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[Priority setting in intensive care from an ethical perspective]. [从伦理角度确定重症监护的优先次序]。
Lakartidningen Pub Date : 2024-09-18
Niklas Juth, Eva Hannerz Schmidtke
{"title":"[Priority setting in intensive care from an ethical perspective].","authors":"Niklas Juth, Eva Hannerz Schmidtke","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Priority setting at intensive care units is legally regulated in accordance with the so-called ethical platform, which states that all priorities must be based on three lexically ranked principles: the principle of human dignity (a ban on discrimination, e.g. based on social standing), the principle of needs and solidarity, and the principle of cost-effectiveness. Prioritization for intensive care is particularly difficult as it requires comparisons between widely different patient categories, occurs in acute situations and is fraught with great uncertainty about the prognosis. Sometimes the degree of severity is maximal for several patients: without treatment, they die. Then treatment effect and cost-effectiveness become more decisive for prioritization decisions. Moreover, withholding and withdrawing intensive care are increasingly considered as morally equivalent. Difficult priority decisions risk moral stress among the intensive care staff.</p>","PeriodicalId":17988,"journal":{"name":"Lakartidningen","volume":"121 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142290335","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}
引用次数: 0
[Intensive care and priority setting during catastrophe or war]. [灾难或战争期间的重症监护和确定优先事项]。
Lakartidningen Pub Date : 2024-09-17
Lars Sandman, Erik Gustavsson
{"title":"[Intensive care and priority setting during catastrophe or war].","authors":"Lars Sandman, Erik Gustavsson","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In this article we discuss some ethically and legally controversial issues in the Swedish priority guidelines for intensive care during the recent covid pandemic. We show how the Swedish ethics platform for priority setting constitutes a robust starting point for such guidance, but that there is a lack of detail leaving some of the more challenging situations without explicit guidance. To provide guidance, which we have reason to do in order to avoid inequality and arbitrariness, we should try to interpret the ethics platform, based on how it is applied in practice together with ethical reasoning. In this article, we illustrate this by focusing on contested guidance concerning biological age when distributing scarce intensive care beds. We conclude that biological age should be interpreted in terms of long-term survival. We also conclude that the ethical platform does not provide guidance in these challenging situations, but needs interpretation. Therefore, there is a need of a legal overview of the principles in order to create an even stronger basis for support in the future.</p>","PeriodicalId":17988,"journal":{"name":"Lakartidningen","volume":"121 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142290334","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}
引用次数: 0
[How Region Sörmland dealt with Covid-19 in 2020-2021]. [2020-2021 年萨尔姆兰地区如何应对 Covid-19]。
Lakartidningen Pub Date : 2024-09-17
Markus Castegren
{"title":"[How Region Sörmland dealt with Covid-19 in 2020-2021].","authors":"Markus Castegren","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In Region Sörmland, the burden of critical illness during the first wave of Covid-19 in april 2020 lead to a 25-fold increase in the number of patients requiring invasive mechanical ventilation. The decision was made that quantity should be prioritised before individual quality. This led to a highly standardised care during the intensive care period. All patients admitted to any of the county's three hospitals were assessed as regarded their ability to survive invasive mechanical ventilation. The assessment was based on the Charlson Age-adjusted Comorbidity Index and the Clinical Frailty Scale. Of all >2000 admitted patients with Covid-19, 37% were assessed as not to benifit from mechanical ventilation. The outcome of intensive care patients was very good in Region Sörmland compared to the rest of Sweden, with a 30-day mortality rate of 14% following intensive care. The outcome after Covid-19-associated intensive care in Sweden differed highly between ICUs, with a span of 7-58% 30-day mortality rate.</p>","PeriodicalId":17988,"journal":{"name":"Lakartidningen","volume":"121 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142290333","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}
引用次数: 0
Gränsvärden för riskbruk av alkohol bör individanpassas. 对危险饮酒的限制应因人而异。
Lakartidningen Pub Date : 2024-09-12
