyperbaric Awareness movement

CutisCare officially announced Hyperbaric Aware Tuesday, May 4. Its aim: To promote a greater understanding of hyperbaric medicine.

Hyperbaric Awareness USA and the Hyperbaric Aware campaign aim to spread national, statewide and local awareness to benefit the people suffering from radiation injury, chronic wounds like diabetic foot ulcers, arterial insufficiencies and more. The Hyperbaric Aware website, in collaboration with the Undersea and Hyperbaric Medical Society (UHMS) and physician leaders, will share articles, latest research, and expert insight for physicians, patients, and the general public.

Join us as we raise awareness for hyperbaric oxygen therapy. There is an opportunity for you to donate to support Hyperbaric Research as well as a T-shirt fundraiser with proceeds to support UHMS research.

For more information see the press release at:

            http://www.prnewswire.com/news-releases/ctiscare-launches-hyperbaric-aware-website-and-national-campaign-to-celebrate-and-elevate-awareness-of-hyperbaric-oxygen-therapy-301283693.html?tc=eml_cleartime

See the website at:

https://hyperbaricaware.com

FDA recommends UHMS-accredited hyperbaric facilities for treatment of specific illnesses

In a July 26 release entitled “Hyperbaric Oxygen Therapy: Get the Facts” the U.S. Food and Drug Administration (FDA) has cleared the use of hyperbaric oxygen therapy (HBOT/HBO2) for the treatment of several conditions. The release further states: “If your health care provider recommends HBOT, the FDA advises you get the treatment at a hospital or facility that has been inspected and is accredited by the Undersea and Hyperbaric Medical Society.”

            The agency advises that individuals seeking hyperbaric oxygen therapy check with their health care provider to make sure they are pursuing the most appropriate care, noting that some facilities operate outside recognized FDA guidelines. “The FDA is aware there are some hyperbaric oxygen treatment centers promoting hyperbaric oxygen chambers for uses that have not been cleared or approved by the FDA, such as treatment of cancer, Lyme disease, autism, or Alzheimer’s disease.” 

FDA-cleared conditions to be treated with hyperbaric oxygen 

The FDA has cleared hyperbaric oxygen therapy for treatment in these disorders:
• air and gas bubbles in blood vessels

• anemia (severe anemia when blood transfusions cannot be used)

• burns (severe and large burns treated at a specialized burn center)

• carbon monoxide poisoning

• crush injury

• decompression sickness (diving risk)

• gas gangrene

• hearing loss (complete hearing loss that occurs suddenly and without any known cause)

• infection of the skin and bone (severe)

• radiation injury

• skin graft flap at risk of tissue death

• vision loss (when sudden and painless in one eye due to blockage of blood flow)

• wounds (non-healing, diabetic foot ulcers)

HBO2 treatment is being studied for other conditions, including COVID-19, but has not cleared or authorized the use of any hyperbaric device to treat COVID-19 or any conditions beyond those listed above. The websites clinicaltrials.gov and the UHMS home pages at https://www.uhms.org/images/Position-Statements/HBO2_and_COVID_8-10-2020_clinicaltrials_8-12-2020.pdf have more information on hyperbaric clinical trials for COVID-19 and other conditions.

~ Taken from MedWatch – The FDA Safety Information and Adverse Event Reporting Program

Get more information on hyperbaric oxygen treatment

• https://www.fda.gov/consumers/consumer-updates/hyperbaric-oxygen-therapy-get-facts?utm_medium=email&utm_source=govdelivery

• https://www.uhms.org/resources/hbo-indications.html

About the UHMS 

Formed in 1967 the UHMS is an important source of scientific and medical information pertaining to undersea and hyperbaric medicine through its bimonthly, peer-reviewed journal, Undersea and Hyperbaric Medicine, symposia, courses, certifications, workshops and publications.

UHMS organizes an annual scientific meeting at different U.S. and international locations to permit review of the latest in research and treatment and to promote the highest standards of practice.

For more information on the UHMS see www.uhms.org

UHMS PROPOSES AN INITIATIVE FOR UHM RESEARCH

From the new branch committee chair for multicenter clinical trials in undersea & hyperbaric medicine

The Undersea and Hyperbaric Medical Society will pursue a proposal that falls directly in line with its mission: To investigate post-acute sequelae of SARS-CoV-2 infection – PASC, aka long-haulers syndrome.

