Aging societies worldwide propose a significant challenge to the model and organisation of the delivery of healthcare services. In developing countries, communicable and non-communicable diseases are affecting how the ageing population access healthcare; this could be due to varying reasons such as geographical barriers, limited financial support and poor literacy. New information and communication technology, such as eHealth have the potential to improve access to healthcare, information exchange and improving public and personalised medicine for elderly groups. In this article we will first frame the context of information and communication technologies in light of an aging landscape. We will also discuss the problems related to implementing the needed infrastructure for uptake of new technology, with particular emphasis on developing countries. In so doing, we highlight areas where newer technologies can serve as promising tools or vehicles to address health and healthcare-related gaps and needs of elderly people living in resource-constrained settings.

In this meta-analysis, the testing uptake of the opt-out strategy was not different from that of the opt-in strategy to detect new cases of HIV infection in EDs.

As cancer treatment improves and survival rates continue to increase, clinicians are seeing increasing numbers of patients with metastatic bone disease (MBD). This term describes cancer that has originated in another organ and subsequently spread to the bone. It is a condition that can severely impact the quality of life for an individual and the treatment is often not curative. This article aims to cover the management of MBD, from early recognition to secondary care interventions. The care of individuals with MBD is evolving in the UK, with the development of specialist regional referral pathways to facilitate prompt and timely management.

An infected aortic aneurysm is a process with high mortality rate. Survival is dependent on an early diagnosis and surgical management. This case report details a rare presentation of aortitis with persistent methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia, which initially presented as retroperitoneal fibrosis and was ultimately fatal.

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IntroductionOur specialist service manages patients with vocal cord dysfunction (VCD), chronic cough (CC) and dysfunctional breathing (DB), and referrals have grown exponentially since we introduced this novel multi-disciplinary (MDT) model in 2006. The team comprises two severe asthma specialist physicians, two respiratory speech and language therapists (rSLT), a severe asthma nurse specialist, respiratory physiotherapist and clinical psychologist.AimsTo describe the clinical characteristics of those referred and assess utilisation of the multi-disciplinary structure.MethodsPatient demographics and clinical data were retrospectively collated from clinical records of patients referred between January and December 2014.ResultsThe service received 249 referrals. Excluding patients still in treatment or who failed to attend initial assessment, 141 complete data sets were available for analysis: 71% female; mean (range) age 55 (18–79) years. Assessment requests were for VCD (71%), CC (28%) or both (1%) and over half were from NW severe asthma centres or extra-regional specialist centres. The majority of referrals were from hospital consultants (72%), with the remainder from GPs (17%) and AHPs (11%). For VCD there was 73% agreement between the clinical suspicion on referral and nasendoscopic assessment. Approximately half had evidence of co-existent reflux (52%) and a third (29%) had nasal disease.The majority were seen by more than one member of the MDT team; all by a specialist physician and a rSLT, 43% by respiratory physiotherapy, and 7% clinical psychology.In the VCD cohort 64% had a previous asthma diagnosis and this was confirmed in the majority (93%) – 49(82%) were ≥Step 3 on BTS/SIGN guidelines; 43% were additionally referred for DB assessment; 78 flow volume loops were available and 31 (40%) were suggestive of extra thoracic inspiratory airway obstruction.Sixty-seven patients (48%) received rSLT management [median (range) 4(1–8) sessions] with a further 16(11%) scheduled to receive it post medical intervention. Of those who completed treatment, 63% had clinically improved presentation on discharge nasendoscopy.ConclusionsA large proportion of patients referred to a specialist service for patients with complex breathlessness require multi-disciplinary intervention. There is a significant incidence of VCD and DB in patients with severe complex asthma. Of those receiving rSLT interventions, outcome was extremely effective at reducing symptoms.

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Background Subacromial injections are common for diagnosis and therapy of shoulder impingement secondary to subacromial bursitis. We evaluated the likelihood of a successful subacromial injection from both the posterior and lateral injection sites. Method We reviewed 100 MRI scans of the shoulder and recorded measurements in both the sagittal (representative of posterior injection) and coronal (representative of lateral injection) orientations. We compared these to the lengths of standard needles. Multiple measurements were taken: Results Measuring along the angle of the acromion demonstrated shorter mean distances from the lateral injection site. The distance from skin to mid-point of the acromion) provided mean values of 51.4mm for posterior and 40.1mm for lateral. A standard 40mm (green) needle would reach the midpoint of the acromion in 58% of lateral measurements and 23% from posterior. Conclusions Injections are more likely to enter the subacromial space from a lateral rather than a posterior entry point.