Wednesday, October 26, 2011

Pure oxygen used in treating brain injuries Rapid Recovery Hyperbarics 909-477-4545

Pure oxygen used in treating brain injuries

Active-duty Marines will undergo trials at Pendleton, Lejeune naval hospitals

By Gidget Fuentes - Staff writer
Posted : Saturday Oct 22, 2011 9:18:14 EDT

Marines are participating in a study to see whether treatments of pure oxygen will help heal service members with mild traumatic brain injuries, one of the most common wounds of the wars in Iraq and Afghanistan.

Medical investigators plan for 96 Marines, sailors and other service members to participate in the initial 10-week trial involving treatments of hyperbaric oxygen therapy, with 24 participants each at Camp Pendleton Naval Hospital, Calif., and Camp Lejeune Naval Hospital, N.C. The Army Medical Research and Materiel Command oversees the study, which also includes Army hospitals at Fort Gordon, Ga., and Fort Carson, Colo.

The trial began in early October and should be completed by year’s end. If the results are positive, it may lead to a larger study involving 300 to 400 participants, said Cmdr. James Caviness, an occupational and environmental medicine physician and principal investigator for the study at Camp Pendleton Naval Hospital.

“Hopefully this will be another tool in the arsenal” to help sufferers, said Caviness, the hospital’s occupational health department head.

Trial participants must have suffered a mild TBI while on active duty operating in the U.S. Central Command region, and they must live or be stationed near a study site.

While most people recover from concussions, or mild TBI, some later suffer what doctors call persistent post-concussive injuries. “They develop some chronic problems,” such as headaches, irritability, poor sleep, memory loss and imbalance, Caviness said. “That’s the group that we have trouble with in our current treatment program.”

Medical researchers suspect that pure oxygen might help heal those injured brain cells, and other recent studies show promising results for concussion sufferers.

“Everything in our body works on oxygen,” which acts as something like a fuel for cellular activity, Caviness said. “But no one knows” definitely if pure oxygen could help heal a bruised brain, he said. “That’s just a theory.”

For this study, some of the participants will breathe air in a hyperbaric chamber, provided and operated by a contractor, over a course of treatments and batteries of tests, while others will receive regular care for mild TBI, Caviness said. The trial is a double-blind, randomized study, so participants won’t know whether they are getting treated with pure oxygen or normal pressurized air. “They don’t know, and we don’t know,” he said.

Interested Marines — active-duty only — can contact the study coordination screening center at 877-445-3199.

Saturday, October 15, 2011


Dear Susan,
Since the health care system is insurance based, until the procedure is recognized as a proper modality for a spectrum of treatments instead of the narrow set presently covered, it will only be people like you who are salvation for many otherwise untreated individuals. Thank you for helping me stay healthy!

Franck XXXX

To Whom It May Concern,

The work that Susan Rodriguez and Rapid Recovery Hyperbarics is doing is commendable. While the academic world is mired in the tedious process of controlled, randomized studies, they are in the trenches treating people in need. The use of hyperbaric oxygen in neurologic conditions is the newest frontier in medicine and Ms. Rodriguez is one of the pioneers. I am certain that someday, when the use of hyperbaric oxygen is a standard of care for many neurologic conditions, the world will look back on these individuals as bold visionaries who ran where others feared to tread.

George Mychaskiw II, DO, FAAP, FACOP

George Mychaskiw II, DO, FAAP, FACOP
Professor and Chair, Department of Anesthesiology
Drexel University College of Medicine
Clinical Service Chief, Hahnemann University Hospital
Editor of UHMS

Sunday, October 9, 2011

Scan Detects Oxygen Levels in Tumors

April 23 (Health Day News) -- New research suggests that scientists are close to developing a simple way to measure oxygen levels in tumors, giving doctors a heads-up about what kind of treatment is best for individual patients.

The findings fit into an emerging trend of individualized treatment for patients with cancer instead of treating people the same way, said Dr. Mark Dewhirst, a professor of radiation oncology at Duke University Medical Center.

"If successful, [the trend] will revolutionize the way that we treat cancer," said Dewhirst, who co-wrote a commentary accompanying the new study, published April 22 in the Journal of Clinical Investigation.

Scientists began realizing the important role of oxygen in tumors about 50 years ago, said study co-author James Mitchell, branch chief of radiation biology at the U.S. National Cancer Institute's Center for Cancer Research. The scientists discovered that tumors with higher concentrations of oxygen were more susceptible to radiation, he said.

