The Technology Review Site for Primary Care Providers
Advances in technology have improved healthcare providers' ability to rapidly diagnose patients at the point of care, screen for common conditions, and provide a variety of effective treatment options. Providers need to be aware of what innovations are available - or will become available in the near future. It is the purpose of Medgizmos to educate and inform healthcare providers regarding the latest and greatest technologies.
ScopeAround Wifi Otoscope, new inexpensive digital otoscope!
I’ve long been a fan of Masimo pulse oximeters for use in pediatric patients. They produce sturdy devices ideal for the medical office that integrates their proprietary signal extraction technology (SET. SET provides accurate readings in moving patients and uncooperative patients as often are the children and infants in my practice. I’ve previous reviewed the Masimo Rad-G pulse oximeter and well and the MightySat. Both have colorful screens, easy to navigate interfaces, reasonable pricetags and display oximetry readings, heart rate, perfusion index, and respiratory rate derived from the plethysmographic waveform.
You may encounter patients whom you suspect have a sleep disorder. Many are reluctant to visit sleep specialist who may order home or sleep center sleep studies. It may be prudent to recommend the $80 Masimo Sleep Device. As presented in the video one fastens the Masimo Sleep device to the wrist, attaches the sensor to a fingertip, and connects the app via Bluetooth to the Masimo Sleep Application. One initiates a sleep session which continuous monitors, oxygen saturation, heart rate, breathing rate, and respiratory rate. Once a session has ended the user is presented with a comprehensive report with the above data and lists major and minor sleep events. This information can be shared with a provider and a referral placed to a sleep center if indicated. Great device and so easy to use.
As a pediatrician I use numerous forms to screen children for depression, anxiety, suicidal risk, substance abuse, ADHD and other. These forms are also used to monitor patients undergoing treatment.
I recently interviewed David Kraus PhD, President, and Chief Scientific Officer of Outcome Referrals, who developed the Treatment Outcome Package (TOP), to screen adults, adolescents and children for a wide range of symptom and functional domains. The TOP consists of a 58-question questionnaire for adults and adolescents and 48 -question questionnaire for children that can be filled out in minutes. It is used to establish a diagnosis and to monitor a patient’s improvement during and following treatment.
Dr. Kraus has demonstrated that the TOP system can be used to identify therapists who are most appropriate to meet a patient’s individual needs. This has been validated via several studies available on the outcome referral web site.
The interview is wide ranging and very informative. The TOP can be filled out via paper forms or via an online portal and repeated as indicated. What I find most exciting is that Dr. Kraus is developing a system, called “FastPass” to facilitate access to appropriate therapists. As we are all aware patients now often must wait months to see a therapist, and hopefully the FastPass system, once implemented will shorten wait times considerably. Stay tuned
Amblyopia is one of the most common visual problems of childhood, occurring in as many as 1% to 4% of children.1 It is defined as poor vision caused by abnormal development of visual areas of the brain; if undetected and untreated it can lead to permanent vision impairment.
Unfortunately, less than 40% of children are screened for this condition.2 Causes of amblyopia include strabismus (misalignment of eyes), anisometropia (inequality of vision of both eyes because of refractive errors or astigmatism), cataracts, ptosis, or other factors. Because children do not complain of problems with visual acuity, and affected eyes often appear normal, amblyopia can easily go undetected unless a child has vision screening done routinely at health maintenance examinations.
Vision screening in children aged younger than 3 years in a medical office can be challenging because few children this age can be screened with a vision chart. From age 3 to 5 years, screening is possible with Snellen charts, Tumbling E charts, or picture tests such as Allen Visual Acuity Cards, but this is time consuming and can lead to inconsistent or erroneous results. According to the 2016 guidelines Screening instruments detect amblyopia, high refractive error, and strabismus. I recommend that Instrument-based screening should be performed at age two and repeated at each annual preventive medicine encounter through 7 years of age.
Amblyopia remains treatable until age 7, with rapid decline of effective treatment after this time. The goal of vision screening in infants and young children, therefore, must be the early detection of high severity (magnitude) amblyopia risk factors (ARFs), including moderate or severe astigmatism, anisometropic myopia, high hyperopia, severe strabismus, and opacities in the visual axis, including retinoblastoma or other ocular entities that cause opacities that interfere with transmission of light to and from the retina.
Plusoptix has offers the S16 photoscreener for practices who do not need a portable device. The S16 features a terrific interface that is displayed on a monitor attached to the device. The results can be printed via a network printer and the system keeps track of previous screens. Plusoptix also provides the free plusoptiXconnect software for practices to store, review, print results.
It is vitally important that providers have unobscured view of the tympanic membrane in order to diagnose Otitis Media, Serous Otitis Media, or Otitis Externa. Additionally, impacted cerumen may be uncomfortable for patients, and in some situations may reduce hearing acuity. So, it has become routine practice for physicians to remove cerumen during an office visit.
Many of us have developed our favorite techniques for removing cerumen. In the video above I share mine. Basic principles include using a ceruminolytic to soften wax. My preferred agent is sodium docusate liquid. ($12 or so for a big bottle on Amazon) I saturate cotton balls with the liquid and put them in the ears for 15 minutes. By using cotton balls, one can soften the cerumen in both ears at the same time. One then can use a syringe or an ear wash system such as the Elephant Ear Washer System ($26 on Amazon) that uses soft plastic catheters ($16 for a bag of 20). The catheter is pushed gently through the wax before irrigation begins, so the cerumen is push out of the canal and not toward the tympanic membrane. Often the cerumen is extruded as a solid plug.
The irrigation solution is room temperature water mixed 4 to 1 with hydrogen peroxide. I use an ear basin to catch cerumen and place chucks on the patient’s shoulder to prevent accidents.
Contraindications to irrigation include the presence or history of a perforated tympanic membrane (or ear tubes), previous pain on irrigation, previous surgery to the middle ear , or the presence of a discharge.
If you use a curette exercise caution. I prefer the EasiEar curettes which are metal, but flexible. These cost $69 for 25 from splashcap.com
I’ve been doing Telehealth visits for many years, mostly for following patients who I treat for attention deficit hyperactivity disorder and/or anxiety or depression. The quality of the visit on several factors, including bandwidth, quality of microphone and webcam at both ends of the virtual visit. As a pediatrician, particularly for my younger patients, I find I can improve patient and parent engagement by using backgrounds with my zoom calls. This can be videos showing me on a warm beach with the waves rolling in, or backgrounds with patient pleasing designs and colors. While Zoom virtual visits can be used without a “green screen”, background images or videos can be distorted unless you use one.
A very affordable and versatile 56-inch circular green screen is the Webaround which can be purchased on Amazon.com, for $50 or less. As described in the video the Webaround is attached to a chair with Velcro straps and positioned appropriately in the room used for virtual visits. In my experience it is a complicated process to re-fold the Webaround so it can be placed back in its transport bag, so I just leave it attached to a chair in a room in my office I use for Telehealth visits.
Please let me know if you have any advice that improves the quality of the virtual visits you conduct with patients.