As November kicks off Lung Cancer Awareness Month, it’s a chance for all of us to take a deep breath, and reflect on lung health. As health professionals, we see the impact of environmental and industrial pollution, and its negative effect on global air quality and lung health. Therefore, as advocates of health, it’s important to focus on preventative measures, by raising awareness and preventing hazardous exposure to common airborne contaminants.
One surprisingly prevalent carcinogen that demands global attention is a mineral that’s been used for decades in the construction and manufacturing industries: asbestos.
Pulse oximetry is a simple, noninvasive and reliable method for rapidly assessing arterial oxygen saturation (SaO2/SpO2) and pulse rate in patients. It is a useful tool for assessing both adults and children.
The main indications of pulse oximetry include the assessment of acute respiratory infections, asthma, COPD and heart failure. In these situations it can provide valuable information about the severity of the illness and help when deciding on the need for hospital referral or admission.
What Are The Guidelines?
In the General Practice setting, the importance of measuring oxygen saturations has been emphasised in the NICE guidelines on COPD, the SIGN guidelines on asthma and community acquired pneumonia and the NICE sepsis guidelines. Assessing oxygen saturation should be used alongside clinical assessment, not as a standalone indicator.
Additionally, pulse oximetry helps to ensure that hypoxic patients are treated appropriately with oxygen. The NICE sepsis guidelines highlight the importance of assessing oxygen saturations when risk stratifying patients.
How Much Do They Cost?
All-in-one pulse oximeters can vary greatly in price from under £10 to over £200.
How Do I Choose A Pulse Oximeter?
There is so much choice available that it can be difficult to know where to begin. When selecting a pulse oximeter for your doctor’s’ bag, ensure that it is:
Lightweight & Portable – Keeping your doctor’s bag as light as possible will make your life much easier when you’re on the move.
Simple-To-Use – With just 10 minutes per consultation, the quicker you can perform an examination, the sooner you can help the patient. A simple-to-use pulse oximeter opens like a crocodile clip and should be able to be used on a wide variety of patients.
Cost-Effective – Nowadays, you don’t need a top-of-the-range model to see great results. A £30 model will serve as well, if not better than a £100+ model as they are often more lightweight and aren’t as expensive to replace if they become damaged or go missing.
Reliable & Accurate – It should go without saying that when assessing a patient, accurate and reliable results are essential. Look for models with signal strength indicators as one of the main causes of inaccuracy in oximetry is incorrect finger insertion.
Additional useful features include being easy to clean (by wiping with a 70% IPA swab, for example) and battery-saving features such as automatically turning off when a finger is withdrawn.
A Note On Assessing Children
When assessing children make sure you invest in a paediatric pulse oximeter as obtaining a correct fit is important to give an accurate reading. In the past, many GPs had to resort to using an adult pulse oximeter to try to assess a sick child. The readings that resulted were often incorrect, if they could be obtained at all.
As you can see above, the adult pulse oximeter (right) is too large to be used effectively on paediatric patients. The two paediatric pulse oximeters fit much more closely, keeping the sensor in contact with the skin and giving more reliable results.
At Medisave, there is a wide range of high-quality, adult and paediatric pulse oximeters from tried and trusted brands including Nonin, ChoiceMMed, Daray and many more.
ChoiceMMed MD300-D Fingertip Pulse Oximeter
£29.99 (ON OFFER)
Our most popular model, the MD300-D has a clear OLED display showing SpO2, pulse rate and waveform and can be configured exactly how you like it.
Diabetes is a serious condition that requires careful monitoring and management. It costs the NHS an estimated £14 billion pounds a year to treat. Medical scientists have been studying diabetes for many years and looking for a cure or long term treatment.
Exciting research studies and clinical trials in the last 5 years give hope of cures, or at least greatly reduced symptoms for both Type 1 and Type 2 diabetes.
A Possible Diabetes Vaccine
Diabetes is an immune system disorder. The pancreas creates insulin, a hormone that regulates the level of glucose in your blood. With Type 1 diabetics, the immune system attacks the insulin producing cells (islets cells) and stops the production of insulin in the pancreas. This means they are unable to regulate their own glucose levels.
Many companies are working to find a vaccine for Type 1 diabetes. The theory is that a vaccine with immunosuppressant drugs could prevent the immune system from attacking the islet cells so the patient could produce insulin.
