Effect of telehealth on glycaemic control: analysis of patients with type 2 diabetes in the Whole Systems Demonstrator cluster randomised trial

Background: The Whole Systems Demonstrator was a large, pragmatic, cluster randomised trial that compared telehealth with usual care among 3,230 patients with long-term conditions in three areas of England. Telehealth involved the regular transmission of physiological information such as blood glucose to health professionals working remotely. We examined whether telehealth led to changes in glycosylated haemoglobin (HbA1c) among the subset of patients with type 2 diabetes. Methods: The general practice electronic medical record was used as the source of information on HbA1c. Effects on HbA1c were assessed using a repeated measures model that included all HbA1c readings recorded during the 12-month trial period, and adjusted for differences in HbA1c readings recorded before recruitment. Secondary analysis averaged multiple HbA1c readings recorded for each individual during the trial period. Results: 513 of the 3,230 participants were identified as having type 2 diabetes and thus were included in the study. Telehealth was associated with lower HbA1c than usual care during the trial period (difference 0.21% or 2.3 mmol/mol, 95% CI, 0.04% to 0.38%, p = 0.013). Among the 457 patients in the secondary analysis, mean HbA1c showed little change for controls following recruitment, but fell for intervention patients from 8.38% to 8.15% (68 to 66 mmol/mol). A higher proportion of intervention patients than controls had HbA1c below the 7.5% (58 mmol/mol) threshold that was targeted by general practices (30.4% vs. 38.0%). This difference, however, did not quite reach statistical significance (adjusted odds ratio 1.63, 95% CI, 0.99 to 2.68, p = 0.053). Conclusions: Telehealth modestly improved glycaemic control in patients with type 2 diabetes over 12 months. The scale of the improvements is consistent with previous meta-analyses, but was relatively modest and seems unlikely to produce significant patient benefit

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Evaluation of geomorphic expressions of bedrock Channels in the Western Ghats of southern Kerala, India, through quantitative analysis

Geomorphic expressions embedded within the bedrock channels, originating from the southernmost part of the Western Ghats, India, are quantitatively characterized through well-defined geomorphic indices using digital elevation models (DEM) and geographical information system (GIS) tools. Drainage basin asymmetry (Af), transverse topographic symmetry factor (T), longitudinal profile, stream length gradient index (SL), hypsometric integral and curve (Ihyp), spatial parameters like drainage density (Dd) and dissection index (DI) are used for extraction of information related to the characteristic pattern and behaviour associated with the Karamana river and its two major tributaries. The independent and cumulative analysis of each geomorphic indices indicates adjustment of Karamana river in response to the tectonic activities. Karamana basin, while showing symmetric character as a single unit, exhibits segments of asymmetric nature associated with the terrain tilting and is evidenced from the variable directional oscillation from E, SSE, S, NW and W. Varying characteristics of the longitudinal profiles and abrupt change in the SL index suggest knick points and uplift of the terrain due to tectonic processes. The influence of tectonic process over the stream characteristics is confirmed by identifying higher levels of SL anomalies in unique lithology. The inferences correlate with the low drainage density and high dissection index zones in the region with varying influence of tectonic processes. Though, the Karamana river basin as a single unit shows old age characteristics in the hypsometric analysis and symmetric nature, the longitudinal profile-assisted SL and SL anomaly indices are found to be capable of revealing evidences of differential effects of tectonic activities over the stream characteristics. The deductions are in agreement with field observations on landforms and channel attributes