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PubMed2003

Use of personal digital assistants with acute care nurse practitioner students.

Personal digital assistants (PDAs) are attaining increased functionality by acute care nurse practitioners (ACNPs). Supplemented by recently developed medical software, these devices assist nurse practitioners in having information available at the point of care. This article reviews the introductory use of PDAs throughout ACNP graduate training with an emphasis on clinical and classroom application.

Computers, Handheld↗
PubMed2003

The emerging role of electronic diaries in the management of diabetes mellitus.

Diabetes mellitus affects an estimated 17 million people in America. A cornerstone to the treatment of this population is appropriate glycemic control, which has been associated with better patient outcomes and cost savings from lack of diabetes complications needing treatment. The patient diary serves as the primary means used by patients and care providers to monitor and ensure glycemic control among this population and as a key component to effective diabetes management. Diabetic patients are encouraged to track continually, in a systematic way, blood glucose levels, dietary intake, activity level, and insulin dose if applicable for use in guiding appropriate care decisions. Traditionally, the recording of such patient experience data has occurred in paper-based diaries. More recently, with the advent of personal digital assistant (PDA) technology, electronic diaries are demonstrating promising benefits over paper-based diaries. To take advantage of this technology, patients must be able to use PDA devices accurately and providers must be knowledgeable about their capabilities. Advanced practice nurses (APNs) in general, and nurse practitioners in the outpatient setting more specifically play a key role in assessing the appropriateness of PDA technology for individual patients, educating patients in various software applications, and ensuring the documentation and trending of data. This article provides an overview of traditional diabetes management record-keeping techniques followed by a review of current PDA technologies and resources that aim to improve the state of diabetic documentation by patients.

Computers, Handheld↗
PubMed2004

The use of a personal digital assistant in orthopaedic surgical practice.

The personal data assistant is a powerful tool enabling data acquisition, analysis, and scheduling. The Palm and Windows Pocket PC Operating Systems are available in various personal data assistants that combine bright screens, ease of use, and compactness. Data that are acquired can be imported into standardized spreadsheets for statistical analysis. Report generation using these data can simplify record keeping, facilitate later research, and decrease secretarial typing time. The use of a forms manager, such as Pendragon Forms, enables rapid creation of personal data assistant forms that interface with numerous computer database programs. We currently use theses programs for data acquisition when patients are seen in the office, in the operating room, and when returning for followup.

Computers, Handheld↗
PubMed2006

An electronic diary study of contextual triggers and ADHD: get ready, get set, get mad.

OBJECTIVE: This study was designed to examine context effects or provocation ecologies in the daily lives of children with ADHD. METHOD: Across 7 days, mothers and children (27 children with attention-deficit/hyperactivity disorder [ADHD] taking stimulant medication; 25 children without ADHD; ages 7-12 years) provided electronic diary reports every 30 +/- 5 minutes during non-school hours. Child and maternal perceptions of behaviors, moods, and interaction quality during preparatory and transitional ("getting ready") activities were compared with those during other activities. RESULTS: Maternal reports revealed that child symptomatic behaviors and negative moods, maternal negative moods, and parent-child disagreement were elevated in the ADHD but not in the comparison group while getting ready versus other activities. Children's self-ratings also revealed situational effects, indicating that school-age children with ADHD can give meaningful self-reports using carefully structured electronic diaries. CONCLUSIONS: Even when children with ADHD are receiving stimulant pharmacotherapy, the preparatory tasks of daily living are especially challenging and linked disproportionately to child behavior problems, parent negative affect, and contentious interactions. Treatment targeted on these transitional hurdles may improve child behavior patterns and enhance parent-child relationships and family harmony.

Activities of Daily Living↗
PubMed2004

Personal digital assistants used to document compliance of bacterial vaginosis treatment.

OBJECTIVE: The objective of this study was to estimate patient compliance with oral and vaginal metronidazole treatment of bacterial vaginosis using personal digital assistants (PDAs) and paper diaries. GOAL: The goal of this study was to assess a novel compliance documentation approach. STUDY: After each dose of intravaginal or oral metronidazole, 71 subjects recorded the time on a paper diary and answered questions on a PDA. All PDA entries were unknowingly time-date-stamped. Subjects returned for 2- and 6-week posttreatment examinations. Compliance was calculated using a repeated-measures multivariate analysis of variance (ANOVA). RESULTS: Mean patient compliance rates within the oral metronidazole group were greater with the paper diary compared with the PDA (68.3% and 50.0%, respectively, P = 0.001). The observed rate of compliance agreement for PDA versus paper diary was 69.0% (kappa = 0.4). The majority of noncompliant subjects reported they were compliant with the PDA and paper diary. CONCLUSIONS: PDAs could more accurately document true compliance rates and could be reasonable instruments to assess compliance in intravaginal antimicrobial drug or contraceptive trials.

Administration, Intravaginal↗
PubMed2003

Initial experience with personal digital assistant-based reflectance photoplethysmograph for free tissue transfer monitoring.

