CareView Communications, Inc., an information technology provider to the healthcare industry, just recently announced the completion of SitterView, an innovative application that employs mobile technology to enable healthcare providers to better utilize patient sitters, improve patient safety, and reduce sitter costs.  SitterView allows a single sitter the ability to monitor multiple patients and utilize the safety features of CareView’s NurseView and Virtual Bed Rails applications.

The SitterView application of the CareView System focuses on utilizing sitters more effectively, allowing the CareView Virtual Bed Rails application to be monitored at the nursing station and on SitterView smart pads while simultaneously reducing overall sitter costs, helping the hospital create a safer environment and reducing patient falls.  The CareView philosophy is to offer services to hospitals and its patients that not only improve the quality and safety of care, but also reduces the cost of that care.

press release | www.care-view.com

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

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

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

mHealth Research Daily with Tim Bredrup

Certain smartphone applications can provide quick assistance in the diagnosis  of disease.  One such example is Cobbmeter, a smartphone application designed for the measurement of Cobb angle on Apple’s iPhone. The Cobb angle measures the degree of spinal deformity which exists in a person with scoliosis.

In efforts to determine the accuracy of Cobbmeter, five spinal surgeons performed a study that focused on the comparison between the smartphone-aided and manual measurement method for determining the Cobb angle in adolescent idiopathic scoliosis. The surgeons measured 53 x-rays of adolescents with thoracic scoliosis. Intraobserver and interobserver differences in measurement were analyzed.

Results of the study revealed similar intra- and interobserver differences among the surgeons. According to the authors, the mean Cobb angle of all measured x-rays was 29.3 degrees (range, 17-58 degrees) in the manual set and 29.1 degrees (range, 18-56 degrees) in the smartphone set. In addition, a the amount of time required for the smartphone-aided measurements was significantly less than the amount for the manual approach. According to authors, the mean time consumed was 13.7 seconds (range, 8.6-18.5 s) for the smartphone set, whereas it was 37.9 seconds (range, 30.1-46.9 s) for the manual set with a p-value less than .05.

The Cobbmeter iPhone app showed excellent reliability and efficiency, proving it’s superiority over manual methods. As a result, adoption of such smartphone-aided methods is now being encouraged in clinical practice by the authors of the study.

Another notable smartphone measurement tool for scoliosis is “Scoligauge” developed by orthopedic surgeon and app developer Matt Ockendon. This iPhone app enables easy and accurate testing of the Adams (forward bend) and also quantifies the results. –iMedicalApps from Sept 2011

Authors: Qiao J, Liu Z, Xu L, Wu T, Zheng X, Zhu Z, Zhu F, Qian B, Qiu Y

Institution: Nanjing University Medical School | Nanjing, China.

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 Surinder Yadav MD

The Parents Diagnostic Aid provides a quick and easy layman’s medical insight into a few common problems in children. It is primarily designed to allow concerned parents to quickly gauge the seriousness of their child’s illness whilst ensuring that the attending physician does not miss crucial questions or misdiagnose.

The app is very easy to navigate and has 3 main headings on the home screen.

The buttons that appear on the home screen allows you to drill down into 13 common problems.

Drilling down into fever as a symptom, for example, or any of the symptoms, brings up some basic information about that symptom with the ability to do three things;  You can navigate to diagnosis, see some exams/tests and recommended treatment of the symptom.

However, the details are limited to the basic information about the particular diagnosis whether it is fever or abdominal pain. One thing to note is that it is a little heavy handed in terms of medical lingo. I would be surprised if many parents had any idea what Kawasakis disease is.

Drilling into diagnosis and treatment also provides some very basic information and suggestions of what the standard of care may be. The information is not very specific for any particular type of problem and provides some oversight.

There is a button that asks if you want to know more? Clicking on it opens up another window that asks if you want more action for the symptom for e.g., for fever.

The details takes you back to symptoms details view with the ability to look at diagnosis, exam and treatment. The diagnosis section is a series of question related to that particular symptom.

Clicking on the question gives brief instructions as to what you should do, such as for severe abdominal pain. In any case or question that suggested increased severity of illness, instructions were given to go to the ER. I have concerns that this type of information that can be confusing and a little heavy-handed.

Despite that, the association with what is severe and requires immediate attention is missing, such as stating that chest pain and injury could be due to cardiac tamponade yet no reference is made to the fact that this could be a life threatening injury – there are several examples like that. So, there should be a great deal of reservation around this type of information being shared openly without some clear guidance or clear references.

I would be inclined to say that at best it is a tool that should be used with a “pinch of salt”, it may help parents ask some informed questions when they do see their physician.

