soapnote.org http://www.soapnote.org share templates, calculators, and clinical decision support Mon, 20 Feb 2012 20:51:42 +0000 en hourly 1 http://wordpress.org/?v=3.3.1 Criteria for definitive diagnosis of rheumatoid arthritis http://www.soapnote.org/musculoskeletal/2010-ra-criteria/ http://www.soapnote.org/musculoskeletal/2010-ra-criteria/#comments Mon, 20 Feb 2012 20:24:03 +0000 Mark Morgan http://www.soapnote.org/?p=2317

summary, references, & relevant links
Summary:  Criteria for definitive diagnosis of rheumatoid arthritis
From the 2010 American College of Rheumatology/European League Against Rheumatism Criteria.
See also the Rheumatoid Arthritis Likelihood calculator at http://www.soapnote.org/musculoskeletal/ra-likelihood/.

—————————————————————————

  • maintained at soapnote.org.
    Target population for this tool:
    1) Patients with at least one joint with definite clinical synovitis (swelling).
    2) Patients with symptoms not better explained by another disease.
    Joint involvement refers to any swollen or tender joint on examination, which may be confirmed by imaging evidence of synovitis. DIP, 1st CMP, and 1st MTP are excluded from assessment. Large joints are shoulders, elbows, hips, knees, and ankles. Small joints are MCPs, PIPs, 2nd to 5th MTPs, thumb IPs, and wrists.
    RF = rheumatoid factor. ACPA = anti-citrullinated protein antibody
    CRP = C-reactive protein. ESR = erythrocyte sedimentation rate.

Result:



Bookmark this soapnote
LoadingFavoriteAdd to favorite soapnotes]]> http://www.soapnote.org/musculoskeletal/2010-ra-criteria/feed/ 0 Top Soapnotes of 2011 http://www.soapnote.org/news-updates/top-2011/ http://www.soapnote.org/news-updates/top-2011/#comments Fri, 23 Dec 2011 14:05:42 +0000 Mark Morgan http://www.soapnote.org/?p=2160

Happy Holidays!

Here’s a brief list of the top soapnotes from 2011.

Highest Rated 5

Those little up and down thumbs at the bottom of every soapnote count!  Below is the top 5 for 2011.  You can check the full list at any time by going to the Highest Rated Soapnotes Page.

#1 MRI and CT Scan Decision Tool - With 10 votes.  Use it when you’re not sure if that CT scan requires contrast or not.

#2 Coumadin Adjustment Calculator - With 8 votes.  A nice decision tool to help end the hand-wringing of anticoagulation adjustment.

#3 Pediatric Health Maintenance Visits – With 7 votes.  Not a calculator, but a set of note templates for pediatrics.

#4 Visit (E&M) Coding – With 6 votes.  Billing shouldn’t be so hard.  Hopefully this calculator helps.

#5 It’s a tie!

Otitis Media Decision Tool - With 5 votes.  Evidence-based treatment of ear infection.

Chronic Kidney Disease in Diabetes – With 5 votes.  Makes tracking CKD in diabetes almost as easy as E&M coding.

Most Favorited 5

Registered users can save favorites and return to them on their own page.  For instance, my page is at www.soapnote.org/author/mmorgan.  To go to your page, just replace “mmorgan” with your user name.

You can see the full list at the Most Favorited Soapnotes Page.  There are a lot more there!

#1 Otitis Media Decision Tool - Favorited 48 times.  Because it’s hard to tell a mom that her kid doesn’t need antibiotics.

#2 Coumadin Adjustment Calculator - Favorited 47 times.  For adjusting coumadin and keeping your actions and decisions consistent.

#3 PTSD Screen – Favorited 32 times.  A good tool for Post Traumatic Stress Disorder.

#4 is a tie, each favorited 30 times

Strep Throat Decision Tool - Based on the Centor criteria.

Visit (E&M) Coding - The billing tool mentioned above.

Dyspepsia Evaluation – Based on Rome III Criteria and the AAFP article.

#5 Chest Pain Calculator - Favorited 26 times.  An effort to determine whether symptoms equate with cardiac risk.

Thank you for using soapnote.org.  Please keep coming to the site and voting and favorite-ing.  Let me know if there are any tools you’d like to see or if you need any help using the site.  You can make your own calculators and decision tools, too.  Just check out the User Guide!

