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PubMed2004

Telephonic back-up improves antibiotic compliance in acute tonsillitis/pharyngitis.

A randomised clinical trial was devised to establish whether telephonic back-up added to educational strategy and improved compliance with antibiotic treatment in acute tonsillitis/pharyngitis compared with educational strategy only. The intervention group was given a telephone call on the fourth day after the start of therapy. There were 64 patients in each group (intervention and control). The criterion for evaluating the compliance was to count the tablets in a spot-check at the patient's house. A tablet count of 80-110% defined good compliance. The effect of the intervention was calculated according to the indicators: absolute risk reduction (ARR), relative risk reduction (RRR) and number needed to treat (NNT). A good compliance percentage was 66.1% (57.7-74.5%) and was significantly higher in the intervention group (78.3%) than in the control group (54.1%) ( P=0.005). Indicators of clinical relevance after the intervention were ARR: 24.2%; RRR: 52.7%; NNT: 4.13. In conclusion telephonic back-up significantly improved the compliance obtained by educational strategy only. It should be used in clinical practice.

Acute Disease↗
PubMed2006

Methodological aspects of telephone scatologia: a case study.

The present paper focuses on the sexual paraphilia of telephone scatologia. Some psychological concepts of scatologia are reviewed; their methodological aspects are examined. It is argued that telephone scatologia is only one of the forms of audio scatologia (akophilia), which together with visual and textual scatologias present interactive but remote--intermediary--forms of sexual excitation, when the function of tactile contact is delegated to the sensory specific communication device, and where the perpetrator can be safe and sexually aggressive at the same time. The main objective of this paper is to present a case of prolific telephone scatologist, with the analysis of which the author was closely affiliated. The present paper does not pretend to cover all of the issues associated with etiology and psychogenesis of scatologia, but intends to offer rarely addressed material that could be useful in the fields of psychology, psychiatry, sexology, criminology and interpersonal violence.

Adult↗
PubMed2004

Osteoporosis health belief scale: minor changes were required after telephone administration among women.

OBJECTIVE: The Osteoporosis Health Belief Scale (OHBS) is a 42-item scale designed to measure general health motivation, perceived susceptibility to and seriousness of osteoporosis, and beliefs about calcium intake and exercise in preventing and treating osteoporosis. The purpose of this study was to examine the psychometric properties of the OHBS by telephone administration among older women. STUDY DESIGN AND SETTING: A convenience sample of 425 women aged 61-93 years participating in a longitudinal arthritis study was recruited by telephone. Item clarity was evaluated and 22 additional items (6 reworded, 16 from other questionnaires) were considered to supplement or replace existing scale items. Multitrait scaling techniques and exploratory factor analysis were used to test scale structure. Construct validity was tested based on theoretical hypothesis between OHBS subscale scores and participant characteristics. RESULTS: A few modifications to the OHBS scale were suggested, reducing the scale by five items (two redundant, three did not load), rewording one item and moving on item to a different subscale. The modified 37-item OHBS had a seven-factor uncorrelated solution explaining 48% of the model variance with internal consistency ranging from 0.73 to 0.88. CONCLUSION: Relatively minor changes to the OHBS results in reduced redundancy and improved internal structure of the scale for telephone administration among women over 60 years of age. Further examination is recommended to confirm these findings.

Aged↗
PubMed2005

Implementing a computer-assisted telephone interview (CATI) system to increase colorectal cancer screening: a process evaluation.

OBJECTIVE: Computer-assisted telephone interviewing (CATI) systems used by telephone counselors (TCs) may be efficient mechanisms to counsel patients on cancer and recommended preventive screening tests in order to extend a primary care provider's reach to his/her patients. The implementation process of such a system for promoting colorectal (CRC) cancer screening using a computer-assisted telephone interview (CATI) system is reported in this paper. METHODS: The process evaluation assessed three components of the intervention: message production, program implementation and audience reception. RESULTS: Of 1181 potentially eligible patients, 1025 (87%) patients were reached by the TCs and 725 of those patients (71%) were eligible to receive counseling. Five hundred eighty-two (80%) patients agreed to counseling. CONCLUSIONS: It is feasible to design and use CATI systems for prevention counseling of patients in primary care practices. PRACTICE IMPLICATIONS: CATI systems have the potential of being used as a referral service by primary care providers and health care organizations for patient education.

