No abstract

Supporting self-management is key in improving disease control, with technology increasingly utilised. We hypothesised the addition of telehealth support following assessment in an integrated respiratory clinic could reduce unscheduled healthcare visits in patients with asthma and COPD. Following treatment optimisation, exacerbation-prone participants or those with difficulty in self-management were offered telehealth support. This comprised automated twice-weekly telephone calls, with a specialist nurse triaging alerts. We performed a matched cohort study assessing additional benefits of the telehealth service, matching by: confirmed diagnosis, age, sex, FEV1 percent predicted, smoking status and ≥1 exacerbation in the last year. Thirty-four telehealth participants were matched to twenty-nine control participants. The telehealth cohort generated 165 alerts, with 29 participants raising at least one alert; 88 (53.5%) alerts received a call discussing self-management, of which 35 (21%) received definitive advice that may otherwise have required an unscheduled healthcare visit. There was a greater reduction in median exacerbation rate across both telehealth groups at 6 months post-intervention (1 to 0, p < 0.001) but not in control groups (0.5 to 0.0, p = 0.121). Similarly, there was a significant reduction in unscheduled GP visits across the telehealth groups (1.5 to 0.0, p < 0.001), but not the control groups (0.5 to 0.0, p = 0.115). These reductions led to cost-savings across all groups, but greater in the telehealth cohorts. The addition of telehealth support to exacerbation-prone patients with asthma or COPD, following comprehensive assessment and treatment optimisation, proved beneficial in reducing exacerbation frequency and unscheduled healthcare visits and thus leads to significant cost-savings for the NHS.Clinical Trial Registration: ClinicalTrials.gov: NCT03096509

Jamaica's trans-shipment industry is amongst the largest in the Caribbean with 90% of trans-shipment activities occurring in Kingston Harbour. The eastern ship channel is populated with patch and fringing coral reefs. In 2002, approximately 20% of an originally sloping face of Rackham's Cay, on the southern edge of the channel, was cut vertically to 18m and dredged to widen the channel. The successional changes on the newly created vertical limestone wall was assessed between 2009 and 2012 at 5m, 10m and 15m depths using bi-annual photographs of fixed 1 m 2 quadrats. Photographs were analyzed using Coral Point Count. No colonization of either algal or coralline species was observed at 15m. Initially calcareous and fleshy algae dominated at 5m but showed a gradual decrease over time. Calcareous algae dominated at 10m and increaseed gradually over the 4 years. Stony corals at both 5m and 10m had overall low cover and slow colonization; the shallower depth had more coverage (4.1% maximum in 2011). Siderastrea sidera -which dominated Rackham's Cay before dredging-was consistently present in low coverage. Colonization by species of Acropora and Scolymia indicate slower but better succession at 10m. Ten years following dredging activities, colonization and recruitment have been slow but successful at 5m and 10m; species previously described as abundant lead the colonization. We recommend limiting coral relocation activities to depths not exceeding 10m. Rev. Biol. Trop. 62 (Suppl. 3): 107-114. Epub 2014 September 01.

No abstract

Bilateral idiopathic optic neuritis is an uncommon presentation of optic neuritis, and the initial treatment options are limited to corticosteroids with consideration for plasma exchange therapy as second-line therapy. We present the case of a 43-year-old deaf and mute patient whose ability to communicate via American Sign Language was severely impaired by her recurrent idiopathic bilateral optic neuritis. She was treated early and aggressively with both plasma exchange and corticosteroids within days of presentation and experienced rapid improvement in her vision. Early treatment with plasma exchange should be considered in patients whose impairment presents a significant communication barrier.