Robert Boland, MD

Effective use of Microsoft PowerPoint can enhance a presentation. Too often, however, speakers obfuscate information by adding fancy effects or showing indecipherable slides, or are ill-prepared or overly dependent on the slides to deliver their message.

PowerPoint is not just for professional lecturers; psychiatrists often are asked to address community or professional organizations and patient advocacy groups. Your ability to clearly explain complicated concepts to lay audiences can help market yourself as a desirable referral source.

This article describes 6 common PowerPoint presentation pitfalls, why they occur, and how to avoid them. Resources to help you create better PowerPoint presentations also are listed (see Related resources).

1 The speaker is in the dark

We’ve all seen it: As soon as the speaker starts a PowerPoint presentation, a helpful audience member turns down the lights. Fearing the projection will not be discernible, the speaker elects to make him/herself less visible in deference to the slides.

This misses the point. The audience came to hear you, so the slides should enhance your talk and not compete with you. To overvalue the slides is to ignore years of pedagogic research showing that learning flourishes when teacher and student are actively engaged.

Most modern LCD projectors are powerful enough to use in ambient light. If a slide is difficult to read, it’s often because of bad slide design, such as poorly contrasting colors or small type sizes (see peeve number 4).

Dimming the lights during a video presentation is acceptable because video usually is more visible in the dark and is the presentation’s focus when running. After the video is finished, restore the lights and return the focus to the speaker.

2 Too many bullets

The bulleted list in the PowerPoint default template is not always the best way to display information. Many speakers are reluctant to stray from this style, however, because they doubt their ability to cover all the points or worry that the audience will miss the information on the screen.

Don’t worry: Audiences are more likely to remember an effective presentation than perfectly complete slides.

3 He’s reading, not speaking

Speakers sometimes read from bulleted lists because they are not sufficiently familiar with their talk. They either turn away from the audience to read off the projected slides or—more commonly—face the audience but look down to read from a computer monitor.

Watching someone read aloud is boring. The audience will disengage if you appear unprepared and uninterested in them.

There is no substitute for planning and practicing your talk in advance. You don’t have to memorize it, but be familiar enough with your talk to require only occasional glances at the monitor. Even talented extemporaneous speakers can improve their performances with planning and practice.

4 ‘I know you can’t read this… ’

Seemingly every PowerPoint presentation includes at least one slide filled with tiny text and graphics. The speaker will laugh, saying, “I apologize, I know you can’t read this, but the point I’m trying to make is…”

This is the worst of many variations of difficult-to-read slides. Speakers also commonly scan material from textbooks into a slide rather than create it anew.

Projecting an indecipherable slide is the inexcusable result of poor planning or laziness. Breaking down a complex idea into understandable chunks of information is hard work, but that is what effective teachers do. Albert Einstein said, “If you can’t explain something simply, you don’t understand it well.” When audiences see difficult-to-read slides, they will suspect you don’t know what you’re talking about.

5 ‘Windows’ dressing

PowerPoint has many bells and whistles to enhance a presentation. Avoid them.

Transitions. PowerPoint offers more than 50 ways to transition from one slide to the next. But despite a century of film innovation, Steven Spielberg still relies on the same three transitions D.W. Griffith used in his silent films: the direct cut, the dissolve, and the wipe. All other transitions are rare in professional film; likewise, they have no place in your presentation.

Animations can be useful. For example, a slide with several bullet points is less distracting if the points are introduced one at a time. As with transitions, simple animations are best; watching words fly around a slide before settling in place has lost its novelty.

Graphics. Other built-in PowerPoint functions—such as prepackaged clip art and sound effects—are of little use. The clip art in particular looks lame and outmoded.

If your presentation calls for graphics, use high-quality photographs. PowerPoint supports numerous image formats including BMP, PCX, PNG, JPEG, and GIF (see Related resources for a comparison of each format’s advantages and disadvantages).

Most images from scanners or digital cameras are at higher resolutions than needed; computer monitors generally cannot display detail beyond 96 dots per inch (DPI), and photographs should be resampled accordingly to reduce file sizes. Resizing the image within PowerPoint does not change the resolution; you need a photo-editing program such as Adobe Photoshop, Corel Paint Shop, or Macromedia Fireworks (while there, be sure to crop out unnecessary parts of the photo).

Humor and comics. Including comic strips in a presentation has become somewhat hackneyed and overused. Use comics minimally and only when they help illustrate an important point.

6 ‘Do you have a handout?’

When audience members request printouts of slide presentations, speakers usually respond with straight printouts of the PowerPoint slides.

This makes little sense. Seeing the slides minus the speaker is like watching a documentary with the narration turned off. The more effective slides are as speaking aids, the less appropriate they are for stand-alone information.

Instead, create annotated slide printouts for distribution. Your best bet is to export the presentation to Microsoft Word, which creates a document containing pictures of the slides with adjacent notes. You could print out your slides using the PowerPoint notes function, but this only lets you print slides or notes on separate documents.

Related resources

• TechRepublic.com. 10 slide design tips for producing powerful and effective presentations. http://articles.techrepublic.com.com/5100-10881-6117178.html.
• Microsoft guidelines for selecting a picture format in an Office XP program. http://support.microsoft.com/kb/320314.
• Tufte ER. The cognitive style of PowerPoint: pitching out corrupts within. Cheshire CT: Graphics Press; 2006. (Edward Tufte, professor emeritus at Yale University, is an authority on presenting graphic information).
• Presentation Zen, a blog maintained by Garr Reynolds, former program manager for worldwide user group relations at Apple. www.presentationzen.com.
• PowerPoint does rocket science. Tufte’s analysis shows the mismanagement resulting from NASA’s insistence on using PowerPoint to present technical analyses, ultimately leading to the Columbia shuttle disaster. www.edwardtufte.com/bboard/q-and-a-fetch-msg?msg_id=0001yB&topic_id=1.
• Peter Norvig’s PowerPoint version of the Gettysburg Address, an intriguing example of “death by PowerPoint.” www.norvig.com/Gettysburg.

