HaemOncRules 1.0 Released

Well I think I have debugged to the best of my ability!
Version 1.0 completed. There are 14 modules comprising algorithms in Haematology-Oncology for computing diagnostic criteria, prognosis and assisting in clinical decision making.
This is freeware and please do beam to other colleagues who might be interested. I welcome suggestions for improvement and additional modules.

Download here.

I hope to see it released on Freewarepalm, Palmgear and Handango soon. The latter two's submission area's down for the moment but I have submitted it to Freewarepalm.

Are you Up-To-Date with Repligo?

As an UpToDate subscriber, I can attest to the site as a fantastic resource for many medical specialities. Online access is easy and they also provide a set of CD-Roms. What more could you ask for? I want to be able to carry the stuff on my Palm of course!! Sadly they do not support PalmOS (it is available though for PocketPC).

This got me thinking. I do want to carry with me some of their articles on my Tungsten for reading away from my PC and on my Palm. I first tried iSiloX but for some reason it did not work. I then tried the Repligo solution. Repligo is a fantastic Document viewer for the Palm. To convert web pages, you just need to select Print and then the Repligo printer driver. This works very well for other documents like Word and Adobe. The converted documents turn out quite nicely, images and all. They can be stored on SD card as well so it saves considerably on space.




Lots of articles, journal reprints are in Adobe Acrobat format and previously I have had less than satisfactory experience with Adobe's Palm reader. Ansyr's was only slightly better. I can say Repligo leaves the competition in the dust. Highly recommended.

Handango's Best Medical App

The recent Handango 2003 software champion award winners have been announced and the best software award in the Medical category goes to Patient Keeper Personal.
The panel of judges comprised 17 people from the IT industry. I could not see what criteria were set. Nothing against PatientKeeper here, it's a great patient tracker software (but personally I prefer to enter just brief details into the builtin Addressbook database using Agendus as it's too slow to enter a lot of things on your Palm) - what I question is that there were no judges from the Medical field to judge the best medical app.
So.....
Palmdoc's vote for the Best Medical App of 2003 goes to..........

MEDCALC 4.3


What's your favorite medical app?

Contractometer

Just when you thought everything that there was to be programmed about women's health from the mentrual cycle thru pregnancy calculators had been programmed, then comes along something spotted in FreewarePalm: Contractometer v1.0.2.
Description:
Contractometer is a program to help with timing contractions.
It calculates lots of data about contraction intervals and durations so that you can tell how things are progressing.
Good for midwifes and doulas.
Expecting mothers might be interested in this also.
It calculates due dates using several common formulas too.

Well you cannot help but give the guy credit for an original idea. The author Jason Stracner even has a blog dedicated to this program.

Doctor's Orders-Complete by DaMilTech Systems


Spotted in Handango: Doctor's Orders Complete - looks like a complete health tracker which would be useful for patients, particularly those with long-term illnesses like hypertension. Not only does the program have a Blood Pressure tracker, it also allows you to track your Prescriptions, your Appointments, your Weight and your Calorie intake.
I haven't tested it out but users are giving it 5 star ratings.

HaemOncRules 0.6
Continuing to add more modules to the HaemOncRules project. I now have a grand total of 11. Phew the fingers are getting tired :)
I envision the application as a handy tool for looking up diagnostic criteria, scoring, prognostic tools and the like in Haematology-Oncology. Probably will be handy to Haematologists as well as trainees and perhaps MLTs. The final version will be released as freeware. Once I get some more modules in I shall email it to some colleagues for feedback but if any one wants a copy, they are welcome to email me for one. I'm no Don Thomas so I guess this will be my little contribution to Haematology ;)

HaemOncRules 0.5

Now that I have completed Fatcalc, it's on to the next NSBasic project! This time it's something more relevant to my practice - I have always wanted a collection of calculators and programs to generate the prognostic scores/indices/diagnostic criteria in Haematology/Oncology.
It's slow going but hopefully the final product will be useful to all Palm toting Haematologists out there (will the five of you please put up your hands?)
Seriously what I hope to receive is any suggestions on what Rules/Scores or anything in the HaemOnc field which users might want to see in the program....

WMD Swag

"Quickly analyzes your observations at a disaster site and provides a fast, scientific guess of which agents of mass destruction are most likely involved."

