Wiley, Jennifer L
.... The study compared means of pre- and post-implementation provider overall job satisfaction, provider satisfaction with the telephone consult process, average daily hours providers spent on telephone...
Sokol, D K; Car, J
Although telephone consultations are widely used in the delivery of healthcare, they are vulnerable to breaches of patient confidentiality. Current guidelines on telephone consultations do not address adequately the issue of confidentiality. In this paper, we propose a solution to the a password system to control access to patient information. Authorised persons will be offered the option of selecting a password which they will use to validate their request for information over the telephone. This simple yet stringent method of access control should improve security while allowing the continuing evolution of telephone consultations.
... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF THE INTERIOR National Park Service Government-to-Government Telephonic Consultation Meetings AGENCY: National Park Service, Interior. SUMMARY: The National Park Service announces two telephonic government- to-government...
Vaona, Alberto; Pappas, Yannis; Grewal, Rumant S; Ajaz, Mubasshir; Majeed, Azeem; Car, Josip
Since 1879, the year of the first documented medical telephone consultation, the ability to consult by telephone has become an integral part of modern patient-centred healthcare systems. Nowadays, upwards of a quarter of all care consultations are conducted by telephone. Studies have quantified the impact of medical telephone consultation on clinicians' workload and detected the need for quality improvement. While doctors routinely receive training in communication and consultation skills, this does not necessarily include the specificities of telephone communication and consultation. Several studies assessed the short-term effect of interventions aimed at improving clinicians' telephone consultation skills, but there is no systematic review reporting patient-oriented outcomes or outcomes of interest to clinicians. To assess the effects of training interventions for clinicians' telephone consultation skills and patient outcomes. We searched CENTRAL, MEDLINE, Embase, five other electronic databases and two trial registers up to 19 May 2016, and we handsearched references, checked citations and contacted study authors to identify additional studies and data. We considered randomised controlled trials, non-randomised controlled trials, controlled before-after studies and interrupted time series studies evaluating training interventions compared with any control intervention, including no intervention, for improving clinicians' telephone consultation skills with patients and their impact on patient outcomes. Two review authors independently selected studies for inclusion, extracted data and assessed the risk of bias of eligible studies using standard Cochrane and EPOC guidance and the certainty of evidence using GRADE. We contacted study authors where additional information was needed. We used standard methodological procedures expected by Cochrane for data analysis. We identified one very small controlled before-after study performed in 1989: this study used a
Lor, Maichou; Chewning, Betty
Over 25 million people in the USA have limited English proficiency (LEP). Interpreters are often used to facilitate communication with health care providers. Little is currently known about interpreter quality. To explore the quality of telephone interpretation during medication consultations between Hmong clients and their pharmacists. This descriptive study analyzed transcripts from videos of consultations between six triads of Hmong patients, pharmacy students and interpreters. Analysis was divided into two segments: (1) pharmacy: communication from student pharmacist the interpreter to patient and (2) patient: communication from patient to interpreter to student pharmacist. Researchers coded transcripts separately then compared codes. The six encounters yielded 496 communications with 275 discrepancies including omissions, additions, and word substitutions. Pharmacy to patient communications included, 45% (118/262) of omissions, 27.5% (72/262) of substitutions, and 15.6% (41/262) of additions. The patient to provider communications included, 8.1% (19/234) of omissions, 6.0% (14/234) of substitutions, and 4.2% (10/234) of word additions. Some omissions, additions, and substitutions in the pharmacy to patient communications were classified as potentially clinically relevant. Significantly, substantial discrepancies between the student pharmacists' comments and the interpretation to patients had potential for hindering relationship building between patients and their providers. Pharmacists may assume that the presence of an interpreter ensures accurate communication from pharmacist to patient and from patient to pharmacist. This study confirms that those assumptions may not be valid. These findings highlight the need to improve pharmacy education and interventions to improve pharmacist communication with LEP patients. © 2015 Royal Pharmaceutical Society.
Zayts, Olga; Sarangi, Srikant
consultations in Hong Kong between genetic nurses and parents whose infants have been diagnosed with a mild hereditary disorder, G6PD deficiency, commonly known as favism. Using discourse analytic methods, we focus on 50 audio-recorded telephone consultations. First, we show the distribution of different types...... as warrants for advice-giving and providing reassurance. We then examine how the genetic nurses interactionally orient themselves to the parents’ existing knowledge regarding G6PD deficiency while delivering these risk explanations. The differences in explanation trajectories are linked to the presence...... or absence of prior knowledge of the condition on the part of the parents; and these differences are displayed at the interactional rather than at the substantive level, that is parents with prior knowledge of the condition occupy a different participant status in eliciting and responding to the risk...
Crossman, Kristen L; Wiener, Ethan; Roosevelt, Genie; Bajaj, Lalit; Hampers, Louis C
Language barriers affect health care interactions. Large, randomized studies of the relative efficacy of interpreter modalities have not been conducted. To compare the efficacy of telephonic and in-person medical interpretation to visits with verified bilingual physicians. This was a prospective, randomized trial. The setting was an urban pediatric emergency department at which approximately 20% of visits are by families with limited English proficiency. The participants were families who responded affirmatively when asked at triage if they would prefer to communicate in Spanish. Randomization of each visit was to (1) remote telephonic interpretation via a double handset in the examination room, (2) an in-person emergency department-dedicated medical interpreter, or (3) a verified bilingual physician. Interviews were conducted after each visit. The primary outcome was a blinded determination of concordance between the caregivers' description of their child's diagnosis with the physician's stated discharge diagnosis. Secondary outcomes were qualitative measures of effectiveness of communication and satisfaction. Verified bilingual providers were the gold standard for noninferiority comparisons. A total of 1201 families were enrolled: 407 were randomly assigned to telephonic interpretation and 377 to in-person interpretation, and 417 were interviewed by a bilingual physician. Concordance between the diagnosis in the medical record and diagnosis reported by the family was not different between the 3 groups (telephonic: 95.1%; in-person: 95.5%; bilingual: 95.4%). The in-person-interpreter cohort scored the quality and satisfaction with their visit worse than both the bilingual and telephonic cohorts (P bilingual-provider cohort were less satisfied with their language service than those in the in-person and telephonic cohorts (P bilingual provider as a gold standard, noninferiority was demonstrated for both interpreter modalities (telephonic and in-person) for quality
Yamadera, Shizuko; Kobune, Fumio; Komatsu, Toshihiko; Suzuki, Kazuyoshi; Nakayama, Mikio; Hagiwara, Toshikatsu; Matsumoto, Miyako; Yamamoto, Kiichi; Renard, Junko; Oya, Akira
The NPO Biomedical Science Association provided telephone consultation, including contacts by fax and email, targeting the general public within the framework of influenza control measures worked out by the Japanese Ministry of Health, Labor and Welfare (MHLW). We received 2,813 inquiries during the 2003-2004 flu season and 2,444 inquiries during the 2004-2005 season. By month, the highest number was in October-November, accounting for 42.6%. The preceding season showed a similar trend. By gender, 72.5% of those seeking advice were women. By area of residence, the highest number was living in metropolitan Tokyo, and the remainder lived in the prefectures of Kanagawa, Chiba, Saitama, Nagano, Shizuoka, and Ibaraki in this order. We received no inquiries from the prefectures of Shimane or Saga. By occupation, housewives accounted for 1,114 inquiries (45.6%), followed by private companies with 447 inquiries (18.3%) and health-care providers with 227 inquiries (9.3%), similar to the 2003-2004 flu season. By subject, 1,545 inquiries concerned vaccines (62.2%) mainly, the pros and cons of vaccination, adverse reactions, and the number of inoculations required. Inquiries about pregnancy, infants and young children, and breast-feeding accounted for 19.2%. Inquiries on vaccine shortages during the 2004-2005 flu season (7), SARS (22), and bird flu (22) decreased compared to the previous season, while the number of consultations on antiviral agents increased (209). In discussing how information on influenza should be communicated to the public, we propose that "Influenza Q & A" provided by the Infectious Diseases Surveillance Center of the NIID, MHLW, should include information on influenza specifically addressing pregnant woman and breast-feeding or child-rearing mothers.
Calitri, Raff; Warren, Fiona C; Wheeler, Benedict; Chaplin, Katherine; Fletcher, Emily; Murdoch, Jamie; Richards, Suzanne; Taylor, Rod S; Varley, Anna; Campbell, John
The ESTEEM trial was a randomised-controlled trial of telephone triage consultations in general practice. We conducted exploratory analyses on data from 9154 patients from 42 UK general practices who returned a questionnaire containing self-reported ratings of satisfaction with care following a request for a same-day consultation. Mode of care was identified through case notes review. There were seven main types: a GP face-to-face consultation, GP or nurse telephone triage consultation with no subsequent same day care, or a GP or nurse telephone triage consultation with a subsequent face-to-face consultation with a GP or a nurse. We investigated the contribution of mode of care to patient satisfaction and distance between the patient׳s home and the practice as a potential moderating factor. There was no overall association between patient satisfaction and distance from practice. However, patients managed by a nurse telephone consultation showed lowest levels of satisfaction, and satisfaction for this group of patients increased the further they lived from the practice. There was no association between any of the other modes of management and distance from practice. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.
Full Text Available Background: The purpose of this study was to evaluate the advantages of a telephone consultation with a specialist in paediatric surgery after taking photographs and video images by a general practitioner for the diagnosis of some diseases. Materials and Methods: This was a prospective study of the reliability of paediatric surgery online consultation among specialists and general practitioners. Results: Of 26 general practitioners included in the study, 12 were working in the city and 14 were working in districts outside the city. A total of 41 pictures and 3 videos of 38 patients were sent and evaluated together with the medical history and clinical findings. These patients were diagnosed with umbilical granuloma (n = 6, physiological/pathological phimosis (n = 6, balanitis (n = 6, hydrocele (n = 6, umbilical hernia (n = 4, smegma cyst (n = 2, reductable inguinal hernia (n = 1, incarcerated inguinal hernia (n = 1, paraphimosis (n = 1, burried penis (n = 1, hypospadias (n = 1, epigastric hernia (n = 1, vulva synechia (n = 1, and rectal prolapse (n = 1. Twelve patients were asked to be referred urgently, but it was suggested that only two of these patients, who had paraphimosis and incarcerated inguinal hernia be referred in emergency conditions. It was decided that there was no need for the other ten patients to be referred to a specialist at night or at the weekend. All diagnoses were confirmed to be true, when all patients underwent examination in the pediatric surgery clinic in elective conditions. Conclusion: Evaluation of photographs and video images of a lesion together with medical history and clinical findings via a telephone consultation between a paediatric surgery specialist and a general practitioner provides a definitive diagnosis and prevents patients from being referred unnecessarily.
Gamst-Jensen, Hejdi; Lippert, Freddy K; Egerod, Ingrid
BACKGROUND: Telephone consultation and triage are used to limit the workload on emergency departments. Lack of visual cues and clinical tests put telephone consultations to a disadvantage compared to face-to-face consultations increasing the risk of under-triage. Under-triage occurs in telephone...... triage; however why under-triage happens is not explored yet. The aim of the study was to describe situations of under-triage in context, to assess the quality of under-triaged calls, and to identify communication patterns contributing to under-triage in a regional OOH service in the capital region...... of Denmark. METHODS: Explanatory simultaneous mixed method with thematic analysis and descriptive statistics was chosen. The study was carried out in an Out-Of-Hours service (OOH) in the Capital Region of Denmark, Copenhagen. Under-triage was defined as Potentially Under-Triaged Calls (PUTC) by specific...
Baar, J.D. van; Joosten, H.; Car, J.; Freeman, G.; Partridge, M.R.; Weel, C. van; Sheikh, A.
OBJECTIVE: To understand factors influencing patients' decisions to attend for outpatient follow up consultations for asthma and to explore patients' attitudes to telephone and email consultations in facilitating access to asthma care. DESIGN: Exploratory qualitative study using in depth interviews.
Kwok, Jonas; Olayiwola, J Nwando; Knox, Margae; Murphy, Elizabeth J; Tuot, Delphine S
Background Electronic consultation systems allow primary care providers to receive timely speciality expertise via iterative electronic communication. The use of such systems is expanding across the USA with well-documented high levels of user satisfaction. We characterise the educational impact for primary care providers of a long-standing integrated electronic consultation and referral system. Methods Primary care providers' perceptions of the educational value inherent to electronic consultation system communication and the impact on their ability to manage common speciality clinical conditions and questions were examined by electronic survey using five-point Likert scales. Differences in primary care providers' perceptions were examined overall and by primary care providers' speciality, provider type and years of experience. Results Among 221 primary care provider participants (35% response rate), 83.9% agreed or strongly agreed that the integrated electronic consultation and referral system provided educational value. There were no significant differences in educational value reported by provider type (attending physician, mid-level provider, or trainee physician), primary care providers' speciality, or years of experience. Perceived benefit of the electronic consultation and referral system in clinical management appeared stronger for laboratory-based conditions (i.e. subclinical hypothyroidism) than more diffuse conditions (i.e. abdominal pain). Nurse practitioners/physician assistants and trainee physicians were more likely to report improved abilities to manage specific clinical conditions when using the electronic consultation and/or referral system than were attending physicians, as were primary care providers with ≤10 years experience, versus those with >20 years of experience. Conclusions Primary care providers report overwhelmingly positive perceptions of the educational value of an integrated electronic consultation and referral system. Nurse
Wu, Hong; Lu, Naiji
The emergence of online health communities broadens and diversifies channels for patient-doctor interaction. Given limited medical resources, online health communities aim to provide better treatment by decreasing medical costs, making full use of available resources and providing more diverse channels for patients. This research examines how online channel usage affects offline channels, i.e., "Online Booking, Service in Hospitals" (OBSH), and how the channel effects change with doctors' online and offline reputation. The study uses data of 4254 doctors from a Chinese online health community. Our findings demonstrate a strong relationship between online health communities and offline hospital communication with an important moderating role for reputation. There are significant channel effects, wherein written consultation complements OBSH (β=3.320, ponline services, especially for these physicians who do not have enough patients. Copyright © 2017 Elsevier B.V. All rights reserved.
Anstey, Erica H; Coulter, Martha; Jevitt, Cecilia M; Perrin, Kay M; Dabrow, Sharon; Klasko-Foster, Lynne B; Daley, Ellen M
Addressing suboptimal breastfeeding initiation and duration rates is a priority in the United States. To address challenges to improving these rates, the voices of the providers who work with breastfeeding mothers should be heard. Research aim: The purpose of this study was to explore lactation consultants' perceived barriers to managing early breastfeeding problems. This qualitative study was conducted with a grounded theory methodological approach. In-depth interviews were conducted with 30 International Board Certified Lactation Consultants across Florida. Lactation consultants were from a range of practice settings, including hospitals, Special Supplemental Nutrition Program for Women, Infants, and Children clinics, private practice, and pediatric offices. Data were digitally recorded, transcribed, and analyzed in Atlas.ti. A range of barriers was identified and grouped into the following categories/themes: indirect barriers (social norms, knowledge, attitudes); direct occupational barriers (institutional constraints, lack of coordination, poor service delivery); and direct individual barriers (social support, mother's self-efficacy). A model was developed illustrating the factors that influence the role enactment of lactation consultants in managing breastfeeding problems. Inadequate support for addressing early breastfeeding challenges is compounded by a lack of collaboration among various healthcare providers and the family. Findings provide insight into the professional management issues of early breastfeeding problems faced by lactation consultants. Team-based, interprofessional approaches to breastfeeding support for mothers and their families are needed; improving interdisciplinary collaboration could lead to better integration of lactation consultants who are educated and experienced in providing lactation support and management of breastfeeding problems.
Kaur, Rupinderjeet; Kajal, Krishan Singh; Kaur, Amarpreet; Singh, Paramdeep
Diabetes mellitus (DM), being a long-term condition, requires consistent blood glucose monitoring and adjustment of doses of the antidiabetic drugs and insulin. Telehealth is an emerging field that can have a positive impact on the management of this disease. The aim was to study the impact of the frequency of consultation and follow-up on telephone of diagnosed follow-up patients of DM on glycemic and metabolic profiles, the patients' compliance, and their quality of life (QoL), and to compare the effectiveness of different modes of follow-up. One hundred twenty patients were enrolled from the outpatient department (OPD) including both type 1 and type 2 DM patients who had already been diagnosed and were on treatment. They were randomly assigned to one of three groups, each consisting of 40 subjects, according to the mode of follow-up: A (rare, i.e., less frequent outpatient visits), B (moderate, i.e., more frequent outpatient visits), and C (frequent, i.e., more frequent outpatient visits with weekly telephonic consultation). Metabolic profiles and the QoL were monitored. The patients' compliance with and adherence to the treatment, and dietary and exercise advice were assessed. The patients' compliance with and adherence to the treatment was higher in group C, followed by groups B and A. There was a net decrease in adverse events, with an increase in the frequency of follow-up. Changes in glycated hemoglobin (HbA1c) suggested a positive impact of weekly telephonic consultation. The lipid profile was also positively affected, with maximum improvement being in high-density lipoproteins (HDLs) and triglycerides. There was an improvement in the QoL domains pertaining to physical health and endurance in patients with higher frequency of follow-ups. There was no effect on emotional or mental health. There was an overall deterioration of the financial domain, being most marked in group B. The treatment satisfaction questionnaire showed better results in the telephone
van Heest, Florien B; Finlay, I G; Kramer, J J E; Otter, R; Meyboom-de Jong, B
GPs with a special interest and with specific training in palliative medicine (GP advisors) supported professional carers (mostly GPs) through a telephone advisory service. Each telephone call was formally documented on paper and subsequently evaluated. Data from 2003 were analysed independently to reveal how often and in what way palliative sedation and euthanasia were discussed. The telephone documentation forms and corresponding evaluation forms of two GP advisors were systematically analysed for problems relating to the role of sedation and/or euthanasia both quantitatively and qualitatively. In 87 (21%) of 415 analysed consultations, sedation and/or euthanasia were discussed either as the presenting question (sedation 26 times, euthanasia 37 times and both 10 times) or arising during discussion (sedation 11 times and euthanasia three times). Qualitative analysis revealed that GPs telephoned to explore therapeutic options and/or wanted specific information. Pressure on the GP (either internal or external) to relieve suffering (including shortening life by euthanasia) had often precipitated the call. On evaluation, 100% of the GPs reported that the advice received was of value in the patient's care. GPs caring for patients dying at home encountered complex clinical dilemmas in end-of-life care (including palliative sedation therapy and euthanasia). They valued practical advice from, and open discussion with, GP advisors. The advice often helped the GP find solutions to the patient's problems that did not require deliberately foreshortening life.
Gulacti, Umut; Lok, Ugur
Consultation, the process of an Emergency Physician seeking an opinion from other specialties, occurs frequently in the Emergency Department (ED). The aim of this study was to determine the effect of secure messaging application (WhatsApp) usage for medical consultations on Emergency Department Length of Stay (ED LOS) and consult time. We conducted a prospective, randomized controlled trial in the ED using allocation concealment over three months. Consultations requested in the ED were allocated into two groups: consultations requested via the secure messaging application and consultations requested by telephone as verbal. A total of 439 consultations requested in the ED were assessed for eligibility and 345 were included in the final analysis: 173 consultations were conducted using secure messaging application and 172 consultations were conducted using standard telephone communications. The median ED LOS was 240 minutes (IQR:230-270, 95% CI:240 to 255.2) for patients in the secure messaging application group and 277 minutes (IQR:270-287.8, 95% CI:277 to 279) for patients in the telephone group. The median total ED LOS was significantly lower among consults conducted using Secure messaging application relative to consults conducted by telephone (median dif: -30, 95%CI:-37to-25, p<0.0001). The median consult time was 158 minutes (IQR:133 to 177.25, 95% CI:150 to 169) for patients in the Secure messaging application group and 170 minutes (IQR:165 to 188.5, 95% CI:170-171) for patients in the Telephone group (median dif: -12, 95%CI:-19 to-7,p<0.0001). Consultations completed without ED arrival was 61.8% in the secure messaging group and 33.1% in the Telephone group (dif: 28.7, 95% CI:48.3 to 66, p<0.001). Use of secure messaging application for consultations in the ED reduces the total ED LOS and consultation time. Consultation with secure messaging application eliminated more than half of in-person ED consultation visits.
Mosinkie Phillip I
Full Text Available Abstract Background Refugees and asylum seekers experience language barriers in general practice. Qualitative studies have found that responses to language barriers in general practice are ad hoc with use of both professional interpreters and informal interpreters (patients' relatives or friends. However, the scale of the issues involved is unknown. This study quantifies the need for language assistance in general practice consultations and examines the experience of, and satisfaction with, methods of language assistance utilized. Methods Data were collected by telephone survey with general practitioners in a regional health authority in Ireland between July-August 2004. Each respondent was asked a series of questions about consulting with refugees and asylum seekers, the need for language assistance and the kind of language assistance used. Results There was a 70% (n = 56/80 response rate to the telephone survey. The majority of respondents (77% said that they had experienced consultations with refugees and asylum seekers in which language assistance was required. Despite this, general practitioners in the majority of cases managed without an interpreter or used informal methods of interpretation. In fact, when given a choice general practitioners would more often choose informal over professional methods of interpretation despite the fact that confidentiality was a significant concern. Conclusion The need for language assistance in consultations with refugees and asylum seekers in Irish general practice is high. General practitioners rely on informal responses. It is necessary to improve knowledge about the organisational contexts that shape general practitioners responses. We also recommend dialogue between general practitioners, patients and interpreters about the relative merits of informal and professional methods of interpretation so that general practitioners' choices are responsive to the needs of patients with limited English.
MacFarlane, Anne; Glynn, Liam G; Mosinkie, Phillip I; Murphy, Andrew W
Refugees and asylum seekers experience language barriers in general practice. Qualitative studies have found that responses to language barriers in general practice are ad hoc with use of both professional interpreters and informal interpreters (patients' relatives or friends). However, the scale of the issues involved is unknown. This study quantifies the need for language assistance in general practice consultations and examines the experience of, and satisfaction with, methods of language assistance utilized. Data were collected by telephone survey with general practitioners in a regional health authority in Ireland between July-August 2004. Each respondent was asked a series of questions about consulting with refugees and asylum seekers, the need for language assistance and the kind of language assistance used. There was a 70% (n = 56/80) response rate to the telephone survey. The majority of respondents (77%) said that they had experienced consultations with refugees and asylum seekers in which language assistance was required. Despite this, general practitioners in the majority of cases managed without an interpreter or used informal methods of interpretation. In fact, when given a choice general practitioners would more often choose informal over professional methods of interpretation despite the fact that confidentiality was a significant concern. The need for language assistance in consultations with refugees and asylum seekers in Irish general practice is high. General practitioners rely on informal responses. It is necessary to improve knowledge about the organisational contexts that shape general practitioners responses. We also recommend dialogue between general practitioners, patients and interpreters about the relative merits of informal and professional methods of interpretation so that general practitioners' choices are responsive to the needs of patients with limited English.
BACKGROUND: Refugees and asylum seekers experience language barriers in general practice. Qualitative studies have found that responses to language barriers in general practice are ad hoc with use of both professional interpreters and informal interpreters (patients\\' relatives or friends). However, the scale of the issues involved is unknown. This study quantifies the need for language assistance in general practice consultations and examines the experience of, and satisfaction with, methods of language assistance utilized. METHODS: Data were collected by telephone survey with general practitioners in a regional health authority in Ireland between July-August 2004. Each respondent was asked a series of questions about consulting with refugees and asylum seekers, the need for language assistance and the kind of language assistance used. RESULTS: There was a 70% (n = 56\\/80) response rate to the telephone survey. The majority of respondents (77%) said that they had experienced consultations with refugees and asylum seekers in which language assistance was required. Despite this, general practitioners in the majority of cases managed without an interpreter or used informal methods of interpretation. In fact, when given a choice general practitioners would more often choose informal over professional methods of interpretation despite the fact that confidentiality was a significant concern. CONCLUSION: The need for language assistance in consultations with refugees and asylum seekers in Irish general practice is high. General practitioners rely on informal responses. It is necessary to improve knowledge about the organisational contexts that shape general practitioners responses. We also recommend dialogue between general practitioners, patients and interpreters about the relative merits of informal and professional methods of interpretation so that general practitioners\\' choices are responsive to the needs of patients with limited English.
Klazinga Niek S
Full Text Available Abstract Background Nowadays, nurses play a central role in telephone triage in Dutch out-of-hours primary care. The percentage of calls that is handled through nurse telephone advice alone (NTAA appears to vary substantially between GP cooperatives. This study aims to explore which determinants are associated with NTAA and with subsequent return consultations to the GP. Methods For the ten most frequently presented problems, a two-week follow-up cohort study took place in one cooperative run by 25 GPs and 8 nurses, serving a population of 62,291 people. Random effects logistic regression analysis was used to study the determinants of NTAA and return consultation rates. The effect of NTAA on hospital referral rates was also studied as a proxy for severity of illness. Results The mean NTAA rate was 27.5% – ranging from 15.5% to 39.4% for the eight nurses. It was higher during the night (RR 1.63, CI 1.48–1.76 and lower with increasing age (RR 0.96, CI 0.93–0.99, per ten years or when the patient presented >2 problems (RR 0.65; CI 0.51–0.83. Using cough as reference category, NTAA was highest for earache (RR 1.49; CI 1.18–1.78 and lowest for chest pain (RR 0.18; CI 0.06–0.47. After correction for differences in case mix, significant variation in NTAA between nurses remained (p Conclusion Important inter-nurse variability may indicate differences in perception on tasks and/or differences in skill to handle telephone calls alone. Future research should focus more on modifiable determinants of NTAA rates.
Gruca, Thomas S; Pyo, Tae-Hyung; Nelson, Gregory C
Workforce experts predict a future shortage of cardiologists that is expected to impact rural areas more severely than urban areas. However, there is little research on how rural patients are currently served through clinical outreach. This study examines the impact of cardiology outreach in Iowa, a state with a large rural population, on participating cardiologists and on patient access. Outreach clinics are tracked annually in the Office of Statewide Clinical Education Programs Visiting Medical Consultant Database (University of Iowa Carver College of Medicine). Data from 2014 were analyzed. In 2014, an estimated 5460 visiting consultant clinic days were provided in 96 predominantly rural cities by 167 cardiologists from Iowa and adjoining states. Forty-five percent of Iowa cardiologists participated in rural outreach. Visiting cardiologists from Iowa and adjoining states drive an estimated 45 000 miles per month. Because of monthly outreach clinics, the average driving time to the nearest cardiologist falls from 42.2±20.0 to 14.7±11.0 minutes for rural Iowans. Cardiology outreach improves geographic access to office-based cardiology care for more than 1 million Iowans out of a total population of 3 million. Direct travel costs and opportunity costs associated with physician travel are estimated to be more than $2.1 million per year. Cardiologists in Iowa and adjoining states have expanded access to office-based cardiology care from 18 to 89 of the 99 counties in Iowa. In these 71 counties without a full-time cardiologist, visiting consultant clinics can accommodate more than 50% of office visits in the patients' home county. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.
Van Cleave, Jeanne; Holifield, Chloe; Perrin, James M
The Massachusetts Child Psychiatry Access Project (MCPAP) provides telephone support from mental health specialists to primary care providers (PCPs). Understanding PCPs' use may inform implementation of similar programs. We sought to examine PCPs' decision-making process to use or not use MCPAP when encountering mental health problems. We analyzed data regarding calls from PCPs to MCPAP from October 1, 2010, to July 31, 2011, and interviewed 14 PCPs with frequent use (≥7 calls) and infrequent use (≤4 calls). PCPs were asked about recent patients with mental health problems, and they were asked to describe reasons for calling or not calling MCPAP. Frequent callers were asked what sustained use; infrequent callers were asked about alternative management strategies. Comparisons were made between these groups in qualitative analysis. PCPs (n = 993) made 6526 calls (mean = 6.6; median = 3). Factors influencing calling included: MCPAP's guidance is timely and tailored to individual scope of practice; MCPAP's ability to arrange therapy referrals exceeds PCPs' ability; providing a plan at point of care relieves anxious families; and MCPAP's assistance helps accommodate families' preference to keep mental health in primary care. Some infrequent callers had gained skills through MCPAP before 2010 and now called only for complex cases. Other reasons for infrequent calling: PCPs have other consultation sources, have fear of being asked to manage more than they are comfortable, or have misperceptions of MCPAP's offerings. MCPAP enhanced PCPs' ability to deliver mental health care consistent with families' preferences. PCPs applied knowledge gained from calls to subsequent patients. Promoting MCPAP components through outreach and tailoring guidance to PCPs' scope of practice may entice greater use. Copyright © 2018. Published by Elsevier Inc.
Campbell, John L; Fletcher, Emily; Britten, Nicky; Green, Colin; Holt, Tim A; Lattimer, Valerie; Richards, David A; Richards, Suzanne H; Salisbury, Chris; Calitri, Raff; Bowyer, Vicky; Chaplin, Katherine; Kandiyali, Rebecca; Murdoch, Jamie; Roscoe, Julia; Varley, Anna; Warren, Fiona C; Taylor, Rod S
Telephone triage is increasingly used to manage workload in primary care; however, supporting evidence for this approach is scarce. We aimed to assess the effectiveness and cost consequences of general practitioner-(GP)-led and nurse-led telephone triage compared with usual care for patients seeking same-day consultations in primary care. We did a pragmatic, cluster-randomised controlled trial and economic evaluation between March 1, 2011, and March 31, 2013, at 42 practices in four centres in the UK. Practices were randomly assigned (1:1:1), via a computer-generated randomisation sequence minimised for geographical location, practice deprivation, and practice list size, to either GP-led triage, nurse-led computer-supported triage, or usual care. We included patients who telephoned the practice seeking a same-day face-to-face consultation with a GP. Allocations were concealed from practices until after they had agreed to participate and a stochastic element was included within the minimisation algorithm to maintain concealment. Patients, clinicians, and researchers were not masked to allocation, but practice assignment was concealed from the trial statistician. The primary outcome was primary care workload (patient contacts, including those attending accident and emergency departments) in the 28 days after the first same-day request. Analyses were by intention to treat and per protocol. This trial was registered with the ISRCTN register, number ISRCTN20687662. We randomly assigned 42 practices to GP triage (n=13), nurse triage (n=15), or usual care (n=14), and 20,990 patients (n=6695 vs 7012 vs 7283) were randomly assigned, of whom 16,211 (77%) patients provided primary outcome data (n=5171 vs 5468 vs 5572). GP triage was associated with a 33% increase in the mean number of contacts per person over 28 days compared with usual care (2·65 [SD 1·74] vs 1·91 [1·43]; rate ratio [RR] 1·33, 95% CI 1·30-1·36), and nurse triage with a 48% increase (2·81 [SD 1·68
Dexter, Eve N; Fields, Scott; Rdesinski, Rebecca E; Sachdeva, Bhavaya; Yamashita, Daisuke; Marino, Miguel
Internet-based patient portals are increasingly being implemented throughout health care organizations to enhance health and optimize communication between patients and health professionals. The decision to adopt a patient portal requires careful examination of the advantages and disadvantages of implementation. This study aims to investigate 1 proposed advantage of implementation: alleviating some of the clinical workload faced by employees. A retrospective time-series analysis of the correlation between the rate of electronic patient-to-provider messages-a common attribute of Internet-based patient portals-and incoming telephone calls. The rate of electronic messages and incoming telephone calls were monitored from February 2009 to June 2014 at 4 economically diverse clinics (a federally qualified health center, a rural health clinic, a community-based clinic, and a university-based clinic) related to 1 university hospital. All 4 clinics showed an increase in the rate of portal use as measured by electronic patient-to-provider messaging during the study period. Electronic patient-to-provider messaging was significantly positively correlated with incoming telephone calls at 2 of the clinics (r = 0.546, P < .001 and r = 0.543, P < .001). The remaining clinics were not significantly correlated but demonstrated a weak positive correlation (r = 0.098, P = .560 and r = 0.069, P = .671). Implementation and increased use of electronic patient-to-provider messaging was associated with increased use of telephone calls in 2 of the study clinics. While practices are increasingly making the decision of whether to implement a patient portal as part of their system of care, it is important that the motivation behind such a change not be based on the idea that it will alleviate clinical workload. © Copyright 2016 by the American Board of Family Medicine.
... 416 RIN 0960-AH17 Consultative Examination--Annual Onsite Review of Medical Providers AGENCY: Social... triggers annual on-site reviews of medical providers who conduct consultative examinations (CEs) for our... in 1991. We expect the revised threshold amount will reestablish the level of oversight activity we...
Augustine, Jill M; Taylor, Ann M; Pelger, Martin; Schiefer, Danielle; Warholak, Terri L
Tobacco use is the nation's leading cause of preventable illness and death, causing a significant burden on the health care system. Many cessation pharmacotherapy treatment options are available to help smokers quit, including nicotine replacement therapies (NRTs) and prescription medications. Research indicates that pharmacists are able to provide a positive benefit to smokers who want to quit through pharmacologic and nonpharmacologic interventions. The aim of the present work was to examine the quit rates among participants who received smoking cessation pharmacotherapy and pharmacist-provided telephone-based quit counseling services. Retrospective database review of enrolled participants. Telephone-based pharmacotherapy and medication counseling services offered from a medication management center. State employees who voluntarily contacted a medication management center for smoking cessation services after receiving promotional flyers. Long-term quit rates at 7 and 13 months were determined by means of patient self-report in response to questioning. Smoking cessation was considered to be a success if the patient reported not smoking for the past 30 days. A total of 238 participants were included in the review. Thirty-nine participants completed the program after the first treatment, 12 participants after the second treatment, and 4 participants after the third treatment. Two patients completed the program more than once. Eighty-five participants (36%) reported results at 7-month follow-up; of these, 43 (51%) were smoking free. A total of 44 participants (18%) reported results at 13-month follow-up; of these, 24 participants (55%) reported being smoking free. There were no significant differences in the percentages of smoking-free participants at 7 or 13 months, regardless of their first treatment (P = 0.06 and 0.345, respectively). Successful quit rates were higher than previously demonstrated with other telephone-based smoking cessation programs. Therefore
Geeta S. Pardeshi
Full Text Available Aims: To describe the number, types and reasons of consultations amongst patients of pulmonary tuberculosis from an urban area. Settings and Design Cross sectional study was conducted amongst new patients of pulmonary tuberculosis initiated on DOTS at District Tuberculosis Centre (DTC, Yavatmal from January to June 2006. Material and Methods: The data regarding consultations were collected along a time line. The reasons for consultations were studied by in-depth interviews. Statistical analysis: Logistic regression analysis and transcripts of interviews. Results and Conclusions A total of 55 patients were studied in whom median duration between first consultation to treatment initiation was 15 days. A majority of cases (87.27% had first consulted a private practitioner. A total of 32 patients reported more than two consultations and 19 had consulted more than two private health service providers. Amongst the movements between consultations, a majority were from private to government. Only four patients had come to DTC without any prior consultation. Many patients came to government health service provider on their own when the symptomatic treatment prescribed by the private practitioners did not relieve their symptoms.
Henn, Patrick; Power, David; Smith, Simon D; Power, Theresa; Hynes, Helen; Gaffney, Robert; McAdoo, John D
In this study we aimed to analyse the structure and content of telephone consultations of final-year medical students in a high-fidelity emergency medicine simulation. The purpose was to identify any areas of deficiency within structure and content in the effective transfer of clinical information via the telephone of final-year medical students. An educational study. Simulation centre in a medical school. 113 final-year medical students. The primary outcome was to analyse the structure and content of telephone consultations of final-year medical students in a high-fidelity emergency medicine simulation. The secondary outcome was to identify any areas of deficiency within structure and content in the effective transfer of clinical information via the telephone of final-year medical students. During phone calls to a senior colleague 30% of students did not positively identify themselves, 29% did not identify their role, 32% did not positively identify the recipient of the phone call, 59% failed to positively identify the patient, 49% did not read back the recommendations of their senior colleague and 97% did not write down the recommendations of their senior colleague. We identified a deficiency in our students skills to communicate relevant information via the telephone, particularly failure to repeat back and write down instructions. We suggest that this reflects a paucity of opportunities to practice this skill in context during the undergraduate years. The assumption that this skill will be acquired following qualification constitutes a latent error within the healthcare system. The function of undergraduate medical education is to produce graduates who are fit for purpose at the point of graduation.
Dong, Betty J; Williams, Michelle R; Bingham, J Tyler; Tokumoto, Jason; Allen, Jeffery D
To describe the collaboration and prospective outcome of challenging human immunodeficiency virus (HIV) cases presented by Board of Prisons (BOP) pharmacists in consultation with Clinician Consultation Center (CCC) clinical pharmacists and physicians to improve correctional patient care. Federal correctional facilities. Pharmacists improve care of incarcerated persons infected with HIV. Pharmacists evaluate, implement, and provide successful oversight of HIV/hepatitis C virus (HCV) care. Retrospective review of the clinical outcomes of HIV and HCV coinfected cases implemented by BOP pharmacists following CCC clinical consultations from 2010 through 2012. Most cases focused on selecting optimal antiretroviral therapy (ART) regimens in patients experiencing treatment failure by interpreting resistance tests, limiting ART toxicity, identifying adherence strategies, and managing HIV/HCV coinfection. In 32 of the 34 cases presented, 87.5% (28/32) of CCC recommendations were implemented, resulting in 89% of those patients (25/28) achieving optimal virologic or clinical outcome. Complete virologic suppression occurred in 64% (18/28), and significant viral load reductions in 25% (7/28) of the cases. No changes occurred in 2 patients, and data were not available in 2 others lost to follow-up. BOP participation has increased since its inception from 6 to 12-15 pharmacists per call. Discussions also included updates in antiretroviral guidelines, screening and management of patients coinfected with HIV and HCV, and implications for BOP guidelines. BOP clinical consultant pharmacists can successfully implement CCC recommendations to achieve desired clinical outcomes. Consultations and educational efforts from CCC experts assist BOP pharmacists in ensuring excellence in management of complex HIV/HCV issues and medication regimens to achieve desired outcomes. CCC collaboration and BOP pharmacist involvement have improved patient care. Using a team approach to include BOP
Lakhan, Shaheen E; Schwindt, Mitchel; Alshareef, Bashar N; Tepper, Deborah; Mays, Maryann
As per the Centers for Medicare and Medicaid Services (CMS) current proposal, many specialties including neurology are not eligible for the increase in Medicare reimbursements that will be allocated to other cognitive specialties, such as the 7% increase for family physicians, 5% for internists, and 4% for geriatric specialists.(1,2) Other specialties such as anesthesiology, radiology, and cardiology are scheduled for a 3%-4% decrease in reimbursement in order to pay for the increases outlined above. Current estimates show that neurologists provide a significant amount of primary care for complex patients and yet these services are not eligible for increased payments. It is estimated that up to 60% of neurologists' services to these complex patients are ineligible for increased payments.(3.)
Jensen, Matilde Nisbeth; Fage-Butler, Antoinette Mary
in our understanding of the group consultation. Our specific focus is on interpersonal communication in group consultations, with specific focus on patient-patient communication. This paper presents findings from a research project on pregnant women’s experiences of group consultations with a midwife...... in the Danish setting. Methods: Using a sequential mixed methods design, we first performed a discourse analysis of the written materials provided to the women about the group consultations. In the second step, we interview the women about their experiences of the group consultations. Findings: The analysis...... of the written materials found the juxtaposition of biomedical and patient empowerment discourses; these findings form the backdrop to the interviews, which are currently being undertaken. Conclusions: This study not only presents empirical findings on a relatively new, but increasingly used, setting for client...
Pearson, Steven D; Moreno, Ricardo; Trnka, Yvona
OBJECTIVE To study the process, outcomes, and time spent on informal consultations provided by gastroenterologists to the primary care general internists of an HMO. DESIGN Observational study. SETTING A large, urban staff-model HMO. PATIENTS/PARTICIPANTS Seven gastroenterologists constituting the total workforce of the gastroenterology department of the HMO. MEASUREMENTS AND MAIN RESULTS Data on 91 informal consultations were obtained, of which 55 (60%) involved the acute management of a patient with new symptoms or test results, and 36 (40%) were for questions related to nonacute diagnostic test selection or medical therapy. Questions regarding patients previously unknown to the gastroenterology department accounted for 74 (81%) of the consultations. Formal referral was recommended in only 16 (22%) of these cases. As judged by the time data gathered on the 91 consultations, the gastroenterologists spent approximately 7.2 hours per week to provide informal consultation for the entire HMO. CONCLUSIONS Gastroenterologists spend a significant amount of time providing informal consultation to their general internist colleagues in this HMO. The role informal consultation plays in the workload of physicians and in the clinical care of populations is an important question for health care system design, policy, and research. PMID:9686708
Full Text Available Abstract Background Given the relatively sudden change from learner to teacher-provider that new consultants experience and the likely clinical and managerial challenges this may pose, there is a relative dearth of research into the problems they may have in relation to their new roles, or how supported they feel by senior colleagues acting in a mentoring role. This research sought to determine new consultants views on the quality and relevance of their training, its relationship to their confidence in clinical and managerial skills and their views on mentorship by senior colleagues. Methods Detailed postal questionnaire to new consultants using open and closed questions. Open questionnaire to established consultants to validate new consultant responses. Results Respondents felt their clinical training was good and were generally confident in most clinical skills although some perceived deficiencies in more complex procedures and specialist areas. Most lacked confidence in many managerial skills. These perceptions were verified by established consultants. Although no relationship was found between total training time or quality of training with confidence, extra training in specific sub-specialities improved confidence in these areas. While most established consultants thought that mentorship would be useful for new consultants, only 52% of them shared this view. Conclusion Training and experience in management should be given greater emphasis. There may be a need for specific, targeted training in complex procedures for doctors who experience lack of confidence in these areas. Mentorship should be offered to new consultants and recognised in the job-plan of the new consultant contract.
van Heest, F. B.; Finlay, I. G.; Kramer, J. J. E.; Otter, R.; Meyboom-de Jong, B.
Objective. Data from 2003 were analysed independently to reveal how often and in what way palliative sedation and euthanasia were discussed. Methods. The telephone documentation forms and corresponding evaluation forms of two GP advisors were systematically analysed for problems relating to the role
Holt, Tim A; Fletcher, Emily; Warren, Fiona; Richards, Suzanne; Salisbury, Chris; Calitri, Raff; Green, Colin; Taylor, Rod; Richards, David A; Varley, Anna; Campbell, John
Telephone triage is an increasingly common means of handling requests for same-day appointments in general practice. To determine whether telephone triage (GP-led or nurse-led) reduces clinician-patient contact time on the day of the request (the index day), compared with usual care. A total of 42 practices in England recruited to the ESTEEM trial. Duration of initial contact (following the appointment request) was measured for all ESTEEM trial patients consenting to case notes review, and that of a sample of subsequent face-to-face consultations, to produce composite estimates of overall clinician time during the index day. Data were available from 16,711 initial clinician-patient contacts, plus 1290 GP, and 176 nurse face-to-face consultations. The mean (standard deviation) duration of initial contacts in each arm was: GP triage 4.0 (2.8) minutes; nurse triage 6.6 (3.8) minutes; and usual care 9.5 (5.0) minutes. Estimated overall contact duration (including subsequent contacts on the same day) was 10.3 minutes for GP triage, 14.8 minutes for nurse triage, and 9.6 minutes for usual care. In nurse triage, more than half the duration of clinician contact (7.7 minutes) was with a GP. This was less than the 9.0 minutes of GP time used in GP triage. Telephone triage is not associated with a reduction in overall clinician contact time during the index day. Nurse-led triage is associated with a reduction in GP contact time but with an overall increase in clinician contact time. Individual practices may wish to interpret the findings in the context of the available skill mix of clinicians. © British Journal of General Practice 2016.
Gamst-Jensen, Hejdi; Lippert, Freddy K; Egerod, Ingrid
Telephone consultation and triage are used to limit the workload on emergency departments. Lack of visual cues and clinical tests put telephone consultations to a disadvantage compared to face-to-face consultations increasing the risk of under-triage. Under-triage occurs in telephone triage; however why under-triage happens is not explored yet. The aim of the study was to describe situations of under-triage in context, to assess the quality of under-triaged calls, and to identify communication patterns contributing to under-triage in a regional OOH service in the capital region of Denmark. Explanatory simultaneous mixed method with thematic analysis and descriptive statistics was chosen. The study was carried out in an Out-Of-Hours service (OOH) in the Capital Region of Denmark, Copenhagen. Under-triage was defined as Potentially Under-Triaged Calls (PUTC) by specific criteria to an OOH Hotline, and identification by integration of three databases: Medical Hotline database, Emergency number database, including the Ambulance database, and electronic patient records. Distribution of PUTC were carried out using ICD-10 codes to identify diagnosis and main themes identified by qualitative analysis of audio recorded under-triaged calls. Study period was October 15 th to November 30 th 2014. Three hundred twenty seven PUTC were identified, representing 0.04% of all calls (n = 937.056) to the OOH. Distribution of PUTC according to diagnoses was: digestive (24%), circulatory (19%), respiratory (15%) and all others (42%). Thematic analysis of the voice logs suggested that inadequate communication and non-normative symptom description contributed to under-triage. The incidence of potentially under-triage is low (0.04%). However, the over-representation of digestive, circulatory, and respiratory diagnoses might suggest that under-triage is related to inadequate symptom description. We recommend that caller and call-handler collaborate systematically on problem
Dwamena, Francesca; Holmes-Rovner, Margaret; Gaulden, Carolyn M; Jorgenson, Sarah; Sadigh, Gelareh; Sikorskii, Alla; Lewin, Simon; Smith, Robert C; Coffey, John; Olomu, Adesuwa
Communication problems in health care may arise as a result of healthcare providers focusing on diseases and their management, rather than people, their lives and their health problems. Patient-centred approaches to care delivery in the patient encounter are increasingly advocated by consumers and clinicians and incorporated into training for healthcare providers. However, the impact of these interventions directly on clinical encounters and indirectly on patient satisfaction, healthcare behaviour and health status has not been adequately evaluated. To assess the effects of interventions for healthcare providers that aim to promote patient-centred care (PCC) approaches in clinical consultations. For this update, we searched: MEDLINE (OvidSP), EMBASE (OvidSP), PsycINFO (OvidSP), and CINAHL (EbscoHOST) from January 2000 to June 2010. The earlier version of this review searched MEDLINE (1966 to December 1999), EMBASE (1985 to December 1999), PsycLIT (1987 to December 1999), CINAHL (1982 to December 1999) and HEALTH STAR (1975 to December 1999). We searched the bibliographies of studies assessed for inclusion and contacted study authors to identify other relevant studies. Any study authors who were contacted for further information on their studies were also asked if they were aware of any other published or ongoing studies that would meet our inclusion criteria. In the original review, study designs included randomized controlled trials, controlled clinical trials, controlled before and after studies, and interrupted time series studies of interventions for healthcare providers that promote patient-centred care in clinical consultations. In the present update, we were able to limit the studies to randomized controlled trials, thus limiting the likelihood of sampling error. This is especially important because the providers who volunteer for studies of PCC methods are likely to be different from the general population of providers. Patient-centred care was defined as a
Ericson, Jenny; Eriksson, Mats; Hellström-Westas, Lena; Hagberg, Lars; Hoddinott, Pat; Flacking, Renée
Although breast milk has numerous benefits for infants' development, with greater effects in those born preterm (at breastfeeding duration than mothers of term infants. One of the explanations proposed is the difficulties in the transition from a Neonatal Intensive Care Unit (NICU) to the home environment. A person-centred proactive telephone support intervention after discharge from NICU is expected to promote mothers' sense of trust in their own capacity and thereby facilitate breastfeeding. A multicentre randomized controlled trial has been designed to evaluate the effectiveness and cost-effectiveness of person-centred proactive telephone support on breastfeeding outcomes for mothers of preterm infants. Participating mothers will be randomized to either an intervention group or control group. In the intervention group person-centred proactive telephone support will be provided, in which the support team phones the mother daily for up to 14 days after hospital discharge. In the control group, mothers are offered a person-centred reactive support where mothers can phone the breastfeeding support team up to day 14 after hospital discharge. The intervention group will also be offered the same reactive telephone support as the control group. A stratified block randomization will be used; group allocation will be by high or low socioeconomic status and by NICU. Recruitment will be performed continuously until 1116 mothers (I: 558 C: 558) have been included. proportion of mothers exclusively breastfeeding at eight weeks after discharge. proportion of breastfeeding (exclusive, partial, none and method of feeding), mothers satisfaction with breastfeeding, attachment, stress and quality of life in mothers/partners at eight weeks after hospital discharge and at six months postnatal age. Data will be collected by researchers blind to group allocation for the primary outcome. A qualitative evaluation of experiences of receiving/providing the intervention will also be
Pastakia, Sonak D; Vincent, William R; Manji, Imran; Kamau, Evelyn; Schellhase, Ellen M
To compare the clinical consultations provided by American and Kenyan pharmacy students in an acute care setting in a developing country. The documented pharmacy consultation recommendations made by American and Kenyan pharmacy students during patient care rounds on an advanced pharmacy practice experience at a referral hospital in Kenya were reviewed and classified according to type of intervention and therapeutic area. The Kenyan students documented more interventions than American students (16.7 vs. 12.0 interventions/day) and provided significantly more consultations regarding human immunodeficiency virus (HIV) and antibiotics. The top area of consultations provided by American students was cardiovascular diseases. American and Kenyan pharmacy students successfully providing clinical pharmacy consultations in a resource-constrained, acute-care practice setting suggests an important role for pharmacy students in the reconciliation of prescriber orders with medication administration records and in providing drug information.
