Toy or tool of the trade? Part I.
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PURPOSE: A scalable, multiuser, personal digital assistant (PDA)-based documentation tool for pharmacist collection of data on drug-related problems (DRPs) is described. SUMMARY: A PDA-based tool for documenting DRPs and pharmacist interventions was developed with database software. Data fields were based on the pharmaceutical care model. PDA synchronization stations were configured to transmit encrypted data from three hospital sites to a central server. Pharmacists in a multisite health care organization were trained to use the documentation tool. Data were analyzed with commercially available software. Users' opinions about the tool were solicited in a survey. Twenty-eight PDAs containing a 15-field database were issued to 39 pharmacists in 31 service areas. Data were successfully transmitted from all hospital sites over the existing corporate local area network. During a two-month period, 5084 DRPs were documented; 90% of them were resolved at the time of data entry. The most frequent types of DRPs were the need to add a drug (31%) and the ordering of an unnecessary drug (15%). Most pharmacists reported that the tool was easy to use, was well integrated with the workflow, and required less than 30 minutes per day for documenting DRPs. CONCLUSION: A PDA-based documentation tool was successfully used in a multisite health care organization to collect data on DRPs and document pharmacist interventions.
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What are the aims appropriate for a science of clinical pharmacology and clinical trials: to test drugs for efficacy and safety in the clinic, to establish the optimal effectiveness and safety of drugs in patient care or both? Current designs of clinical trials test drugs for efficacy and safety in clinical settings-they do not address the clinician's problems adequately. Clinical trials better address the effectiveness of drugs in patient care with analyses to determine drug effects for each individual in the trial. We use current standards and designs for clinical trails supplemented to control random error effects for the individuals in the trials. Test-retest standard error of measurement can control random error effects for individuals. This allows individual clinical courses to be plotted with known precision and certainty. For individuals in a clinical trial the clinical course of surrogate outcome variables can be associated with long-term health outcomes in followup to develop clinical decision rules. Clinical courses on surrogate outcome variables during patient care can be interpreted using these clinical decision rules. In this Age of the Internet, Computers and Handhelds, electronic records and interpretations of clinical examinations and tests can be a part of decision making for every patient. We conclude that practical methods are available for making clinical trials more informative for clinical practice. This modification replaces "unsystematic clinical judgments" with statistically characterized data and interpretations for individuals available as care is delivered in the doctor's office. An AD demonstration can be viewed at www.healthpragmatics.com.
The ability of nursing faculty and students to efficiently obtain accurate information at the point-of-care is a critical aspect of providing quality patient care. Personalized Digital Assistants (PDAs) can provide instant access to entire textbooks of information where it is needed most, in the dynamic learning environment of the clinical setting. With a growing trend in higher education to include instruction on information competency in the curriculum, the use of PDAs in nursing education needs to be explored. This article discusses the use of PDAs by faculty and students within one nursing program. Results from a survey of faculty and students demonstrated a clear discrepancy in their use of PDAs. Although students recognized the benefits of PDA use in the clinical setting, they did not want owning a PDA to be a program requirement. Discussed are several approaches being used to overcome identified barriers to PDA use and ownership.
OBJECTIVE: We describe how our radiology department set up, integrated, and deployed a personal digital assistant-based mobile platform to deliver updated critical departmental and educational material to our residents. CONCLUSION: We have implemented and described a robust mobile solution that maintains a seamless connection with the departmental intranet. Resident feedback regarding the use of the mobile solution program has confirmed our belief that using this mobile technology is a feasible and clinically practical alternative for accessing time-sensitive and educational materials. Furthermore, our description can help others deploy such digital products and facilitate the transition to soft copy that is already occurring in radiology education.
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Tablet computers offer a new method of information management in veterinary medical education. With the tablet computer, students can annotate class notes using electronic ink, search for keywords, and convert handwriting to text as needed. Additional electronic learning resources, such as medical dictionaries and electronic textbooks, can be readily available. Eleven first-year veterinary students purchased tablet computers and participated in an investigation of their working methods and perceptions of the tablet computer as an educational tool. Most students found the technology useful. The small size and portability of the tablet allowed easy transport and use in a variety of environments. Most students adapted to electronic notetaking by the second week of classes; negative experiences with the tablet centered on a failure to become comfortable with taking notes and navigating on the computer as opposed to writing and searching on paper. A few performance-related problems, including short battery life, were reported. Tablet software allowed conversion of faculty course notes from a variety of original formats, meaning that instructors could maintain their original methods of note preparation. Adopting a consistent naming convention for files helped students to locate the files on their computers, and smaller file sizes helped with computer performance. Collaboration between students was fostered by tablet use, which offers possibilities for future development of collaborative learning environments.
