%PDF-1.3
%
2 0 obj
<>
endobj
47 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 53/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0 q-Br44C@B 9 s
(P
endstream
endobj
31 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 55/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0P02S04S @$P5 )1
endstream
endobj
86 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 53/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0 q-Br44C@B 9 s
(P
endstream
endobj
66 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 54/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T R
Ɩf
!\!Y\ !p )P
endstream
endobj
75 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 54/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T R
Ɩf
!\!Y\ !p )P
endstream
endobj
58 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 55/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0P02S04S @$P5 )1
endstream
endobj
26 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 53/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0 q-Br44C@B 9 s
(P
endstream
endobj
44 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 53/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0 q-Br44C@B 9 s
(P
endstream
endobj
89 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 53/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0 q-Br44C@B 9 s
(P
endstream
endobj
41 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 53/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0 q-Br44C@B 9 s
(P
endstream
endobj
95 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 53/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0 q-Br44C@B 9 s
(P
endstream
endobj
3 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 54/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T R
Ɩf
!\!Y\ !p )P
endstream
endobj
96 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 54/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T R
Ɩf
!\!Y\ !p )P
endstream
endobj
37 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 55/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0P02S04S @$P5 )1
endstream
endobj
63 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 54/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T R
Ɩf
!\!Y\ !p )P
endstream
endobj
88 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 55/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0P02S04S @$P5 )1
endstream
endobj
97 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 55/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0P02S04S @$P5 )1
endstream
endobj
24 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 54/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T R
Ɩf
!\!Y\ !p )P
endstream
endobj
94 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 55/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0P02S04S @$P5 )1
endstream
endobj
40 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 55/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0P02S04S @$P5 )1
endstream
endobj
83 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 53/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0 q-Br44C@B 9 s
(P
endstream
endobj
30 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 54/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T R
Ɩf
!\!Y\ !p )P
endstream
endobj
64 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 55/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0P02S04S @$P5 )1
endstream
endobj
50 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 53/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0 q-Br44C@B 9 s
(P
endstream
endobj
16 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 55/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0P02S04S @$P5 )1
endstream
endobj
71 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 53/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0 q-Br44C@B 9 s
(P
endstream
endobj
56 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 53/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0 q-Br44C@B 9 s
(P
endstream
endobj
27 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 54/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T R
Ɩf
!\!Y\ !p )P
endstream
endobj
29 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 53/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0 q-Br44C@B 9 s
(P
endstream
endobj
78 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 54/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T R
Ɩf
!\!Y\ !p )P
endstream
endobj
42 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 54/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T R
Ɩf
!\!Y\ !p )P
endstream
endobj
74 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 53/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0 q-Br44C@B 9 s
(P
endstream
endobj
7 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 55/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0P02S04S @$P5 )1
endstream
endobj
53 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 53/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0 q-Br44C@B 9 s
(P
endstream
endobj
73 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 55/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0P02S04S @$P5 )1
endstream
endobj
62 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 53/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0 q-Br44C@B 9 s
(P
endstream
endobj
61 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 55/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0P02S04S @$P5 )1
endstream
endobj
20 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 53/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0 q-Br44C@B 9 s
(P
endstream
endobj
55 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 55/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0P02S04S @$P5 )1
endstream
endobj
49 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 55/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0P02S04S @$P5 )1
endstream
endobj
77 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 53/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0 q-Br44C@B 9 s
(P
endstream
endobj
34 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 55/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0P02S04S @$P5 )1
endstream
endobj
85 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 55/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0P02S04S @$P5 )1
endstream
endobj
52 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 55/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0P02S04S @$P5 )1
endstream
endobj
87 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 54/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T R
Ɩf
!\!Y\ !p )P
endstream
endobj
65 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 53/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0 q-Br44C@B 9 s
(P
endstream
endobj
12 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 54/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T R
Ɩf
!\!Y\ !p )P
endstream
endobj
80 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 53/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0 q-Br44C@B 9 s
(P
endstream
endobj
46 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 55/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0P02S04S @$P5 )1
endstream
endobj
54 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 54/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T R
Ɩf
!\!Y\ !p )P
endstream
endobj
15 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 54/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T R
Ɩf
!\!Y\ !p )P
endstream
endobj
5 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 53/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0 q-Br44C@B 9 s
(P
endstream
endobj
35 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 53/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0 q-Br44C@B 9 s
(P
endstream
endobj
76 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 55/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0P02S04S @$P5 )1
endstream
endobj
68 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 53/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0 q-Br44C@B 9 s
(P
endstream
endobj
18 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 54/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T R
Ɩf
!\!Y\ !p )P
endstream
endobj
81 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 54/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T R
Ɩf
!\!Y\ !p )P
endstream
endobj
59 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 53/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0 q-Br44C@B 9 s
(P
endstream
endobj
1 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 53/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0 q-Br44C@B 9 s
(P
endstream
endobj
28 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 55/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0P02S04S @$P5 )1
endstream
endobj
4 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 55/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0P02S04S @$P5 )1
endstream
endobj
45 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 54/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T R
Ɩf
!\!Y\ !p )P
endstream
endobj
90 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 54/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T R
Ɩf
!\!Y\ !p )P
endstream
endobj
11 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 53/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0 q-Br44C@B 9 s
(P
endstream
endobj
33 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 54/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T R
Ɩf
!\!Y\ !p )P
endstream
endobj
51 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 54/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T R
Ɩf
!\!Y\ !p )P
endstream
endobj
69 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 54/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T R
Ɩf
!\!Y\ !p )P
endstream
endobj
17 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 53/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0 q-Br44C@B 9 s
(P
endstream
endobj
10 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 55/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0P02S04S @$P5 )1
endstream
endobj
43 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 55/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0P02S04S @$P5 )1
endstream
endobj
60 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 54/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T R
Ɩf
!\!Y\ !p )P
endstream
endobj
84 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 54/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T R
Ɩf
!\!Y\ !p )P
endstream
endobj
67 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 55/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0P02S04S @$P5 )1
endstream
endobj
36 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 54/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T R
Ɩf
!\!Y\ !p )P
endstream
endobj
38 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 53/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0 q-Br44C@B 9 s
(P
endstream
endobj
57 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 54/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T R
Ɩf
!\!Y\ !p )P
endstream
endobj
48 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 54/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T R
Ɩf
!\!Y\ !p )P
endstream
endobj
25 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 55/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0P02S04S @$P5 )1
endstream
endobj
23 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 53/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0 q-Br44C@B 9 s
(P
endstream
endobj
39 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 54/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T R
Ɩf
!\!Y\ !p )P
endstream
endobj
8 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 53/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0 q-Br44C@B 9 s
(P
endstream
endobj
82 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 55/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0P02S04S @$P5 )1
endstream
endobj
13 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 55/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0P02S04S @$P5 )1
endstream
endobj
19 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 55/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0P02S04S @$P5 )1
endstream
endobj
14 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 53/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0 q-Br44C@B 9 s
(P
endstream
endobj
79 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 55/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0P02S04S @$P5 )1
endstream
endobj
72 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 54/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T R
Ɩf
!\!Y\ !p )P
endstream
endobj
6 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 54/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T R
Ɩf
!\!Y\ !p )P
endstream
endobj
32 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 53/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0 q-Br44C@B 9 s
(P
endstream
endobj
92 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 53/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0 q-Br44C@B 9 s
(P
endstream
endobj
70 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 55/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0P02S04S @$P5 )1
endstream
endobj
21 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 54/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T R
Ɩf
!\!Y\ !p )P
endstream
endobj
91 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 55/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0P02S04S @$P5 )1
endstream
endobj
22 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 55/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T0P02S04S @$P5 )1
endstream
endobj
93 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 54/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T R
Ɩf
!\!Y\ !p )P
endstream
endobj
9 0 obj
<>>>/Subtype/Form/BBox[0 0 612 792]/Matrix [1 0 0 1 0 0]/Length 54/FormType 1/Filter/FlateDecode>>stream
xs
w3T04PI2P0T5T R
Ɩf
!\!Y\ !p )P
endstream
endobj
98 0 obj
<>stream
2014-08-26T16:31:08+05:30
Arbortext Advanced Print Publisher 9.0.114/W
2014-11-09T11:24:18-08:00
Atypon Systems, Inc.; modified using iText 4.2.0 by 1T3XT
application/pdf
untitled
uuid:5b717915-af57-402e-9160-8ab35cfdc3f4
uuid:22f42fb4-733b-499d-a77a-4e212701aa34
endstream
endobj
99 0 obj
<>stream
x+ |
endstream
endobj
100 0 obj
<>stream
xS**T0T0 Bil]D. rs
endstream
endobj
101 0 obj
<>stream
x+ |
endstream
endobj
102 0 obj
<>stream
xS**T0T0 Bij]1D. qmj
endstream
endobj
103 0 obj
<>stream
x+ |
endstream
endobj
104 0 obj
<>stream
xS**T0T0 BiU !D. _e1
endstream
endobj
105 0 obj
<>stream
x+ |
endstream
endobj
106 0 obj
<>stream
xS**T0T0 Bia]D. t|
endstream
endobj
107 0 obj
<>stream
x+ |
endstream
endobj
108 0 obj
<>stream
xS**T0T0 Bii]D. rs
endstream
endobj
109 0 obj
<>stream
x+ |
endstream
endobj
110 0 obj
<>stream
xS**T0T0 BiUD* :
endstream
endobj
111 0 obj
<>stream
x+ |
endstream
endobj
112 0 obj
<>stream
xS**T0T0 BifU !D. ss
endstream
endobj
113 0 obj
<>stream
x+ |
endstream
endobj
114 0 obj
<>stream
xS**T0T0 Bin] D. rs
endstream
endobj
115 0 obj
<>stream
x+ |
endstream
endobj
116 0 obj
<>stream
xS**T0T0 Bif]D. qpj
endstream
endobj
117 0 obj
<>stream
x+ |
endstream
endobj
118 0 obj
<>stream
xS**T0T0 Bia]%D. u]
endstream
endobj
119 0 obj
<>stream
x+ |
endstream
endobj
120 0 obj
<>stream
xS**T0T0 Bij]%D. t|
endstream
endobj
121 0 obj
<>stream
x+ |
endstream
endobj
122 0 obj
<>stream
xS**T0T0 Bid]D. qdj
endstream
endobj
123 0 obj
<>stream
x+ |
endstream
endobj
124 0 obj
<>stream
xS**T0T0 BiUD* 8
endstream
endobj
125 0 obj
<>stream
x+ |
endstream
endobj
126 0 obj
<>stream
xS**T0T0 Bii])D. t|
endstream
endobj
127 0 obj
<>stream
x+ |
endstream
endobj
128 0 obj
<>stream
xS**T0T0 Bid]%D. rs
endstream
endobj
129 0 obj
<>stream
x+ |
endstream
endobj
130 0 obj
<>stream
xS**T0T0 Bif])D. rs
endstream
endobj
131 0 obj
<>stream
x+ |
endstream
endobj
132 0 obj
<>stream
xS**T0T0 Bid]1D. pa
endstream
endobj
133 0 obj
<>stream
x+ |
endstream
endobj
134 0 obj
<>stream
xS**T0T0 BiU)D* 9V
endstream
endobj
135 0 obj
<>stream
x+ |
endstream
endobj
136 0 obj
<>stream
xS**T0T0 Bib]9D. rs
endstream
endobj
137 0 obj
<>stream
x+ |
endstream
endobj
138 0 obj
<>stream
xS**T0T0 Bif]D. t
|
endstream
endobj
139 0 obj
<>stream
x+ |
endstream
endobj
140 0 obj
<>stream
xS**T0T0 Bib] D. qjj
endstream
endobj
141 0 obj
<>stream
x+ |
endstream
endobj
142 0 obj
<>stream
xS**T0T0 Bia]1D. rs
endstream
endobj
143 0 obj
<>stream
x+ |
endstream
endobj
144 0 obj
<>stream
xS**T0T0 Bil])D. qgj
endstream
endobj
145 0 obj
<>stream
x+ |
endstream
endobj
146 0 obj
<>stream
xS**T0T0 Bih]D. r^j
endstream
endobj
147 0 obj
<>stream
x+ |
endstream
endobj
148 0 obj
<>stream
xS**T0T0 Bin]9D. t
|
endstream
endobj
149 0 obj
<>stream
x+ |
endstream
endobj
150 0 obj
<>stream
xS**T0T0 BilU !D. rej
endstream
endobj
151 0 obj
<>stream
x+ |
endstream
endobj
152 0 obj
<>stream
xS**T0T0 Bib]D. ss
endstream
endobj
153 0 obj
<>stream
x+ |
endstream
endobj
154 0 obj
<>stream
xS**T0T0 Bin]D. u
|
endstream
endobj
155 0 obj
<>stream
x+ |
endstream
endobj
156 0 obj
<>stream
xS**T0T0 Bih]9D. qaj
endstream
endobj
157 0 obj
<>stream
x+ |
endstream
endobj
158 0 obj
<>stream
xS**T0T0 Bih] D. pa
endstream
endobj
159 0 obj
<>stream
x+ |
endstream
endobj
160 0 obj
<>stream
xS**T0T0 Bij]D. rs
endstream
endobj
161 0 obj
<>stream
x+ |
endstream
endobj
162 0 obj
<>stream
xS**T0T0 Bil]D. pa
endstream
endobj
163 0 obj
<>/XObject<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]/Font<>/Properties<>>>/Thumb 174 0 R/MediaBox[0 0 612 792]/Rotate 0>>
endobj
175 0 obj
<>/ProcSet[/PDF/Text]/Font<>/Properties<>>>
endobj
165 0 obj
<>stream
/GS1 gs
BT
/F1 1 Tf
8.9663 0 0 8.9663 60.0945 693.8644 Tm
0 0 0 1 k
0 Tc
0 Tw
[(Be)28.3(y)14.2(o)14.2(n)14.6(d)-188.2(t)14.8(h)16.2(e)-185.3(P)14.6(a)17.4(t)14.8(i)0(e)26.2(n)14.6(t)-187.5(P)20.9(r)12.6(o)14.2(t)14.8(e)0(c)27.8(t)14.8(i)15.4(o)14.2(n)-187.8(a)17.4(n)14.6(d)-181.8(Af)27.3(f)16.9(o)14.2(r)12.6(d)14.2(a)17.4(b)14.2(le)-176.2(C)15.6(a)17.4(r)12.6(e)-185.3(A)16.8(c)0(t)25.5(,)-184.6(a)-184.9(w)16.2(i)15.4(d)14.2(e)-185.3(r)12.6(a)17.4(n)14.6(g)14.2(e)]TJ
-1.1065 -1.3278 TD
-.0159 Tc
[(of)-283.6(re)-15.9(f)11.7(o)-1.7(rms)-282.2(i)-.5(s)-288.5(n)-1.3(ece)-15.9(s)13.1(s)-15.9(a)13.5(r)-3.3(y)-286.3(t)-1.1(o)-279.9(a)-15.9(d)9.4(d)-1.7(re)-15.9(s)13.1(s)-288.5(intra)-15.9(n)9.8(sige)-15.9(n)9.4(t)-279.3(proble)-15.9(m)12.8(s)-282.2(i)-.5(n)-285.9(h).3(e)-15.9(a)12.2(lthc)-15.9(a)12.2(r)-3.3(e)]TJ
0 -1.3341 TD
0 Tc
[(d)14.2(e)17(l)15.4(i)15.4(v)14.2(er)29.6(y)-194.5(i)15.4(n)-187.8(t)14.8(h)16.2(e)-191.6(U)12.7(n)14.6(i)15.4(t)14.8(e)17(d)-194.5(S)16.2(t)14.8(at)25.9(e)17(s)-190.4(a)17.4(n)14.6(d)-194.5(w)16.2(o)14.2(r)18.9(ld)23.3(w)16.2(i)15.4(d)14.2(e)17(.)-191(T)14.2(he)26.9(se)-173.3(i)15.4(n)14.6(cl)26.2(u)16.2(d)14.2(e)-191.6(i)15.4(n)14.6(e)17(q)14.2(u)0(i)25.3(t)14.8(i)15.4(e)17(s)-190.4(i)15.4(n)]TJ
T*
[(t)14.8(h)16.2(e)-191.6(a)17.4(v)14.2(a)0(i)26.5(l)15.4(a)17.4(b)14.2(il)24.6(i)15.4(t)14.8(y)-188.2(a)0(n)25.7(d)-188.2(ac)28.1(ce)27.8(ss)-178.4(t)14.8(o)-194.5(h)16.2(e)17(al)26.5(t)14.8(h)-192.5(s)18.3(e)0(r)29.6(v)14.2(ic)26.2(e)17(s)-196.7(f)16.9(o)14.2(r)-189.8(s)0(i)27.4(g)14.2(n)14.6(i)15.4(f)16.9(i)15.4(ca)28.1(n)14.6(t)-193.8(se)29(g)14.2(m)18(en)25.3(t)14.8(s)-190.4(o)14.2(f)]TJ
T*
-.0151 Tc
[(the)-421.7(popu)-15.1(l)10.2(a)2.3(tion,)-427.4(i).3(nef)-15.1(f)12.3(ici)-15.1(e)11.1(nci)-15.1(e)11.1(s)-426.8(i).3(n)-424.2(t)-.3(he)-421.7(preva)-15.1(i)11.4(ling)-424.6(m)-15.1(o)17(d)-.9(e)-15.1(s)-416.1(o)5.4(f)-428.2(he)-15.1(a)13(l).3(thc)-15.1(a)13(re)]TJ
T*
[(delive)-15.1(r)14.5(y)-260.2(a)-15.1(n)16.9(d)-260.2(f)-15.1(i)10.9(nanci)-15.1(n)14.9(g,)-263(uneve)-15.1(n)-249.1(distribution)-259.8(of)-257.5(qu)-15.1(a)12.2(lity,)-263(es)-15.1(c)13.9(a)2.3(l)-15.1(a)11.4(ting)-260.2(cos)-15.1(t)11.7(,)]TJ
T*
0 Tc
[(a)17.4(n)14.6(d)-308.3(t)14.8(he)-295.6(p)14.2(r)12.6(e)17(v)14.2(al)26.5(e)17(n)14.6(ce)-294.7(o)14.2(f)-311.9(a)17.4(d)14.2(v)14.2(e)0(r)23.3(s)18.3(e)-311.7(l)15.4(i)15.4(f)16.9(es)29(t)14.8(y)14.2(le)26.2(s)-310.5(t)14.8(h)16.2(a)0(t)-296.5(t)14.8(e)17(n)14.6(d)-314.6(t)14.8(o)-308.3(e)17(x)14.6(a)0(c)28.1(e)0(r)29.6(b)14.2(at)25.9(e)-311.7(t)14.8(h)16.2(e)17(se)]TJ
T*
-.0157 Tc
[(proble)-15.7(m)13(s)-15.7(.)-340.1(C)-15.7(o)7.7(ncurrently,)-358.4(d)-1.5(ra)-15.7(m)13.4(a)-15.7(t)10.2(i)-.3(c)-352.7(a)-15.7(d)9.6(v)-1.5(ance)-15.7(s)-347.1(i)-.3(n)-355.2(t)-.9(he)-359.1(capa)-15.7(b)9.6(ilitie)-15.7(s)-340.8(o)-1.5(f)-359.3(I)1.8(CT)]TJ
T*
-.0153 Tc
[(and)-298.3(i).1(ts)-300.5(expa)-15.3(n)10.4(d)-1.1(ing)-298.3(v)-1.1(ital)-297(role)-301.8(in)-297.9(all)-297(s)-15.3(e)13.7(c)-15.3(t)10.2(o)-1.1(rs)-294.2(of)-301.9(modern)-297.9(s)-15.3(o)10.8(cie)-15.3(t)10.2(y)-298.3(p)-1.1(re)-15.3(s)13.7(e)-15.3(n)10(t)-297.7(a)]TJ
0 -1.3278 TD
-.0149 Tc
[(com)-14.9(p)10.9(elling)-399.1(c)2.1(a)-14.9(s)14.5(e)-396.2(f)2(or)-400.7(a)-395.8(t)-.1(horo)5.6(u)-14.9(g)9.1(h)-397(e)2.1(xam)-14.9(i)12.2(nation)-398.7(of)-396.4(the)-396.2(u)1.3(nde)-14.9(r)14.7(lying)-399.1(e)2.1(vi-)]TJ
0 -1.3341 TD
-.0155 Tc
[(dence)-264(a)1.9(nd)-260.6(its)-262.8(a)1.9(ppropria)-15.5(t)10.4(e)-257.7(de)-15.5(p)9.4(l)-.1(oyme)-15.5(n)9.8(t)-259.9(i)-.1(n)-260.2(h).7(ea)-15.5(l)11(t)-.7(hc)-15.5(a)12.6(r)-2.9(e.)-257(I)-15.5(n)10.2(dee)-15.5(d)9.4(,)-257(t)-.7(he)-264(us)-15.5(e)-245.8(o)-1.3(f)]TJ
T*
0 Tc
[(I)17.5(C)15.6(T)-295.7(i)15.4(n)-288.9(h)16.2(ea)28.1(l)15.4(t)14.8(hc)26.9(ar)30(e)-292.8(l)15.4(ag)25.3(s)-291.6(b)14.2(e)17(h)16.2(i)15.4(n)14.6(d)-295.7(i)15.4(n)-288.9(c)0(o)24.9(m)18(p)14.2(a)0(r)30(i)15.4(so)26.1(n)-288.9(w)0(i)25.3(t)14.8(h)-287.3(o)14.2(t)14.8(h)0(e)26.9(r)-290.9(se)29(ct)25.5(o)14.2(r)18.9(s)-291.5(i)0(n)-279.8(s)18.3(o)14.2(-)]TJ
T*
[(c)17(i)15.4(et)25.5(y)14.2(,)-368(i)15.4(n)14.6(c)17(l)15.4(ud)24(i)15.4(n)14.6(g)-365.2(c)0(o)24.9(m)18(m)18(e)0(r)23.3(c)17(e)17(,)-374.3(e)17(d)14.2(u)16.2(c)0(a)28.1(t)14.8(i)15.4(o)14.2(n)14.6(,)-368(t)14.8(r)12.6(a)17.4(n)14.6(sp)26.1(o)14.2(r)18.9(t)14.8(a)0(t)25.9(i)15.4(o)14.2(n)14.6(,)-368(e)17(n)14.6(t)14.8(er)29.6(ta)25.9(i)15.4(n)14.6(m)18(e)0(n)25.3(t)14.8(,)]TJ
T*
-.0158 Tc
[(and)-241.9(f)1.1(inanc)-15.8(e)12(.)-238.4(I)-15.8(t)-223.8(i)-15.8(s)-228.7(t)-1(ime)-245.4(t)-1(o)-235.6(e)-15.8(x)9.5(a)1.6(mi)-15.8(n)14.2(e)-245.4(the)-239(e)1.2(m)-15.8(p)10(irica)-15.8(l)-223.2(e)-15.8(v)9.1(idenc)-15.8(e)-228.3(re)-15.8(g)9.1(a)1.6(rding)-241.9(t)-1(he)]TJ
T*
0 Tc
[(e)17(f)16.9(fe)27.6(ct)25.5(i)15.4(v)14.2(e)17(n)14.6(es)29(s)-443.3(a)0(n)25.7(d)-441.1(e)17(f)0(f)27.4(i)15.4(ci)26.2(e)17(n)14.6(cy)-430.4(o)14.2(f)-444.7(I)17.5(C)15.6(T)-447.4(i)15.4(n)-440.7(t)14.8(h)16.2(e)-444.5(he)26.9(a)17.4(l)0(t)23.9(h)-439.1(se)29(ct)25.5(o)14.2(r)-442.7(f)16.9(o)14.2(r)-442.7(l)15.4(es)29(so)26.1(n)14.5(s)]TJ
T*
[(l)15.4(e)17(ar)30(n)14.6(e)0(d)-253.3(a)17.4(n)14.6(d)-264(fo)24.7(r)-265.6(o)14.2(p)14.2(t)14.8(i)15.4(m)18(al)-251.7(d)14.2(e)0(p)31.2(l)0(o)23.3(y)14.2(m)18(e)17(n)14.6(t)-269.7(o)14.2(f)-261.4(t)14.8(h)0(e)26.9(s)0(e)-249.2(s)0(y)26.1(s)0(t)26.8(e)17(ms)29.9(.)]TJ
/F4 1 Tf
11.9551 0 0 11.9551 50.1732 490.1101 Tm
[(The)-333.3(Differentials)-344.2(in)-336.6(Access,)-336.2(Quality)-7.9(,)-332.3(and)-336(Cost)]TJ
/F1 1 Tf
8.9663 0 0 8.9663 60.0945 478.2046 Tm
[(Differences)-412.6(in)]TJ
/F5 1 Tf
6.3229 0 TD
(access)Tj
/F1 1 Tf
2.9971 0 TD
[(to)-407.3(care)-410.1(reflect)-407.7(economic,)-411.3(geographic,)-411.7(and)]TJ
-10.4265 -1.3341 TD
[(functional)-513.8(as)-508.1(well)-511.3(as)-514.4(social,)-516.8(cultural,)-514.8(and)-510.3(psychological)-517.7(factors.)]TJ
T*
[(Whereas)-253.7(the)-249.1(Affordable)-255.6(Care)-253.5(Act)-248.5(was)-251.7(implemented)-260.7(mostly)-252.9(to)-249.2(relieve)]TJ
T*
[(the)-489.4(economic)-492.3(burden)-493(of)-493.8(medical)-492.5(care)-492.3(access)-495.6(for)-487.5(those)-494.9(currently)]TJ
T*
[(without)-328.5(insurance)-331.1(or)-327.4(underinsured,)-330.7(there)-327(remain)-328.7(sizeable)-329.7(segments)]TJ
T*
[(of)-278.8(the)-280.7(population)-279.4(\(including)-283.9(the)-280.7(insured\))-281(with)-278.8(limited)-281.7(access)-280.6(to)-280.8(care)]TJ
T*
[(by)-452.2(virtue)-447.2(of)-455.8(where)-452.1(they)-449.9(live)-456.4(and)-447(work)-456.1(or)-447.5(having)-451.8(chronic)-455.7(health)]TJ
T*
[(problems)-205(that)-208.6(require)-211.1(continual)-208.1(care)-214.1(and)-206.8(attention.)-205.1(Residents)-213.2(of)-209.2(rural)]TJ
0 -1.3278 TD
[(and)-181.5(isolated)-189.4(areas)-189.2(are)-180.6(frequently)-188.6(faced)-189.4(with)-190.3(limited)-186.9(medical)-182.7(resources)]TJ
0 -1.3341 TD
[(within)-293.1(reasonable)-290.8(driving)-297.9(distance/time,)-296.3(whereas)-290(many)-296.3(residents)-294.1(of)]TJ
T*
[(the)-255.4(inner)-261(city)-254.7(have)-264(limited)-256.4(access)-261.6(to)-255.5(medical)-258.6(resources)-261.5(for)-259.9(economic)]TJ
T*
[(reasons.)-426.4(It)-429.3(is)-427.9(important)-433.2(that)-423.6(a)-431.5(large)-429.2(and)-428.1(growing)-429.9(segment)-429.9(of)-430.6(the)]TJ
T*
[(population)-349(suffers)-345.5(from)-349.5(chronic)-348.3(diseases)-351(and)-345.9(can)-343(benefit)-351.7(from)-343.1(im-)]TJ
T*
[(proved)-362.7(spatialtemporal)-375.3(access)-362.8(to)-369.4(health)-364.5(resources)-369(while)-362.3(trying)-369.6(to)]TJ
T*
[(manage)-280.8(their)-278(health)-282.3(as)-280.4(best)-283.5(they)-285.5(can)-279.8(in)-279.8(their)-284.3(own)-277.6(homes.)]TJ
6.7246 0 0 5.9768 264.9259 314.8157 Tm
(1)Tj
8.9663 0 0 8.9663 60.0945 298.8282 Tm
[(Concern)-191.7(with)]TJ
/F5 1 Tf
5.678 0 TD
(quality)Tj
/F1 1 Tf
3.0729 0 TD
[(dates)-190.2(back)-184.8(more)-191.2(than)-189.9(a)-184.9(century.)-192.1(For)-186.7(example,)]TJ
-9.8574 -1.3278 TD
[(in)-286.2(1847,)-286(a)-292.4(resolution)-290(was)-283.3(passed)-292.7(at)-290.2(the)-287.1(first)-288.8(national)-287.2(meeting)-287.3(of)-291.5(the)]TJ
0 -1.3341 TD
[(American)-351.8(Medical)-354(Association)-361.1(to)-350.4(determine)-358.9(the)-356.6(quality)-353.9(of)-354.7()55.6(practi-)]TJ
T*
[(tioners)-405.3(of)-405.3(medicine)-402.5(in)-406.3(respective)-405.2(states)]TJ
/F12 1 Tf
16.8253 0 TD
(.)Tj
/F1 1 Tf
.999 0 TD
[(.)54.4()]TJ
6.7246 0 0 5.9768 215.9432 266.9669 Tm
(2)Tj
8.9663 0 0 8.9663 223.0298 262.9984 Tm
[(A)-406.9(subsequent)-408.4(report)]TJ
6.7246 0 0 5.9768 300.6991 266.9669 Tm
(3)Tj
8.9663 0 0 8.9663 50.1732 251.0361 Tm
[(from)-229.3(Virginia)-234.3(pointed)-230.8(out)-233(an)-227.3(alarming)-235.5(number)-230(of)-234.5(practitioners)-231.7()55.6(who)]TJ
0 -1.3341 TD
[(practice)-418.2(without)-423.3(any)-415.4(authority)-426.9(whatever)54.6()-418.6(and)-421.8(those)-419()55.6(who)-422.6(do)-420.6(not)]TJ
T*
[(pretend)-369.9(to)-369.4(have)-371.5(devoted)-368.7(one)-371.6(hour)-370.8(to)-369.4(the)-369.3(study)-371.3(of)-367.3(the)-375.6(profession.)51.8()]TJ
T*
[(However,)-293.8(the)-293.4(drastic)-294.9(reforms)-288.9(in)-292.5(medical)-296.5(education)-295.4(and)-289(professional)]TJ
T*
[(licensing)-231.1(at)-227(the)-236.5(turn)-226.4(of)-234.5(the)-230.1(20th)-231.5(century)-235.1(had)-230.4(the)-230.1(unintended)-233.2(effect)-235.5(of)]TJ
0 -1.3278 TD
[(decreasing)-354.5(physician)-356.8(supply)-356.5(substantially,)-351.3(especially)-357(in)-355.7(rural)-349.5(areas)]TJ
0 -1.3341 TD
[(and)-333.2(among)-339.1(minority)-342.5(populations.)-338.3(We)-341.5(have)-339.8(yet)-339.7(to)-337.7(fully)-339.2(rectify)-334.7(that)]TJ
T*
[(problem.)-186.6(It)-182.7(is)-187.6(interesting)-185.4(that,)-184.6(at)-182.7(the)-185.9(time,)-188.9(some)]TJ
6.7246 0 0 5.9768 221.4424 171.326 Tm
(4,5)Tj
8.9663 0 0 8.9663 231.7039 167.3574 Tm
[(have)-188.1(suggested)-184.7(that)]TJ
-20.246 -1.3341 TD
[(the)-192.2()55.6(alleged)-200.4(shortage)47.5()-197.3(o)0(f)-190.3(physicians)-199.5(would)-202.1(soon)-198.1(be)-196.4(resolved)-199.6(by)-193(a)-197.6(new)]TJ
T*
(technology)Tj
/F12 1 Tf
4.6663 0 TD
(.)Tj
/F1 1 Tf
.999 0 TD
[(the)-312.3(automobile.)-318.7(This)-315.3(has)-314.8(not)-316.9(materialized)-314.1(because)-319.1(the)]TJ
-5.6653 -1.3341 TD
[(problems)-280.9(were)-285(vastly)-278.8(more)-286(complex)-281.7(than)-278.4(mere)-283.2(transportation.)]TJ
1.1065 -1.3341 TD
[(Di)15.5(ff)21.1(er)17(en)18.9(ce)21.4(s)-367.4(i)0(n)-355.7(t)0(h)18.4(e)-368.7(d)14.2(i)0(s)14.7(t)14.8(ri)15.4(bu)17.7(t)14.8(i)0(o)17(n)-364.8(of)-361(g)14.2(o)0(o)15.7(d)0(-)21.8(q)0(u)17.7(a)0(l)20.2(i)0(t)17.6(y)-365.2(he)20.6(al)13.9(t)14.8(h)0(c)14.3(a)0(r)23.7(e)-368.7(la)20.2(r)12.6(g)0(e)18.6(l)0(y)]TJ
-1.1065 -1.3341 TD
[(r)12.6(e)0(f)21.2(l)0(e)13.5(c)0(t)-278(t)0(h)18.4(e)-292.8(di)17(sc)16.3(r)12.6(e)0(p)18.6(a)0(n)19.3(c)0(y)-284.9(b)0(e)18.6(t)0(w)18.3(e)0(e)21.4(n)-295.3(th)18.4(e)-292.8(l)0(o)23.3(c)0(a)15.5(t)0(i)17.6(o)14.2(ns)-283.3(of)-285.1(me)22.4(di)17(ca)21.8(l)-294.4(r)0(e)17(s)0(o)19.8(u)0(r)22.4(c)0(e)15.1(s)-291.5(at)]TJ
0 -1.3278 TD
-.0178 Tc
[(va)-17.8(ri)-17.8(ou)-17.8(s)-261.5(l)-17.8(ev)-17.8(el)-17.8(s)-268.6(o)-17.8(f)-265(e)-17.8(xp)-17.8(er)-5.2(t)-17.8(i)-.2(s)-17.8(e)]TJ
/F5 1 Tf
10.8754 0 TD
0 Tc
[(vi)21.9(s-)15.3(a)]TJ
1.7325 .0063 TD
(`)Tj
.2782 -.0063 TD
[(-v)16.7(i)12.8(s)]TJ
/F1 1 Tf
1.7894 0 TD
[(th)18.4(e)-254.8(l)0(o)17(c)0(a)15.5(t)14.8(io)17(n)-257.3(o)0(f)-247.2(p)0(a)18.9(t)0(i)17.6(e)0(n)18.9(t)0(s)-245.1(w)0(h)19.7(o)-257.7(ne)18.9(ed)]TJ
-14.6755 -1.3341 TD
[(t)14.8(h)0(e)14.3(i)0(r)-212.3(c)0(a)15.5(r)12.6(e.)-218.2(Ph)18.1(ys)19.8(ic)19.8(ia)20.2(ns)-220.1(t)14.8(e)0(n)18.9(d)-232.4(t)14.8(o)-226.1(lo)17(ca)15.5(t)14.8(e)-229.6(in)-216.6(ur)22.4(ba)18.9(n)-225.7(a)0(r)17.3(e)0(a)21.8(s)-228.3(be)18.6(ca)15.5(us)21.8(e)-229.6(t)14.8(he)-219.7(ed)18.6(uc)20.6(a-)]TJ
T*
[(t)14.8(i)0(o)17(n)0(a)19.3(l)-142.6(sy)19.8(st)20.4(em)-135.7(r)12.6(e)0(i)19.8(n)0(f)18.8(o)0(r)14.1(c)0(e)21.4(s)-139.8(sp)13.5(ec)21.4(ia)20.2(li)18.2(za)21.8(ti)17.6(on)16.1(,)-140.4(a)0(n)19.3(d)-143.9(th)18.4(e)-141(a)0(v)18.9(a)0(i)20.2(l)0(a)20.2(b)0(i)17(l)0(i)18.2(t)14.8(y)-143.9(o)0(f)-133.4(a)0(d)18.9(v)0(a)18.9(n)0(c)18.9(e)0(d)]TJ
30.331 69.3876 TD
[(te)19.2(ch)20.6(no)16.1(lo)17(g)14.2(y)-219.8(at)-201.7(te)19.2(rt)21.1(ia)20.2(ry)14.1(-)14(c)0(a)15.5(r)12.6(e)-216.9(c)0(e)21.4(n)0(t)16.7(e)0(r)17(s)-209.4(ac)15.5(ts)-200.9(as)-204.6(a)-216.5(f)0(u)20.4(r)0(t)21.1(h)0(e)14.3(r)-215.1(at)19.6(t)14.8(r)0(a)17.3(c)0(t)19.2(i)0(o)17(n)0(.)-201.7(A)-217.2(lo)23.3(ng)16.1(-)]TJ
0 -1.3278 TD
[(st)20.4(an)19.3(di)17(ng)-287.4(co)18.6(ns)20.2(en)18.9(su)15.5(s)-297.9(a)0(m)22.7(o)0(n)16.1(g)-295.7(st)20.4(ud)17.7(en)19(ts)-289.4(of)-291.5(th)18.4(e)-299.1(f)0(i)19.6(e)0(l)19.8(d)-302(p)14.2(o)0(i)16.9(n)0(t)16.7(s)-297.9(to)-287.2(an)-290.5(op)22(ti)17.6(ma)16.4(l)]TJ
0 -1.3341 TD
-.0188 Tc
[(r)-6.2(a)-18.8(tio)-143.7(o)-18.8(f)-126.9(1)-18.8(:1)-143.7(f)-18.8(o)-.4(r)-139(s)-18.8(pe)-18.8(ci)-18.8(al)-18.8(is)-18.8(t)-131.1(t)-18.8(o)-128.9(g)-18.8(en)-18.8(er)-18.8(al)-18.8(is)-18.8(t.)]TJ
6.7246 0 0 5.9768 454.2235 673.9652 Tm
0 Tc
(6)Tj
8.9663 0 0 8.9663 458.8156 669.9967 Tm
[(In)19.4(st)20.5(ea)15.5(d)14.2(,)-121.4(it)-115.2(is)-111.7(ab)25.3(ou)17.7(t)-124.3(3)0(:)19(1)0(.)-107.2(I)0(n)-113.4(2)0(0)15.7(1)14.2(2,)-113.6(in)]TJ
-15.2445 -1.3341 TD
[(to)16.3(t)14.8(a)0(l)13.9(,)-241.5(8)14.2(7)0(8)15.7(,)0(1)19.2(9)0(4)-230.9(p)0(h)17.7(y)0(s)19.8(i)0(c)19.8(i)0(a)20.2(n)0(s)-232.7(w)0(i)18.9(t)0(h)-234.5(a)0(n)-227.3(a)0(c)15.5(t)0(i)17.6(v)14.2(e)-242.2(l)0(i)18.2(c)0(e)15.1(n)14.6(se)-236.6(we)20.5(r)12.6(e)-242.2(pr)14.1(ac)21.8(ti)17.6(ci)19.8(ng)-230.5(in)-229.2(th)18.4(e)]TJ
T*
[(Un)20.9(it)17.6(ed)-240.7(St)18.4(at)19.6(es)16.3(.)]TJ
6.7246 0 0 5.9768 372.4156 650.0408 Tm
(7)Tj
8.9663 0 0 8.9663 378.1416 646.0723 Tm
[(Of)-243.4(th)18.4(es)22.7(e,)-243.5(65)15.7(7)14.2(,)0(2)19.2(0)0(8)-243.6(\()0(7)17(6)0(.)19.2(5)0(%)16.8(\))-250.1(we)20.5(r)12.6(e)-254.8(ce)21.4(rt)21.1(if)19.6(ie)13.5(d)-245.1(b)0(y)-243.5(a)-248.1(sp)19.8(ec)15.1(ia)20.2(lt)17.6(y)]TJ
-6.247 -1.3341 TD
[(bo)15.7(ar)23.7(d,)-151.5(an)19.3(d)-162.9(2)0(1)22(6)0(,)19.2(3)0(5)15.7(2)-162.9(\(2)23.3(3.)19.2(5%)16.8(\))-161.6(w)0(e)20.5(r)0(e)-153.8(n)0(o)22.4(t)0(.)-150.9(F)0(o)15.7(r)-158.2(ma)16.4(ny)22.4(,)-165.7(s)0(p)19.8(e)0(c)21.4(i)0(a)20.2(l)0(i)18.2(z)0(a)21.8(t)0(i)17.6(o)0(n)-154.7(n)14.5(ar)17.3(r)12.6(o)0(w)17.7(s)]TJ
T*
[(th)18.4(e)-141(s)0(c)22.7(o)0(p)15.7(e)-134.7(of)-133.4(p)14.2(r)0(a)17.3(c)0(t)19.2(i)0(c)19.8(e)-141(to)-129.1(sp)19.8(ec)21.4(if)19.6(ic)-131.9(bo)22(dy)-129.7(or)20.4(ga)19(ns)13.8(,)-134(d)0(i)17(s)0(e)22.7(a)0(s)16.7(e)0(s)16.3(,)-134(or)-131.4(ag)18.9(e)-134.7(a)0(n)19.3(d)-137.6(ge)18.6(nd)16.1(er)]TJ
T*
[(gr)20.4(ou)17.7(ps)19.8(,)-216.2(h)0(e)14.3(n)0(c)18.9(e)-216.9(th)18.4(e)-216.9(t)0(e)19.2(n)0(d)16.1(e)0(n)18.9(c)0(y)-202.7(t)0(o)-211.3(l)0(o)17(c)0(a)21.8(t)0(e)-208.4(s)0(p)19.8(e)0(c)15.1(i)0(a)20.2(l)0(t)17.6(y)-213.5(pr)20.4(ac)15.5(ti)17.6(ce)21.4(s)-215.7(i)0(n)-210.3(l)0(a)20.2(r)12.6(ge)-209.1(ur)16.1(ba)18.9(n)]TJ
T*
[(ar)17.3(ea)21.8(s)-222(w)0(i)18.9(t)0(h)-209.3(l)0(a)20.2(r)0(g)20.4(e)-223.2(po)15.7(p)14.2(u)0(l)19(a)0(t)19.6(i)0(o)17(n)0(s)-207.5(f)0(r)16.8(o)0(m)-208.1(w)0(h)13.4(i)15.4(ch)-213.4(to)-211.3(dr)20.4(aw)-213(th)18.4(ei)19.8(r)-221.4(p)0(a)18.9(t)0(i)23.9(e)0(n)18.9(t)0(s)14.1(.)]TJ
1.1128 -1.3278 TD
[(Concern)-267.6(with)-266.2(medical)-264.9(care)]TJ
/F5 1 Tf
11.3496 0 TD
(cost)Tj
/F1 1 Tf
1.8905 0 TD
[(inflation)-266(\(typically)-270.1(expressed)-267.9(as)-261.5(a)]TJ
-14.353 -1.3341 TD
[(percentage)-242.5(of)-240.9(gross)-238.7(domestic)-237.8(product\))-241.9(dates)-240.7(back)-235.4(to)-242.9(the)-236.5(1960s,)-242.5(when)]TJ
T*
[(it)-203.7(was)-207.4(around)-208.1(5%.)-205.7(It)-201.7(is)-206.6(now)-201.7(close)-208.9(to)-205(18%.)-210.6(As)-205.2(many)-201.5(have)-207.1(observed,)-208.5(the)]TJ
T*
[(health)-434(system)-430.6(in)-431.6(the)-432.5(United)-429.8(States)-432.5(is)-427.9(on)-432.9(a)-431.5(nonsustainable)-435.3(course)]TJ
T*
[(unless)-317.6(significant)-312.9(changes)-315.3(are)-319.7(introduced)-317.8(to)-312.5(deliver)-317.8(care)-315.3(more)-311.3(effi-)]TJ
T*
[(ciently)-637.6(and)-636.7(effectively.)-641(Indeed,)-640.3(without)-632(appropriate)-645.4(innovative)]TJ
T*
[(structural)-236.7(changes,)-234.3(we)-238.7(may)-228.7(soon)-236(be)-234.4(faced)-233.6(with)-234.6(the)-236.5(dilemma)-232.3(of)-234.5(either)]TJ
T*
[(maintaining)-479.5(substantial)-487.1(inequities)-480.2(in)-482.2(access)-482.9(to)-483.2(care)-479.7(by)-483.8(virtue)-478.8(of)]TJ
0 -1.3278 TD
[(residential)-396.9(location,)-396.7(socioeconomic)-400.5(status,)-394.7(and)-390.1(health)-396.1(need)-398.8(or)-390.6(not)]TJ
0 -1.3341 TD
[(being)-430.5(able)-429.1(to)-426.3(afford)-432.8(the)-426.2(system)-430.6(we)-428.4(have.)-436(The)-426.8(basic)-429.8(problem)-432(was)]TJ
T*
[(brought)-264.5(about)-264.7(by)-256.2(a)-260.8(combination)-266.6(of)-259.8(factors,)-263.2(including)-261.4(the)-261.8(following:)]TJ
1.1128 -2.0613 TD
[(1.)-334.9(The)]TJ
/F5 1 Tf
2.8643 0 TD
[(demographic)-263.2(composition)]TJ
/F1 1 Tf
10.8754 0 TD
[(of)-259.8(the)-268.1(population)-260.5(is)-263.5(changing.)-263.4(A)]TJ
-12.6458 -1.3341 TD
[(long-term)-345.9(trend)-344.2(of)-342(low)-346.3(birth)-344.1(rates)-343.5(and)-339.6(longer)-348.4(life)-339.9(expectancy)]TJ
0 -1.3278 TD
[(has)-359.1(resulted)-361.3(in)-355.7(a)-361.9(larger)-359.7(proportion)-358.8(of)-361(the)-362.9(population)-361.6(in)-355.7(older)]TJ
0 -1.3341 TD
[(age)-337.1(groups.)-341.7(This)-340.6(segment)-341.4(of)-342(the)-337.6(population)-342.7(experiences)-343.7(more)]TJ
T*
[(chronic)-335.6(illness,)-335.8(which)-336.3(entails)-336(increased)-337(costs.)]TJ
-1.0939 -1.3341 TD
[(2.)-334.9(Advances)-534.5(in)]TJ
/F5 1 Tf
7.0311 0 TD
[(medical)-529.9(science,)-528.8(technology,)-538.7(and)-526.6(interventions)]TJ
/F1 1 Tf
-5.9372 -1.3341 TD
[(have)-333.5(led)-332.7(to)-337.7(the)-331.3(development)-341.6(of)-335.7(more)-330.3(sophisticated)-342.8(diagnostic)]TJ
T*
[(tools,)-354.4(life-saving)-364.7(interventions,)-360.3(medications,)-356.1(and)-358.5(devices.)-362.3(Al-)]TJ
T*
[(though)-300.3(contributing)-302.6(to)-299.8(improved)-304(health)-301.2(status,)-306.1(this)-302(has)-295.9(fueled)]TJ
T*
[(inflationary)-335.7(trends)-332.2(in)-336.7(healthcare.)]TJ
-1.0939 -1.3278 TD
(3.)Tj
/F5 1 Tf
1.0939 0 TD
[(Advances)-288.3(in)-287.2(ICT)]TJ
/F1 1 Tf
7.088 0 TD
[(have)-289.3(heightened)-292.3(public)-293.3(awareness)-287.6(and)-289(health)]TJ
-7.088 -1.3341 TD
[(sophistication)-525.9(\(with)-522.6(greater)-526.7(public)-527.2(awareness)-521.5(of)-525.4(behavioral)]TJ
T*
[(risk)-275.7(factors,)-275.8(ready)-272.4(access)-280.6(to)-274.5(sources)-278.5(of)-272.5(health)-282.3(information,)-276(and)]TJ
T*
[(an)-239.9(active)-251.8(and)-244.7(extensive)-249.1(lay)-243.8(referral)-245.3(system\),)-252(thereby)-248.1(increasing)]TJ
T*
[(demand)-334.7(for)-335.8(medical)-334.4(care.)]TJ
-1.0939 -1.3341 TD
[(4.)-334.9(Fi)23.3(na)19.3(ll)18.2(y,)]TJ
/F5 1 Tf
4.3628 0 TD
[(sy)16.7(st)22.5(em)-176.7(fr)16.8(a)13.1(g)0(m)18.7(e)0(n)19.6(t)0(a)15.3(t)0(i)21.3(o)0(n)]TJ
/F1 1 Tf
8.6308 0 TD
(,)Tj
/F5 1 Tf
.43 0 TD
[(d)13.1(i)0(s)20.4(c)0(o)14.5(n)0(t)18.4(i)12.8(nu)19.7(it)15(i)12.8(e)0(s)]TJ
/F1 1 Tf
6.1079 0 TD
[(in)-178.7(p)14.2(a)0(t)19.6(i)0(e)13.5(n)14.6(t)-187.5(c)0(a)15.5(r)12.6(e,)-180.2(an)19.3(d)]TJ
-18.4376 -1.3341 TD
[(se)22.7(ri)15.3(o)14.2(u)0(s)]TJ
/F5 1 Tf
3.0603 0 TD
[(i)12.8(n)0(e)19.6(f)0(f)17(i)12.8(ci)16.2(en)19.6(ci)22.5(es)]TJ
/F1 1 Tf
5.4883 0 TD
[(in)-191.3(th)18.4(e)-204.3(f)0(i)19.6(n)0(a)19.3(n)14.6(ci)13.5(n)14.6(g)-207.1(an)19.3(d)-200.8(d)0(e)18.6(l)0(i)18.2(v)0(e)18.6(r)12.6(y)-207.1(o)0(f)-190.3(c)0(a)15.5(r)12.6(e)-204.3(a)0(s)-198.3(w)0(e)20.5(l)0(l)]TJ
-8.5486 -1.3341 TD
[(as)-210.9(th)18.4(e)-216.9(p)0(r)14.1(e)0(v)18.6(a)0(l)20.2(e)0(n)18.9(c)0(e)-212.5(o)0(f)]TJ
/F5 1 Tf
8.2704 0 TD
[(un)19.8(he)19.6(al)15.9(th)18.4(y)-218.5(l)0(i)15.6(f)14.8(es)17.3(ty)17.6(le)18.8(s)]TJ
/F1 1 Tf
8.0238 0 TD
[(ha)21(ve)-215.4(al)20.2(l)-218.5(e)0(x)19(a)0(c)21.8(e)0(r)17(b)0(a)18.9(t)0(e)19.2(d)-219.8(th)18.4(e)]TJ
-16.2941 -1.3278 TD
[(pr)20.4(ob)22(le)13.5(m,)-229.9(es)22.7(pe)18.6(ci)19.8(al)13.9(l)15.4(y)-245.1(am)22.7(on)16.1(g)-238.8(t)0(h)18.4(o)0(s)19.8(e)-242.2(su)21.8(ff)14.7(er)23.3(in)17.3(g)-238.7(f)0(r)16.8(o)14.2(m)-241.3(c)0(h)14.3(r)12.6(on)22.4(ic)-233.1(il)18.2(ln)17.3(es)22.7(s.)]TJ
-2.2067 -2.0044 TD
[(Hence,)-237(the)-236.5(focus)-233.6(of)-234.5(this)-232.5(article)-238(is)-231.9(on)-230.5(the)-236.5(capabilities)-237.9(of)-234.5(health)-238(ICT)-231(not)]TJ
0 -1.3341 TD
[(only)-352.7(in)-349.4(extending)-350.6(the)-350.3(reach)-349.7(of)-354.7(clinical)-346.4(resources)-356.4(to)-350.4(serve)-350.9(a)-349.3(widely)]TJ
0 -1.3278 TD
[(dispersed)-510.1(and)-503.9(underserved)-508.8(patient)-505.1(population,)-508.3(but,)-506.2(more)-507.3(impor-)]TJ
0 -1.3341 TD
[(tantly,)-302.1(in)-298.8(improving)-303.7(the)-306(efficiency,)-301.4(effectiveness,)-305.3(coordination,)-309.7(and)]TJ
T*
[(continuity)-342(of)-335.7(care)-334.3(with)-335.7(active)-340.4(patient)-334.3(participation)-340(in)-336.7(the)-337.6(manage-)]TJ
T*
[(ment)-283.4(of)-278.8(chronic)-285(illness.)]TJ
1.1128 -1.3341 TD
[(As)-179.9(a)-184.9(prelude)-184.3(to)-179.7(the)-185.9(discussion)-186(of)-177.6(the)-185.9(integral)-182.1(role)-187.4(of)-177.6(telemedicine)-186.4(in)]TJ
-1.1128 -1.3341 TD
[(modern)-453.3(healthcare)-458.5(delivery)-461.7(in)-450.6(general)-460.8(and)-453.4(chronic)-455.8(disease)-457.7(man-)]TJ
T*
[(agement)-184.2(in)-185(particular,)-189.6(we)-188.1(begin)-183.9(with)-184(a)-184.9(brief)-189.5(account)-185.9(of)-184(telemedicines)]TJ
T*
[(long)-580.3(history.)-578.5(This)-574.6(demonstrates)-580.3(the)-577.9(centrality)-580.2(of)-582.3(long)-574(distance)]TJ
0 -1.3278 TD
[(communication)-305.4(in)-305.1(medicine)-307.6(and)-301.6(in)-305.1(human)-303.4(experience.)-306.4(At)-303.5(the)-306(same)]TJ
0 -1.3341 TD
[(time,)-479.8(it)-481.9(provides)-487(a)-475.8(stark)-480.2(reminder)-485.7(of)-481.1(the)-476.7(remarkable)-483.9(and)-478.7(steady)]TJ
T*
[(progress)-283.5(in)-279.8(the)-280.7(underlying)-288(technology)-284.5(of)-278.8(telemedicine.)]TJ
/F11 1 Tf
11.9551 0 0 11.9551 50.1732 741.9966 Tm
[(BASHSHUR)-338.5(ET)-334.1(AL.)]TJ
7.9702 0 0 7.9702 50.1732 29.7638 Tm
[(7)-80(7)-80.1(0)-699.9(TELEMEDICINE)-323.9(and)-331.8(e-HEALT)11.5(H)]TJ
/F8 1 Tf
6.9738 0 0 6.9738 176.8818 29.7638 Tm
.1095 Tc
[(SEPT)6.6(EMBER)-333.2(2).1(0)6.8(1)0(4)]TJ
ET
q
1 i
0 792 612 -791.985 re
W n
32.315 .014984 .22675 791.985 re
f
/Document /MC2 BDC
Q
q
1 i
0 792 32.315 -173.367 re
W n
0 0 0 .29999 k
0 618.633 32.315 173.367 re
f
EMC
Q
32.315 763.994 242.646 .22675 re
f
endstream
endobj
176 0 obj
<>stream
Adobe Illustrator CS4
2010-08-04T11:54:42+05:30
2010-08-04T11:54:42+05:30
2010-08-04T11:54:42+05:30
68
256
JPEG
/9j/4AAQSkZJRgABAgEASABIAAD/7QAsUGhvdG9zaG9wIDMuMAA4QklNA+0AAAAAABAASAAAAAEA
AQBIAAAAAQAB/+4ADkFkb2JlAGTAAAAAAf/bAIQABgQEBAUEBgUFBgkGBQYJCwgGBggLDAoKCwoK
DBAMDAwMDAwQDA4PEA8ODBMTFBQTExwbGxscHx8fHx8fHx8fHwEHBwcNDA0YEBAYGhURFRofHx8f
Hx8fHx8fHx8fHx8fHx8fHx8fHx8fHx8fHx8fHx8fHx8fHx8fHx8fHx8fHx8f/8AAEQgBAABEAwER
AAIRAQMRAf/EAaIAAAAHAQEBAQEAAAAAAAAAAAQFAwIGAQAHCAkKCwEAAgIDAQEBAQEAAAAAAAAA
AQACAwQFBgcICQoLEAACAQMDAgQCBgcDBAIGAnMBAgMRBAAFIRIxQVEGE2EicYEUMpGhBxWxQiPB
UtHhMxZi8CRygvElQzRTkqKyY3PCNUQnk6OzNhdUZHTD0uIIJoMJChgZhJRFRqS0VtNVKBry4/PE
1OT0ZXWFlaW1xdXl9WZ2hpamtsbW5vY3R1dnd4eXp7fH1+f3OEhYaHiImKi4yNjo+Ck5SVlpeYmZ
qbnJ2en5KjpKWmp6ipqqusra6voRAAICAQIDBQUEBQYECAMDbQEAAhEDBCESMUEFURNhIgZxgZEy
obHwFMHR4SNCFVJicvEzJDRDghaSUyWiY7LCB3PSNeJEgxdUkwgJChgZJjZFGidkdFU38qOzwygp
0+PzhJSktMTU5PRldYWVpbXF1eX1RlZmdoaWprbG1ub2R1dnd4eXp7fH1+f3OEhYaHiImKi4yNjo
+DlJWWl5iZmpucnZ6fkqOkpaanqKmqq6ytrq+v/aAAwDAQACEQMRAD8A6dhQ7FXYq7FXYq7FXYq7
FUZ/0qf+jj/jTFUHirsVdirsVdirsVdirsVRn/Sp/wCjj/jTFUHirsVdirsVdirsVdirsVRn/Sp/
6OP+NMVQeKuxV2KuxV2KuxV2KuxVGf8ASp/6OP8AjTFUHirsVdirsVdirsVdirsVRn/Sp/6OP+NM
VQeKuxV2KuxV2KuxV2KuxVGf9Kn/AKOP+NMVQeKuxV2KuxV2KuxV2KuxVGf9Kn/o4/40xVB4q7FX
Yq7FXYq7FXYq7FUZ/wBKn/o4/wCNMVQeKuxV2KuxV2KuxV2KuxVGf9Kn/o4/40xVB4q7FXYq7FXY
q7FXYq7FUZ/0qf8Ao4/40xVB4q7FXYq7FXYq7FXYq7FUZ/0qf+jj/jTFUHirsVdirsVdirsVdirs
VRn/AEqf+jj/AI0xVB4q7FXYq7FXYq7FXYq7FUZ/0qf+jj/jTFUHirsVdirsVdirsVdirsVRn/Sp
/wCjj/jTFUHirsVdirsVdirsVdirsVRn/Sp/6OP+NMVQeKuxV2KuxV2KuxV2KuxVGf8ASp/6OP8A
jTFUHirsVdirsVdirsVdirsVRn/Sp/6OP+NMVQeKuxV2KuxV2KuxV2KuxVGf9Kn/AKOP+NMVQeKu
xV2KuxV2KuxV2KuxVGf9Kn/o4/40xVB4q7FXYq7FXYq7FXYq7FUZ/wBKn/o4/wCNMVQeKuxV2Kux
V2KuxV2KuxVGf9Kn/o4/40xVB4q7FXYq7FXYq7FXYq7FUZ/0qf8Ao4/40xVB4q7FXYq7FXYq7FXY
q7FUZ/0qf+jj/jTFUHirsVdirsVdirsVdirsVRn/AEqf+jj/AI0xVB4q7FXYq7FXYq7FXYq7FUZ/
0qf+jj/jTFUHirsVdirsVdirsVdirsVRn/Sp/wCjj/jTFUHirsVdirsVdirsVdirsVRn/Sp/6OP+
NMVQeKuxV2KuxV2KuxV2KuxVGf8ASp/6OP8AjTFUHirsVdirsVdirsVdirsVRn/Sp/6OP+NMVQeK
uxV2KuxV2KuxV2KuxVGf9Kn/AKOP+NMVQeKuxV2KuxV2KuxV2KuxVGf9Kn/o4/40xVB4q7FXYq7F
XYq7FXYq7FUZ/wBKn/o4/wCNMVf/2Q==
application/postscript
saved
xmp.iid:11FB61F30AB7DE11AEB3E861853EAFA4
2009-10-12T14:15:50+05:30
Adobe Illustrator CS4
/
converted
from application/postscript to application/vnd.adobe.illustrator
converted
from application/postscript to application/vnd.adobe.illustrator
saved
xmp.iid:0280117407206811994CBE3149FFDB59
2010-08-04T11:54:42+05:30
Adobe Illustrator CS4
/
converted
from application/postscript to application/vnd.adobe.illustrator
xmp.iid:11FB61F30AB7DE11AEB3E861853EAFA4
xmp.did:11FB61F30AB7DE11AEB3E861853EAFA4
uuid:ee5a72b3-04e4-4157-a8d8-c3a8817872a3
uuid:ee5a72b3-04e4-4157-a8d8-c3a8817872a3
xmp.iid:0280117407206811994CBE3149FFDB59
xmp.did:0280117407206811994CBE3149FFDB59
TouchUp 7.0
False
False
1
684.000000
864.000000
Points
Black
Default Swatch Group
0
PANTONE 3025 C
SPOT
100.000000
CMYK
100.000000
16.859999
0.000000
50.980003
endstream
endobj
173 0 obj
<>
endobj
177 0 obj
<>/XObject<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]/Font<>>>/Thumb 182 0 R/MediaBox[0 0 612 792]/Rotate 0>>
endobj
183 0 obj
<>/ProcSet[/PDF/Text]/Font<>>>
endobj
178 0 obj
<>stream
/GS1 gs
BT
/F4 1 Tf
11.9551 0 0 11.9551 35.8866 691.7101 Tm
0 0 0 1 k
0 Tc
0 Tw
[(Brief)-334.8(History)-337.1(of)-337.8(Telemedicine)]TJ
/F1 1 Tf
8.9663 0 0 8.9663 45.8079 679.9746 Tm
[(The)-395.2(use)-391.1(of)-386.3(long)-390.6(distance)-396.1(communications)-394.6(for)-386.4(medical)-391.3(purposes)]TJ
-1.1065 -1.3341 TD
[(extends)-344.8(into)-345.7(antiquity.)-344.8(\(For)-348.3(a)-343(more)-342.9(complete)-346.6(history,)-344.6(see)-346(Bashshur)]TJ
T*
[(and)-251(Shannon.)]TJ
6.7246 0 0 5.9768 87.7606 660.0754 Tm
(8)Tj
8.9663 0 0 8.9663 91.2755 656.0502 Tm
[(\))-250.1(For)-256.3(example,)-260.7(among)-256.9(aboriginal)-260.2(peoples)-256.5(of)-259.8(Australia)]TJ
-6.1775 -1.3341 TD
[()55.6(message)-279.5(sticks)57.8()-279.5(carried)-279.5(by)-275.2(runners,)-281.2(sometimes)-279(more)-273.4(than)-278.4(70)-275.2(miles,)]TJ
0 -1.3278 TD
[(brought)-454.1(information)-451.7(pertaining)-450.5(to)-451.6(tribal)-453.9(gatherings)-452.4(\(friendly)-452.4(and)]TJ
0 -1.3341 TD
[(hostile\),)-228.6(disease)-230.1(and)-232.1(deaths.)]TJ
6.7246 0 0 5.9768 138.0472 624.1888 Tm
(9)Tj
8.9663 0 0 8.9663 143.6031 620.2203 Tm
[(Medicine)-232.4()55.6(in)-230.5(absentia)52()-228.9(was)-226.4(practiced)-233.4(in)]TJ
-12.0135 -1.3341 TD
[(the)-185.9(17th)-187.2(century)-184.5(common)-188.7(era)-180.6(as)-185.6(patients)-189.6(sent)-188.2(urine)-183.5(samples)-184.9(to)-186(distant)]TJ
T*
[(physicians)-509.3(who,)-511.2(in)-507.5(turn,)-512.2(provided)-510.1(diagnoses)-514.1(based)-513.3(on)-508.7(uroscopy)]TJ
T*
[(charts)-295.7(patterned)-299.7(after)-294.4(those)-292.6(used)-301.1(by)-294.1(the)-293.4(ancient)-300.1(Greeks.)]TJ
6.7246 0 0 5.9768 244.8566 588.3022 Tm
(10)Tj
8.9663 0 0 8.9663 254.4944 584.3337 Tm
[(In)-296.8(return,)]TJ
-24.3811 -1.3341 TD
[(local)-255.6(physicians)-256.4(and)-257.4(their)-259.1(patients)-252.8(received)-261.2(a)-254.5()55.6(prescription-by-post)42.4()]TJ
T*
[(containing)-239.9(detailed)-241.2(instructions)-237.5(on)-243.2(regimen.)]TJ
6.7246 0 0 5.9768 200.6928 564.4345 Tm
(11)Tj
8.9663 0 0 8.9663 209.8204 560.4093 Tm
[(Our)-244.1(major)-238.6(focus)-239.9(here,)]TJ
-19.3987 -1.3341 TD
[(however,)-570.5(is)-573.3(on)-572(the)-571.6(use)-574.5(of)-569.7(electronic)-578.3(communication)-577.3(providing)]TJ
0 -1.3278 TD
[(medical)-277.5(care)-283.7(at)-283.9(a)-279.7(distance.)-283.5(We)-278.3(begin,)-286.3(therefore,)-280.3(with)-285.2(the)-280.7(telegraph.)]TJ
1.1065 -1.3341 TD
[(D)12.7(u)16.2(r)12.6(i)15.4(n)14.6(g)-194.5(t)14.8(h)16.2(e)-197.9(A)16.8(me)28.7(r)12.6(i)15.4(c)17(a)0(n)-183(C)15.6(i)15.4(v)14.2(i)15.4(l)-193.2(W)14.5(a)17.4(r)12.6(,)-197.3(t)14.8(h)16.2(e)-191.6(n)14.6(ee)27.8(d)-194.5(t)14.8(o)-194.5(i)15.4(d)14.2(e)0(n)25.3(t)14.8(i)15.4(f)16.9(y)-194.5(t)14.8(he)-181.7(l)15.4(o)14.2(ca)28.1(t)14.8(i)15.4(o)14.2(n)-194.1(a)17.4(n)14.6(d)]TJ
-1.1065 -1.3341 TD
-.0154 Tc
[(move)-15.4(m)13.3(e)1.6(nt)-240.8(of)-238.8(troops)-237.4(le)-15.4(d)-224.5(t)-.6(o)-241.5(t)-.6(he)-238.6(deve)-15.4(l)10.8(opme)-15.4(n)9.9(t)-234.5(o)-1.2(f)-238.8(t)-.6(he)-238.6(S)-15.4(i)9.9(gnal)-240.2(Corps)-15.4(,)-226(wh)-15.4(i)9.9(c)1.6(h)]TJ
T*
[(re)-15.5(l)10.7(i)-.1(ed)-254.2(he)-15.5(a)12.6(v)-1.3(ily)-254.2(on)-253.9(the)-251.4(t)-.7(e)-15.5(l)10.7(egraph.)-257(T)-1.3(he)-251.4(Corps)-250.1(w).7(a)-15.5(s)-239(e)-15.5(s)13.5(ta)-15.5(b)9.8(lish)-15.5(e)11.4(d)-254.2(i)-.1(n)-247.5(1862)-254.3(and)]TJ
T*
-.0151 Tc
[(bec)-15.1(a)13(me)-200.4(operationa)-15.1(l)-184.6(in)-196.6(1863)-196.9(under)-198.5(t)-.3(he)-200.4(direc)-15.1(t)10.4(ion)-196.6(o)-.9(f)-194.3(M)2.2(a)-15.1(j)11.4(or)-192.2(A)-15.1(l)10.8(bert)-196.3(Mye)-15.1(r)8.2(,)-193.4(a)]TJ
T*
0 Tc
[(s)18.3(u)16.2(r)12.6(g)14.2(eo)24.9(n)-396.4(a)17.4(n)14.6(d)-396.8(m)18(e)0(d)24.9(i)15.4(c)17(a)0(l)-384.4(o)14.2(f)16.9(f)0(i)26(c)17(er)-381.4(in)-387.3(t)14.8(h)16.2(e)-400.3(U)19(n)14.6(i)15.4(o)14.2(n)-396.4(Ar)29.3(my)25.8(.)-393.3(I)0(n)-385.3(a)17.4(d)14.2(d)14.2(i)15.4(t)14.8(i)15.4(o)14.2(n)-396.4(t)14.8(o)-403.1(t)14.8(h)16.2(e)]TJ
T*
[(o)14.2(r)18.9(i)15.4(g)14.2(i)15.4(n)14.6(al)-295.9(i)15.4(n)14.6(t)14.8(e)17(n)14.6(t)-307.6(o)14.2(f)-305.6(t)14.8(h)16.2(e)-311.7(C)15.6(o)14.2(r)18.9(p)14.2(s)0(,)-292.8(h)16.2(e)-311.7(u)16.2(se)29(d)-308.3(t)14.8(h)16.2(e)-305.4(t)14.8(e)0(l)26.2(e)17(g)14.2(r)12.6(a)17.4(p)14.2(h)-306.3(t)14.8(o)-308.3(r)12.6(e)17(q)14.2(ue)26.9(st)-289.4(me)28.7(d)14.2(i)15.4(ca)28.1(l)]TJ
T*
-.0153 Tc
[(suppl)-15.3(i)9.2(e)1.7(s)-325.8(a)2.1(nd)-323.6(coordinate)-327.1(the)-327(t)-.5(ra)-15.3(n)10.4(s)3(port)-322.9(o)-1.1(f)-320.9(p)-1.1(a)-15.3(t)10.6(ients)-15.3(.)]TJ
6.7246 0 0 5.9768 216.1133 456.8314 Tm
0 Tc
(12)Tj
8.9663 0 0 8.9663 225.7511 452.8062 Tm
[(An)25(e)17(c)17(d)14.2(o)14.2(t)14.8(al)-295.9(j)15.4(u)16.2(st)26.8(i)15.4(f)16.9(i)15.4(-)]TJ
-21.1754 -1.3278 TD
-.0154 Tc
[(cat)-15.4(i)8.5(on)-260.1(for)-262.1(u)-15.4(s)12.7(e)-263.9(of)-264.1(the)-263.9(t)-.6(ele)-15.4(p)9.5(hone)-263.9(in)-260.1(dis)-15.4(t)11.4(ant)-266.1(d)-1.2(iagnos)-15.4(i)12(s)-262.7(ca)-15.4(n)-249(b)-1.2(e)-263.9(f)1.5(ound)-266.8(in)-260.1(an)]TJ
0 -1.3341 TD
-.0151 Tc
[(early)-209.6(r)-2.5(eport)-202.6(i)-15.1(n)]TJ
/F5 1 Tf
5.8487 0 TD
-.0156 Tc
[(Th)-15.6(e)-198.4(L)3.9(ance)-15.6(t)]TJ
/F1 1 Tf
4.4956 0 TD
-.0145 Tc
[(in)-208.6(1879.)]TJ
6.7246 0 0 5.9768 157.8897 432.907 Tm
-.0226 Tc
(13)Tj
8.9663 0 0 8.9663 166.4503 428.9385 Tm
-.0158 Tc
[(A)-207.7(m)-15.8(o)10(t)-1(he)-15.8(r)13.8(,)-213.1(convince)-15.8(d)-199.6(h).4(er)-211.9(baby)-210.3(had)]TJ
-14.5617 -1.3341 TD
-.0155 Tc
[(the)-245.1()52.8()-15.5(c)12.9(roup,)52.8()-250.7(c)1.5(al)-15.5(l)9.1(e)1.5(d)-247.9(t)-.7(he)-251.4(infant)-15.5(s)-232.4(grandm)-15.5(o)10.3(t)-.7(he)-15.5(r)]TJ
/F12 1 Tf
17.6852 0 TD
0 Tc
(.)Tj
/F1 1 Tf
.9864 0 TD
-.0153 Tc
[(wh)-15.3(o)8.7(,)-244.2(in)-247.3(turn)-247.3(tele)-15.3(p)9.6(h).9(oned)]TJ
-18.6716 -1.3341 TD
0 Tc
[(t)14.8(h)16.2(e)-450.9(f)16.9(am)29.1(i)15.4(l)15.4(y)-453.7(d)14.2(o)14.2(c)17(t)14.8(o)14.2(r)-449(a)0(t)-435.6(m)0(i)27.1(d)14.2(n)14.6(i)15.4(g)14.2(h)16.2(t)-453.1()74.6(t)26.2(o)-447.4(t)14.8(el)26.2(l)-452.5(h)16.2(i)15.4(m)-449.9(t)14.8(h)16.2(e)-450.9(t)14.8(er)29.6(r)12.6(i)15.4(b)14.2(l)15.4(e)-450.8(n)14.6(ew)26.9(s)18.3(.)0()79.7()-450.2(T)14.2(h)16.2(e)]TJ
T*
[(p)14.2(h)16.2(y)14.2(s)18.3(ic)26.2(i)15.4(a)0(n)-233.6(t)14.8(e)17(l)15.4(ep)24.9(h)16.2(o)14.2(n)14.6(e)17(d)-251.4(t)14.8(h)16.2(e)-248.5(m)18(o)14.2(t)14.8(h)0(e)26.9(r)-246.7(a)17.4(n)14.6(d)-251.4(a)17.4(s)18.3(k)13.1(ed)-234.4(h)16.2(e)0(r)-236(t)14.8(o)-245.1()68.3()17.7(l)15.4(i)15.4(f)0(t)-233.9(t)14.8(h)16.2(e)-248.5(ch)26.9(i)15.4(l)15.4(d)-245.1(t)14.8(o)-251.4(t)14.8(h)16.2(e)]TJ
T*
[(t)14.8(e)17(l)15.4(e)0(p)24.9(h)16.2(o)14.2(n)14.6(e)-179(a)17.4(n)14.6(d)-175.5(l)15.4(e)0(t)-164.1(m)0(e)-161(h)0(e)26.9(a)0(r)-166(i)15.4(t)-174.9(c)17(o)14.2(u)0(g)24(h)16.2(.)17.7()68.3()-178.3(S)16.2(ub)24(s)18.3(e)0(q)24.9(u)16.2(e)17(n)14.6(t)14.8(l)15.4(y)14.2(,)-178.3(he)-162.8(d)14.2(e)0(c)27.8(l)15.4(ar)30(ed)24.9(:)-172.2()68.3(T)25.5(h)16.2(a)17.4(t)-181.2(i)15.4(s)]TJ
T*
-.015 Tc
[(not)-253.1(t)-.2(he)-257.2(croup,)53.3()-256.5(advis)-15(i)12.4(ng)-253.7(the)-257.2(m)3(oth)-15(e)11.9(r,)-250.2(c)-15(h)11.9(ild,)-256.5(a)2.4(nd)-253.7(grandm)-15(o)10.8(t)-.2(her)-255.4(t)-.2(o)-253.7(s)-15(t)11.8(a)2.4(y)-253.7(i).4(n)]TJ
T*
-.0156 Tc
[(bed,)-282.4(whe)-15.6(r)7.7(e)1.4(upon)-279.3()52.7()-15.6(t)10.6(h).6(e)-283.1(t)-.8(ri)-15.6(o)-270.5(s)2.7(e)-15.6(t)9.9(tled)-286(down)-279.3(h).6(a)-15.6(p)9.7(pily)-279.6(f)-15.6(o)9.1(r)-281.2(t)-.8(he)-283.1(night.)52.7()]TJ
1.1065 -1.3278 TD
-.0152 Tc
[(Wil)-15.2(l)9.4(em)-420.9(Ei)-15.2(n)14.8(t)-.4(h)-15.2(o)8.8(ven)-424.3(\().2(18601927\),)-421.1(a)-421.4(Dutch)-422.6(p)-1(h)-15.2(y)8.8(sic)-15.2(i)11(an)-424.3(and)-424.7(i).2(nventor,)]TJ
-1.1065 -1.3341 TD
-.015 Tc
[(dem)-15(o)10.8(n)5.9(s)-15(t)11.8(r)-2.4(ate)-15(d)-217.7(th)-15(e)-222(u)1.2(s)-15(e)-220(of)-232.1(the)-231.9(t)-.2(el)-15(e)11.2(p)-.8(hone)-231.9(f)-15(o)9.7(r)-230.1(d)-.8(iagnos)-15(t)11.8(i).4(c)-231.9(p)-.8(urpos)-15(e)14(s)-230.7(in)-234.4(1905.)]TJ
T*
0 Tc
[(H)14.7(e)-223.2(co)31.2(mb)25.8(i)15.4(n)14.6(e)17(d)-226.1(hi)25.3(s)-222(i)15.4(mp)25.8(r)18.9(o)14.2(v)14.2(e)0(d)-215.4(g)14.2(a)17.4(l)15.4(v)14.2(a)0(n)25.7(o)20.5(me)28.7(t)14.8(e)0(r)-210.7(w)0(i)25.3(t)14.8(h)-224.1(t)14.8(h)16.2(e)-229.6(e)17(m)0(e)28.7(r)12.6(g)14.2(i)15.4(n)14.6(g)-226.1(t)14.8(e)17(l)15.4(e)0(p)24.9(h)16.2(o)14.2(n)14.6(e)]TJ
T*
[(t)14.8(e)17(ch)26.9(n)14.6(o)14.2(l)15.4(o)14.2(g)14.2(y)-169.2(t)14.8(o)-169.2(tr)27.4(an)32(sm)23.6(i)15.4(t)-168.5(h)16.2(e)0(a)28.1(r)12.6(t)-168.5(s)0(o)26.1(u)16.2(n)14.6(d)14.2(s)-171.4(f)16.9(r)12.6(o)14.2(m)-165.4(a)-172.3(h)16.2(o)14.2(sp)26.1(i)15.4(t)14.8(al)-156.8(t)14.8(o)-169.2(hi)25.3(s)-171.4(l)15.4(a)17.4(b)14.2(o)14.2(r)12.6(a)17.4(t)14.8(o)14.2(r)12.6(y)14.2()16.8(a)]TJ
T*
-.0154 Tc
[(dista)-15.4(n)10.3(ce)-238.6(of)-232.5(0.)-15.4(9)-223.8(m)-15.4(i)11.7(l)0(e)-15.4(a)12.5(n)-.8(d)-235.2(r)-2.8(ef)-15.4(e)12.2(rred)-235.2(t)-.6(o)-241.5(t)-.6(he)-238.6(produ)-15.4(c)11.5(t)-234.5(a)-15.4(s)-226.3(a)-231.9()52.9()-15.4(t)10.8(ele)-15.4(c)12.4(ardiogram)-15.4(.)13.9()52.9()]TJ
T*
0 Tc
[(E)16.2(i)15.4(n)14.6(t)14.8(h)16.2(o)14.2(v)14.2(e)0(n)-221.3(i)15.4(s)-234.6(c)0(r)29.6(e)0(d)24.9(i)15.4(t)14.8(e)17(d)-238.7(w)16.2(i)15.4(t)14.8(h)-236.7(t)14.8(h)16.2(e)-235.9(fi)26(r)18.9(s)0(t)-219.8(u)0(s)28.1(e)-235.9(o)14.2(f)-236.1(t)14.8(h)16.2(e)-235.9(p)14.2(r)12.6(e)17(fi)26(x)-232()68.3()17.7(t)14.8(el)26.2(e)17()68.3()-235.2(i)15.4(n)-238.4(a)-229.2(me)28.7(d)14.2(i)15.4(ca)28.1(l)]TJ
T*
-.0153 Tc
[(conte)-15.3(x)16.3(t)-285(t)-.5(hat)-285(a)2.1(ppe)-15.3(a)12.8(r)-2.7(ed)-279.3(in)-285.3(an)-279(a)-15.3(r)14.7(tic)-15.3(l)10.9(e)-282.8(p)-1.1(ublis)-15.3(h)12.8(e)-15.3(d)-268.6(i).1(n)-279(1906.)]TJ
6.7246 0 0 5.9768 231.1369 277.5117 Tm
-.0226 Tc
(14)Tj
8.9663 0 0 8.9663 45.8079 261.5244 Tm
0 Tc
[(In)-265.2(191)10.9(0,)-265.3(Bri)14(tish)-257.7(\(bu)14.2(t)-269.7(Chic)13.7(ag)12.6(o-bo)18.5(rn\))-261(Sid)14.2(ney)-264.1(G.)-264.7(Bro)12.7(wn)-266.5(dis)16.3(cove)11.8(red)-259.7(a)]TJ
-1.1065 -1.3278 TD
[(dia)15.4(gno)11.3(st)14.1(ic)-277.3(fun)16(cti)15.7(on)-274.8(for)-272.6(th)12.1(e)-280.1(tele)13.8(ph)11.4(one)-270.4(whil)19(e)-280.1(loo)12.2(kin)17.8(g)-283(f)0(o)12.1(r)-278.3(a)-279.7(solu)13.5(tio)19.1(n)-282.6(t)0(o)]TJ
0 -1.3341 TD
[(th)12.1(e)-179(rap)12.5(id)-179.1(de)12.2(gra)12.5(dat)14.8(ion)-170.8(of)-177.6(tel)15.7(epho)17.3(ne)-177.1(sign)18.2(als)-170.2(over)-169.7(dis)16.3(tanc)13.3(es)-173.3(of)-177.6(mo)13.2(re)-179.1(th)12.1(an)]TJ
T*
[(20)-256.2(mile)15.3(s.)-254.9(He)-259.1(dev)13.8(elop)16.5(ed)-259.6(a)-267.1()62(re)15.7(peat)12.9(er,)-249.9(amp)11.6(lif)16.1(ier)13.4(,)-266.8(a)0(n)13(d)-264(rec)15(eive)13.1(rs)-253.7(allo)18.2(win)14.5(g)]TJ
T*
[(cl)13.5(ear)-256.5(art)13.2(icu)17.1(lati)18.9(on)-262.1(\(of)-250.7(tele)13.8(ph)11.4(one)14.1(\))-262.8(tra)13.2(nsm)12.8(iss)14(ion)-253(of)-259.8(up)-260.5(to)-255.5(and)-257.4(mo)13.2(re)-261.2(th)12.1(an)]TJ
T*
[(fi)13.3(fty)-213.4(mi)14.4(les)12.8(.)60.7()]TJ
6.7246 0 0 5.9768 78.9165 205.7385 Tm
(15)Tj
8.9663 0 0 8.9663 87.8173 201.7701 Tm
[(Subs)14.2(eq)12.2(uent)18.3(ly,)-211.9(he)-213.4(dem)11.2(ons)15.4(tra)13.2(ted)-206.9(his)-209.3(inv)12.5(ent)14.8(ion)-208.8(at)-214.3(sev)11.5(era)15.4(l)]TJ
-5.7918 -1.3341 TD
[(ho)11.4(spi)16.3(tals)-281.8(in)-279.8(Lond)18.1(on.)-282.4(It)-283.9(is)-288.8(imp)15.9(orta)14.7(nt)-280.5(that)-278.2(Bro)12.7(wn)-285.4(co)12.2(nclu)12.6(de)12.2(d)-289.3()55.6(t)13.6(his)-285.2(tri)17.5(al)]TJ
T*
[(pr)14.1(oved)-421(that)-417.3(it)-425(is)-427.9(now)-423(pos)15(sibl)12.7(e)-431.9(f)0(o)12.1(r)-430(a)-431.5(spe)11.5(cia)12(lis)17.5(t,)-429.1(say)18.2(,)-437.5(i)0(n)-425.3(Lon)16.6(don)11.3(,)-431.2(t)0(o)]TJ
T*
[(ex)12.6(ami)12.9(ne)-234(a)-241.8(p)0(a)12.6(tien)17.6(t,)-239.4(say)11.9(,)-235.2(i)0(n)-235.6(the)-236.5(co)12.2(unt)14(ry,)-233.8(ste)12.2(th)12.1(osc)11.5(opi)12.2(cal)18.3(ly,)-237.2(an)13(d)-238.7(t)0(o)-236.6(arri)20(ve)]TJ
0 -1.3278 TD
[(at)-372.4(a)-380.9(cor)12.2(rect)-368.5(diag)16.9(nos)15.4(is.)13.5()55.6()]TJ
6.7246 0 0 5.9768 123.7039 157.9464 Tm
(15)Tj
8.9663 0 0 8.9663 134.0787 153.9779 Tm
[(Als)12.5(o)-377.9(i)0(n)-381(191)17.2(0,)-379.1(in)-381(Ne)12.8(w)-382.2(Yor)13.1(k,)-373.8(card)16.9(iol)13.4(ogi)12.2(sts)]TJ
-10.9513 -1.3341 TD
[(Wa)12.9(lte)15.7(r)-335.2(Jam)13.5(es)-325.1(and)-320.6(Hora)14.6(tio)-322.3(Wil)13.7(lia)16.7(ms)-324.2(des)11.5(cri)13.4(bed)-321.4(thei)12.9(r)-328.9(exp)14.1(eri)13.4(ence)-320(wi)12.6(th)]TJ
T*
[(th)12.1(e)-400.3(t)0(r)14.7(ans)12.3(mis)13.7(sio)16.3(n)-396.4(o)0(f)-392.6(ele)11.6(ctr)12.8(ocar)16.9(dio)12.2(gr)14.1(ams)-389(\(EC)15.6(Gs\))-387.8(for)-392.7(a)-393.6(wid)14.1(e)-400.3(ran)19.2(ge)-392.4(of)]TJ
T*
[(car)15.4(dia)15.4(c)-210.6(iss)14(ues)13.6(,)-209.9(incl)18.2(udi)14.2(ng)-205.2(hyp)12.9(ert)12.8(roph)19.2(y,)-208.4(ect)11(opi)12.1(cs,)-199.9(an)13(d)-213.5(fib)14.8(rill)14.6(at)13.3(ion)12.5(s:)-204.5()62(We)]TJ
T*
[(ha)14.7(ve)-177.5(th)12.1(e)-179(w)0(a)14.6(rds)-170(of)-171.3(Pre)12.5(sb)13.5(yter)14.3(ian)-167.6(Hos)15.6(pit)12.8(al)-169.5(con)14.1(nect)19.2(ed)-171.1(with)-165(th)12.1(e)-179(lab)15.4(ora)12.5(tor)16.3(y)]TJ
T*
[(by)-458.5(a)-456.8(sys)12.8(tem)-456(of)-455.8(wir)12.5(ing)-449(whic)14.2(h)-464.3(p)0(e)12.2(rmi)14.3(ts)-460.1(th)12.1(e)-463.5(tak)13.8(ing)-449(of)-462.2(an)13(y)-466.4(p)0(a)12.6(tien)17.6(ts)]TJ
T*
[(el)13.5(ect)11(roc)12.2(ard)12.5(iog)18.5(ram)-268.2(wi)12.6(thou)17.1(t)-276(remo)17.5(vin)12.5(g)-276.7(h)0(i)12.7(m)-279.2(fro)18.3(m)-279.2(h)0(i)12.7(s)-278.9(be)12.2(d.)68.5()]TJ
6.7246 0 0 5.9768 244.1763 86.2299 Tm
(16)Tj
8.9663 0 0 8.9663 317.8204 693.8644 Tm
-.0238 Tc
[(In)-331.7(1920,)-334.9(t)3.7(he)-335.5(concept)-337.8(o)3(f)-335.7(u)-1.3(sing)-332.1(tel)]TJ
13.2465 0 TD
-.0244 Tc
[(ecommunic)5.3(a)-.6(tions)-334.9(f)-1.2(or)-340.6(me)5.3(dical)-337.8(p)2.4(ur-)]TJ
-14.3593 -1.3278 TD
-.0249 Tc
[(po)-4.4(ses)-335.4(w)-2.4(as)-335.4(put)-338.9(i)3.2(n)-4(t)2.6(o)-339.5(p)1.9(ract)-3.8(ice)-336.6(i)-3.1(n)-332.8(N)-3.8(orway.)]TJ
6.7246 0 0 5.9768 448.8943 685.9274 Tm
-.031 Tc
(17)Tj
8.9663 0 0 8.9663 458.4755 681.9589 Tm
-.0238 Tc
[(Bergens)-334.3(Ha)6.3(ukeland)-338.4(H)3.6(ospital)]TJ
-16.8 -1.3341 TD
-.0227 Tc
[(est)4.8(a)1(bl)5.4(ish)6.1(e).7(d)-350(a)-353(ra)7.4(di)5.4(o)-350(s)1.9(ervi)5.4(ce)-347.1(to)-350(p)4.1(r)2.5(ov)4.1(id)4.1(e)-347.1(c).7(li)5.4(ni)5.4(cal)-348.7(s)1.9(up)4.1(p)4.1(o)-2.2(rt)-349.3(fo)4.1(r)-351.6(s)1.9(h)6.1(i)-.9(p)4.1(s)-352.2(at)-349.3(se)7(a,)]TJ
T*
-.0232 Tc
[(in)4(cl)4.9(udin)4(g)-274.6(u)-.7(rgent)-267.6(s)1.4(ur)]TJ
8.087 0 TD
-.0214 Tc
[(gi)6.7(cal)-271.5(o)5.4(pe)8.3(ra)8.7(ti)6.7(on)5.8(s.)]TJ
6.7246 0 0 5.9768 438.633 662.003 Tm
-.031 Tc
(18)Tj
8.9663 0 0 8.9663 447.6471 658.0344 Tm
-.0251 Tc
[(By)-276.5(t)-4(h)3.7(e)-279.9(e)4.6(n)-4.2(d)-276.5(of)-273.8(t)-3.9(h)3.7(e)-280(1)1.7(9)-4.6(20s,)-279.3(s)-.5(everal)]TJ
-15.5923 -1.3341 TD
-.0256 Tc
[(West)-4.5(ern)-358.8(Europ)-5.1(ean)-365.1(c)-2.2(ount)-4.5(ries)-367.7(wit)-4.5(h)-363.5(sub)-5.1(s)-1(tant)-4.5(ial)-364.2(m)-1.3(arit)-4.5(ime)-369(operat)-4.5(i)2.5(o)-5.1(n)1.6(s)-361.4(h)-3.1(ad)]TJ
T*
-.0226 Tc
[(est)4.9(a)1.1(bl)5.5(ish)6.2(e).8(d)-387.8(s)2(i)5.5(m)1.7(il)5.5(ar)-383.1(radi)5.5(o)-387.8(s)2(erv)4.2(i)-.8(c)7.1(e).8(s)-390(t)4.9(o)-387.8(p)4.2(ro)4.2(vi)5.5(de)-384.9(med)4.2(i)-.8(c)7.1(a)1.2(l)-386.5(c).8(o)4.2(n)-1.7(su)6.3(lt)4.9(ati)5.5(o)4.2(n,)-384.3(d)4.2(i)-.8(-)]TJ
T*
-.0248 Tc
[(agnosis,)-190.5(and)-194(c)-1.4(linical)-192.7(a)-1(nd)-194(surgic)]TJ
12.1273 0 TD
-.0256 Tc
[(al)-193.5(ment)-4.5(orin)-4.7(g)-194.8(f)-2.4(or)-196.4(ships)-197(a)-1.8(t)-194.1(s)-1(ea.)]TJ
6.7246 0 0 5.9768 516.2455 626.1164 Tm
-.031 Tc
(19)Tj
8.9663 0 0 8.9663 524.5227 622.1479 Tm
-.022 Tc
[(Th)6.8(e)-194.6(I)1.8(t)5.5(a)1.7(li)6.1(an)]TJ
-24.1662 -1.3341 TD
-.0263 Tc
[(marit)-5.2(i)1.8(me)-281.1(p)-5.8(r)-1.1(og)-5.8(ram,)-286.8(begun)-283.6(i)1.8(n)-283.6(1).5(9)-5.8(35,)-286.8(co)]TJ
14.9094 0 TD
-.0258 Tc
[(nt)-4.7(in)-4.9(ues)-279.4(t)-4.7(o)-283.5(b)1(e)-280.6(o)-5.3(perational)-282.3(t)-4.7(oday)-5.3(.)]TJ
-13.7966 -1.3341 TD
0 Tc
[(In)-170.3(194)10.9(8,)-176.8(Aus)13.3(tin)-170.2(Coo)12.3(le)13.5(y,)-176.8(a)-178.6(tel)15.7(eco)10.3(mmu)14.2(nic)15.4(atio)17.6(ns)-175.8(inv)12.5(en)12.6(tor)-173.4(wh)13.4(o)-181.8(pla)15.4(yed)]TJ
-1.1128 -1.3278 TD
[(a)-197.6(maj)19.2(or)-194.6(ro)14.1(le)-195.2(in)-191.3(th)12.1(e)-197.9(d)0(e)12.2(velo)16.5(pme)11.2(nt)-185.6(of)-196.6(th)12.1(e)-197.9(fac)13.4(si)14.7(mile)-180.7(mac)14.5(hine)12.6(,)-191(dev)13.7(elop)16.6(ed)-190.1(a)]TJ
0 -1.3341 TD
[(sys)12.8(tem)-184.1(fo)12.1(r)-196.1()62(lon)17.6(g-di)19.8(sta)12.6(nce)-185.3(roe)12.1(ntg)11.9(en)12.6(ogr)15.6(aphi)12.6(c)-191.6(fac)13.4(sim)13.7(ile)-186(via)-180.6(com)11.2(mer)15.9(cia)12(l)]TJ
T*
[(tel)15.7(epho)17.3(ne)-221.3(wi)12.6(res)-211.4(or)-219.9(rad)18.9(io.)71.3()-222.6(I)0(n)-214.6(195)10.9(0,)-214.7(Ge)12.8(rsho)16.9(n-C)12.5(oh)11.4(en,)-216.3(a)-216.5(rad)12.5(iol)13.4(ogi)12.1(st,)-208.5(and)]TJ
T*
[(Coo)12.3(ley)]TJ
6.7246 0 0 5.9768 333.2408 554.3998 Tm
(20)Tj
8.9663 0 0 8.9663 343.0487 550.4313 Tm
[(des)11.5(cri)13.4(be)12.2(d)-320.9(t)0(h)12.1(eir)-309(ex)12.6(per)12.1(ien)15.4(ce)-313.7(tra)13.2(ns)13.9(mitt)18.8(ing)-309.9(X-)13.8(ray)-309.9(ima)12.9(ge)12.2(s)-316.8(ove)13.8(r)]TJ
-3.9265 -1.3341 TD
[(wir)12.5(e)-463.5(o)0(r)-453.8(rad)12.5(io)-457.3(ci)13.5(rcui)17(ts,)-455(ref)14.8(err)16.9(ing)-455.4(to)-457.9(th)12.1(is)-459.5(sys)12.8(te)12.9(m)-462.6(a)0(s)-457.5()62(t)12.3(elo)15(gno)11.3(sis)14()]TJ
/F12 1 Tf
26.8597 0 TD
(.)Tj
/F1 1 Tf
.9927 0 TD
(a)Tj
-27.8524 -1.3341 TD
[(co)11(nde)14.1(nsa)12.3(tio)19.1(n)-290.2(of)-285.1(th)12.1(ree)-282.2(ter)12.8(ms,)-281.2(to)-287.2(wi)12.6(t,)]TJ
/F5 1 Tf
15.5354 0 TD
[(tel)14.7(eo)]TJ
/F1 1 Tf
1.9032 0 TD
(,)Tj
/F5 1 Tf
.5311 0 TD
[(ro)13.1(entg)18.2(en)]TJ
/F1 1 Tf
3.5219 0 TD
.2921 Tc
[(,a)292.1(n)305.1(d)]TJ
/F5 1 Tf
2.3585 0 TD
0 Tc
[(dia)13.8(gnos)18.7(is)]TJ
/F1 1 Tf
3.8317 0 TD
[(.)67()]TJ
-27.6817 -1.3341 TD
[(Th)11.4(ey)-297.6(use)13.6(d)-295.7(the)-287.1(sys)12.8(tem)-291.6(ro)14.1(utin)16.7(ely)-288.5(ove)13.8(r)-297.3(a)-298.7(dis)16.3(tan)15.2(ce)-294.7(of)-291.4(som)12.5(e)-299.1(2)0(8)-287.8(mile)15.3(s.)-292.8(In)]TJ
T*
[(one)-415.8(ins)16.6(ta)13.3(nce,)]TJ
6.7246 0 0 5.9768 357.9023 506.6077 Tm
(20)Tj
8.9663 0 0 8.9663 368.6739 502.5826 Tm
[(Phi)14.6(la)13.9(delp)16.5(hia)-412.5(phy)12.9(sic)12.8(ian)15.8(s)-424.3(a)0(t)-416.7(A)0(l)13.2(ber)12.1(t)-421.5(Ein)14.6(ste)12.2(in)-412.6(Med)10.6(ica)12(l)]TJ
-6.7845 -1.3278 TD
[(Cen)15.6(ter)-271.7(suc)13.6(ces)14.4(sfu)13.4(lly)-264.8(iden)16.9(tif)15.5(ied)-269.5(a)-273.4(lar)13.8(ge)-272.3(bow)12.9(el)-271(obst)17.2(ruc)14.2(tio)12.8(n)-276.3(o)0(f)-272.5(a)-273.4()55.6()0(p)12.9(rom)13.1(i-)]TJ
0 -1.3341 TD
[(nen)14.5(t)64.1()-304.8(c)0(i)13.5(tize)13.8(n)-301.6(i)0(n)-292.5(Che)10.9(ste)12.2(r)-297.3(Cou)14.3(nty)11.9(,)-304.8(w)0(h)13.4(ich)-292.8(was)-295.9(tr)14.7(eat)11.3(ed)-297.6(loc)15(ally)18.2(.)-304.8(T)0(h)11.4(i)0(s)-295.1(was)]TJ
T*
[(fol)14.8(low)14.1(ed)-177.4(by)-167.7(Albe)12.8(rt)-168.6(Jut)15.4(ras,)-168(a)-172.3(rad)12.5(iol)13.4(ogi)12.2(st)-169.2(in)-172.3(Mon)14.4(tre)12.8(al)-169.5(who)-168.5(dem)11.2(ons)15.4(tra)13.2(ted)]TJ
T*
[(in)-463.2(a)-463.1(195)10.9(7)-460(pub)12.9(lica)14.8(tio)12.8(n)-459.7(the)-457.8(fea)13.4(sibi)19(lit)14.1(y)-466.4(o)0(f)-462.2(tra)13.2(ns)13.9(mitt)18.8(ing)-455.4(rad)12.5(iog)12.2(rap)12.5(hi)12.7(c)]TJ
T*
[(ima)12.9(ge)12.2(s)-259.9(via)-250.1(coax)18.9(ial)-255.2(cab)17(le)-258.4(be)12.2(twee)14.5(n)-257.3(the)-255.4(Hot)18.4(el-)14.8(Dieu)-248.4(and)-251(the)-249.1(Jea)12.5(n-Ta)15.9(lon)]TJ
T*
[(Hos)15.6(pit)12.8(als)13.2(,)-279.5(a)0(b)12.6(out)-271(5)-276.7(mil)17.2(es)-274.5(ap)12.6(art)13.2(;)-279.7(J)0(u)13.2(tra)13.2(s)-278.9(a)0(n)13(d)-276.7(Duc)14.3(ket)13.4(t)]TJ
6.7246 0 0 5.9768 492.7747 434.8345 Tm
(21)Tj
8.9663 0 0 8.9663 502.2424 430.866 Tm
[(pre)12.2(sag)18.2(ed)-272.3()55.6(as)15.5(yn-)]TJ
-21.6813 -1.3341 TD
[(chr)14.2(ono)11.3(us)71.1()-285.8(t)0(e)12.9(lem)12.5(edi)15(cine)-271(by)-281.5(sug)17(ges)11.5(tin)13.2(g)-283()62(the)-269.4(use)-271(of)-278.8(vid)12.2(eo)-278.6(tap)14.8(es)-280.8(wo)11.4(uld)]TJ
T*
[(be)-329.2(an)-322.1(ind)12.5(isp)16.3(ens)11.9(ab)12.6(le)-327.9(too)11.5(l)-326(adj)15.4(unct)12(.)67()-330.1(Jut)15.4(ras)-318.5(int)13.2(rodu)19.2(ced)-324.8(th)12(e)-330.7(ter)12.8(m)-329.8()62(te)11.6(le-)]TJ
0 -1.3278 TD
[(fluo)18.4(ros)13.4(cop)13.8(y)63.5()-387(for)-380.1(the)-381.9(tra)13.2(nsm)12.8(iss)14(ion)-379.5(of)-386.3(rad)12.5(iol)19.8(ogi)12.1(c)-393.9(i)0(m)14.4(ages)-375.7(via)-382.9(coax)18.9(ial)]TJ
0 -1.3341 TD
[(cabl)19.8(e.)-319.3(Bot)15(h)-325.2(J)0(u)13.2(tra)13.2(s)-318.1(ter)12.8(m)-323.5(a)0(n)13(d)-320.9(that)-309.8(of)-316.7(Coo)12.3(ley)-313.8(and)-314.3(Ge)12.8(rsho)16.9(n-C)12.5(oh)11.4(en)-322.5(did)]TJ
T*
[(not)-316.9(ach)12.7(ieve)-315.7(muc)13.3(h)-331.6()62(tr)13.5(act)11.3(ion)12.5()62()-330.1(an)13(d)-327.3(were)-316.6(soon)-318.2(fo)12.1(rgot)17.8(ten)14.8(.)-330.1(A)0(t)-328.8(a)0(b)12.6(out)-321.6(th)12.1(e)]TJ
T*
[(sam)15.7(e)-343.4(tim)16.6(e)-337(a)0(t)-334.5(t)0(h)12.1(e)-343.4(Uni)17.4(ver)12.2(sity)-323(of)-335.7(Neb)14.3(rask)17.1(a,)-331.6(Wit)13.1(tso)15.6(n)-339.5(and)-326.9(Dut)12.1(ton)]TJ
6.7246 0 0 5.9768 539.3762 363.118 Tm
(22)Tj
8.9663 0 0 8.9663 549.3542 359.1495 Tm
(ex-)Tj
-26.9356 -1.3341 TD
[(per)12.1(ime)12.5(nte)14.8(d)-339.9(w)0(i)12.6(t)0(h)-335.7(t)0(h)12(e)-343.4(use)-327.9(of)-335.7(bid)18.5(ire)13.4(ctio)17.2(nal)-332(cl)13.5(ose)11.5(d-c)13.6(irc)13.4(uit)-326.6(tele)13.8(vis)16.3(ion)-328.9(in)]TJ
T*
[(psy)15(chia)15.5(try)-337.8(for)-342.1(med)11.2(ica)18.3(l)-351.3(educ)13.9(at)13.3(ion)-341.5(and)-339.6(tra)13.2(ini)13.8(ng)-344.3(and)-339.6(late)14.1(r)-347.8(t)0(o)-344.1(con)14.1(duct)]TJ
T*
[(gro)15.6(up)-424.9(ther)16.4(apy)-422.1(ses)15.6(sio)16.3(ns)-422.4()55.6(at)-417.9(a)-425.2(dist)18.4(ance)15.5(.)67()-431.2(Tel)15(eme)14.1(dici)17.8(ne)-423.7(cam)14.5(e)-431.9(o)0(f)-424.2(a)0(g)12.6(e)]TJ
T*
[(du)11.4(ring)-316.3(th)12.1(e)-330.7(197)10.9(0s)13.5(.)-330.1(T)0(h)11.4(e)-330.7(fi)13.3(rst)-321.1(pr)14.1(oto)11.5(typ)11.5(e)-324.4(tele)13.8(med)17.5(icin)18.2(e)-330.7(pro)15.6(gra)12.5(m)-323.5(was)-321.2(es-)]TJ
0 -1.3278 TD
[(tab)14.8(lish)14.8(ed)-392.4(in)-393.7(196)10.9(8)-396.8(i)0(n)-393.6(Bos)12.1(ton)11.9(,)-399.6(lin)20.1(king)-385.3(the)-394.6(Med)16.9(ica)12(l)-395.5(Stat)19(ion)-392.1(at)-391.4(Loga)14.6(n)]TJ
0 -1.3341 TD
[(Int)15.2(ern)12.5(ati)16.1(ona)14.5(l)-307(A)0(i)13.2(rpor)15.5(t)-301.3(wit)14.8(h)-306.3(Mas)15.1(sac)14.8(hus)12.7(ett)15.1(s)-304.2(Gen)14.7(era)15.4(l)-307(Hos)15.6(pit)12.8(al.)-290.9(This)-290(was)]TJ
T*
[(fol)14.8(low)14.1(ed)-303.9(by)-306.8(sev)11.5(era)15.4(l)-307(e)0(x)12.6(plo)12.1(rat)13.2(ory)-300.5(pro)15.6(jec)11.6(ts)-302(fun)16(ded)-302.4(by)-300.5(the)-299.7(fede)14.5(ral)-296(gov)10.9(-)]TJ
T*
[(ern)12.5(men)17.9(t)-206.5(\(in)13.8(cl)13.5(udin)16.1(g)-200.8(the)-198.5(Dep)12.3(art)13.2(men)17.9(t)-206.5(o)0(f)-196.6(H)0(e)12.8(alth)13.3(,)-203.6(E)0(d)11.4(uca)12.7(tio)12.8(n)-200.4(and)-194.1(We)12.5(lfar)18(e,)]TJ
T*
[(the)-331.3(Nat)15.4(ion)12.5(al)-333.9(Sci)17.1(ence)-326.4(Fou)12.9(nda)14.5(tio)12.8(n,)-334.5(the)-331.3(Nat)15.4(ion)12.5(al)-333.9(Libr)17.4(ary)-328.9(of)-335.7(Med)16.9(icin)18.2(e,)]TJ
T*
[(the)-312.3(Off)13.8(ic)13.5(e)-324.4(o)0(f)-310.4(Econ)17.7(omic)-308.5(Opp)14.7(ort)16.3(unit)16.7(y,)-315.9(and)-307.9(the)-312.4(Reg)10.9(ion)12.5(al)-308.6(Med)10.6(ica)12(l)-319.7(P)0(r)14.5(o)0(-)]TJ
T*
[(gra)12.5(m\))-200.6(as)-204.6(wel)17(l)-212.2(a)0(s)-198.2(the)-198.5(Nati)18.2(ona)14.5(l)-212.2(Aer)14.8(ona)14.5(ut)12.1(ics)-202.2(an)13(d)-207.1(Spac)14.2(e)-204.3(Admi)13.7(nis)16.6(tra)13.2(tio)12.8(n)13.3(s)]TJ
T*
[(ter)12.8(res)16.3(tria)16(l)-243.8(tel)15.7(eme)14.1(dici)17.8(ne)-240.3(tes)12.2(t)-244.4(bed)13.8(s)-247.3(i)0(n)-235.6(Alas)17.3(ka)-241.3(an)13(d)-245.1(Ari)13.1(zo)12.2(na)-239.9(and)-238.4(its)-236(use)-233(of)]TJ
0 -1.3278 TD
[(tel)15.7(emet)16.3(ry)-270.5(in)-273.5(ear)15.4(ly)-267.6(hum)12.4(an)-271.5(spa)11.9(ce)-269.4(fli)16.1(ght)13.6(.)]TJ
1.1128 -1.3341 TD
[(Today,)-275(telemedicine)-281.2(can)-273.5(be)-278.6(found)-278.1(in)-273.5(every)-279.1(state)-278(of)-272.5(the)-274.4(union)-279.2(and)]TJ
-1.1128 -1.3341 TD
[(almost)-306.6(every)-310.7(country)-307.5(in)-305.1(the)-306(world.)-308.2(However,)-312.7(in)-305.1(the)-306(United)-309.6(States)-306.1(it)]TJ
T*
[(continues)-205.7(to)-198.6(be)-196.4(encumbered)-202.7(by)-205.6(policies)-201.8(that)-196(are)-199.6(no)-198.9(longer)-202.9(functional,)]TJ
T*
[(especially)-508.8(those)-507.5(related)-511.2(to)-508.5(the)-502(rules)-508.5(and)-504(requirements)-514.2(for)-506.5(reim-)]TJ
T*
[(bursement)-281(and)-282.7(interstate)-285.8(licensure)-280.1(and)-282.7(practice.)]TJ
/F4 1 Tf
11.9551 0 0 11.9551 307.8424 118.0346 Tm
[(Prerequisi)-9.8(tes)-334.5(for)-334.7(Definitive)-338.7(Evaluati)-10.5(on)]TJ
0 -1.0006 TD
[(of)-333.1(Telemed)-8.7(icine)]TJ
/F1 1 Tf
8.9663 0 0 8.9663 317.8204 94.1669 Tm
[(Des)16.4(pit)12.8(e)-235.9(vol)12.1(umi)18(nou)13.3(s)-234.6(rese)14.3(arc)15.4(h)-236.7(i)0(n)-229.3(t)0(h)12.1(i)0(s)-231.9(f)0(i)13.3(eld,)-226.5(inv)18.9(est)12.2(iga)15.4(tors)-224.7(hav)16.2(e)-235.9(yet)-225.9(to)]TJ
-1.1128 -1.3341 TD
[(rea)15.4(ch)-447.3(cons)13.4(en)12.6(sus)-446.8(on)-445.5(a)-450.5(set)-449.4(of)-443.2(req)12.2(uir)12.6(eme)14.1(nts)-445.5(fo)12.1(r)-455.3(v)0(a)12.6(lid)-441.8(eval)13.5(ua)14.7(tio)12.8(n)-453.3(i)0(n)]TJ
/F11 1 Tf
11.9551 0 0 11.9551 287.5464 741.9966 Tm
[(TELEMEDICINE)-340.6(FOR)-332.7(CHRONIC)-338.8(DISEASE)-334.7(MANAGE)-7.3(MENT)]TJ
/F9 1 Tf
6.9738 0 0 6.9738 187.9937 29.7638 Tm
()Tj
/F7 1 Tf
1.3251 0 TD
.2015 Tc
[(MAR)-6.9(Y)-327.2(ANN)-334.1(L)1(IEBE)-3.9(RT,)-333.3(I)6.2(NC.)]TJ
/F10 1 Tf
15.015 0 TD
0 Tc
()Tj
/F7 1 Tf
.9999 0 TD
.1028 Tc
[(VO)-11.6(L.)-342.6(2)-8.4(0)-1000.2(N)-10.1(O)-3.5(.)-342.6(9)]TJ
/F10 1 Tf
8.3814 0 TD
0 Tc
()Tj
/F8 1 Tf
.9999 0 TD
.1096 Tc
[(SEPTEM)6.4(BER)-333.1(2).2(01)8.2(4)]TJ
/F4 1 Tf
7.9702 0 0 7.9702 443.055 29.7638 Tm
0 Tc
[(TELEMEDIC)11.7(INE)-333(and)-328.9(e-HEALTH)-647.9(771)]TJ
ET
q
1 i
0 792 612 -791.985 re
W n
579.685 .014984 .22681 791.985 re
f
337.039 767.962 274.961 .22675 re
f
Q
endstream
endobj
184 0 obj
<>/XObject<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]/Font<>/Properties<>>>/Thumb 187 0 R/MediaBox[0 0 612 792]/Rotate 0>>
endobj
188 0 obj
<>/ProcSet[/PDF/Text]/Font<>/Properties<>>>
endobj
185 0 obj
<>stream
/GS1 gs
BT
/F1 1 Tf
8.9663 0 0 8.9663 50.1732 693.8644 Tm
0 0 0 1 k
0 Tc
0 Tw
[(te)12.9(lem)12.5(edi)15(cine)-283.7(as)-293.1(we)14.2(ll)-291.6(as)-293.1(hea)12.7(lth)14.8(car)15.4(e)-292.8(i)0(n)-292.5(gen)14.1(era)15.4(l.)-295.7(\(Fo)18.5(r)-297.3(a)-292.4(deta)12.9(ile)16.3(d)-295.7(dis)16.3(cus)13.6(-)]TJ
0 -1.3278 TD
[(si)14.7(on)-306.4(of)-304.1(thes)15.7(e)-305.4(iss)14(ues)13.6(,)-311.1(see)-301.7(Bas)15.4(hsh)12.7(ur)-300(et)-309.6(al)13.9(.)]TJ
6.7246 0 0 5.9768 196.1007 685.9274 Tm
(23)Tj
8.9663 0 0 8.9663 203.0739 681.9589 Tm
[(\))-307(Cer)13.6(ta)13.3(inl)13.8(y,)-303.3(choi)12.3(ce)-301(of)-304.1(stu)11.3(dy)]TJ
-17.0529 -1.3341 TD
[(de)12.2(sign)-386.5(and)-390.1(sam)15.7(ple)-389.6(des)11.5(ign)12.5(,)-399.6(mea)14.5(sur)15.4(eme)14.1(nt)-394.3(too)11.5(ls,)-391.2(an)13(d)-403.1(a)0(n)13(alyt)17.6(ic)-397.5(met)11.9(h-)]TJ
T*
[(odo)17.2(log)12.2(y)-207.1(are)-199.6(cent)12.9(ral)20.1(.)-209.9(How)13.4(eve)10.3(r,)-203.7(ther)16.4(e)-210.6(are)-199.6(al)13.9(so)-207.8(va)12.6(ria)13.8(tio)12.8(ns)-201.1(in)-204(the)-204.9(set)18.5(tin)13.2(gs,)]TJ
T*
[(cho)15.8(ice)-386.8(of)-392.6(st)14.1(udy)-391.8(pop)17.2(ulat)19.6(ion)12.5(s)-392.7(\(in)-384.5(ter)12.8(ms)-393.7(of)-386.3(ill)14.7(nes)11.9(s)-392.7(sev)11.5(eri)13.4(ty)-388.3(and)-390.1(oth)13.6(er)]TJ
T*
[(pa)12.6(ram)16.3(ete)11(rs\))14.7(,)-273.2(and)-270(pro)15.6(gra)12.5(m)-272.9(imp)15.9(lem)12.5(ent)14.8(atio)17.6(n)-276.3(t)0(h)12.1(a)0(t)-271.2(may)-266.6(hav)16.2(e)-280.1(s)0(i)14.7(gni)12.5(fic)11.4(an)13(t)]TJ
T*
[(im)14.4(pli)13.4(cat)11.4(ion)12.5(s)-272.6(f)0(o)12.1(r)-272(int)13.2(erp)12.2(ret)19.1(ing)-265.7(th)12.1(e)-273.8(fin)15.2(din)12.5(gs.)-266(Th)11.4(ese)-263.8(can)-260.8(be)-272.3(gr)14.1(oup)12.9(ed)-272.3(int)19.5(o)]TJ
T*
[(th)12.1(ree)-351.7(maj)12.9(or)-359(iss)14(ues)13.6(:)-361.9(f)0(i)13.3(del)15(ity)12.8(,)-361.7(mat)12.3(ura)14.6(tio)12.8(n,)-353.4(and)-352.2(bun)13.3(dli)13.4(ng.)-351.9(The)-357.3(is)14.7(sue)-353.2(of)]TJ
T*
[()62(fi)12(de)12.2(lit)14.1(y)63.5()-368(per)12.2(tain)18(s)-373.7(t)0(o)-363(t)0(h)12.1(e)-375(int)13.2(erv)18.5(enti)17.6(on)-369.6(its)16.9(elf)11.4(.)-368(A)-368.9(vali)18.2(d)-371.5(eval)19.8(uati)13.3(on)-363.3(de)12.2(-)]TJ
0 -1.3278 TD
[(pe)12.2(nds)-193.3(on)-192.6(ass)16(essi)18.4(ng)-192.6(the)-192.2(int)13.2(erv)12.2(en)12.6(tio)12.8(n)-200.4(i)0(n)-191.3(a)-197.6()55.6(fu)12.8(ll)-190.4(fid)14.8(elit)18.5(y)-200.8(mod)14.7(e,)65.1()-197.3(t)0(h)12.1(a)0(t)-195.4(is,)-188.9(at)]TJ
0 -1.3341 TD
[(an)-189.3(app)14.1(rop)15.6(ria)13.8(te)-195.8(set)12.2(tin)13.2(g)-194.5(wit)14.8(h)-198.8(the)-185.9(opt)11.5(ima)12.9(l)-199.5(l)0(e)13.5(vel)-187.3(of)-196.6(str)14(en)12.6(gth)-188.8(and)-187.8(int)13.2(egr)12.2(ity)12.8(.)]TJ
T*
[(Te)12.2(lem)12.5(edi)15(cine)-460.7(int)13.2(erv)12.2(en)12.6(tio)12.8(ns)-466.7(var)12.5(y)-472.7(b)0(y)-471.2(c)0(l)13.5(ini)13.8(cal)-468.6(ap)12.6(pli)13.4(cat)11.4(ion)-461.7(\(ty)12.8(pe)-468.3(an)13(d)]TJ
T*
[(ran)19.2(ge)-449.3(of)-455.8(ser)16.3(vic)15(es)-451.6(of)12.1(fere)12.9(d\),)-445.9(te)12.9(chno)17.7(log)12.2(ica)12(l)-452.5(con)14.1(fig)14.8(ura)14.6(tio)12.8(n)-453.3(\(tel)18.5(epho)17.3(ne,)]TJ
T*
[(vid)18.5(eo,)-387.4(cam)14.5(era)15.4(s,)-387.7(sco)11.5(pes)11.5(,)-393.3(sen)11.9(so)13.5(rs,)-387.8(an)13(d)-396.8(oth)13.6(er)-387.7(de)12.2(vice)13.1(s;)-387.9(aut)16.8(oma)11.6(te)12.9(d)-396.8(a)0(n)13(d)]TJ
T*
[(man)18.3(ual\))20.2(,)-532.4(tra)13.2(nsm)12.8(iss)14(ion)-524.9(mo)13.2(de)-531.5(\(sy)16.3(nchr)16.1(ono)17.6(us)-528.3(and/)18.7(or)-529.7(asy)11.9(nc)12.6(hro)11.3(nou)13.3(s\),)]TJ
T*
[(an)13(d)-295.7(hea)12.7(lth)-282.3(manp)13.5(ow)11.4(er)-292.9(mi)14.4(x)-295.3(\(ph)14.2(ysic)14.3(ia)13.9(ns,)-290.9(nur)18(ses,)-282.8(th)12.1(erap)16.9(ists)16.2(,)-292.1(mana)16.8(ge)12.2(rs,)]TJ
T*
[(an)13(d)-226.1(eng)14.1(ine)15.4(ers\))19(,)-228.9(a)0(s)-217.2(well)-214.1(as)-223.5(or)14.1(gani)17.3(zat)11.4(ion)12.5(al)-220.1(st)14.1(ruct)16.4(ure)14.2(s)-228.3(a)0(n)13(d)-226.1(prot)17.8(oco)13.8(ls.)-220.5(Al)13.2(l)]TJ
0 -1.3278 TD
[(ha)14.7(ve)-202.7(impl)18.7(ica)12(tio)12.8(ns)-201.1(on)-198.9(wha)11.8(t)-200.2(hyp)12.9(othe)11.6(ses)-193(can)-197.6(or)-200.9(can)17.4(not)-196.7(be)-202.7(dem)11.2(ons)15.4(tra)13.2(te)12.9(d)]TJ
0 -1.3341 TD
[(in)-362(a)-368.3(giv)18.5(en)-366.8(res)16.3(ear)15.4(ch)-365.1(stu)11.4(dy.)-358.6(Wit)13.1(ho)11.4(ut)-367.3(fi)13.3(del)15(ity)12.8(,)-368(w)0(e)-365.1(may)-361.4(not)-354.8(be)-367.1(ab)12.6(le)-365.9(to)]TJ
T*
[(at)13.3(trib)19(ute)-413.5(outc)11.6(om)13.2(es)-419.9(to)-419.9(int)13.2(erv)18.5(enti)17.6(ons)-414.6(in)-418.9(an)13(y)-428.4(d)0(e)12.2(fin)15.2(iti)14.1(ve)-417.7(mann)13.9(er.)-408(The)]TJ
T*
[(sec)14.4(ond)-222.7(pre)12.2(req)12.2(ui)12.7(site)-225.3(is)-225.5()62(mat)17.3(ura)14.6(tio)12.8(n.)68.9()-235.2(T)0(h)11.4(i)0(s)-231.9(p)0(e)12.2(rta)13.2(ins)-223.6(to)-230.2(the)-223.8(timi)19.4(ng)-230.5(of)-228.2(the)]TJ
T*
[(im)14.4(plem)14(en)12.6(tat)15.5(ion)12.5(/ado)18.3(pti)12.8(on)-432.9(proc)13.7(ess)-427(and)-428.1(the)-432.5(poi)12.2(nt)-432.2(in)-431.6(the)-432.5(mat)12.3(ura)14.6(tio)19.1(n)]TJ
T*
[(pr)14.1(oce)10.3(ss)-260.6(at)-258.6(whi)16.2(ch)-263.9(th)12.1(e)-267.5(ass)16(essm)14.6(en)12.6(t)-263.4(tak)13.8(es)-261.9(pla)15.4(ce.)-258(In)13.1(clud)12.3(ed)-259.6(is)-257.2(the)-255.4(func)14.1(tio)19.1(n)]TJ
T*
[(of)-380(the)-381.9()55.6()0(l)14.2(earn)17.3(ing)-379.5(cur)14.2(ve)67.9()-393.3(n)0(e)12.6(ces)14.4(sary)-380.2(fo)12.1(r)-392.1(t)0(h)12.1(e)-387.6(int)13.2(egr)12.2(ati)16.1(on)-388.6(of)-386.3(pe)12.2(rso)13.4(nne)14.5(l,)]TJ
T*
[(te)12.9(chno)17.7(log)12.2(y,)-176.8(and)-175.2(pat)14.8(ien)15.4(ts)-181.9(to)-179.7(ach)19(ieve)-170.3(maxi)14.8(mum)-169.2(eff)12.8(ici)16.3(ency)12.2(.)-178.3(I)0(t)-182.7(i)0(s)-174.9(dif)14.8(fic)11.4(ul)12.7(t)]TJ
0 -1.3278 TD
[(to)-192.3(dete)12.5(rmi)14.3(ne)-196(th)12.1(e)-204.3(poi)12.2(nt)-198.3(al)13.9(ong)-197.4(th)12.1(e)-204.3(lea)18.3(rnin)19.2(g)-207.1(cur)14.2(ve)-196.4(of)-196.6(a)-203.9(pro)15.6(gra)12.5(ms)-192.7(roa)12.5(d)-200.8(t)0(o)]TJ
0 -1.3341 TD
[(mat)18.6(uri)12.6(ty.)-339(Add)13.5(iti)14.1(ona)14.5(lly)13.4(,)-355.4(t)0(e)12.9(lem)12.5(edi)15(cin)15.4(e)-356(h)0(a)14.7(s)-354.8(ev)12.2(olv)12.2(ed)-348.2(as)-343.7(an)-341.1()55.6()0(i)14.2(nno)11.6(vat)14.8(ion)]TJ
T*
[(bu)11.4(ndl)12.5(e)66.4()-342.7(c)0(o)12.2(nsi)16.6(stin)18.8(g)-339.9(o)0(f)-335.7(var)12.5(iou)14.2(s)-335.8(con)14.1(figu)12.1(rat)19.5(ion)12.5(s)-342.1(o)0(f)-329.4(tec)11(hno)13.3(log)12.1(y,)-334.9(hu)13.4(man)]TJ
T*
[(res)16.3(ou)11.4(rces)14.3(,)-418.6(ser)16.3(vic)15(e)-419.2(pop)10.9(ul)12.7(atio)17.6(ns,)-411.1(cl)13.5(ini)13.8(cal)-405.3(appl)16.9(ica)12(tio)12.8(ns,)-404.7(and)-409.1(org)15.6(ani)15.8(za-)]TJ
T*
[(tio)12.8(na)13(l)-351.3(str)14(uctu)20(res.)-339.1(Eac)12.7(h)-350.5(o)0(f)-348.4(thes)15.7(e)-349.7(com)11.2(pon)11.3(en)12.6(ts)-346.3(may)-342.5(have)-339.8(ind)12.5(epe)10.3(nde)14.1(nt)]TJ
T*
[(eff)12.8(ect)17.3(s)-241(o)0(n)-230.5(acce)11.6(ss,)-224(qual)12.6(ity)19.1(,)-241.5(and)14.5(/or)-228.3(cos)11.5(t.)-233(How)13.4(eve)10.3(r,)-235.3(it)-235.3(is)-231.9(oft)14.2(en)-234(dif)14.8(fic)11.4(ult)-231.8(to)]TJ
T*
[(sep)17.9(arat)18(e)-318.1(the)-312.3(spe)11.5(ci)13.5(fic)-311.1(eff)12.8(ect)11(s)-316.8(o)0(f)-316.7(eac)13.6(h)-318.9(c)0(o)12.2(mpo)14.7(nent)-305.8(in)-317.8(a)-317.7(sci)12.8(en)12.6(tif)15.5(ic)-315.3(stu)11.3(dy)]TJ
T*
[(be)12.2(cau)12.7(se)-205(th)12(e)-204.3(com)11.2(pon)11.3(en)12.6(ts)-200.9(are)-199.6(rar)17.3(ely)-193.6(tak)13.8(en)-202.4(int)13.2(o)-207.1(acc)13.6(ou)11.4(nt)-204.6(in)-197.6(th)12(e)-210.6(d)0(e)12.2(sign)-190.5(of)]TJ
0 -1.3278 TD
[(st)14.1(udie)12.3(s,)-280.2(an)13(d)-289.3(the)-280.7(st)14.1(atis)15.4(tic)15.7(al)-283.3(pow)12.9(er)-280.2(asso)17.5(cia)12(te)12.9(d)-289.3(wit)14.8(h)-287.3(sma)15.7(ll)-285.3(sam)15.7(ple)15(s)-291.5(doe)13.8(s)]TJ
0 -1.3341 TD
[(not)-266.3(usu)19(ally)-266.3(pe)12.2(rmi)14.3(t)-276(rel)13.4(iab)15.4(le)-271(subg)18.5(rou)11.3(p)-276.7(a)0(n)13(alys)14.7(is.)]TJ
/F4 1 Tf
11.9551 0 0 11.9551 50.1732 263.5086 Tm
[(Telemedicine)-342.3(and)-336(Chronic)-338.1(Disease)-336.9(Manage)-9(ment)]TJ
/F1 1 Tf
8.9663 0 0 8.9663 60.0945 251.5464 Tm
[(The)-313(justification)-318.9(for)-310.5(the)-312.3(wider)-316.7(deployment)-314.4(of)-310.4(telemedicine)-319.2(stems)]TJ
-1.1065 -1.3341 TD
[(from)-349.5(an)-353.7(ever-expanding)-364.6(and)-352.2(complex)-357.5(body)-354.3(of)-354.7(empirical)-357(evidence,)]TJ
T*
[(albeit)-215.5(not)-209.4(always)-217.3(based)-216.1(on)-211.6(rigorous)-217.6(methodology,)-220.5(which)-216.2(attests)-213.3(to)-217.6(its)]TJ
T*
[(potential)-355.3(in)-355.7(addressing)-362.4(the)-356.6(seemingly)-361.8(intransigent)-360.1(problems)-356.8(of)-361(in-)]TJ
0 -1.3278 TD
[(equitable)-300.9(access)-305.9(to)-306.1(care,)-303.9(uneven)-304.8(distribution)-306.8(of)-297.8(quality)-309.7(of)-297.8(care,)-303.9(and)]TJ
0 -1.3341 TD
[(healthcare)-338.3(cost)-346.7(inflation.)-336.8(This)-340.6(is)-339.3(particularly)-348.5(notable)-341.3(in)-336.7(the)-344(case)-341.2(of)]TJ
T*
[(chronic)-398.8(disease)-407.2(management.)-407.4(Chronic)-400.3(diseasessuch)-405.6(as)-406.9(heart)-402.5(dis-)]TJ
T*
[(ease,)-279.3(stroke,)-284.3(cancer,)-285(diabetes,)-283.9(pulmonary)-287(disease,)-282(and)-282.7(arthritis)51.9(are)]TJ
T*
[(among)-509.8(the)-514.7(most)-516.5(common,)-512.4(costly,)-514.4(and)-516.6(preventable)-514.5(of)-512.8(all)-514.4(health)]TJ
T*
[(problems)-337.8(in)-336.7(the)-337.6(U.S.)56.7()]TJ
6.7246 0 0 5.9768 131.4141 147.9118 Tm
(24)Tj
8.9663 0 0 8.9663 141.4488 143.9433 Tm
[(Almost)-338.9(50%)-335.7(of)-335.7(all)-337.4(adults)-340(have)-333.5(at)-340.8(least)-334.3(one)]TJ
-10.1799 -1.3341 TD
[(chronic)-228.1(illness.)-221.9(Approximately)-231.3(70%)-228.2(of)-221.9(all)-229.9(deaths)-224.6(in)-222.9(the)-230.1(United)-227.4(States)]TJ
T*
[(are)-364(from)-368.4(chronic)-373.5(diseases,)-371.2(and)-364.8(an)-366.4(estimated)-371.5(50%)-367.3(of)-367.3(all)-369(deaths)-370(are)]TJ
0 -1.3278 TD
[(from)-292.5(heart)-295(disease,)-300.9(cancer,)-297.6(and)-295.3(stroke.)-297(Increasing)-303.1(percentages)-300.1(\(over)]TJ
0 -1.3341 TD
[(7%\))-315.5(of)-316.7(U.S.)-315.1(children)-320.2(and)-314.3(adolescents)-321.3(have)-314.5(a)-317.7(chronic)-316.6(disease)-318.6(condi-)]TJ
T*
[(tion.)-340.6(In)-347.4(terms)-343(of)-342(cost,)-348(approximately)-350.8(75%)-342.1(of)-342(all)-343.7(healthcare)-351(expen-)]TJ
T*
[(ditures)-378.4(are)-382.9(spent)-382.7(on)-382.3(chronic)-379.9(illness.)-380(Thus,)-385.4(an)-379(intervention)-383.6(that)-379.3(\(1\))]TJ
30.331 69.3307 TD
[(promises)-321.1(to)-312.4(involve)-318.7(patients)-322.4(in)-311.4(their)-316(own)-315.5(care,)-322.9(\(2\))-315.4(provides)-316.3(contin-)]TJ
0 -1.3278 TD
[(uous)-181.8(monitoring)-187.3(by)-180.3(their)-183.2(healthcare)-186.6(providers,)-184.9(and)-181.5(\(3\))-182.6(identifies)-188.7(early)]TJ
0 -1.3341 TD
[(symptoms)-274.9(and)-276.3(responds)-275.2(promptly)-274.6(to)-274.5(exacerbations)-282.4(in)-267.2(their)-278(illnesses)]TJ
T*
[(must)-280.5(be)-284.9(seriously)-282.1(considered)-281.8(and)-282.7(carefully)-287.8(assessed.)]TJ
1.1128 -1.3341 TD
-.0152 Tc
[(As)-344.7(with)-340.4(a)-15.2(n)10.5(y)-342.5(o)-1(ther)-344.1(te)-15.2(c)12.6(h)1(nology-ba)-15.2(s)14.2(e)-15.2(d)-331.8(a)2.2(pplic)-15.2(a)12.9(t)-.4(ion,)-345.3(tele)-15.2(m)13.5(e)-15.2(d)16(i)-15.2(c)11(i).2(ne)-345.9(has)]TJ
-1.1128 -1.3341 TD
0 Tc
[(co)31.2(st)26.8(s)-500.2(a)17.4(n)14.6(d)-504.3(b)14.2(e)17(n)14.6(e)0(f)27.6(i)15.4(t)14.8(s)0(.)-488.8(T)14.2(h)16.2(e)-501.4(c)17(o)14.2(st)26.8(s)-500.2(i)15.4(n)14.6(c)17(l)15.4(u)0(d)24(e)-495.1(t)14.8(h)0(e)-491.6(n)20.9(ec)27.8(es)29(sa)29.4(r)12.6(y)-498(i)15.4(n)14.6(v)14.2(e)0(s)29(t)14.8(me)28.7(n)14.5(t)-503.7(i)15.4(n)]TJ
T*
-.0155 Tc
[(te)-15.5(c)12.3(h).7(nology,)-351.9(hum)-15.5(a)13.6(n)-348.7(res)-15.5(o)10.6(urc)-15.5(e)12.3(s)-15.5(,)-333.6(a)-15.5(n)10.2(d)-349.1(o)-1.3(rga)-15.5(n)10.2(iza)-15.5(t)10.4(ional)-347.8(d)-1.3(eve)-15.5(l)10.6(opme)-15.5(n)9.8(t.)-345.6(O)-15.5(v)10.3(er)]TJ
T*
0 Tc
[(t)14.8(i)15.4(me)28.7(,)-330.1(h)16.2(o)14.2(w)16.2(ev)24.9(e)17(r)12.6(,)-330.1(e)17(q)14.2(u)16.2(ip)23.3(m)18(e)17(n)14.6(t)-332.9(a)17.4(n)14.5(d)-327.3(c)0(o)24.9(n)14.6(n)14.6(e)17(ct)25.5(i)15.4(v)14.2(i)15.4(t)14.8(y)-327.3(c)17(o)14.2(s)0(t)26.8(s)-329.5(h)16.2(a)0(v)25.3(e)-324.4(d)14.2(e)0(c)27.8(l)15.4(i)15.4(n)14.5(ed)-316.6(su)28.1(b)14.2(-)]TJ
T*
-.0154 Tc
[(s)-15.4(t)11.4(antia)-15.4(l)11.1(ly,)-402.4(w).8(h)-15.4(e)11.5(reas)-408.1(the)-403(c)-15.4(a)12.7(p)-1.2(a)-15.4(b)9.9(ilities)-408.1(h).8(ave)-409.4(e)1.6(xpande)-15.4(d)-388.9(a)-15.4(t)-394.1(a)-402.6(phenom)-15.4(e)13.3(n)-.9(a)-15.4(l)]TJ
0 -1.3278 TD
0 Tc
[(r)12.6(a)17.4(t)14.8(e)0(.)-275.1(W)14.5(h)16.2(e)17(n)-288.9(p)14.2(r)12.6(o)14.2(p)14.2(e)17(r)12.6(l)15.4(y)14.2(,)-285.8(i)15.4(m)0(p)25.8(l)15.4(e)17(m)0(e)28.7(n)14.6(t)14.8(e)17(d)-289.3(t)14.8(el)26.2(e)17(m)0(e)28.7(d)14.2(i)15.4(c)0(i)26.1(n)14.6(e)-286.5(c)17(an)-271.5(en)25.3(h)16.2(a)17.4(n)14.5(c)0(e)-275.7(c)17(ar)30(e)-286.5(c)0(o)24.9(-)]TJ
0 -1.3341 TD
-.015 Tc
[(ordination)-297.6(ac)-15(r)14.6(o)-.8(s)-15(s)-282(various)-300.2(p)-.8(rovide)-15(r)14.6(s)-15(,)-282.5(e)2(ns)-15(u)13.1(r)-2.4(e)-295.1(c)2(ontinu)-15(i)10.3(t)-.2(y)-291.7(o)-.8(f)-295.3(c)-15(a)13.1(r)-2.4(e)-295.1(r)3.9(e)-15(g)9.9(ard-)]TJ
T*
0 Tc
[(l)15.4(e)0(s)29(s)-222(o)14.2(f)-217.1(s)18.3(i)15.4(t)14.8(e)0(,)-205.5(a)0(n)25.7(d)-213.5(en)25.3(a)17.4(b)14.2(l)15.4(e)-223.2(o)14.2(n)20.9(-)14(s)0(i)27.4(t)14.8(e)-216.9(t)14.8(r)12.6(i)15.4(a)17.4(g)14.2(e)-223.2(a)17.4(n)14.6(d)-219.8(p)14.2(r)12.6(o)20.5(m)0(p)25.8(t)-219.1(r)18.9(e)0(f)27.6(e)0(r)29.6(r)12.6(a)17.4(l)-218.5(wh)26(e)17(n)-219.4(n)14.6(e)17(ed)24.9(e)17(d)14.2(.)]TJ
T*
-.0153 Tc
[(Pati)-15.3(e)10.9(n)-.7(ts)-325.8(can)-323.2(r)-2.7(e)-15.3(c)12.5(ei)-15.3(v)8(e)-320.7(appropriate)-327.1(and)-323.6(t)-.5(im)-15.3(e)13.4(l).1(y)-323.6(c)-15.3(a)12.8(r)-2.7(e)-320.7(f)-15.3(r)14.1(o)-1.1(m)-326.1(a)2.1(n)-323.2(a)-15.3(p)10(p)-1.1(ropriate)]TJ
T*
-.015 Tc
[(provider,)-218.6(whe)-15(t)10.5(h)1.2(e)-15(r)-206.7(loca)-15(l)11.5(l).4(y)-215.8(o)-.8(r)-217.4(w)-15(h)11(e)2(n)-221.7(d)-.8(ete)-15(r)14.6(m)-15(i)12.1(ned)-222.1(t)-.2(o)-215.8(b)-.8(e)-219.3(s)-15(u)13.1(i).4(ta)-15(b)10.3(l).4(e)-219.3(a)2.4(t)-221.5(t)-.2(ertiary-)]TJ
T*
0 Tc
[(ca)28.1(r)12.6(e)-425.6(ce)27.8(n)14.6(t)14.8(er)29.6(s,)-419.3(a)17.4(s)-430.7(i)15.4(n)14.6(d)14.2(i)15.4(c)17(a)0(t)25.9(e)17(d)-434.8(b)14.2(y)-428.4(t)14.8(h)16.2(e)0(i)26.2(r)-430(c)17(o)14.2(n)14.5(d)14.2(i)15.4(t)14.8(i)15.4(o)14.2(n)14.6(.)-431.2(P)14.5(a)17.4(t)14.8(i)15.4(en)25.3(t)14.8(s)-430.7(i)15.4(n)-428.1(r)18.9(e)0(m)28.7(o)14.2(t)14.8(e)-431.9(o)14.2(r)]TJ
T*
[(me)28.7(d)14.2(i)15.4(ca)28.1(l)15.4(l)15.4(y)-295.7(un)24.4(d)14.2(e)17(r)12.6(s)18.3(er)29.6(v)14.2(e)0(d)-284.9(l)15.4(o)14.2(c)0(a)28.1(t)14.8(i)15.4(o)14.2(n)14.6(s)-297.9(c)17(a)0(n)-284.2(h)16.2(av)25.3(e)-299.1(r)18.9(ea)28.1(d)14.2(y)-295.7(ac)28.1(ce)27.8(ss)-285.9(t)14.8(o)-295.7(c)17(l)15.4(in)30(ic)26.1(a)17.4(l)-300.7(r)18.9(e)0(-)]TJ
T*
-.0157 Tc
[(s)-15.7(o)10.4(urces)-389.4(and)-387.2(c)1.3(a)-15.7(n)-375.7(be)-384.4(monitored)-387.2(i)-.3(n)-386.8(t)-.9(h)-15.7(e)11.2(ir)-388.8(home)-390.7(environment.)-390(In)-386.9(ma)-15.7(n)10(y)]TJ
0 -1.3278 TD
[(ins)-15.6(t)11.2(ance)-15.6(s)7.1(,)-415.2(tele)-15.6(m)13.1(e)1.4(di)-15.6(c)10.6(i)-.2(ne)-415.9(obviat)-15.6(e)9.9(s)-414.6(the)-415.9(c)-15.6(o)9.3(s)2.7(t)-418.1(a)1.8(nd)-418.7(time)-415.9(of)-416.1(travel)-417.5(to)-418.7(se)-15.6(e)12.2(k)]TJ
0 -1.3341 TD
-.0152 Tc
[(m)-15.2(e)13.5(dic)-15.2(a)12.9(l)-296.9(s)-15.2(e)13.8(r)-2.6(vice)-15.2(s)-289.7(while)-301.7(provi)-15.2(d)8.1(i).2(ng)-298.2(diagnos)-15.2(t)11.6(ic)-295.3(e)-15.2(x)10.1(pertis)-15.2(e)-283.4(n)-.7(orma)-15.2(l)11.3(l).2(y)-298.2(a)2.2(va)-15.2(i)11.3(l).2(-)]TJ
T*
[(abl)-15.2(e)-292.5(in)-310.5(tertia)-15.2(r)14.8(y)-1(-ca)-15.2(r)14.8(e)-308(c)-15.2(e)12.6(n)-.7(te)-15.2(r)14.4(s)-15.2(.)-295.4(N)-.5(ew)-308.9(mode)-15.2(l)10.9(s)-306.8(of)-308.2(ac)-15.2(c)12.6(o)-1(unta)-15.2(b)10.1(l).2(e)-308(c)1.8(are)-308(o)-1(rg)5.3(a)-15.2(n)10.5(i-)]TJ
T*
0 Tc
[(za)28.1(t)14.8(i)15.4(o)14.2(n)14.6(s)-259.9(a)0(n)25.7(d)-264(t)14.8(h)16.2(e)-261.2(p)14.2(at)25.9(i)15.4(e)17(n)14.6(t)14.8(-)14(c)17(en)25.3(t)14.8(e)17(r)12.6(e)17(d)-264()68.3(m)29.3(e)17(d)14.2(ic)26.1(a)17.4(l)-262.8(ho)24(m)17.9(e)0()85.3()-266.8(a)17.4(l)15.4(so)-252.1(c)17(a)17.4(n)-263.7(i)15.4(n)14.5(c)0(o)24.9(r)18.9(p)14.2(o)14.2(r)12.6(a)17.4(t)14.8(e)]TJ
T*
[(t)14.8(e)0(l)26.1(e)17(me)28.7(d)14.2(i)15.4(ci)26.1(n)14.6(e)-261.2(se)29(r)12.6(v)14.2(i)15.4(c)0(e)27.8(s)-266.3(t)14.8(o)-264(i)15.4(m)0(p)25.8(r)18.9(o)14.2(v)14.2(e)-267.5(t)14.8(h)16.2(ei)26.1(r)-265.6(e)17(ff)27.4(i)15.4(c)0(i)26.1(e)17(n)14.5(c)0(y)-253.3(a)17.4(n)14.6(d)-264(ef)27.6(f)16.9(e)0(c)27.8(t)14.8(iv)23.3(e)17(n)14.6(e)17(s)0(s)23.9(.)]TJ
1.1128 -1.3341 TD
-.0178 Tc
[(Withi)4(n)-445.9(the)-449.7(c)5.6(urrent)-445.6(heal)4(thcare)-443.4(system)6.5(,)-449(w)-1.6(h)4.7(i)-2.4(ch)-444.2(i)4(s)-448.5(we)5.6(ighted)-446.2(hea)6(v)-3.6(i)4(l)-2.4(y)]TJ
-1.1128 -1.3341 TD
-.0184 Tc
[(tow)4.1(a)-1(rd)-282.4(acu)4.1(t)-3.6(e)-279.6(c)-1.4(are,)-278.9(th)4.1(e)-285.9(t)2.7(raditional)-281.2(model)-281.2(o)2.1(f)-279.8(c)-1.4(are)-279.6(f)-1.5(or)-284(those)-285.9(w)-2.2(ith)-286.7(c)-1.4(h)4.1(r).5(onic)]TJ
T*
-.0198 Tc
[(heal)-4.4(th)-465.2(co)-5.6(ndi)-4.4(t)1.3(i)-4.4(o).7(ns)-463.1(can)-460.5(b).7(e)-464.3(a)-2.4(ptl)-4.4(y)-460.9(descri)-4.4(bed)-460.9(a)-2.4(s)-456.8(a)-463.9()54.8()-2.1(revol)-4.4(vi)-4.4(ng)-460.9(d)-5.6(oor)54.8()-463.7(ar-)]TJ
0 -1.3278 TD
-.0181 Tc
[(rangement)-243.5(w)-1.9(h)4.4(e)-1.1(reby)-244.2(patients)-240.1(are)-241.3(s).2(een)-237.5(in)-237.5(a)-240.9(p)-3.9(h)4.4(y)-3.9(s)6.5(i)-2.7(cians)-240.1(of)5.1(fic)5.3(e)-1.1(,)-240.7(a)-.7(nd)-244.2(fu)4.4(tu)4.4(re)]TJ
0 -1.3341 TD
-.0194 Tc
[(app)-5.2(o)1.1(in)-4.8(tments)-399.5(for)-398.9(r)-.5(et)-4.6(urn)-403.2(v)1.1(isi)-4(t)1.7(s)-399.5(a)-2(re)-400.7(schedu)-3.2(led)-403.6(a)4.3(t)-402.9(f)-2.5(ixed)-397.3()48.9()4.6(arb)-5.2(i)2.4(trary)-403.6(t)1.7(ime)]TJ
T*
-.0161 Tc
[(in)4.8(t)5(e).9(rv)4.4(als,)58.5()-352.5(b)4.4(a)1.3(se)7.3(d,)-352.5(a)7.7(t)-355.4(l)5.7(e).9(ast)-349(i)-.7(n)-349.3(p)-1.9(a)7.6(r)2.8(t,)-352.5(o)4.4(n)-349.3(ph)6.4(ysi)5.7(c).9(ia)7.6(n)-355.6(a)7.6(vai)5.7(l)5.7(a)1.3(bi)5.7(li)5.7(t)5(y)-1.9(.)]TJ
6.7246 0 0 5.9768 538.4125 375.0802 Tm
-.0226 Tc
(25)Tj
8.9663 0 0 8.9663 548.277 371.1117 Tm
-.0176 Tc
[(E)4.9(x)3.3(acer-)]TJ
-25.2221 -1.3341 TD
-.019 Tc
[(bat)-4.2(i)2.8(on)-4.4(s)-481.3(i)2.8(n)-485(i)2.8(l)-3.6(l)2.8(ness)-481.3(t)-4.2(h)3.5(at)-478.4(o)-4.8(c)-2(cur)-480.7(i)-3.6(n)-478.7(b)]TJ
14.1633 0 TD
-.0177 Tc
[(etw)4.8(een)-477.4(appointments)-480(are)-474.9(h)-1.5(andled)]TJ
-14.1633 -1.3341 TD
-.0186 Tc
[(mostly)-320.6(by)-320.6(referral)-319.3(t)2.5(o)-320.6(t)2.5(he)-324(emergency)-320.6(r).3(oom)-316.8(o)-4.4(r)-315.9(u)-2.4(rgent)-319.9(t)2.5(reatment)-319.9(center.)]TJ
T*
-.0178 Tc
[(This)-404.2(a)6(rrangeme)5.6(n)-3.2(t)-401.3(i)-2.4(s)-404.2(c)-.8(linic)5.6(a)-.4(lly)-408.3(a)6(nd)-402(economically)-402(i)-2.4(neff)5.4(ective.)-404.8(In)-407.9(m)6.5(o)-3.6(st)]TJ
T*
-.0183 Tc
[(instances,)-253.5(t)2.8(he)-254.2(need)-250.7(for)-252.3(m)-.3(edica)5.5(l)-255.8(atte)]TJ
14.0495 0 TD
-.0203 Tc
[(n)-5.7(t).8(io)-6.1(n)-252.3(g).2(en)-5.7(eral)-4.9(ly)-259(an)-5.7(d)-252.7(a)-2.9(mong)-259.1(pati)-4.9(ents)]TJ
-14.0495 -1.3341 TD
-.0201 Tc
[(w)-3.9(i)1.7(t)-5.3(h)-301.1(ch)-3.9(ron)-5.5(i)1.7(c)-306.6(i)-4.7(ll)-4.7(ness)-305.3(in)-309(parti)-4.7(c)-3.1(ul)-4.7(ar,)-312.2(c)3.3(ann)-5.5(o).4(t,)]TJ
/F5 1 Tf
16.9517 0 TD
.284 Tc
[(ap)306.5(r)298.6(i)303.1(o)301.4(r)304.9(i)]TJ
/F1 1 Tf
3.0224 0 TD
-.0179 Tc
[(,)-303.7(b)-3.7(e)-304.4(d)2.6(etermine)5.5(d)-307.2(w)-1.7(ith)]TJ
-19.9741 -1.3278 TD
-.0184 Tc
[(any)-181.3(a)-1(ccu)4.1(racy.)-184.1(H)2.7(ence,)-184.1(the)-178.4(f)-1.5(ormal)-180(a)-1(nd)-181.3(arbitrary)-181.3(s)-.1(cheduling)-181.3(o)2.1(f)-184.9(r).5(e)5(t)-3.6(urn)-180.9(v)2.1(isits)]TJ
0 -1.3341 TD
-.0176 Tc
[(at)-331.6(f)5.6(i)-2.2(xed)-332.2(d)2.9(ates)-334.4(and)-332.2(t)3.5(im)6.7(es)-334.4(ca)6.2(nnot)-331.6(be)]TJ
14.4795 0 TD
-.0174 Tc
[(synchroni)4.4(zed)-332(to)-332(ma)6.4(tch)-330(t)3.7(he)-329.1(ti)4.4(mi)4.4(ng)]TJ
-14.4795 -1.3341 TD
-.018 Tc
[(wh)4.5(en)-281.7(patients)-284.3(nee)5.4(d)-282(care,)-278.5(r).9(es)6.6(ulting)-275.7(in)-275.3(costly)-275.7(emergency)-282(r).9(oom)-278.3(usage.)]TJ
1.1128 -1.3341 TD
-.0158 Tc
[(In)-481.8(1997,)-478.7(it)-481.5(wa)-15.8(s)-467(obse)-15.8(r)7.5(ved)-482.2(t)-1(hat)-481.5()52.5()-15.8(a)13(vail)-15.8(a)10.7(b)-1.6(le)-479.3(e)-15.8(v)9.1(idenc)-15.8(e)-468.6(su)-15.8(g)8.2(g)-1.6(es)-15.8(t)11(s)-478.1(tha)-15.8(t)]TJ
-1.1128 -1.3341 TD
[(c)-15.7(h)11.2(ronic)-15.7(a)12.4(ll)-15.7(y)-182.1(ill)-196.3(pa)-15.7(t)10.2(i)-.3(ents)-199.8(re)-15.7(c)12.1(e)-15.7(i)10.5(v)-1.5(e)-194.7(lim)-15.7(i)11.4(t)-.9(ed)-197.5(as)-15.7(s)8.2(i)-.3(sta)-15.7(n)10(ce)-194.7(f)-15.7(r)13.7(om)-193.7(th)-15.7(e)11.2(i)-.3(r)-199.1(p)-1.5(rovide)-15.7(r)13.9(s)-199.8(in)]TJ
T*
-.0152 Tc
[(the)-15.2(i)11(r)-274.5(e)-15.2(f)12.4(f)1.7(orts)-275.1(to)-279.2(m)-15.2(a)13.9(intai)-15.2(n)-263.4(f)-15.2(u)11.5(nction)-278.9(and)-279.2(q)-1(ua)-15.2(l)11.3(i).2(ty)-279.2(of)-276.6(life)-276.4(a)-15.2(s)-264(t)-.4(he)-15.2(y)-268.5(c)1.8(ope)-276.4(wit)-15.2(h)]TJ
T*
-.0157 Tc
[(the)-15.7(i)10.5(r)-464.7(illnes)-15.7(s)8.2(.)2()52.6()]TJ
6.7246 0 0 5.9768 370.9983 231.6472 Tm
0 Tc
(26)Tj
8.9663 0 0 8.9663 381.8834 227.622 Tm
-.0149 Tc
[(To)-468.6(addres)-14.9(s)-446.3(t)-.1(h)-14.9(i)10.4(s)-458.2(p)-.7(roble)-14.9(m)13.8(,)-465.1(a)2.5(nd)-462.3(wh)-14.9(i)10.4(l).5(e)-459.4(a)-14.9(c)13.2(k)-1.8(nowle)-14.9(d)10(ging)]TJ
-6.6643 -1.3341 TD
-.0151 Tc
[(barriers)-420.5(i).3(n)-424.2(a)2.3(dopting)-424.6(i).3(t)-417.6(i).3(n)-424.2(i).3(ts)-420.5(e)-15.1(n)16.5(t)-15.1(i)8.8(re)-15.1(t)10.4(y)-.9(,)-421(i).3(n)-417.9(2002)-424.6(Bode)-15.1(n)10.2(h)1.1(ei)-15.1(m)12(e)1.9(r)-426.2(e)1.9(t)-423.9(a)2.3(l.)]TJ
6.7246 0 0 5.9768 569.3101 219.685 Tm
-.0226 Tc
(27)Tj
8.9663 0 0 8.9663 322.129 203.7543 Tm
-.0155 Tc
[(propose)-15.5(d)-363.7(an)-380.3()59.1()-15.5(o)10(p)-1.3(tima)-15.5(l)11()52.8()-377.2(c)1.5(hronic)-377.8(ca)-15.5(r)14.5(e)-377.8(mode)-15.5(l)-362.4(f)-15.5(o)9.2(r)-376(use)-377.8(a)-15.5(s)-365.5(a)1.9(n)-374(u).7(ni)-15.5(v)7.8(e)1.5(rsa)-15.5(l)11(ly)]TJ
T*
-.0151 Tc
[(appl)-15.1(i)9.4(c)1.9(abl)-15.1(e)-513.7(guide)-522.9(t)-.3(o)-525.7(i).3(m)-15.1(p)10.7(rove)-522.9(ou)-15.1(t)9.6(c)1.9(ome)-15.1(s)-510.9(f)-15.1(o)9.6(r)-521(i).3(ndividua)-15.1(l)11.4(s)-521.6(living)-525.7(w)1.1(ith)]TJ
T*
-.0159 Tc
[(c)-15.9(h)11(ronic)-466.8(illne)-15.9(s)13.1(s)-15.9(.)-447.8(I)-15.9(n)9.8(itially,)-466.1(i)-.5(mpl)-15.9(e)10.2(me)-15.9(n)9.4(t)-1.1(ation)-462.9(o)-1.7(f)-466.9(t)-1.1(he)-460.4(m)-15.9(o)9.9(del)-462(r)-3.3(equ)-15.9(i)9.4(re)-15.9(d)-452.6(r)3(e)-15.9(-)]TJ
T*
-.0149 Tc
[(organiz)-14.9(i)11.3(ng)-260(the)-263.4(c)-14.9(a)13.2(r)-2.3(e)-263.4(s)3.4(ys)-14.9(t)11.9(e)2.1(m)-14.9(,)-251.1(typica)-14.9(l)11.6(l).5(y)-260(t)-.1(h)-14.9(r)13.9(ou)-14.9(g)9.1(h)-257.9(a)-263(s)-14.9(t)11.9(a)2.5(f)-14.9(f)12.5(-mode)-14.9(l)-248(m)-14.9(a)14.2(n)-.3(a)-14.9(g)16.7(e)-14.9(d)10(-)]TJ
T*
0 Tc
[(ca)28.1(r)12.6(e)-273.8(p)14.2(l)15.4(an)32(.)-279.5(H)14.7(o)14.2(w)16.2(ev)24.9(e)17(r)12.6(,)-273.2(t)0(h)24.7(e)-273.8(sa)29.4(me)-262.2(mo)25.8(d)14.2(e)17(l)-275.4(w)0(a)27.3(s)-278.9(c)17(o)14.2(n)14.6(s)0(i)27.4(d)14.2(e)17(r)12.6(e)17(d)-276.7(us)28.1(ef)27.6(u)16.2(l)-275.4(as)-261.5(a)-279.8(g)14.2(u)16.2(i)15.4(d)14.2(e)]TJ
T*
[(f)16.9(o)14.2(r)-253(r)18.9(ev)24.9(i)15.4(s)18.3(io)23.3(n)20.9(s)-253.6(a)17.4(t)-250.7(a)-248.1(n)14.6(u)16.2(m)18(b)14.2(e)0(r)-236(o)14.2(f)-248.7(i)15.4(n)14.5(t)14.8(eg)24.9(r)18.9(a)0(t)25.9(e)17(d)-251.4(d)14.2(e)17(l)15.4(iv)23.3(e)17(r)12.6(y)-245.1(s)0(y)26.1(s)18.3(t)14.8(e)0(m)28.7(s)-253.6(t)14.8(h)16.2(a)17.4(t)-250.7(i)15.4(n)14.6(cl)26.2(u)16.2(d)14.2(e)17(d)14.2(,)]TJ
T*
[(a)17.4(t)-377.2(m)18(i)15.4(n)14.6(i)0(m)27.1(u)16.2(m,)-362.7(a)-368.3(h)0(o)24(s)18.3(p)14.2(i)15.4(t)14.8(a)0(l)26.5(,)-374.3(o)14.2(f)16.9(fi)26(c)17(e)-375(p)14.2(r)12.6(a)17.4(c)17(ti)23.9(c)17(e)0(,)-357.3(a)0(n)25.7(d)-371.5(ho)30.4(me)-363.4(c)17(a)0(r)30(e)-375(i)15.4(n)-377.5(t)14.8(h)16.2(e)-375(s)18.3(am)29.1(e)]TJ
T*
-.0155 Tc
[(s)-15.5(y)10.6(ste)-15.5(m)13.2(.)-193.8(A)1.3(s)-193.2(pos)-15.5(i)11.9(t)-.7(ed,)-193.8(t)-.7(he)-194.5(mode)-15.5(l)-179(p)-1.3(redic)-15.5(t)10(ed)-197.3(improvem)-15.5(e)13.2(nt)-190.4(in)-197(six)-197(i)-.1(nterre)-15.5(l)10.6(a)1.9(te)-15.5(d)]TJ
