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Point of-Care Resources & Tools SC

The document discusses point-of-care resources and tools (POCR&T) that can be used by healthcare providers. POCR&T provide evidence-based knowledge to support clinical decision making and patient care. Examples include regularly updated electronic textbooks, clinical guidelines, calculators, and drug references that can be accessed quickly at the point of care. POCR&T fit within the implementation pyramid for evidence-based practice, providing reminders and decision support to healthcare providers and promoting knowledge translation from research to practice.

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HealthCare Informatics: The big picture 1
Exercises for Practice • Diagnosis: What is the sensitivity, specificity and LR for procalcitonin in acute infections? • Prevention: Starting a patient on Aspirin: Who should be offered a Proton Pump Inhibitor? • Risk assessment: How to assess for a DVT risk? • Risk assessment: How to assess the severity of acute pancreatitis? • Quality Improvement: What is the role of Point-ofCare computer reminders in improving patient care?
Exercises for Practice • Therapy: 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? • Therapy: Anti-coagulation in patients with cerebral hemorrhage? • Risk assessment: Calculate your own ATPIII 10 year risk for heart disease based on your age, gender, cholesterol and smoking status. Session 5 3
Exercises for Practice • Medication Side-Effect: A basic metabolic panel reveals that a 30 year old man suffering from bipolar disorder has a serum calcium level of 12.9 mg/dL. He is taking lithium and valproate. Could his medications be a factor? • Therapy: A patient was admitted with an ulcer related upper GI hemorrhage. Outline a management plan and timing of endoscopy. • Therapy: Nebulized epinephrine or steroids for croup in children—are they recommended? 4
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. • What could this be? – http://www.ddderm.blogspot.com/
Exercises for Practice • Calculators: What is the predicted peak flow for a 60 year old woman with asthma? She is 5’2”. • Drug Interaction: A patient on carbamazepine for epilepsy is due to be started on ciprofloxacin..any problem? • Patient Education: an obese patient (BMI 32.6) is due to start on olanzapine—what advice should she receive? Session 5 6
Exercises for Practice • Patient Education: A patient with AF is due to start warfarin..he is requesting to know more? • Prognosis: 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? Session 5 7
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 74 kg. Laboratory tests: serum creatinine 112 umol/dl, Hgb A1C 7.8, liver function tests normal. What is her creatinine clearance? Session 5 8
Exercises for Practice • A basic metabolic panel reveals that a 30 year old woman recovering from trauma has a serum chloride level of 108.9 mEq/L. She is taking ASA. Could her medications be a factor? Session 5 9
Exercises for Practice • In acute respiratory distress syndrome, during the exudative phase, what findings appear on a chest xray? • What is the mortality rate for Rocky Mountain Spotted Fever?
Exercises for Practice • A 65 year old 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?
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. Session 5 12
HEALTH CARE LITERACY IS ESSENTIAL TO THE MEDICAL TEAM Every organization can benefit from speeding up its information metabolism. This metabolism is the process by which content is produced and consumed.
Point-of Care Resources & Tools: Implementing Evidence & Transforming Healthcare Provision Dr. Imad Salah Ahmed Hassan MD FACP FRCPI MSc MBBS Consultant Physician & Pulmonologist Chairman, Knowledge Translation Committee Department of Medicine KAMC Riyadh Kingdom of Saudi Arabia
The Patient Journey: Chances of Error? Treatment Medication and prescriptions Symptoms and history Body physical examination findings Advice and education Hypotheses, Self management and health issues home monitoring Chronic (problems and Conventional medical summary Prevention Well-being and fitness, and disease diagnoses), rehabilitation after illness risks screening, management population health Tests and investigations measures Care planning Social welfare, culture, religion, attitudes, expectations, hopes, fears Procedures and operations Communication, team-based collaboration Consent, permissions, disclosures, complaints Protocols, guidelines, care pathways
Is there a clear need for change: Characteristics of current Heath care? T/F 1. High Efficiency & Productivity 2. Contained Healthcare Costs 3. Guaranteed Good Clinical Outcomes 4. High Patient Care Quality (No Medical Errors) 5. No Unnecessary & Duplicate Tests 6. High Patient Satisfaction 7. High Patient Engagement 8. Comprehensive Dual Preventive as well as Therapy Inputs
Patient Safety & Quality Gaps Acknowledged • “98,000 Hospital Patients Die Yearly Because of Adverse Events” (IOM, 1999) • “Virtually Every Patient Experiences a Gap Between the Best Evidence and the Care They Receive” (IOM, 2001) Medical errors kill enough people to fill four jumbo jets a week!!!!
KNOWLEDGE IS ESSENTIAL TO HEALING
New & Old Knowledge What to Do? Errors
Summary: Access to Evidence-Based Information • Push • Pull System Summaries Synopses Synthesis Studies • Prompt…..some labs and eMRs with a credible evidencebased pedigree 2009
eHealth & mHealth  eHealth  eHealth is a broad term for healthcare practice which is supported by electronic processes and communication.  The term can encompass a range of services that are at the edge of medicine/healthcare and information technology.  mHealth  Mobile Health  Mobile technologies such as mobile phones to collect and access health information.
Health Informatics The intersection of information science, computer science, and health care. It deals with the resources, devices and methods required to optimize the acquisition, storage, retrieval and use of information in health.
Why Health Informatics? Health Informatics provides information to make decisions Better information leads to better decisions leading to better outcomes Health care, management, planning and policy all need good information
Point-of-Care Resources & Tools: POCR&T • Definition • Its’ Place: Where in Knowledge Translation Science • Uses: – Evidence-based Knowledge Acquisition – Decision Making • Diagnosis • Therapy – Patient Centered-Care and Education – Resident/Student education • Examples
What are Point-of-Care R &T? • Point-of-care resources and tools are those research and reference utilities that a clinician can employ immediately at the point-of-care with a patient: (Clinic, ward, home, ER etc) . • They are often easy to use and contain filtered information. • Most of the evidence-based point-of-care tools include levels of evidence, rating scales or grade recommendations as well as citations back to the original research studies, systematic reviews, or guidelines.
