In this episode, Tom Samuelson and I discuss trabecular bypass procedures including the currently available & two future models of the iStent, and the Ivantis Hydrus Microstent. There is a tendency for doctors to prescribe third and fourth glaucoma medications even though it is well known that there is such a diminishing return after two medications. These ab-interno devices can serve as a glaucoma-lite procedure, the next step after two medications for those reluctant to proceed with a potentially more effective but more risky trabeculectomy. The use of multiple iStents, next generation devices, or targeting delivery to visualized collector ducts should lead to improvements in ab-interno trabecular bypass procedures in the years ahead.
Teaching works best when it takes place in the context in which the information will be used. That is one of the fundamental tenants of adult education. Another central principle is that adult learners have other things going on in their lives and cannot spend all their time outside of work still engaged in work related learning activities. An institution that rolls out upgrades to a mission-critical system that is central to the daily care of patients, if they really valued their employees and their patients, would protect time during working hours to allow their employees to learn new features while seeing patients. Or, at the very least, free them from clinical responsibilities for enough time to work with mock patients to learn the new system.
We are trying to reach a point with Electronic Medical Records where we can easily share medical information between providers at different geographic locations. The road map for "meaningful use" had targeted this for 2014-15. Yet, the most widely used hospital based EMR system in this country, EPIC, fails to even allow sharing of data within our own hospital about a given patient let alone between other hospitals and ours. How did we drift so far from the goals of having EMRs actually help us care for patients?
Whether in private practice or a hospital setting, nobody wants to be throwing money away on ancillary testing devices and staff salaries so we usually try to make sure we use our resources to their fullest. With the cost of equipment such as perimeters to perform visual field testing or Ocular Coherence Tomographers for nerve fibre layer scans in the $25-125K range, and technicians to perform the tests drawing salaries of $20-$40 per hour, you can understand why those making the purchasing and hiring decisions would not want to see any idle time. But, does maximizing utilization of resources lead to an improved patient experience in glaucoma care? You need an abundance of resources to have smooth patient flow which leads to a positive patient experience and improved staff morale.
Patient presents 2 weeks following cataract surgery with retained lens fragments, iris chafing from subluxed IOL, broken bag, IOP of 51 and has had lens fragments supposedly removed already along with multiple paracenteses to attempt to bring the IOP down (along with being placed on multiple glaucoma meds.) Case is discussed and the surgery I performed is presented.
It's brand new! Mophie, the makers of external battery packs for iPhones and a few other devices, has created a Juice Pack for the current best phone ever, the HTC One. I pre-ordered it and this is the unboxing. There is a serious flaw making at least the one I received unusable but Mophie will replace it.