Dedicated Phone Line Research Articles

Recruitment strategies in a lung cancer screening program for Asian women with no smoking history.

e22514 Background: The Female Asian Nonsmoker Screening Study (FANSS) is a pilot study for eligible Asian women with no smoking history to provide low-dose CT (LDCT) Chest scans for lung cancer screening annually for 3 years. To recruit for the study, we took into consideration several factors including potential language barriers, low awareness of lung cancer incidence in non-smoking populations, and participant (pt) availability. Here we describe the use of various recruitment strategies to support enrollment to the FANSS study. Methods: Multimodal recruitment strategies for enrollment into FANSS were used. A dedicated phone line answered by receptionists able to speak English and several Chinese dialects was created. Research staff are bilingual or utilized telephonic interpretation services in all pt interactions. Informational flyers available in both English and Chinese were mailed to primary care physicians serving primarily Asian communities and posted in pharmacies and storefronts in NYC Chinatown. A website was developed for interested individuals to submit their contact information for further information. Working with our institutional Epic EMR, a list of all pts with active MyChart accounts was created with criteria “Asian,” “female,” “OK to contact for Research recruitment,” “age 40-74,” and excluded anyone with a smoking history and “Cancer” in the past 5 years. From this list, pts then were sent an IRB-approved recruitment message through MyChart from 3/2023-6/2023. Interested pts who reached out through the above methods were contacted by research staff to determine eligibility. All eligible pts who agreed to participate were consented either in-person or virtually to allow for schedule flexibility to review the consent. Results: From 3/5/21 to 1/27/24, 1518 women inquired about FANSS through our website, dedicated phone line or MyChart messages and were directly contacted by our team. After determination of eligibility, 760 pts had an informed consent discussion either virtually or in-person. From 3/5/21 to 3/2023, 247 pts underwent the consent process and 229 pts had a baseline LDCT. Following the intervention of directed MyChart messaging in 3/2023, 568 pts responded to the MyChart message indicating interest, however 102 pts were not eligible due to inaccurate info in their Epic medical record (i.e. ethnicity or smoking history). Overall, from 3/2023 to 1/27/24, 513 pts underwent the consent process. Among these, 90 subjects (18%) were recruited via MyChart. Conclusions: Recruitment to a lung cancer screening program in non-smokers is feasible, and specific considerations tailored to engage minority populations can improve enrollment such as bilingual staff and translated materials. The use of directed messaging through the Epic EMR is an important tool to identify potential pts which may be applied to aid in recruitment to other clinical trials or lung cancer screening programs.

Fluidification du parcours ville-hôpital : analyse de la trajectoire des patients impliqués dans le dispositif RAPIDO après un an de mise en place

Internal medicine departments manage patients referred by emergency departments or private practitioners. Considering the overcrowding of emergency departments and lack of beds for inpatients, this specialty must be part of an "ambulatory shift", particularly by strengthening the links between community and hospital medicine. Our objective was to evaluate a new care pathway in internal medicine at Nîmes university hospital. Our department has developed the RAPIDO project (Réseau d'Aide à la PrIse en Charge Diagnostique et d'Orientation). The referring general practitioner contacts a senior internist on a dedicated phone line. After careful evaluation, he may offer a consultation within 15 days. A summary report is then given to the patient. Between November 2020 and November 2021, 254 patients were seen via RAPIDO. The average call-consultation time period was 6.4 (±4.5) days, for symptoms lasting for 2 weeks to 3 months in 43% (n=109) of cases. The reason for the call was a suspicion of systemic disease in 28% of cases (n=84), or a dysfunction of an organ in 16%. A diagnosis was made in 89% of cases. The budget of the whole procedure was balanced. A quick internal medicine consultation pathway for general practitioners seems to be a relevant, feasible and economically viable healthcare trajectory, which can be transposed to any type of healthcare institution, as soon as sufficient human resources are dedicated.

