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PubMed2005

askMEDLINE: a free-text, natural language query tool for MEDLINE/PubMed.

BACKGROUND: Plain language search tools for MEDLINE/PubMed are few. We wanted to develop a search tool that would allow anyone using a free-text, natural language query and without knowing specialized vocabularies that an expert searcher might use, to find relevant citations in MEDLINE/PubMed. This tool would translate a question into an efficient search. RESULTS: The accuracy and relevance of retrieved citations were compared to references cited in BMJ POEMs and CATs (critically appraised topics) questions from the University of Michigan Department of Pediatrics. askMEDLINE correctly matched the cited references 75.8% in POEMs and 89.2 % in CATs questions on first pass. When articles that were deemed to be relevant to the clinical questions were included, the overall efficiency in retrieving journal articles was 96.8% (POEMs) and 96.3% (CATs.) CONCLUSION: askMEDLINE might be a useful search tool for clinicians, researchers, and other information seekers interested in finding current evidence in MEDLINE/PubMed. The text-only format could be convenient for users with wireless handheld devices and those with low-bandwidth connections in remote locations.

Academic Medical Centers↗
PubMed1999

Avoid the paper chase. Real-time, wireless patient documentation helps therapists save both time and money.

UNLABELLED: Good Shepherd Medical Center's physical therapy clinic, Longview, Texas. PROBLEM: Streamlining documentation processes in hard-to-reach areas of an off-site facility. SOLUTION: Implementing handheld, point-of-care devices for real-time documentation. RESULTS: Reduction in the time and effort physical therapists spend on "back office" documentation procedures. KEYS TO SUCCESS. "With the wireless link the staff doesn't have to concern itself with technical terms, uploads and network logons. They just enter their information by answering pre-programmed prompts. The information flows over to the host computer in real time."

Documentation↗
PubMed2003

Radioisotope marking under CT guidance and localization using a handheld gamma probe for small or indistinct pulmonary lesions.

STUDY OBJECTIVES: A new marking technique was developed to localize small or indistinct pulmonary lesions, involving preoperative radioisotope injection and intraoperative detection with a handheld gamma probe. SETTING: National hospital for respiratory disease. METHODS: and patients: A technetium suspension (either (99m)Tc tin colloid [2 to 4 mCi, 0.5 to 2.5 mL] or (99m)Tc phytate [2 mCi, 2.0 mL]) was injected preoperatively in the vicinity of the lesion under CT guidance in 25 patients with small or indistinct pulmonary lesions. A handheld gamma probe (Navigator GPS; Tyco Healthcare Japan; Tokyo, Japan) was used to detect the hot spot where radioactivity was localized during surgery. The lesion marked by the radioisotope then was thoracoscopically resected using endostaplers. RESULTS: The preoperative marking procedure took approximately 30 min. A small pneumothorax and mild intrapulmonary bleeding were observed in two patients and one patient, respectively, but no additional treatment was needed for these complications. The lesion was resected soon after the marking procedure in 21 patients, and on the next day in 4 patients. All lesions were easily identified during surgery as radioactive hot spots detected by the handheld gamma probe. Thoracoscopic wedge resection was successfully performed in all patients without complications. CONCLUSION: This new marking technique for small or indistinct pulmonary lesions (radioisotope injection under CT guidance and intraoperative detection with a handheld gamma probe) seems to be safe, reliable, and convenient.

Colloids↗
PubMed2002

North Philadelphia Health System employs handhelds to check data.

Quality control professionals typically do their work after patients have been seen and treated. But North Philadelphia Health System (NPHS) in Philadelphia, PA, is using wireless technology to collect and analyze data while the patient is still in the hospital, giving the quality control department the opportunity to improve care on the spot.

Computer Peripherals↗
PubMed2006

Neuro-muscular junction block stimulator simulator.

Improved technology and higher fidelity are making medical simulations increasingly popular. A simulated peripheral nerve stimulator and thumb actuator has been developed for use with the SimMan Universal Patient Simulator. This device incorporates a handheld control box, a McKibben pneumatic muscle and articulated thumb, and a remote software interface for the simulation facilitator. The system simulates the action of a peripheral nerve stimulator on the ulnar nerve, and the effects of neuromuscular junction blocking agents on the thumb motion.

Anesthetics, Local↗
PubMed2001

Assistance in the palm of your hand. Portable technology can free physicians from billing and coding chains.

PROBLEM: Paper-based billing system required unmanageable amount of paper, time and work. SOLUTION: Integration of handheld devices with ASP-based charge capture service. RESULTS: Increased accuracy in billing information, reduced incidence of denied claims, faster reimbursement, more accurate view of financial status. KEYS TO SUCCESS: The technology's ease of use, varied capabilities and early benefits.

