PPIs (Proton-pump inhibitors) offers the best treatment for acid related diseases. The predominant indications for PPI prescription are:
The market for PPIs continues to expand in most countries. A significant over- and misuse of PPIs prevails in hospital care as well as in general practice. The predominant reasons for and mechanisms behind the over- and misuse of PPIs are well recognised. The most important consequences of this overprescription of PPIs are increasing medical costs and risk for long-term adverse side effects. Continued education and dedicated information are key factors to guide physicians, medical personnel and patients to adopt to generally accepted principles for and balanced use of PPIs.
Vårdrelaterade infektioner är ett särskilt stort problem inom intensivvården där patienterna är kritiskt sjuka och har många riskfaktorer.
För att minska frekvensen vårdrelaterade infektioner måste ett strukturerat arbete bedrivas från flera olika utgångspunkter.
Vi måste bli bättre på att diagnostisera, dokumentera och förebygga dessa infektioner.
Kombinerad intervention av typen »push« och »pull« visade på lovande resultat med införande av bättre diagnostiska metoder och en upplevelse av ökad motivation hos personalen efter besöket.
Råd och anvisningar för toaletträning vid utvecklingsstörning har efterlysts av föräldrar och vårdpersonal.
Evidensbaserade riktlinjer enligt SBU:s rekommendationer för handläggning av toaletträning vid utvecklingsstörning har tagits fram efter granskning av befintlig forskning, som nästan uteslutande berör toaletträning vid måttlig, svår eller grav utvecklingsstörning.
Barnorienterade råd för toaletträning av normalutvecklade barn kan eller ska som regel tillämpas för barn med utvecklingsstörning utan tilläggsproblematik.
Intensiv strukturerad beteendeträning är sannolikt den bästa metoden för barn och ungdomar med svårare grad av utvecklingsstörning och för individer med neuropsykiatriska funktionsnedsättningar.
Medicinsk bedömning ska alltid föregå toaletträning vid utvecklingsstörning, då neurogena och anatomiska avvikelser är vanligare hos barn och ungdomar med utvecklingsstörning.
Anterior cruciate ligament (ACL) injury is a common injury and is often associated with concomitant injuries to the menisci and cartilage and, in the long term, osteoarthritis. Preventive training programs have shown to be highly effective in terms of reducing the risk for ACL injury in sports. ACL reconstruction is indicated when the patient experiences symtoms of instability (»giving way«) despite rehabilitation with a physiotherapist aiming to gain neuromuscular control of the knee. Early ACL reconstruction may be indicated, for example when the patient desires to return to pivoting contact-sports at high level. Modern surgical technique for ACL reconstruction has evolved rapidly and includes »anatomic reconstruction« and individualized treatment, where each patient’s unique anatomy, injury and requests on knee function are taken into consideration. In Sweden, more than 90% of all ACL reconstructions performed are included into the Swedish National ACL Register.
The 2030 Agenda for Sustainable Development and its seventeen Sustainable Development Goals were adopted by the United Nations General Assembly in 2015. It is a bold agenda for global social, environmental and economic development, with human health as a central theme. Even though substantial improvements in health have been achieved during the last decades, every year over 5 million children die, mostly from preventable causes, and 300 000 women die in conjunction with childbirth. Premature deaths from non-communicable diseases are increasing, and our ability to treat infections is under threat through widespread anti-microbial resistance. Climate change is recognized as the biggest threat to health in our time. When the world now starts to plan for how society and our health systems should be reorganized after the COVID-19 pandemic the 2030 Agenda could and should play a central role. In this context, Agenda 2030 provides an ambitious roadmap for development, with its emphasis on collaboration across borders and disciplines. The agenda is achievable but reaching its goals will require strong commitment at all levels and societal change on a large scale.
Lättanvända begrepp och definitioner på sjukdomsaktivitet och behandlingseffekt bör få ökad spridning inom sjukvården.
Majoriteten av patienter med Crohns sjukdom behöver långvarig läkemedelsbehandling, och ungefär hälften genomgår en eller flera operationer någon gång under sjukdomstiden.
Det är viktigt att tidigt i sjukdomsförloppet identifiera riskfaktorer för utveckling av komplicerad och aggressiv sjukdom och behandla intensivt i dessa fall.