The problem with this, however, is that by suppressing the immune system you are then making the patient vulnerable to other infections and illness. There can also be a variety of unwanted side effects, such as stomach upsets, kidney problems and reduced production of blood cells.
Scientists are currently experimenting to see if they can target specific parts of the immune system rather than the system as a whole. If this is successful it could also offer hope of a cure for other autoimmune disorders.
Dr Christie hopes to develop a therapy that can specifically target these damaging cells and leave the rest of the immune system to work as normal. He is looking to combine a protein found on islet cells with a with antibody protein, which marks the cells to be destroyed. The hope is that this new molecule will attract the destructive cells, which will bind with it and then also be destroyed.
Another project funded by Diabetes UK is the study by Lucy Walker at University College London, she has found immune cells (T-Cells) that can trigger the immune system attack on diabetes cells. They are looking at early autoimmune responses to find how these cells cause diabetes and if they can stop the condition from occurring.
Dr Faustman’s team found that the BCG vaccine was killing high levels of T Cells in Type 1 diabetic participants. This shows not only that the vaccine can destroy these cells but that people with Type 1 diabetes have a higher than normal level of T cells.
Further trial phases hope to find if the BCG vaccine can effectively work as a long term affordable treatment for Type 1 diabetes.
The Artificial Pancreas
Dr Roman Horvorka has created a prototype artificial pancreas. This uses a continuous glucose monitor (CGM) to check glucose levels every minute. The machine will then calculate the insulin dose required; and automatically administer it.
The artificial pancreas is worn like a diabetes pump. It sits under the skin and uses wireless transmission to transfer the blood sugar levels to the monitor. The great news is that this can work 24 hours a day, so it offers the potential to maintain good glucose levels throughout the night as well as all day.
Dr Harkorva’s team completed a clinical trial with the artificial pancreas being worn 24 hours a day by participants with Type 1 diabetes. The results showed that the artificial pancreas was halving the amount of time for which participants had low sugar levels. As everything is done automatically the chance of incorrect dosing is greatly reduced.
This research is still in early testing stages, however, it offers hope of an easier way to monitor and administer insulin. This could be the ideal option for people who struggle to calculate their require insulin dose.
Islet Cell Transplants
In Type 1 diabetes, the insulin producing islet cells have been destroyed by the immune system. The Diabetes Research Institute (DRI) at the University of Miami Miller School of Medicine has been studying these cells and possible ways for patients with Type 1 diabetes to reproduce insulin. They recently completed an islet cell transplant for diabetic Wendy Peacock.
Wendy was diagnosed with Type 1 diabetes at 17, she is now 43. Since receiving the minimally invasive surgery she has not needed insulin injections. Other trial participants have not required any treatment for diabetes for more than a decade.
The current islet cell transplant procedure is to infuse the cells into the liver. Although this has had some success, the islet cells don’t always survive in the liver. DRI are currently working to develop their ‘BioHub’. This is a bio-engineered mini-organ that will mimic the pancreas and create insulin. This will be a significant development in the treatment of Type 1 diabetes.
Could Tea be a treatment for Type 2 Diabetes?
Dr Michelle Keske, a senior research fellow at the Menzies Institute in Tasmania has found a surprising potential treatment for Type 2 diabetes – blueberry tea. Their 2015 research trials show blueberry tea may reduce the dependence on insulin as it improves glucose intake in muscles and reduces blood glucose levels.
Other studies, such as those by the Journal of Nutrition have shown berries to be beneficial for diabetes as they have a chemical called anthocyanin that reduces ‘bad’ cholesterol and increases ‘good’ cholesterol. This chemical also reduces insulin resistance and decreases fasting plasma glucose levels.
Cinnamon has also been proven beneficial in reducing blood glucose levels, lowering ‘bad’ cholesterol and increasing sensitivity to insulin so our body is more responsive to it. Other ingredients such as spearmint leaves and raspberry leaf are also suggested to have helpful properties for managing diabetes. This ingredient combination may enhance the effects of berry chemicals, however, research has not yet confirmed this.
The Menzies Institute have conducted pre-clinical trials testing regular intake of herbal blueberry tea and its effects on glucose levels. Gerard Spicer, a participant in one of these trials, found that introducing blueberry tea to his diet greatly reduced his glucose readings.
