Hansson M, Eggertsen G, Paulsson E
… +3 more, Gaunitz S, Jacobsson H, Lindberg G
Lakartidningen
· 2025 Apr · PMID 40272084
This review concerns the diagnosis and therapy of bile acid diarrhea, a common type of chronic diarrhea which is considered underdiagnosed with a presumed prevalence of approximately 1%. A simple blood test, S-7-OH-chole...This review concerns the diagnosis and therapy of bile acid diarrhea, a common type of chronic diarrhea which is considered underdiagnosed with a presumed prevalence of approximately 1%. A simple blood test, S-7-OH-cholestenone/cholesterol ratio, reflecting the bile acid synthesis rate, is a cost-effective analysis to diagnose most patients. Results above 25 nmol/mmol supports the diagnosis, while results <15 nmol/mmol are considered normal. Supplementary 75SeHCAT test may be required for results occurring in the grey zone (15-25 nmol/mmol). The latter investigation is more expensive and utilizes a radioactive isotope. Treatment for bile acid diarrhea consists of bile acid sequestrants that need to be titrated carefully in each patient to achieve lasting results. Future treatment options may include GLP-1 agonists. It is essential to spread information about the condition among general practitioners and physicians in other disciplines who will meet patients with symptoms of diarrhea.
Bölte S, Hirvikoski T, Jonsson U
… +2 more, Nyrenius J, Zander E
Lakartidningen
· 2025 Apr · PMID 40241535
The transition from child to adult health care is particularly challenging for youths with neurodevelopmental conditions, and there is a considerable risk of not receiving sufficient care. In Sweden, national and regiona...The transition from child to adult health care is particularly challenging for youths with neurodevelopmental conditions, and there is a considerable risk of not receiving sufficient care. In Sweden, national and regional guidelines on the transition process for psychiatry and habilitation services exist, describing the important steps. Still, there is a lack of explicit quality indicators and evaluation, making it difficult to know explicit results. The role of physicians in this process is sparsely described in the guidelines. Youths, especially those with autism, express dissatisfaction with the transition to adult health care and with the care itself. Further development of person-centered care, evaluation, and follow-up of the transition process as well as cooperation between different care providers and support systems is recommended. Existing research evidence regarding specific transition interventions for this age group needs to be applied.
Adolescents and young adults represent a growing patient group in various clinical settings. To effectively address their needs, healthcare providers must have knowledge about the unique developmental aspects of this age...Adolescents and young adults represent a growing patient group in various clinical settings. To effectively address their needs, healthcare providers must have knowledge about the unique developmental aspects of this age group, which includes physical, psychological, social, and sexual maturation. Young people, defined as ages 10 to 24, experience critical changes in identity formation, autonomy, and social relationships, all of which influence diverse parameters such as health behaviours, pain perception, and treatment outcomes. Developmental milestones are divided into early, middle, and late adolescence/young adulthood, each with its specific characteristics regarding bodily changes, identity exploration, and increased independence. The structural and functional maturation of the brain continues into the mid-20s, affecting decision-making and risk perception. Health behaviours in youth are important predictors of long-term well-being, while chronic illness during this period can complicate the biopsychosocial development process. The concept of adolescent-friendly health care emphasizes a tailored approach, including appropriate communication, respect for confidentiality, and support for decision-making autonomy. As health care systems strive to improve care for young people, there is a need for integrated, youth-centered services that account for both medical and psychosocial factors. This approach has been shown to enhance patient satisfaction and improve long-term health outcomes for young patients.
Choosing Wisely (CW) is an international campaign aiming to reduce low-value care, care without patient benefit. Despite increasing costs in health care, low-value care is a widespread phenomenon. The Swedish Society of...Choosing Wisely (CW) is an international campaign aiming to reduce low-value care, care without patient benefit. Despite increasing costs in health care, low-value care is a widespread phenomenon. The Swedish Society of Medicine has recently launched CW in Sweden. Other countries have introduced the concept in medical schools. In the present project, we wanted to investigate whether this could be done in Sweden. We interviewed representatives from medical schools in Canada, Norway, and Sweden, to learn how CW was introduced and integrated in medical education in other countries and to examine the knowledge and attitudes about CW among Swedish medical school faculty, to understand how and if CW could be integrated into the Swedish medical curriculum. We found three ways of implementing CW into a medical curriculum: by letting medical students identify teaching activities, such as case discussions, seminars, and lectures, where CW could be integrated ("bottom-up"), by letting program boards change curricula ("top-down"), or by letting medical students work with specific de-implementation projects as part of their scientific projects ("de-implementation lists"). We also found that faculty at Swedish medical schools are aware of CW to a varying degree, but they agree that reducing low-value care is important and that CW could be implemented already in medical school, perhaps by integrating CW into so-called entrustable professional activities, EPA.