POCR&T Aim: Identify useful resources to answer clinical questions quickly – • 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
Pre-requisites For the Effective Use of POCR&Ts Computer Literacy EBM Literacy Resource/Tool: Technical Proficiency in its 'Use
Evidence-based Practice Ask clinical Acquire the questions best evidence Assess effectiveness, efficiency of EBM process 5A’s !! Appraise the evidence Apply evidence to Your patient
Secrets of Literature Searching • Know how to ask a question – Foreground: Diagnosis, Therapy, Prognosis – Background: Epidemiology, Etiology, Pathophysiology etc • Know where to look: Time is money! – EBM resources: • Primary literature • Secondary literature – Other resources: Decision Support, Quality Improvement, Patient Education etc
Ask Clinical Questions: PICO Components of Clinical Questions Patient/ Population Intervention/ Exposure Comparison Outcome In patients with acute MI does early treatment with a statin compared to placebo decrease cardiovascular mortality? In women with suspected coronary disease what is the accuracy of exercise ECHO compared to exercise ECG for diagnosing significant CAD? In postmenopausal women does hormone replacement therapy compared to no HRT increase the risk of breast cancer?
Secrets of Literature Searching • Strategies for Literature Searching:  Strategy 1: Background Knowledge: Textbooks/eTextbooks e.g. emedicine  Strategy 2: Foreground Knowledge: Primary Literature/Original Studies= Pubmed
Secrets of Literature Searching • Strategies for Literature Searching: • Strategy 3: Foreground Knowledge: Secondary Literature/Pre-appraised Literature • Focused/Specific • Broad/General Topic
• Diagnosis e.g. – Troponin in ACS – Uric acid in Pre-eclampsia • Therapy e.g. – Misoprostol for PPH – Statins for hypercholesterolemia – Specific procedure Systematic Review Sites Technology Assessment Sites Guidelines Evidence Based eTextbooks
Broad/General Topic Management of PPH Management of hypertension Guidelines Management of Fetal Respiratory Distress Syndrome Evidence Based Management of cancer pain eTextbooks On-line eTextbooks
The Effectiveness of Mobile-Health Technologies to Improve Health Care Service Delivery Processes: A Systematic Review and Meta-Analysis. Caroline Free et al. Published January 15, 2013 • Background: Mobile health interventions could have beneficial effects on health care delivery processes. We aimed to conduct a systematic review of controlled trials of mobile technology interventions to improve health care delivery processes. • Conclusions: 1. The results for health care provider support interventions on diagnosis and management outcomes are generally consistent with modest benefits. 2. Trials using mobile technology-based photos reported reductions in correct diagnoses when compared to the gold standard. 3. SMS appointment reminders have modest benefits and may be appropriate for implementation. High quality trials measuring clinical outcomes are needed.
Point-R &T: Where in the Implementation Pyramid? ?
5S Information Resources: Information in top 4 are used Computerized Decision Support System (CDSS) Systems Evidence based textbooks :UpTo POCRaTs Summaries Synopses Syntheses Studies Date, DynaMed, ACP PIER, BMJ Clinical Evidence Evidence based journals EBM, EBN, EBMH, ACP J club Systematic Review Cochrane reviews Original articles: BMJUpdates, PubMed Clinical Queries Haynes, R. (2006, November). Of studies, syntheses, synopses, summaries, and systems: the 5S evolution of information services for 2009 NCKUFM-YCY evidence-based health care decisions. ACP Journal Club, 145(3), A8-A9.
Hierarchy of Evidence-Based Implementation Tools: POCR&T are at the TOP The Implementation Pyramid Interventions of variable effectiveness •Audit and feedback •Use of local opinion leaders •Local consensus processes (ownership) •Patient mediated interventions Consistently effective interventions •Educational outreach visits •Reminders (manual or computerized) •Multifaceted interventions* •Interactive educational meetings (workshops) •Financial Incentives Interventions that have little or no effect •Educational materials (Printed practice guidelines, audiovisual materials, and electronic publications) •Didactic educational meetings (such as lectures) * (a combination that includes two or more of the following: audit and feedback, reminders, local consensus processes, or marketing)
5S Information Resources Computerized Decision Support System (CDSS) Systems Evidence based textbooks :UpTo POCRaTs Summaries Synopses Syntheses Studies Date, DynaMed, ACP PIER, BMJ Clinical Evidence Evidence based journals EBM, EBN, EBMH, ACP J club Systematic Review Cochrane reviews Original articles: BMJUpdates, PubMed Clinical Queries Haynes, R. (2006, November). Of studies, syntheses, synopses, summaries, and systems: the 5S evolution of information services for 2009 NCKUFM-YCY evidence-based health care decisions. ACP Journal Club, 145(3), A8-A9.
Clinical Workflow: Where Do P-o-C R & T fit? P-o-C R & Ts Fit in all Steps. 40
Clinical Workflow: Where Do P-o-C R & T fit? Point-of-Care Resources and Tools are Reminder and Decision Making Utilities for Enhancing the Practice of Evidence-Based Medicine (Knowledge Translation) P-o-C R & Ts Fit in all Steps.
The Reminder Systems at the Point-of Care: The P-o-C R & T Computerized Decision Support Systems Integrated Care Pathways, Protocols and Order Sets Best Available Evidence Point-of-Care Educational Resources (Healthcare Provider & Patient) Cognitive Reminders
Examples of POCR&Ts
EBM-based Summaries (regularly updated e-text books)
General Characteristics • Searchable Up-to-Date Medical Databases • Clinically organized summaries and reference tools integrating evidence-based and practical information for decision-making in clinical practice: support in making diagnoses, creating treatment plans, and determining prognoses.
General Characteristics • Variable: • Diagnosis/Differential Diagnosis aids, Laboratory Reference Values, Decision Trees, Procedures, Calculators/Unit and Dose Converters, Drug Reference/Interactions, Videos and Images, Patient Information, Links to EBM websites, PDA/Online, emailing facility, notes entry, feedback etc.
