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Ofpjournal.com

Osteopathic Family Physician (2014)2, 31-32 PRE-ORDER YOUR COPY TODAY!
Mobile Apps for Point-of-Care Calculations,
Somatic Dysfunction in Osteopathic Warfarin Nomogram & Following Guidelines
Robert Hasty, DO, FACOI; Pranav Jain, MD; Brian Kessler, DO
Family Medicine, Second Edition Campbell University School of Osteopathic Medicine; and Southeastern Health, Lumberton, NC Research into evidence-based medicine has yielded a large number of clinical calculators and Mobile apps
nomograms to aid physicians with the care of patients. This article describes three apps that make these evidence-based tools easily accessible and readily available at the point of care of the patient.
TO PRE-ORDER YOUR COPY, VISIT that allows easy access for evidence-based calculators that Evidence-based medicine has revolutionized the knowledge the clinician might need. For instance, a search for alcohol The text now includes QR codes (see example
base of medicine. The challenge lies with how to bring this yields calculators for the alcoholic hepatitis discriminant below) that will allow the reader, while studying knowledge to the point of care.1 The invention of mobile score, CAGE questionnaire, CIWA-Ar alcohol scale, and the the content of a given chapter, to access apps has brought a means to allow the use of this powerful Glasgow Alcohol Hepatitis Score. Mediquations gives a large relevant osteopathic manipulative treatment knowledge easily at the point of care. One prodigious app that number of accessible medical equations that are appropriately (OMT) video procedures with smartphones allows for point of care application is Mediquations. referenced. It is arguably the easiest to use and is significantly and other handheld devices equipped with QR better than the free options, such as using the internet for the reader apps. Such apps are available for free on individual equations Mediquations gives a large number of both iOS and Android devices.
accessible medical equations that are appropriately referenced. It is arguably the easiest to use and is significantly better than the free options, such as using the Internet for the individual The calculators are easy to use. Each calculator allows for quick entry of patient characteristics in logical ways. The scores are calculated instantly and the results are shown in the same pane. Each calculator has a built-in note section where the clinician can add notes. It also has a "Favorites" and Publication Date: May 15, 2014 a "Recents" tab that makes it convenient to access calculators commonly used in an individualized practice setting. Over Mediquations is intuitive and a simple to use. It contains 232 time this feature becomes invaluable; the clinician is able to medical calculations that include the most common equations index the calculators he needs most often and eliminate the Offering a patient-oriented approach, Somatic Dysfunction in Osteopathic Family Medicine, a family physician would want to employ. The app costs $4.99 need for repeated searches. Second Edition, is a practical textbook for both third and fourth year osteopathic students as for all of the medical equations and is available in the iTunes well as an expert reference for seasoned clinicians. The book covers diagnostic work-up, the App Store. It is a simple and fast way to calculate, using clinical rationale for osteopathic manual techniques (OMT) for specific diseases and conditions, everything from the PHQ-9 Patient Health Questionnaire Warfarin is arguably one of the most dangerous medications manipulative techniques for a variety of patient types (psychiatric, pediatric, obstetric, geriatric, to the Modified Centor score for Streptococcal pharyngitis. that physicians prescribe.2 It has now been used for clinical and more), and procedures for common conditions encountered in family practice.
The app also provides quick access to original peer-reviewed purposes for over 50 years, and is still one of the most articles, where calculations have been validated, with a commonly prescribed medications in the United States.3 Reflecting the latest advances and research in the field, the Second Edition provides ten all-new clickable link to view them in PubMed or other respective While there are a number of newer anticoagulants that do not chapters, an updated design and art program, and an expanded array of online instructor and website. The app has an exceptional built-in search tool require monitoring of a patient's international normalized student resources.
ratio (INR), they are not approved for all indications that require anticoagulation (such as prosthetic valves) and cost Address correspondence to: Robert Hasty, DO, FACOI, Campbell
about five times as much as warfarin.4 University School of Osteopathic Medicine; and Southeastern Health, Lumberton, NC; Email: [email protected] 1877-5773X/$ - see front matter. 2014 ACOFP. All rights reserved.

Osteopathic Family Physician, Volume 6, No. 2, March/April 2014 Since 2012, the American College of Chest Physicians The app offers an intuitive user interface, utilizing a guidelines have recommended that for dosing decisions, combination of five questions: age, sex, pregnancy status, physicians use "validated decision support tools (paper tobacco use, and sexual activity status to provide targeted nomograms or computerized dosing programs) rather than guidelines. The guidelines are divided into grades A, B, C, and no decision support".5 However, paper-based nomograms are D. Grades A and B are "Recommended", whereas D is "Not frequently not convenient to use, counter-intuitive, and not Recommended". Category C fal s in the realm of "Uncertain". available at the point of care of the clinician. The developer has provided ability to "Save Searches" for One solution is WarfarinGuide6, a free app available on the quick access to common demographics based on individual iTunes App Store. It offers an easy-to-use nomogram that practitioner preference. It also offers a "Bookmark" feature to assists in dosing decisions. It gives information on initial provide reference to frequently used guidelines and an ability dosing. For patients who are on Warfarin, it asks the clinician to curate them to your needs. The app has a hidden gem in the to tap on the desired goal (2.0 to 3.0 or 2.5 to 3.5), and then "Tools" section, which houses it has a collection of validated asks for the most recent result with common ranges. When tools ranging from depression scale to stroke calculator. These this range is selected, it gives the recommended adjustment are very important and practical tools that further improve the recommendation (if any) to the patients warfarin dosing as ease of use in a point of care setting. well as recommendations for when to repeat INR testing, consistent with current evidence-based guidelines. Even The app also has very good documentation, including a "FAQ" though you may approach patient treatment differently, this (frequently asked questions) section; "What's New" section app allows for practical use of accepted standards of care. and "Instructions for Use". The user can choose to subscribe This should help the family physician supplement their to updates via email as wel . base knowledge, allowing for enhanced clinical practice and Overall, ePSS is a robust app with a well-designed user optimal patient care. interface; excellent documentation and several practical tools make it an essential companion for every clinician. These apps offer unprecedented ease for the family physician to access evidence-based decision support tools at the point REFERENCES
1. J. Med Internet Res. 2010 Jul-Sep; 12(3):e26.
2. Blood 2008 May; 111:4471.
3. Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e. 4. Prescriber's Letter 2011; 18(12):271220.
5. Chest 2012; 141:7S-47S.
ePSS (ELECTRONIC PREVENTIVE SERVICES SELECTOR)
CME RESOURCE: OSTEOPATHIC FAMILY PHYSICIAN
Modern healthcare hinges on providing preventative OFFERS 2 HOURS OF 1-B CME
healthcare to our patients. Adhering to guidelines and recommendations of the U.S. Preventive Services Task Force ACOFP members who read Osteopathic Family Physician (USPSTF) can be challenging, especial y at the point of care. can receive two hours of Category 1-B continuing medical ePSS is an excellent app by the Agency for Healthcare Research education credit for completing quizzes in the journal. Visit and Quality (AHRQ) and is available free of charge on iPhone, the eLearning Center at www.acofp.org to access the quizzes.
iPad, Android devices, Blackberry and Windows devices. It can also be accessed by a web browser. January/February 2014 Answers:
1. c 2. d 3. a 4. d 5. c 6. c 7.b 8. c 9. d 10. a

Source: http://ofpjournal.com/index.php/ofp/article/download/15/14