Disclosure

The author reports no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.

Effective use of Microsoft PowerPoint can enhance a presentation. Too often, however, speakers obfuscate information by adding fancy effects or showing indecipherable slides, or are ill-prepared or overly dependent on the slides to deliver their message.

PowerPoint is not just for professional lecturers; psychiatrists often are asked to address community or professional organizations and patient advocacy groups. Your ability to clearly explain complicated concepts to lay audiences can help market yourself as a desirable referral source.

This article describes 6 common PowerPoint presentation pitfalls, why they occur, and how to avoid them. Resources to help you create better PowerPoint presentations also are listed (see Related resources).

1 The speaker is in the dark

We’ve all seen it: As soon as the speaker starts a PowerPoint presentation, a helpful audience member turns down the lights. Fearing the projection will not be discernible, the speaker elects to make him/herself less visible in deference to the slides.

This misses the point. The audience came to hear you, so the slides should enhance your talk and not compete with you. To overvalue the slides is to ignore years of pedagogic research showing that learning flourishes when teacher and student are actively engaged.

Most modern LCD projectors are powerful enough to use in ambient light. If a slide is difficult to read, it’s often because of bad slide design, such as poorly contrasting colors or small type sizes (see peeve number 4).

Dimming the lights during a video presentation is acceptable because video usually is more visible in the dark and is the presentation’s focus when running. After the video is finished, restore the lights and return the focus to the speaker.

2 Too many bullets

The bulleted list in the PowerPoint default template is not always the best way to display information. Many speakers are reluctant to stray from this style, however, because they doubt their ability to cover all the points or worry that the audience will miss the information on the screen.

Don’t worry: Audiences are more likely to remember an effective presentation than perfectly complete slides.

3 He’s reading, not speaking

Speakers sometimes read from bulleted lists because they are not sufficiently familiar with their talk. They either turn away from the audience to read off the projected slides or—more commonly—face the audience but look down to read from a computer monitor.

Watching someone read aloud is boring. The audience will disengage if you appear unprepared and uninterested in them.

There is no substitute for planning and practicing your talk in advance. You don’t have to memorize it, but be familiar enough with your talk to require only occasional glances at the monitor. Even talented extemporaneous speakers can improve their performances with planning and practice.

4 ‘I know you can’t read this… ’

Seemingly every PowerPoint presentation includes at least one slide filled with tiny text and graphics. The speaker will laugh, saying, “I apologize, I know you can’t read this, but the point I’m trying to make is…”

This is the worst of many variations of difficult-to-read slides. Speakers also commonly scan material from textbooks into a slide rather than create it anew.

Projecting an indecipherable slide is the inexcusable result of poor planning or laziness. Breaking down a complex idea into understandable chunks of information is hard work, but that is what effective teachers do. Albert Einstein said, “If you can’t explain something simply, you don’t understand it well.” When audiences see difficult-to-read slides, they will suspect you don’t know what you’re talking about.

5 ‘Windows’ dressing

PowerPoint has many bells and whistles to enhance a presentation. Avoid them.

Transitions. PowerPoint offers more than 50 ways to transition from one slide to the next. But despite a century of film innovation, Steven Spielberg still relies on the same three transitions D.W. Griffith used in his silent films: the direct cut, the dissolve, and the wipe. All other transitions are rare in professional film; likewise, they have no place in your presentation.

Animations can be useful. For example, a slide with several bullet points is less distracting if the points are introduced one at a time. As with transitions, simple animations are best; watching words fly around a slide before settling in place has lost its novelty.

Graphics. Other built-in PowerPoint functions—such as prepackaged clip art and sound effects—are of little use. The clip art in particular looks lame and outmoded.

If your presentation calls for graphics, use high-quality photographs. PowerPoint supports numerous image formats including BMP, PCX, PNG, JPEG, and GIF (see Related resources for a comparison of each format’s advantages and disadvantages).

Most images from scanners or digital cameras are at higher resolutions than needed; computer monitors generally cannot display detail beyond 96 dots per inch (DPI), and photographs should be resampled accordingly to reduce file sizes. Resizing the image within PowerPoint does not change the resolution; you need a photo-editing program such as Adobe Photoshop, Corel Paint Shop, or Macromedia Fireworks (while there, be sure to crop out unnecessary parts of the photo).

Humor and comics. Including comic strips in a presentation has become somewhat hackneyed and overused. Use comics minimally and only when they help illustrate an important point.

6 ‘Do you have a handout?’

When audience members request printouts of slide presentations, speakers usually respond with straight printouts of the PowerPoint slides.

This makes little sense. Seeing the slides minus the speaker is like watching a documentary with the narration turned off. The more effective slides are as speaking aids, the less appropriate they are for stand-alone information.

Instead, create annotated slide printouts for distribution. Your best bet is to export the presentation to Microsoft Word, which creates a document containing pictures of the slides with adjacent notes. You could print out your slides using the PowerPoint notes function, but this only lets you print slides or notes on separate documents.

