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.
Clarius mobile Ultrasound system facilitates POC diagnoses!
The Covid-19 pandemic has created an opportunity for the engineers at Remmie Health to develop and begin distribution of an inexpensive ($150) otoscope that can be used to capture images of the tympanic membranes and throat of an ill child or adult. The Remmie Otoscope is now available on Amazon and is designed to be non-threatening to children. It complements ear or forehead thermometers that are likely used routinely by parents to screen children for fever. The Remmie Otoscope transmits images to a mobile application which then can be sent to a child’s physician for review.
Several years ago, the CellScope Oto otoscope was developed to enable smartphones to be used as an otoscope. However, it was awkward to use even though the images it captured were of high quality. Because the camera’s associated with smartphones changed so rapidly, it was difficult for the company to produce the plastic adapters necessary to connect the device to smartphones, and sadly the company went out of business.
As more and more physicians have adopted Telehealth, I anticipate that the Remmie Otoscope will prove useful for the Otitis prone child, as physicians can now diagnose otitis media or pharyngitis remotely. It can also be used to detect impacted cerumen, otitis external, and visualize ear canal foreign bodies.
Remmie Health is now working on developing a Software development Kit (SDK) so Telehealth platforms can integrate the device into their software by developing an application programming Interface. In my view, a provider should recommend that families consider acquiring the device and using it in conjunction with your Telehealth visits, as it will reduce much of the guess work when evaluating an ill child.
I continue to be amazed by how versatile smart phones have become and how innovative companies continue to add to our repertoire of “connected” healthcare devices. Such is the case of the D-EYE Portable Retinal Imaging System. Many primary care physicians would benefit from a better way to visualize the retina and optic disc. Our traditional ophthalmoscopes, after all – provide only a limited view of the retina, even when used with the most cooperative patients. The D-EYE system uses the sophisticated optics of the camera built into many iPhone models in combination with a special attachable lens to provide clinicians with an improved view of the retina. We need to visualize the retina during routine examination and in situations where we follow patients for diabetes or hypertension, and in any patient young or old presenting with headaches, or a history of head trauma.
The iPhone is fitted with a bracket that facilitates magnetic attachment of the D-EYE system (see video). Officially priced at $500, I’ve seen the system priced as low as $400. A little bit of training is required to become proficient with the system. Once you learn the application interface and become facile with the device, you will be rewarded with a better view of the retina.
I love tech that is simple, affordable and improves medical practice. Such is the case for the Optivisor which is a $40 to $50 purchase from Staples, or Amazon, or EBay!. It is a visor/headband combination that enables you to see those things you need to see with an increased magnification. I use it for suturing, removing sutures, freezing warts, removing ticks,, removing splinters, or just getting a better look at suspicious nevi.
You can adjust the headband to fit securely. Battery powered headlamps are available as well. If you wear glasses as I do it is an easy matter to position the visor over your head while wearing glasses so I can visualize what I want to see with and without magnification – I just flip the visor down when I want to use it.
Also the visor can be fitted with lenses of different magnifications, depending you the need and your personal preference. Great product and one every primary care physician should consider placing in every exam room!
Pulse oximetry is recognized as the fifth vital sign – together with temperature, respirations, pulse, temperature and blood pressure, it is routinely obtained at most medical visits. While many stand alone pulse oximeters cost upwards of $1000 or more, there are many lower priced “fingertip” units that can connect via cables or better yet via bluetooth wireless connections to a tablet or smartphone. The Masimo MightySat is a standout that provides accurate readings, shows the pulse, pulse waveform, perfusion index on your smartphone . It features a colored touch screen that will display vertically or horizontally, even when used a finger of either hand. It provides readings in situations of low perfusion or even when a patient is moving or shivering. When the app is loaded on your smart device it finds the MightySat quickly. You can’t beat the price of $300 and available for ios as well as android devices.
