OneCalculator

OneCalculator

Introduction to OneCalculator

The PCIT OneCalculator template contains all of the clinical calculators that you might need when using EMIS Web.  Clinical calculators are often lengthy and require many different questions or data points to be entered so PCIT do not include these in individual templates but keep them all together within the OneCalculator template so they are easy to find

Which clinical calculators does OneCalculator include?

The following clinical calculators are included
  1. AUDIT-C & AUDIT
  2. CHADS2-VASc
  3. COPD Assessment Test (CAT)
  4. Cognitive impairment tools
    1. GPCOG
    2. 6CIT
  5. CRB65
  6. Creatinine Clearance (Cockcroft-Gault)
  7. FeverPAIN
  8. FIB-4
  9. Geriatric Depression Scale (GDS-4 & GDS-15)
  10. HASBLED
  11. International Prostate Symptom Score (IPSS)
  12. Marburg
  13. Malnutrition Universal Screening Tool (MUST)
  14. NAFLD
  15. ORBIT
  16. PRISMA-7
  17. QRISK
  18. Rockwood
  19. Spirometry
  20. Wells DVT score

How to use the calculators

Each of the clinical calculators contains a number of questions which need the appropriate answers entering.  The answers to each of these can be selected by clicking on the drop down box next to the question. 
A quirk of EMIS is that if you have clicked on the drop down box once, you have to click on the arrow on the right hand side of the template to open the options a second time.

Once an answer has been entered in all questions the score for the calculator can be obtained by clicking the "Calculate" button.  When closing the template this score will be transferred to the record for saving.  When the consultation is saved this data will be saved to the patients record.

Template detail

This support article provides further detail about each of the individual pages within the OneCalculator template, highlighting information you need to know as well as dealing with common questions and issues.

Template overview and Introduction page

When initially loaded the template looks like this:


From the introduction page users can submit support tickets or development requests as well as providing users with the office telephone number for queries.

AUDIT-C/AUDIT Calculator (Alcohol Use Disorders Identification Test)

What is the calculator for and who produced it?

The AUDIT-C and AUDIT calculators are designed to screen patients for problems with alcohol.  They were developed by the World Health Organisation to screen patients with the aim of iddentifiying patients at risk of dependence and therefore a risk of a range of harmful consequences.

How should it be used?

Users can undertake brief screening with AUDIT-C which consists of 3 questions.  If the AUDIT-C score is 5 or more the full AUDIT questionnaire should be completed.

Interpretation of score

The AUDIT score has the following interpretation:
  1. 0 to 7 indicates low risk
  2. 8 to 15 indicates increasing risk
  3. 16 to 19 indicates higher risk
  4. 20 or more indicates possible dependence
Your local area will likely have support services for patients who have a high risk of harmful consequences of alcohol which you should be able to either refer or signpost patients to.

What does it look like?

The template looks like this:


CAT Score Calculator (COPD Assessment Test)

What is the calculator for and who produced it?

The calculator is for patients with COPD and is designed to measure the impact of COPD on a person's life and how this changes over 

How should it be used?

Users should consider undertaking the CAT score during COPD reviews.  This allows for the tracking of impact of COPD on the patient over time.

Interpretation of score

All patients should have smoking cessation, preventative care and reduced exposure to exacerbation risk factors.  
CAT Score
Health Impact
Suggested actions
0 - 10
Low
Consider LAMA and rescue inhalers
11 - 20
Medium
Consider ICS and/or LABA, referrals for pulmonary rehab and possible lung transplant evaluation
21 - 30
High
As for medium but consider oxygen
31 - 40
Very high
As for medium but consider oxygen
Adapted from GOLD Guidelines 2022

What does it look like?



CHA2DS2-VASc Calculator (Alcohol Use Disorders Identification Test)

What is the calculator for and who produced it?

CHA2DS2-VASc is used to calculate stroke risk in patients with Atrial Fibrillation.  It should be used in combination with another tool to assess bleeding risk (HASBLED or ORBIT) to decide if the patient should be considered for anticoagulation.

