SCHEDULE INFORMATION

PRINTABLE SCHEDULE 

  • SCHEDULES

    • SCHEDULE OVERVIEW

      Subject to Change
      Posted 

      START TIME

      END TIME

      EVENT

      LOCATION

      TUESDAY, June 25

      4:00 PM

      11:00 PM

      UHMS Board of Directors Meeting (Private Meeting)

       

      WEDNESDAY, June 26

      8:00 AM

      5:00 PM

      Pre-Course: How to Prepare for Accreditation 

       

      8:00 AM

      5:30 PM

      Pre-Course: Hyperbaric Oxygen Safety: Clinical and Technical Issues

       

      8:00 AM

      5:00 PM

      Pre-Course 2: Diving



      8:00 AM


      5:00 PM


      Surveyor Training: contact Derall or Beth at 919-490-5140 x105 to sign up




      1:00 PM

      4:00 PM

      ABPM Exam

       

      3:00 PM

      5:00 PM

      Editorial Board Meeting

       

      4:45 PM

      7:45 PM

      HBO Therapy Committee Meeting

       

      5:30 PM

      7:30 PM

      Associate's Council Meeting

       

      7:00 PM

      9:00 PM

      WELCOME RECEPTION

       

      THURSDAY, June 27

      7:00 AM

      8:00 AM

      CONTINENTAL BREAKFAST / EXHIBITS

       

      7:00 AM

      8:00 AM

      Safety Committee Meeting

       

      8:00 AM

      8:30 AM

      President's Address: Nick Bird, MD

       

      8:30 AM

      12:00 PM

      Non-Physician Breakout
      (not approved for physician CME credits)

       

      8:30 AM

      10:00 AM

      Plenary Session: Hyperbaric Medicine and Cancer

       

      10:00 AM

      10:30 AM

      BREAK / EXHIBITS

       

      10:00 AM

      12:00 AM

      Specialty ED & QUARC Team Meeting (Marc Robins)

       

      10:00 AM

      12:00 PM

      Accreditation Council Meeting

       

      10:00 AM

      11:00 AM

      ACEP UHM Section Meeting

       

      10:30 AM

      11:30 AM

      Session A: Diving / Decompression Illness: Theory & Mechanisms



      11:00 AM

      12:00 PM

      GME Committee Meeting

       

      11:30 AM

      12:00 PM

      Poster Session A

       

      12:00 PM

      1:00 PM

      LUNCH

      ON OWN 

      12:00 PM

      1:00 PM

      Associate's Luncheon (sign up required - limited to 50)

       

      1:00 PM

      2:00 PM

      Lambertsen Keynote: 

       

      2:00 PM

      5:00 PM

      Non-Physician Breakout

       

      2:00 PM

      3:00 PM

      Session B: HBO2 Therapy Mechanisms

       

      2:00 PM

      3:30 PM

      Material Testing Advisory (AD HOC) Committee

       

      3:00 PM

      3:30 PM

      BREAK / EXHIBITS

       

      3:30 PM

      4:00 PM

      Poster Session B

       

      4:00 PM

      5:00 PM

      Plenary Session:  Mechanisms of HBO

       

      5:00 PM

      6:00 PM

      Education Committee Meeting

       

      5:00 PM

      6:00 PM

      BNA Board Meeting

       

      6:00 PM

      7:00 PM

      Exhibitor Wine & Cheese Reception

       

      FRIDAY, June 28

      7:00 AM

      8:00 AM

      CONTINENTAL BREAKFAST / EXHIBITS

       

      7:00 AM

      8:00 AM

      Past President’s Breakfast

       

      7:00 AM

      8:00 AM

      NBDHMT Breakfast

       

      8:00 AM

      12:00 PM

      NBDHMT Board Meeting

       

      8:00 AM

      10:00 AM

      Plenary Session: Research and Registries for Hyperbaric Oxygen Therapy



      10:00 AM

      10:30 AM

      BREAK / EXHIBITS

       

      10:30 AM

      11:30 AM

      Session C: Diving and Decompression Illness

       

      10:00 AM

      11:00 AM

      ECCHO Working Group Meeting

       

      10:00 AM

      11:00 AM

      Publication Committee Meeting

       

      11:00 AM

      1:00 PM

      ACHM-UHMS Meeting

       

      11:30 AM

      12:30 PM

      Poster Session C

       

      11:30 AM

      12:30 AM

      Registry Meeting (Buckey)

       

      12:00 PM

      1:00 PM

      LUNCH

      ON OWN 

      1:00 PM

      2:00 PM

      Kindwall Keynote: 

       

      2:00 PM

      3:00 PM

      QUARC Committee Meeting

       

      2:00 PM

      3:00 PM

      Session D: Clinical HBO2 Therapy

       

      3:00 PM

      3:30 PM

      BREAK / EXHIBITS

       

      3:00 PM

      4:00 PM

      BNA General Meeting

       

      3:00 PM

      4:00 PM

      Research Committee Meeting

       

      3:30 PM

      4:30 PM

      Poster Session D

       

      4:30 PM

      5:30 PM

      Plenary Session: HBO and DFU

       

      5:30 PM

      6:30 PM

      UHMS Business Meeting - Open meeting

       

      5:30 PM

      7:30 PM

      Specialty Council Meeting (Toups) PRIVATE Meeting

       

      SATURDAY, June 29

      7:00 AM

      8:00 AM

      CONTINENTAL BREAKFAST / EXHIBITS

       

