All packages run on both Macintosh and Windows platforms, unless otherwise stated. Minimum specifications are a 486 (PC) or 68030 (Mac) processor, 4 MB RAM, 4 MB hard drive space, mouse, SVGA graphics card/monitor and a 2X CD-ROM drive. Additional requirements, the number of disks and any extra items included are noted at the end of each review.

 
ACCSAP 2000
Year/Version: 4th edition

Reviewed September 1999
by: Edward P Hoffer, MD
Lahey Hitchcock Clinic
Framingham, Massachusetts
Assistant Director
Laboratory of Computer Science
Massachusetts General Hospital
Boston, Massachusetts
 
Ratings (1=poor, 5=superior)
Content.........................5
Programming.................4
CAI...............................2
Error handling................4
Support.........................4
 
This CME/self-assessment program covers all of adult cardiology, from basic science through the use of clinical trials for decision-making. For graphics-oriented fields such as echocardiography and electrocardiography it includes extensive high-quality visuals, and summaries of most of the major clinical trials are available. Printed text for 19 of the 20 sections accompanies the program, with ECG interpretation available only from the CD. This is a good decision, because for text-oriented chapters, it remains easier to read blocks of material from a booklet than a CRT.
 
The single CD loaded flawlessly. From the main menu you have access to any of the 20 independently-written sections: epidemiology and prevention of coronary disease; acute myocardial infarction; chronic ischemic heart disease; heart failure; arrhythmias and electrophysiology; adult congenital heart disease; valvular disease; peripheral vascular disease; cardiac consultation; echocardiography; nuclear cardiology; catheterization and interventional cardiology; basic science; proper use of noninvasive testing; ECG interpretation; cardiac surgery (pre-op and post-op); clinical pharmacology; hypertension, and evidence-based medicine. Most of the section editors are well known experts in their fields.
 
Disappointingly, little imaginative use was made of the computer's capabilities in presenting the chapters. Each chapter has Learning Objectives, presented on the first screen. A Summary, which is an abstract of the chapter contents, is available on request. The rest of each chapter is presented as large blocks of text, with figures available on request. Yes, the computer is used: small figures are enlarged and closed by a mouse click; clinical trials, references, and drugs are "hot words" that link you to the full reference or to a drug description; the chapters have subheadings that can be accessed independently. However, the material is basically a computerized version of the text. One would have hoped to see more use of graphics and interactivity to make the computer version an expansion of the text rather than a copy. Each chapter is extensively illustrated and each contains numerous references. For some, but not all, references, the Medline abstract is available.
 
It is easy to navigate around the program, and hard to get lost. At all times the main navigation bar is available, containing buttons for Search, Utilities, Scores, Back, Next, Menu, Help, and Exit. Utilities allow you to print, copy, and bookmark. The only minor navigational hitch I found was in the Search function. After you go to one of the items found in a search, clicking on the Back button takes you to the Main Menu instead of the expected list of items just found. Clicking on Search erases your old search and opens a fresh search page. If you Close the search window, it is not really closed: when you close it and then click on Search, the old search is still there. Trial and error -- and reading the instructions -- finally taught me how to get around this section as desired, but it was not intuitive.
 
The search engine itself is the only weak link in this otherwise excellent product. At first glance it appears robust. You can specify that you want your search to be restricted to any combination of chapters, graphics, trials, drug descriptions, or guidelines or to the entire database. You can use Boolean searches and search for matches using "equals" or "contains." However, entering compound searches (aortic stenosis AND low ejection fraction; atrial fibrillation AND cardioversion) resulted in huge numbers of hits, most irrelevant to the topic. And many of the hits take you to the beginning of a section when the related text is at the end.
 
The chapters in which visuals are important include large numbers of excellent images. The echocardiograms are well chosen and are good illustrations of the points being made. They would have benefited from onscreen labels. Presently, the text refers to specific features as being in a general location: "There is a small vegetation on the mitral valve, seen in the upper right," for example. Such features would be better appreciated with use of an arrow on the graphic, and this should be considered for the next edition.
 
