Effect of telenursing (telephone follow-up)

on glycemic control and body mass index

(BMI) of type 2 diabetes patients.
Abstract

BACKGROUND
Telenursing includes every nursing and care-giving services conducted remotely. In
telenursing, telephone as a device, which is available for most of the people, is being used
increasingly. In a telephone-based system, patients are being contacted by health care
providers on regular bases and they would be provided with some information about their
illness and their treatment method. This study was conducted to determine the effect of
phone-based follow-ups on diabetes patients' metabolic control in the city of Kerman in
Iran.
MATERIALS AND METHODS
This is a quasi-experimental study conducted on 50 type II diabetes patients in Kerman
during 2011. Data were collected using a demographic questionnaire and also by taking
physiological measurement of fasting blood suger (FBS), Glycated Hemoglobin (HbA1c),
and postprandial glucose (PPG). Participants' body mass index (BMI) was calculated by
measuring height and weight. Patients completed the questionnaire at the beginning of the
study and 12 weeks later. The patients were randomly divided into two groups of
experiment and control. Patients in the experimental group received phone calls by the
researcher for 12 weeks, and the follow-ups included instructions on self-care and advices
to follow their diets, exercise, and insu lin titration. Data analysis was done using
descriptive and inferential statistical methods (chi-square, analysis of variance [ANOVA],
independent t-test, and paired t-test).
RESULTS
The decrease of HbA1c and PPG was significantly more in the intervention group
compared with the controls (P < 0.001). However, there was no significant difference
between the mean of FBS (P = 0.42), and BMI (P = 0.31) in both groups after the
intervention.
CONCLUSIONS
According to the results of this study, telenursing was able to improve the metabolic
indices of the patients. Therefore, using this method is recommended for patients with type
II diabetes.

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Authors

Lashkari T, Borhani F, Sabzevari S, Abbaszadeh A

Source

Iranian journal of nursing and midwifery research 18:6 2013 Nov pg 451-6
Pub Type(s)

