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PubMed2005

Telephone vs. face-to-face biofeedback for fecal incontinence: comparison of two techniques in 239 patients.

PURPOSE: Biofeedback is an effective treatment for patients with fecal incontinence, yet little is known about how it works or the minimum regime necessary to provide clinical benefit. This study compares the effectiveness of a novel protocol of telephone-assisted biofeedback treatment for patients living in rural and remote areas with the standard face-to-face protocol for patients with fecal incontinence. METHODS: A new treatment program comprising an initial face-to-face assessment and treatment with transanal manometry and ultrasound biofeedback, followed by three treatments conducted via telephone and a final face-to-face assessment, was developed. Standard treatment involved five face-to-face treatment sessions with manometry and ultrasound. Patients from rural areas were offered the telephone-assisted treatment protocol. Data gathered prospectively included incontinence scores, a quality of life index, anal manometry, and external sphincter isometric and isotonic fatigue times. RESULTS: A total of 239 consecutive patients treated between July 2001 and July 2004 were enrolled. There were no significant differences in demographic details, past history, or pretreatment measures of the two groups. Forty-six of 55 patients (84 percent) treated with the telephone protocol and 129 of 184 (70 percent) treated by the standard technique completed treatment. There were substantial, significant improvements after treatment, including 54 percent mean improvement in patient's own rating of their incontinence in both groups; a mean decrease of 3.1 and 3.2 on the St. Mark's incontinence score (from 7.9 to 4.7 and 7.4 to 4.2 of 13) and relative improvements of 128 and 130 percent in the quality of life index (from 0.29 to 0.65 and 0.3 to 0.69 of 1) for the telephone-assisted and standard groups respectively. Importantly, there were no significant differences between the telephone-assisted or standard groups in any outcome. Of patients who completed treatment, 78 percent were better or much better. CONCLUSIONS: A less intensive regime of biofeedback seems to be equally effective as the standard intensive protocol. This finding adds weight to the evolving concept that the physical aspects of biofeedback treatment, such as manometry or ultrasound, may not be necessary in the treatment of most patients with fecal incontinence. This needs to be further tested in a randomized, controlled trial.

Adult↗
PubMed1988

Cellular telephone communication between hospitals and ambulances.

Cellular telephones provide a new means of wireless telephone communication. In an experimental design study comparing the clarity of receiving and transmitting communications with cellular telephones versus conventional emergency medical radio/microwave equipment, cellular telephones proved to be superior in all aspects of clarity and ease. Cellular telephones have numerous cost and equipment advantages over radio equipment and should replace conventional radio/microwave equipment for emergency medical communication in areas where reliable cellular telephone networks are available. This will improve an important facet of prehospital emergency care.

Ambulances↗
PubMed2006

Improving older adults' knowledge and practice of preventive measures through a telephone health education during the SARS epidemic in Hong Kong: a pilot study.

BACKGROUND: The outbreak of severe acute respiratory syndrome (SARS) in Hong Kong posed many challenges for health promotion activities among a group of older adults with low socio-economic status (SES). With concerns that this vulnerable group could be at higher risk of contracting the disease or spreading it to others, the implementation of health promotion activities appropriate to this group was considered to be essential during the epidemic. OBJECTIVES: To assess the effectiveness of delivering a telephone health education programme dealing with anxiety levels, and knowledge and practice of measures to prevent transmission of SARS among a group of older adults with low SES. DESIGN: Pretest/posttest design. SETTINGS: Subjects were recruited from registered members of a government subsidized social service center in Hong Kong and living in low-cost housing estates. PARTICIPANTS: The eligibility criteria were: (1) aged 55 or above; (2) able to speak Cantonese; (3) no hearing impairment, and (4) reachable by telephone. Of the 295 eligible subjects, 122 older adults completed the whole study. METHODS: The interviewers approached all eligible subjects by telephone during the period of 15-25 May 2003. After obtaining the participants' verbal consent, the interviewer collected baseline data by use of a questionnaire and implemented a health education programme. A follow-up telephone call was made a week later using the same questionnaire. RESULTS: The level of anxiety was lowered (t=3.28, p<0.001), and knowledge regarding the transmission routes of droplets (p<0.001) and urine and feces (p<0.01) were improved after the intervention. Although statistical significant difference was found in the practice of identified preventive measures before and after intervention, influence on behavioral changes needed further exploration. CONCLUSION: The telephone health education seemed to be effective in relieving anxiety and improving knowledge of the main transmission routes of SARS in this group, but not the practice of preventing SARS. Telephone contact appears to be a practical way of providing health education to vulnerable groups when face-to-face measure is not feasible and may be useful in raising health awareness during future outbreaks of emerging infections.

