National Library of Medicine

NLM is available everywhere! You can download access to NLM onto your mobile device by going to PubMED at
www.pubmed.gov

You can access the web version of NLM by going to
http://www.nlm.nih.gov

PubMed also offers other features for your PDA, including the PubMed search engine itself as well as MD on Tap. MD on Tap is software that searches and finds Medline citations. This can be downloaded from
http://mdot.nlm.nih.gov/proj/mdot/download.php

Medline is a great resource for patient information, since it give great easily understandable summaries of drugs and diseases.

This PubMed software allows you to find what you need in evidenced based medicine without using a computer and without needed other EBM software on your PDA. One downfall is that an internet connection is needed to be able to pull up and read the articles.

Diagnasaurus

Diagnasaurus can be found through Access Medicine (through our Hardin Library). This site offers symptom lists and possible diagnoses. This site offers differential "diagn"oses based upon sets of common symptoms. Although the site dose not contain treatment options, through Access Medicine the diseases are linked to other resources containing disease and treatment information.

ACP PIER

ACP PIER is one of the most well-known and best sources of evidence-based medicine. It is web based but a PDA version is downloadable to Palm systems only. It offers disease modules with graded recommendations based on the latest research. The PDA version is updated monthly. PIER offers the most important information with the best evidence on a wide variety of point of care subjects. Not only does PIER offer disease and drug information, but they have complementary and alternative information as well, and recommendations on disease prevention and screening. ACP PIER also has journal club information to keep you updated on the most important and newest discoveries.

DynaMed

­DynaMed, similar to other Evidence Based Resources, offers concise summaries of graded and reviewed information. This resource focuses on diagnosis, treatment and prognosis of many conditions. The information comes from over 500 journals and are carefully reviewed. Retrieving disease information in this manner is much faster than searching for articles on PubMed.

InfoRetriever/ InfoPOEM

InfoRetriever is a PDA and web based resource which provide evidence-based recommendations and useful information. It contains many tools and databases including Practice Guidelines, 5 Minute Clinical Consult, Clinical Calculators and infoPOEMS. These databases give levels of recommendation, references and are wonderfully concise. InfoPOEMS, found here, offer excellent summaries of research. A great way to stay up-to-date is to receive current InfoPOEMS daily via e-mail.

Lexi-Comp On-Hand

Lexi-Comp for PDA is called Lexi-Comp On-Hand is the most comprehensive handheld database that I've seen yet. I don't feel I'd be able to adequately describe all that is available through these programs but more information and very useful online tours can be found at

www.lexi.com

The program can be used on the internet, on a desktop or on a handheld device. The web version obviously is better if you'd like to follow links and does have very complete information. Lexi-comp products encompass many databases and tools, some which can be purchased separately and downloaded onto a palm, pocketPC or blackberry device. Some of the smaller databases included Lexi-drugs, Lexi-interact, Lexi-DrugID, Lexi-Calc and many, many others. I don't believe there is much drug information out there that can't be found under one of the databases offered. For simplicity I will discuss the most used version, which is Lexi-Complete and it offers IV compatibility, drug information, interaction checker, and the calculators. As an aside the calculators are offered on ALL databases that are purchased.

Currently Lexi-Comp is having a sale, and you can purchase a one-year subscription for $75 to one database and add any other for $40.

Within Lexi-Complete you can reference 15 clinical database!! These include very useful installed books containing disease information, herbal drug information, medical abbreviations and many other useful bits of information. Within all the books, drugs and disease are linked to their information found in the other books so that complete information can be searched out easily. The drug database is very comprehensive and has links within that will lead you to important calculators for that drug, definitions of terms, important tables, and much more.

Lexi-interact is has, in my opinion, the most complete information and the most reference. The program actually cites it's sources!! However, because the program is so in depth I feel that it can sometimes be a little confusing to find what you need - even with their new search and "jump" features. If considering this database, I would spend some time on the internet going over the tours and product details, and then spend some time playing around with the database. Although it may be difficult to use at first, once mastered, the Lexi programs will be a great resource!!

Monthy Presribing Reference

Another Free Database! I really like this one, it offers a little bit of everything. Although the information doesn't seem to be too in depth, it has several unique features.

For downloading, as I said it's free, and compatible with any windows system so this includes all the PocketPC PDA's as well as many smartphones which we haven't seen yet. Of course it's accessible via the Internet so any system which has a connection could access this website.

You can search and COMPARE 3000 OTC and Rx drug monographs which include indications, dose, contraindications, precautions, interactions, adverse reactions and how supplied, all very concise. Drugs are listed by brand, generic, manufacturer and therapeutic category.

Other resources, besides monographs, include charts which easily depict comparisons of medication or flow diagrams of disease management and is definitely a unique feature of this reference. Their Prescribing Notes are general important therapeutic points for each drug class. These can be accessed by drug class or can be accessed by a link in the monograph of specific medications. Lastly MPR keeps you updated with news bulletins about drug information and new products.

