iMedicalApps » Clinical Decision Making

Evidence Central App – Evidence Based Medicine Guidelines Instantly Available in Mobile Form [App Review]

Felasfa Wodajo, MD — Wed, 30 Dec 2009 11:12:24 +0000

The challenge of identifying and absorbing relevant medical literature will not abate anytime soon and the proliferation of services that purport to simplify or eliminate this problem for physicians is itself now becoming a distraction. The rapid adoption of web-enabled smart phones by physicians, such as the iPhone, is driving this dilemma from the theoretical realm directly to the bedside. The hope is that if relevant medical literature is immediately available at the point of care, physicians would be more inclined to use it.

At the same time, the mantra of practicing medicine that is evidence-based is ringing ever louder. Thus far, it seems to this reviewer that most physicians apply it most strenuously when criticizing other physicians’ decisions rather than applying it to their own practice. Nevertheless, large well-respected compilations like the Cochrane Abstracts are available and widely used. They offer well constructed summaries of evidence-based diagnostic and treatment guidelines for thousands of pathologies. It is into this nexus that the “Evidence Central” app enters. This review will cover the features of this recently released medical application, which is technically “free” in the App Store, but requires a paid subscription of $79.95 in order to actually use.

Wiley-Blackwell, the venerable scientific publisher (“knowledge for generations” is their tagline) offers subscription web based access to the Cochrane database as well as other partially overlapping databases of clinical literature such as Evidence Based Medical Guidelines and Essential Evidence Plus. Unbound Medicine is a multi-platform mobile medical application developer. The two have partnered to port these databases into the Evidence Central App, available on the iPhone and Android devices.

Unbound Medicine has a long list of prominent electronic offerings including the Merck Manual (reviewed previously), the Oxford Handbook, and Harrison’s Manual. The Evidence Central application is a mirror of a web portal to the three Wiley web databases mentioned above as well as partial web access to four well known journals, American Family Physician, Annals of Internal Medicine, JAMA and NEJM.

While the depth and breadth of information available through these databases is truly impressive, the application unfortunately also propagates the corresponding dilemma. Namely, it does not attempt to solve the problem of parallel entryways into the separate databases nor the multiplicity of similar sounding titles and topics. It does not explain to the user how each database is different and, unlike the corresponding website, does not offer a global search across the databases.

What I liked about this app:

The quality and breadth of the the abstracted information available in the three database families is impressive. Having it quickly available on your mobile device is a fundamental improvement from having one’s medical library taking up shelf space.
The application is quite responsive as most of the content is apparently locally stored

What I didn’t like as much:

There is no guidance available to the user as to where to search for information nor any ready description of the qualities of each database (to be fair, this information is hard to glean from the actual web databases themselves)
There are some rough spots in the application’s user interface with the bottom navigation bar appearing and disappearing unpredictably, as well as the text search box

What I would like to see in future versions:

A global search across the databases, akin to the website (perhaps this was omitted due to technical limitations of the platform)
A more refined search experience, with more explicit guidance as to where to ask a particular question

(below picture is a screen clipping when using evidence central via your computer browser)

Conclusion:

The dilemma of the practicing physician basing complex decisions on incomplete information will undoubtedly remain inseparable in the future from the practice of medicine. However, closing the gap between available evidence based literature and the clinical question at hand is at least partially addressable with improving technology. In this case, Unbound Medicine’s “Evidence Central” assembles a highly potent collection of clinical evidence aimed directly at the practicing physician. Access to the Cochrane Abstracts alone might well justify the price of subscription.

However, what we are also seeing thus far with the first wave of clinically based applications is that more targeted products, e.g. Procedures Consult: Musculoskeletal, are more finely tuned to access via a hand held device. This appears logical since it is significantly more difficult to synthesize thousands of pages of text and literature and have it instantly reborn on a mobile device, which is partially the huge task Evidence Central tries to accomplish.

In the future, it is inevitable that medical authors and publishers will start to primarily design for smaller form factors and this task will not be left solely to software developers. When this occurs, we should see a better translation of medical literature to mobile applications. Until then, we can certainly enjoy the wealth of knowledge that rich applications such as “Evidence Central” allow us to carry in our pockets.

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-Dr. Wodajo is a senior writer for iMedical Apps and we feel privileged to have him on board. He brings an extensive clinical background to the medical app reviews. His blog can be found at http://www.orthoonc.com.

