TechTool Thursday 010

TechTool review of Toxbase by NPIS on iOS  (reviewed on iPhone)

Toxbase allows the user access to the Poisons Database.  All the information about drug toxicity, side effects and monitoring can be easily looked up on your iPhone.

Website: - iTunes - Website

Design

  • I wouldn’t say the design sets the heather alight.
  • It is pretty bland and basic…but on the other hand, it’s very easy to navigate – the UI is simple and intuitive.
  • It is a text-based app, but there is no reason why it couldn’t look nice

User Interface

screenshot1

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Clinical Content

Toxbase iPhone app has four features

  • Poisons database – allowing the user to search for any drug and view the toxicity info about it (accessing the same information that can be viewed via their website)
  • News flashes – information about drug alerts, product withdrawal and new for toxicology trainees
  • Alerts – the ability to send out urgent alerts to users if needed
  • Dosage calculator – make a quick calculation of the mg/kg that your patient has ingested

The database is the main event in this app and I have used it multiple times since I downloaded it last month.  In some hospitals I’ve worked in, access to Toxbase hasn’t been straightforward, especially if you are on the ward rather than in ED and want to look at the tox info.  This way it’s easy to access.  The calculator is a nice extra features too – simple but a handy feature to have within the app.

Cost

  • $10.49 for a one year subscription – this is a reasonable cost and well worth the expense

Room for Improvement

  • A more pleasing design wouldn’t go amiss

Overall

This app is great.  Whether in ED or on the ward it is extremely useful and very easy to use.  Information about drug toxicity can be accessed within seconds.  One not to miss
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Comments

  1. Michael Downes says

    G’day Tessa,

    The tox base app is of very limited relevance to Australian Emergency Medicine /Toxicology practice. It is based on UK practice and areas such as paracetamol poisoning are practiced differently from down under. I would suggest that if you wish good evidence based poisoning advice for common poisonings then your options are :

    Therapeutic guidelines Toxicology and wilderness medicine (eTG) The best resource by far for common poisonings
    Hypertox online available at
    http://curriculum.toxicology.wikispaces.net/Index
    Great for traditional drugs but not well updated in recent years, also free online
    Toxicology Handbook, some useful information but you have to buy it

    Once you get into chemical poisonings that are less common then the above may provide limited information.

    TOXINZ can be useful in such circumstances and is also free on CIAP
    This would be the only circumstance where I think the tox base app would be possibly useful.

    Bottom line, useful as part of the armamentarium but I would discourage it’s use as a first port of call for everyday deliberate self poisonings in Oz.

    Cheers

    Michael
    The eTG are available free in all NSW public hospitals via CIAP The eTG is available free to other ? All states and territories in Oz via other platforms as far as I am aware.
    Hypertox

    • says

      Thanks for the comments Michael. I have found this app very useful in Oz. You are right that paracetamol management is different here and there, but the paracetamol management plan is not part of this app -- it has links to the UK management but these are external links and it makes it clear that it’s linking to UK guidance.

      I always discuss the patient with Poisons Information to come up with the plan (or someone in ED has done before we see in Paeds) but I also like to be able to see the info myself and it’s handy to see on my phone what the side effects can be. I haven’t yet found a situation where the Oz advice was wildly different from the Toxbase advice. Are you aware of drugs were this is an issue?

      What this app offers over the other resources you mentioned is:
      1. Tells you about previous reported overdoses and their outcomes e.g. one patient was reported to have died after x mg ingested
      2. Simple -- you just search for the name and view one page of info. I just tried to search ‘sertraline’ in the WikiTox site and it came up with about 10 powerpoint presentations -- this isn’t useful when you have a patient and need to know the relevant information.
      3. It’s on your mobile -- I’ve not been able to access eTG on numerous occasions because of some computer issue on the hospital’s side.

      Anyway, now it’s beginning to sound like I have shares in the Toxbase app. I don’t. But just because it’s from the UK doesn’t mean it’s irrelevant. And I haven’t found any differences in the country-specific advice yet….

  2. Michael Downes says

    Hi Tessa,

    The wiki tox site contains a few things, hypertox online is one of them. If you follow the link above you will be guided to a page with a few options, you will find Sertrlaine in drugs by name or in drugs by class as part of the SSRIs monograph.

    The overall site is a wiki with a number of contributors hence a no of different power points etc ( in the general site not hypertox)

    Cheers

    Michael

    • says

      Thanks, yes there seems to be lots of useful information on the wiki and I’m sure it is an excellent site. My point was really about ease of access. In the app you just search for a drug and the information you need is right there. That’s not the case for the websites. Sometimes you just need a quick, easy access overview and that’s where apps have the advantage over websites where you have to find a comp and spend time filtering through the info to find what you’re looking for.

      • says

        Toxbase and Wikitox have some significant differences in intent.
        The original and updated e-monographs in Wikitox (derived from HyperTox) predate Toxbase by about 10 years. HyperTox itself has existed in a windows form and on handheld ( palm, windows and iOS) via an isilo platform since the mid 1990′s and specifically addresses poisons management.
        HyperTox was donated to WikiTox to form the background content for an opensource curriculum project: this has allowed the upload of powerpoints, pdf and other teaching materials. It is currently used as the basis of two online course.
        A new iOS app is being released this year moving away from the iSilo platform to provide a cleaner interface: its profits continue to support educational iniatives

  3. Michael Downes says

    Hi Tessa,

    I agree ease of access is nice but not where the information you’re accessing is of poorer quality.

    If you search sertraline on toxbase it leads you to a generic SSRI monograph. It talks about QT prolongation -- only a feature of citalopram/escitalopram ingestion hence misleading, sertraline is a relatively benign drug, the list of cases is based on isolated case reports , I can’t see this as being useful, there are numerous confounding variables and it is highly unlikely that a single SSRI agent could prove a fatal ingestion -- citalopram induced TdP an exception.

    The eTG are based on better evidence, larger studies, done in Australia mostly and conducted in large part by the two main authors. Citalopram/escitalopram clearly identified as uniquely risky SSRIs.

    Other issues with toxbase in a brief look is that venlafaxine -- another commonly ingested agent -- guides you to a generic serotonin syndrome monograph, also recommend a 6 hour observation period. This is quite misleading as all venlafaxine preparations in Australia are slow release and thus the possibility of developing toxicity post 6 hours is not out of the question.

    The generic care plans list doing blood gases for GCS < 8, doesn't mention intubation, haloperidol for agitation, the list goes on………….

    Desktop computers are usually plentiful in the ED and eTG should be available via hospital intranet rather than external email access.

    Bottom line is that toxbase is not a good resource for common deliberate self poisonings in Australian EDs. Use a computer -- albeit a somewhat 20th century approach -- and use the eTG for more practical, evidence based information that's consistent with Australian practice.

    cheers

    Michael

  4. says

    Michael -- you are certainly not a fan of this app, that’s for sure. But the bits you picked out are misleading and you are factually incorrect.

    Venlafaxine
    - ‘those who have ingested a sustained-release preparation….should be observed for 24 hours after ingestion’.
    -The care plan mentions both intubation as point 1 ‘maintain a clear airway and adequate ventilation if consciousness is impaired’
    -and haloperidol under point 12 ‘Agitation’ where it lists doses for sedation, including haloperidol

    Sertraline -- the mention of prolonged QT clearly states ‘which occurred 24 hours after admission in once case’

    So, I think I shall bow out at this point. I will contact the Toxbase team and point them to your comments -- maybe they will have something to add.

    Clearly, we shall have to agree to disagree!

Comments