Received Phone Calls Research Articles

The Construction of Peer Support Among Recently Diagnosed Breast Cancer Patients.

Breast cancer (BC) and its treatments decrease patients' psychological well-being. Peer support is one form of social support, but little is known about what gives rise to peer support. The purpose of this study was to examine how peer support is constructed among recently diagnosed BC patients. Eighteen women were randomly picked from 130 women who had received phone calls from a trained peer supporter and were invited to group interviews. In the interviews, patients discussed their cancer, peer support experiences, and social support. The transcribed data were analyzed using Braun and Clarke's thematic analysis approach. The construction of peer support among newly diagnosed BC patients was complex. It depended on the needs of the patient and the success of interactions. Once they had received a diagnosis, the lives of the patients changed suddenly, and patients dove into the I-we-others consideration and had a need to talk. Interaction with peer supporters gave them a chance to share their stories. At their best, interactions led to belonging, caring, and a sense of security. The need to be heard and seen is strong in a patient's changing health situation. Peer support plays an important role in high-standard care and in strengthening patients' self-determination. Hospitals should create chances for supportive communication, and the supportive communication should be easily accessible and successful. The training of peer supporters should ensure that they have reflected on their own BC process and know how to consider the needs of newly diagnosed patients.

Morbidity and unplanned healthcare encounters after hospital discharge among young children in Dar es Salaam, Tanzania and Monrovia, Liberia

BackgroundResearchers and healthcare providers have paid little attention to morbidity and unplanned healthcare encounters for children following hospital discharge in low- and middle-income countries. Our objective was to compare symptoms...

Abstract 16149: Recruitment Strategies for a Remote Implementation Study in Diabetes Management - Insights Into Optimizing Enrollment

Background/Objectives: Remote clinical studies offer new outreach opportunities, but recruitment remains challenging. We report our experience in identifying potential participants from diverse sources and adopting various outreach and recruitment methods. Methods: We utilized multiple screening and recruitment methods to identify and enroll patients into an implementation study for guideline-directed care in patients with T2D at high risk of cardio-renal complications within the Mass General Brigham health network. Patients were identified by querying the EHR and invited by emails, individualized, or bulk EHR-portal messages. Traditional outreach included reviewing upcoming clinic visits, accepting provider referrals, and mailing invite letters. All screened-in patients received phone calls following the initial invitation ( Figure ). Results: Of 200 enrolled participants, 190/200 (95%) were identified from the EHR, 2/200 (1%) from upcoming clinic visits, and 8/200 (4%) from provider referrals. Of patients identified through the EHR, 49/3317 (1%) of the total enrolled were invited by an individualized EHR message, 61/3317 (2%) by e-mail, 80/588 (14%) by mailed letter, and 0/3666 (0%) by bulk EHR message. From clinic, 2/102 (2%) of upcoming visits and 8/36 (22%) of provider referrals were enrolled. Overall, 90/200 (45%) of enrolled patients came from letters or clinic while 110/200 (55%) came from electronic outreach. Conclusion: Conducting remote clinical research is feasible, however, enrollment remains labor-intensive. Traditional methods of patient engagement are difficult to scale, although they led to high enrollment rates. While the EHR was the primary method for identification of our enrolled participants, traditional approaches including manual screening, mailed letters, and provider referrals continue to play a role in patient enrollment. Innovative approaches are necessary to improve the process.

Use of telephone reminder system to improve review attendance of patients with cleft lip and palate

Background : This study aimed to evaluate the effectiveness of telephone reminders in reducing non-attendance at early review visits following cleft repair surgery.Materials and Methods : Comparative interventional study that included 58 adult parents/caregivers who presented their children for cleft repair surgery. Subjects were randomized into two groups; (phone call group or control group). The outcome was whether the patient attended the review clinic or not. A semi-structured questionnaire was used to collect the necessary information.Results : There was a progressive decline in attendance between the 1st and 3rd review visits, similar for the two groups. At the 4th review visit, the trend of decline was sustained for the control group but reversed for the phone call group, although not statistically significant p=0.292. The overall attendance rate for the control and phone reminder groups were 48.5% and 51.5%, respectively (p=0.469). All the respondents who received phone calls considered phone call reminders helpful.Conclusion : There was some improvement in clinic attendance with phone reminders at early review appointments after cleft repair surgery. The effect of a phone reminder system for patients attending a cleft review in this study area may be more important for the late review visit periods.

