The quality of internal medicine hospital care during summer holiday season

Rationale, aims and objectives The July/August Phenomenon is a period when the quality of care in hospitals is thought to decrease due to summer vacation stand-ins and new staff. The results of studies on the veracity of this claim have been conflicting. This study investigates the situation in internal medicine. Methods Registry data of patients treated in internal medicine wards between 1 July 2000 and 30 November 2009 were obtained and analysed. Results There were no differences in mortality during the July admissions compared with those in November when adjusting for age, diagnosis, gender and year [for the overall data risk ratio (RR) = 1.10, 95% confidence interval (CI) 1.00–1.23, P = 0.06; for the university hospitals RR = 1.10, 95% CI 0.91–1.33, P = 0.34; for the non-university hospitals RR = 1.10, 95% CI 0.97–1.26, P = 0.13]. The duration of admission (overall mean 4.5, standard deviation 6.0) was equal between July and November when adjusted for age, diagnosis, gender and year in all groups (overall data: RR = 1.00, 95% CI 0.99–1.02, P = 0.83; university hospitals RR = 1.02, 95% CI 0.99–1.04, P = 0.13; non-university hospitals RR = 1.00, 95% CI 0.98–1.01, P = 0.67). Conclusions The quality of care in Finnish internal medicine wards in July seems to equal November. Our results do not support the existence of a July Phenomenon in Finland.</p

Trends in the surgical management of vesicoureteral reflux in Finland in 2004-2014

Objectives: Previous data on the trends of surgical treatment of vesicoureteral reflux outside USA are scarce. The aim of this study was to clarify the national trends of operative treatment of vesicoureteral reflux (VUR) in Finland. Methods: We analyzed national data from Finnish Care Register for Health Care on children ( Results: Endoscopic injections of the ureteral orifices were primarily performed for 1212 and open ureteral reimplantation for 272 children. The use of both types of surgery decreased during the study period (p = 0.0043 and p <0.001, respectively). The median age at surgery for VUR was lower in those treated with open ureteral reimplantation than those with endoscopic injections of the ureteral orifices [3 and 4 years, respectively] (p = 0.0001). The length of hospital stay was significantly longer (median 9.9 days) with open ureteral reimplantation compared to that (median 1.3 days) with endoscopic injections (p <0.0001) and did not change during the study period. Reoperations were significantly more common in patients who were primarily treated with endoscopic injections (n = 146/1072, 14%) than with ureteral reimplantation (n = 7/230, 3%) (p <0.0001). Conclusions: While the best treatment options for VUR remain debatable, operative treatment of VUR has become less common in Finland.Peer reviewe

Comparison of mid-age-onset and late-onset Huntington's disease in Finnish patients

The phenotype of juvenile Huntington's disease (HD) differs clearly from that of adult-onset HD, but information about differences between mid-age-onset HD and late-onset HD (LOHD) is scarce. A national cohort of 206 patients with adult-onset HD was identified using national registries and patient records. LOHD was defined as age >= 60 years at HD diagnosis. Genetic disease burden was assessed using CAG age product (CAP) score. LOHD comprised 25% of the adult-onset HD cohort giving a point prevalence of 2.38/100,000 in the Finnish population at least 60 years of age. The proportion of LOHD out of new HD diagnoses increased from 21% in 1991-2000 to 33% in 2001-2010. At the time of diagnosis, patients with LOHD had 10.4 units (95% CI 4.8-15.9; p = 0.0003) higher CAP scores, more severe motor impairment and slightly more severe functional impairment than that in patients with mid-age-onset HD. There was no difference in the rate of disease progression or survival between LOHD and mid-age-onset patients. The lifespans of deceased patients were shorter in mid-age-onset HD (p < 0.001) and LOHD (p = 0.002) than their life expectancies. Causes of death differed between the two patient groups (p = 0.025). LOHD comprises a quarter of Finnish HD patients and the proportion appears to be increasing. Our results did not reveal differences in the phenotype between mid-age-onset HD and LOHD, but prospective studies are needed

