Tidsskr Nor Laegeforen
· 2026 May · PMID 42118917
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BACKGROUND AND AIM: Harmful alcohol use can be a sensitive topic, and discussions with patients about alcohol can be challenging. In some cases, alcohol use can result in patients being deemed unfit to drive. The main ai...BACKGROUND AND AIM: Harmful alcohol use can be a sensitive topic, and discussions with patients about alcohol can be challenging. In some cases, alcohol use can result in patients being deemed unfit to drive. The main aim of this study was to explore general practitioners' experiences with their dual role as clinician and expert assessor in relation to patients' alcohol use. MATERIAL AND METHOD: This is a qualitative study in which general practitioners attending a seminar on changing alcohol habits in general practice were invited to participate. Audio recordings from group discussions in four seminar sessions were transcribed and analysed using systematic text condensation. RESULTS: The general practitioners (N = 36) reported that the dual role of clinician and expert assessor can be challenging when assessing medical fitness to drive in patients with possible or confirmed harmful alcohol use. Several found the regulatory framework governing fitness to drive unclear and difficult to interpret, with the use of discretion within both a clinical and legal framework being particularly challenging. However, some found the regulation to be useful in supporting behavioural change in relation to alcohol. INTERPRETATION: General practitioners experienced a challenging dual role as clinician and expert assessor in the efforts related to alcohol use. It is unclear to what extent the current driving licence regulation and associated guide improve health care and contribute to road safety.
BACKGROUND: Internal herniation is a recognised complication following Roux-en-Y gastric bypass (RYGB) and may lead to life-threatening conditions. The diagnosis of abdominal emergencies in pregnant patients who have und...BACKGROUND: Internal herniation is a recognised complication following Roux-en-Y gastric bypass (RYGB) and may lead to life-threatening conditions. The diagnosis of abdominal emergencies in pregnant patients who have undergone bariatric surgery is particularly challenging due to physiological and anatomical changes. CASE PRESENTATION: A woman in her late twenties, at 37 + 5 weeks' gestation, presented with severe acute abdominal pain. She initially underwent an uncomplicated vaginal delivery but rapidly deteriorated postpartum, developing circulatory shock. Her medical history included RYGB five years earlier and a subsequent laparoscopic procedure for mesenteric defect closure. Her abdominal pain intensified significantly postpartum and was accompanied by nausea and haematemesis. Computed tomography revealed extensive small-bowel ischaemia due to internal herniation through a mesenteric defect with associated vascular compromise. Emergency laparotomy confirmed severe bowel strangulation, requiring extensive intestinal resection and resuscitative measures. INTERPRETATION: Internal herniation after RYGB is a rare but potentially fatal complication. Pregnancy increases the risk, and delayed diagnosis and treatment may result in fatal outcomes for both the mother and the fetus. Awareness of the biomechanical changes after bariatric surgery and in pregnancy is essential for all surgeons. Prompt recognition and early surgical intervention are critical for patient survival in cases of severe internal herniation.
BACKGROUND AND AIM: Documenting data quality is essential for ensuring that register data can be used in quality improvement efforts and research. The aim of this data quality study was to examine inter-rater agreement b...BACKGROUND AND AIM: Documenting data quality is essential for ensuring that register data can be used in quality improvement efforts and research. The aim of this data quality study was to examine inter-rater agreement between healthcare personnel's registering of variables in the Norwegian quality register for severe headaches, based on anonymised case reports. MATERIAL AND METHOD: All neurology departments in Norwegian hospitals were invited to register variables based on ten case reports reflecting real, unstructured medical records. Data were collected in a customised database, and inter-rater agreement between healthcare personnel was calculated. RESULTS: Eleven of the 18 invited neurology departments participated in the study. Observed agreement was ≥ 90 % for 18 of a total of 28 variables, with 100 % agreement for questions on smoking and medication use. Agreement was lower for variables where some case reports lacked information or were based on interpretations. This was particularly true for questions on the efficacy of acute and preventive medication, as well as the number of headache days. INTERPRETATION: There was agreement for the majority of register variables, which is reassuring for future research on quality register data.