MONITORING DRUG THERAPY THROUGH SMARTCHART

ADVERSE DRUG INTERACTIONS AND TOXICITIES ARE COMMON IN ELDERLY PATIENTS. SMARTCHART IS A PROGRAM THAT ALLOWS NURSES AND PHYSICIANS TO ENTER REAL-TIME CLINICAL DATA INTO PC'S FROM THE BEDSIDE. THE PAPER CHART IS GENERATED THROUGHA MICROCOMPUTER RATHER THAN BY PEN OR DICTATION. DURING PHASE I, SMARTCHART WILL BE MODIFIED SO THAT THE THERAPY ENTRIES OF ALL PATIENTS REFER TO A CENTRAL LIST THATWILL AUTOMATICALLY EXPAND AS NEW DRUGS ARE USED AND ENTERED. A DRUG-MONITORING PROGRAM (SMARTDOSE) WILL BE DEVELOPED TO USE THE COMPLETE, ACCURATE, AND TIMELY CLINICALINFORMATION TO ESTIMATE PROPER DRUG DOSAGES AND TO MONITOR FOR POTENTIAL DRUG INTERACTIONS. EACH TIME A THERAPY IS CHANGED OR ENTERED, A PROGRAM WILL CALCULATE THE PROPER DOSAGE ACCORDING TO A NUMBER OF FORMULAS, DETERMINE WHETHER THERE ARE INTERACTIONS WITH OTHER DRUGS, AND DISPLAY MESSAGES IF THE DRUG PRESCRIPTION COULD CAUSE CLINICAL PROBLEMS. THE DATABASE WILL BE CREATED BY SIMPLIFYING THE STANFORD DRUG INTERACTION DATABASE AND ADDING GENERALLY ACCEPTED DRUGDOSING AND KINETIC FORMULAS FOR EACH DRUG TITLE. THE ACCURACY AND UTILITY OF MESSAGES WILL BE TESTED USING CLINICAL INFORMATION FROM A DIAYLSIS PATIENT POPULATION. IN PHASE II, NEURAL NETWORK SIMULATION PROGRAMS WILL BE TESTED TO SEE WHETHER PHYSICIANS AND NURSES COULD EVENTUALLY"TRAIN" A COMPUTER TO MONITOR DRUG USE IN THEIR OWN SPECIALTY UNITS AND HOSPITALS. BAYESIAN METHODS OF DRUG-DOSE CALCULATION AND PREDICTION WILL ALSO BE TESTED. IMPLANTABLE GLUCOSE SENSORS ARE REQUIRED FOR THE MANAGEMENT OF DIABETES. SMALL-SIZED PROBES WOULD REDUCE DISCOMFORT AND HEALTH RISK TO THE USER. A NEW MICROELECTRODE IS PLANNED TO FULFILL THIS NEED. THE MICROELECTRODE WILL UTILIZE GLUCOSE OXIDASE AND WILL INCORPORATE CRUCIAL ADVANCES IN TECHNOLOGY OVER EXISTING ENZYME ELECTRODES. IT WILL OPERATE INDEPENDENTLY OF OXYGEN CONCENTRATION WITH MINIMUM INTERFERENCE FROM OTHER COMPOUNDSIN BLOOD, AND IT WILL NOT USE POTENTIALLY TOXIC REAGENTS. THE APPROACH INVOLVES ENTRAPMENT (IMMOBILIZATION) OF GLUCOSEOXIDASE ONTO A THIN FILM OF AN ELECTRONICALLY CONDUCTING ARGONIC POLYMER (I.E., AN "ORGANIC METAL"). A FUNDAMENTALLYNEW METHOD FOR THE FORMATION OF CONDUCTING POLYMERS HAS BEENDEVISED BY LYNNTECH, INC. THIS NEW METHOD IS IDEALLY SUITEDFOR ENZYME IMMOBILIZATION ONTO MICROELECTRODES. THE OVERALL OBJECTIVE IS TO CONSTRUCT MICROELECTRODES FOR SUBCUTANEOUS IMPLANTATION TO FACILITATE CONTINUOUS GLUCOSE MONITORING.