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Prevalence of cancer in Australia is high, and metastatic spread increases the risk of cancer-related deaths in 9 out of 10 patients. Early detection of cancer and monitoring of treatment effectiveness are therefore paramount to improving overall quality of life and survival of many Australians. The Circulating Tumour Cell (CTC) blood test is a useful screening tool to assess treatment effectiveness. CTC are biomarkers for cancer, with higher CTC counts associated with greater risk of cancer and metastasing potential. Our first in-human Photodynamic Therapy (PDT) Lightbed study involving 85 cancer patients found that PDT using a Lightbed directly after HyperBaric Oxygen Therapy (HBOT) reduced CTC count - by up to 90% - in 75% of patients after 1 week, and almost all patients (93%) after 3 months. Therapy consisted of oral intake of a chlorophyll-based liquid photosensitiser 16-20 hours before combination of 60 minutes of HBOT followed immediately by 30 minutes of lightbed therapy (whole body red light). PDT lightbed therapy was highly tolerable. [ABSTRACT FROM AUTHOR]

Introduction: Blood glucose levels may be influenced by hyperbaric oxygen treatment (HBOT). Patients with diabetes mellitus commonly receive HBOT but there is a lack of standardised blood glucose management guidelines. We documented relevant contemporary practices applied for patients with diabetes treated in hyperbaric medicine units. Methods: A survey was administered in 2022 to the directors of all 13 accredited hyperbaric units in Australia and New Zealand to identify policies and practices related to management of patients with diabetes receiving HBOT. Results: Twelve of the 13 units routinely managed patients with diabetes. Three-quarters (9/12) used < 4 mmol·l-1 as their definition of hypoglycaemia, whereas the other three used < 5, < 3.6, and < 3 mmol·l-1. Units reported 26% (range 13-66%) of their patients have a diagnosis of diabetes of which 93% are type 2. Ten (83%) units reported specific written protocols for managing blood glucose. Protocols were more likely to be followed by nursing (73%) than medical staff (45%). Ten (83%) units routinely tested blood glucose levels on all patients with diabetes. Preferred pre-treatment values for treatments in both multiplace and monoplace chambers ranged from = 4 to = 8 mmol·l-1. Seven (58%) units reported continuation of routine testing throughout a treatment course with five (42%) units having criteria-based rules for discontinuing testing for stable patients over multiple treatments. Two-thirds of units were satisfied with their current policy. Conclusions: This survey highlights the burden of diabetes on patients treated with HBOT and identifies considerable variability in practices which may benefit from further study to optimise management of these patients. [ABSTRACT FROM AUTHOR]

Introduction: This study analysed the treatment outcomes of patients that received hyperbaric oxygen treatment (HBOT) for retinal artery occlusion (RAO) at the Royal Brisbane and Women's Hospital in Brisbane, Australia between 2015 and 2021., Methods: Retrospective study from patient records including 22 eyes from 22 patients that received HBOT for either central RAO (17 patients) or branch RAO (five patients). Patients received the Royal Brisbane and Women's Hospital RAO protocol for their HBOT. Analysis included best corrected visual acuity pre- and post-treatment, subjective improvements, side effects and patient risk factors were also recorded., Results: Improvement in best corrected visual acuity was LogMAR -0.2 for central RAO on average with 8/17 (47%) experiencing objective improvement, 5/17 (29%) experienced no change and 4/22 (24%) experienced a reduction in best corrected visual acuity. Subjective improvement (colour perception or visual fields) was reported in an additional 4/17 patients, resulting in 12/17 (71%) reporting improvement either in visual acuity or subjectively. There was no improvement in the best corrected visual acuity of any of the five patients suffering from branch RAO. Cardiovascular risk factors present in the cohort included hypertension, hypercholesterolaemia, previous cardiovascular events, cardiac disease and smoking. Limited side effects were experienced by this patient cohort with no recorded irreversible side effects., Conclusions: Hyperbaric oxygen treatment appears a safe, beneficial treatment for central RAO. No benefit was demonstrated in branch RAO although numbers were small. Increased awareness of HBOT for RAO resulting in streamlined referrals and transfers and greater uptake of this intervention may further improve patient outcomes., (Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.)