Related resources

• TechRepublic.com. 10 slide design tips for producing powerful and effective presentations. http://articles.techrepublic.com.com/5100-10881-6117178.html.
• Microsoft guidelines for selecting a picture format in an Office XP program. http://support.microsoft.com/kb/320314.
• Tufte ER. The cognitive style of PowerPoint: pitching out corrupts within. Cheshire CT: Graphics Press; 2006. (Edward Tufte, professor emeritus at Yale University, is an authority on presenting graphic information).
• Presentation Zen, a blog maintained by Garr Reynolds, former program manager for worldwide user group relations at Apple. www.presentationzen.com.
• PowerPoint does rocket science. Tufte’s analysis shows the mismanagement resulting from NASA’s insistence on using PowerPoint to present technical analyses, ultimately leading to the Columbia shuttle disaster. www.edwardtufte.com/bboard/q-and-a-fetch-msg?msg_id=0001yB&topic_id=1.
• Peter Norvig’s PowerPoint version of the Gettysburg Address, an intriguing example of “death by PowerPoint.” www.norvig.com/Gettysburg.

Disclosure

The author reports no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.

Effective use of Microsoft PowerPoint can enhance a presentation. Too often, however, speakers obfuscate information by adding fancy effects or showing indecipherable slides, or are ill-prepared or overly dependent on the slides to deliver their message.

PowerPoint is not just for professional lecturers; psychiatrists often are asked to address community or professional organizations and patient advocacy groups. Your ability to clearly explain complicated concepts to lay audiences can help market yourself as a desirable referral source.

This article describes 6 common PowerPoint presentation pitfalls, why they occur, and how to avoid them. Resources to help you create better PowerPoint presentations also are listed (see Related resources).

1 The speaker is in the dark

We’ve all seen it: As soon as the speaker starts a PowerPoint presentation, a helpful audience member turns down the lights. Fearing the projection will not be discernible, the speaker elects to make him/herself less visible in deference to the slides.

This misses the point. The audience came to hear you, so the slides should enhance your talk and not compete with you. To overvalue the slides is to ignore years of pedagogic research showing that learning flourishes when teacher and student are actively engaged.

Most modern LCD projectors are powerful enough to use in ambient light. If a slide is difficult to read, it’s often because of bad slide design, such as poorly contrasting colors or small type sizes (see peeve number 4).

Dimming the lights during a video presentation is acceptable because video usually is more visible in the dark and is the presentation’s focus when running. After the video is finished, restore the lights and return the focus to the speaker.

2 Too many bullets

The bulleted list in the PowerPoint default template is not always the best way to display information. Many speakers are reluctant to stray from this style, however, because they doubt their ability to cover all the points or worry that the audience will miss the information on the screen.

Don’t worry: Audiences are more likely to remember an effective presentation than perfectly complete slides.

3 He’s reading, not speaking

Speakers sometimes read from bulleted lists because they are not sufficiently familiar with their talk. They either turn away from the audience to read off the projected slides or—more commonly—face the audience but look down to read from a computer monitor.

Watching someone read aloud is boring. The audience will disengage if you appear unprepared and uninterested in them.

There is no substitute for planning and practicing your talk in advance. You don’t have to memorize it, but be familiar enough with your talk to require only occasional glances at the monitor. Even talented extemporaneous speakers can improve their performances with planning and practice.

4 ‘I know you can’t read this… ’

Seemingly every PowerPoint presentation includes at least one slide filled with tiny text and graphics. The speaker will laugh, saying, “I apologize, I know you can’t read this, but the point I’m trying to make is…”

This is the worst of many variations of difficult-to-read slides. Speakers also commonly scan material from textbooks into a slide rather than create it anew.

Projecting an indecipherable slide is the inexcusable result of poor planning or laziness. Breaking down a complex idea into understandable chunks of information is hard work, but that is what effective teachers do. Albert Einstein said, “If you can’t explain something simply, you don’t understand it well.” When audiences see difficult-to-read slides, they will suspect you don’t know what you’re talking about.

5 ‘Windows’ dressing

PowerPoint has many bells and whistles to enhance a presentation. Avoid them.

Transitions. PowerPoint offers more than 50 ways to transition from one slide to the next. But despite a century of film innovation, Steven Spielberg still relies on the same three transitions D.W. Griffith used in his silent films: the direct cut, the dissolve, and the wipe. All other transitions are rare in professional film; likewise, they have no place in your presentation.

Animations can be useful. For example, a slide with several bullet points is less distracting if the points are introduced one at a time. As with transitions, simple animations are best; watching words fly around a slide before settling in place has lost its novelty.

Graphics. Other built-in PowerPoint functions—such as prepackaged clip art and sound effects—are of little use. The clip art in particular looks lame and outmoded.

If your presentation calls for graphics, use high-quality photographs. PowerPoint supports numerous image formats including BMP, PCX, PNG, JPEG, and GIF (see Related resources for a comparison of each format’s advantages and disadvantages).

Most images from scanners or digital cameras are at higher resolutions than needed; computer monitors generally cannot display detail beyond 96 dots per inch (DPI), and photographs should be resampled accordingly to reduce file sizes. Resizing the image within PowerPoint does not change the resolution; you need a photo-editing program such as Adobe Photoshop, Corel Paint Shop, or Macromedia Fireworks (while there, be sure to crop out unnecessary parts of the photo).

Humor and comics. Including comic strips in a presentation has become somewhat hackneyed and overused. Use comics minimally and only when they help illustrate an important point.

6 ‘Do you have a handout?’

When audience members request printouts of slide presentations, speakers usually respond with straight printouts of the PowerPoint slides.

This makes little sense. Seeing the slides minus the speaker is like watching a documentary with the narration turned off. The more effective slides are as speaking aids, the less appropriate they are for stand-alone information.

