***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 Heart failure ( HF ) is a chronic condition affecting nearly 5.7 million Americans and is a leading cause of morbidity and mortality . With an aging population , the cost associated with managing HF is expected to more than double from US $ 31 billion in 2012 to US $ 70 billion by 2030 . Readmission rates for HF patients are high—25 % are readmitted at 30 days and nearly 50 % at 6 months . Low medication adherence contributes to poor HF management and higher readmission rates .  Remote telehealth monitoring programs aim ed at improved medication management and adherence may improve HF management and reduce readmissions . Objective The primary goal of this r and omized controlled pilot study is to compare the MedSentry remote medication monitoring system versus usual care in older HF adult patients who recently completed a HF telemonitoring program .  We hypothesized that remote medication monitoring would be associated with fewer unplanned hospitalizations and emergency department ( ED ) visits , increased medication adherence , and improved health-related quality of life ( HRQoL ) compared to usual care . Methods Participants were r and omized to usual care or use of the remote medication monitoring system for 90 days . Twenty-nine participants were enrolled and the final analytic sample consisted of 25 participants . Participants completed question naires at enrollment and closeout to gather data on medication adherence , health status , and HRQoL. Electronic medical records were review ed for data on baseline classification of heart function and the number of unplanned hospitalizations and ED visits during the study period . Results Use of the medication monitoring system was associated with an 80 % reduction in the risk of all-cause hospitalization and a significant decrease in the number of all-cause hospitalization length of stay in the intervention arm compared to usual care . Objective device data indicated high adherence rates ( 95%-99 % ) among intervention group participants despite finding no significant difference in self-reported adherence between study arms . The intervention group had poorer heart function and HRQoL at baseline , and HRQoL declined significantly in the intervention group compared to controls . Conclusions The MedSentry medication monitoring system is a promising technology that merits continued development and evaluation . The MedSentry medication monitoring system may be useful both as a st and alone system for patients with complex medication regimens or used to complement existing HF telemonitoring interventions . We found significant reductions in risk of all-cause hospitalization and the number of all-cause length of stay in the intervention group compared to controls . Although HRQoL deteriorated significantly in the intervention group , this may have been due to the poorer HF-functioning at baseline in the intervention group compared to controls . Telehealth medication adherence technologies , such as the MedSentry medication monitoring system , are a promising method to improve patient self-management , the quality of patient care , and reduce health care utilization and expenditure for patients with HF and other chronic diseases that require complex medication regimens . Trial Registration Clinical Trials.gov NCT01814696 ; https:// clinical trials.gov/ct2/show/ study /NCT01814696 ( Archived by WebCite ® at http://www.webcitation.org/6giqAVhno Developing an evidence base for making public health decisions will require using data from evaluation studies with r and omized and nonr and omized design s. Assessing individual studies and using studies in quantitative research syntheses require transparent reporting of the study , with sufficient detail and clarity to readily see differences and similarities among studies in the same area . The Consoli date d St and ards of Reporting Trials ( CONSORT ) statement provides guidelines for transparent reporting of r and omized clinical trials . We present the initial version of the Transparent Reporting of Evaluations with Nonr and omized Design s ( TREND ) statement . These guidelines emphasize the reporting of theories used and descriptions of intervention and comparison conditions , research design , and methods of adjusting for possible biases in evaluation studies that use nonr and omized design Care transitions from the hospital to home remain a vulnerable time for many patients , especially for those with heart failure ( CHF ) and chronic obstructive pulmonary disease ( COPD ) . Despite regular use in chronic disease management , it remains unclear how technology can best support patients during their transition from the hospital . We sought to evaluate the impact of a technology-supported care transition support program on hospitalizations , days out of the community and mortality . Using a pragmatic r and omized trial , we enrolled patients ( 511 enrolled , 478 analyzed ) hospitalized with CHF/ COPD to  “ E-Coach , ” an intervention with condition-specific customization and in-hospital and post-discharge support by a care transition nurse ( CTN ) , interactive voice response post-discharge calls , and CTN follow-up versus usual