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PubMed2003

Bluetooth wireless database for scoliosis clinics.

A database system with Bluetooth wireless connectivity has been developed so that scoliosis clinics can be run more efficiently and data can be mined for research studies without significant increases in equipment cost. The wireless database system consists of a Bluetooth-enabled laptop or PC and a Bluetooth-enabled handheld personal data assistant (PDA). Each patient has a profile in the database, which has all of his or her clinical history. Immediately prior to the examination, the orthopaedic surgeon selects a patient's profile from the database and uploads that data to the PDA over a Bluetooth wireless connection. The surgeon can view the entire clinical history of the patient while in the examination room and, at the same time, enter in any new measurements and comments from the current examination. After seeing the patient, the surgeon synchronises the newly entered information with the database wirelessly and prints a record for the chart. This combination of the database and the PDA both improves efficiency and accuracy and can save significant time, as there is less duplication of work, and no dictation is required. The equipment required to implement this solution is a Bluetooth-enabled PDA and a Bluetooth wireless transceiver for the PC or laptop.

Computers, Handheld↗
PubMed2005

A mobile trauma database with charge capture.

BACKGROUND: Charge capture plays an important role in every surgical practice. We have developed and merged a custom mobile database (DB) system with our trauma registry (TRACS), to better understand our billing methods, revenue generators, and areas for improved revenue capture. METHODS: The mobile database runs on handheld devices using the Windows Compact Edition platform. The front end was written in C# and the back end is SQL. The mobile database operates as a thick client; it includes active and inactive patient lists, billing screens, hot pick lists, and Current Procedural Terminology and International Classification of Diseases, Ninth Revision code sets. Microsoft Information Internet Server provides secure data transaction services between the back ends stored on each device. Traditional, hand written billing information for three of five adult trauma surgeons was averaged over a 5-month period. Electronic billing information was then collected over a 3-month period using handheld devices and the subject software application. One surgeon used the software for all 3 months, and two surgeons used it for the latter 2 months of the electronic data collection period. This electronic billing information was combined with TRACS data to determine the clinical characteristics of the trauma patients who were and were not captured using the mobile database. RESULTS: Total charges increased by 135%, 148%, and 228% for each of the three trauma surgeons who used the mobile DB application. The majority of additional charges were for evaluation and management services. Patients who were captured and billed at the point of care using the mobile DB had higher Injury Severity Scores, were more likely to undergo an operative procedure, and had longer lengths of stay compared with those who were not captured. CONCLUSION: Total charges more than doubled using a mobile database to bill at the point of care. A subsequent comparison of TRACS data with billing information revealed a large amount of uncaptured patient revenue. Greater familiarity and broader use of mobile database technology holds the potential for even greater revenue capture.

Accounting↗
PubMed2003

Do you know your students' basic clinical skills exposure?

BACKGROUND: Undergraduate medical education in the United States is changing. Many medical schools have developed a set of basic clinical skills (BCS) that all students are required to have mastered; however, very few have acquired objective information regarding specific student experiences. The purpose of this study was to determine the BCS encounters for junior medical students at a large midwestern university utilizing a handheld personal digital assistant (PDA). METHODS: A core curriculum of BCS was proposed and involved 52 procedures/skills. An electronic BCS database was developed utilizing HanDBase software and then placed on a PDA (Palm) and distributed to 25 third-year medical students randomly as they entered their clinical year. Students logged their skill encounters for 9 months and then electronically transferred the database by e-mail. RESULTS: Students participated in 1,115 procedural/skill encounters (range 17 to 90; median 41; average 44.6). Of the 52 core BCS, all students performed 10. Fewer than 50% of students had any exposure to very common skills. Thirty-four percent of skill encounters occurred at a county hospital, 19% at a clinic, 10% at a university hospital, 10% at a private hospital, 7% at a VA hospital, 4% at a children's hospital, and 16% at miscellaneous locations. CONCLUSIONS: The PDA devices were simple and convenient to use, while allowing for easy transfer and tabulation of database information by electronic mail. Significant gaps in BCS exposure were noted across the curriculum. Mentor sign-off on the PDA permitted early feedback opportunities. We can now begin to reward educators for skills mentoring and perform formal assessment of BCS within specific clerkships to enhance future educational objectives.