Background Low value care (LVC) services have limited or no benefit to patients, and curtailing LVC can curb unnecessary spending and improve the quality of care. Some public hospitals in Australia have financial incentives to perform procedures for patients with private health insurance, yet little is known if there are differences in LVC between public and private patients. Methods We performed a retrospective analysis of New South Wales public hospital data from January 2013 to June 2018. We measured hospital-specific rates of five LVC services and compared rates within each public hospital by patient funding status (private or public), descriptively and using random-slope multilevel models. Results Overall rates of LVC varied between services, ranging from 0.3 to 30.8 procedures per 1,000 eligible patients for hyperbaric oxygen therapy and vertebroplasty, respectively. There was large variation in rates of the LVC services between hospitals, and a few hospitals had higher rates of LVC among private than public patients. However, we found no consistent association between patient funding status and LVC services: private patients had lower rates of knee arthroscopic debridement than public patients (aOR:0.56) and higher rates of low value vertebroplasty for osteoporotic spinal fractures (aOR:1.08), hyperbaric oxygen therapy (aOR:1.53) and oophorectomy (aOR:1.77); all statistically non-significant. Conclusions Private patient funding may contribute to LVC in some public hospitals, but it was not consistently associated with higher rates of the five LVC services measured. Key messages Reducing LVC services requires investigating the role of health-system factors at both the global- and local-level. [ABSTRACT FROM AUTHOR]

Introduction: The vast majority of freshwater cave diving in Australia occurs within the limestone caves of the Gambier karst in the south-east of South Australia. The incidence of decompression illness (DCI) in cave divers is presumed to be higher than open-water recreational divers because of the greater depths involved, but has not previously been reported. Our aim was to determine the incidence of DCI in cave divers, the patterns of diving and the outcome of hyperbaric treatment. Methods: This was a retrospective cohort study of cave divers with DCI presenting to the Royal Adelaide Hospital or The Alfred Hospital over a 10-year period between 2002 and 2012. We reviewed case notes of cave divers who were treated for DCI after diving in the Mt Gambier karst. As there are no records of the number of dives performed during the study period we generated a denominator for the incidence of DCI by extrapolating available data and making a number of assumptions about the number of dives per dive permit issued. Results: Sixteen patients were treated for DCI during the study period. The precipitating dive was a single deep decompression dive in seven cases, multiday repetitive dive sequences in eight and a non-decompression dive in one. Three of the 16 cases of DCI involved dives in excess of 90 metres' fresh water (mfw) using trimix. As the total estimated number of dives in the study period was approximately 57,000 the incidence of DCI in Australian cave divers was estimated to be 2.8:10,000 (0.028%). It is possible that the overall incidence of DCI is as high as 0.05%, and even higher when dives to depths greater than 90 mfw are involved. Conclusions: The estimated incidence of DCS in this series is lower than expected but consistent with other series describing DCI in cold-water recreational diving. [ABSTRACT FROM AUTHOR]

The article discusses a study on paediatric hyperbaric oxygen therapy (HBOT) in Australia. The study involved patients treated at four hyperbaric medical units between January 1998 and December 2011. Some adverse events linked with HBOT therapy included middle ear barotraumas, progressive hypoxaemia and central nervous system oxygen toxicity. The study found that hyperbaric oxygen therapy in children is associated with low rates of complications.

The article presents a report on the Hyperbaric Technicians and Nurses Association 2011 Workshop. The workshop's goal was to develop a series of consensus to guide practice around Australia and New Zealand by examining the use of deep recompression treatment tables for treatment of decompression illness. It discusses evidence summary and medical considerations. It also looks at several deep tables including Comex 30 and 50, Hawaiian tables, and U.S. Navy Treatment Table 6A.

