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Article ; Online: Outpatient respiratory syncytial virus infections and novel preventive interventions.

Hak, Sarah F / Venekamp, Roderick P / Wildenbeest, Joanne G / Bont, Louis J

2023 Volume 36, Issue 2, Page(s) 171–181

Abstract: Purpose of review: With interventions to prevent respiratory syncytial virus (RSV) infection within reach, this review aims to provide healthcare professionals with the latest information necessary to inform parents and assess the potential impact of ... ...

Abstract	Purpose of review: With interventions to prevent respiratory syncytial virus (RSV) infection within reach, this review aims to provide healthcare professionals with the latest information necessary to inform parents and assess the potential impact of RSV prevention on everyday practice. We address frequently asked questions for parental counseling. Recent findings: Numerous studies emphasize the major burden of RSV on young children, parents, healthcare and society. In the first year of life, about 14% of healthy term infants visit a doctor and 2% require hospitalization due to RSV. In older children (1--5 years), RSV infections and associated morbidity (wheeze, acute otitis media) are major drivers of outpatient visits. A novel maternal RSV vaccine and long-acting mAb can provide protection during infants' first months of life. This maternal vaccine showed 70.9% efficacy against severe RSV infection within 150 days after birth; the mAb nirsevimab reduces medically attended RSV infections by 79.5% within 150 days after administration. Both gained regulatory approval in the USA (FDA) and Europe (EMA). Summary: Novel RSV immunizations hold promise to reduce the RSV burden in infants, with substantial impact on everyday practice. Tailored parental guidance will be instrumental for successful implementation. Awaiting pediatric vaccines, RSV infections beyond infancy will still pose a significant outpatient burden.
MeSH term(s)	Infant ; Child ; Humans ; Child, Preschool ; Respiratory Syncytial Virus Infections/prevention & control ; Outpatients ; Respiratory Syncytial Virus Vaccines/therapeutic use ; Delivery of Health Care ; Immunization ; Respiratory Tract Infections/prevention & control
Chemical Substances	Respiratory Syncytial Virus Vaccines
Language	English
Publishing date	2023-12-12
Publishing country	United States
Document type	Review ; Journal Article
ZDB-ID	1049374-8
ISSN	1531-698X ; 1040-8703
ISSN (online)	1531-698X
ISSN	1040-8703
DOI	10.1097/MOP.0000000000001323
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Article ; Online: Antibiotics for acute otitis media in children.

Venekamp, Roderick P / Sanders, Sharon L / Glasziou, Paul P / Rovers, Maroeska M

The Cochrane database of systematic reviews

2023 Volume 11, Page(s) CD000219

Abstract: Background: Acute otitis media (AOM) is one of the most common diseases in childhood for which antibiotics are commonly prescribed; a systematic review reported a pooled prevalence of 85.6% in high-income countries. This is an update of a Cochrane ... ...

