Osteopathic Family Physician (2014)2, 31-32
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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
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.
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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
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 $4.99
need for repeated searches.
Second Edition, is a practical textbook for both third and fourth year osteopathic students as
for all of the medical equations and is available in the iTunes
well as an expert reference for seasoned clinicians. The book covers diagnostic work-up, the
App Store. It is a simple and fast way to calculate, using
clinical rationale for osteopathic manual techniques (OMT) for specific diseases and conditions,
everything from the PHQ-9 Patient Health Questionnaire
Warfarin is arguably one of the most dangerous medications
manipulative techniques for a variety of patient types (psychiatric, pediatric, obstetric, geriatric,
to the Modified Centor score for Streptococcal pharyngitis.
that physicians prescribe.2 It has now been used for clinical
and more), and procedures for common conditions encountered in family practice.
The app also provides quick access to original peer-reviewed
purposes for over 50 years, and is still one of the most
articles, where calculations have been validated, with a
commonly prescribed medications in the United States.3
Reflecting the latest advances and research in the field, the Second Edition provides ten all-new
clickable link to view them in PubMed or other respective
While there are a number of newer anticoagulants that do not
chapters, an updated design and art program, and an expanded array of online instructor and
website. The app has an exceptional built-in search tool
require monitoring of a patient's international normalized
ratio (INR), they are not approved for all indications that
require anticoagulation (such as prosthetic valves) and cost
Address correspondence to:
Robert Hasty, DO, FACOI, Campbell
about five times as much as warfarin.4
University School of Osteopathic Medicine; and Southeastern Health,
Lumberton, NC; Email: [email protected]
1877-5773X/$ - 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
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
ZYBAN 150 mg comprimés pelliculés à libération prolongée ZYBAN DENOMINATION DU MEDICAMENT ZYBAN 150 mg, comprimés pelliculés à libération prolongée. (GLAXOSMITHKLINE) XIII L COMPOSITION QUALITATIVE ET QUANTITATIVE Chaque comprimé contient 150 mg de chlorhydrate de bupropion. Pour la liste complète des excipients, voir rubrique: "Liste des excipients". FORME PHARMACEUTIQUE Comprimés pelliculés à libération prolongée. Comprimés blancs, pelliculés, biconvexes et ronds, portant l'inscription « GX CH7 » sur une face et rien sur l'autre. DONNEES CLINIQUES
Treatment of Patients who decline transfusion of Blood Components and/or Blood Products November 2008 Page 1 of 23Page 1 of 23 Title: Treatment of Patients who decline transfusion of Blood Components and/or Blood Products Reference Number: Corp09/003 Implementation Date: This policy will be implemented after being signed off by the Chief Executive Review date: This policy will be reviewed one year after the effective date and thereafter every two years Responsible Officer: The officer responsible for reviewing this policy is the Haemovigilance Practitioner on behalf of the Hospital Transfusion Committee This policy has been developed within the context of Equality and Human Rights statutory obligations and requirements.