Equipping primary care physicians for the digital age. The Internet, online education, handheld computers, and telemedicine.
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Computers↗
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Results for “Computers, Handheld”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
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The handheld computer in critical care medicine.
The wealth of information that can be generated from programmable pocket calculators is not widely appreciated. These inexpensive devices have evolved into "user-friendly" microcomputers with impressive memory capacity and mathematic sophistication. A series of critical care programs is presented to illustrate the degree of computer support that is available from the newest generation of programmable pocket calculators. These programs constitute the most comprehensive microcomputer software package reported in the literature. They demonstrate that high-level mathematic capability is available not only in large medical centers, but in virtually any small community hospital as well.
Aminoglycosides↗
Clinical documentation: the handheld computer as a survival tool.
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Humans↗
The anesthesiologist's guide to Palm Computing.
Handheld personal computers (HPCs) are permeating the clinical and personal lives of anesthesia care providers. Common characteristics include low cost, portability, easy PC data sharing, and applications such as a calendar, phone directory, memo pad, and a task list. Additional software includes databases for case logs, medication lists, task organizers, and document readers. This article discusses the Palm brand HPC (Palm Computing, A 3Com Company, Santa Clara, CA) including purchasing tips, common uses, backing up information, security concerns, and information resources on the Internet including websites providing free trial software.
Anesthesiology↗
Design and development of a mobile system for supporting emergency triage.
OBJECTIVES: Our objective was to design and develop a mobile clinical decision support system for emergency triage of different acute pain presentations. The system should interact with existing hospital information systems, run on mobile computing devices (handheld computers) and be suitable for operation in weak-connectivity conditions (with unstable connections between mobile clients and a server). METHODS: The MET (Mobile Emergency Triage) system was designed following an extended client-server architecture. The client component, responsible for triage decision support, is built as a knowledge-based system, with domain ontology separated from generic problem solving methods and used for the automatic creation of a user interface. RESULTS: The MET system is well suited for operation in the Emergency Department of a hospital. The system's external interactions are managed by the server, while the MET clients, running on handheld computers are used by clinicians for collecting clinical data and supporting triage at the bedside. The functionality of the MET client is distributed into specialized modules, responsible for triaging specific types of acute pain presentations. The modules are stored on the server, and on request they can be transferred and executed on the mobile clients. The modular design provides for easy extension of the system's functionality. A clinical trial of the MET system validated the appropriateness of the system's design, and proved the usefulness and acceptance of the system in clinical practice. CONCLUSIONS: The MET system captures the necessary hospital data, allows for entry of patient information, and provides triage support. By operating on handheld computers, it fits into the regular emergency department workflow without introducing any hindrances or disruptions. It supports triage anytime and anywhere, directly at the point of care, and also can be used as an electronic patient chart, facilitating structured data collection.
Acute Disease↗
Comparison of handheld computer-assisted and conventional paper chart documentation of medical records. A randomized, controlled trial.
BACKGROUND: Daily documentation and maintenance of medical record quality is a crucial issue in orthopaedic surgery. The purpose of the present study was to determine whether the introduction of a handheld computer could improve both the quantitative and qualitative aspects of medical records. METHODS: A series of consecutive patients who were admitted for the first time to a thirty-six-bed orthopaedic ward of an academic teaching hospital for a planned operation or any other treatment of an acute injury or chronic condition were randomized to daily documentation of their clinical charts on a handheld computer or on conventional paper forms. The electronic documentation consisted of a specially designed software package on a handheld computer for bedside use with structured decision trees for examination, obtaining a history, and coding. In the control arm, chart notes were compiled on standard paper forms and were subsequently entered into the hospital's information system. The number of documented ICD (International Classification of Diseases) diagnoses was the primary end point for sample size calculations. All patient charts were reread by an expert panel consisting of two surgeons and the surgical quality assurance manager. These experts assigned quality ratings to the different documentation systems by scrutinizing the extent and accuracy of the patient histories and the physical findings as assessed by daily chart notes. RESULTS: Eighty patients were randomized to one of the two documentation arms, and seventy-eight (forty-seven men and thirty-one women) of them were eligible for final analysis. Documentation with the handheld computer increased the median number of diagnoses per patients from four to nine (p < 0.0001), but it produced some overcoding for false or redundant items. Documentation quality ratings improved significantly with the introduction of the handheld device (p < 0.01) with respect to the correct assessment of a patient's progress and translation into ICD diagnoses. Various learning curve effects were observed with different operators. Study physicians assigned slightly better practicability ratings to the handheld device. CONCLUSIONS: The preliminary data from this study suggest that handheld computers may improve the quality of hospital charts in orthopaedic surgery. LEVEL OF EVIDENCE: Therapeutic study, Level I-1a (randomized controlled trial [significant difference]). See Instructions to Authors for a complete description of levels of evidence.
