human
***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 treatment guidelines emphasize daily weight monitoring for patients with heart failure , but data to support this practice are lacking . Using a technology-based heart failure monitoring system , we determined whether daily reporting of weight and symptoms in patients with advanced heart failure would reduce rehospitalization and mortality rates despite aggressive guideline -driven heart failure care . METHODS This was a r and omized , controlled trial . Patients hospitalized with New York Heart Association class III or IV heart failure , with a left ventricular ejection fraction < or = 35 % were r and omized to receive heart failure program care or heart failure program care plus the AlereNet system ( Alere Medical , Reno , Nev ) and followed-up for 6 months . The primary end point was 6-month hospital readmission rate . Secondary end points included mortality , heart failure hospitalization readmission rate , emergency room visitation rate , and quality of life . RESULTS Two hundred eighty patients from 16 heart failure centers across the United States were r and omized : 138 received the  AlereNet system and 142 received st and ard care .  Mean age was 59 + /- 15 years and 68 % were male . The population had very advanced heart failure , New York Heart Association class III ( 75 % ) or IV ( 25 % ) , as evidence d by serum norepinepherine levels , 6-minute walk distance and outcomes .  No differences in hospitalization rates were observed . There was a 56.2 % reduction in mortality ( P < .003 ) for patients r and omized to the AlereNet group . CONCLUSIONS This is the largest multicenter , r and omized trial of a technology-based daily weight and symptom-monitoring system for patients with advanced heart failure . Despite no difference in the primary end point of rehospitalization rates , mortality was significantly reduced for patients r and omized to the AlereNet system without an increase in utilization , despite specialized and aggressive heart failure care in both groups Education programs for intensive insulin therapy were found to be valuable in improving glycemic control , but , due to low prevalence of type 1 diabetes in children and adolescents , access to those programs varies considerably in rural areas . We report on a telemedical care program that overcomes geographical isolation of patients on intensive insulin therapy . Sixty-one children and adolescents under the age of 26 participated in a telemedical care program . They stored daily information on blood glucose , injected insulin , meals and exercise  in a glucosemeter with electronic memory and transferred the data via modem go a remote diabetes center outside of the region . By individual telephone consultations from home , they review ed the data with a diabetologist at the diabetes center and adjusted their intensive insulin therapy in order to achieve predefined treatment goals . Patients were trained for 19 ( 6 - 48 ) weeks in the program and measured blood glucose 4.9 ( 1.7 - 4.9 ) times daily . Compared to the run-in-period , mean blood glucose had decreased ( 167 to 158 mg/dL , p < 0.01 ) , st and ard deviation of blood glucose had decreased ( 81 to 70 mg/dL , p < 0.001 ) , and frequency of hypoglycemia had decreased ( 5.2 to 3.3 in 4 weeks , p = 0.01 ) at the end of the program . The proportion of blood glucose values within the target range ( 80 - 180 mg/dL ) had increased ( 47 - 55 % , p < 0.001 ) . HbAlc was reduced by 0.4 % ( -3.8 to + 2.2 % , p < 0.05 ) . Telemedical care for intensive insulin therapy is safe , can improve glycemic control , and reduce the number of hypoglycemias in children and adolescents with type 1 diabetes PURPOSE Self-monitoring of blood glucose has become routine practice in the management of diabetes mellitus . When all the data is complete , however , the amount of information to be taken into account when making therapeutic decisions becomes overwhelming not only for the patient but for the healthcare provider . Computers excel at processing large amounts of information quickly and impassively , which makes them potentially helpful for collating and communicating the data in a manner that facilitates decision-making by patient and healthcare provider . This should in turn improve control and help prevent acute and chronic complications . METHOD Using the Vista 350 telephone , we have developed a system that enables patients with diabetes to record home monitoring data to a central data base and receive feedback summaries . A small trial was conducted to determine if the Vista 350 telephone is an acceptable and feasible method to communicate the results of home