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Background: Telenursing triage and advice services are increasingly being used to deliver health advice. Medication-related queries are common, however little research has explored the medication-related calls made to these services. The aim of this study was to examine the profile of medication-related calls to a national telenursing triage and advice service and the medications involved.Methods: This was a retrospective cohort study of medication-related calls received by Australia's national helpline (healthdirect helpline) in 2014, which provides free advice from registered nurses. We examined the volume of medication-related calls over time, user profiles for patients and callers, and call characteristics and we also investigated medications involved in the calls by their generic names and therapeutic classes.Results: Of 675,774 calls, 3.8% (n = 25,744) were medication-related, which was the largest category of calls. The average call length was 10 min. Over half of callers (55.4%) were advised to deliver self-care. Of 7,459 calls where the callers reported they did not know what to do prior to calling, 56.8% were advised to self-care and 3.5% were transferred to the Poisons Information Centre immediately. Of 1,277 calls where callers reported that they had originally intended to call an ambulance or attend an emergency department (ED), none were advised to do so. Advice most frequently requested was about analgesics and antipyretics, followed by non-steroidal anti-inflammatory agents.Conclusion: The telenursing triage and advice helpline offered quick and easily accessible advice, and provided reassurance to patients and callers with medication-related queries. The service also potentially diverted some patients from attending an ED unnecessarily. [ABSTRACT FROM AUTHOR]

Background: Advances in robotics have made teleoperated surgical procedures a feasible means of treating patients in remote locations. In this study a suite of experiments was performed to investigate the influence of time-delay on teleoperation accuracy and efficiency during a path-following task. Materials and Methods: Subjects used a Phantom Omni 6-degrees of freedom (dof) input device (Sensable, Triangle Park, NC) to move the end-effector of a Mitsubishi (Tokyo, Japan) PA-10 7-dof robotic manipulator along a prescribed path. End-effector motion was recorded using a video motion capture system. Time-delays ranging from 0 to 2.5 s were artificially imposed. Performance was quantified by time to complete the task, path length, and square root-mean-square (RMS) error. Randomization of time-delay order and allowance for practice runs reduced the learning effect. An imposed time limit and pacing were used to negate the move-and-pause strategy that emerged in early trials. Results: Time to complete the task and RMS error generally increased with increasing time-delay. Path length also generally increased, but not as consistently. With imposed pacing, RMS error continued to increase beyond 1.5 s, and some subjects were not able to complete the task in the allotted 90 s. Conclusions: The results suggest a threshold of time-delay in the range of 1.5-2.0 s. Beyond 1.5 s, subjects adopted a move-and-pause strategy that increased completion time to preserve path-tracking accuracy. If paced, tracking accuracy tended to degrade substantially beyond 1.5 s. A strong learning effect was evident, and experienced teleoperators performed substantially better than novices. [ABSTRACT FROM AUTHOR]

Objective: Adherence is challenging in episodic chronic conditions that require medication during both symptomatic and quiescent periods, such as ulcerative colitis (UC). Adherence for these conditions is under-studied. This study was a preliminary test of telephone nurse counseling to address cognitive and emotional barriers to adherence in UC. Methods: 524 people taking mesalamine for UC were referred by their health care providers, and 278 (53%) enrolled. There were no demographic differences between program participants and nonparticipants. Participants reported multiple comorbidities and concomitant medications. All participants received telephone follow-up (M =2.1 calls) from a registered nurse who used cognitive-behavioral and motivational interviewing counseling techniques. Adherence measured by structured interview was compared to a population baseline using a binomial test. Results: Attrition was 51% over 6 months but was unrelated to adherence. Participants had better adherence than the expected population rate, with a significant dose–response effect. Reasons for nonadherence were primarily psychological or efficacy-related. Conclusion: Adherence following intervention was better than typical mesalamine adherence. Self-efficacy predicted adherence, but demographic and clinical variables did not. Adherent participants reported more adverse events. Practice implications: Attention to patients’ cognitive and emotional reactions may help to improve adherence in episodic chronic diseases such as UC. [Copyright &y& Elsevier]

