About a year ago I reviewed the 2004 version of Griffith's 5-Minute Clinical Consult. It is a concise reference that runs on both PalmOS and Windows Mobile devices. I have recently upgraded to the 2006 version. The application is now self contained and consists of a standalone reader, data and a new application written by Dr. Roni Zeiger called Diagnosaurus. 5-Minute Clinical Consult is written and kept current by over 330 expert clinicians, and provides on-the-spot facts for more than 1,000 medical and surgical conditions. The entire application is now 308 Mbytes (up from 28 in 2004) and has had extensive revisions.

One of my complaints about the earlier version was that there was no easy way to get from section to section. In the current version, there is a selector that appears below the diagnosis you are reading that allows easy navigation from section to section. The entire mechanism for finding a diagnosis has also been replaced with a search area that moves the display among the matching alphabetic diagnosis listing as you add letters. There is no longer a subspecialty listing, but the new navigation makes finding anything you are looking for quite easy. They have added a new tool that allows you to look up a medication with a list of diagnoses for which the medication is used. There is also a search by ICD-9 code. Overall, this is a huge improvement that greatly improves usability.

Each disease has a section for Basics, Diagnosis, Treatment, Medications, Follow up and Miscellaneous. Some diseases have a subset of these. Basics provides a description of the disease, a listing of systems affected, genetics, US incidence/prevalence, predominant age, sexual distribution, a listing of signs and symptoms which may include grading systems, and risk factors. Diagnosis includes differential, laboratory testing, drugs that may alter lab values, pathology, special tests, imaging and procedures. Treatment includes usual treatment setting (outpatient or inpatient), general measures, surgical measures, activity recommendations, dietary recommendations and patient education. Drug treatment is in the Medications section which includes preferred drugs and alternatives. Follow up includes monitoring recommendations, prevention/avoidance, possible complications, and course/prognosis. The miscellaneous section has associated conditions, age related factor information, other notes that have a variety of useful observations, abbreviations and references that are mostly fairly current. I am again impressed by the amount of work that has been done on this product.

Included at no additional cost is Diagnosaurus which is a system that generates a differential diagnosis from a single symptom. The resulting listing is frequently broken down by acuity and/or organ system. There is a symbol in the upper right near the top that is a blue and red arrow. This links the list returned to a list of related topics in Griffith's and navigates directly to the disease selected. The list is a subset of potential disease states and often seems to specifically consist of the more unusual causes of the symptom. In addition to the Differential Diagnosis, there is often a selector to show Associated conditions and Related Differential Diagnosis, which frequently navigates to a very appropriate list of additional things to think about.

The combination is easy to use and quite likely to prove useful. This application is available through Unbound Medicine, www.unboundmedicine.com and also SkyScape, www.skyscape.com. The current price is $64.95, but watch both sites for occasional discounts.