January 2011
What's New in 2011
Drug and Disease Updates
2011: Innovating the Tools of our Trade
FDA MedWatch Safety Alerts
Telemedicine: Beyond Audio and Video
Earn CME credits with Epocrates CME
Epocrates EHR: What Makes It Unique?
iPhone® Coming to Verizon Wireless®
What's This Disease?

At Epocrates, we are always working to improve upon the mobile and web-based products that help you reduce medical errors, improve patient care and increase productivity. We keep our fingers on the pulse of healthcare to make sure you have current, reliable information at your fingertips.

As Dr. Anne Meneghetti points out below, advances in medical tools and gadgets are coming quickly and also points to a recent AMA survey that found that 78% of people are open to the concept of remote monitoring of their healthcare.

Keep reading to learn more.

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Clinical Editorial

Anne Meneghetti, MD
Director, Clinical Communications, Epocrates

2011: Innovating the Tools of our Trade

Stethescopes, oto/ophthalmoscopes, reflex hammers. These extensions of our eyes, ears and hands have changed little over the decades. I grew up watching the original Star Trek™ television series in the 1960s. Here it is 2011, and I am still waiting for a real medical tricorder, the handy diagnostic scanner device used by Starfleet physicians. Still, innovations in medical tools and gadgets are emerging rapidly, especially in the telecommunications and diagnostics spaces.

Do you remember beepers? Aptly named, they did little else other than beep or squawk out a message audible to everyone in your vicinity. Finally, along came displays with a few lines of text, about as much as a 19th century telegraph. Now, our mobile devices are phone, calendar, plus medical reference all in one.

A laptop, an iPad™, and a smartphone all found their way into my cabin luggage for a recent cross-country plane flight. If devices are so much smarter these days, so multi-functional, then why do I still need so many of them? The form factor of tablets is great for viewing, but not for phoning home. Newer tablets like Xoom™, Galaxy™, and Streak™ might be right-sized for slipping into a white coat pocket, but they do not replace my computer. Laptops are great for documents and programs, but lack the apps I rely on for work and fun. And even with all these devices at my fingertips – I would still rather time a patient's pulse by an analog watch or wall clock.

Medgadget's Best of 2010 list included a one pound, 3 x 5.3 inch-long pocket-sized ultrasound. If only I could make sense of ultrasound images, I could probably imagine many great uses for it. Other notable inventions included real-time moving MRI, a microbial array that scans for 2000 viruses and 900 bacteria in 24 hours, and a radiofrequency device that treats resistant hypertension by eliminating sympathetic innervation to the renal arteries.

This year's Consumer Electronic Show's honorees included mobile device software to assist in cognitive rehab after traumatic brain injury. For patients with complex medication regimens, a home medication machine dispenses pills on time, almost like a vending machine, and offers audiovisual medication and health reminders. It also alerts caregivers when patients are non-adherent.

One of my grandfathers was a farmer, the other a railroad engineer by trade. They understood how their tools worked, could take them apart and reassemble them. Physicians today are not likely to say the same; most of us rely on hardware and software whose inner workings are a mystery. One thing I know for sure is this: A clinician's good judgment is still among the most important tools used in practice today.

Drug and Disease
Social anxiety disorder
Infective endocarditis
Spinal stenosis
Vitamin D deficiency
Evaluation of hearing loss
Adolescent preventive counseling
Evaluation of post-operative fever
Nausea and vomiting in pregnancy
Cystic fibrosis
Amturnide (aliskiren/amlodipine/ hydrochlorothiazide)
Butrans (buprenorphine transdermal)
Egrifta (tesamorelin)
Gamunex-C (immune globulin (human))
Kapvay (clonidine)
Moxeza (moxifloxacin ophthalmic)
Nuedexta (dextromethorphan/ quinidine)
Ofirmev (acetaminophen)
Safyral (drospirenone/ethinyl estradiol/levomefolate)
Teflaro (ceftaroline)
Visine Maximum Redness Relief (tetrahydrozoline/glycerin/ hypromellose/polyethylene glycol 400 ophthalmic)
Visine Tired Eye Relief (glycerin/hypromellose/ polyethylene glycol 400 ophthalmic)
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FDA Medwatch Safety Alerts

