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The design and evaluation of clinical decision support systems in the area of pharmacokinetics.

Gentamicin, an antibiotic drug, can be used in one-sided (unilateral) Meniere's disease to end frequent attacks of spontaneous disabling vertigo. However, with incorrect dose treatment it can profoundly damage patients' inner ear and kidney. The dosage of medication and the dosage interval will affect serum concentration that results therapeutic or damage. Pharmacokinetics is the study of managing the relationship between the dosage medication, dosing interval, and serum concentration. However, due to the complicated mathematical equations of pharmacokinetics, it is rarely used in clinics. The purpose of this study was to use a pharmacokinetics model to build a prototype of gentamicin CDSS embedded in a PDA. This system was implemented in a district teaching hospital in Chiayi area, Taiwan. Empirical data was collected under routine clinical setting with real patients and physicians to validate this CDSS. The research results showed that, considering the therapeutic effect, the pharmacokinetics-based CDSS outperforms physicians' experience. Regarding the intoxication, the pharmacokinetics-based CDSS also performed better than physicians' experience with less intoxication. The physicians using the system revealed a high degree of agreement with the perceived usefulness, perceived ease of use, and intention to use the pharmacokinetics-based CDSS.

Computers, Handheld↗
PubMed2003

24-hour assessment of performance on a palmtop computer: validating a self-constructed test battery.

A test battery was constructed on a palmtop computer for ambulatory purposes. This study explored whether the test battery could assess circadian rhythmicity underconstant routine conditions. Performance, body temperature, and subjective sleepiness of 12 healthy subjects were measured. The test battery consisted of a sleepiness questionnaire and three performance tests: a vigilance detection test, a working memory test, and a choice-reaction time test. The subjects were divided into early-start and late-start groups and were subjected to the constant-routine protocol. All tests showed a trough in performance in the early morning around 07:00h and a peak in the evening between 21:00 and 23:00h. In addition, an afternoon decrement in performance was observed between 15:00 and 17:00h. On average, the circadian (peak-to-trough) variation of the performance variables amounted to 16.9% +/- 1.7 SEM of the maximum across subjects. The late starters showed a larger impairment in performance during the morning than the early starters. This could be attributed to prior wakefulness. The characteristics of the performance rhythms found in this study replicate findings in several other studies carried out under constant routine conditions. In conclusion, the present test battery appeared to be a good tool for future assessment of performance under natural conditions.

Adolescent↗
PubMed2004

Colonization of personal digital assistants carried by healthcare professionals.

This study evaluated personal digital assistant (PDA) microbial colonization before and after cleaning with alcohol. Samples from 75 PDAs were processed. Before cleaning, 96% of the samples were culture positive. After cleaning, 75% became culture negative. PDAs cleaned with an alcohol swab demonstrated significant reduction in colonization.

Bacteria↗
PubMed2004

Closing the loop: the adicol experience.

The objective of the project Advanced Insulin Infusion using a Control Loop (ADICOL) was to develop a treatment system that continuously measures and controls the glucose concentration in subjects with type 1 diabetes. The modular concept of the ADICOL's extracorporeal artificial pancreas consisted of a minimally invasive subcutaneous glucose system, a handheld PocketPC computer, and an insulin pump (D-Tron, Disetronic, Burgdorf, Switzerland) delivering subcutaneously insulin lispro. The present paper describes a subset of ADICOL activities focusing on the development of a glucose controller for semi-closed-loop control, an in silico testing environment, clinical testing, and system integration. An incremental approach was adopted to evaluate experimentally a model predictive glucose controller. A feasibility study was followed by efficacy studies of increasing complexity. The ADICOL project demonstrated feasibility of a semi-closed-loop glucose control during fasting and fed conditions with a wearable, modular extracorporeal artificial pancreas.

Blood Glucose↗
PubMed2004

Information support for the ambulant health worker.

Health workers are trained to work in information-rich environments. Nineteen medical students evaluated 2700 patients in four villages in Kenya where there was no power or phone. A model of information support included personal digital assistants (PDA), electronic medical records (EMR), satellite telecommunications, medical software, and solar power. The students promptly found the advantages of PDA over paper. By using software for decision support and interacting with the EMR data for medical expertise, very few live telemedicine consults were needed. The cost of this information support was only US 0.28 dollars per patient visit. We conclude information resources can be provided in remote environments at reasonable cost.

