Medication and Mothers' Milk



TechMD in his comment on my post about Drugs in Pregnancy mentioned Thomas Hale's "Medications and Mothers' Milk".

You might be interested to check out Medilact 2002 which is the PDA version of the book.

There is a free Demo which contains 50 drugs to sample.

Each drug can be chosen and viewed on the screen, and if you have an infrared printer, you print the monograph and give to your client, patient, or physician.
I find the last bit really useful and every drug reference should have a "beamable" or printable portion which one can transfer - especially advice for patients.

Updates

Updated the Blogroll Palmblog links on the left - Johnwin's MyPalmLife has a new home and also added Guy's World Palmblog archives. I have highlighted The Doctors' Shack which is a Palm medical discussion forum.

EMG v1.0



EMG v1.0 is a free ThinkDB2 database by Michael Poon.

Description:
ThinkDB2 database of commonly sampled muscles relating to needle localisation method, common pitfalls, activation maneuvres and innervation.

Continuous Ambulatory Monitoring with PalmOS

Well not quite PalmOS alone. Vivometrics has come out with LifeShirt Garment, a device which can "measure pulmonary function - sensors are woven into the shirt around the subject's chest and abdomen. A single-channel ECG measures cardiac function, and a dual-axis accelerometer records subject posture and physical activity. "

"The LifeShirt Garment and peripheral devices attach into the LifeShirt Recorder/Subject Diary a PDA (handheld computer) that continuously encrypts and stores the subject's physiologic data on a compact flash memory card. Subjects may also record time-stamped symptoms, moods, activities and other endpoint-specific information in the Recorder's digital subject diary. These features let researchers correlate multiple objectively measured physiologic parameters with subjective input."

What PDA does it use? Well I suspect that's a Palm in the picture, quite possibly a Handspring (must be with a CF adaptor) ....

Natural Family Planning

NFP 2.4 has been updated and is available for free download.

Description:
A freeware program for tracking fertility, known as the Sympto-thermal Method, Fertility Awareness Method, Natural Family Planning, or Ovulation Method.
NFP is a program designed for Palm OS that allows a woman or a couple to track her fertility using a set of simple daily measurements.

NFP can be used either to avoid or achieve pregnancy.

It can be an effective chemical-free method of contraception, or it can be an inexpensive method of conception.

Another baby tracker

McBaby v1.0d is available for free download.

Description:
Keep track of your babies Birth Information, Doctor Information, Doctor Visits, Sicknesses, First Words, First Actions, Insurance, BabySitters, Check List, Multiple Notepad, and all the Well-Baby Checks from birth to 13 YOA to ensure you don't miss any shots.
Set alarms to remind you. It list the shots and what months to get them as recommended by the United States 2002 Recommended Childhood Immunization Schedule.

SUNY Upstate Medical University uses the latest technology

pdaMD.com features this story on PDA usage in Syracuse Medical University by R. Eugene Bailey, M.D. Yet another MD tells of how a PDA is an essential tool for point-of-care access to medical information.

All may not be lost even without broadband. Have discovered Avantblog and if this post works then I can carry on blogging offline with Avantgo!!

Batteries and bacteria...

Brighthand — Three More Hot Technologies That Could Profoundly Change Handhelds: "When your bacterially-powered handheld starts to run low on power, you won't plug it into a wall socket. Instead, you'll pour in a bit of sugar. The sugar will be converted by a strain of bacteria called Rhodoferax ferriducens into carbon dioxide and electricity.
This is the invention of Swades Chaudhuri and Derek Lovley, who have a prototype that is an amazing 83% efficient. The two say their invention is cheap to make and can be used in environments as cold as 40 degrees and as hot as 86 degrees.
These two are currently working to turn their proof of concept into a real product. They see no reason why a bacterial battery couldn't be as small as a typical household battery today. "

The big question: will such revolutionary battery technology work in a hospital environment? The friendly bugs in your PDA may be killed off by the antiseptic and antibiotics permeating the air.... LOL
I can also predict if this thing works, the little packets of sugar in Starbucks will run out very quickly ;)

Seriously, battery technology needs to improve. The Tungsten T3 is fantastically rich in features. I can put lots more medical software, I can view text and data in widescreen mode, things run super fast BUT the PDA really sucks juice. I am a really heavy user so I had to get the Power-2-Go battery sled in order to use it in my clinic otherwise it wouldn't last the day without it going uncomfortably close to the shut down zone.
Now after my half day clinic ends, I have 100% juice still on my PDA. Without the P2G, by the end of the day, my battery level will be about 45-50%........

