Undersea & Hyperbaric Medicine Journal Volume 43, Issue #1

Course overview

Learner Objectives: As a result of having attended the meeting, the participants should have had the opportunity to: 1. Understand CNS oxygen toxicity is a rare adverse event of HBOT, much lower than previously reported. 2. Understand Patients with neurologic indications (such as stroke or traumatic brain injury) do not have additional risk for CNS oxygen toxicity when pressure is limited to maximum of 2ATA. 3. Understand HBO2 treatment protocols should be adjusted to achieve maximal effect with lower oxygen exposure (<2.4 ATA). 4. Compare the direct and indirect costs of aggressive limb salvage vs. primary lower extremity amputation in patients with Wagner Grade 3 or 4 diabetic foot ulcers. 5. Discuss the importance of having a multispecialty limb salvage team as a core component of the wound care center. 6. Discuss the mortality rates in patients following an aggressive limb salvage protocol vs. primary lower extremity amputation for Wagner Grade 3 or 4 diabetic foot ulcers. Subject Matter: 1.Cost and mortality data of a regional limb salvage and hyperbaric medicine program for Wagner Grade 3 or 4 diabetic foot ulcers 2. Seizures during hyperbaric oxygen therapy: retrospective analysis of 62,614 treatment sessions Teaching Methods: •Journal Reading •Examination of material •Evaluation of activity Evaluation Methods: Evaluation is offered through the online educational portal with 3 graded questions each UHM Journal paper and an overall evaluation at completion of the Journal-based activity. References: 1. International Diabetes Federation. IDF diabetes atlas, 6th ed. Brussels, Belgium: International Diabetes Federation, 2014 Update. 2. Utah Department of Health, Fact Sheet. Diabetes inUtah. http://www.choosehealth.utah.gov/documents/pdfs/ factsheets/factSheet_diabetes.pdf. Last accessed 06/01/2015. 3. Driver VR, Fabbi M, Lavery LA, Gibbons G. The costs of diabetic foot: the economic case for the limb salvage team. J Vasc Surg 2010; 52(3 Suppl):17S-22S. 4. Margolis DJ, Malay DS, Hofstede OJ et al. Economic burden of diabetic foot ulcers and amputations. DiabeticFoot Ulcers. Data Points #3 (prepared by the University of Pennsylvania DEclDE Center, under Contract No.HHSA290200500411). Rockville, MD: Agency for Healthcare Research and Quality. January 2011. AHRQ Publication No. 10(11)-EHC009-2-EF. 5. Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA 2005; 293(2):217-228. 6. Centers for Disease Control and Prevention: Number of hospital discharges for nontraumatic lower extremity amputation with diabetes as a listed diagnosis, United States, 1988-2009 http://www.cdc.gov/diabetes/statistics/lea/¿g1. htm. Last accessed 06/01/2015. 7. Margolis DJ, Malay DS, Hoffstad OJ, et al. Incidence of diabetic foot ulcer and lower extremity amputation among Medicare bene¿ciaries, 2006 to 2008. Data Points #2. (Prepared by the University of Pennsylvania DEclDE Center, under Contract No.HHSA29020050041l). Rockville, MD Agency for Healthcare Research and Quality. January 2011. AHRQ Publication No. 10(11)-EHC009-1-EF. 8. Scho¿eld CJ, Libby G, Brennan GM et al. Mortality and hospitalization in patients after amputation: a comparison between patients with and without diabetes. Diabetes Care. 2006; 29(10):2252-6. 9. Brem H, Sheehan P, Rosenberg HJ, Schneider JS, Boulton AJM. Evidence-based protocol for diabetic foot ulcers. Plast Reconstr Surg 2006; 117(7 Suppl):193S-209S. 10. Brem H, Sheehan P, Boulton AJM. Protocol for treatment of diabetic foot ulcers. Am J Surg 2004; 187(5A):1S-10S. 11. Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011. 12. Frykberg RG, Zgonis T, Armstrong DG et al. Diabetic foot disorders. A clinical practice guideline (2006 revision