Conventional Telephone Research Articles

Randomized Controlled Trial to Assess the Feasibility of a Novel Clinical Decision Support System Based on the Automatic Generation of Alerts through Remote Patient Monitoring

Background/Objectives: Early identification of complications in chronic and infectious diseases can reduce clinical deterioration, lead to early therapeutic interventions and lower morbidity and mortality rates. Here, we aimed to assess the feasibility of a novel clinical decision support system (CDSS) based on the automatic generation of alerts through remote patient monitoring and to identify the patient profile associated with the likelihood of severe medical alerts. Methods: A prospective, multicenter, open-label, randomized controlled trial was conducted. Patients with COVID-19 in home isolation were randomly assigned in a 1:1 ratio to receive either conventional primary care telephone follow-up plus access to a mobile app for self-reporting of symptoms (control group) or conventional primary care telephone follow-up plus access to the mobile app for self-reporting of symptoms and wearable devices for real-time telemonitoring of vital signs (case group). Results: A total of 342 patients were randomized, of whom 247 were included in the per-protocol analysis (103 cases and 144 controls). The case group received a more exhaustive follow-up, with a higher number of alerts (61,827 vs. 1825; p < 0.05) but without overloading healthcare professionals thanks to automatic alert management through artificial intelligence. Baseline factors independently associated with the likelihood of a severe alert were having asthma (OR: 1.74, 95% CI: 1.22–2.48, p = 0.002) and taking corticosteroids (OR: 2.28, 95% CI: 1.24–4.2, p = 0.008). Conclusions: The CDSS could be successfully implemented and enabled real-time telemonitoring of patients’ clinical status, providing valuable information to physicians and public health agencies.

The Effect of the Indihome Spin Off from PT Telkom Indonesia (Persero) and the Merger of Indihome with Telkomsel on TLKM Shares on the IDX and TLK Shares on the NYSE

The world of telecommunications in Indonesia cannot be separated from the role of PT Telekomunikasi Indonesia Tbk, as the largest and long-established telecommunications company and has even become a determinant of the development of telecommunications technology in the country. In the past, conventional telephones installed in homes to communicate long distances were the forerunner of a new civilization for the advancement of telecommunications. However, in the middle of 2023, Telkom will release Indihome, aka spin off, Indihome is identical to conventional telephones owned by Telkom. This decision will make the company more effective and efficient and what will be the impact on the capital market, especialy the response of local and foreign investors. This research uses two statistical analysis test methods, namely Mann Whitney and Spearman. Data analysis using SPSS, comparative tests, namely before and after the spinoff. The data object is stock price movements. The results shows that not all management decisions have a positive impact, as can be seen from the response of local and foreign stock investors to the existing sentiment. Referring to the assumption that Indihome joining Telkomsel does not necessarily mean that Singtel's ownership in Telkomsel will disappear even if dilution occurs. Apart from that, Indihome has a large contribution to Telkom, thereby affecting Telkom's revenue in the near future. Although the long-term target of reducing opex and capex can be realized.

Techniques for Improving Electronic Survey Response Rate.

Electronic surveys are readily utilized for the conduction of orthopedic research and are commonly plagued by decreased response rates as compared with more conventional telephone and paper surveys. Given the rise of electronic survey usage and technological implementation into medical research, this paper aims to summarize factors both intrinsic and extrinsic which can increase survey completion in the clinical setting.