Aged↗
PubMed2006

Results of a randomized study of telephone versus in-person breast cancer risk counseling.

OBJECTIVE: Women of all risk levels have reported high interest in obtaining genetic testing for breast cancer risk. Breast cancer risk counseling may help women to learn about their risk and appropriate options of testing. This study measured the effects of an intervention in-person and by telephone, compared to a control group. METHODS: Participants were 340 women, recruited through a network of primary care physicians. They received a baseline questionnaire in the mail, were randomized to one of the three study arms, and completed a follow-up survey 3 months later. RESULTS: Both types of counseling were very well received. The counseling decreased women's cancer worry, risk perceptions, and intentions to pursue genetic testing. There were similar effects for both in-person and telephone counseling. CONCLUSION: Genetic counseling can be used to inform women at all risk levels about their breast cancer risk. PRACTICE IMPLICATIONS: Breast cancer risk counseling can be done in-person and by telephone--thereby reaching women in remote areas.

Adolescent↗
PubMed2006

The effect of telephone versus print tailoring for mammography adherence.

OBJECTIVE: The purpose of this intervention was to increase mammography adherence in women who had not had a mammogram in the last 15 months. METHODS: A prospective randomized intervention trial used four groups: (1) usual care, (2) tailored telephone counseling, (3) tailored print, (4) tailored telephone counseling and print. Participants included a total of 1244 women from two sites-a general medicine clinic setting serving predominately low-income clientele and a Health Maintenance Organization (HMO). Computer-tailored interventions addressed each woman's perceived risk of breast cancer, benefits and/or barriers and self-efficacy related to mammography screening comparing delivery by telephone and mail. RESULTS: Compared to usual care all intervention groups increased mammography adherence significantly (odds ratio 1.60-1.91) when the entire sample was included. CONCLUSIONS: All interventions groups demonstrated efficacy in increasing mammography adherence as compared to a usual care group. When the intervention analysis considered baseline stage, pre contemplators (women who did not intend to get a mammogram) did not significantly increase in mammography adherence as compared to usual care. PRACTICE IMPLICATIONS: Women who are in pre contemplation stage may need a more intensive intervention.

Computer-Assisted Instruction↗
PubMed2007

A prospective manikin-based observational study of telephone-directed cardiopulmonary resuscitation.

INTRODUCTION: Bystander cardiopulmonary resuscitation (CPR) significantly improves the outcome from sudden cardiac arrest (SCA) and is therefore encouraged by offering telephone instructions to the bystander. The effectiveness of this technique was examined in a manikin-based study. METHODS: Subjects performed CPR on an instrumented adult manikin by following Advanced Medical Priority Dispatch System v11.1 (AMPDS) instructions given by telephone from a different room. RESULTS: Fifty-one volunteers (26 males, median age 56, range 27-76 years) with no previous experience of CPR were recruited. No volunteers followed the entire instructions correctly. Forty percent were unable to open the airway, only 18% achieved a median inspiration time of 2 s or greater and only 30% delivered tidal volumes within the range 700-1000 ml. Chest compressions were performed at a median rate of 52 min-1 with only 4% of subjects achieving a rate of 100 min-1. Depth of compression was also inadequate in 88% of subjects and hand positioning was incorrect in a third of subjects. The median duty cycle was 46% and there were significant delays between the commencement of the AMPDS protocol and the delivery of the first breath (123 s) and first chest compression (163 s). DISCUSSION: Few bystanders perform CPR satisfactorily and further work is necessary to improve the effectiveness of telephone CPR instructions.

Adult↗
PubMed2005

Trivalent inactivated influenza vaccine safety in children: assessing the contribution of telephone encounters.