A National Cyberattack Affecting Radiation Therapy: The Irish Experience

On Friday, May 14, 2021, the Health Service Executive, the organization providing public health services in the Republic of Ireland, was the victim of a significant cyberattack on its information technology systems. All systems were subsequently shut down to prevent further damage and to allow cybersecurity experts to investigate the attack. As a result, oncology services were severely disrupted, with the cessation of radiation therapy treatments in all public radiation therapy departments. Ireland has 5 large public and 6 smaller private radiation therapy centers in total. Because of the widespread adoption of electronic medical records in radiation therapy departments, it wasn't possible to retrieve patient details of those who were undergoing radiation therapy at the time of the cyberattack. In total, 513 patients nationally had their radiation therapy interrupted.A national radiation therapy cyberattack response team was formed immediately to oversee the response to the attack. The immediate concerns were radiation therapy emergencies and category 1 patients where gaps in treatment would have an adverse effect on outcome. Communication with patients and the public was also established as a priority and agreements were reached with the private sector for the treatment of patients affected by the cyberattack. The national media was used to alert patients of the need to communicate with their radiation therapy department. Dedicated phone lines were established. Locally, radiation therapy departments held daily crisis meetings with key staff members, including information technology personnel. Individual centers employed different technologies for treatment planning and data storage, so local solutions to the cyberattack to reestablish radiation therapy for patients were developed. In addition, national documentation on prioritization of patients to resume treatment was produced and a national approach was made to compensate for gaps in treatment caused by the attack. All 5 centers had reestablished radiation therapy by May 30, although there has been a long aftermath to the cyberattack. In this article, we provide an overview of the effects of the cyberattack on our national radiation therapy service and our strategy to resume patient treatment in a timely fashion.

Intervention combining nurse navigators (NNs) and a mobile application versus standard of care (SOC) in cancer patients (pts) treated with oral anticancer agents (OAA): Results of CapRI, a single-center, randomized phase III trial.

2000 Background: Various interventions aiming to improve a safe use of oral anti-cancer agents have previously been reported. These retrospective studies involved nurse-led follow-up and use of health technologies. However, the potential impact of these combined strategies is limited by a lack of rigorous methodology. Methods: We performed a randomized phase 3 trial comparing an intervention combining NNs and a mobile application vs. SOC in cancer pts treated with OAA (excluding hormonal therapy) in our tertiary cancer center. Pts initiating OAA (all types of cancer, PS < 3, life expectancy > 6 months), were randomized in a 1:1 basis. The intervention combined a nursing-led follow-up and a mobile application for patients. NNs provided regular phone follow-ups to manage symptoms and assess toxicities, adherence and supportive care needs. Pts had access to a mobile application to record tracking data, contact NNs via secure messaging or a dedicated phone line. The intervention lasted 6 months. The primary endpoint was the Relative Dose Intensity (RDI). Secondary endpoints included adherence, toxicity, response and survival, quality of life, pts experience (PACIC Score), end-of-life support, and economic estimation of the use of healthcare resources. Results: From October 2016 to May 2019, 609 pts (median age: 62 years, 20-92; PS2: 11.8%) were included. 39% were receiving oral chemotherapy, and 61% other OAA. The RDI was significantly higher in the CAPRI arm (93.4% ±0.26 vs. 89.4% ±0.19, p = 0.04). The CAPRI intervention also improved PACIC scores (mean: 2.94±0.83 vs. 2.67±0.89, p = 0.01), the number of unplanned hospitalizations (15.1% vs. 22.0%, p = 0.04), hospitalization duration (mean: 2.82±6.96 days vs. 4.44±9.60, p = 0.02), and treatment-related grade≥3 toxicities (27.6% vs. 36.9%, p = 0.02). Conclusions: Compared to SOC, the CAPRI intervention improved RDI, pts experience, hospitalizations and their duration, as well as the rate of treatment-related grade≥3 toxicities. This type of intervention should represent a new standard in pts receiving OAA. Clinical trial information: NCT02828462.

Women’s experiences of self-referral to an abortion service: qualitative study

BackgroundGuidelines from the UK recommend that women should be able to self-refer to abortion services. In 2016, a self-referral system was introduced to the abortion service in Edinburgh, Scotland, as...

