Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Computers, Handheld”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 631 records · Page 35Linked to original sources
PubMedDate not supplied

Implementing personal digital assistant documentation of pharmacist interventions in a military treatment facility.

OBJECTIVE: To describe the use of personal digital assistants (PDAs) in documenting pharmacists' clinical interventions. SETTING: Evans Army Community Hospital (EACH), a 78-bed military treatment facility, in Colorado Springs. PARTICIPANTS: Pharmacists on staff at EACH. PRACTICE DESCRIPTION: All pharmacists at EACH used PDAs with the pilot software to record interventions for 1 month. The program underwent final design changes and then became the sole source for recording pharmacist interventions. The results of this project are being evaluated every 3 months for the first year and yearly thereafter. PRACTICE INNOVATION: Visual CE (Syware Inc. Cambridge, Mass.) software was selected to develop fields for the documentation tool. This software is simple and easy to use, and users can retrieve reports of interventions from both inpatient and outpatient sections. The software needed to be designed so that data entry would only take a few minutes and ad hoc reports could be produced easily. MAIN OUTCOME MEASURES: Number of pharmacist interventions reported, time spent in clinical interventions, and outcome of clinical intervention. RESULTS: Implementing a PDA-based system for documenting pharmacist interventions across ambulatory, inpatient, and clinical services dramatically increased reporting during the first 6 months after implementation (August 2004-February 2005). After initial fielding, clinical pharmacists in advanced practice settings (such as disease management clinic, anticoagulation clinic) recognized a need to tailor the program to their specific activities, which resulted in a spin-off program unique to their practice roles. CONCLUSION: A PDA-based system for documenting clinical interventions at a military treatment facility increased reporting of interventions across all pharmacy points of service. Pharmacy leadership used these data to document the impact of pharmacist interventions on safety and quality of pharmaceutical care provided.

Computers, Handheld↗
PubMedDate not supplied

Emerging technology at the point of care.

With PDA access to updated clinical information, pharmacists can more easily incorporate evidence-based medicine into their patient-care services. Using PDAs, pharmacists can document patient encounters, consult clinical reference tools, conduct health assessments, provide patient education, track outcomes, and perform a growing number of other clinical tasks. Before purchasing PDA applications, pharmacists are advised to obtain a trial version of the software, ask colleagues for their opinions, and consult reliable reviews, if available.

Computers, Handheld↗
PubMed2006

Performance of drug-drug interaction software for personal digital assistants.

BACKGROUND: Personal digital assistants (PDAs) allow healthcare professionals to check for potential drug-drug interactions (DDIs) at the point of care, reducing the need to consult traditional references. However, PDAs can only be as effective as the software programs they use. OBJECTIVE: To examine the ability of DDI software programs manufactured for Palm OS-compatible PDAs in detecting clinically important DDIs. METHODS: Eight PDA software programs were assessed for sensitivity, specificity, and positive and negative predictive values for 16 well-documented DDIs contained within 6 simulated patient profiles. RESULTS: Sensitivity of the software programs ranged from 0.81 to 1.0, specificity ranged from 0.52 to 1.0, positive predictive values ranged from 0.62 to 1.0, and negative predictive values ranged from 0.88 to 1.0. Five programs scored perfect sensitivity scores: DrugIx, ePocrates Rx, ePocrates Rx Pro, Lexi-Interact, and the Tarascon pocket Pharmacopoeia. Of these, the ePocrates programs scored the highest in specificity (0.9), while Lexi-Interact and the Tarascon pocket Pharmacopoeia scored considerably lower (0.52). MosbyIx was the only program to score a 1.0 in specificity; however, its sensitivity was just 0.81. CONCLUSIONS: ePocrates Rx and ePocrates Rx Pro scored greater than or equal to 90% in regard to both sensitivity and specificity, making them the most reliable in detecting the clinically relevant interactions studied without the distraction of detecting those of no clinical significance. In addition, ePocrates Rx is updated regularly and is easily accessible on the Internet at no cost.

Computers, Handheld↗
PubMedDate not supplied

Opportunities, challenges, and lessons of international research in practice-based research networks: the case of an international study of acute otitis media.

