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BACKGROUND: Proximal humerus fractures (PHFs) are common fractures, especially in older female patients. These fractures are commonly treated surgically, but the consensus on the best treatment is still lacking. METHODS AND FINDINGS: The primary aim of this multicenter, randomized 3-arm superiority, open-label trial was to assess the results of nonoperative treatment and operative treatment either with locking plate (LP) or hemiarthroplasty (HA) of 3- and 4-part PHF with the primary outcome of Disabilities of the Arm, Shoulder, and Hand (DASH) at 2-year follow-up. Between February 2011 and December 2019, 160 patients 60 years and older with 3- and 4-part PHFs were randomly assigned in 1:1:1 fashion in block size of 10 to undergo nonoperative treatment (control) or operative intervention with LP or HA. In total, 54 patients were assigned to the nonoperative group, 52 to the LP group, and 54 to the HA group. Five patients assigned to the LP group were reassigned to the HA group perioperatively due to high comminution, and all of these patients had 4-part fractures. In the intention-to-treat analysis, there were 42 patients in the nonoperative group, 44 in the LP group, and 37 in the HA group. The outcome assessors were blinded to the study group. The mean DASH score at 2-year follow-up was 30.4 (standard error (SE) 3.25), 31.4 (SE 3.11), and 26.6 (SE 3.23) points for the nonoperative, LP, and HA groups, respectively. At 2 years, the between-group differences were 1.07 points (95% CI [-9.5,11.7]; p = 0.97) between nonoperative and LP, 3.78 points (95% CI [-7.0,14.6]; p = 0.69) between nonoperative and HA, and 4.84 points (95% CI [-5.7,15.4]; p = 0.53) between LP and HA. No significant differences in primary or secondary outcomes were seen in stratified age groups (60 to 70 years and 71 years and over). At 2 years, we found 30 complications (3/52, 5.8% in nonoperative; 22/49, 45% in LP; and 5/49, 10% in HA group, p = 0.0004) and 16 severe pain-related adverse events. There was a revision rate of 22% in the LP group. The limitation of the trial was that the recruitment period was longer than expected due to a high number of exclusions after the assessment of eligibility and a larger exclusion rate than anticipated toward the end of the trial. Therefore, the trial was ended prematurely. CONCLUSIONS: In this study, no benefit was observed between operative treatment with LP or HA and nonoperative treatment in displaced 3- and 4-part PHFs in patients aged 60 years and older. Further, we observed a high rate of complications related to operative treatments. TRIAL REGISTRATION: ClinicalTrials.gov NCT01246167.
Objectives: To compare the current disease activity and remission rates, and their regional variation in patients with psoriatic arthritis (PsA) and rheumatoid arthritis (RA) in Finland. Methods: Data of patients’ most recent visit in 1/2020–9/2021 were extracted from the Finnish Rheumatology Quality Register. Measures for disease activity and remission included joint counts, DAS28, cDAPSA, CDAI, the Boolean definition, and physician assessment. Regression analyses were applied, adjusted for age and sex. Results: Data of 3598 patients with PsA (51% female, mean age 54 years) and 13,913 patients with RA (72% female, 74% ACPA-positive, mean age 62 years) were included. The median (IQR) DAS28 was 1.9 (1.4, 2.6) in PsA and 2.0 (1.6, 2.7) in RA (p = 0.94); for cDAPSA, the median (IQR) values were 7.7 (3.1, 14) in PsA and 7.7 (3.3, 14) in RA (p < 0.001). In all regions in both diseases, the median DAS28 was ≤ 2.6 and the median cDAPSA < 13. Remission rates included DAS28 < 2.6 in 73% in PsA and 69% in RA (p = 0.17) and Boolean remission in 17% in PsA and 15% in RA (p < 0.001). By other definitions of remission, the rates ranged between 30% and 46%. Methotrexate was currently used by 49% in PsA and 57% in RA (p < 0.001). Self-administered bDMARDs were currently used by 37% in PsA and 21% in RA (p < 0.001). Conclusion: The overall disease activity was low and similar in patients with PsA and RA across the country. Remission rates varied between 15 and 73%, depending on the definition but were similar in PsA and RA. Key Points • The disease activity and clinical picture was similar between patients with PsA and RA, in a cross-sectional setting in 1.2020–9.2021. • A significant majority of patients with PsA had low disease activity or were in remission according to cDAPSA. Majority of patients with RA were in remission according to DAS28. • Patients with PsA and RA used methotrexate similarly. The utilization of bDMARDs was more prevalent in patients with PsA.
Koneellinen annosjakelu on ollut apteekkien eniten käytetty palvelu viime vuosina. Sosiaali- ja Terveysministeriön mukaan koneellisen annosjakelun tavoitteena on edistää rationaalista lääkehoitoa sekä lisätä potilasturvallisuutta, jotta asiakkaat saisivat oikeat lääkkeet aina oikeaan aikaan. Yksi tapa mitata potilasturvallisuutta on tutkia lääkityspoikkeamia, joita Suomessa kirjataan HaiPro järjestelmään. HaiPro on raportointityökalu, jonne raportoidaan terveydenhuollon yksiköiden potilasturvallisuustapauksista. Tutkimuksessani selvitetään, millaisia lääkityspoikkeamia on raportoitu tutkimani kunnan kotihoidossa vuosina 2010-2022 ja onko koneellinen annosjakelu vaikuttanut lääkityspoikkeamien määrään verrattuna manuaalisesti jaettaviin lääkkeisiin. Tutkimukseni on rekisteritutkimus, jossa käytän tutkimani kunnan kotihoidon lääkitykseen liittyviä HaiPro-raportteja väliltä tammikuu 2010 ja syyskuu 2022. Lääkitykseen liittyviä HaiPro-raportteja tuona aikana oli yhteensä 1262. Suurin osa, noin 90% kotihoidossa tapahtuneista virheistä oli antovirheitä. Jakeluvirheitä oli 4% virheistä ja annosjakelusta johtuvia jakovirheitä vain 0.5%. Saamieni tulosten perusteella koneellisen annosjakelun voidaan katsoa mahdollisesti edistävän lääketurvallisuutta kotihoidossa. Kuitenkin, koska lääkitystuvallisuuteen vaikuttaa monia muitakin tekijöitä, pelkkä koneellisen annostelun käyttöönotto ei ratkaise kaikkia lääkehuoltoon liittyviä lääkityspoikkeamia.