Top Ten Technologies for Primary Care: |
Innovations You Should Know About Now!
Robert T. Smithing, MSN, NP
ObjectivesParticipants will be able to:
- Identify potentially useful innovations for primary care practices.
- EpiScope™ Skin Microscopy
- PanOptic™ Ophthalmoscope
- 3M™ Littmann® Electronic Stethoscope
- Insure™ Fecal Occult Blood Test
- Strep OIA®
- ENT Pocket Light
- Patton Speculum
- Cranial Electrotherapy
New method to screen for cervical cancer: PapSure is a significant improvement over Pap smear alone in identifying cervical pathology. Approximately one half of the 16,000 women in the United States who develop invasive cervical cancer every year have had regular screening with Pap smears. It was believed that cervical cancer exfoliates cells, which can then be picked up when the clinician collects the Pap smear specimen. As it turns out, some cervical cancers do not shed their cells and will not be found by Pap smear. PapSure adds a visual screening of the cervix using magnification and a blue white light called speculoscopy to the Pap smear collection process. It is an easy to do office-based procedure, which will cost your patient approximately $30.
In a 1998 study of 3,300 asymptomatic women, all of whom were screened with cytology, speculoscopy, and colposcopy, there were 25 women with high-grade intraepithelial lesions (HSIL) and 242 with low-grade intraepithelial lesions (LSIL). Pap smear alone detected 76% of the HSIL and speculoscopy alone identified 84%. PapSure, which is pap smear & speculoscopy together, identified 100% of the women with HSIL. The women with LSIL identified by Pap smear was 37%, by speculoscopy 54% and by PapSure 91% of the 242 cases. In this study PapSure increased the sensitivity of cervical cancer screening from 40% to 92%, but resulted in a lower specificity, dropping from 94% to 23%.
Watson Diagnostics 888.727.7873 or www.papsure.com.
Improved assessment of suspicious skin lesions: This tool for skin lesion examination has been on the market for a number of years, but remains essentially unknown except in specialty offices. Using the EpiScope the clinician can do skin surface epiluminescence microscopy (ELM) which magnifies the lesion 10x while providing uniform halogen illumination. It is portable and works with any 3.5v Welch Allyn power source. Lesion visualization is excellent. A ruler, accurate to 0.1 mm is etched into the reticule contact plate which is placed against the skin making it easy to measure the lesion and accurately track the lesion growth. The reticule can be removed and autoclaved to eliminate possible cross-contamination. ELM is the application of oil on the lesion, while performing skin surface microscopy. This renders the epidermis translucent and provides for a more detailed inspection of the surface of pigmented skin lesions. This product comes with a 24 page booklet including 23 full-color images of various skin lesions.
Welch Allyn, 4341 State Street Rd, PO Box 220, Skaneateles Falls, NY 13153, 800.535.6663 www.welchallyn.com
Improved visualization of the optic fundus: This is an innovative redesign of the ophthalmoscope done by Welch Allyn®. The PanOptic ophthalmoscope incorporates a new optical design called Axial PointSource™ Optics. This technology makes it easier to enter small pupils and provides a 25° field-of-view compared with the 5° field-of-view provided by a standard ophthalmoscope. This makes it possible to more easily see the different features of the fundus. It works with any 3.5v Welch Allyn power source.
Welch Allyn, 4341 State Street Rd, PO Box 220, Skaneateles Falls, NY 13153, 800.535.6663 http://panoptic.welchallyn.com
3M™ Littmann® Electronic Stethoscope:
Improved auscultation: Of the many electronic stethoscopes on the market the Littmann electronic stethoscopes live up to a clinician's expectations. There are two models available and both are styled in the matter of a traditional stethoscope. The Model 2000 amplifies sounds 14 times (20 dB), while the Model 4000 amplifies sounds 18 times (25 dB) and can record a 6 second segment of auscultation for playback at either normal or half speed. Both models provide bell (20-200 Hz), diaphragm (100-500 Hz), and extended range (20-1000 Hz) frequency selections.
These stethoscopes stand up to the travails of day-to-day clinical practice, including being bumped, stuffed in pockets and dropped. The volume control is adjustable. So you can use it to listen equally well to a slender child or a thick walled adult with distant breath sounds. Even if you think your current stethoscope is terrific, once you have tried this one you won't want to give it back.
Additional information: www.3m.com/littmann or 800.228.3957.
