GI Liver and Emergencies vs IBD Classes

The field of medicine revolves around putting existing knowledge into action in the best interest of the patient. The field of knowledge translation pertains to bridging barriers in order to bring the existing knowledge into action.1 Large amount of time and resources are spent on creating evidence-based guidelines. They are usually published in textbooks, society guidelines and manuals. They take time for this knowledge to percolate to each and every treating physician and thus do not end up benefitting each and every patient for whom it was intended. 1-3 This vast gap is due to the practical difficulties for the treating doctor in quickly and effectively accessing these resources. The guidelines also keep changing with time and it is impractical for each physician to be abreast with all the latest guidelines.  Various emergency departments have thus created customised protocols for managing emergency situation in their setup. These are usually in a printed format and available as a manual. However, they are difficult to update, bulky to access and may be not easily traceable. There is thus a felt need to provide evidence based information in an easily accessible and updatable format to the treating physician at the bedside of the patient. In India, most of the trainee physicians possess smart phones. A smart app which can provide the necessary information for managing common GI emergencies on their finger tips can enhance patient care and as well provide training.4,5 We, at PGIMER Chandigarh, recently designed a GI liver mobile app to provide a decision support tool for managing 15 common GI liver emergencies. It has been made in a user friendly, intuitive, easily navigatable colour coded actionable format. The assessment and management of each emergency is provided under the sections of diagnosis, investigations, severity assessment and management. The contents of this app were deliberated upon by the departmental faculty and were subsequently vetted by national experts.  The utility of it in clinical scenarios was validated by a study conducted among resident doctors (n=42) in PGIMER, Chandigarh found that it enhanced their mean performance scores from 57 to 71 in simulated conditions(p less than 0.001). This app was launched at the midterm ISG meeting in Delhi and is now freely downloadable from the website (www.pgimer.edu.in). The feedback has been overwhelmingly positive and over 1400 physicians have already downloaded it. We feel that apps like these are likely to reduce time to decision making, reduce duration of stay in the emergency area and improve overall patient outcomes. However, further studies to assess its efficacy in real life scenario needs to be conducted. DISCLAIMER: This app is for the use of Doctors and medical practitioners only. The authors and app developers are not responsible for errors or omissions or for any consequences from application of the information contained in this mobile application and make no warranty, expressed or implied with respect to the currency, completeness or accuracy of the contents of the mobile application. In no event shall the authors or app developers be liable to any party for any damages, included but not limited to direct, indirect, special, incidental, or consequential damages. The application provided hereunder in on an “as is” basis and the authors and app developers have no obligation to provide maintenance, support, updates, enhancements or modifications. The application of the information in any particular situation remains the professional responsibility of the doctor/ medical practitioner.

The PIBD classes app was developed to assist clinicians in the diagnosis of paediatric IBD most specifically in the cases of patients with IBD when trying to distinguish between ulcerative colitis, Crohn’s disease and IBDU. The user should then use this and other clinical information to complete as many of the 23 questions needed to then generate a suggested diagnosis. Once you reach a diagnosis, no further questions are offered eg if class 1 features are present leading to a diagnosis of Crohn’s disease the class 2 and 3 features will not appear.