      8:00 AM

      10:00 AM

      Plenary Session: Emerging Indications for Hyperbaric Oxygen Therapy



      10:00 AM

      10:30 AM

      BREAK / EXHIBITS

       

      10:30 AM

      11:30 AM

      Session E: HBO2 Operations, Chambers, and Equipment

       

      11:30 AM

      12:00 PM

      Poster Session E

       

      10:00 AM

      11:00 PM

      Chapter President's Committee Meeting

       

      10:00 AM

      12:00 PM

      Diving Committee Meeting

       

      11:00 AM

      12:00 PM

      Membership Committee Meeting

       

      12:00 PM

      1:00 PM

      LUNCH

       

      1:00 PM

      2:00 PM

      Plenary Session: New Pearls of Wisdom in the Diving and Hyperbaric Medicine Literature



      2:00 PM

      3:00 PM

      Session F: Top Case Reports

       

      3:00 PM

      3:30 PM

      BREAK / EXHIBITS

       

      3:30 PM

      4:00 PM

      Poster Session F

       

      4:00 PM

      5:00 PM

      Plenary Session: Clinical and Metabolic Aspects in Breath-hold Diving



      7:00 PM

      10:00 PM

      Awards Banquet (separate fee)

       

      10:00 PM

      12:00 AM

      After Party (separate fee)

       

       

       

       

       

       

       

      Read more

    • GENERAL SESSION SCHEDULE

      THURSDAY, JUNE 27 - SATURDAY, JUNE 29
      PDF copy
      Subject to change
      Posted 5/21/18


       

       

       

      Read more

    • PRE-COURSE SCHEDULES

      PRE-COURSES: WEDNESDAY, JUNE 26
      Coming soon

      Read more

    • NON-PHYSICIAN TRACK SCHEDULE

      THURSDAY, JUNE 27
       (subject to change)
      (not approved for physician CME credits)

      8:00-8:30

      President's Address

      Nick Bird, MD i

      8:30-5:00

      NON-Physician Track Kick Off

      8:30-8:40 

      Welcome & Introductions

      Kay Moseley, RRT

      8:40-8:50 

      UHMS Associates Update

      Bradley Walker, RN

      8:50-9:00

      BNA Update

      Annette Gwilliam, ACHRN

      9:00-9:30

      9:30-9:45

      9:45-10:00

      10:00-10:30

      Break/Exhibits

      Break/Exhibits

      10:30-10:45 

      10:45-11:00 

       

      11:00-11:15

       

       

      11:15-1130 

       
      11:30-11:45  

      11:45-12:00 

      Responding to an active shooter – Learning from one facility’s experience

      Judy Ptak 

      12:00-1:00

      Associates Luncheon (registration sign-up required - limited to 50)

       

      1:00-2:00

      Lambertsen Memorial Keynote:

       

      2:00-2:45

       

      2:45-3:00

       

      3:00-3:30

      Break

      Break

      3:30-3:45

       

      3:45-4:00

       

      4:00-4:20

       

      4:20-5:00

       

       

       

       

      Read more

    • ABSTRACT SCHEDULE


       


       

       

      Read more

    Read more

  • Keynote Lectures

    • ::cck::104::/cck::
      ::introtext::

      CHRISTIAN J. LAMBERTSEN MEMORIAL LECTURE
      THURSDAY, JUNE 27: 1:00 pm - 2:00 pm

      GUEST SPEAKER: 
      LECTURE TITLE:


      ABOUT THE LECTURE:

      ABOUT  DR. : 


      CHRISTIAN J. LAMBERTSEN, MD, DSc (Hon) MEMORIAL LECTURE
      About Dr. Lambertsen:

      LAMBERTSEN PIC

      Dr. Christian J. Lambertsen received a B.S. Degree from Rutgers University in 1938 and a M.D. Degree from the University of Pennsylvania in 1943. During his medical school period, he invented and first used forms of the initial U.S. self-contained closed-circuit oxygen rebreathing apparatus, for neutral buoyancy underwater swimming and diving. As a student, he aided the early Office of Strategic Services (O.S.S.) in establishing the first cadres of U.S. military operational combat swimmers. Dr. Lambertsen became a U.S. Army medical officer on graduation from medical school in early 1943, and immediately joined the O.S.S. Maritime Unit on active duty through its period of function in World War II. He joined the University of Pennsylvania Medical Faculty in 1946, and became Professor of Pharmacology in 1952. While a faculty member he combined diving research and further underwater rebreathing equipment developments for the Army and Navy. In 1967 he served as Founding President of the Undersea Medical Society (now Undersea and Hyperbaric Medical Society.) Dr. Lambertsen is recognized by the Naval Special Warfare community as "The Father of U.S. Combat Swimming.” His hand has touched every aspect of military and commercial diving. Dr. Lambertsen’s active contributions to diving began during WWII and became even more progressive in the post-war period through the evolutions of the U.S. Navy Deep Submergence and Naval Special Warfare developmental programs. 