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Need to run a code? There’s an app for that! ACLS Advisor [App Review]

Yousif Alkadhi, MD — Tue, 24 Nov 2009 14:49:22 +0000

There are few moments in medicine where your immediate actions lead to a direct, life altering result for your patient. Obstructed airways and anaphylactic reactions come to mind, but neither of those occur as often as a code (“code blue”, and I’m not talking about when the cold activated indicator on your beer lets you know it’s ready to drink).

Back in medical school, before we entered the wards 3^rd year, our school made sure we were ACLS certified. I realized how lucky I was that my school taught such a rigorous ACLS course when I was doing an away rotation at another medical school and students were complaining about their lack of ACLS training. Enter the “ACLS Advisor – Advanced Cardiovascular Life Support” App (currently $5.99 in the App Store) from Current Clinical Strategies Publishing. This review will cover how this well organized and easy to use application walks you though various ACLS algorithms and then some.

When you open the app, you’re greeted by a brief welcome screen followed by a menu to choose the situation you need help with. These include the fundamentals of any ACLS course such as pulseless ventricular tachycardia, ventricular fibrillation, pulseless electrical activity (PEA), and symptomatic and asymptomatic tachycardia and bradycardia. Additionally, the application includes extra information outside the scope of ACLS, including treatment algorithms for asthma, stroke, electrolyte abnormalities, and a toxicology section as well as anaphylactic reactions.

One of my biggest pet peeves are applications that lack an intuitive navigation experience. Even if an application has all the information in the world, if the information is difficult to access I won’t end up using it. When you’re running form patient to patient, precious seconds add up, and I don’t want to waste time trying to find my way around an app.

Well, when it comes to navigation, this app hits a home run. Every screen (except for the home menu) has a “back” button at the top left, as well as a “home” button on the top right, so you always know how to get back to where you were. Additionally, the algorithms are very easy to navigate through. Let’s take pulseless V. tach for example. From the home screen, you select the “pulseless arrest, VT, VF” button. After telling you to begin compressions it then asks if the patient is in a shockable rhythm or not. In the heat of the moment, say you suddenly forgot which rhythms are shockable. Again, it walks you though, asking if it’s pulseless VF or VT, or PEA.

Another example, say you don’t remember what ventricular fibrillation looks like. Just click on the link, and it shows you a sample rhythm strip of V. fib. Really, it couldn’t get much easier; this is how an app should be built, and it’s just as straight forward and easy to use for other situations (bradycardia, ACS, asthma, etc).

What would I change?

Not much honestly, if you’ve been reading above, you could have probably guessed my answer. However, I would like the option to adjust the size of the font. This would be especially crucial when I’m reading medication dosages. It would really be helpful to have the ability to zoom in or just increase the size (I would hate to misread a mcg vs and mg, etc). This would be good not only for the regular screens, but also for the algorithm diagrams that are included. Additionally, on every screen, an EKG animation continues to scroll by at the top. I wish I had the option to turn that off. They do give you the ability to turn on or off the “splash screen” that greets you before the main menu pops up, but again, font size and the pesky animation are about it.

What does this app do great?

Again, if you’ve been reading above you’d know my answer already. In fact, I can’t wait to check out some of the other apps this developer already has in the App Store. What I was especially thankful to have in the application was an easy to navigate user interface (including back and home buttons) and I appreciated that they also included diagrams of the actual algorithms (accessible from the bottom left button at the main menu). The app is well polished and doesn’t look like someone just copied an ACLS card and made an app. It shows a plethora of additional information, such as sections on asthma, tox, stroke and peds (yes, a pediatric basic life support section is included because “children are not just little adults!”).

Who would benefit from this app?

Besides the patient coding, anyone that takes care of patients, or anyone at the bedside during a code. This includes physicians, residents, medical students, NPs, PAs, RNs, ANAs, etc. Granted, it’d be hard to use the app while doing compressions, but it never hurts to have as much knowledge at the bedside during critical moments. I’m a minimalist, and I’d much rather have this app on my phone, than to have to search through my white coat pockets to find a wrinkled, folded ACLS card. This application also makes for a great study aid if you’re about to take an ACLS course. Just treat the app like a set of flashcards and quiz yourself.