Journal Article

Language

eng

PubMed ID

24554942
Mobile phone messaging for facilitating
self-management of long-term illnesses.
Abstract

BACKGROUND
Long-term illnesses affect a significant proportion of the population in developed and
developing countries. Mobile phone messaging applications, such as Short Message
Service (SMS) and Multimedia Message Service (MMS), may present convenient, cost-
effective ways of supporting self-management and improving patients' self-efficacy skills
through, for instance, medication reminders, therapy adjustments or supportive messages.
OBJECTIVES
To assess the effects of mobile phone messaging applications designed to facilitate self-
management of long-term illnesses, in terms of impact on health outcomes and patients'
capacity to self-manage their condition. Secondary objectives include assessment of: user
evaluation of the intervention; health service utilisation and costs; and possible risks and
harms associated with the intervention.
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL,The
Cochrane Library 2009, Issue 2), MEDLINE (OvidSP) (January 1993 to June 2009),
EMBASE (OvidSP) (January 1993 to June 2009), PsycINFO (OvidSP) (January 1993 to
June 2009), CINAHL (EbscoHOST) (January 1993 to June 2009), LILACS (January 1993
to June 2009) and African Health Anthology (January 1993 to June 2009).We also
reviewed grey literature (including trial registers) and reference lists of articles.
SELECTION CRITERIA
We included randomised controlled trials (RCTs), quasi-randomised controlled trials
(QRCTs), controlled before-after (CBA) studies, or interrupted time series (ITS) studies
with at least three time points before and after the intervention. We selected only studies
where it was possible to assess the effects of mobile phone messaging independent of other
technologies or interventions.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed all studies against the inclusion criteria, with
any disagreements resolved by a third review author. Study design features, characteristics
of target populations, interventions and controls, and results data were extracted by two
review authors and confirmed by a third. Primary outcomes of interest were health
outcomes as a result of the intervention and capacity to self-manage long-term conditions.
We also considered patients' and providers' evaluation of the intervention, perceptions of
safety, health service utilisation and costs, and potential harms or adverse effects. The
included studies were heterogeneous in type of condition addressed, intervention
characteristics and outcome measures. Therefore, a meta-analysis to derive an overall
effect size for the main outcome categories was not considered justified and findings are
presented narratively.
MAIN RESULTS
We included four randomised controlled trials involving 182 participants.For the primary
outcome of health outcomes, including physiological measures, there is moderate quality
evidence from two studies involving people with diabetes showing no statistical difference
from text messaging interventions compared with usual care or email reminders for
glycaemic control (HbA1c), the frequency of diabetic complications, or body weight.
There is moderate quality evidence from one study of hypertensive patients that the mean
blood pressure and the proportion of patients who achieved blood pressure control were
not significantly different in the intervention and control groups, and that there was no
statistically significant difference in mean body weight between the groups. There is
moderate quality evidence from one study that asthma patients receiving a text messaging
intervention experienced greater improvements on peak expiratory flow variability (mean
difference (MD) -11.12, 95% confidence interval (CI) -19.56 to -2.68) and the pooled
symptom score comprising four items (cough, night symptoms, sleep quality, and
maximum tolerated activity) (MD -0.36, 95% CI -0.56 to -0.17) compared with the control
group. However, the study found no significant differences between the groups in impact
on forced vital capacity or forced expiratory flow in 1 second.For the primary outcome of
capacity to self-manage the condition, there is moderate quality evidence from one study
that diabetes patients receiving the text messaging intervention demonstrated improved
scores on measures of self-management capacity (Self-Efficacy for Diabetes score (MD
6.10, 95% CI 0.45 to 11.75), Diabetes Social Support Interview pooled score (MD 4.39,
95% CI 2.85 to 5.92)), but did not show improved knowledge of diabetes. There is
moderate quality evidence from three studies of the effects on treatment compliance. One
study showed an increase in hypertensive patients' rates of medication compliance in the
intervention group (MD 8.90, 95% CI 0.18 to 17.62) compared with the control group, but
in another study there was no statistically significant effect on rates of compliance with
peak expiratory flow measurement in asthma patients. Text message prompts for diabetic
patients initially also resulted in a higher number of blood glucose results sent back (46.0)
than email prompts did (23.5).For the secondary outcome of participants' evaluation of the
intervention, there is very low quality evidence from two studies that patients receiving
mobile phone messaging support reported perceived improvement in diabetes self-
management, wanted to continue receiving messages, and preferred mobile phone
messaging to email as a method to access a computerised reminder system.For the
secondary outcome of health service utilisation, there is very low quality evidence from
two studies. Diabetes patients receiving text messaging support made a comparable
number of clinic visits and calls to an emergency hotline as patients without the support.
For asthma patients the total number of office visits was higher in the text messaging
group, whereas the number of hospital admissions was higher for the control
group.Because of the small number of trials included, and the low overall number of
participants, for any of the reviewed outcomes the quality of the evidence can at best be
considered moderate.
AUTHORS' CONCLUSIONS
We found some, albeit very limited, indications that in certain cases mobile phone
messaging interventions may provide benefit in supporting the self-management of long-
term illnesses. However, there are significant information gaps regarding the long-term
effects, acceptability, costs, and risks of such interventions. Given the enthusiasm with
which so-called mHealth interventions are currently being implemented, further research
into these issues is needed. 

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Authors

de Jongh T, Gurol-Urganci I, Vodopivec-Jamsek V, Car J, Atun R

Source

The Cochrane database of systematic reviews 12: 2012 pg CD007459

MeSH

Asthma
Cellular Phone
Chronic Disease
Diabetes Mellitus
Humans
Hypertension
Patient Satisfaction
Randomized Controlled Trials as Topic
Reminder Systems
Self Care
Text Messaging

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

23235644

Mobile phone text messaging for

promoting adherence to antiretroviral
therapy in patients with HIV infection.
Abstract

