The iPad has created a great deal of buzz in the tech community. The medical and healthcare community at large are set to benefit from some of its key features, mentioned in our prior posting.  One of these key features, the beautiful 1024 by 768 pixel, 9.7 inch screen, is set to change the overall user experience for medical apps that have a focus on imaging, such as anatomy applications.  Although this medical app review was done using an iPod Touch, we can only imagine how much more aesthetically pleasing the iPad’s experience will be. As will be discussed later in the post, these applications are a perfect example of how the upcoming iPad could be used in the clinic setting to improve patient education.

A key thing to remember is your iPhone medical apps will run just fine on the iPad.  This post will review a trio of Modality’s latest anatomy flash card apps and provide extensive pictures of the following: Clemente’s Anatomy, Rohen’s Photographic Anatomy, and Moore’s Clinical Anatomy.

Modality now has a variety of Anatomy Flashcard apps to choose from, depending on your preference. In addition to Netter’s Anatomy, an app we reviewed awhile back, Modality’s newest editions are Clemente’s, Moore’s and Rohen’s anatomy.  They are all priced at $24.99 (except for Netter’s, which is still $39.99).

Due to the similarities of these applications they will be reviewed in one post.  I’ve been using Modality’s Netter’s Anatomy Flashcards app for almost a year now and have a good reference to compare these new apps to.

Ultimately, your choice of anatomy app will come down to the anatomy book you like or the anatomy book your school uses.  I originally chose the Netter’s app for this reason.  These apps have generally the same user interface, and mainly differ on the type of anatomy images they provide.  However, individually, they each have some strengths and weaknesses.

Clemente’s

• Strengths: Great for the lymphatic system and also for schematics to simplify diagrams (e.g. brachial plexus, spinal nerve roots, dermatomes, etc.); Some X-ray images included; Excellent for bones and muscles.



• Weaknesses: Lacks “back of card” information that explains the anatomy in the illustration.

More Clemente’s Sample Pictures:

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.

Merry Christmas everyone! The iMedical Apps Team has been busy with holiday traveling and festivities, so our apologies on the infrequent updates this past week.  In the Christmas spirit, we’re giving away 10 promo codes each for two USMLE study apps.

Continue on for promo codes for these USMLE study apps.

The developer for USMLE Buzz and Step 1 iBank has kindly given us promo codes for each of their apps.  We’ve reviewed USMLE Buzz before on this site and were huge fans of the application.  The Step 1 iBank app is new and we are in the process of reviewing it right now.  I’ve used it some already and it seems very promising.  Unlike the quick hitting questions of USMLE Buzz, USMLE iBank has full length questions with detailed answers. 

If you use a promo code make sure to leave a comment letting others know which one you used, and let us know what you think of the medical app.

USMLE Step 1 iBank:

1. RF467KXFR6TP
2. EEYY3HLMKRAJ
3. 9XJEHWP3LRY9
4. 77JML7PF9XTM
5. MATWAFFXNRLE
6. 47L747HRK7YK
7. YA9EJY6JAWPE
8. NHFWT7R4TL73
9. PLHPRAEXAW7E
10. XYNPFF6NAPWH

USMLE Buzz:

1. AYYYLFPP9JEL
2. L3XHP474XMAP
3. YNAMLE4HTXTP
4. PNWMLLYRRYM7
5. 3XPFY3RE6YNE
6. NEPLT463EH7L
7. R4FY4M43EFJK
8. LFKATKNJ7WMY
9. LPPAK9F9NF47
10. 994YJWFAAJMM
11. XYPPWP7LFX3J
12. MN4XHJ6FJJTM

iTunes Links to the Applications: Step 1 iBank, USMLE Buzz

A new radiology learning tool was just released in the App Store, the iRadiology App.  This app has a catalog of over 500 radiology cases designed to help medical students and residents improve their plain film,CT, and MRI reading skills.  The cases are derived from Dr. Gillian Lieberman, who is the currently Director of Harvard Medical Student training and Associate Director of the Residency Program at Beth Israel Medical Center.  This legitimizes the content of the application.  In this review we’ll discuss the application further and also show you how to turn on the “Zoom” feature built into the iPhone that will enable you to improve the utility of this medical app.

When you open up this application you are presented with the above screen.  With the search feature, you can search for various cases based on certain key words, such as cardiovascular, chest, or actual pathologies.  I didn’t find the Search function to be very helpful, but the topics section was great for navigating with the application.

