Download Point of Care Decision Support Resources

Point of Care
Decision Support Resources
[online and iPhone]
Nancy Clark, M.Ed.
Director Medical Informatics Education
FLORIDA STATE UNIVERSITY
The College of Medicine
Objectives
Identify useful Library resources to answer clinical
questions quickly – select favorites
• Use the differential diagnosis tools
• Locate disease quick references
• Use online and PDA Calculators
– Medical equation
– Clinical rules, decision support
• Find laboratory information
• Use resources with students
FLORIDA STATE UNIVERSITY
Session 4
The College2 of Medicine
2
Handouts
•
•
•
•
•
PowerPoint
Decision Support Handout
Evaluation
Using Resources with Students
Find it Quickly for iPhone/iPad
FLORIDA STATE UNIVERSITY
Session 4
The College3 of Medicine
3
PDA Versions Available
Pocket
PC
Product
iPhone
Blackberry
Android
x
x
x
x
x
x
x
x
Rx
Essential Evidence+
x
x
Access
Online
Access
Online
Harrison's Practice
x
x
x
x
x
PEPID
x
x
x
x
x
Geriatrics At Your
Fingertips
x
x
$$
x
Pediatric Care Online
x
x
x
FLORIDA STATE UNIVERSITY
x
x
x
The College
of
Medicine
x
x
x
x
Palm
(Windows
Mobile)
DynaMed
x
Epocrates Essentials
Clinical Evidence
Access
Online
4
Current Library Web Site (Sum 2010)
FLORIDA STATE UNIVERSITY
Summer 2010
The College of Medicine
5
New Library Webpage
(Fall 2010)
FLORIDA STATE UNIVERSITY
Summer 2010
The College of Medicine
6
Resource Content
Resource
Rx
DDx
DxPlain Online
Dx LAB Calcs
X
Epocrates Essentials PDA
X
Epocrates Online
X
PEPID Online and PDA
X
Dynamed Online and PDA
X
X
Harrison's Practice Online and PDA
X
X
X*
Essential Evidence Plus Online and PDA
FLORIDA STATE UNIVERSITY
X
Pediatric Care Online Online
The College of Medicine
X
X
X
X
X
X
X
X
X
X
online
X
X
X
X
Use of DDx Tools with Students
• During presentation of Patient with
acute problem
• Ask student for DDx
• Tell student to use DxPlain, Epocrates
Sx, which they have, or PEPID and
name other possibilities
FLORIDA STATE UNIVERSITY
Session 4
The College8 of Medicine
8
P
P
P
P
P
Disease Reference
Lab Reference
Calculators
Differential Diagnosis
Drug Information
PEPID
FLORIDA STATE UNIVERSITY
The College of Medicine
PEPID CRC
• Web and PDA (iPhone, Android, and
Blackberry)
• Disease reference, drugs, interactions,
lab manual, clinical clerkships,
calculators, images.
• 2,700 Disease and Trauma topics with
diagnosis, pathophysiology, treatment
and disposition
• Includes Stedman’s Medical Dictionary
FLORIDA STATE UNIVERSITY
The College of Medicine
10
PEPID DDX
• Enter symptoms, exam, labs
• DDx nicely numbered as to likelihood
• Linked to disease info for more
information
FLORIDA STATE UNIVERSITY
Seminar 4Session 4
The College11 of Medicine
PEPID Content
• Diseases info broken down into
Diagnosis
and
Treatment
FLORIDA STATE UNIVERSITY
The College of Medicine
12
PEPID on the PDA
• 100% of content on
web
• Links between
diseases, drugs,
images and
calculators.
FLORIDA STATE UNIVERSITY
The College of Medicine
13
Exercises for Practice
• Which drugs are not effective, and possibly
harmful for patients with PTSD?
• What drugs can cause drug related
headaches?
• What is the best treatment for analgesic
rebound headache?
FLORIDA STATE UNIVERSITY
The College of Medicine
PEPID Calculators
• Both medical equations and “Scores”
• Online and PDA same instruments
FLORIDA STATE UNIVERSITY
Session 5
The College
of Medicine
15
PEPID Calculators PDA
• Under Table of
Contents or
• Icon on tool bar
• Alphabetical List or by
category
• Icon in text
FLORIDA STATE UNIVERSITY
Session 5
The College
of Medicine
16
Exercises for Practice
• An 8 year old girl who is 60 pounds
(27.2 kg) has moderate dehydration.
What should her maintenance fluids in
mL per 24 hours be?
• Calculate your own ATPIII 10 year risk
for heart disease based on your age,
gender, cholesterol and smoking
status.
• Optional: Find
your
CAGE score.