Aim. This paper is a report of a study conducted to develop a theoretical model of the process nurses use to deliver care over the telephone. Background. Telephone nursing is practised internationally in diverse settings, and research has shown it to be an effective service. Although studies have identified important variables that influence the practice, the telephone nursing process in its entirety has not been described. Method. In this grounded theory study, data were collected from ten experienced telephone nurses from four different sites using semi-structured interviews. Concurrent data collection and analysis took place in 2005. A cumulative process of theoretical sampling and constant comparison was used to identify initial concepts, and then expand, validate, and clarify them until the concepts and relationships were fully developed. The findings were validated through peer and participant review. Findings. Telephone nursing is a dynamic and goal-oriented process consisting of three phases: gathering information, cognitive processing, and output. While generally sequential, the phases can be simultaneous or recurring in response to caller needs. Interpreting takes place throughout the call; that is, the nurse translates data from the caller into healthcare information and healthcare information into caller language. Factors shaping the process are call prioritization and level of complexity, resource availability, and the nurse's need for validation. Conclusion. Telephone nursing training and practice should emphasize gathering information, using implicit and explicit information to identify client needs, and translating healthcare information back into language comprehensible to clients. [ABSTRACT FROM AUTHOR]

A review of the literature was conducted on articles that included technical evaluation and assessment. A total of 47 articles were reviewed to assess what level of objectivity they had. Although there is a relatively large amount of work that has been published, it is determined to be insufficient to establish a definitive standards-based telemedicine evaluation framework. Additional research in this area is warranted. [ABSTRACT FROM AUTHOR]

The article discusses the effectiveness and usability of bedside vigilance technology. A study showed that increasing the number of patient per nurse increases patient mortality by 7 percent. The finding suggests that bedside vigilance technology may enhance the capability of hospital-based nurses to improve patient safety. St. Joseph's Hospital and Medical Center claimed that its smart bed technology could appropriately display heart and respiratory rates and could be deployed for medical evacuation in battlefields. Improvements in medical outcomes resulting from the deployment of smart bed are also mentioned.

We have conducted a systematic review of home telecare for frail elderly people and for patients with chronic conditions. We searched 17 electronic databases, the reference lists of identified studies, conference proceedings and Websites for studies available in January 2006. We identified summaries of 8666 studies, which were assessed independently for relevance by two reviewers. Randomized controlled trials of any size and observational studies with 80 or more participants were eligible for inclusion if they examined the effects of using telecommunications technology to (a) monitor vital signs or safety and security in the home, or (b) provide information and support. The review included 68 randomized controlled trials (69%) and 30 observational studies with 80 or more participants (31%). Most studies focused on people with diabetes (31%) or heart failure (29%). Almost two-thirds (64%) of the studies originated in the US; more than half (55%) had been published within the previous three years. Based on the evidence reviewed, the most effective telecare interventions appear to be automated vital signs monitoring (for reducing health service use) and telephone follow-up by nurses (for improving clinical indicators and reducing health service use). The cost-effectiveness of these interventions was less certain. There is insufficient evidence about the effects of home safety and security alert systems. It is important to note that just because there is insufficient evidence about some interventions, this does not mean that those interventions have no effect. [ABSTRACT FROM AUTHOR]

In late 2005, the Northern Norway Regional Health Authority requested an evaluation of all tested telemedicine services in northern Norway to clarify which were suitable for large scale implementation. A total of 282 reports from the Norwegian Centre for Telemedicine, the University Hospital of North Norway and the University of Tromsø were included in the study. Projects not focusing on secondary health care were excluded and 46 studies representing 21 topics entered the final analysis. They were analysed with a self-developed scoring tool focusing on five items. Eleven topics were concluded as being candidates for large scale implementation and grouped according to priority. The first priority topics were teleradiology, digital communication/integration of patient records and education. The second priority topics were teledialysis, pre-hospital thrombolysis, telepsychiatry and teledermatology. The third priority topics were paediatrics, district medical centres, tele-ophthalmology and teleotorhinolaryngology. No priority was suggested for the projects in cardiology, endocrinology, geriatrics, gynaecology/obstetrics, pathology and nursing/care. User support, training, research ability, financial incentives and interaction between clinicians and ICT-personnel were considered as important factors in motivating healthcare personnel to use telemedicine. [ABSTRACT FROM AUTHOR]