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In the late 1970s concern in Melbourne teaching hospitals over the increasing incidence of antibiotic-resistant microorganisms and inappropriate antibiotic prescribing, led to the establishment of a working party to produce guidelines on appropriate antimicrobial therapy. Therapeutic Guidelines: Antibiotic is now produced, marketed and sold by Therapeutic Guidelines Limited, an independent, not-for-profit enterprise that distils best-practice prescribing guidelines for Australian health professionals. Therapeutic Guidelines now cover all major therapeutic areas. Mere distribution of the guidelines had little impact on prescribing habits. However, targeted education campaigns have helped to improve antibiotic prescribing. The Antibiotic title remains the flagship of Therapeutic Guidelines Limited with sales, surveys and endorsements over 11 editions attesting to its wide acceptance and use. Therapeutic Guidelines: Antibiotic is one of many initiatives that have contributed to improving antibiotic use and it serves as a valuable foundation on which to build other strategies. There is demand for a consumer friendly version of the guidelines. In addition, the increasing use of computerised prescribing programs has highlighted the need for electronic guidelines to be closely integrated with decision support software.
From 1975 through 2003, because of the use of safety belts, an estimated 180,000 deaths from traffic crashes have been prevented. In order to assess the gains that have been made in safety belt use across the U.S., in individual states, and in communities, belt use surveys are conducted at regular intervals to determine use rates. The most valid method for surveying safety belt use is through direct observation. Direct observation surveys are conducted along roadways by trained researchers looking into passing vehicles and recording safety belt use. This method of data collection has been effective in the past through the use of paper-and-pencil data recording, yet it could be improved through the use of electronic and communication technology. Reported here is a study designed to compare electronic data collection, using personal digital assistants (PDAs), with collection using the traditional paper-and-pencil method during the annual statewide survey of safety belt use in Michigan that we have been conducting since 1984. The goals of the study were to develop a PDA database program for data entry in the field, to directly compare the PDA data collection process with the paper-and-pencil method on both accuracy and speed, and to assess mechanical and environmental factors, such as battery life, screen visibility, and reaction to adverse weather, that may act as limitations to the PDA method, in comparison with the paper-and-pencil method. In a direct comparison of methods, two observers collected data at the same roadway intersections, one using paper and a pencil and one using a PDA equipped with our custom software. The study showed that the PDA method was as fast and as accurate as the paper-and-pencil method. There were no adverse effects on the PDA caused by environmental conditions. The PDA was superior to the paper-and-pencil method in rainy weather and for data collector supervision. In addition, the use of the PDA obviated the need for entry of paper-recorded data into an electronic format. We conclude that the use of PDAs for safety belt field data collection is superior to the paper-and-pencil method. A Web address is given where the custom PDA safety belt data collection software can be obtained free of charge.
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This study reports on personal digital assistants (PDAs) as a means to prepare nurse professionals who value and seek current information. An interdisciplinary team of nursing and library faculty, information technology and bookstore staff, students, and educational consultants developed this project. A pre-post and comparative group design of second-degree students in the accelerated and traditional baccalaureate nursing degree (BSN) options was used to examine students' information-seeking behaviors, and the effectiveness and cost of innovation strategies associated with incorporation of PDAs into students' clinical practice. Results of this study support PDAs as an effective student learning resource, especially for reference materials. The student group with PDAs had increasing numbers of questions associated with clinical situations and a greater recognition of the need to use current resources. Students made substantial use of their PDAs and health team members, while decreasing reliance on textbooks and clinical faculty. Students' use of and satisfaction with this technology is linked to access speed and readability. Providing faculty with PDAs is recommended to enhance their comfort with and incorporation of PDAs into clinical teaching.