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1.  Surgical procedure logging with use of a hand-held computer 
Canadian Journal of Surgery  2002;45(5):345-350.
Objective
To evaluate the feasibility of incorporating hand-held computing technology in a surgical residency program, by means of hand-held devices for surgical procedure logging linked through the Internet to a central database.
Setting
Division of General Surgery, University of Toronto.
Design
A survey of general surgery residents.
Methods
The 69 residents in the general surgery training program received hand-held computers with preinstalled medical programs and a program designed for surgical procedure logging. Procedural data were uploaded via the Internet to a central database. Survey data were collected regarding previous computer use as well as previous procedure logging methods.
Main outcome measure
Utilization of the procedure logging system.
Results
After a 5-month pilot period, 38% of surgical residents were using the procedure-logging program successfully and on a regular basis. Program use was higher among more junior trainees. Analysis of the database provided valuable information on individual trainees, hospital programs and supervising surgeons, data that would assist in program development.
Conclusions
Hand-held devices can be implemented in a large division of general surgery to provide a reference database and a procedure-logging platform. However, user acceptance is not uniform and continued training and support are necessary to increase acceptance. The procedure database provides important information for optimizing trainees’ educational experience.
PMCID: PMC3684636  PMID: 12387537
2.  Prospective evaluation of an internet-linked handheld computer critical care knowledge access system 
Critical Care  2004;8(6):R414-R421.
Introduction
Critical care physicians may benefit from immediate access to medical reference material. We evaluated the feasibility and potential benefits of a handheld computer based knowledge access system linking a central academic intensive care unit (ICU) to multiple community-based ICUs.
Methods
Four community hospital ICUs with 17 physicians participated in this prospective interventional study. Following training in the use of an internet-linked, updateable handheld computer knowledge access system, the physicians used the handheld devices in their clinical environment for a 12-month intervention period. Feasibility of the system was evaluated by tracking use of the handheld computer and by conducting surveys and focus group discussions. Before and after the intervention period, participants underwent simulated patient care scenarios designed to evaluate the information sources they accessed, as well as the speed and quality of their decision making. Participants generated admission orders during each scenario, which were scored by blinded evaluators.
Results
Ten physicians (59%) used the system regularly, predominantly for nonmedical applications (median 32.8/month, interquartile range [IQR] 28.3–126.8), with medical software accessed less often (median 9/month, IQR 3.7–13.7). Eight out of 13 physicians (62%) who completed the final scenarios chose to use the handheld computer for information access. The median time to access information on the handheld handheld computer was 19 s (IQR 15–40 s). This group exhibited a significant improvement in admission order score as compared with those who used other resources (P = 0.018). Benefits and barriers to use of this technology were identified.
Conclusion
An updateable handheld computer system is feasible as a means of point-of-care access to medical reference material and may improve clinical decision making. However, during the study, acceptance of the system was variable. Improved training and new technology may overcome some of the barriers we identified.
doi:10.1186/cc2967
PMCID: PMC1065064  PMID: 15566586
clinical; computer; critical care; decision support systems; handheld; internet; point-of-care systems; practice guidelines; simulation
3.  Barriers to Acceptance of Personal Digital Assistants for HIV/AIDS Data Collection in Angola 
Purpose
Handheld computers have potential to improve HIV/AIDS programs in healthcare settings in low-resource countries, by improving the speed and accuracy of collecting data. However, the acceptability of the technology (i.e., user attitude and reaction) is critical for its successful implementation. Acceptability is particularly critical for HIV/AIDS behavioral data, as it depends on respondents giving accurate information about a highly sensitive topic – sexual behavior.
Methods
To explore the acceptability of handheld computers for HIV/AIDS data collection and to identify potential barriers to acceptance, five focus groups of 8–10 participants each were conducted in Luanda, Angola. Facilitators presented Palm Tungsten E handhelds to the focus groups, probed participants’ perceptions of the handheld computer, and asked how they felt about disclosing intimate sexual behavior to an interviewer using a handheld computer. Discussions were conducted in Portuguese, the official language of Angola, and audio-taped. They were then transcribed and translated into English for analysis.
Results
In total, 49 people participated in the focus groups. PDAs were understood through the lens of social and cultural beliefs. Themes that emerged were suspicion of outsiders, concern with longevity, views on progress and development, and concern about social status.
