The effect of telecare on the quality of life and psychological well-being of elderly recipients of social care over a 12-month period: the Whole Systems Demonstrator cluster randomised trial. Understanding factors that inhibit or promote the utilization of telecare in chronic lung disease A comprehensive evaluation of the impact of telemonitoring in patients with long-term conditions and social care needs: protocol for the whole systems demonstrator cluster randomised trial Patient and provider perspectives on home telecare: Preliminary results from a randomized controlled trial Telecare Management of Pain and Depression in Patients With Cancer: Patient Satisfaction and Predictors of Use Exploring barriers to participation and adoption of telehealth and telecare within the Whole System Demonstrator trial: a qualitative study TeleHealth Improves Diabetes Self-Management in an Underserved Community Cost effectiveness of telecare management for pain and depression in patients with cancer: results from a randomized trial. Does telecare prolong community living in dementia? A study protocol for a pragmatic, randomised controlled trial Telecare collaborative management of chronic pain in primary care: a randomized clinical trial. Telecare for Diabetes, CHF or COPD: Effect on Quality of Life, Hospital Use and Costs. A Randomised Controlled Trial and Qualitative Evaluation The Indiana Cancer Pain and Depression (INCPAD) trial Design of a telecare management intervention for cancer-related symptoms and baseline characteristics of study participants. Patient perceptions of tobacco cessation services in dental offices. Relation between Telecare Implementation and Number of Treatment Days in a Japanese Town Clinical and psychological telemonitoring and telecare of high risk heart failure patients Telecare of diabetic patients with intensified insulin therapy. A randomized clinical trial. An organisational analysis of the implementation of telecare and telehealth: the whole systems demonstrator Characterization of indeterminate renal masses with molecular imaging: how do we turn potential into reality? Cost-effectiveness of telecare for people with social care needs: the Whole Systems Demonstrator cluster randomised trial Health effectiveness and cost-effectiveness of telehealthcare for heart failure: study protocol for a randomized controlled trial Telecare Provides comparable efficacy to conventional self-monitored blood glucose in patients with type 2 diabetes titrating one injection of insulin glulisine-the ELEONOR study. Effect of a Home Telecare Program on Oral Health among Adults with Tetraplegia: A Pilot Study Centrally Assisted Collaborative Telecare for Posttraumatic Stress Disorder and Depression Among Military Personnel Attending Primary Care: A Randomized Clinical Trial.
BACKGROUND home-based telecare ( TC ) is utilised to manage risks of independent living and provide prompt emergency responses . This study examined the effect of TC on health-related quality of life ( HRQoL ) , anxiety and depressive symptoms over 12 months in patients receiving social care . DESIGN a study of participant-reported outcomes [ the Whole Systems Demonstrator ( WSD ) Telecare Question naire Study ; baseline n = 1,189 ] was nested in a pragmatic cluster-r and omised trial of TC ( the WSD Telecare trial ) , held across three English Local Authorities . General practice ( GP ) was the unit of r and omisation and TC was compared with usual care ( UC ) . METHODS participant-reported outcome measures were collected at baseline , short-term ( 4 months ) and long-term ( 12 months ) follow-up , assessing generic HRQoL , anxiety and depressive symptoms . Primary intention-to-treat analyses tested treatment effectiveness and were conducted using multilevel models to control for GP clustering and covariates for participants who completed question naire measures at baseline assessment plus at least one other assessment ( n = 873 ) . RESULTS analyses found significant differences between TC and UC on Short Form-12 mental component scores ( P < 0.05 ) , with parameter estimates indicating being a member of the TC trial-arm increases mental component scores ( UC-adjusted mean = 40.52 ; TC-adjusted mean = 43.69 ) . Additional significant analyses revealed , time effects on EQ5D ( decreasing over time ) and depressive symptoms ( increasing over time ) . CONCLUSIONS TC potentially contributes to the amelioration in the decline in users ' mental HRQoL over a 12-month period . TC may not transform the lives of its users , but it may afford small relative benefits on some psychological and HRQOL outcomes relative to users who only receive UC . International St and ard R and omised Controlled Trial Number Register : IS RCT N 43002091 Objectives : To perform a process evaluation of a r and omized controlled trial ( RCT ) of home telecare for the management of acute exacerbations of chronic obstructive pulmonary disease ( COPD ) , using the normalization process model ( NPM ) as an explanatory framework . Methods : Semi-structured interviews were carried out with patients ( n = 9 ) and nurses ( n = 11 ) participating in a RCT . A framework approach to data analysis was used . Results : The telecare service did not provide an interactional advantage for the nurses providing this service and did not fit with the nurses ' views of the most appropriate or preferred use of their skills . The telecare service seemed unlikely to become normalized as part of routine healthcare delivery , because the nursing team lacked confidence that it was a safe way to provide healthcare in this context and it was not perceived as improving efficiency . Discussion : The NPM effectively mapped onto the study findings and explained those factors that inhibited the routine delivery of COPD services by telecare Background It is expected that increased dem and s on services will result from exp and ing numbers of older people with long-term conditions and social care needs . There is significant interest in the potential for technology to reduce utilisation of health services in these patient population s , including telecare ( the remote , automatic and passive monitoring of changes in an individual 's condition or lifestyle ) and telehealth ( the remote exchange of data between a patient and health care professional ) . The potential of telehealth and telecare technology to improve care and reduce costs is limited by a lack of rigorous evidence of actual impact . Methods / Design We are conducting a large scale , multi-site study of the implementation , impact and acceptability of these new technologies . A major part of the evaluation is a cluster-r and omised controlled trial of telehealth and telecare versus usual care in patients with long-term conditions or social care needs . The trial involves a number of outcomes , including health care utilisation and quality of life . We describe the broad evaluation and the methods of the cluster r and omised trial Discussion If telehealth and telecare technology proves effective , it will provide additional options for health services worldwide to deliver care for population s with high levels of need . Trial Registration Current Controlled Trials IS RCT A r and omized controlled trial of home telecare for the management of acute exacerbations of chronic obstructive pulmonary disease has been undertaken in the north-west of Engl and . A videophone was used that communicates via the ordinary telephone network . The intervention period for each participant was two weeks . Participants in the telecare arm of the trial were asked to complete logbooks to record their experiences of each telecare encounter . A simple , self-completed , 10–item question naire was used that consisted of a Likert scale , ranging from 1 ( totally disagree ) to 5 ( totally agree ) . Fourteen nurses completed 150 logbooks and 22 patients completed 145 logbooks . These results demonstrate significant differences in perception between patients and their health-care providers with regard to telecare encounters across all the domains addressed . Participating patients consistently demonstrated more positive views of the telecare encounters than their health-care providers Pain and depression are 2 of the most common and disabling cancer-related symptoms . In the Indiana Cancer Pain and Depression trial , 202 cancer patients with pain and /or depression were r and omized  to the intervention group and received central ized telecare management augmented by automated symptom monitoring ( ASM ) . Over the 12-month trial , the average patient completed 2 ASM reports and 1 nurse call per month . Satisfaction with both ASM and care management was high regardless of patient characteristics or cancer type . Adherence was also generally good , although several predictors of fewer ASM reports and nurse calls were identified . Only a minority of ASM reports triggered a nurse call , suggesting the efficiency of coupling clinician-delivered telecare management with automated monitoring Background Telehealth ( TH ) and telecare ( TC ) interventions are increasingly valued for supporting self-care in ageing population s ; however , evaluation studies often report high rates of non-participation that are not well understood . This paper reports from a qualitative study nested within a large r and omised controlled trial in the UK : the Whole System Demonstrator ( WSD ) project . It explores barriers to participation and adoption of TH and TC from the perspective of people who declined to participate or withdrew from the trial . Methods Qualitative semi-structured interviews were conducted with 22 people who declined to participate in the trial following explanations of the intervention ( n = 19 ) , or who withdrew from the intervention arm ( n = 3 ) . Participants were recruited from the four trial groups ( with diabetes , chronic obstructive pulmonary disease , heart failure , or social care needs ) ; and all came from the three trial areas ( Cornwall , Kent , east London ) . Observations of home visits where the trial and interventions were first explained were also conducted by shadowing 8 members of health and social care staff visiting 23 people at home . Field notes were made of observational visits and explored alongside interview transcripts to elicit key themes . Results Barriers to adoption of TH and TC  associated with non-participation and withdrawal from the trial were identified within the following themes : requirements for technical competence and operation of equipment ; threats to identity , independence and self-care ; expectations and experiences of disruption to services . Respondents held concerns that special skills were needed to operate equipment but these were often based on misunderst and ings . Respondents ’ views were often explained in terms of potential threats to identity associated with positive ageing and self-reliance , and views that interventions could undermine self-care and coping . Finally , participants were reluctant to risk potentially disruptive changes to existing services that were often highly valued . Conclusions These findings regarding perceptions of potential disruption of interventions to identity and services go beyond more common expectations that concerns about privacy and dislike of technology deter uptake . These