Machine learning models predicting undertriage in telephone triage

Background Undertriaged patients have worse outcomes than appropriately triaged patients. Machine learning provides better triage prediction than conventional triage in emergency departments, but no machine learning-based undertriage prediction models have yet been developed for prehospital telephone triage. We developed and validated machine learning models for telephone triage. Materials and methods We conducted a retrospective cohort study with the largest after-hour house-call (AHHC) service dataset in Japan. Participants were ≥16 years and used the AHHC service between 1 November 2018 and 31 January 2021. We developed five prediction models based on support vector machine (SVM), lasso regression (LR), random forest (RF), gradient-boosted decision tree (XGB), and deep neural network (DNN). The primary outcome was undertriage, and predictors were telephone triage level and routinely available telephone-based data, including age, sex, 80 chief complaint categories and 10 comorbidities. We measured the area under the receiver operating characteristic curve (AUROC) for all the models. Results We identified 15,442 eligible patients (age: 38.4 ± 16.6, male: 57.2%), including 298 (1.9%; age: 58.2 ± 23.9, male: 55.0%) undertriaged patients. RF and XGB outperformed the other models, with the AUROC values (95% confidence interval; 95% CI) of the SVM, LR, RF, XGB and DNN for undertriage being 0.62 (0.55–0.69), 0.79 (0.74–0.83), 0.81 (0.76–0.86), 0.80 (0.75–0.84) and 0.77 (0.73–0.82), respectively. Conclusions We found that RF and XGB outperformed other models. Our findings suggest that machine learning models can facilitate the early detection of undertriage and early intervention to yield substantially improved patient outcomes. KEY MESSAGES Undertriaged patients experience worse outcomes than appropriately triaged patients; thus, we developed machine learning models for predicting undertriage in the prehospital setting. In addition, we identified the predictors of risk factors associated with undertriage. Random forest and gradient-boosted decision tree models demonstrated better prediction performance, and the models identified the risk factors associated with undertriage. Machine learning models aid in the early detection of undertriage, leading to significantly improved patient outcomes and identifying undertriage-associated risk factors, including chief complaint categories, could help prioritize conventional telephone triage protocol revision.

Video calls did not reduce PTSD symptoms in relatives during restricted ICU visits in the COVID-19 pandemic

To help reduce the spread of the SARS-CoV-2 virus during the COVID-19 pandemic, ICU visits were banned or restricted. Therefore, family-centered care as usually practiced was not feasible Video calls were recommended to meet relatives’ needs. The aim of this study was to investigate the effect of video calls on symptoms of post-traumatic stress disorder (PTSD) in relatives of ICU patients. This single-center study was performed during the first wave (15.03.2020‒30.04.2020; visits banned) and the second wave (01.10.20‒08.02.21: visits restricted) of the COVID-19 pandemic. The Impact of Event Scale-Revised (IES-R) was used to assess PTSD symptoms and an adapted version of the Family Satisfaction in the Intensive Care Unit 24-Item-Revised questionnaire (aFS-ICU 24R) to assess family satisfaction 3 months after ICU stay. The primary outcome was the difference in IES-R score at 3 months between the video call group (VCG) and the standard care group (SCG, no video calls). In addition, inductive content analysis of relatives’ comments regarding their satisfaction with decision-making and ICU care was performed. Fifty-two relatives (VCG: n = 26, SCG: n = 26) were included in this study. No significant difference in IES-R scores was observed between the VCG and the SCG (49.52 ± 13.41 vs. 47.46 ± 10.43, p = 0.54). During the ICU stay (mean 12 days, range 5.25‒18.75 days), the members of the VCG made a median of 3 (IQR 1‒10.75) video calls. No difference between the groups was found for conventional telephone calls during the same period (VCG: 9 calls, IQR 3.75‒18.1; SCG: 5 calls, IQR 3‒9; p = 0.12). The aFS-ICU 24R scores were high for both groups: 38 (IQR 37‒40) in the VCG and 40 (IQR 37‒40: p = 0.24) in the SCG. Video calls appeared largely ineffective in reducing PTSD symptoms or improving satisfaction among relatives affected by banning/restriction of ICU visits during the COVID-19 pandemic. Further investigations are needed to acquire more data on the factors involved in PTSD symptoms experienced by relatives of ICU patients during the COVID-19 pandemic.