Conclusions
The findings from this study suggest that personal and cultural beliefs influence participant acceptance of PDAs in Angola. While PDAs provide great advantages in terms of speed and efficiency of data collection, these barriers, if left unaddressed, may lead to biased reporting of HIV/AIDS risk data. An understanding of the barriers and why they are relevant in Angola may help researchers and practitioners to reduce the impact of these barriers on HIV/AIDS data collection.
doi:10.1016/j.ijmedinf.2011.04.004
PMCID: PMC3152252  PMID: 21622022
Computers; Handheld; Data Collection; HIV; Sexual Behavior; Africa South of the Sahara
4.  Development of Real-Time Dual-Display Handheld and Bench-Top Hybrid-Mode SD-OCTs 
Sensors (Basel, Switzerland)  2014;14(2):2171-2181.
Development of a dual-display handheld optical coherence tomography (OCT) system for retina and optic-nerve-head diagnosis beyond the volunteer motion constraints is reported. The developed system is portable and easily movable, containing the compact portable OCT system that includes the handheld probe and computer. Eye posterior chambers were diagnosed using the handheld probe, and the probe could be fixed to the bench-top cradle depending on the volunteers' physical condition. The images obtained using this handheld probe were displayed in real time on the computer monitor and on a small secondary built-in monitor; the displayed images were saved using the handheld probe's built-in button. Large-scale signal-processing procedures such as k-domain linearization, fast Fourier transform (FFT), and log-scaling signal processing can be rapidly applied using graphics-processing-unit (GPU) accelerated processing rather than central-processing-unit (CPU) processing. The Labview-based system resolution is 1,024 × 512 pixels, and the frame rate is 56 frames/s, useful for real-time display. The 3D images of the posterior chambers including the retina, optic-nerve head, blood vessels, and optic nerve were composed using real-time displayed images with 500 × 500 × 500 pixel resolution. A handheld and bench-top hybrid mode with a dual-display handheld OCT was developed to overcome the drawbacks of the conventional method.
doi:10.3390/s140202171
PMCID: PMC3958276  PMID: 24473286
OCT; handheld probe; GPU; real time; dual display
5.  Handheld Computer Use in U.S. Family Practice Residency Programs 
Objective: The purpose of the study was to evaluate the uses of handheld computers (also called personal digital assistants, or PDAs) in family practice residency programs in the United States.
Study Design: In November 2000, the authors mailed a questionnaire to the program directors of all American Academy of Family Physicians (AAFP) and American College of Osteopathic Family Practice (ACOFP) residency programs in the United States.
Measurements: Data and patterns of the use and non-use of handheld computers were identified.
Results: Approximately 50 percent (306 of 610) of the programs responded to the survey. Two thirds of the programs reported that handheld computers were used in their residencies, and an additional 14 percent had plans for implementation within 24 months. Both the Palm and the Windows CE operating systems were used, with the Palm operating system the most common. Military programs had the highest rate of use (8 of 10 programs, 80 percent), and osteopathic programs had the lowest (23 of 55 programs, 42 percent). Of programs that reported handheld computer use, 45 percent had required handheld computer applications that are used uniformly by all users. Funding for handheld computers and related applications was non-budgeted in 76percent of the programs in which handheld computers were used. In programs providing a budget for handheld computers, the average annual budget per user was $461.58. Interested faculty or residents, rather than computer information services personnel, performed upkeep and maintenance of handheld computers in 72 percent of the programs in which the computers are used. In addition to the installed calendar, memo pad, and address book, the most common clinical uses of handheld computers in the programs were as medication reference tools, electronic textbooks, and clinical computational or calculator-type programs.
Conclusions: Handheld computers are widely used in family practice residency programs in the United States. Although handheld computers were designed as electronic organizers, in family practice residencies they are used as medication reference tools, electronic textbooks, and clinical computational programs and to track activities that were previously associated with desktop database applications.
PMCID: PMC349390  PMID: 11751806
6.  Handheld computers in critical care 
Critical Care  2001;5(4):227-231.
Background
Computing technology has the potential to improve health care management but is often underutilized. Handheld computers are versatile and relatively inexpensive, bringing the benefits of computers to the bedside. We evaluated the role of this technology for managing patient data and accessing medical reference information, in an academic intensive-care unit (ICU).
Methods
Palm III series handheld devices were given to the ICU team, each installed with medical reference information, schedules, and contact numbers. Users underwent a 1-hour training session introducing the hardware and software. Various patient data management applications were assessed during the study period. Qualitative assessment of the benefits, drawbacks, and suggestions was performed by an independent company, using focus groups. An objective comparison between a paper and electronic handheld textbook was achieved using clinical scenario tests.
Results
During the 6-month study period, the 20 physicians and 6 paramedical staff who used the handheld devices found them convenient and functional but suggested more comprehensive training and improved search facilities. Comparison of the handheld computer with the conventional paper text revealed equivalence. Access to computerized patient information improved communication, particularly with regard to long-stay patients, but changes to the software and the process were suggested.
