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PubMed1999

Use of cellular telephones and the risk for brain tumours: A case-control study.

The use of cellular telephones has increased dramatically during the 1990's in the world. In the 1980's the analogue NMT system was used whereas the digital GSM system was introduced in early 1990's and is now the preferred system. Case reports of brain tumours in users initiated this case-control study on brain tumours and use of cellular telephones. Also other exposures were assessed. All cases, both males and females, with histopathologically verified brain tumour living in Uppsala-Orebro region (1994-96) and Stockholm region (1995-96) aged 20-80 at the time of diagnosis and alive at start of the study were included, 233 in total. Two controls to each case were selected from the Swedish Population Register matched for sex, age and study region. Exposure was assessed by questionnaires supplemented over the phone. The analyses were based on answers from 209 (90%) cases and 425 (91%) controls. Use of cellular telephone gave odds ratio (OR) = 0.98 with 95% confidence interval (CI) = 0. 69-1.41. For the digital GSM system OR = 0.97, CI = 0.61-1.56 and for the analogue NMT system OR = 0.94, CI = 0.62-1.44 were calculated. Dose-response analysis and using different tumour induction periods gave similar results. Non-significantly increased risk was found for tumour in the temporal or occipital lobe on the same side as a cellular phone had been used, right side OR = 2.45, CI = 0.78-7.76, left side OR = 2.40, CI = 0.52-10.9 Increased risk was found only for use of the NMT system. For GSM use the observation time is still too short for definite conclusions. An increased risk for brain tumour in the anatomical area close to the use of a cellular telephone should be especially studied in the future.

Adult↗
PubMedDate not supplied

[Telephone consultation in child neurology practice: quantification and contents].

INTRODUCTION: The workload of telephone consultations has been scarcely studied except at the Emergency Units, in spite of the considerable amount of time consumed by the task in normal practice. OBJECTIVE: To asses the workload of telephone consultations in a Neuropediatric Unit, during normal working hours. METHODS: A prospective analysis of all calls received during a year, at the out-patient hospital-based neuropediatric clinic. RESULTS: 150-200 telephone consultations were received every month, decreasing during the holiday seasons. They amount to two thirds of the face-to-face contacts at the clinic, during the same period of time, and require about 10% of our day-time working hours. Disorders more likely to produce the calls: epilepsy (40%), mental retardation (19%), cerebral palsy (11%), all others with a frequency lower than 5%. These percentages, and those of hydrocephalus, autism and spina bifida, are similar to those encountered in normal practice, while headaches, speech delay, hyperactivity, syncopes, etc. produced half the number of calls expected; myopathies doubled the number of calls expected. The monthly frequency of calls varied significatively, along the year, for epilepsy, mental retardation, hyperactivity, migraine and autism. Calls were made especially by the family (49%), but it depends of the purpose and the patient's diagnosis. The purpose was most frequently to consult about the symptomatology of the illness; treatments produced 7% of calls; and discussion about citations, 19.5%, regardless of the diagnosis. CONCLUSION: In neuropediatric practice, telephone consultations should be recognized and provided for in order to manage effectively the clinical demand.

Child↗
PubMed2000

A comparison of suburban and urban daytime telephone triage calls.

OBJECTIVE: To compare daytime nurse telephone triage calls received by a suburban practice with those received by a hospital-based, inner-city pediatric practice. METHODS: A research assistant, listening simultaneously with triage personnel, prospectively coded all calls received by the nurse triage telephone offices in 2 pediatric practices. Calls were coded the first full, nonholiday week of 3 consecutive summer and 3 consecutive winter months, alternating morning and afternoon sessions. One practice was suburban and had almost all commercially insured patients; the other was hospital-based, in an inner-city, and consisted mostly of patients with Medicaid coverage or no health insurance. RESULTS: A total of 901 calls were triaged in the suburban practice (SP) and 768 in the urban practice (UP). The chief complaints of calls regarding medical problems were similar at both sites. Difficulties with language were noted less often in SP compared with UP (1% vs 17%). The reason for the calls differed by site: medical problem relating to illness or injury (SP 55% vs UP 40%); social issue (SP 1% vs UP 9%); documentation request (SP 2% vs UP 7%); request for laboratory work (SP.3% vs UP 4%); and well child advice (SP 9% vs UP 5%). The disposition of calls also differed by site: telephone advice was offered significantly more in SP than in UP (32% vs 20%); fewer calls required the need for the medical record in SP than in UP (2% vs 12%). CONCLUSIONS: Calls received by a daytime nurse telephone triage office in an affluent SP and a UP are similar in regard to medical problems. Training programs can feasibly prepare physicians and nurses for both kinds of practice settings. The urban site received more calls affected by language and social issues. This could have administrative implications for staffing ratios, language skills of staff and knowledge of available support services.

