Darius Wey
06-10-2005, 05:05 PM
<img src="http://www.pocketpcthoughts.com/images/web/2003/wey-ctools-00.jpg" /><br /><br /><b>Product Category:</b> Medical Reference Software<br /><b>Manufacturer:</b> <a href="http://www.cancer.org/">American Cancer Society</a><br /><b>Where to Download:</b> <a href="http://www.cancer.org/c-tools/">American Cancer Society</a><br /><b>Price:</b> Free.<br /><b>System Requirements:</b> Pocket PC 2002 or greater, a minimum of 16MB of RAM, and the <a href="http://www.microsoft.com/downloads/details.aspx?FamilyID=a5a02311-194b-4c00-b445-f92bec03032f&DisplayLang=en">.NET Compact Framework</a>.<br /><br /><b>Pros:</b><li>Free;<br /><li>Easy-to-use tools manager;<br /><li>User-friendly interface.<b>Cons:</b><li>Units use the imperial system only;<br /><li>Only American-oriented resources are made available;<br /><li>Does not support landscape or VGA display modes.<b>Summary:</b><br />The American Cancer Society released C-Tools 2.0 earlier in the year, and the best thing about it is that it's free. However, in some cases, a free application does not necessarily equate to a valuable application, so just how does C-Tools 2.0 rate?<br /><br />Read on to find out!<!><br /><br /><PAGEBREAK><br /><span><b>What is C-Tools?</b></span><br />The American Cancer Society (hereafter, ACS) believes that information is the best way to combat cancer. Whether it be information on prevention, diagnosis, or treatment, every little bit helps and that principle was the basis behind the development of C-Tools.<br /><br />Installation is a breeze, and might I add, highly customisable. As seen in Figure 1, you can choose your platform (as C-Tools supports both Pocket PC and Palm) and what tools you wish to install. For the purpose of this review, I decided to install all of them, and besides, as Francis Bacon said, "knowledge is power". ;-)<br /><br /><img src="http://www.pocketpcthoughts.com/images/web/2003/wey-ctools-01.gif" /><br /><i>Figure 1: Customise your installation.</i><br /><br />When installed, C-Tools consumes a little under 1MB of space. Note that you will need the .NET Compact Framework installed in order for C-Tools to work. The latest version (at the time of writing, Version 1.0 SP3) can be downloaded from <a href="http://www.microsoft.com/downloads/details.aspx?FamilyID=a5a02311-194b-4c00-b445-f92bec03032f&DisplayLang=en">here</a>.<br /><br /><img src="http://www.pocketpcthoughts.com/images/web/2003/wey-ctools-02.gif" /><br /><i>Figure 2: The main C-Tools interface.</i><br /><br /><span><b>Let's Open The Toolbox!</b></span><br />In total, there are twelve tools available in the package. They include: an Adult BMI Calculator, Cancer Screening Guidelines, Communicating Bad News, Drug Calculator, Emerging Technology, Pain/Symptom Management, Pain Medications Database, Prostate Specific Antigen, Questions Patients Ask, Skin Cancer, Tobacco Control, and Warning Signs of Childhood Cancer. To start off, we'll have a look at the 'Adult BMI Calculator'.<br /><br /><img src="http://www.pocketpcthoughts.com/images/web/2003/wey-ctools-03.gif" /><br /><i>Figure 3: The Adult BMI Calculator.</i><br /><br />The 'Adult BMI Calculator' is a little basic but it does the simple task of calculating the body mass index (BMI) of an individual of known height and weight. The condition of the calculated value can be looked up by tapping on the 'Results Chart' button. It is a simple page outlining standard BMI ranges for normal and abnormal weight conditions. One thing you may notice in Figure 3 is that C-Tools only works via the imperial system. I'll happily confess my inability to work with 'feet', 'inches' and 'pounds', so as useful as this tool was, I wasn't too fond of it since I normally use 'centimetres' and 'kilograms' for height and weight respectively. Granted, it is developed by the <i>American Cancer Society</i>, but I think if they wanted widespread adoption of this tool across many different countries, they would need to address this issue and instead have units expressed in both the imperial system and metric system.<br /><br /><img src="http://www.pocketpcthoughts.com/images/web/2003/wey-ctools-04.gif" /><br /><i>Figure 4: Cancer Screening Guidelines.</i><br /><br />The next tool, 'Cancer Screening Guidelines', provides general screening guidelines based on the gender and age of the patient and/or the site of cancer in question. In terms of the types of cancer focused on, this tool covers breast cancer, colon and rectal cancer, cervical cancer, endometrial cancer and prostate cancer. The information is kept relatively concise and there is some degree of integration with other tools of the C-Tools suite. For example, if you select 'prostate cancer', you have the option of launching the PSA (prostate-specific antigen) tool. Late last year, I reviewed <a href="http://www.pocketpcthoughts.com/articles.php?action=expand,35004">Epocrates Essentials</a> (another medical reference application) and one of the features that made it shine was the great deal of integration between Dx, Rx, Lab and so on. Although C-Tools is nowhere near as large as Epocrates Essentials, just that small degree of integration allows for user-friendly navigation throughout the product.