As always, no application is a replacement for good clinical judgment, however it’s always good to have solid references available during critical times. Especially if you’re a clinician who doesn’t often have to deal with medical codes, this application would make a great asset. I’d buy it again, if it wasn’t already on my iPhone.

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The Merck Manual Professional Edition Medical App is the First Encyclopedia of Medicine that Fits in Your Pocket [App Review]

Felasfa Wodajo, MD — Wed, 11 Nov 2009 10:32:00 +0000

The Merck manual is a venerable encyclopedia of medicine that, over the last century, has passed through eighteen editions and attained the generous girth of over 3000 pages. It has such a breadth of scope that, if similar a book were proposed to a publisher today, it would be quickly dismissed as unrealistically ambitious and lacking a clear audience.

However, by encompassing so many clinical and related topics and by virtue of its consistent, tightly honed writing style, it has paradoxically become useful to a large range of readers, including doctors, lawyers and, more recently with its home edition, to lay readers.

Seeking to expand the audience even further, the publishers have now produced an iPhone version of this textbook, which this review will cover.

The Merck Manual Professional Edition is a pedestrian representation of the full text, but, it easily succeeds in making the immense amount of information easily accessible. And, for about half the price of the text (and, even better, a far smaller fraction of the weight), it is indeed a very useful addition to the iPhone medical library of most physicians and residents. Nevertheless, the manual is generally addressed to the clinician with limited knowledge of any given subject matter and should not be considered a substitute for specific subject-matter textbooks.

What I liked about this app:

an enormous amount of diagnostic and therapeutic information in your pocket – pretty amazing
a clear writing style that avoids excessive detail
topics that extend into statistics, medico-legal and even medical economics
hyperlinks within the text to other sections (with a back button to return) that aid comprehension
a clean and unobtrusive user interface

What I did not like about this app:

display of graphics and tables is occasionally awkward
keyword searches only identify articles, not the specific section or words

What I would like to see in future versions:

links for further reading on a topic and more images would be very helpful, although the absence probably reflects the original text
a “physician’s” lay version where specific sections can be clipped and printed (with attribution) to give to patients would be a nice feature

Conclusion:

The Merck Manual Professional Edition iPhone app is a clean and efficient implementation of a time-tested medical encyclopedia. Many clinicians will no doubt feel that the relatively brief descriptions of complex medical conditions is at odds with their specialized, in-depth knowledge. Over time, of course, this easy confidence is little match for the real-world variety of patients that walk in the door. Perhaps this is why the manual has succeeded over so many generations. It will be interesting to observe how the Manual fares in this era of information super abundance.

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Dr. Wodajo is a guest contributor to the medical app review team and we feel privileged to have him on board. He brings an extensive clinical background to the reviews. His blog can be found at http://www.orthoonc.com.

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MD on Call App Hopes to Make Your Call Nights Less Painful [App Review]

Devin Odom, MS4 — Thu, 29 Oct 2009 16:32:00 +0000

Its 3 AM and you are the new intern on call covering far more than your share of patients for multiple services. Your pager goes off. Mrs. Smith is seizing and Mr. Jones is vomiting large amounts of blood and is hypokalemic. What do you do?

MD on Call ($5.99) hopes to provide these answers. The app is developed by MDMarkee Publishing and is a new addition to the App Store. It is a simple application with sometimes basic but vital information, especially useful at those early morning call hours. This review will focus on the information provided and my experience using this application while being on call.

What is it?

MD on Call is a simple repository of 17 typical, bread-and-butter issues that can arise on call, quick advice on how to evaluate the problems and quick management suggestions. The app also contains sections devoted to abnormal lab findings, ECG pathologies, and ‘hardware’ (discussing common problems with central lines, NG tubes, etc.).

The Good

From an ergonomic standpoint, the application is extremely easy to use. Each section is alphabetically organized and searchable by keyword (although the search feature does not handle synonyms or phrases well). The sections on ECG and laboratory findings are particularly complete for any acute abnormality that required immediate action.

If, for example, your patient is hypocalcemic, the application reminds you to double check the patient’s Phosphate and consider other confounding factors, tells you what physical exam findings are commonly seen, and ways to correct the serum Calcium based on the severity. The information is correct and mostly complete: striking a good balance with its easy to read bullet points without being too verbose.