Activating the “Zoom” feature on your iPhone:

Before writing about this application further, I’ll quickly show you how to turn on the native “Zoom” function of your iPhone.  While this app allows you to zoom into pictures,  you can’t zoom in as close as you’d like sometimes, but when you turn on the native “Zoom” function in your iPhone, you can get significantly closer, making these images even more useful.

Go to Settings, tap General, then Accessibility.  Once you tapped on Accessibility, tap Zoom, and slide the Zoom feature to the On position.  The instructions for how to use the extra Zoom feature are shown on the same page.  Make sure you know how to manipulate the “To change zoom” portion correctly.  Below is an example:

This feature will also be useful for other medical applications that require you to read detailed images.  Now back to iRadiology.  For the purpose of this review, I’ll select “Chest” from the Topics section, and then in the subcategory I’ll select Lungs.

Within the Lungs section there are further subcategories, showing the great diversity of cases this application possess.  I’ll select Sarcoidosis and go from there.

When you tap on Labels, you are presented with the above picture, revealing key areas of the image. 

If you have the Zoom feature turned on, as explained at the beginning, you can zoom in ridiculously close and get a better picture of these films.  I wasn’t able to include the pictures where I used the “Zoom” feature because the iPhone doesn’t take screen shots of these pictures.

When you tap on Findings, you are presented with further information about the radiology case at hand, in this case, sarcoidosis.  I found this section to include a great deal of high yield information that is often asked on the USMLE step 1 and step 2 exams.

What I liked:

• Great wealth of knowledge, over 500 radiology cases
• Labels section does a great job of showing the pathology of interest
• Great diversity in the cases present
• Legitimate source for the pictures and cases provided in the application
• Great explanations of the radiology pathology presented in the application
• It’s FREE

What I didn’t like so much:

• Zoom feature, using the traditional pinch motion, could be more robust, although the iPhone’s new native “Zoom” feature can be used
• Supports landscape mode, but the Findings section can only be viewed in vertical screen.

What I’d like to see in future updates:

• Quiz Mode
• Bookmarking of favorite cases to review
• Built in link to Wikipedia for more information about the radiologic case at hand

Conclusion:

We’ve reviewed other radiology related applications before, such as iAnatomy, and the Joslin Chest Atlas.  iAnatomy did a great job of providing cross sectional CT images for anatomy learning, but did not provide pictures of various disease pathologies.  Joslin’s Chest Atlas provided some great plain chest film images, but the amount of content is limited with less than 100 images.  The beauty with iRadiology is in the huge amount of content provided, with over 500 radiology cases, and these cases are high yield as well.  The majority of these cases are ones I’ve seen in the hospital or have learned about.  Oh by the way, this app included plain film x-rays, CT scans, AND MRIs.

This application has the full package and I’d definitely recommend it to medical students, residents, or any other health care providers who want to improve their radiology reading skills.  With the price tag of “free” this app is a no brainer to download.

[itunes]

[website]

This app is 137 mb, so make sure you’re connected to a dedicated WiFi connection when downloading.

Also, special thanks to one of our readers in Taiwan for alerting us of this application.  Remember, many of our post ideas come from you, our readers.

Current Clinical Strategies Publishing recently sent us some free promo codes for this app, ECG Interpreter(you may have noticed) and we were thrilled by the last app we reviewed by them, ACLS Advisor.  So then naturally, we had high expectations for this medical app.  ECG Interpreter is relatively inexpensive at $1.99(current price), but with so many ECG apps out there we wanted to know if this app was on par with similar applications and if it met our high expectations.

When you open the app, you’re given a few options to choose from: Start Analysis, Calipers, Saved Results, and ECG Library.  I’d have to say, the real meat of the app are the Analysis and ECG library sections, but the virtual calipers are also ingenious (and I’d have to say, a lot easier to get through airport security than my other ones).

Analyzing:

The app does a fairly good job of walking you through a step-by-step method of reading ECGs.  It’s similar to how you first learned to read radiology images: if you follow the same steps every time, you decrease the probability of missing something.  The app walks you through analyzing the following (and in this order): rate, rhythm, axis, hypertrophy, conduction blocks, ischemia / injury / infraction, AV nodal blocks, and finally, miscellaneous syndromes (hyper and hypo-kalemia K, hyper and hypo-calcemia; and myocarditis / pericarditis), supraventricular arrhythmias, and finally ventricular tachycardias.  After you walk through all of these questionnaires, it finally summarizes all of your information, and allows you to save the analysis or send it via email.

