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Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Top 10 Applications for your PDA: Practicing Information Mastery at the Point of Care
Scott M. Strayer, MD, MPH
Department of Family Medicine
University of Virginia
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Learning Objectives
• What is Information Mastery and how to practice it at the point-of-care.
• Choosing the right Personal Digital Assistant for your practice.
• How to turn your Personal Digital Assistant into a Medical Digital Assistant.
• The top 10 applications for your Medical Digital Assistant for practicing Information Mastery at the point-of-care.
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
How do we learn?
• Adults learn by solving problems
• Our “problems” = clinical questions
• CME can highlight advances and make us
aware of our deficits
• Answering clinical questions in the context
of a real case at the point of care is how we
learn
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Clinical questions• They’re common: Average 1 question for every other
patient • They’re important
– Only 1 in 3 questions pursued– Found “answer” 80% of time– Guess at 70-80% of information needs!– Journals only used to answer 2 of 1101 questions in busy
practice– Books, colleagues used most often
Ely JE. Analysis of questions asked by family doctors regarding patient care. BMJ 1999;319:358-61
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Clinical Questions
• Internal Medicine Residents– 2 for every 3 patients
– 29% pursued
– textbook (31%); journals (21%); attendings (17%)
• Patient expectation, fear of malpractice associated with seeking answer
• Lack of time (60%), forgot (29%).Am J Med
2000;109:218-33.
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Information Mastery and Computers
Slawson DC, Shaughnessy AF, Bennett JH. Becoming a Medical Information Master:Feeling Good About Not Knowing Everything. The Journal of Family Practice 1994;38:505-13.
Can be reduced bycomputers
Usefulness = Relevance x Validity Work
Not always assessed by software
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Computers to Drill for the Best Information
Web, InfoRetriever
InfoRetriever, JournalWatch
Best Evidence
CogniQ, BMJ, FPIN
Unbound, Skyscape
Use
fuln
ess
CogniQ, SkyscapeMedline
Reviews/Textbooks
POEMs
Clinical EvidenceClinical Inquiries
Cochrane
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Choosing EBM Sources1. How is the information filtered?
– Patient- vs disease- oriented?– Specialty-specific?– Comprehensive? Which journals?– Does it matter (it should change my practice) or is
it simply news?
2. Is the information valid?– Is level or strength of evidence labeled?– Beware “Trojan Horse”!– How often updated?– Evidence or expert opinion
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Two Tools Needed to Master Information
• A method of being alerted to new information (foraging)
• A tool for finding the information again when you need it. (hunting)
• Without both:– You don’t know that new info. is available– You can’t find it when you do
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
So, Which Handheld Should I Buy?
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Pocket PC Models
Dell Axim X30 Dell Axim X50 HP IPaq 2215 HP IPaq hx4715
Casio EG800Premium Asus MyPal A716
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Website for PDA Comparisons
• http://www.healthsystem.virginia.edu/internet/library/services/computing/pda/
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Interactive PDA Choosers
• http://www.davespda.com/resources/recommend/index.htm
• http://www6.activebuyersguide.com/abg/nav/StartGuide.cfm?CatID=12&PID=0X6X98X149243Xdac52&RefID=0
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Websites for Handheld Programs
• www.pdamd.com- great reviews, for physicians specifically
• www.palmgear.com-shareware, freeware and commercial programs.
• www.handango.com-shareware, freeware, and commercial programs.
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Websites for Programs
• www.handbase.com-programs that run on the database program “HanDBase” (many of them are free)
• www.handheldmed.com-physician reviews for Palm Pilots and Windows CE handhelds
• Pbrain.hypermart.net-many useful programs.
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
More Web Sites
• Medical Piloteer Ring healthypalmpilot.hypermart.net/webring
• www.pocketpc.com
• Many useful and convenient links for medical programs on the Palm Pilot.
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
How to Download and Install Handheld Software
• See http://www.pdamd.com/vertical/tutorials/guides/installpalm.xml (for Palm OS)
• http://www.pdamd.com/vertical/tutorials/guides/installce.xml (for PocketPC)
• These are the best tutorials I have seen yet.
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Presenting The Top 10….
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
#10 Your Favorite Textbook on your Handheld
• TextBooks: http://www.skyscape.com; www.unboundmedicine.com
• Merck Manual and 5 Minute Clinical consult on Palm or Pocket PC handhelds.
• Also available: Harrison’s, Neofax, PDR, Emergency Medicine (Cline), Surgical Pearls, DeGowin and DeGowin’s Diagnostic Examination, Obstetrical Pearls, Gynecological Pearls, Red Book, 5 Minute Pediatric Consult.
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
#9 An Immunization Schedule
• Shots 2005-vaccination recommendations with information on all vaccines and catch-up schedules (available at www.immunizationed.org).
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Shots 2005 for Palm
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Shots 2005 for Pocket PC
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
#8 Medical Calculators
• MedCalc for Palm (www.palmgear.com)
• Archimedes for Pocket PC (www.skyscape.com)
• ABG Pro (www.stacworks.com)
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
MedCalc
• MedCalc-formulas for creatinine clearance, fractional excretion of sodium, IV fluid rates, number needed to treat, post-test probabilities, predicted peak flow, pregnancy calculator.
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
MedCalc on Your PDA
Main Menu Calculating FENA
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Medical Calculator for the Pocket PC
• Archimedes-free calculator that has all the same calculations as MedCalc.
