Lakartidningen最新文献

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.

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.

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.

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.

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.

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.

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.

More than 5 billion humans cannot access essential surgery if needed. Surgery was for a long time not a part of the global health agenda, generally considered a luxury. However, the realization that a large proportion of the global burden of disease can be reduced by surgery has gained momentum. The publication of the Lancet Commission on Global Surgery and the Disease Control Priorities volume on surgery, along with the WHO resolution on access to essential and emergency surgical care, has been pivotal in this paradigm shift. Access to surgery is in many settings hampered by a mix of lack of leadership, skilled workforce, equipment, and financial risk protection for patients, to name a few. Importantly, the provision of surgery requires comprehensive health systems which, once established, allow for numerous other health interventions. This cannot be achieved without partnerships, responsible leadership and good governance that prioritizes health care in general and surgery in particular.

Approximately 100,000 persons live with Alzheimer's disease in Sweden. As the population ages, the need for diagnostics and disease-modifying treatment grows. Previously available treatments provide moderate symptom relief but do not affect disease progression. New antibody treatments show promising results and are typically well tolerated. However, adverse events include brain edema and hemorrhages, which can be detected early by MRI. These treatments require substantial resources, including increased use of MRI and radiological expertise. The introduction of new therapies will lead to higher regional healthcare costs and demands for specialized diagnostics. Implementing these therapies therefore necessitates national preparation and planning for coordinated and efficient management, addressing the significant societal and economic challenges posed by Alzheimer's disease.