The requirements of research become more complex and demanding in international collaborations. The opportunity to study naturally occurring variation in treatment prompted networking primary care research networks in the United Kingdom, The Netherlands, and North America to study acute otitis media. Additional challenges faced and addressed in this study included (1) differing national requirements for protecting human subjects; (2) variation in data collection processes in primary care practices; (3) data transmission among participants; (4) duties and tariffs on necessary instruments; (5) fluctuation in currency exchange rates; (6) incapacitation of coinvestigators; (7) complex administration of funds; (8) financing the additional, legitimate costs of collaboration; (9) sustaining strong personal relationships among coinvestigators; and (10) accepting longer time frames than would otherwise be expected. Overall, international practice-based research can be productive, affect millions of people, and be extremely rewarding to investigators. It is not, however, for the faint-hearted.

Adolescent↗
PubMed2006

Clinical characteristics and treatment patterns among patients with ventilator-associated pneumonia.

STUDY OBJECTIVES: To evaluate clinical characteristics and treatment patterns among patients with ventilator-associated pneumonia (VAP), including the implementation of and outcomes associated with deescalation therapy. DESIGN: Prospective, observational, cohort study. SETTING: Twenty ICUs throughout the United States. PATIENTS: A total of 398 ICU patients meeting predefined criteria for suspected VAP. INTERVENTIONS: Prospective, handheld, computer-based data collection regarding routine VAP management according to local institutional practices, including clinical and microbiological characteristics, treatment patterns, and outcomes. MEASUREMENTS AND RESULTS: The most frequent ICU admission diagnoses in patients with VAP were postoperative care (15.6%), neurologic conditions (13.3%), sepsis (13.1%), and cardiac complications (10.8%). The mean (+/- SD) duration of mechanical ventilation prior to VAP diagnosis was 7.3 +/- 6.9 days. Major pathogens were identified in 197 patients (49.5%) through either tracheal aspirate or BAL fluid and included primarily methicillin-resistant Staphylococcus aureus (14.8%), Pseudomonas aeruginosa (14.3%), and other Staphylococcus species (8.8%). More than 100 different antibiotic regimens were prescribed as initial VAP treatment, the majority of which included cefepime (30.4%) or a ureidopenicillin/monobactam combination (27.9%). The mean duration of therapy was 11.8 +/- 5.9 days. In the majority of cases (61.6%), therapy was neither escalated nor deescalated. Escalation of therapy occurred in 15.3% of cases, and deescalation occurred in 22.1%. The overall mortality rate was 25.1%, with a mean time to death of 16.2 days (range, 0 to 49 days). The mortality rate was significantly lower among patients in whom therapy was deescalated (17.0%), compared with those experiencing therapy escalation (42.6%) and those in whom therapy was neither escalated nor deescalated (23.7%; chi2= 13.25; p = 0.001). CONCLUSIONS: Treatment patterns for VAP vary widely from institution to institution, and the overall mortality rate remains unacceptably high. The deescalation of therapy in VAP patients appears to be associated with a reduction in mortality, which is an association that warrants further clinical study.

Adolescent↗
PubMed2006

Examining the adoption of electronic health records and personal digital assistants by family physicians in Florida.

PURPOSE: The purpose of this paper is to comprehensively characterise the current use of electronic health records (EHRs) and personal digital assistants (PDAs) among family physicians in Florida; and to compare family physicians with other doctors with respect to the functions commonly used on their EHR and PDA systems. METHODS: A postal survey was sent to family physicians (n=2076) and other doctors with a clear and active licence in Florida (total n=14 921). To examine factors among family physicians related to EHR and PDA use, binary logistic regression modelling techniques were utilised. Chi-square analysis was used to compare EHR and PDA functions between family physicians and other doctors. RESULTS: A total of 4203 responses, of which 756 were from family physicians, were available for the current study (28.2% overall response rate). EHR use among family physicians was significantly related to large practice size, urban location and young physician age, after controlling for confounders. Likewise, PDA usage among family physicians was independently associated with male gender and younger physician age. Additionally, even though no differences in overall EHR adoption were found, family physicians, when compared with other physicians, were significantly more likely to be using a more robust set of EHR functions. This included allergy and medication lists, diagnosis, problem lists, patient scheduling and educational materials, preventive services reminders and access to reference material. CONCLUSIONS: Even though family physicians utilise many EHR and PDA functions more commonly than other physician groups, the overall level of EHR adoption among family physicians remains low. Until more barriers to the use of EHR are minimised, the goals of the Future of Family Medicine Report to broadly implement EHR and other health IT functions will not be fully realised.

Adult↗
PubMed2002

[Personal emergency call system based on human vital and system technical parameters in a Smart Home environment].

