Telephonic System Research Articles

Individualized lifestyle intervention in PCOS women (IPOS): a study protocol for a multicentric randomized controlled trial for evaluating the effectiveness of an individualized lifestyle intervention in PCOS women who wish to conceive

BackgroundPolycystic ovary syndrome (PCOS) is a common endocrine condition which affects women in the reproductive age group. South Asian women with PCOS have a higher risk of insulin resistance and metabolic disorder compared to women from other ethnic backgrounds. Lifestyle interventions such as dietary advice and physical exercise are recommended as a first-line management option for infertile women with PCOS. Most of the randomized controlled trials evaluating the role of lifestyle interventions in infertile PCOS women were characterized by methodological issues. The uptake of lifestyle modifications as a treatment strategy in the South Asian population is complicated by a difficult-to-change conventional high-carbohydrate diet and limited availability of space for physical activity in the region.MethodsThe study is designed as an open-label, multicentre, randomized controlled trial in South Asian women with PCOS. Women attending the fertility clinic will be screened for eligibility, and women aged between 19 and 37 years who have been diagnosed with PCOS and wishing to conceive will be invited to participate in the trial. We will include women with body mass index (BMI) between ≥ 23 and ≤ 35 kg/m2 and duration of infertility ≤ 3 years. We plan to randomize women with PCOS into two groups: group A will receive the intervention which will consist of individualized advice on diet and physical exercise along with a telephonic reminder system and follow-up visits, and group B (control) will receive one-time advice on diet and physical exercise. Both groups will receive up to three cycles of ovulation induction with letrozole after 3 months of randomization during the 6-month treatment period. The primary outcome of the trial will be the live birth following conception during the intervention period. The secondary outcomes include clinical pregnancy rate, ongoing pregnancy rate, miscarriage rate, ectopic pregnancy rate, stillbirth, time to pregnancy, mean weight loss, differences in anthropometric parameters, improvement in menstrual regularity and quality of life score.DiscussionThe IPOS trial results could help clarify and provide more robust evidence for advocating an individualized lifestyle intervention in PCOS women who wish to conceive.Trial registrationClinical Trial Registry of India CTRI/2023/04/051620. Registered on 13 April 2023.

Reliability and Optimization Measures of Retrial Queue with Different Classes of Customers under a Working Vacation Schedule

A working vacation queueing model is described in this work, with three different classes of customers: regular, priority, and disaster. The regular server serves all arriving customers, whereas the optional reservice is only provided to those who request it. The Bernoulli working vacation (BWV) schedule is considered. In WV time, the server serves at a slower rate. The generating functions (GF) technique is used to determine the system capacity of various server states. Different system performances, reliability indices, and cost optimization values are numerically shown. For the current COVID‐19 pandemic situation, the motivation for this approach is presented in a telephonic communication system.

A sensing network involving citizens for high spatio-temporal resolution monitoring of fugitive emissions from a petroleum pre-treatment plant

In this study an innovative sensing network consisting of eight photoionization detectors, meteorological sensors, a video camera and a telephonic system able to systematize the population complaints was developed for the monitoring of odor emissions. The development of monitoring approaches with high temporal and spatial resolution and actively involving citizens, is strategic in areas where relevant and also short-term emissive events frequently occur and the conventional approaches fail due to the high variability of fugitive emissions. Moreover, even if unpleasant odors are not necessarily direct triggers of health effects, they could be associated with the release of other harmful compounds. Monitoring approaches also involving citizens are thus strategic tools because odors annoyance perceived by population may be a potential health risk warning. Therefore, the developed sensing network was set up in Val d'Agri (Basilicata, Italy) where a petroleum pre-treatment plant (COVA) rises in a rural and inhabited area. The data collected during the monitoring campaign from the 16th February to the 30th July 2017, showed Total Volatile Organic Compounds (TVOCs) concentrations decreasing moving away from the plant and up to five times higher than levels registered in the closest municipality (Viggiano). Moreover, recurrent short-term critical events characterized by concentration values far above the average of the period and with maximum values ranging from 0.92 to 1.89 ppm, were registered in correspondence with high levels of benzene (up to 23.9 μg/m3) and anemometric conditions able to transport pollutants from COVA to each receptor site. The spatial and temporal distribution of TVOC concentrations proved to be affected by the distance from COVA, wind direction and industrial activities verified using video reportage and citizen claims. Therefore, the developed approach has proven to be a useful tool to credit people's perception of odors and also to quantify citizen exposure to VOCs during short-term events.