How should it be used?

The calculator provides the user with the factors that contribute to the CHA2DS2-VASc score so that they can add these together and enter the score created into the template.

Interpretation of score

CHA2DS2-VASc Score
Risk of ischaemic stroke
Risk of stroke/TIA/systemic embolism
0
0.2%
0.3%
1
0.6%
0.9%
2
2.2%
2.9%
3
3.2%
4.6%
4
4.8%
6.7%
5
7.2%
10.0%
6
9.7%
13.6%
7
11.2%
15.7%
8
10.8%
15.2%
9
12.2%
17.4%

What does it look like?



Cognitive Impairment Calculator

What is the calculator for and who produced it?

This page includes a number of different calculators which can be used to assess cognitive impairment including:
  1. GPCOG
  2. 6CIT
  3. Montreal Cognitive Assessment
  4. Mini Mental State Examination
  5. Test Your Memory
  6. Mini-COG

How should it be used?

Any of these scoring metrics can be used to assess cognitive impairment

Interpretation of score

Links within the template take the user to further information about assessment.

What does it look like?




CRB65 Score Calculator

What is the calculator for and who produced it?

The CRB65 score is used to assess risk of mortality from community acquired pneumonia in Primary Care.  It is a NICE quality standard.

How should it be used?

Users can use the template to record the presence of confusion, the respiratory rate and blood pressure.  From this the CRB65 score can be calculated.

Interpretation of score

People are stratified for risk of death within 30 days as follows:

0: Low risk (less than 1% mortality risk)

1 or 2: intermediate risk (1 to 10% mortality risk)

3 or 4: High risk (more than 10% mortality risk)

What does it look like?


 


Estimated Creatinine Clearance Calculator (Cockroft Gault)

What is the calculator for and who produced it?

This page allows the user to calculate an Estimated Creatinine Clearance using the Cockroft Gault formula.  This is recommended as the standard for drug dosing adjustments - being required for calculating if patients are on the correct dose of DOAC.

How should it be used?

The user should ensure that the required metrics of recent weight and creatinine have been entered and then calculate the score.

Interpretation of score

Users should review the drug specific advice within the BNF to understand the impact of the Estimated Creatinine Clearance on the drug the patient is taking.

What does it look like?



FeverPAIN Calculator

What is the calculator for and who produced it?

The FeverPAIN score can be used to calculate the risk of a bacterial streptococcal throat infection within Primary Care

How should it be used?

Users have two options with this page. 
  1. The external link to the FeverPAIN website can be used to calculate the score on this site - there is then a section to paste the information back into the template for storing within the system. 
  2. The drop down boxes can be filled in and then the score calculated by adding the scores from the responses and then entering this in the template

Interpretation of score

The following scores are associated with the following risk of Streptococcus:
A score of 0 or 1 is associated with a 13-18% likelihood
A score of 2 or 3 is associated with a 34-40% likelihood
A score of 4 or 5 is associated with a 62-65% likelihood

What does it look like?



FIB-4 Calculator

What is the calculator for and who produced it?

The Fibrosis-4 index (FIB-4) is used as a non-invasive tool for the presence of advanced liver fibrosis in metabolic dysfunction associated steatotic liver disease and type 2 diabetes

How should it be used?

NICE advises not to use liver function tests to monitor patients with Non Alcoholic Fatty Liver Disease (NAFLD) but use either FIB-4, NAFLD or ELF to estimate the risk of liver fibrosis.

Interpretation of score

A score of greater than 2.67 suggests advanced liver fibrosis.   Patients at high risk of advanced liver fibrosis should be referred to a hepatology specialist for further assessment and management.

What does it look like?




FRAT Calculator (Falls Risk Assessment Tool)

What is the calculator for and who produced it?

The FRAT is a validated falls risk assessment tool.  It is the outcome of a two year project, completed in 1999 by the Falls Prevention Service, Peninsula Health.