0 -1.3278 TD
[(c)-15.4(o)15.8(m)-15.4(p)10.4(onents)-250(\(inc)-15.4(l)10.8(uding)-247.8(s)-15.4(e)13.6(l)-15.4(f)10.6(-)-1.4(ma)-15.4(n)10.3(a)2(gem)-15.4(e)13.3(nt)-253.5(support,)-250.6(cli)-15.4(n)8.3(ical)-252.9(informa)-15.4(t)10.5(ion)]TJ
0 -1.3341 TD
-.015 Tc
[(s)-15(y)11.1(ste)-15(m)13.7(s)-15(,)-320.5(de)-15(l)11.2(i).4(very)-335.9(s)-15(y)11.1(ste)-15(m)-321.4(rede)-15(s)14(i).4(gn,)-338.7(d)-.8(ec)-15(i)11.1(s)3.3(ion)-335.6(s)-15(u)13.1(pport,)-332.4(h)-15(e)11.9(a)-15(l)11.5(thca)-15(r)15(e)-339.4(orga-)]TJ
T*
0 Tc
[(n)14.6(i)15.4(za)28.1(t)14.8(i)15.4(o)14.2(n)14.6(,)-285.8(a)0(n)25.7(d)-283(co)24.9(m)18(m)0(u)27.8(n)14.5(i)15.4(t)14.8(y)-289.3(r)18.9(es)22.7(o)20.5(u)0(r)28.8(c)0(e)27.8(s)0(\))-276.1(i)15.4(n)-288.9(w)16.2(h)16.2(i)15.4(ch)-276.6(i)15.4(n)14.5(f)16.9(o)14.2(r)12.6(m)18(ed)24.9(,)-285.8(a)17.4(ct)25.5(i)15.4(v)14.2(a)17.4(t)14.8(ed)-278.6(p)14.2(a)17.4(-)]TJ
T*
[(t)14.8(i)15.4(en)25.3(t)14.8(s)-259.9(in)23.7(t)14.8(e)17(r)12.6(a)17.4(ct)-252.7(w)16.2(i)15.4(t)14.8(h)-268.3(p)14.2(r)18.9(ep)24.9(a)17.4(r)12.6(e)17(d)14.2(,)-266.8(p)14.2(r)12.6(o)14.2(a)17.4(c)0(t)25.5(i)15.4(v)14.2(e)-261.2(ca)28.1(r)12.6(e)-267.5(t)14.8(e)17(am)29.1(s.)]TJ
/F11 1 Tf
11.9551 0 0 11.9551 50.1732 741.9966 Tm
[(BASHSHUR)-338.5(ET)-334.1(AL.)]TJ
7.9702 0 0 7.9702 50.1732 29.7638 Tm
[(7)-80(7)-80.1(2)-699.9(TELEMEDICINE)-323.9(and)-331.8(e-HEALT)11.5(H)]TJ
/F8 1 Tf
6.9738 0 0 6.9738 176.8818 29.7638 Tm
.1095 Tc
[(SEPT)6.6(EMBER)-333.2(2).1(0)6.8(1)0(4)]TJ
ET
q
1 i
0 792 612 -791.985 re
W n
32.315 .014984 .22675 791.985 re
f
/Document /MC3 BDC
Q
q
1 i
0 792 32.315 -173.367 re
W n
0 0 0 .29999 k
0 618.633 32.315 173.367 re
f
EMC
Q
32.315 763.994 242.646 .22675 re
f
endstream
endobj
189 0 obj
<>stream
Adobe Illustrator CS4
2010-08-04T11:54:42+05:30
2010-08-04T11:54:42+05:30
2010-08-04T11:54:42+05:30
68
256
JPEG
/9j/4AAQSkZJRgABAgEASABIAAD/7QAsUGhvdG9zaG9wIDMuMAA4QklNA+0AAAAAABAASAAAAAEA
AQBIAAAAAQAB/+4ADkFkb2JlAGTAAAAAAf/bAIQABgQEBAUEBgUFBgkGBQYJCwgGBggLDAoKCwoK
DBAMDAwMDAwQDA4PEA8ODBMTFBQTExwbGxscHx8fHx8fHx8fHwEHBwcNDA0YEBAYGhURFRofHx8f
Hx8fHx8fHx8fHx8fHx8fHx8fHx8fHx8fHx8fHx8fHx8fHx8fHx8fHx8fHx8f/8AAEQgBAABEAwER
AAIRAQMRAf/EAaIAAAAHAQEBAQEAAAAAAAAAAAQFAwIGAQAHCAkKCwEAAgIDAQEBAQEAAAAAAAAA
AQACAwQFBgcICQoLEAACAQMDAgQCBgcDBAIGAnMBAgMRBAAFIRIxQVEGE2EicYEUMpGhBxWxQiPB
UtHhMxZi8CRygvElQzRTkqKyY3PCNUQnk6OzNhdUZHTD0uIIJoMJChgZhJRFRqS0VtNVKBry4/PE
1OT0ZXWFlaW1xdXl9WZ2hpamtsbW5vY3R1dnd4eXp7fH1+f3OEhYaHiImKi4yNjo+Ck5SVlpeYmZ
qbnJ2en5KjpKWmp6ipqqusra6voRAAICAQIDBQUEBQYECAMDbQEAAhEDBCESMUEFURNhIgZxgZEy
obHwFMHR4SNCFVJicvEzJDRDghaSUyWiY7LCB3PSNeJEgxdUkwgJChgZJjZFGidkdFU38qOzwygp
0+PzhJSktMTU5PRldYWVpbXF1eX1RlZmdoaWprbG1ub2R1dnd4eXp7fH1+f3OEhYaHiImKi4yNjo
+DlJWWl5iZmpucnZ6fkqOkpaanqKmqq6ytrq+v/aAAwDAQACEQMRAD8A6dhQ7FXYq7FXYq7FXYq7
FUZ/0qf+jj/jTFUHirsVdirsVdirsVdirsVRn/Sp/wCjj/jTFUHirsVdirsVdirsVdirsVRn/Sp/
6OP+NMVQeKuxV2KuxV2KuxV2KuxVGf8ASp/6OP8AjTFUHirsVdirsVdirsVdirsVRn/Sp/6OP+NM
VQeKuxV2KuxV2KuxV2KuxVGf9Kn/AKOP+NMVQeKuxV2KuxV2KuxV2KuxVGf9Kn/o4/40xVB4q7FX
Yq7FXYq7FXYq7FUZ/wBKn/o4/wCNMVQeKuxV2KuxV2KuxV2KuxVGf9Kn/o4/40xVB4q7FXYq7FXY
q7FXYq7FUZ/0qf8Ao4/40xVB4q7FXYq7FXYq7FXYq7FUZ/0qf+jj/jTFUHirsVdirsVdirsVdirs
VRn/AEqf+jj/AI0xVB4q7FXYq7FXYq7FXYq7FUZ/0qf+jj/jTFUHirsVdirsVdirsVdirsVRn/Sp
/wCjj/jTFUHirsVdirsVdirsVdirsVRn/Sp/6OP+NMVQeKuxV2KuxV2KuxV2KuxVGf8ASp/6OP8A
jTFUHirsVdirsVdirsVdirsVRn/Sp/6OP+NMVQeKuxV2KuxV2KuxV2KuxVGf9Kn/AKOP+NMVQeKu
xV2KuxV2KuxV2KuxVGf9Kn/o4/40xVB4q7FXYq7FXYq7FXYq7FUZ/wBKn/o4/wCNMVQeKuxV2Kux
V2KuxV2KuxVGf9Kn/o4/40xVB4q7FXYq7FXYq7FXYq7FUZ/0qf8Ao4/40xVB4q7FXYq7FXYq7FXY
q7FUZ/0qf+jj/jTFUHirsVdirsVdirsVdirsVRn/AEqf+jj/AI0xVB4q7FXYq7FXYq7FXYq7FUZ/
0qf+jj/jTFUHirsVdirsVdirsVdirsVRn/Sp/wCjj/jTFUHirsVdirsVdirsVdirsVRn/Sp/6OP+
NMVQeKuxV2KuxV2KuxV2KuxVGf8ASp/6OP8AjTFUHirsVdirsVdirsVdirsVRn/Sp/6OP+NMVQeK
uxV2KuxV2KuxV2KuxVGf9Kn/AKOP+NMVQeKuxV2KuxV2KuxV2KuxVGf9Kn/o4/40xVB4q7FXYq7F
XYq7FXYq7FUZ/wBKn/o4/wCNMVf/2Q==
application/postscript
saved
xmp.iid:11FB61F30AB7DE11AEB3E861853EAFA4
2009-10-12T14:15:50+05:30
Adobe Illustrator CS4
/
converted
from application/postscript to application/vnd.adobe.illustrator
converted
from application/postscript to application/vnd.adobe.illustrator
saved
xmp.iid:0280117407206811994CBE3149FFDB59
2010-08-04T11:54:42+05:30
Adobe Illustrator CS4
/
converted
from application/postscript to application/vnd.adobe.illustrator
xmp.iid:11FB61F30AB7DE11AEB3E861853EAFA4
xmp.did:11FB61F30AB7DE11AEB3E861853EAFA4
uuid:ee5a72b3-04e4-4157-a8d8-c3a8817872a3
uuid:ee5a72b3-04e4-4157-a8d8-c3a8817872a3
xmp.iid:0280117407206811994CBE3149FFDB59
xmp.did:0280117407206811994CBE3149FFDB59
TouchUp 7.0
False
False
1
684.000000
864.000000
Points
Black
Default Swatch Group
0
PANTONE 3025 C
SPOT
100.000000
CMYK
100.000000
16.859999
0.000000
50.980003
endstream
endobj
186 0 obj
<>
endobj
190 0 obj
<>/XObject<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]/Font<>>>/Thumb 193 0 R/MediaBox[0 0 612 792]/Rotate 0>>
endobj
194 0 obj
<>/ProcSet[/PDF/Text]/Font<>>>
endobj
191 0 obj
<>stream
/GS1 gs
BT
/F1 1 Tf
8.9663 0 0 8.9663 45.8079 693.8644 Tm
0 0 0 1 k
-.0159 Tc
0 Tw
[(In)-304.8(thi)5.9(s)-307.5(mo)4.6(del,)-301.7(the)-302.4(c)1.1(are)-308.7(s)2.4(y)4.6(s)2.4(tem)-307.8(w)6.6(oul)5.9(d)-305.2(be)-302.4(resp)4.6(on)5(sib)4.6(l)-.5(e)-308.7(f)7.3(or)-306.8(d)4.6(e)1.1(vel)5.9(o)-1.7(p)4.6(i)-.5(n)5(g)]TJ
-1.1065 -1.3278 TD
-.018 Tc
[(patient)-502.7(r).9(egis)-18(t)15.1(r).9(ies)-505.6(a)-.6(nd)-509.7(u)4.5(s)-18(i)15.7(n)-3.4(g)-503.3(t)-3.2(h)4.5(e)-1(m)-505.9(t)-3.2(o)-503.3(e)-1(nsure)-506.8(t)3.1(imely)-509.7(p)2.5(reventive)-506.8(a)-.6(nd)]TJ
0 -1.3341 TD
-.0177 Tc
[(maintenance)-278.9(s).6(ervices.)-278.2(B)-.1(ecause)-278.9(t)-2.9(h)4.8(e)-278.9(basic)-278.9(p)-3.5(remise)-278.9(is)-277.6(to)-275.4(activate)-278.9(patients)]TJ
T*
[(i)4(n)-395.3(ma)6(naging)-395.7(their)-390.9(o)2.7(wn)-388.9(health,)-392.1(t)-3(h)4.7(e)-392.8(model)-394.4(m).2(ust)-388.7(e)-.8(ns)-17.8(u)16.7(r)-5.2(e)-386.5(t)-3(hat)-388.7(t)-3(h)4.7(e)-.8(y)-395.7(a)-.4(re)]TJ
T*
-.0174 Tc
[(capable)-215.3(o)-3.2(f)-215.5(s).9(elf-care.)-214.7(T)-3.2(he)-215.3(successful)-210.6(implementation)-217.8(of)-215.5(the)-215.3(m).6(odel)-216.9(w)5.1(o)-3.2(uld)]TJ
T*
-.016 Tc
[(u)6.5(l)-.6(ti)5.8(matel)5.8(y)-280(dep)4.5(e)1(nd)-273.7(on)-279.7(t)5.1(h).2(e)-277.2(e)1(ffect)5.1(ive)-277.2(u).2(se)-277.2(of)-277.4(i)5.8(n)-1.4(fo)4.5(rmati)5.8(o)-1.8(n)-279.7(t)5.1(echn)4.9(o)-1.8(lo)4.5(gy)4.5(.)]TJ
6.7246 0 0 5.9768 273.9401 638.0786 Tm
-.0226 Tc
(28)Tj
/F4 1 Tf
11.9551 0 0 11.9551 35.8866 610.1857 Tm
0 Tc
(Telemonitoring)Tj
/F1 1 Tf
8.9663 0 0 8.9663 45.8079 598.2234 Tm
.0112 Tc
[(Telemo)-6.2(nitoring)-284.5(or)-279.7(monitoring)-284.5(patients)-280.4(at)-277.5(a)-281.2(d)-6.2(ist)-5.6(a)3.3(nce)-281.6(\()1.3(also)-278.1(cal)-5(l)1.3(ed)]TJ
-1.1065 -1.3278 TD
.0098 Tc
[(tel)-6.4(e)1.5(h)-5.6(o)-1.3(me)-289.3(ca)-4.4(re)-283(or)-287.5(ho)-7.6(me)-289.3(tel)-6.4(e)1.6(c)-4.8(a)1.9(re)-4.8(a)-4.4(ltho)-7.6(ugh)-283.8(t)-7(ele)-4.8(m)-3.9(onitoring)-285.9(n)-.9(o)-7.6(w)-283.9(ex-)]TJ
0 -1.3341 TD
.0113 Tc
[(tend)-6.1(s)-242.3(f)2.9(ar)-241.7(beyond)-240.1(t)-5.5(he)-243.5(ho)-6.1(me\))-238.8(i)-4.9(s)-242.3(a)-243.2(component)-245.8(o).2(f)-243.7(a)-236.8(l)-4.9(a)3.4(rger)-241.7(chronic)-243.5(c)-3.3(are)]TJ
T*
.0108 Tc
[(model)-252(t).3(hat)-252.6(i).9(nclud)-6.6(e)2.6(s)-255.5(d)-.3(isease)-256.7(manag)-6.6(e)2.6(ment)-252.6(and)-253.2(c)2.6(are)-250.4(c)2.6(o)-6.6(o)-.3(r)10.8(d)-6.7(i)-5.4(n).1(ati)-5.4(o)-.3(n,)-249.7(in)]TJ
T*
.01 Tc
[(whi)-6.2(ch)-460.7(pati)-6.2(ents)-458.6(a)-4.2(s)3(s)-3.3(u).9(m)-3.7(e)-459.8(a)-453.1(g)-1.1(rea)-4.2(t)-.5(e)-4.6(r)-451.7(rol)-6.2(e)-453.5(in)-456(m)-3.7(a)2.1(na)-4.2(ging)-456.4(t)-6.8(h).9(e)-4.6(i).1(r)-458(h).9(ea)-4.2(lth)-5.4(,)]TJ
T*
.011 Tc
[(whi)-5.2(le)-307.1(having)-303.6(ready)-303.6(a)-3.2(ccess)-305.8(t).5(o)-309.9(t).5(heir)-305.2(providers)-305.8(who)-309.9(hav)-6.4(e)-300.8(up-to-date)]TJ
T*
[(informat)-5.9(ion)-328.6(o)-.2(n)-335(v)-.2(ariou)-4.5(s)-331.2(par)10.9(a)-9.7(meter)10.9(s)-337.6(o)-6.5(f)-326.3(t)-5.9(h)1.8(eir)-330.6(h)1.8(eal)-5.3(t).4(h.)-331.8(It)-328.4(inclu)-4.5(d)-.2(es)-331.2(th)-4.5(e)]TJ
T*
.0105 Tc
[(col)-5.7(l).6(ection)-373.3(of)-371(cl)-5.7(inical)-372.4(dat)-6.3(a)-364.1(from)-369.9(th)]TJ
14.8272 0 TD
.0117 Tc
[(e)-369.6(p).6(atient)-365.5(and)-372.5(t)1.2(h)2.6(e)-369.6(tra)3.8(n)-5.4(s)4.7(m)-2(iss)4.7(i)-4.5(on,)]TJ
-14.8272 -1.3341 TD
.0109 Tc
[(processing)-6.5(,)-243.3(a)3(nd)-246.8(management)-246.2(of)-244.1(su)]TJ
14.6692 0 TD
.0112 Tc
[(ch)-244.5(d)-6.2(a)3.3(ta)-243.3(by)-246.5(a)-243.3(h)-4.2(ealthcare)-243.6(p).1(rovider)]TJ
-14.6692 -1.3278 TD
.0098 Tc
[(throug)-7.6(h)-340.7(a)-4.4(n)-342.4(i)-.1(nte)-4.8(r)-2.9(fa)-4.4(ce)-346.2(s)-3.5(y)-1.3(s)-3.5(t)-.7(em)-3.9(.)-345.6(A)1.3(s)-345(s)-3.5(uc)-4.8(h,)-345.6(it)-342.1(re)-4.8(pres)-3.5(en)-7.3(ts)-345(an)-342.4(i)-6.4(nnovat)-7(i)-.1(ve)]TJ
0 -1.3341 TD
.0111 Tc
[(paradigm)-407.2(for)-406.3(t)-5.7(he)-408.1(medical)-409.7(m)-2.6(anagement)-404(o)0(f)-408.3(c)2.9(hronic)-408.1(ill)-5.1(ness,)-401.2(whi)-5.1(c)2.9(h)]TJ
T*
.0108 Tc
[(aims)-413.5(at)-410.7(p)-6.6(r)10.8(o)-6.7(v)-6.6(iding)-411.3()53.8(app)-6.6(r)10.8(o)-6.7(p)-6.6(r)10.8(i)-5.5(a)-3.4(te)-414.8(care)-408.4(at)-410.7(the)-408.4(a)-3.4(ppropriat)-6(e)-408.4(ti)-5.4(me)-414.8(and)]TJ
T*
.0115 Tc
[(place)-312.9(i)1.6(n)-315.4(t)1(he)-312.9(most)-308.8(appropriate)-312.9(manner)11.5(.)-8.8()54.5()]TJ
6.7246 0 0 5.9768 187.4834 458.7589 Tm
.0196 Tc
(25)Tj
8.9663 0 0 8.9663 197.5181 454.7904 Tm
.0112 Tc
[(The)-313.2(m)3.9(ajor)-311.4(pi)-5(llar)11.2(s)-324.7(of)-313.4(tel-)]TJ
-18.0266 -1.3341 TD
[(emonitorin)-5.9(g)-284.5(i)1.3(n)-5.9(c)2.9(lude)-287.9(patient-cent)]TJ
14.1949 0 TD
.0132 Tc
[(ere)4.9(d)-288.8(ca)5.3(re)5(,)-291.6(t)2.7(h)4.1(e)-285.9(medic)5(a)-1(l)-287.5(h)4.1(ome,)-285.2(a)5.3(n)2.5(d)]TJ
-14.1949 -1.3341 TD
.0112 Tc
[(shared)-214.9(decision)-214.5(making.)-217.7(W).4(hen)-214.5(optim)]TJ
15.6113 0 TD
.0114 Tc
[(ally)-214.7(implemented,)-211.2(patients)-216.9(are)]TJ
-15.6113 -1.3341 TD
.0128 Tc
[(e)4.5(l)2.9(ectronica)4.9(lly)-327.1(connec)4.6(t)2.3(ed)-327.1(w)3.7(i)2.9(th)-325.1(th)3.7(eir)-322.4(u)-2.6(s)5.8(u)-2.6(a)4.9(l)-325.8(sou)3.7(r).1(ce)4.6(s)-329.3(o)1.7(f)-324.4(m)-.9(e)4.6(d)1.7(ical)-319.5(car)12.8(e)-8.2(,)]TJ
T*
.0109 Tc
[(and)-246.8(t).4(eams)-242.7(of)-244.1(provi)-5.3(ders)-242.7(\(nur)10.9(s)-8.9(e)-3.7(s,)-243.3(phys)]TJ
15.4469 0 TD
[(ici)-5.3(a)3(ns,)-243.3(a)3(nd)-246.8(therapists\))-245.5(m)3.6(onit)-5.9(or)]TJ
-15.4469 -1.3278 TD
.0106 Tc
[(criti)-5.6(c)2.4(al)-385(parameters)-388.4(\(gen)-6.5(eral)-5.6(ly)-386.2(vi)]TJ
13.9167 0 TD
.0111 Tc
[(a)-382.5(s)-2.2(ophi)-5.1(s)4.1(t)-5.7(i)1.2(cated)-379.4(c)-3.5(omputer)-381(a)-3.1(nd)-385.7(al-)]TJ
-13.9167 -1.3341 TD
.0114 Tc
[(gorithm-based)-227.3(decision)-227(t)-5.4(ools\))-226.1(aff)]TJ
13.9863 0 TD
[(ecting)-227.3(t).9(h)-4(e)3.1(ir)-229(h)-4(e)3.2(alth)-225.3(and)-227.3(w)2.3(ell-b)-6(e)3.2(ing)]TJ
-13.9863 -1.3341 TD
.0109 Tc
[(and)-227.8(p)-.2(rovide)-231.3(them)-224.1(wit)-5.9(h)-225.8(r)10.9(e)-10.1(levan)-6.2(t)-220.9(advice,)-230.6(i)1(nformat)-5.9(i)1(on,)-224.3(a)-3.3(nd)-221.5(follo)-6.5(w-up)]TJ
T*
.0112 Tc
[(car)11.2(e)-9.8(.)-280.9(U)-1.4(nder)-279.7(this)-280.3(system,)-280.9(p).1(atients)-280.4(w)2.1(o)-6.2(u)2.1(ld)-284.5(hav)-6.2(e)3(:)]TJ
/F13 1 Tf
5.9777 0 0 5.9777 45.8079 340.7243 Tm
0 Tc
(.)Tj
/F1 1 Tf
8.9663 0 0 8.9663 51.8173 339.7039 Tm
[(An)-297.5(electronic)-312.8(device)-303.5(that)-303.5(monitors)-301.7(and)-307.9(reports)-301.1(relevant)-306.9(data)-302.9(to)]TJ
T*
[(a)-273.4(provider)-277.8(team)-280.5(on)-274.8(a)-273.4(prespecified)-285(set)-278.7(of)-272.5(relevant)-281.6(vital)-276.8(signs)-273.4(and)]TJ
T*
[(other)-336.2(disease-specific)-337.8(parameters)]TJ
/F13 1 Tf
5.9777 0 0 5.9777 45.8079 304.8377 Tm
(.)Tj
/F1 1 Tf
8.9663 0 0 8.9663 51.8173 303.8739 Tm
[(Relevant)-251.3(educational)-249.9(materials)-252(tailored)-252(to)-249.2(the)-249.1(individual)-252.3(patient)]TJ
T*
[(concerning)-677.2(medication)-682.9(management,)-679.3(symptom)-678.9(recognition,)]TJ
T*
[(especially)-281.1(when)-271.2(indicative)-280.8(of)-278.8(worsening)-280.4(conditions)-277.4(that)-278.2(require)]TJ
T*
[(action,)-280.9(as)-280.4(well)-277.4(as)-280.4(lifestyle)-285.5(preventive)-279(measures)-282.6(to)-280.8(improve)-280.2(their)]TJ
T*
[(health)-345.5(and)-345.9(well-being)-346.1(\(such)-346.8(as)-343.7(proper)-345.3(diet,)-344.5(smoking)-347.6(cessation,)]TJ
T*
[(exercise,)-333.9(and)-333.2(moderate)-342.7(alcohol)-332.7(consumption\))]TJ
/F13 1 Tf
5.9777 0 0 5.9777 45.8079 233.1212 Tm
(.)Tj
/F1 1 Tf
8.9663 0 0 8.9663 51.8173 232.1008 Tm
-.028 Tc
[(R)-10.4(e)-28(ad)-13.8(y)-247.8(a)-28(cc)-28(es)-28(s)-238.1(t)-13.2(o)-247.8(t)-13.2(h)-28(e)-1.1(i)-12.6(r)-249.4(p)-13.8(e)-28(rs)-28(on)-13.4(a)-10.6(l)-252.8(h)-11.8(e)-28(al)-12.6(t)-13.2(h)-252.1(r)-15.4(e)-11(c)-11(o)-13.8(r)-15.4(d)-13.8(s)-28(,)-238.6(i)-12.6(n)-13.4(c)-11(l)-12.6(u)-11.8(d)-13.8(i)-28(n)2(g)-254.1(l)-12.6(o)-13.8(n)-13.4(g)-13.8(-)-14(t)-13.2(e)-11(r)-15.4(m)]TJ
T*
0 Tc
[(t)14.8(r)18.9(en)25.3(d)14.2(s)-316.8(i)15.4(n)-320.6(t)14.8(h)16.2(ei)26.2(r)-316.2(f)16.9(un)24.4(c)17(t)14.8(i)15.4(o)14.2(n)14.6(a)17.4(l)-319.7(s)0(t)26.8(a)17.4(t)14.8(u)0(s)28.1(,)-317.4(sy)26.1(m)18(p)14.2(t)14.8(o)14.2(ms)23.6(,)-317.4(a)17.4(n)14.6(d)-320.9(b)14.2(e)17(n)14.6(c)0(h)26.9(m)18(ar)30(k)13.1(s)]TJ
/F13 1 Tf
5.9777 0 0 5.9777 45.8079 209.1968 Tm
(.)Tj
/F1 1 Tf
8.9663 0 0 8.9663 51.8173 208.233 Tm
[(Tools)-290.5(for)-291.5(participating)-302.1(in)-286.2(shared)-296.4(decision)-297.5(making)-293(together)-296.5(with)]TJ
T*
[(their)-316(providers)-322.7(and)-320.6(explicit)-318.7(guidance)-322.9(on)-312.7(the)-318.7(appropriate)-322.9(use)-321.5(of)]TJ
T*
[(service,)-408.2(such)-406.5(as)-400.6(when)-410.3(symptoms)-407.7(warrant)-400.3(a)-406.2(visit)-408.7(to)-401(the)-407.2(emer-)]TJ
T*
[(gency)-283.4(room)-282.6(or)-283.1(hospitalization,)-285(as)-280.4(well)-283.7(as)-280.4(when)-283.8(their)-284.4(conditions)]TJ
T*
[(do)-332.1(not)-335.8(warrant)-337.1(emergency)-332.7(care)-340.6(or)-333.7(hospitalization)]TJ
/F13 1 Tf
5.9777 0 0 5.9777 45.8079 149.4425 Tm
(.)Tj
/F1 1 Tf
8.9663 0 0 8.9663 51.8173 148.422 Tm
[(Ready)-412.8(access)-419.7(to)-413.6(medical)-416.6(advice)-416.9(when)-410.3(they)-418.3(have)-415.7(questions)-413.5(or)]TJ
T*
(concerns)Tj
-.6702 -2.1119 TD
[(The)-420.5(preceding)-413.9(discussions)-420.6(were)-417.7(designed)-418.9(to)-413.6(provide)-416.8(a)-412.5(compre-)]TJ
-1.1065 -1.3278 TD
[(hensive)-437.4(context)-443.1(for)-437(the)-438.8(subsequent)-440(analysis)-438.1(of)-436.9(the)-438.8(evidence)-442.6(per-)]TJ
0 -1.3341 TD
[(taining)-386.8(to)-388.3(telemedicines)-397(role)-389.7(in)-393.6(chronic)-386.2(disease)-394.5(management.)-394.8(We)]TJ
T*
[(now)-277.6(turn)-283.3(to)-280.8(a)-279.7(review)-280.7(and)-282.7(analysis)-280(of)-285.1(the)-280.7(evidence.)]TJ
/F4 1 Tf
11.9551 0 0 11.9551 307.8424 691.7101 Tm
[(The)-338.1(Review)-334.9(Process)]TJ
/F1 1 Tf
8.9663 0 0 8.9663 317.8204 679.8046 Tm
[(This)-334.3(review)-337.6(is)-333(based)-336.2(on)-338(a)-330.3(systematic)-340.6(process)-337.4(for)-335.8(the)-337.6(selection)-336.7(of)]TJ
-1.1128 -1.3341 TD
[(relevant)-212.1(literature)-213.4(on)-211.5(the)-211.2(impact)-206.7(of)-209.2(telemedicine)-218(for)-209.3(the)-211.2(management)]TJ
T*
[(of)-430.6(three)-428.2(chronic)-436.8(diseases:)-428.3(CHF,)-431(stroke,)-436.1(and)-428.1(COPD.)-427.3(By)-429.8(design,)-432.4(the)]TJ
T*
[(review)-413.4(focuses)-413.3(on)-407.6(a)-412.5(limited)-408.2(set)-411.4(of)-411.6(representative)-415.4(chronic)-411.5(diseases)]TJ
T*
[(because)-312.8(of)-316.7(their)-309.6(current)-312.5(and)-314.3(increasing)-311.4(importance)-319.1(relative)-312.4(to)-312.4(their)]TJ
T*
[(prevalence,)-338(associated)-335.5(morbidity,)-336.3(mortality,)-332.4(and)-333.2(cost.)-329(Furthermore,)]TJ
T*
[(these)-365.6(three)-358.6(diseases)-363.6(are)-357.6(amenable)-362.2(to)-363(timely)-360.4(interventions)-365.3(and)-358.5(sec-)]TJ
T*
[(ondary)-501(prevention)-502.8(through)-502.7(telemonitoring.)-503.6(In)-492.8(each)-501.4(instance,)-504.4(we)]TJ
0 -1.3278 TD
[(provide)-296.7(a)-292.4(brief)-297(explanation)-292(of)-291.5(the)-293.4(disease)-299.7(entity)-294.9(as)-293.1(well)-290(as)-293.1(essential)]TJ
0 -1.3341 TD
[(information)-262(on)-262.1(its)-261.3(epidemiology)-265.6(and)-257.4(cost,)-265.8(as)-261.5(an)-258.9(appropriate)-266(context)]TJ
T*
[(for)-386.4(the)-394.5(search)-388.3(for)-392.7(evidence)-392(from)-387.4(the)-388.2(scientific)-394.5(literature.)-391.7(As)-388.6(men-)]TJ
T*
[(tioned)-282.9(earlier,)-285.8(a)-279.8(separate)-282.2(section)-280.7(addresses)-289.1(the)-280.7(issue)-281.5(of)-278.8(cost.)]TJ
1.1128 -1.3341 TD
[(T)14.2(h)16.2(e)-299.1(r)18.9(ev)24.9(i)15.4(e)17(w)-300(p)14.2(r)12.6(o)14.2(c)17(e)0(s)29(s)-297.9(e)17(n)14.6(t)14.8(a)0(i)26.5(l)15.4(ed)-284.9(f)16.9(o)14.2(u)16.2(r)-297.3(st)26.8(e)17(p)14.2(s:)-286.7(\()15.4(1)14.2(\))-294.4(a)-298.7(c)17(o)14.2(mp)25.8(r)18.9(e)0(h)26.9(e)0(n)25.3(s)18.3(i)15.4(v)14.2(e)-299.1(s)0(e)29(a)17.4(r)12.6(c)0(h)]TJ
-1.1128 -1.3341 TD
-.0155 Tc
[(for)-483.5(a)-15.5(l)11(l)-486.9(publica)-15.5(t)10.4(ions)-484.1(us)-15.5(i)11.9(n)-.9(g)-481.9(k)-2.4(e)-15.5(y)-471.2(term)-15.5(s)-472.5(s)2.8(uc)-15.5(h)-475.4(a)1.9(s)-484.1()52.8(te)-15.5(l)10.7(em)-15.5(e)13.2(d)-1.3(ic)-15.5(i)10.6(n)-1(e,)-15.5()64.2()-484.7()59.1()-15.5(t)10.7(e)1.5(le)-15.5(-)]TJ
T*
0 Tc
[(h)16.2(e)0(a)28.1(l)15.4(t)14.8(h)0(,)27.6()68.3()-393.3()68.3()17.7(t)14.8(el)26.2(e)17(m)0(o)25.8(n)14.6(i)15.4(t)14.8(o)14.2(r)18.9(i)15.4(n)14.6(g)14.2(,)0()79.7()-393.3(a)17.4(n)14.6(d)-390.5(e)0(a)28.1(c)0(h)-377.7(o)14.2(f)-394.1(t)14.8(he)-377.8(th)24.7(r)18.9(e)0(e)-383.2(c)17(hr)28.8(o)14.2(n)14.5(i)15.4(c)-394(d)14.2(i)15.4(se)29(as)29.4(es)-382(t)14.8(o)]TJ
T*
-.0149 Tc
[(ide)-14.9(n)10.4(tify)-196.7(t)-14.9(h)9.8(e)-200.2(u)1.3(nivers)-14.9(e)-188.2(o)-.7(f)-194(p)-.7(u)-14.9(b)9.1(lica)-14.9(t)11(ions)-199(ava)-14.9(i)11.6(lable)-200.2(d)-.7(uring)-203.1(200)5.6(0e)-14.9(a)13.2(r)-2.3(ly)-196.7(2014;)]TJ
0 -1.3278 TD
-.0153 Tc
[(\(2\))-208.5(a)-206.5(paring)-203.5(dow)-15.3(n)-193.3(o)-1.1(f)-207.1(t)-.5(his)-205.7(l)-15.3(i)9.2(s)3(t)-209.1(t)-.5(o)-203.5(r)-2.7(es)-15.3(e)7.4(a)2.1(rch)-207.8(a)2.1(rticl)-15.3(e)10.8(s)-205.7(o)-1.1(nly;)-206.5(\(3\))-208.5(a)-206.5(re)-15.3(v)9.6(i).1(ew)-207.8(of)-207.1(the)]TJ
0 -1.3341 TD
-.0151 Tc
[(abs)-15.1(t)11.7(rac)-15.1(t)10.4(s)-300.3(o)-.9(f)-301.7(t)-.3(he)-301.6(res)-15.1(e)13.9(a)-15.1(r)14.9(c)-15.1(h)-291.7(public)-15.1(a)13(t)-.3(ions)-300.3(to)-304.4(dete)-15.1(r)14.5(m)-15.1(i)12(n)-.5(e)-301.6(t)-.3(he)-15.1(i)11.1(r)-299.7(e)-15.1(l)11.1(igibility)-304.4(f)1.8(or)]TJ
T*
-.0158 Tc
[(inc)-15.8(l)10.4(us)-15.8(i)11.6(o)-1.6(n)-311.1(i)-.4(n)-317.4(t)-1(he)-314.9(fi)-15.8(n)14.2(a)-15.8(l)-305.4(list,)-320.6(using)-317.8(t)-1(he)-314.9(tw)-15.8(o)-301.6(c)-15.8(r)13.8(i)-.4(te)-15.8(r)7.5(i)-.4(a)-314.5(o)-1.6(f)-315.1(\()-.4(a\))-316.5(robu)-15.8(s)12.3(t)-317.1(res)-15.8(e)13.2(arch)]TJ
T*
-.015 Tc
[(des)-15(i)12.4(gn)-221.7(a)-15(n)10.7(d)-222.1(\().4(b\))-220.9(s)-15(a)14.4(m)-15(p)10.8(le)-219.3(s)-15(i)12.4(ze)-225.6(of)-225.8(150)-222.1(or)-223.7(more;)-225.2(a)2.4(nd)-222.1(\(4\))-227.2(a)-218.9(revie)-15(w)-209.4(of)-225.8(com)-15(p)10.8(lete)]TJ
T*
-.0153 Tc
[(m)-15.3(a)13.8(nus)-15.3(c)13.7(ripts)-186.7(o)-1.1(f)-181.8(a)2.1(l)-15.3(l)-174.1(public)-15.3(a)12.8(t)-.5(ions)-186.7(in)-184.1(the)-187.9(f)1.6(ina)-15.3(l)-172.1(lis)-15.3(t)11.5(.)-181(I)-15.3(n)-173(a)-181.2(f)-15.3(e)12.3(w)-188.8(insta)-15.3(n)10.4(ce)-15.3(s)13.7(,)-187.3(whe)-15.3(r)14.3(e)]TJ
T*
0 Tc
[(a)-374.6(s)18.3(p)14.2(e)0(c)27.8(i)15.4(al)-359.2(ca)28.1(se)-356.7(co)24.9(u)16.2(l)15.4(d)-371.5(b)14.2(e)-375(m)0(a)29.1(d)14.2(e)-375(f)16.9(o)14.2(r)-373.1(t)14.8(h)16.2(ei)26.1(r)-373.1(i)15.4(n)14.6(c)17(lu)25.3(s)18.3(i)15.4(o)14.2(n)-377.5(i)15.4(n)-371.1(t)14.8(h)16.2(e)-375(a)0(n)32(a)0(l)26.5(y)14.2(si)27.4(s)18.3(,)-374.3(w)16.2(e)]TJ
T*
[(i)15.4(n)14.5(cl)26.2(u)16.2(d)14.2(e)17(d)-251.4(s)18.3(t)14.8(u)16.2(d)14.2(ie)26.2(s)-247.3(w)16.2(i)15.4(t)14.8(h)-249.4(s)18.3(am)29.1(p)14.2(l)15.4(es)-230.2(o)14.2(f)-248.7(f)16.9(e)0(w)26.9(e)17(r)-246.7(t)14.8(ha)27.3(n)-244.7(1)14.2(5)14.2(0)-245.1(ca)28.1(se)29(s.)-229.6(In)-233.5(a)17.4(d)14.2(d)14.2(i)15.4(t)14.8(i)15.4(o)14.2(n)14.6(,)-247.9(w)16.2(e)]TJ
T*
[(r)12.6(e)17(v)14.2(i)15.4(ew)26.9(e)17(d)-257.7(t)14.8(h)16.2(e)-248.5(l)0(i)24.6(s)18.3(t)-250.7(o)14.2(f)-255(r)18.9(ef)27.6(er)29.6(en)25.3(c)17(e)0(s)-236.6(i)15.4(n)-257.3(e)17(a)17.4(c)0(h)-238.6(o)14.2(f)-255(t)14.8(h)16.2(e)17(se)-242.9(p)14.2(u)16.2(b)14.2(l)15.4(i)15.4(c)0(a)28.1(t)14.8(i)15.4(o)14.2(n)14.5(s)-253.6(t)14.8(o)-251.4(i)15.4(d)14.2(e)17(n)14.6(t)14.8(i)15.4(fy)]TJ
0 -1.3278 TD
-.0154 Tc
[(artic)-15.4(l)10.8(es)-231.1(tha)-15.4(t)-217.1(shou)-15.4(l)9.9(d)-228.9(be)-226(a)-15.4(d)9.9(ded)-228.9(t)-.6(o)-228.9(t)-.6(he)-232.3(final)-233.9(list.)-231.6(With)-226.8(the)-232.3(e)1.6(xc)-15.4(e)12.4(p)-1.2(tion)-228.5(of)-232.5(two)]TJ
0 -1.3341 TD
0 Tc
[(st)26.8(u)16.2(d)14.2(i)15.4(e)0(s)-236.6(f)0(r)29.4(o)14.2(m)-253.9(G)14.7(e)17(r)12.6(m)18(a)0(n)25.7(y)14.2(,)-247.9(o)14.2(ur)-236.8(se)22.7(a)17.4(r)12.6(c)17(h)-249.4(wa)27.3(s)-253.6(l)15.4(i)15.4(m)0(i)27.1(t)14.8(e)17(d)-251.4(t)14.8(o)-251.4(p)14.2(u)0(b)24(l)15.4(i)15.4(c)17(at)25.9(i)15.4(o)14.2(n)14.6(s)-253.6(f)16.9(r)12.6(o)14.2(m)-247.6(al)26.5(l)]TJ
T*
[(co)31.2(un)24.4(t)14.8(r)18.9(i)15.4(e)0(s)-255.5(w)16.2(h)16.2(e)0(r)29.6(e)-267.5(w)16.2(e)-267.5(co)24.9(u)16.2(l)15.4(d)-264(o)14.2(b)14.2(t)14.8(ai)26.5(n)-263.7(a)17.4(n)-270(E)16.2(n)14.5(g)14.2(l)15.4(i)15.4(s)0(h)-250.1(v)14.2(er)29.6(si)27.4(o)14.2(n)14.6(.)]TJ
1.1128 -1.3341 TD
[(Because)-366.2(the)-362.9(studies)-366.3(did)-360.9(not)-367.5(use)-359.5(a)-361.9(standard)-363.5(methodological)-370.4(pro-)]TJ
-1.1128 -1.3341 TD
[(tocol,)-235.5(their)-227.4(respective)-234.5(findings)-230.7(and)-232.1(conclusions)-229.5(must)-229.9(be)-234.4(viewed)-228.5(from)]TJ
T*
[(the)-457.8(perspective)-466.9(of)-455.8(the)-457.8(specific)-456.8(methodological)-465.3(features)-457.8(that)-461.5(were)]TJ
T*
[(used,)-207.5(including)-210.8(research)-207(design,)-211.1(sample)-209.5(size,)-205.4(specific)-210.2(attributes)-211.2(of)-202.9(the)]TJ
T*
[(intervention)-383.6(itself,)-384(and)-383.8(the)-381.9(population)-380.6(studied.)-384.4(We)-385.8(tried)-381.2(to)-382(reduce)]TJ
0 -1.3278 TD
[(these)-207.5(variations)-212.5(by)-205.6(selecting)-210.3(only)-213.6(randomized)-205.9(clinical)-213.6(trials)-203.2(\(RCTs\))-213.3(or)]TJ
0 -1.3341 TD
[(designs)-197.9(approximating)-201.5(an)-195.7(RCT)-192.9(and)-200.4(by)-193(limiting)-199.2(our)-197.3(analysis)-197.8(to)-198.6(studies)]TJ
T*
[(that)-233.9(had)-236.7(an)-233.6(adequate)-232.1(sample)-234.8(size)-235.7(for)-234.6(reliability)-237.3(and)-232.1(statistical)-238.1(power.)]TJ
1.1128 -1.3341 TD
[(The)-306.7(methodologies)-309.1(used)-301.1(varied)-307.6(from)-305.2(one)-302(study)-308.1(to)-306.1(the)-299.7(next.)-307(They)]TJ
-1.1128 -1.3341 TD
[(differed)-236.3(in)-235.6(terms)-235.5(of)-234.5(the)-236.5(manner)-234.7(in)-229.3(which)-235.1(clinical)-238.9(and)-232.1(utilization)-240.2(data)]TJ
T*
[(were)-266(captured,)-263.6(transferred,)-269.7(processed,)-269.6(and)-263.7(stored)-263.1(\(e.g.,)-267(automated)-267(or)]TJ
T*
[(manual,)-433.4(machine)-428.1(captured)-439.3(or)-428.5(patient)-435.5(reported)-433.6(over)-428.9(time,)-435.5(with)-430.6(or)]TJ
T*
[(without)-404.4(trend)-394.8(displays,)-405.1(provider-only)-401.5(accessed)-401.2(or)-403.2(shared)-397.5(with)-399(the)]TJ
0 -1.3278 TD
[(patient\),)-573.1(human)-568.9(health)-573.1(resources)-577.7(used)-572.9(\(e.g.,)-570.5(doctors,)-572.6(nurses,)-574.6(or)]TJ
0 -1.3341 TD
[(combinations)-362.1(of)-367.3(both\),)-362.8(the)-362.9(content)-360.9(of)-361(the)-362.9(intervention)-364.6(\(e.g.,)-361.8(medi-)]TJ
T*
[(cation)-222.7(management,)-224(education,)-227.2(support\),)-222.9(the)-223.8(protocols)-225.6(for)-222(frequency)]TJ
T*
[(\(e.g.,)-203.8(daily,)-202.9(weekly,)-205.5(monthly,)-203.8(etc.\))-208.8(and)-200.5(duration)-203.1(\(e.g.,)-203.8(from)-204(1)-200.8(month)-200.5(to)]TJ
T*
[(5)-295.7(years)-299.9(or)-295.7(more\),)-297.2(and)-295.3(technology)-303.5(\(e.g.,)-298.6(telephone,)-303.4(video,)-299.4(automated)]TJ
T*
[(and)-282.7(manual)-280.4(devices\).)]TJ
1.1128 -1.3341 TD
[(There)-435.2(was)-428.7(also)-434.2(some)-432.1(variation)-433.1(in)-431.6(the)-438.8(outcomes)-433.1(measured.)-433.4(The)]TJ
-1.1128 -1.3341 TD
[(majority)-308(of)-304.1(studies)-309.4(focused)-309.9(on)-306.4(hospitalization)-309(and)-307.9(mortality)-305.8(as)-305.7(pri-)]TJ
0 -1.3278 TD
[(mary)-386.8(outcomes.)-390.1(Stroke)-386.3(studies,)-386.6(however,)-393.5(focused)-385.8(on)-388.6(event)-384(timing)]TJ
0 -1.3341 TD
[(from)-324.2(onset)-319.5(of)-323.1(symptoms)-325.5(to)-325.1(diagnostic)-325.1(tests)-321.4(to)-325.1(treatment,)-321.8(as)-324.7(will)-323.2(be)]TJ
T*
[(explained)-600(later.)-594.2(Hospitalization)-601.3(included)-596.8(all-cause)-597.9(and)-598.8(disease-)]TJ
/F11 1 Tf
11.9551 0 0 11.9551 287.5464 741.9966 Tm
[(TELEMEDICINE)-340.6(FOR)-332.7(CHRONIC)-338.8(DISEASE)-334.7(MANAGE)-7.3(MENT)]TJ
/F9 1 Tf
6.9738 0 0 6.9738 187.1999 29.7638 Tm
()Tj
/F7 1 Tf
1.3332 0 TD
.2013 Tc
[(MARY)-335.5(ANN)-334.3(L).8(IEBE)-4.1(RT,)-333.5(I)6.1(NC.)]TJ
/F10 1 Tf
15.0069 0 TD
0 Tc
()Tj
/F7 1 Tf
1.0081 0 TD
.1029 Tc
[(VO)-11.5(L.)-342.5(20)-1008.2(N)-10(O)-3.4(.)-342.5(9)]TJ
/F10 1 Tf
8.3814 0 TD
0 Tc
()Tj
/F8 1 Tf
.9999 0 TD
.1095 Tc
[(SEPT)6.6(E)-6.5(M)6.3(BER)-333.2(2).1(0)6.8(1)0(4)]TJ
/F4 1 Tf
7.9702 0 0 7.9702 442.318 29.7638 Tm
0 Tc
[(TELEMEDIC)11.7(INE)-333(and)-328.9(e-HEALTH)-647.9(773)]TJ
ET
q
1 i
0 792 612 -791.985 re
W n
579.685 .014984 .22681 791.985 re
f
337.039 767.962 274.961 .22675 re
f
Q
endstream
endobj
195 0 obj
<>/XObject<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]/Font<>/Properties<>>>/Thumb 199 0 R/MediaBox[0 0 612 792]/Rotate 0>>
endobj
200 0 obj
<>/ProcSet[/PDF/Text]/Font<>/Properties<>>>
endobj
196 0 obj
<>stream
/GS1 gs
BT
/F1 1 Tf
8.9663 0 0 8.9663 50.1732 693.8644 Tm
0 0 0 1 k
0 Tc
0 Tw
[(specific)-355.6(hospital)-354.6(admissions,)-355.8(re-hospitalization,)-361.5(and)-358.5(length)-356.7(of)-354.7(hos-)]TJ
0 -1.3278 TD
[(pital)-188.3(stay.)-189.5(Mortality)-192.6(was)-188.4(typically)-190.7(treated)-189.3(as)-191.9(resulting)-190.3(from)-191.4(any)-187.8(cause.)]TJ
0 -1.3341 TD
[(Some)-257.1(studies)-265.2(focused)-259.3(on)-262.1(other)-260.3(outcomes,)-263.6(such)-261.1(as)-261.5(symptom)-261.6(severity,)]TJ
T*
[(physiological)-487.7(status,)-483.2(functional)-482.1(performance,)-487.5(quality)-486.7(of)-481.1(life,)-480.3(and)]TJ
T*
[(health)-187.4(knowledge.)-187.9(As)-186.3(far)-187.1(as)-185.6(we)-181.8(can)-184.9(determine,)-189.5(no)-186.3(study)-187.9(differentiated)]TJ
T*
[(between)-382.4(appropriate)-386.2(and)-377.5(inappropriate)-381.5(use)-384.8(of)-380(service)-381.6(\(e.g.,)-387.1(appro-)]TJ
T*
[(priate)-370.1(hospitalization)-378.5(or)-371.6(appropriate)-373.5(use)-372.1(of)-373.6(the)-369.3(emergency)-376.9(depart-)]TJ
T*
[(ment\),)-281.9(and)-276.3(no)-281.1(studies)-284.1(addressed)-286.9(the)-280.7(cause)-280.8(of)-285.1(mortality.)]TJ
/F4 1 Tf
11.9551 0 0 11.9551 50.1732 586.318 Tm
(CHF)Tj
/F1 1 Tf
8.9663 0 0 8.9663 60.0945 574.3557 Tm
[(CHF)-252.7(is)-250.8(a)-248.1(chronic,)-254.7(progressive)-255.8(condition)-257.7(in)-248.2(which)-254.1(the)-249.1(heart)-250.8(muscle)]TJ
-1.1065 -1.3341 TD
[(is)-181.3(unable)-189.7(to)-179.7(pump)-190.4(sufficient)-185.3(blood)-187.1(to)-186(meet)-186.1(the)-185.9(bodys)-185.6(need)-183.8(for)-184(oxygen)]TJ
T*
[(and)-415.4(nutrients.)-425.8(Blood)-424(is)-415.2(responsible)-429.6(for)-418(transport)-423.1(of)-417.9(materials)-422.7(and)]TJ
T*
[(waste)-485.3(products)-485.6(throughout)-489.1(the)-489.4(body,)-482.1(carrying)-489.1(oxygen)-486.8(from)-482.2(and)]TJ
T*
[(carbon)-321.1(dioxide)-318.7(to)-318.8(the)-318.7(lungs,)-321(nutrients)-323.3(from)-317.8(the)-318.7(digestive)-327.4(system)-316.8(or)]TJ
T*
[(storage)-346.8(sites)-352.4(to)-350.4(tissues)-349.6(that)-354(require)-350.2(them,)-352.6(and)-345.9(waste)-352.6(products)-352.8(from)]TJ
T*
[(tissues)-254.8(to)-255.5(the)-261.8(liver)-254.2(for)-253.6(detoxification)-264.6(and)-257.4(to)-255.5(the)-255.4(kidneys)-260(for)-253.6(disposal.)]TJ
0 -1.3278 TD
[(When)-310.8(the)-312.3(heart)-307.7(muscle)-315.4(is)-307.7(weakened)-316.1(or)-308.4(stiffened,)-317.8(it)-311.2(compensates)-312.5(by)]TJ
0 -1.3341 TD
[(enlarging,)-460.3(developing)-456.7(more)-463.1(heart)-453.1(muscle)-460.8(or)-460.1(pumping)-456.1(faster.)-460.7(The)]TJ
T*
[(body)-373.3(also)-371(tries)-370.8(to)-369.4(compensate)-375(by)-376.3(narrowing)-367.9(blood)-376.8(vessels)-374.7(and)-371.2(di-)]TJ
T*
[(verting)-270.3(blood)-269.3(away)-269.9(from)-267.3(less)-266.1(important)-268.8(tissues)-273.7(to)-268.2(maintain)-264.4(the)-274.4(flow)]TJ
T*
[(to)-280.8(more)-279.7(vital)-283.1(organs.)]TJ
6.7246 0 0 5.9768 128.3527 446.7967 Tm
(29)Tj
8.9663 0 0 8.9663 60.0945 430.866 Tm
[(Car)14(dio)12.2(log)12.2(ist)16.9(s)-259.9(usu)12.7(all)16.7(y)-264(c)0(l)13.5(assi)18.8(fy)-253.5(pat)14.8(ient)17.6(s)-259.9(wit)14.8(h)-262(h)0(e)14.3(art)-252.4(fai)18.1(lur)12.6(e)-261.2(acc)13.6(ord)15.6(ing)]TJ
-1.1065 -1.3341 TD
[(to)-173.3(the)-173.2(sev)11.5(eri)13.4(ty)-173.3(of)-177.6(thei)19.2(r)-183.4(sym)12.5(pto)11.5(ms)-172.4(and)-175.2(th)12.1(eir)-169.9(elig)17.8(ibi)13.4(lit)14.1(y)-181.8(for)-171.4(var)12.5(iou)14.2(s)-184.1(lev)15(els)]TJ
T*
[(of)-247.2(tre)12.8(atm)12.3(en)12.6(t.)-252(How)13.4(eve)10.3(r,)-254.3(th)12.1(ere)-250.5(are)-243.8(sev)11.5(era)15.4(l)-256.4(dif)14.8(fer)14.8(ent)-250.8(cl)13.5(assi)18.8(fic)11.4(ati)16.1(ons,)-245.1(an)13(d)]TJ
0 -1.3278 TD
[(ser)16.3(iou)14.2(s)-234.6(con)14.1(cer)15(ns)-232.7(ha)14.7(ve)-234.4(be)12.2(en)-234(ex)12.6(pre)12.2(sse)15.6(d)-232.4(abou)17.7(t)-238.1(t)0(h)12.1(eir)-226.8(va)12.6(lid)13.4(ity)12.8(.)-235.2(Acc)12.9(ord)15.6(ing)]TJ
0 -1.3341 TD
[(to)-476.8(cur)14.2(ren)12.5(t)-478.4(reco)16.5(mme)15(ndat)16.7(ion)12.5(s,)-476.2(a)-482.1(diag)16.9(nos)15.4(is)-478.4(of)-481.1(CH)11.4(F)-485.3(req)12.1(ui)12.7(res)-476.9(typ)11.5(ic)13.5(al)]TJ
T*
[(sy)13.5(mpto)16.8(ms)-469.6(and)-466(sign)18.2(s)-474.9(tog)11.5(et)12.9(her)-466.4(with)-462.2(evid)16.5(ence)-465.5(of)-468.5(abn)14.5(orm)13.1(al)-466.6(card)16.9(iac)]TJ
T*
[(st)14.1(ruct)16.4(ure)-434.7(or)-441.2(fun)16(ctio)17.2(n.)]TJ
6.7246 0 0 5.9768 132.2078 363.118 Tm
(30)Tj
8.9663 0 0 8.9663 143.1496 359.1495 Tm
[(In)-442.2(199)17.2(4,)-442.4(the)-438.8(Ne)12.8(w)-445.4(Yor)13.1(k)-448.4(H)0(e)12.8(art)-435.7(Ass)15.4(ocia)13.5(tio)19.1(n)]TJ
-10.3696 -1.3341 TD
[(\(NY)16.6(HA\))-326.1(de)12.2(velo)16.5(ped)-327.7(an)-328.4(upd)12.9(ate)11.4(d)-333.6(fun)16(ctio)17.2(nal)-325.6(capa)15.5(ci)13.5(ty/)14.2(obj)12.2(ect)11(ive)-326.4(ass)16(ess)15.6(-)]TJ
T*
[(men)17.9(t)-263.4(i)0(n)-260.9(f)0(o)12(u)0(r)-255.8(cla)12(sse)15.6(s:)-261.4(no)-255.8(obj)12.2(ect)11(ive)-250.5(evi)15(denc)12.2(e)-261.2(o)0(f)-259.8(car)15.4(dio)12.2(va)12.6(scu)13.6(lar)-251.7(dise)14.3(ase)]TJ
T*
[(\(I)13.9(\))-281.7(o)0(r)-270.4(obj)12.2(ect)11(ive)-269.5(ev)12.2(iden)16.9(ce)-275.7(of)-272.5(min)16.3(ima)12.9(l)-281.7(\()0(I)13.9(I\),)-271.9(mo)13.2(der)12.2(ate)-273.2(\(I)13.9(II\))12.4(,)-279.5(o)0(r)-270.4(sev)11.5(ere)-269.5(\(IV)16(\))]TJ
T*
[(car)15.4(dio)12.2(va)12.6(scu)13.6(lar)-169.6(dise)14.3(ase)14.8(,)-178.3(c)0(o)12.2(upl)14.2(ed)-177.5(wit)14.8(h)-179.8(lim)17.2(itat)18.2(ion)12.5(s)-177.7(i)0(n)-172.3(phy)12.9(sic)12.8(al)-175.8(act)11.4(ivi)19.7(ty.)]TJ
6.7246 0 0 5.9768 297.2408 315.3259 Tm
(31)Tj
8.9663 0 0 8.9663 60.0945 299.3952 Tm
[(In)-366.3(2005,)-368.2(the)-369.3(American)-370.7(College)-365.4(of)-367.3(Cardiology)-371.2(and)-364.8(the)-369.3(American)]TJ
-1.1065 -1.3341 TD
[(Heart)-404(Association)-411.7(published)-409(a)-406.2(combined)-406.6(functional/objective)-414.5(CHF)]TJ
T*
[(classification)-284.6(combining)-279.9(the)-287.1(NYHA)-277.2(functional)-286.1(categories)-284.6(with)-285.1(more)]TJ
T*
[(precise)-223.6(stages)-222.5(of)-221.9(heart)-225.5(failure.)-225.4(Patients)-220.8(in)-222.9(Stages)-224.6(A)-223.5(and)-219.4(B)-222.7(d)0(o)-224.6(not)-222(have)]TJ
T*
[(heart)-377.2(failure)-375.9(but)-372.1(have)-377.8(risk)-376.9(factors)-375.7(that)-379.3(predispose)-375.9(them)-376.6(to)-375.7(the)-375.6(de-)]TJ
T*
[(velopment)-233.7(of)-234.5(heart)-238.1(failure.)-238.1(Patients)-233.5(in)-235.6(Stage)-236.5(C)-237.3(comprise)-233.8(the)-236.5(majority)]TJ
T*
[(of)-582.3(patients)-581.6(with)-582.3(heart)-585.9(failurethose)-588.5(who)-579.5(have)-586.4(current)-584.4(or)-580.3(past)]TJ
T*
[(symptoms)-192.7(of)-196.6(heart)-193.8(failure)-198.9(associated)-196.4(with)-196.6(underlying)-193.2(structural)-198.8(heart)]TJ
0 -1.3278 TD
[(disease.)-250.4(Patients)-252.5(in)-254.5(Stage)-249.1(D)-252.9(have)-251.3(refractory)-255.5(heart)-250.7(failure)-255.8(and)-251(may)-254(be)]TJ
0 -1.3341 TD
[(eligible)-280.5(for)-285.2(specialized,)-284.4(advanced)-285(treatments.)]TJ
6.7246 0 0 5.9768 218.5511 195.7606 Tm
(32)Tj
/F6 1 Tf
9.9626 0 0 9.9626 50.1732 167.8676 Tm
[(CHF)-337.9(EPIDEM)-9.9(IOLOGY)]TJ
7.4718 0 0 6.641 140.3716 172.2897 Tm
(a)Tj
/F1 1 Tf
8.9663 0 0 8.9663 60.0945 155.9055 Tm
-.0148 Tc
[(I)-14.8(n)-286.3(2001,)-294.3(H)-14.8(e)-286.5(e)-14.8(t)-286.4(al.)]TJ
6.7246 0 0 5.9768 123.1937 159.874 Tm
-.0226 Tc
(37)Tj
8.9663 0 0 8.9663 132.6047 155.9055 Tm
0 Tc
[(o)14.2(b)14.2(s)0(e)29(r)12.6(v)14.2(e)17(d)-283(t)14.8(ha)27.3(t)-282.4()68.3(d)31.9(ur)28.8(in)30(g)-289.3(t)14.8(h)16.2(e)-286.5(p)14.2(a)17.4(st)-270.4(s)18.3(e)0(v)24.9(e)17(r)12.6(a)17.4(l)-288.1(d)14.2(e)17(c)17(a)0(d)25.3(e)17(s,)]TJ
-9.1935 -1.3341 TD
[(t)14.8(h)16.2(e)-267.5(i)15.4(n)14.6(c)0(i)26.2(d)14.2(e)17(n)14.6(ce)-256.8(o)14.2(f)-267.7(an)25.7(d)-264(m)0(o)25.8(r)12.6(t)14.8(a)17.4(l)15.4(i)15.4(t)14.8(y)-270.4(f)16.9(r)12.6(o)14.2(m)-266.6(c)0(o)24.9(r)12.6(o)14.2(n)20.9(ar)30(y)-270.4(h)0(e)26.9(a)17.4(r)12.6(t)-269.7(d)14.2(i)15.4(se)29(as)29.4(e)-267.5(h)0(a)27.3(v)14.2(e)-273.8(b)20.5(ee)27.8(n)]TJ
T*
-.0151 Tc
[(continuou)-15.1(s)13(ly)-190.6(decl)-15.1(i)9.5(n)-.5(ing.)-180.8(I)-15.1(n)-172.8(contras)-15.1(t)11.7(,)-187.1(t)-.3(he)-187.7(incide)-15.1(n)10.2(c)1.9(e)-187.7(o)-.9(f)-181.6(a)-15.1(n)10.6(d)-184.3(morta)-15.1(l)11.4(ity)-184.3(f)1.7(rom)]TJ
T*
-.0155 Tc
[(CHF)-342.8(h).7(ave)-346.2(b)-1.3(ee)-15.5(n)-325.3(i)-.1(nc)-15.5(r)14.1(e)-15.5(a)12.6(s)-15.5(i)11.9(n)-.9(g)-342.8(a)1.9(nd)-342.8(ha)-15.5(v)9.8(e)-339.9(bec)-15.5(o)9.4(me)-346.2(important)-342.1(public)-346.2(he)-15.5(a)12.6(l)-.1(th)]TJ
30.331 64.0005 TD
[(and)-266.9(c)-15.5(l)10.7(i)-.1(nica)-15.5(l)-254.5(p)-1.3(roble)-15.5(m)13.2(s)-15.5(.)14.1()52.8()-263.4(C)-15.5(r)12.6(ude)-270.3(p)-1.3(re)-15.5(v)9.4(a)1.9(le)-15.5(n)9.8(c)1.5(e)-264(e)-15.5(s)13.5(t)-.7(im)-15.5(a)13.6(t)-.7(e)-15.5(s)-252.1(s)-15.5(h)12.6(ow)-264.9(tha)-15.5(t)-255.1(in)-260.2(2010,)]TJ
0 -1.3278 TD
-.0153 Tc
[(6.)-15.3(6)-204.7(m)2.7(ill)-15.3(i)9.3(o)-1.1(n)-215.7(o)-1.1(r)-217.7(2)-1.1(.8%)-221.3(o)-1.1(f)-213.4(U)-2.6(.)-15.3(S)12.3(.)-218.9(a)2.1(dults)-218.3(o)-1.1(lde)-15.3(r)-207(than)-222(18)-216.1(yea)-15.3(r)14.7(s)-218.3(o)-1.1(f)-219.7(a)2.1(ge)-219.6(ha)-15.3(d)-205(C).3(HF.)]TJ
6.7246 0 0 5.9768 569.3101 685.9274 Tm
-.0226 Tc
(38)Tj
8.9663 0 0 8.9663 322.129 669.9967 Tm
0 Tc
[(Ba)28.7(se)29(d)-352.6(o)14.2(n)-345.9(d)14.2(at)25.9(a)-349.3(f)16.9(r)12.6(o)14.2(m)-348.8(t)14.8(he)-339.8(F)14.2(r)18.9(am)29.1(i)15.4(n)14.6(g)14.2(h)0(a)27.3(m)-348.8(H)14.7(e)0(a)28.1(l)15.4(t)14.8(h)-350.5(St)24.7(u)16.2(d)14.2(y)14.2(,)-349(t)14.8(h)0(e)-339.8(i)15.4(n)14.5(c)17(i)15.4(d)14.2(en)25.3(c)17(e)-349.7(o)14.2(f)]TJ
0 -1.3341 TD
-.0145 Tc
[(CHF)-272.2(a)2.9(pproac)-14.5(h)12.4(ed)-272.2(10)-265.9(pe)-14.5(r)-256.8(1)-.3(,000)-272.2(of)-263.2(th)-14.5(o)9.5(s)3.8(e)-269.3(ove)-14.5(r)-256.8(6)-.3(5)-265.9(y)-.3(e)-14.5(a)13.6(rs)-268.1(of)-263.2(a)-14.5(g)10.8(e)-269.3(i).9(n)-265.5(2002.)]TJ
6.7246 0 0 5.9768 569.3101 662.003 Tm
-.0226 Tc
(39)Tj
8.9663 0 0 8.9663 332.107 646.0723 Tm
0 Tc
[(The)-464.8(incidence)-464.7(of)-462.2(CHF)-461.3(varies)-461.5(considerably)-466.8(among)-465.5(racial/ethnic)]TJ
-1.1128 -1.3341 TD
[(groups,)-367(with)-367.4(a)-361.9(larger)-366.1(percentage)-369(of)-367.3(black)-365.4(males)-362.8(having)-369.6(CHF)-366.5(com-)]TJ
T*
[(pared)-329.3(with)-329.4(white)-331.3(males.)-332.5(Although)-331.3(the)-331.3(overall)-330.1(incidence)-338.2(is)-326.7(lower)-329.3(in)]TJ
T*
[(females)-335.2(than)-329(in)-330.4(males,)-332.5(the)-331.3(rate)-330.2(in)-330.4(black)-333.8(females)-335.2(tends)-332.1(to)-331.4(be)-329.2(higher)]TJ
T*
[(than)-316.4(that)-316.1(of)-316.7(while)-318.1(females.)-317.5(Annual)-316.1(incidence)-319.3(rates)-318.2(for)-316.8(heart)-314(failure)]TJ
0 -1.3278 TD
[()55.6(events)49.1()-393.3(per)-398.8(1,000)-399.9(population)-393.2(for)-399(white)-394.6(men)-399.4(is)-396.3(approximately)-395(15)]TJ
0 -1.3341 TD
[(cases)-247.1(for)-247.3(those)-248.3(6570)-251.6(years)-249.3(of)-240.9(age,)-249.8(32)-249.9(cases)-247.1(for)-247.3(those)-248.3(7584)-245.3(years)-249.3(of)]TJ
T*
[(age,)-237.2(and)-238.4(65)-230.9(cases)-240.7(for)-234.6(those)-235.7(older)-236.5(than)-240.5(85)-237.2(years)-236.7(of)-234.5(age.)-237.2(For)-237.3(black)-232.6(men)]TJ
T*
[(in)-311.4(the)-318.7(same)-315(age)-318.1(groups,)-316.4(the)-312.3(rates)-318.2(are)-313.4(approximately)-319.2(17,)-314.4(26,)-314.4(and)-314.3(51)]TJ
T*
[(cases)-468.4(per)-468.4(1,000,)-470.7(respectively.)-471.7(For)-471.3(white)-464.1(women)-470.2(in)-463.2(the)-470.4(same)-466.8(age)]TJ
T*
[(groups,)-442.9(the)-445.1(respective)-443.1(rates)-444.7(are)-439.8(8,)-442.4(20,)-440.8(and)-440.7(46,)-440.8(whereas)-441.7(for)-443.3(black)]TJ
T*
[(women)-185.7(in)-185(the)-185.9(same)-182.2(age)-185.3(groups,)-190(the)-185.9(respective)-190.2(rates)-185.4(are)-186.9(14,)-181.6(26,)-187.9(and)-187.8(44.)]TJ
T*
[(Although)-299.7(survival)-293.7(rates)-299.3(after)-294.3(CHF)-297(diagnosis)-294.4(have)-295.6(improved,)-298.9(overall)]TJ
0 -1.3278 TD
[(mortality)-375.4(remains)-373.6(high.)-375.6(It)-372.4(is)-371(estimated)-377.8(that)-373(approximately)-376.1(50%)-373.7(of)]TJ
0 -1.3341 TD
[(people)-287.4(diagnosed)-284.3(with)-278.8(heart)-282.4(failure)-281.1(will)-279(die)-282.2(within)-286.8(5)-276.7(years.)]TJ
6.7246 0 0 5.9768 543.0613 482.6833 Tm
(40)Tj
/F6 1 Tf
9.9626 0 0 9.9626 322.129 454.7904 Tm
[(CHF)-337.9(COST)]TJ
/F1 1 Tf
8.9663 0 0 8.9663 332.107 442.8282 Tm
[(Heart)-410.3(failure)-413.9(is)-408.9(a)-406.2(growing)-411(public)-413.4(health)-415(problem)-413(in)-406.3(the)-413.5(United)]TJ
-1.1128 -1.3341 TD
[(States,)-225.2(with)-221.9(high)-222.5(morbidity)-221.2(and)-225.7(mortality)-223.6(rates)-223.4(and)-219.4(frequent)-224.5(hospital)]TJ
T*
[(admissions.)-279.9(In)-271.5(2005,)-273.4(it)-273.2(was)-276.9(the)-274.4(primary)-275.1(reason)-279(for)-272.6(an)-271.5(estimated)-276.7(12)]TJ
T*
[(15)-230.9(million)-226.7(office)-231.4(visits)-226.1(and)-225.7(6.5)-232.2(million)-226.7(hospital)-228.2(days.)-234.4(In)-227.2(the)-223.8(Medicare)]TJ
0 -1.3278 TD
[(population,)-274.4(CHF)-271.7(is)-269.8(the)-268.1(leading)-271.2(cause)-274.4(for)-266.2(hospitalization,)-278.6(accounting)]TJ
0 -1.3341 TD
[(for)-316.8(more)-324(than)-316.4(1)-314.6(million)-321.5(admissions)-322.9(per)-316.6(year.)]TJ
6.7246 0 0 5.9768 491.7542 387.0424 Tm
(34)Tj
8.9663 0 0 8.9663 501.6188 383.0739 Tm
[(In)-315.7(2010,)-324(the)-318.7(annual)]TJ
-20.0183 -1.3341 TD
[(cost)-194.9(of)-196.6(heart)-200.2(failure)-192.6(for)-196.7(the)-198.5(nation)-193.6(was)-201.1(estimated)-194.5(at)-195.4($39)-195.7(billion.)]TJ
6.7246 0 0 5.9768 551.9054 375.0802 Tm
(41)Tj
8.9663 0 0 8.9663 560.6927 371.1117 Tm
(This)Tj
-26.6068 -1.3341 TD
[(includes)-194.3(the)-185.9(cost)-194.9(of)-184(medical)-195.3(services,)-187.6(medications,)-198(and)-187.8(missed)-189.7(days)-188.9(of)]TJ
T*
[(work.)-305.7(The)-306.7(percentage)-312(of)-304.1(heart)-307.7(failure)-306.4(costs)-303.1(in)-305.1(relation)-308.5(to)-306.1(total)-309(costs)]TJ
T*
[(for)-253.6(cardiovascular)-254.9(disease)-249.1(has)-251.6(increased)-254.8(from)-248.3(approximately)-255.9(24%)-247.2(to)]TJ
T*
[(37%.)-273.8(The)-268.7(largest)-269.7(percentage)-274.1(of)-266.2(costs)-271.5(is)-269.8(associated)-272.2(with)-272.5(hospital)-272.4(care)]TJ
T*
[(\(60%\),)-331.4(followed)-325.5(by)-332.1(nursing)-324.2(home)-326.7(care)-328(\(13%\),)-331.4(home)-326.7(healthcare)-332(and)]TJ
0 -1.3278 TD
[(medication)-227.7(\(9%)-220.6(each\),)-228(and)-219.4(physicians)-231.1(\(7%\).)]TJ
6.7246 0 0 5.9768 482.5132 303.3637 Tm
(42)Tj
8.9663 0 0 8.9663 491.5275 299.3952 Tm
[(In)-227.2(2009,)-222.8(the)-223.8(number)-223.7(of)]TJ
-18.8929 -1.3341 TD
[(hospitalizations)-341.3(per)-341.9(10,000)-341.4(population)-336.3(was)-340.2(34.8)-338.2(for)-335.8(persons)-339.9(4564)]TJ
T*
[(years)-280.9(of)-285.1(age)-280.2(and)-282.7(197.5)-279.7(for)-278.9(persons)-283(65)-281.5(years)-287.3(of)-278.8(age)-280.2(and)-282.7(older.)]TJ
6.7246 0 0 5.9768 551.1683 279.4393 Tm
(42)Tj
/F6 1 Tf
9.9626 0 0 9.9626 322.129 251.5464 Tm
[(CHF)-337.9(TEL)-8.8(EMONITO)-11.3(RING)]TJ
/F1 1 Tf
8.9663 0 0 8.9663 332.107 239.5842 Tm
-.0222 Tc
[(CHF)-286.2(i)-.4(s)-288.5(n)5(ot)-291.9(only)-286.2(a)-289.3(s)2.4(ource)-289.7(o)4.6(f)-289.9(d)-1.7(ifficult)5.3(y)-292.6(f)1(or)-287.8(pat)5.3(i)-.4(ents)-288.5(and)-286.2(t)-1.1(heir)-287.9(families,)]TJ
-1.1128 -1.3341 TD
-.022 Tc
[(but)-298(a)-4.6(l)6.1(s)-3.7(o)-298.7(a)-301.8(serious)-300.9(p)-1.5(ubl)6.1(i)-.2(c)-302.1(h).5(ealt)5.5(h)-303(b)-1.5(urden)-304.6(f)1.2(or)-300.3(society.)-301.5(CHF)-298.7(p)-1.5(atien)5.2(t)-.8(s)-300.9(s)-3.7(uffer)]TJ
T*
[(from)-269.6(a)-263.8(p)4.8(oor)-262.4(quality)-267.1(o)4.8(f)-264.4(life)-270.5(c)1.4(o)4.8(u).5(pled)-267.1(with)-265(short)-266.4(life)-264.2(e)1.4(xpectancy.)-263.5(T)-1.5(he)-264.2(high)]TJ
0 -1.3278 TD
-.0228 Tc
[(mortality)-463.9(r)-3.9(ate)-467.3(a)-5.4(ssociated)-470.2(with)-468.2(CHF)-463.9(e).6(m)-4.8(p)4(has)-4.5(i)-1(zes)-466.1(the)-467.3(n)-1.9(eed)-463.9(to)-470.2(identify)]TJ
0 -1.3341 TD
-.0232 Tc
[(modifia)-5.8(b)3.6(le)-246.4(risk)-250.3(factors)-245.2(a).6(nd)-243(deve)-6.2(lop)-249.3(e).2(ff)]TJ
15.1876 0 TD
-.0222 Tc
[(ective,)-244.8(efficient,)-238.5(timely,)-244.8(a)1.6(nd)-242(cost-)]TJ
-15.1876 -1.3341 TD
-.0229 Tc
[(efficient)-191.4(s)1.7(trategies)-188(f).3(or)-187.4(the)-189.2(m)1.4(a)-5.5(n)4.3(ageme)-5.9(n)4.3(t)-191.4(o)-2.4(f)-189.4(C)-1(HF)-192.1(in)-185.4(the)-189.2(g)-2.4(eneral)-190.8(population.)]TJ
T*
[(The)-328.4(e).4(s)-4.7(s)1.6(ential)-330(eleme)-6(n)4.2(t)-330.6(o)-2.5(f)-328.6(t)-1.9(elem)-5(onitor)]TJ
14.6502 0 TD
-.0252 Tc
[(i)-3.4(n)2(g)-333.5(i)-3.4(s)-335.7(t)-4.1(h)-2.7(e)-330.6(re)-8.2(li)-3.4(an)-4.3(ce)-337(o)-4.7(n)-333.1(in)-4.3(fo)-4.7(rma)-7.8(t)2.3(i)-3.4(o)-4.7(n)]TJ
-14.6502 -1.3341 TD
-.0217 Tc
[(technol)6.4(ogy)-513.4(fo)5.1(r)-515(c)1.7(on)5.5(necting)-507(p)-1.2(atient)5.8(s)-515.6(a)2.1(n)5.5(d)-513.4(provi)6.4(ders)-509.3(in)-506.7(a)-510.1(c)-4.7(o)5.1(o)-1.2(rdinated)]TJ
T*
-.0236 Tc
[(system)-258.6(of)-253.3(c)-6.6(a).2(re,)-258.8(d)3.2(e)-6.6(s)1(cribed)-256(earlie)-6.6(r.)-252.5(Te)]TJ
13.9863 0 TD
-.0222 Tc
[(lemonit)5.3(o)-1.7(ring)-254.6(fig)4.6(u).3(res)-250.5(p)-1.7(rominent)5.3(ly)-254.6(as)]TJ
-13.9863 -1.3341 TD
-.0234 Tc
[(an)-280.7(effic)-6.4(i)4.7(e)-6.4(n)3.8(t)-280.5(a).4(nd)-281.1(effe)-6.4(ctive)-284.6(m).9(odel)-286.2(in)-280.7(the)-284.6(m).9(anage)-6.4(m).9(ent)-280.5(o)3.4(f)-284.8(C)-1.5(HF.)]TJ
/F6 1 Tf
9.9626 0 0 9.9626 322.129 107.5464 Tm
0 Tc
[(EVIDEN)-11.7(CE)-332.8(OF)-337.3(THE)-340.8(IMPACT)-340.2(OF)-337.3(TEL)-8.8(EMONITO)-11.3(RING)]TJ
0 -1.195 TD
[(FOR)-341.8(PATIENT)-11.1(S)-330(WIT)-9.6(H)-331.6(CHF)]TJ
/F1 1 Tf
8.9663 0 0 8.9663 332.107 83.6787 Tm
[(O)18(u)0(r)-287.4(l)0(i)24.6(t)14.8(e)17(r)12.6(a)17.4(t)14.8(ur)28.8(e)-305.4(s)18.3(ea)28.1(r)12.6(c)17(h)-306.3(f)16.9(o)14.2(r)-303.6(t)14.8(e)0(l)26.2(e)17(mo)25.8(n)14.6(i)15.4(t)14.8(o)14.2(r)18.9(i)0(n)23.7(g)-302(a)17.4(n)14.6(d)-302(C)0(H)24(F)-302(y)14.2(i)15.4(el)26.2(d)14.2(e)17(d)-302(a)0(n)-290.5(i)15.4(n)14.5(i)15.4(t)14.8(i)15.4(al)]TJ
-1.1128 -1.3341 TD
-.0149 Tc
[(tota)-14.9(l)-190.7(o)-.7(f)-206.7(436)-203.1(public)-14.9(a)13.2(t)-.1(ions)-14.9(.)-193.9(O)3.1(f)-206.7(t)-.1(he)-14.9(s)14.1(e)-14.9(,)-195.1(o)-.7(nly)-203.1(1)-.7(9)-203.1(m)-14.9(e)13.8(t)-208.7(the)-206.5(c)2.1(rite)-14.9(r)14.7(i).5(a)-206.1(f)1.9(or)-204.7(inc)-14.9(l)11.2(us)-14.9(i)12.5(o)-.7(n)]TJ
ET
q
1 i
50.173 92.693 m
304.214 92.693 l
304.214 71.717 l
50.173 71.717 l
W n
0 0 0 1 K
1 J 1 j .227 w 10 M []0 d
q 1 0 0 1 48.189 92.693 cm 0 0 m
536.655 0 l
S
Q
Q
BT
5.9774 0 0 5.3127 50.1732 86.2299 Tm
0 Tc
(a)Tj
7.9702 0 0 7.9702 53.0079 82.6583 Tm
[(For)-547.9(a)-545.3(more)-537.3(complete)-541.7(review)-540.6(of)-548.3(CHF)-546.7(epidemiolo)9.7(gy,)-542(see)-549.1(Mahmood)-536.6(and)]TJ
-.3557 -1.3728 TD
(Wang,)Tj
5.9774 0 0 5.3127 71.6031 75.2314 Tm
(33)Tj
7.9702 0 0 7.9702 79.7669 71.7165 Tm
[(Rathi)-248(and)-248.6(Deedw)10(ania,)]TJ
5.9774 0 0 5.3127 151.8803 75.2314 Tm
(34)Tj
7.9702 0 0 7.9702 160.1007 71.7165 Tm
[(Zarrinko)12.7(ub)-247.8(et)-251.1(al.,)]TJ
5.9774 0 0 5.3127 217.1338 75.2314 Tm
(35)Tj
7.9702 0 0 7.9702 225.2976 71.7165 Tm
[(and)-248.6(Wong)-240.6(and)-248.6(Felker.)]TJ
5.9774 0 0 5.3127 297.9779 75.2314 Tm
(36)Tj
/F11 1 Tf
11.9551 0 0 11.9551 50.1732 741.9966 Tm
[(BASHSHUR)-338.5(ET)-334.1(AL.)]TJ
7.9702 0 0 7.9702 50.1732 29.7638 Tm
[(7)-80(7)-80.1(4)-699.6(TELEMEDICINE)-323.9(and)-331.8(e-HEALT)11.5(H)]TJ
/F8 1 Tf
6.9738 0 0 6.9738 176.7118 29.7638 Tm
.1095 Tc
[(SEPT)6.6(EMBER)-333.2(2).1(0)6.8(1)0(4)]TJ
ET
q
1 i
0 792 612 -791.985 re
W n
32.315 .014984 .22675 791.985 re
f
/Document /MC4 BDC
Q
q
1 i
0 792 32.315 -173.367 re
W n
0 0 0 .29999 k
0 618.633 32.315 173.367 re
f
EMC
Q
32.315 763.994 242.646 .22675 re
f
endstream
endobj
201 0 obj
<>stream
Adobe Illustrator CS4
2010-08-04T11:54:42+05:30
2010-08-04T11:54:42+05:30
2010-08-04T11:54:42+05:30
68
256
JPEG
/9j/4AAQSkZJRgABAgEASABIAAD/7QAsUGhvdG9zaG9wIDMuMAA4QklNA+0AAAAAABAASAAAAAEA
AQBIAAAAAQAB/+4ADkFkb2JlAGTAAAAAAf/bAIQABgQEBAUEBgUFBgkGBQYJCwgGBggLDAoKCwoK
DBAMDAwMDAwQDA4PEA8ODBMTFBQTExwbGxscHx8fHx8fHx8fHwEHBwcNDA0YEBAYGhURFRofHx8f
Hx8fHx8fHx8fHx8fHx8fHx8fHx8fHx8fHx8fHx8fHx8fHx8fHx8fHx8fHx8f/8AAEQgBAABEAwER
AAIRAQMRAf/EAaIAAAAHAQEBAQEAAAAAAAAAAAQFAwIGAQAHCAkKCwEAAgIDAQEBAQEAAAAAAAAA
AQACAwQFBgcICQoLEAACAQMDAgQCBgcDBAIGAnMBAgMRBAAFIRIxQVEGE2EicYEUMpGhBxWxQiPB
UtHhMxZi8CRygvElQzRTkqKyY3PCNUQnk6OzNhdUZHTD0uIIJoMJChgZhJRFRqS0VtNVKBry4/PE
1OT0ZXWFlaW1xdXl9WZ2hpamtsbW5vY3R1dnd4eXp7fH1+f3OEhYaHiImKi4yNjo+Ck5SVlpeYmZ
qbnJ2en5KjpKWmp6ipqqusra6voRAAICAQIDBQUEBQYECAMDbQEAAhEDBCESMUEFURNhIgZxgZEy
obHwFMHR4SNCFVJicvEzJDRDghaSUyWiY7LCB3PSNeJEgxdUkwgJChgZJjZFGidkdFU38qOzwygp
0+PzhJSktMTU5PRldYWVpbXF1eX1RlZmdoaWprbG1ub2R1dnd4eXp7fH1+f3OEhYaHiImKi4yNjo
+DlJWWl5iZmpucnZ6fkqOkpaanqKmqq6ytrq+v/aAAwDAQACEQMRAD8A6dhQ7FXYq7FXYq7FXYq7
FUZ/0qf+jj/jTFUHirsVdirsVdirsVdirsVRn/Sp/wCjj/jTFUHirsVdirsVdirsVdirsVRn/Sp/
6OP+NMVQeKuxV2KuxV2KuxV2KuxVGf8ASp/6OP8AjTFUHirsVdirsVdirsVdirsVRn/Sp/6OP+NM
VQeKuxV2KuxV2KuxV2KuxVGf9Kn/AKOP+NMVQeKuxV2KuxV2KuxV2KuxVGf9Kn/o4/40xVB4q7FX
Yq7FXYq7FXYq7FUZ/wBKn/o4/wCNMVQeKuxV2KuxV2KuxV2KuxVGf9Kn/o4/40xVB4q7FXYq7FXY
q7FXYq7FUZ/0qf8Ao4/40xVB4q7FXYq7FXYq7FXYq7FUZ/0qf+jj/jTFUHirsVdirsVdirsVdirs
VRn/AEqf+jj/AI0xVB4q7FXYq7FXYq7FXYq7FUZ/0qf+jj/jTFUHirsVdirsVdirsVdirsVRn/Sp
/wCjj/jTFUHirsVdirsVdirsVdirsVRn/Sp/6OP+NMVQeKuxV2KuxV2KuxV2KuxVGf8ASp/6OP8A
jTFUHirsVdirsVdirsVdirsVRn/Sp/6OP+NMVQeKuxV2KuxV2KuxV2KuxVGf9Kn/AKOP+NMVQeKu
xV2KuxV2KuxV2KuxVGf9Kn/o4/40xVB4q7FXYq7FXYq7FXYq7FUZ/wBKn/o4/wCNMVQeKuxV2Kux
V2KuxV2KuxVGf9Kn/o4/40xVB4q7FXYq7FXYq7FXYq7FUZ/0qf8Ao4/40xVB4q7FXYq7FXYq7FXY
q7FUZ/0qf+jj/jTFUHirsVdirsVdirsVdirsVRn/AEqf+jj/AI0xVB4q7FXYq7FXYq7FXYq7FUZ/
0qf+jj/jTFUHirsVdirsVdirsVdirsVRn/Sp/wCjj/jTFUHirsVdirsVdirsVdirsVRn/Sp/6OP+
NMVQeKuxV2KuxV2KuxV2KuxVGf8ASp/6OP8AjTFUHirsVdirsVdirsVdirsVRn/Sp/6OP+NMVQeK
uxV2KuxV2KuxV2KuxVGf9Kn/AKOP+NMVQeKuxV2KuxV2KuxV2KuxVGf9Kn/o4/40xVB4q7FXYq7F
XYq7FXYq7FUZ/wBKn/o4/wCNMVf/2Q==
application/postscript
saved
xmp.iid:11FB61F30AB7DE11AEB3E861853EAFA4
2009-10-12T14:15:50+05:30
Adobe Illustrator CS4
/
converted
from application/postscript to application/vnd.adobe.illustrator
converted
from application/postscript to application/vnd.adobe.illustrator
saved
xmp.iid:0280117407206811994CBE3149FFDB59
2010-08-04T11:54:42+05:30
Adobe Illustrator CS4
/
converted
from application/postscript to application/vnd.adobe.illustrator
xmp.iid:11FB61F30AB7DE11AEB3E861853EAFA4
xmp.did:11FB61F30AB7DE11AEB3E861853EAFA4
uuid:ee5a72b3-04e4-4157-a8d8-c3a8817872a3
uuid:ee5a72b3-04e4-4157-a8d8-c3a8817872a3
xmp.iid:0280117407206811994CBE3149FFDB59
xmp.did:0280117407206811994CBE3149FFDB59
TouchUp 7.0
False
False
1
684.000000
864.000000
Points
Black
Default Swatch Group
0
PANTONE 3025 C
SPOT
100.000000
CMYK
100.000000
16.859999
0.000000
50.980003
endstream
endobj
198 0 obj
<>
endobj
202 0 obj
<>/XObject<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]/Font<>>>/Thumb 204 0 R/MediaBox[0 0 612 792]/Rotate 0>>
endobj
205 0 obj
<>/ProcSet[/PDF/Text]/Font<>>>
endobj
203 0 obj
<>stream
/GS1 gs
BT
/F1 1 Tf
8.9663 0 0 8.9663 35.8866 693.8644 Tm
0 0 0 1 k
0 Tc
0 Tw
[(i)15.4(n)-251(t)14.8(h)0(e)-245(f)16.9(i)15.4(n)14.6(al)-239(an)25.7(a)17.4(l)15.4(y)14.2(s)0(i)27.4(s)0(.)-242.2(I)17.5(n)-257.3(a)17.4(d)14.2(d)14.2(i)15.4(t)14.8(i)15.4(o)14.2(n)14.6(,)-260.5(w)16.2(e)-254.8(e)17(n)14.6(c)0(o)24.9(u)16.2(n)14.6(t)14.8(er)29.6(ed)-240.7(3)14.2(5)-257.7(l)15.4(i)15.4(t)14.8(er)29.6(at)25.9(u)16.2(r)12.6(e)-254.8(r)12.6(e)17(v)14.2(i)15.4(e)0(w)26.9(s)]TJ
0 -1.3278 TD
-.0153 Tc
[(and)-190.8(1)-190.8(r)-2.7(evie)-15.3(w)-178.1(o)-1.1(f)-194.5(r)3.6(e)-15.3(v)9.6(iews)-15.3(.)-181.7(W)-.8(e)-187.9(d)-1.1(id)-190.8(not)-190.2(i).1(nc)-15.3(l)10.9(u).9(de)-194.3(the)-194.3(literatu)-15.3(r)13.5(e)-194.3(r)3.6(e)-15.3(v)9.6(iew)-15.3(s)-176.9(in)-190.4(ou)-15.3(r)]TJ
0 -1.3341 TD
0 Tc
[(a)17.4(n)14.6(a)17.4(l)15.4(y)14.2(s)0(i)27.4(s)-386.4(b)14.2(e)17(ca)28.1(u)16.2(s)0(e)-369.4(o)14.2(ur)-369.6(i)15.4(n)14.6(cl)26.2(u)16.2(s)0(i)27.4(o)14.2(n)-383.8(c)17(r)12.6(i)15.4(t)14.8(e)17(r)12.6(i)15.4(a)-380.9(e)0(x)25.3(c)17(l)15.4(u)0(d)24(e)17(d)-384.2(s)0(e)29(v)14.2(e)17(r)12.6(al)-371.8(s)18.3(t)14.8(ud)30.4(ie)26.2(s)-386.4(t)14.8(h)16.2(a)17.4(t)]TJ
T*
[(w)16.2(e)17(r)12.6(e)-311.7(i)15.4(n)14.6(c)17(l)15.4(u)16.2(d)14.2(ed)-297.6(i)15.4(n)-307.9(t)14.8(h)16.2(es)29(e)-311.8(r)18.9(ev)24.9(i)15.4(e)17(ws)28.1(.)-311.1(S)16.2(i)15.4(g)14.2(n)14.6(i)15.4(fi)26(c)17(a)0(n)25.7(t)-307.6(n)14.6(u)16.2(m)18(b)14.2(er)29.6(s)-310.5(o)14.2(f)-305.6(t)14.8(he)-295.6(st)26.8(u)16.2(d)14.2(i)15.4(e)0(s)-293.5(i)15.4(n)]TJ
T*
-.0153 Tc
[(our)-280.9(a)2.1(na)-15.3(l)11.2(y)-1.1(sis)-281.6(w)-15.3(e)11.6(r)-2.7(e)-282.8(n)-.7(ot)-278.7(lim)-15.3(i)11.8(t)-.5(ed)-285.7(to)-279.3(he)-15.3(a)12.8(r)-2.7(t)-278.7(f)-15.3(a)12.7(ilure)-15.3(,)-265.1(a)-15.3(n)10.4(d)-279.3(the)-15.3(y)-268.6(inc)-15.3(l)10.9(ude)-15.3(d)-268.6(othe)-15.3(r)]TJ
T*
0 Tc
[(c)17(h)16.2(r)12.6(o)14.2(n)14.6(i)15.4(c)-267.5(d)14.2(i)15.4(s)18.3(ea)28.1(se)29(s,)-254.9(a)17.4(l)15.4(t)14.8(h)0(o)30.4(u)0(g)24(h)-262(n)14.6(o)14.2(t)-269.7(c)17(o)14.2(n)14.6(si)27.4(s)18.3(t)14.8(en)25.3(t)14.8(l)15.4(y)-264(t)14.8(h)16.2(e)-267.5(sa)29.4(me)-249.5(se)29(t)14.8(.)]TJ
1.1065 -1.3341 TD
[(This)-207.8(report)-199.2(is)-206.6(based)-203.5(on)-198.9(the)-204.9(findings)-199(from)-204(the)-204.9(select)-203.9(set)-202.8(of)-202.9(19)-199.3(studies)]TJ
-1.1065 -1.3341 TD
[(\(shown)-354.2(in)]TJ
/F5 1 Tf
4.5399 0 TD
[(Table)-353.8(1)]TJ
/F1 1 Tf
3.1109 0 TD
[(\),)-352.6(dating)-358.4(from)-355.8(2000)-354.3(to)-356.7(2013)-354.3(in)-355.7(10)-357.4(countries)-353.1(\(the)]TJ
-7.6507 -1.3341 TD
[(United)-322.3(States,)-326.3(the)-325(United)-328.6(Kingdom,)-327.5(Canada,)-328.3(Germany,)-322.8(France,)-325.8(Bel-)]TJ
0 -1.3278 TD
[(gium,)-449.7(The)-452.1(Netherlands,)-461.3(Italy,)-453.1(China,)-453.2(and)-453.4(Argentina\).)-455.5(Forty-seven)]TJ
0 -1.3341 TD
[(percent)-278.5(of)-285.1(these)-283.4(studies)-284.1(were)-278.6(conducted)-284.5(in)-279.8(the)-287.1(United)-278(States.)]TJ
1.1065 -1.3341 TD
[(As)-293.8(a)-292.4(prelude)-298.1(to)-293.5(the)-299.7(report)-294.1(of)-291.4(the)-299.7(findings)-293.9(from)-292.5(these)-296(studies,)-298.1(it)-292.2(is)]TJ
-1.1065 -1.3341 TD
[(important)-313(to)-318.8(point)-312.6(out)-321.5(again)-313(significant)-319.2(methodological)-319.8(issues)-313.8(that)]TJ
T*
[(may)-336.2(have)-339.8(a)-336.7(direct)-338.9(bearing)-337.3(on)-338(their)-341.3(findings.)-339.4(With)-337.4(four)-338.6(exceptions,)]TJ
T*
[(these)-403.5(studies)-404.3(used)-402.2(the)-400.9(RCT)-401.6(research)-409.3(design.)-400.8(Three)-403.5(of)-405.3(the)-400.9(four)-401.8(ex-)]TJ
T*
[(ceptions)-209.6(used)-206.2(a)-203.9(case)-208.4(control)-207.1(design)-209.9(in)-204(which)-203.5(cases)-209.1(in)-204(the)-211.2(intervention)]TJ
T*
[(group)-497.8(were)-493.6(matched)-498.7(prospectively)-503.4(or)-498.1(retrospectively)-504.7(to)-495.8(create)-498.4(a)]TJ
0 -1.3278 TD
[(control)-219.7(or)-226.2(comparison)-223.6(group.)-227.2(One)-222.3(large)-220.6(study)-225.9(in)-222.9(the)-217.5(United)-227.4(Kingdom)]TJ
0 -1.3341 TD
[(used)-212.5()55.6(cluster)-212.4(randomization)53()-209.9(i)0(n)-210.3(which)-216.2(whole)-211.9(groups)-214(of)-209.3(patients)-208.6(were)]TJ
T*
[(randomized)-288.1(on)-293.8(the)-293.4(basis)-289.5(of)-291.4(their)-290.7(usual)-289.5(sources)-291.1(of)-291.4(care.)-291.3(This)-290(method)]TJ
T*
[(does)-322.1(not)-329.5(assure)-323.9(the)-325(same)-327.7(level)-325.5(of)-329.4(randomization)-325.1(as)-324.7(individual)-328.1(case)]TJ
T*
(randomization.)Tj
1.1065 -1.3341 TD
[(Sample)-211.6(sizes)-211.1(of)-209.3(the)-204.9(studies)-214.6(included)-211.1(here)-209(ranged)-207.3(from)-210.4(a)-210.2(low)-207.2(of)-209.2(160)]TJ
-1.1065 -1.3341 TD
[(to)-388.3(a)-387.2(high)-386.9(of)-392.6(17,025.)-393.3(The)-388.9(most)-390(critical)-387(problem)-394(in)-387.3(interpreting)-391.9(the)]TJ
T*
[(findings)-281.2(has)-283.2(to)-287.2(do)-281.5(with)-285.2(the)-287.1(variation)-281.3(along)-284.7(several)-286.4(different)-290.6(dimen-)]TJ
0 -1.3278 TD
[(sions)-298.7(in)-292.5(which)-304.7(the)-293.4(intervention)-301.4(was)-302.2(applied.)-298.1(From)-301.6(one)-295.7(study)-301.8(to)-293.5(an-)]TJ
0 -1.3341 TD
[(other,)-792.7(the)-792.9(intervention)-794.6(varied)-794.4(by)-793.6(technology,)-791.6(provider)-796.2(mix,)]TJ
T*
[(frequency,)-443.4(and)-447(duration)-443.4(as)-444.8(well)-448.1(as)-444.8(the)-438.8(illness)-448.3(severity)-445.6(in)-444.2(patient)]TJ
T*
[(populations.)-357.3(From)-358.5(a)-355.6(technology)-360.4(standpoint,)-354.7(they)-361.4(used)-351.6(a)-355.6(variety)-362.3(of)]TJ
T*
[(devices)-234.6(and)-238.4(various)-239.5(configurations)-239.6(of)-234.5(telephone,)-240.2(videoconferencing,)]TJ
T*
[(and)-213.1(automated)-216.4(devices.)-216.9(Staffing)-215.1(varied)-212.7(from)-216.7(nurses)-212.9(using)-218.6(telephones)]TJ
T*
[(to)-457.9(visiting)-465.7(nurses)-465.9(who)-459.3(conducted)-467.8(home)-465.8(visits)-460(to)-464.2(physicians.)-466.3(The)]TJ
T*
[(frequency)-347.3(of)-348.4(monitoring)-345.4(was)-346.5(typically)-348.8(daily)-353.3(but)-346.8(varied)-345.5(from)-349.5(twice)]TJ
0 -1.3278 TD
[(daily)-321.7(to)-325.1(every)-329.7(3)-327.3(weeks.)-324.3(The)-325.6(duration)-329.6(of)-323.1(observations)-333.4(varied)-326.5(from)-324.2(a)]TJ
0 -1.3341 TD
[(low)-327.3(of)-329.4(3)-327.3(months)-334(to)-325.1(26)-332.1(months,)-329(typically)-336.1(12)-325.8(months.)-329(Patient)-334(popu-)]TJ
T*
[(lations)-313.5(varied)-313.9(from)-317.8(young)-318.8(and)-314.3(middle-aged)-315.9(adults)-321(\(18)-310.3(years)-318.9(of)-316.7(age)]TJ
T*
[(and)-213.1(over\))-223.8(to)-217.6(older)-217.5(adults)-219.8(\(65)]TJ
/F9 1 Tf
11.7227 0 TD
(+)Tj
/F1 1 Tf
.9358 0 TD
[(years)-224(of)-215.6(age\))-220.5(to)-217.6(the)-217.5(elderly)-216.6(\(75)]TJ
/F9 1 Tf
12.551 0 TD
(+)Tj
/F1 1 Tf
.9358 0 TD
(years)Tj
-26.1452 -1.3341 TD
[(of)-196.6(age\).)-209.1(Some)-200.2(studies)-201.9(selected)-210.6(only)-200.9(patients)-202.3(classified)-207.7(as)-198.2(I)-203.8(o)0(r)-200.9(I)0(I)-199(\(mildly)]TJ
T*
[(impaired\))-252.4(on)-255.8(the)-255.4(NYHA)-251.9(scale,)-257.5(whereas)-252(some)-255(selected)-261.2(only)-251.5(Classes)-252.8(III)]TJ
T*
[(and)-307.9(IV)-302.9(\(moderately)-316.7(to)-306.1(seriously)-313.7(impaired\).)-310.6(One)-304.5(study)-314.4(selected)-311.8(older)]TJ
T*
[(adults)-472.7(with)-474.8(multiple)-474.2(health)-478.3(issues.)-473.2(Moreover,)-476.6(some)-476.3(interventions)]TJ
0 -1.3278 TD
[(included)-356.5(educational)-363.8(content)-360.9(and/or)-359.2(medication)-360.4(management,)-356.8(and)]TJ
0 -1.3341 TD
[(some)-293(were)-291.3(limited)-294.4(to)-293.5(reporting)-300.5(of)-291.5(vital)-295.8(signs)-292.4(and)-289(responses)-298.3(to)-293.5(stan-)]TJ
T*
[(dard)-257.8(inquiries.)-254.2(Hence,)-262.3(generalization)-263.5(across)-256.4(studies)-258.9(is)-257.1(neither)-259.1(simple)]TJ
T*
[(nor)-281.2(straightforward.)]TJ
1.1065 -1.3341 TD
[(We)-202.4(paid)-198(particular)-201(attention)-203.8(to)-198.6(findings)-205.4(pertaining)-197.6(to)-205(the)-198.5(effects)-204.6(of)]TJ
-1.1065 -1.3341 TD
[(telemonitoring)-344.3(on)-344.3(cost-intensive)-349.5(phases)-347.6(of)-342(medical)-347.1(care,)-348.2(including)]TJ
T*
[(emergency)-256.8(department)-262.8(visits,)-259(hospital)-259.8(admissions)-259.7(\(for)-257.1(CHF)-252.7(only)-257.8(and)]TJ
T*
[(for)-443.3(all)-444.9(causes\),)-450.7(and)-440.7(length)-451.6(of)-443.2(hospital)-449.5(stay.)-448.7(We)-442.7(also)-446.9(paid)-444.6(special)]TJ
0 -1.3278 TD
[(attention)-355.6(to)-363(health)-358.1(outcomes,)-358.5(typically)-361.4(measured)-362.5(in)-355.7(terms)-362(of)-354.7(mor-)]TJ
0 -1.3341 TD
[(tality.)-200(Where)-207.2(reported,)-207.2(satisfaction)-203.8(with)-203(service)-204.6(and)-200.5(quality)-208.5(of)-202.9(life)-200.8(are)]TJ
T*
[(also)-345.7(included)-356.5(in)-349.4(our)-349.1(discussion)-350.4(of)-354.7(findings.)-352.1(As)-344.3(it)-355.4(turned)-346.9(out,)-354.4(some)]TJ
T*
[(studies)-277.8(investigated)-280.6(the)-280.7(effects)-280.4(of)-278.8(telemonitoring)-281(on)-274.8(several)-280.1(chronic)]TJ
30.331 69.3307 TD
[(diseases)-496.4(simultaneously,)-496.7(including)-495.3(CHF.)-494.2(When)-494.2(this)-491.7(occurred,)-500.1(we)]TJ
0 -1.3278 TD
[(reported)-281.8(their)-284.3(findings)-281.2(in)-279.8(one)-283(place)-285.6(only.)]TJ
/F6 1 Tf
9.9626 0 0 9.9626 307.8424 658.0344 Tm
[(THE)-340.8(OBSERV)-10.3(ED)-333.8(EFFEC)-9.7(TS)-333.6(OF)-337.3(CHF)-337.9(TEL)-8.8(EMONITO)-11.3(RING)]TJ
/F1 1 Tf
8.9663 0 0 8.9663 317.8204 646.0723 Tm
[(One)-228.6(of)-234.5(the)-230.1(earlier)-233.9(landmark)-231.4(studies)-233.6(was)-226.4(conducted)-240.2(in)-229.2(California)-230.8(at)]TJ
-1.1128 -1.3341 TD
[(Kaiser)-234.7(Permanente)-234.5(in)-235.6(the)-236.5(late)-232.5(1990s)-234.9(\(published)-241.8(in)-229.3(2000\))-237.7(by)-230.9(Johnston)]TJ
T*
[(et)-227.4(al.)]TJ
6.7246 0 0 5.9768 325.644 626.1164 Tm
(43)Tj
8.9663 0 0 8.9663 334.6582 622.1479 Tm
[(It)-227(was)-226.4(based)-228.8(on)-224.2(a)-222.8(quasi-experimental)-235(design,)-223.8(and)-225.7(it)-229(evaluated)]TJ
-2.9907 -1.3341 TD
[(the)-318.7(effects)-318.4(of)-323.1(a)-317.7(videoconferencing)-321.8(system)-323.1(that)-316.1()55.6(allowed)-321.4(nurses)-320.4(and)]TJ
T*
[(patients)-417.2(to)-407.3(interact)-413.8(in)-412.6(real-time.)50.6()]TJ
6.7246 0 0 5.9768 435.7416 602.2487 Tm
(43)Tj
8.9663 0 0 8.9663 446.4566 598.2234 Tm
[(Both)-411.4(intervention)-415.2(and)-409.1(control)]TJ
-15.4595 -1.3278 TD
[(groups)-378.4(received)-381.3(home)-383.6(visits)-377.8(and)-377.5(telephone)-378(contact)-383.3(by)-376.3(nurses.)-378.6(The)]TJ
0 -1.3341 TD
[(study)-592.6(reported)-591.6(no)-590.9(differences)-594.6(in)-583.3(quality)-594.2(indicators)-592.2(\(medication)]TJ
T*
[(compliance,)-296.3(knowledge)-294.1(of)-291.5(disease,)-294.6(and)-289(ability)-291.5(for)-291.5(self-care\),)-295.5(patient)]TJ
T*
[(satisfaction,)-192.5(or)-188.3(use)-188.8(of)-190.3(service.)-193.2(However,)-192.6(the)-192.2(study)-187.9(reported)-193.3(significant)]TJ
T*
[(differences)-189.9(in)-185(direct)-187.1(cost)-182.3(between)-186.4(the)-185.9(intervention)-187.6(and)-187.8(control)-188.1(groups)]TJ
T*
[(\($1,167)-324(versus)-327.1($1,830\))-324(as)-324.7(well)-321.6(as)-318.4(total)-328(cost)-321.4(\($1,948)-324(versus)-327.1($2,674\).)]TJ
T*
[(\(These)-186.4(figures)-186.7(are)-180.6(based)-184.5(on)-179.9(1997)-183.6(dollars)-183.4(and)-181.5(do)-186.6(not)-184.1(include)-181(the)-185.9(cost)-182.3(of)]TJ
T*
[(home)-282.4(health)-282.3(services.\))]TJ
1.1128 -1.3278 TD
[(In)-366.3(2002,)-374.6(another)-373.8(study)-371.3(in)-368.4(California)-376.3(\(RCT,)]TJ
/F5 1 Tf
18.425 0 TD
(n)Tj
/F9 1 Tf
.7082 0 TD
(=)Tj
/F1 1 Tf
.7208 0 TD
[(358:)-370(intervention)]TJ
-20.9668 -1.3341 TD
(group,)Tj
/F5 1 Tf
2.9022 0 TD
(n)Tj
/F9 1 Tf
.7082 0 TD
(=)Tj
/F1 1 Tf
.7145 0 TD
[(130;)-205.6(usual)-201(care)-207.8(group,)]TJ
/F5 1 Tf
9.3263 0 TD
(n)Tj
/F9 1 Tf
.7082 0 TD
(=)Tj
/F1 1 Tf
.7208 0 TD
[(228\))-201.3(investigated)-211(the)-198.5(effects)-204.6(of)-202.9(a)]TJ
-15.0801 -1.3341 TD
[(nurse)-534.7(case)-537.2(management)-538.9(telephone)-542.4(intervention)-535.4(on)-540.3(resource)-539(use)]TJ
T*
[(among)-440.2(patients)-442.5(with)-443.2(CHF.)]TJ
6.7246 0 0 5.9768 409.4928 458.7589 Tm
(44)Tj
8.9663 0 0 8.9663 420.4345 454.7904 Tm
[(Outcome)-447.5(measures)-440.6(included)-445(hospital)]TJ
-12.5573 -1.3341 TD
[(admissions)-202.8(and)-206.8(re-admissions,)-204.7(length)-205(of)-202.9(stay,)-202.2(emergency)-206.2(department)]TJ
T*
[(visits,)-233.7(and)-225.7(inpatient)-228.5(costs)-233.6(as)-223.5(well)-233.1(as)-229.9(patient)-226.9(satisfaction.)-230.4(The)-230.8(findings)]TJ
T*
[(from)-532.8(this)-529.6(study)-535.7(demonstrated)-533.8(that)-531.1(telephonic)-539.6(case)-530.9(management)]TJ
T*
[(provided)-212.9(by)-211.9(registered)-213.6(nurses)-212.9(using)-212.2(decision)-209(support)-211.8(software)-214.1(during)]TJ
0 -1.3278 TD
[(the)-287.1(early)-283.8(months)-283.4(following)-280.9(a)-286.1(heart)-282.4(failure)-281.1(hospitalization)-290(was)-283.3(asso-)]TJ
0 -1.3341 TD
[(ciated)-403.6(with)-399(significant)-401.4(cost)-397.3(savings)-399.9(\(lower)-402.4(re-hospitalization)-404.5(rates)]TJ
T*
[(and)-244.7(use)-239.3(of)-240.9(other)-247.7(resources\).)-247.4(As)-236.9(well,)-247(patients)-246.5(reported)-243.9(being)-240.8(satisfied)]TJ
T*
[(with)-304.1(the)-306(intervention,)-309(which)-311(proved)-305.8(useful)-304.7(in)-305.1(addressing)-311.8(predictors)]TJ
T*
[(associated)-537.8(with)-531.7(CHF)-537.2(hospitalization,)-537.9(such)-533(as)-533.4(poor)-533(adherence)-533.5(to)]TJ
T*
[(medication)-328.8(regimens)-328.2(and)-320.6(to)-325.1(dietary)-330.7(recommendations,)-326.9(and)-326.9(insuffi-)]TJ
T*
[(cient)-458.6(knowledge)-464.8(of)-455.8(symptoms)-464.6(of)-455.8(worsening)-463.8(illness.)-455.9(Heart)-460.9(failure)]TJ
T*
[(hospitalizations)-221.2(in)-216.6(the)-211.2(intervention)-219.2(group)-219.6(were)-215.4(significantly)-220.1(lower)-215.5(at)]TJ
0 -1.3278 TD
[(3)-188.2(months)-182.3(\(45.7%\))-190.8(and)-187.8(at)-182.7(6)-188.2(months)-182.3(\(47.8%\).)-192.1()55.6(There)-189.8(was)-182.1(no)-186.3(evidence)-189.7(of)]TJ
0 -1.3341 TD
[(cost)-466.8(shifting)-468.6(to)-470.5(the)-464.1(outpatient)-472.5(setting.)49.7()]TJ
6.7246 0 0 5.9768 461.14 291.4015 Tm
(44)Tj
8.9663 0 0 8.9663 472.3085 287.433 Tm
[(In)-467.5(addition,)-469.1(both)-465.4(heart)]TJ
-18.3428 -1.3341 TD
[(failurerelated)-386(hospital)-379.9(days)-378.6(and)-377.5(multiple)-379.3(re-admissions)-380.5(were)-379.8(sig-)]TJ
T*
[(nificantly)-299.5(lower)-291.4(in)-292.5(the)-299.7(intervention)-295.1(group)-295.5(at)-296.5(6)-289.3(months.)-297.3(The)-294(authors)]TJ
T*
[(concluded)-454.6(that)-442.6(telephonic)-451.1(case)-448.7(management)-450.4(in)-444.2(the)-451.5(early)-448.2(months)]TJ
T*
[(following)-616.1(CHF)-619.4(is)-611.2(more)-614.8(effective)-618.8(than)-619.9(standard)-616.4(pharmaceutical)]TJ
T*
[(therapy)-285.7(and)-276.3(other)-285.6(case)-284.3(management)-279.7(strategies.)]TJ
1.1128 -1.3341 TD
[(Also)-289.4(in)-292.5(2002)-291.1(\(published)-298.7(in)-286.2(2003\),)-295.9(investigators)-298.4(from)-286.2(several)-292.7(uni-)]TJ
-1.1128 -1.3278 TD
[(versities)-192.1(in)-191.3(the)-192.2(United)-195.8(States)-192.3(conducted)-195.9(a)-191.2(multicenter)-193.8(RCT)-192.9(\()]TJ
/F5 1 Tf
24.0397 0 TD
(n)Tj
/F9 1 Tf
.7082 0 TD
(=)Tj
/F1 1 Tf
.7208 0 TD
[(280\))-188.7(to)]TJ
-25.4687 -1.3341 TD
[(evaluate)-420.5(the)-413.5(effects)-419.5(of)-417.9(daily)-416.6(weight)-418.3(monitoring)-414.9(and)-415.4(symptom)-419.6(re-)]TJ
T*
[(porting)-336.4(among)-332.7()49.3(advanced)53.9()-336.4(heart)-333(failure)-338(patients)-335(\(NYHA)-337.6(Classes)-335(III)]TJ
T*
[(and)-251(IV\))-249.5(using)-250.2(the)-249.1(AlereNet)-253.9(system)-253.6(for)-253.6(a)-248.1(6-month)-248.3(period.)]TJ
6.7246 0 0 5.9768 517.266 171.8362 Tm
(45)Tj
8.9663 0 0 8.9663 526.507 167.8676 Tm
(Although)Tj
-24.3875 -1.3341 TD
[(the)-204.9(use)-207.7(of)-202.9(the)-204.9(AlereNet)-203.4(system)-209.3(was)-201.1(associated)-209(with)-209.3(a)-197.5(56.2%)-209(reduction)]TJ
T*
[(in)-450.6(mortality,)-458.8(it)-450.3(did)-455.7(not)-456(increase)-452.4(hospitalization.)-462(The)-452.1(intervention)]TJ
T*
[(group)-365(experienced)-360.5(greater)-362.3(improvement)-367.6(in)-355.7(all)-362.7(quality)-360.3(of)-361(life)-358.9(mea-)]TJ
T*
[(sures,)-329.9(but)-334.2(the)-331.3(differences)-335.3(were)-329.2(not)-329.5(statistically)-335(significant.)-333.1(The)-332(un-)]TJ
0 -1.3278 TD
[(ique)-417.7(feature)-419.2(of)-417.9(this)-415.8(study)-415.6(was)-416(the)-419.8(strict)-419.2(adherence)-419.7(to)-413.6()55.6(aggressive)]TJ
0 -1.3341 TD
[(guideline-driven)-289.8(heart)-288.7(failure)-281.1(care)50.1()-285.8(b)0(y)-281.5(cardiologists)-291.8(with)-285.2(heart)-282.4(fail-)]TJ
T*
[(ure)-302(expertise.)-309.3(The)-300.4(authors)-307.7(explained)-302.8(that)-303.5()55.6(heart)-308.9(failure)-300(hospitaliza-)]TJ
T*
[(tions)-257.9(may)-254(not)-253.6(be)-253.3(a)-254.5(failing)-257.4(of)-253.5(the)-255.4(patients)-260.4(own)-252.3(personal)-255.8(heart)-257.1(failure)]TJ
/F11 1 Tf
11.9551 0 0 11.9551 287.5464 741.9966 Tm
[(TELEMEDICINE)-340.6(FOR)-332.7(CHRONIC)-338.8(DISEASE)-334.7(MANAGE)-7.3(MENT)]TJ
/F9 1 Tf
6.9738 0 0 6.9738 187.37 29.7638 Tm
()Tj
/F7 1 Tf
1.3332 0 TD
.2008 Tc
[(MARY)-336(ANN)-334.8(L).3(IEBER)-7.6(T)-1.2(,)-334(I)5.6(NC.)]TJ
/F10 1 Tf
15.0069 0 TD
0 Tc
()Tj
/F7 1 Tf
.9999 0 TD
.1111 Tc
[(VOL)8.2(.)-334.3(2)8(0)-1000(NO.)-334.3(9)]TJ
/F10 1 Tf
8.3896 0 TD
0 Tc
()Tj
/F8 1 Tf
.9999 0 TD
.1095 Tc
[(SEPT)6.6(EMBER)-333.2(2).1(0)6.8(1)0(4)]TJ
/F4 1 Tf
7.9702 0 0 7.9702 442.4881 29.7638 Tm
0 Tc
[(TELEMEDIC)11.7(INE)-333(and)-328.9(e-HEALTH)-647.9(775)]TJ
ET
q
1 i
0 792 612 -791.985 re
W n
579.685 .014984 .22681 791.985 re
f
337.039 767.962 274.961 .22675 re
f
Q
endstream
endobj
206 0 obj
<>/XObject<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]/Font<>/Properties<>>>/Thumb 213 0 R/MediaBox[0 0 612 792]/Rotate 0>>
endobj
214 0 obj
<>/ProcSet[/PDF/Text]/Font<>/Properties<>>>
endobj
207 0 obj
<>stream
0 0 0 .695 k
/GS1 gs
50.173 665.858 525.997 18.539 re
f
50.173 652.535 525.997 18.539 re
f
50.173 645.732 525.997 11.962 re
f
0 0 0 .065 k
50.173 621.751 50.173 23.981 re
f
0 0 0 .145 k
100.346 621.751 23.924 23.981 re
f
0 0 0 .065 k
124.271 621.751 41.839 23.981 re
f
0 0 0 .145 k
166.11 621.751 32.258 23.981 re
f
0 0 0 .065 k
198.368 621.751 26.306 23.981 re
f
0 0 0 .145 k
224.674 621.751 43.087 23.981 re
f
0 0 0 .065 k
267.761 621.751 53.802 23.981 re
f
0 0 0 .145 k
321.562 621.751 41.839 23.981 re
f
0 0 0 .065 k
363.401 621.751 26.249 23.981 re
f
0 0 0 .145 k
389.65 621.751 23.924 23.981 re
f
0 0 0 .065 k
413.575 621.751 43.03 23.981 re
f
0 0 0 .145 k
456.605 621.751 35.887 23.981 re
f
0 0 0 .065 k
492.491 621.751 83.679 23.981 re
f
50.173 579.798 50.173 41.953 re
f
0 0 0 .145 k
100.346 579.798 23.924 41.953 re
f
0 0 0 .065 k
124.271 579.798 41.839 41.953 re
f
0 0 0 .145 k
166.11 579.798 32.258 41.953 re
f
0 0 0 .065 k
198.368 579.798 26.306 41.953 re
f
0 0 0 .145 k
224.674 579.798 43.087 41.953 re
f
0 0 0 .065 k
267.761 579.798 53.802 41.953 re
f
0 0 0 .145 k
321.562 579.798 41.839 41.953 re
f
0 0 0 .065 k
363.401 579.798 26.249 41.953 re
f
0 0 0 .145 k
389.65 579.798 23.924 41.953 re
f
0 0 0 .065 k
413.575 579.798 43.03 41.953 re
f
0 0 0 .145 k
456.605 579.798 35.887 41.953 re
f
0 0 0 .065 k
492.491 579.798 83.679 41.953 re
f
50.173 555.76 50.173 24.038 re
f
0 0 0 .145 k
100.346 555.76 23.924 24.038 re
f
0 0 0 .065 k
124.271 555.76 41.839 24.038 re
f
0 0 0 .145 k
166.11 555.76 32.258 24.038 re
f
0 0 0 .065 k
198.368 555.76 26.306 24.038 re
f
0 0 0 .145 k
224.674 555.76 43.087 24.038 re
f
0 0 0 .065 k
267.761 555.76 53.802 24.038 re
f
0 0 0 .145 k
321.562 555.76 41.839 24.038 re
f
0 0 0 .065 k
363.401 555.76 26.249 24.038 re
f
0 0 0 .145 k
389.65 555.76 23.924 24.038 re
f
0 0 0 .065 k
413.575 555.76 43.03 24.038 re
f
0 0 0 .145 k
456.605 555.76 35.887 24.038 re
f
0 0 0 .065 k
492.491 555.76 83.679 24.038 re
f
50.173 504.85 50.173 50.91 re
f
0 0 0 .145 k
100.346 504.85 23.924 50.91 re
f
0 0 0 .065 k
124.271 504.85 41.839 50.91 re
f
0 0 0 .145 k
166.11 504.85 32.258 50.91 re
f
0 0 0 .065 k
198.368 504.85 26.306 50.91 re
f
0 0 0 .145 k
224.674 504.85 43.087 50.91 re
f
0 0 0 .065 k
267.761 530.759 53.802 25.002 re
f
0 0 0 .145 k
321.562 530.759 41.839 25.002 re
f
0 0 0 .065 k
363.401 530.759 26.249 25.002 re
f
0 0 0 .145 k
389.65 530.759 23.924 25.002 re
f
0 0 0 .065 k
413.575 530.759 43.03 25.002 re
f
0 0 0 .145 k
456.605 530.759 35.887 25.002 re
f
0 0 0 .065 k
492.491 504.85 83.679 50.91 re
f
267.761 504.85 53.802 25.909 re
f
0 0 0 .145 k
321.562 504.85 41.839 25.909 re
f
0 0 0 .065 k
363.401 504.85 26.249 25.909 re
f
0 0 0 .145 k
389.65 504.85 23.924 25.909 re
f
0 0 0 .065 k
413.575 504.85 43.03 25.909 re
f
0 0 0 .145 k
456.605 504.85 35.887 25.909 re
f
0 0 0 .065 k
50.173 480.869 50.173 23.981 re
f
0 0 0 .145 k
100.346 480.869 23.924 23.981 re
f
0 0 0 .065 k
124.271 480.869 41.839 23.981 re
f
0 0 0 .145 k
166.11 480.869 32.258 23.981 re
f
0 0 0 .065 k
198.368 480.869 26.306 23.981 re
f
0 0 0 .145 k
224.674 480.869 43.087 23.981 re
f
0 0 0 .065 k
267.761 480.869 53.802 23.981 re
f
0 0 0 .145 k
321.562 480.869 41.839 23.981 re
f
0 0 0 .065 k
363.401 480.869 26.249 23.981 re
f
0 0 0 .145 k
389.65 480.869 23.924 23.981 re
f
0 0 0 .065 k
413.575 480.869 43.03 23.981 re
f
0 0 0 .145 k
456.605 480.869 35.887 23.981 re
f
0 0 0 .065 k
492.491 480.869 83.679 23.981 re
f
50.173 456.831 50.173 24.038 re
f
0 0 0 .145 k
100.346 456.831 23.924 24.038 re
f
0 0 0 .065 k
124.271 456.831 41.839 24.038 re
f
0 0 0 .145 k
166.11 456.831 32.258 24.038 re
f
0 0 0 .065 k
198.368 456.831 26.306 24.038 re
f
0 0 0 .145 k
224.674 456.831 43.087 24.038 re
f
0 0 0 .065 k
267.761 456.831 53.802 24.038 re
f
0 0 0 .145 k
321.562 456.831 41.839 24.038 re
f
0 0 0 .065 k
363.401 456.831 26.249 24.038 re
f
0 0 0 .145 k
389.65 456.831 23.924 24.038 re
f
0 0 0 .065 k
413.575 456.831 43.03 24.038 re
f
0 0 0 .145 k
456.605 456.831 35.887 24.038 re
f
0 0 0 .065 k
492.491 456.831 83.679 24.038 re
f
50.173 441.808 50.173 15.024 re
f
0 0 0 .145 k
100.346 441.808 23.924 15.024 re
f
0 0 0 .065 k
124.271 441.808 41.839 15.024 re
f
0 0 0 .145 k
166.11 441.808 32.258 15.024 re
f
0 0 0 .065 k
198.368 441.808 26.306 15.024 re
f
0 0 0 .145 k
224.674 441.808 43.087 15.024 re
f
0 0 0 .065 k
267.761 441.808 53.802 15.024 re
f
0 0 0 .145 k
321.562 441.808 41.839 15.024 re
f
0 0 0 .065 k
363.401 441.808 26.249 15.024 re
f
0 0 0 .145 k
389.65 441.808 23.924 15.024 re
f
0 0 0 .065 k
413.575 441.808 43.03 15.024 re
f
0 0 0 .145 k
456.605 441.808 35.887 15.024 re
f
0 0 0 .065 k
492.491 441.808 83.679 15.024 re
f
50.173 417.827 50.173 23.981 re
f
0 0 0 .145 k
100.346 417.827 23.924 23.981 re
f
0 0 0 .065 k
124.271 417.827 41.839 23.981 re
f
0 0 0 .145 k
166.11 417.827 32.258 23.981 re
f
0 0 0 .065 k
198.368 417.827 26.306 23.981 re
f
0 0 0 .145 k
224.674 417.827 43.087 23.981 re
f
0 0 0 .065 k
267.761 417.827 53.802 23.981 re
f
0 0 0 .145 k
321.562 417.827 41.839 23.981 re
f
0 0 0 .065 k
363.401 417.827 26.249 23.981 re
f
0 0 0 .145 k
389.65 417.827 23.924 23.981 re
f
0 0 0 .065 k
413.575 417.827 43.03 23.981 re
f
0 0 0 .145 k
456.605 417.827 35.887 23.981 re
f
0 0 0 .065 k
492.491 417.827 83.679 23.981 re
f
50.173 393.789 50.173 24.038 re
f
0 0 0 .145 k
100.346 393.789 23.924 24.038 re
f
0 0 0 .065 k
124.271 393.789 41.839 24.038 re
f
0 0 0 .145 k
166.11 393.789 32.258 24.038 re
f
0 0 0 .065 k
198.368 393.789 26.306 24.038 re
f
0 0 0 .145 k
224.674 393.789 43.087 24.038 re
f
0 0 0 .065 k
267.761 393.789 53.802 24.038 re
f
0 0 0 .145 k
321.562 393.789 41.839 24.038 re
f
0 0 0 .065 k
363.401 393.789 26.249 24.038 re
f
0 0 0 .145 k
389.65 393.789 23.924 24.038 re
f
0 0 0 .065 k
413.575 393.789 43.03 24.038 re
f
0 0 0 .145 k
456.605 393.789 35.887 24.038 re
f
0 0 0 .065 k
492.491 393.789 83.679 24.038 re
f
50.173 369.808 50.173 23.981 re
f
0 0 0 .145 k
100.346 369.808 23.924 23.981 re
f
0 0 0 .065 k
124.271 369.808 41.839 23.981 re
f
0 0 0 .145 k
166.11 369.808 32.258 23.981 re
f
0 0 0 .065 k
198.368 369.808 26.306 23.981 re
f
0 0 0 .145 k
224.674 369.808 43.087 23.981 re
f
0 0 0 .065 k
267.761 369.808 53.802 23.981 re
f
0 0 0 .145 k
321.562 369.808 41.839 23.981 re
f
0 0 0 .065 k
363.401 369.808 26.249 23.981 re
f
0 0 0 .145 k
389.65 369.808 23.924 23.981 re
f
0 0 0 .065 k
413.575 369.808 43.03 23.981 re
f
0 0 0 .145 k
456.605 369.808 35.887 23.981 re
f
0 0 0 .065 k
492.491 369.808 83.679 23.981 re
f
50.173 345.77 50.173 24.038 re
f
0 0 0 .145 k
100.346 345.77 23.924 24.038 re
f
0 0 0 .065 k
124.271 345.77 41.839 24.038 re
f
0 0 0 .145 k
166.11 345.77 32.258 24.038 re
f
0 0 0 .065 k
198.368 345.77 26.306 24.038 re
f
0 0 0 .145 k
224.674 345.77 43.087 24.038 re
f
0 0 0 .065 k
267.761 345.77 53.802 24.038 re
f
0 0 0 .145 k
321.562 345.77 41.839 24.038 re
f
0 0 0 .065 k
363.401 345.77 26.249 24.038 re
f
0 0 0 .145 k
389.65 345.77 23.924 24.038 re
f
0 0 0 .065 k
413.575 345.77 43.03 24.038 re
f
0 0 0 .145 k
456.605 345.77 35.887 24.038 re
f
0 0 0 .065 k
492.491 345.77 83.679 24.038 re
f
50.173 321.789 50.173 23.981 re
f
0 0 0 .145 k
100.346 321.789 23.924 23.981 re
f
0 0 0 .065 k
124.271 321.789 41.839 23.981 re
f
0 0 0 .145 k
166.11 321.789 32.258 23.981 re
f
0 0 0 .065 k
198.368 321.789 26.306 23.981 re
f
0 0 0 .145 k
224.674 321.789 43.087 23.981 re
f
0 0 0 .065 k
267.761 321.789 53.802 23.981 re
f
0 0 0 .145 k
321.562 321.789 41.839 23.981 re
f
0 0 0 .065 k
363.401 321.789 26.249 23.981 re
f
0 0 0 .145 k
389.65 321.789 23.924 23.981 re
f
0 0 0 .065 k
413.575 321.789 43.03 23.981 re
f
0 0 0 .145 k
456.605 321.789 35.887 23.981 re
f
0 0 0 .065 k
492.491 321.789 83.679 23.981 re
f
50.173 297.751 50.173 24.038 re
f
0 0 0 .145 k
100.346 297.751 23.924 24.038 re
f
0 0 0 .065 k
124.271 297.751 41.839 24.038 re
f
0 0 0 .145 k
166.11 297.751 32.258 24.038 re
f
0 0 0 .065 k
198.368 297.751 26.306 24.038 re
f
0 0 0 .145 k
224.674 297.751 43.087 24.038 re
f
0 0 0 .065 k
267.761 297.751 53.802 24.038 re
f
0 0 0 .145 k
321.562 297.751 41.839 24.038 re
f
0 0 0 .065 k
363.401 297.751 26.249 24.038 re
f
0 0 0 .145 k
389.65 297.751 23.924 24.038 re
f
0 0 0 .065 k
413.575 297.751 43.03 24.038 re
f
0 0 0 .145 k
456.605 297.751 35.887 24.038 re
f
0 0 0 .065 k
492.491 297.751 83.679 24.038 re
f
50.173 282.728 50.173 15.024 re
f
0 0 0 .145 k
100.346 282.728 23.924 15.024 re
f
0 0 0 .065 k
124.271 282.728 41.839 15.024 re
f
0 0 0 .145 k
166.11 282.728 32.258 15.024 re
f
0 0 0 .065 k
198.368 282.728 26.306 15.024 re
f
0 0 0 .145 k
224.674 282.728 43.087 15.024 re
f
0 0 0 .065 k
267.761 282.728 53.802 15.024 re
f
0 0 0 .145 k
321.562 282.728 41.839 15.024 re
f
0 0 0 .065 k
363.401 282.728 26.249 15.024 re
f
0 0 0 .145 k
389.65 282.728 23.924 15.024 re
f
0 0 0 .065 k
413.575 282.728 43.03 15.024 re
f
0 0 0 .145 k
456.605 282.728 35.887 15.024 re
f
0 0 0 .065 k
492.491 282.728 83.679 15.024 re
f
50.173 258.69 50.173 24.038 re
f
0 0 0 .145 k
100.346 258.69 23.924 24.038 re
f
0 0 0 .065 k
124.271 258.69 41.839 24.038 re
f
0 0 0 .145 k
166.11 258.69 32.258 24.038 re
f
0 0 0 .065 k
198.368 258.69 26.306 24.038 re
f
0 0 0 .145 k
224.674 258.69 43.087 24.038 re
f
0 0 0 .065 k
267.761 258.69 53.802 24.038 re
f
0 0 0 .145 k
321.562 258.69 41.839 24.038 re
f
0 0 0 .065 k
363.401 258.69 26.249 24.038 re
f
0 0 0 .145 k
389.65 258.69 23.924 24.038 re
f
0 0 0 .065 k
413.575 258.69 43.03 24.038 re
f
0 0 0 .145 k
456.605 258.69 35.887 24.038 re
f
0 0 0 .065 k
492.491 258.69 83.679 24.038 re
f
50.173 234.709 50.173 23.981 re
f
0 0 0 .145 k
100.346 234.709 23.924 23.981 re
f
0 0 0 .065 k
124.271 234.709 41.839 23.981 re
f
0 0 0 .145 k
166.11 234.709 32.258 23.981 re
f
0 0 0 .065 k
198.368 234.709 26.306 23.981 re
f
0 0 0 .145 k
224.674 234.709 43.087 23.981 re
f
0 0 0 .065 k
267.761 234.709 53.802 23.981 re
f
0 0 0 .145 k
321.562 234.709 41.839 23.981 re
f
0 0 0 .065 k
363.401 234.709 26.249 23.981 re
f
0 0 0 .145 k
389.65 234.709 23.924 23.981 re
f
0 0 0 .065 k
413.575 234.709 43.03 23.981 re
f
0 0 0 .145 k
456.605 234.709 35.887 23.981 re
f
0 0 0 .065 k
492.491 234.709 83.679 23.981 re
f
50.173 210.671 50.173 24.038 re
f
0 0 0 .145 k
100.346 210.671 23.924 24.038 re
f
0 0 0 .065 k
124.271 210.671 41.839 24.038 re
f
0 0 0 .145 k
166.11 210.671 32.258 24.038 re
f
0 0 0 .065 k
198.368 210.671 26.306 24.038 re
f
0 0 0 .145 k
224.674 210.671 43.087 24.038 re
f
0 0 0 .065 k
267.761 210.671 53.802 24.038 re
f
0 0 0 .145 k
321.562 210.671 41.839 24.038 re
f
0 0 0 .065 k
363.401 210.671 26.249 24.038 re
f
0 0 0 .145 k
389.65 210.671 23.924 24.038 re
f
0 0 0 .065 k
413.575 210.671 43.03 24.038 re
f
0 0 0 .145 k
456.605 210.671 35.887 24.038 re
f
0 0 0 .065 k
492.491 210.671 83.679 24.038 re
f
50.173 186.69 50.173 23.981 re
f
0 0 0 .145 k
100.346 186.69 23.924 23.981 re
f
0 0 0 .065 k
124.271 186.69 41.839 23.981 re
f
0 0 0 .145 k
166.11 186.69 32.258 23.981 re
f
0 0 0 .065 k
198.368 186.69 26.306 23.981 re
f
0 0 0 .145 k
224.674 186.69 43.087 23.981 re
f
0 0 0 .065 k
267.761 186.69 53.802 23.981 re
f
0 0 0 .145 k
321.562 186.69 41.839 23.981 re
f
0 0 0 .065 k
363.401 186.69 26.249 23.981 re
f
0 0 0 .145 k
389.65 186.69 23.924 23.981 re
f
0 0 0 .065 k
413.575 186.69 43.03 23.981 re
f
0 0 0 .145 k
456.605 186.69 35.887 23.981 re
f
0 0 0 .065 k
492.491 186.69 83.679 23.981 re
f
50.173 162.652 50.173 24.038 re
f
0 0 0 .145 k
100.346 162.652 23.924 24.038 re
f
0 0 0 .065 k
124.271 162.652 41.839 24.038 re
f
0 0 0 .145 k
166.11 162.652 32.258 24.038 re
f
0 0 0 .065 k
198.368 162.652 26.306 24.038 re
f
0 0 0 .145 k
224.674 162.652 43.087 24.038 re
f
0 0 0 .065 k
267.761 162.652 53.802 24.038 re
f
0 0 0 .145 k
321.562 162.652 41.839 24.038 re
f
0 0 0 .065 k
363.401 162.652 26.249 24.038 re
f
0 0 0 .145 k
389.65 162.652 23.924 24.038 re
f
0 0 0 .065 k
413.575 162.652 43.03 24.038 re
f
0 0 0 .145 k
456.605 162.652 35.887 24.038 re
f
0 0 0 .065 k
492.491 162.652 83.679 24.038 re
f
0 0 0 .845 k
50.173 684.453 525.997 1.0205 re
f
0 0 0 .695 k
50.173 679.238 525.997 5.2158 re
f
0 0 0 1 k
q 1 0 0 1 50.173 162.652 cm 0 0 m
525.997 0 l
0 0 l
f
Q
0 0 0 .345 k
50.173 670.734 115.937 .51019 re
f
166.11 665.858 .51024 18.539 re
f
166.62 670.734 101.14 .51019 re
f
267.761 665.858 .45352 18.539 re
f
321.562 665.858 .45352 18.539 re
f
322.016 670.734 170.476 .51019 re
f
492.491 665.858 .51022 18.539 re
f
100.346 652.535 .51024 18.539 re
f
124.271 652.535 .51024 18.539 re
f
166.11 652.535 .51024 18.539 re
f
198.368 652.535 .51025 18.539 re
f
224.674 652.535 .51024 18.539 re
f
267.761 652.535 .45352 18.539 re
f
321.562 652.535 .45352 18.539 re
f
322.016 657.411 67.635 .51019 re
f
389.65 652.535 .51025 18.539 re
f
413.575 652.535 .51022 18.539 re
f
456.605 652.535 .51022 18.539 re
f
492.491 652.535 .51022 18.539 re
f
100.346 645.732 .51024 11.962 re
f
124.271 645.732 .51024 11.962 re
f
166.11 645.732 .51024 11.962 re
f
198.368 645.732 .51025 11.962 re
f
224.674 645.732 .51024 11.962 re
f
267.761 645.732 .45352 11.962 re
f
321.562 645.732 .45352 11.962 re
f
363.401 645.732 .45352 11.962 re
f
389.65 645.732 .51025 11.962 re
f
413.575 645.732 .51022 11.962 re
f
456.605 645.732 .51022 11.962 re
f
492.491 645.732 .51022 11.962 re
f
50.173 645.222 525.997 .51025 re
f
0 0 0 1 k
50.173 621.751 50.173 .51019 re
f
100.346 621.751 .51024 23.981 re
f
100.857 621.751 23.414 .51019 re
f
124.271 621.751 .51024 23.981 re
f
124.781 621.751 41.329 .51019 re
f
166.11 621.751 .51024 23.981 re
f
166.62 621.751 31.748 .51019 re
f
198.368 621.751 .51025 23.981 re
f
198.879 621.751 25.795 .51019 re
f
224.674 621.751 .51024 23.981 re
f
225.184 621.751 42.576 .51019 re
f
267.761 621.751 .45352 23.981 re
f
268.214 621.751 53.348 .51019 re
f
321.562 621.751 .45352 23.981 re
f
322.016 621.751 41.386 .51019 re
f
363.401 621.751 .45352 23.981 re
f
363.855 621.751 25.795 .51019 re
f
389.65 621.751 .51025 23.981 re
f
390.161 621.751 23.414 .51019 re
f
413.575 621.751 .51022 23.981 re
f
414.085 621.751 42.52 .51019 re
f
456.605 621.751 .51022 23.981 re
f
457.115 621.751 35.376 .51019 re
f
492.491 621.751 .51022 23.981 re
f
493.001 621.751 83.168 .51019 re
f
50.173 579.798 50.173 .51019 re
f
100.346 579.798 .51024 41.953 re
f
100.857 579.798 23.414 .51019 re
f
124.271 579.798 .51024 41.953 re
f
124.781 579.798 41.329 .51019 re
f
166.11 579.798 .51024 41.953 re
f
166.62 579.798 31.748 .51019 re
f
198.368 579.798 .51025 41.953 re
f
198.879 579.798 25.795 .51019 re
f
224.674 579.798 .51024 41.953 re
f
225.184 579.798 42.576 .51019 re
f
267.761 579.798 .45352 41.953 re
f
268.214 579.798 53.348 .51019 re
f
321.562 579.798 .45352 41.953 re
f
322.016 579.798 41.386 .51019 re
f
363.401 579.798 .45352 41.953 re
f
363.855 579.798 25.795 .51019 re
f
389.65 579.798 .51025 41.953 re
f
390.161 579.798 23.414 .51019 re
f
413.575 579.798 .51022 41.953 re
f
414.085 579.798 42.52 .51019 re
f
456.605 579.798 .51022 41.953 re
f
457.115 579.798 35.376 .51019 re
f
492.491 579.798 .51022 41.953 re
f
493.001 579.798 83.168 .51019 re
f
50.173 555.76 50.173 .51025 re
f
100.346 555.76 .51024 24.038 re
f
100.857 555.76 23.414 .51025 re
f
124.271 555.76 .51024 24.038 re
f
124.781 555.76 41.329 .51025 re
f
166.11 555.76 .51024 24.038 re
f
166.62 555.76 31.748 .51025 re
f
198.368 555.76 .51025 24.038 re
f
198.879 555.76 25.795 .51025 re
f
224.674 555.76 .51024 24.038 re
f
225.184 555.76 42.576 .51025 re
f
267.761 555.76 .45352 24.038 re
f
268.214 555.76 53.348 .51025 re
f
321.562 555.76 .45352 24.038 re
f
322.016 555.76 41.386 .51025 re
f
363.401 555.76 .45352 24.038 re
f
363.855 555.76 25.795 .51025 re
f
389.65 555.76 .51025 24.038 re
f
390.161 555.76 23.414 .51025 re
f
413.575 555.76 .51022 24.038 re
f
414.085 555.76 42.52 .51025 re
f
456.605 555.76 .51022 24.038 re
f
457.115 555.76 35.376 .51025 re
f
492.491 555.76 .51022 24.038 re
f
493.001 555.76 83.168 .51025 re
f
50.173 504.85 50.173 .51022 re
f
100.346 504.85 .51024 50.91 re
f
100.857 504.85 23.414 .51022 re
f
124.271 504.85 .51024 50.91 re
f
124.781 504.85 41.329 .51022 re
f
166.11 504.85 .51024 50.91 re
f
166.62 504.85 31.748 .51022 re
f
198.368 504.85 .51025 50.91 re
f
198.879 504.85 25.795 .51022 re
f
224.674 504.85 .51024 50.91 re
f
225.184 504.85 42.576 .51022 re
f
267.761 530.759 .45352 25.002 re
f
268.214 530.759 53.348 .51025 re
f
321.562 530.759 .45352 25.002 re
f
322.016 530.759 41.386 .51025 re
f
363.401 530.759 .45352 25.002 re
f
363.855 530.759 25.795 .51025 re
f
389.65 530.759 .51025 25.002 re
f
390.161 530.759 23.414 .51025 re
f
413.575 530.759 .51022 25.002 re
f
414.085 530.759 42.52 .51025 re
f
456.605 530.759 .51022 25.002 re
f
457.115 530.759 35.376 .51025 re
f
492.491 504.85 .51022 50.91 re
f
493.001 504.85 83.168 .51022 re
f
267.761 504.85 .45352 25.909 re
f
268.214 504.85 53.348 .51022 re
f
321.562 504.85 .45352 25.909 re
f
322.016 504.85 41.386 .51022 re
f
363.401 504.85 .45352 25.909 re
f
363.855 504.85 25.795 .51022 re
f
389.65 504.85 .51025 25.909 re
f
390.161 504.85 23.414 .51022 re
f
413.575 504.85 .51022 25.909 re
f
414.085 504.85 42.52 .51022 re
f
456.605 504.85 .51022 25.909 re
f
457.115 504.85 35.376 .51022 re
f
50.173 480.869 50.173 .51022 re
f
100.346 480.869 .51024 23.981 re
f
100.857 480.869 23.414 .51022 re
f
124.271 480.869 .51024 23.981 re
f
124.781 480.869 41.329 .51022 re
f
166.11 480.869 .51024 23.981 re
f
166.62 480.869 31.748 .51022 re
f
198.368 480.869 .51025 23.981 re
f
198.879 480.869 25.795 .51022 re
f
224.674 480.869 .51024 23.981 re
f
225.184 480.869 42.576 .51022 re
f
267.761 480.869 .45352 23.981 re
f
268.214 480.869 53.348 .51022 re
f
321.562 480.869 .45352 23.981 re
f
322.016 480.869 41.386 .51022 re
f
363.401 480.869 .45352 23.981 re
f
363.855 480.869 25.795 .51022 re
f
389.65 480.869 .51025 23.981 re
f
390.161 480.869 23.414 .51022 re
f
413.575 480.869 .51022 23.981 re
f
414.085 480.869 42.52 .51022 re
f
456.605 480.869 .51022 23.981 re
f
457.115 480.869 35.376 .51022 re
f
492.491 480.869 .51022 23.981 re
f
493.001 480.869 83.168 .51022 re
f
50.173 456.831 50.173 .51025 re
f
100.346 456.831 .51024 24.038 re
f
100.857 456.831 23.414 .51025 re
f
124.271 456.831 .51024 24.038 re
f
124.781 456.831 41.329 .51025 re
f
166.11 456.831 .51024 24.038 re
f
166.62 456.831 31.748 .51025 re
f
198.368 456.831 .51025 24.038 re
f
198.879 456.831 25.795 .51025 re
f
224.674 456.831 .51024 24.038 re
f
225.184 456.831 42.576 .51025 re
f
267.761 456.831 .45352 24.038 re
f
268.214 456.831 53.348 .51025 re
f
321.562 456.831 .45352 24.038 re
f
322.016 456.831 41.386 .51025 re
f
363.401 456.831 .45352 24.038 re
f
363.855 456.831 25.795 .51025 re
f
389.65 456.831 .51025 24.038 re
f
390.161 456.831 23.414 .51025 re
f
413.575 456.831 .51022 24.038 re
f
414.085 456.831 42.52 .51025 re
f
456.605 456.831 .51022 24.038 re
f
457.115 456.831 35.376 .51025 re
f
492.491 456.831 .51022 24.038 re
f
493.001 456.831 83.168 .51025 re
f
50.173 441.808 50.173 .51022 re
f
100.346 441.808 .51024 15.024 re
f
100.857 441.808 23.414 .51022 re
f
124.271 441.808 .51024 15.024 re
f
124.781 441.808 41.329 .51022 re
f
166.11 441.808 .51024 15.024 re
f
166.62 441.808 31.748 .51022 re
f
198.368 441.808 .51025 15.024 re
f
198.879 441.808 25.795 .51022 re
f
224.674 441.808 .51024 15.024 re
f
225.184 441.808 42.576 .51022 re
f
267.761 441.808 .45352 15.024 re
f
268.214 441.808 53.348 .51022 re
f
321.562 441.808 .45352 15.024 re
f
322.016 441.808 41.386 .51022 re
f
363.401 441.808 .45352 15.024 re
f
363.855 441.808 25.795 .51022 re
f
389.65 441.808 .51025 15.024 re
f
390.161 441.808 23.414 .51022 re
f
413.575 441.808 .51022 15.024 re
f
414.085 441.808 42.52 .51022 re
f
456.605 441.808 .51022 15.024 re
f
457.115 441.808 35.376 .51022 re
f
492.491 441.808 .51022 15.024 re
f
493.001 441.808 83.168 .51022 re
f
50.173 417.827 50.173 .45355 re
f
100.346 417.827 .51024 23.981 re
f
100.857 417.827 23.414 .45355 re
f
124.271 417.827 .51024 23.981 re
f
124.781 417.827 41.329 .45355 re
f
166.11 417.827 .51024 23.981 re
f
166.62 417.827 31.748 .45355 re
f
198.368 417.827 .51025 23.981 re
f
198.879 417.827 25.795 .45355 re
f
224.674 417.827 .51024 23.981 re
f
225.184 417.827 42.576 .45355 re
f
267.761 417.827 .45352 23.981 re
f
268.214 417.827 53.348 .45355 re
f
321.562 417.827 .45352 23.981 re
f
322.016 417.827 41.386 .45355 re
f
363.401 417.827 .45352 23.981 re
f
363.855 417.827 25.795 .45355 re
f
389.65 417.827 .51025 23.981 re
f
390.161 417.827 23.414 .45355 re
f
413.575 417.827 .51022 23.981 re
f
414.085 417.827 42.52 .45355 re
f
456.605 417.827 .51022 23.981 re
f
457.115 417.827 35.376 .45355 re
f
492.491 417.827 .51022 23.981 re
f
493.001 417.827 83.168 .45355 re
f
50.173 393.789 50.173 .51025 re
f
100.346 393.789 .51024 24.038 re
f
100.857 393.789 23.414 .51025 re
f
124.271 393.789 .51024 24.038 re
f
124.781 393.789 41.329 .51025 re
f
166.11 393.789 .51024 24.038 re
f
166.62 393.789 31.748 .51025 re
f
198.368 393.789 .51025 24.038 re
f
198.879 393.789 25.795 .51025 re
f
224.674 393.789 .51024 24.038 re
f
225.184 393.789 42.576 .51025 re
f
267.761 393.789 .45352 24.038 re
f
268.214 393.789 53.348 .51025 re
f
321.562 393.789 .45352 24.038 re
f
322.016 393.789 41.386 .51025 re
f
363.401 393.789 .45352 24.038 re
f
363.855 393.789 25.795 .51025 re
f
389.65 393.789 .51025 24.038 re
f
390.161 393.789 23.414 .51025 re
f
413.575 393.789 .51022 24.038 re
f
414.085 393.789 42.52 .51025 re
f
456.605 393.789 .51022 24.038 re
f
457.115 393.789 35.376 .51025 re
f
492.491 393.789 .51022 24.038 re
f
493.001 393.789 83.168 .51025 re
f
50.173 369.808 50.173 .45352 re
f
100.346 369.808 .51024 23.981 re
f
100.857 369.808 23.414 .45352 re
f
124.271 369.808 .51024 23.981 re
f
124.781 369.808 41.329 .45352 re
f
166.11 369.808 .51024 23.981 re
f
166.62 369.808 31.748 .45352 re
f
198.368 369.808 .51025 23.981 re
f
198.879 369.808 25.795 .45352 re
f
224.674 369.808 .51024 23.981 re
f
225.184 369.808 42.576 .45352 re
f
267.761 369.808 .45352 23.981 re
f
268.214 369.808 53.348 .45352 re
f
321.562 369.808 .45352 23.981 re
f
322.016 369.808 41.386 .45352 re
f
363.401 369.808 .45352 23.981 re
f
363.855 369.808 25.795 .45352 re
f
389.65 369.808 .51025 23.981 re
f
390.161 369.808 23.414 .45352 re
f
413.575 369.808 .51022 23.981 re
f
414.085 369.808 42.52 .45352 re
f
456.605 369.808 .51022 23.981 re
f
457.115 369.808 35.376 .45352 re
f
492.491 369.808 .51022 23.981 re
f
493.001 369.808 83.168 .45352 re
f
50.173 345.77 50.173 .51022 re
f
100.346 345.77 .51024 24.038 re
f
100.857 345.77 23.414 .51022 re
f
124.271 345.77 .51024 24.038 re
f
124.781 345.77 41.329 .51022 re
f
166.11 345.77 .51024 24.038 re
f
166.62 345.77 31.748 .51022 re
f
198.368 345.77 .51025 24.038 re
f
198.879 345.77 25.795 .51022 re
f
224.674 345.77 .51024 24.038 re
f
225.184 345.77 42.576 .51022 re
f
267.761 345.77 .45352 24.038 re
f
268.214 345.77 53.348 .51022 re
f
321.562 345.77 .45352 24.038 re
f
322.016 345.77 41.386 .51022 re
f
363.401 345.77 .45352 24.038 re
f
363.855 345.77 25.795 .51022 re
f
389.65 345.77 .51025 24.038 re
f
390.161 345.77 23.414 .51022 re
f
413.575 345.77 .51022 24.038 re
f
414.085 345.77 42.52 .51022 re
f
456.605 345.77 .51022 24.038 re
f
457.115 345.77 35.376 .51022 re
f
492.491 345.77 .51022 24.038 re
f
493.001 345.77 83.168 .51022 re
f
50.173 321.789 50.173 .45355 re
f
100.346 321.789 .51024 23.981 re
f
100.857 321.789 23.414 .45355 re
f
124.271 321.789 .51024 23.981 re
f
124.781 321.789 41.329 .45355 re
f
166.11 321.789 .51024 23.981 re
f
166.62 321.789 31.748 .45355 re
f
198.368 321.789 .51025 23.981 re
f
198.879 321.789 25.795 .45355 re
f
224.674 321.789 .51024 23.981 re
f
225.184 321.789 42.576 .45355 re
f
267.761 321.789 .45352 23.981 re
f
268.214 321.789 53.348 .45355 re
f
321.562 321.789 .45352 23.981 re
f
322.016 321.789 41.386 .45355 re
f
363.401 321.789 .45352 23.981 re
f
363.855 321.789 25.795 .45355 re
f
389.65 321.789 .51025 23.981 re
f
390.161 321.789 23.414 .45355 re
f
413.575 321.789 .51022 23.981 re
f
414.085 321.789 42.52 .45355 re
f
456.605 321.789 .51022 23.981 re
f
457.115 321.789 35.376 .45355 re
f
492.491 321.789 .51022 23.981 re
f
493.001 321.789 83.168 .45355 re
f
50.173 297.751 50.173 .51022 re
f
100.346 297.751 .51024 24.038 re
f
100.857 297.751 23.414 .51022 re
f
124.271 297.751 .51024 24.038 re
f
124.781 297.751 41.329 .51022 re
f
166.11 297.751 .51024 24.038 re
f
166.62 297.751 31.748 .51022 re
f
198.368 297.751 .51025 24.038 re
f
198.879 297.751 25.795 .51022 re
f
224.674 297.751 .51024 24.038 re
f
225.184 297.751 42.576 .51022 re
f
267.761 297.751 .45352 24.038 re
f
268.214 297.751 53.348 .51022 re
f
321.562 297.751 .45352 24.038 re
f
322.016 297.751 41.386 .51022 re
f
363.401 297.751 .45352 24.038 re
f
363.855 297.751 25.795 .51022 re
f
389.65 297.751 .51025 24.038 re
f
390.161 297.751 23.414 .51022 re
f
413.575 297.751 .51022 24.038 re
f
414.085 297.751 42.52 .51022 re
f
456.605 297.751 .51022 24.038 re
f
457.115 297.751 35.376 .51022 re
f
492.491 297.751 .51022 24.038 re
f
493.001 297.751 83.168 .51022 re
f
50.173 282.728 50.173 .45352 re
f
100.346 282.728 .51024 15.024 re
f
100.857 282.728 23.414 .45352 re
f
124.271 282.728 .51024 15.024 re
f
124.781 282.728 41.329 .45352 re
f
166.11 282.728 .51024 15.024 re
f
166.62 282.728 31.748 .45352 re
f
198.368 282.728 .51025 15.024 re
f
198.879 282.728 25.795 .45352 re
f
224.674 282.728 .51024 15.024 re
f
225.184 282.728 42.576 .45352 re
f
267.761 282.728 .45352 15.024 re
f
268.214 282.728 53.348 .45352 re
f
321.562 282.728 .45352 15.024 re
f
322.016 282.728 41.386 .45352 re
f
363.401 282.728 .45352 15.024 re
f
363.855 282.728 25.795 .45352 re
f
389.65 282.728 .51025 15.024 re
f
390.161 282.728 23.414 .45352 re
f
413.575 282.728 .51022 15.024 re
f
414.085 282.728 42.52 .45352 re
f
456.605 282.728 .51022 15.024 re
f
457.115 282.728 35.376 .45352 re
f
492.491 282.728 .51022 15.024 re
f
493.001 282.728 83.168 .45352 re
f
50.173 258.69 50.173 .51025 re
f
100.346 258.69 .51024 24.038 re
f
100.857 258.69 23.414 .51025 re
f
124.271 258.69 .51024 24.038 re
f
124.781 258.69 41.329 .51025 re
f
166.11 258.69 .51024 24.038 re
f
166.62 258.69 31.748 .51025 re
f
198.368 258.69 .51025 24.038 re
f
198.879 258.69 25.795 .51025 re
f
224.674 258.69 .51024 24.038 re
f
225.184 258.69 42.576 .51025 re
f
267.761 258.69 .45352 24.038 re
f
268.214 258.69 53.348 .51025 re
f
321.562 258.69 .45352 24.038 re
f
322.016 258.69 41.386 .51025 re
f
363.401 258.69 .45352 24.038 re
f
363.855 258.69 25.795 .51025 re
f
389.65 258.69 .51025 24.038 re
f
390.161 258.69 23.414 .51025 re
f
413.575 258.69 .51022 24.038 re
f
414.085 258.69 42.52 .51025 re
f
456.605 258.69 .51022 24.038 re
f
457.115 258.69 35.376 .51025 re
f
492.491 258.69 .51022 24.038 re
f
493.001 258.69 83.168 .51025 re
f
50.173 234.709 50.173 .45357 re
f
100.346 234.709 .51024 23.981 re
f
100.857 234.709 23.414 .45357 re
f
124.271 234.709 .51024 23.981 re
f
124.781 234.709 41.329 .45357 re
f
166.11 234.709 .51024 23.981 re
f
166.62 234.709 31.748 .45357 re
f
198.368 234.709 .51025 23.981 re
f
198.879 234.709 25.795 .45357 re
f
224.674 234.709 .51024 23.981 re
f
225.184 234.709 42.576 .45357 re
f
267.761 234.709 .45352 23.981 re
f
268.214 234.709 53.348 .45357 re
f
321.562 234.709 .45352 23.981 re
f
322.016 234.709 41.386 .45357 re
f
363.401 234.709 .45352 23.981 re
f
363.855 234.709 25.795 .45357 re
f
389.65 234.709 .51025 23.981 re
f
390.161 234.709 23.414 .45357 re
f
413.575 234.709 .51022 23.981 re
f
414.085 234.709 42.52 .45357 re
f
456.605 234.709 .51022 23.981 re
f
457.115 234.709 35.376 .45357 re
f
492.491 234.709 .51022 23.981 re
f
493.001 234.709 83.168 .45357 re
f
50.173 210.671 50.173 .51024 re
