Review of Handheld Computers in Medicine: Focus on Palm and Pocket PC | Study Guides, Projects, Research Operating Systems

is true throughout the book, applications

are discussed and illustrated by using sim-

ilar examples from the 2 principal hand-

held computer operating systems: Palm

and Pocket PC. The generous use of im-

ages of handheld computer screens helps

to illustrate concepts and the stepwise use

of applications. Also included in this chap-

ter is an explanation of the 2 methods of

information sharing with these devices:

synchronizing and beaming. These pro-

cesses can be especially challenging for

the novice, and the authors provide a suc-

cinct, clear explanation. The issue of con-

fidentiality of patient information is also

mentioned and emphasized here, because

of the ease with which information can be

shared between handhelds, from handheld

to desktop computer, and from desktop to

handheld. The issue of information secu-

rity/confidentiality is still being debated,

weighing the benefit of availability of in-

formation with the potential for breaches

in confidentiality of patient information.

The authors then review the process of

acquiring and installing new software. The

chapter is devoted to the technical proce-

dures for downloading and installing soft-

ware. Finding specific software is discussed

in later chapters. Included in the chapter is

a discussion of the use of the main memory

of the device versus use of expansion mem-

ory, which can be tricky. This issue is dis-

cussed honestly, including the caveat that

some software is limited in the ways it can

be installed and used, and that technical dif-

ficulties are not uncommon.

The remainder of the book introduces the

reader to the many potential uses of hand-

held computers in medicine, highlighting se-

lected software. This part begins with an

effective review of Internet sites related to

handheld computing. The chapter includes

over 80 Web sites devoted to handheld com-

puting in medicine, many of which the au-

thors rate regarding organization, usefulness

and timeliness of information, and various

intangible features unique to some sites. The

rating system resembles movie rating sys-

tems that use a number of stars to indicate

the movie’s quality. Here stethoscopes are

used instead of stars, with 5 stethoscopes

being the highest rating. In their enthusiasm

for the subject, the authors do not mention

the potential for excessive time consump-

tion in searching for information or soft-

ware. Anyone who searches the Internet on

a regular basis knows that the search must

be focused and as narrow as possible. If not,

one can spend hours hopping around cyber-

space.

The first medical application presented is

patient tracking. The biggest selling point of

these applications is probably the accurate

recording of charges. The data entry for the

patient tracking programs presented is mostly

menu-driven. This technique requires enter-

ing certain information before moving on to

the next step, which prevents omitting in-

formation and guarantees that all appropri-

ate patient information is entered, including

charges. Of course, having all the necessary

information required for diagnosis and treat-

ment is critical, and this would also be guar-

anteed with a menu-driven system.

Another invaluable feature of handhelds

is that information can be transmitted im-

mediately, as the clinician enters the data, to

a central database, where it could be avail-

able to other users. The clinician can also

receive updated information, such as labo-

ratory results, patient updates, and new con-

sults. This application can be a very useful,

time-saving tool.

Clinical calculations can be made easy

with appropriate handheld applications,

which is reviewed in the next chapter. Cal-

culations such as anion gap, predicted spi-

rometry values, and Glasgow coma scale

are preprogrammed. The user has only to

enter the relevant data and the calculator

produces the results. Several of these pro-

grams are free and download information is

included in the book.

Another effective exploitation of the size

and capacity of handheld computers is hand-

held-based references. Entire reference texts

can be stored and viewed on a handheld

computer. The reader programs used to ac-

cess these texts allow for searching the text,

which expedites information retrieval. Ref-

erencing peer-reviewed journals is also pos-

sible. The authors describe services that pro-

vide access to journal citations and, in some

cases, abstracts. Although the full text of

articles is not widely available for hand-

helds, many full-text articles will be soon.

Articles in some of the popular electronic

formats can be read by handhelds, so it is

possible to maintain a library of current lit-

erature on a handheld.

Another valuable ability of handhelds is

developing custom databases. While this is

probably not something a novice would be

comfortable with, the process is not very

difficult with some of the database programs.