Single shot interscalene regional anesthesia provides noninferior analgesia and decreased complications compared with an indwelling catheter for arthroscopic and reconstructive shoulder surgery.

There is an abundance of literature comparing the efficacy, safety, and complication rates of regional anesthesia in shoulder surgery. The purpose of this study was to compare analgesia efficacy, and complication rates between single shot and continuous catheters in patients undergoing arthroscopic or reconstructive shoulder surgery in a large cohort. Consecutive patients (n=1888) who underwent shoulder arthroplasty or arthroscopic shoulder surgery and had regional anesthesia were included. Patients had either a single-shot interscalene block (SSIB) or an SSIB with a continuous interscalene nerve block with a catheter (CIB). The decision for SSIB or CIB was selected based on patient risk factors and surgeon preference. Patients received phone calls on postoperative days 1, 2, 7, and 14 to assess for pain levels (numeric rating scale [NRS]) and complications. One hundred sixty patients received SSIB, and 1728 patients received CIB. The postoperative NRS scores at day 1 were also similar. There were 3 complications (2%) in the SSIB group and 172 complications (10%) in the CIB group. Ten patients in the CIB group required emergency department (ED) visits secondary to block complications compared with no ED visits in the SSIB group. In 1888 consecutive patients, SSIB and CIB provided similar pain relief following shoulder surgery. However, patients who received CIB had significantly more complications and ED visits than patients who received SSIB. The potential benefits of longer pain relief may not outweigh the risks of CIB vs. SSIB in common shoulder procedures.

Antimicrobial Stewardship-Driven Monoclonal Antibody Treatment Program for COVID-19 Patients in the Bronx, New York

Background: In November 2020, bamlanivimab received emergency use authorization (EUA) to treat patients with early, mild-to-moderate COVID-19 who are at high risk of progression. Montefiore Medical Center serves an economically underserved community of >1.4 million residents in the Bronx, New York. Montefiore’s antimicrobial stewardship team (AST) developed a multidisciplinary treatment pathway for patients meeting EUA criteria: (1) outpatients and hospital associates and (2) acute-care patients (EDs or inpatient). Methods: The Montefiore AST established a centralized process for screening high-risk COVID-19 patients 7 days a week. Referrals were sent by e-mail from occupational health, primary care practices, specialty practices, emergency departments, and urgent care centers. Patients were screened in real time and were treated in the ED or a newly established infusion center within 24 hours. After infusion, all patients received phone calls from nurses and had an infectious diseases televisit. Demographics, clinical symptoms, subsequent ED visit or hospital admission, and timing from infusion to ED or hospitalization were obtained from the electronic health record. Results: In total, 281 high-risk patients (median age, 62 years; 57% female) received bamlanivimab at the infusion center or in the acute-care setting between December 2, 2020, and January 27, 2021 (Table 1). The number of treated patients increased weekly (Figure 1). Also, 62% were Hispanic or black, and 96% met EUA criteria. Furthermore, 51 (18%) were referred from occupational health, 205 (73%) were referred from the community, and 25 (9%) were inpatients (https://www.fda.gov/media/143605/download). All patients were successfully infused without adverse reactions. In addition, 23 patients (8.2%) were hospitalized and 6 (2.1%) visited EDs within 30 days of treatment. The average number of days between symptom onset and infusion was 4.9. The median age of admitted versus nonadmitted patients was 68 years versus 61.5 years (P = .07). Conclusions: An AST-coordinated bamlanivimab treatment program successfully treated multiple high-risk COVID-19 patients and potentially reduced hospitalizations. However, the effort, personnel, and resources required are significant. Dedicated hospital investment is necessary for maximal success.Funding: NoDisclosures: None

Identification of Sarcopenia in Elderly Trauma Patients: The Value of Clinical Competency and Experience.