F
S
U
LORIDA
TATE
NIVERSITY
Session 5
The College
of Medicine
17
•
PEPID Lab Manual
Online/PDA
Contents:
– Clinical rotations (Peds, Surg, IM, etc.)
– Calculators
– Disease reference
– Drug information and interaction tool
– Lab Manual
– Stedman’s Dictionary
– Illustrations (anatomy, EKG strips, etc.)
– Procedures
FLORIDA STATE UNIVERSITY
Session 5
The College
of Medicine
18
PEPID Lab Manual
FLORIDA STATE UNIVERSITY
Session 5
The College
of Medicine
19
Disease Reference
Lab Reference
Calculators
P
Differential Diagnosis
Drug Information
DXPLAIN
FLORIDA STATE UNIVERSITY
The College of Medicine
Diagnostic Tools
• Enter symptom(s), findings, and labs
– Get a differential in order of likelihood
– Get more info on disease
– Get advice on more symptoms to look for
– Get advice on labs to order
FLORIDA STATE UNIVERSITY
Session 4
The College21 of Medicine
21
DxPlain
• Very powerful expert system
• Included in ePocrates Essentials (Sx)
on Windows Mobile and Palm only
• From Harvard
• Age, gender and duration
• Allows for multiple symptoms and lab
results
• Get Dx information
FLORIDA STATE UNIVERSITY
Session 4
The College22 of Medicine
22
Exercises for Practice
• You have a male 42 yr old present in the ER
with a severe headache, nausea, myalgia,
malaise, prostration. This just started
suddenly a day or so ago. Physical exam
reveals generalized macules that are red,
fever, skin erythema, generalized papules
that are small red, rash on his palms and
soles of his feet. He thinks he has had
insect bites while camping recently.
FLORIDA
• What could this
be?STATE UNIVERSITY
The College of Medicine
P
P
P
Disease Reference
Lab Reference*
Calculators
Differential Diagnosis
P
Drug Information
*PDA Only
EPOCRATES
FLORIDA STATE UNIVERSITY
The College of Medicine
Epocrates Online and PDA
• Disease Tab (3/1/10)
• Content from BMJ
• Same content in
iPhone Epocrates
Essentials
• Nice images
• Nice highlights
summary first
screen
• Organization:
–
–
–
–
–
–
Summary
Basics
Diagnosis
Treatment
Follow-Up
References
FLORIDA STATE UNIVERSITY
The College of Medicine
Epocrates Dx
• New content from
BMJ
• Linked drugs to Rx
• Linked from Lab to
Dx
• Excellent Interface
• Images
• Sections List
–
–
–
–
–
–
–
Basics
Differential
Hx/Exam
Tests
Tx Options
Follow-up
Image Library
FLORIDA STATE UNIVERSITY
Session 4
The College
of Medicine
26
Exercises for Practice
• What is the incidence and prevalence of
Rocky Mountain Spotted Fever in the US?
•
What is the treatment of choice and dosage
for RMSF?
• What medication should be used to treat
RMSF during 1st trimester of pregnancy?
FLORIDA STATE UNIVERSITY
The College of Medicine
MedCalc on Epocrates Online
• Online version is better than PDA version
• MedCalc3000 $29.95/yr (medcalc3000.com)
• Extensive medical calculators and clinical
rules, decision trees
• Organized by specialty or alphabetical
FLORIDA STATE UNIVERSITY
Session 5
The College
of Medicine
28
Types of Calculators
• Medical equation calculations
– i.e. body mass index, dosage calculator,
unit converter – emphasis Patient Safety
– Largely free online and for PDA
• MedMath and MedCalc
• Clinical rules, decision trees or criteria
calculators
– i.e. Ottowa ankle rule, NIH Stroke Score,
diagnostic likelihood calculator, mortality
calculator
FLORIDA STATE UNIVERSITY
Session 5
The College
of Medicine
29
Epocrates Online Clinical Criteria
FLORIDA STATE UNIVERSITY
Session 5
The College
of Medicine
30
MedCalc3000 Calculators
• Also available online in
– Dynamed
– Facts and Comparisons
FLORIDA STATE UNIVERSITY
The College of Medicine
Exercises for Practice
• What is the predicted peak flow for a 60
year old woman with asthma? She is
5’2”.
• A 40 year old woman has just had a
mastectomy. She had a grade 1 tumor,
no lymph nodes and no lymphatic or
vascular invasion. What is her Breast
Cancer Recurrence risk?
