Diving Medicine Research Ideas?

auzz · Jul 25, 2007

Hello,

Let us introduce ourselves, we are five medical students currently in our 4th year studying in London.

As part of our medical course, we are offered to organise Special Study Modules (also called Self selected modules), this gives us an oppurtunity to study into greater depth any medically related subject that is of interest to us.

In our initial investigation we read a bit around the various fields of adventure medicine and we found diving medicine as being the most interesting and exciting topic and we are keen on doing our special study module in this area. We were hoping to do a small research project on diving medicine. It would be nice to experience diving medicine first hand but at the same time contribute to its development by conducting some research. However the field of diving medicine is relatively new for us and hence it would be great to get your expert input regarding diving medicine related topics that warrant further research.

We have been allocated 4-5 weeks in the Nov/Dec period later this year, by our university to do the Special Study Module.

Any help will be much appreciated.

Thank You,
Auzz.

TSandM · Jul 25, 2007

auzz, it's great that you guys would like to do a reseach project related to diving medicine.

HERE's a thread on another board relating to things divers would like to see investigated. If you find this at all helpful, there were spinoff threads by the same author on various subtopics. (Note that somebody will have to register on the site to access the threads.)

HERE is a repository of a great deal of information on what has already been looked at and done. No matter what you might decide to work on, there will be helpful information here.

I don't know what equipment or resources you'll have access to, but one topic that's been brought up here a number of times recently is whether, in fact, there is any difference in susceptibility to DCS between women and men. Despite the fact that Doppler bubble scores don't correlate perfectly with DCS symptoms, it might be interesting to do a project where male and female divers did the same profiles and got Dopplered afterward, to see if there were any consistent differences in amounts of bubbling. That's a project that you could carry out in a few weeks, assuming you could muster the divers, and get the protocol through your IRB.

Gene_Hobbs · Jul 25, 2007

Hi Auzz,

This is a particularly interesting topic to me as we just presented an abstract at this years Undersea and Hyperbaric Medical Society (UHMS) Annual Meeting on this very topic. The abstract is below (Mods, please remove this if it is not appropriate), PM me if you would like a copy of the poster with the comments from the thread aggregated. The main goal of this abstract for the meeting was to facilitate better communication between researchers and divers. Given some of the conversations I have had since, I feel like this goal is well on its way. (EDIT: thanks TSandM for proving the link to that thread, the thread was broken into sub-topics and are also worth checking into.)

Hobbs GW, Armstrong BM, Armstrong HC, Schreiber JS, Kaylor ZM, Vann RD. What Can The Medical Community Do For Technical Divers? Undersea and Hyperbaric Medical Society Annual Meeting, Kapaluna, Maui Hawaii, 2007. (abstract in publication)

Hobbs et. al. - in press:
Rubicon Foundation, Inc., The Deco Stop, North Carolina State University, Divers Alert Network, Inc.

Introduction:
The Internet assists the growth of information sharing and communication of divers worldwide. In preparation for the DAN Technical Diving Symposium 2008, we wanted to facilitate communication between the technical divers and diving researchers. We requested information from technical divers on research needed to improve their safety. A thread and poll were posted to the forum asking the question "If it were up to you, which of the following areas would you like to see the hyperbaric/medical research community focus on?"

Methods:
The Rubicon Foundation requested the assistance of The Deco Stop (TDS), an Internet forum of technical divers from around the world. The TDS forum has 13,140 members and receives 3,000 visits per day. TDS software is vBulletin Version 3.6.1 (Jelsoft Enterprises Ltd. Pangbourne, UK). The poll was set up by forum moderators to allow members to vote for one category, listed below. The associated thread was used to discuss these specific topics as well as any others not included in the poll.

Results:
There were 255 members that elected to vote in the poll over the first 60 days. Votes were distributed as: Decompression Theory 110 (43.14%), Diver Health 43 (16.86%), Post-Mortem Accident Analysis 41 (16.08%), Oxygen Toxicity (CNS & Pulmonary) 28 (10.98%), Gas Narcosis 17 (6.67%), Basic Sciences 5 (1.96%), High Pressure Nervous Syndrome 4 (1.57%), Recompression Therapy 4 (1.57%), Thermal Stress 3 (1.18%).

