Tag Archives: Medical

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Can stem cells help teeth heal? Scientists say yes

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It is generally accepted in the medical community that stem cells play an important role in wound healing. They can develop into specialized cell types throughout the body, aiding in all kinds of tissue regeneration.

A new study led by Dr. Bing Hu from the University of Plymouth’s Peninsula Dental School, with collaboration from researchers worldwide, asserts that certain stem cell tissue regeneration extends to teeth. This finding offers up a new and novel potential solution to tooth repair and may inform the way dentists treat teeth in the future.

Published in early August, in Nature Communications, the study showed that a gene called Dlk1 enhances stem cell activation and tissue regeneration in tooth healing.

Dr. Hu, who is also part of the University’s Institute of Translational and Stratified Medicine (ITSMed), said, “Stem cells are so important, as, in the future, they could be used by laboratories to regenerate tissues that have been damaged or lost due to disease, so it’s vital to understand how they work.”

Here’s the scoop:

Dr. Hu and his team discovered a new population of mesenchymal stem cells in a continuously growing mouse incisor model. If you tripped on the term mesenchymal, no worries. So did we. It just means the stem cells that make up skeletal tissue such as muscle and bone. They showed that these fancy-word stem cells contribute to the formation of tooth dentin, the hard tissue that covers the main body of a tooth.

Importantly, the work showed that when these stem cells are activated, they then send signals back to the mother cells of the tissue to control the number of cells produced, through a molecular gene called Dlk1. This study and resulting report are the first to show that Dlk1 is vital for this process to work.

In the same report, the researchers also proved that Dlk1 can enhance stem cell activation and tissue regeneration in a tooth wound healing model. Why is this so important? This mechanism could provide a novel solution for tooth reparation, dealing with problems such as tooth decay, dental caries and trauma treatment.

Here’s why it matters

Professor Christopher Tredwin, Head of Peninsula Dental School and co-author of the paper, said the following: “We are highly excited by the recent progress in Dr. Bing Hu’s group. This new work, together with a recent high-impact paper, which is about another type of stem cells in the tooth: epithelial stem cells, puts Plymouth at the front of the world’s dental and craniofacial stem cell research and regenerative medicine. We expect those researchers will soon provide dental patients better time and cost-effective solutions to serious tooth problems.”

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4 critical success factors for transitioning to independent living

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For most young adults, leaving home and setting out on their own is inevitable, but success in this endeavor is not.

Students with a learning difference and their parents can increase the likelihood of a successful transition to adulthood by focusing on four critical areas to prepare for the obstacles ahead.

Common Themes

Reducing dependency: Right now, your student is dependent on you for a variety of things from waking them up and keeping track of their schedule to making food for them. The goal, before they leave home to set out on their own, should be personal independence. This means slowly but methodically moving through the prompting hierarchy.

Teaching basic skills: Sometimes parents assume their young adult understands expectations and how to accomplish the tasks they are given. Often what the student needs is more specific instructions on how to complete tasks, including a break own of some tasks into steps so they are less overwhelming.

This may mean using modeling when teaching new tasks and using task lists, so the student has something to refer to when parents aren’t around. Click here to see an example weekly checklist.

Set expectations: It is important to set expectations with your young adults so that they understand what you expect of them before they are ready for independence. This can be an uncomfortable conversation, but it is necessary to make sure everyone is on the same page.

Set several goals leading to the main goal of independence to keep your student focused and reduce the chances of them becoming overwhelmed.

Critical Success Factor No. 1: Cleaning and Organizing

Teach basic cleaning skills: Walk them through each task and model each task so that they understand your expectations.

Break tasks down into less overwhelming steps: This will give them a more attainable goal and increase the chance they will complete the task.

Set realistic expectations: Set expectations now to help your young adult develop a routine to use once they are on their own.

Use task lists to reduce your student’s dependency on you: You can create these with your student or find them on the internet.

Create a schedule: Organizing cleaning tasks on a schedule creates routines that they can continue to follow when they are on their own.

Critical Success Factor No. 2: Planning, Scheduling, and Routines

Begin using a schedule ASAP: Have your student start using a planner to keep appointments, upcoming events and their cleaning schedules. Right now, you are serving as their planner &#8212 use this to reduce their dependency on you.

Plan free time: Your young adult needs to learn to plan out their down time before setting out on their own, especially if they are accustomed to you planning free time for them.

