Telephone triage by nurses in primary care out-of-hours services in Norway: an evaluation study based on written case scenarios

Background: The use of nurses for telephone-based triage in out-of-hours services is increasing in several countries. No investigations have been carried out in Norway into the quality of decisions made by nurses regarding our priority degree system. There are three levels: acute, urgent and non-urgent. Methods: Nurses working in seven casualty clinics in out-of-hours districts in Norway (The Watchtowers) were all invited to participate in a study to assess priority grade on 20 written medical scenarios validated by an expert group. 83 nurses (response rate 76%) participated in the study. A one-out-of-five sample of the nurses assessed the same written cases after 3 months (n¼18, response rate 90%) as a testeretest assessment. Results: Among the acute, urgent and non-urgent scenarios, 82%, 74% and 81% were correctly classified according to national guidelines. There were significant differences in the proportion of correct classifications among the casualty clinics, but neither employment percentage nor profession or work experience affected the triage decision. The mean intraobserver variability measured by the Cohen kappa was 0.61 (CI 0.52 to 0.70), and there were significant differences in kappa with employment percentage. Casualty clinics and work experience did not affect intrarater agreement. Conclusion: Correct classification of acute and nonurgent cases among nurses was quite high. Work experience and employment percentage did not affect triage decision. The intrarater agreement was good and about the same as in previous studies performed in other countries. Kappa increased significantly with increasing employment percentage

Understanding of and adherence to advice after telephone counselling by nurse: a survey among callers to a primary emergency out-of-hours service in Norway

<p>Abstract</p> <p>Background</p> <p>To investigate how callers understand the information given by telephone by registered nurses in a casualty clinic, to what degree the advice was followed, and the final outcome of the condition for the patients.</p> <p>Methods</p> <p>The study was conducted at a large out-of-hours inter-municipality casualty clinic in Norway during April and May 2010. Telephone interviews were performed with 100 callers/patients who had received information and advice by a nurse as a sole response. Six topics from the interview guide were compared with the telephone record files to check whether the caller had understood the advice. In addition, questions were asked about how the caller followed the advice provided and the patient's outcome.</p> <p>Results</p> <p>99 out of 100 interviewed callers stated that they had understood the nurse's advice, but interpreted from the telephone records, the total agreement for all six topics was 82.6%. 93 callers/patients stated that they followed the advice and 11 re-contacted the casualty clinic. 22 contacted their GP for the same complaints the same week, of whom five patients received medical treatment and one was hospitalised. There were significant difference between the native-Norwegian and the non-native Norwegian regarding whether they trusted the nurse (p = 0.017), and if they got relevant answers to their questions (p = 0.005).</p> <p>Conclusion</p> <p>Callers to the out-of-hours service seem to understand the advice given by the registered nurses, and a large majority of the patients did not contact their GP or other health services again with the same complaints.</p> <p>Practice Implication</p> <p>Medical and communicative training must be an important part of the continuous improvement strategy within the out-of-hour services.</p

Incidence of emergency contacts (red responses) to Norwegian emergency primary healthcare services in 2007 – a prospective observational study

<p>Abstract</p> <p>Background</p> <p>The municipalities are responsible for the emergency primary health care services in Norway. These services include casualty clinics, primary doctors on-call and local emergency medical communication centres (LEMC). The National centre for emergency primary health care has initiated an enterprise called "The Watchtowers", comprising emergency primary health care districts, to provide routine information (patients' way of contact, level of urgency and first action taken by the out-of-hours services) over several years based on a minimal dataset. This will enable monitoring, evaluation and comparison of the respective activities in the emergency primary health care services. The aim of this study was to assess incidence of emergency contacts (potential life-threatening situations, red responses) to the emergency primary health care service.</p> <p>Methods</p> <p>A representative sample of Norwegian emergency primary health care districts, "The Watchtowers" recorded all contacts and first action taken during the year of 2007. All the variables were continuously registered in a data program by the attending nurses and sent by email to the National Centre for Emergency Primary Health Care at a monthly basis.</p> <p>Results</p> <p>During 2007 the Watchtowers registered 85 288 contacts, of which 1 946 (2.3%) were defined as emergency contacts (red responses), corresponding to a rate of 9 per 1 000 inhabitants per year. 65% of the instances were initiated by patient, next of kin or health personnel by calling local emergency medical communication centres or meeting directly at the casualty clinics. In 48% of the red responses, the first action taken was a call-out of doctor and ambulance. On a national basis we can estimate approximately 42 500 red responses per year in the EPH in Norway.</p> <p>Conclusion</p> <p>The emergency primary health care services constitute an important part of the emergency system in Norway. Patients call the LEMC or meet directly at casualty clinics with medical problems that initially are classified as a potentially life-threatening situation, a red response.</p

Cross-linguistic variation in word-initial cluster production in adult and child language: evidence from English and Norwegian.

