What's New
New tools, rebuilds and corrections, newest firstSome of what changes here changes a dose. Below is what moved and when, so you can decide whether it matters to a patient you have already treated.
Corrections are listed in full, including the ones that are uncomfortable to publish. A tool that was wrong and has been put right is worth more to you than a tool nobody has audited, and the only way you can tell the two apart is if we say so. How the content is sourced, checked and dated is set out in the editorial policy.
The last three months, and only the tools: what is new, what was rebuilt, what was corrected. A tool retired on its own is not announced here, because knowing that something is gone tells you nothing you can act on. Its address still works, and still redirects. Where a tool was replaced or folded into another one, that is a different matter and the replacement is listed, naming what it took over.
Upper GI Bleed Risk Synthesiser New tool
New tool. Scores the Glasgow-Blatchford Score, AIMS65 and the pre-endoscopy Rockall score from one shared set of admission vitals and bloods, and completes the full Rockall score once endoscopy findings are entered. A Glasgow-Blatchford Score of 0 is highlighted as the headline output: NICE CG141 supports considering that patient for early discharge. All three scores were derived mainly in non-variceal bleeding, and the tool says so. Not yet clinically reviewed.
PHQ-9 + GAD-7 Screening New tool
New tool. Scores the PHQ-9 for depression and the GAD-7 for anxiety, either on its own or together as they are usually given. A positive answer on the PHQ-9's ninth question, thoughts of death or self-harm, is flagged on screen the moment the tool is scored, whatever the total comes to, with the Tele-MANAS national helpline number given directly to act on. English only for now: validated Hindi and Kannada versions exist but are not reproduced here until the actual licensed text has been sourced and checked. Not yet clinically reviewed.
CURB-65 / CRB-65 Pneumonia Severity New tool
New tool. Scores CURB-65 for community-acquired pneumonia where a same-day urea is available, and falls back to CRB-65, built for exactly the setting with no laboratory to hand, where it is not. Turns the score into a site-of-care recommendation, home, hospital-supervised or admit, against the 30-day mortality the original derivation cohort found at each score. Blood urea is entered directly, not BUN, with the mg/dL and mmol/L conversion handled either way. Not yet clinically reviewed.
Corrected Phenytoin (Sheiner-Tozer) New tool
New tool. Corrects a measured total phenytoin level for the albumin actually present, using the Sheiner-Tozer equation, with a separate coefficient where renal function is severely impaired or the patient is on dialysis. A low albumin can hide a toxic free level behind a total that looks safe. Not yet clinically reviewed.
Centor / McIsaac Score New tool
New tool. Scores the Centor criteria with the McIsaac age adjustment for the probability of streptococcal pharyngitis, and names the age band, 5 to 15 years, where India's residual rheumatic heart disease burden is a reason to consider testing sooner than the score alone suggests. Not yet clinically reviewed.
4Ts Score for HIT New tool
New tool. Scores the 4Ts for heparin-induced thrombocytopenia, thrombocytopenia, timing, thrombosis and other cause, and sets out what to do next: stop heparin at an intermediate or high score, which non-heparin anticoagulant fits the patient's renal and hepatic function, and why warfarin waits until the platelet count recovers. Not yet clinically reviewed.
Sepsis & ICU Scoring Correction
The mean arterial pressure was computed from the systolic alone when the diastolic was left blank, and a patient recorded at 120 over nothing scored a MAP of 40. That added four APACHE II points and one SOFA point, and it went into the SBAR text, with nothing on screen saying a value was missing. Diastolic BP is now a required field and no score is produced without it. If you scored a patient here and left the diastolic empty, score them again.
Hepatic Staging Pathway Correction
With the widened A-a gradient and the shunt both ticked and no PaO2 entered, the hepatopulmonary syndrome was graded Very Severe. That was the arithmetic falling through, not a finding: a missing measurement was being reported as the worst grade the tool has. It now says the grade cannot be set without a PaO2 and leaves the diagnosis standing on the two criteria that were met. The severity bands themselves are unchanged.
Alcohol Unit & AUD PathwayAlcohol Withdrawal Pathway Correction
The two tools gave opposite instructions for the hypoglycaemic patient. One said always give thiamine before dextrose; the other said do not withhold glucose from a hypoglycaemic patient while thiamine is found. Both now say the same thing, which is the safer of the two: thiamine first as the rule, and glucose first in the patient who is hypoglycaemic now, with thiamine immediately afterwards, because hypoglycaemia causes harm within minutes.
BMI, BSA & Dosing Weight Correction
The advisory on screen called aminoglycosides partially lipophilic while the text copied to the notes called the same case hydrophilic. They are hydrophilic, which is the reason adjusted body weight is used for them at all. Both now say so, and both say why adjusted weight rather than ideal or actual.
Opioid Conversion Calculator New tool
A conversion calculator for opioid dosing in palliative and cancer pain. Enter every opioid the patient is on, including the rescue doses actually taken, and it converts the lot through the oral morphine equivalent and out to the drug and route you want, oral, subcutaneous, intravenous, intramuscular, patch or syringe pump, with the breakthrough dose, the reduction incomplete cross-tolerance requires and the Indian preparation to write up. It converts on to methadone through the published dose bands and refuses to convert off it, and where two guidelines give different ratios it prints both.
