The iPads large screen and interactive interface make it an ideal platform for medical imaging.

NeuroRad by RadLynx LLC is a clinical neuroradiology reference designed for a range of healthcare professionals involved in neurological imaging of the brain.

Written and designed by an American Board of Radiology certified Neuroradiologist, NeuroRad aims to improve understanding of neurological imaging and associated pathologies.

We have previously reviewed the NeuroRad Mini for the iPhone, and this is the iPad counterpart.

The main feature of this app is the interactive imaging atlases. This is split into a number of sections; Cross Sectional MRI Anatomy, Vascular territories, MR Angiography (both arterial and venous) and CT Angiography.

All three views (Saggital, Coronal and Axial) are accessible complete with labels. Navigation through the different parts is innovative and involves pinch-to-zoom multitouch gestures which scroll through the different anatomical slices. The images are high resolution and clearly labelled. Unfortunately, there was no way to turn off the labels in this section in order to test oneself.

The Vascular territory atlas covers both arterial and venous supply and is an excellent resource navigated in a similar fashion to the cross sectional atlas. A clear key illustrates the different areas of the brain supplied by each artery-key for any neurosurgeon. Labels are also included here to develop recognition of key structures

The MR Angiography section covers both the arterial and venous system. Each view has a multitude of labels which consolidates anatomical knowledge. There are also a range of views including ‘Tumble’ and ‘Spin’ which aim to improve 3-dimensional understanding.

The CT angiography also covers the three main views (Saggital, Axial and Coronal) and both arterial and venous systems. It is useful that these images are highlighted so that the path of the vessels can be visualised.

The other major section of NeuroRad for iPad is a detailed weblink and reference section. There are a decent range of weblinks covering a range of aspects related to neuroradiology from MRI images to clinical sites including journals and professional associations. This collection of weblinks (which open in Safari) is a good resource for residents and interns looking for further information.

The reference section contains some excellent information related to pathologies which may be seen on a scan. These are presented as a list of differential diagnoses which are extensive. There is very little pathophysiology explanation although references are provided for the interested resident who is looking for further reading.

Price:

• $9.99 (although currently on sale as new content is added and updated)

Likes:

• Detailed, labelled radiology atlas covering the three main views
• Excellent visualization of the vessels in the brain using both MR and CT Angiography
• Detailed differential diagnoses for a range of abnormalities seen on radiograms
• Collection of weblinks

Dislikes:

• No ability to share information/screenshots via email/social media
• No ability to turn the labels on/off in order to test oneself

Overall Rating:

• NeuroRad for iPad is a fantastic application for radiologist residents with an excellent neuroradiology atlas
• Has a range of uses for healthcare professionals ranging from student to resident
• An all-round excellent application for those interested in neurological imaging

iTunes link

It is well recognized that when there is a language barrier between patients and physicians, the quality of care delivered suffers. With the rapid rise of patients for whom Spanish is their primary language, this is becoming an increasingly urgent issue to address.

Ultralingua, Inc. has published the Vox Spanish-English Medical Dictionary and Verbs app ($49.99) to help bridge this gap. The app is available for iPhone, iPod touch, and iPad. Read on to see whether this app can help you take better care of your Spanish-speaking patients.

Features:

The app provides these key features:

• English-to-Spanish and Spanish-to-English word translations

• Search function

• Verb conjugations

• A number pad that instantaneously spells out the number in the selected language

• The ability to look up any word with a single tap

It is important to note that this app does not provide any sort of instruction or lessons on how to speak Spanish or form sentences.  It provides translation only, with no definitions or meanings of words.  Additionally, it is specifically a medical dictionary, meaning that ordinary, non-medical terms may not be found (in the screenshot below, I tried to search “girl,” with no results.)

Therefore, this app would be most useful to practitioners or students with at least some background in the Spanish language.  As far as medical terms go, however, this dictionary seems to be thorough.  It even includes different bacterial and fungal species.

User Interface:

Overall, the user interface is decent, but takes a little getting used to.  Because it is not completely intuitive, Ultralingua has kindly provided us with an instruction page that briefs the user on how to navigate the app and use the key features, complete with picture demonstrations.  This short guide can be accessed by tapping on the little lightbulb icon in the bottom left-hand corner.

For the most part, even without taking a peek at the user guide, the app is pretty easily navigated after a few minutes of experimentation.  For example, you might think the clock icon at the top will translate times, but it actually displays your search history.

As mentioned earlier, you can tap on any word and be taken to a translation of that word immediately.  The languages will also instantaneously swap.  This is a handy feature, though I wouldn’t have known it existed without reading the user guide.  At times it was also a little hard to tap the words with enough precision that the translation would come up.

Uses in Practice:

This app would be most useful in practice for looking up a few quick terms.  Even fluent Spanish speakers may not know how to translate some obscure disease, especially if they were trained in an English-speaking country.  The search function is fast enough that a doctor could even look up a word in front of a patient.

The conjugation feature is helpful, but would probably be too tedious to use during a patient conversation.  This app helps facilitate and improve physician-patient communication for the conversational physician, but for the practitioner with little to no Spanish knowledge, it will be of limited use.

Price:

• The paper version of the Vox Medical Spanish and English Dictionary sells for $35, vs. the $49.99 for this app.

