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Purpose: This study aimed to assess adherence to the Scandinavian guidelines, the justification of referrals, and the quality of referrals of patients with mild, minimal, and moderate head injuries in a selection of Norwegian hospitals. Methods: We collected 283 head CT referrals for head trauma patients at one hospital trust in Norway in 2022. The data included the patients’ sex, age, and the referral text. Six radiologists independently assessed all referrals using a registration form developed based on the Scandinavian guidelines for patients with mild, minimal, and moderate head injuries and general referral guidelines. Descriptive statistics was used to analyze data on adherence to guidelines, while Gwet’s AC1/2 was used to test the agreement between the raters. Results: This study found that 65% of referrals were assessed to be justified according to the guideline by at least one rater, while 17% were rated justified outside the guideline. In 52%, at least one rater required more information. There was good to moderate interrater agreement. Conclusions: Adherence to the Scandinavian guidelines and the quality of referrals of patients with mild, minimal, and moderate head injuries are low. Training and using S100B is recommended to improve the justification rate and quality of patient care. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to survey general practitioners' (GPs) and radiologists' perspectives on referrals, imaging justification, and unnecessary imaging in Norway. Materials and methods: The survey covered access to imaging, responsibilities, attitudes toward justification assessment, referral process, and demographics using multiple choice questions, statements to report agreement with using the Likert scale and one open question. Results: Forty radiologists and 58 GPs attending national conferences completed a web-based survey, with a 20/15% response rate, respectively. Both radiologists (97%) and GPs (100%) considered avoiding unnecessary examinations essential to their role in the healthcare service. Still, 91% of GPs admitted that they referred to imaging they thought was not helpful, while about 60% of the radiologists agreed that unnecessary imaging was conducted in their workplace. GPs reported pressure from patients and patients having private insurance as the most common reasons for doing unnecessary examinations. In contrast, radiologists reported a lack of clinical information and the inability to discuss patient cases with the GPs as the most common reasons. Conclusion: This study adds to our understanding of radiologists' and GPs' perspectives on unnecessary imaging and referrals. Better guidelines and, even more importantly, better communication between the referrer and the radiologist are needed. Addressing these issues can reduce unnecessary imaging and improve the quality and safety of care. [ABSTRACT FROM AUTHOR]

• Acknowledging complexity through advanced knowledge synthesis, competence of the context, and broad and strong stakeholder involvement is crucial is crucial to manage task complexity. • Clear consensus-based criteria for selecting low-value imaging procedures are key. • Having a clear target group is important. • Stakeholder engagement is crucial to ascertain intervention relevance and compliance. • Active and well-motivated intervention collaborators is a necessary but not sufficient condition. • It is crucial to pay close attention to the mechanisms of low-value imaging and the barriers to reduce it. Substantial overuse of health care services is identified and intensified efforts are incited to reduce low-value services in general and in imaging in particular. To report crucial success factors for developing and implementing interventions to reduce specific low-value imaging examinations based on a case study in Norway. Mixed methods design including one systematic review, one scoping review, implementation science, qualitative interviews, content analysis of stakeholders' input, and stakeholder deliberations. The description and analysis of an intervention to reduce low-value imaging in Norway identifies six general success factors: 1) Acknowledging complexity: advanced knowledge synthesis, competence of the context, and broad and strong stakeholder involvement is crucial to manage de-implementation complexity. 2) Clear consensus-based criteria for selecting low-value imaging procedures are key. 3) Having a clear target group is critical. 4) Stakeholder engagement is essential to ascertain intervention relevance and compliance. 5) Active and well-motivated intervention collaborators is imperative. 6) Paying close attention to the mechanisms of low-value imaging and the barriers to reduce it is decisive. Reducing low-value imaging is crucial to increase the quality, safety, efficiency, and sustainability of the health services. Reducing low-value imaging is a complex task and paying attention to specific practical success factors is key. [Display omitted] [ABSTRACT FROM AUTHOR]

Rational: Low‐value radiological imaging threatens patient safety and efficient use of limited health resources. It is important to evaluate measures for reducing low‐value utilisation, to learn and to improve. Accordingly, the objective of this study was to qualitatively evaluate a pilot intervention for reducing low‐value imaging in Norway. Methods: Semi‐structured interviews were conducted aimed at describing stakeholders' experience with a multicomponent pilot intervention consisting of a standardised procedure for referral assessment, a standardised return letter, and information about the value and possible risks of magnetic resonance imaging‐examinations to the public. Data were analysed in line with qualitative content analysis with a deductive approach. Results: Seven healthcare providers were interviewed, including two radiologists, two radiographers, one manual therapist, one practice consultant and one general practitioner. Data analysis yielded four categories: (1) information and reception, (2) referral‐ and assessment processes, (3) suggestions for improvement and facilitation and (4) outcomes of the pilot intervention. Conclusions: The pilot intervention was deemed acceptable, feasible, engaging and relevant. Specific training in the use of the new procedure was suggested to improve the intervention. The simple design, as well as the positive acceptance demonstrated and the few resources needed, make the pilot intervention and methodology highly relevant for other settings or when aiming to reduce the number of other low‐value radiology examinations. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to compare changes in hedonic hunger and food reward in individuals with severe obesity achieving 10% to 15% weight loss with a very low-energy diet (VLED) alone or VLED and bariatric surgery.Methods: Patients scheduled for sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) initiated a VLED 2 weeks prior to surgery and continued the diet for 8 weeks postoperatively. BMI-matched controls underwent a VLED for 10 weeks. Hedonic hunger was assessed with the Power of Food Scale, and food reward with the Leeds Food Preference Questionnaire, pre and post intervention.Results: A total of 44 participants completed the study: 15 SG, 14 RYGB, and 15 controls (61%, 79% and 69% females, respectively; BMI: 40.5 ± 0.5 kg/m2 ; age: 43.9 ± 1.4 years). Average weight loss was 18.3 ± 0.6 kg (16%), comprising 13.5 ± 0.5 kg fat mass, with no significant differences between groups. Similar reductions in hedonic hunger were observed in all groups. Overall, food reward was similarly reduced in SG and RYGB groups, whereas controls showed little or no change.Conclusions: Independent of modality, weight loss seems to reduce hedonic hunger, but bariatric surgery leads to several additional favorable changes in food reward and preferences. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to compare changes in gastrointestinal hormones and appetite ratings after a similar weight loss induced by a very low-energy diet alone or in combination with sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB)., Methods: Patients with severe obesity scheduled for SG (n = 15) and RYGB (n = 14) and 15 controls (very low-energy diet alone) were recruited. Body weight/composition, plasma concentrations of ß-hydroxybutyric acid, acylated ghrelin, total glucagon-like peptide-1, total peptide YY, cholecystokinin, and ratings of hunger, fullness, desire to eat, and prospective food consumption were measured pre- and postprandially, before and after 10 weeks of intervention., Results: Changes in body weight/composition and level of ketosis were similar across groups. In SG and RYGB, basal and postprandial acylated ghrelin declined, and postprandial glucagon-like peptide-1 increased, both significantly more compared with controls. Postprandial peptide YY increased in all groups. Overall, postprandial hunger decreased, and postprandial fullness increased. But ratings of desire to eat and prospective food consumption were more favorable after both surgeries compared with controls., Conclusions: Weight loss with SG and RYGB leads to more favorable changes in gastrointestinal hormones compared with diet alone, although ratings of appetite were reduced across all groups., (© 2022 The Authors. Obesity published by Wiley Periodicals LLC on behalf of The Obesity Society.)