<br /><br /><img src="http://www.pocketpcthoughts.com/images/web/2003/wey-ctools-05.gif" /><br /><i>Figure 5: Communicating Bad News - The SPIKES Protocol.</i><br /><br />Next on the list is the 'Communicating Bad News' tool. As a medical professional, the importance of communication skills cannot be stressed enough and ACS have included a short guide on conveying unfavourable news in a physician-patient setting. Different medical schools teach different acronyms. ACS have included one known as SPIKES, and despite the differences, the content of effective physician-patient communication tends to be the same. Reading through this guide was a good refresher. The appendix provides a few extra pointers if required by the user.<br /> <PAGEBREAK> <br /><img src="http://www.pocketpcthoughts.com/images/web/2003/wey-ctools-06.gif" /><br /><i>Figure 6: The Drug Calculator.</i><br /><br />The 'Drug Calculator' tool calculates 24-hour dosage equivalents (in milligrams) for any two drugs listed in the C-Tools database. While it's a nice tool to have, it's far from perfect in a real life situation, and any medico would agree that what's provided here should be taken with a grain of salt. Fortunately, ACS have provided a disclaimer which asserts the fact that the formulae used in the calculations should only be used as a rough guide. That minor rant aside, for basic functionality, the 'Drug Calculator' tool works great.<br /><br /><img src="http://www.pocketpcthoughts.com/images/web/2003/wey-ctools-07.gif" /><br /><i>Figure 7: Emerging Technology - Lung Cancer.</i><br /><br />The 'Emerging Technology' guide contains information on technology used for screening cancer. Often is the case that patients may ask a thing or two about what's available, so this guide can provide a decent breakdown of each procedure. The guide is broken down into three categories – breast cancer, colon cancer and lung cancer. The ones listed in the 'breast cancer' section details the current level of evidence and whether or not it has FDA approval for clinical use and/or screening. The others (i.e. the 'colon cancer' and 'lung cancer' screening technologies) generally have a few short paragraphs outlining the procedure, what it tests, and some other general information bearing relevance to the cancer of interest.<br /><br /><img src="http://www.pocketpcthoughts.com/images/web/2003/wey-ctools-08.gif" /><br /><i>Figure 8: Pain/Symptom Management.</i><br /><br />The 'Pain/Symptom Management' tool contains definitions and lists information to do with types of pain, categories of pain, the scope of the problem, effects of untreated pain, assessing pain, treating pain, treating side effects, treating specific pain sites, tolerance and physical dependence, adjuvant treatments, pain-related resources, and JCAHO standards. These are all broken down into sections, which in turn are broken down into selectable sub-sections. For example, if you look up the treatment of side effects, you have the option of selecting specific ones such as constipation, nausea, sedation, respiratory depression, itching and urinary retention. The great thing about this particular tool is it's straight to the point. Some medical resources often have an excess of information that's a pain to flip through. That is not the case with C-Tools. The information here is presented in a concise and readable manner.<br /><br /><img src="http://www.pocketpcthoughts.com/images/web/2003/wey-ctools-09.gif" /><br /><i>Figure 9: A Pain Medications Database.</i><br /><br />The 'Pain Medications' dictionary contains information on oral and parenteral analgesic doses of drugs ranging from Buprenorphine to Fentanyl. It lists the definitions of each drug as well as any clinically relevant interactions. That aside, the neatest feature has yet to be seen. By tapping Options in the command bar, you are able to add and delete medications as well as edit the comments of any drug listed. All this allows you to expand your drug database as well as remove any drugs you deem unnecessary to have in your guide. However, there is an annoyance to this feature as you will soon discover C-Tools' inability to backup any changes. If you decide to reinstall or delete the tool later down the track, any changes you have made to the 'Pain Medications' tool will be lost. If you ever have to hard reset your Pocket PC, you can see where this might be a problem, especially if you've added a wad of new medications to the list.