DynaMed http://www.dynamicmedical.com/ Essential Evidence Plus (formerly InfoRetriever) http://www.essentialevidenceplus.c First Consult http://www.firstconsult.com/ UpToDate http://www.uptodate.com/ Clinical Evidence http://clinicalevidence.bmj.com/ceweb/index .jsp ACP PIERS http://pier.acponline.org/index.html PEPID om/ http://www.pepid.com/ ClinicalKey http://info.clinicalkey.com/ JBI COnNECT (Clinical Online Network of Evidence for Care and Therapeutics) http://connect.jbiconnectplus.org/Default.asp x Nursing Reference Centre http://www.ebscohost.com/nursing/products /nursing-reference-center
Clinical Knowledge Summaries (CKS) :National Library for Health (Free*) http://cks.library.nhs.uk/ Clin-eguide (Wolters-Kluwer Ovid) http://www.clineguide.com/MarketingSiteMa p.aspx OvidMD™ http://login.ovidmd.ovid.com/login.aspx?disa bleIP= PEMSoft (Pediatrics) http://www.pemsoft.com/ ProQuest Nursing & Allied Health Source http://www.proquest.com/enUS/products/default.shtml Rehabilitation Reference Center™ (RRC) http://www.ebscohost.com/pointOfCare/rrcabout Thomson Clinical Xpert http://truvenhealth.com/your_healthcare_foc us/hospital_management_decisions/ ZynxEvidence website http://www.zynxhealth.com/Solutions/ZynxE vidence.aspx Epocrates (Free*) http://www.epocrates.com/online eMedicine (FREE) http://emedicine.medscape.com/
UpToDate
DynaMed
VisualDx With over 25000 images representing more than 1200 pediatric & adult conditions, VisualDx allows physicians to search by diagnosis, build a patient-specific differential, or look up drug-induced adverse reactions by medication. http://www.visualdx.com/features/mobileaccess
Resource Rx DxPlain Online DDx Dx LAB Calcs X Epocrates Essentials PDA X Epocrates Online X UpToDate X X X X X PEPID Online and PDA X X X X X Dynamed Online and PDA X X Harrison's Practice Online and PDA X X Essential Evidence Plus Online and PDA X Pediatric Care Online Online X X* X X X X X X Online X X X X
Point of Care Clinical Resources: Systematic Reviews & CATs Websites
Cochrane: http://www3.interscience.wiley.com/cgibin/mrwhome/106568753/HOME Database of Systematic Reviews of effectiveness DARE: http://www.crd.york.ac.uk/crdweb/ Pubmed Systematic Reviews: http://www.ncbi.nlm.nih.gov/pubmed/clinical AHRQ EPC Evidence Reports: Agency for http://www.ahrq.gov/CLINIC/epcquick.htm Healthcare Research and Quality: Best BETs: http://bestbets.org/database/browse-bets.php Attract: http://www.attract.wales.nhs.uk/
• JAMAevidence • The JAMAevidence mobile view features a portion of the site's content optimized for mobile browsers. • They are: “Quick Reference" pocket cards from Users' Guides to the Medical Literature” "Make the Diagnosis" sections from The Rational Clinical Examination
Point of Care Clinical Resources: Clinical Pathways & Protocols
NICE Pathways: guidance at your fingertips- www.nice.org.uk http://pathways.nice.org.uk/ Society of Hospital Medicine: http://www.hospitalmedicine.org/ http://www.hospitalmedicine.org/Content/Navi gationMenu/QualityImprovement/QIClinicalTools /Quality_Improvement.htm ICSI Institute for Clinical Systems Improvements: http://www.icsi.org/in dex.aspx (Order Sets) https://www.icsi.org/guidelines__more/search_r esults__browsing/?catalog_search_panel_query=1&cat alog_search_panel_label_ids%5B%5D=98&catalo g_search_panel_label_ids%5B%5D=99&catalog_s earch_panel_label_ids%5B%5D=102&catalog_se arch_panel_label_ids%5B%5D=141&catalog_sear ch_panel_label_ids%5B%5D=101#results_header
Point of Care Clinical Resources: Decision Tools
Point of For Clinical Resources: Decision Tools Resources Care EBM Knowledge Translation Decision Support Systems Software to aid clinical decision-making: characteristics of patient are matched to knowledge base, recommendations are presented to the clinician/patient. (Sim et al, JAMIA, 2001) Objectives:       Diagnostic support Drug dosing Preventive care reminders/risk assessment Disease management (Diabetes, Hypertension, AIDS, Asthma) Test ordering Drug prescription
Clinical Decision 60
CDSS - Benefits • Improve patient safety – Reduce medical errors – Improved medication and test ordering • Improve quality of care – Application of Clinical Pathways and Guidelines – Evidence based Medicine – Improved Clinical documentation – Increase quality time for direct patient care • Improve efficiency in Healthcare delivery – Reduce costs, reduce test duplication, decrease adverse events 61
CDSS: Computerized Physician Order Entry • Growing evidence that CPOE reduce medical errors and adverse drug events. Effects of Computerized Physician Order Entry and Clinical Decision Support Systems on Medication Safety Rainu Kaushal,MD,MPH et al Arch Intern Med. 2003 http://archinte.ama-assn.org/cgi/content/full/163/12/1409 Effects of Computerized Clinical Decision Support Systems on Practitioner Performance and Patient Outcomes Garg et al JAMA. 2005 http://jama.ama-assn.org/cgi/content/full/293/10/1223 62
Opposing views… • CPOE facilitate medication error ‘risks’, create new errors. Role of Computerized Physician Order Entry Systems in Facilitating Medication Errors. Ross Koppel,PhD et al. JAMA. 2005 http://jama.ama-assn.org/cgi/content/full/293/10/1197 Computer Technology and Clinical Work Robert L. Wears et. al. JAMA. 2005;293:1261-1263 . http://jama.ama-assn.org/cgi/content/full/293/10/1261 63
Diagnosaurus
CDSS: Drawbacks 65
CDSS TYPES based on their USAGE • Knowledge-based systems  Alerts and reminders (in real-time)  Diagnostic assistance (some with likelihood input)  Therapy critiquing, interactions and planning  Prescribing decision support systems  Information retrieval (selects best resource)  Image recognition and interpretation  Early warning systems • Expert laboratory information systems (Interpretation) • Machine learning systems (futuristic learning expert system)