Palm OS Handheld version integrates with BioChem (database of 30 chemical and biological warfare agents, suggesting treatment, drugs, dosages, lab tests to help deal with victims). Quickly hop back and forth between WMD SWAG and BioChem without need to pass through the handheld's main menu.

Hmmm. a WMD and biological agent pocket guide. Might be useful to some but I doubt if it will be useful in Iraq if you are looking for WMD there ;)

Blood Pressure Manager
Before you part with $$$ for UTS Blood pressure tracker, you may be interested to know that there is a freeware Blood Pressure Manager written by Rafael Andres Marin de la Cruz. The website lists the current version as 2.7 and seems to be last updated in 2001. I can verify that it works on OS 5.0 as it seems to run flawlessly on my TT.
This is an excellent freebie and you can track multiple "series" or users. There are weekly and daily averages and other nice plots.




Features:
For each reading tracks: date, time, systolic and diastolic pressure, pulse and a notes. If the notes begins with a numerical value then you can plot it in the notes graph. This feature is useful for track the body weight.
Different series of data. This feature is helpful for those that wants to track more than one person on the same handheld.
Readings selection. This feature permits to select a group of readings and see the related statistics and the graph for it.
Overall, weekly, hourly and season averages/minimums/maximums statistics for systolic pressure, diastolic pressure and pulse.
Line graphs for pressure, pulse and notes values
Systolic and diastolic average lines graph
Systolic and diastolic histogram graph
Bar graphs for pulse and notes
Graph customization with the preferences
Reading information popup window when you tap in the graph.



Best part is that there is an export utility for you to generate a CSV file for use in programs like Excel. The author has also included a Windows Desktop module which reads your Palm data.
I think this is one real gem of a freebie for all Palm owners who wish to keep good records of their blood pressure. Well done Rafael!

Palm Boulevard: News: Email Blood Pressure Stats to Doctor from a Handheld

"UTrackSys.com, a maker of multipurpose tracking software for Palm OS handhelds, has updated UTS Blood Pressure to version 1.4.

According to UTrackSys.com, it has found that the majority of UTS Blood Pressure users regularly print out their tracking results or send them via e-mail to the doctor. In the new version, UTrackSys.com has added an E-Mail Report that makes it easier and faster for users to send blood pressure reports to their physicians straight from their handhelds."

I am still waiting for the day when the BP set itself can communicate with the PDA (ideally wirelessly e.g. over Bluetooth) and one can automatically store the readings on the PDA e.g. for charting, emailing/sms one's Physician. If done over Bluetooth, then you wouldn't have to worry about compatible cable connectors, just a Bluetooth capable PDA. Now isn't this a fine idea???

Fatcalc 1.0 released
I have released Fatcalc 1.0 for download from Palmgear.com. The final product has been compiled into one whole PRC so one does not need the NSBasic runtime. I was wrestling with whether or not to release this as freeware but in the end decided to put it up as shareware where the proceeds go to the LyfeLine Leukemia Fund of which I am a commitee member.
Application Description:
Estimates your Body Fat according to BMI, Ideal Body weight and Fat content. Also calculates your BMR, Daily Calorie requirements and has a guide to how many Calories you'll burn according to type of physical activity/exercise.You can Load/Save your data so that you don't have to re-enter measurements. This will also allow you to keep track of your weight and other measurements by Date.The program can also Export calculated measurements to Memopad.This program is **fully functional** even if unregistered. Registration allows you to disable the Splashscreen at startup. Proceeds from registration go towards a leukemia charity fund.

Palm Powered Medicine
There is a very good write up on Medical Palm computing at Palmsource by Kent "Ectopic Brain" Willyard.
It's a very comprehensive piece with lots of links to useful software and sites, so it's highly recommended reading whether you are new to Palm computing or a seasoned user.
The obvious omission Kent has made is a link to the Palmdoc Chronicles :P I guess his ectopic brain must have slipped a bit :P

NIOSH Pocket Guide to Chemical Hazards

Today I read with horror that the Paraquat ban might be reversed all because of some intense lobbying. So much about concern for environmental and occupational health safety.
I also came across this free iSilo Document, NIOSH Pocket Guide to Chemical Hazards from Memoware.