post-discharge care ( UC ) . The primary outcome was 30-day rehospitalization . Secondary outcomes included ( 1 ) rehospitalization and death and ( 2 ) days in the hospital and out of the community . E-Coach and UC groups were similar at baseline except for gender imbalance ( p = 0.02 ) . After adjustment for gender , our primary outcome , 30-day rehospitalization rates did not differ between the E-Coach and UC groups ( 15.0 vs. 16.3 % , adjusted hazard ratio [ 95 % confidence interval ] : 0.94 [ 0.60 , 1.49 ] ) . However , in the COPD subgroup , E-Coach was associated with significantly fewer days in the hospital ( 0.5 vs. 1.6 , p = 0.03 ) . E-Coach , an IVR-augmented care transition intervention did not reduce rehospitalization . The positive impact on our secondary outcome ( days in hospital ) among COPD patients , but not in CHF , may suggest that E-Coach may be more beneficial among patients with COPD .NIH trial registry number : NCT01135381Trial Protocol : Background Comorbidity remains a matter of international interest , given growing prevalence of chronic conditions . Objective To evaluate the impact that adding a telephone coaching intervention by a family physician to usual care has on reducing re source consumption and improving health status , caregiver burden and quality of life among complex chronic patients ( CCP ) compared with usual care . Methods A r and omized controlled trial was conducted on a r and om sample of CCP from three primary care teams in Barcelona . Patients were r and omly allocated into intervention or control groups . Evaluations were conducted at baseline and after six-month follow-up . Intervention patients were phoned twice a month by a family physician . Both groups received usual care . Primary endpoint was change in total number of urgent visits per patient . Secondary endpoints were changes in health and mental status , quality of life and caregiver burden .  Results Hundred and sixty-one CCP were included . During follow-up , 9 patients died and 2 were lost . At baseline , patients ' characteristics and re source consumption were similar for both groups . After six months , urgent visits per patient decreased in intervention ( 1.27 baseline versus 0.89 follow-up , P = 0.091 ) and control ( 1.06 baseline versus 0.86 follow-up , P = 0.422 ) groups , mean difference 0.18 [ confidence interval ( CI ) 95 % -0.48 to 0.84 ] . Intervention patients improved in the physical component of the SF-12 question naire , while worsening in control patients , mean difference 4.71 ( CI 95 % -9.03 to -0.41 ) . Differences were not found in the rest of the endpoints . Conclusion The intervention did not reduce urgent visits among CCP neither improved patient 's health Background Antiretroviral therapy has changed the natural history of human immunodeficiency virus ( HIV ) infection in developed countries , where it has become a chronic disease . This clinical scenario requires a new approach to simplify follow-up appointments and facilitate access to healthcare professionals . Methodology We developed a new internet-based home care model covering the entire management of chronic HIV-infected patients . This was called Virtual Hospital . We report the results of a prospect i ve r and omised study performed over two years , comparing st and ard care received by HIV-infected patients with Virtual Hospital care . HIV-infected patients with access to a computer and broadb and were r and omised to be monitored either through Virtual Hospital ( Arm I ) or through st and ard care at the day hospital ( Arm II ) . After one year of follow up , patients switched their care to the other arm . Virtual Hospital offered four main services : Virtual Consultations , Telepharmacy , Virtual Library and Virtual Community . A technical and clinical evaluation of Virtual Hospital was carried out . Findings Of the 83 r and omised patients , 42 were monitored during the first year through Virtual Hospital  ( Arm I ) and 41 through st and ard care  ( Arm II ) . Baseline characteristics of patients were similar in the two arms . The level of technical satisfaction with the virtual system was high : 85 % of patients considered that Virtual Hospital improved their access to clinical data and they felt comfortable with the videoconference system . Neither clinical parameters [ level of CD4 + T lymphocytes , proportion of patients with an undetectable level of viral load ( p = 0.21 ) and compliance levels > 90 % ( p = 0.58 ) ] nor the evaluation of quality of life or psychological question naires changed significantly between the two types of care . Conclusions Virtual Hospital is a feasible and safe tool for the multidisciplinary home care of chronic HIV patients . Telemedicine should be considered as an appropriate support service for the management of chronic HIV infection . Trial Registration Clinical -Trials.gov : NCT01117675 Background Heart failure is a prevalent health problem associated with costly hospital readmissions . Transitional care programs have been shown to reduce readmissions but are costly to implement . Evidence regarding the effectiveness of telemonitoring in managing the care of this chronic condition is mixed . The objective of this r and omized controlled