      ::/introtext::
      ::fulltext::::/fulltext::
    • ::cck::105::/cck::
      ::introtext::

      ERIC P. KINDWALL, MD MEMORIAL LECTURE
      FRIDAY, JUNE 28: 1:00 pm - 2:00 pm

      GUEST SPEAKER: 
      LECTURE TITLE:

      ABOUT THE LECTURE: 

      ABOUT DR.: 


      ERIC P. KINDWALL, MD MEMORIAL LECTURE
      About Dr. Kindwall:

      KINDWALL PICDr. Kindwall is known by so many as the "Father of Hyperbaric Medicine.” Whether you knew him personally or simply by reputation, we have all benefited from his efforts, passion, wisdom, knowledge, energy and vision. Dr. Kindwall has played a great role in growing and shaping the specialty of Undersea and Hyperbaric Medicine. He was likewise instrumental in molding the UHMS into what it is today.  Dr. Kindwall began diving in 1950. He cultivated his interest in the field and during the Vietnam War served as the Assistant Director of the U.S. Navy School of Submarine Medicine. He also was the Senior Officer responsible for the Diving Medicine Program. In 1969, after leaving the Navy, Dr. Kindwall became Chief of the Department of Hyperbaric Medicine at St. Luke’s Medical Center, Milwaukee, Wis.  Shortly after the Undersea Medical Society was created in the mid-1960s, Dr. Kindwall identified the need for standardized education in the field. He created the UMS Education and Standards Committee to help elevate course content and ensure instructor competence. This committee later became our Education Committee. When the AMA initiated its Continuing Medical Education program, Dr. Kindwall persuaded the organization to recognize the UMS as a grantor of CME credits.  In 1972, Dr. Kindwall felt that the Society’s members would benefit from improved communication. He created our first newsletter and was named editor. Dr. Kindwall chose the name Pressure because clinical hyperbaric medicine was rapidly developing. Even though the UHMS had not yet incorporated "Hyperbaric” into the Society’s name, he wanted a title for the newsletter that would encompass all who worked with increased atmospheric pressure. He stated: "The Society’s goal then, as it is now, is to serve all who deal with the effects of increased barometric pressure.”  That same year, Dr. Kindwall recognized the need to have a relationship with Medicare to help provide insight on reputable clinical management. The UMS followed this lead, and a Medicare Panel was created. The recommendations were presented to the U.S. Public Health Service. The challenge was that no reliable hyperbaric medicine clinical guidelines were available that addressed appropriate applications of Hyperbaric Medicine. To remedy this deficit, the UMS Executive Committee created an Ad Hoc Committee on hyperbaric oxygen therapy. Dr. Kindwall was named Chair. The committee created the first Hyperbaric Oxygen Therapy Committee Report. Again, this text was published 10 years before the UHMS incorporated "Hyperbaric” into its name. The report was sent to HCFA and the Blues and became their source document for reimbursement. Dr. Kindwall updated the text two more times and thus was the Editor and Chair of the Committee and text for three of its 12 editions.  Dr. Kindwall later worked to expand the available information on the specialty by creating one of the first complete texts on the field. He created Hyperbaric Medicine Practice in 1994 and later updated and revised his text two more times.  The Society’s first journal, Hyperbaric Oxygen Review, has also has been influenced by Dr. Kindwall. His love for research and education was clear: He became the initial editor, creating a journal that at first consisted of review articles and one original contribution. Over the years,it has grown to one full of original research.  Dr. Kindwall’s presence is felt in so many of the UHMS’ activities and initiatives. Much of what we all take for granted – what is just "there” and "available” – has his touch and influence. Some of us have been blessed to have had a closer impact by Dr. Kindwall’s life, but I think that I can easily say that each of us has been influenced in some way.

       



      ::/introtext::
      ::fulltext::::/fulltext::

    Read more

  • Plenary Sessions

    • Thursday, June 28

      ::cck::620::/cck::
      ::introtext::

      HYPERBARIC MEDICINE AND CANCER PLENARY             MECHANISMS OF HBO PLENARY



      HYPERBARIC MEDICINE AND CANCER PLENARY
      8:30 AM - 10:00 AM

      0830-0915
      John Feldmeier, DO
      "Hyperbaric oxygen and cancer treatment with emphasis on its potential role combined with ketogenic diet and chemotherapy.

      Feldmeier Pic OfficialAt the same time, other researchers have advocated hyperbaric oxygen as a primary treatment for malignant conditions, though the support is limited here. A number of studies done in the late 1950s through the 1970s even on review many years later firmly establish simultaneous hyperbaric oxygen as a radiosensitizer. There are reasons to believe that sequential hyperbaric oxygen followed immediately by can enhance cancer cell kill. The pioneering work by several Japanese authors have reported encouraging results in applying this combined treatment in high-grade brain tumors. More recently, a similar study supported in part by the Baromedical Research Foundation has shown the feasibility of applying these principles to head and neck cancers receiving both chemotherapy and radiation therapy with impressive results and no unexpected toxicities.
           There is a strong rationale and a bit of research that also suggest that chemotherapy’s antitumor effects can be enhanced by hyperbaric oxygen as well. Certainly, the logistics of delivering chemotherapy in the hyperbaric chamber are much easier than delivering radiation with HBO2.

           In this session, Dr. John Feldmeier will introduce an overview of the above issues. These will include a discussion of the Warburg effect and its implications for combined HBO2 and chemotherapy and HBO2 combined with the ketogenic diet.  A brief update will be presented on the status of HBO2 alone and how it effects malignant growth. Other mechanisms by which chemotherapy delivery and tumoricidal effects can likely be enhanced will be considered. 
           Mr. Richard Clarke will follow with a lecture updating the experience in a multi-center trial using sequential HBO2 and radiation with chemotherapy in advanced head and neck cancer patients.

