Abstract
The clinician's “peripheral brain” has become increasingly digital. What was once a collection of handwritten notes and pocket reference books carried in the front pocket of a white coat has transformed into a collection of medication reference applications, cloud-based note-taking services, and online references.
In this second installment of palliative care digital application reviews, we will discuss two reference applications with clinically relevant point-of-care resources for the hospice and palliative care community. The following review represents only a sampling of websites and mobile apps available and is not meant to be comprehensive.
The authors are both palliative care consultants, one who is an early adopter of technology and the other a late adopter. Each app was accessed in its updated form between the months of November and December 2015.
Fast Facts and Concepts
Price: Free
Platform: iOS, Android (coming in early 2016), Web
Website: www.mypcnow.org
Fast Facts and Concepts are brief peer-reviewed, evidence-based summaries on a wide variety of palliative care topics. They were initially designed with busy residents in mind, providing a broad overview of a topic with practical tips, short enough to be read within minutes. The Fast Facts website has had several hosts, most currently on the Palliative Care Network of Wisconsin.
Disclaimer: Mark is the developer of the iOS Fast Facts app and soon-to-be released Android application. He does not receive any financial compensation.
How I use it in my palliative care practice
Irene:
I had been a long time user of Fast Facts website in my daily clinical work, frequently as a quick and practical teaching tool for clinical colleagues and trainees. Because palliative care spans many disciplines, I often show new users how to (1) use the search function for articles to specific questions and (2) scan for articles of interest based on categories, such as “Communication,” or “Nonpain Symptoms & Syndromes.”
With recent changes in host websites however, it has been increasingly difficult to search by category. In contrast, I discovered that the mobile app has features that emphasize ease of use. Recently viewed articles float to the top of the Fast Facts list. Shake the phone after searching and selecting an article and the highlighted yellow search terms disappear within the article. As a study tool, the mobile app can pull an article at random to learn from. And if you wanted to test yourself, go to the website to take a quiz, linked to the relevant Fast Fact article.
Mark:
Learning about Fast Facts first as a resident, I now use this resource almost on a daily basis. I find having the complete Fast Facts database on my phone and tablet to be very helpful as I can access the articles quickly without the need for an Internet connection, and then use the additional features that the apps have, such as bookmarking and sharing articles. Useful articles that I reference and share regularly are articles #33–35, an informative series about Ventilator Withdrawal and article #125, Palliative Performance Scale.
What draws me to Fast Facts as a reference is the regular update cycle of new articles and how the articles are written specifically for palliative care, which are peer reviewed before being published. Issues that need to be addressed, specifically in the mobile applications of Fast Facts, include increasing the frequency of content updates to the mobile Fast Facts article database, improving the way tables display in the application, and having a way to synchronize usage such as bookmarks between devices.
Medscape
Price: Free (requires registration to access most references)
Platform: iOS, Android, Web
Website: http://www.medscape.com
Medscape describes itself as having “the Web's most robust and integrated medical information and educational tools.” The service comprises three major sections: News and Perspectives—a specialty-specific section with articles about current topics and news. Drugs and Diseases—a drug and disease reference database. CME and Education—a specialty-specific section that users can gain CME credit for watching videos and reading articles.
How I use it in my palliative care practice
Mark:
I use the Android version of Medscape on my smartphone, mainly to search for drug dosing information and drug–drug interactions. I use Medscape as opposed to similar products such as ePocrates because Medscape is free with registration and does not keep any of the reference material behind a premium paywall.
When you initially start the Android version of Medscape, the option to download the entire Medscape drug and disease database on your device is presented to the user. I would recommend downloading this if at all possible. Searching and displaying articles will be faster and more reliable, particularly if your clinical setting does not have reliable cellular access/wifi.
Irene:
Because my work institution has an online subscription to Micromedex that is linked with the electronic medical record, I have found this to be more convenient and faster to use rather than Medscape for drug information.
However, when needed, Medscape has been useful for quickly accessing various references that I have saved on the mobile app, such as American Geriatrics Society's Beers Criteria. I also have bookmarked Benzodiazepines Equivalency Table, Corticosteroid Dose Equivalents, Dermatomes Map, and detailed components of a Mental Status Exam (the latter two require more scrolling and clicks to reach). For current articles related to palliative care, one can set “My Alerts” on the website to “Palliative Care” to generate a daily custom e-mail.
Discussion
Fast Facts and Concepts and Medscape are two “reference apps” that can be excellent additions to any palliative care clinician's digital peripheral brain. They complement one another—Fast Facts offering specific reference information pertaining to palliative care, whereas Medscape offering more general medical reference information.
As palliative care grows in size and awareness, there will be increasing demand for palliative care clinicians and services. Reference applications in hospice and palliative care can be one way to both support clinicians already in the field and also disseminate primary palliative care information to clinicians from other specialties.