***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Case management is believed to promote continuity of care and decrease hospitalization rates , although few controlled trials have tested this approach . OBJECTIVE To assess the effectiveness of a st and ardized telephonic case-management intervention in decreasing re source use in patients with chronic heart failure . METHODS A r and omized controlled clinical trial was used to assess the effect of telephonic case management on re source use .  Patients were identified at hospitalization and assigned to receive 6 months of intervention ( n = 130 ) or usual care ( n = 228 ) based on the group to which their physician was r and omized .  Hospitalization rates , readmission rates , hospital days , days to first rehospitalization , multiple readmissions , emergency department visits , inpatient costs , outpatient re source use , and patient satisfaction were measured at 3 and 6 months . RESULTS The heart failure hospitalization rate was 45.7 % lower in the intervention group at 3 months ( P = .03 ) and 47.8 % lower at 6 months ( P = .01 ) . Heart failure hospital days ( P = .03 ) and multiple readmissions ( P = .03 ) were significantly lower in the intervention group at 6 months . Inpatient heart failure costs were 45.5 % lower at 6 months ( P = .04 ) . A cost saving was realized even after intervention costs were deducted . There was no evidence of cost shifting to the outpatient setting . Patient satisfaction with care was higher in the intervention group . CONCLUSIONS The reduction in hospitalizations , costs , and other re source use achieved using st and ardized telephonic case management in the early months after a heart failure admission is greater than that usually achieved with pharmaceutical therapy and comparable with other disease management approaches Background .The high cost of caring for patients with congestive heart failure ( CHF ) results primarily from frequent hospital readmissions for exacerbations . Home nurse visits after discharge can reduce readmissions , but the intervention costs are high . Objectives .To compare the effectiveness of three hospital discharge care models for reducing CHF-related readmission charges : 1 ) home telecare delivered via a 2-way video-conference device with an integrated electronic stethoscope ; 2 ) nurse telephone calls ; and 3 ) usual outpatient care . Research Design . One-year r and omized trial . Subjects . English-speaking patients 40 years of age and older with a primary hospital admission diagnosis of CHF . Measures .Our primary outcome was CHF-related readmission charges during a 6-month period after r and omization . Secondary outcomes included all-cause readmissions , emergency department ( ED ) visits , and associated charges . Results .Thirty-seven subjects were r and omized : 13 to home telecare , 12 each telephone care and 12 to usual care .  Mean CHF-related readmission charges were 86 % lower in the telecare group ( $ 5850 , SD $ 21,094 ) and 84 % lower in the telephone group ( $ 7320 , SD $ 24,440 ) than in the usual care group ( $ 44,479 , SD $ 121,214 ) . However , the between-group difference was not statistically significant . Both intervention groups had significantly fewer CHF-related ED visits ( P = 0.0342 ) and charges ( P = 0.0487 ) than the usual care group . Trends favoring both interventions were noted for all other utilization outcomes . Conclusions .Substantial reductions in hospital readmissions , emergency visits , and cost of care for patients with CHF might be achieved by widespread deployment of distance technologies to provide posthospitalization monitoring . Home telecare may not offer incremental benefit beyond telephone follow-up and is more expensive This study evaluated the impact of telemedicine technology on the provision of neurosurgical health services . We focused on the differences between the use of real time audio-visual teleconferencing and teleradiology versus conventional telephone consultations in the referral of neurosurgical patients from a large district general hospital . All patients requiring emergency neurosurgical consultation were included for r and omization into  telephone consultation only  ( Mode A ) ,  teleradiology and telephone consultation ( Mode B ) and video-consultation ( Mode C ) . Measures of effectiveness included diagnostic accuracy and adverse events during the transfer and Glasgow Outcome Score . In a 10-month period , 327 patients were recruited and r and omized into the study : the male/female ratio was 2:1 and the number of patients required to be transferred to the neurosurgical unit was 125 ( 38 % ) . There was a trend towards a more favourable outcome in the video-consultation mode ( 44 % , Mode C ) , versus teleradiology ( 31 % , Mode B ) , versus telephone consultation ( 38 % , Mode A ) . The interim data of this prospect i ve r and omized trial suggests that video-consultation may have a favourable impact on emergency neurosurgical consultations Existing st and ards of the management of the diabetic patients are not efficient enough , and further improvement is needed . The major objective of this paper is to present and discuss the therapeutic effectiveness of an intensive care telematic system design ed and applied for intensive treatment of pregnant type 1 diabetic women . The developed system operates automatically , every night transferring all the data recorded during the day in the patient 's glucometer memory to a central clinical unit . In order to assess the efficiency of the design ed and developed system , a 3-year r and omized prospect i ve clinical trial was conducted , using the study group and the control group , each consisting of 15 pregnant type 1 diabetic women . All patients were treated by the same diabetologist . In the presented analysis , two indices calculated weekly were used for the assessment of glycemic control : MBG represents mean blood glucose level , and the universal J-index is sensitive to the glycemic level and glycemic variations . The most important results from the study concern : ( a ) better glycemic control in the study group in comparison with the control group during the course of treatment , as assessed by the average differences of the MBG and J indices calculated weekly ( n = 24 ) ( deltaMBG = -3.2 + /- 4.3 mg/dL , p = 0.0016 , deltaJ = -1.4 + /- 2.3 , p = 0.0065 ) ; ( b ) much more similar results in glycemic control among members of the study group compared to each other , than among members of the control group compared to each other , as indicated by significantly