Pulse Newsletter Epocrates
May 2012

Hippocrates said that in acute disease, physicians must first, “examine the face of the patient, and see whether it is like the faces of healthy people, and especially whether it is like its usual self.”¹ Can you read the diagnoses in the faces depicted in this month’s DocAlert Editor’s Pick and What’s This Disease?

In This Issue
Drug & Disease Updates
Clinical Editorial: Clinician-Patient Face Time
FDA MedWatch Alerts
Clinical Tip of the Month
DocAlert Editor’s Pick: Pigmentation and Confusion
100 Years Ago
Thank You For Making Us #1
Learn & Earn with EssentialPoints
App Highlight: First Aid Q&A for USMLE Step 1
New in the Apple App Store: Free Cardiology Apps
What’s This Disease?

In her Editorial, Dr. Meneghetti examines how, compared to a century ago, increased administrative burdens may result in less face time with patients. Our “100 Years Ago” feature highlights what was on the minds of clinicians in 1912. We’ve come a long way in the practice of medicine. Read the Clinical Tip of the Month and new app features to explore how easy access to clinical answers can preserve your time for what matters most: patient care.

¹ Hippocrates, trans. WHS Jones. Harvard University Press, 1923

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DocAlert Editor’s Pick

Clinician-Patient Face Time
Anne Meneghetti, MD
Director, Clinical Communications

Surface anatomy of the face and neck
Thieme’s Atlas of Anatomy

A century ago, clinicians in rural America were on perpetual call—to deliver a baby, remove tonsils, treat syphilis—or even tend to ailing livestock in a pinch. Sure, there were administrative tasks. For example, one might enter into a ledger the fact that a chicken or a cord of firewood was received as payment for setting a fracture. Debts for many services were simply forgiven. Documentation was minimal. House calls made via horse and buggy may have culminated with the entire household gathered around the kitchen table sharing a meal or a drink. The rural doctor, midwife, and village apothecary were tightly woven into the fabric of the community.

Of all the hours you work in a week, how many of them are spent face-to-face with patients? Nearly half of a primary care physician’s work day is spent outside of the exam room, mostly on follow-up and documentation related to care of patients who are not physically there.¹ Patient face time is a smaller fraction of our work life, and we are a smaller part of our patients’ lives.

The desire to spend more quality time with patients has driven some clinicians to join larger practices that coordinate more of the infrastructure and administration for them. Many are considering technological solutions for decision support and aspects of practice management. Some clinicians even choose to do certain administrative tasks while still inside the exam room, just to squeeze in a few more minutes with patients.

Growing consumer access to live video connections may provide another way to extend face-to-face clinician-patient access beyond the exam room. Security concerns and health plan reimbursement issues still need to be worked out. In the near-term, whatever steps clinicians can take to preserve face time with patients is likely to pay off in terms of personal satisfaction.

Tell us how you maximize your time with patients. We would love to hear from you.

¹ Time Spent in Face-to-Face Patient Care and Work Outside the Examination Room. Ann Fam Med. 2005; 3(6): 488–493.

  update Update (sync) your Epocrates app once a week to ensure that you have the most current clinical information.
Updated Diseases and Conditions
Evaluation of chronic cough
Infantile colic
Evaluation of lower GI bleed
Herpes zoster infection
Cluster headache
Evaluation of falls in the elderly
Acute prostatitis
Evaluation of short stature
Stye and chalazion

New Drug Monographs
Alyacen 1/35
(norethindrone/ethinyl estradiol)

(first-time generic for Stalevo)
(first-time generic for Plavix)
(taliglucerase alfa)
(first-time generic for Viramune)
norgestimate/ethinyl estradiol
(first-time generic for Ortho-Cyclen)
Pepcid Complete
(beclomethasone nasal)
Tums Dual Action
(desogestrel/ethinyl estradiol)

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FDA MedWatch Safety Alerts

Prescription drugs: Aliskiren-containing medications: New warning on use with ACEIs or ARBs. Victrelis (boceprevir) and Boosted HIV protease inhibitor drugs: Co-administration of Victrelis with certain ritonavir-boosted HIV protease inhibitors is not recommended. Gilenya (fingolimod): Updated cardiovascular warnings, extended monitoring. Revlimid (lenalidomide): Increased risk of developing new malignancies. Brilliant Blue G compounded by Franck's and triamcinolone acetonide P.F. 80 mg/mL: Avoid use of compounded products labeled as sterile from Franck’s during ongoing investigation. Hydromorphone HCl Injection 1 mg/mL, 1 mL fill in 2.5 mL carpuject and Morphine Sulfate injection, 4 mg/mL, 1 mL fill in 2.5 mL carpuject by Hospira, Inc: Recall - may contain more than the intended fill volume.

OTC products: X-Rock: Recall - undeclared drug ingredient (sildenafil).

Medical devices: Roche Diagnostics Operations Elecsys Troponin I and Elecsys Troponin I STAT immunoassays: Recall – may yield a falsely low result. Other‐Sonic Generic ultrasound transmission gel: Risk of pseudomonas and klebsiella bacterial contamination.