I'll be going off on Christmas holidays next week, away from broadband, so I may not be able to blog so much the coming week. My NEC notebook's harddisk just crashed too so all I have is my T3 and an old creakingly slow Twinhead notebook. Hope my co-bloggers can take up the slack!! . Wishing you all a Merry Christmas and a Happy new year!

ePocrates Integrates 5-Minute Clinical Consult

Palm Boulevard: News:

ePocrates plans to release a new handheld clinical reference application called ePocrates Dx, which it said will enable medical professionals to access data on over 1,200 diseases and conditions from the point-of-care.

Due next year, ePocrates Dx is distinct from both print and other handheld versions of the popluar clinical reference, as it will integrate with other ePocrates PDA products and updated and supplemented with content from other ePocrates medial information.

New diseases, or an outbreak of a disease that has re-emerged, for example, will be added to the clinical reference in real-time with users having access to up-to-date information whenever they sync their PDA.

Mark R. Dambro, M.D., the creator and editor of 5-Minute Clinical Consult, said "this partnership will result in a truly integrated handheld application that enables users to access up-to-date prescription and alternative medication drug reference information, an infectious disease database and now a comprehensive clinical reference -- wrapped in one easy-to-use source."

Drugs in pregnancy

A couple days back I wanted to recheck the usage of prednisolone in a patient with AIHA who was breastfeeding. Checking up ePocrates vs DxPreg™
According to ePocrates:
"Not safe for nursing infants; medication contraindicated or requires cessation of breast feeding"
According to DxPreg:
"The American Academy of Pediatrics considers prednisone to be compatible with breast feeding." DxPreg also gave references to studies which states that for maternals doses of 20mg once or twice daily, the nursing infant would be exposed to minimal amounts of steroid. At higher doses, they recommended waiting at least 4 hours after a dose before nursing was performed.

What contrasting advice!! I think the lesson is you've got to be careful when relying on the portable information you carry with you in your Palm. You ideally should carry more than one drug reference since there is no one best "all-rounder".

PS. The BNF has this to say about Corticosteroids in Breastfeeding:
"Systemic effects in infant unlikely with maternal dose of prednisolone up to 40 mg daily; monitor infant's adrenal function with higher doses—the amount of inhaled (sic) drugs in breast milk is probably too small to be harmful"

PDA Use Can Prevent More Than $100 Million in Medical Errors

Skyscape reports:

HUDSON, Mass. - December 15, 2003 - More than half the doctors in the United States use PDAs, and among residents and students the percentage is even greater ­therefore it is essential to understand how physicians can best use this technology to maximize their effectiveness. A new survey, released today, shows significant results about doctors’ increasing reliance on their PDAs and their impact on daily activities. More than 85 percent of the survey respondents pointed to PDAs as helping to reduce the number of medical errors, with more than 50 percent of doctors indicating PDA use reduces their medical errors by more than 4-5 percent. With the National Academy of Science – Institute of Medicine reporting that medical errors cost the healthcare system $2 billion a year, this equates to preventing more than $100 million in preventable drug errors alone. Yet less than 20 percent of medical professionals have their PDA software integrated with the larger hospital IT enterprise, signifying an area where there is still room for significant growth.

·The survey of more than 900 doctors who use handheld computers was conducted by Skyscape®, Inc. (www.skyscape.com), a leading provider of
enterprise-wide mobile medical and nursing reference solutions. Skyscape has researched PDA effectiveness for medical professionals for almost a decade­beginning with a landmark Constellation Project involving a study of Apple’s Newton platform with Brigham & Women’s Hospital, Harvard
Medical School and Massachusetts General Hospital.

“The survey results reinforced what we knew of the benefits PDAs bring medical professionals, but the impact PDAs have when it comes to reducing
medical errors, and improving efficiencies, exceeded our expectations,” said RJ Mathew, vice president, marketing and business development for
Skyscape. “The survey clearly shows physicians have moved into a mainstream reliance on PDAs and medical software for PDAs. The results show that just like the stethoscope, the PDA is increasingly becoming an integral tool in doctors' daily practice and by integrating medical references we can enable doctors and their enterprises to realize even greater benefits.”

Respondents to the Skyscape survey stated that PDA use provides significant benefits by enabling them to spend more time with patients, while still treating more each day, and by improving the overall quality of patient care. Specific results include:

* More than 88 percent of doctors use their PDAs at least four times a day, with 15 percent using their PDAs more than 25 times a day.

* When asked how they use their PDAs, 72 percent of doctors reported they rely on their PDA for treatment purposes­primarily using it for
drug references, clinical references, drug interaction guides or hospital treatment guidelines.

* Almost 90 percent of the doctors concluded that PDAs help them provide better care.