Instead, create annotated slide printouts for distribution. Your best bet is to export the presentation to Microsoft Word, which creates a document containing pictures of the slides with adjacent notes. You could print out your slides using the PowerPoint notes function, but this only lets you print slides or notes on separate documents.

Related resources

• TechRepublic.com. 10 slide design tips for producing powerful and effective presentations. http://articles.techrepublic.com.com/5100-10881-6117178.html.
• Microsoft guidelines for selecting a picture format in an Office XP program. http://support.microsoft.com/kb/320314.
• Tufte ER. The cognitive style of PowerPoint: pitching out corrupts within. Cheshire CT: Graphics Press; 2006. (Edward Tufte, professor emeritus at Yale University, is an authority on presenting graphic information).
• Presentation Zen, a blog maintained by Garr Reynolds, former program manager for worldwide user group relations at Apple. www.presentationzen.com.
• PowerPoint does rocket science. Tufte’s analysis shows the mismanagement resulting from NASA’s insistence on using PowerPoint to present technical analyses, ultimately leading to the Columbia shuttle disaster. www.edwardtufte.com/bboard/q-and-a-fetch-msg?msg_id=0001yB&topic_id=1.
• Peter Norvig’s PowerPoint version of the Gettysburg Address, an intriguing example of “death by PowerPoint.” www.norvig.com/Gettysburg.

Disclosure

The author reports no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.

Personal digital assistant (PDA)-based drug reference software can help you make informed point-of-care prescription decisions, but accuracy, usability, and comprehensiveness vary greatly among programs.

This article looks at the benefits and drawbacks of popular PDA drug reference programs and offers advice on choosing the right one for your practice.

PDA Program benefits

Equipping your PDA with drug reference software makes prescription information portable and accessible. PDA-based drug guides also:

• are easy to update. Most PDA-based systems automatically update as part of routine synchronization procedures between the device and its host computer, keeping the information up-to-date. This is an important feature as some drug databases are updated daily.
• list potential side effects. Most programs list all potential medication side effects and distinguish between common and uncommon adverse events.
• list possible drug-drug interactions. This feature gives PDA-based drug guides a clear advantage over print textbooks. Users enter two or more medications, and the program searches for potential interactions between them.
• list interactions with alternative medications. Many databases include herbal supplements and other nontraditional pharmaceuticals.
• offer additional tools, such as medical calculators, treatment algorithms, and other handy features.

Drawbacks

Because PDA screens are so small, PDA-based drug guides must compromise between level of detail and ease of use. Unlike standard drug reference books, for example, PDA programs rarely list rates of side effects or comparisons with placebo.

PDA-based drug guides usually do not display references or analyses of the data behind the lists. For example, many programs provide dosing suggestions for special populations—such as the elderly, medically ill, and children—but the basis for these dose adjustments often is unclear or does not jibe with other programs. Most PDA drug software excludes other specific information, such as the evidence behind drug indications.

Researchers’ ratings

Some PDA-based drug databases, such as mobilePDR, evolved from written pharmacy databases. Others, such as ePharmacopoeia or Epocrates, were developed from more-general reference tools aimed at students and physicians. Overall, the former type of drug guide is more comprehensive and the latter is easier to use, although all PDA drug software offers some degree of comprehensiveness and usability.

PDA-based programs differ greatly, however, and the following researchers have explored the differences.

• Enders et al¹ in 2001 rated Lexi-Drugs Platinum the most comprehensive and accurate among nine programs.
• Galt and colleagues,² placing more weight on safety concerns than ease of use, in 2005 also rated Lexi-Drugs Platinum number one among 11 programs.
• Clauson et al³ in 2004 rated Lexi-Drugs number one among 10 programs, but noted that other products were catching up.
• Knollmann et al⁴ in 2004 rated 11 PDA-based drug databases on ease of use, comprehensiveness, and accuracy. They entered three pairs of drug names into each program; one pair included an herbal supplement.
• Perkins et al⁵ in 2004 entered 37 pairs of drug names into eight programs to test their ability to detect drug-drug interactions. They found that Epocrates offered the best combination of sensitivity (identifying all potential interactions) and specificity (reporting only important interactions). Lexi-Drugs had perfect sensitivity but comparatively poor specificity.

Which program should you choose?

No PDA-based drug reference will provide everything you need, so be clear on what you desire most when choosing a program:

• If drug safety is your primary concern, Lexi-Drugs might be best, although it tends to report clinically insignificant interactions.
• If you want only clinically significant interactions, consider Epocrates or Epocrates RX Pro.
• If a comprehensive database is critical, Clinical Pharmacology OnHand has the most extensive drug database.
• If you’re looking for the best combination of accuracy, comprehensiveness, and physician-friendly features, Lexi-Drugs and PEPID PDC might be most effective, though Epocrates is also a reasonable performer.
• If you wish to understand the evidence behind each recommendation, books and online pharmaceutical references remain better options.

Cost is another factor. This might explain why Epocrates—which offers a free version for physicians and medical students—is more popular than Lexi-Drugs, which is one of the most expensive programs at $70 for the basic version and $285 for the comprehensive suite. Most programs have two options: a less expensive—or even free—drug database that costs up to $75 and a suite of features such as treatment algorithms or diagnosis databases that range from $60 to almost $300.

Personal experience is the best way to determine which product is best. Most manufacturers let you try their programs before buying.

Related resources

Chan CH, Luo JS, Kennedy RS. Concise Guide to Computers in Clinical Psychiatry. Washington DC: American Psychiatric Press; 2002

American Association for Technology in Psychiatry. www.techpsych.org

Personal digital assistant (PDA)-based drug reference software can help you make informed point-of-care prescription decisions, but accuracy, usability, and comprehensiveness vary greatly among programs.

