Hand Held Medicine

It can be difficult to keep track of all the latest evidence-based guidelines. Some commercial tools like InfoRetriever (www.infopoems.com) and Clinical Evidence (www.unboundmedicine.com) do a good job, and are worth trying. But there are also a variety of guidelines in Palm-readable formats available at no charge from other locations, such as:

C-Tools (Cancer Tools) from the American Cancer Society
Shots 2005, by the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP).

For other PDA-based guidelines, you can also try the CMA Infobase and the US National Guideline Clearing House, but neither has a great deal of PDA readable material. However, remember that if you can obtain a guideline in Adobe Acrobat or Word format, you can always use the Adobe Acrobat reader for Palm or Documents to go to take them with you; and if you’re really keen, you can use a program like iSiloX to convert a web page or document into a PDA-readable ebook. See the Document Reader section for more information.

Today’s physicians are often faced with patients taking multiple “natural” supplements, and the need for information to make educated decisions about their effects or interactions with other drugs. DrDrugs includes extensive information about natural product/alternative medicines, while neither LexiDrugs nor ePocrates Rx have significant information on these preparations.

The most authoritative standalone reference in this category is Lexi Natural Products, from Lexi-Comp (who also produce LexiDrugs Platinum, www.lexi.com ). This software covers over 175 of the most commonly used natural products in 6 different categories – herbs, vitamins, minerals, nutraceuticals, ‘glandular nutraceuticals’, and amino acids. Up to 11 key fields of information are provided, including natural product category, dosage and standardization, reported uses, pharmacology, general warnings, theoretical interactions and references (mostly pre-1999 in the present version). Information on possible mechanisms of action is generally good. Lexi Natural Products takes up 300KB, supports expansion cards, and is available for PocketPC.

As a slightly less expensive alternative, ePocrates have worked an alternative medicine reference into their commercial Rx Pro product ( www.epocrates.com ), including over 400 alternative medicine monographs and a built-in interactions checker. The information is from the Natural Medicines Comprehensive Database ( www.naturaldatabase.com ), which promotes itself as the “gold standard for evidence-based, clinical information on natural medicines.” We have not reviewed this title, and therefore can’t comment on the accuracy of their claim.

If it is only drug interactions with natural products that you are interested in, rather than a detailed reference, be aware that LexiInteract (a drug interaction checker from Lexi-Comp designed to be used in concert with LexiDrugs Platinum) includes a wide variety of the most common natural products, as well as over-the-counter products and foods.

The Tarascon Pharmacopaeia also contains a fully integrated “Herbal & Alternative Therapy” section.

MedRules is a popular, free EBM tool featuring useful clinical prediction rules taken from the medical literature, ranging acute sinusitis to UTI diagnosis, with additional rules being released occasionally. It requires about 330 KB of memory (including its required libraries), and is not currently available for the PocketPC. It also does not appear to have been updated for some time, and can be hard to find.

One of the better commercial full-text EBM references for handhelds that we have seen is Medical InfoRetriever ( www.infopoems.com ), which was unique in that it was first available for the PocketPC and only in March 2003 was a PalmOS version launched. This is a large and demanding PalmOS application, with a 66Mhz processor preferred, 2MB of internal memory and 37MB of free space on a memory expansion card required. Despite its large size (or maybe because of it) this is a very impressive reference work, including thousands of InfoPOEMs, abstracts from the Cochrane database, clinical prediction rules, evidence-based guidelines, Griffith’s 5 Minute Clinical Consult, and an ICD-9 lookup tool. It also links automatically into LexiDrugs, if available on your PDA. A 30-day trial is available.

A good Canadian EBM title is EBM2GO ( www.ebm2go.com ), which includes guidelines, summaries of studies, clinical trial summaries, selected provincial formularies (but not Nova Scotia or New Brunswick, yet at least), and tools such as an opioid converter. A subscription to EMB2GO is free, as the development of the program was supported by sponsorships. The content appears to be kept up to date, and is a useful and well-designed product that we hope continues to develop.