Conclusions
The introduction of this technology was well received despite differences in users' familiarity with the devices. Handheld computers have potential in the ICU, but systems need to be developed specifically for the critical-care environment.
PMCID: PMC37409  PMID: 11511337
computer communication networks; medical informatics; medical technology; microcomputers; point-of-care technology
7.  MED31/437: A Web-based Diabetes Management System: DiabNet 
Introduction
A web-based system (DiabNet) was developed to provide instant access to the Electronic Diabetes Records (EDR) for end-users, and real-time information for healthcare professionals to facilitate their decision-making. It integrates portable glucometer, handheld computer, mobile phone and Internet access as a combined telecommunication and mobile computing solution for diabetes management. Methods:
Active Server Pages (ASP) embedded with advanced ActiveX controls and VBScript were developed to allow remote data upload, retrieval and interpretation. Some advisory and Internet-based learning features, together with a video teleconferencing component make DiabNet web site an informative platform for Web-consultation.
Results
The evaluation of the system is being implemented among several UK Internet diabetes discussion groups and the Diabetes Day Centre at the Guy's & St. Thomas' Hospital. Many positive feedback are received from the web site demonstrating DiabNet is an advanced web-based diabetes management system which can help patients to keep closer control of self-monitoring blood glucose remotely, and is an integrated diabetes information resource that offers telemedicine knowledge in diabetes management.
Discussion
In summary, DiabNet introduces an innovative online diabetes management concept, such as online appointment and consultation, to enable users to access diabetes management information without time and location limitation and security concerns.
doi:10.2196/jmir.1.suppl1.e68
PMCID: PMC1761784
Web-based; ActiveX ; Diabetes Management; Decision-Making; Mobile Computing
8.  Hand-held Computer Use in Third-year Medical Clerkships 
Handheld computers (PDA's, palm-tops, etc.) are increasingly popular in medicine. We analyzed a class of medical students to identify and categorize the differences between handheld computer owners vs. non-owners. Medical students were surveyed in several third year clinical rotations regarding demographics, technology use, barriers to ownership and perceived educational advantage. These data provide a profile of the typical medical handheld computer user, useful for institutions seeking to successfully integrate handheld computers into their programs.
PMCID: PMC2243663
9.  Acceptability and adoption of handheld computer data collection for public health research in China: a case study 
Background
Handheld computers for data collection (HCDC) and management have become increasingly common in health research. However, current knowledge about the use of HCDC in health research in China is very limited. In this study, we administered a survey to a hard-to-reach population in China using HCDC and assessed the acceptability and adoption of HCDC in China.
Methods
Handheld computers operating Windows Mobile and Questionnaire Development Studio (QDS) software (Nova Research Company) were used for this survey. Questions on tobacco use and susceptibility were drawn from the Global Adult Tobacco Survey (GATS) and other validated instruments, and these were programmed in Chinese characters by local staff. We conducted a half-day training session for survey supervisors and a three-day training session for 20 interviewers and 9 supervisors. After the training, all trainees completed a self-assessment of their skill level using HCDC. The main study was implemented in fall 2010 in 10 sites, with data managed centrally in Beijing. Study interviewers completed a post-survey evaluation questionnaire on the acceptability and utility of HCDC in survey research.
Results
Twenty-nine trainees completed post-training surveys, and 20 interviewers completed post-data collection questionnaires. After training, more than 90% felt confident about their ability to collect survey data using HCDC, to transfer study data from a handheld computer to a laptop, and to encrypt the survey data file. After data collection, 80% of the interviewers thought data collection and management were easy and 60% of staff felt confident they could solve problems they might encounter. Overall, after data collection, nearly 70% of interviewers reported that they would prefer to use handheld computers for future surveys. More than half (55%) felt the HCDC was a particularly useful data collection tool for studies conducted in China.
Conclusions
We successfully conducted a health-related survey using HCDC. Using handheld computers for data collection was a feasible, acceptable, and preferred method by Chinese interviewers. Despite minor technical issues that occurred during data collection, HCDC is a promising methodology to be used in survey-based research in China.
doi:10.1186/1472-6947-13-68
PMCID: PMC3706303  PMID: 23802988
Surveys; Electronic data collection; Handheld computers; China
10.  Handheld Computer-based Decision Support Reduces Patient Length of Stay and Antibiotic Prescribing in Critical Care 
Objective: This study assessed the effect of a handheld computer-based decision support system (DSS) on antibiotic use and patient outcomes in a critical care unit.
