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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

Masimo Sleep
device and application!

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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

April 20, 2022:  MDMtool.org online! Vision Screening Webinar online!   Masimo Sleep Review online.

Outcome Referrals

Outcome Referrals

Outcome Referrals

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

Plusoptix S16

Plusoptix S16

Plusoptix S16

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.

Ear Irrigation

Ear Irrigation

Ear Irrigation

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

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.