The application states the obvious, but also assumes at least a respectable level of medical knowledge as well. In the above hypocalcemic example, the application states that Chvostek’s and Trousseau’s signs are traditional physical exam findings without wasting space stating how they can be elicited. In the management section, it provides sound medication and dosing advice as well.

My first reaction to the 17 issues discussed by the application was doubt. Only 17? Surely that could not cover the wide variety and sheer quantity of ‘On-call’ issues that can arise. Once I put this put this assumption to the test, however, it was clear that I was wrong. This application is only meant to be a guide for when a patient has an acute change in status; most calls are patient specific medication changes or order related and are not meant for an application such as this.

The Not So Good

As I stated before, the issues covered are ‘bread-and-butter.’ As a result, the application is not perpetually useful. Either you already know what to do when you receive a call, or you quickly learn how to handle the situation and cease to need the application for reference. House officers or residents with substantial experience will not find this application very useful.

I did note a few instances where the information provided by MD On Call was lacking, but these tended to be very specific and minor. For example, the discussion of ‘Fever’ did not include any advice for a patient who was neutropenic, and the app did not offer any advice when documenting a patient’s cause of death and instead focused on the interaction with family when pronouncing death.

A few minor complaints about the interface should be noted as well. The font is very small and can be hard on the eyes when viewing on the run or after long hours on call and the application does not support the iPhone’s position sensor and will not rotate (no landscape mode).

Conclusion

In the field with this application, the section dealing with abnormal lab values has proven to be the most useful while on call and is much faster than trying to locate or sift through dense Up-to-Date chapters or case files.

This is a simple application that contains accurate and concise information for students and new interns. Seasoned residents with more experience will not find a huge benefit with this app. However, if you have ever needed a quick reference to learn on the fly or been stumped by a late night call while cross-covering and you are willing to spend a few dollars to avoid that feeling, you should consider this app.

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eRoentgen App Helps Physicians Choose Appropriate Imagine Studies [App Review]

Iltifat Husain — Mon, 12 Oct 2009 08:58:00 +0000

Update: In response to iMedicalApps editorial and reader feedback, the folks at Iatros Software have lowered the price of this app to $19.99. They have also given us a few promo codes for our readers. Check out the comments section for the codes!

Advances in imaging technologies and skilled radiologists now allow for routine diagnosis of many previously mysterious disorders. Listening for obscure heart sounds and subtle neurological exams still hold a cherished position in medical education but, as one old saying goes, you can replace a whole room of neurologists with an MRI machine.

However, such aphorisms not only raise the ire of card carrying neurologists but ignore the basic problem of knowing which imaging test to order. Many a diagnosis has been delayed or missed in a patient who had a “negative” MRI – the problem was that the MRI was of the wrong body part.

So, what do you do if you are a busy primary care practitioner and a patient presents with, say, hydronephrosis or neck pain or urinary incontinence? There are so many imaging modalities, it is difficult to avoid ordering the wrong or unnecessary test. It is this important problem the eRoentgen applicaton by iAtros software is trying to address. In this review we’ll see if this iPhone medical app is worth the high asking price of $49.99.

The author of eRoentgen, Constantine Brocoum, MD was a neuroradiologist by training and surely had first-hand knowledge of the challenge. The application is a straightforward compendium of textual information that lists recommended imaging studies for each item from a voluminous list of symptoms and diagnoses. The main drawback of the application is the high price of $49.99, which seems out of line with comparable medical iPhone applications.

What I liked about this application:

the breadth of symptoms and diagnoses is impressive
the relative and absolute contraindications for each imaging modality are provided so that incompatible tests can be avoided
the additional information on pre-medication for patients with allergies is appreciated

What I did not like about this application:

the navigation between diagnosis, test contraindications and recommended tests is a bit awkward
the price is set too high

What I would like to see in future updates:

perhaps rather than providing such a breadth of symptoms, a deeper explanation of expected normal and abnormal imaging findings for some important diagnoses would provide more clinical value
some indication of the order in which to order tests, rather than a simple list

Conclusion:

The eRoentgen application achieves its stated goal of guiding physicians in ordering imaging studies and will probably spare the busy clinician a few phone calls to radiologists. However, whiles the author identified an important problem, I feel that the application does not always live up to its own promise. Perhaps with the addition of some deeper clinical knowledge, it may better serve as quick and effective radiology pretest consult.

