Older Adults' Coping With the Stress Involved in the Use of Everyday Technologies.

PURPOSE: This study was conducted to examine the frequency of reported use of everyday technologies (EDT) and its associations with self-efficacy, stress appraisal, and coping strategies. DESIGN AND METHODS: Cross-sectional data were collected from 150 participants (aged ≥ 65 years), measuring use of EDT by means of self-report questionnaires and a computerized simulator of an automatic teller machine (ATM), and EDT-related self-efficacy, stress appraisal, and coping strategies questionnaires. RESULTS: Structured equation modeling analysis showed that EDT-related self-efficacy was related to higher use of EDT, through the mediation of EDT-related stress and coping strategies. Logistic regression showed that use of ATM simulator was predicted by self-efficacy, younger age, and female gender. IMPLICATIONS: Enhancing EDT-self efficacy is suggested to increase the use of EDT among elder adults. The use of simulators may be an efficient mean to promote EDT self-efficacy and use.

Children referred to an emergency department by an after-hours call center: complaint-specific analysis.

BACKGROUND AND OBJECTIVES: Approximately 20% of phone calls to after-hours call centers result in referrals to the emergency department (ED), but data regarding ED management and disposition are lacking. We sought to determine the acuity of illness of referred children as reflected by triage classifications and need for therapeutic interventions, diagnostic testing, and hospitalization, and to stratify the analysis of ED management and dispositions by chief complaints. DESIGN AND METHODS: Patients referred to the ED by the after-hours call centers, without physician consultation, were identified. The 4 most common groups of chief complaints resulting in ED referral were determined, and the records of these children were analyzed. RESULTS: The 525 patients with chief complaints related to the following organ systems were studied: lower respiratory tract, 263 (50%); gastrointestinal, 104 (20%); head, ears, eyes, nose, and throat, 84 (16%); and upper respiratory tract, 74 (14%). The proportion of children referred for lower respiratory tract complaints who received the after-hours call centers call dispositions (99%) or ED triage classifications (38%) of highest priorities, or who required therapeutic interventions (73%), diagnostic testing (40%), or hospitalization (22%) was significantly higher than for all other categories. Thirteen percent with gastrointestinal complaints, referred primarily for dehydration, required intravenous fluids, and 2% of head, ears, eyes, nose, and throat patients required hospitalization. CONCLUSIONS: Children referred to the ED for illnesses related to the lower respiratory tract, principally wheezing, had illnesses of high acuity. On the other hand, current criteria for ED referral for children in the gastrointestinal, head, ears, eyes, nose, and throat, and upper respiratory tract categories result in the referral of many children with nonurgent problems. These data support a reassessment of current referral practices for children with these complaints.

[Control mechanisms in a telemarketing call center and workers' complaints of fatigue and exhaustion]. / Os mecanismos de controle da atividade no setor de teleatendimento e as queixas de cansaço e esgotamento dos trabalhadores.

This study describes the control mechanisms used in a telemarketing call center and compares them with workers' complaints previously filed through the respective trade union. Such complaints related to fatigue, mental exhaustion, and powerlessness in the face of a rigid work organization. The work in various divisions of a company with 2,285 employees was approached using ergonomic analysis methods and analysis of the system's management documents. Control mechanisms were classified according to: call time, content, comportment, volume of calls performed, and results. The conclusion was that the company relies on the telemarketers' mental and affective effort to achieve customer interaction and satisfaction, overcoming the difficulties as they arise without either surpassing the scheduled time limits as set by commercial targets or breaching the established controls.

After-hours telephone triage affects patient safety.

OBJECTIVE: To describe the management of after-hours calls to primary care physicians and identify potential errors that might delay evaluation and treatment. STUDY DESIGN: Survey of primary care practices and audit of after-hours phone calls. Ninety-one primary care offices (family medicine, internal medicine, obstetrics, and pediatrics) were surveyed in October and November 2001. Data collected included number of persons answering the calls, information requested, instructions to patients, who decided whether to contact the on-call physician, and subsequent handling of all calls. We evaluated all after-hours calls to an index office that were not forwarded to the on-call physician. Four family physicians independently reviewed the calls while unaware that these calls had not been forwarded to the physician on call to determine the appropriate triage. POPULATION: Primary care physicians and their telephone answering services. OUTCOME MEASURES (1) Who decided to initiate immediate contact with the physician? (2) Percentage of calls identified as emergent or nonemergent by patients. (3) Independent physician ratings of nonemergent calls. RESULTS: More than two thirds of the offices used answering services to take their calls. Ninety-three percent of the practices required the patient to decide whether the problem was emergent enough to require immediate notification of the on-call physician. Physician reviewers reported that 50% (range, 22%-77%) of the calls not forwarded to the on-call physician represented an emergency needing immediate contact with the physician. CONCLUSIONS: After-hours call systems in most primary care offices impose barriers that may delay care. All clinical patient calls should be sent to appropriately trained medical personnel for triage decisions. We urge all clinicians that use an answering service to examine their policies and procedures for possible sources of medical error.

'Voice mail on steroids' enhances communication, productivity of radiologists'.

Radiologists who discover an urgent medical problem with a patient are accustomed to picking up the phone to immediately contact the referring physician. But in today's busy world it may take several tries to get through to the other doctor, and occassionaly the message may not be received at all.

Qualidade do atendimento em um setor de planejamento familiar sob a percepção de usúarias / Attendance quality on planning family sector under user perception

Trata-se de uma pesquisa descritiva que teve como objetivo conhecer a opinião de usuárias de um Setor de Planejamento Familiar sobre a qualidade percebida acerca do atendimento recebido. O estudo foi realizado no Setor de Planejamento Familiar da Universidade Federal de São Paulo, sendo a amostra constituída por 271 mulheres que consentiram em participar da pesquisa, respondendo a um questionário semi-estruturado de saída. ...