BACKGROUND
More than 34 million people are presently living with HIV infection. Antiretroviral therapy
(ART) can help these people to live longer, healthier lives, but adherence to ART can be
difficult. Mobile phone text-messaging has the potential to help promote adherence in
these patients.
OBJECTIVES
To determine whether mobile phone text-messaging is efficacious in enhancing adherence
to ART in patients with HIV infection.
SEARCH METHODS
Using the Cochrane Collaboration's validated search strategies for identifying randomised
controlled trials and reports of HIV interventions, along with appropriate keywords and
MeSH terms, we searched a range of electronic databases, including the Cochrane Central
Register of Controlled Trials (CENTRAL), EMBASE, Literatura Latino-Americana e do
Caribe em Ciências da Saúde (LILACS), MEDLINE (via PubMed), PsycINFO, Web of
Science, and the World Health Organization (WHO) Global Index Medicus. The date
range was from  01 January 1980 to 01 November 2011. There were no limits to language
or publication status.
SELECTION CRITERIA
Randomised controlled trials (RCTs) in which patients or their caregivers (in the case of
infants and children) of any age, in any setting, and receiving ART were provided with
mobile phone text messages as a means of promoting adherence to ART.
DATA COLLECTION AND ANALYSIS
Two authors independently examined the abstracts of all identified trials. We initially
identified 243 references. Seventeen full-text articles were closely reviewed. Both authors
abstracted data independently, using a pre-designed, standardised data collection form.
When appropriate, data were combined in meta-analysis.
MAIN RESULTS
Two RCTs from Kenya were included in the review. One trial compared short weekly text
messages against standard care. The other trial compared short daily, long daily, short
weekly and long weekly messages against standard care. Both trials were with adult
patients.In the trial comparing only short weekly messages to standard care, text messaging
was associated with a lower risk of non-adherence at 12 months (RR 0.77, 95% CI 0.63 to
0.93) and with the non-occurrence of virologic failure at 12 months (RR 0.83, 95% CI 0.69
to 0.99).In the trial that compared different intervals and lengths for text-messaging to
standard care, long weekly text-messaging was not significantly associated with a lower
risk of non-adherence compared to standard care (RR 0.79, 95% CI 0.60 to 1.04). Patients
receiving weekly text-messages of any length were at lower risk of non-adherence at 48
weeks than were patients receiving daily messages of any length (RR 0.79, 95% CI 0.64 to
0.99). There were no significant differences between weekly text-messaging of any length
(RR 1.01, 95% CI 0.75 to 1.37) and between short or long messaging at either interval (RR
0.99, 95% CI 0.78 to 1.27). Compared to standard care, any daily text-messaging, whether
short or long, did not reduce the risk for non-adherence (RR 0.99, 95% CI 0.82 to 1.20).In
meta-analysis of both trials, any weekly text-messaging (i.e. whether short or long
messages) was associated with a lower risk of non-adherence at 48-52 weeks (RR 0.78,
95% CI 0.68 to 0.89). The effect of short weekly text-messaging was also significant (RR
0.77, 95% CI 0.67 to 0.89).
AUTHORS' CONCLUSIONS
There is high-quality evidence from the two RCTs that mobile phone text-messaging at
weekly intervals is efficacious in enhancing adherence to ART, compared to standard care.
There is high quality evidence from one trial that weekly mobile phone text-messaging is
efficacious in improving HIV viral load suppression. Policy-makers should consider
funding programs proposing to provide weekly mobile phone text-messaging as a means
for promoting adherence to antiretroviral therapy. Clinics and hospitals should consider
implementing such programs. There is a need for large RCTs of this intervention in
adolescent populations, as well as in high-income countries.

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Authors

Horvath T, Azman H, Kennedy GE, Rutherford GW

Source

The Cochrane database of systematic reviews 3: 2012 pg CD009756

MeSH

Adult
Anti-HIV Agents
Cellular Phone
HIV Infections
HIV-1
Health Promotion
Humans
Kenya
Medication Adherence
Randomized Controlled Trials as Topic
Text Messaging
Time Factors