Child↗
PubMed2001

Outpatient laparoscopic cholecystectomy: home visit versus telephone follow-up.

OBJECTIVES: To investigate the post-discharge follow-up required for patients who have undergone laparoscopic cholecystectomy on an outpatient basis and to determine if there was a significant difference in mean concern scores and satisfaction level of patients followed up by a home visit versus a telephone call. DESIGN: Prospective 2-group comparison. SETTING: A 221-bed acute care community hospital in western Canada. PATIENTS: One hundred and forty-nine patients who had undergone laparoscopic cholecystectomy and agreed to be discharged on the day of operation. INTERVENTIONS: Subjects were systematically allocated to receive either a home visit (HV, n = 72) or a telephone call (TC, n = 77) from a registered nurse on the evening of operation. During the follow-up, patient concerns were self-rated, interventions provided by the nurse were recorded, and nurses' perceptions of the need for the home visit were reported. A 48-hour telephone survey was used to determine patient satisfaction. OUTCOME MEASURES: Patient concern scores, patient satisfaction with follow-up, readmission rates and use of emergency room services within 30 days of operation. RESULTS: Subjects in the TC group had a significantly lower mean concern score (p < 0.001) and were significantly more satisfied with their follow-up (p = 0.034) than those in the HV group. Nurses perceived that 75% of the home visits were not necessary. Readmission rate was less than 1% (1 HV) and use of emergency room services was 6% (3 HV, 6 TC). CONCLUSIONS: Telephone contact is an acceptable method of follow-up for patients who have undergone outpatient laparoscopic cholecystectomy. The call should be made later in the evening on the day of operation or the next morning.

Adult↗
PubMed2001

Practical information for audiologists on access to wireless telephones.

Analog cellular telephone service is being phased out in favor of digital wireless services, which are less accessible to people with hearing loss. As a result, audiologists can expect to receive an increasing number of inquiries from clients about using wireless telephones with hearing aids and other assistive technologies. In this article, the underlying transmission technology, telephone handset, roaming, and current solutions to accessibility problems are described. Public policy affecting the accessibility of wireless telephones to people with hearing loss is explained. Alternatives to wireless voice services are explored, and resources for information in a quickly changing industry are provided.

Audiology↗
PubMed2001

Wireless telephone-hearing aid electromagnetic compatibility research at the University of Oklahoma.

A multiphase study examining electromagnetic compatibility (EMC) between wireless digital telephones and hearing aids has been under way at the University of Oklahoma EMC Center since May 1995. In a phase 1 clinical study involving 68 hearing aid wearers, interference varied significantly by telephone technology, hearing aid type, and hearing loss characteristics. More than 80 percent of the tests resulted in either no interference or a detection threshold distance less than 1 meter. Metallic shielding of the units yielded positive results. Various elements of phase 2 involved instrument-based tests of hearing aid interference using telephones in a sound-isolation chamber and radio frequency signals in a waveguide, along with clinical studies of speech-to-interference ratios, all leading to the development of standards of measurement and performance criteria for telephone emissions and hearing aid immunity. Results to date confirm that bystander interference is of less concern than user interference, which is the focus of continuing research.

Electromagnetic Phenomena↗
PubMed2001

A randomized controlled trial of telephone management of suspected urinary tract infections in women.