We assessed the contribution of telephone medical care encounters to surveillance of adverse events (AE) following trivalent influenza vaccination in children age 6 months to 17 years. We used retrospective, self-controlled, case-series analysis to estimate adverse event incidence rate ratios for post-vaccination risk intervals relative to 15-28 days prior to vaccination. We confirmed possible vaccination reactions by medical record abstraction. Detection of 10 of 20 elevated incidence rate ratios required telephone data. We conclude that telephone encounters substantially contribute to the detection of possible influenza vaccination reactions, primarily local injection site and systemic reactions.

Adolescent↗
PubMed2006

A process evaluation of a telephone-based peer-delivered smoking cessation intervention for adult survivors of childhood cancer: the partnership for health study.

OBJECTIVE: We report on the process evaluation of an efficacious national smoking cessation intervention for adult survivors of childhood cancer. We examine associations between intervention implementation characteristics and study outcomes, as well as participant characteristics related to level of involvement in the intervention. METHODS: The study was conducted at the Dana-Farber Cancer Institute in Boston, Massachusetts, from 1999-2001. Participants (n = 398) were randomly assigned to receive a proactive telephone-based peer counseling intervention. They received up to 6 counseling calls, individually tailored and survivor-targeted materials, and nicotine replacement therapy (NRT) patches if they were prepared to quit smoking. RESULTS: Forty-two percent of survivors participated in the maximum number of calls (5-6), and 29% of participants requested and received NRT. Total counseling time was an average of 51 min. Quit status at follow-up was related to intervention dose, and participants who received NRT were significantly more likely to make a 24-h quit attempt. Demographic variables (females, White), higher daily smoking rate, poorer perceived health and moderate perceived risk of smoking were significantly related to greater intervention involvement. CONCLUSIONS: A brief peer-delivered, telephone counseling intervention is an effective way to intervene with adult survivors of childhood cancer who are smoking. Findings from the process evaluation data (call length and number, frequency, and spacing) will inform future telephone counseling cessation programs.

Adult↗
PubMed2006

Effects of a telephone counseling intervention on sisters of young women with breast cancer.

OBJECTIVE: Women that have a first-degree relative diagnosed with breast cancer at an early age are at increased risk of the disease, yet they often lack information about their personal risk of breast cancer and early detection measures. An intervention to provide objective risk information, reduce worries, and promote screening and healthy behaviors was developed. METHOD: In 1999-2002, a randomized pre-post design was used to test a tailored telephone counseling intervention with a sample of 163 women whose sisters were diagnosed with breast cancer at age 50 or younger in the San Francisco Bay Area. Participants were interviewed by telephone regarding their breast cancer risk factors, perceived risk, worries, lifestyle factors, and screening behavior. A modified Gail model was used to compute an objective measure of individualized lifetime risk. RESULTS: Risk overestimates averaged 25 percentage points. The intervention was effective in reducing overestimates in women age 50 and over but not in those under 50. The intervention was effective in increasing physical activity and reinforcing the conviction to maintain good breast health, but not in decreasing worries or increasing screening. CONCLUSION: Telephone counseling appears to be a viable tool for reducing risk overestimates and promoting healthy behaviors among sisters of women with breast cancer.

Adult↗
PubMed2006

Microbial flora on operating room telephones.

Approximately 500,000 surgical site infections (SSIs) occur each year in the United States. The purpose of this study was to determine if the bacteria most frequently involved in SSIs could be found on telephones in the OR. Twenty-six cultures were taken from telephones in 14 ORs and two substerile rooms at a large teaching medical center. Using standard laboratory procedures, the researchers identified coagulase-negative staphylococci in the cultures. The study found that telephones in the OR can serve as reservoirs for SSI-causing bacteria.

Bacterial Infections↗
PubMed2002

Computer-telephone interactive tasks: predictors of musculoskeletal disorders according to work analysis and workers' perception.

