Automated personal health inventory for dentistry: a pilot study

Impact of computer-assisted data collection, evaluation and management on the cancer genetic counselor's time providing patient care

Cancer genetic counseling sessions traditionally encompass collecting medical and family history information, evaluating that information for the likelihood of a genetic predisposition for a hereditary cancer syndrome, conveying that information to the patient, offering genetic testing when appropriate, obtaining consent and subsequently documenting the encounter with a clinic note and pedigree. Software programs exist to collect family and medical history information electronically, intending to improve efficiency and simplicity of collecting, managing and storing this data. This study compares the genetic counselor's time spent in cancer genetic counseling tasks in a traditional model and one using computer-assisted data collection, which is then used to generate a pedigree, risk assessment and consult note. Genetic counselor time spent collecting family and medical history and providing face-to-face counseling for a new patient session decreased from an average of 85-69 min when using the computer-assisted data collection. However, there was no statistically significant change in overall genetic counselor time on all aspects of the genetic counseling process, due to an increased amount of time spent generating an electronic pedigree and consult note. Improvements in the computer program's technical design would potentially minimize data manipulation. Certain aspects of this program, such as electronic collection of family history and risk assessment, appear effective in improving cancer genetic counseling efficiency while others, such as generating an electronic pedigree and consult note, do not.

Agreement between data obtained from repeated interviews with a six-years interval

The objective of the study was to compare information collected through face-to-face interviews at first time and six years later in a city of Southeastern Brazil. In 1998, 32 mothers (N=32) of children aged 20 to 30 months answered a face-to-face interview with structured questions regarding their children's brushing habits. Six years later this same interview was repeated with the same mothers. Both interviews were compared for overall agreement, kappa and weighted kappa. Overall agreement between both interviews varied from 41 to 96%. Kappa values ranged from 0.00 to 0.65 (very bad to good) without any significant differences. The results showed lack of agreement when the same interview is conducted six years later, showing that the recall bias can be a methodological problem of interviews.

In a randomized controlled trial, patients preferred electronic data collection of breast cancer risk-factor information in a mammography setting

BACKGROUND AND OBJECTIVE

We evaluated patient acceptance of an electronic questionnaire to collect breast cancer risk-factor data in a mammography setting.

METHODS

We developed an electronic questionnaire on a tablet computer incorporating prefilled answers and skip patterns. Using a randomized controlled study design, we tested the survey in a mammography clinic that administers a paper risk-factor questionnaire to every woman at her screening mammogram. We randomized 160 women to use the electronic survey (experimental group, n = 86) or paper survey (control group, n = 74). We evaluated patient acceptance and data completeness.

RESULTS

Overall, 70.4% of the experimental group women thought the survey was very easy to use, compared to 55.6% of women in the control group. Ninety percent of experimental group women preferred using the tablet, compared to the paper questionnaire. Preference for the tablet did not differ by age; however, women > or = 60 years did not find the tablet as easy to use as did women < 60 years. The proportion of missing data was significantly lower on the tablet compared to the paper questionnaire (4.6% vs. 6.2%, P = .04).

CONCLUSION

Electronic questionnaires are feasible to use in a mammography setting, can improve data quality, and are preferred by women regardless of age.

A comparison of a computer-based questionnaire and personal interviews in determining oral health-related behaviours

BACKGROUND

A major challenge for survey-based research is to reduce bias. In an interview, subjects may claim more favourable behaviour to please the interviewer or comply with accepted norms.

OBJECTIVES

This study aimed to: (i) determine if adolescents give different answers when using a self-completed computer-administered oral health questionnaire compared with a personal interview, (ii) ascertain if responses to a face-to-face interview are dependant on whether a dentist or nonclinical researcher administered the questionnaire and (iii) examine if responses were influenced by whether they undertook the computer questionnaire first or second.

METHODS

A randomized crossover design was used to investigate the responses to 15 closed questions on oral health-related practices. These were administered to 453, 12-year olds attending school dental inspections in South Wales.

