Solving the Hydroxychloroquine Dosing Dilemma With a Smartphone App
Bibliographic record
Abstract
Solving the Hydroxychloroquine Dosing Dilemma With a Smartphone AppHydroxychloroquine retinopathy (HCR) is a potentially blinding disease.Once HCR is detected, there is no treatment and the disease often continues to progress, even when the medication is stopped.Hence, primary prevention by appropriate dosing of hydroxychloroquine offers the best chance of minimizing the risk of HCR.This strategy remains challenging in practice as up to 56% of patients receive hydroxychloroquine at doses that place them at higher risk for HCR. 1 A key reason is disagreement in how to calculate dosages of hydroxychloroquine.2,3 There are 2 methods: one uses ideal body weight (IBW); the other uses actual body weight (ABW).The IBW method assumes that hydroxychloroquine is stored mostly in lean tissue. 2 The daily dose must be normalized by lean body mass.This makes the calculation more complicated than the ABW method, which assumes that the drug is distributed evenly in muscle, skin, and fat. 3 We describe a free smartphone app-DoseCheckerthat can rapidly calculate the optimal weekly dose of hydroxychloroquine using elements of both methods. Methods |The code for the DoseChecker app was written by one of us (E.M.P.) using the smartBASIC app.SmartBASIC provides an XCode shell for a Basic interpreter and the interpreter is then used to generate an app compatible with the iOS operating system.Massachusetts Eye and Ear became the Apple Developer for the app on May 4, 2017.The app became available in the App Store on September 10, 2017. ABW Method.Maximum Daily Dose = 5 (mg/kg/d) × ABW (kg) IBW Method.The National Lung and Blood Institute formula is expressed in pounds: IBW (lb) = 4.28 × Height (in) -134.32.It is then converted to kilograms.Maximum Daily Dose = 6.5 (mg/kg/d) × IBW (kg).The calculation uses the National Lung and Blood Institute IBW formula for women.4 The app does not distinguish between men and women since 95% of HCR occurs in women; because the IBW calculation yields a lower value for women than for men of the same height, it results in a more conservative dosage for men.By equating the maximum daily dose formulas for each method and solving algebraically, the equation for the line of equality is derived (Figure ).Results | The DoseChecker app uses 2 new approaches to hydroxychloroquine dosing:
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.008 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.008 | 0.004 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".