Seasonality of stroke in Finland

INTRODUCTION: The burden of stroke is increasing globally. Reports on seasonal variations in stroke occurrence are conflicting and long-term data are absent.METHODS: A retrospective cohort study using discharge registry data of all acute stroke admissions in Finland during 2004-2014 for patients ≥18 years age. A total of 97,018 admissions for ischemic stroke (IS) were included, 18,252 admissions for intracerebral hemorrhage (ICH) and 11,271 admissions for subarachnoid hemorrhage (SAH).RESULTS: The rate of IS admissions increased (p = 0.025) while SAH admission rate decreased (p < 0.0001), and ICH admission rate remained stable during the study period. The lowest seasonal admission rates were detected in summer and the highest in autumn for all stroke subtypes. Seasonal variation of IS was more pronounced in men (p = 0.020), while no sex difference was detected in ICH or SAH. The seasonal patterns of in-hospital mortality and length of stay (LOS) differed markedly by stroke subtype. Diagnoses of hypertension, atrial fibrillation, or diabetes showed no seasonality.CONCLUSIONS: All major stroke subtypes occurred most commonly in autumn and most infrequently in summer. Seasonality of in-hospital mortality and length of hospital stay appears to vary by stroke subtype. The seasonal pattern of ischemic stroke occurrence appears to have changed during the past decades. Key messages All major stroke subtypes (ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage) occurred most frequently in autumn and least frequently in summer. Seasonal patterns of in-hospital mortality and length of stay differed markedly by stroke subtype. The seasonal pattern of ischemic stroke occurrence in Finland seems to have changed compared to 1982-1992.</div

Characterization of real-world treatment practices and outcomes among patients with chronic lymphocytic leukemia treated in a Finnish tertiary center

ObjectivesWe conducted this retrospective study to characterize the change in chronic lymphocytic leukemia (CLL) treatment patterns between 2005 and 2019, to understand the treatment sequencing across the course of the disease, and to investigate how targeted agents and prognostic testing were implemented into the patient care.MethodsThis study included adult patients with CLL treated at the Hospital District of Southwest Finland during the study period. Data were collected from the Turku University Hospital data lake.ResultsIn total, 122 and 60 patients received first- and second-line treatments for CLL, respectively. The shift from conventional chemoimmunotherapy to targeted treatments in recent years (2014–2019) was observed. The median overall survival times were not reached in patients treated with targeted agents compared to conventional standard treatments in first- and second-line settings and improved toward the end of the study period. Prognostic testing increased during the study follow-up and patients with unmutated immunoglobulin heavy-chain variable showed significantly poorer overall survival and time-to-next-treatment outcomes than patients with mutated immunoglobulin heavy-chain variable.ConclusionsThis real-world study implicated added value of targeted chemo-free therapies as reported in randomized clinical trials, and highlighted the necessity of prognostic testing in order to improve treatment selection and patient outcomes.</p

Operative versus conservative treatment of small, nontraumatic supraspinatus tears in patients older than 55 years: over 5-year follow-up of a randomized controlled trial

