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Suprasellar arachnoid cyst on account of ectopic choroid plexus: case record.
BACKGROUND There has been a sustained focus on the lack of recruitment to general practice in Norwegian politics, media and research. We have little knowledge of the reasons that have been prominent for doctors who have actively opted out of general practice. We therefore wished to investigate what types of doctors choose not to work in general practice and why. MATERIAL AND METHOD The data are based on a questionnaire that was sent to the 2 195 members of the Medical Panel in 2016/17. The response rate was 73.1 %. We used graphics and descriptive analyses to study inter-group differences between those who had considered general practice but made another choice, and those who had quit general practice. RESULTS Of the 1 153 doctors who were not general practitioners, 44.1 % had not considered this as an option. 39.9 % had considered it, but chosen differently, and 16.0 % had previously worked as GPs, but quit. The administrative burden and small professional community were the main reasons for doctors to opt out of general practice. INTERPRETATION The administrative burden and small professional community were key reasons why doctors opted out of general practice or quit the specialty. A number of other factors also played a role, and the efforts to recruit and retain GPs should therefore be seen in a wider and more overarching context.BACKGROUND Otitis is a frequently occurring condition in young children and involves considerable use of antibiotics. The most common bacterial cause is pneumococci. The pneumococcal vaccine was introduced as part of the Childhood Immunisation Programme in Norway in 2006. The purpose of the study was to investigate whether this vaccination may have reduced the number of otitis cases presenting at emergency primary health care units. MATERIAL AND METHOD The material consists of data from all electronic reimbursement claims from emergency primary health care doctors in the period 2006-18. Annual consultation rates were calculated for children aged 0-5 years attending an emergency primary health care unit, both in total and due to otitis. learn more Registration of vaccination coverage in this age group began in 2006. RESULTS The total consultation rate fell from 674 per 1000 inhabitants in 2006 to 502 in 2018 (a relative reduction of 26 %). The consultation rate for otitis fell from 44 per 1000 inhabitants to 21 (a relative reduction of 52 %). While the total rate fell steadily throughout the period, the reduction in consultation rates for otitis began to fall in 2011, when vaccination coverage in this group was over 90 %. INTERPRETATION The pneumococcal vaccine may have reduced the number of children presenting with otitis at an emergency primary health care unit.Femoral neck stress fracture is a rare occurrence but can arise in athletes and people who exercise, due to repeated stress on the lower extremities. Hip and groin pain and clinical findings can raise suspicion, and MRI examination is the gold standard for determining stress fracture. The injury is treated conservatively or surgically, depending on anatomical location and whether or not the fracture is stable.BACKGROUND European and Norwegian consensus-based guidelines for the management of acute low back pain endorse red flag screening. Red flag symptomatology may ignore important information in the case history and clinical findings. CASE PRESENTATION An active man in his sixties presented with acute low back pain with radiation to the left thigh. A paramedic visited the patient at home and found no serious disease. Over a period of 4 hours, progressive loss of sensation and weakness in both legs developed. He arrived at the Accident and Emergency Department with paralysis, reduced sensation distal to the hips, absent reflexes, urinary retention and reduced sphincter tone. INR was 2.6. MR scan showed an intradural haematoma compressing Th9-L1, and dislocation of medulla and conus. This was followed by urgent Th10-12 laminectomy and evacuation of subdural haematoma, and thereafter rehabilitation. Three years later, he has sequelae for spinal cord injury at level Th12 with impaired mobility and function in the legs. INTERPRETATION This case highlights that patients with ongoing anticoagulation and acute back pain have increased risk of spinal haematoma requiring emergency treatment. Anticoagulation therapy should therefore be included in red flag screening of acute back pain.BACKGROUND Coercion and involuntary psychiatric admission have been the subject of heated debate in recent years. A new Act was proposed in the summer of 2019, the Act on limitation of coercion, which aims to collect all legislation on coercion within a single legislative Act. If the Act is adopted, the framework for the use of coercion will be the same for both somatic illness and psychiatry. Against this backdrop, we wished to investigate how involuntary admissions have been critically examined, debated and enshrined in law previously. MATERIAL AND METHOD We have examined the three main Acts (and the preparatory work on these) that have been adopted in the psychiatric healthcare service in Norway. We have paid particular attention to the criteria for involuntary admissions, which we have attempted to understand in light of their contemporary times. RESULTS AND INTERPRETATION The legislation on coercion retained many basic features from 1848, through 1961 until 1999, even though the attitudes to coercion changed. However, the change in legislation from 2017 shows a significant change in how coercion in the mental healthcare service is viewed. If the Act on limitation of coercion is adopted, coercive mental health care will no longer be regulated by separate legislation.The therapeutic response to immune checkpoint blockade (ICB) is highly variable, not only between different cancers but also between patients with the same cancer type. The biological mechanisms underlying these differences in response are incompletely understood. Identifying correlates in patient tumor samples is challenging because of genetic and environmental variability. Murine studies usually compare different tumor models or treatments, introducing potential confounding variables. This protocol describes bilateral murine tumor models, derived from syngeneic cancer cell lines, that display a symmetrical yet dichotomous response to ICB. These models enable detailed analysis of whole tumors in a highly homogeneous background, combined with knowledge of the therapeutic outcome within a few weeks, and could potentially be used for mechanistic studies using other (immuno-)therapies. We discuss key considerations and describe how to use two cell lines as fully optimized models. We discuss experimental details, including proper inoculation technique to achieve symmetry and one-sided surgical tumor removal, which takes only 5 min per mouse.
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