[Is individualized education for a medical students desirable? A common policy on how to handle medical students requests for individual adaptations is needed]. / Bör individualiserad utbildning för läkarstudenter eftersträvas?

In Sweden, freedom of conscience for health care professionals is not legally permitted. However, requests from medical students to adjust and/or skip compulsory learning activities because of their religious and moral convictions appear to get more abundant. This creates problems when learning activities are directly related to the examination objectives stated by the Higher Education Ordinance of Sweden. Allowing students to abstain from certain parts of the medical program raises difficulties as to what kind of convictions that should be accepted and to what degree. Questions arise regarding equality of learning opportunities, assessment, and reasonable resource allocation. We call for national debate regarding these issues, which different universities now are forced to handle on their own, with the aim of establishing a common approach.

[Post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD) - a clinical update of knowledge]. / Posttraumatiskt stressyndrom (PTSD) och komplex PTSD (CPTSD).

Post-traumatic stress disorder, PTSD, is a psychiatric diagnosis that describes a condition where one or more very traumatic events, that include life-threatening or extreme psychological stress, have left permanent traces of distress that induce sustained suffering.  In this clinical overview, we present current updates in diagnostic criteria and a new diagnosis of complex PTSD, and discuss the problems caused by the new PTSD diagnosis criteria partially differing in the DSM-5 and ICD-11 diagnostic manuals. Diagnostic challenges caused by symptom variations is discussed, as well as the high degree of comorbidity with other psychiatric and somatic illnesses. Combined forms of treatment that reduce both psychological PTSD and somatic symptoms is underscored, as well as the clinical value of early discovery of PTSD and treatment of comorbidity. Furthermore, the article illuminates knowledge about resilience and social support as protective factors.

[PTSD and Complex PTSD - Assessment, management and treatment]. / Utredning, handläggning och behandling av PTSD och CPTSD.

Post-traumatic stress disorder (PTSD) is a disruptive condition associated with great suffering. Fortunately, effective treatments are available. Assessment of children and adolescents with symptoms of PTSD is done within the child and adolescent mental health services. Adults are assessed in primary healthcare settings. In complex conditions with psychiatric comorbidity, assessment is conducted in specialist psychiatric services. Trauma-focused psychotherapy is the treatment of choice for both children and adults. Trauma-focused psychotherapy is also recommended for treating complex PTSD, despite a weaker evidence base. PTSD-specific treatment should normally be offered even in the presence of psychiatric comorbidities. Treatment of children and adolescents with PTSD and CPTSD is provided by child and adolescent mental health services. Adults can receive treatment both in primary and secondary healthcare settings, depending on symptomatology and comorbidities.

Research in disaster settings: a systematic qualitative review of ethical guidelines.

BACKGROUND: Conducting research during or in the aftermath of disasters poses many specific practical and ethical challenges. This is particularly the case with research involving human subjects. The extraordinary circumstances of research conducted in disaster settings require appropriate regulations to ensure the protection of human participants. The goal of this study is to systematically and qualitatively review the existing ethical guidelines for disaster research by using the constant comparative method (CCM). METHODS: We performed a systematic qualitative review of disaster research ethics guidelines to collect and compare existing regulations. Guidelines were identified by a three-tiered search strategy: 1) searching databases (PubMed and Google Scholar), 2) an Internet search (Google), and 3) a search of the references in the included documents from the first two searches. We used the constant comparative method (CCM) for analysis of included guidelines. RESULTS: Fourteen full text guidelines were included for analysis. The included guidelines covered the period 2000-2014. Qualitative analysis of the included guidelines revealed two core themes: vulnerability and research ethics committee review. Within each of the two core themes, various categories and subcategories were identified. CONCLUSIONS: Some concepts and terms identified in analyzed guidelines are used in an inconsistent manner and applied in different contexts. Conceptual clarity is needed in this area as well as empirical evidence to support the statements and requirements included in analyzed guidelines.

Medical ethics, bioethics and research ethics education perspectives in South East Europe in graduate medical education.

