Mean Number Of Calls Research Articles

The Impact of the Use of Electronic and Digital Devices before Bedtime on Sleep Sufficiency among Iraqi Young People

Introduction: Young people often rely on electronic and digital media devices to accomplish many of their daily tasks, which may interfere with their daily physical activities. This study aims to find out the relationship between the use of electronic and digital devices before bedtime and sleep sufficiency among Iraqi young people.
 Methods: This was an analytical, cross-sectional study that was conducted on 383 young adults aged 18-25 years attending in Al-Tahrir Primary Health Care Center for immunization through purposive sampling technique from September 15, 2019 to January 10, 2020. The tool was a researcher- made questionnaire. The SPSS 20 was used for statistical analysis, where the t-test was used to find a possible relationship between the variables. The descriptive statistics included percent, means and standard deviations, independent sample T-test was used to find a possible relationship between the variables. All statistical analysis was conducted in SPSS software version 20 with considering significant level of 5%.
 Results: Mean (SD) use of electronic or digital devices at night in terms of watching television, using play station, using computer, using cell phone for gaming, and using mobile for the Internet [2.8 (3.48), 1.20 (2.0), 2.13 (3.16), 5.37 (5.0) and 10.90 (6.08)] respectively. As a result, there was a significant difference regarding the use of the cell phone for games (P-value= 0.011) and for social media (P-value= 0.000). The mean use of cell phone per night was statistically higher (20.38 minutes) than those who reported having sufficient hours of sleep (10.38 minutes) (P- value=0.040). The study also observed that the mean number of cell phone calls (5.16) was statistically associated with inadequate sleep hours per night (P-value=0.022).
 Conclusions: This study found that most participants reported adequate sleep hours after electronic or digital devices were turned off. This is because the increase in the mean number of calls and the minutes during calls before going to sleep was significantly associated with a lack of sleep.

Analysis of telephone demand in a heart failure unit: something more than a simple call

Abstract Introduction Specific care programs for HF patients significantly reduce readmissions, which is why they are recommended in clinical practice guidelines with the highest level of evidence. Telephone assistance is a service offered to patients within these programs. Purpose The main objective was to evaluate the most frequent reasons for consultation and the ability to resolve them after the call. Methods This is a descriptive, retrospective study of all the telephone consultations registered between June 2020 and January 2021. The calls are attended by the HF consultation nurse, commenting with Cardiology on those that imply changes in the pharmacological treatment. Sociodemographic and clinical variables, reasons for the call and their frequency were collected. Categorical variables were expressed as percentages and quantitative variables as means ± standard deviation. Results During the analyzed period, 1.608 consultations were attended, 494 were telephone calls, which represents 31% of the overall activity of the nursing consultation. 423 consultations were analyzed, 55.7% (235) reactive, and 44.3% (187) proactive. 72.5% of the patients were under follow-up by the nurse, compared to 27.5% who had completed drug titration. The mean age was 65 (± 12.3) years, 65.6% were men, 98.4% had a caregiver, 77% of the patients had an LVEF <40%, Charlson modified mean 4.7 (± 3.6) and 92.3% were on treatment with beta-blockers, 89.1% with ACE inhibitors/ARBs/ARNI and 82.3% with MRA. The mean number of drugs per patient was 8.6 (± 3). Reasons for the reactive calls were in 46% of the cases the consultation of symptoms, 20% to consult doubts about the treatment or procedures, 16% for problems related to the prescription of pharmacological treatment and 14% for the appointment management. Reasons for proactive calls were 40% for symptoms control, 30.5% for appointment management, 27.3% for drug titration and 2.1% related to other causes. When the reason for consultation was the appearance of symptoms, the mean number of calls required was 1.4 (± 0.8), 77.6% of the calls were solved through the telephone, 16.4% required a face-to-face visit in the nursing consultation and 2.7% were referred to the emergency room. Queries related to doubts, problems with the prescription or appointment management were solved in a single telephone consultation. Conclusions The most common telephone request when the patient made the call was the worsening of HF symptoms. The telephone consultation is presented as an effective tool in these cases, by favoring the accessibility of patients and avoiding unnecessary trips to the health center. Funding Acknowledgement Type of funding sources: None. Table 1. Descriptive details of patientsTable 2. Call reasons

