Issuu

Physicians office Resource 2021 | Issue 8

Resources for You, Your Patients, & Your Practice

MEET THE NEW GOLD STANDARD IN FIRST LEVEL OSTEOPOROSIS DIAGNOSTICS Bindex® – the revolutionary, portable bone density scanning device PAGE 12

TABLETS ARE AVAILABLE PUBLISHED BY Medical Education Resources, LLC PUBLISHER Aaron R. Medaris amedaris@physiciansofficeresource.com

CEO Andrew C. Nimmo acnimmo@physiciansofficeresource.com

PRESIDENT John D. Pasquale jpasquale@pharmaconnect.com

Getting the most from this guide

BUSINESS MANAGER Marci J. Hills mhills@physiciansofficeresource.com

TRAVEL EDITOR Brandi L. Brower EDITORIAL BOARD Michael Paquin, FHIMSS Barry Craig, MLT (NCA), CLC

40 mg tablets 80 mg tablets

XTANDI is available in a tablet formulation*

STAFF WRITER Dylan J. Chadwick

There are two simple ways to request

CREATIVE DIRECTOR PRODUCTION MANAGER Jessica Peterson

information about the products and services

found in Physicians Office Resource. 1. Go to www.PhysiciansOfficeResource.com and enter the four-digit reference number found next to the product or service into the search field, then request additional information, schedule a demo, or speak with a sales agent all with just a simple click of a button. 2. Find the Business Reply Card in this issue, circle the desired reference numbers, complete the form, and drop into any USPS mailbox. A representative will contact you as quickly as possible to answer your questions.

www.PhysiciansOfficeResource.com

To continue your free subscription of Physicians Office Resource magazine, please fill out the Business Reply Card (BRC) located within this magazine and drop in any United States Post Office mailbox. If you are a manufacturer of medical products or provide services to medical professionals and would like to advertise your products or services to the nation’s top physicians doing in-office testing, call 801-380-6094 or visit: POR.io for more information.

40 mg

80 mg Not actual size of tablets.

For more information, visit XtandiTablets.com or scan this QR code *Please specify "XTANDI 40 mg tablets" or "XTANDI 80 mg tablets" when prescribing XTANDI to your patients.

© 2021 Astellas Pharma US, Inc. and Pfizer Inc. All rights reserved. 076-6374-PM 1/21 XTANDI, Astellas, and the flying star logo are registered trademarks of Astellas Pharma Inc. 2 | PHYSICIANS OFFICE RESOURCE

TABLE OF CONTENTS

Why Bindex® is a game-changer in osteoporosis diagnostics.

ACCURATE FLU TESTING MADE EASY

Comparable to DXA Extensive clinical research has proven Bindex to be 90% accurate in detecting osteoporosis. It can replace nearly 70% of DXA scans for patients with suspected osteoporosis. Fast and effective Using safe pulse-echo ultrasound to measure cortical bone thickness, Bindex analyzes bone density in just seconds.

9600

Easy to use anywhere Lightweight and pocket-sized, Bindex allows patients to receive on-the-spot bone density scans in doctors’ offices, hospitals and clinics and at home.

uct Prod ht lig Spot

NOW YOU CAN TRIAL BINDEX AT NO COST. To trial Bindex in your office, visit Bindex.us/launch or call (970)-306-7452.

9601

The Acucy® Influenza A&B Test on the Acucy System provides clinicians flexibility in workflow and accurate, standardized results for improved patient care. ACCURATE

Accurate Performance Composite Comparator: Nasal and Nasopharyngeal Swabs

 Innovative Composite Comparator with molecular and culture  Best-In-Class Flu A performance*  Definitive and standardized results

SIMPLE

WHY DXA SHOULDN’T BE YOUR ONLY OPTION

THE ABSTRACT: MEDICAL NEWS AND RESEARCH

HELPING PATIENTS HELP THEMSELVES ONLINE

—

Bindex is the revolutionary, portable bone density scanning device that could be the new gold standard in first-level osteoporosis diagnostics.

A new monthly column from Physicians Office Resource looking into current research and the future of medical science

There’s seemingly no end to the wealth of information afforded to us on the internet, that information does come at a price: internet “quality control” is spotty at best.

 Read Now or Walk Away mode  Results within 15 minutes  Automatically transfer patient result to data management system

Influenza B - 82.3% (95% CI: 75.6% - 87.4%) Influenza A - 96.0% (95% CI: 94.4% - 97.2%) Influenza B - 98.1% (95% CI: 96.9% - 98.8%)

 Nasal & Nasopharyngeal swab types *When compared to immunoassay products in market (refer to manufacturer instructions for use)

For more information call 888-616-0537, Option 2 or visit us at acucy.com

4 | PHYSICIANS OFFICE RESOURCE

Influenza A - 96.4% (95% CI: 93.1% - 98.2%)

sekisuidiagnostics.com

POINT OF CARE

CARDIOLOGY

TRANSFORM PATIENT SATISFACTION AND PRACTICE EFFICIENCY.

PRODUCT FOCUS

EASY, INTEGRATED WITH-PATIENT TESTING I-STAT Testing SYSTEM Easy, Integrated With-Patient From Point of Care at Abbott i-STAT System from Point of Care at Abbott The handheld i-STAT System offers a broad menu of diagnostic tests

the patient’s side in offers just minutes. With just a fewof drops of blood, tests at the The handheldati-STAT System a broad menu diagnostic the i-STAT System delivers real time, lab-accurate results for a wide patient’s side range in just minutes. With just a few of blood,cardiac the i-STAT of tests, including chemistries, blooddrops gas, coagulation, markers, and more. Minimize delays and wasted time with on-side System delivers real time, lab-accurate results for a wide range of tests, tests. Easy, intuitive operation. including chemistries, blood gas, coagulation, cardiac markers, and more. 9602 For intended use andtime complete information, visit pointofMinimize delays and wasted withproduct on-site tests. Easy, intuitive operation. care.abbott.

For intended useFor and complete product information, visit pointofcare.abbott. in vitro diagnostic use only. This material is intended for a U.S.

For in vitro diagnostic use only.only. This material for aof U.S. audience only. Office Reaudience i-STAT isis aintended trademark Abbott. Physician i-STAT is a trademark of Abbott. Physician Office Resource — i-STAT Product Description source i-STAT Product Description US 3064.REV1 08/20 – US 3064.REV1 08/20

View Brochures, Videos & More at POR.io Enter Number 9602 in the Search Area

ACCURATE, ACTIONABLE RESULTS FROM THE LEADER IN POINT-OF-CARE LIPID TESTING From Abbott

IMMUNOASSAY ANALYZERS

9603

View Brochures, Videos & More at POR.io Enter Number 9603 in the Search Area

9605

EHENS PR I M

The CLIA-waived Alere Cholestech LDX™ Analyzer is engineered for confidence, providing accurate, actionable, and readily accessible results that have set the standard in point-of-care lipid profile, cholesterol, and glucose testing. Results are easy to obtain. Fingerstick sampling and a small sample size (40μL) makes results less painful and time consuming.

AVA I L A

CLIA Waived Tests: CMP, BMP, Lipid Panel, Lipid Panel Plus, General Chemistry, Kidney Check, Renal Panel, MetLyte 8 and Electrolytes

9606

Fast—Results in minutes, accelerating patient care decisions. Accurate—Lab-accurate results for a wide range of tests.* Versatile—Comprehensive CLIA-waived menu available.

9604

FULLY AUTOMATED QUANTITIVE IMMUNOASSAY ANALYZER From Sekisui Diagnostics The FastPack® IP System is a fully automated quantitative immunoassay analyzer designed for use in the Physician Office laboratory. Utilizing sophisticated chemiluminescence technology, the FastPack® IP System provides the capability to produce complex immunoassay results in 12 minutes or less with a push of a button. Menu includes Vitamin D, Testosterone, TSH, Free T4 PSA and hCG.

View Brochures, Videos & More at POR.io Enter Number 9604 in the Search Area

6 | PHYSICIANS OFFICE RESOURCE

Simple—Intuitive function to improve operational efficiency. Convenient—Have test results during office visit, increasing patient satisfaction.