Adult↗
Use and perceived benefits of handheld computer-based clinical references.
OBJECTIVE: Clinicians are increasingly using handheld computers (HC) during patient care. We sought to assess the role of HC-based clinical reference software in medical practice by conducting a survey and assessing actual usage behavior. DESIGN: During a 2-week period in February 2005, 3600 users of a HC-based clinical reference application were asked by e-mail to complete a survey and permit analysis of their usage patterns. The software includes a pharmacopeia, an infectious disease reference, a medical diagnostic and therapeutic reference and transmits medical alerts and other notifications during HC synchronizations. Software usage data were captured during HC synchronization for the 4 weeks prior to survey completion. MEASUREMENTS: Survey responses and software usage data. RESULTS: The survey response rate was 42% (n = 1501). Physicians reported using the clinical reference software for a mean of 4 years and 39% reported using the software during more than half of patient encounters. Physicians who synchronized their HC during the data collection period (n = 1249; 83%) used the pharmacopeia for unique drug lookups a mean of 6.3 times per day (SD 12.4). The majority of users (61%) believed that in the prior 4 weeks, use of the clinical reference prevented adverse drug events or medication errors 3 or more times. Physicians also believed that alerts and other notifications improved patient care if they were public health warnings (e.g. about influenza), new immunization guidelines or drug alert warnings (e.g. rofecoxib withdrawal). CONCLUSION: Current adopters of HC-based medical references use these tools frequently, and found them to improve patient care and be valuable in learning of recent alerts and warnings.
Adult↗
Using handheld pocket computers in a wireless telemedicine system.
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Attitude of Health Personnel↗
A review of randomized controlled trials comparing the effectiveness of hand held computers with paper methods for data collection.
BACKGROUND: Handheld computers are increasingly favoured over paper and pencil methods to capture data in clinical research. METHODS: This study systematically identified and reviewed randomized controlled trials (RCTs) that compared the two methods for self-recording and reporting data, and where at least one of the following outcomes was assessed: data accuracy; timeliness of data capture; and adherence to protocols for data collection. RESULTS: A comprehensive key word search of NLM Gateway's database yielded 9 studies fitting the criteria for inclusion. Data extraction was performed and checked by two of the authors. None of the studies included all outcomes. The results overall, favor handheld computers over paper and pencil for data collection among study participants but the data are not uniform for the different outcomes. Handheld computers appear superior in timeliness of receipt and data handling (four of four studies) and are preferred by most subjects (three of four studies). On the other hand, only one of the trials adequately compared adherence to instructions for recording and submission of data (handheld computers were superior), and comparisons of accuracy were inconsistent between five studies. CONCLUSION: Handhelds are an effective alternative to paper and pencil modes of data collection; they are faster and were preferred by most users.
Biomedical Research↗
Handheld computer-based decision support reduces patient length of stay and antibiotic prescribing in critical care.
OBJECTIVE: This study assessed the effect of a handheld computer-based decision support system (DSS) on antibiotic use and patient outcomes in a critical care unit. DESIGN: A DSS containing four types of evidence (patient microbiology reports, local antibiotic guidelines, unit-specific antibiotic susceptibility data for common bacterial pathogens, and a clinical pulmonary infection score calculator) was developed and implemented on a handheld computer for use in the intensive care unit at a tertiary referral hospital. System impact was assessed in a prospective "before/after" cohort trial lasting 12 months. Outcome measures were defined daily doses (DDDs) of antibiotics per 1,000 patient-days, patient length of stay, and mortality. RESULTS: The number of admissions, APACHE (Acute Physiology, Age, and Chronic Health Evaluation) II and SAPS (Simplified Acute Physiology Score) II for patients in preintervention, and intervention (DSS use) periods were statistically comparable. The mean patient length of stay and the use of antibiotics in the unit during six months of the DSS use decreased from 7.15 to 6.22 bed-days (p = 0.02) and from 1,767 DDD to 1,458 DDD per 1,000 patient-days (p = 0.04), respectively, with no change in mortality. The DSS was accessed 674 times during 168 days of the trial. Microbiology reports and antibiotic guidelines were the two most commonly used (53% and 22.5%, respectively) types of evidence. The greatest reduction was observed in the use of beta-lactamase-resistant penicillins and vancomycin. CONCLUSION: Handheld computer-based decision support contributed to a significant reduction in patient length of stay and antibiotic prescribing in a critical care unit.
