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Background: Otomicroscopy and pneumatic methods are superior to otoscopy alone in diagnosing acute otitis media (AOM). There is a lack of knowledge regarding the use of different diagnostic methods for AOM in primary health care in Sweden and Norway. Methods: This cross-sectional study included a questionnaire completed by general practitioners (GPs) and specialist trainees (STs/residents/registrars) working in primary care in Sweden and Norway. Multivariable binary logistic regressions were performed to evaluate the use of diagnostic methods and written advice adjusted for educational level, sex and country. Results: Otoscopy was the most frequently used method. Sweden had greater access to the more accurate diagnostic methods. In Norway, the following methods were used to a lesser extent: pneumatic otoscopy, adjusted OR 0.15 (95% CI 0.10–0.23; p <.001), otomicroscopy, adjusted OR 0.013 (95% CI 0.070–0.027; p <.001), pneumatic otomicroscopy, adjusted OR 0.028 (95% CI 0.010–0.078; p <.001) and tympanometry, adjusted OR 0.31 (95% CI 0.21–0.45; p <.001). Written advice was used to a greater extent in Norway, adjusted OR 4.5 (95% CI 3.1–6.7; p <.001). The STs used pneumatic otoscopy and pneumatic otomicroscopy to a lesser extent, adjusted OR 0.65 (95% CI 0.45–0.93; p =.019) and 0.63 (95% CI 0.43–0.92; p =.016). Conclusions: Swedish physicians both used and had greater access to the significantly better diagnostic methods compared with Norwegian physicians while the opposite applied to the use of written information. The GPs used pneumatic otoscopy and pneumatic otomicroscopy to a greater extent than STs. Compared with 2012, the Swedish physicians now more frequently used pneumatic otoscopy. [ABSTRACT FROM AUTHOR]

To explore the experiences and views of Norwegian Municipality Chief Medical Officers (MCMOs) on preparedness, collaboration, and organization during the COVID-19 pandemic to gain insight into local crisis management of value for future pandemic responses. Longitudinal qualitative interview study. We conducted semi-structured digital interviews with nine MCMOs working in different municipalities in Norway from September to December 2020. Five MCMOs were re-interviewed from January to April 2021. We used thematic analysis to analyze the data. Through the analysis, three major themes were identified in the material; 1) The view of preparedness changed from being low-priority and dormant to the desire to strengthen preparedness as a permanent measure; 2) The nature of the pandemic forced a change in internal and external communication and collaboration for the MCMOs towards direct dialogue, teamwork and digital networking; 3) The pandemic changed the role and position of the MCMO within the municipal organization. Although most MCMOs were given a leading role in the municipal pandemic response, some MCMOs experienced that they were not positioned to fully exercise their intended role. In our material, de-authorization of the MCMO role seemed to coincide with the increasing size and organizational complexity of the municipality. The Norwegian pandemic response and outcome have been regarded as successful internationally. Although the MCMOs managed to implement flexible and quick responses facilitated by teamwork, dialogue, and joint sensemaking, they also identified several challenges and shortcomings of the Norwegian pandemic preparedness requiring organizational and financial changes to sustain future health system resilience. The Norwegian Infection Control Act gave comprehensive responsibility and authority for local COVID-19 pandemic management to the municipalities and the Municipality Chief Medical Officers (MCMOs). The MCMOs highlighted several challenges and shortcomings of the municipal crisis preparedness, of which lack of detailed organizational plans was the most prominent. Teamwork, digital networking and collective sensemaking seemed to enhance pandemic collaboration and resilience within and across municipalities. Most MCMOs gained a leading role at a higher organizational level within the municipality through the COVID-19 pandemic. To strengthen future crisis management, arrangements must be made, both organizationally and financially, for preparedness to remain on the agenda even between epidemics and pandemics. [ABSTRACT FROM AUTHOR]

When the COVID-19 pandemic reached Norway, primary health care had to reorganize to ensure safe patient treatment and maintain infection control. General practitioners (GPs) are key health care providers in the municipalities. Our aim was to explore the experiences and management strategies of Norwegian GPs during the COVID-19 pandemic - over time, and in the context of a sudden organizational change. Longitudinal qualitative interview study with two interview rounds. The first round of interviews was conducted from September–December 2020, the second round from January–April 2021. In the first interview round, we performed eight semi-structured interviews with GPs from eight municipalities in Norway. In the second round, five of the GPs were re-interviewed. Consecutive interviews were performed 2–4 months apart. To analyze the data, we used thematic analysis. The COVID-19 pandemic required GPs to balance several concerns, such as continuity of care and their own professional efforts. Several GPs experienced challenges in the collaboration with the municipality and in relation to defining their own professional position. Guided by The Norwegian Association of General practitioners, The Norwegian College of General Practice and collegial support, they found viable solutions and ended up with a feeling of having adapted to a new normal. Although our study demonstrates that the GPs adapted to the changing conditions, the current municipal health care models are not ideal. There is a need for clarification of responsibilities between GPs and the municipality to facilitate a more coordinated future pandemic response. Facing the COVID-19 pandemic, the primary health care service in Norway had to reorganize to ensure safe patient treatment and maintain infection control. Several GPs experienced challenges in collaboration with the municipalities. There is a need for clarification of responsibilities between GPs and the municipality. [ABSTRACT FROM AUTHOR]

