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Algorithms and heuristics for efficient medical information display in PDA.

Accessing medical information in mobile devices such as PDAs and mobile phones is becoming widespread. Since these devices do not have the same rendering capabilities as of desktop computers, it is necessary for medical information to be fragmented for proper presentation on these types of devices. In this paper, we propose an architecture for displaying medical information in PDA. In the proposed system, a server extracts the information, categorizes the information in order of its relevance for diagnosis, and dynamically generates a hierarchical view of the relevant information based on certain medical domain knowledge. Displaying image and graphics data in PDA poses several challenges. The proposed system supports an image visualization tool, which interactively displays an image or a portion of an image in user's PDA. This visualization tools increases the resource utilization of PDA by offloading a part of the computation to the server. A suitable caching scheme is incorporated for optimum utilization of communication channel bandwidth.

Algorithms↗

A comparative study of mobile electronic data entry systems for clinical trials data collection.

PURPOSE: To determine the speed, accuracy, ease of use, and user satisfaction of various electronic data entry platforms for use in the collection of mammography clinical trials data. METHOD AND MATERIALS: Four electronic data entry platforms were tested: standalone personal digital assistant (PDA), Tablet PC, digitizer Tablet/PDA Hybrid (DTP Hybrid), and digital pen (d-pen). Standard paper data entry was used as control. Each of five radiologist readers was assigned to enter interpretations for 20 screening mammograms using three out of the five data entry methods. Assistants recorded both start and stop data entry times of the radiologists and the number of help requests made. Data were checked for handwriting recognition accuracy for the d-pen platform using handwriting verification software. A user satisfaction survey was administered at the end of each platform reading session. RESULTS: Tablet PC and d-pen were statistically equivalent to conventional pen and paper in initial data entry speed. Average verification time for d-pen was significantly less than secondary electronic data entry of paper forms (p-value <0.001). The number of errors in handwriting recognition for d-pen was less than secondary electronic data entry of the paper forms data. Users were most satisfied with Tablet PC, d-pen, and conventional pen and paper for data entry. CONCLUSIONS: Tablet PC and d-pen are equally fast and easy-to-use data entry methods that are well tolerated by radiologist users. Handwriting recognition review and correction for the d-pen is significantly faster and more accurate than secondary manual keyboard and mouse data entry.

Clinical Trials as Topic↗

Paper and electronic diaries: Too early for conclusions on compliance rates and their effects--Comment on Green, Rafaeli, Bolger, Shrout, and Reis (2006).

This commentary discusses 4 issues relevant to interpretation of A. S. Green, E. Rafaeli, N. Bolger, P. E. Shrout, and H. T. Reis's (2006) article: (a) Self-reported compliance in medical settings has generally been substantially higher than verified compliance, suggesting that this is not a rare phenomenon; (b) none of the studies reported in Green et al. explicitly verified paper diary compliance; (c) the impact of participant motivation on diary compliance is unknown, and it may be difficult for researchers to accurately assess it in their own studies; and (d) without objective verification of diary compliance, analysis of the effects of noncompliance on data quality is difficult to interpret. The authors conclude that compliance in paper diaries and the effects of noncompliance on data quality are still unsettled issues.

Adolescent↗

Recording of time-varying back-pain data: a wireless solution.

Chronic back pain is a debilitating experience for a considerable proportion of the adult population, with a significant impact on countries' economies and health systems. While there has been increasing anecdotal evidence to support the fact that for certain categories of patients (such as wheelchair users), the back pain experienced is dynamically varying with time, there is a relative scarcity of data to support and document this observation, with consequential impact upon such patients' treatment and care. Part of the reason behind this state of affairs is the relative difficulty in gathering pain measurements at precisely defined moments in time. In this paper, we describe a wireless-enabled solution that collects both questionnaire and diagrammatic, visual-based data, via a pain drawing, which overcomes such limitations, enabling seamless data collection and its upload to a hospital server using existing wireless fidelity technology. Results show that it is generally perceived to be an easy-to-use and convenient solution to the challenges of anywhere/anytime data collection.

Back Pain↗

Comparison of deferral rates using a computerized versus written blood donor questionnaire: a randomized, cross-over study [ISRCTN84429599].

BACKGROUND: Self-administered computer-assisted blood donor screening strategies may elicit more accurate responses and improve the screening process. METHODS: Randomized crossover trial comparing responses to questions on a computerized hand-held tool (HealthQuiz, or HQ), to responses on the standard written instrument (Donor Health Assessment Questionnaire, or DHAQ). Randomly selected donors at 133 blood donation clinics in the area of Hamilton, Canada participated from 1995 to 1996. Donors were randomized to complete either the HQ or the DHAQ first, followed by the other instrument. In addition to responses of 'yes' and 'no' on both questionnaires, the HQ provided a response option of 'not sure'. The primary outcome was the number of additional donors deferred by the HQ. RESULTS: A total of 1239 donors participated. Seventy-one potential donors were deferred as a result of responses to the questionnaires; 56.3% (40/71) were deferred by the DHAQ, and an additional 43.7% (31/71) were deferred due to risks identified by the HQ but not by the DHAQ. Fourteen donors self-deferred; 11 indicated on the HQ that they should not donate blood on that day but did not use the confidential self-exclusion option on the DHAQ, and three used the self-exclusion option on the DHAQ but did not indicate that they should not donate blood on the HQ. The HQ identified a blood contact or risk factor for HIV/AIDS or sexually transmitted infection that was not identified by the DHAQ in 0.1% to 2.7% of donors. CONCLUSION: A self-administered computerized questionnaire may increase risk reporting by blood donors.

