D & D Enterprises Session 2: Epocrates Essentials Thursday July 13, 2006 Palm Telemedicine Seminar...

transcript

D & D Enterprises

Session 2: Epocrates EssentialsThursday July 13, 2006

Palm Telemedicine

Seminar Series

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Introduction

Diane Cunningham▪ Palm user since 1996▪ Designed and developed "Computer

Training for Physicians" course – taught since 1995 and the "Physicians Palm Workshop" series

▪ Present Seminars, Presentation and Technology Workshops for:▫ The American College of

Surgeons (ACS)▫ CME Inc. ▫ Congress of Neurological

Surgeons (CNS)▫ Sierra Health Group Las Vegas▫ UCSD Topics and Advances in

Internal Medicine Conference▫ California Society of Addiction

Medicine (CSAM)▫ Kaiser Permanente▫ St. Joseph Heritage Health

Foundation

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Session 2 Agenda

▪ Getting Epocrates ▫ Sign up for an Epocrates Account▫ Download Epocrates Essentials▫ Install Epocrates Essentials

▪ Using Epocrates ▫ Epocrates Essentials Tour

▪ RX Pro▪ SX/DX▪ Labs

▪ Epocrates MedTools

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Create Epocrates Account

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Epocrates website

▪ Point Browser to www.epocrates.com

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Click Register Now

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Fill In

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Fill In

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Continue

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Continue

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Activate

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Download Epocrates Essentials

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Download

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Desktop, Save

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Downloading…

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Install Epocrates Essentials1. Check Available Memory2. Install!

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Check Available Memory

1. Click the Home button to get to the All Applications View

1. Click the Menu Button on the Status Bar

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▪ Click Info

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▪ My Palm has 85.5 M free

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Memory Card?

▪ Switch to Card if you have one

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Memory Card

▪ My card has 326.7 M free▫ Click Done

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Ready to install!

▪ Navigate to your computer’s desktop▫ Double click on the

Epocrates program icon you downloaded

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Click Run

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Click Next

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Click Yes

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Click Next

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Sync More than 1 Palm?

▪ If you sync more than one Palm on the same PC, this dialog box will appear▫ Click on your username

▫ Click Ok

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▪ Enter▫ Username

▫ Password

▫ Click Ok

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In Process…

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Click Next

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Almost Installed!

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Tap the HotSync Icon

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Tab the HotSync Icon Again

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In Process…

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In Process…

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In Process…

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In Process…

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This is going to take a while….

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Almost there…

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Last Step

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Palm Will Reboot

▪ Then…▫ Epocrates is installed!

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EPocrates Essentials TourRX ProSX/DXLabsMedTools

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Launch Epocrates

▪ Click the Home button to get to the All Applications View

▪ Click the Epocrates icon

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First Run License Agreement

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Epocrates Essentials Main Components

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Epocrates Information Sources

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Epocrates RX Pro

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EPocrates SX/DX

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Epocrates Labs

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EPocrates MedTools

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http://www.epocrates.com/products/medtools/

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Adding MedTools

▪ You need to have the most recent version of Epocrates Rx free drug reference, Epocrates Rx Pro premium drug reference or Epocrates Essentials all-in-one reference to install Epocrates MedTools applications▫ Please see each individual MedTools page for

memory requirements and compatibility

▪ Once installed, MedTools applications are conveniently located under the 'black bag' tab in the Epocrates application

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Available MedTools

▪ BMI & Obesity ▪ Bone Health ▪ Drip Rate ▪ Essentials for Cardiology ▪ Epocrates Essentials Tutorial ▪ GFR Calculator ▪ HTN QuickRef ▪ Insulin Calc ▪ *Cancer Staging ▪ Depression Assessment ▪ StatCholesterol ▪ Temperature Conversion

*Requires a separate download

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Scroll to See Installed MedTools

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BMI & Obesity

▪ BMI & Obesity is an in-depth weight management tool developed to assist physicians in the diagnosis and treatment of obesity▫ The tool features a BMI

calculator that quickly gives accurate results in a few seconds

▫ It also displays indications for ▪ pharmacotherapy and

bariatric surgery▪ weight loss guidelines▪ a Basal Energy Expenditure

Calculator using the Harris-Benedict Equation

▪ and other useful information

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Bone Health Assessment Tool

▪ Central bone mineral density (BMD) testing remains the "gold standard" for identifying those at risk of osteoporosis.

