Evaluation of telehealth support in an integrated respiratory clinic.

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.

Deaf and Mute Patient Developing Recurrent Idiopathic Bilateral Optic Neuritis: A Case for Early Treatment With Plasmapheresis?

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.

Cool? Young people investigate living in cold housing and fuel poverty. A mixed methods action research study.

BACKGROUND: Living in cold housing conditions and risk of fuel poverty presents a range of physiological and psychosocial health risks. Limited research has specifically investigated the effects of fuel poverty on children and young people, and even less has been conducted with youth input into the research process. METHODS: The Cool? Study used mixed methods, participatory action research carried out with youth researchers involved at all stages through questionnaire design, analysis, qualitative design, e-interviewing and dissemination of results. This article reports on results of an online survey of 656 adolescents aged 14-16 years completed at 17 schools in New Zealand. Sampling was based on selecting schools for invitation, with the probability of selection weighted proportional to school size, within strata defined by climate zone. Results from a small e-mail interview study of survey respondents who consented to follow-up are also reported. RESULTS: The study found that almost half of the survey respondents (47%) felt their home was sometimes cold during the winter; a further 40% felt their home was often or always cold. More than two thirds of respondents (70%) had shivered inside at least once during winter. Respondents were more likely to report key indicators of fuel poverty depending on their self-reported ethnicity, with Maori at increased risk. Living in private rental housing or state-owned housing also increased risk of fuel poverty compared to those in owner-occupied dwellings. Participants of email interviews expressed concern about the widespread problem of cold housing for youth and a desire for Government intervention. CONCLUSION: The integrated results confirm that cold housing and risk of fuel poverty are important problems for young people in New Zealand. Results contribute to the evidence-base for policy targeting of schemes such as the Government-sponsored retrofitting of insulation to households with dependent children.

Coral and algal community primary succession on new vertical substrate at Rackham’s Cay, Port Royal, Jamaica / Sucesión primaria de una comunidad de coral y algas en el nuevo sustrato vertical en el Cayo de Rackham, Puerto Royal, Jamaica

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 m² 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.

La industria de transbordo en Jamaica es de las mas grandes en el Caribe con el 90% de las actividades de tránsito que ocurren en el puerto de Kingston. El canal oriental de la bahía está poblado de un fragmento y franja de arrecife de coral. En el 2002, aproximadamente el 20% de una cara del Cayo Rackham fue cortado verticalmente a 18m y dragado para facilitar la ampliación del canal. Los cambios sucesionales en la pared de piedra caliza vertical se evaluó entre el 2009 y 2012 en 5m, 10m y 15m de profundidad usando fotografías bianuales en cuadrantes de 1m². Las fotografías fueron analizadas usando “Conteo de Puntos de Coral”. A 15m de profundidad, no se observó ninguna colonización de especies coralinas o algas. Las algas calcáreas y carnosas dominaron inicialmente los 5m de profundidad y mostraron una disminución gradual en el tiempo. Algas calcáreas dominaron los 10m de profundidad y también mostraban un incremento gradual en los 4 años. Corales pétreos en 5m y 10m de profundidad mostraron un % de cobertura bajo y lenta colonización, con la menor profundidad y teniendo la mayor cobertura coralina (4.1% máximo en 2011). Sidera Siderastrea que dominaba Cayo Rackham antes del dragado fue la especie coral constantemente presente aunque en bajo % de cobertura. La colonización por especies de los géneros Acropora y Scolymia son indicación de sucesión más lenta pero mejor a 10m de profundidad. Los diez años siguientes después de las dragas, la colonización de coral y reclutamiento ha sido lento pero exitoso en 5m y 10m de profundidad con especies previamente descritas como siendo abundantes en la zona. Recomendamos limitar las actividades de reubicación de coral a profundidades no superiores a 10m.