Pulse oximetry has become the standard non-invasive method of determining arterial oxygen saturation because of its simple functionality and high clinical value. Pulse oximetry has been on the increase in primary care settings as well. Small, inexpensive pulse oximeter units have changed the way primary care physicians evaluate, manage, and treat patients. It provides the physician with a quantitative assessment and measurement with which to manage patients’ chronic and acute illnesses.

Pulse oximetry procedures are billed under separate current procedural terminology (CPT) codes, and can be used in conjunction with other office and outpatient evaluation and management codes. Office staff can be easily trained to perform pulse oximetry, thereby increasing physician patient time, and office and physician revenue.

Pulse oximetry is a noninvasive measurement of arterial oxygen saturation. It measures oxygen saturation within the patient’s hemoglobin using both red and infrared light. The amplitudes of the light signals are measured and mathematically calculated to give oxygen saturation as a percentage. The medical device industry has created an apparatus standard for pulse oximetry. Pulse oximetry accuracy specifications are +/-2 digits. Although pulse oximetry readings may differ from manufacturer to manufacturer based on their proprietary algorithm, all must meet the industry’s device specifications. This value may be affected by other molecules that bind to the patient’s hemoglobin, like carbon monoxide, which produces a higher measurement of saturated hemoglobin. These high levels produce an inaccurate oxygen saturation reading on the pulse oximeter. Values obtained by pulse oximetry that do not correlate with the patient’s physical findings must be confirmed by arterial blood gas in a laboratory.

This type of medical diagnostic equipment when used on a patient with Chronic Obstructed Pulmonary Disease (COPD) may be of benefit with each primary care office visit. Decreased oxygen saturation readings from the patient’s normal baseline can be an early identifier of infection, medication non-compliance, and disease exacerbation. In conjunction with the patient assessment, the oxygen saturation obtained by pulse oximetry may help avoid hospital admissions.

Primary care physicians treat patients with pneumonia in their office on a routine basis. The pulse oximeter assists the physician in determining the severity of the disease and provides documentation to support hospital admission. Patients with aggressive pneumonias may present with decreased oxygen saturation levels and shortness of breath. Pulse oximetry helps quantify the need for hospital/acute care admission and supports the clinical findings of the physician.

The pulse oximeter can be used by the primary care physician as a screening tool for possible sleep disorders when used in conjunction with a patient history. Some portable pulse oximeters have the ability to record and store readings over a 24-hour period. Patients can be sent home with battery powered oximeters for an overnight recording of oxygen saturation. The patient places the oximetry probe on their finger and turns on the oximeter for an overnight recording at their normal bedtime.

Pulse oximetry can be useful in treating infant and pediatric patients in the primary care setting. Infants with Respiratory Syncytial Virus (RSV) and other respiratory problems can present with increased respiratory rates, retractions and low oxygen saturation levels. Pulse oximetry can be a useful assessment tool in evaluating the severity of the illness, and the need for acute care intervention.

Reimbursement for pulse oximetry in the primary care setting can be billed in addition to normal evaluation and management CPT codes. There are three CPT codes that can be used in the primary care setting for pulse oximetry. All three procedural codes can be billed in conjunction with Evaluation and Management (E&M) codes.

The pulse oximeter can be valuable in a physician’s office for any primary care physician. The clinical information that the pulse oximeter provides can be beneficial for the evaluation and management of different diseases. Pulse oximetry can help justify acute care intervention and placement, and help determine severity of a disease process. At a relatively low cost to the nation, it can be used as a screening tool for sleep disorders. A pulse oximeter is a dependable piece of equipment that needs little maintenance, and can become an indispensable tool for the primary care physician.
Excerpt from article in Physician Office Resource, Issue #3.

Feeling stressed out? If you are like most people, you probably are coping with stress and need to learn how to relieve stress. What can you do about stress? First realize that knowing how to relieve stress is extremely important to your health and well-being, and then begin to focus on reducing the stress in your life before stress takes hold of you.

Most of us are rarely in tranquil environments, or even get a chance to notice the beauty around us. Remember the old saying, “stop and smell the roses?”