Improved microsurgical technique has resulted in a high percentage of successful free tissue transfers. When a tissue transfer fails in the head and neck, however, the results are orocutaneous fistulas, carotid artery exposure, and deformity that adds morbidity, expense, and may delay adjuvant therapy. Postoperative monitoring of tissue perfusion can detect early problems in free tissue transfer that may allow for early intervention and salvage. The authors have demonstrated that reflectance photoplethysmography can detect perfusion changes in free tissue transfer within 5 minutes of a pedicle "insult" intraoperatively. Normative data for viable flaps from various donor sites have been established. The authors now report their initial experience with a newly developed reflectance photoplethysmograph based on a hand-held computer for routine clinical use. Their results are compared with a conventional surveillance protocol that included observation, bleeding to pin prick, and bedside duplex scanning of the vascular pedicle. In a series of 30 free tissue transfers (29 patients), there was one ischemic event (skin paddle loss only), which was detected by the monitor. The monitor was able to predict correctly (one flap) survival of a free tissue transfer even when duplex ultrasonic data were indicative of an absence of perfusion. Personal digital assistant-based photoplethysmography appears to be a promising device for bedside diagnosis of free tissue transfer viability or ischemia.

Computers, Handheld↗
PubMed2006

Communication devices in the operating room.

PURPOSE OF REVIEW: Effective communication is essential to patient safety. Although radio pagers have been the cornerstone of medical communication, new devices such as cellular telephones, personal digital assistants (PDAs), and laptop or tablet computers can help anesthesiologists to get information quickly and reliably. Anesthesiologists can use these devices to speak with colleagues, access the medical record, or help a colleague in another location without having to leave a patient's side. Recent advances in communication technology offer anesthesiologists new ways to improve patient care. RECENT FINDINGS: Anesthesiologists rely on a wide variety of information to make decisions, including vital signs, laboratory values, and entries in the medical record. Devices such as PDAs and computers with wireless networking can be used to access this information. Mobile telephones can be used to get help or ask for advice, and are more efficient than radio pagers. Voice over Internet protocol is a new technology that allows voice conversations to be routed over computer networks. It is widely believed that wireless devices can cause life-threatening interference with medical devices. The actual risk is very low, and is offset by a significant reduction in medical errors that results from more efficient communication. SUMMARY: Using common technology like cellular telephones and wireless networks is a simple, cost-effective way to improve patient care.

Anesthesiology↗
PubMed2004

What is the potential for the use of clinical outcome measures to be computerised? Findings from a qualitative research study.

Clinical outcome measures are used in clinical audit to monitor the quality of care provided to patients. As information technology (IT) is increasingly being integrated into the delivery of health care, computerising the use of clinical outcome measures has been proposed. However, little is known about the attitudes of health professionals towards this. Aims to understand professionals' views on adapting one clinical outcome measure--the palliative care outcome scale (POS)--for use on hand-held computers. Concludes that these results reinforce existing research on clinical outcome measures and IT in health care; identify special palliative care issues when considering the use of computerised clinical outcome measures with patients; and highlight the need for further research.

Attitude of Health Personnel↗
PubMed2005

mobilePDR: a mobile medical information system featuring update via Internet.

This paper presents an analysis of usability of mobile prescription reference systems in medical practice, and presents implementation of mobilePDR (Physician's Desk Reference). Various aspects of mobilePDR are discussed: main functions, information content, performance and design issues, independent evaluation with other similar tools, and lessons learned from the system development.

Computers, Handheld↗
PubMed2003

What to do on spring break? The role of predicted, on-line, and remembered experience in future choice.

When individuals choose future activities on the basis of their past experiences, what guides those choices? The present study compared students' predicted, on-line, and remembered spring-break experiences, as well as the influence of these factors on students' desire to take a similar vacation in the future. Predicted and remembered experiences were both more positive-and, paradoxically, more negative-than on-line experiences. Of key importance, path analyses revealed that remembered experience, but neither on-line nor anticipated experience, directly predicted the desire to repeat the experience. These results suggest that although on-line measures may be superior to retrospective measures for approximating objective experience, retrospective measures may be superior for predicting choice.

Adolescent↗
PubMed2005

The use of personal digital assistants by nurse practitioner students and faculty.

PURPOSE: To describe the prevalence and patterns of use of personal digital assistants (PDAs) by nurse practitioner (NP) students and faculty, examine relationships between patterns of use of PDAs and demographic characteristics of NP students and faculty, and describe patterns of use of PDAs that support evidence-based practice (clinical scholarship). DATA SOURCES: Responses to a 20-item questionnaire administered via electronic or postal mail from 227 NP students and faculty. CONCLUSIONS: A majority (67%) of the participants used PDAs. Use was higher among men (82%) than women (64%) (p < .05). On average, respondents who used a PDA (N = 153) had been using it just over a year (M = 13 months). Respondents reported using a PDA most days of the week (M = 5 days). The top three medical software programs identified by respondents as the most useful in clinical practice were ePocrates Rx (82%), Griffith's 5-Minute Clinical Consult (26%), and MedCalc (22%). Most participants (96%) related that PDA use supported clinical decision making. IMPLICATIONS FOR PRACTICE: Personal digital assistants may facilitate the application of evidence-based knowledge to practice. However, until there is evidence that PDA software is valid and reliable, clinicians should continue to use a multitude of references to assure the quality and safety of care provided.

Adult↗