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PubMed1978

The verbal helping behavior of experienced and novice telephone counselors.

The verbal helping behavior of experienced and novice volunteer telephone counselors was evaluated. Taped telephone interactions with typical helpees were analyzed for the usage of specific response types and for helper talk time, self-references, and feelings. Novices were found to give significantly less advice and their helpees talked significantly longer. The use of continuing responses was significantly associated with helpee talk time for all helpers. Even though telephone counseling may elicit a leading response style from helpers, a continuing or reflective style might be more effective in the relationship-building aspect of telephone counseling.

Counseling↗
PubMed1994

60 Hertz magnetic field exposure assessment for an investigation of leukemia in telephone lineworkers.

The purpose of this paper is to present the assessment of magnetic field exposure conducted as a part of a nested case-control investigation of leukemia mortality in telephone lineworkers. For the purposes of exposure classification, telephone company jobs were initially divided into two classes: those with potential for working in an electric environment, referred to as linework jobs, and those not working in an electric environment, referred to as nonlinework jobs. Linework jobs were further divided into the following four categories: outside plant technicians (OPT), installation/maintenance/repair (IMR) technicians, central office technicians (COT), and cable splicing technicians (CST). These job groupings were based on similarity of work tasks and exposure environments. Emdex data-logging dosimeters were used to measure personal exposures to ELF magnetic fields for 204 telephone company workers. Three general classes of exposure indices were calculated for each exposure record: measures of central tendency, measures of peak or maximum exposure, and measures of exposure variability. CSTs had the highest full-shift mean and median exposure, 4.3 and 3.2 mG, respectively. CSTs also ranked the highest, with average peak, average 95th percentile, and average time above background equal to 99.2 mG, 11.1 mG, and 156 min, respectively. In addition, the results suggest the OPT and IMR technicians have exposures similar to nonlineworkers. Exposure classifications, therefore, which misclassify all lineworkers into one "telephone lineworker" job grouping are not appropriate and future studies should concentrate on cable splicing technicians.

Case-Control Studies↗
PubMed2004

Telephone word-list recall tested in the rural aging and memory study: two parallel versions for the TICS-M.

BACKGROUND: Parallel versions of memory tasks are useful in clinical and research settings to reduce practice effects engendered by multiple administrations. We aimed to investigate the usefulness of three parallel versions of ten-item word list recall tasks administered by telephone. METHODS: A population based telephone survey of middle-aged and elderly residents of Bradley County, Arkansas was carried out as part of the Rural Aging and Memory Study (RAMS). Participants in the study were 1845 persons aged 40 to 95 years. Word lists included that used in the telephone interview of cognitive status (TICS) as a criterion standard and two newly developed lists. RESULTS: The mean age of participants was 61.05 (SD 12.44) years; 39.5% were over age 65. 78% of the participants had completed high school, 66% were women and 21% were African-American. There was no difference in demographic characteristics between groups receiving different word list versions, and performances on the three versions were equivalent for both immediate (mean 4.22, SD 1.53) and delayed (mean 2.35 SD 1.75) recall trials. The total memory score (immediate+delayed recall) was negatively associated with older age (beta = -0.41, 95%CI=-0.11 to -0.04), lower education (beta = 0.24, 95%CI = 0.36 to 0.51), male gender (beta = -0.18, 95%CI = -1.39 to -0.90) and African-American race (beta = -0.15, 95%CI = -1.41 to -0.82). CONCLUSIONS: The two RAMS word recall lists and the TICS word recall list can be used interchangeably in telephone assessment of memory of middle-aged and elderly persons. This finding is important for future studies where parallel versions of a word-list memory task are needed. (250 words).

Aged↗
PubMedDate not supplied

Telephone medicine: a general internal medicine experience.

While a substantial number of patient contacts with internists occur over the telephone, there is little information about the nature and content of these encounters. The authors surveyed patient-initiated phone calls that resulted in a physician response for seven general internists. Over a six-month period, 1,377 telephone encounters met inclusion criteria. Calls were generally short, 73% lasting 4 minutes or less; mean time per call was 3.4 minutes. The doctor spoke to the patient directly 79% of the time and to a relative in 15% of the calls. The most common reason for phoning the doctor was a symptom or medical complaint (45% of all calls), followed by questions about test results (16%) and medication queries (14%). Over 60% of calls dealt with chronic conditions. Diagnoses encountered over the telephone were similar in frequency to those seen in outpatient clinic visits; however, a notable proportion of calls dealt with topics beyond the scope of traditional internal medicine training programs. A medication response was the reason for 22% of the phone calls. The doctors recommended changes in follow up 12% of the time; these included early visits to the clinic, evaluation in the emergency room, and direct admission to the hospital. An appreciation of the scope of telephone medicine in terms of both medical skills applied and time committed is germane to trainees and practitioners alike.

