Swedish Units Research Articles

Unpredictable supplementation of vitamin D to infants in the neonatal intensive care unit: An experimental study.

Extremely premature infants receive nutrition and medication through nasogastric tubes. Breastmilk given accordingly is subject to fat loss. This study aimed to investigate whether this could also apply to vitamin D. A questionnaire investigated vitamin D administration at a level III neonatal intensive care unit in Sweden in 2021. Feeding simulations with breastmilk and various vitamin D mixtures were done accordingly. After administration, vitamin D3 concentration was analysed using chromatography with mass spectrometry, followed by repeated simulations with vitamin D mixtures without breastmilk in 2023. The questionnaire was completed by 10 persons. Vitamin D was administered as drops using an enteral syringe and a nasogastric tube in conjunction with a breastmilk meal. In the feeding simulations, vitamin D3 concentration after administration was significantly higher using a syringe alone compared to standard administration. When vitamins were administered according to standard but without breastmilk, 100% of the vitamin D and 40% of the multivitamins were lost. The vitamins adhered to the material, mainly in the nasogastric tube. Our findings indicate that standard vitamin D supplementation in the neonatal intensive care unit may be unpredictable when administered by enteral syringe and nasogastric tube. We suggest using direct oral administration whenever possible.

Attitudes and Experiences Among Swedish NICU Nurses Regarding Skin-to-Skin Care of Infants Born at 22-23 Weeks of Gestation.

Skin-to-skin care (SSC) is an evidence-based care method for preterm-born infants. Staff may hesitate to initiate early SSC, the first or second week of life, for the most extremely preterm infants; 1 reason could be nurses' attitudes. The aim was to investigate the attitudes and experiences of neonatal nurses regarding early SSC for the most extremely preterm infants, born at gestational week (GW) 22-23, using an exploratory and descriptive approach. A web-based survey was sent to all nurses across the 6 Swedish units routinely caring for the most extremely preterm infants. Descriptive statistics and qualitative content analysis were used to analyze the data. The response rate was 258 out of 547 (47%). This study reveals a spectrum of attitudes and experiences among nurses, ranging from viewing early SSC as an integral aspect of infant care to deeming it very challenging or simply not feasible. The outcomes are presented in 2 categories, describing both facilitators and challenges associated with early SSC. Noteworthy, facilitators include well-implemented guidelines that support early SSC. Conversely, challenges encompass knowledge gaps and the scarcity of scientific evidence demonstrating the safety of all SSC, including early, for the most extremely preterm infants. This study underscores the importance of spreading knowledge, and has clinical adapted guidelines about the practical aspects of SSC for infants born at 22-23 GW. Future research is required to clarify safety aspects pertaining to SSC for the most extremely preterm infants.

Primary chronic osteomyelitis of the jaw - a descriptive study of the condition and its occurrence in Sweden between 2012 and 2018.

Primary chronic osteomyelitis (PCO) of the jaw is a non-infectious, inflammatory state of the jawbone of unknown etiology. This study aimed to investigate the occurrence of PCO in Sweden between the years 2012 and 2018, the characteristics of the condition, treatment methods, and outcomes. Material and methods: The search for patients with PCO in Sweden 2012-2018 was performed at 24 oral and maxillofacial surgery units in Sweden. During this 6-year period, 17 patients were identified as diagnosed with PCO in Sweden. The mean age was 10.6 years at diagnosis, and the female:male ratio was 4:1. We conclude that PCO is a very rare disease in Sweden, and that standardized, well-defined criteria are necessary to calculate incidence rates but also to increase knowledge about etiology, clinical characteristics, and treatment outcomes in rare conditions such as PCO.

Balancing on a slack line - Staffs' experiences of talking about sexuality and sexual health with patients cared for in forensic psychiatry in Sweden.