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

22419345

Unbound MEDLINE

Home telehealth: facilitators, barriers, and

impact of nurse support among high-risk
dialysis patients.
Abstract

OBJECTIVE
The value of home telehealth self-monitoring with nurse oversight has been demonstrated;
however, there is a dearth of objective documentation of patients' experiences with such a
model. We used a mixed methods approach to examine the value of home telehealth
monitoring with remote care nurse (RCN) support from the perspective of participants in
our study.
MATERIALS AND METHODS
Thirty-three patients who used remote technology to self-monitor their health at home
participated in a semistructured interview. The instrument was designed to help identify
facilitators and barriers and to evaluate patient satisfaction with and effectiveness of home
telehealth self-monitoring. Results: Overall, patients reported high levels of satisfaction
with RCN support as they received efficient feedback, were better able to identify changes
in their health status, and experienced enhanced accountability, self-efficacy, and
motivation to make health behavior changes. The most frequently cited barriers related to
malfunctioning equipment or trouble with Internet connections, forgetfulness, and feeling
poorly.
CONCLUSIONS
The results suggest that home telehealth self-monitoring with RCN support is effective in
empowering patients to take a more active role in their healthcare and indirectly improve
quality of life for those living with chronic illness.

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Authors

Minatodani DE, Chao PJ, Berman SJ

Source

Telemedicine journal and e-health : the official journal of the American Telemedicine
Association 19:8 2013 Aug pg 573-8

MeSH

Adult
Aged
Aged, 80 and over
Female
Hawaii
Hemodialysis, Home
Home Nursing
Humans
Male
Middle Aged
Nurse's Role
Patient Participation
Patient Satisfaction
Qualitative Research
Quality of Life
Self Care
Telemedicine

Pub Type(s)
Evaluation Studies
Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

23742629

Body weight telemetry is useful to reduce

interdialytic weight gain in patients with
end-stage renal failure on hemodialysis.
Abstract

Lacking compliance with liquid intake restrictions is one of the major problems in patients
on hemodialysis and causes an increased mortality. In 120 patients on hemodialysis with
an average interdialytic weight gain (IWG) exceeding 1.5 kg on at least 2 days during the 4
weeks preceding the intervention, the effect of telemetric body weight measurement
(TBWM) on IWG, ultrafiltration rate, and blood pressure was evaluated over a period of 3
months. Patients of the telemetric group (TG) were supplied with automatic scales, which
transferred the weight via telemetry on a daily basis. In the case of IWG of more than 0.75
kg/24 h, a telephonic contact was made as required, and in the case of an IWG of more
than 1.5 kg, telephonic contacting was obligatory along with the advice of a liquid intake
restriction to 0.5 L/day until the next dialysis. The patients of the control group (CG)
received standard treatment without telemetric monitoring. We examined specific data of
the second interdialytic interval (IDI2) and the average within 1 week. The average
difference of IWG between TG and CG was not significant before the start of the study but
0.2 kg (p=0.027) (IDI2)/0.27kg (p=0.001) (WP) at the end of the study, respectively. The
average difference in the ultrafiltration rate within 1 week was 19.0 mL/h (p=0.282)
(IDI2)/8.2 mL/h (p=0.409) before the start of the study but 28.4 mL/h (p=0.122)
(IDI2)/30.9 mL/h (p=0.004) at the end of the study, respectively. Thus, TBWM is a
feasible method for optimizing the IWG and reducing the ultrafiltration rate.

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Authors

Neumann CL, Wagner F, Menne J, Brockes C, Schmidt-Weitmann S, Rieken EM,

Schettler V, Hagenah GC, Matzath S, Zimmerli L, Haller H, Schulz EG
Source

Telemedicine journal and e-health : the official journal of the American Telemedicine
Association 19:6 2013 Jun pg 480-6

MeSH

Aged
Aged, 80 and over
Feasibility Studies
Female
Germany
Humans
Kidney Failure, Chronic
Male
Middle Aged
Renal Dialysis
Telemetry
Weight Gain

Pub Type(s)

Evaluation Studies
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23614336

Using a modified technology acceptance

model to evaluate healthcare
professionals' adoption of a new
telemonitoring system.
Abstract