The Center for Evidence-Based Medicine ( www.cebm.utoronto.ca ), funded by the Mount Sinai Hospital in Toronto, has a number of free titles available for the PalmOS, including an EBM Calculator designed to “calculate relevant statistics for Diagnostic studies, Prospective Studies, Case Control Studies, and Randomized Control Trials (RCT)” as well as a set of EBM tables including Number Needed to Treat, Likelihood Ratios, and Sensitivity and Specificity.

Clinical Evidence, produced by the BMJ Publishing Group and Unbound Medicine, provides a concise account of the current state of evidence on the prevention and treatment of a wide range of clinical conditions. It contains evidence related to hundreds of therapeutic and preventative interventions, derived from thousands of original studies, and presents it in a concise, easy-to-use format.

Unbound Medicine’s CogniQ software is also used by by Ovid@Hand ( www.ovid.com ), a much more expensive institutional offering that includes a drug reference, more variety of journals, and other features. At this “advanced” level there are a number of other impressive products that we have seen, including FIRSTConsult (formerly PDxMD), which focusses on differential diagnoses and detailed information on medical conditions. Although available for individual sale, these products are clearly intended for use by practicing physicians rather than medical students, and are most frequently used in institutional settings covered by group licences.

Our recommendation for most authoritative infectious diseases reference is the Sanford Guide to Antimicrobial Therapy ( www.sanfordguide.com ). The PDA version has the exact same content as the familiar print one and includes ambulatory, inpatient, adult and pediatric information. It is evidence-based and has extensive reference citations. Helpful notes suggest when antibiotics may not be necessary. It is not the easiest to navigate but the information is comprehensive and reliable.

The 2003 version of the Sanford Guide has additional content on bioterrorism and management of HIV/AIDS. It does have an auto-update feature (which we have not tried yet). Subscribers are entitled to a year’s worth of downloads, but that is not of much use as the material is only updated annually anyway. Subscribers get a 10% discount on the next edition. The program is not large (just under 1.5 Mb) but prior versions used so many individual files that in our experience it took 30 minutes or more to install. Reportedly, this has been addressed in more recent versions. It will run on memory expansion cards. Also available for PocketPC.

The Johns Hopkins POC-IT ABX Guide ( www.hopkins-abxguide.org ) is the only remaining free ID reference for the Palm we have reviewed. Many people find it easier to navigate, but it has less content, and suffers from having no pediatric information at all. Unlike the independent Sanford Guide, it is sponsored by pharmaceutical interests. Like ePocrates, when it auto-updates it also monitors and reports on your use–nothing is really free! Also available for Blackberry, PocketPC and Windows CE, but not for Windows Mobile 2003 (the latest version).

A relatively new title, which we have not yet reviewed, is Lexi Infectious Diseases, from Lexi-Comp. Containing over 930 disease syndromes, organisms, diagnostic tests and antimicrobial agents, it appears to be a good and comprehensive reference (and the quality of their other products is very high). Finally ePocrates ID used to be a free alternative infectious disease reference, but since the last version of this document has been discontinued as a standalone product. It is now integrated into the fee-based ePocrates Rx Pro product (see the section on Drug References).

There are a variety of medical dictionaries available for the Palm, ranging from consumer-class references to full PDA versions of professional titles. At the top of our list for medical education purposes is the Stedman’s Concise Medical Dictionary, 4th Edition, published by Lippincott, Williams & Wilkins, and available online from Skyscape at www.skyscape.com and from Lexi-Comp at www.lexi.com. The Stedman’s Concise contains 48,000 terms, has clearly written definitions, features common prefixes, suffixes and combining forms. It provides the best balance of price and comprehensiveness-and at 7.8MB, it’s also the pretty big! We found the Stedman’s definitions to be much more technical and useful than the Taber’s-the smaller number of terms in Stedman’s is offset by a larger volume of more useful information on each term, which is why it is bigger, and our choice for both students and practicing doctors. Also available for PocketPC.

