The Sahlgrenska University Hospital (Swedish: Sahlgrenska Universitetssjukhuset) is a hospital network associated with the Sahlgrenska Academy at the University of Gothenburg in Gothenburg, Sweden. With 17,000 employees the hospital is the largest hospital in Sweden by a considerable margin, and the second largest hospital in Europe. It has 2,000 beds distributed across three campuses in Sahlgrenska, Östra, and Mölndal. It provides emergency and basic care for the 700,000 inhabitants of the Göteborg region and offers highly specialised care for the 1.7 million inhabitants of West Sweden. It is named after philanthropist Niclas Sahlgren.
The improved management of craniosynostosis has let emerge concomitant anatomical, functional and clinical features that are frequently faced later in life (especially by syndromic patients) and might variably encompass the cranial nerves due to stenosis of bone foramina, abnormal intracranial pressure, or anomalous gene-driven development. Clinical consequences vary according to the affected nerves, the severity and the pathogenesis of nerve involvement but also might depend on early appropriate treatment. Vision, smell and hearing, but also feeding, swallowing and facial mimic or esthesia might be affected with a possible dramatic impact on the overall development of the child and on its quality of life. A systematic literature review regarding cranial nerves involvement in craniosynostosis was performed, including case series and case reports. According to PRISMA criteria, PubMed and Scopus were searched up to February 2025 by two independent reviewers. Relevant English-language case reports and case series were included, while duplicate or aggregated data were excluded. Reference lists were screened, and disagreements were resolved by consensus. Sixty-three papers were considered. Data extracted from the papers were subjected to statistical analysis only for the optic nerve, owing to the paucity of data concerning the other cranial nerves. Optic nerve involvement was reported in 140 patients (44 papers) and included papilledema (69 patients), optic nerve atrophy (69 patients), and optic nerve hypoplasia (5 patients). Visual function was reduced in 65 patients, normal in 9. In sixty-eight patients (49
Although the technical and diagnostic quality of gastrointestinal endoscopic ultrasound (EUS) has been thoroughly studied, research on the patient experiences of EUS remains limited. This study aimed to identify factors influencing the patient’s experience of EUS performed during conscious sedation. Between September 2020 and December 2021, a cross sectional study was conducted at a high-volume, tertiary endoscopy centre in western Sweden. All outpatients aged > 18 years who underwent EUS were eligible for inclusion. Participants completed a study-specific questionnaire for Patient-Reported Experience Measures (PREM), assessing pre-procedure anxiety, procedure pain, and discomfort of EUS, using the Visual Analogue Scale (VAS). Patient- and procedure related factors were analysed in relation to VAS scores as predictors of patient experience. A total of 306 patients (median age 69 years; 163 women) were included. PREM indicated care as dignified and respectful. Median VAS scores were pre procedure anxiety, 24 (IQR 7–55); procedural pain, 7 (IQR 3–18); and procedural discomfort, 10 (IQR 3–22). A previous negative endoscopy experience was the strongest predictor of higher preprocedural anxiety, followed by female gender. These factors were also common among patients reporting higher levels of procedural pain and discomfort. In general, routine EUS is well tolerated by patients with minimal pain and discomfort during conscious sedation. However, previous negative experiences and female gender were associated with higher pre-procedure anxiety and greater procedural discomfort. These findings stress the importance of personalized care, where patients at increased risk should be offered tailored information and supportive strategies.
Abstract Objective Cardiac involvement (CI) is a major determinant of poor prognosis in idiopathic inflammatory myopathies (IIM). Soluble suppression of tumorigenicity 2 (sST2) is a biomarker linked to cardiac inflammation and remodelling, but its role has scarcely been explored in IIM. We aimed to investigate the levels of sST2 and its longitudinal profile in patients with IIM and CI. Methods Serum sST2 levels were measured longitudinally over the course of two years in 34 patients with newly diagnosed IIM and in 109 patients with established IIM from a cross-sectional cohort, as well as in age and gender matched healthy controls (HC) and in patients with rheumatoid arthritis (RA). CI was assessed using cardiac magnetic resonance (CMR) in newly diagnosed IIM patients. Associations between sST2 and clinical parameters were analyzed. Results Patients with newly diagnosed IIM exhibited significantly higher sST2 levels at diagnosis compared to HC (P < 0.0001) and patients with established IIM (P < 0.0001). sST2 levels were highest at diagnosis, decreased significantly by 6 months, and remained lower during follow-up. sST2 levels were positively associated with cardiac troponin I and N-terminal pro-brain natriuretic peptide (P = 0.0001 and P = 0.0001, respectively). Importantly, IIM patients with active CMR-verified CI exhibited significantly higher sST2 levels than those without ongoing CI. In contrast, patients with established IIM had sST2 levels comparable to HC and RA patients. Conclusion sST2 is elevated in early IIM and closely associated with cardiac biomarkers and CMR-verified cardiac inflammation. Its dynamic decline with treatment suggests potential utility as a biomarker for early detection and monitoring of CI in IIM.