Ethics has an established place within the medical curriculum. However notable differences exist in the programme characteristics of different schools of medicine. This paper addresses the main differences in the curricula of medical schools in South East Europe regarding education in medical ethics and bioethics, with a special emphasis on research ethics, and proposes a model curriculum which incorporates significant topics in all three fields. Teaching curricula of Medical Schools in Bulgaria, Bosnia and Herzegovina, Croatia, Serbia, Macedonia and Montenegro were acquired and a total of 14 were analyzed. Teaching hours for medical ethics and/or bioethics and year of study in which the course is taught were also analyzed. The average number of teaching hours in medical ethics and bioethics is 27.1 h per year. The highest national average number of teaching hours was in Croatia (47.5 h per year), and the lowest was in Serbia (14.8). In the countries of the European Union the mean number of hours given to ethics teaching throughout the complete curriculum was 44. In South East Europe, the maximum number of teaching hours is 60, while the minimum number is 10 teaching hours. Research ethics topics also show a considerable variance within the regional medical schools. Approaches to teaching research ethics vary, even within the same country. The proposed model for education in this area is based on the United Nations Educational, Scientific and Cultural Organization Bioethics Core Curriculum. The model curriculum consists of topics in medical ethics, bioethics and research ethics, as a single course, over 30 teaching hours.

Publication ethics in biomedical journals from countries in Central and Eastern Europe.

Publication ethics is an important aspect of both the research and publication enterprises. It is particularly important in the field of biomedical science because published data may directly affect human health. In this article, we examine publication ethics policies in biomedical journals published in Central and Eastern Europe. We were interested in possible differences between East European countries that are members of the European Union (Eastern EU) and South-East European countries (South-East Europe) that are not members of the European Union. The most common ethical issues addressed by all journals in the region were redundant publication, peer review process, and copyright or licensing details. Image manipulation, editors' conflicts of interest and registration of clinical trials were the least common ethical policies. Three aspects were significantly more common in journals published outside the EU: statements on the endorsement of international editorial standards, contributorship policy, and image manipulation. On the other hand, copyright or licensing information were more prevalent in journals published in the Eastern EU. The existence of significant differences among biomedical journals' ethical policies calls for further research and active measures to harmonize policies across journals.

Preperitoneal approach for femoral hernia repair.

BACKGROUND/AIMS: Although Lichtenstein's procedure is the standard procedure in surgical hernia treatment, and the role of laparoscopic hernia repair is constantly increasing, preperitoneal approach for femoral hernia repair should be equally considered. METHODOLOGY: After the horizontal incision of transversal fascia, preperitoneal space is visualized. The hernial sac is opened and its content is placed in the abdominal cavity, or if there is a need, resection is performed. Once the peritoneum is sutured, the iliopubic tract and Cooper's ligament are bridged with two or three sutures in the medial portion of the femoral ring. RESULTS: From 1998 to 2008, 94 patients were treated for femoral hernia using the preperitoneal approach. Out of 94 participants, 86 were female. Intestinal obstruction was present in 48 cases. Resection of the small intestine or omentum was performed in 40 patients. There was no perioperative mortality. We observed early postoperative complications in 4 patients. Following the procedure, there was no recurrence of the femoral hernia. CONCLUSIONS: We found that preperitoneal repair is the method of choice in surgical treatment of femoral hernia. The surgical technique is simple and feasible, while fully acknowledging the functional anatomy of the inguinofemoral region and the etiology of the condition.

Full trisomy 5 in a sample of spontaneous abortion and Arias Stella reaction.

BACKGROUND: Historically, 50% of spontaneously expelled abortuses have been thought to be chromosomally abnormal; about 60% are trisomies. In general, trisomy 16 is the most frequent chromosomal abnormality, followed by trisomy 21 and trisomy 22. So far only 1 case of a female fetus with multiple congenital malformations associated with full trisomy 5 has been described. REPORT: We present a case of de novo full trisomy 5 in a spontaneous abortion sample. A young couple with normal constitutional karyotype experienced the second spontaneous abortion at 9 weeks of gestation, with the cytogenetic formula 47,XX,+5 in all analyzed cells. CONCLUSIONS: The routine cytogenetic analysis of miscarriages is still an uncommon practice, but it can have a great impact on the management of couples with repeated pregnancy wastage. Besides of the obvious cost benefit for health care, such analysis would help the physician to decide about future patient management, as well as planning the genetic counseling.