COVID-19 outbreak in Northern Italy: Viewpoint of the Milan area surgical community.

COVID-19 outbreak in Northern Italy: Viewpoint of the Milan area surgical community.

CN12 - Patient experience and use of an intervention combining nurse-led telephone and technologies for the monitoring of oral cancer medication

BackgroundCAPRI, a randomized phase III trial comparing: an intervention combining Nurse Navigators (NNs) and a mobile application vs. Standard of care in cancer patients treated with oral anticancer agents was initiated in 2016 at Gustave Roussy (Villejuif, France). NNs provide regular telephone follow-ups to manage patients’ symptoms and assess toxicities, adherence to treatment and supportive care needs. Patients have access to a mobile application to record tracking data, contact NNs via secure messaging, view therapy and side effect information or store documents. Patient can contact the NNs on a dedicated phone line or by email/secure messaging MethodsThe present analysis involves 3 main data sources: - A questionnaire sent to patients after using for 5 months the CAPRI intervention in order to assess their experience, - Interviews conducted with patients to obtain their feedback of the intervention, - Data extraction from the application and NNs’ interventions over a 24-month period. ResultsOverall, 166 patients (83%) filled the questionnaire. Fifteen interviews were conducted. Patients’ experience with CAPRI intervention is summarized in the table below.Table: CN12Table: CN12Items% of patients strongly agree or agreeCAPRI intervention is useful96Communicating with the NNs is a reassuring experience98CAPRI intervention helps me to better manage my treatment79CAPRI intervention is helpful in managing the side effects of my treatment87CAPRI intervention helps me to become involved in my treatment81CAPRI intervention responds to my expectations and needs for care90I am satisfied with the responses from the NNs91CAPRI intervention is overly constraining9The open-ended comments on the questionnaires and interviews with patients highlighted the importance of listening, having a contact person who is easily reachable, available and empathetic. Concerning the use of the mobile application, 53% of patients reported having tried to connect and only 38% reported monitoring data at least once. By focusing on patient-NNs communication during the study period (817 requests), most contacts are performed by phone (78%) or e-mail (18%) but very few by secure messaging (4%). ConclusionsPatients’ experience about the intervention was strongly positive. However, the mobile application is poorly used, suggesting that from the patients’ perspective, the presence of NNs is the key of the intervention. Clinical trial identification2016-A00254-47. Legal entity responsible for the studyGustave Roussy. FundingFondation Philanthropia - Lombard Odier, Agence Nationale de la Recherche IHU-MMO, ARS Ile de France, Novartis, AstraZeneca. DisclosureAll authors have declared no conflicts of interest.

Patient-Initiated Colonoscopy Scheduling Effectively Increases Colorectal Cancer Screening Adherence.

We identified patients without medical record evidence of up-to-date colorectal cancer (CRC) screening and sent an invitation letter to self-schedule a colonoscopy without requiring prior primary care or gastroenterologist consultation. The aim of the study was to evaluate the response rate to the letter and factors associated with colonoscopy completion. A computer algorithm invited patients not up to date with CRC screening, with an INR < 1.5, and living within 300 miles of the Cleveland Clinic main campus through a letter. Patients scheduled a colonoscopy through a dedicated phone line without any prior physician consultation. Clinical, demographic, and socioeconomic variables were extracted from the EMR through natural language algorithms. We analyzed the percentage of patients who completed a colonoscopy within 6months of sending the letter and factors associated with colonoscopy completion. A total of 145,717 letters were sent. 1451 patients were deceased and excluded from analysis. 3.8% (5442) of letter recipients completed a colonoscopy. The strongest factors associated with colonoscopy completion on multivariate analysis included family history of polyps (OR 3.1, 95% CI 2.3, 4.2) or CRC (OR 2.1, 95% CI 1.7, 2.5). Other factors included younger age, male gender, married status, closer distance to endoscopy center, number of visits in the year prior, statin use, and diabetes. There were no immediate procedural complications. Patient-initiated colonoscopy in response to letter invitation for CRC screening is effective and safe with safeguards established a priori. Consultation with a gastroenterologist or primary care physician is not necessary prior to colonoscopy. To our knowledge, this is the first study to evaluate patient-initiated colonoscopy for CRC cancer screening.

