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LETTERS 4 • JAOA • Vol 103 • No 1 • January 2003 Letters Palm technology moves resident data recording into new dimension To the Editor: Palm technology has fostered the develop-ment of palm data acquisition systems. As the recording of procedures, surgeries, and patient interactions to document a resident’s training is a major requirement of the Res-ident Review Committee, as well as intern-ship programs, the real-time logging and easy analysis of resident procedures pos-sible with a Palm handheld logging sys-tem is ideal. Besides ease of logging, a computer-based system has advantages that include simple backup and duplication of data; easy analysis of data; potential for legible, on-the- fly entries; a redistributed workload, as residents enter data; and portability. In addition, computer-based systems allow users the ability to synchronize and enter data into a desktop system fairly effort-lessly. Ease of synchronization enables fre-quent backups of resident logs and frequent analysis of procedure rates based on any parameter. Disadvantages of using a computer-based system include the need to learn to enter data, the need for a terminal or a per-sonal computer to enter data, time required to enter data in a block-mode method, ease with which Palm handhelds can be bro-ken, and the cost of the system. In contrast, the only advantage inher-ent in paper logging is the ease of recording data. In fact, paper logging to track patient data and procedures is cumbersome and often incomplete. In addition, there is an inability to perform statistical analysis. The advent of small computer systems in the 1970s brought with it online logging of resident procedure data,1-5 though the complexities of these systems were many. Data entry was cumbersome, as either a data entry person was needed or the resi-dent would be required to enter their logs when time was available. The development of Palm handhelds (eg, Palm Pilot, 3M Corporation, or Pocket PC), and the development of software allowing data entry into databases has moved the logging of resident data into a new dimension.6-12 A Palm data logging system was devel-oped to provide for potential online or real time logging of resident procedures and resuscitations. The system is based on the PalmPilot computing platform, 3Com, Palm. Currently, the Palm IIIx (4 mega-bytes) and Palm IIIxe (8 megabytes) are used. These are pen-based computing sys-tems operating under Palm OS. Each resident in the Saginaw Coopera-tive Hospitals emergency medicine resi-dency is issued a Palm handheld at the beginning of the program, which becomes the resident’s responsibility. The Depart-ment of Emergency Medicine’s office com-puter system, Windows 98, has a Palm data receptacle for synchronizing the resident’s procedure log with the department’s data-base. Data are entered using a software pack-age (PenDragon Forms 2.0, PenDragon Soft-ware Corp., Libertyville, Ill.). This software package is designed to create a relational database using Microsoft Access 97 or Access 2000. The program forms genera-tor designs a data entry form for the Palm computing platform. Data are entered on the data entry program by PenDragon and are transferred to the personal computer’s Access database by the Palm’s Access con-duit directly loading the data into the defined database. Residents are encour-aged to use the HotSync function to back up data with the residency coordinator’s com-puter on a weekly basis. Following upload, the logged data are available for data processing or report gen-eration using Microsoft Access or any report generation program that can load Access data files. For the program’s report gener-ation, Crystal Reports generator program (Crystal Decisions, Edison, NJ) is used. This program can directly access MS Access’s database and provides an easier interface to generate detailed reports from the logged data. The PenDragon Forms generator pro-duces a data entry sheet and small database program for the PalmPilot. An advantage of this system is that the data entry form and most options are fixed by the form design-er and cannot be modified by the resident. This simplifies data analysis and report generation. Twenty-four residents have been issued Palm handhelds for logging procedure data. Besides the advantages and disadvantages previously noted, users are able to keep medical databases and programs on hand to provide ready reference to drug databas-es and clinical information. Disadvantages are also apparent. All pen-based systems use a glass surfaced, liq-uid- crystal display, which is subject to dam-age in falls or rough handling. Several of the Palm handhelds used in our program have been dropped, necessitating replacement of the screens. Finally, there has been resis-tance to use of the Palm handhelds by sev-eral residents. Not all potential users will use such a