In their App Store description, this app boasts that not only can it “evaluate the 12-lead ECG” but that it “provides a diagnosis and recommends treatment”.  Now, some may have a problem with the details of the treatments recommended (or the lack thereof).  For example, when setting the calipers for a HR of 55, the output simply reads “Diagnosis: Bradycardia. Treatment: atropine, pacemaker.”  To be fair, not all of the diagnoses are this brief and this app is obviously not a replacement for sound clinical judgment.  (I for one would be terrified if I woke up with an HR of 55 and found a team ready at my bedside ready to float a pacer!)  According to the developer, the app is based on sound medicine, powered by the ACCI Cardiology Decision Engine, and follows 2009 AHA / ACCF / HRS / WHO guidelines.

ECG Library

So this is the part of the app I thought I’d get the most out of.  Who couldn’t use a quick pocket reference of a variety of common and not so common 12-lead ECGs. Au contraire, using this is not as easy as it seems.  When you initially click on ECG library, you’re greeted with an endless list of rhythms to choose from.  However, clicking them basically takes you to a picture file that has a zoom capable image of an ECG with a typed explanation above it.  Sounds good in theory, but not really when you take a closer look at the examples.  Too often I found myself scrolling back and forth on the zoomed image to read the cramped text, and then scrolling back down the image to see what they were talking about.

From a user interface perspective, I’d like to be able to see the ECG and read the explanation text at the same time.  I know that’s hard to do on an iPhone screen, but other apps have taught ECGs better (see our review on Instant ECG).  This app gives out really great information, but I’m just not sure if I’d use it in this format, and I think other apps do a better job.

Another aspect not helping this app’s cause is the fact the screen orientations in every mode are locked.  The ECG list is always in portrait, and the ECG images are always in landscape.  Needless to say, if you use the app for any decent amount of time, you end up flipping back and forth too frequently.  Even though I can magnify the images and drag to whichever lead I want, it comes nowhere close to the ability to look at an actual full size EKG on paper.  Also, I would’ve liked the ECG library section of the app to do a better job with the content provided, it really only works as a a quick refresher reference since I already know what to be looking for.

Conclusion:

So who would benefit from this app?  Like our other ECG app reviews, medical students and residents, particularly those on cardiology rotations would probably benefit the most.  If you spend a long amount of time looking at various ECGs and need a reference to remind you of the zebras, it wouldn’t hurt to have this around.  Additionally, if you need help remembering the routine for reading ECGs, this app walks you through it in a straightforward fashion.  However, if you’re looking for a quizzing or teaching app, this may not cut it for you.  If it stays at the low price of $1.99, it would be hard to go wrong either way.

[itunes]

[website]

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.

The interpretation of ECGs is a difficult art to master for medical students and house officers alike. We are all taught to keep to the “Dubin method” and work through each 12-lead study with consistent patience no matter how abnormal the ECG initially appears. A particularly talented cardiologist once told me that ECG interpretation is often equal parts evidence based science, art, and gut feeling. So how is one to navigate the complexities of ECG interpretation without getting overwhelmed? Instant ECG, a well polished ECG interpretation and study guide by iAnesthesia LLC, is how.  Currently the app is on sale for $0.99 in the App Store.  I have used this application for 2 weeks (although not on a cardiology service), and so far am extremely pleased with the results.  I’ve also used the ECG guide, which was previously reviewed on this site.  In the the conclusion I’ll discuss my favored app.

Creating a useful ECG application is difficult. One can try to create a decision tree that takes user input and spits out the possible diagnosis. Unfortunately, this approach is prone to multiple errors and it prevents the user from learning while the program makes all the decisions. An alternative method is simply a digitally indexed textbook that may be inclusive of information, but lacks quick clinical utility on the floor of the hospital. Instant ECG is, in my opinion, the best attempt to create a successful hybrid of the two. Structurally the app is more of a learning reference, but there are several key features that make this ECG application much more than a study guide and solidifies its position as the “app to beat” for ECG interpretation.

What’s to Love:

Instant ECG is an excellent study guide. With the most complete set of rhythm descriptions and examples (at least 3 examples are given for each rhythm) of any of the ECG applications and accurate text to describe ECG pathology, this application is basically an easy to navigate Dubin’s ECG Guide for the iPhone or iPod touch. Descriptions in the ‘ECG Basics’ section contain advice for reading ECGs accurately and quickly and include appropriate images (such as the cardiac axis vectors and action potentials) to aid the text. I found it interesting and informative to skim this application for clinical reminders when reading an ECG and as an organized review to pass the time.

This application is also a good ECG interpretation tool. Granted, it will not do the job for you, but due to its well organized menus, the user can easily search for and compare the findings of an ECG with the text and multiple examples within the application. Each example ECG can be pinch-zoomed and explored using the iPhone interface well. Another useful feature of this application is the inclusion of movies to view the ECG findings as they are seen on telemetry rhythm strips on the hospital floor.  This feature is exceptionally useful in practice to determine the next course of action when an abnormal rhythm is seen prior to obtaining a 12-lead ECG.