Sincerely,

Mark Morgan MD

mark@soapnote.org


Bookmark this soapnote
LoadingFavoriteAdd to favorite soapnotes]]> http://www.soapnote.org/news-updates/top-2011/feed/ 0 Fibromyalgia diagnostic criteria – American College of Rheumatology http://www.soapnote.org/musculoskeletal/fibromyalgia-diagnostic-criteria-american-college-of-rheumatology/ http://www.soapnote.org/musculoskeletal/fibromyalgia-diagnostic-criteria-american-college-of-rheumatology/#comments Sun, 18 Dec 2011 03:11:50 +0000 gnopgip http://www.soapnote.org/?p=2156

American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity

Wolfe, F, Clauw, DJ, Fitzcharles, MA, et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res 2010; 62:600. Copyright © 2010 American College of Rheumatology. 
 
A patient satisfies diagnostic criteria for fibromyalgia if the following 3 conditions are met:
1) Widespread pain index (WPI) ≥7 and symptom severity (SS) scale score ≥5 or WPI 3-6 and SS scale score ≥9.
2) Symptoms have been present at a similar level for at least 3 months.
3) The patient does not have a disorder that would otherwise explain the pain.

The SS scale score is the sum of the severity of the 3 symptoms (fatigue, waking unrefreshed, cognitive symptoms) plus the extent (severity) of somatic symptoms in general. The final score is between 0 and 12.

American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity

  • maintained at soapnote.org.

Result:



Bookmark this soapnote
LoadingFavoriteAdd to favorite soapnotes]]> http://www.soapnote.org/musculoskeletal/fibromyalgia-diagnostic-criteria-american-college-of-rheumatology/feed/ 0 CAGE Questionaire http://www.soapnote.org/mental-health/cage-questionaire/ http://www.soapnote.org/mental-health/cage-questionaire/#comments Sun, 18 Dec 2011 02:57:24 +0000 gnopgip http://www.soapnote.org/?p=2155

From UpToDate.com: “One positive response to any CAGE question suggests the need for closer assessment. A positive response to at least two questions is seen in the majority of patients with alcoholism and to all four questions in approximately 50 percent. The cut-off score of two has a sensitivity of 77 percent and specificity over 80 percent in patients with alcohol dependence. In comparison, over 80 percent of nonalcoholic subjects have a negative response to all four questions and virtually none has a positive response to more than two questions.”

CAGE Questionaire

Alcoholism screening tool
  • maintained at soapnote.org.

Result:



Bookmark this soapnote
LoadingFavoriteAdd to favorite soapnotes]]> http://www.soapnote.org/mental-health/cage-questionaire/feed/ 0 ADHD: DSM-IV criteria for attention deficit hyperactivity disorder http://www.soapnote.org/child-health/adhd-dsm-iv-criteria-for-attention-deficit-hyperactivity-disorder/ http://www.soapnote.org/child-health/adhd-dsm-iv-criteria-for-attention-deficit-hyperactivity-disorder/#comments Sun, 18 Dec 2011 02:51:47 +0000 gnopgip http://www.soapnote.org/?p=2154

Attention Deficit Hyperactivity Disorder DSM-IV criteria

Presence of either 1 or 2
  • maintained at soapnote.org.

Result:



Bookmark this soapnote
LoadingFavoriteAdd to favorite soapnotes]]> http://www.soapnote.org/child-health/adhd-dsm-iv-criteria-for-attention-deficit-hyperactivity-disorder/feed/ 0 Opioid Risk Tool http://www.soapnote.org/musculoskeletal/opioid-risk-tool/ http://www.soapnote.org/musculoskeletal/opioid-risk-tool/#comments Sat, 17 Dec 2011 17:48:03 +0000 gnopgip http://www.soapnote.org/?p=2151

The Opioid Risk Tool (ORT) is an office-based, 5-question assessment designed to predict which patients may develop aberrant, drug-related behaviors based on known risk factors associated with abuse or addiction. The ORT can either be self-administered by the patient at the initial clinic visit or completed by the physician as part of the patient interview.

The ORT displayed  excellent discrimination in predicting opioid abuse-related behaviors in a single-site study of 185 chronic-pain patients. Of the low-risk patients studied, 94% did not demonstrate any aberrant behavior, while in the  high-risk patients, 91% did display an aberrant behavior. Of the medium risk patients, only 28% showed any opioid-related aberrant behavior.

—————————————————————————
CHOOSE: Male Calculator or Female Calculator
—————————————————————————

-

-

-

-

-

-

-

-

-

Opioid Risk Tool (Male)

Opioid risk tool (Male)

  • maintained at soapnote.org.

Result:


Opioid Risk Tool (Female)

Opioid Risk Tool (Female)

  • maintained at soapnote.org.