This article looks at the benefits and drawbacks of popular PDA drug reference programs and offers advice on choosing the right one for your practice.

PDA Program benefits

Equipping your PDA with drug reference software makes prescription information portable and accessible. PDA-based drug guides also:

• are easy to update. Most PDA-based systems automatically update as part of routine synchronization procedures between the device and its host computer, keeping the information up-to-date. This is an important feature as some drug databases are updated daily.
• list potential side effects. Most programs list all potential medication side effects and distinguish between common and uncommon adverse events.
• list possible drug-drug interactions. This feature gives PDA-based drug guides a clear advantage over print textbooks. Users enter two or more medications, and the program searches for potential interactions between them.
• list interactions with alternative medications. Many databases include herbal supplements and other nontraditional pharmaceuticals.
• offer additional tools, such as medical calculators, treatment algorithms, and other handy features.

Drawbacks

Because PDA screens are so small, PDA-based drug guides must compromise between level of detail and ease of use. Unlike standard drug reference books, for example, PDA programs rarely list rates of side effects or comparisons with placebo.

PDA-based drug guides usually do not display references or analyses of the data behind the lists. For example, many programs provide dosing suggestions for special populations—such as the elderly, medically ill, and children—but the basis for these dose adjustments often is unclear or does not jibe with other programs. Most PDA drug software excludes other specific information, such as the evidence behind drug indications.

Researchers’ ratings

Some PDA-based drug databases, such as mobilePDR, evolved from written pharmacy databases. Others, such as ePharmacopoeia or Epocrates, were developed from more-general reference tools aimed at students and physicians. Overall, the former type of drug guide is more comprehensive and the latter is easier to use, although all PDA drug software offers some degree of comprehensiveness and usability.

PDA-based programs differ greatly, however, and the following researchers have explored the differences.

• Enders et al¹ in 2001 rated Lexi-Drugs Platinum the most comprehensive and accurate among nine programs.
• Galt and colleagues,² placing more weight on safety concerns than ease of use, in 2005 also rated Lexi-Drugs Platinum number one among 11 programs.
• Clauson et al³ in 2004 rated Lexi-Drugs number one among 10 programs, but noted that other products were catching up.
• Knollmann et al⁴ in 2004 rated 11 PDA-based drug databases on ease of use, comprehensiveness, and accuracy. They entered three pairs of drug names into each program; one pair included an herbal supplement.
• Perkins et al⁵ in 2004 entered 37 pairs of drug names into eight programs to test their ability to detect drug-drug interactions. They found that Epocrates offered the best combination of sensitivity (identifying all potential interactions) and specificity (reporting only important interactions). Lexi-Drugs had perfect sensitivity but comparatively poor specificity.

Which program should you choose?

No PDA-based drug reference will provide everything you need, so be clear on what you desire most when choosing a program:

• If drug safety is your primary concern, Lexi-Drugs might be best, although it tends to report clinically insignificant interactions.
• If you want only clinically significant interactions, consider Epocrates or Epocrates RX Pro.
• If a comprehensive database is critical, Clinical Pharmacology OnHand has the most extensive drug database.
• If you’re looking for the best combination of accuracy, comprehensiveness, and physician-friendly features, Lexi-Drugs and PEPID PDC might be most effective, though Epocrates is also a reasonable performer.
• If you wish to understand the evidence behind each recommendation, books and online pharmaceutical references remain better options.

Cost is another factor. This might explain why Epocrates—which offers a free version for physicians and medical students—is more popular than Lexi-Drugs, which is one of the most expensive programs at $70 for the basic version and $285 for the comprehensive suite. Most programs have two options: a less expensive—or even free—drug database that costs up to $75 and a suite of features such as treatment algorithms or diagnosis databases that range from $60 to almost $300.

Personal experience is the best way to determine which product is best. Most manufacturers let you try their programs before buying.

Related resources

Chan CH, Luo JS, Kennedy RS. Concise Guide to Computers in Clinical Psychiatry. Washington DC: American Psychiatric Press; 2002

American Association for Technology in Psychiatry. www.techpsych.org

Personal digital assistant (PDA)-based drug reference software can help you make informed point-of-care prescription decisions, but accuracy, usability, and comprehensiveness vary greatly among programs.

This article looks at the benefits and drawbacks of popular PDA drug reference programs and offers advice on choosing the right one for your practice.

PDA Program benefits

Equipping your PDA with drug reference software makes prescription information portable and accessible. PDA-based drug guides also:

• are easy to update. Most PDA-based systems automatically update as part of routine synchronization procedures between the device and its host computer, keeping the information up-to-date. This is an important feature as some drug databases are updated daily.
• list potential side effects. Most programs list all potential medication side effects and distinguish between common and uncommon adverse events.
• list possible drug-drug interactions. This feature gives PDA-based drug guides a clear advantage over print textbooks. Users enter two or more medications, and the program searches for potential interactions between them.
• list interactions with alternative medications. Many databases include herbal supplements and other nontraditional pharmaceuticals.
• offer additional tools, such as medical calculators, treatment algorithms, and other handy features.

Drawbacks

Because PDA screens are so small, PDA-based drug guides must compromise between level of detail and ease of use. Unlike standard drug reference books, for example, PDA programs rarely list rates of side effects or comparisons with placebo.

PDA-based drug guides usually do not display references or analyses of the data behind the lists. For example, many programs provide dosing suggestions for special populations—such as the elderly, medically ill, and children—but the basis for these dose adjustments often is unclear or does not jibe with other programs. Most PDA drug software excludes other specific information, such as the evidence behind drug indications.