Effects of the COVID-19 pandemic on trauma-related emergency medical service calls: a retrospective cohort study

BackgroundThe COVID-19 pandemic has had profound effects on the utilization of health care services, including Emergency Medical Services (EMS). Social distancing measures taken to prevent the spread of the disease have greatly affected the functioning of societies and reduced or halted many activities with a risk of injury. The aim of this study was to report the effects of lockdown measures on trauma-related EMS calls in the Finnish capital area.MethodsWe conducted a retrospective cohort study of all EMS calls in the Helsinki University Hospital (HUH) catchment area between 1 January and 31 July 2020. Calls were identified from the HUH EMS database. Calls were grouped into pre-lockdown, lockdown, and post-lockdown periods according to the restrictions set by the Finnish government and compared to the mean number of calls for the corresponding periods in 2018 and 2019. Statistical comparisons were performed using Mann-Whitney U-test for weekly numbers and percentages.ResultsDuring the study period there was a total of 70,705 EMS calls, of which 14,998 (21.2%) were related to trauma; 67,973 patients (median age 61.6 years; IQR 35.3–78.6) were met by EMS. There was no significant change in the weekly number of total or trauma-related EMS calls during the pre-lockdown period. During the lockdown period, the number of weekly total EMS calls was reduced by 12.2% (p = 0.001) and the number of trauma-related calls was reduced by 23.3% (p = 0.004). The weekly number of injured patients met by EMS while intoxicated with alcohol was reduced by 41.8% (p = 0.002). During the post-lockdown period, the number of total and trauma-related calls and the number of injured patients intoxicated by alcohol returned to previous years’ levels.ConclusionsThe COVID-19 pandemic and social distancing measures reduced the number of trauma-related EMS calls. Lockdown measures had an especially significant effect on the number of injured patients intoxicated by alcohol met by the EMS.Trial registrationNot applicable.

Does the advice requested by carers of people who live with dementia reflect the level of commissioned post-diagnostic support? A retrospective evaluation of calls to the Me2U dementia day centre 24-hour advice line

AimsThe aim was to examine the reasons for advice requests by carers of people who live with dementia (PLWD) that attend the Me2u dementia day centre in order to identify key explanatory themes. We hypothesised that requests were related mainly to coordinating care and clinical issues due to limited post-diagnostic support (PDS) in our area.BackgroundThe Me2u dementia day centre (Merseyside) cares for PLWD and also supports carers. As part of the service, a 24-hour advice line is included for PLWD and their carers who attend the centre. Locally, there is limited PDS and most carers navigate the health and social care system alone mirroring the findings by the National Collaborating Centre for Mental Health (NCCMH).MethodWe undertook a retrospective evaluation of 244 advice calls, from 64 carers, between 01/06/2019 and 31/12/2019. We analysed time of call, type of advice, type of dementia, age and whether the advice was for the PLWD or for the carer.ResultOf the 244 calls, the most common time to call was between 09.00 - 14.00 (n = 168; (68.8%) peak 09.00 - 10.00 (n = 38). Average age of the person about whom the advice was sought was 79.08 years. 91.4% of the advice calls related to PLWD (most common dementia Alzheimer's) and 8.6% to the carer only. The mean number of calls per person was 3.8 (range 1–24).Advice data were grouped into 9 broad themes namely, related to symptoms/behaviour (32.79%, n = 80), request for Me2u to coordinate care (20.08%, n = 49), general advice (14.75%, n = 36), personal care (9.42%, n = 23), carer only advice (8.60%, n = 21), social issues (6.14%, n = 15), social care (4.50%, n = 11), safeguarding (2.46%, n = 6), non-health and social care issue (1.23%, n = 3).ConclusionReasons for limited/poor PDS given by the NCCMH are; absence of named coordinators of care, over-reliance on families and carers to manage and facilitate appointments, poor recognition and management of comorbidities. This data show that 52.87% of calls were for clinical advice and coordination of care reflecting NCCMH findings. The interventions post-call reduced the impact on providers of urgent care.These findings provide support for the provision of a [24-hour] advice line as a routine part of post-diagnostic support services, especially in areas that have limited or poor PDS. Commissioners of PDS services in areas that have limited or poor PDS should make this a priority to prevent unplanned admissions to hospital and carer breakdown.