There is currently no standard definition of sarcopenia, which has often been associated with frailty. A commonly cited surrogate measure of sarcopenia is psoas muscle size. The purpose of this prospective study is to assess medical providers' capabilities to identify frail elderly trauma patients and consequent impact on outcomes after intensive care unit admission. Trauma intensive care unit patients over the age of 50 were enrolled. A preadmission functional status questionnaire was completed on admission. Attendings, residents, and nurses, blinded to their patient's sarcopenic status, completed surveys regarding 6-month prognosis. Chart review included cross-sectional psoas area measurements on computerized tomography scan. Finally, patients received phone calls 3 and 6months after admission to determine overall health and functional status. Seventy-six participants had an average age of 70years and a corrected psoas area of 383 ± 101mm2/m2. Injury Severity Score distribution (17.2 ± 8.9) was similar for both groups. Patients also had similar preinjury activities of daily living. Both groups had similar hospital courses. While sarcopenic patients were less likely to be predicted to survive to 6months (60% vs. 76%, P = 0.017), their actual 6-month mortality was similar (22% vs. 21%, P = 0.915). Despite similar objective measures of preadmission health and trauma injury severity, medical providers were able to recognize frail patients and predicted they would have worse outcomes. Interestingly, sarcopenic patients had similar outcomes to the control group. Additional studies are needed to further delineate factors influencing provider insight into functional reserves of elderly trauma patients.

Effects of Activity Tracker Use With Health Professional Support or Telephone Counseling on Maintenance of Physical Activity and Health Outcomes in Older Adults: Randomized Controlled Trial.

BackgroundDespite a range of efforts to increase physical activity participation in Australia, inactivity levels in older adults have remained high over recent decades, contributing to increased rates of chronic health conditions. Lifestyle interventions, including telephone counseling (TC), improve physical activity participation and associated health outcomes over the short term; however, ongoing feedback and support is required to maintain these changes. Newer technologies such as wearable activity trackers (ATs) may offer an alternative method for providing ongoing support.ObjectiveThis study aims to investigate whether newer technologies such as wearable ATs assist in providing ongoing support to maintain physical activity levels and health outcomes.MethodsOlder adults aged >60 years who had just completed a 12-week face-to-face individualized community exercise program in Tasmania, Australia, participated in the study. They were randomized to receive AT, TC, or usual care (UC). All groups received a home exercise program and an optional referral to a community-based exercise program. The AT group also received an AT and text message feedback from an accredited exercise physiologist (AEP). The TC group received phone calls from an AEP throughout the 12-month intervention. The primary outcome was daily steps measured by an ActivPAL (TM) accelerometer at baseline and at 3, 6, and 12 months. Secondary outcome measures included body composition, blood pressure, 10-time sit-to-stand (TTSTS) test, timed up and go test, and cardiorespiratory fitness. This trial was approved by the Tasmanian Health and Medical Human Research Ethics Committee (H0014713).ResultsA total of 117 participants were randomized to the study (AT, n=37; TC, n=38; UC, n=42). At baseline, the participants (75/117, 64.1% female; mean age 72.4 years, SD 6.4) completed an average of 6136 steps (SD 2985) per day. Although there were no significant differences between groups, the TC and AT groups maintained daily step counts (mean difference [MD] −79 steps, 95% CI −823 to 663 steps; P=.81; and MD −588 steps, 95% CI −1359 to 182 steps; P=.09), and UC showed a reduction in daily steps (MD 981 steps, 95% CI −1668 to −294 steps; P=.003) during the 12-month period. Diastolic blood pressure was significantly higher after AT than after UC (MD 5.62 mm Hg, 95% CI 1.30 to 9.94 mm Hg; P=.01), and TTSTS was significantly slower on TC compared with UC (MD 2.36 seconds, 95% CI −0.14 to 4.87 seconds; P=.03).ConclusionsThe use of an AT with AEP support or TC is effective at maintaining daily step count in older adults over a 12-month period, suggesting that wearable ATs are as effective as TC. Further research to investigate which option is more cost-effective would be beneficial.Trial RegistrationAustralian New Zealand Clinical Trial Registry ACTRN12615001104549; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=369118

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Sequential endoscopist-driven phone calls improve the capture rate of adverse events after ERCP: a prospective study