Instant ECG has exams! Unlike most medical reference guides reviewed by the iMedicalApps team, Instant ECG can actually test your knowledge of the material it presents within the application. There are 144 questions (multiple choice, true/false, and rhythm strip identification) included in this ECG application. Instant ECG keeps track of your answers and progress through the questions, but be warned: many of the questions are not cupcakes.

I also enjoyed the small ‘Reference’ tab on the bottom menu that provides a quick reference for normal measurements on a 12-lead ECG and the images found in the application.

It is impossible to touch on everything this application correctly includes and performs well. It is presented cleanly and is easy to navigate with an interface that is consistent throughout all screens.

What’s to Dislike:

What Instant ECG presents is nearly perfect and leaves little to complain about. Additional images in the ‘ECG Basics’ section demonstrating close up images of the pathology described in the text could be very helpful, especially for students or house-staff on a cardiology rotation. In particular, I would have enjoyed seeing examples of T-wave changes in ischemia while reading the text without having to switch to the ‘Rhythm’ section and zooming in on an example.

A complete search feature should also be included within Instant ECG that includes the text of each section. When interpreting an ECG with the help of this application, the user has to navigate to each section to create a differential for a particular ECG finding.  The ability to search for a particular finding (i.e. regularly irregular rhythm) throughout the entire application would make interpretation with the aid of Instant ECG a bit easier. As it stands, the application is extremely easy to navigate even without this tool.

The previous version of Instant ECG crashed frequently when loading movies, but this issue seems to be resolved.  In its current state the application is quick and responsive.

The Bottom Line:

Every medical professional who ever has to handle or make clinical decisions based on an ECG, or who even possesses the slightest curiosity about the electrical conduction of our miraculous pump should purchase this application. At their current promotional price of $0.99 in the App Store, this application is a steal. In a few weeks, I used this application in the hospital many times and refreshed my knowledge of ECG pathology outside of the hospital as well.

The movies of ECG pathology seem on a rhythm strip are at first glance a waste of memory, but ultimately priceless.  The text is complete and easy to read and capable of making even the most clueless sound like a cardiology fellow.  It is highly recommended for any medical professional: for students and residents for education and patient care, as well as any hospitalist or primary care physician who needs a reference when reviewing an ECG on the floor. Cardiologists may even find it useful as a teaching tool.  Instant ECG is one of the best ECG applications currently in the App store and better than the ECG Guide app we previously reviewed.

Links to Instant ECG app: iTunes, Website

The term “Gray’s Anatomy” has become synonymous with the popular ABC show featuring surgeons who have ridiculous amounts of drama while somehow still finding time for the OR.  I’ve only seen one episode of the show, and would describe the main character as a black hole for drama, but anyways, before the show, “Gray’s Anatomy” was synonymous with gross anatomy, a very familiar text with medical students.  The full version of the Gray’s Anatomy text has now gone mobile and is ready to use on your iPhone.  There are a few versions of this app out, but I’ll be reviewing the Deluxe version.  In this review I’ll focus on how useful it might be for gross anatomy during the first year of medical school.

I preface this review by saying I’m not a huge fan of the Gray’s Anatomy book.  Instead, I was a huge fan of the Netters Anatomy text during my first year of medical school.  Netters has vibrant colors and beautiful illustrations that made gross anatomy significantly easier for me to understand.  On the flip side, I found the Gray’s Anatomy book to be more functional, and significantly less aesthetically pleasing.

There are actually Netters Anatomy Flash Cards already in the App Store.  We have reviewed one of their apps already on this website, the Musculoskeletal app.  The problem is all the Netters Apps are divided into sections, such as,“Musculoskeletal”, “Head and Neck”, and are only available individually.  The nice part about this app is all of Gray’s Anatomy is present and the price is significantly cheaper as well at at $9.99. (Currently the App is on sale for $4.99).

So I’ve already mentioned how I’m not a fan of the images present in the Gray’s Anatomy book, and you’d think the rest of the review here on out would be me bashing this app in favor of the Netters Anatomy apps.  Well….not exactly.  I was pleasantly surprised by this application.

This app is pretty large, 402 mb due to to the thousands of pictures it contains, so make sure you’re connected to Wi-Fi when downloading this app.  You can sense the size of the app because of the increased length in loading time.  I have an iPhone 3gS, and this app takes the longest to load out of any apps I have, which is only a second or two longer than usual.  I imagine it would take a few seconds extra to load on the 3G and 2G phones.