   To accomplish this the UHMS will launch a multi-institutional cooperative research group patterned after oncology cooperative groups sponsored by the National Cancer Institute (NCI). Since 1955 the NCI has supported cooperative research groups with multi-institutional membership. The initial efforts were focused on childhood cancer research but quickly expanded to include study of adult malignancies. By the end of the 1990s there were four groups focusing on pediatric oncology and 11 groups focusing on adult malignancies. In an effort to re-energize the groups and introduce some needed efficiencies into the system, these existing groups were consolidated into the NCI National Clinical Trials Network (NCTN). This action was taken based on a report in 2010 by the National Academies of Science Institute of Medicine entitled “A National Cancer Clinical Trials System for the 21st Century: Reinvigorating the NCI Cooperative Group Program.” The 15 existing groups were combined into six focusing on adult malignancies and two that focus on pediatric tumors. 

We can learn from the NIH experience.

A lesson for our own embryonic efforts to establish a multi-institutional research cooperative is here: From time to time, goals, availability of resources and administrative procedures will need to be reviewed and revised. Nonetheless, the NCI-sponsored groups continue to enroll about 17,000 patients per year into trials and have been responsible for studies leading to an overall cure rate of about 90% in childhood acute lymphoblastic leukemias, a disease that was previously 100% fatal, and overall, about 80% in pediatric tumors. 

   Many landmark trials in adults notably include studies such as NSABP-06, which demonstrated that modified radical mastectomy is not superior to lumpectomy and breast radiation for most women with early breast cancer.

   The effort to establish this research group is not meant to replace or conflict with the efforts of either the Multicenter Registry for Hyperbaric Oxygen Therapy (MCRFHO) or the US Wound Registry. These Registries are both open to our members who desire to participate in clinical research by utilizing the Registry approach. Drs. Jay Buckey and Caroline Fife head up the Registries named above. Dr. Buckey is also one of the co-chairs of the UHMS Research Committee. His experience in establishing the MCRFHO will be invaluable in providing guidance for the administrative structural components required to successfully initiate and operate our new group. 

The aims and vision for this group.

In my vision for this new group, it will complement and be complemented by all of the available hyperbaric registries. Joint membership by individual institutions in both efforts seems desirable. The prior efforts of the Baromedical Research Foundation in enlisting several institutions to conduct hyperbaric research should also be noted. This group is responsible for the HORTIS (Hyperbaric Oxygen for Radiation Tissue Injuries) Trial that gave us a randomized controlled trial demonstrating that hyperbaric oxygen is effective in the treatment of radiation-induced proctitis. 

   We should also recognize the efforts and success of Dr. Lindell Weaver and his colleagues in conducting Department of Defense-sponsored studies investigating a potential role for hyperbaric treatment of traumatic brain injury in service members injured in the line of duty.

   There is no question that the effort to establish a multi-institutional cooperative research group will be a daunting challenge. Our plans will need to address the following issues and many more:

 • Unlike the NCI groups we have no initial federal funding, although an ambitious long-term goal will be to seek NIH funding. Start-up funds will be needed. The UHMS does not have deep pockets, and we will need individual and industry members to contribute to this cause. 

 • The administrative structure for the group will have to be established. We will need enlist an oversight committee to see that administrative issues are properly scrutinized. 

 • Qualifications for membership by applying institutions will have to be established. I believe that we should not restrict membership to academic institutions only. Many of our leaders in hyperbaric medicine come from community practitioners. 

 • I do not believe that we should restrict our membership to U.S. institutions. By using the aegis of the UHMS and its status as a 501(c)(3) organization we should qualify for many government-sponsored grant opportunities. 

 • Quality performance reviews will have to be conducted for member institutions to ensure compliance to the specific requirements of protocols for which they recruit and conduct participation. 

 • It will be essential that the group be able to secure adequate statistical support. Efforts to assist member institutions in data acquisition and entry will be vitally important. 

 • Procedures to acquire IRB (Institutional Review Board) approval will have to be addressed and simplified when and where possible. 

   Other committees will need to be created to review and prioritize protocols as they are submitted. I anticipate and welcome investigator-initiated trials, especially when they coincide with opportunities to compete for a grant from NIH or other funding agencies.

   Some in our group will criticize these efforts as nothing more than a pipe dream. They will sit back and discuss the impossibilities of this proposal. To them I say: Recall the less than elegant statement, the origin of which is uncertain, that poses “no guts, no glory.” 

   We can never know whether success is possible until we try. I believe that almost all of you would agree that in hyperbaric oxygen we have a modality which is not a panacea, but which offers the potential for management of many uninvestigated disorders. The physiology of hyperbaric oxygen is unique, and our understanding of its effect on the human organism and the disorders, especially infectious and inflammatory that affect it, are understood only to a very primitive and incomplete extent. 