Use alarms for events including waking up in the morning: You won’t be there to wake them up or to make sure they get ready for an appointment. Now is the time to have them start setting alarms for themselves.

Set morning and evening routines: Morning and evening routines are extremely important to make sure they are prepared for their day. This should include wake up times, bedtimes, hygiene, and when they need to head out for their day.

Critical Success Factor No. 3: Safety

Teaching basic home safety: This includes how to use a fire extinguisher, smoke alarm maintenance, using home appliances, and the importance of home security.

Understanding resources in the community: It’s important for young adults to understand who to contact in their community. If you know where your student will live, help them create a contact list for emergencies, home repair, doctor, and dentist.

Teach basic home maintenance: Learning simple home maintenance now will help save money in the future. Teach them basic skills like unclogging a toilet, resetting circuit breakers, and using basic tools like a screwdriver and pliers.

Critical Success Factor No. 4: Cooking

Teach them to use kitchen appliances: Understanding how to safely use appliances like the oven, stove and other small appliances are key to avoid potential disaster in the kitchen.

Teach basic cooking skills: Review skills like boiling water, chopping, measuring ingredients, storing food and following simple recipes.

Plan a weekly menu and go grocery shopping: Keep it simple. Find 3 to 5 basic recipes to work on with your student now so they can practice.

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The economic impact of our aging population

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Most of our current crises — global warming, for example — are critical today because they’ve long been underestimated or ignored. The worldwide crisis posed by a rapidly aging first-world population, on the other hand, wasn’t even recognized until recently.

Today, the crisis is already fully present and, unless addressed, will worsen rapidly.

A Little Known and Frightening Statistic

A 2016 article in The Lancet on the implications of rapidly aging world populations cites some disturbing statistics. Important among them is this: Although over the past six decades the world population aged 60 or older has increased only slightly — by around 9% — in the next 40 years this group will more than double, from around 800 million to 2 billion.

The U.S. is one of the countries that will be most affected by this dramatic increase, resulting in lower birthrates, lower labor participation rates and dramatic increases in Social Security payouts and healthcare expenditures.

No current government policy fully addresses any of these changes. A few government agencies, especially the Congressional Budget Office, have issued warnings backed by data, but to date, the realistic and detailed congressional proposals needed to remedy these economic stressors haven’t been made. The longer we wait, the more drastic and politically unpopular these remedies are likely to be.

The Effect of Labor Participation Rates on Social Security Funding

The labor participation rate measures the ratio of employed workers to the total working age population. There are a couple of eye-popping elements in this simple statistic that will have significant economic consequences over the same 40-year period when the population aged 60 and older will more than double.

Even if workers of every age were treated equally, this increase in an aging population would still represent a real problem for Social Security, which depends upon the contributions of current workers to fund benefits for those who have retired.

Workers over 60 soon become workers of retirement age, with the result that this group, which includes the populous baby boomer generation, will require increasing contributory amounts from current workers to keep Social Security funded. The problem is that too few workers will be making contributions and too many retirees will be drawing benefits. That’s even in the best case, when all workers are treated equally.

But all workers are not treated equally. As I’ve written in more detail in an earlier article in this series on aging, workers begin to suffer from involuntary layoffs at age 40.

By age 50, more than half will find themselves involuntarily removed from their jobs. This describes a labor participation rate artificially reduced by what amounts to a prejudice against older workers.

This shrunken workforce can’t possibly make sufficient Social Security contributions to provide the needed retirement benefits for a rapidly growing aging population with increasing longevity. But that’s only one element of this age-related economic crisis.

A Society Moving in the Wrong Direction

Congress has long been aware that without some change in the contributory structure, Social Security will eventually run out of money, most likely before 2035. For an equally long time, Congress has been unable to do anything about it. The increasingly bitter partisan divide over entitlements, especially Social Security, Medicare, and Medicaid, has made finding a solution acceptable to both Democrats and Republicans elusive at best.

The Democratic position, represented by groups like The Center for American Progress, is that existing tax breaks for the ultrawealthy have contributed to an unsustainable degree of economic inequality.

Increasing those taxes effectively solves two problems: the social dysfunction of extreme inequality and the shortfalls in existing entitlement programs. Making up the shortfall with tax increases won’t be easy. In 2019, Social Security and Medicare cost about 9% of GDP. In 40 years, they’ll cost nearly 12%.