Aged↗
PubMed2005

Microbiology of public telephones.

OBJECTIVES: There is an increasing interest in antibacterial products intended for applications, such as in carpets, hand lotions, wallpaper adhesives, gloves and fabrics used in the home and hospital environments. A range of materials impregnated with various types of antimicrobial agents, such as triclosan and silver-zeolite additive is also being evaluated for use in plastics, air filters, toys, tooth-brushes, pagers and telephones. However, there is not enough microbiological data to suggest the need for sterilization of telephones and similar hand-contact objects. METHODS: Bacteriological sampling of 50 public telephones was performed from May to November. RESULTS: Twelve different types of bacteria were found on the surface of telephones. The level of bacterial contamination for the telephone mouthpiece was increased to its highest point in October from its lowest value in August. It was also found that the microbial contamination of mouthpiece was about twice the contamination of earpiece. CONCLUSIONS: These results showed that public telephones are contaminated with various types of microorganisms and the level of contamination changes significantly with time.

Bacteria↗
PubMed2004

Trial of print and telephone delivered interventions to influence walking.

BACKGROUND: Both self-help print materials and telephone-assisted counseling have generally proved useful strategies to increase physical activity. This study examined their effectiveness in an intervention aimed specifically at promoting walking for specific purposes. METHODS: Participants (n = 399) were randomly allocated to one of two 3-week intervention programs. The Print program comprised multiple mailing of brochures that emphasized walking within the local community environments. The Print plus Telephone program received the same brochures plus three telephone calls. Data collected via mailed self-completed surveys were analyzed by exploring outcomes related to walking for specific purposes. RESULTS: There were no significant differences between the two programs in any of the walking measures. Both groups significantly increased time reported walking for exercise per week [Print: t(1,277) = -3.50, P < 0.001; Print plus telephone: t(1,106) = -2.44, P < 0.016]. Significantly, more participants in the Print plus Telephone group reported receiving and reading the materials (chi2 = 20.11, P < 0.0001). CONCLUSIONS: The intervention programs were more successful at increasing walking for exercise than for any other purpose. The addition of brief telephone support was successful in focusing participants' attention on the print materials, but did not result in any additional increase in walking.

Adult↗
PubMed1981

Ear asymmetry in telephone-listening behavior.

The notion that the right ear has an advantage over the left ear in verbal information processing was investigated. Telephone-listening behavior was surveyed in three different groups of subjects to discover whether there is a preference for listening with the right ear. Subjects included 97 persons selected at random whose jobs involved heavy use of the telephone, 141 persons also selected at random whose jobs did not involve heavy use of the telephone, and 99 university secretaries. It was anticipated (1) that a right-ear advantage would be present in all three groups, (2) that the right-ear advantage would be more prominent in persons who used the telephone a great deal, and (3) that the right-ear advantage would be most pronounced in secretaries since they frequently work in noisy offices where competition occurs between the auditory pathways. Findings showed no evidence of a right-ear preference either at the time the survey was conducted or in the respondents' report of their usual telephone-listening behavior. Instead, a statistically significant left-ear preference was discovered in all three groups. Always listening with the left ear was associated with heavy use of the telephone. The most frequently given reason for listening with the left ear was that it freed the right hand for writing and dialing. This preference would appear to be motivated by convenience for although either ear is available for listening, it is easier to hold the receiver to the left than the right ear while grasping it in the left hand. Findings cast doubt on the view that the right ear has an advantage over the left ear in verbal information processing.

Attention↗
PubMed1996

The telephone in primary care.

The telephone, a ubiquitous instrument in the practice of medicine, continues to have new applications for clinical practice. The goals of the ever-increasing managed care environment appear to fit nicely with these applications. Heightened attention toward telephone education, protocol development, and documentation are needed. This article reviews characteristics of telephone encounters, the telephone in managed care, trends in "telemedicine," telephone education, and medicolegal aspects of telephone care.

Communication↗
PubMed1980

An expanded emergency service: role of telephone services in the emergency department.

The Medical Information Center at The Hospital for Sick Children in Toronto began in March 1977 to improve triage, provide an improved poison information center, improve response to telephone callers seeking medical advice, and establish a telephone consultation service for physicians. It employs specially trained nursing staff and integrates functionally related services. To determine program effectiveness we studied the records of patients triaged, telephone calls to the poison information center, and calls for other medical information, for periods both before and after the center's opening. We analyzed in detail a sample of telephone calls about acute illness, and surveyed parents who had made such calls. Unnecessary emergency visits have decreased; more patients are sent to a walk-in clinic. Use of the poison information center, especially by physicians, has increased, but fewer poisonings are treated in the emergency department or hospitalized. The Medical Information Center telephone service ensures that more children are managed at home rather than (unnecessarily) treated in the emergency department. Most parents express satisfaction with this service. Few physicians have used the telephone consultation service.