To learn more, contact your Abbott Point of Care representative at 888-893-0335, your distribution representative, or visit www.pointofcare.abbott *2016 Proficiency Testing Results, American Proficiency Institute, www.api-pt.com [Piccolo Xpress]. See cartridge information at www.pointofcare.abbott [i-STAT]. i-STAT Part No: 04J60-20 Waived Kit, 04J48-50 Moderately Complex Kit, 06F20-20 Waived Analyzer, 04P75-03 Moderately Complex Analyzer Piccolo Xpress Part No: 07P05-50 Piccolo Xpress with 3YR Serv, 07P05-51 Piccolo Xpress with 5YR Serv ©Abbott Point of Care Inc. 400 College Road East, Princeton, NJ 08540 www.pointofcare.abbott For in vitro diagnostic use only. This material is intended for a U.S. audience only. i-STAT is a trademark of Abbott. 3032.REV1 07/20 POR Ad - Abbott POC i-Stat/Piccolo Piccolo Xpress is a registered trademark of Abaxis, Inc. and distributed by Abbott Point of Care. Abaxis 888-3355 Rev A

PRODUCT FOCUS

CHEMISTRY ANALYZERS EASY, INTEGRATED WITH-PATIENT TESTING I-STAT SYSTEM Easy, Integrated With-Patient Testing From Abbott Point of Care i-STAT System from Point of Care at Abbott The handheld i-STAT System offers a broad menu of diagnostic tests

at the patient’sSystem side in just minutes. With justmenu a few drops of blood, The handheld i-STAT offers a broad of diagnostic tests at the the i-STAT System delivers real time, lab-accurate results for a wide patient’s side in just minutes. With just a few drops of blood, the i-STAT range of tests, including chemistries, blood gas, coagulation, cardiac markers, and time, more. Minimize delays and wastedfor timeawith on-side System delivers real lab-accurate results wide range of tests, tests. Easy, intuitive operation. including chemistries, blood gas, coagulation, cardiac markers, and more. 9607 For intended use and complete product information, pointofMinimize delays and wasted time with on-site tests.visit Easy, intuitive operation. care.abbott.

9610

9611

For intended use and complete product information, visit pointofcare.abbott. For in vitro diagnostic use only. This material is intended for a U.S.

For in vitro diagnostic use only. This material intended for U.S. audience only. Office Reaudience only. i-STAT is aistrademark ofaAbbott. Physician i-STAT is a trademark of Abbott. Office Resource i-STAT Product Description – US 3064.REV1 08/20 source i-STAT Physician Product Description — US 3064.REV1 08/20

View Brochures, Videos & More at POR.io Enter Number 9607 in the Search Area

ENVOY500+ DELIVERING PROVEN RESULTS IN CLINICAL CHEMISTRY From EliTech The fully automated Envoy500+ is designed to deliver the performance of a large floor model analyzer but provides the cost efficiency of a benchtop analyzer (TPH approx. 490). It enables accurate treatment decisions sooner. Envoy500+ delivers savings the laboratory requires with the following features positive sample and reagent identification, clot detection, liquid level sensing, dry ISE module, reusable glass cuvettes, and many more.

View Brochures, Videos & More at POR.io Enter Number 9608 in the Search Area

9608 9612

FULL COMPLEMENT OF CLIA-WAIVED

Full Complement of CLIA-waived Blood Chemistry Tests BLOOD CHEMISTRY TESTS PICCOLO ® Chemistry Analyzer from Abbott Piccolo Xpress

XPRESS® CHEMISTRY ANALYZER

Point of Careprovides physician offices with The Piccolo From XpressAbbott Chemistry Analyzer lab-accurateThe results for Xpress a broad range ofAnalyzer CLIA-waived general chemistry Piccolo Chemistry provides physician tests, including metabolic panels, lipids, kidney offices with lab-accurate resultsliver, for a and broad range function, of CLIA- and more general tests, panels, provides with just 100waived microliters of chemistry blood. Easy toincluding use, themetabolic Piccolo Xpress lipids, live, and kidney function, and more with just 100 results during a patient’s visit, accelerating treatment decisions, increasing microliters of blood. Easy to use, the PIccolo Xpress provides 9609efficiency, and supporting Automated quality control on results during apatient patient’ssatisfaction. visit, accelerating treatment decisions, every test helps ensure accuracy. increasing efficiency, and supporting patient satisfaction. Automated quality control on every test helps ensure accuracy.

For in vitro diagnostic use only. This material is intended for a U.S. audience only. Brochures, Videos &distributed More at POR.io Piccolo Xpress is aView registered trademark of Abaxis, Inc. and by Abbott Point of Care. Physician Office Resource Product9609 Description US 3065.REV1 Enter Piccolo Number in –the Search 08/20 Area

8 | PHYSICIANS OFFICE RESOURCE

PRODUCT FOCUS

CLIA WAIVED

GROW WITH CONFIDENCE

Clinical Systems

CLIA-WAIVED BIOFIRE® FILMARRAY® RESPIRATORY PANEL (RP) EZ

9613

From BioFire The BioFire RP EZ accurately detects and identifies 14 viral and bacterial pathogens—not just Flu A and Flu B—so you can provide your patients with the right treatment, the first time. The test is easy and can be performed right in your office or clinic, with results in about an hour. The BioFire RP EZ is designed to run on a single computer/instrument configuration (EZ Configuration) of the BioFire® FilmArray® 2.0 System.

Scalable Chemistry Solutions for the physicians office laboratories Reliability and consistency

—

View Brochures, Videos & More at POR.io Enter Number 9613 in the Search Area

LAB-ACCURATE RESULTS FOR ACR AND HBA1C

9614

The performance and quality are designed into the complete system across all key components: • analyzer & software • liquid stable reagents • calibrators & controls

9616

• ISE (Ion-Selective Electrode) • remote diagnostics

From Abbott With its compact size and panel of tests, the Afinion 2 system is ideal for point-of-care testing in physician offices, clinics, community health centers and hospital out-patient clinics. From just a small urine or fingerstick whole blood sample, lab-accurate results for ACR and HbA1c are made available during the consultation.

ENVOY500+ Larger volume • 20-80 patients per day

View Brochures, Videos & More at POR.io Enter Number 9614 in the Search Area

9617

BD VERITOR™ PLUS SYSTEM From BD Veritor™

9615

The BD Veritor™ Plus System is a portable, easy-to-use, testing solution for SARS-COV-2*, Flu A+ B and other respiratory tract infections that delivers results in 15 minutes or less. It features two analysis modes that adapt to your workflow, online education tools, and optional reporting capabilities including the BD Synapsys™ Informatics Solution—making it the point-ofcare diagnostic tool you won’t want to be without. *EUA authorized by FDA

View Brochures, Videos & More at POR.io Enter Number 9615 in the Search Area

Inquire about our

RENTAL PROGRAMS

Selectra Pro M Mid-volume

Call: 888-755-3916

• 10-40 patients per day

infoUS@elitechgroup.com

9618

Selectra Pro S Compact

www.elitechgroup.com

• 10-15 patients per day 10 | PHYSICIANS OFFICE RESOURCE

ELITechGroup North America, 370 West 1700 South Logan, UT 84321 USA ENVOY500+ is available in the USA only.

Small, portable and easy to use in any setting

The osteoporosis diagnosis gap The discrepancy between patients at risk for osteoporosis and the number of DXA scans performed annually may be attributed to several factors.

FEATURE

Patients without an osteoporosis diagnosis who are at risk because of their age, gender or other health issues may not all be eligible for a DXA scan. Younger at-risk patients may not be eligible because of their age. Many health insurance plans cover only eligible patients (which often means patients over 65) and only for one DXA scan every two years (when osteoporosis is diagnosed) even though more frequent scanning may allow physicians to offer more timely, more customized and, potentially, more effective treatment. Bone density scanning made easier There is, clearly, a need for accurate bone density scanning that is both easier and more affordable for patients, especially Medicare-eligible patients. The answer may come in the form of an outwardly simple but technologically advanced handheld device called Bindex.

Why DXA shouldn’t be your only option Meet Bindex – the revolutionary, portable bone density scanning device that could be the new gold standard in first-level osteoporosis diagnostics ®

For over 30 years, DXA bone density scanning has been the most reliable and the most accurate way to diagnose and monitor osteoporosis. But could it be missing the mark? Osteoporotic fractures account for more hospitalizations than breast cancer, diabetes and myocardial infarction combined.1 Yet while the entire Medicare population of around 60 million is at risk of osteoporosis, only 2.5 million DXA scans are performed annually.

12 | PHYSICIANS OFFICE RESOURCE

While its accuracy is not in question, does the very nature of DXA – high cost, limited to those with appropriate insurance coverage, less than universal availability – ignore all but the most at-risk patients, those who might already have been identified as osteoporosis sufferers? Could there, in fact, be an easier, more inclusive yet comparably accurate way to assess bone density?

Designed and manufactured by Bone Index Ltd, Bindex promises a more equitable arrangement that potentially allows more at-risk patients – of Medicare age and younger, with or without an existing diagnosis – to receive fast and accurate bone density scans in a doctor’s office, clinic or any setting. Bindex is 90% accurate in detecting osteoporosis Extensive clinical research has proven Bindex to be 90% accurate in detecting osteoporosis which means it can replace nearly 70% of DXA scans for patients with suspected osteoporosis. Using safe pulse-echo ultrasound, handheld Bindex measures cortical bone thickness in seconds and instantly analyzes bone density, generating a detailed yet easy-to-read report. Better for patients – with clear advantages for doctors Its size and portability means that Bindex can be used anywhere – in physician’s offices, hospitals and clinics as well as in patients’ homes and at bone density screening events. A Bindex scan costs a fraction of a DXA scan and, for many patients, particularly those who want more frequent screenings than allowed by their insurance, represents a very affordable out-of-pocket medical expense.