The blurb:
The Pocket Guide is 'a source of general industrial hygiene information on several hundred chemicals/classes for workers, employers, and occupational health professionals'. It contains TLV, PEL, BEI, and physical constants, in addition to descriptions of harmful effects and emergency management. Chemistry, medical and safety professionals will find it valuable.





I looked for information on Paraquat and it's there. Very handy. You get to look up via hyperlinks, information on Exposure Limits, Personal protection methods, First Aid etc. This would be a great addition to the pocket library especially for those in the Public health/Occupational healthcare field.

A doctor's PDA ... New system helps doctors keep patient info close at hand - baxterbulletin.com

"As oncologist Dr. Bruce White makes his hospital rounds, he carries the medical records for all his patients in the palm of his hand, available at a keystroke"
I am so envious whenever I read news items like this. It's such a pain having to go to the computer terminal to look up lab results or worse still trying to call the lab...
It would be even better if one could access records and lab data real-time e.g. over WiFI but of course security issues need to be addressed.

As for me, I have to manually key in the lab data and notes directly into the Palm after looking them up in the computer terminal. I use Agendus and the data is logged into the Notes field of the patient's contact info. This is all handy but can make the Notes field very cluttered. I am hoping to see an App which can keep the labs and medical data separately yet integrates with the Datebook/Agendus scheduling and built-in Addressbook i.e. the calendar and contact into are not separate databases. Another NSbasic project???

What about PDAs in exams?

Ectopic Brain blogged about the Uni of Louisville loading Skyscape references on to PDAs and giving (goodness, where is this funding coming from?) them to med students. I wonder if the faculty will accept the pervasiveness of PDAs and permit them to be used freely in the wards and even examinations? One could argue the expanse of medical knowledge is so huge that the human mind cannot retain every important medical fact. It boils down to not how much you can recall but how skilful you are in knowing where to seek the information. After all isn't the PDA now our ectopic brain?
So during the clinical viva, the candidate may now say "Sorry sir, I can't quite recall all the differential diagnoses of [enter rare condition here], but I have it right here on my Palm", whips out his SonyTG50, and blurts, "and they are......."

Fatcalc v 0.99

Well it's almost done. Just putting the finishing touches to the code and doing some more debugging. What started off as an NSBasic exercise to produce a program which will calculate Fat content has gone on to something more elaborate.

I've put in Load and Save data options as I realise it will be cumbersome having to constantly key in measurements. There are drop down menus which generate a more detailed description on the fat/weight data calculated. As per Ectopic Brain's suggestion I have also put in a page on how many calories one will burn according to physical activity. I hope to finish the program by this week.

FreewarePalm: Diet Tracker v0.1
Yet another diet app. Haven't tested it out myself but its free so worth checking out.
The blurb:
Need to lose weight? This application helps you to take control of your diet.
By tracking your weight and the foods you eat each day, you will quickly see how many calories / kilojoules you''re consuming and what adjustments you need to make to get in shape.
You can set yourself goals, such as how many calories you should consume in a day, or how many grams of fat.

Fatcalc version 0.5
Been trying my hand at NSBasic. I must admit my standard is nowhere near as good as Ectopic Brain's (e.g. his wonderful Medrules) or the gurus like Mike Verive who is actively helpful in the NSBasic webboard.
As there doesn't seem to be an app which does fat calculations in cm and kg, I decided this would be a nice NSBasic exercise.

Captures essential data



Outputs your "fatness" as determined by Body Mass Index, Ideal Body Weight, Fat Content. Also tells you your daily calorie requirements according to level of physical activity.
Still some debugging to do.....

Skyscape apps for free
At least if you can convince your pharma rep to get one for you ;)
Now this Skyscape Pharma initiative is a good idea. So instead of all those ball point pens, writing pads, torniquets and other useless freebies, why not get them to sponsor something really educational?

