Epocrates
Epocrates App Utility
 
Drug and Disease Updates
Keys to Making a Meaningful Impact During Disasters
Epocrates Supports Japan Relief Efforts
FDA MedWatch Safety Alerts
Clinical Question of the Month
An Exclusively Android Debut
More Than 65 New Apps
Contact Manufacturer
Implement an EHR, Improve Your Bottom Line
What's This Disease?

App Utility

Epocrates goes where you go - in the hospital, at the clinic, or on the scene of a disaster.

We offer a variety of clinical reference applications on many different devices to give you the flexibility to use Epocrates how, where and when you need it. From Epocrates Rx®, the #1 mobile drug reference, to Epocrates® Deluxe, our all-in-one drug, disease, and diagnostic application.

This issue is packed with information and tools you can use right now. For example, Dr. Dan Diamond, a long-time Epocrates user and disaster expert, illustrates how healthcare professionals can best assist when disaster strikes.

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DocAlert Messages

Keys to Making a Meaningful Impact During Disasters

Dan Diamond, MD
Resuscitating Teams in Transition™
www.dandiamondmd.com

When disaster strikes, our minds are awakened and our hearts beg us to respond. Our day-to-day lives are temporarily put on hold as we ponder what we can do to help. Those of us in the medical profession think to ourselves, "There must be something that I can do to help." There certainly is much to be done. Just the financial need alone is tremendous. Many of us can donate and support the work of experienced NGOs (non-governmental organizations) that make such a fantastic difference. I've had the opportunity to respond to a number of international disasters over the years with a variety of different organizations. I have a passion for leading first-in medical support teams as they respond to situations where the community's normal infrastructure has been demolished.

For people who are interested in being on a team, the time to get involved is before the disaster strikes.

Most organizations require formal training for field team members. Medical Teams International, the organization that I work with, has formal training and they require people to serve on a couple of late phase teams before joining a first-in team. The training that they provide is outstanding and very valuable once you have your "boots on the ground".

Early response requires a unique outlook and approach. There are several things to keep in mind. First of all, we work hard to be sure we don’t show up on the scene and become part of the burden. We travel, therefore, with our own food and water filtration equipment. We are prepared to be self-sufficient for the first couple of weeks. MTI is part of an international consortium of disaster relief NGOs. They also have partners in countries around the globe. When a disaster strikes, they contact their in-country partners and begin the rapid needs assessment process. Our goal is, once the need has been established, to be able to have people on the ground working anywhere in the world within 24-48 hours. Because we have partnered with in-country assets, we usually have an idea of where we are going to be working. However, that can change even while we are in route. People that have a strong need to know "what the plan is" would be much more satisfied with later phase disaster work. First-in teams are known for their improvisational approach. One of the most helpful medical gifts to bring with you on a first-in team is a great sense of humor.

When we first arrive, I have several goals that I try to accomplish simultaneously:

  • Most importantly, TEAM SAFETY. If we get hurt we won't be able to help anyone. It was for this reason that the Germans pulled their team back as soon as they landed in Japan. Unfortunately, the hardest hit areas are the areas where the radiation is the highest.
Drug and Disease
Concussion
Gilbert syndrome
Psoriatic arthritis
Evaluation of pruritus
Wrist fractures
Lichen planus
Malaria
Evaluation of eosinophilia
Reye syndrome
Complement deficiencies
Drugs
Advil Allergy Sinus
(ibuprofen/chlorpheniramine/
pseudoephedrine)
Advil Congestion Relief (ibuprofen/phenylephrine)
Advil PM (ibuprofen/
diphenhydramine)
Allegra Allergy 12 Hour (fexofenadine)
Allegra Allergy 24 Hour (fexofenadine)
Allegra-D 12 Hour Allergy & Congestion (fexofenadine/
pseudoephedrine)
Allegra-D 24 Hour Allergy & Congestion (fexofenadine/
pseudoephedrine)
Altavera (levonorgestrel/ethinyl estradiol)
Benlysta (belimumab)
Children's Allegra Allergy (fexofenadine)
DigiFab (digoxin immune Fab)
docetaxel (first-time generic for Taxotere)
Edarbi (azilsartan)
Fortesta (testosterone topical)
latanoprost ophthalmic (first-time generic for Xalatan)
levocetirizine (first-time generic for Xyzal)
levofloxacin ophthalmic (first-time generic for Quixin)
Makena (hydroxyprogesterone)
NitroMist (nitroglycerin)
oxymorphone (first-time generic for Opana)
Xgeva (denosumab)
     