Likes:

• Thorough dictionary of medical Spanish terms
• Decent UI with short guide to fill in the gaps
• Fast search function
• Provides a medical student or practitioner with a quick reference in their pocket

Dislikes:

• It’s got “granulation” but not “grandmother.” Though not intended to be a comprehensive dictionary, it would have been helpful to include some non-medical words that are commonly used in patient conversation, e.g., family members for taking a family history. This is yet another reason why this app might not be as useful for users who lack a solid background in Spanish
• Does not include audio.  Pronunciation of a different language can be tough, especially with unfamiliar words.  Adding an audio component, where the user can hear a speaker pronounce the word correctly, would be tremendously useful and provide a strong reason for someone to choose the app rather than the paperback dictionary

Overall:

• If you’re at least a decent Spanish speaker who would like to improve the clarity of your conversations with patients, this app is a good reference.
• It’s fast, easy to use, and mobile, and future updates including audio pronunciation and a few select non-medical terms would greatly improve its usefulness.
• If your Spanish proficiency is so limited that you desperately need a translator to begin with, this app is probably not worth the price.

iTunes Link

by: Brian Chau, MS3

Being able to recognize key anatomical landmarks on radiological imagery is important for any medical student or clinician.

NeuroRad Mini is an app available through iTunes for users looking for a mobile reference and review guide to brain images.

NeuroRad Mini, from developer RadLynx, is a clinical MRI brain atlas for iOS devices. It features coronal, sagittal, and axial views of the brain. These are all labeled, allowing for easy viewing and review of important anatomical locations and relationships.

Designed by a senior member of the American Society of Neuroradiology, NeuroRad Mini is a more limited version of the iPad-only app, NeuroRad, also from RadLynx. NeuroRad Mini is designed to be a quick-reference guide to MRI views of the brain, while the iPad version offers more features, due to the limitations of the screen size and processing power of the iPod Touch and iPhone platforms.

I was impressed by how easy it was to navigate NeuroRad Mini on a small device such as the iPod Touch. Everything in the app loaded quickly, with little noticeable lag. Image scrolling through different cross-sectional views are fluid and accomplished by using the Multitouch contols. I could either swipe once to change to a single new view, or enable continuous image changes by dragging two fingers on screen. Just swiping to view the next image seemed to be the best way to view images through NeuroRad Mini.

NeuroRad Mini also allows the user to view labeled images of the various neuro cross-sections. This option is very useful, especially in a clinical educational setting. A simple upward swipe on the screen will turn off labels, while swiping down turns them on. The pointers to each brain region are easy to follow and visualize, even on the smaller screen of the iPod Touch. To zoom in, double-tapping the brain or tapping the magnifier glass will do the trick. I did notice that zoomed in images weren’t quite as detailed as many would like, but they are certainly still useful for learning and reference.

While some medical apps require an active Internet connection to pull images and information, NeuroRad Mini offers almost all of its content locally. This is a huge benefit, as not every user has access to a network data plan or wireless connection 24/7. Even the basic help and support pages on the app do not require active network access. Finally, for users desiring more information or assistance with NeuroRad Mini, the developer’s website offers a fairly comprehensive FAQ and user guide.

Price and technicals:

• NeuroRad Mini is available for $9.99, through iTunes
• This app requires iOS 4.3 or later and runs on the iPod Touch, iPhone and iPad
• There is also a larger version named NeuroRad available for the iPad exclusively.

Likes:

• Wonderful review of brain anatomy seen through MRI imagery
• Large selection of high-quality neuro MRI images
• Smooth navigation and superb layout
• Excellent clinical relevance
• Great customer support, both online and off

Dislikes:

• Users of older iOS devices will not be able to run NeuroRad Mini
• Limited to MRI imagery

Conclusion:

• NeuroRad Mini is a solid choice for a brain atlas utilizing MRI imagery
• It’s a must-have for any user interested in better understanding the anatomic layout of the brain in a clinical setting.

Links:

Developer
iTunes

The recent development of direct-acting antiviral agents (DAA’s) – Merck’s boceprevir (Victrelis) and telaprevir (Incivek) from Vertex has transformed the management of Hepatitis C viral infection (HCV).

In particular, the addition of these agents, just FDA approved in May 2011, can increase the likelihood of attaining a sustained virologic response (SVR) and even decrease the duration of treatment, compared to existing therapies.

Sponsored by pharmaceutical developers Vertex and Merck, the HCV Care & Guidance App was developed by Projects in Knowledge for the iPhone and iPad to assist clinicians, especially nurse practitioners and physician assistants, with the use of these exciting new medications in the clinic setting.

Projects in Knowledge, founded in 1980 and based in New Jersey, specializes in peer-reviewed continuing medical education and has developed a number of medically-themed iPhone & iPad apps, including ones pertaining to multiple sclerosis, rheumatoid arthritis, Parkinson’s disease, and diabetes.

Read below to learn more about how the HCV Care & Guidance App can offer assistance with the use of DAA therapy in HCV.

The use of the HCV Care & Guidance App requires registration with Projects in Knowledge, which is free and takes less than 1 minute.

The app’s table of contents features sections divided into six chapters, webcasts, video vignettes, and content from AASLD 2011, or the American Association for the Study of Liver Diseases.