insights have implication s for health and social care staff indicating that more detailed information and time for discussion could be valuable especially on introduction . It seems especially important for potential recipients to have the opportunity to discuss their expectations and such views might usefully feed back into design and implementation OBJECTIVE To conduct a 1-year r and omized clinical trial to evaluate a remote comprehensive diabetes self-management education ( DSME ) intervention , Diabetes TeleCare , administered by a dietitian and nurse/certified diabetes educator ( CDE ) in the setting of a federally qualified health center ( FQHC ) in rural South Carolina . RESEARCH DESIGN AND METHODS Participants were recruited from three member health centers of an FQHC and were r and omized to either Diabetes TeleCare , a 12-month , 13-session curriculum delivered using telehealth strategies , or usual care .  RESULTS Mixed linear regression model results for repeated measures showed a significant reduction in glycated hemoglobin ( GHb ) in the Diabetes TeleCare group from baseline to 6 and 12 months ( 9.4 ± 0.3 , 8.3 ± 0.3 , and 8.2 ± 0.4 , respectively ) compared with usual care ( 8.8 ± 0.3 , 8.6 ± 0.3 , and 8.6 ± 0.3 , respectively ) . LDL cholesterol was reduced at 12 months in the Diabetes TeleCare group compared with usual care . Although not part of the original study design , GHb was reduced from baseline to 12 and 24 months in the Diabetes TeleCare group ( 9.2 ± 0.4 , 7.4 ± 0.5 , and 7.6 ± 0.5 , respectively ) compared with usual care ( 8.7 ± 0.4 , 8.1 ± 0.4 , and 8.1 ± 0.5 , respectively ) in a post hoc analysis of a subset of the r and omized sample who completed a 24-month follow-up visit . CONCLUSIONS Telehealth effectively created access to successfully conduct a 1-year remote DSME by a nurse CDE and dietitian that improved metabolic control and reduced cardiovascular risk in an ethnically diverse and rural population OBJECTIVE Pain and depression are prevalent and treatable symptoms among patients with cancer , yet they are often undetected and undertreated . The Indiana Cancer Pain and Depression ( INCPAD ) trial demonstrated that telecare management can improve pain and depression outcomes . This article investigates the incremental cost effectiveness of the INCPAD intervention . METHODS The INCPAD trial was conducted in 16 community-based urban and rural oncology practice s in Indiana . Of the 405 participants , 202 were r and omized to the intervention group and 203 to the usual-care group .  Intervention costs were determined , and effectiveness outcomes were depression-free days and quality -adjusted life years . RESULTS The intervention group was associated with a yearly increase of 60.3 depression-free days ( S.E. = 15.4 ; P < 0.01 ) and an increase of between 0.033 and 0.066 quality -adjusted life years compared to the usual care group . Total cost of the intervention per patient was US$ 1189 , which included physician , nurse care manager and automated monitoring set-up and maintenance costs . Incremental cost per depression-free day was US$ 19.72 , which yields a range of US$ 18,018 to US$ 36,035 per quality -adjusted life year when converted to that metric . When measured directly , the incremental cost per quality -adjusted life year ranged from US$ 10,826 based on the modified EQ-5D to US$ 73,286.92 based on the SF-12 . CONCLUSION Central ized telecare management , coupled with automated symptom monitoring , appears to be a cost effective intervention for managing pain and depression in cancer patients Background Assistive technology and telecare ( ATT ) are relatively new ways of delivering care and support to people with social care needs . It is cl aim ed that ATT reduces the need for community care , prevents unnecessary hospital admission , and delays or prevents admission into residential or nursing care . The current economic situation in Engl and has renewed interest in ATT instead of community care packages . However , at present , the evidence base to support cl aims about the impact and effectiveness of ATT is limited , despite its potential to mitigate the high financial cost of caring for people with dementia and the social and psychological cost to unpaid carers . Method / design ATTILA ( Assistive Technology and Telecare to maintain Independent Living At Home for People with Dementia ) is a pragmatic , multi-centre , r and omised controlled trial over 104 weeks that compares outcomes for people with dementia who receive ATT and those who receive equivalent community services but not ATT .  The study hypothesis is that fewer people in the ATT group will go into institutional care over the 4-year period for which the study is funded . The study aims to recruit 500 participants , living in community setting s , with dementia or significant cognitive impairment , who have recently been referred to social services . Primary outcome measures are time in days from r and omisation to institutionalisation and cost effectiveness . Secondary outcomes are caregiver burden , health-related quality of life in carers , number and severity of serious adverse events , and data on acceptability , applicability and reliability of ATT intervention packages . Assessment s will be undertaken in weeks 0 ( baseline ) , 12 , 24 , 52 and 104 or until institutionalisation or withdrawal of the participant from the trial . Discussion In a time of financial austerity , CASSRs in Engl and are increasingly turning to ATT in the belief that it will deliver good outcomes for less money . There is an absence of robust evidence for the cost-effectiveness and benefit of using assistive