Dealing with Community Mental Health post the Fukushima disaster: lessons learnt for the COVID-19 pandemic.

Under the COVID-19 pandemic, mitigation of psychological distress is required. At present, the demand for remote intervention for the numerous affected people is increasing, and telephonic support can be useful. Since the Fukushima nuclear disaster in 2011, we have been developing a large-scale telephonic support system and implementing brief interventions for the Fukushima people identified at risk of psychological problems such as depression and post-traumatic stress disorder. In this article, we report the lessons from the Fukushima disaster that can be applied to the COVID-19 pandemic and describe how the telephonic intervention facilitates easier access to psychological help for people with a broad range of psychological distress who are not able to visit treatment or care resources. In our telephonic intervention, we first sent a mental health and lifestyle survey to the people affected by the Fukushima disaster. The counselor team then provided telephonic intervention to high-risk persons as identified on the basis of the survey results. The individuals had expected to receive from the telephonic system help mainly in the form of stress-coping methods, social resource information such as schools, public offices or medical facilities, and lifestyle advice. Since we also experienced that psychological care for telephone counselors was necessary to mitigate the substantial emotional burden, we used the following three approaches: (i) regular supervision of the telephone counseling methods, (ii) seminars for improvement of counseling skills and (iii) individual psychological support. The positive loops between counselors and consulters will help advance a society affected by a disaster.

Feasibility of computer-generated telephonic message-based follow-up system among healthcare workers with diabetes: a randomized controlled trial

IntroductionTo assess the feasibility of computer-generated educational messaging system in healthcare workers of a tertiary care hospital. The secondary objectives were glycemic control, patient satisfaction and adherence to lifestyle modifications.Research...

Direct-to-Patient Research: Piloting a New Approach to Understanding Drug Safety During Pregnancy.

BackgroundLittle is known about the effects of human fetal exposure when a new drug is authorized unless it was specifically developed for use in pregnancy. Since many factors may contribute to adverse fetal effects, having comprehensive information about in utero exposures will enhance our ability to make correct determinations about causality.ObjectiveThe objective of the study was to assess the extent to which women, recruited without the intervention of health care professionals (HCPs), will provide information, suitable for research purposes, via the Internet or by phone on some potential risk factors in pregnancy.MethodsTo pilot direct-to-patient research for pharmacovigilance, we conducted a prospective, noninterventional study of medication use and lifestyle factors as part of the Pharmacoepidemiological Research on Outcomes of Therapeutics by a European ConsorTium (PROTECT) Consortium. Consenting women who self-identified as pregnant and residing in the United Kingdom (UK), Denmark (DK), The Netherlands, or Poland were recruited and could then choose to provide data every 2 or 4 weeks via the Internet or a telephonic interactive voice response system (IVRS). Self-reported drug use was compared with pharmacy register data in DK and with electronic health records in the UK.ResultsRecruited women were on average older and more highly educated than the general population. Most respondents chose a frequency of every 4 weeks (56.99%, 1177/2065). Only 29.83% (464/1555) of women with due dates occurring during the study provided information on pregnancy outcome. For those responding by Internet, over 90.00% (1915/2065) reported using >1 pregnancy-related medication, 83.34% (1721/2065) reported using >1 other medicine, and 23.53% (486/2065) reported only over-the-counter medications, not counting herbals and dietary supplements. Some respondents (7.16%, 148/2065) reported that they chose not to take a prescribed medication (mostly medicines for pain or inflammation, and for depression) and 1.30% (27/2065) reported using medicines that had been prescribed to a friend or family member (oxycodone, paracetamol, and medications for acid-related problems). Relatively few respondents reported using fish oil (4.60%, 95/2065), other dietary supplements (1.88%, 39/2065), herbal products (7.07%, 146/2065), or homeopathic products (1.16%, 24/2065). Most medications for chronic conditions that were listed in the Danish prescription registry were also self-reported (83.3%, 145/174 agreement), with larger discrepancies for medications indicated for short-term use (54.0%, 153/283 agreement) and pregnancy-related medications (66.1%, 78/118).ConclusionsSelf-reported information on medication use as well as other potential teratogenic factors can be collected via the Internet, although recruitment costs are not insubstantial and maintaining follow-up is challenging. Direct data collection from consumers adds detail, but clinical input may be needed to fully understand patients’ medical histories and capture birth outcomes.

