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    The Medical Palm Review

    June, 2006 (V7N6) - The Forest and the Trees

    Simple tasks make do with simple software. Complex projects may need better tools. But danger lurks in the woods, and the unwary user can lose his way.

    Making a List

    I like to organize my work. I make lists for grocery shopping, outlines of ideas for lectures, and strategic plans for projects. Before PDAs came along I would make notes on paper scraps during the working day or whenever I was away from my desk. Whenever I got a chance to sit down, I would copy the scraps onto larger pieces of paper, which might require further filing. Gradually the papers would coalesce into a coherent whole plan or lecture.

    In the DOS era (before you, gentle reader, were even born), a computer program called PC Outline (from Brown Bag Software) was a better way to sort out all those notes and scraps. To prepare the content of seminars or lectures, I would jot down ideas and teaching points in outline format. Outlines let me shuffle material into different order or insert new points. I could attach notes to items in the outline, which would gradually develop into a narrative flow. Outline notes could also serve as the nuclei for slides or overhead projector transparencies.

    The advent of Windows brought applications ranging from word processors with basic outlining tools to project manager software that will run a medium-sized republic. PowerPoint slide software could take notes and convert them into slides. All these programs were great when I was sitting at a desk.

    PDAs also come with software that can enhance task organization. With my first Palm IIIa I used to make lecture notes in the MemoPad, keep my teaching timetable in the Calendar, and save student e-mail addresses in the Contacts database. I created an Education category within each of those three built-in applications to make it easy to distinguish the relevant information from other data sets. An Education category in the ToDo applet let me list all the tasks pending for a seminar or a semester.

    The Treo 650 I use now makes such an approach even easier. Appointments are colour-coded in the monthly calendar view, so you can figure out your schedule at a glance. I can generate e-mail from the contact list. And I can store PowerPoint presentations on a data card to upload onto a laptop when I start to teach. I appreciate these PDA software tools even more because my laptop PC with all its accessories and case weighs more than five kilos.

    For the past year I have been using Progect, an outliner and project management application which is freely available from SourceForge. It has a pretty basic interface but runs on my PC and on my Treo. Lately I had been using it to keep track of tasks for an upcoming disaster preparedness exercise (see below for an article about that exercise).

    But Progect reminded me abruptly and forcefully how IT can ruin your day. After two days of hectic meetings and planning for the exercise, I HotSynced my Treo while Progect was still open on my desktop PC. After that, my notes in Progect were gone - both on the PDA and the PC. And my backups were two days old - missing some important developments. The Progect software itself no longer ran properly.

    In these situations, it helps to have a data recovery plan. Here is mine, and how it worked - or didn't:

    1. Swear out loud. As you might expect, cursing like a merchant sailor in four languages did nothing to improve my day although it did entertain the family dog.
    2. Restore data from backups. I checked my data backups but they were missing key details because I had neglected to backup daily.
    3. Screenshot of the HotSync desktray icon menuUninstall then reinstall the malfunctioning application. This didn't work. Each time I HotSynced I would get errors. As a temporary measure, I disabled the conduit that regulates HotSyncing of Progect. In Windows, the conduit is controlled from the HotSync desktray icon: click on it to get the menu and select Custom; then find the conduit you wish to switch off in the displayed list. If you know the name of the conduit DLL file you can instead just look for it in the Palm directory (usually "C:\Program Files\palmOne") and rename it temporarily.
    4. Soft Reset. This resolves many issues with corrupted applications in memory. It actually stabilized my Treo but my data was still gone.
    5. Update the offending software. Surprise! The programmers hadn't produced a new version since 2004. Time to get a new outline manager?
    6. Export data. In order to salvage my data and reuse it in a different project manager, I needed to extract it from Progect which uses a proprietary data file. The desktop version of Progect exports outlines as web documents or text files. I exported each of my outlines in both formats because I didn't yet know what import capability a new program would have. I made a note of the folder where I parked the exports, so I could find them again later.
    7. Find a new application. I did some homework, picked a program, bought it and installed it on my PC and PDA. See below for a brief discussion.
    8. Import data to the new application. I imported my outlines (which fortunately needed only a little cleaning up) into the new program. After a few minutes of tweaking I was back in business.

