Using the diagnostic decision support program from Harvard Medical School
DXplain (PCOM network access required) is a diagnostic decision support program from Massachusetts General Hospital. It provides access to a large database of signs and symptoms, and reminds the user of disorders which might, in part, explain a set of clinical features.
On the PCOM Digital Library Home Page, click on "Databases."
- Click on DXplain.
- Enter your e-mail address
- Indicate status in pull-down menu (required to continue).
- Click "I accept terms CONTINUE"
- Select "Enter a Case for Analysis"
- Click actual or hypothetical case
- Select Demographic Information (Age, Gender, Duration)
- In "Enter findings" box, enter clinical manifestations (signs, symptoms and laboratory findings) with semi-colons or commas separating individual entries (fever, rash, abdominal pain, diarrhea, photosensitivity)
- Click "SUBMIT"
- You may be prompted to select from lists of more specific findings. Do so and click "CONTINUE"
- In the right frame of the search results screen, two Current DXplain Disease Lists are displayed, one for common and one for rare diseases. A yellow menu bar above each box lists
- Evidence for Dx
- Dx Description
- Highlight a disease, select Evidence for Dx. Evidence for DX function displays only those findings which are very frequently associated with the disease, or which would make the disease less likely. The first section of the 'Evidence for Dx' screen, provides a crude indication of the prevalence of the disease--Very Common (seen one or more times a day in a busy office practice), Common (seen on the order of once a week to once a month), Rare (seen once a year to once in several years) and Very Rare (seen once in career).
- Dxplain also lists clinical manifestations and laboratory findings which if present would support this disease.
- At the top of the Evidence for Dx page, click on Dx Description.This pagepresents information in a textbook format for the selected disease including definition, etiology, symptoms, physical findings, laboratory findings, x-ray findings, diagnostically helpful signs, pathology, course, and references.
- Click on "Return to Case Analysis Page."
- In the left hand frame, answer the questions marked as Optional - are these findings present? This function solicits additional data considered most important and asks you about the presence or absence of clinical manifestations that will make the leading diseases under consideration more or less likely. You will be asked if a series of findings is present, absent or unknown.Answer "Yes" or "No" to the questions, click on "Submit."
- Review the revised list of possible diseases. DXplain provides an ongoing interactive process. Every time you answer Optional - are these findings present? questions or submit additional findings, the lists of possible diseases are regenerated and additional optional questions are presented.
- Note: in actual patient care situations, the Save Case function allows you to order additional tests, and get additional information. You can return to Dxplain at a later time, and Retrieve Case to update findings. The case will be saved for up to 30 days. Only one saved case may be associated with your e-mail address.
- DXplain can also function as an electronic medical textbook. Click on theD/F Info button to enter a finding or disease name.