ObjectivesTo 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.MethodsPatients were randomly 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 Zealand 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 questionnaire.ResultsThere 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.ConclusionsStrongly 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 RegistrationAustralian New Zealand Clinical Trials Registry ACTRN12610000269033
DEA super-efficiency models were introduced originally with the objective of providing a tie-breaking procedure for ranking units rated as efficient in conventional DEA models. This objective has been expanded to include sensitivity analysis, outlier identification and inter-temporal analysis. However, not all units rated as efficient in conventional DEA models have feasible solutions in DEA super-efficiency models. We propose a new super-efficiency model that (a) generates the same super-efficiency scores as conventional super-efficiency models for all units having a feasible solution under the latter, and (b) generates a feasible solution for all units not having a feasible solution under the latter. Empirical examples are provided to compare the two super-efficiency models.
Objective-To investigate the use of a simple intrasound device in the detection of malleolar fractures in the accident and emergency (A&E) department. Methods-Patients aged 16 to 70 years with ankle injuries presenting within 24 hours were considered for inclusion in the study. Those patients with bony tenderness, inability to weight bear, and swelling were examined with a simple intrasound device before x ray examination. A positive result of discomfort, pain, withdrawal response, or combinations of these was noted.Results-The device had a sensitivity of 85% and a specificity of 52% in detecting malleolar fractures. Conclusions-The use ofintrasound in the detection of malleolar fractures cannot be relied upon alone, but it may help to limit the number of x rays taken unnecessarily. A further study is proposed to confirm these findings.
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