Aim: To compare Australian and New Zealand (NZ) rates of referral to hyperbaric units for patients with, or at risk of developing mandibular or maxillary osteoradionecrosis (ORN) due to a history of radiotherapy for oro-pharyngeal cancer. Method: Relevant patient treatment data from all hyperbaric units in Australia and NZ were collated and analysed. Results: The rate of referral to hyperbaric units in Australia for treatment or prophylaxis of patients with, or at risk of orofacial ORN, was 1.7 times the rate of referral in NZ. Within Australia, there was a greater than three-fold interstate variation. Conclusion: There is a significant referral rate difference both within Australia and between Australia and NZ for hyperbaric oxygen therapy for oro-facial ORN. Possible reasons for this difference include access to funding, logistical difficulties, clinician preference for an alternative treatment and clinician attitudes to hyperbaric oxygen. [ABSTRACT FROM AUTHOR]

Aims and objectives. To examine patients’ memories and experiences of hyperbaric oxygen therapy in a multiplace chamber of a hyperbaric medicine unit in Australia. Background. There is minimal literature available documenting patients’ feelings and memories of hyperbaric oxygen therapy, particularly in a multiplace chamber. Design. Exploratory. Methods. A convenience sample of seven non-emergency patients was interviewed separately at the conclusion of their multi-session therapy. A semi-structured approach elicited in-depth information regarding their experiences and memories of the hyperbaric oxygen therapy. Interviews were 30–45 minutes long and audiotaped for transcription and analysis. Field notes were also used to note non-verbal cues and other observations not evident from the audio material. Data collection ceased when data saturation was evident from the interviews. Interview transcripts were examined using a content analysis approach, with textual coding and thematic development. Results. Issues derived from the data included: the uncertainty of the treatment; the noise and cold of the chamber; the discomfort of the mask or hood; and the boredom. Participant responses to the therapy related to previous noxious experiences and the individual's personality. Conclusions. This information was used to examine ways of reducing any negative feelings and experiences associated with hyperbaric oxygen therapy, thus improving the service provided to patients. Relevance to clinical practice. Identification of these stressors and related issues may also enable subsequent development of a risk-stratification instrument to predict patients who do not complete treatment. [ABSTRACT FROM AUTHOR]

Introduction: Hyperbaric oxygen treatment (HBOT) may be complicated by oxygen toxicity seizures, which typically occur with hyperbaric partial pressures of oxygen exceeding 203 kPa (2 atmospheres absolute). All other hyperbaric units in Australia exclusively use a multiplace chamber when treating with United States Navy Treatment Table 6 (USN TT6) due to this perceived risk. The purpose of this study was to determine the safety of a monoplace chamber when treating decompression illness (DCI) with USN TT6., Methods: A retrospective review of the medical records of all patients treated at Fiona Stanley Hospital Hyperbaric Medicine Unit with USN TT6 between November 2014 and June 2020 was undertaken. These data were combined with previous results from studies performed at our hyperbaric unit at Fremantle Hospital from 1989 to 2014, creating a data set covering a 30-year period., Results: One thousand treatments with USN TT6 were performed between 1989 and 2020; 331 in a monoplace chamber and 669 in a multiplace chamber. Four seizures occurred: a rate of 0.59% (1/167) in a multiplace chamber; and none in a monoplace chamber, indicating no statistically significant difference between seizures in a monoplace versus multiplace chamber (P = 0.31)., Conclusions: The rate of oxygen toxicity seizures in a monoplace chamber is not significantly higher than for treatment in the multiplace chamber. We conclude that using the monoplace chamber for USN TT6 in selected patients poses an acceptably low seizure risk., (Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.)

