Telephone Assistance Research Articles

Meals Offered and Served in US Public Schools: Do They Meet Nutrient Standards?

Background Concerns about the diets of school-aged children and new nutrition recommendations for the US population have increased interest in the nutritional quality of meals available through the National School Lunch Program and School Breakfast Program. Objective This article updates national estimates of the food energy and nutrient content of school meals and compares these estimates to federal nutrient standards established under the 1995 School Meals Initiative for Healthy Children. Design Data were collected as part of the third School Nutrition Dietary Assessment Study, a nationally representative cross-sectional study fielded during school year 2004-2005. Menu and recipe data for a typical school week were collected in a mail survey with telephone assistance. Nutrient information for common commercially prepared food items was obtained from manufacturers, to supplement the Food and Nutrient Database for Dietary Studies used to analyze the data. Analyses were conducted for meals offered and meals served to (selected by) children. Subjects/setting Samples of 130 public school districts that offered federally subsidized school meals, and 398 schools within those districts, participated in the study. Foodservice managers in each school completed a menu survey. Statistical analyses performed Descriptive tabulations present weighted means, proportions, and standard errors for elementary, middle, and high schools, and for all schools combined. Results Most schools offered and served meals that met the standards for protein, vitamins, and minerals. Fewer than one third of schools met the standards for energy from fat or saturated fat in the average lunch, whereas three fourths or more met the fat standards in school breakfasts. For both meals, average levels of sodium were high and fiber was low relative to Dietary Guidelines for Americans 2005 recommendations. Conclusions For school meals to meet nutrient standards and promote eating behaviors consistent with the Dietary Guidelines, future policy, practice, and research should focus on reducing levels of fat and sodium and increasing fiber.

The Third School Nutrition Dietary Assessment Study: Background and Study Design

Objective This article describes the background and design of the third School Nutrition Dietary Assessment Study (SNDA-III). Design SNDA-III is a nationally representative cross-sectional study of the National School Lunch Program and the School Breakfast Program in 2005. The three-stage sample design allowed description of district and school food environments and policies, analysis of foods and nutrients in school lunches and breakfasts, and assessment of the role of school meals and competitive foods in students' diets. Surveys of district and school staff were by telephone or in person; school menu data were collected in a mail survey with telephone assistance; and student and parent interviews were conducted in person and in school, except that parents of secondary-school students were interviewed by telephone. Student interviews included a 24-hour dietary recall, as well as measurement of height and weight. Response rates were 83% for districts, 95% for schools, and 63% for students, whose participation was constrained by consent issues and school schedules. Subjects/setting Data were collected from 130 public school food authorities (districts that offer federally subsidized school meals), 398 schools within those districts, and 2,314 public-school students in grades 1 through 12 in these schools. Of the 2,314 students, a random subset of 666 (29%) completed a second recall to permit estimation of usual nutrient intake distributions. Statistical analyses performed Descriptive tabulations were used to summarize the background characteristics of schools and students and most study outcomes. Multivariate regression models and propensity score matching were used to compare the nutrient intakes of school meal participants and nonparticipants. Conclusions SNDA-III data provide a rich resource for examining interactions among the school meal programs, the school food environment, students' diets, and child obesity. Subsequent articles in this Supplement present analyses in all these areas.

Surfing The Web: Practicing Medicine in a Technological Age: Using Smartphones in Clinical Practice

Mobile technology has the potential to revolutionize how physicians practice medicine. From having access to the latest medical research at the point of care to being able to communicate at a moment's notice with physicians and colleagues around the world, we are practicing medicine in a technological age. During recent years, many physicians have been simultaneously using a pager, cellular telephone, and personal digital assistant (PDA) to keep in communication with the hospital and to access medical information or calendar functions. Many physicians have begun replacing multiple devices with a "smartphone," which functions as a cellular telephone, pager, and PDA. The goal of this article is to provide an overview of the currently available platforms that make up the smartphone devices and the available medical software. Each platform has its unique advantages and disadvantages, and available software will vary by device and is in constant flux.