Price:

• $0.99

Likes:

• Provides some basic information about common issues with kids
• Easy to use and navigate
• Can help ask the right types of questions for parents

Dislikes:

• Too heavy in medical lingo and limited in terms of information
• Poor communication integration and no other tools to provide research or reference if you really want to explore a topic further
• No links to hospital websites or physician group sites
• No priority in terms of seriousness of conditions

Conclusion:

• Overall information is basic (although heavy handed in some medical lingo).
• Although, if a parent has a sick child and doesn’t know what to do, an app like this that just has some basic information may be helpful in asking the right types of questions.
• It should be used just as a brief reference tool for educating parents on what the right questions to ask are. It also helps guide them on when they should speak to a medical provider.

iTunes Link

With mobile health an ever-growing field, students and physicians are always looking for the best medical reference app.

While definitely not the best in its class, Patient Safety Manual, a new free app by Guy’s and St. Thomas’ NHS Foundation Trust, is a decent reference. This app is available for iPhone, iPad, and iPod touch.

The app opens to the index, which lists all of the available references within the app. The Patient Safety Manual contains information about how to manage certain conditions, such as alcohol withdrawal and chest pain, how to interpret EKGs, including example strips, and clinical scores such as the CHADS2 and TIMI scores.

You may access a list of clinical scores only by tapping the “Clinical Scores” area at the bottom of the screen.

The interface is convenient and user-friendly, including a search function in the upper left hand corner, and an alphabetical scrolling bar on the right. Additionally, you can bookmark the information you use the most and find it quickly in the “bookmarks” section in the menu on the bottom of the screen.

Unfortunately, the Patient Safety Manual app is somewhat lacking in content. The index itself is very brief, and some commonly used scores in clinical practice are omitted, such as the MELD or Glasgow coma scores. In fact, only nine clinical scores are available on this app. Also, the information provided under most treatment protocols is fairly basic and vague. For example, under Drug Safety, the app directs you to “See trust anticoagulation guide” for heparin and warfarin, with no further instruction.

It is important to note that this app was created in the UK, not the US. Therefore, physicians in America should use the guidelines in this app cautiously, as some suggested practices may not be common in the US. Also, some sections or information are specific for Guy’s and St. Thomas’ NHS Foundation Trust.

For example, the Pyramid Response to Unwell Patients provides numbers to call for the emergency response team, critical care response team, and acute response team specifically at these health systems. The section on medical and surgical handovers also includes a schedule for checkout at Guy’s and St. Thomas. However, these are easily ignored.

There are several features I feel would improve this app. The app is not interactive at all. Calculating the clinical scores would be more convenient if the user could tap the applicable criteria for their patient, and the app could automatically calculate and interpret the score. More drug information and a more comprehensive list of clinical scores would be useful.

Right now, the app includes very little information about antibiotics, and the section about Common Drug Doses only includes analgesia, anti-emetics, and laxatives. The app could also use more information about different clinical scenarios, such as pneumonia, or a guide to managing a ventilator.

Likes:

• Price is free, nothing to lose by downloading this app!
• Decent reference for student doctors and residents
• Friendly user interface
• Bookmarking feature allows you to easily access the sections you use the most

Dislikes:

•  Somewhat lacking in clinical information
• Omits important clinical scoring systems
• Created in the UK, with some information specific to the Guy’s and St. Thomas hospital system
• Limited drug information
• Not interactive

Conclusion:

• The Patient Safety Manual is a fairly decent but mediocre medical reference app
• It provides some useful information for junior doctors, but the content is lacking
• The app does not allow for user input, rendering the calculation of clinical scores less convenient
• Medical professionals can download it for free and may happen to find it useful in the future, but probably shouldn’t expect to use it as their primary resource.

iTunes Link

mHealth Research Daily, with Tim Bredrup

Common immediate life-threatening conditions such as apnea (APN) and pneumothorax (PTX) can be easily ruled out by performing an ultrasound that visualizes a respiratory motion known as lung sliding (LS). Institutions from around the world collaborated on a study that assessed how economically and practically this information could be obtained remotely over a cellular network.

Remote expert sonographers directed remote providers with little to no ultrasound experience on how to obtain the images needed to rule out APN and PTX. Through the use of handheld ultrasound machines streaming images via Skype services on an iPhone, examinations were conducted between a series of remote sites and a base station. Sites included two remote on-mountain sites, a small airplane in flight, and a Calgary household, with base sites located in Pisa, Rome, Philadelphia, and Calgary.

In all lung fields (20/20) on all occasions, LS could easily and quickly be seen. Furthermore, the respiratory motion was easily corroborated and documented through capture of color-power Doppler and M-mode images. Other ultrasound applications such as the Focused Assessment with Sonography for Trauma examination, vascular anatomy, and a fetal wellness assessment were also demonstrated.

