Outcomes of a home telehealth intervention for patients with heart failure
We evaluated the efficacy of two telehealth applications, delivered by telephone and videophone, for improving outcomes of patients following hospital discharge for an acute exacerbation of heart failure. The outcomes measured were patient self-efficacy, satisfaction with care and knowledge of and compliance with prescribed medications. At hospital discharge, patients were randomly assigned to either control (usual care), telephone or videophone groups. Study nurses contacted the intervention patients each week for 90 days after discharge. A total of 148 patients were enrolled: 49 were randomized to usual care, 52 to the videophone intervention and 47 to the telephone intervention. At 90 days, 126 patients (85%) had completed follow-up; at 180 days, 109 patients (74%) had completed follow-up. There were no significant differences between the groups in medication compliance, self-efficacy or satisfaction with care. The intervention group patients were more likely to have had their medications adjusted during the 90-day intervention period. Knowledge scores improved in the intervention group patients, although these scores were lower at enrolment compared to the control group. It is possible that routine monitoring of symptoms by the study nurses led to medication adjustments and accounted for the intervention patients' significantly delayed time to readmission relative to the control patients.
Available from: Alison While
- "Rosser et al. concluded that technology based self-management systems could provide a practical method for both monitoring chronic illness health status as well as delivering therapeutic interventions to promote desired health behaviours and, indeed, this appears to be echoed in more recently published studies. There are an increasing number of trials reporting benefits including improved treatment adherence, disease knowledge and reduced hospital admissions arising from the use of telemonitoring in various forms especially related to heart failure (Dansky and Vasey, 2009; Bowles et al., 2009; Dang et al., 2009; Wakefield et al., 2009) although not all published trials have reported significant differences (Wootton et al., 2009). This variable effect of telephone interventions was noted in Stolic et al. (2010) review of 24 papers where seven studies demonstrated statistically significant differences in all outcomes measured while eight studies demonstrated some positive effects and nine studies reported no effect. "
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ABSTRACT: In the paper, according to a real example, the problem of setting up an organization meeting the urgent needs in fuzzy environments is proposed and the corresponding network model of the fuzzy shortest path with fuzzy time weight is constructed. Furthermore, the fuzzy decision algorithm for solving the optimal place of the organization is presented. Finally, the network model is popularized in several aspects.
Available from: Paolo Nistri
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ABSTRACT: In this paper we consider, under very general conditions, a constrained minimization problem and we associate to this problem a differential inclusion which has the property that all the trajectories converge to the set C of constrained critical points. The conditions on the functional to be minimized and on the function which defines the constraint are the minimal requirements on these data to use the tools of the nonsmooth analysis to show the convergence of the trajectories to C. Furthermore, if these functions are also subanalytic, then it is proved that any trajectory converges to a critical point and it has finite length. In fact, we show that these assumptions guarantee that the multivalued vector field defining the differential inclusion satisfies a Lojasiewicz-type inequality. The dependence of the rate of convergence on the values of the Lojasiewicz exponent is also shown.
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