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Personal digital assistants are comparable to traditional diaries for dietary self-monitoring during a weight loss program.

Dietary self-monitoring is considered the core of behavioral weight control programs. As software for personal digital assistants (PDA) has become more available, this study investigated whether the use of a PDA would improve dietary self-monitoring frequency and subsequent weight loss over the use of traditional paper diaries. One-hundred-seventy-six adults (BMI 25-39.9) participated in a 6-month behavioral weight control program. Treatment subjects (n = 61) were provided with a PalmZire 21 with Calorie King's Diet Diary software installed. Their self-monitoring habits and weight loss were compared with the results from a previous program (n = 115) which followed the same protocol using paper diaries for self-monitoring. No significant differences in weight loss or dietary self-monitoring were found. More frequent self-monitoring correlated with weight loss in both groups (p<.001). People seeking to lose weight should be encouraged to self-monitor and be matched with a mode of self-monitoring that is fitting to their lifestyle and skills.

Adult↗

A review on diffusion of personal digital assistants in healthcare.

This review draws from a comprehensive literature search and reviews the adoption, usage and impact of personal digital assistants (PDAs) in healthcare. Adoption relates to the rationale for, barriers to and scope of adopting PDAs. Usage relates to the types of health professionals using PDAs, and their functionalities and features. Impact relates to perceived outcomes, actual outcomes and improved productivity from PDA use. The review shows that although PDA adoption and usage in healthcare are growing, there are very few studies that provide evidence-based results about impacts of such adoption and use. However, the preliminary impact studies that have been done have shown promise with regards to PDA use improving patient outcomes. We feel this review will increase awareness and encourage research about PDAs and their use in healthcare.

Computers, Handheld↗

Electronic clinical path system based on semistructured data model using personal digital assistant for onsite access.

Clinical Paths (Paths) have been introduced by different hospitals for patient care management. An Electronic Clinical Path (ECP) with onsite access provision seems to improve the efficiency of medical staffs because they can share vast medical information about patients at a time and also can reuse accumulated data easily, which is impossible with paper-based Path. Data model is the basis for implementing ECP. However, there is no established model for ECP. The purpose of this study is to introduce a model for ECP and implement an ECP with onsite access system. We introduced a Semistructured Data Model (SSDM) for ECP, and implemented a Web application system based on this model using Personal Digital Assistant (PDA) as inputting device. Our system functioned as expected with wireless LAN, and users handled the data on bedside using PDA. By introducing SSDM, we showed the correspondence between schema of Paths and implementation of ECP.

Access to Information↗

Are deficiencies in manual tracking associated with upper extremity cumulative trauma disorders?

OBJECTIVES: To examine the reliability of manual tracking performance and its association with impairment and disability in individuals symptomatic of an upper extremity cumulative trauma disorder (CTD). METHODS: Volunteer and physician referred subjects (100 control, 140 CTD) tracked a target cursor moving quasi-randomly using a hand-held stylus interfaced with a digitizing tablet. Impairment was physician-rated and the Disability of the Arm, Shoulder and Hand questionnaire measured disability. Subsamples of 25 subjects per group were tested on three occasions. RESULTS: Reliability of tracking performance was excellent (ICC > or = 0.88) and sensitivity was 81%. Performance was superior in controls (p < 0.001) and deteriorated as a function of impairment level (p < 0.001). Tracking and impairment rating explained 65% of the disability score. CONCLUSIONS: Tracking performance may be an important outcome for monitoring change over time and the impact of a CTD on function in everyday activities.

Adolescent↗

Development of electronic barcodes for use in plant pathology and functional genomics.

We have developed a novel 'electronic barcode' system that uses radio frequency identification (RFID) tags, cell phones, and portable computers to link phenotypic, environmental, and genomic data. We describe a secure, inexpensive system to record and retrieve data from plant samples. It utilizes RFID tags, computers, PDAs, and cell phones to link, record, and retrieve positional, and functional genomic data. Our results suggest that RFID tags can be used in functional genomic screens to record information that is involved in plant development or disease.

Arabidopsis↗

Use of personal digital assistants in diagnostic radiology resident education.

RATIONALE AND OBJECTIVES: Personal digital assistants (PDAs) are gaining widespread use in the medical community. We introduced a PDA-based mobile system that provides departmental and educational information with a seamless connection to the intranet. The objective of this study is to determine the impact a PDA has on educational resources (learning or data reference) brought to work and used at home by a radiology resident based on user surveys. MATERIALS AND METHODS: Survey was performed on 32 radiology residents in our department before and 6 months after the release of the PDA-based system. We assessed the changes in (1) sources of learning at home and at work, and in (2) data reference. The second survey also evaluated the usefulness of each component of the system. RESULTS: After the release of the PDA-based mobile system, the use of "digital books and references" as data references and educational resources that were brought to work every day significantly increased (P = .016, P < .0001, respectively). "Traditional books and references" remained the "most useful source in learning radiology"; however, "digital books and references" increased as the residents' first choice from 0% to 16% within 6 months of introducing the package (P = .125). CONCLUSION: The introduction of a PDA-based system consisting of educational and departmental information had a statistically significant impact in increasing the use of digitized information in radiology resident education.