The study concluded that the emergent exclusion of APN and PTX can be immediately accomplished by a remote expert economically linked to almost any responder over cellular networks. It’s been suggested that further work should explore the range of other physiologic functions and anatomy that could be so remotely assessed.

As technology continues to grow in exponential fashion, it is likely that more applications of this concept will emerge going forward and the practice of telementoring will become more common place given the many advantages it can provide.

Authors:McBeth PB, Crawford I, Blaivas M, Hamilton T, Musselwhite K, Panebianco N, Melniker L, Ball CG, Gargani L, Gherdovich C, Kirkpatrick AW.

Institutions: From the Departments of Surgery (P.B.M., T.H., K.M., A.W.K.), Critical Care Medicine (A.W.K.), and Regional Trauma Program (C.G.B., A.W.K.), Foothills Medical Centre, Calgary, Alberta, Canada; University of Aberdeen (I.C.), Aberdeen, Scotland; Northside Hospital Forsyth (M.B.), Cumming, Georgia; University of Pennsylvania (N.P.), Philadelphia, Pennsylvania; New York Methodist Hospital (L.M.), New York, New York; Institute of Clinical Physiology (L.G.), National Research Council, Pisa, Italy; and World International Network Focused on Critical Ultrasound Secretariat (C.G.), Bologna, Italy.

Original Abstract:  http://www.ncbi.nlm.nih.gov/pubmed/22182864

Medical information tailored towards consumers continues to be a growing field, and medical applications for smartphones are no exception, as can be evidenced by our previous reviews.

Drugs.com is a comprehensive and popular website devoted to providing updated information on medications, for free. Now they are trying to transition their informative website into apps.

They have two versions: Drug Guide for Consumers and Drug Guide for Healthcare Professionals. The apps are for the iOS platform, and here we review the Drug Guide for Consumers on the iPad.

So does this app fill a patient need, at least one important enough to justify an annual subscription fee?

The app’s interface is simple and clean. The home screen exemplifies that, and presents a search bar, along with FDA MedWatch Alerts to help keep consumers up-to-date.

The content is all within the app, so there is no need for an active internet connection to use the app. With updates occurring once a month, the guide does remain fairly well updated. The apps can be viewed in search, by individual drug, medications for medical conditions, and by drug class. The drug details presented are similar to the information presented on the website, or in the prescription insert.

The Medwatch alerts show a preview of the new FDA warning. Clicking on the full text sends a link to the drug.com website with the full text of the warnings.

As the website’s goal is to provide updated and comprehensive information about medications to consumers, the app also manages to meet that goal by inclusion of simple pharmacology explanations, indications/contraindications, and side effect profiles.

However, the app does not even contain the multitude of features that can be accessed from the website free-of-charge. The app’s benefit of being able to access the information without an active internet connection appears to be the basis for the pricing model. The app is updated on a monthly basis, while the website is continually updated even with news stories and MedWatch Alerts.

Here is an example of the app in landscape mode, again demonstrating its nice, clean user interface.

As anyone can imagine, this app should not replace actual medical advice and all patients should consult their physicians for concerns and questions regarding their medications. That being said, empowering patients with enough knowledge to understand and manage their health is important and this app can clearly do that.

But is there a need for a mobile app, particularly one which requires a subscription. Patients are certainly not going to access this type of information frequently – they are likely to only need it when a new medication is being started (or suggested) which is hopefully not all that often. So it seems unlikely that they would need to commit to paying this premium for mobility, which it isn’t all that clear is useful to them.

Prices:

• $24.99 for the consumer version
• $39.99 for healthcare professional version (not reviewed here)
• Both pricing schemes are for one-year subscriptions only

Likes:

• Easy-to-use and simple format
• Comprehensive guide with basic information quickly accessible
• Medwatch alerts

Dislikes:

• True to their calling, there is limited information on disease states
• Compared to the website, the variety of information presented is limited
• Updated per month (which seems slow) in the realm of medical news and information

Conclusion:

• While the app we reviewed is a solid product, it would be really difficult to encourage subscribing to these plans for a patient.

Find the app on iTunes here.

Surgical careers often attract people who are driven, gain satisfaction from seeing their handy-work progress, enjoy challenges, and can act quickly on their feet.

In today’s day and age, careers in surgery are glorified and thus attract more intrigue by young and interested candidates.

SurgiCareer was created by William Dunne and was intended to help those interested in a career in surgery (ranging from high school students to young surgeons). The goal is to provide information for interested parties that is supposed to be widely practical and easily accessible. The app is accessible via the iPhone and iTouch.