Diabetes Classification Pathway New tool
A four-stage pathway for working out which kind of diabetes a patient has. It confirms the diagnosis, checks whether the HbA1c can be believed at all, and then ranks every type against the phenotype alone, without waiting for antibodies or a C-peptide, saying for each what raises it and what argues against it. It covers type 1 and 1B, LADA, type 2, ketosis-prone type 2, MODY, neonatal diabetes, mitochondrial diabetes, Wolfram, fibrocalculous pancreatic diabetes, the rest of type 3c, cystic fibrosis-related diabetes, type 5, drug-induced, post-transplant, endocrinopathy-related and double diabetes, as well as gestational diabetes and diabetes in pregnancy on both the DIPSI and the IADPSG criteria. The stage that follows offers only the tests the phenotype has made worth sending. It also states which of the numbered names in circulation are real and which are not.
Hyperuricaemia & Gout Pathway New tool
A management pathway for hyperuricaemia and gout, written around the drugs stocked here and the HLA-B*58:01 frequencies reported in Indian populations. Colchicine is dosed at the 0.5 mg strength dispensed in India, not the 0.6 mg of the American literature.
Corrected QT (QTc) Calculator New tool
Corrected QT and torsades risk. Both correction conventions are printed rather than one, because the threshold you are held to depends on which your unit uses.
MAP, Shock Index & Pulse Pressure New tool
Mean arterial pressure, shock index and pulse pressure from one set of vitals, with the bands each of them implies.
Anaemia Indices Calculator New tool
The derived red cell indices, including the discriminant functions that separate iron deficiency from thalassaemia trait before the electrophoresis comes back.
ANA & Autoimmune Serology Correction
The tool was reviewed in full and every point that review raised is now closed. All thirteen references behind it were checked against the source, and the reading of several antibody patterns changed as a result. If you interpreted a pattern from this tool before 20 August, it is worth putting the same values through it again.
NIHSS & Acute Stroke Pathway New tool
The NIH Stroke Scale with the pathway that follows it, rather than the score on its own. No thrombolytic dose is offered before the scan is accounted for.
Kinetic GFR Calculator New tool
Kinetic GFR, for the patient whose creatinine has not settled. The conventional equations assume a steady state and quietly mislead when there is not one.
Pregnancy & Antenatal Scheduler Rebuilt
Iron and folic acid now follows the national programme at 60 mg of elemental iron, not the 100 mg carried before. Gestational diabetes screening follows the single-step DIPSI protocol used here. A supplementation plan printed from this tool before 19 August carries the higher figure.
Antimicrobial Dosing Guide Correction
Cefepime with tazobactam was added. It is in common use in Indian hospitals and was missing, so the tool had nothing to say about a combination being prescribed on the ward.
Antimicrobial Dosing Guide Correction
Seven dosing errors were found in an audit of the tool against current labels, and all seven are corrected. Traditional amikacin dosing was a 50 per cent daily overdose. Vancomycin maintenance on haemodialysis was roughly double the accepted dose. Extended-infusion piperacillin-tazobactam was overriding the renal adjustment instead of applying it, and cefepime started its adjustment one band too late. Underweight patients were being dosed on ideal rather than actual body weight. If you used this tool before 18 August for any of those, the dose is worth re-checking.
Pre-Surgical Risk Pathway Rebuilt
Rewritten against current sources, then audited a second time on the same day for patient safety before hospital use. Neuraxial anaesthesia now carries its own interruption intervals for the direct oral anticoagulants. They are longer than the intervals for surgery in general, and treating the two as one is the error this pass was looking for.
🇮🇳 Soft launch, on Independence Day Milestone
MEDiscuss CDSS was opened to its first users on India's Independence Day. Quietly, and on purpose. A soft launch puts the tools in front of clinicians before any announcement is made, so that whatever is wrong with them is found by the people best placed to see it. What has been found since is on this page.
AF Anticoagulation Pathway Guidance update
The score is still CHA2DS2-VASc and the computation is untouched. What is new is a note explaining the 2024 ESC move to CHA2DS2-VA, the divergent ACC/AHA position, and how to read the sex point off the score if your unit has followed the ESC.
First-Line ART SelectionSecond-Line ART PathwayART Monitoring & ADR GuideOI Prophylaxis PathwayPMTCT PathwayNeedlestick & PEP Pathway Guidance update
NACO guidance governs across the HIV tools and the logic is unchanged. Where WHO 2026 would choose a different drug, an advisory now appears in the output itself rather than in a footnote, so the divergence is on the screen where the decision is being taken.
CVD Risk & CKM Staging Guidance update
The 2025 AHA/ACC blood pressure guideline and LAI Consensus Statement IV were added to the references, with a note on why PREVENT is preferred in the risk cascade. References were refreshed across 27 tools in the same pass.
ANA & Autoimmune Serology Rebuilt
The antibody interpretation and the teaching text behind it were rebuilt. What the tool does with an ANA titre and pattern changed, so a result read off the old version will not always match this one.
Cervical Screening & Pap New tool
Cervical screening and the management of an abnormal Pap, following the screening intervals in use here.
Pyrexia of Unknown Origin New tool
A staged workup for pyrexia of unknown origin. It sequences the investigations rather than ordering everything at once.
Antimicrobial Dosing Guide Rebuilt
The renal adjustment model, the dialysis modalities and the list of drugs covered were all rebuilt. The audit of those doses on 18 August is recorded above.
Undifferentiated Fever Pathway New tool
Acute undifferentiated febrile illness, which is the commonest reason a patient arrives on our wards and the hardest to work up in the first hour.
Tell us. Reports from clinicians using these tools have shaped this system more than anything else in it, and a message saying that something is clinically wrong is read first. You need no account, and you need not leave your name.
If you would rather go further than reporting, by writing a pathway in your own field or reading one against current guidance and being named on it, that is how a good deal of this page happened.