The Massachusetts General Hospital Handbook of Neurology
Any neurologists out there? Skyscape has recently released the MGH Handbook of Neurology.
The Skyscape blurb:
Neurology, neurosurgery, and internal medicine residents and practitioners will find this PDA an essential reference for their day-to-day practice. Blending neurology and general medicine, this PDA-based product includes protocols, step-by-step tests and procedures, and decision-making algorithms. It covers all related topics such as neuroanatomy, neurosurgery, and radiology and highlights topics on the neurology board

In search of.... a body fat calculator
This at first seems harder than finding Nemo. At times, it may be useful for physicians to dose drugs (say the very hydrophilic ones compared to the lipophilic drugs) according to lean body weight rather than total body weight. Surprisingly, fat content is not included in the comprehensive list of stuff in MedCalc or MedMath.
The only one I could locate was US Army body fat % calculator 2.0 which is a shareware (US$4.95) from Cellica Software. It looks pretty with all the colours but it unfortunately limits entry only to inches (these Yanks need to join the rest of the world in the 21st century!). It does however allow one to store measurements for retrieval later.
Still it's not what I am looking for so it looks like another DIY job coming up. Stay tuned......

Statcoder's JNC-7 Hypertension
Stat Hypertension is in beta and an FOC download. Looks like the prolific Andre "Statcoder" Chen has done it again. I did try out RediReference's iSilo version but found it a hassle - one has to launch iSilo first then when opening the document, one has to always key in "7" as the password to access this free document (is this just to incovenience us or piss us off?)
In the end I much prefer Statcoder's version as:
1) You don't need to launch iSilo. It is "standalone"
2) Navigating between the different sections is pretty fast.
The downside is it is monochrome and doesn't look as nice. It works better and is more practical as a quick reference. If you want to just read about the JNC-7 guidelines , then go for the RediReference iSilo version.

Added Blogrolling.com's Blogroll facility. Now I can Blogroll without the hassle of editing the template.

Internal Medicine On Call

Skyscape has just released IM On Call which looks to be a great reference for those of you still doing Internal Medicine calls (Palmdoc has long since stopped doing these). I like the idea of a portable reference which is problem orientated rather than disease orientated so I think this will complement references like 5MCC quite nicely.

The Skyscape blurb:
A concise, portable reference that focuses on the evaluation and treatment of over 60 of the most common internal medicine on-call problems (now updated with three new problems: dizziness, overdoses, and pruritis). Each on call chapter includes a presenting problem, immediate questions, differential diagnosis, laboratory and other diagnostic data, and treatment plan.

Use the ON-CALL series when you want “on-the-spot” treatment advice for the most frequently encountered problems in internal medicine.

Carry ON CALL if you need a comprehensive overview of the initial evaluation and treatment of more than 60 of the most common problems seen daily on the wards.
Unique ON CALL FORMAT is organized for quick access to essential information you need to manage patients efficiently.
Thoroughly revised on-call problems reflect current practice and treatment options.
NEW ON CALL problems: dizziness, overdoses, and pruritis .
ON CALL Therapeutics section offers a quick reference to commonly used medications and includes both generic drugs as well as vitamins, minerals, and natural products .
Must-have reference for students and residents.

The interface is the familiar Skyscape one - very practical and easy to use.

You're still doing calls? At US$44.95, highly recommended.....

The App That Weight Watchers Tried To Kill

While surfing along and looking for diet software (not that Palmdoc is overweight, my BMI is 23 thank you, just curious as to what is available, FOC of course) I stumbled on an interesting story.
Taken from Wired:

Bob Withers wanted to take off a few pounds, so he joined Weight Watchers. The Dallas-based programmer quickly discovered the diet's main problem: It's fiendishly complicated. To succeed, members must obsessively log the "point" value of every hamburger, apple, and celery stick they consume.

Withers - who didn't want to do all that counting - whipped up WWCalc, a Palm OS-based app that automates the tracking process. Just enter what you've eaten, and it assigns the points and adds them up. He put the software on PalmGear.com last December - and observed with delight as nearly 17,000 other WW dieters flocked to download it for free.

Then came the inevitable cease-and-desist letter. Because WW's point system is copyrighted, Withers was told he had to take his software offline. He offered to give it to the company for free, but no dice. Withers suspects that WW, which declined to comment, didn't want competition for its own, $12.95-a-month online tracking tool. "They came off as pretty moneygrubbing," he complains.

His revenge is sweet: WWCalc has become an illicit pass-around hit among dieters, who email and beam it to one another - a viral phenomenon Weight Watchers can't quash. As for Withers? He's lost 50 pounds.