We conducted a two-month feasibility study of telemonitoring based on home visits by a specially trained nurse to 20 elderly patients who would otherwise have been receiving monitoring home visits from their general practitioner (GP). A specially-trained community medicine nurse was instructed to report important changes in the health status of a patient during her home visits immediately via telephone. In the case of 8 patients, various telecare devices were installed by the community medicine nurse according to the patients' needs. Patients were trained to use the devices independently in their homes. Three patients received a one lead ECG meter and made 100 successful transmissions in 101 patient-days. Three patients were supplied with an electric scale and successfully transferred 72 measurements in 73 patient-days. Two patients were equipped with a teletonometry system and used the blood pressure monitor and blood glucose meter successfully. The tonometer itself was used by only one of the patients as suggested by the GP (once per week; 5 successful transmissions in 39 days). The GP reported a positive effect on her work, with time saved because of less travelling for home visits. With the back-up of the measurements obtained by the telecare devices it was possible to delegate monitoring tasks to the community medicine nurse. [ABSTRACT FROM AUTHOR]

Aims and objectives: The aim of the study was to examine the impact on waiting times and patient satisfaction of nurse-led rheumatology telephone clinics. Methods: Patients awaiting outpatient review were contacted by the rheumatology clerk and offered a nurse-led rheumatology telephone appointment. Those who accepted were given a date and time for the appointment. A telephone consultation proforma was used to structure the call and to organize appropriate investigations/action. A questionnaire was mailed to the 68 patients reviewed during the first month of the telephone clinics to assess satisfaction. Status forms were also completed to record further action. Results: Of the 68 patients surveyed 73% completed and returned the questionnaire. Overall 72% were happy with the telephone consultation and would be happy to use the service again. Waiting times were reduced by two months as a total of 169 patients were reviewed during the April to August period. Conclusion. Nurse-led telephone consultation, as part of chronic disease management, can be extremely beneficial for all rheumatology patients as a high level of satisfaction was achieved. In addition telephone consultations have helped to reduce the follow-up waiting times within the department by two months. This audit shows that telephone appointments conducted by an experienced nurse using an assessment proforma can be incorporated into routine follow-up care.

To evaluate the implementation of a primary care, nurse-led, near patient anticoagulant monitoring service. Action research workshops, supported by questionnaires and clinical audit, to define the strengths and weaknesses of the service and the effectiveness of the computerised decision support system used to set the dosage of anticoagulant and time interval to the next appointment. The nurses felt that the patients preferred the practice-based service, finding it more personal and accessible. However, circumstances arose where the nurse's intuition had to override the software's advice. The nurses found it stressful when they were unclear whether their decision making represented acceptable variation or dangerous practice. An audit tool was developed to measure the extent to which there was variation from the software's recommendation, and patterns of variation emerged. Most evident was that nurses responded to uncertainty by practising cautiously, shortening the interval until the next visit and slightly reducing the recommended dose of warfarin. The group, by sharing their experiences through a structured series of workshops, developed an understanding of when it might be appropriate to vary from the decision support software's recommendations and how this could be audited. The technological solution modelled on hospital practice proved hard to implement in primary care. [ABSTRACT FROM AUTHOR]