Oh, and if they don't have the answer you need, check out the forums under the "We Got Answers" tab!

ClinicalXpert

Next up in PDA software comes ClinicalXpert which hails from the Thompson Micromedex Healthcare Series. Information on other Thompson products, including the web-based Micromedex can be found at:

http://www.micromedex.com

ClinicalXpert is free to those in an institution with a subscription to the Micromedex Healthcare Series, which includes many hospitals and clinics. It may be downloaded onto a PocketPC or PalmOS (3.5 or later) system and may run from PalmOS memory expansion cards. This program does not run on the iPhone or Blackberry but may run on a few select Smartphones. The complete list of compatible devices can be found here:

http://www.micromedex.com/support/certifieddevices/index.html

The amount of memory is takes to upload the product is variable since it comes with many optional programs. The program also has an Auto-Update feature which allows current users to get the most updated version of the software as soon as it's available. This enables users to keep the same program without having to delete and reload a new version each year.

Some of the products available include:

Drug Information
Users can search 4,000+ drugs and 300+ alternative drugs for

• generic names
• common trade names
• class
• dosage, adult
• dosage, pediatric
• dose adjustments
• administration
• monitoring
• how supplied
• indications (separated
by “FDA labeled” and
“non-FDA labeled”)
• contraindications
• precautions
• adverse effects (separated into
“common” and “serious”)
• drug interactions
• pregnancy category
• breast feeding

Disease Information
Disease topics written by physicians for clinical
practice including:

• evidence ratings
• test and treatment options
• daily studies and alerts

Drug Interaction Tool
Clinicians can check a patient’s entire list of medications
(up to 32 at once) for potentially harmful interactions.

Warnings include:
• severity • probable mechanism
• onset • evidence
• adverse effects • clinical management

Toxicology Information (very unique!!)
200+ of the most common poisonings and
drug overdoses, including information about:

• clinical effects
• treatment
• range of toxicity

Laboratory Information (Very useful, although sometimes difficult to search)
Details on 500+ laboratory tests, including help:

• identifying appropriate tests
• interpreting test results
• monitoring drug levels
• collecting samples
• submitting tests
• monitoring therapeutic levels and side effects

Also includes formulary information, calculators and a news feature similar to those seen in other programs.

CP on Hand

Information about Clinical Pharmacology on Hand, Gold Standard's PDA product can be found at

www.clinicalpharmacologyonhand.com

Gold Standard offers 3 products available for download onto Pocket PC or Palm, Not Smartphones. They will not download onto a PDA with less than 16 MB of internal memory, and external memory download is preferred. These can be purchased and used separately or together. Although Clinical Pharmacology is offered as an online product, this must be purchased separately. Information below is adapted from the website.

CP onHand ($99):

• Extensive, peer-reviewed drug content
• Drug descriptions, indications, interactions, precautions/contraindications, classifications, adverse reactions, pregnancy/lactation, administration and dosage forms/strengths
• Pediatric, adult, geriatric, hepatic and renal dosing, and dosage limits, specific to indication, including off-label uses
• Search capabilities by generic or brand name, indication, classification, precaution or adverse reaction
• Personal notes capabilities to save your individual reminders and records

• Drug interactions report tool for checking combinations of prescription drugs, OTC, herbal and nutritional products for potential interactions – includes severity rankings and screening for lifestyle factors such as caffeine, food, alcohol, enteral feedings, grapefruit juice and tobacco
• Need 14 MB of free RAM
  

CP onHand Drug Indentifier ($39):

• Allows you to identify drugs based on their markings and/or shape and color.
• Information found will include:

Product Name
Marketer
NDC Number
Legend (Rx, Generic, OTC)
Dosage Form
Route of Administration
Orange Book Rating
Markings/Imprints
Color

• Needs 5 MB of free RAM
  

Shape CP onHand IV Alert ($49):

• Allows you to check the compatibility of two or more intravenous products and/or solutions when mixed in solution or a syringe, or via a Y-site administration
• Needs 2 MB of free RAM
  

None of the other products by Gold Standard are available for download onto a PDA.

Tarascon

Tarascon comes as a paperback and PDA pharmacopoeia. They offer a variety of pocketbooks, each color coded and very small, as well as a few reference cards. The PDA version used to be very similar to Epocrates and was offered for free. Interestingly enough, Tarascon is also a small town in France. Their website is

www.tarascon.com

The PDA pharmacopoeia can be downloaded to Palm, PocketPC and Blackberry. This can be done online or you can buy a CD that will guide you with downloading. It costs $29.95 for a 12 month subscription and includes peer reviewed drug information, typical dosing (FDA approved and off-label uses), available trade name and generic formulations, metabolism and safety in pregnancy and lactation. Other aspects include:

• Expanded drug information from the Deluxe Edition of the print Pocket Pharmacopoeia
• A fully integrated tool for multiple drug interaction checking
• Continuous ongoing drug information auto-updates via the internet
• Palm®, Pocket PC®, and Blackberry® versions, including support for most extended memory cards
• Complete customer privacy. Unlike other medical software we will never sell your personal data and product use patterns to others
• A fully integrated "Herbal & Alternative Therapy" section
• 47 invaluable reference tables and 9 dynamic medical formula calculators
• Both convenient relative pricing codes ($ to $$$$$) and exact prices directly from www.drugstore.com
• Extensive pediatric drug dosing
• Unique Canadian trade names and drugs
• Software written by USBMIS, Inc, creators of the popular PDA versions of The Sanford Guide®

found on the product information page on the website.

