The “New & Interesting” series is a biweekly compilation of select research findings, news articles, and random tidbits in bullet-point format. The entries are highly abbreviated, but provide links to the original articles or abstracts if you desire to read further.

General Articles

• Most powerful 9.4-Tesla MRI is stronger than the Large Hadron Collider (Wired)

• A blind patient regained sight via a tooth implanation into her eye. The procedure, a modified osteo-odonto-keratoprosthesis (MOOKP), was performed at the University of Miami School of Medicine and is the first done in the United States. (U Miami)

• DARPA-funded study at Duke University to detect viral infections even before the development of symptoms (Duke Health)

• Smoking bans cut incidence of heart attacks by as much as 36% after 3 years (Reuters)

The iPhone App store is a veritable treasure chest of free and cheap applications, ranging from productivity tools and reference guides to arcade games to pass the time. As of this writing, there are over 800 applications categorized as “Medical”. For the busy physician and student, wandering through the labyrinth of apps can be a daunting and time-consuming task. The apps can furthermore vary widely in intended use, as do their quality and completeness.

On The Wards has taken the task to list the top medical apps for the iPhone. “Top” is a subjective word, so here are the criteria for inclusion in this list:

Not surprisingly, there were innumerable apps that qualified for inclusion, according to the above criteria. Many of them were excellent and very useful for work on rounds and in general inpatient care. I nevertheless had to limit the list to ten choices. Ultimately, those apps that ranked lower in popularity had to be excluded (I may reconsider them for inclusion in a future list).

Without further ado, here is the On The Wards compilation of the top 10 iPhone medical apps for the wards:

1. Medscape (WebMD) – This is iTune’s most popular medical app, providing a comprehensive drug reference (over 6,000 generic and brand-name drugs, hundreds of herbals and supplements), specialty-specific medical news, continuing medical education (CME), and health directory.

2. Epocrates Rx (Epocrates) – This venerable drug reference has served medical students, residents, and attending physicians since the early days of the original Palm OS. It has since been upgraded and ported to Windows Mobile, Blackberry, and now the iPhone. Epocrates Rx contains information on over 3,300 drugs, including their dosing, adverse effects, drug interactions, pricing, and pictures. This version also has several built-in medical calculations.

3. Medical Encyclopedia (University of Maryland Medical System) – This large medical reference available in both English and Spanish includes over 50,000 pages of in-depth information on symptoms, injury, disease, and surgery. Beef up your fund of knowledge or look up information while on rounds.

4. MedCalc (Mathias Tschopp & Pascal Pfiffner) – No smartphone used by physicians would be complete without a medical calculator. MedCalc offers a “very large selection of formulas and scores” in 4 languages (English, French, German, and Spanish). There is also support for SI and US units.

5. EyeChart (Dok LLC) – This portable Snellen Eye Chart is simple in design and use, but would be invaluable for a quick-and-dirty assessment of a patient’s visual acuity request an ophthalmology consult.

6. BLACKBAG (Ortho-McNeil-Janssen Pharmaceuticals) – The app is a medical news and video aggregator for nearly 40 specialties and categories. The function replicates the medical feeds found in the Medscape app, but the choices of news articles are slightly less technical without sacrificing clinical relevance. This may or may not be a feature, depending on the user. The user interface also looks more elegant, but lacks the ability to save or e-mail articles of interest.

7. ACC Pocket Guidelines (Skyscape) – This reference includes a portable version of the American College of Cardiology (ACC) and American Heart Association (AHA) Practice Guidelines, including standard practices for the management of cardiac patients, use of cardiac imaging modalities, perioperative cardiovascular evaluation for noncardiac surgery, and other related topics.

8. STAT Cardiac Clearance (Austin Physician Productivity) – The cardiovascular evaluation of patients undergoing noncardiac surgery is described in the ACC/AHA Practice Guidelines. This app compresses the information into a quick-access algorithm for perioperative assessment of a patient’s appropriateness for noncardiac surgery.

