Lakartidningen最新文献

{"title":"[The current state of patient safety in pediatric patient safety].","authors":"Kiku Pukk Härenstam Pukk Härenstam, Per Nydert, Linda Kyrk Fabo, Karl Hybinette","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Iatrogenic harm continues to affect considerable numbers of patients in in- and outpatient care settings. Although iatrogenic harm is common in all age groups, children are at greater risk of being harmed by adverse events in health care due to physiological, anatomical, cognitive, and social factors during development. Pediatric patient safety practices are evolving and there has been progress, but injuries due to medical care continue to have substantial negative effects. To be effective, interventions need to be tailored to the pediatric context, and meet the challenges in the pediatric healthcare setting.</p>","PeriodicalId":17988,"journal":{"name":"Lakartidningen","volume":"121 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546197","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":"Fler fall av streptokocktonsillit ska behandlas med antibiotika.","authors":"Anders Ternhag, Magnus Gisslén","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":17988,"journal":{"name":"Lakartidningen","volume":"121 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546248","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":"[New guidelines covering the whole spectrum of the acute coronary syndrome].","authors":"Ellinor Bergdahl, Kasper Andersen, Sara Bentzel, Robin Hofmann, Elin Falås, Anna Holm","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>To better align with the clinical setting, the European Society of Cardiology has published new guidelines covering the whole spectrum of the acute coronary syndrome, including ST-elevation myocardial infarction, non-ST-elevation myocardial infarction and unstable angina.</p>","PeriodicalId":17988,"journal":{"name":"Lakartidningen","volume":"121 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469011","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":"[Summary »The unsuccessful doctors« or »the real doctors«? - what students hear about GPs].","authors":"Malin K Hedman, Mante Hedman, Anette Edin-Liljegren","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>A school's culture has been shown to influence medical students in their choice of future discipline. Therefore, we aimed to explore the culture towards the general practice discipline, as reflected in comments to medical students from their teachers and clinical tutors. Students in their 6th and 11th terms at the Universities of Umeå and Uppsala participated in a questionnaire study. A qualitative analysis of free-text answers of comments was conducted with thematic analysis. The students reported receiving both appreciative and deprecatory comments about general practice and GPs, which altogether ended up in two head themes: work-related factors and opinions about GPs. Appreciative comments included »important«, »varying«, »responsible work«, »broad skills«, and »good working hours«. Deprecatory comments included »stressful jobs«, »unstimulating routine work«, »incompetent doctors«, and »low status«. Considering the present shortfall of GPs, such deprecatory comments are worrying and could hamper the future recruitment of GPs.</p>","PeriodicalId":17988,"journal":{"name":"Lakartidningen","volume":"121 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469013","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":"[Acquired hemophilia - quick diagnosis and treatment can significantly reduce the risk of mortality].","authors":"Jolene Johansson, Mårten Söderberg","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This case report of a 73-year-old male with bleedings provides insights into the clinical characteristics, diagnosis och treatment of acquired hemophilia A. It's a dangerous non-hereditary bleeding disorder caused by autoantibodies against coagulation factor VIII, often linked with other autoimmune diseases or malignancies, but it is also often idiopathic. The diagnosis remains a challenge due to its rarity and non-specific symtoms, but should be considered in unexplained bleeding cases with prolonged activated partial thromboplastin time (APTT). Quick  diagnosis and treatment can significantly reduce the risk of serious complications and mortality. The long-term prognosis usually depends on the presence of any underlying disease.</p>","PeriodicalId":17988,"journal":{"name":"Lakartidningen","volume":"121 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469009","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":"[Hyperferritinemia - investigation, diagnosis and treatment].","authors":"Nikolaos Melas, Per Stål","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Ferritin is one of the most requested blood tests in both primary and inpatient care, and high values occur frequently. One of the greatest challenges in the investigation of hyperferritinemia is to determine if there is a presence of iron overload. Patient history (chronic liver disease, excessive alcohol consumption, hereditary factors), clinical features (metabolic syndrome, acute or chronic inflammation, infection, malignancy) and biochemical tests (ferritin, transferrin saturation, hemoglobin, liver enzymes, CRP/SR, phosphatidyl ethanol, lipid profile, glucose) facilitate the determination of the cause of hyperferritinemia. High transferrin saturation indicates iron overload, which is usually linked to hereditary hemochromatosis. In the case of homozygosity of the HFE mutation p.C282Y in the presence of hyperferritinemia, venesection can be started without further investigations, while in the absence of HFE mutations a possible iron excess must be validated with magnetic resonance imaging (MRI) for iron determination before venesection is started. Dysmetabolic iron overload syndrome (DIOS) or alcohol-related hemosiderosis can be treated with venesection in selected cases if there is a significant deposition of iron in the liver on MRI. An individual with ferritin below 1000 µg/L, a normal transferrin saturation, and normal liver tests does not need further investigations and can be followed in primary care. We propose an algorithm for the investigation of hyperferritinemia that facilitates the investigation both in primary and inpatient care.