f
100.346 210.671 .51024 24.038 re
f
100.857 210.671 23.414 .51024 re
f
124.271 210.671 .51024 24.038 re
f
124.781 210.671 41.329 .51024 re
f
166.11 210.671 .51024 24.038 re
f
166.62 210.671 31.748 .51024 re
f
198.368 210.671 .51025 24.038 re
f
198.879 210.671 25.795 .51024 re
f
224.674 210.671 .51024 24.038 re
f
225.184 210.671 42.576 .51024 re
f
267.761 210.671 .45352 24.038 re
f
268.214 210.671 53.348 .51024 re
f
321.562 210.671 .45352 24.038 re
f
322.016 210.671 41.386 .51024 re
f
363.401 210.671 .45352 24.038 re
f
363.855 210.671 25.795 .51024 re
f
389.65 210.671 .51025 24.038 re
f
390.161 210.671 23.414 .51024 re
f
413.575 210.671 .51022 24.038 re
f
414.085 210.671 42.52 .51024 re
f
456.605 210.671 .51022 24.038 re
f
457.115 210.671 35.376 .51024 re
f
492.491 210.671 .51022 24.038 re
f
493.001 210.671 83.168 .51024 re
f
50.173 186.69 50.173 .45352 re
f
100.346 186.69 .51024 23.981 re
f
100.857 186.69 23.414 .45352 re
f
124.271 186.69 .51024 23.981 re
f
124.781 186.69 41.329 .45352 re
f
166.11 186.69 .51024 23.981 re
f
166.62 186.69 31.748 .45352 re
f
198.368 186.69 .51025 23.981 re
f
198.879 186.69 25.795 .45352 re
f
224.674 186.69 .51024 23.981 re
f
225.184 186.69 42.576 .45352 re
f
267.761 186.69 .45352 23.981 re
f
268.214 186.69 53.348 .45352 re
f
321.562 186.69 .45352 23.981 re
f
322.016 186.69 41.386 .45352 re
f
363.401 186.69 .45352 23.981 re
f
363.855 186.69 25.795 .45352 re
f
389.65 186.69 .51025 23.981 re
f
390.161 186.69 23.414 .45352 re
f
413.575 186.69 .51022 23.981 re
f
414.085 186.69 42.52 .45352 re
f
456.605 186.69 .51022 23.981 re
f
457.115 186.69 35.376 .45352 re
f
492.491 186.69 .51022 23.981 re
f
493.001 186.69 83.168 .45352 re
f
50.173 162.652 50.173 .51024 re
f
100.346 162.652 .51024 24.038 re
f
100.857 162.652 23.414 .51024 re
f
124.271 162.652 .51024 24.038 re
f
124.781 162.652 41.329 .51024 re
f
166.11 162.652 .51024 24.038 re
f
166.62 162.652 31.748 .51024 re
f
198.368 162.652 .51025 24.038 re
f
198.879 162.652 25.795 .51024 re
f
224.674 162.652 .51024 24.038 re
f
225.184 162.652 42.576 .51024 re
f
267.761 162.652 .45352 24.038 re
f
268.214 162.652 53.348 .51024 re
f
321.562 162.652 .45352 24.038 re
f
322.016 162.652 41.386 .51024 re
f
363.401 162.652 .45352 24.038 re
f
363.855 162.652 25.795 .51024 re
f
389.65 162.652 .51025 24.038 re
f
390.161 162.652 23.414 .51024 re
f
413.575 162.652 .51022 24.038 re
f
414.085 162.652 42.52 .51024 re
f
456.605 162.652 .51022 24.038 re
f
457.115 162.652 35.376 .51024 re
f
492.491 162.652 .51022 24.038 re
f
493.001 162.652 83.168 .51024 re
f
0 0 0 .845 k
50.173 688.479 525.997 11.962 re
f
50.173 685.474 525.997 9.9779 re
f
0 0 0 .065 k
50.173 150.69 525.997 11.962 re
f
50.173 138.387 525.997 21.94 re
f
50.173 118.148 525.997 29.877 re
f
50.173 106.696 525.997 11.905 re
f
50.173 150.35 3.9685 9.9779 re
f
572.201 150.35 3.9685 9.9779 re
f
50.173 138.047 3.9685 9.9779 re
f
572.201 138.047 3.9685 9.9779 re
f
50.173 128.069 3.9685 9.978 re
f
572.201 128.069 3.9685 9.978 re
f
50.173 118.148 3.9685 9.9213 re
f
572.201 118.148 3.9685 9.9213 re
f
BT
/F14 1 Tf
9.9626 0 0 9.9626 54.6519 687.9683 Tm
0 0 0 0 k
0 Tc
0 Tw
[(Table)-337.4(1.)-335.7(Metho)-7.4(dology)-337.4(and)-339(Findings)-341.7(Pertaini)-9.1(ng)-334.3(to)-337.1(Conges)-8.5(tive)-337.9(Heart)-338(Failure)]TJ
7.9702 0 0 7.9702 73.3606 674.929 Tm
[(LITERATUR)11.8(E)-333.6(SOURCE)-6021.9(METHODOL)10.8(OGY)-18351.5(FINDINGS)]TJ
5.9774 0 0 5.3127 421.9652 678.5006 Tm
(a)Tj
7.9702 0 0 7.9702 326.0975 661.6061 Tm
[(HOSPITAL)11.3(IZATION)]TJ
-33.9083 -1.6787 TD
[(REFERENCE)-1143.8(DATE)-1023(COUNTRY)-1050.8(DESIGN)]TJ
18.672 1.5009 TD
(SIZE)Tj
.2276 -1.2519 TD
(\()Tj
/F15 1 Tf
.3343 0 TD
(N)Tj
/F14 1 Tf
.6686 0 TD
(\))Tj
1.821 1.2519 TD
(DURATION)Tj
-.0569 -1.2519 TD
[(\()-79.6(MONTHS\))]TJ
5.47 -.249 TD
[(TECHNOL)11.7(OGY)-1756.6(ADMIT)-2072.2(LOS)-1784.2(ED)-1227.2(MORTALITY)-722.5(QUALITY)-3160.7(COMMENTS)]TJ
/F16 1 Tf
6.9738 0 0 6.9738 54.1417 635.8109 Tm
0 0 0 1 k
(Johnston)Tj
0 -1.2844 TD
[(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 67.5779 629.9715 Tm
(43)Tj
6.9738 0 0 6.9738 106.4693 635.8109 Tm
[(2000)-1278.9(United)]TJ
3.1949 -1.2844 TD
(States)Tj
6.8043 1.2844 TD
[(QE)-3444.1(21)-9.4(2)-3764.6(1)-8.8(7)-4171(T)0(,)-338.5(VTC)]TJ
/F17 1 Tf
23.616 0 TD
4.1988 Tc
(YY)Tj
/F16 1 Tf
8.1375 0 TD
0 Tc
[(NM)-3430.5(NM)-4682.4(O)-2809.8(Cost)-338.3(savings)]TJ
-49.2562 -3.4387 TD
[(Riegel)-340.3(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 86.0598 614.9479 Tm
(44)Tj
6.9738 0 0 6.9738 106.4693 611.8298 Tm
[(2002)-1278.9(United)]TJ
3.1949 -1.2844 TD
(States)Tj
6.8043 1.2844 TD
[(RCT)-3017.1(35)-9.4(8)-4008.4(6)-4414.9(T)]TJ
/F17 1 Tf
23.616 0 TD
4.1988 Tc
[(YY)1284.5([)]TJ
/F16 1 Tf
12.942 0 TD
0 Tc
[(NM)-4284.1(NM)-2406.2(Inpatie)-12(nt)-334.3(HF)-334.2(costs)-337.4(45.5%)]TJ
9.4383 -1.2844 TD
[(lower)-336.9(at)-338.5(6)-333.9(months;)-343.6(nurse)]TJ
T*
[(used)-340.8(decision)-336.8(support)]TJ
0 -1.2926 TD
(software.)Tj
-63.4989 -2.1543 TD
(Goldberg)Tj
0 -1.2844 TD
[(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 67.5779 564.0377 Tm
(45)Tj
6.9738 0 0 6.9738 106.4693 569.877 Tm
[(2003)-1278.9(United)]TJ
3.1949 -1.2844 TD
(States)Tj
6.8043 1.2844 TD
[(RCT)-3017.1(28)-9.4(0)-4008.4(6)-4414.9(T,)-338.5(HTM)-6212.6(O)-4313.8(O)-3029.3(O)]TJ
/F17 1 Tf
36.8994 0 TD
4.9711 Tc
(Y[)Tj
/F16 1 Tf
9.0968 0 TD
0 Tc
[(NYHA)-341.9(Class)-333.2(III)-339.8(\(75%\),)-342.5(IV)]TJ
0 -1.2844 TD
(\(25%\))Tj
-63.4989 -2.1543 TD
[(Cleland)-337.2(et)-342.2(al.)]TJ
5.2302 0 0 4.6485 89.5748 548.9573 Tm
(46)Tj
6.9738 0 0 6.9738 106.4693 545.8959 Tm
[(2005)-1278.9(Germ)-10.2(any,)]TJ
3.1949 -1.2926 TD
(United)Tj
0 -1.2844 TD
[(Kingdom)-12.3(,)]TJ
T*
[(and)-338.1(The)]TJ
T*
[(Netherl)-11(ands)]TJ
6.8043 5.1459 TD
[(RCT)-3017.1(42)-9.4(6)-4008.4(8)-4414.9(T)-8476.1(O)-4313.8(O)]TJ
/F17 1 Tf
32.1031 0 TD
4.1094 Tc
([Y)Tj
/F16 1 Tf
10.113 0 TD
0 Tc
[(NM)-2406.2(Usual)-338.4(care)-342.8(control)-334.5(group)]TJ
3.7802 -1.2926 TD
[(mortality)-340.7(was)-341.2(45%.)]TJ
-31.1844 -2.3006 TD
[(HTM)-7123.1(O)]TJ
/F17 1 Tf
13.6899 0 TD
2.9143 Tc
[(Y[)-1195.1(Y)]TJ
/F16 1 Tf
13.7143 0 TD
0 Tc
(NM)Tj
-59.7187 -3.707 TD
(Woodend)Tj
0 -1.2926 TD
[(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 67.5779 489.0896 Tm
(47)Tj
6.9738 0 0 6.9738 106.4693 494.9857 Tm
[(2008)-1278.9(Canada)-3964.4(RCT)-3017.1(24)-9.4(9)-3008.5(3/6/12)-3415.9(T,)-338.5(VTC)]TJ
/F17 1 Tf
33.6152 0 TD
4.1988 Tc
(YY)Tj
/F16 1 Tf
8.544 0 TD
0 Tc
[(O)-3826(N)0(M)-4284.1(N)0(M)-2406.2(3)-309.6(months)-314.3(of)-306.5(VT)-9.3(C)-309.2(with)-312(nurse)]TJ
13.8363 -1.2926 TD
[(interve)-11(ntion)]TJ
-63.4989 -2.1543 TD
[(Darkins)-340.6(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 89.6882 474.066 Tm
(48)Tj
6.9738 0 0 6.9738 106.4693 470.9479 Tm
[(2008)-1278.9(United)]TJ
3.1949 -1.2844 TD
(States)Tj
6.8043 1.2844 TD
[(OS)-2864(17,025)-3198.1(5)-8.8(3)-4171(T,)-338.5(VTC,)-334.7(HTM)]TJ
/F17 1 Tf
23.616 0 TD
4.1988 Tc
(YY)Tj
/F16 1 Tf
8.1375 0 TD
0 Tc
[(NM)-3430.5(NM)-4284.1(NM)-2406.2(25.9%)-342.8(utilization)-339.1(reduct)-11(ion)]TJ
-49.2562 -3.4387 TD
[(Dendale)-336.3(et)-342.2(al.)]TJ
5.2302 0 0 4.6485 91.3889 450.0282 Tm
(49)Tj
6.9738 0 0 6.9738 106.4693 446.9668 Tm
[(2012)-1278.9(Belgium)-3703.4(CRCT)-2497.1(16)-9.4(0)-4008.4(6)-4414.9(HTM,)-335(T)]TJ
/F17 1 Tf
33.6152 0 TD
4.1988 Tc
(YY)Tj
/F16 1 Tf
8.1375 0 TD
0 Tc
(NM)Tj
/F17 1 Tf
5.1459 0 TD
(Y)Tj
/F16 1 Tf
5.3166 0 TD
[(NM)-2406.2(TM)-334.6(increases)-342.1(collabora)-15.5(tion)]TJ
-59.7187 -2.1624 TD
[(Ferrante)-336.5(et)-342.2(al.)]TJ
5.2302 0 0 4.6485 91.8992 435.0046 Tm
(50)Tj
6.9738 0 0 6.9738 106.4693 431.8865 Tm
[(2010)-1278.9(Argentin)-11.6(a)-3056.8(RCT)-2683.8(1,5)-9.4(18)-3431.9(3)-8.8(6)-4171(T)]TJ
/F17 1 Tf
33.6152 0 TD
(Y)Tj
/F16 1 Tf
4.5362 0 TD
[(NM)-2227.4(NM)-3828.8(O)]TJ
/F17 1 Tf
14.4053 0 TD
([)Tj
/F16 1 Tf
3.4387 0 TD
[(T)-338.5(coaching)-337.1(to)-339(improve)-333.4(d)-8.8(iet,)]TJ
0 -1.2844 TD
[(weight,)-340.9(edema,)-342.6(and)-338.1(exercise)]TJ
-63.4989 -2.1543 TD
(Weintraub)Tj
0 -1.2844 TD
[(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 67.5779 402.0093 Tm
(51)Tj
6.9738 0 0 6.9738 106.4693 407.9054 Tm
[(2010)-1278.9(United)]TJ
3.1949 -1.2844 TD
(States)Tj
6.8043 1.2844 TD
[(RCT)-3017.1(18)-9.4(8)-4008.4(3)-4414.9(T,)-338.5(HTM)]TJ
/F17 1 Tf
23.616 0 TD
4.1988 Tc
(YY)Tj
/F16 1 Tf
8.544 0 TD
0 Tc
(O)Tj
/F17 1 Tf
4.7395 0 TD
(Y)Tj
/F16 1 Tf
5.715 0 TD
[(O)-2809.8(NYHA)-341.9(Class)-333.2(II)-335(and)-338.1(III)]TJ
3.3818 -1.2844 TD
(patients)Tj
-63.4989 -2.1624 TD
(Chaudhry)Tj
0 -1.2845 TD
[(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 67.5779 378.0283 Tm
(52)Tj
6.9738 0 0 6.9738 106.4693 383.8676 Tm
[(2010)-1278.9(United)]TJ
3.1949 -1.2845 TD
(States)Tj
6.8043 1.2845 TD
[(RCT)-2683.8(1,6)-9.4(53)-3675.8(6)-4414.9(T)0(,)-338.5(HTM)-6212.6(O)-4313.8(O)-3029.3(O)-4224.4(O)-5086.1(O)-2809.8(Participation)-302.8(waned)-293.8(to)-290.2(55%.)]TJ
-17.5026 -3.4387 TD
(Giordano)Tj
0 -1.2845 TD
[(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 67.5779 353.9905 Tm
(53)Tj
6.9738 0 0 6.9738 106.4693 359.8865 Tm
[(2011)-1278.9(Italy)-5161.4(RCT)-3017.1(35)-9.4(8)-3764.6(9)-8.8(6)-4171(HTM,)-335(NC)]TJ
/F17 1 Tf
33.6152 0 TD
([)Tj
/F16 1 Tf
4.5362 0 TD
[(NM)-2227.4(NM)-3828.8(O)]TJ
/F17 1 Tf
14.4053 0 TD
([)Tj
/F16 1 Tf
3.4387 0 TD
[(Numbe)-9.8(r)-330.2(patients)-344.4(on)-329.8(beta-)]TJ
0 -1.2845 TD
[(blockers)-341.6(decreased.)]TJ
-63.4989 -2.1624 TD
[(Koehler)-340.1(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 89.9149 338.9669 Tm
(54)Tj
6.9738 0 0 6.9738 106.4693 335.8487 Tm
[(2011)-1278.9(Germ)-10.2(any)-3349.2(RCT)-3017.1(71)-9.4(0)-3764.6(2)-8.8(6)-4171(HTM)-7123.1(O)-4313.8(O)-3029.3(O)-4224.4(O)-5086.1(O)-2809.8(NYHA)-341.9(Class)-333.2(II)-335(and)-338.1(III;)]TJ
55.9954 -1.2844 TD
[(physic)-9.5(ian)-330.8(led)]TJ
-63.4989 -2.1543 TD
(Landolina)Tj
0 -1.2844 TD
[(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 67.5779 305.9716 Tm
(55)Tj
6.9738 0 0 6.9738 106.4693 311.8676 Tm
[(2012)-1278.9(Italy)-5161.4(RCT)-3017.1(20)-9.4(0)-3764.6(1)-8.8(6)-4171(T)0(,)-338.5(VTC,)-334.7(HTM)-4285.9(O)]TJ
/F17 1 Tf
38.5009 0 TD
2.9143 Tc
(YY)Tj
/F16 1 Tf
8.0563 0 TD
0 Tc
(NM)Tj
/F17 1 Tf
5.9995 0 TD
([)Tj
/F16 1 Tf
3.4387 0 TD
[(Fewer)-339.1(visits)-335(wi)-10.3(th)-334.3(TM)-334.6(and)]TJ
0 -1.2844 TD
[(increased)-343.7(efficiency)]TJ
-63.4989 -2.1624 TD
[(Chen)-337.4(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 83.5086 290.948 Tm
(56)Tj
6.9738 0 0 6.9738 106.4693 287.8299 Tm
[(2010)-1278.9(China)-4619.4(QE)-3444.1(55)-9.4(0)-4008.4(6)-4414.9(T)]TJ
/F17 1 Tf
33.6152 0 TD
4.1988 Tc
[(YY)1284.5(Y)]TJ
/F16 1 Tf
12.942 0 TD
0 Tc
[(NM)-4284.1(NM)-2406.2(Overal)-11.5(l)-334.8(lower)-336.9(total)-337.6(cost)]TJ
-54.0606 -2.1543 TD
[(Boyne)-337.9(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 86.3433 275.9243 Tm
(57)Tj
6.9738 0 0 6.9738 106.4693 272.8062 Tm
[(2012)-1278.9(The)]TJ
3.1949 -1.2845 TD
[(Netherl)-11(ands)]TJ
6.8043 1.2845 TD
[(RCT)-3017.1(38)-9.4(2)-3764.6(1)-8.8(2)-4171(T)0(,)-338.5(HTM)]TJ
/F17 1 Tf
23.616 0 TD
(Y)Tj
/F16 1 Tf
4.5362 0 TD
[(NM)-2227.4(NM)-3828.8(O)-4687.7(N)0(M)-2406.2(Decrease)-338.5(in)-338.8(contact)-341.1(with)]TJ
17.8441 -1.2845 TD
[(specializ)-13.8(ed)-329.7(nurses)]TJ
-63.4989 -2.1624 TD
(Steventon)Tj
0 -1.2844 TD
[(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 67.5779 242.929 Tm
(58)Tj
6.9738 0 0 6.9738 106.4693 248.7684 Tm
[(2012)-1278.9(United)]TJ
3.1949 -1.2844 TD
(Kingdom)Tj
6.8043 1.2844 TD
[(CRCT)-2163.8(3,2)-9.4(30)-3431.9(1)-8.8(2)-4171(T,)-338.5(HTM)]TJ
/F17 1 Tf
23.616 0 TD
4.1988 Tc
[(YY)1284.5(Y)89.4(Y)]TJ
/F16 1 Tf
18.6001 0 TD
0 Tc
[(NM)-2406.2(Better)-340.2(patient)-337.4(manageme)-14.3(nt)]TJ
3.7802 -1.2844 TD
[(of)-274(CHF)-277.6(and)-273.1(clinical)-279.4(decisions)]TJ
-63.4989 -2.1543 TD
[(Baker)-335(et)-342.2(al.)]TJ
5.2302 0 0 4.6485 84.6992 227.9054 Tm
(59)Tj
6.9738 0 0 6.9738 106.4693 224.7873 Tm
[(2011)-1278.9(United)]TJ
3.1949 -1.2844 TD
(States)Tj
6.8043 1.2844 TD
[(QE)-3110.8(1,7)-9.4(67)-3431.9(2)-8.8(4)-4171(T,)-338.5(HTM)-5806.1(NM)-3511.8(NM)-2227.4(NM)]TJ
/F17 1 Tf
36.8994 0 TD
(Y)Tj
/F16 1 Tf
5.3166 0 TD
[(NM)-2406.2(Savings)-339.7(of)-339(7.713.3%)]TJ
-59.7187 -3.4469 TD
[(Baker)-335(et)-342.2(al.)]TJ
5.2302 0 0 4.6485 84.6992 203.8676 Tm
(60)Tj
6.9738 0 0 6.9738 106.4693 200.7496 Tm
[(2013)-1278.9(United)]TJ
3.1949 -1.2845 TD
(States)Tj
6.8043 1.2845 TD
[(QE)-3110.8(1,7)-9.4(67)-3431.9(2)-8.8(4)-4171(HTM)]TJ
/F17 1 Tf
23.616 0 TD
(Y)Tj
/F16 1 Tf
4.9427 0 TD
3.0293 Tc
(OO)Tj
/F17 1 Tf
8.3408 0 TD
0 Tc
(Y)Tj
/F16 1 Tf
5.3166 0 TD
[(NM)-2406.2(High)-340(impact)-341.9(on)-329.9(outco)-10.9(mes)]TJ
-59.7187 -3.4387 TD
(Takahashi)Tj
0 -1.2844 TD
[(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 67.5779 170.8724 Tm
(61)Tj
6.9738 0 0 6.9738 106.4693 176.7684 Tm
[(2012)-1278.9(United)]TJ
3.1949 -1.2844 TD
(States)Tj
6.8043 1.2844 TD
[(RCT)-3017.1(20)-9.4(5)-3764.6(1)-8.8(2)-4171(VTC)-7456.1(O)-4313.8(O)-3029.3(O)]TJ
/F17 1 Tf
36.8994 0 TD
([)Tj
/F16 1 Tf
5.715 0 TD
[(O)-2809.8(Older)-341.5(and)-338.1(sicker)-335.5(patients)]TJ
5.9774 0 0 5.3127 60.0945 156.4157 Tm
(a)Tj
7.9702 0 0 7.9702 62.759 152.844 Tm
[(Arrows)-331(indicate)-329.1(direction)-326.5(of)-332.9(change)13.3(:)-337.2(increased)-328.4(\()]TJ
/F17 1 Tf
18.6506 0 TD
([)Tj
/F16 1 Tf
.6829 0 TD
[(\))-337.5(o)0(r)-332.9(decreased)-325.3(\()]TJ
/F17 1 Tf
6.0817 0 TD
(Y)Tj
/F16 1 Tf
.6829 0 TD
(\).)Tj
-26.4324 -1.5435 TD
[(CHF,)-349.7(congestive)-338.8(heart)-349.3(failure;)-350.1(CRCT,)-343.7(cluster)-352.2(randomized)-336.4(trial;)-352.4(ED,)-351.8(emergency)-337.3(department;)-341.8(HF,)-350.4(heart)-349.3(failure;)-350.1(HTM,)-344.1(home)-344.6(telemonitoring;)-343.7(LOS,)-347(length)]TJ
57.7658 0 TD
[(of)-354.2(stay;)-348.2(NM,)-345.3(not)]TJ
-57.7658 -1.2519 TD
[(measured;)-251.8(NYHA,)-260.6(New)-256.2(York)-258.8(Health)-255.8(Association)11(;)-266(O)0(,)-258.2(neutral)-257.3(outcome;)-253(OS,)-255.4(observational)-257.2(study;)-257.2(QE,)-259.3(quasi-experi)13.9(mental;)-262(RCT,)-252(randomized)-258.1(controlled)-253(tri)]TJ
56.4098 0 TD
[(al;)-259.9(T,)-260.2(telephone)13.2(;)-266(VTC,)]TJ
-56.4098 -1.2448 TD
[(video)-331.6(teleconfere)14.7(nce.)]TJ
/F11 1 Tf
11.9551 0 0 11.9551 50.1732 741.9966 Tm
[(BASHSHUR)-338.5(ET)-334.1(AL.)]TJ
7.9702 0 0 7.9702 50.1732 29.7638 Tm
[(7)-80(7)-80.1(6)-701.3(TELEMEDICINE)-323.9(and)-324.7(e-HEALTH)]TJ
/F8 1 Tf
6.9738 0 0 6.9738 177.0519 29.7638 Tm
.1095 Tc
[(SEPT)6.6(EMBER)-333.2(2).1(0)6.8(1)0(4)]TJ
ET
q
1 i
0 792 612 -791.985 re
W n
32.315 .014984 .22675 791.985 re
f
/Document /MC5 BDC
Q
q
1 i
0 792 32.315 -173.367 re
W n
0 0 0 .29999 k
0 618.633 32.315 173.367 re
f
EMC
Q
32.315 763.994 242.646 .22675 re
f
endstream
endobj
215 0 obj
<>stream
Adobe Illustrator CS4
2010-08-04T11:54:42+05:30
2010-08-04T11:54:42+05:30
2010-08-04T11:54:42+05:30
68
256
JPEG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application/postscript
saved
xmp.iid:11FB61F30AB7DE11AEB3E861853EAFA4
2009-10-12T14:15:50+05:30
Adobe Illustrator CS4
/
converted
from application/postscript to application/vnd.adobe.illustrator
converted
from application/postscript to application/vnd.adobe.illustrator
saved
xmp.iid:0280117407206811994CBE3149FFDB59
2010-08-04T11:54:42+05:30
Adobe Illustrator CS4
/
converted
from application/postscript to application/vnd.adobe.illustrator
xmp.iid:11FB61F30AB7DE11AEB3E861853EAFA4
xmp.did:11FB61F30AB7DE11AEB3E861853EAFA4
uuid:ee5a72b3-04e4-4157-a8d8-c3a8817872a3
uuid:ee5a72b3-04e4-4157-a8d8-c3a8817872a3
xmp.iid:0280117407206811994CBE3149FFDB59
xmp.did:0280117407206811994CBE3149FFDB59
TouchUp 7.0
False
False
1
684.000000
864.000000
Points
Black
Default Swatch Group
0
PANTONE 3025 C
SPOT
100.000000
CMYK
100.000000
16.859999
0.000000
50.980003
endstream
endobj
212 0 obj
<>
endobj
216 0 obj
<>/XObject<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]/Font<>>>/Thumb 218 0 R/MediaBox[0 0 612 792]/Rotate 0>>
endobj
219 0 obj
<>/ProcSet[/PDF/Text]/Font<>>>
endobj
217 0 obj
<>stream
/GS1 gs
BT
/F1 1 Tf
8.9663 0 0 8.9663 35.8866 693.8644 Tm
0 0 0 1 k
0 Tc
0 Tw
[(care)-296.3(regimen)]TJ
/F12 1 Tf
5.4314 0 TD
(.)Tj
/F1 1 Tf
.999 0 TD
[(but)-296.3(rather)-301.4(a)-298.7(manifestation)-297.1(of)-304.1(their)-297(progressively)-302.1(ad-)]TJ
-6.4304 -1.3278 TD
[(vanced)-405.1(disease)-400.8(state.)54.5()]TJ
6.7246 0 0 5.9768 119.3952 685.9274 Tm
(45)Tj
8.9663 0 0 8.9663 130.0535 681.9589 Tm
[(They)-400(also)-402.6(pointed)-407.8(out)-403.7(that)-398.3(restricting)-408.7(the)]TJ
-10.5024 -1.3341 TD
[(study)-295.4(to)-293.5(patients)-297.1(with)-291.5(advanced)-297.7(heart)-295(failure)-300(\(NYHA)-293.4(Classes)-297(III)-289(and)]TJ
T*
[(IV\))-382.3(left)-384.8(unanswered)-385.8(the)-388.2(question)-387.5(of)-386.3(the)-381.9(effectiveness)-392.6(of)-386.3(the)-381.9(inter-)]TJ
T*
[(vention)-281(among)-282.1(those)-279.9(with)-285.1(moderate)-279.5(or)-283.1(mild)-278.4(heart)-282.4(failure.)]TJ
1.1065 -1.3341 TD
[(Only)-298.3(three)-295.4(studies)-290.5(meeting)-300(our)-292.2(criteria)-295(for)-291.5(inclusion)-295.2(in)-292.5(this)-295.7(anal-)]TJ
-1.1065 -1.3341 TD
[(ysis)-521.9(were)-525.2(conducted)-524.7(between)-527.8(2005)-518.7(and)-522.9(2010,)-526.3(whereas)-523.9(13)-521.8(were)]TJ
T*
[(conducted)-297.1(from)-292.5(2010)-297.4(to)-293.5(2013.)-292.4(A)-293(Trans-European)-298.9(\(United)-294.2(Kingdom,)]TJ
T*
[(Germany,)-265.9(and)-270(the)-268.1(Netherlands\))-273.9(RCT)-268.8(\()]TJ
/F5 1 Tf
15.4911 0 TD
(n)Tj
/F9 1 Tf
.7082 0 TD
(=)Tj
/F1 1 Tf
.7145 0 TD
[(426\))-270.9(was)-270.6(conducted)-271.8(among)]TJ
-16.9138 -1.3278 TD
[(200)-381.1(subjects)-387.2(at)-378.7(high)-386.9(risk)-383.2(for)-380.1(hospital)-386.2(re-admission)-386.1(and)-377.5(death.)]TJ
6.7246 0 0 5.9768 273.9401 590.2864 Tm
(46)Tj
8.9663 0 0 8.9663 284.4283 586.318 Tm
(It)Tj
-27.7196 -1.3341 TD
[(compared)-299.1(three)-308(modalities:)-302.9(\(1\))-302.7(telemonitoring)-300(\(twice)-308.7(daily)-296.4(with)-304.1(au-)]TJ
T*
[(tomated)-395.4(measurement\),)-399.3(\(2\))-391.2(nurse)-395.6(telephone)-403.3(support,)-396.4(and)-396.5(\(3\))-391.2(usual)]TJ
T*
[(care)-264.7(for)-259.9(patients)-265.5(who)-269.6(were)-259.7(at)-264.9(high)-266.8(risk)-263.1(for)-266.2(hospitalization.)-266(The)-262.4(main)]TJ
T*
[(comparison)-324.8(of)-323.1(interest)-324.4(was)-321.2(between)-331.8(telemonitoring)-325.3(and)-320.6(nurse)-326.1(tele-)]TJ
T*
[(phone)-309.6(support.)-314.2(The)-313(study)-314.4(was)-314.9(conducted)-316.1(at)-309.2(12)-313.1(main)-314(and)-314.3(4)-308.3(satellite)]TJ
T*
[(hospitals)-330(in)-330.4(three)-327(countries,)-335.4(and)-326.9(it)-330.1(followed)-331.8(a)-330.3(uniform)-334.9(protocol)-332.4(for)]TJ
T*
[(data)-321.9(collection.)-326.7(After)-326.6(8)-327.3(months,)-322.6(the)-325(number)-324.8(of)-329.4(hospital)-323(admissions)]TJ
0 -1.3278 TD
[(was)-593.1(similar)-595.6(between)-603.7(the)-596.9(telemonitoring)-603.5(and)-592.5(telephone)-605.7(support)]TJ
0 -1.3341 TD
[(groups,)-240.5(whereas)-245.7(length)-242.9(of)-240.9(hospital)-240.8(stay)-245.1(was)-239(reduced)-245.9(by)-237.2(6)-245.1(days)-239.5(in)-241.9(the)]TJ
T*
[(telemonitoring)-306.3(group.)-309.4(Patients)-303(randomly)-309.5(assigned)-307(to)-306.1(the)-306(usual)-302.2(care)]TJ
T*
[(group)-346.1(had)-344.2(higher)-351(1-year)-346.9(mortality)-350.1(\(45%\))-349.1(compared)-349.7(with)-342.1(the)-350.3(nurse)]TJ
T*
[(telephone)-283.2(support)-281.4(\(17%\))-285.9(and)-276.3(those)-286.2(receiving)-286.2(telemonitoring)-281(\(29%\).)]TJ
1.1065 -1.3341 TD
[(In)-341(2008,)-336.6(an)-334.8(RCT)-338.3(\()]TJ
/F5 1 Tf
7.5243 0 TD
(n)Tj
/F9 1 Tf
.7082 0 TD
(=)Tj
/F1 1 Tf
.7145 0 TD
[(249\))-340.4(was)-340.2(conducted)-341.4(in)-336.7(Ontario,)-336.9(Canada)-339.7(in-)]TJ
-10.0534 -1.3341 TD
[(volving)-239.4(cardiac)-236.7(patients)-240.2(at)-233.3(high)-235.2(risk)-237.8(of)-234.5(hospital)-240.8(re-admission)-240.7(\(NYHA)]TJ
T*
[(Class)-262.8(II)-268.6(or)-264.1(higher)-268.8(CHF;)-266.8(Canadian)-265.5(Cardiovascular)-269(Society)-270.5(Class)-262.8(I)-267.1(o)0(r)-264.1(I)0(I)]TJ
0 -1.3278 TD
(angina\).)Tj
6.7246 0 0 5.9768 66.2173 399.0046 Tm
(47)Tj
8.9663 0 0 8.9663 76.5921 395.0361 Tm
[(The)-369.9(intervention)-377.3(consisted)-374.7(of)-373.6(3)-371.5(months)-371.9(of)-373.6(videoconfer-)]TJ
-4.5399 -1.3341 TD
[(encing)-204.4(with)-203(a)-203.9(nurse,)-207.2(daily)-207.9(transmission)-206.6(of)-202.9(weight)-209.7(and)-200.5(blood)-206.1(pressure,)]TJ
T*
[(and)-364.9(periodic)-366.9(transmission)-371(of)-361(the)-369.3(12-lead)-367.8(ECG.)-372.1(Within)-364.3(48)-363.7(hours)-371.5(of)]TJ
T*
[(discharge,)-257.3(a)-254.5(technician)-257.8(set)-259.7(up)-254.2(the)-261.8(monitoring)-256.9(equipment)-257(in)-254.5(patients)]TJ
T*
[(homes)-251.5(and)-244.7(trained)-254.4(them)-250.1(on)-249.5(their)-246.4(use.)-253.3(Weekly)-250.2(videoconferences)-254.7(over)]TJ
T*
[(standard)-293.9(telephone)-302.1(lines)-298.6(were)-297.6(held)-297.6(with)-297.8(a)-292.4(nurse,)-295.7(during)-298.6(which)-298.4(time)]TJ
T*
[(the)-521(patients)-526(progress)-523.7(was)-523.5(assessed)-525.2(and)-522.9(self-care)-524.6(education)-523.1(was)]TJ
T*
[(provided.)-416.5(Data)-411.8(from)-419(electronic)-413.9(weight)-418.3(scales,)-416.3(blood)-414.8(pressure,)-418.9(and)]TJ
0 -1.3278 TD
[(ECG)-282.3(machines)-283.4(were)-285(transmitted)-283.4(via)-281.8(telephone)-289.5(lines)-286(to)-280.8(a)-279.8(central)-283.1(sta-)]TJ
0 -1.3341 TD
[(tion)-408.9(at)-416.7(the)-413.5(Heart)-416.6(Institute)-413(housing)-415.8(the)-413.5(patients)-418.5(electronic)-413.9(record.)]TJ
T*
[(After)-238.1(3)-238.7(months)-239.2(of)-240.9(observation,)-239.2(telemonitoring)-243.1(resulted)-241.2(in)-241.9(reductions)]TJ
T*
[(of)-316.7(51%)-316.8(in)-317.8(hospital)-323(admissions)-322.9(and)-314.3(of)-323.1(61%)-316.8(in)-317.8(length)-318.8(of)-323.1(stay)-314.7(but)-321.5(no)]TJ
T*
[(effect)-305(on)-300.1(re-admissions.)-312.2(After)-301.3(1)-302(year,)-306.8(hospital)-304(admission)-309.6(rates)-299.3(were)]TJ
T*
[(reduced)-290.1(by)-281.5(45%)-291.5(in)-286.2(the)-287.1(intervention)-288.8(group,)-284.1(as)-286.8(well)-290(as)-280.4(a)-286.1(reduction)-294(of)]TJ
T*
[(21%)-304.1(in)-298.8(length)-306.1(of)-304.1(stay.)-303.3(Similar)-306.9(trends)-300.6(were)-310.3(observed)-308.4(in)-298.8(fewer)-306(emer-)]TJ
T*
[(gency)-384.6(department)-395.5(and)-383.8(outpatient)-390.3(cardiologist)-392.3(visits.)-391.7(Although)-388.2(the)]TJ
0 -1.3278 TD
[(rates)-375.1(in)-368.4(utilization)-379.3(of)-373.6(service)-381.6(declined)-374.6(over)-378.4(1)-371.5(year,)-376.4(the)-375.6(differences)]TJ
0 -1.3341 TD
[(between)-281.2(the)-280.7(intervention)-288.8(and)-276.3(control)-283(groups)-283.5(remained)-284.8(significant.)]TJ
1.1065 -1.3341 TD
[(A)-558.6(2008)-556.7(Veterans)-557.7(Health)-555.6(Administration)-561.4(\(VHA\))-555.2(case)-556.2(report)]TJ
6.7246 0 0 5.9768 282.8976 183.7983 Tm
(48)Tj
8.9663 0 0 8.9663 35.8866 167.8676 Tm
[(provided)-206.6(a)-203.9(trend)-205.1(analysis)-210.5(for)-203(a)-203.9(cohort)-208.2(of)-202.9(17,925)-208.7(patients)-208.6(with)-203(chronic)]TJ
T*
[(conditions)-220.5(between)-224.3(July)-216.4(2003)-221.5(and)-219.4(December)-222.2(2007.)-222.8(It)-220.6(was)-220(during)-216.4(this)]TJ
T*
[(period)-228.6(that)-221.3(the)-230.1(VHA)-225.6(introduced)-229.2(a)-229.2(national)-224(home)-225.5(telehealth)-230.6(program:)]TJ
T*
[(Care)-323.1(Coordination/Home)-336.6(Telehealth)-332.4(\(CCHT\).)-327.6(The)-332(purpose)-329.7(of)-323.1(the)-331.3(in-)]TJ
T*
[(tervention)-299.8(was)-302.2(to)-299.8(coordinate)-303.9(care)-302.7(for)-297.9(Veteran)-302.8(patients)-303.4(with)-297.8(chronic)]TJ
0 -1.3278 TD
[(conditions)-429.1(in)-425.3(order)-435.3(to)-426.3(avoid)-430.5(unnecessary)-429.9(admission)-436(to)-426.3(long-term)]TJ
0 -1.3341 TD
[(institutional)-468.9(care.)-462(The)-471.1(chronic)-468.4(conditions)-467(included)-470.3(CHF,)-468.9(diabetes)]TJ
T*
[(mellitus,)-540.9(hypertension,)-551.8(posttraumatic)-547.3(stress)-545.7(disorder,)-546.8(COPD,)-541.1(and)]TJ
T*
[(depression.)-313.5(The)-306.7(program)-308(was)-308.6(necessitated)-316.2(by)-306.8(changes)-309(in)-311.4(the)-306(demo-)]TJ
30.331 69.3307 TD
[(graphic)-285(characteristics)-289.7(of)-285.1(the)-287.1(Veteran)-283.8(population)-285.8(and,)-283.9(more)-286(specifi-)]TJ
0 -1.3278 TD
[(cally,)-427.6(the)-419.8(need)-424.1(for)-424.3(the)-426.2(VHA)-421.6(to)-426.3(increase)-427.1(its)-419.4(non-institutional)-430.6(care)]TJ
0 -1.3341 TD
[(services)-344.4(by)-338.4(100%)-340.5(over)-340.4(its)-337.2(2007)-341.7(level)-344.5(in)-336.7(providing)-339.1(care)-340.6(for)-342.1(an)-334.8(esti-)]TJ
T*
[(mated)-190.5(110,000)-194.5(non-institutional)-196.6(care)-195.2(patients)-189.6(in)-191.3(2011.)-197.5(Now)-188.9(a)-191.2(routine)]TJ
T*
[(non-institutional)-380(care)-378.5(service,)-376.6(the)-375.6(CCHT)-376.2(involves)-376.3(the)-381.9(use)-372.1(of)-373.6(home)]TJ
T*
[(telehealth)-325.4(and)-320.6(disease)-325(management)-323.9(technologies)-330.2(as)-318.4(adjuncts)-327.3(to)-318.8(the)]TJ
T*
[(VHAs)-442.6(existing)-444.8(health)-446.7(information)-445.4(technology)-448.9(infrastructure.)-442.5(The)]TJ
T*
[(CCHT)-224.5(provides)-221.5(a)-216.5(range)-221.4(of)-215.6(interventions,)-227.5(and)-219.4(decisions)-222.4(are)-218.5(made)-217.9(as)-217.2(to)]TJ
T*
[(which)-355.3(one)-352.6(is)-352(best)-353(suited)-353(for)-354.8(each)-355.9(individual)-353.4(patient.)-354.6(These)-353.6(include)]TJ
0 -1.3278 TD
[(videophones,)-274.5(messaging)-270(devices,)-267.5(biometric)-272.4(devices,)-273.8(digital)-266.2(cameras,)]TJ
0 -1.3341 TD
[(and)-314.3(telemonitoring)-319(devices.)-318.1(Twenty-five)-318.5(percent)-316.4(of)-316.7(the)-312.3(CCHT)-319.3(case-)]TJ
T*
[(load)-292.9(were)-297.6(composed)-296.7(of)-291.4(CHF)-297(patients)-290.8(only;)-297.3(another)-291.6(33.3%)-297.5(had)-293.7(mul-)]TJ
T*
[(tiple)-403.6(conditions.)-405.1(Hospital)-406.7(admission)-404.4(data)-404.1(were)-405.1(collected)-407.9(for)-399(CCHT)]TJ
T*
[(patients)-202.3(during)-197.5(the)-204.9(year)-198(prior)-203(to)-198.6(enrollment)-200.5(in)-197.6(the)-198.5(CCHT)-205.5(program)-200.5(and)]TJ
T*
[(compared)-242.2(with)-240.9(data)-239.7(collected)-243.5(6)-238.8(months)-239.2(after)-237.4(enrollment.)-239.7(The)-243.5(overall)]TJ
T*
[(cohort)-347.3(reduction)-344.6(was)-340.2(19.7%.)-349.4(However,)-344.3(the)-344(percentage)-350(decrease)-343.6(for)]TJ
T*
[(CHF)-379.2(patients)-379.3(was)-378.1(25.9%.)-381(The)-376.2(major)-377.7(conclusion)-380.6(from)-381.1(the)-375.6(VHA)-377.4(as-)]TJ
0 -1.3278 TD
[(sessment)-274.8(was)-270.6(that)-278.2()55.6(the)-269.4(CCHT)-275(is)-276.1(a)-273.4(practical)-269.6(and)-276.3(cost-effective)-281.3(means)]TJ
0 -1.3341 TD
[(of)-430.6(caring)-433.6(for)-437(populations)-431.9(of)-436.9(patients)-436.2(with)-430.6(chronic)-436.8(disease)-432.5(that)-436.2(is)]TJ
T*
[(acceptable)-287.3(to)-280.8(both)-282.1(patients)-284.5(and)-276.3(clinicians.)50.6()]TJ
6.7246 0 0 5.9768 469.3038 470.7211 Tm
(48)Tj
8.9663 0 0 8.9663 317.8204 454.7904 Tm
[(A)16.8(c)0(k)30.2(n)14.5(o)14.2(w)16.2(le)26.2(d)14.2(g)14.2(i)15.4(n)14.6(g)-453.7(t)14.8(h)16.2(e)-450.9(n)14.5(ee)27.8(d)-453.7(f)0(o)31(r)-455.3(a)17.4(n)-453.3(ex)25.3(t)14.8(e)17(n)14.6(s)0(i)27.4(v)14.2(e)-450.9(r)12.6(e)17(o)14.2(r)12.6(g)14.2(a)17.4(n)14.5(i)15.4(z)0(a)28.1(t)14.8(i)15.4(o)14.2(n)-453.3(o)14.2(f)-451(t)14.8(h)16.2(e)]TJ
-1.1128 -1.3341 TD
[(h)16.2(e)0(a)28.1(l)15.4(t)14.8(h)0(c)26.9(a)17.4(r)12.6(e)-343.4(s)18.3(y)14.2(st)26.8(e)17(m)-342.5(i)15.4(n)-339.5(Be)28.3(l)15.4(g)14.2(i)15.4(u)16.2(m)-342.4(t)14.8(o)-339.9(p)14.2(r)12.6(e)17(v)14.2(e)0(n)25.3(t)-339.3(u)16.2(n)14.6(n)14.6(e)17(ce)27.8(ss)30.2(ar)30(y)-339.9(r)12.6(e-)31(ho)24(s)18.3(p)14.2(i)15.4(t)14.8(al)26.5(i)15.4(z)17(a-)]TJ
T*
-.0148 Tc
[(tion,)-351.2(a)-14.8(n)-336.9(R)-14.8(C)12.1(T)-348.4(\()]TJ
/F5 1 Tf
5.7918 0 TD
0 Tc
(n)Tj
/F9 1 Tf
.6955 0 TD
(=)Tj
/F1 1 Tf
.7018 0 TD
-.0153 Tc
[(160\))-353.9(wa)-15.3(s)-340(c)1.7(onduc)-15.3(t)10.2(ed)-355.2(am)-15.3(o)10.5(n)-.8(g)-348.9(m)-15.3(a)13.8(l).1(e)-352.3(C)-15.3(H)8.7(F)-348.9(pa)-15.3(t)10.6(i).1(ents)-351.1(dis)-15.3(-)]TJ
-7.1892 -1.3341 TD
0 Tc
[(ch)26.9(a)17.4(r)12.6(g)14.2(e)17(d)-289.3(f)16.9(r)12.6(o)14.2(m)-285.5(s)18.3(ev)24.9(e)17(n)-288.9(h)16.2(o)14.2(s)18.3(p)14.2(it)23.9(a)17.4(l)15.4(s)-285.2(t)14.8(o)-289.3(a)17.4(ss)30.2(es)29(s)-285.2(t)14.8(he)-276.6(e)17(f)16.9(fe)27.6(ct)25.5(s)-285.2(o)14.2(f)-286.6(a)-286.1(t)14.8(e)17(l)15.4(e)0(m)28.7(o)14.2(n)14.6(i)15.4(t)14.8(o)14.2(r)12.6(i)15.4(n)14.6(g)]TJ
T*
-.0151 Tc
[(inte)-15.1(r)14.5(v)-.9(e)-15.1(n)10.2(tion)-297.7(on)-291.4(re-h)-15.1(o)8.9(s)3.2(pita)-15.1(l)11.4(i).3(za)-15.1(t)10.8(i).3(on)-297.7(and)-298.1(m)2.9(ortal)-15.1(i)9.4(ty)-298.1(ra)-15.1(t)10.8(e)1.9(s)-300.3(a)2.3(mong)-298.1(pa)-15.1(t)10.8(i).3(ents)]TJ
0 -1.3278 TD
-.0157 Tc
[(with)-322(se)-15.7(v)9.2(e)1.3(re)-314.8(he)-15.7(a)12.4(r)-3.1(t)-317(f)1.2(ail)-15.7(u)9.6(re)-15.7(.)-303.4(T)-1.5(h)-15.7(e)-304.9(stu)-15.7(d)8.3(y)-311.4(w)-15.7(a)11.6(s)-319.9(conduc)-15.7(t)9.8(e)1.3(d)-317.7(i)-.3(n)-317.3(2010)-317.7(and)-317.7(p)-1.5(ub-)]TJ
0 -1.3341 TD
-.0147 Tc
[(lis)-14.7(h)13.4(e)-14.7(d)-622.1(i).7(n)-638.8(2012.)]TJ
6.7246 0 0 5.9768 367.8235 387.0424 Tm
0 Tc
(49)Tj
8.9663 0 0 8.9663 380.296 383.0739 Tm
-.0151 Tc
[(The)-643(i).3(ntervention)-639.2(g)-.9(roup)-633.2(w)-15.1(a)12.2(s)-635.4(a)-15.1(s)14.3(s)-15.1(i)12.3(g)-.9(ned)-639.6(t)-.3(o)-639.5(t)-.3(ele)-15.1(-)]TJ
-8.0807 -1.3341 TD
-.0156 Tc
[(m)-15.6(o)10.2(n)5.3(i)-15.6(t)8.3(o)-1.4(ring-fa)-15.6(c)12.5(ili)-15.6(t)8.3(a)1.8(te)-15.6(d)-218.3(c)1.4(olla)-15.6(b)9.7(o)-1.4(ra)-15.6(t)10.3(i)-.2(on)-228.7(be)-15.6(t)9.9(w).6(ee)-15.6(n)-218(t)-.8(he)-15.6(i)10.6(r)-230.7(gene)-15.6(r)14(a)-15.6(l)-216.7(p)-1.4(ract)-15.6(i)8.3(t)-.8(ioner)]TJ
T*
-.0151 Tc
[(\(GP\))-360.1(a)-15.1(n)10.6(d)-361.3(h)1.1(ea)-15.1(r)14.9(t)-360.7(f)-15.1(a)12.9(ilu)-15.1(r)13.7(e)-364.8(clinic)-15.1(s)13.9(.)-364.1(Upon)-354.6(di)-15.1(s)12.3(c)-15.1(h)11.8(a)2.3(rge)-358.5(f)-15.1(r)14.3(o)-.9(m)-363.9(t)-.3(he)-364.8(hospit)-15.1(a)10.8(l).3(,)-364.1(p)5.4(a)-15.1(-)]TJ
T*
-.015 Tc
[(tie)-15(n)10.3(ts)-452(in)-455.7(both)-454.1(i).4(nterventi)-15(o)14.6(n)-455.7(a)-15(n)10.7(d)-449.8(c)-15(o)9.9(ntrol)-454.8(g)-.8(roups)-452(r)-2.4(ec)-15(e)12.8(i).4(ve)-15(d)-445.4(a)-452.8(sta)-15(n)10.7(dard)]TJ
T*
0 Tc
[(ed)31.2(uc)26.9(at)25.9(i)15.4(o)14.2(n)-206.7(c)0(o)24.9(u)16.2(r)12.6(s)18.3(e)-210.6(o)14.2(n)-206.7(h)0(e)26.9(a)0(r)30(t)-212.8(f)16.9(a)0(i)26.5(l)15.4(u)16.2(r)12.6(e)-210.6(a)17.4(n)14.6(d)-207.1(we)26.9(r)12.6(e)-210.6(i)15.4(n)14.6(s)18.3(t)14.8(r)12.6(u)16.2(ct)25.5(e)17(d)-213.5(o)14.2(n)-206.7(h)16.2(o)14.2(w)-211.5(t)14.8(o)-213.5(u)16.2(se)-198.6(a)17.4(n)]TJ
T*
-.0155 Tc
[(e)-15.5(l)10.6(ec)-15.5(t)10(r)3.4(onic)-207.1(body)-203.7(we)-15.5(i)10.6(g)-1.3(ht)-209.3(sc)-15.5(a)12.6(l)-.1(e)-15.5(,)-189.4(a)-206.7(b)-1.3(lood)-203.7(pres)-15.5(s)8.4(u).7(re)-207.1(m)-15.5(o)10.3(nitoring)-210(devic)-15.5(e)12.3(,)-206.5(a)1.9(nd)-203.7(a)]TJ
T*
-.0149 Tc
[(c)-14.9(e)12.9(ll)-347.2(phone)-14.9(.)-334.2(I)-14.9(n)-337(addition,)-351.3(t)-.1(he)-351.9(intervention)-348.1(group)-348.5(w)1.3(a)-14.9(s)-333.3(give)-14.9(n)-337.4(a)2.5(utom)-14.9(a)14.2(t)-.1(e)-14.9(d)]TJ
0 -1.3278 TD
-.0153 Tc
[(te)-15.3(l)10.8(e)1.7(m)-15.3(o)10.5(n)5.6(i)-15.3(t)8.6(o)-1.1(ring)-266.7(de)-15.3(v)9.6(i).1(ce)-15.3(s)-258.2(t)-.5(hat)-272.4(r)3.6(e)-15.3(p)9.6(orte)-15.3(d)-256(body)-266.7(we)-15.3(i)10.9(g)-1.1(ht,)-269.5(b)-1.1(lood)-266.7(pres)-15.3(s)14.9(u)-15.3(r)13.5(e)-15.3(,)-252.5(a)-15.3(n)10.4(d)]TJ
0 -1.3341 TD
0 Tc
[(h)16.2(e)0(a)28.1(r)12.6(t)-332.9(r)18.9(at)25.9(e)-330.7(e)17(ac)28.1(h)-331.6(m)0(o)25.8(r)18.9(n)14.5(i)15.4(n)14.6(g)-333.6(at)-315.5(a)-330.3(f)0(i)26(x)14.6(e)17(d)-333.6(t)14.8(i)15.4(me)28.7(.)-330.1(T)14.2(he)-320.8(s)18.3(c)0(a)28.1(l)15.4(e)-337(a)17.4(n)14.5(d)-333.6(s)18.3(p)14.2(hy)24(g)14.2(m)18(o)14.2(m)18(a-)]TJ
T*
-.0164 Tc
[(nome)-16.4(t)9.1(e).6(r)-193.5(w)-16.4(e)10.5(r)-3.8(e)-189(c)-16.4(o)8.5(n)-1.9(nec)-16.4(t)9.1(ed)-191.9(to)-198.2(a)-188.7(d)-2.2(e)-16.4(d)8.5(ica)-16.4(t)9.5(ed)-198.2(cel)-16.4(l)-181.5(p)-2.2(hone)-16.4(,)-177.7(w)-16.4(h)9.6(i)-1(ch)-196.2(au)-16.4(t)8.3(o)-2.2(ma)-16.4(t)9.5(i)-1(ca)-16.4(l)10.1(l)-1(y)]TJ
T*
-.0152 Tc
[(forwa)-15.2(r)14.8(de)-15.2(d)-274.8(t)-.4(he)-289(res)-15.2(u)12.9(lts)-287.8(t)-.4(o)-291.9(a)-288.6(central)-290.6(com)-15.2(p)10.6(ute)-15.2(r)-276.4(program)-15.2(m)14.4(e)-15.2(d)-274.9(t)-.4(o)-285.6(a)-15.2(l)11.3(e)1.8(rt)-284.9(both)]TJ
T*
-.015 Tc
[(the)-345.7(p)-.8(rim)-15(a)14.1(ry)-335.9(c)-15(a)13.1(re)-339.4(phys)-15(i)12.4(c)2(i)-15(a)11.5(n)-341.9(a)2.4(nd)-342.3(the)-339.4(h)1.2(e)-15(a)13.1(rt)-341.6(failu)-15(r)13.8(e)-345.7(clinic)-339.4(via)-345.3(a)2.4(utom)-15(a)14(t)-.2(ic)]TJ
T*
0 Tc
[(e-)31(ma)29.1(i)15.4(l)-288.1(a)17.4(l)15.4(er)29.6(t)14.8(s)0(.)-273.9(T)14.2(h)16.2(i)15.4(s)-285.2(s)0(y)26.1(s)18.3(t)14.8(e)0(m)-274.8(l)15.4(i)15.4(m)18(it)23.9(e)17(d)-283(ca)28.1(l)15.4(l)15.4(s)-285.2(th)24.7(a)17.4(t)-288.7(f)16.9(e)17(ll)-272.6(o)14.2(u)16.2(t)14.8(s)0(i)27.4(d)14.2(e)-286.5(p)14.2(r)18.9(e)0(s)29(c)0(r)23.3(i)15.4(b)14.2(e)17(d)-283(p)14.2(a-)]TJ
T*
-.015 Tc
[(ram)-15(e)13.7(te)-15(r)14.6(s)-15(.)-364.7(T)-.8(h)-15(e)-367.5(tota)-15(l)-367.8(n)-.4(um)-15(b)10.8(e)2(r)-381.8(o)-.8(f)-377.5(d)-.8(a)-15(y)10.3(s)-376.1(l).4(os)-15(t)-367.6(t)-.2(o)-380.2(h)1.2(os)-15(p)11.1(i).4(ta)-15(l)11.5(i).4(za)-15(t)10.9(i).4(on,)-376.7(d)-.8(e)-15(a)13.1(th)-15(,)-366.8(o)-.8(r)]TJ
T*
-.0152 Tc
[(dia)-15.2(l)11.3(ysis)-294.1(a)-15.2(m)13.9(ong)-291.9(C)-15.2(H)8.8(F)-291.9(pati)-15.2(e)11(n)-.6(ts)-294.1(wa)-15.2(s)-283(s)3.1(ignif)-15.2(i)10.8(ca)-15.2(n)10.5(t)-.4(ly)-291.9(lowe)-15.2(r)-282.8(f)1.7(or)-293.5(th)-15.2(e)-279.1(i).2(nte)-15.2(r)8.1(ven-)]TJ
0 -1.3278 TD
[(tion)-196.7(group)-197(c)1.8(om)-15.2(p)10.6(a)2.2(red)-197(w)-15.2(i)10.1(t)-.4(h)-195(t)-.4(he)-200.5(us)-15.2(u)12.9(a)2.2(l)-195.8(c)-15.2(a)12.9(r)-2.6(e)-194.2(g)-1(roup)-197(\(13)-197(d)-1(ays)-199.3(v)-1(ers)-15.2(u)12.9(s)-192.9(3)-1(0)-197(d)-1(a)-15.2(y)10.1(s,)]TJ
/F5 1 Tf
0 -1.3341 TD
0 Tc
(p)Tj
/F9 1 Tf
.6955 0 TD
(=)Tj
/F1 1 Tf
.7018 0 TD
[(0)14.2(.)17.7(0)14.2(2)14.2(\))0(.)-308.3(S)16.2(i)15.4(m)0(i)27.1(l)15.4(a)17.4(r)12.6(l)15.4(y)14.2(,)-323.7(d)14.2(u)16.2(r)18.9(in)30(g)-320.9(t)14.8(he)-308.2(st)26.8(u)16.2(d)14.2(y)-320.9(p)14.2(e)17(r)12.6(i)15.4(o)14.2(d)14.2(,)-317.4(ho)24(s)18.3(p)14.2(i)15.4(t)14.8(al)-308.6(a)17.4(d)14.2(mi)27.1(s)18.3(s)0(i)27.4(o)14.2(n)-320.6(r)18.9(at)25.9(e)17(s)]TJ
-1.3974 -1.3341 TD
[(f)16.9(o)14.2(r)-253(h)16.2(ea)28.1(r)12.6(t)-250.7(f)16.9(a)17.4(il)24.5(u)16.2(r)12.6(e)-248.5(p)14.2(e)17(r)-253(p)14.2(a)17.4(t)14.8(i)0(e)26.2(n)14.6(t)-250.7(w)16.2(er)29.6(e)-254.8(s)18.3(i)15.4(g)14.2(n)14.6(i)15.4(fi)26(c)17(a)0(n)25.7(t)14.8(l)15.4(y)-251.4(l)15.4(o)14.2(w)16.2(e)0(r)-236(\()15.4(0)14.2(.)0(2)25.5(4)-251.4(v)14.2(e)17(r)12.6(s)18.3(us)-237.4(0)14.2(.)0(4)25.5(2)14.2(\))]TJ
T*
[(f)16.9(o)14.2(r)-265.6(t)14.8(he)-251.3(t)14.8(e)0(l)26.2(e)17(mo)25.8(n)14.6(i)15.4(t)14.8(o)14.2(r)12.6(i)15.4(n)14.6(g)-264(c)17(o)14.2(ho)24(r)18.9(t)14.8(.)]TJ
1.1128 -1.3341 TD
[(In)-391.6(contrast)-401.1(to)-394.6(studies)-398(using)-401.9(smaller)-398(samples,)-394.9(shorter)-400.2(follow-up,)]TJ
-1.1128 -1.3341 TD
[(and)-371.2(sicker)-374.4(patients,)-367.9(a)-374.6(large)-372.3(sample)-367.6(study)-371.3(\()]TJ
/F5 1 Tf
18.1278 0 TD
(n)Tj
/F9 1 Tf
.7082 0 TD
(=)Tj
/F1 1 Tf
.7208 0 TD
[(1,518)-368.2(recruited)-375.3(from)]TJ
-19.5568 -1.3341 TD
[(51)-414.3(participating)-422.2(health)-415(centers\),)-424.6(with)-411.6(a)-418.9(longer)-417.9(duration)-418.1(\(1-)-415.3(and)]TJ
T*
[(3-year)-384.9(follow-up\))-391.8(and)-383.8(generally)-393.3(stable)-383.4(patients,)-386.9(was)-390.8(conducted)-385.6(in)]TJ
0 -1.3278 TD
(Argentina.)Tj
6.7246 0 0 5.9768 347.5275 112.0819 Tm
(50)Tj
8.9663 0 0 8.9663 358.4692 108.1133 Tm
[(It)-435.6(was)-441.3(aimed)-436.5(at)-435.6(assessing)-442.7(the)-438.8(effects)-438.5(of)-436.9(a)-437.8(telephone)]TJ
-5.6464 -1.3341 TD
[(intervention)-415.2(on)-413.9(improving)-411.2(patient)-416.5(education)-415.6(and)-415.4(compliance)-415.1(and)]TJ
T*
[(subsequently)-397.7(on)-394.9(hospitalization)-403.8(and)-390.1(death.)-402.2(The)-395.2(study)-396.6(compared)-394(a)]TJ
T*
[(centralized)-655.7(regular)-653.4(telephone)-656.2(intervention)-655.5(with)-651.9(usual)-656.3(care)-650.4(for)]TJ
/F9 1 Tf
6.9738 0 0 6.9738 187.6535 29.7638 Tm
()Tj
/F7 1 Tf
1.3251 0 TD
.2071 Tc
[(M)9.2(A)6.8(RY)-321.6(AN)4.8(N)-320.4(L)6.6(IEB)11.5(E)1.7(R)6.8(T)5.1(,)-327.7(I)3.7(N)12.9(C)3.1(.)]TJ
/F10 1 Tf
15.015 0 TD
0 Tc
()Tj
/F7 1 Tf
.9999 0 TD
.1103 Tc
[(VOL.)-327(20)-1000.8(N)5.5(O)4(.)-335.1(9)]TJ
/F10 1 Tf
8.3814 0 TD
0 Tc
()Tj
/F8 1 Tf
.9999 0 TD
.1099 Tc
[(SEPTEMB)6.6(E)2.1(R)-332.8(2).5(014)]TJ
/F4 1 Tf
7.9702 0 0 7.9702 442.7148 29.7638 Tm
0 Tc
[(TELEMEDICI)10.7(NE)-332(and)-328.9(e-HEALTH)-647.9(777)]TJ
ET
q
1 i
0 792 612 -791.985 re
W n
579.685 .014984 .22681 791.985 re
f
337.039 767.962 274.961 .22675 re
f
Q
BT
/F11 1 Tf
11.9551 0 0 11.9551 287.5464 741.9966 Tm
[(TELEMEDICINE)-340.6(FOR)-332.7(CHRONIC)-338.8(DISEASE)-334.7(MANAGE)-7.3(MENT)]TJ
ET
endstream
endobj
220 0 obj
<>/XObject<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]/Font<>/Properties<>>>/Thumb 223 0 R/MediaBox[0 0 612 792]/Rotate 0>>
endobj
224 0 obj
<>/ProcSet[/PDF/Text]/Font<>/Properties<>>>
endobj
221 0 obj
<>stream
/GS1 gs
BT
/F1 1 Tf
8.9663 0 0 8.9663 50.1732 693.8644 Tm
0 0 0 1 k
0 Tc
0 Tw
[(o)14.2(u)0(t)18.4(p)0(a)18.9(t)0(i)17.6(e)0(n)18.9(t)0(s)-390.5(w)0(i)18.9(t)0(h)-392.6(s)0(t)20.4(a)0(b)18.9(l)0(e)19.8(,)-405.9(ch)20.6(r)12.6(o)0(n)16.1(i)0(c)-391.2(h)0(e)20.6(a)0(r)17.3(t)-402.5(fa)21.6(il)18.2(ur)22.4(e.)-395.2(Pa)19.3(ti)23.9(en)18.9(ts)-396.9(in)-387.3(th)18.4(e)-400.3(i)0(n)17.3(t)0(e)19.2(r)12.6(-)]TJ
0 -1.3278 TD
[(v)14.2(e)0(n)18.9(t)0(i)17.6(o)0(n)-249.5(g)0(r)20.4(o)0(u)17.7(p)-257.7(re)17(ce)15.1(i)15.4(v)0(e)12.2(d)-257.7(an)-246.2(ex)18.9(pl)17(an)19.3(at)19.6(or)20.4(y)-257.7(b)0(o)15.7(o)0(k)21(l)0(e)19.8(t)-263.4(an)25.7(d)-264(w)0(e)20.5(r)12.6(e)-261.2(f)0(o)18.4(l)0(l)18.2(o)0(w)17.7(e)0(d)-247(u)0(p)]TJ
0 -1.3341 TD
[(v)14.2(i)0(a)-270.6(t)0(e)19.2(l)0(e)19.8(p)0(h)17.7(o)0(n)16.1(e)-280.1(by)-268.8(sp)19.8(ec)15.1(ia)20.2(li)18.2(ze)21.4(d)-283(n)14.6(ur)16.1(se)22.7(s.)-273.9(Th)17.7(e)-280.1(i)15.4(nt)16.7(er)17(v)14.2(e)0(n)18.9(t)0(i)17.6(o)0(n)-268.5(o)0(b)15.7(j)0(e)19.8(c)0(t)19.2(i)0(v)17(e)0(s)-268.2(w)0(e)20.5(r)0(e)]TJ
T*
[(t)14.8(o)-257.7(im)20.7(pr)20.4(ov)15.7(e)-254.8(d)0(i)17(e)0(t)19.2(a)0(r)23.7(y)-257.7(an)19.3(d)-251.4(t)0(r)14.7(e)0(a)21.8(t)0(m)20.1(e)0(n)18.9(t)-257.1(co)18.6(mp)19.5(li)24.6(an)19.3(ce)15.1(,)-254.2(t)0(o)-242.9(p)0(r)20.4(o)0(m)13.2(o)14.2(te)-246.3(ex)18.9(er)17(ci)19.8(se)16.3(,)-254.2(t)14.8(o)]TJ
T*
[(r)12.6(e)0(g)18.6(u)0(l)19(a)0(r)17.3(l)0(y)-179.1(m)0(o)19.5(n)0(i)23.7(t)0(o)16.3(r)-189.8(sy)19.8(mp)19.5(to)16.3(ms)23.6(,)-191(w)0(e)14.2(i)15.4(gh)17.7(t,)-182.5(an)19.3(d)-188.2(e)0(d)18.6(e)0(m)16(a)0(,)-179.9(a)0(n)19.3(d)-188.2(to)-179.7(pr)20.4(om)19.5(ot)16.3(e)-191.6(e)0(a)21.8(r)12.6(ly)]TJ
T*
[(v)14.2(i)0(s)14.7(i)0(t)23.9(s)-310.5(if)-296.5(si)21.1(gn)16.1(s)-304.2(o)0(f)-297.8(d)0(e)18.6(t)0(e)19.2(r)0(i)15.4(o)14.2(ra)17.3(ti)17.6(o)14.2(n)-307.9(we)14.2(r)12.6(e)-305.4(de)18.6(te)19.2(ct)19.2(ed)12.2(.)-304.8(A)0(l)19.6(l)-307(pa)18.9(ti)17.6(en)18.9(t)14.8(s)-310.5(we)20.5(re)-299.2(ca)21.8(ll)18.2(ed)]TJ
T*
[(ev)18.6(er)23.3(y)-276.7(1)14.2(4)-276.7(d)14.2(ay)18.9(s)-272.6(\()0(a)-264.3(t)0(o)22.7(t)0(a)19.6(l)-275.4(of)-259.8(fo)18.4(ur)-262.1(ti)17.6(me)22.4(s\))-263.5(af)21.6(te)12.9(r)-265.6(r)0(a)17.3(n)0(d)16.1(o)14.2(mi)14.4(za)21.8(ti)17.6(o)14.2(n)0(.)-264.9(S)0(u)19.7(b)0(s)19.8(e)0(q)18.6(u)0(e)14.3(n)14.6(t)]TJ
T*
[(ca)21.8(ll)-354.8(fr)23.1(eq)18.6(ue)14.3(nc)18.9(y)-365.2(w)0(a)20.9(s)-361.1(ad)18.9(ju)19(st)20.4(ed)-354.5(on)-357(th)18.4(e)-362.3(b)0(a)18.9(s)0(i)21.1(s)-367.4(of)-354.7(ca)21.8(se)-356.7(se)22.7(ve)18.6(ri)15.4(ty)-350.4(an)19.3(d)-365.2(c)0(o)18.6(m)0(-)]TJ
T*
[(p)14.2(l)0(i)18.2(a)0(n)19.3(c)0(e)15.1(.)-178.3(In)-164(ot)16.3(he)20.6(r)-177.1(w)0(o)17.7(r)12.6(ds)13.5(,)-178.3(t)14.8(ho)17.7(se)-173.3(wi)25.3(th)-171.3(se)16.3(v)14.2(e)0(r)17(e)-179(co)18.6(nd)16.1(i)15.4(t)0(i)17.6(o)0(n)16.1(s)-177.7(an)19.3(d)-175.5(w)0(h)19.7(o)-181.8(we)20.5(r)12.6(e)-179(le)19.8(ss)]TJ
0 -1.3278 TD
[(co)18.6(mp)19.5(li)24.6(an)19.3(t)-415.1(w)0(e)20.5(r)12.6(e)-412.9(c)0(o)18.6(n)0(t)23.1(a)0(c)15.5(t)0(e)19.2(d)-409.5(mo)19.5(re)-400.4(fr)16.8(eq)18.6(ue)20.6(nt)16.7(ly)23.3(.)-412.3(U)0(n)20.9(d)0(e)18.6(r)-411.1(su)21.8(pe)18.6(rv)14.1(is)21.1(io)17(n)-409.1(o)14.2(f)-413.1(a)]TJ
0 -1.3341 TD
[(ca)21.8(r)12.6(d)0(i)17(o)0(l)17(o)0(g)22(i)0(s)14.7(t)14.8(,)-323.7(n)0(u)18.1(r)12.6(se)16.3(s)-316.8(w)0(e)20.5(r)0(e)-311.8(a)0(l)20.2(l)0(o)17(w)0(e)20.5(d)-320.9(to)-306.1(ma)16.4(k)13.1(e)-324.4(sh)21.8(or)20.4(t-)16.2(te)19.2(r)12.6(m)-323.5(ch)20.6(an)19.3(ge)18.6(s)-316.8(i)0(n)-311.5(d)0(i)23.3(-)]TJ
T*
[(ur)22.4(et)19.2(ic)19.8(s)-455.9(a)0(n)19.3(d)-447.4(su)15.5(g)14.2(g)0(e)18.6(s)0(t)-447.5(u)0(n)24.4(s)0(c)16.3(h)0(e)20.6(d)0(u)17.7(l)0(e)19.8(d)-453.7(vi)17(si)21.1(ts)-441.1(to)-445.2(t)14.8(h)0(e)-447.3(c)0(a)21.8(r)12.6(di)17(ol)17(og)22(is)14.7(t)14.8(.)-456.5(Co)23.4(nt)16.7(r)12.6(o)0(l)]TJ
T*
-.0175 Tc
[(gr)-17.5(ou)-17.5(p)-461.4(s)-17.5(ub)-17.5(je)-17.5(ct)-17.5(s)-464.9(c)-17.5(on)-17.5(t)5.6(i)-17.5(nu)-17.5(ed)-477.6(tr)-17.5(ea)-17.5(tm)-17.5(ent)-470.6(w)-17.5(it)-17.5(h)-467(t)-17.5(he)-17.5(ir)-466.5(c)-17.5(a)-2(rd)-17.5(io)-17.5(log)-17.5(i)-.5(s)-17.5(t)2.9(s)-473.4(i)-17.5(n)-461.7(t)-17.5(he)]TJ
T*
0 Tc
[(us)21.8(ua)21(l)-351.3(m)0(a)22.7(n)0(n)16.5(e)0(r)23.3(.)-349(A)-350(s)0(i)21.1(g)0(n)16.1(i)0(f)19.6(i)0(c)19.8(a)0(n)19.3(t)-345.6(di)17(ff)21.1(er)17(en)18.9(ce)-339(be)18.6(tw)18.3(ee)21.4(n)-352.2(t)0(h)18.4(e)-343.4(tw)18.3(o)-352.6(g)0(r)20.4(o)0(u)17.7(p)0(s)-340.6(w)0(a)20.9(s)]TJ
T*
[(o)14.2(b)0(s)13.5(e)0(r)23.3(v)0(e)18.6(d)-314.6(wi)18.9(t)14.8(h)-312.6(r)12.6(e)0(g)12.2(a)0(r)23.7(d)-308.3(to)-306.1(ho)17.7(sp)19.8(it)23.9(al)13.9(i)15.4(z)0(a)15.5(t)0(i)17.6(o)14.2(n:)-303.1(16)22(.7)19.2(%)-313.5(o)0(f)-297.8(p)0(a)18.9(t)0(i)17.6(e)0(n)18.9(t)0(s)-302(i)0(n)-298.8(t)0(h)18.4(e)-311.7(in)23.7(-)]TJ
T*
[(t)14.8(e)0(r)17(v)0(e)18.6(n)0(t)16.7(i)0(o)23.3(n)-213.1(g)14.2(r)0(o)14.1(u)0(p)-197.3(a)0(n)19.3(d)-207.1(22)15.7(.3)19.2(%)-206(i)0(n)-197.6(t)0(h)18.4(e)-210.6(co)18.6(nt)23.1(ro)14.1(l)-205.9(g)0(r)20.4(o)0(u)17.7(p)-207.1(ha)21(d)-213.5(a)0(n)-195.6(a)0(d)19(m)0(i)20.7(s)0(s)17.6(i)0(o)17(n)-206.7(fo)18.4(r)]TJ
T*
[(he)20.6(ar)17.3(t)-200.2(f)0(a)15.3(i)0(l)18.2(u)0(r)22.4(e)0(,)-199.2(b)14.2(ut)-196.6(th)18.4(er)17(e)-204.3(w)0(a)20.9(s)-209.4(n)14.6(o)-207.1(si)21.1(gn)16.1(if)19.6(ic)19.8(an)19.3(t)-206.5(e)0(f)21.2(f)0(e)14.9(c)0(t)-195.8(o)14.2(n)-206.7(m)0(o)19.5(r)0(t)21.1(a)0(l)13.9(i)15.4(ty)16.3(.)-203.6(O)0(n)19.9(e)-210.6(y)14.2(e)0(a)15.5(r)]TJ
0 -1.3278 TD
[(la)20.2(te)19.2(r)12.6(,)-298.4(22)15.7(.9)19.2(%)-300.8(o)0(f)-291.5(t)14.8(he)-295.6(i)15.4(n)0(t)16.7(e)0(r)17(v)14.2(en)18.9(ti)17.6(on)-287.4(gr)14.1(o)14.2(u)0(p)-292.1(a)0(n)19.3(d)-302(2)14.2(9)0(%)-293(o)0(f)-291.4(t)0(h)18.4(e)-299.1(co)18.6(nt)23(ro)14.1(l)-294.4(g)0(r)14.1(o)14.2(up)]TJ
0 -1.3341 TD
[(ha)21(d)-409.5(b)0(e)18.6(e)0(n)-398.4(a)0(d)18.9(m)0(i)20.7(t)0(t)17(e)0(d)-398.7(t)0(o)-401(t)0(h)18.4(e)-406.6(ho)17.7(sp)19.8(it)17.6(al)20.2(.)-412.3(T)14.2(hr)16.1(ee)-402.2(y)14.2(e)0(a)15.5(r)12.6(s)-411.7(l)0(a)20.2(t)0(e)19.2(r)0(,)-399.7(2)0(8)15.7(.)0(9)19.2(%)-408.3(of)-398.9(th)18.4(e)]TJ
T*
[(in)23.7(te)19.2(rv)14.1(en)25.3(ti)17.6(on)-192.6(gr)20.4(ou)17.7(p)-200.8(a)0(n)19.3(d)-207.1(3)14.2(5)0(.)19.2(1)0(%)-198.1(o)14.2(f)-204.4(t)0(h)18.4(e)-204.3(co)18.6(n)14.6(t)0(r)14.7(o)14.2(l)-205.9(g)0(r)20.4(o)0(u)17.7(p)-200.8(ha)21(d)-207.1(b)14.2(ee)15.1(n)-200.4(a)0(d)18.9(m)0(i)20.8(t)0(t)17(e)0(d)18.6(.)]TJ
T*
[(Mo)18.9(r)12.6(e)0(o)18.6(v)0(e)18.6(r)12.6(,)-361.7(p)14.2(at)19.6(ie)13.5(n)14.6(t)0(s)-346.3(w)0(h)13.4(o)-352.6(sc)16.3(or)20.4(ed)-348.2(hi)19(gh)-349(on)-344.3(th)18.4(r)12.6(e)0(e)-351.6(c)0(o)18.6(m)0(p)19.5(l)0(i)18.2(a)0(n)19.3(c)0(e)-345.3(i)0(n)17.3(d)14.2(ic)13.5(at)19.6(o)14.2(r)0(s)]TJ
T*
[(\(d)23.3(ie)19.8(t,)-195.1(we)20.5(ig)17(ht)18.4(,)-197.3(a)0(n)19.3(d)-200.8(me)22.4(di)17(ca)21.8(ti)17.6(on)16.1(\))-199.5(h)0(a)21(d)-200.8(lo)17(we)20.5(r)-196.1(r)0(i)15.4(s)0(k)-189.9(e)0(v)18.6(e)0(n)18.9(t)14.8(s.)-191.7(Th)17.7(e)-197.9(s)0(t)14.1(u)0(d)17.7(y)-194.5(au)14.7(th)18.4(o)14.2(r)0(s)]TJ
T*
[(o)14.2(b)0(s)13.5(e)0(r)23.3(v)0(e)18.6(d)-314.6(th)18.4(at)-309.2(a)-311.4()62(s)23.3(im)14.4(p)14.2(l)0(e)19.8(,)-317.4(nu)18.1(r)12.6(s)0(e)16.3(-)0(b)21.8(a)0(s)16.7(e)0(d)-303.9(t)0(e)19.2(l)0(e)13.5(p)14.2(ho)17.7(ne)-303.5(in)17.3(te)19.2(rv)20.4(en)18.9(ti)17.6(on)-306.4(wa)20.9(s)-316.8(a)0(s)23(-)]TJ
T*
[(so)19.8(ci)19.8(at)19.6(ed)-348.2(wi)18.9(th)-342(a)-361.9(c)0(l)19.8(e)0(a)21.8(r)-354.2(cl)19.8(in)17.3(ic)19.8(al)-346.5(be)18.6(ne)18.9(fi)19.6(t)-358.2(f)0(o)18.4(r)-354.2(pa)18.9(ti)17.6(en)18.9(ts)-346.3(wi)18.9(th)-342(CH)17.7(F)-358.9(o)0(n)22.4(e)-356(an)19.3(d)]TJ
T*
[(t)14.8(h)0(r)16.1(e)0(e)-263.1(y)0(e)18.6(a)0(r)23.7(s)-272.6(af)21.6(te)19.2(r)-272(t)0(h)18.4(e)-273.8(i)15.4(n)0(t)16.7(e)0(r)17(v)14.2(en)18.9(ti)17.6(on)-262.1(st)20.4(op)15.7(p)14.2(e)0(d)18.6(.)0()73.3()]TJ
6.7246 0 0 5.9768 207.496 410.9668 Tm
(50)Tj
8.9663 0 0 8.9663 60.0945 395.0361 Tm
[(A)-312(2009)-316.4(\(published)-317.7(in)-311.4(2010\))-313.6(U.S.-based)-314.9(multicenter)-314(RCT)-313(\()]TJ
/F5 1 Tf
23.9575 0 TD
(n)Tj
/F9 1 Tf
.7082 0 TD
(=)Tj
/F1 1 Tf
.7145 0 TD
(188\))Tj
-26.4867 -1.3341 TD
[(investigated)-445(the)-445.1(effects)-444.8(of)-443.2(automated)-444(home)-446.8(monitoring)-446.5(and)-440.7(tele-)]TJ
T*
[(phonic)-439.6(disease)-438.8(management.)]TJ
6.7246 0 0 5.9768 160.611 375.0802 Tm
(51)Tj
8.9663 0 0 8.9663 171.5527 371.1117 Tm
[(Patients)-435.8(in)-437.9(the)-438.8(intervention)-440.5(group)]TJ
-13.5374 -1.3341 TD
[(received)-362.4(an)-366.4(automated)-368.1(home)-364.6(monitoring)-364.4(system,)-362.3(whereas)-365.9(those)-368.4(in)]TJ
T*
[(the)-217.5(control)-226.1(group)-219.6(received)-229.6()55.6(Specialized)-223.2(Primary)-224.1(and)-219.4(Networked)-226.6(Care)]TJ
T*
[(in)-279.8(Heart)-277.5(Failure.)48.8()-279.5(The)-281.4(end)-283(point)-280.9(was)-283.3(hospitalization)-283.7(within)-280.5(90)-281.5(days.)]TJ
T*
[(Patients)-334.7(in)-336.7(the)-337.6(intervention)-339.3(group)-339.7(had)-331.6(fewer)-337.7(hospitalizations)-341.3(com-)]TJ
T*
[(pared)-278.7(with)-285.2(their)-278(counterparts.)]TJ
1.1065 -1.3278 TD
[(In)-227.2(2010,)-229.1(a)-222.8(U.S.)-226.6(large)-226.9(multi-institution)-230.9(RCT)-230.8(\()]TJ
/F5 1 Tf
17.9065 0 TD
(n)Tj
/F9 1 Tf
.7082 0 TD
(=)Tj
/F1 1 Tf
.7208 0 TD
[(1,653\))-226.4(investigated)]TJ
-20.442 -1.3341 TD
[(the)-261.8(effects)-261.5(of)-259.8(telemonitoring)-268.4(using)-256.5(the)-261.8(Pharos)-260.9(Tel-Assurance)-265.5(system)]TJ
T*
[(for)-177.7(patients)-189.6(with)-184(heart)-181.2(failure)-186.2(on)-179.9(hospital)-183.9(re-admission)-190.1(for)-177.7(any)-187.8(reason)]TJ
T*
[(or)-308.4(death)-318.7(within)-312.1(6)-314.6(months)-308.7(of)-316.7(enrollment.)]TJ
6.7246 0 0 5.9768 202.6771 267.4771 Tm
(52)Tj
8.9663 0 0 8.9663 212.485 263.5086 Tm
[(Secondary)-317.9(outcomes)-319.3(in-)]TJ
-18.1025 -1.3341 TD
[(cluded)-310.6(hospitalization)-309(for)-304.2(heart)-314(failure,)-307.6(length)-306.1(of)-310.4(hospital)-310.4(stay,)-303.3(and)]TJ
T*
[(number)-305.9(of)-310.4(hospitalizations)-309.7(in)-305.1(6)-308.3(months.)-310(All)-306.4(patients)-309.8(\(in)-308.7(both)-307.4(inter-)]TJ
T*
[(vention)-413.8(and)-409.1(control)-415.7(groups\))-419.8(received)-413(educational)-420.7(materials)-410(and)-415.4(a)]TJ
T*
[(weight)-336.1(scale.)-339.7(Also,)-335(all)-337.4(patients)-335(were)-335.5(told)-339.8(to)-337.7(contact)-339.1(their)-334.9(clinicians)]TJ
0 -1.3278 TD
[(directly)-284(with)-291.5(any)-282.6(urgent)-290(concern.)-286.4(Hence,)-287.6(this)-289.4(was)-283.3(a)-286.1(comparison)-286.9(be-)]TJ
0 -1.3341 TD
[(tween)-230.2(two)-226.7(robust)-232.3(treatments,)-227.7(and)-232.1(the)-230.1(data)-227(for)-228.3(the)-230.1(intervention)-231.9(group)]TJ
T*
[(were)-240.7(self-reported)-250.8(by)-243.6(patients)-246.5(using)-243.8(an)-246.2(interactive)-247(voice)-244.6(recognition)]TJ
T*
[(system.)-242.2(The)-237.1(participation)-245.2(rate)-241.7(\(adherence)-239.8(to)-242.9(the)-242.8(intervention\))-241.7(started)]TJ
T*
[(at)-277.6(90.2%)-284.9(in)-279.8(the)-287.1(first)-282.5(week)-278.1(but)-283.6(dropped)-285.3(to)-280.8(55.1%)-284.9(by)-281.5(week)-284.4(26.)-282.8(By)-284.4(the)]TJ
T*
[(final)-236.4(week)-240.1(of)-240.9(the)-236.5(6-month)-241.9(study,)-239.8()55.6(only)-240.1(55%)-240.9(of)-240.9(the)-236.5(patients)-240.2(were)-240.7(still)]TJ
T*
[(using)-180.6(the)-179.6(system)-184(at)-182.7(least)-182.6(three)-181.6(times)-182(a)-178.6(week.)54.5()]TJ
6.7246 0 0 5.9768 212.9952 136.0062 Tm
(52)Tj
8.9663 0 0 8.9663 221.6125 131.9811 Tm
[(It)-182.7(is)-181.3(not)-184.1(surprising)-183.5(that)]TJ
-19.1205 -1.3341 TD
[(the)-362.9(authors)-370.9(concluded)-366(that)-366.7(their)-366.5()55.6(telemonitoring)-370.8(strategy)-369.9(failed)-365.2(to)]TJ
0 -1.3278 TD
[(provide)-220.8(a)-222.8(benefit)-225.2(over)-226.6(usual)-220(care)50.1()-222.6(with)-221.9(respect)-224.2(to)-223.9(hospitalization)-226.8(and)]TJ
0 -1.3341 TD
[(mortality.)-281.8(They)-279.9(did)-285(not)-278.9(report)-281.4(any)-282.6(cost)-283.5(data.)]TJ
1.1065 -1.3341 TD
[(Another)-304.9(long-duration)-307.9(\(8-year\))-303.4(study)-308.1(\()]TJ
/F5 1 Tf
16.3194 0 TD
(n)Tj
/F9 1 Tf
.7082 0 TD
(=)Tj
/F1 1 Tf
.7208 0 TD
[(358\))-302.5(was)-302.2(conducted)-309.7(in)]TJ
-18.8549 -1.3341 TD
(Italy.)Tj
6.7246 0 0 5.9768 69.2787 76.1953 Tm
(53)Tj
8.9663 0 0 8.9663 79.9937 72.2267 Tm
[(It)-416.6(investigated)-413.3(the)-419.8(effects)-413.2(of)-411.6(weekly)-419.2(nurse)-414.6(telephone)-416(tele-)]TJ
27.0052 69.3307 TD
[(monitoring)-345.4(and)-345.9(physician)-350.5(follow-up)-350.3(only)-346.4(when)-340.7(needed.)-349.9(Data)-348.6(were)]TJ
0 -1.3278 TD
[(gathered)-300.2(prospectively)-301(over)-296.1(a)-298.7(period)-298.2(of)-297.8(8)-295.7(years)-293.6(following)-299.9(the)-299.7(inter-)]TJ
0 -1.3341 TD
[(vention.)-326.5(The)-319.3(findings)-325.5(suggest)-323.4(improvements)-324(in)-324.1(clinical,)-322.4(functional,)]TJ
T*
[(and)-289(quality)-297(of)-291.4(life)-289.3(measures)-295.2(as)-286.8(well)-296.3(as)-286.8(lower)-291.4(hospital)-297.7(re-admissions)]TJ
T*
[(for)-278.9(cardiovascular)-286.5(reasons.)]TJ
1.1128 -1.3341 TD
[(A)-223.5(s)0(i)27.4(n)14.6(g)14.2(l)15.4(e)17(-)14(si)27.4(t)14.8(e)-223.2(RC)26.9(T)-226.1(\()]TJ
/F5 1 Tf
7.4357 0 TD
(n)Tj
/F9 1 Tf
.6955 0 TD
(=)Tj
/F1 1 Tf
.7018 0 TD
-.0148 Tc
[(710\))-239.6(involving)-240.9(m)-14.8(e)13.9(dium)-14.8(-)10.8(s)3.5(e)-14.8(v)10.1(erity)-240.9(C).8(HF)-240.9(pa)-14.8(t)11.1(i).6(ents)]TJ
-9.9459 -1.3341 TD
[(wa)-14.9(s)-358.6(c)-14.9(o)10(n)-.3(ducte)-14.9(d)-363.1(in)-373.4(Germ)-14.9(a)14.2(n)-.3(y)-373.8(i).5(n)-373.4(2011.)]TJ
6.7246 0 0 5.9768 457.9652 626.1164 Tm
0 Tc
(54)Tj
8.9663 0 0 8.9663 468.0566 622.1479 Tm
[(T)14.2(h)0(e)-346.1(t)14.8(el)26.2(e)17(m)0(e)28.7(d)14.2(i)15.4(c)0(a)28.1(l)-357.6(ma)29.1(n)14.6(a)17.4(g)14.2(e)0(m)28.7(e)0(n)25.3(t)]TJ
-16.2752 -1.3341 TD
-.0153 Tc
[(wa)-15.3(s)-466.5(l).1(ed)-481.7(by)-475.4(ph)-15.3(y)8.7(s)3(ic)-15.3(i)10.9(a)2.1(ns)-15.3(,)-466.2(a)2.1(nd)-481.7(the)-478.8(m)2.7(e)-15.3(d)9.6(ian)-481.3(f)1.6(ollow)-15.3(-)14.8(u)-15.3(p)-465.5(wa)-15.3(s)-466.5(2)-1.1(6)-475.4(m)-15.3(o)10.5(n)-.7(ths)]TJ
T*
[(\(m)-15.4(i)11.7(n)-.8(imum)-15.4(,)-251.6(1)-1.2(2)-266.8(m)-15.4(o)10.4(n)-.8(ths\))-15.4(.)-254.2(T)-1.2(he)-270.2(intervention)-266.4(c)-15.4(o)9.5(n)5.5(s)-15.4(i)12(s)-15.4(t)11.4(e)1.6(d)-266.8(o)-1.2(f)-264.1(portable)-270.2(d)-1.2(evic)-15.4(e)12.4(s)]TJ
0 -1.3278 TD
-.0156 Tc
[(for)-350.8(E).6(CG,)-345.7(b)-1.4(lood)-349.2(pre)-15.6(s)7.1(sure,)-352(a)1.8(nd)-342.9(body)-349.2(we)-15.6(i)10.6(g)-1.4(ht)-348.5(me)-15.6(a)12.5(s)-15.6(u)12.5(r)-3(eme)-15.6(n)9.7(t,)-345.7(wh)-15.6(i)9.7(c)1.4(h)-347.2(w).6(e)-15.6(r)14(e)]TJ
0 -1.3341 TD
0 Tc
[(co)31.2(n)14.6(n)14.6(e)0(c)27.8(t)14.8(ed)-247(t)14.8(o)-264(a)-254.5(p)14.2(er)23.3(s)18.3(o)14.2(n)14.6(a)17.4(l)-262.8(d)14.2(i)15.4(g)14.2(i)15.4(t)14.8(al)-245.3(as)29.4(si)27.4(s)18.3(t)14.8(an)25.7(t)-257.1(w)16.2(it)23.9(h)-255.7(c)0(e)27.8(l)15.4(l)-262.8(p)14.2(h)16.2(o)14.2(n)14.5(e)-261.2(t)14.8(r)12.6(a)17.4(n)14.5(sm)29.9(i)15.4(s)0(s)30.2(i)15.4(o)14.2(n)14.5(.)]TJ
T*
-.015 Tc
[(The)-276.2(s)3.3(tu)-15(d)9(y)-266.4(popu)-15(l)10.3(a)2.4(tion)-272.3(c)-15(o)9.9(nsis)-15(t)11.8(e)2(d)-272.7(o)-.8(f)-270(a)-15(d)10.3(u)1.2(lts)-274.9(1)-.8(8)-272.7(y)-.8(ears)-274.9(of)-270(age)-276.2(o)5.5(r)-274.3(o)-.8(lde)-15(r)-257.3(wit)-15(h)]TJ
T*
0 Tc
[(N)14.7(Y)0(H)26.4(A)-261.4(Cl)24.7(a)17.4(s)0(s)-254.3(I)17.5(I)-267.1(o)14.2(r)-265.6(I)0(I)28.6(I)-267.1(\()15.4(C)15.6(l)15.4(a)0(s)29.4(s)0(e)29(s)-266.3(I)-267.1(a)0(n)25.7(d)-264(I)17.5(V)-269.8(w)16.2(e)0(r)29.6(e)-267.5(ex)25.3(c)17(l)15.4(ud)24(e)17(d)14.2(\))15.4(.)-266.8(A)16.8(m)0(o)25.8(n)14.5(g)-264(p)14.2(at)25.9(i)15.4(e)17(n)14.5(t)14.8(s)]TJ
T*
-.015 Tc
[(as)-15(s)8.9(i).4(gned)-253.7(to)-253.8(the)-257.2(i).4(nterventi)-15(o)8.3(n)-247(g)-.8(roup,)-256.5(81%)-252.6(provi)-15(d)8.3(e)2(d)-253.7(a)2.4(t)-253.1(l).4(e)-15(a)13.1(s)-15(t)-241.2(70%)-252.6(of)-251.1(th)-15(e)11.9(i).4(r)]TJ
T*
-.0151 Tc
[(dai)-15.1(l)9.5(y)-222.2(d)-.9(a)-15.1(t)10.8(a)-225.3(t)-.3(rans)-15.1(f)13.7(e)1.9(rs)-15.1(.)-213.1(H)-.4(enc)-15.1(e)12.7(,)-231.3(a)2.3(bout)-227.9(20%)-227.4(did)-228.6(n)-.5(ot)-221.6(pa)-15.1(r)14.9(t)-.3(i)-15.1(c)11.1(ipa)-15.1(t)10.8(e,)-225(a)-15.1(n)10.6(d)-222.2(o)-.9(f)-225.9(t)-15.1(h)9.6(o)-.9(se)]TJ
T*
-.0156 Tc
[(wh)-15.6(o)-478.4(p)-1.4(a)-15.6(r)14.4(tic)-15.6(i)10.6(pate)-15.6(d)9.3(,)-491.1(30%)-487.2(di)-15.6(d)-479.2(n)-1(ot)-494(com)-15.6(p)10.2(ly)-488.3(wi)-15.6(t)8.3(h)-486.3(da)-15.6(i)10.9(l)-.2(y)-494.6(t)-.8(ra)-15.6(n)10.1(s)2.7(m)-15.6(i)11.5(ss)-15.6(i)11.8(o)-1.4(n)-487.9(o)-1.4(f)]TJ
T*
0 Tc
[(mo)32.1(n)14.5(i)0(t)23.9(o)14.2(r)18.9(i)15.4(n)14.6(g)-320.9(d)14.2(a)17.4(t)14.8(a)0(.)-306.3(T)14.2(h)16.2(e)-318.1(r)18.9(e)0(s)29(u)0(l)25.3(t)14.8(s)-316.8(w)16.2(er)29.6(e)-318.1(m)0(o)25.8(s)18.3(t)14.8(l)15.4(y)-320.9(n)14.6(e)17(u)0(t)24.7(r)18.9(al)26.5()16.8(s)0(h)28.1(o)14.2(w)16.2(i)15.4(n)14.5(g)-320.9(n)14.6(o)-314.6(st)26.8(a)17.4(t)14.8(i)15.4(s)0(-)]TJ
0 -1.3278 TD
[(t)14.8(i)15.4(ca)28.1(l)15.4(l)15.4(y)-371.5(si)27.4(g)14.2(n)14.6(i)15.4(f)0(i)26(c)17(a)17.4(n)14.6(t)-377.2(d)14.2(i)15.4(f)16.9(f)16.9(e)0(r)23.3(e)17(n)14.5(c)17(es)-363(i)15.4(n)-371.1(m)18(o)14.2(r)12.6(t)14.8(a)17.4(l)15.4(it)23.9(y)-371.5(o)14.2(r)-373.1(o)14.2(t)14.8(h)16.2(e)17(r)-373.1(ev)24.9(e)17(n)14.6(t)14.8(-)14(b)14.2(a)17.4(se)29(d)-377.9(o)14.2(u)16.2(t)14.8(-)]TJ
0 -1.3341 TD
[(co)31.2(me)28.7(s.)-880.9(O)18(v)14.2(e)17(r)12.6(al)26.5(l)-888.7(r)18.9(es)29(ul)25.3(t)14.8(s)-892.2(s)18.3(u)16.2(g)14.2(g)14.2(e)0(s)29(t)-895.7(t)14.8(h)16.2(a)17.4(t)-889.4(p)14.2(h)0(y)24(s)18.3(i)15.4(c)0(i)26.2(a)17.4(n)14.6(-)14(l)15.4(e)0(d)-879.3(t)14.8(e)17(l)15.4(em)28.7(ed)24.9(i)15.4(c)17(al)]TJ
T*
[(ma)29.1(n)14.5(a)17.4(g)14.2(e)0(m)28.7(e)0(n)25.3(t)-332.9()68.3()17.7(w)16.2(a)0(s)-324.7(n)14.5(o)14.2(t)-332.9(a)17.4(s)0(s)23.9(o)14.2(c)17(i)15.4(at)25.9(e)17(d)-333.6(wi)25.3(t)14.8(h)-331.6(a)-336.7(r)12.6(e)17(d)14.2(uc)26.9(t)14.8(i)15.4(o)14.2(n)-333.2(in)-324.1(a)17.4(l)15.4(l)15.4(-)14(ca)28.1(u)16.2(s)0(e)-325.1(m)18(o)14.2(r)12.6(-)]TJ
T*
-.0161 Tc
[(tal)-16.1(i)8.4(ty.)52.2()]TJ
6.7246 0 0 5.9768 346.4503 458.7589 Tm
0 Tc
(54)Tj
8.9663 0 0 8.9663 356.2015 454.7904 Tm
-.0149 Tc
[(Howe)-14.9(v)10(e)2.1(r,)-332.3(fe)-14.9(w)12(e)2.1(r)-337.5(h)1.3(ospita)-14.9(l)11.6(i).5(z)-14.9(a)13.2(tions)-331.7(w)1.3(e)-14.9(r)14.7(e)-333(obs)-14.9(e)14.1(r)-2.3(ved)-335.8(i).5(n)-329.1(t)-14.9(h)9.8(e)-333(inter-)]TJ
-3.8001 -1.3341 TD
-.0152 Tc
[(venti)-15.2(o)8.1(n)-240.9(g)-1(rou)-15.2(p)-231.4(c)-15.2(o)9.7(mpared)-247.6(with)-245.6(the)-244.8(c)1.8(ontrol)-240(group)-247.6(\().2(14.7%)-246.5(versu)-15.2(s)-233.6(16.5%\).)]TJ
1.1128 -1.3341 TD
0 Tc
[(In)-220.9(20082009)-232.9(\(published)-229.2(in)-229.3(2012\),)-226.4(Italian)-228.9(researchers)-228.7(conducted)-227.5(a)]TJ
-1.1128 -1.3341 TD
[(multicenter)-295(RCT)-294.1(\()]TJ
/F5 1 Tf
7.3346 0 TD
(n)Tj
/F9 1 Tf
.7082 0 TD
(=)Tj
/F1 1 Tf
.7145 0 TD
[(200\))-296.2(to)-293.5(investigate)-301.1(the)-293.4(effects)-293.1(of)-291.5(remote)-298.4(moni-)]TJ
-8.7572 -1.3341 TD
[(toring)-306.3(on)-306.4(emergency)-307.4(room)-307.9(visits)-308.3(for)-304.2(CHF)-309.6(patients)-309.7(with)-304.1(implantable)]TJ
0 -1.3278 TD
[(ca)21.8(rd)14.1(io)23.3(ve)18.6(rt)14.7(er)-204.3(de)18.6(fi)19.6(br)20.4(il)18.2(la)20.2(to)16.3(r)12.6(s)-222(\(I)20.3(CD)22(s\))14.7(.)]TJ
6.7246 0 0 5.9768 440.7306 399.0046 Tm
(55)Tj
8.9663 0 0 8.9663 449.5747 395.0361 Tm
[(Th)17.7(ey)-209.1(co)18.6(mp)19.5(ar)17.3(ed)-209.1(r)12.6(e)0(m)16(o)0(t)22.7(e)-223.2(mo)19.5(n)14.5(i)0(t)17.6(o)0(r)20.4(i)0(n)17.3(g)]TJ
-14.2139 -1.3341 TD
[(wi)18.9(th)-259.8(st)20.4(an)19.3(d)14.2(a)0(r)17.3(d)-270.4(p)14.2(a)0(t)19.6(i)0(e)13.5(n)14.6(t)-269.7(m)0(a)22.7(n)0(a)19.3(g)0(e)18.6(m)0(e)16(n)14.6(t)-269.7(c)0(o)18.6(n)0(s)20.2(i)0(s)21.1(t)0(i)17.6(n)0(g)-255.8(o)0(f)-259.8(s)0(c)22.7(h)0(e)14.3(d)14.2(ul)19(ed)-259.6(vi)17(si)21.1(ts)-257.8(an)19.3(d)]TJ
T*
[(pa)18.9(ti)17.6(en)19(t)-263.4(r)0(e)17(s)0(p)19.8(o)0(n)16.1(s)0(e)-255.5(t)0(o)-255.5(a)0(u)14.7(d)14.2(ib)17(le)-258.4(IC)20.4(D)-265.5(a)0(l)13.9(e)0(r)23.3(t)0(s)20.4(.)-266.8(Th)17.7(e)-267.5(p)0(r)14.1(i)15.4(ma)16.4(r)12.6(y)-270.4(en)19(d)-264(p)0(o)15.7(i)0(n)23.7(t)-269.7(wa)20.9(s)-266.3(t)0(h)18.4(e)]TJ
T*
[(r)12.6(a)0(t)13.3(e)-482.5(o)14.2(f)-482.7(em)16(er)23.3(ge)12.2(n)14.6(c)0(y)-474.6(d)0(e)18.6(p)0(a)18.9(r)12.6(tm)13.8(en)18.9(t)-478.4(o)0(r)-472.8(u)0(r)16.1(g)0(e)18.6(n)14.6(t)-484.7(i)0(n)17.3(-)14(of)18.4(fi)19.6(ce)-478.1(v)14.2(i)0(s)14.7(i)0(t)23.9(s)-487.6(fo)18.4(r)-480.6(h)0(e)20.6(a)0(r)17.3(t)]TJ
T*
[(fa)21.6(il)18.2(ur)16.1(e,)-218.2(ar)23.7(rh)16.1(yt)16.3(hm)21.5(ia)20.2(s,)-216.9(or)-219.9(IC)20.4(D-)14(r)12.6(e)0(l)19.8(a)0(t)19.6(e)0(d)-221.7(e)0(v)18.6(e)0(n)18.9(t)0(s)20.4(.)-228.9(Th)17.7(e)-229.6(i)0(n)23.7(t)0(e)19.2(r)0(v)14.1(e)0(n)18.9(t)14.8(io)16.9(n)-225.7(c)0(o)18.6(n)0(s)20.2(i)0(s)14.7(t)0(e)19.2(d)]TJ
T*
[(of)-493.8(im)20.8(pl)17(an)19.3(ti)17.6(n)14.6(g)-504.3(he)14.3(ar)23.7(t)-503.7(f)0(a)15.3(i)0(l)24.6(u)0(r)16.1(e)-501.4(pa)19(ti)17.6(en)18.9(ts)-491.7(wi)18.9(th)-500.1(a)-501(w)0(i)18.9(r)12.6(el)19.8(es)16.3(s-)19.6(tr)21.1(an)19.3(sm)17.3(is)21.1(si)21.1(on)16.1(-)]TJ
T*
[(en)18.9(ab)18.9(le)19.8(d)-219.8(I)0(C)20.4(D)0(/)16.9(c)0(a)21.8(r)0(d)20.4(i)0(a)20.2(c)-223.2(r)12.6(e)0(s)16.3(y)0(n)22.4(c)0(h)14.3(r)12.6(on)22.4(iz)13.5(at)19.6(io)23.3(n)-219.4(t)0(h)18.4(e)0(r)17(a)0(p)18.9(y)-213.5(en)18.9(do)15.7(we)20.6(d)-219.8(w)0(i)18.9(t)0(h)-209.3(s)0(p)19.8(e)0(c)21.4(i)0(f)19.6(i)0(c)]TJ
T*
[(di)17(ag)18.9(n)14.6(o)0(s)13.5(t)14.8(ic)-410.1(fe)21.2(at)19.6(ur)16.1(es)-407.3(\(r)21.7(em)22.4(ot)16.3(e)-419.2(a)0(r)23.7(m)0(/)15.8(h)0(o)24(m)0(e)-407.6(m)0(o)19.5(n)0(i)17.3(t)0(o)16.3(r)12.6(\),)-403.1(th)18.4(er)17(eb)18.6(y)-415.8(i)0(n)17.3(c)0(r)23.3(e)0(a)15.5(s)0(i)21.1(n)0(g)]TJ
0 -1.3278 TD
[(ef)21.2(fi)19.6(ci)13.5(en)18.9(cy)-360.8(co)18.6(mp)19.5(ar)23.7(ed)-360.8(wi)18.9(th)-361(th)18.4(e)-375(s)0(t)20.4(a)0(n)19.3(d)14.2(ar)17.3(d)-371.5(m)0(a)22.7(n)0(a)19.3(g)0(e)18.6(m)0(e)16(n)14.5(t)-370.9(p)0(r)14.1(o)14.2(to)16.3(co)18.6(l)-370.3(\()0(s)21.1(t)0(a)19.6(n)0(-)]TJ
0 -1.3341 TD
[(da)18.9(r)12.6(d)-339.9(ar)23.7(m\))14.4(.)-336.4(A)-331(si)14.7(g)14.2(n)0(i)17.3(f)0(i)19.6(c)0(a)21.8(n)0(t)-331(d)14.2(if)19.6(fe)14.9(r)12.6(e)0(n)19(c)0(e)-326.3(i)0(n)-330.4(e)0(m)22.4(e)0(r)17(g)14.2(en)18.9(cy)-329.2(de)18.6(pa)19(r)12.6(t)0(m)13.8(e)0(n)18.9(t)14.8(/u)14.1(r)12.6(g)0(e)18.6(n)0(t)]TJ
T*
[(in)17.3(-)14(o)0(f)18.4(f)0(i)19.6(c)0(e)-244.1(v)14.2(is)14.7(it)23.9(s)-253.6(b)14.2(et)12.9(we)20.5(en)-240.3(th)18.4(e)-248.5(g)0(r)20.4(o)0(u)17.7(p)0(s)-239.5(w)0(a)20.9(s)-247.3(do)15.7(cu)20.6(me)16(nt)23.1(ed)18.6(.)-254.2(O)0(f)-237(a)-248.1(to)16.3(t)14.8(a)0(l)-239(o)0(f)-240.9(1)0(9)15.7(2)]TJ
T*
[(vi)17(si)21.1(ts)20.4(,)-488.1(7)0(5)-477.5(w)0(e)20.5(r)0(e)-482.6(m)0(a)22.7(d)0(e)-481(i)0(n)-475.8(t)0(h)18.4(e)-482.5()62()0(r)17.6(e)0(m)22.4(o)0(t)16.3(e)-488.8(ar)23.7(m)73.6()-488.1(g)0(r)20.4(o)0(u)17.7(p)-485.3(an)19.3(d)-485.3(1)0(1)15.7(7)-485.3(in)-475.8(th)18.4(e)]TJ
T*
[()62()0(s)23.3(t)0(a)19.6(n)0(d)16.1(a)0(r)23.7(d)-270.4(ar)23.7(m)73.6()-266.8(g)0(r)20.4(o)0(u)17.7(p)0(.)-252.7(C)0(o)17.1(m)0(p)19.5(a)0(r)17.3(e)0(d)-253.3(w)0(i)18.9(t)0(h)-259.8(s)0(t)20.4(a)0(n)19.3(d)0(a)18.9(r)12.6(d)-270.4(m)0(a)22.7(n)0(a)19.3(g)0(e)18.6(m)0(e)22.4(n)0(t)16.7(,)-266.8(r)12.6(e)0(m)16(o)0(t)22.7(e)]TJ
T*
[(mo)19.5(ni)17.3(to)22.7(ri)15.4(n)14.6(g)-175.5(wa)20.9(s)-171.4(s)0(i)14.7(g)14.2(ni)17.3(fi)19.6(ca)15.5(n)14.5(t)0(l)17.6(y)-175.5(as)23.1(so)19.8(ci)19.8(at)19.6(ed)-164.8(wi)18.9(th)-165(a)-172.3(r)0(e)17(d)0(u)17.7(c)0(t)19.2(i)0(o)23.3(n)-175.1(of)-165(em)22.4(er)17(ge)18.6(nc)18.9(y)]TJ
T*
[(de)18.6(pa)18.9(r)12.6(t)0(m)13.8(e)0(n)18.9(t)14.8(/u)14.1(r)12.6(g)0(e)18.6(n)0(t)-299.4(i)0(n)17.3(-)14(of)18.4(fi)19.6(ce)-301(vi)17(si)21.1(ts)-302(fo)18.4(r)-309.9(e)0(p)18.6(i)15.4(so)13.5(d)14.2(e)0(s)-299.8(o)0(f)-304.1(h)0(e)20.6(a)0(r)17.3(t)-307.6(fa)21.6(il)18.2(ur)16.1(e)-305.4(w)0(o)17.7(r)0(s)18.2(-)]TJ
T*
[(en)18.9(in)17.3(g)14.2(.)-273.2(Th)17.7(e)-267.5(a)0(u)21(t)0(h)18.4(o)0(r)14.1(s)-266.3(no)16.1(t)14.8(e)0(d)-266(t)14.8(ha)14.7(t)-269.7(i)0(n)-260.9(a)0(d)25.3(d)0(i)17(t)0(i)17.6(o)0(n)-262.1(t)14.8(o)-270.4(r)0(e)17(d)0(u)17.7(c)0(t)19.2(i)0(o)17(n)14.6(s)-272.6(i)0(n)-260.9(e)0(m)22.4(e)0(r)17(g)0(e)18.6(n)0(c)18.9(y)]TJ
0 -1.3278 TD
[(r)12.6(o)0(o)15.7(m)-487.9(vi)17(si)21.1(ts)20.4(,)-488.1(t)0(h)18.4(e)0(r)17(e)-488.8(wa)20.9(s)-487.6(a)0(n)-473.9(o)0(v)15.7(e)0(r)17(a)0(l)20.2(l)-484.1(in)17.3(cr)17(ea)21.8(se)-476.8(in)-475.8(th)18.4(e)-488.8(e)0(f)14.9(f)0(i)19.6(c)0(i)19.8(e)0(n)18.9(t)-484.7(us)15.5(e)-488.8(o)14.2(f)]TJ
0 -1.3341 TD
[(he)20.6(al)20.2(th)18.4(ca)15.5(r)12.6(e)-210.6(pr)14.1(o)14.2(v)0(i)17(d)0(e)18.6(r)12.6(s)-215.7(a)0(n)19.3(d)-207.1(im)14.4(p)14.2(r)0(o)14.1(v)14.2(ed)-202.7(qu)17.7(al)20.2(it)17.6(y)-213.5(o)14.2(f)-210.8(c)0(a)15.5(r)12.6(e.)-205.5(Bu)21.2(t,)-201.4(qu)17.7(al)20.2(it)17.6(y)-213.5(o)14.2(f)-217.1(c)0(a)21.8(r)12.6(e)]TJ
T*
[(wa)20.9(s)-272.6(n)0(o)22.4(t)-276(ex)18.9(p)14.2(r)0(e)17(s)0(s)17.6(e)0(d)-259.6(i)0(n)-260.9(q)0(u)17.7(a)0(n)19.3(t)14.8(it)17.6(at)19.6(iv)17(e)-267.5(t)0(e)12.9(r)12.6(ms)17.3(.)]TJ
1.1128 -1.3341 TD
[(Similar)-439.6(findings)-439.3(were)-443(reported)-439.9(from)-438(a)-437.8(2010)-442.8(study)-440.9(in)-437.9(China)-439.3(in)]TJ
-1.1128 -1.3341 TD
[(which)-247.8(550)-248.4(heart)-244.4(failure)-249.5(patients)-246.5(were)-247(randomized)-250.2(to)-242.9(an)-246.2(intervention)]TJ
T*
[(consisting)-235.3(of)-234.5(nursing)-229.4(telephone)-238.9(consultations)-237.5(versus)-232.3(a)-229.2(control)-232.4(group)]TJ
T*
[(receiving)-412.7(the)-407.2(usual)-409.7(standard)-414.1(of)-405.3(care.)]TJ
6.7246 0 0 5.9768 464.2015 136.0062 Tm
(56)Tj
8.9663 0 0 8.9663 474.9164 131.9811 Tm
[(After)-408.8(6)-409.5(months,)-411.1(the)-407.2(inter-)]TJ
-17.0402 -1.3341 TD
[(vention)-318.9(group)-320.8(had)-318.9(a)-317.7(significantly)-321.2(lower)-316.7(all-cause)-319.7(admission)-315.9(rate,)-318.8(a)]TJ
0 -1.3278 TD
[(shorter)-305.4(all-case)-297.9(hospital)-304(stay)-302(\(8)-299.2(days)-302.7(fewer)-299.7(per)-304(patient\),)-301.2(and)-301.6(overall)]TJ
0 -1.3341 TD
[(lower)-285(total)-277.4(cost.)]TJ
1.1128 -1.3341 TD
[(A)-274.1(multicenter)-276(RCT)-275.1(\()]TJ
/F5 1 Tf
8.2514 0 TD
(n)Tj
/F9 1 Tf
.7082 0 TD
(=)Tj
/F1 1 Tf
.7208 0 TD
[(382\))-277.2(was)-270.6(conducted)-278.1(in)-273.5(The)-275.1(Netherlands)-276.7(in)]TJ
-10.7932 -1.3341 TD
[(2012)-525(to)-527.4(ascertain)-519.3(the)-527.3(effects)-527(of)-525.4(telemonitoring)-527.6(on)-521.4(heart)-522.6(failure)]TJ
/F11 1 Tf
11.9551 0 0 11.9551 50.1732 741.9966 Tm
[(BASHSHUR)-338.5(ET)-334.1(AL.)]TJ
7.9702 0 0 7.9702 50.1732 29.7638 Tm
[(7)-80(7)-80.1(8)-701.6(TELEMEDICINE)-323.9(and)-324.7(e-HEALTH)]TJ
/F8 1 Tf
6.9738 0 0 6.9738 177.222 29.7638 Tm
.1096 Tc
[(SEPT)6.7(EMBER)-333.1(2)8.4(014)]TJ
ET
q
1 i
0 792 612 -791.985 re
W n
32.315 .014984 .22675 791.985 re
f
/Document /MC6 BDC
Q
q
1 i
0 792 32.315 -173.367 re
W n
0 0 0 .29999 k
0 618.633 32.315 173.367 re
f
EMC
Q
32.315 763.994 242.646 .22675 re
f
endstream
endobj
225 0 obj
<>stream
Adobe Illustrator CS4
2010-08-04T11:54:42+05:30
2010-08-04T11:54:42+05:30
2010-08-04T11:54:42+05:30
68
256
JPEG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application/postscript
saved
xmp.iid:11FB61F30AB7DE11AEB3E861853EAFA4
2009-10-12T14:15:50+05:30
Adobe Illustrator CS4
/
converted
from application/postscript to application/vnd.adobe.illustrator
converted
from application/postscript to application/vnd.adobe.illustrator
saved
xmp.iid:0280117407206811994CBE3149FFDB59
2010-08-04T11:54:42+05:30
Adobe Illustrator CS4
/
converted
from application/postscript to application/vnd.adobe.illustrator
xmp.iid:11FB61F30AB7DE11AEB3E861853EAFA4
xmp.did:11FB61F30AB7DE11AEB3E861853EAFA4
uuid:ee5a72b3-04e4-4157-a8d8-c3a8817872a3
uuid:ee5a72b3-04e4-4157-a8d8-c3a8817872a3
xmp.iid:0280117407206811994CBE3149FFDB59
xmp.did:0280117407206811994CBE3149FFDB59
TouchUp 7.0
False
False
1
684.000000
864.000000
Points
Black
Default Swatch Group
0
PANTONE 3025 C
SPOT
100.000000
CMYK
100.000000
16.859999
0.000000
50.980003
endstream
endobj
222 0 obj
<>
endobj
226 0 obj
<>/XObject<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]/Font<>>>/Thumb 229 0 R/MediaBox[0 0 612 792]/Rotate 0>>
endobj
230 0 obj
<>/ProcSet[/PDF/Text]/Font<>>>
endobj
228 0 obj
<>stream
/GS1 gs
BT
/F1 1 Tf
8.9663 0 0 8.9663 35.8866 693.8644 Tm
0 0 0 1 k
0 Tc
0 Tw
[(hospitalization)-384.9(over)-378.3(a)-380.9(1-year)-378.6(follow-up)-381.9(period.)]TJ
6.7246 0 0 5.9768 216.5102 697.8896 Tm
(57)Tj
8.9663 0 0 8.9663 226.9417 693.8644 Tm
[(The)-382.6(intervention)]TJ
-21.3082 -1.3278 TD
[(group)-371.4(received)-368.7(a)-368.3(liquid)-370.7(crystal)-370.8(display)-371.5(device)-373(with)-373.7(four)-370.2(keys)-367.3(con-)]TJ
0 -1.3341 TD
[(nected)-335.3(to)-337.7(a)-336.7(landline)-337.5(phone,)-336.1(but)-340.5(there)-339.7(was)-333.8(no)-338(automatic)-341.6(transfer)-337.5(of)]TJ
T*
[(vital)-384.3(signs.)-382.2(Information)-386.5(on)-382.3(heart)-383.5(rate)-387.1(and)-383.8(blood)-383.2(pressure)-386.1(for)-386.4(both)]TJ
T*
[(intervention)-314.1(and)-307.9(control)-314.6(groups)-315.1(was)-308.6(collected)-319.4(during)-311.3(regular)-311.9(clinic)]TJ
T*
[(visits.)-341.2(The)-344.6(intervention)-345.7(group)-339.7(had)-344.2(daily)-340.7(preset)-342.4(dialogues)-344.6(regarding)]TJ
T*
[(symptoms,)-326.8(knowledge,)-333.3(and)-326.9(behavior.)-335.4(Although)-331.3(telemonitoring)-331.6(had)]TJ
T*
[(no)-205.2(impact)-213(on)-211.6(initial)-213.9(CHF)-208.4(hospitalization,)-215.4(it)-210(was)-213.7(found)-208.6(to)-211.3(reduce)-215.8(heart)]TJ
T*
[(failure)-192.6(re-admissions)-190.8(and)-194.1(to)-192.3(decrease)-191.9(contact)-200(with)-190.3(specialized)-194.6(nurses.)]TJ
1.1065 -1.3278 TD
[(A)-305.7(l)0(a)13.9(rge)-297.7(stu)17.7(dy)-300.5(\()]TJ
/F5 1 Tf
6.1965 0 TD
(n)Tj
/F9 1 Tf
.7018 0 TD
(=)Tj
/F1 1 Tf
.7145 0 TD
[(3,)12.9(230)-298.9(fro)18.3(m)-304.5(179)-292.6(sit)16.9(es)-299.8(in)-298.8(th)12.1(ree)-294.8(are)15.4(as)-299.4(in)-298.8(Eng)19.6(land)17.3(\))]TJ
-8.7193 -1.3341 TD
[(inv)18.9(est)12.2(iga)15.4(ted)-358.6(th)12.1(e)-368.7(i)0(m)14.4(pact)-353.9(of)-361(rem)15.9(ote)-352.3(exch)14.2(an)13(ge)-360.8(of)-361(da)12.6(ta)-359.8(via)-357.6(a)-361.9(ran)12.9(ge)-354.5(of)]TJ
T*
[(de)12.2(vice)13.1(s)-386.4(a)0(n)13(d)-384.2(moni)17.8(tori)19(ng)-382.3(sys)12.8(tem)11.9(s)-386.4(f)0(o)12.1(r)-385.8(pati)17.6(ent)14.8(s)-386.4(with)-373.7(CHF)12.9(,)-387(COPD)16.6(,)-387(a)0(n)13(d)]TJ
T*
[(dia)15.4(be)12.2(tes)12.2(.)]TJ
6.7246 0 0 5.9768 68.0315 554.3998 Tm
(58)Tj
8.9663 0 0 8.9663 77.896 550.4313 Tm
[(Thi)14.2(s)-323.2(was)-314.9(a)-324()62(cl)12.2(ust)17.7(er)-318.2(ran)12.9(dom)14.7(ize)11.6(d)-320.9(tria)16(l,)14.2()55.6()-317.4(whic)14.2(h)-318.9(mea)14.5(ns)-321.3(ran)19.2(-)]TJ
-4.6853 -1.3341 TD
[(dom)14.7(iza)12(tio)19.1(n)-301.6(w)0(a)14.6(s)-297.9(don)11.3(e)-299.1(b)0(y)-294.1(c)0(l)13.5(ust)11.4(ers)-287.2(\(or)-286.6(clin)18.2(ics)12.8(\))-300.7(rat)19.5(her)-289.3(than)-284.8(ind)12.5(ivi)13.4(du)11.4(als)13.2(,)]TJ
T*
[(an)13(d)-194.5(i)0(t)-191(use)13.6(d)-194.5(a)-197.5(rel)13.4(ati)16.1(vel)15(y)-200.8(c)0(o)12.2(stly)-183.9(int)13.2(erv)12.2(en)12.6(tio)12.8(n)-194.1(for)-184(the)-185.9(ele)11.6(ctr)12.8(oni)12.5(c)-191.6(exch)14.2(an)13(ge)]TJ
T*
[(of)-234.5(inf)15.2(orm)13.1(ati)16.1(on)-236.8(bet)14.4(wee)12.3(n)-244.7(p)0(a)12.6(tien)17.6(ts)-238.8(an)13(d)-245.1(pro)15.6(vid)12.2(ers)16.3(.)-241.5(Duri)19(ng)-236.8(the)-236.5(12-)17(mon)15.1(th)]TJ
T*
[(cl)13.5(ini)13.8(cal)-316.8(tria)16(l)-319.7(per)12.2(iod)12.2(,)-323.7(pat)14.8(ient)17.6(s)-323.2(i)0(n)-324.1(t)0(h)12.1(e)-324.4(int)13.2(erv)12.2(ent)14.8(ion)-316.3(gro)15.6(up)-323.7(wer)14.1(e)-324.4(sign)18.2(ifi)16.1(-)]TJ
0 -1.3278 TD
[(can)17.4(tly)-322.3(les)12.8(s)-329.5(lik)12.4(ely)-320.1(to)-331.4(be)-322.9(hosp)12.2(ita)16.1(liz)16.3(ed)-329.2(\(od)12.2(ds)-328(rat)19.5(io)-330.8(of)-323.1(0.82)15.9(\))-332.3(and)-320.6(sign)18.2(ifi)16.1(-)]TJ
0 -1.3341 TD
[(can)17.4(tly)-183.2(les)12.8(s)-190.4(lik)12.4(ely)-181(to)-186(die,)-182.3(co)12.2(mpa)11.6(red)-183.9(wi)12.6(th)-190.3(pa)12.6(tien)17.6(ts)-188.2(in)-185(the)-185.9(co)12.2(ntro)18.2(l)-193.2(clus)16.4(ter)12.8(s.)]TJ
T*
[(Al)13.2(tho)13.6(ugh)-231.6(th)12.1(e)-242.2(inv)18.9(est)12.2(iga)15.4(tors)-224.7(reco)16.5(gni)12.5(zed)-230(th)12.1(e)-235.9(pot)11.5(ent)14.8(ial)-229.9(for)-228.3(sel)12.8(ect)11(ion)-227.7(bia)15.4(s)]TJ
T*
[(be)12.2(cau)12.7(se)-268.2(of)-266.2(grou)12.8(p)-270.4(rat)13.2(her)-264(th)12.1(an)-271.5(ind)18.9(ivi)13.4(dual)-259.2(ran)12.9(dom)14.7(iza)12(tio)12.8(n,)-264.9(th)12.1(ey)-272.3(tri)17.5(ed)-272.3(to)]TJ
T*
[(mat)18.6(ch)-371.4(gro)15.6(ups)-368.7(by)-370(pra)12.5(ct)12.9(ice)-367.8(siz)12.8(e,)-369.9(dis)16.3(ease)-366.5(pr)14.1(eval)13.5(en)12.6(ce,)-365.5(and)-364.8(oth)13.6(er)-368.7(cha)12.7(r-)]TJ
T*
[(act)17.7(eri)13.4(stic)15(s.)-394(Th)11.4(e)-400.3(stu)11.4(dy)-395.3(con)14.1(clud)18.6(ed)-398.8(th)12.1(at)-397.7(th)12.1(e)-400.3(tele)13.8(med)17.5(icin)18.2(e)-400.3(int)13.2(erv)12.2(ent)14.8(ion)]TJ
T*
[(co)12.2(uld)-580.2(ser)16.3(ve)-582.1(sev)17.9(eral)-569.8(pur)11.3(pos)15(es:)-579.5(na)13(mel)12.5(y,)-581.5(to)-578(help)-569.5(pati)17.6(ent)14.8(s)-588.7(man)18.3(age)]TJ
T*
[(chr)14.2(oni)12.5(c)-191.6(dis)16.3(eas)14.8(e)-197.9(b)0(e)12.2(tter)15(,)-191(t)0(o)-192.3(cha)12.7(nge)-181.9(pat)14.8(ient)17.6(s)-191.7(pe)12.2(rcep)16.5(tio)12.8(ns)-188.5(as)-191.9(to)-186(whe)11.5(n)-194.1(t)0(h)12.1(e)0(y)]TJ
0 -1.3278 TD
[(ne)12.6(ed)-247(to)-249.2(see)14.4(k)-252.4(add)14.1(iti)14.1(ona)14.5(l)-256.4(sup)17(port)17.8(,)-254.2(a)0(n)13(d)-257.7(to)-242.9(assi)18.8(st)-251.4(pr)14.1(ofes)15.7(sion)18.2(als)13.2()-254.2(d)0(e)12.2(cis)12.8(ion)12.5(s)]TJ
0 -1.3341 TD
[(reg)18.5(ard)12.5(ing)-265.7(whe)11.5(n)-276.3(t)0(o)-268.2(ref)14.8(er)-273.9(or)-270.4(adm)11.6(it)-266.9(pat)14.8(ient)17.6(s.)]TJ
1.1065 -1.3341 TD
[(The)-388.9(findings)-388.7(from)-387.4(a)-380.9(large)-391.3(study)-384(\()]TJ
/F5 1 Tf
14.3846 0 TD
(n)Tj
/F9 1 Tf
.7082 0 TD
(=)Tj
/F1 1 Tf
.7208 0 TD
[(1,767\))-384.4(of)-386.3(Medicare)-390.4(benefi-)]TJ
-16.9201 -1.3341 TD
[(ciaries)-436.9(reported)-439.9(significant)-439.3(savings)-437.8(among)-433.9(patients)-442.5(who)-434(used)-440.2(the)]TJ
T*
[(Health)-410.2(Buddy)-416.9(program)-415.5(in)-412.6(2011.)]TJ
6.7246 0 0 5.9768 159.4204 351.1558 Tm
(59)Tj
8.9663 0 0 8.9663 170.1354 347.1873 Tm
[(The)-414.2(intervention)-415.2(accounted)-420.3(for)]TJ
-14.9727 -1.3341 TD
[(7.713.3%)-471.3(savings)-463.1(per)-468.4(person)-465.7(per)-468.4(quarter)-470.6(as)-463.8(well)-467.1(as)-463.8()55.6(noticeable)]TJ
T*
[(change)-270.3(in)-273.5(health)-269.6(outcomes.)51.2()]TJ
6.7246 0 0 5.9768 142.3559 327.2881 Tm
(59)Tj
8.9663 0 0 8.9663 151.8236 323.2629 Tm
[(The)-275.1(mortality)-267.9(rate)-273.3(in)-273.5(the)-268.1(second)-277.8(year)]TJ
-12.9304 -1.3341 TD
[(of)-348.4(observation)-358(was)-346.5(2.5%)-356(lower)-348.3(in)-349.4(the)-356.6(intervention)-352(group.)-353.7(It)-347.1(is)-352(im-)]TJ
0 -1.3278 TD
[(portant)-416(to)-419.9(note)-420(that)-423.6(these)-422.5(findings)-420.3(were)-417.7(based)-418.4(on)-420.2(a)-418.9(retrospective)]TJ
0 -1.3341 TD
[(ma)22.7(tc)19.2(he)20.6(d)-283(c)0(o)18.6(h)0(o)17.7(r)12.6(t)-282.4(d)0(e)18.6(s)0(i)21.1(g)0(n)-268.5(t)0(h)18.4(a)0(t)-271.3(r)12.6(el)13.5(i)15.4(e)0(d)-272.3(h)0(e)14.3(a)0(v)18.9(i)15.4(ly)-273.9(on)-268.5()62()0(i)20.5(n)0(t)23.1(e)0(n)18.9(t)-282.4(to)-268.2(tr)21.1(ea)15.5(t,)19.9()62()-279.5(n)14.6(e)0(c)15.1(e)0(s)22.7(-)]TJ
T*
[(si)21.1(ta)19.6(te)19.2(d)-245.1(b)0(y)-237.2(t)0(h)18.4(e)-242.2(lo)17(w)-243.1(l)0(e)13.5(v)14.2(el)-239.4(of)-234.5(pa)18.9(r)12.6(t)0(i)17.6(c)0(i)19.8(p)0(a)18.9(t)0(i)17.6(o)0(n)-236.8(i)0(n)-235.6(t)14.8(he)-238.6(in)17.3(te)19.2(r)12.6(v)0(e)18.6(n)0(t)16.7(i)0(o)23.3(n)0(.)-239.6(O)0(n)19.9(l)0(y)-236(3)14.2(7%)]TJ
T*
[(o)14.2(f)-375.2(th)18.4(os)19.8(e)-375(a)0(s)23(s)0(i)14.7(g)14.2(ne)18.9(d)-377.9(t)14.8(o)-377.9(t)0(h)18.4(e)-368.7(in)17.3(te)19.2(r)12.6(v)0(e)12.2(n)14.6(ti)17.6(on)-363.3(gr)20.4(ou)17.7(p)-371.5(a)0(c)15.5(t)0(u)18.4(a)0(l)20.2(l)0(y)-362.4(a)0(g)18.9(r)12.6(ee)15.1(d)-371.5(t)0(o)-363(p)0(a)18.9(r)12.6(-)]TJ
T*
[(t)14.8(i)0(c)13.5(i)0(p)23.3(a)0(t)19.6(e)0(.)-351(A)-356.3(la)20.2(te)19.2(r)-360.5(a)0(n)19.3(a)0(l)20.2(y)14.2(si)14.7(s)-354.8(o)0(f)-348.4(d)0(a)18.9(t)0(a)-347.1(o)0(n)-344.3(t)0(h)18.4(e)-362.3(sa)23.1(me)-350.7(po)22(pu)17.7(la)20.2(ti)17.6(on)-344.3(\()]TJ
/F5 1 Tf
24.3685 0 TD
(n)Tj
/F9 1 Tf
.7018 0 TD
(=)Tj
/F1 1 Tf
.7082 0 TD
[(1,)19.2(76)22(7\))]TJ
-25.7785 -1.3341 TD
[(fo)18.4(cu)20.6(se)22.7(d)-213.5(o)0(n)-205.2(m)0(o)19.5(r)12.6(ta)19.6(li)18.2(ty)16.3(,)-209.9(h)0(o)17.7(s)0(p)19.8(i)0(t)17.6(a)0(l)-201.1(a)0(d)18.9(m)0(i)20.7(s)0(s)17.6(i)0(o)17(n)14.6(s,)-204.3(an)19.3(d)-213.5(e)0(m)22.4(e)0(r)17(g)0(e)18.6(n)0(c)18.9(y)-213.5(de)18.6(pa)18.9(r)12.6(t)0(m)20.1(e)0(n)18.9(t)]TJ
T*
-.0145 Tc
[(vi)-14.5(si)-14.5(t)9.4(s)-14.5(.)]TJ
6.7246 0 0 5.9768 56.8063 231.6472 Tm
0 Tc
(60)Tj
8.9663 0 0 8.9663 65.9338 227.622 Tm
[(Af)21(te)19.2(r)-240.4(2)-245.1(ye)18.6(ar)23.7(s,)-235.9(pa)18.9(ti)17.6(en)18.9(t)14.8(s)-247.3(us)21.8(in)17.3(g)-238.7(t)0(h)18.4(e)-242.2(He)19.1(al)20.2(th)-234.5(Bu)14.8(d)14.2(d)0(y)-237.2(p)14.2(ro)14.1(g)14.2(r)0(a)17.3(m)-241.3(ha)21(d)-245.1(a)]TJ
-3.3511 -1.3341 TD
[(1)14.2(5)0(%)-362.5(r)12.6(ed)18.6(uc)20.6(ti)17.6(on)-357(in)-355.7(mo)19.5(rt)14.7(al)20.2(i)15.4(t)0(y)-363(r)12.6(is)21.1(k)-366.2(a)0(n)19.3(d)-365.2(an)-360(18)22(%)-370.4(r)12.6(ed)18.6(uc)14.3(t)14.8(i)0(o)17(n)-364.8(in)-362(q)14.2(u)0(a)14.7(r)12.6(te)19.2(r)12.6(l)0(y)]TJ
0 -1.3278 TD
[(ho)24(sp)13.5(it)23.9(al)-371.8(ad)18.9(mi)20.7(ss)17.6(io)23.3(ns)20.2(.)-380.6(T)0(h)17.7(e)-381.3(st)20.4(r)12.6(o)0(n)16.1(g)0(e)18.6(s)0(t)-365.2(e)0(f)14.9(f)0(e)21.2(c)0(t)19.2(s)-380.1(we)20.6(re)-368.7(ob)15.7(se)16.3(r)12.6(v)0(e)18.6(d)-377.9(on)-369.6(ad)18.9(mi)20.7(s-)]TJ
0 -1.3341 TD
[(si)21.1(on)22.4(s)-215.7(a)0(m)22.7(o)0(n)16.1(g)-213.5(CO)20.9(PD)-200.4(pa)18.9(ti)17.6(en)18.9(ts)-200.9(an)19.3(d)-213.5(o)0(n)-205.2(m)0(o)19.5(r)12.6(ta)19.6(li)18.2(ty)-205(am)22.7(on)16.1(g)-213.5(C)0(H)17.7(F)-207.1(pa)18.9(ti)17.6(en)18.9(ts)-200.9(an)19.3(d)]TJ
T*
[(am)22.7(on)16.1(g)-270.4(t)14.8(ho)17.7(se)-261.9(la)20.2(be)18.6(le)19.8(d)-270.4(a)0(s)-261.5()62(e)22.1(ng)16.1(ag)18.9(ed)18.6(.)73.3()]TJ
1.1065 -1.3341 TD
.4005 Tc
[(AU)413.2(.)418.2(S)400.5(.)10.8(R)418.1(C)416.1(T)-2.6(\()]TJ
/F5 1 Tf
5.4314 0 TD
0 Tc
(n)Tj
/F9 1 Tf
.6955 0 TD
(=)Tj
/F1 1 Tf
.7018 0 TD
-.0155 Tc
[(205\))-411.1(\(pu)-15.5(b)8.5(lish)-15.5(e)11.4(d)-418.6(i)-.1(n)-411.9(2012\))-417.4(re)-15.5(p)9.4(o)-1.3(rte)-15.5(d)-401.6(a)-15.5(n)-400.8(increa)-15.5(s)13.9(e)-415.8(in)]TJ
-7.9353 -1.3341 TD
-.0151 Tc
[(mortality)-430.9(a)-15.1(n)10.6(d)-430.9(no)-430.9(impa)-15.1(c)13(t)-430.2(on)-430.5(us)-15.1(e)-416.1(o)-.9(f)-434.5(s)3.2(e)-15.1(r)14.5(vic)-15.1(e)-417.3(a)-15.1(m)14(ong)-430.9(t)-.3(he)-434.3(intervention)]TJ
T*
-.0154 Tc
[(grou)-15.4(p)8.6(.)]TJ
6.7246 0 0 5.9768 59.2441 147.9118 Tm
0 Tc
(61)Tj
8.9663 0 0 8.9663 67.6346 143.9433 Tm
[(T)14.2(h)16.2(e)-166.3(i)15.4(n)14.6(t)14.8(e)17(r)12.6(v)14.2(e)17(n)14.6(t)14.8(io)23.3(n)-162.5(g)14.2(r)12.6(o)14.2(u)16.2(p)-162.9(r)12.6(e)17(ce)27.8(i)15.4(v)14.2(ed)-152.2(t)14.8(h)0(e)-156.5(I)17.5(n)14.6(t)14.8(el)-150.9(H)14.7(e)0(a)28.1(l)15.4(t)14.8(h)-167.2(G)14.7(u)16.2(i)15.4(d)14.2(e,)-154.9(a)-165.9(h)16.2(i)15.4(g)14.2(h-)]TJ
-3.5408 -1.3341 TD
-.0153 Tc
[(end)-412.1(d)-1.1(evic)-15.3(e)-398.5(w).9(i)-15.3(t)8.6(h)-410.1(v)-1.1(ideoc)-15.3(o)9.6(nferenc)-15.3(i)10.9(ng)-412.1(and)-412.1(p)-1.1(eriphe)-15.3(r)14.3(a)-15.3(l)-399.8(a)2.1(tta)-15.3(c)12.8(h).9(m)-15.3(e)13.4(nts)-15.3(.)-396.6(Pa-)]TJ
T*
0 Tc
[(t)14.8(i)15.4(e)17(n)14.6(t)14.8(s)-493.9(p)14.2(e)0(r)29.6(f)0(o)24.7(r)18.9(me)28.7(d)-498(d)14.2(a)17.4(i)15.4(l)15.4(y)-498(s)18.3(e)0(s)29(s)0(i)27.4(o)14.2(n)14.6(s)-493.9(t)14.8(o)-491.7(as)29.4(se)29(ss)-481.9(s)18.3(y)14.2(mp)25.8(t)14.8(o)14.2(m)18(s)-493.9(an)25.7(d)-491.7(b)14.2(i)15.4(o)14.2(me)28.7(t)14.8(r)12.6(i)15.4(c)]TJ
0 -1.3278 TD
[(m)18(e)0(a)28.1(s)0(u)28.1(r)18.9(em)28.7(en)25.3(t)14.8(s)18.3(,)-330.1(w)16.2(hi)25.3(c)17(h)-331.6(w)16.2(e)17(r)12.6(e)-330.7(r)18.9(e)0(l)26.2(a)17.4(y)14.2(e)0(d)-316.6(a)17.4(sy)26.1(n)14.6(c)17(h)16.2(r)12.6(o)14.2(n)14.6(o)14.2(u)16.2(sl)27.4(y)-327.3(t)14.8(o)-327.3(a)-330.3(n)14.6(u)16.2(r)12.6(s)18.3(i)15.4(n)14.6(g)-327.3(s)0(t)26.8(a)17.4(-)]TJ
0 -1.3341 TD
-.0153 Tc
[(tion.)-345.4(A)-352.6(regis)-15.3(t)11.5(ered)-355.2(n)5.6(u)-15.3(r)13.5(s)-15.3(e)-340.4(m)2.7(onitored)-348.9(da)-15.3(t)10.6(a)-345.6(a)-15.3(n)10.4(d)-348.9(c)1.7(om)-15.3(m)14.3(u)-15.3(n)9.1(i).1(cat)-15.3(e)10.2(d)-348.9(w).9(i)-15.3(t)8.6(h)-346.9(p)-1.1(a-)]TJ
T*
-.0155 Tc
[(tients)-484.1(\(a)-15.5(p)9.8(p)-1.3(roxim)-15.5(a)13.6(te)-15.5(l)10.7(y)-481.9(100)-488.2(patie)-15.5(n)9.8(ts,)-484.7(w)-15.5(h)10.5(i)-.1(ch)-486.2(c)-15.5(o)9.4(rres)-15.5(p)10.6(o)-1.3(nds)-484.1(t)-.7(o)-488.2(t)-.7(he)-485.3(total)]TJ
T*
-.0149 Tc
[(numbe)-14.9(r)-238.2(of)-251(patie)-14.9(n)10.4(ts)-249.5(in)-246.9(t)-14.9(h)9.8(e)-250.8(i).5(ntervention)-253.3(g)-.7(roup\))-246.1(b)-.7(y)-253.6(p)-.7(hone)-250.8(or)-248.9(vide)-14.9(o)-236.6(w)-14.9(h)11.1(e)2.1(n)]TJ
30.331 69.3307 TD
-.0151 Tc
[(al)-15.1(e)11.1(r)-2.5(ts)-287.7(w)-15.1(e)11.8(re)-288.9(triggered.)-294.6(The)-295.2(u)1.1(s)-15.1(u)13(al)-296.8(care)-295.2(g)5.4(r)-2.5(oup)-291.8(h)-15.1(a)12.2(d)-291.8(a)-15.1(c)13(ce)-15.1(s)13.9(s)-294(to)-291.8(prima)-15.1(r)14.9(y)-291.8(a)-15.1(n)10.6(d)]TJ
0 -1.3278 TD
0 Tc
[(sp)26.1(e)17(c)0(i)26.1(a)17.4(l)15.4(t)14.8(y)-396.8(c)17(a)17.4(r)12.6(e,)-382.6(t)14.8(e)17(l)15.4(e)0(p)24.9(h)16.2(o)14.2(n)14.5(i)15.4(c)-393.9(n)14.6(u)16.2(r)12.6(s)18.3(i)15.4(n)14.5(g)-396.8(c)17(a)17.4(r)12.6(e,)-382.6(u)16.2(r)18.9(g)14.2(e)0(n)25.3(t)-389.8(ca)28.1(r)12.6(e)17(,)-393.3(a)0(n)25.7(d)-390.5(e)17(m)0(e)28.7(r)12.6(g)14.2(e)17(n)14.6(c)0(y)]TJ
0 -1.3341 TD
[(d)14.2(e)17(p)14.2(a)0(r)23.7(t)14.8(m)18(e)17(n)14.6(t)-314(se)29(r)12.6(v)14.2(i)15.4(c)17(es)29(.)-311.1(T)14.2(he)-301.9(d)14.2(e)17(ci)26.2(s)18.3(i)15.4(o)14.2(n)-314.2(t)14.8(r)12.6(i)15.4(a)17.4(g)14.2(e)-311.7(w)16.2(a)0(s)-299.4(m)18(ad)25.3(e)-311.8(b)14.2(y)-308.3(t)14.8(he)-301.9(n)14.6(u)16.2(r)18.9(s)0(e)-299.8(w)16.2(i)15.4(t)0(h)]TJ
T*
[(d)14.2(e)17(ci)26.1(si)27.4(o)14.2(n)-440.7(s)18.3(u)0(p)24(p)14.2(o)14.2(r)18.9(t)-440.4(a)0(s)29.4(s)0(i)27.4(s)0(t)26.8(a)17.4(n)14.6(c)0(e)-427.5(f)0(r)29.4(o)14.2(m)-443.6(a)17.4(n)-440.7(e)0(l)26.1(e)17(ct)25.5(r)18.9(o)14.2(n)14.5(i)15.4(c)-444.5(m)0(e)28.7(d)14.2(i)15.4(c)0(a)28.1(l)-439.8(r)12.6(e)17(co)24.9(r)18.9(d)14.2(.)-443.9(T)14.2(h)16.2(e)]TJ
T*
-.0153 Tc
[(res)-15.3(u)12.8(lts)-281.6(s)-15.3(h)12.8(o)-1.1(we)-15.3(d)-274.9(n)5.6(o)-285.7(d)-1.1(if)-15.3(f)12.1(e)1.7(renc)-15.3(e)-272.1(b)-1.1(etw)-15.3(e)11.6(e)-15.3(n)-268.2(the)-289.1(t)-.5(wo)-285.7(groups)-287.9(in)-279(te)-15.3(r)14.3(m)-15.3(s)-269.9(o)-1.1(f)-283(h).9(os)-15.3(-)]TJ
T*
0 Tc
[(p)14.2(i)15.4(t)14.8(a)0(l)26.5(i)15.4(z)17(a)0(t)25.9(i)15.4(o)14.2(n)-510.3(o)14.2(r)-505.9(em)28.7(er)29.6(g)14.2(e)0(n)25.3(c)17(y)-510.6(d)14.2(ep)24.9(a)17.4(r)12.6(t)14.8(m)18(en)25.3(t)-510(v)14.2(i)15.4(s)18.3(it)23.9(s)18.3(,)-513.4(b)14.2(u)16.2(t)-510(m)0(o)25.8(r)18.9(t)14.8(a)0(l)26.5(i)15.4(t)14.8(y)-510.6(\()15.4(c)0(a)28.1(u)16.2(se)29(s)]TJ
T*
-.0153 Tc
[(unknown\))-202.2(was)-199.4(h)-15.3(i)10(g)-1.1(he)-15.3(r)-188(i).1(n)-196.8(t)-.5(he)-200.6(te)-15.3(l)10.9(e)1.7(m)-15.3(o)10.5(nitoring)-197.1(group)-197.1(\()-15.3(1)8(4)-1.1(.7%)-202.3(v)-1.1(ersu)-15.3(s)-189.5(3)-1.1(.9%\).)]TJ
1.1128 -1.3341 TD
0 Tc
[(Because)-353.6(this)-352.6(was)-352.8(the)-356.6(only)-352.7(study)-358.7(in)-349.4(our)-355.4(review)-350.2(that)-354(reported)-357.7(the)]TJ
-1.1128 -1.3341 TD
[(intervention)-377.3(group)-377.7(experiencing)-379.2(higher)-370(mortality)-375.4(than)-379.6(the)-369.3(control)]TJ
0 -1.3278 TD
[(group,)-334.7(a)-336.7(closer)-335.4(examination)-338.8(of)-335.7(the)-331.3(methodology)-345.7(of)-329.4(this)-339.9(study)-333.4(may)]TJ
0 -1.3341 TD
[(provide)-321.9(a)-317.7(better)-320.5(understanding)-320.6(of)-316.7(the)-318.7(results.)-318.6(The)-319.3(study)-320.7(population)]TJ
T*
[(consisted)-197.7(of)-196.6(elderly)-197.7(patients)-195.9(with)-196.6(multiple)-196(health)-200.1(issues,)-195(putting)-193(them)]TJ
T*
[(in)-374.7(the)-375.6(top)-374.2(10%)-373.7(on)-375.9(the)-375.6(Elder)-373.5(Risk)-378.2(Assessment)-372.5(Indexan)-379.3(electronic)]TJ
T*
[(database)-425.7(used)-421.2(to)-419.9(assess)-423.6(risk)-421.1(for)-418(hospitalization)-429.1(and)-415.4(comorbidities)]TJ
T*
[(\(stroke,)-382.7(dementia,)-378.7(heart)-383.5(disease,)-383.1(diabetes,)-378.7(and)-383.8(COPD\).)-380.2(The)-376.2(average)]TJ
T*
[(age)-292.8(of)-297.8(study)-295.4(participants)-294.4(was)-295.9(80.3)-300.2(years.)-294.9(Also,)-297(baseline)-294.3(comparison)]TJ
T*
[(between)-268.6(the)-268.1(intervention)-269.8(and)-263.7(control)-270.3(groups)-264.6(revealed)-273.5(slightly)-268.1(lower)]TJ
0 -1.3278 TD
[(mental)-484.5(health)-484.6(scores)-484.4(for)-481.2(the)-483.1(intervention)-484.8(group.)-480.1(During)-483.5(the)-483.1(12-)]TJ
0 -1.3341 TD
[(month)-270.1(study,)-271.4(26)-275.2(patients)-271.8(\(25.5%\))-273(of)-266.2(the)-274.4(intervention)-269.8(group)-276.5(dropped)]TJ
T*
[(out,)-234.3(which)-235.1(represented)-235.4(15)-230.9(deaths)-237.2(and)-232.1(11)-230.9(withdrawals.)-231.9(This)-233.1(compares)]TJ
T*
[(with)-354.7(only)-352.7(12)-351(who)-351.8(dropped)-354.8(out)-353.2(from)-349.5(the)-356.6(usual)-352.8(care)-353.2(group)-352.4(\(11.7%\),)]TJ
T*
[(representing)-418.5(four)-414.4(deaths)-414.2(and)-409.1(eight)-415.5(withdrawals.)-421.6(The)-414.2(analysis)-412.8(was)]TJ
T*
[(made)-230.6(on)-230.5(the)-236.5(basis)-232.6(of)-228.2(the)-230.1(entire)-237.3(original)-228.6(groups)-233(in)-235.6(the)-230.2(study)-232.2(using)-231.2(the)]TJ
T*
[(intent-to-treat)-217.8(method.)-210.4(In)-208.3(other)-209.7(words,)-216.8(utilization)-208.6(and)-213.1(mortality)-211(data)]TJ
T*
[(were)-322.9(imputed)-320.2(for)-323.2(those)-317.9(who)-320.2(died)-324.9(or)-314.7(dropped)-323.2(out.)-322.8(The)-319.3(authors)-320.3(con-)]TJ
0 -1.3278 TD
[(cluded)-190.5(that)-189.7(mortality)-192(experience)-191.3(of)-190.3(patients)-195.9(in)-185(the)-192.2(intervention)-187.6(group)]TJ
0 -1.3341 TD
[(was)-542.5(consistent)-542.9(with)-544.4()55.6(previous)-543.2(experience.)46.4()-538.7(N)0(o)-540.2(information)-546.6(was)]TJ
T*
[(provided)-250.9(on)-243.2(the)-249.1(timing)-242.7(or)-245.2(the)-249.1(causes)-249.8(of)-247.2(death)-242.8(in)-248.2(the)-242.8(two)-245.7(groups,)-253.2(and)]TJ
T*
[(there)-194.2(was)-188.4(no)-186.3(analysis)-191.5(of)-190.3(potential)-197.3(bias)-187.6(that)-189.7(may)-190.7(have)-188.1(been)-196.4(introduced)]TJ
T*
[(as)-280.5(a)-279.8(result)-285(of)-278.8(nonparticipation.)]TJ
1.1128 -1.3341 TD
[(An)-398.6(invited)-406.5(commentary)-398.7(by)-401.6(Wilson)]TJ
6.7246 0 0 5.9768 451.9558 339.1936 Tm
(62)Tj
8.9663 0 0 8.9663 462.5573 335.2251 Tm
[(sheds)-402.9(further)-405.9(light)-398.2(on)-401.2(the)]TJ
-17.2552 -1.3341 TD
[(environment)-452.8(where)-452.1(the)-451.5(study)-447.2(was)-454(conducted,)-450.1(indicating)-454(that)-448.9(the)]TJ
T*
[(study)-187.9(group)-181.7(was)-188.4(composed)-182.9(of)-184()55.6(highly)-187.9(educated)-188.3(and)-181.5(affluent)-187(residents)]TJ
0 -1.3278 TD
[(of)-266.2(Olmsted)-276.3(County,)-265.9(Minnesota,)-275(that)-271.8(may)-266.6(not)-266.3(benefit)-275.8(from)-267.3(telehealth)]TJ
0 -1.3341 TD
[(because)-255.9(such)-248.4(patients)-252.8(are)-250.1(highly)-249.8(activated)-249.7(and)-251(engaged)-251.9(in)-248.2(their)-252.7(own)]TJ
T*
[(health)-465.6(at)-467.3(baseline.)50.9()-462.8(H)0(e)-461.4(cautioned)-466.2(against)-469.6(either)-463.3(a)-463.1(dismissal)-469(or)-460.1(a)]TJ
T*
[(negative)-286.3(indictment)-280.5(of)-285.1(telemedicine)-287.5(as)-280.4(a)-279.8(potentially)-281.5(useful)-285.7(technol-)]TJ
T*
[(ogy)-343.2(and)-345.9(pointed)-350.9(out)-340.5(that)-347.7()55.6(the)-345.2(effectiveness)-348.3(of)-348.4(telehealth)-350.7(programs)]TJ
T*
[(would)-448.7(be)-449.3(mediated)-453.7(by)-445.9(an)-448.6(array)-450.7(of)-449.5(patient,)-449.4(physician,)-452.9(and)-447(larger)]TJ
T*
[(health)-206.4(system)-203(factors,)-206.3(as)-204.6(well)-201.5(as)-204.6(by)-205.6(factors)-205(related)-201.3(to)-205(the)-204.9(details)-203.6(of)-202.9(the)]TJ
T*
[(implementation)-291.4(of)-285.1(the)-293.4(telehealth)-287.5(program.)49.9()]TJ
6.7246 0 0 5.9768 471.0613 219.685 Tm
(62)Tj
8.9663 0 0 8.9663 480.6424 215.6598 Tm
[(It)-290.2(is)-282.4(also)-288.8(important)-287.7(to)]TJ
-19.2722 -1.3278 TD
[(consider)-230.9(the)-236.5(metrics)-228.3(for)-234.6(evaluation.)-230.3(The)-237.1(focus)-227.3(on)-230.5(hospitalization)-239.4(and)]TJ
0 -1.3341 TD
[(emergency)-364.3(visits)-358.9(would)-360.2(ignore)-361(other)-355.2(outcomes,)-364.8(such)-362.3(as)-356.3(healthcare)]TJ
T*
[(spending,)-283.6(outpatient)-282.8(visits,)-284.2(and)-282.6(quality)-284.4(of)-278.8(life.)]TJ
/F4 1 Tf
11.9551 0 0 11.9551 307.8424 155.9055 Tm
[(Stroke)-337.3(\(Cerebrovasc)-9.5(ular)-332.1(Disease)-9.7(\))]TJ
8.9663 0 0 7.969 481.7762 159.7039 Tm
(b)Tj
/F1 1 Tf
8.9663 0 0 8.9663 317.8204 143.9433 Tm
.0108 Tc
[(Stroke)-319.9(is)-318.7(the)-319.9(f)2.4(o)-6.6(u)1.7(rth)-314.4(l)-5.4(eading)-316.5(cause)-319.9(o)-.3(f)-320.1(d)-.3(eath)-320.8(in)-316.1(the)-313.6(U)-1.8(nit)-6(e)2.5(d)-316.5(S)-4.6(tat)-6(e)2.5(s)]TJ
-1.1128 -1.3341 TD
.013 Tc
[(and)-459.7(i)-3.2(s)-461.9(t)2.5(h)3.9(e)-469.5(le)4.7(ading)-466(c)4.7(au)3.9(se)-463.1(of)-463.3(br)13(a)-7.6(i)3.1(n)-465.6(d)1.9(a)5.1(m)-.7(a)5.1(g)1.9(e.)-462.5(Of)4.6(ten)-465.6(r)13(e)-8(f)4.6(erre)4.7(d)-466(t)2.5(o)-466(a)5.1(s)]TJ
ET
q
1 i
307.842 103.691 m
561.883 103.691 l
561.883 71.717 l
307.842 71.717 l
W n
0 0 0 1 K
1 J 1 j .227 w 10 M []0 d
q 1 0 0 1 305.858 103.691 cm 0 0 m
536.655 0 l
S
Q
Q
BT
5.9774 0 0 5.3127 307.8424 97.1716 Tm
0 Tc
(b)Tj
7.9702 0 0 7.9702 310.9605 93.5999 Tm
[(Informat)12.1(ion)-339.9(on)-336.4(stroke)-334.4(was)-338.6(compiled)-336.1(several)-330.6(sources,)-338.2(including)-328.5(the)-343.1(Ameri-)]TJ
-.3912 -1.3728 TD
[(can)-300.3(Heart)-295.6(Associat)10.5(ion/American)-289.9(Stroke)-299.3(Association)12(,)]TJ
5.9774 0 0 5.3127 482.3432 86.2299 Tm
(63)Tj
7.9702 0 0 7.9702 490.9605 82.6583 Tm
[(the)-300.5(National)-292.4(Institute)]TJ
-22.9754 -1.3728 TD
[(of)-334.9(Neurologi)11.5(cal)-336.6(Disorders)-327.1(and)-326.9(Stroke,)]TJ
5.9774 0 0 5.3127 434.2109 75.2314 Tm
(64)Tj
7.9702 0 0 7.9702 443.055 71.7165 Tm
[(and)-334(Go)-329.1(et)-336.4(al.)]TJ
5.9774 0 0 5.3127 486.8219 75.2314 Tm
(65)Tj
/F9 1 Tf
6.9738 0 0 6.9738 186.8031 29.7638 Tm
()Tj
/F7 1 Tf
1.3251 0 TD
.2011 Tc
[(M)-4.9(ARY)-335.7(ANN)-334.5(L).6(IEBERT,)-333.7(I)-2.3(NC.)]TJ
/F10 1 Tf
15.015 0 TD
0 Tc
()Tj
/F7 1 Tf
.9999 0 TD
.1099 Tc
[(VOL.)-335.5(2)6.8(0)-1001.2(N)5.1(O)-4.5(.)-327.4(9)]TJ
/F10 1 Tf
8.3896 0 TD
0 Tc
()Tj
/F8 1 Tf
.9999 0 TD
.1097 Tc
[(SEP)8.5(T)-1.4(EMBER)-333(2)8.5(014)]TJ
/F4 1 Tf
7.9702 0 0 7.9702 441.9211 29.7638 Tm
0 Tc
[(TELEMEDIC)11.7(INE)-333(and)-328.9(e-HEALTH)-647.9(779)]TJ
ET
q
1 i
0 792 612 -791.985 re
W n
579.685 .014984 .22681 791.985 re
f
337.039 767.962 274.961 .22675 re
f
Q
BT
/F11 1 Tf
11.9551 0 0 11.9551 287.5464 741.9966 Tm
[(TELEMEDICINE)-340.6(FOR)-332.7(CHRONIC)-338.8(DISEASE)-334.7(MANAGE)-7.3(MENT)]TJ
ET
endstream
endobj
231 0 obj
<>/XObject<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]/Font<>/Properties<>>>/Thumb 234 0 R/MediaBox[0 0 612 792]/Rotate 0>>
endobj
235 0 obj
<>/ProcSet[/PDF/Text]/Font<>/Properties<>>>
endobj
232 0 obj
<>stream
/GS1 gs
BT
/F1 1 Tf
8.9663 0 0 8.9663 50.1732 693.8644 Tm
0 0 0 1 k
.011 Tc
0 Tw
[(cerebrovascul)-5.2(ar)-242(accident,)-243.2(a)-243.5(stro)]TJ
13.4046 0 TD
.0118 Tc
[(ke)-243(occur)11.8(s)-248.2(when)-239.2(the)-236.7(b)-5.6(lood)-239.6(sup)-5.6(p).7(ly)-239.6(to)]TJ
-13.4046 -1.3278 TD
.0116 Tc
[(part)-226.5(o)-5.8(f)-224.5(the)-230.6(b).5(rain)-233.1(is)-229.4(suddenly)-227.1(o).5(ccl)]TJ
13.8282 0 TD
[(uded)-227.2(or)-228.9(when)-226.9(a)-230.3(b).4(lood)-233.6(vessel)-232.3(i)1.6(n)-226.9(t)-5.3(he)]TJ
-13.8282 -1.3341 TD
[(br)11.6(a)-9(i)1.7(n)-277.3(b).5(ur)11.6(s)-8.2(t)1.1(s)-280(\()1.7(or)-279.3(r)11.6(u)-10.2(ptur)11.6(e)-9.4(s)-1.7(\),)-274.2(causi)-4.6(n).9(g)-277.7(d).5(amage)-281.2(t)1.1(o)-277.7(t)1.1(he)-274.9(brai)-4.6(n.)-274.2(When)-277.3(par)11.6(t)]TJ
T*
.011 Tc
[(of)-199.8(the)-199.6(b)-6.4(r)11(a)-9.6(in)-202.1(cannot)-201.8(g)-.1(et)-201.8(the)-199.6(n).3(ecessar)11(y)-208.9(blo)-6.4(o)-.1(d)-196.1(a)-3.2(nd)-202.5(oxygen)-195.7(i)1.1(t)-201.8(n).3(eeds,)-198.9(t)-5.8(he)]TJ
T*
.0099 Tc
[(af)-4.9(fe)-4.7(cte)-4.7(d)-285.8(br)9.9(a)-10.7(i)0(n)-285.4(c)1.7(e)-4.7(lls)-281.6(d)-7.5(i)0(e.)-282.2(S)-5.5(t)-.6(roke)]TJ
13.2339 0 TD
.011 Tc
[(can)-277.9(b)-.1(e)-288.1(c)2.8(aused)-284.7(b)-.1(y)-284.7(a)-281.4(clot)-284(obstructing)]TJ
-13.2339 -1.3341 TD
.0106 Tc
[(the)-231.6(f)2.2(low)-232.5(o)-.5(f)-225.5(b)-.5(lood)-228.1(to)-228.2(th)-4.8(e)-225.3(b)-.5(rain)-227.8(\(isch)-4.8(emic)-231.6(stroke\),)-224.6(bl)-5.6(eeding)-228.1(wi)-5.6(thi)-5.6(n)-221.4(t)-6.2(h)1.5(e)]TJ
T*
.0115 Tc
[(br)11.5(a)-9.1(i)1.6(n)-562(\()1.6(spont)-5.3(a)3.6(neous)-564.6(i)1.6(ntracerebral)-561.1(hemorrhage\),)-558.8(o)-5.9(r)-557.6(r)-1.2(up)-5.9(ture)-559.5(o)-5.9(f)-559.7(a)]TJ
T*
.0113 Tc
[(weakened)-486.7(blood)-486.7(vessel)-479.1(around)-486.7(the)-490.1(b).2(r)11.3(a)-9.3(in)-486.3(\(subarachnoid)-486.7(h)2.2(emor)11.3(-)]TJ
T*
.0108 Tc
[(r)10.8(h)-11(age\).)-445.7(A)-453(tr)10.8(a)-9.8(n).1(sient)-442.3(i)-5.4(schemi)-5.4(c)-446.4(a)2.9(tt)-6(ack)-444(\().9(T)-6.6(I)3(A\))-5.4(,)-445.7(o)-.3(r)-444.5()53.8(mi)-5.4(n).1(i)-448(s)3.8(troke,)53.8()-445.7(i)-5.4(s)-445.2(a)]TJ
0 -1.3278 TD
[(temporary)-556.7(n).1(eurolo)-6.6(gic)-560.2(d)-.3(efici)-5.4(t)-556.1(th)]TJ
14.2329 0 TD
.0151 Tc
[(at)-551.8(res)8.1(o)4(lv)4(e)6.9(s)-554.7(l)5.2(e).5(a)7.2(v)4(in)4.4(g)-552.4(n)4.4(o)-552.4(r)2.4(e)6.9(s)1.8(i)5.3(d)4(ua)7.2(l)]TJ
-14.2329 -1.3341 TD
.0111 Tc
(damage.)Tj
1.1065 -1.3341 TD
0 Tc
[(Ischemic)-306.2(stroke)-302(accounts)-306.8(for)-297.9(about)-308.9(8387%)-299.6(of)-304.1(all)-299.5(cases,)-305.2(whereas)]TJ
-1.1065 -1.3341 TD
[(hemorrhagic)-284.5(stroke)-289.4(accounts)-287.8(for)-291.5(about)-283.6(1317%)-293.2(of)-285.1(stroke)-289.4(cases.)-286.3(The)]TJ
T*
[(majority)-415.5(of)-411.6(the)-413.5(latter)-420(are)-414.5(intracerebral)-415.3(hemorrhage,)-421.4(a)-412.5(devastating)]TJ
T*
[(condition)-339.9(frequently)-340.4(resulting)-342.1(in)-336.7(a)-336.7(30-day)-341.9(mortality)-337.4(of)-335.7(up)-342.7(to)-337.7(50%.)]TJ
T*
[(Smaller)-216.7(numbers)-218.1(of)-215.6(hemorrhagic)-221.3(strokes)-214.2(are)-218.5(caused)-216(by)-218.3(subarachnoid)]TJ
T*
[(hemorrhage.)-320.2(These)-322(typically)-323.5(result)-323(from)-317.8(rupture)-320.1(of)-316.7(intracranial)-321.2(an-)]TJ
0 -1.3278 TD
[(eurysm)-434.9(or)-434.8(arteriovenous)-440.2(malformations,)-439.2(head)-441(trauma,)-436(or)-434.8(clotting)]TJ
0 -1.3341 TD
[(disorders)-299.6(\(include)-304.7(use)-302.6(of)-304.1(anticoagulant)-302.4(medications\).)-302.7(It)-302.8(is)-301.4(estimated)]TJ
T*
[(that)-436.2(between)-439.3(1.5%)-438.2(to)-432.6(5%)-438.4(of)-436.9(the)-432.5(general)-441.9(population)-437.5(have)-434.7(or)-441.2(will)]TJ
T*
[(develop)-216.3(a)-216.5(cerebral)-224.5(aneurysm.)-214.6(About)-221.1(35)-216.7(million)-220.4(people)-217.8(in)-216.6(the)-217.5(United)]TJ
T*
[(States)-198.6(have)-200.7(cerebral)-199.2(aneurysms,)-202.6(but)-195.1(most)-200.4(do)-199.3(not)-196.7(have)-200.7(any)-200.5(symptoms.)]TJ
T*
[(Between)-315.7(0.5%)-311.7(and)-314.3(3%)-318.3(of)-310.4(people)-319(with)-316.8(a)-311.4(brain)-311.6(aneurysm)-314.4(may)-317.2(suffer)]TJ
T*
[(from)-368.4(bleeding.)-372.5(Brain)-371.3(aneurysms)-372(differ)-368.7(considerably)-378.3(in)-368.4(size,)-369.8(shape,)]TJ
T*
[(and)-213.1(location,)-213.3(but)-214.1(they)-216(are)-218.5(especially)-217.9(likely)-212.8(to)-217.6(be)-209.1(found)-221.2(in)-210.3(the)-217.5(anterior)]TJ
0 -1.3278 TD
[(or)-276.8(posterior)-284.1(communicating)-286.5(arteries)-285.8(or)-276.8(the)-280.7(internal)-282.8(carotids.)]TJ
1.1065 -1.3341 TD
-.0159 Tc
[(A)-258.4(T)-1.7(IA)-258.4(ca)-15.9(n)-243.2(l)-.5(as)-15.9(t)-242(m)-15.9(i)11.2(n)-1.3(utes)-256.9(to)-254.6(h)-15.9(o)8.1(urs)-15.9(.)-245.5(It)-254(oc)-15.9(c)11.9(u)-15.9(r)12.9(s)-256.9(wh)-15.9(e)11(n)-254.3(the)-258.1(b)-1.7(lood)-254.7(s)-15.9(u)12.2(pply)-254.7(t)-1.1(o)]TJ
-1.1065 -1.3341 TD
-.0152 Tc
[(part)-329.2(of)-327.1(the)-333.3(b)-1(ra)-15.2(i)11.3(n)-329.4(is)-325.7(brief)-15.2(l)10.8(y)-329.8(i).2(nterrupted,)-332.6(a)2.2(nd)-329.8(it)-329.2(is)-332(a)-326.6(r)-2.6(isk)-330.9(f)1.7(a)-15.2(c)12.9(tor)-331.4(f)1.7(or)-331.4(sub-)]TJ
T*
0 Tc
[(s)18.3(e)0(q)24.9(u)16.2(e)17(n)14.6(t)-269.7(s)0(t)26.8(r)12.6(o)14.2(k)19.5(e.)-256.1(A)-274.1(T)14.2(I)17.5(A)-274.1(i)15.4(s)-272.6(g)14.2(e)17(n)14.6(e)17(r)12.6(a)17.4(ll)24.6(y)-270.4(t)14.8(h)16.2(o)14.2(u)16.2(g)14.2(ht)-259.8(t)14.8(o)-270.4(b)14.2(e)-273.8(c)17(a)17.4(us)28.1(ed)-259.6(b)14.2(y)-270.4(a)-267.1(c)0(l)26.2(o)14.2(t)14.8(.)-273.2(T)14.2(h)16.2(e)]TJ
T*
-.0153 Tc