The ECG interpretation section includes 39 ECGs. You can measure rates and intervals with an onscreen cursor and, after deciding on your interpretation, can see the expert's opinion. You can log in to the ACC Web site (but no other Web sites) directly from the program, as it automatically checks for an active browser on your hard drive. At any time, you can go to the self-assessment section. Each chapter has a set of questions, the number roughly corresponding to the lengths of the chapters. These range from five relating to the chapter on Estimating the Power of Non-invasive Tests to 68 on Cardiac Arrhythmias and Electrophysiology. There is a total of 437 of these traditional multiple-choice questions. Once you select your answer, you are told if it is correct and given a critique/explanation. The program tracks your progress and at any time you can see how many questions you have done and how well you did. This summary must be printed and mailed to the ACC to receive your CME credit. It can only be submitted once by one user, although the program itself can be used freely by anyone. An added feature of the program is a compilation of summary-abstracts and meta-analyses of clinical trials. This section does not have associated CME questions, but will be highly useful as a reference.
 
The graphics are for the most part excellent. The chapter on echocardiography includes almost 300 images, most of which are echocardiograms, both videos and still frames. The content is as up to date as it can be in a field that changes almost daily. The inclusion of abstracts and meta-analyses of clinical trials means that much of what you need to know about evidence-based cardiology is available from this CD.
 
There are no major drawbacks, although I was somewhat disappointed at the text-on-computer aspect of the content and found the search engine less than ideal. This is a well-written and well-designed package, which belongs on the shelf of all physicians who practice clinical cardiology. Although the price is high, the availability of up to 115 hours of CME credit makes it a relative bargain.
 
This is the fourth edition of ACC's self-assessment program, and it is now a mature, well done product. It would be particularly useful for physicians studying for their Board certification or recertification in cardiology, but should be of much broader interest. Adult cardiologists, as well as internists and family practitioners with a strong interest in cardiology, will benefit from using this product. I hope that the editors consider how to make better use of the full capabilities of the medium in future editions.
 
$345; 400+ questions, 115 AMA hours CME; one CD; requires Pentium with Windows 95, 98, or NT, and 32 Mb RAM; 100 MHz PowerPC with System 8 and QuickTime 3.0, 16 Mb RAM, 13-in. or larger color monitor (800 x 600), 20 Mb hard drive space, 4X CD-ROM drive, 16-bit sound card with speakers
 
Source: American College of Cardiology, Educational Services, PO Box 79231, Baltimore MD 21279-0231; 800-253-4636 or 301-897-5400
 
Originally published in edited form September 1999 in Medical Software Reviews.
 
 
CathSAP
Year/Version: 1999
 
Reviewed October 1999
by: Jay M Kalan, MD, FACC
The Cardiovascular Group, PC
Arlington, Virginia
Clinical Associate Professor of Medicine (Cardiology)
Georgetown University
Washington, DC
 
Ratings (1=poor, 5=superior)
Content.........................4
Programming.................4
CAI...............................4
Error handling................2
Support.........................5
 
CathSAP is the American College of Cardiology (ACC)'s review and self-test program for invasive and interventional cardiology. It was devised as a study aid to prepare for the Interventional Cardiology ABIM board exams, and as an easy way for cardiologists to keep current in these fields. Edited by Carl J. Pepine, MD, and Steven E. Nissen, MD, it boasts 24 contributors to its 15 chapters.
 
CathSAP includes reviews of all facets of cardiac catheterization, from patient selection and choice of contrast to catheterization techniques, followed by reviews of the various modalities of coronary intervention, both approved and emerging. Additional chapters cover atherosclerotic, valvular, congenital, myocardial, and pericardial heart diseases as they relate to cardiac catheterization. The final chapter is a reference guide, with user sortable databases of cardiovascular drugs, synopses of important clinical trials, and full text ACC guideline and policy documents dating back to 1966.
 
