Evidence Based Medicine Reference

MedRules is a popular, free EBM tool featuring useful clinical prediction rules taken from the medical literature, ranging acute sinusitis to UTI diagnosis, with additional rules being released occasionally. It requires about 330 KB of memory (including its required libraries), and is not currently available for the PocketPC. It also does not appear to have been updated for some time, and can be hard to find.

One of the better commercial full-text EBM references for handhelds that we have seen is Medical InfoRetriever ( www.infopoems.com ), which was unique in that it was first available for the PocketPC and only in March 2003 was a PalmOS version launched. This is a large and demanding PalmOS application, with a 66Mhz processor preferred, 2MB of internal memory and 37MB of free space on a memory expansion card required. Despite its large size (or maybe because of it) this is a very impressive reference work, including thousands of InfoPOEMs, abstracts from the Cochrane database, clinical prediction rules, evidence-based guidelines, Griffith's 5 Minute Clinical Consult, and an ICD-9 lookup tool. It also links automatically into LexiDrugs, if available on your PDA. A 30-day trial is available.

A good Canadian EBM title is EBM2GO ( www.ebm2go.com ), which includes guidelines, summaries of studies, clinical trial summaries, selected provincial formularies (but not Nova Scotia or New Brunswick, yet at least), and tools such as an opioid converter. A subscription to EMB2GO is free, as the development of the program was supported by sponsorships. The content appears to be kept up to date, and is a useful and well-designed product that we hope continues to develop.

The Center for Evidence-Based Medicine ( www.cebm.utoronto.ca ), funded by the Mount Sinai Hospital in Toronto, has a number of free titles available for the PalmOS, including an EBM Calculator designed to "calculate relevant statistics for Diagnostic studies, Prospective Studies, Case Control Studies, and Randomized Control Trials (RCT)" as well as a set of EBM tables including Number Needed to Treat, Likelihood Ratios, and Sensitivity and Specificity.

Clinical Evidence, produced by the BMJ Publishing Group and Unbound Medicine, provides a concise account of the current state of evidence on the prevention and treatment of a wide range of clinical conditions. It contains evidence related to hundreds of therapeutic and preventative interventions, derived from thousands of original studies, and presents it in a concise, easy-to-use format.

Unbound Medicine's CogniQ software is also used by by Ovid@Hand ( www.ovid.com ), a much more expensive institutional offering that includes a drug reference, more variety of journals, and other features. At this "advanced" level there are a number of other impressive products that we have seen, including FIRSTConsult (formerly PDxMD), which focusses on differential diagnoses and detailed information on medical conditions. Although available for individual sale, these products are clearly intended for use by practicing physicians rather than medical students, and are most frequently used in institutional settings covered by group licences.