Emergency Service, Hospital↗
PubMed2003

To blow or not to blow: a randomised controlled trial of compression-only and standard telephone CPR instructions in simulated cardiac arrest.

This randomised controlled trial used a manikin model of cardiac arrest to compare skill performance in untrained lay persons randomised to receive either compression-only telephone CPR (Compression-only tel., n=29) or standard telephone CPR instructions (Standard tel., n=30). Performance was evaluated during standardised 10 min cardiac arrest simulations using a video recording and data from a laptop computer connected to the training manikin. A number of subjects in both groups did not open the airway. More than 75% in the Standard tel. group failed to deliver two effective initial rescue breaths, and only 17% provided an adequate inflation volume for subsequent breaths, delivering a median of only five inflations during the entire scenario. Most subjects in both groups gave chest compressions that were too shallow and at an inappropriately rapid rate. Hand position was also poor, but was worse in the group given simplified instructions. There was a significant delay to first compression in both groups, although this interval was shortened by over a minute when ventilations were eliminated from the telephone instruction algorithm (245 vs. 184 s, P<0.001). Over two-and-a-half times as many chest compressions were delivered during an average ambulance response time with compression-only telephone directions compared with standard CPR (461 vs. 186, P<0.001). These variables may be critical in predicting survival from out-of-hospital cardiac arrest. Further research is necessary to establish if modifications to scripted telephone instructions can remedy the identified performance deficiencies. Eliminating instructions for rescue breaths from scripted telephone directions will have little impact on the ventilation of most patients. Research is required to determine if the consequent reduction in the delay to starting chest compressions and the significant increase in the number of compressions delivered can increase survival from out-of-hospital cardiac arrest.

Adult↗
PubMed2003

A randomized study of electronic mail versus telephone follow-up after emergency department visit.

This study was conducted to determine whether electronic mail (e-mail) increases contact rates after patients are discharged from the emergency department (ED). Following discharge, patients were randomized to be contacted by telephone or e-mail. The main outcome was success of contact. Secondary outcome was the median time of response. There were 1561 patients initially screened. Of these, 444 had e-mail and were included in the study. Half were contacted by telephone and the rest via e-mail. Our telephone contact rate was 58% (129/222) after two calls in a 48-h period and our e-mail contact was 41% (90/222). The telephone was nearly two times better than e-mail. The median time of response was 48 h for e-mail and 18 h for telephone. It is concluded that the telephone is a better modality of contact than e-mail for patients discharged from the ED.

Adult↗
PubMed1997

Enhancement of the value of hip questionnaires by telephone follow-up evaluation.

Errors, omissions, false understanding, and contradictory answers can compromise the use of questionnaires to generate follow-up data. To assess the utility of and effort involved in adding routinely a telephone interview to clarify the questionnaire, a study of total hip arthroplasty patients was carried out. Thirty-six patients with 37 primary and 13 revision total hip arthroplasties filled out a standardized questionnaire (which asks a number of demographic questions as well as questions that allow calculation of the Medical Outcome Studies [MOS] 36-Item Short-form Health Survey [SF-36], Western Ontario MacMaster Arthritis Center [WOMAC] osteoarthritis index, and Harris hip score) prior to returning for routine follow-up evaluation a minimum of 1 year after surgery. Two hundred thirty-two of a possible 4,350 responses (5.3%) were missing, contradictory, or answered with two or more answers on the questionnaire. Only eight such defects occurred following the telephone interview by a skilled orthopaedic surgeon, representing a significant reduction in these defects (P < .005). The average time of the telephone call was 2.8 minutes (range, 1-12 minutes), and the average number of attempts to contact the patient was 1.4 (range, 1-6). All questionnaire data and questionnaire data plus telephone data were compared with data obtained from a subsequent face-to-face interview by a different skilled orthopaedic surgeon who was blinded to the data from both the questionnaire and the telephone interview. It is demonstrated that a telephone call to follow up a standardized, self-administered questionnaire is a very effective way to augment the quality and quantity of questionnaire responses.

Adult↗
PubMed1997

Performance of a shortened telephone-administered version of a quantitative food frequency questionnaire.