For sheer comprehensiveness, the new Stedman’s Medical Dictionary, 27th Edition (available online) cannot be matched, with 102,000 terms defined. This title takes up a whopping 14.4MB on a Palm and 21.2MB on a PPC, so it is advised only for power users with lots of add-on memory. After the Stedman’s, our research has shown the Taber’s Cyclopedic Medical Dictionary 19e to be one of the most strictly comprehensive (55,000 terms) title available, though also quite expensive. Despite this, it is smaller than the Stedman’s Concise, at 6.1MB. The print version has historically been aimed at nursing and allied health professionals, and the definitions are more superficial than those in the Stedman’s, but it is still appropriate for medical education use. One reviewer found that the search by typing each letter of the word is a little slow, but acceptable. A major strength of both the Stedman’s and Taber’s titles (both from Skyscape) is the linkage between all Skyscape products, such as 5MCC and DrDrugs. Also available for PocketPC.

Finally, the Beiks Medical Dictionary ( www.beiks.com ), is a reasonable low-priced option. Marketed as “more affordable than Taber’s,” the Beiks uses Bdicty reader software, and defines the words and common short forms used as well as gives a description in non-formal language about the topic. Although not a professional-grade dictionary, it may be very useful for Med I and II students to get them going. It contains 38,000 terms, and takes up 2.8MB of space. Beiks also distributes a Pocket Medical Encyclopedia, which combines the Bdicty reader with content provided by MedicineNet. Both titles are also available for PocketPC.

To start with, we would recommend reading the article entitled Clinical calculators for hand-held computers, written by Dr. Stewart Cameron (from Dalhousie’s Department of Family Medicine), in Canadian Family Physician magazine (September 2003).

MedCalc
MedMath

Of the hundreds of medical calculators available, the two freeware PalmOS medical calculators listed above are the most useful, and widely used, and are therefore our recommendations. Although there is some overlap between the two, each has different strengths. MedCalc in particular has a feature where calculation results can be saved under a patient’s name, for future reference.

Another free option is Skyscape’s Archimedes medical calculator. It takes up 660KB (big for a calculator), but contains over 70 formulas, and integrates well with other Skyscape products. It also supports both PalmOS and PocketPC units. However, it does not allow you to sort formulas, and it does not accept input in SI units (making it of very limited utility for the world beyond the US borders).

Of the variety of more specialized calculators, PregCalc Pro ( www.medicaltoolbox.com ) for pregnancy-wheel type calculations, DoseCalc ( pocket-doc.com ) for drug dosage calculations, and ABGPro ( www.stacworks.com ) for arterial blood gas calculations are the most widely used, most of which are freeware or shareware. In addition, statcoder.com has a variety of useful (and free) calculators covering protocols for things like cholesterol or perioperative cardiovascular evaluation. There are also free calculators for opioid dose conversions from www.paincare.ca and Johns Hopkins.

Two calculators that are specific to pediatrics are worthy of mention. The first is the free Growth Charts from StatCoder.com ( www.statcoder.com ), which automates the June 2000 revision of the CDC Growth Charts. The second is Kidometer ( www.kidometer.com ), an inexpensive program which contains age-based normals for: Adolescence, Basic vitals, Cardiology, Development, Endocrinology, Growth and Nutrition, Hematology, Laboratory, Prevention, Resuscitation, Trisomy 21, and Vaccine. The latest version (4.4) also includes SI units, which is a welcome change for users outside the United States.

A number of all-in-one programs, such as PEPID, include their own integrated medical calculators. ePocrates has a free suite of calculators named MedTools for ePocrates users (you must have ePocrates installed for them to work). Some of them are available separately, such as STAT Cholesterol.

We have two primary recommendations in this area, the first (DrDrugs) a lower-priced option suitable for undergraduate medical students or those limited to 8MB or 16MB of memory, and the second (LexiDrugs) a higher-priced but also more powerful option for residents and physicians, especially those with 16MB or 32MB units and memory expansion cards. Both titles contain a wealth of accurate information (even in often-neglected areas like mechanism of action and pharmacokinetics), include Canadian brand names, and provide updates without sending personal data to the publisher.

A popular option, ePocrates Rx, is not recommended as a primary reference for Canadian medical education use, although we recognize that it may have a useful role in combination with another reference.