monitoring of diabetes mellitus to a central data base and receive feedback summaries . A total of 35 volunteers with insulin-requiring diabetes mellitus in the London area were r and omly allocated to either use the Vista 350 phone for 6 months , or to a control group that continued to use traditional methods for recording home monitoring data . RESULTS 33 of the 35 patients enrolled completed the trial . All 16 patients who began using the phone continued to do so for 6 months confirming the feasibility of the system . Question naires completed at 3 and 6 months confirmed the Vista 350 telephone system to be acceptable to the subjects . The results will enable some minor modifications to be made to the telephone system before a larger definitive trial , design ed to determine the effect on diabetes control , is conducted later this year No " white coat " effect contaminated the validity of measurements in 30 participants in a " Telepress " program , in which subscribers to a telecardiologic facility transtelephonically transmit their self-measured blood pressure values OBJECTIVES We sought to identify whether home telemonitoring ( HTM ) improves outcomes compared with nurse telephone support ( NTS ) and usual care ( UC ) for patients with heart failure who are at high risk of hospitalization or death . BACKGROUND Heart failure is associated with a high rate of hospitalization and poor prognosis . Telemonitoring could help implement and maintain effective therapy and detect worsening heart failure and its cause promptly to prevent medical crises . METHODS Patients with a recent admission for heart failure and left ventricular ejection fraction ( LVEF ) < 40 % were assigned r and omly to HTM , NTS , or UC in a 2:2:1 ratio . HTM consisted of twice-daily patient self-measurement of weight , blood pressure , heart rate , and rhythm with automated devices linked to a cardiology center . The NTS consisted of specialist nurses who were available to patients by telephone . Primary care physicians delivered UC . The primary end point was days dead or hospitalized with NTS versus HTM at 240 days . RESULTS Of 426 patients r and omly assigned , 48 % were aged > 70 years , mean LVEF was 25 % ( SD , 8) and median plasma N-terminal pro-brain natriuretic peptide was 3,070 pg/ml ( interquartile range 1,285 to 6,749 pg/ml ) . During 240 days of follow-up , 19.5 % , 15.9 % , and 12.7 % of days were lost as the result of death or hospitalization for UC , NTS , and HTM , respectively ( no significant difference ) . The number of admissions and mortality were similar among patients r and omly assigned to NTS or HTM , but the mean duration of admissions was reduced by 6 days ( 95 % confidence interval 1 to 11 ) with HTM . Patients r and omly assigned to receive UC had higher one-year mortality ( 45 % ) than patients assigned to receive NTS ( 27 % ) or HTM ( 29 % ) ( p = 0.032 ) . CONCLUSIONS Further investigation and refinement of the application of HTM are warranted because it may be a valuable role for the management of selected patients with heart failure OBJECTIVE To evaluate the effectiveness of at-home infrared temperature monitoring as a preventative tool in individuals at high risk for diabetes-related lower-extremity ulceration and amputation . RESEARCH DESIGN AND METHODS Eighty-five patients who fit diabetic foot risk category 2 or 3 ( neuropathy and foot deformity or previous history of ulceration or partial foot amputation ) were r and omized into a st and ard therapy group ( n = 41 ) or an enhanced therapy group ( n = 44 ) . St and ard therapy consisted of therapeutic footwear , diabetic foot education , and regular foot evaluation by a podiatrist . Enhanced therapy included the addition of a h and held infrared skin thermometer to measure temperatures on the sole of the foot in the morning and evening . Elevated temperatures ( > 4 degrees F compared with the opposite foot ) were considered to be " at risk " of ulceration due to inflammation at the site of measurement . When foot temperatures were elevated , subjects were instructed to reduce their activity and contact the study nurse . Study subjects were followed for 6 months . RESULTS The enhanced therapy group had significantly fewer diabetic foot complications ( enhanced therapy group 2 % vs. st and ard therapy group 20 % , P = 0.01 , odds ratio 10.3 , 95 % CI 1.2 - 85.3 ) . There were seven ulcers and two Charcot fractures among st and ard therapy patients and one ulcer in the enhanced therapy group . CONCLUSIONS These results suggest that at-home patient self-monitoring with daily foot temperatures may be an effective adjunctive tool to prevent foot complications in individuals at