"Radiation damages cells by causing damage to DNA, and one particular type of damage renders the DNA molecule non-reparable," Mitchell said. But less oxygen in the tumor allows tumor cells to survive more easily by making the DNA destruction process more difficult, he said.

According to Dewhirst, the same is true for chemotherapy drugs, which also don't work as well when tumors have less oxygen.

Lower levels of oxygen create other problems, Dewhirst. "One would think at first that lack of oxygen would make tumors unhealthy and easy to kill," he said. "But actually, the opposite happens -- tumor cells that lack oxygen become more aggressive and more difficult to kill."

Tumors with lower oxygen levels even spread more easily through the body, he said.

Doctors can check oxygen levels in patients by inserting a needle. But doctors can't insert needles into some patients, and. in others, it's difficult to insert the needle deep enough, Mitchell said.

In the new study, the researchers tested a scanning technique called pulsed electron paramagnetic resonance imaging and used it in tandem with magnetic resonance imaging. The study authors said they were able to successfully measure oxygen levels in tumors in mice by using the non-invasive technology.

"The imaging that is described in this study provides all of the information necessary to evaluate oxygen levels in tumors as well as to examine underlying causes for the lack of oxygen," Dewhirst said. "The fact that all of the imaging is completely non-invasive provides the ability to perform this measurement more than once, (meaning) this could be used to monitor the effectiveness of cancer therapy."

There are caveats, however. The research hasn't reached the human testing level yet, and it may not work in people. "Scaling up the method to make it suitable for use in humans will be a significant challenge, but not impossible," Dewhirst said.

For now, the plan is to launch more studies with animals to see if the technique works as a way to test cancer drugs. Perspective

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Tuesday, October 4, 2011

Parents Can Detect, Contribute to, or be Affected by Critical Events During a Child's Hospitalization

Parents Can Detect, Contribute to, or be Affected by Critical Events During a Child's Hospitalization


Today, parents are often permitted around-the-clock visiting hours to stay with their hospitalized children, even in neonatal and pediatric intensive care units (ICUs). Many parents take advantage of this option and remain with their children as much as possible. For an ill child, this can be comforting and provides an important emotional benefit. At the same time, parents may be carefully watching and interacting with healthcare professionals, and observing the specialized equipment at their child's bedside, including infusion pumps, IV lines, and drainage systems. A study published by Frey et al. in 2009 suggests that parents who stay with their hospitalized children are inevitably involved in safety issues.[1] In particular, the study showed that parents can help detect critical (harmful or potentially harmful) events precipitated by healthcare professionals. However, the study also showed that parents can contribute to a critical event and are often adversely affected by a critical event.

The study was conducted over a 5½ year period in a neonatal-pediatric intensive care unit and a neonatal intermediate care unit in a university children's hospital. During the first 2 years of the study, visiting hours for parents were limited to afternoons and evenings; morning visitations were not allowed and overnight stays were strongly discouraged. Around-the-clock visiting hours were permitted during the last 3½ years of the study.

During the span of the study, a total of 2,494 critical events were recorded; 101 of these events directly involved parents. In 18 cases, a parent contributed to the critical event. In 11 cases, a parent detected a critical event. In the remaining 72 cases, a parent was one of the affected individuals. For each event, the actual and potential severity was determined to be minor (requiring no interventions), moderate (requiring routine therapy available outside a critical care unit), or major (requiring therapeutic interventions specific to critical care units, or resulted in death).

In the group of critical events that involved parents (n=101), medication events (38%) and line disconnections/reconnections (28%) were most prevalent. In the group of critical events that did not involve parents (n=2,393), events involving medications were again most prevalent (33%), but issues with line disconnections/reconnections (2.7%) were significantly lower. Most events precipitated by parents and subsequently detected by healthcare professionals caused actual harm determined to be of moderate severity, and some events had the potential to cause a high severity of harm. On the other hand, critical events detected by parents did not cause actual harm, although the events had the potential to cause harm of moderate severity. Further details about the study follow.

Parents Detecting Safety Problems

The most common safety problems detected by parents involved medication errors, tubes or drains that became disconnected, and respiratory distress. Examples include:

  • A mother who realized that a physician had prescribed a five-fold overdose of carvedilol for her child (5 mg BID instead of 1 mg BID)
  • A mother who noticed the wrong weight listed on her child's medical record used for prescribing medications
  • Parents who called attention to their child's respiratory distress or failure.