Republicans in Congress strongly oppose funding entitlements “on the backs of the rich.” One popular Republican solution to the Social Security shortfall problem is simply to do away with it in its current form.

Instead, Republicans have proposed an entirely different way of killing two birds with one stone: instead of increasing taxes on the rich to both reduce inequality and fund Social Security, conservative publications like The Federalist have proposed privatizing Social Security to increase benefits while reducing government involvement.

How would this work? Well, for one thing, each participant would obtain their benefits directly from their own contributions. Most likely these would be invested in the stock market, much along the lines of existing 401(k) plans. Democrats find this kind of solution deeply abhorrent — an abnegation of government responsibility unlikely to work.

If the U.S were truly, as we would like to believe, a fully participatory democracy, the Social Security shortfall problem would already have been solved. According to a research study funded by The National Academy of Social Insurance, 83% of Americans want Social Security fully funded “even if it means increasing the Social Security taxes paid by wealthy Americans.” This view, according the study, holds true across party lines and income levels.

But the U.S is not a fully participatory democracy. It is more like a vulnerable and damaged democracy trying to balance citizens’ wants with imperatives demanded by powerful, influential, and not necessarily democratic actors.

The Social Security shortfall, like many other growing crises in the country, will likely by solved, at least to a degree, but only at great cost years after a better lower-cost solution could have been achieved.

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Which industries will benefit most from the industrial internet of things?

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A common statement among historians of the 1849 gold rush was that the people who were most likely to make the most money from their endeavors were the ones who made tools for the miners and not the actual miners themselves.

As industries like transportation, manufacturing, technology, energy and healthcare pursue success with the industrial internet of things (IIoT), this colloquial wisdom stands true. IIoT equips these sectors with the information to operate their businesses more effectively.

It’s no wonder why a majority of the companies who successfully use this technology have reported increases in revenue.

To understand why this is, we must look to the challenges industries are working to overcome and how IIoT helps them cross this digital chasm in business.

Imagine if you’re part of the power grid in the center of Phoenix, Arizona, with high temperatures averaging above 100 degrees for months at a time. For your region, controlling temperature to make it livable for every day is a critical foundation of the city.

In fact, the ability to route power to a specific area experiencing a meteorological event so efficiently is the source of millions upon millions of dollars in energy and utility spend across the country. By cooling off homes in a specific region before a heat wave hits, regions are saving millions of dollars on energy and receiving money back from the government for doing so.

This story goes on across many other industries, including transportation and healthcare. The industries who have data closest to the problem or provide people enough data to make decisions faster are key.

By 2025, 75% of data in these industries is expected to move out of company environments and in our environments — an area known as the edge. Overall, this massive shift in data is a pretty big jump from the 10% of industrial data at the edge today.

IIoT is growing at a rate far greater than most fields. So why is it that industries across tech, transportation, energy, manufacturing, and healthcare are receiving such a big value with the introduction of IIoT?

In order to see the value it brings to these industries, we have to dive into what’s happening in these industries today and the opportunities they might achieve tomorrow.

For many of these industries, their systems, production mechanisms and technology were created up to 30 years ago. From aging facilities and oil rigs in Southern California pumping energy out of the ground to the modern-day automobile engine, not much has changed in the mechanics that contribute to these highly reliable systems.

With IIoT, companies are able to attach sensors or make decisions at the edge, which reduces the time it would take to get information back to the office or a car shop.

Business processes like predictive maintenance in manufacturing and transportation will help replace industrial parts before they fail. This is the case even in the energy sector and healthcare, where having continuous operations and avoiding system downtime may mean the difference between life and death.

As business leaders, managers and experts across the industries look to where they should bring about their next innovation, IIoT becomes even more crucial. It will be critical for any industry that operates in the field, even defense and aerospace, to leverage this technology.

If you’re a manager in transportation, high tech, manufacturing, factory automation, energy or healthcare, look no further for the technology disrupting industry today.

My hope is that, much like the forty-niners, these industries get the tools they deserve to bring us into a new age we’ve never seen before.

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Are you playing in the right healthcare sandbox?

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Within the healthcare industry, there are endless choices when it comes to carving out the career path that’s right for you. Whether in medicine, nursing, leadership, or elsewhere, the world can indeed be your oyster if you play your cards right, network assiduously, make good choices, follow your values, and honor your intuition.

