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Computers, Handheld↗
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Personal digital assistants in health care: experienced clinicians in the palm of your hand?
Physicians and other health-care professionals are rapidly adopting personal digital assistants (PDA). Palm pilots and other hand-held computers are also increasingly popular among medical students. PDAs can be used for medical student education and physician training, daily clinical practice, and research. PDAs and their increasing integration with information technology in hospitals could change the way health care is delivered in the future. But despite the increasing use of PDAs, evidence from well-designed research studies is still needed to show how much these devices can improve the quality of care, save patients' lives, and ultimately reduce health-care expenses. In this Review of PDA use in health care, the operating systems, basic functionality, security and safety, limitations, and future implications of PDAs are examined. A personal perspective and an introduction to medical PDA applications, software, guidelines, and programmes for health-care professionals is also provided.
Computers, Handheld↗
[Mobile internet].
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Computers, Handheld↗
["Pocket" medicine].
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Clinical Medicine↗
[Use of the Internet in a multicenter study of chronic obstructive pulmonary disease in primary care. Pilot phase of the EFEMAP study].
OBJECTIVE: To determine the reliability of clinical data collection and transmission by Internet in a multicenter primary care study. PATIENTS AND METHODS: Multicenter, observational study of a population of patients with exacerbated chronic obstructive pulmonary disease (COPD). All data were gathered in a specifically designed digital program on a palm-held pocket computer. Information was transmitted on-line by modem to a central database. RESULTS: Thirty-nine researchers participated in this pilot phase. Over three months 324 patients were treated. Thirty-seven telephone consultations were generated, most (54%) in reference to how the digitized questionnaire worked. Questions were solved in a mean 5.44 minutes. No important technical problems occurred and no information was lost. CONCLUSIONS: The use of the Internet to transfer data for multicentric studies in primary care is possible. This system should be more widely used in the future, as it allows faster data collection and eliminates the need to input data at the end of the study.
Acute Disease↗
Comparative study of electronic vs. paper VAS ratings: a randomized, crossover trial using healthy volunteers.
The visual analogue scale (VAS) is an established, validated, self-report measure usually consisting of a 10 cm line on paper with verbal anchors labeling the ends. Palmtop computers (PTCs also known as personal digital appliances) have incorporated VAS entry by use of a touch screen. However, the validity and psychophysical properties of the electronic VAS have never been formally compared with the conventional paper VAS. The aim of this study is to determine the agreement between the electronic (eVAS) and paper (pVAS) modes. Twenty-four healthy volunteers were recruited for this study. Each study participant provided input using both measurement methods by marking the eVAS and pVAS in response to two kinds of stimuli, cognitive and sensory. A verbal rating scale of seven descriptors of intensity represented the cognitive stimuli. Participants were asked to mark the location that best corresponded to the pain intensity described by each word on scales from 'no pain' to 'worst possible pain'. The sensory stimuli used were a set of test weights consisting of plastic containers ranging from 7 to 129 g. The VAS for sensory stimuli ranged from 0 (no weight) to 'reference weight' (the heaviest weight outside the range of test weights). There were two types of input stimuli and two modes for recording responses for a total of four experimental conditions. Two evaluators independently measured and recorded all the pVAS forms to the nearest millimeter. A total of 2016 stimuli were rated. The overall correlation for ratings of both sensory and cognitive stimuli on eVAS and pVAS was r = 0.91. For paired verbal stimuli the correlation was r = 0.97. For paired sensory stimuli the correlation was r = 0.86. The correlation between group eVAS and pVAS ratings to common verbal stimuli was r = 0.99. For common sensory stimuli the group correlation was r = 0.99. The median of correlations comparing eVAS and pVAS ratings was 0.99 for verbal stimuli and 0.98 for sensory stimuli. Multivariate analyses showed equivalent stimuli to be rated much the same whether entered on paper VAS or PTC touch screen VAS (P < 0.0001). Support was found for the validity of the computer version of the VAS scale.
Adult↗
Comparison of commonly used orthopaedic outcome measures using palm-top computers and paper surveys.
