Do you use an app or other software to assist in making clinical decisions? What do you like and dislike about it? Tell us!

• Download the new issue each Thursday, and store all downloaded issues in a personal library
• Bookmark articles, images & figures
• Watch clinical medicine videos
• Listen to an audio summary for each issue
• Capture and save article notes, and even share them via email, Facebook & Twitter

Non-subscribers view a fully functional free issue, preview the table of contents for each issue and read Online First articles. App-only subscriptions of the NEJM are $14.99 per month, and purchase of a single issue is $5.99 each. At first glance, it does not yet appear that institutional subscribers can use this app to access NEJM, which is a significant oversight. Many faculty, researchers and physicians here at the University of Utah rely on the NEJM, and if a clinical reference tool such as LexiComp can provide an institutional version of their software, so can a top-notch journal publisher.

In downloading the iPad app, I discovered the NEJM Career Center, an iPhone/iPad app that, like its website counterpart, will help physicians search listings of physician and locum tenens job listings by location, specialty or position type. It notifies users of new jobs that match their search criteria, and allows them to email or tweet jobs to themselves or their personal networks.

If you want to keep up on the latest researched published in NEJM, subscribe to their weekly audio summaries podcast, NEJM This Week. Each podcast is 20-25 minutes long, and includes new medical research findings, review articles, and editorial opinion pieces on topics related to biomedical science and clinical practice.

Do you use any of the NEJM apps? What do you like or dislike about them? Tell us about it!

While its design lacks visual appeal, its functionality and convenience allows users to keep up with new research in the field from the top journal in the field of Pediatrics. (For a more detailed look at the app, read the recent review in the iMedicalApps blog.) It is available for the iPad, iPhone and iPod touch. Best of all, its FREE.

Do you use this app? How has it worked for you? Tell us about it!

The iMedicalApps blog summarizes the strengths of this application:

• If you’re looking for a portable way to study the top 300 most frequently prescribed drugs and are the type of person who is more likely to have a smart phone with you than a pile of flash cards, the Sigler’s app may be for you.
• The informational depth is adequate enough for utilization as a quick reference in the professional setting and could be a valuable tool for students and clinicians alike.
• It’s an expensive download ($29.99), but is priced within range of other traditional pharmacology flash cards, i.e. this list of popular drug cards found on Amazon.com: Brenners Flash Cards($29.99), Lange Flash Cards ($30.23), Range & Dales Flash Cards ($37.00), Pharm Phlash!: Pharmacology Flash Cards ($21.56).

Have you used this app? Tell us about it!

“5,000 doctors at your fingertips”­– with no waiting room, no copay, anytime, anywhere – for free! It lets people get answers to any health question from thousands of America’s best doctors, at home or on the go, and gives doctors a Virtual Practice, where they answer real patient questions in real time, helping build their reputation, attract new patients and improve the quality of care.

What’s in it for doctors participating in this network? iMedicalApps points out that physicians

participate on HealthTap to better serve existing patients and connect with potential new patients, all whilst demonstrating their expertise and commitment to helping people everywhere. In addition, they can build a social media presence – something many current physicians struggle with, yet is going to be increasingly important to building and maintaining patient panels.

What about the issue of liability? The terms of service clearly state:

While HealthTap Medical Experts do not practice medicine on or through HealthTap, they can be a resource for reliable, relevant general health information.

And:

HealthTap is not a doctor and the use of HealthTap does not create a doctor-patient relationship. HealthTap contains content, and may help you identify services or may offer services. Everything on the Site, including Content accessed or Services provided through HealthTap, are for your information, and should be used for informational purposes only. This means that Content and Services are not a substitute for medical advice from your physician (from the Terms of Use page).

While the concept is appealing, it remains to be seen if HealthTap Express will meet its lofty goals. If physicians want to “build a social media presence,” it is not clear how this app will interact with Facebook, Google+ and other social media sites. And will physicians remain available 24/7 on an ongoing basis without clear financial compensation?

Healthcare consumers (i.e. patients) would do better to bookmark the mobile version of MedlinePlus, and use it to search for information on their condition first, in order to be more fully informed when speaking to a medical professional.

Are you a patient or physician who has tried HealthTap Express? What are your experiences with this app & service? Tell us!

After developing a prototype, the team conducted a clinical trial at a hospital in South Africa using two different mobile phones: a Nokia 3110 Classic and an iPhone 3G, and compared them against the £400 3M Littmann Electronic Stethoscope.

They collected phonocardiograms from 150 volunteers with a range of cardiac conditions using the Littmann, the iPhone, and the Nokia 3100 Classic. The trial showed that the Nokia actually out-performed the Littmann in estimating heart rate, although it had to discard more low signal quality recordings. (from the Oxford blog)

The team is now working on an Android application to record and process the heart sound recordings.

Have any of our readers worked in poor countries where medical services is minimal or lacking completely? Would such a device be helpful based on your experience? Tell us about it!