OBJECTIVE: Although urinary tract infections (UTIs) in otherwise healthy ambulatory women are often managed over the telephone, there has been no systematic evaluation of this approach. Our objective was to compare the outcomes of uncomplicated UTIs in healthy women managed over the telephone with those managed in the office. STUDY DESIGN: We randomly assigned women calling their usual provider with a suspected UTI to receive care over the telephone (n=36) or usual office-based care (n=36). All women had urinalyses and urine cultures. All were treated with 7 days of antibiotics. We compared symptom scores at baseline and at day 3 and day 10 after therapy. We also compared patient satisfaction at the end of the study. The settings were family practices in Michigan. POPULATION: We included healthy nonpregnant women older than 18 years. RESULTS: A total of 201 women with suspected UTIs called their physician. Of these, 99 were ineligible, and 30 declined to participate. The women were young (mean age=36.6 years) and predominantly white (86%). Sixty-four percent of the urine cultures had significant growth of a single organism. We observed no difference in symptom scores or satisfaction. Overall, satisfaction was high. CONCLUSIONS: Short-term outcomes of managing suspected UTIs by telephone appear to be comparable with usual office care.

Adult↗
PubMedDate not supplied

Telephone triage.

Nurses frequently provide advice and education over the phone. Telephone triage is an area of potential litigation for the nurse. Information must be clear, concise, and accurate. The nurse needs to ascertain that the patient understands the instructions provided and feels free to ask questions and receive clarification of any information that is confusing. Documentation needs to describe the nursing process of data collection, planning, intervention, and evaluation. In this way, patients will receive quality information that allows them to manage symptoms at home, understand when medical interventions are necessary, and avoid unnecessary delays in care. Telephone triage is an integral part of oncology care that covers a broad range of activities, including symptom management, medication renewal, coordination of care, education, and psychosocial support. As telephone triage becomes more "high risk, high volume," nurses must review the triage process used in their clinical settings. Areas to discuss and delineate include differentiation between medical, nursing, and secretarial responsibilities; technical support systems and access; documentation guidelines; telephone triage protocols; staff education; and patient satisfaction (Nauright, Moneyham, & Williamson, 1999).

Humans↗
PubMedDate not supplied

Telephone health care: it's more than just a phone call.

Telephone care is a flourishing subspecialty of nursing requiring adaptations of bedside nursing skills and expertise in communication and telephone competencies. Telephone health care is more than "just answering the phone," even for the most experienced nurse. Knowledge of the unique skills, techniques, protocols, and legal considerations is essential in performing safe and accurate telephone triage.

Child↗
PubMed2002

[Study on the effects of telephone counseling for family caregivers of demented patients].

PURPOSE: The purposes of this study were to clarify the impact of telephone counseling on the actual state of family caregivers of demented patients, and to investigate strategies of public health care for such caregivers. METHODS: We classified 206 counseling cases, including 103 cases in 1999 and 103 cases through mid-2000, using several checklists, and analyzed date with the chi 2 test. RESULTS: 1) The most common symptom of demented patients was "forgetfulness." (106 cases) 2) 87 caregivers (42.2%) lived separately from demented patients, and in 60 cases the caregivers were daughters. 3) 104 caregivers suffered from stress because of caregiving difficulties, 89 (43.2%) having "emotional difficulties in caregiving," 33 (16.0%) "social difficulties with caregiving," 28 (13.6%) "physical difficulties with caregiving," and 8 (3.9%) "financial difficulties." While 102 caregivers (49.5%) reported no caregiving difficulties. 42 (40.4%) belonged to more than two of the listed categories. 4) The greatest concern of caregivers was "how to care for senile patients' mental symptoms." followed by "whether suffering from dementia" in 36 cases, "how to use welfare services" in 35, "whether the doctor should be consulted" in 30, and "expression of emotion" in 30 cases. The caregivers for whom "expression of emotion was an issue" had emotional, social and physical caregiving difficulties, prompting the contact for telephone counseling. 5) Public health nurses who had been working for more than 10 years tended to deal with the caregivers' "emotional caregiving difficulties" (P = 0.05). There were no differences regarding other items. CONCLUSIONS: 1) The results suggest that living apart, especially for daughters, has an effect on caregiving with senile patients if the number of family caregivers is reduced. In the future, we should consider ways to support families living apart from senile patients. 2) The results also reveal that caregivers of senile patients have emotional, social and physical caregiving difficulties. Therefore, a necessity for support of caregivers' emotional and physical health maintenance, and provision of community education is indicated. 3) Caregivers can talk more freely on the telephone than face-to-face, and get help when senile patients' symptoms are in the early stages. Therefore, it is possible to mitigate caregiving difficulties by intervening in their problems before these become serious and entrenched. 4) Telephone counseling gives caregivers the opportunity to express their emotions. Therefore, it can be expected to mitigate caregiving difficulties through appropriate targets of their expressed concerns.