      0915-1000
      Dick Clarke, CHT
      "Hyperbaric Oxygen Radiation Sensitization of Squamous Cell Carcinomas of the Oropharynx"

      Clarke IMG 1761 2This presentation summarizes the first study of hyperbaric oxygen chemo-radiation sensitization for locally advanced squamous cell carcinomas of the oropharynx. It took the form of a Stage I dose escalation trial, designed to determine safety, feasibility and tolerability when hyperbaric oxygen was added to standard care: namely intensity modulated radiation therapy and cisplatinum chemotherapy. The presentation will describe the biological plausibility and physiologic basis for pre-radiation hyperbaric hyperoxia, and the rationale for selection of this tumor type and tumor grade. The hyperbaric dosing regimen, one based upon previous human tumor oxygen response curves, is discussed, and the critical time window for radiation therapy “beam on” from exiting the chamber discussed. Evolution from earlier sensitization studies that employed concurrent hyperbaric oxygen-radiation therapy to the modern sequential approach are described, as well as its inherent advantages. A staging protocol employed to titrate hyperbaric dose against possible acute toxicities is described. Acute toxicities and five-year follow-up results are presented, as is a Stage III study design, in the form of a randomized, sham controlled clinical double-blind trial.

       


      MECHANISMS OF HBO PLENARY
      4:00 PM - 5:00 PM
       

      1600-1700
      Stephen Thom, MD
      "Hyperbaric Oxygen Therapy Cell Signaling & Mechanisms of Action"

      thom


      This lecture will summarize current knowledge on mechanisms of action for hyperbaric oxygen (HBO2) therapy. Information will include findings from peer-reviewed publications involving both animal and human studies. It will emphasize data from human investigations, with a focus on those actions most relevant to clinical HBO2 indications.

      ::/introtext::
      ::fulltext::::/fulltext::

      Read more

    • Friday, June 29

      ::cck::619::/cck::
      ::introtext::

      RESEARCH AND REGISTRIES FOR HBOT PLENARY               HBO AND DFU PLENARY


       

      RESEARCH AND REGISTRIES FOR HYPERBARIC OXYGEN THERAPY PLENARY
      8:00 AM - 10:00 AM

      0800-0830
      Caroline Fife, MD
      "The Hyperbaric Oxygen Therapy Registry and the role of a Qualified Clinical Data Registry in protecting reimbursement"
      Caroline Fife1716
      The field of hyperbaric oxygen therapy and hyperbaric practitioners are under unprecedented scrutiny, with a resulting 50% decrease in HBO2 utilization nationally. Most practitioners are now subject to The Merit Based Incentive Payment System (MIPS), which requires the submission of quality measures. Qualified Clinical Data Registries (QCDRs) can develop specialty-specific quality measures and transmit data to CMS on behalf of clinicians, increasing the opportunity for bonus payments.
           The HBOTR, through the USWR, offers specialty registry participation as part of MIPS. Registry participation is possible via automated transmission of Continuity of Care Documents (CCDs) which can enable national benchmarking of many key parameters and can address patient selection bias for other types of registry participation by providing a “denominator” for patients/conditions treated. QCDRs manage identified data and can link to the Medicare data warehouse, facilitating HBO2 cost effectiveness research. Patient-reported questionnaires can be enshrined as quality measures, enabling practitioners to realize a small reimbursement benefit for performing them. Provider scores on specialty-specific quality measures are publicly available via the USWR website linked to “Physician Compare,” a welcome alternative to star ratings derived only from standard (and irrelevant) MIPS measures. Hyperbaric Centers may also benefit from quality measure reporting. The HBOTR leverages current mandatory reporting quality requirements and available electronic health record technology to automate registry participation, an important consideration given the lack of funding for HBO2 research.
           The HBOTR has already saved physician payment from a substantial reduction and can be harnessed for clinical research. Since January 2012, data on 27,404 patients has been captured. Among the 62,843 DFUs with data, 9,908 DFUs (15.7%) were treated with HBO2 therapy, although in 2017, the benchmark rate for HBOT was 7.3%, with an average of 28 treatments per patient. There are 2,100 providers who report data to the USWR by transmitting CCDs from their EHR and 688 who submit quality measure data, 300 (43.6%) of whom transmit HBO2 quality measure data.


      0830-0900
      Jay Buckey, MD

      "The hyperbaric medicine registry at Dartmouth"

      Buckey imageThe value of hyperbaric oxygen is being questioned even for well-established UHMS-approved indications. Although every hyperbaric center treats cases for established indications, the outcomes are not gathered together at a central site, analyzed, and published. As a result, outcome data for hyperbaric oxygen are limited and hard to find. An outcomes registry collects outcomes data from multiple sites consistently, which could allow for more powerful analyses, and more widely accessible results. This talk will describe the outcomes-focused hyperbaric registry currently in use at Dartmouth, and how it could be used to advance the field of hyperbaric medicine.



       0900-0930
      Judy Rees, MD, PhD
      "The role of registries in medicine"
      Rees imageThe goal of a disease or treatment registry is to document important data systematically from a sample of patients and use it to make inferences to a larger population. This presentation will consider how registries can be used, some of the pitfalls awaiting the unsuspecting registry researcher; and approaches that will give the best chance of success.

       

       0930-1000
      Panel Discussion


      HBO AND DFU PLENARY
      4:00 PM - 5:00 PM

      1600-1630
      Dirk Ubbink, MD
      "The effectiveness and costs of hyperbaric oxygen therapy for diabetic ischemic ulcers: results of the DAMOCLES multicenter trial
      "
      Ubbink image1
      This trial was conducted in 9 hyperbaric centers and 25 referring hospitals to find out whether additional HBOT would benefit patients with diabetes and ischemic leg ulcers. We randomized 120 diabetic patients with an ischemic wound to standard care without (SC) or with HBOT (SC+HBOT). Primary outcomes were limb salvage and wound healing, amputation-free survival (AFS), and direct and indirect medical costs.