1. Teaching: For medical schools that are teaching eye examinations — instead of having to look at static pictures of eye anatomy, this “live view” could be an optimal and innovative way to teach. This could also be a great way for an ophthalmology attendings to save key eye pathology that they visualize in the mobile setting for teaching purposes.
2. Use in mobile clinics: This could be a good screening tool for various eye pathology — and not necessitate the need for an ophthalmologists or physician to be on site. A physician could view the saved images at a later time and determine correct interventions. (From iMedicalApps blog)

This last idea could be very handy in a disaster area, or in rural areas in poorer countries where no little or no medical services exist.

Below is a video demonstration of how this technology works, including taking fundus photography.

One drawback of this system is that it only works with the iPhone 4, not the iPad or iPod touch.

Detection

At Michigan State University, civil engineering professor Syed Hashsham is developing a device that performs genetic analysis on microRNAs and various other genetic markers, and can be operated by an iPod touch or Android-based tablet. Professor Hashsham received a grant from the Michigan Economic Development Cooperation to develop the “Gene-Z” along with Jim Tiedje from MSU and Erdogan Gulari from the University of Michigan. This device, if successfully developed, could provide a low-cost technology for early detection of cancer, which is sorely needed in less-affluent countries. (Thanks iMedicalApps!)

Management

The cancer information site Cancer.net has a free iPhone and iPad app for cancer patients and their families:

The free app allows cancer patients and their family members to look up pertinent information based on cancer type and download a wealth of oncology related information in the form of videos, podcasts, and up to date articles.

Where the app truly shines is in there key features: Ability to store questions, medications and symptoms. The way this app implements these key features is absolutely stunning, and makes the application a must have for cancer patients and their family members. (From the iMedicalApps blog.)

A full review of the app is available at the iMedicalApps blog.

As pointed out in the iMedicalApps blog, this study has several important shortcomings:

• Small sample size
• It does not take into account “more advanced fusion pumps which can simplify parts of the process.”
• One of the study’s primary authors is a contributor to the app’s development, though without financial investment.

From this author’s perspective, there are two important implications to this study. First, follow-up is needed, taking into account the typical equipment and stress present in the situation. Second, it appears we now trust computers and their programmers more than the writers of printed medical texts. Yet the only oversight of such devices comes from the medical professionals involved in their development. Is the current system sufficient to protect patients from technical problems and market-related pressures? If a book is dropped, its text does not change. Does dropping and repeated use of mobile devices affect the functioning of the software contained within? If it does, can that put a patient at risk?

What do you think? Tell us!

• View images and related text.
• Search image captions, keywords and references to refine search results.
• Bookmark images for later research.
• Email images to your friends and colleagues.

Like so many apps on the market, SpringerImages has multiple subscription levels. The free, basic level allows viewing of images from Open Access, peer-reviewed articles,which amounts to about one-tenth of the three million images in their database. If you choose to pay for improved access, the options include “Medical and Life Sciences (Mobile)” for $29.99, and “All Subjects (Mobile)” for $49.99 per their sign-up system.

The “Home” screen feels crowded, with the top most item showing a tally of the number of images in their database and the number you actually have access to. Below this are a search box, a button for advanced searching, and a list to browse by topic that is so narrow that the user is more likely to select a topic rather than brush to scroll.

I offer two suggestions for making this app more widely available. First, many libraries and other institutions subscribe to SpringerImages for their quality content. Why not offer free or reduced-price access to the equivalent mobile version for students, faculty and librarians? This would get their product in the hands of more end users right away, and have the potential of bringing in new customers down the road when students graduate, or faculty & librarians change institutions. And second, while this app can be used on the iPad, a tablet-friendly version would allow for a better browsing experience.

Do you have a favorite medical images app you use? Tell us about it!

According to the Technology Review website published by MIT, using

a nanosensor “tattoo” and a modified iPhone, cyclists could closely monitor sodium levels to prevent dehydration, and anemic patients could track their blood oxygen levels.

A team at Northeastern University’s Department of Pharmaceutical Sciences is working to make this possible. They have created a specialized, invisible “tattoo” with nanosensors to detect sodium and glucose levels without breaking the skin. Once the tattoo is applied, the end user slips a case over their iPhone which contains “a nine-volt battery, a filter that fits over the iPhone’s camera, and an array of three LEDs that produce light in the visible part of the spectrum” which can read the tattoo. For now, researchers are exporting the data to a computer for analysis. In the future, it is hoped that an app can be developed to do this work.

No doubt diabetics and others who have to take their own blood samples on a regular basis would welcome an end to needle sticks! Do you have an idea for an app that could replace a regular and annoying medical procedure? Tell us about it!

(Thanks to the iMedicalApps blog for this information!)

According to the iMedicalApps blog, this version is only for individual subscribers. Institutional subscribers such as the University of Utah will have a longer wait due to significant technical differences in the way it is implemented. In some institutions, it is integrated into the electronic medical record (EMR), which poses privacy and security issues. When it becomes available here, the Eccles Health Sciences Library will post it to this blog and to our list of mobile applications.