Would the app be able to fulfill its lofty goals?

The home screen of the app reveals an Index with many categories to explore. There is information ranging from Why Surgery? to Surgical Specialities to Getting into Med School and Training. There is also a RSS feed updated with surgical news, which would be of more use to a medical student/surgical resident.

The CV Checklist section helps prospectives learn what factors are important and appropriate to include in pursuit of a surgical career. The limiting step of the resume builder (and the app as a whole) is that the app focuses on mainly applicants in the United Kingdom.

The video section of the app utilizes Youtube videos and attempts to provide insight into various surgical fields. The content and quality of the films is erratic (dependent on the uploader), but can be accessed and viewed directly in the app.

However, most of the videos are of actual operations, which does not carry much educational value for high school and college aged people. A few of the videos (Cardiothoracic Surgeon) do have perspective from someone in the field, which is much more valuable to the targeted demographic.

Unfortunately, the information in the app is quite basic (and doesn’t totally cover all the steps necessary for the careers, average length in training etc), and while this would be helpful to inform those with minimal knowledge (those in high school/college), the attempt to provide this broad range of information further inhibits the app’s utility to serve any one population well.

Furthermore, as has been noted before, the app targets applicants in the UK system, and while the qualities are not completely different, the focus of the specifics is towards UK applicants, a system with which I am unfortunately unclear about.

(For information regarding a career in surgery, the American College of Surgery has created “So you want to be a Surgeon” as a starting point. A similar site from the Royal College of Surgeons is present for UK students here.)

Price:

• $1.99 from the AppStore

Likes:

• Unique idea
• Good overall concept

Dislikes:

• Mainly deals with applicants in the UK
• Information is unfortunately generic, basic and spread very thin
• Video content quite variable

Conclusion:

• An app with a good central idea, but poor execution. The attempt to reach pre-medical candidates and medical candidates spreads the app too thin, and doesn’t fully serve any one demographic.

iTunes Link

Its no secret that healthcare providers are adopting tablets at a rapid pace – one survey found that over 25% of physicians own a tablet and that was nearly nine months ago.

This trend, both with tablets and smartphones, has generally been bottom-up; physicians, PA’s, NP’s, nurses, and other healthcare providers are buying consumer devices and bringing them into the clinical world.

However, as Eric Yablonka, CIO of University of Chicago Hospitals put it, “This is not ‘nice to have stuff’ anymore, this is life saving stuff now.”

And so we’ve seen institutions across the country move to implement mobile devices on an enterprise level – from the Johns Hopkins and University of Chicago Internal Medicine residency programs to the entire VA healthcare system. However, Kaiser Health News reports that less than 1% of hospitals have fully functional tablet systems and points out how one of our biggest investments in health IT, the HITECH act, may be part of the reason why.

When the iPhone was first released, it transformed the way people interact with mobile devices – they became something better than just mini-computers. However, as pointed out by Jenny Gold, staff writer at Kaiser Health News,

“The most popular systems don’t yet make apps that allow doctors to use electronic medical records on a tablet the way they would on a desktop or laptop. To use a mobile device effectively requires a complete redesign of the way information is presented, Jonathon Mack, director of clinical research and development at the West Wireless Health Institute, says.”

We would first point out that the assertion isn’t entirely accurate – Epic, Allscripts, and Centricity as well as many cloud based EMR vendors like MacPractice and Dr. Chrono do have iPad and in some cases Android apps. That being said, these apps are, in many cases, limited – some allow read-only viewing for example.

What is often true, though, is that for hospitals, accessing these apps requires substantial additional cost. For example, Epic and Allscripts both require a separate licensing agreement for their mobile platforms. As Mr. Mack points out, many hospitals and healthcare systems have just made major investments in their IT infrastructure, a trend which was accelerated by the HITECH act. As he puts it, “When you look at a health system that has bought into an EMR, they’re not ready to turn the boat around and start over.”

As a result, healthcare providers are very reliant on workarounds to shoehorn tablets into existing infrastructure. For example, apps like Citrix or VMWare enable access to virtual Windows environments on the iPad or Android tablets, allowing access to fully functional EMR’s, radiology viewers, and so on.

In my own experience, while this method works, it just turns these devices into laptops without the keyboard. Windows is designed for computers and laptops; Microsofts release of Windows Phone and abandonment of Windows Mobile is a testament to that.

Despite these obstacles, healthcare providers like Kate Franko, a physician assistant highlighted in the article, are still finding utility for tablets to improve efficiency, patient communication, and more. While there are many issues to be addressed – cost, security, infection control, and so on – tablets are likely to be an increasingly common feature on medical wards and it’s only a matter of time before the IT infrastructure is forced to catch up.