Sixty-two workers engaged in computer-telephone interactive tasks in an active telemarketing center and a telephone call center of an international bank subsidiary in São Paulo. Brazil, were assessed by means of a work analysis and a self-administered questionnaire aiming to determine the statistical relationship of ergonomic, organizational and psychosocial characteristics of their jobs with the report of symptoms in neck-shoulder and hand-wrist for more than 7 consecutive days and any time away from work during the current job due to musculoskeletal disorders (MSD). According to chi-square univariate tests and multiple logistic regression models, active telemarketing operations, duration in the job and the low level of satisfaction with the physical arrangement of the workstation emerged as the factors most related to neck-shoulder and hand-wrist MSD and MSD-induced time away from work. This study emphasizes the role of psychosocial factors and duration in the job in MSD occurrence and induced absenteeism among workers engaged in computer-telephone interactive tasks.

Adult↗
PubMed1976

Telephone assessment of illness by practicing pediatricians.

Telephone assessment of illness by 40 practicing pediatricians was studied using simulated complaints of cough, vomiting, diarrhea, or rash. Of a possible 370 standardized questions based on the American Academy of Pediatrics "Guidelines for telephone communications," only 194 were used. Crucial questions such as difficulty breathing with cough, the state of hydration in diarrhea, the character of the eruption in rash, or the presence of abdominal pain with vomiting were asked less than 50% of the time. Pediatricians in practice for fewer than five years requested more information and spent more time on the telephone than did those with greater than five years' experience.

Child, Preschool↗
PubMed1991

Psychotherapy by telephone. A therapeutic tool for cancer patients.

Medically ill patients who cannot come to the psychotherapist's office on a regular basis frequently are encountered in consultation-liaison settings. For these individuals the telephone becomes the only link to psychological counseling. The two cases presented in this article of successful telephone therapy with cancer patients exemplify and highlight the effect of this mode of interaction on the therapeutic process and relationship. Telephone communication also differs from face-to-face interaction in areas of therapist-patient accessibility, control, formality, and anonymity, which make it an especially effective psychotherapeutic tool for the medically ill patient.

Adjustment Disorders↗
PubMed2000

Epidemiological evidence on health risks of cellular telephones.

It is too soon for a verdict on the health risks from cellular telephones, especially in view of changing technology. From the Interphone project and some other large studies in progress, better information may emerge. Based on the epidemiological evidence available now, the main public-health concern is clearly motor vehicle collisions, a behavioural effect rather than an effect of radiofrequency exposure as such. Neither the several studies of occupational exposure to radiofrequencies nor the few of cellular telephone users offer any clear evidence of an association with brain tumours or other malignancies. Even if the studies in progress were to find large relative effects for brain cancer, the absolute increase in risk would probably be much smaller than the risk stemming from motor vehicle collisions. Cellular telephones affect the quality of our lives in myriad ways, for good and ill; the health risk is just one part of a picture that is slowly coming into focus.

Automobiles↗
PubMed2001

The effects of postal and telephone reminders on compliance with pravastatin therapy in a national registry: results of the first myocardial infarction risk reduction program.