Abstract	Background: Acute otitis media (AOM) is one of the most common diseases in childhood for which antibiotics are commonly prescribed; a systematic review reported a pooled prevalence of 85.6% in high-income countries. This is an update of a Cochrane Review first published in the Cochrane Library in 1997 and updated in 1999, 2005, 2009, 2013 and 2015. Objectives: To assess the effects of antibiotics for children with AOM. Search methods: We searched CENTRAL, MEDLINE, Embase, Current Contents, CINAHL, LILACS and two trial registers. The date of the search was 14 February 2023. Selection criteria: We included randomised controlled trials comparing 1) antimicrobial drugs with placebo, and 2) immediate antibiotic treatment with expectant observation (including delayed antibiotic prescribing) in children with AOM. Data collection and analysis: Two review authors independently screened trials for inclusion and extracted data using the standard methodological procedures recommended by Cochrane. Our primary outcomes were: 1) pain at various time points (24 hours, two to three days, four to seven days, 10 to 14 days), and 2) adverse effects likely to be related to the use of antibiotics. Secondary outcomes were: 1) abnormal tympanometry findings, 2) tympanic membrane perforation, 3) contralateral otitis (in unilateral cases), 4) AOM recurrences, 5) serious complications related to AOM and 6) long-term effects (including the number of parent-reported AOM symptom episodes, antibiotic prescriptions and health care utilisation as assessed at least one year after randomisation). We used the GRADE approach to rate the overall certainty of evidence for each outcome of interest. Main results: Antibiotics versus placebo We included 13 trials (3401 children and 3938 AOM episodes) from high-income countries, which we assessed at generally low risk of bias. Antibiotics do not reduce pain at 24 hours (risk ratio (RR) 0.89, 95% confidence interval (CI) 0.78 to 1.01; 5 trials, 1394 children; high-certainty evidence), or at four to seven days (RR 0.76, 95% CI 0.50 to 1.14; 7 trials, 1264 children), but result in almost a third fewer children having pain at two to three days (RR 0.71, 95% CI 0.58 to 0.88; number needed to treat for an additional beneficial outcome (NNTB) 20; 7 trials, 2320 children; high-certainty evidence), and likely result in two-thirds fewer having pain at 10 to 12 days (RR 0.33, 95% CI 0.17 to 0.66; NNTB 7; 1 trial, 278 children; moderate-certainty evidence). Antibiotics increase the risk of adverse events such as vomiting, diarrhoea or rash (RR 1.38, 95% CI 1.16 to 1.63; number needed to treat for an additional harmful outcome (NNTH) 14; 8 trials, 2107 children; high-certainty evidence). Antibiotics reduce the risk of children having abnormal tympanometry findings at two to four weeks (RR 0.83, 95% CI 0.72 to 0.96; NNTB 11; 7 trials, 2138 children), slightly reduce the risk of experiencing tympanic membrane perforations (RR 0.43, 95% CI 0.21 to 0.89; NNTB 33; 5 trials, 1075 children) and halve the risk of contralateral otitis episodes (RR 0.49, 95% CI 0.25 to 0.95; NNTB 11; 4 trials, 906 children). However, antibiotics do not reduce the risk of abnormal tympanometry findings at six to eight weeks (RR 0.89, 95% CI 0.70 to 1.13; 3 trials, 953 children) and at three months (RR 0.94, 95% CI 0.66 to 1.34; 3 trials, 809 children) or late AOM recurrences (RR 0.94, 95% CI 0.79 to 1.11; 6 trials, 2200 children). Severe complications were rare, and the evidence suggests that serious complications do not differ between children treated with either antibiotics or placebo. Immediate antibiotics versus expectant observation We included six trials (1556 children) from high-income countries. The evidence suggests that immediate antibiotics may result in a reduction of pain at two to three days (RR 0.53, 95% CI 0.35 to 0.79; NNTB 8; 1 trial, 396 children; low-certainty evidence), but probably do not reduce the risk of pain at three to seven days (RR 0.75, 95% CI 0.50 to 1.12; 4 trials, 959 children; moderate-certainty evidence), and may not reduce the risk of pain at 11 to 14 days (RR 0.91, 95% CI 0.75 to 1.10; 1 trial, 247 children; low-certainty evidence). Immediate antibiotics increase the risk of vomiting, diarrhoea or rash (RR 1.87, 95% CI 1.39 to 2.51; NNTH 10; 3 trials, 946 children; high-certainty evidence). Immediate antibiotics probably do not reduce the proportion of children with abnormal tympanometry findings at four weeks and evidence suggests that immediate antibiotics may not reduce the risk of tympanic membrane perforation and AOM recurrences. No serious complications occurred in either group. Authors' conclusions: This review reveals that antibiotics probably have no effect on pain at 24 hours, a slight effect on pain in the days following and only a modest effect on the number of children with tympanic perforations, contralateral otitis episodes and abnormal tympanometry findings at two to four weeks compared with placebo in children with AOM. In high-income countries, most cases of AOM spontaneously remit without complications. The benefits of antibiotics must be weighed against the possible harms: for every 14 children treated with antibiotics, one child experienced an adverse event (such as vomiting, diarrhoea or rash) that would not have occurred if antibiotics were withheld. For most children with mild disease in high-income countries, an expectant observational approach seems justified. Therefore, clinical management should emphasise advice about adequate analgesia and the limited role for antibiotics.
MeSH term(s)	Child ; Humans ; Anti-Bacterial Agents/adverse effects ; Tympanic Membrane Perforation/drug therapy ; Tympanic Membrane Perforation/chemically induced ; Acute Disease ; Otitis Media/drug therapy ; Otitis Media/epidemiology ; Pain/drug therapy ; Diarrhea/chemically induced ; Exanthema ; Vomiting/chemically induced
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2023-11-15
Publishing country	England
Document type	Systematic Review ; Journal Article ; Review
ISSN	1469-493X
ISSN (online)	1469-493X
DOI	10.1002/14651858.CD000219.pub5
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Article ; Online: Within-episode repeat antibiotic prescriptions in patients with respiratory tract infections: A population-based cohort study.