Ambulatory Care↗
PubMed2006

The outpatient management of low-risk febrile patients with neutropenia: risk assessment over the telephone.

OBJECTIVE: The purpose of this retrospective study is to evaluate the feasibility of the risk assessment over the telephone in the outpatient management of low-risk febrile patients with neutropenia. MATERIALS AND METHODS: Febrile patients with neutropenia were eligible for outpatient management with oral ciprofloxacin if they demonstrated the following characteristics: resolution of neutropenia expected in <10 days, good performance status, controlled cancer, no symptoms or signs suggesting systemic infection other than fever, and no comorbidity requiring hospitalization. Eligible patients received oral ciprofloxacin (400 mg, three times daily) and were monitored as far as possible by telephone. Risk assessment concerning general condition was carried out over the telephone. RESULTS: Of the 60 consecutive patients who received neoadjuvant chemotherapy as a phase II trial of docetaxel (60 mg/m(2)) and doxorubicin (50 mg/m(2)) for primary breast cancer, 30 low-risk febrile patients received oral ciprofloxacin. Twenty-seven of these patients (90%) recovered uneventfully without hospitalization and the use of granulocyte colony-stimulating factor. Treatment was considered to have failed in the remaining three (10%) on the account of the need to modify or change their regimens. CONCLUSIONS: For carefully selected low-risk febrile patients with neutropenia, risk assessment over the telephone may be convenient, and close daily medical scrutiny may be not routinely required in the outpatient.

Adult↗
PubMed2006

Measuring stroke impact with SIS: construct validity of SIS telephone administration.

OBJECTIVES: The purpose of this study was to examine the construct validity of the Stroke Impact Scale (SIS) using telephone mode of administration. METHODS: Stroke patients were identified using national VA administrative data and ICD-9 codes in 13 participating VA hospitals. Stroke was confirmed by reviewing electronic medical records. Patients were administered SIS by telephone at 12-weeks post-stroke, and administered the Functional Independence Measure (FIM) and SF-36V at 16 weeks post-stroke. The instrument's convergent validity and its ability to differentiate between groups of stroke patients with different disability levels were examined using Pearson's correlations and Kruskal-Wallis one way ANOVA tests. RESULTS: All the relevant relationships yielded high correlation coefficients with statistical significance: 0.86 for FIM-motor vs. SIS-ADL, and 0.77 for PF in SF-36V vs. SIS-PHYSICAL. The SIS presented better score discrimination and distribution for different severity of stroke than FIM and SF-36V without severe ceiling and floor effects. Kruskal-Wallis tests showed the Physical Component Score of SF-36V did not discriminate any disability levels. Physical functioning (PF) in SF-36V, FIM-motor, SIS-PHYSICAL, SIS-16, and SIS-ADL showed better discrimination in person's functioning. The pairwise comparisons showed that SIS-PHYSICAL, SIS-16, and SIS-ADL discriminated more Rankin levels than FIM-motor and PF in SF-36V. CONCLUSIONS: SIS telephone survey had superior convergent validity and was better at differentiating between groups of stroke patients with different disability levels than the FIM and SF-36V with no evidence of ceiling and floor effects. Telephone administration of SIS would be a useful and cost-effective method to follow-up community dwelling veterans with stroke.

Activities of Daily Living↗
PubMed1995

The effects of a mobile telephone task on driver behaviour in a car following situation.

The effects of a mobile telephone task on young and elderly drivers' choice reaction time, headway, lateral position, and workload were studied when the subjects were driving in a car-following situation, in the VTI driving simulator. It was found that a mobile telephone task had a negative effect upon the drivers' choice reaction time, and that the effect was more pronounced for the elderly drivers. Furthermore, the subjects did not compensate for their increased reaction time by increasing their headway during the phone task. The subjects' mental workload, as measured by the NASA-TLX, increased as a function of the mobile telephone task. No effect on the subjects' lateral position could be detected. Taken together, these results indicate that the accident risk can increase when a driver is using the mobile telephone in a car following situation. The reasons for the increased risk, and possible ways to eliminate it, are also discussed.

Accidents, Traffic↗
PubMed1987

Cellular telephone transmission of 12-lead electrocardiograms from ambulance to hospital.