Database Comparison

As I review the variety of drug databases available in mobile and online versions, one topic I'm not touching on is validity or scope. There are, however, studies to assess this important aspect. Here are a list of some I found on PubMed. I've included the title and the PubMedID, and they are available online for free either as an abstract or in full.

Clinical decision support tools: analysis of online drug information databases. PMID: 1734633

Performance of drug-drug interaction software for personal digital assistants. PMID: 16622155

Lactation safety recommendations and reliability compared in 10 medication resources. PMID: 17623757

Epocrates

Epocrates: The first in a series of drug databases to be reviewed. Epocrates has a PDA and online version available at www.epocrates.com.

The database itself comes in several forms with different products all of which include free content updates, medical news, mobile CME learning center, MedTools applications, and international drug name indexes. MedTools contains a variety of screening and dosing tools such as BMI and obesity tool, drip rate calculator, INR calc, Heparin dosing protocol etc.

Mobile Devices:

Epocrates RX (free): drug monographs, health plan formularies, drug interaction checker, calculators
Epocrates RX Pro ($60/1 yr): The above and infectious disease treatment guide, alternative medicines, IV compatability checker
Epocrates Essentials ($149/ 1 yr): All the above and disease monographs, symptom assessment, diagnostic and laboratory tests
Epocrates Essentials Deluxe ($199/ 1 yr): All the above and ICD-9 and CPT codes, medical dictionary
Epocrates Coder ($70/ 1yr): CD-9 and CPT codes
Epocrates Medical Dictionary ($20/ 1yr): medical dictionary

These products include more than 3300 drugs, 1200 diseases, 400 alternative medication, 100,000 medical terms, over 30 medical formulas, hundreds of tests and panels as well as 20,000 ICd-9 codes. The drug interaction tool can check 30 drugs at a time and the IV compatability tool references Kings Guide. Each mobile version also includes MyEpocrates which allows you to create shortcuts, add notes to drug monographs, view your Rx look up history, change your default screen, and add whichever MedTools you'd like.

Online Version:

Epocrates Online (free): Drug monographs, health plan and hospital insurance formularies, drug interaction checker, full color pill pictures, patient medication handout (spanish/ english)
Epocrates Online Premium ($60/ 1 yr): All the above plus Pill identifier, clinical tables and guidelines, Med calculators, alternative medicines

If you'd like to learn how to better use the software there is a Tips page at

http://www.epocrates.com/products/tips/

The products themselves are both Palm and PocketPC compatible, however some of the MedTools are Palm only and neither are available for smartphone use.

Overall Epocrates gives good information and is very easy to use. You can search by drug class as well as brand and generic name. Pregnancy and lactation information seems limited and is found under the safety monitoring tab.

Free Stuff!

HEY CHECK IT OUT!! It's FREE STUFF for your PDA

http://www.fppda.com/free.html

The main page might have information you may be interested in as well.

Palm Vs. Pocket

The great handheld debate, which do you choose, a Palm OS or a Pocket PC?

I feel the differences between them are mostly important for what you want to do. A Palm program is older and a little bit more difficult to use. They can typically only run 1 program at a time and may have memory restrictions. Because they have been out for a longer period of time however, there are a great many free or cheap programs for download.

Pocket PC on the other hand really is more like a mini computer. They tend to offer a more user friendly interface and the ability to use more than one application at a time. However, with newer technology usually comes more problems, and they tend to be a little bit more difficult to solve.
Running many programs at a time may slow down your software.

Below are a list of links that include comparisons of the 2:

http://palmtops.about.com/od/pda101/l/blchart.htm

http://www.pcworld.com/article/id,111825-page,1-c,palmbasedpdas/article.html

http://www.mobiletechreview.com/tips/palm_vs_pocketpc.htm

These are in relation to medicine:

http://www.med.yale.edu/library/technology/PDA/pdahardware.html

http://www.collectivemed.com/buyguide_hard2.shtml

And it begins....

Welcome to my new blog, yay.

The purpose of this Internet based collection of post-it notes is to advise the world on my very important opinions as I learn wonderful new insight into the IT world. Also, I will be turning this in for class, and hopefully this site will contain a sufficient amount of information by the end of the semester.

If you have a tidbit or two about new technology especially related to health care, such as an opinion about an information database or some knowledge about the use of PDAs in the workplace, please feel free to share!