Atrial fibrillation is a chronic and complex condition. The new 2024 European Society of Cardiology guidelines emphasize a holistic approach to managing atrial fibrillation, introducing the AF-CARE framework. The guideli...Atrial fibrillation is a chronic and complex condition. The new 2024 European Society of Cardiology guidelines emphasize a holistic approach to managing atrial fibrillation, introducing the AF-CARE framework. The guidelines prioritize addressing (C) Comorbidities and risk factors for all patients, irrespective of their thromboembolic risk or symptoms. This is followed by strategies to (A) Avoid stroke and thromboembolism, and to (R) Reduce symptoms through rate and rhythm control, potentially improving prognosis. Finally, (E) Evaluation and reassessment should be individualized, with a dynamic approach that adapts to changes in the patient's condition over time.
Treutiger I, Haas J, Klevebro S
… +4 more, Malmborg P, Paulsson S, Rosenborg K, Rahm C
Lakartidningen
· 2025 Apr · PMID 40200890
»Ungdomsenheten« at Södersjukhuset in Stockholm started as a project in 2000, focusing on adolescents aged 13 to 20 with chronic illnesses and complex health problems. The aim is to provide tailored medical care for adol...»Ungdomsenheten« at Södersjukhuset in Stockholm started as a project in 2000, focusing on adolescents aged 13 to 20 with chronic illnesses and complex health problems. The aim is to provide tailored medical care for adolescents within a youth-friendly environment. The unit employs a multidisciplinary team, including pediatricians, gynecologists, a pain specialist, nurses, physiotherapists, and an occupational therapist. A close collaboration with social counsellors and psychologists further ensures comprehensive adolescent care at the unit. Transitioning from pediatric to adult care is a key focus, empowering youth in managing their health as they approach adulthood.
Sparud Lundin C, Saarijärvi M, Skogby S
… +4 more, Acuna Mora M, Burström Å, Lena Brorsson A, Bratt EL
Lakartidningen
· 2025 Apr · PMID 40200889
The Stepstones transition project began in 2014 to improve care for young people with chronic conditions transitioning from pediatric to adult healthcare. Based on a Belgian transition program, it was adapted to Swedish...The Stepstones transition project began in 2014 to improve care for young people with chronic conditions transitioning from pediatric to adult healthcare. Based on a Belgian transition program, it was adapted to Swedish settings through preparatory studies and literature reviews. Findings highlighted that early planning and parental involvement are crucial for a successful transition. Empowerment, aiming at increasing adolescents' winvolvement and responsibility in their care, is a key goal of the program. Stepstones implements person-centered care through eight components, with the transition coordinator playing a central role. The program focuses on empowering adolescents through goal setting, learning about their illness and implications for their daily lives. It has shown positive effects, such as increased empowerment and disease-specific knowledge, and has been tested in adolescents with congenital heart disease.
Jarfelt M, Hjorth L, Petersen C
… +5 more, Enskär K, Olsson M, Mattson M, Nath S, Herslow M
Lakartidningen
· 2025 Apr · PMID 40200888
Childhood cancer survivors (CCS) are at increased risk of developing several late complications, often in adulthood. It is therefore essential that accurate information is provided to both the CCS and healthcare provider...Childhood cancer survivors (CCS) are at increased risk of developing several late complications, often in adulthood. It is therefore essential that accurate information is provided to both the CCS and healthcare providers when transitioning to adult healthcare. Since the first publication of the Swedish national guidelines for long-term follow-up in 2016, long-term follow-up clinics for adult CCS have been established at all six university hospitals, offering at least one visit at the age of twenty-five. Dedicated transition clinics at paediatric cancer centres offer two to three visits during adolescence in preparation for the transition, including an individual dialogue between the young person and the paediatric oncologist or nurse. Further developments are ongoing, including the introduction of specialised transition nurses and a more structured element into the visits.
Amputation injuries to the face and scalp, although uncommon, can have devastating consequences. Microvascular replantation of the amputated tissue in the facial or scalp region often yields the best functional and aesth...Amputation injuries to the face and scalp, although uncommon, can have devastating consequences. Microvascular replantation of the amputated tissue in the facial or scalp region often yields the best functional and aesthetic outcomes. It is crucial to promptly assess amputation injuries and contact a reconstructive plastic surgery service to discuss the possibility of microvascular replantation. While awaiting surgery, the amputated tissue should be wrapped in moist gauze, placed in a sealed plastic bag, and stored in an ice water bath or a refrigerator. In the literature, the success rate for microvascular replantation of the face and scalp exceeds 70% for urgent replantations. Notably, successful replantation has been reported even after extended cold ischemia times. However, it is essential to recognize that longer ischemic times are associated with an increased risk of replantation failure.