Sexuality is a central part of being human, however, talking about sexual health is generally avoided in forensic psychiatry. The aim of this qualitative study was to explore how healthcare professionals experience talking about sexuality and sexual health with patients cared for in forensic psychiatry. Individual interviews were conducted with eighteen healthcare professionals from ten different forensic psychiatry care units in Sweden. The interviews were semi-structured, and the data was analyzed with qualitative content analysis. The findings showed the overarching theme "Balancing on a slack line". The conversations the healthcare professionals have about sexuality and sexual health with patients in this setting are affected by forensic psychiatry's dual mission; to provide care and at the same time protect patients and society. These conversations can be about opening up for having responsive conversations, but also closing conversations since the field of sexuality and sexual health is fraught with norms and preconceptions. To be able to conduct these conversations can be a challenge since the professionals can experience uncertainty due to a lack of competence, indicating that knowledge and resources are needed to facilitate conversations. In conclusion, the study indicates that there is a lack of support and structure for performing conversations about sexuality and sexual health in forensic psychiatry care, and there is a need for increased knowledge among healthcare professionals. In order to support staff, the forensic psychiatry services need to acknowledge the national guidelines for sexual and reproductive health and rights and to develop and adapt the local guidelines.

Epidemiology of Spinal Cord Injury in Adults in Sweden, 2016-2020: A Retrospective Registry-Based Study.

We conducted a retrospective, descriptive register study. The aim of the study was to present the epidemiological and demographic characteristics of the Swedish spinal cord injury (SCI) population. Rehabilitation units in Sweden were connected to the National Quality Register for Rehabilitation Medicine (Svenskt Register för Rehabiliteringsmedicin: SveReh). The registry includes data from 26 units around the country. Information was extracted from SveReh for patients who underwent rehabilitation for a new onset SCI between January 1, 2016, and December 31, 2020. Data regarding gender, age, aetiology, level of injury, neurogenic bowel and/or bladder dysfunction, complications during the primary rehabilitation, and the need for bi-level positive airway pressure, continuous positive airway pressure, or ventilator were analysed. Mean age at onset was 56 years, and men were overrepresented (66%). Tetraplegia was more common among traumatic SCI (TSCI) than non-traumatic SCI (NTSCI). The incidence was 11.9-14.8 per million for TSCI and 8.9-11.8 per million for NTSCI. At discharge, 8% of patients needed a breathing aid. Of those who were ventilator-dependent at discharge, 75% had a TSCI. Disturbed bowel and bladder functioning was noted in 58% of patients at discharge. The median time spent at the unit was 40 days, but it was approximately 2 weeks longer for those with a TSCI. Systematic and updated data on the Swedish SCI population show a pattern similar to Scandinavian countries with high age at onset and falls being the main cause of TSCI. The TSCI incidence was lower than in previous studies, and the results for NTSCI were novel.

EVisits to primary care and subsequent health care contacts: a register-based study

BackgroundEvidence concerning health care use related to virtual visits is conflicting. More research has been called for regarding the effectiveness of text-based virtual visits (eVisits). Therefore, we investigated patient characteristics, diagnoses, and subsequent health care contacts after eVisits to primary care.MethodsWe conducted a register-based cohort study of eVisits to an all-virtual public primary care unit in Sweden and subsequent health care contacts within 14 days. Data for 2021 were acquired from the regional health care databases. Diagnoses were sorted into relevant diagnostic groups, such as skin diagnoses and respiratory tract diagnoses. Multiple logistic regression was performed with subsequent health care contact as the outcome variable and diagnostic group for the eVisit as the predictor variable. Analyses were adjusted for age, sex, and socioeconomic index.ResultsThere were 5817 eVisits to a nurse and 4267 eVisits to a general practitioner (N = 10 084). Most patients were 20 to 39 years of age (41.8%). Skin diagnoses were most frequent (47.3%), followed by respiratory tract diagnoses (19.9%). Approximately one-fourth (25.8%) of the patients who completed an eVisit with a nurse or a general practitioner had a subsequent face-to-face visit within 14 days, mostly in primary care. Subsequent contacts were more frequent after an eVisit to a nurse than to a general practitioner. After an eVisit to a general practitioner, patients with infections (especially respiratory tract but also urinary tract) and unspecified diagnoses (especially skin-related) were more likely to require further health care contact compared to a group with various other diagnoses.ConclusionseVisits to an all-virtual primary care unit may be appropriate for uncomplicated medical complaints. Nonetheless, the effectiveness of eVisits in terms of substitution of physical visits, and resource utilization in relation to the more complex care needs of a primary care population, should be further studied.