Progress in microtechnology and radio transmission technology has enabled the development of highly reliable emergency-call systems. The present article describes systems that have been specially designed to improve the safety and independence of handicapped and elderly persons living at home. For such persons immediate help in an emergency situation is of crucial importance. The technical state of the art of emergency-call systems specially developed for use by the elderly, is briefly discussed, in particular the well-known radio emergency-call button, with the aid of which an alarm can be activated manually. This system, however, does not offer adequate safety in all emergency situations. Alternative or complementary systems designed to automatically trigger an alarm on the basis of the recording and evaluation of so-called vital parameters, are therefore proposed. In addition, in a smart-home environment with networked devices, further parameters--so-called environment parameters can be used. It is found that the identification of an emergency situation becomes more reliable as the number of parameters employed increases.

Aged↗
PubMed2005

A tool to assess the comfort of wearable computers.

Wearable computer comfort can be affected by numerous factors, making its assessment based on one value with one scale inappropriate. This paper presents a tool that measures wearable comfort across six dimensions: emotion, attachment, harm, perceived change, movement, and anxiety. The dimensions for these comfort rating scales were specifically developed for wearable equipment assessment by applying multidimensional scaling to a comfort term association matrix developed using the results of groupings of wearable computer comfort terms. Testing the scales on four different types of wearable computer showed that the scales can be used to highlight differences in comfort between different types of technology for different aspects of comfort. An intraclass correlation of .872 suggested that the scales were used with a high level of reliability. A second study showed that modifications made to a wearable computer resulted in improvements in comfort, although they were not significant (p > .05). A potential application for this research is as an aid to designers and researchers for assessing the wearability, in terms of comfort, of wearable computer devices and to determine the effectiveness of any modifications made to the design of a wearable device.

Adolescent↗
PubMed2005

Interacting with notebook input devices: an analysis of motor performance and users' expertise.

In the present study the usability of two different types of notebook input devices was examined. The independent variables were input device (touchpad vs. mini-joystick) and user expertise (expert vs. novice state). There were 30 participants, of whom 15 were touchpad experts and the other 15 were mini-joystick experts. The experimental tasks were a point-click task (Experiment 1) and a point-drag-drop task (Experiment 2). Dependent variables were the time and accuracy of cursor control. To assess carryover effects, we had the participants complete both experiments, using not only the input device for which they were experts but also the device for which they were novices. Results showed the touchpad performance to be clearly superior to mini-joystick performance. Overall, experts showed better performance than did novices. The significant interaction of input device and expertise showed that the use of an unknown device is difficult, but only for touchpad experts, who were remarkably slower and less accurate when using a mini-joystick. Actual and potential applications of this research include an evaluation of current notebook input devices. The outcomes allow ergonomic guidelines to be derived for optimized usage and design of the mini-joystick and touchpad devices.

Analysis of Variance↗
PubMed2004

Pediatricians' use of and attitudes about personal digital assistants.

BACKGROUND: Personal digital assistants (PDAs) are being increasingly used in medical practice. Although they have been touted as having the ability to improve efficiency and safety, little is known about pediatricians' use of and attitudes about PDAs. OBJECTIVE: Our goals were to 1) determine the percentage of pediatricians using PDAs and computers, 2) determine perceived strengths and weaknesses of PDAs, and 3) explore characteristics associated with beliefs and use. DESIGN/METHODS: Pediatricians (2130) were selected randomly from the American Medical Association Physician Masterfile of US-licensed physicians. All participants were mailed a survey along with a prepaid return envelope and a 1 dollar incentive. Up to 3 mailings were sent per participant. RESULTS: Of eligible participants, 63.2% returned a survey. There were no significant differences between respondents and nonrespondents with respect to sex, type of practice, and present employment. Thirty-five percent of respondents currently use PDAs at work, and 40% currently use PDAs for personal use. Of those using PDAs, the most commonly used applications were for drug reference (80%), personal scheduling (67%), and medical calculations (61%). Few pediatricians are currently using PDAs for prescription writing (8%) or billing (4%). Users of PDAs were more likely to be male (adjusted odds ratio [AOR]: 2.29; 95% confidence interval [CI]: 1.64-3.19), in an urban community (AOR: 1.81; 95% CI: 1.30-2.55), in training (AOR: 2.64; 95% CI: 1.58-4.42), not in private practice (AOR: 1.47; 95% CI: 1.03-2.11), and a more recent graduate of medical school (AOR: 1.04 per year; 95% CI: 1.02-1.06). When controlling for covariates, those using PDAs were more likely to believe that PDAs can decrease medical errors (AOR: 2.22; 95% CI: 1.46-3.38) and increase efficiency (AOR: 2.40; 95% CI: 1.56-3.71). When compared with nonusers, users were less likely to view the small screen size (AOR: 0.53; 95% CI: 0.37-0.77) or system speed (AOR: 0.47; 95% CI: 0.26-0.84) as a problem but were significantly more likely to view memory as an issue (AOR: 3.48; 95% CI: 2.30-5.25). CONCLUSIONS: More than one third of pediatricians are using PDAs in clinical practice. There seems to be a general consensus among users that they have the potential to improve patient safety and streamline care. Future studies should explore means to utilize their potential.