ERCP is a high-risk endoscopic procedure, yet reports of ERCP-related adverse events are largely limited to early adverse events based on immediate postprocedure assessment. We hypothesize that immediate/1-day follow-up underestimates the true adverse event rate, and later follow-up calls may enable a more accurate assessment of adverse events, leading to enhanced postprocedural patient care. Consecutive patients undergoing ERCP at our tertiary care academic medical center from 2018 to 2019 were analyzed. Patients were encouraged to contact us with postprocedure symptoms, and they received phone calls at 1, 7, 14, and 30 days after the procedure using a standardized script to assess for delayed adverse events and unplanned health care encounters. This study is notable for a high rate of successful patient follow-up at day 1 (94%) and day 7 (93%). The overall adverse event rate was 1.9% immediately postprocedure, 3.3% on day 1, and 9.8% on day 7. Increased detection of adverse events was accomplished by the day 7 call relative to the day 1 call (pancreatitis 2% vs 0.5%; bleeding 0.5% vs 0.2%; infection 0.9% vs 0.5%). Follow-up calls at 14 and 30 days were lower yield for detection of post-ERCP adverse events. Initial postprocedure assessment and day 1 follow-up calls underestimate adverse event rates/unplanned health care encounters related to ERCP, due to delayed evolution of some adverse events. The day 7 call is optimal in that it resulted in a >3-fold higher rate of detection of adverse events and successful direction of over 10% of symptomatic patients to appropriate assessment and follow-up health care.

Su1429 INCREASED CAPTURE OF POST-ERCP ADVERSE EVENTS BY DELAYED (DAY 7) FOLLOW-UP CALLS: A PROSPECTIVE COMPARISON OF PHYSICIAN AND NURSE-INITIATED CALLS

ERCP is a high-risk endoscopic procedure, but reports of ERCP-related complications are largely based on immediate post-procedure assessment. Some institutions call patients the day after ERCP, but these calls reach as few as 20% of patients. Based on population-level studies demonstrating a >10% rate of unplanned healthcare encounters (UHE) in the 30 days following ERCP, we hypothesized that immediate assessment and day 1 follow-up calls underestimate the true adverse event rate; follow-up calls on day 7 may increase capture and allow a more accurate assessment of adverse event rates. We prospectively evaluated follow up calls on day 1 & day 7 post ERCP and also compared nurse-initiated with physician-initiated calls to assess the impact of transitioning this responsibility to a nurse. This prospective study was conducted on consecutive patients undergoing ERCP at our tertiary care academic medical center from March-October 2019. Patients were encouraged to contact us with post-procedure symptoms. Additionally, patients received phone calls at day 1 and 7 post-ERCP by either an endoscopist or a nurse coordinator using a standardized script to assess for delayed complications (pancreatitis, non-pancreatitis abdominal pain, bleeding, infection, perforation) and UHE [hospitalizations, clinic/urgent care/emergency department (ED) visits)]. 448 ERCP patients (239 physician calls, 209 nursing calls) were included in this study. Physician calls were more successful than nursing calls in reaching patients at both day 1 (96% v 74%, p<0.01) and at day 7 (91% v 63%, p<0.01, Figure 1). Nursing calls were significantly longer than physician calls on both days (p<0.001). The assessed overall adverse event rate was 1.7% upon immediate post-procedure evaluation. Increased detection of complications was accomplished by both physician and nurse calls at day 7 compared to day 1 (p<0.01, Figure 2). A higher adverse event capture rate by physician calls compared to nursing calls was evident on day 1 (3.5% vs. 2.4%, p=0.04) and day 7 (10.6% vs. 6.3%, p<0.01). In addition to patient-initiated UHEs that had already occurred prior to our call, physician day 7 follow-up calls resulted in substantially more patients triaged to the ED, primary care and oncology clinics than nursing calls (p<0.001). 1. Day 1 and day 7 calls increased capture of adverse events relative to immediate post-ERCP assessment, with both physician and nurse-initiated day 7 calls having a 3-fold higher capture of adverse events relative to day 1 calls.