A Bindex scan takes seconds

Bindex means that physicians can diagnose more at-risk patients and scan more diagnosed patients more frequently, and so make timely treatment decisions and adjustments. It may also be a useful patient acquisition and retention tool, especially as patients age into Medicare, allowing physicians to keep an important source of patient revenue within their own practices. An opportunity to trial Bindex at no cost Bone Index Ltd, manufacturer of Bindex, is currently offering selected US-based physicians the opportunity to be part of the device’s US launch by trialing Bindex with patients at no cost. To register your interest in participating in the trial, please visit Bindex.us/launch or call (970)-306-7452. Footnote: 1 International Osteoporosis Foundation

Designed and developed by Bone Index Ltd, a healthcare diagnostics company, Bindex is FDA-cleared and has been validated in clinical trials with several thousand patients. This revolutionary device has already screened over 1.6 million people in the US, and has 19 global patents in the US, China, Japan and major EU countries.

2021, ISSUE 8 | 13

CLIA WAIVED OSOM® BVBLUE® PRODUCT FOCUS

From Sekisui Diagnostics 9619

The OSOM® BVBLUE® detects elevated vaginal fluid sialidase activity, an enzyme produced by bacterial pathogens associated with bacterial vaginosis including Gardnerella, Bacteroides, Prevotella and Mobiluncus. OSOM® BVBLUE® is more sensitive than Amsel criteria providing physicians with a more accurate diagnosis to treat and minimize serious health consequences such as early spontaneous preterm births and miscarriage.

View Brochures, Videos & More at POR.io Enter Number 9619 in the Search Area

ACUCY INFLUENZA A&B TEST

TO X I C O LO G Y S C R E E N I N G

SIMPLIFIED Comprehensive toxicology menu now with 14 CLIA1 categorized moderately complex assays.

From Sekisui Diagnostics The Acucy™ Influenza A&B Test is for the rapid, qualitative detection of influenza A and B viral nucleoprotein antigens from both nasal and nasopharyngeal swabs. Utilizing the Acucy™ Reader in either the point-of-care or laboratory setting, workflow flexibility is achieved with both Read Now and Walk Away features. The combination provides clinicians with standardized and definitive result interpretation.

9620 9622

View Brochures, Videos & More at POR.io Enter Number 9620 in the Search Area

IMMTOX™ 270 BENCHTOP ANALYZER OSOM ULTRA PLUS FLU A&B TEST 9621

Toxicology screening solutions for physician offices, treatment centers and laboratories.

From Sekisui Diagnostics

25 assay menu

Stronger Clinical Performance Takes Lateral Flow Testing To The Next Level. Providing superior rapid results at the point-of-care. Fast, easy, cost effective so you can test and treat in one visit.

Up to 270 tests per hour

Compact footprint

Quality products, service and reliability

• High Performance- Equivalent or exceeding the performance of reader devices, without the need for an instrument • Results in 10 minutes • OSOM® Custom Care- Exceptional Support/Training by licensed medical technologists and experienced healthcare professionals • Made in the USA —

View Brochures, Videos & More at POR.io Enter Number 9621 in the Search Area

COMPLETE LABORATORY SOLUTIONS From consultation, to licensure and compliance, the Abbott Clinical Lab Solutions team has you covered.

CONTACT ABBOTT CLINICAL LAB SOLUTIONS. CALL 888-831-6850 | EMAIL: CLS_SALES@ABBOTT.COM 1. Clinical Laboratory Improvement Amendments (CLIA) © 2020 Abbott. All rights reserved. All trademarks referenced are trademarks of either the Abbott group of companies or their respective owners. Any photos displayed are for illustrative purposes only. MKT52247 REV1 08/20

14 | PHYSICIANS OFFICE RESOURCE

PRODUCT FOCUS

CLIA WAIVED 9623

ULTRA HCG COMBO TEST From Sekisui Diagnostics The OSOM® Ultra hCG Combo test is a simple immunoassay for the qualitative detection of human chorionic gonadotropin (hCG) in serum or urine for the early confirmation of pregnancy. Internal studies have confirmed that the OSOM® Ultra hCG Combo test does not have a false negative result from hCG variants providing physicians with a higher level of confidence.

View Brochures, Videos & More at POR.io Enter Number 9623 in the Search Area

9626

Bionet CardioCare 2000: $1,255.00 Schiller AT-2 Plus: $2,626.00* 9627 *add Spirometry: $649.00 Burdick ELI 280: $4,088.00 Welch Allyn CP150 w/ Interp: $3,465.00

9628

The Adview 2 is still the only truly modular diagnostic station that grows with your needs. Start with blood pressure and choose temperature or pulse oximetry option at the time of purchase.

9629

9630

OSOM® TRICHOMONAS RAPID TEST

From Sekisui Diagnostics

9631

The OSOM® Trichomonas Rapid Test is intended for the qualitative detection of Trichomonas vaginalis antigens from vaginal swabs or from the saline solution. The OSOM® Trichomonas Rapid Test is the only CLIA-waived rapid test available today. OSOM® Trichomonas is more sensitive than wet mount due to the assay being able to detect viable and non-viable organisms which offers significant benefits to the patient and clinician alike.

View Brochures, Videos & More at POR.io Enter Number 9624 in the Search Area

9624

9632

Coaxial Ophth, Fiber Optic Oto, Speucla Dispenser, Aneroid BP, Wall Transformer and Wall Board without Thermometer: $979.00 9634 with Thermometer: $1,416.00

9633

9635

9636 9625

OSOM® ULTRA STREP A TEST From Sekisui Diagnostics

9637

The OSOM® Ultra Strep A test is a color immunochromatographic assay intended for the qualitative detection of Group A Streptococcus antigen directly from throat swab specimens. Shown to be not statistically different than single swab culture. Sensitivity 95.7% and 100% Specificity. Includes two additional test sticks for External QC. CLIA Waived..

9638 View Brochures, Videos & More at POR.io Enter Number 9625 in the Search Area

16 | PHYSICIANS OFFICE RESOURCE

COVID-19 TESTING

Why You Should Be Doing Spirometry

PRODUCT FOCUS

BD VERITOR™ PLUS SYSTEM From BD Veritor™ The BD Veritor™ Plus System is a portable, easy-to-use, testing solution for SARS-COV-2*, Flu A+ B and other respiratory tract infections that delivers results in 15 minutes or less. It features two analysis modes that adapt to your workflow, online education tools, and optional reporting capabilities including the BD Synapsys™ Informatics Solution—making it the point-ofcare diagnostic tool you won’t want to be without.

9639

9642

9643

*EUA authorized by FDA

View Brochures, Videos & More at POR.io Enter Number 9639 in the Search Area

BIOFIRE® RESPIRATORY 2.1-EZ (RP2.1-EZ)1 PANEL (EUA)1

From BioFire

9640

SARS-CoV-2 is everyone’s top suspect, but many other respiratory bugs can cause similar, overlapping symptoms. In your clinic, you can test for 19 common respiratory pathogens, including SARS- CoV-2, with the BioFire RP2.1-EZ Panel (EUA)1—now available under an FDA Emergency Use Authorization. Syndromic testing means all it takes is one test and just 45 minutes to round up SARS-CoV-2—and all the other usual respiratory suspects. 1. This test is not FDA cleared or approved. This test has been authorized by FDA under an EUA for use by authorized laboratories.

View Brochures, Videos & More at POR.io Enter Number 9640 in the Search Area

MEDICUS LIS 9641

From Medicus LIS If you are considering in-house lab testing, including Covid-19 testing and required reporting to state agencies, connecting Lab to LIS and EHR makes the process of test orders to completed results much easier. Providers receive test results posted to patient charts in real-time, expediting patient care, saving time, money and even preparing for lab test reimbursement goals. Link Your Lab with Medicus LIS today! Contact us: 888-643-8081 sales@medicuslis.com —

9525

View Brochures, Videos & More at POR.io Enter Number 9641 in the Search Area

9644 It’s Important - Spirometry is the gold standard for the diagnosis and management of both asthma and COPD. It’s Good Medicine - Your patients are correctly diagnosed and treated more accurately and conveniently in your office. The earlier you detect the disease; the easier you can treat it. It’s Easy - A spirometry test takes less than five minutes to perform. It’s Good Business - Office spirometry is third party reimbursable and will pay for itself within the first year of purchase. It’s Safe - The SpiroSafe filter is single use viral/bacterial filters that helps to protect your patients and staff. It is >99% effective against viral and bacterial cross-contamination. Why Micro Direct? - Micro Direct’s spirometry experts will help you choose the right spirometer and then FULLY support your staff from training on how to use the spirometer through billing questions; and all Micro Direct spirometers are backed by a 30-day money back guarantee.

Micro Direct, Inc. 803 Webster Street Lewiston, ME 04240 1-888-287-8556 sales@mdspiro.com

www.mdspiro.com 18 | PHYSICIANS OFFICE RESOURCE

9645

GET BETTER OUTCOMES WITH CRYOSURGERY

CRYOMEGA® From CryoConcepts This pen-like device is the perfect choice when low entry costs, portability, and precise delivery are critical to the practice. CryOmega® dispenses nitrous oxide – the coldest portable cryogen and the pinpoint tip allow physicians to effective treat the lesion site without harming healthy tissue. —

9646

View Brochures, Videos & More at POR.io Enter Number 9646 in the Search Area

HISTOFREEZER® FLEX From CryoConcepts This canister-based devices is the latest advance in portable cryosurgery for the physician office. Its advanced design give doctors the option of using cones or buds to deliver the cryogen to the treatment site. There is no risk of cryogen splattering during treatment and our cryogen stays colder versus other products on the market which lead to better first time outcomes.

