Gout Diagnosis vs CV Risk Estimation

Gout is a tricky diagnosis to make. Rarely is it made via the gold standard technique of synovial aspiration and polarized light microscopy. The vast majority of diagnoses are clinical. A primary care and rheumatologist team of Dutch researchers led by Hein Janssens derived and published a clinical decision rule in 2010. This app brings that decision rule to primary care physicians, rheumatologists, and acute care (ER/urgent-care) clinicians everywhere. With just a few clicks of information about a patient's case, you can see what the gout diagnosis calculator suggests about the patient's chances of having gout or not having gout. The app is a collaboration by Dr. Joshua Steinberg and Dr. Hein Janssens, both family physicians. The first version offers English and Dutch versions. Updates coming soon will offer German, French, and Spanish versions. The app also contains educational background information about the diagnosis of gout in general and about how the gout diagnostic rule and calculator were developed and later validated. Full references to the literature are provided including links to Pub Med. Like all my apps, this app is intended for clinicians only, not the lay public. It is written to help family physicians, internists, general practitioners, rheumatologists, residents, and students consider the diagnosis of gout in those who present with acute mono-arthritis. As an educator and clinician myself, I am interested in feedback and I would be grateful for guidance on improving this tool.

This app is for CLINICIANS, not the lay public. The CV Risk app presents clinicians with three valuable 10-year cardiovascular event risk calculators to serve clinicians and learners in primary prevention of cardiovascular disease. It is for clinicians only, not the lay public. The calculators are Framingham 2008, ASCVD 2013, and the revised pooled cohort equations ASCVD of 2018. The app addresses such common questions as: • What is the ASCVD 10-year CV risk for a 57 year old male hypertensive smoker with a given set of lipid and blood pressure numbers? • What’s the magnitude of impact of a patient on their own improving their cholesterol by 11, 27, or 41 points? • For a poorly controlled hypertensive smoker with a 10-year risk of 31.3%, how impactful would improved blood pressure control or smoking cessation be? • How impactful is a cholesterol of 220 on a given patient's risk at 35 vs. 55 vs. 75 years old? • I hear that ASCVD 2013 overestimates risk, particularly for black adults? True? What about the revised pooled cohort equations of 2018? The app explicitly does not include treatment thresholds, LDL targets, estimates of impact of therapy, coronary calcium scoring, etc. I wanted the cleanest simplest tool possible for evaluating and discussing cardiovascular risk with all the other more subjective, controversial stuff out of the way. This app is written and intended for practicing clinicians like internists and family physicians; for resident physician trainees; for medical students; and of course for other clinician colleagues like NP's and PA's. Cardiologists could use this app, but you folks are focused on secondary prevention, which is an entirely different ballgame. As an educator and clinician, I am interested in feedback and I would be grateful for guidance on improving the tool.