“Mental health, bonding, family wellbeing, and family functioning in parents of infants receiving neonatal intensive care”.

AimsTo describe self-reported mental health, bonding with the infant, family wellbeing, and family functioning among mothers and non-birthing parents with children receiving neonatal intensive care and to explore factors associated with bonding with the child, family wellbeing, and family functioning. MethodsCross-sectional study included families from three different units in Sweden. Parents received a questionnaire that included self-reported measures of the study variables. ResultsIn total, 75 mothers and 72 non-birthing parents were included. Nearly 40% of the parents reported anxiety symptoms, whereas depression and post-traumatic stress symptoms were uncommon. Mothers reported more mental health issues than non-birthing parents. In the regression analyses depression was associated with problems with bonding and family wellbeing, no other significant associations were identified. ConclusionSymptoms of anxiety were common but might be a natural and transient reaction. Identifying depression is important to be able to provide targeted family support.

First-line managers’ experience of guideline implementation in orthopaedic nursing and rehabilitation: a qualitative study

BackgroundFirst-line managers have a unique role and potential in encouraging the use of evidence-based clinical practice guidelines (CPGs) and thus serve the provision of safe patient care. In acute and planned hospital care, effective yet safeguarded nursing procedures are a necessity. Little is currently known about how first-line managers engage in supporting the adoption of evidence-based nursing care and about what barriers and enablers there are for implementation of CPGs in the orthopaedic care context.PurposeTo investigate first-line managers’ experience of clinical practice guideline implementation in orthopaedic care.MethodsThis qualitative interview study included 30 first-line nursing and rehabilitation managers in 17 orthopaedic units in Sweden. A deductive content analysis, with the Ottawa Model of Implementation Leadership as a guide, was employed.ResultsTo the first-line managers, any guideline implementation required them to balance contexts, including their outer context (signified by the upper-level management and decision-makers) and their inner context, including staff and patients in their unit(s). Acting in response to these contexts, the managers described navigating the organization and its terms and conditions; using relations-, change-, and task-oriented leadership, such as involving the staff; motivating the change by emphasizing the patient benefits; and procuring resources, such as time and training. Even though they knew from past experience what worked when implementing CPGs, the first-line managers often encountered barriers within the contexts that hampered successful implementation.ConclusionsAlthough first-line managers know how to effectively implement CPGs, an organization’s terms and conditions can limit their opportunities to fully do so. Organizational awareness of what supports and hinders first-line managers to offer implementation leadership can enhance opportunities to alter behaviours and conditions for the benefit of CPG implementation.Trial registrationThe study was registered as NCT04700969 with the U.S. National Institutes of Health Clinical Trials Registry on 8 January 2021.

Symposium 2: Nurses’ experiences from a flexible online course in a higher education learning initiative

Remote healthcare is developing at a rapid pace to create high-quality, efficient, and financially sustainable care. The article aims to describe and explore nurses’ experiences of networked learning before and after participation in a higher education lifelong learning initiative. The study was conducted in primary healthcare and hospital units in Sweden with ten nurses (eight women and two men), where the participants answered a web-based questionnaire before and after participating in an online course, Digital Competence in Care. The data were analysed with descriptive statistics and qualitative content analysis. The results show increased development of nurses’ competence and learning. The mean of digital competence among all participants increased from 4.4 to 8.9 on a scale of 0-10 and the mean of expectations for learning among all participants increased from 7.1 to 9.2 on a scale of 0-10. Furthermore, two themes were identified: Lifelong learning important and urgent for nurses and Networked learning a flexible way to strengthen learning and think outside the box. The content and design of DCC were experienced as relevant for the participants, and networked learning was perceived as a way of developing and strengthening learning and competence. The participants indicated that sharing experiences and networking with others supported them in solving problems in their daily work, “thinking outside their own box,” and putting ideas into action together to support a critical and responsible attitude. The use of authentic work-related problems in the course assignments was experienced as a good thing, as it supported the nurses in their everyday work. Finally, the participants described how they became more courageous and confident in their ability to communicate and work securely digitally, and also that their new knowledge and competence were relevant to the continued development of digitalisation in healthcare settings and medical care, as colleges and leaders turned to them for support and advice.