The authors describe the process in a clear,

easily understood, and encouraging way that

I think will help avoid some potential frus-

trations of developing a database. Because

of its clarity and medical specificity, the

description is actually more useful than the

program manual.

The ability of a handheld computer to

transmit, store, and display rich media such

as photographs, video, and audio can add a

new dimension to the clinician’s practice.

While the size of the screen limits the use-

fulness of visual media, it adds a valuable

tool to the clinician’s repertoire. For exam-

ple, the video recording of a bronchoscopy

could be shared with colleagues at a dis-

tance, allowing collaboration from virtually

anywhere. The authors discuss several ex-

amples of the value of this multi-media ca-

pability.

Overall, Handhelds in Medicine is an

excellent introductory text for nonusers and

novices. It is also useful for more experi-

enced clinicians, providing introductions

and “how-tos” on more advanced topics.

The wealth of information on available re-

sources alone may be worth the book’s pur-

chase price. In addition, many of the pro-

grams described in the book are available

on the included CD-ROM. I would recom-

mend this book to all clinicians as an intro-

duction to the coming widespread use of

handheld computers in medicine.

Randy De Kler MSc RRT

School of Allied Health Technologies

Miami Dade College

Miami, Florida

R.A.L.E Lung Sounds 3.1 Professional

Edition. Winnipeg, Manitoba, Canada: Pix-

Soft and Medi-Wave. 2004. Professional

edition download $49; CD-ROM $59; in-

stitutional edition CD ROM $195; student

edition download $19.95.

The difference between listening to a

radio sermon and going to church . . .

is almost like the difference between

calling your girl on the telephone and

spending an evening with her.

—Dwight L Moody

R.A.L.E. Lung Sounds 3.1 is a multi-

media computerized textbook and educa-

tional program. It encompasses over 50 re-

cordings of lung sounds, each with color

graphics that relate the sounds to pitch, tim-

ing within the breathing cycle, and inten-

sity. The program includes 12 teaching case

studies and 24 cases in a quiz/self-assess-

ment format. Version 3.0 of this product

BOOKS,FILMS,TAPES,&SOFTWARE

RESPIRATORY CARE •OCTOBER 2005 VOL 50 NO10 1385

Partial preview of the text

Download Review of Handheld Computers in Medicine: Focus on Palm and Pocket PC and more Study Guides, Projects, Research Operating Systems in PDF only on Docsity!

is true throughout the book, applications are discussed and illustrated by using sim- ilar examples from the 2 principal hand- held computer operating systems: Palm and Pocket PC. The generous use of im- ages of handheld computer screens helps to illustrate concepts and the stepwise use of applications. Also included in this chap- ter is an explanation of the 2 methods of information sharing with these devices: synchronizing and beaming. These pro- cesses can be especially challenging for the novice, and the authors provide a suc- cinct, clear explanation. The issue of con- fidentiality of patient information is also mentioned and emphasized here, because of the ease with which information can be shared between handhelds, from handheld to desktop computer, and from desktop to handheld. The issue of information secu- rity/confidentiality is still being debated, weighing the benefit of availability of in- formation with the potential for breaches in confidentiality of patient information. The authors then review the process of acquiring and installing new software. The chapter is devoted to the technical proce- dures for downloading and installing soft- ware. Finding specific software is discussed in later chapters. Included in the chapter is a discussion of the use of the main memory of the device versus use of expansion mem- ory, which can be tricky. This issue is dis- cussed honestly, including the caveat that some software is limited in the ways it can be installed and used, and that technical dif- ficulties are not uncommon. The remainder of the book introduces the reader to the many potential uses of hand- held computers in medicine, highlighting se- lected software. This part begins with an effective review of Internet sites related to handheld computing. The chapter includes over 80 Web sites devoted to handheld com- puting in medicine, many of which the au- thors rate regarding organization, usefulness and timeliness of information, and various intangible features unique to some sites. The rating system resembles movie rating sys- tems that use a number of stars to indicate the movie’s quality. Here stethoscopes are used instead of stars, with 5 stethoscopes being the highest rating. In their enthusiasm for the subject, the authors do not mention the potential for excessive time consump- tion in searching for information or soft- ware. Anyone who searches the Internet on a regular basis knows that the search must be focused and as narrow as possible. If not,