Abstract NS2: A Rapid Care Evaluation Transient Ischemic Attack Clinic by Nurse Practitioners

Background: Prompt evaluation and management of patients having a transient ischemic attack (TIA) with the ABCD2 triage score has been shown to decrease the risk of stroke and potentially life-long disability. However, creating an organized, well-coordinated approach that provides rapid access for patients is a challenge at many high-volume stroke centers. Purpose: We sought to determine the feasibility of a nurse practitioner (NP)-led Rapid Access Care Execution for Transient Ischemic Attack (RACE-TIA) Clinic as part of an Outpatient Stroke Nurse Practitioner Clinic. Methods: Our RACE-TIA Clinic Algorithm uses ABCD2 score triaging, and outlines the care process for TIA patients who present either through the Emergency Department (ED), Outpatient Clinic or via telephone triage. Patients with possible TIA are triaged using the ABCD2 tool. Those who present to the ED are evaluated by a member of the Acute Stroke Team and patients with a score ≥ 3 remain in the ED Clinical Decision Unit (CDU) for evaluation. Patients with a score &lt; 3 are scheduled in the RACE-TIA Clinic staffed by two stroke-trained NPs. Referrals to the RACE-TIA clinic from the electronic medical record (EMR) referral or the dedicated phone line are triaged by a registered nurse who was trained to complete the ABCD2 scoring. All appointments are scheduled within 24-48 hours of receiving a referral. Results: Since initiating the RACE-TIA Clinic Algorithm in January 2017 a total of 20 patients were seen as outpatients for TIA evaluation. Six patients were directly referred to the RACE-TIA Clinic for acute TIA evaluation and of those, 5 were referred from the ED and 1 from a primary care office. Another 14 patients were scheduled for follow-up after having an initial TIA evaluation at either an outside hospital (3), the ED (2), ED CDU (3) or after inpatient hospitalization (6). The average time from referral to clinic visit was 34 hours. Conclusion: Our NP-led RACE-TIA Clinic has successfully evaluated patients with low risk TIA in the outpatient setting in a timely way and also provided close follow-up for high risk TIA patients after the acute evaluation without expanding or duplicating existing resources.

Developing a Mass Media Campaign to Promote Mammography Awareness in African American Women in the Nation's Capital.

This study developed and examined the reach and impact of a culturally appropriate mass media campaign pilot, designed to increase awareness about the importance of mammography screening and the available community mammography services for low-income African American women ages 40 and above. We conducted formative research using focus groups to inform campaign development, resulting in five emergent themes-good breast health, holistic views of healthiness, cancer fatalism, fear of mammogram machines, and mammogram affordability. The campaign targeted specific low-income African American communities in the District of Columbia via print ads in Metro stations and on buses, print ads in the Washington Informer, and online ads on a local TV network website. Data were collected before, during, and after campaign implementation to assess reach and impact. Reach was measured by number of impressions (number of people exposed to the campaign), while impact was assessed via online ad click-through rates, website use and referrals, and mammography center calls. The campaign was successful in reaching the target audience, with a total combined reach from all media of 9,479,386 impressions. In addition, the mammography center received significant increases in new website visitors (1482 during the campaign, compared to 24 during the preceding period) as well as 97 calls to the dedicated phone line. Further research involving a more long-term investment in terms of funding and campaign run time, coupled with a more robust evaluation, is needed to assess if culturally appropriate mass media campaigns can generate increased mammography screening rates and decrease breast-cancer-related mortality.