           Limb salvage was achieved in 47 patients in the SC group vs. 53 patients in the SC+HBOT group. After 12 months, 28 index wounds were healed in the SC group vs. 30 in the SC+HBOT group. AFS was achieved in 41 patients in the SC group and 49 patients in the SC+HBOT group. In the SC+HBOT group 21 patients (35%) were unable to complete the HBOT-protocol as planned. Those who did had significantly fewer major amputations and higher AFS. Overall costs were slightly higher in the SC+HBOT-group.

      1630-1700
      Michael Strauss, MD
      "The Long Beach Wound Score as a Validated Tool for Comparative Effectiveness Research of Wounds and Objectifying the Indications for Hyperbaric Oxygen"
      Michael B. Strauss image
      The Long Beach Wound Score (LBWS) is a validated wound scoring system that is user-friendly, intuitively obvious and applicable for all wounds - not just diabetic foot ulcers.  Five assessments, each graded from 2-points (best possible) to 0-points using objective criteria to grade each, are summated to generate 0 to 10-point scores.
           The scores then quantify three wound categories; "Healthy" 7.5 to 10 points, "Problem" 3.5 to 7 points and "End-stage" 0 to 3 points.  The assessments include 1) Appearance of the wound base, 2) Size--including undermining, 3) Depth--to wound base or bottom of a tract, 4) Infection and 5) Perfusion.
           For wounds in the "Healthy" category only simple wound care and, occasionally, biologics are needed for management.  Deep infection, deformity, and/or ischemia are invariable present in the "Problem" wound  category.  These require debridements and antibiotics plus revascularization and/or hyperbaric oxygen (HBO2).  Juxta-wound transcutaneous oxygen measurements in room air and with HBO2 objectify when this modality is indicated for wound management. Wounds in the "End-stage" category require amputation or revascularization if salvage is indicated. The decision for amputation versus salvage in a "Transition" zone (LBWS in the 2.5 to 4 point range) require information about the patients' wellness and goals, both quantified by 0 to 10 scores as intuitively obvious and easy to use  as the LBWS.
           With 24 billion dollars a year being spent in the USA for management of chronic wounds, comparative effectiveness research (CER) is needed to evaluate the effectiveness, cost benefits, and convenience  of wound care. The essential consideration for CER is using a wound scoring system that objectifies the evaluation so "like can be compared with like."  The LBWS is the reliable (similar scores by two or more observers) and validated tool that meets this requirement. With the LBWS the UHMS has the potential to establish a registry, document the effectiveness of interventions and become the "go to" source for payers to justify authorizations for wound management including HBO2 treatments. 

      ::/introtext::
      ::fulltext::::/fulltext::

      Read more

    • Saturday, June 30

      ::cck::621::/cck::
      ::introtext::

      EMERGING INDICATIONS FOR HYPERBARIC OXYGEN THERAPY      
      NEW PEARLS OF WISDOM IN THE DIVING AND HYPERBARIC MEDICINE LITERATURE
      CLINICAL AND METABOLIC ASPECTS IN BREATH-HOLD DIVING



      EMERGING INDICATIONS FOR HYPERBARIC OXYGEN THERAPY PLENARY

      8:00 AM - 10:00 AM

      0800-0830
      Enrico Camporesi, MD
      "Hyperbaric Oxygen Therapy for Aseptic Necrosis of the Femoral Head andof the Femoral Condyli"

      camporesi image     Osteonecrosis of the knee (ONK) is a form of aseptic necrosis resulting from ischemia to subchondral bone tissue. Typically, common surgical treatments are invasive and palliative or time-limited. Hyperbaric oxygen (HBO2) therapy may provide a non-invasive alternative by improving oxygenation and reperfusion of ischemic areas, both for distal femoral condyli, as recently described, or for a similar malady of the femoral head, previously published.
           We recently described 37 ONK patients (29 male, 8 female; mean age ±1 SD: 54±14). 83.7% of patients presented with Aglietti stage I-II; 16.3% presented with Aglietti Stage III.  Patients were treated with HBO2 once a day, five days a week, at 2.5 ATA with 100% inspired oxygen by mask for an average of 67.9±15 sessions. Magnetic resonance imaging was performed before HBO2, within one year after completion of HBO2, and in 14 patients, 7 years after treatment. Oxford Knee Scores (OKS), an index of functionality, where 60 is normal,  were recorded before HBO2 and at the end of each HBO2 treatment cycle.
           After the 30 sessions of HBO2, 86% of patients experienced improvement in their OKS, 11% worsened, and 3% did not change. All patients improved in OKS after 50 sessions. MRI evaluation 1 year after HBO2 completion showed that edema at the femoral condyle had resolved in all but one patient. MRI at 7 year after completing therapy were all normal. In conclusion, HBO2 is beneficial in ONK. Patients experienced improvements in pain and mobility as demonstrated by improvement in OKS. Radiographic improvements were also seen upon post treatment follow-up. Aglietti staging for the entire sample saw an aggregate decrease (p < 0.01) from 1.7 ± 0.7 to 0.3 ± 0.6.