9647

NEW FOR

—

2021!

View Brochures, Videos & More at POR.io Enter Number 9647 in the Search Area

Your choice of a cryosurgical device has a big impact on patient outcomes. CryoConcepts has the broadest line of cryosurgical equipment in the world and our 28 years of experience is built into every single product.

CRYOLAB® MEDICAL From CryoConcepts

9648

20 | PHYSICIANS OFFICE RESOURCE

Our world class products include: CryOmega®, a portable pen-like device, CryoLab® Medical, a desktop-sized cryo unit, and Histofreezer® FLEX, our next generation canister that uses both cones and buds AND has the first returnable canister that is better for the environment.

CryoLab is a desk-top sized unit that delivers cryogen and employs pre-set spray times to ensure safe and effective treatment. Our lighted wand can spray the cryogen from any direction making it easier to treat all locations on the patient. CryoLab® can dispense nitrous oxide or carbon dioxide allowing physicians to treat cosmetically sensitive areas on the face, hands, and chest with less trauma and downtime. —

View Brochures, Videos & More at POR.io Enter Number 9648 in the Search Area

9650 9649

BETTER DESIGN. BETTER OUTCOMES. BETTER FOR THE ENVIRONMENT.

MAR-115 (Rev 1)

PRODUCT FOCUS

CRYOSURGERY

❆ A Virtual or In-Office Demo of any of our products

All Things

CRYO

❆ A FREE Lunch & Learn with our nationwide team of Cryo Experts

www.CryoConcepts.com

❆ A FREE E-book on better outcomes using cryosurgery in your practice

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INGREZZA is contraindicated in patients with a history of hypersensitivity to valbenazine or any components of INGREZZA. Rash, urticaria, and reactions consistent with angioedema (e.g., swelling of the face, lips, and mouth) have been reported.

WARNINGS AND PRECAUTIONS

Somnolence INGREZZA can cause somnolence. Patients should not perform activities requiring mental alertness such as operating a motor vehicle or operating hazardous machinery until they know how they will be affected by INGREZZA. QT Prolongation INGREZZA may prolong the QT interval, although the degree of QT prolongation is not clinically significant at concentrations expected with recommended dosing. In patients taking a strong CYP2D6 or CYP3A4 inhibitor, or who are CYP2D6 poor metabolizers, INGREZZA concentrations may be higher and QT prolongation clinically significant. For patients who are CYP2D6 poor metabolizers or are taking a strong CYP2D6 inhibitor, dose reduction may be necessary. For patients taking a strong CYP3A4 inhibitor, reduce the dose of INGREZZA to 40 mg once daily. INGREZZA should be avoided in patients with congenital long QT syndrome or with arrhythmias associated with a prolonged QT interval. For patients at increased risk of a prolonged QT interval, assess the QT interval before increasing the dosage. Parkinsonism INGREZZA may cause parkinsonism in patients with tardive dyskinesia. Parkinsonism has also been observed with other VMAT2 inhibitors. In the 3 placebo-controlled clinical studies in patients with tardive dyskinesia, the incidence of parkinson-like adverse events was 3% of patients treated with INGREZZA and <1% of placebo-treated patients. Postmarketing safety reports have described parkinson-like symptoms, some of which were severe and required hospitalization. In most cases, severe parkinsonism occurred within the first 2 weeks after starting or increasing the dose of INGREZZA. Associated symptoms have included falls, gait disturbances, tremor, drooling, and hypokinesia. In cases in which follow-up clinical information was available, parkinson-like symptoms were reported to resolve following discontinuation of INGREZZA therapy. Reduce the dose or discontinue INGREZZA treatment in patients who develop clinically significant parkinson-like signs or symptoms.

Other Adverse Reactions Observed During the Premarketing Evaluation of INGREZZA Other adverse reactions of ≥1% incidence and greater than placebo are shown below. The following list does not include adverse reactions: 1) already listed in previous tables or elsewhere in the labeling, 2) for which a drug cause was remote, 3) which were so general as to be uninformative, 4) which were not considered to have clinically significant implications, or 5) which occurred at a rate equal to or less than placebo. Endocrine Disorders: blood glucose increased General Disorders: weight increased Infectious Disorders: respiratory infections Neurologic Disorders: drooling, dyskinesia, extrapyramidal symptoms (non-akathisia) Psychiatric Disorders: anxiety, insomnia During controlled trials, there was a dose-related increase in prolactin. Additionally, there was a dose-related increase in alkaline phosphatase and bilirubin, suggesting a potential risk for cholestasis. Postmarketing Experience The following adverse reactions have been identified during post-approval use of INGREZZA that are not included in other sections of labeling. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. Immune System Disorders: hypersensitivity reactions (including allergic dermatitis, angioedema, pruritis, and urticaria) Skin and Subcutaneous Tissue Disorders: rash

DRUG INTERACTIONS

Drugs Having Clinically Important Interactions with INGREZZA Table 2: Clinically Significant Drug Interactions with INGREZZA Monoamine Oxidase Inhibitors (MAOIs) Clinical Implication: Concomitant use of INGREZZA with MAOIs may increase the concentration of monoamine neurotransmitters in synapses, potentially leading to increased risk of adverse reactions such as serotonin syndrome, or attenuated treatment effect of INGREZZA. Prevention or Management: Avoid concomitant use of INGREZZA with MAOIs. Examples: isocarboxazid, phenelzine, selegiline Strong CYP3A4 Inhibitors Clinical Implication: Concomitant use of INGREZZA with strong CYP3A4 inhibitors increased the exposure (Cmax and AUC) to valbenazine and its active metabolite compared with the use of INGREZZA alone. Increased exposure of valbenazine and its active metabolite may increase the risk of exposure-related adverse reactions. Prevention or Management: Reduce INGREZZA dose when INGREZZA is coadministered with a strong CYP3A4 inhibitor. Examples: itraconazole, ketoconazole, clarithromycin Strong CYP2D6 Inhibitors Clinical Implication: Concomitant use of INGREZZA with strong CYP2D6 inhibitors increased the exposure (Cmax and AUC) to valbenazine’s active metabolite compared with the use of INGREZZA alone. Increased exposure of active metabolite may increase the risk of exposure-related adverse reactions. Prevention or Management: Reduce INGREZZA dose when INGREZZA is coadministered with a strong CYP2D6 inhibitor. Examples: paroxetine, fluoxetine, quinidine Strong CYP3A4 Inducers Clinical Implication: Concomitant use of INGREZZA with a strong CYP3A4 inducer decreased the exposure of valbenazine and its active metabolite compared to the use of INGREZZA alone. Reduced exposure of valbenazine and its active metabolite may reduce efficacy. Prevention or Management: Concomitant use of strong CYP3A4 inducers with INGREZZA is not recommended. Examples: rifampin, carbamazepine, phenytoin, St. John’s wort1 Digoxin Clinical Implication: Concomitant use of INGREZZA with digoxin increased digoxin levels because of inhibition of intestinal P-glycoprotein (P-gp). Prevention or Digoxin concentrations should be monitored when coadministering Management: INGREZZA with digoxin. Increased digoxin exposure may increase the risk of exposure-related adverse reactions. Dosage adjustment of digoxin may be necessary.

ADVERSE REACTIONS

Give your patients all the ease of INGREZZA. See more at INGREZZAHCP.com/Dosing Important Information INDICATION & USAGE INGREZZA® (valbenazine) capsules is indicated for the treatment of adults with tardive dyskinesia.

IMPORTANT SAFETY INFORMATION CONTRAINDICATIONS

WARNINGS & PRECAUTIONS (continued)

Parkinsonism INGREZZA may cause parkinsonism in patients with tardive dyskinesia. Parkinsonism has also been observed with other VMAT2 inhibitors. Reduce the dose or discontinue INGREZZA treatment in patients who develop clinically significant parkinson-like signs or symptoms.

WARNINGS & PRECAUTIONS Somnolence INGREZZA can cause somnolence. Patients should not perform activities requiring mental alertness such as operating a motor vehicle or operating hazardous machinery until they know how they will be affected by INGREZZA.

ADVERSE REACTIONS

QT Prolongation INGREZZA may prolong the QT interval, although the degree of QT prolongation is not clinically significant at concentrations expected with recommended dosing. INGREZZA should be avoided in patients with congenital long QT syndrome or with arrhythmias associated with a prolonged QT interval. For patients at increased risk of a prolonged QT interval, assess the QT interval before increasing the dosage.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit MedWatch at www.fda.gov/medwatch or call 1-800-FDA-1088.

Table 1:

Adverse Reactions in 3 Placebo-Controlled Studies of 6-week Treatment Duration Reported at ≥2% and >Placebo

Adverse Reaction1

The most common adverse reaction (≥5% and twice the rate of placebo) is somnolence. Other adverse reactions (≥2% and >Placebo) include: anticholinergic effects, balance disorders/falls, headache, akathisia, vomiting, nausea, and arthralgia.