Lalmohamed, Arief / Venekamp, Roderick P / Bolhuis, Albert / Souverein, Patrick C / van de Wijgert, Janneke H H M / Gulliford, Martin C / Hay, Alastair D

The Journal of infection

2024 Volume 88, Issue 4, Page(s) 106135

Abstract: Background: Antimicrobial stewardship interventions mainly focus on initial antibiotic prescriptions, with few considering within-episode repeat prescriptions. We aimed to describe the magnitude, type and determinants of within-episode repeat antibiotic ...

Abstract	Background: Antimicrobial stewardship interventions mainly focus on initial antibiotic prescriptions, with few considering within-episode repeat prescriptions. We aimed to describe the magnitude, type and determinants of within-episode repeat antibiotic prescriptions in patients presenting to primary care with respiratory tract infections (RTIs). Methods: We conducted a population-based cohort study among 530 sampled English general practices within the Clinical Practice Research Datalink (CPRD). All individuals with a primary care RTI consultation for which an antibiotic was prescribed between March 2018 and February 2022. Main outcome measurement was repeat antibiotic prescriptions within 28 days of a RTI visit stratified by age (children vs. adults) and RTI type (lower vs. upper RTI). Multivariable logistic regression and principal components analyses were used to identify risk factors and patient clusters at risk for within-episode repeat prescriptions. Findings: 905,964 RTI episodes with at least one antibiotic prescription were identified. In adults, 19.9% (95% CI 19.3-20.5%) had at least one within-episode repeat prescription for a lower RTI, compared to 10.5% (95% CI 10.3-10.8%) for an upper RTI. In children, this was around 10% irrespective of RTI type. The majority of repeat prescriptions occurred a median of 10 days after the initial prescription and was the same antibiotic class in 48.3% of cases. Frequent RTI related GP visits and prior within-RTI-episode repeat antibiotic prescriptions were main factors associated with repeat prescriptions in both adults and children irrespective of RTI type. Young (<2 years) and older (65+) age were associated with repeat prescriptions. Among those aged 2-64 years, allergic rhinitis, COPD and oral corticosteroids were associated with repeat prescriptions. Interpretations: Repeat within-episode antibiotic use accounts for a significant proportion of all antibiotics prescribed for RTIs, with same class antibiotics unlikely to confer clinical benefit and is therefore a prime target for future antimicrobial stewardship interventions.
MeSH term(s)	Child ; Humans ; Cohort Studies ; Anti-Bacterial Agents/therapeutic use ; Practice Patterns, Physicians' ; Respiratory Tract Infections/drug therapy ; Prescriptions ; Drug Prescriptions
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2024-03-08
Publishing country	England
Document type	Journal Article
ZDB-ID	424417-5
ISSN	1532-2742 ; 0163-4453
ISSN (online)	1532-2742
ISSN	0163-4453
DOI	10.1016/j.jinf.2024.106135
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Article ; Online: Patients' and GPs' views and expectations of home monitoring with a pulse oximeter: a mixed-methods process evaluation of a pilot randomised controlled trial.