Remote clinical support by telephone for rural district hospital medical officers in the Eastern Cape

Background: Rural district hospitals are frequently understaffed and inexperienced medical officers must make clinical decisions with no supervision. Medical officers from rural district hospitals in the Eastern Cape attending a two-week ‘in-reach’ anaesthesia training course at the Port Elizabeth academic complex were provided with subsequent telephonic support that enabled them to contact an experienced anaesthetist in the urban centre with clinical problems for advice. This survey was to determine user perceptions of the utility and effectiveness of the telephonic support system.Methods: Two questionnaires designed for both rural and urban-based doctors were completed either online or telephonically and were used to assess perceived values and limitations of the support system.Results: A total of 17 rural doctors, of whom 14 were foreign medical graduates, were eligible and agreed to participate; all were positive about the useful role and value of the programme, although many felt that the telephonic support system needs to be more structured and formalised. Open-ended questions revealed feelings of isolation and insecurity amongst the participants.Conclusion: The telephonic system is valuable and readily accessible. However, its ready acceptance by the participants should be viewed in the light of the lack of other resources. A systemic approach towards clinical support of medical officers in rural district hospitals should be adopted, which might include remote supervision by telephone.

Remote clinical support by telephone for rural district hospital medical officers in the Eastern Cape

Background: Rural district hospitals are frequently understaffed and inexperienced medical officers must make clinical decisions with no supervision. Medical officers from rural district hospitals in the Eastern Cape attending a two-week ‘in-reach’ anaesthesia training course at the Port Elizabeth academic complex were provided with subsequent telephonic support that enabled them to contact an experienced anaesthetist in the urban centre with clinical problems for advice. This survey was to determine user perceptions of the utility and effectiveness of the telephonic support system.Methods: Two questionnaires designed for both rural and urban-based doctors were completed either online or telephonically and were used to assess perceived values and limitations of the support system.Results: A total of 17 rural doctors, of whom 14 were foreign medical graduates, were eligible and agreed to participate; all were positive about the useful role and value of the programme, although many felt that the telephonic support system needs to be more structured and formalised. Open-ended questions revealed feelings of isolation and insecurity amongst the participants.Conclusion: The telephonic system is valuable and readily accessible. However, its ready acceptance by the participants should be viewed in the light of the lack of other resources. A systemic approach towards clinical support of medical officers in rural district hospitals should be adopted, which might include remote supervision by telephone.

PHS59 - Cost of reporting possible adverse Drug reactions in medical Outpatients using a Telephonic interactive Voice response system

PHS59 - Cost of reporting possible adverse Drug reactions in medical Outpatients using a Telephonic interactive Voice response system

Emergency telephonic medical triage and counseling system: A new approach

Purpose: The adequacy of the telephonic triage of emergency calls is of paramount importance in an Emergency Medical Systems. Unfortunate, there are not many emergency telephonic medical triage systems developed that would fit with the diversity of systems that exist all over the world.

Physical activity indicators in adults from a state capital in the South of Brazil: a comparison between telephone and face-to-face surveys

The aim of this study was to compare estimates of prevalence of physical activity indicators and associated sociodemographic factors obtained from telephone and face-to-face interviews with adults. Data from a cross-sectional populationbased survey of adults living in Florianópolis, Santa Catarina State, Brazil was compared to data collected through the telephonic system VIGITEL. There was no significant difference between the results from telephone interviews (n = 1,475) and face-to-face interviews (n = 1,720) with respect to prevalence of sufficient leisure time physical activity (19.3% versus 15.5%, respectively), sufficient leisure time and/or commuting physical activity (35.1% versus 29.1%, respectively) and physical inactivity (16.2% versus 12.6%, respectively). Some differences were observed with respect to the sociodemographic factors associated with leisure time and/or commuting physical activity and physical inactivity. The two techniques yielded generally similar results with respect to prevalence and sociodemographic factors associated to physical activity indicators.

PRM114 - Impact of automated telephonic reminders on patient on-time medication refills: Initial findings of a randomized study