system, even when required to do so. A potential advance for this system or other handheld computing systems is the addition of Internet logging of procedures into the same database. This was not a prospective study of the feasibility of using Palm handhelds for log-ging resident procedures, and data were not generated on the acceptance of the sys-tem. The intent was to demonstrate a poten-tial logging system to improve data record-ing by residents in a way that makes the most of department resources and resident time. Marc S. Rosenthal, DO, PhD Robert W. Wolford, MD Department of Emergency Medicine Saginaw Cooperative Hospitals/ Michigan State University Affiliated Emergency Medicine Residency Michigan State University College of Human Medicine Saginaw, Michigan References 1. Wheeler RP. The advantages of a microcom-puter- based procedure log. MD Comput. 1989;6: 24-26. 2. Johnson PC, Hendricks D, White MJ, Futrell JW. Microcomputer database management for surgical residents. Curr Surg. 1989;46:372-377. 3. Ray VG, Garrison HG. Clinical procedures per-formed by emergency medicine resident physi-cians: a computer-based model for documenta-tion. J Emerg Med.1991;9:157-159. JAOA • Vol 103 • No 1 • January 2003 • 5 LETTERS Letters 4. Bear JV, DeCoster TA. Computer corner #19. The computer as an aid to the orthopaedic resi-dent for recordkeeping. Orthop Rev. 1988;17:325- 328. 5. Langdorf MI, Montague BJ, Bearie B, Sobel CS. Quantification of procedures and resuscitations in an emergency medicine residency. J Emerg Med. 1998;16:121-127. 6. Rosenthal M, Wolford RW. Resident procedure and resuscitation tracking using a palm comput-er. Acad Emerg Med. 2000;7:1171. 7. Lal SO, Smith FW, Davis JP, Castro HY, Smith DW, Chinkes DL, et al. Palm computer demon-strates a fast and accurate means of burn data col-lection. J Burn Care Rehabil. 2000;21:559-561. 8. Garvin R, Otto F, McRae D. Using handheld computers to document family practice resident procedure experience. Fam Med. 2000;32:115- 118. 9. Malan TK, Haffner WH, Armstrong AY, Satin AJ, Hand-held computer operating system program for collection of resident experience data. Obstet Gynecol. 2000;96:792-794. 10. Nicolaou D, Davis GL. A distributed asyn-chronous resident procedure log for hand-held devices. Acad Emerg Med. 2001;8:583. 11. Larson JL, Look R, Schiffman B. A hand-held computer based procedure log. Acad Emerg Med. 2001;8:583. 12. Civetta JM, Morejon OV, Kirton OC, Reilly PJ, Serebriakov II, Dobkin ED, et al. Beyond require-ments: residency management through the Inter-net. Arch Surg. 2001;136:412-417. Acknowledging coauthors’ efforts To the Editor: During the opening session of the 107th Annual American Osteopathic Association Convention and Scientific Seminar in Las Vegas, Nevada, I accepted the George W. Northup, DO, Medical Writing Award on behalf of myself and coauthors Kirk K. Har-ris, DO, John Ellis, DO, Edwin S. Purcell, PhD, Joseph Weir, PhD, Maureen Ann Clothier, DO, and David R. Boesler, DO, for the best article published in JAOA—The Journal of the American Osteopathic Association in 2001. The award-winning article was titled “Thoracic lymphatic pumping and the efficacy of influenza vaccination in healthy young and elderly populations.” As there was not an opportunity at the presentation to describe the contributions of the other authors, I would like to describe these contributions so that my coauthors receive the acknowledgment they deserve and so that I may use their efforts to illus-trate the complexities involved in conduct-ing a study that merges human participants with basic clinical science. Maureen Ann Clothier, DO, the princi-pal investigator of the AOA grant that fund-ed this study, recruited more than 100 young and elderly participants for the experimental protocol. She developed screening questionnaires, supervised phys-ical examinations, selected control and treat-ment groups, and scheduled flu vaccina-tions, blood drawings and thoracic lymphatic pumping treatments. In short, Dr Clothier was the clinical supervisor of the treatment phase of the study. Edwin S. Purcell, PhD, was an early motivating force in the execution of this study. He was an author and coinvestiga-tor of the AOA grant that funded this pro-ject. It was Dr Purcell who insisted that we resubmit our research protocol to the AOA after two rejections. The third submission was approved and funded; the result is the awarded article. David R. Boesler, DO, contributed expert osteopathic manipulative treatment skills to the treatment phase of the study. He thoroughly trained his osteopathic manipulative medicine fellows in thoracic lymphatic pumping, and these fellows along with Dr Boesler performed more than 1200 minutes of treatments. Kirk K. Harris, DO, and John Ellis, DO, performed most of the laboratory analyses. They were second-year osteopathic stu-dents when these studies began. Our ana-lytical protocol