The program contains 282 multiple-choice self-assessment questions for the 14 didactic chapters; these questions are written by the individual chapter authors. The test score for each chapter is tallied and stored by the program. Once completed, the test scores can be mailed to the ACC for up to 65 hours of category 1 CME credit.
 
Once loaded, CathSAP is easy to use. The menus are straightforward and easy to understand. Detailed voice instructions are given with each new screen. This feature is easily toggled on and off once you are familiar with the program. The material is fairly current. My disk, released in June 1999, included studies released this same year. In addition, regular updates can be obtained from the ACC Web site. I could not test this function, as it requires Netscape Navigator.
 
Each of the 14 non-reference chapters consists of text equivalent to seven to 20 printed pages, along with more than 1,000 high quality visuals. The text can be reviewed in three levels of detail: as an outline, in a summary mode, or as full text. Full text is available both on the disk and in print. The CathSAP package includes 14 separate booklets of text (about 200 pages total, without illustrations), for easy reference and note taking. On the screen, easily identifiable "hotwords," scattered through the text, may be clicked to bring up corresponding figures and tables. Miniatures of the illustrations and visuals are also arrayed in tabular format next to the text screen, so they can be accessed directly.
 
The visuals are superb, with high quality graphics. During the setup process, the computer monitor must be set to at least 800 x 600 resolution, with 16 bit color, or the program will not load. I viewed it at this minimum setting and the cineangiography and echocardiography images were sharp and easy to see. Photographs had good detail, and were presented in full screen size.
 
Following the text, each chapter has a set of about 20 multiple choice questions. As each question is completed, an immediate answer appears, with a brief explanation and supporting references. Question sets can be answered only once. The program keeps a score for each chapter. As each chapter is completed, the user prints out the scores list and mails it to the ACC for CME credit.
 
The final chapter is a reference guide with three separate sections. The first is a guide to cardiovascular medications, which can be easily accessed and searched from anywhere in the program. The list can also be sorted alphabetically or by drug category, to facilitate useful review. The second section is a list of important, but certainly not all, clinical trials relating to the cath lab. These can be sorted by any of four fields, including title, acronym, date, and topic, making it a very useful tool. A fairly complete synopsis of each study can then be easily called up. The last section consists of full text copies of ACC clinical practice guidelines, expert consensus reports, policy statements, and competency and training statements, all released since 1985, as well as Bethesda Conference reports dating back to 1966.
 
T he program is very easy to use. The menu graphics are well done. It is easy to move around the chapters and between the text and illustrations. The illustration images are in superb detail. The search engine allows you to search the entire disk using simple logical operands.
 
A second strong point is the extensive data in the reference guide. The user gets a handy list of ACC and Bethesda Conference clinical documents, all sortable and easily accessible. The clinical trial summaries, though not all-inclusive, make a good study/review tool.
 
On the other hand, the program was difficult to load. It took me two or three tries until all display properties were set correctly before the program would complete the setup process. On one computer, the SVGA monitor settings had to be changed, requiring rebooting twice. On a second computer, a missing .dll file was the culprit. Technical support was very knowledgeable, however, and quickly e-mailed me the missing Windows file. Error management by the program is nonexistent. When the occasional error message occurs in the questions section, the only option is to exit the program and restart.
 
The text in some of the chapters is skimpy, particularly the sections on valvular and myocardial diseases. CathSAP is a comprehensive review, as billed, but it does not have the depth of a textbook. This is a low-stress way to review interventional cardiology and to study for CME credit, however, and a lack of detail in the text of some of the chapters may be its only limitation.
 
$395; 282 questions; 65 AMA hours CME; requires Pentium running Windows 95, 98, or NT, or a 100-MHz Power PC running System 8; 32 Mb RAM, 26 Mb available hard disk space, QuickTime 3.0 (included), 4X CD-ROM drive, and a 16-bit sound card
 
Source: American College of Cardiology, 9111 Old Georgetown Rd., Bethesda MD 20814; 800-253-4636 or 301-897-5400; http://www.acc.org
 
Originally published in edited form October 1999 in Medical Software Reviews.
 
 

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