lower variations of the applied glycemic control indices ( SDMBG : 11.9 vs. 18.7 mg/dL , p = 0.0498 ; SDJ : 6.5 vs. 10.9 , p = 0.0318 ) ; ( c ) the observed tendency of a better glycemic control for patients with a lower level of intelligence ( IQ < 100 ) supported by the telematic system in comparison with all other assessed groups of patients . The last result was not statistically significant ( p > 0.05 ) . This telematic intensive care system improved the effectiveness of diabetes treatment during pregnancy . It also allows the diabetologist 's strategy to be much more precise than if it were conducted without telematic support . This telematic system is inexpensive and simple in use OBJECTIVE To test the hypothesis that telemedicine for new patient referrals to neurological out patients is as efficient and acceptable as conventional face to face consultation . METHODS A r and omised controlled trial between two groups : face to face ( FF ) and telemedicine ( TM ) . This study was carried out between a neurological centre and outlying clinics at two distant hospitals linked by identical medium cost commercial interactive video conferencing equipment with ISDN lines transmitting information at 384 kbits/s . The same two neurologists carried out both arms of the study . Of the 168 patients who were suitable for the study , 86 were r and omised into the telemedicine group and 82 into the face to face group .  Outcome measures were ( 1 ) consultation process : ( a ) number of investigations ; ( b ) number of drugs prescribed ; ( c ) number of patient review s and ( 2 ) patient satisfaction : ( a ) confidence in consultation ; ( b ) technical aspects of consultation ; ( c ) aspects surrounding confidentiality . Diagnostic categories were also measured to check equivalence between the groups : these were structural neurological , structural non-neurological , non-structural , and uncertain . RESULTS Diagnostic categories were similar ( p>0.5 ) between the two groups . Patients in the telemedicine group had significantly more investigations ( p=0.001 ) . There was no difference in the number of drugs prescribed ( p>0.5 ) . Patients were generally satisfied with both types of consultation process except for concerns about confidentiality and embarrassment in the telemedicine group ( p=0.017 and p=0.005 respectively ) . CONCLUSION Telemedicine for new neurological out patients is possible and feasible but generates more investigations and is less well accepted than face to face examination The dem and for home health care has skyrocketed in recent years . The aging population and the push for more efficient delivery of hospital services have fueled this growing dem and . However , health care financing reforms have constrained the industry 's growth . Home health agencies struggle to deliver high- quality services while staying within the financial limitations imposed by reimbursement changes . Telehomecare is one way to provide cost-effective care in the current environment . Personal computers and video equipment can transmit data over ordinary telephone lines and allow home health providers to monitor patients and provide care at a much lower cost than earlier technologies that required wider b and width telephone lines and more complex equipment . But can telehomecare yield cost-savings for home health agencies ? This article addresses the costs associated with a  telehomecare  intervention  in a large , urban , home health agency . The purpose of the study was two-fold : ( 1 ) to test the effects of telehomecare on clinical outcomes , and ( 2 ) to estimate the financial costs associated with providing telehomecare services . Our results show that , while telehomecare imposes additional expenses for care delivery , it contributes substantial savings without compromising quality . Additionally , we found that the financial benefit increases exponentially as the duration of the patient care episode increases A r and omized controlled trial was conducted to compare the costs of realtime teleneurology  with the cost of  conventional neurological care . Two district hospitals in Northern Irel and were equipped with videoconferencing units and were connected to the regional neurological centre by ISDN at 384 kbit/s . Of 168 patients r and omized to the study , 141 kept their appointments ( 76 male , 65 female ) . Sixty-five patients were r and omized to a conventional consultation while 76 were r and omized to a teleconsultation . The average age was 44 years of those seen conventionally and 42 years of those seen by telemedicine .  The groups had similar diagnoses . The telemedicine group required more investigations and review s than the conventional  group . The average cost of the conventional consultation  was £ 49 compared with £ 72 for the teleconsultation . Realtime teleneurology was not as cost-effective as conventional care Since 1997 , more than 2,700 home care agencies have closed due to changes in reimbursement . With the implementation of a prospect i ve payment system , there is concern -- not only regarding the survival of the remaining home care agencies , but also whether adequate care can be provided to the patient . Chronic wound care is both prevalent and costly in home care . Factors contributing to cost include inconsistency of wound assessment and documentation and low usage of advanced wound products . These factors lead to lengthened healing time , more frequent visits by practitioners , and low healing rates . Involving a wound specialist can improve patient outcomes while decreasing cost . The authors examined the utilization of telemedicine in situations where wound specialists consulted with the home health nurse in the patient 's home regarding care of chronic wounds . During the two-way video visit , the wound specialist assessed the patient and the wounds and made recommendations for treatment . The wound specialist also collected outcome data during the visits . This data was then compared with like data collected as a baseline prior to the telemedicine intervention . Results revealed improved healing rates , decreased healing time , decreased number of home health visits , and a decreased number of hospitalizations related to wound complications .  Telemedicine was deemed a viable option for delivering quality , cost-effective care to chronic wound patients in the home care setting OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised 
    Output:
    
For a number of other applications , reports of clinical or economic benefits essentially confirmed previous findings .