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PubMed2002

SARs for pocket-mounted mobile telephones at 835 and 1900 MHz.

Increasingly, mobile telephones are becoming pocket-sized and are being left in the shirt pocket with a connection to the ear for hands-free operation. We have considered an anatomic model of the chest and a planar phantom recommended by US FCC to compare the peak 1 and 10 g SARs for four typical cellular telephones, two each at 835 and 1900 MHz. An agreement within +/- 10% is obtained between calculated and experimental 1 and 10 g SARs for various separations (2-8 mm) from the planar phantom used to represent different thicknesses of the clothing both for the antenna away from or turned back towards the body. Because of the closer placement of the antennas relative to the body, the peak 1 and 10 g SARs are considerably higher (by a factor of 2-7) for pocket-mounted telephones as compared to the SARs obtained using a 6 mm thick plastic ear head model--a procedure presently accepted both in the US and Europe. This implies that a telephone tested for SAR compliance against the model of the head may be severely out of compliance if it were placed in the shirt pocket.

Cell Phone↗
PubMed2000

Home collection for frequent HIV testing: acceptability of oral fluids, dried blood spots and telephone results. HIV Early Detection Study Group.

OBJECTIVE: To assess the feasibility and acceptability of bimonthly home oral fluid (OF) and dried blood spot (DBS) collection for HIV testing among high-risk individuals. DESIGN: A total of 241 participants [including men who have sex with men (MSM), injecting drug users (IDU), and women at heterosexual risk] were recruited from a randomly selected subset of study participants enrolled at four sites in the HIV Network for Prevention Trials (HIVNET) cohort, and assigned at random to bimonthly home collection of OF or DBS specimens over a 6 month interval. Participants could select telephone calls or clinic visits to receive HIV test results. METHODS: Bimonthly specimens were tracked for adherence to the schedule, were evaluated for adequacy for testing, and tested using antibody assays and polymerase chain reaction (PCR) for DBS. The acceptability of bimonthly home OF and DBS collection and telephone counseling was assessed in an end-of-study questionnaire. RESULTS: The laboratory received 96 and 90% of expected OF and DBS specimens, respectively; 99% of each specimen type was adequate for testing. Almost all (95%) participants chose results disclosure by telephone. The majority of participants (85%) reported that bimonthly testing did not make them worry more about HIV, and almost all (98%) judged that with bimonthly testing their risk behavior remained the same (77%) or became less risky (21%). CONCLUSION: Bimonthly home specimen collection of both OF and DBS with telephone counseling is acceptable and feasible among study participants at high risk. These methods will be useful for the early detection of HIV infection and remote follow-up of research cohort participants in HIV vaccine and prevention trials.

AIDS Serodiagnosis↗
PubMedDate not supplied

Usefulness of human immunodeficiency virus post-test counseling by telephone for low-risk clients of an urban sexually transmitted diseases clinic.

BACKGROUND: Failure of clients to return for post-test counseling for human immunodeficiency virus (HIV) has been noted consistently as a problem with HIV counseling and testing in sexually transmitted disease clinics. GOALS: To assess trends in the rates of HIV post-test counseling in an urban sexually transmitted disease clinic. To determine the usefulness of providing post-test counseling by telephone to clients at low risk for HIV as a means of increasing post-test counseling rates and efficiency of clinic operations. STUDY DESIGN AND METHODS: Human immunodeficiency virus post-test counseling rates were evaluated among clients of a sexually transmitted disease clinic from January 1990 through May 1994. Low-risk clients (n = 1,304) from July 1994 through September 1994 were given the option of obtaining negative HIV test results by telephone. Rates of post-test counseling within 45 days were compared with historical controls from March 1994 through May 1994, during which time a return visit was required. RESULTS: The rate of post-test counseling increased significantly from 1990 to 1992 but remained stable thereafter. After the introduction of post-test counseling by telephone, 704 of 1,304 low-risk clients (54.0%) obtained post-test counseling compared with 476 of 1,187 (40.1%) clients during the control period (odds ratio = 1.75; 95% confidence interval = 1.50-2.06). Post-test counseling rates increased especially among clients younger than 20 years of age (30.6% versus 52.7%) and among those with multiple new sex partners in the last month (31.6% versus 56.1%). CONCLUSIONS: Telephone post-test counseling is an effective method of increasing access for low-risk clients attending sexually transmitted diseases clinics and may be especially useful for those who are otherwise unlikely to obtain post-test counseling.