Smit, Karin / Venekamp, Roderick P / Geersing, Geert-Jan / Rutten, Frans H / Schoonhoven, Lisette / Zwart, Dorien Lm

The British journal of general practice : the journal of the Royal College of General Practitioners

2023 Volume 73, Issue 737, Page(s) e894–e902

Abstract: Background: Research on how home monitoring with a pulse oximeter is executed and experienced by patients with an acute illness such as COVID-19 and their GPs is scarce.: Aim: To examine the process of structured home monitoring with a pulse oximeter ...

Abstract	Background: Research on how home monitoring with a pulse oximeter is executed and experienced by patients with an acute illness such as COVID-19 and their GPs is scarce. Aim: To examine the process of structured home monitoring with a pulse oximeter for patients with COVID-19, their caregivers, and their GPs. Design and setting: This was a mixed-method process evaluation alongside a pilot feasibility randomised controlled trial. Patients drawn from a general practice setting, with COVID-19, and aged ≥40 years with cardiovascular comorbidities were included. Method: Quantitative trial data from 21 intervention group participants (age 63.2 years) were used, plus qualitative data from semi-structured interviews with 15 patients (age 62.9 years), eight informal caregivers, and 10 GPs. Results: Adherence to the intervention was very high; 97.6% of protocolised peripheral oxygen saturation (SpO Conclusion: Structured home monitoring by pulse oximetry supports patients and their informal caregivers in managing, and GPs in monitoring, acute COVID-19 disease. It appears suitable for use in acutely ill patients in general practice.
MeSH term(s)	Humans ; COVID-19/epidemiology ; Motivation ; Oximetry/methods ; Oxygen ; Pilot Projects ; Adult
Chemical Substances	Oxygen (S88TT14065)
Language	English
Publishing date	2023-11-30
Publishing country	England
Document type	Randomized Controlled Trial ; Journal Article
ZDB-ID	1043148-2
ISSN	1478-5242 ; 0035-8797 ; 0960-1643
ISSN (online)	1478-5242
ISSN	0035-8797 ; 0960-1643
DOI	10.3399/BJGP.2023.0139
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Article ; Online: Immunoglobulin treatment for hospitalised infants and young children with respiratory syncytial virus infection.

Sanders, Sharon L / Agwan, Sushil / Hassan, Mohamed / Bont, Louis J / Venekamp, Roderick P

The Cochrane database of systematic reviews

2023 Volume 10, Page(s) CD009417

Abstract: Background: Millions of children are hospitalised due to respiratory syncytial virus (RSV) infection every year. Treatment is supportive, and current therapies (e.g. inhaled bronchodilators, epinephrine, nebulised hypertonic saline, and corticosteroids) ...

