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As the finances of health care providers are increasingly strained, discussions about the closure of some of the emergency hospitals in Sweden have reemerged. I have reviewed the 39 closures that have occurred over the last half century. The closures have come in two distinct waves. The first wave, peaking in 1970-74, was driven by staffing problems with concerns about the quality of care. The second, more prolonged wave occurred in 1995-2004, caused by healthcare providers' strained economy. In 2024, the first closure of an emergency hospital since 2010 occurred and the future of several emergency hospitals is being investigated. A low population in the hospital catchment area has been a strong predictor of hospital closure, but the closure has seldom been followed by a marked population drop. Major arguments in the current debate on emergency hospital closures are listed. The process from a first external evaluation to final closure has followed a stereotypic, often dramatic pattern.

Electrotherapy modalities are currently used in the treatment of animals, but the evidence base supporting their use has not yet been systematically reviewed. Cochrane guidelines, as adapted by the Swedish Agency for Health Technology Assessment and Assessment of Social Services, were followed for this systematic review. A literature search regarding all currently known electrotherapy modalities applied to horses, dogs, and cats was conducted for the years 1980–2020 using three databases: CABI, PubMed, and Web of Science Core Collection. Of the 5385 references found, 41 articles were included in the review: 13 papers on pulsed electromagnetic field therapy (PEMFT), 7 on neural electrical muscle stimulation (NEMS), 5 on transcutaneous electrical nerve stimulation (TENS), 4 on static magnets, 3 on interference, 2 each on percutaneous electrical neural stimulation (PENS), bioelectricity, and diathermy, and 1 each on micro-pulsed stimulation, capacitive coupled electrical stimulation, and microwave therapy. The literature per modality was limited in quantity (mean 3.7 papers). Half of the articles were assessed to have a high risk of bias (20 high, 7 moderate, and 14 low). The existing literature used a spectrum of indications and treatment parameters, which makes comparisons and drawing conclusions to support the use of these modalities in clinical practice challenging. The current scientific evidence is not sufficient to support the clinical effects of electrotherapies for any clinical indication in horses, dogs or cats. The selected suggestive results warrant further high-quality research on PEMFT, NEMS, TENS, and PENS.

We review some of the most frequent ethical issues encountered in stroke care. Priorities in stroke care should be based on the principles of the Swedish prioritization platform: human dignity, needs/solidarity, and cost-effectiveness. The prognosis is often uncertain very early after stroke. We therefore advocate time for careful assessment before taking decisions on treatment restrictions such as do-not-resuscitate orders. Swedish law permits acute treatment for patients unable to consent because of severe stroke. For selected patients already living in home-based medical care or institutional care when afflicted by stroke, it may be appropriate not to transfer them to an acute care hospital, provided that sufficient skills in acute evaluation and stroke care are available. Likewise, if a stroke patient is discharged from hospital with a percutaneous endoscopic gastrostomy, adequate competence is needed in home-based or institutional care. It is not ethically appropriate to continue advanced medical treatment that is without benefit for the patient during the last days of life.

Det vetenskapliga underlag vi lutar oss mot för klinisk praxis, kliniska riktlinjer och folkhälsoinsatser snedvrids om det bygger på oredlig forskning. Följderna blir särskilt allvarliga när artiklar som dragits tillbaka på grund av oredlighet fortsätter att citeras okritiskt över lång tid. Oredlig forskning kan också skada förtroendet för hälso- och sjukvårdens vetenskapliga underlag i stort. Jag utgår i denna artikel från några uppmärksammade fall av oredlighet som kan få oss att skärpa vår kritiska blick. Dessutom diskuteras de skyddssystem som finns och som ger en viss motståndskraft mot den oredliga forskningens skador. Slutligen går jag igenom några av de åtgärder som föreslagits för att komma till rätta med problemen kring oredlig forskning.