PURPOSE: We evaluated the performance of a telephone-administered food frequency questionnaire in a study of 190 men and women, 30-79 years of age, who participated as controls in a study of colon cancer. METHODS: The telephone version of the questionnaire was modified from a longer food frequency questionnaire originally administered in person to each of the participants. One month later, the telephone questionnaire was administered to a subgroup of 190 participants and readministered to 169 members of the subgroup two weeks later to assess the reproducibility and comparative validity of the instrument. RESULTS: The unadjusted correlation for energy between the original in-person full food frequency questionnaire and the abbreviated telephone version was 0.69. The median energy intake from the telephone version was 17% lower in men and 23% lower in women. The energy and sex-adjusted correlation coefficients for other nutrients ranged from 0.45 for vitamin E to 0.78 for fiber. The intraclass correlation coefficients to measure reproducibility ranged from 0.62 for animal protein to 0.83 for folate. CONCLUSIONS: These data indicate that this brief, telephone-administered questionnaire is reproducible and provides a ranking of nutrient intake comparable to that provided by a full in-person interview.

Adult↗
PubMedDate not supplied

Accuracy of fourth-graders' dietary recalls of school breakfast and school lunch validated with observations: in-person versus telephone interviews.

OBJECTIVE: To investigate the accuracy of children's dietary recalls of school breakfast and school lunch validated with observations and obtained during in-person versus telephone interviews. DESIGN: Each child was observed eating school breakfast and school lunch and was interviewed that evening about that day's intake. SETTING: Ten elementary schools. PARTICIPANTS: A sample of fourth-graders was randomly selected within race (black, white) and gender strata, observed, and interviewed in person (n = 33) or by telephone (n = 36). MAIN OUTCOMES MEASURED: Rates for omissions (items observed but not reported) and intrusions (items reported but not observed) were calculated to determine accuracy for reporting items. A measure of total inaccuracy was calculated to determine inaccuracy for reporting items and amounts combined. ANALYSIS: Analysis of variance; chi-square. RESULTS: Interview type (in person, telephone) did not significantly affect recall accuracy. For omission rate, intrusion rate, and total inaccuracy, means were 34%, 19%, and 4.6 servings for in-person recalls and 32%, 16%, and 4.3 servings for telephone recalls of school breakfast and school lunch. CONCLUSIONS AND IMPLICATIONS: The accuracy of children's recalls of school breakfast and school lunch is not significantly different whether obtained in person or by telephone. Whether interviewed in person or by telephone, children reported only 67% of items observed; furthermore, 17% of items reported were not observed.

Child↗
PubMed2003

[Value of telephone interview for quality assurance and therapy evaluation in child and adolescent psychiatry. Review of the literature and empirical results of participation quota and possible sampling bias].

OBJECTIVE: The incurred costs of telephone interviews are lower than those of other methods. Thus the question arises whether this method affords the necessary quality for therapy evaluation in child and adolescent psychiatry and psychopathology. A review of the literature shows higher rates of participation for telephone and personal interviews as opposed to those for questionnaires sent by mail. Results of investigations within the social sciences are inconsistent with regard to the quality of the data collected in telephone interviews. The few results available from samples from psychiatry permit no clear-cut conclusions as to the quality of such data. METHOD: The results of two follow-up studies of former inpatients of a hospital for child and adolescent psychiatry are presented with regard to the rate of participation and the sample bias. RESULTS: The empirical data show a higher rate of participation for telephone interviews (85%) than for either personal interviews or questionnaires sent by mail. Sample bias in telephone interviews is smaller than in the other assessment approaches. CONCLUSIONS: Since the advantages of telephone interviews outweigh those of other methods, this method of interviewing should be used as a matter of routine for quality assurance and therapy evaluation.

Adolescent↗
PubMed2001

Measuring alcohol consumption and alcohol-related problems: comparison of responses from self-administered questionnaires and telephone interviews.

AIMS: Compared with surveys using self-administered questionnaires, telephone interviews generally yield higher coverage rates, have a lower proportion of missing values and result in fewer inconsistencies. Meta-analyses, however, show that responses to sensitive questions by telephone tend to be biased by social expectations. The aim of the study is to examine whether responses on alcohol consumption and alcohol-related problems differ with respect to mode of administration (self-administered vs. telephone). Design and participants. Data were analysed from the 1995 self-administered survey among 6427 subjects and from telephone surveys conducted annually between 1994 and 1996 yielding a pooled sample of 6193 subjects. MEASUREMENTS: Alcohol consumption within the last 30 days was measured using a beverage-specific quantity-frequency index. For a summary measure responses were converted into pure alcohol (ethanol) per day and categorized into no alcohol consumption (0 g), non-hazardous consumption (< or = 20 g for female and < or = 40 g for males) and hazardous consumption (> 20 g for females and > 40 g for males). Alcohol-related problems were assessed using the CAGE questionnaire with a cut-off point of at least two positive responses. FINDINGS: Using (cumulative) logistic regression, a significant mode effect was found for both alcohol consumption and alcohol-related problems. Lower beverage-specific prevalences in the telephone mode were found to be responsible for the difference in the distribution of the summary consumption measure. CONCLUSIONS: Results indicate that patterns of drinking and alcohol-related problems are more easily reported in self-administration questionnaires compared to telephone interviews.