Adult↗
PubMedDate not supplied

Impact of physician telephone management of nursing home residents before the initial assessment: a pilot study.

OBJECTIVE: To describe physician telephone management of newly admitted nursing home residents before direct evaluation by the physician, and the effect on resident outcomes. DESIGN: Retrospective chart review of 111 consecutive discharge records from two proprietary community nursing homes in Baltimore, Maryland in 1999. MEASUREMENTS: Data regarding the admission process were collected, with an emphasis on physician telephone orders at admission and all subsequent telephone orders before the first physician visit. Physicians were categorized as attending physicians or on-call physicians. Unexpected outcomes defined as an unplanned admission to an acute hospital or an unanticipated death within 14 days of admission to the nursing home were identified. The relationships among resident, physician, and admission characteristics and unexpected outcomes were analyzed. RESULTS: Most residents (97 of 111 (87%)) were admitted from an acute hospital, and the remaining 13% were admitted from home or another nursing home. An attending physician confirmed admission orders for 87 of 111 (78%) residents, and an on-call physician confirmed admission orders for the remainder. Physicians changed medications at the time of admission, as compared with preadmission medications, in 58 of 111 (52%) residents and ordered laboratory studies or radiographs in 59 of 111 (53%). On-call physicians were just as likely to make both types of changes as attending physicians. In the time interval after the initial telephone contact but before the first physician visit, medication changes were made in 35 of 111 (32%) residents and testing was ordered in 16 of 111 (14%). Nineteen of 111 (17%) residents were either readmitted to the hospital or died within 14 days of admission to the nursing home. These unexpected outcomes were statistically less likely to occur in the group of residents for whom physicians made medication changes at the time of admission as compared to the group for whom no medication changes were made [6 of 58 (10%) versus 13 of 53 (25%), P = 0.04, respectively], and in the group for whom tests were ordered at the time of admission as compared to not ordered [4 of 59 (7%) versus 15 of 51 (29%), P = 0.002, respectively]. There were no differences in the likelihood of unexpected outcomes when physicians made medication changes or ordered tests after the time of admission but before the first physician visit. CONCLUSIONS: In this study, physicians made adjustments in medications and ordered tests for newly admitted nursing home patients before seeing the resident in the majority of cases. Unexpected outcomes including readmission to the hospital or death within 14 days of admission were less common among those residents when such changes were made at the time of admission. Further studies are needed to identify those changes as well as those resident and physician characteristics that might lead to improved outcomes.

Journal Article↗
PubMed2004

Is cochlear outer hair cell function affected by mobile telephone radiation?

Mobile telephones emit high-frequency pulsed electromagnetic fields (PEMF). These are known to have measurable biological effects, and possible effects on the auditory system. Otoacoustic emissions give an indication of the functional state of the auditory system. Otoacoustics are known to be highly specific for the individual when the test pulse is identical. In this way, subtle changes in the ear can be detected. We investigated whether there is a measurable effect on Otoacoustic emissions from PEMF radiation. A total of 12 volunteers were recruited who had normal hearing; confirmed by pure tone audiometry. An Otoacoustic emission trace was obtained. The test subjects were exposed to a mobile telephone that was placed over the test ears mastoid process. The subjects had Otoacoustic emissions measured without the telephone and again on receive and transmit. There was no change in the trace signature during the test. There was no statistically significant change in the trace figures. This would indicate that PEMF from commonly available hand held mobile telephones have no measurable effect on the outer hair cell function during the time of use.

Audiometry, Pure-Tone↗
PubMed2001

Prospective comparison of endoscopy patient satisfaction surveys: e-mail versus standard mail versus telephone.

