Estudo quantitativo observacional, de intervenção do tipo antes e depois, com objetivo de analisar o efeito do apoio telefônico no conhecimento e atividades de autocuidado de pessoas com diabetes mellitus tipo 2. Foi realizado no Centro de Saúde Escola de uma cidade do interior paulista. A amostra foi constituída por 48 pessoas que participaram do programa Apoio telefônico para o monitoramento em Diabetes mellitus - ATEMDIMEL/EERP/USP, em 2013. Para avaliação, foi utilizado um questionário para avaliação das variáveis sociodemográficas, clínicas e antropométricas, e os instrumentos Diabetes Knowledge Questionnaire e Questionário de Atividades de Autocuidado com o Diabetes. Para análise, utilizou-se estatística descritiva, os testes Qui-Quadrado de Pearson e Exato de Fisher. A idade dos participantes variou de 47 a 87 anos, com predomínio do sexo feminino (52,1%). A maioria era casado (64,6%) e aposentados (60,4%). A média de anos de estudo foi de 7 anos. O tempo de diagnóstico foi de 11 a 20 anos (37,5%), sendo o tratamento medicamentoso com insulina o mais utilizado (97,9%). A hipertensão arterial foi a comorbidade predominante (75,0%). A maior parte apresentava obesidade grau I (41,7%) antes e após a intervenção. Pela circunferência abdominal, a maioria apresentou alto risco cardiovascular (83,3%) antes da intervenção e após houve aumento para 87,5% dos participantes. A maioria antes da intervenção apresentou hiperglicemia (54,2%), com HbA1c alterada (77,1%), LDL-C classificado com ótimo (64,6%) e HDL-C alterado (95,8%). Para os triglicerídeos e colesterol, a maior parte foi classificado como ótimo. Após a intervenção, a maioria apresentou glicemia de jejum dentro da normalidade (52,1%) e HbA1c também alterada (85,4%). Os níveis de LDL-C permaneceram classificados com ótimo (66,7%) e os de HDL-C alterados (95,8%). Triglicerídeos e colesterol total mantiveram a classificação como ótimo. A maioria das pessoas apresentaram conhecimento maior ou igual a 8 (87,4%) antes da intervenção e 83,3% após. Sobre o autocuidado, antes da intervenção, os itens que obtiveram seguimento em cinco ou mais dias na semana foram relacionados ao \"consumo de doces\", \"avaliar o açúcar no sangue\", \"secar entre os dedos dos pés\", \"tomar os medicamentos do diabetes\", \"utilizar a insulina conforme o recomendado\" e \"tomar os comprimidos do diabetes\". Após a intervenção, verificou-se que além destes, também houve seguimento em cinco ou mais dias da semana no que se refere a \"seguir uma dieta saudável\", \"consumo de frutas e vegetais\", \"examinar os pés\" e \"examinar dentro dos sapatos\". Os itens que apresentaram maiores escores antes e após a intervenção foram \"uso dos medicamentos e insulina\" e os menores escores à \"prática de atividade física por 30 minutos\" e realizar \"exercício físico específico\". O apoio telefônico mostrou- se como uma ferramenta importante para favorecer o cuidado à pessoa com DM, pois permite identificar as reais necessidades da população para a mudança de comportamento e adesão ao tratamento proposto. Esta investigação oferece subsídios para novos estudos de intervenção com amostras maiores e tempo prolongado com intuito de melhorar o acompanhamento longitudinal da pessoa com DM / Observational quantitative study, of the \"before and after\" type of intervention, that aims to verify the effects of telephone coaching in the knowledge and self-care activities of people with type 2 diabetes mellitus. It was performed at Centro de Saúde Escola - CSE Prof. Dr. Joel Domingos Machado. Forty-eight people participated in the intervention, which were part of the Telephone coaching for monitoring in Diabetes mellitus - ATEMDIMEL/EERP/USP, in the year of 2013. In the data collection, a questionnaire was used for the evaluation of socio-demographic, clinic and anthropometric variables, in addition to the instruments Diabetes Knowledge Questionnaire and Self-care Activities with Diabetes Questionnaire. For analysis, descriptive statistics were used, besides Pearson\'s Chi-Square test and Fisher\'s Exact test. It was identified that the participants\' ages ranged from 47 to 87 years old, with female predominance (52,1%). The majority of the participants were married (64,6%) and retired (60,4%). The average of schooling years was 7 years. The time of diagnosis was of 11 to 20 years (37,5%), being the drug treatment with insulin the most common (97,9%). Arterial hypertension was the predominant comorbidity (75,0%). The majority of the people presented class 1 obesity (41,7%) before and after the intervention. Most part of the participants presented high cardiovascular risk (83,3%) before the intervention, with an increase after it (87,5%). Previously to the intervention, the majority of patients showed hyperglycemia (54,2%), with altered HbA1c (77,1%), LDL-C classified as great (64,6%) and altered HDL-C (95,8%). About triglycerides and cholesterol, most part remained in great rating. After the intervention, most people presented fasting glycaemia within the normal range (52,1%) and HbA1c also altered (85,4%). LDL-C levels remained classified as great (66,7%), and HDL-C levels, altered (95,8%). Triglycerides and total cholesterol maintained great as their classification. The evaluation of knowledge revealed that before the intervention, 87,4% of the participants showed adequate knowledge in relation to DM, with a discreet reduction after it (83,3%). In the self-care activities evaluation, it was verified that, previously to the intervention, the activities that were most joined were related to the assessment of blood sugar, drying between toes, drug and insulin usage. After the intervention, beyond that, were also identified with fine adherence such activities as following a healthy diet, fruits and/or vegetables intake and examining the feet. It was verified that telephone coaching can be a good tool to assist in the care of a person with DM. This investigation offers subsidies for new intervention studies with larger samples and extended time in order to improve the longitudinal tracking of a person with DM