Researchers’ ratings

Some PDA-based drug databases, such as mobilePDR, evolved from written pharmacy databases. Others, such as ePharmacopoeia or Epocrates, were developed from more-general reference tools aimed at students and physicians. Overall, the former type of drug guide is more comprehensive and the latter is easier to use, although all PDA drug software offers some degree of comprehensiveness and usability.

PDA-based programs differ greatly, however, and the following researchers have explored the differences.

• Enders et al¹ in 2001 rated Lexi-Drugs Platinum the most comprehensive and accurate among nine programs.
• Galt and colleagues,² placing more weight on safety concerns than ease of use, in 2005 also rated Lexi-Drugs Platinum number one among 11 programs.
• Clauson et al³ in 2004 rated Lexi-Drugs number one among 10 programs, but noted that other products were catching up.
• Knollmann et al⁴ in 2004 rated 11 PDA-based drug databases on ease of use, comprehensiveness, and accuracy. They entered three pairs of drug names into each program; one pair included an herbal supplement.
• Perkins et al⁵ in 2004 entered 37 pairs of drug names into eight programs to test their ability to detect drug-drug interactions. They found that Epocrates offered the best combination of sensitivity (identifying all potential interactions) and specificity (reporting only important interactions). Lexi-Drugs had perfect sensitivity but comparatively poor specificity.

Which program should you choose?

No PDA-based drug reference will provide everything you need, so be clear on what you desire most when choosing a program:

• If drug safety is your primary concern, Lexi-Drugs might be best, although it tends to report clinically insignificant interactions.
• If you want only clinically significant interactions, consider Epocrates or Epocrates RX Pro.
• If a comprehensive database is critical, Clinical Pharmacology OnHand has the most extensive drug database.
• If you’re looking for the best combination of accuracy, comprehensiveness, and physician-friendly features, Lexi-Drugs and PEPID PDC might be most effective, though Epocrates is also a reasonable performer.
• If you wish to understand the evidence behind each recommendation, books and online pharmaceutical references remain better options.

Cost is another factor. This might explain why Epocrates—which offers a free version for physicians and medical students—is more popular than Lexi-Drugs, which is one of the most expensive programs at $70 for the basic version and $285 for the comprehensive suite. Most programs have two options: a less expensive—or even free—drug database that costs up to $75 and a suite of features such as treatment algorithms or diagnosis databases that range from $60 to almost $300.

Personal experience is the best way to determine which product is best. Most manufacturers let you try their programs before buying.

Related resources

Chan CH, Luo JS, Kennedy RS. Concise Guide to Computers in Clinical Psychiatry. Washington DC: American Psychiatric Press; 2002

American Association for Technology in Psychiatry. www.techpsych.org

Imagine helping your patient overcome acrophobia by sending her “up” to the 80^th floor, or telling a patient to get “behind the wheel” to see if he can drive safely.

The ability to simulate real situations with virtual reality (VR) technology has shown promise for treating phobias, assessing patient function, diagnosing anxiety disorders, and other psychiatric clinical applications. Though used predominantly in academic settings, technological advances have made VR less expensive and more “realistic.”

VR’s early promise

In 1991, psychiatrists were introduced to VR at the American Psychiatric Association annual meeting. By donning a headset and cyber glove, exhibit hall passers-by could tour the optic nerve.

The experience revealed VR’s promise and limitations. The head-mounted display (HMD) was heavy, graphics were rudimentary, and distracting delays between user movements and visuals plagued the tracking system. Also, the system cost about $50,000. Even so, this glimpse of a burgeoning technology wowed participants. I was sure that VR would become commonplace within a few years.

Fifteen years later, however, VR remains on the cutting edge, mostly because no VR application has been popular enough to drive its use. Consumer demand for more-intuitive and interactive electronic games has pushed computer development in many areas, but most gamers consider VR too awkward and nausea producing to justify the expense.

VR Advances

Some industries—particularly aerospace and the military—took interest in simulating objects and environments and spearheaded gradual improvements to VR technology. HMDs are lighter, graphic displays and sounds are more realistic, and touch, smell, and other sensory inputs can be added. Many VR systems run on today’s faster personal computers.

Virtually Better, a corporation formed in 2000 by researchers at Georgia Tech’s Graphics Visualization and Usability (GVU) Center, develops applications for VR systems and licenses and supports the hardware and software for psychiatric clinical uses.

Virtually Better has improved VR technology and greatly broadened the situations targeted for desensitization—from airplane flights, storms, and combat, to job interviews, public speaking, and environments that cue substance use. The GVU center uses VR to simulate a skyscraper and elevator, and VR systems can create a virtual Vietnam, World Trade Center, or “crack house.”

VR in psychiatric care

Exposure therapy. The GVU Center uses VR to expose patients with posttraumatic stress disorder and various phobias to feared stimuli.¹ The center uses a virtual skyscraper and elevator to treat acrophobia, for example.

Assessing patient function. The ability to create controlled, predictable conditions that mimic real-world situations could also help assess patient function:

• Rizzo et al have shown that the current battery of tests used to gauge ability to drive² does not adequately predict real-world driver safety. His team is experimenting with driving simulators as being more accurate than routine cognitive testing and safer than a real road test.
• Zhang et al³ used a virtual kitchen to assess patients’ functioning after a brain injury. Two assessments 7 to 10 days apart showed the patients were less able than non-injured controls to process information, identify logical sequencing, and complete the assessment. The findings suggest that a virtual environment can supplement traditional rehabilitation assessment.