A New Multiplatform Model for Outpatient Prenatal and Postpartum Care in a Cohort of COVID-19-Affected Obstetric Patients.

Spain was one of the epicenters of the first wave of the COVID-19 pandemic. We describe in this article the design and results of a new telephone-and-telematic multiplatform model of systematic prenatal and postpartum follow-up for COVID-19-affected women implemented in a tertiary reference hospital in Madrid. We included patients with RT-PCR-confirmed COVID-19 during pregnancy or delivery from 10 March 2020 to 15 December 2020. We had a total of 211 obstetric patients: 148 (70.1%) were tested at the onset of suspicious clinical manifestations and 62 (29.4%) were tested in the context of routine screening. Of all the patients, 60 women (28.4%) were asymptomatic and 97 (46%) presented mild symptoms. Fifty-one women (24.2%) were admitted to our hospital for specific treatment because of moderate or severe symptoms. We had no missed cases and a good adherence. The mean number of calls per patient was 2.3. We performed 55 in-person visits. We analyzed the complexity of our program over time, showing a two-wave-like pattern. One patient was identified as needing hospitalization and we did not record major morbidity. Telemedicine programs are a strong and reproducible tool to reach to pregnant population affected by COVID-19, to assess its symptoms and severity, and to record for pregnancy-related symptoms both in an outpatient regime and after discharge from hospital.

Recruitment strategies for sarcopenia trials: lessons from the LACE randomized controlled trial

AbstractBackgroundSarcopenia is rarely diagnosed and is not recorded electronically in routine clinical care, posing challenges to trial recruitment. We describe the performance of four components of a strategy to efficiently recruit participants with sarcopenia to a trial of perindopril and/or leucine for sarcopenia: primary care vs. hospital recruitment, a comparison of central vs. local telephone pre‐screening, performance of a questionnaire on physical function conducted as part of the pre‐screening telephone call, and performance of bioimpedance measurement to identify low muscle mass.MethodsHospital‐based recruitment took place through inpatient and outpatient geriatric medicine services. Local research nurses reviewed medical notes and approached potentially eligible patients. Primary care recruitment reviewed primary care lists from collaborating practices, sending mailshots to patients aged 70 and over who were not taking angiotensin‐converting enzyme inhibitors. Telephone pre‐screening was conducted either by research nurses at each site or centrally by Tayside Clinical Trials Unit. The 10‐point SARC‐F questionnaire was used for pre‐screening. De‐identified recruitment information was held on a central electronic tracking system and analysed using SPSS. Bioimpedance was measured using the Akern BIA 101 system, with the Sergi equation used to estimate lean mass.ResultsFourteen UK sites recruited to the trial. The 1202 sets of notes in hospital‐based care were reviewed at these sites; 7 participants (0.6% of total notes screened) were randomized. From primary care, 13 808 invitations were sent; 138 (1.0% of total invited) were randomized. 633/2987 primary care respondents were pre‐screened centrally; the mean number of calls per respondent was 2.3. For 10 sites where central and local pre‐screening could be compared, the conversion rate from pre‐screening to randomization was 18/588 (3.1%) for centralized calls, compared with 73/1814 (4.0%) for local pre‐screening calls (P = 0.29). A weak relationship was seen between higher (worse) SARC‐F score at screening and lower likelihood of progression to randomization (r = −0.08, P = 0.03). Muscle mass estimates generated using the Sergi equation were systematically biased, and a recalibrated equation for bioimpedance‐estimated muscle mass was derived.ConclusionsPrimary care recruitment led to higher response rates and overall numbers randomized than hospital‐based recruitment. Centralized pre‐screening saved local research nurses' time but did not improve conversion to randomization. SARC‐F did not help to target screening activity in this sarcopenia trial, and a recalibration of the equation for estimating muscle mass from bioimpedance measures may improve accuracy of the screening process.