The six chapters, which are designated as CME/CE activities, cover the following:

1. Getting ready for direct-acting antiviral (DAA) therapy
2. What you need to know about the new direct-acting antiviral (DAA) regimens
3. Hematologic adverse effects
4. Dermatologic adverse effects
5. Gastrointestinal adverse effects
6. Neuropsychiatric adverse effects

Each chapter offers CME/CE credit as shown above, and begins with a short pre-test before introducing the content.

The development of content is overseen by an editorial board that consists of nurse practitioners, physician assistants, and a clinical research director. One strength of this app is the inclusion of embedded links to multimedia, including articles, illustrations, and videos.

Each chapter includes the highlighted “take-away points,” and includes a series of tables among the text for well-organized education on DAA therapy.

References are included, though many are package inserts for medications.

The end of each chapter features a post-test for users to receive credit for completing the learning module.

The app also includes two 30-to-40-minute audio webcasts, which feature slides for visual correlation. The well-presented webcasts also utilize case studies to help educate listeners on new paradigms in the management of HCV as well as monitoring and managing patients on anti-HCV therapy.

Next, the app also features several shorter video vignettes presenting hypothetical cases that clinicians would be likely to encounter in the outpatient setting.

Finally, the app features a near-two-hour video from AASLD on Paradigm Shifts in HCV Standard of Care Treatment: DAAs. Like the rest of the app’s content, the videos can be viewed horizontally or vertically on the iPhone or iPad.

Pricing:

• The HCV Care & Guidance App is free at the iTunes store.

Likes:

• Loads of high-quality information pertaining to the use of DAA’s, including selecting candidates for therapy, dosing guides, managing adverse effects, follow-up scheduling, and monitoring for compliance and virologic response
• Education presented via text, tables, illustrations, webcasts, and videos
• Well-organized content and smooth user interface
• Free!

Concerns:

• Sponsored by pharmaceutical manufacturers Vertex (who developed telaprevir) and Merck (who developed boceprevir)
• Specific content useful mostly for clinicians who manage Hepatitis C

Conclusion:

• The HCV Care & Guidance App from Projects in Knowledge is a free resource sponsored by the pharmaceutical developers of the DAA’s that features well-presented, high-quality, and clinically useful information for clinicians who manage Hepatitis C infection.

iTunes Link

by: Dr Philip Xiu, MB BChir (Cantab)

The use of the SkyScape platform has been previously reviewed by iMedicalApps for the bolt-on app of Outlines in Clinical Medicine: SkyScape review – Outlines in Clinical Medicine.

The breathtaking speed of modern day research results in physicians being besieged with hundreds of new clinical pearls  in their own field alone.

In such a time limited environment, this makes it hard to keep up-to-date with latest protocols and evidence based medicine that is relevant for your particular specialty.

The Journal Watch – Hospital Medicine is another bolt-on app for the SkyScape platform, which is a source for the latest medical news, and guidelines by providing summaries and commentaries of key medical research written by practicing clinicians collated from over 250 journals.

The Hospital Medicine app itself is but one of 13 that Journal Watch offers.

On opening the app, the list of article summaries is displayed by time order, and since the updates come weekly, it is a sensible approach. However it also allows you to search/look at all the previous summaries that were published prior to the date you bought the app – as listed by topic format.

On expanding the various weeks, we can see a list of the clinical research summaries that have been released by the Journal Watch – Hospital Medicine team.

The articles are sent on a weekly basis. Below is a summary of the number of updates you can expect to get over the year split into a monthly analysis:

• Nov. 2011: 3
• Oct. 2011: 2
• Sep. 2011: 5
• Aug. 2011: 2
• Jul. 2011: 3
• Jun. 2011: 3
• Apr. 2011: 5
• Mar. 2011: 4
• Feb. 2011: 3
• Jan. 2011: 5

Although the number of articles that Journal Watch – Hospital Medicine comments on is rather small, the quality of its commentaries is unrivaled.

Pricing and technicals:

• $59.99 on the Blackberry & iPhone for 1 year’s rent
• 193kb initial download
• Weekly updates via SkyScape

Likes:

• Journal Watch – Hospital medicine is part of a suite of other specialties that can be ordered for the specialist (Cardiology, Dermatology etc), that focuses on advances in their own fields
• The quality of the commentaries shows a depth and true appreciation of the topic at hand

Dislikes/possible future updates:

• The sparsity of general updates is disappointing. Some journals such as British Medical Journal features a weekly summary/digest of all topical medical research that may be present in the other medical journals
• Paying $59.99 for 1 year’s rental of this service did not seem to yield suitable value

Conclusion:

• Although a very useful app to have, the price and the sparsity of the updates makes this app a second line solution in keeping up with the latest updates to medical research
• However, with more clinical commentaries and more frequent updates (perhaps bi-weekly), this app may merit stronger consideration.

Blackberry Link

Internal Medicine News, an independent bimonthly newspaper founded in 1968 that is also available online, has finally arrived to the iPhone and iPod Touch in app format.

Owned by Elsevier’s International Medical News Group division, the Internal Medicine News App seeks to bring this leading source of healthcare policy and research development news that affects patient care to mobile devices.

Led by an impressive editorial staff and an illustrious editorial advisory board, Internal Medicine News strives to provide coverage of medical insights and developments that is “fair, balanced, and accurate.”

Read below to see how the Internal Medicine News App stacks up.

The Internal Medicine News App opens with a no-frills home screen, with options for News, Specialty Focus, Blogs, Videos, and Facebook along the bottom index bar.