Design: A DSS containing four types of evidence (patient microbiology reports, local antibiotic guidelines, unit-specific antibiotic susceptibility data for common bacterial pathogens, and a clinical pulmonary infection score calculator) was developed and implemented on a handheld computer for use in the intensive care unit at a tertiary referral hospital. System impact was assessed in a prospective “before/after” cohort trial lasting 12 months. Outcome measures were defined daily doses (DDDs) of antibiotics per 1,000 patient-days, patient length of stay, and mortality.
Results: The number of admissions, APACHE (Acute Physiology, Age, and Chronic Health Evaluation) II and SAPS (Simplified Acute Physiology Score) II for patients in preintervention, and intervention (DSS use) periods were statistically comparable. The mean patient length of stay and the use of antibiotics in the unit during six months of the DSS use decreased from 7.15 to 6.22 bed-days (p = 0.02) and from 1,767 DDD to 1,458 DDD per 1,000 patient-days (p = 0.04), respectively, with no change in mortality. The DSS was accessed 674 times during 168 days of the trial. Microbiology reports and antibiotic guidelines were the two most commonly used (53% and 22.5%, respectively) types of evidence. The greatest reduction was observed in the use of β-lactamase–resistant penicillins and vancomycin.
Conclusion: Handheld computer-based decision support contributed to a significant reduction in patient length of stay and antibiotic prescribing in a critical care unit.
doi:10.1197/jamia.M1798
PMCID: PMC1174884  PMID: 15802478
11.  Ethnic Differences in Achievement of Cholesterol Treatment Goals 
BACKGROUND
African Americans (AA) have the highest coronary heart disease mortality rate of any ethnic group in the United States. Data from the National Cholesterol Education Program Evaluation ProjecT Utilizing Novel E-Technology (NEPTUNE) II survey were used to assess ethnic differences in low-density lipoprotein cholesterol (LDL-C) goal achievement.
METHODS
NEPTUNE II surveyed patients with treated dyslipidemia to assess achievement of treatment goals established by the Adult Treatment Panel III of the National Cholesterol Education Program. United States physicians working in primary care or relevant subspecialties enrolled 10 to 20 consecutive patients (May to September 2003), and patient data were recorded in Personal Digital Assistants and uploaded to a central database via the internet.
RESULTS
Among 4,885 patients receiving treatment for dyslipidemia, 79.7% were non-Hispanic white (NHW) and 8.4% were AA. Non-Hispanic white and AA patients had significantly different frequencies of treatment success, with 69.0% and 53.7%, respectively, having achieved their LDL-C goal (P <.001). African-American patients were more likely to be in the highest risk category, and less likely to be using lipid drug therapy, taking high-efficacy statins, and receiving care from a subspecialist, but the difference in goal achievement remained significant (P <.001) after adjustment for these and other predictors of treatment success.
CONCLUSIONS
The frequency of treatment success in dyslipidemia management was significantly lower in AA than NHW patients. Additional research is needed to elucidate reasons for this disparity and to evaluate strategies for improving goal achievement among AA patients receiving therapy for dyslipidemia.
doi:10.1111/j.1525-1497.2006.00349.x
PMCID: PMC1484721  PMID: 16686806
National Cholesterol Education Program guidelines; ethnicity; lipid treatment
12.  Tapping Trumps Typing: How Users Enter Data in an Electronic Student Encounter Log 
Handheld encounter logs that accurately record patient diagnoses could facilitate several educational tasks. Unfortunately, data entry on hand-held computers is notoriously difficult, requiring either tapping buttons or entering text, for instance by typing. In most medical reference software, long lists of inputs adjust to match typed data, reducing the burden of data entry. Tapping is faster if the user can locate the correct target quickly, but designing and maintaining screens with many fixed targets is tedious, and the program grows large. We developed an Electronic Student Encounter Log, ESEL, allowing students to tap or type to record problems observed in ambulatory patients. The tapping interface comprises collections of related disease checkboxes organized in a shallow, broad tree structure, making 983 diagnoses visible with 2 taps. The typing interface mimics typical reference software, scrolling and searching a list of 1332 common problems to match user-entered text. ESEL records how students look for diagnoses to record. Analysis of 62 ambulatory care students’ ESEL records showed that they used the tapping interface much more often than the typing interface, and recorded data more quickly by tapping than by typing. If accuracy is acceptable, more robust tapping interfaces deserve wider consideration for data capture on handheld computers.
PMCID: PMC1839468  PMID: 17238313
13.  Evidence of Effectiveness of Health Care Professionals Using Handheld Computers: A Scoping Review of Systematic Reviews 
Background
Handheld computers and mobile devices provide instant access to vast amounts and types of useful information for health care professionals. Their reduced size and increased processing speed has led to rapid adoption in health care. Thus, it is important to identify whether handheld computers are actually effective in clinical practice.
