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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.

Iatrogenic harm continues to affect considerable numbers of patients in in- and outpatient care settings. Although iatrogenic harm is common in all age groups, children are at greater risk of being harmed by adverse events in health care due to physiological, anatomical, cognitive, and social factors during development. Pediatric patient safety practices are evolving and there has been progress, but injuries due to medical care continue to have substantial negative effects. To be effective, interventions need to be tailored to the pediatric context, and meet the challenges in the pediatric healthcare setting.

To better align with the clinical setting, the European Society of Cardiology has published new guidelines covering the whole spectrum of the acute coronary syndrome, including ST-elevation myocardial infarction, non-ST-elevation myocardial infarction and unstable angina.

A school's culture has been shown to influence medical students in their choice of future discipline. Therefore, we aimed to explore the culture towards the general practice discipline, as reflected in comments to medical students from their teachers and clinical tutors. Students in their 6th and 11th terms at the Universities of Umeå and Uppsala participated in a questionnaire study. A qualitative analysis of free-text answers of comments was conducted with thematic analysis. The students reported receiving both appreciative and deprecatory comments about general practice and GPs, which altogether ended up in two head themes: work-related factors and opinions about GPs. Appreciative comments included »important«, »varying«, »responsible work«, »broad skills«, and »good working hours«. Deprecatory comments included »stressful jobs«, »unstimulating routine work«, »incompetent doctors«, and »low status«. Considering the present shortfall of GPs, such deprecatory comments are worrying and could hamper the future recruitment of GPs.

This case report of a 73-year-old male with bleedings provides insights into the clinical characteristics, diagnosis och treatment of acquired hemophilia A. It's a dangerous non-hereditary bleeding disorder caused by autoantibodies against coagulation factor VIII, often linked with other autoimmune diseases or malignancies, but it is also often idiopathic. The diagnosis remains a challenge due to its rarity and non-specific symtoms, but should be considered in unexplained bleeding cases with prolonged activated partial thromboplastin time (APTT). Quick  diagnosis and treatment can significantly reduce the risk of serious complications and mortality. The long-term prognosis usually depends on the presence of any underlying disease.

Ferritin is one of the most requested blood tests in both primary and inpatient care, and high values occur frequently. One of the greatest challenges in the investigation of hyperferritinemia is to determine if there is a presence of iron overload. Patient history (chronic liver disease, excessive alcohol consumption, hereditary factors), clinical features (metabolic syndrome, acute or chronic inflammation, infection, malignancy) and biochemical tests (ferritin, transferrin saturation, hemoglobin, liver enzymes, CRP/SR, phosphatidyl ethanol, lipid profile, glucose) facilitate the determination of the cause of hyperferritinemia. High transferrin saturation indicates iron overload, which is usually linked to hereditary hemochromatosis. In the case of homozygosity of the HFE mutation p.C282Y in the presence of hyperferritinemia, venesection can be started without further investigations, while in the absence of HFE mutations a possible iron excess must be validated with magnetic resonance imaging (MRI) for iron determination before venesection is started. Dysmetabolic iron overload syndrome (DIOS) or alcohol-related hemosiderosis can be treated with venesection in selected cases if there is a significant deposition of iron in the liver on MRI. An individual with ferritin below 1000 µg/L, a normal transferrin saturation, and normal liver tests does not need further investigations and can be followed in primary care. We propose an algorithm for the investigation of hyperferritinemia that facilitates the investigation both in primary and inpatient care.