Effectiveness of bibliotherapy self‐help for depression with varying levels of telephone helpline support

The effectiveness of a cognitive behavioural bibliotherapy self-help package, with varied levels of telephone support, delivered through a mental health telephone service was examined with 84 mildly to moderately depressed adults. The study compared the changes in depressive symptoms of three groups: control, self help with minimal contact and self-help with telephone assistance. Both the minimal contact and the assisted self-help groups had significant reductions in their levels of depression compared with the control group. Treatment gains were maintained at a 1-month follow-up. The potential of self-help resources such as this to be successfully disseminated and delivered through a national mental health telephone information service is discussed.

Sclérose en plaques : immunomodulateurs, éducation et auto-injection

One hundred and sixty four patients of the Poitou-Charentes area suffering from multiple sclerosis (MS) and treated with an immunomodulating agent for more than 3 months completed a self-administered questionnaire. More than 60p.cent of the patients performed self-injection. For both modes of injection studied (subcutaneous or intramuscular), self-injection was significantly more frequent among patients who were received training and followed via telephone assistance conducted by a nurse with specialized training in MS. Our study demonstrated that waste disposal (needles), especially among patients performing self-injections, remains an important problem. Efforts must be taken concerning this important healthcare issue.

Weaning from Mechanical Ventilation Followed at Home with the Aid of a Telemedicine Program

We describe the use of telemedicine in support of weaning from invasive mechanical ventilation on a 63-year-old woman of at home by means of a telepneumology program (TPP). Under telephone assistance of a pulmonologist and a TPP nurse tutor, the pulsed arterial saturimetric (pSaT), heart rate (HR), breathing pattern tracing monitoring transmitted via a home telephone line and the aid of the caregiver, the patient was able to maintain diurnal spontaneous breathing after 24 spontaneous breathing trial (SBT) steps twice daily. The duration of each SBT period progressively increased starting from 30 minutes up to 8 hours. This case report shows that many patients at home on ventilators could possibly be weaned through the use of remote monitoring and call center response, with only family/caregivers on-site.

Self-administered behavioral family intervention for parents of toddlers: Part I. Efficacy.

This study examined the efficacy of a self-administered behavioral family intervention for 126 parents of toddlers. The effects of 2 different levels of intensity of the self-administered intervention were contrasted (self-administered alone or self-administered plus brief therapist telephone assistance). The results provide support for the efficacy of the self-administered form of behavioral family intervention. There were significant short-term reductions in reported child behavior problems and improvements in maternal parenting style, parenting confidence, and anger. Families who received minimal therapist assistance made more clinically significant gains compared with families who completed the program with no therapist assistance. The intervention effects were maintained at 6-month follow-up. The implications of the findings for the population-level delivery of behavioral family interventions are discussed.

Mobile eHealth interventions for obesity: a timely opportunity to leverage convergence trends.

Obesity is often cited as the most prevalent chronic health condition and highest priority public health problem in the United States. There is a limited but growing body of evidence suggesting that mobile eHealth behavioral interventions, if properly designed, may be effective in promoting and sustaining successful weight loss and weight maintenance behavior changes.This paper reviews the current literature on the successes and failures of public health, provider-administered, and self-managed behavioral health interventions for weight loss. The prevailing theories of health behavior change are discussed from the perspective of how this knowledge can serve as an evidence base to inform the design of mobile eHealth weight loss interventions. Tailored informational interventions, which, in recent years, have proven to be the most effective form of conventional health behavior intervention for weight loss, are discussed. Lessons learned from the success of conventional tailored informational interventions and the early successes of desktop computer–assisted self-help weight management interventions are presented, as are design principles suggested by Social Cognitive Theory and the Social Marketing Model.Relevant computing and communications technology convergence trends are also discussed. The recent trends in rapid advancement, convergence, and public adoption of Web-enabled cellular telephone and wireless personal digital assistant (PDA) devices provide timely opportunities to deliver the mass customization capabilities, reach, and interactivity required for the development, administration, and adoption of effective population-level eHealth tailored informational interventions for obesity.