General Disorders Somnolence (somnolence, fatigue, sedation) Nervous System Disorders Anticholinergic effects (dry mouth, constipation, disturbance in attention, vision blurred, urinary retention) Balance disorders/fall (fall, gait disturbance, dizziness, balance disorder) Headache Akathisia (akathisia, restlessness) Gastrointestinal Disorders Vomiting Nausea Musculoskeletal Disorders Arthralgia

Please see the adjacent page for Brief Summary of Prescribing Information and visit Neurocrine.com/INGREZZAPI for full Prescribing Information. REFERENCES: 1. Data on file. Neurocrine Biosciences, Inc. 2. INGREZZA [package insert]. San Diego, CA: Neurocrine Biosciences, Inc.

The following adverse reactions are discussed in more detail in other sections of the labeling: • Hypersensitivity • Somnolence • QT Prolongation • Parkinsonism Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice. Variable and Fixed Dose Placebo-Controlled Trial Experience The safety of INGREZZA was evaluated in 3 placebo-controlled studies, each 6 weeks in duration (fixed dose, dose escalation, dose reduction), including 445 patients. Patients were 26 to 84 years of age with moderate to severe tardive dyskinesia and had concurrent diagnoses of mood disorder (27%) or schizophrenia/ schizoaffective disorder (72%). The mean age was 56 years. Patients were 57% Caucasian, 39% AfricanAmerican, and 4% other. With respect to ethnicity, 28% were Hispanic or Latino. All subjects continued previous stable regimens of antipsychotics; 85% and 27% of subjects, respectively, were taking atypical and typical antipsychotic medications at study entry. Adverse Reactions Leading to Discontinuation of Treatment A total of 3% of INGREZZA treated patients and 2% of placebo-treated patients discontinued because of adverse reactions. Common Adverse Reactions Adverse reactions that occurred in the 3 placebo-controlled studies at an incidence of ≥2% and greater than placebo are presented in Table 1.

INGREZZA (n=262) (%)

Placebo (n=183) (%)

10.9%

4.2%

5.4%

4.9%

4.1%

2.2%

3.4% 2.7%

2.7% 0.5%

2.6% 2.3%

0.6% 2.1%

2.3%

0.5%

Within each adverse reaction category, the observed adverse reactions are listed in order of decreasing frequency.

The induction potency of St. John’s wort may vary widely based on preparation.

Drugs Having No Clinically Important Interactions with INGREZZA Dosage adjustment for INGREZZA is not necessary when used in combination with substrates of CYP1A2, CYP2B6, CYP2C8, CYP2C9, CYP2C19, CYP2E1, or CYP3A4/5 based on in vitro study results.

OVERDOSAGE

Human Experience The pre-marketing clinical trials involving INGREZZA in approximately 850 subjects do not provide information regarding symptoms with overdose. Management of Overdosage No specific antidotes for INGREZZA are known. In managing overdose, provide supportive care, including close medical supervision and monitoring, and consider the possibility of multiple drug involvement. If an overdose occurs, consult a Certified Poison Control Center (1-800-222-1222 or www.poison.org). For further information on INGREZZA, call 84-INGREZZA (844-647-3992). Distributed by: Neurocrine Biosciences, Inc. San Diego, CA 92130

INGREZZA is a registered trademark of Neurocrine Biosciences, Inc. CP-VBZ-US-0203v5 05/2020

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• C-Reactive Protein (CRP) Levels may be elevated in COVID-19 cases, especially severe cases.2-15 • Liver, Kidney and Cardiac function Elevated levels of the following biomarkers may be indicators of COVID-19 severity:16-27 - Alanine Aminotransferase (ALT)16,17,20-27 - Albumin (ALB)16,19-22,25-27 - Aspartate Aminotransferase (AST)16,17,19-21,23-26 - Creatine Kinase (CK)16,18,20,22-24 - Creatinine (CREAT)16,22,23,25,27 - Total Bilirubin (TBILI)16,20,25,27

3. 4. 5. 6. 7. 8. 9.

For in vitro diagnostic use only. The Piccolo Xpress does not directly diagnose COVID-19.

10. 11. 12. 13. 14.

The Governing Board The American Association for the Study of Liver Diseases, Released: April 7, 2020. CLINICAL INSIGHTS FOR HEPATOLOGY AND LIVER TRANSPLANT PROVIDERS DURING THE COVID-19 PANDEMIC. Guan WJ et al. medRxiv preprint 2020; doi: https://doi.org/10. 1101/2020.02.06.20020974 Chen N et al. Lancet 2020; 395: 507–13 ; https://doi. org/10.1016/S0140-6736(20)30211-7 Cao W et al. medRxiv preprint 2020; doi: https://doi. org/10.1101/2020.02.23.20026963 Shi H et al. Lancet Infect Dis 2020 ; https://doi.org/10.1016/ S1473-3099(20)30086-4 Shi S et al. Jama Cardiology 2020; published online March 25; doi:10.1001/jamacardio.2020.0950 Xu H et al. medRxiv preprint 2020; doi: https://doi. org/10.1101/2020.03.05.20031591 Young BE et al. JAMA. Published online March 3, 2020; doi:10.1001/jama.2020.3204 Ruan Q et al. Intensive Care Medicine 2020. https://doi. org/10.1007/s00134-020-05991-x Zhou B. Research Square 2020; DOI:10.21203/rs.3.rs-18079/v1 Zhou S et al. AJR 2020; 215:1-8; doi.org/10.2214/AJR.20.22975 Li J et al. medRxiv preprint 2020; doi: https://doi. org/10.1101/2020.02.11.20022053 Deng SQ, Peng HJ. J. Clin. Med. 2020; 9, 575 (Review); doi:10.3390/jcm9020575 Ständiger Arbeitskreis der Kompetenz- und Behandlungszentren für Krankheiten durch hochpathogene Erreger am Robert Koch-Institut (STAKOB). Hinweise zu Erkennung, Diagnostik

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SEE A LIST OF KEY PICCOLO XPRESS PANELS ON BACK.

For in vitro diagnostic use only.

15.

16.

17. 18.

19.

20.

21.

und Therapie von Patienten mit COVID-19; Downloaded 13. March 2020; www.rki.de/covid-19-therapie Chinese CoVID Management Guidelines-19, Version 7; published on 3/3/2020 by R.P.C. National Health Commission and the National Administration of Traditional Medicine of R.P.C.; translated by Jinwei Sun, Physician Specializing in Cardiovascular Disorders at the University of Milan-Bicocca Henry et al. 2020 Apr 10 Clinical Chemistry and Laboratory Medicine. Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 PMID: 32286245 DOI: 10.1515/cclm2020-0369. Ferrari et al. 2020 Apr 16 Clinical Chemistry and Laboratory Medicine. Routine blood tests as a potential diagnostic tool for COVID-19 PMID: 3230176 DOI: 10.1515/cclm-2020-0398. Yuan et al. 2020 Mar 29 Inflammation Research. The correlation between viral clearance and biochemical outcomes of 94 COVID-19 infected discharged patients PMID: 32227274 DOI: 10.1007/s00011-020-013242-0. Huang et al. 2020 Feb 15 The Lancet. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China PMID: 31986264 PMCID: PMC7159299 DOI: 10.1016/ S0140-6736(20) 30183-5. Chen et al. 2020 Feb 15 The Lancet. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study PMID: 32007143 PMCID: PMC7135076 DOI: 10.1016/S0140-6736(20)30211-7. The Governing Board The American Association for the Study of Liver Diseases, Released: April 7, 2020. CLINICAL IN

This material is intended for a U.S. audience only.

COVID-19 Channel Brochure - US 2994Rev.1 09/20 Piccolo Xpress is a registered trademark of Abaxis, Inc. and distributed by Abbott Point of Care. Abaxis 888-3354 Rev A

22.

23.

24.

25.

26.

27.

SIGHTS FOR HEPATOLOGY AND LIVER TRANSPLANT PROVIDERS DURING THE COVID-19 PANDEMIC. Zhou et al. 2020 Mar 28 The Lancet. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study PMID 32171076 DOI: 10.1016/S0140-6736(20) 30566-3. Guan et al. 2020 Apr 30 The New England Journal of Medicine. The Clinical Characteristics of Coronavirus Disease 2019 in China PMID: 32109013 PMCID: PMC7092819 DOI: 10.1056/NEJMoa2002032. Holshue et al and The Washington State 2019-nCoV Case Investigation Team 2020 Mar 5 The New England Journal of Medicine Case Reports. First Case of 2019 Novel Coronavirus in the United States PMID: 32004427 PMCID: PMC7092802 DOI: 10.1056/NEJMoa2001191. Wu et al. 2020 Mar 13 JAMA Internal Medicine. Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China PMID: 32167524 PMCID: PMC7070509 DOI: 10.1001/jamainternmed.2020.0994. Chen et al. 2020 May 1 The Journal of Clinical Investigation. Clinical and immunological features of severe and moderate coronavirus disease 2019 PMID: 32217835 PMCID: PMC7190990 (available on 2020-08-01) DOI: 10.1172/ JCI137244. Wang et al. 2020 Apr 23 The Journal of Clinical Investigation Insight. The laboratory tests and host immunity of COVID-19 patients with different severity of illness PMID: 32324595 DOI: 10.1172/jci.insight.137799.