Introduction: This paper presents a quantitative and qualitative study exploring patients' knowledge and experience of hyperbaric oxygen treatment (HBOT)., Methods: Participants included 29 patients with appropriate indications who were undertaking HBOT at facilities in two different locations: Hobart, Australia, and Plymouth, United Kingdom. Participants completed surveys prior to commencing HBOT, after five sessions, and on completion of HBOT. Semi-structured one-to-one interviews were conducted with each individual on conclusion of their course. Data were analysed using descriptive statistics and interpretive description., Results: Prior to referral, 15/29 (52%) of participants knew HBOT was used to treat divers, and of these, 9/15 (60%) were familiar with its use for non-divers. Only one third sought additional information about the process between referral for HBOT and attending their medical assessment. Anxiety was a pre-treatment concern amongst participants. However, when re-measured after five sessions and upon completion of the HBOT course, anxiety was reduced. The interview data revealed themes based around the physical, emotional and social aspects of HBOT: (1) anxiety within self; (2) naivety to normalisation; (3) enjoyment being a 'diver'; and (4) burdens of HBOT., Conclusions: Many patients experienced anxiety prior to commencing HBOT but, with support, quickly adjusted to treatment, transitioning from a state of naivety to normalisation in their experience of the hyperbaric chamber. They enjoyed feeling like a 'diver' and considered aspects of the burdens of treatment, such as finances or logistics, a minor inconvenience. These results highlight the need for psychosocial support during treatment by identifying gaps in patient preparation for HBOT., (Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.)

Introduction: Idiopathic sudden sensorineural hearing loss (ISSHL) is an otolaryngologic emergency. The Undersea and Hyperbaric Medicine Society (UHMS) revised practice guidelines in 2014 adding ISSHL to approved indications. This study investigated whether the UHMS guidelines influenced referral and practice in Australia and New Zealand., Methods: Retrospective review of 319 patient referrals in two time periods (five years prior to addition of ISSHL to indications (T-PRE) and three years post (T-POST))., Results: Seven of eight participating hyperbaric facilities provided data down to the level of the indication for HBOT for analysis. In T-PRE 136 patients were treated with HBOT for ISSHL, representing between 0% and 18% of the total cases to each facility. In the T-POST period 183 patients were treated for ISSHL, representing from 0.35% to 24.8% of the total patients in each facility. Comparison between the two periods shows the proportion of patients treated with ISSHL among all indications increased from 3.2% to 12.1% (P < 0.0009). One facility accounted for 74% (101/136) of ISSHL patients receiving HBOT in T-PRE and 63% (116/183) in T-POST. ISSHL case load at that facility increased from 18% to 24.8% (P = 0.009) after the UHMS guideline publication. Three of the seven units had a significant increase in referrals after the guideline change., Conclusion: There remains equipoise regarding HBOT in the management of ISSHL. Only three out of seven units had a significant increase in ISSHL patients after the UHMS guidelines publication. Without well controlled RCTs to develop guidelines based on good evidence this is unlikely to change and practice variation will continue., (Copyright: This article is the copyright of the authors who grant Diving and Hyperbaric Medicine a non-exclusive licence to publish the article in electronic and other forms.)

Introduction: Hyperbaric oxygen therapy (HBOT) has been suggested to improve healing of lower limb ulcers, though the quality of available evidence is weak to moderate. This study assessed the opinions and use of HBOT by specialists treating lower limb ulcers., Research Design and Methods: Accredited vascular surgeons and podiatrists in Australia and New Zealand were sent an online survey via their professional organizations. The survey asked about their use and opinions of HBOT in treating lower limb ischemic, neuropathic and venous ulcers. Data were summarized with descriptive statistics. Non-parametric tests were used to compare survey results obtained from vascular surgeons and podiatrists., Results: 61 vascular surgeons and 40 podiatrists completed the survey. Thirty-seven specialists used HBOT for treating lower limb ulcers, with the remainder indicating they did not feel there was a role for HBOT (n=25) or did not have access to HBOT (n=39). Less than 8% of specialists indicated that HBOT frequently or always had a role in treating ischemic, neuropathic or venous ulcers. Compared with podiatrists, vascular surgeons were significantly less likely to indicate HBOT had a treatment role for any ulcer type (p<0.001, p=0.004, and p<0.001, respectively), though significantly more likely to indicate they currently used HBOT for treating lower limb ulcers (p<0.001). Most specialists (n=76) believed that a large clinical trial is needed to determine the efficacy of HBOT in treating lower limb ulcers., Conclusions: Vascular surgeons and podiatrists do not feel HBOT has a frequent role in treating lower limb ulcers, but do feel there needs to be a large clinical trial to test its value., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The article presents the Chairman's Report of the Australian and New Zealand Hyperbaric Medicine Group (ANZHMG) of the South Pacific Underwater Medicine Society (SPUMS). It elaborates on the submission on the Medicare funding for hyperbaric oxygen treatment of late soft-tissue radiation injury and non-diabetic hypoxic problem wounds. It also notes of the Australian Federal Government's non acknowledgment of SPUMS' input in the Safety Work Australia's task of developing a model legislation.