Clinical Clerkship↗
PubMed2005

Chest compression rates during cardiopulmonary resuscitation are suboptimal: a prospective study during in-hospital cardiac arrest.

BACKGROUND: Recent data highlight a vital link between well-performed cardiopulmonary resuscitation (CPR) and survival after cardiac arrest; however, the quality of CPR as actually performed by trained healthcare providers is largely unknown. We sought to measure in-hospital chest compression rates and to determine compliance with published international guidelines. METHODS AND RESULTS: We developed and validated a handheld recording device to measure chest compression rate as a surrogate for CPR quality. A prospective observational study of adult cardiac arrests was performed at 3 hospitals from April 2002 to October 2003. Resuscitations were witnessed by trained observers using a customized personal digital assistant programmed to store the exact time of each chest compression, allowing offline calculation of compression rates at serial time points. In 97 arrests, data from 813 minutes during which chest compressions were delivered were analyzed in 30-second time segments. In 36.9% of the total number of segments, compression rates were <80 compressions per minute (cpm), and 21.7% had rates <70 cpm. Higher chest compression rates were significantly correlated with initial return of spontaneous circulation (mean chest compression rates for initial survivors and nonsurvivors, 90+/-17 and 79+/-18 cpm, respectively; P=0.0033). CONCLUSIONS: In-hospital chest compression rates were below published resuscitation recommendations, and suboptimal compression rates in our study correlated with poor return of spontaneous circulation. CPR quality is likely a critical determinant of survival after cardiac arrest, suggesting the need for routine measurement, monitoring, and feedback systems during actual resuscitation.

Aged↗
PubMed2006

Developing a trauma registry in a forward deployed military hospital: Preliminary report.

BACKGROUND: The 325th Field Surgical Team (FST), a US Army trauma surgical group, was deployed to Afghanistan during Operation Enduring Freedom. Unlike civilian trauma centers, complete trauma registries are lacking from the FST care model. METHODS: A trauma registry was created using a commercially available relational database. Data entry was done using a handheld personal data organizer (PDA). RESULTS: In 82 days, 125 trauma patients were evaluated and treated. The mean age was 23 +/- 11.69 and 85 (68%) were local Afghan nationals. Most patients were transported by helicopter (83; 66%); the remaining arrived by ground transportation (42; 34%). The average US military casualty arrival time from injury was 1 hour 38 minutes +/-46. The most common injury was gunshot wounds 47(38%) and the mean Injury Severity Score was 9, with 29 (23%) patients scoring > or =15. Initial mean vitals were systolic blood pressure (SBP); 119 +/- 23.7, heart rate; 103 +/- 7.35, respiratory rate; 20 +/- 7.35, and temperature (degrees C); 36.6 +/- 1.6. The median Glasgow Coma Scale was 15, and presenting mean hematocrit and base deficit were 35 +/- 9.56 and -5.02 +/- 5.03, respectively. Operative procedures were performed in 54 (43.2%) patients, and the mean time to surgery from admission was 80 +/- 11.5 minutes. The most common operative procedure was debridement or completion of amputation of lost limb debridement and completion of amputations (13). The average length of stay was 4.37 +/- 2.88 days. The mortality rate was 8%. CONCLUSION: The collection of comprehensive prospective data using a PDA can be an efficient and effective method in expanding trauma base registries in forward deployed surgical units.

Adolescent↗
PubMed2002

Validity and reliability of a dietary assessment method: the application of a digital camera with a mobile phone card attachment.

This study was aimed at evaluation of the validity and reliability of an alternative dietary measurement method that assists epidemiologic studies. We validated a handheld personal digital assistant with camera and mobile phone card, called Wellnavi, in which a 1-d weighed diet record was employed as a reference method. Twenty college students majoring in food and nutrition participated in this study. They were asked to keep a diet record and to take digital photos of all these recorded food at the same time, then send them to the dietitians by the mobile phone card. In the reliability study, other twenty students from the same college were asked to take digital photos of the same meal during a day by two same instruments under the same circumstances and to send these photos to the different dietitians electronically. With respect to validity, median nutrient intakes estimated by the Wellnavi method and the diet record method are comparable. Correlation coefficients between the median nutrient intakes estimated from these two methods ranged from 0.46 for monounsaturated fatty acid to 0.93 for vitamin B12 and copper (median r = 0.77). With respect to reliability, our data show a good agreement between two Wellnavi instruments for most of the nutrients. Correlation coefficients between the nutrient intakes estimated from 2 instruments ranged from 0.55 for vitamin B1 and water-insoluble dietary fiber to 0.92 for vitamin B12 (median r = 0.78). In conclusion, the results indicate this dietary assessment instrument can usefully measure individual dietary intakes for a variety of nutrients in an epidemiologic study.

