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Travel medicine is an exciting and rewarding field. This article has provided an overview of basic sources of information. The interested clinician will find many other sources of information on special topics or on travelers with special medical conditions.
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The computer revolution has for almost a decade been central to a nursing revolution known as telephone triage. The registered nurse can be virtually out in any community to help patients and their caregivers make informed decisions on appropriate emergent intervention and the venue commensurate with the determined level of necessity. Moreover, this presence in the province of New Brunswick has spawned positive effects in several unanticipated areas of community nursing.
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BACKGROUND: Experience from 10 telephone consultation courses in 1995, arranged for the emergency service in Copenhagen County, has demonstrated that this type of communication requires specific skills on the doctor's part, especially because the doctor cannot see the patient, patients are frequently in some sort of 'crisis' and, on the basis of limited information, the doctor in charge has to arrive at a prompt diagnosis in order to advise or refer the patient. METHODS: Using video-supervised role-play we compiled and organized the experience of 152 doctors. During the courses we developed principles to help doctors to optimize the information output and reliability of their telephone consultations. The doctors playing their 'patients" role had the opportunity to experience the situation from the patient's point of view and were later able to give the 'doctor' valuable feed-back. RESULTS AND CONCLUSIONS: This 'experimental consultation procedure' constitutes a new research method, at the interface between educational and traditional scientific research. The process in question is a feed-back one, in which findings can be applied and tested instantly, or with little delay, to produce new results. These can be put to use in practical clinical work and tested in new 'laboratory experiments'.
BACKGROUND: The After Hours Primary Medical Trials were initiated by the Australian government to redress difficulties in after hours (AH) GP care in areas of high need. The study's objective is to study the impact of two standalone call centres and one GP cooperative offering comprehensive services, in improving consumer access to services for residents of a defined geographic area. METHODS: A pre-post design was used to evaluate their impact after adjusting for secular trend at a national level. Access was considered in terms of availability, accessibility, affordability, acceptability and responsiveness of care. Unmet need and ease of obtaining AH telephone professional medical advice were also considered. Pre-trial and post-trial telephone surveys of two separate random samples of approximately 350 households using AH services in each trial area as well as in a national sample outside the trial areas. RESULTS: Consumer acceptability and affordability increased in residents in the area served by the GP cooperative. Access, however measured, did not improve in either of the standalone call centre areas. Reduction in unmet need approached but did not achieve statistical significance in most but not all trial areas. CONCLUSIONS: Improvements in access in the GP cooperative conformed to expectations based on current and pre-existing AH care arrangements put in place. Absence of improvements in access in the standalone call centres did not conform to expectations but may be partly explained by the reductions in consumer acceptability, following introduction of telephone triage systems reported elsewhere.
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Questionnaires were mailed to 257 callers of a toll-free telephone "helpline" specializing in Alzheimer's disease and related dementing illnesses; 125 (48.6%) were completed and returned. On the average, 3.94 requests for information were made per call. The most common requests concerned services delivered to the home, general information about dementia, information about adult day care, and support group information. Results indicated that a telephone-based information and referral helpline is useful in disseminating knowledge about resources to caregivers of older community-residing adults with cognitive impairment.
We review the various ways in which telephone counseling has been used in smoking cessation programs. Reactive approaches--help lines or crisis lines--attract only a small percentage of eligible smokers but are sensitive to promotional campaigns. While difficult to evaluate, they appear to be efficacious and useful as a public intervention for large populations. Proactive phone counseling has been used in a variety of ways. In 13 randomized trials, most showed significant short-term (3-6 month) effects, and four found substantial long-term differences between intervention and control conditions. A meta-analysis of proactive studies using a best-evidence synthesis confirmed a significant increase in cessation rates compared with control conditions [pooled odds ratios of 1.34 (1.19-1.51) and 1.20 (1.06-1.37) at short- and long-term follow-up, respectively]. Proactive phone counseling appeared most effective when used as the sole intervention modality or when augmenting programs initiated in hospital settings. Suggestions for further research and utilization are offered.
