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REVIEW: STATworkUP v 1.04: Potential clinical support tool, not yet robust

May 30, 2010

N.B. I received a free copy of this software in order to review it.
I did this review for iMedicalApps.com – check out their extensive collection of reviews and other iPhone medical-related posts


Software: STATworkUP version 1.04
Manufacturer: IatroCom  (statworkup.com)
Cost: 24.99$ USD            Availability: iTunes Store
Basic Connectivity: no subscription or Internet required once installed
Best for: Clinicians who want to broaden their differentials, residents and medical students who need a quick reference for obscure tests
STATworkUP, now in its fourth version, is an App designed to help clinicians with the diagnostic thought process and to provide them with evidence-based facts about symptoms and disorders. If you are not a health care professional who does diagnostics, this probably won’t be your thing (and it will be over your head). Self-proclaimed ‘Medical Decision Support computing,’ this software approaches clinical decision-making in a way that mirrors actual practice.

Program Layout:

The layout is straightforward but I would not say that the workings of the program are equally as obvious. The bottom menu bar provides the ability to search Symptoms, Studies, Diagnoses, and Treatments. To start, one can use the menu bar to navigate to Symptoms, select a few symptoms from the list, press ‘Findings’ to review the choices, and the proceed to ‘Differential’ to get the goods.  The Symptoms section is the only one in which multiple entries can be selected.

Under Studies, Diagnoses, and Treatments, each entry, once highlighted, will reveal more information about that subject. Then, it can be correlated with a subset of Problems/Disorders/Tests/and Remedies which are alternate names for the Symptoms/Studies/Diagnoses/ and Treatments contents.

What I liked:

Overall, there is a lot of information below the surface in this program. Contained within the information section of each symptom, lab, or diagnoses there are encyclopedic, point-form descriptions. Also, it is fast. Using the search bar will quickly yield the item you seek. If you want more detailed information, there are integrated web searches, accessed easily with the “info” button which appears with each entry.

Where it really shines, I think, if you are interested in one ‘hallmark’ symptom. There aren’t a lot of references that correlate symptoms to disease so this can be very handy for helping recall that condition that goes with Adie’s pupil or Fetor Hepaticus!

As I found it difficult to get success with my symptom correlations (see below), I think the program is best used in what I might call ‘reverse.’  It’s easiest to view the disorders or lab tests first, read more about their details, and then correlate backwards with the associate symptoms. The treatment section is particularly good in that, unlike a classic drug guide, it provides a more exhaustive list of indications including off-label uses.

Whether intended or not, the App isn’t without humour. Select Cannibalism, Annoys People (Deliberately), and Condom Nonuse (Failure) from the symptoms and try to correlate them. The result? Kuru!

What I didn’t like:

Their caveat is true – this really cannot replace a clinician, and of course it isn’t expected to. There may be 10, 000 entries, but some basic things like Dehydration or Hypovolemia are absent (instead there is “mucosal dryness” – not intuitive!). Less common  ‘signs’ (like splinter hemorrhages, Janeway lesions, Osler’s nodes, Sister-Mary Joseph’s nodule, etc.) are lacking also.

The lines between symptom/labs/diagnosis are quite blurry. You have to know where to look; there are lots of things that can be both signs/symptoms and diagnoses unto themselves such as hemorrhoids. For these, you just have to look through the different sections until you find them. Obviously a lot of work has gone into making the associations thorough but unless you are in the mind of the designer, you will struggle to chose correlations which yield the expected results.

For example, I often see elderly patients with falls, confusion, and dehydration (“mucosal dryness” in the terms of this App). When I correlate these features, I get a differential which is extensive but still misses the mark. Common things that present this way such as urinary tract infections (UTIs) and hypercalcemia do not appear. Instead “Wallenberg Syndrom” and “vestibular neuronitis” are listed as most likely. Expand the differential and things like “Plague,” “Insulinoma,” and “Shy-Drager Syndrome” appear. Common things are conspicuously absent. Though this isn’t what I expected, the bizarre results are good in that they will challenge you to consider unusual diagnoses and keep a wide view of the differential.

Some entries are obviously not comprehensive. It wasn’t 2 seconds before I had stumbled across entries in the treatment section that had no information about them and had very sparse correlations (despite my knowledge otherwise).

Conclusion:

This program probably works a dream in the hands of its creators, but in mine, it’s a bit cumbersome. I do applaud the effort at what I think is the beginning of a great clinical decision making tool, but it’s not quite ‘fleshed out’ enough yet. I can’t help but think of neural networks when looking at this App; in this case, the front end is clean and easy, and the underlying framework is established, but more data must be entered and associations formed before it can comprehensively perform the task.