Tiwari, Aseem K; Aggarwal, Geet; Dara, Ravi C; Arora, Dinesh; Srivastava, Khushboo; Raina, Vimarsh
Blood donor experiences both immediate adverse reactions (IAR) and delayed adverse reactions (DAR). With limited published data available on the incidence of DAR, a study was conducted to estimate incidence and profile of DAR through telephonic interview. Study was conducted over a 45-day period for consecutive volunteer whole blood donations at tertiary care hospital. Donors were divided into first-time, repeat and regular and were monitored for IAR. They were given written copy of post-donation advice. Donors were contacted telephonically three weeks post-donation and enquired about general wellbeing and specific DAR in accordance with a standard n international (International Society of Blood Transfusion) standard format. Donors participated in the study of which 1.6% donors experienced an IAR. Much larger number reported DAR (10.3% vs.1.6% pdonors (age donors (>50 years). First time (12.3%) and repeat donors (13.5%) had similar frequency of DAR but were lower among regular donors (6.7%). DARs are more common than IAR and are of different profile. Post-donation interview has provided an insight into donor experiences and can be used as a valuable tool in donor hemovigilance. Copyright © 2016 Elsevier Ltd. All rights reserved.
Christen, Margaret H.; Hasbrouck, Jan E.
An observational instrument was developed to facilitate the peer coaching process by special education consulting teachers with regular class teacher colleagues. Use of the instrument was piloted by a special education consulting teacher with three middle school teachers whose classes included special education and at-risk students. The instrument…
The effectiveness and cost-effectiveness of telephone triage of patients requesting same day consultations in general practice: study protocol for a cluster randomised controlled trial comparing nurse-led and GP-led management systems (ESTEEM)
Background Recent years have seen an increase in primary care workload, especially following the introduction of a new General Medical Services contract in 2004. Telephone triage and telephone consultation with patients seeking health care represent initiatives aimed at improving access to care. Some evidence suggests that such approaches may be feasible but conclusions regarding GP workload, cost, and patients’ experience of care, safety, and health status are equivocal. The ESTEEM trial aims to assess the clinical- and cost-effectiveness of nurse-led computer-supported telephone triage and GP-led telephone triage, compared to usual care, for patients requesting same-day consultations in general practice. Methods/design ESTEEM is a pragmatic, multi-centre cluster randomised clinical trial with patients randomised at practice level to usual care, computer decision-supported nurse triage, or GP-led triage. Following triage of 350–550 patients per practice we anticipate estimating and comparing total primary care workload (volume and time), the economic cost to the NHS, and patient experience of care, safety, and health status in the 4-week period following the index same-day consultation request across the three trial conditions. We will recruit all patients seeking a non-emergency same-day appointment in primary care. Patients aged 12.0–15.9 years and temporary residents will be excluded from the study. The primary outcome is the number of healthcare contacts taking place in the 4-week period following (and including) the index same-day consultation request. A range of secondary outcomes will be examined including patient flow, primary care NHS resource use, patients’ experience of care, safety, and health status. The estimated sample size required is 3,751 patients (11,253 total) in each of the three trial conditions, to detect a mean difference of 0.36 consultations per patient in the four week follow-up period between either intervention group and usual
Winkler, Sabune J.; Bierer, Barbara E.; Wolf, Delia
Abstract The Food and Drug Administration (FDA) regulations require sponsors of clinical investigations involving an investigational drug or device to submit an Investigational New Drug (IND) or Investigational Device Exemption (IDE) application. Strict adherence to applicable regulations is vital to the success of clinical research. Unlike most major pharmaceutical sponsors, investigator sponsors often do not fully appreciate their regulatory obligations nor have resources to ensure compliance. As a result they can place themselves and their institutions at risk. Nevertheless, investigator‐initiated clinical trials are vital to the further development of innovative drugs, biologics, and medical devices. The IND/IDE Subcommittee under the Regulatory Knowledge and Support Program at Harvard Catalyst, The Harvard Clinical and Translational Science Center worked in collaboration with Harvard and Harvard affiliated institutions to create and launch an IND/IDE Consult Service in a decentralized network of collaborating Academic Healthcare Centers (AHC). The IND/IDE Consult Service offers expertise, resources, and shared experiences to assist sponsor‐investigators and IRBs in meeting regulatory requirements for conducting and reviewing investigator‐initiated IND/IDE studies. The scope of the services provided by the Harvard Catalyst IND/IDE Consult Service are described, including the specifics of the service, lessons learned, and challenges faced, in a scalable model that builds inter‐institutional capacity. PMID:24455986
La Pean, Alison; Farrell, Michael H.; Eskra, Kerry L.; Farrell, Philip M.
Objectives To assess whether reporting “possible cystic fibrosis (CF)” newborn screening (NBS) results via fax plus simultaneous telephone contact with primary care providers (PCPs), versus fax alone, influenced three outcomes: getting a sweat chloride test, age at sweat chloride test, and sweat-testing before 8 weeks old. Study Design Retrospective cohort comparison of infants born in Wisconsin whose PCPs received telephone intervention (n=301), versus recent historical controls whose PCP did not (n=355). Intervention data were collected during a longitudinal research and quality improvement effort; de-identified comparison data were constructed from auxiliary NBS tracking information. Parametric and nonparametric statistical analyses tested for group differences. Results Most infants (92%) with “possible CF” NBS results whose PCPs lacked telephone intervention ultimately underwent sweat-testing, underlining efficacy for fax-only reporting. Telephone intervention was significantly associated with improvements in infants undergoing sweat-testing at both ≤6 and sweat-testing. The effect of telephone intervention was greater for PCPs whose patients underwent sweat-testing at community-affiliated medical centers versus academic medical centers (p=0.008). Conclusion Reporting “possible CF” NBS results via fax plus simultaneous telephone follow-up with PCPs increases the number of infants who have sweat chloride tests before 8 weeks of age, when affected infants are more likely to receive full benefits of early diagnosis and treatment. PMID:23102590
Laura Muller Silva
Full Text Available Introduction: medical care with the participation of medical students is a reality in many cities where medical schools are located.In such context, gynecology is a unique specialty, because it concerns not only patients with organic problems, but also patients with emotional and sexual issues, or anything that involves the female condition. Objectives: the aim of this study was to identify the positive and negative aspects of gynecological care and if the women changed their opinion after being consulted by a medical student. Method: qualitative study in which 39 women were interviewed. They were aged 19 - 60 years and sought gynecological care in Basic Health Units, which were conducted by professors and medical students from the Faculdade de Medicina de Barbacena. Interviews were conducted before and after the consultation and each participant could express herself freely and spontaneously. Results: regarding the feeling of the first gynecological care with medical students, most women were apprehensive and insecure at first, and only a minority was quiet. However, after the consultation most of them were satisfied. Conclusion: it was observed that there was a change in perception and feelings of women attended by students after consultation. The patients demonstrated acceptance, satisfaction and overcoming of their expectations.
Bruce, Jordan G; Tucholka, Jennifer L; Steffens, Nicole M; Mahoney, Jane E; Neuman, Heather B
Patients facing decisions for breast cancer surgery commonly search the internet. Directing patients to high-quality websites prior to the surgeon consultation may be one way of supporting patients' informational needs. The objective was to test an approach for delivering web-based information to breast cancer patients. The implementation strategy was developed using the Replicating Effective Programs framework. Pilot testing measured the proportion that accepted the web-based information. A pre-consultation survey assessed whether the information was reviewed and the acceptability to stakeholders. Reasons for declining guided refinement to the implementation package. Eighty-two percent (309/377) accepted the web-based information. Of the 309 that accepted, 244 completed the pre-consultation survey. Participants were a median 59 years, white (98%), and highly educated (>50% with a college degree). Most patients who completed the questionnaire reported reviewing the website (85%), and nearly all found it helpful. Surgeons thought implementation increased visit efficiency (5/6) and would result in patients making more informed decisions (6/6). The most common reasons patients declined information were limited internet comfort or access (n = 36), emotional distress (n = 14), and preference to receive information directly from the surgeon (n = 7). Routine delivery of web-based information to breast cancer patients prior to the surgeon consultation is feasible. High stakeholder acceptability combined with the low implementation burden means that these findings have immediate relevance for improving care quality.
Schrooten, Iete; de Jong, Menno D T
This article investigates the relationship between healthcare providers' empathic and communicative competencies and clients' overall satisfaction with consultations. Two aspects of empathy were included: empathic attitude (sensitivity to the clients' perspective) and empathic skills (ability to estimate clients' evaluations). Communicative competencies were narrowed down to the clarity of the information provided. In the context of work disability examinations, 90 healthcare providers (44% physicians, 56% vocational experts) participated. For each provider, up to 20 dyads with clients were investigated. Within every dyad, clients rated their experiences and healthcare providers estimated clients' scores. The results show that both aspects of empathy and clarity of information significantly contribute to clients' overall satisfaction and as such confirm the importance of empathy and communication in medical consultations. Specifically, healthcare providers' empathic dispositions, in addition to their overt communicative behavior, appear to contribute to clients' overall satisfaction. Of the two aspects of empathy, only empathic attitude is significantly related to the clarity of information.
Grevemeyer, Bernard; Betance, Larry; Artemiou, Elpida
Evidence from human medicine shows a rise in telephone communication in support of after-hours services and in providing medical advice, follow-up information, etc. While specific training programs are continuously being developed for human medical education, limited publications are available on training veterinary students in telephone communication. Presented is our method of introducing a telephone communication skills exercise to third-year veterinary students. The exercise progressed over three phases and currently follows the principles of the Calgary-Cambridge Guide. Challenges and improvements on implementing a telephone communication exercise are discussed. Within veterinary communication curricula, attention should be given to the specific communication skills required for successful telephone consultations. In the absence of visual nonverbal cues and prompts during a telephone interaction, communication skills must be applied with greater intent and attention to achieve an effective consultation outcome.
Ericson, Jenny; Eriksson, Mats; Hellström-Westas, Lena; Hagberg, Lars; Hoddinott, Pat; Flacking, Renée
Background: Although breast milk has numerous benefits for infants' development, with greater effects in those born preterm (at < 37 gestational weeks), mothers of preterm infants have shorter breastfeeding duration than mothers of term infants. One of the explanations proposed is the difficulties in the transition from a Neonatal Intensive Care Unit (NICU) to the home environment. A person-centred proactive telephone support intervention after discharge from NICU is expected to promote mo...
Naterop, B Jean
Many people have to use English on the telephone in the course of their work, either at the level of taking a simple message or involving more complex tasks such as requesting information. Telephoning in English provides an up-to-date and relevant context in which students from lower-intermediate level upwards can develop practical telephone skills. The course principally develops spoken interactive skills, but also includes reading material on telephone systems and techniques. As the material is not restricted to particular job functions, it is suitable for students in a wide range of business and administration fields.
As part of the upgrade of telephone services, the CERN exchange switches will be updated on Thursday 2 June between 7.00 p.m. and midnight. Telephone services may be affected and possibly even disrupted during this operation.
Hasbrouck, Jan E.; Christen, Margaret H.
This articles describes the Scale for Coaching Instructional Effectiveness, an instrument to help special education peer coaches observe general education teachers' skills, strategies, and techniques and provide feedback in the areas of planning and organization, instruction, and classroom management. Presents three examples of the instrument…
Brown, Erica; Coad, Jane; Staniszewska, Sophie; Hacking, Suzanne; Chesworth, Brigit; Chambers, Lizzie
Children with life limiting conditions and their families have complex needs. Evaluations must consider their views and perspectives to ensure care is relevant, appropriate and acceptable. We consulted with children, young people, their parents and local professionals to gain a more informed picture of issues affecting them prior to preparing a bid to evaluate services in the area. Multiple methods included focus groups, face-to-face and telephone interviews and participatory activities. Recordings and products from activities were analysed for content to identify areas of relevance and concern. An overarching theme from parents was ‘Why does it happen like this?’ Services did not seem designed to meet their needs. Whilst children and young people expressed ideas related to quality of environment, services and social life, professionals focused on ways of meeting the families’ needs. The theme that linked families’ concerns with those of professionals was ‘assessing individual needs’. Two questions to be addressed by the evaluation are (1) to what extent are services designed to meet the needs of children and families and (2) to what extent are children, young people and their families consulted about what they need? Consultations with families and service providers encouraged us to continue their involvement as partners in the evaluation. PMID:24270996
Bello, Aminu K; Molzahn, Anita E; Girard, Louis P; Osman, Mohamed A; Okpechi, Ikechi G; Glassford, Jodi; Thompson, Stephanie; Keely, Erin; Liddy, Clare; Manns, Braden; Jinda, Kailash; Klarenbach, Scott; Hemmelgarn, Brenda; Tonelli, Marcello
We assessed stakeholder perceptions on the use of an electronic consultation system (e-Consult) to improve the delivery of kidney care in Alberta. We aim to identify acceptability, barriers and facilitators to the use of an e-Consult system for ambulatory kidney care delivery. This was a qualitative focus group study using a thematic analysis design. Eight focus groups were held in four locations in the province of Alberta, Canada. In total, there were 72 participants in two broad stakeholder categories: patients (including patients' relatives) and providers (including primary care physicians, nephrologists, other care providers and policymakers). The e-Consult system was generally acceptable across all stakeholder groups. The key barriers identified were length of time required for referring physicians to complete the e-Consult due to lack of integration with current electronic medical records, and concerns that increased numbers of requests might overwhelm nephrologists and lead to a delayed response or an unsustainable system. The key facilitators identified were potential improvement of care coordination, dissemination of best practice through an educational platform, comprehensive data to make decisions without the need for face-to-face consultation, timely feedback to primary care providers, timeliness/reduced delays for patients' rapid triage and identification of cases needing urgent care and improved access to information to facilitate decision-making in patient care. Stakeholder perceptions regarding the e-Consult system were favourable, and the key barriers and facilitators identified will be considered in design and implementation of an acceptable and sustainable electronic consultation system for kidney care delivery. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Dean L Franklin; Timothy D Krieger
.... Custom Hardware Engineering & Consulting Inc ("Storage Tech. i"), held that 17 U.S.C. S 117 excluded from copyright infringement the copying of computer programs by an ISO while performing ongoing maintenance on a computer system...
Bagcivan, Gulcan; Dionne-Odom, J Nicholas; Frost, Jennifer; Plunkett, Margaret; Stephens, Lisa A; Bishop, Peggy; Taylor, Richard A; Li, Zhongze; Tucker, Rodney; Bakitas, Marie
Early outpatient palliative care consultations are recommended by clinical oncology guidelines globally. Despite these recommendations, it is unclear which components should be included in these encounters. Describe the evaluation and treatment recommendations made in early outpatient palliative care consultations. Outpatient palliative care consultation chart notes were qualitatively coded and frequencies tabulated. Outpatient palliative care consultations were automatically triggered as part of an early versus delayed randomized controlled trial (November 2010 to April 2013) for patients newly diagnosed with advanced cancer living in the rural Northeastern US. In all, 142 patients (early = 70; delayed = 72) had outpatient palliative care consultations. The top areas addressed in these consultations were general evaluations-marital/partner status (81.7%), spirituality/emotional well-being (80.3%), and caregiver/family support (79.6%); symptoms-mood (81.7%), pain (73.9%), and cognitive/mental status (68.3%); general treatment recommendations-counseling (39.4%), maintaining current medications (34.5%), and initiating new medication (23.9%); and symptom-specific treatment recommendations-pain (22.5%), constipation (12.7%), depression (12.0%), advanced directive completion (43.0%), identifying a surrogate (21.8%), and discussing illness trajectory (21.1%). Compared to the early group, providers were more likely to evaluate general pain ( p = 0.035) and hospice awareness ( p = 0.005) and discuss/recommend hospice ( p = 0.002) in delayed group participants. Outpatient palliative care consultations for newly diagnosed advanced cancer patients can address patients' needs and provide recommendations on issues that might not otherwise be addressed early in the disease course. Future prospective studies should ascertain the value of early outpatient palliative care consultations that are automatically triggered based on diagnosis or documented symptom
Chambers, Georgina M; Randall, Sean; Mihalopoulos, Cathrine; Reilly, Nicole; Sullivan, Elizabeth A; Highet, Nicole; Morgan, Vera A; Croft, Maxine L; Chatterton, Mary Lou; Austin, Marie-Paule
Objective To quantify total provider fees, benefits paid by the Australian Government and out-of-pocket patients' costs of mental health Medicare Benefits Schedule (MBS) consultations provided to women in the perinatal period (pregnancy to end of the first postnatal year). Method A retrospective study of MBS utilisation and costs (in 2011-12 A$) for women giving birth between 2006 and 2010 by state, provider-type, and geographic remoteness was undertaken. Results The cost of mental health consultations during the perinatal period was A$17.5million for women giving birth in 2007, rising to A$29million in 2010. Almost 9% of women giving birth in 2007 had a mental health consultation compared with more than 14% in 2010. An increase in women accessing consultations, along with an increase in the average number of consultations received, were the main drivers of the increased cost, with costs per service remaining stable. There was a shift to non-specialist care and bulk billing rates increased from 44% to 52% over the study period. In 2010, the average total cost (provider fees) per woman accessing mental health consultations during the perinatal period was A$689, and the average cost per service was A$133. Compared with women residing in regional and remote areas, women residing in major cities where more likely to access consultations, and these were more likely to be with a psychiatrist rather than an allied health professional or general practitioner. Conclusion Increased access to mental health consultations has coincided with the introduction of recent mental health initiatives, however disparities exist based on geographic location. This detailed cost analysis identifies inequities of access to perinatal mental health services in regional and remote areas and provides important data for economic and policy analysis of future mental health initiatives. What is known about the topic? The mental healthcare landscape in Australia has changed significantly over the
Whelan, Anne Marie; Langille, Donald B; Hurst, Eileen
The objective of this research was to explore pharmacists' knowledge of, experiences with and perception of factors interfering with their ability to provide non-prescription emergency contraceptive pill consultations in the Canadian province of Nova Scotia. A self-administered paper questionnaire was mailed, using Dillman's tailored design method, to all pharmacists (n = 1123) registered with the Nova Scotia College of Pharmacists. The response rate was 53.0% (595/1123), with 451 respondents working in community practice. Most respondents reported that they had provided consultations for the emergency contraceptive product Plan B since it became available without a prescription (93.6%), and that Plan B is kept behind the pharmacy counter (83.6%). Pharmacists most frequently (47.8%) reported spending 6-10 min providing Plan B consultations. Respondents were generally knowledgeable about Plan B; however, only 39.2% knew that it can be effective for up to 5 days and 69.3% knew that the incidence of vomiting is less than 50%. The factors interfering the most with providing Plan B consultations were lack of privacy (46.1%) and lack of staff to cover during the consultation (50.9%). In general, Nova Scotia pharmacists are knowledgeable about emergency contraceptive pills; however, education regarding effective timing for use of such pills would be helpful. Private areas for counselling and consideration of pharmacy staffing schedules in community pharmacies may help address pharmacist concerns regarding their ability to provide Plan B consultations. © 2013 The Authors. IJPP © 2013 Royal Pharmaceutical Society.
Hoffman, Irwin; Cosby, Richard S.
Telephonic electrocardiography is a new and useful adjunct to the diagnosis and treatment of cardiovascular disease. It has already demonstrated its great value both in clinical practice and in hospital teaching. It has, however, many other possible roles, for example, in more efficient monitoring after operations on the heart, or in the office monitoring of seriously ill patients with infarction or Adams-Stokes attacks. The availability of increased data in cardiac cases leads automatically to a better understanding of cardiac disease. PMID:14165874
Cooke, J; Molefe, C; Carew, S; Finucane, P; Clinch, D
Our aim was to assess the acceptability and cost-efficiency of shared consultancy posts. Two consultant physicians worked alternate fortnights for a period of twelve months. Questionnaires were distributed to general practitioners, nurses, consultants and junior doctors affected by the arrangement. Patients or their next of kin were contacted by telephone. 1/17 of consultants described the experience as negative. 14/19 junior doctors reported a positive experience. 11 felt that training had been improved while 2 felt that it had been adversely affected. 17/17 GPs were satisfied with the arrangement. 1/86 nurses surveyed reported a negative experience. 1/48 patients were unhappy with the arrangement. An extra 2.2 (pposts can be broadly acceptable and cost efficient in Ireland.
Szöts, Kirsten; Konradsen, Hanne; Solgaard, Søren
AIM AND OBJECTIVES: To generate information on how telephone follow-up consultations, structured by nursing status according to the VIPS-model, functioned after total knee arthroplasty. The objectives were to unfold the content of the telephone follow-ups according to the structure for nursing...... status and to explore the patients' views of the telephone follow-ups. BACKGROUND: The length of stay in hospital following total knee arthroplasty has fallen markedly, and patients now have to be responsible for their recovery from a very early stage. After discharge, patients may experience a variety...... Telephone follow-up was valued by total knee arthroplasties patients as representing a holistic approach and providing adequate information, counselling and support after discharge to home. Three categories were identified with regard to the patients' views: 'A means for reflection and provision of adequate...
Beddis, H P; Durey, K A; Chan, M F W Y
Background Funding for implant-based treatment within secondary care is limited, and acceptance criteria are determined locally according to funding agreements with NHS England. Indefinite review of all patients in secondary care is unlikely to be feasible due to limitations on departmental capacity. The increasing number of patients provided with implant-based treatment in secondary care has resulted in a growing maintenance burden, raising the question of who should provide this care. Management of some complications within primary care would facilitate patients' access to treatment, although no specific provision for maintenance of implant-retained prostheses is made within the NHS Dental Charges Regulations.Materials and methods An online survey was carried out to review services provided within restorative dentistry departments across the UK, investigating departmental protocols for review and maintenance of patients provided with dental implants.Results There was no consensus view on review protocols, discharge or provision of maintenance following implant placement. Fifty-seven percent would indefinitely carry out remake of implant-retained overdentures when clinically indicated, replace worn inserts, housings or abutments. Sixty-one percent would manage loose/lost screw- or cement-retained restorations and 68% would manage fractured restorations. Re-referral for peri-implant disease would be accepted by 64% of respondents. The lack of clear NHS funding for the management of complications was of concern to respondents in this survey.
van Dillen, S M E; Noordman, J; van Dulmen, S; Hiddink, G J
To examine the content of Dutch practice nurses' (PNs') advices about weight, nutrition and physical activity to overweight and obese patients. A 100 videotaped real-life PN consultations (The Netherlands, 2010/2011) with overweight or obese patients were selected. An observational checklist was developed to assess frequency and content. Personalization of advices was scored, as also the guidelines on which PNs based their advices. Content analysis was used to identify different categories of advices. About one quarter of advices concerned weight, over two-thirds nutrition and one-third physical activity. Lose weight, eat less fat and be more physically active in general were the main categories for each type of advice. Despite high clarity of advices, lower scores were found for specificity and personalization. Very few nutrition advices were provided in combination with physical activity advices. Weight advices often related to the patient's complaint. PNs seldom set a concrete weight goal. Although benefits of physical activity were discussed, often no practical advices were provided about how to achieve this. Integrated lifestyle advice was not common: advices about nutrition and physical activity were fragmented throughout the consultation. Obesity prevention needs more emphasis in PNs' educational programs.
Leemrijse Chantal J
Full Text Available Abstract Background Cardiovascular disease (CVD is the leading cause of death worldwide. Secondary prevention is essential, but participation rates for cardiac rehabilitation are low. Furthermore, current programmes do not accomplish that patients with CVD change their lifestyle in a way that their individual risk factors for recurrent events decrease, therefore more effective interventions are needed. In this study, the effectiveness of the Hartcoach-programme, a telephonic secondary prevention program focussing on self management, is studied. Methods/design A multicenter, randomised parallel-group study is being conducted. Participants are 400 patients with acute myocardial infarction (STEMI, NSTEMI, and patients with chronic or unstable angina pectoris (IAP. Patients are recruited through the participating hospitals and randomly assigned to the experimental group (Hartcoach-programme plus usual care or the control group (usual care. The Hartcoach-programme consists of a period of six months during which the coach contacts the patient every four to six weeks by telephone. Coaches train patients to take responsibility for the achievement and maintenance of the defined target levels for their particular individual modifiable risk factors. Target levels and treatment goals are agreed by the nurse and patient together. Data collection is blinded and occurs at baseline and after 26 weeks (post-intervention. Primary outcome is change in cardiovascular risk factors (cholesterol, body mass index, waist circumference, blood pressure, physical activity and diet. Secondary outcomes include chances in glucose, HbA1c, medication adherence, self-management and quality of life. Discussion This study evaluates the effects of the Hartcoach-programme on the reduction of individual risk factors of patients with CVDs. Patients who are not invited to follow a hospital based rehabilitation programme or patients who are unable to adhere to such a programme, may be
Olick, Robert S; Bergus, George R
Informal ("curbside") consults are widely used by primary care physicians. These interactions occur in person, by telephone, or even by e-mail. Exposure to malpractice liability is a frequent concern of subspecialty physicians and influences their willingness to engage in this activity. To assess this risk, we reviewed reported judicial opinions involving informal consultation by physicians. A search of the existing medical literature, and of the Westlaw national database was undertaken to identify reported judicial opinions involving informal physician consults that address whether informal consultations create a legal relationship between consulting specialist physicians and patients that gives rise to a legal duty of care owed by the consulting specialist to the patient. Courts have consistently ruled that no physician-patient relationship exists between a consultant and the patient who is the focus of the informal consultation. In the absence of such a relationship, the courts have found no grounds for a claim of malpractice. Malpractice risks associated with informal consultation appear to be minimal, regardless of the method of communication. While "informal consultation" is not a term used by the courts, the courts have applied a consistent set of criteria that help define the legal parameters of this activity.
Our aim was to assess the acceptability and cost-efficiency of shared consultancy posts. Two consultant physicians worked alternate fortnights for a period of twelve months. Questionnaires were distributed to general practitioners, nurses, consultants and junior doctors affected by the arrangement. Patients or their next of kin were contacted by telephone. 1\\/17 of consultants described the experience as negative. 14\\/19 junior doctors reported a positive experience. 11 felt that training had been improved while 2 felt that it had been adversely affected. 17\\/17 GPs were satisfied with the arrangement. 1\\/86 nurses surveyed reported a negative experience. 1\\/48 patients were unhappy with the arrangement. An extra 2.2 (p<0.001) patients were seen per clinic. Length of stay was shortened by 2.49 days (p<0.001). A saving of 69,212 was made due to decreased locum requirements. We present data suggesting structured shared consultancy posts can be broadly acceptable and cost efficient in Ireland.
Dharmar, Madan; Kuppermann, Nathan; Romano, Patrick S; Yang, Nikki H; Nesbitt, Thomas S; Phan, Jennifer; Nguyen, Cynthia; Parsapour, Kourosh; Marcin, James P
To compare the frequency of physician-related medication errors among seriously ill and injured children receiving telemedicine consultations, similar children receiving telephone consultations, and similar children receiving no consultations in rural emergency departments (EDs). We conducted retrospective chart reviews on seriously ill and injured children presenting to 8 rural EDs with access to pediatric critical care physicians from an academic children's hospital. Physician-related ED medication errors were independently identified by 2 pediatric pharmacists by using a previously published instrument. The unit of analysis was medication administered. The association of telemedicine consultations with ED medication errors was modeled by using hierarchical logistic regression adjusting for covariates (age, risk of admission, year of consultation, and hospital) and clustering at the patient level. Among the 234 patients in the study, 73 received telemedicine consultations, 85 received telephone consultations, and 76 received no specialist consultations. Medications for patients who received telemedicine consultations had significantly fewer physician-related errors than medications for patients who received telephone consultations or no consultations (3.4% vs. 10.8% and 12.5%, respectively; P telemedicine consultations had a lower odds of physician-related errors than medications for patients who received telephone consultations (odds ratio: 0.19, P telemedicine consultations were associated with a significantly reduced risk of physician-related ED medication errors among seriously ill and injured children in rural EDs.
Urgent maintenance work on CERN telephone exchanges will be performed on 24 March from 6 a.m. to 8 a.m. Telephone services may be disrupted or even interrupted during this time. For more details, please contact us by email at Standard.Telephone@cern.ch.
December, 1982. m23. Hersey , Paul , Kenneth H. Blanchard, Management of Organizational Behavior : Utilizing Human Resources, Englewood Cliffs, N.J...WORDS (Continue on reverse side if necessary and identify by block number) Organizational development Management consulting Organizational assessment...provides some suggestions for enhancing the management consulting process within the Air Force. Part one contains an overview of organizational
Full Text Available The possibilities offered by the telephone for use in distance learning are well known, yet stili far too little used. Consultation by telephone means establishing a live contact between the two people who are communicating, and the opportunity for directly solving the problems. Furthermore, it ensures great rationalization in timeusage, since both the mentor and the student can carry out the consultation at any place which suits them; all that matters is that they are prepared for the discussion. Through the interlinking of the mobile telephone system with the Internet, the access to information on the Internet and to e-mail shifts from the computer to the mobile telephone, thus further increasing the advantages of the mobile telephone over other means of communication.
whether providing patients with digital audio recording of the consultation affects the patients overall perception of their consultation and understanding of the information given. The study includes 5.460 patients from four different outpatient clinics: Pediatrics, Urology, Orthopedics and Internal...... clinicians, the communication is challenged by the fact that patients tend to forget or misunderstand parts of the information given. Thus we have designed a study which gives the patients a possibility to hear their consultation again. An Interactive Voice Response platform enables an audio recording...... of the dialogue between the patient and the clinician via the telephone in the consultation room. By dialing a dedicated number, patients can get access to an audio recording of their consultation by entering their social security number along with a PIN. The primary objective of this study is to determine...
Ian Walkinshaw; Todd Milford; Keri Freeman
Responding to calls for research into measurable English language outcomes from individual language support consultations at universities, this study investigated the effect of individual consultations (ICs) on the academic writing skills and lexico-grammatical competence of students who speak English as an additional language (EAL). Attendance by 31 EAL students at ICs was recorded, and samples of their academic writi...
The clinical effectiveness and cost-effectiveness of telephone triage for managing same-day consultation requests in general practice: a cluster randomised controlled trial comparing general practitioner-led and nurse-led management systems with usual care (the ESTEEM trial).
Campbell, John L; Fletcher, Emily; Britten, Nicky; Green, Colin; Holt, Tim; Lattimer, Valerie; Richards, David A; Richards, Suzanne H; Salisbury, Chris; Taylor, Rod S; Calitri, Raff; Bowyer, Vicky; Chaplin, Katherine; Kandiyali, Rebecca; Murdoch, Jamie; Price, Linnie; Roscoe, Julia; Varley, Anna; Warren, Fiona C
Telephone triage is proposed as a method of managing increasing demand for primary care. Previous studies have involved small samples in limited settings, and focused on nurse roles. Evidence is limited regarding the impact on primary care workload, costs, and patient safety and experience when triage is used to manage patients requesting same-day consultations in general practice. In comparison with usual care (UC), to assess the impact of GP-led telephone triage (GPT) and nurse-led computer-supported telephone triage (NT) on primary care workload and cost, patient experience of care, and patient safety and health status for patients requesting same-day consultations in general practice. Pragmatic cluster randomised controlled trial, incorporating economic evaluation and qualitative process evaluation. General practices (n = 42) in four regions of England, UK (Devon, Bristol/Somerset, Warwickshire/Coventry, Norfolk/Suffolk). Patients requesting same-day consultations. Practices were randomised to GPT, NT or UC. Data collection was not blinded; however, analysis was conducted by a statistician blinded to practice allocation. Primary - primary care contacts [general practice, out-of-hours primary care, accident and emergency (A&E) and walk-in centre attendances] in the 28 days following the index consultation request. Secondary - resource use and costs, patient safety (deaths and emergency hospital admissions within 7 days of index request, and A&E attendance within 28 days), health status and experience of care. Of 20,990 eligible randomised patients (UC n = 7283; GPT n = 6695; NT n = 7012), primary outcome data were analysed for 16,211 patients (UC n = 5572; GPT n = 5171; NT n = 5468). Compared with UC, GPT and NT increased primary outcome contacts (over 28-day follow-up) by 33% [rate ratio (RR) 1.33, 95% confidence interval (CI) 1.30 to 1.36] and 48% (RR 1.48, 95% CI 1.44 to 1.52), respectively. Compared with GPT, NT was associated
Patenaude, Andrea Farkas; Schneider, Katherine A
The defining difference between genetic and traditional medicine is that genetic findings have implications not just for the patient, but also for their relatives. Discussion of a test result between parent and child is both a transformative and a translational moment in the life of a family. Parents report wanting help in talking to their children. The challenge for genetic counselors and other providers is to be able to recognize which issues are at the core of parental distress and be able to offer recommendations to empower and support parents. The complexity of potential genetic findings, including variants of uncertain significance (VUS) and incidental findings have vastly increased, requiring considerable explanation and leaving less time for discussion of emotional issues. While the nature of the testing (single gene to multigene panel and genomic testing) is dramatically changing, the nature of parent concerns remains remarkably constant. Families differ in many respects, so no "recipe" suffices to answer parents' questions about how this important task should be approached in each family. Successful consultation to parents requires true counseling, matching parents' fears and questions with information, exploration and advice specific to their concerns, their circumstances and strengths.
Belshaw, Zoe; Robinson, Natalie J; Dean, Rachel S; Brennan, Marnie L
Dog and cat vaccination consultations are a common part of small animal practice in the United Kingdom. Few data are available describing what happens during those consultations or what participants think about their content. The aim of this novel study was to investigate the attitudes of dog and cat owners and veterinary surgeons towards the content of small animal vaccination consultations. Telephone interviews with veterinary surgeons and pet owners captured rich qualitative data. Thematic analysis was performed to identify key themes. This study reports the theme describing attitudes towards the content of the consultation. Diverse preferences exist for what should be prioritised during vaccination consultations, and mismatched expectations may lead to negative experiences. Vaccination consultations for puppies and kittens were described to have a relatively standardised structure with an educational and preventative healthcare focus. In contrast, adult pet vaccination consultations were described to focus on current physical health problems with only limited discussion of preventative healthcare topics. This first qualitative exploration of UK vaccination consultation expectations suggests that the content and consistency of adult pet vaccination consultations may not meet the needs or expectations of all participants. Redefining preventative healthcare to include all preventable conditions may benefit owners, pets and veterinary surgeons, and may help to provide a clearer structure for adult pet vaccination consultations. This study represents a significant advance our understanding of this consultation type.
Hambleton, Julie; Leung, Lawrence L.; Levi, Marcel
Clinical hematologists are frequently consulted for the care of hospitalized patients with complicated coagulopathies. This chapter provides an update on the scientific and clinical advances noted in disseminated intravascular coagulation (DIC) and discusses the challenges in hemostasis
As part of the upgrade of telephone services, the CERN switching centre will be updated on Wednesday 14 June between 8.00 p.m. and midnight. Telephone services may be disrupted and possibly even interrupted during this operation. We apologise in advance for any inconvenience this may cause. CERN TELECOM Service
As part of the upgrade of telephone services, the CERN switching centre will be updated on Monday 3 July between 8.00 p.m. and 3.00 a.m. Telephone services may be disrupted and possibly even interrupted during this operation. We apologise in advance for any inconvenience this may cause. CERN TELECOM Service
As part of the upgrade of telephone services, work will be carried out on the CERN switching centre between Monday 23 October 8.00 p.m. and Tuesday 24 October 2.00 a.m. Telephone services may be disrupted and possibly even interrupted during this operation. We apologise in advance for any inconvenience this may cause. CERN TELECOM Service
Abildgaard, Mette Simonsen
’ mediated telephone conversations, the study identifies four main enablers/disablers for talk on Tværs (the host, the telephone, time and distance) and explores the conditions for listener access to the phone-in as shaped by these factors. Additionally, the article critically questions these conditions...
As part of the upgrade of telephone services, the CERN switching centre will be updated on Monday 3 July between 8.00 p.m. and 3.00 a.m. Telephone services may be disrupted and possibly even interrupted during this operation.We apologise in advance for any inconvenience this may cause. CERN TELECOM Service
Certified models meet all ENERGY STAR requirements as listed in the Version 3.0 ENERGY STAR Program Requirements for Telephony (cordless telephones and VoIP telephones) that are effective as of October 1, 2014. A detailed listing of key efficiency criteria are available at http://www.energystar.gov/index.cfm?c=phones.pr_crit_phones
As part of the upgrade of telephone services, the CERN switching centre will be updated on between Monday 23 October 8.00 p.m. and Tuesday 24 October 2.00 a.m. Telephone services may be disrupted and possibly even interrupted during this operation. We apologise in advance for any inconvenience this may cause. CERN TELECOM Service
Does access to a colorectal cancer screening website and/or a nurse-managed telephone help line provided to patients by their family physician increase fecal occult blood test uptake?: A pragmatic cluster randomized controlled trial study protocol
Full Text Available Abstract Background Fecal occult blood test screening in Canada is sub-optimal. Family physicians play a central role in screening and are limited by the time constraints of clinical practice. Patients face multiple barriers that further reduce completion rates. Tools that support family physicians in providing their patients with colorectal cancer information and that support uptake may prove useful. The primary objective of the study is to evaluate the efficacy of a patient decision aid (nurse-managed telephone support line and/or colorectal cancer screening website distributed by community-based family physicians, in improving colorectal cancer screening rates. Secondary objectives include evaluation of (disincentives to patient FOBT uptake and internet use among 50 to 74 year old males and females for health-related questions. Challenges faced by family physicians in engaging in collaborative partnerships with primary healthcare researchers will be documented. Methods/design A pragmatic, two-arm, randomized cluster controlled trial conducted in 22 community-based family practice clinics (36 clusters with 76 fee-for-service family physicians in Winnipeg, Manitoba, Canada. Each physician will enroll 30 patients attending their periodic health examination and at average risk for colorectal cancer. All physicians will follow their standard clinical practice for screening. Intervention group physicians will provide a fridge magnet to each patient that contains information facilitating access to the study-specific colorectal cancer screening decision aids (telephone help-line and website. The primary endpoint is patient fecal occult blood test completion rate after four months (intention to treat model. Multi-level analysis will include clinic, physician and patient level variables. Patient Personal Health Identification Numbers will be collected from those providing consent to facilitate analysis of repeat screening behavior. Secondary outcome
Avny, Ohad; Teitelbaum, Tatiana; Simon, Moshe; Michnick, Tatiana; Siman-Tov, Maya
A consultation model between primary care physicians and psychiatrists that has been in operation for 12 years in the Jerusalem district of the Clalit Health Services in Israel is evaluated. In this model psychiatrists provide consultations twice a month at the primary care clinic. All patients are referred by their family physicians. Communication between the psychiatric consultant and the referring physician is carried out by telephone, correspondence and staff meetings. Evaluation of the psychiatric care consultation model in which a psychiatrist consults at the primary care clinic. A questionnaire-based survey distributed to 17 primary care physicians in primary care clinics in Jerusalem in which a psychiatric consultant is present. Almost all of the doctors (93%) responded that the consultation model was superior to the existing model of referral to a secondary psychiatric clinic alone and reduced the workload in caring for the referred patients. The quality of psychiatric care was correlated with the depression prevalence among patients referred for consultation at their clinic (r=0.530, p=0.035). In addition, correlation was demonstrated between primary care physicians impression of alleviation of care of patients and their impression of extent of the patients' cooperation with the consulting psychiatrist (r=0.679, p = 0.015) Conclusions: Very limited conclusions may be drawn from this questionnaire distributed to primary care physicians who were asked to assess psychiatric consultation in their clinic. Our conclusion could be influenced by the design and the actual distribution of the questionnaires by the consulting psychiatrist. Nevertheless answers to the questionnaire might imply that the consultation model of care between a psychiatric consultant and the primary care physician, where the patient's primary care physician takes a leading role in his psychiatric care, is perceived by family physicians as a good alternative to referral to a psychiatric
Richards, Emma C; Cowling, Thomas E; Gunning, Elinor J; Harris, Matthew J; Soljak, Michael A; Nowlan, Naomi; Dharmayat, Kanika; Johari, Nur; Majeed, Azeem
The NHS Choices website (www.nhs.uk) provides data on the opening hours of general practices in England. If the data are accurate, they could be used to examine the benefits of extended hours. To determine whether online data on the opening times of general practices in England are accurate regarding the number of hours in which GPs provide face-to-face consultations. Cross-sectional comparison of data from NHS Choices and telephone survey data reported by general practice staff, for a nationally representative sample of 320 general practices (December 2013 to September 2014). GP face-to-face consultation times were collected by telephone for each sampled practice for each day of the week. NHS Choices data on surgery times were available online. Analysis was based on differences in the number of surgery hours (accounting for breaks) and the times of the first and last consultations of the day only between the two data sources. The NHS Choices data recorded 8.8 more hours per week than the survey data on average (40.1 versus 31.2; 95% confidence interval [CI] = 7.4 to 10.3). This was largely accounted for by differences in the recording of breaks between sessions. The data were more similar when only the first and last consultation times were considered (mean difference = 1.6 hours; 95% CI = 0.9 to 2.3). NHS Choices data do not accurately measure the number of hours in which GPs provide face-to-face consultations. They better record the hours between the first and last consultations of the day. © British Journal of General Practice 2015.
WTP) for rural telephone services and the implications on poverty reduction in Southeast Nigeria. The key research problem was the inability of the telephone providers or regulatory agencies to estimate the amount the people were willing to pay ...
Dillen, S.M. van; Noordman, J.; Dulmen, S. van; Hiddink, G.J.
BACKGROUND/OBJECTIVE: To examine the content of Dutch practice nurses' (PNs') advices about weight, nutrition and physical activity to overweight and obese patients. SUBJECTS/METHODS: A 100 videotaped real-life PN consultations (The Netherlands, 2010/2011) with overweight or obese patients were
Dillen, S.M.E. van; Noordman, J.; Dulmen, S. van; Hiddink, G.J.
Background/Objective: To examine the content of Dutch practice nurses’ (PNs’) advices about weight, nutrition and physical activity to overweight and obese patients. Subjects/Methods: A 100 videotaped real-life PN consultations (The Netherlands, 2010/2011) with overweight or obese patients were
Vermont Center for Geographic Information — (Link to Metadata) The UtilityTelecom_EXCHANGE represents Vermont Telephone Exchange boundaries as defined by the VT Public Service Board. The original data was...
National Oceanic and Atmospheric Administration, Department of Commerce — The Large Pelagics Telephone Survey (LPTS) collects fishing effort information directly from captains holding Highly Migratory Species (HMS) permits (required by...
The possibilities offered by the telephone for use in distance learning are well known, yet stili far too little used. Consultation by telephone means establishing a live contact between the two people who are communicating, and the opportunity for directly solving the problems. Furthermore, it ensures great rationalization in timeusage, since both the mentor and the student can carry out the consultation at any place which suits them; all that matters is that they are prepared for the discu...
Fairley Christopher K
Full Text Available Abstract Background Young people are disproportionately affected by sexually transmissible infections in Australia but face barriers to accessing sexual health services, including concerns over confidentiality and, for some, geographic remoteness. A possible innovation to increase access to services is the use of telemedicine. Methods Young people's (aged 16-24 pre-use views on telephone and webcam consultations for sexual health were investigated through a widely-advertised national online survey in Australia. Descriptive statistics were used to describe the study sample and chi-square, Mann-Whitney U test, or t-tests were used to assess associations. Multinomial logistic regression was used to explore the association between the three-level outcome variable (first preference in person, telephone or webcam, and demographic and behavioural variables; odds ratios and 95%CI were calculated using in person as the reference category. Free text responses were analysed thematically. Results A total of 662 people completed the questionnaire. Overall, 85% of the sample indicated they would be willing to have an in-person consultation with a doctor, 63% a telephone consultation, and 29% a webcam consultation. Men, respondents with same-sex partners, and respondents reporting three or more partners in the previous year were more willing to have a webcam consultation. Imagining they lived 20 minutes from a doctor, 83% of respondents reported that their first preference would be an in-person consultation with a doctor; if imagining they lived two hours from a doctor, 51% preferred a telephone consultation. The main objections to webcam consultations in the free text responses were privacy and security concerns relating to the possibility of the webcam consultation being recorded, saved, and potentially searchable and retrievable online. Conclusions This study is the first we are aware of that seeks the views of young people on telemedicine and access to
Garrett, Cameryn C; Hocking, Jane; Chen, Marcus Y; Fairley, Christopher K; Kirkman, Maggie
Young people are disproportionately affected by sexually transmissible infections in Australia but face barriers to accessing sexual health services, including concerns over confidentiality and, for some, geographic remoteness. A possible innovation to increase access to services is the use of telemedicine. Young people's (aged 16-24) pre-use views on telephone and webcam consultations for sexual health were investigated through a widely-advertised national online survey in Australia. Descriptive statistics were used to describe the study sample and chi-square, Mann-Whitney U test, or t-tests were used to assess associations. Multinomial logistic regression was used to explore the association between the three-level outcome variable (first preference in person, telephone or webcam, and demographic and behavioural variables); odds ratios and 95%CI were calculated using in person as the reference category. Free text responses were analysed thematically. A total of 662 people completed the questionnaire. Overall, 85% of the sample indicated they would be willing to have an in-person consultation with a doctor, 63% a telephone consultation, and 29% a webcam consultation. Men, respondents with same-sex partners, and respondents reporting three or more partners in the previous year were more willing to have a webcam consultation. Imagining they lived 20 minutes from a doctor, 83% of respondents reported that their first preference would be an in-person consultation with a doctor; if imagining they lived two hours from a doctor, 51% preferred a telephone consultation. The main objections to webcam consultations in the free text responses were privacy and security concerns relating to the possibility of the webcam consultation being recorded, saved, and potentially searchable and retrievable online. This study is the first we are aware of that seeks the views of young people on telemedicine and access to sexual health services. Although only 29% of respondents were willing
Arnrup, K; Lundin, S A; Dahllöf, G
All inpatients at a regional hospital in Sweden referred for a paediatric dental consultation (n = 269) were studied retrospectively during a two-year period. The children were studied concerning their medical and oral condition and subsequent dental treatment. The most frequent medical condition among the referred children was insulin dependent diabetes mellitus (20%), asthma (9%) and epilepsy (7%). Children with asthma exhibited a significantly increased caries prevalence (p Gingivitis, disturbances in occlusal development and dental caries were the most commonly found diagnoses Acute dental or oral problems were diagnosed in 9% of the children. The mean time allocated for each patient was 60 minutes. Thirty percent of the children were subsequently treated at the paediatric dentistry specialist clinic. In conclusion the study emphasises the need of paediatric dental consultation services at regional hospitals.
This study assessed Willingness to Pay (WTP) for rural telephone services and the implications for agricultural technology transfer in Southeast Nigeria. The key research problem was the inability of the telephone providers or regulatory agencies to estimate the amount the people were willing to pay for telephone services.
... 7 Agriculture 11 2010-01-01 2010-01-01 false The telephone loan budget. 1744.63 Section 1744.63... Disbursement of Funds § 1744.63 The telephone loan budget. When the loan is made, RUS provides the borrower a Telephone Loan Budget, RUS Form 493. This budget divides the loan into budget accounts such as “Engineering...
Full Text Available Erika Mozer1,2, Bethany Franklin1,3, Jon Rose11Department of Veterans Affairs, Palo Alto Health Care System, Palo Alto, CA, USA; 2PGSP Stanford PsyD Consortium Palo Alto, CA, USA; 3Pacific Graduate School of Psychology Palo Alto, California, USAAbstract: Psychotherapy conducted over the telephone has received increasing amounts of empirical attention given practical advantages that side-step treatment barriers encountered in traditional office-based care. The utility and efficacy of telephone therapy appears generalizable across diverse clinical populations seeking care in community-based hospital settings. Treatment barriers common to older adults suggest that telephone therapy may be an efficient and effective mental health resource for this population. This paper describes empirical studies of telehealth interventions and case examples with psychotherapy conducted via telephone on the Spinal Cord Injury Unit of the Palo Alto Veterans’ Administration. Telephone therapy as appears to be a viable intervention with the aging population.Keywords: telehealth, rural mental health, psychotherapy, healthcare delivery, telecare
Kelsie H. Okamura
Full Text Available ObjectivePublic-sector behavioral health systems seeking to implement evidence-based treatments (EBTs may face challenges selecting EBTs given their limited resources. This study describes and illustrates one method to calculate cost related to training and consultation to assist system-level decisions about which EBTs to select.MethodsTraining, consultation, and indirect labor costs were calculated for seven commonly implemented EBTs. Using extant literature, we then estimated the diagnoses and populations for which each EBT was indicated. Diagnostic and demographic information from Medicaid claims data were obtained from a large behavioral health payer organization and used to estimate the number of covered people with whom the EBT could be used and to calculate implementation-associated costs per consumer.ResultsFindings suggest substantial cost to therapists and service systems related to EBT training and consultation. Training and consultation costs varied by EBT, from Dialectical Behavior Therapy at $238.07 to Cognitive Behavioral Therapy at $0.18 per potential consumer served. Total cost did not correspond with the number of prospective consumers served by an EBT.ConclusionA cost-metric that accounts for the prospective recipients of a given EBT within a given population may provide insight into how systems should prioritize training efforts. Future policy should consider the financial burden of EBT implementation in relation to the context of the population being served and begin a dialog in creating incentives for EBT use.
Stead, Lindsay F; Hartmann-Boyce, Jamie; Perera, Rafael; Lancaster, Tim
Telephone services can provide information and support for smokers. Counselling may be provided proactively or offered reactively to callers to smoking cessation helplines. To evaluate the effect of proactive and reactive telephone support via helplines and in other settings to help smokers quit. We searched the Cochrane Tobacco Addiction Group Specialised Register for studies of telephone counselling, using search terms including 'hotlines' or 'quitline' or 'helpline'. Date of the most recent search: May 2013. randomized or quasi-randomised controlled trials in which proactive or reactive telephone counselling to assist smoking cessation was offered to smokers or recent quitters. One author identified and data extracted trials, and a second author checked them. The main outcome measure was the risk ratio for abstinence from smoking after at least six months follow-up. We selected the strictest measure of abstinence, using biochemically validated rates where available. We considered participants lost to follow-up to be continuing smokers. Where trials had more than one arm with a less intensive intervention we used only the most similar intervention without the telephone component as the control group in the primary analysis. We assessed statistical heterogeneity amongst subgroups of clinically comparable studies using the I² statistic. We considered trials recruiting callers to quitlines separately from studies recruiting in other settings. Where appropriate, we pooled studies using a fixed-effect model. We used a meta-regression to investigate the effect of differences in planned number of calls, selection for motivation, and the nature of the control condition (self help only, minimal intervention, pharmacotherapy) in the group of studies recruiting in non-quitline settings. Seventy-seven trials met the inclusion criteria. Some trials were judged to be at risk of bias in some domains but overall we did not judge the results to be at high risk of bias. Among
Nelson, Jason; Shinn, Antoinette M; Bivens, Ava
...) could be found on telephones in the Operating Room (OR). A total of 26 cultures were taken from telephones within 14 operating rooms and two sub-sterile rooms at a large, teaching, medical center...
