Seguimiento a largo plazo de un programa de prevención y cesación tabáquica en pacientes con fibrosis quística / Long term follow-up of a tobacco prevention and cessation program in cystic fibrosis patients

Este estudio evalúa el impacto en el tiempo de una intervención telefónica de prevención y cesación tabáquica dirigida a pacientes con fibrosis quística (FQ) en la Región de Murcia, España. Estudio prospectivo experimental en una cohorte de pacientes con FQ utilizando un programa integrativo de cesación tabáquica, entre 2008 y 2013. La población diana incluye a pacientes y familiares de la unidad regional de FQ. El estudio incluyó un cuestionario inicial de exposición al tabaco, medición de la función pulmonar, niveles de cotinina en orina, medidas antropomórficas y la intervención realizada en intervalos de tiempo. De los 88 pacientes seguidos, la tasa de fumadores activos se redujo de 10,23% a 4,55% (p = 0,06). La exposición al humo ambiental de tabaco se redujo en los pacientes no fumadores de 62,03% a 36,90% (p < 0,01) durante los cinco años de seguimiento. Se observaron reducciones significativas en la exposición al humo ambiental de tabaco en los hogares, de 31,65% (n = 25/79) a 19,05% (n = 16/84) en 2013 (p = <0,01). La cotinina se correlacionó significativamente con la exposición al tabaco activa y pasiva (p < 0,01) con una reducción significativa de los niveles de cotinina de 63,13 (28,58-97,69) a 20,56 (0,86-40,27) ng/ml (p < 0,01). La intervención para aumentar significativamente la probabilidad de abandono familiar (hogar libre de humo) fue de 1,26 (1,05-1,54). La intervención telefónica mantenida en el tiempo es una herramienta útil para la prevención y cesación tabáquica. Profesionales entrenados en este modelo de intervención con enfoque en salud medioambiental son necesarios para mejorar el tratamiento de FQ

This study evaluates the impact over time of a telephone-based intervention in tobacco cessation and prevention targeting patients with cystic fibrosis (CF) in the Mediterranean region of Murcia, Spain. We conducted an experimental prospective study with a cohort of CF patients using an integrative smoking cessation programme, between 2008 and 2013. The target population included family members and patients from the Regional CF unit. The study included an initial tobacco exposure questionnaire, measurement of lung function, urinary cotinine levels, anthropomorphic measures and the administered intervention at specific time intervals. Of the 88 patients tracked through follow-up, active smoking rates were reduced from 10.23% to 4.55% (p = 0.06). Environmental tobacco exposure was reduced in non-smoker patients from 62.03% to 36.90% (p < 0.01) during the five year follow-up. Significant reductions in the gradient of household tobacco smoke exposure were also observed with a decrease of 12.60%, from 31.65% (n = 25/79) to 19.05% (n = 16/84) in 2013 (p =<0.01). Cotinine was significantly correlated with both active and passive exposure (p<0.01) with a significant reduction of cotinine levels from 63.13 (28.58-97.69) to 20.56 (0.86-40.27) ng/ml (p<0.01). The intervention to significantly increase the likelihood of family quitting (smoke-free home) was 1.26 (1.05-1.54). Telephone based interventions for tobacco cessation and prevention is a useful tool when applied over time. Trained intervention professionals in this area are needed in the environmental health approach for the treatment of CF

Integrating tobacco cessation quitlines into health care: Massachusetts, 2002-2011.

