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Background: Induced hypertension is used clinically to increase cerebral blood flow (CBF) in conditions such as vasospasm after subarachnoid hemorrhage. However, increased blood pressure also raises pulsatile force. Cerebrovascular compliance plays a key role in buffering flow dynamics and protecting the microcirculation, but whether it adapts to elevated pressure remains unclear. This study assessed the response of compliant cerebral arteries to induced hypertension in healthy adults using phase-contrast magnetic resonance imaging (PCMRI) and two compliance models: a two-element Windkessel (CWK) and a simplified model (CVP), representing the extremes of pulsatility transmission at the capillary level.

Methods: Eighteen healthy adults (median age: 34 years; 9 females) underwent PCMRI at baseline and after increasing mean arterial pressure by 20% using norepinephrine (NE) infusion. PCMRI quantified CBF and cardiac output, while cerebrovascular resistance and systemic vascular resistance were derived. Flow waveforms were combined with blood pressure to assess CWK and CVP in CBF, ascending/descending aorta, and external carotid arteries, while corresponding regions of interest were used to calculate cross-sectional flow areas. Data are reported as median (interquartile range).

Results: NE increased cerebrovascular compliance significantly; CWK by 110% (56% to 163%; P=0.001) and CVP by 11% (−2% to 26%; P=0.018). CWK increased in the external carotid artery by 12% (1% to 32%; P=0.037) but did not change in the ascending or descending aorta. CVP decreased in the descending aorta by 5% (-11% to 2%; P=0.028), with no changes in the ascending aorta or external carotid artery. Cross-sectional area of cerebral arteries contributing to CBF decreased by 5% (-17% to -3%; P=0.033), while the ascending and descending aorta areas increased by 7% (4% to 11%; P=0.012) and 8% (6% to 11%; P<0.001), respectively.

Conclusion: Cerebral arteries enhanced their compliance during NE-induced hypertension, unlike systemic arteries, regardless of the assumed degree of pulsatility transmission.

OBJECTIVES: To explore interprofessional team members' experiences of teamwork at an intensive care unit.

DESIGN: Qualitative content analysis of focus group interviews with members from the intensive care teams.

SETTING: University hospital in Sweden.

PARTICIPANTS: In total, 31 participants were interviewed. Enrolled nurses (n=7), critical care registered nurses (n=16), and intensive care physicians (n=8) employed at an intensive care unit were divided into nine focus groups organised according to the profession.

RESULTS: The overall theme, Balancing behaviour and knowledge in teamwork, emerged from the two categories of creating a safe atmosphere when working in an unknown environment and counteracting and mitigating destructive team dynamics. The theme captures how well-functioning teamwork must take into account members not acting as team players while also building a secure environment when working in new surroundings outside the intensive care unit. The categories describe how mutual respect, effective teamwork and a safe atmosphere were fostered through support without taking over tasks and countering power structures.

CONCLUSIONS: Navigating teamwork during critical situations is inherently complex, making it essential to understand team interactions and factors influencing individual behaviour. To ensure patient safety, the interprofessional team must recognise, understand and manage diverse behaviours and knowledge in dynamic settings. This research contributes to existing knowledge on teamwork in the intensive care context by providing insights into how knowledge and behaviour in teamwork can be optimised to enhance patient safety.

Background: The reported incidence of postoperative nausea and vomiting (PONV) after laparoscopic bariatric surgery is up to 60–80%. Hower, studies are limited, and larger studies are warranted. As PONV is usually evaluated in the post-anesthesia care unit (PACU), studying early PONV can be a valuable tool for exploring risk and associated factors for PONV.

Methods: Using prospectively collected data from the Swedish perioperative registry (SPOR) from 2016 to 2022, we explore the incidence and associated factors for early PONV after laparoscopic bariatric surgery. Laparoscopic gastric bypass and laparoscopic gastric sleeve procedures in adult patients (≥ 18 years) were included. The primary outcome was the incidence of PONV in the PACU. Secondary outcomes were factors associated with PONV, which were analyzed using a multivariate logistic regression model.

Results: In total, 14,098 procedures were identified in the registry during the study period, and 8426 unique patients from 32 hospitals in Sweden were included in the final study cohort. PONV in PACU was present in 36% (n = 3018) of patients. Factors associated with early PONV were female sex, age, moderate-severe pain, gastric sleeve procedures, duration in PACU, and hospital.