Anders Helander, Alan Wayne Jones
{"title":"Gränsvärden för riskbruk av alkohol bör individanpassas.","authors":"Anders Helander, Alan Wayne Jones","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":17988,"journal":{"name":"Lakartidningen","volume":"121 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142290337","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}
引用次数: 0
[The Swedish model of Health dialogues - a systematic review]. [瑞典健康对话模式--系统回顾]。
Lakartidningen Pub Date : 2024-09-04
Margareta Kristenson, Mats Börjesson, Yvonne Forsell, Lars Jerdén
{"title":"[The Swedish model of Health dialogues - a systematic review].","authors":"Margareta Kristenson, Mats Börjesson, Yvonne Forsell, Lars Jerdén","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Lifestyle habits are key determinants for premature death. The Swedish model of health dialogues, which has been developed since 1985, aims to promote a healthy lifestyle by inviting everybody in specific age groups to primary care for health dialogues combined with community-oriented efforts. In the first systematic review of the model, seven studies were identified, all with a control/reference group and follow-up of at least one year. GRADE (Grading of Recommendations, Assessment, Development and Evaluation) was used to assess the quality of evidence. Results showed that the model reduced premature all-cause and cardiovascular mortality (moderate evidence/+++), reduced blood pressure, cholesterol, fasting blood glucose, waist size and BMI (moderate/low evidence) and improved dietary habits (moderate evidence/+++). Health benefits were greater when health dialogues were combined with community-oriented efforts.</p>","PeriodicalId":17988,"journal":{"name":"Lakartidningen","volume":"121 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142126112","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}
引用次数: 0
[Acute scrotum in children]. [儿童急性阴囊炎]。
Lakartidningen Pub Date : 2024-09-03
Anna-Maria Zadig, Gylfi Ásbjörnsson, Martin Salö
{"title":"[Acute scrotum in children].","authors":"Anna-Maria Zadig, Gylfi Ásbjörnsson, Martin Salö","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Acute scrotum in a child is common, and the main underlying conditions are torsion of intrascrotal appendages, epididymitis, testicular torsion and idiopathic scrotal edema. The main diagnostic aim is to confirm or rule out testicular torsion, since this may lead to irreversible ischemia within hours. The diagnostics can be difficult, especially in prepubertal boys, but consist of a thorough history and clinical examination, the use of a clinical prediction score, and sometimes ultrasound with doppler. However, none of these tools can with completely accuracy rule out a testicular torsion, and uncertainty should prompt an acute scrotal exploration. The treatment of a testicular torsion is detorsion and bilateral orchidopexy, or unilateral orchidectomy in case of a completely necrotic testicle. Treatment of the other underlying conditions is often only symptomatic, and follow-up is often not required.</p>","PeriodicalId":17988,"journal":{"name":"Lakartidningen","volume":"121 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142126108","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}
引用次数: 0
[Spontaneous coronary artery dissection and physical activity - what we know and don't know]. [自发性冠状动脉夹层与体育锻炼--我们知道的和不知道的]。
Lakartidningen Pub Date : 2024-09-02
Nina Johnston, Sofia Sederholm Lawesson, Eva Swahn
{"title":"[Spontaneous coronary artery dissection and physical activity - what we know and don't know].","authors":"Nina Johnston, Sofia Sederholm Lawesson, Eva Swahn","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Patients suffering from a spontaneous coronary artery dissection (SCAD) are mostly younger to middle-aged women. There are very few data to guide physicians and physiotherapists on recommendations about physical activity for these patients. Based on the few studies that are available, aerobic activity at moderate levels and weightlifting with light weights appears safe. No studies are available on SCAD patients and aerobic activity, at more intensive levels. Follow-up studies after SCAD suggest that many patients receive advice with restrictions on physical activity resulting in a sedentary lifestyle.</p>","PeriodicalId":17988,"journal":{"name":"Lakartidningen","volume":"121 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142126111","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}
引用次数: 0
[Managing medicine shortages: responsibilities and strategies at the Swedish Medical Products Agency]. [管理药品短缺：瑞典医药产品局的责任和战略]。
Lakartidningen Pub Date : 2024-08-27
Sophia Persson Käll, Veronica Arthurson, Maria Wanrud, Luisa Becedas, Rickard Ljung