The Abstract:

Medical News and Research Update Blood Markers Indicating Labor is Approaching Identified Researchers at Stanford University School of Medicine have identified for the first-time blood markers indicating when a pregnant women will go into labor. The study, which was published in Science Translational Medicine, gives insights on how labor begins, by analyzing immune and other biological signals in a blood sample. The study’s lead author, Ina Stelzer, PhD, said, “We found a transition from ‘progressing pregnancy’ to a ‘pre-labor’ phase that happens two to four weeks before the mom goes into labor…We’ve identified a novel way to use the maternal blood to predict when a mother will go into labor. This prediction is independent from the duration of pregnancy.”1 Brice Gaudilliere, MD, PhD, and the study’s senior author said, “Clinicians are good at estimating gestational age, which measures the development of the fetus. But there is a disconnect between this timing and when labor starts, because whether the baby is ready is only one factor in the onset of labor, the other part of the equation is the mother.”1 The study focused on 63 women during the last 100 days of pregnancy. Blood samples were taken two to three time prior to birth and each sample was analyzed for 7,142 metabolic, protein, and single-cell immune features. Researchers utilizing mathematical modeling where able to identify blood markers that best predicted the onset of labor. Current results though imprecise, about a five-week window, could lay the foundation for a more accurate clinical blood test.

New Technique to Treat Middle Ear Infections Middle ear infections affect more than 80% of children. Current treatment methods often include prescribing antibiotics; however research has shown that in 30% of middle ear infection cases, antibiotics don’t work. Also due to the prevalence of middle ear infections, overuse of antibiotics can lead to antibiotic resistant bacteria. That’s why results coming from a study funded by the National Science Foundation is providing hope for another treatment option. Researchers at the University of Illinois Urbana-Champaign have developed a 3D printed device to inactivate a common bacterium that causes middle ear infections. The 3D printed device generates plasma composed of charged particles and reactive molecules which can inactivate a variety of pathogens. Researchers in this project decided to try and penetrate the biofilm of the bacteria within the ear. Helen Nhuyen, an engineer who was part of the study, stated, “Biofilms are very dense, making it difficult for the antibiotics to penetrate. Our idea was that if we could disrupt the structure of the biofilm, we could increase the penetration of the antibiotics.”3 The research has been tested on rats and found after 15 minutes of treatment, bacteria was inactivated with no results of physical damage to the rat eardrum. The results suggest that this method could be used to treat middle ear infections in humans.

“New Generation” Artificial Heart Implanted in Patient – First in United States Drs. Jacob Schroder and Carmelo Milano lead a surgical team at Duke University Hospital which successfully implanted a new generation artificial heart. The 39-year-old man in which the artificial heart was implanted suffered from advanced biventricular heart failure. The artificial heart developed by CARMAT is intended to replace the ventricles of the native heart in patients and is currently approved to begin studies in the US. “Because of the shortages of donor hearts, many patients die while waiting for a heart transplant…we are hopefully for new options to help these patients,” said Dr. Schroder. Dr. Milano continued, “We are encouraged that our patient is doing so well after the procedure. As we evaluate this device, we are both excited and hopeful that patients who otherwise have few to no options could have a lifeline.”2

28 | PHYSICIANS OFFICE RESOURCE

Calcium Regulating Heart theABSTRACT medical news + research Protein Could Lead to New Treatment for Heart Children with Type 2 Diabetes Face Dire Future Failure It has long been known that calcium plays a vital role in bone, muscle, and heart health. Regarding heart health, calcium surge and diminish during and in between normal heart beats. Scientist also know that mitochondria depend on calcium to help produce energy that in return keeps the cell alive. In a recent study published in Nature5, an international study lead by researchers from the University of Utah sought to better understand the specific role of mitochondria and it’s relation to calcium signaling within heart cells. Researchers observed that when the signaling pathway for protein, VDAC2 was disrupted severe impairment of heart cell contraction occurred; thus making it harder for the heart to pump blood to the body. Stavrose Drakos, MD, PhD, senior author on the study, said, “Based on our human and laboratory research, it appears that if VDAC2 is not working properly, then everything in the heart can cascade downward from there. If we can figure out ways to help this protein do its job again, then it’s possible that we might be able to address heart failure far earlier in the disease process.”4 Researchers are hopeful this will open the way for therapeutic drugs to alleviate heart failure by targeting VDAC2.

Sources Blood Markers Indicating Labor is Approaching are Identified 1. https://med.stanford.edu/news/all-news/2021/05/ blood-markers-indicate-labor-approaching.html “New Generation” Artificial Heart Implanted in Patient – First in United States 2. https://corporate.dukehealth.org/news/new-generation-artificial-heart-implanted-patient-duke-first-us New Technique to Treat Middle Ear Infections 3. https://www.nsf.gov/discoveries/disc_summ.jsp?cntn_ id=303107&WT.mc_id=USNSF_1 Calcium Regulating Heart Protein Could Lead to New Treatment for Heart Failure 4. https://healthcare.utah.edu/publicaffairs/news/2021/07/ drakos-heart-failure-protein.php 5. https://www.nature.com/articles/s41467-021-24869-0 Children with Type 2 Diabetes Face Dire Future 6. https://www.nejm.org/doi/10.1056/NEJMoa2100165 7. https://www.nature.com/articles/d41586-021-02074-9 Certain Types of Body Fat Decrease Gray Brain Matter 8. https://www.medicalnewstoday.com/articles/some-typesof-body-fat-decrease-the-amount-of-gray-brain-matter 9. https://www.sciencedirect.com/science/article/abs/pii/ S0197458021000658

Type 2 diabetes in youth is increasing not just within the United States, but throughout the world. Up until now, little was known about the direct impact that type 2 diabetes would have on these youth as they entered adulthood. Now, thanks to a 15 year study, researchers have a better understanding of the dire effects this childhood disease will have on adults. According to a study published in the New England Journal of Medicine, “among participants who had onset of type 2 diabetes in youth, the risk of complications, including microvascular complications, increased steadily over time and affected most participants by the time of young adulthood.”6 500 participants were evaluated with a mean age of 26.4±2.8 years, after being diagnosed with T2D around the age of 13 showed the following complications: Cumulative incidences of hypertension = 67.5% Incidence of dyslipidemia = 51.6% Incidence of kidney disease was 54.8% Incidence of nerve disease 32.4% Prevalence of retinal disease increased from 13.7% in 2010/2011 to 51% in 2017/2018 The study also noted that “complications were more common among participants of minority race and ethic group and among those with hyperglycemia, hypertension, and dyslipidemia.”6

Certain Types of Body Fat Decrease Gray Brain Matter Gray brain matter is named for its grayish-pink color and is home to neural cell bodies, axon terminal, dendrites, and all never synapses. Gray matter is also essential in learning, memory, muscle control, and cognitive function. So, when researchers at the University of South Australia found that some types of obesity lead to a reduction in gray matter in the brain, alarms were raised. Lead author of the study, Anwar Mulugeta, PhD., said “We found that people with higher levels of obesity, especially those with metabolically unfavorable and neutral adiposity subtypes, had much lower levels of gray brain matter, indicating that these people may have compromised brain function, which needed further investigation.”8 The study found that for, “every extra 6.6 lbs. of body weight in a person of average height, the amount of gray matter decreased by .3%”8 Dr. Mulugeta lead author of the study stated, “However, we did not find conclusive evidence to link a specific obesity subtype with dementia or stroke. Instead, our study suggests the possible role of inflammation and metabolic abnormalities and how they can contribute to obesity and gray matter volume reduction.”8 2021, ISSUE 8 | 29

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Capacity 1 cu.ft. 1 cu.ft. 3 cu.ft. 3 cu.ft. 6 cu.ft. 6 cu.ft. 8 cu.ft. 8 cu.ft. 12 cu.ft. 12 cu.ft. 15 cu.ft. 15 cu.ft.

Height 21.5” 21.5” 33.75” 33.75” 32.5” 32.5” 50” 50” 61.75” 61.75” 72” 72”

Width 17.5” 17.5” 18.5” 18.5” 23.5” 23.5” 23.38” 23.38” 23.38” 23.38” 23.5” 23.5”

Depth 19.5” 20” 19” 19.5” 24.5” 25” 24.5” 25” 24.5” 25” 24.5” 25”

Door White Glass White Glass White Glass White Glass White Glass White Glass

790*, 865.00 878.00 965.00 969.00 1,060.00 1,072.00 1,284.00 1,349.00 1,788.00 1,801.00 1,970.00 1,983.00

Height 83.75 83.75 83.75 83.75

Width 27.5 27.5 55.25 55.25

Depth 31 31 31 31

Door (1) Stainless (1) Glass (2) Stainless (2) Glass

790*, 2,466.00 2,811.00 3 634 00 4,186.00

Height 83.75 83.75

Width 27.5 55.25

Depth 31 31

Door (1) Stainless (2) Stainless

790*, 2,804.00 4,299.00

Pharma-Lab Refrigerators

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9658

Refrigeration designed and purpose-built for pharmacy, medication, and vaccination applications to support meeting CDC/VFC vaccine storage guidelines

+/-1ºC variation derived from the maximum deviation of an NTC sensor in a 1 oz. vial located nearest the champer geometric center during a 24 hour test period

Simple to use and easy to maintain with a zero maintenance concept, the Micros ES 60 is a small tabletop hematology analyzer with an integrated data management system. The analyzer provides a CBC with 3-part differential result in less than 60 seconds using only 10 µL of sample. Connect to the LiteDM Patient Data Management System for an affordable way to consolidate patient results to one report.

