Navigating the complex dynamics of anesthesiologists' professional identity formation in the context of their specialty training program: a phenomenographic perspective.

Background: A specialty training program is crucial for shaping future specialist doctors, imparting clinical knowledge and skills, and fostering a robust professional identity. This study investigates how anesthesiologists develop their professional identity while navigating unique challenges specific to their specialty. The formation of professional identity in anesthesiology significantly influences doctors' well-being, teamwork, and ultimately patient care, making it a crucial aspect of anesthesiology education.

First mobilisation after abdominal and cardiothoracic surgery: when is it actually performed? A national, multicentre, cross-sectional study.

Objectives: Knowledge of clinical practice regarding mobilisation after surgery is lacking. This study therefore aimed to reveal current mobilisation routines after abdominal and cardiothoracic surgery and to identify factors associated with mobilisation within 6 hours postoperatively.

Design: A prospective observational national multicentre study.

End-of-life decision-making in critically ill old patients with and without coronavirus disease 2019.

Background: There are few studies on the differences in end-of-life decisions making in critically ill patients with and without coronavirus disease 2019 (COVID-19). This study aimed to investigate the independent factors that predicted the decision to withdraw or withhold life-sustaining treatments (LST) in critically ill patients and if these decisions were based on different variables for critically ill patients with COVID-19 compared to those for critically ill patients with other diagnoses in a Swedish intensive care unit.

Methods: This observational pilot study was performed at Sahlgrenska University Hospital, Gothenburg, Sweden.

Development of and adherence to an ERAS and prehabilitation protocol for patients undergoing pancreatic surgery: An observational study.

Background And Objective: There are still gaps in knowledge concerning the adherence to different multimodal pathways in pancreatic surgery. The aim of this trial was to explore and evaluate an Enhanced Recovery After Surgery (ERAS) and prehabilitation protocol in patients undergoing open pancreatic surgery.

Methods: Three groups of patients were included: two prospective series of 75 patients undergoing open pancreatic surgery following an ERAS protocol with or without prehabilitation, and one group of 55 historical controls.

Long-term outcomes after aneurysmal subarachnoid hemorrhage: A prospective observational cohort study.

Objectives: The survival rates for patients affected by aneurysmal subarachnoid hemorrhage (aSAH) have increased in recent years; however, many patients continue to develop cognitive dysfunctions that affect their quality of life. The commonly used outcome measures often fail to identify these cognitive dysfunctions. This study aimed to evaluate the long-term outcomes at 1 and 3 years after aSAH to assess changes over time and relate outcomes to patient characteristics and events during the acute phase.

Patterns and determinants of blood transfusion in intensive care in Sweden between 2010 and 2018: A nationwide, retrospective cohort study.

Background: Intensive care unit (ICU) patients are transfused with blood products for a number of reasons, from massive ongoing hemorrhage, to mild anemia following blood sampling, combined with bone marrow depression due to critical illness. There's a paucity of data on transfusions in ICUs and most studies are based on audits or surveys. The aim of this study was to provide a complete picture of ICU-related transfusions in Sweden.

Machine learning analysis of heart rate variability to detect delayed cerebral ischemia in subarachnoid hemorrhage.

Objectives: Approximately 30% of patients with aneurysmal subarachnoid hemorrhage (aSAH) develop delayed cerebral ischemia (DCI). DCI is associated with increased mortality and persistent neurological deficits. This study aimed to analyze heart rate variability (HRV) data from patients with aSAH using machine learning to evaluate whether specific patterns could be found in patients developing DCI.

Reasons for physician-related variability in end-of-life decision-making in intensive care.

Background: There is increasing evidence that the individual physician is the main factor influencing variability in end-of-life decision-making in intensive care units. End-of-life decisions are complex and should be adapted to each patient. Physician-related variability is problematic as it may result in unequal assessments that affect patient outcomes.

Long-term outcome after intensive care for COVID-19: differences between men and women-a nationwide cohort study.

Background: Questions remain about long-term outcome for COVID-19 patients in general, and differences between men and women in particular given the fact that men seem to suffer a more dramatic course of the disease. We therefore analysed outcome beyond 90 days in ICU patients with COVID-19, with special focus on differences between men and women.

Methods: We identified all patient ≥ 18 years with COVID-19 admitted between March 6 and June 30, 2020, in the Swedish Intensive Care Registry.

Association between inflammatory response and outcome after subarachnoid haemorrhage.

Objectives: Recent reports suggest an association between the inflammatory response after aneurysmal subarachnoid haemorrhage (aSAH) and patients' outcome. The primary aim of this study was to identify a potential association between the inflammatory response after aSAH and 1-year outcome. The secondary aim was to investigate whether the inflammatory response after aSAH could predict the development of delayed cerebral ischaemia (DCI).

Cerebral ischemia detection using artificial intelligence (CIDAI)-A study protocol.

Background: The onset of cerebral ischemia is difficult to predict in patients with altered consciousness using the methods available. We hypothesize that changes in Heart Rate Variability (HRV), Near-Infrared Spectroscopy (NIRS), and Electroencephalography (EEG) correlated with clinical data and processed by artificial intelligence (AI) can indicate the development of imminent cerebral ischemia and reperfusion, respectively. This study aimed to develop a method that enables detection of imminent cerebral ischemia in unconscious patients, noninvasively and with the support of AI.