Age Factors↗
PubMed2004

The effect of point-of-care personal digital assistant use on resident documentation discrepancies.

BACKGROUND: We recently found documentation discrepancies in 60% of resident daily-progress notes with respect to patient weight, medications, or vascular lines. To what extent information systems can decrease such discrepancies is unknown. OBJECTIVE: To determine whether a point-of-care personal digital assistant (PDA)-based patient record and charting system could reduce the number of resident progress-note documentation discrepancies in a neonatal intensive care unit (NICU). DESIGN/METHODS: We conducted a before-and-after trial in an academic NICU. Our intervention was a PDA-based patient record and charting system used by all NICU resident physicians over the study period. We analyzed all resident daily-progress notes from 40 randomly selected days over 4 months in both the baseline and intervention periods. Using predefined reference standards, we determined the accuracy of recorded information for patient weights, medications, and vascular lines. Logistic and Poisson regression were used in analyses to control for potential confounding factors. RESULTS: A total of 339 progress notes in the baseline period and 432 progress notes in the intervention period were reviewed. When controlling for covariates in the regression, there were significantly fewer documentation discrepancies of patient weights in notes written by using the PDA system (14.4%-4.4% of notes; odds ratio [OR]: 0.29; 95% confidence interval [CI]: 0.15-0.56). When using the PDA system, there were no significant changes in the numbers of notes with documentation discrepancies of medications (27.7%-17.1% of notes; OR: 0.63; 95% CI: 0.35-1.13) or vascular lines (33.6%-36.1% of notes; OR: 1.11; 95% CI: 0.66-1.87). CONCLUSIONS: The use of our PDA-based point-of-care patient record and charting system showed a modest benefit in reducing the number of documentation discrepancies in resident daily-progress notes. Further study of PDAs in information systems is warranted before they are widely adopted.

Computers, Handheld↗
PubMed2006

Risk reduction for adverse drug events through sequential implementation of patient safety initiatives in a children's hospital.

BACKGROUND: Medication management is a complex, multifaceted system. Prescribing errors occur upstream in the process, and as such, their effects can be perpetuated, and sometimes even exacerbated, in subsequent steps. These errors place patients at risk of adverse drug events. Children, especially young infants, are at particular risk because of their size, unique physiology, and immature ability to metabolize drugs. OBJECTIVE: The purpose of this study was to reduce the risk of harm to children resulting from prescribing errors. METHODS: We sequentially implemented patient safety initiatives over a 1-year time frame at a pediatric tertiary care academic facility. The initiatives included an educational Web site with competency examination, distribution of a personal digital assistant-based standardized dosing reference, a zero-tolerance policy for incomplete or incorrect medication orders, prescriber performance feedback, and presentation of outcome data at citywide grand rounds. A total of 8718 orders were collected and analyzed to assess the impact of these initiatives. RESULTS: The absolute risk reduction from prescribing errors was 38 per 100 orders, with a relative risk reduction of 49%. Web-based education with point-of-care drug references and a zero-tolerance policy for incomplete or incorrect orders were most effective in decreasing potential adverse drug events. Documentation of appropriate weight-based dosing and indication for therapy increased by 24% and 42%, respectively. CONCLUSIONS: Process-improvement initiatives focusing on prescriber education and behavior modification can reduce the risk of harm to pediatric patients from prescribing errors.

Child↗
PubMed2006

Clinical and education workload measurements using personal digital assistant-based software.