Aged↗
PubMedDate not supplied

[The telephone interview: the methodological strategy for collecting population data].

The interview by telephone is not an ordinary procedure to obtain investigation data. By knowing that is rarely used in Brazil, the study was planned aiming to: identify the individuals' characteristics who answer the sampled telephones; raise the interviews' statements about the operational technique and evaluate the telephone used as data collection procedure. The data indicate that most of the people who were interviewed, were females, between 30 and 40 years old and housewives. The interviewers considered between 30 and 40 years old and housewives. The interviewers considered the experience interesting, in despite of the difficulty to maintain people talking on the phone. The authors state that the interview by telephone is an efficient and fast way of bringing up data for investigation which aims to raise opinions about certain matters.

Adolescent↗
PubMed1992

Patient access to general practitioners by telephone: the doctor's view.

Few general practitioners have extensive daytime telephone contacts with patients. Forty nine general practitioners responding to a postal survey who reported handling a mean of nine or more calls a day were interviewed about their experiences. The nature of telephone contacts with patients and the organizational strategies employed to minimize disruption to surgeries were explored. Views on the rewards and frustrations of being accessible by telephone and its impact on other aspects of workload were also sought. Recommendations are made for practices contemplating extending telephone access for patients.

Adult↗
PubMed2003

Patient satisfaction with conventional and nurse-led telephone follow-up after nasal septal surgery.

The need to bring down costs while maintaining a high standard of care has led to the expansion in the role of nurses in recent years. We present results of an audit of patient satisfaction with conventional and nurse-led telephone follow-up after nasal septal surgery. Our results indicate that patient satisfaction with nurse-led telephone follow-up is significantly higher than conventional follow-up (p=0.001, two-tailed). More patients in the conventional follow-up group felt that a follow-up appointment with an ENT doctor was essential compared with the patients in the nurse-led telephone follow-up group (p<0.001, two-tailed). We conclude that nurse-led telephone follow-up avoids unnecessary outpatient appointments, while identifying patients who require further care. It makes more appointment slots available for patients with pressing clinical problems and has the potential to reduce outpatient access times in the NHS.

Adult↗
PubMed1992

Telephone calls to a paediatric accident and emergency department.

We report a survey of telephone calls to an Accident and Emergency Department. Telephone calls form a significant part of the workload of an Accident and Emergency Department. The differences between telephone advice from an Accident and Emergency Department and general practice are highlighted. In general telephone advice from the Department is a useful adjunct to the service provided by the NHS. The possibility of medico-legal implications is discussed.

Accidents↗
PubMed2005

[Telephone accessibility in general practices].

BACKGROUND: We wanted to chart telephone accessibility in 100 randomly selected general practices in Norway and to define a standard against which others could compare themselves. MATERIAL AND METHODS: During one week, the telephone company recorded all calls to each practice and how many were answered, unanswered, or blocked. Mean waiting time for answer and mean conversation time were also registered. Each practice received a report, comparing its own results to those of other practices. An accessibility index was calculated by dividing the percentage of answered calls with mean holding time on the line (waiting time plus conversation time). Background variables about the practices were collected by questionnaires. RESULTS: There were 266 calls (95 % confidence interval 219 - 312) per week per 1000 patients on the list. 66 % (61 - 71) were answered. Mean waiting time was 25 seconds (20 - 30), conversation time 119 seconds (111 - 127). It is estimated that 7.0 calls (6.4 - 7.5) are answered per patient on a list per year. The accessibility index showed large variations, mostly independent of background variables. INTERPRETATION: Compared with earlier registrations, telephone accessibility has improved despite a strong increase in traffic. Structural aspects of the practices do not explain the variation in telephone accessibility; interest and attitudes are probably just as important.