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  • BIG PICTURE INTEGRATION. The amount of on-the-ground networking that happens during these events is impressive. Teams are willing to share supplies and expertise in order to get the job done. In Haiti, we had some great relationships with Partners in Hope, the University of Miami, and the Israelis.

  • COMMUNICATIONS. This is always a struggle early on. The cell companies usually send in teams with COWs (cells on wheels) to try to get the network up as soon as possible. We also bring satellite equipment with us.

  • SUPPLIES. We receive supplies from a number of sources during a disaster. One of my main jobs is determining what our team needs, and then like Radar O’Reilly from the old television show M.A.S.H., I go out and try to get what we need. Having someone with medical experience and an "eye" for a deal, helps get us what we need to be successful.

  • ONGOING NEEDS ASSESSMENT. From the moment we land, we start long term planning. In Haiti we landed with 6 people on our team and by the end of the second week we had expanded our team to about 25 folks. All along I approach the situation with an eye for working myself out of a job. We study the needs of our own location as well as the greater needs of the overall situation. Daily there are briefing meetings that are sponsored by the United Nations or the World Health Organization. These are called "cluster" meetings and they include the Logistics Cluster, the Health Cluster, the Housing Cluster, the Food Cluster, the Sanitation Cluster, etc. During and immediately following these meetings networking opportunities abound. It is at these meetings that we glean a better understanding of the big picture and look for opportunities to expand our efforts.

There certainly are plenty of opportunities to make a difference in the midst of these disasters but, once again, it is important to get involved with one of the organizations prior to the disaster. Frequently people feel called by the need and just show up to help. While their intentions are noble, their strategy just doesn't work very well. It is all too easy to contribute to the burden rather than coming and making the positive difference for which they left home. Disasters are complex, disorganized, ever-changing and raw. It is a tremendous opportunity to serve. Whether it is financial support, first-in boots-on-the-ground or late phase disaster response, please get involved. There is a tremendous need.


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Epocrates Supports Japan Relief Efforts


Epocrates applauds the work of medical professionals in Japan helping victims of the earthquake. We are thankful to be in the position to support clinicians en route to or in Japan with free premium subscriptions to Epocrates Essentials. If you or someone you know is interested in this program, please contact us support@epocrates.com for more information.

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FDA Medwatch Safety Alerts

Prescription drugs: Unapproved Cough, Cold, Allergy Products Removed from Market, PPIs: Low Magnesium Levels & Long-Term Use, Topamax: Risk for Cleft Lip/ Palate in Newborns, Abacavir: Possible Increased MI Risk, Kaletra: Serious Health Problems in Preemies, Greenstone Citalopram and Finasteride: Possible Mislabeling, American Regent Injectables: Visible Particulates, Pradaxa: Special Storage & Handling Requirements, Irinotecan HCl Injection: Fungal Contaminant, Meds IV Pharmacy IV Compounded Products: Serratia Marcescens Outbreak

OTC products: Soladek Vitamin Solution: May Contain Dangerous Levels of Vitamins A & D; Undeclared Drug Ingredients in: Celerite Slimming Tea,  X-Hero and Male Enhancer, U-Prosta, Black Ant, Svelte 30