Conclusions: In this national register-based cohort study, one third of patients experienced early PONV in the PACU after laparoscopic bariatric surgery. Several risk factors were associated with increased occurrence of PONV, and there was variability among hospitals in the incidence of PONV.

Clinicaltrials.gov: NCT04433676

Purpose: Providing perioperative care for children who express anxiety or react with negative anxiety-associated consequences can be a challenge. The use of premedication is established as an important intervention for young children before surgery, yet research into care providers’ experiences of premedication is limited. The aim of this study was to explore perioperative staff’s experiences of premedication for preschool-age children.

Design: A descriptive inductive qualitative study was performed based on focus group discussions.

Methods: A purposive sample of a team from the operating department with experience in anesthetizing and caring for children in the perioperative period was interviewed in small focus groups: five preoperative and postoperative care nurses, five nurse anesthetists, and five anesthesiologists. The transcribed text was categorized using qualitative content analysis.

Findings: The content analysis revealed three themes: a matter of time, do not wake the sleeping bear, and on responsive tiptoes.

Conclusions: Care providers must adapt their work to the child’s emotional state of mind and needs, allowing time for the child to trust and accept the premedication and for the premedication to reach its peak effect. Premedication provides light sleep preoperatively, which requires careful treatment of the child to avoid emotional reactions, and the postoperative path is most peaceful when the premedication supports a long duration of sedation. Our findings highlight the need for safety precautions and a permissive and flexible organization with the goal of achieving a smooth and safe journey for the child in the perioperative path.

Objective: Measuring the effectiveness of mass casualty incident (MCI) scenario training is challenging due to simultaneously assessing individual skills, team dynamics, decision-making under pressure and adaptability. Existing instruments often focus too narrowly on individual skills, overlooking the comprehensive range of skills needed for effective prehospital disaster response. This study aims to develop and validate a comprehensive self-Assessment tool for prehospital disaster response skills during initial MCI scenario training.

Design: The instrument was developed and validated using a comprehensive methodology. This included literature reviews to identify the construct, ensuring content validity through expert evaluation and conducting field trials in MCI scenario training to evaluate the instrument under simulated conditions that approximated real-life incidents. The instrument's psychometric properties were assessed using exploratory factor analysis (EFA) and Horn's parallel analysis, as well as Cronbach's α and item-Total correlation analysis.

Setting: Two field trials conducted with participants in Sweden during 2023 and 2024. Participants 75 students from a bachelor's programme at a Swedish university were recruited to participate in the field trials. The programme featured one semester of comprehensive theoretical and practical training in disaster medicine, including MCI response and management. 88 instruments were collected during the field trials.

Results: Overall Cronbach's α score was 0.86, indicating high internal consistency for the instrument. EFA and Horn's parallel analysis revealed a five-factor model accounting for 52.3% of the total variance: incident control and management; systematic examination procedures; risk assessment and management; stress response and impact; and triage procedures. Cronbach's α for all factors indicated good internal consistency (range: 0.74-0.85).

Conclusions: The instrument addresses a critical gap by offering a comprehensive self-evaluation tool for disaster response skills. The robust psychometric properties indicate its potential for practical implication. Future studies should explore its application in diverse training settings and populations to enhance its utility and generalisability. A comprehensive development and validation methodology ensured the high content validity of the instrument.

Background: Maintaining cerebral perfusion during anesthesia and intensive care is critical, yet the relationship between mean arterial pressure (MAP) and cerebral blood flow (CBF) remains poorly defined. In patients with aneurysmal subarachnoid hemorrhage (aSAH), pharmacologically induced hypertension is commonly applied to support cerebral perfusion, but its effects are uncertain.

Methods: This protocol describes two parallel clinical studies using identical methodology. The first study population includes adults undergoing elective general anesthesia (MAP-ANE), and the second comprises sedated intensive care patients with aSAH (MAP-SAH). In both study populations, MAP will be increased stepwise with norepinephrine (NE) infusion under continuous invasive blood pressure monitoring, and CBF measured with phase-contrast MRI (PCMRI) and arterial spin labeling (ASL), while near-infrared spectroscopy (NIRS) will be performed in parallel to evaluate its validity as a surrogate marker. The primary outcome is the change in total CBF between baseline and elevated MAP, directly testing whether induced hypertension increases CBF. Secondary outcomes include ASL perfusion changes, the slope of the MAP–CBF relationship, systemic–cerebral hemodynamic correlations, and NIRS responses.