Cell Phone↗
PubMed2004

Data management using the personal digital assistant in an acute pain service.

Handheld personal digital assistants (PDA) are increasingly being used by physicians for a variety of information and data management purposes. We evaluated a PDA-based data management system for our acute pain service. A structured questionnaire survey was conducted to assess staff experience and attitude towards the paper system before the introduction of the PDA, and three months after introduction of the PDA system. We compared the time taken to conduct the acute pain round before and after the implementation of the PDA. The time saved in data management and the amount of paper saved were estimated. Data from 177 patients with a total of 635 acute pain follow-up visits were entered over a three-month period. User satisfaction, ease of access to drug reference and clinical guidelines were similar between the two systems. The respondents found that the PDA was easy to use but less so than the paper system (P = 0.007), in particular, when accessing a patient's cumulative data (P = 0.007). There was no missed follow-up or data entry with the use of PDA. The time taken to attend follow-up visits was similar for the two systems (Paper: 8.8 +/- 3.2 compared to PDA: 7.0 +/- 2.0 minutes, P = 0.151). The estimated annual amount of paper and time saved in data management was 650 sheets and 130 man-hours respectively. Our experience with the use of the PDA in APS was satisfactory. The PDA system can potentially reduce time and paper use and missed data entry and patient follow-up.

Acute Disease↗
PubMed2006

Diffusion of innovations: anatomical informatics and iPods.

Over the course of many centuries, evolving scientific methods and technologies have advanced the study of anatomy. More recently, such dissemination of innovations has been formally studied in multidisciplinary psychosocial contexts, yielding useful knowledge about underlying principles and processes. We review these precepts and show how diffusion of innovations theory and principles apply to the development and dissemination of anatomical information methods and resources. We consider the factors affecting the late-20th-century dissemination of personal computers and World Wide Web hypermedia into widespread use in anatomical research and instruction. We report on the results of a small experiment in applied diffusion, the development and Internet-based distribution of learning resources for a popular, widely distributed personal media player. With these wearable microcomputer devices already in use by a variety of students, new opportunities exist for widespread dissemination of anatomical information. The continuing evolution of wearable computing devices underscores the need for maintaining anatomical information transportability via standardized data formats.

Anatomy↗
PubMed2005

A study of patients with anorexia nervosa using ecologic momentary assessment.

OBJECTIVE: The purpose of the current study was to demonstrate the feasibility of studying subjects with anorexia nervosa (AN) using ecologic momentary assessment (EMA). A second goal of the current study was to conduct a preliminary investigation of a proposed model of anorexic behavior. METHOD: Ten female participants with AN carried Palm top computers for an average of 2 weeks per participant. Each day, participants were signaled six times by the Palm top and answered questions about mood, behavior, stressful events, and self-appraisal. RESULTS: AN subjects displayed excellent compliance with the protocol. Participants completed more than 90% of the signaled recordings. The results also generally support the model of AN behavior proposed. CONCLUSION: EMA appears to be a feasible and productive means of assessment in studying AN.

Adult↗
PubMed2005

A naturalistic evaluation of the relation between dietary restraint, the urge to binge, and actual binge eating: a clarification.

OBJECTIVE: The current study attempted to characterize the natural course of events linking dietary restraint to urges to binge and actual binge episodes. METHOD: Using preprogrammed, hand-held computers, 39 women with bulimia-spectrum eating disorders monitored ongoing eating episodes, dietary restraint, and binge cravings over a 7-29-day interval. RESULTS: Multilevel modeling analyses indicated that restraint was not systematically elevated before binging. However, elevated restraint preceded strong binge cravings. CONCLUSION: Results suggest that dietary restraint may contribute to binge cravings, but may not be a direct antecedent to binge episodes. Such findings are consistent with restraint theory, which suggests that dietary restraint potentiates binging, but does not necessarily trigger its occurrence.

