Acknowledging coauthors' efforts [letter]

              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