Success with 4-hour rule
THE introduction of the 4-hour rule in the emergency department (ED) of a WA tertiary paediatric hospital resulted in improved timeliness in treatment of patients without comprising quality and safety, according to research published in the MJA. Princess Margaret Hospital for Children in Perth, a 220-bed hospital with more than 65 000 ED presentations annually, launched a 4-hour rule program in April 2009 with a target of 98% of ED patients to be admitted, discharged or transferred within 4 hours of arrival by April 2011. The researchers said increased overall performance resulted from improvements in both the percentage of patients being admitted to hospital within 4 hours (62% in 2009; 74% in 2010; and 80% in 2011), and those being discharged home from the ED within 4 hours (94% in 2009; 96% in 2010; and 98% in 2011). They wrote that improvements in the timely discharge of patients from inpatient wards had been critical to the success of the program. “The [4-hour rule] program provided a unique opportunity to redesign aspects of the patient journey, resulting in significant and sustained benefits for patients and staff. The focus of the redesign program must remain on improving the quality of care for patients, rather than on achieving ‘the target’”, the researchers wrote.

Stimulation best in early Parkinson’s
NEUROSTIMULATION is superior to medical therapy alone in early stage Parkinson’s disease, before severe disabling motor complications appear, according to research published in the New England Journal of Medicine. The trial involved 251 patients with Parkinson’s disease and early motor complications randomly assigned to undergo subthalamic neurostimulation plus medical therapy or medical therapy alone. The primary end point was quality of life, with the neurostimulation group improving and the medical-therapy group slightly worse off after 2 years. Neurostimulation was superior to medical therapy for motor disability, activities of daily living, levodopa-induced motor complications, and time with good mobility and no dyskinesia. Serious adverse events occurred in 54.8% of the patients in the neurostimulation group and in 44.1% of those in the medical-therapy group. The researchers said the results of the study suggested that neurostimulation may be a therapeutic option for patients at an earlier stage than currently recommended.

Risks of too much calcium
WOMEN with a high dietary intake of calcium who also take long-term calcium supplements are at increased risk of all cause and cardiovascular death, according to research published in the BMJ. The population-based cohort study initially involved 61 433 Swedish women born between 1914 and 1948 who were followed up for a median 19 years. The researchers found a moderate increase in risk of mortality among women with a high dietary calcium intake without supplement use, but the combination of a high dietary intake and calcium tablet use resulted in a more pronounced increase. Compared with calcium intakes of 600–1000 mg/day, intakes above 1400 mg/day were associated with higher death rates from all causes, cardiovascular disease, and ischaemic heart disease but not from stroke. The researchers wrote that for the prevention of fractures in elderly people without increasing the risk of serious adverse events related to a high calcium intake, the emphasis should be on monitoring people with a low intake of calcium rather than those already consuming satisfactory amounts.

Vitamin D pills highly variable
THE vitamin D content of vitamin D supplements is highly variable, according to US research published in JAMA Internal Medicine. Researchers tested the vitamin D3 (cholecalciferol) content of cholecalciferol pills (1000 IU and 50 000 IU) compounded on three occasions over 4 months, as well as pills from 15 bottles of OTC vitamin D dietary supplements (1000 IU, 5000 IU and 10 000 IU) bought at five stores in Portland, Oregon. Potency ranged from 9% to 146% of the stated amount of active ingredient. US Pharmacopeial Convention standards require compounded pills to include 90%–110% of the active ingredient. The researchers said although the lack of accuracy in vitamin D dosing may not generally cause harm in most consumers, they may harm women with severe vitamin D deficiencies. They called for increased regulation of dietary supplements.

Folic acid may reduce autism risk
TAKING folic acid supplements around the time of conception has been associated with a lower risk of the child developing autistic disorder, the most severe form of autism spectrum disorder, according to research published in JAMA. The population-based study of more than 85 000 Norwegian children found that among children whose mothers took folic acid, 0.10% had autistic disorder compared with 0.21% of those not exposed. No association was found with Asperger syndrome or pervasive developmental disorder–not otherwise specified. The researchers wrote that the use of folic acid supplements was associated with higher socioeconomic status and more health-conscious maternal behaviour patterns in the study sample. “We cannot exclude the possibility that some portion of the inverse association represents residual, unmeasured confounding”, they wrote. Although the findings could not establish causality, they did support prenatal folic acid supplementation, the researchers said.

Posted 18 February 2013

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