INTERNET DATABASES
Wireless PDAs and smartphones allow instant access to the Internet and the latest published evidence using free journal search software such as PubMed, MedScape, and MerckMedicus. The NLM offers a free PDA program called MD on Tap, which searches for evidence-based articles using criteria set by the user. A PDA version of Google Search offers medical information sites and links to journal abstracts. In addition to the previously discussed subscription online texts DynaMed and UpToDate, there are free online texts, such as eMedicine. Clinical guidelines are available at www. guidelines.gov. These databases are powerful bedside tools that allow clinicians to search for the results of the latest studies and review articles as long as there is wireless service.
Free Web clipping programs, such as Avantgo, allow Web-based text to be copied to the PDA for use when not connected to the Internet. These programs are easy to set up and allow continuous updates while the user has Internet access.
THE PDA IN ACTION
Patient care A 50-year-old male presents to your emergency department with a leg infection in a gash he sustained while cutting bushes in his yard. During the intervening 3 days, the area has become red, painful, and swollen without fluctuance. The patient, who has a history of chronic atrial fibrillation, takes warfarin and long-acting diltiazem every day. He is allergic to penicillin. To manage the pain, he has been taking extra-strength acetaminophen, 2 tablets every 5 hours. He is afebrile. You do a wound culture and are considering therapy for community-aquired methicillin-resistant Staphylococcus aureus. You also order a CBC and prothrombin time (PT). As you await the lab results, you do a fast lookup on your PDA for the best antibiotic covered by the patient's insurance formulary and the ICD-9 code to put on the laboratory slips. You want to use trimethoprim-sulfamethoxazole (TMP-SMX; Bactrim, Septra, generics) to treat the infection, so you enter all the patient's medications in the drug-interaction program and see that both the acetaminophen and TMP-SMX will increase the anticoagulant effect of warfarin. A quick review on atrial fibrillation using the PDA text shows that the international normalized ratio should be between 2 and 3. You know that his PT must be monitored more closely during treatment of the infection, so you tell him to see his primary care clinician in 2 days and educate him about the signs of increased bleeding.
Board review One approach to preparing for the NCCPA board review starts with copying the list of organs to be studied from the NCCPA Physician Assistant National Recertification Examination and Physician Assistant National Certification Examination blueprint for content at www.nccpa.net/EX_samplediseases.aspx?r=panre. This list can be stored on your PDA. As you read, using Epocrates-Dx, PEPID, Merck- Medicus, Harrison's Practice, or The Merck Manual, check off each topic until you complete the list. The disease coverage in these products uses an easy-to-read format to present the main facts that often appear in board questions. These products offer quick reads that can be done during breaks, between patients, or whenever you have some downtime. Each topic can be covered in a few minutes using a portable resource and a method that offers a comprehensive board review.
CONCLUSION
PDAs are becomining an essential clinical tool that can help clinicians engage in lifelong learning as part of their daily routine. Portable, fast access to evidence-based information using PDAs can help prevent medication errors and improve patient care. A combination cell phone/PDA allows clinicians one communication/reference device that should be readily available at the bedside. Today's practicing clinicians must be able to use these tools to keep up with the rapidly growing volume of medical knowledge. Students should be taught early in their studies how to use the tools just as they learn to use their stethoscope. Educators must become familiar with the equipment and software programs to teach the next generation of e-connected clinicians. JAAPA
Allan Platt is advanced didactic coordinator of the PA program at Emory University School of Medicine in Atlanta, Georgia. He has indicated no relationships to disclose relating to the content of this article.
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