{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T11:10:56Z","timestamp":1788779456432,"version":"build-2803163510"},"reference-count":17,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:00:00Z","timestamp":1784505600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:00:00Z","timestamp":1784505600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Internal Medicine Journal"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Hepatic encephalopathy (HE) is a reversible neuropsychiatric complication of cirrhosis associated with cognitive and psychomotor impairment that may compromise driving safety. Deficits in attention, visuospatial ability, reaction time and executive function contribute to impaired on\u2010road performance and increased motor vehicle collision rates. Despite this, there are no standardised Australian guidelines addressing driving in patients with HE, and international guidelines remain heterogenous. This article reviews the impact of overt (OHE) and covert HE on driving performance and outlines a pragmatic, risk\u2010stratified framework. For patients with prior OHE, our approach is a time\u2010limited driving restrictions based risk assessment, with conditional return to driving following sustained clinical stability and adherence to therapy. This framework aims to balance public safety with preservation of patient autonomy and quality of life.<\/jats:p>","DOI":"10.1111\/imj.70523","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T18:45:13Z","timestamp":1784573113000},"page":"1664-1668","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Driving in hepatic encephalopathy"],"prefix":"10.1111","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6306-9783","authenticated-orcid":false,"given":"Keith","family":"Brick","sequence":"first","affiliation":[{"name":"Sunshine Coast University Hospital  Birtinya Queensland Australia"},{"name":"Department of Gastroenterology and Hepatology Queensland Health  Brisbane Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rohit","family":"Gupta","sequence":"additional","affiliation":[{"name":"Sunshine Coast University Hospital  Birtinya Queensland Australia"},{"name":"Department of Gastroenterology and Hepatology Queensland Health  Brisbane Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,20]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1600561"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/gastro\/gox013"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.27210"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCG.0000000000000764"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.23128"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2009.7"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2022.06.001"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/flgastro-2025-103268"},{"key":"e_1_2_13_10_1","volume-title":"Assessing Fitness to Drive for Commercial and Private Vehicle Drivers: Medical Standards for Licensing and Clinical Management Guidelines","author":"Austroads; National Transport Commission","year":"2022"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.20095"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000000603"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12877-024-04835-3"},{"key":"e_1_2_13_14_1","unstructured":"Driver and Vehicle Licensing Agency.Assessing fitness to drive: a guide for medical professionals. [cited 2026 Jan 27]. Available from URL:https:\/\/www.gov.uk\/government\/publications\/assessing\u2010fitness\u2010to\u2010drive\u2010a\u2010guide\u2010for\u2010medical\u2010professionals"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2008.05.025"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2014.05.011"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2009.08.003"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2010.08.061"}],"container-title":["Internal Medicine Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/imj.70523","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/imj.70523","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/imj.70523","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T10:34:17Z","timestamp":1788777257000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/imj.70523"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,20]]},"references-count":17,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1111\/imj.70523"],"URL":"https:\/\/doi.org\/10.1111\/imj.70523","archive":["Portico"],"relation":{},"ISSN":["1444-0903","1445-5994"],"issn-type":[{"value":"1444-0903","type":"print"},{"value":"1445-5994","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,20]]},"assertion":[{"value":"2026-02-17","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-05","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-20","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}