Insure ™ Fecal Occult Blood Test:
No dietary restrictions, no handling of fecal matter and more accurate: The InSure™ Immunochemical FOBT is based on the detection of human hemoglobin as an indicator of blood in the stool. In particular, the test detects the globin portion of the hemoglobin molecule. Globin does not survive passage through the upper gastrointestinal tract. Therefore, the presence of globin in the stool indicates bleeding in the colon or rectum - the region where colorectal cancers originate. To collect the sample a brush is used to dislodge any blood on the surface of the stool into the surrounding water of the toilet bowl. The brush collects water from around the stool. The water is then transferred to the test card, where it will dry into a special pad.. Once dry, any hemoglobin that was in the water is stable and suitable for transport to the laboratory for testing.
The American Cancer Society's Colorectal Cancer Advisory Group stated that: "in comparison with guaiac-based tests for the detection of occult blood, immunochemical tests are more patient friendly, and are likely to be equal or better in sensitivity and specificity."
Currently this test is covered by Medicare, but at present it is not covered by many other insurances. The samples can be sent directly to the Insure laboratory or to Quest Diagnostics. The test kit is processed and the results are then sent to your practice. Collection kits are available at no charge.
Enterix, 248 US Route One, Faimouth, ME, 04105. 800.531.3681 www.insurefobt.com. Quest Diagnostics www.questdiagnostics.com.
Better than traditional streptococcus culture for identifying Group A streptococcus: This office based test gives results that are faster and more accurate than agar strep culture. The only rapid Strep A test that detects more true positives than agar culture thus avoiding the need for a confirmatory agar culture if the rapid Strep test is negative.
Thermo BioStar, 331 South 104th St, Louisville, CO 80027. 800.637.3717 or email firstname.lastname@example.org. www.thermo.com.
ENT Pocket Light:
An otoscope for patients or travel: This is a compact otoscope, which doesn't look very impressive, but stands up to abuse well enough to be used by the United States Marines. This otoscope uses standard disposable speculums and is inexpensive enough for patients who have recurring ear infections or problems with cerumen build-up to buy and have at home. It is easy to use and runs on standard AA batteries. You can tell that the batteries need replacement, because it suddenly becomes more difficult to see in the ear canal. Lighted cerumen loops are available for this instrument and make it much easier to see in the ear canal when you are removing impacted cerumen. I would not use it as my primary otoscope because I'd have to change the batteries too frequently. It is an excellent adjunct, for patients to use at home or for moving cerumen out-of-the-way in the office.
CFM technologies, 192, Worcester St, Wellesley, MA 02481. 800.297.0809 www.cfmtechnologies.com.
Four blades instead of two: This unique speculum has 4 blades instead of two. The additional blades hold the lateral vaginal walls out-of-the-way to improve cervical visualization. The blades spread in a conical manner, achieving improved visualization without over-stretching the sensitive introitus. It is autoclavable and non-conductive for LEEP or LETZ procedures. The high tech polymer is slightly flexible for increased patient comfort.
Patton Surgical Inc. 1000 Westbank Drive Austin, TX 78746, 512.329.0469, www.pattonsurgical.com/products_speculum.htm.
Cranial Electrotherapy Stimulation:
Microcurrent electrical stimulation for pain control: A discussion of this technology is usually greeted with a great deal of skepticism at first. However, if you take the time to read the research literature, you will be pleasantly surprised with its potential. Cranial Electrotherapy Stimulation (CES) uses small electrodes attached to the earlobe, which provide small pulses of electrical energy, which then passes through the limbic system.
Additional information: Therapeutic Resources, 800.488.8492 ask for Nancy Campbell or email her at email@example.com.
New method for the prevention of urinary stress incontinence in women: The FemSoft® Insert is a narrow silicone tube entirely encased in a soft, thin, mineral oil-filled sleeve. It is very flexible and is available in 6 different sizes. It provides immediate control of unintentional urine loss without surgery. When the insert is advanced into the urethra, the fluid in the sleeve flows toward the external end to facilitate the insert's passage through the urethra. When the tip of the FemSoft Insert has entered the bladder, the fluid returns to fill the balloon, creating a seal at the bladder neck and urethra. This transfer of fluid occurs automatically; all the user has to do is advance the device into the urethra. The fluid-filled sleeve readily adjusts to anatomical variations and changes in urethral shape that occur with movement. The fluid-filled sleeve is very soft and highly compressible protecting delicate urethral tissues from trauma or abrasion. To void, a woman simply grasps the external portion and gently removes the insert.
Additional information: Rochester Medical Corporation, www.rocm.com/02x06f.html, 800.336.7638 or email them at firstname.lastname@example.org.
Last updated: November 11, 2003