BackgroundNontraumatic rotator cuff tear is a common shoulder problem that can be treated either conservatively or operatively. In the previous publications of the 1- and 2-year results of this trial, we found no significant between-group clinical differences. The aim of this study was to investigate the differences in mid-term clinical and radiologic outcomes in patients older than 55 years.Materials and methodsOne hundred eighty shoulders with symptomatic, nontraumatic supraspinatus tears were randomly assigned to 1 of the 3 cumulatively designed treatment groups: physiotherapy (group 1); acromioplasty and physiotherapy (group 2); and rotator cuff repair, acromioplasty, and physiotherapy (group 3). The change in the Constant score was the primary outcome measure. The secondary outcome measures were the change in the visual analog scale score for pain and patient satisfaction. Radiologic analysis included evaluation of glenohumeral osteoarthritis (OA) and rotator cuff tear arthropathy (CTA).ResultsA total of 150 shoulders (mean age, 71 years) were available for analysis after a mean follow-up period of 6.2 years. The mean sagittal tear size of the supraspinatus tendon tear at baseline was 10 mm in all groups (P = .33). During follow-up, 8 shoulders in group 1 and 2 shoulders in group 2 crossed over to rotator cuff repair. The mean baseline Constant score was 57.1, 58.2, and 58.7 in groups 1, 2, and 3, respectively (P = .85). There were no significant differences (P = .84) in the mean change in the Constant score: 18.5 in group 1, 17.9 in group 2, and 20.0 in group 3. There were no statistically significant differences in the change in the visual analog scale pain score (P = .74) and patient satisfaction (P = .83). At follow-up, there were no statistically significant differences in the mean progression of glenohumeral OA (P = .538) or CTA (P = .485) among the groups. However, the mean progression of glenohumeral OA from baseline to follow-up was statistically significant in the trial population (P = .0045).ConclusionsOn the basis of this study, operative treatment is no better than conservative treatment regarding small, nontraumatic, single-tendon supraspinatus tears in patients older than 55 years. Operative treatment does not protect against degeneration of the glenohumeral joint or CTA. Conservative treatment is a reasonable option for the primary initial treatment of these tears.Level of evidenceLevel IIRandomized Controlled TrialTreatment StudyKeywordsRotator cuff tearconservative treatmentrotator cuff repairConstant scoreVAS pain scorepatient satisfactionradiographic analysisrandomized controlled trial </div

Trends in the surgical management of vesicoureteral reflux in Finland in 2004-2014

Objectives: Previous data on the trends of surgical treatment of vesicoureteral reflux outside USA arescarce. The aim of this study was to clarify the national trends of operative treatment of vesicoureteralreflux (VUR) in Finland.Methods: We analyzed national data from Finnish Care Register for Health Care on children (of age) surgically treated for VUR in 2004–2014.Results: Endoscopic injections of the ureteral orifices were primarily performed for 1212 and openureteral reimplantation for 272 children. The use of both types of surgery decreased during the studyperiod (p=0.0043 and ptreated with open ureteral reimplantation than those with endoscopic injections of the ureteral orifices[3 and 4 years, respectively] (p=0.0001). The length of hospital stay was significantly longer (median9.9 days) with open ureteral reimplantation compared to that (median 1.3 days) with endoscopic injections(pcommon in patients who were primarily treated with endoscopic injections (n=146/1072, 14%) thanwith ureteral reimplantation (n=7/230, 3%) (pConclusions: While the best treatment options for VUR remain debatable, operative treatment of VURhas become less common in Finland.</p

Esidiabetes lisää valtimotautien riskiä – entä hoidon kustannuksia?

Lähtökohdat Esidiabetekseen liittyy suurentunut riski sairastua tyypin 2 diabetekseen sekä sydän- ja ­verisuonitauteihin. Diabeteksen ja sen lisäsairauksien hoitoon liittyy suuria kustannuksia. Menetelmät Esidiabeetikot tunnistettiin terveyskeskuksen potilasrekisteristä poikkeavien ­verensokeriarvojen perusteella. Heidän hoitoaan, lisäsairauksien määrää ja hoidon kustannuksia verrattiin saman alueen tyypin 2 diabeetikoiden ja vertailuryhmän potilaiden hoitoon ja kustannuksiin. Tulokset Esidiabeteksen esiintyvyys oli kaikissa ikäryhmissä lähes kaksinkertainen verrattuna ­tyypin 2 ­diabeteksen esiintyvyyteen. Lisäsairauksien esiintyvyys ja potilaskohtaiset kustannukset olivat e­sidiabeetikoilla suuremmat kuin vertailuryhmän potilailla, mutta pienemmät kuin tyypin 2 diabeetikoilla ­lähes kaikissa ­diagnoosiryhmissä. Päätelmät Esidiabetes ja lisäsairaudet lisäävät hoidon kustannuksia verrattuna potilaisiin, joilla on normaali sokeriaineenvaihdunta. Koska potilasmäärä on suurempi, kokonaiskustannukset ovat jopa suuremmat kuin tyypin 2 diabeetikoilla ja ne painottuvat enemmän erikoissairaanhoitoon. Hoito ja seuranta ei ole yhtä intensiivistä kuin diabeetikoilla.</p