Performance Analysis of Multi-processor Two-Stage Tandem Call Center Retrial Queues with Non-Reliable Processors

We analyze a multi-processor two-stage tandem call center retrial queueing network in which the processors are subject to active breakdowns and repairs at stage-I. A level-dependent quasi-birth-and-death (LDQBD) process is formulated and a sufficient condition for ergodicity of the system is discussed. Under the stability condition, the stationary distribution of the number of calls in the system, the mean number of calls in the orbit, the mean waiting time of calls in the orbit and the mean busy period of the system along with other descriptors of the system are determined by using the matrix-analytic techniques. Besides, the availability analysis of the processors is also studied. Further, we have also discussed the characteristics of the first-passage time to reach the orbit critical level, the number of calls served in the call center during this period and their corresponding moments. Finally, extensive numerical results are presented to highlight the impact of the system parameters on the performance measures of the two-stage tandem call center retrial queueing system under investigation.

A116 ASSESSING THE EFFECTIVENESS OF THE NURSE NAVIGATOR ROLE IN AN IBD MEDICAL HOME: A RETROSPECTIVE COHORT STUDY

Abstract Background Patients living with chronic illnesses require long-term and often repeated interactions with the healthcare system. Inflammatory Bowel Disease (IBD) is an incurable, chronic gastrointestinal disease which frequently flares and remits. The nurse navigator (NN) serves as the point of first contact for IBD connecting patients with their multidisciplinary care team in order facilitate and expedite assessment, treatment and navigation through the healthcare system with the goal of improving disease-related outcomes while reducing healthcare system burden. Aims The aim of this study was to assess the impact of implementation of an IBD NN role within a multidisciplinary IBD Medical home on access to care, disease related outcomes, patient satisfaction with care, and healthcare resource use. Methods This was a retrospective cohort study comparing an IBD patient population that had access to a 24/7 NN-led helpline to a reference population who did not have access to such a service. Data between August 2017 and October 2019 were extracted from patient charts. Distribution of number of flares and time to clinical assessment between the NN exposed cohort and a non-NN exposed cohort are planned using multivariate analysis. This is a preliminary description of the NN-exposed cohort only. Results Preliminary results identified a total of 643 patients in the NN-exposed cohort. The majority of our NN-exposed population were female (64.3%). The mean age was 46.42 ± 16.86 years. Sixty-five percent of patients had CD, 33% UC and 2% IBDU. Of the 729 calls extracted, care coordination (39%) was the most frequent indication for calls followed by flare (25%), and medication education (16%). Patients made the majority (52.8%) of calls compared to NN initiated calls (47.2%). The mean number of calls per patient was 2.64 ± 2.51 (range 1–18) during the study period. Time to clinic assessment post flare call was on average 10.22 ± 8.51 days. Conclusions These results are descriptive of the NN-exposed cohort. Data comparing outcomes amongst the NN-exposed cohort to the non-exposed cohort will be presented at CDDW. Funding Agencies None

Reducing Postoperative Call Volume Through Verbal Preoperative Education.

To improve patient satisfaction and understanding of what to expect after chronic ear surgery and reduce call volume to an otology clinic at an academic tertiary referral center. Quality improvement initiative. A single-academic tertiary referral center. One hundred and ten patients who underwent chronic ear surgery in March to May 2018. Preoperative counseling over the phone 1 week before surgery. Patient call volume to the clinic within a 2-week postoperative window, patient understanding, and satisfaction of perioperative course. There was a significant increase in patient satisfaction (10.1% increase, 9.8 intervention vs. 8.9 no intervention, p = 0.0032) and in patient understanding of what to expect after surgery (6.7% increase, 9.5 intervention vs. 8.9 no intervention, p = 0.0275). There was a significant decrease in mean number of calls per patient to the clinic (57.6% decrease, 0.31 intervention vs. 0.72 no intervention, p = 0.0105) and in percentage of patients who made any number of calls to the clinic (20% intervention vs. 46%, no intervention, p = 0.00438). Verbal preoperative counseling over the phone was effective in significantly reducing unnecessary call volume to the clinic and in improving patient satisfaction and overall understanding of what to expect after surgery.

