News in brief: App for young onset PD; EDs are overprescribing opiates for migraine; Stroke outcomes in rural Aust comparable to city


8 Apr 2021

Digital support for patients with young onset PD

There is now more support for younger people with Parkinson’s disease in the form of a free-to-download app and resource hub, Young Onset Parkinson’s eXchange (YOP-X).

The initiative recognises that Young Onset Parkinson’s Disease (YOPD) affects people at a time when they should be at their most productive through employment, family and school commitments, sporting and social activities.

Cognitive neuroscientist Dr Fiona Kerr, CEO of The NeuroTech Institute at the South Australian Health & Medical Research Institute, said people with YOPD not only face debilitating motor impairment, but also non-motor symptoms including anxiety, depression, apathy and sleep disorders that can substantially compromise their quality of life.

“The combination of support provided by the YOP-X app and medical care offers YOPD patients a holistic approach to addressing changes involving their work, relationships, sleep, physical ability and mental health,” she said.

YOP-X provides easily accessible information about their disease and its management such as educational videos on mental health and wellbeing, exercises to increase strength and balance, and prompts and reminders to promote positive behavioral change.

The app is available for download from the App Store or Google Play.

Migraine: world’s worst managed medical disorder?

Prescribing patterns for the treatment of acute migraine in the ED across the world reveal an alarming overprescription of opiates and underprescription of triptans.

A scoping review of the evidence, co-authored by senior investigator Professor Tissa Wijeratne from Western Health, found 57% of the included studies focused on the use of opiates.

“Moreover some studies showed very high rates of opiate prescription, in one hospital the prescription rate was 69%,” the review said.

Yet patients who received opiates described poorer outcomes or no increased pain relief.

“Interestingly none of the studies mentioned concepts such as sustained pain free response or 2-h pain freedom as a treatment goal, both of which are important clinical endpoint measures which can be used to assess the outcomes of migraine treatment.”

“This suggests that opiates are being overprescribed to patients with migraine without any clear clinical goals of treatment.”

Antiemetics were the most used medication in 50% of studies followed by non-opioid analgesics in 28.5%. Intravenous fluids were the most commonly reported therapy in 14% of studies.

“The published papers continue to support the notion that migraine headache continues to be the most neglected, worst respected, worst managed medical disorder in the world,” they concluded.

Journal of Clinical Medicine

Surprising stroke outcome date on rural-urban divide

Australians treated for acute stroke in rural hospitals miss out on some components of stroke care available in the city but their health outcomes at six months do not reflect this, according to data from the Australian Stroke Clinical Registry.

An analysis of over 28,000 episodes of care at 50 hospitals between 2010 and 2015 showed patients presenting to rural hospitals had less access to a stroke unit (76.5% v 82.2%), IV thrombolysis for ischaemic stroke (7.5% v 12.7%), and a care plan on discharge (44.7% v 61.3%) than patients presenting to urban hospitals.

However there were no significant differences in survival up to 180 days between the two geographical groups. Most other outcomes such as mobility, self-care, usual activities and anxiety/depression were also similar at 90-180 days.

The investigators said the comparable outcomes between rural and urban hospitals might be influenced by the fact that rural hospitals who participated in the registry were likely to be highly motivated to monitor and improve their delivery of stroke care.

However the roll out of telemedicine to increase rates of thrombolysis was urgently needed, they said.

BMJ Open


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