Innovative approaches to intervention for problem drinking

To critique the recent literature on telephone, correspondence-based, and computerized interventions for alcohol problems, which enhance or substitute for practitioner-delivered treatments. There is an unmet need for screening, assessment and intervention for alcohol problems, in part because of the difficulty in accessing such treatment within the current health care system. Research on the efficacy of correspondence or electronic (for example Internet-based) interventions is beginning to emerge. In the period 2003-2004 we identified nine acceptability or feasibility studies of these approaches and seven efficacy trials covering a wide range of settings. These modes of intervention are acceptable to patients and the public, and with careful planning, can be implemented in a variety of settings. Treatment trials demonstrate the efficacy of these interventions in reducing hazardous drinking by university students, in delaying initiation of heavy drinking in children and adolescents, and, intriguingly, in addressing insomnia among recovering alcoholics. There is strong support among potential users for alcohol interventions that employ telephone assistance, written correspondence, and the Internet. These new technologies offer the prospect of increasing the reach of interventions for problem drinking and being cost-effective alternatives or supplements to face-to-face health service delivery.

Modified cardiopulmonary resuscitation (CPR) instruction protocols for emergency medical dispatchers: rationale and recommendations

Background: International consensus guidelines now support the use of “chest compressions-only” cardiopulmonary resuscitation (CPR) instructions (CCOIs) by emergency medical dispatch (EMD) personnel providing telephone assistance to untrained bystanders at a cardiac arrest scene. These guidelines are based largely on evolving experimental data and a clinical trial conducted in one venue with distinct emergency medical services (EMS) system features. Accordingly, the Council of Standards for the National Academies of Emergency Dispatch was asked to adapt a modified telephone CPR protocol, and specifically one that could be applied more broadly to the spectrum of EMS systems. Methods: A group of international EMD specialists, researchers and professional association representatives analyzed available scientific data and considered variations in EMS systems, particularly those in Europe and North America. Results and conclusions: Several recommendations were established: (1) to avoid confusion, bystanders already providing CPR should continue those previously learned methods; (2) following a sudden collapse unlikely to be of respiratory etiology, CCOIs should be provided when the bystander is not CPR-trained, declining to perform mouth-to-mouth ventilation or unsure of actions to take; (3) following 4 min of CCOIs, ventilations can be provided, but, for now, only at a compression–ventilation ratio of 100:2 until EMS arrives; (4) until more data become available, dispatchers should follow existing compression–ventilation protocols for children and adult cases involving probable respiratory/trauma etiologies; (5) EMD CPR protocols should account for EMS system features and receive quality oversight and expert medical direction.

Canning Spam: Proposed Solutions to Unwanted Email

Unsolicited email is a major problem for anyone who transmits or receives email on a computer, telephone, or personal digital assistant. This article describes the magnitude of the problem, the reasons for proliferation, some interventions available today, and the degree to which each has been effective.

Adaptive user modelling in intelligent telephone and email assistants

With the burgeoning complexity and capabilities of modern information appliances and services, user modelling is becoming an increasingly important research area. Simple user profiles already personalise many software products and consumer goods such as digital TV recorders and mobile phones. A user model should be easy to initialise, and it must adapt in the light of interaction with the user. In many cases, a large amount of training data is needed to generate a user model, and adaptation is equivalent to retraining the system. This paper briefly outlines the user modelling problem and work done at BTexact on an intelligent personal assistant (IPA) which incorporates a user profile. We go on to describe FILUM, a more flexible method of user modelling, and show its application to the telephone assistant and email assistant components of the IPA, with tests to illustrate its usefulness.

Evaluation of a Voice Interface Management System

The final prototype of a centralized voice information system, developed under the framework of the European CeMVocAS (Centralised Management of Vocal Interfaces Aiming at a Better Automotive Safety) project, was evaluated. This system manages all types of voice messages to the driver (i.e., input and output voice flows to and from car telephone, radio, and driver assistance systems) to minimize their disruptive impact on the basic task of driving. Analysis of the results included evaluation of ( a) the part of the system responsible for determining the driver’s potential availability to receive voice messages [driving situation recognition unit (DSRU)] and ( b) the complete system (DSRU plus centralized voice interface management system). Results indicate that the system is quite robust in terms of vehicle, driver, and route variability; in addition, levels of system effectiveness, system efficiency, and user satisfaction were high.

