According to the VisualDx website:

See – with VisualDx. Visual pattern matching is a proven innate human ability. With 65% of the population being visual learners, relaying important information through images is much more efficient than using text alone.
Visual clues are essential to accurate diagnosis, too. Half of all diseases have a skin or pattern clue, and 10-20% of a general practitioner’s diagnosis is visually based. Yet how do clinicians visually discern among common diagnoses – or diagnose a rare disease they have never seen?
Fast and easy to learn, VisualDx links clinicians to superior-quality medical images and information prepared by respected physician specialists – all available on site at the point of care.

Learn – with VisualDx. It is the only technology that delivers the intellectual power of the world’s most comprehensive medical image library combined with concise and regularly updated and reviewed clinical information, sorted by the most relevance to patient findings. Save time that would be otherwise spent consulting and indexing multiple hardcopy resources.
With about 5 minutes of training, begin rapid visual and iconic search entry of visible patient clues to enhance diagnostic processes.

Discern – with VisualDx. Study disease variations by skin type, age, or passage of time, unlike textbooks or atlases that nearly always depict classic or severe cases on fair-skinned individuals. VisualDx visual diagnostic decision support system differentiates common flu-like conditions from those possibly caused by a rare and unusual event, such as a bioterrorism act, as well as from conditions such avian influenza, SARS, or other emerging infectious diseases.
Problem oriented by design, VisualDx helps clinicians dynamically build a customized and patient-relevant pictorial differential diagnosis in seconds, drawn from thousands of medical images revealing variations in presentation between – as well as within – diseases.

Check out the video demonstration below.

And yes, it is available for the iPhone / iPod Touch. However, it doesn’t look like it is available for the iPad yet.

The original version of RxCalc was designed with one thing in mind, to give me the functionality I needed to perform routine pharmacokinetic calculations. The application focused heavily on the math, which has never been an issue. However, the user interface (UI) and options were very basic. It did the job well, but wasn’t very flexible for users outside my sphere of influence. That was evident in much of our user feedback.

So, what’s new in 1.1? You won’t see a lot of changes to the basic UI, but the functionality and usability are significantly better. The user can now configure Units of Measure and adjust the constants used for Volume of Distribution calculations for both the aminoglycosides and vancomycin. This should give people other than myself a much better user experience, i.e. our friends outside the US.

In addition we’ve made some minor changes to the navigation, which on the surface may not be noticeable to many, but gives the end user the ability to freely move between data fields and scroll top to bottom without having to lower the keyboard. Like I said it’s a small thing, but it makes a big difference. And the coup de grace, a nice new icon courtesy of Mr. Layne Lev.

In a nutshell, RxCalc 1.1 now offers:

• User configurable Units of Measure
  • Height (centimeters or inches)
  • Weight (kilograms or pounds)
  • Serum Creatnine (mg/dL or micromol/L)
• Configurable Volume of Distribution
  • Aminoglycoside (0.2 liters/kg to 0.5 liters/kg)
  • Vancomycin (0.5 liters/kg to 1 liter/kg)
• Less rigid scrolling
• Less rigid data entry

The registration process is quick, easy and requires that you identify your profession and specialty practice area. There are some screen shots below that show the process. I’m not clear why they want to know your specialty area, but assume the application attempts to tailor the information to your area of interest.

I haven’t had a lot of time to explore PracticeRx, but the overall layout is nice and I found some of the small articles interesting. One annoyance is the pop-up screen that appears when you first log in. I understand the need to advertise, but a little more discretion would be appreciated.

So, what will happen when the iPad hits AT&T? I have no idea because I don’t plan to buy one with 3G. I will use the device like I use my iPod touch now; inside the walls of my house, the hospital and Starbucks.

Abstract: Diagnostic Efficacy of Handheld Devices for Emergency Radiologic Consultation
OBJECTIVE. Orthopedic injury and intracranial hemorrhage are commonly encountered in emergency radiology, and accurate and timely diagnosis is important. The purpose of this study was to determine whether the diagnostic accuracy of handheld computing devices is comparable to that of monitors that might be used in emergency teleconsultation.
SUBJECTS AND METHODS. Two handheld devices, a Dell Axim personal digital assistant (PDA) and an Apple iPod Touch device, were studied. The diagnostic efficacy of each device was tested against that of secondary-class monitors (primary class being clinical workstation display) for each of two image types—posteroanterior wrist radiographs and slices from CT of the brain—yielding four separate observer performance studies. Participants read a bank of 30 wrist or brain images searching for a specific abnormality (distal radial fracture, fresh intracranial bleed) and rated their confidence in their decisions. A total of 168 readings by examining radiologists of the American Board of Radiology were gathered, and the results were subjected to receiver operating characteristics analysis.
RESULTS. In the PDA brain CT study, the scores of PDA readings were significantly higher than those of monitor readings for all observers (p 0.01) and for radiologists who were not neuroradiology specialists (p 0.05). No statistically significant differences between handheld device and monitor findings were found for the PDA wrist images or in the iPod Touch device studies, although some comparisons approached significance.
CONCLUSION. Handheld devices show promise in the field of emergency teleconsultation for detection of basic orthopedic injuries and intracranial hemorrhage. Further investigation is warranted.

I’m not as sharp as many of you so I had to actually look up the word roentenology, which means “Radiology, the science of radiation and, specifically, the use of both ionizing (like X-ray) and nonionizing (like ultrasound) modalities for the diagnosis and treatment of disease.”

According to the article “the scores of PDA readings were significantly higher than those of monitor readings when all observers’ readings are taken into account” and “no statistically significant differences between handheld device and monitor findings were found for the PDA wrist images or in the iPod Touch devices studies, although some comparisons did approach significance.”