Pacing-induced cardiomyopathy (PIC) is a condition that leads to increased morbidity and mortality. Unfortunately, it is not uncommon after implantation of a pacemaker with a right ventricular lead. Right ventricular pac...Pacing-induced cardiomyopathy (PIC) is a condition that leads to increased morbidity and mortality. Unfortunately, it is not uncommon after implantation of a pacemaker with a right ventricular lead. Right ventricular pacing creates a delayed electrical activation, leading to dyssynchronous contraction, and it is a known risk factor for PIC. Left bundle branch area pacing (LBBAP) is a form of pacing that delivers a physiological activation of the left ventricle. The lead is implanted deep in the septum and captures the left bundle branch of the conduction system. This allows for a synchronous electrical activation of the ventricles. LBBAP has shorter ventricular activation time and less dyssynchronous contraction compared to right ventricular pacing. Recently, studies have shown that the long-term electrical parameters are comparable to right ventricular leads. Randomized trials are underway to compare LBBAP with right ventricular pacing and biventricular pacing.
Sirko A, B Valadka A, Yadav G
… +2 more, A Armonda R, K Sköld M
Lakartidningen
· 2025 Mar · PMID 40135270
Unlike in previous recent conflicts, the casualties in the Ukrainian war are close to advanced medical facilities. We review lessons learned by the neurosurgical service at Mechnikov Dnipropetrovsk Regional Clinical Hosp...Unlike in previous recent conflicts, the casualties in the Ukrainian war are close to advanced medical facilities. We review lessons learned by the neurosurgical service at Mechnikov Dnipropetrovsk Regional Clinical Hospital (MDRCH). Aggressive and early combined treatment of injuries to the brain, the skull and the skull base reduces complications and improves outcomes. Use of the operating microscope optimizes careful handling of tissue. Pericranial flaps that retain vascularized pedicles are extensively used. Initial CT scanning and catheter-based angiography is liberally used if injury to the cerebral vasculature is seen or suspected. Traumatic pseudoaneurysms and arteriovenous fistulae are immediately treated, followed by open craniotomy for hematoma evacuation and calvarial reconstruction. With early and aggressive surgery and postoperative critical care, even the most severely injured patients can expect good recoveries. Premature decisions to withhold or withdraw care should be avoided.
Dahlén E, Bergman Perland E, Maria Bergsten E
… +2 more, Arthurson V, Kimland E
Lakartidningen
· 2025 Mar · PMID 40135269
The prescribing of melatonin continues to increase and occurs partially off-label. The largest increase is among children aged 6-17 years. During the COVID pandemic, the over-the-counter sales of melatonin increased desp...The prescribing of melatonin continues to increase and occurs partially off-label. The largest increase is among children aged 6-17 years. During the COVID pandemic, the over-the-counter sales of melatonin increased despite jet lag in adults being the only approved indication. The Swedish Medical Products Agency notes an increased interest in melatonin and signals of unwarranted sale of melatonin as a dietary supplement. There is a risk that melatonin medications are used too casually. In addition, knowledge of the long-term effects of melatonin use is scarce. The increasing use of melatonin needs to be highlighted and monitored to ensure rational use.
Sleep disorders are common in children. The Swedish Medical Products Agency recommends careful evaluation of children with sleep disorders with focus on underlying disease and lifestyle factors. The treatment of choice i...Sleep disorders are common in children. The Swedish Medical Products Agency recommends careful evaluation of children with sleep disorders with focus on underlying disease and lifestyle factors. The treatment of choice is implementation of sleep hygiene advice. Medical treatment is rarely necessary. The endogenous melatonin level is affected by lifestyle factors such as exposure to darkness and blue light at nighttime. Addressing lifestyle factors is necessary to secure an effective treatment. Within child and adolescent psychiatry, there is a trend of increasing prescription of drug treatment for various diagnoses, including sleep disorders. Caregivers may express a desire to find an easy solution to a complex problem, but extensive prescription of melatonin should be avoided. Melatonin has physiological effects exceeding regulation of sleep. The potential long-term effects of melatonin treatment are not known. Children are vulnerable and should be treated with extra caution.
Thyrotoxicosis caused by human chorionic gonadotropin (hCG) is a rare form of hyperthyroidism, often associated with conditions involving very high levels of hCG and sometimes seen in women with gestational hyperthyroidi...Thyrotoxicosis caused by human chorionic gonadotropin (hCG) is a rare form of hyperthyroidism, often associated with conditions involving very high levels of hCG and sometimes seen in women with gestational hyperthyroidism. Here we present a case of a 53-year-old man with metastatic non-seminomatous testicular cancer (NSGCT) and concomitant thyrotoxicosis related to extremely high hCG levels. The patient sought care with symptoms such as fatigue, weight loss, nausea, and a distended abdomen. Laboratory work-ups showed thyrotoxicosis with suppressed TSH and elevated levels of free T4 and T3. At the same time, a grossly elevated hCG level of over 100,000 IU/L was detected. Further diagnostics confirmed NSGCT with extensive liver, lung, and lymph node metastases. The patient was treated with chemotherapy, which resulted in rapid reduction of hCG levels and remission of thyrotoxicosis. Thyrotoxicosis induced by hCG should be considered in patients with germ cell tumors and very high hCG levels. Effective treatment of the underlying malignancy can lead to normalization of the thyroid function.