Objective To determine whether mobile phone based monitoring improves asthma control compared with standard paper based monitoring strategies.Design Multicentre randomised controlled trial with cost effectiveness analysis.Setting UK primary care.Participants 288 adolescents and adults with poorly controlled asthma (asthma control questionnaire (ACQ) score ≥1.5) from 32 practices.Intervention Participants were centrally randomised to twice daily recording and mobile phone based transmission of symptoms, drug use, and peak flow with immediate feedback prompting action according to an agreed plan or paper based monitoring. Main outcome measuresChanges in scores on asthma control questionnaire and self efficacy (knowledge, attitude, and self efficacy asthma questionnaire (KASE-AQ)) at six months after randomisation. Assessment of outcomes was blinded. Analysis was on an intention to treat basis. ResultsThere was no significant difference in the change in asthma control or self efficacy between the two groups (ACQ: mean change 0.75 in mobile group v 0.73 in paper group, mean difference in change −0.02 (95% confidence interval −0.23 to 0.19); KASE-AQ score: mean change −4.4 v −2.4, mean difference 2.0 (−0.3 to 4.2)). The numbers of patients who had acute exacerbations, steroid courses, and unscheduled consultations were similar in both groups, with similar healthcare costs. Overall, the mobile phone service was more expensive because of the expenses of telemonitoring.Conclusions Mobile technology does not improve asthma control or increase self efficacy compared with paper based monitoring when both groups received clinical care to guidelines standards. The mobile technology was not cost effective. Trial registration Clinical Trials NCT00512837. IntroductionGlobally, an estimated 300 million people have asthma, presenting a considerable and increasing burden of disease to healthcare systems, families, and patients.1 Despite two decades of asthma guidelines, 2 asthma remains poorly controlled in a substantial proportion of people.3 Structured asthma management-which in the United Kingdom is predominantly delivered in primary care 4 -can improve outcomes in terms of exacerbations, admissions to hospital, and days lost from school and work. 5 The concept of supported self management, engaging both clinicians and patients in delivering and implementing regular monitoring of control and adjustment of treatment, is a key recommendation of national and international guidelines. The theoretical model developed by Glasziou and colleagues, using asthma as an exemplar, describes the complementary and evolving roles of periodic support from professionals and RESEARCHongoing self monitoring by patients. 8 Our recent qualitative study suggests that people with asthma perceive a role for mobile technology in aiding transition from clinician supported phases while control is gained to effective self management during maintenance phases. 9Poor adherence to monitoring and drugs is a potentially modifiable factor associated wit...

The term spasticity is inconsistently defined and this inconsistency will need to be resolved. Often, the measures used did not correspond to the clinical features of spasticity that were defined within a paper (i.e. internal validity was compromised). There is need to ensure that this lack of congruence is addressed in future research.

The presentations of spasticity are variable and are not always consistent with existing definitions. Existing clinical scales that depend on the quantification of muscle tone may lack the sensitivity to quantify the abnormal muscle activation and stiffness associated with common definitions of spasticity. Neurophysiological measures may provide more clinically useful information for the management and assessment of spasticity.

In this group of patients who had no arm function within the first 6 weeks of stroke, spasticity was seen early, but did not necessarily hinder functional recovery. Contractures were more likely to develop in patients who did not recover arm function.

No abstract

Surface neuromuscular electrical stimulation reduces pain in stroke patients with a non-functional arm. There was some evidence that treatment with electrical stimulation was beneficial in reducing contractures. Treatment had no effect on spasticity.

Four to ten percent of patients evaluated in emergency departments (ED) present with altered mental status (AMS). The prevalence of non-convulsive seizure (NCS) and other electroencephalographic (EEG) abnormalities in this population is unknown Objectives To identify the prevalence of NCS and other EEG abnormalities in ED patients with AMS. Methods A prospective observational study at two urban ED. Inclusion: patients ≥13 years old with AMS. Exclusion: An easily correctable cause of AMS (e.g. hypoglycemia). A 30-minute standard 21-electrode EEG was performed on each subject upon presentation. Outcome: prevalence of EEG abnormalities interpreted by a board-certified epileptologist. EEGs were later reviewed by two blinded epileptologists. Inter-rater agreement (IRA) of the blinded EEG interpretations is summarized with kappa. A multiple logistic regression model was constructed to identify variables that could predict the outcome. Results 259 patients were enrolled (median age: 60, 54% female). Overall, 202/259 of EEGs were interpreted as abnormal (78%, 95% confidence interval [CI], 73–83%). The most common abnormality was background slowing (58%, 95%CI, 52–68%) indicating underlying encephalopathy. NCS (including non-convulsive status epilepticus [NCSE]) was detected in 5% (95%CI, 3–8%) of patients. The regression analysis predicting EEG abnormality showed a highly significant effect of age (p<0.001, adjusted odds ratio 1.66 [95%CI, 1.36–2.02] per 10-year age increment). IRA for EEG interpretations was modest (kappa: 0.45, 95% CI, 0.36–0.54). Conclusions The prevalence of EEG abnormalities in ED patients with undifferentiated AMS is significant. ED physicians should consider EEG in the evaluation of patients with AMS and a high suspicion of NCS/NCSE.

No abstract