▪ The Bone Health Assessment Tool helps health care professionals interpret BMD T-scores, offers recommendations for treatment initiation, and identifies risk factors for postmenopausal osteoporosis

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Drip Rate

▪ This time saving tool assists the healthcare professional by calculating weight-based IV infusion rates.

▪ The Drip Rate allows you to enter:

▪ Patient weight (in either pounds or kg)

▪ Amount of drug ▪ Total volume of solution ▪ Drug dosing units

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CardioMath

▪ CardioMath is a cardiology calculator with over 50 commonly used formulas in cardiovascular medicine. It is designed to assist physicians, nurses, pharmacists, technologists, technicians, and other allied health professionals in the field of cardiovascular medicine to perform essential day-to-day calculations accurately and efficiently. These formulas are also commonly used by medical professionals involved in intensive and emergency care, internal medicine, and rehabilitation.

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CardioMath

Features include:▪ Formulas arranged in major categories ▪ Comprehensive (more than 50 commonly used formulas);

includes valve area calculators, Duke Treadmill Score, Creatinine Clearance (Cockroft-Gault), Echo formulas, etc.

▪ Global selection of SI or US units ▪ Information screens contain a short description of the

clinical utility for each formula and value ranges provided when appropriate

▪ References are provided for each formula

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CardioMath

CardioMath was developed by Chi-Ming Chow, MD.▪ CardioMath covers the following major areas:

▫ Echocardiography

▫ EKG

▫ Epidemiology

▫ Exercise Stress Test

▫ General Medicine

▫ Hemodynamics

▫ Unit Conversion (SI and US)

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Epocrates Essentials Tutorial

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Epocrates Essentials Tutorial

The Epocrates Essentials tutorial is a quick hands-on guide that will help you get the most out of your Epocrates mobile clinical references. The tutorial is divided into five sections:

1. Getting Started: ▫ Describes icons, navigation, and common look-up features of Epocrates

references. 2. Epocrates Rx:

▫ Demonstrates the features and functionality of our free drug reference. 3. Epocrates Rx Pro:

▫ Highlights the additional features and benefits of our premium drug reference, including our new IV compatibility checker.

4. Epocrates SxDx: ▫ Explains key features of our integrated disease reference and symptom

assessment tool. 5. Epocrates Lab:

▫ Provides an overview of diagnostic content features and user tips.

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GFR Calculator

▪ This tool gives you the ability to instantly calculate the predicted GFR of a patient by selecting the method and then entering an individual’s factors

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GFR Calculator

▪ The GFR calculator provides you with three equations to choose from:1. Cockcroft-Gault

▪ Estimates creatinine clearance based upon a patient’s serum creatinine, age, weight, and sex

2. Modification of Diet in Renal Disease (MDRD)▪ Estimates creatinine clearance based upon a patient’s age,

sex, gender, height, serum creatinine, serum BUN, and serum albumin

3. Abbreviated MDRD▪ A simplified version of the MDRD that uses only three

variables: serum creatinine, age, and gender

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HTN QuickRef

▪ Resources available with HTN QuickRef include:▫ JNC 7

▪ Treatment Algorithm

▫ Framingham Risk Calculator

▫ JNC 7▪ Diagnostic Workup of

Hypertension

▫ ICD-9-CM Coding

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HTN QuickRef

▪ This resource provides diagnostic and treatment guidelines for use in managing patients with hypertension▫ It provides simple data analysis and succinct

reference information

▪ Based on the JNC 7 report, this tool provides practical clinical applications and hands-on management for your patients with hypertension

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Insulin Calc

▪ Insulin Calc will aid you in determining a patient's insulin basal rate and also calculate the required bolus dose based upon the patient weight or the patient's Total Daily Dose of required insulin

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Insulin Calc

▪ Also included in this tool is an algorithm for:▫ Simple titration of NovoLog® Mix 70/30

▫ American Diabetes Association treatment goals

▫ A table that shows the correlation between ▪ A1C and blood glucose (serum) levels

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*Cancer Staging

▪ The National Cancer Institute (NCI) Tumor Staging Application allows you to quickly and easily access tumor staging information for a particular cancer, either alphabetically or by body location/system.