It took parents between 0–70 hours (median 10 hours) to detect a critical event precipitated by a healthcare professional. This suggests that without the parents' interventions, some critical events might have continued without correction. The authors determined the potential harm from continuation of the detected critical events to be severe in 4 cases, moderate in 6 cases, and minor in 1 case. All of the events detected by parents occurred only after around-the-clock visiting hours were made available. This observation suggests that it is easier for parents to detect safety problems if they spend more hours at their child's bedside, observing and participating in their care.

Parents Contributing to Safety Problems

The most common safety problems precipitated by parents involved the disconnection of tubes and drains, medication errors, and physical trauma. Examples include:

  • A mother accidentally disconnected a central venous line while breast feeding her baby
  • A mother accidentally disconnected a pleural drain while holding her infant
  • A father fell off a chair with his child on his lap.

All of the disconnected tubes and drains happened in young infants, from 4 days to 1½ years old. It took healthcare professionals between 0–29 hours (median 0.25 hours) to detect a critical event precipitated by a parent. The authors note that this finding suggests that healthcare professionals are providing appropriate supervision of parents and hospitalized children. Most of these events caused moderate harm (10 cases) before being detected. In all but one event, quick discovery of the problems averted severe harm.

Parents Affected by Safety Events

The most common types of problems affecting parents involved miscommunication and feeding mix-ups. One can expect parents to be emotionally affected by most critical events that involve their children, especially those leading to harm. However, with some critical events, parents were directly affected in ways that were not anticipated. One of the most common examples included mothers who were subjected to viral testing because their breast milk was accidentally fed to another child. Failures such as this increase parental stress during a child's hospitalization.

Safe Practice Recommendations

Consider the following recommendations to strengthen the partnership between the treatment team and a hospitalized child's parents, prevent parental contribution to critical events, promote parental detection of errors, and protect the hospitalized child from harm.

Educate Parents. Teach parents about the disease/condition, medical tests, and treatment plan for their hospitalized child. Specifically tell parents about all the medications their child is receiving, the prescribed doses (including the fact that it differs from the dose taken at home, if applicable), potential side effects, and when and how they are given. Write down important information for parents to reference as needed. Parents who know what to expect can help recognize when something is not right.

Update Parents. Provide parents with timely and comprehensive updates regarding their children in language they understand. Some children's hospitals encourage parents to be part of "family-centered" rounds, allowing them to gain a better understanding of their child's total treatment plan and current status since the entire medical team is available to answer questions and address concerns.

Anticipate Involvement. Be aware of increasingly independent parental involvement in the medical care of their children. A 2001 study by Hurst showed that parents continuously analyze hospital procedures and develop an action plan to protect their babies.[2] A fundamental challenge for mothers in this study was to increase their position of authority relative to the medical team, thereby safeguarding their babies. Parents may intervene during the care of their children, which can lead to prevention and detection of a critical event, or contribution to a critical event despite good intentions. Close parental involvement in the child's treatment plan should be encouraged, supervised, and monitored.

Encourage Parents to Speak up. Encourage parents to report any concerns or worries they have regarding their child's care. Frey et al. suggests periodically asking parents these two questions: "Are there aspects of your child's care that you find concerning?" and "What do you worry about when you leave your child?" Encourage parents to keep asking questions or voicing concerns until they receive an answer with which they are comfortable and fully understand. Remind parents that they know their child better than anyone on the medical team; thus, communication of their observations is extremely important.

Respond to Parents' Queries Appropriately. Parents do not want to be labeled as being "difficult" or "demanding;" they fear no one will want to take care of their child if they are perceived this way.[2] Some may even view basic questions or requests for information about their child's condition as a slight to the medical team's competence. So, when parents do speak up, healthcare professionals should perceive and reflect their actions in a manner that fosters true collaboration and empowerment, and should encourage and reinforce the parents' role in making queries by providing thoughtful and complete answers.

Provide Access to a Rapid Response Team. Allow parents to activate a rapid response team if they feel no one is addressing their expressed concerns regarding their child's condition and/or medical treatment. Instruct parents, upon their child's admission, regarding the purpose of the rapid response team and how to activate it.