OBJECTIVES: The dramatic growth of the Internet holds potential for use in survey distribution. Comparisons of electronic mail (e-mail) to traditional survey techniques are lacking. We compared standard mail, telephone, and e-mail modes of endoscopy satisfaction survey administration with respect to response rate, timeliness of response, response content, and cost-efficiency of responses. METHODS: An endoscopy satisfaction questionnaire consisting of seven core items from the modified Group Health Association of America-9 survey was distributed to patients after routine outpatient endoscopy. Patients were randomized to receive the questionnaire by standard mail, telephone, or e-mail. Response rates and findings in the three groups were compared. The "nonresponders" to the standard mail and e-mail surveys were subsequently contacted by telephone to determine their level of satisfaction. RESULTS: The phone survey response rate (90%) was higher than e-mail (70%) or standard mail (85%), although e-mail was the most cost-efficient mode of survey delivery. There was no significant difference in satisfaction scores among the three groups. Nonresponders were significantly more satisfied than "responders." CONCLUSIONS: A survey technique utilizing e-mail with subsequent follow-up by telephone to nonresponders appears to be the most cost-efficient way to deliver a questionnaire. The satisfaction levels of the responders may underestimate the overall satisfaction of the population being surveyed.

Colonoscopy↗
PubMed2000

Cost analysis of nurse telephone consultation in out of hours primary care: evidence from a randomised controlled trial.

OBJECTIVE: To undertake an economic evaluation of nurse telephone consultation using decision support software in comparison with usual general practice care provided by a general practice cooperative. DESIGN: Cost analysis from an NHS perspective using stochastic data from a randomised controlled trial. SETTING: General practice cooperative with 55 general practitioners serving 97 000 registered patients in Wiltshire, England. SUBJECTS: All patients contacting the service, or about whom the service was contacted during the trial year (January 1997 to January 1998). MAIN OUTCOME MEASURES: Costs and savings to the NHS during the trial year. RESULTS: The cost of providing nurse telephone consultation was 81 237 pound sterling per annum. This, however, determined a 94 422 pound sterling reduction of other costs for the NHS arising from reduced emergency admissions to hospital. Using point estimates for savings, the cost analysis, combined with the analysis of outcomes, showed a dominance situation for the intervention over general practice cooperative care alone. If a larger improvement in outcomes is assumed (upper 95% confidence limit) NHS savings increase to 123 824 pound sterling per annum. Savings of only 3728 pound sterling would, however, arise in a scenario where lower 95% confidence limits for outcome differences were observed. To break even, the intervention would have needed to save 138 emergency hospital admissions per year, around 90% of the effect achieved in the trial. Additional savings of 16 928 pound sterling for general practice arose from reduced travel to visit patients at home and fewer surgery appointments within three days of a call. CONCLUSIONS: Nurse telephone consultation in out of hours primary care may reduce NHS costs in the long term by reducing demand for emergency admission to hospital. General practitioners currently bear most of the cost of nurse telephone consultation and benefit least from the savings associated with it. This indicates that the service produces benefits in terms of service quality, which are beyond the reach of this cost analysis.

Acute Disease↗
PubMed2005

Randomised trial of telephone intervention in chronic heart failure: DIAL trial.

OBJECTIVE: To determine whether a centralised telephone intervention reduces the incidence of death or admission for worsening heart failure in outpatients with chronic heart failure. DESIGN: Multicentre randomised controlled trial. SETTING: 51 centres in Argentina (public and private hospitals and ambulatory settings). PARTICIPANTS: 1518 outpatients with stable chronic heart failure and optimal drug treatment randomised, stratified by attending cardiologist, to telephone intervention or usual care. INTERVENTION: Education, counselling, and monitoring by nurses through frequent telephone follow-up in addition to usual care, delivered from a single centre. MAIN OUTCOME MEASURE: All cause mortality or admission to hospital for worsening heart failure. RESULTS: Complete follow-up was available in 99.5% of patients. The 758 patients in the usual care group were more likely to be admitted for worsening heart failure or to die (235 events, 31%) than the 760 patients who received the telephone intervention (200 events, 26.3%) (relative risk reduction = 20%, 95% confidence interval 3 to 34, P = 0.026). This benefit was mostly due to a significant reduction in admissions for heart failure (relative risk reduction = 29%, P = 0.005). Mortality was similar in both groups. At the end of the study the intervention group had a better quality of life than the usual care group (mean total score on Minnesota living with heart failure questionnaire 30.6 v 35, P = 0.001). CONCLUSIONS: This simple, centralised heart failure programme was effective in reducing the primary end point through a significant reduction in admissions to hospital for heart failure.

Aged↗
PubMed1996

Review of a computer based telephone Helpline in an A&E department.