   I appeal for your help and your participation in this effort. I know this group. It is made up of many dedicated members who advocate for the best patient care possible. We can deliver this optimal care only when our referring colleagues can be persuaded that our efforts are based on sound and proven scientific principles. For those who struggle to be properly reimbursed for their clinical efforts, I ask: “How would you like to have at your fingertips well-conducted recent studies indicating sound supporting information and a cost advantage for hyperbaric oxygen?” 

   Our discipline, our specialty, has been in need of strong evidence to justify many of its applications since the inception of clinical hyperbaric medicine. This evidence can only come from us. To generate it, we must have a mechanism. I believe the establishment of this cooperative multi-institutional clinical trial group provides that mechanism.

   I hope you agree.

JOHN FELDMEIER, DO, FACRO, FUHM    E: jfeldmeier@aol.com  

A longtime UHMS member and supporter, Dr. Feldmeier has served in multiple capacities in the UHMS, including as Past President of the non-profit organization.

From UHMS’ open-access Pressure, available at: https://www.uhms.org/publications/pressure/viewdocument/4816/first-quarter-pressure-2021.html

UHMS’ Pressure is posted: 2021 First Quarter

OPEN-ACCESS PRESSURE IS AVAILABLE AT: https://www.uhms.org/publications/pressure/viewdocument/4816/first-quarter-pressure-2021.html

COLUMNS & FEATURES . . .                                                                                                                                 

 PRESIDENT Dr. Marc Robins

      Revisits a busy 2020 despite its challenges and looks ahead to this year

EXECUTIVE Director John Peters

      From COVID to courses, accreditations & costs, UHMS has remained on steady

SPECIAL REPORT 

      The UHMS proposes a new research initiative to study COVID long-haulers syndrome

POLICIES, PROCEDURES & ADVOCACY

      The AWCS recounts some major victories in an otherwise inglorious year

 SPECIAL REPORT 

      The Jenkins Foundation helps hospitals provide CO alarms to patients after CO poisoning 

UHMS accreditation: How it works

HFA Director Derall Garrett 

      Points out that UHMS hyperbaric accreditation can put your facility a step ahead 

HFA Coordinator Beth Hands

      Posts newly accredited and reaccredited facilities & offers HFA info 

BNA: Kevin Kraft

      Encourages us to join in on National Baromedical Nurses Association Day 10 April

ASSOCIATE Technologist Representative-Elect Matthew Brauninger

      Discusses intrathecal pain pumps and the hyperbaric environment

SAFETY: Greg Raleigh

      Outlines the need for respiratory and eye protection for chamber operators  

MEDFAQs: Q&A  

      Our experts answer: Are divers still fit to dive after COVID-19? Is it possible to check in patients 

      electronically before they undergo HBO2 therapy?  

SPECIAL APPEAL

      Help develop an online counting app for decompression-induced venous gas emboli

MEMBER NEWS & COURSES . . .

      ASM 2021: call for posters and oral presentations & award nominations

      UHMS business: elections, FUHMs, new Associates award & a farewell to Armand Zigahn

      CHAPTER & AFFILIATE news 

      UHM Journal info: First quarter 2021 edition (48-1) online now

      THANK YOU to RestorixHealth

      OCEP courses 

      Joint, Introductory & Directly Provided courses 

      Corporate partners

      WELCOME to these members

ADS

UHMS WHO’S WHO / WHOYOUGONNACALL

PRESSURE CONTACTS

UHM Journal is posted: First quarter 2021

CLINICAL RESEARCH 

Physiologic and biochemical rationale for treating COVID-19 patients with hyperbaric oxygen

     John J. Feldmeier, John P. Kirby, Jay C. Buckey, et al.  

Advances in the treatment of neuropathic pain with hyperbaric oxygen

     Yan-Yan Zhou, Rong-Rong Ren, Yi Cen, et al.

The effect of the perfluorocarbon emulsion OxycyteTM  in an ovine model of severe decompression illness

     William A. Cronin, Kiel Khan, Aaron A. Hall, et al

Non-invasive monitoring of carboxyhemoglobin during hyperbaric oxygen therapy 

Daniel Bidstrup, Frederikke Ravn, Isabel Guida Smidt-Nielsen, et al.

Seizure during hyperbaric oxygen therapy: experience at a single academic hospital in Korea

     Chan Hee Lee, Jin Geul Choi , Je Seop Lee, et al. 

