ABSTRACT. Objective. Lead (Pb) poisoning remains a common disease among children despite successful public health efforts that have reduced its prevalence. Treatment options for children with blood Pb levels (BPbs) <45 g/dL are limited because chelation therapy is generally not indicated. Calcium (Ca) and Pb interactions are well documented. Competition for binding to Ca-binding proteins may underlie a mechanism for Pb absorption. The purpose of this study was to determine the role, if any, of supplemental Ca at reducing BPbs in moderately poisoned children.Methods. Children aged 1 to 6 years with BPbs 10 to 45 g/dL were enrolled in a double-blinded, placebocontrolled trial of the effects of Ca supplementation on BPbs. Children received either a Ca-containing liquid or an indistinguishable placebo. Dosage was adjusted biweekly on the basis of responses to a dietary Ca intake questionnaire to reach 1800 mg in the Ca-supplemented group. Samples for BPbs and measures to assess safety were collected before and after 3 months of supplementation and after an additional 3 months of follow-up. Bivariate and multiple regression analyses were performed.Results. A total of 67 of 88 enrolled children with a mean age of 3.6 years completed 3 months of supplementation. There were no statistically significant differences between groups on hematologic and biochemical measures, including serum and urinary Ca, at any time points. The average compliance rate was estimated to be 80% for each group during the 3-month supplementation period.Conclusions. At enrollment, the average daily Ca intake in this group of inner-city children was greater than the recommended daily intake for age. Although BPbs declined during a 3-month period in both groups, Ca supplementation aimed at providing 1800 mg of Ca/day had no effect on the change in BPbs. Ca supplementation should not be routinely prescribed for mild to moderately Pb-poisoned children who are dietarily Ca sufficient. Pediatrics 2004;113:e34 -e39. URL: http://www. pediatrics.org/cgi/content/full/113/1/e34; lead, lead poisoning, calcium, calcium supplementation.ABBREVIATIONS. Pb, lead; BPb, blood lead level; CDC, Centers for Disease Control and Prevention; EP, erythrocyte protoporphyrin; AAS, atomic absorption spectrometry; SD, standard deviation; sCa, serum calcium; uCa, urinary calcium; uCr, urinary creatinine. C hildhood lead (Pb) poisoning is prevalent worldwide. In the United States alone, an estimated 0.5 million preschool-aged children have elevated blood Pb levels (BPbs; Ն10 g/dL). 1 The poisoning of this large number of children is, in large part, the consequence of the widespread presence of leaded paint in US residential housing. The National Academy of Sciences estimates that there are 3 million tons of leaded paint in housing built primarily before 1960. 2 Outside the US, the continued use of leaded gasoline is associated with elevated BPbs in urban populations. 3 A study completed recently in India found that average BPbs in 5 major cities were comparable to that in the U...

No meaningful difference in peak antifactor Xa activity was found between patients with renal impairment and control subjects. To the extent that peak antifactor Xa levels can be used as markers for adjusting doses of dalteparin, these data suggest that such adjustments are not necessary for patients with renal impairment who are not receiving dialysis.

Caregivers frequently make mistakes when following instructions on discharge medications, and these instructions often contain discrepancies. Minimal literature reflects inpatient discharges. Our objective was to describe failures in caregiver management and understanding of inpatient discharge medications and to test the association of documentation discrepancies and sociodemographic factors with medication-related failures after an inpatient hospitalization. METHODS: This study took place in an urban tertiary care children's hospital that serves a low-income, minority population. English-speaking caregivers of children discharged on an oral prescription medication were surveyed about discharge medication knowledge 48 to 96 hours after discharge. The primary outcome was the proportion of caregivers who failed questions on a 10-item questionnaire (analyzed as individual question responses and as a composite outcome of any discharge medication-related failure). Bivariate tests were used to compare documentation errors, complex dosing, and sociodemographic factors to having any discharge medication-related failure. RESULTS: Of 157 caregivers surveyed, 70% had a discharge medication-related failure, most commonly because of lack of knowledge about side effects (52%), wrong duration (17%), and wrong start time (16%). Additionally, 80% of discharge instructions provided to caregivers lacked integral medication information, such as duration or when the next dose after discharge was due. Twenty five percent of prescriptions contained numerically complex doses. In bivariate testing, only race and/or ethnicity was significantly associated with having any failure (P 5 .03). CONCLUSIONS: The majority of caregivers had a medication-related failure after discharge, and most discharge instructions lacked key medication information. Future work to optimize the discharge process to support caregiver management and understanding of medications is needed.

BACKGROUND Venous thromboembolism (VTE) disease prophylaxis rates among medical inpatients have been noted to be <50%. OBJECTIVE Our objective was to evaluate the effectiveness and safety of a computerized decision support application to improve VTE prophylaxis. DESIGN Observational cohort study. SETTING Academic medical center. PATIENTS Adult inpatients on hospital medicine and nonmedicine services. INTERVENTION A decision support application designed by a quality improvement team was implemented on medicine services in September 2009. MEASUREMENTS Effectiveness and safety parameters were compared on medicine services and nonmedicine (nonimplementation) services for 6‐month periods before and after implementation. Effectiveness was evaluated by retrospective information system queries for rates of any VTE prophylaxis, pharmacologic VTE prophylaxis, and hospital‐acquired VTE incidence. Safety was evaluated by queries for bleeding and thrombocytopenia rates. RESULTS Medicine service overall VTE prophylaxis increased from 61.9% to 82.1% (P < 0.001), and pharmacologic VTE prophylaxis increased from 59.0% to 74.5% (P < 0.001). Smaller but significant increases were observed on nonmedicine services. Hospital‐acquired VTE incidence on medicine services decreased significantly from 0.65% to 0.42% (P = 0.008) and nonsignificantly on nonmedicine services. Bleeding rates increased from 2.9% to 4.0% (P < 0.001) on medicine services and from 7.7% to 8.6% (P = 0.043) on nonmedicine services, with nonsignificant changes in thrombocytopenia rates observed on both services. CONCLUSIONS An electronic decision support application on inpatient medicine services can significantly improve VTE prophylaxis and hospital‐acquired VTE rates with a reasonable safety profile. Journal of Hospital Medicine 2013;8:115–120. © 2012 Society of Hospital Medicine

This cohort study analyzes outcomes associated with the use of patiromer as monotherapy for non–life-threatening hyperkalemia in adult patients in an acute care setting.