The Top Stories section, constantly and automatically updated, reflects the top stories on the Internal Medicine News website, culled from all specialties. Each story features a concise overview of the particular development, well-written and inclusive of direct quotes, as expected from Internal Medicine News. Here is an example of a healthcare policy story from the Top Stories section.

The Specialty Focus option presents news divided into subject areas, such as cardiology, dermatology, geriatrics, infectious diseases, etc. Here, for example, we look at the Gastroenterology section, which features developments in GERD, IBD, and Hepatitis, among others.

This story from the Gastroenterology section summarizes the findings of a recent study published in Gut that explored how geography affects the incidence of inflammatory bowel disease (IBD) in women. These stories not only concisely highlight the findings of interest from the research studies, but also provide the study citation information for further reading.

Moreover, stories can be quickly shared via facebook or email.

The Blogs section features some of Internal Medicine News’s most popular views and commentary. Here is one example, Going Viral: Notes on Residency, a blog written by an internal medicine resident at the Cleveland Clinic.

The Videos section features items from Internal Medicine News’ Youtube video library. These videos play inside the app via YouTube with the usual YouTube play controls, and can be viewed horizontally or vertically.

Finally, Internal Medicine News has hit social media, particularly via Facebook and Twitter.

Pricing:

• The Internal Medicine News App is free at the iTunes store.

Likes:

• Simple, straightforward user interface
• Backed by the prestige and expected top-flight quality reporting of Internal Medicine News
• Free!

Concerns:

• Each story can take several seconds to load, depending on the connection
• The app does not yet have a “Most Popular” listing of stories like the IMN website
• No iPad customized app yet!

Conclusion:

• The Internal Medicine News App from IMNG Medical Media is a free and outstanding, reputable resource for internal medicine news regarding research advances and healthcare policy that should be a must-have for internal medicine practitioners and trainees. Watch for the Internal Medicine News App to make our next edition of Top Apps for Internal Medicine Physicians.

iTunes Link

In the initial review of Surgical Intern Survival Guide , we concluded that the app was a simple starting point that could help the fresh surgical interns get their bearings.

In the few months since our review, the authors have given the app a facelift, in both appearance and content.

On that same plane, the app (which was only available for the iPhone a few months ago) is now also available for the iPad.

The app’s updates are apparent from the home screen. Along with some notable additions in categories, the organization of the app has also been improved. In the previous version the home screen was cluttered, and seemed thrown together.

The reorganization now includes more subcategories, but allows the app to flow in a more logical manner from the home screen. The tabs at the bottom of the screen remain the same, with improvements in some.

The new categories are geared more towards surgical interns; Sutures/Needles, Basic Instruments, Meshes. These categories along with the new OR Etiquette section are especially useful for those, such as medical students, who are new to the surgical realm.

There is also a new ability to create and save notes within the app.

The content of the app is now a bit more comprehensive, ranging from more topics in the “Common Floor Calls” and “Sample Dictations” to the previously mentioned new topics. (As a side-note, the Sample Dictation section can be used as a base to understand the step-by-step procedure that is to be performed. This is really a great way for any medical student to gain insight into surgical procedures.)

In the initial version, the formulas tab only contained 10 formulas. There is a mild improvement, with an attempted expansion in the number of surgically relevant formulas, criteria, and calculations presented. But the section remains purely a list of these formulas, with peculiar choices; from very broad (Cardiovascular with basic physiologic formulas) to very specific (MELD Score/Childs Classification).

The authors also addressed one of the main concerns in the previous version; the formatting. There is a notable improvement in the layout of the text portion, however the newly introduced instruments (images and captions) required some zooming and manipulating on the iPhone.

The iPad version is similar, but as expected, the larger screen helps with reading text, and the instrument images and captions seemed better suited to view on the iPad during the review.

Price:

• Currently $2.99 from the Appstore

Likes:

• Notable improvements in design and content
• New sections (Instruments, suture/needles, meshes) improve surgical relevance

Dislikes:

• While most of the formatting issues have been addressed, there still remain some issues
• Formulas, while increased in quantity, remain a work in progress

Inclusions that would improve the app:

• Getting greedy here, but the inclusion of other items (for example: vascular grafts and laparoscopic instruments)
• Suggested readings/resources for surgical topics

Conclusion:

• The improvements/new additions raise the stock of the app in our eyes. The app’s utility has broadened, and now can also be used by a range of people (medical students to surgical interns), and the app remains an affordable purchase for these populations.
• We look forward to seeing what other improvements the authors make in the future

iTunes Link

by: Brian Chau, MS3

The clinical process of evaluating suspicious skin lesions is often taught in medical school through the ABCDE method.

Student physicians are taught to evaluate said lesions based on Asymmetry, irregular Borders, multiple Colors, Diameters > 6mm, and Enlarging lesion.

Dermoscopy is a non-invasive, clinical examination of skin lesions with the aid of a dermatoscope. This process utilizes a liquid medium between a magnifier, a transparent plate, and a polarized light source to allow physicians to better visualize lesions.

It’s an important technique, used by dermatologists to aid in distinguishing between a benign growth and a malignant lesion. For students and residents interested in learning more about this process, Dermoscopy: An Illustrated Self-Assessment Guide app is an attractive option on the iOS.