The PEPID Portable Drug Companion is a usable reference that may appeal to users of one of the PEPID clinical products, and the Tarascon Pharmacopoeia also has many fans. Finally, if your institution has a site licence to another drug reference, such as MicroMedex, you should definitely take advantage of that.

Reviews

We have found three useful published reviews of the available PDA drug database software titles:

Clauson, KA, Seamon MJ, Clauson AS, Van TB. Evaluation of drug information dtabases for personal digital assistants. Am J Health Syst Pharm. 2004 May 15 61(10):1015-24.

Galt, KA, Rule, AM, Houghton, B, Young, DO, Remington, G. Personal digital assistant-based drug information sources: potential to improve medication safety. J Med Libr Assoc, April 2005, 93(2):229-236.

Barrons R. Evaluation of personal digital assistant software for drug ineractions. Am J Health Syst Pharm. 2004 Feb 15 61(4):380-5.

Note that these are US publications, and do not include in their criteria the requirement for Canadian trade names & availability, which is clearly one of our major interests.

We also recommend that you visit the RxFiles website, an academic detailing program providing drug information and education to Saskatchewan Physicians & other Health Care Professionals.

www.rxfiles.ca

Make sure to download the “Drug Resources for Hand-held PDA” document, in Adobe Acrobat format.

Titles

DrDrugs from Skyscape (www.skyscape.com) is very good, relatively inexpensive, only about 2.4MB in size, does not return usage information to the publisher, and does include Canadian product names (the present version, unlike earlier ones, doesn’t include Canadian availability, but has several improvements in indexing and background information). The content publisher is F.A. Davis Company, and the full name is Drug Guide for Physicians. It is user-friendly, accurate, and has sufficient information on drug action, interactions and natural products to provide a good knowledge base for students. It remains our top recommendation for undergraduate medical students or others without a prior wide knowledge base in drug information.

The drugs can be displayed in 7 different lists: An overall index; selectively under generic names, brand names or combination drugs; or under natural product, therapeutic or pharmacologic indexes. Each drug file is divided into 15 different sections of information, easily called up from a menu. These include the usual categories of indication, dosage, adverse effects etc; but the information under [mechanism of] action, pharmacokinetics, time/action profile, patient/family teaching – and even pronunciation – makes this software very useful for those learning about drugs for the first time. The content is accurate and has useful links to explanations of terms or to other related drugs. Each drug listing includes extensive basic information on potential drug interactions. DrDrugs lists a large number of natural product preparations and covers many new drugs (although not as well as LexiDrugs). A well-integrated drug interaction package named iFacts is also available, but is 3 MB in size. Also available for the PocketPC.

LexiDrugs from Lexi-Comp ( www.lexi.com ) is probably the most thorough electronic drug reference available. Lexi-Drugs Platinum is the core drug reference. LexiInteract is an add-on program that allows you to review a comprehensive list of interactions associated with any individual drug. LexiDrugs is without doubt the most up-to-date in terms of current drugs available, and has a link to Special Alerts from the main menu. These features make LexiDrugs the most attractive for those who need a reference for daily clinical use; however, it is less ideal for students, who are in the process of acquiring knowledge on drug use and action.

There are only two ways of displaying the drug lists: as an overall index or as ‘pharmacological categories’. The latter is so extensive as to be of limited help in navigating (there are for example 7 groups for adrenergic antagonists/blocking agents). The information content however is excellent. The information is organized under 24 categories, each which can be selected using a ‘jump’ function which is essentially a menu tag. The information is less friendly to the student than DrDrugs, with no handy explanations of the basics, but there are links to other drug groups where relevant, and other Lexi-Comp products. There are no herbal/alternative products listed. Canadian trade names are included (in the “Comprehensive” view), as is a subscription allowing unlimited updates (to update, a complete re-installation is necessary). Overall, this is the software of choice for the professional, but less user friendly and comprehensive for the student.