Attitude to Computers↗
PubMed2005

Validation of rule-based inference of selected independent activities of daily living.

This paper explores the validity of a rule-based inference method of selected independent activities of daily living (ADLs). An inexpensive ADL monitoring system was installed in the community for 37 days to monitor a middle-aged, healthy individual living alone. The subject was given a personal digital assistant (PDA), running custom activity diary software, and asked to record activities in real-time. Rule-based activity inference algorithms were refined on data from 17 days, and data from the remaining 20 days were used for validation. The chisquare statistic was computed for 2 x 2 contingency tables comparing activities detected by the algorithms to user-logged activities. The phi (r()) and Cohen's kappa (kappa) coefficients were computed as measures of correlation. After correcting for subject noncompliance in logging activities, the kappa correlation between the meal detection algorithm and the PDA record was 0.84, with 91% sensitivity, and 100% specificity. Similarly, the kappa correlation between the shower detection algorithm and the PDA record is 0.69, with 67% sensitivity and 100% specificity. The detection algorithms and the sensory data did not miss any main meals or showering activities recorded on the PDA. The results suggest that rule-based algorithms can successfully detect meal preparation and showering activities using simple low-cost detectors. The sensors and detection algorithms reported events not recorded by the occupant on the PDA attributed to reporting noncompliance. Overall, the PDA activity journal was a compromise between paper diaries, which are more time consuming to keep, and may result in higher noncompliance errors, and video recording, which is considered intrusive.

Activities of Daily Living↗
PubMed2006

Battlefield Medical Information System-Tactical (BMIST): the application of mobile computing technologies to support health surveillance in the Department of Defense.

This paper discusses the innovation process of the Battlefield Medical Information System- Tactical (BMIST), a point-of-care mobile computing solution for reducing medical errors and improving the quality of care provided to our military personnel in the field. In such remote environments, medical providers have traditionally had limited access to medical information, a situation quite analogous to that in remote areas of underdeveloped or developing countries. BMIST provides an all-in-one suite of mobile applications that empowers providers via access to critical medical information and powerful clinical decision support tools to accurately create an electronic health record (EHR). This record is synchronized with Department of Defense (DOD) joint health surveillance and medical information systems from the earliest echelons of care through chronic care provided by the Veterans Administration. Specific goals met in the initial phase were: integration of the PDA and wireless interface; development of the local application and user interface; development of a communications infrastructure and development of a data storage and retrieval system. The system had been used extensively in the field to create an EHR far forward that supports a longitudinal medical record across time and across all elements of the Military Healthcare System.

Computers, Handheld↗
PubMed2005

Palmtop-assisted self-interviewing for the collection of sensitive behavioral data: randomized trial with drug use urine testing.

Palmtop-assisted self-interviewing (PASI) may provide a cheaper and more mobile alternative to audio-computer-assisted self-interviewing (ACASI) for collecting sensitive behavioral data. To evaluate PASI, in late 2002 the authors enrolled 1,283 Thai students aged 15-21 years in a randomized trial. Data collection used PASI, ACASI, self-administered questionnaire, and face-to-face interview in combination with drug-use urine testing. By use of reported levels of behaviors and agreement between self-reports of smoking and urine test results, PASI and ACASI (alpha = 0.05) were compared for noninferiority, and PASI and interview were compared for superiority (alpha = 0.05). Noninferiority of PASI was demonstrated by use of self-reports of the most sensitive areas of sexual behavior (e.g., oral sex, sexual intercourse, commercial sex, history of genital ulcers, pregnancy), as well as self-reports of less sensitive behaviors (e.g., alcohol use, dietary behaviors, symptoms of depression). Data generally showed noninferiority of PASI, ACASI, and self-administered questionnaires when compared with each other and superiority of PASI, ACASI, and self-administered questionnaires when compared with interviews. PASI agreements between self-reports of tobacco smoking and presence of nicotine metabolites in urine were noninferior to ACASI and superior to interviews. The establishment of PASI noninferiority and superiority using behavioral and biologic measures suggests that PASI is a scientifically acceptable alternative for collecting sensitive behavioral data.

Adolescent↗
PubMed2003

Using personal digital assistants to document pharmacist cognitive services and estimate potential reimbursement.