Numerous studies have shown that non-adherence to medication is associated with increased hospitalization, progression of disease, and higher mortality. One of the most common reasons cited for non-adherence is patient forgetfulness. Automated telephonic reminders are a cost-effective approach to help patients refill their medications on time. To evaluate the impact of an automated telephonic reminder system on patients’ on-time maintenance medications refills. This randomized study used claims data from a large pharmacy chain. Patients were randomly assigned to an intervention group that received automated telephonic reminders 3 days before the expected refill date and a control group that received no calls. For the month of February 2012, there were 4,153,634 patients in the intervention group who received automated telephonic refill reminder calls for their 7,458,213 maintenance prescriptions due for refills; the control group had 84,187 patients with 148,923 maintenance prescriptions due for refills. On-time refills were measured using both daily and cumulative refill rates defined as the percentage of prescriptions refilled on or by a specific date around the expected refill date. Daily and cumulative refill rates were compared between the intervention and control groups to measure the effects of automated telephonic reminders. Patients in the intervention group were more likely to refill their medications before or on the expected refill date than the control group (26.41% vs. 21.85%, p-value<0.001). The effect of telephonic reminders was most pronounced 1 or 2 days after the calls. When compared to the control group, patients in the intervention group refilled 2.18% and 1.36% more prescriptions within 1 and 2 days, respectively, after the call. Automated telephonic reminders helped patients refill their maintenance medications on time to ensure continuous supply of medications.

Comprehensive self management and routine monitoring in chronic obstructive pulmonary disease patients in general practice: randomised controlled trial

Objective To assess the long term effects of two different modes of disease management (comprehensive self management and routine monitoring) on quality of life (primary objective), frequency and patients’ management...

Translating medical screening and brief intervention into behavioral health-care practice in work-related settings

Substantial empirical support exists for alcohol screening and brief intervention (SBI) in medical settings but not in nonmedical settings such as the workplace—a potential but underutilized venue for alcohol SBI. This research aims to translate medical SBI into behavioral health-care practice in US work settings, where millions of workers might be reached annually. The primary objectives of this pilot study are to assess the feasibility of adapting medical SBI practices to telephonic employee assistance programs (EAPs); to develop practical training, implementation, and quality/fidelity monitoring protocols and processes that can be integrated into existing practices; to assess the impact of implementing systematic routine alcohol SBI on key performance measures (rates of screening, alcohol problem identification, treatment initiation); and to assess preliminary outcomes (self-reported alcohol use, mental well-being, and productivity). The multi-site study is being conducted by US EAP providers using pre-test/post-test single-group pre-experimental designs. Screening and brief intervention processes were adapted from the World Health Organization’s alcohol SBI protocol and included systematic screening using the Alcohol Use Disorders Identification Test (AUDIT) during clinical intake, BI using motivational interviewing techniques, referral to face-to-face counseling, and telephonic follow-up. Preliminary findings suggest that integration of routine SBI by EAP consultants at intake is not only feasible in a telephonic delivery system but also increases alcohol problem identification to levels found in the general US population; hence, it provides the opportunity for brief motivational counseling for risky drinking. Furthermore, it is clear that when SBI is integrated as part of routine EAP practice, members are willing to answer questions about their alcohol use and participate in follow-up. To date, findings have shown increases in alcohol-problem identification from 400% to 600% when SBI is integrated into routine practice.

A reforma urbana e a Light: uma revolução na cidade. Rio de Janeiro - início do século XX

O artigo começa analisando as condições de vida do Rio de Janeiro e as principais diretrizes da reforma do Governo Federal e do prefeito Pereira Passos no início do século XX. Aborda, em seguida, a chegada da Rio de Janeiro Tramway Light &amp; Power Co. Ltd. à cidade, então em plena atividade de obras, o que facilitou para a empresa a introdução de fiação elétrica subterrânea, as modificações nas bitolas e no traçado das linhas de bondes, e a completa mudança do sistema telefônico alemão para o norte-americano. Analisa-se a rapidez e objetividade da ação da Companhia e os seus efeitos na malha urbana e no cotidiano da Capital.

Indian mVAS Industry

In the ever growing need for globalization within the modern world, the need for the Mobile Industry in the helm of new scientific service to the public has been spreading its wings all over the world aiming at better means of communication approach. Since, mobile-based value added service came into the field of Indian Communication Industry in the 1990s as an appealing code of belief for a huge mass, be it for the business class or the young learning gamut, it has grown as a promising provision catering to many requirements of the Indian community. Today, mobiles (cell phones) through text-based Short Message Service (SMS), customized Ring Tones (RT), Caller Back Ring Tones (CRBT), etc. have taken over the immediate communication industry wiping out the rigid concept of the old landline telephonic service system. This paper goes into the details of the same.