Satish Misra, MD, of the iMedicalApps blog has a two-part series of posts examining this issue, and asking for opinions from readers. The first posting points out:

In the past ten years, there has been a growing movement to restrict marketing of drugs to physicians by pharmaceutical companies. As a result of programs like the PharmFree project, traditional marketing avenues like free samples, sponsored dinners, and so on have become far more limited. And so naturally, pharmaceutical companies have looked to new avenues through which to reach physicians.

Using Epocrates as an example, Misra evenhandedly explains how free medical apps allow pharmaceutical companies to support physicians in their work while doing market research and sales at the same time. In his second article, Misra briefly examines Skyscape and several of its free apps that allow “life science companies…to reach thousands of HCPs in a new venue and format.”

As a library working with students in the healthcare professions (medicine, nursing, pharmacy, etc.), one of our goals is to help them develop information literacy skills: the ability to critically evaluate information provided via the Web and other electronic formats. When presented with information, it is important to apply a certain set of evaluative principles, as represented by the term “the C.R.A.A.P. Test:”

• Currency: timeliness of the information
• Relevance: importance of the information for your needs.
• Authority: source of the information
• Accuracy: reliability, truthfulness and correctness of the content.
• Purpose: the reason this information exists

Such an evaluation system should be applied to “free” medical apps as well.

The Eccles Health Sciences Library has a list of free and fee medical apps for all of the major mobile platforms. Do you have a favorite application? Tell us about it!

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.

Johns Hopkins and Skyscape have teamed up to offer the POC-IT Guide to Diabetes for iPhone, iPod touch and iPad, part of a series of apps that also include HIV and antibiotic guides. The app itself is free, but to use the guides requires a paid subscription to the online Johns Hopkins Guides service, which iMedicalApps reports as “usually $39.95.”

“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” (from the review). The information resides on your mobile device, so it is available whether or not you have an Internet connection. The iMedicalApps review goes into great detail about the features of this app, concluding that The Diabetes Guide is a “complete, easy to use mobile application that covers the majority of the clinical aspects and associated complications in great depth.”

Do you have access to this app? If so, how useful and user-friendly do you find it?

“With Keynote, an iPad application similar to PowerPoint, children are able to slide through pictures of what will take place from admission to discharge. With this device I can explain surgery preparation through pictures and age-appropriate language.”

The program is designed for children ages 3 and up, and allows for increased interactivity over books.

Their conclusion? “iResus improved junior doctors’ CASTest scores during a standardised simulated cardiac arrest scenario when compared with those applying purely their own knowledge and experience.” In addition, participants “stated that the iResus ‘app’ was easy to use, increased their confidence in making decisions, and that they would be prepared to use it in real clinical emergencies. From their own perspective, they did not think using such an ‘app’ would be unprofessional or indicate poor training.”

The iResus medical app is free in the iTunes store. iMedicalApps has a review of the app itself with plenty of screen shots to see what it looks like and how it works.

References:

Low, D., Clark, N., Soar, J., Padkin, A., Stoneham, A., Perkins, G. D., & Nolan, J. (2011). A randomised control trial to determine if use of the iResus©application on a smart phone improves the performance of an advanced life support provider in a simulated medical emergency*. Anaesthesia, 66(4), 255-262. doi: 10.1111/j.1365-2044.2011.06649.x

We believe that a portable, widely available, real-time communication solution — like MediBabble — has the potential for profound impact and is too important to sell. Which is why we’re giving it away.

I invite readers and subscribers to this blog to download and test this app, then add your comments to this post telling us how well this works for you!

Preparation

Among our most recent e-book purchases is the book Disaster Medicine edited by Hogan and Burnstein. As the editors point out in the first chapter, disaster medicine is

“a system of study and medical practice associated primarily with the disciplines of emergency medicine and public health. Disaster medicine is concerned with the health and medical and emotional issues of disaster casualties. To provide care efficiently, however, the health care provider must be familiar with several elements of disaster management, including planning, mitigation, assessment, response and recovery.”

The book goes on to flesh out these aspect of disaster medicine in detail. In addition, it covers three basic categories of disasters:

• natural disasters,
• industrial, technological and transportation disasters, and
• conflict-related disasters.

Disaster Medicine is available online to University of Utah authorized users, or just search our catalog.

Support

But in a disaster a care provider does not have time to read a textbook. But most of us carry a mobile device which can be used for quick, on-the-spot reference and guidance. Unbound Medicine’s free Relief Central “mobile and web resource developed by staff and friends of Unbound Medicine to assist relief workers, first responders, and others called to serve in disaster relief situations around the world.” It includes the CIA World Factbook, the Field Operations Guide from USAID, MEDLINE Journals, and Relief News from the CDC, Red Cross, FEMA, ReliefWeb, and more. Install this app now and its invaluable information will be at your fingertips even if the telecommunications network is down. It is available for download to your iPod touch®, iPhone®, BlackBerry®, Android™, Palm®, or Windows Mobile® device.

Your turn!

If you’ve worked to provide emergency services in a disaster setting, what are your recommended tools and resources? If you’ve used Relief Central, how helpful was it?