Developed by Usatine Media, from Richard Usatine, MD, Dermoscopy: An Illustrated Self-Assessment Guide is based on the textbook with the same name from McGraw-Hill, by Robert H. Johr, MD, (Clinical Professor of Dermatology, Associate Clinical Professor of Pediatrics, Pigmented Lesion Clinic, University of Miami School of Medicine) and Wilhelm Stolz, MD (Director, Clinic of Dermatology, Allergology and Environmental Medicine, Hospital München Schwabing, Professor of Dermatology, Faculty of Medicine, Ludwig-Maximilians-Universität, Munich, Germany).

It’s important to note that this Dermoscopy app is not a tool to be used as a diagnostic app. There are several “photo” skin lesion diagnostic apps on the market already, such as MelApp.

Instead, this Dermoscopy app is designed to teach the basics of dermoscopy to students and residents, through an introductory text and practice cases.

Dermoscopy: An Illustrated Self-Assessment Guide is divided into 5 core chapters. The first chapter is an incredibly useful introduction to dermoscopy, with a lengthy section entitled “The Two-Step Algorithm.” This portion covers the process behind analyzing a skin lesion with dermoscopy, core principles and criteria involved in this process. Everything is presented in a very clear-cut, high-yield manner.

Throughout this first chapter, dermoscopy images are shown which correspond to the dermatological concept being discussed. At the end of the first chapter is a multiple-choice quiz over the diagnostic process for different lesions. Browsing this first chapter had me feeling like I was reading a textbook, just with a better layout (especially for the quiz) and sharper images.

After the first chapter, users will find the remaining chapters to be organized as case question sets, by anatomical region, from head to toe, 191 cases total. Some regions have more cases than others (Trunk/Extremities with 113 cases, Palm/Nose/Nails with 31 cases).

I felt the cases were well laid out, with a presenting history, associated dermoscopy images, and questions following. Most of the questions are true/false, but the final question for each case asks users to rate the risk level of the lesion and select the correct diagnosis from a list. Also, users must choose a disposition–that is, what sort of intervention the patient will require, if any at all.

The introductory text and subsequent cases are really the key features of Dermoscopy: An Illustrated Self-Assessment Guide. There’s a basic search feature, which helps in quickly locating specific cases, plus a preface and foreword from the textbook.

Overall, I was very impressed with Dermoscopy: An Illustrated Self-Assessment Guide. For me, it served as a very eye-opening guide to the process dermatologists use in evaluating suspicious skin lesions. Not many medical students choose to pursue a career in dermatology, but I feel it’s important to at least have a basic understanding of the complexity involved in such skin lesion analysis. The introductory text was perfect for this purpose and the cases were quite comprehensive. The solid, high-yield feel of a good textbook hasn’t been lost with the transition of this app from text to iOS. The quiz portions load with ease and the images are remarkably detailed.

Dermoscopy: An Illustrated Self-Assessment Guide is available for $94.99, through iTunes. This app requires iOS 3.1.3 or later and runs on the iPod Touch, iPhone and iPad. There is also an Android version available of Dermoscopy: An Illustrated Self-Assessment Guide, along with the previously-mentioned textbook version.

Likes:

• Superb introduction to dermoscopy on the iOS
• Excellent layout for easy navigation
• Detailed dermoscopy images
• Massive selection of cases

Dislikes:

• Price may drive some users away, but it’s on par with the textbook version
• Doesn’t offer cases for some scabies and a few other parasites

Conclusion:

• Dermoscopy: An Illustrated Self-Assessment Guide is a great example of an excellent textbook-to-app port
• This app is easy to navigate, covers high-yield material, and offers a large selection of important clinical cases with detailed dermoscopy imagery

Links:

Developer
iTunes

Harrison’s Principles of Internal Medicine is regarded as one of the premier textbooks for physicians through to medical students.

Primarily aimed at internists, it is accessible to medical professionals at all levels with its fundamental clinical medicine coupled with an explanation of underlying pathophysiology. Now in its 18th edition, it is without doubt one of the most recognizable and useful resources to practicing physicians today.

iMedicalApps has previously reviewed Harrison’s Manual of Internal Medicine for the iPhone here but today we take an in-depth look at the full Principles of Internal Medicine for iPad as it has now arrived via the Inkling platform. Inkling is renowned for taking classic textbooks and ‘reinventing’ them with a range of interactive features and media.

By their own admission, Harrison’s has been the most ambitious project to date and has taken over a year to complete the transformation to the iPad.

This review will not focus on the content of the book as most people will have experienced Harrison’s at some point during their medical career. Suffice to say Harrison’s Principles of Internal Medicine continues to set the standard as the pinnacle of current medical knowledge and practice, offering the definitive review of disease mechanisms and management.

As such, this review will focus on the overall Inkling platform and features which accompany this iPad version of Harrison’s Principles of Internal Medicine.

The first important thing to note about the Harrison’s textbook is its size. The paper version weighs in at 2,800 pages and this translates to approximately 2GB of space on your iPad. However all 397 Chapters and 57 eChapters are stored locally on your device removing the need for an internet connection.

Launching the textbook within Inkling brings the user to a familiar user interface.

All Inkling titles are designed and built upon the same platform and utilize the same structure as seen in other titles such as Essentials of Clinical Anatomy and Ganong’s Physiology.