[(prim)-15.3(a)13.8(r)-2.7(y)-209.8(d)-1.1(if)-15.3(f)12.1(e)-15.3(r)14.3(e)-15.3(n)10(c)1.7(e)-213.2(b)-1.1(etw)-15.3(e)11.6(e)-15.3(n)-198.7(a)-212.9(s)-15.3(t)11.5(r)3.6(oke)-213.2(a)2.1(nd)-216.1(TIA)-213.5(i).1(s)-212(t)-.5(ha)-15.3(t)-198(t)-.5(h)-15.3(e)-203.4(blockage)-213.2(in)-215.7(TIA)]TJ
T*
0 Tc
[(i)15.4(s)-190.4(te)25.5(m)18(p)14.2(o)14.2(r)12.6(a)17.4(r)12.6(y)14.2(,)-197.3(a)17.4(l)15.4(t)14.8(h)0(o)24(u)16.2(g)14.2(h)-192.5(i)15.4(n)-194.1(so)26.1(m)18(e)-197.9(ca)28.1(se)29(s)-196.7(t)14.8(h)16.2(e)17(r)12.6(e)-197.9(m)18(a)0(y)-183.4(b)14.2(e)-191.6(s)0(o)26.1(m)18(e)-197.9(i)15.4(n)14.6(j)15.4(u)16.2(r)12.6(y)-194.5(t)14.8(o)-194.5(b)14.2(r)12.6(a)17.4(i)15.4(n)]TJ
T*
[(t)14.8(i)15.4(s)18.3(s)0(u)28.1(e)0(.)-275.1(I)17.5(n)-288.9(t)14.8(he)-276.6(e)17(a)0(r)30(l)0(i)24.5(e)17(st)-276.7(s)18.3(t)14.8(ag)25.3(e)17(s)-285.2(o)14.2(f)-293(i)15.4(s)18.3(ch)26.9(em)28.7(i)15.4(c)-286.5(n)14.6(e)0(u)26.9(r)12.6(o)14.2(l)15.4(o)14.2(g)14.2(i)15.4(c)-286.5(d)14.2(ef)27.6(i)15.4(c)0(i)26.2(t)14.8(,)-285.8(t)14.8(h)16.2(e)0(r)23.3(e)-286.5(i)15.4(s)-285.2(n)14.5(o)]TJ
T*
-.0152 Tc
[(way)-285.6(t)-.4(o)-279.2(t)-.4(ell)-284.3(i).2(f)-282.9(t)-.4(he)-282.7(individua)-15.2(l)-266.9(is)-281.5(expe)-15.2(r)14.4(i).2(e)-15.2(n)10.1(cing)-285.6(a)-276(T)-1(I)-15.2(A)-265.5(or)-280.8(a)-282.3(m)2.8(a)-15.2(j)11.3(or)-280.8(stroke.)]TJ
1.1065 -1.3278 TD
0 Tc
[(A)-185.6(stroke)-181.9(mimic)-181.7(is)-181.3(a)-178.6(condition)-188.1(that)-177(can)-184.9(present)-182.4(similarly)-186.7(to)-179.7(ischemic)]TJ
-1.1065 -1.3341 TD
[(stroke)-403.2(and)-402.8(may)-405.7(give)-400.8(a)-406.2(false-positive)-409.8(diagnosis)-401.9(of)-405.3(stroke.)-404.5(When)-405.6(it)]TJ
T*
[(occurs,)-354.9(a)-355.6(patient)-353.3(initially)-355(diagnosed)-360.1(with)-354.7(stroke)-358.9(ultimately)-353.4(gets)-359.3(an)]TJ
T*
[(alternate)-415.3(diagnosis,)-415.8(including)-413.1(seizure,)-418.8(conversion)-417.1(disorder,)-420.4(or)-409.6(en-)]TJ
T*
[(cephalopathy.)-318.9(Hence,)-312.9(it)-317.5(is)-314.1(important)-313(to)-312.4(understand)-320.5(the)-312.3(role)-313.9(of)-316.7(tele-)]TJ
T*
[(stroke)-283.1(in)-279.8(differentiating)-281(mimics)-283.6(from)-279.9(actual)-281(stroke.)]TJ
1.1065 -1.3341 TD
[(Stroke)-272.5(can)-273.5(produce)-274(a)-267.1(wide)-272.3(range)-272(of)-272.5(neurological)-271.6(deficits)-275.6(that)-271.8(can)]TJ
-1.1065 -1.3341 TD
[(significantly)-371.8(alter)-365.3(quality)-372.9(of)-367.3(life.)-366.5(A)-368.9(common)-372.1(disability)-370(that)-366.7(results)]TJ
0 -1.3278 TD
[(from)-482.2(stroke)-479.1(is)-478.4(paralysis)-489.1(on)-477.1(one)-485.4(side)-478.9(of)-481.1(the)-483.1(body,)-482.1(which)-488(can)-482.1(be)]TJ
0 -1.3341 TD
[(complete)-207.5(\(hemiplegia\))-207.2(or)-207.2(partial)-202.6(\(hemiparesis\).)-207.9(Stroke)-209.3(may)-203.4(also)-206.6(cause)]TJ
T*
[(problems)-407.4(with)-411.6(thinking,)-407.8(awareness,)-409(attention,)-413.7(learning,)-411.2(judgment,)]TJ
T*
[(sensation,)-362.6(and)-364.8(memory.)-369(Stroke)-367.3(survivors)-370(often)-365.2(have)-365.1(problems)-369.4(un-)]TJ
T*
[(derstanding)-193.3(or)-200.9(using)-193.3(speech.)-198.7(A)-191.9(stroke)-200.9(can)-191.3(lead)-201.5(to)-192.3(emotional)-200.4(problems)]TJ
T*
[(such)-400.2(as)-400.6(difficulty)-406.3(controlling)-400.4(ones)-405.1(emotions)-404.7(or)-403.2(inappropriate)-400.4(ex-)]TJ
T*
[(pressions)-268.3(of)-272.5(emotions.)-273.2(Depression)-269.4(is)-269.8(common.)-272.2(Stroke)-272.5(survivors)-275.2(may)]TJ
T*
[(also)-276.1(experience)-286.1(numbness)-286.3(or)-276.8(strange)-283.2(sensations.)]TJ
1.1065 -1.3278 TD
[(Fewer)-334(people)-337.9(are)-332.3(dying)-332.2(of)-329.4(stroke)-333.6(today.)-337.5(The)-332(age-adjusted)-334.7(stroke)]TJ
-1.1065 -1.3341 TD
[(mortality)-350.1(rate)-355.5(has)-352.8(decreased)-361.1(70%)-354.7(since)-353.9(1950)-354.3(and)-352.2(33%)-354.7(since)-353.9(1996.)]TJ
T*
[(However,)-198.9(as)-198.3(the)-198.5(population)-197.2(ages,)-199.9(further)-197.3(advances)-205(are)-193.2(needed)-203.2(to)-198.6(keep)]TJ
T*
(pace.)Tj
6.7246 0 0 5.9768 69.2787 76.1953 Tm
(66)Tj
8.9663 0 0 8.9663 78.3496 72.2267 Tm
[(It)-233.3(remains)-228.2(a)-229.2(leading)-233.2(cause)-230.2(of)-234.5(disability)-230.9(in)-229.2(the)-230.1(United)-233.7(States.)]TJ
6.7246 0 0 5.9768 297.1842 76.1953 Tm
(67)Tj
/F6 1 Tf
9.9626 0 0 9.9626 322.129 693.1841 Tm
[(STR)-8(OKE)-334.7(EPIDEM)-9.9(IOLOGY)]TJ
7.4718 0 0 6.641 429.4487 697.6061 Tm
(c)Tj
/F1 1 Tf
8.9663 0 0 8.9663 332.107 681.2219 Tm
[(St)12.1(rok)14.6(e)-558.3(kil)18.7(ls)-548(appr)14.1(oxi)12.5(mat)18.6(ely)-547.7(130)17.2(,000)-546.8(Ame)13.8(ri)15.3(cans)-539.7(each)-545.6(ye)12.2(ar,)-546.7(ac-)]TJ
-1.1128 -1.3341 TD
[(coun)17.7(tin)13.2(g)-194.5(for)-184(1)-200.8(o)0(u)11.4(t)-193.8(of)-196.6(ev)12.2(ery)-190.2(19)-193(de)12.2(aths)16.1(.)]TJ
6.7246 0 0 5.9768 458.3621 673.2281 Tm
(d)Tj
8.9663 0 0 8.9663 463.6345 669.2596 Tm
[(On)-188.8(av)12.6(erag)16.9(e,)-192.9(one)-188.2(Ame)13.8(ric)13.4(an)-189.3(die)15(s)]TJ
-15.782 -1.3341 TD
[(fro)12(m)-310.8(str)14(oke)-309.7(ev)12.2(ery)-310.3(4)-314.6(min)16.3(utes)15.7(.)-311.1(Bet)11.5(wee)12.3(n)-314.2(200)10.9(7)-314.6(and)-307.9(201)17.2(0,)-315.9(an)-309.5(est)18.5(ima)12.9(ted)]TJ
T*
[(6.8)-301.7(mil)17.2(lio)13.4(n)-307.9(Ame)13.8(ric)13.4(an)]TJ
/F9 1 Tf
9.3516 0 TD
()Tj
/F1 1 Tf
.7082 0 TD
[(20)-306.8(year)16.9(s)-310.5(o)0(f)-304.1(a)0(g)12.6(e)-311.7(hav)16.2(e)-311.8(had)-300(a)-305(str)14(oke)-303.4(\(e)13.5(xtra)15.1(po-)]TJ
-10.0598 -1.3341 TD
[(lat)16.1(ed)-183.8(to)-179.7(201)17.2(0)-188.2(fro)12(m)-178.1(Nati)18.2(ona)14.5(l)-186.9(H)0(e)12.8(alth)-170.1(and)-175.2(Nut)14.1(riti)14(on)-179.9(Exa)16.6(min)16.3(ati)16.1(on)-179.9(Sur)13.3(vey)]TJ
0 -1.3278 TD
[(200)10.9(72)17.2(010)-317.9(da)12.6(ta\))-312.7(and)-314.3(wer)14.1(e)-324.4(liv)13.4(ing)-309.9(wit)14.8(h)-325.2(its)-311.9(im)14.4(pact)-309.6(eve)10.3(ry)-314.7(day)14.1(.)-323.7(Duri)19(ng)]TJ
0 -1.3341 TD
[(thi)14.8(s)-278.9(p)0(e)12.2(riod)-266.1(th)12.1(e)-273.8(over)13.7(al)13.9(l)-275.4(str)14(oke)-271.8(pr)14.1(eval)13.5(en)12.6(ce)-269.4(was)-270.6(an)-271.5(est)18.5(ima)12.9(ted)-270.1(2.)12.9(8%.)]TJ
6.7246 0 0 5.9768 560.2393 613.4739 Tm
(65)Tj
8.9663 0 0 8.9663 332.107 597.5432 Tm
[(Considered)-460.4(a)-456.8(precursor)-453.5(to)-457.9(symptomatic)-462.4(stroke)-453.8(and)-459.7(progressive)]TJ
-1.1128 -1.3341 TD
[(brain)-254.7(damage,)-257.2(silent)-258.5(cerebral)-262.4(infarction)-258.2(is)-250.8(a)-260.8(brain)-254.7(lesion)-259.2(presumably)]TJ
T*
[(resulting)-411.6(from)-412.7(vascular)-415.3(occlusion)-414.1(found)-410.9(incidentally)-415.2(by)-408(magnetic)]TJ
T*
[(resonance)-312.6(imaging.)]TJ
6.7246 0 0 5.9768 395.3763 565.6251 Tm
(69)Tj
8.9663 0 0 8.9663 405.1274 561.6566 Tm
[(The)-313(prevalence)-311.4(of)-304.1(silent)-309.1(cerebral)-313(infarction)-308.7(is)]TJ
-9.2567 -1.3341 TD
[(estimated)-339.9(to)-331.4(range)-335.2(from)-330.5(6%)-337.3(to)-331.4(28%)-335.7(of)-335.7(the)-331.3(population,)-337.6(with)-335.7(higher)]TJ
T*
[(prevalence)-298.8(associated)-297.5(with)-297.8(increasing)-292.4(age)-299.1(and)-295.3(varying)-295.9(with)-291.5(ethnic-)]TJ
0 -1.3278 TD
[(ity,)-279.3(sex,)-286.5(and)-276.3(risk)-282(factor)-286.5(profile.)]TJ
6.7246 0 0 5.9768 437.6125 529.7951 Tm
(70)Tj
8.9663 0 0 8.9663 332.107 513.8644 Tm
.0092 Tc
[(Ba)-5(se)-5.4(d)-248.5(o)9.2(n)-252.9(t)-1.3(h)-6.2(e)-245.6(late)-5.4(st)-247.9(a)-5(v)-1.9(aila)-5(b)9.2(l)-11.8(e)-245.6(d)-1.9(ata)-5(,)-245(on)-248.1(ave)-5.4(r)9.2(a)-11.4(g)-1.9(e,)-245(e)-5.4(v)-1.9(ery)-248.5(4)-1.9(0)-248.5(s)2.2(e)-5.4(c).9(onds,)]TJ
-1.1128 -1.3341 TD
.01 Tc
[(someone)-352.3(i).1(n)-348.5(t)-.5(he)-352.3(U)10(n)-7(ite)-4.6(d)-348.9(State)-4.6(s)-351.1(has)-351.1(a)-345.6(str)10(o)-7.5(ke.)]TJ
6.7246 0 0 5.9768 487.8991 505.8707 Tm
.0111 Tc
(65)Tj
8.9663 0 0 8.9663 498.2172 501.9022 Tm
.0098 Tc
[(In)-348.7(a)-352.2(n)-.9(ational)-354.1(c)1.5(ohort)]TJ
-19.639 -1.3341 TD
0 Tc
[(s)-13.3(t)-10.5(u)-9.1(d)-11.1(y)-11.1(,)-216.3(t)-10.5(h)-9.1(e)-223.2(p)-11.1(re)-21(va)-19(l)-9.9(e)-8.2(n)-10.7(c)-14.6(e)-216.9(o)-11.1(f)-217.1(a)-7.9(t)-219.1(l)-9.9(e)-14.6(a)-7.9(s)-13.3(t)-219.1(on)]TJ
14.4921 0 TD
.0104 Tc
[(e)-212.8(s)3.4(trok)10.4(e)-10(-)-.9(r)10.4(e)-10.6(lated)-209.4(s)-2.9(ymptom)-205.6(among)]TJ
-14.4921 -1.3341 TD
.011 Tc
[(those)-332.4(f)-3.8(r)11(e)-10(e)-332.4(o)-.1(f)-338.9(a)-332(prior)-330.5(d)-.1(iagno)11(s)-7.1(is)-337.5(of)-332.5(str)11(o)-6.5(ke)-332.4(or)-336.8(TIA)-339(a)3.1(nd)-335.2(older)-336.8(t).5(han)-334.9(4)-.1(5)]TJ
T*
[(year)10.9(s)-242.8(o)-.2(f)-231.5(a)3(ge)-231.3(was)-236.4(a)3(ppr)10.9(o)-6.6(x).2(imately)-234.2(18%.)]TJ
6.7246 0 0 5.9768 462.9542 469.9841 Tm
(71)Tj
8.9663 0 0 8.9663 472.1951 466.0156 Tm
[(Projections)-230(i)1.1(ndicate)-231.2(t).5(hat)-233.4(a)3.1(n)]TJ
-16.7367 -1.3341 TD
.0105 Tc
[(additional)-416.7(3.4)-417.9(m)-3.2(illion)-417.6(p)-.6(eople)]TJ
/F9 1 Tf
13.3477 0 TD
0 Tc
()Tj
/F1 1 Tf
.7271 0 TD
.0105 Tc
[(18)-417.9(year)10.5(s)-426.6(o)-.6(f)-415.2(a)-3.7(ge)-415.1(wil)-5.7(l)-416.7(have)-421.4(had)-417.9(a)]TJ
-14.0748 -1.3341 TD
.0107 Tc
[(str)10.7(o)-6.8(ke)-427.5(by)-430.4(20)10.7(30,)-433.2(a)-427.1(20.5%)-429.2(increase)-427.5(in)-430(prevalence)-427.5(from)-426.6(2012.)-426.9(The)]TJ
0 -1.3278 TD
.0098 Tc
[(high)-5.6(est)-335.8(p)-1.3(r)9.8(o)-7.7(je)-4.8(cted)-336.4(increase)-333.6(\(29%\))-328.9(i)0(s)-332.3(e)1.5(xpec)-4.8(ted)-330.1(t)-.7(o)-336.4(o)-1.3(ccu)-5.6(r)-331.7(among)-330.1(H)-.8(is-)]TJ
0 -1.3341 TD
.0108 Tc
[(panic)-282(m)3.5(en.)]TJ
6.7246 0 0 5.9768 364.1952 422.192 Tm
.0196 Tc
(72)Tj
8.9663 0 0 8.9663 332.107 406.2613 Tm
0 Tc
[(The)-502.7(data)-505.2(on)-502.4(stroke)-504.4(prevalence)-507.4(are)-503.1(unclear.)-504.3(However,)-508.7(there)-504.1(is)]TJ
-1.1128 -1.3341 TD
[(general)-315.4(agreement)-312.7(that)-316.1(women)-312.2(have)-314.5(a)-311.4(higher)-319.4(prevalence)-317.8(rate)-311.2(at)-309.2(all)]TJ
T*
[(ages,)-282.1(whereas)-283.7(men)-279.2(have)-282.9(a)-279.8(higher)-281.5(death)-287.1(rate)-279.6(due)-281.4(to)-280.8(stroke.)]TJ
6.7246 0 0 5.9768 539.1495 386.3054 Tm
(65,73)Tj
8.9663 0 0 8.9663 332.107 370.3747 Tm
.0105 Tc
[(In)-461.8(to)10.5(t)-4.8(a)-3.7(l,)-458.7(27,744)-462.2(p)10.5(a)-8.5(r)10.5(t)-6.4(icipants)-458.1(in)-461.8(a)-452.6(n)-.2(ational)-454.6()53.5(Reasons)-458.1(fo)10.5(r)-468.6(G)-.1(eo-)]TJ
-1.1128 -1.3341 TD
0 Tc
[(g)-11.1(r)-12.7(a)-7.9(p)-11.1(h)-9.1(i)-9.8(c)-349.7(a)-7.9(n)-10.7(d)-346.2(R)-7.7(a)-14.2(c)-8.3(i)-9.9(a)-14.2(l)-345(Di)-22.4(f)-8.4(f)-8.4(e)-14.6(re)-21(nc)-19(e)-8.2(s)-348.5(i)-9.9(n)-345.9(S)-9.1(t)-10.5(r)-12.7(o)-11.1(ke)-355.5(\()-9.9(R)-7.7(E)-15.4(G)-10.6(A)-8.5(R)-7.7(D)-12.6(S)-9.1(\))-345(S)-15.4(t)-10.5(u)-9.1(d)-11.1(y)-11.1()43()-342.7(w)-9.1(e)-14.6(r)0(e)]TJ
T*
.011 Tc
[(followed)-202.5(u)1.9(p)-196.1(f)-3.8(or)-197.7(4.4)-202.5(y)-.1(ear)11(s)-204.8(between)-195.7(2003)-202.5(and)-202.5(201)11(0.)-205.3(In)-195.8(this)-198.4(coho)11(r)-6.5(t).5(,)-198.9(t).5(he)]TJ
0 -1.3278 TD
.0103 Tc
[(overall)-220.9(age-)-222.3(and)-222.1(s)-3(ex-adjusted)-222.1(b)-.8(lack)10.3(/)-10.3(white)-225.6(incidence)-219.3(r)-2.4(atio)-222.1(was)-218(1)-.8(.51,)]TJ
0 -1.3341 TD
.0112 Tc
[(but)-328.1(f)2.8(or)-330.3(those)-332.2(45)11.2(54)-328.7(year)11.2(s)-337.3(o).1(f)-326(a)3.3(ge)-325.8(it)]TJ
15.3773 0 TD
0 Tc
[(w)-15.5(a)-7.9(s)-335.8(4)-11.1(.)-13.9(0)-11.1(2.)-347.5(H)-10.6(o)-11.1(w)-9.1(e)-8.3(v)-11.1(e)-14.6(r,)-349.1(t)-10.5(h)-9.1(e)-337(b)-11.1(l)-9.9(a)-7.9(c)-14.6(k)0(/)]TJ
-15.3773 -1.3341 TD
.0106 Tc
[(wh)-4.8(ite)-231.6(i).7(ncidence)-231.6(ratio)-234.5(f)2.2(or)-229.8(th)-4.8(o)10.6(s)-7.5(e)]TJ
/F9 1 Tf
13.2465 0 TD
0 Tc
()Tj
/F1 1 Tf
.7271 0 TD
.0112 Tc
[(85)-227.6(years)-229.8(o).1(f)-231.2(a)3.3(ge)-231(declined)-227.5(to)-233.9(0.86.)]TJ
6.7246 0 0 5.9768 569.0833 314.5889 Tm
(71)Tj
8.9663 0 0 8.9663 322.129 298.6582 Tm
.0106 Tc
[(In)-512.3(a)-509.4(population-b)10.6(a)-8.4(s)3.6(ed)-512.7(strok)10.6(e)-522(surveillance)-509.8(s)-2.7(tudy)-512.7(\(20002)10.6(0)-5.3(10\),)]TJ
6.7246 0 0 5.9768 569.0833 302.6267 Tm
.0111 Tc
(74)Tj
8.9663 0 0 8.9663 322.129 286.696 Tm
[(sign)11(i)-9.6(f)2.6(ican)11(t)-358(e)-3.6(thnic)-351.3(d)-.1(ispar)11(i)-11.6(ties)-350.1(in)-353.8(str)11(o)-6.5(ke)-351.3(rates)-356.4(f)2.6(or)-349.5(peop)11(le)-357.7(in)-347.5(the)-351.3(45)]TJ
0 -1.3341 TD
[(59-year-old)-360.4(an)11.1(d)-371.2(607)11.1(4-year)11.1(-)-6.6(o)0(ld)-366.7(age)-363.9(g)0(r)11.1(o)-6.4(ups)-362.6(p)0(er)11.1(s)-8.7(i)1.2(sted)-360.4(\(but)-366.1(n)11.1(o)-4.4(t)-366.1(i)1.2(n)]TJ
T*
.01 Tc
[(for)-312.6(p)-1.1(eople)]TJ
/F9 1 Tf
4.8181 0 TD
0 Tc
(>)Tj
/F1 1 Tf
.7335 0 TD
.0105 Tc
[(75)-304.1(year)10.5(s)-319.1(o)-.6(f)-307.8(a)2.6(ge\))-309.2(d)-.6(espite)-307.6(sign)10.5(i)-10.1(f)2.1(icant)-303.5(d)-.6(eclines)-312.7(in)-303.7(ische-)]TJ
-5.5515 -1.3341 TD
[(mi)-5.8(c)-440.5(s)-3(tro)10.4(k)-6.6(e)-446.8(r)-2.3(ates)-445.5(between)-442.9(M)2.5(exican)-442.9(Americans)-445.5(a)-3.8(nd)-443.3(non-Hispanic)]TJ
0 -1.3278 TD
.0092 Tc
[(wh)-6.2(ites)]TJ
/F9 1 Tf
3.1931 0 TD
0 Tc
()Tj
/F1 1 Tf
.7271 0 TD
.0114 Tc
[(60)-284.3(y)11.4(e)-8(ars)-280.2(o).3(f)-275.2(a)3.5(ge.)]TJ
ET
q
1 i
322.129 202.28 m
576.17 202.28 l
576.17 71.717 l
322.129 71.717 l
W n
0 0 0 1 K
1 J 1 j .227 w 10 M []0 d
q 1 0 0 1 320.145 202.28 cm 0 0 m
536.655 0 l
S
Q
Q
BT
5.9774 0 0 5.3127 322.129 195.8173 Tm
0 Tc
(c)Tj
7.9702 0 0 7.9702 324.7936 192.2456 Tm
[(Although)-424.5(based)-430.2(on)-428.9(findings)-424.2(reported)-431.1(in)-426(the)-428.5(current)-428.7(literature,)-427.2(the)-428.5(stroke)]TJ
-.3343 -1.3728 TD
[(prevalence)-392.7(and)-398(incidence)-386.4(estimates)-396.6(presented)-390.6(here)-394.7(are)-398.7(based)-394.7(on)-393.3(a)-403(consid-)]TJ
0 -1.38 TD
[(erable)-388.4(number)-390.4(of)-398.9(diverse)-389.2(study)-389.4(population)9.1(s,)-400.3(in)-390.5(terms)-388.8(of)-398.9(sample)-386.5(size,)-391.9(geo-)]TJ
0 -1.3728 TD
[(graphic)-549.7(setting,)-544.1(and)-547.4(time)-548(period.)-547.6(The)-547.7(reader)-550.1(should,)-543.8(therefore,)-551.3(exercis)10.8(e)]TJ
T*
[(caution)-474.4(in)-475.8(extending)-476.1(and/or)-471.4(assigning)-476.5(validity/acc)13.2(uracy)-482.9(to)-476.8(the)-478.3(estimates)]TJ
T*
(presented)Tj
/F5 1 Tf
4.5097 0 TD
(vis-a)Tj
1.7641 .0071 TD
(`)Tj
.2916 -.0071 TD
(-vis)Tj
/F1 1 Tf
2.0913 0 TD
[(current)-528.2(population)9.1(s)-532.6(and)-526(subpopulation)11.2(s.)-535.5(For)-526.6(a)-531.1(more)]TJ
-8.6567 -1.3799 TD
[(comprehe)9.3(nsive)-333.1(review,)-330.1(the)-328.9(reader)-329.6(is)-329.8(referred)-329(to)-334.6(Go)-329.1(et)-336.4(al.)]TJ
5.9774 0 0 5.3127 512.1069 130.0535 Tm
(65)Tj
-31.7826 -2.0702 TD
(d)Tj
7.9702 0 0 7.9702 325.2471 115.5401 Tm
[(In)-248.5(fact,)-252.8(treatment)-243.8(of)-249.5(stroke)-249(has)-252.4(risen)-250.1(to)-249.2(a)-253.7(cross-natio)10.3(nal)-252.9(goal)-248.6(as)-252.7(stated)-248(in)-255.3(the)]TJ
-.3912 -1.3728 TD
[(World)-420.8(Health)-410.9(Organization)10.2(s)-421.6(Helsingbor)9.1(g)-426(Declaration)-409.8(of)-420.2(2006.)-419.6(One)-424.6(of)-420.2(the)]TJ
0 -1.38 TD
[(goals)-347.3(for)-343.7(2015)-345.6(pertained)-334.6(to)-348.8(the)-343.1(organization)-343.8(of)-342(stroke)-341.5(services)-347.5(and)-341.1(specifi-)]TJ
0 -1.3728 TD
[(cally)-346.5(stated)-347.6(that)-347.7()61.2()0(a)-349(system)-342.8(be)-356(establish)10.4(ed)-348.9(to)-355.9(incorpor)12.8(ate)-355.3(new)-345.8(achievemen)12.2(ts)]TJ
T*
[(into)-333.8(stroke)-327.3(care.)63.9()]TJ
5.9774 0 0 5.3127 379.6723 75.2314 Tm
(68)Tj
/F11 1 Tf
11.9551 0 0 11.9551 50.1732 741.9966 Tm
[(BASHSHUR)-338.5(ET)-334.1(AL.)]TJ
7.9702 0 0 7.9702 50.1732 29.7638 Tm
[(7)-80(8)-75.6(0)-707(TELEMEDIC)12.9(INE)-329.6(and)-331.8(e-HEALTH)]TJ
/F8 1 Tf
6.9738 0 0 6.9738 177.7322 29.7638 Tm
.103 Tc
[(SE)-4.8(P)-6.4(T)-8.1(E)-4.8(M)-8.4(BE)-4.8(R)-339.7(2)-6.4(0)-7.9(1)-6.5(4)]TJ
ET
q
1 i
0 792 612 -791.985 re
W n
32.315 .014984 .22675 791.985 re
f
/Document /MC7 BDC
Q
q
1 i
0 792 32.315 -173.367 re
W n
0 0 0 .29999 k
0 618.633 32.315 173.367 re
f
EMC
Q
32.315 763.994 242.646 .22675 re
f
endstream
endobj
236 0 obj
<>stream
Adobe Illustrator CS4
2010-08-04T11:54:42+05:30
2010-08-04T11:54:42+05:30
2010-08-04T11:54:42+05:30
68
256
JPEG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application/postscript
saved
xmp.iid:11FB61F30AB7DE11AEB3E861853EAFA4
2009-10-12T14:15:50+05:30
Adobe Illustrator CS4
/
converted
from application/postscript to application/vnd.adobe.illustrator
converted
from application/postscript to application/vnd.adobe.illustrator
saved
xmp.iid:0280117407206811994CBE3149FFDB59
2010-08-04T11:54:42+05:30
Adobe Illustrator CS4
/
converted
from application/postscript to application/vnd.adobe.illustrator
xmp.iid:11FB61F30AB7DE11AEB3E861853EAFA4
xmp.did:11FB61F30AB7DE11AEB3E861853EAFA4
uuid:ee5a72b3-04e4-4157-a8d8-c3a8817872a3
uuid:ee5a72b3-04e4-4157-a8d8-c3a8817872a3
xmp.iid:0280117407206811994CBE3149FFDB59
xmp.did:0280117407206811994CBE3149FFDB59
TouchUp 7.0
False
False
1
684.000000
864.000000
Points
Black
Default Swatch Group
0
PANTONE 3025 C
SPOT
100.000000
CMYK
100.000000
16.859999
0.000000
50.980003
endstream
endobj
233 0 obj
<>
endobj
237 0 obj
<>/XObject<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]/Font<>>>/Thumb 239 0 R/MediaBox[0 0 612 792]/Rotate 0>>
endobj
240 0 obj
<>/ProcSet[/PDF/Text]/Font<>>>
endobj
238 0 obj
<>stream
/GS1 gs
BT
/F6 1 Tf
9.9626 0 0 9.9626 35.8866 693.1841 Tm
0 0 0 1 k
0 Tc
0 Tw
[(STROKE)-342.7(RISK)-336.5(FACTO)-11.1(RS)]TJ
/F1 1 Tf
8.9663 0 0 8.9663 45.8079 681.2219 Tm
-.0189 Tc
[(More)-223.2(tha)4.8(n)-219.3(20)-219.7()55.7()-1.2(leading)55.7()-222.5(r)0(isk)-214.4(f)-2(actors)-221.9(h)3.6(a)-1.5(ve)-216.8(bee)4.5(n)-219.3(associated)-219.7(with)-217.7(stroke,)]TJ
-1.1065 -1.3341 TD
-.0163 Tc
[(i)5.5(n)4.6(clu)6.2(d)-2.1(i)5.5(n)4.6(g)-299.3(c)7.1(on)4.6(t)4.8(r)2.6(ol)5.5(la)7.5(bl)5.5(e)-296.4(m)1.7(e)7.1(d)-2.1(i)5.5(c).7(al)-291.7(ris)8.3(k)-294(fact)4.8(o)4.2(r)2.6(s)-295.2(a)1.1(n)4.6(d)-293(li)5.5(fes)8.3(t)-1.5(y)4.2(l)-.9(e)-290.1(r)2.6(isk)-287.7(f).6(act)4.8(o)4.2(rs,)-295.8(a)1.1(s)]TJ
T*
-.0206 Tc
[(we)-3.6(l)-5.2(l)-283.4(a)-3.2(s)-293.2(unc)-3.6(o)-6.4(ntro)-6.4(ll)-5.2(ab)-6.4(le)-288.1(ri)-5.2(sk)-285.7(f)-3.7(a)-3.2(c)-3.6(t).5(ors.)]TJ
6.7246 0 0 5.9768 159.7606 661.266 Tm
-.0226 Tc
(75)Tj
8.9663 0 0 8.9663 169.0015 657.2975 Tm
-.0182 Tc
[(Medica)5.5(l)-287.3(r).7(isk)-283.3(f)-1.3(ac)5.2(tors)-290.8(inclu)4.3(d)-4(e)-285.7(a)-.8(trial)]TJ
-14.8462 -1.3341 TD
-.0163 Tc
[(f)6.9(i)-.9(b)4.2(r)2.6(il)5.5(la)7.4(ti)5.5(on)4.6(,)-314.7(d)4.2(iab)4.2(e).7(t)4.8(e).7(s,)-314.7(hi)5.5(gh)-316.2(b)4.2(l)5.5(oo)4.2(d)-318.3(p)4.2(ressure)7.1(,)-321.1(a)7.5(nd)-312(chro)4.2(n)4.6(i)-.9(c)-315.4(k)3.2(id)4.2(n)4.6(e).7(y)-318.3(d)4.2(is)8.3(ease.)]TJ
T*
.5202 Tc
[(L)539.7(i)542(f)537.1(e)537.2(s)538.5(t)541.3(y)540.7(l)535.6(ef)537.1(a)537.6(c)537.2(t)541.3(o)540.7(r)539.1(s)-5.3(i)542(n)534.8(c)537.2(l)542(u)536.4(d)540.7(es)538.5(m)538.2(o)534.4(k)539.7(i)542(n)541.1(g)534.4(,p)]TJ
15.2951 0 TD
-.0176 Tc
[(h)4.9(y)-3.4(sical)-539.6(i)4.2(na)6.2(ctivity,)-537.3(and)-540.9(o)2.9(besity.)]TJ
-15.2951 -1.3278 TD
-.0192 Tc
[(Mo)-5(reover,)-197.5(a)-197.8(documen)-4.6(ted)-194.7(p)1.3(arent)-4.4(a)-1.8(l)-193.4(i)2.6(schemi)-3.8(c)-198.2(s)-.9(troke)-198.2(b)1.3(y)-201(t)1.9(he)-191.8(ag)-5(e)-191.8(o)-5(f)-192(6)-5(5)-194.7(y)1.3(ears)]TJ
0 -1.3341 TD
-.0173 Tc
[(w)5.2(a).1(s)-270.9(a).1(ssocia)6.4(t)-2.5(ed)-268.7(with)-273(a)-271.8(t)3.8(hreef)5.9(old)-275(i)4.5(nc)6.1(re)]TJ
14.7766 0 TD
.2536 Tc
[(a)271(s)271.9(ei)269(ni)269(s)271.9(c)277(h)269.8(e)270.6(m)271.6(i)275.4(cs)271.9(t)268.4(r)272.5(o)274.1(k)273.1(er)272.5(i)269(s)271.9(ka)271(m)271.6(o)274.1(n)274.5(g)]TJ
-14.7766 -1.3341 TD
-.018 Tc
[(their)-245.7(o)2.5(ff)5.2(spring,)-240.6(e)-1(ven)-243.7(a)-.6(fter)-239.4(adjustin)]TJ
13.5943 0 TD
-.0184 Tc
[(g)-244.5(f)-1.5(or)-239.8(other)-239.8(k)1.1(nown)-244.1(stroke)-247.9(risk)-245.5(fa)5.3(ctors.)]TJ
/F6 1 Tf
9.9626 0 0 9.9626 35.8866 573.6188 Tm
0 Tc
[(STROKE)-342.7(COSTS)]TJ
/F1 1 Tf
8.9663 0 0 8.9663 45.8079 561.6566 Tm
[(Str)12(oke)-417.2(is)-421.5(a)-418.9(maj)12.9(or)-422.2(cau)12.7(se)-419.9(of)-417.9(deat)19.2(h)-426.4(and)-415.4(lon)12.5(g-t)11.4(erm)-414(dis)16.3(abi)15.4(lit)14.1(y)-428.4(w)0(i)12.6(t)0(h)]TJ
-1.1065 -1.3341 TD
[(pot)17.9(enti)17.6(ally)-373.8(en)12.6(orm)13.1(ous)-381.3(emo)17.5(tio)12.8(nal)-376.2(and)-377.5(soc)11.5(ioe)15(co)12.2(nomi)17.8(c)-387.6(res)16.3(ults)-371.6(for)-380.1(pa)12.6(-)]TJ
T*
[(tie)15.7(nts)16(,)-399.6(thei)12.9(r)-398.4(fam)14.3(ili)14.7(es,)-389.6(and)-390.1(hea)12.7(lth)-389.8(serv)17.8(ice)11.6(s.)-394(In)-397.9(sp)13.5(ite)-395.3(of)-392.6(the)-394.5(hi)12.7(gh)-399.6(co)12.2(st)]TJ
0 -1.3278 TD
[(bu)11.4(rde)12.2(n,)-486.2(onl)12.5(y)-491.7(lim)17.2(ite)15.7(d)-491.7(numb)18.6(ers)-483.3(of)-487.5(rec)15(ent)-484.7(stu)11.4(die)15(s)-487.6(have)-478.9(focu)13.7(sed)-481.6(on)]TJ
0 -1.3341 TD
[(st)14.1(rok)14.6(e-r)12(ela)12(ted)-270.1(co)12.2(sts)-271.1(in)-273.5(th)12(e)-280.1(Uni)17.4(ted)-270.1(Sta)16.8(tes)12.2(.)]TJ
6.7246 0 0 5.9768 185.2157 517.8329 Tm
(76)Tj
8.9663 0 0 8.9663 194.6834 513.8644 Tm
[(Thes)15.1(e)-273.8(cos)11.5(ts)-276.7(ha)14.7(ve)-278.6(be)12.2(en)-271.9(es-)]TJ
-17.7105 -1.3341 TD
[(tim)16.6(ate)11.3(d)-605.5(a)0(t)-593.7(abou)17.7(t)-604.8($36)12.9(.5)-600.4(bil)13.4(lio)13.4(n)-605.1(ann)14.9(uall)20.2(y,)-600.4(incl)18.2(udi)14.2(ng)-603.6(th)12(e)-608.9(c)0(o)12.2(s)0(t)-599.2(o)0(f)]TJ
T*
[(hea)12.7(lth)14.8(car)15.4(e)-482.5(ser)16.3(vic)15(es,)-471.8(med)11.2(ica)12(tio)19.1(ns,)-474.3(an)13(d)-479(lost)-468.4(pro)15.6(duct)11.6(ivi)13.4(ty.)]TJ
6.7246 0 0 5.9768 248.4283 493.9085 Tm
(65)Tj
8.9663 0 0 8.9663 259.7102 489.94 Tm
[(Lif)13.8(et)12.9(ime)]TJ
-24.9629 -1.3341 TD
[(co)12.2(sts)-505.1(per)-506.3(str)14(oke)-505.8(pa)12.6(tie)15.7(nt)-508.1(were)-499.9(est)12.2(ima)12.9(ted)-504.1(at)-511.5(be)12.2(twee)14.5(n)-510.2($59)12.9(,80)14.4(0)-517(a)0(n)13(d)]TJ
T*
[($2)11.4(30,)14.4(000)10.9(.)]TJ
6.7246 0 0 5.9768 72.6236 469.9841 Tm
(77)Tj
8.9663 0 0 8.9663 81.411 466.0156 Tm
[(Bro)12.7(wn)-196.9(et)-202.1(al)13.9(.)]TJ
6.7246 0 0 5.9768 125.0645 469.9841 Tm
(78)Tj
8.9663 0 0 8.9663 133.8519 466.0156 Tm
[(at)-195.4(the)-198.5(Un)14.6(iver)14.9(sit)16.9(y)-207.1(o)0(f)-196.6(Mic)11.9(hi)12.7(gan)-194.1(\(pu)14.2(bli)13.4(she)13.6(d)-207.1(i)0(n)]TJ
-10.926 -1.3341 TD
[(200)17.2(6\))-311.8(proj)12.1(ect)17.3(ed)-316.6(U.)11.4(S.)-313.9(cos)11.5(ts)-308.3(of)-316.7(isc)12.8(hem)13.3(ic)-309(str)14(oke)-309.7(fro)12(m)-317.2(200)17.2(5)-320.9(t)0(o)-312.4(205)10.9(0)-314.6(\(in)]TJ
T*
[(200)17.2(5)-213.5(dol)12.2(la)13.9(rs\))-200.3(to)-205(be)-209.1(ap)12.6(prox)17.5(ima)12.9(tel)15.7(y)-213.5($)0(2)11.4(.)0(2)-208.4(tri)17.5(lli)14.7(on:)-200.4($1.5)18(2)-213.5(tri)17.5(lli)14.7(on)-205.2(for)-203(non)11.7(-)]TJ
0 -1.3278 TD
[(His)16.8(pan)14.5(ic)-271(whit)18.3(es,)-269.5($3)11.4(13)-275.2(bil)13.4(lio)13.4(n)-276.3(f)0(o)12.1(r)-278.3(His)16.8(pan)14.5(ics)12.8(,)-279.5(a)0(n)13(d)-276.7($3)11.4(79)-275.2(bil)13.4(lio)13.4(n)-276.3(f)0(o)12.1(r)-278.3(Af)14.7(-)]TJ
0 -1.3341 TD
[(ric)13.4(an)-277.9(Ame)13.8(ric)13.4(ans)12.3(.)]TJ
6.7246 0 0 5.9768 98.7023 422.192 Tm
(79)Tj
8.9663 0 0 8.9663 108.2834 418.2235 Tm
[(Ass)15.4(umi)18(ng)-287.4(a)-286.1(3)0(%)-286.7(y)0(e)12.2(arl)13.8(y)-289.3(inf)15.2(lati)18.9(on)-287.4(fro)18.3(m)-291.9(200)17.2(8,)-284.3(tot)12.2(al)]TJ
-8.0744 -1.3341 TD
[(dir)16.9(ect)-191.4(and)-187.8(ind)12.5(ire)13.4(ct)-195.8(cos)11.5(ts)-194.5(of)-196.6(str)14(oke)-189.6(in)-191.3(the)-192.2(Unit)19.6(ed)-196.4(Stat)19(es)-198.6(was)-188.4(proj)18.4(ect)11(ed)-196.4(to)]TJ
T*
[(be)-335.5($1)11.4(08)-332.1(bil)13.4(lio)13.4(n)-339.5(i)0(n)-336.7(202)17.2(5.)]TJ
6.7246 0 0 5.9768 127.5023 398.2676 Tm
(79)Tj
8.9663 0 0 8.9663 137.537 394.2991 Tm
[(Bas)15.4(ed)-335.5(on)-331.7(the)-331.3(Na)13.2(tio)12.8(nal)-332(In)13.1(pat)14.8(ient)-330.2(Sam)13.6(ple)15(,)]TJ
-11.337 -1.3341 TD
[(ho)11.4(spi)16.3(tali)18.9(zat)11.4(ion)-246.7(cos)11.5(ts)-251.4(for)-253.6(is)14.7(che)12.3(mic)-253.1(st)14.1(rok)14.6(e)-261.2(pat)14.8(ien)15.4(ts)-257.8(in)-248.2(the)-249.1(Unit)13.3(ed)-253.3(St)12.1(ate)11.4(s)]TJ
T*
[(tr)14.7(eat)11.3(ed)-386.1(with)-380(int)13.2(rav)12.5(en)12.6(ous)-387.6(th)12(rom)13.1(bol)12.2(ysi)16.3(s)-392.7(wer)14.1(e)-393.9(ass)16(esse)13.7(d)-390.5(fro)12(m)-393(200)17.2(1)-396.8(t)0(o)]TJ
T*
[(200)17.2(8.)]TJ
6.7246 0 0 5.9768 56.4661 362.4377 Tm
(80)Tj
8.9663 0 0 8.9663 66.6708 358.4125 Tm
[(Med)10.6(ia)13.9(n)-364.8(h)0(o)11.4(spit)18.4(al)-359.2(co)12.2(sts)-353.3(in)-355.7(200)10.9(8)-358.9(dol)12.1(lar)13.8(s)-361.1(wer)14.1(e)-362.3($)0(1)11.4(4,10)15.9(2)-365.2(\(in)13.8(te)12.9(r-)]TJ
-3.4333 -1.3341 TD
[(qu)11.4(art)13.2(ile)-559.1(ran)12.9(ge)12.2(,)-570.3($)0(9)11.4(,987)15.9(20)10.9(,81)14.4(9\))-564.8(for)-563.4(pa)12.6(tie)15.7(nts)-559.4(with)-557(goo)10.9(d)-567.5(out)13.6(com)11.2(e,)]TJ
0 -1.3278 TD
[($1)11.4(8,8)14.4(56)-363.7(\(in)13.8(te)12.9(rqu)11.3(art)13.2(ile)-350.4(ran)12.9(ge,)-355.8($13)12.9(,14)14.4(53)10.9(0,4)14.4(23\))-354.6(for)-354.8(pati)17.6(ent)14.8(s)-367.4(w)0(i)12.6(t)0(h)-361(se-)]TJ
0 -1.3341 TD
[(ve)12.2(re)-217(dis)16.3(abi)15.4(lit)14.1(y,)-214.7(and)-206.8($19)12.9(,12)14.4(9)-219.8(\(in)13.8(ter)12.8(qu)11.4(art)13.2(ile)-211.3(ran)19.2(ge,)-210.3($11)12.9(,96)14.4(63)10.9(0,7)14.4(81\))-209.2(for)]TJ
T*
[(pa)12.6(tien)17.6(ts)-194.5(with)-190.3(in-)12.4(ho)11.4(spit)18.4(al)-201.1(mo)13.2(rta)13.2(lit)14.1(y.)-195.8(Aver)16.3(age)-191.6(200)10.9(8)-200.8(Med)10.6(ica)12(re)-191.7(paym)13.1(en)12.6(ts)]TJ
T*
[(wer)14.1(e)-204.3($)0(1)11.4(0,0)14.4(98)-205.6(fo)12.1(r)-202.4(int)13.2(rav)12.5(en)12.6(ous)-198(thr)12(om)13.2(bol)12.2(ysis)-193.1(wi)12.6(tho)13.6(ut)-202.9(com)11.2(pli)19.7(cat)11.4(ion)-196.1(an)13(d)]TJ
T*
[($1)11.4(3,8)14.4(35)-275.2(fo)12.1(r)-278.3(int)19.5(rav)12.5(eno)14.1(us)-275.4(th)12.1(rom)13.1(bol)12.2(ys)13.5(is)-276.1(wi)12.6(th)-272.5(maj)12.9(or)-270.4(co)12.2(mpli)18.7(cat)11.3(ion)12.5(.)]TJ
/F6 1 Tf
9.9626 0 0 9.9626 35.8866 263.1685 Tm
[(TELESTR)-11.1(OKE)]TJ
/F1 1 Tf
8.9663 0 0 8.9663 45.8079 251.2062 Tm
[(The)-230.8(term)-228.5()55.6(telestroke)50.6()-228.9(was)-226.4(introduced)-229.2(in)-229.3(the)-223.8(published)-232(literature)-232.4(in)]TJ
-1.1065 -1.3278 TD
(1999)Tj
6.7246 0 0 5.9768 54.5386 243.2692 Tm
(81)Tj
8.9663 0 0 8.9663 64.1763 239.3007 Tm
[(as)-286.8(an)-290.5(ICT-based)-294(solution)-288(to)-293.5(overcome)-293.2(the)-287.1(shortage)-292.7(of)-291.4(stroke)]TJ
-3.1551 -1.3341 TD
[(expertise)-219.5(in)-216.6(many)-220.4(areas)-214.5(of)-221.9(the)-217.5(country.)-220.2(It)-220.6(came)-215.1(after)-224.8(the)-217.5(introduction)]TJ
T*
[(of)-316.7(thrombolytic)-318.6(treatment)-320.5(with)-316.8(intravenous)-324(tissue)-317.3(plasminogen)-320(ac-)]TJ
T*
[(tivator)-453(\(tPA\))-454.1(\(approved)-461.1(by)-452.2(the)-457.8(Food)-455.5(and)-453.4(Drug)-450.2(Administration)-460.2(in)]TJ
T*
[(1996\))-345.2(and)-339.6(reflected)-351.2(the)-344(urgent)-340.6(need)-348.2(to)-344.1(increase)-344.9(its)-343.5(appropriate)-341.9(ad-)]TJ
T*
[(ministration)-326.7(during)-330.2(the)-325()55.6(golden)-329.1(hour,)50.3()-330.1(initially)-323.4(set)-329.2(at)-328.2(3)-327.3(hours)-327.3(after)]TJ
T*
[(the)-337.6(onset)-338.5(of)-342(symptoms)-338.1(and)-339.6(now)-340.8(extended)-338.2(to)-337.7(4.5)-339.7(hours.)-341.2(The)-338.3(timely)]TJ
T*
[(administration)-345.7(of)-342(tPA)-345.9(increases)-345.6(the)-344(probability)-350.2(of)-342(a)-343(favorable)-347.6(out-)]TJ
0 -1.3278 TD
[(come)-224.7(substantially,)-231.1(with)-228.2(an)-227.3(odds)-230.1(ratio)-222.8(of)-228.2(2.55)-230.7(in)-222.9(comparison)-230(with)-228.2(no)]TJ
0 -1.3341 TD
[(treatment.)-296.5(However,)-306.4(this)-295.7(requires)-300.4(strict)-305.4(adherence)-299.5(to)-299.8(explicit)-299.7(proto-)]TJ
T*
[(cols)-365(and)-371.2(close)-373.3(supervision)-373.5(by)-370(a)-368.3(stroke)-365.3(specialist.)-375.4(Because)-372.6(tPA)-371.2(dis-)]TJ
T*
[(solves)-256.7(the)-261.8(clot)-254.7(causing)-260(the)-261.8(stroke,)-259(it)-254.3(can)-260.8(also)-257.2(cause)-255.5(bleeding)-263.7(into)-257.2(the)]TJ
T*
[(brain)-235.7(or)-238.8(other)-241.4(serious)-242.1(bleeding)-244.7(that)-240.2(may)-235(lead)-239.4(to)-242.9(death.)-237.8(Indeed,)-242(if)-239.6(tPA)]TJ
T*
[(is)-339.3(administered)-348.6(in)-336.7(cases)-341.9(of)-348.4(hemorrhagic)-341.4(stroke)-346.3(or)-340(stroke)-346.3(mimics,)-341.8(it)]TJ
T*
[(can)-279.8(be)-278.6(fatal)-284.8(or)-276.8(cause)-287.1(severe)-283.3(disability.)]TJ
31.4438 69.3687 TD
[(Stroke)-468.5(presents)-474(a)-469.4(very)-466.9(different)-474(kind)-467.5(of)-474.8(health)-465.6(problem)-476.2(when)]TJ
-1.1128 -1.3278 TD
[(compared)-261.2(with)-259.9(heart)-263.4(failure.)-257.1(The)-262.4(onset)-262.6(of)-253.5(stroke)-264.1(is)-257.1(sudden)-259.7(and)-263.7(often)]TJ
0 -1.3341 TD
[(unexpected.)-413.7(Its)-404.7(prompt)-405.3(and)-402.8(accurate)-407.9(diagnosis)-408.2(and)-409.1(treatment)-402.7(can)]TJ
T*
[(produce)-198.2(optimal)-200.4(outcomes,)-200.4(both)-199.9(short)-195.9(term)-196.9(and)-194.1(long)-194.6(term.)-198.1(Hence,)-199.1(the)]TJ
T*
[(critical)-247.9(variables)-250.1(in)-241.9(the)-242.8(intervention)-250.8(are)-243.8(based)-247.7(on)-249.5(timing:)-244.3(from)-242(onset)]TJ
T*
[(of)-323.1(symptoms)-319.2(to)-318.8(proper)-326.3(diagnosis,)-321(to)-318.8(initiation)-322.1(of)-316.7(appropriate)-322.9(treat-)]TJ
T*
[(ment,)-417.4(to)-413.6(transfer)-419.7(of)-417.9(patients,)-418.5(as)-413.2(indicated)-422.7(in)-412.6(each)-419.2(case.)-418.4(A)-413.2(crucial)]TJ
T*
[(initial)-315.1(step)-321.4(is)-314.1(a)-311.4(computed)-323.4(tomography)-318.1(\(CT\))-312.4(scan)-318.4(of)-316.7(the)-318.7(brain)-311.6(to)-318.8(de-)]TJ
T*
[(termine)-503.9(whether)-497(the)-502(stroke)-504.4(is)-497.4(ischemic)-497.9(\(about)-502.1(87%)-500.1(of)-500.1(cases\))-503.5(or)]TJ
0 -1.3278 TD
[(hemorrhagic)-436.3(\(about)-432.6(13%)-430.6(overall:)-432.7(10%)-430.6(intracerebral)-440.6(and)-428.1(3%)-432.1(sub-)]TJ
0 -1.3341 TD
[(arachnoid)-347.9([that)-349.2(is,)-346.9(between)-350.8(the)-344(pia)-345(and)-345.9(arachnoid)-354.2(membranes)-346.2(that)]TJ
T*
[(surround)-184.8(the)-179.6(central)-182(nervous)-183.9(system]\).)-184(The)-180.2(clinical)-182(protocols)-187.7(for)-184(these)]TJ
T*
[(conditions)-416.5(are)-408.2(well)-410.2(established)-416.1(even)-411.4(though)-414.1(their)-417.1(implementation)]TJ
T*
[(may)-329.8(not)-329.5(be)-335.5(uniform.)-329.8(Ischemic)-337.8(stroke)-327.3(may)-336.1(be)-329.2(treated)-334.7(by)-332.1(tPA,)-328.2(while)]TJ
T*
[(balancing)-365.6(the)-356.6(risks)-358.6(and)-364.8(the)-356.6(benefits)-365(as)-362.6(they)-361.4(pertain)-361.9(to)-356.7(the)-362.9(charac-)]TJ
T*
[(teristics)-210.4(of)-215.6(individual)-208(patients.)-216.2(Hemorrhagic)-210.1(stroke)-213.5(may)-209.7(require)-211.1(more)]TJ
T*
[(complex)-281.7(interventions,)-284.4(including)-286.7(surgery.)]TJ
1.1128 -1.3278 TD
-.0191 Tc
[(S)3.4(o)1.4(me)-526.9(stroke)-526.9(patients)-525.6(may)-523.4(b)1.4(e)-526.9(s)-.8(u)3.4(cce)4.3(ssf)4.1(ully)-529.7(trea)4.6(ted)-529.7(i)2.7(n)-523(t)2.1(heir)-525(local)]TJ
-1.1128 -1.3341 TD
[(comm)5.2(unity)-428.6(h)-2.9(ospital)-427.3(u)3.4(nde)4.3(r)-430.2(re)4.3(mote)-425.7(super)6.1(v)-4.9(ision)-428.2(b)1.4(y)-428.6(a)-425.3(stroke)-425.7(spec)4.3(ia)4.6(list)]TJ
T*
-.0198 Tc
[(without)-333.8(b).7(eing)-328.1(transferred)-334.4(t)1.3(o)-328.1(a)-331.2(s)4.8(t)-5(ro)]TJ
14.0242 0 TD
-.0185 Tc
[(ke)-323.9(center.)-323.3(Some)-323.9(may)-326.8(h)4(ave)-330.3(i)3.3(ntr)6.7(a)-1.1(ve-)]TJ
-14.0242 -1.3341 TD
-.0199 Tc
[(nous)-178.7(t)-5.1(P)1(A)-180.2(t)1.2(reatment)-182.1(start)-5.1(e)3.5(d)-182.8(o).6(n-si)-4.5(te)-179.9(befo)]TJ
15.3394 0 TD
-.0194 Tc
[(re)-179.4(being)-182.3(t)1.7(ransferr)5.8(ed)-182.3(\(also)-182.3(r)-.5(eferred)]TJ
-15.3394 -1.3341 TD
-.02 Tc
[(to)-233.5(as)-229.4()54.6()-2.3(drip)-233.5(and)-233.5(s)4.6(hip)54.6(\),)-229.9(a)-2.6(nd)-227.1(some)-230.6(may)-227.1(r)-1.1(equire)-230.6(prompt)-226.5(transfer)-228.7(to)-233.5(a)-223.9(s)-1.7(troke)]TJ
T*
-.0182 Tc
[(ce)5.2(nte)5.2(r)-321.8(for)-315.5(e)-1.2(xtensive)-317.3(inte)]TJ
9.8321 0 TD
-.0196 Tc
[(rventi)-4.2(ons.)-318.1(Telestroke)-318.7(i)-4.2(s)]TJ
9.5729 0 TD
-.018 Tc
[(of)5.2(ten)-319.6(p)2.5(ra)5.8(ctic)5.4(ed)-320(w)4.5(i)-2.6(thin)]TJ
-19.405 -1.3341 TD
-.019 Tc
[(esta)4.8(blish)3.5(e)-2(d)-453.8(h)3.5(ub-a)4.8(nd-spoke)-450.9(n)1.9(etw)3.5(o)-4.8(r)6.2(k).5(s.)-450.2(More)-450.9(re)4.4(cently,)-450.2(with)-451.7(the)-450.9(a)4.8(va)4.8(il-)]TJ
T*
-.0203 Tc
[(abili)-4.9(ty)-208.5(of)-205.8(more)-205.6(bandwidth)-206.4(a)-2.9(nd)-208.5(securi)-4.9(ty)-208.5(arran)-5.7(g).2(ements)-204.4(\()-4.9(s)-2(uch)-206.4(a)3.4(s)-210.7(operati)-4.9(ng)]TJ
0 -1.3278 TD
[(w)-4.1(i)1.5(th)-4.1(in)-227(prot)-5.5(ected)-227.4(v)-6.1(irtual)-226.2(p)-6.1(r)-1.4(ivate)-230.9(n).6(etworks\),)-230.2(t).8(h)-4.1(e)-230.9(In)-5.7(ternet)-226.8(h)-4.1(a)-2.9(s)-229.7(b).2(een)-227(u)-4.1(sed)-233.8(a)3.5(s)]TJ
0 -1.3341 TD
-.0213 Tc
[(a)-282.1(m)-3.3(ore)-282.5(i).5(nclusi)-5.9(ve)-282.5(an)-6.8(d)-279(m)-3.3(uch)-283.3(b)-.8(road)-7.1(er)]TJ
14.5427 0 TD
-.0198 Tc
[(n)-5.3(e)3.6(twork)-278.6(f)-2.9(or)-279.1(stroke)-281(treat)-5(m)4.5(ent.)]TJ
-13.4299 -1.3341 TD
0 Tc
[(B)17.6(e)0(c)27.8(a)0(u)27.3(s)18.3(e)-179(o)14.2(f)-179.2(t)14.8(h)16.2(e)-179(d)14.2(i)15.4(f)16.9(f)0(e)27.6(r)12.6(e)17(n)14.6(ce)27.8(s)-177.7(b)14.2(e)17(t)14.8(we)26.9(en)-164.4(h)16.2(e)17(ar)30(t)-181.2(f)16.9(ai)26.5(l)15.4(u)16.2(r)12.6(e)-172.6(an)25.7(d)-175.5(s)0(t)26.8(r)18.9(o)14.2(k)13.1(e)17(,)-178.3(t)14.8(h)16.2(e)-179(f)0(o)24.7(c)17(u)16.2(s)]TJ
-1.1128 -1.3341 TD
[(a)17.4(n)14.5(d)-346.2(m)0(e)28.7(t)14.8(ho)24(d)14.2(o)14.2(l)15.4(o)14.2(g)14.2(y)-346.2(f)16.9(o)14.2(r)-347.8(a)17.4(ss)30.2(es)29(si)27.4(n)14.5(g)-346.2(t)14.8(h)16.2(e)-349.7(e)17(ff)27.4(ec)27.8(t)14.8(s)-348.5(o)14.2(f)-343.6(t)14.8(e)0(l)26.2(e)17(st)26.8(r)12.6(o)14.2(k)19.5(e)-349.7(v)14.2(a)17.4(r)12.6(y)-346.2(c)17(o)14.2(n)14.6(s)0(i)27.4(d)14.2(-)]TJ
T*
-.0151 Tc
[(e)-15.1(r)14.5(a)-15.1(b)10.2(ly)-399.3(from)-395.5(thos)-15.1(e)-384.5(o)-.9(f)-402.9(t)-.3(ele)-15.1(m)13.6(onitoring)-399.3(f)1.8(or)-400.9(hea)-15.1(r)14.9(t)-398.6(f)-15.1(a)12.9(ilu)-15.1(r)13.7(e)-15.1(.)-385(W)-.6(he)-15.1(r)14.5(e)-15.1(a)13(s)-401.5(tele)-15.1(-)]TJ
T*
-.0147 Tc
[(m)-14.7(o)11.1(n)6.2(i)-14.7(t)9.2(o)-.5(ring)-342(of)-339.3(he)-14.7(a)13.4(r)-2.1(t)-335(f)-14.7(a)13.3(ilure)-339.1(typic)-14.7(a)13.4(lly)-342(provides)-337.9(l).7(ong-te)-14.7(r)14.9(m)-338.2(s)-14.7(u)13.4(pport)-335(a)-14.7(n)11(d)]TJ
T*
-.0153 Tc
[(ongoing)-184.5(se)-15.3(r)8(v)5.2(i)-15.3(c)10.9(e)-181.6(t)-.5(o)-184.5(h)-15.3(e)11.6(l).1(p)-184.5(p)-1.1(ati)-15.3(e)10.9(nts)-180.4(m)-15.3(a)13.8(i).1(nta)-15.3(i)11.2(n)-184.1(a)2.1(n)-184.1(optima)-15.3(l)-172.1(leve)-15.3(l)-172.5(o)-1.1(f)-181.8(h).9(e)-15.3(a)12.8(lth)-182.5(a)-15.3(n)10.4(d)]TJ
T*
[(fu)-15.2(n)9.2(c)1.8(tioning)-285.6(f)1.7(or)-280.8(the)-282.7(r)-2.6(em)-15.2(a)13.9(i).2(nde)-15.2(r)-270.1(of)-282.9(the)-15.2(i)11(r)-280.8(lives)-15.2(,)-270.1(i).2(nc)-15.2(l)10.9(u)1(ding)-279.2(pa)-15.2(t)10.7(i).2(ent-s)-15.2(p)10.9(ec)-15.2(i)11(f)1.7(ic)]TJ
0 -1.3278 TD
0 Tc
[(me)28.7(d)14.2(i)15.4(ca)28.1(t)14.8(i)15.4(o)14.2(n)-288.9(r)18.9(e)0(g)24.9(i)15.4(m)18(e)0(n)-271.9(a)0(n)25.7(d)-283(he)26.9(al)26.5(t)14.8(h)16.2(y)-289.3(l)15.4(i)15.4(f)16.9(es)29(t)14.8(y)14.2(l)15.4(e)0(,)-275.1(t)14.8(el)26.2(e)17(s)0(t)26.8(r)18.9(o)14.2(k)13.1(e)-286.5(s)0(y)26.1(s)18.3(t)14.8(e)0(m)28.7(s)-291.5(t)14.8(y)14.2(p)14.2(i)15.4(c)17(a)0(l)26.5(l)15.4(y)]TJ
0 -1.3341 TD
[(co)31.2(n)14.6(s)0(i)27.4(s)0(t)-213.5(o)14.2(f)-236.1(p)14.2(r)18.9(o)14.2(mp)25.8(t)-225.4(i)0(n)30(t)0(e)25.5(r)12.6(v)14.2(e)17(n)14.6(t)14.8(i)15.4(o)14.2(n)14.6(s)-228.3(ai)26.5(m)18(e)0(d)-221.7(a)17.4(t)-231.8(o)14.2(p)14.2(t)14.8(i)15.4(m)18(al)-220.1(t)14.8(r)18.9(ea)28.1(t)14.8(m)0(e)28.7(n)14.5(t)14.8(.)-228.9(T)14.2(e)0(l)26.1(e)17(st)26.8(r)12.6(o)14.2(k)19.5(e)]TJ
T*
-.0153 Tc
[(is)-287.9(bas)-15.3(e)13.7(d)-285.7(o)-1.1(n)-285.3(a)-15.3(n)-274.2(e)1.7(xplic)-15.3(i)10.9(t)-285(e)-15.3(v)9.6(idenc)-15.3(e)12.5(-bas)-15.3(e)13.7(d)-285.7(protoc)-15.3(o)9.6(l)-284.4(for)-287.3(t)-.5(he)-289.1(time)-15.3(l)10.9(y)-285.7(adm)-15.3(i)11.8(n-)]TJ
T*
0 Tc
[(i)15.4(s)0(t)26.8(r)18.9(at)25.9(i)15.4(o)14.2(n)-206.7(o)14.2(f)-204.4(t)14.8(h)16.2(r)12.6(o)14.2(m)18(b)14.2(o)14.2(l)0(y)29.6(t)0(i)23.9(c)-204.3(t)14.8(r)12.6(e)17(a)0(t)25.9(m)18(en)31.6(t)14.8(,)-209.9(w)16.2(h)16.2(e)0(n)-196(i)15.4(n)14.5(d)14.2(i)15.4(c)17(at)25.9(e)17(d)14.2(,)-209.9(a)17.4(n)14.5(d)-207.1(t)14.8(h)16.2(e)-210.6(t)14.8(r)18.9(a)0(n)25.7(s)18.3(f)16.9(e)0(r)-191.7(o)14.2(f)]TJ
T*
-.0151 Tc
[(pati)-15.1(e)11.1(n)-.5(ts)-281.4(requiring)-279.1(m)-15.1(o)10.7(r)3.8(e)-282.6(i).3(nte)-15.1(n)10.2(sive)-282.6(interve)-15.1(n)16.5(t)-15.1(i)8.8(ons.)]TJ
1.1128 -1.3341 TD
0 Tc
[(Telestroke)-440.7(systems)-443.9(typically)-443.6(consist)-437.5(of)-443.2(networks)-442.1(wherein)-441.1(com-)]TJ
-1.1128 -1.3341 TD
[(munity)-431.7(and)-428.1(rural)-425.3(hospitals)-431.2(are)-433.5(electronically)-433.7(linked)-428.7(with)-430.6(medical)]TJ
T*
[(centers)-413.5(containing)-404.3(stroke)-409.5(expertise.)-416.8(In)-404.3(some)-406.8(instances,)-410.3(tPA)-409.1(is)-408.9(ad-)]TJ
0 -1.3278 TD
[(ministered)-329.6(on-site)-321.7(with)-329.4(supervision)-329.3(by)-319.4(the)-331.3(remote)-323.7(stroke)-327.3(specialist.)]TJ
0 -1.3341 TD
[(When)-304.5(patients)-303.4(present)-308.9(complex)-307(conditions)-302.7(that)-309.8(require)-306(critical)-304.8(care)]TJ
T*
[(or)-289.4(surgical)-290.8(or)-289.4(arterial)-294.6(interventions,)-290.7(they)-291.9(are)-288.1(transferred)-293.7(to)-293.5(tertiary-)]TJ
T*
[(care)-353.2(centers.)-351.5(If)-351.4(patients)-354(experience)-355.7(a)-349.3(worsening)-356.3(of)-348.4(symptoms)-350.8(after)]TJ
T*
[(tPA,)-442(a)-444.1(C)0(T)-444.5(scan)-444.9(of)-443.2(the)-445.1(brain)-444.3(and)-447(cessation)-447.3(of)-443.2(the)-445.1(medication)-449(are)]TJ
T*
[(indicated,)-284.8(and)-282.7(the)-280.7(patient)-283.8(would)-278(be)-284.9(transferred)-281.1(to)-280.8(a)-279.8(stroke)-283.1(center.)]TJ
/F6 1 Tf
9.9626 0 0 9.9626 307.8424 120.0189 Tm
[(THE)-340.8(SEARCH)-342.1(FOR)-336.1(EV)-7.2(IDENCE)]TJ
/F1 1 Tf
8.9663 0 0 8.9663 317.8204 108.1133 Tm
[(Us)12(ing)-284.6(th)12(e)-292.8(t)0(e)12.9(rms)-280(tele)13.8(med)17.6(icin)18.2(e/te)15.2(leh)17.1(eal)12(th)-285.1(and)-282.7(str)14(oke)12.7(,)-285.8(our)-285.9(ini)20.1(tial)-278.3(lit)14.1(-)]TJ
-1.1128 -1.3341 TD
[(era)15.4(tur)12(e)-235.9(sea)14.8(rch)-232.4(yie)15(lde)15(d)-238.7(422)-229.4(pu)11.4(bli)13.4(cat)11.4(ion)12.5(s.)-229.6(Th)11.4(e)-242.2(f)0(o)12.1(ur-s)16.7(te)12.9(p)-238.8(rev)12.2(iew)-229.6(pr)14.1(oce)10.3(ss)]TJ
T*
[(des)11.5(cri)13.4(be)12.2(d)-339.9(ear)15.4(lier)-325.2(in)-330.4(the)-331.3(sec)14.4(tio)12.8(n)-333.2(o)0(n)-331.7(CHF)-328.6(resu)13.5(lte)15.7(d)-339.9(i)0(n)-330.4(a)-336.7(fi)13.3(nal)-332(lis)17.5(t)-339.3(o)0(f)-329.4(2)0(1)]TJ
T*
[(pu)11.4(bli)13.4(cat)11.4(ion)12.5(s)-569.8(f)0(o)12.1(r)-569.1(ful)16.9(l)-572.6(rev)12.2(ie)13.5(w)-571.9(\()]TJ
/F5 1 Tf
12.9873 0 TD
[(Tab)19.4(le)-562.9(2)]TJ
/F1 1 Tf
3.3006 0 TD
[(\).)-561.2(The)-565.9(sel)19.1(ect)11(ion)-562.8(cri)19.7(ter)12.8(ia)-567.8(fo)12.1(r)]TJ
/F11 1 Tf
11.9551 0 0 11.9551 287.5464 741.9966 Tm
[(TELEMEDICINE)-340.6(FOR)-332.7(CHRONIC)-338.8(DISEASE)-334.7(MANAGE)-7.3(MENT)]TJ
/F9 1 Tf
6.9738 0 0 6.9738 186.8031 29.7638 Tm
()Tj
/F7 1 Tf
1.3251 0 TD
.2011 Tc
[(M)-4.9(ARY)-335.7(ANN)-334.5(L).6(IEBERT,)-333.7(I)-2.3(NC.)]TJ
/F10 1 Tf
15.015 0 TD
0 Tc
()Tj
/F7 1 Tf
.9999 0 TD
.1099 Tc
[(VOL.)-335.5(2)6.8(0)-1001.2(N)5.1(O)-4.5(.)-327.4(9)]TJ
/F10 1 Tf
8.3896 0 TD
0 Tc
()Tj
/F8 1 Tf
.9999 0 TD
.1097 Tc
[(SEP)8.5(T)-1.4(EMBER)-333(2)8.5(014)]TJ
/F4 1 Tf
7.9702 0 0 7.9702 441.9211 29.7638 Tm
0 Tc
[(TELEMEDIC)11.7(INE)-333(and)-328.9(e-HEALTH)-647.9(781)]TJ
ET
q
1 i
0 792 612 -791.985 re
W n
579.685 .014984 .22681 791.985 re
f
337.039 767.962 274.961 .22675 re
f
Q
endstream
endobj
241 0 obj
<>/XObject<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]/Font<>/Properties<>>>/Thumb 244 0 R/MediaBox[0 0 612 792]/Rotate 0>>
endobj
245 0 obj
<>/ProcSet[/PDF/Text]/Font<>/Properties<>>>
endobj
242 0 obj
<>stream
0 0 0 .695 k
/GS1 gs
50.173 718.583 525.883 18.539 re
f
50.173 691.88 525.883 31.861 re
f
0 0 0 .065 k
50.173 661.776 59.754 30.104 re
f
0 0 0 .145 k
109.928 661.776 28.687 30.104 re
f
0 0 0 .065 k
138.614 661.776 43.03 30.104 re
f
0 0 0 .145 k
181.644 661.776 35.887 30.104 re
f
0 0 0 .065 k
217.531 661.776 28.687 30.104 re
f
0 0 0 .145 k
246.217 661.776 47.792 30.104 re
f
0 0 0 .065 k
294.009 676.857 59.811 15.024 re
f
0 0 0 .145 k
353.82 661.776 52.611 30.104 re
f
0 0 0 .065 k
406.431 676.857 35.83 15.024 re
f
0 0 0 .145 k
442.261 661.776 47.849 30.104 re
f
0 0 0 .065 k
490.11 661.776 85.946 30.104 re
f
294.009 661.776 59.811 15.08 re
f
406.431 661.776 35.83 15.08 re
f
50.173 637.795 59.754 23.981 re
f
0 0 0 .145 k
109.928 637.795 28.687 23.981 re
f
0 0 0 .065 k
138.614 637.795 43.03 23.981 re
f
0 0 0 .145 k
181.644 637.795 35.887 23.981 re
f
0 0 0 .065 k
217.531 637.795 28.687 23.981 re
f
0 0 0 .145 k
246.217 637.795 47.792 23.981 re
f
0 0 0 .065 k
294.009 637.795 59.811 23.981 re
f
0 0 0 .145 k
353.82 637.795 52.611 23.981 re
f
0 0 0 .065 k
406.431 637.795 35.83 23.981 re
f
0 0 0 .145 k
442.261 637.795 47.849 23.981 re
f
0 0 0 .065 k
490.11 637.795 85.946 23.981 re
f
50.173 613.757 59.754 24.038 re
f
0 0 0 .145 k
109.928 613.757 28.687 24.038 re
f
0 0 0 .065 k
138.614 613.757 43.03 24.038 re
f
0 0 0 .145 k
181.644 613.757 35.887 24.038 re
f
0 0 0 .065 k
217.531 613.757 28.687 24.038 re
f
0 0 0 .145 k
246.217 613.757 47.792 24.038 re
f
0 0 0 .065 k
294.009 613.757 59.811 24.038 re
f
0 0 0 .145 k
353.82 613.757 52.611 24.038 re
f
0 0 0 .065 k
406.431 613.757 35.83 24.038 re
f
0 0 0 .145 k
442.261 613.757 47.849 24.038 re
f
0 0 0 .065 k
490.11 613.757 85.946 24.038 re
f
50.173 598.734 59.754 15.024 re
f
0 0 0 .145 k
109.928 598.734 28.687 15.024 re
f
0 0 0 .065 k
138.614 598.734 43.03 15.024 re
f
0 0 0 .145 k
181.644 598.734 35.887 15.024 re
f
0 0 0 .065 k
217.531 598.734 28.687 15.024 re
f
0 0 0 .145 k
246.217 598.734 47.792 15.024 re
f
0 0 0 .065 k
294.009 598.734 59.811 15.024 re
f
0 0 0 .145 k
353.82 598.734 52.611 15.024 re
f
0 0 0 .065 k
406.431 598.734 35.83 15.024 re
f
0 0 0 .145 k
442.261 598.734 47.849 15.024 re
f
0 0 0 .065 k
490.11 598.734 85.946 15.024 re
f
50.173 565.738 59.754 32.995 re
f
0 0 0 .145 k
109.928 565.738 28.687 32.995 re
f
0 0 0 .065 k
138.614 565.738 43.03 32.995 re
f
0 0 0 .145 k
181.644 565.738 35.887 32.995 re
f
0 0 0 .065 k
217.531 565.738 28.687 32.995 re
f
0 0 0 .145 k
246.217 565.738 47.792 32.995 re
f
0 0 0 .065 k
294.009 565.738 59.811 32.995 re
f
0 0 0 .145 k
353.82 565.738 52.611 32.995 re
f
0 0 0 .065 k
406.431 565.738 35.83 32.995 re
f
0 0 0 .145 k
442.261 565.738 47.849 32.995 re
f
0 0 0 .065 k
490.11 565.738 85.946 32.995 re
f
50.173 532.8 59.754 32.939 re
f
0 0 0 .145 k
109.928 532.8 28.687 32.939 re
f
0 0 0 .065 k
138.614 532.8 43.03 32.939 re
f
0 0 0 .145 k
181.644 532.8 35.887 32.939 re
f
0 0 0 .065 k
217.531 532.8 28.687 32.939 re
f
0 0 0 .145 k
246.217 532.8 47.792 32.939 re
f
0 0 0 .065 k
294.009 532.8 59.811 32.939 re
f
0 0 0 .145 k
353.82 532.8 52.611 32.939 re
f
0 0 0 .065 k
406.431 532.8 35.83 32.939 re
f
0 0 0 .145 k
442.261 532.8 47.849 32.939 re
f
0 0 0 .065 k
490.11 532.8 85.946 32.939 re
f
50.173 508.762 59.754 24.038 re
f
0 0 0 .145 k
109.928 508.762 28.687 24.038 re
f
0 0 0 .065 k
138.614 508.762 43.03 24.038 re
f
0 0 0 .145 k
181.644 508.762 35.887 24.038 re
f
0 0 0 .065 k
217.531 508.762 28.687 24.038 re
f
0 0 0 .145 k
246.217 508.762 47.792 24.038 re
f
0 0 0 .065 k
294.009 508.762 59.811 24.038 re
f
0 0 0 .145 k
353.82 508.762 52.611 24.038 re
f
0 0 0 .065 k
406.431 508.762 35.83 24.038 re
f
0 0 0 .145 k
442.261 508.762 47.849 24.038 re
f
0 0 0 .065 k
490.11 508.762 85.946 24.038 re
f
50.173 484.781 59.754 23.981 re
f
0 0 0 .145 k
109.928 484.781 28.687 23.981 re
f
0 0 0 .065 k
138.614 484.781 43.03 23.981 re
f
0 0 0 .145 k
181.644 484.781 35.887 23.981 re
f
0 0 0 .065 k
217.531 484.781 28.687 23.981 re
f
0 0 0 .145 k
246.217 484.781 47.792 23.981 re
f
0 0 0 .065 k
294.009 484.781 59.811 23.981 re
f
0 0 0 .145 k
353.82 484.781 52.611 23.981 re
f
0 0 0 .065 k
406.431 484.781 35.83 23.981 re
f
0 0 0 .145 k
442.261 484.781 47.849 23.981 re
f
0 0 0 .065 k
490.11 484.781 85.946 23.981 re
f
50.173 460.743 59.754 24.038 re
f
0 0 0 .145 k
109.928 460.743 28.687 24.038 re
f
0 0 0 .065 k
138.614 460.743 43.03 24.038 re
f
0 0 0 .145 k
181.644 460.743 35.887 24.038 re
f
0 0 0 .065 k
217.531 460.743 28.687 24.038 re
f
0 0 0 .145 k
246.217 460.743 47.792 24.038 re
f
0 0 0 .065 k
294.009 460.743 59.811 24.038 re
f
0 0 0 .145 k
353.82 460.743 52.611 24.038 re
f
0 0 0 .065 k
406.431 460.743 35.83 24.038 re
f
0 0 0 .145 k
442.261 460.743 47.849 24.038 re
f
0 0 0 .065 k
490.11 460.743 85.946 24.038 re
f
50.173 436.762 59.754 23.981 re
f
0 0 0 .145 k
109.928 436.762 28.687 23.981 re
f
0 0 0 .065 k
138.614 436.762 43.03 23.981 re
f
0 0 0 .145 k
181.644 436.762 35.887 23.981 re
f
0 0 0 .065 k
217.531 436.762 28.687 23.981 re
f
0 0 0 .145 k
246.217 436.762 47.792 23.981 re
f
0 0 0 .065 k
294.009 436.762 59.811 23.981 re
f
0 0 0 .145 k
353.82 436.762 52.611 23.981 re
f
0 0 0 .065 k
406.431 436.762 35.83 23.981 re
f
0 0 0 .145 k
442.261 436.762 47.849 23.981 re
f
0 0 0 .065 k
490.11 436.762 85.946 23.981 re
f
50.173 421.682 59.754 15.08 re
f
0 0 0 .145 k
109.928 421.682 28.687 15.08 re
f
0 0 0 .065 k
138.614 421.682 43.03 15.08 re
f
0 0 0 .145 k
181.644 421.682 35.887 15.08 re
f
0 0 0 .065 k
217.531 421.682 28.687 15.08 re
f
0 0 0 .145 k
246.217 421.682 47.792 15.08 re
f
0 0 0 .065 k
294.009 421.682 59.811 15.08 re
f
0 0 0 .145 k
353.82 421.682 52.611 15.08 re
f
0 0 0 .065 k
406.431 421.682 35.83 15.08 re
f
0 0 0 .145 k
442.261 421.682 47.849 15.08 re
f
0 0 0 .065 k
490.11 421.682 85.946 15.08 re
f
50.173 388.743 59.754 32.939 re
f
0 0 0 .145 k
109.928 388.743 28.687 32.939 re
f
0 0 0 .065 k
138.614 388.743 43.03 32.939 re
f
0 0 0 .145 k
181.644 388.743 35.887 32.939 re
f
0 0 0 .065 k
217.531 388.743 28.687 32.939 re
f
0 0 0 .145 k
246.217 388.743 47.792 32.939 re
f
0 0 0 .065 k
294.009 388.743 59.811 32.939 re
f
0 0 0 .145 k
353.82 388.743 52.611 32.939 re
f
0 0 0 .065 k
406.431 388.743 35.83 32.939 re
f
0 0 0 .145 k
442.261 388.743 47.849 32.939 re
f
0 0 0 .065 k
490.11 388.743 85.946 32.939 re
f
50.173 364.705 59.754 24.038 re
f
0 0 0 .145 k
109.928 364.705 28.687 24.038 re
f
0 0 0 .065 k
138.614 364.705 43.03 24.038 re
f
0 0 0 .145 k
181.644 364.705 35.887 24.038 re
f
0 0 0 .065 k
217.531 364.705 28.687 24.038 re
f
0 0 0 .145 k
246.217 364.705 47.792 24.038 re
f
0 0 0 .065 k
294.009 364.705 59.811 24.038 re
f
0 0 0 .145 k
353.82 364.705 52.611 24.038 re
f
0 0 0 .065 k
406.431 364.705 35.83 24.038 re
f
0 0 0 .145 k
442.261 364.705 47.849 24.038 re
f
0 0 0 .065 k
490.11 364.705 85.946 24.038 re
f
50.173 340.668 59.754 24.038 re
f
0 0 0 .145 k
109.928 340.668 28.687 24.038 re
f
0 0 0 .065 k
138.614 340.668 43.03 24.038 re
f
0 0 0 .145 k
181.644 340.668 35.887 24.038 re
f
0 0 0 .065 k
217.531 340.668 28.687 24.038 re
f
0 0 0 .145 k
246.217 340.668 47.792 24.038 re
f
0 0 0 .065 k
294.009 340.668 59.811 24.038 re
f
0 0 0 .145 k
353.82 340.668 52.611 24.038 re
f
0 0 0 .065 k
406.431 340.668 35.83 24.038 re
f
0 0 0 .145 k
442.261 340.668 47.849 24.038 re
f
0 0 0 .065 k
490.11 340.668 85.946 24.038 re
f
50.173 316.687 59.754 23.981 re
f
0 0 0 .145 k
109.928 316.687 28.687 23.981 re
f
0 0 0 .065 k
138.614 316.687 43.03 23.981 re
f
0 0 0 .145 k
181.644 316.687 35.887 23.981 re
f
0 0 0 .065 k
217.531 316.687 28.687 23.981 re
f
0 0 0 .145 k
246.217 316.687 47.792 23.981 re
f
0 0 0 .065 k
294.009 316.687 59.811 23.981 re
f
0 0 0 .145 k
353.82 316.687 52.611 23.981 re
f
0 0 0 .065 k
406.431 316.687 35.83 23.981 re
f
0 0 0 .145 k
442.261 316.687 47.849 23.981 re
f
0 0 0 .065 k
490.11 316.687 85.946 23.981 re
f
50.173 292.649 59.754 24.038 re
f
0 0 0 .145 k
109.928 292.649 28.687 24.038 re
f
0 0 0 .065 k
138.614 292.649 43.03 24.038 re
f
0 0 0 .145 k
181.644 292.649 35.887 24.038 re
f
0 0 0 .065 k
217.531 292.649 28.687 24.038 re
f
0 0 0 .145 k
246.217 292.649 47.792 24.038 re
f
0 0 0 .065 k
294.009 292.649 59.811 24.038 re
f
0 0 0 .145 k
353.82 292.649 52.611 24.038 re
f
0 0 0 .065 k
406.431 292.649 35.83 24.038 re
f
0 0 0 .145 k
442.261 292.649 47.849 24.038 re
f
0 0 0 .065 k
490.11 292.649 85.946 24.038 re
f
50.173 268.668 59.754 23.981 re
f
0 0 0 .145 k
109.928 268.668 28.687 23.981 re
f
0 0 0 .065 k
138.614 268.668 43.03 23.981 re
f
0 0 0 .145 k
181.644 268.668 35.887 23.981 re
f
0 0 0 .065 k
217.531 268.668 28.687 23.981 re
f
0 0 0 .145 k
246.217 268.668 47.792 23.981 re
f
0 0 0 .065 k
294.009 268.668 59.811 23.981 re
f
0 0 0 .145 k
353.82 268.668 52.611 23.981 re
f
0 0 0 .065 k
406.431 268.668 35.83 23.981 re
f
0 0 0 .145 k
442.261 268.668 47.849 23.981 re
f
0 0 0 .065 k
490.11 268.668 85.946 23.981 re
f
50.173 244.63 59.754 24.038 re
f
0 0 0 .145 k
109.928 244.63 28.687 24.038 re
f
0 0 0 .065 k
138.614 244.63 43.03 24.038 re
f
0 0 0 .145 k
181.644 244.63 35.887 24.038 re
f
0 0 0 .065 k
217.531 244.63 28.687 24.038 re
f
0 0 0 .145 k
246.217 244.63 47.792 24.038 re
f
0 0 0 .065 k
294.009 244.63 59.811 24.038 re
f
0 0 0 .145 k
353.82 244.63 52.611 24.038 re
f
0 0 0 .065 k
406.431 244.63 35.83 24.038 re
f
0 0 0 .145 k
442.261 244.63 47.849 24.038 re
f
0 0 0 .065 k
490.11 244.63 85.946 24.038 re
f
50.173 220.649 59.754 23.981 re
f
0 0 0 .145 k
109.928 220.649 28.687 23.981 re
f
0 0 0 .065 k
138.614 220.649 43.03 23.981 re
f
0 0 0 .145 k
181.644 220.649 35.887 23.981 re
f
0 0 0 .065 k
217.531 220.649 28.687 23.981 re
f
0 0 0 .145 k
246.217 220.649 47.792 23.981 re
f
0 0 0 .065 k
294.009 220.649 59.811 23.981 re
f
0 0 0 .145 k
353.82 220.649 52.611 23.981 re
f
0 0 0 .065 k
406.431 220.649 35.83 23.981 re
f
0 0 0 .145 k
442.261 220.649 47.849 23.981 re
f
0 0 0 .065 k
490.11 220.649 85.946 23.981 re
f
50.173 187.653 59.754 32.995 re
f
0 0 0 .145 k
109.928 187.653 28.687 32.995 re
f
0 0 0 .065 k
138.614 187.653 43.03 32.995 re
f
0 0 0 .145 k
181.644 187.653 35.887 32.995 re
f
0 0 0 .065 k
217.531 187.653 28.687 32.995 re
f
0 0 0 .145 k
246.217 187.653 47.792 32.995 re
f
0 0 0 .065 k
294.009 187.653 59.811 32.995 re
f
0 0 0 .145 k
353.82 187.653 52.611 32.995 re
f
0 0 0 .065 k
406.431 187.653 35.83 32.995 re
f
0 0 0 .145 k
442.261 187.653 47.849 32.995 re
f
0 0 0 .065 k
490.11 187.653 85.946 32.995 re
f
50.173 163.672 59.754 23.981 re
f
0 0 0 .145 k
109.928 163.672 28.687 23.981 re
f
0 0 0 .065 k
138.614 163.672 43.03 23.981 re
f
0 0 0 .145 k
181.644 163.672 35.887 23.981 re
f
0 0 0 .065 k
217.531 163.672 28.687 23.981 re
f
0 0 0 .145 k
246.217 163.672 47.792 23.981 re
f
0 0 0 .065 k
294.009 163.672 59.811 23.981 re
f
0 0 0 .145 k
353.82 163.672 52.611 23.981 re
f
0 0 0 .065 k
406.431 163.672 35.83 23.981 re
f
0 0 0 .145 k
442.261 163.672 47.849 23.981 re
f
0 0 0 .065 k
490.11 163.672 85.946 23.981 re
f
0 0 0 .845 k
50.173 737.178 525.883 1.0205 re
f
0 0 0 .695 k
50.173 731.905 525.883 5.2725 re
f
0 0 0 1 k
q 1 0 0 1 50.173 163.672 cm 0 0 m
525.883 0 l
0 0 l
f
Q
0 0 0 .345 k
50.173 723.458 131.471 .51019 re
f
181.644 718.583 .51022 18.539 re
f
182.154 723.458 111.855 .51019 re
f
294.009 718.583 .51025 18.539 re
f
353.82 718.583 .51025 18.539 re
f
354.331 723.458 135.779 .51019 re
f
490.11 718.583 .51022 18.539 re
f
109.928 691.88 .51024 31.861 re
f
138.614 691.88 .51022 31.861 re
f
181.644 691.88 .51022 31.861 re
f
217.531 691.88 .51024 31.861 re
f
246.217 691.88 .51024 31.861 re
f
294.009 691.88 .51025 31.861 re
f
353.82 691.88 .51025 31.861 re
f
406.431 691.88 .51022 31.861 re
f
442.261 691.88 .51025 31.861 re
f
490.11 691.88 .51022 31.861 re
f
50.173 691.37 525.883 .51025 re
f
0 0 0 1 k
50.173 661.776 59.754 .51019 re
f
109.928 661.776 .51024 30.104 re
f
110.438 661.776 28.176 .51019 re
f
138.614 661.776 .51022 30.104 re
f
139.124 661.776 42.52 .51019 re
f
181.644 661.776 .51022 30.104 re
f
182.154 661.776 35.376 .51019 re
f
217.531 661.776 .51024 30.104 re
f
218.041 661.776 28.176 .51019 re
f
246.217 661.776 .51024 30.104 re
f
246.727 661.776 47.282 .51019 re
f
294.009 676.857 .51025 15.024 re
f
294.52 676.857 59.301 .45355 re
f
353.82 661.776 .51025 30.104 re
f
354.331 661.776 52.101 .51019 re
f
406.431 676.857 .51022 15.024 re
f
406.942 676.857 35.32 .45355 re
f
442.261 661.776 .51025 30.104 re
f
442.772 661.776 47.339 .51019 re
f
490.11 661.776 .51022 30.104 re
f
490.62 661.776 85.436 .51019 re
f
294.009 661.776 .51025 15.08 re
f
294.52 661.776 59.301 .51019 re
f
406.431 661.776 .51022 15.08 re
f
406.942 661.776 35.32 .51019 re
f
50.173 637.795 59.754 .45355 re
f
109.928 637.795 .51024 23.981 re
f
110.438 637.795 28.176 .45355 re
f
138.614 637.795 .51022 23.981 re
f
139.124 637.795 42.52 .45355 re
f
181.644 637.795 .51022 23.981 re
f
182.154 637.795 35.376 .45355 re
f
217.531 637.795 .51024 23.981 re
f
218.041 637.795 28.176 .45355 re
f
246.217 637.795 .51024 23.981 re
f
246.727 637.795 47.282 .45355 re
f
294.009 637.795 .51025 23.981 re
f
294.52 637.795 59.301 .45355 re
f
353.82 637.795 .51025 23.981 re
f
354.331 637.795 52.101 .45355 re
f
406.431 637.795 .51022 23.981 re
f
406.942 637.795 35.32 .45355 re
f
442.261 637.795 .51025 23.981 re
f
442.772 637.795 47.339 .45355 re
f
490.11 637.795 .51022 23.981 re
f
490.62 637.795 85.436 .45355 re
f
50.173 613.757 59.754 .51025 re
f
109.928 613.757 .51024 24.038 re
f
110.438 613.757 28.176 .51025 re
f
138.614 613.757 .51022 24.038 re
f
139.124 613.757 42.52 .51025 re
f
181.644 613.757 .51022 24.038 re
f
182.154 613.757 35.376 .51025 re
f
217.531 613.757 .51024 24.038 re
f
218.041 613.757 28.176 .51025 re
f
246.217 613.757 .51024 24.038 re
f
246.727 613.757 47.282 .51025 re
f
294.009 613.757 .51025 24.038 re
f
294.52 613.757 59.301 .51025 re
f
353.82 613.757 .51025 24.038 re
f
354.331 613.757 52.101 .51025 re
f
406.431 613.757 .51022 24.038 re
f
406.942 613.757 35.32 .51025 re
f
442.261 613.757 .51025 24.038 re
f
442.772 613.757 47.339 .51025 re
f
490.11 613.757 .51022 24.038 re
f
490.62 613.757 85.436 .51025 re
f
50.173 598.734 59.754 .51025 re
f
109.928 598.734 .51024 15.024 re
f
110.438 598.734 28.176 .51025 re
f
138.614 598.734 .51022 15.024 re
f
139.124 598.734 42.52 .51025 re
f
181.644 598.734 .51022 15.024 re
f
182.154 598.734 35.376 .51025 re
f
217.531 598.734 .51024 15.024 re
f
218.041 598.734 28.176 .51025 re
f
246.217 598.734 .51024 15.024 re
f
246.727 598.734 47.282 .51025 re
f
294.009 598.734 .51025 15.024 re
f
294.52 598.734 59.301 .51025 re
f
353.82 598.734 .51025 15.024 re
f
354.331 598.734 52.101 .51025 re
f
406.431 598.734 .51022 15.024 re
f
406.942 598.734 35.32 .51025 re
f
442.261 598.734 .51025 15.024 re
f
442.772 598.734 47.339 .51025 re
f
490.11 598.734 .51022 15.024 re
f
490.62 598.734 85.436 .51025 re
f
50.173 565.738 59.754 .51025 re
f
109.928 565.738 .51024 32.995 re
f
110.438 565.738 28.176 .51025 re
f
138.614 565.738 .51022 32.995 re
f
139.124 565.738 42.52 .51025 re
f
181.644 565.738 .51022 32.995 re
f
182.154 565.738 35.376 .51025 re
f
217.531 565.738 .51024 32.995 re
f
218.041 565.738 28.176 .51025 re
f
246.217 565.738 .51024 32.995 re
f
246.727 565.738 47.282 .51025 re
f
294.009 565.738 .51025 32.995 re
f
294.52 565.738 59.301 .51025 re
f
353.82 565.738 .51025 32.995 re
f
354.331 565.738 52.101 .51025 re
f
406.431 565.738 .51022 32.995 re
f
406.942 565.738 35.32 .51025 re
f
442.261 565.738 .51025 32.995 re
f
442.772 565.738 47.339 .51025 re
f
490.11 565.738 .51022 32.995 re
f
490.62 565.738 85.436 .51025 re
f
50.173 532.8 59.754 .45355 re
f
109.928 532.8 .51024 32.939 re
f
110.438 532.8 28.176 .45355 re
f
138.614 532.8 .51022 32.939 re
f
139.124 532.8 42.52 .45355 re
f
181.644 532.8 .51022 32.939 re
f
182.154 532.8 35.376 .45355 re
f
217.531 532.8 .51024 32.939 re
f
218.041 532.8 28.176 .45355 re
f
246.217 532.8 .51024 32.939 re
f
246.727 532.8 47.282 .45355 re
f
294.009 532.8 .51025 32.939 re
f
294.52 532.8 59.301 .45355 re
f
353.82 532.8 .51025 32.939 re
f
354.331 532.8 52.101 .45355 re
f
406.431 532.8 .51022 32.939 re
f
406.942 532.8 35.32 .45355 re
f
442.261 532.8 .51025 32.939 re
f
442.772 532.8 47.339 .45355 re
f
490.11 532.8 .51022 32.939 re
f
490.62 532.8 85.436 .45355 re
f
50.173 508.762 59.754 .51022 re
f
109.928 508.762 .51024 24.038 re
f
110.438 508.762 28.176 .51022 re
f
138.614 508.762 .51022 24.038 re
f
139.124 508.762 42.52 .51022 re
f
181.644 508.762 .51022 24.038 re
f
182.154 508.762 35.376 .51022 re
f
217.531 508.762 .51024 24.038 re
f
218.041 508.762 28.176 .51022 re
f
246.217 508.762 .51024 24.038 re
f
246.727 508.762 47.282 .51022 re
f
294.009 508.762 .51025 24.038 re
f
294.52 508.762 59.301 .51022 re
f
353.82 508.762 .51025 24.038 re
f
354.331 508.762 52.101 .51022 re
f
406.431 508.762 .51022 24.038 re
f
406.942 508.762 35.32 .51022 re
f
442.261 508.762 .51025 24.038 re
f
442.772 508.762 47.339 .51022 re
f
490.11 508.762 .51022 24.038 re
f
490.62 508.762 85.436 .51022 re
f
50.173 484.781 59.754 .45355 re
f
109.928 484.781 .51024 23.981 re
f
110.438 484.781 28.176 .45355 re
f
138.614 484.781 .51022 23.981 re
f
139.124 484.781 42.52 .45355 re
f
181.644 484.781 .51022 23.981 re
f
182.154 484.781 35.376 .45355 re
f
217.531 484.781 .51024 23.981 re
f
218.041 484.781 28.176 .45355 re
f
246.217 484.781 .51024 23.981 re
f
246.727 484.781 47.282 .45355 re
f
294.009 484.781 .51025 23.981 re
f
294.52 484.781 59.301 .45355 re
f
353.82 484.781 .51025 23.981 re
f
354.331 484.781 52.101 .45355 re
f
406.431 484.781 .51022 23.981 re
f
406.942 484.781 35.32 .45355 re
f
442.261 484.781 .51025 23.981 re
f
442.772 484.781 47.339 .45355 re
f
490.11 484.781 .51022 23.981 re
f
490.62 484.781 85.436 .45355 re
f
50.173 460.743 59.754 .51025 re
f
109.928 460.743 .51024 24.038 re
f
110.438 460.743 28.176 .51025 re
f
138.614 460.743 .51022 24.038 re
f
139.124 460.743 42.52 .51025 re
f
181.644 460.743 .51022 24.038 re
f
182.154 460.743 35.376 .51025 re
f
217.531 460.743 .51024 24.038 re
f
218.041 460.743 28.176 .51025 re
f
246.217 460.743 .51024 24.038 re
f
246.727 460.743 47.282 .51025 re
f
294.009 460.743 .51025 24.038 re
f
294.52 460.743 59.301 .51025 re
f
353.82 460.743 .51025 24.038 re
f
354.331 460.743 52.101 .51025 re
f
406.431 460.743 .51022 24.038 re
f
406.942 460.743 35.32 .51025 re
f
442.261 460.743 .51025 24.038 re
f
442.772 460.743 47.339 .51025 re
f
490.11 460.743 .51022 24.038 re
f
490.62 460.743 85.436 .51025 re
f
50.173 436.762 59.754 .45355 re
f
109.928 436.762 .51024 23.981 re
f
110.438 436.762 28.176 .45355 re
f
138.614 436.762 .51022 23.981 re
f
139.124 436.762 42.52 .45355 re
f
181.644 436.762 .51022 23.981 re
f
182.154 436.762 35.376 .45355 re
f
217.531 436.762 .51024 23.981 re
f
218.041 436.762 28.176 .45355 re
f
246.217 436.762 .51024 23.981 re
f
246.727 436.762 47.282 .45355 re
f
294.009 436.762 .51025 23.981 re
f
294.52 436.762 59.301 .45355 re
f
353.82 436.762 .51025 23.981 re
f
354.331 436.762 52.101 .45355 re
f
406.431 436.762 .51022 23.981 re
f
406.942 436.762 35.32 .45355 re
f
442.261 436.762 .51025 23.981 re
f
442.772 436.762 47.339 .45355 re
f
490.11 436.762 .51022 23.981 re
f
490.62 436.762 85.436 .45355 re
f
50.173 421.682 59.754 .51025 re
f
109.928 421.682 .51024 15.08 re
f
110.438 421.682 28.176 .51025 re
f
138.614 421.682 .51022 15.08 re
f
139.124 421.682 42.52 .51025 re
f
181.644 421.682 .51022 15.08 re
f
182.154 421.682 35.376 .51025 re
f
217.531 421.682 .51024 15.08 re
f
218.041 421.682 28.176 .51025 re
f
246.217 421.682 .51024 15.08 re
f
246.727 421.682 47.282 .51025 re
f
294.009 421.682 .51025 15.08 re
f
294.52 421.682 59.301 .51025 re
f
353.82 421.682 .51025 15.08 re
f
354.331 421.682 52.101 .51025 re
f
406.431 421.682 .51022 15.08 re
f
406.942 421.682 35.32 .51025 re
f
442.261 421.682 .51025 15.08 re
f
442.772 421.682 47.339 .51025 re
f
490.11 421.682 .51022 15.08 re
f
490.62 421.682 85.436 .51025 re
f
50.173 388.743 59.754 .45355 re
f
109.928 388.743 .51024 32.939 re
f
110.438 388.743 28.176 .45355 re
f
138.614 388.743 .51022 32.939 re
f
139.124 388.743 42.52 .45355 re
f
181.644 388.743 .51022 32.939 re
f
182.154 388.743 35.376 .45355 re
f
217.531 388.743 .51024 32.939 re
f
218.041 388.743 28.176 .45355 re
f
246.217 388.743 .51024 32.939 re
f
246.727 388.743 47.282 .45355 re
f
294.009 388.743 .51025 32.939 re
f
294.52 388.743 59.301 .45355 re
f
353.82 388.743 .51025 32.939 re
f
354.331 388.743 52.101 .45355 re
f
406.431 388.743 .51022 32.939 re
f
406.942 388.743 35.32 .45355 re
f
442.261 388.743 .51025 32.939 re
f
442.772 388.743 47.339 .45355 re
f
490.11 388.743 .51022 32.939 re
f
490.62 388.743 85.436 .45355 re
f
50.173 364.705 59.754 .51022 re
f
109.928 364.705 .51024 24.038 re
f
110.438 364.705 28.176 .51022 re
f
138.614 364.705 .51022 24.038 re
f
139.124 364.705 42.52 .51022 re
f
181.644 364.705 .51022 24.038 re
f
182.154 364.705 35.376 .51022 re
f
217.531 364.705 .51024 24.038 re
f
218.041 364.705 28.176 .51022 re
f
246.217 364.705 .51024 24.038 re
f
246.727 364.705 47.282 .51022 re
f
294.009 364.705 .51025 24.038 re
f
294.52 364.705 59.301 .51022 re
f
353.82 364.705 .51025 24.038 re
f
354.331 364.705 52.101 .51022 re
f
406.431 364.705 .51022 24.038 re
f
406.942 364.705 35.32 .51022 re
f
442.261 364.705 .51025 24.038 re
f
442.772 364.705 47.339 .51022 re
f
490.11 364.705 .51022 24.038 re
f
490.62 364.705 85.436 .51022 re
f
50.173 340.668 59.754 .51022 re
f
109.928 340.668 .51024 24.038 re
f
110.438 340.668 28.176 .51022 re
f
138.614 340.668 .51022 24.038 re
f
139.124 340.668 42.52 .51022 re
f
181.644 340.668 .51022 24.038 re
f
182.154 340.668 35.376 .51022 re
f
217.531 340.668 .51024 24.038 re
f
218.041 340.668 28.176 .51022 re
f
246.217 340.668 .51024 24.038 re
f
246.727 340.668 47.282 .51022 re
f
294.009 340.668 .51025 24.038 re
f
294.52 340.668 59.301 .51022 re
f
353.82 340.668 .51025 24.038 re
f
354.331 340.668 52.101 .51022 re
f
406.431 340.668 .51022 24.038 re
f
406.942 340.668 35.32 .51022 re
f
442.261 340.668 .51025 24.038 re
f
442.772 340.668 47.339 .51022 re
f
490.11 340.668 .51022 24.038 re
f
490.62 340.668 85.436 .51022 re
f
50.173 316.687 59.754 .51022 re
f
109.928 316.687 .51024 23.981 re
f
110.438 316.687 28.176 .51022 re
f
138.614 316.687 .51022 23.981 re
f
139.124 316.687 42.52 .51022 re
f
181.644 316.687 .51022 23.981 re
f
182.154 316.687 35.376 .51022 re
f
217.531 316.687 .51024 23.981 re
f
218.041 316.687 28.176 .51022 re
f
246.217 316.687 .51024 23.981 re
f
246.727 316.687 47.282 .51022 re
f
294.009 316.687 .51025 23.981 re
f
294.52 316.687 59.301 .51022 re
f
353.82 316.687 .51025 23.981 re
f
354.331 316.687 52.101 .51022 re
f
406.431 316.687 .51022 23.981 re
f
406.942 316.687 35.32 .51022 re
f
442.261 316.687 .51025 23.981 re
f
442.772 316.687 47.339 .51022 re
f
490.11 316.687 .51022 23.981 re
f
490.62 316.687 85.436 .51022 re
f
50.173 292.649 59.754 .51025 re
f
109.928 292.649 .51024 24.038 re
f
110.438 292.649 28.176 .51025 re
f
138.614 292.649 .51022 24.038 re
f
139.124 292.649 42.52 .51025 re
f
181.644 292.649 .51022 24.038 re
f
182.154 292.649 35.376 .51025 re
f
217.531 292.649 .51024 24.038 re
f
218.041 292.649 28.176 .51025 re
f
246.217 292.649 .51024 24.038 re
f
246.727 292.649 47.282 .51025 re
f
294.009 292.649 .51025 24.038 re
f
294.52 292.649 59.301 .51025 re
f
353.82 292.649 .51025 24.038 re
f
354.331 292.649 52.101 .51025 re
f
406.431 292.649 .51022 24.038 re
f
406.942 292.649 35.32 .51025 re
f
442.261 292.649 .51025 24.038 re
f
442.772 292.649 47.339 .51025 re
f
490.11 292.649 .51022 24.038 re
f
490.62 292.649 85.436 .51025 re
f
50.173 268.668 59.754 .51022 re
f
109.928 268.668 .51024 23.981 re
f
110.438 268.668 28.176 .51022 re
f
138.614 268.668 .51022 23.981 re
f
139.124 268.668 42.52 .51022 re
f
181.644 268.668 .51022 23.981 re
f
182.154 268.668 35.376 .51022 re
f
217.531 268.668 .51024 23.981 re
f
218.041 268.668 28.176 .51022 re
f
246.217 268.668 .51024 23.981 re
f
246.727 268.668 47.282 .51022 re
f
294.009 268.668 .51025 23.981 re
f
294.52 268.668 59.301 .51022 re
f
353.82 268.668 .51025 23.981 re
f
354.331 268.668 52.101 .51022 re
f
406.431 268.668 .51022 23.981 re
f
406.942 268.668 35.32 .51022 re
f
442.261 268.668 .51025 23.981 re
f
442.772 268.668 47.339 .51022 re
f
490.11 268.668 .51022 23.981 re
f
490.62 268.668 85.436 .51022 re
f
50.173 244.63 59.754 .51024 re
f
109.928 244.63 .51024 24.038 re
f
110.438 244.63 28.176 .51024 re
f
138.614 244.63 .51022 24.038 re
f
139.124 244.63 42.52 .51024 re
f
181.644 244.63 .51022 24.038 re
f
182.154 244.63 35.376 .51024 re
f
217.531 244.63 .51024 24.038 re
f
218.041 244.63 28.176 .51024 re
f
246.217 244.63 .51024 24.038 re
f
246.727 244.63 47.282 .51024 re
f
294.009 244.63 .51025 24.038 re
f
294.52 244.63 59.301 .51024 re
f
353.82 244.63 .51025 24.038 re
f
354.331 244.63 52.101 .51024 re
f
406.431 244.63 .51022 24.038 re
f
406.942 244.63 35.32 .51024 re
f
442.261 244.63 .51025 24.038 re
f
442.772 244.63 47.339 .51024 re
f
490.11 244.63 .51022 24.038 re
f
490.62 244.63 85.436 .51024 re
f
50.173 220.649 59.754 .51024 re
f
109.928 220.649 .51024 23.981 re
f
110.438 220.649 28.176 .51024 re
f
138.614 220.649 .51022 23.981 re
f
139.124 220.649 42.52 .51024 re
f
181.644 220.649 .51022 23.981 re
f
182.154 220.649 35.376 .51024 re
f
217.531 220.649 .51024 23.981 re
f
218.041 220.649 28.176 .51024 re
f
246.217 220.649 .51024 23.981 re
f
246.727 220.649 47.282 .51024 re
f
294.009 220.649 .51025 23.981 re
f
294.52 220.649 59.301 .51024 re
f
353.82 220.649 .51025 23.981 re
f
354.331 220.649 52.101 .51024 re
f
406.431 220.649 .51022 23.981 re
f
406.942 220.649 35.32 .51024 re
f
442.261 220.649 .51025 23.981 re
f
442.772 220.649 47.339 .51024 re
f
490.11 220.649 .51022 23.981 re
f
490.62 220.649 85.436 .51024 re
f
50.173 187.653 59.754 .51024 re
f
109.928 187.653 .51024 32.995 re
f
110.438 187.653 28.176 .51024 re
f
138.614 187.653 .51022 32.995 re
f
139.124 187.653 42.52 .51024 re
f
181.644 187.653 .51022 32.995 re
f
182.154 187.653 35.376 .51024 re
f
217.531 187.653 .51024 32.995 re
f
218.041 187.653 28.176 .51024 re
f
246.217 187.653 .51024 32.995 re
f
246.727 187.653 47.282 .51024 re
f
294.009 187.653 .51025 32.995 re
f
294.52 187.653 59.301 .51024 re
f
353.82 187.653 .51025 32.995 re
f
354.331 187.653 52.101 .51024 re
f
406.431 187.653 .51022 32.995 re
f
406.942 187.653 35.32 .51024 re
f
442.261 187.653 .51025 32.995 re
f
442.772 187.653 47.339 .51024 re
f
490.11 187.653 .51022 32.995 re
f
490.62 187.653 85.436 .51024 re
f
50.173 163.672 59.754 .51022 re
f
109.928 163.672 .51024 23.981 re
f
110.438 163.672 28.176 .51022 re
f
138.614 163.672 .51022 23.981 re
f
139.124 163.672 42.52 .51022 re
f
181.644 163.672 .51022 23.981 re
f
182.154 163.672 35.376 .51022 re
f
217.531 163.672 .51024 23.981 re
f
218.041 163.672 28.176 .51022 re
f
246.217 163.672 .51024 23.981 re
f
246.727 163.672 47.282 .51022 re
f
294.009 163.672 .51025 23.981 re
f
294.52 163.672 59.301 .51022 re
f
353.82 163.672 .51025 23.981 re
f
354.331 163.672 52.101 .51022 re
f
406.431 163.672 .51022 23.981 re
f
406.942 163.672 35.32 .51022 re
f
442.261 163.672 .51025 23.981 re
f
442.772 163.672 47.339 .51022 re
f
490.11 163.672 .51022 23.981 re
f
490.62 163.672 85.436 .51022 re
f
0 0 0 .845 k
50.173 741.203 525.997 11.962 re
f
50.173 738.198 525.997 9.9779 re
f
0 0 0 .065 k
50.173 151.71 525.997 11.962 re
f
50.173 139.408 525.997 21.94 re
f
50.173 127.105 525.997 21.883 re
f
50.173 106.809 525.997 29.877 re
f
50.173 95.357 525.997 11.962 re
f
50.173 151.37 3.9685 9.9779 re
f
572.201 151.37 3.9685 9.9779 re
f
50.173 139.068 3.9685 9.9212 re
f
572.201 139.068 3.9685 9.9212 re
f
50.173 126.765 3.9685 9.9213 re
f
572.201 126.765 3.9685 9.9213 re
f
50.173 116.787 3.9685 9.9779 re
f
572.201 116.787 3.9685 9.9779 re
f
50.173 106.809 3.9685 9.9779 re
f
572.201 106.809 3.9685 9.9779 re
f
BT
/F14 1 Tf
9.9626 0 0 9.9626 54.6519 740.6927 Tm
0 0 0 0 k
0 Tc
0 Tw
[(Table)-337.4(2.)-335.7(Metho)-7.4(dology)-337.4(and)-339(Findings)-341.7(Pertaini)-9.1(ng)-334.3(to)-337.1(Stroke)]TJ
7.9702 0 0 7.9702 81.1275 727.6534 Tm
[(LITERATUR)11.8(E)-333.6(SOURCE)-7672.2(METHODOL)10.8(OGY)-17782.5(FINDINGS)]TJ
-2.575 -4.1754 TD
[(REFERENCE)-2047.2(DATE)-1400(COUNTRY)-1342.4(DESIGN)]TJ
20.621 1.2519 TD
(SIZE)Tj
.2347 -1.2519 TD
(\()Tj
/F15 1 Tf
.3343 0 TD
(N)Tj
/F14 1 Tf
.6615 0 TD
(\))Tj
2.2691 1.2519 TD
(DURATION)Tj
-.0569 -1.2519 TD
[(\()-86.7(MONTHS)12.2(\))]TJ
5.9181 1.2519 TD
(TELEMEDICINE)Tj
.2347 -1.2519 TD
[(TECHNOL)11.8(OGY)]TJ
7.4475 2.4967 TD
[(FEASIBILI)10.8(TY)]TJ
1.5222 -1.2448 TD
(AND)Tj
-1.5293 -1.2519 TD
(RELIABILITY)Tj
6.6437 1.2519 TD
(EVENT)Tj
-.3628 -1.2519 TD
(TIMING)Tj
5.9774 0 0 5.3127 435.5715 697.8896 Tm
(a)Tj
7.9702 0 0 7.9702 453.3164 704.3525 Tm
(HEALTH)Tj
-.9389 -1.2519 TD
[(OUTCOM)12.2(ES)]TJ
5.9774 0 0 5.3127 484.044 697.8896 Tm
(b)Tj
7.9702 0 0 7.9702 513.1841 694.3746 Tm
(COMMENTS)Tj
/F16 1 Tf
6.9738 0 0 6.9738 54.1417 681.9589 Tm
0 0 0 1 k
[(Khan)-337.4(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 83.5086 685.077 Tm
(82)Tj
6.9738 0 0 6.9738 118.4315 681.9589 Tm
[(2010)-1620.3(Canada)-4330.2(PCC)-3773.3(210)-3952.8(24)-5626.8(T)-8354.1(Yes)]TJ
/F17 1 Tf
43.6387 0 TD
([)Tj
/F16 1 Tf
6.0564 0 TD
[(O)-3671.6(N)0(o)-329.7(differenc)-13.3(e)-329(between)-335.6(T)-330.4(and)]TJ
4.2436 -1.2844 TD
(VTC)Tj
-25.9654 -.8699 TD
(VTC)Tj
/F17 1 Tf
15.6654 0 TD
([)Tj
/F16 1 Tf
-52.8575 -2.1624 TD
[(Gonzalez)-338.2(et)-342.2(al.)]TJ
5.2302 0 0 4.6485 93.9401 654.973 Tm
(83)Tj
6.9738 0 0 6.9738 118.4315 651.855 Tm
[(2011)-1620.3(United)-259.5(States)-2050.8(PCC)-3773.3(960)-3855.3(NR)-5527.4(CVP)-7240.2(Yes)]TJ
/F17 1 Tf
43.6387 0 TD
(Y)Tj
/F16 1 Tf
6.0564 0 TD
[(O)-3671.6(3)0(8)-334.6(seconds)-340.9(longer)-332.8(th)-9.1(an)]TJ
4.2436 -1.2845 TD
(bedside)Tj
-63.1575 -2.1543 TD
[(Demaerscha)-14.4(lk)]TJ
0 -1.2844 TD
[(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 67.5779 621.9778 Tm
(84)Tj
6.9738 0 0 6.9738 118.4315 627.8738 Tm
[(2012)-1620.3(United)-259.5(States)-2050.8(PCC)-3773.3(100)-3855.3(NR)-5527.4(Network)-5523.2(Yes)-5303.9(NM)-5023.9(O)-3671.6(NIHSS:)-309.4(8)-309.6(high,)-311(6)-301.4(modera)-11.1(te,)-301.6(1)]TJ
53.9387 -1.2844 TD
[(poor)-340.3(agreement)-336.3(\(ataxia\))]TJ
-63.1575 -2.1624 TD
[(Allibert)-344.6(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 88.8378 606.9542 Tm
(85)Tj
6.9738 0 0 6.9738 118.4315 603.8361 Tm
[(2012)-1620.3(Franc)-10.2(e)-4629.5(RCC)-3743.8(161)-3952.8(72)-5626.8(VTC)-7334.2(Yes)-5303.9(NM)-5023.9(O)-3671.6(LOS)-332.9(shorte)-9.5(r)]TJ
-9.2188 -2.1543 TD
[(Pervez)-339.6(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 87.0803 591.9305 Tm
(86)Tj
6.9738 0 0 6.9738 118.4315 588.8124 Tm
[(2010)-1620.3(United)-259.5(States)-2270.3(RR)-3990.8(296)-3814.6(3/6)-5484.1(T,)-338.5(VTC)-6423.7(Yes)]TJ
/F17 1 Tf
43.6387 0 TD
([)Tj
/F16 1 Tf
6.0564 0 TD
[(O)-3671.6()73.2(Drip)-337.6(and)-338.1(ship)68()-333.3(i)0(s)-341.9(safe/)]TJ
4.2436 -1.2844 TD
[(effective;)-338.3(spok)-8.9(e)-329(patie)-11.2(nts)-333.2(less)]TJ
T*
(severe)Tj
-63.1575 -2.1624 TD
[(Spokoyny)-336.6(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 95.4708 558.9353 Tm
(87)Tj
6.9738 0 0 6.9738 118.4315 555.8172 Tm
[(2014)-1620.3(United)-259.5(States)-2091.5(RCT)-3805.6(261)-3855.3(NR)-5527.4(T,)-338.5(VTC)-6423.7(Yes)-5303.9(NM)]TJ
/F17 1 Tf
49.6382 0 TD
([)Tj
/F16 1 Tf
4.3005 0 TD
[(Telestroke)-296.8(evaluatio)-12.6(n)-288.6(o)0(f)-290.2(head)]TJ
0 -1.2845 TD
[(CT)-338.8(scans)-335.9(for)-335.9(acute)-338.7(tPA)]TJ
T*
[(assessments)-345.9(is)-333.8(reliable.)]TJ
-63.1575 -2.1543 TD
[(Demaerscha)-14.4(lk)]TJ
0 -1.2844 TD
[(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 67.5779 516.9825 Tm
(88)Tj
6.9738 0 0 6.9738 118.4315 522.8786 Tm
[(2012)-1620.3(United)-259.5(States)-1498(2)-333.9(RCTs)-3211.2(276)-4196.7(3)-5861.9(T)0(,)-338.5(VTC)-5066(VT)-9.3(C)-333.6(better)]TJ
/F17 1 Tf
43.6387 0 TD
([)Tj
/F16 1 Tf
5.0077 0 TD
(VTC)Tj
/F9 1 Tf
1.5771 0 TD
(>)Tj
/F16 1 Tf
.7154 0 TD
[(T)-2614.8(VTC)-334.7(higher)-336.2(sensit)-12.4(ivity)-332.8(than)]TJ
2.9998 -1.2844 TD
(phone)Tj
-63.1575 -2.1624 TD
[(Handschu)-338(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 96.4913 501.9589 Tm
(89)Tj
6.9738 0 0 6.9738 118.4315 498.8408 Tm
[(2008)-1620.3(Germ)-10.2(any)-3715(PCC)-3773.3(151)-3952.8(12)-5626.8(T,)-338.5(VTC)-6423.7(Yes)-3946.3(VTC)]TJ
/F17 1 Tf
43.3461 0 TD
(Y)Tj
/F16 1 Tf
.691 0 TD
.3301 Tc
(;T)Tj
/F17 1 Tf
.9593 0 TD
3.9549 Tc
([[)Tj
/F16 1 Tf
8.9424 0 TD
0 Tc
[(Exam)-334.8(time)-11.2(s)-332.3(\(VTC,)-334.9(49.8)]TJ
0 -1.2844 TD
[(minutes)-10.1(/T,)-333.9(27.2)-335.2(minutes)-10.1(\))]TJ
-63.1575 -2.1543 TD
[(Puetz)-335.9(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 84.5858 477.9211 Tm
(90)Tj
6.9738 0 0 6.9738 118.4315 474.8597 Tm
[(2012)-1620.3(Germ)-10.2(any)-3715(PCC)-3773.3(536)-3855.3(NR)-5527.4(Network)-5523.2(Yes)-5303.9(NM)]TJ
/F17 1 Tf
49.6382 0 TD
([)Tj
/F16 1 Tf
4.3005 0 TD
[(Stroke)-337.5(neurologis)-12.8(ts)-329.2(can)]TJ
0 -1.2844 TD
[(reliably)-339.9(interpret)-343.1(CT)-338.8(scans.)]TJ
-63.1575 -2.1624 TD
(Mu)Tj
.878 -.0081 TD
()Tj
.3821 .0081 TD
[(ller)-337.1(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 86.9669 453.94 Tm
(91)Tj
6.9738 0 0 6.9738 118.4315 450.8219 Tm
[(2006)-1620.3(Germ)-10.2(any)-2780.2(PCC/RCC)-2846.2(299)-3952.8(24)-5626.8(VTC)-7334.2(Yes)-5303.9(NM)]TJ
/F17 1 Tf
49.6382 0 TD
([)Tj
/F16 1 Tf
4.3005 0 TD
[(All)-340(quality)-333.8(indicat)-13.4(ors)]TJ
0 -1.2845 TD
[(improved;)-339(LOS)-341(lower)]TJ
-63.1575 -2.1543 TD
[(Audebert)-340.5(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 94.0535 429.9023 Tm
(92)Tj
6.9738 0 0 6.9738 118.4315 426.8408 Tm
[(2009)-1620.3(Germ)-10.2(any)-3902(NR)-3950.3(267)-4196.7(3)-5861.9(VTC)-7334.2(Yes)]TJ
/F17 1 Tf
43.6387 0 TD
([)Tj
/F16 1 Tf
6.0564 0 TD
[(O)-3671.6(Acceptance)-339.8(high)-343.5(and)-330(stabl)-11(e)]TJ
-58.9139 -2.1624 TD
[(Pedragos)-10.6(a)-333.4(e)0(t)-334.1(al.)]TJ
5.2302 0 0 4.6485 97.3417 414.8786 Tm
(93)Tj
6.9738 0 0 6.9738 118.4315 411.7605 Tm
[(2009)-1620.3(Spain)-4133.3(RCC/PCC)-2846.2(201)-3952.8(12)-5626.8(VTC)-7334.2(Yes)]TJ
/F17 1 Tf
43.6387 0 TD
5.3125 Tc
([[)Tj
/F16 1 Tf
10.3 0 TD
0 Tc
[(Telemedicine)-348.2(allowed)-334.1(38)-9.4(%)]TJ
0 -1.2845 TD
[(\(from)-336.9(17%\))-342.3(neurologist)]TJ
T*
[(evaluatio)-12.6(n)]TJ
-63.1575 -2.1543 TD
[(Nagao)-338.7(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 87.137 381.8834 Tm
(94)Tj
6.9738 0 0 6.9738 118.4315 378.8219 Tm
[(2012)-1620.3(Australia)-4019.7(RR)-3990.8(275)-3952.8(12)-5626.8(VTC)-7334.2(Yes)]TJ
/F17 1 Tf
43.6387 0 TD
([)Tj
/F16 1 Tf
6.0564 0 TD
[(O)-3671.6(Telestroke)-345.6(faster,)-335.2(safe,)]TJ
4.2436 -1.2926 TD
(reliable)Tj
-63.1575 -2.1543 TD
[(Sairanen)-341.2(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 93.033 357.9023 Tm
(95)Tj
6.9738 0 0 6.9738 118.4315 354.7841 Tm
[(2011)-1620.3(Finlan)-11.7(d)-4390.5(PCC)-3773.3(985)-3952.8(24)-5626.8(VTC)-7334.2(Yes)]TJ
/F17 1 Tf
43.6387 0 TD
([)Tj
/F16 1 Tf
6.0564 0 TD
[(O)-3671.6(On-site)-340.9(versus)-339.9(telestroke)]TJ
4.2436 -1.2844 TD
[(similar)-342.8(results)]TJ
-63.1575 -2.1543 TD
[(Rudd)-334.2(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 83.9055 333.8645 Tm
(96)Tj
6.9738 0 0 6.9738 118.4315 330.8031 Tm
[(2014)-1620.3(United)]TJ
3.5363 -1.2926 TD
(Kingdom)Tj
7.1376 1.2926 TD
[(RCC)-3077.2(2,922)-3953.5(36)-5626.8(T)-8354.1(Yes)-5368.9(T)]TJ
/F17 1 Tf
33.2412 0 TD
(Y)Tj
/F16 1 Tf
5.78 0 TD
[(O)-3671.6(In-person)-344.4(65)-334.6(minutes,)-335.3(T)-338.5(7)0(3)]TJ
4.2436 -1.2926 TD
(minutes)Tj
-63.1575 -2.1543 TD
[(Bruno)-339.3(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 86.0598 309.8834 Tm
(97)Tj
6.9738 0 0 6.9738 118.4315 306.7653 Tm
[(2013)-1620.3(United)-259.5(States)-2270.3(RR)-3990.8(889)-3952.8(20)-5626.8(VTC)-7334.2(Yes)]TJ
/F17 1 Tf
43.6387 0 TD
5.3125 Tc
([[)Tj
/F16 1 Tf
10.3 0 TD
0 Tc
[(Registration)-347.2(delay)-335.2(\(median)]TJ
0 -1.2844 TD
[(39)-334.6(minutes)-10.1(\))]TJ
-63.1575 -2.1543 TD
[(Pedragos)-10.6(a)-333.4(e)0(t)-334.1(al.)]TJ
5.2302 0 0 4.6485 97.3417 285.8456 Tm
(98)Tj
6.9738 0 0 6.9738 118.4315 282.7842 Tm
[(2012)-1620.3(Spain)-5068.2(PCC)-3773.3(119)-3952.8(24)-5626.8(VTC)]TJ
/F17 1 Tf
34.4037 0 TD
([)Tj
/F16 1 Tf
.8536 0 TD
[(Endovascu)-13(lar)]TJ
.2032 -1.2926 TD
(treatment)Tj
/F17 1 Tf
8.1782 1.2926 TD
5.3125 Tc
([[)Tj
/F16 1 Tf
10.3 0 TD
0 Tc
[(Saved)-339.1(time)-336.4(in)-338.8(endovascular)]TJ
0 -1.2926 TD
[(treatmen)-11.6(t)]TJ
-63.1575 -2.1543 TD
[(Walter)-338.4(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 87.4771 261.8645 Tm
(99)Tj
6.9738 0 0 6.9738 118.4315 258.7464 Tm
[(2012)-1620.3(Germ)-10.2(any)-3755.7(RCT)-3805.6(100)-1530.3(Stopped)-252.7(at)-240.9(100)]TJ
18.9659 -1.2845 TD
(patients)Tj
9.0074 1.2845 TD
[(MSU)-4912.1(MSU)-335.2(feasible)-12.1(/)]TJ
8.0156 -1.2845 TD
(reliable)Tj
/F17 1 Tf
7.6498 1.2845 TD
([)Tj
/F16 1 Tf
6.0564 0 TD
[(O)-3671.6(Timing)-338.9(improved)]TJ
-58.9139 -3.4387 TD
[(Audebert)-340.5(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 94.0535 237.8267 Tm
(100)Tj
6.9738 0 0 6.9738 118.4315 234.7653 Tm
[(2009)-1620.3(United)]TJ
3.5363 -1.2926 TD
(Kingdom)Tj
7.1701 1.2926 TD
[(PCC)-3106.7(3,060)-3335.6(12/24)-5005.7(VTC)-7334.2(Yes)]TJ
/F17 1 Tf
32.9323 0 TD
5.3125 Tc
([[)Tj
/F16 1 Tf
10.3 0 TD
0 Tc
[(Long-term)-339.5(bene)-9(fit)-336.8(for)-335.9(acute)]TJ
0 -1.2926 TD
[(stroke)-339.2(patients)]TJ
-63.1575 -2.1543 TD
[(Theiss)-337.7(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 85.833 213.8456 Tm
(101)Tj
6.9738 0 0 6.9738 118.4315 210.7275 Tm
[(2013)-1620.3(Germ)-10.2(any)-4056.5(LS)-3441.2(1,152)-3953.5(48)-5626.8(VTC)-7334.2(Yes)]TJ
/F17 1 Tf
43.3542 0 TD
5.597 Tc
([[)Tj
/F16 1 Tf
10.5845 0 TD
0 Tc
[(Increased)-339(telecon)-11.3(sultations)]TJ
0 -1.2844 TD
[(and)-273.1(4)-8.8(5)0(%)-276.5(increase)-278(in)-273.8(protocol)]TJ
T*
(conformity)Tj
-63.1575 -2.1624 TD
[(Switzer)-343.8(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 89.348 180.8503 Tm
(102)Tj
6.9738 0 0 6.9738 118.4315 177.7323 Tm
[(2013)-1620.3(United)-259.5(States)-2050.8(PCC)-3106.7(1,112)-3953.5(60)-5626.8(VTC)-7334.2(Yes)]TJ
/F17 1 Tf
43.3542 0 TD
5.597 Tc
([[)Tj
/F16 1 Tf
10.5845 0 TD
0 Tc
[(Spoke)-336.2(hospita)-11(ls)-333.8(more)]TJ
0 -1.2845 TD
[(effectively)-338.8(used)]TJ
5.9774 0 0 5.3127 60.0945 157.3795 Tm
(a)Tj
7.9702 0 0 7.9702 62.759 153.8645 Tm
[(Arrows)-331(indicate)-329.1(direction)-326.5(of)-332.9(change)13.3(:)-337.2(faster)-325.9(or)-332.9(increased)-328.4(use)-326.9(\()]TJ
/F17 1 Tf
23.9215 0 TD
([)Tj
/F16 1 Tf
.6829 0 TD
[(\))-337.5(o)0(r)-325.8(slower)-332.7(or)-332.9(decrease)13.7(d)-331.9(use)-334(\()]TJ
/F17 1 Tf
11.6371 0 TD
(Y)Tj
/F16 1 Tf
.69 0 TD
(\).)Tj
5.9774 0 0 5.3127 60.0945 145.0771 Tm
(b)Tj
7.9702 0 0 7.9702 62.8157 141.5621 Tm
[(Arrows)-331(indicate)-329.1(direction)-326.5(of)-332.9(change:)-323.8(improved)-323.8(\()]TJ
/F17 1 Tf
18.6222 0 TD
([)Tj
/F16 1 Tf
.6829 0 TD
[(\))-337.5(o)0(r)-325.8(declined)-331.5(\()]TJ
/F17 1 Tf
5.4558 0 TD
(Y)Tj
/F16 1 Tf
.69 0 TD
(\).)Tj
-25.7922 -1.5435 TD
[(CT,)-280.8(computed)-276.2(tomography)15.2(;)-287.4(CVP,)-277.2(cellular)-277.1(videophone;)-275.4(LS,)-278.8(longitudina)11(l)-287(study;)-278.5(MSU,)-278.2(mobile)-277.8(stroke)-278.2(unit)-276.7(with)-281.5(compute)13(d)-282.1(tomography)-276.4(scanner;)-272.3(NIHSS,)-282(Natio)]TJ
58.1784 0 TD
[(nal)-278.9(Institutes)-271.1(of)]TJ
-58.1784 -1.2519 TD
[(Health)-390.9(Stroke)-387.2(Scale;)-394.2(NM,)-388(not)-387.7(measured;)-386.9(NR,)-393.6(nonrandomize)16.3(d;)-398.8(O,)-386.2(neutral)-392.5(outcome;)-388.2(PCC,)-385.3(prospective)-389.3(case)-386.5(control;)-391.1(RCC,)-387.3(retrospective)-386.3(case)-393.6(control;)-384(RCT,)]TJ
59.8001 0 TD
(randomized)Tj
-59.8001 -1.2519 TD
[(controlled)-324.1(trial;)-331(RR,)-331.5(retrospective)-329.4(review;)-328.4(T,)-331.4(telephon)13(e;)-337(t-PA,)-329.5(tissue)-325.3(plasminogen)-324.5(activator;)-327.5(VTC,)-328.6(video)-331.6(teleconference.)]TJ
/F11 1 Tf
-1.2448 -9.9797 TD
[(7)-80(8)-75.6(2)-707(TELEMEDIC)12.9(INE)-329.6(and)-331.8(e-HEALTH)]TJ
/F8 1 Tf
6.9738 0 0 6.9738 177.7322 29.7638 Tm
.103 Tc
[(SE)-4.8(P)-6.4(T)-8.1(E)-4.8(M)-8.4(BE)-4.8(R)-339.7(2)-6.4(0)-7.9(1)-6.5(4)]TJ
ET
q
1 i
0 792 612 -791.985 re
W n
32.315 .014984 .22675 791.985 re
f
/Document /MC8 BDC
Q
q
1 i
0 792 32.315 -173.367 re
W n
0 0 0 .29999 k
0 618.633 32.315 173.367 re
f
EMC
Q
32.315 763.994 242.646 .22675 re
f
endstream
endobj
246 0 obj
<>stream
Adobe Illustrator CS4
2010-08-04T11:54:42+05:30
2010-08-04T11:54:42+05:30
2010-08-04T11:54:42+05:30
68
256
JPEG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application/postscript
saved
xmp.iid:11FB61F30AB7DE11AEB3E861853EAFA4
2009-10-12T14:15:50+05:30
Adobe Illustrator CS4
/
converted
from application/postscript to application/vnd.adobe.illustrator
converted
from application/postscript to application/vnd.adobe.illustrator
saved
xmp.iid:0280117407206811994CBE3149FFDB59
2010-08-04T11:54:42+05:30
Adobe Illustrator CS4
/
converted
from application/postscript to application/vnd.adobe.illustrator
xmp.iid:11FB61F30AB7DE11AEB3E861853EAFA4
xmp.did:11FB61F30AB7DE11AEB3E861853EAFA4
uuid:ee5a72b3-04e4-4157-a8d8-c3a8817872a3
uuid:ee5a72b3-04e4-4157-a8d8-c3a8817872a3
xmp.iid:0280117407206811994CBE3149FFDB59
xmp.did:0280117407206811994CBE3149FFDB59
TouchUp 7.0
False
False
1
684.000000
864.000000
Points
Black
Default Swatch Group
0
PANTONE 3025 C
SPOT
100.000000
CMYK
100.000000
16.859999
0.000000
50.980003
endstream
endobj
243 0 obj
<>
endobj
247 0 obj
<>/XObject<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]/Font<>>>/Thumb 249 0 R/MediaBox[0 0 612 792]/Rotate 0>>
endobj
250 0 obj
<>/ProcSet[/PDF/Text]/Font<>>>
endobj
248 0 obj
<>stream
/GS1 gs
BT
/F1 1 Tf
8.9663 0 0 8.9663 35.8866 693.8644 Tm
0 0 0 1 k
0 Tc
0 Tw
[(te)12.9(les)12.8(trok)16.7(e)-191.6(s)0(t)26.8(u)16.2(d)14.2(i)15.4(es)-167(ha)27.3(d)-181.8(t)14.8(o)-188.2(b)14.2(e)-179(a)0(d)25.3(a)17.4(p)14.2(t)14.8(ed)-171.1(b)14.2(e)17(ca)28.1(us)28.1(e)-185.3(t)14.8(h)16.2(e)-185.3(R)17.6(C)0(T)-172.6(r)12.6(e)17(q)14.2(u)16.2(i)15.4(r)12.6(e)17(me)28.7(n)14.6(t)-187.5(c)17(o)14.2(u)16.2(l)15.4(d)]TJ
0 -1.3278 TD
[(n)14.6(o)14.2(t)-219.1(b)14.2(e)-216.9(m)0(e)28.7(t)-219.1(i)15.4(n)-219.4(mo)25.8(s)18.3(t)-219.1(ca)28.1(se)29(s.)-204.3(St)24.7(r)18.9(o)14.2(k)13.1(e)-223.2(s)18.3(t)14.8(ud)24(i)15.4(e)17(s)-222(d)14.2(o)-219.8(n)14.6(o)14.2(t)-219.1(r)18.9(e)0(a)28.1(d)14.2(i)15.4(l)15.4(y)-219.8(le)26.2(n)14.6(d)-219.8(t)14.8(h)16.2(em)28.7(se)29(l)15.4(v)14.2(es)]TJ
0 -1.3341 TD
-.0148 Tc
[(to)-455.9(c)-14.8(a)13.3(s)-14.8(e)-447.4(randomiz)-14.8(a)13.3(t)0(ion)-461.8(a)2.6(nd)-462.2(prospe)-14.8(c)13(t)0(ive)-459.3(obs)-14.8(e)14.2(r)-2.2(vat)-14.8(i)9.1(on)-455.5(or)-463.8(blinding)-455.9(f)-14.8(o)9.9(r)]TJ
T*
0 Tc
[(c)17(l)15.4(i)15.4(n)14.6(i)15.4(c)0(a)28.1(l)-243.8(a)17.4(n)14.6(d)-245.1(e)17(t)14.8(h)16.2(i)15.4(c)0(a)28.1(l)-243.8(r)12.6(e)17(a)17.4(s)0(o)26.1(n)14.6(s)18.3(.)-241.5(Be)28.3(ca)28.1(us)28.1(e)-242.2(t)14.8(h)16.2(e)-242.2(r)12.6(e)17(la)26.5(t)14.8(i)15.4(v)14.2(e)-242.2(e)17(f)0(f)27.4(i)15.4(ca)28.1(cy)-228(a)17.4(n)14.6(d)-245.1(s)18.3(af)28(et)25.5(y)-238.8(o)14.2(f)]TJ
T*
-.0149 Tc
[(the)-339.3(c)2.1(linic)-14.9(a)13.2(l)-340.9(protoc)-14.9(o)10(l).5(s)-338.1(a)2.5(re)-333(w)-14.9(e)12(ll)-340.9(es)-14.9(t)11.9(a)2.5(blis)-14.9(h)13.2(e)-14.9(d)10(,)-332.3(de)-14.9(n)10.4(y)-.7(ing)-335.8(a)2.5(ppropriate)-339.3(treat-)]TJ
T*
0 Tc
[(m)18(e)0(n)31.6(t)-269.7(f)16.9(o)14.2(r)-265.6(p)14.2(a)17.4(t)14.8(ie)26.2(n)14.6(t)14.8(s)-266.3(i)15.4(n)-263.7(t)14.8(he)-251.3(co)24.9(n)14.6(t)14.8(r)18.9(o)14.2(l)-269.1(g)14.2(r)18.9(o)14.2(up)-254.2(w)16.2(o)14.2(u)16.2(l)15.4(d)-270.4(n)14.6(o)14.2(t)-263.4(b)14.2(e)-267.5(j)15.4(u)16.2(st)26.8(i)15.4(f)16.9(i)15.4(e)0(d)24.9(.)]TJ
1.1065 -1.3341 TD
-.0153 Tc
[(Th)-15.3(e)11.6(r)-2.7(e)-320.7(a)2.1(re,)-320.1(h)-15.3(o)8.7(w).9(eve)-15.3(r)14.3(,)-326.4(o)-1.1(ther)-325.2(me)-15.3(t)10.2(h).9(odologica)-15.3(l)-311.2(options)-319.5(tha)-15.3(t)-305.5(e)-15.3(n)10(able)-320.7(reli-)]TJ
-1.1065 -1.3341 TD
0 Tc
[(a)17.4(b)14.2(l)15.4(e)-267.5(a)17.4(n)14.6(d)-264(v)14.2(a)17.4(l)0(i)24.6(d)-264(a)17.4(s)0(s)30.2(e)0(s)29(s)0(m)29.9(e)0(n)25.3(t)-263.4(o)14.2(f)-261.4(t)14.8(h)0(e)-251.3(e)0(f)27.6(f)16.9(ec)27.8(t)14.8(s)-266.3(o)14.2(f)-261.4(t)14.8(e)0(l)26.2(e)17(st)26.8(r)12.6(o)14.2(k)19.5(e)-267.5(u)16.2(n)14.6(d)14.2(e)0(r)-248.6(t)14.8(he)26.9(se)-249.2(co)24.9(n)14.6(-)]TJ
T*
-.0153 Tc
[(ditions.)-440.2(Th)-15.3(e)11.6(s)-15.3(e)-428.9(m)2.7(e)-15.3(t)10.2(hodologie)-15.3(s)-428.9(inclu)-15.3(d)8.7(e)-440.9(v)-1.1(ariations)-439.6(o)-1.1(f)-441.1(t)-.5(h)-15.3(e)-431(ca)-15.3(s)14.1(e)-440.9(c)-15.3(o)9.6(ntrol)]TJ
0 -1.3278 TD
0 Tc
[(s)18.3(t)14.8(ud)24(y)-219.8(d)14.2(es)29(i)15.4(g)14.2(n)14.6(,)-228.9(w)16.2(h)16.2(e)0(r)29.6(e)-229.6(c)17(a)17.4(se)29(s)-228.3(i)15.4(n)-225.7(t)14.8(h)16.2(e)-223.2(i)15.4(n)14.6(t)14.8(e)0(r)29.6(v)14.2(en)25.3(t)14.8(i)15.4(o)14.2(n)-225.7(g)14.2(r)18.9(o)14.2(u)16.2(p)-226.1(a)0(r)30(e)-229.6(m)18(a)17.4(t)14.8(c)0(h)26.9(e)0(d)-209.1(e)0(i)26.2(t)14.8(h)16.2(e)0(r)]TJ
0 -1.3341 TD
-.0155 Tc
[(pros)-15.5(p)10.6(e)1.5(c)-15.5(t)10(ively)-191(o)-1.3(r)-186.3(r)-2.9(et)-15.5(r)11.9(o)-1.3(s)-15.5(p)10.6(ec)-15.5(t)10(i)-.1(vely)-191(to)-191(crea)-15.5(t)10.4(e)-188.1(the)-188.1(c)-15.5(o)9.4(n)-.9(trol)-189.8(group.)-187.5(Su)-15.5(c)11.4(h)-189(qua)-15.5(s)13.9(i)-15.5(-)]TJ
T*
0 Tc
[(e)17(x)14.6(p)14.2(e)17(r)12.6(i)15.4(me)28.7(n)14.6(t)14.8(a)17.4(l)-376.6(d)14.2(e)17(si)27.4(g)14.2(n)14.6(s)-373.7(h)16.2(av)25.3(e)-375(t)14.8(h)16.2(e)-375(u)16.2(n)14.6(i)15.4(q)14.2(u)16.2(e)-375(ad)25.3(v)14.2(a)17.4(n)14.6(t)14.8(a)17.4(g)14.2(e)-375(o)14.2(f)-375.2(r)12.6(e)17(a)0(d)25.3(y)-371.5(a)17.4(c)0(c)27.8(e)0(s)29(s)-373.7(t)14.8(o)]TJ
T*
[(l)15.4(a)17.4(r)12.6(g)14.2(e)-216.9(s)0(a)29.4(m)0(p)25.8(l)15.4(e)17(s)0(,)-210.6(t)14.8(h)16.2(e)0(y)-209.1(a)17.4(r)12.6(e)-223.2(s)18.3(u)16.2(b)14.2(s)0(t)26.8(a)17.4(n)14.6(t)14.8(ia)26.5(l)15.4(l)15.4(y)-219.8(le)26.2(ss)-203.7(co)24.9(s)18.3(t)14.8(ly)-210.7(t)14.8(h)16.2(an)-208.3(R)17.6(C)15.6(T)14.2(s)0(,)-210.6(a)17.4(n)14.6(d)-219.8(t)14.8(h)0(e)26.9(y)-219.8(d)14.2(o)]TJ
T*
[(n)14.6(o)14.2(t)-231.8(v)14.2(i)15.4(o)14.2(l)15.4(a)0(t)25.9(e)-235.9(a)17.4(n)14.6(y)-238.7(p)14.2(o)14.2(t)14.8(e)17(n)14.6(t)14.8(i)15.4(al)-220.1(et)25.5(h)16.2(i)15.4(ca)28.1(l)-237.5(r)18.9(ul)25.3(e)17(s)-234.6(in)-222.9(i)15.4(n)14.6(f)16.9(o)14.2(r)12.6(m)0(e)28.7(d)-238.7(c)17(o)14.2(n)14.6(s)18.3(en)25.3(t)14.8(.)-235.2(T)14.2(h)16.2(e)-235.9(t)14.8(y)14.2(p)14.2(i)15.4(ca)28.1(l)]TJ
T*
[(s)18.3(t)14.8(at)25.9(i)15.4(s)18.3(t)14.8(i)0(c)26.2(a)17.4(l)-174.2(m)18(ea)28.1(su)28.1(r)18.9(e)-172.6(o)14.2(f)-166.5(ef)27.6(fe)27.6(c)17(t)-174.9(i)15.4(n)-168.8(t)14.8(h)16.2(e)-172.6(c)17(as)29.4(e)-172.6(c)17(o)14.2(n)14.6(t)14.8(r)12.6(o)14.2(l)-167.9(d)14.2(e)17(si)27.4(g)14.2(n)-168.8(i)15.4(s)-171.4(u)16.2(s)0(u)28.1(a)0(l)26.5(l)15.4(y)-169.2(g)14.2(i)15.4(v)14.2(e)17(n)-168.8(as)]TJ
T*
-.0154 Tc
[(an)-279.1(odds)-281.7(ratio)-285.8(\(i.e)-15.4(.)13(,)-282.2(t)-.6(he)-282.9(e)-15.4(f)12.2(fe)-15.4(c)12.4(t)-278.8(of)-283.1(te)-15.4(l)10.8(e)1.6(s)-15.4(t)11.4(roke,)-282.2(g)-1.2(ive)-15.4(n)-268.3(the)-282.9(a)2(l)-15.4(t)8.5(ernative)-15.4(\))10.8(.)]TJ
1.1065 -1.3341 TD
0 Tc
[(The)-458.4(telestroke)-459(evidence)-455.2(presented)-454.7(here)-455.6(covers)-456.9(the)-457.8(period)-456.2(from)]TJ
-1.1065 -1.3278 TD
[(2005)-291.1(through)-294(the)-293.4(spring)-296.6(of)-291.4(2014.)-292.4(Unless)-295.7(otherwise)-294.6(noted,)-293.3(our)-292.2(anal-)]TJ
0 -1.3341 TD
[(ysis)-382.8(of)-386.3(the)-388.2(findings)-382.4(is)-383.6(limited)-389.2(to)-382(studies)-391.6(during)-387.1(this)-384.2(period)-386.7(with)-386.3(a)]TJ
T*
[(minimum)-257.6(sample)-266.4(size)-267.3(of)-259.8(150)-267.3(and)-257.4(a)-267.1(robust)-263.9(research)-263.9(design)-266.8(\(typically)]TJ
T*
[(casecontrol)-281.2(quasi-experimental)-285.6(design\).)]TJ
1.1065 -1.3341 TD
[(The)-407.8(findings)-407.7(can)-406.2(be)-405.1(grouped)-409.7(into)-408.9(three)-409.2(sets:)-407.3(\(1\))-403.9(feasibility)-407.2(and)]TJ
-1.1065 -1.3341 TD
[(reliability)-344.8(of)-335.7(telestroke,)-346.5(\(2\))-347(intermediate)-342.8(outcomes:)-346.1(event)-339.7(timing)-343.9(in)]TJ
T*
[(the)-299.7(care)-302.7(process)-299.5(\(time)-298.7(lapse)-303.4(between)-306.5(onset)-300.5(of)-297.8(symptoms,)-301.5(diagnostic)]TJ
T*
[(tests)-220.3(and)-225.7(treatment\),)-224.2(and)-219.4(\(3\))-226.8(health)-219(outcomes)-230.8(and)-219.4(cost.)-221.5(As)-224.2(mentioned)]TJ
0 -1.3278 TD
[(earlier,)-374.3(the)-369.3(findings)-376.1(from)-374.7(studies)-372.7(that)-379.3(incorporated)-372(more)-374.6(than)-373.3(one)]TJ
0 -1.3341 TD
[(chronic)-278.7(condition)-283(are)-281.8(discussed)-287.4(only)-283.1(once.)]TJ
/F5 1 Tf
.999 -2.624 TD
[(Feasibility)-245.9(and)-242.1(reliability.)]TJ
/F1 1 Tf
11.0335 0 TD
[(Initially,)-189.9(we)-194.4(report)-192.9(the)-185.9(findings)-192.7(from)-191.4(six)]TJ
-12.0325 -1.3341 TD
[(studies)-423.3(\(three)-419.1(from)-425.3(the)-419.8(United)-423.4(States)-426.2(and)-415.4(one)-422.1(each)-425.5(from)-419(Canada,)]TJ
T*
[(France,)-370.1(and)-377.5(Germany\))-369.3(that)-373(investigated)-381.7(the)-369.3(feasibility)-375.6(and/or)-378.2(reli-)]TJ
T*
[(ability)-215.6(of)-215.6(telestroke.)-220(In)-214.6(2010,)-216.5(a)-216.5(study)-213.2(reported)-218.6(on)-217.9(a)-216.5(2-year)-214.2(experience)]TJ
T*
[(with)-361(210)-362.2(patients)-366.7(with)-367.3(acute)-360.1(stroke)-365.3(who)-364.5(were)-367.2(referred)-367(to)-363(the)-362.9(tele-)]TJ
0 -1.3278 TD
[(stroke)-283.1(program)-282.7(serving)-279.5(remote)-285.8(hospitals)-285.8(in)-279.8(Alberta,)-278.8(Canada.)]TJ
6.7246 0 0 5.9768 261.5243 303.7606 Tm
(82)Tj
8.9663 0 0 8.9663 271.0487 299.7921 Tm
(Tele-)Tj
-26.2274 -1.3341 TD
[(phone)-214.7(and)-213.1(video)-215.9(were)-209.1(both)-218.9(used)-212.5(in)-216.6(connecting)-213.4(the)-217.5(remote)-209.9(sites)-219.7(to)-211.3(the)]TJ
T*
[(University)-236.6(of)-240.9(Alberta)-239.5(Hospital.)-243.5(Over)-235.4(a)-235.5(2-year)-239.5(period,)-242.5(77%)-240.9(of)-234.5(patients)]TJ
T*
[(in)-185(the)-185.9(video)-190.6(group)-188(received)-191.7(thrombolysis)-193.8(versus)-188(45%)-184(in)-185(the)-192.2(telephone)]TJ
T*
[(group.)-429.5(Over)-425.1(21%)-430.6(of)-430.6(patients)-429.9(were)-430.4(treated)-429.6(with)-430.6(tPA)-428.1(at)-429.3(their)-429.8(local)]TJ
T*
[(hospital.)-318(The)-319.3(authors)-320.3(concluded)-321.8(that)-316.1(telestroke)-319.9(is)-320.4(not)-316.9(only)-314.7(feasible,)]TJ
T*
[(but)-435.4(it)-437.6(can)-444.2(also)-434.2(significantly)-447.7(reduce)-437.1(the)-438.8(need)-443(to)-438.9(transfer)-438.7(patients.)]TJ
T*
[(Furthermore,)-284.9(the)-280.7(study)-282.8(suggests)-286.1(the)-280.7(value)-280.1(of)-278.8(visual)-282.4(information.)]TJ
1.1065 -1.3278 TD
[(A)-312(2011)-310.1(study)-308.1(tested)-314.8(the)-306(feasibility)-312.4(and)-307.9(reliability)-313.2(of)-310.4(using)-307.1(a)-305(vid-)]TJ
-1.1065 -1.3341 TD
[(eophone)-284.7(to)-287.2(assess)-284.5(compliance)-288.7(with)-285.2(the)-287.1(National)-287(Institutes)-287.2(of)-285.1(Health)]TJ
T*
[(Stroke)-304.1(Scale)-308.9(\(NIHSS\))-300.8(in)-305.1(patients)-309.8(with)-304.1(acute)-303.2(stroke)-308.4(before)-306.5(they)-304.5(were)]TJ
T*
[(admitted)-184(to)-179.7(the)-185.9(hospital.)]TJ
6.7246 0 0 5.9768 124.7811 172.233 Tm
(83)Tj
8.9663 0 0 8.9663 133.3984 168.2645 Tm
[(A)-185.6(cellular)-183.3(videophone)-184(with)-184(two-way)-184(audio)]TJ
-10.8754 -1.3341 TD
[(and)-200.5(one-way)-202.3(video)-203.2(was)-194.7(used)-206.2(to)-198.6(connect)-206.9(patients)-202.3(from)-197.7(the)-198.5(originating)]TJ
T*
[(site.)-308.8(In)-309.4(total,)-310.3(480)-305.3(paired)-313.9(comparisons)-312.9(by)-306.8(40)-306.8(physicians)-313.3(were)-310.3(gener-)]TJ
T*
[(ated)-366.5(to)-369.4(assess)-366.7(the)-369.3(feasibility)-369.3(and)-364.8(reliability)-370.1(of)-367.3(the)-369.3(videophone)]TJ
/F5 1 Tf
26.7712 0 TD
(vis-)Tj
-26.7712 -1.3341 TD
(a)Tj
.2087 .0126 TD
(`)Tj
.2909 -.0126 TD
(-vis)Tj
/F1 1 Tf
2.1877 0 TD
[(bedside)-635.8(stroke)-630.8(management.)-635(Performing)-634.2(the)-634.8(NIHSS)-628.8(over)]TJ
-2.6872 -1.3278 TD
[(videophone)-354.8(took)-354.7(38)-351(seconds)-360.7(longer)-354.7(than)-354.3(the)-350.3(bedside)-357.6(examination,)]TJ
0 -1.3341 TD
[(but)-277.3(it)-285.9(was)-276.9(equally)-282.2(reliable.)]TJ
1.1065 -1.3341 TD
[(A)-375.2(s)0(o)13.5(mew)13.2(hat)-362.5(sim)13.7(ila)16.7(r)-373.1(stu)11.4(dy)-363.7(in)-368.4(201)17.2(2)-371.5(com)11.2(pa)12.6(red)-360.9(the)-362.9(rel)13.4(iabi)18.2(lit)14.1(y)-371.5(o)0(f)-367.3(a)]TJ
-1.1065 -1.3341 TD
[(vid)18.5(eo)-190.1(sma)15.7(rtph)19.8(one)-181.9(\(i.e)15(.,)-185.9(Ap)12(ple)-187.3([C)14.1(uper)15.7(tin)13.2(o,)-183.1(CA])-184.1(iPh)14.6(one)]TJ
/F9 1 Tf
6.7246 0 0 5.9768 228.0755 76.5921 Tm
()Tj
/F1 1 Tf
8.9663 0 0 8.9663 235.1054 72.6236 Tm
[(4\))-185.4(with)-177.7(beds)13.1(ide)]TJ
8.1123 69.2865 TD
[(obs)15(erv)12.2(ati)16.1(on)-224.2(for)-215.7(asse)14.1(ssi)14(ng)-217.9(NIHS)18.9(S)-230.4(i)0(n)-222.9(acu)12.7(te)-221.1(str)14(oke)-214.9(pat)14.8(ient)17.6(s)-228.3(a)0(n)13(d)-232.4(rep)18.5(orte)14.3(d)]TJ
0 -1.3278 TD
[(sim)13.7(ila)16.7(r)-177.1(resu)13.5(lts)16.9(.)]TJ
6.7246 0 0 5.9768 360.907 685.9274 Tm
(84)Tj
8.9663 0 0 8.9663 369.4676 681.9589 Tm
[(One)-171.7(hun)15.3(dre)12.2(d)-181.8(c)0(o)12.2(nse)11.9(cut)16.4(ive)-174.7(pa)12.6(tie)15.7(nts)-173.7(30)17.2(96)-174(year)16.9(s)-177.7(o)0(f)-177.6(a)0(g)12.6(e)]TJ
-6.873 -1.3341 TD
[(pre)12.1(sen)11.9(tin)19.5(g)-181.8(a)0(t)-176.4(the)-173.2(Mayo)-170.8(Cl)12.1(ini)13.8(c)-185.3(w)0(i)12.6(t)0(h)-177.6(a)-178.6(susp)16.3(ect)11(ed)-177.4(str)14(oke)-170.6(wer)14.1(e)-185.3(obs)15(erv)12.2(ed)-177.4(at)]TJ
T*
[(the)-274.4(be)12.2(dsid)17.8(e)-286.5(a)0(n)13(d)-283(via)-275.4(vid)18.5(eo)-278.6(\(whi)19(ch)-276.6(capt)12.9(ure)14.2(d)-283(v)0(e)12.2(rba)12.5(l)-281.7(res)16.2(pon)11.3(ses)15.6(,)-285.8(act)17.7(ion)12.5(s,)]TJ
T*
[(and)-339.6(bod)17.2(y)-352.6(e)0(x)12.6(pre)12.2(ssi)14(ons)15.4(\).)-346.2(Of)-338.2(thes)15.7(e,)-344.6(46.)14.4(8%)-343.6(had)-337.9(a)-349.3(f)0(i)13.3(nal)-338.3(diag)16.9(nos)15.4(is)-345.7(of)-342(is-)]TJ
T*
[(che)12.3(mic)-164.5(str)14(oke)12.7(,)-178.3(8.7)14.4(%)-180.7(o)0(f)-171.3(tra)13.2(ns)13.8(ient)-165.8(isc)12.8(hem)13.3(ic)-169.9(att)15.5(ack,)-168.7(7.)12.9(5%)-172.9(of)-171.3(hem)13.3(orr)14(hagi)19(c)]TJ
T*
[(str)14(oke)12.7(,)-412.3(a)0(n)13(d)-415.8(36.)14.4(1%)-406.8(of)-405.3(str)14(oke)-404.6(mim)13.4(ic)13.5(s;)-406.9(0.96)15.9(%)-414.6(o)0(f)-405.3(t)0(h)12.1(e)-412.9(dia)15.4(gno)11.3(ses)-401.7(wer)14.1(e)]TJ
T*
[(unc)16.2(ert)12.8(ain.)-270(Amon)12.9(g)-283(isc)12.8(hem)13.3(ic)-277.3(ale)12(rt)-282.4(pa)12.6(tien)17.6(ts,)-278(14.)14.4(1%)-280.3(rece)13.1(ive)15(d)-283(tPA)14.5(,)-285.8(3.5%)]TJ
T*
[(rec)15(eive)13.1(d)-289.3(tPA)-282.6(plu)14.2(s)-291.6(int)13.2(ra-)18.7(art)13.2(eri)13.4(al)-289.6(tr)14.7(eat)11.3(men)11.6(ts)14.1(,)-292.1(and)-282.6(4.0)14.4(%)-294.5(rec)15(eive)13.1(d)-289.3(int)13.2(ra-)]TJ
0 -1.3278 TD