Adigamova Farida F.
Full Text Available The purpose of the research is to review and analyze the data on the necessity to provide an educational environment for training and advanced training of tax consultants in Russia. The article considers the types of tax consulting, the historical background of training financiers in Russia, as well as identifies conditions determining the significance of tax consulting. The research establishes the connection between the negative attitude to tax payment and tax evasion. The advanced training of tax consultants should be a continuous process as they need to take into account both external and internal taxpayers risks associated with the development of law and law-enforcement practice. Obviously, the training of tax consultants should take into account the experience of developed foreign countries, such as Germany, Austria, Czech Republic, Slovakia and other European countries as well. In Russia, it is necessary to open educational institutions, which will not only be involved in the certification of tax consultants, but also provide training courses. These courses should contribute to constant increase of tax consultants knowledge, consider the tax treatment of economic activities, as well changes in the legislation, economics, finance, accounting, manufacturing processes, which will improve the quality of services provided by tax consultants.
Boccio, Mindy; Sanna, Rashel S; Adams, Sara R; Goler, Nancy C; Brown, Susan D; Neugebauer, Romain S; Ferrara, Assiamira; Wiley, Deanne M; Bellamy, David J; Schmittdiel, Julie A
Many Americans continue to smoke, increasing their risk of disease and premature death. Both telephone-based counseling and in-person tobacco cessation classes may improve access for smokers seeking convenient support to quit. Little research has assessed whether such programs are effective in real-world clinical populations. Retrospective cohort study comparing wellness coaching participants with two groups of controls. Kaiser Permanente Northern California, a large integrated health care delivery system. Two hundred forty-one patients who participated in telephonic tobacco cessation coaching from January 1, 2011, to March 31, 2012, and two control groups: propensity-score-matched controls, and controls who participated in a tobacco cessation class during the same period. Wellness coaching participants received an average of two motivational interviewing-based coaching sessions that engaged the patient, evoked their reason to consider quitting, and helped them establish a quit plan. Self-reported quitting of tobacco and fills of tobacco cessation medications within 12 months of follow-up. Logistic regressions adjusting for age, gender, race/ethnicity, and primary language. After adjusting for confounders, tobacco quit rates were higher among coaching participants vs. matched controls (31% vs. 23%, p Coaching participants and class attendees filled tobacco-cessation prescriptions at a higher rate (47% for both) than matched controls (6%, p coaching was as effective as in-person classes and was associated with higher rates of quitting compared to no treatment. The telephonic modality may increase convenience and scalability for health care systems looking to reduce tobacco use and improve health.
The area code is now required for all telephone calls within Switzerland. Unfortunately this is causing some confusion. CERN has received complaints that incoming calls intended for CERN mobile phones are being directed to private subscribers. This is caused by mistakenly dialing the WRONG code (e.g. 022) in front of the mobile number. In order to avoid these problems, please inform your correspondents that the correct numbers are: 079 201 XXXX from Switzerland; 0041 79 201 XXXX from other countries. Telecom Service
he area code is now required for all telephone calls within Switzerland. Unfortunately this is causing some confusion. CERN has received complaints that incoming calls intended for CERN mobile phones are being directed to private subscribers. This is caused by mistakenly dialing the WRONG code (e.g. 022) in front of the mobile number. In order to avoid these problems, please inform your correspondents that the correct numbers are: 079 201 XXXX from Switzerland; 0041 79 201 XXXX from other countries. Telecom Service
The New York State Department of Transportation (NYSDOT) Consultant Management Bureaus primary responsibilities are to negotiate staffing hours/resources with : engineering design consultants, and to monitor the consultant's costs. Currently the C...
System-level consultation or organizational development in schools is an area in great need of theoretical models and definitions. The three articles in this special issue provide a unique learning opportunity not only for consultation across borders but also for consultation within the same nation. In my commentary, I limit my remarks to a few…
Greenhalgh, Trisha; Vijayaraghavan, Shanti; Wherton, Joe; Shaw, Sara; Byrne, Emma; Campbell-Richards, Desirée; Bhattacharya, Satya; Hanson, Philippa; Ramoutar, Seendy; Gutteridge, Charles; Hodkinson, Isabel; Collard, Anna; Morris, Joanne
Remote video consultations between clinician and patient are technically possible and increasingly acceptable. They are being introduced in some settings alongside (and occasionally replacing) face-to-face or telephone consultations. To explore the advantages and limitations of video consultations, we will conduct in-depth qualitative studies of real consultations (microlevel) embedded in an organisational case study (mesolevel), taking account of national context (macrolevel). The study is based in 2 contrasting clinical settings (diabetes and cancer) in a National Health Service (NHS) acute trust in London, UK. Main data sources are: microlevel--audio, video and screen capture to produce rich multimodal data on 45 remote consultations; mesolevel--interviews, ethnographic observations and analysis of documents within the trust; macrolevel--key informant interviews of national-level stakeholders and document analysis. Data will be analysed and synthesised using a sociotechnical framework developed from structuration theory. City Road and Hampstead NHS Research Ethics Committee, 9 December 2014, reference 14/LO/1883. We plan outputs for 5 main audiences: (1) academics: research publications and conference presentations; (2) service providers: standard operating procedures, provisional operational guidance and key safety issues; (3) professional bodies and defence societies: summary of relevant findings to inform guidance to members; (4) policymakers: summary of key findings; (5) patients and carers: 'what to expect in your virtual consultation'. The research literature on video consultations is sparse. Such consultations offer potential advantages to patients (who are spared the cost and inconvenience of travel) and the healthcare system (eg, they may be more cost-effective), but fears have been expressed that they may be clinically risky and/or less acceptable to patients or staff, and they bring significant technical, logistical and regulatory challenges. We
Asmat, Huma; Shinwari, Shah Khalid; Cooksley, Tim; Duckitt, Roger; Le Jeune, Ivan; Subbe, Christian P
The Society for Acute Medicine's Benchmarking Audit (SAMBA) was undertaken for the 5th time in June 2016. For the first time, data on telephone triage calls prior to admission to Acute Medical Units were collected: 1238 patients were referred from Emergency Departments, 925 from General Practitioners (GPs), 52 from clinics and 147 from other sources. Calls from Emergency Departments rarely resulted in admission avoidance. Calls from Primary Care resulted in avoidance of an admission in 115 (12%) patients; the percentage of avoided admissions was highest if the call was taken by a Consultant. Consultant triage might result in admission avoidance but the impact of local context on the effectiveness is not clear.
Woolfson, Richard C.; Harker, Michael; Lowe, Dorothy; Shields, Mary; Banks, Margaret; Campbell, Lindsay; Ferguson, Ellen
The increasing recognition that children and young people should be consulted and involved in decision-making about their lives is reflected in national and international legislation. A great deal of this legislation, stemming from the UN convention on the Rights of the Child (1989), requires education authorities to consult children and young…
Florentina Loredana Tache
Full Text Available Economic development of electronic services provide advice and many agents of existingreferral systems to recommend and provide products, information and customized views of thecommunity through a personalized interaction in real time. Distributed systems of autonomous agentsare becoming increasingly important in electronic comet because the basic decisions of agents adviceon trust and reputation are taken in a similar way human society. If these decisions will be as a realconsumer protection, when new aspects of online consumer legislation will become usefulinformation in advice and consulting of electronic commerce.
Riley, Sam G.; Wiessler, Joel M.
Federal and state law provides, for the most part, little specific guidance to persons tape recording their own telephone calls for their own record-keeping purposes. In a specific case, a Pennsylvania newsman was prosecuted in 1972 on charges of wiretapping his own telephone conversations without notice to the other parties in the calls. A review…
... if it provides internal means for effective use with hearing aids that are designed to be compatible... 47 Telecommunication 3 2010-10-01 2010-10-01 false Hearing aid-compatible telephones. 68.4 Section... (CONTINUED) CONNECTION OF TERMINAL EQUIPMENT TO THE TELEPHONE NETWORK General § 68.4 Hearing aid-compatible...
Wasfy, Jason H; Rao, Sandhya K; Kalwani, Neil; Chittle, Melissa D; Richardson, Calvin A; Gallen, Kathleen M; Isselbacher, Eric M; Kimball, Alexandra B; Ferris, Timothy G
Cardiac e-consults may be an effective way to deliver value-oriented outpatient cardiology care in an accountable care organization. Initial results of cardiac e-consults have demonstrated high satisfaction among both patients and referring providers, no known adverse events, and low rates of diagnostic testing. Nevertheless, differences between e-consults and traditional consults, effects of e-consults on traditional consult volume, and whether patients seek traditional consults after e-consults are unknown. We established a cardiac e-consult program on January 13, 2014. We then conducted detailed medical record reviews of all patients with e-consults to detect any adverse clinical events and detect subsequent traditional visits to cardiologists. We also performed 2 comparisons. First, we compared age, gender, and referral reason for e-consults vs traditional consults. Second, we compared changes in volume of referrals to cardiology vs other medical specialties that did not have e-consults. From January 13 to December 31, 2014, 1,642 traditional referrals and 165 e-consults were requested. The proportion of e-consults of all evaluations requested over that period was 9.1%. Gender balance was similar among traditional consults and e-consults (44.8% male for e-consults vs 45.0% for traditional consults, P = .981). E-consult patients were younger than traditional consult patients (55.3 vs 60.4 years, P cardiology visit during the follow-up period. E-consults are an effective and safe mechanism to enhance value in outpatient cardiology care, with low rates of bounceback to traditional consults. E-consults can account for nearly one-tenth of total outpatient consultation volume at 1 year within an accountable care organization and are associated with a reduction in traditional referrals to cardiologists. Copyright © 2015 Elsevier Inc. All rights reserved.
Carletti, Gabrielle; Giuliodori, Paolo; Di Pietri, Vincenzo; Peretti, Alessandro; Amenta, Francesco
A realistic possibility to obtain medical care for patients located in remote sites such as seagoing vessels, in which health professionals are not available, is to contact a doctor via telecommunication systems. In general, the medical knowledge of who on board ships is in charge of medical care is quite limited and therefore, in a first level telemedical consultation, the flow of information should be correct and its efficiency should be maximised. This paper describes an application conceived to improve requests of medical assistance from sailing ships. The ultimate objective of this system is a) to standardise as much as possible the requests of medical advice at a distance, b) to overcome language barriers and jammed-related troubles that could make difficult or not understandable a telephone conversation. The application is based on a software engine extracting data from an ontological knowledgebase built ad hoc using Protégé. Compared to the conventional consultation systems based on telephone and e-mail, the proposed device is more accurate and complete in terms of information contained in the request of assistance. Moreover, data received by the medical centre can be more easily managed, as they can be standardised. The system described here allows people responsible of medical care on board ships to forward detailed requests of assistance containing symptom-guided information on patient clinical conditions. This may represent an innovative tool for medical consultations at distance allowing the remote centre to provide more precise and quicker medical advice.
Newman, Daniel S.; Salmon, Diane; Cavanaugh, Kate; Schneider, Mary Frances
Response to intervention (RtI) is an influential system of service delivery in contemporary schools, but the specific role of school consultation in RtI implementation is not clearly defined. Instructional consultation provides a potential meeting point between consultation and RtI practices. Through a mixed-methods approach, this study explored…
McConnachie, Alex; Wilson, Phil; Thomson, Hilary; Ross, Sue; Watson, Richard; Muirhead, Patricia; Munley, Andrew
Background: Severity of illness, sociodemographic factors, and breastfeeding have been identified as predictors of consultation rates in infants, and prescriptions for antibiotics have been found to increase future consultation rates in older children. The Baby Check trial (1996–1998) provided detailed information about consultations for 935 babies during their first 6 months.
Making difficult healthcare decisions is often helped by consultation with a bioethics committee. This article reviews the main bioethics principles, when it is appropriate and how to call a bioethics consult, ethical concerns, and members of the consult team. Bioethics resources are included.
There has been an increased need for consultation to summer camps from the allied health/mental health fields because camps are available to children with medical and psychological illnesses. Factors in camp programs that are necessary for effective consultation and the various roles a consultant may serve within the camp community are discussed in this article.
Olson, Thomas; Poulfelt, Flemming; Greiner, Larry
to current management consulting. Each of the four parts of the text presents a cogent introduction by the editors, delineating topics that are critical for today's consultants to understand. The cases represent major practice areas of consulting and afford new insights into change processes and other...
Liddiard, Andrea; Bain, Christine
This retrospective case-note study was performed to examine the ways in which an already established menopause clinic could improve service to its patients. The management of 151 patients was examined. Most were referred by their general practitioner and the most common reason for referral was to seek an alternative to hormone replacement therapy (HRT). The consultant saw 17% of the patients, and with the trainee was most likely to discharge the patient. Better information on alternatives to HRT, more consultant input and better use of telephone consultation for follow-up would enhance the service provided by the menopause clinic.
Dale, Jeremy; Caramlau, Isabela O; Lindenmeyer, Antje; Williams, Susan M
) > 12). The peer support intervention significantly decreased depressive symptomatology at the 4-week assessment (odds ratio (OR) 6.23 (95% confidence interval (CI) 1.15 to 33.77; P = 0.02)) and 8-week assessment (OR 6.23 (95% CI 1.40 to 27.84; P = 0.01). One study investigated the use of peer support for patients with poorly controlled diabetes. There were no significant differences between groups for self-efficacy, HbA1C, cholesterol level and body mass index. Whilst this review provides some evidence that peer support telephone calls can be effective for certain health-related concerns, few of the studies were of high quality and so results should be interpreted cautiously. There were many methodological limitations thus limiting the generalisability of findings. Overall, there is a need for further well designed randomised controlled studies to clarify the cost and clinical effectiveness of peer support telephone calls for improvement in health and health-related behaviour.
American Psychologist, 2007
The purpose of these "Guidelines for Education and Training at the Doctoral and Postdoctoral Levels in Consulting Psychology/Organizational Consulting Psychology" is to provide a common framework for use in the development, evaluation, and review of education and training in consulting psychology/organizational consulting psychology (CP/OCP). The…
Peetoom, Kirsten K B; Smits, Jacqueline J M; Ploum, Luc J L; Verbakel, Jan Y; Dinant, Geert-Jan; Cals, Jochen W L
Fever is common in preschool children and is often caused by benign self-limiting infections. Parents' lack of knowledge and fever phobia leads to high healthcare consumption. To systematically review the effect of providing educational interventions about childhood fever and common infections in well-child clinics (WCCs), prior to illness episodes, on parental practices: healthcare-seeking behaviour (frequency of physician consultations, appropriateness of consultations) and medication management. Medline, Embase, CINAHL, PsycINFO, Cochrane Library, Web of Science were searched. We included randomised controlled trials evaluating interventions in WCC settings focusing on educating parents prior to new illness episodes to improve parental practices during episodes of childhood fever and common infections. Data were extracted on study design, sample characteristics, type of intervention, outcome measures and results. Eight studies were eligible for data extraction. Educating parents, in WCCs, prior to new episodes of childhood fever and common infections reduces daytime physician consultations of parents, home visits and telephone consultations, and enhances medication management. However, single and multicomponent interventions vary in effectiveness in reducing the frequency of daytime physician consultations and differ in their potential to reduce the number of home visits and general practitioner out-of-hours contacts. Only multicomponent interventions achieved a reduction in telephone consultations and improved medication management. Educating parents in WCCs prior to episodes of childhood fever and common infections showed potential to improve parental practices in terms of healthcare-seeking behaviour and medication management. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Casarett, David; Pickard, Amy; Bailey, F Amos; Ritchie, Christine; Furman, Christian; Rosenfeld, Ken; Shreve, Scott; Chen, Zhen; Shea, Judy A
To determine whether inpatient palliative consultation services improve outcomes of care. Retrospective telephone surveys conducted with family members of veterans who received inpatient or outpatient care from a Department of Veterans Affairs (VA) medical facility in the last month of life. Five VA Medical Centers or their affiliated nursing homes and outpatient clinics. Veterans had received inpatient or outpatient care from a participating VA in the last month of life. One family member completed each survey. The telephone survey assessed nine aspects of the care the patient received in his or her last month of life: the patient's well-being and dignity (4 items), adequacy of communication (5 items), respect for treatment preferences (2 items), emotional and spiritual support (3 items), management of symptoms (4 items), access to the inpatient facility of choice (1 item), care around the time of death (6 items), access to home care services (4 items), and access to benefits and services after the patient's death (3 items). Interviews were completed with 524 respondents. In a multivariable linear regression model, after adjusting for the likelihood of receiving a palliative consultation (propensity score), palliative care patients had higher overall scores: 65 (95% confidence interval (CI)=62-66) versus 54 (95% CI=51-56; P<.001) and higher scores for almost all domains. Earlier consultations were independently associated with better overall scores (beta=0.003; P=.006), a difference that was attributable primarily to improvements in communication and emotional support. Palliative consultations improve outcomes of care, and earlier consultations may confer additional benefit.
Full Text Available Abstract Background Respiratory tract infections in children result in more primary care consultations than any other acute condition, and are the most common reason for prescribing antibiotics (which are largely unnecessary. About a fifth of children consult again for the same illness episode. Providing parents with written information on respiratory tract infections may result in a reduction in re-consultation rates and antibiotic prescribing for these illnesses. Asking clinicians to provide and discuss the information during the consultation may enhance effectiveness. This paper outlines the protocol for a study designed to evaluate the use of a booklet on respiratory tract infections in children within primary care consultations. Methods/Design This will be a cluster randomised controlled trial. General practices will be randomised to provide parents consulting because their child has an acute respiratory tract infection with either an interactive booklet, or usual care. The booklet provides information on the expected duration of their child's illness, the likely benefits of various treatment options, signs and symptoms that should prompt re-consultation, and symptomatic treatment advice. It has been designed for use within the consultation and aims to enhance communication through the use of specific prompts. Clinicians randomised to using the interactive booklet will receive online training in its use. Outcomes will be assessed via a telephone interview with the parent two weeks after first consulting. The primary outcome will be the proportion of children who re-consult for the same illness episode. Secondary outcomes include: antibiotic use, parental satisfaction and enablement, and illness costs. Consultation rates for respiratory tract infections for the subsequent year will be assessed by a review of practice notes. Discussion Previous studies in adults and children have shown that educational interventions can result in reductions
Hills, Laura Sachs
The telephone is usually the first contact a prospective or new patient has with a medical practice. It is also the method that existing patients and others commonly use to ask questions or convey information. At the same time, a telephone that rings off the hook can be one of the biggest drains on staff time and a source of tremendous frustration. This article suggests practical techniques for managing the medical practice telephone. It provides seven never-fail strategies for saving time on the phone while remaining courteous and attentive to callers. It offers tips to help readers avoid getting caught in an endless game of telephone tag. The article highlights strategies that work particularly well when placing calls and when dealing with a busy signal or voicemail system problem in the practice. It also describes the fine points for taking accurate and complete telephone messages without turning off callers or misleading them. This article further explores practical strategies for using and not abusing the hold button and offers additional tips for telephone equipment and accessories readers may find helpful. Finally, this article suggests guidelines for using an answering machine or voicemail system and provides a 25-question quiz to help readers assess their own telephone technique.
Kaminsky, Elenor; Röing, Marta; Björkman, Annica; Holmström, Inger K
Telephone nursing services are expanding globally. Swedish Healthcare Direct is the largest healthcare provider in Sweden. This paper provides a comprehensive understanding of telephone nursing, as reflected by research on Swedish national telephone nursing, and discusses the findings in relation to international literature. A descriptive, mixed-studies literature review was conducted. Twenty-four articles from January 2003 to April 2015 were identified from PubMed, Scopus, and CINAHL, and included. The issues explored in this study are how telephone nursing is perceived by callers, telephone nurses, and managers, and what characterizes such calls. Callers value reassurance, support, respect and satisfaction and involvement in decisions can increase their adherence. The telephone nurses' perspective focused on problems and ethical dilemmas, communication, the decision support tool, and working tasks. The managers' perspective focused on nursing work goals and malpractice claims. Concerning call characteristics, authentic calls, incident reports, and threats to patient safety were considered. Telephone nursing seems safe, but gender can play a role in calls. Future research on caller access, equity, and efficiency, healthcare cost-effectiveness, distribution, and patient safety is needed. © 2017 John Wiley & Sons Australia, Ltd.
Rutter, Paul; Mytton, Oliver; Ellis, Benjamin; Donaldson, Liam
To examine use of a novel telephone and Internet service-the National Pandemic Flu Service (NPFS)-by the population of England during the 2009-2010 influenza pandemic. National telephone and Internet-based service. Service available to population of England (n=51.8 million). Primary: service use rate, by week. Numbers and age-specific and sex-specific rates of population who: accessed service; were authorised to collect antiviral medication; collected antiviral medication; were advised to seek further face-to-face assessment. Secondary: daily mean contacts by hour; proportion using service by telephone/Internet. The NPFS was activated on 23 July 2009, operated for 204 days and assessed 2.7 million patients (5200 consultations/100 000 population). This was six times the number of people who consulted their general practitioner with influenza-like illness during the same period (823 consultations/100 000 population, rate ratio (RR)=6.30, 95% CI 6.28 to 6.32). Women used the service more than men (52.6 vs 43.4 assessments/1000 population, RR1 21, 95% CI 1.21 to 1.22). Among adults, use of the service declined with age (16-29 years: 74.4 vs 65 years+: 9.9 assessments/1000 population (RR 7.46 95% CI 7.41 to 7.52). Almost three-quarters of those assessed met the criteria to receive antiviral medication (1 807 866/2 488 510; 72.6%). Most of the people subsequently collected this medication, although more than one-third did not (n=646 709; 35.8%). Just over one-third of those assessed were advised to seek further face-to-face assessment with a practitioner (951 332/2 488 504; 38.2%). This innovative healthcare service operated at large scale and achieved its aim of relieving considerable pressure from mainstream health services, while providing appropriate initial assessment and management for patients. This offers proof-of-concept for such a service that, with further refinement, England can use in future pandemics. Other countries may wish to adopt a similar system as
Ethics is a relevant value in business and management consulting. The presence of recognized ethics tends to reduce the need for informative or legal-contractual precautions in the formalization of relationships, for both of the parts involved in a negotiation. Management Consulting on ethics will develop more and more. Law will consider more and more ethics in business and management consulting. The ethics of corporations influences their workers and behaviour with the customers. It is an e...
Jespersen, Astrid Pernille; Jensen, Torben Elgaard
This article investigates the skilful use of time in general practice consultations. It argues that consultation work involves social and material interactions, which are only partially conceptualized in existing medical practice literatures. As an alternative, this article employs ideas from...... the field of science and technology studies (STS), including notions of relationality, multiplicity and otherness. Through this lens, and based on extensive fieldwork, it describes the daily work of arranging time before, during and after consultations. In conclusion, it suggests that a STS...
Biesbroeck, Lauren K; Shinohara, Michi M
Dermatology consultation can improve diagnostic accuracy in the hospitalized patient with cutaneous disease. Dermatology consultation can streamline and improve treatment plans, and potentially lead to cost savings. Dermatology consultants can be a valuable resource for education for trainees, patients, and families. Inpatient consultative dermatology spans a breadth of conditions, including inflammatory dermatoses,infectious processes, adverse medication reactions, and neoplastic disorders, many of which can be diagnosed based on dermatologic examination alone, but when necessary, bedside skin biopsies can contribute important diagnostic information. Copyright © 2015 Elsevier Inc. All rights reserved.
Casarett, David; Johnson, Megan; Smith, Dawn; Richardson, Diane
Growing attention to end-of-life care has led to intensive efforts to provide better palliative care. However, it is not known whether palliative care is best provided by consultative teams or in dedicated units. This nationwide telephone survey was conducted in 77 Veterans Affairs medical centers that offer palliative care consultation services and dedicated palliative care units. One family member per patient who died at a participating Veterans Affairs medical center between July 1, 2008, and December 31, 2009, was invited to participate. The telephone survey included 1 global rating item and 9 core items describing the patient's care in the last month of life. Interviews were completed with family members for 5901 of 9546 patients. Of these, 1873 received usual care, 1549 received a palliative care consultation, and 2479 received care in a palliative care unit. After nonresponse weighting and propensity score adjustment, families of patients who received a palliative care consultation were more likely than those who received usual care to report that the patient's care in the last month of life had been "excellent" (adjusted proportions: 51% vs 46%; odds ratio [OR], 1.25; 95% confidence interval [CI], 1.02-1.55; P = .04). However, families of patients who received care in a palliative care unit were even more likely to report excellent care (adjusted proportions: 63% vs 53%; OR, 1.52; 95% CI, 1.25-1.85; P < .001). Care received in palliative care units may offer more improvements in care than those achieved with palliative care consultations.
Full Text Available Introduction:Postpartum depression is a common disorder. Systematic reviews emphasized the need to conduct more trials about interventions to prevent postpartum depression. The aim of this study was to determine the effect of postpartum telephone support on maternal depression. Methods:366 postpartum women with no history of known depression were randomly assigned into control (244 subjects and intervention (122 subjects groups. The control group received only routine postpartum care. In the intervention group, telephone support was provided twice in the first week and once a week during the second to sixth week of postpartum by a trained midwife in addition to the routine care. In order to meet their unpredicted needs, the mothers could contact the consultant 24 hours a day. Postpartum depression was assessed using the self-administered Edinburgh Depression Scale at 60 to 65 days of postpartum. Mothers with scores of 13 and above were considered to have depression. Logistic regression and Student’s t-test were used for the data analysis. Results:There was no significant difference regarding frequency of depression between the intervention and control groups (29.9% vs. 31.6%; Odds ratio 0.91, 95% CI 0.56 to 1.49. Mean of depression score was not significantly different between the groups [9.2 (6.1 vs. 10.4 (5.8; mean difference -1.19, 95%CI -2.5 to 0.13]. Conclusion:This study did not provide evidence to show that telephone support of a midwife during postpartum period have a preventive effect on postpartum depression.
Cummins, Mollie R; Crouch, Barbara; Gesteland, Per; Wyckoff, Anastasia; Allen, Todd; Muthukutty, Anusha; Palmer, Robin; Peelay, Jitsupa; Repko, Katherine
Poison control centers (PCCs) and emergency departments (EDs) rely upon telephone communication to collaborate. PCCs and EDs each create electronic records for the same patient during the course of collaboration, but those electronic records are not shared. The purpose of this study was to describe the current, telephone based process of PCC-ED communication as the basis for potential process improvement. This study was conducted at one PCC and two tertiary care EDs. We developed workflow diagrams to depict clinician descriptions of the current process, descriptions obtained through interviews of key informants. We also analyzed transcripts of phone calls between emergency departments and the poison control center, corresponding to a random sample of 120 PCC cases occurring January 1-December 31, 2011. Collaboration between the ED and PCC takes place during multiple telephone calls, and the process is unsupported by shared documentation. The process occurs in three phases: notification, collaborative care, and ongoing consultation. In the ED, multiple care providers may communicate with the PCC, but only one ED care provider communicates with the poison control center specialist at a time. Handoffs occur for both ED and PCC. Collaborative care planning is common and most cases involve some type of request for information, whether vital signs, laboratory results, or verification that a treatment was administered. We found evidence of inefficiencies and safety vulnerabilities, including the inability of PCC specialists to reach ED care providers, telephone calls routed through multiple ED staff members in an attempt to reach the appropriate care provider, and exchange of clinical information with non-clinical staff. In 55% of cases, the patient was discharged prior to any synchronous telephone communication between the ED care provider and a PCC specialist. Ambiguous communication of information was observed in 22% of cases. In 12% of cases, a PCC specialist was
This study was undertaken to provide a demographic and clinical profile of all patients consulted by the consultation-liaison psychiatry (CLP) service at the Helen Joseph Hospital (HJH) in Johannesburg, and to describe the clinical management of patients admitted with a diagnosis of a mental disorder associated with a ...
Exceptionally, the telephone switchboard will close at 4 p.m. on Friday, 19 December, instead of the usual time of 6 p.m., to allow time for closing all systems properly before the annual closure. Therefore, switchboard operator assistance to transfer calls from/to external lines will stop. All other phone services will run as usual.
A maintenance of CERN telephone exchanges will be performed on 21st, 22nd, 23rd, 24th of September from 7 p.m. to 9 p.m. Disturbances or even interruptions of telephony services may occur during this lapse of time. We apology in advance for any inconveniences that this may cause.
Jörg Jasper DÖTSCH
Full Text Available Digitalization, globalization, new technologies and shorter product life cycles are only a few keywords underlining the fact that companies are under increasing pressure for faster adaptation, innovation and hence applying a higher knowledge intensity. We assume that these conditions require an increasingly important role of consulting companies, because they seem to be the intermediaries needed to bridge the faster growing gaps between existing business models, organizational structures and accelerating market change. Market pressure is growing on the market for consultant companies as well. New technologies and digitalization should influence both the structure of the consultancy market and the business models of consultancies. Christensen suggested a trend from ǲsolution shop” to ǲboutique consulting.” To track current developments, we concentrate on the German consulting market as one of the most important consultant markets worldwide and explore changes of the last two years based on various studies. Processes of change seem to be both substantially driven by digitalization and to reflect change on the non-consultancy markets. A high willingness to switch among providers documents a high pressure on performance. The impact of digitalisation seem to be observable in structural and qualitative change. With regard to the German consulting market and the latest available data we cannot validate a tendency from a dominance of “solution shop” consultancies to “boutique” consultancy services.
Muhr, Sara Louise; Kirkegaard, Line
Consultants are known to work extreme hours. We show empirically how consultants fantasize about off-work activities, which are impossible to realize with their work schedule. These fantasies are, however, not obstructing their work, but important to justify the extreme hours and sustain desire f...
Described are student/consultant reports, turned in as homework, that reflected their abilities to distinguish useful from irrelevant information, solve the underlying calculus extremum problem, and reconcile the individual mathematical solutions with the ethical considerations surrounding the moral dilemma of the hypothetical consulting client.…
Full Text Available Bedside ultrasonographic assessment of the lung and pleura provides rapid, noninvasive, and essential information in diagnosis and management of various pulmonary conditions. Ultrasonography helps in diagnosing common conditions, including consolidation, interstitial syndrome, pleural effusions and masses, pneumothorax, and diaphragmatic dysfunction. It provides procedural guidance for various pulmonary procedures, including thoracentesis, chest tube insertion, transthoracic aspiration, and biopsies. This article describes major applications of ultrasonography for the pulmonary consultant along with illustrative figures and videos.
Chichra, Astha; Makaryus, Mina; Chaudhri, Parag; Narasimhan, Mangala
Bedside ultrasonographic assessment of the lung and pleura provides rapid, noninvasive, and essential information in diagnosis and management of various pulmonary conditions. Ultrasonography helps in diagnosing common conditions, including consolidation, interstitial syndrome, pleural effusions and masses, pneumothorax, and diaphragmatic dysfunction. It provides procedural guidance for various pulmonary procedures, including thoracentesis, chest tube insertion, transthoracic aspiration, and biopsies. This article describes major applications of ultrasonography for the pulmonary consultant along with illustrative figures and videos.
Quality Assurance for Consumers of Private Training Programs. Findings and Recommendations from the Consultation on the Regulation and Support of Training Providers in New Brunswick = Assurance de la qualite pour les consommateurs de programmes de formation du secteur prive. Resultats et recommandations a la suite des consultations relativement a la reglementation et au soutien des fournisseurs de cours de formation au Nouveau-Brunswick.
New Brunswick Labour Force Development Board, Fredericton.
Eighteen key individuals from the business, labor, and training sectors and other organizations concerned with the purchase of private training programs were consulted in an effort to determine the role of Canada's federal government and New Brunswick's provincial government in quality assurance for consumers of private training programs. There…
This is part of a series of books, which gives training in key business communication skills. Emphasis is placed on building awareness of language appropriateness and fluency in typical business interactions. This new edition is in full colour.
Funderburk, Beverly; Chaffin, Mark; Bard, Elizabeth; Shanley, Jenelle; Bard, David; Berliner, Lucy
Posttraining expert case consultation is a key component of transporting and scaling up evidence-based treatments, and hopefully retaining their efficacy. Live practice observation and in vivo coaching is a strategy used in academic training environments, but is rarely feasible in field settings. Post hoc telephone consultation is a substitute strategy but does not approximate many aspects of live coaching. Live video technology offers a closer approximation but has not yet been sufficiently tested. Using a roll-out experimental design, this study compared client outcomes across doses of two posttraining expert consultation strategies-standard telephone consultation and live video coaching. The study was conducted during a two-state, 30-agency implementation involving 80 therapists and 330 cases receiving Parent-Child Interaction Therapy (PCIT). Child behavior problems fell from well above to below clinical cutoff values, with about a 1 standard deviation improvement in 14 sessions, which is within the range reported in laboratory efficacy trials. Symptom improvement was augmented by increased therapist dose of live video consultations. Phone consultation dose had no association with client level outcomes. PCIT benefits appear to be retained when the model is transported at scale into the field, and live video consultation appeared to offer small but significant advantages over telephone consultation as one element of an overall transport strategy.
The telephone service will make modifications on the LEP network the 12th December 2000 from 5.30pm. This will cause disturbances on telephone connections on the whole LEP area. For more information please call 160026.
Full Text Available Optimising weight status after childbirth is important. Video consultations are an unexplored opportunity to deliver real-time support to postpartum women to improve lifestyle behaviours. This study aims to provide insight into postpartum women’s perspectives of engaging with a dietitian and exercise physiologist through video consultations for tailored nutrition and exercise care. A qualitative study using individual telephone interviews (13–36 min was undertaken. 21 women (body mass index (BMI: 28.1 ± 3.8 kg/m2; age: 32.3 ± 3.0 years; parity: 1.6 ± 0.9 children who had completed the 8 week “Video-coaching to assist lifestyle (VITAL change for mums” intervention participation included up to five video consultations with a dietitian and exercise physiologist. The interviews were audiorecorded and transcribed. Thematic data analysis was conducted by an independent researcher using NVIVO11. Themes relating to the video consultation experience included feeling that they did not differ from other consultations, they were convenient, and the length of time and flexible options were appropriate; however there was a desire for increased contact frequency. The dietitian and exercise physiologist were perceived to increase the participants’ knowledge and confidence to improve health behaviours. The approach to setting realistic and tailored goals was well received. Tailored advice from a dietitian and exercise physiologist received via video consultations is acceptable for postpartum women and offers a viable alternative to in-person care.
Moroz Yustina S.; Drozdov Igor N.
The article reviews the primary goals and problems of consulting entrepreneurship. The principles defining efficiency of entrepreneurship in the field of consulting are generalized. The special attention is given to the importance of ethical principles of conducting consulting entrepreneurship activity.
Clark, Thomas R
To understand the importance of services provided by consultant pharmacists and to assess perception of their performance of services. Cross-sectional; nursing facility team. Random e-mail survey of consultant pharmacists; phone survey of team members. 233 consultant pharmacists (practicing in a nursing facility); 540 team members (practicing in a nursing facility, interacting with > or = 1 consultant pharmacist): 120 medical directors, 210 directors of nursing, 210 administrators. Consultant pharmacists, directors of nursing, medical directors, and administrators rating importance/performance of 21 services. Gap between teams' ratings of importance and consultant pharmacists' performance is assessed to categorize services. Importance/performance ranked on five-point scale. Mean scores used for gap analysis to cluster services into four categories. Per combined group, six services categorized as "Keep It Up" (important, good performance), consensus with individual groups, except discrepancy with medical directors, for one service. Six services each categorized as "Improve" (important, large gap) and "Improve Second" (lower importance, large gap), with varied responses by individual groups. Three different services were categorized into "Don't Worry," with consensus within individual groups. Consensus from all groups found 5 of 21 services are important and performed well by consultant pharmacists, indicating to maintain performance of services. For three services, consultant pharmacists do not need to worry about their performance. Thirteen services require improvement in consultant pharmacists' performance; various groups differ on extent of improvement needed. Results can serve as benchmark comparisons with results obtained by consultant pharmacists in their own facilities.
Huibers, Linda; Moth, Grete; Carlsen, Anders H; Christensen, Morten B; Vedsted, Peter
In the UK, telephone triage in out-of-hours primary care is mostly managed by nurses, whereas GPs perform triage in Denmark. To describe telephone contacts triaged to face-to-face contacts, GP-assessed relevance, and factors associated with triage to face-to-face contact. A prospective observational study in Danish out-of-hours primary care, conducted from June 2010 to May 2011. Information on patients was collected from the electronic patient administration system and GPs completed electronic questionnaires about the contacts. The GPs conducting the face-to-face contacts assessed relevance of the triage to face-to-face contacts. The authors performed binomial regression analyses, calculating relative risk (RR) and 95% confidence intervals. In total, 59.2% of calls ended with a telephone consultation. Factors associated with triage to a face-to-face contact were: patient age >40 years (40-64: RR = 1.13; >64: RR = 1.34), persisting problem for 12-24 hours (RR = 1.15), severe problem (RR = 2.60), potentially severe problem (RR = 5.81), and non-severe problem (RR = 2.23). Face-to-face contacts were assessed as irrelevant for 12.7% of clinic consultations and 11.7% of home visits. A statistically significantly higher risk of irrelevant face-to-face contact was found for a persisting problem of >24 hours (RR = 1.25), contact on weekday nights (RR = 1.25), and contact triage is efficient. Knowledge of the factors influencing triage can provide better education for GPs, but future studies are needed to investigate other quality aspects of GP telephone triage. © British Journal of General Practice 2016.
Carter, Keme; Golden, Andrew; Martin, Shannon; Donlan, Sarah; Hock, Sara; Babcock, Christine; Farnan, Jeanne; Arora, Vineet
An important area of communication in healthcare is the consultation. Existing literature suggests that formal training in consultation communication is lacking. We aimed to conduct a targeted needs assessment of third-year students on their experience calling consultations, and based on these results, develop, pilot, and evaluate the effectiveness of a consultation curriculum for different learner levels that can be implemented as a longitudinal curriculum. Baseline needs assessment data were gathered using a survey completed by third-year students at the conclusion of the clinical clerkships. The survey assessed students' knowledge of the standardized consultation, experience and comfort calling consultations, and previous instruction received on consultation communication. Implementation of the consultation curriculum began the following academic year. Second-year students were introduced to Kessler's 5 Cs consultation model through a didactic session consisting of a lecture, viewing of "trigger" videos illustrating standardized and informal consults, followed by reflection and discussion. Curriculum effectiveness was assessed through pre- and post- curriculum surveys that assessed knowledge of and comfort with the consultation process. Fourth-year students participated in a consultation curriculum that provided instruction on the 5 Cs model and allowed for continued practice of consultation skills through simulation during the Emergency Medicine clerkship. Proficiency in consult communication in this cohort was assessed using two assessment tools, the Global Rating Scale and the 5 Cs Checklist. The targeted needs assessment of third-year students indicated that 93% of students have called a consultation during their clerkships, but only 24% received feedback. Post-curriculum, second-year students identified more components of the 5 Cs model (4.04 vs. 4.81, pconsultation process (0% vs. 69%, pstudents scored higher in all criteria measuring consultation
Full Text Available Abstract Background Family practitioners take care of large numbers of seniors with increasingly complex mental health problems. Varying levels of input may be necessary from psychiatric consultants. This study examines patients'/family, family practitioners', and psychiatrists' perceptions of the bi-directional pathway between such primary care doctors and consultants. Methods An 18 month survey was conducted in an out-patient psychogeriatric clinic of a Montreal university-affiliated community hospital. Cognitively intact seniors referred by family practitioners for assessment completed a satisfaction and expectation survey following their visits with the psychiatric consultants. The latter completed a self-administered process of care questionnaire at the end of the visit, while family doctors responded to a similar survey by telephone after the consultants' reports had been received. Responses of the 3 groups were compared. Results 101 seniors, referred from 63 family practitioners, met the study entry criteria for assessment by 1 of 3 psychogeriatricians. Both psychiatrists and family doctors agreed that help with management was the most common reason for referral. Family physicians were accepting of care of elderly with mental health problems, but preferred that the psychiatrists assume the initial treatment; the consultants preferred direct return of the patient; and almost 1/2 of patients did not know what to expect from the consultation visit. The rates of discordance in expectations were high when each unique patient-family doctor-psychiatrist triad was examined. Conclusion Gaps in expectations exist amongst family doctors, psychiatrists, and patients/family in the shared mental health care of seniors. Goals and anticipated outcomes of psychogeriatric consultation require better definition.
Williams, Stephen M.
Examined relationship between handedness and preferred ear for telephoning in 140 college students. Increased degree of sinistrality was associated with increased tendency to use left ear for telephoning. Found tendency to pick up telephone receiver with preferred hand and hold earpiece to ipsilateral ear. Results may relate to reports of reduced…
U.S. Department of Health & Human Services — The purpose of the ACF Tribal Consultation Policy is to build meaningful relationships with federally recognized tribes by engaging in open, continuous, and...
Brenes, Gretchen A; Ingram, Cobi W; Danhauer, Suzanne C
Telephone-delivered psychotherapy has increased utility as a method of service delivery in the current world, where a number of barriers, including economic hardships and limited access to care, may prevent people from receiving the treatment they need. This method of service provision is practical and has the potential to reach large numbers of underserved people in a cost-effective manner. The aim of this paper is to review the state-of-the-art of telephone-delivered psychotherapy and to identify improvements and possible solutions to challenges. Results of randomized controlled trials indicate high client acceptance and positive outcomes with this method of delivering psychotherapy. Nonetheless, psychotherapists wishing to deliver psychotherapy by telephone face a number of challenges, including a lack of control over the environment, potential compromises of privacy and confidentiality, developing therapeutic alliance without face-to-face contact, ethical and legal issues in providing psychotherapy by telephone, handling crisis situations at a distance, and psychotherapist adjustment to conducting psychotherapy in an alternative manner. There remains a need for further research, including direct comparisons of face-to-face psychotherapy with telephone-delivered psychotherapy and feasibility of telephone delivery of psychotherapies other than cognitive behavioral therapy.
Chen, Melissa J; Rounds, Kacie M; Creinin, Mitchell D; Cansino, Catherine; Hou, Melody Y
Compare proportion lost to follow-up, successful abortion, and staff effort in women who choose office or telephone-based follow-up evaluation for medical abortion at a teaching institution. We performed a chart review of all medical abortions provided in the first three years of service provision. Women receiving mifepristone and misoprostol could choose office follow-up with an ultrasound evaluation one to two weeks after mifepristone or telephone follow-up with a scheduled telephone interview at one week post abortion and a second telephone call at four weeks to review the results of a home urine pregnancy test. Of the 176 medical abortion patients, 105 (59.7%) chose office follow-up and 71 (40.3%) chose telephone follow-up. Office evaluation patients had higher rates of completing all required follow-up compared to telephone follow-up patients (94.3% vs 84.5%, respectively, p=.04), but proportion lost to follow-up was similar in both groups (4.8% vs 5.6%, respectively, p=1.0). Medical abortion efficacy was 94.0% and 92.5% in women who chose office and telephone follow-up, respectively. We detected two (1.2%) ongoing pregnancies, both in the office group. Staff rescheduled 15.0% of appointments in the office group. For the telephone follow-up cohort, staff made more than one phone call to 43.9% and 69.4% of women at one week and four weeks, respectively. Proportion lost to follow-up is low in women who have the option of office or telephone follow-up after medical abortion. Women who choose telephone-based evaluation compared to office follow-up may require more staff effort for rescheduling of contact, but overall outcomes are similar. Although women who choose telephone evaluation may require more rescheduling of contact as compared to office follow-up, having alternative follow-up options may decrease the proportion of women who are lost to follow-up. Copyright © 2016 Elsevier Inc. All rights reserved.
Full Text Available Call centre largely came into being as a result of consumerneeds converging with enabling technology- and by the companiesrecognising the revenue opportunities generated by meetingthose needs thereby increasing customer satisfaction. Regardlessof the specific application or activity of a Call centre, customersatisfaction with the interaction is critical to the revenuegenerated or protected by the Call centre. Physical(v, Call centreset up is a place that includes computer, telephone and supervisorstation. Call centre can be available 24 hours a day - whenthe customer wants to make a purchase, needs information, orsimply wishes to register a complaint.
In this paper the theory of speech acts is applied for a structural reconstruction of medical diagnostic consultations. The reconstruction provides the conceptual model for a research prototype of a consultation tool which is expected to play a mediating role between the participants in the professional diagnostic discourse. Preliminary results of the design will be outlined.
Russell, Michael L.
This model examines the theory, clinical process, and intervention techniques of behavioral consultation in educational and medical settings. Behavioral consultation requires empirical validation of intervention. It also holds the counselee accountable for consultations. The consultant has many techniques, but must be sensitive to interaction…
Ottewill, Geraldine A.; Walsh, Frank C.
A consultancy enquiry, telephoned to a university chemistry department has been used as the basis of a classwork program designed to develop a variety of skills including team working and project management in addition to the application of chemical knowledge. The consultancy enquiry came from a small industrial electroplating company and concerned the removal of copper (II) ions from rinse water as part of a surface finishing process fro printed circuit boards. This teamwork exercise was formulated, not only to deliver academic learning but also to enhance transferable skills and improve industrial awareness. A set of model process data was provided for the students and they were asked to address the following series of questions: a. How could the amount of copper in the rinse water be reduced? b. What were the environmental implications of metal ion contamination and water remediation techniques could be used? c. How could copper be recovered in metallic form? d. Could feasibility be demonstrated experimentally? e. If an electrolytic process were used, what current would be needed and for how long? f. How could the copper concentration be monitored? Through this sophisticated education role play the class learns a good deal about the role of an industrial consultant.
Yano, V M
The U.S. affiliated Pacific Island nations spend an average of over 10% of total health budget on off-island referral care to tertiary centers. Tripler Army Regional Medical Center (TAMC) has been the major provider of this service for many years. Prior to 1995 communication to consultants at TAMC was by long distance telephone, fax and regular mail. Connecting to a specialist sometimes took hours and clearly a better communication link was needed. The AT&T Picasso phone, an instrument the size of a small briefcase was developed to reliably transmit still images over the regular phone. Freeze-frame images captured at the sending end by a cam recorder were transmitted to a remote receiver unit, where they were displayed and stored. A typical medical consultation involved about three images, with each transmission over the 28.8 Kbps modem taking about one minute. A separate consultation form submitted by fax to TAMC was attached to the transferred images. Four Picasso phones were used to test their usefulness in linking isolated Pacific islands to a metropolitan medical center. For the first time ever, coloured patient images, data, X-rays etc were transmitted with a faxed written medical report. The Picasso phone was the spark of the Telemedicine development in the US affiliated Pacific islands.
Klenin Oleh Volodymyrovych
Full Text Available In the article essence of terms “consulting” and “strategic consulting” was studied. It was proved that strategic consulting must be analyzed as professional activity in the system of enterprise strategic management. Specific features of consultative services and its composition was added from the point of view of strategic management and innovative development were studied. In the process of providing consulting services it was suggested to take into account the strategic orientation of human capital of consulting company that was accepted to determine as professional actions of consultants. It was found out main problems that could prevent stable activity of industrial enterprises. It was proved necessity of researches concerning authentication factors of industrial enterprises innovative development and the role of consulting company in its decision making. It was made review of the most widespread classifications of consulting services. Was shown author`s view concerning forming more demanded services of strategic consulting by subject basis.
Wolderslund, Maiken; Kofoed, Poul-Erik; Axboe, Mette
Introduction In order to give patients possibility to listen to their consultation again, we have designed a system which gives the patients access to digital audio recordings of their consultations. An Interactive Voice Response platform enables the audio recording and gives the patients access...... to replay their consultation. The intervention is evaluated in a randomised controlled trial with 5.460 patients in order to determine whether providing patients with digital audio recording of the consultation affects the patients overall perception of their consultation. In addition to this primary...... objective we want to investigate if replay of the consultations improves the patients’ recall of the information given. Methods Interviews are carried out with 40 patients whose consultations have been audio recorded. Patients are divided into two groups, those who have listened to their consultation...
Full Text Available Consulting companies in order to be successful and to provide services at high professional level inevitably need clear strategy. They must have an established vision, following up on strategy that forms their way of development. Continuously changing area, strong competition, growing demands by the clients for professionally provided services with additional value and new technology represent key features that evoke necessity of use of marketing at the activity of consulting companies. At consulting companies, the marketing system has its particulars that are typical for consulting companies. The mentioned particulars regard mainly marketing mixture and the position of consultant.
Atkins, Sarah; Roberts, Celia; Hawthorne, Kamila; Greenhalgh, Trisha
Assessment of consulting skills using simulated patients is widespread in medical education. Most research into such assessment is sited in a statistical paradigm that focuses on psychometric properties or replicability of such tests. Equally important, but less researched, is the question of how far consultations with simulated patients reflect real clinical encounters--for which sociolinguistics, defined as the study of language in its socio-cultural context, provides a helpful analytic lens. In this debate article, we draw on a detailed empirical study of assessed role-plays, involving sociolinguistic analysis of talk in OSCE interactions. We consider critically the evidence for the simulated consultation (a) as a proxy for the real; (b) as performance; (c) as a context for assessing talk; and (d) as potentially disadvantaging candidates trained overseas. Talk is always a performance in context, especially in professional situations (such as the consultation) and institutional ones (the assessment of professional skills and competence). Candidates who can handle the social and linguistic complexities of the artificial context of assessed role-plays score highly--yet what is being assessed is not real professional communication, but the ability to voice a credible appearance of such communication. Fidelity may not be the primary objective of simulation for medical training, where it enables the practising of skills. However the linguistic problems and differences that arise from interacting in artificial settings are of considerable importance in assessment, where we must be sure that the exam construct adequately embodies the skills expected for real-life practice. The reproducibility of assessed simulations should not be confused with their validity. Sociolinguistic analysis of simulations in various professional contexts has identified evidence for the gap between real interactions and assessed role-plays. The contextual conditions of the simulated
Lemon, Thomas I.; Smith, Rebecca H.
