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Absence of cough, nasal congestion, and nasal discharge distinguishes bacterial from viral aetiologies. Bacterial pharyngitis is more common in winter (or early spring), while enteroviral infection is more common in the summer and autumn. Generally a self-limited condition with resolution within two weeks.\r\n\t\t\t\t\t</p>\r\n\t\t\t\t\t<p>The goal of treatment of GAS is to prevent acute rheumatic fever, reduce the severity and duration of symptoms, and prevent transmission.</p>\r\n\t\t\t\t\t<p>Acute pharyngitis is generally a self-limited condition with resolution within two weeks</p>\r\n\r\n\t\t\t\t\t<h3 class=\"txt--lg\">Tonsillitis</h3>\r\n\t\t\t\t\t<p>Acute tonsillitis is an acute infection of the parenchyma of the palatine tonsils. The clinical distinction between tonsillitis and pharyngitis is unclear in the literature, and the condition is often referred to simply as 'acute sore throat'.</p>\r\n\t\t\t\t\t<p>Reference – <a href=\"https://bestpractice-bmj-com.knowledge.idm.oclc.org/topics/en-gb/5\" target=\"_blank\">BMJ Best Practice (NHS Scotland ATHENS login required)</a></p>\r\n\t\t\t\t\t`\r\n\t\t\t\t},\r\n\t\t\t\t{\r\n\t\t\t\t\tdisplay: false,\r\n\t\t\t\t\ttitle: \"Guidance & actions\",\r\n\t\t\t\t\tcontent: `\r\n\t\t\t\t\t<h3 class=\"txt--lg\">Key guidelines</h3>\r\n\t\t\t\t\t\t<p>National Institute for Health and Care Excellence and Public Health England (2020) <a href=\"https://www.nice.org.uk/Media/Default/About/what-we-do/NICE-guidance/antimicrobial%20guidance/summary-antimicrobial-prescribing-guidance.pdf\" target=\"_blank\">Summary of antimicrobial prescribing guidance – managing common infections</a></p>\r\n\t\t\t\t\t\t<p>National Institute for Health and Care Excellence (2018) <a href=\"https://www.nice.org.uk/guidance/ng84\" target=\"_blank\">Sore throat (acute): antimicrobial prescribing</a></p>\r\n\t\t\t\t\t\t<p>National Institute for Health and Care Excellence (2008) <a href=\"https://www.nice.org.uk/guidance/CG69\" target=\"_blank\">Respiratory tract infections (self-limiting): prescribing antibiotics</a></p>\r\n\t\t\t\t\t\t<p class=\"mb--1\">National Institute for Health and Care Excellence (2019) <a href=\"https://www.nice.org.uk/guidance/dg38\" target=\"_blank\">Rapid tests for group A streptococcal infections in people with a sore throat</a></p>\r\n\t\t\t\t\t\t<h3 class=\"txt--lg\">Key actions</h3>\r\n\t\t\t\t\t\t<ul>\r\n\t\t\t\t\t\t\t\t<li>Steroids and NSAIDS improve symptoms; antibiotics are often indicated in streptococcal pharyngitis, but do not prevent its suppurative complications, such as peritonsillar abscess. (<a href=\"https://www.nice.org.uk/guidance/ng84\" target=\"_blank\">NICE 2018 guidance</a>)</li>\r\n\t\t\t\t\t\t\t\t<li>Provide patient information and self-care advice (see below).</li>\r\n\t\t\t\t\t\t\t\t<li>Carefully consider patients with symptom duration longer than 3 days, even though the Centor Score does not apply. While symptoms are not compatible with a diagnosis of acute pharyngitis, these patients require evaluation for suppurative complications (e.g. peritonsillar abscess), or viral infections in adult patients (infectious mononucleosis or acute HIV.)</li>\r\n\t\t\t\t\t\t</ul>\r\n\t\t\t\t\t`\r\n\t\t\t\t},\r\n\t\t\t\t{\r\n\t\t\t\t\tdisplay: false,\r\n\t\t\t\t\ttitle: \"Efficacy of antibiotics for sore throat (NNT, NNH)\",\r\n\t\t\t\t\tcontent: `\r\n\t\t\t\t\t\t<p>Recommendations in <a href=\"https://www.nice.org.uk/guidance/ng84\" target=\"_blank\">NICE 2018 guidance</a> highlight the findings from a <a href=\"https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000023.pub4/full?highlightAbstract=antibiotic%7Cantibiot%7Cprescribing%7Cprescrib%7C2013\" target=\"_blank\">2013 Cochrane Review</a>. Based on low to moderate quality evidence, this review found that:</p>\r\n\t\t\t\t\t\t<p><strong>1.With antibiotics, significantly more people with acute sore throat were symptom free at days 3 and 7 compared with placebo.</strong></p>\r\n\t\t\t\t\t\t<ul>\r\n\t\t\t\t\t\t\t<li>At day 3, 51% were symptom free with antibiotics compared with 34% with placebo (NNT 6 [range 5 to 7]). At day 7, most people in both groups were symptom free (87% versus 82%, NNT 21 [range 14 to 49]).</li>\r\n\t\t\t\t\t\t</ul>\r\n\t\t\t\t\t\t<p><strong>2.Overall, antibiotics shortened the duration of symptoms by about 16 hours over 7 days.</strong></p>\r\n\t\t\t\t\t\t<p><strong>3.Antibiotics are more effective in people with a throat swab positive for GABHS.</strong></p>\r\n\t\t\t\t\t\t<ul>\r\n\t\t\t\t\t\t\t<li>The NNT with antibiotics compared with placebo to prevent 1 person with a negative throat swab having a sore throat on day 3 was 7 (range 5 to 12), with an NNT of about 4 (range 4 to 5) for people with a throat swab positive for GABHS.</li>\r\n\t\t\t\t\t\t</ul>\r\n\t\t\t\t\t\t<p><strong>4.The overall incidence of suppurative complications, including acute otitis media, acute sinusitis and quinsy (peri-tonsillar abscess), was low.</strong></p>\r\n\t\t\t\t\t\t<ul>\r\n\t\t\t\t\t\t\t<li>This finding was based on data from older studies, mostly conducted in the 1950s. These studies found that antibiotics significantly reduced the incidence of acute otitis media and acute sinusitis within 14 days, and quinsy (peri-tonsillar abscess) within 2 months, compared with placebo. Based on the complication rates from studies conducted after 1975, the review authors estimated that 200 people would need to be treated with antibiotics to prevent 1 case of acute otitis media.</li>\r\n\t\t\t\t\t\t\t<li>Rheumatic fever was reported only in RCTs published before 1961. The incidence has continued to decline in western societies since then. Results from these early studies found that antibiotics reduced acute rheumatic fever by more than two-thirds compared with placebo (low quality evidence).</li>\r\n\t\t\t\t\t\t</ul>\r\n\t\t\t\t\t\t<h3 class=\"txt--lg\">\r\n\t\t\t\t\t\t\t\tHarms associated with antibiotic use\r\n\t\t\t\t\t\t</h3>\r\n\t\t\t\t\t\t<p><a href=\"https://www.nice.org.uk/guidance/ng84\" target=\"_blank\">NICE 2018 Guidance</a> highlights the following issues about safety of antibiotic use for sore throat:</p>\r\n\t\t\t\t\t\t<ul>\r\n\t\t\t\t\t\t\t<li>Allergic reactions to penicillins occur in 1 to 10% of people and anaphylactic reactions occur in less than 0.05%. People with a history of atopic allergy (for example, asthma, eczema and hay fever) are at a higher risk of anaphylactic reactions to penicillins. People with a history of immediate hypersensitivity to penicillins may also react to cephalosporins and other beta-lactam antibiotics.</li>\r\n\t\t\t\t\t\t\t<li>Antibiotic-associated diarrhoea is estimated to occur in 2 to 25% of people taking antibiotics, depending on the antibiotic used (<a href=\"https://cks.nice.org.uk/topics/diarrhoea-antibiotic-associated/\" target=\"_blank\">NICE Clinical Knowledge Summary [CKS]: diarrhoea – antibiotic associated).</a></li>\r\n\t\t\t\t\t\t</ul>\r\n\t\t\t\t\t\t<h3 class=\"txt--lg\">Antibiotic resistance</h3>\r\n\t\t\t\t\t\t<p>\r\n\t\t\t\t\t\t\tEvery course of antibiotic is likely to result in some emerging resistance which could affect the next choice of antibiotic regimen for that individual, especially if within 3 months of the previous antibiotic.