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Clinical Tip of the Month

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

One of our goals in developing applications and content for Epocrates is to minimize the number of steps it takes to get to clinically relevant answers. For this month’s Clinical Tip of the Month, I thought it might be useful to highlight some of the questions you can answer in three steps from the Epocrates home screen.

#1: Find a Tier 1 inhaled corticosteroid on my patient’s insurance plan.

  • Step 1: Tap the “Drugs” icon.
  • Step 2: Tap the “Asthma/Pulmonary” class.
  • Step 3: Tap the “Corticosteroids, Inhaled” subclass.

Here, you can see the formulary status of each brand and generic product on the Formulary you have selected. From there, you can select any product for even more information.

#2: Find appropriate empiric treatment for epiglottitis in adults.*

  • Step 1: Tap the “ID Tx Selector” icon.
  • Step 2: Tap the “ENT” system.
  • Step 3: Tap “Epiglottitis”.

Here, you can see appropriate empiric treatment and also have access to sections with specific treatment and additional information.

*Epocrates Rx Pro and Epocrates Essentials only

#3: Identify an unknown pill.

  • Step 1: Tap the “Pill ID” icon.
  • Step 2: Enter the imprint code from a single side of the pill (e.g., “u129”)
  • Step 3: Tap the “View” button under the message about the number of matches found.

Here, you can see the pills that match the imprint codes and select the one that matches your unknown pill.

In just 3 steps, tell us about your favorite Epocrates feature.

  • Step 1: Swipe left in Epocrates.
  • Step 2: Tap the “Feedback” icon.
  • Step 3: Complete the email that is already addressed to us.
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DocAlert Editor’s Pick

BMJ 2011; 342 doi: 10.1136/bmj.c7437

Picture Quiz: Pigmentation and confusion

Cheung W, Dua J, Reed J, Russell S

Fig A photograph of the patient taken three years earlier | at admission

A previously well 51 year old woman presented to the emergency department with a five day history of vomiting. She reported no diarrhoea, fever, or abdominal pain. Her medical history included recently diagnosed depression and [evaluation] by dermatologists two years previously for generalized darkening of her skin. Her dentist had biopsied an area of discoloration on her gums.

What is the most likely diagnosis? [Free full-text article PDF for answers]

© 2012 BMJ Publishing Group Ltd


100 Years Ago

Modern medical practice might seem unrecognizable to clinicians of a century ago. This snapshot of 1912 is evidence that the seeds of modern standards were planted by pioneers in medical practice and policy.

Rocky Mountain spotted fever
Fitzpatrick’s Clinical Dermatology
Heart, anterior aspect
Rohen’s Photographic Anatomy
  • The Annual Report of the Surgeon General describes outbreaks of typhoid, trachoma, and Rocky Mountain spotted fever, and updates the nation on the standardization of digitalis.
  • Congress enacts the Sherley Amendment to the Food and Drugs Act to prohibit false therapeutic claims on medicine labels, like the morphine-laced Mrs. Winslow’s Soothing Syrup for infant colic.
  • 1912 Nobel Prize in Medicine¹ was awarded to Alexis Carrel for his pioneering work on blood vessel and organ surgery. He later partnered with pilot Charles Lindbergh to devise the mechanics needed to keep organs viable for transplant.

¹ From Nobel Lectures, Physiology or Medicine 1901-1921, Elsevier Publishing Company, Amsterdam, 1967


Thank You For Making Us #1

Epocrates is the number one medical app among U.S. physicians, according to the recently released Manhattan Research Taking the Pulse® U.S. 2012 annual study. More than half of physicians who use Epocrates on a smartphone access our application daily to find relevant, trusted clinical information. Thank you for your continued support and for once again making Epocrates the #1 medical app in reach among U.S. physicians.

“We are committed to continuing to deliver the clinical content and tools you need in the exact time, place, and format you want to access it.”

—Andy Hurd, President & CEO, Epocrates


Learn & Earn with EssentialPoints

Catch up on the latest specialty-specific treatment option overviews with EssentialPoints Mobile Detail programs! Available for iPhone and Android.


App Highlight: First Aid Q&A for USMLE Step 1

Ace the boards with First Aid Q&A for USMLE Step 1. Create personalized quizzes with almost 1,000 USMLE Step 1-style practice questions covering 17 content areas.

This application is based on the print product of the same name, First Aid Q&A for the USMLE Step 1, 2nd Edition, 2009, written by Tao T. Le, MD, MHS, Assistant Clinical Professor of Pediatrics in the Division of Allergy and Immunology at the University of Louisville. Please note that an Epocrates account is required to use this app.

App content © McGraw-Hill Professional.

Learn More

New in the Apple App Store: Free Cardiology Apps

Cardiology Tool offers more than 25 calculators and tools to help you perform essential day-to-day cardiology calculations more accurately and efficiently. Download Now

Echocardiography Atlas features 250 annotated images and 189 videos encompassing a wide range of cardiac pathology. Download Now


What is this disease?

Test your knowledge!
Can you identify the disease in this image?


Find this image and many others in Epocrates Essentials for iPhone, Android, BlackBerry, and Epocrates Essentials Deluxe for iPhone, Android, and BlackBerry.


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