Now that the iPhone is available on Verizon, the question everyone will be asking themselves is “should I dump my current Verizon device and move to the iPhone?” It’s a good question and I’m sure many, many people will do it. Then again, I assume many ex-Verizon-switched-because-of-the-iPhone-but-now-I’m-unhappy-with-AT&T customers will simply switch back.

To test the desire of the average smartphone user to switch between Android and the iPhone on Verizon, I asked my wife if she’d like to jump ship now that she has the option. You see, we’re a Mac family at home; three Mac desktops, one Mac laptop,  eight iPods of various configurations and an iPad. My wife and I have talked about this day for a long time and always assumed we would make the change when the opportunity presented itself. But to my utter surprise my wife said ‘no’. Her explanation was simple. She said she was happy with the Android platform, already had an iPod Touch and an iPad, liked the integration of Google with her Droid and simply didn’t feel it offered any advantage. Zing!

And for me? I briefly had an iPhone and really liked the device. At one time I think I would have made the switch, but now I’m happily married to Google and the Android platform. I’ll be sticking with that combination for now.

RxCalc has slowly, but steadily gained functionality mainly due to some great user feedback we’ve received since it was initially released in July 2009.

So, what’s new in the latest release? Glad you asked. The featured changes include:

1. Support for dosing adjustment using single level vancomycin kinetics.
   • The calculations are performed using both patient specific information supplied by the user as well as patient population parameters.
2. Literature supported High Dose Extended Interval (HDEI) (aka “once daily” or “pulse”) aminoglycoside dosing.
   • Calculations for gentamicin and tobramycin are based on 7mg/kg adjusted body weight.
   • Calculations for amikacin are based on 15mg/kg adjusted body weight.

I have five free download codes for RxCalc. If you’d like to download the app for free just shoot me a quick email and I will send you one of the codes. It only takes a second and I’m sure you’ll like performing pharmacokinetics on your iPhone or iPod Touch. I know I do.

The codes expire in four weeks so make sure you contact me sooner rather than later.

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.