Currently, only single-lead, serial telemetry rhythm strips can be transmitted from ambulances. Triage of patients with chest pain and administration of thrombolytic therapy in ambulances is limited by the lack of specific electrocardiographic (ECG) diagnosis. A new technique is described using cellular telephone transmission of simultaneous 12-lead ECGs from ambulance to hospital to overcome this limitation. A portable 12-lead ECG installed in an ambulance was connected via modern link to a cellular telephone and digitized ECG information was transmitted to an ECG device in the hospital emergency room. Paramedics in the field placed adhesive patch electrodes and attached ECG wires. Field ECGs from 23 patients were compared with corresponding transmitted ECGs. There were no differences in heart rate, PR interval, QRS duration, QT interval or R- and T-wave axes. Baseline and transmitted ECGs had identical morphologic characteristics. Differences in R-wave amplitude in 5 transmitted tracings compared with hospital-recorded ECGs resulted in computer diagnosis of left ventricular hypertrophy by voltage, possibly due to differences in patient position. Twelve-lead ECGs can be easily transmitted from a moving ambulance using cellular telephones. This allows diagnosis before hospital arrival, improves prehospital triage of patients and may facilitate prehospital therapy with lidocaine or streptokinase. In addition, the cellular telephone link can convey both verbal and digitized information and thus improve on current telemetry systems.

Ambulances↗
PubMed1996

[Evaluation of pediatric advise asked by telephone in emergency units].

BACKGROUND: Telephone calls for advice are common in pediatric emergency departments. This study was conducted to determine the nature of these calls and the answers provided. METHODS: From 24 April through 24 July 1994, all telephone calls requesting pediatric advice in the emergency department of the Poissy Hospital were independently analysed by two pediatricians from forms prospectively filled in for each call by the resident or the attending people who answered the call. RESULTS: Of the 239 registered calls, 186 could be analysed. They represented, in number, 15.25% of the children seen at the same emergency department during the study period. Weekend and holiday calls accounted for 35.5% of calls. 7.8% of calls were received from 0.01 am to 8.00 am, 28.7% from 8.01 am to 4.00 pm, and 63.5% from 4.01 pm to 12.00 pm. Thirty-seven percent concerned children under one year of age. The caller was one of the parents in 93% of cases. The four most frequent complaints were fever (26.5%), requests for information (17.2%), rash (12.3%), and vomiting (10.2%). The review of calls by two pediatricians determined that 67% of children did not need to be seen by a physician within six hours; 28% needed to be seen within 6 hours, and 5% needed to be seen within one hour. The advice given was followed in 88% of cases; 96% of callers were satisfied with their calls management. CONCLUSIONS: Telephone advice constitutes an important part of the activity in the pediatric emergency department. Instructional programs in telephone management are necessary for physicians. These programs should include communication skills and familiarization with protocols concerning the most frequent complaints, especially those regarding children under one year of age.

Adolescent↗
PubMed1994

Telephone triage: results of adolescent clinic responses to a mock patient with pelvic pain.

PURPOSE: The purpose of this study was to evaluate the appropriateness of telephone advice given by adolescent clinics. METHODS: Using a mock scenario simulated by a teenage actress, adolescent clinics nationwide were telephoned by a 16-year-old female complaining of acute onset of "belly pain" in her left lower side. Upon questioning the mock patient, clinics were able to obtain further information. In short, it could be determined that the mock patient was sexually active, did not use contraception, was "late" for her period, and had just begun spotting. With the information available, a potentially life-threatening ectopic pregnancy could not be ruled out. Telephone triage of 35 clinics was evaluated according to the final disposition. Appropriate advice included arranging to see the patient that day or referring the patient to another facility (i.e., emergency department) to be seen that day. RESULTS: Sixty-three percent of the clinics gave appropriate advice; 37% gave inappropriate advice. Nonprofessional personnel rendered the advice in over 60% of the calls. CONCLUSION: This study suggests a need to reevaluate the procedures utilized to provide proper telephone advice to adolescents.

Adolescent↗
PubMed2004

[Pediatric telephone advice in the emergency department].

OBJECTIVES: To describe the activity of telephone advice in a pediatric emergency department and assess the influencing factors to improve quality of care. METHODS: Descriptive study about all the anonymous telephone calls received on the direct line of the pediatric emergency room of Le Havre hospital, from 25 January to 25 July 2002, and all the advices given by a doctor or a nurse. RESULTS: The mean daily call frequency was 2.15 (0-12) with 586 calls during the 6 months period and the mean call duration was 3 min (1-20). Parents took telephone advices for: fever (27%), digestive troubles (22%), and trauma (14%). We found no difference concerning symptoms according to season. The rush hours were, on a bimodal graph, 0-1 am and 8-9 pm, paralleling the rush activity of consultation in pediatric emergency room. The heavy days for phone advices during the week were Tuesday and Wednesday. We found no correlation between heavy days of week and phone call duration. Thirty percent of cases did not need any advice because the asks were only an orientation advice. Advice to go to our emergency department was done in 11% of orientation advice. The call duration was significantly longer for: (1) calls including several symptoms or griefs, (2) calls given by a nurse; (3) calls taking place during hours of lowest activity in the emergency room (between 6 and 12 am), (4) calls including advice about medication or diet; (5) calls for counselling an orientation other than medical establishment. CONCLUSION: Our assessment of telephone call advices represented the first step to improve the quality of answer to families. Next step will be written protocols to answer more adequately to main griefs and symptoms that lead families to search for phone counselling.