Although isotretinoin has anti-inflammatory and immunomodulatory properties, it can exacerbate atopic dermatitis. National estimates of the extent to which patients with atopic dermatitis are affected by severe acne and isotretinoin tolerability are lacking. The aim of this study is to investigate isotretinoin therapy in patients with atopic dermatitis and to compare the nationwide prevalence with individuals without atopic dermatitis. All Norwegian residents were followed for 17 years until age 20–22 years in 2020. Approximately 28% of patients with atopic dermatitis had been treated for acne, and 8% had received isotretinoin before age 23 years. In those over 17 years old, significantly more patients with atopic dermatitis were treated with isotretinoin than those without. At age 22 years, 2.21% (95% confidence interval 1.92–2.49) of patients with atopic dermatitis were treated with isotretinoin, compared with 1.55% (95% confidence interval 1.44–1.65) of those without, representing 42.8% (1.43; 95% confidence interval 1.24–1.65) higher use in patients with atopic dermatitis. Patients who received long-term treatment (probable severe atopic dermatitis) tolerated isotretinoin similarly to patients who received short-term treatment (probable mild atopic dermatitis). There was significantly higher use of topical corticosteroids during isotretinoin therapy in patients with atopic dermatitis. Conclusively, severe acne (isotretinoin therapy) was associated with atopic dermatitis at the population level in young adults. [ABSTRACT FROM AUTHOR]

Background: Urinary tract infections (UTIs) affect around 20% of the male population in their lifetime. The incidence of UTIs in men in the community is 0.9–2.4 cases per 1000 aged <55 years and 7.7 per 1000 aged ≥85 years. Aim: To evaluate the outcomes of randomised controlled trials (RCTs) comparing the effectiveness of different antimicrobial treatments and durations for uncomplicated UTIs in adult males in outpatient settings. Method: A systematic literature review of RCTs of adult male patients with an uncomplicated UTI treated with oral antimicrobials in any outpatient setting. The outcomes were symptom resolution within 2 weeks of starting treatment, duration until symptom resolution, clinical cure, bacteriological cure, and frequency of adverse events. Results: From the 1052 abstracts screened, three provided sufficient information on outcomes. One study compared trimethoprim-sulfamethoxazole for 14 days (21 males) with 42 days (21 males). Fluoroquinolones were compared in the two other RCTs: lomefloxacin (10 males) with norfloxacin (11 males), and ciprofloxacin for 7 days (19 males) and 14 days (19 males). Combining the results from the three RCTs shows that for 75% males with a UTI (76/101) bacteriological cure was reported at the end of the study. Of the 59 patients receiving a fluoroquinolone, 57 (97%) reported bacteriological and clinical cure within 2 weeks after treatment. Conclusion: The evidence available is insufficient to make any recommendations in relation to type and duration of antimicrobial treatment for male UTIs. Sufficiently powered RCTs are needed to identify best treatment type and duration for male UTIs in primary care. [ABSTRACT FROM AUTHOR]

Background: Clerkship in general practice has been considered removed from the fifth year at the University of Oslo for economical reasons. During the autumn 2007, we evaluated the clerkship after the implementation of a new feedback tool, StudPEP. This study presents how the clerkship was organized for learning based on pedagogical advice for effective learning., Material and Methods: 79 of 81 students completed a questionnaire regarding the clerkship. After five independent tutor-observed consultations, the students recorded their patients' diagnosis, age and gender, in a total of 363 consultations., Results: The students received eight patients per day on average during their last week of clerkship. On average, they had their own office during 64 % of their clerkship, but 19 % had their own office in less than a third of the time. The tutor observed 42 % of the students during more than six consultations in addition to the five compulsory ones, but 23 % of the students were only observed during the five compulsory sessions. The students were generally content with the feedback from their tutor, but 20 % gave critical answers. The students recorded 167 different diagnoses from all the chapters in the International Classification of Primary Care., Interpretation: The clerkship is well organized for learning medicine in general practice. There is a potential for quality improvement and this article presents suggestions from educational literature.

Background: Many medical students experience that they do not get satisfactory feedback during their general practice preceptorship. We wanted to explore whether an evaluation questionnaire answered by patients could be a useful tool for students and tutors., Material and Methods: The Department of General Practice and Community Medicine at the University of Oslo invited medical students who attended general practice preceptorship during spring 2005 to participate. The questionnaire consisted of eight questions regarding the consultation. Both tutors and students also considered the benefits of the evaluation form in a subsequent questionnaire. The answers to both of the questionnaires were analysed statistically. Some students were organised into focus groups that discussed the use of patient questionnaires before and after the preceptorship period., Results: 648 patients answered questionnaires following 36 students' independent consultations. The patient, the observing tutor and the student assessed 63 of these consultations. The patients scored eight issues with mean values from 4.3 to 5.0, with 5.0 being the best possible result. The questionnaires from the observed consultations showed that the tutors' assessment did not differ from the patients' on five out of seven compared issues. The tutors gave higher scores on the subject of the student's use of complicated language, and lower on the subject of physical examination. The students' self-assessment was significantly lower in six out of seven issues. The reactions to the questionnaire from both tutors and students were mixed. The students expressed that the use of questionnaires might contribute to better feedback from the preceptors or to obtain more independent consultations., Interpretation: The students' consultations received a very high score from both patients and tutors, while the students themselves scored their own achievements lower. The evaluation questionnaires may be useful tools to improve feedback to students on their consultations in the preceptorship period.