Bakgrund: I västvärlden har telefonrådgivning utvidgats för att minska onödiga sjukvårdsbesök och kostnader för sjukvården. Syftet med telefonrådgivning är att göra vården effektiv, säker och mer tillgänglig för uppringaren. Ett av de vanligaste problemen mellan uppringare och vårdgivare är bristande kommunikation, det som påverkar är när sjuksköterskan inte lyssnar noga och ställer för få frågor. Dessa faktorer ökar risken för felbehandling och misstag. Syfte: Att observera hur distriktssköterskor kommunicerar med uppringare under rådgivande samtal på vårdcentral. Metod: Studien har en deskriptiv design med kvantitativ ansats och görs i form av en empirisk observationsstudie. I studien används en deduktiv ansats då ett strukturerat observationsformulär används. Resultat: Kategori 1) Bedöma, hänvisa och ge råd användes i 96 av 96 samtal (100%). Kategori 2) Ge stöd och omvårdnad användes i 51 av 96 samtal (53%). Kategori 3) Stärka och bekräfta användes i 64 av 96 samtal (66%). Kategori 4) Undervisa och lära ut användes i 45 av 96 samtal (47%). Kategori 5) Att utgå från uppringarens förståelse av problemet användes i 90 av 96 samtal (94%).Slutsats: Distriktssköterskan har ett aktivt lyssnande med uppringaren som utgångspunkt. Distriktssköterskan kommunicerade genom öppna frågor i större delen av samtalen vilket ledde till att uppringaren fick möjlighet att sätta ord på sin situation och sitt lidande. Egenvårdsråd ges i liten utsträckning likaså guidas sällan uppringaren till annan vårdinrättning. Det rådgivande samtalet inom rekommenderad tidsgräns däremot återstår ofta dokumentation efter avslutat samtal vilket kan orsaka stress. / Background: In the Western world telephone counseling has been expanded to reduce unnecessary health care visits and healthcare costs. The purpose of telephone counseling is to make the care efficient, secure and more accessible to the population. One of the most common problems between callers and caregivers is lack of communication. Aim: Study how district nurses communicate with callers during telephone counseling at a health care center.Method: The study has a descriptive design with a quantitative approach and is done in the form of an empirical observational study of district nurse interviews with callers at a health center. In the study a deductive approach is used with a structured observation form. Result: Category 1) Assessing, referring and giving advice was used in 96 of 96 calls (100%). Category 2) Support and care was used in 51 of 96 calls (53%). Category 3) Strengthen and confirm was used in 64 of 96 calls (66%). Category 4) Teach the caller was used in 45 of 96 calls (47%). Category 5) Based on the caller's understanding of the problem was used in 90 of 96 calls (94%)Conclusion: The district nurse used active listening and communicated through open questions. This led the caller to put words to his situation and suffering. Self-care advice was given in a small extent, the caller was rarely guided to another care facility. The district nurse held the recommended time in telephone counseling, but documentation often remains after the end of the call which can cause stress.