high risk for lower-extremity ulceration and amputation BACKGROUND Outcomes related to chronic heart failure ( HF ) remain relatively poor , despite advances in pharmacological therapy and medical and nursing care . Experts agree that outpatient care may be among the factors that affect HF outcomes . We hypothesized that the method by which outpatient care is delivered may affect outcomes in this patient population . METHODS A prospect i ve , r and omized design was used to compare HF outcomes from 216 patients r and omized to 1 of 2 home health care delivery methods for 3 months after discharge . Care was delivered by the home nurse visit ( HNV ) or the nurse telemanagement ( NTM ) method . In the latter , patients used transtelephonic home monitoring devices to measure their weight , blood pressure , heart rate , and oxygen saturation . These data were transmitted daily to a secure Internet site . An advanced- practice nurse worked collaboratively with a cardiologist and subsequently treated patients via the telephone . Both delivery methods used the same HF-specific clinical guidelines to direct care . Outcomes include HF readmissions and length of stay , anxiety , depression , self-efficacy , and quality of life . Data were primarily tested using a 2-group analysis of variance ( ANOVA ) . We used a repeated- measures ANOVA to conduct preintervention-postintervention analyses . RESULTS After 3 months , patients in the  NTM group ( n = 108 ; mean + /- SD age , 62.9 + /- 13.2 years ; 83 % African American ; 64 % female ) had fewer HF readmissions ( 13 vs 24 ; P</=.001 ) with shorter lengths of stay ( 49.5 vs 105.0 days ; P</=.001 ) compared with the HNV group ( n = 108 ; mean + /- SD age , 63.2 + /- 12.6 years ; 89 % African American ; 62 % female ) . Hospitalization charges at 3 months were less in the NTM group compared with the HNV group ( $ 65 023 vs $ 177 365 ; P</=.02 ) . At 6 and 12 months , cumulative readmission charges in the NTM group were also less ( $ 223 638 vs $ 500 343 [ P<.03 ] and $ 541 378 vs $ 677 710 [ P</=.16 ] , respectively ) compared with the HNV group . Quality of life was significantly improved for both groups when we compared postintervention and preintervention scores . CONCLUSION The adaptation of state-of-the-art computerized technology to closely monitor patients with HF with advanced- practice nurse care under the guidance of a cardiologist significantly improves HF management while reducing the cost of care We assessed the utilization of health-care services and clinical outcomes in veterans with diabetes who were enrolled in two care coordination/home telehealth programmes .  One group of patients was monitored weekly  ( n = 197 ) , with more intensive evaluations , while the other was monitored daily ( n = 100 ) , but less intensively . Although patients in the two groups were fairly similar in demographic terms and in their clinical characteristics at baseline , they had different service utilization patterns during the 12-month pre-enrollment period . Over the 12-month study period , the proportion of one or more hospital admissions and number of bed days of care decreased in the daily monitoring group , and increased in the weekly monitoring group , more or less doubling in the former and being halved in the latter . Unscheduled primary care clinic visits were lower in the daily monitored group than in the weekly monitored group . The differences between the two groups were significant ( P < 0.01 ) . There were no significant differences between the groups in the clinical outcomes . Future research should employ r and omized controlled trial design s to determine if intensities of home monitoring lead to differences in service utilization and health outcomes This is a controlled pilot study of twenty patients to see if heart failure management can be optimised in the community using telemedicine . The study seeks to examine the feasibility , acceptability and reliability of using telemedicine in this context . Heart failure is a common condition . It is an important cause of mortality and morbidity and has large cost implication s for the NHS . Most patients are managed in the UK in General Practice based on clinical assess 
    Output:
    
agent
RESULTS The magnitude and significance of the telemonitoring effects on patients ' conditions ( e.g. , early detection of symptoms , decrease in blood pressure , adequate medication , reduced mortality ) still remain inconclusive for all four chronic illnesses .
However , the results of this study suggest that regardless of their nationality , socioeconomic status , or age , patients comply with telemonitoring programs and the use of technologies .