technology and telecare . The ATTILA trial meets a pressing need for robust , generalisable evidence to either justify continuing investment or reappraise the appropriate scale of ATT use . Trial registration Current Controlled TrialsIS RCT IMPORTANCE Chronic musculoskeletal pain is among the most prevalent , costly , and disabling medical disorders . However , few clinical trials have examined interventions to improve chronic pain in primary care . OBJECTIVE To determine the effectiveness of a telecare intervention for chronic pain . DESIGN , SETTING , AND PARTICIPANTS The Stepped Care to Optimize Pain Care Effectiveness ( SCOPE ) study was a r and omized trial comparing a telephone-delivered collaborative care management intervention vs usual care in 250 patients with chronic ( ≥3 months ) musculoskeletal pain of at least moderate intensity ( Brief Pain Inventory [ BPI ] score ≥5 ) . Patients were enrolled from 5 primary care clinics in a single Veterans Affairs medical center from June 2010 through May 2012 , with 12-month follow-up completed by June 2013 . INTERVENTIONS Patients were r and omized either to an  intervention group  ( n = 124 ) or to a  usual care group whose members received all pain care as usual from their primary care physicians ( n = 126 ) . The intervention group received 12 months of telecare management that coupled automated symptom monitoring with an algorithm-guided stepped care approach to optimizing analgesics . MAIN OUTCOMES AND MEASURES Primary outcome was the BPI total score , which ranges from 0 ( " no pain " ) to 10 ( " pain as bad as you can imagine " ) and for which a 1-point change is considered clinical ly important . Secondary pain outcomes included BPI interference and severity , global pain improvement , treatment satisfaction , and use of opioids and other analgesics . RESULTS Overall , mean ( SD ) baseline BPI scores in the intervention and control groups were 5.31 ( 1.81 ) and 5.12 ( 1.80 ) , respectively . Compared with usual care , the intervention group had a 1.02-point lower ( 95 % CI , -1.58 to -0.47 ) BPI score at 12 months ( 3.57 vs 4.59 ) . Patients in the intervention group were nearly twice as likely to report at least a 30 % improvement in their pain score by 12 months ( 51.7 % vs 27.1 % ; relative risk , 1.9 [ 95 % CI , 1.4 to 2.7 ] ) , with a number needed to treat of 4.1 ( 95 % CI , 3.0 to 6.4 ) for a 30 % improvement . Secondary pain outcomes also improved . Few patients in either group required opioid initiation or dose escalation . CONCLUSIONS AND RELEVANCE Telecare collaborative management increased the proportion of primary care patients with improved chronic musculoskeletal pain . This was accomplished by optimizing nonopioid analgesic medications using a stepped care algorithm and monitoring . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00926588 Objectives To assess the effect of telecare on health related quality of life , self-care , hospital use , costs and the experiences of patients , informal carers and health care professionals . Methods Patients were r and omly assigned either to usual care or to additionally entering their data into a commercially-available electronic device that uploaded data once a day to a nurse-led monitoring station . Patients had congestive heart failure ( Site A ) , chronic obstructive pulmonary disease ( Site B ) , or any long-term condition , mostly diabetes ( Site C ) . Site C contributed only intervention patients – they considered a usual care option to be unethical . The study took place in New Zeal and between September 2010 and February 2012 , and lasted 3 to 6 months for each patient . The primary outcome was health-related quality of life ( SF36 ) . Data on experiences were collected by individual and group interviews and by question naire . Results There were 171 patients ( 98 intervention , 73 control ) . Quality of life , self-efficacy and disease-specific measures did not change significantly , while anxiety and depression both decreased significantly with the intervention . Hospital admissions , days in hospital , emergency department visits , outpatient visits and costs did not differ significantly between the groups . Patients at all sites were universally positive . Many felt safer and more cared-for , and said that they and their family had learned more about managing their condition . Staff could all see potential benefits of telecare , and , after some initial technical problems , many staff felt that telecare enabled them to effectively monitor more patients . Conclusions Strongly positive patient and staff experiences and attitudes complement and contrast with small or non-significant quantitative changes . Telecare led to patients and families taking a more active role in self-management . It is likely that subgroups of patients benefitted in ways that were not measured or visible within the quantitative data , especially feelings of safety and being cared-for . Trial Registration Australian New Zeal and Clinical Trials Registry OBJECTIVE Pain and depression are two of the most prevalent and treatable cancer-related symptoms , each present in at least 20 - 30 % of oncology patients . Both symptoms are frequently either unrecognized or undertreated , however . This article describes a telecare management intervention delivered by a nurse-psychiatrist team that is design ed to improve recognition and treatment of pain and depression . The enrolled sample is also described . METHODS The Indiana Cancer Pain and Depression study is a National Cancer Institute-sponsored r and omized clinical trial . Four hundred five patients with cancer-related pain and /or clinical ly significant