Adolescent↗
PubMedDate not supplied

Feasibility and acceptability of a telephone psychotherapy program for depressed adults treated in primary care.

OBJECTIVE: Telephone psychotherapy is an emerging model of care that appears feasible for extending the reach of evidence-based psychotherapy treatment without accruing the full costs of traditional office-based, mental health care. This manuscript describes the development, implementation and acceptance of a 12-month telephone psychotherapy program (TPP) for depressed adults not fully responding to standard antidepressant treatment in primary care. METHOD: The TPP combined a population-based medication monitoring and information system with a structured cognitive-behavioral treatment (CBT) program. The TPP included 8-12 telephone sessions (eight core CBT sessions and three to four clinical booster sessions) delivered by a master-level therapist working in tandem with each patient's primary care physician (PCP). RESULTS: The TPP was well accepted (i.e., 80% completed the core program) by a population-based sample of adult primary care patients initiating antidepressant treatment. The mean duration of core telephone psychotherapy sessions was approximately 31 min during acute-phase treatment (0-6 months). Eighty-two percent of TPP patients maintained contact with their therapist during maintenance-phase treatment (6-12 months). CONCLUSIONS: The practical and efficient nature of this TPP appears to sidestep many of the treatment barriers encountered in traditional office-based care. Implementation of this TPP program in other primary care settings may be valuable for enhancing standard pharmacotherapy treatment of adult depression, especially among populations facing greater barriers of care.

Adult↗
PubMed2006

Reliability and predictive validity of the Asthma Control Test administered by telephone calls using speech recognition technology.

BACKGROUND: The Asthma Control Test (ACT) has been validated in a paper and pencil version but has not been validated for use by telephone. OBJECTIVE: The purpose of this study was to provide validation data for the ACT administered by interactive telephone calls using speech recognition technology. METHODS: The ACT was administered to patients who confirmed a diagnosis of physician-diagnosed asthma, and information regarding race/ethnicity, smoking, and asthma course was also obtained during the call. Asthma emergency department visits, hospitalizations, and oral corticosteroid and beta-agonist canister dispensings were assessed for the 12 months after the date of each patient's call. Internal consistency reliability and predictive validity were assessed. RESULTS: Asthma Control Test scores (higher indicates better control) were completed by 2244 patients and were inversely related to black or Hispanic race/ethnicity and smoking. Reliability was 0.83. ACT scores were significantly related to emergency hospital care and oral corticosteroid and beta-agonist dispensings over the period of the subsequent 6 and 12 months. After adjusting for demographic characteristics, a score < or = 15 was associated significantly with an increased 12-month risk of emergency hospital care (odds ratio [OR], 2.5), oral corticosteroid dispensings (OR, 2.6) and dispensing of more than 6 beta-agonist canisters (OR, 6.8) compared with a score > or = 20. CONCLUSION: These data support the reliability and predictive validity of the ACT administered by interactive telephone calls using speech recognition technology. CLINICAL IMPLICATIONS: The ACT can be used for outreach or follow-up by means of interactive telephone calls using speech recognition technology.

Adrenal Cortex Hormones↗
PubMed2004

Telephone reminders are effective in recruiting nonresponding patients to randomized controlled trials.

OBJECTIVE: Studies investigating means of recruiting participants to randomized controlled trials (RCTs) are sparse. We investigated the effects of telephone reminders as a recruitment strategy. STUDY DESIGN AND SETTING: Sick-listed employees received a written invitation to participate in a study comparing standard treatments with a solution-focused follow-up and were randomly allocated to an intervention or control group (n=703). Those who did not respond within 2 weeks received either 'no reminder' (n=242) or 'attempted telephone reminder' (n=256). Outcome was enrollment to the RCT. RESULTS: An intention to recruit analysis revealed no significant differences between the groups (P=.229). An intention to phone analysis among nonresponders revealed significant differences between 'no reminder' (recruited 4.5%) and 'attempted telephone reminder' (recruited 12.1%) (P=.003, odds ratio 2.89, 95% confidence interval [CI] 1.42-5.90). An analysis of numbers needed to phone showed that to recruit one more person in this group of nonresponders, we needed to phone 13 persons (95% CI=8-33). CONCLUSION: Systematic use of telephone calls can increase the recruitment rate among nonresponders in RCTs.