OBJECTIVE
To examine the factors that could influence the decision of healthcare professionals to use
a telemonitoring system.
MATERIALS AND METHODS
A questionnaire, based on the Technology Acceptance Model (TAM), was developed. A
panel of experts in technology assessment evaluated the face and content validity of the
instrument. Two hundred and thirty-four questionnaires were distributed among nurses and
doctors of the cardiology, pulmonology, and internal medicine departments of a tertiary
hospital. Cronbach alpha was calculated to measure the internal consistency of the
questionnaire items. Construct validity was evaluated using interitem correlation analysis.
Logistic regression analysis was performed to test the theoretical model. Adjusted odds
ratios (ORs) and their 95% confidence intervals (CIs) were computed.
RESULTS
A response rate of 39.7% was achieved. With the exception of one theoretical construct
(Habit) that corresponds to behaviors that become automatized, Cronbach alpha values
were acceptably high for the remaining constructs. Theoretical variables were well
correlated with each other and with the dependent variable. The original TAM was good at
predicting telemonitoring usage intention, Perceived Usefulness being the only significant
predictor (OR: 5.28, 95% CI: 2.12-13.11). The model was still significant and more
powerful when the other theoretical variables were added. However, the only significant
predictor in the modified model was Facilitators (OR: 4.96, 95% CI: 1.59-15.55).
CONCLUSION
The TAM is a good predictive model of healthcare professionals' intention to use
telemonitoring. However, the perception of facilitators is the most important variable to
consider for increasing doctors' and nurses' intention to use the new technology.

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Authors

Gagnon MP, Orruño E, Asua J, Abdeljelil AB, Emparanza J

Source

Telemedicine journal and e-health : the official journal of the American Telemedicine
Association 18:1 pg 54-9

MeSH

Adult
Attitude to Computers
Confidence Intervals
Female
Health Care Surveys
Humans
Logistic Models
Male
Medical Informatics
Middle Aged
Monitoring, Physiologic
Odds Ratio
Spain
Telemedicine
Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22082108

 Gagnon MP, Orruño E, Asua J, et al. 

 Using a modified technology acceptance model to evaluate healthcare professionals'
adoption of a new telemonitoring system. [Journal Article, Randomized Controlled Trial,
Research Support, Non-U.S. Gov't]
 Telemed J E Health 2012 Jan-Feb; 18(1):54-9.
The decreasing cost of telemedicine and
telehealth.
Abstract

The teleoncology practice based at the University of Kansas Medical Center (KUMC) in
Kansas City, Kansas, is one of the longest running practices of its kind worldwide. The
practice began in 1995 and connected an oncologist at KUMC with a rural medical center
in Hays, Kansas. Fifteen years later, the practice continues to thrive at Hays Medical
Center and has also expanded to include two additional sites within the state-the Northeast
Kansas Center for Health and Wellness in Horton and Goodland Regional Medical Center
in Goodland-that offer regularly scheduled teleoncology clinics. While the KUMC practice
has witnessed an expansion in service sites throughout its history, the practice has seen a
significant decrease in the costs associated with providing such services since its inception.
The cost decrease can, in part, be attributed to an increase in the number of teleoncology
visits conducted through the practice since it began. In Fiscal Year 1995 (FY 1995), 103
teleoncology visits resulted in a cost per visit of $812. Five years later, the FY 2000 $410
per visit cost for 121 visits was almost half the cost identified in the initial cost analysis.
The FY 2003 cost per visit for 219 visits saw another decrease to $401, and the most recent
FY 2005 cost analysis yielded another decrease to $251 per visit for 235 visits. The data
reported below are likely to be the best now available to track time trends in the cost of
providing telemedicine or telehealth consultations. The Conclusion and Policy
Recommendations at the end of this article will focus on both the cost-time profile and
some other challenges and lessons learned.

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Authors

Doolittle GC, Spaulding AO, Williams AR

Source

Telemedicine journal and e-health : the official journal of the American Telemedicine
Association 17:9 2011 Nov pg 671-5

MeSH

Adolescent
Adult
Aged
Aged, 80 and over
Costs and Cost Analysis
Female
Humans
Kansas
Longitudinal Studies
Male
Medical Oncology
Middle Aged
Rural Health Services
Socioeconomic Factors
Telemedicine
Young Adult

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22035320

 Doolittle GC, Spaulding AO, Williams AR 

 The decreasing cost of telemedicine and telehealth. [Journal Article]
 Telemed J E Health 2011 Nov; 17(9):671-5.

elemonitoring increases patient awareness

of health and prompts health-related
action: initial evaluation of the TELE-
ERA study.
Abstract

