The Electronic British National Formulary
and Drug and Therapeutics Bulletin.
Carl Littlejohns
Carl.Littlejohns@ambrosia.demon.co.uk


Introduction.

Distributed on CD ROM, but run from hard disk, the Electronic British
National Formulary (eBNF), a six monthly revised publication of
classified notes on drugs and preparations consisting of the full text
of the paper version (BNF) distributed to all doctors in the United
Kingdom has been revised since the authors last review in late 1995.
The biggest change is that it is bundled with five years worth of
Drug and Therapeutics Bulletin (DTB)- and both eBNF and DTB are
searched by an upgraded 'Browser' package (v3.00.16 by Quartet
Software) which runs under Windows 3.1x, Windows 95, OS/2 and
WindowsNT. The Windows 3.1 version was tested here- 8MB RAM required,
other versions 16MB recommended. An optional separately installed
picture viewer lets users view and print a few 'extras'- a
cardio-pulmonary resuscitation chart, a drug paracetamol level chart,
a list of sports drugs and two sample prescriptions.

Subscribers just to DTB will not be able to run the eBNF, although
both can be installed. Three install options are given, that vary in
space demands but there isn't an option to run from CDROM and about
33MB is needed for a full install.

When an unregistered eBNF is run, the user is given a number code,
against which they must enter an alphanumeric code which is obtained
from a supplied telephone number. A new number code is generated each
time the unregistered eBNF is activated so you have to be sitting in
front of your PC to do this- or perhaps leave the PC running all day
if like the reviewer you started to install it at 11pm. Reinstalling
the software will mean another telephone call- rather a labour
intensive security system! The eBNF is timed, and will expire in
line with the present paper based BNF which should not be used when no
longer current.

There are three ways of 'opening' the eBNF in order to make use of the
contents. The first, default, and most familiar view for BNF users is
'Contents'.

Contents view

Two main windows appear. The left windows has a list of titles-
initially just two
'BNF No 33 March 1997' and
'Drug and Therapeutics Bulletin.'
Clicking on the former expands it to list the chapter headings of the
BNF. You can select these chapter headings by clicking once with the
mouse and the contents of that page appear in the right window. If
you double-click a heading the heading expands to more subheadings and
in this way you 'drill down' into specific items in the eBNF- the last
two levels being generic drug names, and finally branded preparations.
When showing a generic preparation (but not, oddly, a branded drug) a
third window appears listing all the generic medicines that will
interact with the one selected (see Interactions view for details).
The fact that any generic drug is displayed with a list of drugs which
it interacts is a splendid example of how the eBNF excels over the
paper version. The second big advantage is that where the text says
'see section nn' a single click will take you there- and afterwards
clicking the Back icon will bring you back - this is much easier than
page flipping! Hypertext style links can appear in different colours
(although they were the same colour as the text on my copy until I
discovered them). When a title is selected on the left it also
appears on the top of the right hand window. Clicking the top right
title shows the position of the heading within the eBNF structure- a
similar result is obtained by right clicking a title and selecting
WHERE? from the menu that appears.

Index View.
If you know where you are headed, this is the more direct way to find
a drug entry- especially if you are unsure as to what it does. This
time you start with an A-Z list and you drill down to the name of the
drug you want. It is slower than the contents view, but quite usable.
When a generic preparation is viewed, the interactions are also
available. Company names appear in the index as italics, highlighting
them does nothing and the 'where' command doesn't help either but
double clicking takes you to the preparation and the 'where' command
is then able to supply context of which part of the eBNF you are in.

Interactions
The third view mode is Interactions. A list of generic preparations
appear on the left, when selected the preparations that interact are
listed lower right, and clicking this list shows the nature of the
interaction top right. It is easier to use than describe, and works
very well.

Searching.
The eBNF can be used adequately with the three 'views' related above,
but a fourth system of finding information is by means of a single
keyword search.
There appear to be two different searches available. Both searches
are available in all views and consists of typing a word in the box
top left and clicking the binoculars. This often finds the required
entry, but not always, because it only appears to search the titles
visible in the left window and the part-word 'preg' for example will
find PREGNANCY in the DTB, but not the chapter on the same subject in
the eBNF. The second, much better search is started the same way, by
typing a keyword- but then you click the magnifying glass (not the
binoculars!) and a very powerful keyword search is conducted.
My view here is that the former (binocular) search should be dropped,
and the latter (magnifying glass) should be expanded to be able to use
AND and OR for multiple keywords. A 'sounds-like' option for people
who are unsure of spelling would be a useful addition here.

Icons.
In any view, the BACK button takes you through your previous
selections in sequence up to a mysteriously harmless 'can't read
parent record' message. The RESET button collapses all the menus back
to their titles, tidying the display ready for another search. The
CONTENTS, INDEX and INTERACTIONS modes each have a single button as
does the WORD SEARCH- (the magnifying glass). The SHOW POSITION
button is different to the 'WHERE?' function and repositions you in
CONTENTS view but keep the selected information the same and thus
makes it easier to find related information by browsing.

Print
It is possible to print any items, or even chapters found in the eBNF
( and DTB) - there is no print preview however and very long print
runs may be inadvertently selected. The formatting is however very
neat and effective- although the information printed is not too
clearly dated (More relevant for DTB information)

Summary

Dislikes:
The keyword search needs refining. Although combining the DTB with
the eBNF is very sensible, the eBNF is by it's nature an up to date
reference- whereas some of the DTB issues on disk are 5 years old-
there needs to be greater distinction between the two on screen- or
more emphasis on the DATE of the information shown. I don't really
like the security system - a single user should be able to 'buy' a
single password- say based on their encrypted name- a new password for
each re-installation is a pain. I would rather the eBNF didn't time
expire too- but you can't have everything.

Likes:
Much better than version 1.0. Simple to use without having to type
anything. Good use of hypertext, and the BACK key makes following
land retracing inks much less complicated. Contents, Index and
Interactions modes work quickly and are clearly laid out. £65 for
this and the Drug and Therapeutics Bulletin is very good value.


The eBNF is a very useful tool for doctors, pharmacists, nurses,
medical secretaries and students alike. This version offers real
advantages over the paper one for usefulness. That the excellent Drug
and Therapeutics Bulletin is bundled and can be searched seamlessly
with the eBNF makes it all the more tempting. A recommended purchase
for pharmacies giving telephone support to medical staff, medical
libraries and postgraduate centres at the very least.


Carl Littlejohns
Consultant Community Psychiatrist

 

© Priory Lodge Education 2000

Last Amended: 18/02/00