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The Swedish National Guidelines for Bone and Joint Infections were revised during 2018. The work was carried out on behalf of the Swedish Society for Infectious Diseases. The study group consists of senior consultants in infectious diseases, supported by specialists in orthopedic surgery, clinical microbiology and allergology when needed. The study group emphasizes that implant associated infections are challenging and requires multidisciplinary cooperation, including, but not limited to, specialists in orthopedic surgery, infectious diseases, clinical microbiology and radiology for optimal treatment results. All aspects of the clinical management are equally important; selecting the optimal antibiotic prophylaxis in arthroplasty as well as fracture surgery, early diagnosis of infection, adequate treatment, follow-up, and finally a structured evaluation of outcome. Profound and updated knowledge of treatment of biofilm related infection is necessary to achieve optimal results in patients with implant-associated infections. Future challenges include improved decision support for combining surgical treatment with selection of proper antibiotics, as well as management of antibiotic resistance, drug-drug interactions and adverse effects of antibiotic treatment.

MM-ARG, the Swedish maternal maternity mortality group within SFOG (Swedish Society of Obstetrics and Gynecology) has, since 2008, surveyed and analysed maternal deaths in Sweden with the aim to find and give feedback on lessons learned to the medical professions. MM-ARG consists of obstetricians, midwives and anesthetists and the strength of the working model is that the profession itself takes responsibility for the scrutiny. A summary of 67 known maternal deaths from 2007‒2017 is presented. Direct causes of death are dominated by hypertensive disease/preeclampsia, followed by thromboembolic disease, sepsis and obstetric bleeding. Indirect death, where a known or unknown underlying disease is exacerbated by pregnancy, is dominated by cardiovascular disease. This review shows that the diagnostics and clinical management could be improved. Besides obstetrics/gynecology, maternal mortality affects other specialties and thus holds important lessons to many.

The Swedish Association of General Practice has published a set of guidelines for general practitioner's (GPs') learning in general practice/family medicine. This article is a summary of principles, guidelines and applications regarding Swedish GPs' continuing professional development (CPD). We argue that reflection on own practice, reflection with colleagues in small groups and use of written learning plans and portfolios for courses and lectures are important parts of CPD and should be increasingly used and supported by employers. Collection of CME credits for certification purposes does not ensure that educational measures have been effective. Statements of recurring CPD should be incorporated in contracts between health care authorities and health care units.

The Swedish Association for Child and Adolescent Psychiatry conducted a survey among their specialty trainees in 2018. Of the 48% response rate, around 48% admitted hesitancy to continue in their chosen specialty. A further 12% planned to depart from their field after completion of training. Factors associated with discontinuation in training were the perception of ineffective psychotherapeutic treatments and a lack of autonomy at work; which was strongly correlated to the doctor's role and team collaboration. Workload was generally perceived as excessive, with not enough time for after work recovery and the subsequent negative impact on private life. However, these factors were not found to significantly affect trainees' decision to leave. The doctor's role requires better clarification and medical leadership needs to be improved, so that evidence based treatments can be offered.

Syncope is the chief complaint in 1-2 percent of emergency department visits. Syncope belongs to the broader category transient loss of consciousness (TLOC), defined as a short loss of consciousness with loss of awareness and responsiveness, and with subsequent amnesia for the event. Syncope is defined as TLOC due to cerebral hypoperfusion, with rapid onset and spontaneous complete recovery. The main categories of syncope are reflex syncope, orthostatic hypotension, and cardiac syncope. The 2018 guidelines by the European Society of Cardiology emphasizes the process of risk stratification in the initial management of suspected syncope. Risk stratification serves to separate the patients with likely orthostatic and reflex syncope with good prognosis from the patients with likely cardiac syncope and high short-term risk of an adverse outcome. It determines the appropriate next level of care. Further evaluation should be based on clinical suspicion and frequency of symptoms.

This report summarizes some of the most important changes and new recommendations from the ESC ST-elevation myocardial infarction and double antiplatelet therapy guidelines for 2017, which are of interest for physicians managing patients with coronary artery disease.

In 2017 the International League Against Epilepsy (ILAE) published position papers outlining new classifications of seizures and epilepsies. The aims of the new documents are to encompass advances in the field, provide a conceptual framework for future developments, and facilitate communication. In practice, the terminology is somewhat revised. For seizures the terms "partial" and "simple/complex" are replaced by "focal" and "aware/impaired awareness". The classification of a patient's epilepsy is based on seizures types (e.g. focal or generalized) as well as aetiology (e.g. structural, immune-mediated, genetic) and epilepsy syndrome. The present article describes the Swedish translation, endorsed by the Swedish Epilepsy Society.

Assessment of neurologic prognosis after cardiac arrest. Updated recommendations from the Swedish CPR Council Expert Group European Resuscitation Council (ERC) issued updated guidelines for postresuscitation care in 2015. This paper provides updated Swedish recommendations for neurological prognostication of patients remaining unconscious after cardiac arrest (CA). The prognostication should be based on independent methods; clinical and neurophysiological examinations, imaging and biomarkers. It should not be performed earlier than three days after CA and any influence from sedatives must be negligible. Bilateral absence of both corneal and pupillary reflexes and bilaterally absent Somatosensory Evoked N20 Potentials (SSEP) at 72 hours are reliable predictors of poor outcome but the ocular reflexes have limited sensitivity and SSEP has limited availability. Hence, further delay of at least 24 hours and combinations of findings from multiple methods are often needed for reliable prognostication. If firm evidence of a poor prognosis is lacking four days after CA, further expectation with repeated examinations is recommended.

NIPT - implentation, counselling and ethical issues It is today possible to analyze cell-free fetal DNA from a blood sample from the pregnant woman, i.e. non-invasive prenatal testing, NIPT. Thus, by a simple blood test from the mother you can detect trisomy 13, 18 and 21 in the fetus with high accuracy. However, NIPT is not a diagnostic test and a positive result should be confirmed by an invasive test, like chorionic villus sampling or amniocentesis. There are national guidelines from the Swedish Society of Obstetrics and Gynaecology (SFOG) on how to implement and use NIPT for trisomies in the Swedish health care. As NIPT is only a blood test there is a risk that it is seen by the expectant parents as a routine test or as a recommendation from the health care. Pre-test counselling is therefore of great importance to enable informed choice.