OBJECTIVE: An audit of use of the telephone Helpline in the accident and emergency (A&E) department was conducted to establish the type of call, time, by whom the calls were made, appropriateness of advice given, and whether callers attended or not as advised, and also to obtain feedback from callers as to the degree of satisfaction with the advice given. METHODS: All calls over a four week period were included in the study. The information logged comprised name, age, telephone number, date and time of call, nature of query, advice given, and name of advisor. Callers whose telephone number had been noted were contacted for feedback. RESULTS: There were 300 calls over the four week period, and 150 callers were available for feedback. Most calls were received between 12.00 and 20.00 hours. The majority of callers were parent or self, 52% of calls were for problems concerning adults, and 40% for children; no age was recorded in 8%. Nursing staff answered 90.7% of the calls. Queries were wide ranging but commonly involved open and closed wounds and head injuries, with 29.3% being advised to attend A&E, 32.3% to ring or see their GP, and 38.4% were reassured or given other advice; 4% of callers attended A&E despite being advised otherwise, 97% were judged to have received appropriate advice, and 91.3% of callers were satisfied with the advice given. CONCLUSION: The Helpline has proved of benefit to the public. It is necessary and important to have protocols for common problems and to document all details carefully. It is also necessary that nursing staff are trained in handling the telephone queries and using the protocols. The use of a PC based system has improved data collection and also allows immediate access to protocols.

Adult↗
PubMed2006

A comparison of information on motor vehicle crashes as reported by written or telephone interviews.

OBJECTIVE: To compare information about traffic crash injuries and kilometers driven reported in a written questionnaire with information reported in a telephone interview. DESIGN: Telephone and paper surveys. SETTING: The Seguimiento Universidad de Navarra (SUN, University of Navarra Follow-up) study, in Spain. The SUN study is an open enrollment cohort study with 17 000 enrolled graduates followed through biennial mailed questionnaires. SUBJECTS: A sample of 542 individuals from the SUN study participants. MAIN OUTCOME MEASURE: Agreement on information about traffic crash injuries and mileage driven in a mailed questionnaire and a telephone survey. RESULTS: Participation was 90.4%. Considering the phone survey as the gold standard, data on traffic crash injuries in the mailed questionnaire had 83% sensitivity (95% CI 77% to 89%), 77% specificity (95% CI 71% to 82%), 74% positive predictive value (95% CI 67% to 80%), and 89% negative predictive value (95% CI 83% to 93%). Agreement beyond chance, measured by the kappa statistic, was 0.63 (95% CI 0.56 to 0.70). Correlation between questionnaire and telephone surveys and kilometers driven on average during a year assessed by the intraclass correlation coefficient was 0.64 (95% CI 0.57 to 0.70), p<0.001. CONCLUSIONS: Information on sustained traffic crash injuries and traveled mileage over the previous two years as reported through mailed questionnaires in a highly educated population could be used in the study of associations between traffic crash injuries and a variety of risk factors.

Accidents, Traffic↗
PubMed2005

Assessment of cognitive decline in old age with brief tests amenable to telephone administration.

The adequacy with which brief cognitive tests suitable for telephone administration can assess cognitive decline due to aging and Alzheimer's disease is uncertain. The authors examined these issues with data from the Religious Orders Study, which involves annual clinical evaluations and brain donation at death. Participants are 996 older Catholic clergy members. Analyses focused on seven cognitive tests which can be administered in person or by telephone in less than 15 min. Composite measures of global cognition and of episodic, semantic and working memory were formed. During a mean of 5.8 years of follow-up, performance on each composite measure declined in persons with and without dementia at baseline. Among those without dementia, possession of the apolipoprotein E epsilon4 allele was associated with more rapid cognitive decline, especially in episodic and working memory. Level of performance on each cognitive measure proximate to death was inversely related to the level of cortical plaques and tangles in the brain. In a subset of persons who were given the tests by telephone, there was no evidence that performance differed from in-person administration. The results suggest that briefly assessing cognition with tests amenable to telephone administration may prove useful in longitudinal epidemiologic studies of older persons.

Age Factors↗
PubMed2002

Telephone intervention with family caregivers of stroke survivors after rehabilitation.