- Clive Thompson

Bob still maintains a WWCalc documentation site and you can view the screenshots there.
I am surprised Weight Watchers did not jump at his offer for the wonderful Palm program he came up with. It's a great journaling app for dieters and you can keep track of the things you've consumed each day, your WW points etc. The great thing is it reads food databases in List format.

Getting the BNF in my Palm

--Details removed at the request of the BNF--

I've been syndicated as well
Chris Paton of Doctors Gadgets has included the Palmdoc Chronicles RSS Feed. Sorry the formatting is off but I don't know how (if this is possible at all) to tweak the settings in the RSSify program.
Doctors Gadgets looks like a really cool site. Well designed and packed with info for the gadget happy medico (hey I know alot of these!!)

Antivenom handbook
Years ago as a young medical officer, I was posted to a rural district general hospital where admissions for snake bites were a daily affair, the poisonous snakes in the locality being Pit Vipers which caused systemic bleeding as a result of envenomation. The other poisonous snakes in Peninsular Malaysia btw are cobras, coral snakes and sea snakes.
I was interesed to see James Quok come out with the Antivenom handbook which is an iSilo conversion of the Australian CSL Antivenom Handbook. Unfortunately it doesn't list the management of pit viper bites as it covers only the poisonous bites of Aussie snakes and other creatures like jelly fish and spiders. Nevertheless it has some pretty useful general info like "first aid for snakebites" and "pressure immobilisation method" etc. There is detailed info on speciifc treatment for the various bites and even venom detection. The latter info will unlikely be of use unless you very unfortunately happen to encounter some of the nast inhabitants Down Under like the Taipan, the "world's deadlest snake" with a bite 50x more deadly than a cobra's ......

Advanced Cardiac Life Support 2000
ACLS 2000 v2.1 is a freeware iSilo document by Stephen Tam. It's just been updated 4 July 2003.
The blurb:
It is a quick reference for all busy physicians in the latest International Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.
The International Resuscitation Guidelines 2000 is a consensus on science among organizations of different countries including the American Heart Association, European Resuscitation Council, the Heart and Stroke Foundation of Canada, Australian Resuscitation Council, New Zealand Resuscitation Council, Resuscitation Council of South Africa, the Latin American Resuscitation Council and from Japan

Scalpel, Swab, PDA
There's an interesting article on PDAs in the June 5 2003 issue of the Far Eastern Economic Review.

Some interesting facts I learned:

- about 30,000 of Skyscape's 170,000 customers live in Asia--from Taiwan, Singapore, China, and Japan to Hong Kong, Thailand, Malaysia, Indonesia, South Korea and the Philippines
- Skyscape founder and chief executive Sandeep Shah, launched the company in 1993. Shah, whose wife is a physician, realized that doctors seeing patients in different hospital wards, or on calls, needed access to medical texts that they couldn't carry on their rounds. PDAs offered the perfect solution to Shah, a graduate in computer science from the Indian Institute of Technology in Bombay
- Skyscape has converted more than 264 medical reference texts for PDA use

Doctors in Asia give Skyscape high marks. Ng Yih Yng, a doctor with the Singapore military, who is currently participating in a United Nations peacekeeping mission in East Timor, recalls using his PDA when he had to treat a child suffering from acute renal failure.

"We had to figure out the doses of medication and it would have taken a lot more time to verify the dosages on the Internet," he explains. "You usually can get your answer within a half a minute using the PDA--whereas it might take five or 10 minutes on the Internet."

Stedman's Medical Dictionary
The other day, someone asked me for a recommendation for a good medical dictionary and I told him I thought Stedman's was the best there is for the Palm.
I was only aware of the Skyscape version of Stedman's.

Now I just stumbled on PocketLingo Medical - American Heritage Stedman's Medical Dictionary by Harvard Language Company, LLC
The blurb:
PocketLingo Medical turns your PDA into a reference and learning tool that will enrich your vocabulary effortlessly and quickly. Using The American Heritage® Stedman's Medical Dictionary, PocketLingo Medical gives you clear, authoritative definitions of up-to-date entries in all areas of medicine. This software also helps you expand your medical vocabulary by using proven learning methods, such as study cards and a customized word list.
The American Heritage® Stedman's Medical Dictionary combines the expertise of Stedman's medical dictionaries with the clarity of the American Heritage® dictionaries to produce an indispensable reference for general readers, medical professionals, and professionals in allied and related fields.