depression from 16 urban or rural oncology practice s throughout Indiana have been enrolled and r and omized to either the  intervention group or to a  usual-care control group  . Intervention patients receive central ized telecare management coupled with automated home-based symptom monitoring . Outcomes will be assessed at 1 , 3 , 6 and 12 months by research assistants blinded to treatment arms . RESULTS Of 4465 patients screened , 2185 ( 49 % ) endorsed symptoms of  pain or depression . Of screen-positive patients , about one-third were ineligible ( most commonly due to pain or depression not meeting severity thresholds or to pain that is not related to cancer ) . Of the 405 patients enrolled , 32 % have depression only , 24 % have pain  only and 44 % have both depression and pain . At baseline , participants reported an average of 16.8 days out of the past 4 weeks during which they were confined to bed or had to reduce their usual activities by > or = 50 % due to pain or depression . Also , 176 ( 44 % ) reported being unable to work due to health reasons . CONCLUSIONS When completed , the Indiana Cancer Pain and Depression trial will test whether central ized telecare management coupled with automated home-based symptom monitoring improves outcomes in cancer patients with depression and /or pain . Findings will be important for both oncologists and mental health clinicians confronted with oncology patients ' depression or pain BACKGROUND Tobacco use is a leading cause of periodontitis and other oral diseases . Dental professionals can help patients quit , but few routinely offer tobacco cessation services , or TCS . In this article , the authors examine dental professionals ' attitudes toward offering TCS and patients ' attitudes toward receiving TCS from their dental offices . METHODS The authors used baseline data from a three-year r and omized controlled trial design ed to test the effectiveness of a dissemination strategy aim ed at increasing the proportion of tobacco users identified by the dental office , as well as the proportion of tobacco users advised to quit . Fifty-two dental offices in rural communities completed a question naire asking for demographic and professional information about their offices , usual TCS offered , barriers to providing TCS and their views on patient receptivity to TCS . A r and om sample of patients seen during one month were interviewed over the telephone about the TCS provided during their last visit and their comfort in receiving such services from their dental offices . RESULTS The authors found that 58.5 percent of the 3,088 dental patients surveyed believed that dental offices should provide TCS to patients . There was equal support among tobacco users and nonusers . Male patients ( 60.8 percent ) and younger patients ( 69.6 percent ) were more likely to believe that dental offices should provide TCS than were female patients ( 56.8 percent , P < .05 ) and older patients ( 57.3 percent , P < .05 ) . The authors also found that patients who had an interest in quitting were more likely to feel comfortable receiving TCS  than were those patients who were not interested in quitting ( 59.7 percent vs. 39.4 percent , P < .01 ) . A total of 61.5 percent of dentists , however , thought patients did not expect such services . When dentists were asked about barriers to providing TCS , 94.3 percent listed patient resistance as a barrier , and 53.9 percent were concerned that patients would leave their practice s. CONCLUSIONS The authors found a wide discrepancy between patients ' and dental professionals ' views on TCS . A total of 58.5 percent of patients believe dentists routinely should offer such services , while 61.5 percent of dental professionals believed patients did not expect TCS . Patients who were interested in quitting felt more comfortable receiving quit advice . CLINICAL IMPLICATION S Periodontitis and other oral diseases are linked directly to tobacco use . Advising patients to quit is a professional responsibility . Tobacco users expect and are comfortable receiving such advice . It is up to dental professionals to overcome their concerns about patient receptivity and provide these services We analysed data on the medical expenditure of 199 telecare users in Nishiaizu Town , Fukushima Prefecture , which has one of the oldest ongoing telecare implementations in Japan . As controls , 450 out of 3528 non-users residents covered by National Health Insurance were r and omly selected in the same age and sex ratios as the telecare users . An analysis by the Generalized Method of Moments ( GMM ) was conducted in order to examine causality , i.e. that telecare use reduces the number of treatment days . To reduce sample selection bias , the presence of chronic diseases , age and education were added as control variables in the estimation . The results show that the treatment days of those who had chronic diseases were greater than those who did not have chronic diseases by 8.7 days per year ( P < 0.10 ) , and they were increased by 5.6 days ( P < 0.01 ) according to their age . Finally ,  telecare use decreased treatment days by 3.1 days ( P < 0.05 ) We conducted a trial of telemonitoring and telecare for patients with chronic heart failure leaving hospital after being treated for clinical instability . Eighty patients were r and omized before hospital discharge to a  usual care group  ( n = 40 : follow-up at the outpatient clinic ) or to an  integrated management group  ( n = 40 : patients learned to use a h and held PDA and kept in touch daily with the monitoring centre ) . At enrolment , the groups were similar for all clinical variables . At one-year follow-up , integrated management patients showed better adherence , reduced anxiety and depression , and lower NYHA class and plasma levels of BNP with respect to the usual care patients ( e.g. NYHA class 2.1 vs 2.4 , P < 0.02 ) . Mortality and hospital re-admissions for congestive heart failure were also reduced in integrated management patients ( P < 0.05 ) .  