Importantly , the telemonitoring effects on clinical effectiveness outcomes ( e.g. , decrease in the emergency visits , hospital admissions , average hospital length of stay ) are more consistent in pulmonary and cardiac studies than diabetes and hypertension .
Home telemonitoring of chronic diseases seems to be a promising patient management approach that produces accurate and reliable data , empowers patients , influences their attitudes and behaviors , and potentially improves their medical conditions .
***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 treatment guidelines emphasize daily weight monitoring for patients with heart failure , but data to support this practice are lacking . Using a technology-based heart failure monitoring system , we determined whether daily reporting of weight and symptoms in patients with advanced heart failure would reduce rehospitalization and mortality rates despite aggressive guideline -driven heart failure care . METHODS This was a r and omized , controlled trial . Patients hospitalized with New York Heart Association class III or IV heart failure , with a left ventricular ejection fraction < or = 35 % were r and omized to receive heart failure program care or heart failure program care plus the AlereNet system ( Alere Medical , Reno , Nev ) and followed-up for 6 months . The primary end point was 6-month hospital readmission rate . Secondary end points included mortality , heart failure hospitalization readmission rate , emergency room visitation rate , and quality of life . RESULTS Two hundred eighty patients from 16 heart failure centers across the United States were r and omized : 138 received the  AlereNet system and 142 received st and ard care .  Mean age was 59 + /- 15 years and 68 % were male . The population had very advanced heart failure , New York Heart Association class III ( 75 % ) or IV ( 25 % ) , as evidence d by serum norepinepherine levels , 6-minute walk distance and outcomes .  No differences in hospitalization rates were observed . There was a 56.2 % reduction in mortality ( P < .003 ) for patients r and omized to the AlereNet group . CONCLUSIONS This is the largest multicenter , r and omized trial of a technology-based daily weight and symptom-monitoring system for patients with advanced heart failure . Despite no difference in the primary end point of rehospitalization rates , mortality was significantly reduced for patients r and omized to the AlereNet system without an increase in utilization , despite specialized and aggressive heart failure care in both groups Education programs for intensive insulin therapy were found to be valuable in improving glycemic control , but , due to low prevalence of type 1 diabetes in children and adolescents , access to those programs varies considerably in rural areas . We report on a telemedical care program that overcomes geographical isolation of patients on intensive insulin therapy . Sixty-one children and adolescents under the age of 26 participated in a telemedical care program . They stored daily information on blood glucose , injected insulin , meals and exercise  in a glucosemeter with electronic memory and transferred the data via modem go a remote diabetes center outside of the region . By individual telephone consultations from home , they review ed the data with a diabetologist at the diabetes center and adjusted their intensive insulin therapy in order to achieve predefined treatment goals . Patients were trained for 19 ( 6 - 48 ) weeks in the program and measured blood glucose 4.9 ( 1.7 - 4.9 ) times daily . Compared to the run-in-period , mean blood glucose had decreased ( 167 to 158 mg/dL , p < 0.01 ) , st and ard deviation of blood glucose had decreased ( 81 to 70 mg/dL , p < 0.001 ) , and frequency of hypoglycemia had decreased ( 5.2 to 3.3 in 4 weeks , p = 0.01 ) at the end of the program . The proportion of blood glucose values within the target range ( 80 - 180 mg/dL ) had increased ( 47 - 55 % , p < 0.001 ) . HbAlc was reduced by 0.4 % ( -3.8 to + 2.2 % , p < 0.05 ) . Telemedical care for intensive insulin therapy is safe , can improve glycemic control , and reduce the number of hypoglycemias in children and adolescents with type 1 diabetes PURPOSE Self-monitoring of blood glucose has become routine practice in the management of diabetes mellitus . When all the data is complete , however , the amount of information to be taken into account when making therapeutic decisions becomes overwhelming not only for the patient but for the healthcare provider . Computers excel at processing large amounts of information quickly and impassively , which makes them potentially helpful for collating and communicating the data in a