The use of personal digital assistants (PDAs) to document pharmacist cognitive services and estimate potential reimbursement was studied. Between September 2001 and February 2002, four pharmacy residents and four clinical pharmacists used PDAs for documenting cognitive services. Interventions recorded on paper during the same six-month period one year earlier were reviewed for comparison. Potential reimbursement for these services was calculated by linking current procedural terminology codes and charges to the electronically documented services. Over the six-month study period, pharmacists recorded 7319 interventions with PDAs, compared with 5028 documented on paper during the earlier six-month period. Potential claims for pharmacists' cognitive services documented with PDAs amounted to more than $1 million in the six months, assuming a 100% reimbursement rate. PDAs provide a simple, efficient paperless system for documenting pharmacists' clinical services and generating reimbursement claims.

Computers, Handheld↗
PubMed2004

Evaluation of drug information databases for personal digital assistants.

PURPOSE: Core and supplemental drug information databases available for use with personal digital assistants (PDAs) were evaluated. METHODS: Ten core (or standalone) databases, six drug interaction analyzers, and three dietary supplement databases used with the Palm and Pocket PC operating systems were selected for study. The databases were rated for scope (the absence or presence of an answer to a drug information question), completeness (the comprehensiveness of an answer), and ease of use (the number of hypertext links needed to reach the desired answer). A total of 14 weighted categories, consisting of 146 and 30 drug questions for the core and supplemental databases, respectively, were used to determine the overall scores. RESULTS: The best overall performers were, in order of total scores, Lexi-Drugs Platinum, Tarascon Pocket Pharmacopoeia, ePocrates Rx Pro, and Clinical Pharmacology OnHand. The databases with the lowest composite scores were Triple i Prescribing Guide and A2Z Drugs. CONCLUSION: Drug information databases for PDAs varied in scope, completeness, and ease of use. The results may help clinicians find the most appropriate product for their practice setting.

Computers, Handheld↗
PubMed2004

Evaluation of personal digital assistant software for drug interactions.

PURPOSE: The accuracy, comprehensiveness, and ease of use of drug interaction software used with personal digital assistants (PDAs) were studied. METHODS: Each program was assessed for accuracy using 40 clinically important and 40 clinically unimportant drug interaction pairs. Accuracy was scored through the summation of software sensitivity, specificity, and positive and negative predictive values. The comprehensiveness of each program was determined by the number of components in the drug interaction monograph. Time needed to identify the management of five important drug interactions defined each program's ease of use. The aggregate scores for accuracy, comprehensiveness, and ease of use were calculated. RESULTS: Scoring 777 and 756 out of a possible 800 points, iFacts and Lexi-lnteract, respectively, provided the most competent, complete, use-friendly compendia for assessment of drug interactions. Mosby's Drug Consult and Mobile Micromedex ranked third and fourth, scoring 688 and 655 points, respectively, while ePocrates Rx v. 6.0 rated seventh, with a score of 559. All drug interaction resources suffer from limitations in the quality or relevance of evidence for the interaction, an absence of identifiable patient and medication risk factors, and a lack of standardization in assigning significance to the interaction. Consequently, clinicians must interpret the importance of the interaction based on all available evidence. Discussion of such evidence was available for only iFacts and Lexi-Interact. CONCLUSION: Both iFacts and Lexi-Interact excelled as PDA pharmacopoeia for assessing drug interactions. However, clinicians should understand the limitations of all current drug interaction resources and exercise vigilance in prevention and recognition of interactions relevant to their patients.

Computers, Handheld↗
PubMed2005

Curriculum design and program to train older adults to use personal digital assistants.

PURPOSE: The aim of this study was to demonstrate that many older adults can share in the potential benefits of using a personal digital assistant (PDA), including using the device as a memory aid for addresses and appointments, to improve medication adherence, and as a useful organizational tool and communication device. DESIGN AND METHODS: A curriculum, designed specifically for older adults, was developed that provided the necessary information and practice to use the technology. The degree to which the curriculum improved user skills was measured by testing participants on basic and advanced features of each of the standard PDA programs. RESULTS: Participants were successful in using the technology and indicated satisfaction with the medication-reminder program specifically designed to accommodate the needs of older adults. IMPLICATIONS: The PDA, supported with well-designed software and well-executed training, can provide unique benefits to older adults.

Aged↗