We can, of course, encounter option paralysis when faced with too many alternatives; however, with a burgeoning healthcare industry facing an increasingly aging and diversifying population, the avenues for career success and satisfaction are legion. So, are you playing in the right career sandbox?

What You Want Matters

If you decide to become a nurse, there will be plenty of people with strong opinions about where you should work after graduation, what kinds of nursing are best to pursue, and how you should structure and plan your new career. If you go into medicine, the same plethora of choices and opinions apply, and there are plenty of sandboxes to choose from.

From physical therapists and speech language pathologists to those seeking success through informatics or public health, what you want matters more than any “shoulds” that your friends, colleagues, professors, family, and even total strangers impose on you. Those “shoulds” should likely go in one ear and out the other.

So, how does a newly minted healthcare professional make the right choices? Consider these notions for this process:

  • Why did you enter the healthcare arena in the first place? What drew you to this industry?
  • While you were in school, what were the experiences that held the most meaning for you?
  • Do you enjoy task-based work or are you more of a thinker, planner, leader, scientist, or theoretician?
  • Is patient care the thing that lights your fire? If not, it certainly isn’t the only game in town.
  • What are your career goals for 5 years, 10 years, and perhaps even 20 years hence? Do you have a plan or are you trusting your intuition and serendipity (a strategy that can actually be quite successful if you’re good at trusting your gut and being in the right place at the right time)?
  • If you’ve frequently been told what you “should” pursue, do any of those choices feel right?
  • Where do your greatest talents and strengths lie vis-à-vis the skills and knowledge inherent in your new career?
  • If you have a sense of what you want in the mid- or long-term, what path(s) do you feel are most likely to get you where you want to go?
  • Are there others who’ve carved a professional niche that you would like to emulate?
  • Do you have debts and financial concerns that your new career must adequately address?
  • Will the career path you’re planning allow you to create the lifestyle you desire and deserve?

These and other questions can help you focus on what’s most important, leading you in a direction that’s aligned with your desires, goals, strengths, and personal/professional interests.

There’s No Shortage of Sandboxes

Let’s say you graduate from nursing school and take a med-surg position because everyone said you should. After a year or so, you realize that acute care nursing is far from what you really want to do.

With your clinical skills, knowledge, and experience, you can plot any career course that can move you in the direction of the professional satisfaction and lifestyle you desire. However, in order to accomplish this, you need to know yourself well so that your choices are aligned with your true nature.

If you’ve finished medical residency and landed a position that doesn’t suit you, you may feel locked into your chosen specialty even though you’re beginning to chafe at the restrictions of your current path. Remember that when you see only limited choices, it’s probably because your thinking is limited; can you open the window and let in the fresh air of your many potential options?

And if you’ve chosen a clinical career route (RN, MD, PT, etc.) but then realize you have more gifts in areas like leadership, informatics, or other nonclinical milieus, you must realize that an informatics nurse is as valuable as an oncology nurse, and a medical consultant is as valid a choice as that of trauma surgeon. In our society, certain roles seem to hold more prestige than others, but you truly need to ignore those unfounded opinions and chart your own course.

There are, of course, many healthcare career sandboxes in which you can play. Make prudent choices, listen to the voice inside of you more than the ones imposing their will from the outside, and trust the power of your intuition and self-knowledge. The world is truly at your feet; can you see the possibilities?

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2019: The year of patient health record breaches

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Patient health record breaches are on a big rise this year, doubling last year’s figures. About 32 million patient records have already been breached during the first half of 2019, twice as many as the total for all of 2018, according to the 2019 Mid-Year Breach Barometer Report from IT security firm Protenus.

For reference, 2018 experienced more than 15 million patient records breaches. Current numbers for the first half of the year also point to the fact that there were 285 total breaches reported between January and June.

Surprisingly and shockingly, since 2016, not a day has gone by without a breach. Most of those reportedly have happened during the first half of the current year, with 59% because of hacking.

Insider error contributed only 21% of the total. Loss or theft resulted in 9%. Unknown reasons caused the remaining breaches.

Breach activity details are as follows: 41 in January; 38 in February; 43 in March; 57 in April; 67 in May; and 39 in June. The number of breaches in May were responsible for 21 million breached patient records.