Impact of collegial midwifery assistance during second stage of labour on women’s experience: a follow-up from the Swedish Oneplus randomised controlled trial

ObjectiveTo compare experiences of the second stage of labour in women randomised to assistance by one or by two midwives to reduce severe perineal trauma (SPT).DesignAnalysis of a secondary outcome...

Patient participation-18 months of patient and staff perspectives in kidney care: A mixed methods study addressing the effects of facilitating staff person-centredness.

Patient participation should encapsulate the individual's resources and needs, though such standards remain rationed for people living with a long-term health concern like kidney failure. To illustrate what patient participation signified to patients and staff in kidney care, and whether an agreed or disagreed conceptualisation occurred over time, evaluating the influence of two study-specific interventions to facilitate more person-centred participation. By convergent mixed methods design across 9 units in Sweden, we repeated the following data collection at 3 time points over 18 months: semistructured interviews with patients and staff (n = 72), and structured reviews for accounts of participation in patient records (n = 240). Data were subjected to content analysis and descriptive statistics, respectively. The outcomes were appraised for changes over time besides the interventions to enhance attention to patients' participation: a clinical tool and guidance distributed to management, and additional local support, respectively. Both patients and staff described patient participation as a comprehension of the disease and its management in everyday life. Yet, patients accentuated participation as one's experiences being recognised, and mutual knowledge exchange. Instead, staff emphasised the patients managing their treatment. The health records primarily represented what staff do to support their notion of patient participation. No influence of the interventions was noted, but what signified patient participation was maintained over time. Both patients and staff stress the importance of patient participation, although they focus on different elements. Further person-centred conduct warrants a shared conceptualisation and strategies addressing and scaffolding patients' preferences and means.

Navigating the gap between policy and practice: frontline and second-tier management perspectives and strategies in offering vocational and educational support to young adults with mental health problems

ABSTRACT Mental health problems among young adults often lead to obstacles to completing higher education and becoming established in the labour market. It is important to offer support that can help these individuals realize educational and vocational goals in order to become self-sufficient and achieve social inclusion. Individual Placement and Support (IPS) and Supported Education (SEd) are two methods developed for supporting people with mental health problems in attaining competitive employment and reaching educational goals. These methods have not been widely implemented in Sweden, therefore making it interesting to study management perspectives in organizations offering IPS/SEd. The study aimed to explore the reasoning and strategies managers described in offering vocational and educational support to young adults with mental health problems. This study is based on 12 qualitative interviews with managers from six units in Sweden offering support through IPS/SEd. Results show a variety in interpretation of legislation and responsibility for young adults with mental health problems. The managers were positioned between policy and practice, having to navigate between the organizational restraints and their professional assessment in offering this support and pushing traditional boundaries in prioritizing long-term individual goals over short-term economic and political considerations. These managers demonstrate the possibilities for how IPS/SEd can be implemented and made to fit different organizational contexts, even within a highly sectorized welfare system as in Sweden. However, the methods might need to be adapted and adjusted to not only fit local organizational restraints, but also to fit into the Swedish welfare system.