When you open up the app you are presented with 3 main navigation areas.  Search, Tips on how to use the App, and the basic table of contents.  You quickly realize how crucial the “Tips on how to use this App” section is when you try to dive into the app with reckless abandonment.

The Tips sections is definitely helpful and you realize the app actually has a pretty nice User Interface and Navigation built in.  The navigation gives you a key toolbar when you are viewing images.  The Menu selection allows you to go back/forward, search and access the index.  There is also a key “text icon” that brings up information about the anatomic figure you’re looking at.  I can’t stress how nice this text information is.  It gives you a descriptions of the anatomy you are looking at and gives you information on related anatomy.  This text section is essentially where your gross anatomy test questions will come from, and this app does a beautiful job of laying out this information.

The search feature is actually pretty nice once you realize how to use it.  For this review, I searched for the brachial nerve.  When I did this I got the option to view different anatomical pictures at different angles, as you can see from the pictures.  Once you get the picture that you feel gives you the right angle, good luck finding what you’re looking for unless you know where to look.  Gross Anatomy was 3 years ago for me, and I definitely forgot a lot of it.  If you know what you’re looking for, and actively taking an anatomy class, then you’ll be able to use this portion of the app much better.

Even though it took me a few extra seconds to find what I was looking for, again, I was extremely impressed by the text portion of this application.  The text gave me information on all the nerves I was looking at, key innervations, and the nerve branches I need to know.

When it comes to the pictures I refer you to the comments I made earlier, and the screen shots I have taken.  The anatomy in this application is not readily identifiable and I would definitely not suggest exclusively using these images to study for your practical.

What I Liked:

• Search feature is robust
• Text information in each diagram is key for gross anatomy questions you’ll be asked
• “Tips on how to use the App” section is definitely helpful

What I didn’t like:

• It can be difficult to find anatomy of interest using the pictures
• Did I mention I really don’t like the images?
• Tables of contexts, I’d rather see things separated into sections, e.g. Head/Neck, Musculoskeletal

What I’d like to see improved:

• This is probably not possible, but if the authors somehow went through and labeled the anatomic figures so they would be easier to identify.  Again, this would understandably take forever to do, and its probably never going to happen, but if it did I would pay big money for this app.

Conclusion:

So I’ve made it painfully evident I’m not a fan of the pictures in this application and you should definitely not use this application as the sole way to memorize the anatomy you need.  That said, the text provided in each image is rich and very informative.  The text is not too long, but just right, and you get hit with key information you’ll need for your anatomy tests questions (e.g, innervation, branching, key related structures).

Do I recommend this App? It depends. If you need a great anatomy app that has great content from a text standpoint, then yes, get it.  However, if you are looking for an anatomy app with aesthetically pleasing pictures and one to help you for your lab practicals, then this is not that app.  Now if the developers could add some of the labeling my opinion would change.

The price of this app is another reason I would recommend it to the above people.  At $9.99 (currently $4.99), this app is a great deal when compared to the Netters apps, which only give anatomy in sections.  Each of the Netter Anatomy sections costs a whopping $39.99, pretty expensive for medical students.  If this app was the same price as the Netter applications I would not recommend it, however, its clearly not.

We’ve reviewed other Anatomy applications but they all failed to include key information about the actual anatomy you are reviewing.  This application definitely excited us because it did not fall into this category.

[itunes]

[website]

By: Iltifat Husain, MD/MPH student, MS4

The Human Body 3D Anatomy App enables you to view different organ systems from a 3D perspective.  The app also offers an encyclopedia with some basic information about the organ systems.  It currently holds the #2 ranking in the paid medical apps section and costs $3.99.  This app has some of the same 3D features and graphics found in the 3D Brain app, which we recently reviewed.  Unlike the 3D Brain app that has detailed labeling of structures, this app’s largest shortcoming is the lack of labels on any of the structures present. I’ll mention more of these shortcomings in this full review.

When you open this app you are presented with three options.  Encyclopedia, 3D organs, or Radiography.

Encyclopedia mode gives you different organ systems to choose from.  Once you have selected your system, you are given some basic information about your selected system with some aesthetically pleasing pictures.  I found the cardiology system to be the best because it talks about basic physiology of how the heart works.  Unfortunately, the information is too basic for a medical student or someone in a college/graduate level anatomy class.  You can find essentially the same information in Wikipedia.