Initially, the user is presented with a (very long) list of chapters. Each group of chapters is collected under a ‘Part’ but unfortunately there is no way to expand or hide these parts meaning that you have to scroll through every chapter until you find the one you want. I feel Inkling may have missed a trick here as the closest feature that has this function is the actual contents page (see screenshot) which breaks the book up into its various ‘parts’. This has more to do with the structure of the book which splits each section into chapters but it does mean finding the required chapter can be more challenging than it should be.

However, once a chapter has been selected, navigation throughout the text is simple and straightforward. The arrows in the bottom left of the toolbar quickly jump between sections.

Navigating within a section was sometimes more challenging than desired. While there was some inertial scrolling, I found that this was not always enough to quickly scroll through the sections in each chapter. This was only really apparent on the larger chapters which contained vast amounts of information. In general, though, I did not have any problems interacting with the book. I was pleasantly surprised by the speed at which different sections and images were loaded.

One aspect of this title which the Inkling platform does not cope particularly well with is the sheer size and detail of many sections. Although there are options to change the text size, I felt that sometimes the text was too big (even on the smallest setting) and as a result actually became harder to read.

An example is shown in the screenshot below where one paragraph takes up the entire page which is difficult to read. Page fidelity with the paper version is maintained and marked off at the start of each chapter.

Integrating media into textbooks has always been an Inkling strong point and they do not disappoint with Harrison’s. There is a wealth of images, tables, slideshows, videos and more, all fully integrated and linked to within the text.

Tapping on a table or image will cause it to slide in on a new page so that you can purely concentrate on the information while a quick flick will cause it to slide away. I found I often used the search function to navigate as it was often quicker and easier than scrolling through numerous detailed chapters. I liked the fact that all information related to treatment and management had been highlighted which made finding this essential information quick and easy.

One of the nice things about using the Inkling platform is that thought that has gone into the little details. For example, including an inbuilt dictionary to define words or including the option to search by content type. One feature I hadn’t noticed before was the inclusion of a ‘back’ button when a hyperlink takes you between chapters.

The inbuilt search function is highly effective and useful tools such as bookmarks, highlighting, and basic annotation make customizing the textbook easy. While the annotation tools are not as comprehensive as those seen in PDF management apps, they are generally suitable for most uses.

Having used this book for a number of weeks now, I think it is an excellent title and believe that Inkling have done a fantastic job transferring this title to the iPad. The rich text and media go a long way to making Harrison’s more accessible to medical professionals and students alike. Time will tell if the inbuilt social features allowing users to share notes takes off.

Price:

• $199 although there is currently a 20% discount code posted in the forum

Likes

• All content stored locally
• Treatment information clearly highlighted including algorithms
• The range of interactive features that have become an integral part of Inkling titles
• Having each chapter split into sections making it easier to find information

Dislikes/Future updates I’d like to see

• More inertial scrolling
• Expandable sections and chapters to make navigating 350+ chapters easier
• I would like to see the option of a smaller text size whilst reading the main sections
• Constantly having to scroll whilst reading which can become cumbersome

Overall Rating

• Harrison’s Principle of Internal Medicine is another excellent title from Inkling
• One or two navigation issues do not take away from the fact this is the only iPad optimized version of this essential clinical reference text
• Medical professionals who purchase this text will know they carry one of the most extensive medical resources in a highly accessible format on a device no larger than a notepad.

iTunes link:
Inkling Store:

The medical education learning environment is rapidly evolving with the development of mobile technology, high speed internet and the improved connectivity with learning institutions.

These developments have enabled huge growth in less traditional learning tools such as online textbooks, anatomy videos, video lectures and a whole host of other resources. Podmedics is a site designed by UK foundation doctor Ed Wallitt and contains a vast range of podcasts for medical students and junior doctors alike.

Podmedics is a website, which means that it is accessible from home computers, iOS devices, Android devices etc. In fact, PodMedics should be accessible from most modern devices with an internet connection.

Once you have registered on the site, it is possible to search all podcasts, view all lectures or navigate by specialty. There is an excellent range of specialties available ranging from Cardiology to Rheumatology and extra sections dedicated to Surgery, Clinical Specialties and Clinical Sciences.

In total there are over 150 different podcasts available.

There is also an excellent set of notes for Surgery and Clinical Pharmacology which are at ideal level for medical students on their rotations (please note that the guidelines contained are for the UK and may differ elsewhere).

The podcasts are an excellent learning resource and offer an alternative style to those who prefer audio-visual learning rather than pure text. Each podcast has an associated slideshow and is narrated clearly. Each podcast varies in length between 10mins and 50mins depending on the subject being covered.

The level of detail in each is appropriate for advanced medical students and junior doctors. Overall I found the podcasts engaging and informative and a great way to fill a few moments of spare time or learn more about a patient I had recently seen.

Each podcast has attractive animations which showcase the essential learning points for each topic. It is an annoyance, though, that there is no native app for Podmedics. While an internet connection is required in order to view the podcasts, it is also possible to download the audio or video from the website to your computer or mobile device for offline watching. This is a useful workaround but not ideal or straightforward for busy clinicians.

Podmedics is soon to be updated and will include a brand new interface, new notes system with pdf export, recommended order to watch podcasts in, and a podcast tracking system to track which podcasts each user has watched.