Objective
A scoping review of systematic reviews was designed to provide a quick overview of the documented evidence of effectiveness for health care professionals using handheld computers in their clinical work.
Methods
A detailed search, sensitive for systematic reviews was applied for Cochrane, Medline, EMBASE, PsycINFO, Allied and Complementary Medicine Database (AMED), Global Health, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. All outcomes that demonstrated effectiveness in clinical practice were included. Classroom learning and patient use of handheld computers were excluded. Quality was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR) tool. A previously published conceptual framework was used as the basis for dual data extraction. Reported outcomes were summarized according to the primary function of the handheld computer.
Results
Five systematic reviews met the inclusion and quality criteria. Together, they reviewed 138 unique primary studies. Most reviewed descriptive intervention studies, where physicians, pharmacists, or medical students used personal digital assistants. Effectiveness was demonstrated across four distinct functions of handheld computers: patient documentation, patient care, information seeking, and professional work patterns. Within each of these functions, a range of positive outcomes were reported using both objective and self-report measures. The use of handheld computers improved patient documentation through more complete recording, fewer documentation errors, and increased efficiency. Handheld computers provided easy access to clinical decision support systems and patient management systems, which improved decision making for patient care. Handheld computers saved time and gave earlier access to new information. There were also reports that handheld computers enhanced work patterns and efficiency.
Conclusions
This scoping review summarizes the secondary evidence for effectiveness of handheld computers and mhealth. It provides a snapshot of effective use by health care professionals across four key functions. We identified evidence to suggest that handheld computers provide easy and timely access to information and enable accurate and complete documentation. Further, they can give health care professionals instant access to evidence-based decision support and patient management systems to improve clinical decision making. Finally, there is evidence that handheld computers allow health professionals to be more efficient in their work practices. It is anticipated that this evidence will guide clinicians and managers in implementing handheld computers in clinical practice and in designing future research.
doi:10.2196/jmir.2530
PMCID: PMC3841346  PMID: 24165786
handheld computers; mobile devices; mhealth; PDA; information seeking behavior; evidence-based practice; delivery of health care; clinical practice; health technology adoption; diffusion of innovation; systematic review; evidence synthesis; documentation
14.  Clinician Use of a Palmtop Drug Reference Guide 
Objective: Problems involving drug knowledge are one of the most common causes of serious medication errors. Although the information that clinicians need is often available somewhere, retrieving it expeditiously has been problematic. At the same time, clinicians are faced with an ever-expanding pharmacology knowledge base. Recently, point-of-care technology has become more widely available and more practical with the advent of handheld, or palmtop, computing. Therefore, the authors evaluated the clinical contribution of a drug database developed for the handheld computer. ePocrates Rx (formerly known as qRx; ePocrates, San Carlos, California) is a comprehensive drug information guide that is downloadable free from the Internet and designed for the Palm OS platform align="right".
Design: A seven-day online survey of 3,000 randomly selected ePocrates Rx users was conducted during March 2000.
Measurements: User technology experience, product evaluation and usage patterns, and the effects of the drug reference database on information-seeking behavior, practice efficiency, decision making, and patient care.
Results: The survey response rate was 32 percent (n=946). Physicians reported that ePocrates Rx saves time during information retrieval, is easily incorporated into their usual workflow, and improves drug-related decision making. They also felt that it reduced the rate of preventable adverse drug events.
Conclusions: Self-reported perceptions by responding clinicians endorse improved access to drug information and improved practice efficiency associated with the use of handheld devices. The clinical and practical value of using these devices in clinical settings will clearly grow further as wireless communication becomes more ubiquitous and as more applications become available.
doi:10.1197/jamia.M1001
PMCID: PMC344582  PMID: 11971883
15.  Handheld Optical Coherence Tomography Scanner for Primary Care Diagnostics 
The goal of this study is to develop an advanced point-of-care diagnostic instrument for use in a primary care office using handheld optical coherence tomography (OCT). This system has the potential to enable earlier detection of diseases and accurate image-based diagnostics. Our system was designed to be compact, portable, user-friendly, and fast, making it well suited for the primary care office setting. The unique feature of our system is a versatile handheld OCT imaging scanner which consists of a pair of computer-controlled galvanometer-mounted mirrors, interchangeable lens mounts, and miniaturized video camera. This handheld scanner has the capability to guide the physician in real time for finding suspicious regions to be imaged by OCT. In order to evaluate the performance and use of the handheld OCT scanner, the anterior chamber of a rat eye and in vivo human retina, cornea, skin, and tympanic membrane were imaged. Based on this feasibility study, we believe that this new type of handheld OCT device and system has the potential to be an efficient point-of-care imaging tool in primary care medicine.
doi:10.1109/TBME.2010.2096816
PMCID: PMC3214662  PMID: 21134801
Handheld imaging scanner; optical coherence tomography (OCT); primary care medicine
16.  Patient Perceptions of Physician Use of Handheld Computers 
Background
Handheld computers have advantages for physicians, including portability and integration into office workflow. However, negative patient perceptions of physician use of handheld computers in the examining room might limit integration.