The suggestion that increased consultation length leads to improved patient satisfaction has some evidence, albeit uncertain. Importantly there are other determinants within the doctor-patient consultation that themselves may be responsible for this improved satisfaction and it is these we investigate in this paper. A systematic review of PubMed and associated papers was carried out using search terms ‘family practice consultation length’, ‘general practice consultation length’, ‘local health authority consultation length’ and ‘primary care consultation length’. 590 papers were originally selected using these search terms, post scoring this number became 9. The results obtained support the idea that consultation length does not directly improve consultation outcome, but rather there are variables integrated within the consultation affecting this. Increased time purely allows a physician to implement management, particularly relating to psychosocial aspects. PMID:25657939
Thomas I Lemon
Full Text Available The suggestion that increased consultation length leads to improved patient satisfaction has some evidence, albeit uncertain. Importantly there are other determinants within the doctor-patient consultation that themselves may be responsible for this improved satisfaction and it is these we investigate in this paper. A systematic review of PubMed and associated papers was carried out using search terms ′family practice consultation length′, ′general practice consultation length′, ′local health authority consultation length′ and ′primary care consultation length′. 590 papers were originally selected using these search terms, post scoring this number became 9. The results obtained support the idea that consultation length does not directly improve consultation outcome, but rather there are variables integrated within the consultation affecting this. Increased time purely allows a physician to implement management, particularly relating to psychosocial aspects.
Morey, Muriel Perriot
The cross-disciplinary activities of pain resource nurses were provided with guidelines in 2007. Due to the development of their role in care structures and the ongoing organisation of the nursing activity, guidelines relating to their consultation activities were drawn up in 2016. These describe the circumstances in which a pain resource nurse may intervene and the types of consultation she carries out. Copyright © 2017 Elsevier Masson SAS. All rights reserved.
Hughes, Jan N.; Falk, Robert S.
Presents a review of techniques for dealing with consultee resistance. Suggests the social psychological theory of reactance is a useful conceptual framework for considering resistance in consultation. Discusses examples of its application, variables that predict the likely effectiveness of a reactance utilization intervention, and ethical issues.…
Mandarin Chinese is the official language in China and Taiwan, it is the native language of a quarter of the world population. As the services enabled by speech recognition technology (e.g. telephone voice dialing, information query) become more popular in English, we would like to extend this capability to other languages. Mandarin is one of the major languages under research in our laboratory. This paper describes how we extend our work in English speech recognition into Mandarin. We will described the corpus: Voice Across Taiwan, the training of a complete set of Mandarin syllable models, preliminary performance results and error analysis. A fast prototyping system was built, where a user can write any context free grammar with no restriction of vocabulary, then the grammar can be compiled into recognition models. It enables user to quickly test the performance of a new vocabulary.
Maintenance work will be carried out on the CERN telephone exchanges between 8 p.m. and midnight on 3 December. During this time, the fixed-line telephone and audio-conference services may be disrupted. However, the CCC and the Fire Brigade will be reachable at all times. Mobile telephone services (GSM) will not be affected by this work. For further details please contact Netops@cern.ch.
A maintenance of the CERN telephone exchanges will be performed on the 10th of July from 8 p.m. to midnight. During this intervention, the fixed telephone services, audioconference services, and GSM calls made via the 333 prefix may be disrupted. However, the CCC and the fire brigade will be reachable at any time. For more details about this maintenance, please contact the telephone switchboard at 76111 or by email. Telecom Section IT/CS
Maintenance work on the CERN telephone exchanges will be performed on 10 July from 8 p.m. to midnight. During this intervention, the fixed telephone services, audioconference services and GSM calls made via the 333 prefix may be disrupted. However, the CCC and the fire brigade will be reachable at all times. For more details about this maintenance work, please call the telephone switchboard on 76111 or send an e-mail. Telecom SectionIT/CS
Maintenance work will be carried out on the CERN telephone exchanges between 8 p.m. and midnight on 3 December. During this time, the fixed-line telephone and audio-conference services may be disrupted. However, the CCC and the Fire Brigade will be reachable at all times. Mobile telephone services (GSM) will not be affected by this work. For further details please contact mailto:Netops@cern.ch.
Maintenance work will be carried out on the CERN telephone exchanges between 8 p.m. and midnight on 20 November. Fixed-line telephone and audioconference services may be disrupted while the work is being carried out. However, the CCC and the fire brigade will be contactable at any time. Mobile telephony services (GSM) will not be affected by the maintenance work. For further details about the maintenance work, please contact the telephone switchboard on 76111 or by email to email@example.com. Telecom Section IT/CS
Full Text Available Abstract Background Epidemiological and other studies that require participants to respond by completing a questionnaire face the growing threat of non-response. Response rates to household telephone surveys are diminishing because of changes in telecommunications, marketing and culture. Accordingly, updated information is required about the rate of telephone listing in directories and optimal strategies to maximise survey participation. Methods A total of 3426 households in Sydney, Australia were approached to participate in a computer assisted telephone interview (CATI regarding their domestic (recycled and/or drinking water usage. Only randomly selected households in the suburb and postcode of interest with a telephone number listed in the Electronic White Pages (EWP that matched Australian electoral records were approached. Results The CATI response rate for eligible households contacted by telephone was 39%. The rate of matching of electoral and EWP records, a measure of telephone directory coverage, was 55%. Conclusion The use of a combination of approaches, such as an advance letter, interviewer training, establishment of researcher credentials, increasing call attempts and targeted call times, remains a good strategy to maximise telephone response rates. However, by way of preparation for future technological changes, reduced telephone number listings and people's increasing resistance to unwanted phone calls, alternatives to telephone surveys, such as internet-based approaches, should be investigated.
O'Toole, Joanne; Sinclair, Martha; Leder, Karin
Epidemiological and other studies that require participants to respond by completing a questionnaire face the growing threat of non-response. Response rates to household telephone surveys are diminishing because of changes in telecommunications, marketing and culture. Accordingly, updated information is required about the rate of telephone listing in directories and optimal strategies to maximise survey participation. A total of 3426 households in Sydney, Australia were approached to participate in a computer assisted telephone interview (CATI) regarding their domestic (recycled and/or drinking) water usage. Only randomly selected households in the suburb and postcode of interest with a telephone number listed in the Electronic White Pages (EWP) that matched Australian electoral records were approached. The CATI response rate for eligible households contacted by telephone was 39%. The rate of matching of electoral and EWP records, a measure of telephone directory coverage, was 55%. The use of a combination of approaches, such as an advance letter, interviewer training, establishment of researcher credentials, increasing call attempts and targeted call times, remains a good strategy to maximise telephone response rates. However, by way of preparation for future technological changes, reduced telephone number listings and people's increasing resistance to unwanted phone calls, alternatives to telephone surveys, such as internet-based approaches, should be investigated.
Félix, Sylvie; Bonvin, Raphaël; Bischoff, Thomas
Hosting a medical student in one's primary care consultation challenges the practitioner to be a clinical teacher as well as providing high-quality patient care. A few tips can make this double task easier. Before the consultation it is possible to define the student's learning objectives and to plan the consultation. During the consultation itself some teaching models exist (One minute preceptor, SNAPP) that facilitate the teaching by maximising the teaching moments for each student-patient encounter. And finally after the consultation a time of reflection where both student and clinical teacher can think about what went well and what could be done better.
Gamst-Jensen, Hejdi; Huibers, Linda; Pedersen, Kristoffer
BACKGROUND: Telephone triage is used to assess acute illness or injury. Clinical decision making is often assisted by triage tools that lack callers' perspectives. This study analysed callers' perception of urgency, defined as degree of worry in acute care telephone calls. AIM: To explore...... emotions of feeling bothered to feeling distressed. Callers provided more contextual information when asked about their degree of worry. CONCLUSION: Callers were able to rate their degree of worry. The degree of worry scale is feasible for larger-scale studies if incorporating a patient-centred approach...
Kennedy, B; Covington, K; Evans, T; Williams, C A
As the world's population ages, increasing numbers of people can anticipate spending their latter years in long-term care settings. Many of these nursing home residents will also present psychiatric illnesses as primary or secondary diagnoses. The resulting behavioral problems may present challenges to nursing staff that they are ill-prepared to meet. This article illustrates the application of the Blake and Mouton consultation model to a Veterans Administration (VA) nursing home situation by a team of psychiatric mental health nurse specialists. The consultation is described and interpreted in terms of the Blake and Mouton model. The focal conflicts addressed in the consultation included issues of morale/cohesion, power/authority, and norms/standards. Interventions used were acceptant, prescriptive, confrontation, and theories/principles. The model provided a useful structure for conceptualizing and organizing assessment and intervention in the consultation situation.
CERN will be changing mobile telephone operators on 24 June. As the community prepares for the summer switchover, everyone has questions. What brought on the change? Why are we losing our old phone numbers? What kind of improvements will we see? "Just as with every contract at CERN, we issue calls for tenders every few years to ensure we are still receiving the best possible service," explains Tony Cass, from the Communication Systems group within the IT department. "As we came to the end of our contract with Sunrise, we put out a call for tenders, which was won by Swisscom. Not only is their pricing more competitive, they will also be providing better service conditions." The scope of these new service conditions is multifaceted: there will be improvements to the redundancy and reliability of the network as well as modern 4G network coverage in the LHC tunnel. "People will also see their mobile phone bills decrease," says Tony. "This will esp...
DiPiro, Pamela J; Krajewski, Katherine M; Giardino, Angela A; Braschi-Amirfarzan, Marta; Ramaiya, Nikhil H
The purpose of the article is to describe the various radiology consultation models in the Era of Precision Medicine. Since the inception of our specialty, radiologists have served as consultants to physicians of various disciplines. A variety of radiology consultation services have been described in the literature, including clinical decision support, patient-centric, subspecialty interpretation, and/or some combination of these. In oncology care in particular, case complexity often merits open dialogue with clinical providers. To explore the utility and impact of radiology consultation services in the academic setting, this article will further describe existing consultation models and the circumstances that precipitated their development. The hybrid model successful at our tertiary cancer center is discussed. In addition, the contributions of a consultant radiologist in breast cancer care are reviewed as the archetype of radiology consultation services provided to oncology practitioners.
DiPiro, Pamela J.; Krajewski, Katherine M.; Giardino, Angela A.; Braschi-Amirfarzan, Marta; Ramaiya, Nikhil H. [Dept. of Radiology, Brigham and Women' s Hospital, Harvard Medical School, Boston (United States)
The purpose of the article is to describe the various radiology consultation models in the Era of Precision Medicine. Since the inception of our specialty, radiologists have served as consultants to physicians of various disciplines. A variety of radiology consultation services have been described in the literature, including clinical decision support, patient-centric, subspecialty interpretation, and/or some combination of these. In oncology care in particular, case complexity often merits open dialogue with clinical providers. To explore the utility and impact of radiology consultation services in the academic setting, this article will further describe existing consultation models and the circumstances that precipitated their development. The hybrid model successful at our tertiary cancer center is discussed. In addition, the contributions of a consultant radiologist in breast cancer care are reviewed as the archetype of radiology consultation services provided to oncology practitioners.
Whiplash associated disorder (WAD) is a common and costly condition, and recommended management includes advice to “act as usual” and exercise. Providing this treatment through a telephonic intervention may help to improve access to care, and reduce costs. This pilot study assessed: (1) the effectiveness of a ...
In this paper Ill discuss the first outcomes of an explorative research concerning the consultancy projects of a consultancy-based learning programme (Minor Consultancy 2006 - 2007, half-year bachelor programme University of Applied Sciences, Hogeschool Utrecht, The Netherlands). In order to
Schüz, Joachim; Jacobsen, Rune; Olsen, Jørgen H.
BACKGROUND: The widespread use of cellular telephones has heightened concerns about possible adverse health effects. The objective of this study was to investigate cancer risk among Danish cellular telephone users who were followed for up to 21 years. METHODS: This study is an extended follow-up ...
This paper aims to write the history of yet another form of resistance to colonial rule in British Africa with a focus on telephone operators in the erstwhile Cameroons Province. The pith and kernel of the paper therefore is to show how telephone operators resisted the colonial administration. This typology of resistance is yet to ...
As part of the upgrade of telephone services, maintenance work will be carried out on the CERN switching centre between 8.00 p.m. and 10.00 p.m. on Monday 9 October. Telephone services may be disrupted and possibly even interrupted during this time. We apologise in advance for any inconvenience this may cause. CERN TELECOM Service
treating a service member or veteran . Spouses can have a dramatic effect on the reintegration of the family after deployment and can be a major support...Physical Health in a Sample of Spouses of OEF/OIF Service Members .......... 37 Easing Reintegration : Telephone Support Groups for Spouses of...68 Reintegration : The Role of Spouse Telephone BATTLEMIND Pilot Project
... Cordless telephones. (a) For equipment authorization, a single application form, FCC Form 731, may be filed... protection against unintentional access to the public switched telephone network by the base unit and... network shall occur only if the code transmitted by the handset matches code set in the base unit...
Holten-Rossing, Henrik; Larsen, Lise Grupe; Toft, Birgitte Grønkaer
digital consultation took place over the telephone using remote access software. Time of start and finish for each case was logged. For the physically referred cases, time from arrival to sign-out was logged in the national pathology information system, and time spent on microscopy and reporting was noted......, but they emphasized that a fast internet connection was essential for a smooth consultation. DISCUSSION AND CONCLUSION: An almost perfect agreement between live digital and conventional microscopy was observed in this study. Live digital consultation allowed cases to be referred from local hospitals to central cancer...
Dufrene, Brad A.; Zoder-Martell, Kimberly A.; Dieringe, Shannon Titus; Labrot, Zachary
Applied behavior analysis provides a technology of human behavior that demonstrates great potential for improving socially important outcomes for individuals. School-based consultation may provide a vehicle for delivering applied behavior analysis services in schools to address academic referral concerns. In this article, we propose that…
Raaber, Nikolaj; Bøtker, Morten T; Riddervold, Ingunn S
. In the intervention period, the EMCC was manned 24/7 with physicians experienced in emergency care. Eligible participants included all patients with nonurgent conditions receiving an ambulance after a medical emergency call. Ambulance personnel assessed patients and subsequently performed a telephone consultation...
Buiting, Hilde M; Willems, Dick L; Pasman, H Roeline W; Rurup, Mette L; Onwuteaka-Philipsen, Bregje D
There is much debate about euthanasia within the context of palliative care. The six criteria of careful practice for lawful euthanasia in The Netherlands aim to safeguard the euthanasia practice against abuse and a disregard of palliative treatment alternatives. Those criteria need to be evaluated by the treating physician as well as an independent euthanasia consultant. To investigate 1) whether and how palliative treatment alternatives come up during or preceding euthanasia consultations and 2) how the availability of possible palliative treatment alternatives are assessed by the independent consultant. We interviewed 14 euthanasia consultants and 12 physicians who had requested a euthanasia consultation. We transcribed and analyzed the interviews and held consensus meetings about the interpretation. Treating physicians generally discuss the whole range of treatment options with the patient before the euthanasia consultation. Consultants actively start thinking about and proposing palliative treatment alternatives after consultations, when they have concluded that the criteria for careful practice have not been met. During the consultation, they take into account various aspects while assessing the criterion concerning the availability of reasonable alternatives, and they clearly distinguish between euthanasia and continuous deep sedation. Most consultants said that it was necessary to verify which forms of palliative care had previously been discussed. Advice concerning palliative care seemed to be related to the timing of the consultation ("early" or "late"). Euthanasia consultants were sometimes unsure whether or not to advise about palliative care, considering it not their task or inappropriate in view of the previous discussions. Two different roles of a euthanasia consultant were identified: a limited one, restricted to the evaluation of the criteria for careful practice, and a broad one, extended to actively providing advice about palliative care. Further
Goodyear-Smith, Felicity; Kerse, Ngaire; Warren, Jim; Arroll, Bruce
To evaluate the acceptability and utilisation of three electronic textbooks: DynaMed, MD Consult (including FirstConsult) and UpToDate. Two hundred general practitioners accessed three e-textbooks through a web portal. General practitioners completed an electronic survey and used a random selection during a telephone interview to answer four clinical questions: screening, diagnosis, treatment and prognosis. One hundred and twenty-two GPs made at least one hit through the study website. Eighty-four GPs completed the emailed questionnaire and 77 completed the telephone interview (36% of enrolled, 61% of users). Fifty-one percent of users accessed the e-textbooks less than 10 times over 8 months. There was no significant difference in preference for, or usage levels of, the three e-textbooks. During the telephone interview the three texts performed similarly in terms of time to answer and satisfaction with answer. There was no clear 'winner' between the three e-textbooks.
Full Text Available The present paper addresses quality management from the specific perspective of project management consulting service providers, in the framework of large infrastructure projects. Because of their supposed superiority in knowledge and experience, project management consultants have an ultimate responsibility for the proper implementing of the project. Therefore, quality management in consulting organizations should focus on critical success factors. As there is no consensus yet regarding the most important aspects of the consulting activity on which depend the achievement of the project aims, there is scope for further investigating this subject. Here, the case of a project management consulting organization involved in large infrastructure projects in Romania, Bulgaria, Moldova, Ukraine and Serbia is analyzed. Data collected through a questionnaire-based survey among international consultants and support personnel suggest that factors related to leadership style and communication skills are more closely tied to the success of the project than more technical aspects. The results constitute an empirical evidence of main success factors for specialized consulting services in project management and can be useful in improving business and project performance and achieving business excellence.
Maintenance work will be carried out on the CERN telephone exchanges between 8 p.m. and midnight on 20 November. Fixed-line telephone and audioconference services may be disrupted while the work is being carried out. However, the CCC and the fire brigade will be reachable at any time. Mobile telephony services (GSM) will not be affected by the maintenance work. For further details about the maintenance work, please contact the telephone switchboard on 76111 or by email. Telecom Section - IT/CS
Mayer, Jonathan; Mutchler, Patrick; Mitchell, John C
Since 2013, a stream of disclosures has prompted reconsideration of surveillance law and policy. One of the most controversial principles, both in the United States and abroad, is that communications metadata receives substantially less protection than communications content. Several nations currently collect telephone metadata in bulk, including on their own citizens. In this paper, we attempt to shed light on the privacy properties of telephone metadata. Using a crowdsourcing methodology, we demonstrate that telephone metadata is densely interconnected, can trivially be reidentified, and can be used to draw sensitive inferences.
Kozlov, Elissa; Carpenter, Brian D; Thorsten, Michael; Heiland, Mark; Agarwal, Anupam
Palliative care consultation teams (PCCTs) provide care that enhances quality of life. The effectiveness of PCCTs depends, however, on their timely utilization by other providers. The goal of this study was to examine the timing of palliative care consultation requests and responses at a single Veteran Affairs Medical Center. The median interval between admission and consultation request was 5 days (range = 0-73 days). The median interval between consultation request and death was 23 days (range = 0-847 days). In logistic regressions, timing variables were not significant predictors of whether consultation recommendations were made or implemented. There is substantial variability in when patients receive a palliative care consultation. Many patients receive palliative care within the first week of hospitalization and their final month of life. © The Author(s) 2014.
Williams, Renee; Miler, Roy; Shah, Brijen; Chokhavatia, Sita; Poles, Michael; Zabar, Sondra; Gillespie, Colleen; Weinshel, Elizabeth
Gastroenterology (GI) training programs are mandated to teach fellows interpersonal communication and professionalism as basic competencies. We sought to assess important skill sets used by our fellows but not formally observed or measured: handoffs, telephone management, and note writing. We designed an Observed Standardized Clinical Examination (OSCE) form and provided the faculty with checklists to rate fellows' performance on specific criteria. We created two new scenarios: a handoff between a tired overnight senior fellow on call and a more junior fellow, and a telephone management case of an ulcerative colitis flare. Fellows wrote a progress notes documenting the encounters. To add educational value, we gave the participants references about handoff communication. Four OSCE stations-handoff communication, telephone management, informed consent, and delivering bad news-were completed by fellows and observed by faculty. Eight faculty members and eight fellows from four GI training programs participated. All the fellows agreed that handoffs can be important learning opportunities and can be improved if they are structured, and that handoff skills can improve with practice. OSCEs can serve as practicums for assessing complex skill sets such as handoff communication and telephone management.
Brenni, Paolo (CNR-FST-IMSS, Florence, Italy)
The names of A.G. Bell, A. Meucci, P.Reis, E. Gray, just to mention the most important ones, are all connected with the invention of the telephone. Today, the Italian inventor A. Meucci is recognized as being the first to propose a working prototype of the electric telephone. However, for a series of reasons his strenuous efforts were not rewarded. I will not repeat here the endless and complex disputes about the 'real father' of the telephone. From an historical point of view it is more interesting to understand why so many individuals from different backgrounds conceived of a similar apparatus and why most of these devices were simply forgotten or just remained laboratory curiosities. The case of the development of the telephone is an emblematic and useful example for better understanding the intricate factors which are involved in the birth of an invention and reasons for its success and failure.
Ni, Yong; Yu, Senjiang; Jiang, Hongyuan; He, Linghui
Formation of telephone cord blisters as a result of buckling delamination is widely observed in many compressed film-substrate systems. Here we report a universal morphological feature of such blisters characterized by their sequential sectional profiles exhibiting a butterfly shape using atomic force microscopy. Two kinds of buckle morphologies, light and heavy telephone cord blisters, are observed and differentiated by measurable geometrical parameters. Based on the Föppl-von Kármán plate theory, the observed three-dimensional features of the telephone cord blister are predicted by the proposed approximate analytical model and simulation. The latter further replicates growth and coalescence of the telephone cord into complex buckling delamination patterns observed in the experiment.
... Agency have a legitimate right to receive information and to present their views regarding Agency... conversations are not utilized to circumvent the provisions of this part. (b) Two basic rules apply to telephone...
Schmitz, Peter MU
Full Text Available This paper describes a method that uses a desktop geographical information system (GIS) to plot cellular telephone conversations made when crimes are committed, such as hijackings, hostage taking, kidnapping, rape and murder. The maps produced...
Holmström, Inger K; Nokkoudenmäki, Mai-Britt; Zukancic, Selma; Sundler, Annelie J
The aim of the study was to explore older persons' experiences of telephone advice nursing at primary healthcare centres. Telephone advice nursing is expanding worldwide, and the older population is increasing. Little is known about older persons' experiences of telephone advice nursing provided by primary healthcare. This study has a descriptive design with a qualitative inductive approach. Data were collected via interviews with a purposive sample of 10 older persons in 2014. The data were analysed using qualitative content analysis. The older persons' experiences were described in two themes: the patient-friendly aspects of telephone advice nursing and the patient-unfriendly aspects of telephone advice nursing. The themes can be understood as two sides of the same coin; the differences point to both the advantages and disadvantages of the service and are further illuminated through seven subthemes. This study contributes to increased awareness of the advantages and disadvantages of the telephone advice nursing system as experienced by older persons. To be the focus of attention during calls was highlighted as important; and clear communication was deemed crucial. When the communication between the nurse and the older persons was perceived as good and the perspective of the caller was the focus, an experience of safety and satisfaction was described. Older persons had great confidence in the telephone nurses' competence and perceived their ability to access the service as mostly good, even if it was sometimes difficult to use the service. The communicative competence of telephone nurses is essential when providing telephone advice nursing to older persons. In addition, a person-centred approach is important to provide optimal care in telephone advice nursing. © 2016 John Wiley & Sons Ltd.
Maintenance work will be carried out on the CERN telephone exchanges between 8 p.m. and 2 a.m. on 26 August. Fixed-line telephone and audio-conference services may be disrupted during this intervention. Nevertheless, the CCC and the Fire Brigade will be reachable at any time. Mobile telephony services (GSM) will not be affected by the maintenance work.
This preliminary, exploratory study examined the level of satisfaction of patients and relatives with the telephone communication skills of nurses. Results indicate that callers experienced several difficulties, particularly with regards to knowing who they were speaking to, being treated as an individual rather than just another caller, having their calls dealt with efficiently, or redirected correctly. It is suggested that nurse educators include training in telephone use in courses on communication skills.
Maintenance work will be carried out on the CERN telephone exchanges between 20h00 and midnight on the 29th of July in order to apply the latest software patches. Fixed-line telephone and audio-conference services may be disrupted during this intervention. Nevertheless, the CCC and the fire brigade will be reachable at any time. Mobile telephony services (GSM) will not be affected by the maintenance work. IT/CS/CS
Maintenance work will be carried out on the CERN telephone exchanges between 20h00 and midnight on the 21st of February in order to apply the latest software patches. Fixed-line telephone and audio-conference services may be disrupted during this intervention. Nevertheless, the CCC and the fire brigade will be reachable at any time. Mobile telephony services (GSM) will not be affected by the maintenance work. CS Group
Maintenance work will be carried out on the CERN telephone exchanges between 20h00 and 2h00 on the 16 November. Fixed-line telephone and audio-conference services may be disrupted during this intervention. Nevertheless, the CCC and the fire brigade will be reachable at any time. Mobile telephony services (GSM) will not be affected by the maintenance work. IT/CS
Maintenance work will be carried out on the CERN telephone exchanges between 8h30 and 17h30 on Saturday 9 May. Fixed-line telephone and audio-conference services may be disrupted during this intervention. Nevertheless, the CCC and the fire brigade will be reachable at any time. Mobile telephony services (GSM) will not be affected by the maintenance work. IT/CS/CS
Purc-Stephenson, Rebecca J; Thrasher, Christine
To systematically investigate the extent to which patients comply with triage advice from telenurses and to identify factors that potentially influence compliance. Findings from 13 studies identified through interdisciplinary research databases (1990-2010) were meta-analyzed. Separate pooled analyses compared patients' compliance rates for emergency services and office care (13 outcomes), emergency services and self care (13 outcomes), and self care and office care (12 outcomes). Overall patient compliance was 62%, but varied by intensity of care recommended with low compliance rates for advice to see a general practitioner. Reasons for noncompliance include patients reporting to have heard a different disposition, patients' intentions and health beliefs. Patient compliance to triage recommendations was influenced by the interactive role of patient perceptions and the quality of provider communication, both of which were mediated by access to health services. Further research is needed to clarify whether noncompliance is attributable to poor communication by the nurse or patient misinterpretation. We highlight the need for communication-skills training in a telephone-consultation context that is patient centered, and specifically addresses building active listening and active advising skills and advantages to structuring the call. Crown Copyright © 2011. Published by Elsevier Ireland Ltd. All rights reserved.
Moth, Grete; Huibers, Linda; Christensen, Morten Bondo
De danske praktiserende læger visiterer alle patienter, der henvender sig til lægevagten med et akut helbredsproblem. Omkring 60 % af alle henvendelser afslutter lægerne selv ved en telefonkonsultation, ofte i form af rådgivning eller receptudskrivning. Alligevel er der kun begrænset viden om hyp...
Kalichman, Seth C; Amaral, Christina M; Cherry, Chauncey; Flanagan, Jody; Pope, Howard; Eaton, Lisa; Kalichman, Moira O; Cain, Demetria; Detorio, Mervi; Caliendo, Angela; Schinazi, Raymond F
Although demonstrated valid for monitoring medication adherence, unannounced pill counts conducted in patients' homes are costly and logistically challenging. Telephone-based unannounced pill counts offer a promising adaptation that resolves most of the limitations of home-based pill counting. We tested the reliability and criterion-related validity of a telephone-based unannounced pill count assessment of antiretroviral adherence. HIV-positive men and women (N = 89) in Atlanta, Georgia, completed a telephone-based unannounced pill count and provided contemporaneous blood specimens to obtain viral loads; 68 participants also received an immediate second pill count conducted during an unannounced home visit. A high degree of concordance was observed between the number of pills counted on the telephone and in the home (intraclass correlation [ICC] = .981, p criterion-related validity. Unannounced telephone-based pill counts offer a feasible objective method for monitoring medication adherence.
Walpole, Sarah C; Mortimer, Frances; Inman, Alice; Braithwaite, Isobel; Thompson, Trevor
This study aimed to engage wide-ranging stakeholders and develop consensus learning objectives for undergraduate and postgraduate medical education. A UK-wide consultation garnered opinions of healthcare students, healthcare educators and other key stakeholders about environmental sustainability in medical education. The policy Delphi approach informed this study. Draft learning objectives were revised iteratively during three rounds of consultation: online questionnaire or telephone interview, face-to-face seminar and email consultation. Twelve draft learning objectives were developed based on review of relevant literature. In round one, 64 participants' median ratings of the learning objectives were 3.5 for relevance and 3.0 for feasibility on a Likert scale of one to four. Revisions were proposed, e.g. to highlight relevance to public health and professionalism. Thirty three participants attended round two. Conflicting opinions were explored. Added content areas included health benefits of sustainable behaviours. To enhance usability, restructuring provided three overarching learning objectives, each with subsidiary points. All participants from rounds one and two were contacted in round three, and no further edits were required. This is the first attempt to define consensus learning objectives for medical students about environmental sustainability. Allowing a wide range of stakeholders to comment on multiple iterations of the document stimulated their engagement with the issues raised and ownership of the resulting learning objectives.
Van Wesemael, Yanna; Cohen, Joachim; Bilsen, Johan; Onwuteaka-Philipsen, Bregje D; Distelmans, Wim; Deliens, Luc
In Belgium and the Netherlands, consultation of a second independent physician by the attending physician is mandatory in euthanasia cases. In both countries, specialized consultation services have been established to provide physicians trained for that purpose. This retrospective study describes and compares the quality of consultation of both services based on surveys of attending physicians and those providing the consultation (consultants). While Dutch consultants discussed certain subjects, for example, alternative curative or palliative treatment more often with the attending physician than Belgian consultants, both usually discussed those subjects considered necessary for a quality consultation and were independent from patient and attending physician. Over 90% of attending physicians in both countries evaluated the consultant's knowledge of palliative care, patient's disease, and judicial procedure, and their communication skills, as sufficient. Consultation with specialized consultation services seems to promote quality of euthanasia consultations.
Full Text Available Orientation: The researcher described the systems psychodynamics of boundary management in organisations. The data showed how effective boundary management leads to good holding environments that, in turn, lead to containing difficult emotions.Research purpose: The purpose of the research was to produce a set of theoretical assumptions about organisational boundaries and boundary management in organisations and, from these, to develop a set of hypotheses as a thinking framework for practising consulting psychologists when they work with boundaries from a systems psychodynamic stance.Motivation for the study: The researcher used the belief that organisational boundaries reflect the essence of organisations. Consulting to boundary managers could facilitate a deep understanding of organisational dynamics.Research design, approach and method: The researcher followed a case study design. He used systems psychodynamic discourse analysis. It led to six working hypotheses.Main findings: The primary task of boundary management is to hold the polarities of integration and differentiation and not allow the system to become fragmented or overly integrated. Boundary management is a primary task and an ongoing activity of entire organisations.Practical/managerial implications: Organisations should work actively at effective boundary management and at balancing integration and differentiation. Leaders should become aware of how effective boundary management leads to good holding environments that, in turn, lead to containing difficult emotions in organisations.Contribution/value-add: The researcher provided a boundary-consulting framework in order to assist consultants to balance the conceptual with the practical when they consult.
Full Text Available This paper is supported by the Sectoral Operational Programme Human Resources Development (SOP HRD, financed from the European Social Fund and by the Romanian Government under the contract number SOP HRD/89/1.5/S/62988. In this paper we propose some perspectives on the relationship between standardization and innovation in the management consulting business. Most of the consulting services are situated somewhere between absolute standardization and absolute innovation. Approaching any of these poles brings some advantages and disadvantages, both to the service providers and to their customers. It is important to find a balance between innovation and standardization to maximize the results of all agents involved.
Larsen, Henry; Huijboom, Nina; Holm Nielsen, Anne
Knowledge-intensive business services, such as design consultancies are perceived as key drivers for innovation and competitiveness. However, many designers create their own companies, which often remain as one-man companies. By interviewing designers who own small design firms we found patterns...... and identities that resonate more with freelancing and portfolio careers than with the intention of creating firms that are intended to expand. We recognized a pattern where freelancers build up their work as a portfolio by moving from one engagement to another, a process that we will call sequential freelancing....... This paper aims to understand the emergence of such identities amongst designers and we suggest that instead of focusing on their individual firms as entities of growth, other strategies such as networking might be more fruitful. If this approach was adopted, we believe that those local authorities who focus...
Full Text Available Due to the development of the Internet, online medical consultation has become another source for consumers to search for medical information. Medication consultation is one of the medical consultation, and drug treatment acts an important role in the course of treatment for the patients. The health will be improved by following the medical compliance. Based on different demographic differences, the demand for the medical advice is also different. Thus, the research is based on the gender and age, and sets to analyze the expression, requirement and require performance characteristics of the online medication consultation. This study content analyzed 1,272 medication consultation questions posted on Taiwan e-Doctor platform, an official online medical consultation service supported by Ministry of Health and Welfare in Taiwan. It is aimed to provide insights and understanding into people’s information need for medication.
Scott M. Sporer
Full Text Available DESCRIPTION A user friendly reference for decision making in hip arthroplasty designed in a question formed clinical problem scenarios and answers format .The articles composed of the answers, containing current concepts and preferences of experts in primary and revision hip surgery are enhanced by several images, diagrams and references and written in the form of a curbside consultation by Scott M. Sporer, MD. and his collaborators. PURPOSE By this practical reference of hip arthroplasty, Scott M. Sporer, MD. and the contributors have aimed providing the reader practical and clinically relevant information, evidence-based advices, their preferences and opinions containing current concepts for difficult and controversial clinical situations in total hip replacement surgery which are often not addressed clearly in traditional references. FEATURES The book is composed of 9 sections and 49 articles each written by a different expert designed in a question and answers format including several images and diagrams and also essential references at the end of each article. In the first section preoperative questions is subjected. Second section is about preoperative acetabulum questions. Third section is about preoperative femur questions. Fourth section is about intraoperative questions. Intraoperative acetabulum question is subjected in the fifth section and the intraoperative femur questions in the sixth section. The seventh section is about postoperative questions. Eighth and ninth sections are about general questions about failure and failure of acetabulum in turn. AUDIENCE Mainly practicing orthopedic surgeons, fellows and residents who are interested in hip arthroplasty have been targeted but several carefully designed scenarios of controversial and difficult situations surrounding total hip replacement surgery and the current information will also be welcomed by experienced clinicians practicing in hip arthroplasty. ASSESSMENT Scott M. Sporer
Jachna, John S.; Powsner, Seth M.; McIntyre, Patrick J.; Byck, Robert S.
Evaluating patients on medical and surgical wards for psychiatric problems can be an adventure, from determining the actual reason for the consult request, to finding the medical records and actually interviewing the patient. The PsyConsult Adventure Simulation adapts the excitement of computer adventure game simulations to teaching general hospital psychiatric consultation. The trainee, in the role of a senior medical student, must navigate a simulated hospital environment and deal with mult...
LeMaire, Ryan; Fisher, Kirk; Watson, Edward F., III
This article reports on an innovative MBA elective consulting course that attempts to address how to better prepare inexperienced MBA students for a competitive job market. This article is a best practice paper designed to provide insights and encouragement to educators.
Strickland, Ben; Arnn, John
This handbook attempts to revise and revitalize the concept of consultation as commonly employed by members of the helping professions, particularly school counselors and student personnel workers in educational settings. The authors believe that neither counseling nor coordination provide the kind of visibility necessary for credibility, and that…
Lee, Jinhee; Danes, Sharon M
The purpose of this study is to address how the consulting approaches of family therapists working with family businesses differ from those of business consultants. The logic of analytic induction was used to analyze qualitative data from family business consultants with and without training in family therapy. Consultants were asked to respond to two vignettes: one emphasized primarily family system problems, whereas the other emphasized business problems with influencing issues at the family/business intersection. Both similarities and differences were found in reference to problem assessment, consulting goal orientation, intervention strategy focus, consultant role and function, and consulting setting preference between consultants with and without family therapy training. Results indicate that consultants of each discipline provide a unique perspective and expertise that allow them to successfully address the spectrum of issues that family firms face. Further, findings highlight the unique contribution of family therapists to an interdisciplinary consulting team. © 2012 American Association for Marriage and Family Therapy.
Bergman, Aeron; Salinas, Alejandra
Separatutstilling. Samarbeidspartner: Alejandra Salinas. Feng Shui Consultation for 0047 by Experts Gabriella Chow and Christina Aas (Performance by Aeron Bergman/Alejandra Salinas) 0047, Oslo November 18, 2011
Ingraham, Colette L.
Literature about educating consultants with knowledge, skills, and dispositions to work effectively within culturally and linguistically diverse schools is scarce. Research suggests that additional attention is needed on the preparation of consultants to practice with multicultural competence. This article reviews theories and research and…
McKenney, Elizabeth L. W.; Mann, Kacee A.; Brown, Danice L.; Jewell, Jeremy D.
This study explored whether and to what extent consultation practices specifically focused on culturally responsive instruction provided additive benefit, after establishing strong classroom management. Three teachers leading culturally diverse classrooms participated in two phases of consultation. The first was a traditional, classroom-management…
Dinkmeyer, Don, Jr.; Carlson, Jon
Decades after consultation has become a mandated function of school counselors, consultants still seek effective ways to deliver this essential role. This book, geared towards mental health professionals, provides a set of skills for working with the school-based population. The ideas, based on Adlerian psychology, present a theory of consultation…
DiPietro, Michele; Norman, Marie
Learning theory provides a powerful framework for analyzing instructional consultations and increasing their effectiveness. In this paper, the authors review the main tenets of learning theory, apply them to consultation scenarios, and present a complex case study to show how they can guide analysis and problem solving around challenging…
Rossen, Camilla B; Buus, Niels; Stenager, Egon
is when the final clarification of the patient's symptoms takes place. The primary data of the study were eight audio recordings of consultations, and the secondary data were ethnographic field descriptions. In most consultations, packaged assessment was a resource as it provided fast and efficient...
Westerman, Michiel; Teunissen, Pim W.; Jorgensen, Rasmus Lundhus
Danish and Dutch new consultants' perceptions regarding the transition to consultant were compared to gain insight into this period, particularly the influence of contextual factors concerning the organisation of specialty training and health care therein. Preparation for medical and generic comp...... competencies, perceived intensity and burnout were compared. Additionally, effects of differences in working conditions and cultural dimensions were explored....
Bradbury, A R; Patrick-Miller, L; Fetzer, D; Egleston, B; Cummings, S A; Forman, A; Bealin, L; Peterson, C; Corbman, M; O'Connell, J; Daly, M B
BRCA1/2 test disclosure has, historically, been conducted in-person by genetics professionals. Given increasing demand for, and access to, genetic testing, interest in telephone and Internet genetic services, including disclosure of test results, has increased. Semi-structured interviews with genetic counselors were conducted to determine interest in, and experiences with telephone disclosure of BRCA1/2 test results. Descriptive data are summarized with response proportions. One hundred and ninety-four genetic counselors completed self-administered surveys via the web. Although 98% had provided BRCA1/2 results by telephone, 77% had never provided pre-test counseling by telephone. Genetic counselors reported perceived advantages and disadvantages to telephone disclosure. Thirty-two percent of participants described experiences that made them question this practice. Genetic counselors more frequently reported discomfort with telephone disclosure of a positive result or variant of uncertain significance (p disadvantages to telephone disclosure, and recognize the potential for testing and patient factors to impact patient outcomes. Further research evaluating the impact of testing and patient factors on cognitive, affective, social and behavioral outcomes of alternative models of communicating genetic information is warranted. © 2010 John Wiley & Sons A/S.
Wen, Li Ming; Rissel, Chris; Baur, Louise A; Hayes, Alison J; Xu, Huilan; Whelan, Anna; Hua, Myna; Shaw, Miranda; Phongsavan, Philayrath
With an increasing prevalence of obesity in young children globally, there is an urgent need for the development of effective early interventions. A previous Healthy Beginnings Trial using a nurse-led home visiting program has demonstrated that providing mothers with evidence-based advice can improve maternal practice regarding obesity prevention, and can reduce Body Mass Index (BMI) in the first few years of life. However, the costs for scale-up of home visiting limit its population reach. This trial aims to determine the efficacy of Communicating Healthy Beginnings Advice by Telephone (CHAT) to mothers with infants in improving infant feeding practices and preventing the early onset of childhood overweight and obesity. We propose a 3-arm randomised controlled trial (RCT) with a consecutive sample of 1056 mothers with their newborn children in New South Wales (NSW) Australia. Pregnant women who are between weeks 28 and 34 of their pregnancy will be invited to participate in the CHAT trial. Informed consent will be obtained, and after baseline data collection, participants will be randomly allocated to the telephone intervention, text messaging intervention, or the control group. The intervention comprises telephone consultations or text messages, together with 6 intervention packages being mailed at specific times from the third trimester of pregnancy until 12 months post birth. The main trial outcome measures include a) duration of breastfeeding, b) timing of introduction of solids, c) nutrition behaviours, physical activity and television viewing, and d) weight and BMI z-score at 12 and 24 months, e) cost-effectiveness, as well as f) feasibility and acceptability of the interventions. The results will ascertain whether early intervention using telephone consultation or text messaging together with staged mailed intervention resources can be feasible and effective in improving infant feeding practices, physical activity and reducing children's BMI in the early
Li Ming Wen
Full Text Available Abstract Background With an increasing prevalence of obesity in young children globally, there is an urgent need for the development of effective early interventions. A previous Healthy Beginnings Trial using a nurse-led home visiting program has demonstrated that providing mothers with evidence-based advice can improve maternal practice regarding obesity prevention, and can reduce Body Mass Index (BMI in the first few years of life. However, the costs for scale-up of home visiting limit its population reach. This trial aims to determine the efficacy of Communicating Healthy Beginnings Advice by Telephone (CHAT to mothers with infants in improving infant feeding practices and preventing the early onset of childhood overweight and obesity. Methods/Design We propose a 3-arm randomised controlled trial (RCT with a consecutive sample of 1056 mothers with their newborn children in New South Wales (NSW Australia. Pregnant women who are between weeks 28 and 34 of their pregnancy will be invited to participate in the CHAT trial. Informed consent will be obtained, and after baseline data collection, participants will be randomly allocated to the telephone intervention, text messaging intervention, or the control group. The intervention comprises telephone consultations or text messages, together with 6 intervention packages being mailed at specific times from the third trimester of pregnancy until 12 months post birth. The main trial outcome measures include a duration of breastfeeding, b timing of introduction of solids, c nutrition behaviours, physical activity and television viewing, and d weight and BMI z-score at 12 and 24 months, e cost-effectiveness, as well as f feasibility and acceptability of the interventions. Discussion The results will ascertain whether early intervention using telephone consultation or text messaging together with staged mailed intervention resources can be feasible and effective in improving infant feeding practices
Gray, R T
INTRODUCTION: Patients undergoing selective minor emergency and elective procedures are followed up by a nurse-led structured telephone review six weeks post-operatively in our hospital. Our study objectives were to review patients\\' satisfaction, assess cost-effectiveness and compare our practice with other surgical units in Northern Ireland (NI). PATIENTS AND METHODS: Completed telephone follow-up forms were reviewed retrospectively for a three-year period and cost savings calculated. Fifty patients were contacted prospectively by telephone using a questionnaire to assess satisfaction of this follow-up. A postal questionnaire was sent to 68 general and vascular surgeons in NI, assessing individual preferences for patient follow-up. RESULTS: A total of 1378 patients received a telephone review from September 2005 to September 2008. One thousand one hundred and seventy-seven (85.4%) were successfully contacted, while 201 (14.6%) did not respond despite multiple attempts. One hundred and forty-seven respondents (10.7%) required further outpatient follow-up, thereby saving 1231 outpatient reviews, equivalent to pound41,509 per annum. Thirty-nine (78%) patients expected post-operative follow-up, with 29 (58%) expecting this in the outpatient department. However, all patients were satisfied with the nurse-led telephone review. Fifty-three (78%) consultants responded. Those who always, or occasionally, review patients post-operatively varies according to the operation performed, ranging from 2.2% appendicectomy patients to 40.0% for varicose vein surgery. CONCLUSION: Current practice in NI varies, but a significant proportion of patients are not routinely reviewed. This study confirmed that patients expect post-operative follow-up. A nurse-led telephone review service is acceptable to patients, cost-effective and reduces the number of unnecessary outpatient reviews.
DuVal, Gordon; Clarridge, Brian; Gensler, Gary; Danis, Marion
OBJECTIVE To identify the ethical dilemmas that internists encounter, the strategies they use to address them, and the usefulness of ethics consultation. DESIGN National telephone survey. SETTING Doctors’ offices. PARTICIPANTS General internists, oncologists, and critical care/pulmonologists (N = 344, 64% response rate). MEASUREMENTS Types of ethical dilemmas recently encountered and likelihood of requesting ethics consultation; satisfaction with resolution of ethical dilemmas with and without ethics consultation. RESULTS Internists most commonly reported dilemmas regarding end-of-life decision making, patient autonomy, justice, and conflict resolution. General internists, oncologists, and critical care specialists reported participating in an average of 1.4, 1.3, and 4.1 consultations in the preceding 2 years, respectively (P ethics training had the least access to and participated in the fewest ethics consultations; 19% reported consultation was unavailable at their predominant practice site. Dilemmas about end-of-life decisions and patient autonomy were often referred for consultation, while dilemmas about justice, such as lack of insurance or limited resources, were rarely referred. While most physicians thought consultations yielded information that would be useful in dealing with future ethical dilemmas (72%), some hesitated to seek ethics consultation because they believed it was too time consuming (29%), might make the situation worse (15%), or that consultants were unqualified (11%). CONCLUSIONS While most internists recall recent ethical dilemmas in their practices, those with the least preparation and experience have the least access to ethics consultation. Health care organizations should emphasize ethics educational activities to prepare physicians for handling ethical dilemmas on their own and should improve the accessibility and responsiveness of ethics consultation when needed. PMID:15009780
Santos López, Pascual
Full Text Available Only 19 years after a timid introduction of telephony in Spain and seven years before the founding of the National Telephonic Company of Spain, Pascual Salmerón Gómez records his two patents: "Duplex telephonic" and "Simultaneous duplex telephonic with telegraph machines". Two high technical complexity patents, registered in 1917 in the town of Arucas, province of Gran Canaria analyzed to our readers.Nephew of the inventor of the "Float Salmerón," José Salmerón Rojas and brother of Gerónimo Gómez Salmerón, inventor of "Cerealémetro" and owner of the theater Borras and with which we ended the saga Salmerón.
Zhou, Yuefang; Humphris, Gerry; Ghazali, Naseem; Friderichs, Simon; Grosset, David; Rogers, Simon N
Head and neck cancer (HNC) patients suffer substantial emotional problems. This study aimed to explore how utterance-level variables (source, type and timing of emotional cues) and patient-level variables (e.g. age, gender and emotional well-being) relate to consultants' responses (i.e. reducing or providing space) to patient expressions of emotional distress. Forty-three HNC outpatient follow-up consultations were audio recorded and coded, for patients' expressions of emotional distress and consultants' responses, using the Verona Coding Definitions of Emotional Sequence. Multilevel logistic regression modelled the probability of the occurrence of consultant-reduced space response as a function of patient distress cue expression, controlling for consultation and patient-related variables. An average of 3.5 cues/concerns (range 1-20) was identified per consultation where 84 out of 152 total cues/concerns were responded by reducing space. Cue type did not impact on response; likewise for the quality of patient emotional well-being. However, consultants were more likely to reduce space to cues elicited by patients, as opposed to those initiated by themselves. This reduced space response was more pronounced as the consultation continued. However, about 6 min into the consultation, this effect (i.e. tendency to block patients) started to weaken. Head and neck consultants' responses to negative emotions depended on source and timing of patient emotional expressions. The findings are useful for training programme development to encourage consultants to be more flexible and open in the early stages of the consultation.
Cooley, Philip C; Miller, Heather G; Gribble, James N; Turner, Charles F
This paper describes a new interview data collection system that uses a personal computer equipped with a telephone interface card. This system, telephone audio computer-assisted self-interviewing or T-ACASI, offers the economy of telephone interviews while providing the privacy of self-administered questionnaires. We describe T-ACASI design considerations and operational characteristics. In addition, we present data from recent studies indicating that the T-ACASI system is stable, robust, and suitable for administering relatively long and complex questionnaires on sensitive topics, including drug use and sexual behaviors associated with HIV and other STDs.
Full Text Available Determinants of management innovation (MI within the Ghanaian construction consulting sector are examined. A sample of 70 consulting firms is surveyed using self-administered questionnaires. Data are analysed using descriptive statistics and factor analysis. Findings indicate that determinants of MI were interwoven among seven principal factors viz: community and market demands; financial and business management practices; human resource policies; creativity and organizational strategies; corporate social responsibility; prevailing conditions; and competitive leverage. The study adds to the discourse on evolution of innovation within the global consulting sector generally, while providing reference for practitioners and academics in the field with respect to MI determinants more specifically. It is envisaged that practitioners who adopt these findings in the construction consultancy sector would enhance their ability to provide innovative services to clients. Study recommendations include that future research should explore how innovation is diffused within consulting enterprises’ value chains. Paper Type: Research article
Full Text Available Ethical conduct within consulting has become increasingly important since management consulting has developed into an independent profession. The objective of this research was to determine if differences exist in client consultant relationship ethics within a defined group of management consultancies in South Africa. A questionnaire was developed to assess ethical behaviour across five dimensions, namely the client consultant relationship, financial and contractual concerns, delivery of expectations, orientation and competence of consultants, and ethics in consultant behaviour. Thirty-nine respondents completed the questionnaire. Significant differences on ethical dimensions in relation to job level, between consulting firms, the level of senior management commitment to ethics and the existence of a code of ethics were obtained. Opsomming Namate bestuurskonsultasie as ‘n onafhanklike professie ontwikkel het, het etiese optrede binne hierdie professie algaande belangriker geword. Die doel met hierdie navorsing was om vas te stel of daar verskille ten opsigte van etiek tussen bestuurskonsultasie-ondernemings in Suid-Afrika is sover dit die kliënt-konsultantverhouding aangaan. ‘n Vraelys is ontwikkel om die etiese dimensie van bestuurskonsultasie oor vyf dimensies te beoordeel, naamlik die kliënt-konsultantverhouding, finansiële oorwegings, voldoening aan verwagtinge, oriëntasie en bevoegheid van konsultante, en die etiese gedrag van konsultante. Nege-en-dertig respondente het die vraelys voltooi. Beduidende verskille in die etiese dimensies ten opsigte van posvlak, die konsultasie-onderneming, die graad van senior bestuur se toegewydheid tot etiek, en die bestaan van ‘n etiese kode is gevind.
