MAPPP vs EBM Stats Calc

Despite the considerable efficacy of antithrombotics and the increased number of oral anticoagulants now available, preventable bleeding and thrombotic events are still unacceptably common. While recently marketed agents require less laboratory monitoring, problems with the clinical management of anticoagulated patients persist, particularly in the peri-procedural period. Surgery and invasive medical interventions increase the risk of bleeding, while withholding anticoagulants increases the risk of thrombosis due to the underlying condition(s) for which anticoagulation was originally prescribed. The clinical team must therefore balance these competing risks and make educated decisions regarding the decision to interrupt oral anticoagulation for a medical procedure and, if interrupted, whether to "bridge" anticoagulation with injectable anticoagulants, such as low molecular weight heparin (LMWH) in warfarin treated patients. This guide is intended to: -Assist clinicians in the simultaneous evaluation of procedure-related bleeding risk and underlying risk of thrombosis -Guide decisions regarding the interruption of anticoagulation and the use of anticoagulant "bridging" -Provide detailed guidance for drug dosing and laboratory monitoring in the peri-procedural period -Encourage clear communication between clinicians involved in prescribing anticoagulants and performing invasive procedures This material was created by the multidisciplinary members of the Peri-Procedural Task Force of the New York State Anticoagulation Coalition and IPRO, the Medicare Quality Improvement Organization for New York State, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents do not necessarily reflect CMS policy. 10SOW-NY-AIM-7.3-14-01

Occasionally in medicine, we really need to "do the math". This app will help. EBM Stats Calc let's a clinician do calculations that are hard or impossible to do in one's head. A clinician can get NNT's (number needed to treat) from rates, percentages, or raw event and patient numbers. And a clinician can use sensitivity and specificity or likelihood ratios (LR+, LR-) to go from a pretest probability to posttest probability and positive predictive value and negative predictive value. Although these calculators themselves are somewhat novel for apps, the unique tool in this app is for educators. Students and residents have a hard time understanding how the utility of a test can vary with pretest probability. Instead of saying it in words and hoping they get it, now you can demonstrate it. A test might perform well, giving good PPV and NPV, when pretest probability is in a certain range. But slide that pretest probability up or down and see the diagnostic utility change with the numbers flying right before your eyes. The tool also shows a student that in many cases, an imprecise estimate of pretest probability doesn't much matter. Different doctors might judge a clinical case to suggest likelihood of disease (pretest probability) of 40%, 50%, or 60%. The slider tool shows that the differences may not matter, and the test in mind will render good clarity regardless of differing opinions on pretest probability. The app is written for clinicians, students, residents, and especially educators, in any discipline of medicine. As a clinician and educator myself, I would be grateful for feedback to make the tool better.