The article features a continuing medical education course on diver drug use and mental health. About 80% of questions in each quiz should be answered correctly to complete a course successfully. The course is aimed at anaesthetists and other specialists who are members of the Australia and New Zealand College of Anaesthetists SIG in Diving and Hyperbaric Medicine and members of the European Underwater and Baromedical Society (EUBS). The questions aim to affirm the takers' knowledge of the subjects covered.

The article discusses the treatment data collated and published by the Hyperbaric Technicians and Nurses Association (HTNA) from hyperbaric facilities in Australia and New Zealand in the magazine "Offgassing." The data collected from 2009 to 2010 shows the number of patients treated, total treatments, and chamber runs which are divided into 36 sub-categories in eight diagnostic groups. These include bubble injury, radiation tissue damage, and problem wounds.

The article presents developments in the Australian and New Zealand Hyperbaric Medicine Group (ANZHMG). The author announces the submission of reports to the Australian Federal Government Medical Services Authority Committee (MSAC) which seeks subsidy from Medicare for hyperbaric oxygen treatment of soft-tissue radiation injury and necrosis and non-diabetic problem wounds caused by hypoxia. He stresses that the reports are supported by the Australian Society of Anaesthetists and Australian Medical Association. A brief outline of the reports is provided.

The article presents the minutes of the Annual General Meeting of the Australian and New Zealand Hyperbaric Medicine Group on August 11, 2007. The difficulties faced by the journal "Diving and Hyperbaric Medicine" in attracting quality papers was discussed. An update on enrollment in the Hyperbaric Oxygen Radiation Tissue Injury Study (HORTIS) was also provided.

A man in his 50s presented to a rural Australian emergency department with complete unilateral hearing loss following transurethral resection of the prostate. His hearing impairment progressed from 'muffled hearing' with tinnitus on emergence from anaesthesia, to total sensorineural deafness by day three. His surgery and anaesthesia were uncomplicated and he had remained normotensive throughout. He had no pre-existing auditory disease. He had received 240 mg of intravenous gentamicin intraoperatively for surgical prophylaxis. Renal function was normal. Brain imaging was negative for structural pathology, stroke and circulatory insufficiency. Ear nose and throat advised 7 days of oral corticosteroids, transtympanic dexamethasone and hyperbaric oxygen therapy. A working diagnosis of gentamicin-induced ototoxicity was applied. Intervention has proven unsuccessful and there is no possibility for rehabilitation. The patient is permanently disabled., (2015 BMJ Publishing Group Ltd.)

The article discusses the official opening of the new hyperbaric facility at the Department of Diving and Hyperbaric Medicine at the Prince of Wales Hospital. It notes that the facility has a four-compartment multiplace recompression chamber deigned and built by Fink Engineering. It also offers information on the staffing of the department which is accredited for registrar training by the Australian and New Zealand College of Anaesthetists and the Australian College of Emergency Physicians.

