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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.

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Latest Reviews

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Connected Technology

ScopeAround Wifi Otoscope, new inexpensive digital otoscope!

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Medical Devices

Check My Ear
Acoustic Otoscope

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Software/Applications

Scoliometer application quantifies scoliosis via a smartphone!

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Latest Interviews/Webinars

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Interview

Outcome Referrals
Dr. David Kraus

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Webinar

Plusoptix Vision Screening
Webinar

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Subscribe to receive notifications of our latest posts.

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View our Spring/Summer 2021 Newsletter

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New! Visit Our Podcast Page

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New! Visit MDMtool.org

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Navigation

Home page sections include recent video reviews, a searchable list of all posts, and a list of post pages organized by topic.

Medgizmos

Is the “virtual medical home” of Andrew J. Schuman MD, who has been writing about medical technology and medical practice for over 30 years!

Update

May 28, 2022:  MDMtool.org online! Vision Screening Webinar online!  Acoustic Otoscope review  online.

Webaround Green Screen

Webaround Green Screen

Webaround Green Screen

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. 

SoftSpot Application

SoftSpot Application

SoftSpot Application

Most pediatricians are aware that plagiocephaly (asymmetric head shape), and brachycephaly (wide head shape), occur frequently in young infants, with some estimates placing the incidence as high as 19 to 40%. Plagiocephaly and brachycephaly occurs from there is prolonged pressure on the skull before or after birth and is more easily corrected before ossification begins at 5 to 6 months of age. Congenital muscular torticollis, resulting from shortening of the sternocleidomastoid muscle unilaterally can contribute to the development of these conditions. Plagiocephaly and brachycephaly, if not diagnosed and left untreated place an infant at risk for facial asymmetry, mandibular asymmetry, asymmetric motor skills, and increased risk of development delay. They are also associated with increased risk of in utero positional deformities such as clubfoot and developmental hip dysplasia. 

Treatment of brachycephaly and plagiocephaly with or without congenital muscular torticollis involves range of motion and positional therapy. Often affected children who are diagnosed late or do not improve are then referred for physical therapy.  If diagnosed after 5-6 months of age or when other therapies do not produce adequate improvement, helmet therapy is then indicated.

It is estimated that only a fraction of the babies born each year with plagiocephaly and or brachycephaly are treated, leaving the remainder undiagnosed and never treated. 

SoftSpot Application

Two scientist parents whose child was diagnosed with plagiocephaly, thought there should be a better way to screen for these conditions as well and monitor improvement with therapy.  They joined with other scientists to investigate the possibility of making a mobile application to facilitate the diagnoses and monitor therapy. The company, PediaMetrix was formed in 2018, and now after years of research and development they now have FDA approval to market their prescription based mobile application called SoftSpot. 

Neurosurgery and craniofacial centers employ hand calipers to measure the cranial index. The oblique diagonal difference is a measurement of the asymmetry of the skull. These measurements quantify the severity of the problem and are used to determine if the infant would benefit from positional and range of motion therapy, physical therapy, or helmet therapy.

The SoftSpot application is available on android and ios platforms. A cap is placed on the infant’s head to prevent artifacts due to the baby’s hairline, a sticker placed on the top of the head and a short video taken via the SoftSpot application. This is then upload to the PediaMetrix site where AI based algorithms are used to compute cranial measurements.  A report is sent to the pediatrician who can discuss this with parents and make recommendations. Measurements are taken monthly for those infants who are being observed, or who are receiving therapy, and a progress report sent to the pediatrician. 

The application is easy to use and is expected to be very affordable.  PediaMetrix has recently received an NIH grant to develop a mobile application that may be able to identify infants at risk for craniosynostosis. 

I think the application lends itself to Telehealth visits, and can help identify the many babies with plagiocephaly or brachycephaly that go undiagnosed and untreated.  Stay tuned!

Caregiver Interview

Caregiver Interview

Caregiver Interview

Early physicians recognized that illness often was associated with fever, but it took centuries for scientists to develop the means to measure body temperature. Although Galileo in 1592 was the first to fashion a crude thermometer, it was another Italian scientist, Santorio Santorio, who was the first to take oral temperatures in 1625. His thermoscope, as it was called, was large and cumbersome, and took hours to perform a single measurement.

It was not until the mid-1800s that the German physician Carl Wunderlich developed a foot-long thermometer that could take clinical temperatures. In 1868, he published his data of more than 1 million axillary readings from more than 25,000 patients. He determined that there was a diurnal variation in daily body temperatures ranging from 97.3°F in the morning to 99.5°F in the evening. He also originated the standard of 98.6°F as “normal body temperature” that we use today. His readings took 20 minutes to perform, and for anyone but the most patient of physicians, this was not a practical device.

When I opened my first practice in 1986, I was intrigued by an advertisement in Contemporary Pediatrics that caught my attention, and days later I was the proud owner of a FirstTemp tympanic thermometer. The manufacturer (Intelligent Medical Systems; Carlsbad, California) promised the device’s measurements were as accurate as oral and rectal temperatures taken with glass thermometers. I was initially skeptical of this high-tech thermometer, but within weeks it proved to be a very popular device among staff, providers, and patients. The reason it was successful was that it required little patient cooperation and took temperatures in seconds, and it produced measurements comparable to those obtained with our digital oral and rectal thermometers. 