required that two distinct methods—hemagglutination inhibition assays and enzyme-linked immunosorbent assays—be used to determine serum levels of antiflu antibodies. Harris and Ellis devel-oped both of these methods, then assayed prevaccination and postvaccination serum samples from study participants. Each sam-ple was assayed a minimum of six times by each method. Harris and Ellis generated more than 3000 data points of remarkable reproducibility. It should be noted that we were blinded as to the origin of these serum samples until the assays were completed. Joseph Weir, PhD, contributed critical thinking and statistical expertise to analyz-ing the experimental data. In addition, Drs Weir and Purcell were active in editing and proofreading the manuscript. Thomas Breithaupt, PhD (left), and Howard S. Teitelbaum, DO, PhD, MPH, admire the plaque that Dr. Breithaupt received for being the lead author of the paper that won the 2001 George W. Northup, DO, Medical Writing Award. Dr. Teitelbaum is dean of the Des Moines University, College of Osteopathic Medicine and Surgery in Iowa. (Photo by Michael Fitzgerald) 6 • JAOA • Vol 103 • No 1 LETTERS Letters In summary, it is important to recog-nize the individual efforts of coauthors as well as to recognize the teamwork that occurred during this protocol. I thank the Journal of the American Osteopathic Association for this opportunity. Thomas Breithaupt, PhD Professor of Biochemistry Des Moines University Osteopathic Medical Center Des Moines, Iowa Red Secrets My heart races I am holding back a breast Handling tubes Hemoglobin comes back five Still working to get a line in Physicians debating One wants the line in One wants to move We need blood Get OR ready Back to surgery Big incisions Belly full of blood Med student spattered Where is the fountain For all this life? Surgery site is clean Run the bowel There, the tiny seeping spot! One stitch Nurse on her knees counting Blood filled sponges stretched out Over the floor I step off my stool and land on one It feels odd beneath my foot Soft like mud between my toes. I am back in the barn Watching this woman Feed whiskey to a calf I cut out of a dying cow Years ago When even then I sheltered my secret Only to realize it here With my red hands and racing heart. I am a part of her life story now As she was a part of mine. Rita Roberts, MSIV Ohio University College of Osteopathic Medicine Athens, Ohio
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Transcript | LETTERS 4 • JAOA • Vol 103 • No 1 • January 2003 Letters Palm technology moves resident data recording into new dimension To the Editor: Palm technology has fostered the develop-ment of palm data acquisition systems. As the recording of procedures, surgeries, and patient interactions to document a resident’s training is a major requirement of the Res-ident Review Committee, as well as intern-ship programs, the real-time logging and easy analysis of resident procedures pos-sible with a Palm handheld logging sys-tem is ideal. Besides ease of logging, a computer-based system has advantages that include simple backup and duplication of data; easy analysis of data; potential for legible, on-the- fly entries; a redistributed workload, as residents enter data; and portability. In addition, computer-based systems allow users the ability to synchronize and enter data into a desktop system fairly effort-lessly. Ease of synchronization enables fre-quent backups of resident logs and frequent analysis of procedure rates based on any parameter. Disadvantages of using a computer-based system include the need to learn to enter data, the need for a terminal or a per-sonal computer to enter data, time required to enter data in a block-mode method, ease with which Palm handhelds can be bro-ken, and the cost of the system. In contrast, the only advantage inher-ent in paper logging is the ease of recording data. In fact, paper logging to track patient data and procedures is cumbersome and often incomplete. In addition, there is an inability to perform statistical analysis. The advent of small computer systems in the 1970s brought with it online logging of resident procedure data,1-5 though the complexities of these systems were many. Data entry was cumbersome, as either a data entry person was needed or the resi-dent would be required to enter their logs when time was available. The development of Palm handhelds (eg, Palm Pilot, 3M Corporation, or Pocket PC), and the development of software allowing data entry into databases has moved the logging of resident data into a new dimension.6-12 A Palm data logging system was devel-oped to provide for potential online or real time logging of resident procedures and resuscitations. The system is based on the PalmPilot computing platform, 3Com, Palm. Currently, the Palm IIIx (4 mega-bytes) and Palm IIIxe (8 megabytes) are used. These are pen-based computing sys-tems