[(art)13.2(eri)13.4(al)-213.7(tre)12.8(atm)12.3(en)12.6(t)-219.1(onl)12.5(y.)-214.7(The)-211.8(auth)14.1(ors)-207.9(con)14.1(clud)12.3(ed)-215.4(th)12.1(at)-220.7(th)12(e)-223.2(iPh)14.6(one)-207.2(was)-213.7()62()0(a)]TJ
0 -1.3341 TD
[(ver)12.1(y)-422.1(rel)13.4(ia)13.9(ble)-414.9(too)11.5(l)-420.8(f)0(o)12.1(r)-423.7(str)14(oke)-410.9(tele)13.8(med)17.5(icin)18.2(e.)65.1()]TJ
6.7246 0 0 5.9768 470.7211 578.3243 Tm
(84)Tj
8.9663 0 0 8.9663 481.4361 574.3557 Tm
[(Mor)12.5(eov)13.8(er,)-414.3(phy)12.9(sic)12.8(ian)15.8(s)]TJ
-19.3608 -1.3341 TD
[(wer)14.1(e)-273.8(high)17.7(ly)-273.9(sat)12.6(isf)12.6(ie)13.5(d)-276.7(wit)14.8(h)-274.7(the)-268.1(iPh)14.6(one)-270.4(in)-267.2(thi)14.8(s)-278.9(c)0(o)12.2(nte)14.8(xt.)]TJ
1.1128 -1.3341 TD
[(In)-486.5(2012,)-488.4(a)-482.1(French)-490.2(study)-485.1(compared)-488.8(the)-489.4(efficacy)-487.8(and)-485(safety)-489.5(of)]TJ
-1.1128 -1.3341 TD
[(thrombolytic)-356.5(treatment)-358.5(of)-354.7(ischemic)-352.5(stroke)-358.9(at)-347.1(a)-355.6(distant)-352.1(hospital)-360.9(via)]TJ
T*
(telemedicine.)Tj
6.7246 0 0 5.9768 357.222 530.4755 Tm
(85)Tj
8.9663 0 0 8.9663 366.1227 526.507 Tm
[(A)-210.9(retrospective)-218.2(analysis)-210.5(of)-209.3(161)-210.4(patients)-208.6(over)-214(a)-210.2(6-year)]TJ
-6.5 -1.3341 TD
[(period)-430.9(compared)-425.6(the)-426.2(experience)-431.6(of)-430.6(a)-425.2(university)-429.1(hospital)-424.2(versus)-428.3(a)]TJ
T*
[(remote)-462.8(hospital)-455.8(via)-458.8(telemedicine.)-465.9(No)-458(significant)-464.6(differences)-461.8(were)]TJ
0 -1.3278 TD
[(observed)-283.1(between)-287.5(the)-280.7(two)-283.6(settings.)]TJ
1.1128 -1.3341 TD
[(In)-423.2(another)-430.7(study,)-429.5(data)-429.3(were)-430.4(abstracted)-430.3(from)-431.7(patient)-429.2(records)-425.3(to)]TJ
-1.1128 -1.3341 TD
[(ascertain)-203.2(the)-204.9(feasibility)-204.9(and)-200.5(safety)-204.9(of)-196.6(telestroke)-206.1(services)-205.3(provided)-206.6(in)-197.6(a)]TJ
T*
[(regional)-334.5(network.)-341.4(The)-332(complications)-344.2(and)-333.2(outcomes)-338.2(of)-335.7(296)-336.9(patients)]TJ
T*
[(with)-285.2(acute)-290.5(ischemic)-289.2(stroke)-289.4(were)-285(compared)-292.8(with)-285.1(those)-286.2(receiving)-292.5(tPA)]TJ
T*
[(treatment)-352.2(using)-351.3()55.6(drip)-349.6(and)-345.9(ship)50.1()-349(treatment)-352.1(and)-345.9(those)-349.5(treated)-353.7(at)-347.1(the)]TJ
T*
[(regional)-612.7(stroke)-611.9(center.)]TJ
6.7246 0 0 5.9768 397.3038 422.929 Tm
(86)Tj
8.9663 0 0 8.9663 409.7763 418.9038 Tm
[(Patients)-606.5(at)-612.7(the)-609.5()55.6(spoke)-607.4(hospital)48.8()-608.3(were)]TJ
-11.3686 -1.3341 TD
[(younger)-497.8(with)-493.8(fewer)-495.7(severe)-491.9(symptoms.)-497.5(The)-496.4(outcomes)-496.3(of)-493.8(the)-495.7(two)]TJ
0 -1.3278 TD
[(groups)-315.1(were)-310.3(similar.)-306.1(Among)-314.4(survivors,)-308.1(length)-312.5(of)-310.4(stay)-308.4(among)-313.8(spoke)]TJ
0 -1.3341 TD
[(hospital)-455.8(patients)-455.2(was)-447.7(shorter.)-458.4(However,)-458.1(these)-454.1(differences)-455.5(may)-450(be)]TJ
T*
[(explained)-283.8(by)-281.5(the)-280.7(selectivity)-287.9(of)-278.8(the)-280.7(two)-283.6(groups.)]TJ
1.1128 -1.3341 TD
[(A)-248.8(somewhat)-260(different)-252.7(methodology)-257.2(was)-258(used)-250.5(in)-254.5(a)-254.5(pooled)-252.3(analysis)]TJ
-1.1128 -1.3341 TD
[(of)-329.4(data)-328.2(from)-330.5(Arizona)-328.3(and)-326.9(California.)]TJ
6.7246 0 0 5.9768 447.1936 351.1558 Tm
(87)Tj
8.9663 0 0 8.9663 457.1148 347.1873 Tm
[(The)-332(data)-328.2(were)-329.2(derived)-331.7(from)]TJ
-16.6482 -1.3341 TD
[(prospective,)-369.9(randomized,)-358.9(outcome-blinded)-370.4(studies)-360(comparing)-362(tele-)]TJ
T*
[(medicine/teleradiology)-594.3(with)-588.6(telephone-only)-590.3(consultations.)-592.8(Inter-)]TJ
T*
[(observer)-664.1(reliability)-660.9(was)-662.6(ascertained)-658.8(between)-666.9(the)-660.1(hub)-655.3(vascular)]TJ
0 -1.3278 TD
[(neurologist)-307.4(\(telemedicine)-303.7(arm\))-303.4(and)-301.6(the)-306(spoke)-302.6(radiologist)-308.2(\(telephone)]TJ
0 -1.3341 TD
[(arm\))-372.9(regarding)-380.1(contraindications)-376.8(for)-380.1(tPA,)-372.4(hemorrhage,)-383.4(tumor,)-374.5(hy-)]TJ
T*
[(perdense)-425.3(artery,)-424.9(acute)-423.3(stroke,)-423.4(prior)-424.3(stroke,)-423.4(and)-421.7(ischemic)-428.3(changes.)]TJ
T*
[(There)-194.9(was)-194.7(substantial)-202.6(agreement)-192.5(\(over)-198.5(94%)-196.6(for)-196.7(all)-192(measures\))-197.6(between)]TJ
T*
[(vascular)-516.4(neurologists)-523.1(and)-516.6(radiologists)-517.5(at)-517.8(spoke)-517.6(sites.)-518.1(This)-511.3(study)]TJ
T*
[(demonstrated)-337.8(that)-335.1(telestroke)-332.5(evaluation)-336.5(of)-335.7(head)-333.5(CT)-330.7(scans)-331.8(for)-335.8(acute)]TJ
T*
[(tPA)-364.8(assessments)-359.9(is)-364.6(reliable.)-363.6(Furthermore,)-367.1(pooled)-366.1(analysis)-362.2(from)-362.1(the)]TJ
T*
[(same)-258.1(trials)-253.8(and)-251(based)-260.4(on)-255.8(a)-254.5(total)-252.1(of)-253.5(276)-261(patients)-252.8(reported)-262.9(that)-252.9(correct)]TJ
0 -1.3278 TD
[(thrombolysis)-370.8(eligibility)-370.5(decisions)-374.1(were)-367.2(more)-368.2(often)-365.2(made)-369.7(by)-370(use)-365.8(of)]TJ
0 -1.3341 TD
[(telemedicine)-508.8(services)-508.8(versus)-510.5(other)-506.9(modalities)-503.8(\(96%)-510(telemedicine,)]TJ
T*
[(83%)-247.2(telephone\))-242.5(with)-247.2(an)-239.9(odds)-242.7(ratio)-248.1(of)-240.9(4.2.)-246.1(Administration)-245.2(of)-240.9(tPA)-244.7(was)]TJ
T*
[(also)-352(higher)-351(in)-349.4(telemedicine)-357.1(compared)-349.7(with)-348.4(telephone-only)-356.3(consul-)]TJ
T*
[(tations)-339.4(\(26%)-339.3(versus)-339.8(24%\),)-334.2(but)-340.5(there)-339.7(was)-333.9(no)-338(statistically)-341.3(significant)]TJ
T*
[(difference)-454.7(in)-456.9(post-thrombolysis)-459.8(hemorrhage.)]TJ
6.7246 0 0 5.9768 479.792 147.9118 Tm
(88)Tj
8.9663 0 0 8.9663 490.8471 143.9433 Tm
[(This)-454.4(analysis)-450.7(con-)]TJ
-20.4104 -1.3341 TD
[(cluded)-329.6(that)-328.8(telemedicine)-331.8(\(i.e.,)-322.6(video\))-333.2(significantly)-327.5(improved)-329.3(correct)]TJ
T*
[(decision)-386.1(making)-387.9(for)-386.4(acute)-385.4(ischemic)-390.4(stroke)-390.6(as)-381.6(compared)-387.6(with)-386.3(tele-)]TJ
0 -1.3278 TD
[(phone.)-367.8(The)-369.9(study)-365(authors)-370.9(concluded)-372.4(that)-366.7()55.6(poor)-369.9(sensitivity)-365(of)-367.3(tele-)]TJ
0 -1.3341 TD
[(phone)-745.9(determination)-748.5(of)-740.4(thrombolysis)-750.2(eligibility)-743.5(suggests)-747.7(that)]TJ
T*
[(telephone)-397(assessments)-397.9(may)-393.1(result)-392.5(in)-393.6(stroke)-396.9(consultants)-393.5(ruling)-398.5(out)]TJ
T*
[(patients)-265.5(who)-257(should)-266(have)-264(been)-259.7(treated)-265.2(with)-259.9(tPA.)49.9()]TJ
6.7246 0 0 5.9768 492.4345 76.1953 Tm
(88)Tj
8.9663 0 0 8.9663 501.7321 72.2267 Tm
[(Similar)-262.6(findings)]TJ
/F9 1 Tf
6.9738 0 0 6.9738 186.0661 29.7638 Tm
()Tj
/F7 1 Tf
1.3251 0 TD
.2005 Tc
[(M)-5.5(ARY)-336.3(ANN)-335.1(L)0(I)5.3(E)-4.9(BERT,)-334.3(I)-2.9(NC.)]TJ
/F10 1 Tf
15.015 0 TD
0 Tc
()Tj
/F7 1 Tf
.9999 0 TD
.1103 Tc
[(VOL.)-327(20)-1000.8(N)5.5(O)-4.1(.)-327(9)]TJ
/F10 1 Tf
8.3814 0 TD
0 Tc
()Tj
/F8 1 Tf
1.008 0 TD
.103 Tc
[(SE)-4.8(P)-6.3(T)-8.1(E)-4.8(M)-8.4(BE)-4.8(R)-339.7(2)-6.3(0)-7.9(1)-6.5(4)]TJ
/F4 1 Tf
7.9702 0 0 7.9702 441.1841 29.7638 Tm
0 Tc
[(TELEMEDI)14.5(CINE)-328.7(and)-336(e-HEALTH)-647.9(783)]TJ
ET
q
1 i
0 792 612 -791.985 re
W n
579.685 .014984 .22681 791.985 re
f
337.039 767.962 274.961 .22675 re
f
Q
BT
/F11 1 Tf
11.9551 0 0 11.9551 287.5464 741.9966 Tm
[(TELEMEDICINE)-340.6(FOR)-332.7(CHRONIC)-338.8(DISEASE)-334.7(MANAGE)-7.3(MENT)]TJ
ET
endstream
endobj
251 0 obj
<>/XObject<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]/Font<>/Properties<>>>/Thumb 254 0 R/MediaBox[0 0 612 792]/Rotate 0>>
endobj
255 0 obj
<>/ProcSet[/PDF/Text]/Font<>/Properties<>>>
endobj
252 0 obj
<>stream
/GS1 gs
BT
/F1 1 Tf
8.9663 0 0 8.9663 50.1732 693.8644 Tm
0 0 0 1 k
0 Tc
0 Tw
[(regarding)-260(the)-261.8(poor)-261.1(sensitivity)-263.9(of)-266.2(the)-261.8(telephone)-264.2(compared)-261.2(with)-259.9(video)]TJ
0 -1.3278 TD
[(were)-278.6(reported)-288.1(in)-279.8(an)-277.8(earlier)-284.5(\(published)-286.1(in)-279.8(2008\))-282(study)-282.8(in)-279.8(Germany.)]TJ
6.7246 0 0 5.9768 296.2771 685.9274 Tm
(89)Tj
8.9663 0 0 8.9663 60.0945 669.9967 Tm
[(Similarly,)-449.3(in)-450.6(a)-444.1(2012)-449.2(German)-449.5(study,)-448.5(the)-451.4(reliability)-452.3(of)-443.2(brain)-450.7(CT)]TJ
-1.1065 -1.3341 TD
[(evaluation)-387.1(by)-389(telestroke)-389.4(neurologist)-389.6(was)-390.8(confirmed.)]TJ
6.7246 0 0 5.9768 249.1653 662.003 Tm
(90)Tj
8.9663 0 0 8.9663 259.6534 658.0344 Tm
[(Two)-385.5(neuro-)]TJ
-23.3632 -1.3341 TD
[(radiologists)-448(re-examined)-447.9(all)-444.9(CT)-444.5(scans)-451.9(for)-443.3(536)-450.7(patients)-442.5(who)-446.7(were)]TJ
T*
[(initially)-367.7(assessed)-373.4(by)-370(stroke)-371.6(neurologists.)-372.6(The)-369.9(neuroradiologists)-373.5(de-)]TJ
T*
[(tected)-373(discrepant)-375.7(findings)-376.1(in)-374.7(8%)-375.2(of)-373.6(the)-375.6(cases,)-374.8(but)-372.1(only)-371.6(1.7%)-374.9(were)]TJ
T*
[(rated)-271.7(as)-267.8(clinically)-272.6(relevant.)-270.3(One)-272.9(patient)-271.1(had)-268.4(evidence)-278.2(of)-266.2(intracranial)]TJ
T*
[(hemorrhage,)-301.2(but)-296.3(it)-298.5(was)-295.9(not)-297.9(clear)-299.9(whether)-301(that)-297.1(patient)-296.4(received)-299.1(tPA.)]TJ
0 -1.3278 TD
[(The)-186.5(authors)-187.5(concluded)-189(that)-189.7()55.6(stroke)-189.5(neurologists)-194.3(can)-184.9(reliably)-188.2(interpret)]TJ
0 -1.3341 TD
[(the)-356.6(cerebral)-363.6(CT)-355.9(scan)-362.7(of)-354.7(patients)-360.3(with)-361(clinically)-361.1(suspected)-365.2(acute)-360.1(is-)]TJ
T*
[(chemic)-278.7(stroke)-283.1(in)-279.8(telemedicine)-287.5(in)-279.8(real)-279(time.)50.1()]TJ
6.7246 0 0 5.9768 213.1086 566.3621 Tm
(90)Tj
/F5 1 Tf
8.9663 0 0 8.9663 59.1307 538.4691 Tm
[(Intermediate)-403.4(outcomes:)-407.5(event)-408.4(timing.)]TJ
/F1 1 Tf
16.2119 0 TD
[(A)-350(large)-353.3(number)-350.1(of)-354.7(studies)]TJ
-17.211 -1.3341 TD
[(focused)-265.6(on)-268.5(the)-268.1(critical)-266.8(time)-269.9(intervals)-265(from)-267.3(onset)-268.9(of)-266.2(symptoms,)-269.9(to)-268.2(CT)]TJ
T*
[(scan)-236.2(of)-234.5(the)-236.5(brain,)-237(to)-236.6(treatment)-238.3(and/or)-232.7(transfer,)-237.6(but)-239.3(not)-234.7(always)-236.2(on)-236.9(the)]TJ
T*
[(same)-359.3(intervals.)-367.4(We)-360.5(report)-369.9(here)-360.8(on)-363.3(seven)-367.9(such)-362.3(studies)-366.3(that)-360.4(met)-367.5(the)]TJ
0 -1.3278 TD
[(inclusion)-181.4(criteria)-187.5(for)-184(our)-184.7(review.)-187.1(None)-186.1(of)-184(these)-188.5(studies)-183(utilized)-190.6(an)-183(RCT)]TJ
0 -1.3341 TD
[(design)-279.4(for)-285.2(the)-280.7(reasons)-279.7(explained)-283.8(earlier.)]TJ
1.1065 -1.3341 TD
[(A)-223.5(study)-225.9(conducted)-227.5(in)-222.9(Germany)-220.4(in)-222.9(2006)-227.9(investigated)-223.7(the)-223.8(quality)-227.5(of)]TJ
-1.1065 -1.3341 TD
[(procedures)-321(related)-315.1(to)-318.8(stroke)-321(diagnosis)-313.4(and)-320.6(treatment)-320.5(at)-315.5(community)]TJ
T*
[(hospitals)-374.3(via)-370.3(telemedicine)-376.1(\(or)-375.2(telestroke\))-374(before)-376.1(\()]TJ
/F5 1 Tf
20.8403 0 TD
(n)Tj
/F9 1 Tf
.7082 0 TD
(=)Tj
/F1 1 Tf
.7145 0 TD
[(299\))-378.3(and)-371.2(after)]TJ
-22.263 -1.3341 TD
[(implementation)-341.9(of)-348.4(telestroke)-345.2(\()]TJ
/F5 1 Tf
12.766 0 TD
(n)Tj
/F9 1 Tf
.7082 0 TD
(=)Tj
/F1 1 Tf
.7145 0 TD
(305\).)Tj
6.7246 0 0 5.9768 196.1007 434.8345 Tm
(91)Tj
8.9663 0 0 8.9663 206.1921 430.866 Tm
[(More)-343.6(patients)-347.7(were)-341.9(trans-)]TJ
-17.4007 -1.3341 TD
[(ferred)-276.5(after)-275.4(than)-272.1(before)-274.9(telestroke)-282(\(10.3%)-275.8(versus)-276.6(1.3%\))-277.3(to)-274.5(acute)-271.6(care)]TJ
T*
[(hospitals,)-318.7(but)-315.2(all)-318.4(indicators)-320.4(of)-316.7(quality)-316(improved,)-324.2(including)-318.3(cerebral)]TJ
0 -1.3278 TD
[(imaging)-244.9(\(from)-245.5(56.5%)-253.3(to)-249.2(96.4%\),)-245.4(speech)-254.3(therapy)-247.7(\(from)-245.5(0%)-248.7(to)-249.2(58.8%\),)]TJ
0 -1.3341 TD
[(and)-383.8(occupational)-393.8(therapy)-393.1(\(from)-384.6(0%)-387.8(to)-388.3(33.4%\).)-390.9(One)-386.7(year)-387.7(after)-389.2(ad-)]TJ
T*
[(mission,)-570.1(mortality)-577.7(declined)-577(from)-570.8(18.9%)-575.8(to)-571.7(17.2%,)-577(respectively,)]TJ
T*
[(whereas)-384.8(10.2%)-386.1(and)-377.5(6.1%,)-388.9(respectively,)-389.5(were)-386.1(living)-378.7(in)-387.3(institutions.)]TJ
T*
[(The)-300.4(authors)-307.7(published)-307.9(another)-304.2(report)-306.7(later)]TJ
6.7246 0 0 5.9768 209.6503 351.1558 Tm
(92)Tj
8.9663 0 0 8.9663 219.4015 347.1873 Tm
[(based)-304.6(on)-300.1(the)-306(same)-302.4(ex-)]TJ
-18.8739 -1.3341 TD
[(perience)-387.3(and)-383.8(reported)-389.3(high)-380.6(levels)-389.5(of)-386.3(satisfaction)-387.2(among)-383.3(clinicians)]TJ
T*
[(related)-283.5(to)-280.8(video)-279.1(quality,)-285.6(time)-282.5(consumption,)-285.2(and)-276.3(medical)-283.8(relevance.)]TJ
1.1065 -1.3341 TD
[(Ano)13.9(ther)-204.9(tr)14.7(end)-207.2(an)13(alys)14.7(is)-206.6(was)-207.4(co)12.2(ndu)13.3(cte)11(d)-213.5(i)0(n)-204(Spai)12.6(n)-206.8(usi)12(ng)-211.6(ba)12.6(sel)12.8(ine)-205.9(da)12.6(ta)]TJ
-1.1065 -1.3278 TD
[(fo)12.1(r)-215.1(201)-204.1(cas)14.8(es)-205(in)-210.3(200)17.2(6)-213.5(and)-206.8(198)-204.1(cas)14.8(es)-205(in)-210.3(200)17.2(7)-213.5(afte)15.6(r)-208.7(the)-204.9(act)11.4(iva)15.4(tio)12.8(n)-213.1(o)0(f)-202.9(the)]TJ
0 -1.3341 TD
[(te)12.9(les)12.8(trok)16.7(e)-330.7(p)0(r)14.1(ogra)14.1(m.)]TJ
6.7246 0 0 5.9768 122.2866 291.4015 Tm
(93)Tj
8.9663 0 0 8.9663 132.2078 287.433 Tm
[(Te)12.2(les)12.8(trok)16.7(e)-330.7(c)0(o)12.2(nsis)15.9(ted)-320.7(of)-323.1(vid)12.2(eoc)10.3(onf)14(ere)15(nc)12.6(ing)-322.6(be)12.2(-)]TJ
-9.1493 -1.3341 TD
[(tw)12(een)-198(th)12.1(e)-204.3(pati)17.6(ent)14.8(s)-209.4(a)0(t)-195.4(a)-203.9(com)11.2(mun)17.1(ity)-195.8(hosp)18.5(ital)-189.8(and)-200.5(th)12(e)-204.3(str)14(oke)-195.9(exp)14.1(ert)12.8(s)-203(a)0(t)-201.7(a)]TJ
T*
[(te)12.9(rtia)16(ry-)15.4(car)15.4(e)-191.6(cen)17(ter)12.8(.)-191(S)0(p)11.4(eci)11.6(ali)16.7(sts)-182.6(als)13.2(o)-188.2(had)-179.8(acc)13.6(ess)-180.4(to)-179.7(neur)16.1(oim)15.9(agin)17.3(g)-188.2(sca)14.8(ns)]TJ
T*
[(via)-237.5(the)-242.8(Pict)17.6(ure)-245.1(Arc)14.8(hiv)14.2(ing)-246.7(an)13(d)-251.4(Comm)15.1(uni)14.6(cat)17.7(ion)-246.7(Sy)11.4(ste)12.2(m.)-242.6(The)-243.4(his)12(tori)19.1(cal)]TJ
T*
[(co)12.2(mpa)11.6(ris)14.7(ons)-250.2(pre)12.2(-)-257.9(and)-251(post)17.2(-te)14.2(les)12.8(trok)16.7(e)-261.2(int)13.2(erv)12.2(en)12.6(tio)12.8(n)-257.3(rev)12.2(eal)-253.6(an)-252.6(incr)15.3(eas)14.8(e)]TJ
T*
[(in)-222.9(th)12.1(rom)13.1(bol)12.2(yti)12.8(c)-229.6(tre)12.8(atm)12.3(en)12.6(t)-231.8(o)0(f)-228.2(4)0(.)12.9(5%,)-224.7(a)-229.2(d)0(e)12.2(crea)13.5(se)-223.9(in)-222.9(the)-223.8(int)13.2(erv)18.5(al)-226.4(betw)17.9(een)]TJ
T*
[(ons)15.4(et)-278(of)-272.5(sym)12.5(pto)11.5(ms)-273.6(and)-270(thr)12(om)13.2(bol)12.2(yti)12.8(c)-280.1(tre)12.8(atm)12.3(en)12.6(t)-282.4(fro)12(m)-279.2(210)-273.6(mi)14.4(nut)14(es)-280.8(to)]TJ
0 -1.3278 TD
[(162)-267.3(mi)14.4(nut)14(es,)-269.5(an)13(d)-276.7(a)-273.4(red)12.2(ucti)12.9(on)-268.5(in)-267.2(betw)17.9(een-)18.3(hosp)12.2(ita)16.1(l)-275.4(p)0(a)12.6(tien)17.6(t)-276(tra)13.2(nsfe)16.1(rs.)]TJ
1.1065 -1.3341 TD
-.0282 Tc
[(A)-5.1(n)-216(A)-5.1(u).6(s)-3.6(t)-.7(rali)-6.4(an)-222.3(st)-7.1(udy)-222.7(g)-1.4(ath)-5.7(e)1.5(re)-4.8(d)-216.4(b)-1.4(a)-4.4(s)-3.6(eli)-6.4(n)-1(e)-219.8(d)-1.4(ata)-219.4(o)-7.7(n)-216(145)-222.7(pa)-4.4(tient)-7.1(s)-218.6(in)-222.3(the)-219.8(f)-5(irst)]TJ
-1.1065 -1.3341 TD
-.0269 Tc
[(or)-242(control)-245.4(y)-.1(ear)-242(a)3.2(nd)-240.4(on)-246.3(130)-240.4(patient)-5.8(s)-236.3(in)-240(the)-243.8(s)-2.3(econd)-240.4(o)-.1(r)-242(t).6(elestroke)-243.8(y)-.1(ear.)]TJ
6.7246 0 0 5.9768 287.1495 183.7983 Tm
-.031 Tc
(94)Tj
8.9663 0 0 8.9663 295.8235 179.8298 Tm
-.0243 Tc
(Of)Tj
-27.3972 -1.3341 TD
-.0267 Tc
[(145)-189.6(in)-189.2(t)-5.6(h)2.1(e)-193(c)3(ont)-5.6(r)4.8(ol)-194.6(group,)-192.4(36)-189.6(were)-193(eligible)-193(for)-191.2(t)-5.6(PA,)-192.4(w)2.1(hereas)-191.8(54)-189.6(of)-193.2(130)-189.6(were)]TJ
T*
-.0273 Tc
[(eli)-5.5(g)-.5(ible)-358(fo)-6.8(r)-349.8(t)-6.2(PA)-352(i)-5.5(n)-354.2(the)-358(i).8(nt)-6.2(erven)-6.4(t).2(ion)-354.2(g)-.5(rou)-4.8(p)-.5(.)-351(O)-3(f)-358.2(t).2(hose)-358(el)-5.5(igible,)-357.4(8)-354.6(patients)]TJ
T*
-.0264 Tc
[(received)-385.3(thrombolysis)-381.2(in)-378.6(the)-382.4(i)1.7(nt)-5.3(er)]TJ
13.7017 0 TD
-.0268 Tc
[(vent)-5.7(ion)-385.3(g)0(roup,)-382.2(w)-4.3(hereas)-381.6(none)-382.8(i)-5(n)-379(t)-5.7(h)2(e)]TJ
-13.7017 -1.3341 TD
-.0264 Tc
[(control)-251.2(g).4(r)5.1(o).4(up)-246.2(received)-246.2(the)-243.3(t)-5.3(r)5.1(e)-3(atm)4.2(e)-3(nt.)-249(T).4(im)4.2(e)-249.6(l)1.7(aps)4.5(e)-249.6(between)-245.8(a)-2.6(rr)5.1(ival)-244.9(and)-246.2(C)1.8(T)]TJ
T*
-.0276 Tc
[(scan)-278.6(was)-274.9(s)-3(imilar)-280.6(in)-272.3(bo)-7.1(th)-277(groups,)-275.5(b)-.8(ut)-278.3(th)]TJ
15.4089 0 TD
-.0265 Tc
[(e)-281.3(u)2.3(se)-275(of)-275.2(a)-274.6(t)1(elestroke)-275(i)1.6(ntervention)]TJ
-15.4089 -1.3278 TD
-.0259 Tc
[(r)5.6(e)-2.5(du)2.9(ce)3.8(d)-296.3(u)2.9(nnec)3.8(e)-2.5(ss)5(ary)-289.9(p).9(a)4.2(t)-4.8(ie)3.8(nt)-295.6(tra)4.2(n)1.3(sf)3.6(ers)-292.2(a)4.2(nd)-289.9(enable)3.8(d)-296.3(p).9(h)2.9(y).9(sicia)4.2(n)-5(s)-285.8(p)-5.4(r)5.6(o).9(mptly)]TJ
0 -1.3341 TD
-.0268 Tc
[(to)-278.2(identify)-278.2(patients)-280.4(requiri)-5(n).4(g)-278.2(u)2(rgent)-277.5(n).4(eurosurgical)-283.2(intervention)-5.9(s.)]TJ
1.1065 -1.3341 TD
0 Tc
[(A)-368.9(prospective)-374.9(cohort)-366.3(study)-371.3(in)-368.4(Finland,)-369.8(conducted)-373(from)-368.4(2007)-367(to)]TJ
-1.1065 -1.3341 TD
[(2009)-575.6(\(published)-583.3(in)-577(2011\),)-580.4(compared)-583.7(thrombolysis)-585.8(rates)-577.5(at)-574.8(five)]TJ
30.331 69.3307 TD
[(community)-249.7(hospitals)-247.8(\()]TJ
/F5 1 Tf
9.2567 0 TD
(n)Tj
/F9 1 Tf
.7082 0 TD
(=)Tj
/F1 1 Tf
.7208 0 TD
[(106\))-245.6(via)-243.8(telestroke)-250.3(with)-247.2(those)-248.3(appearing)-242.4(in)]TJ
-10.6857 -1.3278 TD
[(person)-206.4(at)-208(the)-204.9(emergency)-206.2(room)-206.7(at)-208(the)-204.9(hub)-206.4(hospital)-209.2(\()]TJ
/F5 1 Tf
20.7518 0 TD
(n)Tj
/F9 1 Tf
.7082 0 TD
(=)Tj
/F1 1 Tf
.7208 0 TD
(985\).)Tj
6.7246 0 0 5.9768 539.6597 685.9274 Tm
(95)Tj
8.9663 0 0 8.9663 548.5605 681.9589 Tm
(Among)Tj
-25.2537 -1.3341 TD
[(those)-286.2(patients)-284.5(with)-285.1(whom)-283.3(telestroke)-282(was)-283.3(used,)-289.7(57.5%)-284.9(had)-281(thrombo-)]TJ
T*
[(lytic)-283.5(treatment)-282.6(\(a)-277(two-)-282.3(to)-274.5(threefold)-285.4(increase\).)-286.4(Time)-276.8(to)-280.8(tPA)-276.3(treatment)]TJ
T*
[(\(onset)-190.3(to)-192.3(treatment)-194.1(time\))-191.2(was)-194.7(120)-191.5(minutes,)-190.5(and)-194.1(length)-192.3(of)-190.3(consultation)]TJ
T*
[(was)-276.9(25)-275.2(minutes)-277.8(when)-277.5(it)-279.6(led)-275.8(to)-274.5(thrombolysis)-282.3(and)-276.3(15)-275.2(minutes)-277.8(if)-277.5(it)-273.2(did)]TJ
T*
[(not.)-337.1(Patients)-334.7(treated)-341.1(with)-335.7(tPA)-333.2(at)-340.8(the)-331.3(community)-338.3(hospitals)-342.7(via)-332.3(tele-)]TJ
T*
[(stroke)-283.1(had)-281(similar)-279.5(outcomes)-287.7(as)-280.4(those)-279.9(treated)-284.1(at)-283.9(the)-280.7(hub)-282.2(hospital.)]TJ
1.1128 -1.3341 TD
[(A)-255.1(more)-254.4(recently)-256.7(published)-257.3(\(in)-258.1(2014\))-256.7(study)-257.5(in)-254.5(the)-255.4(United)-252.7(Kingdom)]TJ
-1.1128 -1.3278 TD
[(used)-440.2(a)-437.8(retrospective)-452.1(case)-436.1(series)-445.2(design)-437.5(to)-445.2(assess)-436.2(the)-445.1(efficacy)-443.5(and)]TJ
0 -1.3341 TD
[(safety)-407.3(of)-398.9(thrombolysis)-408.8(treatment)-402.7(via)-401.9(telephone-based)-409.4(telestroke.)]TJ
6.7246 0 0 5.9768 569.14 578.3243 Tm
(96)Tj
8.9663 0 0 8.9663 322.129 562.3936 Tm
[(This)-283.7(study)-282.8(was)-283.3(based)-285.7(on)-281.1(a)-286.1(sample)-279.1(of)-285.1(2,922)-286(patients)-284.5(who)-282.3(were)-285(given)]TJ
T*
[(tPA)-194.1(between)-199(2007)-189.9(and)-194.1(2010.)-197.5(Of)-192.8(these,)-196.1(192)-191.4(were)-196.5(treated)-195.6(with)-196.6(tPA)-187.8(after)]TJ
T*
[(an)-322.1(assessment)-321.3(by)-319.4(a)-317.7(remote)-323.7(specialist.)-324.8(The)-319.3(median)-320.7()55.6(door-to-needle)46.6()]TJ
T*
[(time)-320.4(was)-321.2(8)-320.9(minutes)-322(faster)-326.7(in)-317.8(the)-318.7(group)-327.1(that)-322.4(was)-321.2(seen)-318.8(in)-324.1(person)-320.2(\(65)]TJ
T*
[(minutes)-378.9(versus)-384(73)-382.7(minutes)-378.9(by)-382.7(telephone\),)-382.8(but)-378.5(no)-382.3(differences)-385.9(were)]TJ
T*
[(observed)-283.1(in)-279.8(neurological)-290.6(outcomes)-281.3(or)-283.1(instance)-281.9(of)-278.8(hemorrhage.)]TJ
1.1128 -1.3278 TD
[(A)-350(retrospective)-351(record)-355.1(review)-350.2(was)-346.5(conducted)-354(in)-349.4(Georgia)-349.7(on)-350.7(889)]TJ
-1.1128 -1.3341 TD
[(telestroke)-515.9(consultations)-522(involving)-512.9(115)-513.9(patients)-518.4(treated)-511.8(with)-519.1(tPA)]TJ
T*
[(during)-229.1(a)-222.8(20-month)-234.1(period)-228.6(\(20112012\).)]TJ
6.7246 0 0 5.9768 469.7574 470.7211 Tm
(97)Tj
8.9663 0 0 8.9663 478.7715 466.7527 Tm
[(The)-230.8(authors)-225.5(calculated)-230(the)]TJ
-17.4702 -1.3341 TD
[(time)-194(elapsed)-190(between)-192.7(emergency)-199.9(department)-193.2(arrival)-192.2(and)-187.8(registration,)]TJ
T*
[(start)-409(of)-405.3(specialist)-412(consultation,)-408.8(CT)-406.5(scan,)-408.2(and)-402.8(thrombolytic)-413.4(recom-)]TJ
T*
[(mendation)-523.8(and)-529.2(initiation.)-525.7(The)-521.7(most)-522.8(conspicuous)-532.7(delay)-522.4(occurred)]TJ
T*
[(during)-425.1(registration)-419.4(\(median)-425.4(of)-417.9(39)-420.6(minutes\).)-428(However,)-420.2(the)-426.2(median)]TJ
T*
[(time)-333.1(from)-336.8(emergency)-332.7(department)-338.6(arrival)-337.6(to)-331.4(thrombolysis)-339.2(initiation)]TJ
0 -1.3278 TD
[(was)-359.1(88)-357.4(minutes.)-361.2(The)-357.3(main)-358.3(benefit)-364.3(of)-354.7(telestroke)-364.1(was)-359.1(to)-356.7(shorten)-360.3(the)]TJ
0 -1.3341 TD
[(time)-390(from)-387.4(emergency)-395.9(department)-389.2(arrival)-388.2(to)-388.3(thrombolysis.)-397.4(Overall,)]TJ
T*
[(thrombolysis)-440.4(was)-435(initiated)-436.3(within)-438.5(60)-433.2(minutes)-442.2(from)-431.6(arrival)-438.8(to)-432.6(the)]TJ
T*
[(emergency)-282.1(room)-282.6(and)-282.7(was)-283.3(administered)-285.4(to)-280.8(13%)-278.8(of)-278.8(the)-287(patients.)]TJ
1.1128 -1.3341 TD
[(A)-255.1(p)14.2(r)12.6(o)14.2(sp)26.1(e)17(c)0(t)25.5(i)15.4(v)14.2(e)-254.8(an)25.7(a)17.4(l)15.4(y)14.2(s)0(i)27.4(s)-259.9(o)14.2(f)-261.4(1)14.2(1)14.2(9)-257.7(p)14.2(a)17.4(t)14.8(i)15.4(en)25.3(t)14.8(s)-259.9(d)14.2(e)17(mo)25.8(n)14.5(s)18.3(t)14.8(r)12.6(a)17.4(t)14.8(ed)-247(t)14.8(h)16.2(e)-261.2(b)14.2(en)25.3(e)17(f)16.9(it)23.9(s)-259.9(o)20.5(f)]TJ
-1.1128 -1.3341 TD
[(t)14.8(e)0(l)26.1(e)17(me)28.7(d)14.2(i)15.4(ci)26.1(n)14.6(e)-343.4(f)16.9(o)14.2(r)-347.8(p)14.2(a)17.4(t)0(i)23.9(e)17(n)14.5(t)14.8(s)-348.5(w)16.2(i)15.4(t)14.8(h)-344.2(a)0(c)28.1(u)0(t)24.7(e)-343.4(st)26.8(r)18.9(o)14.2(k)13.1(e)-343.4(p)14.2(r)12.6(es)29(en)25.3(t)14.8(i)15.4(n)14.6(g)-346.2(a)17.4(t)-345.6(co)24.9(m)18(m)18(u)0(n)24.4(i)15.4(t)14.8(y)]TJ
T*
-.0151 Tc
[(hos)-15.1(p)11(ital)-15.1(s)-398.7(i)-15.1(n)-402.4(S)1.1(pa)-15.1(i)11.4(n)-411.5(\(publi)-15.1(s)12.3(h)1.1(e)-15.1(d)-401.2(in)-417.9(2012\).)]TJ
6.7246 0 0 5.9768 467.6597 327.2881 Tm
0 Tc
(98)Tj
8.9663 0 0 8.9663 478.1479 323.2629 Tm
-.0153 Tc
[(This)-414.3(s)-15.3(t)11.5(udy)-412.1(f)-15.3(o)9.4(c)1.7(us)-15.3(e)13.7(d)-418.4(on)-411.7(the)]TJ
-17.4007 -1.3341 TD
-.0156 Tc
[(e)-15.6(f)12(fe)-15.6(c)12.2(t)-.8(s)-212.3(o)-1.4(f)-213.7(t)-.8(ele)-15.6(m)13.1(e)-15.6(d)9.3(icine)-213.5(i)-.2(n)-209.7(t)-.8(e)-15.6(r)14(m)-15.6(s)-200.7(of)-207.4(rec)-15.6(e)12.2(iving)-216.4(e)1.4(ndovas)-15.6(c)13.4(u)-15.6(l)9.7(ar)-211.7(trea)-15.6(t)10.3(m)2.3(ent)-215.8(\()-.2(as)]TJ
0 -1.3278 TD
-.0149 Tc
[(c)-14.9(o)16.3(ntra)-14.9(s)14.5(t)-.1(e)-14.9(d)-192.4(with)-207.4(thrombolytic)-206.5(treatm)-14.9(e)13.8(n)-.3(t\).)-205.9(T)-.7(he)-206.5(te)-14.9(l)11.3(e)2.1(m)-14.9(e)13.8(dic)-14.9(i)11.2(ne)-200.2(inte)-14.9(r)14.7(v)-.7(e)-14.9(n)10.4(tion)]TJ
0 -1.3341 TD
[(c)-14.8(o)16.4(ns)-14.8(i)12.6(s)-14.8(t)12(e)2.2(d)-506.5(o)-.6(f)-497.5(a)-14.8(n)-488.7(i).6(nte)-14.8(r)14.8(a)-14.8(c)13.3(tive)-503.6(vide)-14.8(o)10.1(c)2.2(onfe)-14.8(r)14.8(e)-14.8(n)10.5(c)2.2(ing)-506.5(s)3.5(ys)-14.8(t)12(e)2.2(m)-502.7(t)0(h)-14.8(a)12.5(t)-499.5(e)-14.8(n)10.5(a)2.6(ble)-14.8(d)]TJ
T*
0 Tc
[(st)26.8(r)18.9(o)14.2(k)13.1(e)-356(e)17(x)14.6(p)14.2(e)0(r)29.6(t)14.8(s)-354.8(t)14.8(o)-352.6(p)14.2(er)23.3(f)16.9(o)14.2(r)12.6(m)-348.8(t)14.8(h)0(e)26.9(i)15.4(r)-354.2(a)17.4(ss)23.9(e)17(s)0(s)30.2(m)0(e)28.7(n)14.6(t)14.8(s)-354.8(b)14.2(a)17.4(se)29(d)-358.9(o)14.2(n)-352.2(v)14.2(i)15.4(t)14.8(a)17.4(l)-357.6(s)18.3(i)0(g)23.3(n)20.9(s,)-343.4(i)15.4(n)14.6(-)]TJ
T*
-.0154 Tc
[(te)-15.4(r)14.2(v)-1.2(ie)-15.4(w)11.5(,)-358.1(a)-15.4(n)10.3(d)-361.6(p)-1.2(hysi)-15.4(c)10.8(a)2(l)-360.4(e)-15.4(x)9.9(a)2(m)-15.4(i)11.7(nation.)-364.4(A)-359(2-yea)-15.4(r)-345.8(a)-15.4(n)16.6(a)-15.4(l)11.1(ys)-15.4(i)12(s)-357.5(of)-359(pa)-15.4(t)10.5(i)0(ents)-363.9(re)-15.4(-)]TJ
T*
-.0152 Tc
[(c)-15.2(e)12.6(iving)-443.6(u)1(rgent)-443(e)-15.2(n)10.1(dovas)-15.2(c)13.8(ul)-15.2(a)11.3(r)-445.2(re)-15.2(c)12.6(a)-15.2(n)16.8(a)-15.2(l)11.3(i).2(z)-15.2(a)12.9(tion)-443.2(proce)-15.2(d)16(u)-15.2(r)13.6(e)-15.2(s)-428.8(s)-15.2(h)12.9(ow)-15.2(e)11.7(d)-443.6(tha)-15.2(t)]TJ
T*
0 Tc
[(t)14.8(e)0(l)26.1(e)17(me)28.7(d)14.2(i)15.4(ci)26.1(n)14.6(e)-280.1(p)14.2(a)17.4(t)14.8(i)15.4(en)25.3(t)14.8(s)-278.9(w)16.2(e)17(r)12.6(e)-280.1(mo)25.8(r)18.9(e)-280.1(l)15.4(i)15.4(k)13.1(el)26.2(y)-276.7(t)14.8(o)-283(r)18.9(ec)27.8(ei)26.2(v)14.2(e)-280.1(su)28.1(c)17(h)-281(t)14.8(r)12.6(e)17(a)0(t)25.9(m)18(en)25.3(t)-276(t)14.8(h)16.2(a)0(n)]TJ
T*
-.015 Tc
[(non-tele)-15(m)13.7(e)-15(d)9.9(i).4(cine)-427.9(pa)-15(t)10.9(i).4(ents)-433(\(20.5%)-429.6(vers)-15(u)13.1(s)-426.7(16.)-15(4)10.5(%).3(\).)-427.3(This)-433(sys)-15(t)11.8(em)-427(s)-15(a)14.4(ve)-15(d)]TJ
T*
0 Tc
[(t)14.8(i)15.4(me)-199(i)15.4(n)-213.1(t)14.8(h)16.2(e)-210.6(i)15.4(n)14.5(i)15.4(t)14.8(i)15.4(at)25.9(i)15.4(o)14.2(n)-213.1(o)14.2(f)-210.8(i)15.4(n)14.6(t)14.8(e)17(r)12.6(v)14.2(e)17(n)14.5(t)14.8(i)15.4(o)14.2(n)14.6(a)0(l)-201.1(t)14.8(h)16.2(e)17(r)12.6(a)17.4(p)14.2(y)14.2(,)-216.3(a)17.4(s)-209.4(we)26.9(l)15.4(l)-212.2(a)17.4(s)-215.7(t)14.8(h)16.2(e)-210.6(n)14.6(ec)27.8(es)29(sa)29.4(r)12.6(y)]TJ
0 -1.3278 TD
[(p)14.2(r)12.6(o)14.2(c)17(es)29(si)27.4(n)14.6(g)-295.7(o)14.2(f)-299.3(i)15.4(n)14.6(f)16.9(o)14.2(r)12.6(m)18(ed)-284.9(c)17(o)14.2(n)14.6(s)0(e)29(n)14.5(t)-301.3(a)17.4(n)14.6(d)-295.7(p)14.2(r)12.6(e)17(p)14.2(ar)30(at)25.9(i)15.4(o)14.2(n)-295.3(o)14.2(f)-299.3(t)14.8(h)16.2(e)-299.1(i)15.4(n)14.6(t)14.8(e)17(r)12.6(v)14.2(e)17(n)14.5(t)14.8(i)15.4(o)14.2(n)14.5(al)]TJ
0 -1.3341 TD
[(t)14.8(e)0(a)28.1(m)-266.6(b)14.2(e)17(f)16.9(o)14.2(r)12.6(e)-267.5(t)14.8(h)16.2(e)-267.5(p)14.2(a)17.4(t)14.8(i)15.4(e)0(n)25.3(t)14.8(s)18.3()-266.8(ar)30(r)12.6(i)15.4(v)14.2(a)17.4(l)-269.1(a)17.4(t)-263.4(t)0(h)24.7(e)-267.5(r)18.9(e)0(g)24.9(i)15.4(o)14.2(n)14.6(a)17.4(l)-262.8(st)26.8(r)12.6(o)14.2(k)19.5(e)-267.5(ce)27.8(n)14.5(t)14.8(e)17(r)12.6(.)]TJ
1.1128 -1.3341 TD
[(Al)13.2(tho)13.6(ugh)-351.8(th)12.1(e)-356(vas)11.9(t)-351.9(maj)12.9(orit)19(y)-358.9(o)0(f)-348.4(tele)13.8(st)14.1(rok)14.6(e)-356(stu)11.4(die)15(s)-354.8(rel)13.4(ied)-351.7(on)-350.7(qu)11.4(asi)13.2(-)]TJ
-1.1128 -1.3341 TD
[(exp)14.1(eri)13.4(men)11.6(ta)13.3(l)-547.3(d)0(e)12.2(sign)18.2(s,)-539.4(mos)12.5(tly)-537.3(by)-540.7(ne)12.6(cess)13.7(ity)12.8(,)-545(i)0(n)-539.1(201)17.2(2)-548.6(a)-545.3(rar)17.3(e)-545.7(RCT)15.7(,)]TJ
T*
[(co)18.6(nd)16.1(uc)20.6(te)19.2(d)-327.3(i)0(n)-324.1(G)14.7(er)17(ma)22.7(ny)16.1(,)-330.1(c)0(o)18.6(m)0(p)19.5(a)0(r)17.3(e)0(d)-316.5(d)0(i)17(a)0(g)18.9(n)14.6(os)13.5(is)-314.1(an)19.3(d)-333.6(t)0(r)21.1(e)0(a)21.8(t)0(m)13.8(e)0(n)18.9(t)-326.6(of)-316.7(st)14.1(r)12.6(o)0(k)21(e)]TJ
T*
[(pa)18.9(ti)17.6(en)19(ts)-314.7(in)-317.8(a)-330.3(m)0(o)19.5(b)14.2(il)18.2(e)-330.7(s)0(t)20.5(r)12.6(ok)14.7(e)-324.4(u)0(n)18.1(i)0(t)-317.5(v)0(e)18.6(r)0(s)18.2(u)0(s)-319.6(i)0(n)23.7(-)0(h)17.5(o)0(s)19.8(p)0(i)17(t)0(a)19.6(l)0(.)]TJ
6.7246 0 0 5.9768 510.5196 147.9118 Tm
(99)Tj
8.9663 0 0 8.9663 520.3841 143.9433 Tm
[(Ra)22.4(nd)16.1(om)19.5(iz)19.8(at)19.6(io)17(n)]TJ
-22.1112 -1.3341 TD
[(wa)20.9(s)-133.5(b)0(y)-123.4(w)0(e)20.6(e)0(k)17.5(,)-134.1(al)20.2(te)19.2(r)12.6(n)0(a)19.3(t)0(i)17.6(n)0(g)-123(b)14.2(et)12.9(we)20.5(en)-120.2(ex)18.9(pe)18.6(ri)15.3(me)22.4(nt)16.7(al)-118.9(an)19.3(d)-131.3(c)0(o)18.6(n)0(t)16.7(r)12.6(ol)-122.2(gr)20.4(ou)17.7(ps)19.8(,)-134.1(a)0(n)19.3(d)]TJ
T*
[(wa)20.9(s)-253.6(n)0(o)16.1(t)-250.7(ma)16.4(sk)25.1(ed)-247(fr)23.1(om)-246.1(pa)18.9(ti)17.6(en)18.9(ts)-238.8(or)-245.2(in)17.3(ve)18.6(st)20.4(ig)17(at)19.6(or)20.4(s.)-242.2(Th)17.7(e)-254.8(m)0(o)19.5(b)0(i)23.3(l)0(e)-245.7(u)0(n)18.1(i)0(t)17.6(s)-253.6(we)20.5(r)12.6(e)]TJ
0 -1.3278 TD
[(eq)18.6(ui)19(pp)15.7(ed)-247(wi)18.9(th)-253.5(a)-260.8(C)0(T)-248.5(s)0(c)16.3(a)0(n)19.3(n)14.6(er)17(,)-260.5(l)0(a)20.2(b)0(o)15.7(r)12.6(at)19.6(or)20.4(y,)-252.7(an)19.3(d)-257.7(t)0(e)19.2(l)0(e)13.5(m)0(e)22.4(d)0(i)16.9(c)0(i)19.8(n)0(e)-246.6(e)0(q)18.6(u)0(i)19(p)0(m)19.5(e)0(n)19(t)0(.)]TJ
0 -1.3341 TD
[(The)-154.9(study)-162.7(was)-150.5(terminated)-160.3(after)-155.3(interim)-157.8(analysis)-159.9(of)-152.3(100)-159.8(cases)-158.5(because)-154.7(it)]TJ
T*
[(met)-247.4(prespecified)-247.1(criteria)-244.4(for)-247.3(termination)-248.6(\(i.e.,)-246.8(the)-242.8(benefits)-251.2(were)-240.7(obvi-)]TJ
T*
[(ous\).)-449.4(The)-452.1(median)-447.2(time)-446.9(from)-450.6(alarm)-444(to)-451.6(therapy)-450(decision)-449.3(decreased)]TJ
/F11 1 Tf
11.9551 0 0 11.9551 50.1732 741.9966 Tm
[(BASHSHUR)-338.5(ET)-334.1(AL.)]TJ
7.9702 0 0 7.9702 50.1732 29.7638 Tm
[(7)-80(8)-75.6(4)-706.7(TELEMEDIC)12.9(INE)-329.6(and)-331.8(e-HEALTH)]TJ
/F8 1 Tf
6.9738 0 0 6.9738 177.5621 29.7638 Tm
.103 Tc
[(SE)-4.8(P)-6.4(T)-8.1(E)-4.8(M)-8.4(BE)-4.8(R)-339.7(2)-6.4(0)-7.9(1)-6.5(4)]TJ
ET
q
1 i
0 792 612 -791.985 re
W n
32.315 .014984 .22675 791.985 re
f
/Document /MC9 BDC
Q
q
1 i
0 792 32.315 -173.367 re
W n
0 0 0 .29999 k
0 618.633 32.315 173.367 re
f
EMC
Q
32.315 763.994 242.646 .22675 re
f
endstream
endobj
256 0 obj
<>stream
Adobe Illustrator CS4
2010-08-04T11:54:42+05:30
2010-08-04T11:54:42+05:30
2010-08-04T11:54:42+05:30
68
256
JPEG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application/postscript
saved
xmp.iid:11FB61F30AB7DE11AEB3E861853EAFA4
2009-10-12T14:15:50+05:30
Adobe Illustrator CS4
/
converted
from application/postscript to application/vnd.adobe.illustrator
converted
from application/postscript to application/vnd.adobe.illustrator
saved
xmp.iid:0280117407206811994CBE3149FFDB59
2010-08-04T11:54:42+05:30
Adobe Illustrator CS4
/
converted
from application/postscript to application/vnd.adobe.illustrator
xmp.iid:11FB61F30AB7DE11AEB3E861853EAFA4
xmp.did:11FB61F30AB7DE11AEB3E861853EAFA4
uuid:ee5a72b3-04e4-4157-a8d8-c3a8817872a3
uuid:ee5a72b3-04e4-4157-a8d8-c3a8817872a3
xmp.iid:0280117407206811994CBE3149FFDB59
xmp.did:0280117407206811994CBE3149FFDB59
TouchUp 7.0
False
False
1
684.000000
864.000000
Points
Black
Default Swatch Group
0
PANTONE 3025 C
SPOT
100.000000
CMYK
100.000000
16.859999
0.000000
50.980003
endstream
endobj
253 0 obj
<>
endobj
257 0 obj
<>/XObject<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]/Font<>>>/Thumb 259 0 R/MediaBox[0 0 612 792]/Rotate 0>>
endobj
260 0 obj
<>/ProcSet[/PDF/Text]/Font<>>>
endobj
258 0 obj
<>stream
/GS1 gs
BT
/F1 1 Tf
8.9663 0 0 8.9663 35.8866 693.8644 Tm
0 0 0 1 k
0 Tc
0 Tw
[(from)-153.4(76)-161.4(minutes)-157.6(to)-160.7(35)-155(minutes.)-158.9(Similar)-161.4(gains)-154.1(were)-164.8(observed)-156.6(regarding)]TJ
0 -1.3278 TD
[(times)-175.7(from)-178.7(alarm)-172.1(to)-179.7(CT)-178.9(scan,)-174.3(to)-179.7(end)-175.5(of)-177.6(laboratory)-181.9(analysis,)-173.8(and)-181.5(to)-173.3(start)]TJ
0 -1.3341 TD
[(of)-354.7(intravenous)-361.9(thrombolysis.)-365.8(Differences)-368.4(in)-355.7(neurological)-366.5(outcomes)]TJ
T*
[(between)-243.3(the)-242.8(two)-239.4(groups)-245.6(at)-239.6(7)-238.7(days)-239.5(were)-247(not)-241(statistically)-240.1(significant.)]TJ
/F5 1 Tf
.999 -2.6683 TD
[(Health)-443.1(outcomes)-441.3(and)-444.4(cost.)]TJ
/F1 1 Tf
11.8934 0 TD
-.015 Tc
[(Th)-15(r)13.8(e)-15(e)-379.3(l).4(arge-s)-15(c)14(a)-15(l)11.5(e)-390(stu)-15(d)9(ies)-388.7(i).4(nve)-15(s)14(tiga)-15(t)10.9(e)2(d)]TJ
-12.8924 -1.3341 TD
[(hea)-15(l)11.5(th)-365.5(outc)-15(o)9.9(m)3(es)-15(.)-352.1(I)-15(n)-349.7(2009,)-364(a)-364.3(p)-.8(rospe)-15(c)12.8(tive)-364.7(nonrandom)-15(i)12.1(z)2(e)-15(d)-350.5(s)-15(t)11.8(udy)-367.6(c)2(om-)]TJ
T*
-.0153 Tc
[(pared)-329.9(a)-326.7(network)-324.6(o)-1.1(f)-327.2(f)-15.3(i)10.7(v)-1.1(e)-327(c)1.7(om)-15.3(m)14.3(u).9(nity)-329.9(hos)-15.3(p)10.8(ital)-15.3(s)-316.7(w).9(ith)-327.9(t)-.5(e)-15.3(l)10.9(es)-15.3(t)11.5(r)3.6(oke)-327(s)-15.3(e)13.7(r)-2.7(vice)-15.3(s)]TJ
T*
-.0151 Tc
[(with)-321.4(five)-320.5(m)-15.1(a)14(tch)-15.1(e)11.8(d)-323.4(c)1.9(om)-15.1(m)14.5(u)1.1(nity)-323.4(hos)-15.1(p)11(itals)-319.3(w)-15.1(i)10.2(t)-.3(hout)-322.7(tele)-15.1(s)13.9(t)-.3(roke,)-319.9(i).3(nvolving)]TJ
0 -1.3278 TD
-.0158 Tc
[(all)-190(p)-1.6(a)-15.8(t)10.1(ients)-193.5(\()]TJ
/F5 1 Tf
4.8117 0 TD
0 Tc
(n)Tj
/F9 1 Tf
.6955 0 TD
(=)Tj
/F1 1 Tf
.7018 0 TD
[(3)14.2(,)0(0)25.5(6)14.2(0)14.2(\))-174.2(w)16.2(i)15.4(t)14.8(h)-179.8(c)17(o)14.2(n)14.6(s)0(e)29(c)17(ut)24.7(i)15.4(v)14.2(e)-172.6(i)0(s)27.4(c)0(h)26.9(e)17(mi)27.1(c)-172.6(o)14.2(r)-177.1(h)16.2(em)28.7(o)14.2(r)12.6(r)12.6(h)16.2(a)17.4(g)14.2(i)15.4(c)-179(st)26.8(r)18.9(o)14.2(k)13.1(e)]TJ
-6.2091 -1.3341 TD
-.0153 Tc
[(admi)-15.3(t)8.6(t)-.5(ed)-260.4(betw)-15.3(e)11.6(e)1.7(n)-260(2003)-260.4(and)-254(2005.)]TJ
6.7246 0 0 5.9768 158.7401 578.3243 Tm
-.0226 Tc
[(10)-22.6(0)]TJ
8.9663 0 0 8.9663 171.1559 574.3557 Tm
0 Tc
[(T)14.2(h)16.2(i)15.4(s)-247.3(G)14.7(e)17(r)12.6(m)18(an)-227.3(st)26.8(u)16.2(d)14.2(y)-245.1(m)18(ea)28.1(su)28.1(r)12.6(e)17(d)-245.1(t)14.8(h)16.2(e)]TJ
-15.0865 -1.3341 TD
-.0154 Tc
[(eff)-15.4(e)12.2(c)-15.4(t)10.1(s)-212.1(o)-1.2(f)-213.5(t)-.6(ele)-15.4(s)13.6(t)-15.4(r)12(oke)-213.3(o)-1.2(n)-209.5(d)-1.2(e)-15.4(a)12.7(th)-15.4(,)-202.8(i)0(nsti)-15.4(t)8.5(u).8(tional)-214.9(ca)-15.4(r)8.3(e)1.6(,)-212.7(a)2(nd)-216.2(dis)-15.4(a)14(bility.)-219(Of)-213.5(3,060)]TJ
T*
-.0151 Tc
[(patie)-15.1(n)10.2(ts,)-313.5(1)-.9(,938)-317.1(were)-314.2(in)-310.4(the)-314.2(i).3(ntervention)-316.7(g)-.9(roup,)-313.5(a)-15.1(n)16.9(d)-317.1(1,122)-310.8(w)-15.1(e)11.8(re)-307.9(in)-316.7(the)]TJ
T*
0 Tc
[(c)17(o)14.2(n)14.6(t)14.8(r)12.6(o)14.2(l)-332.3(g)14.2(r)18.9(o)14.2(up)24(.)-330.1(F)14.2(o)14.2(l)15.4(l)15.4(o)14.2(w-)23.8(u)16.2(p)-333.6(r)12.6(a)17.4(t)14.8(e)17(s)-335.8(w)16.2(er)29.6(e)-337(h)16.2(i)15.4(g)14.2(h:)-320.4(9)14.2(7)14.2(.)0(2)25.5(%)-332.4(f)16.9(o)14.2(r)-335.2(1)14.2(2)-333.6(m)18(o)14.2(n)14.6(t)14.8(h)16.2(s)-335.8(a)17.4(n)14.6(d)]TJ
T*
-.015 Tc
[(95.7%)-309.5(afte)-15(r)-295.2(3)-.8(0)-304.3(m)3(onth)-15(s)-296.7(f)1.9(or)-305.9(dea)-15(t)10.9(h)-302.3(a)-15(n)10.7(d)-304.3(depe)-15(n)10.3(d)-.8(enc)-15(y)16.2(.)-307.1(T)-.8(h)-15(e)-291.6(a)-15(u)12.3(thors)-306.5(f)1.9(ound)]TJ
T*
-.0154 Tc
[(that)-221.9(dea)-15.4(t)10.5(h)-220.5(a)2(nd)-222.5(depende)-15.4(n)9.9(cy)-222.5(we)-15.4(r)14.2(e)-219.7(s)-15.4(i)12(gnific)-15.4(a)12.7(n)-.8(tly)-222.5(l)0(owe)-15.4(r)-207.1(in)-215.8(th)-15.4(e)-209.8(i)0(ntervention)]TJ
T*
0 Tc
[(g)14.2(r)18.9(o)14.2(u)0(p)-279.5(a)17.4(n)14.6(d)-289.3(t)14.8(h)0(a)27.3(t)-288.7(t)14.8(h)0(e)26.9(s)0(e)-274.5(d)14.2(if)26(f)16.9(e)0(r)29.6(e)0(n)25.3(c)17(es)-274.5(he)26.9(l)15.4(d)-295.7(a)17.4(c)17(r)12.6(o)14.2(ss)-273.3(t)14.8(h)0(e)-276.6(t)14.8(wo)-279.5(f)16.9(o)14.2(l)15.4(l)0(o)23.3(w)16.2(-)14(u)16.2(p)-289.3(t)14.8(i)15.4(m)0(e)28.7(s)0(.)]TJ
0 -1.3278 TD
-.0154 Tc
[(Moreove)-15.4(r)14.2(,)-282.2(th)-15.4(e)11.5(s)-15.4(e)-270.9(d)-1.2(iff)-15.4(e)12.2(renc)-15.4(e)12.4(s)-288(re)-15.4(m)13.3(a)2(i)-15.4(n)8.3(ed)-285.8(whe)-15.4(n)-268.3(t)-.6(h)-15.4(e)-273(au)-15.4(t)9.3(h).8(ors)-281.7(c)1.6(ontrolle)-15.4(d)-268.7(f)-15.4(o)9.3(r)]TJ
0 -1.3341 TD
-.015 Tc
[(age,)-477.8(ge)-15(n)10.3(d)-.8(er,)-477.8(living)-475.1(w)-15(i)10.3(t)-.2(h)-479.3(a)-471.8(pa)-15(r)15(t)-.2(ne)-15(r)14.6(,)-477.8(s)-15(e)14(ve)-15(r)14.6(i)-15(t)8.9(y)-475.1(of)-478.7(the)-478.5(s)-15(t)11.8(r)3.9(oke,)-477.8(a)-15(n)10.7(d)-475(c)-15(o)16.2(-)]TJ
T*
-.0152 Tc
[(morbidities)-15.2(.)-270.1(The)-276.4(m)-15.2(o)10.6(s)3.1(t)-278.6(s)-15.2(i)12.2(g)-1(nif)-15.2(i)10.8(cant)-278.6(f)-15.2(i)10.8(nding)-279.2(w)1(a)-15.2(s)-264(th)-15.2(e)-266.5(l).2(ong-term)-281.8(re)-15.2(d)9.7(u)1(ction)]TJ
T*
[(in)-278.9(dea)-15.2(t)10.7(h)-277.2(a)-15.2(n)10.5(d)-279.2(dis)-15.2(a)14.2(bility)-285.6(f)1.7(or)-280.8(thos)-15.2(e)-270.7(r)3.7(e)-15.2(c)12.6(e)-15.2(i)11(ving)-279.2(tel)-15.2(e)11(s)-15.2(t)11.6(roke)-282.7(se)-15.2(r)14.4(v)-1(ic)-15.2(e)12.6(s)-15.2(.)]TJ
1.1065 -1.3341 TD
0 Tc
[(Another)-241.7(long-term)-238.4(longitudinal)-241.9(study)-238.5(was)-239(conducted)-240.2(in)-235.6(Germany)]TJ
-1.1065 -1.3341 TD
[(from)-286.2(2006)-297.4(to)-287.2(2009.)]TJ
6.7246 0 0 5.9768 108.6803 434.8345 Tm
(101)Tj
8.9663 0 0 8.9663 121.7763 430.866 Tm
[(Over)-292.3(a)-292.4(period)-291.8(of)-291.4(4)-289.3(years,)-288.5(the)-293.4(number)-293.2(of)-291.5(tele-)]TJ
-9.5792 -1.3341 TD
[(consultations)-401.9(increased)-406.6(from)-406.4(49)-401.6(in)-400(2006)-404.9(\(technical)-408.6(and)-402.8(organiza-)]TJ
T*
[(tional)-186.4(proof-of-concept)-190.3(phase\))-186(to)-186(177)-185.1(in)-185(2007)-189.9(\(implementation)-187.4(stage\))]TJ
0 -1.3278 TD
[(and)-225.7(577)-229.4(in)-229.2(2009,)-229.1(with)-228.2(a)-229.2(total)-226.8(of)-228.2(1,152)-229.1(consultations)-231.1(during)-229.1(the)-230.1(study)]TJ
0 -1.3341 TD
[(period.)-539.7(Clinical)-543.9(data)-543.2(were)-544.2(gathered)-546.8(from)-539.1(a)-545.3(nationwide)-541.8(network)]TJ
T*
[(consisting)-292.2(of)-291.4(11)-294.1(hospitals)-292.1(\(six)-290.4(primary-care)-298.2(NeuroNet)-296(hospitals)-292.1(and)]TJ
T*
[(five)-568.8(tertiary-care)-568.2(stroke)-573.9(centers\).)-570(In)-568.7(addition,)-570.3(five)-568.8(primary-care)]TJ
T*
[(hospitals)-241.5(were)-234.4(used)-244.2(as)-236.2(controls)-239.4(\(matched)-243(by)-237.2(bed)-239.2(size,)-237(departments)-244.5(of)]TJ
T*
[(internal)-403(medicine,)-403.7(and)-396.5(distance)-408.7(to)-401(specialized)-403.2(stroke)-403.2(centers\).)-405.6(The)]TJ
T*
[(hospitals)-450.2(in)-456.9(the)-451.4(control)-453.7(group)-459.9(benefited)-453.2(from)-450.6(the)-457.8(same)-454.1(manage-)]TJ
T*
[(ment)-340.3(system)-348.4(with)-342.1(educational)-344.8(content)-348.3(and)-339.6(peer)-343.9(review)-350.2(but)-340.5(had)-344.2(no)]TJ
0 -1.3278 TD
[(telestroke)-294.6(capability.)-294.7(The)-294(NeuroNet)-296(concept)-295.8(involved)-291.9(the)-293.4(use)-296.3(of)-291.4(tel-)]TJ
0 -1.3341 TD
[(emedicine)-277.9(\(a\))-274.2(to)-274.5(transfer)-280.6(knowledge)-275.1(from)-279.9(stroke)-276.7(centers)-274.4(to)-280.8(primary-)]TJ
T*
[(care)-302.7(hospitals,)-306(\(b\))-302.7(to)-306.1(implement)-304.5(a)-305(standardized)-306.1(stroke)-302(protocol,)-308.4(and)]TJ
T*
.0107 Tc
[(\(c\))-441.8(t).2(o)-436.7(p)-.4(ro)10.7(v)-5.2(i).8(de)-440.2(contin)10.7(u)-9.1(i).8(ng)-436.7(medical)-435.4(e)-3.9(d)10.7(u)-9.5(cati)-5.5(o)10.7(n)-447.4(and)-436.7(p)-.4(eer)-438.3(r)-2(eview)-434.7(i).8(n)]TJ
T*
[(strok)10.7(e)-9.7(.)-205.5(O)3.4(ver)-204.4(t).2(he)-206.2(course)-206.2(of)-206.4(the)-206.2(s)3.7(tudy,)-205.5(t)10.7(h)-8.9(e)-206.2(u)1.6(se)-206.2(of)-206.4(thrombolytic)-206.2(ther)10.7(apy)]TJ
T*
.0099 Tc
[(increased)-361.6(b)-1.2(y)-355.3(4)-1.2(.8%)-360.5(i)0(n)-354.9(N)-.7(euroNet)-354.7(h)-5.5(ospitals)-363.8(while)-358.8(mortality)-361.6(r)9.9(i)-6.4(s)-3.4(k)-356.3(d)-1.2(e-)]TJ
T*
.0107 Tc
[(creased)-411.4(b)-.4(y)-411.4(a)2.8(pprox)10.7(i)-9.9(m)3.4(ately)-411.4(2)10.7(9%)-410.3(compared)-411.4(with)-415.7(contr)10.7(o)-6.8(l)-410.1(h)1.6(ospitals.)]TJ
T*
[(Bet)10.7(w)-8.9(een)-259.3(2006)-259.7(an)10.7(d)-270.4(2009,)-262.5(ischemic)-263.1(strok)10.7(e)-268.9(mor)10.7(t)-6.2(ali)-5.5(t).2(y)-259.7(d)-.4(ecr)10.7(e)-10.3(ased)-259.7(i)-5.5(n)-259.3(all)]TJ
0 -1.3278 TD
[(thr)10.7(e)-10.3(e)-269.4(h)1.6(ospital)-271(c)-3.9(ohor)10.7(t)-6.2(s)-2.6(.)-268.8(D)-1.9(uring)-272.3(t).2(he)-269.4(implementation)-271.9(stage)-269.4(\().8(2007)-272.3(an)10.7(d)]TJ
0 -1.3341 TD
[(200)10.7(8\),)-414.2(both)-415.7(N).1(euroNet)-417.1(a)2.8(nd)-411.4(contr)10.7(o)-6.8(l)-416.5(h)1.6(ospitals)-413.6(had)-417.7(n)10.7(e)-8.3(a)2.8(rly)-411.4(i).8(den)10.7(t)-4.2(i)-5.5(c)2.4(al)]TJ
T*
.0106 Tc
[(mortality)-613.8(d)-.5(eclines)-616.1(\(from)-610.1(10.5%)-619(to)-613.8(7)10.6(.)-8.1(5%)-612.7(and)-613.8(10%)-612.7(an)10.6(d)-618.3(7)-.5(.5%,)]TJ
T*
.0104 Tc
[(r)10.4(e)-10.6(spectively\).)-319.7(Treatment)-316.2(w)-5.1(ith)-314.8(t)-.1(PA)-320.6(in)-316.5(Neu)-5(r)10.4(o)-7.1(N)-.2(et)-316.2(hosp)10.4(i)-10.6(t)-.1(als)-319.1(i).5(ncreased)]TJ
T*
[(by)-411.6(1)10.5(.)-8.2(6%)-410.5(per)-413.2(y)-.6(ear)10.5(,)-420.8(r)10.5(e)-10.5(achin)10.5(g)-416(5.8%)-410.5(after)-406.9(4)-411.6(years.)-414.4(Confor)10.5(m)-9.6(i).6(ty)-411.6(with)]TJ
T*
[(pr)10.5(o)-7(t)0(ocols)-540.3(f)2.1(or)-539.7(str)10.5(o)-7(ke)-535.2(coding)-538.1(\(a)-534.8(process)-540.3(v)-.6(ariable\))-543.1(also)-538.1(increased)]TJ
T*
[(by)-418(45%)-423.2(in)-424(NeuroNet)-423.7(hospitals)-426.6(a)2.5(nd)-424.4(b)10.4(y)-429.2(18%)-423.2(in)-424(contr)10.4(o)-7.1(l)-423.1(h)1.3(ospitals.)]TJ
T*
[(The)-383.4(a)2.6(u)-4.9(t)0(hor)10.5(s)-394.9(concluded)-380(t)0(h)-4.9(a)2.6(t)-385.7()59.8(Neu)-4.9(r)10.5(o)-7(Net)-385.7(h)1.4(as)-382.2(substantially)-386.3(contrib)10.5(-)]TJ
0 -1.3278 TD
.0108 Tc
[(uted)-620(to)-613.6(impr)10.8(o)-6.7(v)-.3(ing)-613.6(s)-2.5(tr)10.8(o)-6.7(k)-1.4(e)-617.1(c)2.5(ar)10.8(e)]TJ
/F12 1 Tf
13.9736 0 TD
0 Tc
(.)Tj
/F1 1 Tf
1.0053 0 TD
.011 Tc
[(and)-613.4(y)-.1(ielded)-613.4(ben)11(e)-8(fits)-615.7(even)-613.1(in)]TJ
-14.979 -1.3341 TD
.0086 Tc
[(str)-4.1(o)-2.5(k)8.6(e)-290(ce)-6(nter)-4.1(s.)-5.3()57.9()]TJ
6.7246 0 0 5.9768 94.7905 100.1197 Tm
.0111 Tc
[(10)-8.5(1)]TJ
8.9663 0 0 8.9663 45.8079 84.189 Tm
-.0199 Tc
[(In)-504.9(2)-5.7(012)-511.6(\(published)-511.6(i)1.9(n)-511.2(2013)-5.7(\),)-508(the)-508.7(c)3.5(o)-5.7(s)4.7(t)-5.1(-).4(effectiv)-5.7(eness)-507.5(o).6(f)-508.9(t)1.2(elestroke)]TJ
-1.1065 -1.3341 TD
-.0219 Tc
[(net)-7.1(w).6(orks)-193.3(in)-197(the)-194.5(m)-3.9(an)-7.3(age)-4.9(m)-3.9(ent)-196.8(o)-1.4(f)-194.7(a)1.9(c)-4.9(u).6(t)-7.1(e)-194.5(is)-3.6(ch)-5.7(em)-3.9(ic)-194.5(s)-3.6(t)-.8(roke)-194.5(wa)-4.5(s)-193.3(a)-4.5(ss)-3.6(e)-4.9(s)-3.6(se)-4.9(d)-191.1(f)-5(rom)]TJ
30.331 69.3307 TD
-.0201 Tc
[(the)-281.3(p).4(erspect)-5.3(i)1.7(ve)-287.6(of)-281.5(a)-287.2(h)2.4(ub-an)-5.5(d).4(-spoke)-281.3(h)-3.9(ospit)-5.3(a)3.7(l)-282.9(n)-5.5(et)-5.3(work.)]TJ
6.7246 0 0 5.9768 499.8613 697.8896 Tm
-.031 Tc
[(10)-8.4(2)]TJ
8.9663 0 0 8.9663 512.3904 693.8644 Tm
-.0227 Tc
[(Ov)-8.5(er)-288.4(a)-283.5(7)-8.5(-ye)-5.7(a)1.1(r)]TJ
-22.8131 -1.3278 TD
-.0198 Tc
[(period,)-318.3(data)-318.5(from)-318(two)-315.5(h)2.7(ub-and-spoke)-318.9(n)1.1(etwork)6(s)-317.7(\()-4.4(each)-319.7(havi)-4.4(ng)-315.5(one)-318.9(h)2.7(ub)]TJ
0 -1.3341 TD
-.0191 Tc
[(and)-498.1(s)5.5(even)-497.7(spoke)4.3(s)-.8(,)-500.9(a)4.7(s)-500.3(a)-494.9(typica)4.7(l)-496.9(t)2(elestroke)-495.2(n)1.8(etwork\)Georgia)-494.9(H)-4.4(e)4.3(a)-1.7(lth)]TJ
T*
-.0185 Tc
[(Sc)4.9(ie)4.9(nces)-329(University)-326.8(and)-333.1(t)2.6(h)4(e)-330.2(Ma)5.3(yo)-326.8(Cl)]TJ
14.9663 0 TD
-.0201 Tc
[(inicwere)-325.5(u)-3.9(sed)-334.7(t)1(o)-328.4(c)-3.1(ompare)-331.9(costs)]TJ
-14.9663 -1.3341 TD
-.0219 Tc
[(a)-4.5(n)-1(d)-355.5(e)-4.9(ff)-5(ec)-4.9(ti)-6.5(ven)-7.4(e)1.5(s)-3.6(s)-357.7(wi)-6.5(th)-353.5(a)-4.5(n)-1(d)-355.5(w)-5.7(ith)-5.7(o)-1.4(ut)-361.2(a)-352.2(t)-7.1(el)-6.5(es)-3.6(troke)-358.9(n)-1(e)-4.9(t)-.8(wo)-7.7(rk.)-358.3(T)-1.4(h)-5.7(e)-352.6(a)-4.5(u).6(t)-7.1(h).6(ors)]TJ
T*
-.0204 Tc
[(developed)-366.6(a)-363.4(deci)-5(si)-5(on-analyti)-5(c)-363.8(m)3.9(o)-6.2(d)]TJ
14.2392 0 TD
-.0189 Tc
[(e)4.5(l)-363.9(to)-365.1(compa)4.8(r)0(e)-362.3(t)-4.1(h)3.6(e)-362.3(costs)-361(a)-1.5(nd)-365.1(e)4.5(ffe)4.5(c-)]TJ
-14.2392 -1.3341 TD
-.0198 Tc
[(ti)-4.4(ven)-5.2(e)3.6(ss)-197.5(of)-199(t)-5(h)2.7(e)-198.8(t)1.3(elestroke)-198.8(n)1.1(etwork)6(.)-204.4(T).7(hi)]TJ
14.8019 0 TD
-.0205 Tc
[(s)-198.2(m)3.8(o)-6.3(d)0(el)-201.1(traced)-202.3(the)-199.5(c)-3.5(riti)-5.1(cal)-201.1(d)0(eci)-5.1(s)4.1(i)-5.1(o)0(n)]TJ
-14.8019 -1.3341 TD
-.0187 Tc
[(points)-335.5(i)-3.3(n)-332.9(t)2.4(he)-336.8(ca)5.1(re)-336.8(process)-335.5(f)4.5(or)-334.9(isch)3.8(em)5.6(ic)-336.8(stroke)-336.8(patients)-335.5(pre)4.7(s)-.4(enting)-339.6(at)-332.7(a)]TJ
T*
-.0202 Tc
[(telestroke)-376.2(n)-5.6(e)3.2(t)-5.4(w)2.3(ork)-380.1(a)3.6(n)-5.6(d)-379.1(tho)-6(s)4.4(e)-382.5(w)2.3(i)-4.8(t).9(ho)-6(ut,)-381.9(i)1.6(ncluding)-379.1(b)-6(o).3(th)-377(hub)-379.1(a)-2.8(nd)-379.1(spoke)]TJ
0 -1.3278 TD
-.0185 Tc
[(sites.)-342.2(Outcome)-342.9(m)-.5(ea)5.3(sures)-341.7(i)3.3(nc)4.9(luded)-345.8(t)2.6(el)]TJ
14.9663 0 TD
[(ec)5(ons)6.2(u)-2.2(ltation)-339(r).5(ates,)-342.1(t)2.7(h)4.1(r).5(om)5.9(bolysis)]TJ
-14.9663 -1.3341 TD
-.0198 Tc
[(treat)-5(m)4.5(ent,)-311.9(endovascular)-310.7(therapies,)-311.9(and)-309.1(p).7(atient)-308.5(t)-5(r)5.4(ansfers)-311.4(f)3.4(rom)-311.7(s)-1.5(poke)-312.6(t)1.3(o)]TJ
T*
-.0203 Tc
[(hub)-341.2(h)-4.1(ospital.)-344(The)-344.7(a)-2.9(nal)-4.9(y).2(sis)-343.5(s)4.3(t)-5.5(a)3.5(rted)-341.2(wi)-4.9(th)-339.2(an)-340.9(annual)-340(1,112)-341.2(p)-6.1(a)3.4(ti)-4.9(en)-5.7(ts)-337.1(with)]TJ
T*
-.0191 Tc
[(isch)3.4(emic)-337.2(stroke)-343.5(pre)4.3(s)-.8(enting)-340(a)4.6(t)-339.4(em)5.2(ergency)-340(d)1.4(e)4.3(p)-4.9(a)4.6(r)-.2(tments)-335.9(in)-339.7(th)3.4(e)-343.5(n)1.8(etw)3.4(o)1.4(rk.)]TJ
T*
-.0203 Tc
[(The)-306.8(m)-2.3(odel)-302(p)-6.1(redi)-4.9(ct)-5.5(ed)-309.6(114)-309.6(fewer)-311.2(p).2(atients)-311.9(w)2.2(ould)-309.6(be)-306.8(admitt)-5.5(ed)-309.6(to)-309.6(the)-306.8(h)2.2(ub)]TJ
T*
[(each)-181.1(year)-178.5(for)-178.5(t).8(hose)-180.3(i)-4.9(n)-176.5(a)-179.9(n)-5.7(et)-5.5(work)-184.2(and)-183.2(t).8(hat)-182.5(1)-6.1(6)-176.9(a)-2.9(ddi)-4.9(tion)-5.8(al)-181.9(patient)-5.5(s)-179.1(wo)-6.1(uld)-183.2(b).2(e)]TJ
T*
-.0197 Tc
[(admitted)-220.5(t)1.4(o)-220.5(e)3.7(ach)-218.5(s)-1.4(poke)-217.6(h)-3.5(ospital)-219.2(w)2.8(i)-4.3(t)1.4(hout)-219.9(a)-217.3(n)1.2(etwork)6.1(.)-223.3(A)3.4(bo)-5.5(ut)-219.9(45)-220.5(additi)-4.3(onal)]TJ
T*
-.0204 Tc
[(patients)-400.5(would)-398.3(b).1(e)-395.4(t).7(reated)-398.3(with)-396.2(tP)-5.9(A,)-394.7(and)-398.3(2).1(0)-391.9(m)-2.4(ore)-395.4(w)-4.2(ith)-396.2(e)-3.4(ndov)-6.2(ascul)-5(a)3.4(r)]TJ
0 -1.3278 TD
-.0193 Tc
[(stroke)-444.9(the)4.1(r)-.4(apy,)-444.2(in)-447.4(the)-444.9(t)1.8(e)4.1(l)-3.9(e)4.1(s)-1(troke)-444.9(n)1.6(etwork.)-444.2(T)1.2(he)-444.9(cost)-440.8(savings)-443.6(e)4.1(stim)5(ate)]TJ
0 -1.3341 TD
-.0197 Tc
[(averaged)-384.9($358,435)-391.2(ann)-5.1(u)2.8(ally)-391.2(in)-384.5(the)-388.4(t)1.4(elest)-4.9(r)-.8(oke)-382(n)-5.1(etwork)-385.9(and)-384.9(i)2.1(n)-5.2(c)3.7(reased)]TJ
T*
-.0201 Tc
[(over)-241.5(t)-5.3(ime)-243.3(f)3.1(o)-5.9(r)-241.5(patients)-248.4(treated)-246.2(d).4(uri)-4.7(n).8(g)-239.9(t)-5.3(he)-243.3(first)-245.5(y).4(ear)-247.8(f)3.1(rom)-242.4($)-3.9(234,83)-5.9(6)-239.9(a)-2.7(t)-245.5(t)1(he)]TJ
T*
-.0184 Tc
[(end)-333(o)-4.2(f)-336.7(Y)5.9(ear)-334.6(1)-339.3(to)-333($393,)5.6(7)2.1(12)-333(at)-338.7(th)4.1(e)-336.5(e)-1.4(nd)-339.3(of)-336.7(5)-339.3(y)2.1(ea)5.4(rs.)-335.8(E)4.1(ach)-337.3(s)6.2(poke)-336.5(h)4.1(o)-4.2(s)6.2(p)2.1(ital)]TJ
T*
-.0202 Tc
[(woul)-4.8(d)-296.9(s)-1.9(av)-6(e)-294($)-4(109,08)-6(0)-296.9(p).3(er)-298.5(year,)-299.7(w)2.3(hereas)-299.1(the)-300.3(h)-4(ub)-303.2(hospi)-4.8(t).9(al)-295.6(wo)-6(uld)-303.2(b).3(ear)-298.5(a)]TJ
T*
-.0199 Tc
[(posi)-4.5(t)1.2(ive)-445.5(c)-2.9(ost)-447.7(o).6(f)-445.7($)2.6(405)-5.7(,8)-5.7(04)-442(p)-5.7(e)3.5(r)-443.6(y)-5.7(ear.)-444.8(The)-445.5(a)-2.5(uthors)-444.2(estimated)-442(t)1.2(hat)-441.4(c)-2.9(ost)]TJ
T*
-.0201 Tc
[(sharing)-214.6(b).4(etween)-214.2(hub)-208.3(a)-2.7(nd)-214.6(sp)-5.9(oke)-211.7(h)2.4(o)-5.9(s)4.5(p)-5.9(i)1.7(tals)-210.5(would)-214.6(r)5.1(esul)-4.7(t)-207.6(i)-4.7(n)-207.9(c)-3.1(ost)-213.9(s)-1.8(avi)-4.7(n).8(gs)-210.5(of)]TJ
T*
-.0199 Tc
[($44,804)-536.9(annual)-4.5(ly)-536.9(for)-538.5(5)-543.2(years.)-539.7(Sens)]TJ
15.2698 0 TD
-.0206 Tc
[(iti)-5.2(v)-.1(ity)-543.9(a)3.2(n)-6(a)3.1(l)-5.2(y)-.1(sis)-539.8(r)-1.7(ev)-6.4(ealed)-537.6(r)-1.7(obu)-4.4(st)]TJ
-15.2698 -1.3278 TD
-.0187 Tc
[(overall)-218.2(re)4.7(sults.)-216(Cost)-218.9(s)5.9(a)-1.3(vings)-215.4(w)-2.5(er)6.5(e)-223(e)4.7(stim)5.6(ated)-219.5(to)-219.5(increa)5.1(se)-216.6(with)-217.5(incr)6.5(eas)5.9(e)-1.7(s)-221.7(i)3.1(n)]TJ
0 -1.3341 TD
-.0194 Tc
[(the)-236.3(n)-4.8(umber)-234.5(o)-5.2(f)-236.5(s)-1.1(poke)-242.6(h)3.1(o)-5.2(s)5.2(p)-5.2(i)2.4(tals.)-242(C)2.5(ost)-238.5(s)-1.1(aving)-245.5(e)4(sti)-4(m)4.9(ates)-241.4(for)-240.8(5)-239.2(years)-235.1(r)-.5(anged)]TJ
T*
-.0208 Tc
[(fro)-6.6(m)-325.3($8,974)-329.1(with)-327.1(no)-329.1(sp)-6.6(oke)-326.2(h)1.7(ospi)-5.4(tals)-325(to)-329.1($2)-6.6(,4)-6.6(00,000)-329.1(for)-330.7(4)-.3(0)-322.8(s)-2.5(poke)-326.2(h)-4.6(os-)]TJ
T*
-.0182 Tc
[(pita)5.6(ls.)-291.4(I)-.7(n)-288.2(o)-4(th)4.3(er)-296.5(m)6.1(o)2.3(de)5.2(l)-293.6(s).1(ce)5.2(na)5.6(rios)6.4(,)-297.7(e)5.2(stima)5.5(t)2.9(es)-297.1(of)-292.2(cost)-294.2(s)6.4(a)-.8(vings)-290.8(r).7(anged)-294.9(f)5(rom)]TJ
T*
-.02 Tc
[($159,718)-284(to)-277.7($1,359,50)-5.8(0)-277.7(p).5(er)-279.3(year)-285.6(from)-280.2(a)-280.8(n).9(etwork)-278.8(persp)-5.8(e)3.4(ctiv)-5.8(e.)]TJ
/F4 1 Tf
11.9551 0 0 11.9551 307.8424 311.3007 Tm
0 Tc
(COPD)Tj
/F1 1 Tf
8.9663 0 0 8.9663 317.8204 299.3952 Tm
[(COPD)-274.3(is)-276.1(an)-271.5(umbrella)-278.5(term)-272.7(for)-272.6(a)-273.4(group)-276.5(of)-278.8(progressive,)-276(debilitating)]TJ
-1.1128 -1.3341 TD
[(respiratory)-475.4(conditions)-473.4(characterized)-483.4(by)-471.2(difficulty)-475.9(breathing,)-471.9(lung)]TJ
T*
[(airflow)-321.9(limitations,)-320.7(cough,)-321.9(and)-320.6(other)-323.6(symptoms.)]TJ
6.7246 0 0 5.9768 490.0534 279.4393 Tm
(e)Tj
8.9663 0 0 8.9663 495.9495 275.4708 Tm
[(Although)-325(there)-320.7(is)]TJ
-20.9794 -1.3341 TD
[(no)-287.4(consensus)-294.3(on)-293.8(the)-287.1(definition)-296.5(of)-291.4(COPD,)]TJ
6.7246 0 0 5.9768 460.0062 267.4771 Tm
(104)Tj
8.9663 0 0 8.9663 473.1589 263.5086 Tm
[(the)-287.1(Global)-294.3(Initiative)-292.3(for)]TJ
-18.4376 -1.3341 TD
[(Chronic)-330.7(Obstructive)-327(Lung)-327.7(Disease)-326.4(\(GOLD\))-327.9(guidelines)-329.1(define)-328.5(it)-323.8(as)-324.7()55.6()0(a)]TJ
ET
q
1 i
307.842 224.22 m
561.883 224.22 l
561.883 71.717 l
307.842 71.717 l
W n
0 0 0 1 K
1 J 1 j .227 w 10 M []0 d
q 1 0 0 1 305.858 224.22 cm 0 0 m
536.655 0 l
S
Q
Q
BT
5.9774 0 0 5.3127 307.8424 217.7007 Tm
(e)Tj
7.9702 0 0 7.9702 310.507 214.1858 Tm
[(The)-661.5(GOLD)-658.2(COPD)-664.7(definition)-651.3(excludes)-662.1(emphasis)-655.5(on)-663.6()61.2(emphy)10.3(sema)61.6()-664.4(and)]TJ
-.3343 -1.3799 TD
[()61.2(chronic)-303.6(bronchitis)64.5()-308.7(that)-312.1(have)-303.4(been)-310.2(used)-312.1(in)-305.1()61.2(many)-310.2(previou)10.5(s)-312.1(definitions.)69.5()]TJ
5.9774 0 0 5.3127 552.5856 206.759 Tm
(103)Tj
7.9702 0 0 7.9702 307.8424 192.2456 Tm
[(The)-505(2014)-502.1(update)-502.8(states)-503.9(that)-497.1()61.2(emphysema)10.7(,)-507.9(o)0(r)-506(destruction)-493.2(of)-505.6(the)-506.7(gas-ex-)]TJ
0 -1.3728 TD
[(changing)-368.8(surfaces)-370.5(of)-377.6(the)-378.7(lung)-368(\(alveoli\))-377.6(is)-372.5(a)-374.6(pathological)-367.3(term)-375.4(that)-376.1(is)-372.5(often)]TJ
0 -1.38 TD
[(\(but)-323.5(incorrectl)11.6(y\))-322.9(used)-319.2(clinically)-318.3(and)-319.8(describes)-318.3(only)-317.9(one)-323.3(of)-320.7(several)-316.4(structural)]TJ
0 -1.3728 TD
[(abnormalities)-275(present)-283.5(in)-283.8(patients)-282.8(with)-281.9(COPD.)-283.4(And,)-278.2(chronic)-279.4(bronchitis,)-284(or)-285.4(the)]TJ
T*
[(presence)-341.7(of)-349.1(cough)-347.4(and)-348.2(sputum)-341.8(production)-341.1(for)-350.8(at)-347.1(least)-350.9(3)-347.8(months)-345(in)-347.8(each)-340.9(of)]TJ
T*
[(two)-484.4(consecutive)-485.7(years,)-485.3(remains)-484.2(a)-488.4(clinical)11.7(ly)-493.6(and)-483.4(epidemiolo)9.7(gically)-484.4(useful)]TJ
0 -1.3799 TD
[(term.)-321.4(However,)-328.5(it)-324.6(is)-329.8(important)-320.8(to)-327.4(recogniz)11.4(e)-328.3(that)-326.3(chronic)-322.1(cough)-326.1(and)-326.9(sputum)]TJ
0 -1.3728 TD
[(production)-227.3(\(i.e.,)-237.2(chronic)-229.6(bronchitis)10.5(\))-238.3(i)0(s)-230.3(a)0(n)-235.1(independent)-227.6(disease)-228.5(entity)-236.3(that)-233.9(may)]TJ
T*
[(precede)-374.6(or)-370.8(follow)-370.1(the)-378.7(developm)9.6(ent)-374.8(of)-370.5(airflow)-370.1(limitation)-373.2(and)-369.6(may)-368.5(be)-377.4(asso-)]TJ
0 -1.38 TD
[(ciated)-508.6(with)-516.7(developm)9.6(ent)-517.1(and/or)-506.9(acceleration)-509.4(of)-512.7(fixed)-513.1(airflow)-505.2(limitation.)]TJ
0 -1.3728 TD
(\(Further\))Tj
/F12 1 Tf
3.6277 0 TD
(.)Tj
/F1 1 Tf
.9958 0 TD
[(Chronic)-382.1(bronchitis)-387.9(also)-390.7(exists)-383.7(in)-390.5(patients)-389.5(with)-388.6(normal)-383.6(spirome-)]TJ
-4.6235 -1.3728 TD
[(try.)63.5()]TJ
5.9774 0 0 5.3127 322.4692 75.2314 Tm
(103,p.2)Tj
/F11 1 Tf
11.9551 0 0 11.9551 287.5464 741.9966 Tm
[(TELEMEDICINE)-340.6(FOR)-332.7(CHRONIC)-338.8(DISEASE)-334.7(MANAGE)-7.3(MENT)]TJ
/F9 1 Tf
6.9738 0 0 6.9738 186.2362 29.7638 Tm
()Tj
/F7 1 Tf
1.3251 0 TD
.1994 Tc
[(MA)-9(RY)-337.4(ANN)-336.2(L)-1.1(IE)-6(BERT,)-335.4(I)-4(NC.)]TJ
/F10 1 Tf
15.015 0 TD
0 Tc
()Tj
/F7 1 Tf
.9999 0 TD
.1103 Tc
[(VOL.)-327(20)-1000.8(N)5.5(O)-4.1(.)-327(9)]TJ
/F10 1 Tf
8.3814 0 TD
0 Tc
()Tj
/F8 1 Tf
1.0081 0 TD
.103 Tc
[(SE)-4.8(P)-6.4(T)-8.1(E)-4.8(M)-8.4(BE)-4.8(R)-339.7(2)-6.4(0)-7.9(1)-6.5(4)]TJ
/F4 1 Tf
7.9702 0 0 7.9702 441.3542 29.7638 Tm
0 Tc
[(TELEME)13.6(DICINE)-327.7(and)-336(e-HEALTH)-647.9(785)]TJ
ET
q
1 i
0 792 612 -791.985 re
W n
579.685 .014984 .22681 791.985 re
f
337.039 767.962 274.961 .22675 re
f
Q
endstream
endobj
261 0 obj
<>/XObject<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]/Font<>/Properties<>>>/Thumb 264 0 R/MediaBox[0 0 612 792]/Rotate 0>>
endobj
265 0 obj
<>/ProcSet[/PDF/Text]/Font<>/Properties<>>>
endobj
262 0 obj
<>stream
/GS1 gs
BT
/F1 1 Tf
8.9663 0 0 8.9663 50.1732 693.8644 Tm
0 0 0 1 k
0 Tc
0 Tw
[(common)-346.8(preventable)-356.4(and)-352.2(treatable)-352.5(disease,)]TJ
/F12 1 Tf
18.2985 0 TD
(.)Tj
/F1 1 Tf
.999 0 TD
[(characterized)-356.9(by)-351(per-)]TJ
-19.2975 -1.3278 TD
[(sistent)-335.7(airflow)-340.9(limitation)-337.7(that)-341.4(is)-333(usually)-342.1(progressive)-338(and)-339.6(associated)]TJ
0 -1.3341 TD
[(with)-228.2(an)-233.6(enhanced)-232.4(chronic)-234.4(inflammatory)-234.9(response)-234.3(in)-229.2(the)-236.5(airways)-230(and)]TJ
T*
[(lungs)-579(to)-578(noxious)-581.9(particles)-578.6(or)-580.3(gases.)51()]TJ
6.7246 0 0 5.9768 199.2188 662.003 Tm
(103)Tj
8.9663 0 0 8.9663 214.9228 658.0344 Tm
[(Exacerbations)-580.4(and)-579.8(co-)]TJ
-18.3744 -1.3341 TD
[(morbidities)-203.6(contribute)-209.6(to)-198.6(the)-204.9(overall)-209.9(severity)-205.3(and)-200.5(the)-204.9(quality)-202.2(of)-209.3(life)-200.8(in)]TJ
T*
[(individual)-283.9(patients.)-285.7(As)-287.4(the)-287.1(incidence)-287.7(of)-285.1(COPD)-286.9(increases,)-283.6(so)-283.7(does)-290.5(the)]TJ
T*
[(burden)-278.1(on)-281.1(health)-282.3(services.)]TJ
6.7246 0 0 5.9768 148.422 626.1164 Tm
(105)Tj
8.9663 0 0 8.9663 60.0945 610.1857 Tm
[(An)-405(exacerbation)-414.5(of)-405.3(COPD)-407.1(is)-402.6(an)-404.3(acute)-410.7(event)-409.2(characterized)-407.5(by)-408(a)]TJ
-1.1065 -1.3341 TD
[(worsening)-602.9(of)-601.3(respiratory)-608.2(symptoms)-603.7(beyond)-607.3(normal)-603.4(day-to-day)]TJ
0 -1.3278 TD
[(variation,)-428(typically)-431(requiring)-430.6(changes)-435.4(in)-425.3(medication)-430(and)-428.1(possibly)]TJ
0 -1.3341 TD
(hospitalization.)Tj
6.7246 0 0 5.9768 107.8866 578.3243 Tm
(106108)Tj
8.9663 0 0 8.9663 134.8724 574.3557 Tm
[(Variable)-267.8(decrease)-274.1(in)-273.5(pulmonary)-274.4(function)-268.4(and)]TJ
-9.4464 -1.3341 TD
[(the)-217.5(occurrence)-224.1(of)-221.9(tachypnea)-217.6(\(excessively)-223.4(rapid)-223.4(breathing\))-221.3(are)-218.5(typical)]TJ
T*
[(in)-431.6(acute)-436(exacerbations.)]TJ
6.7246 0 0 5.9768 139.3511 554.3998 Tm
(103)Tj
8.9663 0 0 8.9663 153.8078 550.4313 Tm
[(COPD)-432.4(exacerbations)-440.5(are)-433.5(especially)-439.2(im-)]TJ
-11.5583 -1.3341 TD
[(portant)-346.4(because)-344.4(they)-348.8(adversely)-346.6(affect)-342.6(quality)-347.6(of)-342(life,)-347.5(take)-342.2(weeks)-348.3(to)]TJ
T*
[(resolve,)-322.6(accelerate)-324(decline)-325.6(in)-317.8(lung)-325.3(function,)-320.3(and)-320.6(potentially)-325.7(lead)-321.6(to)]TJ
T*
[(death.)-282(In)-277.8(addition,)-285.8(they)-279.2(are)-281.8(associated)-284.9(with)-285.2(high)-279.4(healthcare)-287.7(cost.)]TJ
/F6 1 Tf
9.9626 0 0 9.9626 50.1732 490.677 Tm
[(COPD)-340.2(EPIDEMIO)-8.9(LOG)-8.8(Y)]TJ
/F1 1 Tf
8.9663 0 0 8.9663 60.0945 478.7148 Tm
[(COPD)-438.7(is)-440.5(a)-431.5(major)-440.9(cause)-438.8(of)-436.9(disability)-439.6(and)-434.4(death)-438.8(throughout)-444.9(the)]TJ
-1.1065 -1.3341 TD
[(world,)-403(estimated)-409.4(to)-407.3(affect)-405.8(about)-403.8(10%)-405.3(of)-405.3(the)-407.2(population.)]TJ
6.7246 0 0 5.9768 267.0802 470.7211 Tm
(109)Tj
8.9663 0 0 8.9663 281.2534 466.7527 Tm
[(In)-404.3(the)]TJ
-25.7722 -1.3341 TD
[(United)-189.5(States,)-193.6(COPD)-192.1(is)-193.9(the)-192.2(primary)-186.6(contributor)-199.9(to)-186(mortality)-198.3(caused)-190.7(by)]TJ
T*
[(chronic)-335.6(lower)-342(respiratory)-342.7(diseases,)-339.6(which)-336.3(became)-341.9(the)-337.6(third)-337.8(leading)]TJ
T*
[(cause)-198.6(of)-196.6(death)-204.9(in)-197.6(2008)-202.6(and)-200.5(retained)-199.4(that)-202.3(position)-201.5(in)-197.6(2010,)-197.5(accounting)]TJ
T*
[(for)-278.9(5.6%)-280.1(\(138,080)-286.5(deaths\))-285(of)-278.8(all)-280.5(deaths.)]TJ
6.7246 0 0 5.9768 197.348 422.929 Tm
(110,111)Tj
8.9663 0 0 8.9663 60.0945 406.9417 Tm
[(The)-249.8(true)-242.9(prevalence)-248.2(data)-239.7(for)-247.3(COPD)-242.7(in)-241.9(the)-242.8(population)-247.8(is)-244.5(difficult)-243.5(to)]TJ
-1.1065 -1.3278 TD
[(obtain.)-372.3(Only)-367.8(two)-372.2(sourcesthe)-378.1(National)-369.2(Health)-372.2(Information)-373.8(Survey)]TJ
0 -1.3341 TD
[(and)-371.2(the)-375.6(Behavioral)-373.7(Risk)-378.2(Factor)-371.4(Surveillance)-380.5(Systemgather)-380.6(infor-)]TJ
T*
[(mation)-272.4(on)-268.5(COPD.)-269.2(Both)-272.3(sources)-278.5(use)-271(an)-271.5(all-inclusive)-274.7(question)-273.7(in)-267.2(their)]TJ
T*
[(surveys)-331.9(that)-335.1(includes)-333.4(emphysema)-336.7(and)-333.2(chronic)-329.3(bronchitis,)-341.8(and)-326.9(data)]TJ
T*
[(are)-414.5(self-reported.)-416.5(The)-414.2(Behavioral)-417.9(Risk)-416.1(Factor)-415.7(Surveillance)-418.5(System)]TJ
T*
[(estimated)-264(14.7)-262.3(million)-264.6(adults)-257.8(\(defined)-267.3(as)]TJ
/F9 1 Tf
17.2868 0 TD
()Tj
/F1 1 Tf
.7208 0 TD
[(18)-262.5(years)-262(of)-259.8(age\),)-266(or)-264.1(6.2%)]TJ
-18.0077 -1.3341 TD
[(of)-512.8(this)-510.7(population,)-521(had)-508.6(COPD)-514.5(\(including)-517.8(chronic)-512.7(bronchitis)-517.6(and)]TJ
T*
[(emphysema\))-567.8(in)-564.4(2011,)-570.6(whereas)-568.2(the)-571.6(National)-565.2(Health)-568.2(Information)]TJ
0 -1.3278 TD
[(Survey)-282.7(estimated)-283(12.7)-281.2(million)-283.6(\(or)-280.3(5.5%\).)]TJ
6.7246 0 0 5.9768 201.5432 303.3637 Tm
(112)Tj
8.9663 0 0 8.9663 60.0945 287.433 Tm
.0113 Tc
[(In)-359.8(2011,)-363(the)-357.4(a)-2.9(ge-adjust)-5.5(e)3.1(d)-360.2(p).2(reval)-4.9(e)3.1(nce)-357.4(f)-3.5(or)-361.8(adults)-362.5(was)-362.4(6).2(.5%)-365.4(\()1.4(ap-)]TJ
-1.1065 -1.3341 TD
.0109 Tc
[(pr)10.9(o)-13(x).2(imately)-221.5(13.7)-221.5(m)3.6(il)-5.3(lion\))-5.3(.)]TJ
6.7246 0 0 5.9768 149.6693 279.4393 Tm
.0196 Tc
[(11)8.5(3)]TJ
8.9663 0 0 8.9663 162.4818 275.4708 Tm
.0132 Tc
[(Hispanics)-215.1(w)4.1(ere)-216.3(l)3.3(ess)-215.1(l)3.3(ik)13.2(e)-7.2(l)3.3(y)-219.2(t)2.7(ha)5.3(n)-218.8(w)4.1(hites)]TJ
-12.5257 -1.3341 TD
.011 Tc
[(and)-303.6(b)-.1(lacks)-305.8(t).5(o)-297.3(r)-1.7(eport)-303(h)1.9(aving)-303.6(C)1.3(OPD)-298.8(\()1.1(4)-6.4(.)3.4(0%)-302.5(comp)-6.4(ared)-303.6(with)-301.6(6.3%)-302.5(and)]TJ
T*
.0108 Tc
[(6.1%)-5.5(,)-180.2(r)-1.9(espect)-6(ivel)-5.4(y\).)-180.2(W)0(o)-6.6(m)3.5(en)-183.3(wer)10.8(e)-193.5(more)-180.8(l)-5.4(i).9(kely)-183.7(to)-183.7(report)-176.7(h)-4.6(av)-6.6(ing)-183.7(C)1.1(OPD)]TJ
T*
.0112 Tc
[(than)-347.3(men)-347.3(\()1.3(6.7%)-346.5(v)-6.2(e)3(rsus)-349.9(5.2%\).)-350.5(Peo)-6.2(p).1(le)-344.8(without)-347(a)-350.7(hi)-5(gh)-345.7(school)-346.4(edu-)]TJ
T*
[(cation)-239.9(had)-240.3(a)-243.4(pr)11.1(e)-9.9(v)0(alen)-6(ce)-243.7(r)11.1(a)-9.5(te)-243.7(of)-237.6(9.5%)-239.1(compared)-240.3(with)-238.3(6.8%)-239.1(for)-241.9(t).6(hose)]TJ
T*
.0115 Tc
[(who)-220.9(completed)-214.6(h)2.4(i)-4.7(g).4(h)-212.6(s)-1.8(chool)-213.3(and)-214.6(4).4(.6%)-213.5(o)-5.9(f)-211.9(t)1(hose)-211.7(who)-214.6(c)-3.1(ompleted)-220.9(some)]TJ
0 -1.3278 TD
.0125 Tc
[(c)4.2(o)1.4(lle)4.2(g)1.4(e.)-349.2(Pre)4.3(v)-4.9(a)4.6(l)2.6(ence)-349.8(r)12.5(a)-8.1(tes)-348.6(w)3.4(er)12.5(e)-356.2(m)-1.2(u)3.4(c)-2.1(h)-350.7(h)3.4(igh)3.4(e)-2.1(r)-348(\()2.6(20.9%\))-351.4(a)4.6(mong)-352.7(th)3.4(ose)]TJ
0 -1.3341 TD
.0109 Tc
[(unable)-503.2(to)-499.7(work)-500.8(co)-6.5(mpared)-506.1(with)-504(the)-503.2(u)1.8(nempl)-5.3(oyed)-506.1(\()1(7.8%\),)-502.5(retired)]TJ
T*
.0114 Tc
[(\(7.6%\),)-483.1(h)2.3(omemak)11.4(e)-9(r)-1.3(s)-476.2(o)-6(r)-475.5(s)-1.9(tudent)-5.4(s)-476.2(\()-4.8(4.9%)-4.9(\),)-476.7(o)-6(r)-475.5(employed)-480.3(\()1.5(3.8%\).)-483.1(A)]TJ
T*
.011 Tc
[(considerabl)-5.2(y)-221.4(higher)-223(percent)-5.8(a)3.1(ge)-224.9(of)-218.7(curr)11(e)-10(n).3(t)-220.8(s)-2.3(mokers)-217.3(rep)-6.4(o)-.1(r)11(t)-12.2(ed)-221.4(having)]TJ
T*
.0115 Tc
[(COPD)-475.3(\(13.3%\))-478.9(t)1(han)-479.8(f)3.1(ormer)-475.4(s)-1.8(mokers)-476.1(\(6)-5.9(.8%)-4.8(\))-472.6(or)-481.8(those)-477.3(w)2.4(ho)-473.8(never)]TJ
T*
.0094 Tc
[(sm)-4.3(ok)-2.8(ed)-305.2(\(2.)-4.5(8)-1.7(%\).)]TJ
6.7246 0 0 5.9768 108.5669 147.9118 Tm
.0111 Tc
[(11)-8.5(0)]TJ
8.9663 0 0 8.9663 122.0598 143.9433 Tm
[(There)-294.4(w)-4.5(as)-299.5(considerable)-300.7(geo)-6.4(g)-.1(r)11(a)-9.6(phi)-5.2(c)-294.4(v)-6.4(a)3.1(riation)-296.9(i)1.1(n)]TJ
-8.0175 -1.3341 TD
[(r)11.2(e)-9.8(spondents)-900(r)11.2(e)-9.8(porting)-904.1(physicia)]TJ
14.4289 0 TD
.0099 Tc
[(n-diag)-7.5(nosed)-899.1(C)-6.1(OPD)-900.5(\().1(i)-6.3(n)-.8(cl)-6.3(uding)]TJ
-14.4289 -1.3341 TD
.0113 Tc
[(chr)11.3(o)-6.2(n)-5.8(i)1.4(c)-370(b).2(ronchi)-4.9(tis)-375.1(a)3.4(nd)-379.2(emphysema\):)-369.6(K)-.7(entucky)-372.9(\()1.4(1)-6.1(0).2(.1%)-5(\))1.4(,)-375.7(A)2.8(labama)]TJ
0 -1.3278 TD
.0111 Tc
[(\(9.9%\),)-388.5(I)-3(ndiana)-388.8(\(8)-6.3(.9%)-5.2(\))1.2(,)-388.5(a)-3.1(nd)-385.7(West)-391.4(Virginia)-395.1(\(8.8%\))-390.8(were)-389.2(the)-395.5(s)4.1(t)-5.7(a)3.2(tes)]TJ
0 -1.3341 TD
.0106 Tc
[(with)-339.9(t)-6.2(h)1.5(e)-339.1(h)-4.8(ighe)-4(st)-335(re)-4(porte)-4(d)-335.6(i)-5.6(ncide)-4(n)-.1(c)-4(e)-339.1(of)-339.3(COPD,)-338.4(w)-4.9(he)-4(r)10.6(e)-10.4(as)-344.2(state)-4(s)-337.9(w)-4.9(i).7(th)]TJ
T*
.011 Tc
[(the)-231.2(l)-5.2(owest)-233.4(r)-1.7(ates)-236.3(incl)-5.2(uded)-234.1(Minnesota)-230.8(\(4.1%\))-5.2(,)-230.5(U)-1.6(tah,)-230.5(Washingto)-6.4(n).3(,)-230.5(a)3.1(nd)]TJ
T*
[(North)-282.6(D)11(a)-9.5(k)-1.2(ota)-281.4(\()1.1(4.5%\).)]TJ
/F6 1 Tf
9.9626 0 0 9.9626 322.129 693.1841 Tm
0 Tc
[(COPD)-340.2(COST)]TJ
/F1 1 Tf
8.9663 0 0 8.9663 332.107 681.2219 Tm
.0112 Tc
[(During)-391.9(the)-389.1(p)-6.2(eriod)-391.9(f)-3.6(rom)-388.2(1)-6.2(979)-391.9(to)-391.9(200)-6.2(1,)-388.4(data)-395(from)-394.5(the)-395.4(N).7(ational)]TJ
-1.1128 -1.3341 TD
[(Hospit)-5.6(al)-365.4(Discharge)-363.8(S)-4.2(urvey)-360.3(e)-3.4(stimated)-366.7(a)-363.4(t).7(otal)-365.4(of)-364(ap)-6.2(pr)11.2(o)-12.7(x).5(imately)-366.7(4).1(5)]TJ
T*
.01 Tc
[(milli)-6.2(on)-380.1(\()-6.2(8)-1.1(.5%)-385.7(o)-1.1(f)-384.1(a)-4.2(ll)-385.5(ho)-7.4(spi)-6.2(t)-.5(al)-6.2(izations)-389(in)-386.4(adu)-5.4(l).2(ts)]TJ
/F9 1 Tf
20.5115 0 TD
0 Tc
(>)Tj
/F1 1 Tf
.7271 0 TD
.0118 Tc
[(25)-385(years)-380.9(o).7(f)-382.3(a)-2.4(ge\))]TJ
-21.2387 -1.3341 TD
.0112 Tc
[(dischar)11.2(g)-6.3(es)-267.7(wer)11.2(e)-275.3(for)-260.8(p)-6.2(atients)-267.7(w)2.1(i)-5(t).7(h)-263.5(C)1.5(OPD.)-268.3(Of)-269.1(these,)-268.3(abou)-4.2(t)-264.8(3).1(6)-265.5(m)-2.5(ill)-5(ion)]TJ
T*
.0118 Tc
[(dischar)11.8(g)-5.7(es)-197.6(\(79%)-4.5(\))-194.1(o).7(ccur)11.8(r)-7.3(e)-2.8(d)-195.3(w)2.7(it)-5(h)-193.3(C)-4.2(OPD)-196.8(a)-2.4(s)-191.2(a)-198.4(secondary)-195.3(d).7(iagnosis,)-191.8(a)-2.4(nd)]TJ
0 -1.3278 TD
.0111 Tc
[(9.8)-404.7(m)-2.6(ill)-5.1(ion)-404.3(\()-5.1(20.8%\))-409.7(o)0(ccurred)-411(w)2(i)-5.1(t).6(h)-409(C)1.4(OPD)-406.1(a)3.2(s)-413.2(t).6(he)-408.1(primary)-411(d)0(iagno-)]TJ
0 -1.3341 TD
.0125 Tc
(sis.)Tj
6.7246 0 0 5.9768 334.0912 613.4739 Tm
.0196 Tc
(114)Tj
8.9663 0 0 8.9663 348.4912 609.5054 Tm
.0113 Tc
[(In)-391.5(2)-6.1(008,)-394.6(t)-5.5(h)2.2(e)-395.3(e)-3.3(stimated)-398.2(direct)-397.5(econo)-6.1(m)4(ic)-401.6(cost)-397.5(of)-401.8(COPD)-399.6(and)]TJ
-2.9402 -1.3341 TD
.0108 Tc
[(asth)-4.6(ma)-300.6(w)-4.7(a)2.9(s)-306($)1.7(53.7)-303.8(b)-.3(illi)-5.4(on.)-300.3(T)-.3(hese)-301(co)-6.6(sts)-306(i).9(ncluded)-297.5(p)-6.7(r)10.8(e)-10.2(scripti)-5.4(o)-.3(n)-297.1(m)-2.9(edi-)]TJ
T*
[(cines)-470.4(\()-5.4($20.4)-468.2(b)-.3(i)-5.4(llion)-6.3(\)).9(,)-471(v)-.3(isits)-470.4(t).3(o)-474.5(o)-.3(utpatient)-467.6(c)-3.8(lin)-6.3(ics)-470.4(o)-.3(r)-469.8(o)-6.6(ffi)-5.4(ce-based)]TJ
T*
[(providers)-413.5(\($1)-6.6(3)-.3(.2)-417.6(bill)-5.4(ion\),)-414.1(h)-4.6(ospi)-5.4(tal)-416.4(i).9(npatient)-410.7(stays)-413.5(\()1($13.1)-417.6(b)-.3(ill)-5.4(ion\),)]TJ
T*
[(ho)-6.5(me)-389.4(h)-4.5(e)2.6(alth)-4.5(care)-389.4(\($4)-6.5(.)3.3(0)-392.2(b)-.2(ill)-5.3(i)1(on\),)-395(and)-392.2(e)2.6(mer)10.9(g)-13(ency)-385.9(d)-6.5(e)2.6(partment)-391.6(visits)]TJ
T*
.01 Tc
[(\($)-5.4(3.1)-190.8(b)-1.1(illi)-6.2(on\).)]TJ
6.7246 0 0 5.9768 373.096 553.7195 Tm
.0111 Tc
[(11)-8.5(3)]TJ
8.9663 0 0 8.9663 385.5684 549.6943 Tm
[(In)-183(2)-6.3(010,)-186.2(133,575)-183.4(deaths)-185.6(wer)11.1(e)-193.2(attribut)-5.7(able)-186.8(to)-183.4(COPD.)]TJ
-7.0753 -1.3341 TD
[(During)-379.4(the)-376.5(s)4.1(ame)-376.5(y)-6.3(ear)11.1(,)-388.6(there)-376.5(w)2(er)11.1(e)-382.9(1)0(0)-6.3(.)3.5(3)-379.4(m)3.8(i)-5.1(llion)-379(\(498)-6.3(.4)-379.4(per)-381(10,000)]TJ
0 -1.3278 TD
.0106 Tc
[(population\))-416.6(p)-.5(hysician)-417.5(office)-408.6(vi)-5.6(si)-5.6(ts,)-408(1)-6.8(.5)-411.5(mil)-5.6(lion)-411.1(\()-5.6(72.0)-417.8(p)-.5(er)-413.1(1)-6.8(0)-.5(,00)-6.8(0)-.5(\))]TJ
0 -1.3341 TD
.0114 Tc
[(emergency)-341.2(d).3(epartment)-340.5(v).3(isits,)-344(and)-347.5(699,000)-341.2(\(32)-6.1(.)3.8(2)-347.5(p).3(er)-342.8(10,000\))-346.2(hos-)]TJ
T*
[(pit)-5.4(a)3.5(l)-283(d).3(ischarges)-280.1(f)3(or)-279.5(COPD.)]TJ
6.7246 0 0 5.9768 422.3621 505.8707 Tm
.0111 Tc
[(11)-8.5(3)]TJ
/F6 1 Tf
9.9626 0 0 9.9626 322.129 478.4881 Tm
0 Tc
[(TELE)-8.8(PULMONO)-10.1(LOGY)]TJ
/F1 1 Tf
8.9663 0 0 8.9663 332.107 466.5258 Tm
.0111 Tc
[(Pat)-5.7(i)1.2(ent)-5.7(s)-552.3(wi)-5.1(th)-554.4(COPD)-551.6(often)-549.7(e)-3.5(xper)11.1(i)-11.5(e)2.9(nce)-553.6(e)-3.5(xacerbations)-558.7(in)-556.1(their)]TJ
-1.1128 -1.3341 TD
.0095 Tc
[(s)-3.8(y)-1.6(mp)-7.9(toms)-541.3(th)-5.9(at)-538.4(m)-4.2(a)1.6(y)-539.1(r)-3.2(eq)-7.9(uir)-3.2(e)-536.2(h)-5.9(o)-1.6(s)-3.8(p)-1.6(ita)-4.7(liz)-5.1(ati)-6.7(o)-1.6(n.)-535.5(Fr)-3.2(e)-5.1(q)-1.6(ue)-5.1(nt)-538.4(mo)-7.9(nitor)-3.2(-)]TJ
T*
.0099 Tc
[(ing)-564(i)0(s)-559.9(i)0(ndic)-4.7(at)-6.9(ed)-557.6(t)-6.9(o)-557.6(ev)-7.5(alu)-5.5(a)2(te)-561.1(th)-5.5(ei)-6.3(r)-552.9(l)-6.3(ung)-557.6(f)-4.9(unc)-4.7(t)-.6(ion)-563.6(a)2(nd)-557.6(t)-6.9(o)-557.6(ass)-3.5(i)0(st)]TJ
T*
.0112 Tc
[(in)-416.9(managing)-417.2(t)-5.6(h)2.1(ei)-5(r)-412.5(h)-4.2(ealth.)-413.7(Telepulmonol)-5(ogy)-417.2(is)-419.5(designed)-417.2(to)-417.2(serve)]TJ
T*
.0107 Tc
[(th)-4.7(at)-379.1(p)-6.7(u)1.6(rpose,)-382.6(and)-386.1(i).8(t)-379.1(c)-3.9(onsists)-375.7(p)-6.7(r)10.7(i)-11.9(mar)10.7(i)-11.9(ly)-379.8(of)-383.4(two)-386.1(a)2.8(ctivit)-6.1(ies:)-382.8(\(1\))-378.5(t)-6.1(ele-)]TJ
0 -1.3278 TD
.0113 Tc
[(spirometry)-385.5(for)-380.8(r)-1.4(emote)-382.6(m)-2.4(easureme)]TJ
14.7577 0 TD
.0112 Tc
[(nt)-378.6(of)-382.9(lung)-379.3(function)-385.2(\(volume)-382.7(o).1(f)]TJ
-14.7577 -1.3341 TD
.0109 Tc
[(air)-343.3(i)1(nhaled)-341.7(and)-341.7(e)-3.7(xhaled\),)-344.5(initi)-5.3(a)3(ll)-5.3(y)-341.7(t).4(o)-341.7(d)-.2(iagnose)-338.8(C)-5.1(OPD)-343.1(a)-3.3(nd)-341.7(perio)-6.5(d)-.2(i-)]TJ
T*
.0106 Tc
[(call)-5.6(y)-278.7(t).1(o)-278.7(a)-3.6(scertain)-284.7(cli)-5.6(n)-.1(ical)-283.8(statu)-4.8(s)3.6(,)-281.5(a)-3.6(nd)-278.7(\(2\))-283.8(t).1(el)-5.6(econsultatio)-6.8(ns)-274.6(b)-6.8(e)2.4(tw)-4.9(een)]TJ
T*
.0112 Tc
[(primary)-499.4(c)-3.4(ar)11.2(e)-509.3(p).1(rovi)-5(ders)-501.7(\(physici)-5(ans)-501.7(a)-3(nd)-499.4(nur)11.2(s)-8.6(es\))-504.5(a)-3(nd)-499.4(pulmon)-5.9(ary)]TJ
T*
[(specialists)-381.6(for)-381(t).6(he)-382.8(car)11.1(e)-389.3(and)-385.7(t).6(r)11.1(e)-9.9(atment)-385.1(of)-383(pati)-5.1(ents)-387.9(at)-385.1(r)11.1(e)-9.9(mote)-382.9(sites.)]TJ
T*
.0114 Tc
[(The)-382.6(goal)-384.2(o).3(f)-382.7(t).9(eleconsul)-4.8(t).9(at)-5.4(ion)-385(i)1.5(s)-381.3(t)-5.4(o)-379.1(p)-6(r)11.4(o)-6.1(v)-6(i)1.5(de)-382.5(ready)-385.4(a)-2.8(ccess)-387.6(t).9(o)-385.4(e)3.1(xpert)]TJ
T*
.0127 Tc
[(cons)5.7(ultants)-455.9(i)2.8(n)-453.3(a)-1.5(re)4.5(as)-449.6(la)4.8(cking)-453.7(t)2.2(he)4.4(se)-457.1(r)12.7(e)-8.3(sou)3.6(r)0(ce)4.4(s)-455.9(a)-1.5(nd)-453.7(a)4.8(l)-3.5(s)5.7(o)-460(to)-453.7(re)4.5(duc)4.5(e)]TJ
T*
.0109 Tc
[(un)-6.2(necessary)-316.4(ho)-6.5(spi)-5.3(t).4(al)-5.3(ization.)-319.2(Telep)-6.5(u)1.8(lmonolog)-6.5(y)-316.4(c)2.6(an)-316(be)-313.5(designed)-316.4(as)]TJ
0 -1.3278 TD
[(an)-537.2(ongoing)-543.9(remote)-541(moni)-5.2(toring)-537.6(of)-541.2(COPD)-539(in)-543.5(similar)-539.2(f)2.6(ashion)-543.5(to)]TJ
0 -1.3341 TD
[(telemoni)-5.3(toring)-341.7(of)-339(CH)-6(F.)]TJ
/F4 1 Tf
11.9551 0 0 11.9551 322.129 275.244 Tm
0 Tc
[(Evidence)-339.9(of)-333.1(the)-335.4(Impact)-338.1(of)-337.8(Telepulmonology)]TJ
/F1 1 Tf
8.9663 0 0 8.9663 332.107 263.2818 Tm
[(As)-230.5(with)-234.6(the)-230.1(other)-235(two)-233.1(chronic)-234.5(diseases,)-232.1(our)-235.3(review)-230.1(of)-234.5(the)-230.2(evidence)]TJ
-1.1128 -1.3341 TD
[(for)-354.8(telepulmonology)-365.5(is)-358.3(focused)-360.5(primarily)-358(on)-357(the)-356.6(period)-361.4(from)-355.8(2005)]TJ
T*
[(through)-306.7(2013.)-298.7(Our)-301(initial)-302.4(search)-306.1(identified)-306.6(172)-298.9(studies.)-304.4(Of)-300.3(these,)-303.6(17)]TJ
T*
[(were)-209.1(included)-211.1(in)-204(the)-211.2(final)-204.8(analysis.)-205.4(Here)-210.5(again,)-206.8(our)-210(analysis)-204.1(is)-206.6(limited)]TJ
0 -1.3278 TD
[(to)-192.3(robust)-200.7(studies)-195.6(with)-196.6(adequate)-194.2(sample)-196.9(size.)-192.7(COPD)-198.4(is)-193.9(similar)-191(to)-198.6(CHF)-189.5(in)]TJ
0 -1.3341 TD
[(terms)-273.4(of)-278.8(its)-273.9(long-term)-276.3(chronic)-272.4(nature)-280.5(that)-271.8(exacerbates)-277.9(with)-278.8(time,)-271.1(its)]TJ
T*
[(amenability)-344.6(to)-337.7(treatment,)-340.8(and)-339.6(the)-337.6(feasibility)-344(of)-335.7(conducting)-347.4(clinical)]TJ
T*
[(trials.)-242.4(Hence,)-243.3(the)-242.8(majority)-244.8(of)-240.9(the)-242.8(studies)-246.2(reported)-243.9(here)-247(were)-240.7(based)-247.7(on)]TJ
T*
[(RCTs.)-390.9(Most)-390.7(of)-386.3(these)-390.8(studies)-385.3(were)-392.5(focused)-392.1(on)-382.3(COPD,)-389.4(but)-391.1(a)-387.2(few)-386.2(in-)]TJ
T*
[(corporated)-243.9(more)-235.5(than)-240.5(one)-232.5(of)-240.9(the)-236.5(three)-238.5(chronic)-240.8(disease)-242.8(entities)-239.3(in)-235.6(this)]TJ
T*
[(report.)-314.3(Hence,)-312.9(we)-308.2(tried)-311.7(to)-312.5(include)-307.4(each)-311.7(study)-314.4(only)-308.4(once.)-311.5(Deviations)]TJ
T*
[(from)-387.4(this)-384.2(rule)-387.7(are)-389.3(noted)-386.8(explicitly,)-391.5(and)-390.1(the)-388.2(discussion)-388.3(in)-387.3(repeated)]TJ
0 -1.3278 TD
[(cases)-329.3(is)-333(very)-334.1(limited.)-333.6(As)-325.4(with)-335.7(telestroke)-332.5(findings,)-333.1(those)-330.5(from)-330.5(COPD)]TJ
0 -1.3341 TD
[(studies)-252.5(are)-250.2(grouped)-251.6(into)-244.5(three)-251.1(clusters)-256.1(of)-247.2(outcomes,)-251(but)-252(with)-247.2(a)-248.1(slight)]TJ
T*
[(variation)-224.4(in)-216.6(headings)-220.5(specific)-229.1(to)-217.6(COPD:)-218.9(\(1\))-220.5(feasibility)-223.9(and)-219.4(acceptance)]TJ
T*
[(of)-297.8(telepulmonology,)-303.5(\(2\))-296.4(use)-302.6(of)-297.8(service,)-300.7(and)-295.3(\(3\))-296.4(health)-301.2(outcomes)-300.3(and)]TJ
T*
[(cost)-283.5(\()]TJ
/F5 1 Tf
2.2257 0 TD
[(Table)-284.2(3)]TJ
/F1 1 Tf
3.0413 0 TD
(\).)Tj
/F11 1 Tf
11.9551 0 0 11.9551 50.1732 741.9966 Tm
[(BASHSHUR)-338.5(ET)-334.1(AL.)]TJ
7.9702 0 0 7.9702 50.1732 29.7638 Tm
[(7)-80(8)-75.6(6)-708.4(TELEMEDI)12.8(CINE)-329.6(and)-331.8(e-HEALTH)]TJ
/F8 1 Tf
6.9738 0 0 6.9738 177.8456 29.7638 Tm
.1099 Tc
[(SEPTEMB)6.6(E)2.1(R)-332.8(2).5(014)]TJ
ET
q
1 i
0 792 612 -791.985 re
W n
32.315 .014984 .22675 791.985 re
f
/Document /MC10 BDC
Q
q
1 i
0 792 32.315 -173.367 re
W n
0 0 0 .29999 k
0 618.633 32.315 173.367 re
f
EMC
Q
32.315 763.994 242.646 .22675 re
f
endstream
endobj
266 0 obj
<>stream
Adobe Illustrator CS4
2010-08-04T11:54:42+05:30
2010-08-04T11:54:42+05:30
2010-08-04T11:54:42+05:30
68
256
JPEG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application/postscript
saved
xmp.iid:11FB61F30AB7DE11AEB3E861853EAFA4
2009-10-12T14:15:50+05:30
Adobe Illustrator CS4
/
converted
from application/postscript to application/vnd.adobe.illustrator
converted
from application/postscript to application/vnd.adobe.illustrator
saved
xmp.iid:0280117407206811994CBE3149FFDB59
2010-08-04T11:54:42+05:30
Adobe Illustrator CS4
/
converted
from application/postscript to application/vnd.adobe.illustrator
xmp.iid:11FB61F30AB7DE11AEB3E861853EAFA4
xmp.did:11FB61F30AB7DE11AEB3E861853EAFA4
uuid:ee5a72b3-04e4-4157-a8d8-c3a8817872a3
uuid:ee5a72b3-04e4-4157-a8d8-c3a8817872a3
xmp.iid:0280117407206811994CBE3149FFDB59
xmp.did:0280117407206811994CBE3149FFDB59
TouchUp 7.0
False
False
1
684.000000
864.000000
Points
Black
Default Swatch Group
0
PANTONE 3025 C
SPOT
100.000000
CMYK
100.000000
16.859999
0.000000
50.980003
endstream
endobj
263 0 obj
<>
endobj
267 0 obj
<>/XObject<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]/Font<>>>/Thumb 270 0 R/MediaBox[0 0 612 792]/Rotate 0>>
endobj
271 0 obj
<>/ProcSet[/PDF/Text]/Font<>>>
endobj
268 0 obj
<>stream
0 0 0 .695 k
/GS1 gs
35.887 718.583 525.997 18.539 re
f
35.887 691.88 525.997 31.861 re
f
0 0 0 .065 k
35.887 667.842 51.364 24.038 re
f
0 0 0 .145 k
87.25 667.842 23.924 24.038 re
f
0 0 0 .065 k
111.175 667.842 41.839 24.038 re
f
0 0 0 .145 k
153.014 667.842 33.505 24.038 re
f
0 0 0 .065 k
186.52 667.842 22.677 24.038 re
f
0 0 0 .145 k
209.197 667.842 41.839 24.038 re
f
0 0 0 .065 k
251.036 667.842 58.62 24.038 re
f
0 0 0 .145 k
309.657 667.842 47.792 24.038 re
f
0 0 0 .065 k
357.449 667.842 61.002 24.038 re
f
0 0 0 .145 k
418.45 667.842 65.707 24.038 re
f
0 0 0 .065 k
484.157 667.842 77.726 24.038 re
f
35.887 652.819 51.364 15.024 re
f
0 0 0 .145 k
87.25 652.819 23.924 15.024 re
f
0 0 0 .065 k
111.175 652.819 41.839 15.024 re
f
0 0 0 .145 k
153.014 652.819 33.505 15.024 re
f
0 0 0 .065 k
186.52 652.819 22.677 15.024 re
f
0 0 0 .145 k
209.197 652.819 41.839 15.024 re
f
0 0 0 .065 k
251.036 652.819 58.62 15.024 re
f
0 0 0 .145 k
309.657 652.819 47.792 15.024 re
f
0 0 0 .065 k
357.449 652.819 61.002 15.024 re
f
0 0 0 .145 k
418.45 652.819 65.707 15.024 re
f
0 0 0 .065 k
484.157 652.819 77.726 15.024 re
f
35.887 619.823 51.364 32.995 re
f
0 0 0 .145 k
87.25 619.823 23.924 32.995 re
f
0 0 0 .065 k
111.175 619.823 41.839 32.995 re
f
0 0 0 .145 k
153.014 619.823 33.505 32.995 re
f
0 0 0 .065 k
186.52 619.823 22.677 32.995 re
f
0 0 0 .145 k
209.197 619.823 41.839 32.995 re
f
0 0 0 .065 k
251.036 619.823 58.62 32.995 re
f
0 0 0 .145 k
309.657 619.823 47.792 32.995 re
f
0 0 0 .065 k
357.449 619.823 61.002 32.995 re
f
0 0 0 .145 k
418.45 619.823 65.707 32.995 re
f
0 0 0 .065 k
484.157 619.823 77.726 32.995 re
f
35.887 595.842 51.364 23.981 re
f
0 0 0 .145 k
87.25 595.842 23.924 23.981 re
f
0 0 0 .065 k
111.175 595.842 41.839 23.981 re
f
0 0 0 .145 k
153.014 595.842 33.505 23.981 re
f
0 0 0 .065 k
186.52 595.842 22.677 23.981 re
f
0 0 0 .145 k
209.197 595.842 41.839 23.981 re
f
0 0 0 .065 k
251.036 595.842 58.62 23.981 re
f
0 0 0 .145 k
309.657 595.842 47.792 23.981 re
f
0 0 0 .065 k
357.449 595.842 61.002 23.981 re
f
0 0 0 .145 k
418.45 595.842 65.707 23.981 re
f
0 0 0 .065 k
484.157 595.842 77.726 23.981 re
f
35.887 571.805 51.364 24.038 re
f
0 0 0 .145 k
87.25 571.805 23.924 24.038 re
f
0 0 0 .065 k
111.175 571.805 41.839 24.038 re
f
0 0 0 .145 k
153.014 571.805 33.505 24.038 re
f
0 0 0 .065 k
186.52 571.805 22.677 24.038 re
f
0 0 0 .145 k
209.197 571.805 41.839 24.038 re
f
0 0 0 .065 k
251.036 571.805 58.62 24.038 re
f
0 0 0 .145 k
309.657 571.805 47.792 24.038 re
f
0 0 0 .065 k
357.449 571.805 61.002 24.038 re
f
0 0 0 .145 k
418.45 571.805 65.707 24.038 re
f
0 0 0 .065 k
484.157 571.805 77.726 24.038 re
f
35.887 529.909 51.364 41.896 re
f
0 0 0 .145 k
87.25 529.909 23.924 41.896 re
f
0 0 0 .065 k
111.175 529.909 41.839 41.896 re
f
0 0 0 .145 k
153.014 529.909 33.505 41.896 re
f
0 0 0 .065 k
186.52 529.909 22.677 41.896 re
f
0 0 0 .145 k
209.197 529.909 41.839 41.896 re
f
0 0 0 .065 k
251.036 529.909 58.62 41.896 re
f
0 0 0 .145 k
309.657 529.909 47.792 41.896 re
f
0 0 0 .065 k
357.449 529.909 61.002 41.896 re
f
0 0 0 .145 k
418.45 529.909 65.707 41.896 re
f
0 0 0 .065 k
484.157 529.909 77.726 41.896 re
f
35.887 496.913 51.364 32.995 re
f
0 0 0 .145 k
87.25 496.913 23.924 32.995 re
f
0 0 0 .065 k
111.175 496.913 41.839 32.995 re
f
0 0 0 .145 k
153.014 496.913 33.505 32.995 re
f
0 0 0 .065 k
186.52 496.913 22.677 32.995 re
f
0 0 0 .145 k
209.197 496.913 41.839 32.995 re
f
0 0 0 .065 k
251.036 496.913 58.62 32.995 re
f
0 0 0 .145 k
309.657 496.913 47.792 32.995 re
f
0 0 0 .065 k
357.449 496.913 61.002 32.995 re
f
0 0 0 .145 k
418.45 496.913 65.707 32.995 re
f
0 0 0 .065 k
484.157 496.913 77.726 32.995 re
f
35.887 472.875 51.364 24.038 re
f
0 0 0 .145 k
87.25 472.875 23.924 24.038 re
f
0 0 0 .065 k
111.175 472.875 41.839 24.038 re
f
0 0 0 .145 k
153.014 472.875 33.505 24.038 re
f
0 0 0 .065 k
186.52 472.875 22.677 24.038 re
f
0 0 0 .145 k
209.197 472.875 41.839 24.038 re
f
0 0 0 .065 k
251.036 472.875 58.62 24.038 re
f
0 0 0 .145 k
309.657 472.875 47.792 24.038 re
f
0 0 0 .065 k
357.449 472.875 61.002 24.038 re
f
0 0 0 .145 k
418.45 472.875 65.707 24.038 re
f
0 0 0 .065 k
484.157 472.875 77.726 24.038 re
f
35.887 430.979 51.364 41.896 re
f
0 0 0 .145 k
87.25 430.979 23.924 41.896 re
f
0 0 0 .065 k
111.175 430.979 41.839 41.896 re
f
0 0 0 .145 k
153.014 430.979 33.505 41.896 re
f
0 0 0 .065 k
186.52 430.979 22.677 41.896 re
f
0 0 0 .145 k
209.197 430.979 41.839 41.896 re
f
0 0 0 .065 k
251.036 430.979 58.62 41.896 re
f
0 0 0 .145 k
309.657 430.979 47.792 41.896 re
f
0 0 0 .065 k
357.449 430.979 61.002 41.896 re
f
0 0 0 .145 k
418.45 430.979 65.707 41.896 re
f
0 0 0 .065 k
484.157 430.979 77.726 41.896 re
f
35.887 406.942 51.364 24.038 re
f
0 0 0 .145 k
87.25 406.942 23.924 24.038 re
f
0 0 0 .065 k
111.175 406.942 41.839 24.038 re
f
0 0 0 .145 k
153.014 406.942 33.505 24.038 re
f
0 0 0 .065 k
186.52 406.942 22.677 24.038 re
f
0 0 0 .145 k
209.197 406.942 41.839 24.038 re
f
0 0 0 .065 k
251.036 406.942 58.62 24.038 re
f
0 0 0 .145 k
309.657 406.942 47.792 24.038 re
f
0 0 0 .065 k
357.449 406.942 61.002 24.038 re
f
0 0 0 .145 k
418.45 406.942 65.707 24.038 re
f
0 0 0 .065 k
484.157 406.942 77.726 24.038 re
f
35.887 373.946 51.364 32.995 re
f
0 0 0 .145 k
87.25 373.946 23.924 32.995 re
f
0 0 0 .065 k
111.175 373.946 41.839 32.995 re
f
0 0 0 .145 k
153.014 373.946 33.505 32.995 re
f
0 0 0 .065 k
186.52 373.946 22.677 32.995 re
f
0 0 0 .145 k
209.197 373.946 41.839 32.995 re
f
0 0 0 .065 k
251.036 373.946 58.62 32.995 re
f
0 0 0 .145 k
309.657 373.946 47.792 32.995 re
f
0 0 0 .065 k
357.449 373.946 61.002 32.995 re
f
0 0 0 .145 k
418.45 373.946 65.707 32.995 re
f
0 0 0 .065 k
484.157 373.946 77.726 32.995 re
f
35.887 341.008 51.364 32.939 re
f
0 0 0 .145 k
87.25 341.008 23.924 32.939 re
f
0 0 0 .065 k
111.175 341.008 41.839 32.939 re
f
0 0 0 .145 k
153.014 341.008 33.505 32.939 re
f
0 0 0 .065 k
186.52 341.008 22.677 32.939 re
f
0 0 0 .145 k
209.197 341.008 41.839 32.939 re
f
0 0 0 .065 k
251.036 341.008 58.62 32.939 re
f
0 0 0 .145 k
309.657 341.008 47.792 32.939 re
f
0 0 0 .065 k
357.449 341.008 61.002 32.939 re
f
0 0 0 .145 k
418.45 341.008 65.707 32.939 re
f
0 0 0 .065 k
484.157 341.008 77.726 32.939 re
f
35.887 308.013 51.364 32.995 re
f
0 0 0 .145 k
87.25 308.013 23.924 32.995 re
f
0 0 0 .065 k
111.175 308.013 41.839 32.995 re
f
0 0 0 .145 k
153.014 308.013 33.505 32.995 re
f
0 0 0 .065 k
186.52 308.013 22.677 32.995 re
f
0 0 0 .145 k
209.197 308.013 41.839 32.995 re
f
0 0 0 .065 k
251.036 308.013 58.62 32.995 re
f
0 0 0 .145 k
309.657 308.013 47.792 32.995 re
f
0 0 0 .065 k
357.449 308.013 61.002 32.995 re
f
0 0 0 .145 k
418.45 308.013 65.707 32.995 re
f
0 0 0 .065 k
484.157 308.013 77.726 32.995 re
f
35.887 266.06 51.364 41.953 re
f
0 0 0 .145 k
87.25 266.06 23.924 41.953 re
f
0 0 0 .065 k
111.175 266.06 41.839 41.953 re
f
0 0 0 .145 k
153.014 266.06 33.505 41.953 re
f
0 0 0 .065 k
186.52 266.06 22.677 41.953 re
f
0 0 0 .145 k
209.197 266.06 41.839 41.953 re
f
0 0 0 .065 k
251.036 266.06 58.62 41.953 re
f
0 0 0 .145 k
309.657 266.06 47.792 41.953 re
f
0 0 0 .065 k
357.449 266.06 61.002 41.953 re
f
0 0 0 .145 k
418.45 266.06 65.707 41.953 re
f
0 0 0 .065 k
484.157 266.06 77.726 41.953 re
f
35.887 224.107 51.364 41.953 re
f
0 0 0 .145 k
87.25 224.107 23.924 41.953 re
f
0 0 0 .065 k
111.175 224.107 41.839 41.953 re
f
0 0 0 .145 k
153.014 224.107 33.505 41.953 re
f
0 0 0 .065 k
186.52 224.107 22.677 41.953 re
f
0 0 0 .145 k
209.197 224.107 41.839 41.953 re
f
0 0 0 .065 k
251.036 224.107 58.62 41.953 re
f
0 0 0 .145 k
309.657 224.107 47.792 41.953 re
f
0 0 0 .065 k
357.449 224.107 61.002 41.953 re
f
0 0 0 .145 k
418.45 224.107 65.707 41.953 re
f
0 0 0 .065 k
484.157 224.107 77.726 41.953 re
f
35.887 173.254 51.364 50.854 re
f
0 0 0 .145 k
87.25 173.254 23.924 50.854 re
f
0 0 0 .065 k
111.175 173.254 41.839 50.854 re
f
0 0 0 .145 k
153.014 173.254 33.505 50.854 re
f
0 0 0 .065 k
186.52 173.254 22.677 50.854 re
f
0 0 0 .145 k
209.197 173.254 41.839 50.854 re
f
0 0 0 .065 k
251.036 173.254 58.62 50.854 re
f
0 0 0 .145 k
309.657 173.254 47.792 50.854 re
f
0 0 0 .065 k
357.449 173.254 61.002 50.854 re
f
0 0 0 .145 k
418.45 173.254 65.707 50.854 re
f
0 0 0 .065 k
484.157 173.254 77.726 50.854 re
f
35.887 131.301 51.364 41.953 re
f
0 0 0 .145 k
87.25 131.301 23.924 41.953 re
f
0 0 0 .065 k
111.175 131.301 41.839 41.953 re
f
0 0 0 .145 k
153.014 131.301 33.505 41.953 re
f
0 0 0 .065 k
186.52 131.301 22.677 41.953 re
f
0 0 0 .145 k
209.197 131.301 41.839 41.953 re
f
0 0 0 .065 k
251.036 131.301 58.62 41.953 re
f
0 0 0 .145 k
309.657 131.301 47.792 41.953 re
f
0 0 0 .065 k
357.449 131.301 61.002 41.953 re
f
0 0 0 .145 k
418.45 131.301 65.707 41.953 re
f
0 0 0 .065 k
484.157 131.301 77.726 41.953 re
f
0 0 0 .845 k
35.887 737.178 525.997 1.0205 re
f
0 0 0 .695 k
35.887 731.905 525.997 5.2725 re
f
0 0 0 1 k
q 1 0 0 1 35.887 131.301 cm 0 0 m
525.997 0 l
0 0 l
f
Q
0 0 0 .345 k
35.887 723.458 117.128 .51019 re
f
153.014 718.583 .51024 18.539 re
f
153.524 723.458 97.512 .51019 re
f
251.036 718.583 .51022 18.539 re
f
309.657 718.583 .45352 18.539 re
f
310.11 723.458 174.047 .51019 re
f
484.157 718.583 .51025 18.539 re
f
87.25 691.88 .51022 31.861 re
f
111.175 691.88 .51024 31.861 re
f
153.014 691.88 .51024 31.861 re
f
186.52 691.88 .45355 31.861 re
f
209.197 691.88 .51024 31.861 re
f
251.036 691.88 .51022 31.861 re
f
309.657 691.88 .45352 31.861 re
f
357.449 691.88 .51025 31.861 re
f
418.45 691.88 .45355 31.861 re
f
484.157 691.88 .51025 31.861 re
f
35.887 691.37 525.997 .51025 re
f
0 0 0 1 k
35.887 667.842 51.364 .51025 re
f
87.25 667.842 .51022 24.038 re
f
87.761 667.842 23.414 .51025 re
f
111.175 667.842 .51024 24.038 re
f
111.685 667.842 41.329 .51025 re
f
153.014 667.842 .51024 24.038 re
f
153.524 667.842 32.995 .51025 re
f
186.52 667.842 .45355 24.038 re
f
186.973 667.842 22.224 .51025 re
f
209.197 667.842 .51024 24.038 re
f
209.707 667.842 41.329 .51025 re
f
251.036 667.842 .51022 24.038 re
f
251.546 667.842 58.11 .51025 re
f
309.657 667.842 .45352 24.038 re
f
310.11 667.842 47.339 .51025 re
f
357.449 667.842 .51025 24.038 re
f
357.959 667.842 60.491 .51025 re
f
418.45 667.842 .45355 24.038 re
f
418.904 667.842 65.254 .51025 re
f
484.157 667.842 .51025 24.038 re
f
484.668 667.842 77.216 .51025 re
f
35.887 652.819 51.364 .51025 re
f
87.25 652.819 .51022 15.024 re
f
87.761 652.819 23.414 .51025 re
f
111.175 652.819 .51024 15.024 re
f
111.685 652.819 41.329 .51025 re
f
153.014 652.819 .51024 15.024 re
f
153.524 652.819 32.995 .51025 re
f
186.52 652.819 .45355 15.024 re
f
186.973 652.819 22.224 .51025 re
f
209.197 652.819 .51024 15.024 re
f
209.707 652.819 41.329 .51025 re
f
251.036 652.819 .51022 15.024 re
f
251.546 652.819 58.11 .51025 re
f
309.657 652.819 .45352 15.024 re
f
310.11 652.819 47.339 .51025 re
f
357.449 652.819 .51025 15.024 re
f
357.959 652.819 60.491 .51025 re
f
418.45 652.819 .45355 15.024 re
f
418.904 652.819 65.254 .51025 re
f
484.157 652.819 .51025 15.024 re
f
484.668 652.819 77.216 .51025 re
f
35.887 619.823 51.364 .51019 re
f
87.25 619.823 .51022 32.995 re
f
87.761 619.823 23.414 .51019 re
f
111.175 619.823 .51024 32.995 re
f
111.685 619.823 41.329 .51019 re
f
153.014 619.823 .51024 32.995 re
f
153.524 619.823 32.995 .51019 re
f
186.52 619.823 .45355 32.995 re
f
186.973 619.823 22.224 .51019 re
f
209.197 619.823 .51024 32.995 re
f
209.707 619.823 41.329 .51019 re
f
251.036 619.823 .51022 32.995 re
f
251.546 619.823 58.11 .51019 re
f
309.657 619.823 .45352 32.995 re
f
310.11 619.823 47.339 .51019 re
f
357.449 619.823 .51025 32.995 re
f
357.959 619.823 60.491 .51019 re
f
418.45 619.823 .45355 32.995 re
f
418.904 619.823 65.254 .51019 re
f
484.157 619.823 .51025 32.995 re
f
484.668 619.823 77.216 .51019 re
f
35.887 595.842 51.364 .51019 re
f
87.25 595.842 .51022 23.981 re
f
87.761 595.842 23.414 .51019 re
f
111.175 595.842 .51024 23.981 re
f
111.685 595.842 41.329 .51019 re
f
153.014 595.842 .51024 23.981 re
f
153.524 595.842 32.995 .51019 re
f
186.52 595.842 .45355 23.981 re
f
186.973 595.842 22.224 .51019 re
f
209.197 595.842 .51024 23.981 re
f
209.707 595.842 41.329 .51019 re
f
251.036 595.842 .51022 23.981 re
f
251.546 595.842 58.11 .51019 re
f
309.657 595.842 .45352 23.981 re
f
310.11 595.842 47.339 .51019 re
f
357.449 595.842 .51025 23.981 re
f
357.959 595.842 60.491 .51019 re
f
418.45 595.842 .45355 23.981 re
f
418.904 595.842 65.254 .51019 re
f
484.157 595.842 .51025 23.981 re
f
484.668 595.842 77.216 .51019 re
f
35.887 571.805 51.364 .51025 re
f
87.25 571.805 .51022 24.038 re
f
87.761 571.805 23.414 .51025 re
f
111.175 571.805 .51024 24.038 re
f
111.685 571.805 41.329 .51025 re
f
153.014 571.805 .51024 24.038 re
f
153.524 571.805 32.995 .51025 re
f
186.52 571.805 .45355 24.038 re
f
186.973 571.805 22.224 .51025 re
f
209.197 571.805 .51024 24.038 re
f
209.707 571.805 41.329 .51025 re
f
251.036 571.805 .51022 24.038 re
f
251.546 571.805 58.11 .51025 re
f
309.657 571.805 .45352 24.038 re
f
310.11 571.805 47.339 .51025 re
f
357.449 571.805 .51025 24.038 re
f
357.959 571.805 60.491 .51025 re
f
418.45 571.805 .45355 24.038 re
f
418.904 571.805 65.254 .51025 re
f
484.157 571.805 .51025 24.038 re
f
484.668 571.805 77.216 .51025 re
f
35.887 529.909 51.364 .45349 re
f
87.25 529.909 .51022 41.896 re
f
87.761 529.909 23.414 .45349 re
f
111.175 529.909 .51024 41.896 re
f
111.685 529.909 41.329 .45349 re
f
153.014 529.909 .51024 41.896 re
f
153.524 529.909 32.995 .45349 re
f
186.52 529.909 .45355 41.896 re
f
186.973 529.909 22.224 .45349 re
f
209.197 529.909 .51024 41.896 re
f
209.707 529.909 41.329 .45349 re
f
251.036 529.909 .51022 41.896 re
f
251.546 529.909 58.11 .45349 re
f
309.657 529.909 .45352 41.896 re
f
310.11 529.909 47.339 .45349 re
f
357.449 529.909 .51025 41.896 re
f
357.959 529.909 60.491 .45349 re
f
418.45 529.909 .45355 41.896 re
f
418.904 529.909 65.254 .45349 re
f
484.157 529.909 .51025 41.896 re
f
484.668 529.909 77.216 .45349 re
f
35.887 496.913 51.364 .51022 re
f
87.25 496.913 .51022 32.995 re
f
87.761 496.913 23.414 .51022 re
f
111.175 496.913 .51024 32.995 re
f
111.685 496.913 41.329 .51022 re
f
153.014 496.913 .51024 32.995 re
f
153.524 496.913 32.995 .51022 re
f
186.52 496.913 .45355 32.995 re
f
186.973 496.913 22.224 .51022 re
f
209.197 496.913 .51024 32.995 re
f
209.707 496.913 41.329 .51022 re
f
251.036 496.913 .51022 32.995 re
f
251.546 496.913 58.11 .51022 re
f
309.657 496.913 .45352 32.995 re
f
310.11 496.913 47.339 .51022 re
f
357.449 496.913 .51025 32.995 re
f
357.959 496.913 60.491 .51022 re
f
418.45 496.913 .45355 32.995 re
f
418.904 496.913 65.254 .51022 re
f
484.157 496.913 .51025 32.995 re
f
484.668 496.913 77.216 .51022 re
f
35.887 472.875 51.364 .51022 re
f
87.25 472.875 .51022 24.038 re
f
87.761 472.875 23.414 .51022 re
f
111.175 472.875 .51024 24.038 re
f
111.685 472.875 41.329 .51022 re
f
153.014 472.875 .51024 24.038 re
f
153.524 472.875 32.995 .51022 re
f
186.52 472.875 .45355 24.038 re
f
186.973 472.875 22.224 .51022 re
f
209.197 472.875 .51024 24.038 re
f
209.707 472.875 41.329 .51022 re
f
251.036 472.875 .51022 24.038 re
f
251.546 472.875 58.11 .51022 re
f
309.657 472.875 .45352 24.038 re
f
310.11 472.875 47.339 .51022 re
f
357.449 472.875 .51025 24.038 re
f
357.959 472.875 60.491 .51022 re
f
418.45 472.875 .45355 24.038 re
f
418.904 472.875 65.254 .51022 re
f
484.157 472.875 .51025 24.038 re
f
484.668 472.875 77.216 .51022 re
f
35.887 430.979 51.364 .45355 re
f
87.25 430.979 .51022 41.896 re
f
87.761 430.979 23.414 .45355 re
f
111.175 430.979 .51024 41.896 re
f
111.685 430.979 41.329 .45355 re
f
153.014 430.979 .51024 41.896 re
f
153.524 430.979 32.995 .45355 re
f
186.52 430.979 .45355 41.896 re
f
186.973 430.979 22.224 .45355 re
f
209.197 430.979 .51024 41.896 re
f
209.707 430.979 41.329 .45355 re
f
251.036 430.979 .51022 41.896 re
f
251.546 430.979 58.11 .45355 re
f
309.657 430.979 .45352 41.896 re
f
310.11 430.979 47.339 .45355 re
f
357.449 430.979 .51025 41.896 re
f
357.959 430.979 60.491 .45355 re
f
418.45 430.979 .45355 41.896 re
f
418.904 430.979 65.254 .45355 re
f
484.157 430.979 .51025 41.896 re
f
484.668 430.979 77.216 .45355 re
f
35.887 406.942 51.364 .51022 re
f
87.25 406.942 .51022 24.038 re
f
87.761 406.942 23.414 .51022 re
f
111.175 406.942 .51024 24.038 re
f
111.685 406.942 41.329 .51022 re
f
153.014 406.942 .51024 24.038 re
f
153.524 406.942 32.995 .51022 re
f
186.52 406.942 .45355 24.038 re
f
186.973 406.942 22.224 .51022 re
f
209.197 406.942 .51024 24.038 re
f
209.707 406.942 41.329 .51022 re
f
251.036 406.942 .51022 24.038 re
f
251.546 406.942 58.11 .51022 re
f
309.657 406.942 .45352 24.038 re
f
310.11 406.942 47.339 .51022 re
f
357.449 406.942 .51025 24.038 re
f
357.959 406.942 60.491 .51022 re
f
418.45 406.942 .45355 24.038 re
f
418.904 406.942 65.254 .51022 re
f
484.157 406.942 .51025 24.038 re
f
484.668 406.942 77.216 .51022 re
f
35.887 373.946 51.364 .51022 re
f
87.25 373.946 .51022 32.995 re
f
87.761 373.946 23.414 .51022 re
f
111.175 373.946 .51024 32.995 re
f
111.685 373.946 41.329 .51022 re
f
153.014 373.946 .51024 32.995 re
f
153.524 373.946 32.995 .51022 re
f
186.52 373.946 .45355 32.995 re
f
186.973 373.946 22.224 .51022 re
f
209.197 373.946 .51024 32.995 re
f
209.707 373.946 41.329 .51022 re
f
251.036 373.946 .51022 32.995 re
f
251.546 373.946 58.11 .51022 re
f
309.657 373.946 .45352 32.995 re
f
310.11 373.946 47.339 .51022 re
f
357.449 373.946 .51025 32.995 re
f
357.959 373.946 60.491 .51022 re
f
418.45 373.946 .45355 32.995 re
f
418.904 373.946 65.254 .51022 re
f
484.157 373.946 .51025 32.995 re
f
484.668 373.946 77.216 .51022 re
f
35.887 341.008 51.364 .51022 re
f
87.25 341.008 .51022 32.939 re
f
87.761 341.008 23.414 .51022 re
f
111.175 341.008 .51024 32.939 re
f
111.685 341.008 41.329 .51022 re
f
153.014 341.008 .51024 32.939 re
f
153.524 341.008 32.995 .51022 re
f
186.52 341.008 .45355 32.939 re
f
186.973 341.008 22.224 .51022 re
f
209.197 341.008 .51024 32.939 re
f
209.707 341.008 41.329 .51022 re
f
251.036 341.008 .51022 32.939 re
f
251.546 341.008 58.11 .51022 re
f
309.657 341.008 .45352 32.939 re
f
310.11 341.008 47.339 .51022 re
f
357.449 341.008 .51025 32.939 re
f
357.959 341.008 60.491 .51022 re
f
418.45 341.008 .45355 32.939 re
f
418.904 341.008 65.254 .51022 re
f
484.157 341.008 .51025 32.939 re
f
484.668 341.008 77.216 .51022 re
f
35.887 308.013 51.364 .51025 re
f
87.25 308.013 .51022 32.995 re
f
87.761 308.013 23.414 .51025 re
f
111.175 308.013 .51024 32.995 re
f
111.685 308.013 41.329 .51025 re
f
153.014 308.013 .51024 32.995 re
f
153.524 308.013 32.995 .51025 re
f
186.52 308.013 .45355 32.995 re
f
186.973 308.013 22.224 .51025 re
f
209.197 308.013 .51024 32.995 re
f
209.707 308.013 41.329 .51025 re
f
251.036 308.013 .51022 32.995 re
f
251.546 308.013 58.11 .51025 re
f
309.657 308.013 .45352 32.995 re
f
310.11 308.013 47.339 .51025 re
f
357.449 308.013 .51025 32.995 re
f
357.959 308.013 60.491 .51025 re
f
418.45 308.013 .45355 32.995 re
f
418.904 308.013 65.254 .51025 re
f
484.157 308.013 .51025 32.995 re
f
484.668 308.013 77.216 .51025 re
f
35.887 266.06 51.364 .51025 re
f
87.25 266.06 .51022 41.953 re
f
87.761 266.06 23.414 .51025 re
f
111.175 266.06 .51024 41.953 re
f
111.685 266.06 41.329 .51025 re
f
153.014 266.06 .51024 41.953 re
f
153.524 266.06 32.995 .51025 re
f
186.52 266.06 .45355 41.953 re
f
186.973 266.06 22.224 .51025 re
f
209.197 266.06 .51024 41.953 re
f
209.707 266.06 41.329 .51025 re
f
251.036 266.06 .51022 41.953 re
f
251.546 266.06 58.11 .51025 re
f
309.657 266.06 .45352 41.953 re
f
310.11 266.06 47.339 .51025 re
f
357.449 266.06 .51025 41.953 re
f
357.959 266.06 60.491 .51025 re
f
418.45 266.06 .45355 41.953 re
f
418.904 266.06 65.254 .51025 re
f
484.157 266.06 .51025 41.953 re
f
484.668 266.06 77.216 .51025 re
f
35.887 224.107 51.364 .51024 re
f
87.25 224.107 .51022 41.953 re
f
87.761 224.107 23.414 .51024 re
f
111.175 224.107 .51024 41.953 re
f
111.685 224.107 41.329 .51024 re
f
153.014 224.107 .51024 41.953 re
f
153.524 224.107 32.995 .51024 re
f
186.52 224.107 .45355 41.953 re
f
186.973 224.107 22.224 .51024 re
f
209.197 224.107 .51024 41.953 re
f
209.707 224.107 41.329 .51024 re
f
251.036 224.107 .51022 41.953 re
f
251.546 224.107 58.11 .51024 re
f
309.657 224.107 .45352 41.953 re
f