The 3D organs system has great aesthetics.  The pictures render quickly and are fun to look at, much like the 3D brain app.  You can rotate the pictures 360 degrees and zoom in and out.  The largest shortcoming of this app is made glaringly clear in this section.  There are no labels!!  In the picture I’ve included you can see the heart and brain, which look beautiful, and you can manipulate these pictures in essentially a three dimensional fashion, but you can’t see any labels.  This makes the app useless for people learning anatomy, or even patients who want to find a particular structure.

The Radiography option of this app allows you to see x-rays of the chest, head, arms, and legs.  There is random information in each of these sections about the particular x-ray format.  (e.g., The difference between an AP view and a PA view).  The images are in this weird greenish tint that I’ve never seen before.  None of the x-rays are actually explained, rather you just get info about the type of x-ray.  Again, this all looks pretty, but for people in a graduate level  course or medical school, it’s not useful.  However, I could see how this information might be useful for a patient with laymen knowledge about x-rays.

What I liked:

• I really like the overall User Interface of this app.  It’s clean and not cluttered.
• There is a nice tutorial section that gives a good explanation about how to navigate the application
• Could potentially be used to show patients the localization of their disease pathology in the relevant organ system
• 3D navigation of organ systems is athletically pleasing and utilizes the graphics of the iPhone

What I didn’t like as much:

• No labeling of the organ systems, or anything else for that matter.  Basically making the app useless for Anatomy Study
• Information in the encyclopedia is too basic and not in depth
• Not a fan of the green tint of the x-ray images
• Not enough 3D images of each organ system, e.g., you can see a full lung, but you cant see the cross sections.

What could be improved upon:

• Labels, Labels, Labels, Labels. I cant emphasize that enough.  A glaring example of this is the 3D image of the brain, which is color coded into proper lobes, but there are no labels!
• More 3D images of each organ system: e.g., It would be great to have the ability to see the heart valves and then show a patient the mitral valve
• Pictures of pathologic conditions, or “damaged” organ systems: e.g. This is what the intestines of a patient who has Crohn’s disease looks like.

Conclusion:

It should be noted I’m reviewing this app from a medical perspective, which is why I don’t really find it useful for medical professionals.  It seems this app would be better suited to be in the Healthcare section of the app store, rather than the medical.  The app has a great user interface and people who want to see cool images of organ systems might like this application.

This app is definitely not useful for studying anatomy but has a great potential to do this in the future.  If labels were added to this application, people studying basic anatomy would find it useful.  Until then, there isn’t really an educational component to this application, other than the sparse encylopedia it contains.

The only way I can see the 3D organs section and Radiography section being useful is if you are trying to explain to a patient the pathology of a disease and where it’s localized.  But you better know where to look for, because there are no labels to guide you.

To me this app seems to be more of a novelty application that would find a larger audience if it was in the healthcare section of the App Store.  I can see people with a layman understanding of anatomy finding it useful and fun to use because of the 3D rendering of organ systems, maybe that’s the reason for its high ranking in the App Store.

This app definitely has potential, but until labels are added, I wouldn’t recommend it to people in the medical field.

[itunes]

[website]

The App, 3D Brain, has been out since October, but it’s location under the “education” category of the App Store allowed it to slip under our radar.  The 3D app is derived from the Genes to Cognition Online website, funded by the Dana Foundation and Hewlett Foundation.  Using the native iPhone gestures, the app allows you to zoom and rotate images of the brain in a three dimensional fashion.  In this post I’ll cover how this app can be used with your patients.

When you open up this application you are greeted with a picture of the brain, color coded by regions.  You can rotate this picture around and also zoom in and out.  In the toolbar there is a great Help Section that tells you how to use the zoom and rotate features.  The toolbar also allows you to reveal labels, search for different parts of the brain, and get more information on the various parts of the brain you are viewing.

I can’t emphasize how fun this app is to use.  There is definitely a “wow” factor pertaining to their utilization of the iPhones graphics.  When I show this app to colleagues many of them go ahead and download it right there because of how fun it is.  Wi-Fi is needed to download this app because of it’s size (49.5mb).

I could see this app being used to help study for basic brain anatomy but I feel it has a greater potential, such as being used to education patients on different brain pathologies.  When trying to explain to a family member why their loved one is having difficulty with speech after a stroke you could quickly show Broca’s area in a three dimensional fashion.  Your point would get across a lot better this way than to exclusively show CT or MRI images.

In the future I’d love to see them incorporate cross sectional images of the brain with detailed labeling.  This would help with learning more anatomy and it would also help you explain more complex diseases, such as Parkinsons.

Needless to say, it’s definitely an app that all neurologists should have.  But even if you’re not a neurologist, it’s free so you might as well download it and have fun playing with the three dimensional imaging.

