By Tim Bredrup

Unbound Medicine, a leader in knowledge management solutions for health care, announces new mobile platforms and resources at Pediatric Care Online (PCO) from the American Acadamy of Pediatrics (AAP).  PCO is now available as a downloadable native application for iPad and Windows Phone.  Simultaneously, important new clinical information was added to the extensive library of references and tools.

Content additions across all platforms (Web, iOS, Android, BlackBerry, and Windows Phone) include access to AAP webinars, the newly published Performing Preventive Services – part of the AAP’s Bright Futures initiative, and an extensive collection of tools and parent handouts on the subject of attention-deficit/hyperactivity disorder (ADHD) that facilitates assessment and simplifies parent/patient education by caregivers.

press release | www.unboundmedicine.com | www.aap.org

Statistics from the 2011 National Diabetes Fact Sheet (link here) show that the prevalence of diabetes in the U.S. is 8.3% or 25.8 million people. In 2007, the total cost of diagnosed diabetes in the U.S. alone reached $174 billion. It is clear that diabetes is a major healthcare issue in modern medicine. On the basis of this, it is important that healthcare professionals are well informed about diabetes and its potential complications as it will have a significant impact on future practice. This is where the Johns Hopkins POC-IT Guide to Diabetes becomes invaluable.

The POC-IT guide is a universal app which can be accessed on the iPad or iPhone. It is developed by Unbound Medicine in cooperation with clinicians at Johns Hopkins Medicine and is part of the POC-IT series, which includes antibiotic and HIV guides . The Diabetes Guide is designed to assist clinicians by distilling complex material into need-to-know information, easily accessible for rapid viewing and which can be frequently updated.
First impressions of the guide are good, as information is laid out in a clear pattern that allows the user to easily access the information they require. Initially users must choose from a menu of: overview, management, complications & comorbidities, medications, clinical tests and brand names.

Within each heading lie a number of sub-headings that cover clinically relevant aspects of diabetes. The content in each article is laid out in a consistent manner between sections covering: Definition, Epidemiology, Diagnosis, Signs & Symptoms, Clinical Treatment, Follow Up, Expert Comments, References.

Articles can be saved as favourites for quick access from the title page. It should be noted that all the information is stored locally on the device. The next section covers a brief summary of the main content covered by each of the major headings.

Overview

This section offers a detailed overview of the main features of type 1 and type 2 diabetes. This includes classification and diagnosis of diabetes as well as important epidemiological data. This information is backed up by relevant studies examining the effectiveness and efficiency of therapies as well as management of complications and prevention techniques.

Management

The management section offers information related to a wide range of relevant topics, each of which is further broken down into smaller sub units. Each sub unit is typically focused on a very specific aspect of diabetes management eg. Hypoglycemia: Nocturnal. There is a strong focus on the clinical aspects of each condition which is ideal for healthcare professionals.

Complications and Comorbidities

A wide range of complications and comorbidities are described in the app. Information on the epidemiology and its direct relation to diabetes is given for each complication. Signs and symptoms, clinical tests and diagnostic criteria are covered. A particularly useful section is the ‘Expert Comments’ section – where content is primarily chosen on the basis of clinical relevance with important information displayed in a clear bullet point format.

Clinical Tests

The clinical tests mentioned in this section are described in extensive detail. This information allows clinicians to quickly evaluate which tests need to be carried out in order to assess the management needs of their patient. The differential diagnosis section is particularly useful to assess complications that may have arisen as a result of diabetes.

Medications/Brand Names

The content of this section is related to medication used to treat specific symptoms of diabetes. Information is well laid out and contains details related to all the major pharmaceutical brands. This section covers all the major medications used in the treatment of various aspects of diabetes. The information on each medication is detailed and useful as you can quickly check dosages and any contraindications.

CME

The POC-IT Center also integrates Continuing Medical Education programs into Guides. These opportunities allow clinicians to learn while acquiring CME credit in the context of actual patient care. Accredited by Johns Hopkins Office of CME, these education materials qualify for quarter-hour and one-hour credits AACME credits.

In summary it should be noted that this is a universal app which can be accessed on the iPad or iPhone which allows it to be used efficiently and quickly. Furthermore it has a well thought out design and polish. This ensures that the user will always have easy access to information.

Likes

• Expert comments break down intricate topics into manageable points
• Very detailed and concise; ideal to quickly cover all the important clinically relevant information regarding a specific aspect of Diabetes
• Universal App; well formatted and easy to use on an iPad or iPhone
• Intuitive user interface makes the POC-IT guide quick to use and easy to follow
• Content is automatically updated by Johns Hopkins therefore information is always up to date.
• This is an evidence based app with clear, well referenced sources used throughout.

Dislikes

• Expensive (usually $39.95)
• Only three POC-IT guides available (Diabetes, HIV, ABX guide)

Overall Rating

• I would highly recommend this app to any physician who encounters and treats diabetes on a regular basis.
• Its high level of detail is useful to anyone trying to improve their understanding of the clinical aspects and treatment options of various diabetic conditions.
• The high cost of the app combined with it’s specific focus on diabetes means that it may not cater to everyone.
• Despite this, the Johns Hopkins diabetes guide is a complete, easy to use mobile application that covers the majority of the clinical aspects and associated complications in great depth

iTunes link here

Move over Epocrates, Pepid, Skyscape, and LexiComp — the first big player to offer medical apps on Windows Phone 7 devices is Unbound Medicine.  Although not all of their medical apps have made their way to the brand new operating system platform, they have brought nine key medical apps to the Windows Phone Marketplace:

Nursing Central, 5-Minute Clinical Consult, Diagnosaurus, Nurses’ Handbook of Health Assessment, The Merck Manual, Family Drug Guide, Relief Central, Taber’s Medical Dictionary, and Davis’s Drug Guide [We have reviewed the iPhone versions of some of these apps].

Incidentally, the first app ever reviewed on iMedicalApps was the differential diagnosis app by Unbound Medicine – Diagnosaurus Ddx, still one of our favorite medical apps.

So far the other big players in the mobile medical ecosystem — Epocrates, Pepid, Skyscape, and LexiComp have not released any apps for the new Windows Phone 7 platform.  Unbound Medicine’s bold foray to be the first in the space should pay dividends due to the lack of medical reference apps in the Windows Phone Marketplace. Their entrance into the ecosystem should also reassure physicians thinking of purchasing Windows Phone 7 devices — drug reference apps will be available for point of care use. 

Just one week ago we did a post highlighting the lack of medical apps in the Windows Phone Marketplace.  We interviewed Evan Schoenberg, the physician developer of Med Mnemonics, a popular iPhone medical app that has been ported over to Windows Phone 7.

In our interview, Schoenberg had positive things to say about he Windows Phone 7′s (WP7) user interface and the innovation occurring with the overall operating system. Of note, app fragmentation — the inability to run the same version of an app on all phones, a problem that has plagued Android devices — is an issue Microsoft appears to have understood, and they are strictly controlling hardware specifications and OS releases so this isn’t an issue with WP7 devices.

Hopefully this is something they can stick by because Windows Phone 7′s streamlined user interface definitely has potential to make waves in the medical community.  But unfortunately, with Microsoft’s muddled mobile history, one can only hope they don’t drop the ball this time around.

The full list of medical apps released by Unbound Medicine for Windows Phone 7 devices can be found here:

http://www.unboundmedicine.com/products/windows_phone

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

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

Advantages:

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

Improvements that could be made:

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

Who this App would be great for:

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

Conclusion:

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

[itunes]

[website]

Further Review:

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

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

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

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