Lakartidningen最新文献

In 1924 the German psychiatrist Hans Berger made the first electroencephalographical (EEG) recording of cerebral activity in humans. Worldwide, EEG developed into a widely used diagnostic method and was introduced in Sweden in 1937. Today EEG is an essential diagnostic and monitoring standard in epilepsy, sleep disorders, neonatology and intensive care, and provides prognostic information after perinatal asphyxia and cardiac arrest. Like ECG, EEG is an old electrophysiological method that today, and in the future, provides unique diagnostic information.

The efficacy of escitalopram in treating social anxiety disorder is significantly influenced by expectations shaped through communication, contributing to about half the improvement. Overt SSRI treatment with accurate information about its effectiveness doubled the clinical outcome compared to covert treatment with misinformation about the therapeutic effect. Clinical improvements are not solely due to serotonin reuptake inhibition, as indicated by similar serotonin transporter occupancy in both treatment types, without correlation to anxiety reduction. There was, however, notable correlation between clinical improvement and reduced dopamine transporter availability in the overt SSRI group, possibly due to increased dopamine turnover. This was also observed in a study on combined CBT and  SSRI treatment. Conversely, clinical improvement after CBT combined with placebo showed an inverse correlation with dopamine transporters and did not inhibit serotonin transporters.

Almost 100 years ago, the French physician Pierre Mauriac described a syndrome named after him, resulting from poorly controlled type 1 diabetes, with growth retardation, delayed puberty, Cushingoid features and hepatomegaly. With modern diabetes care, this is very rare but does occur; however, despite the condition having important clinical implications and being easily treatable, this diabetes complication remains relatively unknown. We present here an authentic patient case in the form of a young man with glycemically poorly controlled type 1 diabetes who developed hepatomegaly, hyperlactatemia and histopathological changes in the liver consistent with glycogenosis, a state readily reversed by normalization of glycemia.

Delivery care in Sweden is very safe, the incidence of maternal death is 5/100 000 and perinatal death <2/100 000. The perinatal death rate among babies born at or after week 41+0 decreased from 0.17 to 0.09% (p<0.001) and obstetric anal sphincter injuries have decreased from 3.5% to 2.6%; however interventions such as induction of labour increase. A national project to improve safety for newborns at delivery was initiated in 2007, engaging all delivery clinics in Sweden. The cooperative work process resulted in implementation of protocols, safety tools (SBAR; NEWS2) and intensified simulation training. The Swedish Pregnancy Register offers available data on pregnancy and delivery, enabling delivery clinics to assess results and direct improvement efforts. Still, challenges concerning teamwork and communication in difficult situations such as vacuum extraction and fetal surveillance with CTG need attention. Individualized support to »second victims« and continuous focus on phycological safety have the potential to further improve delivery care.

Safe healthcare means care without preventable harm. Different parts of healthcare face various challenges, with types of harm varying by specialty and context. In primary care, delayed diagnoses dominate serious harm, while in home care settings, challenges often arise from the transfer of information among different caregivers or assistants, thereby increasing the risk of harm from for example medications or complications from catheters, stents, and urinary catheters. Poor continuity of care contributed to the suffering of the patient in this article, showcasing systemic vulnerabilities. To improve patient safety, patient engagement, continuity of care, and information exchange across care transitions are vital. Collaboration among healthcare providers towards shared patient-centred goals is essential for effective and safe care delivery.

There is a multiplicity of signals and evidence of avoidable harm and lack of quality in health care. In parallel the medical results often are excellent. Better understanding and knowledge is needed regarding how different factors interact in a complex way resulting in both good and bad outcomes. That would improve the possibilities for better patient safety as well as even better medical results. Evaluation and follow-up of safety and results always in itself influences the processes. Evaluation has to be done in a balanced and well elaborated way to provide a basis for wise governance and improvement. There is need of a leadership that keeps focus on safety and quality even when there is a competition with economy and other challenges.

It is difficult to predict who will end their life by suicide, but often possible to prevent a suicide. To succeed with suicide prevention within healthcare, a clinical practice is required that includes more than assessing signs of psychiatric disease. Assessments of suicide risk must include the patient's own perspective and narrative, as well as life-threatening behavior and reasons to live. Cooperation with relatives is necessary to understand the whole picture, and alternative behavior in situations where life seems impossible to endure should be the long-term goal of all suicide prevention.

Swedish surgical care shows high quality and patient safety. The reasons for this are several; among the most important are a generally well-educated staff and nation-wide quality registers. Areas in need of development are improved risk assessment and risk management, both for individual patients and for specific types of operations. The ability of the surgical team to synthesize information on what has been done and what should be done postoperatively and communicate this to the teams that take care of the patients after surgery needs further honing. This could result in decreased failure-to-rescue in the postoperative period. Also, strengthening of teamwork and team performance is needed. As new knowledge on the detrimental effects of rude behaviour emerges, it becomes obvious that further work to diminish this is needed. Research is under way of identifying the possibility to identify good and safe surgeons already at the start of their education.