Abstract	Background: Millions of children are hospitalised due to respiratory syncytial virus (RSV) infection every year. Treatment is supportive, and current therapies (e.g. inhaled bronchodilators, epinephrine, nebulised hypertonic saline, and corticosteroids) are ineffective or have limited effect. Respiratory syncytial virus immunoglobulin may be used prophylactically to prevent hospital admission from RSV-related illness. It may be considered for the treatment of established severe RSV infection or for treatment in an immunocompromised host, although it is not licensed for this purpose. It is unclear whether immunoglobulins improve outcomes when used as a treatment for established RSV infection in infants and young children admitted to hospital. This is an update of a review first published in 2019. Objectives: To assess the effects of immunoglobulins for the treatment of RSV-proven lower respiratory tract infections (LRTIs) in children aged up to three years, admitted to hospital. Search methods: For this 2022 update, we searched the Cochrane Central Register of Controlled Trials (CENTRAL), which contains the Cochrane Acute Respiratory Infections Specialised Register, Ovid MEDLINE, Embase, CINAHL, and Web of Science (from inception to 2 December 2022) with no restrictions. We searched two trial registries for ongoing trials (to 2 December 2022) and checked the reference lists of reviews and included articles for additional studies. Selection criteria: Randomised controlled trials comparing immunoglobulins with placebo in hospitalised infants and children aged up to three years with laboratory-diagnosed RSV lower respiratory tract infection. Data collection and analysis: Two review authors independently selected trials, assessed risk of bias, and extracted data. We assessed evidence certainty using GRADE. Main results: In total, we included eight trials involving 906 infants and children aged up to three years. We included one new trial in this update. The immunoglobulin preparations used in these trials included anti-RSV immunoglobulin and the monoclonal antibody preparations palivizumab and motavizumab. Five trials were conducted at single or multiple sites within a single high-income country (four in the USA, one in Qatar). Three trials included study sites in different countries. All three of these trials included study sites in one or more high-income countries (USA, Chile, New Zealand, Australia, Qatar), with two trials also including a study site in a middle-income country (Panama). Five of the eight trials were "supported" or "sponsored" by the trial drug manufacturers. The evidence is very uncertain about the effect of immunoglobulins on mortality (risk ratio (RR) 0.87, 95% confidence interval (CI) 0.14 to 5.27; 4 studies, 309 participants). There were four deaths - two amongst 98 children receiving immunoglobulins, and two amongst 98 children receiving placebo. One additional death occurred in a fourth trial, however the study group of the child was not known and the data were not included in the analysis (very low-certainty evidence). The use of immunoglobulins in infants and children admitted to hospital with RSV proven LRTI probably results in little to no difference in the length of hospitalisation (mean difference (MD) -0.13 days, 95% CI -0.37 to 0.12; 6 studies, 737 participants; moderate-certainty evidence). Immunoglobulins may result in little to no difference in the number of children who experience one or more adverse events of any severity or seriousness compared to placebo (RR 1.18, 95% CI 0.78 to 1.78; 5 studies, 340 participants; low-certainty evidence) or the number of children who experience one or more adverse events judged by study investigators to be serious in nature, compared to placebo (RR 1.08, 95% CI 0.65 to 1.79; 4 studies, 238 participants; low-certainty evidence). Certainty of evidence for secondary outcomes was low. This evidence suggests that use of immunoglobulins results in little to no difference in the need for, or duration of, mechanical ventilation and the need for, or duration of, supplemental oxygen. The use of immunoglobulins does not reduce the need for admission to the intensive care unit (ICU) and when children are admitted to the ICU results in little to no difference in the duration of ICU stay. Authors' conclusions: We are very uncertain about the effect of immunoglobulins on mortality. We are moderately certain that use of immunoglobulins in hospitalised infants and children may result in little to no difference in the length of hospitalisation. Immunoglobulins may result in little to no difference in adverse events, the need for or duration of mechanical ventilation, supplemental oxygen, or admission to the intensive care unit, though we are less certain about this evidence and the true effect of immunoglobulins on these outcomes may differ markedly from the estimated effect observed in this review. All trials were conducted in high-income countries, and data from populations in which the rate of death from RSV infection is higher are lacking.
MeSH term(s)	Infant ; Child ; Humans ; Child, Preschool ; Respiratory Syncytial Virus Infections/drug therapy ; Hospitalization ; Adrenal Cortex Hormones/therapeutic use ; Respiratory Tract Infections ; Oxygen
Chemical Substances	Adrenal Cortex Hormones ; Oxygen (S88TT14065)
Language	English
Publishing date	2023-10-23
Publishing country	England
Document type	Systematic Review ; Journal Article ; Review ; Research Support, Non-U.S. Gov't
ISSN	1469-493X
ISSN (online)	1469-493X
DOI	10.1002/14651858.CD009417.pub3
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Article ; Online: Acute rhinosinusitis and systemic corticosteroids--response to Ukwaja.

