“Watchful Waiting” Advice for Pediatric Ear Infections

2020 ◽  
Vol 39 (3) ◽  
pp. 414-424
Author(s):  
Erina L. MacGeorge ◽  
Kasey A. Foley ◽  
Emily P. C. Firgens ◽  
Rachel R. Vanderbilt ◽  
Amber K. Worthington ◽  
...  
Keyword(s):  
Clinical Guidelines ◽  
Watchful Waiting ◽  
Antibiotic Use ◽  
Response Theory ◽  
Medical Visits ◽  
Ear Infections ◽  
Advice Response Theory

To reduce antibiotic use, clinical guidelines recommend treating many pediatric ear infections with watchful waiting (WW), which entails parents managing children’s symptoms while waiting to see if the infection will resolve without antibiotics. This study examines providers’ WW advice in recorded medical visits ( n = 28), focusing on five communication elements specified by guidelines and consistent with advice response theory. Results suggest directions for improving providers’ delivery of WW advice and are discussed with regard to theory.

Expanding Advice Response Theory by Incorporating Goal Inference: College Students’ Perceptions of Parental Exercise Advice

2019 ◽  
Author(s):  
Lisa M Guntzviller ◽  
Chelsea L Ratcliff ◽  
Kimberly B Pusateri
Keyword(s):  
College Students ◽  
Parenting Style ◽  
Response Theory ◽  
Goal Inference ◽  
Advice Response Theory

Abstract We expanded Advice Response Theory (ART) by proposing that recipient perceptions of advisor characteristics can be distal (e.g., parenting style) and proximal (e.g., goal inference). We examined how the recipient’s inference of the advisor’s goals (confirmation, change, and novelty) mediates associations between distal characteristics and message feature evaluations and outcomes. As predicted, positive associations occurred between perceptions of parenting style, confirmation goal inference, advice efficacy and positive facework, and desirable advice outcomes. Counter to predictions, inferring change and novelty goals did not have uniformly undesirable effects. An inference of the change goal was associated with higher efficacy ratings and the recipient changing plans following the conversation. Our findings support conceptualizing ART advisor characteristics as distal and proximal, and advisor goal inference as a relevant proximal characteristic.

How do emerging adults respond to exercise advice from parents? A test of advice response theory

2016 ◽  
Vol 34 (6) ◽  
pp. 936-960 ◽  
Author(s):  
Lisa M. Guntzviller ◽  
Chelsea L. Ratcliff ◽  
Travis E. Dorsch ◽  
Keith V. Osai
Keyword(s):  
Emerging Adults ◽  
Social Issues ◽  
Message Content ◽  
Response Theory ◽  
Parent Child Relationship ◽  
Child Relationship ◽  
Influence Attempts ◽  
Advice Quality ◽  
Parent Child ◽  
Advice Response Theory

Advice response theory (ART) proposes advisor characteristics, advice politeness, and advice content impact recipient perceptions of advice quality, their intention to implement the advice, and their coping. However, ART has primarily been examined in friend-to-friend advising on academic, romantic, or social issues. To test ART in an understudied relational and topical context, emerging adults ( N = 196, aged 18–28 years) were surveyed about physical activity or exercise advice they received from a parent. Current findings supported propositions about advisor characteristics and politeness, and parent–child relational elements were particularly salient. Emerging adults satisfied with their parent–child relationship rated all advice features and outcomes more favorably, and participants who reported their parents conveyed that the participant was approved of, competent, and likeable rated all outcomes more favorably. Counter to ART predictions, emerging adults displayed psychological reactance to certain message content features, responding favorably to advice they perceived to propose an efficacious solution but reacting negatively to advice perceived to emphasize their capability of performing the action and the lack of drawbacks in doing so (especially when feelings of obligation were high). ART propositions about advisor characteristics and politeness may hold across advice situations, but the parent–child dynamic during emerging adulthood and inherent face threat for health influence attempts may explain why certain formulations of advice messages elicited responses inconsistent with ART.

scholarly journals 1473. Guideline Adherence in Pediatric Ambulatory Visits for Acute Otitis Media

