Clinical use

‘Genomic data are inherently computable’, or the opportunities and challenges for using genomic information in health care systems

Genomics is at the forefront of clinical decision support because the
data are inherently computable and therefore could be provided as supporting
information at the point of care, […].
Clinical decision support provides a better opportunity for physicians and
patients to use genomic data than either could have when the information
is solely contained in paper format. Validating the algorithms that are
being used to […]

The materiality of medications matters – from a paper in Social Science and Medicine

“… the GP explained that these visits gave him a chance to familiarise himself with the ‘stuff’ he had ‘no opportunity to see during day-to-day work’ as he ‘just jots down [a name]’ when issuing a prescription (GP19). The opportunity to see and hold the physical objects in his hands, the GP explained, gives him a chance to regain […]

Don’t keep taking the tablets – from the Guardian, 25 May 2015

Does paracetamol do you more harm than good?
http://www.theguardian.com/lifeandstyle/2015/may/25/does-paracetamol-do-you-more-harm-than-good

The US and UK are reviewing guidance on paracetamol (sales and prescribing) based on recent research.

““Paracetamol can actually be a very dangerous drug,” says Dr John Dickson, who retired from general practice in Northallerton, North Yorkshire, last year. “It can cause kidney and liver problems, and causes as much gastrointestinal bleeding as […]

‘drugs just stopped scheduling and fell off the drug chart’

There is something material in this description of the effects of a digital bug in the ePrescribing system that was piloted at King’s College Hospital NHS Foundation Trust in 2004:

‘drugs just stopped scheduling and fell off the drug chart’

As if they physically fell and actively stopped appearing on time…

The full story on the eHealth Insider (recently renamed Digital Health.net […]

Hospital electronic prescribing and patient safety

A new book by Robert Wachter has just been published on digitalisation and patient safety.

It discusses the case of an antibiotic overdose linked with the use of electronic prescribing, robotic dispensing and electronic administration.

Wachter, R (2015) The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age, McGraw-Hill.

Part of the text is available on Amazon look […]

March 31st, 2015|Clinical use|0 Comments|

Enduring and Emerging Challenges of Informed Consent

A very good paper on the old and new challenges for Ethics in the current era of personalised medicine, by Christine Grady, on New England Journal of Medicine:

Grady, C. (2015). “Enduring and Emerging Challenges of Informed Consent.” New England Journal of Medicine 372(9): 855-862. http://www.nejm.org/doi/full/10.1056/NEJMra1411250?rss=searchAndBrowse

For example, the boundaries between clinical care and research are “shifting”: what are the right […]

Personalized medicine: a podcast

“… we almost certainly over treat many, many patients, we almost certainly give patients treatments that aren’t going to work, and we almost certainly under- or over-dose patients. So there’s a lot of room to move in medical oncology and I think we’ve got plenty of room to do it.”

The area of oncology one with “the greatest potential for […]

Molecular stethoscopes (and precision medicine)

Eric Topol And Stephen R. Quake (2015) A Stethoscope for the Next 200 Years. The ability to see ‘alien’ DNA and RNA in the blood can detect cancers very early. The Wall Street Journal. Jan. 2, 2015 6:55 p.m. ET http://www.wsj.com/articles/eric-topol-and-stephen-r-quake-a-stethoscope-for-the-next-200-years-1420242913

“the amazing specificity of DNA and RNA sequencing has the potential to lead to much more informative, and better-performing […]

On Swiss-type claims and off-label use

Not directly connect to ‘digital drugs’ but very relevant to the understanding of off label use.

A very clear report on recent patent dispute between Warner-Lambert (part of the Pfizer group) and Actavis (a generic manufacturer):

Carpmaels & Ransford LLP (2015) International report – English courts tackle Swiss-type claims and off-label use, in : Intellectual Asset Management (IAM […]

A decision support tool for warfarin prescribing

Anna-Karin Hamberg, Jacob Hellman, Jonny Dahlberg, E Niclas Jonsson and Mia Wadelius (2015)
A Bayesian decision support tool for efficient dose individualization of warfarin in adults and children
BMC Medical Informatics and Decision Making 2015, 15:7
http://www.biomedcentral.com/1472-6947/15/7

Based on population based Pharmacokinetic-pharmacodynamic (PK/PD) model of warfarin.
The tool is developed in Java.
“.. user enters information on body weight, age, baseline and target INR, and […]