Financialization the Swedish way: How Vonovia became the largest owner of former public housing estates through transaction pathways and calculative practices

ABSTRACT The Swedish rental housing market has been in transition. The once dominating municipal public housing sector has been steadily decreasing. International firms have increasingly taken over rental housing in so-called socially deprived areas. This article analyzes the financialization of the former public housing stock. It traces activities in two housing estates and outlines the history and operations of venture capital-based real estate companies focusing on deprived areas in Sweden. These companies have upgraded multifamily homes and thus increased rents, which resulted in large profits and a decrease in the affordable housing stock. In this new reality, venture capital actors have taken advantage of contextual conditions and applied powerful calculative devices. Drawing on studies of financialization as a socio-technical process, the article contributes to knowledge by de-mystifying financialization through a detailed study of specific practices undertaken by international investors who acquire former public housing units in Sweden.

Midwives views about preceptorship and peer-learning in a birth unit: A cross-sectional study

BackgroundPractical training in a birthing unit is an important part of midwifery education. Previous research on the preceptor role predominantly consists of qualitative interview studies and have not explored pedagogical models like peer learning. ObjectivesThe purpose of this study was to quantitatively describe midwives' experiences, conditions, and needs in their role as preceptors in a birthing unit, as well as their attitudes towards and experiences of peer-learning. DesignA cross-sectional study, using a web-survey. SettingsThe survey was distributed to all midwives working in a birthing unit in Sweden. ParticipantsA total of 573 valid responses were obtained. MethodsA questionnaire consisting of 22 questions, which included background questions, questions to be answered on a four-point Likert scale, and open-ended questions, was sent out from November 2022 to March 2023. The collected data were analysed using descriptive statistics, Chi-square, and Mann Whitney U test analyses. The open-ended responses were analysed using quantitative content analysis. ResultsMidwives with ≤10 years of experience were more hesitant about taking on the preceptor role. They also described a lack of support and found it more challenging to integrate supervision into their working hours than midwives with >10 years of experience. Time for supervision and time for reflection with midwifery students were identified as areas that could improve the quality of supervision. Of the respondents, 42.8 % had experience of peer learning. “Students learn from each other” was identified as the most common advantage of peer learning. ConclusionsLong-term experience as a midwife plays a crucial role in how midwives perceive their role as a preceptor and the conditions they experience. The midwives in this study had started supervising students earlier than they deemed advantageous. As the preceptor plays a critical role in the midwifery student's learning process, it is important to have experienced preceptors.

Probiotic supplementation and risk of necrotizing enterocolitis and mortality among extremely preterm infants—the Probiotics in Extreme Prematurity in Scandinavia (PEPS) trial: study protocol for a multicenter, double-blinded, placebo-controlled, and registry-based randomized controlled trial

BackgroundExtremely preterm infants, defined as those born before 28 weeks’ gestational age, are a very vulnerable patient group at high risk for adverse outcomes, such as necrotizing enterocolitis and death. Necrotizing enterocolitis is an inflammatory gastrointestinal disease with high incidence in this cohort and has severe implications on morbidity and mortality. Previous randomized controlled trials have shown reduced incidence of necrotizing enterocolitis among older preterm infants following probiotic supplementation. However, these trials were underpowered for extremely preterm infants, rendering evidence for probiotic supplementation in this population insufficient to date.MethodsThe Probiotics in Extreme Prematurity in Scandinavia (PEPS) trial is a multicenter, double-blinded, placebo-controlled and registry-based randomized controlled trial conducted among extremely preterm infants (n = 1620) born at six tertiary neonatal units in Sweden and four units in Denmark. Enrolled infants will be allocated to receive either probiotic supplementation with ProPrems® (Bifidobacterium infantis, Bifidobacterium lactis, and Streptococcus thermophilus) diluted in 3 mL breastmilk or placebo (0.5 g maltodextrin powder) diluted in 3 mL breastmilk per day until gestational week 34. The primary composite outcome is incidence of necrotizing enterocolitis and/or mortality. Secondary outcomes include incidence of late-onset sepsis, length of hospitalization, use of antibiotics, feeding tolerance, growth, and body composition at age of full-term and 3 months corrected age after hospital discharge.DiscussionCurrent recommendations for probiotic supplementation in Sweden and Denmark do not include extremely preterm infants due to lack of evidence in this population. However, this young subgroup is notably the most at risk for experiencing adverse outcomes. This trial aims to investigate the effects of probiotic supplementation on necrotizing enterocolitis, death, and other relevant outcomes to provide sufficiently powered, high-quality evidence to inform probiotic supplementation guidelines in this population. The results could have implications for clinical practice both in Sweden and Denmark and worldwide.Trial registration(Clinicaltrials.gov): NCT05604846