Adolescent↗
PubMed2000

An evaluation of the safety and effectiveness of telephone triage as a method of patient prioritization in an ophthalmic accident and emergency service.

Service changes in the accident and emergency service at Manchester Royal Eye Hospital in England resulted in a telephone triage-based referral service for health care professionals. It became clear that this service needed evaluation in order to assure both providers and users of the service that this referral strategy, based on experienced nurse practitioners making decisions about patient priority, was safe and effective. The evaluation was extended to encompass the other area of the service where telephone referrals tend to be directly from patients. A mixed method was used. Information gained within the telephone triage conversation was compared with a final diagnosis through retrospective analysis of secondary data; the documentation of those patients who were not given access to the service initially was followed-up to ensure that this decision was safe and a number of nurses were questioned about telephone information gathering, using partially structured interviews. The study showed that nurse practitioners within the accident and emergency service were able to elicit accurate information from the telephone triage conversation on which to base a decision about patient access in most cases (76% over the whole service). This resulted in the appropriate prioritization of patients. No patient who needed urgent access to the service was denied it. The decisions made to deny urgent appointments to a number of patients were safe in all cases. It appears that one of the problem areas in the gathering of information for prioritization purposes is in the nurses' telephone triage discussions with some, but by no means all, doctors. Some general practitioners seemed unwilling to discuss the patient and give accurate information to a nurse and this is an area which appears to need some further work.

Emergencies↗
PubMed2003

Follow-up for people with cancer: nurse-led services and telephone interventions.

BACKGROUND: Questions about the suitability of traditional outpatient follow-up clinics as a way of providing on-going monitoring for patients following serious illness have led to the development of a range of nurse-led services. However, there has been little attempt to draw some of this knowledge together formally and consider the weight of evidence on the necessity and value of nurse-led follow-up. AIM: To provide a review of literature evaluating the impact of nurse led follow-up in cancer care, with particular focus on the use and value of telephone interventions. METHOD: A literature search was conducted of nursing, medical and social science databases and the following keywords: cancer follow-up, nurse-led follow-up, telephone follow-up, telephone-based interventions and telephone survey. The search yielded over 150 papers, of which 37 were relevant to this review. FINDINGS: The literature suggests that nurse-led follow-up for people with cancer meets their needs for psychological support and information. The telephone is identified as a suitable means of providing this kind of service. CONCLUSION: This review demonstrates that nurse-led follow-up services are acceptable, appropriate and effective. Combined with use of the telephone, such services can be an efficient means of maintaining contact with a large client group, providing vital support to vulnerable patients during their move into aftercare and beyond.

Ambulatory Care Facilities↗
PubMed2002

Professional telephone advice to parents with sick children: time for quality control!

OBJECTIVE: To assess the quality of professional telephone advice given to parents with sick children. METHODS: All hospitals with an emergency department and a paediatric ward and a designated child health telephone advice line in the greater Brisbane region were invited to participate in the study. Case scenarios involving a febrile baby, a 14-month-old with gastroenteritis and an 18-month-old with a head injury were used three times with each institution. Each of the cases should have elicited a response indicating the need for urgent medical attention. A research assistant presented the symptoms in accordance with the questions of the telephone advice-giver. Aspects of the call were recorded, including time between call made and access to advice-giver, profession of advice-giver, identifying details sought by advice-giver, questions asked about the case presented, length of call, and advice-given. RESULTS: Of the 10 hospitals asked, six agreed to participate. Included in the study were two paediatric hospitals, two general public hospitals, one private hospital, and a Statewide-designated child health telephone advice line. Calls were generally attended to promptly. Only 37 (68.5%) of the advisers recognized the urgency of the case scenarios, with the febrile infant having the least likelihood of eliciting the correct advice (39%). Doctors gave more reliable advice than nurses in the fever scenario, but not in the other cases. CONCLUSIONS: Telephone advice to parents with sick children is easily accessible, but is often dangerously inappropriate. There is a need for tighter quality control and/or for a centralised telephone advice line to prevent inappropriate advice being given to parents.

Child↗