“Since [drinking the tea] I’ve been waking up with a more normal reading… very rarely high” – Gerard Spicer, trial participant
The tea includes raspberry leaf, spearmint and cinnamon as well as blueberry. Senior Research Fellow Michelle Keske has been studying the tea and its effects on diabetes, with the possible suggestion that it could reduce the need for insulin.
“The tea has enabled that hormone, insulin, to improve glucose uptake into muscle and by doing that it lowers blood glucose levels and it does that by stimulating blood flow”
– Michelle Keske, Senior Research Fellow, Menzies Institute
Keske believes the polyphenols and flavonoids in blueberries may be the vital ingredient in the tea. Currently, it is unknown if it is the blueberry alone that stimulates blood flow or if it is a combination of ingredients. Arguably, you could say it may be more beneficial to eat blueberries themselves as these would contain higher levels of polyphenols and flavonoids.
Green Tea to Increase Insulin Sensitivity
Diabetics will have a greater risk of developing heart disease. Suzanne Steinbaum is a Cardiologist and the Director of Women’s Heart Health at Lennox Hill Hospital. She has found that green tea is very beneficial for Type 2 diabetes and may help to lower your risk of heart disease.
Steinbaum has been researching Japanese studies and notes that people who drank 6 or more cups of green tea a day were 33% less likely to develop Type 2 diabetes than people who drank less than 1 cup of green tea a week.
Tea contains Polyphenols, these are natural antioxidants found in plants. As green tea contains higher levels of polyphenols than black tea this is better for diabetics. Polyphenols help reduce glucose and makes them ideal for preventing and controlling diabetes. Polyphenols are also great for anyone at risk of heart problems as they widen arteries, this reduces blood pressure, helps to prevent clotting and lower cholesterol.
Dr Stenibaum explains it is the Polyphenols that give the bright colours in fruit and vegetables. Unfermented leaves will contain higher levels of polyphenals and therefore green tea has a higher antioxident level than black tea.
Dr Steinbaum’s research supports the results of studies by the Menzies Institute which found blueberry tea to greatly reduce glucose levels. The brightly coloured berries contain a high level of polyphenols, so knowing these help reduce glucose, it is not surprising to find that blueberry tea lowers sugar levels.
A Potential Drug to Prevent Diabetes
The Menzies Institute have also been looking closely at the causes for Type 2 diabetes, in the hope of preventing the condition before it develops. The have discovered that insulin has a significant stimulatory effect on the flow of blood within our muscles. This also led to the discovery that increasing muscle blood flow will improve the access to insulin and the flow of glucose to the muscle cells.
With this new information, they are looking at how blood flow effects insulin up-take, and how this relationship can be used to improve insulin intake. Dr Stephen Richards is one of the researchers leading this study, along with Dr Keske and professor Stephen Rattigan. He gives hope that new drugs to stop Type 2 diabetes may be close to development:
“We are now actively investigating how insulin causes this blood flow effect, with a view to finding ways of enhancing it. As a result new drugs that reverse the impairment in insulin resistant states and prevent the onset of diabetes may soon be discovered.” – Dr. Stephen Richards, Lead Researcher, Menzies Institute
Looking at the results from recent diabetes studies, we can be confident that more efficient and manageable ways to administer insulin are under development. There is hope that we could have a cure for diabetes in the next decade or two.
For Type 2 diabetes we can look at not just sugar intake but also consider foods that may help to reduce sugar levels, such as herbal teas and brightly coloured berries.
We will keep our fingers crossed and hope for another medical breakthrough!
Please be advised that there are many on-going and completed diabetic studies and clinical trials. While we have picked some of these to discuss we are not disregarding other diabetes studies, this is a sample of the studies we located during our research. We hope it will keep you positive with the outlook of finding a long term cure for diabetes.
Smartphones are a huge part of day to day life, and mobile health is developing at incredible speeds as mobile technology keeps expanding. More and more healthcare professionals are using their smartphone apps to provide more efficient healthcare.
We list 10 top apps that a healthcare professional could find beneficial in a healthcare environment.
Medscape is one of the leading medical apps and resources used by healthcare professionals.