\r\n\t\t\t\t\t\t</p>\r\n\t\t\t\t\t`\r\n\t\t\t\t},\r\n\t\t\t\t{\r\n\t\t\t\t\tdisplay: false,\r\n\t\t\t\t\ttitle: \"Patient information & self-care advice\",\r\n\t\t\t\t\tcontent: `\r\n\t\t\t\t\t<p><strong>Key patient information resources</strong></p>\r\n\t\t\t\t\t\t<p><a href=\"https://www.nhsinform.scot/illnesses-and-conditions/ears-nose-and-throat/sore-throat\" target=\"_blank\">NHS inform – Sore throat</a></p>\r\n\t\t\t\t\t\t<p><a href=\"https://www.nhsinform.scot/illnesses-and-conditions/ears-nose-and-throat/tonsillitis\" target=\"_blank\">NHS inform - Tonsillitis</a></p>\r\n\t\t\t\t\t\t<p><a href=\"https://www.nhsinform.scot/tests-and-treatments/medicines-and-medical-aids/types-of-medicine/antibiotics\" target=\"_blank\">NHS inform – Antibiotics</a></p>\r\n\t\t\t\t\t\t<p><strong>Self-care advice</strong></p>\r\n\t\t\t\t\t\t<p>(from National Institute for Health and Care Excellence (2018) <a href=\"https://www.nice.org.uk/guidance/ng84\" target=\"_blank\">Sore throat (acute): antimicrobial prescribing</a> )</p>\r\n\t\t\t\t\t\t<p><strong>General self-care advice for all people with acute sore throat</strong></p>\r\n\t\t\t\t\t\t<ul>\r\n\t\t\t\t\t\t\t\t<li>Consider paracetamol for pain or fever, or if preferred and suitable, ibuprofen.</li>\r\n\t\t\t\t\t\t\t\t<li>Advise about the adequate intake of fluids.</li>\r\n\t\t\t\t\t\t\t\t<li>Explain that some adults may wish to try medicated lozenges containing either a local anaesthetic, a non-steroidal anti-inflammatory drug (NSAID) or an antiseptic. However, they may only help to reduce pain by a small amount.</li>\r\n\t\t\t\t\t\t\t\t<li>Be aware that NICE guidance found no evidence on non-medicated lozenges, mouthwashes, or local anaesthetic mouth spray used on its own.</li>\r\n\t\t\t\t\t\t</ul>\r\n\t\t\t\t\t\t<p>\r\n\t\t\t\t\t\t\t\t<strong>Advice for people who are unlikely to benefit from an antibiotic</strong> (<a href=\"https://www.nice.org.uk/guidance/ng84/chapter/terms-used-in-the-guideline\" target=\"_blank\">\r\n\t\t\t\t\t\t\t\t\t\tFeverPAIN score\r\n\t\t\t\t\t\t\t\t</a> of 0 or 1, or <a href=\"https://www.nice.org.uk/guidance/ng84/chapter/terms-used-in-the-guideline\" target=\"_blank\">Centor score</a> of 0, 1 or 2):\r\n\t\t\t\t\t\t</p>\r\n\t\t\t\t\t\t<p>As well as the general self-care advice above, give advice about: </p>\r\n\t\t\t\t\t\t<ul>\r\n\t\t\t\t\t\t\t\t<li>\r\n\t\t\t\t\t\t\t\t\t\tan antibiotic not being needed\r\n\t\t\t\t\t\t\t\t</li>\r\n\t\t\t\t\t\t\t\t<li>seeking medical help if symptoms worsen rapidly or significantly, do not start to improve after 1 week, or the person becomes systemically very unwell.</li>\r\n\t\t\t\t\t\t</ul>\r\n\t\t\t\t\t\t<p><strong>Advice for people who may be more likely to benefit from an antibiotic</strong> ( <a href=\"https://www.nice.org.uk/guidance/ng84/chapter/terms-used-in-the-guideline\" target=\"_blank\">FeverPAIN score</a> of 2 or 3)</p>\r\n\t\t\t\t\t\t<p>When a back-up antibiotic prescription is given, as well as the general self-care advice above, give advice about:</p>\r\n\r\n\t\t\t\t\t\t<ul>\r\n\t\t\t\t\t\t\t\t<li>\r\n\t\t\t\t\t\t\t\t\t\tan antibiotic not being needed immediately\r\n\t\t\t\t\t\t\t\t</li>\r\n\t\t\t\t\t\t\t\t<li>\r\n\t\t\t\t\t\t\t\t\t\tusing the back-up prescription if symptoms do not start to improve within 3 to 5 days or if they worsen rapidly or significantly at any time\r\n\t\t\t\t\t\t\t\t</li>\r\n\t\t\t\t\t\t\t\t<li>seeking medical help if symptoms worsen rapidly or significantly or the person becomes systemically very unwell.</li>\r\n\t\t\t\t\t\t</ul>\r\n\t\t\t\t\t\t<p><strong>Advice for people who are most likely to benefit from an antibiotic</strong> (<a href=\"https://www.nice.org.uk/guidance/ng84/chapter/terms-used-in-the-guideline\" target=\"_blank\">FeverPAIN score</a> of 4 or 5, or <a href=\"https://www.nice.org.uk/guidance/ng84/chapter/terms-used-in-the-guideline\" target=\"_blank\">Centor score</a> of 3 or 4)</p>\r\n\t\t\t\t\t\t<ul>\r\n\t\t\t\t\t\t\t\t<li>When an immediate antibiotic prescription is given, as well as the general self-care advice above, give advice about seeking medical help if symptoms worsen rapidly or significantly or the person becomes systemically very unwell.</li>\r\n\t\t\t\t\t\t</ul>\r\n\t\t\t\t\t`\r\n\t\t\t\t},\r\n\t\t\t\t{\r\n\t\t\t\t\tdisplay: false,\r\n\t\t\t\t\ttitle: \"Severe complications\",\r\n\t\t\t\t\tcontent: `\r\n\t\t\t\t\t<p>(<a href=\"https://gpnotebook.com/\" target=\"_blank\">Based on GP Notebook</a>)</p>\r\n\t\t\t\t\t<h3 class=\"txt--lg\">Peritonsillar abscess (Quinsy)</h3>\r\n\t\t\t\t\t\t<p><strong>Clinical features</strong></p>\r\n\t\t\t\t\t\t<ul>\r\n\t\t\t\t\t\t\t\t<li>the patient is already suffering from acute tonsillitis</li>\r\n\t\t\t\t\t\t\t\t<li>\r\n\t\t\t\t\t\t\t\t\t\tthe patient continues to become more ill\r\n\t\t\t\t\t\t\t\t</li>\r\n\t\t\t\t\t\t\t\t<li>\r\n\t\t\t\t\t\t\t\t\t\treferred earache is a common feature\r\n\t\t\t\t\t\t\t\t</li>\r\n\t\t\t\t\t\t\t\t<li>\r\n\t\t\t\t\t\t\t\t\t\tthe patient develops severe dysphagia\r\n\t\t\t\t\t\t\t\t</li>\r\n\t\t\t\t\t\t\t\t<li>trismus is often a feature</li>\r\n\t\t\t\t\t\t</ul>\r\n\t\t\t\t\t\t<p>\r\n\t\t\t\t\t\t\t\t<strong>\r\n\t\t\t\t\t\t\t\t\t\tOn examination\r\n\t\t\t\t\t\t\t\t</strong>\r\n\t\t\t\t\t\t</p>\r\n\t\t\t\t\t\t<ul>\r\n\t\t\t\t\t\t\t\t<li>\r\n\t\t\t\t\t\t\t\t\t\tthe buccal mucosa is dirty and fetor is present\r\n\t\t\t\t\t\t\t\t</li>\r\n\t\t\t\t\t\t\t\t<li>\r\n\t\t\t\t\t\t\t\t\t\tthe uvula may be very oedematous and displaced downwards and medially by the infected tonsil\r\n\t\t\t\t\t\t\t\t</li>\r\n\t\t\t\t\t\t\t\t<li>the uvula may be so oedematous so as to resemble a white grape</li>\r\n\t\t\t\t\t\t</ul>\r\n\t\t\t\t\t\t<h3 class=\"txt--lg\">Scarlet fever</h3>\r\n\t\t\t\t\t\t<p>\r\n\t\t\t\t\t\t\t\t<strong>\r\n\t\t\t\t\t\t\t\t\t\tClinical features\r\n\t\t\t\t\t\t\t\t</strong>\r\n\t\t\t\t\t\t</p>\r\n\t\t\t\t\t\t<ul>\r\n\t\t\t\t\t\t\t\t<li>Fever (usually above 38.3º C/101º F or higher)</li>\r\n\r\n\t\t\t\t\t\t\t\t<li>\r\n\t\t\t\t\t\t\t\t\t\tHeadache, malaise, nausea and vomiting\r\n\t\t\t\t\t\t\t\t</li>\r\n\r\n\t\t\t\t\t\t\t\t<li>\r\n\t\t\t\t\t\t\t\t\t\tSwollen neck glands\r\n\t\t\t\t\t\t\t\t</li>\r\n\t\t\t\t\t\t\t\t<li>\r\n\t\t\t\t\t\t\t\t\t\tCharacteristic fine red rash\r\n\t\t\t\t\t\t\t\t\t\t<ul>\r\n\t\t\t\t\t\t\t\t\t\t\t\t<li>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\tdevelops twelve to forty eight hours after the onset of these symptoms\r\n\t\t\t\t\t\t\t\t\t\t\t\t</li>\r\n\t\t\t\t\t\t\t\t\t\t\t\t<li>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\tfirst appears on the chest and stomach and later covers the entire body and limbs and consists of many small papules on diffuse erythema that blanches on pressure.\r\n\t\t\t\t\t\t\t\t\t\t\t\t</li>\r\n\t\t\t\t\t\t\t\t\t\t\t\t<li>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\toften more marked over the skinfolds where transverse lines containing tiny petichae may be seen\r\n\t\t\t\t\t\t\t\t\t\t\t\t</li>\r\n\t\t\t\t\t\t\t\t\t\t\t\t<li>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\tthe rash lasts for a period of two to three days, after which desquamation occurs that is most prominent on the soles of the feet and the palms of the hands\r\n\t\t\t\t\t\t\t\t\t\t\t\t</li>\r\n\t\t\t\t\t\t\t\t\t\t</ul>\r\n\t\t\t\t\t\t\t\t</li>\r\n\t\t\t\t\t\t\t\t<li>\r\n\t\t\t\t\t\t\t\t\t\tExamination of the throat generally reveals that the pharynx is diffusely reddened, with enlarged and red tonsils covered with a white exudate.