Coumadin Dosing Calculator	For Palm OS 3.0 or higher
Based on Anticoagulation Guidelines from the University of Michigan Cardiovascular Center

The "Consider Dose Option"
One of the frustrating things that I have found while using a coumadin dosing calculator's in the past is that all to often the computer/PDA returns a dose which is not easily obtainable. I know in some clinical instances or in the hospital exact dosing may not be difficult to obtain but I haven't found this to be the case in most outpatient settings. To solve this problem, I added a "Consider Dose Option". The "Consider Dose Option" still uses the same guidelines from the U of M CVS Center but returns the dosages in an easier to obtain form. Let's look at the example above. If our patient's current dose is 7.5 mg but the INR < 1.5 then the guidelines call for a new dose of 8.25 - 9 mg per day or an average dose of 8.62 mg. With the "Consider Dose" option the application computes not only a new average daily dose but a new weekly dose. The data is then "looped" by the application yeilding a specific 7 day dose. The total 7 day dose is very close to the computed weekly dose, in our example 60 mg compared to 60.37 mg which was computed. If instead of a current INR < 1.5 we used 4.0 - 4.9 the guidelines suggest a new dose of 6.75 mg but consider holding for 0 - 2 days. With our "Consider Dose Option" the application automatically does this for us and gives us a 7 Day Dose with the first dose held then a total weekly dose of 41 mg. Of course one does not have to use the "Consider Dose Option" and it is not a specific part of the U of M CVS Center but again is based on their guidelines and is included if it makes a practitioner's job easier.

Patient Database
To use the Database Option, simply click on Patients from our start form. This opens up a form called Patient Data. All the patients in our database are accessible by last name from the 3 alphabetical dropdown lists. To add a patient, click the "Add/Edit Patient" button which opens up another form. To add a patient, simply click the "Add New" button and enter the patients first and last name. You may also add the date of birth by checking the "Include DOB?" checkbox, but this is optional. Click the "Save New" make any necessary changes then close the form. Our patient should be listed in the appropriate letter. Click on the patient's name and this takes us to form labeled "Patient Database". To add data click the "New" button which opens up numerous text fields to enter data. At least the date and INR must be entered to save the data to our database. The other text fields are Pt time and Coumadin dosages for 7 days. Again, not all fields must be completed. Enter the appropriate data then click the "Save" button. The keypad checkbox will cause the keypad to "popup" if desired for entering data. The data is then displayed by Date Added and INR in the list box. Click on any specific date and all the data stored for that date is available. Data can be edited our deleted by using the appropriate buttons. Click the "Done" button to return to the Patient Data form and use the "Close" button to return to the main Coumadin Dosing form or "End" to close the application.
The image above shows the main patient database form with patients sorted alphabetically and by date of birth (if DOB was entered). Clicking on the patient's name takes the user to a form where new data is entered. When the Add New button is clicked a new form opens where the patient's current INR, PT, and 7 day dose may be entered. Ifthere is no previous data then the current dose will be listed as 0. The program takes the current dose and INR and based on the Target INR computes a new dose based on the University of Michigan algorithms. By clicking the refresh button then highlighting the Date/INR row the new and previous dose 7 day dose is seen.
If the Add New Button is clicked without highlighting any Date/INR row the application issues a message letting the user know to highlight the last data row to have this data automatically entered into the next form. If a row is highlighted the average current dose is already listed on the form and the user need only enter the lab date, INR, and optionally the PT. If the lab date is the same as the last lab date a messagebox appears and asks the user if the calculation is to be continued or if the date was not changed in error.
After this calculation is done the new data is automatically entered into the database. By clicking the refresh button the lastest data entry is now seen in the list. Data can be easily deleted by highlighting the desired row of data and then clicking the Delete button.
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