Smartphone Selection Recommendation System

Smartphone is a telecommunications tool that has the same capabilities as conventional telephones, where smartphones are much more practical and easy to carry anywhere. The brands smartphone offered have many models and specifications such as ram, rom, camera, processor and others. To make it easier for users to choose the type of smartphone, it takes a smartphone selection recommendation system to assist users in making a decision. In this study resulted in a smartphone selection recommendation system application that is designed to assist users in making decisions in choosing a smartphone. This system is designed with reference to the calculation results of the Simple Additive Weighting (SAW) method by considering several criteria used to search smartphones. From the results of calculations using the SAW method, the preference values ​​of V1 to V3 are determined where according to alternative data, V1 for alternative A1 with a value of 0.76, V2 for alternative A2 with a value of 0.77, and V3 for alternative A3 with a value of 0.85. So that the largest ranking value is obtained, namely V3 with a value of 0.85. So alternative V3 is the alternative that was chosen as the best alternative.

"We can't do without it": Parent and call-handler experiences of video triage of children at a medical helpline.

Pediatric out-of-hours calls are common, as parents worry and seek reassurance and shared responsibility. Nevertheless, most children assessed in this context are not seriously ill. Conventional telephone triage lacks visual cues and is further limited by third part communication in calls concerning children. We investigated implementation of video triage in two previous studies. The aim of the present study was to investigate 1) How video triage versus telephone triage in children was experienced by parents and call-handlers, and 2) call-handlers' evaluation of the video triage projects. We triangulated data from surveys and interviews in five sub-studies. Sub-study 1: Parents' experience of video triage reported in closed-ended questionnaire items using quantitative analysis; Sub-study 2: Parents' experience of video triage reported as questionnaire free-text using qualitative content analysis; Sub-study 3: Call-handlers' experience of video triage reported in closed-ended questionnaire items using quantitative analysis; and Sub-studies 4 and 5: Individual interviews of call-handlers' experience of 1) video triage using thematic analysis and 2) the video triage project using process evaluation. Most parents' comments regarding video triage were positive (n = 164, 83%). Video triage was perceived as reassuring and reducing the likelihood of misunderstandings and unnecessary hospital visits. Call-handlers experienced that video triage improved patient assessment and caller reassurance. Some call-handlers complained that the time allocated for study participation was inadequate and requested a more accessible video set-up. Both parents and call-handlers were significantly more satisfied and reassured after video triage than after telephone triage and suggested video triage as a permanent option. Video triage was appreciated by parents and call-handlers and was recommended as a permanent option. The call-handlers suggested that designated time for participation in the studies would have been desirable in this busy call-center. We recommend video triage as a contemporary solution in out-of-hours service.

The role of digital mobile technology in elderly health management among health care workers in Indonesia: Analysis of knowledge, attitudes, and practice.

BackgroundTechnology, including information and communication technology (ICT), plays a significant role in the quality of health services. However, its application in elderly health services is still lacking. The aim of this study was to determine the knowledge of, attitudes toward, and practices of cell phone and mobile application use for elderly health care among Indonesian health care workers.MethodsThis was a cross-sectional study conducted with health care workers in Jakarta, Indonesia. The potential subjects were contacted through instant messenger application and/or through conventional short message service or telephone calls from August through November 2020.ResultsThere were 134 subjects. All the subjects had used various health applications to assist with their daily work, including telemedicine (64.2%), guidelines (60.4%), and medical calculators (46.3%). However, 96.3% of the subjects were not aware of the existence of a health application for geriatric assessment. Furthermore, 98.5% of subjects thought that it is important to use ICT to manage geriatric patients, and 94.8% felt that comprehensive geriatric assessment (CGA) in digital form would help them manage geriatric patients better. Nevertheless, 35.10% of subjects had never applied CGA to their geriatric patients.ConclusionsThe current health care system has begun to enter a period of using ICT in performing health services for geriatric patients. Nevertheless, only a few Indonesian health care workers were aware of or were using the geriatric mobile application. It is essential to improve the dissemination of geriatric health care and e-health literacy among them to improve the quality of elderly health care.

