Telephone Inquiries Research Articles

Predictors of outcome after dorsal decompressive laminectomy for degenerative lumbosacral stenosis in dogs: 69 cases (1987-1997).

To identify predictive factors of long-term outcome after dorsal decompressive laminectomy for the treatment of degenerative lumbosacral stenosis (DLSS) in dogs. Retrospective study. 69 client-owned dogs. Medical records of dogs that had undergone dorsal laminectomy at North Carolina State University and the University of Tennessee between 1987 and 1997 were reviewed. Dogs with diskospondylitis, traumatic lesions, or neoplasia of the lumbosacral region were excluded. All dogs had evidence of cauda equina compression on myelography, epidurography, computed tomography, or magnetic resonance imaging, along with subsequent confirmation of the lesion at surgery. Follow-up was performed by telephone inquiries to the referring veterinarian, the owner, or both, using a detailed questionnaire. The outcome was excellent or good in 54 of 69 (78%) dogs over a mean follow-up period of 38+/-22 months. Five of these 54 dogs had been incontinent for a median of 2 weeks prior to surgery. Six of the 15 dogs with a poor outcome had been incontinent for a median of 8 weeks before surgery. A significant correlation was detected between the presence of urinary and fecal incontinence prior to surgery and outcome. When duration of signs was considered, urinary incontinence was the only variable that significantly affected outcome. Decompressive laminectomy is an effective treatment for DLSS, although dogs with urinary or fecal incontinence have a worse prognosis than dogs that are continent before surgery. Chronic urinary incontinence is a predictor of poor outcome for dogs with DLSS.

Reference laboratory telephone service quality.

To establish the rates with which reference laboratories resolve inquiries telephoned to them from primary laboratories and to identify reference laboratory practices associated with higher rates of inquiry resolution. For 2 months, or until 50 contacts had occurred, 545 primary laboratories participating in the College of American Pathologists Q-Probes laboratory quality improvement program prospectively documented and characterized telephone inquiries they made to a reference laboratory of their choice. Participants also cataloged their own laboratory's demographic and practice characteristics and their reference laboratory's customer service characteristics. Rates with which reference laboratories resolved telephone inquiries. Participants characterized 11 031 (78.7%) of 14 017 telephone inquiries as resolved by the reference laboratories. Ranked according to inquiry resolution rates, primary laboratories in the 90th percentile characterized reference laboratories as resolving 100% of their inquiries; those in the 10th percentile characterized reference laboratories as resolving only 54.2% of their inquiries. The rate of resolved inquiries was significantly higher (P =.0047) for participants using reference laboratories with 24-hour customer service than it was for participants using reference laboratories with less than 24-hour service. Most primary laboratories (80.9%) chose to monitor 1 of 11 national reference laboratories; in this subset, median rates of inquiry resolution ranged from 90.2% to 55.0% (P <.0001), despite no significant variation in other measured customer service characteristics. Primary laboratories experience significant differences in the rates with which reference laboratories resolve telephone inquiries. The performance benchmark for reference laboratories is resolution of at least 90% of telephone inquiries from primary laboratory customers.

Reference laboratory telephone service quality.

Abstract Objectives.—To establish the rates with which reference laboratories resolve inquiries telephoned to them from primary laboratories and to identify reference laboratory practices associated with higher rates of inquiry resolution. Design and Participants.—For 2 months, or until 50 contacts had occurred, 545 primary laboratories participating in the College of American Pathologists Q-Probes laboratory quality improvement program prospectively documented and characterized telephone inquiries they made to a reference laboratory of their choice. Participants also cataloged their own laboratory's demographic and practice characteristics and their reference laboratory's customer service characteristics. Main Outcome Measure.—Rates with which reference laboratories resolved telephone inquiries. Results.—Participants characterized 11 031 (78.7%) of 14 017 telephone inquiries as resolved by the reference laboratories. Ranked according to inquiry resolution rates, primary laboratories in the 90th percentil...