APACHE↗
Providing context-sensitive decision-support based on WHO guidelines.
A decision support system was developed implementing the WHO guideline for diarrhea management. The decision-support system is integrated into a medical records application on a handheld computer. The system will be used by primary health care workers in rural India. The guideline was encoded as a set of chained rules in CLIPS format. To enhance adherence to guidelines, we use a model based on a context-adapted guideline to provide decision support at the point of care in a particular setting. The purpose of the system is to tailor the recommendations based on the patient's condition and the local factors such as resource availability in order to create feasible uniformity in a practice across different providers of care.
Computers, Handheld↗
The role of title, metadata and abstract in identifying clinically relevant journal articles.
Access to current clinical information involves searches of bibliographic databases, such as MEDLINE, and subsequent evaluation of retrieval results for relevance to a specific clinical situation and quality of the reported research. We establish the amount of information that needs to be provided by an information retrieval system to assist healthcare practitioners in identifying clinically relevant information and evaluating its potential strength of evidence. We find 92% of titles informative enough for a practitioner to correctly classify publications as clinical, but not sufficient for classification of research quality. We suggest automatic organization of retrieval results into strength of evidence categories to supplement title-based judgments and provide quick access to the abstracts of the most promising articles. We find information in the abstracts sufficient to identify articles potentially immediately useful for clinical decision support. These findings are important to the design of information retrieval systems supporting small, low-bandwidth handheld computers.
Abstracting and Indexing↗
A computerised communication aid for people with aphasia.
PURPOSE: To develop a portable computerised communication aid for aphasic people to support communication in everyday life. METHOD: A multidisciplinary team of aphasiologists, augmentative and alternative communication specialists, speech and language therapists and technicians developed a portable, modular system, PCAD (portable communication assistant for people with dysphasia), running on a commercially available handheld computer. The system was tested in a multiple case study. Aphasia therapy services In the UK, Portugal and The Netherlands referred 28 people with aphasia, who were considered eligible for a computerised communication aid. Participants were trained following a protocol and used the device in self-chosen real life settings. RESULTS: Six of the 28 selected aphasic patients decided not to test the device; 22 participated in the training. All 22 learned to operate the aid, 17 used it functionally, in everyday life. Five people did not use the aid outside the therapy room, although they were able to operate the aid and to use it in role play. These unsuccessful clients were younger, and tended to have a shorter duration of the aphasia. CONCLUSIONS: Carefully selected aphasic patients may benefit from a computerised communication aid, using it functionally in everyday communicative settings.
Adult↗
Electronic diaries and questionnaires: designing user interfaces that are easy for all patients to use.
We propose a set of requirements for designing handheld computer systems for electronic collection of patient diary and questionnaire data in clinical trials: (1) the system should be suitable for use by all types of patient to be included in the clinical trial programme; (2) patients must be capable of using the system and be comfortable with it after a short period of training; (3) responses should always result from an action by the user--defaults should not be taken as data; (4) all information necessary to a given question should be simultaneously available on the screen. This applies to both the questions and the response options. We present guidelines as to how these requirements may be met in practice, so that bias may be avoided both in patient selection and in the responses made; so that electronic data collection may be as effective as possible, and so that study procedures are convenient and unobtrusive for the patients.
Computers, Handheld↗
Location-aware access to hospital information and services.