Integrated management  was more expensive than usual care , although the cost of adverse events was 42 % lower . In heart failure patients at high risk of relapse , the regular acquisition of simple clinical information and the possibility for the patient to contact the clinical staff improved drug titration , produced better psychological status and quality of life , and reduced hospitalizations for heart failure BACKGROUND Patients with insulin dependent diabetes require frequent advice if their metabolic control is suboptimal . A telemedical system for transmission of self monitoring blood glucose values from the patients ' home to the diabetes center with a combined modem-interface is described . Data are processed by PC and advice is given by telephone . The study focuses on metabolic outcome , fiscal and administrative aspects . METHODS A prospect i ve , r and omized trial with 46 patients with intensified insulin therapy was conducted , 30 patients used telecare and 16 conventional care .  RESULTS HbA1c , as a parameter of metabolic control , dropped from 8.3 % to 7.3 % in the telecare group and from 8.0 % to 6.8 % in the conventional group after 8 months of observation . There was no significant difference between the two groups . Time expenditure for telemanagement , compared to conventional advice , was moderately higher , but there was a substantial amount of time on the patients side that could be saved mainly by reduction of to travel time and work stoppage . Setting up an optimal telemanagement scenario a cost analysis was done . This yields a cost saving of about 650 EURO per year . CONCLUSION Telemanagement of insulin-requiring diabetic patients is a cost and time saving procedure for the patients and results in metabolic control comparable to conventional outpatient management Background To investigate organisational factors influencing the implementation challenges of re design ing services for people with long term conditions in three locations in Engl and , using remote care ( telehealth and telecare ) .  Methods Case- studies of three sites forming the UK Department of Health ’s Whole Systems Demonstrator ( WSD ) Programme . Qualitative research techniques were used to obtain data from various sources , including semi-structured interviews , observation of meetings over the course programme and prior to its launch , and document review . Participants were managers and practitioners involved in the implementation of remote care services .  Results The implementation of remote care was nested within a large pragmatic cluster r and omised controlled trial ( RCT ) , which formed a core element of the WSD programme . To produce robust benefits evidence , many aspect of the trial design could not be easily adapted to local circumstances . While remote care was successfully rolled-out , wider implementation lessons and levels of organisational learning across the sites were hindered by the requirements of the RCT . Conclusions The implementation of a complex innovation such as remote care requires it to organically evolve , be responsive and adaptable to the local health and social care system , driven by support from front-line staff and management . This need for evolution was not always aligned with the imperative to gather robust benefits evidence . This tension needs to be resolved if government ambitions for the evidence -based scaling-up of remote care are to be realised Background The majority of enhancing renal masses are unable to be effectively characterized as benign or malignant using st and ard cross-sectional imaging modalities including multi-phase computed tomography ( CT ) [ 1 ] and magnetic resonance imaging ( MRI ) [ 2 ] . This is particularly unfortunate in light of the steady increase in the incidence of these lesions , many of which are discovered incidentally on imaging studies performed for nonurologic indications [ 3 , 4 ] . Moreover , it has been estimated that upwards of 5600 unnecessary partial and radical nephrectomies are performed each year in the USA for the false presumption of cancer [ 5 ] . In light of these data , recently , there has been a growing interest in the use of molecular imaging to characterize the aggressiveness of renal masses [ 6 , 7 ] . To date , several reports have been published on the ability of Tc-sestamibi planar and single photon emission computed tomography (SPECT)/CT imaging to differentiate mitochondrial-rich benign and indolent renal masses such as oncocytomas and hybrid oncocytic/ chromophobe tumors ( HOCTs ) from more aggressive renal tumor histologies including the clear cell subtype of renal cell carcinoma ( RCC ) [ 8–10 ] . In this issue of European Journal of Nuclear Medicine and Molecular Imaging Research , Tzortzakakis et al. [ 11 ] add to this body of literature with a prospect i ve study evaluating Tc-sestamibi SPECT/CT in 24 patients with 31 clinical ly localized T1 renal masses planned for biopsy or surgery . The authors reported that 11 of 12 ( 92 % ) oncocytomas and 3 of 3 ( 100 % ) HOCTs demonstrated Tc-sestamibi uptake , while all other lesions were negative for uptake with the exception of mild uptake in a single papillary RCC . These findings are concordant with earlier studies [ 9 , 10 ] and dramatically increase the number of Tc-sestamibi positive