Adherence of patients with type 2 diabetes to refills and medications: a comparison between ‘telephone and collect’ and conventional counter services in a health clinic

Value-added services (VAS) have been implemented in primary and tertiary care in Malaysia to improve patients’ accessibility to their follow-up medication supplies. Previous studies on VAS have evaluated patient satisfaction and waiting time, but none have investigated the effects of VAS on adherence to refills and medications. This study aimed to compare medication and refill adherence scores between patients with type 2 diabetes mellitus (T2DM) using the Conventional Counter Service (CCS) and Telephone and Collect (TC 12 items). Data were analysed using Statistical Package for the Social Sciences (SPSS®) software version 24. A total of 112 respondents from CCS and 100 respondents from the T&C group participated in the survey. The T&C group had significantly better (i.e. lower) mean ARMS total and subscale scores than the CCS group. Patients who were retired, had shorter travel distances to their pharmacy and who assigned someone else to collect their medication had significantly better adherence. Pharmacy VAS could be an effective option in improving adherence to medications and refills in patients with T2DM. Further research is needed to assess its generalizability to other chronic diseases and to various types of healthcare settings in Malaysia.

The Personal Health Network Mobile App for Chemotherapy Care Coordination: Qualitative Evaluation of a Randomized Clinical Trial.

BackgroundCancer care coordination addresses the fragmented and inefficient care of individuals with complex care needs. The complexity of care coordination can be aided by innovative technology. Few examples of information technology-enabled care coordination exist beyond the conventional telephone follow-up. For this study, we implemented a custom-designed app, the Personal Health Network (PHN)—a Health Insurance Portability and Accountability Act-compliant social network built around a patient to enable patient-centered health and health care activities in collaboration with clinicians, care team members, caregivers, and others designated by the patient. The app facilitates a care coordination intervention for patients undergoing chemotherapy.ObjectiveThis study aimed to understand patient experiences with PHN technology and assess their perspectives on the usability and usefulness of PHNs with care coordination during chemotherapy.MethodsA two-arm randomized clinical trial was conducted to compare the PHN and care coordination with care coordination alone over a 6-month period beginning with the initiation of chemotherapy. A semistructured interview guide was constructed based on a theoretical framework of technology acceptance addressing usefulness, usability, and the context of use of the technology within the participant’s life and health care setting. All participants in the intervention arm were interviewed on completion of the study. Interviews were recorded and transcribed verbatim. A summative thematic analysis was completed for the transcribed interviews. Features of the app were also evaluated.ResultsA total of 27 interviews were completed. The resulting themes included the care coordinator as a partner in care, learning while sick, comparison of other technology to make sense of the PHN, communication, learning, usability, and usefulness. Users expressed that the nurse care coordinators were beneficial to them because they helped them stay connected to the care team and answered their questions. They shared that the mobile app gave them access to the health information they were seeking. Users expressed that the mobile app would be more useful if it was fully integrated with the electronic health record.ConclusionsThe findings highlight the value of care coordination from the perspectives of cancer patients undergoing chemotherapy and the important role of technology, such as the PHN, in enhancing this process by facilitating better communication and access to information regarding their illness.

General and substantive theories of the media and audiences

The use of new technologies as instruments of rapprochement between the public and the radio gives us a meaning of the power that the media have to announce what happens daily in society, applying techniques that allow them to be in the place where the events take place. facts and transmit them as they are, from the journalist's perception that allows him to get closer to the truth and why get closer to the truth, because the journalist must remember that one of the rules that govern this activity is the fact of asking and asking questions until to have the information that is needed and not to believe any version that the source expresses, and especially because doubt is the essence of journalism. Public participation in the media is a phenomenon that has emerged and has been promoted in recent years in Cuenca. Now not only with the use of the conventional telephone but with the application of technology such as: Internet, cell phone messages, emails and chats that have made the newscasts the most popular genre by audiences. This construction motivates the investigation of theories that support this position. In this context, we currently live in a technological culture that advances day by day and that marks in a matter of months a rapid obsolescence of much knowledge and the emergence of others. The impact of this culture is immense since it produces continuous transformations in economic, social and cultural globalization, and affects practically all aspects of personal life: work, commerce, bureaucratic management, leisure and education. For these reasons, technology urgently requires learning to live with it and authorize its undoubted benefits.