Adolescent↗
PubMed2005

Mail surveys resulted in more reports of substance use than telephone surveys.

OBJECTIVE: To determine to what extent the substance-use information obtained in surveys is affected by method of data collection. STUDY DESIGN AND SETTING: Questions on the use of alcohol and drugs were administered to samples of Minnesota adults assigned to one of two conditions to test the effect of mode of administration (mail and telephone); 816 persons completed the survey, roughly one half by mail and one half by telephone. RESULTS: Those interviewed by telephone revealed more heavy use of alcohol, but the mail sample includes disproportionate numbers of respondents from demographic groups that exhibit less use. Controlling for these differences across modes, as well as the differential use of listed telephone numbers and addresses, reduces the effect of mode on one measure of heavy alcohol use to nonsignificance but yields significant effects of mode on others. Specifically, those in the mail condition reported higher levels of illicit drug use in the last year, alcohol use in the last month, and heavy alcohol use in the last 2 weeks. CONCLUSIONS: The greater, and arguably more accurate, reporting of substance use, coupled with potential cost savings, suggests that researchers should consider using mail surveys for investigating substance use.

Alcohol-Related Disorders↗
PubMed2006

Formation and validation of a telephone battery to assess cognitive function in acute respiratory distress syndrome survivors.

PURPOSE: Describe initial development and validation of a test battery composed of established instruments designed to detect, via telephone interview, cognitive abnormalities in survivors of acute respiratory distress syndrome. METHODS: Two cross-sectional studies were performed, including the following phases: (1) initial battery construction, (2) feasibility, (3) item reduction, (4) convergent and divergent validity, and (5) telephone administration compared with in-face interviews in a separate population. RESULTS: There was a broad range of cognitive function detected in the derivation population, and all subjects completed the interview. There was convergence of cognitive impairment with moderate/severe anxiety (P = .008), the Sickness Impact Profile Psychosocial Summary Score (mean difference, 15.3; 95% CI, 7.74-22.9; P = .0001), and the mental health domains of the Short Form 36. Subjects with cognitive impairment had no detectable difference in the physical function domains of the Short Form 36. When administered to the validation population, telephone tests of memory, attention, reasoning, and executive functions had good intraclass correlation with the in-face interviews (P < .01). CONCLUSIONS: Detection of cognitive abnormalities in acute respiratory distress syndrome survivors using a telephone-administered test battery derived from standard cognitive tests is feasible and has evidence of construct validity. This battery may be useful as a research tool when in-face interviews are not feasible.

Adult↗
PubMed2005

Cornea donation: evaluation of a training session to obtain consent by telephone.

BACKGROUND: Obtaining consent from relatives is essential for cornea donation. When a face-to-face interview is not possible, telephone contact is used to obtain donation consent. We tried to evaluate the role of experience on the acceptance rate using this method. METHODS: This was a prospective study conducted over a 22-month period. Two nonmedical coordinators were evaluated. Telephone contact was conducted using a standardized procedure. We recorded for each coordinator the number of telephone contacts and the acceptance rate. RESULTS: Among 455 families contacted, the mean acceptance rate was 60%. Initial acceptance rate was below 30% for both coordinators, showing dramatic improvement with experience (acceptance rate >70% after 100 contacts). CONCLUSIONS: Telephone contact is an efficient method to obtain cornea donation consent. However, as with other new methods, a training period is necessary to increase effectiveness.

Attitude to Health↗
PubMed2004

Using mobile telephones: cognitive workload and attention resource allocation.

Driver distraction is recognized as being one of the central causes of road traffic incidents and mobile telephones are tangible devices (among many other electronic devices) that can distract the driver through changes in workload. Forty participants completed a motorway route characterized by a low level of road complexity in the form of vehicle handling and information processing. A peripheral detection task (PDT) was employed to gauge mental workload. We compared effects of conversation type (simple versus complex) and telephone mode (hands-free versus handheld) to baseline conditions. The participants' reaction times increased significantly when conversing but no benefit of hands-free units over handheld units on rural roads/motorways were found. Thus, in regard to mobile telephones, the content of the conversation was far more important for driving and driver distraction than the type of telephone when driving on a motorway or similar type of road. The more difficult and complex the conversation, the greater the possible negative effect on driver distraction.

Adult↗