Enhancing Lecture Interaction through Live SMS

A consistent challenge with lectures to large audiences is the extent to which the lecturer can develop interaction with the audience. Obtaining answers to the lecturer’s questions or stimulating questions from the audience during the lecture may be hampered by the fact that the lecturer and the audience are not able to hear speakers in the audience clearly. This article reports on an experimental design to test the feasibility of allowing live SMS messaging as a means to stimulate interaction during large lectures. The context concerned lectures on academic writing in bachelor’s programmes in business and economics. Each lecture attracted about 500 students. The students were invited to send text messages to a dedicated phone line connected to a computer, which, at chosen intervals, displayed messages for everyone to see. The set-up allowed the lecturer to switch instantly from slides to the message display. Messages could be easily transferred to an Excel fi le for subsequent processing if necessary. Results showed that students did not use the opportunity as frequently as expected, and most messages were not relevant to the topics of the lectures. In this article, explanations for these outcomes are discussed, and recommendations for further implementation are presented. Using a new technology, even a pervasive one like SMS messaging, in a lecture entails modifications to the design, delivery and content of the lecture itself.

Implementation of a Centralized Infectious Diseases Telehealth (IDt) Service for 16 Small Community Hospitals

Abstract Background The majority of U.S. small community hospitals (SCHs) lack access to infectious diseases (ID) subspecialists. Telehealth can extend ID expertise to such facilities. We describe lessons learned from implementing a new IDt program for 16 SCHs in the Intermountain Healthcare system in Utah and Idaho. Methods From October 1, 2016 to April 30, 2017, we implemented an IDt service comprised of: a 24-hour ID physician advice line; an inpatient ID consult service that provided chart review and documentation (e-consults) and daytime telemedicine consultation (TC) using encrypted, HIPAA-compliant, synchronous, 2-way audio-video connection; and an ID pharmacist-led antibiotic stewardship program. The IDt service included a medical director, operations officer, ID pharmacist, analyst, and rotating ID physicians, and was implemented in a step-wise manner at 16 SCHs. IDt requests were received through a dedicated phone line with duplicate transcription to a monitored email inbox or generated from daily antibiotic stewardship rounds. Results The physician advice line was operational for all 16 SCHs on October 1, 2016. 312 advice-only calls were fielded (92 per 1000 hospital-days covered) through April 30, 2017. Common infections requiring phone advice included: bloodstream (16%), genitourinary (13%), and musculoskeletal (12%). E-consult and TC services were operational at 11 SCHs by April 30, 2017 (hospital-days covered: 1074). The IDt service completed 104 eConsults, 163 TCs, and 1198 stewardship reviews. Mean time [minutes (range)] spent per case was 16 (5–30) for eConsults and 55 (30–120) for TCs [on-camera time: 25 (12–46)]. Common infections requiring e-consult or TC were: bloodstream (45%), musculoskeletal (16%), and skin/soft tissue (11%). 22 patients (14%) seen by TC were surveyed: 100% felt the service improved their care and was necessary at their SCH. 97% of surveyed SCH staff felt the IDt service improved patient care and 90% felt it was a necessary service (32% response from 98 providers, nurses, pharmacists). Conclusion A new IDt service was well utilized and received by SCH staff and patients, with bloodstream infections being the most common reason for consultation. Future steps include evaluation of the IDt effect on clinical outcomes, financial metrics, and staff education on common ID conditions. Disclosures All authors: No reported disclosures.

Community Nurse-led clinic: competence and accountability in the management of complex chronic cardiac care within the integrated Hospital-Territory network

