Software can turn a tablet into a digital library and make it easier for orthopaedic surgeons to find timely, relevant articles. PDF of image.

AAOS Now

Published 2/1/2014
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Orrin I. Franko, MD

A Shift to Digital: Creating an Orthopaedic Library

Paradoxically, recent increases in the availability of digital and online orthopaedic literature have made it harder for many surgeons to find the most relevant and interesting articles in their specialty. The transition to digital journals has made it easier to access information anywhere and anytime, but the proliferation of new journals has simultaneously expanded the pool of available papers to read.

I use iPad and Android tablets as my primary educational reading platforms. Both devices have useful features for reading pertinent and timely articles relevant to education and practice. In addition, reading digital content and building an orthopaedic library on a device can be done in the following three ways:

  • Use a PDF (portable document format) reader or annotation app for organizing, searching, and managing a library of articles that are already owned.
  • Download individual journal apps and websites to access content, typically via a personal subscription or institutional access.
  • Use a content aggregator to help identify the most relevant literature.

Each method has its own strengths and weaknesses, which are not mutually exclusive. This article addresses these three models and provides tips and tricks to improve educational efficiency.

PDF library
Physicians who have amassed a personal library of journal articles and books may find that the simplest method to access articles on a mobile device is to purchase PDF management software. This method enables complete access to the library at all times, regardless of wireless data access. It enables full content reading while traveling, flying, or lying on a remote beach.

The limitation, however, is that these apps only provide content that is uploaded or files that have been synchronized (synced) by the user. Thus, the surgeon must find, download, and update content to the device for viewing. The integration and synchronization of cloud servers such as DropBox can certainly make this process faster and more efficient, but it does not eliminate the need for the user to select the articles.

Many apps are available for both iPad and Android devices, and range in cost from free to about $10. Some of the most highly rated PDF readers for the iPad include iBooks, iAnnotate, GoodReader, and PDF Expert. Each has various benefits, and I suggest that readers search for reviews and compare screenshots before selecting one.

For example, iBooks is free with iOS, but has limited organizational capacity and limited annotation functionality. In contrast, iAnnotate has the best search tool for large libraries and has expanded viewing and annotating functionality. GoodReader is very popular due to its low cost and integration with many cloud platforms and remote servers, but I find the user interface somewhat confusing. PDF Expert has the ability to sign and complete PDF documents with form fields, as well as read any Microsoft Office files such as Word and PowerPoint.

Android users can check out the Adobe Reader App, ezPDF Reader, and RepliGo Reader. Accessing content on Android devices is simpler than on an iPad device because the Android devices have a standard file management system that uses an external memory card. Each app has unique benefits such as improved speed and rendering (Adobe), playing embedded video and active hyperlinks (exPDF) or an intuitive user interface (RepliGo). All of these apps (and others not listed here) include the ability to highlight and underline text, and most allow the user to archive and email annotated files.

Subscriptions and databases
The second model for accessing content involves using the individual website or app published by a specific journal. For example, mobile apps have been developed by publisher Lippincott Williams & Wilkins for orthopaedic journals such as the Journal of Orthopaedic Trauma, Journal of Pediatric Orthopaedics, Spine, and others. Another publisher, SAGE, has released apps for the American Journal of Sports Medicine and the open access Orthopaedic Journal of Sports Medicine.

Similarly, individual journals such as the Bone and Joint Journal have released independent apps that include access to their related journals—Bone & Joint Research and Bone & Joint 360. The Acta Orthopaedica app provides full, free access to all content. With the exception of open access journals, most of these apps require a subscription and login information for full text reading. Some of the apps include limited highlighting and underlining functionality, but for full annotation capabilities I recommend downloading the PDF file directly into one of the aforementioned PDF tools.

Content aggregators
The third model for article delivery is a content aggregator app. Broadly speaking, this app searches multiple relevant sources to find content that would be useful to the reader, usually based on predefined search variables. These apps provide current and relevant articles to keep the user abreast of the latest research from many potential sources. However, they require wireless data access, may not permit full text viewing, and have limited annotation or archiving functions.

Several content aggregating tools exist specifically for orthopaedic surgeons, while others are for general medical knowledge. The newest and most versatile is Insights Orthopedics, a free app released for iPad. After the surgeon selects a specialty or topic of interest, the app autopopulates with related journal articles, videos, techniques, news articles, podcasts, and images—all gathered from the most popular orthopaedic journals, societies, and news sources. The app includes additional features such as university journal club article selections, an events calendar, and full content access to certain journals for AO foundation members.

Another series of apps—BoneFeed, HandFeed, and SportsMed—aggregate abstracts from leading orthopaedic, hand surgery, and sports medicine journals, respectively. The app does not provide full text, only access to the abstract, but can link to the journal’s website and allow readers to quickly scan the table of contents of several favorite journals.

General medical data aggregators include Docphin, a free service. Accessible via the web or a mobile app (iPhone, iPad, and Android), Docphin customizes medical articles based on the journals selected by the user. Additional features include a category for “landmark articles,” a versatile search function, the ability to create “alerts” for key words, and the integration of a university’s subscription access after providing VPN (virtual private network) login information.

In summary, options for accessing digital content from mobile devices continue to expand. Publishers, developers, and consumers are all becoming more sophisticated with regard to digital content and a plethora of options for sorting, archiving, and reading both classic and recent orthopaedic literature is available.

Orrin I. Franko, MD, is an orthopaedic resident at the University of California, San Diego department of orthopaedics and founder of the website, www.toporthoapps.com

Disclosure information: Dr. Franko reports ties to the following: www.TopOrthoApps.com; Lineage Medical, LLC; OrthoMind, LLC; CARE, LLC; Visible Health, LLC; Journal of Mobile Technology in Medicine.