Computers, Handheld↗

Colonization of personal digital assistants used in a health care setting.

BACKGROUND: The use of personal digital assistants (PDAs) by health care workers is increasing. Increasing rates of infection in our institution led to the question of whether PDAs were colonized with pathogenic organisms. METHODS: Specimens for culture were obtained from PDAs used at our institution, and surveys were distributed to the users to determine factors predisposing to colonization. RESULTS: Forty percent of PDAs had growth on culture. The most common organism detected on 27 of 82 PDAs was coagulase-negative Staphylococcus (82%). No isolates of methicillin-resistant Staphylococcus aureus or vancomycin-resistant enterococci were detected. Colonization was more common on PDAs that had undergone previous cleaning. No other predisposing factors to colonization were found. CONCLUSIONS: PDAs are frequently colonized with typical skin organisms and less commonly with pathogenic organisms. Whether PDAs used in the health care setting serve as vectors for nosocomial infection is not determined.

Bacteria↗

Comparison of the amblyopia treatment study HOTV and electronic-early treatment of diabetic retinopathy study visual acuity protocols in children aged 5 to 12 years.

PURPOSE: To compare two established visual acuity protocols: the Amblyopia Treatment Study HOTV (ATS HOTV) visual acuity protocol and the Electronic-Early Treatment of Diabetic Retinopathy Study (E-ETDRS) protocol, in children aged 5 to 12 years. DESIGN: Prospective cohort study. METHODS: Crowded HOTV optotypes and crowded ETDRS optotypes were presented to 236 consecutive children aged 5 to 12 years using an electronic visual acuity tester (Palm handheld, personal computer, and monitor). Twenty-three percent of the children were classified as amblyopic, 35% as having uncorrected refractive error, 36% as normal, and 6% as other. Visual acuity test results were converted to logarithm of minimal angle of resolution (logMAR) units for analysis. RESULTS: In developmentally normal children (n = 230), testability was 100% for HOTV in 5- to 12-year-olds and 100% for E-ETDRS in 7- to 12-year-olds. The E-ETDRS testing could be completed in 52% of 5-year-olds and in 87% of 6-year-olds. Visual acuity performance was better when measured by HOTV compared with E-ETDRS (median difference 0.06 logMAR [three letters on a chart with five letters/line], P =.0001), and the difference was found in normal eyes, eyes with refractive error, and amblyopic eyes. CONCLUSIONS: The ATS HOTV protocol yields slightly better visual acuity performance compared with E-ETDRS in 5- to 12-year-olds, but on average by less than a logMAR level. This systematic difference is important when a physician changes testing modality as a child matures and should be considered when interpreting the results of recent and ongoing clinical trials in amblyopia.

Amblyopia↗

Use of a personal digital assistant to monitor surgery student work and sleep hours.

BACKGROUND: We developed a personal digital assistant (PDA)-based program to assess compliance with our medical student work hours policy, and to correlate work hours with sleep and performance. METHODS: Medical students on surgery clerkship logged real-time work and sleep hours for 1 week. Estimated work hours, clinical evaluations, and score on the National Board of Medical Examiners (NBME) surgery examination were recorded. RESULTS: Thirty-seven students logged work hours, which correlated poorly with estimated work hours and sleep hours. The majority of students overestimated work hours by a mean of 19.5 hours. Twenty-four students transgressed written policy. Increased in-hospital study hours correlated with improved clinical ratings but poorer NBME examination scores. Increased operating room hours correlated with higher NBME examination scores. CONCLUSIONS: Medical students inaccurately estimate work hours; a PDA-based log facilitates hours monitoring. Unenforced work hour policies are frequently transgressed. Work activity patterns, but not total work hours, correlated with outcomes on standardized written tests and clinical ratings.

Clinical Clerkship↗

Telemetric electrochemical sensor.

A telemetric system was designed and constructed to sense pH and ethanol variation in aqueous solutions. The measured signals were transferred by software digitally and transmitted wirelessly by the telemeter, personal digital assistant (PDA), through the General Packet Radio Service (GPRS) protocol. The pH sensing electrode was designed to measure a chemical potential induced by a proton concentration gradient on the electrode's surface which exhibits internal Donnon diffusion behavior, and a linear relationship between the electrical potential and pH was found. The result shows that the wireless sensing system allowed not only long-term usage and long-distance transmission but also with high accuracy (e.g. S.D. less than +/-2%). The telemetric system can also be modified to measure ethanol concentration in aqueous solution amperometrically. It was found that the sensitivity of that ex situ measurements matched those of in field measurements with negligible deviation, less than 4%.

Cell Phone↗

Monitoring methods: SNAP.