UNIT FOR MONITORING OF OPERABILITY OF FXS CHANNELS OF A DIGITAL AUTOMATIC TELEPHONE EXCHANGE

In some cases, digital automatic telephone exchanges (DATE) require objective monitoring of the correctness of switching, which is quite a challenge when using conventional telephone channels with a two‑wire termination (FXS lines). The article describes the features of the operation and circuit implementation of the control unit for monitoring telephone channel of the DATE. The main idea of the proposed implementation is the use of test signals of frequency dialing for testing the correctness of addressing and as a source of controlled sound. The control unit consists of two keys and a high‑pass filter used to generate frequency dialing, as well as of a key to pick up the receiver. Testing of the FXS channel is performed in four stages, and its total duration can be less than 1 s. The layout of the control unit successfully passed verification tests.

Effects of comprehensive health intervention by new media on patients' self-management ability after percutaneous coronary intervention

Objective To compare the effects of the comprehensive health intervention by new media and the conventional telephone follow-up on patients' self-management ability after percutaneous coronary intervention (PCI) , and to explore the comprehensive health interventions by new media which can improve the self-management ability of patients after PCI. Methods A total of 130 patients with coronary heart disease who received PCI in a ClassⅢ Grade A hospital in Nanjing between August and December 2016 were selected by convenient sampling and divided into the treatment group (n=64) and the control group (n=66) according to the random number table. Patients in the control group received the conventional telephone follow-up, while patients in the treatment group received the comprehensive health intervention by new media. The self-management ability was compared before and after intervention using the Coronary Disease Self-Management Scale (CSMS) . The incidence of adverse cardiovascular events, readmission rate at emergency service and the number of patients with regular subsequent visits to outpatient service were recorded. Results The treatment group scored higher in all dimensions of the self-management ability than the control group (P<0.05) after intervention; the readmission rate was lower in the treatment group than in the control group (χ2=4.997, P=0.044) ; and more patients with regular subsequent visits to outpatient patients were found in the treatment group (χ2=7.897, P=0.007) . Conclusions The comprehensive health intervention by new media can improve the self-management ability of patients, reduce the readmission rate at emergency service and increase the rate of regular subsequent visits to outpatient service. Key words: Nursing care; Self-management; Coronary heart disease; Health intervention

WhatsApp as a Tool for Participation on Spanish Radio: A Preliminary Study of the Program Las Mañanas on RNE

This study was conducted in an environment of widespread use of social media and mobile applications in the mass media. The general goal of the study was to analyze the use of WhatsApp in cybermedia, specifically in radio. A case study was proposed to examine the use of WhatsApp on the program Las mañanas de RNE, broadcast by Spanish National Radio. It was found that the public was very accepting of the program’s initiative to solicit WhatsApp voice messages, beginning in November 2015. The case study used audio files of a direct broadcast that included specific times for audience participation. The use of WhatsApp was accepted by the audience, in addition to the use of the conventional telephone, as a tool well-suited to listener participation in radio programming. Finally, the study highlights the importance of interactive, participatory spaces in broadcasts through the creation of synergies with new forms of online participation.

The future of telephone surveys in Hong Kong

PurposeThis paper aims to compare residential fixed-line telephone surveys with cell phone surveys for assessing the extent of the potential undercoverage issue evaluating the necessity and feasibility of conducting cell phone surveys or dual-frame telephone surveys in Hong Kong.Design/methodology/approachThe research team simultaneously carried out a conventional fixed-line telephone survey and a cell phone survey in 2015 with similar features on survey design, sampling and data collection procedures. Two samples with sample size of 801 and 1,203 were achieved separately. Data collected were analysed to see to what extent survey findings will be biased if the sampling frame of telephone surveys is solely based on residential fixed-line numbers in Hong Kong, and if such a bias does exist, whether a survey conducted through cell phones or by adding a cell phone-only (CO) group would be an ideal solution for it.FindingsThe findings show that the cooperation rates for the cell phone survey were much lower than those of the fixed-line telephone survey. The respondents from two surveys were fairly different. However, estimates of most commonly used socio-demographic characteristics from the latter group had the least bias compared with population statistics. Supplanting the traditional fixed-line survey with a cell phone survey or supplementing it with a CO group will not make the resulting sample a better representative of the population but it will amplify the sample bias on the major social socio-demographic characteristics.Originality/valueThis paper empirically compares the two types of telephone surveys in a well-designed scientific study.