QuitWorks is a Massachusetts referral program that links health care organizations, providers, and patients to the state's tobacco cessation quitline and provides feedback reporting. Designed collaboratively with all major Massachusetts health plans, QuitWorks was launched in April 2002. In 2010, approximately 340 institutions and practices used QuitWorks. Between April 2002 and March 2011, approximately 3,000 unique providers referred patients and 32,967 tobacco users received referrals. An analysis of QuitWorks data showed 3 phases in referrals between April 2002 and March 2011: referrals increased from April 2002 through November 2005, plateaued during December 2005 through January 2009, then substantially increased during February 2009 through March 2011. Factors responsible include partnerships with stakeholders, periodic program promotions, hospital activities in response to Joint Commission tobacco use measures, service evolutions, provision of nicotine replacement therapy for referred patients, and electronic referral options. QuitWorks' history demonstrates that tobacco cessation referral programs can be successfully sustained over time; reach substantial numbers of tobacco users, benefit providers and health care organizations; and contribute to sustainable systems-level changes in health care.

Clinical and cost effectiveness of mobile phone supported self monitoring of asthma: multicentre randomised controlled trial.

OBJECTIVE: To determine whether mobile phone based monitoring improves asthma control compared with standard paper based monitoring strategies. DESIGN: Multicentre randomised controlled trial with cost effectiveness analysis. SETTING: UK primary care. PARTICIPANTS: 288 adolescents and adults with poorly controlled asthma (asthma control questionnaire (ACQ) score ≥ 1.5) from 32 practices. INTERVENTION: Participants were centrally randomised to twice daily recording and mobile phone based transmission of symptoms, drug use, and peak flow with immediate feedback prompting action according to an agreed plan or paper based monitoring. MAIN OUTCOME MEASURES: Changes in scores on asthma control questionnaire and self efficacy (knowledge, attitude, and self efficacy asthma questionnaire (KASE-AQ)) at six months after randomisation. Assessment of outcomes was blinded. Analysis was on an intention to treat basis. RESULTS: There was no significant difference in the change in asthma control or self efficacy between the two groups (ACQ: mean change 0.75 in mobile group v 0.73 in paper group, mean difference in change -0.02 (95% confidence interval -0.23 to 0.19); KASE-AQ score: mean change -4.4 v -2.4, mean difference 2.0 (-0.3 to 4.2)). The numbers of patients who had acute exacerbations, steroid courses, and unscheduled consultations were similar in both groups, with similar healthcare costs. Overall, the mobile phone service was more expensive because of the expenses of telemonitoring. CONCLUSIONS: Mobile technology does not improve asthma control or increase self efficacy compared with paper based monitoring when both groups received clinical care to guidelines standards. The mobile technology was not cost effective. TRIAL REGISTRATION: Clinical Trials NCT00512837.

Health-related quality of life in a multicenter randomized controlled comparison of telephonic disease management and automated home monitoring in patients recently hospitalized with heart failure: SPAN-CHF II trial.

BACKGROUND: Although disease management programs have been shown to provide a number of clinical benefits to patients with heart failure (HF), the incremental impact of an automated home monitoring (AHM) system on health-related quality of life (HRQL) is unknown. METHODS AND RESULTS: We performed a prospective randomized investigation, examining the additive value of AHM to a previously described nurse-directed HF disease management program (SPAN-CHF), with attention to HRQL, in patients with a recent history of decompensated HF. A total of 188 patients were randomized to receive the SPAN-CHF intervention for 90 days, either with (AHM group) or without (NAHM, standard-care group) AHM, with a 1:1 randomization ratio after HF-related hospitalization. HRQL, measured by the Minnesota Living With Heart Failure Questionnaire (MLHFQ) (Physical, Emotional, and Total scores on MLHFQ) was assessed at 3 time points: baseline, 45 days, and 90 days. Although both treatments (AHM and NAHM) improved HRQL at 45 and 90 days compared with baseline with respect to Physical, Emotional, and Total domain scales, no significant difference emerged between AHM and NAHM groups. CONCLUSIONS: AHM and NAHM treatments demonstrated improved HRQL scores at 45 and 90 days after baseline assessment. When comparing 2 state-of the-art disease management programs regarding HRQL outcomes, our results did not support the added value of AHM.

Rapid implementation of a smokers' quitline fax referral service in an urban area.