P226 Assessing the effectiveness of the nurse navigator role in an inflammatory bowel disease medical home: A retrospective cohort study

Abstract Background Patients living with chronic illnesses require long-term and often repeated interactions with the healthcare system. inflammatory bowel disease (IBD) is an incurable, chronic gastrointestinal disease which frequently flares and remits. The nurse navigator (NN) serves as the point of first contact for IBD connecting patients with their multidisciplinary care team in order to facilitate and expedite assessment, treatment and navigation through the healthcare system with the goal of improving disease-related outcomes while reducing healthcare system burden. The aim of this study was to assess the impact of implementation of an IBD NN role within a multidisciplinary IBD Medical home on access to care, disease-related outcomes, patient satisfaction with care, and healthcare resource use. Methods This was a retrospective cohort study comparing an IBD patient population that had access to a 24/7 NN-led helpline to a reference population who did not have access to such a service. Data between August 2017 and October 2019 were extracted from patient charts. Distribution of the number of flares and time to clinical assessment between the NN exposed cohort and a non-NN exposed cohort are planned using multivariate analysis. This is a preliminary description of the NN-exposed cohort only. Results Preliminary results identified a total of 643 patients in the NN-exposed cohort. The majority of our NN-exposed population were female (64.3%). The mean age was 46.42 ± 16.86 years. Sixty-five per cent of patients had CD, 33% UC and 2% IBDU. Of the 729 calls extracted, care coordination (39%) was the most frequent indication for calls followed by flare (25%), and medication education (16%). Patients made the majority (52.8%) of calls compared with NN initiated calls (47.2%). The mean number of calls per patient was 2.64 ± 2.51 (range 1–18) during the study period. Time to clinic assessment post flare call was on average 10.22 ± 8.51 days. Conclusion These results are descriptive of the NN-exposed cohort. Data comparing outcomes amongst the NN-exposed cohort to the non-exposed cohort will be presented at ECCO.

A comparison of call volumes before, during, and after Hurricane Harvey

BackgroundThere is currently minimal data regarding the demand placed on Emergency Medical Services in the wake of hurricanes and other natural disasters. This retrospective review provides an opportunity to analyze call volumes to EMS and their distribution before, during, and after Hurricane Harvey in one area on the Texas Gulf Coast. ObjectivesCall volumes from Galveston Area Ambulance Authority were reviewed to provide insights for allocation of resources during natural disasters, identifying weaknesses in the current EMS system, and recommending proactive changes for future disasters. MethodsThis study was conducted based on data gathered from the Galveston Area Ambulance Authority which records the call volumes to EMS as well as the paramedics' primary impression of the patients. An analysis of variance (ANOVA) was used to calculate the differences in mean number of calls among the selected days for the periods before, during, and after the hurricane. Also, a paired t-test was used to calculate the difference in means for calls per day and the number calls during the peak days. Statistical significance was set at P ≤ 0.05 with a 95% confidence interval. ResultsThe 6 days prior to the storm had an average of 48 ± 6 calls, the 6 days during the storm had an average of 50 ± 15 calls, and the 6 days after the storm had an average of 49 ± 14 calls (p = 0.95). The peak number of calls between August 19–September 5 occurred the last 2 days of the storm, into the first 2 days after the storm. The average call volume for these four days was 65 ± 3 calls compared to the average number of calls for the total 18 days which was 49 ± 12 calls (p = 0.008). During the peak days, there were large percentages of calls due to: injury, general pain, respiratory distress, chest pain, and generalized weakness. ConclusionsEMS and emergency departments can expect peak volumes in the last days of a natural disaster as well as the first few days after the event with increases in injuries, general pain, respiratory distress, chest pain, and generalized weakness. EMS education, proper hospital staffing, and increased telemedicine/community paramedicine usage presents opportunities to increase efficiency in community healthcare during natural disasters.