An interesting follow-up to this study would be to insert an iPad into the same scenario against the iPod touch. I would be very interested to see how radiologists would react to that. The iPad would offer similar functionality to the iPod touch with the advantage of a larger screen. I can only speculate that more screen real estate would be preferred over less screen real estate for radiologists if given a choice. Just a thought.

With the volume of healthcare related applications available, I’m surprised at how few I actually use. I spend quite a bit of time surfing the app store looking for new applications that I can apply to pharmacy. I’ve downloaded numerous applications, but have deleted most for one reason or another.

My “research” has led to the list below of applications that I find most useful as a pharmacist.

Drug information:

Lexi-Drugs: No surprise here. I’ve been using Lexi-Comp products for years, and have always found them to be a well designed and informative resource. Their paperback Drug Information Handbook is a mainstay in any hospital pharmacy.

EPocrates Rx: I have this on my iPod touch, but don’t use it very often. In fact, I often forget it’s there. I find that EPocrates is popular among physicians, nurses and outpatient pharmacists, while Lexi-Drugs appear to be king of the acute care pharmacy setting.

Honorable mention:

AHFS Essentials: The Essentials iPhone reference is derived from AHFS Drug Information. While the AHFS reference is supposed to be geared toward pharmacists, I’ve never found it that helpful. The one thing I like is the inclusion of off-label uses.

Drugs.com: Hey, it’s free and is accessed via the internet. I wouldn’t use it as a primary drug reference, but it might be helpful in a pinch.

Calculators:

RxCalc: RxCalc is the only pharmacokinetics calculator currently available for the iPhone. It was designed as a tool for pharmacists to perform aminoglycoside and vancomycin kinetics, including new starts using population parameters and dosage adjustments using levels. It does all the basics in a simple to use, straight forward interface.

MedCalc: This is a free medical calculator with an extensive list of formulas (http://medcalc.medserver.be/iphone_formulas.html ). It’s been around since the first Palm Pilots were popular. I don’t use it often, but considering the price (Free) it is nice to have.

Other:

Skyscape: This is a suite a free applications including, RxDrugs, Archimedes Medical Calculator, and Outline in Clinical Medicine. The application also has a nice little feature called MedAlert that gives you timely little notices like drug recall information. I find it useful on occasion.

BLACKBAG: This application provides medical news across multiple specialties and therapeutic areas. You select “subscriptions” to the specialties you like to read about and BLACKBAG delivers pertinent information on a daily basis.

As I said, these are the applications that I’ve found useful as a pharmacist. If you have a favorite application for the iPhone or iPod touch let me know. I’m always interested in adding stuff to my list.

There are hundreds of healthcare related applications in the iTunes App Store and I encourage you to spend some time browsing. Who knows what you’ll find.

Vancomycin and aminoglycoside (especially vancomycin) pharmacokinetics are very popular in hospitals, and are part of a select group of drugs that physicians prefer pharmacists to handle. Doing pharmacokinetic consults isn’t difficult per se, but can involve lots of numbers and equations. Many people find it a bit tedious and boring. There is also considerable variability in methods used for performing pharmacokinetic calculations. For example there are several existing pharmacokinetic models for vancomycin including Bauer, Matzke, Winter, Moellering, etc. Some of the models are more popular than others, but each has merit. As I’ve heard many times, “there are many roads to Rome.”

Pharmacists typically choose a favorite pharmacokinetic model and then alter the model to fit their needs based on years of clinical experience. I’m no different. Even though I was taught pharmacokinetics by Mike Winter at the UCSF School of Pharmacy, I prefer the vancomycin formulas derived by someone else. Please don’t tell Mike, he’s considered one of the best in the business and might revoke my alumni card if he found out.

Not all pharmacokinetic “starts” and adjustments require advanced calculations. Often times, years of experience and a good eye are all you need. However, there are times when you need a little more. Since the days of the Palm Pilot, I’ve always desired a portable pharmacokinetics program. It always made sense to me to use the technology at my finger tips to make my job easier. I’ve written several pharmacokinetic calculators, including simple Microsoft Excel spreadsheets and a little Java Script tied to a web front end, but I never got the opportunity to create a portable version. The iPhone (and iPod Touch) changed all that. The iPhone is a compelling device with a great user interface and unheard of popularity among healthcare professionals. My desire for a portable pharmacokinetics calculator, and the appearance of the iPhone, resulted in the creation of RxCalc.

RxCalc is designed for pharmacists based on my experiences over the past ten years. While not perfect, RxCalc does what I need. It’s clearly a work in progress. I don’t use it all the time because it’s simply not necessary. I still do a lot of “guess work” here and there, but rely on RxCalc when I need something to handle the more advanced calculations. Like every piece of software ever used, there is room for improvement. I have received lots of good, constructive feedback from several users. Combined with my desires, the feedback has created quite a list of future “enhancements” I’d like to see in RxCalc over the next several months. Among these include High Dose Extended Interval (a.k.a. once-daily) aminoglycoside dosing, single dose vancomycin kinetics, the option to change units (i.e. lbs, kg, cm, inches, etc), the ability to select different dosing models, alternate color schemes or themes and a more user friendly interface. Unfortunately, I don’t have the skill set to make the changes myself. That’s why God gave me a brother. I come up with the ideas and he does all the work to make it a reality. We make a great team.

I mentioned in a previous post that it may be time for me to put away my calculator in favor of newer technology. Pharmacokinetics was the last thing I really needed my calculator for. Well, with the creation of RxCalc I’ve finally put my calculator in the drawer and have been using pen, paper and my iPod Touch almost exclusively for a few weeks now. I must say, so far the results have been encouraging.