Large variations in atrial fibrillation screening practice after ischemic stroke and transient ischemic attack in Sweden: a survey study

BackgroundAtrial fibrillation (AF) screening after ischemic stroke or transient ischemic attack (TIA) is given high priority in clinical guidelines. However, patient selection, electrocardiogram (ECG) modality and screening duration remains undecided and current recommendations vary.MethodsThe aim of this study was to investigate the clinical practice of AF screening after ischemic stroke or TIA at Swedish stroke units. In collaboration with the stakeholders of the Swedish Stroke Register (Riksstroke) a digital survey was drafted, then tested and revised by three stroke consultants. The survey consisted of 17 multiple choice/ free text questions and was sent by e-mail to the medical directors at all stroke units in Sweden.ResultsAll 72 stroke units in Sweden responded to the survey. Most stroke units reported that ≥ 75% of ischemic stroke (69/72 stroke units) or TIA patients (67/72 stroke units), without previously known AF, were screened for AF. Inpatient telemetry ECG was the method of first-choice in 81% of the units, but 7% reported lack of access. A variety of standard monitoring durations were used for inpatient telemetry ECG. The second most common choice was Holter ECG (17%), also with considerable variations in monitoring duration. Other AF screening modalities were used as a first-choice method (handheld and patch ECG) but less frequently.ConclusionsClinical practice for AF screening after ischemic stroke or TIA differed between Swedish stroke units, both in choice of AF screening methods as well as in monitoring durations. There is an urgent need for evidence and evidence-based recommendations in this field.Trial registrationNot applicable.

The circulatory death that saves lives-Intensive care nurses' conceptions of participating during 'donation after circulatory death': A phenomenographic study.

To describe intensive care nurses' conceptions of participating during the donation after circulatory death (DCD) process in intensive care units in Sweden. A qualitative design with a phenomenographic approach. In total, 12 semi-structured interviews were conducted in April 2022 with intensive care nurses from three hospitals. Data were analysed using a phenomenographic approach. Conceptions of participating during the DCD process varied. Four main themes emerged: DCD as a system; Intensive care nurses' role in the situation; Life to death to life; The essence of DCD. Variations emerged regarding what the informants talked about and how they talked about the what. Variations were based on informants' perspective of their role in relation to the structure and the team, and their conceptions of care for patients and their relatives. The findings illustrated success factors and challenges. Knowledge, experience, distinct structure, and relationship with relatives, among other factors, were described as success factors, while a lack of experience, difficulty in prognosing death, and organisational obstacles emerged as challenges. Furthermore, the findings showed that intensive care nurses play an important role in optimising the outcome of the DCD process. Their work related to DCD was conceived as being meaningful to fulfil more peoples' wishes to donate organs. People on the waiting list for organ transplantation are dying due to a shortage of organs. The implementation of DCD, as a complement to Donation after Brain Death (DBD), contributed to an increase in the number of organ donors, and intensive care nurses play an important role during the DCD process. Previous research manifests the complexity concerning their role. There is a lack of nursing research regarding intensive care nurses' conceptions of what it means to participate in the DCD process, which emphasises the significance of this study. This study is reported using consolidated criteria for reporting qualitative research (SRQR). No patient or public contribution.

The use and application of intensive care unit diaries: An instrumental multiple case study.