Expected impact: These studies test the hypothesis that pharmacological MAP augmentation does not predictably increase CBF. By combining quantitative MRI with invasive monitoring, it aims to clarify MAP–CBF interactions, define the physiological basis of induced hypertension, and assess whether NIRS can serve as a clinically useful proxy. Findings are expected to inform safer and more individualized blood pressure management in perioperative and neurocritical care.

Introduction: Despite the increasing use of distributed healthcare teams, performance evaluation is largely lacking. This study examined rural emergency health care in Sweden to determine the effect of teams being either co-located or distributed with remote physicians accessible via telemedicine.

Method: In this crossover study, 17 three-person teams were video recorded during co-located and distributed simulated scenarios. Team performance in the video recordings was evaluated using the TEAM instrument.

Results: Co-located scenarios had significantly higher Total ratings for the instrument (items 1–11), in the teamwork domain (items 3–9), and in overall performance (item 12) compared with distributed scenarios (P < 0.005). Item-level analysis revealed that co-located teams were better at completing tasks on time (item 4) and showed greater adaptability to changing situations (item 7).

Conclusions: The higher rating of the performance of co-located teams underscores the challenges facing distributed teams. Given that distributed healthcare teams are a reality in rural areas in northern Sweden, education and training must be adapted to address these challenges. This adaptation is crucial for ensuring high-quality patient care by distributed teams.

• För att få svensk läkarlegitimation ska läkaren kunna utöva läkaryrket på ett patientsäkert sätt.
• Låga krav på dokumentation av tidigare utbildning för tillträde till kunskapsprovsvägen till svensk legitimation nödvändiggör ett brett kunskaps- och färdighetsprov.
• Kunskapsprovet har samma målbild för säkerställande av kunskaper och färdigheter som svensk legitimationsgrundande läkarutbildning.
• Vägen via kompletterande utbildning till svensk legitimation kommer att förändras för att bli direkt legitimationsgrundande.
• Målbilden för säkerställande av kunskaper och färdigheter vid kompletterande utbildning bör vara densamma som vid svensk legitimationsgrundande läkarutbildning.

There are four paths to a Swedish medical license. A shared agreement exists for those converting from a European license to recognize qualifications granted in the respective countries mutually. Swedish medical graduates and International Medical Graduates (IMGs) trained outside the EU/EES/Schweiz are assessed against the professional qualifications specified in the Higher Education Ordinance (1993:100). This paper discusses the different pathways to a Swedish Medical License, how they are interrelated and changing, and the number of licenses granted via the specific pathways in 2023 and the previous 7 years. In 2023, 2,318 Swedish medical licenses were awarded. The largest group (1,407/2,318) were graduates from a Swedish medical school (with a minimum of 18 months of internship (AT)). The second largest group (704/2,318) were licensed physicians from a country within the EU/EEA. The smallest group (207/2,318) were international medical graduates (IMGs) who had passed the proficiency test (with a 6-month internship) or a complementary medical education (KUL) at one of the Swedish universities (with a minimum of 18 months of internship (AT)). During 2016–2023, 826 IMGs passed the proficiency test, and 533 IMGs completed KUL. During the same period, 10,958 students graduated from Swedish medical programmes, and 6,844 medical licenses were approved based on education in the EU/EEC. The pathway for IMGs starts with applying to the National Board of Health and Welfare to be approved for the tests. The theoretical test is a 180-item exam with single-best answers covering the medical field with basic and clinical sciences. After passing the theoretical test, the practical skills are tested with an Objective Structured Clinical Examination (OSCE) with fourteen 6-minute and four 14-minute stations. After passing the practical test, the IMG is assessed during a 6-month internship and must take an online Swedish law course. When successfully passing these steps, the IMG applies for a Swedish medical license with a certificate of passing a language test in Swedish at the C1 level. The educational pathway consists of a 1- to 2-year-long complementary programme for international medical graduates (KUL) offered at five Swedish universities. The regular Swedish medical programmes are in transition from preparing for an internship to preparing to qualify directly for a medical license without an intermediate internship. Consequently, KUL also needs to develop new curricula, preparing for direct qualification for a medical license, from which the first students will most likely graduate in spring 2027.