Our lifestyles are so high-speed, we rarely get a chance to stop and do anything other than mind-race about our “to-do” list, or worry about the things we didn’t get done. When was the last time you took a moment to gaze at the ocean and just watch and listen to the waves hit the shore? It can be a wonderfully mesmerizing and stress relieving experience. How about watching flowers glistening in the sun, or the leaves on a tree blowing in the wind? These moments are natural stress relievers. When you allow yourself to soak in and appreciate these peaceful moments, you can experience instant stress relief and tranquility.

But because our lifestyles or so high-speed we don’t always have that line for these moments. The Alexander Technique can show you new ways to relieve the stress. This is a learned method to improve postural and movement dysfunction. It engages the mind and body to reduce physical misuse in daily activities. In a series of one-on-one lessons with a certified teacher, a student of the Alexander Technique of New York develops the skills to execute any action with minimized strain and maximized balance. The result is optimal functional mobility, decreased pain, and a greater sense of well being.

How many genes can you name and not the manufacturers? No matter what jeans are called they are determined by current styles, sex, and by the manufacturer. Here are some of the names/styles/fits produced for jeans:

• Ankle jeans
• Baggy jeans
• Bell bottom/Flares
• Bootcut
• Boy cut or Boyfriend (for women)
• Carpenter jeans
• Classic
• Denim
• Designer jeans
• Destroyed jeans
• Distressed jeans
• Hip-huggers
• Jorts (Jean shorts)
• Jean skirt
• Jeans fetishism
• Loose jeans
• Low-rise jeans
• “Mom” jeans
• Original jeans
• Overall
• Phat pants
• Recycled jeans
• Relaxed Fit
• Ripped jeans
• Saggy
• Skinny jeans
• Slinkies
• Straight jeans
• Wide leg

Rises in jeans is the distance from the crotch to the waistband and range from high-waisted to super low-rise (Low rise can be called Low Riders). Jeans for men usually have a longer rise and zipper, whereas women have a shorter rise and zipper, although exceptions do exist and this is largely a function of current trends. In decades past, when high-waisted jeans were popular, it was often the women’s that featured a longer rise.

In today’s society jeans are an all-around product. Blue jeans are being recycled and it is becoming a popular insulation material (sometimes called Cotton Batt insulation) used in the construction of houses. Due to its low relative synthetic chemical composition and because it is made of recycled materials, it is gaining prominence in green building circles. Like conventional insulation, it moderates temperature and reduces sound transfer between floors or rooms. Blue Jean insulation has an excellent R-Value of 3.7, making it a preferable insulator to typical fiberglass batts even without taking into account the environmental considerations.

They say that flying is still the safest way to travel. Depending on how much money you have to spend a commercial flight can give you economy seats, business seats or even first class. Or you could fly the skies in a private jet charter, use an executive jet service or even a luxury private jet. Sure, you can get luxury in a commercial flight in first class but how wonderful is it to really get luxury in a private jet. That is like taking a road trip in an RV.

Imagine, you could get a private jet charter to fly to a wedding, a birthday party or going on vacation. Just think of how you would feel once you arrive at your destination. Can you imagine how a business meeting within an executive jet service would end? Imagine the deals that you could make using such a service.

Then there is that once-in-a-lifetime opportunity to pamper yourself in a luxury private jet with champagne and caviar. The longer you are in flight the more pampered you could be. You would definitely be ready for anything once you reached your destination.

Luxury can make a huge difference in your life and your success. No matter what the reason is for your flight, to impress a lady/gentleman, to impress a client or potential business partner, or just to pamper yourself and/or your family you can fly the skies in luxury. The next time you have to fly anywhere for any reason do it in luxury and enjoy yourself.

Everybody knows how difficult it can be to get their cat or dog go to bed when they do whether that bed is in a cage/create, outside, or a specific place within the home. Cats are a little more independent and harder to train but it can be done. For a dog, if you give them a comfortable place to sleep and train them to it they will love it.

Cats always seem to like the worst place in the house to sleep at night, your chest. Some dogs have the same problem, your feet. Providing them with their own pet bed can make a big difference on whether you can breathe or move your feet at night.