Validity of an automated telephonic system to assess COPD exacerbation rates

Current tools for recording chronic obstructive pulmonary disease (COPD) exacerbations are limited and often lack validity testing. We assessed the validity of an automated telephonic exacerbation assessment system (TEXAS) and compared its outcomes with existing tools. Over 12 months, 86 COPD patients (22.1% females; mean age 66.5 yrs; mean post-bronchodilator forced expiratory volume in 1 s 53.4% predicted) were called once every 2 weeks by TEXAS to record changes in respiratory symptoms, unscheduled healthcare utilisation and use of respiratory medication. The responses to TEXAS were validated against exacerbation-related information collected by observations made by trained research assistants during home visits. No care assistance was provided in any way. Diagnostic test characteristics were estimated using commonly used definitions of exacerbation. Detection rates, compliance and patient preference were assessed, and compared with paper diary cards and medical record review. A total of 1,824 successful calls were recorded, of which 292 were verified by home visits (median four calls per patient, interquartile range three to five calls per patient). Independent of the exacerbation definition used, validity was high, with sensitivities and specificities between 66% and 98%. Detection rates and compliance differed extensively between the different tools, but were highest with TEXAS. Patient preference did not differ. TEXAS is a valid tool to assess COPD exacerbation rates in prospective clinical studies. Using different tools to record exacerbations strongly affects exacerbation occurrence rates.

Cost of Medical Services in Older Patients With Heart Failure: Those Receiving Enhanced Monitoring Using a Computer-Based Telephonic Monitoring System Compared With Those in Usual Care: The Heart Failure Home Care Trial

BackgroundPrior studies suggest that disease management programs may be effective in improving clinical and economic outcomes in patients with heart failure. Whether these types of programs can lower health care cost and be adapted to the primary care setting is unknown. This study was designed to assess the impact of a home-based disease management program, the Alere DayLink HF Monitoring System (HFMS), on the clinical and economic outcomes of Medicare beneficiaries recently hospitalized for heart failure who received the care from a community-based primary care practitioner. Methods and ResultsThe Heart Failure Home Care trial was a multicenter, randomized, controlled trial of sophisticated, monitoring of heart failure patients with an interactive program versus standard heart failure care with enhanced patient education and follow-up (SC) in Medicare-eligible patients. The study endpoints included cardiovascular death or rehospitalization for heart failure, length of hospital stay, total patient cost, and cost to Medicare at 6 months of enrollment. A total of 315 patients age ≥65 years old were randomized: 160 to the HFMS and 155 to SC. There were no significant statistical differences between the groups in regards to 6-month cardiac mortality, rehospitalizations for heart failure, or length of hospital stay. Of those, 304 patients had their Medicare data available. The information from the Medicare claims data was used to determine the cost. Information from the trial was used to determine costs of out-patient drugs and the interventions. The 6-month mean Medicare costs were estimated to be $17,837 and $13,886 for the HFMS and the SC groups, respectively. We found that overall medical costs of medicare patients were significantly higher for patients who were randomized to the HFMS arm than they were for the patients randomized to the SC arm. ConclusionsOur study results suggest that enhanced patient education and follow-up is as successful as a sophisticated home monitoring device with an interactive program and less costly in patients who are elderly and receive the care from a community-based primary care practitioner.

Apparatus for personalizing computerized customer service

A method for improving user satisfaction with automated response computer driven systems is provided. In one embodiment the automated computer system utilizes a Web browser accessing at least a Web site. In another embodiment, the automated computer system is a telephonic response system with voice recognition and generation capability. In each embodiment the user is first prompted to provide indications of user language usage preferences which are then analyzed and stored in a user profile. Thereafter, subsequent information from the automated system is modified in accordance with the stored user profile before presentation to the user.

Clinical-Technical Performance and Physician Satisfaction with a Transnational Telephonic ECG System

The effective use of cardiology hospital services could improve patient safety while shortening pre- and in-hospital stay periods using modern transtelephonic technologies and consultations by phone to follow up electrocardiograph (ECG) changes of the patients on a waiting list. The aim of this study was to assess clinical-technical performance and satisfaction with application of an international telephonic ECG system. A transnational telephonic ECG system was established between Lithuania and Germany. A follow-up study design was used to assess clinical-technical performance and user satisfaction with the system. According to inclusion and exclusion criteria, 34 patients were enrolled who transmitted 329 ECG's, of which 14 ECGs showed clinical changes. Of the ECGs sent 254/329 (77%) were of good quality, 9 (3%) were of moderate quality, and 66 (20%) were of bad quality. Among physicians surveyed, 77.6% were satisfied or very satisfied with telemedicine services. A telecardiology service can help to identify patients with urgent problems requiring rapid assessment at the hospital. The service has high acceptance from physicians but needs to be improved in terms of technical performance and patient compliance expectations.