Intracapsular tonsillectomy in the treatment of recurrent and chronic tonsillitis in adults : a protocol of a prospective, single-blinded, randomised study with a 5-year follow-up (the FINITE trial)

Introduction The standard surgical treatment for recurrent or chronic tonsillitis is extracapsular tonsillectomy. Recent studies show that intracapsular tonsillectomy has the potential to reduce the postoperative morbidity of patients undergoing tonsil surgery. The Finnish Intracapsular Tonsillectomy (FINITE) trial aims to provide level I evidence to support the hypothesis that the recovery time from tonsil surgery can be reduced with intracapsular tonsillectomy. Additionally, from this trial, major benefits in quality of life, reduction of postoperative complications, treatment costs and throat symptoms might be gained. Methods and analysis The FINITE trial is a prospective, randomised, controlled, patient-blinded, three-arm clinical trial. It is designed to compare three different surgical methods being extracapsular monopolar tonsillectomy versus intracapsular microdebrider tonsillectomy versus intracapsular coblation tonsillectomy in the treatment of adult patients (16-65 years) suffering from recurrent or chronic tonsillitis. The study started in September 2019, and patients will be enrolled until a maximum of 200 patients are randomised. Currently, we are in the middle of the study with 125 patients enrolled as of 28 February 2022 and data collection is scheduled to be completed totally by December 2027. The primary endpoint of the study will be the recovery time from surgery. Secondary endpoints will be the postoperative pain scores and the use of analgesics during the first 3 weeks of recovery, postoperative haemorrhage, quality of life, tonsillar remnants, need for revision surgery, throat symptoms, treatment costs and sick leave. A follow-up by a questionnaire at 1-21 days and at 1, 6, 24 and 60 months will be conducted with a follow-up visit at the 6-month time point. Ethics and dissemination Ethical approval was obtained from the Medical Ethics Committee of the Hospital District of Southwest Finland (reference number 29/1801/2019). Results will be made publicly available in peer-reviewed scientific journals.Peer reviewe

Arthroscopic Bankart versus open Latarjet as a primary operative treatment for traumatic anteroinferior instability in young males : a randomised controlled trial with 2-year follow-up

Objectives To compare the success rates of arthroscopic Bankart and open Latarjet procedure in the treatment of traumatic shoulder instability in young males. Design Multicentre randomised controlled trial. Setting Orthopaedic departments in eight public hospitals in Finland. Participants 122 young males, mean age 21 years (range 16-25 years) with traumatic shoulder anteroinferior instability were randomised. Interventions Arthroscopic Bankart (group B) or open Latarjet (group L) procedure. Main outcome measures The primary outcome measure was the reported recurrence of instability, that is, dislocation at 2-year follow-up. The secondary outcome measures included clinical apprehension, sports activity level, the Western Ontario Shoulder Instability Index, the pain Visual Analogue Scale, the Oxford Shoulder Instability Score, the Constant Score and the Subjective Shoulder Value scores and the progression of osteoarthritic changes in plain films and MRI. Results 91 patients were available for analyses at 2-year follow-up (drop-out rate 25%). There were 10 (21%) patients with redislocations in group B and 1 (2%) in group L, p=0.006. One (9%) patient in group B and five (56%) patients in group L returned to their previous top level of competitive sports (p=0.004) at follow-up. There was no statistically significant between group differences in any of the other secondary outcome measures. Conclusions Arthroscopic Bankart operation carries a significant risk for short-term postoperative redislocations compared with open Latarjet operation, in the treatment of traumatic anteroinferior instability in young males. Patients should be counselled accordingly before deciding the surgical treatment.Peer reviewe