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Gene editing is a novel technology within gene therapy, which changes sequences in chromosomal DNA with precision. Even if there are alternative strategies, the Nobel Prize-winning CRISPR/Cas technology has become the dominating principle. During recent years base editing and prime editing, permitting editing without DNA double-strand breaks, have been developed. The first clinical gene editing results were reported in 2021; since then many patients have been treated, and recently the first treatment was approved as a novel therapy in the UK and later in USA and in EU. This update describes various aspects including methodological developments and safety.

The Swedish quality register AmbuReg collects all the country's ambulance missions. There is an increasing demand on the Emergency Medical Services (EMS) due to decreasing hospital resources and referral to self-care, primary care and mobile teams. This, in combination with fast tracks for patients with myocardial infarction, stroke, hip fracture or sepsis, increases the requirement for optimal triage at the scene. The aim of the registry is to ensure the quality and identify limitations in the EMS that may threaten patient safety, such as documentation, assessment, triage and treatment. The development of decision support tools will be required in the future and in collaboration with other national quality registries. Regarding adherence to guidelines for assessment and treatment of symptoms, particularly pain, and the use and analysis of equipment such as ECG and analysis of serum glucose, different quality goals may be set. An example may be that at least 80% of strokes should be recognized at the scene.

There are four paths to a Swedish medical license. A shared agreement exists for those converting from a European license to recognize qualifications granted in the respective countries mutually. Swedish medical graduates and International Medical Graduates (IMGs) trained outside the EU/EES/Schweiz are assessed against the professional qualifications specified in the Higher Education Ordinance (1993:100). This paper discusses the different pathways to a Swedish Medical License, how they are interrelated and changing, and the number of licenses granted via the specific pathways in 2023 and the previous 7 years. In 2023, 2,318 Swedish medical licenses were awarded. The largest group (1,407/2,318) were graduates from a Swedish medical school (with a minimum of 18 months of internship (AT)). The second largest group (704/2,318) were licensed physicians from a country within the EU/EEA. The smallest group (207/2,318) were international medical graduates (IMGs) who had passed the proficiency test (with a 6-month internship) or a complementary medical education (KUL) at one of the Swedish universities (with a minimum of 18 months of internship (AT)). During 2016-2023, 826 IMGs passed the proficiency test, and 533 IMGs completed KUL. During the same period, 10,958 students graduated from Swedish medical programmes, and 6,844 medical licenses were approved based on education in the EU/EEC. The pathway for IMGs starts with applying to the National Board of Health and Welfare to be approved for the tests. The theoretical test is a 180-item exam with single-best answers covering the medical field with basic and clinical sciences. After passing the theoretical test, the practical skills are tested with an Objective Structured Clinical Examination (OSCE) with fourteen 6-minute and four 14-minute stations. After passing the practical test, the IMG is assessed during a 6-month internship and must take an online Swedish law course. When successfully passing these steps, the IMG applies for a Swedish medical license with a certificate of passing a language test in Swedish at the C1 level. The educational pathway consists of a 1- to 2-year-long complementary programme for international medical graduates (KUL) offered at five Swedish universities. The regular Swedish medical programmes are in transition from preparing for an internship to preparing to qualify directly for a medical license without an intermediate internship. Consequently, KUL also needs to develop new curricula, preparing for direct qualification for a medical license, from which the first students will most likely graduate in spring 2027.

Type 2 diabetes (T2D) is increasing relentlessly globally, affecting ever younger patients. Many T2D patients do not attain glycemic target levels, indicating a clear need for novel antihyperglycemic drugs. Ideally, these should not only control glycemia, but also halt or slow the progressive loss of beta cells. Two entirely novel classes of antihyperglycemic agents - glucokinase activators and imeglimin -  were recently approved in Asian markets and will be discussed in this review. These two novel drug classes will be a welcome addition and complement to existing treatments. Time will tell whether these new antihyperglycemic agents will add value to the current treatment paradigms against T2D and provide sustained antihyperglycemic effect, acceptable safety, usefulness in combination therapy, and effects on hard end-points such as cardiovascular disease.

Cardiac arrest is the most time-sensitive condition that personnel face in the emergency department. Optimal management consists of good quality cardiopulmonary resuscitation, the simultaneous performance of focused investigations to identify potential reversible causes, and the delivery of cause-specific treatments. In order to manage patients with cardiac arrest in an efficient manner, team members need to have clearly defined roles and ready access to required equipment. This article presents the latest guidelines for cardiopulmonary resuscitation of patients with cardiac arrest in the emergency department and specific initial therapies for reversible causes. The article highlights specific aspects of the management of patients with cardiac arrest due to major trauma and accidental hypothermia, as well as cardiac arrest in the setting of advanced pregnancy. The article also provides recommendations regarding role allocation to team members involved in cardiac arrest management.

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.

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.