Point of Care Clinical Resources: Decision Tools • Isabel: http://www.isabelhealthcare.com/home/defa ult •Open Clinical: http://www.openclinical.org/dss.html • DXplain: http://dxplain.org/dxp/dxp.pl Calculators, Conversions and Scoring Tools Skyscape: http://www.skyscape.com/Windows/Archime des360BySpecialty.aspx •Emergency Medicine on the Web: Best viewed on Internet Explorer not Google Chrome. http://www.ncemi.org/ MedicineWorld.Org: http://medicineworld.org/online-medicalcalculators.html •Clinical Decision Making Calculators: http://www.fammed.ouhsc.edu/robhamm/cd mcalc.htm
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, CURb-65, Killip Class, Ranson’s, APGAR et Session 5 68
EPR HealthCare Informatics: The big picture 69
Disease Specific CDSS
Bronchial Asthma
The ATHENA/EON Hypertension-Management SystSoftware to aid clinical decision-making; characteristics of patient are matched to knowledge base, recommendations are presented to the clinician/patient (Sim et al, JAMIA, 2001)
Point of Care Clinical Resources: Patient Education
Patient Education: Multiple Tools
Point of Care Clinical Resources: Patient Education WebMD: http://www.webmd.com/ PubMed Health: http://www.ncbi.nlm.nih.gov/pubmedhealth/s/ diseases_and_conditions/a/ MedlinePlus: http://www.nlm.nih.gov/medlineplus/ NHS Choices: http://www.nhs.uk/Conditions/Pages/hub.aspx The NNT: •http://www.medicine.ox.ac.uk/bandolier/ban d50/b50-8.html •http://www.thennt.com/ •http://www.nntonline.net/visualrx/v3/display. aspx King Abdullah Encyclopedia: http://www.kaahe.org/ar/
• WebMD Mobile WebMD Mobile provides consumers with reliable, timely, and accurate health information on the go. It includes the award-winning WebMD Symptom Checker, a comprehensive drug, supplement and vitamin treatment database, as well as essential first aid information.http://www.webmd.com/ • MedlinePlus MedlinePlus is the National Institutes of Health's Web site for patients and their families. Produced by the National Library of Medicine, it brings information about diseases, conditions, and wellness issues in lay language.
• drawMD is a free app for the iPad to enhance doctor-patient communication by offering interactive visual guides as a tool for explaining complex issues and possible medical and surgical solutions. • Select one of the detailed anatomic images from the 10 medical specialties or upload your own, and then sketch, stamp, or type directly on the images.  The images and stamps are tailored to each specialty and allow you to explain treatments and procedures in a personalized, easily understood way. Then, share those images and notes with the patient and retain them as a record of the consultation. • With drawMD, patients better understand  conditions and procedures, while the time required for the consultation is reduced. Simple, visuallyoriented consultations are more understandable for patients, and can provide the context that is used to improve and engagement and satisfaction. • More information about the app is available fromhttp://www.drawmd.com/. The app is available for download from the AppStore.
Health Care Literacy Around the World
Explaining NNT to Patients: http://www.nntonline.net/visualrx/
Patient-Centered Shared Decision Making Mayo Clinic: http://shareddecisions.mayoclinic.org/ Diabetes: http://shareddecisions.mayoclinic.org/files/2011/08/Diabetes_Medication_Cho ice.pdf Patient Decision Aids http://decisionaid.ohri.ca/AZlist.html
Shared Decision Making Resources • DHMC Center for Shared Decision Making – http://www.dhmc.org/dept/csdm • Ottawa Health Research Institute – http://decisionaid.ohri.ca/index.html • Healthwise Preferred Care – http://www.healthwise.net/preferredcare • WebMD – http://www.webmd.com/ • Foundation for Informed Medical Decision Making – http://www.informedmedicaldecisions.org • Health News Review – http://www.healthnewsreview.org
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 Session 4 83 83
SOFTWARE PUBLISHERS • • • • • Apps for Healthcare Professionals Collection Apple's App Store has put together a collection to make it easier for healthcare professionals to find apps for their mobile devices. It includes six categories: reference apps, educational apps, EMR & patient monitoring apps, imaging apps, point of care apps, and personal care apps (which is actually aimed for consumers.) See the link above for a review by iMedicalApps. Medical Wizards Software for medical professionals by medical professionals. Not free. QxMD Authored by clinician experts, QxMD’s authoritative free and inexpensive mobile apps are relied upon by physicians, nurses and other health care professionals. Skyscape - 25% discount - Skyscape offers medical references for mobile devices. - Available for Windows Mobile, Palm, iPhone, BlackBerry, Android. - In collaboration with the University of Calgary Libraries, Skyscape now offers a 25% discount on the purchase of Skyscape resources for mobile devices. Unbound Medicine Unbound Medicine offers medical references for purchase for mobile devices.
• Discussions • Questions 85
• Thank you! 86

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Point of-Care Resources & Tools SC

  • 1.
  • 2.
    Exercises for Practice •Diagnosis: What is the sensitivity, specificity and LR for procalcitonin in acute infections? • Prevention: Starting a patient on Aspirin: Who should be offered a Proton Pump Inhibitor? • Risk assessment: How to assess for a DVT risk? • Risk assessment: How to assess the severity of acute pancreatitis? • Quality Improvement: What is the role of Point-ofCare computer reminders in improving patient care?
  • 3.