FLORIDA STATE UNIVERSITY
Session 5
The College
of Medicine
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MedMath in Epocrates PDA
•
•
•
•
Few basic calculators
Under X2 Tools
MedMath
Pick calculator
FLORIDA STATE UNIVERSITY
Session 5
The College
of Medicine
33
Exercises for Practice
• Calculate your own Body Mass Index, Ideal
Body Weight, Basal Energy Expenditure, and
Body Surface Area.
• 81 year old female with long standing
diabetes, and hypertension. Her BP is
usually 140-150/85-90. Her ideal body weight
is 112 lb. Laboratory tests: serum creatinine
1.2mg/dl, Hgb A1C 7.8, liver function tests
normal. What is her creatinine clearance?
FLORIDA STATE UNIVERSITY
Session 5
The College
of Medicine
34
Epocrates Essentials Lab on PDA
• Labs only
• Interpretation linked to
Rx and Dx sections
• Panels
• Browse or search
FLORIDA STATE UNIVERSITY
Session 5
The College
of Medicine
35
Exercises for Practice
• A basic metabolic panel reveals that a
30 year old man suffering from bipolar
disorder has a serum calcium level of
10.9 mg/dL. He is taking lithium and
valproate. Could his medications be a
factor?
FLORIDA STATE UNIVERSITY
Session 5
The College
of Medicine
36
P
Disease Reference
Lab Reference
Calculators
Differential Diagnosis
P
Drug Information
HARRISON’S PRACTICE
FLORIDA STATE UNIVERSITY
The College of Medicine
Harrison’s Practice
•
•
•
•
Address disease quick reference needs
Nice interface
From Access Medicine/Harrison's
Web and PDA versions
– contains LexiDrug database
• Content Internal Medicine focus
• Easy to navigate – content growing
FLORIDA STATE UNIVERSITY
The College38 of Medicine
Harrison’s Practice PDA
•
•
•
•
•
•
BASICS: Definition, Epidemiology, Risk Factors,
Etiology, Associated Conditions
DIAGNOSIS: Symptoms & Signs, Differential
Diagnosis, Diagnostic Approach, Laboratory
Tests, Imaging, Diagnostic Procedures,
Classification
TREATMENT: Treatment Approach, Specific
Treatments,
ONGOING CARE: Monitoring, Complications,
Prognosis, Prevention
RESOURCES: ICD-9-CM, See Also Internet Sites,
References
PEARLS
FLORIDA STATE UNIVERSITY
Session 4
The College
of Medicine
39
Exercises for Practice
• In acute respiratory distress syndrome,
during the exudative phase, what findings
appear on a chest x-ray?
•
• What is the mortality rate for Rocky Mountain
Spotted Fever?
FLORIDA STATE UNIVERSITY
The College of Medicine
P
Disease Reference
Lab Reference
P
Calculators
Differential Diagnosis
Drug Information
DYNAMED
FLORIDA STATE UNIVERSITY
The College of Medicine
DynaMed
• Combines summary of topics with
latest evidence on topic
• Updated constantly (more up to date
than UpToDate)
• Links out to articles and reviews if
more details needed – run PubMed
first, minimize
PDA
FLORIDA STATE UNIVERSITY
Session 4
The College42 of Medicine
and Online
42
DynaMed Organization of Results
• Description (including ICD9 Codes)
– Description, Also called,
ICD-9 Codes, Types,
Organs Involved, Who Is
Most Affected,
Incidence/Prevalence
• Causes and Risk Factors
– Causes, Pathogenesis,
Likely risk factors,
Possible risk factors
• Complications and
Associated Conditions
• History
– CC, HPI, Meds, PMH, FH,
SH, ROS
• Diagnosis
– Making the diagnosis,
Rule out, Tests to order,
Blood tests, Urine studies,
Imaging studies,
Pathology tests, Other
diagnostic testing
• Prognosis
• Treatment
– Treatment Overview, Diet,
Activity, Counseling,
Medications, Surgery,
Consultation and referral,
Other management,
Follow-up
• Prevention and Screening
• References (including
• Physical
Reviews and Guidelines)
– Skin, HEENT, Neck,
• Patient Information
Extremities, Neuro, Pelvic
FLORIDA STATE UNIVERSITY
Session 4
The College
of Medicine
43
DynaMed PDA
•
•
•
•
•
•
Complete disease content of web site
Free to faculty and students
Navigation can be tricky
Lots of scrolling
Linking out only works if wireless
iPhone, Blackberry, Android, Palm and
WM versions
FLORIDA STATE UNIVERSITY
Session 4
The College44 of Medicine
44
Calculators in Dynamed
• Online Medcalc 3000 (same as
Epocrates Online)
• On the PDA, Archimedes free with
Skyscape
FLORIDA STATE UNIVERSITY
The College of Medicine
Exercises for Practice
• A 65 year old Jewish woman is worried that
she may get Parkinson’s Disease because
her father was diagnosed with it when he
was 65. He was a heavy smoker. She does
not smoke or drink alcohol or coffee. What
do you tell her?