Rate of mortality with hip fracture and its prognostic factors in an elderly Japanese population

The purpose of this study was to clarify the survival rates and prognostic factors in elderly Japanese patients with hip fractures. This study investigated the outcome of 256 patients aged 60 years and older with surgically treated hip fractures. Information including age, gender, duration of hospitalization, place of residence before fracture and at discharge, and level of mobility before fracture and at discharge was obtained from patient records. The survival of the patients after discharge was determined by mail surveys supplemented with telephone inquiries.The observed survival rates were significantly lower than the expected survival rates p<0.001, by Mantel Haenszel test). The short-term mortality rates were 6% for six months and 12.7% for one year, which were lower than previously reported rates in Western countries. Significantly higher hazard ratios (HR) for mortality adjusted for age and gender were observed in patients who had lived in places other than their own home before fracture (HR=2.67 (1.63-4.3)). were discharged to places other than their own home (Nursing home HR=2.25 (1.24-4.1) or to a non-orthopedic unit (HR=5.95 (3.12-11.34), those requiring full-time assistance for mobility at discharge (HR=5.71 (3.59-9.01)), and those who had stayed in a hospital for fewer than 40 days (HR=2.20 (1.38-3.51)). After adjusting for the effects of all the potential prognostic factors, discharge to places other than their own home and the lowest level of mobility at discharge remained significant factors causing adverse effects on survival. Therefore, to improve the prognosis, patients should be allowed to recover to a level at which they can ambulate with some assistance, enabling them return to their own homes.

Why did Patients Default Follow-Up at Accident and Emergency Department and Ways to Reduce Default Rate? - A Retrospective Study

The follow-up clinic of the accident and emergency department is important in terms of risk management and quality assurance. Its purpose is defeated if patients do not return for the scheduled follow up. In this study, the reasons why some patients defaulted were investigated by telephone enquiry. It was found that about 30% of patients defaulted each day. Among those who could be contacted, almost one third said their illnesses have recovered or improved. A significant proportion of them suffered from sprains, minor burns or scald. The personal, familial or socio-economic factors also prevented some of them from returning. There were patients who did not come back because they have been admitted to hospital before the appointment, suggesting that patients with certain conditions are not suitable candidates for follow-up. The telephone enquiry of these defaulted patients provide a good opportunity for the patient to voice their views and opinions on the service they received and patient satisfaction can be enhanced by telephone enquiry. Based on the findings of this study, recommendations on service improvement has been proposed including a detailed study on the feasibility of the telephone follow-up system, and rescheduling the time and date of follow-up for the convenience of the patients.

Outpatient Pleurodesis of Malignant Pleural Effusions Using a Small-Bore Pigtail Catheter

Patients with symptomatic malignant pleural effusion are usually treated with large-bore chest tube placement and pleurodesis requiring > or = 3 days of hospitalization. We sought to demonstrate the feasibility of ambulatory drainage and sclerosis using a small-bore pigtail catheter in patients with malignant pleural effusions. We reasoned that this approach would improve symptoms and quality of life at a reduced cost. A 14F pigtail catheter was percutaneously inserted into the pleural space and connected to a closed gravity-drainage bag system. The patients were instructed in the use of the drainage system and discharged to return for sclerosis with 4 g of talc after the drainage was < 100 mL/24 h. Patients were graded for dyspnea and performances status using the Eastern Cooperative Oncology Group score (ECOG) and baseline and transitional dyspnea index score (BDI-TDI) before tube placement and again at 30 days. Radiographic response was graded as total response, partial response, or failure. Telephone follow-up was initiated when the patient could not return for evaluation. Ten ambulatory women, ages 41 to 79 years, were enrolled. The chest tube was left in place from 1 to 10 days, draining a mean of 2,956 mL (1,685 to 6,050 mL). Only two patients were unable to undergo sclerosis owing to catheter dislodgment and minimal drainage. Six reported symptomatic improvement at 30 days confirmed by TDI and ECOG scores in four of six. One with a prior history of a lobectomy was found to have a chylous pleural effusion and experienced a hydropneumothorax, for which sclerosis was unsuccessful. One died in hospital on day 26 after sclerosis despite radiographic resolution. Of the four patients who had improved dyspnea and functional status by TDI and EGOG scores, radiographic response was complete in three and partial in one. Two of the six were not able to return for follow-up because of weakness but reported improvement by telephone inquiry. Ambulatory sclerosis of malignant effusion using a small-bore catheter is a feasible alternative to inpatient sclerosis with a large-bore chest tube, especially in patients with strong preferences for outpatient care.

Partial tibial neurectomy in 113 Belgian blue calves with spastic paresis

One hundred and thirteen double-muscled Belgian blue calves (69 males and 44 females) with spastic paresis (52 unilateral and 61 bilateral) were treated surgically by partial tibial neurectomy under caudal...