Result:


 


Bookmark this soapnote
LoadingFavoriteAdd to favorite soapnotes]]> http://www.soapnote.org/musculoskeletal/opioid-risk-tool/feed/ 0 COPD Screening tool http://www.soapnote.org/respiratory/copd-screening-tool/ http://www.soapnote.org/respiratory/copd-screening-tool/#comments Thu, 15 Dec 2011 23:07:01 +0000 gnopgip http://www.soapnote.org/?p=2149

 Journal of Chronic Obstructive Pulmonary Disease, April 2008, Martinez, F. J., Raczek, A. E., Seifer, F. D., Conoscenti, C. S., Curtice, T. G. & D’Eletto, T., et al. (2008). Development and Initial Validation of a Self-Scored COPD Population Screener Questionnaire (COPD-PS). COPD: Journal of Chronic Obstructive Pulmonary Disease, 5:2, 85-95.
 

Screening tool adapted from Drive4COPD campaign.

Score >=5 may indicate COPD

COPD Screening Tool

  • maintained at soapnote.org.

Result:



Bookmark this soapnote
LoadingFavoriteAdd to favorite soapnotes]]> http://www.soapnote.org/respiratory/copd-screening-tool/feed/ 0 Chronic Kidney Disease Initial Evaluation http://www.soapnote.org/kidney/ckd-initial/ http://www.soapnote.org/kidney/ckd-initial/#comments Fri, 28 Oct 2011 08:58:04 +0000 Mark Morgan http://www.soapnote.org/?p=2145

  • summary, references, & relevant links
    Summary: A checklist of some recommended tests for an initial chronic kidney disease workup.
    Indian Health Service Guideline (2010) Type 2 Diabetes - Chronic Kidney Disease.
    ---------------------------------------------------------------------------

Result:



Bookmark this soapnote
LoadingFavoriteAdd to favorite soapnotes]]> http://www.soapnote.org/kidney/ckd-initial/feed/ 0 Chronic Kidney Disease in Diabetes http://www.soapnote.org/kidney/ckd-dm-decision-tool/ http://www.soapnote.org/kidney/ckd-dm-decision-tool/#comments Thu, 27 Oct 2011 11:00:07 +0000 Mark Morgan http://www.soapnote.org/?p=2120

summary, references, & relevant links
Summary: This decision tool assists with management of patients with diabetic nephropathy (diabetes mellitus-related chronic kidney disease, stages III, IV, and V). It is not intended to manage CKD patients on dialysis.
Note: Detection of kidney disease should prompt a workup to determine the cause. A recommended initial evaluation is at www.soapnote.org/kidney/ckd-initial/.
Indian Health Service Guideline (2010) Type 2 Diabetes – Chronic Kidney Disease.
FP notebook page: Renal Osteodystrophy.

—————————————————————————

  • maintained at soapnote.org.
  • Step 1 of 3: Enter lab and objective findings
    Item 1: What is the Glomerular Filtration Rate?
    GFR levels
    60 and above: stage II, stage I, or no CKD
    30 - 59: stage III CKD
    15 - 29: stage IV CKD
    0 - 14: stage V CKD
  • note: Chronic Kidney Disease (CKD) is estimated Glomerular Filtration Rate (eGFR) < 60 ml/min or kidney damage for ≥ 3 months (e.g. urine sediment, abnormal imaging, or albuminuria (Urine Albumin to Creatinine Ratio (UACR) < 30mg/g = nl, 30-300 = micro, >300 = macro))
  • Item 2: Male or Female?
  • Item 3: What is the bicarbonate level?
  • Item 5: What is the Blood Pressure?
  • Item 6: What is the Calcium level?
  • Item 9: What is the 25(OH)D (Vitamin D) level?
  • Step 2 of 3: Review and select from recommendation checklists.
  • Step 3 of 3: Click "Submit" to build the note!
    (and see it below under "Result")

Result:



Bookmark this soapnote
LoadingFavoriteAdd to favorite soapnotes]]> http://www.soapnote.org/kidney/ckd-dm-decision-tool/feed/ 0 Calculate the value of your free time http://www.soapnote.org/fun/time-value/ http://www.soapnote.org/fun/time-value/#comments Sat, 15 Oct 2011 08:42:26 +0000 Mark Morgan http://www.soapnote.org/?p=2141

This calculator is intended to help you determine the value of your time. This is just for fun. No personal information is recorded.

Result:



Bookmark this soapnote
LoadingFavoriteAdd to favorite soapnotes]]> http://www.soapnote.org/fun/time-value/feed/ 0