Have you ever struggled with formulas for anion gap, osmolal gap or bicarb deficits? Well, you're not alone and this month we explore some of the Palm application software which can help you with all those 2 am medical management problems.

Here is a selection of specialized applications for medical purposes:

• ABGPro (http://www.stacworks.com) helps you interpret ABG and electrolyte values. There is some useful educational commentary appended to each calculation. This program is perhaps most useful for students and trainees. Here is a screenshot….

• Cardiac Risk Factors (www.statcoder.com) allows you to put in all the appropriate variables to provide a rough estimate of risk of coronary artery disease for a particular patient. The underlying assumptions are all documented and even referenced to online sources of (among other
  things) the Framingham Study and other research. A good example of a specialized tool.
• MedCalc (http://netxperience.org/medcalc/) provides you with a set of
  canned formulas, as does
• MedMath (http://mail.med.upenn.edu/~pcheng/medmath/). Note the nice touch of an onscreen tappable keypad to save you from inputting numbers using Graffiti. Note also the button which accesses a menu of other calculations and formulae. MedMath also can switch between SI and Imperial units.
  
  

But what if you want to develop your own, unique set of formulae and equations for your particular work/study situation? That, my friends, is the top of the slippery slope. More doctors' marriages fail because of the urge to tweak a PalmPilot than because of golf and alcohol combined. But, if you insist….

Rolling your own medical formulas requires either a programmable calculator, a spreadsheet, or a database program with some math capability.

Palm calculators come in several flavours. Most popular are the programmable calculators which augment or replace the built-in calculator application. Parens (http://www.probe.net/~rhuebner/parensplugins.html) is a powerful calculator which provides multiple math functions and many options. Syncalc (http://www.synsolutions.com) has a powerful but (to my untutored eye) obscure programming language. CbasPad (http://www.hotpaw.com/rhn/hotpaw/) is derived from BASIC and has more flexibility in designing data entry screens and output than most other software described here. The simplest programmable interface belongs to MathPad (http://www.probe.net/~rhuebner/mathpad.html). MathPad resembles the MemoPad function on your Palm. Write in a formula instead of a memo, tap the "solve" button and get an answer. Equations can be saved in libraries. It's easy to edit formulas but also easy to accidentally mess them up if you aren't careful. Check out the picture on the right, which shows an anion gap calculation screen (compare it to MedMath above). An add-on series of medical formulae for MathPad is available as freeware (Medmathpad.zip) from many online medical software sites. If you can't find it let me know and I will send you a copy. There are many programs out there which I haven't mentioned, and legions of lost souls staying up late writing formula sets for them. Somewhere out there is the package you need.

Alternatively, you may want to install a spreadsheet on your Palm. The advantages of this are that you can do your development work on your PC or Mac using Microsoft Excel, then transfer the sheet to your PDA later. Many algorithms are available from (http://www.medal.org/index.html). One significant drawback is that spreadsheets can be awkward on a small screen. Recalculation of the whole sheet can also be slow - annoying if you only want one formula solved. Fortunately there are numerous choices so you can experiment until you find one you like.

• Pilot MiniCalc (www.solutions.hand.org)
  
• TinySheet (www.iambic.com)
  
• QuickSheet (www.cesinc.com)
  
• DocumentsToGo lets you LOOK at Excel files only (www.dataviz.com) which might be handy if you need only refer to a table of solutions rather than solve the equations afresh.

I haven't even mentioned HanDBase or other database programs for calculations and data entry. Oh well, leave something for next time….
For more on this topic, see Jim Thompson's excellent reviews and analysis of needs at his site (http://www.jimthompson.net/pilot/medcalcs.htm) or the spreadsheet comparison at (http://solutionsinhand.com/UsVsThem.html).

Since the last issue, I have learned of several developments in document conversion utilities.

Doc2Go (www.dataviz.com) now handles tables better and can automatically convert Microsoft Word documents and web files (HTML) to Palm format. Pricey and it slows down HotSync but effective overall.

iSilo (www.isilo.com) has also been improved. This document and web page reader now provides better image and font mgmt although tables are still not very well done. It can also handle doc bookmarks. Overall it is now versatile enough to replace most file readers and thereby save a bit of memory on your Palm.

PenDragon Browser (http://www.pendragonsoftware.com) is a new software and service package that allows you to take web pages or files clipped from your own hard drive and view them on your Palm. Still a work in progress, this is free product. Unfortunately, it doesn't handle pictures or tables well, and the converter program sometimes crashes. Worth watching but not ready for prime time yet.

Plucker (http://plucker.gnu-designs.com/) is another new product for web page viewing which shows promise, but is still in development. Try it with some care.

All this goes to show that there is lots of action out there and I am only skimming a sample of it. I hope that this newsletter stimulates you to go out there and hunt for solutions to your needs but I won't pretend to have found all the answers for you.

Hack of the Month

Not a surgical technique, "hack" refers to a modification of the Palm operating system, to provide special tools. There are many enhancements available to Palm users, many of them free. To use them, you need to download HackMaster (http://www.daggerware.com), an application which permits you to enable or disable the individual "hacks". HackMaster can be tried out for free. As an example of what is possible (and in keeping with our theme of calculators), try PopUpCalc (www.benc.hr). If you know the equations and all you need is a quick arithmetic calculator, PopUpCalc can be, ah, popped up to let you do the math without switching out of your current application, saving you a bit of time and inconvenience. You can also cut and paste the output into other applications.

Medical "Doc" of the Month

Finally, I want to share with you a free text, MiniFolstein Mental Status Exam, Which you may find useful. This is another free download from the Web which you may find useful. I enclose two versions. One is in Palm PDB format. The other is in plain text format in case the enterprising among you want to convert this into a format suitable for another program.

Enjoy the rest of the summer….

This is one of a continuing series of newsletters on Palm handheld computers, prepared for doctors, nurses, IT professionals and video game afficionados at the UHN. Feel free to pass copies around electronically or on paper. To subscribe, or complain, contact the author at the following address: p.arnold.mpr@sympatico.ca

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