INTRODUCTION: Measuring patient-perceived outcomes following orthopaedic procedures have become an important component of clinical research and patient care. General and disease-specific outcomes measures have been developed and applied in orthopaedics to assess the patients' perceived health status. Unfortunately, paper-based, self-administered instruments remain inefficient for collecting data because of: (a) missing data (b) respondent error, and (c) the costs to administer and enter data. OBJECTIVE: To study the comparability of palm-top computer devices and paper-pencil self-administered questionnaires in the collection of health-related quality of life (HRQL) information from patients. METHODS: The comparability of administering HRQL questionnaires using palm-top computer and traditional paper-based forms was tested in a sample of 96 patients with complaints of hip and/or knee pain. Each patient completed mailed versions of the Medical Outcomes Study (MOS), 36-item Health Survey (SF-36), and Western Ontario and McMasters University Arthritis Index (WOMAC) three weeks prior to presenting to clinic. At the clinic they were asked to complete the same outcomes measures using the palm-top computer or a paper-and-pencil version. ANALYSIS: In the analysis, scale distributions, floor and ceiling effects, internal consistency and retest reliability of scales were compared across the two data collection methods. Because the baseline characteristics of the groups were not strictly comparable according to age, the data were analyzed for the entire sample and stratified according to age. RESULTS: Few statistically significant differences were found for the means, variances and intra-class correlation coefficients between the methods of administration. While the scale distribution between the two methods was comparable, the internal consistency of the scales was dissimilar. CONCLUSIONS: Administration of HRQL questionnaires using portable palm-top computer devices has the potential advantage of decreased cost and convenience. These data lend some support for the comparability of palm-top computers and paper surveys for outcomes measures widely used in the field of orthopaedic surgery. The present study identified the lack of reliability across modes of administration that requires further study in a randomized comparability trial. These mode effects are important for orthopaedic surgeons to appreciate before implementing innovative data-capture technologies in their practices.
Aged↗
[Data recording using a personal digital assistant. Experience of prospective survey on pain in 3196 patients].
OBJECTIVE: To assess the interest of a personal digital assistant (PDA) when used as data collector in a prospective survey on pain in general practice. METHODS: Prospective, multicentre and national survey concerning the identification of 4g/24h paracetamol prescription conditions as well as the characterization of the pain justifying it. Data were collected with a dedicated PDA including an electronic visual analogue scale (VAS). It also included a data controlling program of probability, consistency, date recording and time of data entry. RESULTS: 3.196 patients were enrolled by 830 general practitioners (GPs). For 1.066 of them enrolled by 277 GPs, the consistency analysis showed an a posteriori data entry. However, for assessment of pain intensity using the VAS, the physical presence of the patient is mandatory because self-evaluation is the rule. CONCLUSION: The use of an electronic questionnaire permits the collection of good quality data and the possibility of a posteriori control and hence the identification of breaches in clinical trial protocols.
Acetaminophen↗
Collaborative environment for clinical reasoning and distance learning sessions.
BACKGROUND: The medical curriculum has changed with the adoption of the student-centered learning paradigm. Clinical reasoning learning (CRL) is used in order to develop and improve students' clinical reasoning and problem-solving skills. PURPOSE: We have observed that, in complement to traditional CRL sessions, students commonly consult resources available on the internet. Based on this observation, our objective is to create computer tools to coordinate CRL sessions at distance, integrating these electronic resources at every step of the reasoning process. MATERIAL AND METHODS: In order to create the system, we elaborated an object-oriented model of a computer-supported collaborative learning environment. The proposed system includes a local web-server to store electronic resources and a relational database to store their electronic addresses (urls). JAVA was used as the programming language. RESULTS: We developed a set of cooperative platform-independent tools. This environment includes a communication tool. Multimedia data exchange is possible. Information is shared thanks to an electronic notepad and whiteboard tools. PERSPECTIVES: This learning environment will be integrated in the French Virtual Medical University project, and is intended to be used for undergraduate, internships, residency or continuing medical education.
Computers, Handheld↗
Information-to-go: publishing organization-specific information for personal digital assistants.
A Web-based resource enables staff to access to patient management information.
Computers, Handheld↗
Mood- and restraint-based antecedents to binge episodes in bulimia nervosa: possible influences of the serotonin system.
BACKGROUND: In bulimic syndromes, binge episodes are thought to be caused by dietary restraint and negative moods. However, as central serotonin (5-hydroxytryptamine: 5-HT) mechanisms regulate appetite and mood, the 5-HT system could be implicated in diet- and mood-based binge antecedents. METHOD: We used hand-held computers to obtain repeated "online" measurements of eating behaviors, moods, and self-concepts in 21 women with bulimic syndromes, and modeled 5-HT system activity with a measure of platelet [3H]paroxetine-binding density. RESULTS: Mood and self-concept ratings were found to be worse before binge episodes (than at other moments), and cognitive restraint was increased. After binges, mood and self-concept deteriorated further, and thoughts of dieting became more intense. Intriguingly, lower paroxetine-binding density predicted poorer mood and self-concept before a binge, larger post-binge decrements in mood and self-concept, and larger post-binge increases in dietary restraint. CONCLUSIONS: Paroxetine binding thus seemed to reflect processes that impacted upon mood-related antecedents to binge episodes, and consequences implicating mood and dietary restraint.
Adult↗
Environmental implications of wireless technologies: news delivery and business meetings.