Maybe I’m using it incorrectly, or I’ve missed the mark, but I’m what I think is an average user – someone with a bit of programming experience, who regularly uses medical Apps, and who knows about clinical presentations and diagnostics. If it needs a tutorial to walk you through its use, maybe it wasn’t meant for the user-friendly iPhone. I don’t think the claim on the website – that “the operation is intuitive” is fair.

Set your expectations carefully; this isn’t a wizard to replace your clinical reasoning. However, it may help expand your differentials and serve as a reference for a wide range of clinical considerations. There’s lots of room for improvement with future iterations.

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One Comment leave one →
  1. June 4, 2010 12:52 pm

    Hi Jessica,

    Thank you for your efforts to review STATworkUP for IatroCom at drottematic.wordpress.com and at imedicalapps.com.

    I found the review to be an honest and impartial appraisal of our work.

    You made several observations that will help us improve the app in the future.

    (A custom version is being designed and built for the iPad presently.) STATworkUP works on the iPad like it does on the iPhone now.

    As you noted, the app has been designed as a fast, relational, and fairly comprehensive database to facilitate recall and link to detailed info for most medical workup entities.

    The app was released prior to fully completing the database to be first to market, with the idea that the frequent monthly free updates will make it better very soon.

    Regarding the things that you didn’t like … let me clarify:

    Dehydration and Hypovolemia are not absent from the database…

    These terms are included, but they are listed as Diagnoses entities, appearing on the full Diagnosis List.

    (Simply tap the Diagnosis (Dx) tab item and search for them on the resulting full Dx list.)

    Another way to find them is to locate their Symptom (Sx) “mucosal dryness” on the Full symptom list and drill down. (You don’t have to check it as a finding.)

    In the Info view for the Sx open the correlation panel and then select the Disorders button.

    When you do this you will see that a number of related diagnoses appear that can include the symptom “mucosal dryness”.

    As I write this, I have added Dehydration to the list of correlated disorders (Diagnoses), that also includes Hypovolemia.

    (Again, this is an evolving work … I do promise that incomplete relationships will be resolved quickly.)

    The common things that are conspicuously absent will be included within the next few versions.

    We do intend for the results to be good and to challenge how providers consider unusual diagnoses, by getting a wide view of the differential (or allow them to narrow it)

    In my experience much of the high cost of medicine, and medical errors, occur because of the blurring the distinction between Symptoms and Diagnoses.

    Hemorrhoid is a Diagnosis and not a symptom.

    The Problems (Symptoms) of Hemorrhoid can be seen by selecting Hemorrhoid on the Diagnosis list.

    Then you can drill down to its info view, tap the Correlate button, and then tap the Problems button to see Problems (Symptoms) for Hemorroid.

    Problems for the Diagnosis of Hemorrhoid are listed:

    DX: Hemorrhoid
    SX: (Problems)

    Bleeding
    Constipation
    Hematochezia
    Pain (Abdominal)
    Pain (Rectal)
    Pruritus
    Rectal Bleeding
    Tenesmus

    You will also see that any listed Problem (Symptom) can also be checked into a Finding, lending its weight to Differential computations.

    If you check each problem they will appear on the findings list.

    (You can see the Findings by tapping the finding button.)

    If you uncheck a finding it is removed from the Finding list. (Each finding lends various weight to various Diagnoses on the Differential List)

    Symptoms, can be selected as finding from the full list or from any Problem correlations.

    All of the findings can be Cleared in the Findings view or individual findings can be Deleted from the list by back-swiping a table item and tapping Delete.

    Additionally, you can build lists of Problems for any Selected Symptom by tapping the correlation panel in the info view for the symptom.

    These are many other problems to consider during the workup, for all of the database Diagnoses that can include the selected Symptom.

    For instance:

    Drill down on Annoys People (Deliberately) and Correlate its Problems

    You will see:

    Other related symptoms to investigate.

    If you check a number of those into Findings and then tap the Differential button you will see related Diagnoses that can be prioritized or listed alphabetically.

    You can also expand or constrain the list by adjusting the sliding likelihood meter to less likely or more likely respectively.

    Cannibalism Needs some info built to go into the drill down view like: (Associations) – Kuru … Then you will be able to correlate it too.

    I did like the anecdote…

    There is a tutorial to walk you through its use, on line and in the Help section of the app.

    I think these are brief and straight forward explanation of how STATworkUP works.

    If you tap the Navigation Bar (i) button in the Home view, the view flips around to get Help.

    Also you can go to the web site: http://www.STATworkUP.com and tap:

    Product Support & Help Tutorial (Click Here)

    That link also is present at iTunes where you buy the app.

    Again, we really appreciate your help with this Doctor Otte.

    Best regards Jessica,

    Sincerely,

    Steve

    Stephen Mlawsky, MD, CMM, FAAFP
    CEO, Director, Founder, IatroCom
    (916) 849 6178
    PO Box 2537
    Mill Valley, CA 94942

    http://www.iatrocom.org

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