The most significant breach in the first half of 2019 was a hack of the American Medical Collection Agency. The agency works with the likes of Quest Diagnostics and LabCorp. Hackers accessed sensitive medical information, with data eventually found for sale on the dark web.

According to the Protenus study, the majority of breaches (72%) occurred in the provider setting. That equates to 205 breaches, compared to the 32 in a health plan; 26 by a business associate or third-party vendor; and 22 disclosed by businesses organization.

The AMCA breach “contributes significantly to this sharp increase in affected patient records and is an unfortunate example of the damage that can be done by hacking incidents that remain undiscovered over long periods,” Protenus said in its report.

For the discovered breaches, discovery took an average of 214 days, but time until discovery varied, from one day to eight-and-a-half-years.

Of the 135 incidents involving hacking that disclosed details to HHS or the media, 27 were because of ransomware or malware; 88 because of phishing attacks and one extortion.

Most of the insider breaches are not malicious. Research from Forrester shows the most significant volume of these security breaches (36%) comes from ignorant or careless user actions that inadvertently cause security breaches. IT professionals often feel that naive users pose the most significant security risk to their organization.

Users share their credentials or share sensitive data or information daily. Research featuring 2,000 U.S. and U.K. desk workers found more than half (52%) of employees see no security risk to their employer in sharing work logins.

The Protenus study found that, geographically, California had the most data breaches by state so far in 2019, 26 incidents. Texas was second with 22 and Florida had 20.

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Improvise, adapt, overcome: Change is inevitable

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“Improvise! Adapt! Overcome!” I feel like I’m doing this a lot lately. I first heard this phrase when my son was in high school — it’s what his AP chemistry teacher barked at his students when they complained. Considered an informal U.S. Marines slogan, it sure can help direct us when we’re faced with change — be it desired or not.

Most of us are content operating within our regularities, routines and rituals. We like the stability and safety of the status quo.

When things get shaken up, often we get frustrated, impatient, and mad. Or frightened. A diagnosis, death, job loss, and aging all require us to move into a new normal.

Think, too, of the task of moving. Most of us hate the massive upheaval this singular event produces and don’t really start to feel settled until after we’ve put everything away and returned to some sort of rhythm.

Even when we are doing something fun — like going on vacation — it can be disruptive. How often have we said, “It feels so good to be back home?”

Recently, I traveled with my elderly mother. While navigating traffic and airports is challenging at any age these days, I got to see firsthand how difficult it can be to adjust as we get older. Although she was a real trooper and was delighted to go, the journey took its toll. She’s still not quite back up to speed.

What happens physiologically when we are confronted with change, good or bad? Neuroscience explains our resistance to it — our brain initially considers change a possible threat to our survival.

Dr. Sanam Hafeez, a licensed clinical psychologist and neuropsychologist, noted in an NBC News article, “From an evolutionary standpoint we develop these neural pathways to adapt to live, so when we encounter change our brain shifts into a protective mode. It has to use energy from reserves and it doesn’t know, from that evolutionary standpoint, if the change is good for us or not. It doesn’t know if this change is a one-time deal or whether it needs to re-establish a routine. ‘Will it hurt me?’ A lot of red flags go up.”

She continues, “If you stretch your brain passed its comfort zone, you’re opening the door to being receptive to other types of change.”

So, it’s actually good for us to get out of our ruts, switch things up and challenge ourselves.

Not only does it stave over off cognitive impairments, we become more confident. We realize we are no longer stuck in the muck that we think we are. Once able to muster up enough hyperspeed and break through our habitual orbit, we find a whole new universe out there.

Then, there’s no going back. There’s also a rippling effect. Family systems theory teaches us when one person in the family changes, the whole system does as well.

Start with simple changes. Try using a different hand to eat with. Exercise in the morning instead of the evening. Notice how you feel. Surprised? Did you get a different result?

Apply it emotionally as well. Carlos Castaneda wrote, “Things don’t change, only the way you look at them.” Currently, I’m cultivating changing my lens regarding a hurtful interaction. I’m viewing it now as an opportunity for practice. More human homework! It’s become my teacher on how to love bigger.

Whether it’s an external situation or internal dilemma that’s requiring our shape shifting, by improvising, adapting and overcoming we can, indeed, change.

