Campbell’s Operative Orthopedics is a cornerstone of any orthopedic surgeon’s library. It’s one of the few volumes that every resident knows he or she will have to own – no point complaining about the price. If a junior resident shows up to do a case and has not at least read the requisite chapter in Campbell’s, then they should be prepared to go no further than a few hours of holding retractors for the attending and making idle chit-chat.

So, the arrival of an iPhone version of this four volume tome is certainly an important milestone. How did they do? This full review will explain.

This iPhone / iPod Touch medical application is another collaboration between the book’s publisher Elsevier and the mobile medical software publisher Modality.  As with other Modality titles, the user interface is clean and easy to navigate. The transition between text and images is easy to understand and the wealth of videos will please almost any user. A total of 242 techniques and nearly 25 videos have been ported to the mobile application.  Of course, the videos come with a storage price of  874 Mb on your iPhone or iPod Touch. While this will almost certainly be the largest app on your iPhone, a few minutes of use will have you wondering how you got by without it.

What I liked:

• gives you the opportunity to think about upcoming surgeries while on the go
• uncluttered and straightforward user interface
• text reduced to mobile screen-ready bullet points
• numerous embedded videos
• 1/4th the price of the printed version with DVD (currently more than $400 on Amazon.com)

What I didn’t like so much, and what could be improved upon:

• a “home” button to navigate to the root menu would be handy as it sometimes takes 3-4 steps to return
• the chapter authors are not always identified, important to know since surgical techniques are as much surgeon preference as science
• displaying the appropriate bullet point from the text beneath the operative drawings would make them even more valuable
• would like to have references from the text for additional reading (as an example, see the previously reviewed Clinical Orthopaedic Exam App)
• an option to enter your own notes for procedures would be a nice addition

Conclusion:

Disseminating text and visual information on surgical techniques would seem an obvious fit for technology and there are several very good resources already.The American Academy of Orthopedic Surgeons has “Orthopedic Knowledge Online”, a members-only website with surgical techniques and videos.  Other sources are the subscription-based Video Journal of Orthopedics, that is aligned with the important Journal of Bone and Joint Surgery and VuMedi is a commercial site with a wealth of videos and good social networking features. The missing link seems to be a mobile interface, so that the information is made available at the point of care. In that sense, the arrival of this application is timely.

Since surgical techniques are, to a large part, surgeon preference, there will likely never be a single definitive source of information. Nevertheless, within orthopedics, Campbell’s is as close as it gets to an authoritative resource. This pedigree immediately lifts this application, while the clean and easy to navigate interface makes it more attractive than the cluttered facade of all three of the above sites.

It is also striking that despite the wealth of information and careful editing that goes into a finely crafted tome such as Campbell’s Operative Orthopedics, textbooks still stand as isolated silos of information in an otherwise highly networked and rapidly-evolving internet era. Therefore, more innovations in medical education must necessarily be yet to arrive. For now though, just about every orthopedic resident and most attendings with an iPhone or iPod Touch would do well to save up the $99 to buy this application.

[itunes]

[website]

-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 his medical app reviews. His blog can be found at http://www.orthoonc.com.

MedPage Today’s motto is, “Putting Breaking Medical News Into Practice”.  I’ve been a fan of the website, medpagetoday.com for a few years now because they provide great medical commentary in a short, concise manner.  I call it “high-yield” reading.  Their articles often highlight key papers from the New England Journal or other reputed journals.  Another reason I’m a fan is because of their partnership with the University of Pennsylvania School of Medicine to provide Continuing Medical Education(CME).  A partnership with a well respected academic institution definitely gives me greater respect for their articles.

All the content from their website has now been brought to the iPhone platform, and the app is free!  Although the application was released awhile back, it was recently updated with some nice additions.  In this review of the MedPage Today Mobile App I’ll cover how to best utilize the features this free application provides.

When you open up the application you’re asked to register, although you don’t need to provide any personal identifying information if you don’t want to, just your specialty and what type of topics you’re interested in.  In the settings menu you can change your specialty information and topics of interest.  You can also set up the twitter client you want to use if you plan on tweeting stories you read through the application.