Seibel, Ira; Imai, Tanya; Holzapfel, Christian; Husstedt, Ingo W; Heuft, Gereon; Schneider, Gudrun
This study investigates the success of recommendations for psychotherapy given in a psychosomatic consultation service to neurological inpatients. In 2005, a subset of 401 (55.7 %) former neurologic inpatients from the initial sample of 720 who underwent psychosomatic consultation between 1999 and 2004 completed follow-up questionnaires to telephone interviews. 279 (69.6 %) participants stated that they had received a recommendation for in- or outpatient psychotherapy during the psychosomatic consultation. Of these, 152 (54.5 %) followed this recommendation. No differences in age, gender, familial status, initial symptoms, and diagnoses were detected between those who underwent psychotherapy and those who did not. Patients who underwent psychotherapy reported significant improvement of symptoms, less impairment, and less disability. A psychosomatic consultation may be a useful adjunct to neurological diagnostics in order to determine the correct diagnosis and therapy for patients with pseudo-neurological symptoms or evidence of psychological problems.
Burton, Christopher R; Bennett, Bev; Gibbon, Bernard
As the basis for the design of career development opportunities for current and aspiring nursing and therapy consultants, we aimed to explore the factors that shape how these roles have embedded in UK stroke services. The non-medical consultant role has been introduced into UK health care services to provide opportunities for experienced practitioners to progress their careers in clinical practice. Whilst there have been evaluations of the impact of the role on service delivery, little attention has been paid to the pathways towards consultantship. An exploratory design, incorporating focus group discussions, was used to address the research questions. Participating consultants, both nurses and allied health professionals, worked in stroke services, although it is anticipated that the results will have wider application. Two focus groups were held with non-medical consultants in stroke from across the UK. Participants had the opportunity to comment on an interim paper prior to publication of the results. Thirteen consultants took part in the study. A lack of consensus about the nature of clinical expertise and a diverse range of pathways towards consultantship were identified. Health care policy had presented the opportunity for consultants to be entrepreneurial in the development of stroke services, although this had limited the scope for the development of professional knowledge. Inflexible programmes to support aspiring consultants may limit the opportunities to develop these entrepreneurial skills. This study challenges health care organizations and the education and research departments that support them to think creatively in the way that the non-medical consultant role is embedded, and that this should draw on the commitment of existing consultants to support succession planning. The identification of those aspects of career pathways that current consultants have found to be helpful will be useful in designing opportunities for aspiring consultants.
Alavijeh, Amir Hossein Poorjam; Hesaraki, Soheila; Safavi, Saeid
This paper proposes an automatic smoking habit detection from spontaneous telephone speech signals. In this method, each utterance is modeled using i-vector and non-negative factor analysis (NFA) frameworks, which yield low-dimensional representation of utterances by applying factor analysis on G...
This guidebook explains how to conduct a telephone survey that will gather the information necessary for new program needs assessment in the Wisconsin Vocational, Technical, and Adult Education system. The guidebook is based on pilot assessments conducted by Fox Valley Technical College. The guidebook contains five sections: (1) introduction--why…
Corrective maintenance work on the CERN telephone exchanges will be carried out on 13th March 2006, resulting in service interruptions across the west area of the Meyrin site between 9.00 p.m. and 11.00 p.m. We apologise for any inconvenience this may cause. CERN TELECOM Service Tel.: 76111 GSM: 160101
Feb 26, 1983 ... In a time-and-motion study in family practice it was found that 35,8% of all patient contact was per tele- phone. The study further revealed that 12,3% of total practice time was spent on the telephone, stressing its importance as a useful tool.in family practice. The study supports others which suggest that 'tele-.
Power is a central aspect of nursing, especially in telephone-advice nursing, where nurses assess callers' medical problems and decide what measures that need to be taken. This article presents a framework for understanding how power operates in social interaction between nurses and callers in telephone-advice nursing in primary care in Sweden. Power is analysed as the result of nurses and callers being oriented to five social structures that are relevant to their actions in this context, namely the organization of telephone-advice nursing, the social stock of medical knowledge, the professional division of labour between nurses and doctors, structures of social interaction and structures of emotions. While structural constraints govern some actions to a high degree, calls take place in an organizational free room that give nurses more leeway for acting more creatively. The discussion focuses on the introduction of new technologies of control, for instance computerized decision support systems and audio recording of calls, and on how they reduce the free room. Empirical data consist of 276 audio-recorded telephone calls to 13 nurses at six primary-care centres and of qualitative interviews with 18 nurses.
Van der Kooij, B.J.G.
This case study is a historic analysis of the developments that resulted in the electric telephone. It is a story about human communication. Long distance communication that had already developed with the electrical telegraph system created by Samuel Morse in America and Cooke & Wheatstone in
The next maintenance of CERN telephone exchanges will be performed on 19th, 20th, 21st, and 22nd of September from 7 p.m. to 9 p.m. Disturbances or even interruptions of telephony services may occur during this lapse of time. We apology in advance for any inconveniences that this may cause.
Dietrich, Frederick; Shipherd, Amber M; Gershgoren, Lael; Filho, Edson Medeiros; Basevitch, Itay
A social networking Web site, Facebook, was used to deliver long-term sport psychology consultation services to student-athletes (i.e., soccer players) in 30- to 60-min weekly sessions. Additional short-term team building, group cohesion, communication, anger management, injury rehabilitation, mental toughness, commitment, and leadership workshops were provided. Cohesion and overall relationships between both the student-athletes and the sport psychology consultants benefited from this process. Social networking Web sites offer a practical way of providing sport psychology consulting services that does not require use of major resources. (c) 2012 APA, all rights reserved.
Pearl, Phillip L; Sable, Craig; Evans, Sarah; Knight, Joseph; Cunningham, Parker; Lotrecchiano, Gaetano R; Gropman, Andrea; Stuart, Sheela; Glass, Penny; Conway, Anne; Ramadan, Issam; Paiva, Tania; Batshaw, Mark L; Packer, Roger J
A telemedicine program was developed between the Children's National Medical Center (CNMC) in Washington, DC, and the Sheikh Khalifa Bin Zayed Foundation in the United Arab Emirates (UAE). A needs assessment and a curriculum of on-site training conferences were devised preparatory to an ongoing telemedicine consultation program for children with neurodevelopmental disabilities in the underserved eastern region of the UAE. Weekly telemedicine consultations are provided by a multidisciplinary faculty. Patients are presented in the UAE with their therapists and families. Real-time (video over Internet protocol; average connection, 768 kilobits/s) telemedicine conferences are held weekly following previews of medical records. A full consultation report follows each telemedicine session. Between February 29, 2012 and June 26, 2013, 48 weekly 1-h live interactive telemedicine consultations were conducted on 48 patients (28 males, 20 females; age range, 8 months-22 years; median age, 5.4 years). The primary diagnoses were cerebral palsy, neurogenetic disorders, autism, neuromuscular disorders, congenital anomalies, global developmental delay, systemic disease, and epilepsy. Common comorbidities were cognitive impairment, communication disorders, and behavioral disorders. Specific recommendations included imaging and DNA studies, antiseizure management, spasticity management including botulinum toxin protocols, and specific therapy modalities including taping techniques, customized body vests, and speech/language and behavioral therapy. Improved outcomes reported were in clinician satisfaction, achievement of therapy goals for patients, and requests for ongoing sessions. Weekly telemedicine sessions coupled with triannual training conferences were successfully implemented in a clinical program dedicated to patients with neurodevelopmental disabilities by the Center for Neuroscience at CNMC and the UAE government. International consultations in neurodevelopmental
Drevenhorn, Eva; Bengtson, Ann; Kjellgren, Karin I.
Objective: This paper reports on patients' perspectives on the nurse management of hypertension following consultation training, elicited as part of a randomised controlled study. Method: Telephone interviews were conducted with 16 patients in an intervention group (IG) and eight patients in a control group (CG), 3 years after nurses' consultation…
National Park Service, Department of the Interior — This feature class represent telephone lines at Pipe Spring National Monument, Arizona. The utility pipelines were collected by a Trimble GeoXT GPS unit with...
Graham, Iain W
The aim was to describe the process of role transition by an individual who has assumed the position of a consultant nurse in cardiovascular health care. The objective was to explain the 'gestalt' of being a consultant nurse and how the 'gestalt' has evolved. The development of the consultant nurse role is new, research has described the value and potential contribution of the role. The literature suggests that the role still requires further evaluation and description to be understood better. DESIGN. A free-association narrative interview method was chosen as the research design. An in depth interview, tape-recorded and analysed along with field note analysis was the method for eliciting the narrative. The analysis of the narrative reveals an emerging 'gestalt' for being a consultant nurse. Various concepts and phenomena attributable to the role are identified from the experience described. The gestalt explains the journey of the individual through an 'apprenticeship' to role attainment, whereby a new sense of professional self or 'Me' is realized. The significance of the paper lies in the analysis of the narrative and the insights it gives to help other aspirant consultant nurses. It is through the understanding of these insights that individuals could plan their own learning and development to be achieved in the role of consultant nurse. To be effective and provide effective patient care, one can argue that appropriate learning needs to take place. Those that have been appointed to the role have battled to find achievement and acceptance. These battles may be made easier to win if the role is better understood and appropriate preparation provided. Only then will the real potential of the role be realized in improved patient care outcomes.
Hassan, A; Ibrahim, F.
This paper presents the development of kidney TeleUltrasound consultation system. The TeleUltrasound system provides an innovative design that aids the acquisition, archiving, and dissemination of medical data and information over the internet as its backbone. The system provides data sharing to allow remote collaboration, viewing, consultation, and diagnosis of medical data. The design is layered upon a standard known as Digital Imaging and Communication in Medicine (DICOM). The DICOM standa...
Barker, Randolph T.; Gower, Kim
Teaching business communication while performing professional business consulting is the perfect learning match. The bizarre but true stories from the consulting world provide excellent analogies for classroom learning, and feedback from students about the consulting experiences reaffirms the power of using stories for teaching. When discussing…
... information when the new service provider requests a CSR: any working telephone number associated with the... requests a Customer Service Record (CSR). Best Practice 70 provides that the transferring service provider may only require the following information when the new service provider requests a CSR: any working...
Corrective maintenance work on the CERN telephone exchanges will be carried out on 23 September 2004, resulting in interruptions of service across the whole CERN site between 6:00 a.m. and 8:00 a.m. and from 7:00 p.m. onwards. We apologise for any inconvenience this may cause. CERN TELECOM Service Tel.: 76111 GSM: 160026- 163610 Calls between GSM mobile phones will not be affected.
The continuation of ours tasks to update the network is scheduled as follows: Date Change type Affected area June 11 Update of switch N4 Meyrin Ouest Update of switch N2 Meyrin Disturbances or even interruptions of telephony services may occur from 18:30 to 00:00 hrs on the above mentioned dates. In case of problem, please send us your remarks by email to Standard.Telephone@cern.ch.
Ford, Peter, E-mail: firstname.lastname@example.org [Western Sussex Hospitals NHS Trust, St Richards Hospital, Chichester, West Sussex, PO19 6SE (United Kingdom)
Aim: To explore the experience of the first consultant practitioners appointed; including the appointment process, nature of the role, their perceptions of success and challenges. Method: This was a whole population study of the known consultant radiographers appointed up to March 2005. It consisted of 3 phases. The first compared appointees job descriptions with the Department of Health guidance, the second collected contextual information using a questionnaire, and the third explored postholders experiences using telephone interviews. Results: Ten of the possible twelve appointees participated. All posts were established according to the guidelines, with largely similar job descriptions allowing for the different clinical specialist areas. All were very positive in their perceptions of their role, and faced similar challenges. They were strongest in their expert clinical practice working but had strong training and leadership roles. The number working at strategic level was low with limited research and few published papers, although there were notable exceptions. Conclusions: The first appointees demonstrated notable successes, strongest in the expert clinical practice element of roles, with evidence of team leadership, and involvement in training and education. Strategic engagement was disappointing, with little research being undertaken. Their experience was that the nature of consultancy was poorly understood by peers and medical colleagues.
Afifi, Ladan; Shinkai, Kanade
Inpatient dermatology consultative services care for hospitalized patients with skin disease in collaboration with the primary inpatient team. Effective, efficient communication is important. A consultation service must develop strong relationships with primary inpatient teams requesting consults in order to provide optimal patient care. Prior studies have identified effective communication practices for inpatient consultative services. This narrative review provides a summary of effective communication practices for an inpatient dermatology consultation service organized into 5 domains: (1) features of the initial consult request; (2) best practices in responding to the initial consult; (3) effective communication of recommendations; (4) interventions to improve consultations; and (5) handling curbside consultations. Recommendations include identifying the specific reason for consult; establishing urgency; secure sharing of sensitive clinical information such as photographs; ensuring timely responses; providing clear yet brief documentation of the differential diagnosis, problem list, final diagnosis and recommendations; and limiting curbside consultations. Future studies are needed to validate effective strategies to enhance communication practices within an inpatient dermatology consultative service. ©2017 Frontline Medical Communications.
Henderson, J; Kurinczuk, J J; Knight, M
Several key policy documents have advocated 24-hour consultant obstetrician presence on the labour ward as a means of improving the safety of birth. However, it is unclear what published evidence exists comparing the outcomes of intrapartum care with 24-hour consultant labour ward presence and other models of consultant cover. To collate and critically appraise evidence of the effect of continuous resident consultant obstetrician cover on the labour ward on outcomes of intrapartum care compared with other models of consultant cover. Studies were included which quantitatively compared intrapartum outcomes for women and babies where continuous resident consultant obstetric cover was provided with other models of consultant cover. Quantitative studies within healthcare systems with mixed obstetric-midwifery models of care. Two researchers independently screened titles and full-text publications, extracted data and assessed the quality of included studies. Meta-analysis was performed using REVIEW MANAGER 5.3. About 1508 publications were screened resulting in two papers, three conference abstracts and one letter being included. All were single-site time-period comparison studies. The quality of studies overall was poor with significant risk of bias. The only significant finding in meta-analysis related to instrumental deliveries, which occurred more frequently when there was on-call consultant cover (unadjusted risk ratio 1.14; 95% CI 1.04-1.24). No reliable evidence of the effects of 24-hour resident consultant presence on the labour ward on intrapartum outcomes was identified. More robust research is needed to assess intrapartum outcomes with resident consultant labour ward presence. © 2017 The Authors. BJOG An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists.
Blake, Robert R.; Mouton, Jane Srygley
Consultation needs a sound basis for an integration of its parts in order to become a scientific discipline. Help givers have concentrated on specializing to the detriment of solidarity of consultation. Studying and evaluating consultation behavior results in a coherent and systematic basis for a consultation theory. (Author/MFD)
... 24 Housing and Urban Development 5 2010-04-01 2010-04-01 false Telephone and cable TV. 3285.906... Installation Instructions § 3285.906 Telephone and cable TV. It is recommended that the installation instructions explain that telephone and cable TV wiring should be installed in accordance with requirements of...
... 24 Housing and Urban Development 5 2010-04-01 2010-04-01 false Telephone and cable TV. 3285.704....704 Telephone and cable TV. Refer to § 3285.906 for considerations pertinent to installation of telephone and cable TV. ...
This change not only affects all telephone subscribers but also the design of telephone call charging systems and billing software. The design of call charging systems is based on the structure of the national and international telephone numbering scheme in a country. A change in this structure therefore affects the design of ...
In a time-and-motion study in family practice it was found that 35,8% of all patient contact was per telephone. The study further revealed that 12,3% of total practice time was spent on the telephone, stressing its importance as a useful tool. in family practice. The study supports others which suggest that 'telephone medicine' ...
... 7 Agriculture 11 2010-01-01 2010-01-01 false Telephone loan budget. 1737.60 Section 1737.60... Cost Estimation Procedures § 1737.60 Telephone loan budget. (a) RUS shall prepare a “Telephone Loan Budget” (RUS Form 493) showing all costs for the proposed project and the amount of loan and nonloan...
Telecommunications Policy Research Conference, Inc., Washington, DC.
Three papers consider the provision of telephone service to rural and/or low income customers. The first paper, "An Analysis of Telephone Penetration" (Alexander Belinfante), analyzes the relationship between telephone penetration (the proportion of households with phone service) and prices, household income, and other factors. This…
... or premises wiring. These costs as well as the cost of replacing a public telephone shall be charged... 47 Telecommunication 2 2010-10-01 2010-10-01 false Public telephone terminal equipment. 32.2351....2351 Public telephone terminal equipment. (a) This account shall include the original cost of coinless...
Hollier, L P; Pettigrew, S; Slevin, T; Strickland, M; Minto, C
A large proportion of health promotion campaign evaluation research has historically been conducted via telephone surveys. However, there are concerns about the continued viability of this form of surveying in providing relevant and representative data. Online surveys are an increasingly popular alternative, and as such there is a need to assess the comparability between data collected using the two different methods to determine the implications for longitudinal comparisons. The present study compared these survey modes in the context of health promotion evaluation research. Data were collected via computer-assisted telephone interviewing and an online panel. In total, 688 and 606 respondents aged between 14 and 45 years completed the online and telephone surveys, respectively. Online respondents demonstrated higher awareness of the advertisement, rated the advertisement as more personally relevant and had better behavioural outcomes compared with the telephone respondents. The results indicate significant differences between the telephone and online surveys on most measures used to assess the effectiveness of a health promotion advertising campaign. Health promotion practitioners could consider the combination of both methods to overcome the deterioration in telephone survey response rates and the likely differences in respondent outcomes.
Raaff, C; Glazebrook, C; Wharrad, H
There are calls to enhance existing child weight management interventions and to develop new treatment approaches. The potential for interactive electronic resources (e-resources) to support child-dietitian communication has yet to be explored. Towards developing such a tool, the present study aimed to understand dietetic attitudes and approaches to communicating with preadolescent overweight children in individual consultations to support behaviour change. A purposive sample of 18 dietitians, providing weight management advice to overweight 7-11-year-old children, took part in the study. Individual semi-structured telephone interviews were conducted. Data were transcribed and then analysed using inductive thematic analysis. Content analysis was used to interpret dietetic attitude towards e-resources. Six overarching themes were identified describing dietitians' views: the complexity of treating childhood obesity, the strategic balance of dietetic communication focus between child and parent, the child's capacity to communicate affecting their contribution, dietetic approaches to verbal child communication and the features of resources that can support them, as well as dietetic expectations for resources. Independent inter-rater agreement for the themes was 76.9% and 73.1%, respectively. The majority of dietitians (n = 13) supported the concept of introducing an interactive multimedia e-resource into child weight management consultations. Most dietitians sought to engage the preadolescent child in the consultation, using dietetic visual aids to complement verbal strategies and to serve as scaffolding for the conversation. There is scope for interactive e-resources to enhance communication, provided that they are flexibly tailored to meet the needs of the dietitian and the overweight child. © 2014 The Authors. Journal of Human Nutrition and Dietetics published by John Wiley & Sons Ltd on behalf of The British Dietetic Association Ltd.
The Final Report on the U.S.-U.S.S.R. Telemedicine Consultation Spacebride to Armenia and Ufa is presented. The goal of this activity was to provide expert medical consultation to the Armenian medical personnel in the areas of plastic and reconstructive surgery, physical and psychological rehabilitation, public health, and epidemiology following the devastating earthquake in Dec. 1988. The U.S. and U.S.S.R. implementation teams developed new standards for medical information transmittal as well as protocols and schedules on how to conduct medical consultations. The consultations were provided to the Republic Diagnostic Center in Yerevan, U.S.S.R. by four U.S. medical centers: University of Utah/LDS Hospital, University of Texas, Maryland Institute for Emergency Medical Service Systems, and Uniformed Services University of the Health Sciences.
Lin, Huang-Li; Chou, Hung-Hsueh; Liu, Chia-Yih; Hsu, Shi-Chieh; Hsiao, Mei-Chun; Juang, Yeong-Yuh
The purpose of this study was to investigate the consultation psychiatry service to the Obstetrics and Gynecology Department in a general hospital, focusing on referral patterns and consultation recommendations. A retrospective review of the medical charts and consultation records of obstetric and gynecological patients referred for psychiatric consultation from Dec. 2003 to Nov. 2009 was performed. One hundred and eleven patients were referred during the 6-year period, a psychiatric referral rate of 0.11% among 99,098 obstetric and gynecologic admissions. Obstetric and gynecologic consultations comprised 0.64% of all psychiatric consultations. The most common reasons for referral were depression (52.25%), past psychiatric history (31.53%), insomnia (29.73%) and confusion (24.32%). The most common DSM-IV psychiatric diagnoses were depressive disorder (37.84%), schizophrenia and other psychoses (20.72%), delirium (17.12%) and adjustment disorder (10.81%). The most frequent physical diagnoses of referred patients were neoplasms (72.97%), infectious diseases (42.34%) and complications of pregnancy and puerperium (17.12%). Recommendations included pharmacological intervention (89.19%) and psychological management (72.07%). The psychiatric referral rate of obstetric and gynecological inpatients was relatively low compared with that of other departments. More collaboration and liaison between gynecologists and consultation psychiatrists may provide better care for obstetric and gynecological inpatients.
Long, Jennifer; Long, Airdrie
Ergonomics is a holistic discipline encompassing a wide range of special interest groups. The role of an ergonomics consultant is to provide integrated solutions to improve comfort, safety and productivity. In Australia, there are two types of consultants--generalists and specialists. Both have training in ergonomics but specialist knowledge may be the result of previous education or work experience. This paper presents three projects illustrating generalist and specialist (visual ergonomics) consultancy: development of a vision screening protocol, solving visual discomfort in an office environment and solving postural discomfort in heavy industry. These case studies demonstrate how multiple ergonomics consultants may work together to solve ergonomics problems. It also describes some of the challenges for consultants, for those engaging their services and for the ergonomics profession, e.g. recognizing the boundaries of expertise, sharing information with business competitors, the costs-benefits of engaging multiple consultants and the risk of fragmentation of ergonomics knowledge and solutions. Since ergonomics problems are often multifaceted, ergonomics consultants should have a solid grounding in all domains of ergonomics, even if they ultimately only practice in one specialty or domain. This will benefit the profession and ensure that ergonomics remains a holistic discipline.
Agich, George J
In this paper, I describe the development of ethics consultation services and their operation at the Cleveland Clinic; my own educational experiences and background and how I came to see the importance of setting and collaboration for successfully doing clinical ethics; the unique culture of the Cleveland Clinic and its influence on the ethics consultation services provided there; and, finally, the place of personal commitments and values on the conduct of ethics consultations. I stress the point that although philosophers (and perhaps other bioethicists without health professions training) are socialized and educated to do solitary work, successfully conducting ethics consultations requires relatively high levels of collaboration and cooperation that have not been sufficiently discussed. Although this paper is more a description than an analysis of the influence of institutional setting on ethics consultation, I would claim that attention to setting, either as the local scene of the consultation or the institutional and social framework, deserves more attention by bioethicists intent on understanding ethics consultation.
Galimberti, Fabrizio; Guren, Lauren; Fernandez, Anthony P; Sood, Apra
Cutaneous abnormalities are common in hospitalized patients but are frequently missed or misdiagnosed by admitting teams. Inpatient dermatology consultations provide important information to help diagnose and manage these patients. However, few studies have analyzed dermatology inpatient consultations and their effect. We prospectively collected information for 691 consecutive dermatology consultations from November 2013 to November 2014. Patients ranged in age from newborns to 97 years old. The internal medicine service requested the most consultations (45%). Only 6.5% of consultations were requested within 24 hours of appearance of cutaneous findings. Before consultation, 70.3% of patients did not receive treatment for or based on their cutaneous findings. Dermatology consultation resulted in treatment change in 81.9% of patients. The most common diagnoses were drug rash and contact dermatitis. Biopsies confirmed 71.7% of the initial bedside diagnoses by the dermatology consultation team. Common skin diseases were responsible for the majority of dermatology consultations. Most patients were not treated for their cutaneous conditions before the dermatology consultation. Dermatology consultations resulted in treatment changes in the majority of cases. © 2016 The International Society of Dermatology.
Lins, Sabine; Hayder-Beichel, Daniela; Rücker, Gerta; Motschall, Edith; Antes, Gerd; Meyer, Gabriele; Langer, Gero
integrated quantitative RCT data with the qualitative data. Nine RCTs and two qualitative studies were included. Six studies investigated telephone counselling without additional intervention, one study combined telephone counselling with video sessions, and two studies combined it with video sessions and a workbook. All quantitative studies had a high risk of bias in terms of blinding of participants and outcome assessment. Most studies provided no information about random sequence generation and allocation concealment. The quality of the qualitative studies ('thin descriptions') was assessed as moderate. Meta-analyses indicated a reduction of depressive symptoms for telephone counselling without additional intervention (three trials, 163 participants: standardised mean different (SMD) 0.32, 95% confidence interval (CI) 0.01 to 0.63, P value 0.04; moderate quality evidence). The estimated effects on other outcomes (burden, distress, anxiety, quality of life, self-efficacy, satisfaction and social support) were uncertain and differences could not be excluded (burden: four trials, 165 participants: SMD 0.45, 95% CI -0.01 to 0.90, P value 0.05; moderate quality evidence; support: two trials, 67 participants: SMD 0.25, 95% CI -0.24 to 0.73, P value 0.32; low quality evidence). None of the quantitative studies included reported adverse effects or harm due to telephone counselling. Three analytical themes (barriers and facilitators for successful implementation of telephone counselling, counsellor's emotional attitude and content of telephone counselling) and 16 descriptive themes that present the carers' needs for telephone counselling were identified in the thematic synthesis. Integration of quantitative and qualitative data shows potential for improvement. For example, no RCT reported that the counsellor provided 24-hour availability or that there was debriefing of the counsellor. Also, the qualitative studies covered a limited range of ways of performing telephone counselling
Chong, Eunice; Alayli-Goebbels, Adrienne; Webel-Edgar, Lori; Muir, Sarah; Manson, Heather
Telephone focus groups have been increasingly popular in public health research and evaluation. One of the main concerns of telephone focus groups is the lack of nonverbal cues among participants, which could limit group interactions and dynamics during the focus group discussion. To overcome this limitation, we supplemented telephone focus groups with webinar technology in a recent evaluation of a provincial public health program in Ontario, Canada. In this article, we share the methods used and our experiences in conducting telephone focus groups supplemented with webinar technology, including advantages and challenges. Our experience will inform other researchers who may consider using telephone focus groups with webinars in future research and evaluation. PMID:28462318
In order to secure the power supply of the telephone exchange in Building 40, maintenance work will be done on 18th December from 7.30 am to 8 am. During this intervention, the fixed telephone services in Building 39 and 40 will be interrupted. The fixed telephone services in other CERN buildings will not be affected by this maintenance. The mobile telephone services (GSM) will not be affected. For more details, please send your questions to Standard.Telephone@cern.ch Telecom Services IT/CS
Bassilios, Bridget; Harris, Meredith; Middleton, Aves; Gunn, Jane; Pirkis, Jane
The characteristics of people who use telephone counseling are not well understood. This secondary analysis used data from a nationally representative community survey of 8,841 Australian adults to compare callers and non-callers to telephone counseling services. Callers have a poorer clinical profile, including a higher risk of suicide, than people who do not use telephone counseling. They also use a variety of other mental health services. Repeat calls are associated with anxiety disorders, receipt of mental health care from general practitioners, and social disadvantage. All callers have a potential need for telephone counseling and further population studies that distinguish between telephone services intended to provide crisis (one-off) and ongoing counseling are warranted.
Pejova, Zdravka, Ed.; Horton, Forest W., Ed.
At the workshop, better management through strategic planning of information and consultancy was discussed as one way in which developing and Eastern European countries could tackle the complex information problems they are facing during the transition to a market economy. The sixteen papers in this volume are grouped into three basic categories:…
Ledgard, Anna; Thomas, Beverly; McClelland, Siobhan; Robbé, Iain
A study of consultant appraisal in Welsh trusts revealed concerns about lack of protected time and uncertainty about how issues raised should be handled. The research showed it is important to ensure that issues raised are addressed by the organisation. Resources must be made available to trusts to offer protected time for the process, and adequate training.
Boyer, Carol M; Lewis, Darrell R.
The potential benefits--to the individual, the institution, and society--and the potential costs of faculty consulting are examined. A review of the relevant literature and data precedes a presentation of new findings and a taxonomy for developing institutional guidelines. (Author/MLW)
Lee, William W.
Organizations vary greatly in how they monitor training instructors. The methods used in monitoring vary greatly. This article presents a systematic process for improving instructor skills that result in better teaching and better learning, which results in better-prepared employees for the workforce. The consultative supervision and evaluation…
Blaauw, Frank; Bazylevska, L.; Aiello, M.
Gamification refers to the use of game-design elements in a non-gaming context. The consulting company Capgemini has set up a rudimentary Gamification platform to help motivating the people to do extra work for the company in their spare time. In order to re- ward people for this effort, they can
This article explores the process of consultation to professional networks, teams, groups and individuals concerned with the mental health of children and young people in the care system, and those adopted. Frequently there are significant elements of early trauma suffered by the young people and disruption in the professional organisation. The…
Brookhuis, K A; de Vries, G; de Waard, D
The effects of telephoning while driving were studied in three different traffic conditions, i.e. in light traffic on a quiet motorway, in heavy traffic on a four-lane ring-road, and in city traffic. Twelve subjects, unfamiliar with mobile telephones, drove an instrumented vehicle for one hour each day during three weeks and while in each of the three traffic conditions, had to operate the mobile telephone for a short while. To ensure a fixed "heavy traffic load" in the second condition, the subjects were instructed to follow another instrumented vehicle (at a safe distance). The results showed a significant effect of telephoning while driving as opposed to normal driving (i.e., not involving telephone conversation), on the effort subjectively measured by an effort scale and objectively measured by heartrate indices and on some of the measured parameters of driving performance. One half of the subjects had to operate the telephone manually, the other half performed the telephone task with a handsfree mobile telephone set. The subjects who operated the handsfree telephone showed better control over the test vehicle than the subjects who operated the handheld telephone, as measured by the steering wheel movements. Also, a clear improvement over time in the course of the 15 test days was found for some of the measurements. As a consequence of the results, some advice concerning mobile telephoning can be given to authorities, manufacturers, and users.
Ward, Kim; Gott, Merryn; Hoare, Karen
To offer a unique contribution to the evolving debate around the use of the telephone during semistructured interview by drawing on interviewees' reflections on telephone interview during a grounded theory study. The accepted norm for qualitative interviews is to conduct them face-to-face. It is typical to consider collecting qualitative data via telephone only when face-to-face interview is not possible. During a grounded theory study, exploring users' experiences with overnight mask ventilation for sleep apnoea, the authors selected the telephone to conduct interviews. This article reports participants' views on semistructured interview by telephone. An inductive thematic analysis was conducted on data pertaining to the use of the telephone interview in a grounded theory study. The data were collected during 4 months of 2011 and 6 months in 2014. The article presents an inductive thematic analysis of sixteen participants' opinions about telephone interviewing and discusses these in relation to existing literature reporting the use of telephone interviews in grounded theory studies. Overall, participants reported a positive experience of telephone interviewing. From each participants reports we identified four themes from the data: being 'phone savvy; concentrating on voice instead of your face; easy rapport; and not being judged or feeling inhibited. By drawing on these data, we argue that the telephone as a data collection tool in grounded theory research and other qualitative methodologies need not be relegated to second best status. Rather, researchers can consider telephone interview a valuable first choice option. © 2015 John Wiley & Sons Ltd.
Moss, Edtrina L
The purpose of this article is to examine the Institute of Medicine's recommendations, the National Prevention Council Action Plan, the medical home model, and the nursing standards that drive quality for telephone nursing triage. These guidelines require reconceptualizing nursing roles, a commitment to lifelong learning, continued competence, and transformational leadership as demonstrated in a best practice case study. Given the changing climate of the healthcare system, telephone nurses are capable of improving healthcare delivery in the twenty-first century. © 2014 Wiley Periodicals, Inc.
On the theme of Linus Geisler's nine steps for a successful consultation between doctor and patient, the ability for self-criticism, the ability to be able to listen to oneself and the value of the doctor-patient relationship in the context of medical practice will be discussed. Subsequently, the framework of the consultation, the consulting room atmosphere and the complete setting of the consultation will be dealt with. The importance of active listening and the recognition of all messages, both verbal and from body language, will be particularly emphasized. The capability for empathy is presented as the necessary bridge to recognition of the feelings and inner world of the patient. Because one only sees what one is looking for and only recognizes what one knows, the recognition of typical complaints presented by patients in a consultation represents the "something" which must be specifically elucidated. The problems and symptoms which the patient brings to the doctor are surrounded by a ring of fears and apprehensions. For this reason it is decisive to uncover the accompanying cloud of fears and apprehensions with appropriate questions, to correctly assign the unsettling symptoms of the patient and to be able to correctly interpret them. As illustrated by the language of nature - the translation of deoxyribonucleic acid (DNA) triplets into amino acids - the translation of biological, psychological and social aspects of the complaints symptomatic into the level of diagnosis and the translation of the referential, social and affective meaning of the expressions used by the patient, into the level of the significance will be discussed. The role of the doctor here is that of a producer of context and a skilled translator. In the management of functional disorders and chronic diseases the construction of a shared reality is important. The therapeutic function of consultations is due to an introduction of metaphors as bridges - bridges to an improved understanding of
Kinnersley, P; Edwards, A; Hood, K; Cadbury, N; Ryan, R; Prout, H; Owen, D; Macbeth, F; Butow, P; Butler, C
patient satisfaction (SMD 0.09 (95% CI 0.03 to 0.16)). There was a notable but not statistically significant decrease in patient anxiety before consultations (weighted mean difference (WMD) -1.56 (95% CI -7.10 to 3.97)). There were small and not statistically significant changes in patient anxiety after consultations (reduced) (SMD -0.08 (95%CI -0.22 to 0.06)), patient knowledge (reduced) (SMD -0.34 (95% CI -0.94 to 0.25)), and consultation length (increased) (SMD 0.10 (95% CI -0.05 to 0.25)). Further analyses showed that both coaching and written materials produced similar effects on question asking but that coaching produced a smaller increase in consultation length and a larger increase in patient satisfaction. Interventions immediately before consultations led to a small and statistically significant increase in consultation length, whereas those implemented some time before the consultation had no effect. Both interventions immediately before the consultation and those some time before it led to small increases in patient satisfaction, but this was only statistically significant for those immediately before the consultation. There appear to be no clear benefits from clinician training in addition to patient interventions, although the evidence is limited. Interventions before consultations designed to help patients address their information needs within consultations produce limited benefits to patients. Further research could explore whether the quality of questions is increased, whether anxiety before consultations is reduced, the effects on other outcomes and the impact of training and the timing of interventions. More studies need to consider the timing of interventions and possibly the type of training provided to clinicians.
Lauckner, Heidi M; Stadnyk, Robin L
The age-friendly community movement is a community-level approach to promoting seniors' health that has yet to be thoroughly examined from an occupational perspective. Through the application of the Canadian Practice Process Framework to an age-friendly consultation process, the authors examined how age-friendly community consultations may provide strategies for occupational therapists to strengthen their work with communities. A consultation with a rural Canadian community was guided by the Age-Friendly Rural/Remote Communities Initiative. Focus groups were held with 35 older adults to identify age-friendly features of the community. Twenty key informants who provide services to seniors were also interviewed individually. Following the community consultation, we examined the relationship between the age-friendly community consultation process and occupational therapy community development practice processes using the Canadian Practice Process Framework. The steps of the consultation process paralleled the occupational therapy practice process, with occupational issues implicitly identified in the age-friendly consultation. The age-friendly consultation process emphasised the importance of collaborative partnerships and the need for occupational therapists to adopt a facilitative rather than leadership role. Skills that enable occupation were used throughout this age-friendly consultation. The study suggests that the process of this age-friendly community consultation has relevance to occupational therapy theory and practice, and can provide a useful framework for collaborative consultative processes when working with communities. © 2014 Occupational Therapy Australia.
Shetty, Amith L; Vaghasiya, Milan; Boddy, Rachel; Byth, Karen; Unwin, Danielle
Perceived incivility during ED medical phone consultations is poorly researched. We aimed to determine frequency and factors influencing perceived incivility during ED phone consultations. We conducted a prospective self-reported survey of 40 consecutive phone consultations for 21 ED volunteer doctors. Consultations were classified based on the aim of consultation and deemed as 'positive', 'neutral' or 'negative' based on the perceptions of the consulting doctor. Training levels, time bands and specialty data were collected for both consulting and consulted parties. Fifty-seven of 714 included consultations (7.98%, 95% CI 6.2-10.2%) were reported as negative by ED medical staff. Factors associated with significant incidence of negative grading of consultation involved requests for investigations (19.3% vs 5.3%, P 4 (9.1% vs 3.8%, P incivility during ED phone consultations. Perceived incivility occurs infrequently during ED phone consultations. ED female medical staff are at an increased risk of perceived incivility during phone consultations with non-ED medical professionals. Health organisations should actively pursue programmes to investigate the occurrence of incivility during healthcare consultations and implement programmes to mitigate the risk of developing a negative workplace culture. © 2016 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.
Ignacio Reguero, IT Department
Newly created IT Consultancy Team provides advice on IT matters to communities at CERN starting new projects or reviewing computing activities of old. The members of CERN's IT Consultancy Team. The consultants share their knowledge and experience to improve awareness of the IT landscape at CERN and to advise on system architecture and design to ensure best usage of existing IT services and solutions that favour, and are compatible with, the infrastructure already in place. They also help to formalise requirements and assess impact on security, software licenses and cost, especially where contacts among different services are needed and questions go beyond the current computing service offerings. For instance, the IT consultants may help answering questions like the ones below: We are starting with project X – how could we make its computing aspects compatible with the CERN IT infrastructure? E.g. if you need a web content management system favour Drupal instead of Wor...
Darbar, U R
The role of a hospital consultant has changed extensively over the past decade as the National Health Service has progressed through a series of challenges including an ageing population and rising costs of clinical care. The traditional concept of a consultant has changed with different and increased expectations of the role as the pressures to deliver high quality patient care, education and advice continue to rise in a difficult financial climate. In addition, consultants in restorative dentistry are faced with the challenge of a poor general awareness of the scope of their speciality and their role. This paper provides an update on how the role of the consultant in restorative dentistry has evolved in the last decade and how it differs from that of other dental specialists and general dental practice.
The aim of this study, conducted in Sweden, was to investigate the cultural barriers between school personnel (teachers and principals) and nonschool personnel (a resource team), who were external to the school system, regarding consultation about challenging or difficult-to-teach students. Focus groups with teachers, principals, and the resource…
Mai T. Nguyen
Full Text Available The research conducted here looks at the current Urban Aboriginal Strategy (UAS in Toronto. The purpose of this Strategy is to provide long-term investments to support Aboriginal communities in urban settings by focusing on three priority areas: improving life skills; promoting job training, skills, and entrepreneurship; and supporting Aboriginal women, children, and families. This article seeks to answer the following question: Does the UAS provide Aboriginal participants with the ability to effectively participant in the consultation process? It argues that the UAS process of consulting with the urban Aboriginal community does not allow for the effective participation of Aboriginal peoples because of problematics related to consulting in an urban setting and despite the language of partnership, the federal government still reserves the right to make final decisions. These problems diminish the ability to build renewed Aboriginal-State relations based on mutual respect and trust, which has been absent within the Aboriginal-State apparatus and resulted in the political exclusion of Aboriginals in Canada. Though consultation can be a vehicle for empowering participants with decision-making authority, this is not the case in Toronto. The lack of a common vision, political buy-in, and the aura of secrecy leads to a political relationship built on mistrust. Mistrust between members and government renders the consultation process ineffective. This article combines the literature on public consultations with official government documents to identify critical components that must be evident for consultations to be fruitful and participation effective. These criteria are the benchmarks upon which to measure effectiveness. Based on interviews with the Steering Committee, this article finds that the UAS process of consulting with the Toronto Aboriginal community does not enable Aboriginal participants to effectively participate in the democratic process.
Thais Marques Lima
Full Text Available ABSTRACT Objective: to test the effects of behavioral and educational intervention by telephone on adherence of women with inappropriate periodicity to colpocytological examination. Method: quasi-experimental study with a sample of 524 women, selected with the following inclusion criteria: be aged between 25 and 64 years, have initiated sexual activity, have inappropriate periodicity of examination and have mobile or landline phone. The women were divided into two groups for application of behavioral and educational intervention by telephone. It was used an intervention script according to the principles of Motivational Interviewing. Results: on comparing the results before and after the behavioral and educational interventions, it was found that there was a statistically significant change (p = 0.0283 with increase of knowledge of women who participated in the educational intervention. There was no change in the attitude of women of any of the groups and there was an increase of adherence to colpocytological examination in both groups (p < 0.0001, with greater adherence of women participating in the behavioral group (66.8%. Conclusion: the behavioral and educational interventions by phone were effective in the adherence of women to colpocytological examination, representing important strategies for permanent health education and promotion of care for the prevention of cervical cancer.
The purpose of these "Guidelines for Education and Training at the Doctoral and Postdoctoral Levels in Consulting Psychology/Organizational Consulting Psychology" is to provide a common framework for use in the development, evaluation, and review of education and training in consulting psychology/organizational consulting psychology (CP/OCP). The intent of these guidelines is to improve the quality of teaching and learning in the area of the practice of CP, especially OCP, within the scientific discipline and profession of psychology. Towards these ends, this document is intended as guidance for psychologists who teach or plan curricula for teaching CP/OCP at doctoral or postdoctoral levels of professional education and training in psychology. The guidelines are structured in the form of overarching principles, general competencies, and domain-specific competencies that are ideally obtained by persons receiving training at the doctoral or postdoctoral level in CP/OCP. (Copyright) 2007 APA.
Rosen, Rochelle K; McGarrity, Larissa A; Salmoirago-Blotcher, Elena; Rich, Carla; Rana, Aadia; Carey, Michael P
For people living with HIV and AIDS (PLWHA), life stress often undermines quality of life and interferes with medical care. Mindfulness training (MT) may help PLWHA to manage stress. Because standard MT protocols can be burdensome, we explored telephone delivery as a potentially more feasible approach. We used an innovative 360° qualitative inquiry to seek input regarding telephone-delivery of MT for PLWHA in advance of a planned intervention trial. We also sought input on a time- and attention-matched control. Twenty five HIV patients, providers and advocates, were recruited to five focus groups. Participants understood the construct of mindfulness and recognized its potential benefits for stress management and improving medication adherence. Patients preferred the term "mindfulness" to meditation. Telephone-delivery appealed to all patients but several challenges were raised. Topics for the control intervention included nutrition, sleep, and aging. The 360° approach allowed three groups (patients, providers, advocates) to influence intervention development.
Walpole, Sarah C; Shortall, Clare; van Schalkwyk, May Ci; Merriel, Abi; Ellis, Jayne; Obolensky, Lucy; Casanova Dias, Marisa; Watson, Jessica; Brown, Colin S; Hall, Jennifer; Pettigrew, Luisa M; Allen, Steve
Globalisation is having profound impacts on health and healthcare. We solicited the views of a wide range of stakeholders in order to develop core global health competencies for postgraduate doctors. Published literature and existing curricula informed writing of seven global health competencies for consultation. A modified policy Delphi involved an online survey and face-to-face and telephone interviews over three rounds. Over 250 stakeholders participated, including doctors, other health professionals, policymakers and members of the public from all continents of the world. Participants indicated that global health competence is essential for postgraduate doctors and other health professionals. Concerns were expressed about overburdening curricula and identifying what is 'essential' for whom. Conflicting perspectives emerged about the importance and relevance of different global health topics. Five core competencies were developed: (1) diversity, human rights and ethics; (2) environmental, social and economic determinants of health; (3) global epidemiology; (4) global health governance; and (5) health systems and health professionals. Global health can bring important perspectives to postgraduate curricula, enhancing the ability of doctors to provide quality care. These global health competencies require tailoring to meet different trainees' needs and facilitate their incorporation into curricula. Healthcare and global health are ever-changing; therefore, the competencies will need to be regularly reviewed and updated. © The Author 2016. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.
Vorm, J.K.J. van der
The success of managing Occupational Health and Safety (OHS) depends on an effective and efficient process of becoming aware of the potential for improvement, problem definition, diagnosis, designing possible improvements, decision making and implementing potential improvements. This process
information la plus fiable. Cette personne connaît bien les modalités du contrat et est la mieux placée pour répondre à vos questions et préoccupations. Voici les réponses à quelques questions que vous pourriez vous poser. [Sans aucune ...
Stacey, Dawn; Green, Esther; Ballantyne, Barbara; Skrutkowski, Myriam; Whynot, Angela; Tardif, Lucie; Tarasuk, Joy; Carley, Meg
Assess patient and family member experiences with telephone cancer treatment symptom support. Descriptive study guided by the Knowledge-to-Action Framework. Patients and family members who received telephone support for a cancer treatment symptom within the last month at one of three ambulatory cancer programs (Nova Scotia, Ontario, Quebec) were eligible. An adapted Short Questionnaire for Out-of-hours Care instrument was analyzed with univariate statistics. Of 105 participants, 83 % telephoned about themselves and 17 % for a family member. Participants received advice over the telephone (90 %) and were advised to go to emergency (13 %) and/or the clinic (9 %). Two left a message and were not called back. Participants were "very satisfied" with the manner of nurse or doctor (58 %), explanation about problem (56 %), treatment/advice given (54 %), way call was handled (48 %), getting through (40 %), and wait time to speak to a nurse or doctor (38 %). The proportion "dissatisfied" or "very dissatisfied" for the above items was 4, 5, 9, 11, 10, and 14 %, respectively. Suggestions were shorter call back time, weekend access to telephone support, more knowledgeable advice on self-care strategies, more education at discharge, and shared documentation on calls to avoid repetition and improve continuity. Most patients and family members who responded to the survey were satisfied with telephone-based cancer treatment symptom support. Programs could improve telephone support services by providing an estimated time for callback, ensuring that nurses have access to and use previous call documentation, and enhancing patient education on self-care strategies for managing and triaging treatment-related symptoms.
Riggs, Alexa; Breuer, Brenda; Dhingra, Lara; Chen, Jack; Portenoy, Russell K; Knotkova, Helena
In the U.S., palliative care programs improve access to hospice through enhanced communication and efficiencies in hospice eligibility review and enrollment. For community-based programs, this task may begin with telephone contact. To evaluate the incidence and predictors of hospice enrollment following telephonic outreach by a nurse after referral to a community-based, specialist palliative care program. During 2012-2014, 299 consecutive patients who were referred to a palliative care program and subsequently enrolled in hospice provided electronic health record data for a retrospective cohort study. Those who elected hospice after telephonic outreach and before the first palliative care home visit, were compared with those who enrolled in hospice after palliative care visits began, using both bivariate and multivariate analyses. Mean (SD) age was 74.1 (18.7) years; 60.2% were women, 44.4% were White, 22.5% were Hispanic, 20.9% were Black, and 9.6% were Asian. In total, 177 patients (59.2%) elected hospice following telephonic outreach and 122 (40.8%) enrolled after home visits began. The former group received a mean of 4.5 calls (median = 3.0) before hospice election. In multivariate analysis, hospice enrollment following telephonic outreach alone was associated with hospital or nursing home referral, not married status, and poor performance status (all P palliative care program did so following telephonic outreach alone. Both sociodemographic and clinical characteristics predicted this outcome. Palliative care programs can improve hospice access through initial telephonic outreach by trained professionals. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
US Fish and Wildlife Service, Department of the Interior — This is the Endangered Species Consultation Request report for bald eagles and peregrine falcons on Muscatatuck NWR. This consultation was in response to the...
Jenkins, David A.
A nurse education consultant can help a college enhance the educational process and market effectively and ethically. Nurses considering consultancy should examine their personal qualities, skill and knowledge base, and personal values and beliefs about education and nursing. (SK)
Li, Jia; Liu, Minghui; Liu, Xuan; Ma, Ling
e-Consultation provides a new way to deliver healthcare services online. With the help of e-Consultation services, patients can gain access to nationwide medical expertise that otherwise would not be available to them. As an online delivery approach, e-Consultation also provides a choice for patients to receive medical advice from online doctors immediately, no matter how far away from the hospital they may be or how late in the day it is. However, the adoption and usage of e-Consultation is still far from satisfactory. Therefore, understanding why and when patients use e-Consultation services are important research questions. Considering that the choice of a healthcare provider is a serious decision, this research uses the trust perspective to explain the e-Consultation service adoption phenomenon. Specifically, trust is conceptualized as a second-order construct consisting of two dimensions: competence and integrity. In addition, e-Consultation is viewed as a supplementary resource to traditional off-line consultation services, and disease type as a contextual factor is hypothesized to focus the context where e-Consultation services are more suitable. A scenario-based survey was conducted to test the proposed research model. We obtained a total of 190 valid questionnaires. Our results indicated that trust (p e-Consultation service. Meanwhile, our results also indicated that the higher the disease is in rarity (p e-Consultation service. Trust is the major driving force of an e-Consultation service adoption. When the disease is high in rarity, severity, or urgency, an off-line healthcare provider is less capable of providing meaningful, qualified, and immediate service. Therefore, there is a decreased positive effect of trust on the intention to use an e-Consultation service for those diseases.