manner that facilitates decision-making by patient and healthcare provider . This should in turn improve control and help prevent acute and chronic complications . METHOD Using the Vista 350 telephone , we have developed a system that enables patients with diabetes to record home monitoring data to a central data base and receive feedback summaries . A small trial was conducted to determine if the Vista 350 telephone is an acceptable and feasible method to communicate the results of home monitoring of diabetes mellitus to a central data base and receive feedback summaries . A total of 35 volunteers with insulin-requiring diabetes mellitus in the London area were r and omly allocated to either use the Vista 350 phone for 6 months , or to a control group that continued to use traditional methods for recording home monitoring data . RESULTS 33 of the 35 patients enrolled completed the trial . All 16 patients who began using the phone continued to do so for 6 months confirming the feasibility of the system . Question naires completed at 3 and 6 months confirmed the Vista 350 telephone system to be acceptable to the subjects . The results will enable some minor modifications to be made to the telephone system before a larger definitive trial , design ed to determine the effect on diabetes control , is conducted later this year No " white coat " effect contaminated the validity of measurements in 30 participants in a " Telepress " program , in which subscribers to a telecardiologic facility transtelephonically transmit their self-measured blood pressure values OBJECTIVES We sought to identify whether home telemonitoring ( HTM ) improves outcomes compared with nurse telephone support ( NTS ) and usual care ( UC ) for patients with heart failure who are at high risk of hospitalization or death . BACKGROUND Heart failure is associated with a high rate of hospitalization and poor prognosis . Telemonitoring could help implement and maintain effective therapy and detect worsening heart failure and its cause promptly to prevent medical crises . METHODS Patients with a recent admission for heart failure and left ventricular ejection fraction ( LVEF ) < 40 % were assigned r and omly to HTM , NTS , or UC in a 2:2:1 ratio . HTM consisted of twice-daily patient self-measurement of weight , blood pressure , heart rate , and rhythm with automated devices linked to a cardiology center . The NTS consisted of specialist nurses who were available to patients by telephone . Primary care physicians delivered UC . The primary end point was days dead or hospitalized with NTS versus HTM at 240 days . RESULTS Of 426 patients r and omly assigned , 48 % were aged > 70 years , mean LVEF was 25 % ( SD , 8) and median plasma N-terminal pro-brain natriuretic peptide was 3,070 pg/ml ( interquartile range 1,285 to 6,749 pg/ml ) . During 240 days of follow-up , 19.5 % , 15.9 % , and 12.7 % of days were lost as the result of death or hospitalization for UC , NTS , and HTM , respectively ( no significant difference ) . The number of admissions and mortality were similar among patients r and omly assigned to NTS or HTM , but the mean duration of admissions was reduced by 6 days ( 95 % confidence interval 1 to 11 ) with HTM . Patients r and omly assigned to receive UC had higher one-year mortality ( 45 % ) than patients assigned to receive NTS ( 27 % ) or HTM ( 29 % ) ( p = 0.032 ) . CONCLUSIONS Further investigation and refinement of the application of HTM are warranted because it may be a valuable role for the management of selected patients with heart failure OBJECTIVE To evaluate the effectiveness of at-home infrared temperature monitoring as a preventative tool in individuals at high risk for diabetes-related lower-extremity ulceration and amputation . RESEARCH DESIGN AND METHODS Eighty-five patients who fit diabetic foot risk category 2 or 3 ( neuropathy and foot deformity or previous history of ulceration or partial foot amputation ) were r and omized into a st and ard therapy group ( n = 41 ) or an enhanced therapy group ( n = 44 ) . St and ard therapy consisted of therapeutic footwear , diabetic foot education , and regular foot evaluation by a podiatrist . Enhanced therapy included the addition of a h and held infrared skin thermometer to measure temperatures on the sole of the foot in the morning and evening . Elevated temperatures ( > 4 degrees F compared with the opposite foot ) were considered to be " at risk " of ulceration due to inflammation at the site of measurement . When foot temperatures were elevated , subjects were instructed to reduce their activity and contact the study nurse . Study subjects were followed for 6 months . RESULTS The enhanced therapy group had