Le processus de vieillissement expose naturellement à la fragilité et à ces problématiques psycho-sociales et sanitaires qui affectent le bien-être. Couplées à l’accroissement de cette population, la question de l’accompagnement dans le grand âge pose un réel problème de société. Alors que les ressources humaines sont rares et onéreuses, nombreux sont les acteurs cherchant des solutions du côté de la technologie pour soutenir le phénomène. Toutefois souvent stigmatisantes, coûteuses, requérant un effort d’apprentissage et dont l’utilité est souvent contestée, les outils spécialisés dans le vieillissement peinent à pénétrer l’espace de vie des personnes âgées. Dans ce contexte, une technologie abordable, qui s’ancrerait naturellement dans les habitudes de vie et dont l’esthétique n’évoquerait jamais le handicap, dispose de qualités particulièrement intéressantes. Se positionnant dans le champ de l’actimétrie appliquée à la gérontechnologie, ce travail doctoral a donc pour objectif d’étudier les potentialités offertes par les métadonnées téléphoniques pour la déduction de comportements sociaux et la détection d’évènements pouvant affecter le bien-être et la qualité de vie des personnes âgées. L’idée sous-jacente est que le comportement humain, qu’il soit biologique ou social, est quantifiable en rapport à une moyenne individuelle et qu’une déviation significative par rapport à celle-ci est le signe d’un évènement caractéristique. Nous utilisons donc des traces numériques en tant que reflet de l’activité téléphonique dans l’optique de reconstituer des schèmes d'utilisations porteurs de significations sociales en lien avec l’activité sociale et la santé. Les résultats montrent l’existence de corrélations statistiquement significatives entre des variables téléphoniques et l‘activité sociale, l’état de santé psychique et physique. Le travail valide donc les résultats de précédentes recherches qui confèrent au téléphone un rôle prépondérant dans la gestion de la vie sociale et l’apaisement d’affects négatifs liés à des symptomatologies psychiques. Il permet par ailleurs d’approfondir les connaissances actuelles sur les relations entre la santé physique et l’usage du téléphone. / The ageing process exposes the fragility and the psycho-social and health issues that affect well-being. Coupled with the increase of population, the issue of support in old age is a real problem for society. While human resources are scarce and expensive, many players seeking solutions turn to technology to support the phenomenon. However these solutions are often stigmatizing, costly, require a learning effort and whose usefulness is often questioned. Specialized tools in aging struggle to penetrate the living space of the elderly. In this context, an affordable technology, which would anchor naturally in everyday life and whose design never evokes disability, has particularly interesting qualities. Positioned in the actimetry applied to gerontechnology, this doctoral work therefore aims to explore the potential of telephone metadata for social behavior deduction and the detection of events that may affect the well-being and the quality of life of the elderly. The underlying idea is that human behavior, whether biological or social, is quantifiable in relation to an individual average and a significant deviation is the sign of a characteristic event. We use digital traces as a reflection of the telephone activity to reconstruct some social patterns related to social activity and health. The results show statistically significant correlations between variables of telephone and social activity, the state of mental and physical health. This work validates previous research that gives the phone a key role in the management of social life and appeased negative emotions related to psychological symptomatology. It also enables to deepen the current knowledge about the relationship between physical health and use of the phone.