The main drawbacks of LexiDrugs are size and cost. Together, the Lexi titles can take up to 6.5 megabytes, making use of a memory expansion card essential on 8MB units (it fully supports the use of Handspring flash memory expansion, SD or CF cards, and the Sony MemoryStick). A discount is available if the two titles are purchased at the same time on their website. A 20-use demo version is available. Also available for the PocketPC.

ePocrates Rx (www.epocrates.com) is one of the best-known Palm drug references–largely because it is, and has always been, free. However, there is now a commercial (not free) version, Rx Pro. Unlike the free version, Rx Pro includes an alternative medicine reference, an infectious disease guide, clinical tables, and the MedMath medical calculator, and does get high marks in the reviews shown above; we have, however, not tested the Pro version, and evaluated it for Canadian content. The free version does include a suite of free MedTools, which includes calculators such as STATCholesterol, Physician Psychiatry Compendica, and an IV Drip Calculator (among others). Both come with a PocketPC version (a relatively new development).

It has been widely reported, and discussed within this committee, that by default ePocrates includes a component (AutoUpdate) that, at every HotSync, returns to the publisher a list of the drugs that have been looked up. In addition, ePocrates requests information about the users occupation and specialty, which is ostensibly used to provide appropriate DocAlert messages. The return of usage information to the company, and the storage of demographic information, bothers some people more than others, and we believe these factors should be taken into consideration when making your decision about whether or not to use the title. The company’s explanation about what is done with this information, and how your personal information is kept private, can be found at:

http://www2.epocrates.com/company/privacy.html

ePocrates is simple to navigate, with a general listing as well as a grouping by drug class. The classification is sometimes hard to follow, but is at least of a manageable size (19 classes). The content is basic, with less than the information most students would hope for (much of the material is in the form of lists, with limited explanations). Information on drug pharmacokinetics and mechanism of action is limited. The main concern for those who are unfamiliar with drug information (such as beginning medical students) is that there is some outdated data, especially concerning generic drugs and mechanisms of action. The free ePocrates contains no Canadian trade names, and no information on alternative medicines. Nevertheless, it remains a widely used, user-friendly and well-regarded reference, and its drug interactions feature (MultiCheck) is very popular. Many people, if they have enough free memory, run this as well as another drug reference, and will cross-check between them.

Three Alternatives

Users of PEPID products may wish to consider using the PEPID Portable Drug Companion ( www.pepid.com ), a drug reference product that is included with any of their clinical products (for emergency physicians, family physicians, medical students, nurses, and EMS and EMT professionals). The Portable Drug Companion is independent of pharmaceutical company financing (unlike ePocrates) and does include Canadian trade names, though they are not linked to the main database, and are thus somewhat less useful than the integrated ones include in Lexidrugs. It also includes a wide variety of medical calculators. Our reviewers tended to prefer the LexiDrugs or Skyskape interfaces, but the Portable Drug Companion is a usable and reasonably comprehensive listing, and PEPID users may find it more convenient and cost-effective to use it than adding a separate drug reference. A Pocket PC version is also available.

The Tarascon Pocket Pharmacopoeia ( www.tarascon.com ) is another title that some physicians prefer, for a number of reasons:

Most of it resides on the memory card
It has most Canadian tradenames
Interactions are based on medical letter
It doesn’t report your usage back to the vendor
It has alternative medicine tables (+ID & a/b)

Tarascon also gets good reviews in the published articles listed above, and also is known for having excellent pediatric content. However, Tarascon has insufficient detail for some people. A 30-day trial is available for you to test it out, and we recommend doing this if you are interested.

Some hospitals have site licences to MICROMEDEX (from Thomson Healthcare), which has a downloadable PDA version that focusses on drug and toxicology data, with concise information on alternative medicines and acute care included, and even a Diagnosis tool. This is an excellent title, if a little large and unwieldy to install (it appears to take up 21.5 MB on a Tungsten T5) and for most uses can replace any of the titles above, if you have access to it.

This latest edition (16th) of Harrison’s Manual of Medicine is published by McGraw-Hill, and is based on software from Unbound Medicine (who also support high-end references like the BMJ and Ovid).

The Faculty of Medicine purchases licenses for all Undergraduate Medical Students, and detailed instructions for how to receive the software for free, are available on Dalmedix.