Montani, C; Billaud, N; Couturier, P; Fluchaire, I; Lemaire, R; Malterre, C; Lauvernay, N; Piquard, J F; Frossard, M; Franco, A
Evaluation of the clinical feasibility of remote psychometric consultation with elderly patients. Remote consultation with six women and four men (average age 87) was compared with a standard consultation. An interview and two psychometric tests were used: the Mini-Mental Status Examination (MMSE) and the Clock Face Test (CFT), which were administered by a clinical psychologist and controlled by a psychologist observer who remained in the room with the patient. The experimental setting consisted of two rooms linked by a coaxial cable. Each room was equipped with a camera, television screen, and microphone. The clinician was able to operate the mobile camera in the patient's room by remote control. The clinician was assisted by a computer, which helped to focus on standardized points. A video camera recorded the consultation for documentation purposes. Decreased performance was observed in the remote versus the standard consultation for both tests (MMSE: p = 0.008; CFT: p = 0.006). Physiologic hearing loss may have been responsible for a fall in the patients' attention. Remote psychometric consultation can be applied successfully to the psychological examination of elderly patients provided that communication problems are solved.
Cohen, N L; Waltzman, S B; Shapiro, W H
The reported telephone usage by cochlear implant recipients has become a major issue of controversy. Although patients and clinicians report good communication skills via the telephone, no standardized tests have been used and no quantifiable results have been reported. In an effort to determine the extent to which our better-performing patients can use the telephone, we established a clinical protocol to assess their ability to recognize speech, taking into consideration the problems inherent in telephone testing. Eight cochlear implant recipients were administered the NU-6 Monosyllabic Word Test and the City University of New York Topic Related Sentences under the following listening conditions: soundfield in a soundproof suite and via telephone within the hospital, locally, and long-distance. Twenty-three percent of the patients implanted at New York University Medical Center demonstrated a significant degree of telephone communication ability.
Jiwa, Moyez; Meng, Xingqiong
There is unequal access to health care in Australia, particularly for the one-third of the population living in remote and rural areas. Video consultations delivered via the Internet present an opportunity to provide medical services to those who are underserviced, but this is not currently routine practice in Australia. There are advantages and shortcomings to using video consultations for diagnosis, and general practitioners (GPs) have varying opinions regarding their efficacy. The aim of this Internet-based study was to explore the attitudes of Australian GPs toward video consultation by using a range of patient scenarios presenting different clinical problems. Overall, 102 GPs were invited to view 6 video vignettes featuring patients presenting with acute and chronic illnesses. For each vignette, they were asked to offer a differential diagnosis and to complete a survey based on the theory of planned behavior documenting their views on the value of a video consultation. A total of 47 GPs participated in the study. The participants were younger than Australian GPs based on national data, and more likely to be working in a larger practice. Most participants (72%-100%) agreed on the differential diagnosis in all video scenarios. Approximately one-third of the study participants were positive about video consultations, one-third were ambivalent, and one-third were against them. In all, 91% opposed conducting a video consultation for the patient with symptoms of an acute myocardial infarction. Inability to examine the patient was most frequently cited as the reason for not conducting a video consultation. Australian GPs who were favorably inclined toward video consultations were more likely to work in larger practices, and were more established GPs, especially in rural areas. The survey results also suggest that the deployment of video technology will need to focus on follow-up consultations. Patients with minor self-limiting illnesses and those with medical
Dinkmeyer, Don; Dinkmeyer, Don, Jr.
The failure to consult effectively with teachers is often due to a lack of understanding the purpose of behavior. Specific propositions basic to understanding behavior are presented. A transcript which clearly illustrates and critiques Adlerian consultation is included. Specific steps in the consultant process are included. (Author)
This presentation reviews the concept of school-based consultation (Lambert, 1974) and contrasts it with other consultation models. The validity of this model for the professional talking relationships of school psychologists (school-based consultation) is assessed first by examining: (1) the likelihood that interprofessional interchange will take…
Tweed, Mike; Ingham, Christopher
Judgments made by the assessors observing consultations are widely used in the assessment of medical students. The aim of this research was to study judgment accuracy and confidence and the relationship between these. Assessors watched recordings of consultations, scoring the students on: a checklist of items; attributes of consultation; a…
Burkhouse, Katie Lynn Sutton
The purpose of this research was to develop and validate a set of core competencies of effective school-based consultants for preservice school psychology consultation training. With recent changes in service delivery models, psychologists are challenged to engage in more indirect, preventative practices (Reschly, 2008). Consultation emerges as…
Glueckauf, Robert L; Davis, W Shuford; Willis, Floyd; Sharma, Dinesh; Gustafson, David J; Hayes, Jocelyn; Stutzman, Mary; Proctor, James; Kazmer, Michelle M; Murray, Leticia; Shipman, Judith; McIntyre, Vera; Wesley, Lonnie; Schettini, Gabriel; Xu, Jian; Parfitt, Francine; Graff-Radford, Neill; Baxter, Cynthia; Burnett, Kathleen; Noël, La Tonya; Haire, Kambria; Springer, Jane
Discuss initial findings of a randomized clinical trial comparing the effects of telephone-based and face-to-face (f-to-f) cognitive-behavioral therapy (CBT) on changes in caregiver (CG) burden, assistance support, depression, and health status for African American (AA) CGs with depression. Pilot study using a prepost, two-group design with 14 enrolled and randomized participants. Subjective Burden subscale of the Caregiver Appraisal Inventory, Assistance Support subscale of the Interpersonal Support Evaluation List, Physical Symptoms subscale of the Caregiver Health and Health Behavior Inventory and the Center for Epidemiologic Studies Depression Scale. Prepost improvements were found on 11 completers across all measures for both telephone and f-to-f CBT. Moderate and similar effects sizes for CG subjective burden and assistance support were found for both the telephone and f-to-f groups. Effect sizes for physical symptoms and depression varied from low to moderate, respectively, with a trend toward smaller improvements in f-to-f CBT than in telephone CBT. Qualitative analysis highlighted CGs' perceptions of the active ingredients of treatment and provided indirect support for similar gains in emotional and psychosocial functioning across the two treatment modalities. Both telephone-based and f-to-f CBT showed improvements in depression, subjective burden, and assistance support in dementia AA CGs. Replication with a larger sample size (N = 106) is currently in progress. Study limitations and future directions for research are also addressed. PsycINFO Database Record (c) 2012 APA, all rights reserved.
Full Text Available Objective: Telephone-based weight loss programs are offered as an alternative to face-to-face obesity treatments, but data on the effectiveness regarding weight loss are limited. Therefore, we evaluated a telephone-based lifestyle program in a real-world setting. Methods: The telephone-based intervention consists of regular phone calls providing individualized lifestyle recommendations, and delivery of printed materials. Anthropometric and metabolic data are collected by general practitioners or are self-reported. Results: Baseline data were available from 398 participants (61% men; weight 103.12 ± 14.21 kg; BMI 33.38 ± 2.83 kg/m2 and 1-year data from 258 (65% participants. In the completers, mean weight change was -4.25 ± 5.18 kg (p Conclusions: The telephone-based lifestyle program results in a moderate weight loss after 12 months, which may be comparable to face-to-face interventions. Telephone-based weight loss support is independent of time and location and represents a tool which is also accepted by men.
Nasar, Jack; Hecht, Peter; Wener, Richard
Driver distraction is a major cause of traffic accidents, with mobile telephones as a key source of distraction. In two studies, we examined distraction of pedestrians associated with mobile phone use. The first had 60 participants walk along a prescribed route, with half of them conversing on a mobile phone, and the other half holding the phone awaiting a potential call, which never came. Comparison of the performance of the groups in recalling objects planted along the route revealed that pedestrians conversing recalled fewer objects than did those not conversing. The second study had three observers record pedestrian behavior of mobile phone users, i-pod users, and pedestrians with neither one at three crosswalks. Mobile phone users crossed unsafely into oncoming traffic significantly more than did either of the other groups. For pedestrians as with drivers, cognitive distraction from mobile phone use reduces situation awareness, increases unsafe behavior, putting pedestrians at greater risk for accidents, and crime victimization.
... the central office, private branch exchange, teletypewriter exchange, and at public telephone stations..., REVENUES, EXPENSES, TAXES AND RESERVES FOR TELECOMMUNICATIONS COMPANIES 1 Operating Expenses and Taxes...
Schmidt, Robert L; Garcia, Christopher A; Panlener, Jeanne; Ashwood, Edward R; Jackson, Brian R; Hussong, Jerry W
Clinical consultation is a key role of pathologists. Many have advocated that pathologists expand their consulting activities to improve laboratory utilization. Although many have suggested that residency programs need to provide experience in clinical consultation, little has been written on the nature of consultation or on the methods of training. To characterize the content of consultations and to describe training in consultation in chemical pathology within the residency program at the University of Utah, Salt Lake City. Retrospective review of the consultation database for the period between July 2011 and July 2012. Residents performed an average of 159 consultations a month covering 276 topics during the course of a year. Each topic involved 1 or more specific tests. Eighty percent of the topics received fewer than 12 calls. The most common topics involved virus testing (eg, hepatitis B virus, hepatitis C virus, human immunodeficiency virus). Consultations most often involved test interpretation (53%), selection (38%), and performance characteristics (21%). Twenty-seven percent of consultations involved 2 or more consultation categories (eg, interpretation and performance). Consultation calls in chemical pathology are widely distributed across topics. Consultations most often involve test interpretation and selection. Methods to assess the effectiveness of consultations and resident teaching should be devised.
Elham Agha Alikhani
Full Text Available For over two decades, telephone banking has steadily become a useful feature and all banks have tried to provide this feature as part of their services. In this paper, we present an empirical investigation to study the role of personal and social characteristics on acceptance of new telephone banking services. The proposed study designs two questionnaires and distributes them among 384 randomly selected people who use telephone banking in city of Tehran, Iran. Using structural equation modeling, the study examines various hypotheses and the results of our survey indicate that there were some positive and meaningful relationships between perception usefulness and users’ attitude, perception and ease of use, perception and intention to use as well as perception and intention to use. In addition, the study has detected a negative and meaningful relationship between personal risk and intention to use and perception of personal time and intention to use among mobile users.
Rushton, Cherie; Robertson, Leeah; Taylor, Tracie; Taylor, Peter; Alfred, Arun
The prompt assessment of patients as fit for photopheresis is imperative to ensure delivery of a safe and efficient service. Before January 2015 the photopheresis unit was reliant on patients contacting the department directly to cancel their appointment if they were unwell or were suffering from any pre-defined exclusion criteria. Methods to reduce the number of cancellations and patients arriving unwell were therefore examined. The authors combined aspects of patient pre-assessment with telephone triage to develop a system that could provide better care and improve the use of resources within the department. The pre-assessment telephone triage system successfully reduced cancellations and increased patient awareness of conditions that would prevent delivery of photopheresis treatment. Subsequently the quality improvement initiative established that the pre-assessment telephone triage system saved the photopheresis unit over £33 000 over a 12-month period.
Sansoni, Janet E; Grootemaat, Pam; Duncan, Cathy
This review examines the use and effectiveness of Question Prompt Lists (QPL) as communication aids to enhance patient question asking, information provision to patients and patient participation in health and medical consultations. A systematic search was undertaken to identify relevant literature concerning QPLs including academic databases, Google-based and snowball searching. Forty-two relevant studies reporting 50 interventions were identified. Although findings varied there was some evidence that a QPL endorsed by the physician increased total question asking. Using a QPL increased question asking concerning specific content areas (e.g. prognosis). There was some evidence that physicians provided more information during consultations. There were no consistent findings concerning effects on patient knowledge recall, anxiety and satisfaction or consultation time. Some interventions that increased question asking had longer consultation times. There is evidence that an appropriate QPL, endorsed by the physician and provided immediately before the consultation, may increase patient question asking and lead to more information being provided by the physician. There is increasing evidence to support QPL use in routine practice. Further trials might address the issues identified including an assessment of QPL optimal length and QPL adaptation for cultural and special needs groups. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Peleg, Roni; Avdalimov, Angelika; Freud, Tamar
The provision of cell phone numbers and email addresses enhances the accessibility of medical consultations, but can add to the burden of physicians' routine clinical practice and affect their free time. The objective was to assess the attitudes of physicians to providing their telephone number or email address to patients. Primary care physicians in the southern region of Israel completed a structured questionnaire that related to the study objective. The study population included 120 primary care physicians with a mean age of 41.2 ± 8.5, 88 of them women (73.3%). Physicians preferred to provide their cell phone number rather than their email address (P = 0.0007). They preferred to answer their cell phones only during the daytime and at predetermined times, but would answer email most hours of the day, including weekends and holidays (P = 0.001). More physicians (79.7%) would have preferred allotted time for email communication than allotted time for cell phone communication (50%). However, they felt that email communication was more likely to lead to miscommunication than telephone calls (P = 0.0001). There were no differences between male and female physicians on the provision of cell phone numbers or email addresses to patients. Older physicians were more prepared to provide cell phone numbers that younger ones (P = 0.039). The attitude of participating physicians was to provide their cell phone number or email address to some of their patients, but most of them preferred to give out their cell phone number.
The 'Pocket films empathy' activity is aimed at young people at risk of dropping out of school and those in crisis, often struggling to interact and show empathy with others. It provides support led by street educators trained in the use of the mobile telephone as a tool for talking and creating. By inviting them to put images and words to their emotions and compare their points of view, it enables these young people to express their anger, to escape from the fascination for sectarian ideas and to start to create their own personal history as well as their history within their family and society as a whole. Copyright © 2017 Elsevier Masson SAS. All rights reserved.
Bugtai, Nilo T.; Ong, Aira Patrice R.; Angeles, Patrick Bryan C.; Cervera, John Keen P.; Ganzon, Rachel Ann E.; Villanueva, Carlos A. G.; Maniquis, Samuel Nazirite F.
There are numerous efforts to add value for telehealth applications in the country. In this study, the design of a telepresence doctor to facilitate remote medical consultations in the wards of Philippine General Hospital is proposed. This includes the design of a robot capable of performing a medical consultation with clear audio and video information for both ends. It also provides the operating doctor full control of the telepresence robot and gives a user-friendly interface for the controlling doctor. The results have shown that it provides a stable and reliable mobile medical service through the use of the telepresence robot.
Full Text Available Background: Doctors’ verbal and non-verbal communication skills have an impact on patients’ health outcomes, so it is important for medical students to develop these skills. Traditional, non-verbal communication skills training can involve a tutor manually annotating a student's non-verbal behaviour during patient–doctor consultations, but this is very time-consuming. Tele-conference systems have been used in verbal communication skills training. Methods: We describe EQClinic, a system that enables verbal and non-verbal communication skills training during tele-consultations with simulated patients (SPs, with evaluation exercises promoting reflection. Students and SPs can have tele-consultations through the tele-consultation component. In this component, SPs can provide feedback to students through a thumbs-up/ thumbs-down tool and a comments box. EQClinic automatically analyses communication features in the recorded consultations, such as facial expressions, and provides graphical representations. Our 2015 pilot study investigated whether EQClinic helped students be aware of their non-verbal behaviour and improve their communication skills, and evaluated the usability of the platform. Students received automated feedback, and SP and tutor evaluations, and then completed self-assessment and reflection questionnaires. Results: Eight medical students and three SPs conducted 13 tele-consultations using EQClinic. More students paid attention to their non-verbal communication and students who were engaged in two consultations felt more confident in their second consultation. Students rated the system positively, felt comfortable using it (5.9/7, and reported that the structure (5.4/7 and information (5.8/7 were clear. This pilot provides evidence that EQClinic helps, and positively influences, medical students practise their communication skills with SPs using a tele-conference platform. Discussion: It is not easy to improve non
Liu, Chunfeng; Scott, Karen M; Lim, Renee L; Taylor, Silas; Calvo, Rafael A
Doctors' verbal and non-verbal communication skills have an impact on patients' health outcomes, so it is important for medical students to develop these skills. Traditional, non-verbal communication skills training can involve a tutor manually annotating a student's non-verbal behaviour during patient-doctor consultations, but this is very time-consuming. Tele-conference systems have been used in verbal communication skills training. We describe EQClinic, a system that enables verbal and non-verbal communication skills training during tele-consultations with simulated patients (SPs), with evaluation exercises promoting reflection. Students and SPs can have tele-consultations through the tele-consultation component. In this component, SPs can provide feedback to students through a thumbs-up/ thumbs-down tool and a comments box. EQClinic automatically analyses communication features in the recorded consultations, such as facial expressions, and provides graphical representations. Our 2015 pilot study investigated whether EQClinic helped students be aware of their non-verbal behaviour and improve their communication skills, and evaluated the usability of the platform. Students received automated feedback, and SP and tutor evaluations, and then completed self-assessment and reflection questionnaires. Eight medical students and three SPs conducted 13 tele-consultations using EQClinic. More students paid attention to their non-verbal communication and students who were engaged in two consultations felt more confident in their second consultation. Students rated the system positively, felt comfortable using it (5.9/7), and reported that the structure (5.4/7) and information (5.8/7) were clear. This pilot provides evidence that EQClinic helps, and positively influences, medical students practise their communication skills with SPs using a tele-conference platform. It is not easy to improve non-verbal communication skills in a short time period. Further evaluation of
Bank, Adam L.; Arguelles, Soledad; Rubert, Mark; Eisdorfer, Carl; Czaja, Sara J.
Purpose: Dementia caregiving is a rapidly growing public health problem. Logistical problems prevent many caregivers from utilizing available interventions. This article provides a demonstration of the usefulness of technology for conducting telephone-based support groups in ethnically diverse dementia caregivers. Design and Methods: Participants…
Miller, Susan C; Dahal, Roshani; Lima, Julie C; Intrator, Orna; Martin, Edward; Bull, Janet; Hanson, Laura C
Although specialty palliative care in hospital and outpatient settings is associated with lower acute care use, its impact in U.S. nursing homes (NHs) is unknown. To understand how NH use of palliative care consults is associated with end-of-life hospitalizations. Seven consult providers in four states and 24 counties shared data on the number of consult visits and residents served (per NH) in study years 2000-2010. All NHs in the 24 counties were studied (n = 286). An NH-level longitudinal file included consult data, aggregated Medicare resident assessment and claims data, and NH characteristics. Consult introduction was "yes" when 1% of residents received consults. Volume was the number of consult visits per 100 residents, annually. Panel multivariate regression with NH fixed effects examined whether rates of hospital deaths and hospitalizations in the last 30 days of life differentially changed for NHs introducing consults, or increasing consult volume. One hundred seventy (59%) of the 286 NHs introduced consults by 2010. NHs with consults, compared to others, had residents with higher acuity and functional impairment, and lower nurse but higher nursing assistant staffing. Controlling for covariate differences and compared to NHs without consults, NHs introducing consults had a 1% (95% CI -0.021, 0.002) greater reduction in hospital death rates and a 1.6% (95% CI -0.031, -0.002) greater reduction in hospitalizations in the last 30 days of life. No statistically significant associations between volume and study outcomes were observed. The introduction of specialty palliative care consults in NHs is associated with overall reductions in end-of-life hospitalizations. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
Bryan, J M; Geroy, G D; Isernhagen, S J
Industrial physical therapists (IPTs) are working as external consultants with business and industry to provide injury prevention and/or rehabilitation services. This consulting presents a very new practice setting for therapists and requires specialized nonclinical competencies. The purpose of this study was to identify these nonclinical competencies. The research was based on an evaluation research model using a stakeholder group. Stakeholders represented five groups: 1) IPTs, 2) continuing education providers, 3) business and industry employers of IPTs, 4) safety/risk managers, and 5) human resource development professionals. Thirty-five nonclinical competencies were identified through qualitative analysis of in-depth interviews with 17 subject matter experts representing the five groups. The competencies addressed marketing, program planning, managing the consulting process, training, and understanding organizations. This list of nonclinical competencies may serve as a self-assessment tool that IPTs can use to help plan their professional development. It may also facilitate planning continuing education programs for IPTs.
Fukkink, R.G.; Hermanns, J.M.A.
Background: In line with the wider trend of offering support via the Internet, many counseling and referral services for children have introduced online chat, often in addition to a traditional telephone service. Methods: A comparative study was conducted between the telephone service and the
..., not telephone dial-up. \\19\\ U.S. Census Bureau, E-Stats, 2007 E-Commerce Multi-Sector Report, May 28... Mail-Order Houses--Total and E-Commerce Sales by Merchandise Line: 2006-2007. Second, consumer... buyers access the Internet (e.g., dial-up telephone modem, cable, or wireless); (2) allow sellers to...
Ma, Zilong; Lei, Ying
Introduces a system design scheme of the telephone dialer based on Arduino, including the design principle, hardware and software design and the experimental results in this paper. The scheme is based on the dual tone multi frequency (DTMF) dialing mode, using the Arduino UNO as the main controller, the serial port send out the telephone number to be dialed, speaker synthesize the voice.
... 47 Telecommunication 4 2010-10-01 2010-10-01 false Broadcast of telephone conversations. 73.1206 Section 73.1206 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) BROADCAST RADIO SERVICES RADIO BROADCAST SERVICES Rules Applicable to All Broadcast Stations § 73.1206 Broadcast of telephone...
year period of amortization of the remaining unrecovered investment would better avoid the problems of intergenerational inequities than the current...means of safeguarding the subscriber’s premises and telephone network from atmospheric or other electrical discharges through the outside telephone
... 49 Transportation 3 2010-10-01 2010-10-01 false Telephonic notice of certain accidents. 195.52... TRANSPORTATION OF HAZARDOUS LIQUIDS BY PIPELINE Annual, Accident, and Safety-Related Condition Reporting § 195.52 Telephonic notice of certain accidents. (a) At the earliest practicable moment following discovery of a...
BROOKHUIS, KA; DEVRIES, G; DEWAARD, D
The effects of telephoning while driving were studied in three different traffic conditions, i.e. in light traffic on a quiet motorway, in heavy traffic on a four-lane ring-road, and in city traffic. Twelve subjects, unfamiliar with mobile telephones, drove an instrumented vehicle for one hour each
The rapid increase in mobile telephone use has generated concern about possible health risks related to radiofrequency electromagnetic fields from this technology.......The rapid increase in mobile telephone use has generated concern about possible health risks related to radiofrequency electromagnetic fields from this technology....
... subscriber for toll telephone service furnished to the hotel or its guests, but no tax attaches to any charge made by the hotel for service rendered in placing the calls for its guests. (c) Cross reference. For... 26 Internal Revenue 16 2010-04-01 2010-04-01 true Toll telephone service. 49.4252-2 Section 49...
... total charge made to a hotel or similar subscriber for general telephone service furnished to the hotel or its guests, but no tax attaches to any charge made by the hotel for service rendered in placing... 26 Internal Revenue 16 2010-04-01 2010-04-01 true General telephone service. 49.4252-1 Section 49...
Vellapandian Ponnusamy, J. Robert Grove
Factors relevant to the working alliance between athletes and sport psychology consultants were investigated in a sample of elite Malaysian athletes (n = 217). The athletes represented a variety of team and individual sports, and they provided information about the perceived importance of seven consultant characteristics/behaviors as well as seven program delivery options. At a full-sample level, general preferences were expressed for consultants to lead a physically active lifestyle, regular...
Sustainable Development Commission Scotland
The final report produced after the consultation is entitled 'Public bodies climate change duties : putting them into practice'. The Climate Change (Scotland) Act requires that Scottish Ministers provide guidance to relevant public bodies in relation to their climate change duties and that those bodies must have regard to such guidance. A public consultation on draft Scottish Government guidance will take place in summer 2010. In advance of that a series of pre-consultation workshops were ...
Full Text Available Telephone focus groups have been increasingly popular in public health research and evaluation. One of the main concerns of telephone focus groups is the lack of nonverbal cues among participants, which could limit group interactions and dynamics during the focus group discussion. To overcome this limitation, we supplemented telephone focus groups with webinar technology in a recent evaluation of a provincial public health program in Ontario, Canada. In this article, we share the methods used and our experiences in conducting telephone focus groups supplemented with webinar technology, including advantages and challenges. Our experience will inform other researchers who may consider using telephone focus groups with webinars in future research and evaluation.
Olubunmi Philip Aborisade
Full Text Available Telephone technology is a technology that stands the test of time. Since it was invented in 1876 by Alexander Graham Belle, it remains the technology of all time. This article reports the major finding of a recent research, how technology transforms citizen journalism business in Nigeria. According to the research, Telephone technology has over the years emerged the major tool with which ordinary citizens in Nigeria without journalism and media background or affiliation participate in the process of news gathering, reporting and distribution. Guided by the recent use of telephone around the world by ordinary citizens to report themselves during protests through different social media outlets-Facebook, Tweeter, Youtube, the article illuminates the evergreen nature of the telephone. The article therefore concluded that the telephone technology invented in 1876 has survived the test of time. Instead of being obsolete, it blends with emerging communications technology to improve on its performance.
Seren, Erdal; Ilhanlı, Ilker; Bayar Muluk, Nuray; Cingi, Cemal; Hanci, Deniz
Snoring is a sound caused by vibration of collapsed and/or unsteady airway walls of the pharynx and soft palate. We compared stored spectra of snoring sounds recorded via cell phone (CP) and a microphone placed over the head (head phone [HP]). Thirty-four snoring patients were included in this prospective study. Groups were identified by reference to body mass index (BMI) values: group 1, BMI obese patients of group 3, almost all F(max) and SSIL values were higher than those of groups 1 and 2. In particular, the CP F(max) values were elevated in such patients. The advanced technologies used in modern CPs may allow some snoring sounds in susceptible individuals to be defined as oronasal. Cell phone technology allows snoring to be evaluated in patients located in areas remote from a hospital. To explore the intensity of snoring and to postoperatively monitor the efficacy of surgery used to treat snoring, telephonic sound analysis is both new and effective and reduces the need for patient attendance at a hospital. Those experiencing severe snoring and/or who are obese should be told of what can be done to solve such problems. © The Author(s) 2014.
Paskoff, B M
Six factual queries were unobtrusively telephoned to fifty-one U.S. academic health sciences and hospital libraries. The majority of the queries (63.4%) were answered accurately. Referrals to another library or information source were made for 25.2% of the queries. Eleven answers (3.6%) were inaccurate, and no answer was provided for 7.8% of the queries. There was a correlation between the number of accurate answers provided and the presence of at least one staff member with a master's degree in library and information science. The correlation between employing a librarian certified by the Medical Library Association (MLA) and providing accurate answers was significant. The majority of referrals were to specific sources. If these "helpful referrals" are counted with accurate answers as correct responses, they total 76.8% of the answers. In a follow-up survey, five libraries stated that they did not provide accurate answers because they did not own an appropriate source. Staff-related problems were given as reasons for other than accurate answers by two of the libraries, while eight indicated that library policy prevented them from providing answers to the public.
Wang, George Sam; Monte, Andrew; Hatten, Benjamin; Brent, Jeffrey; Buchanan, Jennie; Heard, Kennon J
Currently, only 10% of board-certified medical toxicologists are pediatricians. Yet over half of poison center calls involve children toxicology consultation is not common at children's hospitals. In collaboration with executive staff from Department of Pediatrics and Emergency Medicine, regional poison center, and our toxicology fellowship, we established a toxicology consulting service at our tertiary-care children's hospital. There were 139 consultations, and the service generated 13 consultations in the first month; median of 11 consultations per month thereafter (range 8-16). The service increased pediatric cases seen by the fellowship program from 30 to 94. The transition to a consult service required a culture change. Historically, call center advice was the mainstay of consulting practice and the medical staff was not accustomed to the availability of bedside medical toxicology consultations. However, after promotion of the service and full attending and fellowship coverage, consultations increased. In collaboration with toxicologists from different departments, a consultation service can be rapidly established. The service filled a clinical need that was disproportionately utilized for high acuity patients, immediately utilized by the medical staff and provided a robust pediatric population for the toxicology fellowship.
Atherton, Helen; Brant, Heather; Ziebland, Sue; Bikker, Annemieke; Campbell, John; Gibson, Andy; McKinstry, Brian; Porqueddu, Tania; Salisbury, Chris
NHS policy encourages general practices to introduce alternatives to the face-to-face consultation, such as telephone, email, e-consultation systems, or internet video. Most have been slow to adopt these, citing concerns about workload. This project builds on previous research by focusing on the experiences of patients and practitioners who have used one or more of these alternatives. To understand how, under what conditions, for which patients, and in what ways, alternatives to face-to-face consultations present benefits and challenges to patients and practitioners in general practice. Focused ethnographic case studies took place in eight UK general practices between June 2015 and March 2016. Non-participant observation, informal conversations with staff, and semi-structured interviews with staff and patients were conducted. Practice documents and protocols were reviewed. Data were analysed through charting and the 'one sheet of paper' mind-map method to identify the line of argument in each thematic report. Case study practices had different rationales for offering alternatives to the face-to-face consultation. Beliefs varied about which patients and health issues were suitable. Co-workers were often unaware of each other's practice; for example, practice policies for use of e-consultations systems with patients were not known about or followed. Patients reported benefits including convenience and access. Staff and some patients regarded the face-to-face consultation as the ideal. Experience of implementing alternatives to the face-to-face consultation suggests that changes in patient access and staff workload may be both modest and gradual. Practices planning to implement them should consider carefully their reasons for doing so and involve the whole practice team. © British Journal of General Practice 2018.
Wright, Diane; Pincombe, Jan; McKellar, Lois
Listening to women as part of their antenatal care has been recognized as valuable in understanding the woman's needs. Conversations as part of routine antenatal interactions offer ideal opportunities for women to express themselves and for midwives to learn about the woman's issues and concerns. The antenatal visit and the convention of antenatal consultations for midwives have not been well explored or defined and much of what takes place replicate medical consultative processes. As a consequence, there is little to assist midwives construct woman-centred care consultations for their routine antenatal care practice. This study showed how some practices were better in promoting the woman's voice and woman-centred care in the hospital setting. Contemporary focused ethnography using both interview and observations, explored how midwives from six different public antenatal clinics in South Australia organized their antenatal care consultations with pregnant women. Thematic analysis of the data provided insights into professional interpretation of woman-centred practice. How midwives interacted with women during routine antenatal care events demonstrated that some practices in a hospital setting could either support or undermine a woman-centred philosophy. Individual midwives adopted practices according to their own perceptions of actions and behaviors that were considered to be in accordance with the philosophy of woman-centred care. Information arising from this study has shown ways midwives may arrange antenatal care consultations to maximize women's participation. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
Lima, Julie C; Miller, Susan C
Little is known about nursing home (NH) residents who receive palliative care (PC) consults in the United States. Separately by short versus long (≥90 days) stays, to describe NH residents with PC consults compared to a prevalent NH sample. Descriptive longitudinal study. NH residents in 2008-2010 in 54 NHs. Resident characteristics came from merged Medicare and NH data from the Centers for Medicare and Medicaid Services and consult information from two PC organizations that were the sole PC consult providers in the study NHs. Four percent of all NH residents received a PC consult during the study period. Two-thirds had short NH stays, and 81% of short- and 27% of long-stay consult recipients were on the Medicare skilled nursing facility (SNF) benefit at the time of initial consult. Short- and long-stay NH residents with PC consults differed not only, in many respects, from NH residents generally but also from each other. Despite these differences, half of short-stay and 57% of long-stay residents were alive six months after initial consults. Residents dead at six months died at 33.5 and 34.5 median days (respectively) after initial consults. At six months, 65% of surviving short-stay consult recipients were in the community without hospice, while 59% of long-stay residents were in the NH without hospice or Medicare SNF care. The high rates of SNF care and six-month survival among NH recipients of PC consults demonstrate the utility of these consults before Medicare hospice eligibility or use.
Penna, Lucia Helena Garcia; Carinhanha, Joana Iabrudi; Rodrigues, Raquel Fonseca
This article describes the Collective Prenatal Consultation as a new healthcare methodology, which is performed according to government standards, but collectively. Relaxation and sensitization techniques are used, as well as group dynamics, including a collective exam of the pregnant women. The Collective Consultation is carried out in a welcoming environment, which provides clarification and socialization of experiences and information, centered on those women. The healthcare professional records every obstetric parameter and behavior in the patient's prenatal card and history file. Priority is given to the principle of integrality and citizenship, with the aim to break the biomedical care paradigm, thus favoring humanized and comprehensive care to the women.
Mitchell, Lana J; Ball, Lauren E; Ross, Lynda J; Barnes, Katelyn A; Williams, Lauren T
A dietetic consultation is a structured process aimed at supporting individual patients to modify their dietary behaviors to improve health outcomes. The body of evidence on the effectiveness of nutrition care provided by dietitians in primary health care settings has not previously been synthesized. This information is important to inform the role of dietitians in primary health care service delivery. The aim of this systematic review was to evaluate the evidence of the effectiveness of individual consultations provided exclusively by dietitians in primary care to support adult patients to modify dietary intake and improve health outcomes. ProQuest Family Health, Scopus, PubMed Central, Medline, the Cumulative Index to Nursing and Allied Health Literature, and Cochrane databases were searched for English language systematic reviews or randomized controlled trials published before October 2016. The key terms used identified the provision of nutrition care exclusively by a dietitian in a primary health care setting aimed at supporting adult patients to modify dietary behaviors and/or improve biomarkers of health. Interventions delivered to patients aged younger than 18 years, in hospital, via telephone only, in a group or lecture setting, or by a multidisciplinary team were excluded. The methodologic quality of each study was appraised using the Cochrane Risk of Bias tool and the body of evidence was assessed using the Academy of Nutrition and Dietetics Evidence Analysis Manual. Outcomes included the effectiveness of dietetic interventions in terms of anthropometry, clinical indicators, and dietary intake. A statistically significant between-group difference was used to indicate intervention effectiveness (P<0.05). Twenty-six randomized controlled studies met eligibility criteria, representing 5,500 adults receiving dietetic consultations in a primary care setting. Eighteen of 26 included studies showed statistically significant differences in dietary
Engle, Xavier; Aird, James; Tho, Ly; Bintcliffe, Fiona; Monsell, Fergal; Gollogly, Jim; Noor, Saqib
Telemedicine has the potential to increase access to both clinical consultation and continuing medical education in Cambodia. We present a Cambodian surgical centre's experience with a collaboration in which complicated orthopaedic cases were presented to a panel of consultants using free online videoconferencing software, providing a combined opportunity for both continuing education and the enhancement of patient care. Effects of the case conference on patient care were examined via a retrospective review and clinician perspectives were elicited via a qualitative survey. The case conference altered patient care in 69% of cases. All Cambodian staff reported learning from the conference and 78% reported changes in their care for patients not presented at the conference. Real-time videoconferencing between consultants in the developed world and physicians in a developing country may be an effective, low-cost and easily replicable means of combining direct benefits to patient care with continuing medical education.
Wolderslund, Maiken; Kofoed, Poul-Erik; Holst, René
OBJECTIVES: To investigate the effects on patients' outcome of the consultations when provided with: a Digital Audio Recording (DAR) of the consultation and a Question Prompt List (QPL). METHODS: This is a three-armed randomised controlled cluster trial. One group of patients received standard care......, while the other two groups received either the QPL in combination with a recording of their consultation or only the recording. Patients from four outpatient clinics participated: Paediatric, Orthopaedic, Internal Medicine, and Urology. The effects were evaluated by patient-administered questionnaires....... RESULTS: A total of 4349 patients participated in the study. DAR significantly increased the probability of fulfilling the participants' self-perceived information needs by 4.1% to 6.3%, particularly with regard to test results (OR=1.41, 95%CI: 1.14-1.74, p=0.001) and treatment options (OR=1.39, 95%CI: 1...
abstract objective. This descriptive study was undertaken to document the nature of medical and injury consultations of the athletes and officials of the South African Team at the 2004 Olympic Games, and to provide data for planning future events. setting. South African medical facility, 2004 Olympic Games,. Athens, Greece.
Peak, Daniel A.; O'Hara, Michael J.
Examines liability incurred by university-sponsored information technology internships and consulting relationships with the business community. In these outreach engagements, the university takes the role of primary insurer for the business client and provides an indemnity shield for the university's representatives. As the number of engagements…
Childers, Adam F.
Facebook provides businesses and organizations with copious data that describe how users are interacting with their page. This data affords an excellent opportunity to turn introductory statistics students into consultants to analyze the Facebook data using descriptive and inferential statistics. This paper details a semester-long project that…
Hollensen, Svend; Grünbaum, Niels Nolsøe; Andresen, Marc
Early B2B buying-behavior literature strongly emphasizes the rational aspects of buying behavior in B2B services. Based on a comprehensive exploratory study of Danish companies’ purchases of HR consulting services, the authors provide insights into the factors that determine how Danish companies ...
Objective. This descriptive study was undertaken to document the nature of medical and injury consultations of the athletes and officials of the South African Team at the 2004 Olympic Games, and to provide data for planning future events. Setting. South African medical facility, 2004 Olympic Games, Athens, Greece.
This paper canvasses for the teaching of statistical consulting as a course inAfrican Universities. Hitherto, majority of the African Universitiescurriculum in statistics just provides for the teaching of the act of consultingas an intern with older statistician. Since African students, learning statistics,are given little, if any, preparation ...
If pursued independently it can actually function as an 'employer of labour and developed further to provide services both within and outside the immediate library environment. This paper examines the nature and prospects of consultancy as a suitable employment option for graduates of library and information science.
... HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION LABORATORY REQUIREMENTS Personnel for Nonwaived... laboratory performing moderate complexity testing may function as the technical consultant provided he or she... biology and additionally has documentation of 2 years of work experience performing tests of moderate...
Full Text Available Abstract Background Surgical site infection (SSI is a common post-operative complication causing significant morbidity and mortality. Many SSI occur after discharge from hospital. Post-discharge SSI surveillance in low and middle income countries needs to be improved. Methodology We conducted an observational cohort study in Dodoma, Tanzania to examine the sensitivity and specificity of telephone calls to detect SSI after discharge from hospital in comparison to a gold standard of clinician review. Women undergoing caesarean section were enrolled and followed up for 30 days. Women providing a telephone number were interviewed using a structured questionnaire at approximately days 5, 12 and 28 post-surgery. Women were then invited for out-patient review by a clinician blinded to the findings of telephone interview. Results A total of 374 women were enrolled and an overall SSI rate of 12% (n = 45 was observed. Three hundred and sixteen (84% women provided a telephone number, of which 202 had at least one telephone interview followed by a clinical review within 48 h, generating a total of 484 paired observations. From the clinical reviews, 25 SSI were diagnosed, of which telephone interview had correctly identified 18 infections; telephone calls did not incorrectly identify SSI in any patients. The overall sensitivity and specificity of telephone interviews as compared to clinician evaluation was 72 and 100%, respectively. Conclusion The use of telephone interview as a diagnostic tool for post-discharge surveillance of SSI had moderate sensitivity and high specificity in Tanzania. Telephone-based detection may be a useful method for SSI surveillance in low-income settings with high penetration of mobile telephones.
Statter, Mindy B
The cultural, ethnic, religious, socioeconomic, and educational diversity of the patient population and the expanded surgical options provided by innovation and technology can pose significant ethical challenges. The questions confronting pediatric surgeons and their patients' families have greater complexity, and both the pediatric surgeon and the family perceive increasing vulnerability and uncertainty. The analysis and management of ethical issues in pediatric surgery cannot simply be extrapolated from the approach applied to adult cases. By reviewing the history of the events that contributed to the creation and utilization of hospital ethics committees and examining the role of the ethics consultant in the context of pediatric surgical care, practitioners and trainees will be better able to address these multifaceted situations. Copyright © 2013 Elsevier Inc. All rights reserved.
... Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR... on occupational safety and health issues by telephone and correspondence, and at locations other than... specified by the Assistant Secretary, include training and education. ...
BACKGROUND: The desire of patients for personal continuity of care with a General Practitioner (GP) has been well documented, but not within non-registered private patients in Ireland. This study set out to examine the attitudes and reported behaviours of private fee-paying patients towards continuity of GP care and universal registration for patients. METHODS: Cross-sectional telephone survey of 400 randomly chosen fee-paying patients living within County Dublin. There is no formal system of registration with a GP for these patients. Main outcomes were attendance of respondents at primary health care facilities and their attitudes towards continuity of care and registration with a GP. Data was analysed using descriptive statistics and using parametric and non-parametric tests of association. Pearson correlation was used to quantify the association between the described variables and attitudes towards continuity and registration with a GP. Variables showing significance at the 5% level were entered into multiple linear regression models. RESULTS: 97% of respondents had seen a GP in the previous 5 years. The mean number of visits to the GP for respondents was 2.3 per annum. 89% of respondents had a regular GP and the mean length of time with their GP was 15.6 years. 96% preferred their personal medical care to be provided within one general practice. 16% of respondents had consulted a GP outside of their own practice in the previous year. They were more likely to be female, commute a longer distance to work or have poorer health status. 81% considered it important to be officially registered with a GP practice of their choice. CONCLUSION: Both personal and longitudinal continuity of care with a GP are important to private patients. Respondents who chose to visit GPs other than their regular GP were not easily characterised in this study and individual circumstances may lead to this behaviour. There is strong support for a system of universal patient registration
Harris, Scott H.; Johnson, Joel A.; Neiswanger, Jeffery R.; Twitchell, Kevin E.
The present invention includes systems configured to distribute a telephone call, communication systems, communication methods and methods of routing a telephone call to a customer service representative. In one embodiment of the invention, a system configured to distribute a telephone call within a network includes a distributor adapted to connect with a telephone system, the distributor being configured to connect a telephone call using the telephone system and output the telephone call and associated data of the telephone call; and a plurality of customer service representative terminals connected with the distributor and a selected customer service representative terminal being configured to receive the telephone call and the associated data, the distributor and the selected customer service representative terminal being configured to synchronize, application of the telephone call and associated data from the distributor to the selected customer service representative terminal.
Sara Nora Ross
Full Text Available As a powerful way to help understand the behaviors of people and social groupings of all kinds, developmental stage theory attracts attention and use outside of purely academic environments. These uses take the form of written materials and many kinds of interventions. The level of accuracy of developmental theory information generated and used outside of academe demonstrates wide variety. This variety is reflected in materials and interventions. The information used in materials and interventions becomes increasingly distorted as it becomes further removed from original theoretical sources. This has major implications for the ethics and expertise issues that are inherent in applied developmental theory. A classification scheme of information-use behaviors, many of which contribute to distortion processes, is used to code actual cases of creating and disseminating distorted developmental theory information, invoking the metaphor of telephone games. Case evidence indicates that casual, illustrative figures in a 2006 book by Wilber were used by others for various serious and theoretical purposes, and resulted in major distortions of developmental theory. Wilber’s figures represent problematic issues and errors, including distortion of theory, if they are used—as they indeed were—for any purpose more serious than his original purpose. Stemming from those issues and errors, a highly distorted picture of cognitive development and a pseudo-version of Commons and Richards’ Model of Hierarchical Complexity theory emerged, telephone game-like, in the cases discussed. Errors were widely propagated on the internet. Because outside of academe, specialized expertise in developmental theory is difficult to acquire, the sub-field of applied developmental theory requires not only accurate information but also strong communication ethics to govern behaviors of information providers. Such providers need to protect themselves at the same time they protect
Sara Nora Ross
Full Text Available As a powerful way to help understand the behaviors of people and socialgroupings of all kinds, developmental stage theory attracts attention and use outside ofpurely academic environments. These uses take the form of written materials and manykinds of interventions. The level of accuracy of developmental theory informationgenerated and used outside of academe demonstrates wide variety. This variety isreflected in materials and interventions. The information used in materials andinterventions becomes increasingly distorted as it becomes further removed from originaltheoretical sources. This has major implications for the ethics and expertise issues that areinherent in applied developmental theory. A classification scheme of information-usebehaviors, many of which contribute to distortion processes, is used to code actual casesof creating and disseminating distorted developmental theory information, invoking themetaphor of telephone games. Case evidence indicates that casual, illustrative figures in a2006 book by Wilber were used by others for various serious and theoretical purposes,and resulted in major distortions of developmental theory. Wilber’s figures representproblematic issues and errors, including distortion of theory, if they are used—as theyindeed were—for any purpose more serious than his original purpose. Stemming fromthose issues and errors, a highly distorted picture of cognitive development and a pseudoversionof Commons and Richards’ Model of Hierarchical Complexity theory emerged,telephone game-like, in the cases discussed. Errors were widely propagated on theinternet. Because outside of academe, specialized expertise in developmental theory isdifficult to acquire, the sub-field of applied developmental theory requires not onlyaccurate information but also strong communication ethics to govern behaviors ofinformation providers. Such providers need to protect themselves at the same time theyprotect and inform consumers of
Nasiriani, Khadijeh; Motevasselian, Monireh; Farnia, Farahnaz; Shiryazdi, Seyed Mostafa; Khodayarian, Mahsa
Breast cancer is the most common form of malignancy among females. Family history is a key risk factor for breast cancer. Breast cancer screening practices are vital in patients with family history of breast cancer. Telephone counseling and education may be appropriate for improved breast cancer screening. This study was done to determine family caregiver patients' knowledge of risk factors for breast cancer and practice of breast cancer screening and also to assess the effect of telephone counseling and education on mammography screening. This study was a community-based trial. The participants of the study were 90 caregivers who were randomly divided into an experimental group, telephone counseling and education, and a control group. The intervention group received counseling and education phone calls. A three-section questionnaire was responded and filled out through telephone interviews with the participants. The collected data were analyzed with SPSS18, using descriptive and inferential statistics. The results showed that 88.9% of the participants did not know when to do breast self-exam (BSE). Mammography was performed by the participants before and after the telephone counseling in intervention group (Ppatients was low. Telephone counseling and educating may provide a suitable technique for earlier detection of breast cancer in family caregivers of breast cancer patients and it can influence the decision making regarding mammography screening among 40-year-old or older women. Trial Registration Number: 2017052316870N3.
Tremont, Geoffrey; Davis, Jennifer; Papandonatos, George D; Grover, Christine; Ott, Brian R; Fortinsky, Richard H; Gozalo, Pedro; Bishop, Duane S
Family caregivers of individuals with dementia are at heightened risk for emotional and mental health problems. Many caregivers do not seek assistance or become isolated in their caregiving role. Multi-component interventions have demonstrated efficacy for reducing emotional distress and burden, although these approaches are potentially costly and are not widely accessible. In response to these issues, we developed the Family Intervention: Telephone Tracking - Caregiver (FITT-C), which is an entirely telephone-based psychosocial intervention. The purpose of this paper is to describe the study design, methodology, and baseline data for the trial. This study uses a randomized controlled trial design to examine the efficacy of the FITT-C to reduce depressive symptoms and burden in distressed dementia caregivers. All participants (n=250) received a packet of educational materials and were randomly assigned to receive 6 months of the FITT-C intervention or non-directive telephone support. The FITT-C intervention was designed to reduce distress in caregivers and is based on the McMaster Model of Family Functioning, transition theory, and Lazarus and Folkman's Stress and Coping Models. The primary dependent variables were depressive symptoms (Centers for Epidemiological Studies - Depression) and burden (Zarit Burden Interview, Revised Memory and Behavior Problems Checklist - Reaction). Secondary outcome measures included family functioning, self-efficacy, and health-related quality of life. Results of the study will provide important data about the efficacy of a telephone-based approach to reduce distress in dementia caregivers. © 2013.
Smith, Robin M.; Nevin, Ann
We support role changes for educational and psychological consultants who work with children and youth with disabilities as they make important transitions. Principles derived from critical pedagogy and disability studies could provide the theoretical framework for the proposed shift in roles that change the basis on which consulting services are…
... examination. 416.919s Section 416.919s Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL... providers, with respect to SSA's program requirements involving consultative examination report content and... Monitoring the Referral Process § 416.919s Authorizing and monitoring the consultative examination. (a) Day...
Sherblom, Stephen A.; Bahr, Michael W.
In the United States, controversy persists regarding what it means for heterosexuality to be the norm, or more pointedly, what it means for those not strictly heterosexual to be outside the norm. It is important that consultants in schools be aware of the current state of research bearing on homosexuality. Consultation provides a viable approach…
Bernhardt, B. May; Bacsfalvi, Penelope; Adler-Bock, Marcy; Shimizu, Reiko; Cheney, Audrey; Giesbrecht, Nathan; O'Connell, Maureen; Sirianni, Jason; Radanov, Bosko
Ultrasound has shown promise as a visual feedback tool in speech therapy. Rural clients, however, often have minimal access to new technologies. The purpose of the current study was to evaluate consultative treatment using ultrasound in rural communities. Two speech-language pathologists (SLPs) trained in ultrasound use provided consultation with…
Nieuwboer, C.C.; Fukkink, R.G.; Hermanns, J.M.A.
Online consultation is increasingly offered by parenting practitioners, but it is not clear if it is feasible to provide empowerment-oriented support in a single session email consultation. Based on the empowerment theory, we developed the Guiding the Empowerment Process model (GEP model) to
dr. Christa C.C. Nieuwboer
Online consultation is increasingly offered by parenting practitioners, but it is not clear if it is feasible to provide empowerment-oriented support in a single session email consultation. Based on the empowerment theory, we developed the Guiding the Empowerment Process model (GEP model) to
dr. Christa C.C. Nieuwboer
Background. Online consultation is increasingly offered by parenting practitioners, but it is not clear if it is feasible to provide empowerment oriented support in single session email consultation. Method. Based on empowerment theory we developed the Guiding the Empowerment Process model (GEP
Keme Carter; Andrew Golden; Shannon Martin; Sarah Donlan; Sara Hock; Christine Babcock; Jeanne Farnan; Vineet Arora
Introduction: An important area of communication in healthcare is the consultation. Existing literature suggests that formal training in consultation communication is lacking. We aimed to conduct a targeted needs assessment of third-year students on their experience calling consultations, and based on these results, develop, pilot, and evaluate the effectiveness of a consultation curriculum for different learner levels that can be implemented as a longitudinal curriculum. Metho...
... COMMISSION In the Matter of Certain Mobile Telephones and Wireless Communication Devices Featuring Digital... mobile telephones or wireless communication devices featuring digital cameras, or ] components thereof... the sale within the United States after importation of certain mobile telephones and wireless...