Pursuit of Assisted Dying: A Pilot Study of Inquiries Made to a National Consumer-Based Organization

Legal developments in assisted dying have focused on assisted suicide for mentally competent, terminally ill adults. Requests for assisted dying are likely to represent broader concerns, but studies have been limited to surveys of specific patient groups or recollections of physicians. To describe the nature of inquiries by a broad range of persons seeking assisted dying, a retrospective review was performed of confidential client memoranda summarizing telephone inquiries regarding assisted dying to a counseling service of a national, not-for-profit, consumer-based organization. The review evaluated the underlying medical condition prompting the inquiry, evidence of patient's decisional capacity, and relationship of caller to the patient. Of 125 assisted suicide calls, 111 with medical illness were analyzed. Among 111 inquiries, 71 (64%) were made by someone other than the person suffering from the illness (“the patient”); 52 (47%) of these were family members, 14 (13%) were friends, and 5 (7%) were professionals. Cancer accounted for 25% of cases, HIV/AIDS and amyotrophic lateral sclerosis (ALS) for 10 and 9%, respectively, other neurological diseases for 23%, and chronic or other medical conditions for approximately 17%. In an additional 10 cases, there was no medical illness. Within the group of callers inquiring on behalf of others, 18 (25%) stated the patient lacked ability to communicate his or her wishes and 7 (10%) stated there was uncertainty. Inquiries about assisted dying represent a broader range of concerns than represented by legal initiatives. More study is needed to determine if enhanced knowledge about alternatives, such as palliative care, reduces requests for assisted dying.

Airway obstruction in severe syndromic craniosynostosis.

Airway obstruction is frequent in patients with severe syndromic craniosynostosis, and must be treated for successful, complete care. The purpose of this study was to evaluate the incidence and the management of airway obstruction in patients with severe craniosynostosis. All patients with complex syndromic craniosynostosis at Chang Gung Craniofacial Center were evaluated retrospectively. Criteria for inclusion of patients were the presence of adequate follow-up and documentation. A total of 40 patients were included, of whom 13 had Apert's syndrome and 27 had Crouzon's disease. Clinical symptoms and signs related to airway obstruction and its treatment were evaluated carefully, and were verified further by telephone inquiry. The status of the airway was categorized into one of three groups: no obstruction; mild obstruction, for which positioning and medical treatment were needed; and severe obstruction, for which surgical intervention was needed. The results showed that 24 patients (60%) did not have airway obstruction, 11 patients (27.5%) had mild obstruction, and 5 patients (12.5%) had severe obstruction. There was no significant difference in the distribution of airway status between patients with Apert's syndrome and Crouzon's disease. Causes for the 5 patients with severe obstruction were midface hypoplasia, lower airway obstruction, tonsillar and adenoid hypertrophy, and choanal atresia. Tracheostomy was performed to control airway in 3 patients, and 1 patient died. Midface anterior distraction helped to decannulate 1 patient. In conclusion, airway obstruction was observed in 40% of patients with severe craniosynostotic syndromes. Most of them could be managed successfully with conservative or medical treatment, and surgical intervention should be considered on the basis of each patient's individual condition.

A circumcision service for religious reasons.

To review the results of a pioneering service introduced under National Health Service (NHS) cover, providing circumcision on religious grounds. The service was offered to all male babies aged 6-14 weeks. Circumcision was carried out using the Plastibell technique under 1% lignocaine ring block/penile block anaesthesia. Between July 1996 and August 1998, 168 circumcisions were performed and assessed postoperatively by telephone enquiry, visiting at home by the nurse and review at the hospital if and when required. Of the 168 babies, 31 required some follow-up care. In six babies the separated ring tracked back onto the shaft of the penis and had to be removed using a ring-cutter. Ten babies were referred for incomplete separation of the Plastibell ring; only two required removal, the rest of the rings detaching spontaneously within a few days. Two babies were reviewed for early separation of the ring and seven were reviewed for bleeding within 24 h of the operation. Two of these were immediately after circumcision, when the bleeding was seen to be from the torn frenulum. They were converted to a more formal circumcision without the Plastibell under the same anaesthesia. Surveillance with no intervention was required in the others, except one who needed a compression dressing. One baby had apyrexia, requiring antibiotics. Four babies had suspected wound infection but none was clinically significant. One parent remained dissatisfied and complained about the inadequate removal of the foreskin. The aim of the service was to provide safe circumcision requested on religious grounds. The technique was simple and easily learned by nurses. Parents have generally been very satisfied and the complication rate was acceptable, with most problems occurring early in the series, suggesting an improvement with experience.

The Access Unit: Facilitating Entry to an Aged Care Program

Abstract. The Access Unit was established in 1995 to provide a single point of entry to programs provided by North West Hospital in Victoria. All telephone enquiries are now answered by health care professionals who are able to provide an immediate clinical response. Each referral is triaged to an appropriate service, whether provided by North West Hospital or elsewhere. The establishment of the Access Unit has not only improved clinical management, it has identified a number of deficiencies in the hospital's protocols which have now been addressed. Following the successful implementation of this model in the subacute sector, the Western Healthcare Network is investigating the feasibility of expanding it to the acute hospital sector.