Improving Patient-Centered Transitional Care after Complex Abdominal Surgery

Poor-quality transitions of care from hospital to home contribute to high rates of readmission after complex abdominal surgery. The Coordinated Transitional Care (C-TraC) program improved readmission rates in medical patients, but evidence-based surgical transitional care protocols are lacking. This pilot study evaluated the feasibility and preliminary effectiveness of an adapted surgical C-TraC protocol. The intervention includes in-person enrollment of patients. Follow-up protocolized phone calls by specially trained surgical C-TraC nurses addressed medication management, clinic appointments, operation-specific concerns, and identification of red-flag symptoms. Enrollment criteria included pancreatectomy, gastrectomy, operative small bowel obstruction or perforation, ostomy, discharge with a drain, in-hospital complication, and clinician discretion. Engaged patients participated in the first phone call, which was within 48 to 72 hours of discharge and continued every 3 to 4 days. Patients completed the program once they and surgical C-TraC nurse agreed that no additional follow-up was needed or the patient was readmitted. Two hundred and twelve patients were enrolled, October 2015 through April 2016, with a mean age of 56 years (range 19 to 89 years); 33% of patients were 65 years or older. Surgery sites included colon (46%), small bowel (16%), pancreas (12%), multivisceral (9%), liver (4.5%), retroperitoneum/soft tissue (4.5%), gastric (4%), biliary (2%), and appendix (1.5%). Refusal rate was 1% and engagement was 95%. At initial call, 47% of patients had at least 1 medication discrepancy (range 0 to 6). Mean number of calls from provider to patient was 3.2 (range 0 to 20, median 3). A phone-based transitional care protocol for surgical patients is feasible, with <1% refusals and 95% engagement. Medication management is a prominent issue. Future studies are needed to assess the impact of surgical C-TraC on post-discharge healthcare use.

Telehealth Management in Movement Disorder: A Retrospective Study

Management of chronic diseases such as movement disorders can be challenging. Nurse-administered telephone follow-up programs have demonstrated clinical and cost efficacy in a variety of health care models. However, their efficacy in movement disorders has not been sufficiently addressed. This observational study fills a knowledge gap by reporting the nature of individuals utilizing a nurse-administered telephone service and the reasons for and the outcomes of calls. Consecutive calls received by the clinic for a 12-month duration were recorded. A sample of 312 calls from 132 patient charts was analyzed. Variables for analysis and coding schema were determined a-priori and included demographic information as well as information around the reasons for and outcomes of calls. The narratives of documented calls were reviewed retrospectively and responses coded for analysis by a separate researcher. Data was analyzed using descriptive statistical methods. Patients made the majority of calls (49%). 27% of calls related to worsening symptoms and another 35% of calls related to medication issues or renewals. The mean call duration was 15.93 minutes. The majority of calls were received mid-way between clinic visits (M = 89.24 days). The nurse resolved 84% of calls independently. The mean number of calls per patient was 2.93. Issues reported by patients were resolved (approximately 90%) without need for follow-up emergency, family, or subspecialty clinic visits. The results underscore the complexity of medical issues in a movement disorders population. The current study provides support for a nurse-administered telephone follow-up program in movement disorders.

Sleep Disruption Secondary to Overnight Call Shifts Is Associated With Irritable Bowel Syndrome in Residents: A Cross-Sectional Study

Sleep disruption has been associated with irritable bowel syndrome (IBS). We hypothesized that residents with greater sleep disruption secondary to intermittent overnight call shifts would have a higher prevalence of IBS. Postgraduate residents completed a Web-based survey including demographic data, frequency and characteristics of call shifts, the Rome III questionnaire, and the IBS-quality of life measure. For every hour of sleep deprivation while on call vs. off call, the odds ratio for an increased likelihood of IBS was 1.32, after adjustment for age and gender. The mean number of calls per block, sleep deprivation while on call, and specialty program vs. family practice each predicted the severity of IBS. Sleep disruption secondary to overnight call in residents was associated with an increased prevalence of IBS.