Diagnosis. VR could be used to diagnose and treat primary psychiatric disorders. By “creating” people and environments, psychiatrists could invent standardized interpersonal interactions that would be difficult to duplicate in the real world.

Freeman et al⁴ created a neutral virtual environment (a library) populated by computer-generated characters. The investigators used a Cave Automatic Virtual Environment (CAVE) system to project images on the walls while subjects wore 3-D glasses, allowing them to walk through the environment. The subjects, college students without psychiatric disorders, then recorded their thoughts after interacting with the characters. Though most experiences were positive, some reported ideas of reference and persecutory thoughts. These students were more likely than those without such thoughts to report anxiety and high interpersonal sensitivity.

Although the study was devised to investigate how persecutory thoughts originate, it also showed how VR convincingly replicates human interaction, suggesting endless treatment possibilities.

Further research will determine whether:

• VR offers a tangible advantage over more-traditional techniques
• that advantage would justify the expense of a VR system.

Can VR help your patients?

VR system prices, though still substantial, have decreased considerably over 15 years. Depending on configuration, hardware/software systems supported by Virtually Better cost $5,500 to $7,000.

Third-party payers generally have been covering VR, and some VR therapists are “preferred providers” for major insurers in their areas. Some providers bill the insurer, while others request payment up front and require the patient to seek reimbursement.

Related resources

HPCCV Publications. The CAVE: A virtual reality theater. http://www.evl.uic.edu/pape/CAVE/oldCAVE/CAVE.html

Georgia Institute of Technology. Graphics Visualization & Usability (GVU) Center. http://www-static.cc.gatech.edu/gvu

Virtually Better www.virtuallybetter.com

Disclosure

Dr. Boland report no financial relationship with any company whose products are mentioned in this article, or with manufacturers of competing products. The opinions he expresses in this column are his own and do not necessarily reflect those of Current Psychiatry.

Imagine helping your patient overcome acrophobia by sending her “up” to the 80^th floor, or telling a patient to get “behind the wheel” to see if he can drive safely.

The ability to simulate real situations with virtual reality (VR) technology has shown promise for treating phobias, assessing patient function, diagnosing anxiety disorders, and other psychiatric clinical applications. Though used predominantly in academic settings, technological advances have made VR less expensive and more “realistic.”

VR’s early promise

In 1991, psychiatrists were introduced to VR at the American Psychiatric Association annual meeting. By donning a headset and cyber glove, exhibit hall passers-by could tour the optic nerve.

The experience revealed VR’s promise and limitations. The head-mounted display (HMD) was heavy, graphics were rudimentary, and distracting delays between user movements and visuals plagued the tracking system. Also, the system cost about $50,000. Even so, this glimpse of a burgeoning technology wowed participants. I was sure that VR would become commonplace within a few years.

Fifteen years later, however, VR remains on the cutting edge, mostly because no VR application has been popular enough to drive its use. Consumer demand for more-intuitive and interactive electronic games has pushed computer development in many areas, but most gamers consider VR too awkward and nausea producing to justify the expense.

VR Advances

Some industries—particularly aerospace and the military—took interest in simulating objects and environments and spearheaded gradual improvements to VR technology. HMDs are lighter, graphic displays and sounds are more realistic, and touch, smell, and other sensory inputs can be added. Many VR systems run on today’s faster personal computers.

Virtually Better, a corporation formed in 2000 by researchers at Georgia Tech’s Graphics Visualization and Usability (GVU) Center, develops applications for VR systems and licenses and supports the hardware and software for psychiatric clinical uses.

Virtually Better has improved VR technology and greatly broadened the situations targeted for desensitization—from airplane flights, storms, and combat, to job interviews, public speaking, and environments that cue substance use. The GVU center uses VR to simulate a skyscraper and elevator, and VR systems can create a virtual Vietnam, World Trade Center, or “crack house.”

VR in psychiatric care

Exposure therapy. The GVU Center uses VR to expose patients with posttraumatic stress disorder and various phobias to feared stimuli.¹ The center uses a virtual skyscraper and elevator to treat acrophobia, for example.

Assessing patient function. The ability to create controlled, predictable conditions that mimic real-world situations could also help assess patient function:

• Rizzo et al have shown that the current battery of tests used to gauge ability to drive² does not adequately predict real-world driver safety. His team is experimenting with driving simulators as being more accurate than routine cognitive testing and safer than a real road test.
• Zhang et al³ used a virtual kitchen to assess patients’ functioning after a brain injury. Two assessments 7 to 10 days apart showed the patients were less able than non-injured controls to process information, identify logical sequencing, and complete the assessment. The findings suggest that a virtual environment can supplement traditional rehabilitation assessment.

Diagnosis. VR could be used to diagnose and treat primary psychiatric disorders. By “creating” people and environments, psychiatrists could invent standardized interpersonal interactions that would be difficult to duplicate in the real world.

Freeman et al⁴ created a neutral virtual environment (a library) populated by computer-generated characters. The investigators used a Cave Automatic Virtual Environment (CAVE) system to project images on the walls while subjects wore 3-D glasses, allowing them to walk through the environment. The subjects, college students without psychiatric disorders, then recorded their thoughts after interacting with the characters. Though most experiences were positive, some reported ideas of reference and persecutory thoughts. These students were more likely than those without such thoughts to report anxiety and high interpersonal sensitivity.

Although the study was devised to investigate how persecutory thoughts originate, it also showed how VR convincingly replicates human interaction, suggesting endless treatment possibilities.

Further research will determine whether:

• VR offers a tangible advantage over more-traditional techniques
• that advantage would justify the expense of a VR system.

