Computing for Medicine: Can We Prepare Medical Students for the Future?

PROBLEM: Technology can transform health care; future physicians need to keep pace to ensure optimal patient care. Because future doctors are poorly prepared in computer literacy, the authors designed a computer programming certificate course. This Innovation Report describes the course and findings from a qualitative study to understand the ways it prepares medical students to use computing science and technology in medicine. APPROACH: The 14-month Computing for Medicine certificate course (C4M, offered beginning in February 2016), University of Toronto, is comprised of hands-on workshops to introduce programming accompanied by homework exercises, seminars by computer science experts on the application of programming to medicine, and coding projects. Using purposive and maximal variation sampling, 17 students who completed the course were interviewed from April-May 2017. Thematic analysis was performed using an iterative constant comparison approach. OUTCOMES: Participants praised the C4M as an opportunity to achieve computer literacy-including language, syntax, and fundamental computational ideas (and their application to medicine)-and acquire or strengthen algorithmic and logical thinking skills for approaching problems. They highlighted that the course illustrated linkages between computer science and medicine. Participants acknowledged a sometimes-existent chasm between producers and users of technology in medicine, recommending two-way communication between the disciplines when developing technology for use in medicine. NEXT STEPS: We recommend that medical schools consider computer literacy an essential skill to foster future collaborative computing partnerships for improved technology use by physicians and optimal patient care. We encourage further evaluation of future iterations of the C4M and similar courses.

Randomised comparison of intravenous paracetamol and intravenous morphine for acute traumatic limb pain in the emergency department.

OBJECTIVE: To compare the clinical effectiveness of intravenous paracetamol with intravenous morphine in patients with moderate to severe traumatic limb pain. METHODS: This randomised, double-blind pilot study was conducted in an urban UK emergency department. Patients between 16 and 65 years old with isolated limb trauma and in moderate to severe pain (pain score of 7 or more) received either 1 g intravenous paracetamol or 10 mg intravenous morphine sulphate over 15 min. The primary outcome measure was pain score measured on a visual analogue scale at 0, 5, 15, 30 and 60 min after commencing drug administration. The requirement for rescue analgesia and the frequency of adverse reactions were also recorded. RESULTS: 55 patients were recruited over 10 months. There was no significant difference in analgesic effect between the paracetamol and morphine groups at any time interval. There was no significant difference in the rescue analgesia administered, but there were significantly more adverse reactions in the morphine group. CONCLUSION: Intravenous paracetamol appears to provide a level of analgesia comparable to intravenous morphine in isolated limb trauma. Further larger studies are required.

Autonomic nerve fiber function and bone mineral density in individuals with type 1 diabetes: a cross-sectional study.

AIMS: Experimental models support a role for the sympathetic nervous system in bone metabolism. Beta-adrenoreceptors have been demonstrated on osteoblast-like cells. Beta-blocker use is associated with higher bone mineral density (BMD) in some epidemiologic studies. The aim of this study was to determine if measures of the autonomic nervous system (ANS) were associated with reduced BMD in type 1 diabetes. METHODS: We studied 66 individuals with type 1 diabetes. Dual-energy X-ray absorptiometry was used to measure BMD and bone mineral content (BMC). Measures of heart rate variability (HRV) (e.g., power spectral analysis, mean circular resultant) and circulating norepinephrine levels were used to evaluate autonomic function. RESULTS: BMD/BMC were examined by gender for individuals with a normal versus elevated low-frequency (LF) band (expressed in normalized units). No significant differences in BMD/BMC were shown for individuals with an elevated LF band. Direct-entry linear regression models with BMD/BMC as the dependent variable were performed. Duration, gender, BMI, HbA(1c), insulin dose/kg, activity energy expenditure, and measures of HRV were entered as potential independent variables. No measures of HRV, or norepinephrine, were independently associated with BMD/BMC. CONCLUSIONS: The ANS, as assessed by measures of HRV, does not appear to impact BMD/BMC in type 1 diabetes.

Zinc intake and biochemical markers of bone turnover in type 1 diabetes.

OBJECTIVE: To examine the relationship between Zn nutritive status and biochemical markers of bone turnover in type 1 diabetes. RESEARCH DESIGN AND METHODS: Serum osteocalcin, urine N-telopeptides, and dietary intake data, obtained by 3-day food records, were assessed for 66 individuals with type 1 diabetes. RESULTS: Zn intake correlated with osteocalcin in the group overall (r = 0.48; P < 0.001) but not with N-telopeptides. Examined by sex, both Zn and osteocalcin correlated for men (r = 0.57; P < 0.001), but the correlation did not reach statistical significance for women (r = 0.34; P = 0.09). A direct-entry linear regression model with osteocalcin as the dependent variable was performed. Duration, sex, A1C, insulin use per kilogram, total calorie intake, and Zn intake were entered as potential independent variables. The model was statistically significant (R(2) = 0.32; P < 0.01). Zn intake (P < 0.001), however, was the only independent correlate of osteocalcin. CONCLUSIONS: This study provides evidence of a positive relationship between Zn intake and osteocalcin in type 1 diabetes.

A Response to the Viewpoint Paper in Vol 6 issue 2.

We read with interest the "viewpoint" by Sarbjit Clare and colleagues recommending that specialist registrars in acute medicine should receive patients in the resuscitation room.1 We agree that this is a valuable training experience, but question some of the assumptions made.

Capillary blood gases in acute exacerbations of COPD.

OBJECTIVES: To assess the correlation and agreement between measurements of PO(2), PCO(2), H(+) and HCO(3)(-) in arterial and capillary blood in patients with acute exacerbations of COPD. To assess the repeatability of capillary measurements. DESIGN: Method comparison study. SETTING: Accident and emergency department in a university teaching hospital. MAIN OUTCOME MEASURES: Measurements of PO(2), PCO(2), H(+) and HCO(3)(-) in one arterial and two capillary samples taken from consecutive patients with acute exacerbations of COPD. RESULTS: The agreement between measurements of PCO(2), H(+) and HCO(3)(-) in arterial and capillary blood was good with mean differences of 0.087 kPa, 1.044 nmol/l and 0.513 mmol/l, respectively. The corresponding 95% limits of agreement were narrow. The agreement between measurements of PO(2) was poor with a mean difference of 1.256 kPa and wide 95% limits of agreement. There was good repeatability between capillary samples with mean differences of 0.094 kPa, 0.674 nmol/l and 0.028 mmol/l for measurements of PCO(2), H(+) and HCO(3) respectively and narrow coefficients of repeatability. CONCLUSIONS: Capillary blood gas measurements provide an accurate assessment of PCO(2), H(+) and HCO(3)(-) and can be used to reliably measure the ventilatory status of patients. Combined with continuous pulse oximetry they can be used as an alternative to arterial blood gas measurements in patients with acute exacerbations of COPD.