9. PEPID (PEPID) – This robust toxicology reference provides information on the management of diverse toxicology emergencies, such as drug/chemical ingestion, gas inhalation, occupational exposures, and food allergies. It also includes a comprehensive antidote reference, toxicology-specific lab profiles, and poisonous plant images. This app may be of higher yield in the emergency department than on the wards, but the inpatient teams will eventually be responsible for affected patients once they get admitted.

10. STAT Insulin DM2 (Austin Physician Productivity) – The app applies the 2006 consensus algorithm developed by the American Diabetes Association (ADA) and European Association for the Study of Diabetes (EASD) for the initiation and adjustment of antiglycemic therapy in type 2 diabetes.

As mentioned earlier, there are many other outstanding apps not included in this list due to lack of space. With a vigorously active software development for the iPhone, coupled with medicine’s embrace of emerging technologies, this list will undoubtedly evolve over time. If you have any suggestions or beefs about any medical apps for the wards, feel free to leave me a note. We hope you find this list helpful for your education and work, and we look forward to seeing you with the next edition of the On The Wards top 10.

For a growing non-exhaustive list of iPhone medical apps, also check out our Squidoo lens.

Over the past year, I have noticed a surge in the number of medical colleagues using the Apple iPhone. I can no longer recall how many times I have seen students, residents, fellows, and attendings pulling the device out of their white coat pockets. This is not surprising, considering that Apple has had phenomenal success with the product. The company sold over a million units within 3 days of launching its latest iPhone 3G S model.

Besides its phone, web surfing, e-mail, and personal information management (PIM) functions, the iPhone has become a veritable tool for medical reference and calculations. Ye olden days of the Palm Tungstens or Treos as the must-have tool for students and residents are no more.

As an interesting side project, I decided to create a Squidoo page on iPhone medical apps. This will serve as a growing catalog of useful medical applications for the iPhone. If your favorite app is missing, do not hesitate to leave me a message.

Financial Disclosure: No, I do not own Apple or related stocks, but maybe I should.

Catherine Mohr, research surgeon and instructor at the Stanford University School of Medicine, presents a TED talk on the history of surgery and the exciting visions for the future.

The journey begins 10,000 years earlier with the illustration of a trephanated skull and rapidly traverses eons to talk about the seemingly barbaric operations preceding the development of anesthesia. The demonstration of ether as an anesthetic at the Massachusetts General Hospital in 1847 heralded a new era in pain-free surgery, but the triumphs were marred with poor mortality rates. Dr. Mohr then highlights the revolution in surgical outcomes after the introduction of the sterile technique. She briefly discusses laparoscopic surgery and fast forwards to the invention of robotic surgery … and beyond.

To avoid spoiling the whole talk, I will let you view the video and hear for yourself some exciting new developments in the field of surgery.

Doctors at the University Hospitals and Medical School of Geneva recently diagnosed a new disease, which they dubbed the “PlayStation palmar hidradenitis” in reference to the popular Sony PlayStation video game console. It was found in an otherwise healthy 12 year-old girl who demonstrated painful lesions along the palms of both hands. They were noted on physical examination to appear red, firm, nodular, and very tender. No other lesions were detected throughout her body.

The examined lesions resemble those in palmoplantar eccrine hidradenitis, a dermatologic disorder often found on the soles of highly-active children. These are presumably caused from intense sweating and pressure to the affected regions. The girl was not particularly active, but her parents remarked that she had been playing “The Sims” on the Sony PlayStation for several hours daily prior to the appearance of the lesions. This phenomenon is reminiscent of “Wiiitis”, an acute tendonitis from excessive repetitive motions while using the Nintendo Wii controller.

Video games have already been associated with a range of health concerns, including addiction, violent behavior, and lack of physical activity. There are even extreme news reports of video game-associated dehydration and death. Now here is more ammunition for critics of the video gaming industry. I personally enjoy video games and would hate to have creativity and development stifled by future fines or regulations. It would be best that parents monitor and set limits to their children’s gaming habits. As for adults, self-control is key. In other words, play with moderation.

• Sources
• Kasraee B, Masouye I, Piguet V. PlayStation plamar hidradenitis. Br J Dermatol 2009 [Epub ahead of print]
• Image: Wikipedia