      0830-0900
      Gerardo Bosco, MD
      "Hyperbaric pre-conditioning"
      Bosco image
      Pre-conditioning (PC) has been described as the hyperbaric oxygen (HBO2) experience before a critical event, with the aim to prevent a specific clinical condition, and its development as a valuable complement both in diving medicine (Bosco, 2010) as well as prior to ischemic or inflammatory situations. PC is a preventive treatment that triggers endogenous cascades, which can protect from stress-activated and stress-reactive responses. A possible mechanism of HBO-PC mediating beneficial effects has been described as attenuation of the production of proinflammatory cytokines in response to an inflammatory stimulus such as surgery and modulation of the immune response. HBO-PC protocols are performed at 2.0–2.5 atmospheres absolute (ATA), and usually only applied for one or a few days. The physical adaptations in response to alterations in atmospheric oxygen appear to extend not only to survival, but also a preconditioned state.
           Similar to ischemic and stress preconditioning, many different paradigms have been used to demonstrate that either rapid or delayed tolerance is affected by the HBO2 therapy. Irrespective of the cause of injury, inflammatory cytokines released after the primary event trigger leukocyte activation and free radical release, causing secondary damage and extension of injury. Thus, modulating inflammatory molecules has the potential benefit of limiting leukocyte-mediated extension of injury. Many studies demonstrated a protective mechanism of HBO-PC in the injured brain, heart, or liver. Previous data by Yang and colleagues on animals demonstrated that HBO2 inhibits TNF-α production during intestinal, brain and muscle ischemia-reperfusion and it has a beneficial effect, mediated by decreased production of IL-6, IL-1β, dopamine and lactate (Bosco, 2007; Yang, 2001;2006;2010). Studies on animals showed that HBO-PC can protect the brain from ischemia-reperfusion injury and that Sirt1 is a potential molecular target for therapeutic approaches (Ding, 2017). In man, HBO-PC induces endogenous cardioprotection subsequent to ischemic reperfusion injury (Allen, 2014).
           Additionally, clinical HBO-PC showed effects before surgery. A single preoperative hyperbaric oxygen treatment on the day before surgery may reduce the complication rate in pancreatic resection (Bosco, 2014). In liver surgery, studies demonstrated to increase the number of new cells and the density of microcirculation in the regenerating liver after HBO-PC (Theodoraki, 2011). Furthermore, hyperbaric oxygen preconditioning improves postoperative dysfunctions by reducing oxidant stress and inflammation (Gao, 2017). A recent experimental paper has identified an important mechanism involved in triggering the beneficial effect of HBO-PC, as the intracellular induction of heme-oxygenase-1 in hepatic IR injury. Moreover, in dive medicine HBO-PC reduced bubble formation and platelets activation; HBO-PC might enhance lymphocyte antioxidant activity and reduce reactive oxygen species levels. Pre-breathing oxygen in water may also preserve calcium homeostasis, suggesting a protective role in the physiological lymphocyte cell functions (Bosco, 2010; Morabito, 2011).

           Whether the various preconditioning protocols contribute to the different results should be investigated in further studies and applied to diverse surgical procedures, especially major surgeries leading to postoperative ICU admission. Therefore, HBO-PC is an encouraging and feasible therapeutic strategy for protecting organs from the subsequent lethal stimulus.
      References
      1. Ding P, Ren D, He S, He M, et al (2017). Sirt1 mediates improvement in cognitive defects induced by focal cerebral ischemia following hyperbaric oxygen preconditioning in rats. Physiological research, 66(6).
      2. Yang ZJ, Bosco G, Montante A, Ou XL and Camporesi EM (2001) Hyperbaric O2 reduces intestinal ischemia-reperfusion-induced TNF-a production and lung neutrophil sequestration. Eur J Appl Physiol 85: 96-103
      3. Yang Z, Nandi J, Wang G, Bosco G, et al. (2006) Hyperbaric Oxygenation ameliorates indomethacin-induced enteropaty in rats by modulating TNF-a and IL-1 b production. Dig Dis Sci 34(1-2):70-6.
      4. Bosco G, Zj Yang, J Nandi, Jp Wang, et al. (2007) Effects of hyperbaric oxygen on glucose, lactate, glycerol and antioxidant enzymes in the skeletal muscle of rats during ischemia and reperfusion. Clin Exp Pharmacol Physiol 34, 70-76.
      5. Yang Zj, Bosco G, Xie Y, Chen Y, Camporesi EM. (2010) Hyperbaric oxygenation alleviates MCAO-induced brain injury and reduces hydroxyl radical formation and glutamate release. Eur J Appl Physiol. Feb;108(3):513-22.
      6. Bosco G, Yang Zj, Di Tano G, Camporesi EM, et al. (2010) Effect of in-water versus normobaric oxygen pre-breathing on decompression-induced bubble formation and platelet activation. J Appl Physiol. May;108(5):1077-83.
      7. Morabito C, Bosco G, Pilla R, Corona C, et al. (2011) Effect of pre-breathing oxygen at different depth on oxydative status and calcium concentration in lymphocytes of scuba divers. Acta Physiol (Oxf). May;202(1):69-78.
      1. Bosco G, Casarotto A, Nasole E, Camporesi E, et al. (2014). Preconditioning with hyperbaric oxygen in pancreaticoduodenectomy: a randomized double-blind pilot study. Anticancer research, 34(6), 2899-2906.
      2. Theodoraki K, Tympa A, Karmaniolou I, Tsaroucha A, et al. (2011). Ischemia/reperfusion injury in liver resection: a review of preconditioning methods. Surgery Today, 41(5), 620.
      3. Gao Z. X, Rao J, & Li Y. H. (2017). Hyperbaric oxygen preconditioning improves postoperative cognitive dysfunction by reducing oxidant stress and inflammation. Neural regeneration research, 12(2), 329.
      4. Allen M, Golembe E, Gorenstein S, Butler G. Protective effects of hyperbaric oxygen therapy (HBO2) in cardiac care-A proposal to conduct a study into the effects of hyperbaric pre-conditioning in elective coronary artery bypass graft surgery (CABG) Undersea Hyperb Med. 2014;42:107–114.