    Exercises for Practice •Therapy: 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? • Therapy: Anti-coagulation in patients with cerebral hemorrhage? • Risk assessment: Calculate your own ATPIII 10 year risk for heart disease based on your age, gender, cholesterol and smoking status. Session 5 3
  • 4.
    Exercises for Practice •Medication Side-Effect: A basic metabolic panel reveals that a 30 year old man suffering from bipolar disorder has a serum calcium level of 12.9 mg/dL. He is taking lithium and valproate. Could his medications be a factor? • Therapy: A patient was admitted with an ulcer related upper GI hemorrhage. Outline a management plan and timing of endoscopy. • Therapy: Nebulized epinephrine or steroids for croup in children—are they recommended? 4
  • 5.
    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. • What could this be? – http://www.ddderm.blogspot.com/
  • 6.
    Exercises for Practice •Calculators: What is the predicted peak flow for a 60 year old woman with asthma? She is 5’2”. • Drug Interaction: A patient on carbamazepine for epilepsy is due to be started on ciprofloxacin..any problem? • Patient Education: an obese patient (BMI 32.6) is due to start on olanzapine—what advice should she receive? Session 5 6
  • 7.
    Exercises for Practice •Patient Education: A patient with AF is due to start warfarin..he is requesting to know more? • Prognosis: 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? Session 5 7
  • 8.
    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 74 kg. Laboratory tests: serum creatinine 112 umol/dl, Hgb A1C 7.8, liver function tests normal. What is her creatinine clearance? Session 5 8
  • 9.
    Exercises for Practice •A basic metabolic panel reveals that a 30 year old woman recovering from trauma has a serum chloride level of 108.9 mEq/L. She is taking ASA. Could her medications be a factor? Session 5 9
  • 10.
    Exercises for Practice •In acute respiratory distress syndrome, during the exudative phase, what findings appear on a chest xray? • What is the mortality rate for Rocky Mountain Spotted Fever?
  • 11.
    Exercises for Practice •A 65 year old 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?
  • 12.
    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. Session 5 12
  • 13.
    HEALTH CARE LITERACYIS ESSENTIAL TO THE MEDICAL TEAM Every organization can benefit from speeding up its information metabolism. This metabolism is the process by which content is produced and consumed.
  • 14.
    Point-of Care Resources& Tools: Implementing Evidence & Transforming Healthcare Provision Dr. Imad Salah Ahmed Hassan MD FACP FRCPI MSc MBBS Consultant Physician & Pulmonologist Chairman, Knowledge Translation Committee Department of Medicine KAMC Riyadh Kingdom of Saudi Arabia
  • 15.
    The Patient Journey:Chances of Error? Treatment Medication and prescriptions Symptoms and history Body physical examination findings Advice and education Hypotheses, Self management and health issues home monitoring Chronic (problems and Conventional medical summary Prevention Well-being and fitness, and disease diagnoses), rehabilitation after illness risks screening, management population health Tests and investigations measures Care planning Social welfare, culture, religion, attitudes, expectations, hopes, fears Procedures and operations Communication, team-based collaboration Consent, permissions, disclosures, complaints Protocols, guidelines, care pathways
  • 16.
    Is there aclear need for change: Characteristics of current Heath care? T/F 1. High Efficiency & Productivity 2. Contained Healthcare Costs 3. Guaranteed Good Clinical Outcomes 4. High Patient Care Quality (No Medical Errors) 5. No Unnecessary & Duplicate Tests 6. High Patient Satisfaction 7. High Patient Engagement 8. Comprehensive Dual Preventive as well as Therapy Inputs
  • 17.
    Patient Safety &Quality Gaps Acknowledged • “98,000 Hospital Patients Die Yearly Because of Adverse Events” (IOM, 1999) • “Virtually Every Patient Experiences a Gap Between the Best Evidence and the Care They Receive” (IOM, 2001) Medical errors kill enough people to fill four jumbo jets a week!!!!
  • 18.
  • 19.
    New & OldKnowledge What to Do? Errors
  • 20.
    Summary: Access to Evidence-BasedInformation • Push • Pull System Summaries Synopses Synthesis Studies • Prompt…..some labs and eMRs with a credible evidencebased pedigree 2009
  • 21.
    eHealth & mHealth eHealth  eHealth is a broad term for healthcare practice which is supported by electronic processes and communication.  The term can encompass a range of services that are at the edge of medicine/healthcare and information technology.  mHealth  Mobile Health  Mobile technologies such as mobile phones to collect and access health information.
  • 22.
    Health Informatics The intersectionof information science, computer science, and health care. It deals with the resources, devices and methods required to optimize the acquisition, storage, retrieval and use of information in health.
  • 23.
    Why Health Informatics? HealthInformatics provides information to make decisions Better information leads to better decisions leading to better outcomes Health care, management, planning and policy all need good information
  • 24.
    Point-of-Care Resources &Tools: POCR&T • Definition • Its’ Place: Where in Knowledge Translation Science • Uses: – Evidence-based Knowledge Acquisition – Decision Making • Diagnosis • Therapy – Patient Centered-Care and Education – Resident/Student education • Examples
  • 25.
    What are Point-of-CareR &T? • Point-of-care resources and tools are those research and reference utilities that a clinician can employ immediately at the point-of-care with a patient: (Clinic, ward, home, ER etc) . • They are often easy to use and contain filtered information. • Most of the evidence-based point-of-care tools include levels of evidence, rating scales or grade recommendations as well as citations back to the original research studies, systematic reviews, or guidelines.
  • 26.
    POCR&T Aim: Identify useful resourcesto answer clinical questions quickly – • 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
  • 27.
    Pre-requisites For the Effective Use ofPOCR&Ts Computer Literacy EBM Literacy Resource/Tool: Technical Proficiency in its 'Use
  • 28.
    Evidence-based Practice Ask clinical Acquirethe questions best evidence Assess effectiveness, efficiency of EBM process 5A’s !! Appraise the evidence Apply evidence to Your patient
  • 29.
