Distal radius fractures in children aged 5-12 years: a Swedish nationwide register-based study of 25 777 patients.

BACKGROUND: Distal radius fracture (DRF) is the most common type of fracture in children. There is no clear consensus on primary treatment for complete DRFs. Kirschner wire (K-wire) fixation has been recommended, to avoid the risk of redislocation. However, recent studies have indicated that casting can be sufficient, at least for children with two or more years left to grow. There is no recent study regarding pediatric DRFs and the extent of K-wire fixations in the Swedish population. The purpose of this study was to investigate epidemiology and treatment of pediatric DRFs registered in the Swedish Fracture Register (SFR). METHODS: In this retrospective study, based on data from SFR for children aged 5-12 years with DRF between January 2015 and October 2022, we investigated epidemiology and choice of treatment. Sex, age, type of DRF, treatment, cause and mechanism of injury, were analyzed. RESULTS: In total, 25,777 patients were included, 7,173 (27%) with complete fractures. Number and peak age of girls vs. boys with fractures were 11,742 (46%), 10 years, and 14,035 (54%), 12 years, respectively. Odds ratio (OR) for a K-wire fixation in girls vs. boys was 0.81 (95% confidence interval (CI) 0.74-0.89, p < .001). With age 5 -7 years as reference, OR for age group 8-10 years was 0.88 (95% CI 0.80-0.98 p = .019) and OR for age group 11-12 years was 0.81 (95% CI 0.73-0.91 p = < .001. CONCLUSION: Casting only was the preferred treatment for all fractures (76%). Boys acquired DRFs more often than girls, with a peak age of 12 years. Younger children and boys with a complete fracture were more likely than older children and girls to receive a K-wire. Further research regarding indications for K-wiring of DRFs in the pediatric population is needed.

A multi-intervention approach on drug therapy can lead to a more appropriate drug use in the elderly. LIMM-Landskrona Integrated Medicines Management.

RATIONALE, AIMS AND OBJECTIVES: To evaluate if an integrated medicines management can lead to a more appropriate drug use in elderly inpatients. METHOD: The study was an intervention study at a department of internal medicine in southern Sweden. During the intervention period pharmacists took part in the daily work at the wards. Systematic interventions aiming to identify, solve and prevent drug-related problems (DRPs) were performed during the patient's hospital stay by multidisciplinary teams consisting of physicians, nurses and pharmacists. DRPs identified by the pharmacist were put forward to the care team and discussed. Medication Appropriateness Index (MAI) was used to evaluate the appropriateness in the patients' drug treatment at admission, discharge and 2 weeks after discharge. In total 43 patients were included, 28 patients in the intervention group and 25 patients in the group which was used as control. RESULTS: For the intervention group there was a significant decrease in the number of inappropriate drugs compared with the control group (P = 0.049). Indication, duration and expenses were the MAI-dimensions with most inappropriate ratings, and the drugs with most inappropriate ratings were anxiolytics, hypnotics and sedatives. CONCLUSION: This kind of systematic approach on drug therapy can result in a more appropriate drug use in the elderly.

Improved quality in the hospital discharge summary reduces medication errors--LIMM: Landskrona Integrated Medicines Management.

PURPOSE: We have developed a model for integrated medicines management, including tools and activities for medication reconciliation and medication review. In this study, we focus on improving the quality of the discharge summary including the medication report to reduce medication errors in the transition from hospital to primary and community care. METHODS: This study is a longitudinal study with an intervention group and a control group. The intervention group comprised 52 patients, who were included from 1 March 2006 until 31 December 2006, with a break during summer. Inclusion in the control group was performed in the same wards during the period 1 September 2005 until 20 December 2005, and 63 patients were included in the control group. In order to improve the quality of the medication report, clinical pharmacists reviewed and gave feedback to the physician on the discharge summary before patient discharge, using a structured checklist. Medication errors were then identified by comparing the medication list in the discharge summary with the first medication list used in the community health care after the patient had returned home. RESULTS: By improving the quality of the discharge summary, patients had on average 45% fewer medication errors per patient (P = 0.012). The proportion of patients without medication errors was 63.5% in the control group and 73.1% in the intervention group. However, this increase was not significant (P = 0.319). Patients who used a specific medication dispensing system (ApoDos) had a 5.9-fold higher risk of suffering from medication errors than those without this medication dispensing system (P < 0.001). CONCLUSION: Review and feedback on errors in the discharge summary, including the medication report and a correct medication list, reduced medication errors during the transfer of information from hospital to primary and community care.