En aktiv strategi med regelbundet övervägande av tillgängliga behandlingsalternativ medför att de flesta patienter med Crohns sjukdom behåller en god livskvalitet.
Patienter med svårt skov av ulcerös kolit bör vårdas på sjukhus och handläggas av gastroenterolog och kolorektal kirurg i nära samarbete.
Skovets svårighetsgrad kan underskattas, varför noggrann bedömning av inflammationens utbredning och svårighetsgrad enligt validerade kriterier är viktigt.
Intravenös behandling med kortikosteroider är en av hörnstenarna i den akuta behandlingen.
Patienter som inte förbättras på denna behandling, bör erbjudas medicinsk »rescue-behandling« eller kolektomi.
Infliximab har visats vara en effektiv rescue-behandling och kan minska behovet av kolektomi inom de första 3 månaderna och upp till 3 år.
Overdiagnosis and overtreatment receive increasing attention. More than 20 percent of health expenditure is without patient benefit, so-called low-value care. Several national and international initiatives have been launched to minimize low-value care. Arguably, the most widely spread initiative is Choosing Wisely. First launched by the American Board of Internal Medicine in 2012, this campaign has spread to more than 20 countries. The Swedish Society of Medicine has identified low-value care as a significant problem in Swedish health care and has established a working group to investigate if and how a campaign based on Choosing Wisely would be feasible in Sweden. Here, the working group reports on the history of Choosing Wisely, identifies potential challenges for deimplementation generally and in the Swedish context specifically.
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A retrospective review of medical records (2017-2018) at Linköping University Hospital compared hospital mortality for the 2-month period of summer vacations (group A) with two months of regular activity (group B). The mortality was 163 patients in group A and 216 in group B. Emergency admittance dominated (95%) in both groups. Comorbidity was found in 81%, and at admittance the risk for death during the hospital stay was estimated to more than 50% in three out of four patients. There was no difference between the groups regarding demography, hospital stay, or diagnosis. Due to a 30% reduction of hospital beds during the summer some patients were relocated to other specialties. No relocated patient died in group A but six in group B. Eight deaths were judged as probably preventable, but none definitely preventable. The similarity between the groups regarding mortality does not allow estimations of differences in adverse events in general. Low mortality among relocated patients is probably due to identification of high-risk patients not suitable for relocation.
Hyperacusis innebär extrem känslighet för vardagens ljud är ett problem som drabbar cirka 8% av befolkningen. I svåra fall uppstår undvikande av många situationer samt en vana att skydda öronen med hörselskydd även i situationer där det inte behövs. Orsakerna till hyperacusis är till viss del kända, men många frågetecken kvarstår. För hyperacusis finns ingen dokumenterat botande behandling, men kognitiv beteendeterapi, samt eventuellt även tinnitus retraining therapy med brusgenerator, kan minska besvären,. Gott omhändertagande och en multidisciplinär utredning är att rekommendera i svåra fall. En av de viktigaste uppgifterna för framtida forskning är att kartlägga naturalförloppet vad gäller hyperacusis, då detta är i stort okänt. Det finns även ett stort behov av kontrollerade behandlingsstudier.
Borderline personlighetsstörning (BPD) kännetecknas av ett genomgående mönster av instabilitet i regleringen av känslor, bristande impulskontroll, relationsproblem och låg självkänsla. Självskadande beteenden och självmordsförsök är vanliga. Dialektisk beteendeterapi (DBT) är en form av kognitiv beteendeterapi som utvecklats för självmordsbenägna patienter med BPD. I DBT ingår beteendeförändrande tekniker och metoder för att lära sig acceptera känslor. Behandlingen ges i form av individualterapi med telefonstöd och gruppterapi samt genomförs i flera steg, där självskadande och terapistörande beteenden prioriteras. Enligt SBUs granskning är det vetenskapliga stödet DBT begränsat (Evidensstyrka 3) och främst avgränsat till minskning av självskadande beteende.
[No abstract available]
Vid opportunistisk svampinfektion i huden är diagnosen sällan självklar. Ett samarbete mellan dermatolog, patolog och mykolog kan behövas, som i detta fall av kutan alternarios. Denna typ av svampinfektion innefattas i begreppet feohyfomykos.
