Karin Mossberg, Martin Garwicz, Pontus Henriksson, Riitta Möller, Estelle Naumburg, Jeanette Wahlberg, Susanna M Wallerstedt
{"title":"[Preparing for patient work founded on evidence in medical school - a questionnaire study on final-year medical students].","authors":"Karin Mossberg, Martin Garwicz, Pontus Henriksson, Riitta Möller, Estelle Naumburg, Jeanette Wahlberg, Susanna M Wallerstedt","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Several of the requirements for obtaining a medical degree according to the Swedish Higher Education Ordinance illustrate the scientific basis of the profession, and systematic reviews as well as health technology assessments (HTA) constitute cornerstones in evidence-based medicine. In this study, medical students' experience of scientific education related to the profession was explored, and their knowledge achieved was sampled by five multiple-choice questions (MCQ). A total of 433 out of 641 students attending the final semester in six medical schools in Sweden participated (response rate: 68%). Most of them experienced that a majority of the scientifically related learning outcomes for the medical degree had been adequately examined. Regarding the steps of a systematic review, 60% stated that they had been trained to define a specific research question, 64% to find relevant literature according to such a specific research question, 72% to assess scientific articles according to a checklist, 40% to compile results from several studies, and 35% to assess the certainty of evidence according to GRADE. Only 6% stated that they had received education regarding HTA, a factor that was strongly associated with students' perception that they had obtained adequate skills regarding how patient work is based on scientific evidence (adjusted odds ratio [OR] 14.1; 95% CI 1.80-110). Such an association was also found for credit-awarded hands-on evidence-related learning activities during clinical courses (OR 2.72; 95% CI 1.02-7.24). The median student answered 3 of 5 MCQs correctly. The results of a case/control study, a forest plot, and the concept of cost-effectiveness were frequently interpreted erroneously. In conclusion, several aspects of the scientific basis for professional life as a medical doctor seem to be well covered in the medical degree program, whereas others deserve increased attention.</p>","PeriodicalId":17988,"journal":{"name":"Lakartidningen","volume":"122 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Erik Näslund, Ingmar Näslund, Johan Ottosson, Erik Stenberg
{"title":"[The Scandinavian Obesity Surgery Registry - register for quality and research].","authors":"Erik Näslund, Ingmar Näslund, Johan Ottosson, Erik Stenberg","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The Scandinavian Obesity Surgery Registry (Soreg) was initiated in 2007 in order to track the quality of bariatric surgery in Sweden during a period of rapid expansion. The main focus of Soreg is quality control and a base for research. All surgical units that perform bariatric surgery in Sweden report to Soreg, and to date about 93 000 patients are included in Soreg. The rate of laparoscopic access has increased and has been over 99 percent the last 10 years. The number of complications has continuously decreased, and bariatric surgery in Sweden has results in line with those published from international high-volume centers. About 160 peer-reviewed publications have used data from Soreg, many of them published in high impact journals. Two randomized controlled trials have used Soreg and 20 PhD theses have used data from Soreg. The focus of Soreg has shifted to long-term complications.</p>","PeriodicalId":17988,"journal":{"name":"Lakartidningen","volume":"122 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142984000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Konrad Nylund, Zainab Al-Hadrawi, Anna Björkenheim
{"title":"[Structured switching from warfarin to DOAC in patients with atrial fibrillation].","authors":"Konrad Nylund, Zainab Al-Hadrawi, Anna Björkenheim","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In patients with atrial fibrillation (AF) at risk of stroke, direct oral anticoagulants (DOAC) have been shown to be at least as effective as warfarin, offering advantages like reduced monitoring requirements and lower bleeding risks. Disadvantages include limited data in patients with severe chronic kidney disease and higher patient costs. In mid-2021, Region Örebro County, Sweden, decided to switch suitable patients with AF from warfarin to DOAC. Out of the 823 patients receiving warfarin therapy, 732 were identified as suitable candidates for DOAC, and 89 percent of these patients were successfully switched. Switching from warfarin to DOAC offers superiority and simplifies treatment and monitoring. However, individual needs and risk factors must be carefully considered before switching. As many patients in Sweden continue to be prescribed warfarin, this initiative could potentially model for other regions.</p>","PeriodicalId":17988,"journal":{"name":"Lakartidningen","volume":"121 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"[Recreational use of nitrous oxide may lead to acute complications].","authors":"Lee Ti Davidson","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The use of nitrous oxide (N2O) as a recreational drug has significantly increased around the world in the last decade and has become a common occurrence in Sweden. Nitrous oxide can be easily accessed, purchased from party stores and online, and is legal in Sweden. There is a common misconception that nitrous oxide is harmless because it is used in healthcare. However, chronic nitrous oxide abuse can lead to a functional state of B12 deficiency with neurological and thromboembolic complications. The present case illustrates that recreational use of nitrous oxide may also lead to acute complications, including seizures and rupture of the airways.