BACKGROUND:Ensuring that national governance and healthcare systems include the organization and provision of palliative care in all care settings for all patients in need is a global imperative. In cancer care, early palliative care can improve quality of life for patients and families and receiving specialised palliative care increases opportunities for care and death in the preferred place, which for a majority is the own home. In Sweden, national general health policy only vaguely addresses palliative care, leading to the introduction of specific guidelines in 2013. These coexist with national disease-specific guidelines for cancer care that are ambiguous in their conceptualisation and inclusion of palliative care. From a governance and organisation perspective, place of death serves as a key indicator of palliative care infrastructure and organisation. Since policy initiation in 2013, hospital has remained the predominant place of death in Sweden. Further, regional disparities persist and are influenced by factors such as age, sex, and access to specialised services, pointing to inequities and unsatisfactory governance and organisation of palliative care. The aim of this study was to explore the perspectives of cancer care leads and patient representatives on national governance and organisation of palliative cancer care. METHODS:Interpretive description methodology was used to generate and inductively analyse data from group discussions and individual interviews with 36 cancer- and palliative care leads, and patient representatives from the six Swedish regional cancer centres. RESULTS:The analysis revealed patterns of interdependent conditions that, from the perspectives of cancer care leads and patient representatives shape the governance and organisation of palliative cancer care and seemingly trigger ambiguity regarding responsibilities and inequalities in service provision: Multilevel knowledge gaps about palliative care; Challenges and complexities of providing palliative care in a fragmented healthcare system; and Policy impact and ownership problems. CONCLUSIONS:The study revealed significant challenges in national palliative cancer care governance, primarily due to a multilevel knowledge gap about palliative care, a fragmented healthcare system, and non-directive national policies. Integration of mandatory national minimum requirements for palliative care in national policy, and clearer standards for palliative care resource allocation are needed. Comprehensive strategies and coordinated efforts that can be uniformly implemented across regions, and establishing national collaborative spaces for regional stakeholders are essential to ensure equitable and timely access to palliative care for all patients with advanced cancer.
BACKGROUND:The quality of midwifery education and the quality of care are influenced by the capabilities of those who educate future midwives. In Bangladesh, where midwifery is a new profession, it is crucial that midwifery educators are supported, prepared and equipped to teach in both academic and clinical settings. This study aimed to identify the professional development needs of midwifery educators in Bangladesh. METHODS:A cross-sectional online survey consisting of closed and open-ended questions, and statements answered using a four- and five-point response scale, was conducted. A total of 118 individuals responded to the survey, of whom 113 met the inclusion criteria and were included in the final analysis. Data were analysed using descriptive statistics including frequencies and percentages and inferential statistics (Spearman's rank-order correlation and ANOVA). Internal consistency was evaluated using Cronbach's alpha coefficient. Responses to the open-ended questions were analysed using systematic text condensation. RESULTS:Among 113 respondents, working as an educator the majority (78%) held a master's degree. The most reported development needs were in midwifery theory (41.6%), face-to-face teaching (41.6%) and clinical simulation (39.8%). Research capacity was also a key area, with 38.1% reporting a need for support in scientific manuscript writing. Leadership and management development were prioritised by 37.2%. Educators preferred face-to-face programme delivery (53.1%) and short, intensive formats (74%). Open-ended responses underscored a need for structured pedagogical training, as well as research and leadership mentorship. CONCLUSIONS:Continuous professional development for educators in Bangladesh is needed, particularly in education, research, and leadership. To address these needs, the study highlights the importance of incorporating its identified needs into a national educator development programme. We propose co-creating such a programme, guided by the ICM Global Standards for Midwife Faculty Development, to ensure a structured, relevant, and sustainable response.