Objective
To survey patients’ perceptions of handheld use, and compare those with their providers’ perceptions.
Methods
A survey of patient attitudes toward handhelds was conducted among patients at a low-income university clinic. Internal Medicine residents providing care were also surveyed.
Results
Patients (N=93) were mostly female (79%) and ethnic minorities (67%) with average age of 39. Only 10% of patients did not like the idea of a handheld computer in the exam room. Other negative attitudes were also seen in a minority of patients. Some physicians (23%) reported reservations about using the handheld with patients.
Conclusions
Negative attitudes were rare among patients, but some providers were concerned about using the handheld in the exam room.
PMCID: PMC1480272  PMID: 14728182
handheld computers; patients; evaluation; outcomes; doctor-patient communication
17.  The Effects of Redesigning the IDEATel Architecture on Glucose Uploads 
Telemedicine Journal and e-Health  2009;15(3):248-254.
The Informatics for Diabetes Education and Telemedicine (IDEATel) project has demonstrated significant changes in clinical outcome measures over the past years. This report describes upgrades and innovations in the system that allow a much more rapid upload of data and thus significant system improvement.
Abstract
The objective of this evaluation was to determine the effect of redesigning the Informatics for Diabetes Education and Telemedicine (IDEATel) telemedicine architecture on the average upload delay and on the average number of glucose uploads to a central database. These two measures positively influence our ability to deliver timely and accurate patient care to the study population. The redesign was also undertaken to improve the patients' experience in using the system and thereby increase the frequency and timeliness of their self-monitoring behavior. Using the total number of glucose uploads, we compared the delay in glucose upload times according to the type of home telemedicine unit the study participants used and the region where the participants lived. The participants were Medicare beneficiaries with diabetes living in medically underserved neighborhoods in New York City and rural Upstate New York. The populations in these two regions differed considerably in terms of ethnicity, language spoken (Spanish, English), and education level. Participants who had Generation 2 (Gen 2) (mean = 10.75, SD ± 7.96) home telemedicine units had significantly shorter upload delay times (p < 0.001) as measured in days than those participants with Generation 1 (Gen 1) (mean = 22.44, SD ± 11.18) and those who were upgraded from Gen 1 (mean = 20.67, SD ± 8.85) to Gen 2 (mean = 14.93, SD ± 9.37). Additionally, the delay was significantly shorter for participants living upstate (mean = 24.14 days, SD ± 11.95 days) than downstate (mean = 15.30 days, SD ± 7.87 days), t (975) = 13.98, p < 0.01. The system redesign made a significant impact in reducing glucose upload delays of IDEATel participants. However, upload delays were significantly impacted by the region where the participants resided.
doi:10.1089/tmj.2008.0101
PMCID: PMC2956565  PMID: 19382862
telemedicine evaluation; technical architecture; diabetes telemedicine
18.  Intraoperative and postoperative gamma detection of somatostatin receptors in bone-invasive en plaque meningiomas 
Neurosurgery  2005;57(1 Suppl):107-13; discussion 107.
Objective
Scintigraphy with radiolabeled somatostatin analogue ([111In-DTPA] octreotide), detects the somatostatin receptors that are found in vitro in all meningiomas. Previous studies have proved the benefit of radioimmunoguided surgery with a handheld gamma probe, for the assessment and the removal of neuroendocrine tumors. We conducted a study to determine whether intraoperative radiodetection of somatostastin receptors is feasible and could increase the probability of complete meningioma resection, especially for bone invasive “en plaque” meningiomas that are difficult to control surgically.
Methods
Eighteen patients with “en plaque” sphenoid wing and skull convexity meningiomas were studied for pre and post-operative somatostatin receptor scintigraphy. In 10 of them, intraoperative radiodetection using a handheld gamma probe was performed 24 hours after the intravenous administration of [111In-DTPA] octreotide. This procedure was combined with a computer-aided navigation system.
Results
All pre-operative scintigraphies were positive. Intraoperative gamma probe detection was possible for invaded bone, dura, and periorbit of sphenoid wing meningiomas. The average tumor/non-tumor counting ratio was 2:1 with a maximum of 12:1, allowing precise detection capable of defining the tumor margins. In three cases of sphenoid wing meningiomas, post-operative scintigraphies were helpful for the determination of recurrences that MRI failed to detect.