Venekamp, Roderick P

CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne

2013 Volume 185, Issue 1, Page(s) 62

MeSH term(s)	Female ; Glucocorticoids/therapeutic use ; Humans ; Male ; Prednisolone/therapeutic use ; Rhinitis/drug therapy ; Sinusitis/drug therapy
Chemical Substances	Glucocorticoids ; Prednisolone (9PHQ9Y1OLM)
Language	English
Publishing date	2013-01-07
Publishing country	Canada
Document type	Letter ; Comment
ZDB-ID	215506-0
ISSN	1488-2329 ; 0008-4409 ; 0820-3946
ISSN (online)	1488-2329
ISSN	0008-4409 ; 0820-3946
DOI	10.1503/cmaj.113-2093
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Article ; Online: Een acuut loopoor.

Hullegie, Saskia / Schilder, Anne G M / Damoiseaux, Roger A M J / Venekamp, Roderick P

Nederlands tijdschrift voor geneeskunde

2022 Volume 166

Abstract: It is often thought that acute ear discharge as a presenting symptom of acute otitis media (AOM) means that the infection is petering out. However, children with AOM presenting with ear discharge due to a spontaneous perforation of the eardrum (AOMd) ... ...

Title translation	Acute ear discharge, a reason for consultation.
Abstract	It is often thought that acute ear discharge as a presenting symptom of acute otitis media (AOM) means that the infection is petering out. However, children with AOM presenting with ear discharge due to a spontaneous perforation of the eardrum (AOMd) have a poorer prognosis (i.e. higher rates of ear pain and/or fever at 3-7 days) than those without ear discharge. In this article we emphasize the importance of physical examination and early treatment of children and adults who present with acute ear discharge.
MeSH term(s)	Adult ; Child ; Humans ; Infant ; Acute Disease ; Anti-Bacterial Agents/therapeutic use ; Otitis Media/complications ; Otitis Media/diagnosis ; Otitis Media/drug therapy ; Pain/drug therapy ; Referral and Consultation
Chemical Substances	Anti-Bacterial Agents
Language	Dutch
Publishing date	2022-08-30
Publishing country	Netherlands
Document type	English Abstract ; Journal Article
ZDB-ID	82073-8
ISSN	1876-8784 ; 0028-2162
ISSN (online)	1876-8784
ISSN	0028-2162
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Article ; Online: Antibiotics provide no clinically important benefit in mild to moderate acute sinusitis.

Venekamp, Roderick P

Evidence-based medicine

2012 Volume 17, Issue 6, Page(s) e16

Language	English
Publishing date	2012-12
Publishing country	England
Document type	Comment ; Journal Article
ZDB-ID	1324346-9
ISSN	1473-6810 ; 1356-5524
ISSN (online)	1473-6810
ISSN	1356-5524
DOI	10.1136/ebmed-2012-100763
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Article ; Online: Home monitoring by pulse oximetry of primary care patients with COVID-19: a pilot randomised controlled trial.

Smit, Karin / Venekamp, Roderick P / Krol, Loeke A / Geersing, Geert-Jan / Schoonhoven, Lisette / Kaasjager, Karin Ah / Rutten, Frans H / Zwart, Dorien Lm

The British journal of general practice : the journal of the Royal College of General Practitioners

2023 Volume 73, Issue 730, Page(s) e356–e363

Abstract: Background: Pulse oximetry as a home or remote monitoring tool accelerated during the pandemic for patients with COVID-19, but evidence on its use is lacking.: Aim: To assess the feasibility of home monitoring by pulse oximetry of patients aged ≥40 ... ...

