Danderyd Hospital (Swedish: Danderyds sjukhus) is a hospital in Danderyd Municipality in northern Greater Stockholm opened in 1922. Until 1964 it was called Centrallasarettet i Stocksund.As a result of rising levels of open threats to staff from patients and their relatives, in the spring of 2018 staff received anonymous name badges and security guards escorted staff to their private vehicles on the car park to protect them from threatening individuals waiting for staff to end their shift.
Purpose Hand osteoarthritis poses a growing health concern, necessitating accurate and efficient diagnostic methods. Convolutional neural networks offer a promising approach for automating osteoarthritis classification, but their application to hand osteoarthritis remains underexplored. This study aimed to develop and evaluate a convolutional neural network model for detecting and classifying hand osteoarthritis on plain radiographs according to the Kellgren-Lawrence (KL) and modified Eaton-Littler (EL) classification systems.Methods A total of 7515 examinations were retrospectively collected (27,965 images) from one hospital (2002-2016) and split into training (n = 7,100), validation (n = 415), and test (n = 327) sets with no patient overlap. Images were labelled for presence, grade, and joint involvement (interphalangeal, metacarpophalangeal, thumb carpometacarpal, and scaphotrapeziotrapezoidal joints). A residual-network model with 39 convolutional layers was trained from scratch in PyTorch with data augmentation (random rotation, flipping, and cropping).Results The convolutional neural network model achieved adequate performance in detecting hand OA (AUC = 0.91, sensitivity = 90%, specificity = 83%) and classifying osteoarthritis grades. However, lower osteoarthritis grades were challenging, particularly in the CMC1 and STT joints. Despite limitations in inter-reader reliability of classification systems, the convolutional neural network model demonstrated capability in localising osteoarthritis findings.Conclusion This study demonstrates the feasibility of convolutional neural network models in automating hand osteoarthritis detection and classification. The model's adequate performance suggests its potential for clinical use in enhancing classification accuracy and streamlining workflows. Challenges in lower-grade osteoarthritis classification highlight the need for improved standardisation in classification systems. Further research is warranted to validate and refine the model's performance in diverse clinical settings and assess its real-world implications.Level of Evidence Level III.
Background Neuromuscular blocking agents (NMBA) provide optimal conditions for tracheal intubation. A high dose of opioid can be used as an alternative but may give suboptimal conditions for intubation. The use of a video laryngoscope for intubation might eliminate this potential difference.Methods A survey examining clinical practice regarding tracheal intubation with and without NMBA and use of video laryngoscopes was conducted in Sweden and Denmark.Results 1771 out of 3181 (56%) of invited anaesthetists responded. Overall, 1365/1771 (77%) preferred using NMBAs for non-acute tracheal intubation with a considerably higher NMBA preference in Sweden 1011/1073 (94%) than in Denmark 354/700 (51%). A high proportion of Danish anaesthetists 327/700 (47%) compared to 40/1071 (4%) of Swedish anaesthetists reported primarily using opioids without NMBA. Remifentanil was the preferred opioid (1158/1361 (85%)) for intubation without NMBA. The reasons for using NMBA were improved intubating conditions (948/1771 (54%)), departmental tradition (285/1771 (16%)), adherence to local guidelines (264/1771 (15%)), and adherence to national/international guidelines (143/1771 (8%)). Video laryngoscopes were present in every operating theatre for 349/700 (50%) of Danish anaesthetists and 131/1071 (12%) of Swedish anaesthetists. Video laryngoscopes were easily accessible outside the operating room for 350/700 (50%) of Danish anaesthetists and 940/1071 (88%) of Swedish anaesthetists.Conclusions NMBA use remains the standard for non-acute tracheal intubation. However, a substantial number of anaesthetists regularly employ a NMBA-free approach facilitated by high-potency opioids and video laryngoscopy, particularly in Denmark. These findings emphasise the need for further research and subsequently updated evidence-based guidance to support safe and effective intubation practices.Editorial Comment This study, reporting a survey of anesthesia practitioners in Sweden and Denmark assessed preferences concerning how the respondents would manage a series of case scenarios concerning anesthetic drug choices for facilitation of intubation and employment of video laryngoscopy. Quite a bit of variation for preferences is presented by the responses concerning neuromuscular blockade or not to facilitate intubation.