INTRODUCTION
Telemonitoring is being increasingly used for chronic disease monitoring. Understanding
elderly patients' feelings and perspectives toward telemonitoring is important to minimize
any barriers to implementation in this population.
METHODS
Twenty Tele-Era Trial participants completed qualitative interviews assessing opinions
about their telemonitoring experience. Participants also rated telemonitoring on burden,
communication with clinicians, impact on medical condition knowledge, and confidence in
using the monitor.
RESULTS
On an average, participants rated telemonitoring as minimally burdensome, rated
themselves confident in using the monitor, and positively rated telemonitoring for clinical
communication. Qualitative analysis revealed a predominant theme that telemonitoring
increases patient awareness of their health and also that telemonitoring prompts action.
CONCLUSION
Elderly patients find home telemonitoring to be an acceptable and satisfying experience
that can increase their awareness of their health and provide a sense of safety in their
home. Home telemonitoring can lead to earlier evaluation of decline in health status.

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Authors

Pecina JL, Vickers KS, Finnie DM, Hathaway JC, Hanson GJ, Takahashi PY

Source

Telemedicine journal and e-health : the official journal of the American Telemedicine
Association 17:6 pg 461-6

MeSH

Aged
Aged, 80 and over
Chronic Disease
Comorbidity
Female
Health Knowledge, Attitudes, Practice
Home Care Services
Humans
Interviews as Topic
Male
Monitoring, Physiologic
Patient Satisfaction
Program Evaluation
Qualitative Research
Randomized Controlled Trials as Topic
Telemedicine

Pub Type(s)

Evaluation Studies
Journal Article
Research Support, Non-U.S. Gov't

Language
eng

PubMed ID

21612521

 Pecina JL, Vickers KS, Finnie DM, et al. 

 Telemonitoring increases patient awareness of health and prompts health-related
action: initial evaluation of the TELE-ERA study. [Evaluation Studies, Journal Article,
Research Support, Non-U.S. Gov't]
 Telemed J E Health 2011 Jul-Aug; 17(6):461-6.

Home-based preventative care in high-risk

dialysis patients: a pilot study.
Abstract

OBJECTIVE
Most dialysis patients have multiple comorbidities with complex healthcare needs and
consume a disproportionate share of medical resources. We conducted a pilot study
employing telehealth technology to determine whether home-based preventative care can
improve healthcare outcomes, impact quality of life (QOL), and be cost effective by
proactively managing underlying chronic conditions that place the patient at risk.
MATERIALS AND METHODS
Forty-four patients (19 in the remote technology group [RT] and 25 in the usual care group
[UC]) participated in this study. The mean age was 57 for those in the RT group (7 females
and 12 males) and 62 for those receiving UC (11 females and 14 males). Health outcome
measurements included hospitalizations, emergency room visits, and the number of days
hospitalized. Economic analysis included total hospital and emergency room charges. QOL
was measured using the medical outcomes survey instrument 36-Item Short Form Health
Survey (SF-36).
RESULTS
Hospitalizations (RT 0.0018 and UC 0.0056 per study day), hospital days (RT 0.008 and
UC 0.036 per study day), emergency room visits (RT 0.0003 and UC 0.0019 per study
day), and associated charges (RT $114 and UC $322 per study day) were significantly less
in the RT group of the study compared with patients receiving UC. The perceived QOL
remained the same in the UC group from outset to midpoint of the study (59.1, 59.5),
whereas it decreased slightly in the RT group (63.9, 60.76).
CONCLUSIONS
The results suggest that remote telehealth technology can play an important role in
improving health outcomes and the cost of care of patients with end-stage renal disease
who have complex healthcare needs.

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Authors

Berman SJ, Wada C, Minatodani D, Halliday T, Miyamoto R, Lindo J, Jordan PJ

Source

Telemedicine journal and e-health : the official journal of the American Telemedicine
Association 17:4 2011 May pg 283-7

MeSH

Adult
Aged
Aged, 80 and over
Chronic Disease
Female
Health Care Surveys
Home Care Services
Hospitalization
Humans
Karnofsky Performance Status
Male
Middle Aged
Physician-Patient Relations
Pilot Projects
Preventive Medicine
Quality of Life
Renal Dialysis
Risk Assessment
Self Report
Telemedicine

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

21480788