      0900-0930
      Shai Efrati, MD
      "Brain injury"

      efratiObjectives:

      1. Basics pathophysiological cascade of non-recoverable brain injuries.
      2. The neuroplasticity effect of hyperbaric oxygen therapy
      3. Selecting the optimal candidate for the treatment

      Clinical studies published in recent years present convincing evidences that hyperbaric oxygen (HBO2) therapy can be the coveted neurotherapeutic method for brain repair of neurological incidents like traumatic brain injury and stroke. This new understanding leads to a paradigm change in the way that we refer to chronic brain injuries; from now these should be thought of like other non-healing wounds in other parts of the body.
           The classical candidate for HBO2 is a patient with unrecovered brain injury where tissue hypoxia is the limiting factor for the regeneration process. In this patient, HBO2 may induce neuroplasticity in the stunned regions where there is a brain anatomy/physiology mismatch (as for example PET/MRI).
           In this lecture we will discuss the multifaceted role HBO2 can play in neurotherapeutics based on recent persuasive evidence demonstrating HBO2 efficacy in brain repair as well as a new understanding of brain energy management and response to brain damage. We will also discuss how to select suitable candidates and how to choose the optimal HBO2 protocol for the selected candidate.


      0930-1000
      Panel Discussion


      NEW PEARLS OF WISDOM IN THE DIVING AND HYPERBARIC MEDICINE LITERATURE PLENARY
      1:00 PM - 2:00 PM

      1300-1330
      Brian Keuski, MD; Fellow, Duke Hyperbarics
      "Diving medicine literature update"

      headshot Keuski

      Take a whirlwind tour through the last 12 months of diving medicine literature. Major topics include: decompression illness, fitness to dive issues, immersion pulmonary edema, and diving physiology.



      1330-1400
      Lince Varughese, MD; Fellow, LSU Hyperbarics
      "Hyperbaric medicine literature update"

      Lince Varughese MD

      Dr. Varughese will give a brief update on key articles in recent hyperbaric medicine literature; novel ideas and newfound wisdom.



      CLINICAL AND METABOLIC ASPECTS IN BREATH-HOLD DIVING PLENARY
      4:00 PM - 5:00 PM

      1600-1620
      Gerardo Bosco, MD
      "Adaptive mechanisms in breath-hold divers"

      Bosco imageThe human body faces extreme physiological challenges while immersed with voluntary breath-holding. Breath-hold diving is potentially associated to extreme environmental factors such as increased hydrostatic pressure, hypoxia, hypercapnia, hypothermia and strenuous exercise. Physiological adaptations can depend among the time of breath suspension and the depth of diving. While descending chest squeeze and blood redistribution occur. Indeed, blood as being an incompressible fluid from peripheral circulation is shifted to the chest. The intrathoracic blood volume increases. Moreover, face immersion results in induced bradycardia, due to the diving reflex. Conversely, breath-holding at rest, out of water, induces non-significant changes in heart rate. Breath-hold swimming, even on the surface, instead causes pronounced bradycardia. During deep diving a higher O2 consumption and a fall in alveolar and blood O2 content was observed. Consequently, alveolar CO2 pressure increases due to chest compression while descending.
           It was supposed that the maximum reachable depth in breath-hold diving was determined by the relationship between total lung capacity and residual volume. Craig suggested a compensatory physiologic mechanism to explain why thoracic implosion does not occur and hypothesized that a certain amount of blood was diverted from the peripheral circulation into the chest. Intrathoracic pressure in such a condition represented the elastic behavior of the chest wall when exposed to high hydrostatic pressure. The increased hydrostatic pressure at depth reduces pulmonary gas volumes and consequently increases intrathoracic blood volume, with enlargement of the right heart chambers and pressures. On the contrary, the left sections of the heart do not undergo any enlargement, and do not show any sign of pressure increase. The systolic stroke volume is the consequence of Starling’s law: the blood shift stretches the heart and increases the intracardiac volume. This certainly means that, although rarely exploited in nature, anaerobic metabolic reserve represents a resource for survival of the animal. The same can be said for high-altitude hypoxic environments.
           Another consideration is the “graded response” to breath-hold diving in relation to the level of physiological stress and to the control by the central nervous system. The diving response is a strategic adaptation to hostile environmental conditions common to many animals but human breath-hold divers require knowledge for the safe and health of participants. 

      1620-1640
      Peter Lindholm, MD
      "Pulmonary pathophysiology in deep breath-hold diving"
      lindholm image

      Deep breath-hold diving may expose the lungs to the limits of known human physiology. We will discuss barotrauma of descent with pulmonary edema, glossopharyngeal hyperinsufflation and arterial gas embolism.

      1640-1700
       Alessandro Marroni, MD
      "Breaking news on breath-hold diving research"
      A.Marroni VHQ small


      Recent data from field research on pathophysiology of breath-hold diving will be presented, with a particular focus on breath-hold diving-induced pulmonary edema, Taravana, epidemiology, mechanisms, pathogenetic hypotheses and data on genetic predisposing factors.


       

       

      ::/introtext::
      ::fulltext::::/fulltext::

      Read more

    Read more

  • Continuing Education Credits: Annual Meeting

    In order to receive continuing education for the UHMS ASM you must complete and submit an evaluation.