Anonymous Testing↗

[Medical image transfer for emergency care utilizing internet and mobile phone].

The purpose of this study was to utilize a mobile phone for transferring medical images to a specialist at a remote site in emergency care. CT images obtained in emergency treatment are transmitted via the Internet or mobile phone (CDMA: Code Division Multiple Access communication method). A specialist even at a remote mobile site may receive the appended images of e-mail sent via mobile phone to his PDA (Personal Digital Assistant, image indicator). The images are originally obtained in DICOM format by CT, and are then converted to JPEG format. To reduce transmission time, the JPEG files can be compressed without causing undue deterioration in image quality. To evaluate the quality of images received at the remote site, images were compressed at 25, 40, 50, 60, 70 and 80% compression ratios and transmitted to a PDA via the Internet and a mobile phone or a mobile phone alone. Image quality was visually evaluated by BVC analysis. The analysis revealed that the image compression ratio must be at least 50% for diagnosis. Considering the transmission speed, a 50% compression ratio was considered the most suitable for this application.

Cell Phone↗

Paper and plastic in daily diary research: Comment on Green, Rafaeli, Bolger, Shrout, and Reis (2006).

The authors applaud A. S. Green, E. Rafaeli, N. Bolger, P. E. Shrout, and H. T. Reis's (2006) response to one-sided comparisons of paper versus electronic (plastic) diary methods and hope that it will stimulate more balanced considerations of the issues involved. The authors begin by highlighting areas of agreement and disagreement with Green et al. The authors review briefly the broader literature that has compared paper and plastic diaries, noting how recent comparisons have relied on study designs and methods that favor investigators' allegiances. The authors note some sorely needed data for the evaluation of the implications of paper versus plastic for the internal and external validity of research. To facilitate evaluation of the existing literature and assist in the design of future studies, the authors offer a balanced comparison of paper and electronic diary methods across a range of applications. Finally, the authors propose 2 study designs that offer fair comparisons of paper and plastic diary methods.

Adolescent↗

Applications of ecological interface design in supporting the nursing process.

Today's nursing environment is complex, with many sources of data that are often poorly displayed. Ecological interface design (EID) is a systematic approach to designing interfaces to complex systems. EID has been used to design interfaces for aviation displays, power plant monitoring and control, human hemodynamic monitoring, anesthesia monitoring, and neonatal intensive care monitoring and diagnosis. EID makes critical relationships easily visible, eliminating the mental workload of integrating, calculating, or remembering multiple values. This paper reviews past experimental studies of EID in healthcare applications and discusses the application of EID to a decision-support tool for diabetic patients using personal digital assistants. The authors also discuss other contributions that EID could make to the nursing process in the areas of physiological monitoring, decision support, database design, and the measurement and analysis of nurse-sensitive outcomes, including patient safety outcomes.

Computers, Handheld↗

Personal digital assistant-based drug information sources: potential to improve medication safety.

OBJECTIVES: This study compared the potential for personal digital assistant (PDA)-based drug information sources to minimize potential medication errors dependent on accurate and complete drug information at the point of care. METHODS: A quality and safety framework for drug information resources was developed to evaluate 11 PDA-based drug information sources. Three drug information sources met the criteria of the framework: Eprocrates Rx Pro, Lexi-Drugs, and mobileMICROMEDEX. Medication error types related to drug information at the point of care were then determined. Forty-seven questions were developed to test the potential of the sources to prevent these error types. Pharmacists and physician experts from Creighton University created these questions based on the most common types of questions asked by primary care providers. Three physicians evaluated the drug information sources, rating the source for each question: 1=no information available, 2=some information available, or 3 = adequate amount of information available. RESULTS: The mean ratings for the drug information sources were: 2.0 (Eprocrates Rx Pro), 2.5 (Lexi-Drugs), and 2.03 (mobileMICROMEDEX). Lexi-Drugs was significantly better (mobileMICROMEDEX t test; P=0.05; Eprocrates Rx Pro t test; P=0.01). CONCLUSION: Lexi-Drugs was found to be the most specific and complete PDA resource available to optimize medication safety by reducing potential errors associated with drug information. No resource was sufficient to address the patient safety information needs for all cases.

Academic Medical Centers↗

[JPIP-based wireless transmission and display of high resolution DICOM medical images].

This paper uses JPIP protocol to transmit and display high-resolution medical images through the wireless network. JPIP server extracts medical images from PACS system, transforms the format of medical images, and parses and recomposes the JPEG2000 codestream. Wireless PDA access and display DICOM medical images through accessing the JPIP server.

Computers, Handheld↗