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Telecommunication will revolutionize how international medical research is completed. It is faster, more accurate, less expensive, and potentially more accessible than all other existing modes of communication. It is time for medical scientists to come into the age of electronic communication.
Telecommunication relay service (TRS) is a lifeline for deaf, deaf-blind, hard-of-hearing, and speech-disabled persons. Nurses who are technology shy and unfamiliar with TRS fail to integrate this simple telephone process into their pursuit of quality healthcare outcomes for patients with communication disorders. This article aims to increase home care nurses' awareness, comfort, and use of TRS.
With the increased acuity of patients and the resultant complexity of care required, effective and efficient communication among patients, nurses, and physicians is a critical variable in patient outcomes. In recognition of the need for rapid communication between health professionals, University Hospital in Denver, Colorado, instituted a wireless telecommunication system on two medical-surgical nursing units. Evaluation research of this innovation in practice revealed a significant time savings by both nurses and clerical staff members. This time savings translates into improved patient care because skilled personnel have more time available for direct patient care.
Examination of the accident records from the telecommunication industry covering some 100 000 engineers over a 12-month period showed that 25% of accidents resulting in more than three days' sick leave gave rise to back injuries. Handling accidents and falls accounted for 65% of three-day-plus accidents; handling accidents alone gave rise to 65% of back injuries. The absolute numbers of accidents have been compared with the total population of engineers to estimate the effects of age or occupation on levels of hazard; certain occupations constituting 33% of the engineers' population suffered 70% of all three-day-plus accidents. Accidents occurred most frequently in the group aged from 31 to 48 years. Other significant factors affecting the occurrence of accidents were time of year and duty experience of the workers.
The incidence of back injuries has been shown to be greater in occupations as heavy manual work than light manual work. To plan a programme aimed at reducing the incidence of back injuries in industry those workers at high risk of incurring handling accidents and back injuries need to be identified and a knowledge of the specific occupational factors causing such injuries sought. This has been achieved for telecommunications engineers using epidemiological and radio pressure pill methodologies. The results verify the correlation between the back injury rates and physical work stresses of different occupational groups. The magnitude and relative frequency of trunk stresses in hazardous tasks has been determined and compared with those with lower incidences of back disorders. The study has confirmed that in examining manual handling hazards in industrial male populations a critical value of truncal stress can be applied and used to determine the safety of occupational factors in relation to their potential causing or contributing to degenerative back diseases.
A retrospective cohort study of 2918 workers in the telecommunications industry in Sweden recorded the cancer morbidity for the period 1958-79. Cases of cancer were collected from the Swedish Cancer Registry for this period and information on work characteristics was collected for the entire period of employment. The total cancer morbidity was as expected. There was no excess risk of lung cancer but an excess risk of malignant melanoma of the skin was detected (SMR = 2.6, 12 cases). This excess risk was particularly associated with work environments where soldering was practised. Estimates of the SMR became larger with the assumption of a longer induction/latency period.
As part of a large cross sectional epidemiological study of respiratory disease in coalminers, the respiratory health of miners in one colliery in south Wales has been compared with the health of nearby telecommunication (telecom) workers. The studies were carried out in 1981 and 1982. The answers to questionnaires on respiratory symptoms and results of lung spirometry indicate a much greater frequency of respiratory ill health among the miners than the telecom workers. The frequency of symptoms of chronic bronchitis among the current employees was 31% in the miners and 5% in the telecom workers, and these symptoms were reported as frequently by younger as by older miners. Reports of other respiratory symptoms showed similarly large differences between current miners and telecom workers. These differences were seen both within non-smoking and smoking groups. Comparisons of FEV1 with predicted values (several different predictions were used) confirmed that the differences in reported symptoms were accompanied by differences in lung function; of the order of 20% of current miners had an FEV1 less than 80% of predicted compared with 10% of current telecom workers. The excess of respiratory disease shown among these miners is not necessarily a consequence of the dust concentrations currently experienced underground, nor is the colliery necessarily representative of the coal industry generally. The findings, however, indicate the continued need for measures to improve the respiratory health of these men.
In 1982 physicians at a hospital melanoma clinic in Montreal noticed that among their patients there had been seven men working in a single telecommunications company. This raised suspicions that working in that industry might be associated with development of malignant melanoma of the skin (MMS). A preliminary gross comparison with general population rates indicated that there was an increased risk in this working group. To estimate the risk of MMS more accurately, a standardised incidence ratio (SIR) was calculated based on the rates of MMS in the local population of the Greater Metropolitan Montreal Area for the years 1976-83. During that period, among workers in all plants for the company, 10 male cases of MMS were observed for an expected number of 3.7 (SIR = 2.7; 95% CI = 1.31-5.02). No cases were observed among female workers (expected = 1.3). The excess was significant among cases with a short latency (less than 20 years since beginning of employment). There was no apparent pattern of exposure based on job titles or departments.