Cats have one unique rate that seems to be true for the mall. They like to be above everything so they can look down on it. Providing a clawing post that reaches to the ceiling and then placing their bed near the top on a shelf could make it easier to breathe at night.

Dogs love to please their masters. So if you provide them with a dog bed and put it where you want them to sleep you will solve the problem with your feet. And because they are pleasing you but they will be happy and comfortable.

When pets are shown love they will return it tenfold. So find out where your pet really enjoys sleeping other than your chest or at your feet and you will have a happy pet when you provide them with their own bad.

Where would you like to live, work or retire? Are there times when you want to get off the overcrowded highway to the city and head for a small, more picturesque location?

Indeed, many use the word “love” in describing their feelings about where they live or want to live. They say a place with small-town charm but also big-city amenities does exist.

Nyack is one place that is not nearby to or easy to reach from New York City. Bus-to-train-to-subway commutes are the price of living there. Nyack’s New York Real Estate can provide that.

Memories, relationships, treasured possessions — these are the things that a home holds within its walls. Understanding that a home, regardless of its cost, reflects the priceless value of the life within should not be taken lightly. The people of Palisades believe this. Residents of the hamlet are known for the way in which they jealously guard against development that they consider out of character. They out bid an oil company just to keep a 3-mile square area filled with woods. Palisades is another place that is off the beaten track. Palisades Real Estate can help you become part of this community.

No matter where it is, on the shore of a river, near a waterfall, huddled in the woods or on the top of a mountain it is your home. It is where your family will reside. Your heart will be in the walls and ceilings and the floors because it is your home. Piedmont Real Estate can help you find it.

The people at Nyack’s New York Real Estate, Palisades Real Estate, and Piedmont Real Estate believe that home is where the heart is and will help you find your dream home.

A physician has a degree in medicine, not computer science or business management. The good news is that selecting an EMR does not require in-depth technical knowledge. But it does require additional physician office equipment, namely a computer. An EMR can reduce time spent charting, provide more efficient patient visits and help meet regulatory requirements.

Take ownership of your decision because it will impact how you practice medicine. Do not delegate it back to office staff or your local computer guy. Although, staff should play a key role in its selection.

Determine what your requirements are. Do not let the salesman drive your selection process. Only you, the physician, know how you practice medicine. It is critical to get the ideal workflow as well as the interaction with office staff to complete a patient visit. You must determine what you want; just electronic charting or do you want end-to-end solutions that extend all the way to claim management.

This means that you must get the right EMR for your specialty. The narrow focus of a specialty EMR allows it to design its system around the unique needs of a position with in his target market. A large focus EMR will have more resources and a wider reach for a client database.

When integrating your practice management you need to consider how you want your system to support metal billing, patient scheduling and practice management. Are all these functions in one complete package or should the EMR interface with existing solutions? An advantage to integrated clinical and practice management is that an integrated coding and can help you develop a more accurate claims process during the encounter, reduce the need to “downcode” or have the staff scrub the claim later.

It is critical to find a system that makes each encounter easier, not harder. Medicine is complex enough without software making things more difficult so focus on ease of use in your search. The simplest way to evaluate ease-of-use is to sample a demo copy a straightforward system will be especially important when staff turns over and new employees need to be brought up to speed quickly.

What about support and upgrades US? You most likely want we can support and possibly nighttime support, even if only reviewing the records. You must consider how seem to support, is it online, phone, 24/7 and are you prepared to talk to a foreign support staff member. Check the references if they give you. Talked to the doctors who have already purchased an EMR. You also need to as, “Will it continue to meet regulatory requirements and support new standards? Can and will it invest in new development? How strong is the company?”

You must also consider the cost of GM cars. The prices ranging from $1000-$100000 can quickly narrow down the search of the system you want. You also need to consider Internet connections and new technologies. It is possible to access medical records entirely over the web. There are options that lower upfront costs, simplify maintenance and provide ease of use of a web application. Do not forget the technology. In healthcare development language and databases should not drive a software selection process. It should assess underlying technology from a defensive standpoint.