Referenced to the world’s best-selling internal medicine textbook, it contains lots of explanatory physiology and diagnostic information, but also covers adult therapeutics. The PDA version reads like a textbook, so scrolling is required. It would find most use in a hospital environment or Internal Medicine service and is our recommendation for undergraduate medical students (Med1 and Med2).

Harrison’s Manual of Medicine is available from harrisons.unboundmedicine.com. For your subscription you get a perpetual licence to the 16th edition, as well as 12 months of web and wireless PDA access to the same content (a new and very interesting development, which we have not yet tested). It requires at least 5 megabytes of space on both PalmOS and PocketPC.

Griffith’s 5 Minute Clinical Consult, published by Lippincott Williams & Wilkins, is another popular reference work for students and practicing clinicians alike. It provides comprehensive yet concise information on over a thousand topics under the fields Basics, Diagnosis, Treatment, Medications and Follow up. It would be useful in an ambulatory clinic and contains some pediatrics. It is available online from several medical websites (Skyscape, HandHeldMed, Unbound Medicine, and even Lexi-Comp). It requires a reasonably large 4.3MB of RAM (without images).

An excellent all-in-one title is named PEPID, which comes in various specific packages-including one for emergency physicians (ED), one for primary care physicians (Primary Care Plus), and one for medical students (Clinical Rotation Companion Suite). Compared to eMedicine (below) PEPID is point-form and less in depth, so it is easier to look up practical answers rapidly in PEPID. But eMedicine has more complete write-ups, so often the two are complementary. PEPID also has a linked drug database, conversion calculators, lab values reference, a database of medical equations, a table of Canadian trade names and other handy references. We have reviewed the ED and CRC versions in depth, and have found them to be excellent references–in fact, members of our committee are using them on a daily basis. We highly recommend the CRC version to clinical clerks (Med3 and Med4). Also available on PocketPC, Window PC, and online.

The 30th edition of the Washington Manual of Medical Therapeutics, by Lippincott Williams & Wilkins, is also available in PDA format. It provides more information on inpatient therapeutics, and offers drug information and clinical practice guidelines (which are American based, however). It takes just 2.4MB of memory. It can be purchased at discount in bundles from several medical web sites.

Midnight Medicine (from Medical Wizards) is a quick-reference meant to assist Emergency, Primary Care Physicians, Mid Level Providers and House Staff in managing patients during the initial hours of common medical emergencies. It was written by members of the Department of Family Medicine at the Dalhousie University Faculty of Medicine.

Clinical Medicine Consult is a comprehensive electronic textbook written exclusively for handheld computers. The entire collection covers 2,500 topics in most specialties, including 135 step-by-step procedures. There are more than 230 useful line drawings that reproduce very nicely on handheld computers. The content is intended for generalist primary care physicians, including internists, family physicians, emergency physicians, residents, and students. Both learner and experienced physicians working in office and hospital practices find it useful. Authored by a single Board certfied internist (Carl G. Weber), other specialists have edited some sections, and the author invites comments and suggestions from anyone. The entire database requires 5.2 MB memory and the ISilo or MobiPocket reader, and can be stored on an expansion memory card. Individual topics can be purchased as well. A subscription includes 4-5 free updates per year.

At www.eMedicine.com, a variety of useful PDA resources for various specialties are available, in addition to the online material. You can subscribe to and download the entire eMedicine reference collection as a set of PDA ebooks, or individual specialty ebooks. We have reviewed the Emergency Medicine title and found it very useful-in fact one physician reports using it on “almost every shift.” There is some disagreement about how easy it is to navigate and search (especially across separate eBook files), though this concern is really more about the MobiPocket reader than the eMedicine content itself, which is evidence-based, and considered very reliable. Another concern is size: the Emergency Medicine ebook is over 8MB.