With the progressive aging of the population, the widespread increase in chronic and degenerative diseases and the need for constant improvement in the quality of services, outpatient nursing represents a new model of community organization and management of nursing care which can respond with competence to the diverse needs of the community. Nurse-led Clinic takes care of patients with chronic heart disease (486 pts), heart failure (260 pts) and advanced heart failure (173 pts), outpatient and home management of patients with end-stage heart failure (continuous infusion of positive inotropic with portable insulin pumps, 14 pts), management of patients on oral anticoagulant therapy and new oral anticoagulants (398 pts). Across the clinics, the triage nurse takes care of patients who access the clinic through direct access or dedicated phone line for urgent assessment/monitoring of health needs. Out of 46.1% of patients who had a cardiovascular event and/or an active problem, only 1.3% was kept under observation in the ER or hospitalized. These patients had a greater hemodynamic instability that met criteria for activation of hospitalization (severe hypotension, desaturation, brady/ tachyarrhythmias, symptoms and signs of acute heart failure). The rest of the patients, with a minor instability were referred to the clinic nursing program with telephone and/or clinical follow-ups. This allows the activation of specific interventions needed to prevent hospitalization. Where necessary, local services (either district/home and/or social) are activated in order to respond to the needs expressed by the patient and his/her family. Role of Nurses: Nursing interventions are initially done in conjunction with physician's visits to provide education and counseling for patients and caregivers to improve outcomes (mortality, readmissions to hospital, hospital length of stay). Patients and/or caregivers deemed requiring specific assessment and/or support are referred to a psychologist who also provides specific training and counseling supervision allowing for a steady update and strengthening of nurses' communication and educational skills. Follow-ups vary in frequency (e.g. monthly or bi-monthly) while medical followups still tend to be scheduled quarterly to yearly according to the clinical severity of the patient. The patient's letter contains both medical and nurses' information integrating the both assessments. Conclusions: The Nurse-led Clinic may allow the improvement of health services and is a key tool for integrating hospital and community care within a health/social care framework of services which accompany the complexity of chronic care from the onset of the disease through supportive and palliative care assistance.

Recruitment and retention strategies in longitudinal clinical studies with low-income populations

Background Conducting longitudinal research studies with low-income and/or minority participants present a unique set of challenges and opportunities. Purpose To outline the specific strategies employed to successfully recruit and retain participants in a longitudinal study of nutritional anticipatory guidance during early childhood, conducted with a low-income, ethnically diverse, urban population of mothers. Methods We describe recruitment and retention efforts made by the research team for the ‘MOMS’ Study (Making Our Mealtimes Special). The ‘multilayered’ approach for recruitment and retention included commitment of research leadership, piloting procedures, frequent team reporting, emphasis on participant convenience, incentives, frequent contact with participants, expanded budget, clinical staff buy-in, a dedicated phone line, and the use of research project branding and logos. Results Barriers to enrollment were not encountered in this project, despite recruiting from a low-income population with a large proportion of African-American families. Process evaluation with clinic staff demonstrated the perception of the MOMS staff was very positive. Participant retention rate was 75% and 64% at 6 months and 12 months post-recruitment, respectively. We attribute retention success largely to a coordinated effort between the research team and the infrastructure support at the clinical sites, as well as project branding and a dedicated phone line. Conclusions Successful participant recruitment and retention approaches need to be specific and consistent with clinical staff buy in throughout the project.

Cutting-edge Discussions of Management, Policy, and Program Issues in Emergency Care

Cutting-edge Discussions of Management, Policy, and Program Issues in Emergency Care

The experience of starting a poison control centre in Africa--the Ghana experience.

The need for a poison centre in Ghana has been well demonstrated over the years as evidenced by the occurrence of a variety of cases of poisoning. Important causes are accidental poisoning from mishandling of pesticides, accidental poisoning among children from kerosene and pesticide' ingestion due to unsafe storage methods in the home, use of herbal potions of unknown composition, overdoses of certain pharmaceuticals for illegal abortion, and accidental food poisonings. Bites from venomous animals particularly snakes are also common. Though preparations toward the establishment of a poison control centre started in mid 1999, it was not until early 2002 that the operations of a modest information centre commenced. Major roles the centre are currently performing include providing: an information service for health professionals on management advice in cases of poisoning; training for primary health personnel in the management of common poisonings; training for agricultural personnel in prevention and first aid management of pesticide poisoning; public awareness education and information programmes for prevention of poisoning. Some of the important challenges being faced include ensuring adequate sensitization on the need for centers particularly among health professionals, difficulties in acquiring adequate numbers of and appropriate training for staff of the centre, dedicated phone lines, literature and timely acquisition of toxicological data-bases. Others are poor networking among centers in the region and the absence of clinical and laboratory toxicology services dedicated to managing poisonings. The key lessons learned include the need for multi-sectoral involvement and support from the onset, the need to learn from experiences of established centers and the need to model requirements to suit local conditions without compromising the effectiveness of services.

