TSP Mobile: ECG

EDIT: The Android version of TSP Mobile: ECG is available for download, but due to the way in which Google Play operates, I have been unable to offer it for free. The iOS version, when available, will be gratis for the promised 14 days however. Still no word from Apple when that will be, but I have been assured that it is being vetted as I type this, so fingers crossed!

Original article follows:

Well, that TSP mobile app I promised…

I’ve been saying I’d do it for months and, despite remaining fairly quiet with information about starting, I actually have been working on it. So much so, in fact, that the bulk of the development is finished! It’s in final stages of testing, after which it will be available on the Google Play and iOS app stores, where it will be free for the first two weeks of release, so please download it and leave some constructive feedback and a review.

The app features tutorials on ECG analysis, exercise and ambulatory ECG, cardiac flow and cycles, action potentials and useful formulae for trace analysis. Each section is laid out in an easy to follow format, with colourful diagrams and both real and illustrated ECG traces.

Heart rate and QTc calculators are included to aid analysis without leaving the app, and also access to the website blog, so you need never miss an update.

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I hate advertisements in apps, so in order to keep TSP mobile ad-free, I will charge £1 to download it after these introductory 14 days are over. In an ideal scenario, I would keep it completely free, but it has been, and continues to be, a rather expensive endeavour from both a chronological and economical standpoint especially for my shallow, student pockets, so I hope you understand why I have decided to charge.

Stay tuned to TSP via site, Twitter or email for a release date. It’s very soon!

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Is Mobile Echocardiography On The Horizon?

Smartphone and tablet technology is advancing at a rapid rate, so it should come as no surprise that it is being used for a variety of different purposes. Healthcare companies are finding novel ways to encourage patients to take charge of their own health; peripherals allow for BP measurement and three lead ECG monitoring in one’s own home, and it’s possible to measure your heart rate at rest and during exercise now, with software that comes as a pre-installed fitness suite on most modern devices.

It stands to reason, then, that these same companies would create clinical grade applications and device extensions that would benefit practitioners, also. I covered the use of Google Glass in revascularisation, already, but another device is making its way to the market at the moment, too; mobile ultrasound.

After unveiling it in 2014, Philips were granted FDA approval of their Luimfy system only a couple of weeks ago and have announced that it is now available for purchase in the US.

A $199 per month subscription, an Android phone/tablet and a micro USB probe are all you need, as the app and it’s peripheral are designed to work with compatible devices off-the-shelf.

In its current form, the scanning app allows practitioners to examine the gall bladder, abdomen and lungs, in addition to having obstetric, vascular, superficial, musculoskeletal and soft tissue functionality, so the device isn’t suitable for echocardiography, but I’m certain that in the future, given the power already available in modern devices, it’s a real possibility.

In UK hospitals, where space is a deciding factor for treatment options, having an ultrasound monitor that can fit in a small case would be a real boon. Emergency and critical care ultrasound is actually what the system was designed for, so it makes sense that the most obvious impact relates to time and accessibility.

Streamlining the healthcare process is paramount, and the fact that this system is based around an app could be a real advantage. The images gained by the practitioner can be shared via the cloud, so the network of professionals involved with one patient can have near instant access to the relevant materials needed for diagnosis. Philips could also provide continued software support and provide updates based on user feedback, without the need for engineer call outs.

Now, I’m no app developer (I’m trying. It’s rather complex…), but I do use them, so I can identify some common problems in cloud storage and functionality.

Firstly, as this is an Android app, it may present issues in performance across devices. There are a number of latency issues with apps for this OS and further issues regarding app performance in general from one device to another, especially if the base OS differs slightly between manufacturers (if you’ve tried to compare performance between Samsung and Google Nexus, you’ll know what I mean). In this case, Philips would have to be fairly on the ball with their customer support, especially given the subscription costs for practitioners.

I guess the issue with cloud storage brings us to patient confidentiality, as the last couple of years have seen some high profile cloud hacks leak “sensitive” data to the public, but many hospitals are already digital, so surely it’s a case of ensuring the level of security is appropriate.

As far as echo goes, the advantage of switchable probes and live, cloud updating comes into its own; echo features could be added with an update, in theory. It’s a case of making it happen. It’s unlikely, but if I ever get a chance to try one, I’ll make sure to tell you of my experience.

For more information, go here: http://www.ifa.philips.com/news/digital-innovations/philips-lumify

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Review: Analyze ECG Reporting

Download for Google Play: Free

Download for iOS: Free

Developer: Cathal Breen

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When you’re just beginning to get to grips with analysing a 12-lead, taking a methodical approach is recommended, but in practice that’s easier said than done. Remembering what you’re measuring, and in what order you’re measuring it, is sometimes confusing, especially when, like me, you’re still getting your head around the various concepts behind the plethora of arrhythmias and pathological morphologies you’re likely to find in a patient ECG.

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I’ve already covered the tutorial apps documenting normal and abnormal values that I felt were most beneficial to PTP students, but Analyze ECG Reporting by Cathal Breen exists solely to guide the practitioner through each, single analysis and serves as a methodical reminder of everything that should be documented in your report.