Conclusion
These preliminary data show that intraoperative radiodetection of somatostatin receptors using a handheld gamma probe is feasible and may be helpful to guide the surgical removal of bone invasive “en plaque” meningiomas. Pre and postoperative scintigraphy may be useful for the management and follow-up of these tumors.
PMCID: PMC2756774  PMID: 15987576
Adult; Female; Follow-Up Studies; Humans; Intraoperative Care; methods; Male; Meningioma; metabolism; pathology; radionuclide imaging; surgery; Middle Aged; Neoplasm Invasiveness; Octreotide; analogs & derivatives; diagnostic use; pharmacokinetics; Postoperative Care; methods; Prognosis; Radionuclide Imaging; instrumentation; methods; Radiopharmaceuticals; diagnostic use; pharmacokinetics; Receptors, Somatostatin; metabolism; Skull Neoplasms; metabolism; pathology; radionuclide imaging; surgery; Surgery, Computer-Assisted; methods; Treatment Outcome; bone invasion; intraoperative radiodetection; meningiomas; somatostatin receptor scintigraphy.
19.  Survey Assessment of Personal Digital Assistant Use among Trainees and Attending Physicians 
Limited information is available on personal digital assistant (PDA) use patterns in medical settings. Recognizing that use patterns may be important considerations for development of handheld-based information systems, the authors characterized PDA use at their institution. A survey was mailed to all internal medicine physicians at the Mayo Clinic, Rochester, Minnesota, in May 2002. PDA use prevalence, user demographics, hardware preferences, and work setting and application use frequencies were assessed for respondents reporting current PDA use. Use patterns of trainees (residents and subspecialty fellows) and attending physicians were compared. Trainees reported more frequent PDA use in the hospital setting and for direct patient care. Attending physicians reported more frequent PDA use in administrative settings and for calendar functions. These findings may reflect differences in the information needs and work roles of learners and experienced physicians. Such factors may be important considerations for the development and implementation of institutional PDA resources.
doi:10.1197/jamia.M1313
PMCID: PMC264439  PMID: 12925551
20.  The feasibility of nurse practitioner-performed, telementored lung telesonography with remote physician guidance - ‘a remote virtual mentor’ 
Background
Point-of-care ultrasound (POC-US) use is increasingly common as equipment costs decrease and availability increases. Despite the utility of POC-US in trained hands, there are many situations wherein patients could benefit from the added safety of POC-US guidance, yet trained users are unavailable. We therefore hypothesized that currently available and economic ‘off-the-shelf’ technologies could facilitate remote mentoring of a nurse practitioner (NP) to assess for recurrent pneumothoraces (PTXs) after chest tube removal.
Methods
The simple remote telementored ultrasound system consisted of a handheld ultrasound machine, head-mounted video camera, microphone, and software on a laptop computer. The video output of the handheld ultrasound machine and a macroscopic view of the NP's hands were displayed to a remote trauma surgeon mentor. The mentor instructed the NP on probe position and US machine settings and provided real-time guidance and image interpretation via encrypted video conferencing software using an Internet service provider. Thirteen pleural exams after chest tube removal were conducted.
Results
Thirteen patients (26 lung fields) were examined. The remote exam was possible in all cases with good connectivity including one trans-Atlantic interpretation. Compared to the subsequent upright chest radiograph, there were 4 true-positive remotely diagnosed PTXs, 2 false-negative diagnoses, and 20 true-negative diagnoses for 66% sensitivity, 100% specificity, and 92% accuracy for remotely guided chest examination.
Conclusions
Remotely guiding a NP to perform thoracic ultrasound examinations after tube thoracostomy removal can be simply and effectively performed over encrypted commercial software using low-cost hardware. As informatics constantly improves, mentored remote examinations may further empower clinical care providers in austere settings.
doi:10.1186/2036-7902-5-5
PMCID: PMC3735420  PMID: 23805869
Pneumothorax; Remote medicine; Tele-ultrasound; Education; Global health
21.  Use of Handheld Computers in Medical Education 
BACKGROUND
Over the past decade, handheld computers (or personal digital assistants [PDAs]) have become a popular tool among medical trainees and physicians. Few comprehensive reviews of PDA use in medicine have been published.
OBJECTIVE
We systematically reviewed the literature to (1) describe medical trainees' use of PDAs for education or patient care, (2) catalog popular software applications, and (3) evaluate the impact of PDA use on patient care.
DATA SOURCES
MEDLINE (1993 to 2004), medical education-related conference proceedings, and hand search of article bibliographies.
REVIEW METHODS
We identified articles and abstracts that described the use of PDAs in medical education by trainees or educators. Reports presenting a qualitative or quantitative evaluation were included.