one can spend hours hopping around cyber- space. The first medical application presented is patient tracking. The biggest selling point of these applications is probably the accurate recording of charges. The data entry for the patient tracking programs presented is mostly menu-driven. This technique requires enter- ing certain information before moving on to the next step, which prevents omitting in- formation and guarantees that all appropri- ate patient information is entered, including charges. Of course, having all the necessary information required for diagnosis and treat- ment is critical, and this would also be guar- anteed with a menu-driven system. Another invaluable feature of handhelds is that information can be transmitted im- mediately, as the clinician enters the data, to a central database, where it could be avail- able to other users. The clinician can also receive updated information, such as labo- ratory results, patient updates, and new con- sults. This application can be a very useful, time-saving tool. Clinical calculations can be made easy with appropriate handheld applications, which is reviewed in the next chapter. Cal- culations such as anion gap, predicted spi- rometry values, and Glasgow coma scale are preprogrammed. The user has only to enter the relevant data and the calculator produces the results. Several of these pro- grams are free and download information is included in the book. Another effective exploitation of the size and capacity of handheld computers is hand- held-based references. Entire reference texts can be stored and viewed on a handheld computer. The reader programs used to ac- cess these texts allow for searching the text, which expedites information retrieval. Ref- erencing peer-reviewed journals is also pos- sible. The authors describe services that pro- vide access to journal citations and, in some cases, abstracts. Although the full text of articles is not widely available for hand- helds, many full-text articles will be soon. Articles in some of the popular electronic formats can be read by handhelds, so it is possible to maintain a library of current lit- erature on a handheld. Another valuable ability of handhelds is developing custom databases. While this is probably not something a novice would be comfortable with, the process is not very difficult with some of the database programs. The authors describe the process in a clear, easily understood, and encouraging way that

I think will help avoid some potential frus- trations of developing a database. Because of its clarity and medical specificity, the description is actually more useful than the program manual. The ability of a handheld computer to transmit, store, and display rich media such as photographs, video, and audio can add a new dimension to the clinician’s practice. While the size of the screen limits the use- fulness of visual media, it adds a valuable tool to the clinician’s repertoire. For exam- ple, the video recording of a bronchoscopy could be shared with colleagues at a dis- tance, allowing collaboration from virtually anywhere. The authors discuss several ex- amples of the value of this multi-media ca- pability. Overall, Handhelds in Medicine is an excellent introductory text for nonusers and novices. It is also useful for more experi- enced clinicians, providing introductions and “how-tos” on more advanced topics. The wealth of information on available re- sources alone may be worth the book’s pur- chase price. In addition, many of the pro- grams described in the book are available on the included CD-ROM. I would recom- mend this book to all clinicians as an intro- duction to the coming widespread use of handheld computers in medicine.

Randy De Kler MSc RRT School of Allied Health Technologies Miami Dade College Miami, Florida

R.A.L.E Lung Sounds 3.1 Professional Edition. Winnipeg, Manitoba, Canada: Pix- Soft and Medi-Wave. 2004. Professional edition download $49; CD-ROM $59; in- stitutional edition CD ROM $195; student edition download $19.95.

The difference between listening to a radio sermon and going to church... is almost like the difference between calling your girl on the telephone and spending an evening with her. —Dwight L Moody