310.11 224.107 47.339 .51024 re
f
357.449 224.107 .51025 41.953 re
f
357.959 224.107 60.491 .51024 re
f
418.45 224.107 .45355 41.953 re
f
418.904 224.107 65.254 .51024 re
f
484.157 224.107 .51025 41.953 re
f
484.668 224.107 77.216 .51024 re
f
35.887 173.254 51.364 .45351 re
f
87.25 173.254 .51022 50.854 re
f
87.761 173.254 23.414 .45351 re
f
111.175 173.254 .51024 50.854 re
f
111.685 173.254 41.329 .45351 re
f
153.014 173.254 .51024 50.854 re
f
153.524 173.254 32.995 .45351 re
f
186.52 173.254 .45355 50.854 re
f
186.973 173.254 22.224 .45351 re
f
209.197 173.254 .51024 50.854 re
f
209.707 173.254 41.329 .45351 re
f
251.036 173.254 .51022 50.854 re
f
251.546 173.254 58.11 .45351 re
f
309.657 173.254 .45352 50.854 re
f
310.11 173.254 47.339 .45351 re
f
357.449 173.254 .51025 50.854 re
f
357.959 173.254 60.491 .45351 re
f
418.45 173.254 .45355 50.854 re
f
418.904 173.254 65.254 .45351 re
f
484.157 173.254 .51025 50.854 re
f
484.668 173.254 77.216 .45351 re
f
35.887 131.301 51.364 .45352 re
f
87.25 131.301 .51022 41.953 re
f
87.761 131.301 23.414 .45352 re
f
111.175 131.301 .51024 41.953 re
f
111.685 131.301 41.329 .45352 re
f
153.014 131.301 .51024 41.953 re
f
153.524 131.301 32.995 .45352 re
f
186.52 131.301 .45355 41.953 re
f
186.973 131.301 22.224 .45352 re
f
209.197 131.301 .51024 41.953 re
f
209.707 131.301 41.329 .45352 re
f
251.036 131.301 .51022 41.953 re
f
251.546 131.301 58.11 .45352 re
f
309.657 131.301 .45352 41.953 re
f
310.11 131.301 47.339 .45352 re
f
357.449 131.301 .51025 41.953 re
f
357.959 131.301 60.491 .45352 re
f
418.45 131.301 .45355 41.953 re
f
418.904 131.301 65.254 .45352 re
f
484.157 131.301 .51025 41.953 re
f
484.668 131.301 77.216 .45352 re
f
0 0 0 .845 k
35.887 741.203 525.997 11.962 re
f
35.887 738.198 525.997 9.9779 re
f
0 0 0 .065 k
35.887 119.339 525.997 11.962 re
f
35.887 89.065 525.997 39.855 re
f
35.887 77.613 525.997 11.962 re
f
35.887 118.998 3.9685 9.9213 re
f
557.915 118.998 3.9685 9.9213 re
f
35.887 109.02 3.9685 9.978 re
f
557.915 109.02 3.9685 9.978 re
f
35.887 99.042 3.9685 9.9779 re
f
557.915 99.042 3.9685 9.9779 re
f
35.887 89.065 3.9685 9.9779 re
f
557.915 89.065 3.9685 9.9779 re
f
BT
/F14 1 Tf
9.9626 0 0 9.9626 40.3653 740.6927 Tm
0 0 0 0 k
0 Tc
0 Tw
[(Table)-337.4(3.)-335.7(Metho)-7.4(dology)-337.4(and)-339(Findings)-341.7(Pertaini)-9.1(ng)-334.3(to)-337.1(Chroni)-8.4(c)-332.6(Obstru)-8(ctive)-340.4(Pulmonar)-10.7(y)-332.6(Disea)-8.8(se)]TJ
7.9702 0 0 7.9702 59.6976 727.6534 Tm
[(LITERAT)12.4(URE)-334.1(SOURCE)-5865.4(METHODOL)10.8(OGY)-19134(FINDINGS)]TJ
-2.198 -4.1754 TD
[(REFERENC)14.9(E)-1229.8(DATE)-1023(COUNTRY)-1121.9(DESIGN)]TJ
18.6649 1.2519 TD
(SIZE)Tj
.2347 -1.2519 TD
(\()Tj
/F15 1 Tf
.3343 0 TD
(N)Tj
/F14 1 Tf
.6615 0 TD
[(\))-1189.2(DURATION)]TJ
6.9353 1.2519 TD
[(TELEMED)10.8(ICINE)]TJ
.2276 -1.2519 TD
[(TECHNOL)11.8(OGY)]TJ
7.0704 2.4967 TD
(FEASIBILITY)Tj
1.5222 -1.2448 TD
(AND)Tj
-1.5222 -1.2519 TD
(RELIABILITY)Tj
7.732 1.2519 TD
[(USE)-330.6(OF)]TJ
-.1921 -1.2519 TD
(SERVICE)Tj
8.0521 1.2519 TD
(HEALTH)Tj
-.754 -1.2519 TD
[(OUTCOM)12.2(ES)-4074.3(COMMENTS)]TJ
/F16 1 Tf
6.9738 0 0 6.9738 39.8551 681.9589 Tm
0 0 0 1 k
[(Raza)-342.5(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 68.3716 685.077 Tm
(115)Tj
6.9738 0 0 6.9738 93.3732 681.9589 Tm
[(2009)-1278.9(United)]TJ
3.1949 -1.2844 TD
(States)Tj
5.8938 1.2844 TD
[(RCC/PCC)-2244.6(314)-1099.4(7)-333.9(years)-5889.5(VTC)-6570(Yes)-3312.1(8%)-341.5(required)]TJ
29.4204 -1.2844 TD
[(in-pers)-11.2(on)-329.9(visits)]TJ
8.7473 1.2844 TD
[(NM)-8056.1(Patient)-337.4(travel)-336.5(avoide)-10.7(d;)]TJ
9.4301 -1.2844 TD
[(patient)-337.4(satisfied)]TJ
-64.3606 -2.1543 TD
[(Bonavia)-343.9(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 76.8756 661.0392 Tm
(116)Tj
6.9738 0 0 6.9738 93.3732 657.9778 Tm
[(2009)-1278.9(Italy)-5429.6(OS)-3416.8(937)-1099.4(2)-333.9(years)-5092.8(TS)-335.8(via)-338.8(T)-5777.1(Yes)-3312.1(NM)-7373.3(O)-8858.1(High)-331.8(GP)-334.4(acceptance)-336.2(of)-330.9(TS)]TJ
-7.6742 -2.1624 TD
(Averame)Tj
0 -1.2844 TD
[(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 53.2913 637.0581 Tm
(117)Tj
6.9738 0 0 6.9738 93.3732 642.8975 Tm
[(2009)-1278.9(Italy)-4527.3(OS/PCC)-2519.2(638)-1099.4(NR)-6738.7(TS)-335.8(via)-338.8(T)-5777.1(Yes)-3312.1(NM)-7373.3(TS)-335.8(used)-332.7(in)-338.8(diagnosis)]TJ
47.2563 -1.2844 TD
[(and)-338.1(airway)]TJ
T*
(management)Tj
9.4301 2.5689 TD
[(Encourages)-343.2(testing)-336.2(of)]TJ
0 -1.2844 TD
[(smokers)-334(without)]TJ
T*
(symptoms)Tj
-64.3606 -2.1543 TD
[(Bernocch)-10.8(i)]TJ
0 -1.2926 TD
[(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 53.2913 604.0629 Tm
(118)Tj
6.9738 0 0 6.9738 93.3732 609.9589 Tm
[(2012)-1278.9(Italy)-5429.6(OS)-3416.8(474)-1099.4(6/12)-322.5(mont)-10.5(hs)-3254.8(T,)-330.4(POx)-6095.3(Yes)-3312.1(NM)-7373.3(HPS)-7900.2(Growing)-338.2(need)-337.6(for)-335.9(home)]TJ
56.6864 -1.2926 TD
(management)Tj
-64.3606 -2.1543 TD
[(Whitten)-338.2(and)]TJ
0 -1.2844 TD
(Mickus)Tj
5.2302 0 0 4.6485 58.4504 580.0817 Tm
(119)Tj
6.9738 0 0 6.9738 93.3732 585.9211 Tm
[(2007)-1278.9(United)]TJ
3.1949 -1.2844 TD
(States)Tj
6.8694 1.2844 TD
[(RCT)-3204.1(161)-1099.4(11)-334.6(weeks)-5096.8(VTC)-6570(Yes)-3312.1(NM)-7373.3(HPS)-7900.2(Small)]TJ
/F18 1 Tf
49.0367 0 TD
(n)Tj
/F16 1 Tf
-66.7751 -3.4387 TD
[(Vitacca)-337(et)-342.2(al.)]TJ
5.2302 0 0 4.6485 74.7779 565.0015 Tm
(120)Tj
6.9738 0 0 6.9738 93.3732 561.94 Tm
[(2009)-1278.9(Italy)-5226.4(RCT)-3204.1(240)-1099.4(1)-333.9(year)-5784.8(T,)-330.4(POx)-6095.3(Yes)]TJ
/F9 1 Tf
38.6798 0 TD
(-)Tj
/F16 1 Tf
.7154 0 TD
(36%)Tj
-.8861 -1.2926 TD
[(hospit)-10.9(alizations;)]TJ
/F9 1 Tf
.1707 -1.2844 TD
(-)Tj
/F16 1 Tf
.7154 0 TD
[(65%)-342.2(GP)-334.4(calls)]TJ
/F9 1 Tf
8.0237 2.577 TD
(-)Tj
/F16 1 Tf
.7235 0 TD
[(71%)-334(acute)]TJ
-.8861 -1.2926 TD
[(exacerbations)-13.4(;)]TJ
0 -1.2844 TD
[(telemedicine)-339.9(greate)-10.5(r)]TJ
T*
[(care)-334.7(advantage)]TJ
9.4301 3.8615 TD
[(Overall)-338.2(costs)-337.4(33%)-334(less)]TJ
0 -1.2926 TD
[(with)-336.4(telemedicine)]TJ
-64.3606 -4.7232 TD
[(Vitacca)-337(et)-342.2(al.)]TJ
5.2302 0 0 4.6485 74.7779 523.0487 Tm
(121)Tj
6.9738 0 0 6.9738 93.3732 519.9872 Tm
[(2010)-1278.9(Italy)-5429.6(OS)-3416.8(396)-1099.4(5)-333.9(years)-5035.9(NC,)-337.4(POx)-5713.2(Yes)-3312.1(Nurse)-341(time)]TJ
38.5091 -1.2844 TD
[(increased;)-348.6(MD)-334.6(time)]TJ
0 -1.2926 TD
(decreased)Tj
12.3161 2.577 TD
[()-5195.3(39%)-334(cost)-338.5(savings)]TJ
-58.4993 -4.7313 TD
[(Dinesen)-338.5(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 76.7055 490.1101 Tm
(122)Tj
6.9738 0 0 6.9738 93.3732 486.992 Tm
[(2012)-1278.9(Denmark)-3466.5(RCT)-3204.1(111)-1099.4(10)-334.6(m)-8.9(onths)-3248.2(WTM,)-340.3(VTC)-5342.4(Yes)-3312.1(Lowe)-10.4(r)]TJ
38.5091 -1.2844 TD
[(hospit)-10.9(alization)]TJ
12.3161 1.2844 TD
[()-5195.3(Small)-334.5(sample)-339.2(size)]TJ
-58.4993 -3.4387 TD
(Sorknaes)Tj
0 -1.2926 TD
[(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 53.2913 457.1149 Tm
(123)Tj
6.9738 0 0 6.9738 93.3732 463.0109 Tm
[(2013)-1278.9(Denmark)-3466.5(RCT)-3204.1(266)-1099.4(26)-334.6(weeks)-5096.8(VTC)-6570(Yes)-3312.1(O)-8175.3(1)-333.9(week)-334(of)]TJ
47.2563 -1.2926 TD
[(teleconsulta)-12.9(tions)]TJ
0 -1.2844 TD
[(post-AECOPD,)-342.8(no)]TJ
T*
(effect)Tj
9.4301 3.8615 TD
[(Patients)-336.3(had)-338.1(ECOPD;)-341.6(only)]TJ
0 -1.2926 TD
[(1)-334(week)-334(of)-339(telesupport)]TJ
-64.3606 -4.7232 TD
(Sorknaes)Tj
0 -1.2845 TD
[(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 53.2913 415.1621 Tm
(124)Tj
6.9738 0 0 6.9738 93.3732 421.0582 Tm
[(2011)-1278.9(Denmark)-3157.5(NRCT)-2899(100)-1099.4(28)-334.6(d)-8.8(ays)-5661(VTC)-6570(Yes)-3312.1(NM)-7373.3(HPS)-7900.2(VTC)-334.7(showed)-334(protect)-12.7(ive)]TJ
56.6864 -1.2845 TD
(factor)Tj
-64.3606 -2.1624 TD
[(Pinnock)-337(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 76.5354 400.1385 Tm
(125)Tj
6.9738 0 0 6.9738 93.3732 397.0204 Tm
[(2013)-1278.9(United)]TJ
3.1949 -1.2845 TD
(States)Tj
6.8694 1.2845 TD
[(RCT)-3204.1(256)-1099.4(12)-334.6(m)-8.9(onths)-4313.2(HTM)-6407.7(Yes)-3312.1(Not)-342.9(effective)-333.4(wi)-10.3(th)]TJ
28.4448 -1.2845 TD
(ECOPD)Tj
8.7473 1.2845 TD
[(O)-8858.1(Speculates)-292.2(positive)-292.5(results)]TJ
9.4301 -1.2845 TD
[(of)-330.9(other)-335.7(studi)-10.2(es)-328(due)-341.9(to)]TJ
T*
[(clinical)-336.3(service)]TJ
-64.3606 -2.1543 TD
(Strickland)Tj
0 -1.2926 TD
[(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 53.2913 358.1857 Tm
(126)Tj
6.9738 0 0 6.9738 93.3732 364.0818 Tm
[(2011)-1278.9(Canada)-3639.2(CNRA)-2824.3(409)-1099.4(6)-333.9(m)-8.9(onths)-4963.6(VTC)-6570(Yes)-3312.1(Reduced)-342.4(and)]TJ
38.5091 -1.2926 TD
[(delayed)-339.7(re-)]TJ
0 -1.2845 TD
[(admi)-11.2(sions/LOS)]TJ
8.7473 2.577 TD
[(QoL)-336.3(up)-6678.9(Lower)-332.5(re-admiss)-15.2(ion)-331.4(rate)]TJ
9.4301 -1.2926 TD
[(\(12%)-334.2(versus)-339.9(22%\))]TJ
-64.3606 -3.4387 TD
[(de)-337.8(Toledo)]TJ
0 -1.2844 TD
[(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 53.2913 325.1905 Tm
(127)Tj
6.9738 0 0 6.9738 93.3732 331.0865 Tm
[(2006)-1278.9(Spain)-4767.4(RCT)-3204.1(157)-1099.4(1)-333.9(year)-3573.6(Call)-344.9(center,Web,)]TJ
23.2501 -1.2844 TD
[(HTM)-9.9(,)-333.3(VTC)]TJ
10.6658 1.2844 TD
[(Yes)-3312.1(Lowe)-10.4(r)-330.2(number)]TJ
4.5931 -1.2844 TD
[(of)-339(re-admission)-13.2(s)]TJ
12.3161 1.2844 TD
[()-5195.3(Value)-330.6(in)-338.8(integrate)-13(d)]TJ
5.8613 -1.2844 TD
[(telemedicine)-339.9(case)]TJ
T*
(management)Tj
-64.3606 -2.1624 TD
[(Gellis)-341.1(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 69.959 301.2094 Tm
(128)Tj
6.9738 0 0 6.9738 93.3732 298.0912 Tm
[(2012)-1278.9(United)]TJ
3.1949 -1.2844 TD
(States)Tj
6.8694 1.2844 TD
[(RCT)-3204.1(102)-1099.4(12)-334.6(m)-8.9(onths)-3858(T,)-338.5(HTM)-5952.5(Yes)-6539.5()-4853.9(Health,)-340.2(social)]TJ
37.1921 -1.2844 TD
(functioning,)Tj
T*
[(depression,)-343.4(ER)-337.1(visits)]TJ
T*
[(all)-336.4(improved)]TJ
9.4301 3.8533 TD
[(LOS)-332.9(not)-334.9(significa)-13.8(nt)-334.3(at)]TJ
0 -1.2844 TD
[(12)-334.6(months)]TJ
-64.3606 -4.7313 TD
[(Pedone)-338.9(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 75.1181 259.2566 Tm
(129)Tj
6.9738 0 0 6.9738 93.3732 256.1385 Tm
[(2013)-1278.9(Italy)-5226.4(RCT)-3204.1(100)-1099.4(9)-333.9(m)-8.9(onths)-2272.7(P)-8.8(Ox,)-330.8(T,)-338.5(wristband)]TJ
23.2501 -1.2844 TD
[(vit)-10.4(als)-333.9(monitor)]TJ
10.6658 1.2844 TD
[(Yes)-3312.1(LOS)-341(longer)-340.9(for)]TJ
4.5931 -1.2844 TD
[(interve)-11(ntion)-332.3(grou)-10.4(p)]TJ
8.7473 1.2844 TD
[(Med)-333.9(use,)]TJ
0 -1.2844 TD
(hospitalization,)Tj
T*
[(exacerbation)-339.6(risk)-339.3(all)]TJ
T*
(lower)Tj
9.4301 3.8533 TD
[(Vitals)-336.4(collected)-343.2(every)]TJ
0 -1.2844 TD
[(3)-334(hours)]TJ
-64.3606 -4.7232 TD
[(Cardozo)-337.8(and)]TJ
0 -1.2926 TD
(Steinberg)Tj
5.2302 0 0 4.6485 64.9701 208.3464 Tm
(130)Tj
6.9738 0 0 6.9738 93.3732 214.2425 Tm
[(2010)-1278.9(United)]TJ
3.1949 -1.2926 TD
(States)Tj
7.0726 1.2926 TD
[(OS)-3416.8(851)-1099.4(60)-334.6(d)-8.8(ays)-2970.2(HTM)-343.2(\(embedded)-336.9(in)]TJ
12.9827 -1.2926 TD
(EMR\))Tj
10.6658 1.2926 TD
[(Yes)-3312.1(Positiv)-12.2(e)]TJ
4.5931 -1.2926 TD
[(teleme)-10.8(dicine)]TJ
0 -1.2845 TD
[(bene)-9(fit)-336.8(for)]TJ
T*
[(hospit)-10.9(alization,)-344.9(ER)]TJ
T*
(visits)Tj
8.7473 5.1459 TD
[(Improved)-337.5(survival)-2587.8(Re-hospitalization)-352.3(rate)]TJ
9.4301 -1.2926 TD
[(13.9%)-334.7(and)-338.1(ER)-337.1(visits)-335(29%)]TJ
0 -1.2845 TD
[(\(versus)-332(nati)-10.7(onal)-331.5(rat)-10.2(es)-328(of)]TJ
T*
[(56.4%)-334.7(and)-338.1(45%,)]TJ
T*
(respectively\))Tj
-64.3606 -2.1543 TD
(Thijssing)Tj
0 -1.2845 TD
[(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 53.2913 157.4362 Tm
(131)Tj
6.9738 0 0 6.9738 93.3732 163.3322 Tm
[(2013)-1278.9(The)]TJ
3.1949 -1.2845 TD
[(Netherl)-11(ands)]TJ
7.0726 1.2845 TD
[(OS)-2750.2(1,958)-1100(3.5)-342.7(years)-5491.1(TS)-6855.6(Yes)-3312.1(Phy)-8.6(sical)-335.9(referrals)]TJ
28.2416 -1.2845 TD
[(reduce)-9.8(d)-333.9(27%)]TJ
8.7473 1.2845 TD
[(TPC)-331.3(incr)-11.1(eased)]TJ
0 -1.2845 TD
[(pulmonologist)-12.5(s)]TJ
0 -1.2926 TD
[(referrals)-337.5(18%)-342.2(where)]TJ
0 -1.2845 TD
(needed)Tj
9.4301 3.8615 TD
[(Unneeded)-338.5(referrals)]TJ
0 -1.2845 TD
[(reduced)-335.7(68%)]TJ
7.9702 0 0 7.9702 45.8079 121.4929 Tm
[(A)14.6(E)0(C)35.2(O)0(P)26.7(D)17.2(,)-282.5(a)20.2(c)14.8(u)16.3(te)-264(e)14.4(x)14.8(ac)27.9(e)21.6(r)0(b)30.2(a)0(t)33.5(e)14.4(d)-282.1(c)14.8(h)16.3(r)20.4(on)25.8(i)18.8(c)-284(o)16.6(b)17(s)19.3(t)0(r)26.5(u)16.3(c)21.9(t)0(i)25(v)21.6(e)-284.3(p)16.6(u)16.3(l)18.8(mo)30.1(n)16.3(a)0(r)33.5(y)-284.3(d)16.6(i)18.8(se)26.7(a)20.2(s)0(e)26.7(;)-280.3(C)15(N)16.5(R)14.6(A)21.7(,)-282.5(c)14.8(o)16.6(m)0(p)30.1(a)20.2(ra)26.3(t)20.4(i)0(v)26.2(e)-277.2(n)16.3(o)16.6(n)16.3(r)0(a)26.3(n)16.3(d)16.6(o)16.7(m)20.6(i)0(z)26.8(e)14.4(d)-275(a)0(n)29.4(a)0(l)31.9(y)14.4(s)19.3(i)0(s)31.1(;)-280.3(EC)28.1(O)17.2(P)16.7(D,)-265.3(e)14.4(x)14.8(ac)35(e)14.4(r)0(b)30.2(a)0(t)33.5(e)14.4(d)-282.1(c)14.8(h)16.3(r)20.4(on)25.8(i)18.8(c)-284(o)16.6(b)17(s)19.3(t)0(r)26.5(u)16.3(c)]TJ
55.5038 0 TD
[(ti)25(v)21.5(e)-284.3(p)16.6(u)16.3(l)18.8(m)0(o)30.1(n)16.3(ar)33.5(y)-284.3(d)16.6(i)18.8(s)0(e)26.7(a)20.2(se)26.7(;)]TJ
-55.5038 -1.2519 TD
[(EM)33.3(R)14.6(,)-382.1(e)14.4(l)0(e)26.2(c)21.9(tr)26.5(o)16.6(n)16.3(i)18.8(c)-383.6(me)27.9(d)16.6(i)18.8(c)14.8(a)0(l)-373.5(r)20.4(e)14.4(c)14.8(o)16.6(r)0(d)29.9(;)-379.8(ER)27.7(,)-382(e)14.4(me)35(rg)29.9(e)14.4(n)16.3(c)14.8(y)-383.9(r)20.4(o)16.6(om)30.1(;)-387(G)16.8(P)16.6(,)-382.1(g)16.6(e)14.4(n)16.3(e)14.4(ra)33.5(l)-386.6(p)16.6(ra)33.5(c)14.8(t)0(i)25(t)20.4(io)28.4(n)16.3(e)14.4(r)20.4(;)-387(H)16.8(P)16.7(S)17(,)-389.2(h)16.3(i)18.8(g)16.6(h)-382(p)16.6(a)0(t)26.3(i)18.8(e)14.4(n)16.3(t)-385.1(s)0(a)32.4(t)0(i)32.1(s)0(f)25.5(a)20.2(c)14.8(t)0(i)32.1(o)16.6(n)16.3(;)-387(H)16.8(T)15.1(M,)-368.9(h)16.3(o)16.6(me)-370.4(t)20.4(e)14.4(le)33.3(mo)30.1(n)16.3(i)0(t)32.1(o)16.6(ri)25(n)16.3(g)16.6(;)-379.8(L)15.1(O)17.2(S)0(,)-372.2(l)18.8(e)14.4(n)16.3(g)]TJ
56.6205 0 TD
[(th)-368.8(o)16.6(f)-385.1(st)32.6(ay)27.5(;)-379.8(N)16.5(M,)-368.9(n)16.3(o)16.7(t)]TJ
-56.6205 -1.2519 TD
[(me)35(as)25.3(u)16.3(r)20.4(e)14.4(d)16.6(;)-344.3(N)16.5(R)14.6(,)-346.5(n)16.3(o)16.6(t)-342.4(r)0(e)34.8(p)0(o)26.2(r)20.4(te)27.7(d)16.6(;)-344.3(N)16.5(R)14.6(C)15(T)15.1(,)-339.4(n)16.3(o)16.6(n)16.3(ra)26.3(n)16.3(d)16.6(o)16.6(m)20.6(iz)26.8(e)14.4(d)-339(c)14.8(o)16.6(n)16.3(t)0(r)26.5(o)16.6(l)18.8(l)0(e)26.2(d)-339(tr)26.5(i)18.8(a)0(l)31.9(;)-344.3(O,)-329.3(n)16.3(e)14.4(u)16.3(t)0(r)26.5(a)20.2(l)-343.9(o)16.6(u)16.3(t)0(c)28(o)16.6(me)35(;)-344.3(O)0(S)27.1(,)-339.4(ob)26.5(s)19.3(e)14.4(rv)34.8(at)26.3(i)18.8(o)16.6(n)16.3(a)0(l)-330.8(s)0(t)32.6(u)16.3(d)16.6(y)14.4(;)-344.3(P)16.6(C)15(C)15(,)-346.5(p)16.6(r)0(o)29.9(s)19.3(p)16.6(e)14.4(c)14.8(t)20.4(iv)26.2(e)-341.2(c)14.8(as)32.4(e)-341.2(c)14.8(o)16.7(n)16.3(tr)26.5(o)16.6(l)18.8(;)-344.3(P)16.7(Ox)]TJ
56.0871 0 TD
-.0167 Tc
[(,)-363.2(p)-.1(ul)-16.7(s)14.4(e)-365(oxim)-16.7(e)18.3(t)-16.7(e)11(r)-16.7(;)-347.7(Q).5(oL,)]TJ
-56.0871 -1.2519 TD
0 Tc
[(q)16.6(u)16.3(al)31.9(it)25(y)-312.8(o)16.7(f)-321.1(l)18.8(if)25(e)21.6(;)-322.9(R)14.6(C)15(C)22.1(,)-318(re)27.7(tr)33.6(o)16.6(s)0(p)28.9(e)14.4(c)14.8(t)20.4(iv)26.2(e)-312.8(c)14.8(as)32.4(e)-319.9(c)14.8(o)16.6(n)16.3(t)20.4(r)0(o)29.9(l)0(;)-304.1(T)15.1(,)-318(t)0(e)34.8(l)0(e)26.2(p)16.6(h)16.3(o)16.6(n)16.3(e)14.4(;)-315.8(T)15.1(P)16.6(C)15(,)-318(t)0(e)34.8(l)0(e)26.2(p)16.6(u)16.3(l)18.8(mo)30.1(n)16.3(a)0(r)33.5(y)-319.9(c)14.8(o)16.6(n)16.3(s)19.3(u)16.3(l)0(t)25(a)20.2(ti)32.1(on)25.8(s)19.3(;)-315.8(T)15.1(S)17(,)-318(t)0(e)27.7(l)18.8(e)14.4(s)0(p)28.9(i)18.8(ro)29.9(me)35(tr)26.5(y)14.4(;)-315.8(V)16.3(T)15.1(C)15(,)-318(v)14.4(i)18.8(d)16.6(e)14.4(o)-317.7(t)0(e)34.8(l)0(e)26.1(c)21.9(on)25.8(f)20.4(e)14.4(re)34.8(n)16.3(c)14.8(e)]TJ
52.3527 0 TD
-.0159 Tc
[(;)-331.7(W)-.2(TM)-15.9(,)-320.8(w)2.8(i)-15.9(r)16.2(el)-15.9(e)17.4(s)-15.9(s)-318.6(t)-15.9(e)11.8(l)2.9(em)-15.9(o)14.2(n).4(it)-15.9(o)14(r)-15.9(i)16.2(n).4(g.)]TJ
/F9 1 Tf
6.9738 0 0 6.9738 186.4629 29.7638 Tm
0 Tc
()Tj
/F7 1 Tf
1.3251 0 TD
.201 Tc
[(M)-5(ARY)-335.8(ANN)-334.6(L).5(IEBER)-7.4(T)-1(,)-325.7(I)-2.4(NC.)]TJ
/F10 1 Tf
15.015 0 TD
0 Tc
()Tj
/F7 1 Tf
.9999 0 TD
.1111 Tc
[(VOL)8.2(.)-334.3(2)8(0)-1000(NO.)-326.2(9)]TJ
/F10 1 Tf
8.3896 0 TD
0 Tc
()Tj
/F8 1 Tf
.9999 0 TD
.1095 Tc
[(SEPT)6.6(EMBER)-333.2(2).1(0)6.8(1)-.1(4)]TJ
/F4 1 Tf
7.9702 0 0 7.9702 441.581 29.7638 Tm
0 Tc
[(TELEMEDIC)11.7(INE)-333(and)-328.9(e-HEALTH)-647.9(787)]TJ
ET
q
1 i
0 792 612 -791.985 re
W n
579.685 .014984 .22681 791.985 re
f
337.039 767.962 274.961 .22675 re
f
Q
endstream
endobj
272 0 obj
<>/XObject<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]/Font<>/Properties<>>>/Thumb 275 0 R/MediaBox[0 0 612 792]/Rotate 0>>
endobj
276 0 obj
<>/ProcSet[/PDF/Text]/Font<>/Properties<>>>
endobj
273 0 obj
<>stream
/GS1 gs
BT
/F6 1 Tf
9.9626 0 0 9.9626 50.1732 693.1841 Tm
0 0 0 1 k
0 Tc
0 Tw
[(FEASIB)-8.3(ILITY)-338.8(AND)-336.9(ACC)-8.8(EPTANC)-9.3(E)]TJ
/F1 1 Tf
8.9663 0 0 8.9663 60.0945 681.392 Tm
.011 Tc
[(One)-256.5(o)-.1(f)-263(t).5(he)-256.5(earli)-5.2(e)2.7(r)-261(s)4(t)-5.8(u)1.9(dies)-255.3(\(p)-6.4(ubli)-5.2(shed)-259.4(in)-259(2009\))-258.1(was)-261.6(observational,)]TJ
-1.1065 -1.3278 TD
.0124 Tc
[(a)4.5(n)1.7(d)-435(i)2.5(t)-428(d)1.3(esc)4.2(r)-.3(ibed)-428.7(a)-431.7(p)1.3(ulmona)4.5(ry)-428.7(te)4.2(leme)4.2(dicine)-432.1(model)-427.4(a)-1.8(t)-428(a)-431.7(Vete)4.1(rans)]TJ
0 -1.3341 TD
.011 Tc
[(Affairs)-217.3(h)1.9(ospital)-220.2(i)1.1(n)-214.7(M)-3.3(ilw)-4.5(au)-4.4(k)11(e)-9.4(e,)-217.9(WI.)]TJ
6.7246 0 0 5.9768 179.5464 661.4928 Tm
[(11)-8.5(5)]TJ
8.9663 0 0 8.9663 192.3023 657.5242 Tm
[(In)-214.6(tot)-5.7(a)3.2(l,)-217.8(31)-6.3(4)-215(p)0(atients)-217.2(r)-1.6(ecei)-5.1(ved)]TJ
-15.8515 -1.3341 TD
.0106 Tc
[(tel)-5.6(e)2.3(medi)-5.6(ci)-5.6(ne)-440.3(co)-6.8(nsultations)-445.3(f)2.2(or)-444.7(abnormal)-441.9(radiology)-443.1(\()-5.6(38%\),)-445.9(COPD)]TJ
T*
.011 Tc
[(\(26%\))-5.2(,)-300.1(an)-6.1(d)-297.3(d)-6.4(yspnea)-300.4(or)-305.2(shortness)-305.8(o)-.1(f)-300.9(b)-.1(reath)-307.9(\()1.1(13%\).)-306.4(Physical)-302.4(exami-)]TJ
T*
[(nati)-5.2(ons)-305.8(w)1.9(ere)-307.1(c)-3.6(onducted)-303.6(mostly)-309.9(by)-303.6(t)-5.8(e)2.8(lemedi)-5.2(cine)-313.4(nurses)-305.8(or)-311.5(respira-)]TJ
T*
[(tory)-569.3(therapists)-571.5(\(90%)-574.5(of)-572.9(the)-572.7(c)-3.7(ases\))-5.3(.)-572.1(Tel)-5.3(e)2.7(medi)-5.3(cine)-572.7(consul)-5.3(tati)-5.3(ons)]TJ
T*
.0112 Tc
[(r)11.2(e)-9.8(sulted)-214.9(in)-208.2(changes)-217.1(i)1.3(n)-208.2(p).1(atient)-214.2(management)-214.2(in)-208.2(41)-6.2(%)-207.4(o).1(f)-212.2(t).7(h)-4.2(e)-212(cases,)-211.4(and)]TJ
T*
[(only)-354.1(8%)-359.3(required)-360.4(an)-353.7(in)-6(-person)-353.7(v)0(isit.)-356.9(I)-3(n)-353.7(a)-3.1(ddition)-6(,)-350.6(o)0(v)-6.3(e)2.9(r)-355.7(t).6(he)-351.2(5-y)-6.3(e)2.9(ar)]TJ
0 -1.3278 TD
[(period)-335.1(of)-332.5(the)-332.3(s)-2.2(tudy,)-331.6(tel)-5.1(e)2.9(pulmonol)]TJ
14.4731 0 TD
.0116 Tc
[(ogy)-334.6(saved)-328.3(p).5(atients)-330.5(over)-329.9(a)3.7(n)-334.3(e)3.4(sti-)]TJ
-14.4731 -1.3341 TD
.0108 Tc
[(mated)-310.1(2)-.3(9)-6.6(4)-.3(,00)-6.6(0)-303.8(miles)-312.4(o)-.3(f)-307.5(t).3(ravel,)-312.9(th)]TJ
14.3151 0 TD
.011 Tc
[(ereby)-309.9(r)-1.7(ed)-6.4(ucing)-309.9(c)2.8(arbon)-309.6(foot)-5.8(pr)11(i)-11.6(n).3(t.)]TJ
-14.3151 -1.3341 TD
[(The)-364.1(a)-3.3(uthors)-362.8(rep)-6.5(o)-.2(r)10.9(t)-12.3(ed)-367(that)-366.3(thi)-5.3(s)-362.8(intervent)-5.9(i)1(on)-366.6(was)-362.8(n).2(ot)-366.3(only)-367(feasi)-5.3(b)-.2(le)]TJ
T*
.0114 Tc
[(from)-343.7(a)-350.5(t).9(echnical)-346.2(perspective)-350.9(b).3(ut)]TJ
14.3846 0 TD
.013 Tc
[(also)-345.9(im)5.7(pr)13(ove)4.8(d)-345.9(ac)4.8(ce)4.8(ss)-348.1(to)-345.9(subspe-)]TJ
-14.3846 -1.3341 TD
.0113 Tc
[(cialty)-606.8(care.)-609.6(M)3.4(oreover,)-603.3(patients)]TJ
14.5427 0 TD
.0112 Tc
[(w)-4.3(e)3(re)-604(sat)-5.6(i)1.3(sfied)-600.6(w)-4.3(ith)-604.9(t).7(h)-4.2(e)3(i)-5(r)-602.2(tele-)]TJ
-14.5427 -1.3341 TD
.0125 Tc
[(m)5.2(e)-2.1(dicine)-280.3(e)4.2(x)1.8(pe)4.2(rienc)4.3(e)-2.1(.)]TJ
1.1065 -1.3341 TD
.0122 Tc
[(Telespirometry)-201.3(h)-3.2(a)4.3(s)-203.5(b)1.1(een)-200.9(investigat)]TJ
14.6249 0 TD
.011 Tc
[(ed)-208.8(for)-210.4(i)1.1(ts)-204.7(potential)-201.2(i)-5.2(n)-202.1(assisting)]TJ
-15.7314 -1.3341 TD
[(GPs)-198.4(i)-5.2(n)-195.7(m)-2.7(anaging)-202.5(t).5(hei)-5.2(r)-197.7(patients)-198.4(with)-200.4(COPD.)-205.2(I)3.2(n)-202.1(2009,)-205.2(an)-202.1(Itali)-5.2(a)3.1(n)-202.1(s)-2.3(tudy)]TJ
0 -1.3278 TD
.0114 Tc
[(of)-294.2(937)-296.9(GPs)-292.8(w)2.3(ho,)-293.4(over)-292.2(a)-293.6(2-year)-292.2(per)11.4(i)-11.2(od,)-293.4(recei)-4.8(v).3(ed)-296.9(the)-294(r)11.4(e)-9.6(s)-1.9(ult)-5.4(s)-292.8(of)-294.2(tele-)]TJ
0 -1.3341 TD
[(spi)-4.8(r)11.4(o)-12.5(m)4.1(etry)-353.8(performed)-360.1(o).3(n)-353.4(over)-355.4(20,000)-360.1(patien)-5.7(ts)-356(\(conducted)-353.8(by)-360.1(pa-)]TJ
T*
.0107 Tc
[(tients)-274.5(wit)-6.1(h)-270.3(tracing)-6.7(s)-274.5(sent)-271.7(by)-278.6(tel)-5.5(e)2.4(phone\))-5.5(.)]TJ
6.7246 0 0 5.9768 198.6519 458.2487 Tm
.0196 Tc
(116)Tj
8.9663 0 0 8.9663 211.918 454.2802 Tm
.0114 Tc
[(Data)-274.7(indicated)-277.9(t).9(hat)-271(70%)]TJ
-18.0393 -1.3341 TD
[(of)-306.9(the)-313(t).9(ests)-305.4(met)-302.6(t)-5.4(he)-306.7(cr)11.4(i)-11.2(t).9(eria)-306.3(for)-304.8(g)-6(ood)-303.2(o)-6(r)-304.8(par)11.4(t)-5.5(i)-4.8(a)3.5(l)-308.3(c)-3.2(ompl)-4.8(iance)-306.7(i)1.5(n)-309.2(p).3(er)11.4(-)]TJ
T*
.0127 Tc
[(f)4.3(o)1.6(rming)-403.1(t)2.2(he)-406.5(pr)12.7(o)-11.2(c)4.5(edu)3.6(r)0(e,)-399.6(allow)3.6(i)2.8(ng)-409.4(a)4.8(b)1.6(norma)4.8(l)2.8(ities)-405.3(t)2.2(o)-403.1(b)1.6(e)-406.5(d)1.6(etec)4.5(ted)-403.1(i)2.8(n)]TJ
T*
.0109 Tc
[(40%)-239.3(of)-237.8(the)-237.6(t).4(racing)-6.5(s.)-237(Only)-240.5(9.2)-6.5(%)-233(coul)-5.3(d)-234.2(n).2(ot)-239.8(be)-237.6(evaluat)-5.9(e)2.7(d.)-237(Over)10.9(a)-9.7(ll,)-237(t)-5.9(h)1.8(e)]TJ
T*
.0114 Tc
[(authors)-318.1(c)-3.2(oncluded)-322.2(that)-321.5(tel)-4.8(e)3.2(spir)]TJ
13.3603 0 TD
.01 Tc
[(om)-3.7(etry)-323.6(wa)-4.2(s)-319.5(w)-5.5(ell)-322.3(a)-4.2(cc)-4.6(e)-4.6(p)-1.1(ted)-323.6(b)-1.1(y)-323.6(t)-.5(h)-5.4(e)1.8(s)-3.3(e)]TJ
-13.3603 -1.3341 TD
.0113 Tc
[(Italian)-277.6(G).7(Ps.)]TJ
1.1065 -1.3278 TD
.0171 Tc
[(A)-326.5(s)3.8(omewhat)-322.2(s)-2.6(imilar)-318.1(s)-2.6(tudy)-322.8(was)-318.7(c)-3.8(onducted)-322.8(by)-322.8(the)-319.9(s)-2.6(ame)-319.9(a)-3.4(uthors)]TJ
-1.1065 -1.3341 TD
.0173 Tc
[(\(published)-322.6(i)1.1(n)-322.2(2009\))-5.2(,)]TJ
6.7246 0 0 5.9768 128.2393 374.57 Tm
.028 Tc
[(11)8.4(7)]TJ
8.9663 0 0 8.9663 142.1291 370.6015 Tm
.0173 Tc
[(wherein)-328.6(638)-322.6(GPs)-324.8(w)1.8(ere)-326.1(t).5(rai)-5.2(n)6.6(ed)-322.6(to)-328.9(perform)]TJ
-10.2558 -1.3341 TD
[(telespirometry)-189.8(on)-189.4(four)-191.4(sets)-192.1(of)-193.5(subjects:)-186.5(\()-5.2(1)6.2(\))-194.9(smokers)-192.1(a)3.1(nd)-196.2(ex-smokers)]TJ
T*
[(without)-739.4(r)-1.9(espiratory)-740(symptoms,)-749.1(\()]TJ
15.2256 0 TD
.0168 Tc
[(2\))-739.2(patients)-749(with)-744.7(respiratory)]TJ
-15.2256 -1.3341 TD
.0172 Tc
[(symptoms)-280.7(but)-277.8(n).1(ot)-284.1(diagnosed,)-281.2(\(3\))-283.5(p)]TJ
14.96 0 TD
.0176 Tc
[(atients)-280.3(d).2(iagn)6.9(osed)-278.1(w)-4.2(i)1.4(th)-282.3(asthma,)]TJ
-14.96 -1.3341 TD
.0167 Tc
[(and)-285.3(\().5(4\))-290.3(patients)-287.5(diagnosed)-285.3(w)-5.1(ith)-283.2(C)-5.7(OPD.)-288.1(All)-290.3(t)-.1(races)-281.2(w)-5.1(ere)-288.7(i).5(nterpreted)]TJ
T*
.0169 Tc
[(by)-436.8(specialists.)-439.6(I)2.8(n)-436.4(a)-3.6(ddition)-436.4(to)-436.8(confirming)-443.2(the)-434(f)-4.2(easibil)-5.6(i).7(ty)-436.8(of)-434.1(tele-)]TJ
T*
.0171 Tc
[(spirometry)-430.3(i)-5.4(n)-429.9(a)-439.7(p)-.3(ri)-5.4(mary)-436.6(care)-433.8(setting,)-439.4(t).3(his)-438.8(s)3.8(tudy)-436.6(challenged)-436.6(the)]TJ
0 -1.3278 TD
.0169 Tc
[(strategy)-240.8(of)-238.1(denying)-240.8(s)-2.8(pirometry)-240.8(f)2.1(or)]TJ
14.9853 0 TD
[(individuals)-236.7(w)1.4(ithout)-240.2(respiratory)]TJ
-14.9853 -1.3341 TD
.0162 Tc
[(symptomsif)-510.7(t)-.6(h)-5.5(e)1.6(y)-513.4(w).7(e)-4.7(r)3.5(e)-510.5(s)-3.5(moke)-4.7(rs.)-509.9(T)-1.2(he)-516.8(auth)-5.5(ors)-515.6(a)2(rgued)-513.4(t)-.6(ha)-4.3(t)-512.7(t)-.6(he)]TJ
T*
.017 Tc
[(finding)-335.6(o)-.4(f)-332.9(a)2.8(irfl)-5.5(ow)-333.6(obstruction)-328.9(from)-338.1(spirometry)-329.2(may)-335.6(b)-.4(e)-332.7(u)1.6(sed)-335.6(a)-3.5(s)-331.5(a)]TJ
T*
[(deterrent)-410.7(a)2.9(gainst)-410.7(smoking.)-407.8(At)-404.4(the)-408.5(s)-2.6(ame)-414.8(t).3(ime,)-407.8(a)-408.1(s)-2.6(ignificant)-410.7(pro)6(-)]TJ
T*
.0167 Tc
[(portion)-196.4(\(23%\))-189.2(o)-.7(f)-194.1(p)-.7(atients)-186.3(a)-3.8(lready)-196.8(diagnosed)-190.4(w)-5.1(ith)-188.4(C)-5.7(OPD)-191.9(h)1.3(ad)-190.4(normal)]TJ
T*
.0152 Tc
[(spir)-3.9(ome)-5.7(t)-1.6(r)-3.9(i)-1(c)-277.6(v)-2.2(a)-5.3(l)-1(ue)-5.7(s.)]TJ
1.1065 -1.3341 TD
0 Tc
[(The)-388.9(experience)-381(of)-386.3(a)-380.9(regional)-385.1(network)-384.4(in)-381(Lombardy,)-383(Italy,)-383.5(dem-)]TJ
-1.1065 -1.3341 TD
[(onstrated)-330.1(the)-337.6(feasibility)-331.3(and)-333.2(patient)-334.3(acceptance)-335.9(of)-335.7(telemedicine)-338.1(for)]TJ
0 -1.3278 TD
[(managing)-184.1(heart)-187.5(failure)-186.2(and)-187.8(COPD)-185.8(\(published)-191.3(in)-185(2012\).)]TJ
6.7246 0 0 5.9768 247.8047 195.2503 Tm
(118)Tj
8.9663 0 0 8.9663 259.9936 191.2818 Tm
[(In)-183(total,)-190.2(474)]TJ
-23.4011 -1.3341 TD
[(patients)-208.6(with)-209.3(COPD)-211(received)-216.9(remote)-209.9(consultations.)-213.4(More)-210.8(than)-208.9(95%)-215.6(of)]TJ
T*
[(patients)-271.8(were)-272.3(satisfied)-275.9(with)-272.5(the)-274.4(service,)-275.4(and)-270(98%)-272.5(were)-278.6(satisfied)-275.9(with)]TJ
T*
[(the)-280.7(nurse-tutor.)]TJ
1.1065 -1.3341 TD
[(Patient)-213.8(perceptions)-210.1(of)-209.3(a)-210.2(home)-212.8(telemedicine)-211.7(program)-213.1(for)-209.3(COPD)-204.7(and)]TJ
-1.1065 -1.3341 TD
[(CHF)-252.7(patients)-252.8(were)-259.7(compared)-254.9(with)-253.5(those)-254.6(of)-253.5(a)-254.5(control)-257.7(group)-251.2(receiving)]TJ
T*
[(usual)-283.2(care.)]TJ
6.7246 0 0 5.9768 90.3118 123.5338 Tm
(119)Tj
8.9663 0 0 8.9663 103.3511 119.5086 Tm
[(No)-287.2(significant)-281.3(differences)-291(were)-285(observed)-289.4(between)-281.2(pa-)]TJ
-5.9309 -1.3341 TD
[(tients)-284.4(in)-279.8(the)-287.1(intervention)-288.8(group)-289.2(and)-282.6(those)-286.2(in)-286.2(the)-280.7(control)-289.3(group)-289.2(with)]TJ
0 -1.3278 TD
[(regard)-323.1(to)-318.8(perceptions)-323.9(of)-323.1(health)-320.2(and)-320.6(well-being.)-328.4(However,)-325.4(the)-318.7(small)]TJ
0 -1.3341 TD
[(sample)-279.1(size)-286.3(for)-285.2(patients)-284.5(with)-278.8(COPD)-286.9(\(28)-278.7(of)-285.1(161)-286.3(patients)-284.5(in)-279.8(the)-287.1(study\))]TJ
T*
[(precludes)-281.7(any)-282.7(generalization)-282.4(regarding)-285.2(COPD.)]TJ
/F6 1 Tf
9.9626 0 0 9.9626 322.129 693.1841 Tm
[(EFFEC)-9.7(TS)-333.6(OF)-337.3(TELE)-8.8(PULMONO)-10.1(LOG)-8.8(Y)-333.8(O)0(N)-339.3(USE)-333.7(OF)-337.3(SERVIC)-9.7(E)]TJ
/F1 1 Tf
8.9663 0 0 8.9663 332.107 681.392 Tm
[(Two)-265.3(reports)-269.5(were)-272.3(published)-269.9(from)-267.3(one)-270.4(program)-270.1(in)-260.9(Italy,)-269.7(labeled)-268.7(as)]TJ
-1.1128 -1.3278 TD
[()55.6(Tele-assistance)-210.3(in)-204(COPD.)52()]TJ
6.7246 0 0 5.9768 420.6046 673.455 Tm
(120,121)Tj
8.9663 0 0 8.9663 445.0959 669.4865 Tm
[(The)-211.8(first)-200.3(was)-207.4(an)-208.3(RCT)-205.6(of)-202.9(240)-210.4(patients)]TJ
-13.7144 -1.3341 TD
[(allocated)-312.3(to)-312.4(either)-317.9(an)-309.5(intervention)-314.1(or)-314.7(a)-311.4(control)-314.6(group)-314.4(and)-307.9(observed)]TJ
T*
[(over)-195(a)-191.2(1-year)-188.9(period,)]TJ
6.7246 0 0 5.9768 398.381 649.5305 Tm
(120)Tj
8.9663 0 0 8.9663 410.6266 645.5621 Tm
[(and)-194.1(the)-192.2(second)-189.3(was)-194.7(an)-189.3(observational)-192.4(study)-194.3(of)]TJ
-9.8701 -1.3341 TD
[(396)-280(patients)-284.5(over)-283.5(a)-279.8(5-year)-283.7(period.)]TJ
6.7246 0 0 5.9768 449.3479 637.5684 Tm
(121)Tj
8.9663 0 0 8.9663 332.107 621.6376 Tm
[(In)-296.8(the)-299.7(first)-295.1(study,)-303(in)-298.8(total,)-297.7(866)-298.9(patients)-303.4(were)-297.6(discharged)-298.8(from)-298.9(the)]TJ
-1.1128 -1.3341 TD
[(respiratory)-184.6(unit,)-186.9(but)-182.4(only)-188.3(240)-178.8(met)-184.1(the)-185.9(selection)-185(criteria)-187.5(for)-184(the)-185.9(clinical)]TJ
T*
[(trial.)-184.8(Although)-185.9(patients)-189.6(with)-184(worsening)-185.6(symptoms)-186.4(had)-186.2(a)-178.6(significantly)]TJ
T*
[(higher)-300.4(number)-299.6(of)-297.8(re-hospitalizations,)-311.6(as)-293.1(would)-303.3(be)-297.6(expected,)-305.4(the)-299.7(re-)]TJ
0 -1.3278 TD
[(sults)-353.3(from)-355.8(the)-356.6(RCT)-357.3(revealed)-355.7(no)-357(significant)-357.1(differences)-354.3(in)-355.7(mortality)]TJ
0 -1.3341 TD
[(between)-407.7(the)-400.9(control)-409.4(and)-402.8(intervention)-408.9(groups.)-404.9(However,)-407.6(compared)]TJ
T*
[(with)-285.2(the)-280.7(control)-289.3(group,)-284.1(those)-286.2(in)-279.8(the)-280.7(intervention)-288.8(group)-282.8(experienced)]TJ
T*
[(fewer)-280.8(hospitalizations)-278.1(\()]TJ
/F9 1 Tf
9.8827 0 TD
(-)Tj
/F1 1 Tf
.7208 0 TD
[(36%\),)-277.3(urgent)-277.4(calls)-276.8(to)-274.5(the)-274.4(GPs)-274.9(\()]TJ
/F9 1 Tf
12.8102 0 TD
(-)Tj
/F1 1 Tf
.7208 0 TD
[(65%\),)-277.3(and)]TJ
-24.1346 -1.3341 TD
[(acute)-221(exacerbations)-219.2(\()]TJ
/F9 1 Tf
8.89 0 TD
(-)Tj
/F1 1 Tf
.7145 0 TD
[(71%\).)-220.4(Cost)-221.7(savings)-216.5(were)-215.4(estimated)-219.8(at)-220.7(33%)-215.6(per)]TJ
-9.6045 -1.3341 TD
[(patient)-264.8(after)-262.7(discounting)-261.2(the)-261.8(cost)-264.5(of)-259.8(the)-261.8(telepulmonology)-264.3(system.)-267.5(Of)]TJ
T*
[(interest)-368.6(also)-364.7(is)-358.3(that)-366.7(these)-365.6(benefits)-365(were)-367.2(still)-363.2(significant)-369.8(among)-364.3(pa-)]TJ
T*
[(tients)-221.2(suffering)-218.5(from)-216.7(chronic)-221.8(respiratory)-222.5(failure)-217.8(who)-219.1(were)-221.7(on)-217.9(oxygen)]TJ
0 -1.3278 TD
[(or)-283.1(home)-282.4(ventilators.)]TJ
1.1128 -1.3341 TD
[(The)-275.1(second)-277.8(article)-275.9(was)-270.6(based)-279.3(on)-274.8(an)-271.5(observational)-280.9(study)-276.5(over)-277.2(a)-273.4(5)0(-)]TJ
-1.1128 -1.3341 TD
[(year)-255(period)-253.9(\(20042009\))-252.6(of)-253.5(patients)-252.8(with)-253.5(chronic)-253.4(respiratory)-254.1(failure.)]TJ
T*
[(It)-239.6(reported)-237.6(on)-236.8(trends)-237.4(over)-239.3(time)-238.2(among)-237.9(those)-235.7(having)-243.2(the)-236.5(telemedicine)]TJ
T*
[(intervention,)-302.7(as)-293.1(well)-302.7(as)-293.1(effects)-299.4(on)-300.1(staff)-295.2(activity)-300.3(and)-295.3(salary)-296.7(cost.)-297.4(The)]TJ
T*
[(trend)-388.4(data)-391.4(showed)-390.9(a)-393.6(shifting)-386.4(in)-393.6(costs,)-392.9(with)-386.3(an)-391.7(overall)-393.3(decrease)-387.9(in)]TJ
T*
[(physician)-186.1(time)-181.3(and)-181.5(an)-176.7(increase)-186.8(in)-178.7(nurse)-180.6(time,)-182.6(thereby)-184.9(resulting)-184(in)-185(cost)]TJ
T*
[(savings)-279.7(of)-285.1(39%.)]TJ
1.1128 -1.3278 TD
[(Somewhat)-319(similar)-311.1(findings)-319.2(were)-316.6(reported)-319.8(in)-317.8(2012)-316.4(from)-311.5(a)-317.7(Danish)]TJ
-1.1128 -1.3341 TD
[(RCT)-433.2(\()]TJ
/F5 1 Tf
2.3964 0 TD
(n)Tj
/F9 1 Tf
.7082 0 TD
(=)Tj
/F1 1 Tf
.7208 0 TD
[(111\))-428.9(that)-429.9(investigated)-432.3(the)-432.5(use)-429(telemedicine)-433(for)-430.6(COPD.)]TJ
6.7246 0 0 5.9768 565.6251 374.57 Tm
(122)Tj
8.9663 0 0 8.9663 322.129 358.6393 Tm
[(Patients)-214.5(were)-209.1(recruited)-217.2(from)-210.3(a)-210.2(health)-219(center,)-211.7(a)-210.2(general)-214.3(practice,)-217.2(and)-206.8(a)]TJ
0 -1.3341 TD
[(pulmonary)-211.1(hospital)-215.5(ward.)-206.5(Both)-215.4(intervention)-212.9(and)-206.8(control)-213.4(groups)-214(were)]TJ
T*
[(observed)-460.1(over)-460.5(a)-456.8(10-month)-461.7(period.)-457.5(The)-458.4(intervention)-459.5(group)-459.9(had)-458(a)]TJ
T*
[(lower)-234.5(hospital)-240.8(admission)-233.7(rate)-241.6(compared)-235.9(with)-234.6(the)-236.5(control)-238.7(group)-238.6(\(0.49)]TJ
T*
[(versus)-314.5(1.17\).)-317.7(Other)-313.4(outcome)-318.6(measures)-314.2(were)-316.6(not)-316.9(statistically)-316(signifi-)]TJ
T*
[(cant,)-285.2(likely)-276.1(because)-287.5(of)-278.8(a)-279.7(small)-282.2(sample)-285.4(size.)]TJ
1.1128 -1.3278 TD
[(A)-324.7(more)-324(recent)-324.3(\(published)-330.4(in)-324.1(2013\))-326.3(RCT)-325.7(\()]TJ
/F5 1 Tf
17.1288 0 TD
(n)Tj
/F9 1 Tf
.7082 0 TD
(=)Tj
/F1 1 Tf
.7145 0 TD
[(266\))-327.8(in)-324.1(Denmark)-324.6(in-)]TJ
-19.6643 -1.3341 TD
[(vestigated)-361.1(the)-356.6(effect)-355.6(of)-354.7(daily)-359.7(teleconsultations)-362.8(for)-354.8(1)-352.6(week)-360.3(between)]TJ
T*
[(specialized)-295.7(nurses)-295.1(and)-289(patients)-290.8(who)-294.9(had)-293.6(severe)-289.6(COPD)-293.3(and)-289(had)-293.7(been)]TJ
T*
[(discharged)-412.6(from)-412.7(the)-413.5(hospital)-411.5(after)-414.5(an)-404.3(exacerbation.)]TJ
6.7246 0 0 5.9768 521.0645 255.0046 Tm
(123)Tj
8.9663 0 0 8.9663 535.2376 251.0361 Tm
[(Patients)-410.5(in)]TJ
-23.7678 -1.3341 TD
[(both)-427.5(the)-432.5(intervention)-427.9(and)-428.1(control)-428.4(groups)-429(were)-430.4(offered)-428.8(outpatient)]TJ
T*
[(clinic)-366.6(consultations)-370.2(with)-373.7(a)-361.9(nurse)-370.3(at)-366.1(4-)-363.9(and)-371.2(12-week)-368.5(intervals.)-367.4(The)]TJ
T*
[(intervention)-187.6(group)-181.7(was)-182.1(offered)-188.5(daily)-182.6(consultations)-186.9(by)-180.3(video)-184.3(for)-184(about)]TJ
T*
[(7)-434.8(days)-435.5(\(range,)-434.9(59)-438(days\))-432.7(that)-436.2(included,)-440(when)-435.6(indicated,)-436.6(smoking)]TJ
0 -1.3278 TD
[(cessation,)-195.7(physical)-188(training,)-192.2(and)-187.8(rehabilitation)-196.1(followed)-192.7(by)-186.6(telephone)]TJ
0 -1.3341 TD
[(consultations.)-188.1(The)-186.6(study)-187.9(found)-183.3(no)-179.9(significant)-186.4(differences)-189.9(between)-186.4(the)]TJ
T*
[(two)-334.2(groups)-327.8(with)-335.7(regard)-329.4(to)-331.4(mortality)-331.1(or)-327.4(hospital)-335.7(re-admissions.)-331.2(The)]TJ
T*
[(authors)-434.1(concluded)-435.6(that)-429.9(the)-432.5(limited)-427.2(\(1-week\))-434(teleconsultations)-438.7(be-)]TJ
T*
[(tween)-306.1(hospital-based)-303.8(nurses)-301.5(and)-301.6(patients)-303.4(with)-304.1(severe)-302.2(COPD)-299.6(did)-304(not)]TJ
T*
[(significantly)-346.5(reduce)-348.6(readmissions)-350.2(or)-346.3(affect)-348.9(mortality.)-345(Yet,)-349.8(different)]TJ
T*
[(findings)-262.3(were)-266(reported)-269.2(by)-262.5(the)-261.8(same)-264.4(senior)-262.1(author)-269(\(with)-263.4(different)-265.3(co-)]TJ
T*
[(authors\))-285.9(about)-283.6(1)-283(year)-280.2(earlier.)]TJ
6.7246 0 0 5.9768 430.8093 111.5717 Tm
(124)Tj
8.9663 0 0 8.9663 443.8487 107.5464 Tm
[(This)-283.7(was)-283.3(an)-277.8(interventional)-287.5(study)-282.8(in)]TJ
-13.5753 -1.3278 TD
[(which)-235.1(all)-229.9(patients)-233.9(were)-234.4(consecutively)-237.2(assigned)-237.4(to)-230.2(the)-230.1(intervention)-238.2(or)]TJ
0 -1.3341 TD
[(control)-409.4(group)-415.6(on)-407.6(the)-413.5(basis)-409.6(of)-411.6(the)-407.2(municipality)-412.6(of)-411.6(their)-410.8(residence.)]TJ
T*
[(Very)-535.9(similar)-538.7(protocols)-535.4(were)-537.9(used.)-536.3(Here,)-534.2(the)-540(authors)-535.3(found)-537.4(that)]TJ
/F11 1 Tf
7.9702 0 0 7.9702 50.1732 29.7638 Tm
[(7)-80(8)-75.6(8)-708.7(TELEMEDI)12.8(CINE)-329.5(and)-331.8(e-HEALTH)]TJ
/F8 1 Tf
6.9738 0 0 6.9738 178.0157 29.7638 Tm
.1099 Tc
[(SEPTEMB)6.6(E)2.1(R)-332.8(2).5(014)]TJ
ET
q
1 i
0 792 612 -791.985 re
W n
32.315 .014984 .22675 791.985 re
f
/Document /MC11 BDC
Q
q
1 i
0 792 32.315 -173.367 re
W n
0 0 0 .29999 k
0 618.633 32.315 173.367 re
f
EMC
Q
32.315 763.994 242.646 .22675 re
f
BT
/F11 1 Tf
11.9551 0 0 11.9551 50.1732 741.9966 Tm
0 Tc
[(BASHSHUR)-338.5(ET)-334.1(AL.)]TJ
ET
endstream
endobj
277 0 obj
<>stream
Adobe Illustrator CS4
2010-08-04T11:54:42+05:30
2010-08-04T11:54:42+05:30
2010-08-04T11:54:42+05:30
68
256
JPEG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application/postscript
saved
xmp.iid:11FB61F30AB7DE11AEB3E861853EAFA4
2009-10-12T14:15:50+05:30
Adobe Illustrator CS4
/
converted
from application/postscript to application/vnd.adobe.illustrator
converted
from application/postscript to application/vnd.adobe.illustrator
saved
xmp.iid:0280117407206811994CBE3149FFDB59
2010-08-04T11:54:42+05:30
Adobe Illustrator CS4
/
converted
from application/postscript to application/vnd.adobe.illustrator
xmp.iid:11FB61F30AB7DE11AEB3E861853EAFA4
xmp.did:11FB61F30AB7DE11AEB3E861853EAFA4
uuid:ee5a72b3-04e4-4157-a8d8-c3a8817872a3
uuid:ee5a72b3-04e4-4157-a8d8-c3a8817872a3
xmp.iid:0280117407206811994CBE3149FFDB59
xmp.did:0280117407206811994CBE3149FFDB59
TouchUp 7.0
False
False
1
684.000000
864.000000
Points
Black
Default Swatch Group
0
PANTONE 3025 C
SPOT
100.000000
CMYK
100.000000
16.859999
0.000000
50.980003
endstream
endobj
274 0 obj
<>
endobj
278 0 obj
<>/XObject<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]/Font<>>>/Thumb 281 0 R/MediaBox[0 0 612 792]/Rotate 0>>
endobj
282 0 obj
<>/ProcSet[/PDF/Text]/Font<>>>
endobj
280 0 obj
<>stream
/GS1 gs
BT
/F1 1 Tf
8.9663 0 0 8.9663 35.8866 693.8644 Tm
0 0 0 1 k
0 Tc
0 Tw
[(videoconferencing)-207.9(was)-201.1(significantly)-207.4(related)-201.3(to)-205(reductions)-206.2(in)-197.6(early)-207.9(re-)]TJ
0 -1.3278 TD
[(admission)-265.3(\(16%)-269.7(in)-260.9(the)-268.1(intervention)-269.8(group)-270.2(versus)-263.9(30%)-272.5(in)-260.9(the)-268.1(control)]TJ
0 -1.3341 TD
(group\).)Tj
1.1065 -1.3341 TD
[(A)-248.8(2013)-253.2(study)-251.2(of)-253.5(a)-248.1(multicenter)-250.7(RCT)-249.8(\()]TJ
/F5 1 Tf
14.8778 0 TD
(n)Tj
/F9 1 Tf
.7082 0 TD
(=)Tj
/F1 1 Tf
.7208 0 TD
[(256\))-251.9(conducted)-252.8(over)-251.9(a)-248.1(12-)]TJ
-17.4133 -1.3341 TD
[(month)-314.3(period)-317.1(among)-313.8(individuals)-322.5(with)-316.8(a)-311.4(history)-318(of)-316.7(hospitalizations,)]TJ
T*
[(however,)-450.4(did)-449.4(not)-449.6(find)-444.8(that)-448.9(videoconferencing)-454.5(postponed)-452.5(hospital)]TJ
T*
[(admissions)-341.9(or)-346.3(improved)-341.9(the)-344(quality)-347.6(of)-342(patients)-349(lives.)]TJ
6.7246 0 0 5.9768 238.6204 626.1164 Tm
(125)Tj
8.9663 0 0 8.9663 252.2267 622.1479 Tm
[(The)-338.3(inter-)]TJ
-24.1282 -1.3341 TD
[(vention)-205.1(consisted)-204(of)-202.9(daily)-201.6(patient)-207.9(responses)-203.4(entered)-208.9(on)-198.9(a)-203.9(touchscreen)]TJ
T*
[(device)-290.8(to)-293.5(questions)-293.4(about)-296.3(symptoms)-293.9(and)-295.3(use)-289.9(of)-291.5(treatment)-295.2(and)-289(oxy-)]TJ
0 -1.3278 TD
[(gen)-238.8(saturation.)-243.9(The)-243.5(study)-244.9(was)-239(focused)-246.7(on)-236.8(investigating)-248.6(the)-236.5(effects)-248.8(of)]TJ
0 -1.3341 TD
[(telemonitoring)-540.3(technology.)-538.7(The)-540.6(intervention)-541.7(and)-535.6(control)-535.9(groups)]TJ
T*
[(were)-297.6(both)-307.4(provided)-301.4(with)-304.1(the)-306(same)-302.4(clinical)-302.2(care)-302.7(\(i.e.,)-303.7(a)-298.7(written)-305.6(man-)]TJ
T*
[(agement)-386.5(plan,)-388.6(antibiotics,)-392.4(and)-383.8(steroids\).)-392.2(The)-388.9(study)-384(concluded)-391.3(that)]TJ
T*
[(among)-396(patients)-404.6()55.6(with)-400.2(a)-399.9(history)-400.2(of)-405.3(admission)-398.1(for)-399(exacerbations)-408.8(of)]TJ
T*
[(COPD,)-408.3(telemonitoring)-413.8(was)-409.7(not)-411.7(effective)-410.1(in)-412.6(postponing)-408(admissions)]TJ
T*
[(and)-358.5(did)-367.2(not)-361.1(improve)-368.7(patients)-361.6(quality)-366.6(of)-367.3(life.)55.9()]TJ
6.7246 0 0 5.9768 211.3511 518.5699 Tm
(125)Tj
8.9663 0 0 8.9663 225.1275 514.5447 Tm
[(The)-363.6(investigators)]TJ
-21.1059 -1.3341 TD
[(speculated)-464.4(that)-455.2(the)-464.1(positive)-464.5(effects)-463.8(of)-455.8(telemonitoring)-464.4(reported)-465.2(in)]TJ
0 -1.3278 TD
[(earlier)-196(studies)-195.6(may)-197(have)-200.7(been)-196.4(due)-199.2(to)-192.3(enhancements)-201.9(of)-196.6(clinical)-201(service)]TJ
0 -1.3341 TD
[(in)-279.8(the)-280.7(telemonitoring)-287.4(group.)]TJ
/F6 1 Tf
9.9626 0 0 9.9626 35.8866 454.7904 Tm
[(HEALTH)-339.6(OU)-7.4(TCOME)-9.5(S)-330(AND)-342.6(COST)]TJ
/F1 1 Tf
8.9663 0 0 8.9663 45.8079 442.8282 Tm
[(A)-274.1(Canadian)-278.1(comparative)-276.7(nonrandomized)-282.8(analysis)-273.7(was)-276.9(conducted)]TJ
-1.1065 -1.3341 TD
[(on)-413.9(a)-418.9(group)-415.6(of)-417.9(147)-419.1(COPD)-419.7(patients)-417.2(who)-415.1(participated)-422.5(in)-418.9(an)-417(8-week)]TJ
T*
[(pulmonary)-337.6(rehabilitation)-335.2(program)-339.6(via)-332.3(telemedicine)-338.1(and)-339.6(a)-330.3(group)-339.7(of)]TJ
T*
[(262)-292.6(patients)-290.8(who)-294.9(received)-299.1(the)-287.1(same)-296(educational)-294.2(content)-297.7(via)-288.1(a)-292.4(stan-)]TJ
0 -1.3278 TD
[(dard)-270.5(outpatient)-282.8(hospital-based)-278.6(program.)]TJ
6.7246 0 0 5.9768 186.9165 399.0046 Tm
(126)Tj
8.9663 0 0 8.9663 199.8992 395.0361 Tm
[(Both)-278.6(groups)-277.2(had)-274.7(similar)]TJ
-18.2922 -1.3341 TD
[(improvements)-292.4(in)-286.2(quality)-290.7(of)-291.5(life)-289.3(and)-289(exercise)-288.3(capacity,)-291.1(and)-289(these)-296(re-)]TJ
T*
[(sults)-391.2(were)-392.5(sustained)-391.3(over)-391(a)-387.2(period)-393(of)-392.6(6)-390.5(months.)-392.2(The)-395.2(authors)-389.9(con-)]TJ
T*
[(cluded)-595.2(that)-594.3(telehealth)-597.3(rehabilitation)-594.4(was)-593.1()55.6(an)-595.3(effective)-593.5(tool)-599(for)]TJ
T*
[(increasing)-279.8(COPD)-280.6(pulmonary)-287(rehabilitation)-284.6(services.)51.4()]TJ
6.7246 0 0 5.9768 232.8377 351.1558 Tm
(126)Tj
8.9663 0 0 8.9663 45.8079 335.2251 Tm
[(In)-435.9(2006,)-437.8(an)-429.6(RCT)-433.2(\()]TJ
/F5 1 Tf
7.91 0 TD
(n)Tj
/F9 1 Tf
.7082 0 TD
(=)Tj
/F1 1 Tf
.7145 0 TD
[(157\))-435.3(conducted)-442.5(in)-431.6(Spain)-434.4(investigated)-438.6(the)]TJ
-10.4391 -1.3341 TD
[(effects)-198.2(of)-196.6(an)-202(integrated)-202.1(telemedicine)-199(system)-203(on)-198.9(hospital)-196.6(re-admission)]TJ
T*
[(rates)-356.2(and)-352.2(mortality.)]TJ
6.7246 0 0 5.9768 110.6645 315.3259 Tm
(127)Tj
8.9663 0 0 8.9663 124.3842 311.3007 Tm
[(The)-350.9(telemedicine)-363.4(service)-356.3(consisted)-355.8(of)-354.7(a)-355.6(call)]TJ
-9.8701 -1.3278 TD
[(center,)-433(an)-435.9(application)-443.3(server,)-434.4(and)-434.4(an)-435.9(educational)-439.6(server,)-440.8(all)-432.2(con-)]TJ
0 -1.3341 TD
[(nected)-291(to)-293.5(the)-287.1(patients)-298.4(homes.)-290.7(The)-294(application)-291.5(server)-294.1(included)-293.3(three)]TJ
T*
[(different)-290.6(applications:)-300(a)-292.4(Web-based)-295.6(Patient)-296(Management)-292.9(Module,)-298.9(a)]TJ
T*
[(telemonitoring)-382.2(module,)-386.9(and)-383.8(a)-380.9(home)-383.6(visit)-383.4(server.)-383.9(Care)-380(was)-384.4(coordi-)]TJ
T*
[(nated)-219.2(by)-224.6(a)-222.8(specialized)-232.5(nurse)-224.9(\(case)-224.6(manager\))-221.2(and)-225.7(involved)-222.3(a)-222.8(specialist)]TJ
T*
[(and)-352.2(other)-355.2(professionals.)-357.4(Both)-360.8(groups)-353.1(received)-362.4(a)-349.3(single)-354(educational)]TJ
T*
[(session)-244.4(and)-244.7(a)-248.1(single)-246.5(home)-244.5(visit.)-245.6(Patients)-246.1(in)-248.2(the)-242.8(control)-245(group)-251.2(did)-247.1(not)]TJ
T*
[(have)-238.7(access)-249(to)-236.6(the)-249.1(call)-238.2(center.)-243.3(The)-243.5(authors)-244.4(found)-246.5(that)-240.2(the)-242.8(integration)]TJ
0 -1.3278 TD
[(of)-436.9(telemedicine)-439.3(with)-436.9(case)-436.1(management)-444.1()55.6(increased)-439.5(the)-438.8(number)-438.7(of)]TJ
0 -1.3341 TD
[(patients)-461.5(who)-459.3(were)-462(not)-462.3(readmitted)-457.9(\(51%)-465.7(intervention)-459.5(versus)-466.2(33%)]TJ
T*
[(control\),)-243.5(is)-244.5(acceptable)-249.4(to)-249.2(professionals,)-249.9(and)-244.7(involves)-249.8(low)-245.1(installation)]TJ
T*
[(and)-276.3(exploitation)-285.9([utilization])-287.5(costs.)54.7()]TJ
6.7246 0 0 5.9768 170.9291 171.8362 Tm
(127)Tj
8.9663 0 0 8.9663 45.8079 155.9055 Tm
[(The)-306.7(following)-312.6(two)-308.9(studies)-309.4(had)-306.3(samples)-305.1(fewer)-306(than)-310.1(our)-304.8(suggested)]TJ
-1.1065 -1.3341 TD
[(standard)-211.7(of)-209.3(150)-210.4(cases.)-210.4(Nonetheless,)-215.7(they)-209.7(are)-212.2(included)-211.1(here)-209(because)-217.9(of)]TJ
T*
[(some)-394.1(unique)-393.3(features.)-395.9(A)-394.2(small)-396(RCT)-395.2(\()]TJ
/F5 1 Tf
15.8199 0 TD
(n)Tj
/F9 1 Tf
.7082 0 TD
(=)Tj
/F1 1 Tf
.7208 0 TD
[(102\))-397.3(involving)-392.7(both)-395.9(heart)]TJ
-17.2489 -1.3341 TD
[(failure)-217.8(and)-219.4(COPD)-223.7(patients)-221.2(was)-220(conducted)-227.5(in)-222.9(2012.)]TJ
6.7246 0 0 5.9768 220.0818 124.044 Tm
(128)Tj
8.9663 0 0 8.9663 232.5543 120.0189 Tm
[(The)-224.5(technology)]TJ
-21.9342 -1.3278 TD
[(included)-400.8(a)-399.9(small)-396(table-top)-407.8(in-home)-396.5(monitor)-402.2(and)-402.8(a)-393.6(central)-403.3(station)]TJ
0 -1.3341 TD
[(located)-471.6(at)-473.6(the)-470.4(home)-472.1(health)-471.9(agency.)-476(Data)-468.7(were)-474.6(transmitted)-473.1(via)-471.4(a)]TJ
T*
[(telephone)-422.3(line)-418.1(through)-420.5(a)-418.9(secure)-420.3(link.)-423.3(The)-420.5(intervention)-421.5(group)-421.9(had)]TJ
T*
[(better)-358.5(health)-358.1(outcomes)-363.5(\(general)-363.2(health,)-359.4(social)-357.5(functioning,)-364.6(and)-358.5(re-)]TJ
30.331 69.3307 TD
[(duction)-443.7(in)-437.9(depression\).)-443.5(Additionally,)-438.9(they)-443.6(had)-439.1(fewer)-438.8(visits)-441.1(to)-438.9(the)]TJ
0 -1.3278 TD
[(emergency)-376.9(department)-376.6(and)-377.5(a)-374.6(general)-372.3(trend)-375.8(of)-373.6(fewer)-375.6(hospital)-379.9(days)]TJ
0 -1.3341 TD
[(\(but)-236.6(the)-230.2(number)-236.3(of)-234.5(days)-233.2(hospitalized)-240.4(did)-234.4(not)-234.7(reach)-229.6(significance)-243(at)-227(12)]TJ
T*
(months\).)Tj
1.1128 -1.3341 TD
[(Another)-279.6(small)-282.2(RCT)-281.4(\()]TJ
/F5 1 Tf
8.4474 0 TD
(n)Tj
/F9 1 Tf
.7082 0 TD
(=)Tj
/F1 1 Tf
.7208 0 TD
[(100\))-277.2(from)-279.9(Italy)-281.1(investigated)-286.9(the)-280.7(effects)-280.4(of)]TJ
-10.9892 -1.3341 TD
[(telemonitoring)-255.8(on)-249.5(respiratory)-254.1(outcomes)-256.1(in)-248.2(an)-246.2(elderly)-254.6(population)-254.1(\(65)]TJ
T*
[(years)-299.9(of)-297.8(age)-299.1(and)-295.3(older\).)]TJ
6.7246 0 0 5.9768 396.3401 626.1164 Tm
(129)Tj
8.9663 0 0 8.9663 409.5495 622.1479 Tm
[(The)-300.4(intervention)-301.4(group)-295.5(received)-305.5(a)-292.4(wrist-)]TJ
-11.3433 -1.3341 TD
[(band)-344.4(with)-335.7(sensors)-348.4(for)-335.8(heart)-345.6(rate,)-337.8(physical)-346.1(activity,)-345.9(near-body)-342(tem-)]TJ
T*
[(perature,)-638.2(and)-636.7(galvanic)-633.1(skin)-634.1(response.)-640.3(The)-635.5(wristband)-633.9(was)-637.3(also)]TJ
0 -1.3278 TD
[(connected)-422.3(to)-413.6(a)-418.9(pulse)-418.4(oximeter.)-421.5(A)-413.2(cellular)-423.5(telephone)-416(received)-425.6(and)]TJ
0 -1.3341 TD
[(transmitted)-302.4(the)-306(data)-302.9(to)-299.8(a)-305(monitoring)-301.1(system.)-305.4(The)-306.7(system)-304.1(performed)]TJ
T*
[(measurements)-268.8(every)-266.5(3)-270.4(hours.)-265.3(Data)-266.4(were)-266(gathered)-268.6(automatically,)-274.1(but)]TJ
T*
[(the)-217.5(patient)-214.2(had)-217.8(to)-211.3(wear)-221.3(and)-213.1(turn)-213.7(on)-217.9(the)-211.2(wristband.)-217.8(A)-217.2(sound)-213.5(reminded)]TJ
T*
[(the)-242.8(patient)-252.1(to)-242.9(wear)-246.6(the)-242.8(pulse)-247.7(oximeter)-243.2(when)-245.9(the)-249.1(measures)-244.6(were)-247(to)-242.9(be)]TJ
T*
[(collected.)-251.1(After)-244.4(9)-245.1(months,)-253.1(the)-242.8(intervention)-250.8(group)-244.9(had)-249.4(a)-241.8(lower)-247.1(rate)-248(of)]TJ
T*
[(exacerbations)-421.5(requiring)-418(change)-415.7(in)-412.6(medication)-417.3(and)-415.4(hospitalization)]TJ
T*
[(\(incidence)-240.6(rates)-236(of)-234.5(28%)-234.6(versus)-238.6(42%)-234.6(per)-234.4(year\))-233.2(and)-238.4(a)-235.5(33%)-234.6(reduced)-239.6(risk)]TJ
0 -1.3278 TD
[(of)-367.3(exacerbation.)-377.8(However,)-369.6(the)-369.3(average)-370.7(length)-375.7(of)-367.3(stay)-371.6(in)-368.4(the)-369.3(inter-)]TJ
0 -1.3341 TD
[(vention)-337.9(group)-333.4(was)-340.2(longer,)-337(suggesting)-336.1(that)-335.1(the)-337.6(threshold)-335.4(for)-335.8(hospi-)]TJ
T*
[(talization)-286(was)-276.9(lower)-285(in)-279.8(the)-280.7(control)-283(group.)]TJ
1.1128 -1.3341 TD
[(Tw)11.3(o)-276.7(obs)15(erv)12.2(at)13.3(ion)12.5(al)-270.6(st)14.1(udie)12.3(s)-272.6(may)-260.3(be)-272.3(wo)11.3(rth)-266.2(rep)12.2(or)14.1(tin)13.2(g)-276.7(her)14.2(e,)-268.8(pri)16.9(mar)16.3(ily)]TJ
-1.1128 -1.3341 TD
[(bec)10.3(aus)14(e)-292.8(o)0(f)-291.4(thei)19.2(r)-297.3(lar)13.8(ge)-291.3(sam)15.7(ple)15(s.)-292.8(Th)11.4(e)-299.1(fir)13.2(st)-289.4(doc)13.8(ume)13.3(nte)14.8(d)-295.7(the)-287.1(resu)13.5(lts)-280.3(of)-291.5(a)]TJ
T*
[(ho)11.4(me-b)12.6(ase)14.8(d)-200.8(cas)14.8(e)-197.9(man)18.3(agem)16(ent)-187.5(tele)13.8(med)17.5(icin)18.2(e)-204.3(p)0(r)14.1(ogra)14.1(m)-197(for)-190.4(COP)16.5(D)-202.3(ove)13.8(r)-196.1(a)]TJ
T*
[(2-m)14.5(ont)11.9(h)-211.4(per)12.2(iod)-202.8(\()]TJ
/F5 1 Tf
6.9489 0 TD
(n)Tj
/F9 1 Tf
.7018 0 TD
(=)Tj
/F1 1 Tf
.7145 0 TD
[(851)17.2(\))-212.2(i)0(n)-210.3(Mic)11.9(hi)12.7(gan)14.5(.)]TJ
6.7246 0 0 5.9768 447.4771 422.929 Tm
(130)Tj
8.9663 0 0 8.9663 459.8361 418.9038 Tm
[(Alt)15.4(hou)14.9(gh)-209.9(not)-203.1(defi)19.2(nit)13.2(ive)15(,)-216.3(t)0(h)12.1(e)]TJ
-16.9517 -1.3341 TD
[(fin)15.2(din)12.5(gs)-226.8(sug)17(ges)11.5(t)-231.8(som)12.5(e)-229.6(pos)15(iti)14.1(ve)-228(be)12.2(nefi)13.3(ts)-219.8(fro)12(m)-228.6(tele)13.8(med)17.6(icin)18.2(e)-229.5(i)0(n)-229.3(t)0(e)12.9(rms)-223.1(of)]TJ
0 -1.3278 TD
[(ho)11.4(spit)12.1(al)13.9(iza)12(tio)12.8(n,)-353.5(emer)14(ge)12.2(ncy)-358.9(vis)16.3(its)16.9(,)-368(a)0(n)13(d)-365.2(mo)13.2(rta)13.2(lit)14.1(y.)-360.2(Th)11.4(e)-362.3(seco)15.9(nd)-357(obse)13(r-)]TJ
0 -1.3341 TD
[(vat)14.8(ion)12.5(al)-270.6(stu)11.4(dy)-275.2(was)-264.3(con)14.1(duct)11.6(ed)-272.3(in)-273.5(Th)11.4(e)-280.1(N)0(e)12.8(ther)16.4(lan)15.8(ds)-277.4(\()]TJ
/F5 1 Tf
20.9794 0 TD
(n)Tj
/F9 1 Tf
.7082 0 TD
(=)Tj
/F1 1 Tf
.7082 0 TD
[(1,95)15.9(8\))-273.9(and)-270(as-)]TJ
-22.3958 -1.3341 TD
[(ses)15.6(sed)-431.1(the)-426.2(eff)12.8(ect)-431.6(of)-430.6(tele)13.8(pu)11.4(lmo)15.9(nol)12.5(ogy)-431.7(on)-432.8(qu)11.4(alit)18.9(y)-441.1(a)0(n)13(d)-441.1(ef)14.9(fic)11.4(ien)15.4(cy)-436.7(of)]TJ
T*
[(car)15.4(e.)]TJ
6.7246 0 0 5.9768 325.2471 363.118 Tm
(131)Tj
8.9663 0 0 8.9663 338.3432 359.1495 Tm
[(All)-287.5(GPs)-287.6(in)-292.5(The)-287.7(Neth)18.5(erl)13.4(and)14.5(s)-297.9(who)-288.6(had)-287.3(a)-298.7(s)0(p)13.5(irom)15.9(ete)11(r)-297.3(a)0(n)13(d)-295.7(com)11.2(-)]TJ
-3.4017 -1.3341 TD
[(pu)11.4(ter)-372.9(acc)13.6(ess)-363.7(wer)14.1(e)-375(elig)17.8(ibl)13.4(e)-381.3(t)0(o)-369.4(use)-365.8(tele)13.8(pu)11.4(lmo)15.9(nol)12.5(ogy)-368.5(an)13(d)-377.8(wer)14.1(e)-381.3(lin)20.1(ked)]TJ
T*
[(wit)14.8(h)-243(p)0(u)11.4(lmon)17.8(olo)12.1(gis)16.3(ts.)-233.7(Ove)11.3(r)-240.4(a)-241.8(3-)18.2(year)-229.7(per)12.2(iod)12.2(,)-241.5(158)-229.4(GPs)-230.7(cons)13.4(ul)12.7(ted)-232.2(with)]TJ
T*
[(32)-439.6(pu)11.4(lmon)17.8(olo)12.2(gis)16.3(ts)-441.1(in)-437.9(thi)14.8(s)-443.3(nat)15.2(ion)12.5(al)-435(Web-)15.4(bas)11.9(ed)-436.7(sys)12.8(tem)11.9(,)-443.9(g)0(e)12.2(ner)12.5(ati)16.1(ng)]TJ
T*
[(195)10.9(8)-213.5(tele)13.8(co)12.2(nsul)20.2(tati)18.2(ons)-212.3(fo)12.1(r)-215.1(1,8)14.4(28)-211.9(pati)17.6(ents)-207.2(\(ra)20.1(ngi)12.5(ng)-211.6(in)-210.3(age)-210.6(fro)12(m)-216(6)-213.5(to)-211.3(91)]TJ
0 -1.3278 TD
[(year)16.9(s\).)-422.8(Of)-426.7(th)12.1(ese)14.4(,)-431.2(23%)-424.3(of)-430.6(pa)12.6(tie)15.7(nts)-426.6(wer)14.1(e)-431.9(dia)15.4(gno)11.3(sed)-418.4(wit)14.8(h)-432.7(COPD)16.6(.)-431.2(T)0(h)11.4(e)]TJ
0 -1.3341 TD
[(maj)12.9(ori)16.9(ty)-186(of)-184(th)12.1(e)-191.6(c)0(o)12.2(nsul)13.9(ta)13.3(tio)12.8(ns)-182.2(\(69)12.2(%\))-184.2(ask)17.2(ed)-183.8(for)-177.7(adv)14.1(ice)11.6(.)-191(E)0(i)12.7(ght)13.6(een)-179(per)12.1(cent)]TJ
T*
[(of)-196.6(the)-198.5(tel)15.7(epul)18.6(mon)15.1(olo)12.2(gy)-199.3(con)14.1(sul)12(tat)15.5(ion)12.5(s)-203(resu)19.8(lted)-191.5(in)-197.6(a)-203.9(phy)12.9(sic)12.8(al)-201.1(ref)14.8(err)16.9(al)-201.1(of)]TJ
T*
[(pat)14.8(ien)15.4(ts)-200.9(who)-193.7(wo)11.4(uld)-194.5(not)-190.4(have)-194.4(be)12.2(en)-196(refe)12.9(rr)12.5(ed)-196.4(with)18.4(out)-195.1(thi)14.8(s)-203(sys)12.8(tem)11.9(.)-203.6(Whe)16.1(n)]TJ
T*
[(ask)17.2(ed)-588.4(wh)13.4(ethe)14.5(r)-588.1(t)0(h)12.1(e)-590(tel)15.7(eco)10.3(nsul)20.2(tat)15.5(ion)-581.8(wi)12.6(th)-582.3(the)-584.2(pu)11.4(lmo)15.9(nol)12.5(ogi)12.1(st)-580.2(was)]TJ
T*
[(help)18.6(ful,)-389.1(onl)18.9(y)-403.1(4)0(%)-394.2(o)0(f)-392.6(GPs)-388.7(gav)14.1(e)-400.3(a)-399.9(neg)14.1(ati)16.1(ve)-398.8(an)13(swe)13.5(r.)-393.4(Abou)17(t)-402.5(one)14.1(-th)13.4(ird)]TJ
T*
[(\(31)12.1(%\))-342.3(of)-342(th)12.1(e)-349.7(t)0(e)12.9(lep)15(ulm)11.7(ono)11.3(log)12.2(y)-346.2(p)0(a)12.6(tie)15.7(nts)-338.1(wer)14.1(e)-349.7(ref)14.8(err)16.9(ed)-341.8(for)-335.8(dire)14.9(ct)-341.2(car)15.4(e)]TJ
T*
[(ser)16.3(vice)13.1(s,)-204.3(an)13(d)-213.5(68%)-196.6(of)-209.3(th)12.1(ese)-200.6(con)14.1(sul)12(tat)15.5(ion)12.5(s)-209.4(act)11.4(ua)14.7(lly)-201.6(pre)12.2(ven)14.1(ted)-200.6(a)-210.2(ref)14.8(erra)15.3(l.)]TJ
/F4 1 Tf
11.9551 0 0 11.9551 307.8424 191.7921 Tm
[(Cost)-335.3(Studies)]TJ
/F1 1 Tf
8.9663 0 0 8.9663 317.8204 179.8298 Tm
[(The)-382.6(initial)-378.3(literature)-384.1(search)-388.3(yielded)-379.4(for)-386.4(cost)-378.3(studies)-385.3(yielded)-385.7(499)]TJ
-1.1128 -1.3341 TD
[(articles.)-322.2(Of)-319.2(these,)-316.3(14)-319.4(were)-322.9(used)-320(in)-317.8(the)-318.7(final)-318.6(analysis.)-319.2(Although)-325(sev-)]TJ
T*
[(eral)-348.5(studies)-347.4(cited)-351.5(above)-353(included)-350.2(some)-343.6(economic)-353.2(data,)-348.4(typically)-348.8(in)]TJ
T*
[(terms)-210.2(of)-202.9(use)-207.7(of)-209.3(service)-210.9(\(hospitalization,)-212.6(emergency)-212.5(department)-212.2(visits,)]TJ
T*
[(etc.\),)-387.1(we)-384.1(include)-383.3(here)-386.1(a)-380.9(special)-384.7(section)-388.2(on)-382.3(studies)-385.3(that)-379.3(focused)-385.8(on)]TJ
T*
[(economic)-283.6(analysis.)-281.3(The)-281.4(methods)-279.4(include)-288.5(cost-benefit)-279.7(analysis,)-281.3(cost-)]TJ
0 -1.3278 TD
[(effectiveness)-481.1(analysis,)-483.6(cost)-479.5(minimization)-480(analysis,)-477.3(and)-478.7(return)-481.3(on)]TJ
0 -1.3341 TD
[(investment.)-449.6(Because)-448.4(telemedicine)-451.9(research)-453.6(cost)-447.9(analysis)-444.4(does)-448.5(not)]TJ
T*
[(adhere)-272.3(consistently)-273(to)-268.2(these)-270.7(traditional)-270(methodologies,)-272.5(we)-270.3(include)-269.5(a)]TJ
T*
[(brief)-284.4(explanation)-279.4(for)-285.2(each:)]TJ
/F11 1 Tf
11.9551 0 0 11.9551 287.5464 741.9966 Tm
[(TELEMEDICINE)-340.6(FOR)-332.7(CHRONIC)-338.8(DISEASE)-334.7(MANAGE)-7.3(MENT)]TJ
/F9 1 Tf
6.9738 0 0 6.9738 185.6692 29.7638 Tm
()Tj
/F7 1 Tf
1.3251 0 TD
.2071 Tc
[(M)9.2(A)6.8(RY)-321.6(AN)12.9(N)-328.5(L)6.6(IEB)11.5(E)1.7(R)6.8(T)5.1(,)-327.7(I)3.7(N)12.9(C)3.1(.)]TJ
/F10 1 Tf
15.015 0 TD
0 Tc
()Tj
/F7 1 Tf
.9999 0 TD
.1103 Tc
[(VOL.)-327(20)-1000.8(N)5.5(O)4(.)-335.1(9)]TJ
/F10 1 Tf
8.3814 0 TD
0 Tc
()Tj
/F8 1 Tf
.9999 0 TD
.1094 Tc
[(SEPTEM)6.2(BER)-333.3(2)0(014)]TJ
/F4 1 Tf
7.9702 0 0 7.9702 440.7306 29.7638 Tm
0 Tc
[(TELEMEDICI)10.7(NE)-332(and)-328.9(e-HEALTH)-647.9(789)]TJ
ET
q
1 i
0 792 612 -791.985 re
W n
579.685 .014984 .22681 791.985 re
f
337.039 767.962 274.961 .22675 re
f
Q
endstream
endobj
283 0 obj
<>/XObject<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]/Font<>/Properties<>>>/Thumb 286 0 R/MediaBox[0 0 612 792]/Rotate 0>>
endobj
287 0 obj
<>/ProcSet[/PDF/Text]/Font<>/Properties<>>>
endobj
284 0 obj
<>stream
/GS1 gs
BT
/F13 1 Tf
5.9777 0 0 5.9777 60.0945 694.9415 Tm
0 0 0 1 k
0 Tc
0 Tw
(.)Tj
/F1 1 Tf
8.9663 0 0 8.9663 66.1039 693.9211 Tm
[(Cost-benefit)-540.4(analysis)-545.6(is)-535.4(based)-544.9(on)-540.3(converting)-540.7(all)-539.7(inputs)-538.9(and)]TJ
0 -1.3278 TD
[(benefits)-396.6(\(or)-400.4(outputs\))-400.7(into)-396.3(monetary)-402.1(terms)-393.6(as)-400.6(a)-393.6(basis)-403.3(for)-392.7(com-)]TJ
0 -1.3341 TD
[(paring)-417.5(the)-419.8(merits)-416.1(of)-417.9(two)-416.4(or)-415.9(more)-418.8(programs,)-423.8(interventions,)-417.2(or)]TJ
T*
[(projects.)-402.6(It)-397.7(provides)-398.5(a)-399.9(concrete)-400.5(basis)-397(for)-399(determining)-401.3(whether)]TJ
T*
[(the)-242.8(benefits)-244.9(of)-240.9(a)-235.5(given)-247.1(intervention)-244.5(\(or)-242.4(policy\))-241.9(outweigh)-242.6(its)-242.3(cost.)]TJ
T*
[(The)-332(main)-339.3(impediment)-334.6(in)-336.7(using)-338.7(cost-benefit)-336.6(analysis)-336.9(in)-336.7(health-)]TJ
T*
[(care)-536.6(is)-535.4(the)-533.6(difficulty)-539.1(of)-538(achieving)-541.4(consensus)-534.5(on)-534(translating)]TJ
T*
[(benefits)-333.4(such)-337(as)-331(years)-337.8(of)-335.7(life)-333.6(or)-333.7(disability)-338.4(into)-333(dollar)-334.4(amounts.)]TJ
/F13 1 Tf
5.9777 0 0 5.9777 60.0945 599.3007 Tm
(.)Tj
/F1 1 Tf
8.9663 0 0 8.9663 66.1039 598.2802 Tm
[(On)-365.8(the)-369.3(other)-374.1(hand,)-368.9(in)-374.7(cost-effectiveness)-377.5(analysis)-368.5(the)-369.3(costs)-372.7(are)]TJ
0 -1.3278 TD
[(monetary,)-580.4(whereas)-580.8(the)-577.9(outcomes)-578.5(are)-578.9(non-monetary.)-580.1(It)-581(can)]TJ
0 -1.3341 TD
[(provide)-309.3(a)-311.4(comparison)-312.2(of)-316.7(the)-312.3(relative)-312.4(costs)-309.5(of)-310.4(two)-315.3(interventions)]TJ
T*
[(for)-278.9(achieving)-275.9(the)-280.7(same)-277.1(result,)-280(such)-280.1(as)-274.1(a)-279.7(medical)-277.5(visit)-282.3(or)-276.8(a)-273.4(given)]TJ
T*
[(state)-334.9(of)-335.7(health.)]TJ
/F13 1 Tf
5.9777 0 0 5.9777 60.0945 539.5463 Tm
(.)Tj
/F1 1 Tf
8.9663 0 0 8.9663 66.1039 538.5258 Tm
[(Cost)-449.3(utility)-456.4(analysis)-450.7(is)-453.2(a)-450.5(particular)-453.9(type)-452(of)-449.5(cost-effectiveness)]TJ
T*
[(analysis)-330.6(that)-335.1(uses)-334.9(quality-adjusted)-345.2(life)-333.6(years)-337.9(as)-331(an)-334.8(outcome.)]TJ
/F13 1 Tf
5.9777 0 0 5.9777 60.0945 515.6219 Tm
(.)Tj
/F1 1 Tf
8.9663 0 0 8.9663 66.1039 514.6014 Tm
[(Cost)-499.9(minimization)-505.3(analysis)-501.3(\(or)-501.6(cost)-504.8(saving)-506.7(analysis\))-498.5(is)-503.7(con-)]TJ
T*
[(cerned)-356.5(with)-354.7(finding)-350.1(the)-356.6(least)-353.3(costly)-355(alternative)-360.4(to)-350.4(producing)-360.7(a)]TJ
0 -1.3278 TD
[(medical)-283.8(visit)-288.6(or)-289.4(an)-284.2(episode)-288.1(of)-285.1(care,)-291.3(assuming)-285(health)-288.6(outcome)-287(is)]TJ
0 -1.3341 TD
[(the)-331.3(same.)]TJ
/F13 1 Tf
5.9777 0 0 5.9777 60.0945 467.7731 Tm
(.)Tj
/F1 1 Tf
8.9663 0 0 8.9663 66.1039 466.8093 Tm
[(Finally,)-261.4(return)-266.4(on)-262.1(investment)-271.3(divides)-264.4(the)-261.8(total)-264.8(monetary)-269.3(benefit)]TJ
T*
[(by)-351(initial)-359.4(investment)-353.5(and)-358.5(subsequent)-357.8(cost,)-354.3(expressed)-362.7(as)-356.3(a)-349.3(per-)]TJ
T*
[(centage)-406.4(or)-409.6(ratio.)-407.4(However,)-407.6(return)-411.8(on)-407.6(investment)-410.4(may)-405.7(include)]TJ
T*
[(non-monetary)-237.4(benefits)-238.6(that)-233.9(may)-235(be)-240.7(difficult)-237.1(to)-236.6(quantify,)-238.1(such)-235.8(as)]TJ
T*
[(contribution)-340.6(to)-344.1(public)-343.8(service,)-345(enhanced)-346.2(reputation,)-343.3(and)-339.6(client)]TJ
T*
(satisfaction.)Tj
6.7246 0 0 5.9768 111.0047 411.0235 Tm
(132)Tj
8.9663 0 0 8.9663 124.2708 406.9983 Tm
[(Downstream)-305.9(revenue)-308.7(from)-305.2(enhanced)-308.3(reputation)]TJ
-6.4873 -1.3278 TD
[(can)-248.2(be)-253.3(measured)-255(in)-248.2(quantitative)-256.3(terms,)-249.4(but)-252(it)-247.9(is)-250.8(often)-251.4(difficult)-256.1(to)]TJ
0 -1.3341 TD
[(trace.)-270.1(Nonetheless,)-272.6(despite)-268.4(the)-268.1(inherent)-269.8(importance)-268.5(of)-272.5(return)-266.4(on)]TJ
T*
[(investment)-404.1(to)-401(health)-402.4(systems)-399.7(or)-403.2(private)-406.5(investors,)-399.4(we)-403.1(did)-405.2(not)]TJ
T*
[(find)-331(robust)-339.8(return)-335.9(on)-331.7(investment)-334.5(studies)-341.1(for)-329.5(this)-339.9(report.)]TJ
-.6702 -1.9475 TD
[(It)-334.4(should)-329.2(also)-333(be)-335.5(pointed)-331.9(out)-334.2(that)-328.8(the)-331.3(cost)-334(studies)-334.7(reviewed)-331.6(here)]TJ
-1.1065 -1.3278 TD
[(were)-310.3(not)-310.5(all)-312.1(based)-311(on)-312.7(a)-311.4(single)-309.8(perspective.)-316.4(They)-311.5(assumed)-317(a)-311.4(societal)]TJ
0 -1.3341 TD
[(perspective,)-284.8(a)-279.7(health)-282.3(system)-285.2(perspective,)-284.8(or)-283.1(a)-279.7(payer)-278.7(perspective.)]TJ
1.1065 -1.3341 TD
[(Although)-356.6(not)-348.5(included)-350.2(in)-349.4(this)-352.6(review,)-351.5(there)-352.3(also)-352(is)-345.7(a)-349.3(substantial)]TJ
-1.1065 -1.3341 TD
[(research)-244.9(literature)-251.3(on)-243.2(telemedicine)-255.9(costs)-246.2(in)-248.2(various)-245.9(settings)-245.7(\(primary)]TJ
T*
[(care,)-569.5(healthcare)-572.3(networks,)-576.1(etc.\).)-570.5(Examples)-570.8(include)-573(psychiatry)]TJ
6.7246 0 0 5.9768 293.6692 285.959 Tm
(133)Tj
8.9663 0 0 8.9663 50.1732 270.0283 Tm
[(\(including)-391.4(depression)]TJ
6.7246 0 0 5.9768 131.4708 273.9968 Tm
(134136)Tj
8.9663 0 0 8.9663 159.5338 270.0283 Tm
[(and)-396.5(dementia)]TJ
6.7246 0 0 5.9768 211.4078 273.9968 Tm
(137)Tj
8.9663 0 0 8.9663 221.9527 270.0283 Tm
[(\),)-390.5(dermatology,)]TJ
6.7246 0 0 5.9768 279.6094 273.9968 Tm
[(1381)-13.5(44)]TJ
8.9663 0 0 8.9663 50.1732 258.066 Tm
[(sleep)-329(apnea,)]TJ
6.7246 0 0 5.9768 96.1511 262.0912 Tm
(145)Tj
8.9663 0 0 8.9663 109.5874 258.066 Tm
(orthopedics,)Tj
6.7246 0 0 5.9768 155.2818 262.0912 Tm
(146)Tj
8.9663 0 0 8.9663 168.7181 258.066 Tm
(nephrology,)Tj
6.7246 0 0 5.9768 213.7322 262.0912 Tm
(147)Tj
8.9663 0 0 8.9663 227.2251 258.066 Tm
(diabetes,)Tj
6.7246 0 0 5.9768 259.8235 262.0912 Tm
(148152)Tj
8.9663 0 0 8.9663 287.3196 258.066 Tm
(can-)Tj
-26.4487 -1.3341 TD
(cer,)Tj
6.7246 0 0 5.9768 63.496 250.1291 Tm
[(1531)-13.5(55)]TJ
8.9663 0 0 8.9663 92.4094 246.1039 Tm
(otolaryngology,)Tj
6.7246 0 0 5.9768 152.1637 250.1291 Tm
(156)Tj
8.9663 0 0 8.9663 166.9606 246.1039 Tm
[(lifestyle)-487.8(\(smoking,)-485.2(diet,)-483.6(obesity)]TJ
6.7246 0 0 5.9768 289.0204 250.1291 Tm
(157)Tj
8.9663 0 0 8.9663 299.5086 246.1039 Tm
(\),)Tj
-27.8082 -1.3278 TD
(tuberculosis,)Tj
6.7246 0 0 5.9768 97.285 238.1668 Tm
(158)Tj
8.9663 0 0 8.9663 110.6645 234.1983 Tm
[(high-risk)-313.6(pregnancy,)]TJ
6.7246 0 0 5.9768 189.1842 238.1668 Tm
(159)Tj
8.9663 0 0 8.9663 202.507 234.1983 Tm
[(intensive)-320.3(care,)]TJ
6.7246 0 0 5.9768 256.8755 238.1668 Tm
(160)Tj
8.9663 0 0 8.9663 270.1983 234.1983 Tm
[(and)-314.3(neo-)]TJ
-24.5392 -1.3341 TD
[(natal)-280.7(care,)]TJ
6.7246 0 0 5.9768 89.1779 226.2046 Tm
(161)Tj
8.9663 0 0 8.9663 102.2173 222.2361 Tm
[(as)-280.4(well)-283.7(as)-280.4(other)-279.3(applications.)]TJ
-4.6979 -1.3341 TD
[(The)-211.8(following)-205.1(analysis)-210.5(is)-206.6(based)-203.5(on)-211.6(14)-205.6(cost)-207.6(studies)-208.3(\()]TJ
/F5 1 Tf
20.6886 0 TD
[(Table)-208.4(4)]TJ
/F1 1 Tf
2.9654 0 TD
[(\))-205.9(dealing)]TJ
-24.7605 -1.3341 TD
[(with)-285.2(one)-289.4(or)-289.4(more)-286(of)-285.1(the)-287.1(target)-294.9(chronic)-285(diseases)-294(in)-286.2(this)-283(article)-294.9(and)-282.6(is)]TJ
T*
[(organized)-185.9(on)-186.3(the)-185.9(basis)-188.3(of)-184(the)-185.9(particular)-188.4(cost)-188.6(method)-183.9(used)-187.2(in)-185(the)-185.9(study.)]TJ
/F6 1 Tf
9.9626 0 0 9.9626 50.1732 155.7921 Tm
[(THE)-335.1(EVIDEN)-11.7(CE)-332.8(RELAT)-10.9(ED)-333.7(TO)-337.3(COST)]TJ
/F1 1 Tf
8.9663 0 0 8.9663 60.0945 143.8299 Tm
[(Three)-321.3(studies)-315.8(that)-316.1(investigated)-324.8(cost-effectiveness)-320.6(of)-316.7(heart)-320.3(failure)]TJ
-1.1065 -1.3341 TD
[(telemonitoring,)-219.1(telestroke,)-226.3(or)-213.5(a)-216.5(combination)-222.3(of)-215.6(chronic)-221.8(diseases)-218.2(were)]TJ
T*
[(reviewed)-192.5(earlier)-189.7(and)-187.8(will)-190.5(not)-190.4(be)-190.1(repeated)-191.9(here.)-191.4(In)-183(chronological)-194.2(order,)]TJ
T*
[(these)-428.8(were)-424.1(the)-432.5(Veterans)-430(Affairs)-429.6(CCHT)-426.8(program)-428.1(for)-430.6(Veterans)-430(with)]TJ
T*
[(chronic)-335.6(conditions)-334.3(by)-332.1(Darkins)-332.2(et)-334.9(al.)]TJ
6.7246 0 0 5.9768 186.2362 99.9496 Tm
(48)Tj
8.9663 0 0 8.9663 196.2141 95.9811 Tm
[(\(published)-336.7(in)-330.4(2008\),)-333.8(the)-337.6(Tel-)]TJ
-16.2878 -1.3341 TD
[(Assistance)-198.8(program)-200.5(for)-196.7(COPD)-198.4(by)-199.3(Vitacca)-195.9(et)-202.1(al.)]TJ
6.7246 0 0 5.9768 218.8346 88.0441 Tm
(120)Tj
8.9663 0 0 8.9663 231.0802 84.0189 Tm
[(\(published)-203.9(in)-197.6(2009\),)]TJ
-20.1764 -1.3341 TD
[(and)-402.8(the)-407.2(Georgia/Mayo)-408.9(Clinic)-412.4(hub-and-spoke)-409.6(networks)-410.4(serving)-406(is-)]TJ
30.331 69.3497 TD
[(chemic)-525.3(stroke)-529.7(patients)-524.7(by)-528.1(Switzer)-523(et)-530.9(al.)]TJ
6.7246 0 0 5.9768 482.003 697.8896 Tm
(102)Tj
8.9663 0 0 8.9663 497.1967 693.8644 Tm
[(\(published)-532.7(in)-520.1(2013\).)]TJ
-19.5251 -1.3278 TD
[(All)-565.7(three)-567.3(studies)-568.7(reported)-572.7(positive)-572(findings)-565.8(regarding)-569.8(the)-565.3(cost-)]TJ
0 -1.3341 TD
[(effectiveness)-297.7(of)-291.4(the)-293.4(respective)-297.7(telemedicine)-293.9(interventions.)-297.1(The)-294(find-)]TJ
T*
[(ings)-557.2(were)-556.9(not)-557.1(uniformly)-558.2(positive,)-560.6(however.)-557.9(A)-552.3(British)-559.9(study)-554.7(by)]TJ
T*
[(Henderson)-286.6(et)-278(al.)]TJ
6.7246 0 0 5.9768 382.7905 650.0408 Tm
(162)Tj
8.9663 0 0 8.9663 395.8298 646.0723 Tm
[(\(published)-286.1(in)-279.8(2013\))-282(reported)-288.2(neutral)-277.7(findings.)]TJ
/F6 1 Tf
9.9626 0 0 9.9626 322.129 622.1479 Tm
[(COST)-10(-BENEFIT)-341.3(ANALY)-9.7(SIS)]TJ
/F1 1 Tf
8.9663 0 0 8.9663 332.107 610.1857 Tm
[(Only)-235(two)-239.4(of)-234.5(the)-236.5(cost)-239.2(studies)-239.9(meeting)-236.8(the)-236.5(criteria)-238.1(for)-240.9(inclusion)-238.3(\(i.e.,)]TJ
-1.1128 -1.3341 TD
[(having)-300.1(a)-298.7(focus)-296.9(on)-300.1(CHF,)-304.6(stroke,)-297(and/or)-302.3(COPD\))-296.8(used)-301.1(variants)-299(of)-297.8(cost-)]TJ
0 -1.3278 TD
[(benefit)-320.1(analysis.)-319.2(The)-319.3(first)-314.1(was)-321.2(discussed)-319(in)-317.8(two)-315.3(publications)-318.7(from)-317.8(a)]TJ
0 -1.3341 TD
[(telecardiology)-381.3(project)-381.6(in)-374.7(the)-375.6(State)-374.9(of)-373.6(Minas)-378.6(Gerais)-372.4(in)-374.7(Brazil)-378.7(\(pub-)]TJ
T*
[(lished)-289.2(in)-279.8(2011)-291.1(and)-282.6(2012\))-288.3(and)-282.6(consisted)-286.2(of)-285.1(a)-286.1(cost-benefit)-286(analysis)-286.3(of)]TJ
T*
[(conducting)-480.2(an)-480.2(ECG)-478.3(via)-477.8(telemedicine)-483.6(versus)-478.9(in-person.)]TJ
6.7246 0 0 5.9768 535.6912 554.3998 Tm
(163,164)Tj
8.9663 0 0 8.9663 562.6203 550.4313 Tm
(The)Tj
-26.8218 -1.3341 TD
[(authors)-295(calculated)-293.2(the)-293.4(opportunity)-289.7(cost)-296.1(of)-291.5(transportation,)-291(food,)-296(and)]TJ
T*
[(wage)-188.1(loss,)-188(as)-191.9(well)-188.9(as)-185.6(the)-192.2(specific)-191.2(charges)-190.8(for)-184.1(the)-192.2(ECG)-187.4(and)-187.8(consultation)]TJ
T*
[(with)-493.8(a)-494.7(specialist.)]TJ
6.7246 0 0 5.9768 388.2896 518.5699 Tm
(163)Tj
8.9663 0 0 8.9663 403.2566 514.5447 Tm
[(Input)-498.2(costs)-492.8(included)-495.6(wages,)-499.9(equipment,)-498.5(im-)]TJ
-9.0481 -1.3341 TD
[(plementation,)-401.9(maintenance,)-398.8(and)-396.5(assessment.)-398.4(The)-395.2(cost)-397.3(estimate)-398.3(for)]TJ
0 -1.3278 TD
[(transmitting)-346.3(ECG)-345.5(tracings)-343.6(together)-347.1(with)-342.1(a)-343(consultation)-344.3(with)-342.1(a)-343(car-)]TJ
0 -1.3341 TD
[(diologist)-192.7(was)-182.1(28.92)-191.2(R$)-181.2(\(Brazilian)-189.4(Reals,)-187.4(equivalent)-191.5(to)-186(about)-188.8($13)-183.1(U.S.\),)]TJ
T*
[(compared)-394(with)-392.6(a)-393.6(range)-392.2(of)-392.6(30.9154.58)-393.5(R$)-396.1(\(equivalent)-391(to)-394.6($13.90)]TJ
T*
[(24.54)-311.3(U.S.\))-306(for)-310.5(a)-305(patient)-309.1(referral)-308.5(to)-306.1(have)-308.2(the)-312.3(ECG)-307.6(in)-305.1(another)-310.6(city.)-306.5(A)]TJ
T*
[(year)-469.9(later,)-474.1(another)-474.9(report)-471.1(from)-469.6(the)-470.4(same)-473.1(project)]TJ
6.7246 0 0 5.9768 512.5038 446.7967 Tm
(164)Tj
8.9663 0 0 8.9663 527.244 442.8282 Tm
[(showed)-473.1(sub-)]TJ
-22.8763 -1.3341 TD
[(stantial)-270.2(savings)-267.1(in)-260.9(travel)-269(costs.)-266.5(Over)-267(a)-267.1(5-year)-264.7(period,)-274.2(the)-261.8(investment)]TJ
T*
[(of)-342($9,000,000)-348.8(U.S.)-346.7(resulted)-342.4(in)-343.1(over)-346.7(twice)-343.1(the)-344(savings)-343(\($20,081,840)]TJ
T*
[(U.S.\))-280.7(for)-285.2(the)-280.7(public)-280.6(health)-282.3(system.)]TJ
1.1128 -1.3278 TD
[(In)-201.9(2012,)-210.2(a)-203.9(matched-pair)-210.1(analysis)-210.5(\(essentially)-211.3(a)-203.9(casecontrol)-211.7(study\))]TJ
-1.1128 -1.3341 TD
[(of)-209.3(281)-204.1(program)-206.8(participants)-212.2(receiving)-210.3(an)-202(intervention)-212.9(consisting)-210(of)-202.9(a)]TJ
T*
[(decreasing)-322.8(intensity)-316.2(of)-316.7(nurse-supervised)-325.5(telephone)-321.1(calls)-321.1(were)-316.6(com-)]TJ
T*
[(pared)-297.7(with)-297.8(a)-298.7(control)-301.9(group)-295.5(of)-304.1(843)-298.9(cases)-297.7(\(a)-295.9(ratio)-298.6(of)-297.8(1:3\))-299.2(matched)-296.3(on)]TJ
T*
[(demographics)-437.4(and)-434.4(morbidity)-436.2(status.)]TJ
6.7246 0 0 5.9768 460.5731 351.1558 Tm
(165)Tj
8.9663 0 0 8.9663 474.9731 347.1873 Tm
[(In)-435.9(the)-432.5(intervention)-440.5(group,)]TJ
-17.0466 -1.3341 TD
[(patients)-606.9(were)-607.4(encouraged)-604.4(to)-609.6(perform)-602.9(self-measurements)-610.8(\(blood)]TJ
T*
[(pressure,)-425.3(pulse,)-426(weight\))-428.2(via)-427.2(portable)-424(devices,)-431.9(and)-421.8(they)-424.6(received)-425.6(a)]TJ
T*
[(mobile)-228.3(phone)-227.4(to)-230.3(transmit)-221.9(the)-230.1(data)-227(to)-223.9(the)-230.2(clinic)-227.5(if)-227(a)-222.8(telephone)-232.6(was)-226.4(not)]TJ
0 -1.3278 TD
[(already)-296.4(available)-292.3(in)-292.5(the)-293.4(household.)-302.1(Monetized)-294.7(cost)-296.1(data)-290.2(for)-297.9(the)-293.4(two)]TJ
0 -1.3341 TD
[(groups)-239.3(\(including)-239.6(medication,)-241.6(hospitalization,)-240.7(therapeutic)-238.2(aids,)-239.5(total)]TJ
T*
[(treatment,)-340.8(and)-333.2(mortality\))-334.6(were)-335.5(compared)-337.1(over)-340.4(a)-330.3(1-year)-340.6(period.)-337.4(Al-)]TJ
T*
[(though)-363.5(the)-362.9(intervention)-364.6(group)-365(had)-363.2(up)-361.7(to)-363(a)-361.9(25%)-361(reduction)-369.9(in)-362(total)]TJ
T*
[(cost,)-550.3(patients)-550(with)-550.7(mild)-550.3(symptoms)-553.1(and)-548.2(slight)-550.6(limitationNYHA)]TJ
T*
[(Class)-338.6(IIhad)-336.8(the)-337.6(most)-339.5(gains.)-338.7(More)-337.2(severe)-340.2(classes)-339.8(\(III)-336.8(and)-339.6(IV\))-331.7(had)-337.9(a)]TJ
T*
[(slight)-443.1(cost)-447.9(advantage.)-448.1(Overall,)-447.6(patients)-442.5(in)-444.2(the)-445.1(intervention)-446.8(group)]TJ
T*
[()55.6(experienced)-260.6(a)-254.5(reduced)-252.2(number)-255.3(of)-253.5(hospital)-259.8(stays,)-253.4(optimized)-258.1(medical)]TJ
0 -1.3278 TD
[(therapy,)-312.2([achieved)-315.6(a])-306.5(better)-314.2(quality)-309.7(of)-310.4(life,)-309.6(and)-307.9([had])-309.3(a)-305(reduction)-313(in)]TJ
0 -1.3341 TD
[(mortality.)52()]TJ
6.7246 0 0 5.9768 362.7212 195.7606 Tm
(165)Tj
/F6 1 Tf
9.9626 0 0 9.9626 322.129 167.8676 Tm
[(COST)-10(-EFFECT)-10.5(IVENE)-8(SS)-330(AN)-8.8(ALYSIS)]TJ
/F1 1 Tf
8.9663 0 0 8.9663 332.107 155.9055 Tm
[(In)-258.8(total,)-266(six)-267.9(studies)-265.2(met)-260(the)-268.1(criteria)-263.4(for)-266.2(inclusion)-263.6(based)-266.7(on)-262.1(the)-268.1(use)]TJ
-1.1128 -1.3341 TD
[(of)-259.8(a)-254.5(cost-effectiveness)-270.1(analysis.)-262.3(In)-258.8(2008,)-260.8(a)-254.5(large)-258.5(RCT)-262.5(\()]TJ
/F5 1 Tf
22.3768 0 TD
(n)Tj
/F9 1 Tf
.7082 0 TD
(=)Tj
/F1 1 Tf
.7208 0 TD
[(1,069\))-264.3(U.S.)]TJ
-23.8058 -1.3341 TD
[(study)-472.5(investigated)-476.6(the)-470.4(cost-effectiveness)-478.7(and)-472.3(health)-472(outcomes)-471(of)]TJ
T*
[(telephonic)-413.2(disease)-413.5(management)-418.8(for)-411.7(heart)-408.8(failure.)]TJ
6.7246 0 0 5.9768 510.8597 124.044 Tm
(166)Tj
8.9663 0 0 8.9663 525.033 120.0189 Tm
[(Patients)-416.9(were)]TJ
-22.6297 -1.3278 TD
[(enrolled)-202.1(for)-203(a)-197.6(period)-203.3(of)-202.9(18)-199.3(months)-201.2(and)-200.4(randomized)-199.6(into)-206.6(three)-200.5(groups:)]TJ
0 -1.3341 TD
[(usual)-397(care,)-392.5(disease)-394.5(management,)-394.8(and)-396.5(augmented)-394.1(disease)-394.5(manage-)]TJ
T*
[(ment.)-449.1(All)-451.9(patients)-455.2(were)-449.4(assigned)-452.4(a)-450.5(disease)-451.4(manager,)-452.9(a)-450.5(registered)]TJ
T*
[(nurse)-319.7(who)-320.2(provided)-326.7(education)-320.7(and)-320.6(medication)-322.5(management.)-325.2(Those)]TJ
/F11 1 Tf
11.9551 0 0 11.9551 50.1732 741.9966 Tm
[(BASHSHUR)-338.5(ET)-334.1(AL.)]TJ
7.9702 0 0 7.9702 50.1732 29.7638 Tm
[(7)-80(9)-78.2(0)-707(TELEM)12(EDICINE)-328.7(and)-331.8(e-HEALT)11.5(H)]TJ
/F8 1 Tf
6.9738 0 0 6.9738 177.4488 29.7638 Tm
.1096 Tc
[(SEPTEM)6.4(BER)-333.1(2).2(01)8.2(4)]TJ
ET
q
1 i
0 792 612 -791.985 re
W n
32.315 .014984 .22675 791.985 re
f
/Document /MC12 BDC
Q
q
1 i
0 792 32.315 -173.367 re
W n
0 0 0 .29999 k
0 618.633 32.315 173.367 re
f
EMC
Q
32.315 763.994 242.646 .22675 re
f
endstream
endobj
288 0 obj
<>stream
Adobe Illustrator CS4
2010-08-04T11:54:42+05:30
2010-08-04T11:54:42+05:30
2010-08-04T11:54:42+05:30
68
256
JPEG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application/postscript
saved
xmp.iid:11FB61F30AB7DE11AEB3E861853EAFA4
2009-10-12T14:15:50+05:30
Adobe Illustrator CS4
/
converted
from application/postscript to application/vnd.adobe.illustrator
converted
from application/postscript to application/vnd.adobe.illustrator
saved
xmp.iid:0280117407206811994CBE3149FFDB59
2010-08-04T11:54:42+05:30
Adobe Illustrator CS4
/
converted
from application/postscript to application/vnd.adobe.illustrator
xmp.iid:11FB61F30AB7DE11AEB3E861853EAFA4
xmp.did:11FB61F30AB7DE11AEB3E861853EAFA4
uuid:ee5a72b3-04e4-4157-a8d8-c3a8817872a3
uuid:ee5a72b3-04e4-4157-a8d8-c3a8817872a3
xmp.iid:0280117407206811994CBE3149FFDB59
xmp.did:0280117407206811994CBE3149FFDB59
TouchUp 7.0
False
False
1
684.000000
864.000000
Points
Black
Default Swatch Group
0
PANTONE 3025 C
SPOT
100.000000
CMYK
100.000000
16.859999
0.000000
50.980003
endstream
endobj
285 0 obj
<>
endobj
289 0 obj
<>/XObject<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]/Font<>>>/Thumb 292 0 R/MediaBox[0 0 612 792]/Rotate 0>>
endobj
293 0 obj
<>/ProcSet[/PDF/Text]/Font<>>>
endobj
290 0 obj
<>stream
0 0 0 .695 k
/GS1 gs
35.887 665.801 525.997 18.482 re
f
35.887 649.02 525.997 21.94 re
f
0 0 0 .065 k
35.887 625.039 50.513 23.981 re
f
0 0 0 .145 k
86.4 625.039 27.496 23.981 re
f
0 0 0 .065 k
113.896 625.039 50.513 23.981 re
f
0 0 0 .145 k
164.409 625.039 35.83 23.981 re
f
0 0 0 .065 k
200.239 625.039 50.513 23.981 re
f
0 0 0 .145 k
250.753 625.039 50.513 23.981 re
f
0 0 0 .065 k
301.266 625.039 57.373 23.981 re
f
0 0 0 .145 k
358.639 625.039 59.811 23.981 re
f
0 0 0 .065 k
418.45 625.039 59.754 23.981 re
f
0 0 0 .145 k
478.205 625.039 83.679 23.981 re
f
0 0 0 .065 k
35.887 592.044 50.513 32.995 re
f
0 0 0 .145 k
86.4 592.044 27.496 32.995 re
f
0 0 0 .065 k
113.896 592.044 50.513 32.995 re
f
0 0 0 .145 k
164.409 592.044 35.83 32.995 re
f
0 0 0 .065 k
200.239 592.044 50.513 32.995 re
f
0 0 0 .145 k
250.753 592.044 50.513 32.995 re
f
0 0 0 .065 k
301.266 592.044 57.373 32.995 re
f
0 0 0 .145 k
358.639 592.044 59.811 32.995 re
f
0 0 0 .065 k
418.45 592.044 59.754 32.995 re
f
0 0 0 .145 k
478.205 592.044 83.679 32.995 re
f
0 0 0 .065 k
35.887 568.063 50.513 23.981 re
f
0 0 0 .145 k
86.4 568.063 27.496 23.981 re
f
0 0 0 .065 k
113.896 568.063 50.513 23.981 re
f
0 0 0 .145 k
164.409 568.063 35.83 23.981 re
f
0 0 0 .065 k
200.239 568.063 50.513 23.981 re
f
0 0 0 .145 k
250.753 568.063 50.513 23.981 re
f
0 0 0 .065 k
301.266 568.063 57.373 23.981 re
f
0 0 0 .145 k
358.639 568.063 59.811 23.981 re
f
0 0 0 .065 k
418.45 568.063 59.754 23.981 re
f
0 0 0 .145 k
478.205 568.063 83.679 23.981 re
f
0 0 0 .065 k
35.887 526.11 50.513 41.953 re
f
0 0 0 .145 k
86.4 526.11 27.496 41.953 re
f
0 0 0 .065 k
113.896 526.11 50.513 41.953 re
f
0 0 0 .145 k
164.409 526.11 35.83 41.953 re
f
0 0 0 .065 k
200.239 526.11 50.513 41.953 re
f
0 0 0 .145 k
250.753 526.11 50.513 41.953 re
f
0 0 0 .065 k
301.266 526.11 57.373 41.953 re
f
0 0 0 .145 k
358.639 526.11 59.811 41.953 re
f
0 0 0 .065 k
418.45 526.11 59.754 41.953 re
f
0 0 0 .145 k
478.205 526.11 83.679 41.953 re
f
0 0 0 .065 k
35.887 502.072 50.513 24.038 re
f
0 0 0 .145 k
86.4 502.072 27.496 24.038 re
f
0 0 0 .065 k
113.896 502.072 50.513 24.038 re
f
0 0 0 .145 k
164.409 502.072 35.83 24.038 re
f
0 0 0 .065 k
200.239 502.072 50.513 24.038 re
f
0 0 0 .145 k
250.753 502.072 50.513 24.038 re
f
0 0 0 .065 k
301.266 502.072 57.373 24.038 re
f
0 0 0 .145 k
358.639 502.072 59.811 24.038 re
f
0 0 0 .065 k
418.45 502.072 59.754 24.038 re
f
0 0 0 .145 k
478.205 502.072 83.679 24.038 re
f
0 0 0 .065 k
35.887 469.134 50.513 32.939 re
f
0 0 0 .145 k
86.4 469.134 27.496 32.939 re
f
0 0 0 .065 k
113.896 469.134 50.513 32.939 re
f
0 0 0 .145 k
164.409 469.134 35.83 32.939 re
f
0 0 0 .065 k
200.239 469.134 50.513 32.939 re
f
0 0 0 .145 k
250.753 469.134 50.513 32.939 re
f
0 0 0 .065 k
301.266 469.134 57.373 32.939 re
f
0 0 0 .145 k
358.639 469.134 59.811 32.939 re
f
0 0 0 .065 k
418.45 469.134 59.754 32.939 re
f
0 0 0 .145 k
478.205 469.134 83.679 32.939 re
f
0 0 0 .065 k
35.887 445.096 50.513 24.038 re
f
0 0 0 .145 k
86.4 445.096 27.496 24.038 re
f
0 0 0 .065 k
113.896 445.096 50.513 24.038 re
f
0 0 0 .145 k
164.409 445.096 35.83 24.038 re
f
0 0 0 .065 k
200.239 445.096 50.513 24.038 re
f
0 0 0 .145 k
250.753 445.096 50.513 24.038 re
f
0 0 0 .065 k
301.266 445.096 57.373 24.038 re
f
0 0 0 .145 k
358.639 445.096 59.811 24.038 re
f
0 0 0 .065 k
418.45 445.096 59.754 24.038 re
f
0 0 0 .145 k
478.205 445.096 83.679 24.038 re
f
0 0 0 .065 k
35.887 403.143 50.513 41.953 re
f
0 0 0 .145 k
86.4 403.143 27.496 41.953 re
f
0 0 0 .065 k
113.896 403.143 50.513 41.953 re
f
0 0 0 .145 k
164.409 403.143 35.83 41.953 re
f
0 0 0 .065 k
200.239 403.143 50.513 41.953 re
f
0 0 0 .145 k
250.753 403.143 50.513 41.953 re
f
0 0 0 .065 k
301.266 403.143 57.373 41.953 re
f
0 0 0 .145 k
358.639 403.143 59.811 41.953 re
f
0 0 0 .065 k
418.45 403.143 59.754 41.953 re
f
0 0 0 .145 k
478.205 403.143 83.679 41.953 re
f
0 0 0 .065 k
35.887 352.233 50.513 50.91 re
f
0 0 0 .145 k
86.4 352.233 27.496 50.91 re
f
0 0 0 .065 k
113.896 352.233 50.513 50.91 re
f
0 0 0 .145 k
164.409 352.233 35.83 50.91 re
f
0 0 0 .065 k
200.239 352.233 50.513 50.91 re
f
0 0 0 .145 k
250.753 352.233 50.513 50.91 re
f
0 0 0 .065 k
301.266 352.233 57.373 50.91 re
f
0 0 0 .145 k
358.639 352.233 59.811 50.91 re
f
0 0 0 .065 k
418.45 352.233 59.754 50.91 re
f
0 0 0 .145 k
478.205 352.233 83.679 50.91 re
f
0 0 0 .065 k
35.887 301.323 50.513 50.91 re
f
0 0 0 .145 k
86.4 301.323 27.496 50.91 re
f
0 0 0 .065 k
113.896 301.323 50.513 50.91 re
f
0 0 0 .145 k
164.409 301.323 35.83 50.91 re
f
0 0 0 .065 k
200.239 301.323 50.513 50.91 re
f
0 0 0 .145 k
250.753 301.323 50.513 50.91 re
f
0 0 0 .065 k
301.266 301.323 57.373 50.91 re
f
0 0 0 .145 k
358.639 301.323 59.811 50.91 re
f
0 0 0 .065 k
418.45 301.323 59.754 50.91 re
f
0 0 0 .145 k
478.205 301.323 83.679 50.91 re
f
0 0 0 .065 k
35.887 277.342 50.513 23.981 re
f
0 0 0 .145 k
86.4 277.342 27.496 23.981 re
f
0 0 0 .065 k
113.896 277.342 50.513 23.981 re
f
0 0 0 .145 k
164.409 277.342 35.83 23.981 re
f
0 0 0 .065 k
200.239 277.342 50.513 23.981 re
f
0 0 0 .145 k
250.753 277.342 50.513 23.981 re
f
0 0 0 .065 k
301.266 277.342 57.373 23.981 re
f
0 0 0 .145 k
358.639 277.342 59.811 23.981 re
f
0 0 0 .065 k
418.45 277.342 59.754 23.981 re
f
0 0 0 .145 k
478.205 277.342 83.679 23.981 re
f
0 0 0 .065 k
35.887 217.474 50.513 59.868 re
f
0 0 0 .145 k
86.4 217.474 27.496 59.868 re
f
0 0 0 .065 k
113.896 217.474 50.513 59.868 re
f
0 0 0 .145 k
164.409 217.474 35.83 59.868 re
f
0 0 0 .065 k
200.239 217.474 50.513 59.868 re
f
0 0 0 .145 k
250.753 217.474 50.513 59.868 re
f
0 0 0 .065 k
301.266 217.474 57.373 59.868 re
f
0 0 0 .145 k
358.639 217.474 59.811 59.868 re
f
0 0 0 .065 k
418.45 217.474 59.754 59.868 re
f
0 0 0 .145 k
478.205 217.474 83.679 59.868 re
f
0 0 0 .065 k
35.887 184.479 50.513 32.995 re
f
0 0 0 .145 k
86.4 184.479 27.496 32.995 re
f
0 0 0 .065 k
113.896 184.479 50.513 32.995 re
f
0 0 0 .145 k
164.409 184.479 35.83 32.995 re
f
0 0 0 .065 k
200.239 184.479 50.513 32.995 re
f
0 0 0 .145 k
250.753 184.479 50.513 32.995 re
f
0 0 0 .065 k
301.266 184.479 57.373 32.995 re
f
0 0 0 .145 k
358.639 184.479 59.811 32.995 re
f
0 0 0 .065 k
418.45 184.479 59.754 32.995 re
f
0 0 0 .145 k
478.205 184.479 83.679 32.995 re
f
0 0 0 .065 k
35.887 142.526 50.513 41.953 re
f
0 0 0 .145 k
86.4 142.526 27.496 41.953 re
f
0 0 0 .065 k
113.896 142.526 50.513 41.953 re
f
0 0 0 .145 k
164.409 142.526 35.83 41.953 re
f
0 0 0 .065 k
200.239 142.526 50.513 41.953 re
f
0 0 0 .145 k
250.753 142.526 50.513 41.953 re
f
0 0 0 .065 k
301.266 142.526 57.373 41.953 re
f
0 0 0 .145 k
358.639 142.526 59.811 41.953 re
f
0 0 0 .065 k
418.45 142.526 59.754 41.953 re
f
0 0 0 .145 k
478.205 142.526 83.679 41.953 re
f
0 0 0 .845 k
35.887 684.34 525.997 1.0771 re
f
0 0 0 .695 k
35.887 679.124 525.997 5.2157 re
f
0 0 0 1 k
q 1 0 0 1 35.887 142.526 cm 0 0 m
525.997 0 l
0 0 l
f
Q
0 0 0 .345 k
35.887 670.677 128.523 .45355 re
f
164.409 665.801 .45355 18.482 re
f
164.863 670.677 136.403 .45355 re
f
301.266 665.801 .51025 18.482 re
f
358.639 665.801 .51022 18.482 re
f
359.15 670.677 119.055 .45355 re
f
478.205 665.801 .51025 18.482 re
f
86.4 649.02 .45354 21.94 re
f
113.896 649.02 .45355 21.94 re
f
164.409 649.02 .45355 21.94 re
f
200.239 649.02 .51024 21.94 re
f
250.753 649.02 .51022 21.94 re
f
301.266 649.02 .51025 21.94 re
f
358.639 649.02 .51022 21.94 re
f
418.45 649.02 .45355 21.94 re
f
478.205 649.02 .51025 21.94 re
f
35.887 648.51 525.997 .51025 re
f
0 0 0 1 k
35.887 625.039 50.513 .51025 re
f
86.4 625.039 .45354 23.981 re
f
86.854 625.039 27.043 .51025 re
f
113.896 625.039 .45355 23.981 re
f
114.35 625.039 50.06 .51025 re
f
164.409 625.039 .45355 23.981 re
f
164.863 625.039 35.376 .51025 re
f
200.239 625.039 .51024 23.981 re
f
200.75 625.039 50.003 .51025 re
f
250.753 625.039 .51022 23.981 re
f
251.263 625.039 50.003 .51025 re
f
301.266 625.039 .51025 23.981 re
f
301.776 625.039 56.863 .51025 re
f
358.639 625.039 .51022 23.981 re
f
359.15 625.039 59.301 .51025 re
f
418.45 625.039 .45355 23.981 re
f
418.904 625.039 59.301 .51025 re
f
478.205 625.039 .51025 23.981 re
f
478.715 625.039 83.168 .51025 re
f
35.887 592.044 50.513 .51025 re
f
86.4 592.044 .45354 32.995 re
f
86.854 592.044 27.043 .51025 re
f
113.896 592.044 .45355 32.995 re
f
114.35 592.044 50.06 .51025 re
f
164.409 592.044 .45355 32.995 re
f
164.863 592.044 35.376 .51025 re
f
200.239 592.044 .51024 32.995 re
f
200.75 592.044 50.003 .51025 re
f
250.753 592.044 .51022 32.995 re
f
251.263 592.044 50.003 .51025 re
f
301.266 592.044 .51025 32.995 re
f
301.776 592.044 56.863 .51025 re
f
358.639 592.044 .51022 32.995 re
f
359.15 592.044 59.301 .51025 re
f
418.45 592.044 .45355 32.995 re
f
418.904 592.044 59.301 .51025 re
f
478.205 592.044 .51025 32.995 re
f
478.715 592.044 83.168 .51025 re
f
35.887 568.063 50.513 .45349 re
f
86.4 568.063 .45354 23.981 re
f
86.854 568.063 27.043 .45349 re
f
113.896 568.063 .45355 23.981 re
f
114.35 568.063 50.06 .45349 re
f
164.409 568.063 .45355 23.981 re
f
164.863 568.063 35.376 .45349 re
f
200.239 568.063 .51024 23.981 re
f
200.75 568.063 50.003 .45349 re
f
250.753 568.063 .51022 23.981 re
f
251.263 568.063 50.003 .45349 re
f
301.266 568.063 .51025 23.981 re
f
301.776 568.063 56.863 .45349 re
f
358.639 568.063 .51022 23.981 re
f
359.15 568.063 59.301 .45349 re
f
418.45 568.063 .45355 23.981 re
f
418.904 568.063 59.301 .45349 re
f
478.205 568.063 .51025 23.981 re
f
478.715 568.063 83.168 .45349 re
f
35.887 526.11 50.513 .51025 re
f
86.4 526.11 .45354 41.953 re
f
86.854 526.11 27.043 .51025 re
f
113.896 526.11 .45355 41.953 re
f
114.35 526.11 50.06 .51025 re
f
164.409 526.11 .45355 41.953 re
f
164.863 526.11 35.376 .51025 re
f
200.239 526.11 .51024 41.953 re
f
200.75 526.11 50.003 .51025 re
f
250.753 526.11 .51022 41.953 re
f
251.263 526.11 50.003 .51025 re
f
301.266 526.11 .51025 41.953 re
f
301.776 526.11 56.863 .51025 re
f
358.639 526.11 .51022 41.953 re
f
359.15 526.11 59.301 .51025 re
f
418.45 526.11 .45355 41.953 re
f
418.904 526.11 59.301 .51025 re
f
478.205 526.11 .51025 41.953 re
f
478.715 526.11 83.168 .51025 re
f
35.887 502.072 50.513 .51022 re
f
86.4 502.072 .45354 24.038 re
f
86.854 502.072 27.043 .51022 re
f
113.896 502.072 .45355 24.038 re
f
114.35 502.072 50.06 .51022 re
f
164.409 502.072 .45355 24.038 re
f
164.863 502.072 35.376 .51022 re
f
200.239 502.072 .51024 24.038 re
f
200.75 502.072 50.003 .51022 re
f
250.753 502.072 .51022 24.038 re
f
251.263 502.072 50.003 .51022 re
f
301.266 502.072 .51025 24.038 re
f
301.776 502.072 56.863 .51022 re
f
358.639 502.072 .51022 24.038 re
f
359.15 502.072 59.301 .51022 re
f
418.45 502.072 .45355 24.038 re
f
418.904 502.072 59.301 .51022 re
f
478.205 502.072 .51025 24.038 re
f
478.715 502.072 83.168 .51022 re
f
35.887 469.134 50.513 .45352 re
f
86.4 469.134 .45354 32.939 re
f
86.854 469.134 27.043 .45352 re
f
113.896 469.134 .45355 32.939 re
f
114.35 469.134 50.06 .45352 re
f
164.409 469.134 .45355 32.939 re
f
164.863 469.134 35.376 .45352 re
f
200.239 469.134 .51024 32.939 re
f
200.75 469.134 50.003 .45352 re
f
250.753 469.134 .51022 32.939 re
f
251.263 469.134 50.003 .45352 re
f
301.266 469.134 .51025 32.939 re
f
301.776 469.134 56.863 .45352 re
f
358.639 469.134 .51022 32.939 re
f
359.15 469.134 59.301 .45352 re
f
418.45 469.134 .45355 32.939 re
f
418.904 469.134 59.301 .45352 re
f
478.205 469.134 .51025 32.939 re
f
478.715 469.134 83.168 .45352 re
f
35.887 445.096 50.513 .51025 re
f
86.4 445.096 .45354 24.038 re
f
86.854 445.096 27.043 .51025 re
f
113.896 445.096 .45355 24.038 re
f
114.35 445.096 50.06 .51025 re
f
164.409 445.096 .45355 24.038 re
f
164.863 445.096 35.376 .51025 re
f
200.239 445.096 .51024 24.038 re
f
200.75 445.096 50.003 .51025 re
f
250.753 445.096 .51022 24.038 re
f
251.263 445.096 50.003 .51025 re
f
301.266 445.096 .51025 24.038 re
f
301.776 445.096 56.863 .51025 re
f
358.639 445.096 .51022 24.038 re
f
359.15 445.096 59.301 .51025 re
f
418.45 445.096 .45355 24.038 re
f
418.904 445.096 59.301 .51025 re
f
478.205 445.096 .51025 24.038 re
f
478.715 445.096 83.168 .51025 re
f
35.887 403.143 50.513 .51022 re
f
86.4 403.143 .45354 41.953 re
f
86.854 403.143 27.043 .51022 re
f
113.896 403.143 .45355 41.953 re
f
114.35 403.143 50.06 .51022 re
f
164.409 403.143 .45355 41.953 re
f
164.863 403.143 35.376 .51022 re
f
200.239 403.143 .51024 41.953 re
f
200.75 403.143 50.003 .51022 re
f
250.753 403.143 .51022 41.953 re
f
251.263 403.143 50.003 .51022 re
f
301.266 403.143 .51025 41.953 re
f
301.776 403.143 56.863 .51022 re
f
358.639 403.143 .51022 41.953 re
f
359.15 403.143 59.301 .51022 re
f
418.45 403.143 .45355 41.953 re
f
418.904 403.143 59.301 .51022 re
f
478.205 403.143 .51025 41.953 re
f
478.715 403.143 83.168 .51022 re
f
35.887 352.233 50.513 .51022 re
f
86.4 352.233 .45354 50.91 re
f
86.854 352.233 27.043 .51022 re
f
113.896 352.233 .45355 50.91 re
f
114.35 352.233 50.06 .51022 re
f
164.409 352.233 .45355 50.91 re
f
164.863 352.233 35.376 .51022 re
f
200.239 352.233 .51024 50.91 re
f
200.75 352.233 50.003 .51022 re
f
250.753 352.233 .51022 50.91 re
f
251.263 352.233 50.003 .51022 re
f
301.266 352.233 .51025 50.91 re
f
301.776 352.233 56.863 .51022 re
f
358.639 352.233 .51022 50.91 re
f
359.15 352.233 59.301 .51022 re
f
418.45 352.233 .45355 50.91 re
f
418.904 352.233 59.301 .51022 re
f
478.205 352.233 .51025 50.91 re
f
478.715 352.233 83.168 .51022 re
f
35.887 301.323 50.513 .51025 re
f
86.4 301.323 .45354 50.91 re
f
86.854 301.323 27.043 .51025 re
f
113.896 301.323 .45355 50.91 re
f
114.35 301.323 50.06 .51025 re
f
164.409 301.323 .45355 50.91 re
f
164.863 301.323 35.376 .51025 re
f
200.239 301.323 .51024 50.91 re
f
200.75 301.323 50.003 .51025 re
f
250.753 301.323 .51022 50.91 re
f
251.263 301.323 50.003 .51025 re
f
301.266 301.323 .51025 50.91 re
f
301.776 301.323 56.863 .51025 re
f
358.639 301.323 .51022 50.91 re
f
359.15 301.323 59.301 .51025 re
f
418.45 301.323 .45355 50.91 re
f
418.904 301.323 59.301 .51025 re
f
478.205 301.323 .51025 50.91 re
f
478.715 301.323 83.168 .51025 re
f
35.887 277.342 50.513 .51025 re
f
86.4 277.342 .45354 23.981 re
f
86.854 277.342 27.043 .51025 re
f
113.896 277.342 .45355 23.981 re
f
114.35 277.342 50.06 .51025 re
f
164.409 277.342 .45355 23.981 re
f
164.863 277.342 35.376 .51025 re
f
200.239 277.342 .51024 23.981 re
f
200.75 277.342 50.003 .51025 re
f
250.753 277.342 .51022 23.981 re
f
251.263 277.342 50.003 .51025 re
f
301.266 277.342 .51025 23.981 re
f
301.776 277.342 56.863 .51025 re
f
358.639 277.342 .51022 23.981 re
f
359.15 277.342 59.301 .51025 re
f
418.45 277.342 .45355 23.981 re
f
418.904 277.342 59.301 .51025 re
f
478.205 277.342 .51025 23.981 re
f
478.715 277.342 83.168 .51025 re
f
35.887 217.474 50.513 .51022 re
f
86.4 217.474 .45354 59.868 re
f
86.854 217.474 27.043 .51022 re
f
113.896 217.474 .45355 59.868 re
f
114.35 217.474 50.06 .51022 re
f
164.409 217.474 .45355 59.868 re
f
164.863 217.474 35.376 .51022 re
f
200.239 217.474 .51024 59.868 re
f
200.75 217.474 50.003 .51022 re
f
250.753 217.474 .51022 59.868 re
f
251.263 217.474 50.003 .51022 re
f
301.266 217.474 .51025 59.868 re
f
301.776 217.474 56.863 .51022 re
f
358.639 217.474 .51022 59.868 re
f
359.15 217.474 59.301 .51022 re
f
418.45 217.474 .45355 59.868 re
f
418.904 217.474 59.301 .51022 re
f
478.205 217.474 .51025 59.868 re
f
478.715 217.474 83.168 .51022 re
f
35.887 184.479 50.513 .51022 re
f
86.4 184.479 .45354 32.995 re
f
86.854 184.479 27.043 .51022 re
f
113.896 184.479 .45355 32.995 re
f
114.35 184.479 50.06 .51022 re
f
164.409 184.479 .45355 32.995 re
f
164.863 184.479 35.376 .51022 re
f
200.239 184.479 .51024 32.995 re
f
200.75 184.479 50.003 .51022 re
f
250.753 184.479 .51022 32.995 re
f
251.263 184.479 50.003 .51022 re
f
301.266 184.479 .51025 32.995 re
f
301.776 184.479 56.863 .51022 re
f
358.639 184.479 .51022 32.995 re
f
359.15 184.479 59.301 .51022 re
f
418.45 184.479 .45355 32.995 re
f
418.904 184.479 59.301 .51022 re
f
478.205 184.479 .51025 32.995 re
f
478.715 184.479 83.168 .51022 re
f
35.887 142.526 50.513 .51024 re
f
86.4 142.526 .45354 41.953 re
f
86.854 142.526 27.043 .51024 re
f
113.896 142.526 .45355 41.953 re
f
114.35 142.526 50.06 .51024 re
f
164.409 142.526 .45355 41.953 re
f
164.863 142.526 35.376 .51024 re
f
200.239 142.526 .51024 41.953 re
f
200.75 142.526 50.003 .51024 re
f
250.753 142.526 .51022 41.953 re
f
251.263 142.526 50.003 .51024 re
f
301.266 142.526 .51025 41.953 re
f
301.776 142.526 56.863 .51024 re
f
358.639 142.526 .51022 41.953 re
f
359.15 142.526 59.301 .51024 re
f
418.45 142.526 .45355 41.953 re
f
418.904 142.526 59.301 .51024 re
f
478.205 142.526 .51025 41.953 re
f
478.715 142.526 83.168 .51024 re
f
0 0 0 .845 k
35.887 688.365 525.997 11.962 re
f
35.887 685.417 525.997 9.9213 re
f
0 0 0 .065 k
35.887 130.564 525.997 11.962 re
f
35.887 100.346 525.997 39.855 re
f
35.887 88.894 525.997 11.962 re
f
35.887 130.224 3.9685 9.978 re
f
557.915 130.224 3.9685 9.978 re
f
35.887 120.302 3.9685 9.9212 re
f
557.915 120.302 3.9685 9.9212 re
f
35.887 110.324 3.9685 9.978 re
f
557.915 110.324 3.9685 9.978 re
f
35.887 100.346 3.9685 9.9779 re
f
557.915 100.346 3.9685 9.9779 re
f
BT
/F14 1 Tf
9.9626 0 0 9.9626 40.3653 687.9116 Tm
0 0 0 0 k
0 Tc
0 Tw
[(Table)-337.4(4.)-335.7(Metho)-7.4(dology)-337.4(and)-339(Findings)-341.7(Pertaini)-9.1(ng)-334.3(to)-337.1(Cost)]TJ
7.9702 0 0 7.9702 65.3669 674.8156 Tm
[(LITERATUR)11.8(E)-333.6(SOURCE)-9016.6(METHODOL)10.8(OGY)-17967.4(FINDINGS)]TJ
-2.9662 -2.9235 TD
[(REFERENCE)-1385.7(DATE)-1791.3(COUNTRY)-1819(DESIGN)-2097.8(SIZE)-326.8(\()]TJ
/F15 1 Tf
23.8219 0 TD
(N)Tj
/F14 1 Tf
.6686 0 TD
(\))Tj
2.7386 1.2519 TD
(DURATION)Tj
-.0569 -1.2519 TD
[(\()-86.7(MONTHS)12.2(\))-1658.7(TECHNOLOG)11.7(Y)-1514.7(COST)-328.8(BENEFIT)]TJ
22.5629 1.2519 TD
(COST-)Tj
-1.9774 -1.2519 TD
[(EFFECTIVEN)11.2(ESS)-3184.5(COMMENTS)]TJ
/F16 1 Tf
6.9738 0 0 6.9738 39.8551 639.0991 Tm
0 0 0 1 k
(Henderson)Tj
0 -1.2844 TD
[(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 53.2913 633.2597 Tm
(162)Tj
6.9738 0 0 6.9738 94.2803 639.0991 Tm
[(2013)-1539(United)-259.5(Kingdom)-2117.8(CRCT)-4496.9(965)-6180.3(12)-5513(T,)-330.4(HTM)-6749.1()-4764.5(Neutral)-5738.5(Neutral)-340.5(to)-339(equivocal)]TJ
55.6947 -1.2844 TD
[(findings)-341.6(for)-335.9(QALY)-339.9(and)-338.1(cost)]TJ
-63.4989 -2.1543 TD
(Andrade)Tj
0 -1.2844 TD
[(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 53.2913 609.2219 Tm
(163)Tj
6.9738 0 0 6.9738 94.2803 615.1179 Tm
[(2011)-1539(Brazil)-6200.2(CBA)-3784.5(82)-334.6(towns)-5090.2(18)-6049.6(ECG)-7293()-4764.5(HTM,)-335(28.92R$)]TJ
47.1263 -1.2844 TD
[(\(versus)-340.1(3155R$\))]TJ
8.5684 1.2844 TD
[(Cost)-338.3(calculation:)-349.6(travel,)]TJ
0 -1.2844 TD
[(food,)-340.3(lost)-331.3(wages)-12.4(,)-333.3(ECG)]TJ
T*
(charges)Tj
-63.4989 -2.1624 TD
[(Alkmim)-342.1(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 75.6283 585.2408 Tm
(164)Tj
6.9738 0 0 6.9738 94.2803 582.1227 Tm
[(2012)-1539(Brazil)-6200.2(OS)-3481.8(825,349)-337.2(ECGs)-4235.3(60)-6049.6(ECG)-4146.9(Cost)-248.8(\($9M\);)-246.1(savings)]TJ
38.5497 -1.2845 TD
[(\($20)-9.9(M\))]TJ
11.7145 1.2845 TD
4.7645 Tc
(2)Tj
/F9 1 Tf
6.0808 0 TD
0 Tc
()Tj
/F16 1 Tf
1.0487 0 TD
[(health)-343.8(system)-336.7(cost)]TJ
-1.6991 -1.2845 TD
(benefit)Tj
-63.4989 -2.1543 TD
[(Sohn)-339.3(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 69.1653 561.203 Tm
(165)Tj
6.9738 0 0 6.9738 94.2803 558.1416 Tm
[(2012)-1539(Germany)-4855.2(PCC)-4610.6(1,124)-5847.6(12)-4781.4(Cell)-332.4(p)-8.8(hone)-2866(25%)-285.3(cost)-289.7(reduction)-4195.7()-4764.5(Decreasing)-340.8(inten)-10.4(sity)-334.6(of)]TJ
55.6947 -1.2845 TD
[(nurse)-324.9(calls;)-324.5(QoL)-328.1(up,)-321.7(hospital)]TJ
0 -1.2926 TD
[(stays/m)-11.3(ortality)-339.9(down,)-339.3(NYHA)]TJ
0 -1.2844 TD
[(Class)-341.3(IIIV)-336.4(gains)]TJ
-63.4989 -2.1543 TD
[(Smith)-342(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 71.2063 519.3069 Tm
(166)Tj
6.9738 0 0 6.9738 94.2803 516.1888 Tm
[(2008)-1539(United)-340.8(States)-3099.5(RCT)-4683.6(1,069)-5847.6(18)-6643(T)-7874.5()-4764.5(Telemedicine)]TJ
47.1263 -1.2844 TD
[(effective)-341.6(but)-331.5(costly)]TJ
13.4217 1.2844 TD
()Tj
-68.3522 -3.4469 TD
[(Elliot)-335.5(et)-342.2(al.)]TJ
5.2302 0 0 4.6485 68.8819 495.2692 Tm
(167)Tj
6.9738 0 0 6.9738 94.2803 492.1511 Tm
[(2008)-1539(United)-259.5(Kingdom)-2117.8(RCT)-5016.9(500)-6659.9(1)-6642.4(T)-7874.5()-4764.5(Lower)-340.6(costs)-329.3(aft)-10.2(er)-334.1(2)]TJ
47.1263 -1.2844 TD
(months)Tj
8.5684 1.2844 TD
[(Pharm)-10.7(acy/medications)]TJ
0 -1.2844 TD
[(compliance)-14.1(,)-333.3(fewer)-335.5(adverse)]TJ
T*
(events)Tj
-63.4989 -2.1543 TD
(Salvador)Tj
0 -1.2845 TD
[(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 53.2913 453.3164 Tm
(168)Tj
6.9738 0 0 6.9738 94.2803 459.2125 Tm
[(2008)-1539(Spain)-6198.2(NRP)-4828.9(108)-6180.3(12)-5317.9(Internet)]TJ
31.5015 -1.2845 TD
[(m)-8.9(onitoring)]TJ
10.1943 1.2845 TD
[()-4764.5(Hospital)-342.2(visits)]TJ
5.4305 -1.2845 TD
[(lower,)-336.9(QoL)-336.2(higher)]TJ
8.5684 1.2845 TD