operating under Palm OS. Each resident in the Saginaw Coopera-tive Hospitals emergency medicine resi-dency is issued a Palm handheld at the beginning of the program, which becomes the resident’s responsibility. The Depart-ment of Emergency Medicine’s office com-puter system, Windows 98, has a Palm data receptacle for synchronizing the resident’s procedure log with the department’s data-base. Data are entered using a software pack-age (PenDragon Forms 2.0, PenDragon Soft-ware Corp., Libertyville, Ill.). This software package is designed to create a relational database using Microsoft Access 97 or Access 2000. The program forms genera-tor designs a data entry form for the Palm computing platform. Data are entered on the data entry program by PenDragon and are transferred to the personal computer’s Access database by the Palm’s Access con-duit directly loading the data into the defined database. Residents are encour-aged to use the HotSync function to back up data with the residency coordinator’s com-puter on a weekly basis. Following upload, the logged data are available for data processing or report gen-eration using Microsoft Access or any report generation program that can load Access data files. For the program’s report gener-ation, Crystal Reports generator program (Crystal Decisions, Edison, NJ) is used. This program can directly access MS Access’s database and provides an easier interface to generate detailed reports from the logged data. The PenDragon Forms generator pro-duces a data entry sheet and small database program for the PalmPilot. An advantage of this system is that the data entry form and most options are fixed by the form design-er and cannot be modified by the resident. This simplifies data analysis and report generation. Twenty-four residents have been issued Palm handhelds for logging procedure data. Besides the advantages and disadvantages previously noted, users are able to keep medical databases and programs on hand to provide ready reference to drug databas-es and clinical information. Disadvantages are also apparent. All pen-based systems use a glass surfaced, liq-uid- crystal display, which is subject to dam-age in falls or rough handling. Several of the Palm handhelds used in our program have been dropped, necessitating replacement of the screens. Finally, there has been resis-tance to use of the Palm handhelds by sev-eral residents. Not all potential users will use such a system, even when required to do so. A potential advance for this system or other handheld computing systems is the addition of Internet logging of procedures into the same database. This was not a prospective study of the feasibility of using Palm handhelds for log-ging resident procedures, and data were not generated on the acceptance of the sys-tem. The intent was to demonstrate a poten-tial logging system to improve data record-ing by residents in a way that makes the most of department resources and resident time. Marc S. Rosenthal, DO, PhD Robert W. Wolford, MD Department of Emergency Medicine Saginaw Cooperative Hospitals/ Michigan State University Affiliated Emergency Medicine Residency Michigan State University College of Human Medicine Saginaw, Michigan References 1. Wheeler RP. The advantages of a microcom-puter- based procedure log. MD Comput. 1989;6: 24-26. 2. Johnson PC, Hendricks D, White MJ, Futrell JW. Microcomputer database management for surgical residents. Curr Surg. 1989;46:372-377. 3. Ray VG, Garrison HG. Clinical procedures per-formed by emergency medicine resident physi-cians: a computer-based model for documenta-tion. J Emerg Med.1991;9:157-159. JAOA • Vol 103 • No 1 • January 2003 • 5 LETTERS Letters 4. Bear JV, DeCoster TA. Computer corner #19. The computer as an aid to the orthopaedic resi-dent for recordkeeping. Orthop Rev. 1988;17:325- 328. 5. Langdorf MI, Montague BJ, Bearie B, Sobel CS. Quantification of procedures and resuscitations in an emergency medicine residency. J Emerg Med. 1998;16:121-127. 6. Rosenthal M, Wolford RW. Resident procedure and resuscitation tracking using a palm comput-er. Acad Emerg Med. 2000;7:1171. 7. Lal SO, Smith FW, Davis JP, Castro HY, Smith DW, Chinkes DL, et al. Palm computer demon-strates a fast and accurate means of burn data col-lection. J Burn Care Rehabil. 2000;21:559-561. 8. Garvin R, Otto F, McRae D. Using handheld computers to document family practice resident procedure experience. Fam Med. 2000;32:115- 118. 9. Malan TK, Haffner WH, Armstrong AY, Satin AJ, Hand-held computer operating system program for collection of resident experience data. Obstet Gynecol. 2000;96:792-794. 10. Nicolaou D, Davis GL. A distributed asyn-chronous resident procedure log for hand-held devices. Acad Emerg Med. 2001;8:583. 11. Larson JL, Look R, Schiffman B. A hand-held computer based procedure log. Acad Emerg Med. 2001;8:583. 