Session 2: Epocrates Essentials

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Palm Telemedicine Seminar Series

• Session 2 Epocrates Essentials
• Thursday July 13, 2006

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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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Card?
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Begin
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Save
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Desktop, Save
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Downloading
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Install Epocrates Essentials

1. Check Available Memory
2. Install!

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Check Available Memory

• Click the Home button to get to the All
  Applications View
• Click the Menu Button on the Status Bar

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Check Available Memory

• Click Info

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Check Available Memory

• 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 computers 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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Setup

• 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 Tour

• RX Pro
• SX/DX
• Labs
• MedTools

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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
• Getting Started
• Describes icons, navigation, and common look-up
  features of Epocrates references.
• Epocrates Rx
• Demonstrates the features and functionality of
  our free drug reference.
• Epocrates Rx Pro
• Highlights the additional features and benefits
  of our premium drug reference, including our new
  IV compatibility checker.
• Epocrates SxDx
• Explains key features of our integrated disease
  reference and symptom assessment tool.
• 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
  individuals factors

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GFR Calculator

• The GFR calculator provides you with three
  equations to choose from
• Cockcroft-Gault
• Estimates creatinine clearance based upon a
  patients serum creatinine, age, weight, and sex
• Modification of Diet in Renal Disease (MDRD)
• Estimates creatinine clearance based upon a
  patients age, sex, gender, height, serum
  creatinine, serum BUN, and serum albumin
• 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/prod
ucts/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 gt3 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

• Open your Epocrates application
• Tap on the MedTools tab (black bag)
• Palm OS
• Tap the blue 'e' in the upper left corner
• Tap "App" and then "Delete MTA"
• Select the MedTools applications you wish to
  delete (by tapping on them), and then tap
  "Delete"
• Tap "Done"

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Any Questions?