* Over 85 percent of physician respondents agreed that by using a PDA they had decreased the number of potential medical errors. And more
than 50 percent communicated that by using a PDA they were able to eliminate over 4 percent of medical errors.

* When asked to quantify the specific benefits PDAs bring to their daily practice, almost 20 percent of respondents concluded that PDA use
enables them to treat at least three more patients a day, with another 20 percent of respondents concluding that they can treat 1 – 2 additional
patients per day.

* Doctors do not just rely on one reference for their PDA. More than 70 percent of doctors have at least three medical references on their PDA
and 22 percent have more than eight references.

* Medical software for PDAs is increasingly being integrated with other applications but there is still significant room for growth. In each
case less than ten percent of medical professionals reported their PDA software is integrated with prescription, billing, charge capture or patient
records systems.

Skyscape solutions are increasingly being adopted by leading medical institutions, and today more than 240,000 medical professionals rely on
Skyscape-powered references. Over the next year, medical professionals will further increase their PDA usage, with industry analyst firm Forrester
Research reporting that 90 percent of all health systems are engaged in a handheld project or are considering one.

In the top ten for the week

Blogger Forum has chosen The Palmdoc Chronicles as one of the weekly Top Ten BlogSpot Sites

Here's my badge :




:D

Handyshopper and Health databases
Handyshopper 2.8 has just been updated. What's this got to do with Health & Medicine you ask? Well, HandyShopper is a great free shopping list tool, with plenty of features. You can even use it for other kinds of lists!
Visit the Handyshopper discussion group and you can see a list of Health related databases for Handyshopper

Any of you use Handyshopper too?

Cancer Prevention Tools

CA-Tools 1.0 is a free program provided by the Physician Oncology Education Program, under the auspices of the Texas Medical Association and The American Cancer Society - Texas division.
There are Palm and Pocket PC versions available for free download.

Features:
The following applications are contained within the CA-Tools:

· Warning Signs of Childhood Cancer – Provides a list of symptoms and warning signs that may indicate the presence of cancer, especially if they persist.
· Childhood and Adolescent Cancers – Lists types of childhood and adolescent cancers, risk factors, and common signs/symptoms.
· Skin Cancer – Lists various types of common indicators of skin cancer (A, B, C, D).
· "A" for Effort: Smoke-Free Patients – Provides guidance for physicians who are willing to assist their patents in quitting smoking.
· American Cancer Society Screening Recommendations for the Early Detection of Cancer – Describes who should be screened, when, and by what method. Covers Breast, Cervix, Colon and Rectum, Endometrium and Prostate Cancers, as well as a Cancer-Related Checkup.
· Pain Medications – Lists oral and parenteral equi-analgesic doses, as compared with a standard dose of 10 mg of parenteral morphine. It also lists available dosage forms and duration of action of each main medication.
· Drug Calculations – Allows the user to compute dosage equivalents for any two drugs in the database. All calculations are in milligrams and are based on 24-hour usage of medication.
· Pain Management – Lists pain definitions, types of pain, categories of pain, scope of the problems, effects of untreated pain, assessing pain, treating pain and specific pain sites, resources, and JCAHO Standards.
· PSA Information – Provides information to assist physicians who are willing to participate in informed decision-making with patients considering having a prostate-specific antigen (PSA) test to detect prostate cancer.

Opinion:
Free app. Not bad for a Primary Care Physician but somehow I found it not very "meaty" enough. Short on facts and references. The Drug calculator seems buggy and I could not say convert Morphine to Fentanyl.

Pubmed in your Palm

PubMed On Tap v1.2 has been released - completely free.


Description:
PubMed on Tap is an application for PDAs that facilitates Internet access to NLM's MEDLINE database using PubMed ultilies.
PubMed on Tap is a developing application targeted at mobile health care professionals.

The goal of our project is to discover and implement design principles that will facilitate practitioners' access to medical information at the point of service.

Currently the application supports retrieval of MEDLINE® citations from a PDA through a wireless connection to the Internet.

PubMed on Tap options include several PubMed search limits, email of citations, and clustered results.

Impressing your patients with cool gadgets

One of the things about using your Palm in place of a desktop PC or notebook in your office is that it never fails to fascinate patients (I guess they think I'm extra geeky).
I am still using my trusty PPK now with my T3 (and Power to Go for the extra juice). The wireless keyboard looks cool but I would sorely miss the top row for easy access to numbers.



Patients get really fascinated when they see IR printing from my Palm to my Canon BJ50 printer. They are amazed when I tell them my T3 + keyboard combo is still way cheaper than a notebook and much more portable too!