RESULTS

A total of 449 valid pairings of computer/interview responses were available for analysis. Responses to the questionnaire variables demonstrated good to very good levels of agreement (kappa 0.68-0.90) when comparing the face-to-face and computer-administered questionnaire. With the exception of questions on dental attendance, responses were not influenced by whether the questions were posed by the research officer or the dentist. A minimal order effect could be detected when undertaking the computer-administered questionnaire first.

CONCLUSIONS

Whilst a study such as this cannot determine the true validity of the responses achieved, it is concluded that a computer-administered questionnaire, comprising closed questions, can be utilized to determine oral health-related behaviours in oral health surveys.

Parents as partners in obtaining the medication history

OBJECTIVE

Patient-centered information management may overcome barriers that impede high-quality, safe care in the emergency department (ED). The utility of parents' report of medication data via a multimedia, touch screen interface, the asthma kiosk, was investigated. Our specific aims were (1) to estimate the validity of parents' electronically entered medication history for asthma and (2) to compare the parents' kiosk entries regarding medications to the documentation of ED physicians and nurses.

METHODS

We enrolled a cohort of parents to use the asthma kiosk and tested the validity of this communication channel for medication data specific to pediatric asthma. Parents' data provided via the kiosk during the ED encounter and the documentation of ED nurses and physicians were compared with a telephone-based interview with the parent after discharge that reviewed all asthma-specific medications physically present in the home. Treating clinicians in the ED were blinded to the parents' kiosk entries.

RESULTS

Sixty-six parents were enrolled and 49 of 66 (74.2%) completed the gold standard interview. When analyzed at the level of individual medications, the validity of parental report was 81% for medication name, 79% for route of delivery, 66% for the form of the medication, and 60% for dose. Parents' report improved on the validity of documentation by physicians across all medication details save for medication name. Parents' report was more valid than nursing documentation at triage for all medication details.

CONCLUSION

Parents can provide an independent source of medication data that improves on current documentation for key variables that impact quality and safety in emergency asthma care.

Handheld computers. A feasible alternative to paper forms for field data collection

Recent advances in handheld computer hardware and software may provide alternatives to paper-based data collection methods. The authors compared data collected with paper forms to data collected with handheld computer-based forms in a field observation study of alcohol purchase attempts at 47 community festivals in a large metropolitan area. Agreement between data collected with paper forms and data collected with handheld computers was greater than 95%. Computer-based forms handled branching patterns better and yielded data that were immediately available for analyses. Paper forms handled written comments better. Handheld computers are a feasible alternative to paper forms for field data collection.

The use of handheld computers in clinical trials

A recently completed, randomized, double-blind placebo-controlled clinical trial is presented in which Palm handheld computers were used as a substitute for normal paper-based patient diaries. In this nasal provocation study, a common antihistamine approved for the treatment of seasonal allergic rhinitis was tested against placebo for evidence of additional properties. In addition to their medical examinations, the 12 study volunteers rated subjective complaints in a diary program on 4 examination days, for a duration of 4.5 hours every 15 minutes at each visit. This resulted in 903 data sets consisting of five questions each, or 4515 data points total. In this study the use of handheld computers resulted in an increase in data quality and shortened the time needed to close the database. Moreover, the benefit of electronic reminders for protocol compliance is clearly demonstrated. Our findings support the results found in the literature we reviewed. For more than 16 years, mobile computers have been supporting the implementation of clinical trials. Our review of 27 articles out of more than 100 clinical trials in which mobile computers have been used elaborates on the advantages and problems of this technology. We give a comprehensive overview of the various technologies as used in different settings, and then discuss the methodology of using mobile devices in comparison to traditional methods, the considerations that need to be made and things to be avoided in order to conduct a successful clinical trial with mobile tools. We conclude that mobile devices are very useful in most cases, especially when design and software validation aspects have been taken into account.