9656

Refrigerators & Freezers From 23 to 49 Cu.ft.

Capacity 23 cu.ft. 23 cu.ft. 49 cu.ft. 49 cu.ft.

Pharma-Lab Freezers Accucold AFS23ML AFS49ML

Capacity 23 cu.ft. 49 cu.ft.

Choosing the Right Sized Unit Below are a few handy steps for determining the ideal Accucold refrigerator size for your clinic:

Estimate the maximum number of doses of publicly-provided vaccine and privately purchased vaccine that will be in your refrigerator.

Refrigerator: Public Vaccine

Add the number of doses on hand (current inventory) from your last order form. ________________

Match your maximum doses with the minimum cubic feet needed to safely store your vaccine

Max. Doses

Minimum Cubic Ft.

2,000+ doses

may need more than one refrigerator

1000-2000

40 cu.ft 36 cu.ft 21-23 cu.ft

Private Vaccine

+ ________________

900-1000 801-900

Total doses

= ________________

701-800

17-19.5 cu.ft

Multiply (max inventory) Maximum doses

x 1.25 = ________________

400-700

11-16.7 cu.ft

100-399

4.9-6.1 cu.ft

The first and only single-dose ciprofloxacin otic suspension administered by a healthcare professional in an office setting

OTIPRIO® (ciprofloxacin otic suspension) 6% Rx only

Staying Power Thermosensitive liquid-to-gel technology

OTIPRIO uses proprietary formulation technology THERMOSENSITIVE PROPERTIES After administration to the external ear canal, OTIPRIO warms and transitions to a gel.

BRIEF SUMMARY OF PRESCRIBING INFORMATION FOR OTIPRIO INDICATIONS AND USAGE OTIPRIO is a fluoroquinolone antibacterial indicated for the treatment of acute otitis externa in patients 6 months of age and older due to Pseudomonas aeruginosa and Staphylococcus aureus. DOSAGE AND ADMINISTRATION Dosage and Important Administration Instructions • OTIPRIO is for otic administration by a healthcare professional only. • OTIPRIO is intended for single-patient use, discard unused portion. • For acute otitis externa, administer OTIPRIO as a single 0.2 mL (12 mg) administration to the external ear canal of each affected ear of patients aged 6 months and older. Preparation of OTIPRIO Directions for OTIPRIO dose preparation and handling for acute otitis externa is illustrated in Figure 1 of the full prescribing information. DOSAGE FORMS AND STRENGTHS Otic Suspension: Each 1 mL of OTIPRIO contains a white, preservative-free, sterile otic suspension consisting of 6% (60 mg/mL) ciprofloxacin in a single-patient use glass vial.

For more information on OTIPRIO, please contact your local ALK representative or call 1-800-325-7354.

INDICATIONS AND USAGE OTIPRIO® (ciprofloxacin otic suspension) 6% is a fluoroquinolone antibacterial indicated for the treatment of acute otitis externa in patients 6 months of age and older due to Pseudomonas aeruginosa and Staphylococcus aureus.

IMPORTANT SAFETY INFORMATION CONTRAINDICATIONS

OTIPRIO (ciprofloxacin otic suspension) 6% is contraindicated in patients with a history of hypersensitivity to ciprofloxacin, to other quinolones, or to any of the components of OTIPRIO. WARNINGS AND PRECAUTIONS Potential for Microbial Overgrowth: OTIPRIO may result in overgrowth of non-susceptible bacteria and fungi. If such infections occur, institute alternative therapy. ADVERSE REACTIONS Acute otitis externa clinical trial: Adverse reactions (incidence at least 2%) with OTIPRIO vs sham were: ear pruritus (2% vs 2%), headache (2% vs 1%), otitis media (2% vs 1%), and ear discomfort (2% vs 0%). USE IN SPECIFIC POPULATIONS Pediatric Use: The safety and effectiveness of OTIPRIO in infants below 6 months of age have not been established for the treatment of acute otitis externa. Please see Brief Summary of Prescribing Information for OTIPRIO on the following page

OTIPRIO is being marketed by ALK-Abelló, Inc. and Otonomy, Inc.

CONTRAINDICATIONS OTIPRIO is contraindicated in patients with a history of hypersensitivity to ciprofloxacin, to other quinolones, or to any of the components of OTIPRIO. WARNINGS AND PRECAUTIONS Potential for Microbial Overgrowth OTIPRIO may result in overgrowth of nonsusceptible bacteria and fungi. If such infections occur, institute alternative therapy. ADVERSE REACTIONS Clinical Trials Experience Because clinical studies are conducted under widely varying conditions, adverse reaction rates observed in the clinical studies of a drug cannot be directly compared to rates in the clinical studies of another drug and may not reflect the rates observed in practice. In a single randomized, sham controlled Phase 3 clinical trial, 259 pediatric and adult patients with acute otitis externa were treated with OTIPRIO or sham administered by a healthcare professional to the external ear canal as a single dose (0.2 mL to each affected ear). The median age of the patients enrolled in the clinical trial was 34 years; 26% were pediatric patients (age 3 to 17 years), 65% were adults (age 18 to 64 years), and 8% were elderly patients (age 65 years and older).

Adverse reactions that occurred in at least 2% of OTIPRIO patients and at an incidence greater than sham are presented in Table 1. Table 1: Adverse Reactions in Phase 3 Acute Otitis Externa Trial OTIPRIO Sham Adverse Reactions (N=127) (N=132) Ear Pruritus 2% 2% Headache 2% 1% Otitis Media 2% 1% Ear Discomfort 2% 0% USE IN SPECIFIC POPULATIONS Pregnancy Risk Summary Animal reproduction studies have not been conducted with OTIPRIO. No adequate and well-controlled studies have been performed in pregnant women. Because of the negligible systemic exposure associated with clinical administration of OTIPRIO, this product is expected to be of minimal risk for maternal and fetal toxicity when administered to pregnant women. Lactation Risk Summary Ciprofloxacin is excreted in human milk with systemic administration. However, because of the negligible systemic exposure after otic application, nursing infants of mothers receiving OTIPRIO should not be affected. Pediatric Use The safety and effectiveness of OTIPRIO for the treatment of acute otitis externa was established in 67 pediatric patients (3 through 17 years of age) who participated in the Phase 3 trial; 57% of patients were 3 through 11 years of age and 43% of patients were 12 through 17 years of age. The safety and efficacy observed in the pediatric patients was no different from the older population. OTIPRIO is indicated for the treatment of acute otitis externa in pediatric patients 6 months of age and older. The safety and effectiveness of OTIPRIO in infants below 6 months of age have not been established for the treatment of pediatric patients with acute otitis externa. For more detailed information, please read the full Prescribing Information. Distributed by: Otonomy, Inc. San Diego, CA 92121 www.otiprio.com OTIPRIO® is a registered trademark of Otonomy. U.S. Patent Nos: 8,318,817, 9,205,048, 9,220,796, 9,233,068, 9,486,405, and 9,603,796

. . . �L

.:•.• .:: .....::r:::...... ...•...:•:.• : ·.=:.:::

FEATURE

HELPING PATIENTS HELP THEMSELVES ONLINE BY DLYAN CHADWICK

These days, virtually any brick and mortar service has its own internet doppleganger. One can attain a college degree by attending online classes, stream movies directly from the source and of course, there’s Wikipedia, the online staple that’s put the final nail in the coffin of the door-to-door Encyclopedia industry. And while there’s seemingly no end to the wealth of information afforded to us on the internet, that information does come at a price: internet “quality control” is spotty at best. Now, that’s well and good, likely entry level information to anyone who’s ever written a term paper or sought out unbiased information in a Honda forum...but then again, internet literacy isn’t always a straightforward metric. In an article by Tanya Fenke MD, (Dr. Google Should Be Sued for Malpractice. Here’s Why), the author illustrates the inherent problem of taking all our health concerns to Google, namely that internet sources quickly become outdated, are biased towards their benefactors and constituents, aren’t often written by healthcare professionals and often lack traceable references. In fact, as the title dictates, she suggests that if Google were a physician, he or she should be sued for malpractice, based on the number of problems that disseminating false information causes (no word on Dr. Pepper and Dr. Feelgood’s prospects at the time of publication). While I wholeheartedly agree with Fenke’s assessment, that Google, or an internet search, isn’t a sustainable replacement for actual medical advice from an actual, living, breathing medical professional, I also realize the dilemma of Google’s involvement in everything. The trends of internet ubiquity aren’t going to slow, nor will Google’s lumbering ascent into total control

of the internet cease. This isn’t glass half-empty philosophizing either, just the acceptance that if/when (more like when) the machines finally do take over, we can assume Google will be in the mix somewhere. Instead, it’s becoming important for physicians to not only be the conduits towards viable health information, but also to help patients establish good searching habits for when they come across health information on their own time. Physicians cannot dictate what their patients will read and see outside of the office, but by giving them the tools to sniff out what’s good and what probably needs a second opinion, they greatly reduce the number of faulty accidents and misunderstandings. Look for Recent Content Health information is subject to ongoing developments and research, on micro and macro scales. What was once the de-rigeur health fad or yesterday might have been proven total bunk today, and vice versa. In that regard, information on the internet can run a little bit dicey since (theoretically) anything put online stays online forever. Encourage patients to check their sources and to be wary of any sources from more than a few years old, particularly if it’s dispensing health advice. Even if the information has stayed the same, credible and reputable outlets will be sure to keep things current anyway. Additionally, the idea of timeliness opens up the discussion for physician blogging and social media, a great way to create relevant and reputable content quickly, to update on information that is changing and to just generally maintain a current channel of communication. Patients should also be wary of