Per your specialty and topics of interest, you’re shown different categories, such as Cardiovascular, Heme/Onc, etc.  After selecting a particular specialty, you’re presented with the latest related articles.  These articles deliver information through video, audio, or text.  Almost all the articles contain CME credit opportunities.  After reading, hearing, or viewing the information in an article, you can take a post test at the end to get CME credit.

What I liked:

• Ability to get CME credit in the palm of your hand
• You can tweet and e-mail the article your just read
• Once you load articles they are saved on your device and you can access them in “off-line” mode.
• One of my favorite categories is the default “Latest News” category.  Often this section correlates with the front page of MedPageToday.  It’s basically akin to CNN headlines made for healthcare providers
• Nice user interface
• Don’t need to register with username or password if you only want to read the articles

What I didn’t like so much:

I like to listen to the videos and audio when I have my iPhone hooked up to my car.  When the phone goes into sleep mode the audio and video stop, and the same thing happens when I click the hold button.  Hopefully this is a bug that will be worked out in the next edition.

What I’d like to see in future updates:

• more access to all the information on the website.  I find a lot of the commentary interesting, and instead of only one default category, “latest news”, it would be nice to add more specific categories of news and commentary.
• When you want to take the post test for CME credit you are linked to safari.  It would be nice to have the ability to take the test within the application.
• Ability to Bookmark your favorite articles
• Ability to share articles via Facebook.

Conclusion:

The ability to attain CME credits from the palm of your hand is definitely a huge service this application provides, but I feel the ability to get current medical news is just as beneficial.  Even if you aren’t interested in getting CME credits, the CME articles are extremely informative and concise. You can read and listen to them on the go in order to stay up to date with hot button topics related to medicine.  The app is useful for not only providers, but medical students and residents as well and would definitely be helpful in the wards when getting grilled by attendings on updated medical guidelines.

In the future, I’d love to see this application expand even more to include all the rich content included on the MedPage Today website, but overall, this is a great medical application and a must have for healthcare providers and students.

Also, MedPage Today has another app, CME store[iTunes Link], that bundles together CME articles related specifically to your specialty.  We’re working on a review of this app and will release it soon.

[itunes]

[website]

Update:

There actually is a save/bookmark button, contrary to what I said above.  My apologies on the oversight and thanks to the MedPage Today team for catching this.

To our readers:

We will be providing commentary and short reviews to medpagetoday.com two or three times a month.  We feel honored to be included in their short list of talented and well respected bloggers.  The following is a little clip from our first post titled, Optimizing Your Medical Practice Experience with the iPod Touch. Rest assured, we’ll keep the frequency of our posts and reviews the same on our site.

There has been a great deal of commentary profiling medical applications that are useful for healthcare providers. However, there hasn’t been much talk about how mobile medical applications can enhance the doctor-patient experience and in turn, help optimize your practice’s overall experience. In future posts, we’ll focus more on applications for medical providers, but this post will discuss applications centered around the physician-patient relationship.   

 

We all know how busy clinic can be, and this leads to increased waiting times for patients.   Understandably, patients often complain that this is the most frustrating time for them, and none of us likes walking in excessively late on an angry patient because we had to deal with another patient’s medical emergency. So how can this downtime be made more bearable and productive at the same time? 

 

Here is where the iPod Touch comes in.  It runs basically the same operating system as the iPhone, and the applications I’ll discuss work for both devices. 

 

During a patient’s waiting time in the waiting room or exam room, you could give them an iPod Touch with some of the following applications pre-loaded. 

FDA Drugs is an iPhone application that functions as a mobile drug database. The user selects a drug and the application exposes brand and generic equivalent drug information, with the added twist of being able to display the actual FDA approval document.

The name is unfortunate as it implies that the application was developed by the FDA, which it is not. Rather, the developers draw on publicly available FDA data stores to display the label information for thousands of FDA approved prescription and over-the-counter drugs. When the label information is not stored inside the application, it displays a NIH website (“Daily Med”) where the user can search for FDA label information.

While seeing the original FDA document is of some satisfying curiosity, what is not immediately apparent to this reviewer is the additional benefit this application provides compared to other, more mature drug database applications, such as Epocrates or Medscape.