Analyse is nicely presented, with a very simple user interface set up for each section. The display contains boxes for measured values, buttons to advance to the next measurement, or to go back to make corrections and some pop-up menus for comments on the ECG waves. It doesn’t suffer from a text overload, or clutter in any way. The colour scheme is visually appealing, but conservative, so when using the app, you’re kept on task and not distracted by needless images or too many different colours.

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This app is merely a way to educate practitioners into using the same approach to study each trace. It may seem like an obvious thing to point out, as ECG cannot provide a diagnosis on its own, but Analyse is not an algorithm that will diagnose a pathology for you.
This is not to diminish this app’s merits whatsoever, though. Analyse does a great job of clarifying the process of ECG analysis and provides a list of the necessary things to include when reporting. Since installing it, I have used it to methodically review lots of the traces I’ve obtained, including those set in my coursework.

In fact, my only problem with Analyse ECG Reporting is in correcting mistakes from the drop down menu. A long press on the option that you have selected will remove it from the final list, but this isn’t explained at any point. It took me a little while to figure it out, so some brief instructions wouldn’t have gone amiss upon starting up the app for the first time. It’s a minor niggle and it didn’t detract from my overall experience with Analyse, however.

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Consistency and a methodological approach are key parts of analysis, and Analyse ECG Reporting is a great trainer. This app is a must have for PTP students, but I’d recommend it to any student who’ll have more than a passing dalliance with electrocardiograms.

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The Best Apps For Student Physiologists

(in my opinion and predominantly found on android)

EDIT: I have added a 5th app at the bottom of the page, “Read by QxMD”.

My bus journey to university can take anywhere from 1.5 to 2.25 hours, depending on how willing the driver is to break the speed limit, so I try my best to make good use of the time available.
It can be rather cumbersome to hold a textbook when the bus is full and the constant movement makes it rather difficult to follow the words on a page, so I downloaded a few apps to help pass the time as well as study and, as you can imagine, some of them have been better than others.
So that you don’t have to spend your wages/student loan unnecessarily, I’ve decided to share those few apps that have either interested me, or helped me during the PTP programme so far.

I’ve omitted any apps that are effectively digital print textbooks, as these are often promoted in both Google Play and the App Store, costing £20-30 and are nowhere near as difficult to find as a couple of these picks.
I’m also not suggesting that you get all of these apps, either; were it not for this post, I wouldn’t have them all. Everyone learns differently, so you’ll probably need one or two at most.

All of these prices are correct at the time of posting, but if any have changed, let me know and I’ll update them accordingly.

 

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1.) ECGsource, Cathsource, Echosource (ECGsource LLC)
 Google Play: £1.92, £2.54, £3.03
App Store:      £0.79, £2.29, £2.29

These three apps provide a great deal of content and are very reasonably priced, but ECGsource on it’s own is the app that will benefit Y1&2 PTP students the most. It contains information and analysis parameters for a very large number of pathologies, videos to help you understand key principles in ECG science and a tutorial on reading a normal ECG.
This app is a personal favourite of mine, not just for the number of arrhythmias it covers, but for the examples it gives in addition to these.
If you have an android device and you can only get one app, make it this one.

Screenshot_2015-10-05-21-09-05~22.) ECG Practical Demo (One 2 One Medicine LTD)
Google Play: Free
App Store:     N/A

This app isn’t nearly as easy to follow as ECGsource, but is still packed with content once you know what you’re doing. It also contains a rate/R-R correction tool, a set of digital calipers and an easy to use axis calculator for measurements on the go.
There is a paid version of this app available to purchase, but if you spend a couple of quid, you’ll get all the same information with better quality examples by getting ECGsource or QxMD. For the tools you get with the free version, however, you can check your answers on analysis assignments for free, making this worth a look.

I’m yet to find an app with all of these features on the App Store, but, if I’m honest, I started running out of money whilst wading through the plethora of terrible apps out there, so stopped looking.

Screenshot_2015-10-05-17-24-33~23.) 100 ECG Cases for Finals (One 2 One Medicine LTD)
Google Play: Free
App Store:     N/A

A quiz featuring (shockingly) 100 ECG Cases for you to analyse and be graded on.
Quizzes are grouped into categories such as Uncommon Arrhythmias, Supraventricular Arrhythmias, etc, so you can really fine-tune your skills in a particular area.
100 ECfF doesn’t offer any tutorials, so obviously it’s recommended that you have some knowledge from other sources before you have a go at it, but it’s made for USMLE finals, so it’s a handy thing to have as you progress.

It isn’t available on iOS, but ACLS Rhythm Quiz is the best option over on the App Store, costing £0.79

Screenshot_2015-10-05-20-42-30~24.) QxMD ECG Guide (QxMD)
Google Play: £3.19
App Store:     £0.79

Much the same as ECGsource, but seemingly optimised for iDevices, this app has everything a PTP student could need for ECG analysis and arrhythmia recognition. This great app also comes with a handy analysis tool that can you can use to check your answers when you’re practicing.

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5.) Read by QxMD (QxMD)

Google Play: Free

App Store:    Free

This app is a wonderful way to tailor your journal reading experience to suit your course needs. New updates and articles are available frequently and are all viewable and searchable within the app. I have personally found this tool to be invaluable when trying to further understand the nuances of pathologies within cardiac science.

Hopefully these will help you along your programme as much as they have me.

Thanks!

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