This will definitely add to the physician office equipment inventory increasing the value of your practice. This may not be as expensive as some of your medical diagnostic equipment but it is just as important. It may even allow you access information to some of the pharmaceutical company’s newest drugs via the Internet. Now is the time to get your EMR up and running before the government mandates.

You know, I can remember times before the computer. An entrepreneur could only dream about having a computer for his business. I remember when the PC first came out and you had to have 2 floppy disks (you remember those, they were 4″ square). One was used to start the computer and the other was your program. And the Internet that was an even bigger dream. Back then only the government and rich people had access to the Internet.

Then before you knew it the PC started improving. It had hard drives that held the operating system so you did not have to put in a floppy disk; but, you had to use a floppy disk to save all your information on. Now, the hard drives are not in megs they are in gigs! You do not need to use a floppy disk unless you want to and the floppy disk is 3.5, CD-RW or a memory stick.

Of course, with all these improvements new problems developed. Viruses, worms, and a plethora of other problems that have driven people crazy. You need to run scans for viruses and worms. You need to run scans for spam and spyware, all to protect your system. Why do you ask, the Internet.

The Internet gives us access to so much that we never had before from our homes. You used to “need” to go to a store and buy the things that you wanted. Now you can do your shopping from the luxury of your home. You can even work from home if you have access to the Internet.

Now working from home is the best thing that has come out of this with the development of the computer and the Internet. You can develop a business by simply setting up a website. But, there are other problems when you do this. You run into so many questions:

Am I doing this correctly?

How do I get people to come to my website?

Who can I get to help me with my website?

How do I improve my sales?

You need to make sure that your website is optimized correctly and that you have been listed in search engines. Now, just starting out you may not be able to afford an SEO (Search Engine Optimization) firm but it is a priceless advantage. It answers all of the above questions. Money that you spend on a website optimization consultant can improve your sales. And that is the object of any good entrepreneur or business.

Jeans rocked the American world in 1872 when Jacob Davis burst onto the pants making scene with the new rugged, durable, but most importantly, comfortable pair of pants that he called “jeans”. This became a hit sensation with the common working man, who saw this as a replacement to their loose, sometimes even fragile pants they were wearing at the time. In 1873 in a joint partnership with Levi Strauss, Davis patented his riveted pants he called jeans, and a long history of comfortable, but strong, leggings was born.

Since the patent was bought in the 19th century, the jeans have gone through many different stages before becoming one of the most popular, and for that matter cost effective, pairs of pants available. But there is some irony in the shift in focus from the more pristine look of a new pair, to the now wildly popular appearance of ripped jeans. Where these articles of clothings’ sales were once predicated on their versatility in the work place, they are now valued by the level of disrepair in which you can find them, perhaps a testament of the generation’s desire to fundamentally “break out” of standard behavioral procedures: what’s a better way than to destroy the indestructible?

What was once seen as a simple phase in the grand scheme of fashion has evolved into a rather lucrative business, as websites such as Destroyed Brand base their business on the selling of destroyed jeans, or, if you already have a pristine pair, you can send them in to be distressed by the owners of the website for a small fee.

Therefore, it should go without saying that the new “in” is ripped jeans - and with big names like Masuimi Max featuring Destroyed Brand distressed jeans in their special edition clothing lines, they don’t appear to be a fading fad like some predicted.

Dogs are very important to their owners and that is why they should be treated the way you would any other member of the family. Aside from their regular feeding, vet visits and provision of all the vitamins and nutrients that they need for growth, your dog also deserves to be pampered once in a while. There are companies such as Pet Dreams that continue to provide all the items that you would possibly need to make your dog feel like the king of his own dog house. Dogs have often been referred to as “man’s best friend”. Why would anyone want to let their “best friend” sleep on the floor when he could be resting on a dog bed? Dog beds are made to provide your dogs and pets with a level of comfort during naptime in the home or in their dog house as well as when you take along on your travels in their pet carriers.

When a dog uses a pet bed such as this, one would find that it caters for your dog’s nap time during both summer and winter. A dog bed is reversible and it keeps them cool during the hotter months and warm during the winter.