[(Reduced)-342.4(oral)-332.5(anti)-10.7(coagulant)]TJ
0 -1.2845 TD
[(therap)-10.7(y)-329(manageme)-14.3(nt)-334.3(costs)]TJ
-63.4989 -2.1624 TD
[(Datta)-340.7(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 70.2425 438.2928 Tm
(169)Tj
6.9738 0 0 6.9738 94.2803 435.1747 Tm
[(2010)-1539(United)-340.8(States)-3099.5(RCT)-5016.9(588)-6180.3(24)-6643(T)-7874.5()-4764.5(No)-329.7(sig)-9.2(nificant)]TJ
47.1263 -1.2844 TD
(differences)Tj
8.5684 1.2844 TD
[(Called)-341.3(for)-335.9(1)-333.9(week,)-342.1(then)]TJ
0 -1.2844 TD
[(every)-337.6(2)-333.9(months)-338.7(for)-335.9(24)]TJ
T*
[(months;)-343.6(nurse)-333(BP)]TJ
T*
[(manageme)-14.3(nt)]TJ
-63.4989 -2.1624 TD
(Wennberg)Tj
0 -1.2844 TD
[(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 53.2913 387.3826 Tm
(170)Tj
6.9738 0 0 6.9738 94.2803 393.2219 Tm
[(2010)-1539(United)-340.8(States)-3099.5(RCT)-4204(174,120)-5369.3(12)-6643(T)-7874.5()-4764.5(10.1%)-334.7(admission)]TJ
47.1263 -1.2844 TD
[(cost)-338.5(reduction)]TJ
8.5684 1.2844 TD
[(Lower)-340.6(medications/)-13.1(scripts)]TJ
0 -1.2844 TD
[($)-333.6(cost)-338.5(\(3.6%\);)-339.2(telehealt)-12.6(h)]TJ
T*
[(coachin)-11.3(g)-333.9(\(costs,)-337.6(self-care,)]TJ
T*
[(behavi)-10.7(or,)-330.9(etc.\);)-339.6(program)]TJ
T*
(cost)Tj
/F9 1 Tf
2.073 0 TD
(<)Tj
/F16 1 Tf
.7235 0 TD
[($2.00/person/)-14.4(month)]TJ
-66.2954 -2.1624 TD
[(Minetak)-11.1(i)]TJ
0 -1.2845 TD
[(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 53.2913 336.4724 Tm
(171)Tj
6.9738 0 0 6.9738 94.2803 342.3117 Tm
[(2011)-1539(Japan)-6094.2(CBA)-4881.9(408)-6180.3(48)-5513(T,)-330.4(HTM)-6749.1()-7902.4()-4764.5(Freque)-9.8(ncy/duration)-342(of)]TJ
55.6947 -1.2845 TD
[(teleme)-10.8(dicine)-337.2(decreased)-342.7(use)]TJ
T*
[(of)-339(output)-336.5(services,)-341.7(travel,)]TJ
T*
[(worsenin)-10.6(g)-334(patient)]TJ
T*
[(sympto)-10(ms)]TJ
-63.4989 -2.1543 TD
[(Brunetti)-248.4(et)-244.7(al.)]TJ
5.2302 0 0 4.6485 76.0252 294.5196 Tm
(172)Tj
6.9738 0 0 6.9738 94.2803 291.4582 Tm
[(2014)-1539(Italy)-6657.2(CA)-4589(109,750)-5369.3(12)-3976.6(ICD/ECG)-340(tria)-11.7(ge)-5207.3()-7902.4()-4764.5(Cost)-338.3(savings)-341.4(of)]TJ
/F19 1 Tf
62.0031 0 TD
(e)Tj
/F16 1 Tf
.5203 0 TD
[(8)-8.8(.10)]TJ
-6.8287 -1.2926 TD
(38.50/case)Tj
-63.4989 -2.1543 TD
[(Calo)-335.9(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 67.2945 270.5385 Tm
(173)Tj
6.9738 0 0 6.9738 94.2803 267.4204 Tm
[(2013)-1539(Italy)-6657.2(RCT)-5016.9(233)-6180.3(12)-5513(T,)-330.4(HTM)-6749.1()-7902.4()-4764.5(HTM,)-343.2(hospital)-337.7(visits/LOS)]TJ
55.6947 -1.2845 TD
[(shorte)-9.5(r)-330.2(\(47)-334.7(minute)-11.2(s)-332.3(versus)]TJ
T*
[(86)-334.6(minute)-11.2(s\);)-329.2(HTM)-343.2(savings:)]TJ
T*
[($51/pati)-12.5(ent/year)-338.4(for)]TJ
0 -1.2926 TD
[(hospita)-11(ls,)-333.8($190/pat)-11.6(ient/year)]TJ
0 -1.2844 TD
[(for)-335.9(patient)-12.2(s)]TJ
-63.4989 -2.1543 TD
(Zanaboni)Tj
0 -1.2845 TD
[(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 53.2913 201.6566 Tm
(174)Tj
6.9738 0 0 6.9738 94.2803 207.5527 Tm
[(2013)-1539(Italy)-6657.2(RCT)-5016.9(200)-6180.3(16)-6163.4(ICD)-7408.2()-4764.5(N)0(o)-329.7(health)-343.8(system)]TJ
47.1263 -1.2845 TD
[(cost)-338.5(savings)]TJ
8.5684 1.2845 TD
[(Signifi)-11.5(cant)-334.9(remote)-336.3(patie)-11.2(nt)]TJ
0 -1.2845 TD
[(cost)-338.5(reduction;)-339.1(0.065)-344(QALY)]TJ
T*
(gain)Tj
-63.4989 -2.1624 TD
[(Chen)-337.4(et)-334.1(al.)]TJ
5.2302 0 0 4.6485 69.222 177.6755 Tm
(175)Tj
6.9738 0 0 6.9738 94.2803 174.5574 Tm
[(2013)-1539(Taiwan)-5637.2(QE)-5443.9(141)-5903.9(6/6)-6638.4(T)-7874.5()-4764.5(48%)-334(cost)-338.5(decrease)]TJ
47.1263 -1.2844 TD
[(\(from)-336.9($937)-335.5(to)]TJ
T*
[($492/month)-12.2(\))]TJ
8.5684 2.5689 TD
[(CHF)-334.5(te)-8.9(lemedicine)-339.1(service,)]TJ
0 -1.2844 TD
[(hospita)-11(l)-334.8(admissions/sta)-13.9(y)]TJ
T*
[(down;)-336(no)-338(difference)-342.4(in)-338.8(ER)]TJ
T*
(visits)Tj
7.9702 0 0 7.9702 45.8079 132.7181 Tm
[(BP,)-265.1(blood)-269.9(pressure)13.2(;)-273.1(CA,)-267.1(cost)-263.2(analysis;)-267.9(CBA,)-266.4(cost)-263.2(benefit)-262.4(analysis,)-263(ICD,)-267.4(implantable)-267.3(cardiac)-265.4(defibrillator;)-259.1(CHF,)-271.5(congestive)-253.5(heart)-271.1(failure;)-264.7(CRCT,)-265.5(cl)]TJ
53.5813 0 TD
[(uster)-266.8(randomized)-258.1(trial;)-267(ECG,)]TJ
-53.5813 -1.2519 TD
[(electrocardiog)9.2(ram;)-297.4(HTM,)-294.3(home)-294.8(telemonitoring;)-293.9(ICD,)-295.9(implantable)-295.7(cardiac)-293.9(defibrillator;)-294.7(NC,)-293.7(nurse)-297.4(calls)-299.2(by)-295.8(telephone;)-295.5(NRP,)-291.6(nonrandomized)-287.1(prospect)]TJ
55.8493 0 TD
[(ive)-289.7(study;)-299.9(NYHA,)-296.1(New)]TJ
-55.8493 -1.2448 TD
[(York)-422.4(Heart)-419.9(Association)11(;)-422.5(OS,)-426.1(observati)12.2(onal)-425.9(study;)-413.7(PCC,)-420.8(prospective)-417.7(case)-414.9(control;)-419.5(QE,)-422.9(quasi-experim)13.1(ental;)-424.9(QoL,)-418.5(quality)-415(of)-425.3(life;)-421.2(QALY,)-418.1(quality-adju)]TJ
56.7479 0 TD
[(st)10.6(ed)-424.2(life)-418.3(year;)-424.2(RCT,)]TJ
-56.7479 -1.2519 TD
[(randomized)-322.2(controlled)-331.2(trial;)-331(SR,)-329.1(self-reportin)11.5(g;)-334.7(T,)-331.4(telephone.)]TJ
/F11 1 Tf
11.9551 0 0 11.9551 287.5464 741.9966 Tm
[(TELEMEDICINE)-340.6(FOR)-332.7(CHRONIC)-338.8(DISEASE)-334.7(MANAGE)-7.3(MENT)]TJ
/F9 1 Tf
6.9738 0 0 6.9738 187.1432 29.7638 Tm
()Tj
/F7 1 Tf
1.3251 0 TD
.1997 Tc
[(M)-6.4(ARY)-337.1(ANN)-335.9(L)-.8(IE)-5.7(BERT,)-335.1(I)-3.7(NC.)]TJ
/F10 1 Tf
15.015 0 TD
0 Tc
()Tj
/F7 1 Tf
.9999 0 TD
.1103 Tc
[(VOL.)-327(20)-1000.8(N)5.5(O)-4.1(.)-327(9)]TJ
/F10 1 Tf
8.3814 0 TD
0 Tc
()Tj
/F8 1 Tf
1.008 0 TD
.103 Tc
[(SE)-4.8(P)-6.4(T)-8.1(E)-4.8(M)-8.4(BE)-4.8(R)-339.7(2)-6.4(0)-7.9(1)-6.5(4)]TJ
/F4 1 Tf
7.9702 0 0 7.9702 442.2613 29.7638 Tm
0 Tc
[(TELEMEDI)14.5(CINE)-328.7(and)-336(e-HEALTH)-647.9(791)]TJ
ET
q
1 i
0 792 612 -791.985 re
W n
579.685 .014984 .22681 791.985 re
f
337.039 767.962 274.961 .22675 re
f
Q
endstream
endobj
294 0 obj
<>/XObject<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]/Font<>/Properties<>>>/Thumb 297 0 R/MediaBox[0 0 612 792]/Rotate 0>>
endobj
298 0 obj
<>/ProcSet[/PDF/Text]/Font<>/Properties<>>>
endobj
295 0 obj
<>stream
/GS1 gs
BT
/F1 1 Tf
8.9663 0 0 8.9663 50.1732 693.8644 Tm
0 0 0 1 k
0 Tc
0 Tw
[(in)-324.1(the)-325(augmented)-324.5(disease)-325(management)-330.3(group)-327.1(also)-320.4(received)-330.8(devices)]TJ
0 -1.3278 TD
[(for)-411.7(self-monitoring)-415.6(\(electronic)-417.5(blood)-414.8(pressure)-411.3(monitor,)-416.1(pulse)-412.1(oxi-)]TJ
0 -1.3341 TD
[(meter,)-238(and)-232.1(a)-241.8(wristwatch)-239.5(activity)-237.1(monitor\).)-236.3(However,)-243.2(data)-239.7(for)-234.6(the)-236.5(two)]TJ
T*
[(intervention)-434.2(groups)-441.6(\(disease)-436(management)-437.8(and)-434.4(augmented)-444.7(disease)]TJ
T*
[(management\))-485.5(were)-493.6(combined)-488.8(in)-488.5(a)-488.4(pooled)-492.6(analysis)-488.7(because)-489.8(their)]TJ
T*
[(outcomes)-224.4(were)-228.1(similar.)-230.2(Of)-224.4(the)-230.1(original)-228.6(sample,)-223.4(30%)-228.2(did)-228.1(not)-228.3(complete)]TJ
T*
[(the)-268.1(study,)-271.4(missed)-271.9(one)-264.1(or)-270.5(more)-267.1(visits,)-271.6(were)-272.3(lost)-272.4(to)-268.2(follow-up,)-269.4(or)-270.4(died.)]TJ
T*
[(An)-461.9()55.6(intent-to-treat)45.2()-469.2(methodology)-472.2(was)-466.6(used)-465.5(to)-470.5(estimate)-467.9(cost)-466.8(and)]TJ
T*
[(survival)-306.3(data)-302.9(for)-304.2(the)-299.7(entire)-306.9(sample.)-305.6(The)-306.7(resulting)-304.1(difference)-309.3(in)-298.8(total)]TJ
0 -1.3278 TD
[(costs)-202(between)-199(the)-198.5(two)-201.5(disease)-204.8(management)-197.5(groups)-201.3(and)-200.5(the)-198.5(usual)-201(care)]TJ
0 -1.3341 TD
[(group)-352.4(could)-346.6(be)-354.5(almost)-350.9(entirely)-353.2(attributed)-348.1(to)-350.4(the)-350.3(costs)-353.7(of)-348.4(the)-350.3(inter-)]TJ
T*
[(vention)-458(itself.)-466.2(At)-461.6(the)-457.8(same)-466.8(time,)-460.8(the)-457.8(analysis)-463.4(showed)-466.8(significant)]TJ
T*
[(survival)-331.6(advantage)-339.4(among)-332.7(the)-331.3(combined)-337.1(intervention)-339.3(groups)-334.1(\(79.4)]TJ
T*
[(days\))-337.9(compared)-343.4(with)-335.7(all)-337.4(patients)-341.4(\(17.4)-341.7(days\).)-339.1(Even)-342.7(those)-336.8(in)-336.7(the)-344(in-)]TJ
T*
[(tervention)-223.9(groups)-226.6(who)-225.4(were)-228.1(acutely)-223(ill)-225.6(\(NYHA)-223.8(Classes)-227.5(III)-219.5(and)-225.7(IV\))-224.2(had)]TJ
T*
[(survival)-350.6(of)-354.7(47.7)-357.1(days.)-354.6(There)-353(was)-352.8(also)-352(evidence)-354.1(that)-354(patients)-354(in)-355.7(the)]TJ
T*
[(non-augmented)-210.4(disease)-211.1(management)-216.4(group)-213.3(received)-210.6(more)-210.2(care,)-215.4(with)]TJ
0 -1.3278 TD
[(higher)-287.8(costs)-290.5(for)-291.5(emergency)-294.7(room)-288.9(visits,)-290.6(hospital)-291.4(admissions,)-292.6(outpa-)]TJ
0 -1.3341 TD
[(tient)-302.7(visits,)-309.5(and)-307.9(drugs.)-311.6(The)-306.7(authors)-307.7(concluded)-309.1(that)-309.8(although)-305.4(the)-312.3(in-)]TJ
T*
[(vention)-281(was)-283.3(effective,)-284.9(it)-279.6(was)-283.3(also)-276.1(costly)-285.5(to)-280.8(implement.)]TJ
1.1065 -1.3341 TD
[(An)-335.4(RCT)-332(\()]TJ
/F5 1 Tf
3.8759 0 TD
(n)Tj
/F9 1 Tf
.7082 0 TD
(=)Tj
/F1 1 Tf
.7145 0 TD
[(500\))-334.1(conducted)-341.4(in)-330.4(the)-331.3(United)-334.9(Kingdom)-338.8(assessed)-335.5(the)]TJ
-6.4051 -1.3341 TD
[(cost-effectiveness)-390.2(of)-392.6(a)-380.9(telephonic)-394.2(pharmacy)-391.5(intervention)-389.9(on)-382.3(com-)]TJ
T*
[(pliance)-388.4(with)-392.6(prescribed)-397.7(medications.)]TJ
6.7246 0 0 5.9768 189.8645 434.8345 Tm
(167)Tj
8.9663 0 0 8.9663 203.8676 430.866 Tm
[(After)-396.2(a)-387.2(4-week)-395.4(follow-up,)]TJ
-17.1414 -1.3341 TD
[(patients)-404.6(receiving)-406.3(telephone)-409.6(calls)-409.6(from)-406.4(the)-400.9(pharmacist)-407.8(were)-411.4(more)]TJ
T*
[(likely)-225.5(to)-223.9(comply)-229.5(with)-221.9(their)-227.4(medication)-227.7(regimen)-226.4(and)-225.7(also)-225.6(experienced)]TJ
0 -1.3278 TD
[(fewer)-331.3(medication-related)-339.1(adverse)-331.9(events.)-335.3(After)-332.9(2)-333.6(months,)-335.3(the)-331.3(same)]TJ
0 -1.3341 TD
[(group)-282.8(had)-281(lower)-278.7(costs.)]TJ
1.1065 -1.3341 TD
[(A)-489.1(nonrandomized)-491.4(pilot)-495(study)-491.4(in)-488.5(Spain)-485(\()]TJ
/F5 1 Tf
17.8559 0 TD
(n)Tj
/F9 1 Tf
.7082 0 TD
(=)Tj
/F1 1 Tf
.7145 0 TD
[(108\))-492.2(compared)-495.1(an)]TJ
-20.3851 -1.3341 TD
[(Internet-based)-313.2(monitoring)-307.4(intervention)-314.1(with)-304.1(usual)-314.8(care)-309(for)-304.2(patients)]TJ
T*
[(on)-420.2(oral)-421(anticoagulant)-422.5(therapy)-424.7(\(typically)-421.9(prescribed)-429.3(for)-418(heart)-421.5(fail-)]TJ
T*
(ure\).)Tj
6.7246 0 0 5.9768 66.8409 339.1936 Tm
(168)Tj
8.9663 0 0 8.9663 82.4882 335.2251 Tm
[(The)-565.9(measurement)-571.6(for)-569.7(calibrating)-571.3(the)-571.6(optimal)-567.1(dose)-568.7(was)]TJ
-3.6041 -1.3341 TD
[(standardized)-363(by)-370(the)-362.9(World)-365.5(Health)-365.9(Organization)-364.5(in)-362(1983)-367(as)-362.6(the)-362.9(In-)]TJ
T*
[(ternational)-400.8(Normalized)-406.8(Ratio)-401.1(\(INR\))-399.8(to)-401(minimize)-406.6(adverse)-401.5(effects)-406.9(of)]TJ
0 -1.3278 TD
[(anticoagulant)-283.4(therapy.)-286.9(The)-281.4(INRs)-279.7(were)-285(similar)-279.5(between)-287.5(the)-280.7(interven-)]TJ
0 -1.3341 TD
[(tion)-465.8(and)-466(control)-466.3(groups.)-468.2(However,)-470.8(quality)-467.7(of)-462.2(life)-466.4(measures)-465.9(were)]TJ
T*
[(higher)-395.3(and)-390.1(outpatient)-396.7(visits)-396.8(were)-398.8(substantially)-394.3(lower)-398.9(in)-387.3(the)-394.5(inter-)]TJ
T*
[(vention)-281(group)-282.8(compared)-286.5(with)-278.8(the)-280.7(control)-283(group.)]TJ
1.1065 -1.3341 TD
[(In)-461.2(2010,)-463.1(an)-461.2(RCT)-464.8(at)-460.9(the)-457.8(Durham,)-464.6(NC)-462.9(Veterans)-461.6(Affairs)-461.2(Medical)]TJ
-1.1065 -1.3341 TD
[(Center)-243.5(\()]TJ
/F5 1 Tf
3.212 0 TD
(n)Tj
/F9 1 Tf
.7082 0 TD
(=)Tj
/F1 1 Tf
.7145 0 TD
[(588\))-245.6(evaluated)-248.3(the)-249.1(economic)-245.7(effects)-248.8(of)-240.9(telephone)-251.6(calls)-245.2(by)]TJ
-4.6347 -1.3341 TD
[(nurses)-453.2(in)-450.6(a)-450.5(program)-453.4(designed)-450.6(to)-451.6(improve)-457.3(blood)-452.7(pressure)-455.6(control)]TJ
T*
[(among)-301.1(hypertensive)-301.4(primary)-300.4(care)-302.7(patients.)]TJ
6.7246 0 0 5.9768 211.2944 219.685 Tm
(169)Tj
8.9663 0 0 8.9663 224.5039 215.6598 Tm
[(The)-306.7(nurses)-301.5(used)-301.1(edu-)]TJ
-19.443 -1.3278 TD
[(cational)-518.6(scripts)-521.7(and)-516.6(tailored)-517.6(algorithms)-526.4(to)-514.8(fit)-521.9(individual)-517.8(patient)]TJ
0 -1.3341 TD
[(needs.)-299.6(Telephone)-302.8(calls)-302.1(were)-303.9(initially)-298.1(made)-300.1(1)-302(week)-303.4(after)-300.7(randomiza-)]TJ
T*
[(tion)-244.5(and)-238.4(subsequently)-252.3(every)-247.5(2)-238.7(months)-245.5(for)-247.3(24)-243.6(months.)-246.8(Patients)-246.1(in)-241.9(the)]TJ
T*
[(control)-301.9(group)-308.1(were)-310.3(also)-301.4(contacted)-314.2(at)-302.9(6)-302(and)-307.9(24)-306.8(months)-302.4(by)-306.8(their)-309.6(pri-)]TJ
T*
[(mary)-178.2(care)-182.5(provider.)-190.5(The)-180.2(direct)-187.1(and)-181.5(indirect)-182.5(costs)-183(of)-184(the)-185.9(two)-182.5(modalities)]TJ
T*
[(were)-215.4(calculated,)-218.6(and)-219.4(the)-217.5(total)-214.2(cost)-220.2(difference)-220.8(between)-218(the)-217.5(two)-214.1(groups)]TJ
T*
[(was)-276.9(not)-285.3(statistically)-284.4(significant.)]TJ
1.1065 -1.3341 TD
[(In)-385.3(the)-381.9(same)-378.2(year,)-382.7(a)-380.9(very)-378.3(large)-384.9(U.S.-based)-384.4(RCT)-382.6(\()]TJ
/F5 1 Tf
20.5305 0 TD
(n)Tj
/F9 1 Tf
.7082 0 TD
(=)Tj
/F1 1 Tf
.7208 0 TD
[(174,120\))-387.7(in-)]TJ
-23.066 -1.3278 TD
[(vestigated)-316.9(the)-312.3(economic)-315.2(effects)-318.4(of)-310.4(a)-311.4(telephone-based)-320.9(care)-315.3(manage-)]TJ
0 -1.3341 TD
[(ment)-315(intervention)-320.4(on)-319(medical)-315.5(costs)-322.1(and)-314.3(healthcare)-319.4(resource)-324.1(use.)]TJ
6.7246 0 0 5.9768 293.6692 100.1197 Tm
(170)Tj
8.9663 0 0 8.9663 50.1732 84.189 Tm
[(Health)-239.5(coaches)-243.2(contacted)-244.6(patients)-240.2(with)-240.9(high-cost)-245.4(chronic)-240.8(conditions)]TJ
T*
[(to)-394.6(instruct)-394.8(them)-395.6(about)-397.4(shared)-397.5(decision)-398.7(making,)-395.5(self-care,)-399.4(and)-390.1(be-)]TJ
30.331 69.3307 TD
[(havioral)-231.3(change.)-227.3(Patients)-227.2(were)-228.1(randomly)-227.3(assigned)-231.1(to)-230.2(telephonic)-229.8(case)]TJ
0 -1.3278 TD
[(management)-374.5(plus)-378.5(enhanced)-371.5(support)-376.2(\(coaching\))-380.6(or)-371.6(only)-378(telephonic)]TJ
0 -1.3341 TD
[(case)-252.7(management.)-262(A)-248.8(10.1%)-259.6(reduction)-256(in)-254.5(annual)-252.2(hospital)-259.8(admissions)]TJ
T*
[(accounted)-407.7(for)-405.3(the)-400.9(majority)-402.8(of)-405.3(the)-400.9(cost)-403.6(savings)-406.2(for)-405.3(patients)-404.6(in)-400(the)]TJ
T*
[(group)-415.6(that)-417.3(received)-419.3(enhanced)-415.8(support.)-421.7(They)-412.6(also)-415.2(had)-413.8(3.6%)-419.2(lower)]TJ
T*
[(medical)-283.9(and)-282.6(prescription)-281.4(drug)-284.4(costs.)]TJ
1.1128 -1.3341 TD
[(In)-461.2(2011,)-469.4(matched)-467.1(panel)-465.2(data)-467.3(of)-462.2(medical)-467.2(expenditures)-471.7(for)-462.2(408)]TJ
-1.1128 -1.3341 TD
[(residents)-224.6(in)-222.9(Fukushima)-228.1(Prefecture,)-224.9(Japan,)-225.2(were)-221.7(analyzed)-226.8(to)-223.9(ascertain)]TJ
T*
[(the)-261.8(cost)-264.5(effects)-267.8(of)-259.8(e-health)-263.9(in)-260.9(relation)-264.3(to)-261.9(the)-261.8(duration)-266.4(and)-257.4(frequency)]TJ
0 -1.3278 TD
[(of)-392.6(the)-388.2(intervention.)]TJ
6.7246 0 0 5.9768 396.6235 590.2864 Tm
(171)Tj
8.9663 0 0 8.9663 410.6833 586.318 Tm
[(Investigators)-391.2(found)-398.3(that)-392(the)-388.2(frequency)-397.8(and)]TJ
-9.8764 -1.3341 TD
[(duration)-386.5(of)-380(e-health)-384(use)-384.8(decreased)-386.4(travel)-389.1(expenses)-381.2(and)-383.8(the)-381.9(use)-384.8(of)]TJ
T*
[(outpatient)-282.8(services)-287.5(by)-281.5(preventing)-281.5(exacerbation)-288(of)-278.8(symptoms.)]TJ
1.1128 -1.3341 TD
[(In)-189.3(the)-192.2(remainder)-190.1(of)-190.3(this)-194.5(section,)-193.5(we)-188.1(report)-192.9(on)-192.6(four)-193.1(studies)-195.6(that)-189.7(were)]TJ
-1.1128 -1.3341 TD
[(published)-263.6(in)-260.9(20132014:)-266(three)-263.8(from)-260.9(Italy)-262.1(and)-257.4(one)-264.1(from)-260.9(Taiwan.)-260.2(The)]TJ
T*
[(Italian)-361.7(studies)-366.3(focused)-366.8(on)-363.3(cost)-365.7(implications)-366.3(of)-361(ECG)-364.5(triage)-363.8(and)-364.9(im-)]TJ
T*
[(plantable)-232.6(ICDs.)-228.1(The)-224.5(first)-231.9(was)-226.4(a)-222.8(cost)-232.9(analysis)-223.1(from)-229.3(the)-230.2(perspective)-232.9(of)-221.9(a)]TJ
T*
[(regional)-283.9(healthcare)-281.4(system.)]TJ
6.7246 0 0 5.9768 424.5164 506.6077 Tm
(172)Tj
8.9663 0 0 8.9663 437.5558 502.5826 Tm
[(It)-277.5(was)-276.9(based)-279.3(on)-281.1(the)-280.7(costs)-277.8(incurred)-278.8(by)]TJ
-12.8734 -1.3278 TD
[(all)-210.9(patients)-214.9(who)-212.7(called)-213.3(the)-217.5(local)-211.4(emergency)-218.9(service)-210.9(in)-210.3(2012)-215.2(and)-213.1(had)-211.4(a)]TJ
0 -1.3341 TD
[(pre-hospital)-436(triage)-427(for)-430.6(those)-431.7(with)-424.3(suspected)-434.7(acute)-429.6(cardiac)-432.7(disease)]TJ
T*
(\()Tj
/F5 1 Tf
.2845 0 TD
(n)Tj
/F9 1 Tf
.7082 0 TD
(=)Tj
/F1 1 Tf
.7145 0 TD
[(109,750\).)-376.3(The)-376.2(pre-hospital)-379.1(ECGs)-371.5(were)-373.5(read)-375.1(by)-376.3(a)-368.3(remote)-374.3(cardi-)]TJ
-1.7072 -1.3341 TD
[(ologist.)-331.1(Cost)-329.2(savings)-330.3(were)-329.2(calculated)-337.5(by)-325.8(subtracting)-330.1(the)-331.3(cost)-327.7(of)-329.4(the)]TJ
T*
[(pre-hospital)-562.5(triage.)-554.8(The)-553.3(cost)-555.3(for)-557.1(a)-558(single)-556.4(ECG/consultation)-559.1(was)]TJ
/F19 1 Tf
T*
(e)Tj
/F1 1 Tf
.5185 0 TD
[(16.70)-330.3(\($22.70)-324(U.S.\),)-326.2(compared)-324.4(with)-323.1(a)-324(regional)-328.2(rate)-323.8(list)-321.7(of)]TJ
/F19 1 Tf
24.4507 0 TD
(e)Tj
/F1 1 Tf
.5185 0 TD
(24.80)Tj
-25.4877 -1.3341 TD
[(55.20)-197.5(\($33.8175.25)-203.8(U.S.\))-198.5(for)-190.4(emergency)-199.9(department)-199.5(charges.)-198.4(Hence,)]TJ
T*
[(the)-204.9(telemedicine)-211.7(consultation)-211.5(resulted)-209.6(in)-204(cost)-207.6(savings)-210.2(of)]TJ
/F19 1 Tf
23.1671 0 TD
(e)Tj
/F1 1 Tf
.5248 0 TD
(8.1038.50)Tj
-23.692 -1.3278 TD
[(\($11.0452.48)-286(U.S.\))-287(per)-278.7(case.)]TJ
1.1128 -1.3341 TD
[(The)-344.6(second)-341(was)-346.5(an)-341.1(RCT)-338.3(\()]TJ
/F5 1 Tf
10.6731 0 TD
(n)Tj
/F9 1 Tf
.7082 0 TD
(=)Tj
/F1 1 Tf
.7208 0 TD
[(233\))-340.4(comparing)-343.1(the)-344(costs)-347.4(of)-342(remote)]TJ
-13.2149 -1.3341 TD
[(monitoring)-301.1(of)-297.8(implantable)-306.7(defibrillators)-298.4(with)-304.1(those)-298.9(of)-297.8(conventional)]TJ
T*
[(in-hospital)-392.9(quarterly)-390.4(follow-ups)-395.3(over)-391(a)-387.2(12-month)-392.2(period.)]TJ
6.7246 0 0 5.9768 542.6644 363.118 Tm
(173)Tj
8.9663 0 0 8.9663 556.6676 359.1495 Tm
(Costs)Tj
-26.1579 -1.3341 TD
[(were)-285(calculated)-286.9(for)-285.2(patients)-284.5(and)-282.7(providers)-284.8(separately,)-285.5(excluding)-285.1(the)]TJ
T*
[(cost)-416.2(of)-417.9(the)-413.5(device.)-418.5(Patients)-416.9(in)-412.6(the)-419.8(remote)-412.3(monitoring)-421.3(group)-415.6(were)]TJ
T*
[(scheduled)-391.9(for)-380.1(one)-390.5(in-hospital)-386.5(visit)-383.4(per)-386.2(year)-387.7(unless)-387.1(more)-380.9(visits)-390.5(are)]TJ
T*
[(indicated)-245.6(by)-243.6(device)-252.9(alarms)-242.4(or)-245.2(the)-242.8(patients)-247.8(clinical)-245.3(status.)-242.9(Patients)-246.1(in)]TJ
0 -1.3278 TD
[(the)-464.1(remote)-462.8(monitoring)-459.2(group)-466.2(had)-464.4(fewer)-457.8(hospital)-468.4(admissions)-462(and)]TJ
0 -1.3341 TD
[(substantially)-274.1(shorter)-267.4(duration)-266.4(of)-266.2(follow-up)-274.4(visits)-270.3(compared)-267.5(with)-266.2(the)]TJ
T*
[(control)-200.8(group)-207(\(47)-196.5(minutes)-201.9(versus)-207(86)-199.3(minutes\).)-200.4(The)-205.5(authors)-200.2(concluded)]TJ
T*
[(that)-208.6(if)-208(the)-204.9(costs)-208.3(of)-202.9(the)-211.2(device)-208.6(and)-206.8(service)-210.9(were)-209.1(not)-203.1(charged)-207.6(to)-211.3(patients)]TJ
T*
[(or)-295.7(providers,)-292.4(patients)-297.1(could)-296(save)-293.5($190)-295.4(by)-294.1(using)-294.4(remote)-292.1(monitoring,)]TJ
T*
[(and)-282.7(hospitals)-279.5(could)-283.4(save)-287.2(an)-277.8(additional)-283.3($51)-284.3(per)-278.7(patient)-283.8(per)-278.7(year.)]TJ
1.1128 -1.3341 TD
[(Another)-323.9(cost)-327.7(analysis)-330.6(of)-323.1(implantable)-332(defibrillators)-330(was)-327.5(based)-329.9(on)]TJ
-1.1128 -1.3341 TD
[(an)-473.9(RCT)-477.4(\()]TJ
/F5 1 Tf
3.9455 0 TD
(n)Tj
/F9 1 Tf
.7082 0 TD
(=)Tj
/F1 1 Tf
.7208 0 TD
(200\).)Tj
6.7246 0 0 5.9768 388.97 219.685 Tm
(174)Tj
8.9663 0 0 8.9663 403.7668 215.6598 Tm
[(Patients)-473.8(with)-474.8(implantable)-477.4(defibrillators)-475.4(with)]TJ
-9.105 -1.3278 TD
[(wireless)-306.1(transmission)-307.8(were)-303.9(randomized)-307.1(between)-306.5(remote)-304.8(monitoring)]TJ
0 -1.3341 TD
[(and)-459.7(conventional)-461.6(care)-460.7(and)-459.7(were)-462(followed)-464.6(up)-462.8(for)-455.9(16)-458.5(months.)-461.7(No)]TJ
T*
[(significant)-237(cost)-239.2(savings)-241.8(for)-234.6(the)-236.5(healthcare)-237.2(system)-240.9(were)-240.7(observed,)-240.1(but)]TJ
T*
[(there)-213.2(was)-207.4(a)-210.2(significant)-205.4(reduction)-218.1(in)-204(cost)-213.9(for)-209.3(patients.)-209.9(Also,)-208.5(patients)-208.6(in)]TJ
T*
[(the)-362.9(remote)-361.7(arm)-363(gained)-362.5(0.065)-368.3(quality-adjusted)-364.2(life-years)-366.6(compared)]TJ
T*
[(with)-234.6(those)-229.3(in)-235.6(the)-230.2(standard)-230.7(arm.)-231.5(A)-236.1(cost)-232.9(savings)-229.2(of)]TJ
/F19 1 Tf
20.3155 0 TD
(e)Tj
/F1 1 Tf
.5185 0 TD
[(888.10)-234(\($1,210.66)]TJ
-20.834 -1.3341 TD
[(U.S.\))-280.7(was)-283.3(realized)-284.8(per)-278.7(patient)-283.8(over)-283.5(the)-280.7(16-month)-284.7(study)-282.8(period.)]TJ
1.1128 -1.3341 TD
[(Finally,)-318.3(a)-311.4(2013)-322.7(quasi-experimental)-317.2(study)-320.7(in)-311.4(Taiwan)-322.2(investigated)]TJ
-1.1128 -1.3278 TD
[(the)-198.5(clinical)-194.7(outcomes)-199.1(and)-194.1(cost-effectiveness)-200.5(of)-196.6(a)-191.2(telemedicine)-199(service)]TJ
0 -1.3341 TD
[(for)-190.4(older)-185.9(adults)-188.2(with)-190.3(cardiovascular)-191.7(diseases.)]TJ
6.7246 0 0 5.9768 486.255 100.1197 Tm
(175)Tj
8.9663 0 0 8.9663 498.444 96.1512 Tm
[(This)-188.8(study)-187.9(followed)-186.4(a)]TJ
-19.6643 -1.3341 TD
[(single)-252.9(group)-257.5(prepost)-253.7(design.)-255.4(In)-252.5(total,)-253.4(141)-254.7(consecutive)-260.5(patients)-252.8(with)]TJ
T*
[(cardiovascular)-299.2(disease)-299.7(were)-297.6(recruited.)-300.7(Of)-293.9(these,)-303.6(93)-294.1(were)-297.6(65)-294.1(years)-299.9(of)]TJ
/F11 1 Tf
11.9551 0 0 11.9551 50.1732 741.9966 Tm
[(BASHSHUR)-338.5(ET)-334.1(AL.)]TJ
7.9702 0 0 7.9702 50.1732 29.7638 Tm
[(7)-80(9)-78.2(2)-707(TELEM)12(EDICINE)-328.7(and)-331.8(e-HEALT)11.5(H)]TJ
/F8 1 Tf
6.9738 0 0 6.9738 177.4488 29.7638 Tm
.1096 Tc
[(SEPTEM)6.4(BER)-333.1(2).2(01)8.2(4)]TJ
ET
q
1 i
0 792 612 -791.985 re
W n
32.315 .014984 .22675 791.985 re
f
/Document /MC13 BDC
Q
q
1 i
0 792 32.315 -173.367 re
W n
0 0 0 .29999 k
0 618.633 32.315 173.367 re
f
EMC
Q
32.315 763.994 242.646 .22675 re
f
endstream
endobj
299 0 obj
<>stream
Adobe Illustrator CS4
2010-08-04T11:54:42+05:30
2010-08-04T11:54:42+05:30
2010-08-04T11:54:42+05:30
68
256
JPEG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application/postscript
saved
xmp.iid:11FB61F30AB7DE11AEB3E861853EAFA4
2009-10-12T14:15:50+05:30
Adobe Illustrator CS4
/
converted
from application/postscript to application/vnd.adobe.illustrator
converted
from application/postscript to application/vnd.adobe.illustrator
saved
xmp.iid:0280117407206811994CBE3149FFDB59
2010-08-04T11:54:42+05:30
Adobe Illustrator CS4
/
converted
from application/postscript to application/vnd.adobe.illustrator
xmp.iid:11FB61F30AB7DE11AEB3E861853EAFA4
xmp.did:11FB61F30AB7DE11AEB3E861853EAFA4
uuid:ee5a72b3-04e4-4157-a8d8-c3a8817872a3
uuid:ee5a72b3-04e4-4157-a8d8-c3a8817872a3
xmp.iid:0280117407206811994CBE3149FFDB59
xmp.did:0280117407206811994CBE3149FFDB59
TouchUp 7.0
False
False
1
684.000000
864.000000
Points
Black
Default Swatch Group
0
PANTONE 3025 C
SPOT
100.000000
CMYK
100.000000
16.859999
0.000000
50.980003
endstream
endobj
296 0 obj
<>
endobj
300 0 obj
<>/XObject<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]/Font<>>>/Thumb 302 0 R/MediaBox[0 0 612 792]/Rotate 0>>
endobj
303 0 obj
<>/ProcSet[/PDF/Text]/Font<>>>
endobj
301 0 obj
<>stream
/GS1 gs
BT
/F1 1 Tf
8.9663 0 0 8.9663 35.8866 693.8644 Tm
0 0 0 1 k
0 Tc
0 Tw
[(age)-330.7(or)-327.4(older,)-332.6(and)-333.2(48)-332.1(were)-329.2(younger)-333.4(than)-335.3(65)-332.1(years.)-332.8(The)-332(intervention)]TJ
0 -1.3278 TD
[(included)-445(real-time)-446.3(transmission)-446.9(of)-443.2(biometric)-449.4(measures,)-448.2(telephone)]TJ
0 -1.3341 TD
[(exchanges)-315.3(for)-316.8(communication)-318.1(and)-307.9(health)-320.2(promotion,)-318.2(and)-314.3(full-time)]TJ
T*
[(case)-334.9(managers)-338.5(and)-333.2(cardiologists.)-343.7(The)-338.3(telemedicine)-344.4(intervention)-339.3(re-)]TJ
T*
[(sulted)-289.8(in)-286.2(significant)-293.9(reductions)-288.4(in)-286.2(all-case)-291.6(admission)-290.6(rates)-292.9(and)-289(hos-)]TJ
T*
[(pital)-453.8(stays,)-462.1(an)-454.9(increase)-458.7(in)-456.9(outpatient)-466.2(visits,)-455(and)-459.7(no)-458.1(difference)-461.1(in)]TJ
T*
[(emergency)-326.3(visits.)-328.5(The)-332(total)-328(cost)-327.7(of)-329.4(all-cause)-326(healthcare)-332(\(comparing)]TJ
T*
[(costs)-214.6(6)-213.5(months)-220.2(before)-211.7(and)-219.4(6)-213.5(months)-213.9(after)-218.5(the)-217.5(intervention\))-216.4(decreased)]TJ
T*
[(by)-281.5(48%:)-280.3(from)-279.9($937)-282.7(to)-280.8($491.52)-287.3(per)-278.7(month.)]TJ
/F4 1 Tf
11.9551 0 0 11.9551 35.8866 574.3557 Tm
[(Summary)-335.5(and)-336(Conclusion)-9.7(s)]TJ
/F1 1 Tf
8.9663 0 0 8.9663 45.8079 562.3936 Tm
[(This)-340.6(article)-345.5(assessed)-341.8(the)-337.6(evidence)-347.7(concerning)-342.1(the)-337.6(effects)-343.7(of)-342(tele-)]TJ
-1.1065 -1.3341 TD
[(medicine)-326.6(on)-331.7(healthcare)-332(quality,)-329.9(access,)-332.5(and)-333.2(costs)]TJ
/F5 1 Tf
21.0932 0 TD
(vis-a)Tj
1.7704 .0126 TD
(`)Tj
.2909 -.0126 TD
(-vis)Tj
/F1 1 Tf
1.8905 0 TD
[(three)-333.3(of)]TJ
-25.0451 -1.3341 TD
[(the)-375.6(leading)-378.6(causes)-376.3(of)-373.6(death)-375.6(in)-374.7(the)-375.6(United)-379.2(States:)-377.1(CHF,)-380.4(stroke,)-372.9(and)]TJ
T*
[(COPD.)-370.4(Conclusions)-370.1(were)-373.5(based)-367.9(on)-369.6(a)-368.3(systematic)-372.2(review)-369.2(of)-373.6(the)-369.3(pro-)]TJ
T*
[(fessional)-181.4(literature)-188.1(published)-187.7(from)-178.7(2000)-183.6(to)-186(early)-182.6(2014,)-184.9(selected)-185.3(on)-186.3(the)]TJ
T*
[(basis)-232.6(of)-234.5(scientific)-236.4(merit.)-233.3(Of)-230.7(the)-236.5(studies)-233.6(that)-233.9(met)-234.7(the)-236.5(minimum)-232.3(criteria)]TJ
0 -1.3278 TD
[(for)-278.9(inclusion,)-283.8(19)-281.5(dealt)-287.8(with)-278.8(CHF,)-285.6(21)-281.5(with)-285.2(stroke,)-278(and)-282.7(17)-281.5(with)-285.2(COPD.)]TJ
0 -1.3341 TD
[(An)-278.5(additional)-283.3(set)-278.7(of)-285.1(14)-281.5(studies)-284.1(investigated)-280.6(cost.)]TJ
/F6 1 Tf
9.9626 0 0 9.9626 35.8866 454.7904 Tm
[(CONTE)-9.7(XTUAL)-341.7(AND)-336.9(METHO)-8.3(DOLO)-10.7(GICAL)-336.5(I)-6.7(SSUES)]TJ
/F1 1 Tf
8.9663 0 0 8.9663 45.8079 442.8282 Tm
[(A)-444.8(careful)-443.9(review)-445(of)-443.2(the)-438.8(published)-447(literature)-447.3(reveals)-444.5(significant)]TJ
-1.1065 -1.3341 TD
[(variations)-313.6(in)-317.8(the)-318.7(methodologies)-321.8(used)-320(as)-318.4(well)-315.3(as)-318.4(the)-318.7(outcomes)-319.3(mea-)]TJ
T*
[(sured.)-296.1(These)-296.7(include)-294.8(research)-301.8(design)-292.1(and)-295.3(sample)-298.1(size,)-293.9(as)-299.4(well)-296.3(as)-293.1(the)]TJ
T*
[(specific)-406.2(attributes)-413.5(of)-405.3(the)-413.5(intervention)-408.9(itself,)-409.2(such)-412.8(as)-406.9(technological)]TJ
0 -1.3278 TD
[(configuration,)-537.4(provider)-537(mix,)-541.4(patient)-536.7(mix,)-535(program)-535.6(content,)-539.2(fre-)]TJ
0 -1.3341 TD
[(quency,)-217.9(and)-213.1(duration.)-210.7(The)-218.2(technologies)-216.3(used)-218.9(ranged)-213.6(from)-216.7(telephones)]TJ
T*
[(\(including)-328.1(smartphones\))-327.6(to)-325.1(videoconferencing,)-329.3(from)-324.2(manual)-324.6(to)-325.1(au-)]TJ
T*
[(tomated)-408.1(data)-410.4(entry,)-408.7(from)-412.7(point-to-point)-416.4(connections)-410.1(to)-413.6(dedicated)]TJ
T*
[(networks)-612.8(to)-609.6(the)-615.8(Internet,)-611.9(and)-611.4(from)-615(autonomous)-613.5(equipment)-617.4(to)]TJ
T*
[(wearable)-302.7(or)-308.4(implantable)-306.7(devices,)-311.8(some)-305.6(with)-304.1(remote)-304.8(diagnostic)-312.4(cap-)]TJ
T*
[(abilities.)-186.6(Some)-181.2(systems)-184.7(linked)-188.4(patients)-183.3(with)-184(providers,)-191.2(whereas)-188.8(others)]TJ
T*
[(linked)-277(providers)-278.5(with)-272.5(other)-279.3(providers.)-279.7(For)-275.3(stroke)-276.7(in)-279.8(particular,)-278.2(some)]TJ
0 -1.3278 TD
[(included)-280.6(specially)-285.5(equipped)-282.3(emergency)-288.4(mobile)-278.9(units.)]TJ
1.1065 -1.3341 TD
[(Other)-218.6(significant)-218(aspects)-218.1(of)-221.9(the)-217.5(various)-214.2(telemedicine)-224.3(interventions)]TJ
-1.1065 -1.3341 TD
[(included)-381.8(the)-381.9(types)-383.1(of)-380(providers)-379.6(and)-383.8(patients.)-380.6(For)-382.7(instance,)-378(nurses,)]TJ
T*
[(registered)-238.9(nurses,)-245.8(and)-238.4(specialized)-245.1(nurses)-238.2(were,)-242(in)-241.9(most)-238.3(instances,)-245.9(the)]TJ
T*
[()55.6(front)-510(line)48.5()-507.1(managers/contact)-521.6(persons)-510.6(regardless)-519.6(of)-512.7(the)-514.7(level)-515.2(of)]TJ
T*
[(technology)-442.6(used.)-435.1(And,)-442.7(where)-439.5(required,)-438.5(technicians)-441.8(set)-436.7(up)-437.5(remote)]TJ
T*
[(monitoring)-440.2(equipment)-446.7(in)-437.9(patients)-443.8(homes)-447.5(and)-440.7(trained)-444.1(patients)-442.5(in)]TJ
T*
[(their)-417.1(use.)-424(In)-423.2(two)-422.8(instances,)]TJ
6.7246 0 0 5.9768 140.9385 219.685 Tm
[(54,)-10.9(96)]TJ
8.9663 0 0 8.9663 160.3842 215.6598 Tm
[(remote)-424.9(telemonitoring)-426.5(cases)-417.8(were)]TJ
-13.8851 -1.3278 TD
[(managed)-285.6(by)-281.5(specialist)-285.6(physicians.)-289.2(The)-287.7(patient)-283.8(populations)-286.5(varied)-288.6(in)]TJ
0 -1.3341 TD
[(age,)-300.4(severity)-306.5(of)-304.1(illness,)-304.1(comorbidity,)-311.4(and)-301.6(location.)-308.2(Finally,)-305.7(issues)-307.5(of)]TJ
T*
[(program)-466.1(fidelity,)-466(maturation,)-465.6(and)-459.7(bundling)-469.4(add)-466.4(another)-462.3(layer)-467.1(of)]TJ
T*
[(complications)-192.4(that)-183.3(may)-190.7(be)-190.1(important)-186.6(to)-186(consider.)-194.2(The)-186.5(variations)-193.5(from)]TJ
T*
[(one)-485.4(study)-491.4(to)-483.2(another)-493.9(significantly)-491.9(constrain)-487.2(our)-488.2(ability)-487.5(to)-489.5(draw)]TJ
T*
[(conclusions)-387.6(that)-379.3(can)-387.3(be)-379.8(generalized.)-385.8(At)-385.7(the)-381.9(same)-384.6(time,)-384.9(it)-380.7(must)-388(be)]TJ
T*
[(recognized)-188.2(that)-189.7(a)-191.2(homogeneous)-192.8(telemedicine)-192.7(landscape)-189.6(now)-189.1(or)-188.3(in)-185(the)]TJ
T*
[(future)-216.2(is)-212.9(beyond)-215.3(reasonable)-215(expectation.)-222.2(Indeed,)-216.7(we)-213.4(might)-212.3(anticipate)]TJ
0 -1.3278 TD
[(even)-405.1(greater)-412.9(diversity)-407.7(as)-406.9(the)-413.5(implementation)-411.5(of)-405.3(telemedicine)-414(ma-)]TJ
0 -1.3341 TD
[(tures.)-352.3(Therefore,)-350.5(the)-350.3(heterogeneity)-357.4(of)-348.4(telemedicine)-357.1(applications)-355.4(re-)]TJ
T*
[(viewed)-203.2(here)-202.7(does)-201.9(provide)-201.8(a)-197.5(window)-206.6(into)-200.3(telemedicines)-207.3(impact)-200.3(across)]TJ
T*
[(the)-337.6(complex)-344.9()55.6(real)-343.5(world)52.2()-342.7(o)0(f)-342(current)-344.2(programs)-340.3(designed)-343.1(to)-344.1(manage)]TJ
30.331 69.3307 TD
[(chronic)-360.9(illnesses,)-357.4(as)-356.3(well)-353.2(as)-356.3(the)-356.6(specific)-361.9(application)-354.7(configurations)]TJ
0 -1.3278 TD
[(that)-328.8(had)-325.3(positive)-331.8(impacts.)-335.1(Because)-328.3(of)-329.4(these)-327.6(variations,)-333.9(the)-325(findings)]TJ
0 -1.3341 TD
[(and)-326.9(conclusions)-330.7(must)-324.8(be)-329.2(viewed)-329.6(from)-324.2(the)-331.3(perspective)-327.8(of)-329.4(the)-325(meth-)]TJ
T*
[(odology)-291.6(used)-288.4(in)-286.2(each)-286.4(study.)-290.4(Nonetheless,)-297.9(there)-289.1(are)-281.8(significant)-293.9(areas)]TJ
T*
[(of)-278.8(agreement)-287.4(on)-281.1(several)-280.1(dimensions.)]TJ
/F6 1 Tf
9.9626 0 0 9.9626 307.8424 616.7053 Tm
[(THE)-340.8(EVIDENCE)]TJ
/F1 1 Tf
8.9663 0 0 8.9663 317.8204 604.7432 Tm
[(The)-395.2(preponderance)-404.2(of)-398.9(evidence)-404.6(from)-393.7(studies)-404.3(using)-395.6(rigorous)-401(re-)]TJ
-1.1128 -1.3341 TD
[(search)-217.6(methods)-222.5(points)-218.4(to)-217.6(beneficial)-225.3(results)-216.2(from)-223(telemonitoring)-217.8(in)-216.6(its)]TJ
T*
[(various)-309.1(manifestations,)-311.7(albeit)-310.3(with)-304.1(a)-311.4(few)-304(exceptions.)-312.1(Generally,)-311.8(the)]TJ
T*
[(benefits)-396.6(include)-389.6(reductions)-395.9(in)-387.3(use)-397.4(of)-386.3(service:)-395.8(hospital)-392.6(admissions/)]TJ
T*
[(re-admissions,)-388.1(length)-388.3(of)-380(hospital)-386.2(stay,)-385.5(and)-383.8(emergency)-389.6(department)]TJ
T*
[(visits)-428.4(typically)-431(declined.)-432.8(It)-429.3(is)-427.9(important)-433.2(that)-429.9(there)-428.2(often)-428.4(were)-430.4(re-)]TJ
T*
[(ductions)-362.2(in)-362(mortality)-362.7(\(decreases)-360.5(ranging)-365(from)-355.8(15%)-361(to)-363(56%\).)-359.5(Some)]TJ
0 -1.3278 TD
[(studies)-315.8(reported)-313.4(neutral)-315.6(or)-308.4(mixed)-312.9(findings.)-314.1(For)-313.2(example,)-311.3(there)-314.4(may)]TJ
0 -1.3341 TD
[(have)-194.4(been)-202.8(no)-192.6(decrease)-198.2(in)-197.6(hospital)-196.6(admissions,)-197.7(but)-195.1(a)-197.6(reduced)-195.3(length)-198.6(of)]TJ
T*
[(stay)-321(or)-321(a)-324(corresponding)-325.6(increase)-325.9(in)-324.1(outpatient)-320.8(visits.)-328.5(Some)-320.3(investi-)]TJ
T*
[(gators)-427.1(reported)-420.9(little)-425.5(change)-428.4(in)-418.9(health)-427.7(services)-426.6(utilization)-423.6(but)-422.7(re-)]TJ
T*
[(ductions)-286.3(in)-286.2(mortality.)-281.8(One)-285.5(study)]TJ
6.7246 0 0 5.9768 429.2219 477.1841 Tm
(61)Tj
8.9663 0 0 8.9663 438.7463 473.2156 Tm
[(reported)-288.2(an)-284.2(increase)-287.9(in)-279.8(mortality)]TJ
-14.5996 -1.3341 TD
[(among)-256.9(frail)-257.4(elderly)-260.9(patients)-265.5(but)-258.3(no)-255.8(increase)-262.7(in)-254.5(use)-258.3(of)-259.8(services.)-263.5(These)]TJ
T*
[(findings)-230.7(and)-232.1(explanations)-229.5(for)-228.3(them)-231.2(are)-231.2(reported)-231.2(in)-229.3(detail)-234.5(in)-229.3(the)-230.2(main)]TJ
T*
[(body)-303.7(of)-304.1(the)-306(report.)-301.7(In)-303.1(totality,)-303.8(however,)-304.9(the)-306(findings)-300.2(provide)-309.3(useful)]TJ
0 -1.3278 TD
[(insight)-561.4(and)-560.9(notable)-556.3(trends)-559.9(in)-558(telemedicine)-565.8(interventions)-561.3(in)-558(the)]TJ
0 -1.3341 TD
[(management)-286(of)-278.8(three)-282.7(major)-282.9(chronic)-278.7(diseases.)]TJ
1.1128 -1.3341 TD
[(The)-395.2(implications)-391.6(of)-392.6(the)-394.5(evidence)-398.3(can)-393.6(be)-392.4(summarized)-398.7(at)-391.4(several)]TJ
-1.1128 -1.3341 TD
[(levels)-326.2(of)-329.4(generality.)-329.2(At)-322.5(the)-325(most)-326.8(general)-328.1(level,)-326.8(the)-325(telemedicine)-331.8(in-)]TJ
T*
[(tervention)-255.5(in)-254.5(chronic)-253.4(disease)-255.4(management)-254.4(consists)-254.9(of)-253.5(a)-248.1(set)-253.4(of)-253.5(inputs)]TJ
T*
[(and)-516.6(outputs.)-518.6(Telemedicine)-522.1(changes)-523.9(the)-514.7(inputs)-519.9(of)-519.1(the)-514.7(traditional)]TJ
T*
[(medical)-296.5(care)-296.3(process.)-294.4(Patients)-296.7(consequently)-299.4(are)-294.4(engaged)-302.4(in)-292.5(manag-)]TJ
T*
[(ing)-347.9(their)-347.6(own)-347.1(health)-345.5(in)-349.4(an)-347.4(increased)-349.7(number)-343.8(of)-348.4(phases)-347.6(of)-348.4(the)-350.3(care)]TJ
0 -1.3278 TD
[(process.)-509.4(They)-501.2(are)-503.1(encouraged)-509.6(to)-502.1(adopt)-500.6(healthy)-508.4(lifestyles)-507.5(and)-497.6(to)]TJ
0 -1.3341 TD
[(manage)-337.7(their)-341.3(medications,)-337.1(and)-339.6(they)-342.4(are)-332.4(provided)-345.7(with)-335.7(coordinated)]TJ
T*
[(remote)-462.8(and)-453.4(local)-464.3(continuous)-457.9(care)-460.7(management.)-464.3(The)-458.4(capacity)-460.5(for)]TJ
T*
[(early)-315.4(intervention)-314.1(and)-307.9(rapid)-311.9(response)-316.6(associated)-316.5(with)-310.4(telemedicine,)]TJ
T*
[(plus)-321.6(empowered,)-322.6(educated,)-322.3(and)-320.6(engaged)-321.4(patients,)-323.7(can)-317.7(have)-320.9(signifi-)]TJ
T*
[(cant)-233.3(effects)-236.2(on)-230.5(the)-236.5(outputs.)-234.1(Costs)-235(frequently)-239.2(are)-231.2(reduced)-233.2(by)-237.2(avoiding)]TJ
T*
[(unnecessary)-271.8(services.)-269.8(Moreover,)-274.3(the)-268.1(costly)-272.8(complications)-268.3(of)-272.5(chronic)]TJ
T*
[(illness)-328.2(may)-323.5(be)-329.2(reduced,)-329.3(yielding)-328.5(improved)-329.3(health)-326.5(outcomes)-331.9(among)]TJ
0 -1.3278 TD
[(more)-349.3(informed)-345.2(patients,)-355.3(who)-345.5(are)-345(more)-349.3(likely)-352(to)-344.1(engage)-348.2(in)-349.4(positive)]TJ
0 -1.3341 TD
[(health)-351.8(behaviors)-347.4(and)-345.9(to)-350.4(adhere)-348.2(more)-349.3(closely)-350(to)-350.4(prescribed)-353.4(medical)]TJ
T*
[(regimens)-334.6(and)-326.9(self-care)-334.9(guidelines.)-330.4(In)-328.4(brief,)-329.9(the)-331.3(extent)-330.8(to)-331.4(which)-330(the)]TJ
T*
[(inputs)-450.3(in)-450.6(the)-451.5(care)-448.1(process)-451.2(are)-452.5(changed)-452.2(is)-446.8(likely)-446.8(to)-451.6(have)-453.6(a)-444.2(direct)]TJ
T*
[(bearing)-280.4(on)-281.1(the)-287.1(nature)-280.5(and)-276.3(magnitude)-288.2(of)-278.8(changes)-283.7(in)-279.8(outputs.)]TJ
1.1128 -1.3341 TD
[(At)-436.3(the)-438.8(second)-442.2(lower)-436.8(level)-439.4(of)-443.2(generality,)-443(there)-434.5(are)-439.8(five)-442.3(notable)]TJ
-1.1128 -1.3341 TD
[(interactions)-294.4(between)-293.9(aspects)-300.3(of)-291.4(the)-293.4(intervention)-295.1(and)-289(observed)-295.7(find-)]TJ
T*
[(ings)-279(from)-286.2(the)-280.7(studies:)]TJ
1.1128 -1.998 TD
(1.)Tj
/F5 1 Tf
1.0939 0 TD
[(The)-419.5(technological)-423.7(configuration.)]TJ
/F1 1 Tf
14.0432 0 TD
[(The)-426.8(type)-420.3(and)-421.8(complexity)-420.6(of)]TJ
-14.0432 -1.3341 TD
[(the)-445.1(technology)-455.3(can)-450.5(have)-447.3(an)-448.6(independent)-452.1(effect)-450.4(on)-451.8(the)-445.1(out-)]TJ
T*
[(comes)-383.4(under)-387.1(investigation.)-389(For)-382.7(example,)-387.2(in)-387.3(telestroke,)-384.4(visual)]TJ
T*
[(clues)-339.7(and)-333.2(the)-337.6(ability)-342(to)-337.7(interact)-337.9(virtually)-338.6(with)-335.7(the)-344(patient,)-335.6(to-)]TJ
0 -1.3278 TD
[(gether)-540.5(with)-544.4(neuroimaging)-543.5(to)-540.1(assess)-543.7(the)-540(appropriateness)-545.7(of)]TJ
0 -1.3341 TD
[(administering)-556.9(tPA,)-555.8(provided)-560.7(significant)-559.5(information)-559.2(to)-552.7(the)]TJ
/F11 1 Tf
11.9551 0 0 11.9551 287.5464 741.9966 Tm
[(TELEMEDICINE)-340.6(FOR)-332.7(CHRONIC)-338.8(DISEASE)-334.7(MANAGE)-7.3(MENT)]TJ
/F9 1 Tf
6.9738 0 0 6.9738 186.4063 29.7638 Tm
()Tj
/F7 1 Tf
1.3251 0 TD
.1992 Tc
[(MA)-9.2(RY)-337.6(ANN)-328.3(L)-9.4(I)4(E)-6.2(BE)-6.2(RT,)-335.6(I)-4.2(NC.)]TJ
/F10 1 Tf
15.015 0 TD
0 Tc
()Tj
/F7 1 Tf
.9999 0 TD
.1103 Tc
[(VOL.)-327(20)-1000.8(N)5.5(O)4(.)-335.1(9)]TJ
/F10 1 Tf
8.3814 0 TD
0 Tc
()Tj
/F8 1 Tf
.9999 0 TD
.1099 Tc
[(SEPTEMB)6.6(E)2.1(R)-332.8(2).5(014)]TJ
/F4 1 Tf
7.9702 0 0 7.9702 441.5243 29.7638 Tm
0 Tc
[(TELEME)13.6(DICINE)-327.7(and)-328.9(e-HEALTH)-655(793)]TJ
ET
q
1 i
0 792 612 -791.985 re
W n
579.685 .014984 .22681 791.985 re
f
337.039 767.962 274.961 .22675 re
f
Q
endstream
endobj
304 0 obj
<>/XObject<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]/Font<>/Properties<>>>/Thumb 307 0 R/MediaBox[0 0 612 792]/Rotate 0>>
endobj
308 0 obj
<>/ProcSet[/PDF/Text]/Font<>/Properties<>>>
endobj
305 0 obj
<>stream
/GS1 gs
BT
/F1 1 Tf
8.9663 0 0 8.9663 69.9023 693.8644 Tm
0 0 0 1 k
0 Tc
0 Tw
[(consultant)-531.9(in)-526.4(making)-527(a)-526.3(diagnosis)-528.3(and)-529.2(in)-526.4(guiding)-528.2(the)-527.3(care)]TJ
0 -1.3278 TD
[(process)-318.4(from)-317.8(a)-311.4(distance.)-321.5(Telephone-only)-319(discussions)-319.4(were)-316.6(less)]TJ
0 -1.3341 TD
[(effective.)-322.9(However,)-325.4(the)-318.7(technology)-322.5(has)-314.8(been)-316.6(evolving)-323.5(rapidly,)]TJ
T*
[(and)-276.3(it)-273.2(may)-266.6(be)-278.6(the)-268.1(case)-278(that)-271.8(advances)-274.6(in)-273.5(mobile)-272.5(telephony)-279.7(with)]TJ
T*
[(high-resolution)-511.2(video)-513.1(and)-504(audio)-510.6(connectivity)-512.3(will)-506.6(result)-506.4(in)]TJ
T*
[(increased)-653.2(telephone)-649.9(utility.)-647.4(Wearable)-645.8(sensors,)-653.2(implantable)]TJ
T*
[(devices,)-457.2(and)-447(smartphones)-456.9(have)-447.3(produced)-455.9(demonstrable)-457.3(effi-)]TJ
T*
[(ciencies)-336(in)-324.1(the)-331.3(delivery)-335.2(of)-329.4(service.)-332.3(These)-334.6(are)-326(less)-329.3(cumbersome)]TJ
T*
[(for)-323.1(older)-318.7(patients)-322.4(with)-316.8(multiple)-322.4(health)-320.2(issues)-320.2(and)-314.3(are)-319.7(likely)-320.3(to)]TJ
0 -1.3278 TD
[(provide)-340.9(more)-330.3(reliable)-337(information)-337.9(than)-335.4(patient)-334.3(self-reporting.)]TJ
-1.0939 -1.3341 TD
(2.)Tj
/F5 1 Tf
1.0939 0 TD
[(Pat)11.9(ien)13.4(t)-585.9(mix)12.5(.)]TJ
/F1 1 Tf
5.8993 0 TD
[(Whe)16.1(n)-586.1(hig)14.2(hly)-580.2(sk)12.4(ewe)12.3(d)-586.5(tow)13.5(ard)-581.8(a)-583.3(sic)12.8(ker)-576.9(pa)12.6(tien)17.6(t)]TJ
-5.8993 -1.3341 TD
[(pop)10.9(ulat)19.6(ion)12.5(,)-361.7(suc)13.6(h)-363.2(p)0(a)12.6(tien)17.6(t)-364.6(cha)12.7(rac)15.4(ter)12.8(ist)16.9(ics)-353.9(as)-356.3(age,)-351(sev)11.5(eri)13.4(ty)-356.7(of)-354.7(ill)14.7(-)]TJ
T*
[(nes)11.9(s,)-368.7(and)-364.8(com)11.2(or)14.1(bid)12.2(iti)14.1(es)-369.4(can)-368.3(mas)15.7(k)-372.6(t)0(h)12.1(e)-375(tru)12(e)-375(eff)12.8(ect)17.3(s)-373.8(o)0(f)-373.6(t)0(h)12(e)-375(tel)15.7(e-)]TJ
T*
[(med)11.2(ici)16.3(ne)-663.9(int)13.2(erv)18.5(enti)17.6(on)-660.5(in)-659.2(a)-665.4(way)-654.1(that)-651.2(is)-661.8(les)12.8(s)-664.6(lik)12.4(el)13.5(y)-668.7(w)0(h)13.4(e)0(n)]TJ
T*
[(tele)13.8(med)17.5(icin)18.2(e)-273.8(i)0(s)-263.5(use)13.6(d)-270.4(wit)14.8(h)-274.7(a)-267.1(hea)12.7(lth)14.8(ier)-264.8(gro)15.6(up)-266.8(of)-266.2(pat)14.8(ien)15.4(ts,)-265.4(wi)12.6(tho)13.6(ut)]TJ
T*
[(com)11.2(ple)15(x)-510.2(com)11.2(or)14.1(bid)12.2(iti)14.1(es.)-503.4(Fra)12.5(il)-500.2(elde)13.1(rly)-495.3(pati)17.6(ents)-498.1(suf)13.4(fer)14.8(ing)-499.6(fro)12(m)]TJ
T*
[(sev)11.5(era)15.4(l)-300.7(ser)16.3(iou)14.2(s)-297.9(chr)14.2(oni)12.5(c)-299.1(ill)14.7(nes)11.9(ses)-287.9(are)-288.1(not)-285.3(lik)12.4(ely)-288.5(to)-293.5(use)-289.9(or)-295.7(be)12.2(nefi)19.6(t)]TJ
0 -1.3278 TD
[(fro)12(m)-329.8(t)0(h)12.1(i)0(s)-326.7(t)0(e)12.9(chno)17.7(log)12.2(y)-333.6(a)0(s)-318.4(i)0(t)-323.8(has)-321.2(thu)15.6(s)-329.5(far)-319.9(bee)10.3(n)-326.9(imp)15.9(lem)12.5(ent)14.8(ed.)]TJ
.999 -1.3341 TD
[(In)-176.6(ad)18.9(di)17(ti)23.9(on)-179.9(t)14.8(o)-188.2(a)-184.9(g)0(e)18.6(n)14.6(er)17(at)19.6(io)17(na)19.3(l)-180.6(d)0(i)17(f)0(f)21.1(e)0(r)17(e)0(n)18.9(c)0(e)21.4(,)-184.6(ma)16.4(ny)-173.6(pa)18.9(ti)17.6(en)18.9(t)14.8(s)-190.4(l)15.4(a)0(c)15.5(k)-182.9(th)18.4(e)]TJ
-.999 -1.3341 TD
[(ne)18.9(ce)15.1(ss)23.9(ar)17.3(y)-352.6(m)0(a)22.7(n)0(u)18.1(a)0(l)-340.2(d)14.2(ex)18.9(te)12.9(r)12.6(i)0(t)17.6(y)14.2(,)-355.4(p)14.2(at)19.6(ie)19.8(nc)18.9(e,)-344.6(o)14.2(r)-354.2(in)23.7(cl)19.8(in)17.3(at)19.6(io)17(n)-345.9(t)0(o)-344.1(r)12.6(el)19.8(y)-352.6(o)14.2(n)]TJ
T*
[(de)18.6(vi)17(ce)21.4(s)-361.1(t)0(o)-350.4(m)0(a)16.4(n)14.6(ag)18.9(e)-362.3(t)0(h)18.4(e)0(i)19.8(r)-360.5(de)18.6(te)19.2(r)12.6(i)0(o)17(r)0(a)17.3(t)0(i)23.9(n)0(g)-350.7(h)0(e)14.3(a)0(l)20.2(t)0(h)-348.4(u)0(n)18.1(l)0(e)19.8(s)0(s)17.6(,)-355.4(of)-354.7(co)18.6(ur)22.4(se)16.3(,)]TJ
T*
[(th)18.4(es)16.3(e)-160(d)0(e)18.6(v)0(i)17(c)0(e)21.4(s)-158.8(ar)17.3(e)-160(t)0(o)22.7(t)0(a)19.6(l)0(l)18.2(y)-162.9(un)18.1(o)14.2(b)0(t)16.3(r)12.6(us)15.5(iv)23.3(e)-166.3(a)0(n)25.7(d)-162.9(si)21.1(mp)19.5(le)-150.9(to)-154.4(o)14.2(p)0(e)18.6(r)0(a)17.3(t)0(e)19.2(.)-159.3(It)-151.1(ma)22.7(y)]TJ
T*
[(be)18.6(,)-172(h)0(o)17.7(w)0(e)20.5(v)0(e)18.6(r)0(,)-159.4(t)0(h)18.4(a)0(t)-157.4(t)0(e)19.2(l)0(e)13.5(m)0(e)22.4(d)0(i)17(c)0(i)19.8(n)0(e)-158.1(c)0(o)18.6(u)0(l)19(d)-169.2(be)-164.8(b)14.2(e)0(n)18.9(e)0(f)14.9(i)0(c)19.8(i)0(a)20.2(l)-167.9(to)-160.7(ge)18.6(ri)21.7(at)19.6(ri)15.4(ci)19.8(an)19.3(s)]TJ
T*
[(an)19.3(d)-162.9(o)0(t)16.3(h)0(e)20.6(r)12.6(s)-165.1(w)0(h)19.7(o)-162.9(sp)19.8(ec)15.1(i)15.4(a)0(l)13.9(i)15.4(ze)-155.6(in)-153.4(tr)21.1(ea)21.8(ti)17.6(ng)-154.6(th)18.4(e)-160(e)0(l)19.8(d)0(e)18.6(r)0(l)15.4(y)14.2(,)-165.7(a)0(l)20.2(l)0(o)23.3(w)0(i)18.9(n)0(g)-154.6(t)0(h)18.4(e)0(m)-154.7(t)14.8(o)]TJ
T*
[(or)14.1(g)14.2(a)0(n)19.3(i)0(z)19.8(e)-305.4(th)18.4(e)-299.1(t)0(r)21.1(e)0(a)15.5(t)0(m)20.1(e)0(n)18.9(t)-301.3(of)-291.4(co)18.6(mp)19.5(le)19.8(x)-301.6(p)0(a)18.9(t)0(i)17.6(e)0(n)25.3(t)0(s)-295.7(w)0(i)18.9(t)0(h)-291.5(m)0(u)21.5(l)0(t)17.6(i)0(p)17(l)15.4(e)-305.4(d)0(i)23.3(a)0(g)18.9(-)]TJ
0 -1.3278 TD
[(no)16.1(se)22.7(s,)-134.8(to)-129.1(im)20.8(pr)14.1(o)14.2(v)0(e)-133.2(t)0(h)18.4(e)0(i)19.8(r)-139.2(ma)16.4(na)19.3(g)14.2(e)0(m)16(e)0(n)18.9(t)-143.3(at)-125.8(ti)17.6(me)16(s)-139.8(o)14.2(f)-141.2(c)0(a)15.5(r)12.6(e)-141(t)0(r)21.1(a)0(n)19.3(s)0(i)14.7(t)14.8(io)17(ns)]TJ
6.7246 0 0 5.9768 293.8393 399.0046 Tm
[(17)19.9(6)]TJ
8.9663 0 0 8.9663 69.9023 383.0739 Tm
[(\(s)14.7(ee)-288.4(al)20.2(so)-283.7(Ch)19.1(ug)17.7(h)-299.9(e)0(t)-290.6(a)0(l)20.2(.)]TJ
6.7246 0 0 5.9768 148.422 387.0424 Tm
[(17)19.9(7)]TJ
8.9663 0 0 8.9663 158.6834 383.0739 Tm
[(\),)-289.3(an)19.3(d)-295.7(p)0(o)22(s)0(s)17.6(i)0(b)17(l)0(y)-286.5(t)0(o)-287.2(f)0(a)15.3(c)0(i)19.8(l)0(i)18.2(t)14.8(at)19.6(e)-299.1(t)0(h)18.4(e)0(i)19.8(r)-297.3(un)18.1(de)18.6(r)12.6(-)]TJ
-9.9017 -1.3341 TD
[(st)14.1(an)25.7(di)17(ng)-230.5(an)19.3(d)-238.7(a)0(d)18.9(h)0(e)14.3(r)12.6(en)18.9(ce)-231.5(to)-230.2(di)17(sc)22.7(ha)14.7(r)12.6(g)0(e)-234.4(i)0(n)23.7(s)0(t)14.1(r)12.6(uc)20.6(ti)17.6(on)22.4(s.)]TJ
.999 -1.3341 TD
[(If)-395.6(th)18.4(e)-406.6(s)0(a)23(m)0(p)19.5(l)0(i)18.2(n)0(g)-394.9(f)0(r)16.8(a)0(m)22.7(e)-406.6(is)-389.9(di)17(ve)18.6(rs)18.2(e,)-395.2(r)12.6(a)0(n)19.3(d)0(o)15.7(m)0(i)20.7(z)0(a)21.8(t)0(i)17.6(o)0(n)-394.9(o)0(f)-392.6(s)0(u)15.5(b)0(j)23.3(e)0(c)15.1(t)0(s)]TJ
-.999 -1.3341 TD
[(ca)15.5(n)14.6(n)0(o)16.1(t)-339.3(fu)14.1(ll)24.6(y)-346.2(r)12.6(ec)15.1(ti)17.6(fy)-329.4(th)18.4(e)-343.4(p)0(r)20.4(o)0(b)15.7(l)0(e)19.8(m)0(,)-331.1(e)0(s)16.3(p)14.2(ec)15.1(ia)20.2(ll)18.2(y)-339.9(w)0(h)19.7(e)0(n)-335.1(i)0(n)17.3(v)14.2(es)16.3(ti)17.6(ga)18.9(to)22.7(rs)]TJ
T*
[(at)19.6(te)19.2(mp)19.5(t)-206.5(t)0(o)-192.3(i)0(m)14.4(p)14.2(ut)18.4(e)-204.3(v)0(a)18.9(l)0(u)19(e)0(s)-198.6(o)14.2(f)-204.4(m)0(i)14.4(s)0(s)23.9(i)0(n)17.3(g)-200.8(da)18.9(ta)-195.4(fo)18.4(r)-202.4(n)0(o)16.1(n)0(p)22.4(a)0(r)17.3(t)0(i)17.6(c)0(i)19.8(p)0(a)18.9(n)0(t)23.1(s)-203(an)19.3(d)]TJ
T*
[(dr)14.1(o)14.2(p)0(o)15.7(u)0(t)18.4(s)0(,)-172.7(a)0(s)-166.6(s)0(o)19.8(m)0(e)16(t)0(i)17.6(m)0(e)22.4(s)-184.1(o)14.2(c)0(c)15.1(u)0(r)22.4(s)-184.1(wh)19.7(en)-170.7(an)-170.4()62()0(i)20.5(n)0(t)16.7(e)0(n)25.3(t)0(-)16.2(t)0(o)16.3(-)14(tr)14.7(ea)21.8(t)76.8()-184.6(a)0(n)19.3(a)0(l)20.2(y)0(s)19.8(i)0(s)]TJ
T*
[(is)-130.7(us)15.5(ed)18.6(.)-140.4(F)0(o)22(r)-145.5(ex)18.9(am)22.7(pl)17(e,)-129.7(im)20.7(pu)17.7(ti)17.6(ng)-129.4(ut)18.4(il)18.2(iz)19.8(at)19.6(io)17(n)-137.2(d)0(a)18.9(t)0(a)-132.1(a)0(f)21.6(t)0(e)19.2(r)-145.5(p)14.2(a)0(t)19.6(i)0(e)13.5(n)14.6(ts)-131.3(di)17(e)-141(o)0(r)]TJ
0 -1.3278 TD
[(dr)14.1(o)14.2(p)-207.1(ou)17.7(t)-206.5(o)0(f)-196.6(a)-203.9(st)20.4(ud)17.7(y)-207.1(i)0(s)-193.9(a)0(t)-195.4(b)0(e)18.6(s)0(t)-194.5(a)0(n)-195.7(i)0(m)20.7(p)0(e)18.6(r)0(f)16.8(e)0(c)21.4(t)-206.5(in)17.3(te)19.2(r)12.6(p)0(o)15.7(l)0(a)20.2(t)0(i)17.6(o)14.2(n,)-195.4(ba)18.9(se)16.3(d)-207.1(o)14.2(n)]TJ
0 -1.3341 TD
[(th)18.4(e)-292.8(h)0(i)19(g)0(h)17.7(l)0(y)-280.2(q)0(u)17.7(e)0(s)22.7(t)0(i)17.6(o)0(n)16.1(a)0(b)18.9(l)15.4(e)-292.8(a)0(s)16.7(s)0(u)21.8(m)0(p)19.5(t)0(i)17.6(o)0(n)-281.1(t)0(h)18.4(a)0(t)-277.6(v)0(a)18.9(l)0(u)19(e)0(s)-280.8(a)0(r)17.3(e)-292.8(mi)20.7(ss)17.6(in)23.7(g)-295.7(e)0(n)25.3(-)]TJ
T*
[(ti)17.6(r)12.6(e)0(l)13.5(y)-238.7(at)-227(ra)17.3(nd)16.1(o)14.2(m)0(.)]TJ
-1.0939 -1.3341 TD
(3.)Tj
/F5 1 Tf
1.0939 0 TD
[(Patient)-516.3(engagement.)]TJ
/F1 1 Tf
9.1303 0 TD
[(A)-508(related)-517.5(phenomenon)-509.5(pertains)-514.4(to)-508.5(the)]TJ
-9.1303 -1.3341 TD
[(level)-300.3(and)-289(intensity)-297.2(of)-291.5(patient)-296.4(participation)-302.1(in)-292.5(the)-293.4(intervention.)]TJ
T*
[(One)-348.8(large)-347(study)]TJ
6.7246 0 0 5.9768 129.8267 243.5527 Tm
(59)Tj
8.9663 0 0 8.9663 139.9747 239.5842 Tm
[(suggested)-349.1(that)-347.7()55.6(patient)-354.6(engagement)50()-342.7(had)-350.6(a)]TJ
-7.8151 -1.3341 TD
[(significant)-243.3(effect)-241.8(in)-241.9(terms)-235.5(of)-240.9(use)-239.3(of)-240.9(service)-242.5(and)-238.4(cost.)-240.5(Obviously,)]TJ
T*
[(the)-306(true)-299.8(effects)-305.7(of)-297.8(the)-299.7(intervention)-307.7(can)-298.7(be)-303.9(manifest)-297.6(only)-302.1(when)]TJ
0 -1.3278 TD
[(it)-336.5(is)-333(administered)-335.9(in)-336.7(full)-334.4(fidelity.)]TJ
-1.0939 -1.3341 TD
(4.)Tj
/F5 1 Tf
1.0939 0 TD
[(Provider)-436.9(mix.)]TJ
/F1 1 Tf
6.1585 0 TD
[(Whereas)-437.1(nurses)-440.6(served)-437.9(as)-432.2(the)-438.8()55.6(front)-434.2(line)-437(pro-)]TJ
-6.1585 -1.3341 TD
[(fessional)51.3()-424.9(i)0(n)-425.3(the)-426.2(vast)-428.5(majority)-421.8(of)-424.2(studies,)-430.8(they)-424.6(were)-430.4(not)-424.4(as-)]TJ
T*
[(signed)-367.9(the)-362.9(same)-365.6(level)-369.8(of)-361(responsibility)-367.8(in)-362(decision)-367.1(making.)-370.2(It)]TJ
T*
[(seems)-347.7(that)-347.7(they)-342.4(performed)-350.4(best)-346.7(when)-340.7(an)-347.4(explicit)-344(protocol)-351.4(in-)]TJ
T*
[(cluding)-664.4(software)-663.1(was)-662.6(followed.)-661.9(In)-663.5(one)-662.4(instance,)]TJ
6.7246 0 0 5.9768 268.781 147.9118 Tm
(54)Tj
8.9663 0 0 8.9663 281.707 143.9433 Tm
(where)Tj
-23.6224 -1.3341 TD
[(physicians)-452.4(were)-455.7(in)-450.6(control)-447.4(of)-449.5(the)-451.5(telemedicine)-458.3(intervention,)]TJ
T*
[(more)-267.1(patients)-265.5(in)-267.2(the)-268.1(intervention)-263.5(group)-270.2(were)-266(hospitalized)-272(than)]TJ
0 -1.3278 TD
[(those)-336.8(in)-336.7(the)-331.3(control)-339.9(group.)]TJ
-1.0939 -1.3341 TD
(5.)Tj
/F5 1 Tf
1.0939 0 TD
-.0173 Tc
[(Trunc)5(ate)5(d)-680.7(c)5(o).1(mp)5.2(arison)]TJ
/F1 1 Tf
9.3073 0 TD
-.0176 Tc
[(.)-682.8(S)-1.4(ome)-677.1(s).7(tu)4.9(dies)-682.2(e)5.8(n)-3(h)4.9(a)-.2(nced)-680(the)-683.4(s)7(ervices)]TJ
-9.3073 -1.3341 TD
[(available)-462.2(t)3.4(o)-458.8(t)-2.9(h)4.8(e)-462.2(control)-457.5(g)2.8(rou)4.8(p)-3.5(n)]TJ
13.9104 0 TD
.4418 Tc
[(o)462.3(r)460.7(m)459.8(a)459.2(l)463.6(l)457.2(yr)460.7(e)458.8(f)458.7(e)465.2(r)460.7(r)460.7(e)458.8(d)-5.6(t)462.9(oa)459.2(s)516.4()459.5(u)458(s)460.1(u)464.3(a)459.2(l)]TJ
-13.9104 -1.3341 TD
-.0184 Tc
[(care)56.2()-.7()4.7(i)-3(n)-320(o)2.1(rder)-322(to)-320.4(isolate)-323.8(t)2.7(he)-317.5(speci)]TJ
13.8092 0 TD
-.0178 Tc
[(f)5.4(i)-2.4(c)-316.9(e)-.8(ff)5.4(ects)-322(o)2.7(f)-317.1(t)-3(h)4.7(e)-323.2(tech)4.7(nologica)6(l)]TJ
16.5281 69.3307 TD
-.0186 Tc
(component)Tj
/F5 1 Tf
4.8623 0 TD
-.0225 Tc
[(pe)-6.5(r)-355.7(s)-8.5(e)]TJ
/F1 1 Tf
2.4343 0 TD
-.0199 Tc
[(,)-356.3(b)-5.7(y)-353.5(p)-5.7(rovi)-4.5(di)-4.5(ng)-359.8(pati)-4.5(en)-5.3(ts)-355.7(ready)-359.8(a)-2.5(ccess)-355.7(t)-5.1(o)-353.5(n)-5.3(urses)]TJ
-7.2966 -1.3278 TD
-.0184 Tc
[(and)-396.3(p)2.1(hysic)5(i)-3(ans)-398.5(o)2.1(n)-395.9(d)2.1(emand)-396.2(a)-1(nd)-396.2(giving)-396.2(them)-392.5(weigh)4.1(t)-395.6(scales)-398.5(a)5.3(n)-3.8(d)]TJ
0 -1.3341 TD
-.0176 Tc
[(oth)4.9(e)-.6(r)-485.6(d)2.9(evices,)-480.4(i)-2.2(n)-483.6(o)2.9(the)5.8(r)-485.6(words,)-480.4(equ)4.9(a)-.2(ting)-490.3(the)-481.1(e)-.6(xperimenta)6.2(l)-489(a)6.1(nd)]TJ
T*
-.0178 Tc
[(control)-375.4(g)2.7(roups)-372.6(i)-2.4(n)-376.3(e)5.6(very)-370.4(way)-376.7(e)-.8(xcep)]TJ
14.4415 0 TD
-.0182 Tc
[(t)-376.4(f)-1.3(or)-372.4(elec)5.2(tronic)-374.2(connectivity.)]TJ
-14.4415 -1.3341 TD
[(This)-404.6(ignores)-404.6(t)2.9(he)-405.8(fact)-401.7(th)4.3(at,)-411.5(u)4.3(nder)-404(norma)5.6(l)-407.4(conditions)-404.6(\(outside)-405.8(of)]TJ
T*
-.02 Tc
[(parti)-4.6(c)-3(ipat)-5.2(ing)-239.8(i)-4.6(n)-239.4(a)-236.5(st)-5.2(ud)-5.8(y\),)-242.6(p).5(ati)-4.6(e)-3(nts)-242(w)-3.8(ould)-239.8(no)-5.8(t)-239.1(h)-3.8(av)-5.8(e)-236.9(t)-5.2(hese)-236.9(ad)-5.8(dit)-5.2(i)1.8(o)-5.8(n).9(al)]TJ
T*
-.018 Tc
[(benefi)3.8(ts.)-461.9(A)5.1(lthough)-463.4(t)3.1(hi)3.8(s)-461.3(a)-.6(pproach)-463.4(m)6.3(ay)-465.4(e)5.4(n)-3.4(abl)3.8(e)-462.5(a)-462.1(m)0(ore)-462.5(t)-3.2(a)5.7(r).9(geted)]TJ
T*
-.0186 Tc
[(testi)-3.2(n)2.3(g)-263.7(o)-4.4(f)-261(s)-.3(pecifi)-3.2(c)-260.8(h)-2.4(yp)-4.4(otheses)-259.6(r).3(eg)]TJ
13.2465 0 TD
-.0189 Tc
[(a)4.9(r)0(ding)-270.3(telecommunications,)-266.8(it)-263.3(is)]TJ
-13.2465 -1.3341 TD
-.0205 Tc
[(not)-264.9(a)-3.1(n)-258.9(a)-3.1(ppro)-6.3(p)0(ri)-5.1(at)-5.7(e)-262.7(c)-3.5(ont)-5.7(r)-1.6(ol)-264.3(fo)-6.3(r)-260.9(a)-256()47.8()3.5(b)-6.3(u)2(n)-5.9(d)0(l)-5.1(e)2.9(d)-6.3()54.1()-262(i)1.3(n)-5.9(n).4(ov)-6.3(at)-5.7(io)-6.3(n)-258.9(t).6(hat)-258.6(s)-2.2(erves)]TJ
0 -1.3278 TD
.315 Tc
[(a)332.4(s)4.5(as)333.3(u)337.5(b)329.2(s)333.3(t)336.2(i)336.8(t)329.8(u)337.5(t)329.8(ef)331.9(o)329.2(r)5.1(i)330.4(n)335.9(-)335.3(p)329.2(e)338.4(r)333.9(s)333.3(o)329.2(nc)332(a)338.7(r)333.9(ei)336.8(na)332.4(ni)330.4(n)335.9(t)336.1(e)332(g)335.5(r)327.6(a)338.8(t)329.8(e)332(ds)333.3(y)335.5(s)333.3(t)336.1(e)332(m)333(.)]TJ
-1.0939 -2.7252 TD
0 Tc
[(At)-423.7(a)-418.9(more)-425.1(detailed)-424.6()55.6(fine-grained)54.2()-424.9(level,)-421.7(the)-426.2(main)-421.5(body)-423.9(of)-424.2(this)]TJ
-1.1128 -1.3341 TD
[(article)-200.1(provided)-206.6(the)-198.5(key)-202.3(findings)-199.1(from)-197.7(each)-204.2(of)-196.6(the)-198.5(studies)-201.9(that)-202.3(met)-196.8(the)]TJ
T*
[(minimal)-334.7(inclusion)-333.1(criteria)-339.3(concerning)-335.8(the)-331.3(effects)-337.3(of)-335.7(telemonitoring)]TJ
T*
[(among)-275.8(persons)-276.7(with)-272.5(CHF,)-272.9(stroke,)-278(or)-270.5(COPD.)-275.6(An)-272.2(empirical)-274.8(assessment)]TJ
T*
[(of)-304.1(these)-302.3(findings)-306.5(reveals)-305.4(significant)-300.2(concurrence)-310.8(on)-300.1(positive)-306.5(effects)]TJ
/F5 1 Tf
0 -1.3278 TD
(vis-a)Tj
1.7704 .0063 TD
(`)Tj
.2909 -.0063 TD
(-vis)Tj
/F1 1 Tf
1.9285 0 TD
[(the)-362.9(following:)-371(\(1\))-366(process)-362.7(of)-367.3(care)-365.9(\(early)-369.5(detection,)-368(timely)]TJ
-3.9898 -1.3341 TD
[(initiation)-290.5(of)-291.5(treatment,)-290.2(prompt)-291.5(referral)-289.5(and)-289(follow-up,)-294.7(and)-289(accurate)]TJ
T*
[(measurement)-299.7(and)-289(diagnosis\);)-299.4(\(2\))-290.1(intermediate)-298.6(outcomes)-300.3(\(reductions)]TJ
T*
[(in)-444.2(hospitalization,)-449.4(re-hospitalization,)-450(length)-445.2(of)-443.2(hospital)-443.1(stay,)-448.7(and)]TJ
T*
[(emergency)-288.4(department)-281.7(visits\);)-288(and)-282.6(\(3\))-283.8(ultimate)-281.9(outcomes)-287.7(\(improved)]TJ
T*
[(symptoms,)-295.1(reduced)-296.5(disability,)-301.8(and)-289(reduced)-296.5(mortality/increased)-303.5(lon-)]TJ
T*
[(gevity)-270.6(as)-267.8(well)-271.1(as)-267.8(increased)-273.8(satisfaction\).)-271.9(The)-268.7(empirical)-274.8(assessment)-270.7(is)]TJ
T*
[(based)-285.7(on)-281.1(the)-280.7(direction)-282.1(and)-282.7(weight)-279.2(of)-285.1(the)-280.7(evidence.)]TJ
1.1128 -1.3278 TD
[(The)-407.8(extant)-406.3(data)-404.1(provide)-410.5(strong)-404.7(support)-407.8(for)-405.3(the)-407.2(contention)-411.6(that)]TJ
-1.1128 -1.3341 TD
[(telemonitoring)-243.1(of)-240.9(patients)-246.5(with)-240.9(CHF)-240(is)-244.5(likely)-238.1(to)-242.9(reduce)-247.4(mortality)-242.6(and)]TJ
T*
[(morbidity.)-222.5(The)-218.2(evidence)-221.3(is)-212.9(even)-221.7(stronger)-217(for)-215.7(the)-217.5(cost-effectiveness)-225.8(of)]TJ
T*
[(telemedicine)-451.9(interventions)-447.5(among)-452.9(persons)-447.4(with)-443.2(these)-454.1(chronic)-443.1(ill-)]TJ
T*
[(nesses.)-593.4(Significant)-586.8(associations)-595.1(have)-586.4(been)-588.5(found)-588(between)-591(tele-)]TJ
T*
[(medicine)-358.2(and)-352.2(reduced)-353.4(hospital)-354.6(admissions,)-355.8(shorter)-356(length)-356.7(of)-354.7(stays,)]TJ
T*
[(and)-415.4(reductions)-414.8(in)-418.9(emergency)-414.9(department)-420.8(visits.)-417(Hence,)-414.1(it)-418.7(may)-412(be)]TJ
T*
[(reasonably)-306.4(inferred)-303.4(that)-303.5(cost)-302.4(savings)-305(and)-301.6(health)-307.6(benefits)-301.8(would)-303.3(ac-)]TJ
0 -1.3278 TD
[(crue)-284.9(to)-280.8(both)-282.1(patients)-284.5(and)-276.3(providers)-284.8(from)-279.9(this)-283(intervention.)]TJ
1.1128 -1.3341 TD
[(Significant)-220.1(reductions)-225.1(in)-222.9()55.6(death)-218.8(and)-219.4(dependency)45.1()-216.2(were)-221.7(associated)]TJ
-1.1128 -1.3341 TD
[(with)-285.2(telestroke)-288.3(interventions)-289.5(for)-285.2(persons)-289.3(suffering)-288(a)-286.1(stroke.)-284.3(Support)]TJ
T*
[(for)-506.5(this)-510.7(general)-505.1(conclusion)-513.4(derives)-504.7(from)-507.5(studies)-511.8(assessing)-505.9(event)]TJ
T*
[(timing)-324.9(from)-330.5(onset)-325.8(of)-329.4(symptoms,)-326.8(to)-325.1(diagnostic)-331.4(tests,)-329(to)-325.1(initiation)-328.5(of)]TJ
T*
[(thrombolytic)-381.8(treatment)-377.4(when)-378.7(indicated,)-379.7(and)-377.5(to)-375.7(referral)-378(when)-378.7(nec-)]TJ
T*
[(essary.)-428.3(Telestroke)-428(programs)-428.8(demonstrated)-426.3(accuracy)-433.8(in)-418.9(diagnosing)]TJ
T*
[(ischemic)-301.9(versus)-308.2(hemorrhagic)-303.5(stroke)-302(and)-301.6(in)-298.8(reducing)-302.5(time)-301.5(to)-306.1(defini-)]TJ
0 -1.3278 TD
[(tive)-343.2(treatment.)-340.8(Also)-340(impressive)-345.5(were)-341.9(the)-344(wide)-341.9(range)-341.6(and)-339.6(combina-)]TJ
0 -1.3341 TD
[(tions)-384.3(of)-380(telemedicine)-388.7(technologies)-387.1(used)-383.3(that)-379.3(uniformly)-387.5(resulted)-380.3(in)]TJ
T*
[(improvements)-305.1(in)-298.8(the)-299.7(diagnosis)-307(and)-295.3(management)-305(of)-297.8(stroke.)-303.3(It)-302.8(is)-301.4(im-)]TJ
T*
[(portant)-226.3(that)-227.6(these)-226.5(improvements)-229.2(were)-228.1(obtained)-226(across)-224.7(a)-222.9(wide)-228.1(variety)]TJ
T*
[(of)-417.9(settings)-422.7(involving)-418(patients)-423.6(in)-412.6(remote)-424.9(communities.)-423.1(Studies)-419(fo-)]TJ
T*
[(cusing)-599.9(specifically)-602.9(on)-597.3()55.6(cost-effectiveness)43.5()-595.6(were)-601.1(limited.)-599.1(Never-)]TJ
T*
[(theless,)-478.6(annual)-479.8(cost)-473.2(savings)-482.1(to)-476.8(hub-and-spoke)-479.1(hospital)-481.1(networks)]TJ
T*
[(were)-240.7(identified.)-238.4(More)-242.4(timely)-240.3(remote)-235.2(identification)-244.4(of)-234.5(stroke)-238.8(type)-243.3(and)]TJ
0 -1.3278 TD
[(simultaneous)-303.8(reduction)-300.3(of)-297.8(time)-295.2(to)-299.8(treatment)-301.6(are)-294.4(associated)-303.8(with)-297.8(re-)]TJ
0 -1.3341 TD
[(duced)-313.4(cost)-315.1(to)-312.4(both)-313.7(patient)-315.4(and)-307.9(provider,)-317(coupled)-315.4(with)-310.4(better)-314.2(health)]TJ
T*
[(outcomes)-287.7(and)-276.3(improved)-285(quality)-284.4(of)-278.8(life)-283(for)-278.9(patients.)]TJ
1.1128 -1.3341 TD
-.0183 Tc
[(The)-273.1(m)-.3(ajor)-271.3(issue)-279.5(a)-.9(ddressed)-276(i)3.5(n)-275.6(a)-.9(ssessing)-276(telemedic)5.1(i)-2.9(nes)-278.2(impact)-275.4(on)-275.6(the)]TJ
-1.1128 -1.3341 TD
-.0198 Tc
[(treatment)-245.2(o).7(f)-243.2(C)2.1(OPD)-241(f)-2.9(ocused)-245.9(on)-239.2(pred)-5.6(icti)-4.4(ng)-5.6(,)-236(a)-2.4(nt)-5(icip)-5.6(atin)-5.3(g,)-242.4(prevent)-5(i)2(n)-5.2(g).7(,)-242.4(a)-2.4(nd)]TJ
/F11 1 Tf
11.9551 0 0 11.9551 50.1732 741.9966 Tm
0 Tc
[(BASHSHUR)-338.5(ET)-334.1(AL.)]TJ
7.9702 0 0 7.9702 50.1732 29.7638 Tm
[(7)-80(9)-78.2(4)-706.7(TELEMEDI)12.8(CINE)-329.6(and)-331.8(e-HEALT)11.5(H)]TJ
/F8 1 Tf
6.9738 0 0 6.9738 177.2787 29.7638 Tm
.1096 Tc
[(SEPTEM)6.4(BER)-333.1(2).2(01)8.2(4)]TJ
ET
q
1 i
0 792 612 -791.985 re
W n
32.315 .014984 .22675 791.985 re
f
/Document /MC14 BDC
Q
q
1 i
0 792 32.315 -173.367 re
W n
0 0 0 .29999 k
0 618.633 32.315 173.367 re
f
EMC
Q
32.315 763.994 242.646 .22675 re
f
endstream
endobj
309 0 obj
<>stream
Adobe Illustrator CS4
2010-08-04T11:54:42+05:30
2010-08-04T11:54:42+05:30
2010-08-04T11:54:42+05:30
68
256
JPEG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application/postscript
saved
xmp.iid:11FB61F30AB7DE11AEB3E861853EAFA4
2009-10-12T14:15:50+05:30
Adobe Illustrator CS4
/
converted
from application/postscript to application/vnd.adobe.illustrator
converted
from application/postscript to application/vnd.adobe.illustrator
saved
xmp.iid:0280117407206811994CBE3149FFDB59
2010-08-04T11:54:42+05:30
Adobe Illustrator CS4
/
converted
from application/postscript to application/vnd.adobe.illustrator
xmp.iid:11FB61F30AB7DE11AEB3E861853EAFA4
xmp.did:11FB61F30AB7DE11AEB3E861853EAFA4
uuid:ee5a72b3-04e4-4157-a8d8-c3a8817872a3
uuid:ee5a72b3-04e4-4157-a8d8-c3a8817872a3
xmp.iid:0280117407206811994CBE3149FFDB59
xmp.did:0280117407206811994CBE3149FFDB59
TouchUp 7.0
False
False
1
684.000000
864.000000
Points
Black
Default Swatch Group
0
PANTONE 3025 C
SPOT
100.000000
CMYK
100.000000
16.859999
0.000000
50.980003
endstream
endobj
306 0 obj
<>
endobj
310 0 obj
<>/XObject<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]/Font<>>>/Thumb 312 0 R/MediaBox[0 0 612 792]/Rotate 0>>
endobj
313 0 obj
<>/ProcSet[/PDF/Text]/Font<>>>
endobj
311 0 obj
<>stream
/GS1 gs
BT
/F1 1 Tf
8.9663 0 0 8.9663 35.8866 693.8644 Tm
0 0 0 1 k
-.0182 Tc
0 Tw
[(m)6.1(a)-.8(na)5.6(ging)-250.6(exacerbations)-246.5(i)-2.8(n)-243.9(p)-4(atie)5.2(nts)]TJ
14.7134 0 TD
-.0206 Tc
[(con)-6(d)-.1(it)-5.8(io)-6.4(ns.)-249.5(A)-3.8(lt)-5.8(ho)-6.4(ug)-6.4(h)-251(a)3.2(menabl)-5.2(e)-250.1(t).5(o)]TJ
-14.7134 -1.3278 TD
-.02 Tc
[(treatment,)-223.6(t)-5.2(h)-3.8(ese)-224.3(c)-3(on)-5.4(di)-4.6(tio)-5.8(n).9(s)-223(a)-2.6(dv)-5.8(ersel)-4.6(y)]TJ
14.9663 0 TD
-.0185 Tc
[(aff)4.7(ect)-225(qua)5.3(l)-3.1(ity)-219.3(o)-4.3(f)-216.6(l)-3.1(ife.)-222.1(A)-223(s)-.2(ignificant)]TJ
-14.9663 -1.3341 TD
-.0187 Tc
[(decline)-343.1(i)-3.3(n)-339.3(p)-4.5(u)3.8(l)-3.3(m)5.6(o)-4.5(nary)-346(f)4.5(u)-2.5(nction)-345.6(incr)]TJ
14.3657 0 TD
-.0185 Tc
[(e)4.9(a)-1.1(ses)-341.7(t)-3.7(he)-349.2(risk)-340.5(of)-343.1(mortality,)-342.2(and)-345.8(i)3.3(ts)]TJ
-14.3657 -1.3341 TD
-.0163 Tc
[(m)8(a)1.1(na)7.5(ge)7.1(men)4.6(t)-229.1(is)-225.7(co)4.2(st)4.8(ly)4.2(.)-226.2(T)-2.1(h)6.2(e)-226.9(maj)5.5(o)-2.1(r)-225(t)4.8(el)]TJ
14.334 0 TD
-.0183 Tc
[(em)6(edicine)-228.9(i)3.5(ntervention)-231.4(f)-1.4(or)-227(COPD)-226.9(is)]TJ
-14.334 -1.3341 TD
-.02 Tc
[(telespi)-4.6(r)-1.1(ometry)-220.8(\(remot)-5.2(e)-211.6(t)-5.2(est)-5.2(i)1.8(n)-5.4(g)-214.5(fo)-5.8(r)-216.1(l)1.8(ung)-214.5(f)-3.1(uncti)-4.6(o).5(n\))-219.5(al)-4.6(on)-5.4(g)-214.5(w)2.5(i)-4.6(t)1.1(h)-218.8(m)-2(oni)-4.6(t)1.1(o)-5.8(r)-1.1(ing)]TJ
T*
-.0195 Tc
[(of)-293.5(heart)-289.2(r)-.6(at)-4.7(e,)-292.7(p)-5.3(h)3(y)-5.3(s)-1.2(ical)-288.6(acti)-4.1(vi)-4.1(ty,)-292.7(a)-2.1(nd)-296.2(oxy)-5.3(g)1(en)-289.5(sat)-4.7(u)3(rati)-4.1(on.)-292.7(P)-4.9(erhaps)-292.1(i)-4.1(n)-289.5(p)-5.3(a)4.3(rt)]TJ
T*
[(because)-217.3(o)-5.2(f)-217.5(t)1.7(he)-223.7(nature)-217.3(of)-223.8(COPD)-6.7(,)-216.7(f)-2.5(ew)-218.2(studi)-4(e)-2.4(s)-216.1(i)-4(ncorpo)-5.2(rat)-4.6(e)-2.4(d)-220.2(m)-1.4(ortal)-4(i)2.4(ty)-220.2(as)-222.4(an)]TJ
T*
-.0199 Tc
[(en)-5.3(d)-195.4(poi)-4.5(nt.)-198.2(I)-2.4(t)-188.4(i)-4.5(s)-191.3(i)-4.5(mport)-5.1(a)3.9(n)-5.3(t)1.2(,)-191.9(h)-3.7(owever,)-191.9(t)]TJ
14.2518 0 TD
-.0204 Tc
[(h)-4.2(a)3.4(t)-195.3(t)-5.6(el)-5(emed)-6.2(icin)-5.8(e)-193(i)-5(nterven)-5.8(t).7(io)-6.2(ns)-191.8(w)-4.2(e)-3.4(re)]TJ
-14.2518 -1.3341 TD
-.0184 Tc
[(f)4.8(o)-4.2(u)4.1(n)-3.8(d)-301.4(t)-3.6(o)-301.4(r).5(educe)-304.9(a)-1(c)5(u)-2.2(te)-304.9(exa)5.4(cerbation)]TJ
14.334 0 TD
-.0181 Tc
[(s)-303.3(r).8(equiring)-301.1(change)-304.6(in)-300.7(medica)5.7(tions,)]TJ
-14.334 -1.3278 TD
-.0201 Tc
[(ho)-5.9(spit)-5.3(ali)-4.7(z)3.3(at)-5.3(ion)-5.5(s)-1.8(,)-407.1(a)-2.7(nd)-404.3(re-)-6.1(a)3.7(d)-5.9(m)4.2(i)-4.7(ssio)-5.9(n).8(s.)-407.1(Add)-5.9(i)1.7(ti)-4.7(on)-5.5(al)-4.7(ly)-5.9(,)-407.1(t)1(elemedi)-4.7(c)-3.1(ine)-407.7(i)-4.7(nt)-5.3(er-)]TJ
0 -1.3341 TD
-.0183 Tc
[(vention)-357.8(w)-2.1(as)-354.1(associated)-358.2(with)-356.2(improv)]TJ
14.7387 0 TD
[(ed)-358.3(reh)4.1(a)-1(bilitation)-357.9(and)-358.3(a)-355.1(decrease)5(d)]TJ
-14.7387 -1.3341 TD
-.0187 Tc
[(need)-276.4(for)-284.3(u)3.8(rgent)-275.8(c)-1.7(are)-279.9(f)-1.8(rom)-278.9(p)-4.5(ulmono)]TJ
14.2518 0 TD
-.0201 Tc
[(log)-5.9(i)1.7(st)-5.3(s)-280(o).4(r)-279.4(t)-5.3(he)-281.3(pati)-4.7(en)-5.5(ts)-280.6(o)-5.9(wn)-283.8(GP)-5.5(s.)]TJ
/F6 1 Tf
9.9626 0 0 9.9626 35.8866 538.4691 Tm
0 Tc
[(A)-333.4(FINAL)-342.9(COMMEN)-11.1(T)]TJ
/F1 1 Tf
8.9663 0 0 8.9663 45.8079 526.507 Tm
-.0211 Tc
[(W)-6.6(i).7(th)-232.5(t)-6.3(h)1.4(e)-238(w)1.4(id)-6.9(er)-236.2(di)-5.7(ssemi)-5.7(n)-.2(at)-6.3(ion)-234.2(o)-.6(f)-238.2(t)0(elemo)-6.9(n)-.2(itori)-5.7(n)-.2(g,)-237.3(we)-238(can)-234.2(e)2.3(x)-6.5(p)-.6(ect)-233.9(m)-3.1(ore)]TJ
-1.1065 -1.3341 TD
-.0205 Tc
[(pat)-5.7(i)1.3(ents)-362.6(wit)-5.7(h)-358.4(seri)-5.1(ous)-362.6(c)2.9(hronic)-363.9(il)-5.1(lnesses)-356.3(t)-5.7(o)-360.4(s)4.1(urviv)-6.3(e)-357.5(lon)-5.9(g)0(er)-362(and)-360.4(t).6(o)-360.4(e)-3.5(njoy)]TJ
T*
-.0183 Tc
[(be)5.1(tter)-265(qu)4.2(ality)-269.7(o)2.2(f)-267(l)-2.9(if)4.9(e)-273.1(t)2.8(ha)5.5(n)-269.3(i)-2.9(n)-269.3(t)2.8(he)-266.8(pre-telem)6(e)-1.3(dic)5.1(i)-2.9(ne)-266.8(era)5.5(.)-272.5(Of)-267(cour)6.9(se,)-266.2(i)-2.9(n)-269.3(t)2.8(his)]TJ
0 -1.3278 TD
-.0198 Tc
[(case,)-337.2(t)1.3(he)-331.5(law)-332.4(o)-5.6(f)-331.7()54.8(unin)-5.2(t)1.3(ended)-334.4(c)3.6(on)-5.2(sequences)54.8()-330.9(may)-334.4(c)-2.8(ome)-331.5(i)-4.4(nto)-334.4(p).7(l)-4.4(a)4(y.)-337.2(De-)]TJ
0 -1.3341 TD
-.0209 Tc
[(laying)-272.3(mo)-6.7(rt)-6.1(al)-5.5(ity)-272.3(f)2.3(or)-267.6(o)-6.7(l).9(der)-267.6(a)2.9(d)-6.7(u)1.6(lt)-6.1(s,)-268.8(as)-268.2(th)-4.7(ey)-266(li)-5.5(ve)-269.4(long)-6.7(er,)-268.8(i).9(s)-268.2(l)-5.5(ikely)-266(t)-6.1(o)-266(l).9(ead)-266(t).2(o)]TJ
T*
-.019 Tc
[(incre)4.4(a)-1.6(se)4.4(d)-384.2(u)-2.8(se)-381.3(of)-381.5(hea)4.7(l)-3.6(th)-382.2(se)4.4(rvic)4.4(es,)-380.7(e)-2(spec)4.4(ia)4.8(lly)-384.2(over)-385.8(t)2.1(he)-387.7(long)-384.2(run.)-380.7(None)4.4(-)]TJ
T*
[(th)3.5(eless,)-380.7(the)-381.3(h)3.5(igh)-382.2(c)-2(ost)-383.6(o)1.5(f)-381.5(a)-1.6(c)4.4(u)-2.8(te)-381.3(epis)5.6(odic)-381.3(car)6.2(e)-387.7(w)3.5(i)-3.6(ll)-382.9(be)-381.3(redu)3.5(ced)-384.2(th)3.5(rough)]TJ
T*
-.0206 Tc
[(timely)-215.1(in)-6(tervent)-5.8(i)1.2(on)-214.7(and)-215.1(s)-2.3(ub)-6.4(st)-5.8(itu)-4.4(t).5(io)-6.4(n,)-211.6(and)-215.1(p)-6.4(ati)-5.2(e)2.8(n)-6(t).5(s)-217.3(m)3.7(ay)-215.1(be)-218.5(more)-212.2(l)-5.2(i)1.2(kely)-215.1(to)]TJ
T*
-.0201 Tc
[(avo)-5.9(i)1.7(d)-189.3(r)-1.2(isky)-189.3(behaviors,)-185.8(t)-5.3(h)2.4(ereby)-189.3(l)-4.7(owerin)]TJ
15.0232 0 TD
.1692 Tc
[(go)189.7(v)183.4(e)192.6(r)188.1(a)186.6(l)191(l)1.3(h)185.4(e)192.6(a)186.6(l)191(t)184(h)191.7(c)186.2(a)]TJ
6.9931 0 TD
-.019 Tc
[(re)-191.6(expenditur)6.2(es.)]TJ
/F4 1 Tf
11.9551 0 0 11.9551 35.8866 406.9417 Tm
0 Tc
[(Executive)-339.2(Summary)]TJ
/F1 1 Tf
8.9663 0 0 8.9663 45.8079 395.0361 Tm
-.0181 Tc
[(Conc)5.3(ern)-427.2(w)-1.9(ith)-425.5(i)-2.7(ssu)4.4(es)-429.8(of)-424.9(inequitabl)]TJ
13.9673 0 TD
-.0178 Tc
[(e)-424.4(a)-.4(cc)5.6(ess,)-430.1(u)4.7(n)-3.2(even)-426.9(distribu)4.7(tion)-426.9(of)]TJ
-15.0738 -1.3341 TD
-.0163 Tc
[(q)4.2(u)-.1(a)7.4(l)-.9(i)5.5(t)-1.5(y)4.2(,)-182(a)7.5(n)-1.7(d)-179.2(c)7.1(ost)-178.5(i)5.5(nf)6.9(la)7.5(ti)5.5(on)-178.8(i)5.5(n)-178.8(he)7.1(alt)4.8(h)-.1(ca)7.5(re)-182.6(h)6.2(a)1.1(s)-181.4(l)5.5(on)4.6(g)-179.2(h)6.2(ist)4.8(o)-2.1(ri)5.5(cal)-177.9(r)2.6(o)4.2(o)-2.1(t)4.9(s)2(.)-175.6(Y)1.7(et)4.8(,)-182(t)4.8(he)]TJ
T*
-.019 Tc
[(vario)-4.8(u)3.5(s)-323.2(p)1.5(o)-4.8(l)2.8(i)-3.6(c)4.4(i)-3.6(e)-2(s)-316.9(a)-1.6(n)-4.4(d)-321(prog)-4.8(rams)-323.2(aimed)-321(a)-1.6(t)-320.3(r)-.1(edressi)-3.6(ng)-321(them)-317.2(si)-3.6(nce)-324.4(t)2.1(he)-318.1(b)-4.8(e)4.4(-)]TJ
T*
-.0176 Tc
[(gi)4.2(nning)-262.7(o)2.9(f)-260(t)3.5(he)-259.8(20th)-260.6(centu)4.9(ry)-262.7(ha)6.2(ve)-259.8(met)-255.7(w)]TJ
15.997 0 TD
[(ith)-260.7(l)4.1(imite)5.7(d)-262.8(succ)5.7(ess,)-259.2(as)-258.7(manife)5.7(st)]TJ
-15.997 -1.3341 TD
-.0198 Tc
[(in)-207.6(t)-5(h)2.7(ei)-4.4(r)-203.2(c)-2.8(o)-5.6(n)1.1(ti)-4.4(nuit)-5(y)-208(a)-2.4(nd,)-210.8(i)-4.4(n)-207.6(s)-1.5(ome)-205.1(i)-4.4(nst)-5(a)4(n)-5.2(c)3.6(es,)-210.8(e)-2.8(xacerbati)-4.4(on.)-210.8(A)-3(lt)-5(ho)-5.6(ug)-5.6(h)-205.9(t)1.3(here)]TJ
T*
.4486 Tc
[(i)470.4(s)-1(n)469.5(o)-5.1(c)472(o)462.8(n)469.5(s)466.9(e)465.6(n)469.5(s)466.9(u)464.8(so)469.1(nt)463.4(h)471.1(e)-2.3(m)466.6(o)469.1(s)466.9(t)-4.5(e)472(f)465.5(f)465.5(e)465.6(c)472(t)463.4(i)470.4(v)462.8(e)4.1(a)466(p)462.8(p)469.1(r)467.5(o)469.1(a)466(c)465.6(h)464.8(e)472(st)463.4(oa)466(d)469.1(d)469.1(r)467.5(e)465.6(s)466.9(st)469.7(h)464.8(e)465.6(s)466.9(e)]TJ
T*
-.02 Tc
[(prob)-5.8(lems,)-369(t)-5.2(here)-376(is)-374.8(un)-5.4(iv)-5.8(ersal)-371.3(a)-2.6(greement)-371.9(r)-1.1(egardi)-4.6(ng)-372.6(th)-3.8(eir)-374.2(s)-1.7(erio)-5.8(us)-374.8(imp)-5.8(li-)]TJ
T*
-.0203 Tc
[(cat)-5.5(i)1.5(on)-5.8(s)-217(f)2.9(o)-6.1(r)-216.4(th)-4.1(e)-218.2(h)2.2(ealt)-5.5(h,)-217.6(w)-4.1(e)-3.3(ll)-4.9(-bei)-4.9(ng,)-217.6(a)]TJ
13.9736 0 TD
-.02 Tc
[(nd)-220.8(prod)-5.8(uct)-5.2(i)1.8(vi)-4.6(ty)-220.8(of)-218.1(large)-217.9(s)-1.7(egment)-5.2(s)-216.7(o).5(f)]TJ
-13.9736 -1.3278 TD
-.018 Tc
[(the)-279.2(p)2.5(opulation,)-278.5(as)-277.9(well)-280.8(as)-277.9(th)4.5(e)-279.2(t)-3.2(h)4.5(r).9(eat)-281.4(t)3.1(o)-282(t)3.1(he)-279.2(public)-279.2(pu)4.5(rse.)]TJ
1.1065 -1.3341 TD
0 Tc
[(Advanced)-399.5(applications)-399.7(in)-400(ICT)-395.4(in)-393.6(healthcare)-401.6(\(referred)-402.2(to)-394.6(here)-398.7(as)]TJ
-1.1065 -1.3341 TD
[(telemedicine\))-449.1(were)-449.4(developed)-457(and)-447(tested)-453.9(with)-443.2(an)-448.6(eye)-451.3(to)-451.6(improve)]TJ
T*
[(healthcare)-357.3(access)-362.8(and)-358.5(quality)-360.2(while)-362.3(attempting)-363.3(to)-356.7(contain)-366.2(cost)-359.3(in-)]TJ
T*
[(flation.)-518.6(This)-524(technology)-531.1(has)-523.5(opened)-522.2(new)-521.3(vistas)-527.6(in)-520.1(connectivity,)]TJ
T*
[(clinical)-251.6(and)-257.4(shared)-252.1(decision)-259.6(making,)-256.4(system)-253.6(integration,)-259.9(and)-251(patient)]TJ
T*
[(empowerment,)-289.4(as)-293.1(well)-283.7(as)-293.1(organizational)-291.2(and)-289(operational)-294.4(efficiency.)]TJ
T*
[(Indeed,)-324.2(the)-325(need)-329.2(for)-323.1(the)-325(wider)-323(deployment)-333.4(of)-323.1(telemedicine)-325.5(systems)]TJ
0 -1.3278 TD
[(\(also)-210.1(referred)-215.3(to)-211.3(as)-210.9(telehealth,)-219.2(e-health,)-214.6(mobile)-215.6(health,)-214(and)-213.1(connected)]TJ
0 -1.3341 TD
[(health\))-393.3(stems)-400.5(from)-393.7(a)-399.9(large)-391.3(and)-396.5(ever-expanding)-402.5(body)-398.6(of)-398.9(empirical)]TJ
T*
[(evidence)-556.4(that)-556.4(attests)-561.1(to)-559(their)-556.2(merit)-554.5(in)-558(addressing)-558.4(the)-558.9(issues)-560.4(of)]TJ
T*
[(healthcare)-205.6(access,)-206(quality,)-209.8(and)-206.8(cost.)-202.5(This)-207.8(is)-200.2(particularly)-209.4(notable)-208.5(in)-204(the)]TJ
T*
[(case)-315.9(of)-316.7(chronic)-323(diseases,)-320.6(which)-323.6(are)-313.4(leading)-321.7(causes)-319.4(of)-316.7(death,)-320(illness,)]TJ
T*
[(disability,)-225.9(and)-225.7(diminished)-227(quality)-227.5(of)-228.2(life.)-227.4(Together)-227.6(they)-228.6(also)-225.6(make)-225.3(up)]TJ
T*
[(the)-331.3(largest)-332.9(contributor)-339(to)-331.4(healthcare)-338.3(costs.)-336(It)-328.1(is)-333(estimated)-333.6(that)-335.1(over)]TJ
T*
[(50%)-215.6(of)-215.6(all)-217.3(adults)-213.5(have)-219.7(at)-214.3(least)-220.5(one)-213.5(chronic)-221.8(illness.)-215.6(It)-214.3(is)-219.2(important)-218.2(that)]TJ
0 -1.3278 TD
[(these)-283.4(diseases)-281.4(are)-281.8(amenable)-280(to)-280.8(telemedicine)-287.5(intervention.)]TJ
1.1065 -1.3341 TD
[(A)-571.3(careful)-564(review)-571.5(of)-569.7(the)-565.3(published)-573.4(literature)-567.5(on)-565.6(telemedicine)]TJ
-1.1065 -1.3341 TD
[(management)-336.6(of)-335.7(three)-339.7(chronic)-341.9(diseases)-338.3(\(CHF,)-339.7(stroke,)-341.2(and)-333.2(COPD\))-341(re-)]TJ
T*
[(veals)-347.6(inconsistencies)-352.4(in)-349.4(methodologies)-353.4(used)-345.3(and)-352.2(variations)-345.3(in)-349.4(out-)]TJ
30.331 69.3307 TD
[(comes)-200.1(measured.)-199.4(We)-202.4(tried)-197.9(to)-198.6(reduce)-203.1(such)-197.9(variations)-199.8(by)-199.3(selecting)-204(only)]TJ
0 -1.3278 TD
[(RCTs)-237.9(or)-232.5(designs)-235.9(approximating)-233.1(an)-233.6(RCT)-237.2(and)-232.1(a)-229.2(minimal)-233.6(sample)-234.8(of)-234.5(150)]TJ
0 -1.3341 TD
[(cases)-272.4(\(with)-269.7(a)-267.1(few)-272.4(exceptions,)-274.2(which)-273.1(are)-269.1(noted\).)-271.5(A)-267.8(separate)-269.6(section)-274.4(is)]TJ
T*
[(devoted)-343.4(to)-344.1(cost)-340.4(studies.)-348.6(Because)-341(the)-344(studies)-341.1(did)-341.9(not)-342.2(use)-346.8(a)-336.7(standard)]TJ
T*
[(methodological)-364.1(protocol,)-359(their)-360.2(respective)-367.2(findings)-357.1(and)-358.5(conclusions)]TJ
T*
[(must)-236.3(be)-240.7(viewed)-241.1(from)-242(the)-236.5(perspective)-245.6(of)-234.5(the)-242.8(design)-235.2(features)-242.9(that)-240.2(were)]TJ
T*
[(used,)-334(including)-330.9(research)-327.1(design,)-331.3(sample)-336(size,)-325.5(and)-333.2(the)-331.3(specific)-330.3(attri-)]TJ
T*
[(butes)-279.9(of)-272.5(the)-280.7(intervention)-276.1(itself,)-282.8(such)-273.7(as)-280.4(technological)-277.6(configuration,)]TJ
T*
[(provider)-214.5(mix,)-218.9(patient)-214.2(mix,)-212.6(program)-213.2(content,)-216.8(frequency,)-222.1(and)-213.1(duration)]TJ
0 -1.3278 TD
[(of)-386.3(the)-388.2(intervention.)-391.2(There)-390.9(were)-386.1(also)-390(variations)-389.5(in)-381(the)-388.2(measures)-390(of)]TJ
0 -1.3341 TD
[(outcome.)-332.5(Findings)-334.5(are)-326(presented)-334.6(in)-324.1(terms)-330.3(of)-329.4(the)-331.3(reported)-332.4(empirical)]TJ
T*
[(evidence)-284.5(on)-281.1(health)-282.3(outcomes,)-282.6(use)-283.6(of)-285.1(service,)-281.7(and)-282.6(cost.)]TJ
/F6 1 Tf
9.9626 0 0 9.9626 307.8424 538.4691 Tm
[(FINDING)-14.2(S)-330(REL)-9.8(ATED)-334.9(TO)-337.3(HE)-7.2(ALTH)-338(OU)-7.4(TCOMES)]TJ
/F1 1 Tf
8.9663 0 0 8.9663 317.8204 526.507 Tm
[(Among)-263.8(CHF)-271.7(patients,)-266.8(telemonitoring)-268.4(was)-270.6(significantly)-264.3(associated)]TJ
-1.1128 -1.3341 TD
[(with)-392.6(reductions)-395.9(in)-387.3(mortality)-394.3(ranging)-396.7(from)-387.4(15%)-392.6(to)-394.6(56%)-392.6(compared)]TJ
T*
[(with)-493.8(patients)-499.4(undergoing)-498()55.6(usual)55.7()-494.5(care.)-493.6(In)-492.8(only)-498.1(one)-491.7(study)]TJ
6.7246 0 0 5.9768 536.2581 506.6077 Tm
(61)Tj
8.9663 0 0 8.9663 547.7101 502.5826 Tm
(was)Tj
-26.7522 -1.3278 TD
[(mortality)-470.2(higher)-477.5(among)-465.5(the)-476.7(telemonitoring)-470.7(group.)-473.8(However,)-477.1(this)]TJ
0 -1.3341 TD
[(exception)-215.3(may)-216(be)-209.1(accounted)-218(for)-215.7(by)-211.9(the)-211.2(fact)-212.1(that)-214.9(the)-211.2(study)-219.6(population)]TJ
T*
[(was)-258(composed)-258.7(of)-253.5(a)-254.5(very)-258.2(elderly)-260.9(and)-251(severely)-260(sick)-258.6(patient)-258.5(population)]TJ
T*
[(and)-377.5(other)-374.1(methodological)-383.1(issues.)-378.3(Conclusions)-376.4(from)-374.7(several)-381.3(studies)]TJ
T*
[(indicate)-519()55.6(noticeable)-527(change)-516.9(\(improvement\))-526.4(in)-513.8(health)-522.5(outcomes,)51.2()]TJ
T*
[()55.6(fewer)-218.8(episodes)-212.9(of)-215.6(health)-212.7(worsening,)52.1()-209.9()49.3(improved)-210.4(quality)-214.8(of)-215.6(life,)55.9()-216.2(and)]TJ
T*
[()55.6(general)-493.7(improvement)-494.1(in)-488.5(clinical,)-493.1(functional,)-496.1(and)-485(quality)-493(of)-493.8(life)]TJ
T*
[(status.)53()-387(I)0(n)-385.3(one)-390.5(robust)-390.4(study,)]TJ
6.7246 0 0 5.9768 416.8062 410.9668 Tm
(54)Tj
8.9663 0 0 8.9663 427.2944 406.9417 Tm
[(no)-388.6(significant)-388.8(differences)-392.2(were)-386.1(ob-)]TJ
-13.3224 -1.3278 TD
[(served)-494.8(between)-489.9(the)-489.4(intervention)-497.4(and)-491.3(control)-491.6(groups)-492.2(in)-488.5(terms)-488.4(of)]TJ
0 -1.3341 TD
[(mortality)-432.3(and)-428.1(morbidity.)-437.5(Telemonitoring)-433.5(offers)-429.1(lesser)-432.5(benefits)-434.6(for)]TJ
T*
[(elderly)-210.3(patients)-202.3(with)-209.3(multiple)-208.6(health)-206.4(problems,)-206.3(especially)-205.3(when)-207.9(those)]TJ
T*
[(in)-279.8()55.6(usual)-284.5(care)56.5()-285.8(have)-276.6(ready)-285(access)-280.6(to)-280.8(appropriate)-285(care.)]TJ
1.1128 -1.3341 TD
[(Telestroke)-232(provides)-234.1(an)-227.3(inherent)-225.6(advantage)-231.9(for)-228.3(stroke)-232.5(patients)-233.9(who)]TJ
-1.1128 -1.3341 TD
[(do)-445.9(not)-437(have)-447.3(ready)-443.1(access)-445(to)-445.2(stroke)-441.1(specialists.)-445.6(Prompt)-442.9(diagnosis,)]TJ
T*
[(initiation)-227.3(of)-221.9(treatment,)-227(supervision,)-229.4(and)-225.7(referral)-226.3(\(when)-224.1(indicated\))-230.2(are)]TJ
T*
[(critical)-311.1(for)-310.5(a)-305(successful)-316.3(outcome,)-313.5(given)-310.3(a)-311.4(potentially)-313.1(debilitating,)-311.6(if)]TJ
0 -1.3278 TD
[(not)-335.8(fatal,)-336.6(disease.)-338.9(Except)-342.5(for)-335.8(the)-337.6(telephone-only)-337.4(intervention)-345.7(\(with)]TJ
0 -1.3341 TD
[(poor)-482.4(sensitivity)-478.8(compared)-482.5(with)-481.2(video\),)-486.3(the)-476.7(various)-479.8(modalities)-484.8(of)]TJ
T*
[(telestroke)-193.4(have)-194.4(been)-196.4(demonstrated)-192.4(to)-192.3(reduce)-196.8(mortality)-198.3(in)-191.3(the)-192.2(range)-189.8(of)]TJ
T*
[(25%)-285.1(during)-279.7(the)-280.7(first)-282.5(year)-280.2(after)-281.7(the)-280.7(event.)]TJ
1.1128 -1.3341 TD
[(Only)-291.9(three)-301.7(COPD)-293.2(studies)-303.1(measured)-299.3(mortality)-293.2(outcomes.)-301.6(Two)-297(RCT)]TJ
-1.1128 -1.3341 TD
[(studies)-195.6(reported)-193.3(neutral)-189.1(findings,)-194(but)-195.1(one)-188.2(of)-196.6(these)-188.5(studies)-195.6(followed)-192.7(up)]TJ
T*
[(patients)-410.9(for)-411.7(only)-415.9(1)-409.5(week.)]TJ
6.7246 0 0 5.9768 405.4676 231.6472 Tm
(123)Tj
8.9663 0 0 8.9663 419.6408 227.622 Tm
[(An)-411.3(observational)-413.7(study)-415.6(found)-410.9()55.6(some)]TJ
-12.4688 -1.3341 TD
[(positive)-249.6(benefits)]TJ
/F5 1 Tf
7.0374 0 TD
(vis-a)Tj
1.7704 .0127 TD
(`)Tj
.2909 -.0127 TD
(-vis)Tj
/F1 1 Tf
1.802 0 TD
[(COPD)-242.7(mortality)53.3()-247.9(2)-238.8(months)-245.5(after)-243.8(discharge)]TJ
-10.9007 -1.3278 TD
[(from)-330.5(the)-325(hospital.)]TJ
6.7246 0 0 5.9768 375.307 207.7228 Tm
(130)Tj
8.9663 0 0 8.9663 388.7999 203.7543 Tm
[(Likely)-329(positive)-325.4(effects)-331(of)-329.4(telepulmonology)-333.8(in-)]TJ
-9.0291 -1.3341 TD
[(clude)-185.7(fewer)-192.2(exacerbations)-187.5(in)-185(the)-185.9(disease)-185.9(and)-187.8(improvements)-191.3(in)-185(quality)]TJ
T*
[(of)-278.8(life)-283(and)-282.7(exercise)-282(capacity.)]TJ
/F6 1 Tf
9.9626 0 0 9.9626 307.8424 155.9055 Tm
[(FINDING)-14.2(S)-330(REL)-9.8(ATED)-334.9(TO)-337.3(USE)-339.4(OF)-337.3(SERVIC)-9.7(E)]TJ
/F1 1 Tf
8.9663 0 0 8.9663 317.8204 143.9433 Tm
[(The)-433.1(majority)-434.5(of)-436.9(studies)-435.9(of)-430.5(telemonitoring)-439.1(for)-430.6(all)-438.6(three)-434.5(chronic)]TJ
-1.1128 -1.3341 TD
[(diseases)-616.5(reported)-623.3(lower)-620.2(hospital)-613.9(admissions)-620.1(and)-617.8(re-admissions,)]TJ
T*
[(length)-255.5(of)-247.2(stay,)-252.7(and)-251(emergency)-250.5(department)-256.4(visits.)-252.6(There)-251.8(were)-253.4(notable)]TJ
0 -1.3278 TD
[(exceptions,)-267.8(but)-264.6(in)-260.9(those)-260.9(instances)-263.6(the)-261.8(effects)-267.8(of)-259.8(telemonitoring)-268.4(were)]TJ
0 -1.3341 TD
[(neutral.)-184.1(One)-184.4(study)]TJ
6.7246 0 0 5.9768 374.9101 100.1197 Tm
(121)Tj
8.9663 0 0 8.9663 387.0424 96.1512 Tm
[(found)-189.6(telepulmonology)-188.4(to)-186(result)-183.9(in)-178.7(cost)-188.6(shifting)]TJ
-8.8331 -1.3341 TD
[(in)-305.1(the)-306(outpatient)-314.5(setting)-308.2(\(i.e.,)-310(a)-305(decrease)-305.7(in)-311.4(demand)-303(for)-310.5(pulmonolo-)]TJ
T*
[(gists)-279.4(and)-282.7(an)-284.2(increase)-281.6(in)-279.8(demand)-284.1(for)-278.9(nurses\).)]TJ
/F11 1 Tf
11.9551 0 0 11.9551 287.5464 741.9966 Tm
[(TELEMEDICINE)-340.6(FOR)-332.7(CHRONIC)-338.8(DISEASE)-334.7(MANAGE)-7.3(MENT)]TJ
/F9 1 Tf
6.9738 0 0 6.9738 186.5763 29.7638 Tm
()Tj
/F7 1 Tf
1.3251 0 TD
.1996 Tc
[(MA)-8.8(RY)-329.1(A)-8.8(N)-2.7(N)-327.9(L)-.9(IE)-5.8(BE)-5.8(RT,)-335.2(I)-3.8(NC.)]TJ
/F10 1 Tf
15.015 0 TD
0 Tc
()Tj
/F7 1 Tf
.9999 0 TD
.1103 Tc
[(VOL.)-327(20)-1000.8(N)5.5(O)4(.)-335.1(9)]TJ
/F10 1 Tf
8.3814 0 TD
0 Tc
()Tj
/F8 1 Tf
.9999 0 TD
.1099 Tc
[(SEPTEMB)6.6(E)2.1(R)-332.8(2).5(014)]TJ
/F4 1 Tf
7.9702 0 0 7.9702 441.6377 29.7638 Tm
0 Tc
[(TELEMEDICI)10.7(NE)-332(and)-328.9(e-HEALTH)-647.9(795)]TJ
ET
q
1 i
0 792 612 -791.985 re
W n
579.685 .014984 .22681 791.985 re
f
337.039 767.962 274.961 .22675 re
f
Q
endstream
endobj
314 0 obj
<>/XObject<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]/Font<>/Properties<>>>/Thumb 319 0 R/MediaBox[0 0 612 792]/Annots[320 0 R 321 0 R 322 0 R 323 0 R 324 0 R 325 0 R 326 0 R 327 0 R 328 0 R 329 0 R 330 0 R 331 0 R 332 0 R 333 0 R 334 0 R 335 0 R 336 0 R 337 0 R 338 0 R 339 0 R 340 0 R 341 0 R 342 0 R 343 0 R 344 0 R 345 0 R 346 0 R 347 0 R 348 0 R 349 0 R 350 0 R 351 0 R 352 0 R 353 0 R]/Rotate 0>>
endobj
354 0 obj
<>/ProcSet[/PDF/Text]/Font<>/Properties<>>>
endobj
315 0 obj
<>stream
/GS1 gs
BT
/F6 1 Tf
9.9626 0 0 9.9626 50.1732 693.1841 Tm
0 0 0 1 k
0 Tc
0 Tw
[(FINDINGS)-344.3(RELAT)-10.9(ED)-333.8(TO)-337.3(COST)]TJ
/F1 1 Tf
8.9663 0 0 8.9663 60.0945 681.2219 Tm
[(The)-395.2(economic)-397.4(effects)-394.2(of)-392.6(telemonitoring)-394.9(have)-396.7(been)-392.5(measured)-394.1(or)]TJ
-1.1065 -1.3341 TD
[(examined)-333.4(in)-330.4(two)-334.2(ways:)-327.5(\(1\))-334.3(changes)-334.2(in)-330.4(rates)-330.9(or)-333.7(volumes)-335.7(of)-329.4(hospital)]TJ
T*
[(admissions,)-475.9(re-admissions,)-483(length)-483.2(of)-474.8(stay,)-480.4(and/or)-479.3(emergency)-478.1(de-)]TJ
T*
[(partment)-350.9(visits)-352.5(and)-352.2(\(2\))-353.3(cost-benefit)-355.6(analysis)-349.6(and)-352.2(cost-effectiveness)]TJ
T*
[(analysis)-368.5(of)-367.3(telemonitoring)-369.6(in)-368.4(terms)-368.3(of)-373.6(specified)-373(outcomes.)-371.1(In)-366.3(both)]TJ
0 -1.3278 TD
[(instances)-358.4(and)-364.8(with)-361(few)-360.9(exceptions,)-369(the)-362.9(evidence)-366.7(supports)-364.3(the)-356.6(eco-)]TJ
0 -1.3341 TD
[(nomic)-325.5(benefits)-333.4(of)-329.4(telemonitoring)-338(compared)-330.7(with)-329.4(usual)-333.8(care)-328(among)]TJ
T*
[(patients)-278.1(with)-285.2(CHF,)-279.3(stroke,)-284.3(and)-282.6(COPD.)]TJ
/F4 1 Tf
11.9551 0 0 11.9551 50.1732 571.6345 Tm
(Conclusions)Tj
/F1 1 Tf
8.9663 0 0 8.9663 60.0945 559.6723 Tm
[(There)-220.2(is)-219.2(an)-214.6(ever-growing)-222.4(and)-219.4(complex)-218.4(body)-215.2(of)-221.9(empirical)-217.9(evidence)]TJ
-1.1065 -1.3341 TD
[(that)-290.8(attests)-289.2(to)-287.2(the)-293.4(potential)-292.1(of)-291.5(telemedicine)-293.9(for)-291.5(addressing)-292.9(problems)]TJ
T*
[(of)-335.7(access)-337.5(to)-331.4(care,)-341.9(quality)-335(of)-335.7(care,)-335.5(and)-339.6(healthcare)-338.3(costs)-334.7(in)-336.7(the)-337.6(man-)]TJ
T*
[(agement)-234.8(of)-240.9(the)-236.5(three)-238.5(chronic)-240.8(diseases)-237.1(chosen)-237.9(for)-241(this)-232.5(review.)-244(Despite)]TJ
T*
[(some)-444.7(inconsistencies)-447.3(in)-444.2(methodologies,)-449.5(the)-445.1(preponderance)-448.5(of)-443.2(the)]TJ
0 -1.3278 TD
[(evidence)-411(produced)-411.6(by)-414.3(telemonitoring)-413.8(studies)-410.6(points)-408.1(to)-413.6(significant)]TJ
0 -1.3341 TD
[(trends)-294.3(in)-292.5(reducing)-296.2(hospitalization)-302.7(and)-295.3(emergency)-301.1(department)-294.4(visits)]TJ
T*
[(and)-282.7(preventing)-294.1(and/or)-283.3(limiting)-287.8(illness)-290.2(severity)-287.5(and)-289(episodes,)-290(result-)]TJ
T*
[(ing)-189.8(in)-191.3(improved)-196.5(health)-193.7(outcomes.)-200.4(It)-189(is)-193.9(hoped)-196.2(that)-189.6(this)-194.5(evidence)-196(would)]TJ
T*
[(be)-417.7(useful)-418.5(for)-418(policymakers,)-421.5(researchers,)-425.9(program)-421.8(developers,)-422.6(pro-)]TJ
T*
[(viders,)-282.7(payers,)-280.7(and)-282.7(the)-280.7(public)-280.6(at)-283.9(large.)]TJ
/F4 1 Tf
11.9551 0 0 11.9551 50.1732 414.1983 Tm
(Acknowledgements)Tj
/F1 1 Tf
8.9663 0 0 8.9663 60.0945 402.2361 Tm
[(The)-211.8(Alliance)-212.3(for)-209.3(Connected)-215.1(Health)-214.2(provided)-212.9(partial)-208.9(support)-218.1(for)-209.3(the)]TJ
-1.1065 -1.3278 TD
[(work)-234.8(leading)-245.9(to)-236.6(this)-238.8(publication)-242.2(in)-241.9(the)-236.5(form)-242(of)-240.9(an)-233.6(unrestricted)-245.5(grant.)]TJ
/F4 1 Tf
11.9551 0 0 11.9551 50.1732 363.9117 Tm
[(Disclosure)-340.5(Statement)]TJ
/F1 1 Tf
8.9663 0 0 8.9663 60.0945 351.9495 Tm
[(J.S.)-330.7(is)-333(an)-328.4(employee)-334.6(of)-329.4(The)-332(Global)-332.3(Telemedicine)-332.5(Group.)-334.1(No)-325.2(com-)]TJ
-1.1065 -1.3341 TD
[(peting)-282.9(financial)-279.5(interests)-280.8(exist)-286.6(for)-278.9(any)-282.7(of)-278.8(the)-280.7(other)-285.6(authors.)]TJ
/F6 1 Tf
7.9702 0 0 7.9702 50.1732 304.1574 Tm
.1833 Tc
[(RE)-4.5(FE)-4.5(R)-6.1(E)2.6(N)-4.3(C)-5.8(E)-4.5(S)]TJ
/F16 1 Tf
0 -1.6289 TD
0 Tc
[(1.)-706.8(Bodenheime)14.2(r)-335.3(T)0(,)-331.4(Chen)-329.2(E,)-333.4(Bennett)-323.9(HD.)-333.8(Confronting)-325.5(the)-333(growing)-324(burden)-325.8(of)]TJ
1.3728 -1.1239 TD
[(chronic)-330.1(disease:)-320.6(Can)-332.6(the)-333(U.S.)-332(health)-327.5(care)-328.6(workforce)-326.6(do)-329.5(the)-333(job?)]TJ
/F18 1 Tf
25.0951 0 TD
[(Health)-323.4(Aff)]TJ
-25.0951 -1.1239 TD
[(\()-81.4(Millwood\))]TJ
/F20 1 Tf
4.4457 0 TD
(2009;)Tj
/F16 1 Tf
2.4398 0 TD
(28:6474.)Tj
-8.2583 -1.6858 TD
(2.)Tj
/F18 1 Tf
1.3728 0 TD
[(Trans)-324.8(Am)-334.7(Med)-325.7(Assoc)]TJ
/F20 1 Tf
8.486 0 TD
(1848;)Tj
/F16 1 Tf
2.4469 0 TD
[(1:10113)14.1(3.)]TJ
-12.3057 -1.6929 TD
[(3.)-706.8(Johnson)-326.6(C,)-331.5(Conway)-325.5(J,)-333.6(Talliaferro)-329.3(H.)-329.7(Report)-330.8(on)-329.8(the)-333(number)-321.8(of)-332.9(practitioners)-324.5(in)]TJ
1.3728 -1.1239 TD
(Virginia.)Tj
/F18 1 Tf
3.4072 0 TD
[(Trans)-331.9(Am)-327.6(Med)-325.7(Assoc)]TJ
/F20 1 Tf
8.4931 0 TD
(1848;)Tj
/F16 1 Tf
2.4398 0 TD
[(1:35936)14.1(4.)]TJ
-15.7129 -1.6858 TD
[(4.)-706.8(Lyon)-328.7(E.)-333.4(Further)-325.2(data)-335.1(on)-329.8(the)-325.9(alleged)-328.1(lack)-336.9(of)-325.8(physicians)-330(and)-330.9(distribut)11.5(ion)-332.3(of)]TJ
1.3728 -1.1239 TD
[(irregular)-324.5(practitioners.)]TJ
/F18 1 Tf
8.863 0 TD
(JAMA)Tj
/F20 1 Tf
2.5038 0 TD
(1923;)Tj
/F16 1 Tf
2.4398 0 TD
(80:718.)Tj
-15.1794 -1.6858 TD
[(5.)-706.8(Smith)-269.7(H,)-279.9(Warnshuis)-271.2(F.)-274.8(The)-274.2(distribution)-271(of)-276(physicians)-273.1(in)-270.7(relation)-273.7(to)-276(population)]TJ
1.3728 -1.131 TD
[(A)-284.1(statistical)-279.4(survey)-277.7(and)-281.2(study)-282.8(covering)-280.1(ten)-276.1(years)-281.1(\(19131924\).)]TJ
/F18 1 Tf
24.1775 0 TD
[(J)-285.8(Mich)-285.5(Med)-275.9(Soc)]TJ
/F20 1 Tf
-24.1775 -1.1239 TD
(1926;)Tj
/F16 1 Tf
2.4398 0 TD
(25:8994.)Tj
-3.8126 -1.6858 TD
[(6.)-706.8(Carroll)-332.2(A.)-331.9(Too)-328.6(few)-330.6(physicians)-322.9(doesnt)-328.1(necessarily)-328(mean)-326.8(too)-330.5(many)-326.8(specialists.)]TJ
1.3728 -1.1239 TD
[(June)-331.3(16,)]TJ
/F20 1 Tf
3.5637 0 TD
(2013.)Tj
/F16 1 Tf
2.7314 0 TD
[(news@JAMA.)-325(Available)-326.3(at)-329.3(http://theinciden)10.5(taleconomis)12(t.com/)]TJ
-6.2951 -1.1239 TD
[(wordpress/ja)13(ma-forum-to)10.2(o-few-genera)10.7(list-physicians-do)10(esnt-necess)13.5(arily-)]TJ
T*
[(mean-too-m)12.4(any-specialists)-323.4(\(last)-329.9(accessed)-328.4(May)-329.2(1,)-329.8(2014\).)]TJ
-1.3728 -1.6929 TD
[(7.)-706.8(Young)-287.3(A,)-296.3(Chaudhry)-291.3(H,)-294.1(Thomas)-290.2(J,)-290.9(et)-292.4(al.)-300.3(A)-291.2(census)-290.7(of)-297.3(actively)-290.5(licensed)-286.1(physicians)]TJ
1.3728 -1.1239 TD
[(in)-334.7(the)-325.9(United)-330.5(States,)-327.3(2012.)]TJ
/F18 1 Tf
10.7551 0 TD
[(J)-328.5(Med)-332.8(Reg)]TJ
/F20 1 Tf
4.4386 0 TD
(2013;)Tj
/F16 1 Tf
2.4398 0 TD
(99:1124.)Tj
-19.0063 -1.6858 TD
[(8.)-706.8(Bashshur)-326.3(R,)-331.9(Shannon)-322(G.)]TJ
/F18 1 Tf
11.1107 0 TD
[(History)-328.4(of)-325.8(telemedicine:)-328.5(Evolution,)-323.1(context)-330.5(and)]TJ
-9.7379 -1.1239 TD
[(transformati)13.4(on)]TJ
/F16 1 Tf
5.7972 0 TD
[(.)-332.3(New)-327.4(Rochelle,)-331.4(NY:)-325.4(Mary)-330.2(Ann)-329.8(Liebert,)-332.7(Inc.,)]TJ
/F20 1 Tf
17.0004 0 TD
(2009.)Tj
/F16 1 Tf
-24.1704 -1.6858 TD
[(9.)-706.8(Howitt)-329.3(A.)]TJ
/F18 1 Tf
5.342 0 TD
[(The)-331.1(native)-325.8(tribes)-330.7(of)-332.9(South-Easte)14.9(rn)-333.2(Australia.)]TJ
/F16 1 Tf
17.6406 0 TD
[(New)-334.5(York:)-325.7(MacMillan)]TJ
-21.6097 -1.131 TD
[(and)-330.9(Company,)]TJ
/F20 1 Tf
5.8612 0 TD
(1904.)Tj
/F16 1 Tf
26.8876 77.5758 TD
[(10.)-227.8(Fine)-284.2(L.)-288.7(Circle)-289(of)-283.1(urine)-283.7(glasses:)-280.2(Art)-286.1(of)-290.2(uroscop)14(y.)]TJ
/F18 1 Tf
19.4402 0 TD
[(Am)-284.9(J)-285.8(Nephrol)]TJ
/F20 1 Tf
5.4985 0 TD
(1986;)Tj
/F16 1 Tf
2.4398 0 TD
(6:307311.)Tj
-27.3785 -1.6858 TD
[(11.)-227.8(Wild)-250.1(W.)-259.7(Doc)20.1(tor)14.7(-pa)16.4(tie)18.1(nt)-255(cor)16.2(res)18.6(pon)14(de)16.9(nce)-253.2(in)-256.5(eig)14.3(hte)15.5(en)16.5(th-)16.2(cen)17.1(tu)15.3(ry)-263.9(Br)14(ita)16.7(in:)-252.2(A)-269.9(c)0(h)16.9(ang)17.6(e)]TJ
1.3728 -1.1239 TD
[(in)-327.6(rh)15.3(eto)15.9(ric)-315.9(an)15.2(d)-331.9(rel)18.1(ati)16.7(ons)16.7(hi)13.8(p.)]TJ
/F18 1 Tf
10.9685 0 TD
[(Stu)18.1(d)-331.9(Eig)20.1(hte)15.5(en)16.5(th)-326.1(Ce)15.2(ntu)17.4(ry)-320.9(Cul)14.5(tu)15.3(re)]TJ
/F20 1 Tf
12.825 0 TD
[(200)15.4(0;)]TJ
/F16 1 Tf
2.4185 0 TD
[(29:)16.2(47)21.5(64.)]TJ
-27.5847 -1.6858 TD
[(12.)-227.8(Jepsen)-332.7(T.)]TJ
/F18 1 Tf
5.1499 0 TD
[(My)-328.1(sisters)-330.3(telegraph)12.4(ic:)-334.2(Women)-328.9(in)-327.6(the)-333(telegraph)-321.9(office,)-333.5(18461950)14.6(.)]TJ
/F16 1 Tf
-3.7771 -1.1239 TD
[(Athens,)-330.5(OH:)-331.6(Ohio)-329.4(University)-323.8(Press,)]TJ
/F20 1 Tf
13.6217 0 TD
(2000.)Tj
/F16 1 Tf
-14.9945 -1.6929 TD
[(13.)-227.8(Letter)-328.8(to)-332.9(the)-333(editor.)]TJ
/F18 1 Tf
9.3111 0 TD
(Lancet)Tj
/F20 1 Tf
2.8381 0 TD
(1879;)Tj
/F16 1 Tf
2.4398 0 TD
(\(Nov\).)Tj
-14.589 -1.6858 TD
[(14.)-227.8(Einthoven)-329.9(W.)-330.8(Het)-332.5(telecard)12(iogram)-334.9([The)-327.2(telecardiogra)12.2(m].)]TJ
/F18 1 Tf
22.883 0 TD
[(Ned)-329.4(Tijd)-328.9(Geenesk)]TJ
/F20 1 Tf
-21.5101 -1.1239 TD
(1906;)Tj
/F16 1 Tf
2.4469 0 TD
[(6:30731)14.1(1.)]TJ
-3.8198 -1.6858 TD
[(15.)-227.8(Brown)-332.7(SG.)-326.9(A)-333.9(telephone)-328.2(relay.)]TJ
/F18 1 Tf
13.0668 0 TD
[(J)-328.5(Inst)-331(Electr)-332(Eng)]TJ
/F20 1 Tf
6.6294 0 TD
(1910;)Tj
/F16 1 Tf
2.4398 0 TD
(45:590601.)Tj
-22.1361 -1.6858 TD
[(16.)-227.8(James)-289.5(W,)-288.1(Williams)-282.8(H.)-287(The)-288.5(electrocardi)11.5(ogram)-289.7(in)-285(clinical)-285.4(medicine.)]TJ
/F18 1 Tf
26.404 0 TD
[(Am)-284.9(J)-293(Med)-283(Sci)]TJ
/F20 1 Tf
-25.0311 -1.131 TD
(1910;)Tj
/F16 1 Tf
2.4469 0 TD
[(140:408)14.1(421,)-332.1(644669.)]TJ
-3.8198 -1.6858 TD
[(17.)-227.8(Rafto)-334.6(T.)]TJ
/F18 1 Tf
4.7018 0 TD
[(Telegrafverket)15.1(s)-336.3(historie:)-329.4(18551955)]TJ
/F16 1 Tf
13.6999 0 TD
[(.)-332.3(Bergen,)-327.6(Norway:)-329.9(John)-329.1(Griegs)]TJ
-17.0288 -1.1239 TD
(Boktr,)Tj
/F20 1 Tf
2.5465 0 TD
(1955.)Tj
/F16 1 Tf
-3.9193 -1.6858 TD
[(18.)-227.8(Elford)-320.9(DR.)-321.8(Telemedicine)-314.5(in)-320.5(northern)-321.3(Norway.)]TJ
/F18 1 Tf
18.8996 0 TD
[(J)-321.4(Telemed)-312.3(Telecare)]TJ
/F20 1 Tf
7.4688 0 TD
(1997;)Tj
/F16 1 Tf
2.4398 0 TD
(3:122.)Tj
-28.8082 -1.6858 TD
[(19.)-227.8(Goethe)-242.4(WHG.)-240.3(Medical)-238.8(care)-243.2(on)-244.5(ships)-236.7(without)-242.4(a)-243(doctorRad)12(io)-249.1(medical)-238.5(advice.)-240.1(In:)]TJ
/F18 1 Tf
1.3728 -1.131 TD
[(Handbook)-323.8(of)-332.9(nautical)-330.8(medicine)]TJ
/F16 1 Tf
12.1706 0 TD
[(.)-332.3(Berlin:)-325.9(Springer,)]TJ
/F20 1 Tf
6.978 0 TD
(1984:)Tj
/F16 1 Tf
2.454 0 TD
(5365.)Tj
-22.9754 -1.6858 TD
[(20.)-227.8(Gershon-Coh)12.5(en)-324.9(J,)-319.4(Cooley)-323.7(AG.)-322.1(Telognos)13(is,)-322.5(three)-319.6(year)-321.8(experience)-317.1(with)-317(diagnosis)]TJ
1.3728 -1.1239 TD
[(by)-331.4(telephone-tra)11(nsmitted)-329.7(roentgenogram)16.5(s.)]TJ
/F18 1 Tf
16.8937 0 TD
(Radiology)Tj
/F20 1 Tf
4.1256 0 TD
(1950;)Tj
/F16 1 Tf
2.4398 0 TD
(55:582587.)Tj
-24.832 -1.6858 TD
[(21.)-227.8(Jutras)-331.5(A,)-331.9(Duckett)-329.9(G.)-329.7(Distant)-329.8(radiodiagn)10.6(osis;)-334.1(telefluoros)11.6(copy)]TJ
/F21 1 Tf
24.7182 0 TD
(&)Tj
/F16 1 Tf
-23.3453 -1.1239 TD
[(cinefluorogra)10.2(phy.)]TJ
/F18 1 Tf
7.0064 0 TD
[(Union)-327.6(Med)-325.7(Canada)]TJ
/F20 1 Tf
7.8742 0 TD
(1957;)Tj
/F16 1 Tf
2.4398 0 TD
[(86:1284128)14.2(9.)]TJ
-18.6933 -1.6929 TD
[(22.)-227.8(Wittson)-327.7(CL,)-330.6(Dutton)-333.9(R.)-331.9(A)-326.8(new)-334.7(tool)-325.9(in)-334.8(psychiatric)-324.4(education.)]TJ
/F18 1 Tf
7.9702 0 0 7.9702 517.7762 461.14 Tm
[(Mental)-327.1(Hosp)]TJ
/F20 1 Tf
-23.1746 -1.1239 TD
(1955;)Tj
/F16 1 Tf
2.4469 0 TD
[(11:3538)14.1(.)]TJ
-3.8198 -1.6858 TD
[(23.)-227.8(Bashshur)-326.3(R,)-331.9(Shannon)-322(G,)-329.7(Sapci)-332.2(H.)-329.6(Telemedici)10.4(ne)-332(evaluation.)]TJ
/F18 1 Tf
24.2344 0 TD
[(Telemed)-319.4(J)-335.6(E)-328.3(Health)]TJ
/F20 1 Tf
-22.8616 -1.1239 TD
(2005;)Tj
/F16 1 Tf
2.4469 0 TD
[(11:2963)14.1(16.)]TJ
-3.8198 -1.6858 TD
[(24.)-227.8(Chronic)-329.9(disease)-324.9(prevention)-329.2(and)-330.9(health)-327.5(promotio)11.5(n.)-337.3(Available)-326.3(at)-329.3(www.CDC.gov/)]TJ
1.3728 -1.131 TD
[(chronicdisease/)10.1(overview/index)10.6(.htm)-324.8(\(last)-337(accessed)-321.3(March)-327.8(25,)-334.5(2014\).)]TJ
-1.3728 -1.6858 TD
[(25.)-227.8(Woolliscroft)-330.4(J,)-326.5(Koelling)-332.6(TM.)-325.4(Redesigning)-329.1(the)-325.9(management)-325(of)-332.9(chronic)-323(illness.)]TJ
/F18 1 Tf
1.3728 -1.1239 TD
[(Telemed)-326.5(J)-335.6(E)-335.4(Health)]TJ
/F20 1 Tf
7.732 0 TD
(2004;)Tj
/F16 1 Tf
2.4398 0 TD
(10:118121.)Tj
-11.5446 -1.6858 TD
[(26.)-227.8(Wagner)-308.9(EH.)-309.4(Managed)-302.1(care)-307.2(and)-309.6(chronic)-301.7(illness:)-310.8(Health)-305.6(services)-305.1(research)-300.8(needs.)]TJ
/F18 1 Tf
1.3728 -1.1239 TD
[(Health)-330.5(Serv)-332.1(Res)]TJ
/F20 1 Tf
6.4872 0 TD
(1997;)Tj
/F16 1 Tf
2.4398 0 TD
(32:702.)Tj
-10.2998 -1.6929 TD
[(27.)-227.8(Bodenheimer)-321.1(T,)-331.4(Wagner)-323.2(EH,)-330.8(Grumbach)-320(K.)-330.2(Improving)-324.8(primary)-323.8(care)-328.6(for)-326.7(patients)]TJ
1.3728 -1.1239 TD
[(with)-331.2(chronic)-330.1(illness.)]TJ
/F18 1 Tf
8.0236 0 TD
(JAMA)Tj
/F20 1 Tf
2.5038 0 TD
(2002;)Tj
/F16 1 Tf
2.4398 0 TD
[(288:17751779)11.9(.)]TJ
-14.3401 -1.6858 TD
[(28.)-227.8(Coleman)-326.2(K,)-337.3(et)-328(al.)-335.9(Evidence)-325.2(on)-329.8(the)-333(chronic)-323(care)-335.7(model)-325.4(in)-334.8(the)-325.9(new)-327.6(millennium.)]TJ
/F18 1 Tf
1.3728 -1.1239 TD
[(Health)-330.5(Aff)-328.8(\()-88.5(Millwood\))]TJ