According to the Swedish Ethics Review Act, research involving personal data on crimes should undergo independent ethics review. To explore the reporting of ethics approval, we extracted information from articles with Swedish personal data on crimes published in 2013–2021. Of the identified 298 articles, 92 (31%) failed to report ethics approval. Failures were particularly common in articles with a qualitative design, single or few authors and when there was a social science focus. Failures varied markedly between universities. We conclude that failures to report compulsory ethics approval are common in articles involving personal data on crime and that these failures vary markedly with the research setting. Several indicators of poor adherence to the Ethics Review Act have been identified.

Soft tissue mobilization is frequently used in the treatment of sport and companion animals. There is, however, uncertainty regarding the efficacy and effectiveness of these methods. Therefore, the aim of this systematic literature review was to assess the evidence for clinical effects of massage and stretching in cats, dogs, and horses. A bibliographic search, restricted to studies in cats, dogs, and horses, was performed on Web of Science Core Collection, CABI, and PubMed. Relevant articles were assessed for scientific quality, and information was extracted on study characteristics, species, type of treatment, indication, and treatment effects. Of 1189 unique publications screened, 11 were eligible for inclusion. The risk of bias was assessed as high in eight of the studies and moderate in three of the studies, two of the latter indicating a decreased heart rate after massage. There was considerable heterogeneity in reported treatment effects. Therefore, the scientific evidence is not strong enough to define the clinical efficacy and effectiveness of massage and stretching in sport and companion animals.

Prompted by the Macchiarini research fraud case, an Act on Research Misconduct was introduced in Sweden in January 2020. In accordance with international convention, it defines unlawful research misconduct as “…severe deviation from good research practice in the form of fabrication, falsification or plagiarism.” To qualify as severe, the misconduct must be either intentional or caused by serious neglect. Universities are obliged to report suspected cases for investigation by a newly established governmental agency. The Act does not include regulation of penalties or sanctions. The expected consequences of the Act and its limitations are discussed. The crucial roles of universities and scientific journals in the prevention of misconduct remain, and improved European legislation to protect whistleblowers is described. Future directions in the struggle against research misconduct include use of technical advances to detect data and image manipulation.

Background: Extracorporeal shockwave therapy (ECSWT) is increasingly used to treat different types of musculoskeletal conditions in sport and companion animals. To explore the scientific basis for the treatment, we conducted a systematic review of the literature on ECSWT used in horses, dogs, and cats. Methods: Relevant articles published in 1980–2020 were identified from three major databases. Each article was assessed for risk of bias. Results: The review identified 27 relevant articles on the effects of ECSWT in horses, nine in dogs, but none in cats. Typically, ECSWT involved one to three treatment sessions at 1- to 3-week intervals. We identified studies on bone mass and bone healing, wound healing, navicular disease, ligament injury, desmitis, sesamoiditis, tendon injury, osteoarthritis, and short-term analgesic effects. Common to all indications was that the scientific evidence was very limited. For each separate indication, there were relatively few studies, many of which had methodological flaws. Where favorable results were reported, they were usually not replicated in independent studies. A few encouraging results were found. Conclusions: In sport and companion animals, the scientific evidence for clinical effects of ECSWT in horses, dogs, and cats is limited. For some applications, notably short-term pain relief, ligament ailments, and osteoarthritis, the results seem promising and warrant further exploration in high-quality studies.

Background: To explore the scientific evidence for therapeutic ultrasound (TU), we conducted a systematic review of the literature on TU in dogs, horses, donkeys, and cats. Methods: In three major databases, relevant articles published in 1980–2020 were identified. The risk of bias in each article was evaluated. Results: Twenty-four relevant articles on the effects of TU in dogs, nine in horses, two in donkeys, and one in cats were identified. TU usually involved 2–6 treatments weekly for up to 4 weeks. Articles on tendon, ligament, and bone healing, acute aseptic arthritis, osteoarthritis, paraparesis, hindquarter weakness, and back muscle pain were identified. In experimental bone lesions in dogs, there is moderate scientific evidence for enhanced healing. For the treatment of other musculoskeletal conditions, the scientific evidence is insufficient due to the high risk of bias. There is substantial evidence that continuous TU increases tissue temperature in muscles and tendons by up to 5 °C in healthy animals. For disorders in tendons, ligaments, muscles, and joints in sport and companion animals, there is insufficient evidence for the clinical effects of TU.