Finn Olesen

The effect of real-time teleconsultations between hospital-based nurses and patients with severe COPD discharged after an exacerbation

Summary We investigated the effect of daily real-time teleconsultations for one week between hospital-based nurses specialised in respiratory diseases and patients with severe COPD discharged after acute exacerbation. Patients admitted with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) at two hospitals were recruited at hospital discharge. They were randomly assigned to intervention or control. The telemedicine equipment consisted of a briefcase with built-in computer including a web camera, microphone and measurement equipment. The primary outcome was the mean number of total hospital readmissions within 26 weeks of discharge. A total of 266 patients (mean age 72 years) were allocated to either intervention (n = 132) or control (n = 134). There was no significant difference in the unconditional total mean number of hospital readmissions after 26 weeks: mean 1.4 (SD 2.1) in the intervention group and 1.6 (SD 2.4) in the control group. In a secondary analysis, there was no significant difference between the two groups in mortality, time to readmission, mean number of total hospital readmissions, mean number of readmissions with AECOPD, mean number of total hospital readmission days or mean number of readmission days with AECOPD calculated at 4, 8, 12 and 26 weeks. Thus the addition of one week of teleconsultations between hospital-based nurses and patients with severe COPD discharged after hospitalisation did not significantly reduce readmissions or affect mortality.

Rhetorical Authority in STS: Reflections on a Study of IT Implementation at a Hospital Ward

In Denmark as in other European countries, information technologies have become an important political topic in ways that relate to the role of the university in society. The politicization is usually based on the understanding that ‘science and technology shape society’ (Bijker et al., 1993, p. 3), which can be named technological determinism. Technological innovation is considered a driving force in social development, as if technology forms a rational structure, effecting progress and anticipating the future. Further, innovation is often understood as the outcome of a collaborative process between researchers at the university and private firms or public institutions in order to develop new technologies. In this view usefulness is turned into a primarily technological and economic issue. But what might one do, if it is precisely this idea of technology and progress one wants to debate? How can we question dominant images of technology, and find ways of reimagining the techno-scientific world we live in? Under the present circumstances, what are our possibilities for intervening and making a difference? This is a challenge that scholars in science and technology studies (STS) face, in general, and that we, in particular, faced when we carried out an STS study of IT in the health sector some years ago. In this paper we will examine the idea of intervention based on this project. We take as a starting point the notion of rhetorical authority developed by Michael Lynch as it expresses a view on scholarly practices that we find important. We sketch the research environment, and the options that we faced when we arranged the project at the outset. Subsequently we introduce the idea of ‘naturally occurring experiments’ as an appropriate methodological device, which can be contrasted with conventional ideas about scientific method. On this basis we account for the course of our project regarding the introduction of a medication module in an electronic patient record (EPR) at a Danish hospital ward. We focus on various discourses on technology that we identified in our experiments and how they perform technology differently, and on how we happened to make ourselves relevant to people engaged in the work of developing and implementing EPRs. Finally we Science as Culture Vol. 16, No. 3, 267–279, September 2007