Factors affecting the use of a telephone-based intervention for caregivers of people with Alzheimer's disease.

We investigated the usefulness of a computer-mediated interactive voice response (IVR) system integrated with voicemail to help family caregivers manage disruptive behaviours in people with Alzheimer's disease. The randomization procedure resulted in 49 caregivers being assigned to the intervention group and 51 to the control group. Using their ordinary telephone, the caregivers were linked to the four components of the IVR system: monitoring and counselling, an in-home support group, 'ask the expert', and a respite conversation. During an 18-month study, total system usage amounted to 55 min per user (SD 78, range 1-318). Half the participants used the system for at least 22 min, and 25% for at least 70 min. Participants made between one and 45 calls over the study period, averaging 11 calls (SD 12). Approximately half of the intervention group used the system regularly for two or more months. These 'adopters' were significantly older, more highly educated and reported a greater sense of management of the situation than 'non-adopters'. Adopters were much more likely than non-adopters to have been rated as highly proficient by the trainer following the technology training session. The IVR approach appealed to a subset of users. However, the overall preference was for human interaction.

Developing technology applications for intervention research: a case study.

The REACH for TLC (telephone-linked care) project is a randomized study to assess the feasibility and usefulness of a computer-mediated telecommunications system for family caregivers of persons with Alzheimer's disease. The development of this automated system created technical challenges compounded by the participation in a national multisite research study. Issues arose due to the difference of cultures between researchers and technology developers. Strategic approaches were implemented proactively and during the course of the intervention to balance the competing demands of technology development and outcomes research. Key issues are discussed and recommendations made to assist others interested in developing technology-based applications for intervention research.

A rapid stress-testing protocol for the detection of coronary artery disease: comparison of two-stage transesophageal atrial pacing stress echocardiography with dobutamine stress echocardiography.

OBJECTIVES: We compared a new two-stage transesophageal atrial pacing stress echocardiography (TAPSE) protocol with a standard dobutamine stress echocardiography (DSE) protocol. BACKGROUND: Transesophageal atrial pacing stress echocardiography has been proposed as an efficient alternative to DSE. METHODS: Two-stage TAPSE (85% and 100% of age-predicted maximum heart rate) and DSE (5 to 40 microg/kg/min at 3-min stages with or without atropine) were both performed, in random sequence, in each patient of a study group of 36 patients. Regional wall-motion analysis, patient acceptance (1 = low, 5 = high), hemodynamics and duration for performing and interpreting tests were compared. RESULTS: Transesophageal atrial pacing stress echocardiography was successful in 35 of the 36 patients (feasibility 97%). More TAPSE than DSE studies were called "ischemic" (37% vs. 14%; p = 0.005). Peak heart rate was higher with TAPSE (144 +/- 18 vs. 129 +/- 15 beats/min, p = 0.0001). Peak cardiac index (4.6 +/- 2.1 vs. 5.1 +/- 1.9 liters/min/m2, p = 0.14), patient acceptance score (4.2 +/- 0.7 vs. 3.8 +/- 1.3, p = 0.17) and study duration (14.2 +/- 9.3 vs. 13.3 +/- 3.3 min, p = 0.59) were similar. Recovery time (7.1 +/- 7.6 vs. 16.2 +/- 15.9 min, p = 0.0003) and interpretation time (9.1 +/- 2.8 vs. 13.5 +/- 4.4 min, p = 0.0001) were shorter for TAPSE than for DSE. CONCLUSIONS: Two-stage TAPSE permits rapid evaluation of cardiac patients. Peak cardiac index and patient acceptance scores were similar for TAPSE and DSE. Ischemia was detected more often with TAPSE; this result was attributed to the higher peak heart rate obtained with this protocol.

The virtual visit: using telecommunications technology to take care of patients.

Telephone-Linked Care (TLC) technology has been developed and applied as an alternative to and a supplement for office visits as a means to deliver ambulatory care. TLC is used to monitor patients with chronic diseases, counsel patients on important health behaviors, and provide information and support to home caregivers of patients with disabling conditions. TLC speaks to patients over the telephone in their homes using computer-controlled digitized human speech. Patients use their telephone keypad to communicate. TLC conversations last 2-15 minutes per call and take place weekly for periods of at least 3 months. The conversations consist of a salutation, password verification, the core clinical part, and a closing. The structure of the clinical part is similar for each of the application groups: chronic disease, health behavior, and caregiver support. The system architecture consists of linked voice and database components and their subcomponents. Preliminary evaluation indicates that TLC is well accepted by patients and their providers and can improve clinical outcomes.