\r\n\t\t\t\t\t\t\t\t</li>\r\n\t\t\t\t\t\t\t\t<li>\r\n\t\t\t\t\t\t\t\t\t\tTongue may be initially furred with enlarged papillae - an appearance described as a 'white strawberry tongue', lost after two or three days to become strawberry tongue.\r\n\t\t\t\t\t\t\t\t</li>\r\n\t\t\t\t\t\t\t\t<li>\r\n\t\t\t\t\t\t\t\t\t\tUsually there is enlargement of regional lymph nodes\r\n\t\t\t\t\t\t\t\t</li>\r\n\t\t\t\t\t\t\t\t<li>\r\n\t\t\t\t\t\t\t\t\t\tFlushed red face with paleness around the mouth\r\n\t\t\t\t\t\t\t\t</li>\r\n\t\t\t\t\t\t</ul>\r\n\t\t\t\t\t\t<h3 class=\"txt--lg\">Acute rheumatic fever</h3>\r\n\t\t\t\t\t\t<p><strong>Clinical features</strong></p>\r\n\t\t\t\t\t\t<ul>\r\n\t\t\t\t\t\t\t\t<li>\r\n\t\t\t\t\t\t\t\t\t\tpatients are 5 to 15 years old\r\n\t\t\t\t\t\t\t\t</li>\r\n\t\t\t\t\t\t\t\t<li>\r\n\t\t\t\t\t\t\t\t\t\tstreptococcal infection is a prerequisite for subsequent development of rheumatic fever\r\n\t\t\t\t\t\t\t\t</li>\r\n\t\t\t\t\t\t\t\t<li>\r\n\t\t\t\t\t\t\t\t\t\tthe latent period following a streptococcal infection is 2 to 6 weeks\r\n\t\t\t\t\t\t\t\t</li>\r\n\t\t\t\t\t\t\t\t<li>\r\n\t\t\t\t\t\t\t\t\t\ttypically the patient will have migratory polyarthritis with a low-grade fever\r\n\t\t\t\t\t\t\t\t</li>\r\n\t\t\t\t\t\t\t\t<li>\r\n\t\t\t\t\t\t\t\t\t\t50-75% of children will develop acute carditis; in adults this figure is only 35%\r\n\t\t\t\t\t\t\t\t</li>\r\n\t\t\t\t\t\t\t\t<li>\r\n\t\t\t\t\t\t\t\t\t\tmyocarditis causes arrythmias, usually atrial fibrillation, and a prolonged P-R interval\r\n\t\t\t\t\t\t\t\t</li>\r\n\t\t\t\t\t\t\t\t<li>\r\n\t\t\t\t\t\t\t\t\t\tcardiac dilatation may occur, resulting in murmurs of valvular insufficiency, mitral most commonly, then aortic, then tricuspid\r\n\t\t\t\t\t\t\t\t</li>\r\n\t\t\t\t\t\t\t\t<li>\r\n\t\t\t\t\t\t\t\t\t\tvalvulitis is marked by the systolic murmur of mitral regurgitation and the diastolic murmur of aortic regurgitation\r\n\t\t\t\t\t\t\t\t</li>\r\n\t\t\t\t\t\t\t\t<li>\r\n\t\t\t\t\t\t\t\t\t\tsubcutaneous nodules are a rare feature\r\n\t\t\t\t\t\t\t\t</li>\r\n\t\t\t\t\t\t</ul>\r\n\t\t\t\t\t\t<p><strong>Other abnormal findings on cardiovascular examination include</strong></p>\r\n\t\t\t\t\t\t<ul>\r\n\t\t\t\t\t\t\t\t<li>\r\n\t\t\t\t\t\t\t\t\t\tsinus tachycardia\r\n\t\t\t\t\t\t\t\t</li>\r\n\t\t\t\t\t\t\t\t<li>\r\n\t\t\t\t\t\t\t\t\t\traised jugular venous pressure, due to heart failure which is now rare\r\n\t\t\t\t\t\t\t\t</li>\r\n\t\t\t\t\t\t\t\t<li>\r\n\t\t\t\t\t\t\t\t\t\ta Carey-Coombs murmur\r\n\t\t\t\t\t\t\t\t</li>\r\n\t\t\t\t\t\t</ul>\r\n\t\t\t\t\t`\r\n\t\t\t\t},\r\n\t\t\t\t{\r\n\t\t\t\t\tdisplay: true,\r\n\t\t\t\t\ttitle: \"Regulatory Information\",\r\n\t\t\t\t\tcontent: `\r\n\t\t\t\t\t\t<p>\r\n\t\t\t\t\t\t<strong>Product Name: </strong>Calculator Suite <br>\r\n\t\t\t\t\t\t<strong>Calculator Name: </strong>Centor Score (Modified, McIsaac) for Streptococcal Pharyngitis<br>\r\n\t\t\t\t\t\t<strong>Calculator Version: </strong> v2.0.0\r\n\t\t\t\t\t\t</p>  \r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t<div class=\"col-xs-4 col-lg-2\">\r\n\t\t\t\t\t\t\t<img src=\"/img/cemark/shii.png\" alt=\"InnoScot Health\"/>\r\n\t\t\t\t\t\t</div>\r\n\t\t\t\t\t\t<div class=\"col-xs-8 col-lg-10\">\r\n\t\t\t\t\t\t\t<p>\r\n                  InnoScot Health<br>\r\n                  272 Bath Street<br>\r\n                  Glasgow<br>\r\n                  Scotland<br>\r\n                  G2 4JR\r\n                </p>\r\n\t\t\t\t\t\t</div>\r\n\t\t\t\t\t\t</div>\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-xs-12\">\r\n\t\t\t\t\t\t\t\t<p>\r\n\t\t\t\t\t\t\t\t<img src=\"/img/cemark/ukca.png\" alt=\"UK Conformity Assessed\"/>\r\n\t\t\t\t\t\t\t\t<!-- <img src=\"/img/cemark/ce.png\" alt=\"CE marking\"/> -->\r\n\t\t\t\t\t\t\t\t</p>\r\n\t\t\t\t\t\t\t</div>\r\n\t\t\t\t\t\t</div>\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-xs-4 col-lg-2\">\r\n\t\t\t\t\t\t\t\t<img src=\"/img/cemark/warning.png\" alt=\"InnoScot Health\"/>\r\n\t\t\t\t\t\t\t</div>\r\n\t\t\t\t\t\t\t<div class=\"col-xs-8 col-lg-10\">\r\n\t\t\t\t\t\t\t\t<p>\r\n\t\t\t\t\t\t\t\t<strong>Calculators are <u>not</u> intended to be used by members of the public as a substitute for professional advice.</strong>\r\n\t\t\t\t\t\t\t\t</p>\r\n\t\t\t\t\t\t\t</div>\r\n\t\t\t\t\t\t</div>\r\n\t\t\t\t\t\t\r\n\t\t\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t\t\t<div class=\"col-xs-4 col-lg-2\">\r\n\t\t\t\t\t\t\t\t<img src=\"/img/cemark/info.png\" alt=\"More Information on Right Decision\"/>\r\n\t\t\t\t\t\t\t</div>\r\n\t\t\t\t\t\t\t<div class=\"col-xs-8 col-lg-10\">\r\n\t\t\t\t\t\t\t\t<p>\r\n\t\t\t\t\t\t\t\t\t<a href=\"https://rightdecision.scot.nhs.uk/quality-assurance-and-regulation/calculator-suite-instructions-for-use.pdf\" target=\"_blank\">Instructions for use</a>\r\n\t\t\t\t\t\t\t\t</p>\r\n\t\t\t\t\t\t\t</div>\r\n\t\t\t\t\t\t</div>\r\n\t\t\t\t\t`\r\n\t\t\t\t}\r\n\t\t\t]\r\n\t\t}\r\n\t}\r\n};\r\n</script>\r\n","import mod from \"-!../../node_modules/cache-loader/dist/cjs.js??ref--12-0!../../node_modules/thread-loader/dist/cjs.js!../../node_modules/babel-loader/lib/index.js!../../node_modules/cache-loader/dist/cjs.js??ref--0-0!../../node_modules/vue-loader/lib/index.js??vue-loader-options!./Content.vue?vue&type=script&lang=js&\"; export default mod; export * from \"-!../../node_modules/cache-loader/dist/cjs.js??ref--12-0!../../node_modules/thread-loader/dist/cjs.js!../../node_modules/babel-loader/lib/index.js!../../node_modules/cache-loader/dist/cjs.js??ref--0-0!../../node_modules/vue-loader/lib/index.js??vue-loader-options!./Content.vue?vue&type=script&lang=js&\"","import { render, staticRenderFns } from \"./Content.vue?vue&type=template&id=d0610902&\"\nimport script from \"./Content.vue?vue&type=script&lang=js&\"\nexport * from \"./Content.vue?vue&type=script&lang=js&\"\n\n\n/* normalize component */\nimport normalizer from \"!../../node_modules/vue-loader/lib/runtime/componentNormalizer.js\"\nvar component = normalizer(\n  script,\n  render,\n  staticRenderFns,\n  false,\n  null,\n  null,\n  null\n  \n)\n\nexport default component.exports","<template>\r\n\t<div id=\"calc\" class=\"calculator wrapper container-fluid\" @click.stop.prevent=\"handleClick\">\r\n\t\t<p class=\"txt--xl mb--2 mb-2\">\r\n\t\t\tEstimates probability that pharyngitis is streptococcal, and suggests management course – strep testing/culture/antibiotics. \r\n\t\t</p>\r\n\t\t\r\n\t\t<div class=\"tabs mb--2\">\r\n\t\t\t<nav class=\"tabs__nav\">\r\n\t\t\t\t<button v-for=\"(tab) in tabs\" v-bind:key=\"tab.title\" role=\"button\" class=\"tabs__nav-item txt--strong\" :class=\"{ 'tabs__nav-item--active bg--primary': tab.display }\" v-on:click=\"selectTab(tab)\">\r\n\t\t\t\t\t<span v-html=\"tab.title\"></span>\r\n\t\t\t\t\t<i v-if=\"!tab.display\" aria-hidden=\"true\" class=\"fa fa-chevron-down ml-1 ml--1 show--md\"></i>\r\n\t\t\t\t\t<i v-if=\"tab.display\" aria-hidden=\"true\" class=\"fa fa-chevron-up ml-1 ml--1 show--md\"></i>\t\r\n\t\t\t\t</button>\r\n\t\t\t</nav>\r\n\t\t\t<div class=\"tabs__content\" id=\"tabcontent\">\r\n\t\t\t\t<div v-for=\"(tab) in tabs\" v-bind:key=\"tab.content\">\r\n\t\t\t\t\t<div v-if=\"tab.display\" class=\"bdr--light-gray p--1 wysiwyg\" role=\"tabpanel\" :aria-labelledby=\"tab.title\" v-html=\"tab.content\"></div>\r\n\t\t\t\t</div>\r\n\t\t\t</div>\r\n\t\t</div>\r\n\r\n\t\t<!