    How did I find a new outliner? I did a Google search for "outline manager Palm PDA" and got lucky. First I found some online reviews of a clutch of programs. I checked those out, and looked on a variety of online sites for leads to more applications. Then I downloaded four demos. I installed and ran them on desktop and PDA, and kept notes in a spreadsheet.

    I find that you can get an excellent feel for the basics by just installing and starting to use a program. The interface, use of stylus or keyboard, navigation tools should all be intuitive. A browse through the manual reveals subtle and high-powered features which can then be tested. Finally, I uninstall the application, to see what breaks.

    I tried out these four products:

    • Bonsai sample screenshotBonsai (USD38). All the basic features I need to create outlines and project management task lists. Pretty good at linking to Contacts, Task List and Calendar on the PDA. Outlines are extensively customizable. Printing and data export can be customized too, with some effort. Desktop app interface is easy to use. The screenshot at right showcases how much detail gets packed into one screen without getting excessively cluttered.
    • Brainforest (USD25). I used this for some years on my Palm IIIa but the program was sold to another developer, it wasn't updated and became incompatible with newer hardware. That's all remedied now and the program is quite solid if lacking some of the bells and whistles of the other three listed here.
    • Shadowplan sample screenShadowPlan (CD27). Lots of features and has many fans who maintain a discussion forum. The developer is famously responsive to requests for features or fixes. I unfortunately had trouble with it when I tried to link items in an outline to my Task List or Contacts: it was painfully slow to create the link and my Task List was subsequently corrupted. I didn't find any info about this so I don't know what went wrong and whether it would happen again. I also found that its desktop PC app interface was a tad awkward compared to the others, but this is a matter of personal preference.
    • Thought Manager (USD20). Has all the basics and many extras. The company also has a free reader for other Palm users to read (but not edit) outlines you create - very handy for distributing seminar notes. It has a built-in sketchpad which can be great for brainstorming. It created the best looking exports to Word or to the printer. It proved a little tricky to remove a setting in the Windows Registry when I uninstalled the demo. This was not covered in the manual but tech support responded within one day to my request for assistance and gave me the precise info needed to solve the problem.

    There are many more options out there but I had to draw the line somewhere and get back to work. I would have been happy with any of them but opted for Bonsai, despite the higher price tag. A month later it is doing the job, and (even more important) is stable on my computing systems.

    See? it only took a half day to recover from the carelessness of not doing daily backups.

    Disaster Strikes

    IDEAS Network CBRN exercise, Sudbury, OntarioNot me this time. And not my personal computing gear either. I refer to a training exercise staged by Toronto physicians, paramedics and firefighters at a local community college at the beginning of May. The conference and exercise were staged by IDEAS Network and Centennial College.

    The exercise offered different opportunities to different people. Hospital administrators got to test their disaster response plan. Medical residents and nurses rehearsed triage and trauma case treatment. Hospital staff also practiced putting on protective suits and decontamination of patients arriving at the Emergency Department. I got to test computing and communications tools that might be helpful in a crisis.

    Some of the ideas we tried out:

    • webcams provided live feeds from the simulated Emergency Department and the field to command centres.
    • Voice over Internet Phone service was set up using wireless networks.
    • mobile computing devices (laptops mostly) were used to register and track patients entering treatment at the mock hospital.

    The most important thing you need to know as Palm PDA users is: we didn't use any Palm OS devices in the exercise. Why not? Because all the cool hardware and software really is tied to the Windows platform or to the Internet. Wireless networking can be unreliable and PDAs don't have high-speed connections to the web at the best of times. We just didn't have any core role for PDAs.