Objective: There is limited knowledge about how female specific factors such as fluctuating sex hormones influence symptom display and health-related conditions that are unique to, or more prevalent in females with ADHD. This study aims to investigate how women of reproductive age with ADHD experience their ADHD symptoms and well-being in relation to hormonal fluctuations, and secondly, how they perceive hormonal and reproductive counseling in healthcare.Method: Semi-structured interviews were conducted with 14 women with ADHD and analyzed using inductive thematic analysis.Results: Three main themes emerged from the analysis; (1) Controlled by female hormones, (2) Frustration with lack of knowledge/understanding, and (3) Living with ADHD and comorbidities. Many women have experienced challenges and fluctuations related to hormonal changes during their menstrual cycles and in different stages of life. Using hormones to stabilize mood and impulsivity and adjusting stimulant doses were suggested as potential solutions. Participants expressed frustration about the lack of knowledge, interest, and understanding from healthcare professionals regarding ADHD and how hormones influenced symptoms of ADHD and comorbidities in women.Conclusion: This qualitative study highlights the impact of cyclical hormonal fluctuations on daily functioning across the menstrual cycle. Specifically, participants reported cyclic patterns of high energy and productivity related to ovulation followed by low energy and difficulty managing tasks in the premenstrual week. This aligns with clinical experience, anecdotal evidence, and limited literature that suggest that women with ADHD may be particularly vulnerable to hormonal fluctuations. Our findings suggest that especially the premenstrual phase is a challenging time for women with ADHD. Our results emphasize the need for healthcare professionals to improve their understanding of the role sex hormones and the menstrual cycle play in female ADHD. The potential effect of adjusting ADHD medication dosage and introducing hormonal treatment for premenstrual dysphoric disorder (PMDD) in women with ADHD should be further explored.
BACKGROUND:Routine use of neuromuscular blocking agents (NMBAs) is widely recommended to facilitate tracheal intubation. However, NMBA use is associated with potential adverse effects, including postoperative respiratory complications, intraoperative awareness and anaphylaxis. Bolus remifentanil is an alternative, but evidence supporting its effectiveness on first-pass success when using video laryngoscopy is sparse. We hypothesise that rocuronium reduces failed first-pass and the risk of induction- or airway-management-related complications compared with bolus remifentanil when using a video laryngoscope. METHODS:ROCVIDEO is a Danish-Swedish, blinded, randomised, controlled trial comparing rocuronium (0.6 mg/kg) with remifentanil (4 μg/kg) at anaesthesia induction for facilitating orotracheal intubation using video laryngoscopy. Eligible adult participants (ASA-class I-III) undergoing general anaesthesia with video laryngoscopy-assisted orotracheal intubation will be randomised to rocuronium or remifentanil in a ratio of 1:1. Anaesthesia will be induced with propofol and optional fentanyl or sufentanil. Intubation will be initiated 120 s after administration of trial medicine. The two co-primary outcomes are: (I) anaesthesia-related adverse events and (II) failed first-pass intubation. Secondary outcomes include patient satisfaction, length of stay in the post anaesthesia care unit and serious adverse events. The trial will randomise 2684 participants to be able to detect a 30% relative risk reduction in failed first pass intubation and anaesthesia-related adverse events, with corresponding power of 80% and 99%, respectively, using a two-sided α of 0.025. PERSPECTIVES:Given the global volume of tracheal intubation, even small differences may have substantial clinical implications. ROCVIDEO will generate high-quality evidence to inform future guidelines aiming to improve global clinical practice. STATUS:As of 15 June 2026, the trial has randomised 707 participants across 15 sites. Recruitment is expected to be completed in the third quarter of 2027. TRIAL REGISTRATION:ClinicalTrials.gov: NCT06564857; EUClinicalTrials.eu: 2025-521405-40-01.
Abstract Introduction International guidelines (1) recommend routine NSAID prophylaxis as ‘Level 1A’ evidence for the prevention of post-ERCP pancreatitis. The aim of this study was to evaluate the effect of this routine in an unselected population in a high-volume biliary surgery center over two decades, with a particular focus on how the implementation of guidelines affects outcomes. The unit routinely introduced Diclofenac 100mg sup prior to ERCP in 2016. A recently published meta-analysis has questioned the value of NSAIDs as prophylaxis against post-ERCP pancreatitis (2) and previous meta-analysis has pointed to NSAIDs as a triggering risk factor for pancreatitis (3). Methods 6174 consecutive ERCP procedures with 201 outcomes (2006–2025) with clinic-own quality data from gallriks. Analysis: Multivariable logistic regression. The model adjusts for age, sex, malignancy as an indication for ERCP, surgery time, elective status, previous papillotomy, deep cannulation of pancreatic duct, rendezvous technique, and NSAIDs. Result Variable Odds Ratio (OR) 95% Conf.int. P-value NSAID (preop) 1,709 1,210–2,414 0.002 Elective procedure 1,375 1,024–1,848 0.034 Operation time (min) 1,013 1,007–1,019 <0.001 Age 0,988 0,979–0,996 0.004 Previous papillotomy 0,223 0,105–0,475 <0.001 Rendez-vous 0,658 0,477–0,906 0.010 Discussion The results raise doubts about the international expert groups' evaluation of data in the formulation of guidelines. In a time of guideline-driven care, it may be wise to maintain a healthy skepticism. Variation in care is not always undesirable as it means opportunities to let the tree of knowledge grow where the light is strongest.