    Secrets of LiteratureSearching • Know how to ask a question – Foreground: Diagnosis, Therapy, Prognosis – Background: Epidemiology, Etiology, Pathophysiology etc • Know where to look: Time is money! – EBM resources: • Primary literature • Secondary literature – Other resources: Decision Support, Quality Improvement, Patient Education etc
  • 30.
    Ask Clinical Questions:PICO Components of Clinical Questions Patient/ Population Intervention/ Exposure Comparison Outcome In patients with acute MI does early treatment with a statin compared to placebo decrease cardiovascular mortality? In women with suspected coronary disease what is the accuracy of exercise ECHO compared to exercise ECG for diagnosing significant CAD? In postmenopausal women does hormone replacement therapy compared to no HRT increase the risk of breast cancer?
  • 31.
    Secrets of LiteratureSearching • Strategies for Literature Searching:  Strategy 1: Background Knowledge: Textbooks/eTextbooks e.g. emedicine  Strategy 2: Foreground Knowledge: Primary Literature/Original Studies= Pubmed
  • 32.
    Secrets of LiteratureSearching • Strategies for Literature Searching: • Strategy 3: Foreground Knowledge: Secondary Literature/Pre-appraised Literature • Focused/Specific • Broad/General Topic
  • 33.
    • Diagnosis e.g. – Troponinin ACS – Uric acid in Pre-eclampsia • Therapy e.g. – Misoprostol for PPH – Statins for hypercholesterolemia – Specific procedure Systematic Review Sites Technology Assessment Sites Guidelines Evidence Based eTextbooks
  • 34.
    Broad/General Topic Management ofPPH Management of hypertension Guidelines Management of Fetal Respiratory Distress Syndrome Evidence Based Management of cancer pain eTextbooks On-line eTextbooks
  • 35.
    The Effectiveness ofMobile-Health Technologies to Improve Health Care Service Delivery Processes: A Systematic Review and Meta-Analysis. Caroline Free et al. Published January 15, 2013 • Background: Mobile health interventions could have beneficial effects on health care delivery processes. We aimed to conduct a systematic review of controlled trials of mobile technology interventions to improve health care delivery processes. • Conclusions: 1. The results for health care provider support interventions on diagnosis and management outcomes are generally consistent with modest benefits. 2. Trials using mobile technology-based photos reported reductions in correct diagnoses when compared to the gold standard. 3. SMS appointment reminders have modest benefits and may be appropriate for implementation. High quality trials measuring clinical outcomes are needed.
  • 36.
    Point-R &T: Wherein the Implementation Pyramid? ?
  • 37.
    5S Information Resources:Information in top 4 are used Computerized Decision Support System (CDSS) Systems Evidence based textbooks :UpTo POCRaTs Summaries Synopses Syntheses Studies Date, DynaMed, ACP PIER, BMJ Clinical Evidence Evidence based journals EBM, EBN, EBMH, ACP J club Systematic Review Cochrane reviews Original articles: BMJUpdates, PubMed Clinical Queries Haynes, R. (2006, November). Of studies, syntheses, synopses, summaries, and systems: the 5S evolution of information services for 2009 NCKUFM-YCY evidence-based health care decisions. ACP Journal Club, 145(3), A8-A9.
  • 38.
    Hierarchy of Evidence-Based ImplementationTools: POCR&T are at the TOP The Implementation Pyramid Interventions of variable effectiveness •Audit and feedback •Use of local opinion leaders •Local consensus processes (ownership) •Patient mediated interventions Consistently effective interventions •Educational outreach visits •Reminders (manual or computerized) •Multifaceted interventions* •Interactive educational meetings (workshops) •Financial Incentives Interventions that have little or no effect •Educational materials (Printed practice guidelines, audiovisual materials, and electronic publications) •Didactic educational meetings (such as lectures) * (a combination that includes two or more of the following: audit and feedback, reminders, local consensus processes, or marketing)
  • 39.
    5S Information Resources ComputerizedDecision Support System (CDSS) Systems Evidence based textbooks :UpTo POCRaTs Summaries Synopses Syntheses Studies Date, DynaMed, ACP PIER, BMJ Clinical Evidence Evidence based journals EBM, EBN, EBMH, ACP J club Systematic Review Cochrane reviews Original articles: BMJUpdates, PubMed Clinical Queries Haynes, R. (2006, November). Of studies, syntheses, synopses, summaries, and systems: the 5S evolution of information services for 2009 NCKUFM-YCY evidence-based health care decisions. ACP Journal Club, 145(3), A8-A9.
  • 40.
    Clinical Workflow: WhereDo P-o-C R & T fit? P-o-C R & Ts Fit in all Steps. 40
  • 41.
    Clinical Workflow: WhereDo P-o-C R & T fit? Point-of-Care Resources and Tools are Reminder and Decision Making Utilities for Enhancing the Practice of Evidence-Based Medicine (Knowledge Translation) P-o-C R & Ts Fit in all Steps.
  • 42.
    The Reminder Systemsat the Point-of Care: The P-o-C R & T Computerized Decision Support Systems Integrated Care Pathways, Protocols and Order Sets Best Available Evidence Point-of-Care Educational Resources (Healthcare Provider & Patient) Cognitive Reminders
  • 43.
  • 44.
    EBM-based Summaries (regularlyupdated e-text books)
  • 45.
    General Characteristics • SearchableUp-to-Date Medical Databases • Clinically organized summaries and reference tools integrating evidence-based and practical information for decision-making in clinical practice: support in making diagnoses, creating treatment plans, and determining prognoses.
  • 46.
    General Characteristics • Variable: •Diagnosis/Differential Diagnosis aids, Laboratory Reference Values, Decision Trees, Procedures, Calculators/Unit and Dose Converters, Drug Reference/Interactions, Videos and Images, Patient Information, Links to EBM websites, PDA/Online, emailing facility, notes entry, feedback etc.
  • 47.