    But when I think back to the impact and immediacy of images sent by commuters using camera phones after the London bombings last year I realize that there is great potential for rescue teams to deploy using camera phones like the Treo, mobile wireless networks (e.g.. using wireless routers in emergency services vehicles), and PDAs with customized triage software. There is already a slew of software for PDAs on managing victims of biological and chemical weapons.

    So I plan to try more tinkering with these ideas during the next exercise (keep an eye on the IDEAS Network site for dates). My goal is to develop tools and techniques that will be effective in the event of a real disaster.

    Checking It Twice

    We are all hostages to Fortune. If your car breaks down, you hope to flag down a cab. If you switch on your PDA and the screen is blank all the arm waving in the world won't bring your data back.

    I find that as my PDA memory fills up with applications and data, it slows down and gets flaky. And it's just overwhelming to try to fix it all at one go.

    The solution: every week I look at one application. I remove unnecessary data files or even entire applications, do a soft reset, backup everything to PC or SD card. Incrementally, my PDA gets more stable.

    If I can just clean house faster than I add junk then I'm a winner and there is a bonus -- more free memory to install and test new software. Ultimately, it all comes down to discipline: can I force myself to invest a few minutes every week to backup the data on my PDA, and to review what's on board?

    Well, I clearly failed to prevent trouble with Progect, but my Treo is pretty stable most of the time.

    Medical "Doc" of the Month

    The U.S. Agency for Healthcare Research and Quality has an interesting calculator for severity of community acquired pneumonia. This can help guide diagnosis and treatment decisions. This is part of a growing trend to put the latest diagnostic and treatment algorithms into caregivers' hands right at the bedside.

    Can handheld computers improve adherence to guidelines? (Price M, Can Fam Phys, 2005;51:1506-7) describes a pilot study of Canadian family physicians who use preventive health guidelines on their Palm PDAs. The author asserts that the convenient, accessible handheld computer encouraged reference and adherence to the guidelines.

    Medical Computing

    Many ideas are circulating for not just mobile medical computing but also delivering care to mobile patients, and people outside traditional health care environments. Here are a few recent news items.

    Wireless technology is being used in North Carolina to transmit ECGs from ambulances to cardiac specialists. The ECGs can be checked on a doctor's PDA to speed the decision whether to perform angioplasty or only medical therapy when the patient arrives at the hospital.

    The U.S. Army wants to monitor combat troops remotely. Proposed sensors would allow medics or command posts to track injury, sleep status, and vital signs.

    Patient vital signs can also be monitored using cellular telephone networks and Treo smart phones, as proposed in systems by Sprint and Telzuit.

    Nuts and Bolts

    Palm has released the new Treo 700p. This model will still not offer WiFi networking (it is designed to be offered by cellular service providers), but it will have more memory and a better camera (see the review on CNet). The Treo 700 also continues to showcase wireless e-mail and messaging, a web browser and Documents to Go (Word, Excel, PowerPoint, and PDF file compatibility). Sounds nice but I still want wireless networking. Hey Palm: listen up!

    The Sandisk Ultra II Plus Secure Digital memory card has a very clever feature. It has a USB port built-in. That way, to transfer data between from a PDA or camera to a PC doesn't require cables or a card reader. Just remove the SD card from your gadget, unfold the port, connect to a USB jack on the PC, and you are all set. The premium over regular SD cards is only about $10 - less than the price of Card Export from Softick, and you don't need to carry around a cable.

    Hack of the Month

    PalmFocus maintains a Treo software compatibility list. A large list of titles have been tested and found to be OK (or not) for the Treo. Browsing the list before you install something may save a great deal of aggravation and wasted time.

    In Times to Come

    It's (almost) summer. Don't ask me about next month's issue because I am too distracted by the mild weather....

    Until July, then, enjoy!

    This is one of a continuing series of newsletters about Palm handheld computers, prepared for doctors, nurses, IT professionals, educators and other people who need tools that work. The Review is published monthly on our web site. Subscription is free; the principal benefit is receiving e-mail notification of new issues.

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