PURPOSE: To increase use of fax referral services to a state smokers' quitline. DESIGN: Program evaluation. SETTING: A populous urban county. SUBJECTS: Smokers older than 17 years. INTERVENTION: In January 2005, a state-funded smoking cessation center began to offer training and technical assistance to clinical sites to expand tobacco control services. MEASURES: Proportion of each county's smokers referred to quitline. RESULTS: Prior to program onset, only one Bronx provider had made a fax referral to the quitline. In 2006, 943 fax referrals were made, representing 0.5% of all smokers in the county. This was a higher proportion than any other state county with an adult population exceeding 250,000. Bronx smokers are 2.47 times more likely to be fax-referred to the quitline than other smokers in New York. CONCLUSION: A program consisting of training and technical assistance, and emphasizing systems change, can markedly increase providers' use of quitline referral services.

Personal emergency alarms: what impact do they have on older people's lives?

OBJECTIVES: To determine if, how often and in what types of situations older people use personal alarms and to explore the impact of personal alarm technology on older people's lives. METHODS: This study was retrospective and involved a mail-out survey to 2610 users of the Silver Chain Care Link Personal Alarm Service. RESULTS: Clients wear their alarm consistently around their home and in the garden; however, use is low in the shower/bath and in bed at night. Clients reported positive impacts in terms of: gaining faster assistance in an emergency, extending the time they are able to remain living at home, increasing their sense of security, reducing anxiety about falling and increasing confidence in performing everyday activities. CONCLUSIONS: Personal alarms have many positive impacts on the lives of older people.

112. Teléfono de emergencias: ¿cómo funciona? / No disponible

El teléfono único de emergencias nace de la decisión dela Unión Europea que promueve la implantación de unúnico número para todas las emergencias, el 1-1-2, tomandocomo referente las experiencias de gestión integradadesarrolladas en los Países Escandinavos y los EstadosUnidos (AU)

The only phone of emergencies is born of the decision ofthe European Union that promotes the implantation of theonly number for all the emergencies, 1-1-2, taking likeregarding the experiences of integrated management developedin the Scandinavian Countries and the United States (AU)

TIPS: telephone intervention--problem solving for persons with schizophrenia.

A prospective experimental design was used to examine whether face-to-face meetings designed to establish rapport had an effect on the verbal responses of persons with schizophrenia in subsequent Telephone Intervention--Problem Solving (TIPS). Verbal responsiveness was operationalized as length of telephone conversation, number of feeling statements expressed, and number of one-word responses. Experimental participants met with the TIPS provider twice during hospitalization, while controls did not meet with the TIPS provider. All subjects received TIPS weekly from a psychiatric nurse for six weeks after hospital discharge. Compared to controls, experimental participants conversed longer at every measurement point, and significantly longer during weeks one through three. Experimental participants were approximately twice as likely to make a feeling statement as those in the control group. These data suggest that psychiatric nurses who would like to employ TIPS to support clients in the community should plan for at least two face-to-face interventions to establish rapport prior to initiating TIPS.

Validación de un protocolo telefónico para cardiopatía isquémica en emergencias sanitarias / Validation of a telephone questionannaire for Ischemic Cardiopathy in Emergency Healt Services