This paper reports on the development, promotion and use of a coordinated program of low intensity intervention services designed to appeal to smokers (and smokeless tobacco users) at various stages of change. An initial package of four components: a telephone advice line, self-help materials, single session group meetings and bi-monthly newsletter was offered to subjects in a variety of different settings (outpatient clinics, dental offices, worksites, hospitals) within a health maintenance (HMO) program project. Based upon consumer response and formative evaluations, these components were modified during the course of the year-long intervention. Results revealed differences in use of the various components of the program, with greatest use of self-help materials (manuals, 'tobacco substitutes' and a computerized smoking cessation aid) and least response to group meetings and the advice line. Most encouraging was the finding that it was possible to reach heavy smokers and to engage them in tobacco cessation activities through a centralized program of low intensity services. Data are presented on member characteristics associated with use/non-use of the various low intensity resources and suggestions are made for wider use of such interventions in other health care systems.
A minority of child abuse cases is recognized by professionals, making the role of non-professional bystanders essential. The stages of change construct, as proposed by the Transtheoretical Model, may provide a useful approach to explain non-professional helping behavior. The objective of this study was to test the applicability of the stages of change construct by (i) assessing whether cognitive determinants distinguish between the stages, (ii) testing the predictive value of the stages for future helping behavior and (iii) examining the mediating role of the stages in the relation between previous and future helping behavior. Data of 126 adult non-professional bystanders were analyzed. Respondents were questioned by telephone or via an Internet questionnaire, at baseline and after a follow-up of about two months later. Attitude toward helping was significantly less positive in pre-contemplation than in the other stages, and self-efficacy expectations were significantly higher in preparation compared with the other stages. Moreover, baseline preparators were more likely to conduct future helping behavior than those in the two earlier stages. Finally, the stages of change mediated the relation between previous and future helping behavior. Initial support was found for the applicability of the stages of change construct for helping behavior by non-professional bystanders.
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This paper reports the findings of the evaluation of a national smokers' helpline which was set up by British Telecom (BT) for its employees. The helpline formed part of a new comprehensive smoking policy for all BT staff. Over 1000 employees, more than 3.0% of all smokers, phoned the helpline during the first three months of its operation. Two-thirds of callers tried to quit smoking after calling the helpline, and a quarter were still successful three months later. One in six callers reduced the number of cigarettes that they smoked on working days. While the helpline and other cessation support services were evaluated positively by callers, it appears that helplines only appeal to a small minority of smokers. However, they do seem to be an effective mechanism for a nationwide company to identify those smokers who want support, and a useful means of centralizing the administration of support services. They are potentially a cost-effective option for larger employers.
This paper describes the management of public relations following an outbreak of multidrug resistant TB at a London hospital. Eight patients were involved, all of the secondary cases occurred in HIV seropositive patients, and three cases died. The paper describes how the the Incident Committee undertook to recall contacts of the cases for screening, inform the general practitioners of all of the contacts about their patients' exposure, warn other organizations and professionals interested or involved in the management of HIV in the London area as to the nature of the incident, and establish a helpline, before informing a wider audience through the EPINET, Communicable Disease Report and national press.
Multi-disciplinary public health audit involving whole departments is often perceived as difficult to carry out in areas other than the annual report of the Director of Public Health. This paper describes the audit of an emergency telephone helpline set up during a meningococcal disease outbreak and provides standards that could be applied to any emergency helpline set up in response to issues of public health concern.
BACKGROUND: NHS Direct was set up in 1998 and now covers all of England. One site in South East London, which went live in April 1999, has been studied to gain an insight into how NHS Direct is used and by whom. METHODS: Routine data from TAS was obtained from NHS Direct in South East London for its first year of operation. RESULTS: Data were collected on 56540 calls. Almost one-quarter of calls were for 0- to 5-year-olds. The service was busiest between 9 a.m. and 2 p.m. and again between 6 p.m. and 9 p.m. The majority of calls (68 per cent) were received during the out-of-hours period. Most calls to the service (56 per cent) are categorized with no urgency level, with 37 per cent of callers given advice on how to look after the problem themselves. Over the millennium celebration period the call volume tripled. However, calls tended to be less urgent, with more being from the older age groups. CONCLUSION: NHS Direct is an important service to parents of young children and can provide advice about when contact with another service is necessary to those who traditionally worry about this.
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