What I liked about this app:

• the ability search by active ingredient to find equivalent brand and generic drugs is nice

What I did not like about this app:

• there are some user interface quirks which are confusing, for example the “Legend” tab does not seem to do anything except simply redirect to the other 3 application tabs
• the large icons in the “Drug” view are distracting, more so since clicking on the majority of them results in no action
• for drugs where there is no stored labeling information, the application  simply opens to the home page of the website “DailyMed” after which the user has to again enter the drug name

What I would like to see in future versions:

• bug and UI fixes

Conclusion:

While the ability to quickly look up information on prescription and over-the-counter medications is of great utility for physicians, other mobile applications provide a richer interface to publicly available information  when compared to FDA drugs. For example, ePocrates not only provides prescribing information and drug interactions, but goes as far as providing the ability to identify a drug by the shape and color of the pill. These are very useful features for a prescribing physician. Thus, it would seem to this physician that the availability of a publicly available database led to the creation of this application, rather than an identified real user need.

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Free medical applications for the iPhone are being released on a daily basis, but not all of them are useful.  This isn’t a surprise since they are after all free to download.  However, there are definitely some free medical applications worth downloading.

This will be a regular column on iMedicalApps.com, where we will periodically post commentary on recently released free medical apps that are actually useful from a physician, medical student, or any other healthcare providers’ perspective.

In this post I’ll focus on three free medical applications related to the following: clinical trials, Framingham scale, and a radiology teaching app.

STAT Framingham Heart Age

We all know how the Framingham scale is a crucial tool for primary care physicians when trying to calculate morbidity and mortality of cardiovascular risk factors for patients.  Although there are other medical calculator apps that provide this for free as well, such as MedCalc, this app is simple to use and does the job quicker. You’ll see advertisements on the second page of this app, but it doesn’t hinder the functionality at all.  This app is quick as well, enabling you to show patients how much of an effect certain risk factors have while you’re sitting next to them.

App Links: iTunes, Website

Drug Trials

I’ll go ahead and say this medical app is a must download if you use clinicaltrials.gov to pull information about drug trials for your patients.  This app actually deserves a more full review, one we’ll try to get out soon.  It’s packed with features such as eligibility criteria, e-mail out functionality, and even pulling up google maps on your phone to show the location of the trial! We’ve reviewed another similar type of app awhile back, Clinical Trials, and when it comes to searching for drug trials, this app is just as good or slightly better.  Unlike Clinical Trials($7.99) though, this one is free.

App Links: iTunes, Website

MSK Radiology Teaching File – LITE

This is the lite version of Radiopaedia.org’s Radiology Teaching Files: Volume 3, an app designed to teach radiology.  Although this is a lite version, I was surprised to find out how much information it packs, 10 full cases.  This lite version comes included with some relatively common pathologies and even though its free, you could definitely get some good learning accomplished if you’re a resident or a medical student.  There are other LITE versions of Radiopaedia.org’s content, and each of these files contains 10 cases also.  Usually I wouldn’t include a LITE version of an application in this list of free medical apps, but this app had plenty of content.

App Links: iTunes, Website

Note: At the time of this post these applications were free, this can obviously change over time.  If you’ve got some free medical apps you love to use, make sure to comment and let the community know.

iCME is a simple mobile database for physicians to track CME (continuing medical education) events. Appreciating its purpose is clouded at first since it doesn’t seem obvious that keeping a list of one’s conferences is weighty enough of a task to devote an entire application. But, it turns out, that is indeed the one and only function of the application. Specifically, the user is asked to manually enter the date, title and hours of every CME event attended and, in return, the user is rewarded with a display of all their events in table format. As every physician needs to document continuing medical education at each biennial state license renewal, the need for recording such events certainly exists. However, the question is whether a dedicated smartphone application beats a simple piece of paper.

What I liked about this app:

• It addresses a real need
• Simple to understand

What I did not like:

• The application does not add up CME hours per time period, an important oversight
• There is no way to specify recurring CME events
• If the idea is that a smartphone allows for quick, on-site data entry, then the default behavior should be to request the smallest possible amount of information, however the application default is 10 data fields per event (customizable to a maximum of 18 fields!)
• Similarly, requiring the user to scroll through 17 different types of CME events seems inconsiderate

What I Would Like to See in Future Versions:

• This type of app might more naturally exist as a mobile interface to a web application, that way the data can be viewed and backed up online
• Perhaps better would be integration with an existing web information service, such as Evernote, so as to spare us accrual of yet another on-line service
• Yet even better might be re-imagining it more as a calendar add-on and have it accept email event invites (standard VCAL format from Outlook or iCal), to which it simply adds the CME hours on top of the existing calendar event data – why enter the same information twice?