Influence of Telecommunication Modality, Internet Transmission Quality, and Accessories on Speech Perception in Cochlear Implant Users.

BackgroundTelecommunication is limited or even impossible for more than one-thirds of all cochlear implant (CI) users.ObjectiveWe sought therefore to study the impact of voice quality on speech perception with voice over Internet protocol (VoIP) under real and adverse network conditions.MethodsTelephone speech perception was assessed in 19 CI users (15-69 years, average 42 years), using the German HSM (Hochmair-Schulz-Moser) sentence test comparing Skype and conventional telephone (public switched telephone networks, PSTN) transmission using a personal computer (PC) and a digital enhanced cordless telecommunications (DECT) telephone dual device. Five different Internet transmission quality modes and four accessories (PC speakers, headphones, 3.5 mm jack audio cable, and induction loop) were compared. As a secondary outcome, the subjective perceived voice quality was assessed using the mean opinion score (MOS).ResultsSpeech telephone perception was significantly better (median 91.6%, P<.001) with Skype compared with PSTN (median 42.5%) under optimal conditions. Skype calls under adverse network conditions (data packet loss > 15%) were not superior to conventional telephony. In addition, there were no significant differences between the tested accessories (P>.05) using a PC. Coupling a Skype DECT phone device with an audio cable to the CI, however, resulted in higher speech perception (median 65%) and subjective MOS scores (3.2) than using PSTN (median 7.5%, P<.001).ConclusionsSkype calls significantly improve speech perception for CI users compared with conventional telephony under real network conditions. Listening accessories do not further improve listening experience. Current Skype DECT telephone devices do not fully offer technical advantages in voice quality.

Text messaging research participants as a follow-up strategy to decrease emergency department study attrition

Collecting patient-reported follow-up data for prospective studies in the emergency department (ED) is challenging in this minimal continuity setting. The objective of this study was to determine whether text messaging study participants involved in an ongoing randomized trial resulted in a lower rate of attrition as compared to conventional telephone follow-up. This was a nested cohort analysis of research participants enrolled in a randomized controlled trial assessing head injury discharge instructions. During the first 4 months of study follow-up, participants were contacted by a conventional telephone call. For the final 3 months, participants were contacted by text messaging following the first failed telephone attempt. A total of 118 patients were enrolled in the study (78 underwent conventional follow-up, and 40 received text messages). During the period of conventional follow-up, 3 participants withdrew from the study. Of the remaining 75 participants, 24 (32.0%) at 2 weeks and 32 (42.7%) at 4 weeks were unable to be contacted. Of the 40 participants receiving a reminder text message, 4 (10.0%) at 2 weeks and 10 (25.0%) at 4 weeks were unable to be contacted. Overall, text messaging study participants decreased attrition by 22% (95% CI: 5.9%, 34.7%) and 17.7% (95% CI: -0.8%, 33.3%) at 2- and 4-week follow-ups, respectively. In this ED cohort participating in a randomized trial, text message reminders of upcoming telephone follow-up interviews decreased the rate of attrition. Text messaging is a viable, low-cost communication strategy that can improve follow-up participation in prospective research studies.

Integrated different forms of business communication by using internet telephony

The paper provides an overview of development and use of Internet technologies in improving business by integrating different types of communication. The advantages of using the standard open IP - Internet Protocol in establishing integrated communication are presented as some of the potential possibilities of upgrading the existing conventional telephone network. The paper presents a concrete implementation of internet telephony in business premises in order to reduce operating costs, as well as the analysis of the possibilities of applying new multimedia applications and services by using a single integrated network. Comparison of performance of the original, sent speech signal and the received speech signal, after passing through the IP network, for different values of packet loss rate is analyzed.