An incidence study of malignant melanoma of the skin (MMS), conducted previously among the workers of four plants of a large telecommunications industry located in Montreal, Canada, showed a standardised incidence ratio of 2.7 (95% confidence interval (95% CI) 1.3-5.02) for the years 1976 to 1983. To describe more precisely the magnitude of the problem a mortality study was started among the same population (n = 9590) for the same period (1976-83). At the end of 1983, 9180 workers were alive, 261 were dead, and 149 (1.5%) were not traced. Standardised mortality ratios (SMRs) for all causes of death were surprisingly low for men (SMR = 0.57; 95% CI 0.50-0.64) and women (SMR = 0.56; 95% CI 0.37-0.82). The SMRs for major causes of death were also less than expected. These results may be explained by a pronounced selection bias (healthy worker effect) and by the short duration of follow up (eight years). For MMS, two deaths occurred among men (SMR = 2.00; 95% CI 0.24-7.22) and one among women (SMR = 4.81; 95% CI 0.12-26.78). A third man who died of MMS was miscoded as having a primary pulmonary melanoma. Including this case increased the SMR for MMS to 3.00 (95% CI 0.62-8.77; p = 0.08). Polyvinyl chloride and polychlorinated biphenyls were used in the plants and some of the workers did soldering. A planned case-control study will investigate other possible exposures at work.
Because technological innovations will enable geographic proximity to be replaced eventually by electronic proximity, telecommunication systems could play a substantial role in psychiatry's future. As a result, the uses, advantages, and limitations of interactive television and videotelephones for psychiatric service and training are discussed.
PURPOSE: The Women to Women Diabetes Project tested the use of telecommunication technology to deliver diabetes education and social support to rural women with diabetes. The aims were to (1) test the effects of the computer intervention in providing support, information, and education on selected outcomes, and (2) evaluate the women's attitudes toward and satisfaction with the intervention and the support provided. METHODS: Thirty women were randomized into computer and noncomputer groups and participated for 10 months. For 5 months, one group participated in a self-help support and educational group via the computer; the other group continued to use their usual modes of support and communication. Psychosocial well-being scales were administered and attitudes were surveyed. RESULTS: Improving health and higher educational levels positively influenced measures of social support and quality of life. Women who were married or who reported greater support had higher scores on the Personal Resource Questionnaire. The women expressed positive effects of the computer-based support group on their lives. CONCLUSIONS: The intervention was enthusiastically accepted, and could be conducted effectively in isolated rural areas.
The purpose of this study was to evaluate the efficacy of using a telecommunication system to assist in the outpatient management of pediatric patients with insulin-dependent diabetes. Metabolic control, patients' psychosocial status, family functioning, perceived quality of life, patterns of parental/child responsibility for daily diabetes maintenance, and nursing time-on-task were evaluated. One hundred six pediatric patients (mean age = 13.3 years) were randomly assigned to an experimental or control outpatient clinic for 1 year. Experimental subjects transmitted self-monitoring blood glucose data by modem to the hospital every 2 weeks. Transmitted data were reviewed by nurse practitioners who telephoned subjects to discuss regimen adjustments. Control subjects received standard care with regimen adjustments made by physicians. There were no significant between-group differences for metabolic control, rates of hospitalization or emergency-room visits, psychological status, general family functioning, quality of life, or parent-child responsibility. A significant decrease was noted in nursing time-on-task for experimental subjects.
Successful implementation of telemedicine services depends on an adequate telecommunications infrastructure. At present the main infrastructure in Russia and the countries of the former Soviet Union consists of analogue telephone lines. These are sufficient for e-mail and access to the World Wide Web but do not provide sufficient bandwidth for the transmission of realtime teleconsultations. ISDN lines and fibre optic cables are becoming more widespread in the major cities but have yet to be installed in the regions.
A consortium of three educational institutions was developed to respond to a possible need for educational programs in the workplace through teleconferencing technology. Based on survey findings, a pilot project of three educational programs was presented. Evaluation of the adequacy of such programming indicated its success in the use of such technology. The effort was unique because there was unprecedented collaboration among nurse executives, nurse educators, the Pennsylvania Nurses Association, the Hospital Association of Pennsylvania, and WITF, the publicly owned telecommunications center.
The overall success of the delivery of courses in the nursing major via telecommunication requires careful planning and coordination among the on-campus course faculty, satellite area faculty facilitators, the personnel responsible for the technology, and contact persons in satellite areas responsible for classroom scheduling. Maintaining satellite programs for RN students is a project that requires ongoing evaluation.
A report by the Environmental Science and Policy Institute paints a picture of a healthcare telecommunications "super highway" system with on and off ramps leading directly to the most disaffected in our society. It offers an inviting tour into the possibilities of tomorrow, but is it realistic?
This article has examined the impact that telecommunications technologies may have on the way in which health care services are delivered. A number of scenarios of how that might occur were discussed. Some of these scenarios are already being realized. Telemedicine, for instance, is being used in certain geographic regions of the United States. Various community health information networks are in the developmental stages or at varying degrees of operability. Two such networks in Colorado and Wisconsin were offered as examples. The impact of these developments on confidentiality and security of patient information, issues central to the responsibilities of health information managers, has been discussed. These technological advancements will have consequences for health information managers in other ways, too. The types of tasks that are performed and how those tasks are performed related to storing and retrieving information will be different in the future. In the transition period, blurring of job functions may occur as different types of practitioners strive to carve their niche in the electronic environment. For instance, as electronic patient records are linked to bibliographic databases of medical literature, where do the responsibilities of health information managers end and medical librarians begin? The best way to ensure a position on the health care team of the future is to recognize the opportunities provided by this dynamic period in health care.
A more regionalized healthcare delivery system has expanded the role of the telecommunications department. Applications such as teleradiology and telemedicine are making increasingly sophisticated demands on communications systems and their managers.