How should it be used?

It should be used to assess patients at risk of falls.

Interpretation of score

If there is a positive response to three or more of the questions in the tool there is a moderate/high risk of falls.  If there are fewer than three positives but the assessor remains concerned about the patients risk of falling then the patient should be reviewed by a GP.  If there are no concerns and a score of less than three the pateint should be considered as being at low risk of falls.

What does it look like?



GDS4/15 Calculator

What is the calculator for and who produced it?

The Geriatric Depression Scale is designed to rate depression in the elderly.  It was designed by Yesavage et al.

How should it be used?

The GDS 4 can be used to make a brief assessment of mood and the GDS15 can be used for a fuller assessment.

Interpretation of score

GDS4:
0 - Not depressed
1 - Uncertain
2-4 - Likely depressed

GDS15:
0-4 - Normal
5-9 - mild depression
10-15 - more severe depression

What does it look like?



Greene Climacteric Scale Calculator

What is the calculator for and who produced it?

The Greene Climacteric Scale is used to assess menopausal symptoms.  It was created by Dr J. G. Greene in the Department of Clinical Psychology in Gartnavel Royal Hospital , Glasgow.

How should it be used?

It can be used at initial presentation of menopausal symptoms and also to monitor progress of symptoms over time.  It assesses psychological symptoms, physical symptoms and vasomotor symptoms

Interpretation of score

The scores break into the following areas:
  1. Anxiety
  2. Depression
  3. Sexual
  4. Psychological 
  5. Physical 
  6. Vasomotor

Anxiety
Depression
Psychological
Physical
Vasomotor
Average Woman
<10
<10
7
3
2
Average Menopausal Woman
<10
<10
12
6
4

What does it look like?



HASBLED Calculator

What is the calculator for and who produced it?

The HAS-BLED score for major bleeding risk estimates the risk of major bleeding for patients on anticoagulation.  It was created by Ron Pisters, a cardiologist at Rijinstate Ziekenhuis Arnhem in the Netherlands

How should it be used?

It can be used in combination with CHA2DS2-VASc to work out the benefits and risks of anticoagulation in patients with Atrial Fibrillation

Interpretation of score

HASBLED
Risk Group
Risk of major bleeding
Bleeds per 100 patient years
Recommendation
0
Relatively low
0.9%
1.13
Should consider anticoagulation 
1
Relatively low
3.4%
1.02
Should consider anticoagulation 
2
Moderate
4.1%
1.88
Can consider anticoagulation 
3
High
5.8%
3.72
Consider alternatives to anticoagulation
4
High
8.9%
8.70
Consider alternatives to anticoagulation
5
High
9.1%
12.5
Consider alternatives to anticoagulation
>5
Very high
-
-
Consider alternatives to anticoagulation

What does it look like?



IPSS Calculator (International Prostate Symptom Score)

What is the calculator for and who produced it?

The IPSS calculator is for classifying the severity of lower urinary tract symptoms (LUTS) 

How should it be used?

NICE recommend that IPSS is used in the baseline assessment of men presenting with LUTs

Interpretation of score

The IPSS severity score is interpreted as:
0 - Asymptomatic
1-7 - Mildly symptomatic
8-19 - Moderately symptomatic
20-35 - Severely symptomatic

What does it look like?



Marburg Calculator

What is the calculator for and who produced it?

The Marburg calculator is for assessing the risk of chest pain in Primary Care having a cardiac origin.  It was produced by Stefan Bosner, Professor of General Practice in the University of Marburg in Germany.

How should it be used?

It should be used to assess patients presenting with chest pain in primary care

Interpretation of score

Marburn Heart Score
CAD risk
Recommendation
0-2
3%
Outpatient evaluation as needed
3 or more
23%
Consider urgent evaluation or inpatient admission

What does it look like?



MUST Score Calculator (Malnutrition Universal Screening Tool)

What is the calculator for and who produced it?

This calculator can identify patients who are malnourished or at risk of malnutrition.  It can only be used in patients 18 or older.