-- <div class=\"accordion bdr--light-gray accordion--arrows mb--2 hide--md\">\r\n\t\t\t<div class=\"accordion__item bdr__top--light-gray\" data-accordion-type=\"default\" v-for=\"(tab, index) in tabs\" v-bind:key=\"tab.title\">\r\n\t\t\t\t<button :id=\"'tab'+index\" class=\"accordion__header txt--md txt--strong\" :class=\"{ 'accordion__header--active' : tab.accordion }\" @click=\"tab.accordion = !tab.accordion\">{{tab.title}}</button>\r\n\t\t\t\t<div :aria-labelledby=\"'tab'+index\" class=\"accordion__content\" :class=\"{ 'accordion__content--active active' : tab.accordion }\" v-html=\"tab.content\"></div>\r\n\t\t\t</div>\r\n\t\t</div> -->\r\n\r\n\t\t<div class=\"questions__intro-text\">\r\n\t\t\t<div class=\"row\">\r\n\t\t\t\t<div class=\"col-xs-12\">\r\n\t\t\t\t\t<p>Click on the answer to each question below, then click on Calculate.</p>\r\n\t\t\t\t</div>\r\n\t\t\t</div>\r\n\t\t</div>\r\n\r\n\t\t<div class=\"row\" v-for=\"q in questions\" :key=\"q.id\">\r\n\t\t\t<div class=\"col-12 col-xs-12 mb-1 mb--1\">\r\n\t\t\t\t<div class=\"row\" v-if='q.header != \"\"'>\r\n\t\t\t\t\t<div class=\"col-12 col-xs-12\"><h2>{{q.header}}</h2></div>\r\n\t\t\t\t</div>\r\n\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t<div class=\"col-12 col-xs-12 col-sm-6\">\r\n\t\t\t\t\t\t<h3 class=\"txt--xl mb-1 mb--1\">{{q.title}}</h3>\r\n\t\t\t\t\t\t<p v-html=\"q.info\"></p>\r\n\t\t\t\t\t</div>\r\n\t\t\t\t\t<div class=\"col-12 col-xs-12 col-sm-6\">\r\n\t\t\t\t\t\t<div class=\"list-group\">\r\n\t\t\t\t\t\t\t<div v-for=\"o in q.options\" :key=\"o.id\">\r\n\t\t\t\t\t\t\t\t<button @click=\"optionclicked(q.id,o.id)\"\r\n\t\t\t\t\t\t\t\t\t\t@keydown.enter=\"optionclicked(event, q.id,o.id)\"\r\n\t\t\t\t\t\t\t\t\t\ttype=\"button\"\r\n\t\t\t\t\t\t\t\t\t\tv-bind:class=\"{'list-group-item list-group-item-action d-flex justify-content-between align-items-center active':(o.selected), 'list-group-item list-group-item-action d-flex justify-content-between align-items-center':(!o.selected)}\">\r\n\t\t\t\t\t\t\t\t\t{{o.text}}\r\n\t\t\t\t\t\t\t\t\t<span class=\"badge badge-success badge-pill\">{{o.value_label}}</span>\r\n\t\t\t\t\t\t\t\t</button>\r\n\t\t\t\t\t\t\t</div>\r\n\t\t\t\t\t\t</div>\r\n\t\t\t\t\t</div>\r\n\t\t\t\t</div>\r\n\t\t\t\t<hr class=\"mb-2 mb--2\">\r\n\t\t\t</div>\r\n\t\t</div>\r\n\t\t<div id=\"error\" class=\"row\">\r\n\t\t\t<div class=\"col-12 col-xs-12\">\r\n\t\t\t\t<div class=\"alert alert-info alert-informative alert--info mb-3 mb--3\" role=\"alert\" v-if=\"errormessage.length > 0\" v-html=\"errormessage\"></div>\r\n\t\t\t</div>\r\n\t\t</div>\r\n\t\t<div class=\"row\">\r\n\t\t\t<div class=\"col-12 col-xs-12\">\r\n\t\t\t\t<div class=\"calculator__result bg-secondary bg--secondary p--2 p-2 mb--2 mb-2\">\r\n\t\t\t\t\t<div id=\"calculator-copy\" class=\"color--white text-white mb-1 mb--1\" v-if=\"displayresult\">\r\n\t\t\t\t\t\t<div id=\"result-response\" v-if=\"isvalid\"></div>\r\n\t\t\t\t\t\t<p v-if=\"result.text.length > 0 && errormessage.length == 0\" class=\"h3 txt--xl\"><strong>Summary:</strong> {{result.text}}</p>\r\n\t\t\t\t\t\t<h3 v-if=\"errormessage.length == 0\"  class=\"h4 txt--lg\"><strong>Total Centor Score</strong> : {{result.score}}</h3>\r\n\t\t\t\t\t\t<h3 v-if=\"errormessage.length > 0\"  class=\"h4 txt--lg\"><strong>Total Centor Score</strong> : N/A</h3>\r\n\t\t\t\t\t\t<p v-if=\"result.calctext.length > 0 && errormessage.length == 0\" v-html=\"result.subtext\"></p>\r\n\t\t\t\t\t\t<p v-if=\"result.text.length > 0\" v-html=\"result.calctext\"></p>\r\n\t\t\t\t\t\t<!-- -->\r\n\t\t\t\t\t</div>\r\n\t\t\t\t\t<div class=\"control-holder \">\r\n\t\t\t\t\t\t<button class=\"btn mr-1 mr--1\" @click=\"calculateclicked\" type=\"button\" v-if=\"!displayresult\">Calculate</button>\r\n\t\t\t\t\t\t<button class=\"btn mr-1 mr--1\" type=\"button\" @click=\"reset\" v-if=\"displayresult\">Reset</button>\r\n            <button class=\"btn mr-1 mr--1\" id=\"copyButton\" type=\"button\" @click=\"copyToClipboard\" v-if=\"displayresult\">Copy Result</button>\r\n\t\t\t\t\t\t<button class=\"btn mr-1 mr--1 hide--quris\" type=\"button\" @click=\"displayForm\" v-if=\"displayresult\">Email PDF</button>\r\n\t\t\t\t\t</div>\r\n\t\t\t\t</div>\r\n\t\t\t\t<div class=\"bg--offwhite bg-offwhite p-2 p--2\" v-if=\"displayresult && showform\">\r\n\t\t\t\t\t\t<p class=\"color--black\">For security reasons, this form is only available within the NHS network. You can use it to email to an NHS email a PDF with the decision support result for this patient and then save it to the patient record.</p>\r\n\t\t\t\t\t\t<div class=\"color--black alert alert-danger alert--error mb-1 mb--1\" role=\"alert\" v-if=\"emailmessage.length > 0\" v-html=\"emailmessage\"></div>\r\n\t\t\t\t\t\t<div class=\"form__group mb--2\">\r\n\t\t\t\t\t\t\t<label for=\"emailaddresses\" class=\"form__label mb--1 txt--strong\">Email addresses:</label>\r\n\t\t\t\t\t\t\t<input v-model=\"emailaddresses\" type=\"text\" class=\"form__input\" name=\"emailaddresses\" id=\"emailaddresses\" placeholder=\"Enter email address(es) to receive this decision support output. NHS emails only\">\r\n\t\t\t\t\t\t</div>\r\n\t\t\t\t\t\t<div class=\"form__group mb--2\">\r\n\t\t\t\t\t\t\t<label for=\"patientname\" class=\"form__label mb--1 txt--strong\">Patient's Full Name:</label>\r\n\t\t\t\t\t\t\t<input v-model=\"patientname\" type=\"text\" class=\"form__input\" name=\"patientname\" id=\"patientname\" placeholder=\"Enter patient’s full name\">\r\n\t\t\t\t\t\t</div>\r\n\t\t\t\t\t\t<div class=\"form__group mb--2\">\r\n\t\t\t\t\t\t\t<label for=\"patientchinumber\" class=\"form__label mb--1 txt--strong\">Patient CHI Number:</label>\r\n\t\t\t\t\t\t\t<input v-model=\"patientchinumber\" type=\"text\" class=\"form__input\" name=\"patientchinumber\" id=\"patientchinumber\" placeholder=\"Enter patient’s CHI number\">\r\n\t\t\t\t\t\t</div>\r\n\t\t\t\t\t\t<button class=\"btn mr-1 mr--1\" type=\"button\" @click=\"sendToPDF\">Send</button>\r\n\t\t\t\t\t</div>\r\n\t\t\t\t\t<div class=\"alert alert-success alert--success mb-3 mb--3\" role=\"alert\" v-if=\"displayresult && !showform && emailmessage.length > 0 && emailaddresses.length > 0 && patientname.length > 0 && patientchinumber.length > 0\" v-html=\"emailmessage\"></div>\r\n\t\t\t</div>\r\n\t\t</div>\r\n\t\t<Content />\r\n\t</div>\r\n</template>\r\n\r\n<script>\r\nimport Content from '@/components/Content';\r\nimport \"isomorphic-fetch\";\r\n\r\nexport default {\r\n\tname: \"Calculator\",\r\n\tcomponents: {\r\n    Content\r\n  },\r\n  data() {\r\n    return {\r\n      emailaddresses: \"\",\r\n      patientname: \"\",\r\n      patientchinumber: \"\",\r\n      questions: [\r\n        {\r\n          id: \"q1\",\r\n          title: \"Age\",\r\n\t\t\t\t\theader: \"\",\r\n          required: false,\r\n          info: \"\",\r\n          options: [\r\n            {\r\n              id: \"o1\",\r\n              text: \"3-14 years\",\r\n              value_label: \"+1\",\r\n              value: 1,\r\n              selected: false\r\n            },\r\n            {\r\n              id: \"o2\",\r\n              text: \"15-44 years\",\r\n              value_label: \"0\",\r\n              value: 0,\r\n              selected: false\r\n            },\r\n            {\r\n              id: \"o3\",\r\n              text: \">= 45 years\",\r\n              value_label: \"-1\",\r\n              value: -1,\r\n              selected: false\r\n            },\r\n          ]\r\n        },\r\n        {\r\n          id: \"q2\",\r\n          title: \"Exudate or swelling on tonsils \",\r\n\t\t\t\t\theader: \"\",\r\n          required: false,\r\n          info: \"\",\r\n          options: [\r\n            {\r\n              id: \"o4\",\r\n              text: \"No\",\r\n              value_label: \"0\",\r\n              value: 0,\r\n              selected: false\r\n            },\r\n            {\r\n              id: \"o5\",\r\n              text: \"Yes\",\r\n              value_label: \"+1\",\r\n              value: 1,\r\n              selected: false\r\n            }           \r\n          ]\r\n        },\r\n        {\r\n          id: \"q3\",\r\n          title: \"Tender/swollen anterior or cervical lymph nodes \",\r\n\t\t\t\t\theader: \"\",\r\n          required: false,\r\n          info: \"\",\r\n          options: [\r\n            {\r\n              id: \"o6\",\r\n              text: \"No\",\r\n              value_label: \"0\",\r\n              value: 0,\r\n              selected: false\r\n            },\r\n            {\r\n              id: \"o7\",\r\n              text: \"Yes\",\r\n              value_label: \"+1\",\r\n              value: 1,\r\n              selected: false\r\n            }           \r\n          ]\r\n        },\r\n        {\r\n          id: \"q4\",\r\n          title: \"Temperature above 38 degrees C (100.4 F) \",\r\n\t\t\t\t\theader: \"\",\r\n          required: false,\r\n          info: \"\",\r\n          options: [\r\n            {\r\n              id: \"o8\",\r\n              text: \"No\",\r\n              value_label: \"0\",\r\n              value: 0,\r\n              selected: false\r\n            },\r\n            {\r\n              id: \"o9\",\r\n              text: \"Yes\",\r\n              value_label: \"+1\",\r\n              value: 1,\r\n              selected: false\r\n            }           \r\n          ]\r\n        },\r\n        {\r\n          id: \"q5\",\r\n          title: \"Cough\",\r\n\t\t\t\t\theader: \"\",\r\n          required: false,\r\n          info: \"\",\r\n          options: [\r\n            {\r\n              id: \"o10\",\r\n              text: \"Present\",\r\n              value_label: \"0\",\r\n              value: 0,\r\n              selected: false\r\n            },\r\n            {\r\n              id: \"o11\",\r\n              text: \"Absent\",\r\n              value_label: \"+1\",\r\n              value: 1,\r\n              selected: false\r\n            }           \r\n          ]\r\n        }\r\n      ],\r\n      result: {\r\n        score: 0,\r\n        calctext: \"\",\r\n        text: \"\",\r\n        subtext: \"\"\r\n      },\r\n      displayresult: false,\r\n      showform: false,\r\n      errormessage: \"\",\r\n      emailmessage: \"\",\r\n      isvalid: false,\r\n      answered_count: 0,\r\n\t\t\tanswer_acutechange: false,\r\n\t\t\ttabs: [\r\n        {\r\n          title: \"When to use\",\r\n          display: false,\r\n          accordion: false,\r\n\t\t\t\t\tcontent: `\r\n\t\t\t\t\t\t<p>Use only in patients with recent onset (3 days or less) acute pharyngitis.</p>\r\n\t\t\t\t\t\t<p>Most pharyngitis is viral and does not respond to antibiotic treatment. The Centor Score attempts to predict which patients will have culture-confirmed streptococcal infections of their pharynx to help determine which patients to test in the first place.</p>\r\n            <p>The FeverPAIN Score is similar, but the Centor Score has the advantage of distinguishing adolescents and young adults from pre-adolescents. This is important because strep carrier rates are higher in preadolescents than adolescents/young adults, and older patients are more likely to have severe symptoms and develop suppurative complications.</p>\r\n\t\t\t\t\t`,\r\n        },\r\n        {\r\n          title: \"Evidence\",\r\n          display: false,\r\n          accordion: false,\r\n          content: `\r\n\t\t\t\t\t\t<p>The original 1981 study by <a target=\"_blank\"  href=\"http://www.ncbi.nlm.nih.gov/pubmed/6763125\">Centor et al</a> focused on criteria to diagnose GAS infection in adult patients presenting to the emergency department with sore throat. <a target=\"_blank\"  href=\"http://www.ncbi.nlm.nih.gov/pubmed/9475915\">McIsaac 1998</a> modified the Centor Score to include age. This modified score was <a href=\"http://jama.jamanetwork.com/article.aspx?articleid=198485\" target=\"_blank\">validated</a> in 2004 for use in both children and adults presenting with sore throat. </p>\r\n\t\t\t\t\t\t<p><a target=\"_blank\" href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3627733/\">Fine et al (2012)</a> performed a national-scale validation of the score on a geographically diverse population of over 140,000 patients over the course of more than a year, mitigating any impact of seasonality of GAS incidence on the results. This analysis provided more precise interpretations of risk for each category of the Centor Score</p>\r\n\t\t\t\t\t\t<h4 class=\"txt--lg\">References </h4>\r\n\t\t\t\t\t\t<p>Centor RM, Witherspoon JM, Dalton HP, Brody CE, Link K. The diagnosis of strep throat in adults in the emergency room. <em>Med Decis Making</em>. 1981;1(3):239-246. <a href=\"https://journals.sagepub.com/doi/10.1177/0272989X8100100304\" target=\"_blank\">doi:10.1177/0272989X8100100304</a></p>\r\n\t\t\t\t\t\t<p>McIsaac WJ, White D, Tannenbaum D, Low DE. A clinical score to reduce unnecessary antibiotic use in patients with sore throat. <em>CMAJ</em>. 1998;158(1):75-83. </p>\r\n\t\t\t\t\t\t<p>McIsaac WJ, Kellner JD, Aufricht P, Vanjaka A, Low DE. Empirical Validation of Guidelines for the Management of Pharyngitis in Children and Adults. <em>JAMA</em>. 2004;291(13):1587&ndash;1595. <a href=\"https://jamanetwork.com/journals/jama/fullarticle/198485\" target=\"_blank\">doi:10.1001/jama.291.13.1587</a></p>\r\n\t\t\t\t\t\t<p>Fine AM, Nizet V, Mandl KD. Large-scale validation of the Centor and McIsaac scores to predict group A streptococcal pharyngitis. <em>Arch Intern Med</em>. 2012;172(11):847-852. <a href=\"https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1157417\" target=\"_blank\">doi:10.1001/archinternmed.2012.950</a></p>\r\n\t\t\t\t\t`,\r\n        },\r\n        {\r\n          title: \"Calculation<span class='show--md'> & interpretation</span>\",\r\n          display: false,\r\n          accordion: false,\r\n\t\t\t\t\tcontent: `\r\n\t\t\t\t\t\t<h4 class=\"txt--lg\">Calculation</h4>\r\n\t\t\t\t\t\t<p>Add the selected points for each criterion:</p>\r\n\t\t\t\t\t\t<table class=\"table tbl\">\r\n\t\t\t\t\t\t\t<tr>\r\n\t\t\t\t\t\t\t\t<th width=\"40%\">Criteria</th>\r\n\t\t\t\t\t\t\t\t<th width=\"35%\">Input value</th>\r\n\t\t\t\t\t\t\t\t<th align=\"right\" width=\"25%\">Points</th>\r\n\t\t\t\t\t\t\t</tr>\r\n\t\t\t\t\t\t\t<tr>\r\n\t\t\t\t\t\t\t\t<td valign=\"top\">Age</td>\r\n                 <td valign=\"top\" colspan=\"2\">\r\n                  <table>\r\n                    <tr style=\"display:none;\"><td colspan=\"2\">Data</td></tr>\r\n                    <tr>\r\n                      <td>3-14 years</td>\r\n                      <td align=\"right\">+1</td>\r\n                    </tr>\r\n                    <tr>\r\n                      <td>15-44 years</td>\r\n                      <td align=\"right\">0</td>\r\n                    </tr>\r\n                    <tr>\r\n                      <td>>= 45 