Interrupciones por llamadas telefónicas en la consulta del médico de familia en 2 centros de salud de Zaragoza

ObjectivesTo analyse disruptions due to telephone calls in primary care clinics, their reasons and distribution during the working day. DesignCross-sectional descriptive study. SettingThe study was conducted in primary care, 2 urban Primary Care Health Centres in Area II of Zaragoza. MethodologySeven primary care physicians recorded all calls, whether or not they were passed on from the admissions service to clinics, their origin and characteristics, over a period of 5.5 months. ResultsThe overall mean percentage of calls per day for each doctor was of 1.39 (SD 1.5), being 1.66 (SD 1.53) in San José Norte and 1.22 (SD 1.46) in San José Centro (P=.012), with a difference between 0.2 and 0.68 calls per day per clinic. The mean number of calls per day in the morning clinics and per clinic was 1.37 (SD 1.53) and 1.44 (SD 1.41) in the afternoon clinics, there being a significant difference (P=. 62). Calls originated by the patients themselves to speak directly with their doctors are more frequent in the morning than afternoon hours (28.5% and 26.5%). The distribution of calls is mainly from the 10.30 to 1 p.m., and between the 17:00 and 18:00hours. ConclusionsQuantifying the telephone calls that occur during the family physician clinics, as well as determining their distribution and reasons, allows strategies to be developed to take advantage of the phone calls, as well as minimising disruption in the clinics.

Application of Erlang Formulae in Next Generation Networks

The paper deals with the possibility of the Erlang B and Erlang C formula utilization in Next Generation Networks (NGN). Based on the common properties of synchronous and asynchronous networks it is possible the utilization of Erlang formulas also for asynchronous networks. It is possible to describe traffic in NGN networks by calculation of following parameters - loss, link utilization and bandwidth. The second part of this paper deals with the possibility of application of Erlang B formula in contact center. Contact center is one of the many examples of the NGN networks. By application of Erlang B formula in contact center environment it is possible to monitor following important parameters - number of agents, probability of call blocking, utilization of agents and mean number of calls in the system.

Performance analysis of a dynamic handoff scheme in wireless networks with heterogeneous call arrival processes

The Guard Channel Scheme (GCS) and Handoff Queueing Scheme (HQS) are the popular and practical strategies to prioritize handoff calls in wireless cellular networks. A key issue of giving handoff calls the higher priority is how to achieve a tradeoff among the handoff call blocking probability, new call blocking probability and handoff delay. This paper extends GCS and HQS and presents an efficient handoff scheme that dynamically manages the channels reserved for handoff calls depending on the current status of the handoff queue. A three-dimensional Markov model is developed to analyze the performance of this scheme and investigate the desirable performance tradeoff. The Poisson process and Markov-Modulated-Poisson-Process (MMPP) are used to model the arrival processes of new and handoff calls, respectively. The accuracy of this model is evaluated through the extensive comparison of the analytical results to those obtained from discrete-event simulation experiments. Performance measures in terms of the mean number of calls in the system, aggregate response time, aggregate call blocking probability, handoff call blocking probability, new call blocking probability and handoff delay are evaluated. The analytical model is used to investigate the effects of the number of channels originally reserved for handoff calls, the number of dynamic channels, and the ratio of the rate of handover calls to the aggregate arrival rate on the system performance.

Characteristics of Telephone Calls in a Psychiatric Outpatient Practice

The goal of this study was to document the volume and characteristics of telephone calls from patients in an outpatient psychiatric clinic. Telephone calls from a psychiatric resident's patients were logged over a 6-month period. Information collected included sex of the caller, reason for the call, deemed importance of the call, primary psychiatric diagnosis, and insurance type. A total of 291 calls occurred during the 6-month period, with an average of 2.4 calls per work day. The physician deemed 1.5% of calls to be an emergency and 15% to be urgent. Of the resident's total case load of 115 patients over the 6 month period, 29% (n = 33) of patients never made physician-patient telephone contact. Female patients were significantly more likely to call than males. Requests for medication refills were the most frequent type of call (38%). The mean number of calls per patient in the caseload was significantly different across diagnostic groups, with patients with personality disorders and anxiety spectrum disorders making more calls than other groups. There was no significant difference in the volume of telephone calls between patients with private health insurance and those without. This study may be of particular interest to physicians and managed care systems who are interested in reimbursement for telephone psychiatry. This study confirms and extends the previously reported association between certain psychiatric disorders (personality disorders, anxiety spectrum disorders) and relative frequency of telephone calls to the physician. In addition, the high volume of calls for prescription refills is an important issue in telephone management.