Healthcare costs have risen from 13.8% in 2000 to 17.9% in 2009 (Gordon, Leiman, Deland, & Pardes, 2014). Poor transitional care has been identified as a cause of the high healthcare costs (Naylor et al., 2013; Obama, 2013). In 2009, the Department of Veterans Health Administration (VHA) implemented a national reform of outpatient care to create Patient-Aligned Care Teams (PACTs) with a goal to improve transitional care and reintegration into outpatient care through registered nurse case managers conducting discharge telephone follow-up calls. However, discharge telephone follow-up calls have not been explored within the VHA. This study explored the relationships among discharge telephone follow-up calls, selected Veteran characteristics including the length of index hospital stay, and 30-day all cause hospital readmissions between fiscal years 2011 and 2013. Hospital readmissions were explored in parallel time periods to the timing of the discharge telephone follow-up calls. Study data were collected retrospectively from VHA inpatient and outpatient records. Descriptive statistics, measures of central tendency, bivariate statistics, and logistic regression were used to analyze the data. The study found 124,069 Veterans were discharged from the VHA from 2011 to 2013. Of those discharges, 15,954 (12.86%) were readmitted to the hospital within 30 days and 35.06% of the readmissions occurred within the first seven days after discharge. Discharge telephone follow-up calls increased from 312 in 2011 to 26,549 in 2013. Increasing Veteran age, number of comorbidities, length of index hospital stay, and being identified as frequently hospitalized in the previous year were significantly related to hospital readmissions at each of the hospital readmission time frames (within two days, between three and seven days, and between eight and thirty days after hospital discharge). This study identified a relationship between discharge telephone follow-up calls and the parallel hospital readmission time period. However, only discharge telephone follow-up calls within two days were found to decrease the likelihood of hospital readmissions and only hospital readmissions within two days after discharge (OR=0.595). The relationships between discharge telephone follow-up calls and hospital readmissions potentially explains previously mixed results and suggests two potential explanations. One, discharge telephone follow-up calls have a limited relationship to hospital readmissions and a short duration of protective effects preventing hospital readmissions. The second explanation is self-selection bias confounds the relationship between discharge telephone follow-up calls and hospital readmissions. Both explanations suggest future research and clinical practice should focus on exploring bundled transitional care interventions as a method to reduce hospital readmissions.

The TEL-PHONE Telecoil Simulator Program was invented as a solution to the problem of customizing programmable telecoils (T-coils) in a standardized and convenient manner. The objective of this project was to evaluate the suitability of the device for clinical use. A preliminary review of the TEL-PHONE protocol revealed that the protocol was in need of refinement. Following a preliminary examination of the TEL-PHONE device, a detailed evaluation of acoustic and electromagnetic output was conducted. The output was analyzed using information gleaned from Electronic Industries Association Recommended Standard RS-504 (EIA RS-504) Magnetic Field Intensity Criteria for Telephone Compatibility with Hearing Aids and American National Standards Institute (ANSI) S3.22-1996 Specification of Hearing Aid Characteristics. This analysis indicated that the controls on the device were not reliable and the output did not approximate that of a standard telephone.

No description available.

The work in this thesis concerns the use of reinforcement learning solutions to re-source allocation problems in channelised cellular networks. The methodology of re-inforcement learning techniques was chosen for application to these problems due to its capability of finding efficient policies in a fully on-line, adaptable manner, without requiring specific environment models. All of the presented agent architectures are assumed to simultaneously learn and perform network control functions in a totally on-line and unsupervised manner, and agents are developed with a view to real-world implementability by focussing on techniques that have low resource requirements and make use of only local system information.