Medical devices: ACCU-CHEK FlexLink Plus Infusion Set: Potential Insulin Under-Delivery, Cook Central Venous Catheter and PICC Trays: Plunger Luer Leaks, Gen-Probe Group B Strep, M. tb Complex and M. avium Complex Cx ID Tests: Recall, Davol XenMatrix Surgical Graft: Elevated Endotoxin Levels, Negative Pressure Wound Therapy Systems - Preliminary Public Health Notification


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Joshua L. Conrad, Pharm.D.
Managing Editor, Medical Information, Epocrates

Q: Why does Epocrates have two different calculators for BSA? Which should I use?
A: There are at least half a dozen different body surface area (BSA) calculations that have been validated and published in the medical literature over time. [1-5] We have chosen to present two of these in Epocrates for mobile devices. First, we elected to present the DuBois method. [1] Although it is rather old and the methods for its development are somewhat outdated and suboptimal, it is still probably the most widely-recognized calculation. Many clinicians are familiar with this equation. We also selected the Gehan & George method. [2] This method has been found to be the most statistically accurate. [6-8] Indeed, the Gehan & George formula has been suggested to be used as the medical standard, especially when it may be incorporated into calculators not requiring manual calculation. [8]

References
1. DuBois D, DuBois EF. A formula to estimate the approximate surface area if height and weight be known. Arch Int Med 1916;17:863-71.

2. Gehan EA, George SL. Estimation of human body surface area from height and weight. Cancer Chemother Rep 1970;54:225-35.

3. Mosteller RD. Simplified calculation of body-surface area. N Engl J Med 1987;317:1098.

4. Haycock GB, Schwartz GJ, Wisotsky DH. Geometric method for measuring body surface area: a height-weight formula validated in infants, children and adults. J Pediatr 1978;93:62-6.

5. Boyd E. The growth of the surface of the human body. University of Minnesota Press, 1935. Minneapolis, MN.

6. Vu TT. Standardization of body surface area calculations. J Oncol Pharm Practice 2002;8:49-54.

7. Verbraecken J, Van de Heyning P, De Backer W, Van Gaal L. Body surface area in normal-weight, overweight, and obese adults: a comparison study. Metab Clin Exper 2006;55:515-24.

8. Baily BJ, Briars GL. Estimating the surface area of the human body. Stat Med 1996;15:1325-32.

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An Exclusively Android Debut

For the first time on Android only, you can add formularies, upgrade versions, and view video tutorials on device. Premium users can consult in-depth citations, reference images, and evidence codes within the disease reference.

To install updates (highly recommended):

    1. Check that you have Android 1.6 or newer
    2. Tap the Market icon
    3. Tap the "Downloads" button
    4. Locate and Tap "Epocrates"
    5. Tap the 'Update" button
    6. Follow the on-screen instructions

Need assistance? View our FAQ»

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More Than 65 New Apps

There are now 65 intuitive, interactive titles in our newly expanded collection of apps. This month, we're highlighting Thieme's complete Anatomy on the Go, where you can view and customize exquisite, detailed illustrations.

 


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Contact Manufacturer: Simple Access to Experts

In a recent survey, doctors who use Contact Manufacturer remarked on the ease of access to responsive drug experts who could address their questions on the spot. "The rep answered my questions concerning cardiac toxicity and the need for baseline EKG prior to institution of treatment with this drug" said Dr. William Thomas Muuse, "I was able to get an answer within a few minutes."

You don't have to forage for phone numbers, or be passed through multiple transfers. Dr. Harris Cohen points out, "It's instantaneous—I usually have to track down a drug rep ... this is quicker and very reliable."

Watch tutorial video»


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Implement an EHR, Improve Your Bottom Line

If you're like many small-practice physicians, you probably have some concerns about the cost of purchasing and implementing an EHR system. However, research shows that an EHR can actually help to improve your bottom line. Working with paper files is surprisingly costly: up to $17,000 a year is spent filing and retrieving records, while the traditional means of refilling prescriptions can cost your practice up to $7500 each year.

Learn more about the savings that are possible with an EHR »


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