Conclusion:

The developers state on their iTunes page “Every health professional will find this program invaluable!”. Well, that might be a slight overstatement. While logging CME events is certainly a necessity, it is not a burning need for most physicians. The occurrences are infrequent and will probably leave some trail of evidence (emails, handouts, etc) so that they can be recalled at a later date. It is not clear that physicians will compulsively remember to use a dedicated free-standing application to log their CME events. In reality, a simple paper list or text document will suffice for most people . As always, any new service will have to provide a high enough value proposition for folks to change behavior. Nevertheless, iCME does provide a simple and useful venue to address an existing need. Perhaps if the developers imagined a way to integrate this application into existing products and services, it could become even more useful.

[itunes]

[website]

Dr. Wodajo is one of our senior writers on the iMedical Apps team.  He brings an extensive clinical background to the reviews and commentary he provides.  He is a bone and soft tissue tumor specialist with interests in health policy, technology, and tumor research. His blog can be found at http://www.orthoonc.com.

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.

[itunes]

[website]

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.

[itunes]

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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.

We’ve always been a big fan of Medical Radio, the free iPhone app from the folks over at ReachMD. The app is in our top 7 list of medical applications because of the great utility it provides to medical professionals. We actually reviewed an old version of this application, ReachMD CME awhile back. You can find out more information about this live event on the ReachMD site:

“This represents the first national broadcast of it’s kind for continuing medical education where participants can interact with the world renown faculty that NACCME has lined up for this program,” said Gary Epstein, CEO of ReachMD. “ReachMD is proud to continue to deliver innovation in the Medical Education media space and we expect this new live programming to generate as much enthusiasm as our iPhone application last year.”

This event isn’t a one time thing, and will occur eight times from November 16th to December 15th. The schedule of the live events is listed on their website.

You can participate and ask questions during the live broadcast via phone(888-MD1-REACH), email (CME@ReachMD.com), and twitter(CMEonReachMD). Participation in the event is free, just like the application.

Here is an excerpt of what we wrote in the past about the Medical Radio app by ReachMD:

We thought the ReachMD CME app had promise, but didn’t capitalize on it’s full potential. Needless to say, the Medical Radio app definitely does not disappoint. This app provides an easy way for you to get CME credit by listening to streaming CME education from legitimate health care professionals, and then taking quizzes right through your phone. Imagine getting CME credit while on a train ride or in some waiting line. Imagine no more.

The iTunes link to the Medical Radio application can be found here.

If one wanted to get an idea of the potential of the iPhone as a tool for bedside medical and surgical education, this application by Modality and Elsevier would be a good starting place to get inspired. While it seems obvious that a portable device with a great user interface, a sophisticated operating system and great multimedia features should be a shoe-in for portable medical education, what is equally true is that the critical ingredient remains great instructional content.

“Procedures Consult: Internal Medicine – Musculoskeletal” brings together a highly detailed review of orthopedic bedside procedures, such as aspiration of small and large joints, splint application and reduction of joint dislocations, with a well crafted user interface to create an application that will genuinely be useful for emergency room physicians and junior orthopedic residents.  This review will cover how this medical application for the iPhone and iPod Touch goes about teaching these procedures.

The content is derived from Elsevier’s Procedures Consult website, which is a curated video site describing over 270 procedures spanning several disciplines. (Please see the recent review of the companion application “Procedures Consult: Internal Medicine – General” on this website. The content for this application is derived mostly from the emergency medicine/musculoskeletal section. The information for each procedure consists of pre-procedure and post-procedure check lists as well as step-by-step instructions of the procedure itself, accompanied by references. In addition, one or more videos for each procedure is embedded into the app, available for immediate viewing. Surface landmarks are shown graphically as is a simplified 3 cut-away dimensional graphic of the relevant deep anatomy. Some procedures, such as shoulder reductions, are also accompanied by a representative radiographs of the problem.