The article discusses the eligibility criteria for candidates in the examination for the Australian and New Zealand College of Anaesthetists (ANZCA) Certificate in Diving and Hyperbaric Medicine in 2012. These reportedly include an Australian or New Zealand Specialist College Fellowship and completion of at least four weeks' training course in Diving Medicine and Hyperbaric Medicine. The alternative criteria for training courses are also given.

The article presents information on the Australian and New Zealand College of Anaesthetists (ANZCA) certificate in diving and hyperbaric medicine. Eligibility criteria include fellowship of a specialist college in Australia or New Zealand and completion of training courses in diving medicine and in hyperbaric medicine of at least 4 weeks' total duration.

The article reports on the Australian and New Zealand College of Anesthetists Special Interest Group-Diving and Hyperbaric Medicine (ANZCA SIG-DHM) scientific meeting conducted during the ANZCA annual scientific meeting in Melbourne, Australia on May 28, 2007. Speakers include Simon Mitchell, Bruce Speiss and David Smart. The role of perfluorocarbon emulsions in treating decompression illness and the role of the transcutaneous oximetry in hypoxic wounds were discussed in the meeting.

The article presents the eligibility criteria for the certificate in diving and hyperbaric medicine offered by the Australian and New Zealand College of Anaesthetists (ANZCA). One of the criteria is the completion of at least four weeks total training courses in diving medicine and in hyperbaric medicine like those offered by the Australian and New Zealand Hyperbaric Medicine Group and University of Auckland in New Zealand.

Introduction: We report the first use in Australia of hyperbaric oxygen therapy for sudden hearing loss following head trauma in a child with large vestibular aqueduct syndrome., Case Report: A 12-year-old boy with large vestibular aqueduct syndrome presented with significant hearing loss following head trauma. He was treated with steroids and hyperbaric oxygen therapy, with good improvement of hearing thresholds on audiography. This case represents the first reported use of hyperbaric oxygen therapy for this indication in Australia, following a few previous reports of patients in Japan. We review the literature on management of acute sensorineural hearing loss in large vestibular aqueduct syndrome. The reported case demonstrates a potentially beneficial therapy for a rare condition that usually results in an inevitable decline in hearing., Conclusion: Hyperbaric oxygen therapy can be tolerated well by children, and may represent a potential treatment for sudden sensorineural hearing loss in patients with large vestibular aqueduct syndrome.

These two attachments were in highly specialised fields of medicine and only loosely connected with anaesthesia. However, as a military anaesthetist, both of these areas are highly relevant. The jobs were of high quality from an educational and training perspective and were also allied with an increased amount of autonomy and responsibility appropriate to this stage of training.

We reviewed the records of the Australian Venom Research Unit and The Alfred Hospital Department of Hyperbaric Medicine from January 1992 to July 1998 and found 15 cases of skin ulceration after spider bite that could be followed up with the patient and the treating physician. Fourteen patients had skin ulceration attributed to white-tailed spider bites but in only three was this confirmed. One patient had skin necrosis after a confirmed black house spider bite. Recurrent skin ulceration occurred in nine of the 15 patients.

Since 1968, studies have been conducted in Australia and New Zealand to improve the results of treatment for invasive bladder cancer. The prognostic value of clinical stage and of ureteric obstruction has been confirmed. Radiotherapy has been established as appropriate treatment for the majority of patients with bladder cancer, most of whom are elderly and suffer from other health problems. There has been no additional benefit from radiosensitizers in increasing the effectiveness of radiotherapy such as hyperbaric oxygen or misonidazole, or from irradiation of the para-aortic nodes, all of which can result in additional toxicity without increasing tumour control. Pre-emptive chemotherapy with cisplatin has had no obvious impact on improving survival. Elective total cystectomy has shown the prognostic value of tumour downstaging by pre-operative pelvic radiotherapy. Although younger patients are usually selected for total cystectomy and urinary diversion, there is no evidence that, stage for stage, elective total cystectomy confers a survival advantage compared with radical pelvic radiotherapy.