</p>","PeriodicalId":17988,"journal":{"name":"Lakartidningen","volume":"121 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"[Retrograde cricopharyngeal dysfunction (inability to belch) - a »new« diagnosis that deserves attention].","authors":"Anders Lehmann","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The belching reflex involves transient lower oesophageal sphincter relaxation and relaxation of the cricopharyngeus (CP). In some individuals, the latter stage fails,leading to return of gas to the stomach. This pattern is then repeated, which is accompanied by chest pain and loud, gurgling noises. Abdominal distension, epigastric pain and excessive flatulence are other common symptoms. Since CP relaxation is normal during deglutition, the syndrome is called retrograde CP dysfunction (RCPD). The anamnesis should be supported by e.g. manometry under conditions stimulating belching to validate the diagnosis. First-line treatment is injection of botulinum toxin (botox) into the CP. The prevalence is unknown and although RCPD is rare, a large number of confirmed and self-diagnosed RCPD patients have emerged in social media after dissemination of the efficacy of botox. RCPD patients suffer considerably, and awareness of the disease must therefore increase in the medical community.</p>","PeriodicalId":17988,"journal":{"name":"Lakartidningen","volume":"121 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Emily Tegnell, Jonna Idh, Henrik Jörnvall, Jannicke Mellin-Olsen
{"title":"[The role of anaesthesia in global health].","authors":"Emily Tegnell, Jonna Idh, Henrik Jörnvall, Jannicke Mellin-Olsen","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The article explores the role of anaesthesia in global health and highlights key initiatives such as the Lancet Commission on Global Surgery and the National Surgical, obstetric and Anaesthesia Plans (NSOAP). Recognizing the global disparities in anaesthesia education, the article mentions the varying standards of training for anaesthesia providers worldwide as well as the problem of low status of providers. The article underscores a shift in focus from traditional aid models to capacity-building approaches, risks associated with indiscriminate donations of tools and technology to low and middle-income countries, as well as both positive and negative aspects of investing in education and training programs. Furthermore, the article calls for the anaesthesia community to continue to provide decision makers with evidence to support investment in anaesthesia services.</p>","PeriodicalId":17988,"journal":{"name":"Lakartidningen","volume":"121 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142729655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"[Task sharing - a solution for rich and poor?]","authors":"Lotta Velin, Jenny Löfgren","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The global shortage of surgical and anesthesiologic specialists is partly overbridged by task sharing to unspecialized physicians (often called \"medical officers\" and non-physician staff (often called »associate clinicians\"). Task sharing is defined as the delegation of specific tasks from those who traditionally carry them out, to someone with shorter training. There is ample evidence for good patient outcomes after surgeries carried out through task sharing to associate clinicians, especially for hernia repairs, acute laparotomies, orthopaedic surgeries, and caesarean sections. There is limited research on the role of medical officers, and further research is also needed to assess which procedures are appropriate for task sharing. In Sweden, task sharing is also widespread, but not as far-reaching as in many low-income countries. This article provides an overview of task sharing globally and suggests that there may be lessons to learn for high-income countries like Sweden.</p>","PeriodicalId":17988,"journal":{"name":"Lakartidningen","volume":"121 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142729654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"[Unequal access to safe cesarean section - threat to global maternal health care].","authors":"Mehreen Zaigham, Helena Litorp","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Despite evidence that cesarean section rates above 10 percent at the population level do not reduce maternal or neonatal mortality, global rates continue to rise and are projected to reach 30 percent by 2030. The factors behind this increase are complex and vary across contexts, emphasizing the need for a local understanding in order to design and implement effective interventions to curb overuse. In contrast to many other high-income countries, Nordic countries exemplify how robust obstetric practices, midwifery led care and evidence-based guidelines can achieve excellent outcomes while maintaining low cesarean section rates. This success underscores the potential for healthcare systems worldwide to optimize cesarean use without compromising maternal and neonatal health.</p>","PeriodicalId":17988,"journal":{"name":"Lakartidningen","volume":"121 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142729590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"[Wise priorities and Essential Emergency and Critical Care (EECC) can save many lives].","authors":"Carl Otto Schell, Anna Hvarfner, Märit Halmin","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>An increased focus on essential care could avert more preventable deaths among critically ill patients in the world than the current focus on advanced technologies. Intensive care is expensive and high-risk in absence of training and safety standards. Identification and basic care of failing vital organs across hospitals are the fundaments of all critical care. EECC comprises 40 such life-saving clinical processes that are affordable and practical enough to be applied in any hospital ward worldwide. Ensuring EECC is provided to all critically ill patients across hospitals has the potential to save many lives.</p>","PeriodicalId":17988,"journal":{"name":"Lakartidningen","volume":"121 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142729616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}