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Automation in Medicine: Humans vs. Machines
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In many ways, machines have enabled what was previously thought to be impossible. X-ray machines for example, used to be mere fantasy in comic books.

Fear not, there's no danger of machines taking over completely. What could imitate the human touch, the human mind? Eyes can see, ears can hear and noses can smell—all discerning information that cannot be completely processed by a machine.

For more on "man v. machine", keep reading…

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Clinical Editorial

Anne Meneghetti, MD
Director, Clinical Communications, Epocrates

Automation in Medicine: Humans vs. Machines
Robots don't need vacations. Unlike med students, they don't get tired or bored holding retractors in the OR. Whether serving as a robotic scrub nurse, a miniature mobile sewing machine, or a remotely controlled surgical arm equipped with a high-speed CT scanning eye, bots offer some real advantages over humans. They can maneuver into tight anatomical spaces, require only small keyhole incisions for access, and are less likely to contaminate the field. Robots are also less likely to complain about bad lighting, table height, and room temperature. Unlike most humans, they have no life at all outside the hospital.

Newer cameras allow robotic assistants to respond to hand gestures like those Tom Cruise used in the movie Minority Report. Surgeons can use hand signals to bring up an imaging study or electronic medical record data into view, without touching a thing. Similar gesture-sensing technology is available in consumer electronic games that track hand movements in 3-D space.

Paging Dr. Watson
Robots are not the only high-tech newcomers to medicine. Enter Watson, the artificial intelligence supercomputer from the IBM® "Deep Question" program. It processes natural-language questions and scours massive databases looking for answers, just like the fictional computers aboard interstellar vessels in sci-fi movies. After beating uber-contestant Ken Jennings at Jeopardy!, Watson went to medical school at both Columbia and University of Maryland. Watson will spend a few years learning about the types of diagnostic and therapeutic questions that arise in clinical practice. Is it possible that unearthing facts buried within massive volumes of medical journals and other data can support tailored clinical decision-making for an individual patient? Maybe we will find out in a few years.

Humans Behind the Machines
I once shook the large hand of famed heart surgeon Michael DeBakey, who learned to stitch from his mother, a seamstress and sewing teacher. He described the thrill of sewing his first synthetic bypass grafts by hand and autoclaving them. He went on to invent dozens of machines that are now commonplace in medicine. I am reminded that behind all these great mechanical and electronic innovations are real human beings. When it comes to beside manner–actively listening, expressing genuine caring, and delivering encouragement—the vast majority of human clinicians have the clear advantage over robots, hands down.

Advantage, Robot?

Which of these inventions do you think has potential value? Email your thoughts on automation in medicine.

Drug and Disease
Acute asthma exacerbation in adults
Evaluation of acute headache in children
ST-elevation myocardial infarction
Gout
Evaluation of nausea and vomiting in adults
Pertussis
Community-acquired pneumonia
Type 2 diabetes mellitus in adults
Septic arthritis
Vascular dementia
Drugs
Amethyst
(levonorgestrel/ethinyl estradiol)
Bayer Advanced Aspirin Extra Strength (aspirin)
Bayer Advanced Aspirin Regular Strength (aspirin)
Bonine for Kids (cyclizine)
Daliresp (roflumilast)
Edurant (rilpivirine)
Fluzone Intradermal (influenza intradermal vaccine)
Fungi-Nail (undecylenic acid topical)
Incivek (telaprevir)
letrozole (first-time generic for Femara)
levofloxacin (first-time generic for Levaquin)
Lincocin (lincomycin)
Marezine (cyclizine)
Nexterone (amiodarone)
Primatene Tablets (ephedrine/guaifenesin)
Prolastin-C (alpha1-proteinase inhibitor)
triamcinolone nasal (first-time generic for Nasacort AQ)
Viibryd (boceprevir)
     
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  • Anesthesia bot. Nicknamed “McSleepy”, McGill University’s automated anesthesia delivery and feedback system

  • Pharmacist bot. Mobile bots prepare, track, and navigate through doors and elevators to deliver oral and injectable meds to nursing stations

  • Intubation bot. A joystick-remote-controlled video laryngoscope intubator device

  • Medical coding bot. Extracts data from free-text medical records to automate coding

  • Nurse bot. Home personal service robots assist with activities of daily living for the chronically ill

  • Child abuse detector. Artificial intelligence software examines patient records for red flags of abuse

  • Smart pills. Digestible sensors embedded in pills, activated by stomach fluid, create a digital signal to a skin receiver patch that records biometric data

  • Computer-aided visual diagnosis. Computers can examine Pap smears or double-read radiology images; coming next is software to diagnose melanoma from skin photos

  • Medical ethicist bot. Artificial intelligence based on ethics principles offers guidance to clinicians faced with ethical dilemmas

Please note that external links are not Epocrates information. The views expressed on these websites are solely those of the authors' and do not necessarily reflect the opinions or endorsement of Epocrates.

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Clinical Question of the Month

Joshua L. Conrad, Pharm.D.
Managing Editor, Medical Information, Epocrates

Q: Why does the Epocrates IBW calculator use different equations than the ones familiar to most of us?