Family Practice↗
PubMedDate not supplied

[Follow-up of patients submitted to antireflux laparoscopic treatment. A study by a telephone questionnaire].

OBJECTIVE: As it is difficult to submit patients to instrumental follow-up after laparoscopic treatment of the gastroesophageal reflux disease (GERD), it is not easy to have a complete patients analysis after fundoplication. Telephone questionnaire can be a valid instrument to investigate clinical outcome and patients satisfaction to surgery. METHODS: This study discusses the results acquired through a telephone questionnaire which has been administered to patients undergoing laparoscopic fundoplication to study postoperative clinical evolution of GERD and satisfaction to surgery through a numerical rating scale from 1 to 10. RESULTS: Sixty three patients, who had a laparoscopic antireflux procedure at Department of General Surgery of the University of Udine (Italy), answered to telephone questionnaires. Fifty patients (74.9%) reported no symptoms. Patients satisfaction to surgery was 7.93 +/- 2.36. Fifty eight patients (92.1%) would have repeated the operation and 59 (93.6%) would have advised it to a friend suffering of GERD. A significant difference of patients satisfaction between preoperative typical and atypical symptoms has been found (8.43 +/- 2.04 vs. 6.95 +/- 2.71 p < 0.05). DISCUSSION AND CONCLUSION: Telephone questionnaire is comparable with face to face consultation, allowing to do a correct clinical follow-up, to exclude patients accusing pathological acid reflux after fundoplication; however preoperative symptoms are not so accurate as postoperative symptoms. Their presence giustifies a postoperative oesophageal pH metry.

Adult↗
PubMed2005

Effects of telephone intervention on arthritis self-efficacy, depression, pain, and fatigue in older adults with arthritis.

PURPOSE: Arthritis self-efficacy (ASE) characterizes individuals' confidence in managing their arthritis. This study's purpose was to examine the effects of a telephone intervention on ASE, depression, pain, and fatigue in older adults with arthritis. METHODS: Eighty-five elders with arthritis were randomly assigned to the intervention or control group. Participants in both groups: (a) completed baseline assessments of ASE, depression, pain, and fatigue; (b) received written information on arthritis management; and (c) received individualized action plans for achieving their own arthritis management goal over the 6-week study. Participants in the intervention group received a telephone intervention including instruction on managing arthritis and encouragement to pursue their goal. In the sixth week the assessment tools were re-administered. Quantitative and qualitative data analysis methods were employed. RESULTS: Quantitative analyses showed a significant increase in ASE and a significant reduction in depression and pain over time for both groups. Qualitative analyses revealed several themes related to benefits of telephone intervention. CONCLUSION: Study results suggest that minimal intervention (ie, written information, goal-setting, and action plans) may produce positive changes in ASE, depression, and pain in some older adults with arthritis. Furthermore, telephone intervention may assist older patients in managing their arthritis.

Aged↗
PubMed1991

["Hello, doctor's office? May I talk to the doctor?" An analysis of telephone accessibility in offices of general practitioners. A survey of patients in northern Norway 1987].

In a survey among 3,739 patients belonging to 36 general practices in northern Norway, 33% reported difficult access to their local surgery by telephone. 43% reported difficulty in obtaining access to the doctor once they had obtained contact with the reception. The proportion of patients reporting problems of accessibility by telephone varied greatly, from 5 to 75%. Patients belonging to practices located in towns, with long waiting lists and many doctors, were most dissatisfied with the telephone service. Stable doctor/patient-relationships made direct contact with the doctor easier, while a scheduled time when patients could call the office made direct contact more difficult. We discuss ways to improve accessibility by telephone.

Family Practice↗