Putthasri, Weerasak; Mathurapote, Nanoot; Srisookwattana, Orapan
The World Health Organization handbook on Strategizing National Health in the 21st Century has emphasized the importance of the process of population consultation on needs and expectations. According to Thailand National Health Act 2007, three innovative social tools for participatory healthy public policy process were proposed, i.e., health assembly, health impact assessment and health system statute (charter). In practice, population consultation process is required in the process of the tools implementation. Therefore, this paper aims to illustrate how local health statute implementation supports population participation and consultation at the local level. The first local health statute owned by Cha-lae sub-district in Songkla Province had been introduced in 2009. So far, there are above 500 sub-districts or "Tambon" having their own health system statutes. Tambon Administrative Organization (TAO), health and non-health sectors, community leaders and civil society seemed to be key actors or a mechanism for the local health statute. This demonstrated three crucial elements or sectors for policy development, i.e., policy maker, evidence support and society. Contents of the local health statute are wide ranged, including social determinants, risks and diseases, life style, health services, health fund, to mental and social health in regard to the local problem and context. Therefore, it needs the process of discussion and consultation to seek their common interest and expectation. Local health statute in Thailand is an example of engagement and consultation of the population for health policy. This confirmed the process of population consultation on their needs and expectation that can be implemented both at national and local levels. This is also the strategy to improve the accountability of policy makers for health impacts at all levels of policy making. The challenges of local health statute include the mechanism to maintain and ensure the engagement and
Van Wesemael, Yanna; Cohen, Joachim; Onwuteaka-Philipsen, Bregje D; Bilsen, Johan; Deliens, Luc
The Netherlands, Belgium, and Luxembourg have adopted laws decriminalizing euthanasia under strict conditions of prudent practice. These laws stipulate, among other things, that the attending physician should consult an independent colleague to judge whether the substantive criteria of due care have been met. In this context initiatives were taken in the Netherlands and Belgium to establish specialized services providing such consultants: Support and Consultation for Euthanasia in the Netherlands (SCEN) and Life End Information Forum (LEIF) in Belgium. The aim of this study is to describe and compare these initiatives. We studied and compared relevant documents concerning the Dutch and Belgian consultation service (e.g. articles of bye-laws, inventories of activities, training books, consultation protocols). In both countries, the consultation services are delivered by trained physicians who can be consulted in cases of a request for euthanasia and who offer support and information to attending physicians. The context in which the two organisations were founded, as well as the way they are organised and regulated, is different in each country. By providing information on all end-of-life care matters, the Belgian LEIF seems to have a broader consultation role than the Dutch SCEN. SCEN on the other hand has a longer history, is more regulated and organised on a larger scale and receives more government funding than LEIF. The number of training hours for physicians is equal. However, SCEN-training puts more emphasis on the consultation report, whereas LEIF-training primarily emphasizes the ethical framework of end-of-life decisions. In case of a request for euthanasia, in the Netherlands as well as in Belgium similar consultation services by independent qualified physicians have been developed. In countries where legalising physician-assisted death is being contemplated, the development of such a consultation provision could also be considered in order to safeguard
Full Text Available Abstract Background The Netherlands, Belgium, and Luxembourg have adopted laws decriminalizing euthanasia under strict conditions of prudent practice. These laws stipulate, among other things, that the attending physician should consult an independent colleague to judge whether the substantive criteria of due care have been met. In this context initiatives were taken in the Netherlands and Belgium to establish specialized services providing such consultants: Support and Consultation for Euthanasia in the Netherlands (SCEN and Life End Information Forum (LEIF in Belgium. The aim of this study is to describe and compare these initiatives. Methods We studied and compared relevant documents concerning the Dutch and Belgian consultation service (e.g. articles of bye-laws, inventories of activities, training books, consultation protocols. Results In both countries, the consultation services are delivered by trained physicians who can be consulted in cases of a request for euthanasia and who offer support and information to attending physicians. The context in which the two organisations were founded, as well as the way they are organised and regulated, is different in each country. By providing information on all end-of-life care matters, the Belgian LEIF seems to have a broader consultation role than the Dutch SCEN. SCEN on the other hand has a longer history, is more regulated and organised on a larger scale and receives more government funding than LEIF. The number of training hours for physicians is equal. However, SCEN-training puts more emphasis on the consultation report, whereas LEIF-training primarily emphasizes the ethical framework of end-of-life decisions. Conclusion In case of a request for euthanasia, in the Netherlands as well as in Belgium similar consultation services by independent qualified physicians have been developed. In countries where legalising physician-assisted death is being contemplated, the development of such a
Perelman, Phyllis F.; And Others
A program designed to train learning specialists called consulting teachers who, in turn, train classroom teachers to educate handicapped children in the regular classroom setting is described. Consulting teacher trainees are selected on the basis of teaching experience, leadership capability, academic promise, and commitment to special education.…
... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Consultant activities. 92.358 Section 92.358 Housing and Urban Development Office of the Secretary, Department of Housing and Urban Development HOME INVESTMENT PARTNERSHIPS PROGRAM Other Federal Requirements § 92.358 Consultant activities. No...
Ciaverella, Michael A.
The school counselor is the most logical person in the school to act as a mental health consultant. He has the necessary psychosocial background, is available for consultations, has a wealth of information about the students, and maintains a working relationship with other mental health specialists. He can do much to improve the school environment…
... Program Manager Region XI, e-mail [email protected] or phone (202) 401- 5964. Additional...) Tribal Consultations ] for leaders of Tribal Governments operating Head Start and Early Head Start... Natives convention. We are convening the OHS Tribal Consultations in conjunction with other Tribal Leader...
... 57701. FOR FURTHER INFORMATION CONTACT: Robert Bialas, Regional Program Manager, Region XI, Office of...) Tribal Consultations for leaders of Tribal Governments operating Head Start and Early Head Start programs... the issues and concerns raised in 2012 OHS Tribal Consultations. Tribal leaders and designated...
Jul 21, 2011 ... (RSS, 2005). As a result of the much usefulness of statistics, statisticians are usually saddled with consultancy responsibility in many areas of statistics and related fields. This consultation called has a technique and procedure to be carried out to achieve a success. This know-how is not part of the statistics.
Korelitz, Ann; Schulder, Diane
Discusses a pilot study in which joint consultations with a family therapist and a matrimonial attorney were offered to 10 couples and one woman contemplating divorce. Videotaped sessions. Suggests joint consultations can be useful in helping couples understand the psychological and legal implications of conflicts expressed during separation.…
Dictionary consultation and compilation is a two-way engagement between two parties, namely a dictionary user and a lexicographer. How well users cope with looking up words in a Bantu language dictionary and to what extent their expectations are met, depends on their consultation skills, their knowledge of the structure ...
... Program Manager Region XI, email [email protected] or phone (202) 401- 5964. Additional information... Consultations with leaders of Tribal Governments operating Head Start (including Early Head Start) programs for...) programs are located. We are convening the OHS Tribal Consultations in conjunction with other Tribal Leader...
Dunyon, Josh; Gossling, Valerie; Willden, Sarah; Seiter, John S
A fitness equipment salesperson sold more add-on merchandise and earned a higher commission when complimenting customers (47 men, 41 women) than when not complimenting them during telephone interactions. Compliments did not increase the sales of fitness equipment, however.
Reagan, Joey; And Others
Finds that including the statement "I'm not selling anything" in a telephone survey introduction does not significantly affect response rates. Shows that only an introduction with a university reference significantly increased response rates. (SR)
Lima, Thais Marques; Nicolau, Ana Izabel Oliveira; Carvalho, Francisco Herlânio Costa; Vasconcelos, Camila Teixeira Moreira; Aquino, Priscila de Souza; Pinheiro, Ana Karina Bezerra
to test the effects of behavioral and educational intervention by telephone on adherence of women with inappropriate periodicity to colpocytological examination. quasi-experimental study with a sample of 524 women, selected with the following inclusion criteria: be aged between 25 and 64 years, have initiated sexual activity, have inappropriate periodicity of examination and have mobile or landline phone. The women were divided into two groups for application of behavioral and educational intervention by telephone. It was used an intervention script according to the principles of Motivational Interviewing. on comparing the results before and after the behavioral and educational interventions, it was found that there was a statistically significant change (p = 0.0283) with increase of knowledge of women who participated in the educational intervention. There was no change in the attitude of women of any of the groups and there was an increase of adherence to colpocytological examination in both groups (p educativa por telefone na adesão das mulheres com periodicidade inadequada ao exame colpocitológico. estudo quase-experimental, com amostra constituída por 524 mulheres selecionadas conforme os critérios de inclusão: estar na faixa etária entre 25 e 64 anos, ter iniciado atividade sexual, estar com a periodicidade do exame inadequada e possuir telefone móvel ou fixo. As mulheres foram divididas em dois grupos para aplicação da intervenção comportamental e educativa por telefone. Utilizou-se um roteiro de intervenção segundo os preceitos da Entrevista Motivacional. ao comparar antes e depois das intervenções comportamental e educativa constatou-se que houve uma mudança estatisticamente significativa (p = 0,0283) no aumento do conhecimento das mulheres que participaram da intervenção educativa; não houve mudança comprovada na atitude das mulheres de nenhum dos grupos e houve um aumento da adesão ao exame colpocitológico nos dois grupos (p
Forsyth, Lesley J., E-mail: email@example.com [School of Health Sciences, Robert Gordon University, Aberdeen, AB10 7QG (United Kingdom); Maehle, Valerie [Faculty of Health and Social Care, Robert Gordon University, Aberdeen, AB10 7QG (United Kingdom)
Aim: The aim of this research is to examine the profile of first generation consultant radiographers: their demographics, educational backgrounds, qualifications and training, career experience and progression, teaching, lecturing and research activities. Method: Participant recruitment was drawn from the Society and College of Radiographers consultant radiographer group. Data collection involved a self-administered paper based and web based questionnaire. Results: Participant response rate of 55% (n = 11). Conclusions: The profile of the first consultant radiographer cohort reflects a diverse and eclectic mix. While some aspects of their development such as educational background, clinical training and skills enhancement are comparable to nurse consultants, clinical experience and employment history show some differences. Commitment to development of expert clinical skills is evident within the profile of the first generation cohort of consultant radiographers however research and leadership training are not strong features.
van den Berg, Neeltje; Grabe, Hans-Jörgen; Freyberger, Harald J; Hoffmann, Wolfgang
As in other countries worldwide, the prevalence of mental disorders in Germany is high. Although numerically a dense network of in- and outpatient psychiatric health services exists, the availability in rural and remote regions is insufficient.In rural regions, telemedical concepts can be a chance to unburden and complement the existing healthcare system. Telemedical concepts consisting of video or telephone consulting show first positive results, but there are only a few studies with a randomized controlled design.To improve the treatment of patients with mental disorders in rural regions, we developed a telemedical care concept based on telephone contacts and text-messages. The primary objective of this study is to evaluate the effects of the telemedical interventions on psychopathological outcomes, e. g. anxiety, depressive symptoms, and somatisation. Secondary objective of the study is the analysis of intervention effects on the frequency of medical contacts with healthcare services. Furthermore, the frequency of patients' crises and the frequency and kind of interventions, initiated by the project nurses will be evaluated. We will also evaluate the acceptance of the telemedical care concept by the patients. In this paper we describe a three-armed, randomized, controlled study. All participants are recruited from psychiatric day hospitals. The inclusion criteria are a specialist-diagnosed depression, anxiety disorder, adjustment disorder or a somatoform disorder and eligibility to participate in the study. Exclusion criteria are ongoing outpatient psychotherapy, planned interval treatment at the day clinic and expected recurrent suicidality and self-injuring behaviour.The interventions consist of regular patient-individual telephone consultations or telephone consultations with complementing text-messages on the patients' mobile phone. The interventions will be conducted during a time period of 6 months. This study is registered in the German Clinical Trials
Freyberger Harald J
Full Text Available Abstract Background As in other countries worldwide, the prevalence of mental disorders in Germany is high. Although numerically a dense network of in- and outpatient psychiatric health services exists, the availability in rural and remote regions is insufficient. In rural regions, telemedical concepts can be a chance to unburden and complement the existing healthcare system. Telemedical concepts consisting of video or telephone consulting show first positive results, but there are only a few studies with a randomized controlled design. To improve the treatment of patients with mental disorders in rural regions, we developed a telemedical care concept based on telephone contacts and text-messages. The primary objective of this study is to evaluate the effects of the telemedical interventions on psychopathological outcomes, e. g. anxiety, depressive symptoms, and somatisation. Secondary objective of the study is the analysis of intervention effects on the frequency of medical contacts with healthcare services. Furthermore, the frequency of patients' crises and the frequency and kind of interventions, initiated by the project nurses will be evaluated. We will also evaluate the acceptance of the telemedical care concept by the patients. Methods/Design In this paper we describe a three-armed, randomized, controlled study. All participants are recruited from psychiatric day hospitals. The inclusion criteria are a specialist-diagnosed depression, anxiety disorder, adjustment disorder or a somatoform disorder and eligibility to participate in the study. Exclusion criteria are ongoing outpatient psychotherapy, planned interval treatment at the day clinic and expected recurrent suicidality and self-injuring behaviour. The interventions consist of regular patient-individual telephone consultations or telephone consultations with complementing text-messages on the patients' mobile phone. The interventions will be conducted during a time period of 6 months
Aline Furtado Rosa
Full Text Available The Brazilian elderly population, that is, the population aged 60 or older according to the Elderly Estatute, has increased in recent decades, a phenomenon observed in Brazil and worldwide. This rapid growth represents a major political and social impact, reflecting the consequent rise in cost of health services because this is the population that most need this service. Objective: To understand the meaning of Nursing Consultation for elderly women assisted at a School Clinic in Mountain Region-RJ-Brazil. Method: The is a qualitative study of descriptive and exploratory nature supported by the theoretical and methodological framework of Alfred Schutz through sociological phenomenology. The study was approved by the Ethics and Research Committee of the Arthur Sá Earp Neto Faculty on April 11, 2015 under Opinion number 1.019361. We used phenomenological interview. Results: We performed 19 interviews with elderly women aged 60-80 years. The responses provided the understanding of women's experiences during the nursing consultation. This study gave rise to three categories that revealed the intentionality of this social group when searching for the nursing consultation: "To be well assisted", "To have resolving power" and "To prevent health problems". Conclusions: The found that the nursing consultation promotes the approximation between women and the nursing professionals, establishing bonds, presenting efficient and effective results to treatment and prevention, besides providing mutual learning.
Miloslavsky, Eli M; Chang, Yuchiao
Subspecialty consultation in inpatient medicine is increasing, and enhancing performance of consultation services may have a broad-reaching impact. Multisource feedback is an important tool in assessing competence and improving performance. A mechanism for primary team resident feedback on performance of consult services has not been described. We developed and evaluated an instrument designed to assess internal medicine (IM) subspecialty inpatient consult service performance. We hypothesized that the instrument would be feasible to administer and provide important information to fellowship directors. The instrument was administered in 2015 and 2016 at a single academic center. All IM residents were invited to evaluate 10 IM subspecialty consult services on 4 items and an overall satisfaction rating. The instrument allowed for free-text feedback to fellows. Program directors completed another survey assessing the impact of the consult service evaluation. A total of 113 residents responded (47 in 2015 and 66 in 2016, for a combined response rate of 35%). Each of the 4 items measured (communication, professionalism, teaching, and pushback) correlated significantly with the overall satisfaction rating in univariate and multivariate analyses. There were no differences in ratings across postgraduate year or year of administration. There was considerable variation in ratings among the services evaluated. The 7 program directors who provided feedback found the survey useful and made programmatic changes following evaluation implementation. A primary team resident evaluation of inpatient medicine subspecialty consult services is feasible, provides valuable information, and is associated with changes in consult service structure and curricula.
Full Text Available Abstract Background Five percent of the Swiss population attribute symptoms to electromagnetic fields (EMF. General practitioners (GPs might play a key role in recognising an emerging health risk, since they are the first to observe and follow up persons who attribute symptoms to EMF. It is unclear to what extent EMFs have become an issue in general practice and which experiences GPs report from the consultations. Methods We conducted telephone interviews in a random sample of GPs in Switzerland in order to assess the frequency of consultations in primary care due to EMF and the GPs' experience with these patients. Results 342 general practitioners were interviewed, corresponding to a response rate of 28.2%. 69% of the GPs reported at least one consultation due to EMF, but GPs with a certificate in complementary medicine were much more likely to report EMF consultations. The median of EMF consultation numbers within one year was three. An overview of the most recent EMF-related consultation per GP yielded sleep disorders, headaches and fatigue as the most often reported symptoms and mobile phone base stations, power lines and the own use of mobile phones as the main EMF sources suspected to be associated to symptoms. GPs judged the association between EMF and the symptoms to be plausible in 54% of the cases. There was no combination of symptoms and EMF sources that was remarkably and consistently judged to be a plausible cause of the symptoms. Conclusion In our survey, GPs often judged the association between the health problems and the suspected exposure to be plausible. This plausibility assessment seems to be based on grounds of preventive positions in a situation of scientific uncertainty. More research effort is needed to obtain more insight on a potential association between long term EMF exposure and unspecific symptoms.
Arnedt, J Todd; Cuddihy, Leisha; Swanson, Leslie M; Pickett, Scott; Aikens, James; Chervin, Ronald D
To compare the efficacy of telephone-delivered cognitive-behavioral therapy for insomnia to an information pamphlet control on sleep and daytime functioning at pretreatment, posttreatment, and 12-wk follow-up. Randomized controlled parallel trial. N/A. Thirty individuals with chronic insomnia (27 women, age 39.1 ± 14.4 years, insomnia duration 8.7 ± 10.7 years). Cognitive behavioral therapy for insomnia (CBTI) delivered in up to eight weekly telephone sessions (CBTI-Phone, n = 15) versus an information pamphlet control (IPC, n = 15). Sleep/wake diary, sleep-related questionnaires (Insomnia Severity Index, Pittsburgh Sleep Quality Index, 16-item Dysfunctional Beliefs and Attitudes about Sleep), and daytime symptom assessments (fatigue, depression, anxiety, and quality of life) were completed at pretreatment, posttreatment, and 12-wk follow-up. Linear mixed models indicated that sleep/wake diary sleep efficiency and total sleep time improved significantly at posttreatment in both groups and remained stable at 12-wk follow-up. More CBTI-Phone than IPC patients showed posttreatment improvements in unhelpful sleep-related cognitions (P Phone patients and small to moderate (Cohen d = -0.1-0.6) for IPC patients. All CBTI-Phone patients completed posttreatment and 12-wk follow-up assessments, but three IPC patients discontinued the study. The findings provide preliminary support for telephone-delivered CBTI in the treatment of chronic insomnia. Future larger-scale studies with more diverse samples are warranted. Some individuals with insomnia may also benefit from pamphlet-delivered CBTI with brief telephone support. Arnedt JT; Cuddihy L; Swanson LM; Pickett S; Aikens J; Chervin RD. Randomized controlled trial of telephone-delivered cognitive behavioral therapy for chronic insomnia. SLEEP 2013;36(3):353-362.
Arnedt, J. Todd; Cuddihy, Leisha; Swanson, Leslie M.; Pickett, Scott; Aikens, James; Chervin, Ronald D.
Study Objectives: To compare the efficacy of telephone-delivered cognitive-behavioral therapy for insomnia to an information pamphlet control on sleep and daytime functioning at pretreatment, posttreatment, and 12-wk follow-up. Design: Randomized controlled parallel trial. Setting: N/A. Participants: Thirty individuals with chronic insomnia (27 women, age 39.1 ± 14.4 years, insomnia duration 8.7 ± 10.7 years). Interventions: Cognitive behavioral therapy for insomnia (CBTI) delivered in up to eight weekly telephone sessions (CBTI-Phone, n = 15) versus an information pamphlet control (IPC, n = 15). Measurements and Results: Sleep/wake diary, sleep-related questionnaires (Insomnia Severity Index, Pittsburgh Sleep Quality Index, 16-item Dysfunctional Beliefs and Attitudes about Sleep), and daytime symptom assessments (fatigue, depression, anxiety, and quality of life) were completed at pretreatment, posttreatment, and 12-wk follow-up. Linear mixed models indicated that sleep/wake diary sleep efficiency and total sleep time improved significantly at posttreatment in both groups and remained stable at 12-wk follow-up. More CBTI-Phone than IPC patients showed posttreatment improvements in unhelpful sleep-related cognitions (P Phone patients and small to moderate (Cohen d = -0.1–0.6) for IPC patients. All CBTI-Phone patients completed posttreatment and 12-wk follow-up assessments, but three IPC patients discontinued the study. Conclusions: The findings provide preliminary support for telephone-delivered CBTI in the treatment of chronic insomnia. Future larger-scale studies with more diverse samples are warranted. Some individuals with insomnia may also benefit from pamphlet-delivered CBTI with brief telephone support. Citation: Arnedt JT; Cuddihy L; Swanson LM; Pickett S; Aikens J; Chervin RD. Randomized controlled trial of telephone-delivered cognitive behavioral therapy for chronic insomnia. SLEEP 2013;36(3):353-362. PMID:23450712
National Park Service, Department of the Interior — This feature class represent the nodes of the telephone lines at Pipe Spring National Monument, Arizona. The utility pipelines were collected by a Trimble GeoXT GPS...
Business communication (BC) is a crucial aspect of management consulting. BC scholars have widely studied the relationship between BC and management consulting, including consulting by BC academics. A limited review of the studies of management consulting, including consulting done by business college academics, hereafter referred to simply as…
Storan, Eoin R; McEvoy, Marian T; Wetter, David A; el-Azhary, Rokea A; Hand, Jennifer L; Davis, Dawn M R; Bridges, Alina G; Camilleri, Michael J; Davis, Mark D P
Data describing the management of pediatric patients admitted to a hospital under the care of a dermatologist and dermatology hospital consults for pediatric inpatients are limited. We aim to describe the role of an inpatient hospital service jointly run by dermatology and pediatrics and the activities of a pediatric dermatology hospital consult service. We retrospectively identified pediatric (age dermatology inpatients and hospital consult patients from January 1, 2009, through December 31, 2010. We examined patient demographics, indications for admission, length of stay, treatment provided, consult-requesting service, and consult diagnosis. One hundred eight admissions were by a dermatologist. The mean age was 5.8 years; the median length of stay was 3 days. Indications for admission included atopic dermatitis (86.1%), psoriasis (3.7%), and eczema herpeticum (2.8%). The main treatment provided was wet dressings (97.2%). Eighty-three dermatology hospital consults were requested. The mean age was 7.4 years. The main indications for dermatology consultation included drug rash (12.1%), cutaneous infections (12.1%), contact dermatitis (9.6%), psoriasis (8.4%), atopic dermatitis (6.0%), and hemangiomas (6.0%). This study describes the utility of the hospital pediatric dermatology inpatient and consult services in treating patients with severe skin disease. © 2013 Wiley Periodicals, Inc.
Liddy, Clare; Maranger, Julie; Afkham, Amir; Keely, Erin
There is dissatisfaction among primary care physicians, specialists, and patients with respect to the consultation process. Excessive wait times for receiving specialist services and inefficient communication between practitioners result in decreased access to care and jeopardize patient safety. We created and implemented an electronic consultation (e-consultation) system in Eastern Ontario to address these problems and improve the consultation process. The e-consultation system has passed through the proof-of-concept and pilot study stages and has effectively reduced unnecessary referrals while receiving resoundingly positive feedback from physician-users. Using our experience, we have outlined the 10 steps to developing an e-consultation service. We detail the technical, administrative, and strategic considerations with respect to (1) identifying your partners, (2) choosing your platform, (3) starting as a pilot project, (4) designing your product, (5) ensuring patient privacy, (6) thinking through the process, (7) fostering relationships with your participants, (8) being prepared to provide physician payment, (9) providing feedback, and (10) planning the transition from pilot to permanency. In following these 10 steps, we believe that the e-consultation system and its associated improvements on the consultation process can be effectively implemented in other healthcare settings.
Tudor Car, Lorainne; Gentry, Sarah; van-Velthoven, Michelle H M M T; Car, Josip
third reviewer resolved any disagreement. Out of 14 717 citations, only one study met the inclusion criteria; an RCT conducted on homeless and high-risk youth between September 1998 and October 1999 in Portland, United States. Participants (n=351) were offered counselling and oral HIV testing and were randomised into face-to-face (n=187 participants) and telephone (n=167) notification groups. The telephone notification group had the option of receiving HIV test results either by telephone or face-to-face. Overall, only 48% (n=168) of participants received their HIV test results and post-test counselling. Significantly more participants received their HIV test results in the telephone notification group compared to the face-to-face notification group; 58% (n=106) vs. 37% (n=62) (p < 0.001). In the telephone notification group, the majority of participants who received their HIV test results did so by telephone (88%, n=93). The study could not offer information about the effectiveness of telephone HIV test notification with HIV-positive participants because only two youth tested positive and both were assigned to the face-to-face notification group. The study had a high risk of bias. We found only one eligible study. Although this study showed the use of the telephone for HIV test results notification was more effective than face-to-face delivery, it had a high-risk of bias. The study was conducted about 13 years ago in a high-income country, on a high-risk population, with low HIV prevalence, and the applicability of its results to other settings and contexts is unclear. The study did not provide information about telephone HIV test results notification of HIV positive people since none of the intervention group participants were HIV positive. We found no information about the acceptability of the intervention to patients' and providers', its economic outcomes or potential adverse effects. There is a need for robust evidence from various settings on the effectiveness of
Full Text Available Abstract Background As a matter of routine, midwives in Sweden have spoken with women about their experiences of labour in a so-called 'postpartum consultation'. However, the possibility of offering women this kind of consultation today is reduced due to shortage of both time and resources. The aim of this study was to explore the occurrence, women's requirements of, and experiences of a postpartum consultation, and to identify expectations from women who wanted but did not have a consultation with the midwife assisting during labour. Methods All Swedish speaking women who gave birth to a live born child at a University Hospital in western Sweden were consecutively included for a phone interview over a three-week period. An additional phone interview was conducted with the women who did not have a postpartum consultation, but who wanted to talk with the midwife assisting during labour. Data from the interviews were analysed using qualitative content analysis. Results Of the 150 interviewed women, 56% (n = 84 had a postpartum consultation of which 61.9% (n = 52 had this with the midwife assisting during labour. Twenty of the 28 women who did not have a consultation with anyone still desired to talk with the midwife assisting during labour. Of these, 19 were interviewed. The content the women wanted to talk about was summarized in four categories: to understand the course of events during labour; to put into words, feelings about undignified management; to describe own behaviour and feelings, and to describe own fear. Conclusion The survey shows that the frequency of postpartum consultation is decreasing, that the majority of women who give birth today still require it, but only about half of them receive it. It is crucial to develop a plan for these consultations that meets both the women's needs and the organization within current maternity care.
The aim of this three-year study was to operationalize the role of a consultant nurse and, in so doing, facilitate the development of nurses and nursing for the purpose of providing better patient services. Action research was used because it focuses on developing practitioners, developing practice and contributing to understanding both the phenomena being studied and the processes being used. The role of leadership is recognised as key to bringing about cultural change, as is the use of approaches that clarify values and highlight the contradiction between espoused culture and culture in practice. The resulting culture had a positive impact on the unit in which the consultant nurse was based, on practitioners and their practice, and also on the trust. A number of factors, including transformational leadership, other facilitative processes, expertise in the practice of nursing, and other subroles of the consultant nurse were shown to be influential. This article explores the concept of organisational culture, and a second article to be published next week, discusses the consultant nurse outcomes.
Bart M. Demaerschalk
Full Text Available Objective. The objective was to define and evaluate a role for the Vascular Neurology-Nurse Practitioner (VN-NP in the delivery of telemedicine consultations in partnership with a vascular neurologist. Methods. Prospective stroke alert patients at participating hospitals underwent a two-way audio video telemedicine consultation with a VN-NP at a remotely located stroke center in partnership with a vascular neurologist. Demographic information, National Institutes of Health Stroke Scale (NIHSS scores, diagnoses, CT contraindications to thrombolysis, thrombolysis eligibility, and time interval data were collected. The inter-rater agreement between VN-NP and vascular neurologist assessments was calculated. Results. Ten patients were evaluated. Four were determined to have ischemic stroke, one had a transient ischemic attack, two had intracerebral hemorrhages, and three were stroke mimics. Overall, three patients received thrombolysis. The inter-rater agreement between VN-NP and vascular neurologist assessments were excellent, ranging from 0.9 to 1.0. The duration of VN-NP consultation was 53.2±9.0 minutes, which included the vascular neurologist supervisory evaluation time of 12.0±9.6 minutes. Conclusion. This study illustrated that a stroke center VN-NP, in partnership with a vascular neurologist, could deliver timely telemedicine consultations, accurate diagnoses, and correct treatments in acute stroke patients who presented to remotely located rural emergency departments within a hub and spoke network. VN-NPs may fulfill the role of a telestroke provider.
Wouda, Jan C; van de Wiel, Harry B M
The model of expert performance predicts that neither physicians in training nor experienced physicians will reach an expert level in communication. This study tested this hypothesis. Seventy-one students, twenty-five residents and fourteen consultants performed a 'breaking bad news' exercise with a simulated patient. Their communication competency was assessed with the CELI instrument. Actor assessments were also obtained. The differences in communication competency between students, residents and consultants were established. The mean performance scores ranged from bad to adequate. An expert level of performance was seldom reached. Novice students scored lower than the other groups in their competency and in the actor assessment. First-year students scored lower than the consultants in their competency and in the actor assessment. No differences in performance were found between third-year students, interns, residents and consultants. Students acquire a 'satisfactory' level of communication competency early in the curriculum. Communication courses in the curriculum do not enhance this level. Clinical experience has also a limited effect. The learning conditions for deliberate practice must be fulfilled in medical curricula and in postgraduate training in order to provide medical students and physicians the opportunity to attain an expert level in communication. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
Misono, Alexander S; Mueller, Peter R; Hirsch, Joshua A; Sheridan, Robert M; Siddiqi, Assad U; Liu, Raymond W
Interventional radiology (IR) has historically failed to fully capture the value of evaluation and management services in the inpatient setting. Understanding financial benefits of a formally incorporated billing discipline may yield meaningful insights for interventional practices. A revenue modeling tool was created deploying standard financial modeling techniques, including sensitivity and scenario analyses. Sensitivity analysis calculates revenue fluctuation related to dynamic adjustment of discrete variables. In scenario analysis, possible future scenarios as well as revenue potential of different-size clinical practices are modeled. Assuming a hypothetical inpatient IR consultation service with a daily patient census of 35 patients and two new consults per day, the model estimates annual charges of $2.3 million and collected revenue of $390,000. Revenues are most sensitive to provider billing documentation rates and patient volume. A range of realistic scenarios-from cautious to optimistic-results in a range of annual charges of $1.8 million to $2.7 million and a collected revenue range of $241,000 to $601,000. Even a small practice with a daily patient census of 5 and 0.20 new consults per day may expect annual charges of $320,000 and collected revenue of $55,000. A financial revenue modeling tool is a powerful adjunct in understanding economics of an inpatient IR consultation service. Sensitivity and scenario analyses demonstrate a wide range of revenue potential and uncover levers for financial optimization. Copyright © 2016 SIR. Published by Elsevier Inc. All rights reserved.
Fong, Tamara G.; Fearing, Michael A.; Jones, Richard Norman; Shi, Peilin; Marcantonio, Edward Ralph; Rudolph, James; Yang, Frances Margaret; Kiely, Dan K.; Inouye, Sharon
Background Brief cognitive screening measures are valuable tools for both research and clinical applications. The most widely used instrument, the Mini-Mental State Examination (MMSE), is limited in that it must be administered face-to-face, cannot be used in participants with visual or motor impairments, and is protected by copyright. Screening instruments such as the Telephone Interview for Cognitive Status (TICS) were developed to provide a valid alternative, with comparable cut-point s...
Rogers, Arvey I
Too often, actions and decisions affecting patient care are determined by expediency, cost-effectiveness, and time constraints. At risk of sacrifice are ethics and professionalism, pillars essential to the very structure of medical practice. In particular, there appears to be an erosion of consultation etiquette-exchanges between physicians and patients as well as among physicians. While methods to maximize efficiency are essential to medical practice, they should not come at the expense of etiquette. To improve patient care and strengthen relationships between patients and physicians, as well as relationships between referring and consulting physicians, a set of guidelines for improving consultation etiquette is proposed.
Full Text Available Community health service center (CHSC and community health service station (CHSS are the main institutions where general practitioners (GPs deliver primary care in the urban area of China. Motivated by incentive policies, visits to community health service institutions (CHSIs increased gradually in recent years, but concerns had been raised on the quality of general practice consultation. This is a preliminary study aimed to investigate the existing problems of general practice consultation in Beijing and provide practical evidence for developing relevant policies.Six GPs from 2 CHSCs and 3 CHSSs were selected by purposive sampling. The GPs were observed for 4 or 5 consecutive days during January 2013 to March 2013. The length and content of consultations were recorded in structured observation forms. Quantitative description was applied to describe the median, percentage and frequency of variables.A total of 1135 consultations were observed. The most frequent reason for consultations was specific prescription (61.6%, followed by presenting symptoms (20.7%, check-up (9.1%, counseling (5.4%, transfusion & injection (3.0% and sickness certificate (0.2%. The median consultation length of all consultations was 2.0 minutes. The GPs prescribed in 81.0% of the consultations, on the other hand, history taking, physical examination, explanation of illness and health education only took place in 27.0%, 28.0%, 21.9% and 17.7% of the consultations respectively.The adequacy of consultation length in CHSIs is in doubt. Most patients visited the CHSIs for prescription renewal. Health promotion e.g. health education are not adequately provided in consultations. The quality of general practice consultations was jeopardized by the large amount of patient flow for medicine renewal. Policies should be adjusted to reduce unnecessary consultations. Further studies are in need to evaluate the outcome and influencing factors of general practice consultation in China.
Deveugele, M.; Derese, A.; Brink-Muinen, A. van den; Bensing, J.; Maeseneer, J. de
Objectives: To compare determinants of consultation length discussed in the literature with those found in consultations with general practitioners from different European countries; to explore the determinants of consultation length, particularly the effect of doctors' and patients' perceptions of
Kuin, A.; Deliens, L.; Zuylen, L. van; Courtens, A.M.; Vernooij-Dassen, M.J.F.J.; Linden, B.; Wal, G. van der
INTRODUCTION: In the Netherlands, healthcare professionals are able to consult Palliative Care Consultation (PCC) teams about individual patients, for information, support and advice. This study aims to understand which spiritual issues are discussed in these consultations and to determine which
Shershneva, Marianna B; Carnes, Molly; Bakken, Lori L
A new paradigm in continuing medical education is characterized by emphasis on physicians' learning in practice. Consistent with this paradigm, our study examined a subset of clinical practice--generalist-specialist consultations--from an educational perspective. We applied the grounded-theory method with semistructured interviews. Ten primary care physicians and 9 internal medicine subspecialists were interviewed regarding their approaches to learning and teaching during generalist-specialist consultations. Based on 48 formal and informal consultations reported by physicians, we developed a theory of teaching-learning transactions in generalist-specialist consultations. As a teaching-learning transaction, the mutual learning process in generalist-specialist consultations involves 3 components: needs assessment, dialogue, and sufficiency. Providers of continuing medical education may use the proposed theoretical framework to help clinicians and health care organizations analyze and enhance educationally valuable interactions at the interface of primary and secondary care.
Rick Yiu-Cho Kwan
Full Text Available TBCA has emerged to solve the limitations of administering cognitive assessments face-to-face. The recent development of telephones and knowledge advances in the area of cognitive impairment may affect the development of TBCA. The purpose of this paper is to discuss how smartphones can be used to enhance the applicability of TBCA, which has previously been administered by conventional telephone. This paper will first review, describe and critique the existing TBCA instruments. It will then discuss the recent developments in tele-technology, the popularity of tele-technology among the elderly, potential benefits and challenges in using smartphones for cognitive assessment, and possible future developments in this technology. In the systematic review, eighteen TBCA instruments were identified. They were found to be valid in differentiating between people with and without dementia. TBCA was previously found to be launched on a conventional telephone platform. The advances in understanding of cognitive impairment may demand that telephones be equipped with more advanced features. Recently, the development and penetration of smartphones among the elderly has been rapid. This may allow the smartphone to enhance its TBCA applicability by overcoming the limitations of the conventional telephone, rendering the TBCA more efficient in addressing the increasing demand and complexity of cognitive assessments in the future. However, more research and technology developments are needed before smartphones can become a valid platform for TBCA.
Kitchingman, Taneile A; Wilson, Coralie J; Caputi, Peter; Wilson, Ian; Woodward, Alan
In order to respond to crises with appropriate intervention, crisis workers are required to manage their own needs as well as the needs of those they respond to. A systematic review of the literature was conducted to examine whether telephone crisis support workers experience elevated symptoms of psychological distress and are impaired by elevated symptoms. Studies were identified in April 2015 by searching three databases, conducting a gray literature search, and forward and backward citation chaining. Of 113 identified studies, seven were included in the review. Results suggest that that telephone crisis support workers experience symptoms of vicarious traumatization, stress, burnout, and psychiatric disorders, and that they may not respond optimally to callers when experiencing elevated symptoms of distress. However, definitive conclusions cannot be drawn due to the paucity and methodological limitations of available data. While the most comprehensive search strategy possible was adopted, resource constraints meant that conference abstracts were not searched and authors were not contacted for additional unpublished information. There is an urgent need to identify the impact of telephone crisis support workers' role on their well-being, the determinants of worker well-being in the telephone crisis support context, and the extent to which well-being impacts their performance and caller outcomes. This will help inform strategies to optimize telephone crisis support workers' well-being and their delivery of support to callers.
... Services, Administration for Children and Families, Office of Head Start leadership and the leadership of... Consultation Session will be summarized in the report without attribution, along with topics of concern and...
... Services, Administration for Children and Families, Office of Head Start leadership and the leadership of... Consultation Session will be summarized in the report without attribution, along with topics of concern and...
Full Text Available The Conversational Plenary Session began with a clear agenda of describing the process and challenge of developing eLearning and eTraining. After a brief discussion of the benefits and challenges of the modality, the conversation quickly segued to a highly spirited conversation related to consulting and the negative implications when one calls oneself a consultant. In fact, this became an integral theme of multiple discussions throughout the rest of the conference. This author strives to identify a selection of literature which supports the viewpoint that consulting does indeed inform best practices in academia. Those professors with up-to-the-minute consultancies in their fields offer an enriched experience for their students.
Hanno, P.; Lin, A.; Nordling, J.
cytology and cystoscopy are recommended if clinically indicated. Treatment progresses from conservative management through various oral and intravesical therapies, with most surgical therapies reserved for unresponsive cases. Pain management is critical throughout the treatment process. The consultation......Aims of Study: The Bladder Pain Syndrome Committee of the International Consultation on Incontinence was assigned the task by the consultation of reviewing the syndrome, formerly known as interstitial cystitis, in a comprehensive fashion. This included the topics of definition, nomenclature...... possible, existing evidence was assessed and a level of recommendation was developed according to the Oxford system of classification. Results: The consultation decided to refer to the condition as "bladder pain syndrome" (BPS) because the designation is more descriptive of the clinical condition...
Henningsson, Stefan; Øhrgaard, Christian
strategic IT initiatives and how companies can draw effectively on their services. The paper investigates the use of consultants in relation to one type of major strategic IT initiative: acquisition IT integration. Acquisition IT integration, which is the integration of the acquirer’s and target......’s IT following a corporate acquisition, presents a difficult but crucial IT challenge for the many acquiring organizations. Through a comparative case study of four acquirers, theoretically grounded in the resource-based view of the firm, it is analyzed how acquirers draw on external consultants to realize...... acquisition IT integration. Two complementary and two supplementary roles consultants assume in these projects are identified. Additionally, three characteristics of the acquisition IT integration strategy are identified that influence how the acquirers assign different roles to IT consultants. The resulting...
Strang, David; David, Robert J; Akhlaghpour, Saeed
The rise of management consultancy has been accompanied by increasingly marked faddish cycles in management techniques, but the mechanisms that underlie this relationship are not well understood. The authors develop a simple agent-based framework that models innovation adoption and abandonment on both the supply and demand sides. In opposition to conceptions of consultants as rhetorical wizards who engineer waves of management fashion, firms and consultants are treated as boundedly rational actors who chase the secrets of success by mimicking their highest-performing peers. Computational experiments demonstrate that consultant-driven versions of this dynamic in which the outcomes of firms are strongly conditioned by their choice of consultant are robustly faddish. The invasion of boom markets by low-quality consultants undercuts popular innovations while simultaneously restarting the fashion cycle by prompting the flight of high-quality consultants into less densely occupied niches. Computational experiments also indicate conditions involving consultant mobility, aspiration levels, mimic probabilities, and client-provider matching that attenuate faddishness.
Full Text Available This paper aims to analyze the evolution of Human Resources (HR consulting in transitional economies of Eastern Europe (EE from the political changes till the economic crisis (2008. This article provides insights into the specific socio-economic environment and HR practice of the region. Following Markham's model (1999 we analyze specific characteristics of four typical ways of external consultant involvement: informative-becnhmarking, design, change and organizational learning consulting. in this region. In general, before the political changes at the end of the 1980's, in most EE countries , consulting service was redendered by sector research institutes, controlled by the state or by the different minsitries. Consulting approach in EE countries were predominant similar to the school of scientific management. HR consulting hardly existed that time. Since changes in the regime's consulting linked to privatization, firm restructuring, and development has been developing significantly in all countries of the region. HR consulting underwent a significant development in the region.
Fukuyama, M; Asai, A; Itai, K; Bito, S
Clinical ethics support, including ethics consultation, has become established in the field of medical practice throughout the world. This practice has been regarded as useful, most notably in the UK and the USA, in solving ethical problems encountered by both medical practitioners and those who receive medical treatment. In Japan, however, few services are available to respond to everyday clinical ethical issues, although a variety of difficult ethical problems arise daily in the medical field: termination of life support, euthanasia and questions about patient autonomy. In light of these conditions, a group of 17 volunteer educators and researchers from the area of biomedical ethics, including the authors, have formed the Clinical Ethics Support and Education Project, and began providing Japan's first small team clinical ethics consultation service in October, 2006. Members include scholars of biomedical ethics, scholars of philosophy and ethics, legal professionals and legal scholars, nurses and doctors, consisting of five women and 12 men. Consultation teams, made up of a small number of members, were organised each time a request for consultation was received. Over approximately 15 months (October 2006-December 2007), the programme received 22 consultation requests from medical practitioners and medical institutions, and three from the families of patients. In this paper, we will discuss the status of our consultation service and examples of consultation cases we have handled. In addition, we will examine the process of evaluating small team clinical ethics consultation services, as well as the strengths and weakness of such programmes.
Tsao, Lee-Ing; Yu, Shu-Hsiang; Kao, Chen-Hui
Women's health problems are increasing among teenage girls in modern society. However, there are only a few programs related to women's health consultation on campuses. Three issues are explored in this paper - the health rights of teenage girls, women's health consultations, and teenage girls' subjective views about the establishment of a women's health consultation service on their campus. In the course of our research of teenage girls' subjective views, three hundred and eighty-seven young girl students responded to questionnaires and seven volunteer students among them were invited to do in-depth interviews. Most students (98.2%) thought that it was necessary to set up a women's health consultation service on campus, because they hoped to get personal health information that could not be found in a textbook. Three hundred and five (78.8%) students perceived that they had women's health problems. Their health problems are ranked as follows: dysmenorrhea, irregularity of menstrual periods, unusual vaginal secretions and questions of contraception and urinary system health. They suggested that campus consultation centers should have the following characteristics: protection of students' privacy, provision of multiple channels for consultation, strict limitation on numbers of people in the consulting office, and a non-discriminatory policy towards all clients. Hopefully, an information database can provide a good reference for establishing a women's health consultation service on campus in the near future.
Bradford, Natalie K; Armfield, Nigel R; Young, Jeanine; Smith, Anthony C
In the vast state of Queensland, Australia, access to specialist paediatric services are only available in the capital city of Brisbane, and are limited in regional and remote locations. During home-based palliative care, it is not always desirable or practical to move a patient to attend appointments, and so access to care may be even further limited. To address these problems, at the Royal Children's Hospital (RCH) in Brisbane, a Home Telehealth Program (HTP) has been successfully established to provide palliative care consultations to families throughout Queensland. A cost minimisation analysis was undertaken to compare the actual costs of the HTP consultations, with the estimated potential costs associated with face-to face-consultations occurring by either i) hospital based consultations in the outpatients department at the RCH, or ii) home visits from the Paediatric Palliative Care Service. The analysis was undertaken from the perspective of the Children's Health Service. The analysis was based on data from 95 home video consultations which occurred over a two year period, and included costs associated with projected: clinician time and travel; costs reimbursed to families for travel through the Patients Travel Subsidy (PTS) scheme; hospital outpatient clinic costs, project co-ordination and equipment and infrastructure costs. The mean costs per consultation were calculated for each approach. Air travel (n = 24) significantly affected the results. The mean cost of the HTP intervention was $294 and required no travel. The estimated mean cost per consultation in the hospital outpatient department was $748. The mean cost of home visits per consultation was $1214. Video consultation in the home is the most economical method of providing a consultation. The largest costs avoided to the health service are those associated with clinician time required for travel and the PTS scheme. While face-to-face consultations are the gold standard of care, for families located
Damschroder, Laura J; Reardon, Caitlin M; Sperber, Nina; Robinson, Claire H; Fickel, Jacqueline J; Oddone, Eugene Z
The Telephone Lifestyle Coaching (TLC) program provided telephone-based coaching for six lifestyle behaviors to 5321 Veterans at 24 Veterans Health Administration (VHA) medical facilities. The purpose of the study was to conduct an evaluation of the TLC program to identify factors associated with successful implementation. A mixed-methods study design was used. Quantitative measures of organizational readiness for implementation and facility complexity were used to purposively select a subset of facilities for in-depth evaluation. Context assessments were conducted using interview transcripts. The Consolidated Framework for Implementation Research (CFIR) was used to guide qualitative data collection and analysis. Factors most strongly correlated with referral rates included having a skilled implementation leader who used effective multi-component strategies to engage primary care clinicians as well as general clinic structures that supported implementation. Evaluation findings pointed to recommendations for local and national leaders to help anticipate and mitigate potential barriers to successful implementation.
Gong, Shuangping; Dai, Yonghui; Ji, Jun; Wang, Jinzhao; Sun, Hai
Customer complaint has been the important feedback for modern enterprises to improve their product and service quality as well as the customer's loyalty. As one of the commonly used manners in customer complaint, telephone communication carries rich emotional information of speeches, which provides valuable resources for perceiving the customer's satisfaction and studying the complaint handling skills. This paper studies the characteristics of telephone complaint speeches and proposes an analysis method based on affective computing technology, which can recognize the dynamic changes of customer emotions from the conversations between the service staff and the customer. The recognition process includes speaker recognition, emotional feature parameter extraction, and dynamic emotion recognition. Experimental results show that this method is effective and can reach high recognition rates of happy and angry states. It has been successfully applied to the operation quality and service administration in telecom and Internet service company.
International Telecommunication Union. Geneva
Recommendation E.123 defines a standard way to write telephone numbers, e-mail addresses, and web addresses. It recommends the following formats (when dialing the area code is optional for local calling): Telephone number: National notation (042) 123 4567 International notation +31 (0)42 123 4567 E-mail address: firstname.lastname@example.org Internet address / URL: www.company.com It also recommends that a hypen (-), space ( ), or period (.) can be used to visually separate groups of numbers. The parentheses are used to indicate digits that are sometimes not dialed. a slash (/) is used to indicate alternate numbers. This information is important if you want to make sure people know how to dail a phone number in a specific country.
Full Text Available Customer complaint has been the important feedback for modern enterprises to improve their product and service quality as well as the customer’s loyalty. As one of the commonly used manners in customer complaint, telephone communication carries rich emotional information of speeches, which provides valuable resources for perceiving the customer’s satisfaction and studying the complaint handling skills. This paper studies the characteristics of telephone complaint speeches and proposes an analysis method based on affective computing technology, which can recognize the dynamic changes of customer emotions from the conversations between the service staff and the customer. The recognition process includes speaker recognition, emotional feature parameter extraction, and dynamic emotion recognition. Experimental results show that this method is effective and can reach high recognition rates of happy and angry states. It has been successfully applied to the operation quality and service administration in telecom and Internet service company.
Elahe Sahimi Izadian
Full Text Available The high comorbidity of medical and psychiatric diagnoses in the general hospital population requires collaboration between various medical fields to provide comprehensive health care. This study aims to find the rate of psychiatric consultations, their timing and overall diagnostic trend in comparison to previous studies. Tehran University of Medical Sciences has got an active psychiatric consultation-liaison service which includes services provided by four faculty psychiatrists (two full-time and two part-time. This study was done in two general hospitals by simple sampling in available cases. For each consultation, a board-certified faculty psychiatrist conducted a clinical evaluation based on DSM-IV-TR. Other than psychiatric diagnoses, socio-demographic variables, relative consultation rates, reasons for referral, medical diagnoses and the time stay after admission were assessed. Among 503 patients who were visited by the consultation-liaison service, there were 54.3% female with mean age of 39.8 years. In 90.1% of consultations, at least one DSM-IV-TR diagnosis was made. The most frequent diagnosis groups were mood disorder (43.5%, adjustment disorder (10.9% and cognitive disorder (7.6%. In about 10.9% of the consultations, multiple psychiatric diagnoses were made. The mean length of hospital stay before the consultation was 12.56 days (range=1-90, SD=13. Based on our findings, the mood and cognitive disorders still remain major foci of consultation-liaison practice in general hospitals; however our findings showed high rate of adjustment disorders diagnosis and ambiguous request for psychiatric consultation which need more interdisciplinary interaction.
Sommer, Susan L.