OBJECTIVE: There are no accepted and practical measures of the relative clinical and educational activities of pediatricians who work in an academic health science center. Such measures are necessary for justification of existing and future human resource plans and evaluation of the activities and performance of physicians. The limited literature on the measurement of physician workload usually focuses on a specific subspecialty group and does not account for such issues as indirect patient care, such as telephone calls or e-mail consultations; variables that affect the delivery of clinical care, including patient acuity and complexity; and the presence of students during the patient care activities. After completing a pilot study that assessed the educational workload of faculty members, we adapted existing personal digital assistant technology and software to document clinical and educational activities. METHODS: Twenty full-time physicians from 4 subspecialty pediatric divisions participated in a 2-week evaluation project in May through June 2005. Clinical activities, with and without trainees, and educational activities were collected with the use of personal digital assistants. Software allowed an individualized division-specific drop-down menu. Information that was collected included clinical (location of activity, diagnosis, and time requirement) and educational activities. After completion of a 2-week data collection period, each physician was asked to complete a 5-question evaluation form. RESULTS: The project was completed successfully with capture of additional clinical and educational activities. A 5-question evaluation form was completed by 70% of the participants at the end of the 2-week data collection. Data on clinical and educational activities were analyzed qualitatively and graphed. CONCLUSIONS: This method of workload data collection added significant information in capturing activities that are not measured in traditional workload evaluations for either clinical activities, such as e-mail, telephone, and patient information review, or educational endeavors, including mentoring and educational lectures and presentations.

Academic Medical Centers↗
PubMedDate not supplied

Evaluation of personal digital assistant drug information databases for the managed care pharmacist.

BACKGROUND: Personal digital assistants (PDAs) are becoming a necessity for practicing pharmacists. They offer a time-saving and convenient way to obtain current drug information. Several software companies now offer general drug information databases for use on hand held computers. PDAs priced less than 200 US dollars often have limited memory capacity; therefore, the user must choose from a growing list of general drug information database options in order to maximize utility without exceeding memory capacity. OBJECTIVE: This paper reviews the attributes of available general drug information software databases for the PDA. It provides information on the content, advantages, limitations, pricing, memory requirements, and accessibility of drug information software databases. SUMMARY: Ten drug information databases were subjectively analyzed and evaluated based on information from the product.s Web site, vendor Web sites, and from our experience. Some of these databases have attractive auxiliary features such as kinetics calculators, disease references, drug-drug and drug-herb interaction tools, and clinical guidelines, which may make them more useful to the PDA user. CONCLUSION: Not all drug information databases are equal with regard to content, author credentials, frequency of updates, and memory requirements. The user must therefore evaluate databases for completeness, currency, and cost effectiveness before purchase. In addition, consideration should be given to the ease of use and flexibility of individual programs.

Computers, Handheld↗
PubMed2006

Experience with a clinical decision support system in community pharmacies to recommend narrow-spectrum antimicrobials, nonantimicrobial prescriptions, and OTC products to decrease broad-spectrum antimicrobial use.

BACKGROUND: Overuse of antibiotics increases the incidence of bacterial resistance and contributes avoidable costs to the health care system. OBJECTIVE: To determine the feasibility of a protocol-driven community pharmacy intervention that was designed to decrease broad-spectrum antimicrobial (BSA) use in patients with upper respiratory tract infections. METHODS: The intervention involved pharmacists who conducted guided interviews regarding patient symptoms in a cohort of patients with BSA prescription visiting 2 rural community pharmacies during peak respiratory illness season. A clinical decision support system was provided to aid in pharmacist diagnosis and assist in determining if the BSA therapy was appropriate. Upon patient consent, pharmacists attempted to contact primary care providers (PCPs) to confirm the diagnosis and recommend appropriate alternative therapy. RESULTS: There were 192 subjects with prescriptions for BSAs and symptoms of respiratory tract infection. Only 3% of the patients who were approached declined to discuss their symptoms and treatment with the pharmacist. A mean of 3 minutes was required to collect symptom and treatment information from the patients. However, when patients were asked if the pharmacist could contact their PCP to recommend alternative therapy, only 7% (n=4) of patients agreed to the intervention. The PCPs who were contacted by pharmacists were receptive to altering the BSA to first-line antimicrobial therapy such as amoxicillin or doxycycline. CONCLUSION: Despite a description of the importance of the intervention, more than 90% of patients prescribed a BSA declined to permit the community pharmacist to contact the prescriber to discuss first-line therapeutic alternatives. This experience in a pilot study to explore the feasibility of pharmacist intervention at the point of dispensing of a BSA made clear that a successful community pharmacy intervention to reduce BSA use would require an alternative method, perhaps via a collaborative practice protocol that does not require patient consent to make the drug substitution to first-line antibiotic therapy.

Anti-Bacterial Agents↗