oncocytomas and HOCTs reported in the literature . As a brief aside , it should be mentioned that there is also a growing interest in the use of renal mass biopsy for determining the histology of renal tumors , particularly as data from two recent systematic review s have suggested that the rates of complications and nondiagnostic biopsies are tolerable [ 12 , 13 ] . However , limitations of renal mass biopsy remain , including the intrinsically invasive nature of this procedure , the inaccessibility of some tumors to safe approaches for biopsy , and the heterogeneous population of renal masses that can present as oncocytic neoplasms on biopsy [ 14 , 15 ] . As such , the non-invasive characterization of renal masses with molecular imaging techniques continues to be of interest and may serve as an adjunct to , or even a replacement of , biopsy in selected cases Purpose of the study : to examine the costs and cost-effectiveness of ‘ second-generation ’ telecare , in addition to st and ard support and care that could include ‘ first-generation ’ forms of telecare , compared with st and ard support and care that could include ‘ first-generation ’ forms of telecare . Design and methods : a pragmatic cluster-r and omised controlled trial with nested economic evaluation . A total of 2,600 people with social care needs participated in a trial of community-based telecare in three English local authority areas . In the Whole Systems Demonstrator Telecare Question naire Study , 550 participants were r and omised to intervention and 639 to control . Participants who were offered the telecare intervention received a package of equipment and monitoring services for 12 months , additional to their st and ard health and social care services . The control group received usual health and social care . Primary outcome measure : incremental cost per quality -adjusted life year ( QALY ) gained . The analyses took a health and social care perspective . Results : cost per additional QALY was £ 297,000 . Cost-effectiveness acceptability curves indicated that the probability of cost-effectiveness at a willingness-to-pay of £ 30,000 per QALY gained was only 16 % . Sensitivity analyses combining variations in equipment price and support cost parameters yielded a cost-effectiveness ratio of £ 161,000 per QALY . Implication s : while QALY gain in the intervention group was similar to that for controls , social and health services costs were higher . Second-generation telecare did not appear to be a cost-effective addition to usual care , assuming a commonly accepted willingness to pay for QALYs . Trial registration number : IS RCT N 43002091 Background Several heart failure studies have shown promising results for implementing telehealthcare . These studies have led to clinical and political interest in telehealthcare as a way to improve heart failure outcomes and lower costs . However , there is a need for large-scale clinical trials with cost-effectiveness assessment s. Methods / design The present study is known as the TeleCare North Heart Failure Trial in Denmark . We are study ing the health effectiveness and cost-effectiveness of a telehealth ( Telekit ) solution compared with usual care for patients with heart failure . The design is a multicenter , two-arm , parallel-group , nonblinded , superiority r and omized controlled trial . Outpatient healthcare centers will be responsible for recruiting eligible participants ( 600 participants are expected ) for the trial in the geographic area of the North Denmark Region . Participants are qualified for inclusion if they have been diagnosed according to national guidelines and are categorized in New York Heart Association class 2 , 3 , or 4 . Patients must have a permanent residence and be motivated to use telehealth care . The primary outcomes are changes in health-related quality of life ( assessed using the Kansas City Cardiomyopathy Question naire , the EuroQol EQ-5D-5L question naire , and the Short Form Health Survey [ SF-36 ] ) and in the incremental cost-effectiveness ratio measured from baseline to follow-up . The secondary outcomes are changes in mortality and in physiological indicators such as blood pressure , pulse , and weight . Discussion The TeleCare North Heart Failure Trial is intended to improve the international evidence base for the health effectiveness and cost-effectiveness of telehealthcare for patients with heart failure . The expectation is that the results of the trial can be generalized to all municipalities in Denmark and serve as an inspiration for further international research .Trial registration Clinical Trials.gov ( NCT02860013 ) . Registered on 28 July 2016 BACKGROUND We compared telecare and conventional self-monitored blood glucose ( SMBG ) programs for titrating the addition of one bolus injection of insulin glulisine in patients with type 2 diabetes uncontrolled on oral hypoglycemic agents for ≥3 months who were first titrated with basal insulin glargine . METHODS This r and omized , multicenter , parallel-group study included 241 patients ( mean screening glycosylated hemoglobin [ HbA(1c ) ] , 8.8 % [ 73 mmol/mol ] ) . In the run-in phase , any antidiabetes medication , except for metformin , was discontinued . Metformin was then up-titrated to 2 g/day ( 1 g twice daily ) until study completion . Following run-in , all patients started glargine for 8 - 16 weeks , targeting fasting plasma glucose ( FPG ) ≤5.6 mmol/L using conventional SMBG . Patients with FPG ≤7 mmol/L added a glulisine dose at the meal with the highest postpr and ial plasma glucose excursion , titrated to target 2-h postpr and ial plasma glucose level < 7.8 mmol/L using telecare or SMBG for 24 weeks . Patients with FPG > 7 mmol/L at week 16 were withdrawn from the study . RESULTS After glargine titration , 224 patients achieved FPG ≤7 mmol/L , without any difference between telecare and SBMG groups ( mean±SD , 6.2±0.8 vs. 6.0±0 . 