Fundamento: Ante la relevancia en la toma de decisiones en los centros de coordinación de una empresa de emergencias sanitarias, disponer de un instrumento (protocolo telefónico) científicamente validado permitiría una más adecuada asignación de recursos prioritarios, Unidad de Cuidados Intensivos, a estos pacientes demandantes de asistencia emergente. Esto es especialmente importante en los casos de cardiopatía isquémica, en los que una rápida actuación mejorará la supervivencia y calidad de vida posterior. El objetivo de este estudio ha sido la validación de un protocolo telefónico para cardiopatía isquémica en emergencias sanitarias. Material y métodos: Diseño: Estudio transversal de base extrahospitalaria. Ámbito de estudio: El estudio se ha realizado en cuatro provincias andaluzas (Almería, Cádiz, Granada y Jaén) de la Empresa Pública de Emergencias Sanitarias. Sujetos de estudio: La muestra objeto del estudio ha estado constituida por 736 pacientes con dolor torácico tomados de una muestra mayor constituida por 13.689 llamadas asistenciales a través de la línea 061. Instrumentalización: Se ha diseñado un cuestionario mediante un comité de 12 expertos. El cuestionario se le ha realizado a todas las llamadas asistenciales recibidas en los cuatro centros de coordinación que han participado en el estudio. Posteriormente mediante registros hospitalarios se ha realizado una identificación de casos diagnosticados de cardiopatía isquémica (Infarto agudo de miocardio y/o angina inestable). Se ha construido un modelo, mediante regresión logística, determinando su calibración (utilizando el test de Hosmer-Lemeshow) y su discriminación estudiando el área bajo la Curva ROC. Resultados: Se ha obtenido un protocolo final según modelo de regresión logística en el que se incluyen las siguientes seis variables: Presencia de antecedentes de cardiopatía isquémica, Edad mayor de 40 años, Dolor torácico irradiado a brazo izquierdo, Presencia de síntomas vegetativos entre un conjunto multisintomático, Disminución del dolor torácico tras la toma de nitritos y Sexo. El test de calibración presentó una 2 de 4,3613 con p=0,7374. Para la discriminación se ha calculado el área bajo la curva ROC (curva de rendimiento diagnóstico), obteniendo un área de 0,6904 y p<0,05.Conclusiones: El protocolo propuesto según modelo calibra y discrimina bien, selecciona adecuadamente a los pacientes con cardiopatía isquémica de aquellos que no la presenta (AU)

Mobile information and communication tools in the hospital.

Mobile information and communication systems in clinical routine have the potential to greatly improve communication, facilitate information access, eliminate double documentation, and increase quality of patient care in the long run. Projects to date have focused, for the most part, on highly specialized applications of the mobile computer. In our research project, 'Cooperative Problem Solving in Health Care', we have, among other things, designed a multifunctional mobile information and communication assistant. A prototype version of this system was implemented. This article outlines the close-to-reality evaluation of our prototype in a 1-week simulation study in a Heidelberg University hospital. We describe methods, aims, design and results of the simulation study, as well as discuss our methodology and the results we have obtained. We argue that the diverse requirements of different professional groups cannot be fulfilled by a single multifunctional device and propose, therefore, a 'multi-device mobile computer architecture'. Finally, we present consequences for the future computing infrastructure.

Servicios de atención telefónica: 0800-Salud

Artículo sobre las diferentes líneas gratuitas que asisten en casos de emergencia e informan sobre diferentes temas médicos en la Ciudad de Buenos Aires

Servicios de atención telefónica: 0800-Salud

Artículo sobre las diferentes líneas gratuitas que asisten en casos de emergencia e informan sobre diferentes temas médicos en la Ciudad de Buenos Aires

Atención telefónica para madres: Programa Pediatra en Casa

El servicio de atención telefónica para madres se encuentra incluído dentro del programa Pediatra en Casa, y está dirigido a la madre embarazada y en época de lactancia. Provee información necesaria, y cuenta con una guardia telefónica durante las 24 hs. del día

Boletín del servicio telefónico Salud Mental Responde

Informa sobre características del servicio de orientación telefónica e incluye el análisis de datos sobre atención en salud mental en el sector público

Boletín del servicio telefónico Salud Mental Responde

Informa sobre características del servicio de orientación telefónica e incluye el análisis de datos sobre atención en salud mental en el sector público

Atención telefónica para madres: Programa Pediatra en Casa

El servicio de atención telefónica para madres se encuentra incluído dentro del programa Pediatra en Casa, y está dirigido a la madre embarazada y en época de lactancia. Provee información necesaria, y cuenta con una guardia telefónica durante las 24 hs. del día