</p>","PeriodicalId":17988,"journal":{"name":"Lakartidningen","volume":"121 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469010","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":"[Online quizzes for practice and assessment of pharmacotherapeutic knowledge during clinical courses in medical school - a pilot study in the psychiatry and neurology courses].","authors":"Susanna M Wallerstedt, Katarina Jood, Silke Kern, Catrin Rönnbäck, Steinn Steingrimsson, Elisabet Wentz, Johan Zelano, Filip Bergquist","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In this study, we developed auto-graded quizzes for practice and for summative assessment, covering drugs of relevance in the undergraduate clinical psychiatry and neurology courses in medical school. The underlying intention was to combine repetition of theoretical aspects and promoting progression to the clinical context. The quizzes were implemented in two steps. After the courses in question were completed, before and after the first as well as the second step of quiz implementation, the students' achieved level of knowledge was investigated by a voluntary formative test/questionnaire including 20 patient-based single best answer questions. In the first step, voluntary practice quizzes and a summative assessment test were introduced. In the second step, a clinical context was provided to the quizzes, using the structure of the practical manual to good prescribing issued by the World Health Organization in 1994. Furthermore, the summative test was expanded for improved constructive alignment, exposing the students to the drug-related course content to a greater extent. In all, 274 students out of 404 participated in the study (response rate: 68%; 56% women; 66% ≤24 years). Compared with before the quiz implementation (median number of correct answers: 10 [interquartile range: 9-13]), no difference was seen after the first step (11 [8-13]; P=0.88) but a clear improvement appeared after the second step (14 [12-16]; P<0.0001). After the second step, the students reported having used all (17%), most (22%), some (32%), or no (29%) practice quizzes. The extent of use was positively correlated with the number of correct answers in the formative test (r=0.33; P=0.002). After the second step, the student-reported number of attempts at the assessment quiz was in median 6 times (interquartile range: 3-9). There was a negative correlation between the number of quiz attempts and the extent of use of practice quizzes (r=-0.22; P=0.034) as well as the number of correct answers in the formative test (r=-0.44; P<0.0001). In conclusion, practice and assessment quizzes about drugs, elaborated with clinical context and constructive alignment, may increase pharmacotherapeutic knowledge in medical students.</p>","PeriodicalId":17988,"journal":{"name":"Lakartidningen","volume":"121 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469012","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":"[The diabetic hand - a forgotten complication].","authors":"Mattias Rydberg, Malin Zimmerman, Peter M Nilsson, Anders Gottsäter, Lars B Dahlin","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The term »the diabetic hand« traditionally denotes complications affecting the hand in individuals with diabetes mellitus, such as restricted finger movement, numbness, and pain. Trigger finger, Dupuytren's disease, carpal tunnel syndrome, ulnar nerve entrapment, and osteoarthritis of the first carpometacarpal joint are all conditions that are more prevalent among individuals with both type 1 and type 2 diabetes. This overview aims to shed light on a somewhat neglected area in diabetes complications, i.e. the diabetic hand, to increase the knowledge among physicians and surgeons as well as nurses, physiotherapists, and occupational therapists treating patients with diabetes.</p>","PeriodicalId":17988,"journal":{"name":"Lakartidningen","volume":"121 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142372227","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":"[Recommendations regarding arthroscopic surgery in the knee joint and the updated National Guidelines for Musculoskeletal Diseases].","authors":"Anastasia Simi, Nils Hailer, Magnus Eneroth, Ingemar Petersson, Maziar Mohaddes","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The article discusses the Swedish National Board of Health and Welfare's recommendations regarding arthroscopic surgery in the knee joint and the updated National Guidelines for Musculoskeletal Diseases from 2021. It emphasizes the ongoing discussion within the orthopedic profession and aims to summarize constructive discussions between the National Board of Health and Welfare, the Swedish Orthopedic Association, and the National program board for Musculoskeletal Diseases. The text notes a significant decrease in knee arthroscopies due to knee osteoarthritis and degenerative meniscus injuries over the past decade although 5,000 and 6,000 arthroscopies were performed in 2022 due to knee osteoarthritis or degenerative meniscus rupture. The reasons for the continued performance of the procedure are discussed, including the lack of a precise definition of »degenerative meniscus rupture« and interpretation differences within the profession. A recent report from the National Board of Health and Welfare indicates that the profession has largely embraced the recommendations from 2012, but there are significant regional differences in the number of performed arthroscopies. The text emphasizes the need for clearer recommendations, refined data collection, and constructive dialogue to improve the implementation of the National Board of Health and Welfare's recommendations and reduce the use of procedures classified as »not recommended.« The authors believe that continuous dialogue and follow-up are necessary to decrease the use of procedures not recommended in the guidelines.</p>","PeriodicalId":17988,"journal":{"name":"Lakartidningen","volume":"121 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361736","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":"[Antibiotic antimicrobial stewardship rounds is an effective tool in geriatric clinics].","authors":"Emilia Titelman, Annika Hahlin","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The antibiotic stewardship round (ASR) is a way to use the knowledge of the infectious disease (ID) specialist to audit and assess the treatment with antibiotics and promote rational use. We implemented ASRs twice a week in two geriatric hospitals and weekly in advanced home care facilities during 9 weeks. All patients treated with antibiotics were discussed and advice regarding the antibiotic treatment was given. In 25 percent of the cases the ID specialist found that the ASR made a difference to the treatment plan, and in 10,8 percent of cases the antibiotic treatment could be discontinued. Other common advice was to switch from intravenous to oral administration and shorten the number of treatment days. Thus, ASRs were found to be an intervention associated with lower and more rational antibiotic use and should be considered an important tool for antimicrobial stewardship in geriatric hospitals.</p>","PeriodicalId":17988,"journal":{"name":"Lakartidningen","volume":"121 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142361733","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}