Accounts Payable and Receivable↗
PubMed2006

A case report of an unstable cervical spine fracture: parallels to the thoracolumbar chance fracture.

OBJECTIVE: To discuss the case of a 40-year-old woman who had a cervical spine fracture similar in appearance to a Chance fracture and to discuss its radiographic appearance. CLINICAL FEATURES: A 40-year-old woman sought chiropractic care for neck pain and weakness in both arms after a motor vehicle accident. Neck flexion worsened the weakness in her upper extremities, her radiating neck pain, and upper extremity pain. A transverse fracture through the spinous process of C6 and narrowed C6 disk space was noted on plain film radiographs. Magnetic resonance imaging findings were consistent with a large midline extruded disk herniation at the C6-7 level with marked extrinsic compression on the cervical cord in addition to the fracture. These findings were similar to a lumbar spine Chance fracture. INTERVENTION AND OUTCOME: The patient was referred for surgical consultation, and discectomy with fusion of C6-7 was performed. After the surgery, the upper extremity pain and weakness subsided. Postsurgical care included chiropractic adjustments with a handheld spring-loaded adjusting instrument and physiotherapy. CONCLUSION: The radiographic features of an unusual cervical spine fracture with the characteristics of a Chance-type fracture are discussed.

Adult↗
PubMed2003

Head up versus head down: the costs of imprecision, unreliability, and visual clutter on cue effectiveness for display signaling.

We conducted 2 experiments to investigate the clutter-scan trade-off between the cost of increasing clutter by overlaying complex information onto the forward field of view using a helmet-mounted display (HMD) and the cost of scanning when presenting this information on a handheld display. In the first experiment, this trade-off was examined in terms of the spatial accuracy of target cuing data in a relatively sparse display; in the second, the spatial accuracy of the cue was varied more radically in an information-rich display. Participants were asked to detect and identify targets hidden in the far domain while performing a monitoring task in the near domain using either an HMD or a handheld display. The results revealed that on a sparse display, the reduced scanning from the HMD presentation of cuing out-weighed the costs of clutter for cued targets, regardless of cue precision, but no benefit was found for uncued targets. When the HMD displayed task-irrelevant information, however, target detection was hindered by the extraneous clutter in the forward field of view relative to the handheld display condition, and this cost of clutter increased as the amount of data that needed to be inspected increased. Potential applications of this research include the development of design considerations for head-up displays for aviation and military applications.

Aerospace Medicine↗
PubMedDate not supplied

Three-dimensional vertebral motions produced by mechanical force spinal manipulation.

OBJECTIVE: The aim of this study was to quantify and compare the 3-dimensional intersegmental motion responses produced by 3 commonly used chiropractic adjusting instruments. METHODS: Six adolescent Merino sheep were examined at the Institute for Medical and Veterinary Science, Adelaide, Australia. In all animals, triaxial accelerometers were attached to intraosseous pins rigidly fixed to the L1 and L2 spinous processes under fluoroscopic guidance. Three handheld mechanical force chiropractic adjusting instruments (Chiropractic Adjusting Tool [CAT], Activator Adjusting Instrument IV [Activator IV], and the Impulse Adjusting Instrument [Impulse]) were used to randomly apply posteroanterior (PA) spinal manipulative thrusts to the spinous process of T12. Three force settings (low, medium, and high) and a fourth setting (Activator IV only) were applied in a randomized repeated measures design. Acceleration responses in adjacent segments (L1 and L2) were recorded at 5 kHz. The multiaxial intersegmental (L1-L2) acceleration and displacement response at each force setting was computed and compared among the 3 devices using a repeated measures analysis of variance (alpha = .05). RESULTS: For all devices, intersegmental motion responses were greatest for axial, followed by PA and medial-lateral (ML) measurement axes for the data examined. Displacements ranged from 0.11 mm (ML axis, Activator IV low setting) to 1.76 mm (PA axis, Impulse high setting). Compared with the mechanical (spring) adjusting instruments (CAT, Activator IV), the electromechanical Impulse produced the most linear increase in both force and intersegmental motion response and resulted in the greatest acceleration and displacement responses (high setting). Significantly larger magnitude intersegmental motion responses were observed for Activator IV vs CAT at the medium and high settings (P < .05). Significantly larger-magnitude PA intersegmental acceleration and displacement responses were consistently observed for Impulse compared with Activator IV and CAT for the high force setting (P < .05). CONCLUSIONS: Larger-magnitude, 3D intersegmental displacement and acceleration responses were observed for spinal manipulative thrusts delivered with Impulse at most force settings and always at the high force setting. Our results indicate that the force-time characteristics of impulsive-type adjusting instruments significantly affects spinal motion and suggests that instruments can and should be tuned to provide optimal force delivery.