Adult↗
PubMed2006

Thinking and/or doing as strategies for resisting smoking.

The effects of behavioral strategies and cognitive strategies, individually or in combination, on the likelihood of lapsing during smoking cessation were examined by random effects regression analyses of 1,499 temptations reported by 61 smokers during the first 2 weeks of cessation. Compared to using no strategies, using either type exclusively or in combination was significantly protective from lapsing. The combination was not significantly better than using multiple cognitive strategies, but was superior to using a single behavioral strategy, a single cognitive strategy, or multiple behavioral strategies. Use of coping strategies during temptation episodes was highly related to resisting smoking. Maximum benefit accrued to using more than one strategy of which at least one was a cognitive strategy.

Adaptation, Psychological↗
PubMed2002

Evaluation of pain and disability in plug repair with the aid of a personal digital assistant.

The purpose of this paper is to illustrate the method of real-time data collection using a hand-held personal digital assistant (PDA) in the operating suite, hospital, and office. The technique for the placement of a round Atrium ProLite self-forming, layered polypropylene plug in 155 hernia repairs is described. The study measured postoperative pain by the number of pills used (6.6) and categorizes patient return to work according to sedentary, manual, and standing with an average return to work time of 15.6 days for unilateral repair and 20.4 days for bilateral repair. Return to normal daily activity was within 22.3 days for unilateral- and 28.5 days for bilateral repair.

Computers, Handheld↗
PubMed2006

Use of personal digital assistant devices in order to access, consult and apply a corpus of clinical guidelines and decision-based support documentation like the Italian SPREAD Guidelines on stroke disease.

During the past few years, personal digital assistants (PDAs) have become widespread commodities, like computers and mobile phones. Many health-care providers, particularly physicians, routinely use PDAs in their everyday work. Accessing guidelines and clinical decision-based support tools, such as the downloadable version of the Italian SPREAD Guidelines represents one of the most important and common clinical applications. The current experience suggests that the need for best evidence models at the time of decision making is strong and that portable accessibility is critical: including just-in-time information systems that allow physicians to retrieve the best evidence at the point of care, and a standardized electronic health record (EHR) easily integrating into daily practice and is affordable to most family physicians.

Computers, Handheld↗
PubMed2004

Integrating multiple clinical information systems using the Java Message Service framework.

This article describes an application for capturing, delivering, and tracking urgent radiology exam results. Urgent exam findings are entered using a Web form embedded within the Picture archiving and communication system (PACS) display station. The findings are then accessible via soft copy using the PACS display stations, hospital information system (HIS) terminals, or wireless-enabled personal digital assistants (PDAs) or via hard copy printouts that are generated automatically or on demand. Additionally, quality control is performed on those findings entered by radiology residents and fellows, the results of which are used for both performance tracking and educational activities. The application was developed using Sun Microsystems' Java programming language. The Java Message Service (JMS) was used to manage the delivery of findings. JMS provides a robust, flexible framework for exchanging messages between disparate applications. The application is now used for all urgent exams; completely replacing the original paper-based system. The use of JMS provides the necessary level of reliability needed by this application.

Computer Communication Networks↗
PubMed2006

Toward mapping daily challenges of living with ADHD: maternal and child perspectives using electronic diaries.

Attention-deficit/hyperactivity disorder (ADHD) has an impact on the family as well as the affected child. This study developed and tested an electronic diary for mapping the challenges of everyday family life in a sample of children with ADHD being treated with pharmacotherapy. Across 7 days, mothers and children (27 ADHD; 25 non-ADHD) independently reported their moods, behaviors, and social contexts every 30 min during nonschool hours. Symptomatic behaviors and negative moods were elevated in the ADHD group, combined with maternal perceptions of lower parenting effectiveness and quality of life. Differences in the contexts of maternal anger were salient, with mothers in the ADHD group more often angry when with their children and comparison mothers more often angry when not. Although mothers' diaries were more informative, children's diaries also distinguished the two groups, especially during mornings and weekends. The need for family-wide interventions, the utility of child self-reports, and the promise of electronic diaries are discussed.

Activities of Daily Living↗