Freeware for the Palm Operating System

Journal of Family Practice, Sept, 2001 by Gary N. Fox

Freeware for the Palm Operating System

A previous article in JFP reviewed the medical uses of hand-held computers.[1] Most hand-held computers use 1 of 2 major operating systems (OS), the Palm OS and Windows CE, which is used by PocketPC devices like the Compaq iPaq 3650. The Palm OS has been licensed to Handspring for its Visor line of hand-held computers and to Sony and TRG. Software written for one OS is not directly transferable to the other. This review focuses on free clinically oriented software for Palm OS devices (Table). A subsequent review will focus on such software for PocketPC devices.

TABLE
FREE SOFTWARE FOR THE PALM OPERATING SYSTEM

Program                   Size, kb   Web Site

ePocrates                   1053     www.epocrates.com
Tarascon ePharmacopoeia     1013     www.medscape.com
MedCalc                     177      medcalc.med-ia.net
MedMath                      33      mail.med.upenn.edu/~pcheng/
                                       medmath/index.html.
MedRules(*)                 186      pbrain.hypermart.net/medrules.html
InfoRules(*)                183      www.infopoems.com
DietCalc(*)                  17      www.jfponline.com
STAT Cardiac Risk            22      statcode.hypermart.net
STAT Growth Charts           81      statcode.hypermart.net

(*) These programs require installation of the NSBasic Runtime module
and/or the NSBasic Math library (138 kb total).

Drug Databases

The killer application for physicians using the Palm OS is ePocrates, a drug database: An ePocrates session begins with an extensive alphabetic scrolling searchable drug list that includes both brand and generic names (Figure 1). Once a drug is chosen, generic name, brand names, dosage forms (eg, "10; 10 SL; 1 mg/mL syrup"), and dosing information for adults appears. Off-label indications are marked with an asterisk. Users may easily access information such as pediatric dosing, contraindications/cautions, drug interactions, adverse reactions, manufacturer, and the current retail price from www.drugstore.com (Figure 2). There is also an Other Info screen that includes pregnancy and lactation classifications, metabolism and excretion, Drug Enforcement Agency (DEA) classification, and mechanism of action. Users may enter personal notes, choose to peruse the database by drug classification, and perform cross-checking for drug interactions among, multiple drugs (MultiCheck). ePocrates can be updated through synchronization with its Web site (www.epocrates.com).

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ePocrates is a great tool but has limits. It makes no attempt to indicate whether tablets are scored or breakable. There are rare errors, such as listing ceftibuten (Cedax) suspension as 90 and 180 mg per mL rather than per 5 mL. It lists ethanol, but states that there are no significant interactions found or known. Consistent with this, entering disulfiram (Antabuse), metronidazole (Flagyl), and ethanol into the multidrug interactions module produces no indication of interactions. Drug costs are presented inconsistently; for example, the cost for gatifloxacin (Tequin) is presented for a 30-day supply, while that for levofloxacin (Levaquin) is given for 10 days.

The Tarascon ePharmacopoeia is another drug reference. Tarascon's opening screen lists drugs by class, but the "by drug" scrolling searchable alphabetic list is one click away using a tab at the left side of the screen (Figure 3). There are also tabs for tables that present such things as thrombolytic indications/contraindications and endocarditis prophylaxis regimens, and there is a Common area where users can easily list drugs they access frequently. Although ePocrates has tables, Tarascon contains more. It also appears to have more drug listings. For example, a patient of mine returned from a consultation with a nutritionist who recommended that she switch her calcium supplementation from Oscal to Viactiv. ePocrates lists calcium carbonate and Tums (but not Viactiv or Oscal), while Tarascon lists all of these. Likewise, Rondec, Vicks, and dermatologic fluorouracil (5FU), and immunizations--hepatitis A and B, Prevnar, rabies, tetanus--are listed only in Tarascon. Comparatively, Tarascon's major deficits are its lack of drug interaction information and generally less detailed information about potential adverse reactions.

[ILLUSTRATION OMITTED]

Once a drug is selected in Tarascon the user sees a series of symbols, any of which may be tapped with the stylus to obtain further interpretation (Figure 4). The symbols indicate the major route of metabolism, pregnancy classification, compatibility with breast-feeding, DEA status, and cost category (eg, [is less than] $25, $25-49, $50-99). Cost is per month for chronic medications and per usual course for short-term therapies. The remainder of the Adult tab shows information for US Food and Drug Administration-approved indications followed by those that are not approved. Tabs along the bottom allow users to switch to pediatric information (Peds), how the medication is supplied (Forms), and additional information about the drug (Notes). The Forms sections sometimes specify whether tablets are scored, but this is inconsistent. The Notes sections variably include additional dosing or usage instructions (eg, "Prime the nasal spray pump"), common or serious side effects, or drug interactions. The Notes sections are not user modifiable, but there is another section for the user's annotations. Tarascon and ePocrates are complementary but still incomplete: Neither includes the injectable hyaluronate derivatives (Hyalgan, Synvisc) or uniformly contains pill-splitting information.