Objective To assess the effect of telehealthcare compared with usual practice in patients with chronic obstructive pulmonary disease (COPD). Design A cluster-randomised trial with 26 municipal districts that were randomly assigned either to an intervention group whose members received telehealthcare in addition to usual practice or to a control group whose members received usual practice only (13 districts in each arm). Setting Twenty-six municipal districts in the North Denmark Region of Denmark. Participants Patients who fulfilled the Global Initiative for COPD guidelines and one of the following criteria: COPD Assessment Test score ≥10; or Medical Research Dyspnoea Council Scale ≥3; or Modified Medical Research Dyspnoea Council Scale ≥2; or ≥2 exacerbations during the past 12 months. Main outcome measures Health-related quality of life (HRQoL) assessed by the physical component summary (PCS) and mental component summary (MCS) scores of the Short Form 36-Item Health Survey, Version 2. Data were collected at baseline and at 12 month follow-up and analysed according to the intention-to-treat principle with complete cases, n=574 (258 interventions; 316 controls) and imputed data, n=1225 (578 interventions, 647 controls) using multilevel modelling. Results In the intention-to-treat analysis (n=1225), the raw mean difference in PCS from baseline to 12 month follow-up was −2.6 (SD 12.4) in the telehealthcare group and −2.8 (SD 11.9) in the usual practice group. The raw mean difference in MCS scores in the same period was −4.7 (SD 16.5) and −5.3 (SD 15.5) for telehealthcare and usual practice, respectively. The adjusted mean difference in PCS and MCS between groups at 12 months was 0.1 (95% CI −1.4 to 1.7) and 0.4 (95% CI −1.7 to 2.4), respectively. Conclusions The overall sample and all subgroups demonstrated no statistically significant differences in HRQoL between telehealthcare and usual practice. Trial registration number NCT01984840; Results.
It is known that there are school choice problems without an efficient and stable assignment. We consider comparing assignments in terms of their stability by comparing their sets of blocking (student-school) pairs or comparing their sets of blocking students who are involved in at least one blocking pair. Although there always exists a Pareto improvement over the student-optimal stable (DA) assignment which is minimally unstable among efficient assignments when the stability comparison is based on comparing the sets of blocking pairs in the set-inclusion sense, we show that this is not necessarily true when the stability comparison is based on comparing the sets of blocking pairs in the cardinal sense, or when it is based on comparing sets of blocking students (in the set-inclusion or cardinal sense). Given the latter impossibilities, we characterize the priority profiles where there exists a Pareto improvement over the DA mechanism which is cardinally minimally stable among efficient assignments when counting blocking pairs or counting blocking students. The resulting domain restrictions suggest to take with caution school choice analysis which relies on a particular stability comparison method.
Abstract This study was conducted as part of a randomized, controlled trial, and explored whether the introduction of a Danish telehomecare intervention, referred to as ‘the Telekit’, and its associated educational components affect functional health literacy. The study sample consisted of 60 chronic obstructive pulmonary disease patients in the intervention group who received the Telekit, and 56 in the control group; all participants were collected from the large‐scale, randomized TeleCare North trial by consecutive sampling. To avoid recall bias, the design did not include a baseline measurement, comparing instead the post‐intervention measurements between the intervention and control groups. First, the comparability of the two groups was determined, and statistically significant differences in their functional health literacy scores were examined using an independent t ‐test. Furthermore, the associations between functional health literacy and both groups were tested using multiple regression analysis. No statistically significant difference was observed between the intervention and control groups, suggesting that the introduction of the Telekit and its associated educational components has no effect on functional health literacy. However, further research should be conducted using a larger sample.
For Clostridioides difficile infection (CDI), faecal microbiota transplantation (FMT) is currently recommended for patients with three or more CDI episodes. A recent randomised controlled trial (RCT) show that FMT may be considered early, defined as intervention during the first or second CDI episode. Compared with standard care for first or second CDI, patients randomised to FMT had €1,645 lower hospital costs over 26 weeks owing to fewer admissions and hospital contacts and less medication use.