Accuracy and concordance of measurement methods to assess non-adherence after renal transplantation - a prospective study

BackgroundNon-adherence (NA) to immunosuppressants (IS) among renal transplant recipients (RTRs) is associated with higher risk of allograft rejection, graft loss, and mortality. A precise measurement of NA is indispensable, although its prevalence differs greatly depending on the respective measurement methods. The objective of this study was to assess the accuracy and concordance of different measurement methods of NA in patients after renal transplantation.Design and methodsThis was a single-center prospective observational study. At baseline (T0), NA was measured via physicians’ estimates (PE), self-reports (SR), and tacrolimus trough level variability (CV%) in 78 RTRs. A Visual Analogue Scale (VAS, 0–100%) was applied both for SR and PE. In addition, we used BAASIS© for SR and a 5-point Likert scale for PE. NA was measured prospectively via electronic monitoring (EM, VAICA©) during a three month period. Meanwhile, all participants received phone calls in a two week interval (T1-T6) during which SRs were given.ResultsSeventy-eight RTRs participated in our study. At t0, NA rates of 6.4%, 28.6%, and 15.4% were found for PE, SR, and CV%, respectively. No correlation was found between these methods. During the study, the percentages of self-reported and electronically monitored adherence remained high, with a minimum mean of 91.2% for the strictest adherence measure (Timing Adherence ±30 min). Our results revealed a moderate to high association between SR and EM. In contrast to PE and CV%, SR significantly predicted electronically monitored adherence. Overall, a decreasing effect of electronically monitored adherence was found for both taking and timing adherence (±2 h, ±30 min) over the course of the study.DiscussionThe moderate to high concordance of SR and EM suggests that both methods measure NA equally accurately. SR seems to be a method that can adequately depict electronically monitored NA and may represent a good and economical instrument to assess NA in clinical practice. The increased adherence at the beginning of the study and its subsequent decrease suggests an intervention effect. Surveillance of IS intake via EM with intermittent phone calls could improve adherence on a short-term basis. To establish long-term effects, further research is necessary.

A Coaching Program to Improve Dietary Intake of Patients with CKD: ENTICE-CKD.

The dietary self-management of CKD is challenging. Telehealth interventions may provide an effective delivery method to facilitate sustained dietary change. This pilot, randomized, controlled trial evaluated secondary and exploratory outcomes after a dietitian-led telehealth coaching intervention to improve diet quality in people with stage 3-4 CKD. The intervention group received phone calls every 2 weeks for 3 months (with concurrent, tailored text messages for 3 months), followed by 3 months of tailored text messages without telephone coaching, to encourage a diet consistent with CKD guidelines. The control group received usual care for 3 months, followed by nontailored, educational text messages for 3 months. Eighty participants (64% male), aged 62±12 years, were randomized to the intervention or control group. Telehealth coaching was safe, with no adverse events or changes to serum biochemistry at any time point. At 3 months, the telehealth intervention, compared with the control, had no detectable effect on overall diet quality on the Alternative Health Eating Index (3.2 points, 95% confidence interval, -1.3 to 7.7), nor at 6 months (0.5 points, 95% confidence interval, -4.6 to 5.5). There was no change in clinic BP at any time point in any group. There were significant improvements in several exploratory diet and clinical outcomes, including core food group consumption, vegetable servings, fiber intake, and body weight. Telehealth coaching was safe, but appeared to have no effect on the Alternative Healthy Eating Index or clinic BP. There were clinically significant changes in several exploratory diet and clinical outcomes, which require further investigation. Evaluation of Individualized Telehealth Intensive Coaching to Promote Healthy Eating and Lifestyle in CKD (ENTICE-CKD), ACTRN12616001212448.

Prevalence, Challenges, and Interventions for Child Neglect: Cases Reported through Childline Kenya Helpline (2016-2018)

It is not easy to approximate the degree and scale of maltreatment meted against children. However, the world today is reporting a consistent increase in the number of children who are subjects of investigation or alternative response. This is a cue that the likely number of children who finally get confirmed as maltreated may be very high. Kenya particularly, is reporting an increasing rate of violence against children. This study examined the prevalence of child neglect cases reported through Childline Kenya over a period of three years, 2016 to 2018, the nature and trends of child neglect cases reported in Kenya and the interventions employed by Childline Kenya to curb child neglect. The descriptive research design was used for the study. The data were collected through Childline Kenya’s helpline “116” harnessed from received phone calls from 2016 to 2018. Childline Kenya personnel received calls and recorded child neglect cases that were reported through this span of time. Interviews with Childline Kenya personnel were also conducted to complement the data reported through phone calls. Further, a desktop review of best practices of preventing and intervening for child neglect were also conducted. The collected data are presented through descriptive statistics, tables, graphs and emerging themes. The study found that, on average, there was a high prevalence of reported child neglect cases in Kenya, that there was an increase in child neglect cases reported in 2016 and 2017, with a slight drop in 2018. It also emerged that both males and females experienced child neglect, but more cases were reported among the males than females. Case management plan is the key strategy used by Childline Kenya as an intervention measure.