What I liked about this app:

• the attention to the relevant surface and deep anatomy, as well as the indications for each procedure is very helpful
• videos are of high quality and are embedded directly in the application. (refer to other Procedures consult review for more details)
• the techniques themselves are well-described and, I believe, few practitioners will find much cause to quibble with the instructions

What I did not like about the app:

• not much really, perhaps the post procedure care is unrealistically detailed for the typical bedside interaction

What I’d like to see in future versions:

• the content for this application is aimed mostly at ED procedures, which is surely a good market, however a future application with a more orthopedic focus, including closed fracture management and even surgical procedures would certainly be appreciated

Conclusion:

While there has been a proliferation of medical instructional websites over the last five years, bringing that information to the bedside is more than just a convenience, it is a critical next step. Websites and mobile applications will not replace peer-reviewed scientific literature nor the principle of apprenticeship in medical training. However, I can easily imagine when all post-graduate trainees are routinely expected to refer to mobile applications such as this one before undertaking unfamiliar procedures. This will undoubtedly reduce errors and enhance the care of our patients.

Title of app: Procedures Consult: Internal Medicine – Muscloskeletal

[itunes]

[website]

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.

Procedure apps appear to be all the rage lately in the mobile medical world, and rightfully so. These instructional apps are a valuable resource to those learning how to do procedures in the health care world. We reviewed another Procedures app recently, Procedures Consult-Internal Medicine, that covers a wide variety of procedures. However, this app focuses on one specific procedure, and is a fraction of the cost.

Procedures – Subclavian Line, is a $2.99 app produced by MeisterMed. You might remember one of our previous reviews on a MeisterMed app, PediDoser. We weren’t huge fans of that app (although to their credit, PediDoser has a 3.5 star rating in the App Store). Nonetheless, once I tried out this current app for this review I was definitely impressed.

I’ve had the opportunity to do a few subclavian lines as a medical student, and the experience is exciting and frightening at the same time. The best way to learn at first is to see, but unfortunately you don’t always have a good view, or the resident might not be the best teacher. Thats where this app comes in.

The navigation is pretty simple. When the app opens you have the option to view the procedure details or watch the full video. In the procedure details section you have a few different options, from step-by-step instructions to complications and coding numbers. There is also a toolbar at the bottom of the screen. It contains navigation tools, bookmarking, and an option to write custom notes. The bookmarking feature was not useful, but the custom note feature was a nice touch.

Video:

The video is approximately 10 minutes long and included within the app. You don’t need internet access to view the video. It shows the full procedure being done from start to finish. The audio component of the video is instructional. I found the audio to be layered nicely with the video. The instructions were concise, high yield, and the explanation of the procedure was excellent.

What I liked:

• Simple, easy to use
• Great Price
• Ability to take custom notes
• Video is standalone, no Internet access required
• The verbal explanation during the video is done well
• There is a separate text section step by step instructions.

What I didn’t like and Improvements that could be made:

• Overall video is great, but at 10 minutes in length, it would be nice to see the video broken into separate sections that are easy to access.
• It would be nice to see text inter-laid with the video on the crucial steps of the procedure, so you can view the video without always needing the audio
• The step by step text instructions only contain one picture. More pictures would be nice additions to this section.

Conclusion:

This is a great medical application for those learning how to do subclavian line procedures. It’s simple, easy to use, and easily accomplishes its goal of teaching how to put in a subclavian line. Like I’ve mentioned with past procedure applications, there is no substitute for getting lots of supervised practice before actually doing this procedure on your own. However, this app definitely reduces the apprehension felt when attempting this procedure for the first time under supervision. I could also see it helping speed up the learning time needed for this procedure.

The previous procedures app we reviewed, Procedures Consult-Internal Medicine, had 25 procedures explained(including subclavian line), but costs $39.99. We really liked that app, but if you don’t need access to all those procedures or don’t want to spend that much right now, then this app is a great buy at $2.99.

I’d definitely recommend this medical application as a must have for 3rd/4th year medical students, interns, residents, and other healthcare professionals who are learning to do subclavian lines.

[itunes]

[website]

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.