The app, developed by WebMD, allows Physicians to ask clinical questions, share images and discuss cases with only a registration required. With over 4 million registered users, this app is a must.
Quickly look up medications and dosages with the Drug Reference Tool
2. Figure 1
You could call Figure 1 the Instagram of the medical world. The idea is to view and share medical images and cases to sharpen medical knowledge on the go and ask healthcare professionals for instant feedback. Having over 1 million medical professionals using the app and being rated highly, it could be seen as an essential learning and collaborative tool.
View thousands of real-world teaching cases from Physicians and Nurses in hundreds of specialities
Page healthcare professionals around the world for instant feedback
Communicate with your colleagues using secure, encrypted direct messaging
Recognise rare conditions in patients
UpToDate is an evidence-based, Physician-authored clinical decision support resource with over 1.3 million clinician users in 197 countries. With over 30 research studies confirming that widespread usage of the app is associated with improved patient care and hospital performance, it’s clear that numbers don’t lie and UpToDate is a worthy inclusion. Just be careful of the high individual subscription cost.
iOS/Android/Free to download (individual or institutional subscription required).
Easy search with auto-completion
Earn and track free CME/CE/CPD credit
Bookmarks and history
Mobile-optimized medical calculators
Print and email topics or graphics to patients and colleagues
4. Touch Surgery
Certainly a visually appealing medical app, Touch Surgery is an interactive (and fun looking!) mobile surgical simulator that guides you through a range of operations.
Though potentially more suited toward Surgical Trainees, there’s no doubt that more experienced healthcare professional can still learn and refresh their knowledge.
Learn operations step-by-step in the training mode
Experience realistic surgical environments created with state-of-the-art 3D graphics
Track your results and measure your progress
Build a personalised library of procedure
Learn new techniques from top physicians
Spy glass feature allows you to identify and learn about the instruments, tissues, muscles and bones contained in procedures
Access a wide range of 3D simulations
Share your progress with fellow professionals
Medtimer has been included because of its ease of use and accuracy. It has been crafted to enable health professionals to time heart rate (HR) and respiratory rate (RR) while removing the need to perform calculations or counting. Allowing full concentration on your patient and being a completely free and non disturbing app (no advertising) makes it a quick and easy essential to add to your smartphone.
• Works for heart rate (HR) and respiratory/breathing rate (RR)
• Count the number of beats or breaths for you
• Calculate the rate per minute from the count (BPM)
• Display comparison charts for all age ranges
• Works across all of your Apple devices including phones, tablets and watches
Similar to Medscape, Epocrates is another popular drug reference app that also includes a few tools such as BMI checker. Users can search medications by generic name, brand name or using a list of conditions.
The app is free to download and use but has basic features until you pay for a yearly subscription, but with over 1 million users, it has to be worth it.
iOS/Android/Free – yearly subscription starting at £119.99.
• Review drug prescribing and safety information for thousands of brand, generic, and OTC drugs
• Check for potentially harmful drug-drug interactions among up to 30 drugs at a time
• Identify pills by imprint code and physical characteristics
• Access timely medical news and research information
• Find providers for consults and referrals in the Provider Directory
• Select national and regional healthcare insurance formularies for drug coverage information
• Perform dozens of calculations, such as BMI and GFR
• Coordinate care securely with HIPAA-compliant text messaging
Touted the LinkedIn for Doctors, Doximity is a social networking app with over 60% of Clinicians signed up. Staying connected with your colleagues is only part of the appeal as Doximity includes tools for HIPAA-secure communication, electronic faxing and custom curated medical news to name a few.
Having raised $54 million funding in 2014 and the extremely high rated app experience, you can be sure that you need this app on your smartphone.
Another app that could be more suited to a junior healthcare professional, Pocket Anatomy is similar to Touch Surgery due to its visual appeal.
With this app you can search through thousands of anatomical structures then move and zoom through high resolution complex medical structures. It will be a challenge and refresher for a junior or a more experienced healthcare professional.
Like to read? Then Read by QxMD is the app for you. It provides a place where you can keep up to date with new medical and scientific research literature, and search PubMed for articles.
With thousands of outstanding topic reviews and access to millions of articles in one app where you can organise your own personal collection, Read by QxMD is a clear choice if you’re an avid reader and learner of medical research.