comparative effectiveness study is to evaluate the effectiveness of a care transition intervention that includes pre-discharge education about heart failure and post-discharge telephone nurse coaching combined with home telemonitoring of weight , blood pressure , heart rate , and symptoms in reducing all-cause 180-day hospital readmissions for older adults hospitalized with heart failure . Methods / Design A multi-center , r and omized controlled trial is being conducted at six academic health systems in California . A total of 1,500 patients aged 50 years and older will be enrolled during a hospitalization for treatment of heart failure . Patients in the intervention group will receive intensive patient education using the ‘ teach-back ’ method and receive instruction in using the telemonitoring equipment . Following hospital discharge , they will receive a series of nine scheduled health coaching telephone calls over 6 months from nurses located in a central ized call center . The nurses also will call patients and patients ’ physicians in response to alerts generated by the telemonitoring system , based on predetermined parameters . The primary outcome is readmission for any cause within 180 days . Secondary outcomes include 30-day readmission , mortality , hospital days , emergency department ( ED ) visits , hospital cost , and health-related quality of life . Discussion BEAT-HF is one of the largest r and omized controlled trials of telemonitoring in patients with heart failure , and the first explicitly to adapt the care transition approach and combine it with remote telemonitoring . The study population also includes patients with a wide range of demographic and socioeconomic characteristics . Once completed , the study will be a rich re source of information on how best to use remote technology in the care management of patients with chronic heart failure . Trial registration Clinical Trials.gov # NCT01360203 Background . Policy makers require estimates of comparative effectiveness that apply to the population of interest , but there has been little research on quantitative approaches to assess and extend the generalizability of r and omized controlled trial ( RCT ) –based evaluations . We illustrate an approach using observational data . Methods . Our example is the Whole Systems Demonstrator ( WSD ) trial , in which 3230 adults with chronic conditions were assigned to receive telehealth or usual care .  First , we used novel placebo tests to assess whether outcomes were similar between the RCT control group and a matched subset of non participants who received usual care . We matched on 65 baseline variables obtained from the electronic medical record . Second , we conducted sensitivity analysis to consider whether the estimates of treatment effectiveness were robust to alternative assumptions about whether “ usual care ” is defined by the RCT control group or non participants . Thus , we provided alternative estimates of comparative effectiveness by contrasting the outcomes of the RCT telehealth group and matched non participants . Results . For some endpoints , such as the number of outpatient attendances , the placebo tests passed , and the effectiveness estimates were robust to the choice of comparison group . However , for other endpoints , such as emergency admissions , the placebo tests failed and the estimates of treatment effect differed markedly according to whether telehealth patients were compared with RCT controls or matched non participants . Conclusions . The proposed placebo tests indicate those cases when estimates from RCTs do not generalize to routine clinical practice and motivate complementary estimates of comparative effectiveness that use observational data . Future RCTs are recommended to incorporate these placebo tests and the accompanying sensitivity analyses to enhance their relevance to policy making OBJECTIVE With the advent of personal health records and other patient-focused health technologies , there is a growing need to better underst and factors that contribute to acceptance and use of such innovations . In this study , we employed the Unified Theory of Acceptance and Use of Technology as the basis for determining what predicts patients ' acceptance ( measured by behavioral intention ) and perceived effective use of a web-based , interactive self-management innovation among home care patients . DESIGN Cross-sectional secondary analysis of data from a r and omized field study evaluating a technology-assisted home care nursing practice with adults with chronic cardiac disease . MEASUREMENT AND ANALYSIS : A question naire was design ed based on vali date d measurement scales from prior research and was completed by 101 participants for measuring the acceptance constructs as part of 
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The 34 articles selected identified  virtual support , telephone monitoring  and  electronic devices  as the main characteristics of tele-nursing ; the patient 's profile ( not young , with a low socio-economic and educational level ) and the  resistance of the nursing professionals  were the barriers identified ; while the new technological age was identified as a factor facilitating its implementation .