How should it be used?

It should be used to assess patients who may be at risk of malnourishement or malnutrition.

Interpretation of score

Must Score:
0 - Low risk - Routine clinical care
1 - Medium risk - Observe and follow up
2 or more - High risk - treat/refer

What does it look like?



NAFLD Calculator (Non-Alcoholic Fatty Liver Disease)

What is the calculator for and who produced it?

The NAFLD fibrosis score estimates the amount of scarring in the liver based on several laboratory tests.

How should it be used?

NICE recommend the use of ELF, NAFLD or FIB4 to assess the risk of liver fibrosis in patients with suspected non-alcoholic fatty liver disease.

Interpretation of score

NAFLD Score
Correlated Fibrosis Severity
< -1.455
F0-F2
-1.455 - 0.657
Indeterminant score
>0.675
F3-F4

Fibrosis severity scale:
F0 - No fibrosis
F1 - Mild fibrosis
F2 - Moderate fibrosis
F3 - Severe fibrosis
F4 - Cirrhosis

What does it look like?



ORBIT Calculator

What is the calculator for and who produced it?

The ORBIT bleeding risk score for atrial fibrillation predicts bleeding risk in patients on anticoagulation for atrial fibrillation.  

How should it be used?

Use each of the sections to work out the points scored in that area and then add them together to give the overall ORBIT score

Interpretation of score

ORBIT Score
Risk group
Bleeds/100 patient years
0-2
Low
2.4
3
Medium
4.7
4-7
High
8.1

What does it look like?



PRISMA7 Calculator

What is the calculator for and who produced it?

The PRISMA 7 questionnaire is a seven item assessment that has been used in frailty studies.

How should it be used?

It can be used to assess frailty in an objective way

Interpretation of score

If the respondant has had 3 or more yes answers this indicates an increased risk of frailty and the need for further clinical review.

What does it look like?



QRISK Calculator

EMIS Health have removed the QRISK calculators within their electronic health record.  It is not possible at the current time to calculate QRISK3 entirely within EMIS.  QRISK3 can only be calculated by using the Clinrisk website.  OneCalculator pulls together all the data in existence within EMIS and allows the user to update this information - it is laid out in the same order as on the Clinrisk to aid transfer over.

What is the calculator for and who produced it?

QRISK is used to calculate cardiovascular disease risk.  It was developed by Clinrisk Ltd.

How should it be used?

It should be used to calculate cardiovascular risk where patients have had other markers that may indicate increased risk - e.g. BP, smoking status, cholesterol results etc.

Interpretation of score

NICE have published comprehensive guidance on the assessment of and management of cardiovascular risk which incorporates QRISK.

What does it look like?



Rockwood Calculator

What is the calculator for and who produced it?

Rockwood is a way of assessing frailty within patients.  It was produced by K. Rockwood Dalhousie University, Halifax, Nova Scotia, Canada

How should it be used?

It should be used as a way of assessing frailty in patients who are at risk of this.

Interpretation of score

There is a scale of 1-9 depending on the describtor that the patient fits into.

What does it look like?



Spirometry Calculator

What is the calculator for and who produced it?

This page of the template is used to record the calculations undertaken when performing spirometry

How should it be used?

It should be used when undertaking spirometry testing.

Interpretation of score

This should be done by a clinician who has undergone specific training in spirometry assessment.

What does it look like?



Wells DVT Score

What is the calculator for and who produced it?

The Wells DVT score is to assess the risk of patients having a deep vein thrombosis. It was created by Dr Phil Wells

How should it be used?

This model should only be applied after a history and physical examination suggests that venous thromboembolism is a diagnostic possibility.  It should not be applied to all patients with chest pain or dyspnoea or to all patients with leg pain or swelling.

Interpretation of score

Wells' Score
Risk Group
Prevalence of DVT
0
Low/unlikely
5%
1-2
Moderate
17%
3 or more
High/likely
17-53%


What does it look like











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