This study assessed the appropriateness of advice given by teletriage nurses to patients in northern Ontario. Assessments used audiotapes and printed records of 73 calls, selected from approximately 350 calls based on sound quality, completeness, and consent of caller and teletriage nurse. Audits were conducted independently by one family physician, one nurse practitioner, and one registered nurse with teletriage experience. In 56% of the 73 calls, all three auditors judged the nurse's advice as "appropriate." In 92% of the 73 calls, at least two of the three auditors judged the teletriage nurse's advice as "appropriate." All calls were rated as "appropriate" by at least one auditor. If not "appropriate," then auditors were three times more likely to rate the advice as "overly-cautious" rather than "insufficient." The percentage of calls with the same rating varied from 62% to 86% with an outlier of 33%. Nurse practitioners tended to rate the appropriateness of the advice slightly, but significantly lower than the rating given by family physicians or registered nurses. Interestingly, nurse practitioners tended to rate aspects of the nurse–caller interaction advice as slightly and significantly better than the rating chosen by family physicians or registered nurses. The teletriage service was providing appropriate advice, but the generalizability of these results may be limited because of the selection of calls. [ABSTRACT FROM AUTHOR]

As the first step in developing a protocol for the use of video-phones in community health, we carried out a feasibility study among clients with a range of health needs. Clients were equipped with a commercially available video-phone connected using the client s home telephone line. A hands-free speaker-phone and a miniature video-camera (for close-up views) were connected to the video-phone. Ten clients participated: five required wound care, two palliative care, two long-term therapy monitoring and one was a rural client. All but two were aged 75 years or more. Each client had a video-phone for an average of two to three weeks. During the six months of the study, 43 client calls were made, of which 36 (84%) were converted to video-calls. The speaker-phone was used on 24 occasions (56%) and the close-up camera on 23 occasions (53%). Both clients and nurses rated the equipment as satisfactory or better in questionnaires. None of the nurses felt that the equipment was difficult to use, including unpacking it and setting it up; only one client found it difficult. Taking into account the clients responses, including their free-text comments, a judgement was made as to whether the video-phone had been useful to their nursing care. In seven cases it was felt to be unhelpful and in three cases it was judged helpful. Although the study sample was small, the results suggest that home telenursing is likely to be useful for rural clients in Australia, unsurprisingly, because of the distances involved. [ABSTRACT FROM AUTHOR]

Elderly individuals involved in a home telenursing project were studied. The project nurses provided home health services from telenursing cockpits' located in three separate sites in Kansas. A cable television-based interactive video system was used to transmit video pictures at 30 frames s, with 288 horizontal lines of resolution. During phase 1 of the study, interview data were collected from22 subjects 4 men, 18 women . During phase 2, the original participants were contacted but only 9 1 man, 8 women were still receiving home health services. Contrary to expectations, the technology was not an important issue for the participants. They did not express any particular worry or excitement about it. Nor did they describe difficulties in adapting to its use. Use of telemedicine technology did not appear to have any negative effects on communication. The results suggests that further thought needs to be given to defining clearly the purpose and goals of telemedicine projects. [ABSTRACT FROM AUTHOR]

The article discusses the use of personal digital assistants (PDAs) in nursing practice. The PDA is a handheld computer with various software applications. Aside from drug references, many other references are available for the PDA, such as laboratory and diagnostic test references, assessment and diagnosis guides, and procedure manuals and guides. PDAs offer the potential to improve patient safety. Drip rates, infusion amounts, mixing guidelines, and other calculations are available in the PDA.

We evaluated user satisfaction with realtime telemedicine for monitoring vital signs. Over eight weeks, 20 patients and 12 residents in family medicine participated in the study. At the end of the study, the patients and doctors completed a questionnaire detailing satisfaction with the service. Responses were obtained from 18 of the 20 patients and were generally positive: 61% were comfortable using the system and 94% did not believe that the technology had a negative effect on their relationship with the health-care provider. Eleven physician responses were obtained. Physicians were more uncertain about the benefits of the service: only 45% felt that telemedicine could adequately assess patients, although 82% felt that telemedicine would be an important part of primary-care services. From a user perspective, our study showed that patients were more satisfied with the telemedicine service than were doctors. [ABSTRACT FROM AUTHOR]

Editorial. Features a telehome care program in Philadelphia, Pennsylvania. Use of the program as an adjunct to traditional nurse home visits; Technology employed in the program.