Nurses’ phone advice may be put on tape

Inquest highlights legal problems facing nurses who deal with telephone inquiries

Faculty appointment and tenure policies in medical schools

The authors present recent data on changes under way in and the current status of faculty appointment and tenure policies in U.S. medical schools. The data are drawn from a survey conducted by the Association of American Medical Colleges in 1997, to which deans at all 125 U.S. allopathic medical schools responded, supplemented by follow-up telephone and electronic mail inquiries. Faculty evaluation systems and faculty compensation systems top the list of areas in which medical schools are most frequently making policy changes, with approximately half of the schools involved in each area. Changes in evaluation systems reflect an increasing emphasis on post-tenure review. Changes in compensation systems are characterized by the division of pay into separate components, each with its own financial guarantees and with the level of compensation tied specifically to measures of individual and group productivity. Other policy changes include introducing new faculty tracks and career pathways, redefining or clarifying the portion of salary or compensation that is defined by tenure, lengthening the pre-tenure probationary period, and modifying the link between promotion and tenure. Of the 125 medical schools in the United States, only five do not award tenure, while another six effectively limit eligibility for tenure to basic science faculty. These numbers are unchanged from those reported in 1994. Only two schools indicated that eliminating tenure or ceasing to make tenure-eligible appointments was being considered, and neither reported that a policy change was imminent. Current data on the status of tenure guarantees, tenure probationary periods, other tenure eligibility criteria, and special clinical tracks are provided. Nearly three fourths of the medical schools in the United States now have a separate and distinct faculty track for full-time clinical faculty whose primary responsibilities are in patient care and teaching. The vast majority of these tracks do not permit faculty to be tenured, but 71% require evidence of scholarship for promotion. The authors conclude that faculty personnel policies in medical schools are likely to continue to evolve, consistent with a growing insinuation of the corporate culture into academia.

The prospective value of the IPCS/EC/EAPCCT poisoning severity score in cases of poisoning.

The poisoning severity score is a four-point severity-classification scale, developed by the International Programme on Chemical Safety, the Commission of the European Union, and the European Association of Poison Centres and Clinical Toxicologists (IPCS/EC/EAPCCT), for the retrospective assessment of cases of poisoning reported to poisons information centers. The aims of this study were to test the validity of using the poisoning severity score obtained at initial referral to assess clinical severity and the likelihood of subsequent deterioration, to select cases for follow-up, and also to determine the need for referral to a clinical toxicologist. The poisoning severity score was determined at the time of initial inquiry. Follow-up was then undertaken until either the patient was discharged from medical attention or died. A second poisoning severity score was then calculated taking note of the most severe features present after the initial inquiry. Of 718 consecutive telephone inquiries, 397 were given an initial poisoning severity score of 0 (no signs and symptoms), 225 a score of 1 (mild symptoms), 71 a score of 2 (moderate symptoms), and 25 a score of 3 (severe symptoms). Follow-up data are available only in 638 cases because the patient or referring doctor could not be traced in 80 instances. Of the 638 cases, 41 deteriorated; 31 of these were graded initially as poisoning severity score 0, four as 1, and six as 2. Five patients died (two with an initial score of 2 and three with an initial score of 3). This study demonstrates that it is useful to score telephone inquiries to a poisons information service at initial referral with the poisoning severity score. First, the poisoning severity score is helpful in assessing accurately the clinical severity and the likelihood of further deterioration. Second, the poisoning severity score is useful in determining the need for referral of the inquiry to a clinical toxicologist, thus ensuring that more serious and complicated cases of poisoning receive expert medical advice on management. Third, the poisoning severity score is helpful in selecting those cases which warrant follow-up for medical and epidemiological reasons.

The Durham telephone enquiry system

The Durham telephone enquiry system is a speaker/gender independent telephone enquiry service Which operates in real-time. The system has been successfully applied to English and Italian telephone databases of up to 100,000 entries. The mechanism by which the telephone database is searched is a key feature of the enquiry system and is based upon a management-of-uncertainty methodology. The practical result of which is that there is no expectation that the user's utterances will always be correctly interpreted by the speech recognition stage. This paper contains a description of the components of the system and how they are integrated. Issues which had to be addressed in ensuring that the system operates in real-time on 'live' input are also discussed.