2021, ISSUE 8 | 35

FEATURE

“...It’s becoming important for physicians to not only be the conduits towards viable health information, but also to help patients establish good searching habits for when they come across health information on their own time.”

information that doesn’t contain any dates as there’s no way to determine how recently it was obtained and published. Objectivity and Bias It can be difficult to look objectively at one’s own symptoms, especially when emotions are running strong and influencing one’s actions. In this regard, internet searching along various strings of keywords can push the user towards a “self-diagnosis” that is biased or at the very least a little skewed. This also introduces what I call the “WebMD” effect in which a person goes down the internet rabbit-hole of reading all symptoms associated with a certain disorder and slowly convinces themselves that they indeed have the disorder. No one is immune to momentary flashes of anxious grandiosity. Furthermore, there’s a wealth of “for profit” sources out there, posing as viable health professionals, even when they’re not. Wary patients should be mindful of any sites with corporate sponsors, as the information contained may just be a sideways plug to get you to buy a miracle product or to sell you on an affliction you don’t actually have. Solid health information is a right, and shouldn’t market you towards buying anything new. Experience and Credibility It goes without saying, but a number of those dispensing health care information are just writers….not doctors (this one included). In this regard, knowing exactly where a source comes from can be what will set off the “nonsense meter” right away. Patients should look for the credentials of an author who’s dispensing health care information, ensuring that they’re actual, medically licensed doctors. Even so, it’s not uncommon for professionals to get their articles ghost written by off-site writers. Patients should assume that any information coming from a source that doesn’t identify as a physician should probably not be regarded at all, and those that come from doctors, should be carefully vetted before following up on them. Sources and Citations In print, most must cite their sources, but on the internet, and it can be a bit more difficult to truly regulate this principle. If a site doesn’t cite the sources of its claims, or if they’re especially absolute or broad and sweeping, one should main-

tain their skeptic senses a bit. Information can be sensationalized to drive ratings and page views to a site, and often take claims and facts out of context, specifically to fit their own content agenda. If a site doesn’t provide sources for its health care advice, isn’t from a health sanctioned organization or contains many sources from less credible sources, patients shouldn’t accept the information sight unseen. Remember, if a site doesn’t want readers to know where they got their stories, at best they likely don’t have anyone’s best interests in mind and at worst, could be hiding something. Encourage the In-Person Follow Up Fortunately, physicians still have the ultimate, and most credible, say in directing patients towards quality health care information. Besides endowing them with a dose of healthy skepticism towards online health information (and let’s be honest, it’s a good trait to have in an election year too), it’s important to remind them that they can always follow up directly with you, a primary health care source, about anything unclear. Not only does this type of outreach send the message that you’re there to help and guide them in their healthcare journey, but also establishes a precedent for always checking up with a qualified source before taking anything to heart. Ultimately, we shouldn’t recognize Google as anything even remotely like a doctor and should recast it for what it really is: “a huge repository of information, scrupulously indexed and largely unregulated.” Patients and users still have the power.

References Feke, Tanya, MD. “Dr. Google Should Be Sued for Malpractice. Here’s Why.” KevinMD.com. KevinMD, 09 Aug. 2015. Web. 17 Aug. 2015. Johns Hopkins Medicine Health Library. “Finding Reliable Health Information Online.” Hopkinsmedicine.org. Johns Hopkins, n.d. Web. 17 Aug. 2015.

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36 | PHYSICIANS OFFICE RESOURCE

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SPIROMETRY PORTABLE, SINGLE CLICK OPERATION SPIROMETER

HEMATOLOGY TESTING MADE EASY From Sysmex 9661

9664

Designed for labs testing up to 25 samples per day, the Sysmex pocH-100i™ has the smallest footprint of any analyzer on the market. The instrument requires only 15uL of whole blood for reporting of 17 clinical parameters, including a 3-part WBC Differential. It is ideal for urgent care, physician office lab, small clinic, or any outpatient setting where a point of care CBC is needed.

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From MicroDirect The MicroDirect SpiroUSB many features include single click operation of all main functions, full ATS/ERS test quality checks, real time Flow/Volume and Volume/ Time traces, a choice of child incentive displays, choice of predicted values, estimated lung age, pre/post bronchodilator comparisons and can be used on multiple PC’s with dongle software protection key. The child incentive display and ATS quality checks ensure maximal results every time. Use with a laptop for true portability.

PRODUCT FOCUS

HEMATOLOGY ANALYZERS

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MICRO 1 SPIROMETER

SYSMEX XN-L™ SERIES AUTOMATED HEMATOLOGY ANALYZERS

From MicroDirect

From Sysmex Now lower volume customers can enjoy the same capabilities in CBC testing as larger hospitals and reference labs. Enhanced clinical value is standard and optional licenses for reticulocyte or body fluid testing are available. The XN-L analyzers are the first to feature BeyondCareSM Quality Monitor, an innovative, webbased QC and calibration management program.

9662

View Brochures, Videos & More at POR.io Enter Number 9662 in the Search Area

Specifically designed for situations where low cost precision spirometry measurements are required, the Micro I Spirometer measures the following parameters FEV1, FVC, PEF, FEF25-75, EEV6, FEV1/FVC, FEV1/FEV6, FEF25 and FEF25 that cn be displayed along with percent predicted and post bronchodilator comparisons and provide an optional printout if needed. Extremely lightweight and portable making it suitable for hospital outreach clinics, bedside screenings, health fair screenings and other situations where remote testing is required.

9665

View Brochures, Videos & More at POR.io Enter Number 9665 in the Search Area

9663

FIRST EVER CLIA WAIVED HEMATOLOGY ANALYZER From Sysmex

SPIROMETRY IS EASY

Faster test results, clinical decisions and greater practice efficiency are coming to physicians’ offices with the first CLIA-waived CBC analyzer. Hematology diagnostics leader Sysmex is bringing more lab testing to the point of care. One of the most common blood tests can be conducted reliably and accurately on-site, in as few as three minutes. The device’s ease of use and innovative technology means in-house staff can operate it in just a few easy steps, without lengthy certification and training. The new Sysmex XW-100 will improve health care efficiency and patient care.

From MicroDirect Unless the equipment is easy to use, it will not be fully utilized by your staff. The MicroLab and MicroLoop are menu driven via a large graphic display and the test takes less than five minutes to perform. The easy-to-read reports, quality checks and built-in interpretation assist with your diagnosis. Your office sees patients with indications for spirometry on a daily basis. Accurately and quickly diagnosis them so you can properly treat them.

View Brochures, Videos & Mores at POR.io Enter Number 9663 in the Search Area 9666 38 | PHYSICIANS OFFICE RESOURCE

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2021, ISSUE 8 | 39

Pinpoint SARS-CoV-2 and 18 other bugs. The new BioFire® Respiratory 2.1-EZ (RP2.1-EZ) Panel1 covers COVID-19 detection in your clinic. SARS-CoV-2 is everyone’s top suspect, but many other respiratory bugs can cause similar, overlapping symptoms. In your clinic, you can test for 19 common respiratory pathogens, including SARSCoV-2, with the BioFire RP2.1-EZ Panel—now available under an FDA Emergency Use Authorization.1.2 Syndromic testing means all it takes is one test and about 45 minutes to round up SARS-CoV-2—and all the other usual respiratory suspects. Rapid answers on a broad range of pathogens can inform patient management and alleviate patients and staff alike. What’s your frontline solution into respiratory season and beyond?

9667

1. This test has not been FDA cleared or approved. This test has been authorized by FDA under an EUA for use by authorized laboratories. This test has been authorized only for the detection and differentiation of nucleic acid of SARS-CoV-2 from multiple respiratory viral and bacterial organisms. This test is only authorized for the duration of the declaration that circumstances exist justifying the authorization of emergency use of in vitro diagnostics for detection and/or diagnosis of COVID-19 under Section 564(b)(1) of the Federal Food, Drug, and Cosmetic Act, 21 U.S.C. § 360bbb-3(b)(1), unless the authorization is terminated or revoked sooner. 2. For use with the CLIA-waived BioFire® FilmArray® 2.0 EZ configuration.

BFR0001-0515-01

To learn more, visit biofiredx.com