In cases of sexual assault, physical evidence can be of crucial importance for a conviction. Intimate samples initially collected by a physician can prove to be the only supporting evidence for the prosecution to present at court proceedings. New analysis techniques and methods have increased the positive outcome of the samples collected. This in combination with increased use of national criminal DNA databases results in the solving of sexual crimes with unknown perpetrators. The use of standardised rape care kits facilitates the work of the physician in performing an adequate sampling procedure. The Swedish "rape care kit" has been developed and updated in response to experience gained and new possibilities.
Given the setting of Stockholm County, a recently published health-economic analysis shows that the cost per Quality-adjusted life year (QALY) of a free TBE vaccinations program is below generally acceptable cost-effectiveness thresholds in Sweden. A report from the Public Health Agency (PHA), based on similar input data, shows that it is not cost effective to subsidize TBE vaccination in the Stockholm county. The main difference in the two analyses is the time horizon for the analyses; a life-time perspective versus 10-year perspective. Health economics of vaccination strategies should be based on a long time perspective and especially when the disease is more severe in older adults, i.e. TBE. Health-care decision-makers should be aware of the importance of the time horizon for the results when considering these evaluations in prioritization decisions. With a life-time perspective a TBE-vaccination program appears cost-effective.
The annual incidence rate of high grade malignant glioma (WHO grade III-IV) in Sweden is approximately 400 patients. The objective for the Swedish National CNS-tumor Group is to lay a foundation for research efforts and facilitate implementation and assessment of therapeutic strategies and health care for this patient group. In the analyses the diagnoses of high grade malignant gliomas are compared for the years 1999-2003, 2004-2006 and 2007-2009 for the Northern Region, the Uppsala Region and the South-east Region of Sweden, a population of 1844 patients. Survival was estimated from Kaplan-Meier survival curves, and a log-rank test was performed to assess whether the survival curves differed. The crude hazard ratio between years of diagnosis was estimated from a Cox regression model. Median survival for all patients 2004-2006 was 10.0 months (95 % confidence interval (CI) 8.9-10.9) compared to 8.1 months 1999-2003 (95 % CI 7.3-8.8). For patients 60-69 years of age almost a doubling of the survival rate has occurred during the last decade. Medan survival has increased from 5.8 months (95 % CI 5.1-7.5) 1999-2003 to 8.5 months (95 % CI 7.0-10.3) for 2004-2006 and to 10.5 months (95 % CI 9.0-12.6) for 2007-2009. Concomitant radiochemotherapy, but also the development of neurosurgical and radiotheraputic techniques and a more active therapeutic attitude, including the older patient groups, have probably contributed to the improved survival rate. A national population based registry, with a close to 100% registration compliance for important diagnostic and outcome parameters is probably an efficient instrument for evaluation of quality measures and implementation of new therapeutic strategies.
Platelet concentrates have been implicated in bone and soft tissue repair for decades, but results from both preclinical and clinical studies have been meagre and conflicting. In a small animal model, a locally injected platelet concentrate accelerated the repair of injured Achilles tendons. This has raised a hope for clinical success in the treatment of tendon pathology. Treatment of tendinosis with platelet concentrates has been heavily marketed, and there is now an increasing public demand for this treatment. At a recent meeting in Linköping, Sweden, 2 ongoing randomised controlled studies were described, with some preliminary results. It was concluded that there is an increasing enthusiasm, but no useful clinical data.
Stress fractures are caused by material fatigue. Microcracks appear normally in bone, and are dealt with by remodeling, specifically targeting areas of microdamage. Inhibition of targeted remodeling can allow microcracks to grow and form fractures. Intensive athletic training can lead to an increased microcrack formation rate, which exceeds what can be balanced by remodeling. Stress fractures often heal poorly, possibly because they are so thin: normal deformation of the bone during loading has been shown to lead to strains within thin cracks that are incompatible with cell survival. If the patient can't reduce loading sufficiently to allow healing, surgical stabilization will therefore be required. If the crack is transformed into a larger defect, e.g. by drilling a hole, strains will be reduced and healing facilitated by a simple procedure.