[itunes]

[website]

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

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

What is it?

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

The Good

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

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

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

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

The Not So Good

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

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

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

Conclusion

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

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

[itunes]

[website]

Get yourself a copy of Pocket Heart (iTunes price is $5.99) and you’ll immediately be impressed by this app. Yes, the graphics and animations will be what first grabs your attention, but you’ll soon find out in this review that Pocket Heart is truly a good learning tool for cardiac anatomy and physiology.

What I liked about this application:

• This app is very well designed and I presume that the programming involved is also very elegant given the nature of the graphics.
• It’s really quite comprehensive in terms of its cardiovascular information, though definitely is more concerned with breadth rather than depth (i.e. this isn’t going to be enough info about the heart for medical students’ cardiac anatomy or physiology).
• I’m a very visual learner, so the ability to rotate, enlarge and move around the heart are great features! The added heart beat showing the direction of blood flow are also nice touches. But the added ability to turn all of these features on and off is even more thoughtful.
• The Quiz section is actually pretty good for testing concepts and there is also good variety in terms of types of quizzes available.
• The Video Tips (could also be called Help function) are a great little bonus.

What I did not like about this application:

• Not much actually…you have to be a bit patient for a few seconds as the app loads and when switching from one section to another – that’s really as hard as I can be on this app in its current form, but do see the “what I would like to see in future updates” heading below for how I’d like to see the program improved.
• I’m not sure that it would be that makes much of a difference, but one downside is that the program only works in Portrait mode, and therefore not in Landscape.

What I would like to see in future updates:

• Addition of some basic cardiac pathology information would be helpful, primarily in the Heart Info section, with corresponding images of the major cardiovascular changes.
• I’d like to see more of the vascular system (rather than just cardiac) in the Explore section of the app, for instance with the inclusion of models such as the pulmonary and portal circulations; I’d also love to see the ability to show a very basic model/outline of the lungs and perhaps other nearby organs to get a better sense of the regional anatomy
• If the developers really want to be bold, adding some cardiac embryology to the app would be wonderful.

Who this App would be good for:

• This app is great for medical students and other health professional students.
• It is also good for anyone else who wants to learn more about the heart in an engaging and interactive way.

Conclusion:

I really liked this app, even though it is somewhat basic in terms of its information level. The graphics are great and the app is designed very well. As a supplementary learning tool for students in health profession schools or even baccalaureate programs in biology or physiology this app will be a welcome change to having your head stuck in a textbook.

Please note the following on upcoming updates, straight from the developer:

“We’ve just submitted version 1.1 to Apple…(decreased loading times, improved usability, more intuitive labels, and new logo!)

Next version will include more detailed modeling of the heart along with added exterior vessels.”

[itunes]

[website]

The developer of USMLE Buzz Flash Cards App, Andrew Yu, has graciously given us some promo codes to distribute to our readers. We’re in the process of reviewing this application, but so far we really like it. These flashcards are quick hitting facts that are high yield and useful for Step 1. I’d compare them to the quick hitting facts you’d find at the end of First Aid. I can’t emphasize how high yield these flash cards are. The app itself has over 3,000 flashcards.

Continue on if you’re interested in the free promo codes for the App. We’re giving them out on a first come, first serve basis.

The Promo codes are below. Please write a comment letting fellow readers know you’ve used the promo codes. It would be great if you could leave a comment about the app as well. To our foreign readers, unfortunately, the promo codes are only valid in the United States App Store. The original cost of the app is $2.99.

1) LFKEHHYAKFML

2) H3YTMFLTEWFJ

3) WPPMWNXJ4P67

4) L6YHY4R7AMA4

5) RXLEY3AL6KR4

Here is the iTunes link to the application.

If you type “USMLE Step 2″ into the App Store, you don’t get many results. One of the applications that shows up is the recently released Lange Q&A: USMLE Step 2 CK app, produced by Modality, and costing $33.99. We’ve reviewed other USMLE study apps for the iPhone in the past, such as the USMLE disease deck, and not been huge fans.

This time I was hoping for better results. I’m just a few weeks removed from taking step 2 CK (hooray!), and figured it would be the perfect time to review this app. I’ll admit, I’ve been a fan of Lange products since using their Pharmacology flashcards for Step 1 studying. I found the flashcards to be well written, concise, and high yield.  I wrote this review in the hopes that this question bank on the iPhone would give me similar results.