    Accreditation Statement:  
    The Undersea and Hyperbaric Medical Society is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

    Designation Statements: 
    The Undersea and Hyperbaric Medical Society designates this live activity for a maximum of TBD AMA PRA Category 1 Credit(s)™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Nursing CEU is approved by the Florida Board of Registered Nursing Provider #50-10881. ASM Credit hours TBD.
    Licenses Types Approved:

    • Advanced Registered Nurse Practitioner
    • Clinical Nurse Specialist
    • Licensed Practical Nurse
    • Registered Nurse
    • Certified Nursing Assistant
    • Respiratory Care Practitioner Critical Care
    • Respiratory Care Practitioner Non-Critical Care
    • Registered Respiratory Therapist
    • Certified Respiratory Therapist

    NBDHMT: This live activity is approved for TBD Category A credit hours by National Board of Diving and Hyperbaric Medical Technology, 9 Medical Park, Suite 330, Columbia, South Carolina 29203.

    Full Disclosure Statement:
     All faculty members and planners participating in continuing medical education activities sponsored by Undersea and Hyperbaric Medical Society are expected to disclose to the participants any relevant financial relationships with commercial interests. Full disclosure of faculty and planner relevant financial relationships will be made at the activity.

    Disclaimer: The information provided at this CME activity is for Continuing Medical Education purposes only.  The lecture content, statements or opinions expressed however, do not necessarily represent those of the Undersea and Hyperbaric Medical Society

     

    MAINTENANCE OF CERTIFICATION (MOC):

    “MOC ABPM: This activity has been approved by the American Board of Preventive Medicine for up to 18 MOC credits. Claiming ABPM MOC credit is appropriate for those who are ABPM diplomates.”

    Read more

  • Social Events

     

    WEDNESDAY, JUNE 26

    WELCOME RECEPTION
    7:00 pm - 9:00 pm

    THURSDAY, JUNE 27

    EXHIBITORS WINE & CHEESE RECEPTION
    6:00 pm - 7:00 pm
    Exhibit Hall 

    SATURDAY, JUNE 29

    ANNUAL AWARDS BANQUET (additional fees for banquet and after party)
      Banquet Reception: 7:00 pm - 7:30 pm
      Dinner: 7:30 pm - 10:00 pm 
      After Party: 10:00pm - 12am  

    Read more

  • Committee Meeting Schedule

    ::cck::16::/cck::
    ::introtext::

    SUBJECT TO CHANGE
    posted 3-6-18

    Please contact lisa@uhms.org to schedule

    EVENT

    START TIME

    END TIME

    LOCATION

    TUESDAY, JUNE 26

    UHMS Board of Directors Meeting (Private Meeting)

    4:00 PM

    11:00 PM

    Sierra 2

    WEDNESDAY, JUNE 27          

    ABPM Exam

    1:00 PM

    4:00 PM

    Fiesta 1

    Editorial Board Meeting

    3:00 PM

    5:00 PM

    Fiesta 2

    HBO Therapy Committee Meeting

    4:45 PM

    7:45 PM

    Fiesta 1

    Associate's Council Meeting

    5:30 PM

    7:30 PM

    Fiesta 2

    THURSDAY, JUNE 28

    Safety Committee Meeting

    7:00 AM

    8:00 AM

    Fiesta 2

    Specialty ED & QUARC Team Meeting (Marc Robins)

    10:00 AM

    12:00 AM

    Fiesta 1

    Accreditation Council Meeting

    10:00 AM

    12:00 PM

    Fiesta 2

    ACEP UHM Section Meeting

    10:00 AM

    11:00 AM

    Fiesta 3

    GME Committee Meeting

    11:00 AM

    12:00 PM

    Fiesta 3

    Material Testing Advisory (AD HOC) Committee

    2:00 PM

    3:30 PM

    Fiesta 1

    Education Committee Meeting

    5:00 PM

    6:00 PM

    Fiesta 1

    BNA Board Meeting

    5:00 PM

    6:00 PM

    Fiesta 3

    FRIDAY, JUNE 29

    PAST PRESIDENT'S BREAKFAST

    7:00 AM

    8:00 AM

    Fiesta 3

    NBDHMT Breakfast

    7:00 AM

    8:00 AM

    Fiesta 2

    NBDHMT Board Meeting

    8:00 AM

    12:00 PM

    Fiesta 1

    ECCHO Working Group Meeting

    10:00 AM

    11:00 AM

    Fiesta 2

    Publication Committee Meeting

    10:00 AM

    11:00 AM

    Fiesta 3

    ACHM-UHMS Meeting

    11:00 AM

    1:00 PM

    Fiesta 2

    Registry Meeting (Buckey)

    11:30 AM

    12:30 AM

    Fiesta 3

    QUARC Committee Meeting

    2:00 PM

    3:00 PM

    Fiesta 2

    BNA General Meeting

    3:00 PM

    4:00 PM

    Fiesta 1

    Research Committee Meeting

    3:00 PM

    4:00 PM

    Fiesta 2

    UHMS Business Meeting - Open meeting

    5:30 PM

    6:30 PM

    Fiesta 5

    Specialty Council Meeting (Toups) PRIVATE Meeting

    5:30 PM

    7:30 PM

    Fiesta 1

    SATURDAY, JUNE 30

    Chapter President's Committee Meeting

    10:00 AM

    11:00 PM

    Fiesta 1

    Diving Committee Meeting

    10:00 AM

    12:00 PM

    Fiesta 3

    Membership Committee Meeting

    11:00 AM

    12:00 PM

    Fiesta 1

    ::/introtext::
    ::fulltext::::/fulltext::

    Read more