Acceleration↗
PubMed1996

[Detection and diagnosis of small ocular misalignment with the Purkinje reflex pattern method].

BACKGROUND: Application test for an automatic classification strategy for ocular alignment data for the detection of ocular misalignment in strabismic patients. METHODS: Photographic Purkinje Reflection Pattern Evaluation was used a) with a handheld device for the detection and measurement of ocular misalignments in near fixation (group 1, n = 64 strabismic patients) and b) with a stationary device for the detection and measurement of ocular misalignments in near fixation (group 2, n = 38 patients) and in distance fixation (group 3, n = 36 patients). The orthoptic diagnoses were mostly primary and secondary microtropia with manifest angles of strabismus from naught or 0.25 degrees to 3-4 degrees, with maximum angles up to 6-9 degrees. The ocular alignment data were classified using the computer based strabismus index procedure. This strategy relies on thresholds derived from means and standard deviations in orthotropic control populations. In this way the data sets were classified automatically as "no referral" or "referral". In addition, an automatic diagnosis of the type of misalignment was given and the results were compared to the orthoptic gold standard. RESULTS: The sensitivity for the detection of a manifest ocular misalignment was a ca. 80% in group 1 and 2, and 90% in group 3, with specificities from 90% to 100%. All manifest angles of strabismus larger than 1 degree were correctly classified as "referral". There was good agreement between the diagnoses of the type of misalignment in most cases. Discrepancies were observed with very small ocular misalignments or with incomplete data sets, or they could be explained by a switch of fixation. The amount of the misalignment varied markedly as compared to the orthoptic measurement in a number of cases. CONCLUSIONS: The examination allows for a detection of small manifest ocular misalignments with a very high sensitivity. The deviated eye and the type of the misalignment in the primary position are evaluated automatically by a data base computer algorithm. The differences between the measured angles of strabismus indicate that the photographic examination conditions and the orthoptic simultaneous prism and cover test conditions are not exactly alike. Purkinje Reflection Pattern Evaluation represents a step towards an examiner-independent measurement of the angle of strabismus.

Adolescent↗
PubMed1997

[Experiences with the hand-held autorefractometer "Retinomax" in adults and children].

BACKGROUND: A measurement of ametropia with a table-top mounted autorefractor can be difficult or impossible on children--especially when the children are very young or handicapped. A hand-held autorefractor, however, may be successfully applied in some of these problematic cases. METHODS: Results of comparative measurements are presented concerning the accuracy and applicability of the hand-held autorefractor. The data were obtained on healthy young adults (100 eyes) and children (age 2-10 years, 50 eyes). In the group of adults, the autorefractor readings (obtained with a Retinomax K-plus) were compared with the results of subjective refractions. The effectiveness of the technique to relax accommodation was also evaluated. All children were measured with a Retinomax in cycloplegia. Here, retinoscopy and a conventional autorefractor served as reference methods. The accuracy of measurement was analysed by using the following criteria: "Difference of the spherical equivalents" (delta SA), "difference of the cylinder powers" (delta C), "axis difference" (delta A), and "difference of the cylindrical corrections" (delta CK). RESULTS: a) Adults: On average, the spherical equivalent of the autorefractor was +0.28 D larger than the subjectively obtained value. In 88% of all cases, the difference of the spherical equivalents fell into the interval [-0.25 D, +0.75 D]. delta C and delta A were < or = +/- 0.5 D in 95% and 87% respectively. b) Children: When compared with retinoscopy, delta SA fell into the interval [-0.25 D, +0.75 D] in 72% of all cases. delta C and delta A were < or = +/- 0.5 D in 86% and 87% respectively. CONCLUSIONS: The accuracy of measurement of the handheld autorefractor is comparable to conventional table-top autorefractors. As it is also applicable in some problematic cases, such as small children, on whom objective refraction data can not be obtained with ordinary autorefractors, it seems to be a valuable addition to the existing set of ophthalmic refraction devices.

Adult↗
PubMed2005

Intraoperative optical spectroscopy identifies infiltrating glioma margins with high sensitivity.