years</td>\r\n                      <td align=\"right\">-1</td>\r\n                    </tr>\r\n                  </table>\r\n\t\t\t\t\t\t\t\t</td>\r\n\t\t\t\t\t\t\t</tr>\t\r\n\t\t\t\t\t\t\t<tr>\r\n\t\t\t\t\t\t\t\t<td valign=\"top\">Exudate or swelling on tonsils</td>\r\n                <td valign=\"top\" colspan=\"2\">\r\n                  <table>\r\n                    <tr style=\"display:none;\"><td colspan=\"2\">Data</td></tr>\r\n                    <tr>\r\n                      <td>No</td>\r\n                      <td align=\"right\">0</td>\r\n                    </tr>\r\n                    <tr>\r\n                      <td>Yes</td>\r\n                      <td align=\"right\">+1</td>\r\n                    </tr>\r\n                  </table>\r\n\t\t\t\t\t\t\t\t</td>\r\n\t\t\t\t\t\t\t</tr>\t\r\n\t\t\t\t\t\t\t<tr>\r\n\t\t\t\t\t\t\t\t<td valign=\"top\">Tender/swollen anterior or cervical lymph nodes</td>\r\n\t\t\t\t\t\t\t\t\r\n                <td valign=\"top\" colspan=\"2\">\r\n                  <table>\r\n                    <tr style=\"display:none;\"><td colspan=\"2\">Data</td></tr>\r\n                    <tr>\r\n                      <td>No</td>\r\n                      <td align=\"right\">0</td>\r\n                    </tr>\r\n                    <tr>\r\n                      <td>Yes</td>\r\n                      <td align=\"right\">+1</td>\r\n                    </tr>\r\n                  </table>\r\n\t\t\t\t\t\t\t\t</td>\r\n\t\t\t\t\t\t\t</tr>\t\r\n\t\t\t\t\t\t\t<tr>\r\n\t\t\t\t\t\t\t\t<td valign=\"top\">Temperature above 38 degrees C (100.4 F)</td>\r\n\t\t\t\t\t\t\t\t\r\n                <td valign=\"top\" colspan=\"2\">\r\n                  <table>\r\n                    <tr style=\"display:none;\"><td colspan=\"2\">Data</td></tr>\r\n                    <tr>\r\n                      <td>No</td>\r\n                      <td align=\"right\">0</td>\r\n                    </tr>\r\n                    <tr>\r\n                      <td>Yes</td>\r\n                      <td align=\"right\">+1</td>\r\n                    </tr>\r\n                  </table>\r\n\t\t\t\t\t\t\t\t</td>\r\n\t\t\t\t\t\t\t</tr>\t\r\n\t\t\t\t\t\t\t<tr>\r\n\t\t\t\t\t\t\t\t<td valign=\"top\">Cough</td>                \r\n                <td valign=\"top\" colspan=\"2\">\r\n                  <table>\r\n                    <tr style=\"display:none;\"><td colspan=\"2\">Data</td></tr>\r\n                    <tr>\r\n                      <td>Present</td>\r\n                      <td align=\"right\">0</td>\r\n                    </tr>\r\n                    <tr>\r\n                      <td>Absent</td>\r\n                      <td align=\"right\">+1</td>\r\n                    </tr>\r\n                  </table>\r\n\t\t\t\t\t\t\t\t</td>\r\n\t\t\t\t\t\t\t</tr>\t\r\n\t\t\t\t\t\t</table>\r\n\t\t\t\t\t\t<h4 class=\"txt--xl\">Interpreting Centor scores</h4>\r\n\t\t\t\t\t\t<table class=\"tbl table\">\r\n\t\t\t\t\t\t\t<tr>\r\n\t\t\t\t\t\t\t\t<th valign=\"bottom\" width=\"25%\">Centor Score</th>\r\n\t\t\t\t\t\t\t\t<th valign=\"bottom\" width=\"35%\">Probability of strep pharyngitis </th>\r\n\t\t\t\t\t\t\t\t<th valign=\"bottom\" width=\"40%\">Recommendation</th>\r\n\t\t\t\t\t\t\t</tr>\r\n\t\t\t\t\t\t\t<tr>\r\n\t\t\t\t\t\t\t\t<td valign=\"top\">\r\n\t\t\t\t\t\t\t\t\t0<br>1\r\n\t\t\t\t\t\t\t\t</td>\r\n\t\t\t\t\t\t\t\t<td valign=\"top\">\r\n\t\t\t\t\t\t\t\t\t1-2.5%<br>5-10%\r\n\t\t\t\t\t\t\t\t</td>\r\n\t\t\t\t\t\t\t\t<td valign=\"top\">\r\n\t\t\t\t\t\t\t\t\tNo further testing or antibiotics. <br><br>Clinicians should also refer to local guidance when appropriate.\r\n\t\t\t\t\t\t\t\t</td>\r\n\t\t\t\t\t\t\t</tr>\r\n\t\t\t\t\t\t\t<tr>\r\n\t\t\t\t\t\t\t\t<td valign=\"top\">\r\n\t\t\t\t\t\t\t\t\t2\r\n\t\t\t\t\t\t\t\t</td>\r\n\t\t\t\t\t\t\t\t<td valign=\"top\">\r\n\t\t\t\t\t\t\t\t\t11-17%\r\n\t\t\t\t\t\t\t\t</td>\r\n\t\t\t\t\t\t\t\t<td valign=\"top\">\r\n                  Consider throat swab to help inform shared decision making about antibiotics.<br><br>Clinicians should also refer to local guidance when appropriate.\r\n\t\t\t\t\t\t\t\t</td>\r\n\t\t\t\t\t\t\t</tr>\t\t\t\t\t\t\t\r\n\t\t\t\t\t\t\t<tr>\r\n\t\t\t\t\t\t\t\t<td valign=\"top\">\r\n\t\t\t\t\t\t\t\t\t3\r\n\t\t\t\t\t\t\t\t</td>\r\n\t\t\t\t\t\t\t\t<td valign=\"top\">\r\n\t\t\t\t\t\t\t\t\t28-35% \r\n\t\t\t\t\t\t\t\t</td>\r\n\t\t\t\t\t\t\t\t<td valign=\"top\">\r\n\t\t\t\t\t\t\t\t\tConsider throat swab to help inform shared decision making about antibiotics.<br><br>Clinicians should also refer to local guidance when appropriate.\r\n\t\t\t\t\t\t\t\t</td>\r\n\t\t\t\t\t\t\t</tr>\t\t\t\t\r\n\t\t\t\t\t\t\t<tr>\r\n\t\t\t\t\t\t\t\t<td valign=\"top\">\r\n\t\t\t\t\t\t\t\t\t>=4\r\n\t\t\t\t\t\t\t\t</td>\r\n\t\t\t\t\t\t\t\t<td valign=\"top\">\r\n\t\t\t\t\t\t\t\t\t51-53% \r\n\t\t\t\t\t\t\t\t</td>\r\n\t\t\t\t\t\t\t\t<td valign=\"top\">\r\n\t\t\t\t\t\t\t\t\tEmpiric antibiotics may be appropriate depending on the specific scenario. Consider throat swab to help inform shared decision making about antibiotics.<br><br>Clinicians should also refer to local guidance when appropriate.\r\n\t\t\t\t\t\t\t\t</td>\r\n\t\t\t\t\t\t\t</tr>\r\n\t\t\t\t\t\t</table>\r\n\t\t\t\t\t`,\r\n        },\r\n        {\r\n          title: \"Practice<span class='show--md'> considerations</span>\",\r\n          display: false,\r\n          accordion: false,\r\n          content: `\r\n\t\t\t\t\t\t<p>When applying the Centor score in practice, clinicians should be aware of the following points:</p>\r\n\t\t\t\t\t\t<h4 class=\"txt--lg\">Diagnostic accuracy</h4>\r\n\t\t\t\t\t\t<p>A <a target=\"_blank\" href=\"https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-9-67\">2011 systematic review</a> of the diagnostic accuracy of the Centor score concluded that: </p>\r\n\t\t\t\t\t\t<p>Overall, as a decision rule for considering antibiotic prescribing (score ≥ 3), the Centor score has reasonable specificity (0.82, 95% CI 0.72 to 0.88) and a post-test probability of 12% to 40% based on a prior prevalence of 5% to 20%.</p>\r\n\t\t\t\t\t\t<p>The score is reasonably specific when ≥ 3 signs or symptoms are present (0.82) and very specific when 4 are present (0.95).</p>\r\n\t\t\t\t\t\t<p>The post-test probability of GABHS pharyngitis is relatively low (that is, for a prevalence of 15% and a score of ≥ 3, post-test probability is 32%</p>\r\n\t\t\t\t\t\t<p>The authors therefore recommend that, although the Centor score can enhance appropriate prescribing of antibiotics, it should be used with caution as treating all patients presenting with a sore throat and a score of ≥ 3 may lead to many patients being treated with antibiotics inappropriately.</p>\r\n            <p><strong>Other considerations</strong></p>\r\n            <p>Clinicians should be aware that the Centor criteria were developed in the US in an emergency department setting in 1981, and have only been validated in an adult population.</p>\r\n            <p>Centor has only been validated in an adult population. However the risk of streptococcal infection decreases significantly with age into adulthood, and therefore the tool is most likely to be used with younger people.</p>\r\n            <p>Young children (under 3 years) are unlikely to present with sore throat symptoms alone. <a href=\"https://www.nice.org.uk/guidance/ng84\" target=\"_blank\">NICE NG84 guidance</a> recommends that prescribers should follow the relevant guidelines on fever in under 5s to assess and manage fever in this population.