BACKGROUND AND PURPOSE: Social problem-solving therapy shows promise as an intervention to improve the well-being of family caregivers. There is some evidence that training in problem solving may be effectively delivered by telephone. The purpose of this study was to quantify the impact of social problem-solving telephone partnerships on primary family caregiver outcomes after stroke survivors are discharged home from a rehabilitation facility. METHODS: Using a randomized 3-group repeated-measures experimental design, 74 stroke survivors with an admitting diagnosis of ischemic stroke and their primary family caregivers were entered into the study. The intervention consisted of an initial 3-hour home visit between a trained nurse and the family caregiver within 1 week after discharge to begin problem-solving skill training. This initial session was followed by weekly (the first month) and biweekly (the second and third month) telephone contacts. RESULTS: Compared with the sham intervention and control groups, family caregivers who participated in the social problem-solving telephone partnership intervention group had better problem-solving skills; greater caregiver preparedness; less depression; and significant improvement in measures of vitality, social functioning, mental health, and role limitations related to emotional problems. There were no significant differences among the groups in caregiver burden. Satisfaction with healthcare services decreased over time in the control group while remaining comparable in the intervention and sham intervention groups. CONCLUSION: These results indicate that problem-solving training may be useful for family caregivers of stroke survivors after discharge from rehabilitative facilities.

Adaptation, Psychological↗
PubMed2000

Verifying the stroke-free phenotype by structured telephone interview.

BACKGROUND AND PURPOSE: Case-control, cohort, and twin studies support a genetic contribution to ischemic stroke risk. Sibling pair linkage methods require identification of concordant or discordant siblings or both. We designed and tested a structured telephone interview to verify the stroke-free phenotype. METHODS: A coordinator unaware of medical record data used an 8-item questionnaire to conduct a structured telephone interview of 70 outpatients aged >60 years. The questionnaire inquired about the sudden onset of deficits in strength, sensation, vision, and language. A subject was defined as stroke free by interview if responses to all items on the questionnaire were negative. Results of the telephone interview were compared with data obtained from a systematic medical record review (benchmark). RESULTS: Interview time was 5 minutes or less for all subjects. All subjects who began the interview completed it. Records were reviewed in all subjects. Medical record review detected ischemic stroke or transient ischemic attack (TIA), or both, in 5 patients (7%). There were no significant differences in sex distribution or risk factor rates in patients who were designated stroke free or not stroke free by interview. Having 1 or more positive items on the questionnaire was significantly associated with finding stroke (P<0.001), TIA (P<0.001), or either stroke or TIA (P<0.001), on medical record review. The telephone interview had a sensitivity of 1.0 (95% CI 0.48 to 1.0), specificity of 0.86 (95% CI 0.75 to 0.93), positive predictive value of 0.36 (95% CI 0.13 to 0.65), and negative predictive value of 1.0 (95% CI 0.94 to 1.0). CONCLUSIONS: Our instrument can identify the stroke-free individual with a high degree of confidence in a very efficient manner. It may be particularly suited for centralized verification of stroke discordancy in multicentered sib-pair genetic studies.

Aged↗
PubMed2005

A comparison of two Native American Navigator formats: face-to-face and telephone.

The study was designed to test the relative effectiveness of a Navigator intervention delivered face-to-face or by telephone to urban Native American women. The effectiveness of the intervention was evaluated using a design that included a pretest, random assignment to face-to-face or telephone group, and posttest. The Social Cognitive Theory-based intervention was a tailored education program developed to address individual risk factors for breast cancer. At posttest, self-reported mammograms in the past year increased from 29% to 41.3% in the telephone group and from 34.4% to 45.2% in the face-to-face group. There was no difference in change from pretest to posttest between the telephone and face-to-face groups. Navigators can be effective in increasing adherence to recommendations for screening mammography among urban American Indian women.

Aged↗
PubMed2005

Bases for assessments made by telephone advice nurses.

Telephone advice nursing includes triage, advice, referral, information and coordination. The aim of the study was to explore what telephone nurses base their assessments on. We conducted 14 interviews with seven telephone nurses at a health-care call centre in Sweden. Two authentic calls per nurse were used in stimulated recall interviews, where the nurses commented on the basis for their assessments. A qualitative manifest content analysis was employed. Three major categories emerged in the analysis: care-seeker, e.g. 'symptomatic sounds'; nurse, e.g. 'nurse's own experience'; and organization, e.g. 'health-care accessibility'. The findings show that the telephone advice nurses' bases for assessments appear to be very broad. They include both verbally and nonverbally communicated information, and care-seeker-, nurse- and certain organization-related factors influence the assessments. We found that an individualistic view of the care-seeker seems to dominate the assessments in non-urgent calls to a health-care call centre.