Hyperbaric oxygen therapy for hypoxic-ischemic encephalopathy in non-fatal drowning

     Andreia Fiúza Ribeiro, Joana Gomes Vieira, Marta Moniz, et al.

DIVE RESEARCH 

Ultrasound in decompression research: fundamentals, considerations, and future technologies

     David Q. Le, Paul A. Dayton, Frauke Tillmans, et al.  

A fully automated method for late ventricular diastole frame selection in post-dive echocardiography 

without ECG gating

     Eric Markley, David Q. Le, Peter Germonpré, et al. 

Breathing through a diving snorkel; theory and experiment of air flow resistance and cost of breathing

     N.A.M. Schellart

Preventing carbon monoxide poisoning in the Hudson River Tunnel in 1921: recounting history

     Neil B. Hampson

INDICATIONS: (from Hyperbaric Oxygen Therapy Indications, 14th edition)

Hyperbaric oxygen for intracranial abscess

     Edward O. Tomoye, Richard E. Moon

LETTERS 

HBO2 combined with steroid therapy for sudden sensorineural hearing loss within two weeks

     Hui-jun Hu, Wei Zhang, Dan-feng Fan 

MISSION SUPPORTERS

UHMS-accredited facilities

UHMS Corporate Partners

UHMS supporters, partners and house ads

Members, log in at:

https://www.uhms.org/uhm-search/uhm-journal-volume-48-2021.html

New CMS code for Undersea and Hyperbaric Medicine in 2019: D4

Undersea and Hyperbaric Medicine practitioners, you have a new CMS code next year: D4.

Through the joint efforts of several individuals in the Undersea and Hyperbaric Medical Society and the American College of Hyperbaric Medicine, physicians who specialize in Undersea and Hyperbaric Medicine have been assigned a unique specialty code by the Centers for Medicare and Medicaid Services. That specialty code is D4. The code goes into effect on January 1, 2019.

Current CMS regulations state that if a patient has been seen by another provider in the same specialty within the past 36 months, you may NOT bill an E/M for a new patient evaluation, but, must use a follow-up evaluation and management CPT code (e.g., if you are a surgeon practicing hyperbaric oxygen therapy, and another surgeon refers a patient with necrotizing fasciitis to you, you cannot bill for a new patient evaluation if that surgeon has seen the patient in the past 36 months. This rule prevents you from obtaining reimbursement for a lengthy new patient evaluation. Similarly, if you are an emergency physician and are referred a diver or CO poisoning patient from the ER, you cannot bill for a new patient evaluation.)

The new code will eliminate that restriction.

This may also affect physicians under the Merit-Based Incentive Payment System. Since cost will be factored into the MIPS score from now on, calculations that reflect cost attribution may be linked to specialty codes. For example, Family Practice physicians who designate as FP will be compared to other FPs. If those same physicians practice hyperbaric medicine and wound care and designate themselves D4, they should be compared to other D4s regardless of primary specialty. Since so many of the products and services provided by hyperbaric and wound care physicians are costly, comparison to non-HBO2/WC physicians would be unfair. Hopefully, this new specialty code will allow a more equitable comparison of cost as we move away from a fee-for-service model.

Those who would most benefit from this change are physicians who solely practice UHM. If you are a physician who practices part-time, you may or may not want to change your specialty code. Since Medicare specialty codes are self-designated, this will have no effect on Medicare fee schedules, only on the ability to bill for a new patient exam as described above.

Existing enrolled providers who want to update their specialty to reflect the new specialty code must submit a change of information application to their Medicare Administrative Contractor (MAC). Providers may submit within 60 days of the implementation of the new specialty code, which goes into effect on January 1, 2019. Physicians who are newly enrolling should submit a Medicare enrollment application (CMS-8551 or CMS-8550) form.

HFA Application/Presurvey Questionnaire launches on August 1, 2018

The UHMS Hyperbaric Facility Accreditation Program (HFA) announces the launch of the new secure online platform for electronic submission of all facility accreditation survey documentation. It will be located on the HFA page on the UHMS website along with the instructions.

We will be launching HFA Application/Presurvey Questionnaire (HFA SA/PQ) on August 1, 2018.

You will now be able to submit the application, presurvey questionnaire, and additional required documents in one place.We will receive them once the “submit” button is clicked.

You will no longer have to submit multiple files via email! After August 1, 2018, we will no longer accept submission via email. If you have already provided your documentation for surveys scheduled after August 1, 2018, you will nothave to resubmit.