Can VR help your patients?

VR system prices, though still substantial, have decreased considerably over 15 years. Depending on configuration, hardware/software systems supported by Virtually Better cost $5,500 to $7,000.

Third-party payers generally have been covering VR, and some VR therapists are “preferred providers” for major insurers in their areas. Some providers bill the insurer, while others request payment up front and require the patient to seek reimbursement.

Related resources

HPCCV Publications. The CAVE: A virtual reality theater. http://www.evl.uic.edu/pape/CAVE/oldCAVE/CAVE.html

Georgia Institute of Technology. Graphics Visualization & Usability (GVU) Center. http://www-static.cc.gatech.edu/gvu

Virtually Better www.virtuallybetter.com

Disclosure

Dr. Boland report no financial relationship with any company whose products are mentioned in this article, or with manufacturers of competing products. The opinions he expresses in this column are his own and do not necessarily reflect those of Current Psychiatry.

Imagine helping your patient overcome acrophobia by sending her “up” to the 80^th floor, or telling a patient to get “behind the wheel” to see if he can drive safely.

The ability to simulate real situations with virtual reality (VR) technology has shown promise for treating phobias, assessing patient function, diagnosing anxiety disorders, and other psychiatric clinical applications. Though used predominantly in academic settings, technological advances have made VR less expensive and more “realistic.”

VR’s early promise

In 1991, psychiatrists were introduced to VR at the American Psychiatric Association annual meeting. By donning a headset and cyber glove, exhibit hall passers-by could tour the optic nerve.

The experience revealed VR’s promise and limitations. The head-mounted display (HMD) was heavy, graphics were rudimentary, and distracting delays between user movements and visuals plagued the tracking system. Also, the system cost about $50,000. Even so, this glimpse of a burgeoning technology wowed participants. I was sure that VR would become commonplace within a few years.

Fifteen years later, however, VR remains on the cutting edge, mostly because no VR application has been popular enough to drive its use. Consumer demand for more-intuitive and interactive electronic games has pushed computer development in many areas, but most gamers consider VR too awkward and nausea producing to justify the expense.

VR Advances

Some industries—particularly aerospace and the military—took interest in simulating objects and environments and spearheaded gradual improvements to VR technology. HMDs are lighter, graphic displays and sounds are more realistic, and touch, smell, and other sensory inputs can be added. Many VR systems run on today’s faster personal computers.

Virtually Better, a corporation formed in 2000 by researchers at Georgia Tech’s Graphics Visualization and Usability (GVU) Center, develops applications for VR systems and licenses and supports the hardware and software for psychiatric clinical uses.

Virtually Better has improved VR technology and greatly broadened the situations targeted for desensitization—from airplane flights, storms, and combat, to job interviews, public speaking, and environments that cue substance use. The GVU center uses VR to simulate a skyscraper and elevator, and VR systems can create a virtual Vietnam, World Trade Center, or “crack house.”

VR in psychiatric care

Exposure therapy. The GVU Center uses VR to expose patients with posttraumatic stress disorder and various phobias to feared stimuli.¹ The center uses a virtual skyscraper and elevator to treat acrophobia, for example.

Assessing patient function. The ability to create controlled, predictable conditions that mimic real-world situations could also help assess patient function:

• Rizzo et al have shown that the current battery of tests used to gauge ability to drive² does not adequately predict real-world driver safety. His team is experimenting with driving simulators as being more accurate than routine cognitive testing and safer than a real road test.
• Zhang et al³ used a virtual kitchen to assess patients’ functioning after a brain injury. Two assessments 7 to 10 days apart showed the patients were less able than non-injured controls to process information, identify logical sequencing, and complete the assessment. The findings suggest that a virtual environment can supplement traditional rehabilitation assessment.

Diagnosis. VR could be used to diagnose and treat primary psychiatric disorders. By “creating” people and environments, psychiatrists could invent standardized interpersonal interactions that would be difficult to duplicate in the real world.

Freeman et al⁴ created a neutral virtual environment (a library) populated by computer-generated characters. The investigators used a Cave Automatic Virtual Environment (CAVE) system to project images on the walls while subjects wore 3-D glasses, allowing them to walk through the environment. The subjects, college students without psychiatric disorders, then recorded their thoughts after interacting with the characters. Though most experiences were positive, some reported ideas of reference and persecutory thoughts. These students were more likely than those without such thoughts to report anxiety and high interpersonal sensitivity.

Although the study was devised to investigate how persecutory thoughts originate, it also showed how VR convincingly replicates human interaction, suggesting endless treatment possibilities.

Further research will determine whether:

• VR offers a tangible advantage over more-traditional techniques
• that advantage would justify the expense of a VR system.

Can VR help your patients?

VR system prices, though still substantial, have decreased considerably over 15 years. Depending on configuration, hardware/software systems supported by Virtually Better cost $5,500 to $7,000.

Third-party payers generally have been covering VR, and some VR therapists are “preferred providers” for major insurers in their areas. Some providers bill the insurer, while others request payment up front and require the patient to seek reimbursement.

Related resources

HPCCV Publications. The CAVE: A virtual reality theater. http://www.evl.uic.edu/pape/CAVE/oldCAVE/CAVE.html

Georgia Institute of Technology. Graphics Visualization & Usability (GVU) Center. http://www-static.cc.gatech.edu/gvu

Virtually Better www.virtuallybetter.com

Disclosure

Dr. Boland report no financial relationship with any company whose products are mentioned in this article, or with manufacturers of competing products. The opinions he expresses in this column are his own and do not necessarily reflect those of Current Psychiatry.