[itunes]

[website]

There are a few different medical apps that provide you with reference lab values. I’m going to go through each one to see how they compare to each other and see which ones are the most useful in the wards/clinic. The main four in the App Store are Pocket Lab Values ($2.99), Normal Lab Values ($1.99), MedRef ($0.99), and Lab Tests ($5.99). Each medical app overlaps a decent amount of information, but there are definitely significant differences. Epocrates also has a lab values section, but you need to be a premium member in order to use it (expensive). A key thing to note is different hospitals can have different reference ranges (depending on how their in-house lab works), so always make sure your hospital’s references ranges match up with the app you use. With that said, the reference ranges are usually pretty universal. Anyways, let the battle begin.

This post will discuss how these different medical apps stack up to each other.

Lab Tests ($5.99):

Positives:

-Aesthetically pleasing.
-Gives an excellent amount of information for each lab value.
-Tells you what High and Low values for the particular lab might mean, providing great differentials.
-Gives you the option to learn more about the lab value with an extra information tab
-gives you the citations and references to the information provided.

Negatives:

-It would be nice if they started off the descriptions with the lab values. Sometimes you need to scroll down to see them.
-Is more expensive than the other medical lab value apps.
-No bookmarking.

Pocket Lab Values($2.99):

Positives:

-Has a nice user interface and nice aesthetics.
-Ability to search and make bookmarks. Separates the labs by category.
-Each lab value has a small description about the particular value.
-Does a great job of linking Wikipedia, MedlinePlus, and Google within the app itself.

Negatives:

-The small amount of information provided on each lab value could be expounded upon.
-It would be nice to see more information about high vs. low lab values.

MedRef ($0.99):

Positives:

-Opens up to the search page for lab values (not shown in picture).
-Easy to use.
-Has a charting section that can be used for Admit Orders, H&P, Neuro Exam, Progress note, and more.(shown in picture)
-Also has a reference section separated into systems. These reference sections don’t have a plethora of data, but do have some key information. An example is the Neuro section, where you can access the dermatomes map. Only $0.99.

Negatives:

-Doesn’t provide any supplemental information on the lab values.
-Would be nice to see more information in the reference section.
-No bookmarking

Normal Lab Values ($1.99):

Positives:

-The User Interface is straight forward.
-The app opens to the search page with all the different lab values.

Negatives:

-Out of the 4 medical apps, this one is the most simple, and definitely way too simple.
-It’s not aesthetically pleasing to use and no extra information is provided in the app.

Conclusion:

Out of the four apps here, Normal Lab Values is definitely an app I would not recommend. The other apps are more sophisticated and you’ll get a better value out of them. Deciding how to rank the remaining three apps is a bit more complicated. I personally loved Lab Tests. I would find it to be the most useful to me in the wards.

It gives you the differentials for high and low lab values, and has a vast amount of high yield information that’s useful for treating patients and when getting asked random questions by attendings (pimped). I think every resident and medical student would benefit greatly from knowing the information contained in the Lab Tests app. Even though it’s a bit expensive in comparison to the apps, if you use the app on a consistent basis, it’s worth the high yield medical knowledge you’ll glean from it.

However, if you don’t need a differential for high and low lab values and you just need some quick values, then MedRef and Pocket Lab Values are the ones to decide between. I actually enjoyed the supplemental information provided in MedRef a lot (mentioned in above description). Instead of looking at my Maxwell, I’ve actually used the admit orders and discharge summary forms provided in the app while on the wards. It’s the best value out of all these apps at $0.99, but it doesn’t provide any extra information on the lab values themselves. If you want extra information about the lab values, but don’t want to spend $5.99 for the Lab Tests app, then Pocket Lab Values might be the app to choose from. The app has a nice User Interface and links to Wikipedia, MedlinePlus, and Google within the app.

At the end of the day, I’m still waiting on a lab values app that mirrors www.labtestsonline.org. I’ve used this website throughout med school and in the wards constantly. However, out of the 4 lab values apps, Lab Tests came the closest to matching this website.

Rankings:

1) Lab Tests ($5.99)
2) Tie – MedRef ($0.99) and Pocket Lab Values ($2.99)
4) Normal Lab values ($1.99)

**UPDATE: One of the readers made an excellent point about Epocrates having a nice lab values section. I choose not to include Epocrates in this discussion because you need to be buy their premium package in order to use the lab values section(expensive). The same is the case with the SkyScape App. These apps get the job done for significantly cheaper.

