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used when no
longer current.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