Addendum from iMedicalApps Team:

We completely agreed with Dr. Wodajo’s excellent review of this medical application. Just wanted to add that we ran this app by residents and fellows, including a rad/onc fellow, and for the most part they agreed with the points made in this review. The biggest complaint we received was the high asking price for a relatively simple application. This is the most expensive app reviewed on this site, yet it will not make our top medical app lists. Many of the residents also mentioned how the EMR systems in hospitals and the clinic already point out the contraindications and indications for much of the imaging. One of the main reasons we reviewed this app is because it got a lot of sponsored publicity, and we wanted to make sure our readers had an objective review to go by.

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Clinical ORthopaedic Exam App (CORE): Portable Physical Diagnosis on the iPhone [App Review]

Felasfa Wodajo, MD — Mon, 28 Sep 2009 17:32:00 +0000

This App recently received a significant update, including a number of suggestions made by the iMedicalApps team and readers. These changes include the ability to email links of useful videos and PubMed links, a “search” feature, and the ability to save particular entries to a “favorites” list.

One of the most enjoyable aspects of orthopedic surgery is the role of physical examination in diagnosis. The patient may tell you their knee (or hip, shoulder, etc) hurts “sometimes”, and if you’re lucky, they might tell you under what conditions. Your job is figure out which of that joint’s particular ligaments, labrum or tendon is injured.

Luckily, for almost every musculoskeletal ailment, there is a specific physical maneuver to discover the underlying problem. Often, there are several maneuvers for each problem. And, therein lies the problem: How do you remember the specifics of each maneuver, its indications, and the positive and negative findings when its been months or more since the last time you used the maneuver?

It’s with a warm welcome that CORE (“Clinical Orthopedic Exam”) arrives. This iPhone medical application packs a significant amount of text and video for a price of $29.99. Hopefully it will help herald in a new generation of bedside clinical decision-making applications.

Continue on for the full review of the Clinical Orthopedic Exam medical app (This app is for primary care providers as well!).

The authors of CORE were ambitious in their scope. They assembled almost 250 physical exam maneuvers, encompassing all the extremities as well as the spine. For each exam, they have included step by step instructions, positive and negative findings and, most critical, a short video clip of the exam being performed. If that’s not enough, they have also included peer-reviewed references and a quick summary of inter and intra-observer reliability for each exam.

The authors have chosen to store the videos on YouTube, no doubt in part to decrease the size of the application but also to allows them flexibility in the future. There is also a remarkably long legal disclaimer that greets you every time you launch the application. Personally, I find it hard to imagine the “my iPhone made me do it” defense but I suppose there is a proud attorney somewhere who wrote that opaque text. (Editor note: Internet access is required in order to view the videos on this application, Wi-Fi, 3G, or EDGE)

What I liked about this app:

The sheer scope of exams is an impressive achievement. Covering tendinous, neuropathic, ligamentous problems for each body part
Reporting reliability statistics for each exam is appropriate and admirable
Navigating by tapping a body part is very intuitive, also appreciated is having the option to navigate textually
Being able to view the video within the application is good design

What I did not like about this app:

The descriptions of test statistics are so full of abbreviations, they are difficult to read – this could be improved (perhaps by small pop-ups when tapped?)
There are a few navigation quirks. For example the “pathology” button duplicates the “back” button. Traversing the statistical explanations is a bit awkward and tests with more than one name still have their own entries, etc
The application does not remember where you left off, forcing you to click through the disclaimer and navigation every time you enter

What I would like to see in future updates:

Sound in the videos would be nice – for some of the videos you have to watch a couple of times to figure out what is being done
Bookmarks so you can choose your favorites
Anatomical drawings for selected disorders to make the concept underlying the exam clearer
A text search box for text based navigation.

Conclusion:

CORE is a great addition to the burgeoning collection of medical applications on the iPhone. On their website, the developers state their interest is developing applications that focus on the musculoskeletal system with the motto “Solutions based on evidence not opinion”. Their target users are healthcare providers in orthopedics, neurosurgery, family medicine, physical therapy, rheumatology, among others. If their first application is any indication, it seems we will have more to celebrate in the future.

iMedicalApps Addenum:

We agree with Dr. Wodajo’s overall review of the app, it’s an excellent application for doing the musculoskeletal portion of the physical exam. We’d like to also stress how this is a great medical application for primary care physicians. All primary care physicians know how important a strong musculoskeletal physican exam can be, as they are often the first line for presenting symptoms.

