A new app for physicians on environmental medicine

The purpose of the “Medicine in Challenging Environments” app, published in 2014 by the Mayo Clinic, is stated as “. . . to provide practical, evidence-based multi-specialty knowledge . . .” for the primary care physician to provide guidance for their patients who engage in high adventure activities and to assist high adventurers in their planning for such activities. The app editors are 3 Mayo Clinic physicians: Dr. Jan Stepanek (internist and aerospace medicine), Dr. Robert Johnson (pediatrician) and Dr. Daniela Cocco (Mayo Clinic Aerospace Medicine and Vestibular Research Laboratory researcher). The content of the application is organized in 3 main sections with multiple chapters in each section: Environments, Specific Clinical Problems and Special Considerations. This “app” is essentially a book. Navigation through the app is similar to most book-type apps. The “Home” tab leads to an introduction and hypoxia, temperature and wind/pressure calculators. The “Chapters” tab leads to all the book chapters. Each chapter is broken down into subsections. Swiping up/down scrolls a single page and swiping left and right changes pages, sections and chapters. The app is searchable by keyword. The only interactive aspects of the app are the hypoxia, temperature and wind/ pressure calculators. The content of the “Environments” section focuses on the human physiology and medical/clinical considerations as related to exposure to extremes of environmental conditions including hyper/hypo-gravity, altitude, hydration, ionizing radiation, thermal, etc.. There is also a chapter on motor sports but there is no specific chapter or content dedicated to undersea/hyperbaric medicine. The content of the “Specific Clinical Problems” focuses on medical sub-specialty specific management of travel-related medical problems and is not really related directly to the “Environments” section of the app. Each chapter has “Clinical Vignette(s)” which describes a clinical case(s) that a clinician may encounter, which enhances the practical aspect of the app. The content of the “Special Considerations” section has chapters focusing on survival strategies. For the clinician without knowledge or previous experience in guiding patients who might be facing extreme environmental conditions, this app would be a very good basic reference. The editors do attempt to make the information practical by including clinical cases (“Clinical Vignettes”). However, the challenge with any clinical reference is that it is difficult to anticipate every clinical scenario that one may face and every chapter of book could be a book in and of themselves. Moreover, clinical practice can change very quickly, so the information needs to be updated frequently. The most useful section of the app, as it relates to the title of the app, is the “Environments” section. The “Hydration” and “Thermal” chapters of this section, written by Dr. Stephen Cheung of Brock University (Canada), and Dr. Christopher Tyler of Roehampton University (UK), 2 physiologists with extensive research background in the fields, are very thorough and provide very practical information related to strategies for managing one’s hydration and how to deal with heat and cold stress, respectively. The “Specific Clinical Problems” section is essentially a Travel Medicine reference. The “Special Considerations” section has survival strategies chapters. Some added interactivity within each chapter would make the app more interesting. Medicine in Challenging Environments is available in the Apple App Store, and is compatible with iPad but not iPhone or Mac OS. Currently $CAN 9.99, the app is reasonably priced.