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GlobalRPh Website News - David McAuley, Pharm.D.

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July 24th, 2010 The HbA1c to plasma glucose calculator has been updated based on important feedback from:

Tyan Thomas, PharmD
University of the Sciences in Philadelphia
http://www.usp.edu/

The original version was based on the following equation:
Mean Plasma Blood Glucose = (HbA1c * 35.6) - 77.3

Updated equation:
eAG = (28.7 X A1C) – 46.7        [eAG (estimated average glucose)]

Greater accuracy is expected with the updated equation... See quote below:

"RESULTS— Approximately 2,700 glucose values were obtained by each subject during 3 months. Linear regression analysis between the A1C and AG values provided the tightest correlations (AGmg/dl = 28.7 x A1C - 46.7, R2 = 0.84, P < 0.0001), allowing calculation of an estimated average glucose (eAG) for A1C values. The linear regression equations did not differ significantly across subgroups based on age, sex, diabetes type, race/ethnicity, or smoking status." Source.
July 14th, 2010 Minor updates have been completed for the IV Dilution database section including the addition of colistin and ketorolac

Here is a preview of the new Oncology dilution section.....  It will probably take another sixty days or so to wrap this section up.  All of the initial navigation and launch pages have been completed.

internal med icon


Renal dosing section:  Several new updates should be available later this month.  A comprehensive list has already been developed (new listings).  Over 100 new agents may be added.

Calculators:
Based on feedback from several visitors, we will be creating a benzodiazepine equivalence calculator.  Also, a levothyroxine dosing calculator.   Release date: ~August 2010.
March 9th, 2010 Vancomycin - single level analysis.
Based on important feedback from Dr. MacKichan, subtle improvements were made to this recently released program [Jan 2010]. After further analysis it was determined that the recommended dose was being calculated using the 'regimen' interval and not the 'calculated' interval. This unintentional mix up in programmatic variable names did not affect the final dosage analysis. The newly calculated recommended dosage and interval data should now be much closer to the final regimen recommendations.

Contributor:
Janis J. MacKichan, Pharm.D., FAPhA
Vice Chair
Professor of Pharmacy Practice
Northeastern Ohio Universities
College of Pharmacy

Link to the Single level analysis tool ....

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October 20th
2009
Important update to the lean body weight equation. A pharmacist from Nova Scotia had contacted one of the original authors of the LBW article:
Demirovic JA, Pai AB, Pai MP. Estimation of creatinine clearance in morbidly obese patients. Am J Health Syst Pharm. 2009 Apr 1;66(7):642-8

Mary Doig, BSc (Pharm)
South Shore Regional Hospital
Bridgewater, Nova Scotia

Substituting the lean body weight into the Cockcroft and Gault equation (Female patient):
Manjunath (Amit) Pai, PharmD, BCPS:
"Most important point is to not multiply by 0.85 for female as the LBW compensates for the weight differential between males and females. The 0.85 assumption was made up as no females were studied by Cockcroft and Gault."

The multi-CRCL calc has been updated....
October 20th
2009
Released updated IV dilution guidelines....  A few minor revisions remain.
Improved main index page.

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August 12th
2009
Added Non-steady state dosing by levels calculator....
August 11th
2009
Started a new calculator section - Home Theater / Speaker systems / Widescreen LCD/Plasma screenwidth calculator......
August 4th
2009
Improved the handling of high-dose extended-interval dosing by providing additional guidance.   Original Pharmacokinetics program updated.....

This update was based on important feedback from:
Thomas M. Gray, PharmD - Manager Clinical Pharmacy Services- Genesys Regional Medical Center

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July 23rd
2009
Recent updates are now added to twitter (new account) to improve delivery of update notices
July 22
2009
The website forum will be removed soon...... Over 8000 spam posts were removed recently.  If I locate a better platform, a new web forum will be added in the future.
July 15th
2009
Several improvements were made to our popular blood alcohol calc... used by several universities ... 
July 14th
2009
A large medical terminology section was added based on input from our visitors.
July 3rd
2009
Added an additional option (LBW) for obese patients to our Multi-CRCL calc...
July 2nd
2009
Added ng/kg/min option to our drip rate calc based on a suggestion from Jennifer Pawelek -  Bronson Methodist Hospital.

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June 30th
2009
Released a web version of the  Advanced Pharmacokinetic Calc....
June 2nd
2009
MASSIVE update to the financial calculator section ....  There are now more than 40 calculators.   Everything from asset allocation, retirement, investing, mortgages, etc.