Dr. Wodajo mentions how having the physican exams available on youtube allows the application to be more flexible, but as we mentioned in our Blausen Human Atlas app review, we think it’s important to have the videos built into the app. Many providers might not have internet access available to them, and even portions of hospitals don’t always have a reliable connection. To users without dedicated internet service, we’re hesitant to recommend this application.

However, if you do have dedicated internet (Wi-Fi, 3G, or EDGE), as most providers do, then this is a brilliant application and we’d definitely recommend it.

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Diagnosaurus DDx (1.3) [App Review]

Iltifat Husain — Sun, 14 Jun 2009 04:55:00 +0000

Diagnosaurus is an app that you might be familiar with if your hospital / medical school uses Access Medicine. It’s on the homepage the Access Medicine portal.

Diagnosaurus helps you form a differential diagnosis (it helps you come up with a list of possible diseases or causes based on vague to specific symptoms). This is key to note, because I found many people reviewing this app in the app store complaining that it doesn’t help you make a diagnosis. That is not the purpose of this app. It only helps you “start” the process of formulating a differential. In this review we’ll discuss how to use this application.

Advantages:

Great for formulating differentials based on patients symptoms.
Search toolbar, which allows you to quickly search thousands of symptoms.
Loads in under 2 seconds, and does not require Internet connection. (Helpful when in parts of the hospital without wifi or reception)
Stable, have been using it since March without any issues.
Relatively cheap (99 cents)
New version has landscape mode
Hyperlinks within the app allow you to narrow down vague symptoms.
Compatible with iPhone and itouch

Improvements that could be made:

Saving recent page. If you were looking up a differential and then close the app, when you return it starts you on the home page. It would be nice if it started you off on the last page you were viewing.
Have a search bar on the home page. I use the search bar almost 99% of the time, and I have to go through one of the categories to use it. Not a big issue but would save one step.
No registration. App asks for your name and email address to “register you” for tech support when you first install it. I put in random info, and don’t really see the point of the registration process.
Differentials can be a bit too broad at times, but this depends on your medical experience.

Who this App would be great for:

Intern / nurse / medical student / PA student
This app is particularly useful if you’re on your Internal Medicine rotation or Peds rotation. Its great for coming up with a quick differential before you present your patients in the morning.

Conclusion:

Overall, I’d definitely have to recommend this app to the above people. I’ve found it extremely useful in the wards, especially when I was on my internal medicine rotation. Even a seasoned attending might find this app useful for patients with atypical presentations. I’m honestly surprised this app is only rated 3/5 in the App store, but when I was reading the comments I saw alot of them were from people who were expecting an app for diagnosing, rather than for formulating a differential. For 99 cents its a great deal, and I don’t think you can go wrong with it.

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Further Review:

I found the Access Medicine online version of Diagnosaurus helpful, but tedious to use, since there was no search function, and everything was more or less organized alphabetically. I’m glad they didn’t use the same approach when they converted this app for the iphone / itouch.

Gone are the alphabetical listings of symptoms, instead, replaced by a nice search toolbar that makes the process much quicker. The interface is simple and easy to use, although I don’t know the effectiveness of the different categories. Rarely, when I’m on the wards, do I find myself looking up particular diseases or organ systems. Those categories having huge listings within themselves, and are not very useful. The main utility in this App, and where it absolutely shines is in the symptoms category, and then using the search option from there. It does an excellent excellent job of giving a broad differential to work from. Some might argue the differential lists given can be too broad, this is true, and I feel this complaint is more of an issue of who is using this app and for what purpose. For a seasoned attending, the differential might be too much, but for an intern or med student, it might be perfect.

The other nice feature about this app is how it helps you narrow down your symptom. Lets say you want to look up the differential diagnosis for abdominal pain. When you do this, it gives you hyperlinks within the app that will narrow down your differential, such as, right upper quadrant abdominal pain verse left lower quadrant pain, and many others.

There is also a favorites bar. I didn’t use this option a great deal, but I could see how it might be useful to store some of the most popular symptoms and the differentials for them. Some of those being, abdominal pain, chest pain, headache, etc. (the pictures within this post are the ones provided in the app preview in the app store).

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