    DynaMed http://www.dynamicmedical.com/ Essential Evidence Plus(formerly InfoRetriever) http://www.essentialevidenceplus.c First Consult http://www.firstconsult.com/ UpToDate http://www.uptodate.com/ Clinical Evidence http://clinicalevidence.bmj.com/ceweb/index .jsp ACP PIERS http://pier.acponline.org/index.html PEPID om/ http://www.pepid.com/ ClinicalKey http://info.clinicalkey.com/ JBI COnNECT (Clinical Online Network of Evidence for Care and Therapeutics) http://connect.jbiconnectplus.org/Default.asp x Nursing Reference Centre http://www.ebscohost.com/nursing/products /nursing-reference-center
  • 48.
    Clinical Knowledge Summaries(CKS) :National Library for Health (Free*) http://cks.library.nhs.uk/ Clin-eguide (Wolters-Kluwer Ovid) http://www.clineguide.com/MarketingSiteMa p.aspx OvidMD™ http://login.ovidmd.ovid.com/login.aspx?disa bleIP= PEMSoft (Pediatrics) http://www.pemsoft.com/ ProQuest Nursing & Allied Health Source http://www.proquest.com/enUS/products/default.shtml Rehabilitation Reference Center™ (RRC) http://www.ebscohost.com/pointOfCare/rrcabout Thomson Clinical Xpert http://truvenhealth.com/your_healthcare_foc us/hospital_management_decisions/ ZynxEvidence website http://www.zynxhealth.com/Solutions/ZynxE vidence.aspx Epocrates (Free*) http://www.epocrates.com/online eMedicine (FREE) http://emedicine.medscape.com/
  • 49.
  • 50.
  • 51.
    VisualDx With over 25000images representing more than 1200 pediatric & adult conditions, VisualDx allows physicians to search by diagnosis, build a patient-specific differential, or look up drug-induced adverse reactions by medication. http://www.visualdx.com/features/mobileaccess
  • 52.
    Resource Rx DxPlain Online DDx Dx LABCalcs X Epocrates Essentials PDA X Epocrates Online X UpToDate X X X X X PEPID Online and PDA X X X X X Dynamed Online and PDA X X Harrison's Practice Online and PDA X X Essential Evidence Plus Online and PDA X Pediatric Care Online Online X X* X X X X X X Online X X X X
  • 53.
    Point of CareClinical Resources: Systematic Reviews & CATs Websites
  • 54.
    Cochrane: http://www3.interscience.wiley.com/cgibin/mrwhome/106568753/HOME Database of SystematicReviews of effectiveness DARE: http://www.crd.york.ac.uk/crdweb/ Pubmed Systematic Reviews: http://www.ncbi.nlm.nih.gov/pubmed/clinical AHRQ EPC Evidence Reports: Agency for http://www.ahrq.gov/CLINIC/epcquick.htm Healthcare Research and Quality: Best BETs: http://bestbets.org/database/browse-bets.php Attract: http://www.attract.wales.nhs.uk/
  • 55.
    • JAMAevidence • TheJAMAevidence mobile view features a portion of the site's content optimized for mobile browsers. • They are: “Quick Reference" pocket cards from Users' Guides to the Medical Literature” "Make the Diagnosis" sections from The Rational Clinical Examination
  • 56.
    Point of CareClinical Resources: Clinical Pathways & Protocols
  • 57.
    NICE Pathways: guidanceat your fingertips- www.nice.org.uk http://pathways.nice.org.uk/ Society of Hospital Medicine: http://www.hospitalmedicine.org/ http://www.hospitalmedicine.org/Content/Navi gationMenu/QualityImprovement/QIClinicalTools /Quality_Improvement.htm ICSI Institute for Clinical Systems Improvements: http://www.icsi.org/in dex.aspx (Order Sets) https://www.icsi.org/guidelines__more/search_r esults__browsing/?catalog_search_panel_query=1&cat alog_search_panel_label_ids%5B%5D=98&catalo g_search_panel_label_ids%5B%5D=99&catalog_s earch_panel_label_ids%5B%5D=102&catalog_se arch_panel_label_ids%5B%5D=141&catalog_sear ch_panel_label_ids%5B%5D=101#results_header
  • 58.
    Point of CareClinical Resources: Decision Tools
  • 59.
    Point of ForClinical Resources: Decision Tools Resources Care EBM Knowledge Translation Decision Support Systems Software to aid clinical decision-making: characteristics of patient are matched to knowledge base, recommendations are presented to the clinician/patient. (Sim et al, JAMIA, 2001) Objectives:       Diagnostic support Drug dosing Preventive care reminders/risk assessment Disease management (Diabetes, Hypertension, AIDS, Asthma) Test ordering Drug prescription
  • 60.
  • 61.
    CDSS - Benefits •Improve patient safety – Reduce medical errors – Improved medication and test ordering • Improve quality of care – Application of Clinical Pathways and Guidelines – Evidence based Medicine – Improved Clinical documentation – Increase quality time for direct patient care • Improve efficiency in Healthcare delivery – Reduce costs, reduce test duplication, decrease adverse events 61
  • 62.
    CDSS: Computerized Physician OrderEntry • Growing evidence that CPOE reduce medical errors and adverse drug events. Effects of Computerized Physician Order Entry and Clinical Decision Support Systems on Medication Safety Rainu Kaushal,MD,MPH et al Arch Intern Med. 2003 http://archinte.ama-assn.org/cgi/content/full/163/12/1409 Effects of Computerized Clinical Decision Support Systems on Practitioner Performance and Patient Outcomes Garg et al JAMA. 2005 http://jama.ama-assn.org/cgi/content/full/293/10/1223 62
  • 63.
    Opposing views… • CPOEfacilitate medication error ‘risks’, create new errors. Role of Computerized Physician Order Entry Systems in Facilitating Medication Errors. Ross Koppel,PhD et al. JAMA. 2005 http://jama.ama-assn.org/cgi/content/full/293/10/1197 Computer Technology and Clinical Work Robert L. Wears et. al. JAMA. 2005;293:1261-1263 . http://jama.ama-assn.org/cgi/content/full/293/10/1261 63
  • 64.
  • 65.
  • 66.