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S738-S738
Author(s):  
Joshua C Herigon ◽  
Sarah Mousseau ◽  
Amir Kimia ◽  
Jonathan Hatoun ◽  
Louis Vernacchio
Keyword(s):  
Otitis Media ◽  
Watchful Waiting ◽  
Treatment Guidelines ◽  
Medical Condition ◽  
Acute Otitis Media ◽  
Antibiotic Use ◽  
The United States ◽  
Chronic Medical Condition ◽  
Cross Sectional ◽  
Strict Adherence

Abstract Background Acute otitis media (AOM) is the most common pediatric outpatient condition treated with antibiotics in the United States. Over 30% of children receive inappropriate antibiotics for AOM, contributing to increasing antimicrobial resistance and unnecessary adverse events. Strict adherence to diagnostic and treatment guidelines has been proposed by the American Academy of Pediatrics (AAP) Committee on Infectious Diseases as one strategy to combat inappropriate antibiotic use. Our objective was to describe adherence to the 2013 AAP guidelines on AOM. Methods We performed a cross-sectional study on a random sample of visit notes for patients 3 to 59 months old diagnosed with otitis media based on ICD-10-CM codes (H65, H66, H67) and treated with antibiotics between 9/1/2017 and 8/31/2018 in an association of pediatric practices across Massachusetts. Children with tympanostomy tubes or a chronic medical condition increasing their risk for AOM were excluded. Based on the 2013 AAP diagnostic criteria, tympanic membrane exam descriptions were reviewed and classified as describing AOM or not. Antibiotic choices were classified as appropriate or inappropriate. Notes were then labeled as “fully adherent” (exam consistent with AOM and appropriate antibiotic choice), “partially adherent” (exam inconsistent with AOM or inappropriate antibiotic choice), and “non-adherent” (exam inconsistent with AOM and inappropriate antibiotic choice). Results Three hundred and ninety-four visit notes from 39 different practices were analyzed. One hundred and sixty-six notes (42%) were “fully adherent” to the AAP guidelines, 183 (46%) were “partially adherent” and 45 (11%) were “non-adherent” (Figure 1). In the “partially adherent” and “non-adherent” groups combined, exams were inappropriate in 179 notes (45.4%) and antibiotic choice was inappropriate in 94 notes (23.9%). Cefdinir was the most frequent inappropriate antibiotic (44/94, 46.8%) (Table 1). “Watchful waiting” occurred in only 7% (16/229) of eligible cases. Figure 1. Breakdown of encounters by adherence type Table 1. Cross-table of indicated and prescribed antibiotics Conclusion Our analysis of independent pediatric practices showed moderate adherence to the AAP guidelines for AOM. Substantial room exists for improvement in diagnosing and treating AOM in young children, especially regarding the potential for watchful waiting. Disclosures All Authors: No reported disclosures

scholarly journals Impact of the COVID-19 Pandemic on Antibiotic Prescribing for Common Infections in The Netherlands: A Primary Care-Based Observational Cohort Study

Antibiotics ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 196
Author(s):  
Alma C. van de Pol ◽  
Josi A. Boeijen ◽  
Roderick P. Venekamp ◽  
Tamara Platteel ◽  
Roger A. M. J. Damoiseaux ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Primary Care ◽  
Health Care ◽  
Antibiotic Prescription ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Skin Infections ◽  
Prescription Rates ◽  
Ear Infections ◽  
Disease Entities

