Preop Eval vs Gout Diagnosis

Preop Eval organizes and presents much of the guidance that one needs in order to evaluate and prepare adult patients for non-cardiac surgery. It is based upon the guidelines on this topic from the American College of Cardiology, the European Society of Anaesthesiology, the American Society of Anesthesiologists, the Institute for Clinical Systems Improvement, the American College of Chest Physicians, and more (full references in the app). The app contains 1 algorithm and 3 resources: the cardiac evaluation algorithm, guidance on starting and stopping key medications in the perioperative period, guidance on timing of surgery after cardiac events, and guidance on preoperative testing. It also contains a review of preoperative evaluation mainly for students and residents. The app addresses such common questions as: - who needs bloodwork before surgery? - who needs an EKG or a CXR? - how do I handle patients on warfarin, clopidogrel, and DOAC's? - which patients need adjustment of perioperative insulin and diabetic meds, and how? - which active cardiac conditions preclude surgery? - how long after MI or stent should a patient wait before surgery? - are there adjustments to make on psych meds, rheumatologic meds, ACE's and ARB's? This app is written and intended for practicing physicians like internists, family physicians, and hospitalists; for resident physician trainees; and for medical students. In addition to being a reference, the algorithm is written to be a teaching tool by not just delivering an answer, but instead walking a physician through the evaluation process so that one learns that process along the way. As an educator and clinician, I am interested in feedback and I would be grateful for guidance on improving the tool.

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.