significantly fewer diabetic foot complications ( enhanced therapy group 2 % vs. st and ard therapy group 20 % , P = 0.01 , odds ratio 10.3 , 95 % CI 1.2 - 85.3 ) . There were seven ulcers and two Charcot fractures among st and ard therapy patients and one ulcer in the enhanced therapy group . CONCLUSIONS These results suggest that at-home patient self-monitoring with daily foot temperatures may be an effective adjunctive tool to prevent foot complications in individuals at high risk for lower-extremity ulceration and amputation BACKGROUND Outcomes related to chronic heart failure ( HF ) remain relatively poor , despite advances in pharmacological therapy and medical and nursing care . Experts agree that outpatient care may be among the factors that affect HF outcomes . We hypothesized that the method by which outpatient care is delivered may affect outcomes in this patient population . METHODS A prospect i ve , r and omized design was used to compare HF outcomes from 216 patients r and omized to 1 of 2 home health care delivery methods for 3 months after discharge . Care was delivered by the home nurse visit ( HNV ) or the nurse telemanagement ( NTM ) method . In the latter , patients used transtelephonic home monitoring devices to measure their weight , blood pressure , heart rate , and oxygen saturation . These data were transmitted daily to a secure Internet site . An advanced- practice nurse worked collaboratively with a cardiologist and subsequently treated patients via the telephone . Both delivery methods used the same HF-specific clinical guidelines to direct care . Outcomes include HF readmissions and length of stay , anxiety , depression , self-efficacy , and quality of life . Data were primarily tested using a 2-group analysis of variance ( ANOVA ) . We used a repeated- measures ANOVA to conduct preintervention-postintervention analyses . RESULTS After 3 months , patients in the  NTM group ( n = 108 ; mean + /- SD age , 62.9 + /- 13.2 years ; 83 % African American ; 64 % female ) had fewer HF readmissions ( 13 vs 24 ; P</=.001 ) with shorter lengths of stay ( 49.5 vs 105.0 days ; P</=.001 ) compared with the HNV group ( n = 108 ; mean + /- SD age , 63.2 + /- 12.6 years ; 89 % African American ; 62 % female ) . Hospitalization charges at 3 months were less in the NTM group compared with the HNV group ( $ 65 023 vs $ 177 365 ; P</=.02 ) . At 6 and 12 months , cumulative readmission charges in the NTM group were also less ( $ 223 638 vs $ 500 343 [ P<.03 ] and $ 541 378 vs $ 677 710 [ P</=.16 ] , respectively ) compared with the HNV group . Quality of life was significantly improved for both groups when we compared postintervention and preintervention scores . CONCLUSION The adaptation of state-of-the-art computerized technology to closely monitor patients with HF with advanced- practice nurse care under the guidance of a cardiologist significantly improves HF management while reducing the cost of care We assessed the utilization of health-care services and clinical outcomes in veterans with diabetes who were enrolled in two care coordination/home telehealth programmes .  One group of patients was monitored weekly  ( n = 197 ) , with more intensive evaluations , while the other was monitored daily ( n = 100 ) , but less intensively . Although patients in the two groups were fairly similar in demographic terms and in their clinical characteristics at baseline , they had different service utilization patterns during the 12-month pre-enrollment period . Over the 12-month study period , the proportion of one or more hospital admissions and number of bed days of care decreased in the daily monitoring group , and increased in the weekly monitoring group , more or less doubling in the former and being halved in the latter . Unscheduled primary care clinic visits were lower in the daily monitored group than in the weekly monitored group . The differences between the two groups were significant ( P < 0.01 ) . There were no significant differences between the groups in the clinical outcomes . Future research should employ r and omized controlled trial design s to determine if intensities of home monitoring lead to differences in service utilization and health outcomes This is a controlled pilot study of twenty patients to see if heart failure management can be optimised in the community using telemedicine . The study seeks to examine the feasibility , acceptability and reliability of using telemedicine in this context . Heart failure is a common condition . It is an important cause of mortality and morbidity and has large cost implication s for the NHS . Most patients are managed in the UK in General Practice based on clinical assess 
    Output:
    