Heart failure exacerbation leading to hospital admission: a cross-sectional study.

OBJECTIVES: The aim of this pilot study was to investigate cause(s) of heart failure (HF). SETTING: The emergency department and medical wards at Malmö University Hospital. METHOD: A cross sectional pilot study. MAIN OUTCOME MEASURES: Comparison of compliance, comprehension and optimal treatment on a population basis between men and women, younger (< or =75 years) and elderly (>75 years) patients, and patients in different New York Heart Association (NYHA) classes, in order to assess if exacerbation could have been caused by any of these factors. RESULTS: Of the 47 patients included, 60% reported high compliance, with significant differences between women and men, and between patients in NYHA class IV and patients in NYHA class III. Comprehension on self-care was poor. Only 30% weighed themselves regularly and 45% did not limit the amount of fluids. No more than 28% reported they would contact a health professional in the case of experiencing more symptoms. Suboptimal treatment was also found to be a great concern. The majority were treated with recommended agents, but had not achieved target dose as recommended in the guidelines. CONCLUSION: This pilot study indicates suboptimal HF management of patients with HF prior to hospital admission due to HF exacerbation. A larger study is needed to assess the extent of the problem, and establish the need and nature of management improvement in different patient subgroups.

Medication report reduces number of medication errors when elderly patients are discharged from hospital.

OBJECTIVE: To investigate whether a Medication Report can reduce the number of medication errors when elderly patients are discharged from hospital. METHOD: We conducted a prospective intervention with retrospective controls on patients at three departments at Lund University Hospital, Sweden that where transferred to primary care. The intervention group, where patients received a Medication Report at discharge, was compared with a control group with patients of the same age, who were not given a Medication Report when discharged from the same ward one year earlier. MAIN OUTCOME MEASURES: The main outcome measure was the number of medication errors when elderly patients were discharged from hospital. RESULTS: Among 248 patients in the intervention group 79 (32%) had at least one medication error as compared with 118 (66%) among the 179 patients in the control group. In the intervention group 15% of the patients had errors that were considered to have moderate or high risk of clinical consequences compared with 32% in the control group. The differences were statistically significant (P<0.001). CONCLUSION: Medication errors are common when elderly patients are discharged from hospital. The Medication Report is a simple tool that reduces the number of medication errors.

Medication errors when transferring elderly patients between primary health care and hospital care.

OBJECTIVE: The aims were to evaluate the frequency and nature of errors in medication when patients are transferred between primary and secondary care. METHOD: Elderly primary health care patients (> 65 years) living in nursing homes or in their own homes with care provided by the community nursing system, had been admitted to one of two hospitals in southern Sweden, one university hospital and one local hospital. A total of 69 patient-transfers were included. Of these, 34 patients were admitted to hospital whereas 35 were discharged from hospital. MAIN OUTCOME MEASURE: Percentage medication errors of all medications i.e. any error in the process of prescribing, dispensing, or administering a drug, and whether these had adverse consequences or not. RESULTS: There were 142 medication errors out of 758 transfers of medications. The patients in this study used on an average more than 10 drugs before, during and after hospital stay. On an average, there were two medication errors each time a patient was transferred between primary and secondary care. When patients were discharged from the hospital, the usage of a specific medication dispensing system constituted a significant risk for medication errors. The most common error when patients were transferred to the hospital was inadvertent withdrawal of drugs. When patients left the hospital the most common error was that drugs were erroneously added. CONCLUSION: Medication errors are common when elderly patients are transferred between primary and secondary care. Improvement in documentation and transferring data about elderly patients' medications could reduce these errors. The specific medication dispensing system that has been used in order to increase safety in medication dispensing does not seem to be a good instrument to reduce the number of errors in transferring data about medication.