Young children simplify word initial consonant clusters by omitting or substituting one (or both) of the elements. Vocalic insertion, coalescence and metathesis are said to be used more seldom (McLeod, van Doorn & Reed, 2001). Data from Norwegian children, however, have shown vocalic insertion to be more frequently used (Simonsen, 1990; Simonsen, Garmann & Kristoffersen, 2019). To investigate the extent to which children use this strategy to differing degrees depending on the ambient language, we analysed word initial cluster production acoustically in nine Norwegian and nine English speaking children aged 2;6-6 years, and eight adults, four from each language. The results showed that Norwegian-speaking children produce significantly more instances of vocalic insertions than English-speaking children do. The same pattern is found in Norwegian- versus English-speaking adults. We argue that this cross-linguistic difference is an example of the influence of prosodic-phonetic biases in language-specific developmental paths in the acquisition of speech.British Academy Small Research Grant SG122210 ‘The acquisition of consonant timing: a study in cross-linguistic micro-variation’, MultiLing, A Centre of Excellence funded by the Research Council of Norway (project number 223265), and from the Faculty of Education and International Studies at Oslo Metropolitan University

Vocalic Intrusions in Consonant Clusters in Child-Directed vs. Adult-Directed Speech.

In this paper, we investigate a prosodic-phonetic feature in child-directed speech within a dynamic, complex, interactive theoretical framework. We focus on vocalic intrusions, commonly occurring in Norwegian word initial consonant clusters. We analysed child-directed speech from nine Norwegian-speaking mothers to their children, aged 2;6, 4, and 6 years, and compared the incidence and duration of vocalic intrusions in initial consonant clusters in these data with those in adult-directed speech and child speech. When viewed overall, vocalic intrusion was found to be similar in incidence in child- and adult-directed speech. However, closer examination revealed differential behaviour in child-directed speech for certain conditions. Firstly, a difference emerged for one particular phonetic context: While vocalic intrusions in /Cr/ clusters are frequent in adult-directed speech, their presence is near-categorical in child-directed speech. Secondly, we found that the duration of vocalic intrusions was longer in child- than in adult-directed speech, but only when directed to 2;6-year-olds. We argue that vocalic intrusions in child-directed speech may have both a bonding as well as a didactic function, and that these may vary according to the age of the child being addressed

Protein Replacement Therapy Partially Corrects the Cholesterol-Storage Phenotype in a Mouse Model of Niemann-Pict Type C2 Disease

Niemann-Pick type C2 (NPC2) disease is a fatal autosomal recessive neurovisceral degenerative disorder characterized by late endosomal-lysosomal sequestration of low-density lipoprotein derived cholesterol. The breach in intracellular cholesterol homeostasis is caused by deficiency of functional NPC2, a soluble sterol binding protein targeted to the lysosomes by binding the mannose-6-phosphate receptor. As currently there is no effective treatment for the disorder, we have investigated the efficacy of NPC2 replacement therapy in a murine gene-trap model of NPC2-disease generated on the 129P2/OlaHsd genetic background. NPC2 was purified from bovine milk and its functional competence assured in NPC2-deficient fibroblasts using the specific cholesterol fluorescent probe filipin. For evaluation of phenotype correction in vivo, three-week-old NPC2−/− mice received two weekly intravenous injections of 5 mg/kg NPC2 until trial termination 66 days later. Whereas the saline treated NPC2−/− mice exhibited massive visceral cholesterol storage as compared to their wild-type littermates, administration of NPC2 caused a marked reduction in cholesterol build up. The histological findings, indicating an amelioration of the disease pathology in liver, spleen, and lungs, corroborated the biochemical results. Little or no difference in the overall cholesterol levels was observed in the kidneys, blood, cerebral cortex and hippocampus when comparing NPC2−/− and wild type mice. However, cerebellum cholesterol was increased about two fold in NPC2−/− mice compared with wild-type littermates. Weight gain performance was slightly improved as a result of the NPC2 treatment but significant motor coordination deficits were still observed. Accordingly, ultrastructural cerebellar abnormalities were detected in both saline treated and NPC2 treated NPC2−/− animals 87 days post partum. Our data indicate that protein replacement may be a beneficial therapeutic approach in the treatment of the visceral manifestations in NPC2 disease and further suggest that neurodegeneration is not secondary to visceral dysfunction