Hospital workers are highly mobile; they are constantly changing location to perform their daily work, which includes visiting patients, locating resources, such as medical records, or consulting with other specialists. The information required by these specialists is highly dependent on their location. Access to a patient's laboratory results might be more relevant when the physician is near the patient's bed and not elsewhere. We describe a location-aware medical information system that was developed to provide access to resources such as patient's records or the location of a medical specialist, based on the user's location. The system is based on a handheld computer which includes a trained backpropagation neural-network used to estimate the user's location and a client to access information from the hospital information system that is relevant to the user's current location.
Algorithms↗
Integration of a handheld based anaesthesia rounding system into an anaesthesia information management system.
BACKGROUND: At the University Hospital Giessen, an anesthesia information management system (AIMS) is used for online record keeping of perioperative patient care, but preoperative anaesthesia assessments were still being recorded on paper and subsequently entered into the AIMS. Personal digital assistants (PDAs) seem to be useful instruments to establish a seamless digital anesthesiological documentation. OBJECTIVES: We decided to implement a solution for direct integration of data gathered during the preoperative assessment into the existing data management infrastructure. Parallel to the development of the system, we surveyed the future users to match their wishes and needs as far as possible. SYSTEM DESCRIPTION: A C program embedding the preoperative AIMS' data fields was developed. Data alignment with the Hospital information system (HIS) is controlled by a Java desktop software. The anaesthesiologist completes the available fields at the patient's bedside following the same algorithm and integrity check as the PC version. STATUS REPORT: Overall, 68% of the surveyed physicians supported the implementation of the system. The PDA solution has been available since May 2002. Data replication into the handheld and integration of mobile collected data into the AIMS generally work without problems. The HIS interconnection software converts the PDA file into the AIMS format for further processing. DISCUSSION: The preoperative anaesthetic assessment is a standardised task well suitable for conversion to an electronic data storage medium. Changing from redundant data entry in the OR to direct electronic recording at the patient's bedside seems simply logical. Handheld computers are inexpensive, flexible gadgets to realize this.
Anesthesia↗
Using PDAs for data collection.
Advances in handheld computer technology are making data collection faster, easier, and more accurate. In this article, the use of personal digital assistants (PDAs) to collect data for a study on elder neglect is described and evaluated. Methods for integrating this technology into a research study are discussed as are suggestions for increasing the performance of data collectors using these devices. The authors offer some practical solutions for researchers and clinicians planning to use PDAs in their research.
Attitude of Health Personnel↗
The personal digital assistant (PDA) as a tool for telementoring endoscopic procedures.
The telementoring of surgical procedures is currently achieved via a wired infrastructure that usually requires sophisticated videoconference systems. This project represents the first step in assessing the potential for using handheld computers as a mobile alternative to current telementoring systems. Specifically, this project compares a handheld computer to a standard CRT monitor regarding their capability to accurately display video images from an endoscopic procedure. Video images from two previously recorded endoscopic procedures were transmitted from a standard VCR to: 1) a handheld computer (iPAQ 3670 running Pocket PC) via a wireless LAN and 2) a standard CRT monitor via a wired analog connection. The software-used on the handheld device was custom designed to allow 320 X 240 pixel video images to be broadcast in real time. Twenty-three surgical residents who had completed an endoscopy rotation were randomized to watch one of the two videotaped endoscopic procedures on the hand held computer or on the CRT monitor. After viewing the procedure, a ten-question quiz was used to assess the ability of each participant to recognize several anatomic landmarks. The result of each questionnaire was expressed as the percentage of correct responses. Using a crossover design, each participant then viewed the other videotaped procedure using the alternate device and completed a second quiz. The mean test score for each device was calculated, and these data was analyzed using a Student T test. The observed difference between the mean test score associated with the handheld device (77.93 +/- 11.26) and the CRT monitor (81.30 +/- 12.54) was not statistically significant (p<0.41). In addition, regardless of the device used, scores corresponding to video tape one were significantly higher than those recorded for video tape two (84.35 +/- 9.92 vs. 74.35 +/- 11.61; p < 0.01) All participants were able to recognize anatomic landmarks equally well when viewing broadcasted endoscopic procedures on a handheld display or a standard CRT monitor. Handheld computers may have a role in telementoring residents who are performing endoscopic procedures. Further research is needed to evaluate the integration of handheld devices into telementoring and robotic system to perform surgical procedures.
Computers, Handheld↗