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Hyperbaric oxygen therapy: The 30-day requirement for diabetic foot ulcers

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This article originally appeared on WoundReference.

When denying HBO services, Medicare generally issues statements explaining reasons for denial. Insufficient documentation is among the most frequent ones. Below is a statement from Wisconsin Physician Services (Medicare Administrative Contractor, or MAC) in response to records that were submitted by a provider’s office for a patient with a Wagner Grade 3 DFU.

“A review of 30 units of HBO therapy services billed on the claim for dates of service _____ through ______ was performed. The HBO therapy services initially denied, as the documentation was insufficient to support the services were medically reasonable and necessary. The 30 units of HBO therapy services will remain denied.

This decision was made in accordance with the Centers for Medicare & Medicaid Services (CMS) Internet Only Manual (IOM), Publication 100-3, Medicare National Coverage Determination (NCD) Manual, Chapter 1, Part 1, Section 20.29. This regulation outlines the covered and non-covered conditions for which Medicare will allow payment for HBO therapy services

The records indicated that HBO treatment began on __________, however the documentation did not include previous wound care records with measurements and records of medical/surgical management to support that the wound demonstrated no signs of healing with conventional treatment for at least 30 days prior to the start of HBO therapy.”

Importance of HBO for DFU treatment

Hyperbaric oxygen therapy (HBO) for diabetic foot ulcers (DFU) has been shown to improve healing rates and decrease the number of major amputations in the diabetic population. Recent research and evidence have driven the new paradigm of aggressive treatment and the attempt to save a limb, if at all possible, to prevent the morbidity and mortality associated with a major amputation.

HBO is an accepted and approved treatment for DFUs by the Center for Medicare Studies (CMS) and by third-party insurance payers. Patients require careful screening and selection, and the recommendations set forth by CMS and the Undersea and Hyperbaric Medicine Society should be followed.

The use of HBO therapy is covered as adjunctive therapy only after there are no measurable signs of healing for at least 30 days of treatment with standard wound therapy. Also, HBO must be used in addition to standard wound care.

We have developed an easy to use tool for providers to reference prior to initiating HBOT for the DFU (see link in “Closing” below). Find out what criteria and documentation should be in place to support medical necessity and ensure insurance coverage.

Guide for HBO use for DFUs

The Center’s for Medicare and Medicaid Services National Coverage Determination 20.29 states the criteria that must be present and clearly documented in order to meet the medical necessity requirements to initiate hyperbaric oxygen therapy for the Diabetic wounds of the lower extremities. The Criteria are as follows:

  1. Patient has type I or type II diabetes and has a lower extremity wound that is due to diabetes;
  2. Patient has a wound classified as Wagner grade III or higher; and
  3. Patient has failed an adequate course of standard wound therapy.

The use of HBO therapy is covered as adjunctive therapy only after there are no measurable signs of healing for at least 30 days of treatment with standard wound therapy and must be used in addition to standard wound care.

Standard wound care in patients with diabetic wounds includes:

  1. Assessment of a patient’s vascular status and correction of any vascular problems in the affected limb if possible,
  2. Optimization of nutritional status,
  3. Optimization of glucose control,
  4. Debridement by any means to remove devitalized tissue, maintenance of a clean, moist bed of granulation tissue with appropriate moist dressings,
  5. Appropriate off-loading, and necessary treatment to resolve any infection that might be present.

There is further clarification to this in the Novitas Medicare Administrative Contractor (MAC) Local Coverage Determination (LCD) L35021 and First Coast Service Options (MAC) LCD 36504

Wound volume or surface area is expected to measurably diminish over 30 days of wound care.

“Measurable signs of healing” are best defined as specific, documented, clinical evidence of healing. Physician statements should be descriptive and complete with interval measurements to substantiate wound improvement.

Documentation of all aspects of optimization defined by the NCD (clarified by these LCDS) and the absence of improvement in the wound characteristics constitutes stalled wound healing and suggests that it may benefit from adjunctive HBOT.

So, when does the 30-day clock start and how do you document it?

The clock starts with the patient consultation in your wound center. This allows the provider to ensure Standard of Care has been initiated, maintained and measured to ensure HBOT is medically necessary for treatment of the DFU.

Some might say the clock could start with the referring provider if Standard of Care was provided there. The responsibility falls in the lap of the wound department to ensure that you have obtained all of the documentation supporting standard of care and can produce it for a Medicare audit.