So when you are you gonna get that keyboard? :)

5MCC 2004 from Skyscape
Skyscape has also updated their version of Griffith's 5 Minute Clinical Consult 2004.
Description:
The 5-Minute Clinical Consult 2004 for PDAs is a comprehensive and structured clinical resource for handheld devices, and is one of the most respected sources of information for medical disorders. It covers more than 1,000 medical/surgical conditions and is indexed with more than 7,500 terms and medications to help clinicians locate the desired information quickly.
Features include:
Fully customizable by allowing users to add notes and create new personal topics
Provides more than 85% of updated topics
New topics detail SARS and Zygomycosis
New treatments and medications to reflect newly released drugs
An ICD-9-CM code index
New insights from more than 330 experienced clinicians
Coverage of each topic includes basics, diagnosis, treatment, medications, follow-up, and miscellaneous considerations

5MCC 2004

Palm Boulevard: News: Unbound Puts Consult in Physicians' Hands:


Griffith's 5-Minute Clinical Consult (5MCC), 2004 from Unbound Medicine is a clinical resource for health professionals with Palm OS and Pocket PC handhelds.

According to the company, 5MCC ($64.95) covers more than 1,000 medical/surgical conditions and is indexed with over 7,500 terms and medications to help students and practitioners locate desired information quickly. Users can select subjects from the "Topics", "Medications" or "ICD Codes" indexes and then review the Basics, Diagnosis, Treatment, Medications, Follow-up, and other considerations.

A Doctor in your Pocket

PocketDoctor is an Avantgo Channel which you can access from your offline browser like Avantgo or Plucker. I stumbled upon it when looking for things to add to my Plucker channels. I have found Plucker Jpluck an excellent combo for taking things from the web on your Palm. The beauty is Plucker is free and there is no 2MB restriction which the free Avantgo places - you are only limited by your Ram.
Anyway POcket Doctor is a free medical reference for the layman. It has a mini-encyclopedia called "Heath-E-Ref" where you can browse for medical conditions aphabetically or by body zone. It's not comprehensive but still quite extensive.
I like the DoctorQ section - Suggests questions to ask your doctor, depending on the medical situation, ranging from what to do when prescribed medicine to what questions to ask when going into hospital for surgery
There is also a Doctor-on-call phone service available only in the UK and chargeable at £1.50 per minute.

Free ID related references




Febrile Neutropenia is a free iSilo reference by Steve Burdette.
Description:
A basic one page reference to the approach to and management of fever in the neutropenic patient.
Organized with a hyperlinked table of contents. Compact and easy to use.





Antibiotic Mechanisms is another reference by Steve Burdette

Description:
A one page reference listing the mechanisms of action of antibiotics. Hyperlinked table of contents makes it easy to find the drug you're looking for.




Overwhelming Postsplenectomy Infection

Description:
A basic one page reference to overwhelming infection in the patient with surgical or functional asplenia.





West Nile Virus 2003 is a reference by Bob Hoyt

Description:

Very nice, easy-to-use reference to West Nile Virus infection. Includes case definitions, lab diagnosis, and clinical management. Well organized with a hyperlinked table of contents and bookmarks. Get it!


Zoonotic Diseases Tutorial by Chris Olsen

Description:
Compilation from a veterinary medicine website detailing zoonotic infections (infections that are transmitted between man and animals). Includes lots of details about background information, organism life cycles and symptoms but doesn't detail treatment in humans. Overall, a nice collection of information that could make interesting reading during down times.

Another mnemonics program

Differential Diagnosis Mnemonics v1.0 has just been released by Michael Ward.
Description:
This program helps healthcare providers come up with a differential diagnosis based upon the chief complaint.
Original, useful, easy to remember and thorough mnemonics will help providers in identifying the cause of the patient''s chief complaint.

The download is from Freewarepalm.com but apparently it is a demo version and the full version has to be purchased from the author

The future is wireless

A couple of WiFi news items from Palm Boulevard.

Palm Boulevard: News: Tungsten C Finds Way into Hospitals tells of Tungsten C devices being deployed in hospitals. Medical centres cited as examples are the Brigham and Women's Hospital in Boston, Sacred Heart Medical Center in Spokane, Indiana-based St. Mary's Health System and Detroit Medical Center and Wayne State University.

Direct Web Access to Patient Data details how QDX Physician Portal "enables doctors, surgeons, nurses and consultants to have real-time access, via a Web browser, to a patient's electronic health records and test results, allowing them to review lab and test results as well as all of an organization's clinical, financial and demographic information in an aggregated fashion. "

Diagnosaurus - FREE Differential Diagnosis Tool!
http://books.mcgraw-hill.com/medical/diagnosaurus/index.html
Diagnosaurus is a free differential diagnosis (DDx) PDA tool from McGraw-Hill Professional. It is available in both PalmOS and PocketPC. Try it! =P