Heart rate variability monitoring for the detection of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage.

Background: Delayed cerebral ischemia (DCI) is a major cause of impaired outcome after aneurysmal subarachnoidal hemorrhage (aSAH). In this observational cohort study we investigated whether changes in heart rate variability (HRV) that precede DCI could be detected.

Methods: Sixty-four patients with aSAH were included.

Intraperitoneal ropivacaine reduces time interval to initiation of chemotherapy after surgery for advanced ovarian cancer: randomised controlled double-blind pilot study.

Background: Advanced-stage ovarian cancer has a poor prognosis; surgical resection with the intent to leave no residual tumour followed by adjuvant chemotherapy is the standard treatment. Local anaesthetics (LA) have anti-inflammatory and analgesic effects. We hypothesised that intraperitoneal LA (IPLA) would lead to improved postoperative recovery, better pain relief, and earlier start of chemotherapy.

Swedish intensivists' experiences and attitudes regarding end-of-life decisions.

Background: To make end-of-life (EOL) decisions is a complex and challenging task for intensive care physicians and a substantial variability in this process has been previously reported. However, a deeper understanding of intensivists' experiences and attitudes regarding the decision-making process is still, to a large extent, lacking. The primary aim of this study was to address Swedish intensivists' experiences, beliefs and attitudes regarding decision-making pertaining to EOL decisions.

A Challenging diagnosis that eventually results in a life-threatening condition: Addison's disease and adrenal crisis.

A young man endures many years with classic symptoms of Addison's disease due to difficulties in distinguishing this rare condition, whose features are non-specific and insidious in nature. With all facts on hand, the patient's notable history of psychiatric disorders, namely depression, anxiety and social isolation, as well as signs of extreme fatigue and syncope may well have been caused by a gradual onset of primary adrenal insufficiency. Long delays in diagnosis are not uncommon, as in this case where the actual condition was identified just in time when the patient presented with a life-threatening cardiovascular collapse.

Does intraperitoneal ropivacaine reduce postoperative inflammation? A prospective, double-blind, placebo-controlled pilot study.

Background: Postoperative inflammation is a common consequence of surgery and the ensuing stress response. Local anesthetics have anti-inflammatory properties. The primary aim of this study was to evaluate if LA administrated intraperitoneally perioperatively might inhibit expression of inflammatory cytokines.

Age, SAPS 3 and female sex are associated with decisions to withdraw or withhold intensive care.

Background: Intensive care treat critically ill patients. When intensive care is not considered beneficial for the patient, decisions to withdraw or withhold treatments are made. We aimed to identify independent patient variables that increase the odds for receiving a decision to withdraw or withhold intensive care.

Glial dysfunction and persistent neuropathic postsurgical pain.

Background: Acute pain in response to injury is an important mechanism that serves to protect living beings from harm. However, persistent pain remaining long after the injury has healed serves no useful purpose and is a disabling condition. Persistent postsurgical pain, which is pain that lasts more than 3 months after surgery, affects 10-50% of patients undergoing elective surgery.

Ultralow Dose of Naloxone as an Adjuvant to Intrathecal Morphine Infusion Improves Perceived Quality of Sleep but Fails to Alter Persistent Pain: A Randomized, Double-blind, Controlled Study.

Introduction: This randomized, cross-over, double-blind, controlled study of continuous intrathecal morphine administration in patients with severe, long-term pain addresses whether the supplementation of low doses of naloxone in this setting is associated with beneficial clinical effects.

Methods: All of the study subjects (n=11) provided informed consent and were recruited from a subset of patients who were already undergoing long-term treatment with continuous intrathecal morphine because of difficult-to-treat pain. The patients were (in a randomized order) also given intrathecal naloxone (40 ng/24 h or 400 ng/24 h).

Ultralow concentrations of bupivacaine exert anti-inflammatory effects on inflammation-reactive astrocytes.

Bupivacaine is a widely used, local anesthetic agent that blocks voltage-gated Na(+) channels when used for neuro-axial blockades. Much lower concentrations of bupivacaine than in normal clinical use, < 10(-8)  m, evoked Ca(2+) transients in astrocytes from rat cerebral cortex, that were inositol trisphosphate receptor-dependent. We investigated whether bupivacaine exerts an influence on the Ca(2+) signaling and interleukin-1β (IL-1β) secretion in inflammation-reactive astrocytes when used at ultralow concentrations, < 10(-8)  m.

Naloxone and ouabain in ultralow concentrations restore Na+/K+-ATPase and cytoskeleton in lipopolysaccharide-treated astrocytes.

Astrocytes respond to inflammatory stimuli and may be important modulators of the inflammatory response in the nervous system. This study aimed first to assess how astrocytes in primary culture behave in response to inflammatory stimuli concerning intracellular Ca(2+) responses, expression of Toll-like receptor 4 (TLR4), Na(+)/K(+)-ATPase, actin filament organization, and expression of cytokines. In a cell culture model with lipopolysaccharide (LPS), astrocyte response was assessed first in the acute phase and then after incubation with LPS for 1-48 h.

The value of mentorship within nursing organizations.

Problem: Hospitals are facing nurse retention challenges in the new millennium. Nurses are abandoning the bedside because of job dissatisfaction. Mentorship programs should be developed to enhance nursing satisfaction and thus improve retention and ultimately patient outcomes.