Prevention and slowing the progression, of chronic diseases ( such as cancer, heart disease, arthritis, diabetes, asthma, osteoporosis, dementia and incontinence ), and influencing risk factors and health behaviours of a population, relies on the best available data - driven evidence. The quality of measurement techniques to collect representative population health survey and surveillance data is, as a consequence, brought under scrutiny. The presentation of this thesis is the culmination of 17 years work that has been focused on contributing to improving public health in South Australia. It is premised on the understanding that continual epidemiological assessment using representative population health surveys can deliver evidence - based information needed by health policy makers, health planners and health promoters to make appropriate, timely and efficient evidence - based decisions. The objective of the portfolio of published papers was to demonstrate the contribution to producing quality data - driven evidence using population surveys through rigour in collecting self - reported data, diversifying surveillance data collection methods and facilitating collaboration. This portfolio presents papers that have addressed a range of methodological and chronic disease and risk factor epidemiological issues. In terms of demonstrating rigour the publications have addressed the bias associated with non - response, the methodological rigour inherent in face - to - face surveys, the differences in estimates that can occur based on mode of administration, the science of telephone surveying and the importance of good questionnaire design to produce valid and meaningful data. The literature presented has also demonstrated the first South Australian population - wide prevalence survey dealing with the consequences of domestic violence and associated issues ( for males and females ) in the community, and in doing so, demonstrated the use of the telephone to collect large - scale data in Australia on domestic violence and associated factors in the population. In addition, the first time the importance of undertaking an array of methodological precautions during the data collection phase associated with collecting data on sensitive health issues on the telephone was demonstrated in Australia as was the assessment of the bias obtained in health estimates dependent upon which telephone - based sample was used. In demonstrating the need for diversity in data collection the research submitted within this thesis has demonstrated the range of telephone surveying development issues and challenges in Australia and the benefits and the value of both face - to - face and telephone as survey data collection tools in Australia. The publications also made a significant contribution to the literature in the survey methodology area, in particular, within the systematic error in questionnaire design, the measurement error in BMI self - reported measurements, validity of self - reported height and weight, and the overall CATI methodology area. Epidemiological collaborative research in particular in the areas of social capital, HRT, mental health, suicide ideation, osteoporosis, interpersonal violence, chronic disease epidemiology and risk factor epidemiology was demonstrated. As a consequence of my research, surveying populations about their health is now entrenched into public health and health service sectors in SA. Rigour in collecting self - reported data, diversifying survey and surveillance data collection methods and facilitating collaboration, has produced quality date - driven evidence for South Australia. / Thesis (Ph.D.)--University of Adelaide, School of Medicine, Discipline of Medicine, 2006.

The telephone-banking channel, delivered through call centres, has become an integral part of the distribution mix of retail financial institutions. To get the greatest competitive advantage from this channel, the strategic orientation, structural and behavioural aspects of the call centre must be aligned with its operational-service and sales-performance objectives. Unfortunately, while considerable managerial effort is expended developing call centres, often their performance results remain uncertain or uncommunicated. There are indications also that financial institutions should not underestimate active market orientation benefits; innovative, strategic-thinking and progressive structures; flexible, empathic leadership, and, valuing supportive human resource strategies. Our survey of Australian deposit-taking institutions investigates the extent to which strategic and behavioural aspects are aligned with its operational-service and sales-performance objectives. Specifically, managerial approaches to IT development, competitive positioning, leadership delegation, market research attitudes and product orientation were considered. Approaches to trust, conflict, morale and reward, and, key performance indicator (KPI) choices were sought also. Results show sales performance is positively related to more externally focussed strategic orientations. Reinforcing the importance of innovative human resource practices, performance is also related positively to psychosocial climate in general and employee reward and morale, in particular. This extension of management theory urges financial service leaders to actively contemplate one of its most important resources, people. Further, the survey itself indicated that while the majority of institutions continue to use operationally based key performance indicators, such as minimum call duration, the ability of the call centre to generate sales revenue is also being recognised. In summary, given the size and potential of the telephone-banking channel, this research encourages further, urgent exploration of strategic relationships among the channel, its market, performance measures and comprehensive people-centred HR strategies aimed at developing high employee trust, and satisfaction.

No description available.