For further information, please contact:

Derall Garrett, HFA Director, (210) 404-1553, 877-533-8467 x106: derall@uhms.org

Beth Hands, HFA Coordinator, (210) 404-1553, 877-533-8467 x105: beth@uhms.org

 

 

CUHMA Announces 2018 Annual Scientific Meeting

The Canadian Undersea and Hyperbaric Medical Association (CUHMA) has announced its annual meeting for 2-4 November in beautiful Quebec City.

We have an interesting scientific program and will be offering a Hyperbaric Emergency Training Simulation course at our hyperbaric facility in Lévis as a pre-conference workshop.

For more info, see:  https://cuhma.ca/events/annual-scientific-meeting

 

 

TBI PROGRESS REPORT: A new paper on hyperbaric oxygen therapy for traumatic brain injury has been published

The Department of Defense-sponsored clinical trial on hyperbaric oxygen for mild traumatic brain injury has yielded promising findings for future research.

The Emmes Corporation of Rockville, Maryland, recently announced that scientists and health professionals from Emmes; LDS Hospital in Salt Lake City, Utah; Lovelace Biomedical Environmental Research Institute in Albuquerque, New Mexico; and the U.S. Army Medical and Materiel Development Activity at Fort Detrick, Maryland, have completed a multiyear clinical trial testing hyperbaric oxygen as an intervention for U.S. military service members who have suffered mild traumatic brain injuries with persistent symptoms.

Eleven researchers, as well as members of the study team, collaborated to write a paper that summarized these most recent comprehensive findings in the series of studies. ‘Hyperbaric oxygen for post-concussive symptoms in United States military service members: a randomized clinical trial’ was published in March-April 2018 issue of Undersea and Hyperbaric Medicine, the bimonthly member publication of the Undersea and Hyperbaric Medical Society

The Department of Defense-sponsored study included both active-duty soldiers and veterans in the military who suffered from mild traumatic brain injuries.

Millions of people in the United States deal with traumatic brain injuries, and combat military personnel have increased risk for persistent post-concussive symptoms. This clinical research studied military personnel with post-concussive symptoms occurring three months to five years after mild traumatic brain injury. The randomized clinical trial evaluated participants’ specific symptoms, as well as a range of other assessments such as quality of life, sleep, cognitive processing, as well as auditory, visual and neuroimaging traits.

Hyperbaric oxygen produced short-term improvement in self-reported post-concussive and post-traumatic stress disorder (PTSD) symptoms, as well as some cognitive processing speed and sleep measures, in comparison to a control group. These improvements regressed after six months, however. One notable finding was that improvements were most significant in trial participants suffering from both traumatic brain injury and PTSD.

“Results suggest that hyperbaric oxygen may have a favorable effect that merits further study in service members, especially in those with PTSD,” said Dr. Lindell Weaver, principal investigator and a member of the Hyperbaric Medicine Department of LDS Hospital. “This could be a promising avenue for further research.”

“We are planning to produce more in-depth papers on the findings of this study,” noted Dr. Steffanie Wilson, Emmes biostatistician and principal investigator of Emmes’ data analysis and management center for the research team. Wilson added that additional research could address such issues as dosing, length of treatment and patient selection.

According to Dr. Anne Lindblad, president and chief executive officer of Emmes: “We learned a great deal from this research, from design to outcomes to logistics. This will be extremely helpful in developing more efficient clinical trials in the future and ultimately more effective ways to treat brain injuries and PTSD.”

About the paper

The paper was published in the March/April 2018 issue of the Undersea and Hyperbaric MedicineJournal. Members can access the paper by logging into the website at https://www.uhms.org/publications/uhm-journal/download-uhm-journal-pdfs/hyperbaric-oxygen-for-post-concussive-symptoms-in-united-states-military-service-members-a-randomized-clinical-trial/viewdocument.html

Non-subscribers can access the paper fora nominal fee at https://www.uhms.org/publications/research-article-hyperbaric-oxygen-for-post-concussive-symptoms-in-united-states-military-service-members-a-randomized-clinical-trial.html

About the Contract

This material is based upon work supported by the Department of Defense under Contract No. W81XWH-15-D-0039-0003. The views, opinions and/or findings contained in this report are those of the author(s) and should not be construed as an official Department of the Army position, policy or decision unless so designated by other documentation. In the conduct of the protection of human subjects as prescribed by Code of Federal Regulations (CFR) Title 45, Volume 1, Part 46; Title 32, Chapter 1, Part 219; and Title 21, Chapter 1, Part 50 (Protection of Human Subjects).