Abstract	Background: Pulse oximetry as a home or remote monitoring tool accelerated during the pandemic for patients with COVID-19, but evidence on its use is lacking. Aim: To assess the feasibility of home monitoring by pulse oximetry of patients aged ≥40 years with cardiovascular comorbidity and moderate-to-severe COVID-19. Design and setting: A primary care-based, open, pilot randomised controlled trial, with nested process evaluation, was undertaken in the Netherlands. Method: From November 2020 to June 2021, eligible patients presenting to one of 14 participating Dutch general practices were randomly allocated to regular measurement of peripheral oxygen saturation (at least three SpO Results: All 41 participants (21 intervention, 20 usual care) completed the 45-day follow-up period. Overall, the intervention group performed 97.6% of protocolised measurements; the median daily measurement per participant was 2.7 (interquartile range 1-4). Hypoxemia (SpO Conclusion: Home monitoring of patients with moderate-to-severe COVID-19 by pulse oximetry appeared feasible; adherence was high, patients reported a high feeling of safety, while the number of primary care consultations remained similar to usual care.
MeSH term(s)	Humans ; COVID-19/epidemiology ; Pilot Projects ; Oximetry ; Hospitalization ; Primary Health Care
Language	English
Publishing date	2023-04-27
Publishing country	England
Document type	Randomized Controlled Trial ; Journal Article
ZDB-ID	1043148-2
ISSN	1478-5242 ; 0035-8797 ; 0960-1643
ISSN (online)	1478-5242
ISSN	0035-8797 ; 0960-1643
DOI	10.3399/BJGP.2022.0224
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Article ; Online: Displaying concerns within telephone triage conversations of callers with chest discomfort in out-of-hours primary care: A conversation analytic study.

Spek, Michelle / van Charldorp, Tessa C / Vinck, Vera V / Venekamp, Roderick P / Rutten, Frans H / Zwart, Dorien L / de Groot, Esther

Patient education and counseling

2023 Volume 113, Page(s) 107770

Abstract: Objectives: In primary care out of hours service (OHS-PC), triage nurses ask questions to assign urgency level for medical assessment. A semi-automatic decision tool (the Netherlands Triage Standard, NTS) facilitates triage nurses with key questions, ... ...

Abstract	Objectives: In primary care out of hours service (OHS-PC), triage nurses ask questions to assign urgency level for medical assessment. A semi-automatic decision tool (the Netherlands Triage Standard, NTS) facilitates triage nurses with key questions, but does not leave much room for paying attention to callers' concerns. We wanted to understand how callers with chest pain formulate their concerns and are helped further during telephone triage. Methods: We conducted a conversation analytic study of 68 triage calls from callers with chest discomfort who contacted OHS-PC of which we selected 35 transcripts in which concerns were raised. We analyzed expressions of concerns and the corresponding triage nurse response. Results: Due to the task-oriented nature of the NTS, callers' concerns were overlooked. For callers, however, discussing concerns was relevant, stressed by the finding that the majority of callers with chest discomfort expressed concerns. Conclusions: Interactional difficulties in concern-related discussions arised directly after expressed concerns if not handled adequately, or during the switch to the counseling phase. Practice implications: When callers display concerns during telephone triage, we recommend triage nurses to explore them briefly and then return to the sequence of tasks described in the NTS-assisted triage process.
MeSH term(s)	Humans ; Triage ; After-Hours Care ; Chest Pain ; Telephone ; Primary Health Care
Language	English
Publishing date	2023-05-04
Publishing country	Ireland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	605590-4
ISSN	1873-5134 ; 0738-3991
ISSN (online)	1873-5134
ISSN	0738-3991
DOI	10.1016/j.pec.2023.107770
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In stock of ZB MED Cologne/Königswinter

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In stock of ZB MED Cologne/Königswinter

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In stock of ZB MED Cologne/Königswinter

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In stock of ZB MED Cologne/Königswinter

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In stock of ZB MED Cologne/Königswinter

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