▪ Most cancers are classified based upon the primary tumor (T), regional lymph node involvement (N), and distant metastasis (M). The American Joint Committee on Cancer (AJCC) has designated staging based upon this scheme, which describes how far the cancer has spread from the original site to other parts of the body. Cancer staging is important for the identification of appropriate treatment options for a particular cancer and individual.

*Separate download: http://www.epocrates.com/products/medtools/ncistagingreference.html

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Depression Assessment

▪ The PHQ-9™ is a validated 9-item, patient self-report depression assessment specifically developed for use in primary care. The PHQ-9 has demonstrated usefulness as an assessment tool for the diagnosis of depression in primary care with acceptable reliability, validity, sensitivity, and specificity. The nine items of the PHQ-9 come directly from the nine DSM-IV signs and symptoms of major depression. Patients should not be diagnosed solely on the basis of a PHQ-9 score. The clinician should corroborate the score with clinical determination that a significant depressive syndrome is present.

▪ After making a provisional diagnosis with the PHQ-9, there are additional clinical considerations that may affect decisions about management and treatment.

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StatCholesterol

This newly updated application guides the healthcare professional through the ATP III cholesterol guidelines and assists the clinician in the calculation of coronary heart disease

▪ This version includes:▫ Classification of lipid levels and new guidelines for patients at higher-risk ▫ Coronary Heart Disease Risk Calculation ▫ Recommendations for lifestyle modifications ▫ Drug therapy recommendations for lipid lowering ▫ Recommendations for C-reactive protein monitoring

▪ LIPITOR is indicated to reduce the risk of myocardial infarction, revascularization procedures, angina, and stroke in adult patients with multiple risk factors but without clinically evident CHD; to reduce the risk of myocardial infarction and stroke in patients with type 2 diabetes and without clinically evident CHD, but with multiple risk factors; as an adjunct to diet to reduce elevated total-C, LDL-C, apo B, and TG levels; and to increase HDL-C in patients with primary hypercholesterolemia (heterozygous familial and nonfamilial) and mixed dyslipidemia.

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StatCholesterol

▪ LIPITOR is contraindicated in patients with active liver disease or unexplained persistent elevations of serum transaminases; in women who are or may become pregnant or who are nursing; in patients with hypersensitivity to any component of this medication.

▪ Rare cases of rhabdomyolysis have been reported with LIPITOR and other statins. With any statin, tell patients to promptly report muscle pain, tenderness, or weakness. Discontinue drug if myopathy is suspected, if creatine phosphokinase (CPK) levels rise markedly, or if the patient has risk factors for rhabdomyolysis.

▪ Due to increased risk of myopathy seen with LIPITOR and other statins, physicians should carefully consider combined therapy with fibric acid derivatives, erythromycin, immunosuppressive drugs, azole antifungals, or niacin and carefully monitor patients for signs or symptoms of myopathy early during therapy and when titrating dose of either drug.

▪ It is recommended that liver function tests be performed prior to and 12 weeks following both the initiation of therapy and any elevation of dose, and periodically thereafter. If ALT or AST values >3 x ULN persist, dose reduction or withdrawal is recommended.

▪ In clinical trials, the most common adverse events were constipation, flatulence, dyspepsia, and abdominal pain.

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Temperature Conversion

The Temperature Converter allows the user to quickly and easily convert between Celsius and Fahrenheit

▪ To simplify use, two separate programs are included:▫ From Celsius to Fahrenheit

▫ From Fahrenheit to Celsius

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Deleting MedTools

1. Open your Epocrates application

2. Tap on the MedTools tab (black bag)

3. Palm OS▪ Tap the blue 'e' in the upper left corner

▪ Tap "App" and then "Delete MTA"

4. Select the MedTools applications you wish to delete (by tapping on them), and then tap "Delete"

5. Tap "Done"

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Any Questions?

D & D Enterprises Session 2: Epocrates Essentials Thursday July 13, 2006 Palm Telemedicine Seminar...

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