In 2020, the COVID-19 pandemic brought dramatic changes in the delivery of primary health care across the world, presumably changing the number of consultations for infectious diseases and antibiotic use. We aimed to assess the impact of the pandemic on infections and antibiotic prescribing in Dutch primary care. All patients included in the routine health care database of the Julius General Practitioners’ Network were followed from March through May 2019 (n = 389,708) and March through May 2020 (n = 405,688). We extracted data on consultations for respiratory/ear, urinary tract, gastrointestinal and skin infections using the International Classification of Primary Care (ICPC) codes. These consultations were combined in disease episodes and linked to antibiotic prescriptions. The numbers of infectious disease episodes (total and those treated with antibiotics), complications, and antibiotic prescription rates (i.e., proportion of episodes treated with antibiotics) were calculated and compared between the study periods in 2019 and 2020. Fewer episodes were observed during the pandemic months than in the same months in 2019 for both the four infectious disease entities and complications such as pneumonia, mastoiditis and pyelonephritis. The largest decline was seen for gastrointestinal infections (relative risk (RR), 0.54; confidence interval (CI), 0.51 to 0.58) and skin infections (RR, 0.71; CI, 0.67 to 0.75). The number of episodes treated with antibiotics declined as well, with the largest decrease seen for respiratory/ear infections (RR, 0.54; CI, 0.52 to 0.58). The antibiotic prescription rate for respiratory/ear infections declined from 21% to 13% (difference −8.0% (CI, −8.8 to −7.2)), yet the prescription rates for other infectious disease entities remained similar or increased slightly. The decreases in primary care infectious disease episodes and antibiotic use were most pronounced in weeks 15–19, mid-COVID-19 wave, after an initial peak in respiratory/ear infection presentation in week 11, the first week of lock-down. In conclusion, our findings indicate that the COVID-19 pandemic has had profound effects on the presentation of infectious disease episodes and antibiotic use in primary care in the Netherlands. Consequently, the number of infectious disease episodes treated with antibiotics decreased. We found no evidence of an increase in complications.

Extending advice response theory to the advisor: Similarities, differences, and partner-effects in advisor and recipient advice evaluations

2019 ◽  
Vol 87 (1) ◽  
pp. 114-135 ◽  
Author(s):  
Lisa M. Guntzviller ◽  
Danni Liao ◽  
Manuel D. Pulido ◽  
Chelsea P. Butkowski ◽  
Aaron D. Campbell
Keyword(s):  
Response Theory ◽  
Advice Response Theory

scholarly journals Antibiotic Use in Children with Acute Respiratory or Ear Infections: Prospective Observational Comparison of Anthroposophic and Conventional Treatment under Routine Primary Care Conditions

2014 ◽  
Vol 2014 ◽  
pp. 1-17 ◽  
Author(s):  
Harald J. Hamre ◽  
Anja Glockmann ◽  
Reinhard Schwarz ◽  
David S. Riley ◽  
Erik W. Baars ◽  
...  
Keyword(s):  
Observational Studies ◽  
Antibiotic Prescription ◽  
Secondary Analysis ◽  
Public Health Problem ◽  
Antibiotic Use ◽  
Major Public Health Problem ◽  
Unadjusted Odds Ratio ◽  
Prescription Rates ◽  
Ear Infections

Children with acute respiratory or ear infections (RTI/OM) are often unnecessarily prescribed antibiotics. Antibiotic resistance is a major public health problem and antibiotic prescription for RTI/OM should be reduced. Anthroposophic treatment of RTI/OM includes anthroposophic medications, nonmedication therapy and if necessary also antibiotics. This secondary analysis from an observational study comprised 529 children <18 years from Europe (AT, DE, NL, and UK) or USA, whose caregivers had chosen to consult physicians offering anthroposophic (A-) or conventional (C-) treatment for RTI/OM. During the 28-day follow-up antibiotics were prescribed to 5.5% of A-patients and 25.6% of C-patients (P<0.001); unadjusted odds ratio for nonprescription in A- versus C-patients 6.58 (95%-CI 3.45–12.56); after adjustment for demographics and morbidity 6.33 (3.17–12.64). Antibiotic prescription rates in recent observational studies with similar patients in similar settings, ranged from 31.0% to 84.1%. Compared to C-patients, A-patients also had much lower use of analgesics, somewhat quicker symptom resolution, and higher caregiver satisfaction. Adverse drug reactions were infrequent (2.3% in both groups) and not serious. Limitation was that results apply to children of caregivers who consult A-physicians. One cannot infer to what extent antibiotics might be avoided in children who usually receive C-treatment, if they were offered A-treatment.

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