    CDSS TYPES basedon their USAGE • Knowledge-based systems  Alerts and reminders (in real-time)  Diagnostic assistance (some with likelihood input)  Therapy critiquing, interactions and planning  Prescribing decision support systems  Information retrieval (selects best resource)  Image recognition and interpretation  Early warning systems • Expert laboratory information systems (Interpretation) • Machine learning systems (futuristic learning expert system)
  • 67.
    Point of CareClinical Resources: Decision Tools • Isabel: http://www.isabelhealthcare.com/home/defa ult •Open Clinical: http://www.openclinical.org/dss.html • DXplain: http://dxplain.org/dxp/dxp.pl Calculators, Conversions and Scoring Tools Skyscape: http://www.skyscape.com/Windows/Archime des360BySpecialty.aspx •Emergency Medicine on the Web: Best viewed on Internet Explorer not Google Chrome. http://www.ncemi.org/ MedicineWorld.Org: http://medicineworld.org/online-medicalcalculators.html •Clinical Decision Making Calculators: http://www.fammed.ouhsc.edu/robhamm/cd mcalc.htm
  • 68.
    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, CURb-65, Killip Class, Ranson’s, APGAR et Session 5 68
  • 69.
  • 70.
  • 71.
  • 73.
    The ATHENA/EON Hypertension-Management SystSoftwareto aid clinical decision-making; characteristics of patient are matched to knowledge base, recommendations are presented to the clinician/patient (Sim et al, JAMIA, 2001)
  • 74.
    Point of CareClinical Resources: Patient Education
  • 75.
  • 76.
    Point of CareClinical Resources: Patient Education WebMD: http://www.webmd.com/ PubMed Health: http://www.ncbi.nlm.nih.gov/pubmedhealth/s/ diseases_and_conditions/a/ MedlinePlus: http://www.nlm.nih.gov/medlineplus/ NHS Choices: http://www.nhs.uk/Conditions/Pages/hub.aspx The NNT: •http://www.medicine.ox.ac.uk/bandolier/ban d50/b50-8.html •http://www.thennt.com/ •http://www.nntonline.net/visualrx/v3/display. aspx King Abdullah Encyclopedia: http://www.kaahe.org/ar/
  • 77.
    • WebMD Mobile WebMDMobile provides consumers with reliable, timely, and accurate health information on the go. It includes the award-winning WebMD Symptom Checker, a comprehensive drug, supplement and vitamin treatment database, as well as essential first aid information.http://www.webmd.com/ • MedlinePlus MedlinePlus is the National Institutes of Health's Web site for patients and their families. Produced by the National Library of Medicine, it brings information about diseases, conditions, and wellness issues in lay language.
  • 78.
    • drawMD isa free app for the iPad to enhance doctor-patient communication by offering interactive visual guides as a tool for explaining complex issues and possible medical and surgical solutions. • Select one of the detailed anatomic images from the 10 medical specialties or upload your own, and then sketch, stamp, or type directly on the images.  The images and stamps are tailored to each specialty and allow you to explain treatments and procedures in a personalized, easily understood way. Then, share those images and notes with the patient and retain them as a record of the consultation. • With drawMD, patients better understand  conditions and procedures, while the time required for the consultation is reduced. Simple, visuallyoriented consultations are more understandable for patients, and can provide the context that is used to improve and engagement and satisfaction. • More information about the app is available fromhttp://www.drawmd.com/. The app is available for download from the AppStore.
  • 79.
    Health Care LiteracyAround the World
  • 80.
    Explaining NNT toPatients: http://www.nntonline.net/visualrx/
  • 81.
    Patient-Centered Shared DecisionMaking Mayo Clinic: http://shareddecisions.mayoclinic.org/ Diabetes: http://shareddecisions.mayoclinic.org/files/2011/08/Diabetes_Medication_Cho ice.pdf Patient Decision Aids http://decisionaid.ohri.ca/AZlist.html
  • 82.
    Shared Decision MakingResources • DHMC Center for Shared Decision Making – http://www.dhmc.org/dept/csdm • Ottawa Health Research Institute – http://decisionaid.ohri.ca/index.html • Healthwise Preferred Care – http://www.healthwise.net/preferredcare • WebMD – http://www.webmd.com/ • Foundation for Informed Medical Decision Making – http://www.informedmedicaldecisions.org • Health News Review – http://www.healthnewsreview.org
  • 83.
    Use of DDxTools 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 Session 4 83 83
  • 84.
    SOFTWARE PUBLISHERS • • • • • Apps forHealthcare Professionals Collection Apple's App Store has put together a collection to make it easier for healthcare professionals to find apps for their mobile devices. It includes six categories: reference apps, educational apps, EMR & patient monitoring apps, imaging apps, point of care apps, and personal care apps (which is actually aimed for consumers.) See the link above for a review by iMedicalApps. Medical Wizards Software for medical professionals by medical professionals. Not free. QxMD Authored by clinician experts, QxMD’s authoritative free and inexpensive mobile apps are relied upon by physicians, nurses and other health care professionals. Skyscape - 25% discount - Skyscape offers medical references for mobile devices. - Available for Windows Mobile, Palm, iPhone, BlackBerry, Android. - In collaboration with the University of Calgary Libraries, Skyscape now offers a 25% discount on the purchase of Skyscape resources for mobile devices. Unbound Medicine Unbound Medicine offers medical references for purchase for mobile devices.
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Editor's Notes

  • #6 DIAGNOSTIC TOOLSUse DxPlain: This is Rocky Mountain Spotted Fever. It is a Rare disease. Therefore, it won’t be under the common problems. It will show up as highly likely with ++ PEPID only takes: Headache, severe; palmar erythema; skin rashes, erythematous, maculopapular; muscle pain (instead of myalgia) malaise and tick bite. Adding others confuses it. Exercises for Practice should be used as examples for Demo. Start demoing when you get to these slides. You can say something like “let’s work this exercise together…” and On your computer, you would go to ….. If you let them look this up first then show them how, you won’t make it thru all the content.