Prescription drugs:  Acetaminophen Prescription Products Limited to 325mg/ Dosage Unit; Multaq (dronedarone): Severe Liver Injury RiskMorphine Sulfate Oral Solution: Medication Use Error, Reports of Accidental Overdose;  Metronidazole 250mg Tablets: RecallAlbuterol Inhalation Solution: Mislabeled Vials;  Acetadote (acetylcysteine): Particulate Matter Found; Lantus (insulin glargine): Safety Review Update

OTC products:  Undeclared drug ingredients in the following:  Celerite Slimming Capsules, Nite Rider Maximum Sexual Enhancer For Men, STUD Capsules for Men, Fruta Planta, Rock Hard Extreme and Passion Coffee by Drive Total Energy  

Medical devices:   Breast Implants: Possible Association With Rare Cancer;  Triad Alcohol Prep Pads, Swabs, Swabsticks: Potential Microbial Contamination; Arrow Intra-Aortic Balloon Catheter Recall; Fresenius CombiSet True Flow Hemodialysis Blood Tubing Set: Potential for Arterial Line Kinking; AngioSculpt Percutaneous Transluminal Angioplasty Scoring Balloon Catheter OTW: Recall

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Telemedicine: Beyond Audio and Video
by Anne Meneghetti, MD

A recent AMA survey1 found that 78% of people are open to the concept of remote monitoring of their healthcare. Chronically ill patients and men were most likely to embrace virtual medical visits. An Agency for Healthcare Research and Quality (AHRQ) pilot project2 set up one-to-many videoconferencing access in dozens of rural clinics and community centers. Academic and community clinicians co-managed patients with chronic conditions such as Hepatitis C, and experts offered case-based learning for community clinicians. Another AHRQ pilot established telemedicine access in schools and day care centers, arranging virtual visits with each child's own pediatrician. Overall costs of care were reduced, and children spent less time away from school.

Telemedicine innovations include scope-to-scope tele-auscultation, wherein sound is digitally captured from the stethescope's bell in one location, and Bluetooth™ transfers the audio in real time to earpieces in another location. Remote monitoring strips of OB, ICU, and cardiac data are available, beaming results down to smartphones. There are still limitations to being remote: if a monitor strip reveals a fatal dysrhythmia on my smartphone miles away, realistically, am I going to run a code from the restaurant or theatre?

Robotic surgery is not new, yet transcontinental remote anesthesia is. Last year anesthesiologists in North America sat in a cockpit of videoconference monitors streaming images and data from an Italian OR, where staff implemented orders during a thyroid surgery. Also in 2010, the first endovascular catheter ablation procedure controlled by robotic arm was done in a 70 year-old man with atrial fibrillation. The cardiologist was actually in a room close by, but could have been anywhere.

Despite these welcome advances in telemedicine, nothing compares to a live presence between patients and clinicians. A reassuring touch to a patient's hand can convey more than electrons ever could.

1 American Medical News, amednews.com, Jan. 25, 2011
2 Au M, et al. Using Health IT: Eight Quality Improvement Stories. AHRQ, September 2010

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Epocrates EHR: What Makes It Unique?

While EHRs have been around for some time, they have been evolving slowly and haven't lived up to the expectations of many early adopters.

Epocrates is building its new EHR with the full benefit of this knowledge on a contemporary and secure platform, using the latest thinking and technologies. Epocrates EHR has an intuitive interface that enables you to work the way you like. Other user-friendly features enhance your workday without adding to it, and our outstanding support and training are always just a click away.

Coming Spring 2011. Learn more at ehr.Epocrates.com.

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iPhone Coming to Verizon Wireless

If you are one of the many waiting on this release on February 10, 2011, we welcome you to make Epocrates the first application you download!

Select your application »

Already have an Epocrates subscription? Log-in to your account to transfer your current subscription. Select the “Change” link under the heading "Platform" to the right of your subscription.

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January 2011

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