Based on Gustavus Adolphus College's experience with hiring a consultant for student recruitment, suggestions for optimizing the working relationship are provided. Issues include establishing needs, selecting a firm, setting a schedule, using progress reports, and avoiding communication problems. (MSE)
Ota, Ken S; Beutler, David S; Sheikh, Hassam; Weiss, Jessica L; Parkinson, Dallin; Nguyen, Peter; Gerkin, Richard D; Loli, Akil I
This study investigated the trend of phone calls in the Banner Good Samaritan Medical Center (BGSMC) Heart Failure Transitional Care Program (HFTCP). The primary goal of the HFTCP is to reduce 30-Day readmissions for heart failure patients by using a multi-pronged approach. This study included 104 patients in the HFTCP discharged over a 51-week period who had around-the-clock telephone access to the Transitionalist. Cellular phone records were reviewed. This study evaluated the length and timing of calls. A total of 4398 telephone calls were recorded of which 39% were inbound and 61% were outbound. This averaged to 86 calls per week. During the "Weekday Daytime" period, Eighty-five percent of the totals calls were made. There were 229 calls during the "Weekday Nights" period with 1.5 inbound calls per week. The "Total Weekend" calls were 10.2% of the total calls which equated to a weekly average of 8.8. Our experience is that direct, physician-patient telephone contact is feasible with a panel of around 100 HF patients for one provider. If the proper financial reimbursements are provided, physicians may be apt to participate in similar transitional care programs. Likewise, third party payers will benefit from the reduction in unnecessary emergency room visits and hospitalizations.
Kristiansen, Simon; Sørensen, Matias; Herold, Michald B.
In the different stages of the educational system, the demand for efficient planning is increasing. This article treats the $$\\mathcal NP $$ NP -hard Consultation Timetabling Problem, a recurrent planning problem for the high schools in Denmark, which has not been described in the literature before......, it is shown that the ALNS algorithm in average provides results within 5 % of optimum. The developed algorithm has been implemented in the commercial product Lectio, and is therefore available for approximately 95 % of the Danish high schools....
Karam, L R; Ratel, G
In response to the CIPM MRA, and to improve radioactivity measurements in the face of advancing technologies, the CIPM's consultative committee on ionizing radiation developed a strategic approach to the realization and validation of measurement traceability for radionuclide metrology. As a consequence, measurement institutions throughout the world have devoted no small effort to establish radionuclide metrology capabilities, supported by active quality management systems and validated through prioritized participation in international comparisons, providing a varied stakeholder community with measurement confidence. Published by Elsevier Ltd.
Kenett, R.; Thyregod, Poul
Education in statistics is preparing for statistical analysis but not necessarily for statistical consulting. The objective of this paper is to explore the phases that precede and follow statistical analysis. Specifically these include: problem elicitation, data collection and, following...... statistical data analysis, formulation of findings, and presentation of findings, and recommendations. Some insights derived from a literature review and real-life case studies are provided. Areas for joint research by statisticians and cognitive scientists are outlined....
Lännerström, Linda; von Celsing, Anna-Sophia; Holmström, Inger K; Wallman, Thorne
To describe registered nurses' work with sick leave questions by telephone. In Sweden, when a sick person needs to request a sickness certification, it is common to contact the primary healthcare centre. The main access to primary health care is by telephone, with a registered nurse answering the care seeker's questions, triaging and helping care seekers to the right level of care. Registered nurses' work with sick leave questions has not been studied, except for two qualitative interview studies. A descriptive cross-sectional study. A questionnaire with 120 questions was distributed to 185 registered nurses in one county in central Sweden. Descriptive statistics were used for analysis. Response rate was 62% (n = 114). Registered nurses (n = 105) in this study talked weekly to persons on, or at risk, for sick leave. A large part (n = 78) felt they had a role in the care of persons on sick leave, consisting of booking appointments as well as acting as a pilot, advisor, caretaker and coordinator. For 74 of 114 registered nurses, it was problematic to handle the phone calls weekly. Measures were 'often' booking appointments with physicians (n = 67) and 'seldom' providing information on social insurance rules ('never' n = 51). The registered nurses expressed a great need for more education. Registered nurses in this study reported having a role in the care of persons on sick leave when handling sick leave questions by telephone. The telephone calls were problematic to handle, and the registered nurses expressed a great need for education and training in social insurance medicine. There is a need to educate and train registered nurses in social insurance medicine to provide high-quality nursing for patients on or at risk for sick leave. © 2016 John Wiley & Sons Ltd.
In this case study, computer supported argument visualisation has been applied to the analysis and representation of the draft South East Queensland Regional Plan Consultation discourse, demonstrating how argument mapping can help deliver the transparency and accountability required in participatory democracy. Consultative democracy for regional planning falls into a category of problems known as “wicked problems”. Inherent in this environment is heterogeneous viewpoints, agendas and voices, built on disparate and often contradictory logic. An argument ontology and notation that was designed specifically to deal with consultative urban planning around wicked problems is the Issue Based Information System (IBIS) and IBIS notation (Rittel & Webber, 1984). The software used for argument visualisation in this case was Compendium, a derivative of IBIS. The high volume of stakeholders and discourse heterogeneity in this environment calls for a unique approach to argument mapping. The map design model developed from this research has been titled a “Consultation Map”. The design incorporates the IBIS ontology within a hybrid of mapping approaches, amalgamating elements from concept, dialogue, argument, debate, thematic and tree-mapping. The consultation maps developed from the draft South East Queensland Regional Plan Consultation provide a transparent visual record to give evidence of the themes of citizen issues within the consultation discourse. The consultation maps also link the elicited discourse themes to related policies from the SEQ Regional Plan providing explicit evidence of SEQ Regional Plan policy-decisions matching citizen concerns. The final consultation map in the series provides explicit links between SEQ Regional Plan policy items and monitoring activities reporting on the ongoing implementation of the SEQ Regional Plan. This map provides updatable evidence of and accountability for SEQ Regional Plan policy implementation and developments.
Hill, D W; Mable, S E; Payne, J P
The increasing use of digital computer techniques for the analysis of signals such as the EEG, ECG, plethysmograms and cardiac output curves has led to the use of multichannel analogue frequency modulation telephone data links in the forward direction from the patient to the computer and digital links in the return direction. Single-channel analogue links are also being used for the surveillance of cardiac pacemaker patients and the television Viewphone offers the possibility of a visual contact between two centers. Examples will be given of the use of these various forms of telephone link.
The continuation of ours tasks to update the network is scheduled as follows: May 12 Update of switch N7: Bldg. 39 and 40 We would like to remind you that disturbances or even interruptions of telephony services may occur from 18:30 to 00:00 on the above mentioned dates. CERN divisions are invited to avoid any change requests (set-ups, move or removals) of telephones and fax machines until 12th May. Should you need more details, please send us your questions by email to Standard.Telephone@cern.ch.
In order to secure the power supply of the telephone exchange in building 40, a maintenance will be done on the 18th of December from 7.30 am to 8 am. During this intervention, the fixed telephony services in building 39 and 40 will be interrupted. The fixed telephony services in other CERN buildings won't be affected by this maintenance. The mobile telephony services (GSM) won't be affected. For more details, please send your questions to Standard.Telephone@cern.ch Telecom Services IT/CS
Brenes, Gretchen A.; Ingram, Cobi W.; Danhauer, Suzanne C.
Telephone-delivered psychotherapy has increased utility as a method of service delivery in the current world, where a number of barriers, including economic hardships and limited access to care, may prevent people from receiving the treatment they need. This method of service provision is practical and has the potential to reach large numbers of underserved people in a cost-effective manner. The aim of this paper is to review the state-of-the-art of telephone-delivered psychotherapy and to id...
Manley, Kim; Webster, Jonathan; Hale, Nick; Hayes, Nicky; Minardi, Henry
The aim of the co-operative enquiry undertaken was to explore how the leadership component of the Consultant Nurse for Older People role was reflected in day-to-day working. Leadership is one of the four key elements of the Consultant Nurse role and is the key mechanism for achieving and embedding transformation in practice. However, within the role of the Consultant Nurse this area has not been explored in detail. A 6-month co-operative inquiry approach was used to develop insights into leadership strategies of Consultant Nurses for Older People and involved the five authors of the paper, four Consultant Nurses in Older People nursing and the lead author who was also an experienced Consultant Nurse and practice-based researcher from a different nursing specialism. Through the analysis of the stories shared by the co-authors/participants, two key themes emerged relating to complexity and pathway. These themes provided a major focus for the Consultant Nurses in their leadership role. The outcome of the study is a framework that describes the triggers and enabling factors that precede the use of leadership strategies at the clinical and organizational level and associated outcomes. In defining how leadership is reflected by Consultant Nurses for Older People, a complex picture emerges that is multifaceted and multidimensional. Consultant Nurses need support to make visible the valuable contribution they make to enabling healthcare teams, organizations and work places. Consultant Nurses for Older People are key in ensuring the quality agenda within their organizations as they are well placed to provide leadership at both a strategic and clinical level, while providing influence to operational development. Within the context of the literature this area is under investigated. Understanding how leadership is reflected in the role of Consultant Nurses is complex as Consultant Nurses work across traditional interfaces and between different levels within organizations
Scuffham Paul A
Full Text Available Abstract Background An estimated 285 million people worldwide have diabetes and its prevalence is predicted to increase to 439 million by 2030. For the year 2010, it is estimated that 3.96 million excess deaths in the age group 20-79 years are attributable to diabetes around the world. Self-management is recognised as an integral part of diabetes care. This paper describes the protocol of a randomised controlled trial of an automated interactive telephone system aiming to improve the uptake and maintenance of essential diabetes self-management behaviours. Methods/Design A total of 340 individuals with type 2 diabetes will be randomised, either to the routine care arm, or to the intervention arm in which participants receive the Telephone-Linked Care (TLC Diabetes program in addition to their routine care. The intervention requires the participants to telephone the TLC Diabetes phone system weekly for 6 months. They receive the study handbook and a glucose meter linked to a data uploading device. The TLC system consists of a computer with software designed to provide monitoring, tailored feedback and education on key aspects of diabetes self-management, based on answers voiced or entered during the current or previous conversations. Data collection is conducted at baseline (Time 1, 6-month follow-up (Time 2, and 12-month follow-up (Time 3. The primary outcomes are glycaemic control (HbA1c and quality of life (Short Form-36 Health Survey version 2. Secondary outcomes include anthropometric measures, blood pressure, blood lipid profile, psychosocial measures as well as measures of diet, physical activity, blood glucose monitoring, foot care and medication taking. Information on utilisation of healthcare services including hospital admissions, medication use and costs is collected. An economic evaluation is also planned. Discussion Outcomes will provide evidence concerning the efficacy of a telephone-linked care intervention for self-management of
Sands, Natisha; Elsom, Stephen; Keppich-Arnold, Sandra; Henderson, Kathryn; King, Peter; Bourke-Finn, Karen; Brunning, Debra
Telephone-based mental health triage services are frontline health-care providers that operate 24/7 to facilitate access to psychiatric assessment and intervention for people requiring assistance with a mental health problem. The mental health triage clinical role is complex, and the populations triage serves are typically high risk; yet to date, no evidence-based methods have been available to assess clinician competence to practice telephone-based mental health triage. The present study reports the findings of a study that investigated the validity and usability of the Mental Health Triage Competency Assessment Tool, an evidence-based, interactive computer programme designed to assist clinicians in developing and assessing competence to practice telephone-based mental health triage. © 2015 Australian College of Mental Health Nurses Inc.
Woodward, Valerie A; Webb, Christine; Prowse, Morag
This paper reports on organizational influences on nurse consultant post holders. The influence of individual characteristics has been the subject of another paper. Nurse consultant posts were set up in the United Kingdom from the late 1990s onwards and, therefore, there has been little opportunity to report on evaluations of these innovative initiatives. A cross-sectional design, using a convenience sample, was adopted. Ten nurse consultants working in a variety of settings and specialties participated in in-depth, tape-recorded interviews. The data were analysed using the Framework approach. Support systems were important influences on nurse consultants' role achievement levels. These took the form of internal trust networks, nurse consultant forums and links with higher education institutions. Post holders both gave and received support and acted to empower other nurses. Thus, relationships were vital to successful role integration. The culture and structures of the National Health System were also a powerful influence in terms of local and national modernization policies, and participants had to be careful in their choice of strategies to deal with the traditional medically dominated culture. The new nurse consultant role is challenging and innovative, but a major area of contention is how much post holders are expected to take on work previously done by doctors rather than developing their nursing role. Organizational support and commitment are needed if nurse consultants are to maximize the benefits of this innovation. The findings show that new nursing roles are not always easily accepted in multidisciplinary settings and that holders of such post need to have the appropriate previous knowledge, skills and personal characteristics, as well as the ability to negotiate their way through organizational influences.
Phillippi, J C; Holley, S L; Schorn, M N; Lauderdale, J; Roumie, C L; Bennett, K
To plan and implement an interprofessional collaborative care clinic for women in midwifery care needing a consultation with a maternal-fetal medicine specialist. A community-engaged design was used to develop a new model of collaborative perinatal consultation, which was tested with 50 women. Participant perinatal outcomes and semistructured interviews with 15 women (analyzed using qualitative descriptive analysis) and clinic providers were used to evaluate the model. Participant perinatal outcomes following a simultaneous consultation visit involving a nurse-midwife and maternal-fetal medicine specialist were similar to practice and hospital averages. Women's comments on their experience were positive and had the theme 'on the same page' with six subcategories: clarity, communication, collaboration, planning, validation and 'above and beyond'. Providers also were pleased with the model. A simultaneous consultation involving the woman, a nurse-midwife and a maternal-fetal medicine specialist improved communication and satisfaction among women and providers.
Freites, Jawad; Ruprai, Chetan; Paul, Haran; Lindow, Stephen William
Abstract Introduction: The Royal College of Obstetricians and Gynaecologists, in their document "The future role of the consultant," recommended that there should be a resident obstetric consultant present in the labour ward for 24 h in large UK hospitals. There is little work that validates this recommendation. The period from midnight to 08:00 h is the most disruptive to work-life balance. This retrospective study evaluates obstetric outcomes from midnight until 08:00 h in relation to the consultant being a resident or on-call from home over a 3-year period. The Hull Royal Infirmary is a obstetric unit delivering more than 5000 babies annually. There are nine consultant obstetricians and three associate specialists who provide cover; nine always go home when on-call and return to the hospital if needed after midnight and three are resident in the hospital for personal reasons. There is a registrar and house officer resident at all times. All birth data are contemporaneously recorded on a database. A total of 5318 deliveries were studied over a 3-year period (resident consultant, n=1226; consultant on-call from home, n=4092). There were significantly fewer forceps deliveries when the consultant was on-call from home (3.3% vs. 5.1%, odds ratio 0.65, 95% confidence interval 0.48-0.88), but there was no difference in any other delivery outcome (caesarean 14.5% vs. 13.9%). There were no differences between the rates of stillbirth (0.4% vs. 0.4%) and babies born with low Apgar scores (1.4% vs. 1.3%) when the consultant was on-call from home. There is an increased incidence of forceps delivery when the consultant is resident, but there is no difference in any other obstetric parameter. The recommendation for consultant presence in the labour ward has not been validated by this study.
Hoek, Patrick D; Schers, Henk J; Hendriks, Jan C M; Vissers, Kris C P; Hasselaar, Jeroen G J
Expert consultation supports general practitioners (GPs) in delivering adequate palliative homecare. Insight into consultation practices from a GP's perspective is needed in order to shape consultation services to their wishes and needs. To explore palliative care consultation practices from a GP's perspective. Cross-sectional web-based survey among all GPs (n=235) in the region of Nijmegen, the Netherlands. Our questionnaire contained questions about the delivery of palliative care by GPs, their consultation practices and satisfaction with current services. Questions consisted mainly of 5-point Likert scales. We transformed these scales into numerical values to calculate mean scores. Linear mixed models for repeated measurements were used to study differences in scores. GPs most often consulted informal caregivers (mean score 3.6) or fellow GPs (mean score 3.3). Physical problems were discussed the most (mean score 3.5), while social and existential issues were discussed least (mean score 1.9 for both). In their choice of a particular consultation service, GPs considered the quality of the provided advice to be the most important factor. GPs were satisfied with current consultation services, with fellow GPs receiving the highest satisfaction scores (mean score 4.6). Finally, when recalling their last palliative patient, most GPs started requesting consultation during this patient's last month of life. Next to informal caregivers, GPs preferably seek advice from fellow GPs. Physical issues receive much attention during consultations; however, other vital aspects of palliative care seem to remain relatively neglected, such as social and existential issues and a proactive care approach. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Małgorzata Zajdel; Małgorzata Michalcewicz-Kaniowska
Social consultation is a simultaneous process of providing and getting information from the society in key decision-making, e.g. crucial laws, investment planning and essential enterprises. The aim of the present study was to collect opinions of the respondents on the social consultations essential for the launch of KPROP. One of the key points was finding factors affecting the social consultations process in the Kujawy and Pomorze region. The survey covered 300 respondents, including entrepr...
Full Text Available Abstract Background The use of cellular and cordless telephones has increased dramatically during the last decade. There is concern of health problems such as malignant diseases due to microwave exposure during the use of these devices. The brain is the main target organ. Methods Since the second part of the 1990's we have performed six case-control studies on this topic encompassing use of both cellular and cordless phones as well as other exposures. Three of the studies concerned brain tumours, one salivary gland tumours, one non-Hodgkin lymphoma (NHL and one testicular cancer. Exposure was assessed by self-administered questionnaires. Results Regarding acoustic neuroma analogue cellular phones yielded odds ratio (OR = 2.9, 95 % confidence interval (CI = 2.0–4.3, digital cellular phones OR = 1.5, 95 % CI = 1.1–2.1 and cordless phones OR = 1.5, 95 % CI = 1.04–2.0. The corresponding results were for astrocytoma grade III-IV OR = 1.7, 95 % CI = 1.3–2.3; OR = 1.5, 95 % CI = 1.2–1.9 and OR = 1.5, 95 % CI = 1.1–1.9, respectively. The ORs increased with latency period with highest estimates using > 10 years time period from first use of these phone types. Lower ORs were calculated for astrocytoma grade I-II. No association was found with salivary gland tumours, NHL or testicular cancer although an association with NHL of T-cell type could not be ruled out. Conclusion We found for all studied phone types an increased risk for brain tumours, mainly acoustic neuroma and malignant brain tumours. OR increased with latency period, especially for astrocytoma grade III-IV. No consistent pattern of an increased risk was found for salivary gland tumours, NHL, or testicular cancer.
Turner, Aaron P; Roubinov, Danielle S; Atkins, David C; Haselkorn, Jodie K
Poor medication adherence exerts a substantial negative impact on the health and well-being of individuals with multiple sclerosis (MS). Improving adherence rates requires a proactive approach of frequent and ongoing monitoring; however, this can be difficult to achieve within traditional, reactive health care systems that generally emphasize acute care services. Telephone-based home monitoring may circumvent these barriers and facilitate optimal care coordination and management for individuals with MS and other chronic illnesses. The current study evaluated the utility of a one-item, telephone-administered measure of adherence expectations as a prospective predictor of medication adherence across a six month period among individuals with MS. As part of a longitudinal study, Veterans with MS (N = 89) who were receiving medical services through the Veterans Health Administration completed monthly telephone-based interviews for six months. Using mixed model regression analyses, adherence expectations predicted adherence after adjusting for demographic, illness-related, and psychosocial factors (B = -5.54, p adherence expectations may represent an easy and efficient method for monitoring medication use among individuals with MS. The results offer an efficient method to detect and provide support for individuals who may benefit from interventions to promote medication adherence. Copyright © 2016 Elsevier Inc. All rights reserved.
Spicer, J; Schmidt, R; Ward, C D; Pinnington, L L
The primary aim of this study was to assess a range of desktop text telephones and to provide comparative data to enable healthcare professionals and users to make informed choices when selecting products. Our second objective was to highlight the effect of different product features on ease of communication. We used three methods of evaluation. (1) User trials of seven desktop textphones were carried out by 28 people. (2) The same desktop textphones, along with three portable models, were appraised by two independent assessors. (3) All 10 products were discussed by groups of hearing and hearing-impaired users-112 in all. Participant ratings, user comments, and observations of sample conversations all revealed that ease of communication was greatly influenced by the type of technology employed to connect the textphone to the telephone network. Overall, conversations held on text telephones with a direct connection were more successful and produced fewer garbled messages than those made with an acoustic connection. Although individual preferences were expressed, other defining features such as the size of keyboard, display type and size of text did not have a comparable impact on communication. Future research and development could focus on the design of products that would cater simultaneously for the communication needs of hearing, deaf and speech-impaired users.
Travis, Jamie; Roeder, Kathryn; Walters, Heather; Piette, John; Heisler, Michele; Ganoczy, Dara; Valenstein, Marcia; Pfeiffer, Paul
To evaluate the acceptability, feasibility and depression-related outcomes of a telephone-based mutual peer support intervention for individuals with continued depressive symptoms in specialty mental health treatment. Participants were depressed patients with continued symptoms or functional impairment treated at one of the three outpatient mental health clinics. Participants were partnered with another patient, provided with basic communication skills training, and asked to call their partner at least once a week using a telephone platform that recorded call initiation, frequency and duration. Depression symptoms, quality of life, disability, self-efficacy, overall mental and physical health and qualitative feedback were collected at enrolment, 6 weeks and 12 weeks. Fifty-four participants enroled in the 12-week intervention and 32 participants (59.3%) completed the intervention. Participants completing the study averaged 10.3 calls, with a mean call length of 26.8 min. The mean change in BDI-II score from baseline to study completion was -4.2 (95% CI: -7.6, -0.8; pmeaning and support through interactions with their partners. Telephone-based mutual peer support is a feasible and acceptable adjunct to specialty depression care. Larger trials are needed to determine efficacy and effectiveness of this intervention.
Good, B J; Herrera, H; Good, M J; Cooper, J
A Mexican-American woman who complained of persistent head pain and a bothersome "voice" was seen by a team consisting of a psychiatrist, social scientists, and spiritualist healers in a Cultural Consultation Clinic of a Psychiatric Consultation Liaison Service. This single case is analyzed to provide an understanding of the interpretive dimensions of psychiatric practice. It is argued that a hermeneutic analysis of clinical phenomena focuses attention on three distinct aspects of interpretation: on the interpretation by clinicians and clients of the discourse of the other in terms of their own clinical models; on the influence of deeply embedded personal meanings on this interpretive process; and on the role of the observer in clinical ethnography. It is argued that to sustain a hermeneutic analysis of psychiatric practice, an account of transference and countertransference in terms of interpretation theory will have to be developed.
Dr. Ilias Said
Full Text Available Architects, engineers and quantity surveyors are among the main players in construction.Coming from different background and professional background, these professionals bring in their own respective styles and methods of project management practices. There is now a body of opinion among industry people and academics alike that the industry needs to establish competency standard especially for project managers. Irrespective of their professional background, competent project managers should hypothetically deliver high quality services to the clients. A study was conducted at the School of Housing, Building and Planning, University of Science Malaysia (USM, to develop a job competence model for Consultant Project Managers (CPMs. It attempts to determine a set of minimum standards of skills and competencies for CPMs. This paper reports the findings of the study. It provides an insight into the type of competencies needed by CPMs based on the “Job Competence Model for Consultant Project Managers” developed from the study.
Patrick-Miller, Linda J; Egleston, Brian L; Fetzer, Dominique; Forman, Andrea; Bealin, Lisa; Rybak, Christina; Peterson, Candace; Corbman, Melanie; Albarracin, Julio; Stevens, Evelyn; Daly, Mary B; Bradbury, Angela R
Dissemination of genetic testing for disease susceptibility, one application of "personalized medicine", holds the potential to empower patients and providers through informed risk reduction and prevention recommendations. Genetic testing has become a standard practice in cancer prevention for high-risk populations. Heightened consumer awareness of "cancer genes" and genes for other diseases (eg, cardiovascular and Alzheimer's disease), as well as the burgeoning availability of increasingly complex genomic tests (ie, multi-gene, whole-exome and -genome sequencing), has escalated interest in and demand for genetic risk assessment and the specialists who provide it. Increasing demand is expected to surpass access to genetic specialists. Thus, there is urgent need to develop effective and efficient models of delivery of genetic information that comparably balance the risks and benefits to the current standard of in-person communication. The aim of this pilot study was to develop and evaluate a theoretically grounded and rigorously developed protocol for telephone communication of BRCA1/2 (breast cancer) test results that might be generalizable to genetic testing for other hereditary cancer and noncancer syndromes. Stakeholder data, health communication literature, and our theoretical model grounded in Self-Regulation Theory of Health Behavior were used to develop a telephone communication protocol for the communication of BRCA1/2 genetic test results. Framework analysis of selected audiotapes of disclosure sessions and stakeholders' feedback were utilized to evaluate the efficacy and inform refinements to this protocol. Stakeholder feedback (n=86) and audiotapes (38%, 33/86) of telephone disclosures revealed perceived disadvantages and challenges including environmental factors (eg, non-private environment), patient-related factors (eg, low health literacy), testing-related factors (eg, additional testing needed), and communication factors (eg, no visual cues
Wearn, Andy; Goodyear-Smith, Felicity; Everts, Hans; Huggard, Peter
To identify the frequency of non-English languages used in general practice consultations and to explore the effects on practice for general practitioners (GPs). Randomly selected Auckland GPs were telephone-interviewed using standardised questions. Interview data were entered electronically in real time and audiotaped. Data were reviewed upon collection and analysed using constant comparison thematic content analysis. Quantitative data were analysed using SPSS (v12) software. Eighty GPs were interviewed. Forty-two spoke one or more languages apart from English. Thirty-one different languages were spoken, 83% of which were used in patient consultation. Most GPs (73/80) experienced language difficulties in practice. Three broad issues arose: English language proficiency per se, accented English, and physical problems affecting speech. Four themes reflected the influence of language difficulties on the encounter: information sharing, process effects, cultural issues, and use of interpreters. Non-English language consultations occur commonly within current Auckland general practice with associated issues of misunderstanding and interpretation difficulties. GPs are often called upon to use their own language skills, especially Asian and Pacific Island tongues. Non-English speaking encounters frequently require additional time. Patients with some English language proficiency may cause more anxiety than those with none. Non-professional interpreters may colour or alter patients' meaning and accurate translation is required rather than 'interpretation'.
... to be substituted; (f) Description of the service area affected including population and general character of business of the community; (g) Name of any other carrier or carriers providing telephone... impairment; (i) Statement of the factors showing that neither present nor future public convenience and...
Shariffuddin, Nadia Alina Amir; Abidin, Nazirah Zainul
Construction projects, green or conventional, involve multi-faceted disciplines engaged with the goal of delivering products i.e. building, infrastructure etc. at the best quality within stipulated budgets. For green projects, additional attention is added for environmental quality. Due to the various responsibilities and liabilities involved as well as the complexity of the construction process itself, formal engagement of multi-disciplinary professionals i.e. project consultants is required in any construction project. Poor selection of project consultants will lead to a multitude of complications resulting in delay, cost escalation, conflicts and poor quality. This paper explores the challenges that occur during the engagement of project consultants in a green project. As the engagement decision involves developers and architects, these two groups of respondents with green project backgrounds were approached qualitatively using interview technique. The challenges identified are limited experience and knowledge, consultants' fee vs. quality, green complexity, conflicts of interest, clients' extended expectation and less demand in green projects. The construction shifts to green project demands engagement of project consultants with added skills. It is expected that through the identification of challenges, better management and administration can be created which would give impact to the overall process of engagement in green projects.
Aledavood, Talayeh; Roberts, Sam G B; Reed-Tsochas, Felix; Moro, Esteban; Dunbar, Robin I M; Saramäki, Jari
Circadian rhythms are known to be important drivers of human activity and the recent availability of electronic records of human behaviour has provided fine-grained data of temporal patterns of activity on a large scale. Further, questionnaire studies have identified important individual differences in circadian rhythms, with people broadly categorised into morning-like or evening-like individuals. However, little is known about the social aspects of these circadian rhythms, or how they vary across individuals. In this study we use a unique 18-month dataset that combines mobile phone calls and questionnaire data to examine individual differences in the daily rhythms of mobile phone activity. We demonstrate clear individual differences in daily patterns of phone calls, and show that these individual differences are persistent despite a high degree of turnover in the individuals' social networks. Further, women's calls were longer than men's calls, especially during the evening and at night, and these calls wer...
telemedicine? Telemedicine is defined as 'the practice of medicine, from a distance, in which interventions, diagnostic and treatment decisions and recommendations are based on clinical data, documents and other information transmitted ... whether telephone management is appropriate in the situation concerned, and ...
Cooper, Antony K
Full Text Available of tracking cellular telephones and using the data to populate transport and other models. We report here on one of the pilots, known as DYNATRACK (Dynamic Daily Path Tracking), a larger experiment conducted in 2007 with a more heterogeneous group of commuters...
This study was carried out to investigate the prospects of mobile telephone in dissemination of agricultural information in Ondo state, Nigeria. A multistage sampling technique was used for the study, both descriptive and inferential statistics were used to analyse results. The study revealed that the majority (85%) of the ...
Lee, Sunghee; Elkasabi, Mahmoud; Streja, Leanne
We examined whether the widespread assumption that Hispanics are subject to greater noncoverage bias in landline telephone surveys because they are more likely than other ethnic groups to use cell phones exclusively was supported by data. Data came from the 2010 National Health Interview Survey and the 2009 California Health Interview Survey. We considered estimates derived from surveys of adults with landline telephones biased and compared them with findings for all adults. Noncoverage bias was the difference between them, examined separately for Hispanics and non-Hispanic Whites. Differences in demographic and health characteristics between cell-only and landline users were larger for non-Hispanic Whites than Hispanics; cell usage was much higher for Hispanics than non-Hispanic Whites. The existence, pattern, and magnitude of noncoverage bias were comparable between the groups. We found no evidence to support a larger noncoverage bias for Hispanics than non-Hispanic Whites in landline telephone surveys. This finding should be considered in the design and interpretation of telephone surveys.
Grant, Joan S; Elliott, Timothy R; Weaver, Michael; Bartolucci, Alfred A; Giger, Joyce Newman
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. 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. 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. These results indicate that problem-solving training may be useful for family caregivers of stroke survivors after discharge from rehabilitative facilities.
Johnston, J.W.; Davis, L.J.
This report describes the procedures used to design and select a sample for a telephone survey of individuals who use electricity in irrigating agricultural cropland in the Pacific Northwest. The survey is intended to gather information on the irrigated agricultural sector that will be useful for conservation assessment, load forecasting, rate design, and other regional power planning activities.
Chequer, P; VanOss Marín, B; Paiva, L; Hudes, E S; Piazza, T; Rodrigues, L; Hearst, N
A telephone survey was conducted to measure AIDS knowledge, media usage and condom attitudes and behaviors among 500 adults aged 18 to 49 in Brasilia, as well as to evaluate the feasibility of the telephone survey method in a developing country. The response rate was 91.6%. Respondents had good knowledge about correct modes of HIV transmission and prevention but also believed HIV was transmitted through blood donation, public toilets, swimming pools, and mosquito bites. TV and newspapers were the most important sources of information on health matters and AIDS, though health workers were considered the most credible sources of such information. Only 19% of sexual encounters in the 4 weeks prior to the survey included condoms. Single and younger respondents and those with more positive attitudes used condoms more frequently. More work is needed to identify appropriate messages to motivate people to use condoms. Telephone surveys regarding AIDS and sexual attitudes and behaviors are feasible in Brasilia, a planned community with universal telephone coverage.
Kontopantelis, Evangelos; Olier, Ivan; Planner, Claire; Reeves, David; Ashcroft, Darren M; Gask, Linda; Doran, Tim; Reilly, Siobhan
Objectives Little is known about service utilisation by patients with severe mental illness (SMI) in UK primary care. We examined their consultation rate patterns and whether they were impacted by the introduction of the Quality and Outcomes Framework (QOF), in 2004. Design Retrospective cohort study using individual patient data collected from 2000 to 2012. Setting 627 general practices contributing to the Clinical Practice Research Datalink, a large UK primary care database. Participants SMI cases (346 551) matched to 5 individuals without SMI (1 732 755) on age, gender and general practice. Outcome measures Consultation rates were calculated for both groups, across 3 types: face-to-face (primary outcome), telephone and other (not only consultations but including administrative tasks). Poisson regression analyses were used to identify predictors of consultation rates and calculate adjusted consultation rates. Interrupted time-series analysis was used to quantify the effect of the QOF. Results Over the study period, face-to-face consultations in primary care remained relatively stable in the matched control group (between 4.5 and 4.9 per annum) but increased for people with SMI (8.8–10.9). Women and older patients consulted more frequently in the SMI and the matched control groups, across all 3 consultation types. Following the introduction of the QOF, there was an increase in the annual trend of face-to-face consultation for people with SMI (average increase of 0.19 consultations per patient per year, 95% CI 0.02 to 0.36), which was not observed for the control group (estimates across groups statistically different, p=0.022). Conclusions The introduction of the QOF was associated with increases in the frequency of monitoring and in the average number of reported comorbidities for patients with SMI. This suggests that the QOF scheme successfully incentivised practices to improve their monitoring of the mental and physical health of this group of patients
Full Text Available Abstract Background The provision of cell phone numbers and email addresses enhances the accessibility of medical consultations, but can add to the burden of physicians' routine clinical practice and affect their free time. The objective was to assess the attitudes of physicians to providing their telephone number or email address to patients. Methods Primary care physicians in the southern region of Israel completed a structured questionnaire that related to the study objective. Results The study population included 120 primary care physicians with a mean age of 41.2 ± 8.5, 88 of them women (73.3%. Physicians preferred to provide their cell phone number rather than their email address (P = 0.0007. They preferred to answer their cell phones only during the daytime and at predetermined times, but would answer email most hours of the day, including weekends and holidays (P = 0.001. More physicians (79.7% would have preferred allotted time for email communication than allotted time for cell phone communication (50%. However, they felt that email communication was more likely to lead to miscommunication than telephone calls (P = 0.0001. There were no differences between male and female physicians on the provision of cell phone numbers or email addresses to patients. Older physicians were more prepared to provide cell phone numbers that younger ones (P = 0.039. Conclusions The attitude of participating physicians was to provide their cell phone number or email address to some of their patients, but most of them preferred to give out their cell phone number.
Erchul, William P.; Raven, Bertram H.; Wilson, Kristen E.
This study's focus was on school psychologists' perceived effectiveness of 11 social power bases (Raven, 1993) that may be drawn upon when consulting with initially resistant teachers. Specifically, the relationship between consultant gender and perceptions of power base effectiveness was examined. The Interpersonal Power Inventory-Form CT…
Woolfson, Richard C.; Bryce, Donna; Mooney, Lindsay; Harker, Michael; Lowe, Dorothy; Ferguson, Ellen
National and international legislation has increasingly placed a duty on professionals to consult with young people about matters affecting their lives. Consequently, conducting consultation exercises with young people in order to improve the quality of services available is becoming established practice in many areas. Following on from previous…
Newman, Daniel S.; Guiney, Meaghan C.; Barrett, Courtenay A.
This study was an exploration of school consultation interactions between instructional consultants and consultees. Of specific interest was how consultants (n = 18) and consultees (n = 18) used verb tense and emotion words during the problem identification and analysis instructional consultation stage, similarities and differences in…
Full Text Available Aarti Bansal,1 Jennifer Swann,1 William Henry Smithson2 1Academic Unit of Primary Medical Care, University of Sheffield, UK; 2Department of General Practice, University College Cork, Cork, Ireland Abstract: The ability to work with interpreters is a core skill for UK medical graduates. At the University of Sheffield Medical School, this teaching was identified as a gap in the curriculum. Teaching was developed to use professional interpreters in role-play, based on evidence that professional interpreters improve health outcomes for patients with limited English proficiency. Other principles guiding the development of the teaching were an experiential learning format, integration to the core consultation skills curriculum, and sustainable delivery. The session was aligned with existing consultation skills teaching to retain the small-group experiential format and general practitioner (GP tutor. Core curricular time was found through conversion of an existing consultation skills session. Language pairs of professional interpreters worked with each small group, with one playing patient and the other playing interpreter. These professional interpreters attended training in the scenarios so that they could learn to act as patient and family interpreter. GP tutors attended training sessions to help them facilitate the session. This enhanced the sustainability of the session by providing a cohort of tutors able to pass on their expertise to new staff through the existing shadowing process. Tutors felt that the involvement of professional interpreters improved student engagement. Student evaluation of the teaching suggests that the learning objectives were achieved. Faculty evaluation by GP tutors suggests that they perceived the teaching to be worthwhile and that the training they received had helped improve their own clinical practice in consulting through interpreters. We offer the following recommendations to others who may be interested in
Beidas, Rinad S.; Edmunds, Julie M.; Cannuscio, Carolyn C.; Gallagher, Mark; Downey, Margaret Mary; Kendall, Philip C.
Consultation is an effective implementation strategy to improve uptake of evidence-based practices for youth. However, little is known about what makes consultation effective. The present study used qualitative methods to explore therapists’ perspectives about consultation. We interviewed 50 therapists who had been trained 2 years prior in cognitive-behavioral therapy for child anxiety. Three themes emerged regarding effective elements of consultation: (1) connectedness with other therapists and the consultant, (2) authentic interactions around actual cases, and (3) the responsiveness of the consultant to the needs of individual therapists. Recommendations for the design of future consultation endeavors are offered. PMID:23435832
Simonsen, Henrik Køhler
the participants looked, but also how they accessed lexicographic data. The paper presents a suitable method for using eye-tracking studies in Internet lexicography and advocates an increased use of this method to produce empirical data upon which additional theoretical considerations on the information and data......The purpose of this paper is to explore and discuss user consultation behaviour on the basis of eye-tracking data and interview data. To date the focus has been almost exclusively on the use of log files in Internet lexicography - an approach which is questioned in this article. The paper is based...... on empirical data from an exploratory eyetracking study of the user consultation behaviour of six participants and on interview data from a follow-up post-study interview of the participants. The paper elucidates and discusses the consultation behaviour in Internet lexicography and shows not only at what...
U.S. Department of Health & Human Services — The Hospice Utilization and Payment Public Use File provides information on services provided to Medicare beneficiaries by hospice providers. The Hospice PUF...
De Lusignan, Simon; Kumarapeli, Pushpa; Debar, Safia; Kushniruk, Andre W; Pearce, Chris
Computerization of general practice is an international phenomenon. Many of the Electronic Patient Record (EPR) systems have developed organically with considerable variation in their interface and functionality. Consequently they have differing impact on the clinical consultation. There is a dearth of tools available to study their impact on the consultation. The objective is to use ALFA to film and analyze a simulated clinical consultation. We used the ALFA (Activity Log File Aggregation) open source toolkit, to make video based observation and analysis of the computer mediated consultation. ALFA enables precise comparison of core elements of EPR systems. It allows multiple video channels including screen capture, data about computer use, and verbal interactions to be synchronized, timed and navigated through for analysis. The toolkit is free and can be downloaded under an open source license from www.biomedicalinformatics.info/alfa/. Its outputs, which include Unified Modelling Language (UML), provide the evidence-base for assessing the impact of the computer on the consultation the designing of EPR systems. ALFA has been used to compare different brands of primary care computer systems; nurse case-load selection and consultation in psychiatry.
Isaac, T. [McCarthy Tetrault LLP, Vancouver, BC (Canada)
This presentation outlined some of the legal aspects related to Aboriginal involvement in wind power development consultation processes and disputes. Aboriginal rights are rights held by Aboriginal people that are an element of a practice, custom, or tradition integral to the culture of groups claiming such rights. Wind power developers should understand that Aboriginal rights claims may include fishing; whaling; transportation; and cultural and spiritual activities. Aboriginal title is a subcategory of Aboriginal rights, and is a right to land itself, and an encumbrance on the Crown's underlying title to land. Weak Aboriginal claims where potential infringement by energy developers is minor may only require notice and information. Strong prima facie cases for Aboriginal rights and title where the potential for infringement is of high significance may result in more extensive consultation involving interim solutions; formal Aboriginal participation in decision-making processes; and written responses demonstrating how Aboriginal concerns have been considered. There are a number of circumstances requiring a case-by-case approach, and the Crown may make decisions in the face of Aboriginal disagreement. However, energy developers should ensure that consultation processes are fair and reasonable. Conflicting interests can often be successfully resolved through consultation, and accommodation to Aboriginal rights may include mitigation, avoiding interference, and agreeing to as little infringement as possible. Aboriginal title may attach to private land but only to the Crown's underlying title. The Crown has no duty to consult respecting Aboriginal title on private land because title has already been infringed. In these cases, duty to consult and accommodate may be discharged through other regulatory processes such as environmental impact assessments. It was concluded that wind power project proponents should build a relationship with the Crown, as avoiding
Patel, Pankaj B; Vinson, David R
Enhancing emergency department (ED) patient satisfaction has wide-ranging benefits. We seek to determine how postvisit patient-physician contact by e-mail or telephone affects patients' satisfaction with their emergency physician. We undertook this crossover study from May 1, 2010, to June 30, 2010, at 2 community EDs. Forty-two physicians either e-mailed or telephoned their patients within 72 hours of the ED visit for 1 month; in the alternate month, they provided no contact, serving as their own controls. Patients received satisfaction surveys after their ED visit. Patient satisfaction is reported as a percentage of those responding very good or excellent on a 5-point Likert scale for 3 questions about their emergency physician's skills, care, and communication. We calculated differences between patient groups (noncontact versus contact) using an intention-to-treat analysis. The mean patient satisfaction score was 79.4% for the 1,002 patients in the noncontact group and 87.7% for the 348 patients in the contact group (difference 8.3%; 95% confidence interval 4.0% to 12.6%). Patient satisfaction scores were similar for e-mail and telephone contact: 89.3% for the e-mail group and 85.2% for the telephone group (difference 4.1%; 95% confidence interval -2.3% to 10.5%). Patient satisfaction was higher when emergency physicians contacted patients briefly after their visit, either by e-mail or by telephone. Higher patient satisfaction was observed equally among patients contacted by e-mail and those contacted by telephone. Postvisit patient-physician contact could be a valuable practice to improve ED patient satisfaction. Copyright © 2013 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.
Full Text Available Background: Breast cancer is the most common form of malignancy among females. Family history is a key risk factor for breast cancer. Breast cancer screening practices are vital in patients with family history of breast cancer. Telephone counseling and education may be appropriate for improved breast cancer screening. This study was done to determine family caregiver patients’ knowledge of risk factors for breast cancer and practice of breast cancer screening and also to assess the effect of telephone counseling and education on mammography screening. Methods: This study was a community-based trial. The participants of the study were 90 caregivers who were randomly divided into an experimental group, telephone counseling and education, and a control group. The intervention group received counseling and education phone calls. A three-section questionnaire was responded and filled out through telephone interviews with the participants. The collected data were analyzed with SPSS18, using descriptive and inferential statistics. Results: The results showed that 88.9% of the participants did not know when to do breast self-exam (BSE. Mammography was performed by the participants before and after the telephone counseling in intervention group (P<0.00, which were 13.3% and 77.8% respectively. Moreover, the major cause of failure to participate in mammography was lack of enough knowledge in 73.3% of the participants. Conclusion: This study concluded that knowledge and practice on breast cancer screening in family caregiver of breast cancer patients was low. Telephone counseling and educating may provide a suitable technique for earlier detection of breast cancer in family caregivers of breast cancer patients and it can influence the decision making regarding mammography screening among 40-year-old or older women. Trial Registration Number: 2017052316870N3
Carlbring, Per; Bohman, Susanna; Brunt, Sara; Buhrman, Monica; Westling, Bengt E; Ekselius, Lisa; Andersson, Gerhard
This study evaluated a 10-week Internet-based bibliotherapy self-help program with short weekly telephone calls for people suffering from panic disorder with or without agoraphobia. After the authors confirmed the diagnosis by administering the Structured Clinical Interview for DSM-IV by telephone, 60 participants were randomly assigned to either a wait-listed control group or a multimodal treatment package based on cognitive behavior therapy plus minimal therapist contact via e-mail. A 10-minute telephone call was made each week to support each participant. Total mean time spent on each participant during the 10 weeks was 3.9 hours. The participants were required to send in homework assignments before receiving the next treatment module. Analyses were conducted on an intention-to-treat basis, which included all randomly assigned participants. From pretreatment to posttreatment, all treated participants improved significantly on all measured dimensions (bodily interpretations, maladaptive cognitions, avoidance, general anxiety and depression levels, and quality of life). Treatment gains on self-report measures were maintained at the 9-month follow-up. A blind telephone interview after the end of treatment revealed that 77% of the treated patients no longer fulfilled the criteria for panic disorder, whereas all of the wait-listed subjects still suffered from it. This study provides evidence to support the use of treatment distributed via the Internet with the addition of short weekly telephone calls to treat panic disorder. Replication should be made to compare self-help and telephone treatment based on cognitive behavior methods with nonspecific interventions.
Hanno, P.; Lin, A.; Nordling, J.
Aims of Study: The Bladder Pain Syndrome Committee of the International Consultation on Incontinence was assigned the task by the consultation of reviewing the syndrome, formerly known as interstitial cystitis, in a comprehensive fashion. This included the topics of definition, nomenclature...... to the bladder with at least one urinary symptom, such as frequency not obviously related to high fluid intake, or a persistent urge to void should be evaluated for possible BPS. The initial assessment consists of a frequency/volume chart, focused physical examination, urinalysis, and urine culture. Urine...
Cruickshank, Susanne; Steel, Emma; Fenlon, Deborah; Armes, Jo; Scanlon, Karen; Banks, Elspeth; Humphris, Gerald
Fear of recurrence (FoR) is a major concern for patients following treatment for primary breast cancer, affecting 60-99% of breast cancer survivors. Mini-AFTER is a brief intervention developed to address this fear, that breast care nurses are ideally placed to deliver. However, their interest in delivering such an intervention is unknown and crucial to its introduction. This study aims to assess the perceived feasibility of the Mini-AFTER telephone intervention for implementation by breast care nurses to manage moderate levels of fear of recurrence among breast cancer survivors. A sequential explanatory mixed-methods design will be used, informed by normalisation process theory (NPT). The design will be guided by the stages of NPT. Specifically, understanding and evaluating the process (implementation) that would enable an intervention, such as the Mini-AFTER, not only to be operationalised and normalised into everyday work (embedded) but also sustained in practice (integration). Phase 1: all members on the UK Breast Cancer Care Nursing Network database (n = 905) will be emailed a link to a web-based survey, designed to investigate how breast cancer survivors' FoR is identified and managed within current services and their willingness to deliver the Mini-AFTER. Phase 2: a purposive sample of respondents (n = 20) will be interviewed to build upon the responses in phase 1 and explore breast care nurses' individual views on the importance of addressing fear of recurrence in their clinical consultations, interest in the Mini-AFTER intervention, the content, skills required and challenges to deliver the intervention. This study will provide information about the willingness of breast care nurses (BCNs) to provide a structured intervention to manage fear of recurrence. It will identify barriers and facilitators for effective delivery and inform the future design of a larger trial of the Mini-AFTER intervention.
Full Text Available Consultation research to date has largely concentrated on how consultation practices generally serve only the purpose of procedural compliance. This article identifies and explores the gap in existing research on the impact of law on consultation practices and purposes. To explore current practices and the potential contribution of law to the nature of consultation practices, the article focuses on the NSW duty to consult Aboriginal people before permitting harm to Aboriginal cultural heritage. Conventional regulatory approaches to consultation assume that Aboriginal interests are accommodated by the same consultation strategies applied to other stakeholders in rural law and policy. This article uses an administrative law doctrinal research approach to identify the specific issues and requirements for Aboriginal consultation relating to cultural heritage. Consideration is given to the effectiveness of the case study consultation requirements, the duty design, and the recent Land and Environment Court judgment of Ashton Coal Operations Pty Limited v Director-General, Department of Environment, Climate Change and Water. The article argues that statutory consultation requirements and purposes can, and should, be taken more seriously. The law reform discussion highlighted in the paper considers how identified consultation requirements can be incorporated into Australian Cultural Heritage legislation, and the possible impact of such incorporation on the purpose of the consultation. More broadly, the law reform discussion indicates that when consultation requirements are tailored to suit the purpose of the consultation and the consultation parties, the law can play a positive role in consultation, engagement and capacity building.
Barnes, M L; Hussain, S S M
To present our experience of running a consultant-based otolaryngology emergency care service for more than five years. In 2003, we developed a system of consultant-based emergency service: consultants spent a week on-call providing a dedicated emergency service, with routine commitments cancelled. Our new system had advantages over traditional working practices in terms of consultant involvement, trainee education, continuity and efficiency. It also reduced disruption to elective commitments for both consultants and registrars. This system was fundamental to the successful review of all urgent (and in future elective) cases within target periods. Only 31 per cent of new referrals to the consultant emergency clinics required a further appointment. Good teamwork and flexibility in working arrangements have been essential to the success of this service. Given that health service changes have reduced junior trainee working hours and numbers, and that patients increasingly expect to be treated by trained doctors, our new consultant-based emergency service has merit. Although implementation in other units may differ, we recommend this new service, for the above reasons.
Bujoreanu, Simona; White, Matthew T; Gerber, Bradley; Ibeziako, Patricia
The purpose of this study was to evaluate the impact of timing of a psychiatry consultation during pediatric hospitalization on length of hospital stay and total hospitalization charges. The charts of 279 pediatric patients (totaling 308 consultations) referred to the psychiatry consultation liaison service at a freestanding tertiary pediatric hospital between January 1, 2010, and June 30, 2010 were retrospectively analyzed. The variables analyzed included the following: patient demographic characteristics; dates of admission, psychiatric consultation, and discharge; psychiatric diagnoses based on the psychiatric diagnostic evaluation; psychiatric treatment disposition; and illness severity and total charges associated with the medical stay. Earlier psychiatry consultation was associated with shorter length of stay and lower hospitalization charges after adjusting for psychiatric functioning, physical illness severity, and psychiatric disposition. Poorer psychiatric functioning and milder physical illness were associated with shorter referral time. Timely involvement of psychiatry consultation services during a medical or surgical hospitalization was associated with reductions in length of stay and total hospital charges in pediatric settings. These findings have important effects on quality of care via decreasing burden on the patient and family and on the medical system resources. Educating pediatric health care providers about the importance of early psychiatry consultation regardless of physical illness severity or psychiatric acuity will likely improve resource management for patients and hospitals. Copyright © 2015 by the American Academy of Pediatrics.