Establish Safe Handling Guidelines. To reduce the risk of tubing disconnections, establish guidelines for safe handling of infants and children with lines and drains, teach these guidelines to parents, and monitor adherence to the guidelines.

Teach Parents Not to Reconnect Tubes. Orient parents to the tubes or drains attached to their child. Teach them about the dangers of reconnecting tubes and drains themselves and how to call for immediate help from a healthcare professional if their child's tubes or drains become dislodged or disconnected.



1. Frey B, Ersch J, Bernet V, Baenziger O, et al. Involvement of parents in critical incidents in a neonatal-paediatric intensive care unit. QualSaf Health Care. 2009;18(6):446–449.

2. Hurst I. Vigilant watching over: mothers' actions to safeguard their premature babies in the newborn intensive care unit. J Perinat Neonatal Nurs. 2001;15(3):39–57.

ISMP Medication Safety Alert © 2011 Institute for Safe Medication Practices

Monday, October 3, 2011

Brain injury study under way at Camp Pendleton

MILITARY: Brain injury study under way at Camp Pendleton
MILITARY: Brain injury study under way at Camp Pendleton County Times Posted: Friday, September 30, 2011 8:00 pm

A hyperbaric chamber at Camp Pendleton is being used to treat troops with mild traumatic brain injuries in a trial program to see if it speeds their recovery. Courtesy photo
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Related: MILITARY: Brain-injured Marines to test new treatment
A half-dozen Marines with brain injuries from combat in Afghanistan or Iraq will crawl inside a hyperbaric chamber at Camp Pendleton next week to begin eight weeks of treatment breathing pure oxygen to see if it speeds their recovery.
Up to 100 base troops eventually are expected to take part in the study trying to find the best treatments for what is known as traumatic brain injury.
Many other troops suffering from post-traumatic stress disorder from their battlefield experiences also are expected to take part in the study to see if it helps them heal.
"I'm really hopeful that this potential treatment will help," said Navy Cmdr. James Caviness, head of occupational health services and the study's principal investigator at Naval Hospital Camp Pendleton.
"The anecdotal reports of hyperbaric chamber use in civilian settings are positive, and we need to rigorously look at this to see if we can use it," he added.
The troops taking part in the study are volunteers. Hundreds of others at the Marine Corps' Camp Lejeune in North Carolina and at Army bases at Fort Carson, Colo., and Fort Gordon, Ga., are taking part in similar studies.
Researchers will measure whether the use of the chamber can ease the headaches, memory loss and other ailments from mild traumatic brain injury, which are common after-effects for troops who are injured in roadside bomb attacks.
When the program was designed last year, U.S. Army Col. Richard Ricciardi at the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury described it as one of many commissioned by the Pentagon to improve brain injury care.
"It's one part of the arsenal of treatments being tested across the system to tackle this challenging problem and do the right thing for our warriors," he said.
Traumatic brain injury has emerged as a common injury among troops in Iraq and Afghanistan, where anti-government forces rely on homemade bombs as a primary weapon.
More than 134,000 U.S. troops have been treated for such injuries since the Afghanistan and Iraq wars began, according to Pentagon statistics.
Close to 1,400 service members have suffered concussions or traumatic brain injury so far this year, according to the Defense Department.
The malady is divided into three classifications. Mild cases involve loss of consciousness for up to 30 minutes and mild amnesia.
The hyperbaric chamber at Camp Pendleton is inside a trailer adjacent to the hospital. Pressure inside it will be equivalent to what divers experience at about 20 feet under water.
The pressurization forces pure oxygen into the cells. The experiment tests whether the repeated trips to the chamber speed healing.
Some troops breathe pure oxygen administered under a tentlike hood so no gas escapes. Others will get a lesser amount of pure oxygen, and a third group will breathe normal air under near-similar pressure conditions to test the results.
Camp Pendleton's role is to help establish the precise treatment regimen and baseline testing troops will undergo to see if the treatment helps.
"There are a lot of unknowns about traumatic brain injury, which has emerged as the 'signature injury' of the wars in Iraq and Afghanistan," Caviness said. "We need to learn a lot more, and this study will hopefully demonstrate it is something we can use."
Troops suffering from moderate or severe brain injuries are not part of the study because there is no evidence hyperbaric chambers speed their recovery.
Among the measurements technicians will use are batteries of memory, mood and motor function tests administered to troops before the study, as it takes place and at the end of the eight weeks.
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