RESULTS
Sixty-seven studies met inclusion criteria. Approximately 60% to 70% of medical students and residents use PDAs for educational purposes or patient care. Satisfaction was generally high and correlated with the level of handheld computer experience. Most of the studies included described PDA use for patient tracking and documentation. By contrast, trainees rated medical textbooks, medication references, and medical calculators as the most useful applications. Only 1 randomized trial with educational outcomes was found, demonstrating improved learning and application of evidence-based medicine with use of PDA-based decision support software. No articles reported the impact of PDA use on patient outcomes.
CONCLUSION
Most medical trainees find handhelds useful in their medical education and patient care. Further studies are needed to evaluate how PDAs impact learning and clinical outcomes.
doi:10.1111/j.1525-1497.2006.00444.x
PMCID: PMC1484794  PMID: 16704405
handhelds; personal digital assistants (PDAs); medical trainees; medical education
22.  A handheld computer as part of a portable in vivo knee joint load monitoring system 
Journal of medical devices  2008;2(3):350011-350019.
In vivo measurement of loads and pressures acting on articular cartilage in the knee joint during various activities and rehabilitative therapies following focal defect repair will provide a means of designing activities that encourage faster and more complete healing of focal defects.
It was the goal of this study to develop a totally portable monitoring system that could be used during various activities and allow continuous monitoring of forces acting on the knee. In order to make the monitoring system portable, a handheld computer with custom software, a USB powered miniature wireless receiver and a battery-powered coil were developed to replace a currently used computer, AC powered bench top receiver and power supply.
A Dell handheld running Windows Mobile operating system(OS) programmed using Labview was used to collect strain measurements. Measurements collected by the handheld based system connected to the miniature wireless receiver were compared with the measurements collected by a hardwired system and a computer based system during bench top testing and in vivo testing. The newly developed handheld based system had a maximum accuracy of 99% when compared to the computer based system.
doi:10.1115/1.2952815
PMCID: PMC2752888  PMID: 19789715
23.  A comparison of a printed patient summary document with its electronic equivalent: early results. 
Clinicians are always searching for efficient access to clinical data. The Regenstrief Medical Record System has a printed report that fills this niche: Pocket Rounds. Handheld computers may offer an alternative, but it is unclear how effectively a handheld computer can display such data. We surveyed residents and students on the general medicine services for their opinions regarding Pocket Rounds. Those with handheld computers were given access to an electronic version of Pocket Rounds-e-Rounds. We surveyed the subjects who used e-Rounds for their opinions on the electronic format and how it compared to paper. Users overall satisfaction with Pocket Rounds was 5.8 on a seven-point scale. User s overall satisfaction for e-Rounds was 5.6 on a seven-point scale. The most useful function was retrieval of lab data for both modalities. The results suggest that the electronic format is a viable alternative to paper. Further evaluation is needed, and we plan a prospective controlled trial to study this further.
PMCID: PMC2243457  PMID: 11825276
24.  Validation of electronic student encounter logs in an emergency medicine clerkship. 
Handheld electronic patient encounter logs offer opportunities to understand and enhance medical students' clinical experiences. Before using the data, the reliability of log entries needs to be verified. We assessed the sensitivity and specificity of handheld patient encounter logs by comparing documented entries with reliable external data sources. During an Emergency Medicine clerkship, medical students voluntarily recorded their patients' diagnoses in an Electronic Student Encounter Log (E-SEL) on handheld computers. We used patient demographics to match anonymous log entries with medical charts. Most students recorded 60% or more of their patient encounters and on average 60% of their patients' medical problems in the log. The false positive rate was 26% for patient encounters and 19% for patient problems. In general, students recorded more diagnoses in more detail than was available in the patient's ED chart. Improvements in the log's interface and documentation incentives should enhance the log's accuracy and utility.
PMCID: PMC2244433  PMID: 12463859
25.  Introducing handheld computing into a residency program: preliminary results from qualitative and quantitative inquiry. 
Although published reports describe specific handheld computer applications in medical training, we know very little yet about how, and how well, handheld computing fits into the spectrum of information resources available for patient care and physician training. This paper reports preliminary quantitative and qualitative results from an evaluation study designed to track changes in computer usage patterns and computer-related attitudes before and after introduction of handheld computing. Pre-implementation differences between residents and faculty s usage patterns are interpreted in terms of a "work role" construct. We hypothesize that over time residents and faculty will adopt, adapt, or abandon handheld computing according to how, and how well, this technology supports their successful completion of work role-related tasks. This hypothesis will be tested in the second phase of this pre- and post-implementation study.
PMCID: PMC2243603  PMID: 11825224

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