</p>\r\n            <p>The Centor criteria were developed in the US in an emergency department setting in 1981. Centor has not been validated in a UK population or in primary and community care settings.</p>\r\n            <p>The <a href=\"https://www.nice.org.uk/guidance/ng84\" target=\"_blank\">NICE guideline NG84</a> overview of identifying people most likely to benefit from antibiotics includes a fuller comparison of Centor and FeverPain scoring systems.</p>\r\n          `,\r\n        }\r\n      ]\r\n    };\r\n  },\r\n  methods: {\t\t\t\r\n    handleClick(e) {\r\n      if (e.target.matches(\"a\")) {\r\n        let url = e.target.href;\r\n        let target = e.target.target == \"_blank\" ? \"_blank\" : \"_self\";\r\n        let dataId = e.target.dataset.id == null ? -1 : e.target.dataset.id;\r\n        var isnativeapp = document.getElementById(\"isnativeapp\");\r\n        if (isnativeapp === undefined || isnativeapp === null) \r\n        {\r\n          window.open(url,target);  \r\n        }\r\n        else{\r\n          if(target == \"_blank\") {\r\n            let data = {title:'',nodeid: dataId, href:url, target: target};\r\n            window.Native('dataCallback', data);\r\n          } \r\n        }\t\r\n      }\r\n    },\r\n\t\tselectTab(selectedTab) {\r\n\t\t\tthis.tabs.forEach(tab => {\r\n\t\t\t\tif(tab.display) {\r\n\t\t\t\t\ttab.display = false;\r\n\t\t\t\t} else {\r\n\t\t\t\t\ttab.display = (tab.title == selectedTab.title);\r\n\t\t\t\t}\r\n\t\t\t});\r\n\t\t},\r\n    reset() {\r\n      this.emailaddresses = \"\";\r\n      this.patientname = \"\";\r\n      this.patientchinumber = \"\";\r\n      this.result.score = 0;\r\n      this.result.calctext = \"\";\r\n      this.result.text = \"\";\r\n      this.displayresult = false;\r\n      this.showform = false;\r\n      this.errormessage= \"\";\r\n      this.emailmessage = \"\";\r\n      this.isvalid= false;\r\n      this.answered_count= 0;\r\n      this.answer_acutechange= false;\r\n      this.questions.forEach(q => {\r\n        q.options.forEach(o => {\r\n\t\t\t\t\to.selected = false;\r\n\t\t\t\t});\r\n      });\r\n    },\r\n\t\tdisplayForm(){\t\t\r\n      this.showform = !this.showform;\r\n\t\t},\r\n    calculateclicked() {\r\n      this.displayresult = true;\r\n      this.showform = false;\r\n\t\t\tthis.emailmessage\t= \"\";\r\n      this.emailaddresses = \"\";\r\n      this.patientname = \"\";\r\n      this.patientchinumber = \"\";\r\n      if (this.answered_count < this.questions.length) {\r\n        this.errormessage =  \"<h2 class='txt--lg'>One or more inputs missing.</h2>\";\r\n\t\t\t\tthis.errormessage += \"<p>Total Centor score cannot be calculated as one or more inputs are missing.</p>\";\r\n\t\t\t\tthis.errormessage += \"<p>Required inputs are: Age, Tonsil exudate or swelling, Swollen lymph nodes, Temperature, Cough.</p>\";\r\n\t\t\t\tthis.errormessage += \"<p>If 4 of the Centor criteria are met, PPV is 60%. The absence of 3 or 4 of the Centor criteria has a NPV of 80%.</p>\";\r\n\t\t\t\tsetTimeout(()=> {\r\n\t\t\t\t\tdocument.getElementById(\"error\").scrollIntoView(true)},100);\r\n      } else {\r\n        this.errormessage = \"\";\r\n      }\r\n\t\t},\r\n    copyToClipboard() {\r\n      var range;\r\n      var finalText = \"\";\r\n      if (document.selection) { // IE\r\n        range = document.body.createTextRange();\r\n        range.moveToElementText(document.getElementById('calculator-copy'));\r\n        range.select();\r\n        finalText = this.getDateToday() + \"\\n\\nCentor Score (Modified, McIsaac) for Streptococcal Pharyngitis\\n\\n\" + range + \"\\nEnter action taken as a result of this alert\";\r\n        document.selection.empty();\r\n      } else if (window.getSelection) {\r\n        range = document.createRange();\r\n        range.selectNode(document.getElementById('calculator-copy'));\r\n        window.getSelection().removeAllRanges();\r\n        window.getSelection().addRange(range);\r\n        finalText = this.getDateToday() + \"\\n\\nCentor Score (Modified, McIsaac) for Streptococcal Pharyngitis\\n\\n\" + window.getSelection().toString() + \"Enter action taken as a result of this alert\";\r\n        window.getSelection().removeAllRanges();\r\n      }\r\n      var dummy = document.createElement(\"textarea\");\r\n      // Add it to the document\r\n      document.body.appendChild(dummy);\r\n\r\n      // Set its ID\r\n      dummy.setAttribute(\"id\", \"dummy_id\");\r\n\r\n      // Output the array into it\r\n      document.getElementById(\"dummy_id\").value = finalText;\r\n\r\n      // Select it\r\n      dummy.select();\r\n\r\n      // Copy its contents\r\n      document.execCommand(\"copy\");\r\n\r\n      // Remove it as its not needed anymore\r\n      document.body.removeChild(dummy);\r\n\r\n      var clicked = false;\r\n      var copyButton = document.getElementById('copyButton');\r\n      if (!clicked) {\r\n            var last = copyButton.innerHTML;\r\n            copyButton.innerHTML = 'Copied!';\r\n            clicked = true;\r\n            setTimeout(function () {\r\n                copyButton.innerHTML = last;\r\n                clicked = false;\r\n            }.bind(copyButton), 5000);\r\n        }\r\n    },\r\n    getDateToday() {\r\n      var date = \"\";\r\n      var today = new Date();\r\n      date = today.getDate() + \"/\" + (today.getMonth() + 1) + \"/\" + today.getFullYear() + \" \" + (today.getHours() < 10 ? \"0\" + today.getHours() : today.getHours()) + \":\" + (today.getMinutes() < 10 ? \"0\" + today.getMinutes() : today.getMinutes());\r\n      return date;\r\n    },\r\n    sendToPDF() {\r\n        // if (this.emailaddresses == \"\") {\r\n        //     this.emailmessage = \"You must supply at least one email address.\";\r\n        // }\r\n        // else if (this.patientname == \"\") {\r\n        //     this.emailmessage = \"You must supply the patient's name.\";\r\n        // }\r\n        // else if (this.patientchinumber == \"\") {\r\n        //     this.emailmessage = \"You must supply the patient CHI number.\"\r\n\t\t\t\t// }\r\n\r\n\t\t\t\tif (this.patientchinumber == \"\" || this.patientname == \"\" || this.patientchinumber == \"\"){\r\n\t\t\t\t\t\tthis.emailmessage = \"All fields are required.