Phone-call reminders narrow the intention-action gap by increasing follow-through for a residential tree giveaway program

Residents’ participation is key to the success of urban tree planting programs, yet a gap between resident intentions and participation actions may limit the benefits provided by such programs. Philadelphia Parks and Recreation (Pennsylvania, US) has conducted tree giveaway events for residents since 2012 with the goal of increasing tree canopy. But some residents who register for giveaway events do not follow through and attend the event, creating logistical and planning difficulties that increase program costs. We tested whether phone call reminders could narrow the intention-action gap and increase the likelihood that registered residents attend a yard tree giveaway event. A total of 251 people registered for a spring 2018 giveaway event. Registered participants were randomly assigned to receive either a standard set of email and paper reminders representing normal program operations (126 participants), or to receive up to two phone call reminder attempts in addition to the standard reminders (125 participants). The follow-through (attendance) rate among registered participants who received phone calls was compared to those who did not receive phone calls. The phone calls increased attendance by 16 percentage points, a statistically significant increase. Based on this effect size and time spent making phone calls, staff spent an average of 12.4 min making phone calls per additional attendee. This study demonstrates the feasibility of using an experimental approach to facilitate evidence-based decisions in an urban tree planting context. Further research is needed to evaluate the impacts of communication strategies on resident behavior in tree planting and distribution programs.

Physical activity in COPD: Minimal clinically important difference for medical events.

Estimates of the minimal clinically important difference (MCID) for physical activity (PA) in chronic obstructive pulmonary disease (COPD) are needed. The objective is to provide an anchor-based estimate of the MCID for daily step count. PA was promoted in persons with COPD using a pedometer (Omron HJ-720ITC) alone or a pedometer plus interactive website for 3 months. Participants wore the pedometer daily and received phone calls monthly to ascertain medical events. Medical events were counted when a participant self-reported that he/she had (1) worsening of breathing, (2) change to breathing medications, (3) medical care from an emergency room for any reason, or (4) hospitalization for any reason. Generalized linear regression models assessed daily step count as change at the end of study and averaged over the 15, 31, or 61 days centered on the event, in those with an event compared to those without one. All categories of events carried equal weight in the analyses. We studied 93 persons, 46 of whom had an event. Participants who experienced an event had a decrease of 1086 (95% confidence interval (CI): −2124 to −48) or 887 (95% CI: −2030 to 257) steps/day in the pedometer plus website or pedometer alone groups, respectively, compared to those without one. In the days centered on an event, participants who had an event experienced a decrease of 882–983 steps/day (pedometer plus website) or a decrease of 351–495 steps/day (pedometer alone), compared to those without one. The MCID for PA in COPD ranges from 350 steps/day to 1100 steps/day.

The Impact of a Phone Assistance Nursing Program on Adherence to Home Exercises and Final Outcomes in Patients Who Underwent Shoulder Instability Surgery: A Randomized Controlled Study.

The purpose of this study was to assess the impact of a phone assistance nursing program as an adjunct to conventional physiotherapy to increase adherence to a home exercise program on functional outcomes of patients who underwent shoulder instability surgery. A randomized controlled study of 70 patients allocated to a phone assistance program (study group, n = 36 patients) or conventional postoperative management (control group, n = 34 patients) was conducted. All patients in both groups received conventional rehabilitation at the outpatient clinic after surgery. In addition, patients in the study group received phone calls from a nurse (who had access to a physiotherapist) 3 days per week. During the calls these patients received a coaching session about self-care and support with the home exercise program. Evaluations were performed during a follow-up of 12 months for range of motion (ROM), pain (visual analog scale [VAS] score), Disability of the Arm, Shoulder, and Hand (DASH) score, Oxford Shoulder Instability Score (OSIS), and Rowe score. All scores significantly improved from preoperative to the final follow-up in both groups (p = .001). At the final follow-up, there were no significant differences between groups in VAS, DASH, or Rowe scores. However, those in the study group had significantly better OSIS (p = .013) and ROM (p = .001), particularly for anterior forward motion (p = .001). Likewise, the study group achieved full motion and function significantly faster than the control group (p = .002). The amount of rehabilitation sessions at the outpatient clinic was 1.7 times higher in the control group (p = .004) than in the study group. The phone assistance nursing program was an effective procedure to significantly improve the outcomes of conventional physiotherapy in patients who have undergone an operation for shoulder instability.