Communication↗
PubMed2003

Can the Expanded Disability Status Scale be assessed by telephone?

Information from patients who are unable to continue their visits to a study centre may be of major importance for the interpretation of results in multiple sclerosis (MS) clinical trials. To validate a questionnaire based on the Expanded Disability Status Scale (EDSS), patients in five different European centres were assessed independently by pairs of trained EDSS raters, first by telephone interview and a few days later by standardized neurological examination. Seventy women and 40 men with an average age of 43.7 years (range 19-74 years) were included in the study. Mean EDSS score at the last visit was 4.5 (0-9). EDSS assessment by telephone was highly correlated with the EDSS determined by physical examination (Pearson's correlation coefficient = 0.95). An intraclass correlation coefficient (ICC) of 94.8% was found for the total sample; 77.6% and 86%, respectively, for patients with EDSS < 4.5 (n = 46) and > 4.5 (n = 64). Kappa values for full agreement were 0.48; for variation by +0.5 steps and +1.0 steps, 0.79 and 0.90, respectively. Best agreement could be found in higher EDSS scores, where assessment by telephone interview might be needed most. The telephone questionnaire is a valid tool to assess EDSS score in cases where the patient is unable to continue visiting a study centre or in long-term follow-up of trial participants.

Adult↗
PubMed2005

Electronic medical record review as a surrogate to telephone follow-up to establish outcome for diagnostic research studies in the emergency department.

BACKGROUND: Follow-up for diagnostic research studies might be facilitated if medical record review (MRR) could be used instead of telephone calls. OBJECTIVES: The authors hypothesized that MRR would yield similar accuracy to telephone follow-up. METHODS: This was a secondary analysis of 2,178 initially disease-free patients who were followed after enrollment in a diagnostic study of either acute coronary syndrome (45 days) or pulmonary embolism (90 days) conducted in an urban teaching emergency department (ED). Disease status (positive or negative) was defined explicitly. Using structured data forms, trained researchers performed MRR using a comprehensive electronic database, and formulated an opinion about disease status. Trained researchers, blinded to the MRR, then dialed telephone numbers, asked questions from a script, and categorized disease status. The criterion standard was adjudication by consensus of two of three physicians who independently determined disease status based on explicit criteria and access to all follow-up data. RESULTS: Adjudicators found that 13 of 2,178 patients developed disease during follow-up; all 13 true positives occurred among the 2,054 (94.3%) of patients who acknowledged intent to return to the study hospital. Telephone follow-up was successful in 81% of patients, and found all 13 true positives (sensitivity 100%) but with three additional false-positive cases. MRR disclosed 12 of 13 cases of disease (sensitivity 92%) with no false-positive cases. Further review of the one false-negative case from MRR revealed that it occurred after the prescribed time limit for follow-up. CONCLUSIONS: Under limited circumstances, accurate clinical follow-up for diagnostic studies conducted in the ED can be obtained by medical record review.

Acute Disease↗
PubMed2003

Telephone counselling for adolescent suicide prevention: changes in suicidality and mental state from beginning to end of a counselling session.

Telephone counselling is an accessible and confidential means by which distressed young people can seek help. Telephone counselling services were funded under Australia's National Youth Suicide Prevention Strategy between 1997 and 2000. In this study, the effectiveness of telephone counselling for young people seeking help in the context of suicidal ideation or intent was evaluated in an investigation of calls made by suicidal young people to a telephone counselling service. Independent raters measured callers' suicidality and mental state at the beginning and end of 100 taped counselling sessions. Changes in suicidality and mental state were measured using a reliable rating scale developed for the study. Significant decreases in suicidality and significant improvement in mental state were found to occur during the course of counselling sessions, suggesting positive immediate impact. Limitations of the study with respect to longer-term outcomes and the relevance of the results for suicide prevention are discussed. Notwithstanding the study limitations, the results lend support for continuing development of hotline services.

Adolescent↗