12. Civetta JM, Morejon OV, Kirton OC, Reilly PJ, Serebriakov II, Dobkin ED, et al. Beyond require-ments: residency management through the Inter-net. Arch Surg. 2001;136:412-417. Acknowledging coauthors’ efforts To the Editor: During the opening session of the 107th Annual American Osteopathic Association Convention and Scientific Seminar in Las Vegas, Nevada, I accepted the George W. Northup, DO, Medical Writing Award on behalf of myself and coauthors Kirk K. Har-ris, DO, John Ellis, DO, Edwin S. Purcell, PhD, Joseph Weir, PhD, Maureen Ann Clothier, DO, and David R. Boesler, DO, for the best article published in JAOA—The Journal of the American Osteopathic Association in 2001. The award-winning article was titled “Thoracic lymphatic pumping and the efficacy of influenza vaccination in healthy young and elderly populations.” As there was not an opportunity at the presentation to describe the contributions of the other authors, I would like to describe these contributions so that my coauthors receive the acknowledgment they deserve and so that I may use their efforts to illus-trate the complexities involved in conduct-ing a study that merges human participants with basic clinical science. Maureen Ann Clothier, DO, the princi-pal investigator of the AOA grant that fund-ed this study, recruited more than 100 young and elderly participants for the experimental protocol. She developed screening questionnaires, supervised phys-ical examinations, selected control and treat-ment groups, and scheduled flu vaccina-tions, blood drawings and thoracic lymphatic pumping treatments. In short, Dr Clothier was the clinical supervisor of the treatment phase of the study. Edwin S. Purcell, PhD, was an early motivating force in the execution of this study. He was an author and coinvestiga-tor of the AOA grant that funded this pro-ject. It was Dr Purcell who insisted that we resubmit our research protocol to the AOA after two rejections. The third submission was approved and funded; the result is the awarded article. David R. Boesler, DO, contributed expert osteopathic manipulative treatment skills to the treatment phase of the study. He thoroughly trained his osteopathic manipulative medicine fellows in thoracic lymphatic pumping, and these fellows along with Dr Boesler performed more than 1200 minutes of treatments. Kirk K. Harris, DO, and John Ellis, DO, performed most of the laboratory analyses. They were second-year osteopathic stu-dents when these studies began. Our ana-lytical protocol required that two distinct methods—hemagglutination inhibition assays and enzyme-linked immunosorbent assays—be used to determine serum levels of antiflu antibodies. Harris and Ellis devel-oped both of these methods, then assayed prevaccination and postvaccination serum samples from study participants. Each sam-ple was assayed a minimum of six times by each method. Harris and Ellis generated more than 3000 data points of remarkable reproducibility. It should be noted that we were blinded as to the origin of these serum samples until the assays were completed. Joseph Weir, PhD, contributed critical thinking and statistical expertise to analyz-ing the experimental data. In addition, Drs Weir and Purcell were active in editing and proofreading the manuscript. Thomas Breithaupt, PhD (left), and Howard S. Teitelbaum, DO, PhD, MPH, admire the plaque that Dr. Breithaupt received for being the lead author of the paper that won the 2001 George W. Northup, DO, Medical Writing Award. Dr. Teitelbaum is dean of the Des Moines University, College of Osteopathic Medicine and Surgery in Iowa. (Photo by Michael Fitzgerald) 6 • JAOA • Vol 103 • No 1 LETTERS Letters In summary, it is important to recog-nize the individual efforts of coauthors as well as to recognize the teamwork that occurred during this protocol. I thank the Journal of the American Osteopathic Association for this opportunity. Thomas Breithaupt, PhD Professor of Biochemistry Des Moines University Osteopathic Medical Center Des Moines, Iowa Red Secrets My heart races I am holding back a breast Handling tubes Hemoglobin comes back five Still working to get a line in Physicians debating One wants the line in One wants to move We need blood Get OR ready Back to surgery Big incisions Belly full of blood Med student spattered Where is the fountain For all this life? Surgery site is clean Run the bowel There, the tiny seeping spot! One stitch Nurse on her knees counting Blood filled sponges stretched out Over the floor I step off my stool and land on one It feels odd beneath my foot Soft like mud between my toes. I am back in the barn Watching this woman Feed whiskey to a calf I cut out of a dying cow Years ago When even then I sheltered my secret Only to realize it here With my red hands and racing heart. I am a part of her life story now As she was a part of mine. Rita Roberts, MSIV Ohio University College of Osteopathic Medicine Athens, Ohio |
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