Effect of medication renewal access on blood pressure control

Medications at the Family Medicine Clinic are renewed either by the physician during the office visit or by a clinical pharmacist via a telephone medication renewal service. This study evaluated the effect of medication renewal access on blood pressure control in an academic family medicine clinic. Age, gender, diagnosis of heart failure and/or diabetes were recorded for all patients seen at the Family Medicine Clinic with an ICD-9 code for hypertension during the year 2000. The frequency of hypertension related office visits and calls for antihypertensive medication renewals were recorded. Mean systolic and diastolic pressures and blood pressure control rates were calculated at the last clinic visit based on JNC-VI guidelines. ANOVA and stepwise logistic regression were performed to examine the frequency of office visits and the frequency of medication renewal requests on blood pressure control. Co-variables such as age, gender, diabetes and heart failure were included in the model. Of the 938 patients seen for hypertension, 368 were seen only one time. The medication renewal service was used at least once by 332 patients. The mean number of office visits was 2.6±2.2(±SD). Among those patients who used the telephone renewal service, the mean number of calls was 1.9±1.4. Overall, blood pressure control was 45.8%. Mean systolic pressure was 139±19.2 mm Hg while diastolic pressure was 81.8±11.0 mm Hg. The frequency of office visits had no significant effect on blood pressure control (n=938, p=0.48;CI 0.95-1.1). There was no difference in blood pressure control among those patients who used the telephone renewal service compared to those who did not use the service (p=0.86;CI 0.7-1.3). The number of office visits or renewal requests had no effect on systolic pressure (p=0.9, p=0.6, respectively) or diastolic pressure (p=0.14, p=0.6, respectively). Blood pressure control was no better for patients seeing a physician more frequently (p=0.61;CI 0.7-1.5). The lack of difference in blood pressure control with utilization of the medication renewal service or office visits may have several explanations. First, the renewal service provides increased access but the volume does not allow adequate time for patient education and counseling. Second, simply providing increased access to medications is necessary, but not sufficient, to insure good blood pressure control. The high blood pressure control rates in this clinic may have influenced the findings. Additional research should be conducted to determine if the observed higher blood pressure control rates may be due to the academic environment and/or the interdisciplinary practice with physicians, nurses, pharmacists, social workers and dieticians.

Prospective study of telephone consultation and communication in pediatric infectious diseases.

Subspecialists are often called on to provide informal or "curbside" telephone consultation. There is limited documentation of the time spent on, content, nature and source of such consultations by pediatric infectious disease (PID) specialists. Nursing staff frequently assist physicians by triaging telephone calls. No previous studies have examined this aspect of their role in subspecialty practice. We prospectively recorded all telephone calls to a newly established PID program for 1 year. Results were entered into a database and analyzed using the ABSTAT software. A total of 621 calls were received by the PID specialist and 1,260 by the PID nurse from March 1, 1999, through February 29, 2000. The mean number of calls per month was 51.8 +/- 24.8 for the physician and 105 +/- 43.3 for the nurse. The mean time spent per call was 9.6 +/- 5.9 min for the physician and 3.3 +/- 1.4 min for the nurse. A total of 103.5 h were spent directly on telephonic consultation/communication by the physician and 68.7 h by the nurse, respectively. Of the calls to the physician 78.6% came from other physicians, 51.5% being pediatricians in practice and 57% involving case management. Calls to the nurse were primarily from the laboratory (26.3%), with 93% regarding patients seen on the inpatient or outpatient service. Telephone consultation/communication is an integral and important part of a PID practice.