Analysis of Follow-Up Methods of Vascular Access and Patient Outcomes in Hemodialysis at a Tertiary Care Hospital in China.

Arteriovenous fistula is the preferred option for vascular access in hemodialysis patients. The aim of this study was to assess different follow-up methods for hemodialysis patients in our hemodialysis center in China. A cohort of 124 patients with stage 3 chronic kidney disease was recruited and double-blind randomly assigned into two groups. Patients in Group A received phone calls to schedule their next consultation a week in advance. Patients in Group B scheduled their next appointment at the end of each visit. A total of 116 patients were included in the study and eight dropped out. Twenty-seven patients (46.4%) in Group A and 13 patients (22.4%) in Group B had an AVF prior to hemodialysis (P = 0.006), and 44.8% of patients in Group A and 15.5% of patients in Group B were using AVFs at the initiation of dialysis (P = 0.003). Sixteen patients (27.6%) in Group A and 24 patients (41.3%) in Group B required central venous catheters due to acute on chronic kidney disease and 13 patients (22.4%) in Group A and 21 patients (36.2%) in Group B required central venous catheters due to patient-related delays (P = 0.02). At the end of the study, seven patients in Group A died and 17 patients in Group B died (P = 0.027). The patients who received phone calls to schedule appointments in advance had a higher rate of arteriovenous fistulas prior to dialysis and at hemodialysis initiation had a reduced incidence of acute on chronic kidney disease and patient-related delays, and had an improved prognosis.

Mobile Phone Usage for Accessing Agricultural Information in Southern Ethiopia

ABSTRACTThis study was conducted in Ethiopia to determine the use of mobile phones in agriculture. The study included 320 household heads who owned mobile phones. Data were collected using an interview schedule. The results revealed that the majority (90.6%) of household heads made phone calls for agricultural purposes. Over three quarters (85.9%) of the household heads received phone calls related to agriculture. Short message service (SMS) was poorly used. It is concluded that mobile phones are playing an important role as an informational medium. Therefore, the Ministry of Agriculture in Ethiopia needs to develop a mobile-based agricultural information dissemination system to enhance information delivery to rural farming households.

An Evaluation of Parent–Child Interaction Therapy With and Without Motivational Enhancement to Reduce Attrition

Although many interventions for child externalizing behavior report promising outcomes for families, high attrition prior to program completion remains a problem. Many programs report dropout rates of 50% or higher. In this trial we sought to reduce attrition and improve outcomes by augmenting a well-known evidence-based intervention, Parent–Child Interaction Therapy (PCIT), with a 3-session individual motivational enhancement component. Participants were 192 Australian caregivers (91.7% female; Mage = 34.4 years) and their children (33.3% female; Mage = 4.4 years). Families (51% referred from child welfare or health services for risk of maltreatment) were assigned to PCIT or a supported waitlist, with families assigned to PCIT receiving either standard PCIT (S/PCIT) or motivation-enhanced PCIT (M/PCIT), depending on their time of entry to the study. Waitlist families received phone calls every week for 12 weeks. Parents in M/PCIT reported more readiness to change their behavior from preassessment to after the motivation sessions. Also, parents who reported high, rather than low, motivation at preassessment did have a lower attrition rate, and there was some evidence that enhancing motivation was protective of premature attrition to the extent that caregivers achieved a high degree of change in motivation. Yet comparison of attrition rates and survival analyses revealed no difference between M/PCIT and S/PCIT in retention rate. Finally, there were greater reductions in externalizing and internalizing child behavior problems and parental stress among families in S/PCIT and M/PCIT compared with waitlist, and there was generally no significant difference between the two treatment conditions.