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Archimedes on your Pocket PC
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
ABG Pro
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
#7 Information Mastery Calculators
• MedRules (http://pbrain.hypermart.net).
• Handheld Computer Smoking Intervention Tool (www.smokefree.gov/hp-hcsit.html).
• Fine’s Rule for Pneumonia (www.ahrq.gov)
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
MedRules
• Medrules-Gail breast cancer risk, bishop’s score, Goldman’s score, APACHE II scores, Sinusitis predictor, UTI predictor, Appendicitis score, Pharyngitis evaluation, Ottawa rules, and many more.
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
MedRules on your PDA
Main Menu Bishop’s Score
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Handheld Computer Smoking Intervention Tool (HCSIT)
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Fine’s Rule for Pneumonia
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
#6 OB Wheels
• PregCalc Pro (www.medicaltoolbox.com).
• PregTrak (www.stacworks.com).
• Due Date Calc (www.handango.com).
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
OB Tools
• PregCalc Pro-allows you to enter LMP, EDD or U/S data to calculate EGA, EDC, etc. Allows you to save patients.
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
PregPro
-Set LMP-Set EDD-Confirm U/S dating-Lab reminder-Saves patients
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
DueDateCalc
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
#5 Daily Updates from the Web
• AvantGo (www.avantgo.com)
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
AvantGo Mobile Internet
• Free! - http://www.avantgo.com• Web-based (content written in HTML)• Users subscribe to “channels” (specially-
formatted Web sites)– Commercial– Private
• Automatically updated with each HotSync
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
• A Student's Guide to the Medical Literature, PDA VersionURL: http://denison.uchsc.edu/SG/PDA.htmlAuthor: Katherine McLucas, University of Colorado Health Sciences Center medical studentOperating System: Palm OS, PocketPC, WinCE
• A how-to guide developed for medical students on appraising the medical literature. Covers how to frame research questions, develop search strategies, appraise the results, and implement findings into clinical practice. Free AvantGo account required.
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
• Duke University Medical Center Library Evidence-Based Medicine File URL: http://www.mclibrary.duke.edu/respub/pdaformat/Author: Connie Schardt, MLS, AHIPOperating System: Palm OS, Pocket PC, WinCE
• Free PDA file of evidence-based medicine resources. Contains information on EBM terminology, how to construct a well-built clinical question, and how to evaluate various types of journal articles. A reference guide on searching Ovid MEDLINE is also included. Free AvantGo account required.
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
AvantGo
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
#4 Your Favorite Websites at the Point-of-Care
• iSilo (www.isilo.com)
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Using Your Favorite Websites at the Point of Care
• iSilo-allows you to add web pages to your Palm Pilot. I.e. can add JFP Poems index (www.infopoems.com) or Iowa Family Practice Handbook (www.vh.org/providers/clinref/fphandbook/fpcontents.html)
• Get browser at www.isilo.com• Follow instructions on using iSilo web.
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Cochrane Abstracts on iSilo
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
CDC Travel on Your Palm
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
• Creating iSilo content for your handheld computer (link)
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
#3 Database Program
• HanDBase (www.handbase.com).
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
CME Tracker on HanDBase
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Entering a Procedure in HanDBase
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
#2 A Good IM Reference
• InfoRetriever (www.infopoems.com)
• Unbound Medicine and Clinical Evidence from BMJ (www.unboundmedicine.com)
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
InfoRetriever 2005Windows 95/98/NT/ME/2000/XP, PocketPC, Palm and Web
Bayesian diagnostic test / H&P calculator (2000+)
Basic drug info by class and cost for 1200 drugs
Key evidence-basedtreatment guidelines
Cochrane Databaseof Systematic Reviews:over 1750+ abstracts
200+ clinical predictionrules
www.InfoPOEMs.com
2200+ short research synopses (400 added per year)
5 Minute Clinical Consult
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
InfoRetriever to help with treatment decisions
• A 46 y/o male, smoker– PMH significant for hypertension treated with HCTZ.
Most recent BP = 138/86. – FH: Both parents have HTN over age 70, no h/o CAD. – Lipids: Chol = 197; HDL = 41; LDL = 141.
• Questions:– What is his risk of an AMI or sudden cardiac death
in the next 10 years? – How much will lowering the SBP below 130 reduce
the risk? – How much will stopping smoking affect his risk?
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
InfoRetriever
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
InfoRetriever
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
InfoRetriever
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Should his SBP be lowered to <130?
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
What if he quit smoking instead?
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
A Patient Success Story
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Unbound Medicine
• http://www.unboundmedicine.com
• CogniQ platform enables installation of popular reference titles with auto-updating capability
• Has OVID searching capability with web-based management of knowledge
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
#1 A Good Drug Reference
• ePocrates qRx 6.0 (www.epocrates.com)
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Writing Prescriptions
• Epocrates qRX 6.0-comprehensive free drug database. Replaces PDR, Pocket Pharmacopiea. (www.epocrates.com go to “product information” and register )
• adult dosing, pediatric dosing, metabolism, pregnancy categories, drug interactions and contraindications.
• Notes section for your own comments.• Hotsync daily with web updates.
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Pinnacle Health Ground Rounds 2005 ©2005, Scott M. Strayer, MD, MPH
Information Mastery at the Point of Care
Contact us:Scott Strayer
Website:Center for Information
Masteryhttp://
www.healthsystem.virginia.edu/internet/familymed/docs/
info_mastery.cfm
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