R.A.L.E. Lung Sounds 3.1 is a multi- media computerized textbook and educa- tional program. It encompasses over 50 re- cordings of lung sounds, each with color graphics that relate the sounds to pitch, tim- ing within the breathing cycle, and inten- sity. The program includes 12 teaching case studies and 24 cases in a quiz/self-assess- ment format. Version 3.0 of this product

was reviewed in RESPIRATORY CARE in 2002.^1 The present analysis will again provide a general description of the software and com- ment on the changes in version 3.1. The computer-based tutorial functions much like a “hybrid” Internet-based format that combines written text, digital images, and hypertext links to Web sites. Figure 1 shows the basic screen layout, with the graphics and navigation buttons on the left and a text box on the right. The initial in- structions clearly explain the system. The reader proceeds through the text and clicks on the blue hypertext links to bring up the graphics and sounds. The table of contents includes blue hy- pertext links that allow immediate naviga- tion to all parts of the tutorial. This is handy for independent learners who want to stop

and later pick up where they left off, or classroom instructors who want to go to a specific area of the text as part of their pre- sentation or quiz. The pink hypertext links point to Web sites, and these links have been updated for this version 3.1. The linked Web pages provide both background and greater details on the topics discussed in the text. The interactivity of the tutorial allows breaks in the reading and makes wonderful use of Web resources. The advantage of R.A.L.E. Lung Sounds over other lung-sounds teaching systems is the integration of the text, graph- ics (sonograms), and sound recordings. The upper part of the screen’s graphics area (see Fig. 1) shows flow-versus-time curves, for several breaths, with a blue line, similar to the graphics on contemporary ventilators.

Yellow or red lines are used for volume- versus-time curves. A blue vertical “respi- ration bar” (on the right side of the graphics area) dynamically displays the inspiratory versus expiratory movements of the breath. This helps the learner easily reference the inspiratory versus expiratory timing of the breath sounds. This bar is an updated fea- ture from the previous version of R.A.L.E. Lung Sounds. A white vertical line scans left-to-right over the flow or volume curve as the sound is played, correlating the sound to the position on the curve. The lower part of the graphics area shows the sonogram and the breath’s “sound characteristics.” As it moves across the screen (ie, through time), the white vertical line’s dynamic position on the left vertical axis represents frequency (in hertz) or pitch as the sound evolves. The

Fig. 1. Sample of the teaching window in the R.A.L.E. Lung Sounds tutorial. This frame describes stridor. In the text box (right) the user can read content and click on hypertext-linked words. The white vertical line moves left to right in synchrony with the lung sound as it plays. In this graphic the line is nearing the end of inspiration of the last breath of a flow-versus-time curve. The sonogram (below the flow- versus-time curve) shows both the frequency and the loudness (in decibels [dB], with a color spectrum). Note that the stridor in this recording is predominately during inspiration. The solid bar on the upper right corner of the sonogram elevates and descends with inspiration and expiration. The navigation buttons (at the bottom of the graphics area) are “Help”, “Find”, “Back”, “Stop”, and the volume-control button (speaker symbol). (Courtesy of PixSoft.)

to conventional teaching methods.15,16^ This tutorial is unique among lung-sounds teach- ing materials. The first lung-sounds teach- ing systems used audio tapes with books. Audio CDs then replaced tapes. Some sys- tems have offered CD-ROMs with narrated script and the user clicked on (static) spec- tral images of breath sounds while the sounds were played. R.A.L.E. Lung Sounds is the first to combine dynamic graphics with acoustics. I commend PixSoft for their com- panion R.A.L.E. Repository Web site, at which they make many sounds available.^2 Chest auscultation requires blending an understanding of the physics of acoustics with the skills of interpretation and human interaction. It is neither exact science nor voodoo. In addition to auscultation, assess- ment of breathing also requires inspecting chest motion, muscle movement, skin color, and palpation of the body. The challenge of bringing new acoustic and imaging technol- ogy along with computers to this cognitive and time-honored standard has provided plenty of grist for editorials.17–19^ Portable ultrasound devices may evolve to parallel the usefulness of the imaginary “tricorder” bioscanner device in Gene Roddenberry’s “Star Trek” science fiction series. Most com- mentaries recount the stethoscope’s power as a bonding tool for the clinician and the patient, especially since many patients are unable to speak because they are intubated. I found a recent letter-to-the-editor in RE- SPIRATORY CARE quite interesting; Murphy recounted that the original impetus for the development of the stethoscope was in fact to distance the listener from the patient’s body odors and lice.^20 R.A.L.E. Lung Sounds is a wonderful software tutorial. This 2004 update, Ver- sion 3.1, provides some minor enhancements

to an already fine learning system. I would recommend this teaching system for both individuals who are beginning their study of chest auscultation and educational pro- grams for nurses, respiratory therapists, and physicians. It is a great starting point. How- ever, since there is considerable variation in lung sounds among patients, the next step is to listen to many lung sounds with an ex- perienced mentor.