PocketLingo's version retails for US$26.95 whereas Skyscape's retails for US$49.95 (39.95 for the concise version). Don't you love free markets ;)

Pacific Primary Care
CG Weber has been so active producing e-medical books for the Palm I've got to mention his products on this blogspot though I must admit I haven't tried them. They seem very suited for generalists/primary care practitioners though.
The Clinical Medicine Consult v3.6 was updated and released in June this year.

The author's blurb:

Fully indexed with over 2,500 clinical topics for rapid reference.
A complete medical textbook.
This is iSilo file with multiple cross references and hyperlinks for fast navigation.

Includes all the current Clinical Medical Series titles:
Clinical Endocrinology, Neurology, Orthopedics, Nephrology, Dermatology, Gastroenterology, ENT, Psychiatry, Urology, Infectious Disease, Women's Health, Hematology/ Oncology, Geriatrics-Death & Dying, Rheumatology, Pulmonology, Allergy, Pediatrics, Critical Care, Trauma & Tox, Ethics-Alternative Medicine-Evidence Based Medicine-Communication, Cardiology, Wound Care, Travel Medicine, Procedures and Ophthalmology. **>230 line drawing illustrations.

The space it will take up on your PDA will be 5.2 MB (the typical Pocket PC is 64 MB, 8-64MB on palm, more if you add memory cards).

Free upgrades for 1yr. Expect updates 4 X/yr. The FREE DEMO is 332K and contains the basic layout with live links to each chapter with sublinks to 1-2 topics per chapter and a few active links in the INDEX. Both require the iSilo reader.

Over 180 Step-by-step Procedures Included!
No other text on the market provides succinct and clinically relevant material that can be accessed at the bedside. This download is a non-expiring file (it never expires) We do and will continue to offer all past subscribers a "two years for the price of one discount". Thus for a nominal charge, you can continue get all the latest medical updates on a quarterly basis along with continual improvement in the program with additional topics added or enhanced with every new release.

All for US$49.99 - what a bargain!! If you are a happy user, please let me know what you like about this product. I am quite tempted to get it myself.....

Blimey, where's the BNF?
Speaking about drug references on your Palm, a subject I've already blogged about, the glaring missing link seems to be the venerable British National Formulary. Kudos to the BNF people for making the current edition available online. They however state in their website that "Current internet technology is not sufficiently reliable to deliver information for use in clinically critical situations. " These Brits should realise that current PDA technology already makes it possible to have the information in your Palm during critical situations. Besides, their counterparts in the Antipodes already have a version of the MIMs for PDAs. If the BNF ever comes up with a PDA version, somebody drop me a line! I'm still waiting........

Interacting with iFacts
The Palm saves the day again. When you need a quick reference for possible drug interaction, it's nice to have the facility to check for one right with you all the time. I had a patient with Erythema multiforme and agranulocytosis - she was on Carbamazepine but had been on this for many years. Likely to be a Carbamazepine adverse effect but why so delayed? A bit of history taking reveals a neurologist at another hospital had put her on Lamotrigine. Am not a neurologist so needed some help here. Whipped out my T|T and launched iFacts. Sure enough the answer was there, clearly stating "serum levels of the active epoxide metabolite of carabmazepine may be elevated, increasing the risk of CBZ toxicity"

The Skyscape blurb: iFacts™ is the handheld version of Drug Interaction Facts, a best selling drug interaction analyzer covering thousands of brand and generic drugs. iFacts™ enables the practitioner to refer to accurate and reliable information regarding drug interactions at point of care. Skyscape indexes the information on your handheld by group, significance, and by generic and trade name, allowing you to access the information that you need in a professional and efficient manner. Do not waste time worrying about the possibility of adverse prescription interactions when you can justify your hypothesis with iFacts™ in just seconds!

I think a PDA for checking interaction is invaluable and indeed may be life saving. The freebie ePocrates has a builtin interaction checker so there's really no excuse.....

Comments?
Added the Haloscan commenting system to the Blog. Am now seriously considering opening up this blog to other busy Palm toting medicos! Anyone interested please Email me