Videoconference System Based on WebRTC With Access to the PSTN

The research presented in this paper introduces Rendez-Vous, which is a system oriented to provide its users with a greater communication availability through the convergence of the conventional telephony and the real-time multimedia on the web browsers. The system consists on a web application that provides a videoconference room for multiple users without having to download any additional software. For the cases in which a user with no internet connection might need to participate in a conference, it is possible to dial and answer phone calls to/from the PSTN directly on the web browser, allowing the telephonic user to interact with the others using his/her voice. The aim of the present project is to propose a unified communications system that differs from others mainly in the interaction with the telephone network directly from a web browser while having an active videoconference, allowing real-time exchange of media streams between these two technologies. The system Rendez-Vous was implemented with the use of WebRTC (Web Real-Time Communications) for the transmission of audio and video on real-time, Node.js as a web and signaling server, as well as the software Asterisk for providing telephonic access, along with jsSIP, which is a JavaScript library for implementing a SIP User Agent.

Teaching the iPhone with VoiceOver Accessibility to People with Visual Impairments

Moving from a conventional telephone keypad to a cellular telephone with a touch-screen can seem quite challenging for some people. When one is visually impaired, there is always the option of using VoiceOver, the iPhone's built-in access technology that is designed to allow individuals with visual impairments the ability to access the visual information on the device's screen (see, for example, Apple, n.d.). This accessibility feature also allows items on the screen to be spoken aloud when touched. With the use of additional finger gestures (taps and flicks or swipes of one or multiple fingers on the screen), VoiceOver is designed to provide users with visual impairments the same amount of information as is accessible to sighted users using the device. The learning curve can seem steep and daunting, but the right teaching strategies can make the process of adjusting to a cellular telephone with a touchscreen easier for people with visual impairments. Teaching students to identify the similarities that exist in applications or apps (the location of buttons or icons, for example) can increase comprehension for individuals who have experienced challenges in exploring unfamiliar apps. Connecting the dots can begin with establishing basic comfort with receiving voice feedback from the device, learning basic orientation skills, and beginning training with the Phone app, which allows individuals to dial numbers and manage contacts. Individuals who teach the use of the iPhone with VoiceOver may not realize the importance of orientation skills when interacting with apps. Being mindful of the location of items within an app can enhance the ability of learners to develop basic problem-solving strategies. This report intends to provide readers with a method for teaching introductory skills for using the iPhone with VoiceOver. STRATEGIES FOR COMFORT AND BUILDING FOUNDATIONAL SKILLS Before delving into the Phone app, some primary building blocks have to be laid to make learning the iPhone less tedious. Comfort is key for conducive learning environments, so the learner needs to feel comfortable touching the screen and listening to VoiceOver's feedback. This comfort level will increase with training. When introduced to the idea of Voice-Over, learners tend to want to press their fingers down in different areas of the screen. One way to counteract this response is to have a student slowly glide a finger over the surface of the screen. As visual items or icons on the telephone's touchscreen are announced by Voice-Over, teachers can explain briefly what each item is. Lest learners begin to think that the slow-glide gesture is the primary way to navigate an iPhone with Voice-Over, teachers should next introduce the idea of using distinct finger gestures to operate the device. Have the learner perform a four-finger double tap to enter Help mode and experiment with the other finger gestures recognized by the iPhone. In Help mode, learners will receive auditory messages describing the correct finger gesture and its function. Once learners feel comfortable with finger gestures, introduce them to the layout of the home screen, which is the primary screen of the device. Show learners how to navigate to the major areas of the screen (Status Bar, Dock, and the array of apps) by placing a finger in the area, then having them perform finger gestures to navigate to the same location. Explain that whenever VoiceOver speaks an item, a little black box is drawn around that item. When the item is spoken, the focus is placed on that item. If the learner performs a double tap, the focused item is opened. The focus can be on an icon at the bottom of the home screen, but the learner can double tap anywhere and still open the icon because of where the focus is placed. Once the learner finds the desired item, he or she can perform a double tap or keep a finger on the item and tap anywhere on the screen with an additional finger to interact with the item. …