<br /> <PAGEBREAK> <br /><img src="http://www.pocketpcthoughts.com/images/web/2003/wey-ctools-10.gif" /><br /><i>Figure 10: The Prostate-Specific Antigen (PSA) Tool.</i><br /><br />If a patient requires a PSA test, then the 'Prostate-Specific Antigen' tool is a great companion to have. In it, you'll find general PSA information, details on PSA velocity, PSA density, percent-free PSA and age-specific PSA results. It's a rather small tool but concise nonetheless. As stated earlier, it integrates with the 'Cancer Screening Guidelines' tool.<br /><br /><img src="http://www.pocketpcthoughts.com/images/web/2003/wey-ctools-11.gif" /><br /><i>Figure 11: A Guide for Questions That Patients Ask.</i><br /><br />Once again, here comes the issue of effective physician-patient communication, which ideally should be present at all times. The 'Questions Patients Ask' tool can help refresh your mind on typical issues raised by patients as well as tips on how to deal with them.<br /><br /><img src="http://www.pocketpcthoughts.com/images/web/2003/wey-ctools-12.gif" /><br /><i>Figure 12: A Skin Cancer Guide.</i><br /><br />The 'Skin Cancer' tool was one of my favourites. It is broken down into four sections: (a) skin cancer information - this contains a short paragraph on common forms of skin cancer; (b) the ABCD rule - this contains information on moles sporting unique characteristics outlined in the ABCD acronym (each is accompanied with a picture of a common mole as can be seen in Figure 12); (c) sun safety - this contains general guidelines on the well-known Slip, Slop, Slap, Wrap campaign; (d) other warning signs - a few other skin cancer-related points are listed here.<br /><br /><img src="http://www.pocketpcthoughts.com/images/web/2003/wey-ctools-13.gif" /><br /><i>Figure 13: Tobacco Control.</i><br /><br />We all know the effects of tobacco, so there is little surprise in seeing a 'Tobacco Control' tool in C-Tools. Like the previous tool, this one is broken up into sections: helping smokers quit, available resources, and a pharmacotherapy quick guide. The first one provides guidance for the physician in helping his/her patient quit his/her smoking habit. The second lists available resources (phone numbers and websites) for the patient. Since this is an American-based tool, it only lists information for American services. People living elsewhere will have to refer to other sources for that kind of information. The third section contains information on possible drugs which can be used to help the patient combat their smoking habit. It's basic, but straight to the point.<br /><br /><img src="http://www.pocketpcthoughts.com/images/web/2003/wey-ctools-14.gif" /><br /><i>Figure 14: Childhood Cancers - A Warning Guide.</i><br /><br />The final tool, 'Warning Signs of Childhood Cancer', lists some possible warning signs and symptoms associated with childhood cancer. It is presented in an easily remembered CHILDREN acronym.<br /><PAGEBREAK><br /><span><b>Any Irks?</b></span><br />Yes, there are a couple. This tool is largely American-oriented both in the expression of units and the information. While this can be disregarded to an extent, it isn't encouraging for worldwide users looking to check out this tool for the first time. Apart from that, if you own a newer device, one thing you may notice is C-Tools' lack of support for landscape and VGA display modes. This is something I'd like to see fixed in a later release given the fact that more and more people are beginning to eyeball VGA devices.<br /><br /><span><b>Conclusions</b></span><br />Overall, you'll find C-Tools to be a great little resource. I wouldn't call it the greatest medical reference out there, but I definitely wouldn't call it the worst either, given the fact that it is freely available. If ACS ever sorts out the display mode issues and attempts to make the application a little more globally oriented, then I could see this being a favoured tool among many medicos. But for now, if you're an American physician, there's no reason why you shouldn't check this guide out. If you live elsewhere, there are alternative reference guides available, but C-Tools is still worth a look nevertheless. It's concise cancer-related information at a reasonable price!<br /><br /><i>Darius Wey loves technology! When he's not working at this website, he's either busy working for his medical degree (MBBS) or being happily involved in audio and video editing, web and graphic designing, photography and the odd bit of programming. He lives in Perth, Western Australia.</i>