Seriously, I can never manage to remember the differences between Monteggia and Galeazzi fractures – especially when it shows up on standardized tests. So, this edition of Fracture Fridays focuses on differentiating the two. Essentially, when one forearm bone breaks and is displaced, angulated and foreshortened something happens to the other one – usually a fracture – but sometimes a dislocation. These are much more common in adults, since pediatric bones have greater plasticity, and often break at the physis. The simple mnemonic I came across states that Monteggia is fracture of ulna. Therefore, Galeazzi is fracture of radius. See, not so great. I’m not a mnemonic guy myself, so I made this handy table.
In February, I presented at an educational conference of the American Academy of Sleep Medicine. After my talk I met sleep physician Dr. Clifford Molin who has developed ZeeAppnea, an app that utilizes a smartphone to provide a ubiquitous way of determining sleep apnea risk. The app does not require special equipment, but rather utilizes standard earbuds with a microphone. It is important to emphasize that ZeeAppnea is not a diagnostic tool, but rather a screening tool to determine sleep apnea risk.
Shiv Gaglani, Medgadget: How did you come up with the idea for Zee Appnea?
Dr. Clifford Molin: The idea for this App actually occurred after downloading another App that demonstrated the functionality of existing sensors available in smartphones. One of the sensors available was a decibel meter that displayed the sound amplitude in a waveform tracing. Being a sleep physician interested in breathing problems I was curious to see if I could emulate sleep breathing patterns using the App on the smartphone. What appeared was a pattern of breathing that was consistent and reproducible. I was then able to reproduce on the smartphone abnormal breathing patterns that can only be demonstrated while doing an actual sleep study in the sleep lab.
The need for such an App, became clear to me after seeing one woman after the next coming in to the sleep clinic armed with a smartphone recording and with their significant other (the prospective patient) in tow. The smartphone recording demonstrated snoring and then a prolonged period of silence. What was being captured was sleep apnea. With this evidence in hand the bed partner had no choice but to agree to a sleep evaluation. The App could provide a more sophisticated and objective risk assessment tool than a crude recording of snoring.
Medgadget: Can you describe the current problem?
Dr. Molin: Currently 80% of individuals with sleep apnea are undiagnosed. A simple objective screening tool is essential to increase awareness of this disorder and encourage further evaluation. Sleep apnea symptoms like snoring and pausing to breath occur while sleeping, so are not evident to the sufferer.
ZeeAppnea helps reinforce the fact that the problem is real and quantifiable by providing actual displays of sleep breathing pauses generated by the smartphone recording.
The ultimate hope is that ZeeAppnea App, will provide a simple way, to objectively identify sleep apnea risk, so those suffering from this disorder can be identified and treated in an expeditious fashion.
Medgadget: Have you been able to validate the app?
Dr. Molin: The App has been internally validated by comparing formal sleep studies that are performed in the lab with the analysis from the smartphone. Over 85 App studies have been subsequently validated with a traditional sleep study. The results have been surprisingly consistent, demonstrating that the App recording is an excellent screening tool for determining sleep apnea risk.
Medgadget: How does this compare to other apps/devices on the market?
Dr. Molin: There are no other Apps for sleep apnea that are comparable. Apps currently on the App store record snoring and use this as a surrogate indicator of sleep apnea. ZeeAppnea actually records real breath-by-breath patterns and can effectively demonstrate breathing pauses.
Medgadget: Can you describe the process you went through to create the app?
Dr. Molin: Building a prototype and creating a functional and reliable app are two very different things. As with most things the devil is in the details. And those details come to the surface day-by-day and week-by-week as the App gets tested and deployed. It has taken many iterations of rebuilding to get an App that will work on multiple phones across multiple networks and operating systems.
The unforeseen glitches and bugs can be overwhelming and very often are only demonstrated when real users attempt to utilize the App in a variety of ways and situations.
Most of the bugs have been ironed out creating a relatively robust App that can withstand most user fallibilities, utilizing almost any phone on any network.
But the process of improving the App remains a never-ending process of development and redevelopment.
Medgadget: Do you have any advice for other people looking to develop health apps?
Dr. Molin: The current smartphone technology with the myriad of built in sensors and relatively cheap development cost, is just waiting for application development. It is important to understand the built in smartphone sensor technology and then figure out how to utilize the sensors in ways that can make tasks that where once only possible with sophisticated customized devices relatively simple and cheap to reproduce on a smartphone.3
AirStrip (San Antonio, TX) received FDA clearance for the company’s Sense4Baby monitor to be used by expecting mothers to perform at-home fetal non-stress tests (NSTs). These are commonly performed inside clinics, but thanks to new technology and a bit of training these can be done accurately at home.
Once the test is performed, the data is uploaded to the company’s AirStrip ONE platform from where it can be viewed by clinicians using computers, tablets, or smartphones.
The company is working with The University of Utah to do an initial trial of the device testing its benefits when used at home in both high and low risks pregnancies.
Baxter received regulatory approval to introduce its HOMECHOICE CLARIA automated peritoneal dialysis (APD) system to the European market. Designed for home use, the device was made for ease of use and it works with Baxter’s SHARESOURCE online platform that allows clinicians to review patients’ dialysis sessions. Thanks to this feature, patients don’t have to keep journals and clinics don’t have to bother creating reports from those journals, since all that is done automatically.
The readout on the device itself can be set to work with any of 41 pre-programmed languages, allowing it to be used in different markets around the world. Baxter will soon begin introducing the system both in Europe and certain Asian countries.
Researchers at The University of New South Wales in Australia, with the help of folks at Cleveland Clinic, Brown and Stanford Universities, and Zeiss, harnessed Google’s own algorithms to create essentially a “Google Maps” for the human anatomy. Just as with satellite imagery of the Earth, the technology relies on imaging done at different resolutions and fields of view, capturing the overall view and at various steps getting down to the level of individual cells. The tool looks and works like Google Maps, letting users pan and zoom just like we’re all already used to, but it reminds us of the 70’s movie Powers of Ten that demonstrates how the world looks like when viewed at different levels of magnifications.
Currently, the technology is being used to study osteoporosis and osteoarthritis, specifically focusing on the human hip with those conditions. But that is just a start, and the main task lies ahead, requiring massive amounts of imaging and data to create comprehensive maps of our anatomy.
La giornata volge al termine quando arriva la telefonata del 118: “Codice Rosso; scarica ripetuta di ICD”. Il tempo di recuperare il magnete dalla borsa e siamo sul posto, ma non appena svoltiamo l’angolo e vediamo l’agitazione delle persone che abitano questa piccola contrada su per le montagne capiamo che le cose non saranno semplici. […]