/F20 1 Tf
8.8061 0 TD
(2009;)Tj
/F16 1 Tf
2.4398 0 TD
[(28:7585)14.1(.)]TJ
-12.6187 -1.6858 TD
[(29.)-227.8(American)-329.4(Heart)-327.5(Association.)-328.4(About)-327.6(heart)-328(failure.)-331(Available)-326.3(at)-336.4(www.heart.)9.6(org/)]TJ
1.3728 -1.131 TD
[(HEARTORG/Co)8.7(nditions/Heart)11.4(Failure/AboutH)8.6(eartFailure/Abo)9.1(ut-Heart-)]TJ
0 -1.1239 TD
[(Failure_UCM_)9.2(002044_Artic)13.1(le.jsp)-336.7(\(last)-329.9(accessed)-321.3(February)-331.6(15,)-327.4(2014\).)]TJ
-1.3728 -1.6858 TD
[(30.)-227.8(McMurray)-237.2(J,)-241.1(Adamopoulos)-233.7(S,)-244.1(Arker)-235.5(S,)-244.1(et)-242.6(al.)-243.4(ESC)-239.5(guidelines)-234.8(for)-241.4(the)-240.5(diagnosis)-235.5(and)]TJ
1.3728 -1.1239 TD
[(treatment)-330.5(of)-332.9(acute)-326.5(and)-331(chronic)-323(heart)-335.1(failure)-325.9(2012.)]TJ
/F18 1 Tf
20.0875 0 TD
[(Eur)-334.3(J)-328.5(Heart)-331(Fail)]TJ
/F20 1 Tf
-20.0875 -1.1239 TD
(2012;)Tj
/F16 1 Tf
2.4469 0 TD
[(14:8038)14.1(69.)]TJ
-3.8198 -1.6858 TD
[(31.)-227.8(American)-300.9(Heart)-291.9(Association.)-300(Classificati)11.5(on)-301.4(of)-304.4(functional)-290.5(capacity)-293.7(and)-302.5(objective)]TJ
1.3728 -1.131 TD
[(assessment.)-326.4(Available)-326.3(at)-336.4(https://my)11.4(.americanheart)11.8(.org/profession)10.6(al/)]TJ
0 -1.1239 TD
[(StatementsGu)10.2(idelines/ByPu)11.5(blicationDate/Pre)11.6(viousYears/Clas)11.6(sification-of-)]TJ
T*
[(Functional-Ca)10.2(pacity-and-Ob)9.4(jective-Assessmen)11.5(t_UCM_423)12.7(811_Article)10.6(.jsp)]TJ
T*
[(\(last)-337(accessed)-321.3(February)-324.5(22,)-334.5(2014\).)]TJ
-1.3728 -1.6858 TD
[(32.)-227.8(Horsley)-327.3(L.)-338.5(ACC)-325.3(and)-330.9(AHA)-330.9(update)-329.3(on)-329.8(chronic)-330.1(heart)-328(failure)-325.9(guidelines.)]TJ
/F18 1 Tf
27.9831 0 TD
[(Am)-334.7(Fam)]TJ
-26.6102 -1.1239 TD
(Physician)Tj
/F20 1 Tf
3.9265 0 TD
(2010;)Tj
/F16 1 Tf
2.4469 0 TD
[(81:6546)14.1(65.)]TJ
-7.7462 -1.6929 TD
[(33.)-227.8(Ma)26.2(h)16.3(m)20.6(o)16.6(o)16.6(d)-317.7(S)17(S)17(,)-318(W)15.7(a)0(n)29.4(g)-317.7(T)15.1(J)20(.)-325.1(T)22.2(h)16.3(e)-319.9(e)14.4(p)16.6(i)18.8(d)16.6(e)14.4(m)0(i)32.3(o)16.6(lo)28.4(g)16.6(y)-319.9(o)16.6(f)-314(c)14.8(o)16.6(n)16.3(g)16.6(e)14.4(s)0(t)32.6(i)0(v)26.1(e)-312.8(h)16.3(e)14.4(ar)33.5(t)-321.1(f)0(a)33.5(i)0(l)30.6(u)16.3(re)27.7(:)]TJ
1.3728 -1.1239 TD
-.0169 Tc
[(Cont)-16.9(r)9.6(i)1.9(but)-16.9(i)8.1(ons)-331.9(f)-16.9(r)16.7(o)-.3(m)-337.8(t)-16.9(h)12.6(e)-329.7(Fr)-16.9(a)16.6(m)-16.9(i)8.3(n)-.6(gham)-337.8(Hear)-16.9(t)-324.7(S).1(tudy.)]TJ
/F18 1 Tf
18.8569 0 TD
[(Gl)-16.9(o)11.5(b).1(al)-339.5(Heart)]TJ
/F20 1 Tf
5.0646 0 TD
-.0146 Tc
[(20)7.1(13;)]TJ
/F16 1 Tf
2.3616 0 TD
-.0166 Tc
[(8)-16.6(:)11.4(7782.)]TJ
-27.6559 -1.6858 TD
0 Tc
[(34.)-227.8(Rathi)-272.4(S,)-279.7(Deedwania)-262.7(PC.)-279.3(The)-267.1(epidemiology)-265.9(and)-274(pathophysi)12.1(ology)-272.5(of)-276(heart)-271.1(failure.)]TJ
/F18 1 Tf
1.3728 -1.1239 TD
[(Med)-332.8(Clin)-329.4(North)-329.5(Am)]TJ
/F20 1 Tf
7.9383 0 TD
(2012;)Tj
/F16 1 Tf
2.4469 0 TD
[(96:8818)14.1(90.)]TJ
-11.758 -1.6858 TD
[(35.)-227.8(Zarrinkoub)-327.6(R,)-331.9(Wettermar)10.3(k)-333.8(B)0(,)-331.5(W)0(a)]TJ
13.5932 0 TD
[()-81.8(ndell)-334.6(P,)-329.8(Mejhert)-323.2(M,)-333.4(Szulkin)-331(R,)-331.9(Ljunggren)-325.6(G,)]TJ
-12.2204 -1.131 TD
[(Kahan)-330.3(T.)-331.4(The)-331.1(epidemiolog)11.3(y)-334.1(o)0(f)-332.9(heart)-328(failure,)-331(based)-324.9(on)-336.9(data)-328(for)-333.9(2.1)-327.4(million)]TJ
0 -1.1239 TD
[(inhabitants)-329.4(in)-327.6(Sweden.)]TJ
/F18 1 Tf
9.1333 0 TD
[(Eur)-334.3(J)-328.5(Heart)-331(Fail)]TJ
/F20 1 Tf
6.3449 0 TD
(2013;)Tj
/F16 1 Tf
2.4398 0 TD
[(15:9951)14.1(002.)]TJ
-19.2908 -1.6858 TD
[(36.)-227.8(Wong)-333.1(YW,)-328.4(Felker)-329.2(GM.)-330.8(Etiology)-326.9(and)-331(overview)-323(of)-332.9(heart)-328(failure.)-331(In:)-330.8(Krum)-331.9(H,)-329.7(von)]TJ
1.3728 -1.1239 TD
[(Lueder)-244.1(T,)-246(eds.)]TJ
/F18 1 Tf
5.3064 0 TD
[(Advances)-242.7(in)-249.4(heart)-239.1(failure)-244.1(management.)]TJ
/F16 1 Tf
15.3288 0 TD
[(London:)-239.5(Future)-246(Medicine,)]TJ
-20.6352 -1.1239 TD
(Ltd.,)Tj
/F20 1 Tf
1.885 0 TD
(2012;)Tj
/F16 1 Tf
2.4398 0 TD
(617.)Tj
/F11 1 Tf
11.9551 0 0 11.9551 50.1732 741.9966 Tm
[(BASHSHUR)-338.5(ET)-334.1(AL.)]TJ
7.9702 0 0 7.9702 50.1732 29.7638 Tm
[(7)-80(9)-78.2(6)-708.4(TELEM)12(EDICINE)-328.7(and)-331.8(e-HEALT)11.5(H)]TJ
/F8 1 Tf
6.9738 0 0 6.9738 177.6189 29.7638 Tm
.1098 Tc
[(SEPT)6.9(E)-6.2(M)6.6(BER)-332.9(2).4(01)8.4(4)]TJ
ET
q
1 i
0 792 612 -791.985 re
W n
32.315 .014984 .22675 791.985 re
f
/Document /MC15 BDC
Q
q
1 i
0 792 32.315 -173.367 re
W n
0 0 0 .29999 k
0 618.633 32.315 173.367 re
f
EMC
Q
32.315 763.994 242.646 .22675 re
f
endstream
endobj
355 0 obj
<>stream
GJKCBG+AdvP641C :dm AdvP641C 4ztȱƹd^IMWTqBxzmTS7hbX`eԪݿKC2KD3[\^@f9%Tְ[`ϭջ|lunudI^bްͧʒ_888BfaQobGNྷε
endstream
endobj
356 0 obj
<>
endobj
357 0 obj
<>stream
Adobe Illustrator CS4
2010-08-04T11:54:42+05:30
2010-08-04T11:54:42+05:30
2010-08-04T11:54:42+05:30
68
256
JPEG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application/postscript
saved
xmp.iid:11FB61F30AB7DE11AEB3E861853EAFA4
2009-10-12T14:15:50+05:30
Adobe Illustrator CS4
/
converted
from application/postscript to application/vnd.adobe.illustrator
converted
from application/postscript to application/vnd.adobe.illustrator
saved
xmp.iid:0280117407206811994CBE3149FFDB59
2010-08-04T11:54:42+05:30
Adobe Illustrator CS4
/
converted
from application/postscript to application/vnd.adobe.illustrator
xmp.iid:11FB61F30AB7DE11AEB3E861853EAFA4
xmp.did:11FB61F30AB7DE11AEB3E861853EAFA4
uuid:ee5a72b3-04e4-4157-a8d8-c3a8817872a3
uuid:ee5a72b3-04e4-4157-a8d8-c3a8817872a3
xmp.iid:0280117407206811994CBE3149FFDB59
xmp.did:0280117407206811994CBE3149FFDB59
TouchUp 7.0
False
False
1
684.000000
864.000000
Points
Black
Default Swatch Group
0
PANTONE 3025 C
SPOT
100.000000
CMYK
100.000000
16.859999
0.000000
50.980003
endstream
endobj
318 0 obj
<>
endobj
358 0 obj
<>/XObject<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]/Font<>>>/Thumb 360 0 R/MediaBox[0 0 612 792]/Annots[361 0 R 362 0 R 363 0 R 364 0 R 365 0 R 366 0 R 367 0 R 368 0 R 369 0 R 370 0 R 371 0 R 372 0 R 373 0 R 374 0 R 375 0 R 376 0 R 377 0 R 378 0 R 379 0 R 380 0 R 381 0 R 382 0 R 383 0 R 384 0 R 385 0 R 386 0 R 387 0 R 388 0 R 389 0 R 390 0 R 391 0 R 392 0 R 393 0 R 394 0 R 395 0 R 396 0 R 397 0 R 398 0 R 399 0 R 400 0 R 401 0 R 402 0 R 403 0 R 404 0 R 405 0 R 406 0 R 407 0 R 408 0 R 409 0 R 410 0 R 411 0 R 412 0 R 413 0 R 414 0 R 415 0 R 416 0 R 417 0 R 418 0 R 419 0 R 420 0 R 421 0 R 422 0 R 423 0 R 424 0 R 425 0 R 426 0 R 427 0 R 428 0 R 429 0 R 430 0 R 431 0 R 432 0 R 433 0 R 434 0 R 435 0 R 436 0 R]/Rotate 0>>
endobj
437 0 obj
<>/ProcSet[/PDF/Text]/Font<>>>
endobj
359 0 obj
<>stream
/GS1 gs
BT
/F16 1 Tf
7.9702 0 0 7.9702 35.8866 694.2612 Tm
0 0 0 1 k
0 Tc
0 Tw
[(37.)-227.8(He)-295.9(J,)-298(Ogden)-295.8(L,)-295.8(Bazzano)-294(L,)-302.9(et)-299.5(al.)-293.2(Risk)-302.3(factors)-294.7(for)-291.2(congestive)-296.1(heart)-292.4(failure)-297.5(in)-299.2(U.S.)]TJ
1.3728 -1.1239 TD
[(men)-325.7(and)-323.8(women)-318.8(\(NHANES1)-318.8(Epidemiolog)10(ic)-329.2(Follow-up)-317(Study\).)]TJ
/F18 1 Tf
23.893 0 TD
[(Arch)-325.2(Intern)-320.5(Med)]TJ
/F20 1 Tf
-23.893 -1.1239 TD
(2001;)Tj
/F16 1 Tf
2.4398 0 TD
[(161:996100)14.2(2.)]TJ
-3.8126 -1.6858 TD
[(38.)-227.8(Heidenreich)-322.8(P,)-329.8(Trogdon)-329.8(J,)-333.6(Khavjou)-322(O,)-336.4(et)-328(al.)-335.9(Forecasting)-326.6(the)-325.9(future)-332.9(of)]TJ
1.3728 -1.1239 TD
[(cardiovascul)12.2(ar)-336.4(disease)-324.9(in)-334.7(the)-325.9(United)-330.5(States:)-332.2(A)-326.8(policy)-333.7(statement)-324.4(from)-327.5(the)]TJ
T*
[(American)-329.4(Heart)-327.5(Association)11(.)]TJ
/F18 1 Tf
11.1961 0 TD
(Circulation)Tj
/F20 1 Tf
4.4884 0 TD
(2011;)Tj
/F16 1 Tf
2.4469 0 TD
[(123:933)14.1(944.)]TJ
-19.5042 -1.6929 TD
[(39.)-227.8(Lloyd-Jones)-321.5(D,)-336.4(Larson)-325.9(M,)-333.4(Leip)-326.2(E,)-333.4(et)-335.1(al.)-328.8(Lifetime)-333.6(risk)-325(for)-333.9(developing)-327(congestive)]TJ
1.3728 -1.1239 TD
[(heart)-320.9(failure:)-328.8(The)-324(Framingham)-320.3(Heart)-327.5(Study.)]TJ
/F18 1 Tf
17.164 0 TD
(Circulation)Tj
/F20 1 Tf
4.4884 0 TD
(2002;)Tj
/F16 1 Tf
2.4398 0 TD
[(106:3068)14.1(3072.)]TJ
-25.465 -1.6858 TD
[(40.)-227.8(Go)-265.3(AS,)-272.2(Mozaffarian)-267.7(D,)-265.3(Roger)-265.8(VL,)-272.4(et)-271.1(al.)-271.9(Heart)-263.5(disease)-268(and)-266.9(stroke)-264(statistics201)11.4(3)]TJ
1.3728 -1.1239 TD
[(update:)-325(A)-333.9(report)-332.2(from)-327.5(the)-325.9(American)-329.4(Heart)-327.5(Association.)]TJ
/F18 1 Tf
21.6737 0 TD
(Circulation)Tj
/F20 1 Tf
-21.6737 -1.1239 TD
(2013;)Tj
/F16 1 Tf
2.4398 0 TD
[(127:e6-e24)13(5.)]TJ
-3.8126 -1.6929 TD
[(41.)-227.8(Lloyd-Jones)-321.5(D,)-336.4(Adams)-328.3(R,)-331.9(Brown)-325.6(T,)-331.4(et)-335.1(al.)-328.8(Heart)-334.6(disease)-324.9(and)-330.9(stroke)-328(statistics)]TJ
1.3728 -1.1239 TD
[(2010)-324.6(update:)-332.2(A)-333.9(report)-325.1(from)-327.5(the)-333(American)-329.4(Heart)-327.5(Association)11(.)]TJ
/F18 1 Tf
23.9215 0 TD
[(Circulati)10.5(on)]TJ
/F20 1 Tf
-23.9215 -1.1239 TD
(2012;)Tj
/F16 1 Tf
2.4398 0 TD
[(121:e46e215)12.2(.)]TJ
-3.8126 -1.6858 TD
(42.)Tj
/F18 1 Tf
1.3728 0 TD
[(Morbidity)-263.5(and)-270.5(mortalit)10.3(y:)-275.1(2012)-267.7(chart)-267.2(book)-262.2(on)-272.9(cardiovas)12.1(cular)-268.7(and)-270.5(lung)-266.2(diseases)]TJ
/F16 1 Tf
30.0601 0 TD
(.)Tj
-30.0601 -1.1239 TD
[(Bethesda,)-323.6(MD:)-335.3(National)-328.7(Heart)-327.5(Lung)-326.9(and)-330.9(Blood)-328.8(Institute,)]TJ
/F20 1 Tf
22.0507 0 TD
(2012.)Tj
/F16 1 Tf
-23.4236 -1.6929 TD
[(43.)-227.8(Johnston)-242.2(B,)-253.3(Wheeler)-241.2(L,)-253.1(Deuser)-239.4(J,)-255.3(et)-249.7(al.)-250.5(Outcomes)-244.5(of)-247.5(the)-247.7(Kaiser)-246.2(Permanente)-238.5(tele-)]TJ
1.3728 -1.1239 TD
[(home)-330.4(health)-327.5(research)-322.1(project.)]TJ
/F18 1 Tf
11.886 0 TD
[(Arch)-332.3(Fam)-324.7(Med)]TJ
/F20 1 Tf
6.0177 0 TD
(2000;)Tj
/F16 1 Tf
2.4398 0 TD
(9:4045.)Tj
-21.7164 -1.6858 TD
[(44.)-227.8(Riegel)-329(B,)-331.5(Carlson)-328.6(B,)-331.5(Kopp)-332.1(C,)-331.5(et)-328(al.)-335.9(Effect)-330.5(of)-332.9(a)-328.3(standardized)-325.5(case-managem)13.6(ent)]TJ
1.3728 -1.1239 TD
[(telephone)-321.1(intervention)-325.9(on)-329.8(resource)-325.7(use)-334(in)-327.6(patients)-330.1(with)-331.3(chronic)-323(heart)-328(failure.)]TJ
/F18 1 Tf
T*
[(Arch)-332.3(Intern)-327.6(Med)]TJ
/F20 1 Tf
6.7006 0 TD
(2002;)Tj
/F16 1 Tf
2.4398 0 TD
(162:705712.)Tj
-10.5132 -1.6858 TD
[(45.)-227.8(Goldberg)-275.2(LR,)-281.2(Piette,)-277(JD,)-288(Walsh,)-277.5(MN,)-281.3(et)-278.2(al.)-286.1(Random)12.5(ized)-283.5(trial)-278.4(of)-283.1(a)-285.7(daily)-280.9(electronic)]TJ
1.3728 -1.131 TD
[(home)-330.4(monitoring)-323.5(system)-325.4(in)-334.7(patients)-323(with)-331.3(advanced)-328.7(heart)-328(failure:)-328.8(The)-331.1(Weight)]TJ
0 -1.1239 TD
[(Monitoring)-323.9(in)-334.7(Heart)-327.5(Failure)-331.5(\(WHARF\))-328.2(trial.)]TJ
/F18 1 Tf
16.6519 0 TD
[(Am)-334.7(Heart)-331(J)]TJ
/F20 1 Tf
4.7302 0 TD
(2003;)Tj
/F16 1 Tf
2.4398 0 TD
(146:705712.)Tj
-25.1947 -1.6858 TD
[(46.)-227.8(Cleland)-327.9(JG,)-331(Louis,)-331.4(AA,)-331.5(Rigby,)-329(AS,)-329.1(et)-335.1(al.)-328.8(Noninvasive)-325.9(home)-330.4(telemoni)12.4(toring)-331.9(for)]TJ
1.3728 -1.1239 TD
[(patients)-330.1(with)-324.1(heart)-335.1(failure)-325.9(at)-336.4(high)-330.2(risk)-325(of)-332.9(recurrent)-326(admission)-324.1(and)-330.9(death:)-327.5(The)]TJ
T*
[(Trans-Europ)11.7(ean)-304.7(Network-H)11.5(ome-Care)-304.3(Manageme)15(nt)-304.8(System)-299.3(\(TEN-HMS\))-298(study.)]TJ
/F18 1 Tf
29.9179 0 TD
(J)Tj
-29.9179 -1.1239 TD
[(Am)-327.6(Coll)-336.2(Cardiol)]TJ
/F20 1 Tf
6.4089 0 TD
(2005;)Tj
/F16 1 Tf
2.4398 0 TD
(45:16541664.)Tj
-10.2216 -1.6929 TD
[(47.)-227.8(Woodend)-320.9(AK,)-336.9(Sharrard)-325.2(H,)-329.7(Fraser)-331.5(M,)-333.4(et)-328(al.)-335.9(Telehome)-324.5(monitoring)-323.5(in)-334.7(patients)]TJ
1.3728 -1.1239 TD
[(with)-331.3(cardiac)-329.4(disease)-324.9(who)-332.5(are)-329.1(at)-329.3(high)-330.2(risk)-332.1(of)-332.9(readmission.)]TJ
/F18 1 Tf
22.5984 0 TD
[(Heart)-331(Lung)]TJ
/F20 1 Tf
-22.5984 -1.1239 TD
(2008;)Tj
/F16 1 Tf
2.4398 0 TD
(37:3645.)Tj
-3.8126 -1.6858 TD
[(48.)-227.8(Darkins)-328.2(A,)-331.9(Ryan)-332.8(P,)-329.8(Kobb)-331.4(R,)-331.9(et)-328(al.)-335.9(Care)-328.4(coordinatio)11.3(n/home)-331.8(telehealth)10.9(:)-337.2(The)]TJ
1.3728 -1.1239 TD
[(systematic)-272.6(implementa)10.5(tion)-283.5(of)-276(health)-277.7(informatics,)-275(home)-280.6(telehealth)10.9(,)-282.5(and)-281.2(disease)]TJ
0 -1.131 TD
[(management)-325(to)-325.8(support)-328.9(the)-333(care)-328.6(of)-332.9(veteran)-327.6(patients)-323(with)-331.3(chronic)-330.1(conditions.)]TJ
/F18 1 Tf
0 -1.1239 TD
[(Telemed)-326.5(J)-335.6(E)-328.3(Health)]TJ
/F20 1 Tf
7.732 0 TD
(2008;)Tj
/F16 1 Tf
2.4398 0 TD
[(14:1118112)14.2(6.)]TJ
-11.5446 -1.6858 TD
[(49.)-227.8(Dendale)-323(P,)-329.8(De)-331.2(Keulenaer)-325(G,)-329.7(Troisfontai)10.9(nes)-326.9(P,)-329.8(et)-328(al.)-335.9(Effect)-323.4(of)-332.9(a)-328.3(telemonitori)10.3(ng-)]TJ
1.3728 -1.1239 TD
[(facilitated)-251.4(collaborati)10.6(on)-251.6(between)-247.1(general)-248.7(practitioner)-244.2(and)-252.7(heart)-249.8(failure)-247.7(clinic)-246.2(on)]TJ
T*
[(mortality)-327.3(and)-331(rehospitaliz)9.6(ation)-334.4(rates)-325(in)-334.7(severe)-329.3(heart)-328(failure:)-328.8(The)-331.1(TEMA-HF)-324.1(1)]TJ
T*
[(\(TElemonito)11.2(ring)-333.3(in)-334.7(the)-325.9(MAnagemen)11.5(t)-335.3(o)0(f)-332.9(Heart)-327.5(Failure\))-327.6(study.)]TJ
/F18 1 Tf
23.6369 0 TD
[(Eur)-327.2(J)-335.6(Heart)-331(Fail)]TJ
/F20 1 Tf
-23.6369 -1.131 TD
(2012;)Tj
/F16 1 Tf
2.4398 0 TD
(14:333340.)Tj
-3.8126 -1.6858 TD
[(50.)-227.8(F)14.8(e)0(r)20.6(r)0(a)19.2(n)0(t)22.4(e)-327(D)17.2(,)-325.1(Va)22.3(ri)17.9(ni)-313.4(S,)-308.2(Ma)19.1(c)14.8(c)0(h)16.9(i)0(a)-309.5(A)0(,)-310.5(e)0(t)-313.7(a)0(l)17.7(.)-318(Lo)17.5(ng)25.8(-t)21.2(er)20.6(m)-320.9(r)0(e)20.6(s)0(u)21.4(l)0(t)17.9(s)-322.1(af)19.2(te)27.7(r)-328.2(a)-321.2(te)20.6(le)26.2(ph)18.7(on)25.8(e)]TJ
1.3728 -1.1239 TD
[(in)20.9(te)20.6(rv)20.6(e)14.4(n)0(t)22.4(i)0(o)21.2(n)-232.7(in)-213.8(ch)16.9(ro)22.8(ni)20.9(c)-227.1(h)0(e)23.6(a)0(r)19.2(t)-228.6(fa)19.2(il)16.3(u)16.3(r)0(e)20.6(:)-230.5(DI)21.4(AL)-219.2(\(r)17.2(an)22.3(do)26.2(mi)18.1(ze)22.4(d)-232.3(t)0(r)26.5(i)0(a)17.7(l)-230.1(of)-219.1(ph)18.7(o)16.6(n)0(e)-218.2(i)0(n)20.9(t)0(e)20.6(r)0(v)20.6(e)14.4(nt)15.3(io)21.2(n)]TJ
T*
[(in)-313.4(c)14.8(h)0(r)22.4(o)0(n)18.7(i)0(c)-307.8(h)0(e)16.5(a)0(r)26.3(t)-328.2(fa)26.3(il)16.3(ur)22.4(e\))-308.8(fo)15.7(ll)23.4(ow)21.1(-u)24.3(p.)]TJ
/F18 1 Tf
13.4794 0 TD
.322 Tc
[(JA)336.6(m)-6(C)337(o)322(l)343.2(lC)322(a)339.4(r)322(d)344.8(i)322(o)343.3(l)]TJ
/F20 1 Tf
6.9353 0 TD
0 Tc
[(20)22.1(10)22.1(;)]TJ
/F16 1 Tf
2.39 0 TD
[(56)19.1(:3)20.9(7)16.6(2)0()19.1(3)0(7)26.2(8)0(.)]TJ
-24.1775 -1.6858 TD
[(51.)-227.8(Weintraub)-324.2(A,)-331.9(Gregory)-328.4(D,)-329.3(Patel)-336.3(A,)-331.9(et)-328(al.)-335.9(A)-333.9(multicen)12.4(ter)-336.1(randomized)-322.2(controlled)]TJ
1.3728 -1.1239 TD
[(evaluation)-328.5(of)-325.8(automated)-325.1(home)-330.4(monitoring)-323.5(and)-330.9(telephonic)-323.2(disease)]TJ
0 -1.131 TD
[(management)-296.5(in)-313.4(patients)-301.6(recently)-307.1(hospitalize)10.6(d)-310.6(for)-312.5(congestive)-303.3(heart)-306.7(failure:)-307.4(The)]TJ
0 -1.1239 TD
[(SPAN-CHF)-328.8(II)-332.9(trial.)]TJ
/F18 1 Tf
7.1558 0 TD
[(J)-335.6(Card)-329.7(Fail)]TJ
/F20 1 Tf
4.4173 0 TD
(2010;)Tj
/F16 1 Tf
2.4469 0 TD
[(16:2852)14.1(92.)]TJ
-15.3928 -1.6858 TD
[(52.)-227.8(Chaudhry)-298.4(SI,)-296.8(Mattera)-304.8(JA,)-297.6(Curtis)-302.4(JP,)-302.7(et)-299.5(al.)-307.4(Telemonitori)12.2(ng)-301.4(in)-306.3(patients)-294.5(with)-302.8(heart)]TJ
1.3728 -1.1239 TD
(failure.)Tj
/F18 1 Tf
2.952 0 TD
[(N)-332(Engl)-326.3(J)-335.6(Med)]TJ
/F20 1 Tf
5.5767 0 TD
(2010;)Tj
/F16 1 Tf
2.4469 0 TD
[(363:2301)14.1(2309.)]TJ
-12.3484 -1.6858 TD
[(53.)-227.8(Giordano)-327(A,)-331.9(Zanelli)-331.2(E,)-333.4(Scalvini)-323.2(S.)-336.6(Home-bas)12.1(ed)-331.7(telemanageme)12.3(nt)-333.2(in)-334.7(chronic)]TJ
1.3728 -1.131 TD
[(heart)-328(failure:)-328.8(An)-331.8(8-year)-332.7(single)-322.4(site)-332.5(experience.)]TJ
/F18 1 Tf
18.2523 0 TD
[(J)-335.6(Telemed)-326.5(Telecare)]TJ
/F20 1 Tf
7.5044 0 TD
(2011;)Tj
/F16 1 Tf
2.4398 0 TD
(17:)Tj
-28.1965 -1.1239 TD
(382386.)Tj
-1.3728 -1.6858 TD
[(54.)-227.8(Koehler)-323.7(F,)-331.7(Winkler)-328.9(S,)-336.6(Shieber)-322.7(M,)-333.4(et)-335.1(al.)-328.8(Impact)-330(of)-332.9(remote)-327.1(telemedic)11.1(al)]TJ
1.3728 -1.1239 TD
[(management)-325(on)-329.8(mortality)-327.3(and)-330.9(hospitaliz)10.4(ations)-329.3(in)-334.7(ambulatory)-327.2(patients)-323(with)]TJ
T*
[(chronic)-330.1(heart)-328(failure.)]TJ
/F18 1 Tf
8.4291 0 TD
[(Circulati)10.5(on)]TJ
/F20 1 Tf
4.4813 0 TD
(2011;)Tj
/F16 1 Tf
2.4469 0 TD
[(123:1873)14.1(1880.)]TJ
-16.7301 -1.6929 TD
.0146 Tc
[(5)14.6(5)14.6(.)-213.2(Landol)5(ina)-335.1(M)-.7(,)-331.9(P)2.8(erego)-331.5(G)3(,)-331.9(L)1.3(unati)-329.3(M)-.7(,)-331.9(e).6(t)-334.9(a)-.8(l.)-331.9(Remote)-333.7(m)6.7(o)-4.3(nitoring)-331.5(reduces)]TJ
1.3728 -1.1239 TD
.0143 Tc
[(healthcare)-334(use)-334(a)-1(nd)-331.8(improves)-336.2(quality)-334(o)2.5(f)-335.2(c).6(are)-326.9(i)-2.4(n)-332.2(h)2.2(eart)-335.2(failure)-334(p)2.5(atients)-336.2(w)4.6(ith)]TJ
T*
.0149 Tc
[(im)7(pla)6.7(n)-4.4(ta)6.7(ble)-326.3(d)-4(efi)5.3(b)-3.7(ri)5.3(llators:)-329.4(T)1.6(he)-333.4(evolution)-331.6(of)-327.5(managem)7(e).9(nt)-334.6(strate)14.9(g)-10.9(i)-1.8(es)-328.5(of)-334.6(heart)]TJ
T*
.0154 Tc
[(fail)5.8(ure)-332.9(p)3.6(atients)-335.1(w)5.7(ith)-331.1(i)-1.3(mpla)7.2(nta)7.2(b)-3.2(le)-325.8(defi)5.8(bri)5.8(llators)-328(\(EVOLVO)4.1(\))-336.3(s)6.3(t).2(udy.)]TJ
/F18 1 Tf
25.3868 0 TD
.0143 Tc
(Circulation)Tj
/F20 1 Tf
-25.3868 -1.1239 TD
.0138 Tc
(2012;)Tj
/F16 1 Tf
2.5181 0 TD
.0118 Tc
[(125:)-5.3(29)-7.1(852)-7.1(992)-7.1(.)]TJ
30.2308 76.4946 TD
0 Tc
[(56.)-227.8(Chen)-236.7(YH,)-241.9(Ho)-236.8(YL,)-236.5(Huang)-233.8(HC,)-236.4(et)-242.6(al.)-236.3(Assessment)-227.3(of)-240.4(the)-240.5(clinical)-235.6(outcome)13(s)-243.9(and)-238.5(cost-)]TJ
7.9702 0 0 7.9702 318.7841 685.3038 Tm
[(effectiveness)-325.9(of)-332.9(the)-325.9(management)-325(of)-332.9(systolic)-326.9(heart)-328(failure)-333(in)-327.6(Chinese)-326.4(patients)]TJ
0 -1.1239 TD
[(using)-332.3(a)-328.3(home-based)-327.2(interventi)11.1(on.)]TJ
/F18 1 Tf
13.3656 0 TD
[(J)-328.5(Int)-336.1(Med)-325.7(Res)]TJ
/F20 1 Tf
5.7118 0 TD
(2010;)Tj
/F16 1 Tf
2.4398 0 TD
(38:242252.)Tj
-22.8901 -1.6858 TD
[(57.)-227.8(Boyne)-328.7(JJ,)-334.9(Vrijhoef)-327.4(HJ,)-331(Crijns)-332.4(HJ,)-331(et)-328(al.)-335.9(Tailored)-328.4(telemonit)11.4(oring)-330.9(in)-334.8(patients)-323(with)]TJ
1.3728 -1.1239 TD
[(heart)-320.9(failure:)-321.6(Results)-317.8(of)-325.8(a)-321.2(multicentre)-316.6(randomized)-315(controlled)-317(trial.)]TJ
/F18 1 Tf
25.8989 0 TD
[(Eur)-320.1(J)-321.4(Heart)]TJ
-25.8989 -1.1239 TD
(Fail)Tj
/F20 1 Tf
1.636 0 TD
(2012;)Tj
/F16 1 Tf
2.4398 0 TD
(14:791801.)Tj
-5.4487 -1.6929 TD
[(58.)-227.8(Steventon)-326.3(A,)-331.9(Bardsley)-330.2(M,)-326.3(Billings)-334(J,)-333.6(et)-328(al.)-335.9(Effect)-330.5(of)-332.9(telehea)12.3(lth)-335.7(on)-329.8(use)-326.9(of)]TJ
1.3728 -1.1239 TD
[(secondary)-330.5(care)-328.6(and)-330.9(mortality:)-323.1(Findings)-331.8(from)-327.5(the)-333(Whole)-323.6(System)-327.8(Demonstrato)10.3(r)]TJ
T*
[(cluster)-330.8(randomised)-325(trial.)]TJ
/F18 1 Tf
9.6881 0 TD
(BMJ)Tj
/F20 1 Tf
1.9419 0 TD
(2012;)Tj
/F16 1 Tf
2.4398 0 TD
(344:e3874.)Tj
-15.4426 -1.6858 TD
[(59.)-227.8(Baker)-334.9(LC,)-330.6(Johnson)-326.6(SJ,)-330.8(Macaulay)-324.3(D,)-336.4(et)-328(al.)-335.9(Integrate)12.2(d)-331.9(telehealth)-330.5(and)-331(care)]TJ
1.3728 -1.1239 TD
[(management)-261(program)-259.8(for)-269.8(Medicar)11.7(e)-270.1(beneficiari)9.4(es)-272.1(with)-260.1(chronic)-266.1(disease)-260.9(linked)-262.9(to)]TJ
0 -1.131 TD
(savings.)Tj
/F18 1 Tf
3.3361 0 TD
[(Health)-330.5(Aff)-328.8(\()-81.4(Millwood\))]TJ
/F20 1 Tf
8.799 0 TD
(2011;)Tj
/F16 1 Tf
2.4469 0 TD
[(30:1689)14.1(1697.)]TJ
-15.9548 -1.6858 TD
[(60.)-227.8(Baker)-285.1(LC,)-287.9(Macaul)11(ay)-285.4(L,)-288.7(Sorg)-277.9(R,)-289.2(Diener)-282.6(M,)-283.6(et)-278.2(al.)-286.1(Effects)-282.7(of)-283.1(care)-285.9(management)-275.2(and)]TJ
1.3728 -1.1239 TD
[(telehealth:)-326.3(A)-333.9(longitudina)11(l)-336.8(analysis)-329.1(using)-325.1(Medicare)-329.5(data.)]TJ
/F18 1 Tf
21.8658 0 TD
[(J)-328.5(A)0(m)-334.7(Geriatr)-327.4(Soc)]TJ
/F20 1 Tf
-21.8658 -1.1239 TD
(2013;)Tj
/F16 1 Tf
2.4469 0 TD
[(61:1560)14.1(1567.)]TJ
-3.8198 -1.6858 TD
[(61.)-227.8(Takahashi)-329.5(P,)-329.8(Pecina)-332.7(J,)-333.6(Upatising)-326.8(B,)-331.5(et)-328(al.)-335.9(A)-333.9(randomized)-322.2(controlled)-324.1(trial)-335.3(of)]TJ
1.3728 -1.1239 TD
[(telemonitoring)-326.6(in)-327.6(older)-332.8(adults)-329.3(with)-331.2(multiple)-324.7(health)-327.5(issues)-333.4(to)-325.8(prevent)]TJ
0 -1.131 TD
[(hospitalizatio)8.2(ns)-334.2(and)-331(emergency)-323.1(department)-324.7(visits.)]TJ
/F18 1 Tf
19.7105 0 TD
[(Arch)-332.3(Intern)-327.6(Med)]TJ
/F20 1 Tf
-19.7105 -1.1239 TD
(2012;)Tj
/F16 1 Tf
2.4469 0 TD
[(172:773)14.1(780.)]TJ
-3.8198 -1.6858 TD
[(62.)-227.8(Wilson)-250(S.)-251.3(Another)-243.7(sobering)-244.6(result)-246(for)-248.5(home)-245(telehealthAn)10.7(d)-253.7(where)-243(we)-251.4(might)-248.7(go)]TJ
1.3728 -1.1239 TD
(next.)Tj
/F18 1 Tf
2.1624 0 TD
[(Arch)-332.3(Intern)-327.6(Med)]TJ
/F20 1 Tf
6.7006 0 TD
(2012;)Tj
/F16 1 Tf
2.4469 0 TD
[(172:779)14.1(780.)]TJ
-12.6827 -1.6858 TD
[(63.)-227.8(American)-322.2(Heart)-320.4(Association/Ame)14.4(rican)-322.1(Stroke)-323.2(Association)11(.)-332.3(About)-320.5(stroke.)]TJ
/F20 1 Tf
29.2279 0 TD
(2012.)Tj
/F16 1 Tf
-27.855 -1.131 TD
[(Available)-333.4(at)-329.3(www.strokeas)11.6(sociation.org/S)10.6(TROKEORG/Abou)8.1(tStroke/Abo)12.1(ut-)]TJ
0 -1.1239 TD
[(Stroke_UCM_)10.4(308529_SubH)12.6(omePage.jsp)-321.5(\(last)-337(accessed)-321.3(February)-324.5(25,)-334.5(2014\).)]TJ
-1.3728 -1.6858 TD
[(64.)-227.8(National)-328.7(Institute)-326(of)-332.9(Neurological)-324.5(Disorders)-327.7(and)-330.9(Stroke.)-328.3(NINDS)-326.9(stroke)]TJ
1.3728 -1.1239 TD
[(information)-328.1(page.)]TJ
/F20 1 Tf
7.1914 0 TD
(2014.)Tj
/F16 1 Tf
2.7314 0 TD
[(Available)-333.4(at)-329.3(www.ninds.ni)12.1(h.gov/disorders)11.8(/stroke/)]TJ
-9.9228 -1.1239 TD
[(stroke.htm)-325.6(\(last)-329.9(accessed)-328.4(February)-324.5(25,)-334.5(2014\).)]TJ
-1.3728 -1.6858 TD
[(65.)-227.8(Go)-272.4(AS,)-265.1(Mozaffarian)-267.7(D,)-272.4(Roger)-265.8(VL,)-265.3(et)-271.1(al.)-271.9(Heart)-270.6(disease)-260.9(and)-266.9(stroke)-271.1(statistics)11.3(2014)]TJ
1.3728 -1.131 TD
[(update:)-332.2(A)-326.8(report)-332.2(from)-327.5(the)-333(American)-329.4(Heart)-327.5(Association)11(.)]TJ
/F18 1 Tf
21.6737 0 TD
(Circulation)Tj
/F20 1 Tf
-21.6737 -1.1239 TD
(2014;)Tj
/F16 1 Tf
2.4469 0 TD
[(129:e28e2)14.5(92.)]TJ
-3.8198 -1.6858 TD
[(66.)-227.8(National)-328.7(Institutes)-328(of)-332.9(Health.)-324.9(Stroke)-330.3(fact)-329.7(sheet.)-332.7(2010.)-329.7(Available)-326.3(at)-329.3(http://)]TJ
1.3728 -1.1239 TD
-.0164 Tc
[(r)-16.4(e)11.3(por)-16.4(t)17.2(.)-16.4(n)9.1(i)2.4(h.gov/ni)-16.4(h)11.6(f)-16.4(a)17.1(ct)-16.4(s)16.2(h)-.1(eet)-16.4(s)16.2(/)1.4(Pd)-16.4(f)13.5(s)-16.4(/)13.6(S).6(t)-16.4(r)10.1(ok)5.5(e\()-16.4(N)11.1(I)2.1(NDS)-16.4(\))11.6(.pdf)-294.8(\()-16.4(l)13.5(a)-16.4(s)16(t)-294.8(a)-16.4(c)11.5(c)-1.6(es)-16.4(s)15.2(e)-2(d)-298.5(A)5.3(pr)-16.4(i)8.6(l)-289.2(2)-16.4(1)9.8(,)-291.8(2014\))-16.4(.)]TJ
-1.3728 -1.6858 TD
0 Tc
[(67.)-227.8(Murphy)-279.8(SL,)-278.8(Xu)-273.3(J,)-283.8(Kochanek)-275.7(KD.)-277.4(Deaths:)-272(Final)-280.9(data)-278.2(for)-284.1(2010.)]TJ
/F18 1 Tf
24.4336 0 TD
[(Natl)-283.3(Vital)-271.8(Stat)-281.3(Rep)]TJ
/F20 1 Tf
-23.0608 -1.131 TD
(2013;)Tj
/F16 1 Tf
2.4469 0 TD
[(61\(4\):11)12.4(18.)]TJ
-3.8198 -1.6858 TD
[(68.)-227.8(Kjellstrom)-313.4(T,)-310(Norrving)-308.1(B,)-317.3(Shatchukute)-303.7(A,)-310.5(eds.)-317.4(Helsingbo)12.6(rg)-318.6(Declarati)8.7(on)-315.6(2006)-310.4(on)]TJ
1.3728 -1.1239 TD
[(European)-328.4(Stroke)-330.3(Strategies)11.2(.)]TJ
/F18 1 Tf
10.9187 0 TD
[(Cerebrovasc)-328.8(Dis)]TJ
/F20 1 Tf
6.4445 0 TD
(2007;)Tj
/F16 1 Tf
2.4398 0 TD
(23:229241.)Tj
-21.1758 -1.6858 TD
[(69.)-227.8(Das)-334.5(R,)-331.9(Seshadri)-326.4(S,)-329.5(Beiser)-331.5(A,)-331.9(et)-335.1(al.)-328.8(Prevalence)-325.9(and)-331(correlates)-325.3(of)-332.9(silent)-325.8(cerebral)]TJ
1.3728 -1.1239 TD
[(infarcts)-333.2(in)-327.6(the)-333(Framingham)-320.3(Offspring)-331.9(study.)]TJ
/F18 1 Tf
17.4343 0 TD
(Stroke)Tj
/F20 1 Tf
2.7243 0 TD
(2008;)Tj
/F16 1 Tf
2.4398 0 TD
(39:29292935.)Tj
-23.9713 -1.6929 TD
[(70.)-227.8(Vermeer)-327.2(W,)-330.8(Longstreth)-329.2(W,)-330.8(Koudstaal)-326(P.)-329.8(Silent)-328.2(brain)-334.1(infarcts:)-328.9(A)-326.8(systematic)]TJ
1.3728 -1.1239 TD
(review.)Tj
/F18 1 Tf
2.9946 0 TD
[(Lancet)-329.2(Neurol)]TJ
/F20 1 Tf
5.7118 0 TD
(2007;)Tj
/F16 1 Tf
2.4469 0 TD
[(6:61161)14.1(9.)]TJ
-12.5262 -1.6858 TD
[(71.)-227.8(Howard)-331.6(V,)-330.2(Kleindorfer)-325.8(D,)-329.3(Judd)-328.7(S,)-336.6(et)-328(al.)-335.9(Disparities)-329.1(in)-327.6(stroke)-328(incidence)]TJ
1.3728 -1.1239 TD
[(contribution)-327.9(to)-332.9(disparities)-322.5(in)-334.7(stroke)-328(mortality.)]TJ
/F18 1 Tf
17.9962 0 TD
[(Ann)-329.8(Neurol)]TJ
/F20 1 Tf
4.7516 0 TD
(2011;)Tj
/F16 1 Tf
2.4398 0 TD
(69:619627.)Tj
-26.5605 -1.6858 TD
[(72.)-227.8(Ovbiagele)-296.2(B,)-296(Goldstein)-297(L,)-295.8(Higashida)-291.4(R,)-296.3(et)-299.5(al.)-300.3(Forecasting)-291(the)-297.4(future)-290.2(of)-297.3(stroke)-292.4(in)]TJ
1.3728 -1.131 TD
[(the)-254.8(United)-252.2(States:)-246.8(A)-255.7(policy)-255.5(statement)-246.2(from)-249.3(the)-254.8(American)-244(Heart)-256.3(Association)-245.1(and)]TJ
0 -1.1239 TD
[(American)-329.4(Stroke)-330.3(Association)11(.)]TJ
/F18 1 Tf
11.5019 0 TD
(Stroke)Tj
/F20 1 Tf
2.7243 0 TD
(2013;)Tj
/F16 1 Tf
2.4398 0 TD
[(44:2361237)14.2(5.)]TJ
-18.0389 -1.6858 TD
[(73.)-227.8(Seshadri)-297.9(S,)-308.2(Beiser)-296(A,)-303.4(Kelly-Hayes)-300.5(M,)-304.9(et)-299.5(al.)-307.4(The)-295.6(lifetime)-301.5(risk)-303.7(of)-304.4(stroke:)-302.4(Estimate)12.1(s)]TJ
1.3728 -1.1239 TD
[(from)-334.6(the)-325.9(Framingham)-327.4(Study.)]TJ
/F18 1 Tf
11.5446 0 TD
(Stroke)Tj
/F20 1 Tf
2.7243 0 TD
(2006;)Tj
/F16 1 Tf
2.4398 0 TD
(37:345350.)Tj
-18.0816 -1.6858 TD
[(74.)-227.8(Morgenstern)-323.8(L,)-331.4(Smith)-333.7(M,)-326.3(Lisabeth)-327.9(L,)-331.4(et)-335.1(al.)-335.9(Excess)-323.9(stroke)-328(in)-334.8(Mexican)-321.5(American)]TJ
1.3728 -1.1239 TD
[(compared)-329.2(with)-331.2(non-Hispa)14(nic)-334.2(whites:)-328.8(The)-331.1(Brain)-329(Attack)-328.8(Surveillance)-328.7(in)-327.6(Corpus)]TJ
0 -1.131 TD
[(Christi)-333.4(Project.)]TJ
/F18 1 Tf
5.9324 0 TD
[(Am)-334.7(J)-328.5(Epidemiol)]TJ
/F20 1 Tf
6.3093 0 TD
(2004;)Tj
/F16 1 Tf
2.4398 0 TD
(160:376383.)Tj
-16.0543 -1.6858 TD
[(75.)-227.8(National)-243.3(Stroke)-245(Association)11(.)-246.9(A)0(m)-242.2(I)-244.7(at)-244(risk)-246.8(for)-241.4(stroke:)-245.5(Stroke)-237.9(risk)-246.8(factors.)-242.9(Availab)10.3(le)]TJ
1.3728 -1.1239 TD
-.0201 Tc
[(at)-334.1(ww)5.7(w.stroke.org/s)6.4(ite/)]TJ
8.486 0 TD
-.0211 Tc
(PageServer?pagename)Tj
/F9 1 Tf
8.2939 0 TD
0 Tc
(=)Tj
/F16 1 Tf
.6971 0 TD
-.0209 Tc
[(ris)5.6(k)-333.3(\(las)5.6(t)-334.9(a)-.7(cce)-6.5(s)5.6(s)-1.6(ed)-331.5(March)-331.8(2,)-338.9(2014\).)]TJ
-18.8498 -1.6858 TD
0 Tc
[(76.)-227.8(Demaerschalk)-307.8(BM,)-318.4(Hwang)-309.6(HM,)-309.4(Leung)-312.4(G.)-315.4(US)-314.7(cost)-313(burden)-311.5(of)-311.5(ischemic)-310.3(stroke:)-309.5(A)]TJ
7.9702 0 0 7.9702 318.7841 129.4299 Tm
[(systematic)-329.5(literature)-327.7(review.)]TJ
/F18 1 Tf
11.1676 0 TD
[(Am)-334.7(J)-335.6(Manag)-326.1(Care)]TJ
/F20 1 Tf
7.3692 0 TD
(2010;)Tj
/F16 1 Tf
2.4398 0 TD
(16:525533.)Tj
-22.3495 -1.6929 TD
[(77.)-227.8(Caro)-333.3(J,)-333.6(Huybrechts)-320.7(K,)-330.2(Duschesne)-328.2(I.)-328(Management)-325.3(patterns)-328.6(and)-330.9(costs)-329.2(of)-325.8(acute)]TJ
1.3728 -1.1239 TD
[(ischemic)-331.6(stroke:)-323.7(An)-331.8(international)-324(study.)]TJ
/F18 1 Tf
15.6916 0 TD
(Stroke)Tj
/F20 1 Tf
2.7243 0 TD
(2003;)Tj
/F16 1 Tf
2.4398 0 TD
(31:582590.)Tj
-22.2285 -1.6858 TD
[(78.)-227.8(Brown)-304.2(DL,)-307.1(Boden-Albal)12.9(a)-307(B)0(,)-310.2(Langa)-302.7(KM,)-302.8(et)-306.6(al.)-300.3(Projected)-302.1(costs)-300.8(of)-304.4(ischemic)-303.2(stroke)]TJ
1.3728 -1.1239 TD
[(in)-334.7(the)-333(United)-323.4(States.)]TJ
/F18 1 Tf
8.3295 0 TD
[(Neurolo)13(gy)]TJ
/F20 1 Tf
4.2537 0 TD
(2006;)Tj
/F16 1 Tf
2.4398 0 TD
(67:13901395.)Tj
/F11 1 Tf
11.9551 0 0 11.9551 287.5464 741.9966 Tm
[(TELEMEDICINE)-340.6(FOR)-332.7(CHRONIC)-338.8(DISEASE)-334.7(MANAGE)-7.3(MENT)]TJ
/F9 1 Tf
6.9738 0 0 6.9738 186.8031 29.7638 Tm
()Tj
/F7 1 Tf
1.3251 0 TD
.2011 Tc
[(M)-4.9(ARY)-335.7(ANN)-334.5(L).6(IEBERT,)-333.7(I)-2.3(NC.)]TJ
/F10 1 Tf
15.015 0 TD
0 Tc
()Tj
/F7 1 Tf
.9999 0 TD
.1099 Tc
[(VOL.)-335.5(2)6.8(0)-1001.2(N)5.1(O)-4.5(.)-327.4(9)]TJ
/F10 1 Tf
8.3896 0 TD
0 Tc
()Tj
/F8 1 Tf
.9999 0 TD
.1097 Tc
[(SEP)8.5(T)-1.4(EMBER)-333(2)8.5(014)]TJ
/F4 1 Tf
7.9702 0 0 7.9702 441.9211 29.7638 Tm
0 Tc
[(TELEMEDIC)11.7(INE)-333(and)-328.9(e-HEALTH)-647.9(797)]TJ
ET
q
1 i
0 792 612 -791.985 re
W n
579.685 .014984 .22681 791.985 re
f
337.039 767.962 274.961 .22675 re
f
Q
endstream
endobj
438 0 obj
<>/XObject<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]/Font<>/Properties<>>>/Thumb 441 0 R/MediaBox[0 0 612 792]/Annots[442 0 R 443 0 R 444 0 R 445 0 R 446 0 R 447 0 R 448 0 R 449 0 R 450 0 R 451 0 R 452 0 R 453 0 R 454 0 R 455 0 R 456 0 R 457 0 R 458 0 R 459 0 R 460 0 R 461 0 R 462 0 R 463 0 R 464 0 R 465 0 R 466 0 R 467 0 R 468 0 R 469 0 R 470 0 R 471 0 R 472 0 R 473 0 R 474 0 R 475 0 R 476 0 R 477 0 R 478 0 R 479 0 R 480 0 R 481 0 R 482 0 R 483 0 R 484 0 R 485 0 R 486 0 R 487 0 R 488 0 R 489 0 R 490 0 R 491 0 R 492 0 R 493 0 R 494 0 R 495 0 R 496 0 R 497 0 R 498 0 R 499 0 R 500 0 R 501 0 R 502 0 R 503 0 R 504 0 R 505 0 R 506 0 R 507 0 R 508 0 R 509 0 R 510 0 R 511 0 R 512 0 R 513 0 R 514 0 R 515 0 R 516 0 R 517 0 R 518 0 R 519 0 R 520 0 R 521 0 R 522 0 R 523 0 R 524 0 R 525 0 R]/Rotate 0>>
endobj
526 0 obj
<>/ProcSet[/PDF/Text]/Font<>/Properties<>>>
endobj
439 0 obj
<>stream
/GS1 gs
BT
/F16 1 Tf
7.9702 0 0 7.9702 50.1732 694.2612 Tm
0 0 0 1 k
0 Tc
0 Tw
[(79.)-227.8(Partridge)-326.3(M.)-333.4(Costs)-329(of)-332.9(ischemic)-324.5(stroke)-328(projected)-323.5(to)-332.9(rise.)-330.4(Physicians)-322.9(Practice.)]TJ
/F20 1 Tf
1.3728 -1.1239 TD
(2006.)Tj
/F16 1 Tf
2.7172 0 TD
[(Available)-319.2(at)-315.1(www.physicians)12.7(practice.com)-310.6(\(last)-322.8(accessed)-307.1(April)-323.3(24,)-313.2(2014\).)]TJ
-4.0901 -1.6858 TD
.3476 Tc
[(8)347.6(0)347.6(.)119.8(B)334.1(r)332.4(i)330.9(n)335.5(j)330.9(i)338(k)326.8(j)338(iW)334.8(,R)333.8(a)332.2(b)329(i)338(n)335.5(s)331.4(t)332.4(e)333.6(i)330.9(nA)333.8(,C)334.1(l)330.9(o)335.8(f)332.4(t)-1.9(H)336(.)-6(H)336(o)]TJ
16.0543 0 TD
.015 Tc
[(spital)5.4(ization)-331.5(c)1.3(os)5.9(ts)-335.5(for)-334.5(a)-.4(cute)-333.3(i)5.4(s)-1.2(chemic)]TJ
-14.6815 -1.1239 TD
.0146 Tc
[(str)6.5(o)-4.3(ke)-333.7(pati)5(ents)-328.8(treated)-331.5(w)4.9(i)-2.1(th)-331.9(intravenou)]TJ
15.7414 0 TD
.013 Tc
[(s)-337.5(t)-2.2(hrombo)-5.9(lysis)-330.4(i)-3.7(n)-333.5(t)-2.2(he)-335.3(Un)-6.3(ited)-333.1(S)-5.6(t)-2.2(ates)]TJ
-15.7414 -1.1239 TD
.0155 Tc
[(are)-332.8(s)6.4(ubs)6.4(t).3(antially)-325.7(hi)5.9(gher)-334(t)7.4(h)-3.8(an)-331(M)7.3(e)1.5(di)5.9(care)-332.8(payments.)]TJ
/F18 1 Tf
20.1657 0 TD
.0135 Tc
(Stroke)Tj
/F20 1 Tf
2.8097 0 TD
.0138 Tc
(2012;)Tj
/F16 1 Tf
2.518 0 TD
.0115 Tc
[(43)-7.4(:11)-7.4(31)]TJ
-25.4935 -1.1239 TD
.0118 Tc
[(113)-7.1(3.)]TJ
-1.3728 -1.6929 TD
0 Tc
[(81.)-227.8(Levine)-326.1(SR,)-336.2(Gorman)-323(M.)-333.4()66.1(Telestroke)66.2(:)-328(The)-331.1(application)-328.1(of)-332.9(telemedic)11.1(ine)-334.5(for)-333.9(stroke.)]TJ
/F18 1 Tf
1.3728 -1.1239 TD
(Stroke)Tj
/F20 1 Tf
2.7243 0 TD
(1999;)Tj
/F16 1 Tf
2.4398 0 TD
(30:464469.)Tj
-6.537 -1.6858 TD
[(82.)-227.8(Khan)-279.4(K,)-280.4(Shuaib)-278.5(A,)-282.1(Whittaker)-272.6(T,)-281.6(et)-285.3(al.)-279(Telestroke)-279.4(in)-277.8(Northern)-278.4(Alberta:)-275.4(A)-284.1(two)-278.6(year)]TJ
1.3728 -1.1239 TD
[(experience)-324.3(with)-331.2(remote)-327.1(hospitals.)]TJ
/F18 1 Tf
13.3158 0 TD
[(Can)-336.2(J)-328.5(Neurol)-330.8(Sci)]TJ
/F20 1 Tf
6.7859 0 TD
(2010;)Tj
/F16 1 Tf
2.4469 0 TD
[(37:8088)14.1(13.)]TJ
-23.9215 -1.6858 TD
[(83.)-227.8(Gonzalez)-328.9(M,)-326.3(Hanna)-329.8(N,)-337.1(Rodrigo)-320.6(M,)-333.4(et)-335.1(al.)-328.8(Reliability)-331.2(of)-332.9(prehospital)-320.7(real-time)]TJ
1.3728 -1.131 TD
[(cellular)-326.9(video)-331.6(phone)-325.1(in)-334.7(assessing)-319.9(the)-333(simplified)-328.8(National)-328.7(Institutes)-328(of)-325.8(Health)]TJ
0 -1.1239 TD
[(Stroke)-330.3(Scale)-327.3(in)-334.7(patients)-323(with)-331.3(acute)-326.5(stroke:)-330.8(A)-333.9(novel)-324.8(telemedicine)-323.5(technology.)]TJ
/F18 1 Tf
T*
(Stroke)Tj
/F20 1 Tf
2.7243 0 TD
(2011;)Tj
/F16 1 Tf
2.4398 0 TD
[(42:1522152)14.2(7.)]TJ
-6.537 -1.6858 TD
[(84.)-227.8(Demaerschal)11.7(k)-333.8(B)0(,)-331.5(Vegunta)-327.6(S,)-329.5(Vargas)-327.9(B,)-338.6(et)-328(al.)-335.9(Reliability)-324.1(of)-332.9(real-time)-327.7(video)]TJ
1.3728 -1.1239 TD
[(smartphone)-323.9(for)-326.7(assessing)-327(National)-328.7(Institutes)-328(of)-332.9(Health)-326.9(Stroke)-330.3(Scale)-327.3(scores)-329(in)]TJ
T*
[(acute)-326.5(stroke)-328(patients.)]TJ
/F18 1 Tf
8.6425 0 TD
(Stroke)Tj
/F20 1 Tf
2.7243 0 TD
(2012;)Tj
/F16 1 Tf
2.4398 0 TD
[(43:3271327)14.2(7.)]TJ
-15.1794 -1.6929 TD
[(85.)-227.8(A)-13.8(l)-9.6(l)-9.6(i)-16.7(b)-11.5(e)-14(r)-8.1(t)-392.2(R)-13.8(,)-389.2(Z)-11.8(i)-16.7(eg)-18.7(l)-16.7(e)0(r)-399.1(F)-13.7(,)-389.2(B)-13.5(a)-15.4(t)-8.1(a)-15.4(i)-9.6(l)-16.7(l)-9.6(a)-8.2(r)-15.2(d)-388.8(M)-15.3(,)-389.2(G)-11.6(o)-11.8(m)-15(es)-400.1(C)-13.5(,)-389.2(J)-15.5(a)-8.2(r)-15.2(y)-391(A,)-403(M)-8.2(o)-11.8(u)-12.1(l)-9.6(i)-16.7(n)-389.1(T)-13.3(.)-389.2(T)-13.3(e)-14(l)-9.6(e)-14(m)-7.9(e)-14(d)-11.8(i)-9.6(c)-13.7(i)-9.6(n)-12.1(e)]TJ
1.3728 -1.1239 TD
.0148 Tc
[(a)6.6(n)2.7(d)-381.1(f)6.7(ib)3.3(r)6.7(i)-1.9(n)14.8(o)-2(ly)14.8(s)-8.3(i)5.2(s)-378.4(i)5.2(n)-381.5(F)14.8(r)-7(a)6.6(nce-)14.8(Comt)6.7(e)-376.2([)4.5(in)-374.3(Fr)6.7(ench)14.8(])-7.6(.)]TJ
/F18 1 Tf
18.3377 0 TD
.0126 Tc
[(Re)12.6(v)-385.3(N).6(eurol)-381.1(\()2.3(Paris\))]TJ
/F20 1 Tf
7.6537 0 TD
.0138 Tc
[(201)13.8(2)-6.7(;)]TJ
/F16 1 Tf
2.5038 0 TD
.0118 Tc
(168:)Tj
-28.4952 -1.1239 TD
(4048.)Tj
-1.3728 -1.6858 TD
0 Tc
[(86.)-227.8(Pervez)-324.2(MA,)-333(Silva)-330.4(G,)-336.8(Masrur)-324.2(S,)-329.5(et)-335.1(al.)-335.9(Remote)-325.7(supervision)-320.7(of)-332.9(IV-tPA)-325.2(for)-333.9(acute)]TJ
1.3728 -1.1239 TD
[(ischemic)-267.6(stroke)-271.1(by)-267.3(telemedicine)-266.6(and)-274(telephon)13(e)-277.2(prior)-269.9(to)-268.9(a)-278.5(regional)-270.3(stroke)-264(center)]TJ
0 -1.131 TD
[(is)-331.7(feasible)-326(and)-331(safe.)]TJ
/F18 1 Tf
7.9667 0 TD
(Stroke)Tj
/F20 1 Tf
2.7243 0 TD
(2010;)Tj
/F16 1 Tf
2.4398 0 TD
(41:e18e24.)Tj
-14.5037 -1.6858 TD
[(87.)-227.8(Spokoyny)-321.3(I,)-335.1(Raman)-327.8(R,)-331.9(Ernstrom)-329.5(K,)-330.2(et)-335.1(al.)-328.8(Pooled)-326.9(assessment)-321.4(of)-332.9(computed)]TJ
1.3728 -1.1239 TD
[(tomography)-326.2(interpret)12.7(ation)-334.4(by)-331.3(vascular)-325(neurologists)-326.6(in)-327.6(the)-333(STRokE)-328.4(DOC)]TJ
T*
[(Telestroke)-322.1(Network.)]TJ
/F18 1 Tf
7.8244 0 TD
[(J)-328.5(Stroke)-330.3(Cerebrovas)12.1(c)-333.8(Dis)]TJ
/F20 1 Tf
9.8304 0 TD
(2014;)Tj
/F16 1 Tf
2.4398 0 TD
(23:511515.)Tj
-21.4674 -1.6858 TD
[(88.)-227.8(Demaerschal)11.7(k)-269.7(B)0(,)-267.5(Roman)-267.3(R,)-260.7(Enstrom)-264.5(K,)-266.2(et)-271.1(al.)-264.8(Efficacy)-268.6(of)-261.7(telemedicine)-259.5(for)-269.8(stroke:)]TJ
1.3728 -1.1239 TD
[(Pooled)-326.9(analysis)-329.1(of)-332.9(the)-325.9(stroke)-328(team)-329.9(remote)-327.1(evaluation)-328.5(using)-325.1(a)-335.4(digital)]TJ
0 -1.131 TD
[(observation)-296.3(camera)-294.9(\(STRoKE)-301.6(DOC\))-302.4(Arizona)-297.6(telestroke)-295.5(trials.)]TJ
/F18 1 Tf
22.9399 0 TD
[(Telemed)-298.1(J)-300.1(E)-307(Health)]TJ
/F20 1 Tf
-22.9399 -1.1239 TD
(2012;)Tj
/F16 1 Tf
2.4398 0 TD
(18:230237.)Tj
-3.8126 -1.6858 TD
[(89.)-227.8(Handschu)-275.8(R,)-289.2(Scibor)-279.5(M,)-283.6(Willasczek)-277.3(B,)-288.8(et)-285.3(al.)-286.1(Telemedi)12.4(cine)-284.2(in)-285(acute)-283.8(stroke,)-276.1(remote)]TJ
1.3728 -1.1239 TD
[(video-examinat)14.2(ion)-332.3(compared)-329.2(to)-325.8(simple)-332.4(telephone)-321.1(consultation.)]TJ
/F18 1 Tf
24.775 0 TD
[(J)-335.6(Neurol)]TJ
/F20 1 Tf
-24.775 -1.1239 TD
(2008;)Tj
/F16 1 Tf
2.4398 0 TD
[(255:179217)14.2(97.)]TJ
-3.8126 -1.6929 TD
[(90.)-227.8(Puetz)-251.5(V,)-259(Bodechtel)-250.9(U,)-258.5(Gerber)-252.3(C,)-260.4(et)-256.8(al.)-257.7(Reliability)-260(of)-254.6(brain)-255.9(CT)-261.6(evaluatio)10.9(n)-261.1(b)0(y)-253.1(stroke)]TJ
1.3728 -1.1239 TD
[(neurologists)-319.4(in)-334.7(telemedicin)10.6(e.)]TJ
/F18 1 Tf
11.3526 0 TD
(Neurology)Tj
/F20 1 Tf
4.2608 0 TD
(2012;)Tj
/F16 1 Tf
2.4398 0 TD
(80:332338.)Tj
-19.426 -1.6858 TD
[(91.)-227.8(Muller)-239.6(H,)-237.2(Nimmrichter)-239.1(B,)-239(Schenkel)-235.9(J,)-241.1(et)-242.6(al.)-243.4(Improvement)-233.5(in)-242.3(stroke)-235.5(care)-236.1(in)-242.3(a)-243(non-)]TJ
1.3728 -1.1239 TD
[(urban)-237(commun)12.7(ity)-238(hospitalQual)10.8(ity)-238(of)-240.4(procedures)-228.4(before)-238.2(and)-231.4(after)-238.6(participatin)9(g)]TJ
T*
[(in)-334.7(a)-328.3(telemedical)-326.9(stroke)-328(network)-326.5([in)-330.8(German].)]TJ
/F18 1 Tf
17.6406 0 TD
[(Dtsch)-331.7(Med)-325.7(Wochenschr)]TJ
/F20 1 Tf
-17.6406 -1.1239 TD
(2006;)Tj
/F16 1 Tf
2.4398 0 TD
[(131:130913)14.2(14.)]TJ
-3.8126 -1.6929 TD
.0229 Tc
[(9)22.9(2)22.9(.)-204.9(Au)-3.5(deber)-6.5(t)-376.4(H,)-380.5(T)-4.7(i)-.9(et)-6.5(z)-381.7(V)3.6(,)-380.5(B)-4.8(oy)-375.2(S,)-380.5(e)-5.3(t)-383.5(al.)-380.5(A)-5.2(cc)-5(eptan)-3.5(c)2.1(e)-382.3(o)-3.1(f)-383.5(t).6(el)-8.1(emedic)-5(in)-3.5(e)-375.2(f)-6.5(or)-383.5(ac)-5(u)-3.5(t).6(e)]TJ
1.3728 -1.1239 TD
.0274 Tc
[(s)4.1(t)5.1(ro)8.5(ke)-377.8(c)6.6(a)4.9(re)6.3(.)-376(T)-.2(h)8.1(e)-377.8(Ge)6.3(rm)5.3(a)4.9(n)-376(Pr)5.1(oj)3.6(e)6.3(c)-.5(t)-379(T)7(EM)5(P)8.5(i)-3.6(S)-375.3([)2.9(i)3.6(n)-376(Ge)6.3(r)5.1(m)-1.8(a)4.9(n)8.1(].)]TJ
/F18 1 Tf
22.3495 0 TD
.0204 Tc
[(Ne)-7.8(rve)-7.8(n)1.1(a)-5.6(r)-1.9(z)-7.2(t)]TJ
/F20 1 Tf
4.8156 0 TD
.0209 Tc
[(20)-7.2(09)-7.1(;)]TJ
/F16 1 Tf
-27.1651 -1.1239 TD
.0258 Tc
[(80)6.9(:184)6.9(189)6.9(.)]TJ
-1.3728 -1.6858 TD
0 Tc
[(93.)-227.8(Pedragosa)-294.1(A,)-310.5(Alvarez-Sab)9.5(in)-306.3(J,)-305.1(Molina)-301.5(C,)-303.1(et)-306.6(al.)-300.3(Impact)-301.5(of)-304.4(a)-307(telemedicin)10.6(e)-305.7(system)]TJ
1.3728 -1.1239 TD
[(on)-329.8(acute)-326.5(stroke)-328(care)-335.7(in)-327.6(a)-335.4(community)-324.9(hospital.)]TJ
/F18 1 Tf
18.3092 0 TD
[(J)-328.5(Telemed)-326.5(Telecare)]TJ
/F20 1 Tf
-18.3092 -1.1239 TD
(2009;)Tj
/F16 1 Tf
2.4398 0 TD
(15:260263.)Tj
-3.8126 -1.6929 TD
[(94.)-227.8(Nagao)-265.5(KJ,)-260.4(Koschel)-260.4(A,)-267.8(Haines)-263.9(HM,)-259.6(et)-264(al.)-271.9(Rural)-258.2(Victorian)-264.2(Telestroke)-258.1(project.)]TJ
/F18 1 Tf
29.3346 0 TD
(Intern)Tj
-27.9617 -1.1239 TD
[(Med)-325.7(J)]TJ
/F20 1 Tf
2.6603 0 TD
(2012;)Tj
/F16 1 Tf
2.4398 0 TD
[(42:1088109)14.2(5.)]TJ
-6.473 -1.6858 TD
-.0205 Tc
[(9)-20.5(5)-20.5(.)-248.3(S)3.6(a)-.3(ira)6.8(n)-4.2(en)-231.8(T,)-238.9(S)3.6(o)3.3(inila)-235(S)3.6(,)-238.9(Nikka)6.8(nen)-231.8(M)-.3(,)-231.8(e)1.1(t)-234.9(a)-.3(l.)-239(Tw)5.3(o)-238.6(y)1(ear)7(s)-235.9(of)-234.9(Fi)5.4(nni)5.4(s)-1.2(h)-238.9(t)7(elest)7(r)-.1(oke)-233.7(t)-.1(hromb)3.6(o)3.3(lys)6(i)-1.7(s)]TJ
1.3728 -1.1239 TD
.3153 Tc
[(a)335.5(t)8.5(s)334.6(p)339.1(o)331.9(k)337.2(e)344(s).3(e)336.9(q)339.1(u)338.7(a)335.5(lt)342.8(ot)342.8(h)331.6(a)342.6(ta)335.5(tt)335.7(h)338.7(e)9.6(h)331.6(u)338.7(b)339.4(.)]TJ
/F18 1 Tf
13.4296 0 TD
-.0228 Tc
[(Neuro)-6.2(l)3.1(og)-6.2(y)]TJ
/F20 1 Tf
4.0687 0 TD
-.0217 Tc
(2011;)Tj
/F16 1 Tf
2.3402 0 TD
-.0238 Tc
[(76.)-7.5(13:)-5.3(1145)-7.2(1152)-7.2(.)]TJ
-21.2114 -1.6929 TD
0 Tc
[(96.)-227.8(Rudd)-327(M,)-333.4(Rodgers)-322.3(H,)-336.8(Curless)-324.6(R,)-331.9(et)-335.1(al.)-328.8(Remote)-332.8(specialist)-323.4(assessment)-321.4(for)]TJ
1.3728 -1.1239 TD
[(intravenous)-261.7(thrombolysis)-265(of)-276(acute)-269.6(ischaemic)-268.7(stroke)-271.1(by)-267.3(telephone.)]TJ
/F18 1 Tf
25.3085 0 TD
[(Emerg)-270.6(Med)-268.8(J)]TJ
/F20 1 Tf
-25.3085 -1.1239 TD
(2014;)Tj
/F16 1 Tf
2.4398 0 TD
(29:704708.)Tj
-3.8126 -1.6858 TD
[(97.)-227.8(Bruno)-320.9(A,)-317.6(Lanning)-321.3(K,)-323.1(Gross)-320(H,)-322.5(et)-320.9(al.)-321.7(Timeliness)-321.9(of)-318.7(intravenous)-311.5(thrombolysis)-314.8(via)]TJ
1.3728 -1.1239 TD
[(telestroke)-323.9(in)-334.7(Georgia.)]TJ
/F18 1 Tf
8.5429 0 TD
(Stroke)Tj
/F20 1 Tf
2.7172 0 TD
(2013;)Tj
/F16 1 Tf
2.4398 0 TD
(44:26202622.)Tj
-15.0727 -1.6858 TD
[(98.)-227.8(Pedragosa)-322.6(A,)-331.9(Alvarez-Sabin)-325.3(J,)-333.6(Rubiera)-326.4(M.)-333.4(Impact)-330(of)-332.9(telemedic)11.1(ine)-334.5(on)-329.8(acute)]TJ
1.3728 -1.131 TD
[(management)-325(of)-325.8(stroke)-328(patients)-330.1(undergoing)-321.7(endovascular)-325(procedures)13.5(.)]TJ
/F18 1 Tf
7.9702 0 0 7.9702 61.1149 106.9795 Tm
[(Cerebrovas)12.1(c)-333.8(Dis)]TJ
/F20 1 Tf
6.4445 0 TD
(2012;)Tj
/F16 1 Tf
2.4398 0 TD
[(34:4364)14.1(42.)]TJ
-10.2571 -1.6858 TD
[(99.)-227.8(Walter)-331.2(S,)-329.5(Kostopoulos)-325.6(P,)-329.8(Haass)-330.9(A,)-331.9(et)-328(al.)-335.9(Diagnosis)-327.5(and)-330.9(treatmen)11.9(t)-335.3(o)0(f)-332.9(patients)]TJ
1.3728 -1.1239 TD
[(with)-288.6(stroke)-285.3(in)-292.1(a)-292.8(mobile)-292(stroke)-285.3(unit)-291(versus)-287(in)-292.1(hospital:)-289.6(A)-291.2(randomized)-279.5(controlled)]TJ
T*
(trial.)Tj
/F18 1 Tf
2.0272 0 TD
[(Lancet)-329.2(Neurol)]TJ
/F20 1 Tf
5.7118 0 TD
(2012;)Tj
/F16 1 Tf
2.4398 0 TD
(11:397404.)Tj
22.57 77.6185 TD
[(100.)-246.8(Au)16.7(d)16.7(e)0(b)17.2(e)14.4(rt)-215.3(H)16.8(,)-225.6(Sc)24.6(hu)18.4(lt)25(es)-215.2(K)16.3(,)-225.6(Ti)19.7(e)14.4(t)0(z)-213.5(V)0(,)-209.3(e)0(t)-214.2(a)0(l)24.8(.)-225.6(Lo)24.6(ng)18.7(-)15.1(t)0(e)20.6(r)0(m)-215.1(e)14.4(ff)19.4(e)14.4(c)0(t)20.9(s)-222.5(of)-212(sp)21.8(e)14.4(c)0(i)19.4(a)0(l)17.7(i)0(z)19.7(e)14.4(d)-218.1(s)0(t)18.4(r)0(o)22.8(k)0(e)-212.6(c)14.8(ar)19.2(e)]TJ
1.8708 -1.1239 TD
[(wi)16.2(th)-226.5(te)20.6(le)19(me)27.9(di)21.2(ci)19.4(ne)-225.3(su)21.4(pp)19.1(or)22.8(t)-242.8(i)0(n)-228.1(c)14.8(om)23(mu)22.7(ni)20.9(ty)-228.4(ho)18.7(sp)28.9(it)17.8(al)17.7(s)-236.7(o)0(n)-230.2(b)0(e)24.3(h)0(a)22.3(l)0(f)-231.1(o)0(f)-226.2(t)0(h)22.4(e)-241.6(Te)22.4(le)19(me)27.9(di)21.3(ca)20.8(l)]TJ
T*
[(Pr)15.7(o)16.6(j)0(e)19(c)0(t)-228(f)0(o)22.8(r)-242.8(In)20.6(te)20.6(g)16.6(r)0(a)19.2(t)0(i)17.8(v)14.4(e)-241.6(S)0(t)23.1(r)0(o)22.8(k)0(e)-226.9(C)0(a)21(r)0(e)-228.4(\()0(T)19(E)0(M)19.1(P)0(i)21.2(S)0(\))20.9(.)]TJ
/F18 1 Tf
16.4669 0 TD
[(St)23.1(ro)22.8(ke)]TJ
/F20 1 Tf
2.575 0 TD
[(20)22.1(09)22.1(;)]TJ
/F16 1 Tf
2.39 0 TD
[(40)19.1(:9)20.9(02)26.2(9)19.1(08)19.1(.)]TJ
-23.3026 -1.6858 TD
[(101.)-246.8(Theiss)-259.4(S,)-258.4(Gunzel)-257.8(F,)-260.6(Storm)-260.7(A,)-260.7(et)-264(al.)-257.7(Using)-260.6(routine)-253.8(data)-264(for)-255.6(quality)-258.5(assessment)-250.2(in)]TJ
1.8708 -1.1239 TD
[(NeuroNet)-326.8(telestroke)-323.9(care.)]TJ
/F18 1 Tf
10.1433 0 TD
[(J)-335.6(Stroke)-323.2(Cerebrovasc)-321.7(Dis)]TJ
/F20 1 Tf
9.8304 0 TD
(2013;)Tj
/F16 1 Tf
2.4398 0 TD
(22:984990.)Tj
-24.2842 -1.6858 TD
[(102.)-246.8(Switzer)-330.5(J,)-333.6(Demaerschal)11.7(k)-333.8(B)0(,)-331.5(Xie)-334.5(J,)-333.6(et)-328(al.)-335.9(Cost)-327(effectiveness)-325.9(of)-332.9(hub-and-)12.1(spoke)]TJ
1.8708 -1.131 TD
[(telestroke)-331.1(networks)-321.4(for)-333.9(the)-333(manageme)15.3(nt)-333.2(of)-332.9(acute)-326.5(ischemic)-331.6(stroke)-328(from)-327.5(the)]TJ
0 -1.1239 TD
[(hospitals)-329.4(perspectives)12(.)]TJ
/F18 1 Tf
9.0906 0 TD
[(Circ)-336.5(Cardiovas)12.2(c)-333.8(Qual)-329.4(Outcomes)]TJ
/F20 1 Tf
12.5191 0 TD
(2013;)Tj
/F16 1 Tf
2.4469 0 TD
(6:1826.)Tj
-25.9274 -1.6858 TD
[(103.)-246.8(GOLD.)]TJ
/F18 1 Tf
4.5097 0 TD
[(Global)-329.1(strategy)-326.9(for)-333.9(the)-333(diagnosis,)-322.4(management)-317.9(and)-334.5(prevention)-322(of)]TJ
-2.639 -1.1239 TD
[(chronic)-330.1(obstructive)-326.4(pulmonary)-319.8(disease.)-326.4(NHLBI/WHO)-327.2(Workshop)-326(Report,)-328.8(April)]TJ
T*
(2001)Tj
/F16 1 Tf
1.9134 0 TD
[(.)-332.3(NIH)-332.3(publication)-324.5(no.)-334.9(2701:1-1)12.5(00.)-334.5(Bethesda,)-323.6(MD:)-328.2(National)-328.7(Heart,)-332.5(Lung)]TJ
-1.9134 -1.131 TD
[(and)-331(Blood)-328.8(Institute,)-331.1(updated)]TJ
/F20 1 Tf
11.4237 0 TD
(2014.)Tj
/F16 1 Tf
-13.2944 -1.6858 TD
[(104.)-246.8(Caramori)-331.6(G,)-329.7(Adcock)-327.4(I,)-335.1(Papi)-333.1(A.)-331.9(Clinical)-327.9(definition)-327.5(of)-332.9(COPD)-325.3(exacerbations)-327.2(and)]TJ
1.8708 -1.1239 TD
[(classification)-325.6(of)-332.9(their)-329.4(severity.)]TJ
/F18 1 Tf
11.9216 0 TD
[(South)-326(Med)-332.8(J)]TJ
/F20 1 Tf
5.2353 0 TD
(2009;)Tj
/F16 1 Tf
2.4398 0 TD
(102:277282.)Tj
-21.4674 -1.6858 TD
[(105.)-246.8(Donaldson)-325.6(G,)-336.8(Wedzich)12.2(a)-335.4(J)0(.)-333.6(COPD)-332.4(exacerbati)11.8(ons)-331.8(1:)-334.7(Epidemiol)12.3(ogy.)]TJ
/F18 1 Tf
26.8521 0 TD
(Thorax)Tj
/F20 1 Tf
-24.9813 -1.1239 TD
(2006;)Tj
/F16 1 Tf
2.4469 0 TD
[(61:1641)14.1(68.)]TJ
-4.3177 -1.6929 TD
[(106.)-246.8(Rodriguez-Ro)11(isin)-332.1(R.)-331.9(Toward)-333.3(a)-328.3(consensus)-323.8(definition)-327.5(for)-333.9(COPD)-325.3(exacerbations.)]TJ
/F18 1 Tf
1.8708 -1.1239 TD
(Chest)Tj
/F20 1 Tf
2.4683 0 TD
(2000;)Tj
/F16 1 Tf
2.4398 0 TD
[(117\(5)-327.8(Suppl)-327.2(2\):398S401S)11.7(.)]TJ
-6.7788 -1.6858 TD
[(107.)-246.8(Burge)-244.5(S,)-251.3(Wedzicha)-245(JH.)-245.6(COPD)-247(exacerbations:)-237.5(Definitions)-243.6(and)-245.6(classification)8.7(s.)]TJ
/F18 1 Tf
30.366 0 TD
(Eur)Tj
-28.4952 -1.1239 TD
[(Respir)-329.7(J)-335.6(Suppl)]TJ
/F20 1 Tf
5.8114 0 TD
(2003;)Tj
/F16 1 Tf
2.4398 0 TD
(41:46s53s.)Tj
-10.122 -1.6858 TD
[(108.)-246.8(Celli)-291.1(B,)-288.8(Barnes)-278.5(P.)-287.2(Exacerbations)-278.7(of)-290.2(chronic)-280.3(obstructive)-276.6(pulmonary)-280.7(disease.)]TJ
/F18 1 Tf
30.366 0 TD
(Eur)Tj
-28.4952 -1.1239 TD
[(Respir)-329.7(J)]TJ
/F20 1 Tf
3.3503 0 TD
(2007;)Tj
/F16 1 Tf
2.4398 0 TD
[(29:1224123)14.2(8.)]TJ
-7.6609 -1.6929 TD
[(109.)-246.8(Rabe)-332.1(K,)-330.2(Hurd)-335.3(S,)-329.5(Anzueto)-327.2(A,)-331.9(et)-328(al.)-335.9(Global)-332.7(strategy)-323.3(for)-333.9(the)-325.9(diagnosis,)]TJ
1.8708 -1.1239 TD
[(management,)-251.8(and)-252.7(prevention)-243.8(of)-254.6(chronic)-251.9(obstructive)-248.2(pulmona)11.7(ry)-256.9(disease:)-249.5(GOLD)]TJ
T*
[(executive)-326.7(summary.)]TJ
/F18 1 Tf
7.9311 0 TD
[(Am)-327.6(J)-335.6(Respir)-329.7(Crit)-330.9(Care)-331.9(Med)]TJ
/F20 1 Tf
10.7124 0 TD
(2007;)Tj
/F16 1 Tf
2.4398 0 TD
(176:532555.)Tj
-22.9541 -1.6858 TD
[(110.)-246.8(Centers)-327.9(for)-333.9(Disease)-324.4(Control)-331.1(and)-331(Prevention)12.3(.)-332.3(Chronic)-329.9(obstructive)-326.4(pulmona)11.7(ry)]TJ
1.8708 -1.1239 TD
[(disease)-332(among)-329.3(adultsU)12.1(nited)-333.1(States,)-327.3(2011.)]TJ
/F18 1 Tf
17.1782 0 TD
[(MMWR)-327.6(Morb)-324.1(Mortal)-335.1(Wkly)-327.5(Rep)]TJ
/F20 1 Tf
-17.1782 -1.131 TD
(2012;)Tj
/F16 1 Tf
2.4469 0 TD
[(61:9389)14.1(51.)]TJ
-4.3177 -1.6858 TD
[(111.)-246.8(Centers)-327.9(for)-333.9(Disease)-324.4(Control)-331.1(and)-331(Prevention)12.3(.)-332.3(QuickStats:)-328.8(Number)-328.8(of)-332.9(deaths)]TJ
1.8708 -1.1239 TD
[(from)-313.3(10)-315.3(leading)-312(causesNati)14.1(onal)-312.1(vital)-319.9(statistics)-306.2(system,)-309.1(United)-309.2(States,)-313(2010.)]TJ
/F18 1 Tf
T*
[(MMWR)-327.6(Morb)-331.2(Mortal)-327.9(Wkly)-327.5(Rep)]TJ
/F20 1 Tf
12.3555 0 TD
(2013;)Tj
/F16 1 Tf
2.4398 0 TD
(62:155.)Tj
-16.6661 -1.6858 TD
[(112.)-246.8(American)-329.4(Lung)-326.9(Association.)]TJ
/F18 1 Tf
12.8463 0 TD
[(Trends)-324.6(in)-334.7(COPD)-325.3(\(chronic)-333.3(bronchit)12.5(is)-331.7(and)]TJ
-10.9756 -1.1239 TD
[(emphysema\):)-324.3(Morbidity)-327.5(and)-327.4(mortality.)]TJ
/F16 1 Tf
15.151 0 TD
[(Washington)13(,)-339.4(DC:)-326.4(American)-329.4(Lung)]TJ
-15.151 -1.131 TD
[(Association,)-328.4(Epidemiolog)10(y)-334.1(and)-330.9(Statistics)-329.9(Unit,)-323.9(Research)-327.9(and)-331(Education)]TJ
0 -1.1239 TD
(Division,)Tj
/F20 1 Tf
3.5281 0 TD
(2013.)Tj
/F16 1 Tf
-5.3989 -1.6858 TD
[(113.)-246.8(Ford)-329.9(E,)-333.4(Croft)-334.1(J,)-333.6(Mannino)-323.3(D,)-329.3(et)-335.1(al.)-335.9(COPD)-325.3(surveillanceUn)10(ited)-328.1(States,)-327.3(1999)]TJ
1.8708 -1.1239 TD
(2011.)Tj
/F18 1 Tf
2.4327 0 TD
(Chest)Tj
/F20 1 Tf
2.4611 0 TD
(2013;)Tj
/F16 1 Tf
2.4469 0 TD
[(144:284)14.1(305.)]TJ
-9.2115 -1.6858 TD
[(114.)-246.8(Holguin)-270.8(F,)-274.8(Folk)-269.3(E,)-276.5(Redd)-264.9(SC,)-271.9(Mannino)-266.4(DM.)-273.5(Comorbidi)11.1(ty)-278.2(and)-266.9(mortality)-270.4(in)-270.7(COPD-)]TJ
1.8708 -1.131 TD
[(related)-330(hospitalizatio)8.2(ns)-334.2(in)-327.6(the)-333(United)-330.5(States,)-327.3(1979)-331.8(to)-325.8(2001.)]TJ
/F18 1 Tf
23.3595 0 TD
(Chest)Tj
/F20 1 Tf
-23.3595 -1.1239 TD
(2005;)Tj
/F16 1 Tf
2.4469 0 TD
[(128:2005)14.1(2011.)]TJ
-4.3177 -1.6858 TD
[(115.)-246.8(Raza)-335.3(T,)-331.4(Joshi)-328.5(M,)-333.4(Shapira)-325.7(RM,)-333(Agha)-330.6(Z.)-329.8(Pulmonary)-323.4(telemedicine)10.8(A)-336.6(model)-325.4(to)]TJ
1.8708 -1.1239 TD
[(access)-302.6(the)-304.6(subspecial)12.1(ist)-304.2(services)-297.9(in)-306.3(underserved)-292.9(rural)-302.3(areas.)]TJ
/F18 1 Tf
23.2173 0 TD
[(Int)-307.6(J)-300.1(Med)-304.4(Inform)]TJ
/F20 1 Tf
-23.2173 -1.1239 TD
(2009;)Tj
/F16 1 Tf
2.4469 0 TD
[(78:5359)14.1(.)]TJ
-4.3177 -1.6929 TD
[(116.)-246.8(Bonavia)-333.6(M,)-326.3(Averame)-329.1(G,)-329.7(Canonica)-331.2(W,)-330.8(et)-335.1(al.)-328.8(Feasibility)-330.5(and)-331(validation)-323.7(of)]TJ
1.8708 -1.1239 TD
[(telespirometry)-326.1(in)-334.7(general)-326.9(practice:)-324.8(The)-331.1(Italian)-329.1(Alliance)-332.6(study.)]TJ
/F18 1 Tf
23.8148 0 TD
[(Respir)-329.7(Med)]TJ
/F20 1 Tf
-23.8148 -1.1239 TD
(2009;)Tj
/F16 1 Tf
2.4469 0 TD
[(103:1732)14.1(1737.)]TJ
-4.3177 -1.6858 TD
[(117.)-246.8(Averame)-329.1(G,)-329.7(Bonavia)-333.6(M,)-326.3(Ferri)-330.9(P,)-337(et)-328(al.)-335.9(Office)-328(spirometry)-323.1(can)-332.8(improve)-326.2(the)]TJ
1.8708 -1.1239 TD
[(diagnosis)-328(of)-332.9(obstructive)-326.4(airway)-328.3(disease)-324.9(in)-334.7(primary)-330.9(care)-328.6(setting.)]TJ
/F18 1 Tf
24.8675 0 TD
[(Respir)-329.7(Med)]TJ
/F20 1 Tf
-24.8675 -1.1239 TD
(2009;)Tj
/F16 1 Tf
2.4469 0 TD
[(103:866)14.1(872.)]TJ
-4.3177 -1.6929 TD
[(118.)-246.8(Bernocchi)-279.4(P,)-280(Scalvini)-280.5(S.)-286.8(Tridico)-277.1(C,)-281.7(et)-285.3(al.)-286.1(Healthcare)-278.5(continu)12.8(ity)-287.8(from)-277.7(hospital)-279.6(to)]TJ
1.8708 -1.1239 TD
[(territory)-331.8(in)-334.7(Lombard)12.7(y:)-337(TELEMACO)-324.7(project.)]TJ
/F18 1 Tf
7.9702 0 0 7.9702 467.0928 165.2598 Tm
[(Am)-327.6(J)-335.6(Manag)-326.1(Care)]TJ
/F20 1 Tf
7.3621 0 TD
(2012;)Tj
/F16 1 Tf
2.4469 0 TD
(18:e101)Tj
-26.1265 -1.1239 TD
(e108.)Tj
-1.8708 -1.6858 TD
[(119.)-246.8(Whitten)-333(P,)-329.8(Mickus)-329.6(M.)-326.3(Home)-329.9(telecare)-331.6(for)-326.7(COPD/CHF)-332(patients)11.3(:)-337.2(Outcomes)-322.8(and)]TJ
1.8708 -1.1239 TD
(perceptions.)Tj
/F18 1 Tf
4.9294 0 TD
[(J)-328.5(Telemed)-326.5(Telecare)]TJ
/F20 1 Tf
7.4972 0 TD
(2007;)Tj
/F16 1 Tf
2.4469 0 TD
[(13:6973)14.1(.)]TJ
-16.7443 -1.6929 TD
[(120.)-246.8(Vitacca)-329.8(M,)-333.4(Bianchi)-327.9(L,)-331.4(Guerra)-332.5(A,)-331.9(et)-328(al.)-335.9(Tele-assist)10.4(ance)-332.6(in)-334.7(chronic)-323(respiratory)]TJ
1.8708 -1.1239 TD
[(failure)-333(patients:)-325.8(A)-333.9(randomized)-322.2(clinical)-335.2(trial.)]TJ
/F18 1 Tf
17.0502 0 TD
[(Eur)-334.3(Respir)-329.7(J)]TJ
/F20 1 Tf
4.9365 0 TD
(2009;)Tj
/F16 1 Tf
2.4469 0 TD
[(33:4114)14.1(18.)]TJ
-26.3044 -1.6858 TD
[(121.)-246.8(Vitacca)-329.8(M,)-333.4(Bazza,)-332(A,)-331.9(Bianchi)-327.9(L,)-331.4(et)-335.1(al.)-328.8(Tele-assistance)-322.2(in)-334.8(chronic)-330.1(respirato)10.7(ry)]TJ
1.8708 -1.1239 TD
[(failure:)-335.9(Patients)11.3()-332.3(characterizatio)8.6(n)-332.2(and)-331(staff)-333.3(workload)-326.7(of)-332.9(5-year)-325.6(activity.)]TJ
/F18 1 Tf
T*
[(Telemed)-326.5(J)-335.6(E)-335.4(Health)]TJ
/F20 1 Tf
7.732 0 TD
(2010;)Tj
/F16 1 Tf
2.4469 0 TD
[(16:2993)14.1(05.)]TJ
/F11 1 Tf
11.9551 0 0 11.9551 50.1732 741.9966 Tm
[(BASHSHUR)-338.5(ET)-334.1(AL.)]TJ
7.9702 0 0 7.9702 50.1732 29.7638 Tm
[(7)-80(9)-78.2(8)-701.6(TELEMEDICINE)-323.9(and)-331.8(e-HEALT)11.5(H)]TJ
/F8 1 Tf
6.9738 0 0 6.9738 177.7889 29.7638 Tm
.1095 Tc
[(SEPT)6.6(EMBER)-333.2(2).1(0)6.8(1)0(4)]TJ
ET
q
1 i
0 792 612 -791.985 re
W n
32.315 .014984 .22675 791.985 re
f
/Document /MC16 BDC
Q
q
1 i
0 792 32.315 -173.367 re
W n
0 0 0 .29999 k
0 618.633 32.315 173.367 re
f
EMC
Q
32.315 763.994 242.646 .22675 re
f
endstream
endobj
527 0 obj
<>stream
Adobe Illustrator CS4
2010-08-04T11:54:42+05:30
2010-08-04T11:54:42+05:30
2010-08-04T11:54:42+05:30
68
256
JPEG
/9j/4AAQSkZJRgABAgEASABIAAD/7QAsUGhvdG9zaG9wIDMuMAA4QklNA+0AAAAAABAASAAAAAEA
AQBIAAAAAQAB/+4ADkFkb2JlAGTAAAAAAf/bAIQABgQEBAUEBgUFBgkGBQYJCwgGBggLDAoKCwoK
DBAMDAwMDAwQDA4PEA8ODBMTFBQTExwbGxscHx8fHx8fHx8fHwEHBwcNDA0YEBAYGhURFRofHx8f
Hx8fHx8fHx8fHx8fHx8fHx8fHx8fHx8fHx8fHx8fHx8fHx8fHx8fHx8fHx8f/8AAEQgBAABEAwER
AAIRAQMRAf/EAaIAAAAHAQEBAQEAAAAAAAAAAAQFAwIGAQAHCAkKCwEAAgIDAQEBAQEAAAAAAAAA
AQACAwQFBgcICQoLEAACAQMDAgQCBgcDBAIGAnMBAgMRBAAFIRIxQVEGE2EicYEUMpGhBxWxQiPB
UtHhMxZi8CRygvElQzRTkqKyY3PCNUQnk6OzNhdUZHTD0uIIJoMJChgZhJRFRqS0VtNVKBry4/PE
1OT0ZXWFlaW1xdXl9WZ2hpamtsbW5vY3R1dnd4eXp7fH1+f3OEhYaHiImKi4yNjo+Ck5SVlpeYmZ
qbnJ2en5KjpKWmp6ipqqusra6voRAAICAQIDBQUEBQYECAMDbQEAAhEDBCESMUEFURNhIgZxgZEy
obHwFMHR4SNCFVJicvEzJDRDghaSUyWiY7LCB3PSNeJEgxdUkwgJChgZJjZFGidkdFU38qOzwygp
0+PzhJSktMTU5PRldYWVpbXF1eX1RlZmdoaWprbG1ub2R1dnd4eXp7fH1+f3OEhYaHiImKi4yNjo
+DlJWWl5iZmpucnZ6fkqOkpaanqKmqq6ytrq+v/aAAwDAQACEQMRAD8A6dhQ7FXYq7FXYq7FXYq7
FUZ/0qf+jj/jTFUHirsVdirsVdirsVdirsVRn/Sp/wCjj/jTFUHirsVdirsVdirsVdirsVRn/Sp/
6OP+NMVQeKuxV2KuxV2KuxV2KuxVGf8ASp/6OP8AjTFUHirsVdirsVdirsVdirsVRn/Sp/6OP+NM
VQeKuxV2KuxV2KuxV2KuxVGf9Kn/AKOP+NMVQeKuxV2KuxV2KuxV2KuxVGf9Kn/o4/40xVB4q7FX
Yq7FXYq7FXYq7FUZ/wBKn/o4/wCNMVQeKuxV2KuxV2KuxV2KuxVGf9Kn/o4/40xVB4q7FXYq7FXY
q7FXYq7FUZ/0qf8Ao4/40xVB4q7FXYq7FXYq7FXYq7FUZ/0qf+jj/jTFUHirsVdirsVdirsVdirs
VRn/AEqf+jj/AI0xVB4q7FXYq7FXYq7FXYq7FUZ/0qf+jj/jTFUHirsVdirsVdirsVdirsVRn/Sp
/wCjj/jTFUHirsVdirsVdirsVdirsVRn/Sp/6OP+NMVQeKuxV2KuxV2KuxV2KuxVGf8ASp/6OP8A
jTFUHirsVdirsVdirsVdirsVRn/Sp/6OP+NMVQeKuxV2KuxV2KuxV2KuxVGf9Kn/AKOP+NMVQeKu
xV2KuxV2KuxV2KuxVGf9Kn/o4/40xVB4q7FXYq7FXYq7FXYq7FUZ/wBKn/o4/wCNMVQeKuxV2Kux
V2KuxV2KuxVGf9Kn/o4/40xVB4q7FXYq7FXYq7FXYq7FUZ/0qf8Ao4/40xVB4q7FXYq7FXYq7FXY
q7FUZ/0qf+jj/jTFUHirsVdirsVdirsVdirsVRn/AEqf+jj/AI0xVB4q7FXYq7FXYq7FXYq7FUZ/
0qf+jj/jTFUHirsVdirsVdirsVdirsVRn/Sp/wCjj/jTFUHirsVdirsVdirsVdirsVRn/Sp/6OP+
NMVQeKuxV2KuxV2KuxV2KuxVGf8ASp/6OP8AjTFUHirsVdirsVdirsVdirsVRn/Sp/6OP+NMVQeK
uxV2KuxV2KuxV2KuxVGf9Kn/AKOP+NMVQeKuxV2KuxV2KuxV2KuxVGf9Kn/o4/40xVB4q7FXYq7F
XYq7FXYq7FUZ/wBKn/o4/wCNMVf/2Q==
application/postscript
saved
xmp.iid:11FB61F30AB7DE11AEB3E861853EAFA4
2009-10-12T14:15:50+05:30
Adobe Illustrator CS4
/
converted
from application/postscript to application/vnd.adobe.illustrator
converted
from application/postscript to application/vnd.adobe.illustrator
saved
xmp.iid:0280117407206811994CBE3149FFDB59
2010-08-04T11:54:42+05:30
Adobe Illustrator CS4
/
converted
from application/postscript to application/vnd.adobe.illustrator
xmp.iid:11FB61F30AB7DE11AEB3E861853EAFA4
xmp.did:11FB61F30AB7DE11AEB3E861853EAFA4
uuid:ee5a72b3-04e4-4157-a8d8-c3a8817872a3
uuid:ee5a72b3-04e4-4157-a8d8-c3a8817872a3
xmp.iid:0280117407206811994CBE3149FFDB59
xmp.did:0280117407206811994CBE3149FFDB59
TouchUp 7.0
False
False
1
684.000000
864.000000
Points
Black
Default Swatch Group
0
PANTONE 3025 C
SPOT
100.000000
CMYK
100.000000
16.859999
0.000000
50.980003
endstream
endobj
440 0 obj
<>
endobj
528 0 obj
<>/XObject<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]/Font<>>>/Thumb 531 0 R/MediaBox[0 0 612 792]/Annots[532 0 R 533 0 R 534 0 R 535 0 R 536 0 R 537 0 R 538 0 R 539 0 R 540 0 R 541 0 R 542 0 R 543 0 R 544 0 R 545 0 R 546 0 R 547 0 R 548 0 R 549 0 R 550 0 R 551 0 R 552 0 R 553 0 R 554 0 R 555 0 R 556 0 R 557 0 R 558 0 R 559 0 R 560 0 R 561 0 R 562 0 R 563 0 R 564 0 R 565 0 R 566 0 R 567 0 R 568 0 R 569 0 R 570 0 R 571 0 R 572 0 R 573 0 R 574 0 R 575 0 R 576 0 R 577 0 R 578 0 R 579 0 R 580 0 R 581 0 R 582 0 R 583 0 R 584 0 R 585 0 R 586 0 R 587 0 R 588 0 R 589 0 R 590 0 R 591 0 R 592 0 R 593 0 R 594 0 R 595 0 R 596 0 R 597 0 R 598 0 R 599 0 R 600 0 R 601 0 R 602 0 R 603 0 R 604 0 R 605 0 R 606 0 R 607 0 R 608 0 R 609 0 R 610 0 R 611 0 R 612 0 R 613 0 R 614 0 R 615 0 R 616 0 R 617 0 R 618 0 R 619 0 R 620 0 R 621 0 R 622 0 R 623 0 R 624 0 R 625 0 R]/Rotate 0>>
endobj
626 0 obj
<>/ProcSet[/PDF/Text]/Font<>>>
endobj
530 0 obj
<>stream
/GS1 gs
BT
/F16 1 Tf
7.9702 0 0 7.9702 35.8866 694.2612 Tm
0 0 0 1 k
0 Tc
0 Tw
[(122.)-246.8(Dinesen)-267.3(B,)-267.5(Haesum)-269.3(L,)-267.4(Sorensen)-263.5(N,)-273.1(et)-271.1(al.)-271.9(Using)-267.7(preventive)-262.1(home)-266.4(monitoring)-266.6(to)]TJ
1.8708 -1.1239 TD
[(reduce)-308.5(hospital)-315.2(admission)-309.9(rates)-317.9(and)-309.6(reduce)-315.6(costs:)-310.7(A)-312.6(case)-315.3(study)-311.2(of)-318.7(telehealth)]TJ
T*
[(among)-329.3(chronic)-323(obstructive)-326.4(pulmonary)-323.4(disease)-332(patients)11.3(.)]TJ
/F18 1 Tf
21.7591 0 TD
[(J)-328.5(Telemed)-326.5(Telecare)]TJ
/F20 1 Tf
-21.7591 -1.1239 TD
(2012;)Tj
/F16 1 Tf
2.4398 0 TD
(18:221225.)Tj
-4.3106 -1.6858 TD
[(123.)-246.8(S)-11.5(o)0(r)-12.8(k)-13.7(na)-20.4(es)-350.3(A,)-346.1(B)-13.5(e)0(c)-20.6(h)-339.4(M)-8.2(,)-339.4(M)-8.2(a)-15.4(ds)-13.8(en)-353.4(H,)-351(et)-349.3(a)-15.4(l)-9.6(.)-339.4(T)-13.3(he)-346.3(ef)-22.1(f)-8.1(e)0(c)-20.6(t)-342.4(of)-347.1(r)-8.1(e)-14(a)-8.2(l)-9.6(-t)-21.4(i)-9.6(m)-7.9(e)]TJ
1.8708 -1.1239 TD
[(t)-8.1(e)-14(l)-9.6(e)0(c)-13.5(o)-11.8(ns)-14.1(u)-12.1(l)-9.6(t)-8.1(a)-8.2(t)-8.1(i)-16.7(on)-16.8(s)-336.3(b)-11.5(et)-22.1(we)-16.7(en)-346.3(h)-12.1(o)0(s)-13.8(p)-11.8(i)-9.6(t)-8.1(a)-8.2(l)-9.6(-)-13.3(b)-11.5(a)-8.2(s)-9.1(ed)-345.9(n)-12.1(u)0(r)-20.2(s)-9.1(es)-350.3(a)-8.2(n)0(d)-351.2(p)0(a)-20(t)-8.1(i)-9.6(e)0(n)-19(t)-8.1(s)-343.4(w)-9.7(i)-9.6(t)-8.1(h)-339.3(s)-9.1(ev)-20.9(er)-15(e)]TJ
0 -1.131 TD
[(CO)-17.7(P)-11.8(D)-338.5(d)-11.8(i)-9.6(s)-9.1(c)0(h)-18.7(a)-8.2(r)-8.1(g)-11.8(ed)-345.9(a)-15.4(f)-8.1(t)-8.1(e)0(r)-349.3(a)-15.4(n)-339.3(e)0(x)-20.6(a)-8.2(ce)-13.5(r)-15.2(b)0(a)-12.6(t)-15.2(i)-9.6(o)0(n)-16.8(.)]TJ
/F18 1 Tf
16.0259 0 TD
[(J)-342.7(T)-13.3(el)-16.5(em)-14.8(e)-14(d)-339(T)-13.3(e)0(l)-16.5(e)0(c)-20.6(a)0(r)-12.8(e)]TJ
/F20 1 Tf
7.668 0 TD
[(20)-13.4(1)-13.8(3)0(;)]TJ
/F16 1 Tf
2.4896 0 TD
[(19)-16.5(:)]TJ
-26.1835 -1.1239 TD
.0153 Tc
[(46)15.3(6)15.3(47)15.3(4.)]TJ
-1.8708 -1.6858 TD
0 Tc
[(124.)-246.8(Sorknaes)-245.1(A,)-246.5(Madsen)-248.5(M,)-248(Hallas)-248.5(J,)-255.3(et)-249.7(al.)-250.5(Nurse)-247.4(tele-consul)14.7(tation)-250.1(with)-245.9(discharged)]TJ
1.8708 -1.1239 TD
[(COPD)-239.9(patients)-244.7(reduce)-237.4(early)-246(readmission)13.9(An)-246.5(interventi)11.1(onal)-248.1(study.)]TJ
/F18 1 Tf
25.1236 0 TD
[(Clin)-244(Respir)-244.3(J)]TJ
/F20 1 Tf
-25.1236 -1.1239 TD
(2011;)Tj
/F16 1 Tf
2.4398 0 TD
(5:2634.)Tj
-4.3106 -1.6929 TD
[(125.)-246.8(Pinnock)-326.7(H,)-329.7(Hanley)-332.9(J,)-333.6(McCloug)11.7(han)-331.3(L,)-331.4(et)-335.1(al.)-328.8(Effectiveness)-327.2(of)-332.9(telemoni)12.4(toring)]TJ
1.8708 -1.1239 TD
[(integrated)-326.5(into)-333.3(existing)-322.8(clinical)-328.1(services)-326.4(on)-336.9(hospital)-322.3(admission)-331.2(for)]TJ
T*
[(exacerbation)-325.2(of)-332.9(chronic)-323(obstructive)-326.4(pulmonary)-323.4(disease:)-327.7(Researcher)-328.6(blind,)]TJ
T*
[(multicentr)10.4(e,)-332(randomised)-325(controlled)-331.2(trial.)]TJ
/F18 1 Tf
15.841 0 TD
(BMJ)Tj
/F20 1 Tf
1.949 0 TD
(2013;)Tj
/F16 1 Tf
2.4398 0 TD
[(347:f6070)13.1(.)]TJ
-22.1005 -1.6858 TD
[(126.)-246.8(Strickland)-270.1(M,)-276.5(Jourdain)-267.2(T,)-274.5(Wong)-269.1(E,)-276.5(et)-271.1(al.)-279(Using)-267.7(telehealth)-266.5(technology)-268.5(to)-276(deliver)]TJ
1.8708 -1.1239 TD
[(pulmonary)-323.4(rehabilitation)-325.8(to)-332.9(patients)-330.1(with)-331.3(chronic)-323(obstructive)-326.4(pulmona)11.7(ry)]TJ
0 -1.131 TD
(disease.)Tj
/F18 1 Tf
3.2649 0 TD
[(Can)-329.1(Respir)-329.7(J)]TJ
/F20 1 Tf
5.1713 0 TD
(2011;)Tj
/F16 1 Tf
2.4398 0 TD
(18:216220.)Tj
-12.7467 -1.6858 TD
[(127.)-246.8(de)-331.7(Toledo)-328.5(P,)-329.8(Jime)]TJ
8.2584 .0142 TD
()Tj
.3557 -.0142 TD
[(nez)-331.1(S,)-329.5(del)-334.2(Pozo)-326.2(F,)-331.7(Roca)-332.1(J,)-333.6(Alonso)-324.4(A,)-331.9(Hernandez)-325.9(C.)]TJ
-6.7433 -1.1239 TD
[(Telemedici)10.4(ne)-332(experience)-324.3(for)-333.9(chronic)-323(care)-335.7(in)-327.6(COPD.)]TJ
/F18 1 Tf
19.7603 0 TD
[(IEEE)-333.4(Trans)-331.9(Inf)-329(Technol)]TJ
-19.7603 -1.1239 TD
(Biomed)Tj
/F20 1 Tf
3.1867 0 TD
(2006;)Tj
/F16 1 Tf
2.4469 0 TD
[(10:5675)14.1(73.)]TJ
-7.5044 -1.6858 TD
[(128.)-246.8(Gellis)-269.9(Z,)-272.9(Kenaley)-262(B,)-274.6(McGinty)-262.3(J,)-269.6(et)-271.1(al.)-271.9(Outcomes)-265.8(of)-268.9(a)-271.4(telehealth)-266.5(interventi)11.1(on)-272.9(for)]TJ
1.8708 -1.1239 TD
[(homeboun)13.3(d)-331.9(older)-332.8(adults)-329.3(with)-331.3(heart)-328(of)-332.9(chronic)-323(respiratory)-331.5(failure:)-328.8(A)]TJ
0 -1.131 TD
[(randomized)-322.2(controlled)-331.2(trial.)]TJ
/F18 1 Tf
10.9685 0 TD
(Gerontologist)Tj
/F20 1 Tf
5.5056 0 TD
(2012;)Tj
/F16 1 Tf
2.4469 0 TD
[(52:5415)14.1(52.)]TJ
-20.7917 -1.6858 TD
[(129.)-246.8(Pedone)-324.6(C,)-331.5(Chiurco)-329.9(D,)-329.3(Scarlata)-331.8(S,)-336.6(et)-328(al.)-335.9(Efficacy)-325.5(of)-332.9(multiparametri)10.8(c)]TJ
1.8708 -1.1239 TD
[(telemonitori)10.3(ng)-329.8(on)-336.9(respirato)10.7(ry)-335.1(outcome)13(s)-336.3(i)0(n)-327.6(elderly)-330.2(people)-329.2(with)-331.3(COPD:)-328.1(A)]TJ
T*
[(randomized)-322.2(controlled)-331.2(trial.)]TJ
/F18 1 Tf
10.9685 0 TD
[(BMC)-333.9(Health)-330.5(Serv)-325(Res)]TJ
/F20 1 Tf
8.614 0 TD
(2013;)Tj
/F16 1 Tf
2.4469 0 TD
(13:82.)Tj
-23.9001 -1.6858 TD
[(130.)-246.8(Cardozo)-327.5(L,)-331.4(Steinberg)-328.4(J.)-333.6(Telemedic)12.9(ine)-334.5(for)-333.9(recently)-321.3(discharged)-323.7(older)-332.8(patients.)]TJ
/F18 1 Tf
1.8708 -1.131 TD
[(Telemed)-326.5(J)-335.6(E)-328.3(Health)]TJ
/F20 1 Tf
7.732 0 TD
(2010;)Tj
/F16 1 Tf
2.4398 0 TD
(16:4955.)Tj
-12.0425 -1.6858 TD
[(131.)-246.8(Thijssing)-317(L,)-324.3(Van)-317.1(Der)-325(Heijen)-312.9(J,)-326.5(Chavanne)12.2(s)-322.1(N)0(,)-322.9(e)0(t)-320.9(al.)-328.8(Telepulmon)11.6(ology:)-318(Effect)-316.3(on)]TJ
1.8708 -1.1239 TD
[(quality)-329.6(and)-330.9(efficiency)-323.3(of)-332.9(care.)]TJ
/F18 1 Tf
11.9003 0 TD
[(Respir)-322.5(Med)]TJ
/F20 1 Tf
4.6733 0 TD
(2014;)Tj
/F16 1 Tf
2.4398 0 TD
[(108:314318)14.2(.)]TJ
-20.8842 -1.6858 TD
[(132.)-246.8(Reardon)-307.6(T.)-310(Research)-306.5(findings)-304.9(and)-309.6(strategies)-306.5(for)-312.5(assessing)-305.7(telemedicin)10.6(e)-312.8(costs.)]TJ
/F18 1 Tf
1.8708 -1.1239 TD
[(Telemed)-326.5(J)-335.6(E)-328.3(Health)]TJ
/F20 1 Tf
7.732 0 TD
(2005;)Tj
/F16 1 Tf
2.4398 0 TD
(11:348368.)Tj
-12.0425 -1.6929 TD
[(133.)-246.8(Rabinowitz)-328.4(T,)-331.4(Murphy)-322.5(KM,)-331.3(Amour)-331.2(JL,)-332.7(Ricci)-330.7(MA,)-325.9(Caputo)-328.8(MP,)-331(Newhouse)-322.6(PA.)]TJ
1.8708 -1.1239 TD
[(Benefits)-330.4(of)-325.8(a)-335.4(telepsychia)10.8(try)-336.1(consultati)11.2(on)-329.8(service)-331.5(for)-326.7(rural)-337.8(nursing)-324(home)]TJ
T*
(residents.)Tj
/F18 1 Tf
3.9407 0 TD
[(Telemed)-326.5(J)-328.5(E)-335.4(Health)]TJ
/F20 1 Tf
7.7249 0 TD
(2010;)Tj
/F16 1 Tf
2.4469 0 TD
[(16:3440)14.1(.)]TJ
-15.9832 -1.6858 TD
[(134.)-246.8(Simon)-330.3(GE,)-330.8(VonKorff)-326.2(M,)-333.4(Rutter)-327.5(C,)-331.5(Wagner)-323.2(E.)-333.4(Randomised)-323.7(trial)-335.3(of)-332.9(monitoring)10.8(,)]TJ
1.8708 -1.1239 TD
[(feedback,)-327.7(and)-330.9(management)-317.9(of)-332.9(care)-335.7(by)-324.2(telephone)-328.2(to)-332.9(improve)-326.2(treatment)-323.4(of)]TJ
T*
[(depression)-324.9(in)-327.6(primary)-330.9(care.)]TJ
/F18 1 Tf
10.8191 0 TD
(BMJ)Tj
/F20 1 Tf
1.9419 0 TD
(2000;)Tj
/F16 1 Tf
2.4398 0 TD
(320:550.)Tj
-17.0715 -1.6929 TD
[(135.)-246.8(P)-26(y)-21.1(n)-26.4(e)-405.2(J)-22.7(M)-22.4(,)-403.4(F)-27.9(o)-18.9(r)-29.4(t)-22.3(n)-19.3(e)-28.2(y)-405.2(J)-22.7(C)-20.6(,)-410.5(T)-20.4(r)-29.4(i)-23.8(p)-18.9(a)-29.6(t)-22.3(h)-26.4(i)-400.8(S)-25.7(P)-26(,)-403.4(M)-22.4(a)-22.5(c)-27.9(i)-23.8(e)-21.1(j)-31(e)-21.1(w)-24(s)-23.3(k)-20.8(i)-408(M)-22.4(L)-27.6(,)-403.4(E)-22.5(d)-26(l)-23.8(u)-26.4(n)-19.3(d)-403(M)-22.4(J)-29.8(,)]TJ
1.8708 -1.1239 TD
.0238 Tc
[(Willia)-5.8(ms)-376.5(DK.)-379.6(C)3.2(ost)-5.6(-)3.4(ef)-5.6(fectiveness)-383.6(a)]TJ
13.8137 0 TD
[(nalysis)-376.4(o)-2.1(f)-382.5(a)-375.6(r)-5.5(u)4.6(r)-5.5(a)1.4(l)-384.1(t)1.6(el)-7.1(emedicine)]TJ
-13.8137 -1.1239 TD
.0226 Tc
[(coll)-8.4(abor)-6.8(ativ)-5.6(e)-382.6(c)1.8(ar)-6.8(e)-382.6(i)-1.2(nt)-6.8(erv)-5.6(e)1.5(ntion)-380.8(f).3(or)-383.8(de)-5.6(pr)-6.8(ession.)]TJ
/F18 1 Tf
19.3762 0 TD
.0218 Tc
[(Ar)-7.6(ch)-381.6(Gen)-381.6(P)-4.2(sy)-6.4(ch)-4.6(iat)-7.6(r)-.5(y)]TJ
/F20 1 Tf
-19.3762 -1.1239 TD
.0209 Tc
[(20)-7.1(10)-7.2(;)]TJ
/F16 1 Tf
2.5678 0 TD
.0258 Tc
[(6)6.9(7)-.2(:812)6.9(82)6.9(1.)]TJ
-4.4386 -1.6858 TD
0 Tc
[(136.)-246.8(Lokkerbol)-328(J,)-333.6(Adema)-326.1(D,)-329.3(Cuijpers)-329.8(P,)-329.8(Reynolds)-331.1(CF)-325.9(3rd,)-335.5(Schulz)-328.5(R,)-331.9(Weehuizen)-320.5(R,)]TJ
1.8708 -1.1239 TD
[(Smit)-250.5(F.)-253.5(Improving)-246.5(the)-247.7(cost-effective)11(ness)-250.7(of)-254.6(a)-250.1(healthcare)-250.6(system)-247.2(for)-248.5(depressive)]TJ
0 -1.131 TD
[(disorders)-328.2(by)-331.3(implemen)12.6(ting)-333.3(telemedic)11.1(ine:)-337.4(A)-326.8(health)-327.5(economic)-329.4(modeling)-323.4(study.)]TJ
/F18 1 Tf
0 -1.1239 TD
[(Am)-327.6(J)-335.6(Geriatr)-327.4(Psychiatry)]TJ
/F20 1 Tf
9.5174 0 TD
(2014;)Tj
/F16 1 Tf
2.4398 0 TD
(22:253262.)Tj
-13.8279 -1.6858 TD
[(137.)-246.8(Wray)-263.6(LO,)-271.5(Shulan)-264.9(MD,)-266.4(Toseland)-260.8(RW,)-266.4(Freeman)-263(KE,)-267.3(Va)]TJ
21.062 .0071 TD
()Tj
.3628 -.0071 TD
[(squez)-266.7(BE,)-268.6(Gao)-266.4(J.)-269.6(The)-267.1(effect)]TJ
-19.554 -1.1239 TD
[(of)-332.9(telephone)-321.1(support)-328.9(groups)-328(on)-329.8(costs)-329.2(of)-332.9(care)-328.6(for)-333.9(veterans)-322.5(with)-331.3(dementia.)]TJ
/F18 1 Tf
T*
[(Gerontologis)12.7(t)]TJ
/F20 1 Tf
5.5056 0 TD
(2010;)Tj
/F16 1 Tf
2.4398 0 TD
(50:623631.)Tj
-9.8161 -1.6929 TD
[(138.)-246.8(Moreno-Ra)12.3(mirez)-330.4(D,)-336.4(Ferrandiz)-326.7(L,)-331.4(Ruiz-de-Cas)10(as)-330.3(A,)-331.9(Nieto-Garcia)-327.5(A,)-331.9(Moreno-)]TJ
1.8708 -1.1239 TD
[(Alvarez)-330.1(P,)-329.8(Galdeano)-329.4(R,)-331.9(Camacho)-324.5(FM.)-332.8(Economic)-323.6(evaluation)-328.5(of)-332.9(a)-328.3(store-and-)]TJ
T*
[(forward)-329.1(telederma)10.9(tology)-330.3(system)-325.4(for)-333.9(skin)-329.1(cancer)-325.9(patients.)]TJ
/F18 1 Tf
22.4917 0 TD
[(J)-335.6(Telemed)-326.5(Telecare)]TJ
/F20 1 Tf
-22.4917 -1.1239 TD
(2009;)Tj
/F16 1 Tf
2.4398 0 TD
(15:4045.)Tj
-4.3106 -1.6858 TD
[(139.)-246.8(Ferra)]TJ
3.4072 .0071 TD
()Tj
.3628 -.0071 TD
[(ndiz)-331.4(L,)-331.4(Moreno-Ram)11.5()246.5()32(rez)-334.2(D,)-329.3(Ruiz-de-Cas)10(as)-330.3(A,)-331.9(Nieto-Garc)249.8()32(a)-328.3(A,)-331.9(Moreno-)]TJ
-1.8992 -1.1239 TD
(A)Tj
.1351 .2134 TD
()Tj
.4055 -.2134 TD
[(lvarez)-330.5(P,)-329.8(Galdeano)-329.4(R,)-331.9(Camacho)-324.5(FM.)-332.8(An)-331.8(economic)-322.3(analysis)-329.1(of)-332.9(presurgical)]TJ
-.5406 -1.131 TD
[(teledermatol)9.8(ogy)-236.8(in)-235.2(patients)-237.6(with)-231.7(nonmelanoma)-229.8(skin)-236.6(cancer)-233.5([in)-238.3(Spanish].)]TJ
/F18 1 Tf
7.9702 0 0 7.9702 271.1054 115.937 Tm
(Actas)Tj
-27.6416 -1.1239 TD
[(Dermosifiliog)9.9(r)]TJ
/F20 1 Tf
5.6834 0 TD
(2008;)Tj
/F16 1 Tf
2.4398 0 TD
(99:795802.)Tj
-9.994 -1.6858 TD
[(140.)-246.8(Ng)-265.6(MF,)-268.8(Stevenson)-256.2(JH.)-267(Diagnostic)-261.9(value)-264.3(and)-266.9(cost-effe)13.6(ctiveness)-260.3(of)-268.9(good)-267.7(quality)]TJ
1.8708 -1.1239 TD
[(digital)-332(images)-323.9(accompanying)-327.1(electronic)-321.1(referrals)-329.2(for)-333.9(suspected)-324.3(skin)]TJ
T*
[(malignancie)11(s.)]TJ
/F18 1 Tf
5.4842 0 TD
[(Ann)-329.8(Plast)-327.9(Surg)]TJ
/F20 1 Tf
6.1457 0 TD
(2011;)Tj
/F16 1 Tf
2.4398 0 TD
[(66:3773)14.1(80.)]TJ
18.1812 77.6185 TD
[(141.)-246.8(van)-333.2(Os-Medendorp)-322.4(H,)-329.7(Koffijberg)-325.3(H,)-336.8(Eland-de)-324(Kok)-329.3(PCM,)-330.2(van)-333.2(der)-325.6(Zalm)-329.2(A,)-339(de)]TJ
1.8708 -1.1239 TD
[(Bruin-Weller)-329.1(MS,)-330.6(Pasmans)-322.6(SGMA,)-327.6(et)-335.1(al.)-335.9(E-health)-327.7(in)-327.6(caring)-333.9(for)-326.7(patients)-330.1(with)]TJ
T*
[(atopic)-333.6(dermatitis:)-325.1(A)-333.9(randomized)-322.2(controlled)-324.1(cost-effective)11(ness)-328.9(study)-332.6(of)]TJ
T*
[(internet-guide)11.7(d)-331.9(monitoring)-330.7(and)-330.9(online)-325.4(self-manag)11.3(ement)-333.6(training.)]TJ
/F18 1 Tf
25.842 0 TD
[(Br)-327.4(J)]TJ
-25.842 -1.1239 TD
(Dermatol)Tj
/F20 1 Tf
3.8695 0 TD
(2012;)Tj
/F16 1 Tf
2.4398 0 TD
[(166:106010)14.2(68.)]TJ
-8.1801 -1.6858 TD
[(142.)-246.8(Bergmo)-244.9(TS.)-243.3(A)-248.6(cost-minim)10.6(ization)-243.6(analysis)-243.7(of)-247.5(a)-243(realtime)-243.2(teledermatol)9.8(ogy)-243.9(service)]TJ
1.8708 -1.131 TD
[(in)-334.7(northern)-328.4(Norway.)]TJ
/F18 1 Tf
8.1801 0 TD
[(J)-335.6(Telemed)-326.5(Telecare)]TJ
/F20 1 Tf
7.5044 0 TD
(2000;)Tj
/F16 1 Tf
2.4398 0 TD
(6:273277.)Tj
-19.995 -1.6858 TD
[(143.)-246.8(Armstrong)-325.6(AW,)-330.4(Dorer)-330.7(DJ,)-330.6(Lugn)-334(NE,)-331.1(Kvedar)-324.4(JC.)-332.8(Economic)-323.6(evaluation)-328.5(of)]TJ
1.8708 -1.1239 TD
[(interactive)-325.9(teledermatology)-326.6(compared)-322.1(with)-331.2(conventional)-322.3(care.)]TJ
/F18 1 Tf
24.3056 0 TD
[(Telemed)-326.6(J)-328.5(E)]TJ
-24.3056 -1.1239 TD
(Health)Tj
/F20 1 Tf
2.8595 0 TD
(2007;)Tj
/F16 1 Tf
2.4398 0 TD
(13:9199.)Tj
-7.17 -1.6858 TD
[(144.)-246.8(Pak)-332.5(HS,)-334(Datta)-328.5(SK,)-334.5(Triplett)-324.5(CA,)-331.1(Lindquist)-332.4(JH,)-331(Grambow)-324.9(SC,)-328.8(Whited)-331.7(JD.)-330.6(Cost)]TJ
1.8708 -1.131 TD
[(minimization)-233.8(analysis)-229.5(of)-240.4(a)-235.9(store-and-fo)12.4(rward)-238(telederma)10.9(tology)-237.9(consult)-226(system.)]TJ
/F18 1 Tf
0 -1.1239 TD
[(Telemed)-326.5(J)-335.6(E)-335.4(Health)]TJ
/F20 1 Tf
7.732 0 TD
(2009;)Tj
/F16 1 Tf
2.4469 0 TD
[(15:1601)14.1(65.)]TJ
-12.0497 -1.6858 TD
[(145.)-246.8(Pelletier-Fleury)-326.1(N,)-330(Gagnadoux)-329.1(F,)-331.7(Philippe)-325.2(C,)-331.5(Rakotonanahar)12.6(y)-334.1(D)0(,)-336.4(Lanoe)]TJ
28.545 .0142 TD
()Tj
.6829 -.0142 TD
(JL,)Tj
-27.3571 -1.1239 TD
[(Fleury)-334.8(B.)-331.5(A)-326.8(cost-minimizatio)6.8(n)-332.2(study)-325.5(of)-332.9(telemedicin)10.6(e.)]TJ
/F18 1 Tf
20.6352 0 TD
[(Int)-336.1(J)-328.5(Technol)-328.6(Assess)]TJ
-20.6352 -1.1239 TD
[(Health)-330.5(Care)]TJ
/F20 1 Tf
4.9294 0 TD
(2001;)Tj
/F16 1 Tf
2.4398 0 TD
(17:604611.)Tj
-9.24 -1.6858 TD
[(146.)-246.8(Harno)-329.3(K,)-337.3(Araja)]TJ
7.1558 0 TD
[()-81.8(rvi)-330.5(E,)-333.4(Paavola)-328.1(T,)-331.4(Carlson)-328.6(C,)-331.5(Viikinkoski)-323.9(P.)-336.9(Clinical)-327.9(effectiveness)]TJ
-5.2851 -1.131 TD
[(and)-331(cost)-334.3(analysis)-329.1(of)-325.8(patient)-328.1(referral)-334.3(by)-331.4(videoconf)13.9(erencing)-330.3(in)-327.6(orthopaedics.)]TJ
/F18 1 Tf
29.2421 0 TD
(J)Tj
-29.2421 -1.1239 TD
[(Telemed)-326.5(Telecare)]TJ
/F20 1 Tf
6.8428 0 TD
(2001;)Tj
/F16 1 Tf
2.4398 0 TD
[(7:21922)14.1(5.)]TJ
-11.1534 -1.6858 TD
[(147.)-246.8(Mark)-280.1(DA,)-272(Fitzmaurice)-274.9(GJ,)-274.1(Haughey)-268.9(KA,)-280(ODonnel)12.2(l)-279.9(ME,)-277.6(Harty)-270.6(JC.)-275.9(Assessment)-270(of)]TJ
1.8708 -1.1239 TD
[(the)-254.8(quality)-244.3(of)-254.6(care)-243.2(and)-252.7(financial)-247.9(impact)-244.3(of)-254.6(a)-250.1(virtual)-247.7(renal)-251.3(clinic)-246.2(compared)-243.8(with)]TJ
T*
[(the)-283.2(traditional)-276.1(outpatient)-274.8(service)-281.7(model.)]TJ
/F18 1 Tf
15.6773 0 TD
[(Int)-286.3(J)-278.7(Clin)-279.6(Pract)]TJ
/F20 1 Tf
5.9537 0 TD
(2011;)Tj
/F16 1 Tf
2.4398 0 TD
(65:11001107.)Tj
-25.9416 -1.6929 TD
[(148.)-246.8(Fischer)-279.5(HH,)-277.3(Eisert)-270.6(SL,)-278.8(Everhart)-273(RM,)-276.1(Durfee)-273.9(MJ,)-277.8(Moore)-274.5(SL,)-278.8(Soria)-276.9(S,)-279.7(et)-278.2(al.)-279(Nurse-)]TJ
1.8708 -1.1239 TD
[(run,)-257.9(telephone-base)14(d)-260.8(outreach)-251.8(to)-261.7(improve)-255.1(lipids)-253.6(in)-256.5(people)-258(with)-253(diabetes.)]TJ
/F18 1 Tf
27.8835 0 TD
[(Am)-256.4(J)]TJ
-27.8835 -1.1239 TD
[(Manag)-333.2(Care)]TJ
/F20 1 Tf
5.093 0 TD
(2012;)Tj
/F16 1 Tf
2.4398 0 TD
(18:7784.)Tj
-9.4036 -1.6858 TD
[(149.)-246.8(Eakin)-336.5(EG,)-330.8(Reeves)-328(MM,)-327.4(Marshall)-329.4(AL,)-331(Dunstan)-322.1(DW,)-335(Graves)-328.3(N,)-330(Healy)-327.8(GN,)-334.5(et)-328(al.)]TJ
1.8708 -1.1239 TD
[(Living)-333.7(Well)-330.6(with)-331.3(Diabetes:)-323.4(A)-333.9(randomized)-322.2(controlled)-331.2(trial)-328.2(of)-332.9(a)-335.4(telephon)13(e-)]TJ
T*
[(delivered)-327.5(intervention)-325.9(for)-333.9(maintena)12.1(nce)-331.5(of)-332.9(weight)-328.6(loss,)-329.2(physical)-330.1(activity)-327.2(and)]TJ
0 -1.131 TD
[(glycaemic)-330.2(control)-324.2(in)-334.7(adults)-329.3(with)-331.3(type)-325.3(2)-331.9(diabetes.)]TJ
/F18 1 Tf
19.3122 0 TD
[(BMC)-326.8(Public)-331.5(Health)]TJ
/F20 1 Tf
-19.3122 -1.1239 TD
(2010;)Tj
/F16 1 Tf
2.4469 0 TD
(10:452.)Tj
-4.3177 -1.6858 TD
[(150.)-246.8(Kesavadev)-290.6(J,)-298(Shankar)-294.5(A,)-296.3(Pillai)-300.4(PBS,)-297.9(Krishnan)-289.9(G,)-294.1(Jothydev)-293.5(S.)-293.9(Cost-effective)-294.6(use)]TJ
1.8708 -1.1239 TD
[(of)-332.9(telemedicine)-323.5(and)-331(self-monitorin)11.1(g)-331.9(o)0(f)-332.9(blood)-326.8(glucose)-331.2(via)-330.6(Diabetes)-327.7(Tele)]TJ
T*
[(Management)-325.3(System)-327.8(\(DTMS\))-328.1(to)-332.9(achieve)-327.6(target)-328.6(glycosylat)10.9(ed)-331.7(hemoglobin)]TJ
T*
[(values)-259.2(without)-249.5(serious)-251.7(symptomatic)-252.5(hypoglycem)14.3(ia)-259.7(in)-256.5(1,000)-258.6(subjects)-250.9(with)-253(type)]TJ
0 -1.131 TD
[(2)-331.9(diabetes)-328.2(mellitusA)-331.3(retrospect)14.1(ive)-336.4(study.)]TJ
/F18 1 Tf
16.6661 0 TD
[(Diabetes)-331.3(Technol)-321.5(Ther)]TJ
/F20 1 Tf
-16.6661 -1.1239 TD
(2012;)Tj
/F16 1 Tf
2.4469 0 TD
[(14:7727)14.1(76.)]TJ
-4.3177 -1.6858 TD
[(151.)-246.8(Eminovic)]TJ
4.9579 .0142 TD
()Tj
.6331 -.0142 TD
[(N,)-280.2(Dijkgraaf)-287.8(MG,)-281(Berghout)-283.7(RM,)-283.2(Prins)-278.4(AH,)-286.6(Bindels)-286.1(PJ,)-281.4(de)-289(Keizer)-277.5(NF.)-286.8(A)]TJ
-3.7202 -1.1239 TD
[(cost)-334.3(minimisat)10.2(ion)-332.3(analysis)-329.1(in)-334.7(telederm)12(atology:)-327.2(Model-based)-322.6(approach.)]TJ
/F18 1 Tf
27.6416 0 TD
(BMC)Tj
-27.6416 -1.1239 TD
[(Health)-330.5(Serv)-332.1(Res)]TJ
/F20 1 Tf
6.4872 0 TD
(2010;)Tj
/F16 1 Tf
2.4398 0 TD
(10:251.)Tj
-10.7977 -1.6858 TD
[(152.)-246.8(Salzsieder)-329.8(E,)-333.4(Augstein)-325.5(P.)-329.8(The)-331.1(Karlsburg)-325.5(Diabetes)-327.7(Management)-325.3(System:)]TJ
1.8708 -1.131 TD
[(Translation)-331(from)-327.5(research)-329.2(to)-332.9(eHealth)-326.7(application.)]TJ
/F18 1 Tf
19.3193 0 TD
[(J)-328.5(Diabetes)-331.3(Sci)-326.4(Technol)]TJ
/F20 1 Tf
-19.3193 -1.1239 TD
(2011;)Tj
/F16 1 Tf
2.4469 0 TD
(5:1322.)Tj
-4.3177 -1.6858 TD
[(153.)-246.8(Hitt)-250.8(WC,)-244.7(Low)-241.2(G,)-244.3(Bird)-249.3(TM,)-240(Ott)-248(R.)-246.5(Telemedical)-239.7(cervical)-240.3(cancer)-247.7(screenin)13.9(g)-246.5(t)0(o)-247.5(bridge)]TJ
1.8708 -1.1239 TD
[(Medicaid)-264.8(service)-260.4(care)-257.4(gap)-266.6(for)-262.7(rural)-266.7(women.)]TJ
/F18 1 Tf
16.7443 0 TD
[(Telemed)-262.5(J)-264.5(E)-264.3(Health)]TJ
/F20 1 Tf
7.4617 0 TD
(2013;)Tj
/F16 1 Tf
2.4398 0 TD
(19:403)Tj
-26.6458 -1.1239 TD
(408.)Tj
-1.8708 -1.6929 TD
[(154.)-246.8(Kimman)-328.2(ML,)-332.5(Dirksen)-326.9(CD,)-335.7(Voogd)-322.6(AC,)-331.1(Falger)-328.6(P,)-337(Gijsen)-329.3(BCM,)-324.8(Thuring)-328.3(M,)-333.4(et)-335.1(al.)]TJ
1.8708 -1.1239 TD
[(Economic)-280.9(evaluation)-285.8(of)-283.1(four)-282(follow-up)-282.9(strategies)-278(after)-288.4(curative)-280(treatment)-280.7(for)]TJ
T*
[(breast)-329.3(cancer:)-328.8(Results)-332(of)-325.8(an)-333.4(RCT.)]TJ
/F18 1 Tf
13.1664 0 TD
[(Eur)-334.3(J)-328.5(Cancer)]TJ
/F20 1 Tf
5.2281 0 TD
(2011;)Tj
/F16 1 Tf
2.4398 0 TD
(47:11751185.)Tj
-22.7051 -1.6858 TD
[(155.)-246.8(Th)17.2(ak)20.8(e)14.4(r)-242.8(DA)24.7(,)-239.8(M)0(o)22.7(n)0(y)23.6(p)0(e)24(n)0(n)18.4(y)-234.5(R,)-232.3(Ol)21.8(ve)21.8(r)-242.8(I)0(,)-228.4(S)0(a)23(b)0(e)24.3(s)0(a)18.2(n)-239.8(S.)-229.9(C)15(o)0(s)21.8(t)-242.8(sa)25.3(vi)19(ng)25.8(s)-243.8(f)0(r)19.4(o)16.7(m)-242.6(a)-235.9(te)20.6(le)19(me)20.8(d)16.6(i)0(c)19.4(i)0(n)20.9(e)]TJ
1.8708 -1.1239 TD
[(mo)23(de)16.9(l)-201.7(o)16.7(f)-200.1(c)0(a)20.8(r)0(e)-192.8(i)0(n)-185.4(n)0(o)18.7(r)0(t)19.4(h)16.3(er)20.6(n)-197.1(Q)0(u)19.3(e)0(e)21.8(n)0(s)21.4(l)0(a)17.7(n)16.3(d,)-187.6(Au)16.7(st)25.5(ra)19.2(li)16.3(a.)]TJ
/F18 1 Tf
17.9962 0 TD
[(Me)20.4(d)-196.7(J)-200.5(Au)16.7(st)]TJ
/F20 1 Tf
4.275 0 TD
-.0146 Tc
[(20)-14.6(1)7.5(3)-14.6(;)]TJ
/F16 1 Tf
2.39 0 TD
0 Tc
[(19)26.2(9:)20.9(41)19.1(4)26.2(41)19.1(7.)]TJ
-26.532 -1.6929 TD
[(156.)-246.8(Xu)-287.5(CQ,)-293(Smith)-284(AC,)-288.4(Scuffham)-280.9(PA,)-286.8(Wootton)-282.8(R.)-289.2(A)-284.1(cost)-291.6(minimisa)11.2(tion)-290.6(analysis)-286.4(of)-283.1(a)]TJ
1.8708 -1.1239 TD
[(telepaediatric)-326.8(otolaryngology)-325.4(service.)]TJ
/F18 1 Tf
14.6175 0 TD
[(BMC)-334(Health)-330.5(Serv)-325(Res)]TJ
/F20 1 Tf
7.9702 0 0 7.9702 507.9117 169.7385 Tm
(2008;)Tj
/F16 1 Tf
2.4469 0 TD
(8:30.)Tj
-27.5492 -1.6858 TD
[(157.)-246.8(Joo)-330.8(NS,)-334.3(Park)-326.4(YW,)-335.5(Park)-326.3(KH,)-334.7(Kim)-328.4(CW,)-330.1(Kim)-328.4(BT.)-337.7(Cost-effect)13.3(iveness)-331(of)-332.9(a)]TJ
1.8708 -1.1239 TD
[(community-bas)9.9(ed)-331.7(obesity)-327.1(control)-331.3(programme.)]TJ
/F18 1 Tf
18.1954 0 TD
[(J)-328.5(Telemed)-326.5(Telecare)]TJ
/F20 1 Tf
-18.1954 -1.1239 TD
(2010;)Tj
/F16 1 Tf
2.4469 0 TD
[(16:6367)14.1(.)]TJ
-4.3177 -1.6858 TD
[(158.)-246.8(Wade)-331.4(VA,)-329.8(Karnon)-327.8(J,)-333.6(Eliott)-332.9(JA,)-333.2(Hiller)-325.8(JE.)-334.7(Home)-329.8(videophones)-317.3(improve)-326.2(direct)]TJ
1.8708 -1.131 TD
[(observation)-267.8(in)-270.7(tuberculosis)-264.1(treatment:)-269.4(A)-269.9(mixed)-270.4(methods)-266.9(evaluation.)]TJ
/F18 1 Tf
26.1906 0 TD
[(PLoS)-268.9(One)]TJ
/F20 1 Tf
-26.1906 -1.1239 TD
(2012;)Tj
/F16 1 Tf
2.4469 0 TD
(7:e50155.)Tj
-4.3177 -1.6858 TD
[(159.)-246.8(Buysse)-328(H,)-336.8(De)-331.2(Moor)-324.5(G,)-336.8(Van)-324.2(Maele)-331.5(G,)-329.7(Baert)-336.5(E,)-333.4(Thienpont)-318.5(G,)-336.8(Temmerm)12.2(an)-333.4(M.)]TJ
1.8708 -1.1239 TD
[(Cost-effectivenes)11.5(s)-265.2(o)0(f)-261.7(telemonitori)10.3(ng)-265.8(for)-262.7(high-risk)-256.1(pregnant)-257.1(women.)]TJ
/F18 1 Tf
26.1834 0 TD
[(Int)-257.8(J)-264.5(Med)]TJ
-26.1834 -1.1239 TD
(Inform)Tj
/F20 1 Tf
2.9093 0 TD
(2008;)Tj
/F16 1 Tf
2.4469 0 TD
[(77:4704)14.1(76.)]TJ
/F11 1 Tf
11.9551 0 0 11.9551 287.5464 741.9966 Tm
[(TELEMEDICINE)-340.6(FOR)-332.7(CHRONIC)-338.8(DISEASE)-334.7(MANAGE)-7.3(MENT)]TJ
/F9 1 Tf
6.9738 0 0 6.9738 186.0094 29.7638 Tm
()Tj
/F7 1 Tf
1.3251 0 TD
.2013 Tc
[(MARY)-335.5(ANN)-334.3(L).8(IEBE)-4.1(RT,)-333.5(I)6(NC.)]TJ
/F10 1 Tf
15.0069 0 TD
0 Tc
()Tj
/F7 1 Tf
1.008 0 TD
.1028 Tc
[(VO)-11.6(L.)-342.6(2)-8.4(0)-1000.2(N)-10.1(O)-3.5(.)-342.6(9)]TJ
/F10 1 Tf
8.3814 0 TD
0 Tc
()Tj
/F8 1 Tf
.9999 0 TD
.1096 Tc
[(SEPTEM)6.4(BER)-333.1(2).2(01)8.2(4)]TJ
/F4 1 Tf
7.9702 0 0 7.9702 441.0707 29.7638 Tm
0 Tc
[(TELEMEDIC)11.7(INE)-333(and)-328.9(e-HEALTH)-647.9(799)]TJ
ET
q
1 i
0 792 612 -791.985 re
W n
579.685 .014984 .22681 791.985 re
f
337.039 767.962 274.961 .22675 re
f
Q
endstream
endobj
627 0 obj
<>/XObject<>/ProcSet [/PDF /Text /ImageB /ImageC /ImageI]/Font<>/Properties<>>>/Thumb 630 0 R/MediaBox[0 0 612 792]/Annots[631 0 R 632 0 R 633 0 R 634 0 R 635 0 R 636 0 R 637 0 R 638 0 R 639 0 R 640 0 R 641 0 R 642 0 R 643 0 R 644 0 R 645 0 R 646 0 R 647 0 R 648 0 R 649 0 R 650 0 R 651 0 R 652 0 R 653 0 R 654 0 R 655 0 R 656 0 R 657 0 R 658 0 R 659 0 R 660 0 R 661 0 R 662 0 R 663 0 R 664 0 R 665 0 R 666 0 R 667 0 R 668 0 R]/Rotate 0>>
endobj
669 0 obj
<>/ProcSet[/PDF/Text]/Font<>/Properties<>>>
endobj
628 0 obj
<>stream
/GS1 gs
BT
/F16 1 Tf
7.9702 0 0 7.9702 50.1732 694.2612 Tm
0 0 0 1 k
0 Tc
0 Tw
[(160.)-246.8(Lilly)-333.6(CM,)-332.6(McLaugh)12.9(lin)-337.3(JM,)-327.6(Zhao)-328.5(H,)-329.7(Baker)-334.9(SP,)-327.1(Cody)-328.5(S,)-336.6(Irwin)-327(RS.)-329.1(A)-333.9(multicenter)]TJ
1.8708 -1.1239 TD
[(study)-325.5(of)-332.9(ICU)-333.8(telemedic)11.1(ine)-334.5(reengineering)-322.3(of)-332.9(adult)-327.3(critical)-329.6(care.)]TJ
/F18 1 Tf
24.2842 0 TD
(Chest)Tj
/F20 1 Tf
-24.2842 -1.1239 TD
(2014;)Tj
/F16 1 Tf
2.4398 0 TD
[(145:500507)14.2(.)]TJ
-4.3106 -1.6858 TD
[(161.)-246.8(Isetta)-235.3(V,)-237.7(Lopez-Agu)12.6(stina)-239.3(C,)-239(Lopez-Berna)15.7(l)-244.4(E)0(,)-233.8(Amat)-237.2(M,)-233.8(Vila)-238.8(M,)-240.9(Valls)-233.7(C,)-239(et)-235.5(al.)-236.3(Cost-)]TJ
1.8708 -1.1239 TD
[(effectivene)12.5(ss)-331.2(of)-332.9(a)-335.4(new)-327.6(internet-based)-324.9(monitoring)-323.5(tool)-333(for)-326.7(neonatal)-326.2(post-)]TJ
T*
[(discharge)-326.1(home)-330.4(care.)]TJ
/F18 1 Tf
8.55 0 TD
[(J)-335.6(Med)-325.7(Internet)-328.4(Res)]TJ
/F20 1 Tf
7.6893 0 TD
(2013;)Tj
/F16 1 Tf
2.4398 0 TD
(15:e38.)Tj
-20.5498 -1.6929 TD
[(162.)-246.8(Henderson)-239.9(C,)-246.2(Knapp)-241.1(M,)-240.9(Fernandez)-242.6(JL,)-240.2(et)-249.7(al.)-243.4(Cost)-248.8(effectiven)12.2(ess)-245.6(of)-247.5(telehealth)-238.1(for)]TJ
1.8708 -1.1239 TD
[(patients)-330.1(with)-331.3(long)-322.8(term)-329.7(conditions)-330.4(\(Whole)-326.8(System)-327.8(Demonstrato)10.3(r)-328.2(telehealth)]TJ
T*
[(questionna)11.8(ire)-337.6(study\):)-324.4(Nested)-325.1(economic)-329.4(evaluatio)10.9(n)-332.2(i)0(n)-334.7(a)-335.4(pragmati)11.6(c,)-338.8(cluster)]TJ
T*
[(randomized)-322.2(control)-331.3(trial.)]TJ
/F18 1 Tf
9.8517 0 TD
(BMJ)Tj
/F20 1 Tf
1.9419 0 TD
(2013;)Tj
/F16 1 Tf
2.4398 0 TD
(346:119.)Tj
-16.1041 -1.6858 TD
[(163.)-246.8(Andrade)-243.5(M,)-248(Maia)-247.7(A,)-253.6(Cardoso)-245.1(C,)-246.2(et)-249.7(al.)-250.5(Cost-benef)12.5(it)-252.4(of)-247.5(the)-247.7(telecardiology)-241.6(service)]TJ
1.8708 -1.131 TD
[(in)-263.6(the)-261.9(state)-260.9(of)-261.7(Minas)-253.6(Gerais:)-262.7(Minas)-260.7(Telecardio)-256.5(Project)-254.9([in)-266.8(English,)-255.6(Portuguese].)]TJ
/F18 1 Tf
0 -1.1239 TD
[(Arq)-332.5(Bras)-327(Cardiol)]TJ
/F20 1 Tf
6.7148 0 TD
(2011;)Tj
/F16 1 Tf
2.4398 0 TD
(97:307316.)Tj
-11.0254 -1.6858 TD
[(164.)-246.8(Alkmim)-325.7(M,)-333.4(Figueira)-329.1(R,)-331.9(Marcolino)-328(M.)-333.4(Improving)-324.8(patient)-328.1(access)-323.9(to)-332.9(specialized)]TJ
1.8708 -1.1239 TD
[(health)-284.8(care:)-281.6(The)-288.5(telehea)12.3(lth)-285.9(network)-283.9(of)-283.1(Minas)-289.2(Gerais,)-279.2(Brazil.)]TJ
/F18 1 Tf
22.9256 0 TD
[(Bull)-286.7(World)-281.7(Health)]TJ
-22.9256 -1.1239 TD
(Organ)Tj
/F20 1 Tf
2.6674 0 TD
(2012;)Tj
/F16 1 Tf
2.4469 0 TD
[(90:3733)14.1(78.)]TJ
-6.9851 -1.6858 TD
[(165.)-246.8(So)19.4(h)16.3(n)-211.3(S,)-201.5(He)24.2(lm)25.2(s)-215.4(T)15.1(M,)-198.2(Pe)16.9(ll)23.4(et)20.6(e)14.4(r)-214.4(JT)20.9(,)-211.3(e)14.4(t)-207.3(a)0(l)17.7(.)-211.3(Co)24.5(st)18.4(s)-208.3(a)0(n)22.3(d)-211(be)24.3(ne)23.6(fi)17.9(ts)-195(of)-204.8(p)16.6(e)0(r)20.6(s)0(o)21.8(n)0(a)22.3(l)0(i)16.3(z)15.1(ed)-203.6(h)16.3(e)0(a)20.4(l)0(t)17.9(h)16.3(ca)20.8(re)]TJ
1.8708 -1.131 TD
[(fo)22.8(r)-242.8(p)16.6(at)19.2(ie)19(nt)22.4(s)-236.7(w)0(i)16.2(t)0(h)-226.5(c)14.8(hr)15.3(o)16.6(n)0(i)20.9(c)-241.3(he)23.6(ar)19.2(t)-235.7(f)0(a)19.2(i)0(l)16.3(u)16.3(r)0(e)-228.4(i)0(n)-235.2(t)0(h)22.4(e)-234.5(ca)20.8(re)-228.4(an)22.3(d)-239.4(e)0(d)24(u)0(c)16.9(a)0(t)26.3(i)0(o)21.2(n)-239.8(pr)22.8(og)19.1(ra)19.2(m)]TJ
0 -1.1239 TD
[()73.2()0(T)17.2(e)14.4(le)19(me)20.8(d)16.6(i)0(c)19.4(i)0(n)20.9(e)-241.6(fo)22.8(r)-235.7(t)0(h)22.4(e)-241.6(He)24.2(ar)19.2(t.)22.4()66.1()]TJ
/F18 1 Tf
10.8191 0 TD
[(T)15.1(e)0(l)19(e)14.4(me)20.8(d)-239.4(J)-236(E)-243(H)0(e)24.2(a)0(l)21.2(t)0(h)]TJ
/F20 1 Tf
7.2483 0 TD
-.0146 Tc
[(20)-14.6(1)7.5(2)-14.6(;)]TJ
/F16 1 Tf
2.39 0 TD
-.0189 Tc
[(18)-18.9(:1)-18.9(98)-18.9()7.3(2)-18.9(04)-18.9(.)]TJ
-22.3281 -1.6858 TD
0 Tc
[(166.)-246.8(Smith)-234.2(B,)-231.9(Hughes-Cromw)14.2(ick)-236.1(P,)-237.4(Forkner)-230.9(E,)-233.8(et)-235.5(al.)-236.3(Cost-effect)13.3(iveness)-231.4(of)-233.3(telephonic)]TJ
1.8708 -1.1239 TD
[(disease)-324.9(management)-325(in)-334.7(heart)-328(failure.)]TJ
/F18 1 Tf
14.7455 0 TD
[(Am)-327.6(J)-335.6(Manag)-326.1(Care)]TJ
/F20 1 Tf
7.3692 0 TD
(2008;)Tj
/F16 1 Tf
2.4398 0 TD
[(14:1061)14.1(15.)]TJ
-26.4253 -1.6858 TD
[(167.)-246.8(Elliot)-263.3(R,)-260.7(Barber)-255.5(N,)-266(Clifford)-251.3(S,)-265.5(et)-256.8(al.)-264.8(The)-260(cost)-256.1(effectiveness)-254.7(of)-261.7(a)-257.2(telephone-base)14(d)]TJ
1.8708 -1.131 TD
[(pharmacy)-326(advisory)-328.6(service)-324.4(to)-332.9(improve)-326.2(adherence)-328.7(to)-325.8(newly)-329.8(prescribed)]TJ
0 -1.1239 TD
(medicines.)Tj
/F18 1 Tf
4.3034 0 TD
[(Pharm)-322(World)-331.5(Sci)]TJ
/F20 1 Tf
6.8571 0 TD
(2008;)Tj
/F16 1 Tf
2.4398 0 TD
(30:1723.)Tj
-15.4711 -1.6858 TD
[(168.)-246.8(Salvador)-325.2(C,)-338.6(Ruiz-San)12.6(chez)-330.6(A,)-331.9(Gonzalez)-328.9(de)-331.7(Mingo)-323.9(M,)-333.4(et)-335.1(al.)-328.8(Evaluation)-329.8(of)-332.9(a)]TJ
1.8708 -1.1239 TD
[(telemedicin)10.6(e-based)-331(service)-324.4(for)-333.9(the)-325.9(follow-up)-332.7(and)-323.8(monitoring)-330.7(of)-325.8(patients)]TJ
T*
[(treated)-328.4(with)-331.3(oral)-329.4(anticoagulan)9.3(t)-335.3(therapy.)]TJ
/F18 1 Tf
15.8623 0 TD
[(IEEE)-333.4(Trans)-331.9(Inf)-329(Technol)-328.6(Biomed)]TJ
/F20 1 Tf
-15.8623 -1.1239 TD
(2008;)Tj
/F16 1 Tf
2.4398 0 TD
(12:696706.)Tj
-4.3106 -1.6929 TD
[(169.)-246.8(Datta)-314.3(S,)-315.3(Oddone)-307.6(E,)-319.2(Olsen)-312.2(M,)-312(et)-320.9(al.)-314.6(Economic)-309.4(analysis)-307.7(of)-318.7(a)-314.1(tailored)-316(behavioral)]TJ
1.8708 -1.1239 TD
[(intervention)-304.5(to)-304.4(improve)-304.9(blood)-305.5(pressure)-306.9(control)-302.9(for)-312.5(primary)-302.5(care)-307.2(patients.)]TJ
/F18 1 Tf
28.4739 0 TD
(Am)Tj
-28.4739 -1.1239 TD
[(Heart)-331(J)]TJ
/F20 1 Tf
3.1156 0 TD
(2010;)Tj
/F16 1 Tf
2.4398 0 TD
(160:257263.)Tj
-7.4261 -1.6858 TD
[(170.)-246.8(Wennberg)-302.8(DE,)-302(Marr)-310.1(A,)-303.4(Lang)-308.7(L,)-310(OMalley)-300.6(S,)-308.2(Bennett)-302.5(G.)-308.3(A)-305.5(randomized)-300.8(trial)-306.9(of)-311.5(a)]TJ
1.8708 -1.1239 TD
[(telephone)-321.1(care-managemen)9.8(t)-335.3(strategy.)]TJ
/F18 1 Tf
15.0087 0 TD
[(N)-332(Engl)-333.5(J)-335.6(Med)]TJ
/F20 1 Tf
5.5838 0 TD
(2010;)Tj
/F16 1 Tf
2.4398 0 TD
[(363:12451255)11.9(.)]TJ
-24.9031 -1.6929 TD
[(171.)-246.8(Mi)24.8(ne)16.5(ta)26.3(ki)-229.6(K,)-230.6(Ak)22.3(em)20.8(at)19.2(su)-227.5(Y)16.6(,)-239.8(Ts)20.2(uj)20.9(i)-244.4(M)0(.)-226.7(E)0(f)19.2(f)0(e)27.7(c)0(t)-235.2(o)16.6(f)-242.8(e)14.4(-h)17.2(e)14.4(a)0(l)17.7(t)0(h)-226.5(o)0(n)-230.2(m)0(e)27.9(d)0(i)21.3(c)0(a)20.8(l)-244.4(e)14.4(x)0(p)24.3(e)0(n)16.5(d)16.6(it)17.9(ur)22.4(es)-229.4(of)]TJ
1.8708 -1.1239 TD
[(ou)25.8(tp)15.7(at)26.3(ie)19(nt)22.4(s)-194.1(w)0(i)23.3(t)0(h)-183.8(l)0(i)23.4(f)0(e)20.6(s)0(t)18.4(y)14.4(le)19(-)15.1(r)0(e)20.6(l)0(a)17.7(t)0(e)20.6(d)-189.6(di)21.2(se)19.6(as)25.3(es)19.6(.)]TJ
/F18 1 Tf
15.6773 0 TD
[(Te)22.4(le)19(me)20.8(d)-189.6(J)-193.4(E)-186.1(H)0(e)17(a)16.6(lt)17.9(h)]TJ
/F20 1 Tf
7.0562 0 TD
[(20)22.1(11)22.1(;)]TJ
/F16 1 Tf
2.39 0 TD
[(17)19.1(:5)20.9(91)26.2(5)19.1(95)26.2(.)]TJ
7.1274 44.4357 TD
[(172.)-246.8(Brunetti)-327.6(N,)-337.1(Dellegrottagl)13.2(ie)-336.6(G,)-329.7(Lapriore)-326.9(C,)-338.6(et)-328(al.)-335.9(Prehospital)-320.6(telemedicine)]TJ
1.8708 -1.1239 TD
[(electrocardiog)9.2(ram)-273.2(triage)-273.3(for)-269.8(a)-278.5(regional)-263.2(public)-274.6(emergency)-266.2(medical)-266.9(service:)-270.3(Is)-275.1(it)]TJ
T*
[(worth)-334.4(it?)-329.8(A)-333.9(preliminary)-326.6(cost)-327.2(analysis.)]TJ
/F18 1 Tf
14.7669 0 TD
[(Clin)-329.4(Cardiol)]TJ
/F20 1 Tf
4.8227 0 TD
(2014;)Tj
/F16 1 Tf
2.4398 0 TD
(37:140145.)Tj
-23.9001 -1.6858 TD
[(173.)-246.8(Calo)-285(L,)-274.5(Gargao)-280.3(A,)-275(De)-281.4(Ruvo)-279.4(E,)-276.5(et)-278.2(al.)-279(Economic)-273.8(impact)-279.8(of)-276(remote)-277.3(monitoring)-273.8(on)]TJ
1.8708 -1.1239 TD
[(ordinary)-247.4(follow-up)-247.4(of)-247.5(implantabl)9.9(e)-255.9(cardioverte)13.7(r)-249.9(defibrillators)-244(as)-252.1(compared)-243.8(with)]TJ
T*
[(conventional)-293.8(in-hospital)-300.5(visits.)-299.4(A)-298.4(single)-301.1(center)-297.7(prospective)-289.7(randomized)-293.7(study.)]TJ
/F18 1 Tf
0 -1.131 TD
[(J)-335.6(Interv)-329.5(Card)-329.7(Electrophysi)12(ol)]TJ
/F20 1 Tf
10.9542 0 TD
(2013;)Tj
/F16 1 Tf
2.4398 0 TD
(37:6978.)Tj
-15.2648 -1.6858 TD
[(174.)-246.8(Z)-11.8(a)-15.4(n)-12.1(a)-8.2(b)-11.5(o)-11.8(n)-12.1(i)-343.9(P)-11.8(,)-346.5(L)-13.3(a)-15.4(nd)-16.8(o)-11.8(l)-16.7(i)-9.6(n)-12.1(a)-342.6(M)-15.3(,)-346.5(M)-8.2(a)-8.2(r)-15.2(z)-13.3(e)0(g)-18.7(a)-15.4(l)-9.6(l)-16.7(i)-9.6(,)-346.5(e)-14(t)-342.4(a)-15.4(l)-9.6(.)-346.5(C)-13.5(o)-11.8(s)-9.1(t)-8.1(-)-13.3(u)-12.1(t)-15.2(i)-9.6(l)-16.7(i)-9.6(t)-15.2(y)-341.2(a)-15.4(na)-20.4(l)-9.6(y)-14(s)-9.1(i)-16.7(s)-343.4(o)-11.8(f)-342.4(t)-15.2(h)-12.1(e)]TJ
1.8708 -1.1239 TD
.0123 Tc
[(EVOLVO)-326.2(study)-336(o).5(n)-327(r)-2.9(e)12.3(m)-9.6(ote)-336(m)4.4(onitorin)]TJ
14.1623 0 TD
.0099 Tc
[(g)-336.2(f)1.8(or)-332.5(he)-4.1(ar)-5.3(t)-332.5(f)-5.3(ai)-6.8(lur)-5.3(e)-331.3(pa)-5.5(ti)-6.8(e)9.9(n)-9.2(t)-5.3(s)-333.5(wi)-6.8(th)]TJ
-14.1623 -1.1239 TD
.016 Tc
[(im)8.1(pla)7.8(n)3.9(ta)7.8(b)4.5(l)-.7(e)-325.2(d)4.2(ef)7.9(ib)4.5(r)7.9(i)-.7(l)6.4(l)6.4(a).6(to)16(rs)6.9(:)-335.4(R)]TJ
11.0115 0 TD
.0127 Tc
[(a)-9.4(n).6(do)12.7(m)-7(i)3.1(zed)-326.3(c)-1(ontrolle)12.7(d)-340.3(t)-2.5(rial.)]TJ
/F18 1 Tf
10.9823 0 TD
0 Tc
[(J)-342.8(M)-8.2(e)-14(d)-346.1(I)-10(n)-12.1(t)-8.1(e)-14(r)-15.2(n)-12.1(et)-356.4(Re)-20.7(s)]TJ
/F20 1 Tf
-21.9938 -1.1239 TD
.0138 Tc
[(2013)13.8(;)]TJ
/F16 1 Tf
2.5038 0 TD
.0118 Tc
[(15:)-5.3(e)11.8(1)-6.9(06.)]TJ
-4.3746 -1.6929 TD
0 Tc
[(175.)-246.8(Chen)-258.1(YH,)-256.1(Lin)-262.7(YH,)-256.1(Hung)-254(CS,)-257.6(et)-256.8(al.)-264.8(Clinical)-256.8(outcom)12.8(es)-257.9(and)-259.8(cost-effecti)10.6(veness)-257.4(of)-254.6(a)]TJ
1.8708 -1.1239 TD
[(synchronous)-247.1(telehealth)-245.2(service)-246.2(for)-248.5(seniors)-251.7(and)-252.7(nonsen)14(iors)-252(with)-253(cardiovascul)12.2(ar)]TJ
T*
[(diseases:)-329.7(Quasi-expe)10.8(rimental)-326.7(study.)]TJ
/F18 1 Tf
14.0271 0 TD
[(J)-335.6(Med)-325.7(Internet)-328.4(Res)]TJ
/F20 1 Tf
7.6893 0 TD
(2013;)Tj
/F16 1 Tf
2.4398 0 TD
(15:e87.)Tj
-26.027 -1.6858 TD
[(176.)-246.8(Coleman)-333.3(EA,)-325.9(Parry)-334.8(C,)-331.5(Chalmers)-324.5(S,)-336.6(et)-328(al.)-335.9(The)-331.1(care)-328.6(transitions)-326.6(interventi)11.1(on:)]TJ
1.8708 -1.1239 TD
[(Results)-332(of)-332.9(a)-328.3(randomized)-329.3(controlled)-324.1(trial.)]TJ
/F18 1 Tf
15.9548 0 TD
[(Arch)-325.2(Intern)-327.6(Med)]TJ
/F20 1 Tf
6.7006 0 TD
(2006;)Tj
/F16 1 Tf
2.4398 0 TD
(166:1822)Tj
-25.0951 -1.1239 TD
(1828.)Tj
-1.8708 -1.6929 TD
[(177.)-246.8(Chugh)-332(A,)-331.9(Williams)-325.5(MV,)-331.3(Grigsby)-331.8(J,)-326.5(et)-335.1(al.)-335.9(Better)-329(transitions:)-322.3(Improving)]TJ
1.8708 -1.1239 TD
[(comprehension)-319(of)-332.9(discharge)-326.1(instructions.)]TJ
/F18 1 Tf
16.2749 0 TD
[(Front)-323.8(Health)-330.5(Serv)-332.1(Manage)]TJ
/F20 1 Tf
-16.2749 -1.1239 TD
(2009;)Tj
/F16 1 Tf
2.4469 0 TD
[(25:1132)14.1(.)]TJ
/F1 1 Tf
8.9663 0 0 8.9663 471.9684 462.3873 Tm
[(Address)-337.7(correspondence)-342.1(to:)]TJ
/F5 1 Tf
1.018 -1.3341 TD
[(Rashid)-336.8(L.)-331.8(Bashshur,)-341.2(PhD)]TJ
-1.0496 -1.3278 TD
[(Senior)-332.1(Advisor)-336.5(for)-332.5(e-Health)]TJ
-4.3122 -1.3341 TD
[(University)-340.2(of)-328.2(Michigan)-339.7(Health)-335.6(System)]TJ
3.6357 -1.3341 TD
[(300)-335.7(North)-333.2(Ingalls,)-335.4(SPC)-333.7(5402)]TJ
.3225 -1.3341 TD
[(Ann)-334.5(Arbor,)-333.7(MI)-332.5(48109-5402)]TJ
-2.5797 -3.446 TD
(E-mail)Tj
/F1 1 Tf
2.8327 0 TD
[(:)-330.3(bashshur@med.umich.edu)]TJ
/F5 1 Tf
1.6945 -2.1624 TD
(Received:)Tj
/F1 1 Tf
4.1984 0 TD
[(May)-330.4(28,)-339.7(2014)]TJ
/F5 1 Tf
-4.4197 -1.3341 TD
(Accepted:)Tj
/F1 1 Tf
4.4197 0 TD
[(May)-330.4(28,)-339.7(2014)]TJ
/F11 1 Tf
11.9551 0 0 11.9551 50.1732 741.9966 Tm
[(BASHSHUR)-338.5(ET)-334.1(AL.)]TJ
7.9702 0 0 7.9702 50.1732 29.7638 Tm
[(8)-75.6(0)-81.1(0)-707(TELEMEDI)12.8(CINE)-329.6(and)-331.8(e-HEALT)11.5(H)]TJ
/F8 1 Tf
6.9738 0 0 6.9738 178.1858 29.7638 Tm
.1094 Tc
[(SEPTEM)6.2(BER)-333.3(2)0(014)]TJ
ET
q
1 i
0 792 612 -791.985 re
W n
32.315 .014984 .22675 791.985 re
f
/Document /MC17 BDC
Q
q
1 i
0 792 32.315 -173.367 re
W n
0 0 0 .29999 k
0 618.633 32.315 173.367 re
f
EMC
Q
32.315 763.994 242.646 .22675 re
f
endstream
endobj
670 0 obj
<>stream
Adobe Illustrator CS4
2010-08-04T11:54:42+05:30
2010-08-04T11:54:42+05:30
2010-08-04T11:54:42+05:30
68
256
JPEG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application/postscript
saved
xmp.iid:11FB61F30AB7DE11AEB3E861853EAFA4
2009-10-12T14:15:50+05:30
Adobe Illustrator CS4
/
converted
from application/postscript to application/vnd.adobe.illustrator
converted
from application/postscript to application/vnd.adobe.illustrator
saved
xmp.iid:0280117407206811994CBE3149FFDB59
2010-08-04T11:54:42+05:30
Adobe Illustrator CS4
/
converted
from application/postscript to application/vnd.adobe.illustrator
xmp.iid:11FB61F30AB7DE11AEB3E861853EAFA4
xmp.did:11FB61F30AB7DE11AEB3E861853EAFA4
uuid:ee5a72b3-04e4-4157-a8d8-c3a8817872a3
uuid:ee5a72b3-04e4-4157-a8d8-c3a8817872a3
xmp.iid:0280117407206811994CBE3149FFDB59
xmp.did:0280117407206811994CBE3149FFDB59
TouchUp 7.0
False
False
1
684.000000
864.000000
Points
Black
Default Swatch Group
0
PANTONE 3025 C
SPOT
100.000000
CMYK
100.000000
16.859999
0.000000
50.980003
endstream
endobj
629 0 obj
<>
endobj
671 0 obj
[/Indexed/DeviceRGB 255 672 0 R]
endobj
672 0 obj
<>stream
8;X]O>EqN@%''O_@%e@?J;%+8(9e>X=MR6S?i^YgA3=].HDXF.R$lIL@"pJ+EP(%0
b]6ajmNZn*!='OQZeQ^Y*,=]?C.B+\Ulg9dhD*"iC[;*=3`oP1[!S^)?1)IZ4dup`
E1r!/,*0[*9.aFIR2&b-C#soRZ7Dl%MLY\.?d>Mn
6%Q2oYfNRF$$+ON<+]RUJmC0InDZ4OTs0S!saG>GGKUlQ*Q?45:CI&4J'_2j$XKrcYp0n+Xl_nU*O(
l[$6Nn+Z_Nq0]s7hs]`XX1nZ8&94a\~>
endstream
endobj
673 0 obj
<>stream
hތNAo:Q#
L)#`hn6p8@.
H|bc;AhܣpKs11h\]TyZVK(ήlKf/?˷}w91:_Pܢ[$Qu68H
]Vʁ6H
p#\\z:c<
ؽGC[( R$Z>j R LM@WIҀ%)'҄1!~scD-KgC
iX<߿n>2R?
endstream
endobj
674 0 obj
<>
endobj
171 0 obj
<>
endobj
192 0 obj
<>
endobj
676 0 obj
<>stream
h,?N0
,=GR*u'
:uҨs%8b(
J'}rNrix}\rsG(>#gä(2dxI^N8D`2\I*ZM51FRHu+$6ژM[iֺҊx-lf6.m>0+OMXT%+B,眤$!1v Vm
endstream
endobj
675 0 obj
<>
endobj
210 0 obj
<>
endobj
679 0 obj
<>
endobj
208 0 obj
<>
endobj
680 0 obj
<>stream
hތUiTWz*֪F҈#(-i4k$CNT4%
ee'313s&twW2踸)g7]Ue[Xľ
9#wuh5yYk2LWM2M5f[L,kM9rrҊ,>&Shv)I/4%Y
-7)(Diڴ)w)t4SY9>hq0q1㝘i#&ebL<,d3ư3iL S\ՌԼPsDX+h'hhhjOu.NNƲl<aovn*p|L9O^~o9y:-p:U:. x@|3ODdm0J!
6L0
l$\^"jl(A:j9