Jeffrey J Ward MEd RRT University of Minnesota/Mayo Program in Respiratory Care Rochester, Minnesota

REFERENCES

Wilkins RL. R.A.L.E. Lung Sounds 3. (media review). Respir Care 2002;47(9): 1024–1025.
PixSoft. The R.A.L.E. Repository. http:// www.rale.ca. Accessed July 26, 2005.
Pasterkamp H, Kraman SS, Wodicka GR. Respiratory sounds: advances beyond the stethoscope. Am J Respir Crit Care Med 1997;156(3 Pt 1):974–987.
http://www.campanellaacoustics.com/ faq.htm. Accessed July 26, 2005.
Thompson BH, Lee WJ, Galvin JR, Wilson JS. University of Iowa’s virtual hospital: lung anatomy. 1993. http://www.vh.org/ adult/provider/radiology/lunganatomy/ introduction.html. Accessed July 26, 2005.
Gudmundsson G, Asmundsson T. Lung sounds: chest auscultation. University of Io- wa’s Virtual Hospital: Lung Anatomy. 2000 http: //www.vh.org/adult/provider/internal medicine/lungsounds/lungsounds.html. Accessed July 26, 2005.
Updated nomenclature for membership re- action. Reports of the ATS-ACCP Ad Hoc subcommittee on pulmonary nomenclature. ATS News 1977; 3:5–6. 8. Cugell DW. Lung sound nomenclature. Am Rev Respir Dis 1987;136(4):1016–1017. 9. Mikami R, Murao M, Cugell DW, Chretien J, Cole P, Meier-Sydow J, et al. Intern- tional symposium on lung sounds. Synop- sis of proceedings. Chest 1987;92(2):342– 346.
Verghese ST, Hannallah RS, Slack MC, Cross RR, Patel KM. Auscultation of bi- lateral breath sounds does not rule out en- dobronchial intubation in children. Anesth Analg 2004;99(1):56–58.
Paciej R, Vyshedskiy A, Bana D, Murphy R. Squawks in pneumonia. Thorax 2004; 59(2):177–178.
Welsby PD, Parry G, Smith D. The stetho- scope: some preliminary investigations. Postgrad Med J 2003;79(938):695–698.
Sprikkelman AB, Grol MH, Lourens MS, Gerritsen J, Heymans HS, van Aalderen WM. Use of tracheal auscultation for the assessment of bronchial responsiveness in asthmatic children. Thorax 1996;51(3): 317–319.
Kompis M, Pasterkamp H, Wodicka GR. Acoustic imaging of the human chest. Chest 2001;120(4):1309–1321.
Mangione S, Duffy F. The teaching of chest auscultation during primary care training: has anything changed in the 1990s? Chest 2003;124(4):1430–1436.
Sestini P, Renzoni E, Rossi M, Beltrami V, Vagliasindi M. Multimedia presentation of lung sounds as a learning aid for medical students. Eur Respir J 1995;8(5):783–788.
Ward JJ. Lung sounds: easy to hear, hard to describe (editorial). Respir Care 1989; 34(1):17–19.
Wilkins R. Is the stethoscope of the verge of becoming obsolete? (editorial) Respir Care 2004;49(12):1488–1489.
Hubmayr RD. The times are a-changin’: should we hang up the stethoscope? (edi- torial) Anesthesiology 2004;100(1):1–2.
Murphy RL. The stethoscope—obsoles- cence or marriage (letter). Respir Care 2005;50(5):660–661.

Review of Handheld Computers in Medicine: Focus on Palm and Pocket PC, Study Guides, Projects, Research of Operating Systems

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