Lakartidningen最新文献

There is a breathtakingly rapid development in various areas that take advantage of the ever-improving possibilities to record and analyze the electrical activity generated in the brain. In this article, we attempt to briefly describe some of these areas, including AI-assisted EEG interpretation, the use of BCI (brain-computer interface) in a medical setting, and the possible new applications connected to the development of very small wearable EEG devices. Furthermore, we discuss the concerns and challenges presented by these advancements in neurotechnology.

Open science aims to make research accessible to all, enhancing transparency and promoting replication. It involves practices such as open access publishing, sharing statistical code, and making non-sensitive data a available to encourage critical review, reduce errors and prevent selective reporting of favorable results. A key component of open science is preregistration, where researchers outline their hypotheses and planned analysis methods in advance, minimizing bias and promoting accountability. Despite its benefits, misconceptions about open science practices hinder its widespread adoption among researchers. Common myths include the belief that preregistration prevents any deviation from the original plan, that it only applies to clinical trials, or that it's unnecessary if data have already been collected. By challenging these misunderstandings, we can leverage open science practices to improve the integrity and quality of research.

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.