Before the Haemophilus influenzae type b vaccine first became available in 1985 and the first pediatric conjugate pneumococcal vaccine became available in 2000, pediatricians routinely encountered severe illnesses in patients that included meningitis, septic arthritis, osteomyelitis, and sepsis. These were so common that blood cultures and spinal taps were routine office procedures. Before the introduction of the H influenzae and pneumococcal vaccines, 3% of young febrile children without a focus of infection had positive blood cultures for H influenzaeStreptococcus pneumoniae, or Neisseria meningitides. Six percent of those patients positive for pneumococcus also were discovered to have meningitis, while up to 20% of positive blood cultures for H influenzae were associated with meningitis. Today, the incidence of occult bacteremia is 0.5%, and we rarely perform blood cultures or spinal taps in the workup of infections, except in febrile young infants. The key point is that, just 2 decades ago, parents and pediatricians were alerted to the possibility of severe pediatric illness by the presence of fever, and they were comforted by its absence. Today, documentation of a fever alerts physicians regarding the cause of the associated symptoms. In most situations, there is an infectious cause with rheumatologic illnesses, malignancy-related fevers, and period fevers being much less common.

Ron Benincasa and Gary O’Hara invented the first infrared ear thermometer, the FirstTemp mentioned above,  which was introduced to medical practices in 1984. Because of its speed, it became extremely popular and eventually sold about 80,000 units. It was replaced by a more streamlined unit called the Genius and the company was eventually sold to Sherwood Medical (Now Covidien) in 1993. You can still purchase the Genius 3 online for $379 dollars. 

Ron and Gary reinvented infrared thermometry about a decade ago, forming a company called Thermomedics, producing first accurate non-contact clinical forehead thermometer called the Caregiver PRO-TF300-CS. Ron estimates the company has sold more than 80,000 units and studies have demonstrated that the thermometer is extremely accurate. It takes temperatures in 2 seconds and two AA batteries can provide up to 15000 measurements.  In my own experience it produces temperature measurements comparable to that produced Exergen’s TAT-5000 contact thermometer, while costing substantially less. 

PlusOptix Vision Screening Webinar

PlusOptix Vision Screening Webinar

PlusOptix Vision Screening Webinar

Amblyopia is one of the most common visual problems of childhood, occurring in 2.5 % of children. 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. 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 latest 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 years, with rapid decline of effective treatment after age 5 years. 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.This webinar, sponsored by Plusoptix, details how screening with Plusoptix photoscreeners can facilitate identification of children at risk for amblyopia who should be seen by an optometrist or ophthalmologist for diagnosis and treatment. It also describes a pilot study demonstrating that if a child who refers on vision screening is given an appointment with a vision specialist before departing the pediatrician’s office, the success of achieving a completed diagnostic exam will exceed 90%!

CHADIS System

CHADIS System

CHADIS System

In 2001, 2 developmental pediatricians, Drs. Barbara Howard and Raymond Sturner, developed the Child Health and Development Interactive System (CHADIS; Total Child Health Inc; Baltimore, Maryland), a comprehensive web-based system for screening children for behavioral and developmental problems. The CHADIS online portal has received 26 million dollars in federal and foundation grants for research and development of the current system. To date, more than 5000 providers from around the globe are using the CHADIS system, and it continues to grow in features and popularity. The CHADIS assessment tool allows pediatricians to invite parents to fill out online, age-appropriate screening tools in advance of well-child visits. The CHADIS system evaluates the forms filled out by parents, performs scoring when indicated, and alerts pediatricians of issues that need to be discussed with parents at well-child or behavior-related visits. Many pediatricians speak favorably of the CHADIS system in that it allows them to identify parental concerns and behavior issues that would have gone unidentified in the past. A CHADIS subscription costs about $1500 per provider per year, paid either annually or via monthly installments with discounts available for volume licenses.

As of this writing, CHADIS incorporates more than 200 screening tools that pediatricians utilize frequently, such as the Modified Checklist for Autism in Toddlers Revised with Follow-up (MCHAT R/F), Ages and Stages (ASQ), Vanderbilt Assessment Scales, Patient Health Questionnaire for Adolescents (PHQ-9), and Generalized Anxiety Disorder (GAD-7) forms, as well as forms. However, CHADIS doesn’t stop at screening. It also provides a full library of resources for pediatricians and parents to assist in management once a condition is diagnosed. Another benefit of CHADIS is that Dr. Howard conducts a case webinar on a monthly basis to discuss issues related to developmental screening and management.

The CHADIS screenings can be used by parents via their home computers in advance of visits or alternatively via a tablet-based interface that is handed to them at the reception window. The CHADIS reports can be copied and pasted into your EHR so that the results of the screening are documented.

For an excellent overview of chides and demonstration of new features please visit:  https://youtu.be/_pKaAAhPAT0