Chapter 5. Accommodating the Elderly

ABSTRACT The stigmatizing effects of the “elderly” label in obtaining community accommodation were examined, in a sample of 120 individuals advertising rooms or flats for rent in two Canadian cities, Windsor and London, Ontario. Telephone enquiries were made by an adult male (two conditions), young adult female, and an elderly (female) individual, who were ostensibly in search of rental accommodation. Rooms were significantly more likely to be described as unavailable when the caller was elderly, or when enquiries were made on her behalf. Comparisons are made to similar previous research and to current perspectives about community reactions to stigmatizing conditions.

Children poisoning in Taiwan.

Poisoning is a well known cause of morbidity and mortality in children. In Taiwan, little information has been published regarding the status of pediatric poisoning exposures. To provide more information on pediatric poisoning exposures for the purpose of poison prevention, a retrospective study was designed and conducted to analyse the data of National Poison Centre (NPC), Taiwan. All telephone inquiries concerning poisoning exposures in those under 19 years of age, received by NPC-Taiwan from July 1985 through December 1993, were included in this study. The age, sex, reason for exposure, route of exposure, substances involved and clinical outcome of those telephone calls were then analyzed. A total of 5,812 inquiries concerning poisoning exposures in children were recorded. Male exposures were more prevalent than females (59%) Vs. 41%) Accidental exposures accounted for 77.7% of the cases and most were exposed by the oral route. Substances most frequently ingested were household products, benzodiazepines and pesticides. The data revealed a mortality rate of 1.4%. Accidental poisoning exposures from household products and drugs remain a significant problem for those younger than 6 years of age. Further education of parents and care takers and the employment of child-resistant containers are needed to prevent cases of pediatric poisoning. Reduction of amphetamine abuse in adolescents is also of major concern and deserves more attention.

Acute poisoning: initial management and sources of information.

Poisoning is responsible for 2-3 per cent of attendances to urban A&F. departments in the UK each year ( MacNamara et al 1996 ). It accounts for about 7 per cent of accidents in children under five years of age ( Consumer Safety Unit 1995 ). The National Poison Information Service (NPIS) deals with hundreds of emergency telephone enquiries every day. and the number of such calls has risen sharply in recent years. Figure 1 demonstrates the annual call load of NPIS (London). A&E nurses account for 42 per cent of these telephone enquiries.

Anaesthesia for electroconvulsive therapy Personnel and facilities

In order to compare the anaesthetic staffing and facilities provided for patients undergoing electroconvulsive therapy with those provided for patients undergoing elective cystoscopy, a confidential telephone enquiry was conducted. An anaesthetist in each of the 40 hospitals where electroconvulsive therapy is performed in three Health Regions chosen at random was questioned. The results show that a high standard of care is provided for patients undergoing elective cystoscopy in terms of pre-operative assessment, anaesthetic assistance, intra-operative monitoring and postoperative recovery facilities. The standards of care and of facilities for patients undergoing electroconvulsive therapy are substantially inferior and commonly fall short of accepted national guidelines.

Aortic balloon valvuloplasty and aortic valve replacement: A comparative follow-up study

The purpose of this study was to compare the short-term and long-term benefits and complications of patients subjected to aortic balloon valvuloplasty with those of a similar group of patients subjected to aortic valve replacement. Both groups were matched for age and sex and followed up to December 1991. The study period for the valvuloplasty group was from 1986 to 1991. The surgical group was studied from 1979 to 1991. Clinical and hemodynamic data were collected prospectively. Short- and long-term follow-ups were collected retrospectively from chart reviews, telephone inquiries with patients, immediate relatives, and family physicians. A total of 66 patients were studied; 33 had balloon valvuloplasty. A similar number of surgical patients were randomly selected from a group of 60 who had aortic valve replacement, to match the age and sex of the valvuloplasty group. Baseline, clinical, and hemodynamic characteristics were similar in both groups. All patients had right, retrograde, and transseptal left heart catheterization. Gradient across aortic valve was measured by simultaneous recording of pressures in left ventricle and aorta. Indicator dilution curves were used to calculate cardiac index and assess severity of aortic regurgitation. Patients with regurgitant fraction >25% were excluded from aortic valvuloplasty. Although inhospital mortality was higher in surgically treated patients (12% vs 9%) the 5-year survival of valve replacement was much better than those treated with balloon valvuloplasty (71% vs 7%). Our selection of patients and immediate results of valvuloplasty are comparable to seven published series. Aortic balloon valvuloplasty should not be used as a routine or elective procedure for treatment of adult patients with aortic stenosis. It could, however, be considered as a “bridge” procedure to stabilize high-risk patients before surgical replacement of the valve.