Price:

• Registration on the Podmedics website is free and allows 7 days access
• Upgrading to a full subscription costs £30 per year (Approx $50)

Likes:

• Wide selection of podcasts available
• Playable on a range of devices

Dislikes:

• Podcasts require an active internet connection/not straightforward to watch offline
• No native app

Overall Rating:

• Podmedics is a superb resource for medical students and junior doctors alike
• The wide selection of topics, appropriate level of content and variation in length means the podcasts can be used for a quick reminder or a more detailed discussion of a particular topic

Site

When it comes to anatomy apps on the iPhone, users are spoilt for choice. There is a huge range available ranging from flashcards to reference textbooks and more.

In a fantastic development, Visible Body has been released on the iPhone. When we reviewed Visible Body for the iPad, we were greatly impressed by its combination of anatomical detail, clinical correlations and novel approach to anatomy noting ” Visible Body is a dazzling demonstration of human anatomy”.

With the release of Visible Body for iPhone, it will be interesting to see if it is possible to maintain the high standards previously set.

Launching Visible Body takes a few moments and presents the user with a contents screen. Here it is possible to select the particular system and then a particular viewpoint e.g. Muscular System and then Upper Arm.

There is an excellent range of systems covered as shown in the screenshots.

There are 270 different views in total spread over 11 systems. It is also possible to change the gender of the 3D model while selecting a particular view. This impressive range of views makes up for the fact that there is no viewpoint of the complete 3D model. This omission does not impact upon what is a complete range of anatomical viewpoints.

Selecting a view and navigating through the menus is intuitive and simple, leading to the real strength of the application-the 3D model. Visible Body for iPhone makes excellent use of multitouch gestures to manipulate the model including pinch to zoom, rotate and pan. The controls are intuitive and it is very easy to learn how to quickly manipulate the model into a desired position.

Tapping on a structure highlights the structure and names it in a box at the top of the screen. There is a small plus symbol next to the name which can be used to show which system and the location of the selected structure. There are also options to show, hide or fade the structure which enables the user to understand the complex interplay between various anatomical structures.

At the bottom of the screen is a number of other options including Views, Definition, Actions, Help and Search. The Views button returns the user to the original selection of anatomical views whilst the Definition tab provides useful information related to the selected structure. The Actions tab offers a range of other view options such as the ability to refresh the model, change gender etc. Finally, the Help and Search tabs are self-explanatory.

The search function is particularly effective; typing a keyword into the search form brings up a list of structures. If the structure isn’t in the current model, one can add it. If it is in the model, one can select it or center the view on the structure. However, the search function does suffer from one or two drawbacks.

First, there can be a noticeable delay while searching and second, the search result will only be displayed with the current model. For example if you are looking at a nervous system view and add an artery it can be challenging to understand the anatomy. (See below for a screenshot of the left coronary artery added to a view of the nerves of the head and neck.)

Price:

• $9.99

Likes:

• Gorgeous, detailed 3D anatomical model
• Clever use of multitouch gestures to adjust 3D model
• Accompanying text contains a high level of detail

Dislikes:

• Memory intensive so therefore subject to occasional slowdowns and unresponsive (as such this is only recommended for users of iPhone 4/4S)
• Search function displays search results in current model which is not always appropriate

Overall Rating:

• Visible Body for iPhone is just as impressive as the iPad version
• The level of anatomical detail is very high and nothing major has been lost in the transition to the smaller device
• At $9.99, Visible Body is a steal when compared to other decent anatomy apps available for the iPhone
• Visible Body has many uses from patient education, to medical students and medical educators. Hands down one of, if not the best, anatomy app available for the iPhone.

iTunes link

by: Surinder Yadav MD

The Med Student’s Differentials Dx app is designed for students that may have trouble remembering differentials for any particular symptom or sign. It is available for the iPhone and iPad.

The goal of the app is to reduce the incidence of diagnostic errors by providing information that is useful to understanding differentials in a concise package.

The home screen has two headings –Common Complaints and Serious Complaints.

If you choose to look at common complaints, the app provides a list of common symptoms and signs that a patient may complain of such as abdominal pain. Tapping on that button provides an alphabetical laundry list of serious causes and less serious causes but no clear delineation with respect to frequency of occurrence.

One thing I would like to point out, is that the app developers should have created the  laundry list in the descending order of occurrences. This would have been a simple addition that would increase the utility of the app. It would also have been relatively important to specify what is as rare as “Hens Teeth” or the most common etiology.

Once in a specific list, you have to click on questions to have some common question based answers as your reference for the possible problem and its related causes. The answers are very basic and direct instructions, such as – “If the pain is right lower side: consider appendicitis and call a surgeon or send the child to the ER”.

Clicking on the disease listed in the differential does not do anything and provides no reference material or information about the disease itself.

The app is limited in what it can provide but may be useful as a quick reference or reminder. For the layman who might want to have this type of information at hand, it could turn out to be confusing and anxiety provoking.

One thing that does irritate me is the disregard for grammatically correct sentences scattered throughout the app. The idea of the app is a thoughtful one in terms of trying to reduce diagnostic errors, however, with the way it is set up currently, the app may lead to more confusion.

Price:

• Currently $1.99

Likes:

• Easy to use
• Quick reference

Dislikes:

• Limited in reference material
• Basic information

Conclusion:

• The app is a quick and dirty reference material for those that may just be starting out in their careers or have trouble remembering lists.

iTunes Link

After reviewing the less-than-impressive Pretest Psychiatry app, I decided to give the Pretest series another try.