• What is the prognosis for a 60 y/o female
with Stage IV metastatic breast cancer?
FLORIDA STATE UNIVERSITY
The College of Medicine
P
Disease Reference*
Lab Reference
P
P
Calculators
Differential Diagnosis
Drug Information
*evidence summaries by disease
ESSENTIAL EVIDENCE PLUS
FLORIDA STATE UNIVERSITY
The College of Medicine
Essential Evidence Plus
• Evidence based resource for:
– Cochrane Abstracts
– InfoPOEMS
– Summaries of latest evidence on
conditions/diseases
– Clinical decision/prediction tools
– Guidelines
– Calculators
– Dermatologic
DDx (Derm Expert)
FLORIDA STATE UNIVERSITY
The College of Medicine
EE+ iPhone/iPod
• Access EE+ online in PDA formatted
webpage. Use Safari.
www.eeplus.mobi/m
FLORIDA STATE UNIVERSITY
The College of Medicine
Essentials Evidence +
• Web page
See Handout for list of calculators
FLORIDA STATE UNIVERSITY
Session 5
The College
of Medicine
50
Derm Expert
•
•
•
•
Dermatological DDx
Web and PDA
Pick your lump or bump
Drill down to the disease with images
FLORIDA STATE UNIVERSITY
The College of Medicine
Essential Evidence Plus (EE+)
Calculators
(formerly InfoRetriever)
• Few medical equation calculators,
many decision rules
• Evidence based, translating guidelines
into decision tools
• Appear in content of keyword search
• Separate index of just Decision Support
clinical rules and calculators
FLORIDA STATE UNIVERSITY
Session 5
The College
of Medicine
52
EE+ Online and PDA
• Three Types of calculators
– Decision Support Calculators (index)
– Diagnostic Test Calculators
– History and Physical Test Calculators
FLORIDA STATE UNIVERSITY
Session 5
The College
of Medicine
53
Clinical Rules and Calculators
• Link bottom right
of Web site
• On PDA, First
thing under Tools
See Handout for list of calculators
FLORIDA STATE UNIVERSITY
Session 5
The College
of Medicine
54
Using EE+ Rules & Calculators
• Several ways to
locate calculators
1. Look up a disease
and expand section
needed (Dx, Tx, etc.)
and refine by type of
resource
2. Browse by Resource
and select Clinical
Rules and
Calculators, then drill
down to disease
FLORIDA STATE UNIVERSITY
Session 5
The College
of Medicine
55
EE+ Decision Support Calculators
•
•
•
•
•
Some medical equations
Estimate the likelihood of a diagnosis
Calculate risk for disease
Estimate a prognosis
Determine actions
FLORIDA STATE UNIVERSITY
Session 5
The College
of Medicine
56
Exercises for Practice
• A 45 year old man has been a smoker
for over 20 years is worried that he
might have diabetes mellitus because
his father had it. He does not think
anyone else in his family has ever been
diagnosed with it. He is 6 feet tall and
weighs 250 pounds. What is his
Diabetes risk score? You will first need
to determine his body mass index.
FLORIDA STATE UNIVERSITY
Session 5
The College
of Medicine
57
EE+’s Coding Tool
• Just ICD-9 disease
and V codes, no E
codes
• On PDA, under
Tools
• Online, Link at
bottom right of web
site
• Enter term
• Search
FLORIDA STATE UNIVERSITY
Session 5
The College
of Medicine
58
P
Disease Reference
Lab Reference
P
Calculators*
Differential Diagnosis
P
Drug Information
*Online Only
PEDIATRIC CARE ONLINE
FLORIDA STATE UNIVERSITY
The College of Medicine
Pediatric Care On-line
FLORIDA STATE UNIVERSITY
The College of Medicine
In Summary
Resource
Epocrates Essentials PDA
DDx
Dx LAB Calcs
X*
X
Epocrates Online
X
X
PEPID Online and PDA
X
X
X
X
X
X
X
Dynamed Online and PDA
X
Harrison's Practice Online and PDA
X
Essential Evidence Plus Online and PDA
X
X
Pediatric Care Online Online
FLORIDA STATE UNIVERSITY X
The College of Medicine
X
X
Next Session
• Drug References
– Meredith Goodwin
– 3:00-5:00 pm, Wednesday, Aug 4.
FLORIDA STATE UNIVERSITY
The College of Medicine