{"title":"[Managing medicine shortages: responsibilities and strategies at the Swedish Medical Products Agency].","authors":"Sophia Persson Käll, Veronica Arthurson, Maria Wanrud, Luisa Becedas, Rickard Ljung","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The paper outlines the role of the Swedish Medical Products Agency (Läkemedelsverket) in managing medicine shortages. The agency receives reports from pharmaceutical companies, investigates causes, and disseminates information to pharmacies, healthcare providers, and the public. While focusing on mitigating shortages, the agency clarifies its non-involvement in manufacturing or sales decisions. Pharmaceutical companies must promptly report shortages, with sanctions enforced for non-compliance. Various measures, including regulatory actions, interchangeable medicines, temporary dispensations, and licensing, are employed to address shortages. Additionally, the agency advocates for stable national drug supply preparedness, emphasizing collaboration and governmental intervention.</p>","PeriodicalId":17988,"journal":{"name":"Lakartidningen","volume":"121 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142126110","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}
引用次数: 0
[Increased self-reported eating disorder symptoms in outpatients at a Child and Adolescent Psychiatry Clinic in Sweden between 2018 and 2022]. [2018年至2022年期间，瑞典一家儿童和青少年精神病诊所门诊患者自我报告的饮食失调症状有所增加]。
Lakartidningen Pub Date : 2024-08-22
Helena Zetterqvist, Tove Marthin, Kent W Nilsson, Maria Hedqvist, Susanne Olofsdotter
{"title":"[Increased self-reported eating disorder symptoms in outpatients at a Child and Adolescent Psychiatry Clinic in Sweden between 2018 and 2022].","authors":"Helena Zetterqvist, Tove Marthin, Kent W Nilsson, Maria Hedqvist, Susanne Olofsdotter","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Eating disorders are common disorders that cause significant suffering and functional impairment for those affected. They often emerge in adolescence and can go undetected for many years before an individual presents to services. Early diagnosis and treatment have been shown to significantly improve the prognosis, highlighting the need for proactive screening. This study compared the frequency of self-reported eating disorder symptoms in (n = 2137) outpatients at the Child and Adolescent Psychiatry Clinic (BUP) in Region Västmanland, Sweden between 2018 and 2022. The results showed that the proportion of young people reporting frequent eating disorder symptoms increased from 16% to 28% over this time period. This result is in line with previous research describing an increase in the prevalence of eating disorder symptoms among different groups in relation to the Covid-19 pandemic. It underscores the importance of screening for eating disorder symptoms to better address care needs.</p>","PeriodicalId":17988,"journal":{"name":"Lakartidningen","volume":"121 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142126109","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}
引用次数: 0
[New Swedish national guidelines - management of Percuteaneous Endoscopic Gastrostomy (PEG) and other enteral feeding tubes]. [瑞典国家新指南--经皮内镜胃管造口术（PEG）和其他肠内喂养管的管理]。
Lakartidningen Pub Date : 2024-08-21
Karin Stenberg, Anna Eriksson, Ulrika Tullberg, Peter T Schmidt, Peter Elbe
{"title":"[New Swedish national guidelines - management of Percuteaneous Endoscopic Gastrostomy (PEG) and other enteral feeding tubes].","authors":"Karin Stenberg, Anna Eriksson, Ulrika Tullberg, Peter T Schmidt, Peter Elbe","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Numerous patients stand to gain significant health benefits from enteral nutrition support facilitated by percutaneous feeding tubes. Consequently it is crucial for endoscopists, general practitioners, surgeons and neurologists to be well-versed with indications, contraindications and potential complications of PEG and other enteral feeding tubes. In this context we present a concise overview of the new national guidelines by the Swedish Society of Gastroenterology regarding the management of PEG and other enteral feeding tubes. Indications for the use of enteral feeding tubes include conditions such as stroke and obstructive cancer. The care of patients with percutaneous feeding tubes necessitates the expertise of a specialized team. Complications related to PEG include, among others, buried bumper syndrome, local infection and dislocation of the feeding tube.</p>","PeriodicalId":17988,"journal":{"name":"Lakartidningen","volume":"121 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142017922","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}
引用次数: 0
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