Links:

Lab Tests: Website, iTunes Link
MedRef: Website, iTunes Link
Pocket Lab values: iTunes Link
Normal Lab values: Website, iTunes Link

Medical Spanish, made by Batoul Apps, and available in the App Store for $6.99, just added audio to their top 25 medical app. As you can tell by the title, we’re definitely excited about the 2.0 version of this medical app. Some of the new features include audio for over 3,000 phrases, interactive bookmarking, a slightly different interface, and some new content. Did we mention there are over 3,000 phrases with audio now?

We reviewed Medical Spanish back in June and were definitely fans back then. The app even made our top 7 Medical apps list, coming in at #6. We’ll start the review by summarizing our last review, and then talking about the new features.

In our previous review, here is what we liked:

• Search function allows you to easily find thousands of key medical phrases / words instantaneously. By far the best feature of the App.
• The pharmacy section is great for giving instructions on how to take medications (dosage, timing, etc)
• You can use this app even if you can’t speak a single spanish word.
• Made by healthcare providers, so questions are on par.
• Thousands of phrases can help you with a full H&P and chief complaint.
• Can help you save time while you are waiting on the translator.

In our previous review, here are the things we didn’t like so much, and improvements we hoped for:

• A favorites section. It would be nice to have a favorites section where you could put the most frequently used spanish phrases.
• An option to where the application opens up to the search menu. I find myself using the search option 90% of the time.
• Hispanic patients tend to use more nontraditional medications, it would be helpful to have a section dedicated to some of the nontraditional med/treatments used by them.
• The developers have announced they will be adding audio to this app as well, which would be amazing.

The developers added 3 out of the 4 things we wanted to see in their new version of the app. They’ve added audio, bookmarks, and a section on commonly used medicinal herbs and plants by the Hispanic population.

Having a medical Spanish app with audio is nothing new. There is another medical app, called Emergency Medical Spanish Guide (EMSG) with this feature already. We tried out this app but were not fans because it lacked one of the most basic functions, a search feature. They also only have a couple hundred audio phrases. A search function is critical in a medical Spanish app because you don’t always have the time to go through every section to find out exactly what you’re looking for. Needless to say, with Medical Spanish adding audio, the EMSG app is nowhere close to the level of the updated version of Medical Spanish.

Audio feature and bookmarking:

To access the audio, you tap on a phrase, then a new section appears within the same page, with a play button and a star representing the bookmarks button. (Refer to the pictures). Once you tap the play button, you can stop the audio at any point in the phrase. This is all simple, fast, and fantastically done.

Issues and Improvements we’d like to see in the future:

Overall, we like the user interface, but we have some gripes with the organization of this app. The app opens up with a Review of Systems page, and lists the different systems. You have to scroll down to see other key sections, such as directions, and vocab. Also, the new medicinal herbs section is hard to find. You have to go to the vocabs section and then scroll down to medical plants. This section is crucial because almost all of us have encountered some Hispanic patients who use home remedies they get from local markets. The developers did a nice job of adding bookmarks for separate phrases, but why not add bookmarks for actual sections of the app? We’d like to be able to bookmark sections such as diagnostic tests and medicinal plans. It would also be nice to search for these sections of the app as well, instead of just specific phrases.

With it’s collection of extensive medical phrases and audio, we’d love to see this app have the ability to be a medical Spanish teaching app for healthcare providers. The developers could make a teaching mode, where they would add English audio along with the Spanish audio translations. Can you imagine making a customized playlist using the bookmarks section, then playing it on your way to work? In this manner you could memorize all of the Spanish physical exam instructions, along with anything else of your choosing.

Who this app would be great for:

Every healthcare provider who deals with a large Spanish speaking population.

Conclusion:

Our title of this review explains it all, we’re smitten with this Medical Spanish app. The developers took all the suggestions we made in our previous review and basically nailed them. With the addition of extensive audio, this is a definite must have application for healthcare providers who deal with large Hispanic populations. Unlike other medical Spanish audio apps who have only a few hundred audio phrases, this application has over 3,000. Even if you speak Spanish this could be useful for finding those key medical phrases you might not know. The user interface is quick, stable, and easy to use. The sky is the limit for this medical application and in the future we’d love to see a teaching function added. Oh, and is this app worth the $6.99 asking price? Most definitely.

[itunes]

[website]