BACKGROUND: Noncompliance with cardiovascular therapy and prevention initiatives is well documented. OBJECTIVES: The purpose of the First Myocardial Infarction (MI) Risk Reduction Program, an open-label drug registry involving mainly primary-care patients at increased risk of a first MI, was to examine the effects of postal and telephone reminders, as well as demographic and other baseline characteristics, on patient self-reported compliance with pravastatin treatment. A second objective was to determine whether regimen adherence was associated with the adoption of other lifestyle modifications recommended to decrease the risk of coronary artery disease. METHODS: Patients with risk scores of > or = 4 on a scale of -1 to +16 for men and -1 to +17 for women on the First Heart Attack Risk Test were considered to be at increased risk of a first MI and eligible for enrollment in the registry program. An elevated total cholesterol level despite dietary interventions was an additional inclusion criterion. Patients were prospectively randomized (4:1) to either an intervention involving postal and telephone reminders (about coronary risk reduction and medication compliance), which were sent during the first 2 months of pravastatin treatment, or usual care. Both groups received reminder postcards at 4 and 5 months, in addition to counseling by physicians about coronary risk reduction. At 3 and 6 months (or study discontinuation), patients completed and mailed to the program-coordinating center questionnaires concerning compliance with care, including current use of prescribed pravastatin, as well as self-reported adoption of other lifestyle modifications, such as changing eating habits, losing weight, increasing physical activity, and/or quitting smoking. Compliance with pravastatin therapy and with these coronary risk-reducing behaviors was also assessed by physicians at the 3-month follow-up visit. RESULTS: A total of 10,335 patients were in the intervention group, and 2765 received usual care. The 2 groups were well balanced at baseline with respect to age, race, and total cholesterol values. Neither early reminders nor baseline patient characteristics were significantly associated with reported pravastatin compliance rates, which were approximately 79% overall. However, according to self-reports at 6 months, regimen compliance was associated with the adoption of other coronary risk-reducing behaviors. CONCLUSIONS: The results of this study suggest that early telephone and postal reminders do not improve compliance with drug treatment or with recommended coronary risk-reducing behaviors.

Anticholesteremic Agents↗
PubMedDate not supplied

The pilot study of a telephone disease management program for depression.

Most depressed patients are seen and treated exclusively by primary care clinicians. However, primary care patients with depression are often not adequately treated. The aims of this pilot study were to measure the impact of a telephone disease management program on patient outcome and clinician adherence to practice guidelines, measure the relationship of clinician adherence to patient outcome, and explore the measurement of patient adherence to clinician recommendations and its impact on patient outcomes. Thirty-five primary care practices in the University of Pennsylvania Health System were randomized to telephone disease management (TDM) or "usual care" (UC). All patients received a baseline and a 16-week follow-up clinical evaluation performed over the telephone. Those from TDM practices also received follow-up contact at least every 3 weeks, with formal evaluations at weeks 6 and 12. These interval contacts were designed to facilitate patient and clinician adherence to a treatment algorithm based on the Agency for Health Research and Quality (AHRQ) practice guidelines. Depressive symptoms evaluated with the Community Epidemiologic Survey of Depression (CES-D) scale as well as guideline adherence were the primary outcome measures. Sixty-one patients were enrolled in this pilot project. The overall effect for CES-D scores over time was significant, (P <.001), indicating that those participating in the trial (both TDM and UC groups) showed significant improvement. The interaction between intervention condition and time was also significant (P <.05), indicating that TDM patients improved significantly more over time than did UC patients. A greater proportion of TDM patients had CES-D scores <16 by Week 16 (66.7 versus 33.3%; chi(2), P <.05). The improvement in depression outcome for the TDM group was related to its impact on improving clinician adherence to depression treatment algorithms. The TDM pilot did not show a statistically significant effect on improving patient adherence to clinician recommendations, however. This preliminary data suggests that TDM for depression improves both clinician guideline adherence and patient outcomes in the acute phase of depression. The effect on patient outcome is at least partially explained by the effect of TDM on clinician adherence to depression treatment algorithms.

Acute Disease↗
PubMed1989

Emergency department telephone advice.

Emergency department personnel are frequently asked to give advice to members of the community who telephone for advice or information about a wide variety of medical problems. A study was designed to determine the consistency and accuracy of directions given to adults who call EDs seeking advice about a problem. Forty-six EDs were selected and telephoned for advice by a research assistant who presented a scenario that could have reasonably been interpreted as a patient experiencing myocardial ischemia. Nine percent of the calls were answered and managed only by ED unit secretaries. Fifty-six percent of the respondents failed to ask the caller any questions about the patient or the chief complaint. Only four ED respondents instructed the caller to call 911 and have the patient brought to the ED. The data suggest that telephone advice given by some EDs is nonstandardized and may be inadequate to the point of jeopardizing the welfare of the caller.

Adult↗