Publishers

A number of titles are offered in different versions by different publishers; below is a list of five of the most popular, who between them offer versions of all the titles mentioned above:

www.skyscape.com would be a good place to start looking. This publisher offers many references that cross-index with each other. Their products are easy to use. Many of these titles can be downloaded for a trial period before purchase, so users can ensure the book meets their needs before committing to a purchase. Look for bundled discounts on multiple titles; a residency program discount is also sometimes available.
www.handheldmed.com sells many medical titles (including the Red Book and Merck Manual) that use their free Reader software. This means individual titles require less memory space. They also have free trials and bundles. Their version of the Harrison’s Companion Handbook was discontinued in late 2002 when McGraw Hill put out the 15th edition, but is still available in the software bundle from PCPC at an attractive price.
www.unboundmedicine.com also sells many medical titles (including the Harrison’s Manual of Medicine, 5MCC, and Taber’s dictionary), all with built-in audo-update features.
www.lexi.com, which is known for its LexiDrugs drug databases, but also carries a version of Griffith’s 5 Minute Clinical Consult as well as Stedman’s medical dictionary, which integrate well with LexiDrugs.
www.medicalwizards.com, who publish Netter’s Anatomy Flashcards, Midnight Medicine, and versions of Taber’s medical dictionary and DrDrugs (for physicians and for nurses).

The Canadian Federation of Medical Students has negotiated a substantial discount for medical students with some publishers (go to www.cfms.org for more information). The Canadian Medical Association also provides discounts on both PDA hardware and software to members at their website, www.cma.ca (go to ePractice Tools and click on PDA Centre).

A decision on which medical text(s) to use will depend on several things. Requirements will be different for a clerk and an experienced staff physician. Some texts will do superior jobs in an ambulatory clinic, while an inpatient unit will require a different book. Some people’s preferences may lean toward terse summaries and bullet lists, while others may want narrative text.

Secondary considerations are how much space you have available and your budget. You will definitely want to consider whether you’d like a suite of products that work well together, or prefer a choice of stand-alone titles. Ensure that your choice is evidence-based and free of bias or influence.

Finally, you will want a reference that you find easy to navigate; the most authoritative information will be of little help if you find it too cumbersome to use. Almost all titles have 30-day demo versions; try before you buy.

here is a huge and rapidly growing selection of medically related PDA software available, which makes the selection of PDA hardware seem easy by comparison! To simplify things, rather than listing all of the available software we have instead done our research, and made specific recommendations in fifteen categories. In some categories we have also included some alternative options that may be better suited to some uses.

Note that the Faculty of Medicine is strongly opposed to the use of unlicensed or black market software, cracks, and so-called “warez.” We firmly believe that sharing or using illegally obtained software is behavior that is inappropriate.

Keep in mind that these recommendations are based on the informed personal opinions of the members of this committee, and are not official endorsements by the Faculty of Medicine, or Dalhousie University. Also, these recommendations are geared more towards medical education than clinical practice.

In general, we have listed only software that is of general use and interest; however, more detailed special reports on software intended for particular specialties are in the works, and are being added to the Documents section of this site as they become available.

In this version of this website we have decided to stop giving specific hardware recommendations, because, due to the rapid rate of change in the world of handhelds, this is always the first section to become obsolete, and the hardest to update.

At the time of writing (May 2007), our experience is that most medical students are using either the Tungsten T|X or New Brunswick students get Lifedrive models. Very few students use the Palm Treo. See the Med Students and PDA’s section.

The T|X model has more than 100 MB of memory, and prices of below $400, with prices cheaper at PCPC on campus.

One website that does attempt a complete listing of all currently available handheld hardware is the University of Virginia Health System. The prices are in US dollars, of course.

Note that the category of combined cellphone / PDA “smartphones” is dealt with separately in the Connectivity section.

We encourage you to do your own research, and to seek out the opinions of others as well; for example, you can find a great deal of information on a specific model by going to the manufacturers’ site, or to www.google.com and entering the model name.

No matter what make or model you purchase, keep in mind that although handhelds generally don’t contain any moving parts, they are nonetheless prone to damage when abused. Screens break, styli get lost, and units can die completely when they get too hot, too cold, or too wet. We recommend that you get some kind of padded case to keep your unit in, that you keep it with you at all times (don’t leave it in your car), and that you take care not to drop it or use it to hammer in a nail.