The value of video and telephone assistance in mock resuscitations for persons with no training in cardiopulmonary resuscitation

The value of video and telephone assistance in mock resuscitations for persons with no training in cardiopulmonary resuscitation

The value of video and telephone assistance for persons with no cardiopulmonary resuscitation training in mock resuscitations

Accident and Emergency Department, Royal Victoria Hospital, and Department of Telemedicine Queens University, Belfast, Ireland

The value of video and telephone assistance for persons with no cardiopulmonary resuscitation training in mock resuscitations

The value of video and telephone assistance for persons with no cardiopulmonary resuscitation training in mock resuscitations

The value of video and telephone assistance for persons with no cardiopulmonary resuscitation training in mock resuscitations

Accident and Emergency Department, Royal Victoria Hospital, and Department of Telemedicine Queens University, Belfast, Ireland

New developments in customer service training

In today’s volatile economy, providing excellent customer service can be the critical difference between a company’s success and failure. Customers today are better educated than ever before. They are increasingly careful about purchases and the dollars they spend and want value for their money. Customers also want good service and are willing to pay for it. The level of courtesy and assistance required from a customer service representative has increased dramatically over the past decade as a result of the customer’s upgraded “acceptable” service standards; more skills are required, such as telephone courtesy and assistance, effective telemarketing skills, customer retention, problem‐solving capabilities, maintaining customer satisfaction, and effective use of available technology. As a result, companies in various industries are induced to provide distinguished customer service in order to remain competitive. Learning is taking on strategic importance. Demand for customer service training is higher than ever before. Such extraordinary commitment can be elicited only in the context of a corporate culture that emphasizes caring about employees and sharing of the service ethic by everyone in the organization ‐ starting with the CEO. A business which offers not just the bare‐bones basics but exceptional, value‐amplified service, which anticipates and caters to a whole range of customer needs and desires, sets itself far above the competition.

La relation de service et la gestion des urgences psychiatriques

Service relationships and managin psychiatric emergencies Besieged by all the cases - alcoholics, drug addicts, suicidal people - which their entourage doesn't know what to do with, and rushed by the hospitals forcing people out of their beds, emergency psychiatric help has become a kind of marshalling yard in the urban public health network. A complex activity, consultation is the sensitive point in the encounter and in the redistribution of medical, administrative and social work. From the health care worker who takes and standardizes the first call to the doctor who decides on how to intervene, many interactive skills are required which follow on from each other within the various facilities, during telephone assistance and in simple face-to-face encounters.

Project Ernestine: Validating a GOMS Analysis for Predicting and Explaining Real-World Task Performance

Project Ernestine served a pragmatic as well as a scientific goal: to compare the worktimes of telephone company toll and assistance operators on two different workstations and to validate a GOMS analysis for predicting and explaining real-world performance. Contrary to expectations, GOMS predicted and the data confirmed that performance with the proposed workstation was slower than with the current one. Pragmatically, this increase in performance time translates into a cost of almost $2 million a year to NYNEX. Scientifically, the GOMS models predicted performance with exceptional accuracy. The empirical data provided us with three interesting results: proof that the new workstation was slower than the old one, evidence that this difference was not constant but varied with call category, and (in a trial that spanned 4 months and collected data on 72,450 phone calls) proof that performance on the new workstation stabilized after the first month. The GOMS models predicted the first two results and explained all three. In this article, we discuss the process and results of model building as well as the design and outcome of the field trial. We assess the accuracy of GOMS predictions and use the mechanisms of the models to explain the empirical results. Last, we demonstrate how the GOMS models can be used to guide the design of a new workstation and evaluate design decisions before they are implemented.