\"\r\n\t\t\t\t}\r\n        else {\r\n            var formToPost = {\r\n                EmailAddresses: this.emailaddresses,\r\n                PatientName: this.patientname,\r\n                PatientChiNumber: this.patientchinumber,\r\n                Questions: this.questions,\r\n                Result: this.result,\r\n                DisplayWarning: this.answered_count < this.questions.length,\r\n            };\r\n\r\n            var model = JSON.stringify(formToPost);\r\n\r\n            fetch(\"/SoreThroat/GetCentorPDF\", {\r\n                method: 'POST',\r\n                headers: {\r\n                    'Content-Type': 'application/json'\r\n                },\r\n                body: model\r\n            })\r\n                .then(response => response.text())\r\n                .then(data => {\r\n                    if (data.startsWith(\"Email Error: \")) {\r\n                        this.emailmessage = data.replace(\"Email Error: \", \"\");\r\n                        this.showform = true;\r\n                    } else {\r\n                        this.emailmessage = data;\r\n                        this.showform = false;\r\n                    }\r\n                })\r\n                .catch((error) => {\r\n                    console.log('EMAIL ERROR', error);\r\n                });\r\n        }\r\n    },\r\n\t\tanchorLink(i) {\r\n\t\t\tvar element = document.getElementById(i);\r\n\t\t\telement.scrollIntoView();\r\n\t\t\t// console.log(element);\r\n\t\t\t// console.log(top);\r\n\t\t\t// window.scrollTo(0, top);\r\n\t\t},\r\n\t\t\r\n    closedclicked() {\r\n      this.displayresult = false;\r\n    },\r\n    optionclicked(qid, oid) {\r\n      this.displayresult = false;\r\n      let _score = 0;\r\n      this.questions.forEach(q => {\r\n        if (q.id === qid) {\r\n          q.options.forEach(o => {\r\n            if (o.id === oid) {\r\n              if(o.selected)\r\n              {\r\n                o.selected = false;\r\n              }\r\n              else\r\n              {\r\n                o.selected = true;\r\n              }\r\n              \r\n            } else {\r\n              o.selected = false;\r\n            }\r\n          });\r\n        }\r\n      });\r\n      let _cnt = 0;\r\n      let _required_cnt = 0;\r\n      let _required_answered_cnt = 0;\r\n      this.answer_acutechange = false;\r\n      this.questions.forEach(q => {\r\n        if (q.required) {\r\n          _required_cnt++;\r\n        }\r\n      });\r\n      this.questions.forEach(q => {\r\n        q.options.forEach(o => {\r\n          if (o.selected) {\r\n            _score += o.value;\r\n            _cnt++;\r\n          }\r\n          if (o.selected && q.required) {\r\n            _required_answered_cnt++;\r\n          }\r\n          // if (q.id === \"q4\") {\r\n          //   if (o.selected) {\r\n          //     this.answer_acutechange = true;\r\n          //   }\r\n          // }\r\n        });\r\n      });\r\n\r\n      this.answered_count = _cnt;\r\n      this.isvalid = _required_answered_cnt === _required_cnt ;\r\n      if (this.isvalid) {\r\n        this.errormessage = \"\";\r\n      }\r\n      this.result.score = _score;\r\n\r\n      if (_score <= 0) {\r\n\t\t\t\tthis.result.text = \"Probability of strep pharyngitis 1-2.5%\";\r\n\t\t\t\tthis.result.subtext = \"No further testing or antibiotics.<br><br>Clinicians should also refer to local guidance when appropriate.\";\r\n      }\r\n      if (_score == 1) {\r\n\t\t\t\tthis.result.text = \"Probability of strep pharyngitis 5-10%\";\r\n\t\t\t\tthis.result.subtext = \"No further testing or antibiotics.<br><br>Clinicians should also refer to local guidance when appropriate.\";\r\n\t\t\t}\r\n\t\t\tif (_score == 2) {\r\n\t\t\t\tthis.result.text = \"Probability of strep pharyngitis 11-17%\";\r\n\t\t\t\tthis.result.subtext = \"Consider throat swab to help inform shared decision making about antibiotics.<br><br>Clinicians should also refer to local guidance when appropriate.\";\r\n\t\t\t}\r\n\t\t\tif (_score == 3) {\r\n\t\t\t\tthis.result.text = \"Probability of strep pharyngitis 28-35%\";\r\n\t\t\t\tthis.result.subtext = \"Consider throat swab to help inform shared decision making about antibiotics.<br><br>Clinicians should also refer to local guidance when appropriate.\";\r\n\t\t\t}\r\n\t\t\tif (_score >= 4) {\r\n        this.result.text = \"Probability of strep pharyngitis 51-53%\";\r\n\t\t\t\tthis.result.subtext = \"Empiric antibiotics may be appropriate depending on the specific scenario. Consider throat swab to help inform shared decision making about antibiotics.<br><br>Clinicians should also refer to local guidance when appropriate.\";\r\n      }\r\n\r\n      \r\n\r\n      let _calctext = \"\";\r\n      let _idx2 = 0;\r\n      //let _len = this.questions.length;\r\n      this.questions.forEach(q => {\r\n        //_calctext = _calctext + q.title+\": \";\r\n\r\n        q.options.forEach(o => {\r\n          if (o.selected) {\r\n            if (_idx2 === 0) {\r\n\t\t\t\t\t\t\t_calctext = _calctext + \"<strong>\" + q.title + \"</strong><br><span class='badge badge-success badge-pill'>\"+ o.value_label + \"</span>&nbsp;\"+ o.text +\"<br><br>\";\r\n            } else {\r\n\t\t\t\t\t\t\t_calctext = _calctext + \"<strong>\" + q.title + \"</strong><br><span class='badge badge-success badge-pill'>\"+ o.value_label + \"</span>&nbsp;\"+ o.text +\"<br><br>\";\r\n            } \r\n          }\r\n\t\t\t\t});\r\n\r\n        _idx2++;\r\n      });\r\n      \r\n      this.result.calctext = _calctext;\r\n    }\r\n  }\r\n};\r\n</script>","import mod from \"-!../../node_modules/cache-loader/dist/cjs.js??ref--12-0!../../node_modules/thread-loader/dist/cjs.js!../../node_modules/babel-loader/lib/index.js!../../node_modules/cache-loader/dist/cjs.js??ref--0-0!../../node_modules/vue-loader/lib/index.js??vue-loader-options!./Calculator.vue?vue&type=script&lang=js&\"; export default mod; export * from \"-!../../node_modules/cache-loader/dist/cjs.js??ref--12-0!../../node_modules/thread-loader/dist/cjs.js!../../node_modules/babel-loader/lib/index.js!../../node_modules/cache-loader/dist/cjs.js??ref--0-0!../../node_modules/vue-loader/lib/index.js??vue-loader-options!./Calculator.vue?vue&type=script&lang=js&\"","import { render, staticRenderFns } from \"./Calculator.vue?vue&type=template&id=35793856&\"\nimport script from \"./Calculator.vue?vue&type=script&lang=js&\"\nexport * from \"./Calculator.vue?vue&type=script&lang=js&\"\n\n\n/* normalize component */\nimport normalizer from \"!../../node_modules/vue-loader/lib/runtime/componentNormalizer.js\"\nvar component = normalizer(\n  script,\n  render,\n  staticRenderFns,\n  false,\n  null,\n  null,\n  null\n  \n)\n\nexport default component.exports","<template>\r\n  <div id=\"app\">\r\n    <Calculator/>\r\n  </div>\r\n</template>\r\n\r\n<script>\r\nimport Calculator from './components/Calculator.vue'\r\n\r\nexport default {\r\n  name: 'App',\r\n  components: {\r\n    Calculator\r\n  }\r\n}\r\n</script>\r\n","import mod from \"-!../node_modules/cache-loader/dist/cjs.js??ref--12-0!../node_modules/thread-loader/dist/cjs.js!../node_modules/babel-loader/lib/index.js!../node_modules/cache-loader/dist/cjs.js??ref--0-0!../node_modules/vue-loader/lib/index.js??vue-loader-options!./App.vue?vue&type=script&lang=js&\"; export default mod; export * from \"-!../node_modules/cache-loader/dist/cjs.js??ref--12-0!../node_modules/thread-loader/dist/cjs.js!../node_modules/babel-loader/lib/index.js!../node_modules/cache-loader/dist/cjs.js??ref--0-0!../node_modules/vue-loader/lib/index.js??vue-loader-options!./App.vue?vue&type=script&lang=js&\"","import { render, staticRenderFns } from \"./App.vue?vue&type=template&id=3091ac46&\"\nimport script from \"./App.vue?vue&type=script&lang=js&\"\nexport * from \"./App.vue?vue&type=script&lang=js&\"\n\n\n/* normalize component */\nimport normalizer from \"!../node_modules/vue-loader/lib/runtime/componentNormalizer.js\"\nvar component = normalizer(\n  script,\n  render,\n  staticRenderFns,\n  false,\n  null,\n  null,\n  null\n  \n)\n\nexport default component.exports","import Vue from 'vue'\r\nimport App from './App.vue'\r\n// import 'bootstrap'\r\n// import 'bootstrap/dist/css/bootstrap.min.css'\r\n// import '../../../base-redesign/dist/css/calculator-redesign.css'\r\n\r\nVue.config.productionTip = false;\r\nVue.config.devtools = true;\r\n\r\nnew Vue({\r\n  render: h => h(App),\r\n}).$mount('#app')\r\n"],"sourceRoot":""}