Keep in mind that while the device can be used for spot readings, it can also be used for continuously monitoring a patient. The bluetooth connectivity reaches distances of 10 to 15 meters or more. This lets you have a poor man’s remote monitoring system at a fraction of the cost. It communicates through walls, around corners, etc. so it is easy to monitor a patient prior to , during and after a nebulizer treatment or in any situation when monitoring the pulse and/or pulse oximeter readings would be useful.
There is no medical device more iconic of medical practice than the stethoscope we carry in our lab coat or drape around our neck. I’ve been a user of the Littmann 3200 digital stethoscope for many years. As an early adopter of this technology it was obvious that this $400 stethoscope had many advantages over traditional stethoscopes. Firstly, is features ambient noise reduction, facilitating auscultation in noisy environments. As I am a pediatrician this alone is worth its purchase. Additionally, it can be used to improve auscultation via it’s ability to “magnify” sound volume without sacrificing sound quality. As my hearing is not as good as it was 30 years ago, I also find this feature particularly useful. It is an easy matter to learn how to navigate the interface. One pushes a button to turn the stethoscope on, presses a plus or minus button to change the volume level. Another button changes the frequency level from bell to diaphragm as well as to a combined mode. One of the best features of the Littman 3200 is that it can record up to 12, 20 second sound tracks. This can be used to record heart murmurs or lung sounds. I place the ear tips in the parent’s ears so I can demonstrate what I have heard. This makes it very easy to share the significance of my findings parents and patients. The stethoscope can cannect via Bluetooth to a pc or mac computer and Littmann’s free StethAssist software can be used to transfer auscultated recordings to your computer. In a future article I will detail a portal developed by Sensicardiac which analyses recorded murmurs and indicates whether the murmur is benign or whether the patient should be referred to cardiology for further evaluation.
Several studies have shown that OAE hearing screening can be easily performed in pediatric practice and it will identify children with hearing problems. Otoacoustic emissions can be used as a screening test for any age. The technology is especially convenient with infants and toddlers, for whom audiometry can be difficult or impossible to perform. It is also helpful in deciding if surgical management is needed for bilateral middle ear effusion of longer than 3 months’ duration.
When sound enters the ear canal, the tympanic membrane vibrates and the middle ear ossicular chain transmits the sound to the cochlea. The sound waves in the cochlea excite the outer hair cells and a backwash of sound energy–otoacoustic emissions (OAEs)–travels in the reverse direction, from the cochlea through the middle ear into the ear canal. In an abnormal ear, the intensity of the emissions is much weaker than in a normal ear.
Transient OAEs are produced by the outer hair cells of the cochlea when a “click” sound stimulus is presented to the ear. In contrast, distortion product otoacoustic emissions (DPOAEs) are the emissions produced by the outer hair cells in the cochlea when sound stimulus is provided by the simultaneous presentation of 2 pure tones of equal intensity but different frequencies. In either situation, an OAE screening instrument, using a sensitive microphone in the ear canal, assigns a pass or fail grade for the child’s hearing based on an algorithm stored in memory.
Otoacoustic emissions screeners test hearing at 2, 3, 4, and 5 kHz in a matter of minutes. An infant or child who “refers” should be examined for evidence of ear canal obstruction with cerumen, otitis media, or serous otitis, with treatment as indicated. In the absence of a treatable cause, or watchful waiting in the case of a serous otitis, repeat testing should occur in 2 to 4 weeks’ time, and if there is no improvement, the child should be referred to a pediatric audiologistPediatricians should screen children for hearing problems throughout childhood as per the Bright Futures guidelines. This means screening children at ages 4, 5, 6, 8, and 10 years and whenever risk factors are identified. Additionally, those children who are being monitored for developmental delays or speech problems also should be subjected to hearing screening.
The Welch Allyn Hearing Screener is a very basic OAE screener. Advantage include low cost of acquisition (around $4000) the color screen (albeit small compared to other models), and the probe fit and repositioning screening, which launches the test automatically. Overall for pediatricians I like cartoon based OAE screeners (this model does not have a cartoon screen!) which keep kids cooperative for screening (see other reviews on Medgizmos).