OBJECTIVE: Adult gliomas have indistinct borders. As the ratio of neoplastic cells to normal cells becomes lower, the ability to detect these cells diminishes. We describe a device designed to augment intraoperative identification of both solid tumor and infiltrating tumor margins. METHODS: A novel, intraoperative, optical spectroscopic tool, using both white light reflectance and 337-nm excitation fluorescence spectroscopy, is described. Discrimination algorithms have been developed to segregate neoplastic tissues from normal glial and neuronal elements. The spectroscopy device was used to measure 5 to 10 locations during glioma resection. Beneath the tool, a biopsy sample was obtained and the pathological results were reviewed in a blinded fashion. Samples were classified as solid tumor, infiltrating tumor, or normal gray or white matter. Comparisons were made between the optical spectra and the histopathological results of sampled areas in evaluating the sensitivity and specificity of the tool for tissue discrimination. RESULTS: Spectral data were obtained from 24 patients with glioma and from 11 patients with temporal lobe epilepsy. A sensitivity of 80% and a specificity of 89% in discriminating solid tumor from normal tissues were obtained. In addition, infiltrating tumor margins were distinguished from normal tissues with a sensitivity of 94% and a specificity of 93%. CONCLUSION: We have developed a handheld, optical spectroscopic device that may be used rapidly and in near real time with high sensitivity and reproducibility as an optical tissue discrimination tool in glioma surgery.

Adult↗
PubMed2005

Personalized online information search and visualization.

BACKGROUND: The rapid growth of online publications such as the Medline and other sources raises the questions how to get the relevant information efficiently. It is important, for a bench scientist, e.g., to monitor related publications constantly. It is also important, for a clinician, e.g., to access the patient records anywhere and anytime. Although time-consuming, this kind of searching procedure is usually similar and simple. Likely, it involves a search engine and a visualization interface. Different words or combination reflects different research topics. The objective of this study is to automate this tedious procedure by recording those words/terms in a database and online sources, and use the information for an automated search and retrieval. The retrieved information will be available anytime and anywhere through a secure web server. RESULTS: We developed such a database that stored searching terms, journals and et al., and implement a piece of software for searching the medical subject heading-indexed sources such as the Medline and other online sources automatically. The returned information were stored locally, as is, on a server and visible through a Web-based interface. The search was performed daily or otherwise scheduled and the users logon to the website anytime without typing any words. The system has potentials to retrieve similarly from non-medical subject heading-indexed literature or a privileged information source such as a clinical information system. The issues such as security, presentation and visualization of the retrieved information were thus addressed. One of the presentation issues such as wireless access was also experimented. A user survey showed that the personalized online searches saved time and increased and relevancy. Handheld devices could also be used to access the stored information but less satisfactory. CONCLUSION: The Web-searching software or similar system has potential to be an efficient tool for both bench scientists and clinicians for their daily information needs.

Databases, Bibliographic↗
PubMed1999

Comparison of numerical and experimental methods for determination of SAR and radiation patterns of handheld wireless telephones.

Some recent developments in both the numerical and experimental methods for determination of SARs and radiation patterns of handheld wireless telephones are described, with emphasis on comparison of results using the two methods. For numerical calculations, it was possible to use the Pro-Engineer CAD Files of cellular telephones for a realistic description of the device. Also, we used the expanding grid formulation of the finite-difference time-domain (FDTD) method for finer-resolution representation of the coupled region, including the antenna, and an increasingly coarser representation of the more-distant, less-coupled region. Together with the truncation of the model of the head, this procedure led to a saving of computer memory needed for SAR calculations by a factor of over 20. Automated SAR and radiation pattern measurement systems were used to validate both the calculated 1-g SARs and radiation patterns for several telephones, including some research test samples, using a variety of antennas. Even though widely different peak 1-g SARs were obtained, ranging from 0.13 to 5.41 W/kg, agreement between the calculated and the measured data for these telephones, five each at 835 and 1900 MHz, was excellent and generally within +/-20% (+/-1 dB). An important observation was that for a maximum radiated power of 600 mW at 800/900 MHz, which may be used for telephones using AMPS technology, the peak 1-g SARs can be higher than 1.6 W/kg unless antennas are carefully designed and placed further away from the head.

Adult↗
PubMed2004

Evaluation of SET--a new device for the measurement of pain perception in comparison to standard measures of diabetic neuropathy.