For Step 2 studying on my computer, I found the USMLE World question bank to be the most helpful. I’ve tried the Kaplan and USMLE World question banks together for step 1, but realized USMLE World did a better job covering high yield information. Also, USMLE World’s user interface mimics what you see on the actual test day, unlike the other question banks. I always dreamed USMLE World would make an iPhone app and I could always have my question bank within the reach of my fingers. Unfortunately, this dream didn’t come true. But never fear, coming in to the rescue is the Lange Q&A Step 2 CK question bank for you iPhone, costing $33.99(discounted until October 31st)

When you open up this app you are prompted to register with Modality. You don’t have to register, and this sign eventually goes away. If you closed the app by accident while taking a quiz, when you startup the app, you’re prompted to resume from where you left off. There are 4 main navigation tools on the homepage. New Quiz, Saved Quizzes, Question Browser, Cumulative Stats.

There are a total of 1,104 questions in this apps question bank. You can create a quiz from the 8 practice tests provided (46 questions each) or you can customize a quiz. In the custom quiz section you can choose to include or exclude the different specialties, Internal Medicine, OB/GYN, Pediatrics, Preventive Medicine, Psychiatry, Surgery. You can also change the number of questions your quiz will have, with a maximum of 50. You have the option to change the name of the quiz and once the quiz starts, a timer appears in the right upper corner.

Answering questions is pretty straight forward, you just select your answer choice, and there are easily marked navigation buttons. If you run out of time in quiz mode the app doesn’t make you stop, instead, the timer turns red telling you how much extra time you are using. If you leave a quiz in the middle or pause it, you can always come back and pick right up from where you left off, preserving the question number and time remaining.

The other main navigation option is “Question Browser”. This mode is analogous to the “study mode” option that is offered by computer based question banks. You can either view all questions, choose to view questions based on category, or view all the questions you’ve bookmarked. Within these views, you can organize the resulting questions by number, percentage correct/incorrect, or you can shuffle them. When reviewing the questions in this mode or quiz mode, clicking the rationale button allows you to see the explanations. You can also select the stats button to see how well you’ve been doing overall on that particular question, and the last time you attempted the question.

Question Quality:

Now to the most important part, the quality of the 1,104 questions. Overall, I’d have to say the questions do a pretty good job of being high yield in terms of the medical knowledge covered. Looking at the questions, I easily found topics that were definitely on my Step 2 test. When it comes to accurately portraying the style of writing you’ll find on step 2, I think this app did a decent job, not a great job. I still think USMLE World and Kaplan do a better job overall when it comes to emulating a USMLE question, but then again, they don’t have their Qbanks on the iPhone. That said, the material covered in the questions and the explanations is definitely high yield and you’ll get a lot of good learning out of these questions.

What I liked:

• High Yield topics covered with solid questions and explanations.
• Overall great user interface.
• If you accidentally closed the app during a quiz, app will give you the option to start where you left off.
• Nice use of pictures within the questions. Pictures will expand once clicked on.
• Timer in quiz mode.
• Cumulative performance broken down by sections.
• Ability to bookmark.

What I didn’t like:

• In some questions, text is too small (when answering questions that are in a 2 or 3 part series). In these types of questions, the explanation is the same and answers all parts of the question, instead of being unique to each question.
• No option to view lab values
• No landscape mode, and cannot zoom in or out.
• Although most of the questions are categorized, the questions for practice tests 1-8 are not categorized based on specialty.

Improvements that could be made:

• Ability to sync more questions
• An option to increase the text size, or zoom in and out.
• Option to cross out answer choices.
• Option to highlight parts of a question or parts of the explanation.
• Ability to add custom notes to the questions.

Conclusion:

So overall, my opinion of medical educational products by Lange hasn’t changed too much, I’m still a fan. I found the question bank to be high yield, but the questions were not written as well as USMLE World or Kaplan. My biggest complaint has to be the small text size experienced in some of the questions, it would be great to have the option to customize the size of the font.

It should be noted that this app isn’t a substitute for a larger traditional computer based Q bank, such as Kaplan, USMLE World, or Exam Masters. You should definitely still use those question banks as your primary source of study. They have more questions and are written very well. That said, this is still a good USMLE step 2 study app.

The best way to use this app is to supplement the Q-bank you already have. Whether you’re riding the bus, subway, or waiting in line, you can always be studying for Step 2. The user interface is designed well enough to where you can do bursts of studying, and pick up right where you left off with ease. At the end of the day, I wish I would have had this app while I was studying for step 2. Plus, at $33.99(discounted until October 31st), it’s a good buy when you take into account the number of questions you get verse one of the traditional computer Q banks, except the Lange Q bank app will always be at your fingertips and in the palm of your hands. This type of portability for step 2 questions is much needed and sorely lacking.

[itunes]

[website]