Outcomes during middle school for an elementary school-based preventive intervention for conduct problems: Follow-up results from a randomized trial

Middle school outcomes for a population-based, randomized preventive intervention trial for conduct problems are reported. Students ( n = 361), and their parents, from six elementary schools participated in the trial. Randomization into control and preventive intervention conditions occurred at the school level. Schools were located in neighborhoods characterized by high rates of juvenile delinquency. The Linking the Interest of Families and Teachers (LIFT) multimodal preventive intervention, which included behavioral parent management training, child social and problem-solving skills training, a recess behavior management program, and a classroom dedicated phone line and answering machine, was offered to students and parents from all fifth and combined fourth-fifth classrooms within preventive intervention schools. Survival analyses were conducted using logistic regression for substance use outcomes and Cox regression for police arrest. The onset of polic arrest and patterned alcohol use during the middle school years was less likely for participants in the preventive intervention condition than for participants in the control condition, but no differences were found in terms of onset of tobacco use or marijuana use.

Control of a remote microscope over the Internet.

Globally connected research sites frequently find the need to share information on a timely basis. The sharing of data obtained from microscopy has historically required that the researcher take micrographs of the desired image and send the film to the other site or, more recently, scan the micrographs into a computer and send the micrographs through e-mail. The authors identified the need to control and view, in as close to real time as possible, images being viewed on a remote microscope. The goal was to develop a system that would be versatile, easy to learn and readily adapted from existing materials and that would allow several users to simultaneously view and control the microscope. The use of commercially available materials along with a simple, custom-designed slide holder allowed researchers at remote sites to view one of 15 slides and move the slide as needed. The penalty for use of the Internet vs. dedicated phone lines such as Integrated Services Digital Network (ISDN) is that only 1 frame/7 s can be viewed at video resolution. The advantages of cost and multiple, simultaneous use over a ubiquitous system outweigh the disadvantage for most users.

ACS expands industrial, job assistance programs

At the American Chemical Society's 209th national meeting in Anaheim, crucial pieces began to fall into place to enable ACS to increase support for unemployed members and to enhance activities for industrial members. A highlight was approval by the board of directors of a seven-point program to help members with employment problems. The board authorized $245,000 in immediate funding this year to implement seven new services—including an on-line job data bank listing job postings for both candidates and recruiters that will be made available on the Internet using World Wide Web. Other new services include a dedicated phone line (800-ACS-JOBS) to provide members with direct access to career services; expanded career services for graduate students; expansion of the existing Professional Data Bank to include consultants and volunteers; programs on alternative careers in a variety of chemical specialties; increased publicity about ACS career services; and a one-year experiment to offer ACS short courses at no ...

Adverse Drug Reactions: Communications and Reporting — Hospital and Home Health Care Perspectives

Emphasis on adverse drug reaction (ADR) monitoring and reporting in the hospital setting has spawned a number of model ADR programs across the country. Although the pharmacy department usually becomes the caretaker of such programs in the hospital, a multidisciplin ary approach may be the cornerstone to an effective and efficient program. In contrast, little information is available regarding ADR monitoring in the home setting. Developing and implementing an ADR monitoring program in the home health-care setting presents unique administrative and clinical challenges to home infusion providers. The decentralized nature of formalized home care emphasizes the need for open communication channels in all aspects of care, but particularly for the monitoring and reporting of ADRs. Establishing an effective ADR program in the home setting may optimize patient safety, and provide valuable information regarding the nature and significance of reactions that occur in this population. The University of Kansas has established a dedicated phone line which enables home health care professionals to monitor and report ADRs. The data collected in this pilot project is reviewed, with respect to the type of reaction and its degree of severity, patient outcome and the United States market life of drugs associated with these reactions.