Discussion:
This clarifies interests and risks incurred by technical divers recreationally and the potential use of these divers in further research. The thread and poll have remained open so that more opinions and comments could be collected in the future. The months of December through March have been historically lower participation months on the forum.

We are also in need of some help on our Repository project if that is of interest. (2 Duke Pre-med Undergrads and one MS3 are helping us now.)

As you are in London, I would also suggest talking to Jeysen Z. Yogaratnam at the University of Hull. Jeysen is a surgery resident and won the "best presentation" award for his presentation at the UHMS meeting this year.

Please let me know if I can be of any other assistance.

Mako Mark · Jul 25, 2007

I havent accessed the TDS thread, but two things that have always struck me as diving research that would be fairly simple to conduct but as far as I know havent been resolved are:

Long term effects on recreational dive professionals with regards to hearing loss compared to a non diving population.

and

the effects of repeated and sustained cold water immersion on the immune system.

Rick Murchison · Jul 25, 2007

My favorite compendium of diving medical info is at Dr. Ernest Campbell's Scubadoc's Diving Medicine site. While most of the papers are aimed at the layman, you may get a good overview of what's been done over the years and what's in need of more work.
Rick

Dr Deco · Jul 26, 2007

Hello auzz and friends :

With the time limits that you have, the most expeditious method for a research project, in my experience, is to link up to something already in progress. The amount of time necessary to do anything precludes starting from a dead stop.

Even individuals with a very extensive background in hyperbaric physiology would not be able to organize a project in a short time. (That is, it would need to pass the Institutional Review Board – for either humans or animals).

Any projects with humans require a long lead-time; even surveys by mail are time consuming. As Gene Hobbs suggests, connecting with a project such as his is very practical. If you find another project already underway, and are allowed to join, that would be a great piece of luck.

Dr Deco :doctor:

The next class in Decompression Physiology for 2007 is August 18-19. :1book:
This class is at the USC campus in Los Angeles.
http://wrigley.usc.edu/hyperbaric/advdeco.htm

Kingpatzer · Jul 26, 2007

I would love to see a study on the relationship between using various equalization techniques (Valsalva, Frenzel and Toynbee) with post-dive ear infections!

I suspect that the Valsalva is not only associated with barotrauma, but that even minor barotrauma can increase risk of infection.

You could set up a simple protocol with 3 groups each using only one of the three techniques to equalize, then swabbing the ear canal of all subjects to get a pre-dive bacterial count. Let the divers dive with all groups diving to prescribed depths, then re-swabbing the ears after each day of diving for some set period of time to get new counts.

You would need to find a steady supply of divers who would be willing to limit their equalization techniques and who would be all willing to dive similar profiles.

The above, being entirely non-invasive and observational should easily pass review. The question is could you get the permission in time?

cwilson · Jul 31, 2007

The external ear canal is not continuous with the eustation tube. Unless the participants perforated their ear drum, you would get as much information by swabbing their armpits (or other bodily nether regions).

What I assume you meant is that swabs should be taken of the lumen of the eustation tube. This would be pretty invasive, not to mention hard to do.

What could potentially be looked at would be the rate of infection say 4 weeks after the maneuver. However I think you would need a very large number of participants, because the rate of middle or inner ear infection after diving to any depth is fairly low.

How many divers do you have access to as research subjects?

auzz · Aug 3, 2007

Thanks a lot to everyone for all their input. We are looking more into topics that have already been mentioned in the above posts.

We are going to Sharm for around a month to conduct the research on volunteers. There will be 5 of us so hopefully we should be able to get a decent sample size.

Since the time when we have to start doing the work is fast approaching we have decided to do something which is not too invasive in order to ensure that we can obtain approval easily. We are thinking of doing simple tests to make some pre and post diving comparisons on our volunteers. It would be great to get your input regarding what things we can compare pre and post dive.

mdjh51 · Aug 9, 2007

PFTs would be a good pre and post dive study. and fairly easy to conduct with low risk

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