9 mmol/L , respectively ) . HbA(1c ) levels were lower following titration and were similar for telecare and SMBG ( 7.9±0.9 % vs. 7.8±0.9 % [ 63 vs. 62 mmol/mol ] , respectively ) . Adding glulisine  further reduced HbA(1c ) in both groups ( -0.7 % vs. -0.7 % ) ; 45.2 % and 54.8 % ( P=0.14 ) , respectively , of patients achieved HbA(1c ) ≤7.0 % ( ≤53 mmol/mol ) . Weight change and hypoglycemia were similar between groups . CONCLUSIONS Patients adding one dose of glulisine at the meal with the highest postpr and ial plasma glucose excursion to titrated basal glargine achieved comparable improvements in glycemic control irrespective of traditional or telecare blood glucose monitoring Study design : one group pre- and post-test design . Objectives : The primary aim was to examine both the short- and long-term effects of an oral home telecare program on improving gingival health  among adults with tetraplegia . Methods : Eight adults with tetraplegia participated . The oral home telecare program consisted of individualized oral hygiene training in the use of assistive devices ( powered toothbrush and adapted flosser and /or oral irrigator ) using personal computer-based videoconferencing between each participant and an occupational therapist . Training was conducted on an average of five 15−30 min sessions across 3 months . During these training sessions , supervised practice of oral hygiene , and provision of immediate corrective feedback and positive reinforcement in the use of adaptive oral hygiene devices was emphasized . Gingival health assessment using the Löe-Silness gingival index ( LSGI ) was conducted at baseline , 6 and 12 months . Results : From baseline to 6 months , participants showed statistically significant differences ( that is , improvement with less gingival inflammation ) in their LSGI scores ( z=2.18 , P=.03 ) . From baseline to 12 months , participants also showed a statistically significant difference ( that is , improvement , z=2.03 ; P=0.04 ) in their LSGI scores . Conclusion : This study indicates that preventive oral home telecare with repeated oral hygiene training in the use of adaptive devices improved gingival health at 6 and 12 months among adults with tetraplegia IMPORTANCE It is often difficult for members of the US military to access high- quality care for posttraumatic stress disorder ( PTSD ) and depression . OBJECTIVE To determine effectiveness of a central ly assisted collaborative telecare ( CACT ) intervention for PTSD and depression in military primary care . DESIGN , SETTING , AND PARTICIPANTS The STEPS-UP study ( Stepped Enhancement of PTSD Services Using Primary Care ) is a r and omized trial comparing CACT with usual integrated mental health care for PTSD or depression . Patients , mostly men in their 20s , were enrolled from 18 primary care clinics at 6 military installations from February 2012 to August 2013 with 12-month follow-up completed in October 2014 . INTERVENTIONS R and omization was to CACT ( n = 332 ) or usual care ( n = 334 ) . The CACT patients received 12 months of stepped psychosocial and pharmacologic treatment with nurse telecare management of caseloads , symptoms , and treatment . MAIN OUTCOMES AND MEASURES Primary outcomes were severity scores on the PTSD Diagnostic Scale ( PDS ; scored 0 - 51 ) and Symptom Checklist depression items ( SCL-20 ; scored 0 - 4 ) . Secondary outcomes were somatic symptoms , pain severity , health-related function , and mental health service use . RESULTS Of 666 patients , 81 % were male and the mean ( SD ) age was 31.1 ( 7.7 ) years . The CACT and usual care patients had similar baseline mean ( SD ) PDS PTSD ( 29.4 [ 9.4 ] vs 28.9 [ 8.9 ] ) and SCL-20 depression ( 2.1 [ 0.6 ] vs 2.0 [ 0.7 ] ) scores . Compared with usual care , CACT patients reported significantly greater mean ( SE ) 12-month decrease in PDS PTSD scores ( -6.07 [ 0.68 ] vs -3.54 [ 0.72 ] ) and SCL-20 depression scores -0.56 [ 0.05 ] vs -0.31 [ 0.05 ] ) . In the CACT group , significantly more participants had 50 % improvement at 12 months compared with usual care for both PTSD ( 73 [ 25 % ] vs 49 [ 17 % ] ; relative risk , 1.6 [ 95 % CI , 1.1 - 2.4 ] ) and depression ( 86 [ 30 % ] vs 59 [ 21 % ] ; relative risk , 1.7 [ 95 % CI , 1.1 - 2.4 ] ) , with a number needed to treat for a 50 % improvement of 12.5 ( 95 % CI , 6.9 - 71.9 ) and 11.1 ( 95 % CI , 6.2 - 50.5 ) , respectively . The CACT patients had significant improvements in somatic symptoms ( difference between mean 12-month Patient Health Question naire 15 changes , -1.37 [ 95 % CI , -2.26 to -0.47 ] ) and mental health-related functioning ( difference between mean 12-month Short Form-12 Mental Component Summary changes , 3.17 [ 95 % CI , 0.91 to 5.42 ] ) , as well as increases in telephone health contacts and appropriate medication use . CONCLUSIONS AND RELEVANCE Central assistance for collaborative telecare with stepped psychosocial management modestly improved outcomes of PTSD and depression among military personnel attending primary care . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01492348
TC led to a greater decrease in systolic and diastolic BP  than UC .
The differences between TC and UC for systolic BP tend to become larger when no treatment modification is applied .
TC seems a valuable tool for hypertension management
There is an increasing interest for using telecare(TC ) in the management of hypertension .