Evaluation of the efficacy of hand-held computer screens for cardiologists' interpretations of 12-lead electrocardiograms.

BACKGROUND: Newly designed computer-based applications and the development of wireless technology have allowed the transmission of 12-lead electrocardiogram (ECG) waveforms from remote locations to the hand-held computers of cardiologists. If these computer ECGs can be reliably interpreted, then the time to treatment for cardiac patients may be reduced. METHODS AND RESULTS: Twenty classic examples of cardiac abnormalities were chosen to test the efficacy of the hand-held computer's liquid crystal display (LCD) screen in the interpretation of 12-lead ECGs. Ten cardiologists interpreted these 20 ECGs on the hand-held computers and then twice later on traditional printed paper. The control intraobserver agreement between the sets of paper-displayed ECGs was measured against the agreement between each of the paper sets and the LCD-displayed set of ECGs. Eighty-nine percent (178/200) of the ECGs were interpreted identically by the participants between the 2 paper sets. When comparing the interpretations of the LCD-displayed ECGs with those of each of the paper sets of ECGs, 88.0% (176/200) and 87.5% (175/200) of identical diagnoses were noted. These differences of 1.0% and 1.5% in intraobserver agreement between paper-to-paper and each of the 2 paper-to-LCD comparisons were not significant (P =.75 and P =.88, respectively). CONCLUSIONS: The strong intraobserver agreement shows that cardiologists make the same diagnoses when viewing LCD-displayed ECGs as they do when viewing paper-displayed ECGs. A study to measure the intraobserver agreement of the decision regarding administration of reperfusion therapy after interpretation of ECGs of patients with acute chest pain is now underway.

Reporting elder mistreatment.

Elder mistreatment, defined as the abuse and neglect of older persons, includes physical, psychological, and sexual abuse, caregiver and self-neglect, and financial exploitation. Fifty states and the District of Columbia have passed legislation to establish adult protective service (APS) programs. State APS statutes authorize APS agencies to investigate cases of elder mistreatment. Some status fund services to alleviate the abusive or neglectful situation. This article analyzes the critical aspects of state-specific APS legislation affecting nursing practice with older adults and the nurse's role in reporting cases of elder mistreatment.