Wireless information technologies are providing new ways to communicate, and are one of several information and communication technologies touted as an opportunity to reduce society's overall environmental impacts. However, rigorous system-wide environmental impact comparisons of these technologies to the traditional applications they may replace have only recently been initiated, and the results have been mixed. In this paper, the environmental effects of two applications of wireless technologies are compared to those of conventional technologies for which they can substitute. First, reading newspaper content on a personal digital assistant (PDA) is compared to the traditional way of reading a newspaper. Second, wireless teleconferencing is compared to business travel. The results show that for both comparisons wireless technologies create lower environmental impacts. Compared to reading a newspaper, receiving the news on a PDA wirelessly results in the release of 32-140 times less CO2, several orders of magnitude less NOx and SOx, and the use of 26-67 times less water. Wireless teleconferencing results in 1-3 orders of magnitude lower CO2, NOx, and SO2 emissions than business travel.
Commerce↗
Data security issues arising from integration of wireless access into healthcare networks.
The versatility of having Ethernet speed connectivity without wires is rapidly driving adoption of wireless data networking by end users across all types of industry. Designed to be easy to configure and work among diverse platforms, wireless brings online data to mobile users. This functionality is particularly useful in modern clinical medicine. Wireless presents operators of networks containing or transmitting sensitive and confidential data with several new types of security vulnerabilities, and potentially opens previously protected core network resources to outside attack. Herein, we review the types of vulnerabilities, the tools necessary to exploit them, and strategies to thwart a successful attack.
Computer Communication Networks↗
Testing the usability of two automated home-based patient-management systems.
To explore to what extent observation and semistructured in-depth interviews provide effective tools for usability testing of two automated home-based systems aimed at monitoring patients' health status at home and improving self-care. Telephone-Linked Care for Diet Adherence in Dyslipidemia (TLC-DietAid) used computer telephony to interact with users and Home Asthma Telemonitoring System (HAT System) used a combination of Personal Digital Assistant (palmtops) and the Internet for similar purposes. Both systems were evaluated in two separate pilot studies. Our pilot studies uncovered "medium-specific" and "content-specific" issues that addressed either the process of the interaction or its content. The results demonstrated that patient-users tended to evaluate each system on the basis of how it fit into everyday life and corresponded to personal preferences. The methodology also allowed the system designers to understand users' concerns and the context of adoption in order to introduce necessary changes to the design to address such concerns.
Asthma↗
Information technology in the future of health care.
Technology advances have changed the face of health care. This paradigm shift blurred the boundaries between public health, acute care, and prevention. Technology's role in the diagnosis, treatment assignment, follow-ups, and prevention will be reviewed and future impact projected. The understanding of shift in our expectation for each aspect of health care is critical so that levels of success are understood. Technology advances in health care delivery will be discussed. Specific applications are presented and explained and future trends discussed. Four applications are defined, and related to categories of technologies and their attributes.
Artificial Intelligence↗
The morning after: limit violations and the self-regulation of alcohol consumption.
The authors examined whether the reciprocal relationship between alcohol consumption and distress unfolded over time in 2 samples of social drinkers. Participants monitored their alcohol intake and their cognitive and emotional responses to that drinking on hand-held computers. On mornings after drinking, those who had violated their self-imposed limits the day before reported more guilt, even after controlling for acute negative symptoms of drinking and amount consumed. Reciprocally, guilt led to poorer self-regulation of alcohol intake: Greater distress over alcohol consumption was linked to more intake, intoxication, and more limit violations. Individual differences moderated the relationships among limit violations, distress, and drinking. Consistent with the limit violation effect, violating a limit produced distress over consumption among social drinkers, and they responded to that distress by drinking more.
Adult↗
Using diary methods to study marital and family processes.
Diary methods allow researchers to study marital and family processes within the context of daily life in a way that is not possible with more traditional methods. The authors review applications of diary designs in marital and family research and detail the types of research questions that can uniquely be asked of dyadic/family diary data. Technological developments for the use of electronic palm-top devices for implementing diary methods are also reviewed. Additionally, the authors discuss specific issues relevant to the analysis of diary data that come from dyads or families. Last, the authors raise unresolved issues and directions for future research in the use of diary methods for studying marital and family processes.
Behavioral Research↗
Correlates of within-person (across-occasion) variability in reaction time.
A total of 420 adults between 18 and 91 years of age carried palm pilot (Palm M100; PalmOne, Milpitas, CA) devices and performed several reaction time trials when prompted at random times during the day. On the average, within-person variability in median reaction time from one occasion to the next was nearly the same magnitude as the between-persons variability in across-occasion mean reaction time. Analyses controlling the variation in one variable when examining relations involving the other variable suggested that an individual's mean reaction time is a more powerful predictor of relations with age and with the level of various cognitive abilities than his or her across-occasion SD.
Adult↗