BACKGROUND: Early detection of sensory impairment and loss of protective pain sensation is of major importance for the prevention of neuropathic foot ulceration. The aim of our study was to evaluate a new handheld device (SET, a prototype developed by Dr. W. Henniges, Zülpich, Germany) for measurement of pain perception, in comparison with established methods for diagnosis of diabetic neuropathy. METHODS: Sixty-one patients with diabetes mellitus (13 type 1, 48 type 2; 42 men, 19 women; mean +/- SD age 61.6 +/- 11.6 years) received measurement of pain perception threshold using the new SET device and a measurement of light touch sensation, temperature sensation, and vibration sensation by the use of standard clinical devices. In addition, warm, cold, heat pain and vibration perception thresholds were determined by the use of a computer-based peltier thermode and a vibration stimulator (TSA 2001, Medoc, Ramat Yishai, Israel). RESULTS: Using the new SET device, patients with sensory impairment showed significantly elevated pain perception thresholds at the dorsum of the foot (P < 0.001), while only a trend towards higher measurements could be observed at the plantar aspect of the foot. A significant correlation could be observed between plantar and dorsal measuring sites (r = 0.78, P < 0.0001) and between both feet (r = 0.85, P < 0.0001). Compared with other qualities of sensory dysfunction, pain perception measurement with the SET device provided the highest sensitivity (pain = 0.82; vibration = 0.61; temperature = 0.42; light touch = 0.11). CONCLUSIONS: Measurement of pain perception threshold using the SET device is an easy and reliable method for identifying patients with impaired small nerve fiber function.

Cold Temperature↗
PubMed2006

Online guideline assist in intensive care medicine--is the login-authentication a sufficient trigger for reminders?

INTRODUCTION: Rising cost pressure due to the implementation of the DRG-System and quality assurance lead to an increased use of therapy standards and standard operating procedures (SOPs) in intensive care medicine. The intention of the German Scientific Society supported project "OLGA" (Online Guideline Assist) is to develop a prototype of a knowledge based system supporting physicians of an intensive care unit in recognizing the indication for and selecting a specific guideline or SOP. While the response of the prototype on user entries can be displayed as a signal on the used workstation itself, the location and time for a reminder of scheduled or missed procedures or reactions to imported information is a difficult issue. One possible approach to this task is the display of non acknowledged reminders or recommendations while logging on to a system. The objective of this study is to analyse user behaviour of the physicians working on the surgical intensive care unit to decide whether the login authentication is a sufficient trigger for clinical reminding. METHODS: The surgical intensive care unit examined in this study comprises 14 beds. Medical care is provided by physicians working in shifts 24 hours a day, 7 days a week, with two anaesthetists at a time and an additional senior consultant during daytime. The entire documentation (examinations, medication, orders, care) is performed using the patient data management system ICUData. The authentication process of the physicians was logged and analysed. RESULTS: Throughout the observation period from December 13th 2005 to January 11th 2006 3563 physician logins were counted in total. The mean span between logins was in 11.3 minutes (SD 14.4), the median 7 minutes. The 75% centile was 14 minutes, the 95% centile 38 min. Intervals greater than 60 minutes occurred in 75%, and greater than 90 minutes in 25% of the days. DISCUSSION: It seems reasonable that reminders sent during authentication are able to enforce workflow compliance. It is possible to send notifications caused by external events to the physician depending on the importance of the event. Serious events with high urgency should be reliably passed using wireless pager or handheld technology. It seems that after the implementation of the prototype guideline assist further investigation is needed to monitor changes in authentication behaviour and reactions to the guideline advisory. This is also required to investigate the influence of unit's size, medical specialty and actual ward workload.

Critical Care↗
PubMed1994

Voice output reader for displays on video cassette recorders and other domestic products.

The increasing use of electronic displays in domestic products can pose great problems for blind people wishing to use microwave ovens, video cassette recorders, hi-fi systems, etc. One method of trying to solve these problems is to provide a handheld "display reader" that can translate the alphanumeric and symbolic information presented on the display into speech. A prototype system has been developed and evaluated. User requirements for this device and the problems of the image sensor, the image processing method, and the user interaction with the system are also discussed.

Blindness↗
PubMed2006

Handheld rectilinear ion trap mass spectrometer.

A shoebox-sized, 10-kg, handheld mass spectrometer, Mini 10, based on a rectilinear ion trap mass analyzer has been designed, built, and characterized. This instrument has evolved from a decade-long experimental and simulation program in mass spectrometer miniaturization. The rectilinear ion trap has a simplified geometry and high trapping capacity, and when used with a miniature and ruggedized pumping system, it allows chemical analysis while the instrument is being carried. Compact electronics, including an air core RF drive coil, were developed to control the instrument and to record mass spectra. The instrument runs on battery power, consuming less than 70 W, similar to a laptop computer. Wired and wireless networking capabilities are implemented. The instrument gives unit resolution and a mass range of over m/z 500. Tandem mass spectrometry capabilities are implemented using collision-induced dissociation, and they are used to provide confirmation of chemical structure during in situ analysis. Continuous monitoring of air and solution samples is demonstrated, and a limit of detection of 50 ppb was obtained for toluene vapor in air and for an aqueous naphthalene solution using membrane sample introduction.

Journal Article↗