THE DIGITAL REVOLUTION
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VO2max so accurately predicts mortality , it indicates overall health status and comorbidity burden ( Pronk ). Developing a technology that could accurately estimate VO2max from phone recordings would be massively valuable .
But the most interesting and promising finding in our pilot study was the accuracy of pre-exercise recordings of subjects at rest . Why don ’ t we order VO2max for every patient ? Because it is uncomfortable . By definition , one must perform at maximum exercise capacity . It ain ’ t fun . Imagine a treadmill stress test that goes to maximum intensity , while wearing a BiPAP mask . You can estimate VO2Max without fancy equipment ( Balderrama ), but the various calculators all require running ( or walking or biking or swimming ) as hard as you can . MPA could be the first modality to measure VO2max in people ( like many of our patients ) who cannot sprint .
Ultimately , we envision the MPA “ device ” as a diagnostic platform to detect , monitor and predict acute ( infections , shock ) and chronic ( cardiopulmonary disease ) conditions . The technology could extend to the entire frontline of medicine , from EMS to underserved to primary care and population health .
I have learned several lessons on this long road of technology development . The iterative process has involved many slow weeks and months . I found evidence of William Gibson ’ s quote “ The future is already here – it ’ s just not evenly distributed .” Several technologies have attempted to use portable technology to auscultate the body ( search PubMed for “ phonocardiogram ”).
I have also developed a deeper understanding of gray areas in medicine . Who really has pneumonia or especially acute bronchitis ? How accurate are pulmonary function tests ? Which patients have volume overload , and what is it anyway ( Miller )?! How do stroke volume and ejection fraction describe cardiac function ? What does a placenta sound like ? When exactly does a trauma patient progress from volume depletion to volume overload ? Why can ’ t we be more like the fitness industry and teach our patients that wellness means more than absence of disease ?
I have gained respect for innovators in medicine who progress beyond idea generation to apply for patents , create prototypes and maintain their vision of a product that will someday benefit patients . I must admit I have also gained even more pride for the flexibility and open-mindedness of our UofL Emergency Medicine program . Not all academic departments ( or IRB ’ s ) would support large time and energy commitments on projects that frankly have little to do with the core topics of our board certification . But breadth is part of the beauty of EM , and why I chose it on my second chance at residency .
Technology will continue to affect medicine , as evidenced by trends in use of AI . It makes sense to stay on the cutting edge : AI will not take your job , someone using AI will ( Lakhani ). Attia professes to maintain “ Strong convictions , loosely held .” A firm grasp of what constitutes “ evidence ” becomes more crucial every decade as the medical literature expands exponentially . Medical schools should teach dispassionate , unbiased assessment of published research all four years ( as Vinay Prasad advocates ), instead of cramming it into four weeks . We should strive for a balanced approach to innovation and not hold too tightly our old ways . Just like the human body , skepticism can quietly progress from healthy to diseased .
References
Balderrama C , Ibarra G , De La Riva J , López S . Evaluation of three methodologies to estimate the VO2max in people of different ages . Appl Ergon . 2010 ; 42 ( 1 ): 162- 168 . doi : 10.1016 / j . apergo . 2010.06.017
Buster , Rebecca , et al . A Novel Application of a Smartphone App to Detect and Monitor Gestational Hypertensive Disorders in Pregnancy . Research Louisville . September 2023 .
L . Daniel , et al . Mobile Phone Auscultation to Diagnose Chronic Obstructive Pulmonary Disease Using Pulmonary Fluid Dynamics . American College of Emergency Physicians Scientific Assembly . Las Vegas , NV . September 2024 .
J . Dickens , et al . 118 Auscultatory Mapping and Chaotic Reconstruction of Cardiovascular Fluid Dynamics Using Unmodified Cell Phone Recordings . Presented at ACEP Boston , MA , 2021 . RESEARCH FORUM ABSTRACT | VOLUME 78 , ISSUE 4 , SUPPLEMENT , S48 , OCTOBER 2021 . Winner of Student Section .
Herrera-Perez D , Haslam A , Crain T , et al . A comprehensive review of randomized clinical trials in three medical journals reveals 396 medical reversals . Elife . 2019 ; 8 : e45183 . Published 2019 Jun 11 . doi : 10.7554 / eLife . 45183
Huecker M , et al . Mobile Phone Auscultation Determines Volume Overload in Cardiac Catheterization Lab and Emergency Department Patients . SAEM Scientific Assembly . Phoenix AZ . May 2024 .
Huecker M , et al . Accurate Modeling of Ejection Fraction and Stroke Volume With Mobile Phone Auscultation : Prospective Case-Control Study . JMIR Cardio . 2024 Jun 26 ; 8 : e57111 . doi : 10.2196 / 57111 . PMID : 38924781 ; PMCID : PMC11237790 .
Ioannidis JP . Why most published research findings are false [ published correction appears in PLoS Med . 2022 Aug 25 ; 19 ( 8 ): e1004085 . doi : 10.1371 / journal . pmed . 1004085 ]. PLoS Med . 2005 ; 2 ( 8 ): e124 . doi : 10.1371 / journal . pmed . 0020124
Lakhani , Karim . AI Won ’ t Replace Humans — But Humans With AI Will Replace Humans Without AI . Harvard Business Review . August 4 , 2023 . https :// hbr . org / 2023 / 08 / ai-wont-replace-humans-but-humans-with-ai-will-replacehumans-without-ai
Mattingly , Jonathan , et al . Auscultatory Mapping & Chaotic Reconstruction of Cardiovascular Fluid Dynamics . Research Louisville . September 2023 .
Miller WL . Fluid Volume Overload and Congestion in Heart Failure : Time to Reconsider Pathophysiology and How Volume Is Assessed . Circ Heart Fail . 2016 ; 9 ( 8 ): e002922 . doi : 10.1161 / CIRCHEARTFAILURE . 115.002922
Alexandra Parson , et al . OBGYN Auscultatory mapping and chaotic reconstruction of fluid dynamics . Research Louisville . September 2024 .
Prasad V , Cifu A . Medical reversal : why we must raise the bar before adopting new technologies . Yale J Biol Med . 2011 ; 84 ( 4 ): 471-478 .
Prasad VK , Cifu AS . Ending Medical Reversal : Improving Outcomes , Saving Lives . Johns Hopkins University Press ; 2015 .
Pronk NP , Boyle RB , O ’ Connor PJ . The association between physical fitness and diagnosed chronic disease in health maintenance organization members . Am J Health Promot . 1998 ; 12 ( 5 ): 300-306 . doi : 10.4278 / 0890-1171-12.5.300
Schutzman C , et al . Cellular Phone Acoustic Recordings Predict Formal Echocardiogram Metrics With Impressive Accuracy . SAEM Scientific Assembly . Austin , TX . May 2023 .
Scribbans TD , Vecsey S , Hankinson PB , Foster WS , Gurd BJ . The Effect of Training Intensity on VO2max in Young Healthy Adults : A Meta-Regression and Meta-Analysis . Int J Exerc Sci . 2016 ; 9 ( 2 ): 230-247 . Published 2016 Apr 1 .
Dr . Huecker is a Professor and Research Director in the UofL Department of Emergency Medicine .
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