Document at least weekly that you continue to address the standards care, making changes if measurable signs of healing are not present, and include wound measurements & assessment.

During the initial evaluation, the wound provider should immediately institute and document the standard of care steps listed above and state the date of initiation in the History and physical (H&P).

Document any interventions:

  • Antibiotic therapy
  • Laboratory and Pathology findings
  • Radiology studies/ findings
  • Vascular studies/ findings
  • Operative and procedure reports such as debridement

Tell the story: At the end of 30 days, the provider should dictate a separate HBO H&P that clearly states the indication being recommended (DFU) and “tell the story”. Provide the payer with clear and organized documentation.

Remember, you are trying to support that the patient received conventional wound care with no measurable signs of healing for 30 days (before initiating HBOT).


An effective approach to meet medical necessity guidelines is critical.

With the current state of CMS audits through the Targeted Probe and Educate initiative, it is imperative that Wound and HBO centers develop an organized and effective approach for documentation in order to meet medical necessity guidelines.

We have developed an easy to use tool for providers to reference prior to initiating HBOT for the DFU, the “HBO request requirements checklist,” part of the Diabetic Foot Ulcer – Hyperbaric Oxygen Therapy Treatment Protocol Guideline. This tool includes the CMS criteria for the DFU and should be accessible to all providers.


To read more on DFU and HBO, see “Diabetic Foot Ulcer – Hyperbaric Oxygen Therapy” on the WoundReference Hyperbaric Oxygen Therapy Knowledge Base.

The WoundReference Hyperbaric Oxygen Therapy Knowledge Basefeatures guidelines and other important tools to promote high standards of patient care and operational safety within the hyperbaric program. The WoundReference Curbside Consult gives you actionable, specific answers from our expert panel in a timely manner.

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Dentistry of the future? An army of miniature robots could wipe out tooth decay

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What if, with one marching order, a swarm of micro-robots (directed by magnets!) could break apart and remove dental plaque from a tooth? A cross-disciplinary partnership among dentists, biologists and engineers agree that it’s possible in the very near future.

A team of scientists from the three fields at the University of Pennsylvania have developed a microscopic robotic cleaning crew. With two types of robotic systems — one designed to work on surfaces and the other to operate inside confined spaces — the scientists showed that robots could ably destroy biofilms, the sticky amalgamations of bacteria enmeshed in a protective scaffolding.

Robotic biofilm-removal systems like the one they developed could be valuable in a wide range of potential applications, from keeping dental tools clean to reducing the risk of tooth decay, endodontic infections and implant contamination.

The work, published in Science Robotics, was led by Hyun (Michel) Koo of the School of Dental Medicine and Edward Steager of the School of Engineering and Applied Science.

“This was a truly synergistic and multidisciplinary interaction,” said Koo. “We’re leveraging the expertise of microbiologists and clinician-scientists as well as engineers to design the best microbial eradication system possible. This is important to other biomedical fields facing drug-resistant biofilms as we approach a post-antibiotic era.”

Addressing plaque that occurs on teeth requires a great deal of manual labor, both on the part of the consumer and the dentist. This project was birthed with the hope of improving treatment options as well as reducing the difficulty of care.

To advance the project along its journey to clinical use, the researchers are receiving support from the Penn Center for Health, Devices, and Technology, an initiative supported by Penn’s Perelman School of Medicine, Penn Engineering, and the Office of the Vice Provost for Research.

Penn Health-Tech, as it’s known, awards select interdisciplinary groups with support to create new health technologies, and the robotic platforms project was one of those awarded support in 2018.

“The team has a great clinical background on the dental side and a great technical background on the engineering side,” says Victoria Berenholz, executive director of Penn Health-Tech. “We’re here to round them out on the business side. They have really done a fantastic job on the project.”

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Infographic: Opioids and the American workplace

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The opioid crisis is consuming our society, and not much is currently being done about it. It has even started to affect workplaces, where 31% have already seen an overdose, injury, or arrest related to opioids.

Getting people the help they need is about more than just being compassionate — it can also make a workplace safer. Employees who are suffering from addiction can often feel their job would be threatened if they were to come forward and seek help. Providing employees with a path to rehab and then back into the workplace can address the opioid crisis head-on.

Learn more about opioids in the workplace from the infographic below.

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