I used the entire Pretest Medicine app while studying for my internal medicine rotation, and found it to be a helpful review for the exam.

This app, compatible with iPhone, iPod Touch, and iPad, costs $29.99 and is based on its corresponding text (which, incidentally, was written by physicians at my institution).

It is published by Modality Inc., the same publishers of the previously reviewed First Aid for the USMLE Step 1.

From the opening screen, users can create a new quiz, view saved quizzes, go to the question browser, or view their cumulative statistics. I enjoyed the question browser mode, a tutor-type, untimed mode where you can answer questions and read explanations with just a few taps of the screen. In this mode, users can view a list of all questions, filter questions by section, and review bookmarked questions.

Within the question browser, you may also select reference mode, which will automatically display correct answers. There are 15 different question sections, including:

• Infectious Disease
• Hospital-Based Medicine
• Rheumatology
• Pulmonary Disease
• Cardiology
• Endocrinology and Metabolic Disease
• Gastroenterology
• Nephrology
• Hematology and Oncology
• Neurology
• Dermatology
• General Medicine and Prevention
• Allergy and Immunology
• Geriatrics
• Women’s Health

As in the other Pretest apps, correct and incorrect answers are not saved in the question browser mode.

Creating a quiz allows you to track your performance. Quiz questions can be drawn from any section, and each quiz can contain up to 50 questions. Quizzes are timed at an average rate of one minute per question. You can review your cumulative statistics later from the app’s home screen.

Since the majority of people using this app are preparing for either their internal medicine shelf or USMLE Step 2 CK, an important question is: How do these questions compare to those on the board exam? I took the shelf exam recently, and found the questions on the app to be much shorter and overall less difficult than the actual exam questions.

That being said, the app does a good job of covering essential concepts tested on the NBME, and most of the answer explanations were adequate. They thoroughly explained the rationale for the correct answer, and in most cases, discussed the reasons that other answer choices were not appropriate. Reading them provided a useful review for me and helped to clarify high-yield information.

I do wish that the app contained more questions. Like most books and apps in the Pretest series, this app contains around 500 questions (496 to be exact, while the text version contains 500). However, since internal medicine is such a broad field, providing more questions would allow even more comprehensive coverage of material.

While I would not use Pretest Medicine as my only resource for exam preparation, it covers a vast amount of material and serves well to test understanding of concepts and augment your knowledge base.

Price:

• Currently $29.99

Likes:

• Good coverage of high-yield information
• Helpful and thorough answer explanations
• Interface is intuitive and identical to those of other Pretest apps
• Ability to track performance on questions
• Convenience of answering questions and reviewing explanations instantly

Dislikes:

• Questions not representative of the length or difficulty of those on the actual exam
• Could use more questions for even more extensive coverage of material
• Price—the text version can be found cheaper used or on online retailers such as Amazon.com

Overall:

• Though not recommended as a sole resource, Pretest Medicine is a valuable supplement to other materials for board preparation.

iTunes Link

by: Sumeet Banker, MD, MPH

Pediatrics is the official journal of the American Academy of Pediatrics presents intriguing original research, perspectives, reviews, and commentaries from the field.

The monthly peer-reviewed publication contains articles that have the power to change the practice of pediatrics, and there’s no better way to access the latest research at your fingertips than through this attractive app that fits the convenience of your mobile device.

I recently reviewed Pediatrics Digest , an app that similarly provides access to abstracts from the latest issue of Pediatrics.

However, after reviewing this app and comparing the two head-to-head, the attractiveness and intuitiveness of the graphics and layout make this app far superior to the former.

From the start, I was immediately struck by the visual appeal of this app. From colors and fonts to the layout, it reflects the familiar look and feel of the print version. Indeed, the majority of the images are screenshots, including the one-page abstract included at the start of every article in the journal.

However, for those not interested in zooming and panning, a text format is also available for all abstracts.

There are a few ways of getting to the abstracts. First, simply click on an issue from the home screen and choose from the article titles listed below. This takes you to the text version of the abstract, with easy one-click navigability to get to the article or return back to the table of contents for the issue.

Another way to retrieve abstracts is to click the “View” icon after selecting an issue to scroll through screenshots of the one-page abstracts. This method allows you to scroll through more than just titles – you can quickly scan the abstracts themselves.

The third way to find abstracts is by searching within an issue. Although, there is no way to search across multiple issues, search results cross-check titles, keywords, and abstract text for hits.

Other features include an option to bookmark articles in order to store them in an easy-access list for later reference. Additionally, a “News & Views” section includes pediatrics news and commentary from members of the Pediatrics editorial board. These entries from the Editor Blog often address the newest articles and controversies within the field and provide interesting insight.

To access the full-length articles in full-text or PDF format, an individual or institutional membership with the American Academy of Pediatrics is required.

Price:

• Free

Likes:

• Ease of navigation through issues and abstracts
• Visually appealing graphics and layout
• Quick link to full-length articles
• Free to view abstracts for all users

Dislikes:

• Low-resolution screenshots
• Cannot search across multiple issues

Conclusion:

• Overall, this app presents the Digital Abstracts Edition of Pediatrics in a manner that is visually appealing and logically organized for easy browsing
• Powered by Texterity, there is no better way to stay up-to-date on the cutting edge research and opinion as reported in the journal Pediatrics through your mobile device
• If you’re deciding between this app and Pediatrics Digest, go with this one.

iTunes Link