The SNAP electroencephalogram (EEG) monitor, described as an interesting, innovative EEG tool that samples raw EEG signals and uses its own unique algorithm, analyses both high- (80-420 Hz) and low- (0-20 Hz) frequency components of the signal. This is termed the SNAP index, and it ranges from 100 (arbitrarily representing the fully awake state) to 0 to provide functional data points for patient management. The SNAP is the first commercial EEG-monitoring tool to use Personal Digital Assistant computer technology. The first version of SNAP index was introduced in 2002, and so far there has been little experience with the SNAP device reported in the literature. Compared with other EEG devices, there is no evidence that SNAP is superior to others in generating more specific information about 'depth of sedation'. Moreover, the influence of high-frequency electromyographic activity on the SNAP needs to be clarified.

Algorithms↗

Intraclass correlation coefficients for cluster randomized trials in primary care: the cholesterol education and research trial (CEART).

Cluster randomization trials are increasingly being used in primary care research. The main feature of these trials is that patients are nested within large clusters such as physician practices or communities and the intervention is applied to the cluster. This study design necessitates calculation of intraclass correlation coefficients in order to determine the required sample size. The purpose of this study is to determine intraclass correlation coefficients for a number of outcome measures at the primary care practice level. The CEART study is a randomized trial testing the effectiveness of translating ATP III guidelines into clinical practice, with primary care physician practices as the unit of randomization and patients as the unit of data collection. The intraclass correlation coefficient (ICC) was<0.02 and the design effect ranged from 1.0 to 2.3, respectively, for weight, total cholesterol, LDL, non-HDL, glucose, creatinine, and % at non-HDL goal. For smoking status, body mass index, systolic blood pressure, HDL cholesterol triglycerides, total cholesterol/HDL ratio and % at LDL goal, the ICC was 0.02-0.047 and the design effect was 2.6-4.1. The largest ICCs (0.05-0.12) and design effects (4.4-9.4) were found for height and diastolic blood pressure. These findings suggest that cluster randomization may substantially increase the sample size necessary to maintain adequate statistical power for selected outcomes such as diastolic blood pressure studies compared with simple randomization for most outcomes evaluated in this study where the design effect is small to moderate. Overall, the ICCs presented will be useful in calculating sample sizes at the primary care level.

Adult↗

MobileNurse: hand-held information system for point of nursing care.

Healthcare information travels with patients and clinicians and therefore the need for information to be ubiquitously available is key to reliable patient care and reliable medical systems. We have implemented MobileNurse, a prototype point-of-care system using PDA. MobileNurse has four modules each of which performs: (1) patient information management; (2) medical order check; (3) nursing recording; and (4) nursing care plan. MobileNurse provides easy input interface and various outputs for nursing records. The system consists of PDAs and a mobile support system (MSS) which supports clinical data exchange between PDAs and hospital information system. Two synchronization modules have been developed to keep the patient data consistent between PDAs and MSS. Clinical trials were performed with six volunteered nurses. They tried MobileNurse for 1-day caring-simulated patients. According to the survey after the trials, most of volunteers agreed that MobileNurse is more helpful and convenient than other non-mobile care systems to check medical orders and retrieve the results of recent clinical tests at the bedside. Through the involvement, we found out that ease-to-use interface is the most critical successful factor for mobile patient care systems.

Computer Systems↗

Development of a personal digital assistant-based wireless application in clinical practice.

PURPOSE: Our study aims to develop a personal digital assistant (PDA)-based wireless application in medical information processing by using Bluetooth and IEEE 802.11b wireless standards and SyncML codes. METHODS: In this study, an "integrated database access module" is used to provide a unified integrated access interface while consistency of wireless data transmission is achieved by using the standardized SyncML protocol. A prototype of the system has been developed, implemented, and tested for its mobility, usability, stability, and performance with questionnaire survey. RESULTS: Response time for browsing/searching was usually less than 3s. The average time intervals needed for data transmissions were 68.6+/-8.5s for Bluetooth and 47.0+/-4.8s for 802.11b. The five-point Likert scale (from 1=least to 5=most) questionnaire survey of 30 medical professionals yielded a high degree of satisfaction with the system's mobility (4.18+/-0.89), usability (4.69+/-0.90), stability (3.81+/-0.94), and performance (3.97+/-0.88). CONCLUSION: The results of our study suggested that PDA applications which exploit wireless communication are convenient and feasible in clinical practice.

Computers, Handheld↗

Long-term monitoring of gait in Parkinson's disease.

A new system for long-term monitoring of gait in Parkinson's disease (PD) has been developed and validated. The characteristics of every stride taken over 10-h epochs were acquired using a lightweight ankle-mounted sensor array that transmitted data wirelessly to a small pocket PC at a rate of 100 Hz. Stride was calculated from the vertical linear acceleration and pitch angular velocity of the leg with an accuracy of 5 cm. Results from PD patients (5) demonstrate the effectiveness of long-term monitoring of gait in a natural environment. The small, variable stride length characteristic of Parkinsonian gait, and fluctuations of efficacy associated with levodopa therapy, such as delayed onset, wearing off, and the 'off/on' effect, could reliably be detected from long-term changes in stride length.

Adult↗