The study aim was to explore the use of an Intensive Care Unit (ICU) diary within four different ICUs units in Sweden and thereby contribute to practice guidelines regarding the structure, content and use of an ICU diary. ICU diaries are used to aid psychological recovery among critical care patients, but differences remain in diary writing both within and across countries. Few studies have focused on the combined views and experiences of ICU patients, family members and nursing staff about the use of ICU diaries. An instrumental multiple case study design was employed. Three focus groups interviews were carried out with 8 former patients and their family members (n = 5) from the research settings. Individual interviews were carried out with 2 patients, a family member and a nurse respectively. Observations, field notes, documentary analysis and conversations with nursing staff were also conducted. Consolidated criteria for reporting qualitative research (COREQ) was followed. The qualitative findings firstly consisted of a matrix and descriptive text of the four ICU contexts and current practices. This highlighted that there were similarities regarding the aims and objectives of the diaries. However, differences existed across the case study sites about how the ICU diary was developed and implemented. Namely, the use of photographs and when to commence a diary. Second, a thematic analysis of the qualitative data regarding patients' and family members' use of the ICU diary, resulted in four themes: i) the diary was used to take in and fully understand the situation; ii) the diary was an opportunity to assimilate warm, personalised and human care; iii) the diary was used to manage existential issues; and iv) the diary was a tool in daily activities. Analysis of the instrumental case study data led to the identification of core areas for inclusion in ICU diary practice guidelines.

Unit-to-unit transfer due to shortage of intensive care beds in Sweden 2015–2019 was associated with a lower risk of death but a longer intensive care stay compared to no transfer: a registry study

BackgroundIntensive care unit-to-unit transfer due to temporary shortage of beds is increasing in Sweden. Transportation induces practical hazards, and the change of health care provider may prolong the length of stay in intensive care. We previously showed that the risk of death at 90 days did not differ between patients transferred due to a shortage of beds and non-transferred patients with a similar burden of illness in a tertiary intensive care unit. The aim of this study was to widen the analysis to a nation-wide cohort of critically ill patients transferred to another intensive care unit in Sweden due to shortage of intensive care beds.MethodsRetrospective comparison between capacity transferred and non-transferred patients, based on data from the Swedish Intensive Care Registry during a 5-year period before the COVID-19 pandemic. Patients with insufficient data entries or a recurring capacity transfer within 90 days were excluded. To assess the association between capacity transfer and death as well as intensive care stay within 90 days after ICU admission, logistic regression models with step-wise adjustment for SAPS3 score, primary ICD-10 ICU diagnosis and the number of days in the intensive care unit before transfer were applied.ResultsFrom 161,140 eligible intensive care admissions, 2912 capacity transfers were compared to 135,641 discharges or deaths in the intensive care unit. Ninety days after ICU admission, 28% of transferred and 21% of non-transferred patients were deceased. In the fully adjusted model, capacity transfer was associated with a lower risk of death within 90 days than no transfer; OR (95% CI) 0.71 (0.65–0.69) and the number of days spent in intensive care was longer: 12.4 [95% CI 12.2–12.5] vs 3.3 [3.3–3.3].ConclusionsIntensive care unit-to-unit transfer due to shortage of bed capacity as compared to no transfer during a 5-year period preceding the COVID-19 pandemic in Sweden was associated with lower risk of death within 90 days but with longer stay in intensive care.

Validation of red flags in the workup of children with long-term abdominal pain - A retrospective study.

To evaluate red flags as an instrument to distinguish other medical conditions from Functional Gastrointestinal Disorders (FGID) in children with long-term abdominal pain. In a retrospective follow-up, data were collected from 317 children who were referred for medical assessment due to long-term abdominal pain between the years 2011 and 2012 at three Swedish paediatric open clinic units in Sweden. Throughout the review of medical records, any documented red flags at the primary consultation and finally set diagnosis after 1 year were noted for all cases. A non-FGID disease was diagnosed in 32 cases (10.1%). The sensitivity of red flags to predict inflammatory bowel disease (IBD) was 100% and the specificity 64.1%. The sensitivity of red flags to predict celiac disease was 45.5% and the specificity 63.7%. The sensitivity of red flags to predict any non-FGID disease was 59.4%, and the specificity was 65.6%. The use of red flags is a sensitive instrument to identify patients with IBD but less applicable when identifying celiac disease and other organic diseases. Specificity is generally low and future biomarkers for assessing children with long-term abdominal pain is needed.