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April 8th
2009
In the next couple of weeks, I will be adding several new financial calculators including new investment tools, retirement calculators, as well as a few other calculators.  

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March 24th
2009
Minor changes were made to our phenytoin calculator based on comments from a VA (Veterans Administration) pharmacist: Kelly Maxwell, Pharm.D.
The updated version now has a specific option for patient's with profound renal insufficiency (CrCL<10 ml/min). The previous version provided guidelines but did not actually calculate corrected phenytoin levels for this type of patient.  Additional dosing information can be found here.....

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February 19th
2009
Quick Access: Easy access to all major section menus - New Page.  This page can also be accessed by clicking the main header (top) image on the homepage.

Laboratory values (tables):  Added navigation buttons to the top of each separate lab page.  Also added a quick drop down menu to the Lab home page.

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December 17th
2008
New custom sodium calculator released... This new tool was created based on important feedback from Dr. Shaw. Minor changes to the original calc were completed as well.
   
Robert F. Shaw, PharmD, MPH, BCPS, BCNSP
ICU Clinical Pharmacy Specialist  

".....The hypertonic saline calculator still did not meet what I was looking for, but I understand one calculator cannot fit every need and the inherent risks and liability with administration of 3% saline.

If I had the "perfect" calculator... I would want fields for:
starting Na
desired ending Na
gender
weight
choice of saline concentration 0.9% or 3%

This would provide how many ml of either 3% or 0.9% saline required to change the sodium to the desired value. This could further be defined if a meq/hr choice was provided of 0.5 meq/hr or 1 to give a infusion rate...."

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November 18th
2008

The Internal Medicine section has been completedInternal Med......


Also, the following additional updates have been completed:

(1) A double alligation compounding calculator was added based on a request from:
     
Jessica Morehouse, Pharm.D.       "............  I needed to make a 12.5 % dextrose and 1/4 % NS 250 ml infusion out of a dextrose 70% bag and a bottle of concentrated NaCl 23.4%...."  .."I think it would be extremely helpful if you put in another calculator to calculate out a solution with one base and 2 additives. I know I have run into this before, and it would be great to have a verification of our math.."

    
(2)  An option for the new serum creatinine IDMS method was added to the
   CRCL Multi-calc.   Background info.   This update was based on a request from:
   
 Patricia Vetter, Pharm.D. -  Central Washington Hospital.  "I want to know what reference standard for SCr value you are using in the multi-calculator. I am assuming you are using the more traditional serum creatinine range and not the IDMS based range for your calculator......"   ".... I suggest you add another option to the serum creatinine box, so one can enter either SCr (traditional range) or SCr (IDMS)...."

Future updates in the coming months:
Expanded pediatric section and a complete review and update to the infectious disease empiric dosing section.

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October 8th
2008
In the next couple of weeks, a completely new section will be added to help navigate the entire GlobalRPh website.  In many cases, typical users are not aware of or are unable to quickly locate several valuable tables, calculators, or articles that be needed.    This new section will divide the website into the primary Internal Medicine disciplines in order to improve the navigation of the site.  Here is an early glimpse.... click the thumbnail below for a larger view.....

internal med icon

Also, new programs are being created for the infectious disease section. Here is an early look at the cephalosporin's dosing program, which is based primarily on package insert data. It covers all of the IV cephalosporin's [ Microbiology, Indications, and Dosing].  All antibiotics will eventually be covered.
September 9th
2008
Significant changes/updates to the current Intravenous Dilution Guidelines have been completed.  I was especially interested in reviewing the latest stability data from the various manufacturers.  Occasionally new formulations or even new studies have led to changes in the recommended storage requirements for some agents.  

Currently, GlobalRPh is the 8th largest medical reference site on the internet (MDConsult leads this group).  One of the reasons this site has grown so large is due to the tremendous support this site receives from its visitors.  I frequently receive emails from our visitors with helpful insight and ideas for improving this site.... Examples include:  1) Simple message informing us of a missing dilution standard for a new medication. 2)  Summary of a recently published study that may impact one of our current drug monographs. 3) Ideas for new medical calculators.  4)  Many others...     THANK YOU!!!!

Future revisions:
Several other sections of this website will be undergoing substantial revisions.  The infectious disease section in particular should be completed by the end of this year.

New tools for the palm and pocket pc:
Actually, some of our latest work can be found on the Epocrate's website.  Check out the Medtools section... GlobalRPh has been a long time contributor to this section along with other outside developers. You will find some of our popular tools as well as a few new ones.  Looking for a medical software suite??  Take a look at the software solution page at Epocrates...
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