A: The familiar ideal body weight (IBW) equation to which you referred is probably the one developed by Devine and published in 1974. [1] After research into which IBW formulas are the most accurate for drug dosing and applicable across the widest population and most uses, we feel that the formulas published by Robinson, et al. in 1983 [2], are more appropriate than the more simplistic formulas published by Devine. The respective formulas appear below.

Devine [1]
IBW (males) = 50 kg + (2.3 kg * (height" - 60"))
IBW (females) = 45.5 kg + (2.3 kg * (height" - 60"))

Robinson, et al. [2]
IBW (males) = 51.65 kg + (1.85 kg * (height" - 60"))
IBW (females) = 48.67 kg + (1.65 kg * (height" - 60"))

The Devine equations have probably remained in high use because of their ease of recall. However, with the more ubiquitous use of computerized and digital mobile devices for such calculations, there is little reason to rely on "simplified" calculations when more accurate or better validated equations are available.

References
1. Devine BJ. Gentamicin therapy. Drug Intell Clin Pharm 1974;7:650-5.
2. Robinson JD, Lupkiewicz SM, Palenik L, Lopez LM, Ariet M. Determination of ideal body weight for drug dosage calculations. Am J Hosp Pharm 1983;40:1016-9.

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FDA Medwatch Safety Alerts

Prescription drugs: Zocor (simvastatin): New restrictions, contraindications, dose limits, Valproate Products: Impaired cognitive development from in utero exposure, 5-alpha reductase inhibitors: Increased prostate CA risk, Erythropoiesis-Stimulating Agents in Chronic Kidney Disease: Modified dosing recs, Actos (pioglitazone): Potential increased bladder CA risk, Chantix (varenicline): CV adverse events, Victoza (liraglutide): Thyroid C-cell tumor risk, acute pancreatitis, Risperidone (Risperdal), Ropinirole (Requip): Name confusion

OTC products: Nature Relief Instant Wart, Mole Remover: Severe skin burn risk, Via Xtreme Ultimate Sexual Enhancer Dietary Supplement for Men: Undeclared drug ingredient

Medical devices: Boston Scientific Innova Self-Expanding Stent: Failure to deploy, Boston Scientific iCross, Atlantis SR Pro 2 Coronary Imaging Catheters: Catheter tip can break, Terumo Coronary Ostia Cannular: Fragments may embolize, Maquet Datascope Corp. IABP: Shuts off w/o warning, Triad Alcohol Prep Pads, Swabs, Swabsticks: Potential microbial contamination, Oridion Medical, Philips Healthcare Microstream CO2 Filterline: Plastic strands may dislodge

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Learn and Earn
EssentialPoints® mobile detail programs keep you current on medical topics such as disease states, therapeutic areas, and treatment options. Many of these activities offer a free month of the Epocrates Essentials clinical reference suite for completion!

To view all activities in your queue, anytime, visit “EssentialPoints” from the “More” tab within your Epocrates application.

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Where do you CME? Photo Contest Winner

Dr. Lim is a family medicine doctor with the University of Pittsburgh Medical Center (UPMC) Partners in Health practice, based in Delmont, PA. When he's not feeding and caring for 4 young children (that's Addie and Lulu in the photo—6-month-old fraternal twins born on Christmas Eve) and 8 chickens, he teaches medical students at Lake Erie College of Osteopathic Medicine (LECOM) Seton Hill, and hopes to get more involved with medical education in the future.

Thank you to all who participated. We appreciate you taking the time to share your photographs and experiences.

Access Epocrates CME online and download it for free from the App Store™



 

 

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DocAlert Messages: Editor’s Pick
Monique Yohanan, MD, MPH
Physician Editor, Epocrates
BMJ 2011; 342:d286

Conventional versus automated measurement of blood pressure in primary care patients with systolic hypertension: randomised parallel design controlled trial.

Martin MG, et al

Objective To compare the quality and accuracy of manual office blood pressure and automated office blood pressure using the awake ambulatory blood pressure as a gold standard.

Participants 555 patients with systolic hypertension and no serious comorbidities under the care of 88 primary care physicians in 67 practices in the community.

Interventions Practices were randomly allocated to either ongoing use of manual office blood pressure (control group) or automated office blood pressure (intervention group).

Conclusion In compliant, otherwise healthy, primary care patients with systolic hypertension, introduction of automated office blood pressure into routine primary care significantly reduced the white coat response compared with the ongoing use of manual office blood pressure measurement. The quality and accuracy of automated office blood pressure in relation to the awake ambulatory blood pressure was also significantly better when compared with manual office blood pressure.

Read the free full-text BMJ article PDF

© 2011 BMJ Publishing Group Ltd. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

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The Epocrates EHR Solution

With the Epocrates EHR solution set to launch this summer, we are pleased to announce that we will be hosting a series of informational webinars on topics such as EHR adoption and Meaningful Use on www.epocratesehr.com. The first in the series will debut in mid-July and will feature the Epocrates EHR demo. Participants will get the first glimpse of our system’s intuitive design, its physician-inspired tools, and insights into how the EHR enhances the small-practice workflow.

Don’t miss this opportunity to experience what Epocrates subscribers have been waiting for! Sign up now to secure your spot.

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