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PubMed2000

The 'right kind' of pain: talking about symptoms in outpatient oncology consultations.

Despite improvements in cancer management over the past 25 years, unrelieved symptoms continue to be reported. Little is known about how patients' problems and concerns are communicated to professionals during oncology treatment. This qualitative study investigates the process of communication between cancer patients and oncologists during consultations in outpatient clinics of a regional teaching hospital. Data were collected by nonparticipant observation and audiotaping consultations. Analyses were by qualitative content analysis and conversation analysis. An objectives, strategies and tactics model was applied to organize the findings. Seventy-four consultations between cancer patients and 15 doctors were observed and audiotaped. Pain talk is defined and identified as a substantial topic, occurring in 39 out of 74 consultations. Doctor-initiated questions are the predominant discourse feature and are prominent not only in initiating discussions but also in directing further talk (e.g. over three-quarters of doctor-initiated questions are in a closed form which focus narrowly on limited physical aspects of patients' pain). This limited information exchange is used alongside other communication tactics to identify the 'right kind' of pain that may benefit from cancer therapy and to truncate talk of problems perceived to be outside of this specialist remit. Although individualized, holistic care is the expressed philosophy of the clinic, our data show that doctors tightly control the agenda to focus narrowly on pain which was amenable to radiotherapy, chemotherapy, surgery or hormone manipulation. Inadequate exploration of patients' pain is likely to be detrimental to symptom control.

Adult↗
PubMed1999

Intonation unit analysis of conversational discourse in closed head injury.

This study employed a modification of the intonation unit analysis for conversational discourse developed by Mentis and Prutting. The percentage of total intonation units produced within separate ideational categories was calculated for groups of closed head-injured and normal control subjects as well as the examiner. No significant differences were found between subject groups or the examiner's performance within the two groups. However, significant differences were noted between the examiner's production of intonation units and the performances of both subject groups. Findings suggest the manner in which samples of conversation were elicited may have constrained the context, thereby masking potential differences between groups.

Adult↗
PubMed1997

Analysis of conversational topic shifts: a multiple case study.

Investigation into the natural conversational discourse of patients with Dementia of the Alzheimer Type has received minimal attention, in part due to the inherent methodological problems. There are no satisfactory theoretical models of conversation; existing global checklists give minimal information on meaning relationships and analysis of conversation does not lend itself to group studies. The present study offered an initial example of how meaning relationships, expressed through topic shifting behavior, can be described in DAT and normal elderly subjects in natural conversational discourse. Categorization of topic units was done in an attempt to describe general phenomena, type of shift, reason for shift, and contextual relationship. Although very little differences were visually observed in the general categories, some convergence of data were observed in other topic shift categories. Discussion of the results in relation to a discourse processing model is presented.

Aged↗
PubMed1980

Heterozygosis of phage 16-3 of Rhizobium meliloti: moderate level of mismatch repair or gene conversion.

Analysis of clear/turbid mottled (heterozygotic plaques) of Rhizobium meliloti temperate phage 16-3 indicates that the efficiency of repair at three sites (ti3, ti4, and ti5) in the C cistron is 2 to 20-fold less than that observed in E. coli phage lambda. In agreement with this conclusion, heterozygotic plaques were observed at similar frequency in crosses where point and small deletion mutants were combined, suggesting that in Rhizobium, DNA molecules with short single-stranded loops can escape from repair as efficiently as the simple mismatches.

Bacteriophage lambda↗
PubMedDate not supplied

Computerized content analysis of conversational interactions.

The emotional impact of illness sustained by patients, their families, and friends is increasingly recognized as an important dimension of clinical evaluation and intervention. This study first attempted to extend a computerized technique of measuring the magnitude of mental events from a content analysis of speech initially designed for use on single verbal samples or verbal texts to the analysis of conversational interactions. The study then applied this method of extended measurement to conversations concerning seriously ill surgical patients. The authors' objective was to develop a graphic method that illustrates the neuropsychological interchanges occurring in these conversations. Speech samples were recorded during discussions among nurses, surgeons, intensivists, and family members involved in the care and treatment of seriously ill patients hospitalized in the surgical intensive care unit at Barnes-Jewish Hospitals associated with Washington University School of Medicine, St. Louis, Missouri. These samples then were transcribed into computer-readable text files and divided into utterances: uninterrupted speech by a single individual. The utterances were assigned numeric scores by a computer program on each of 14 validated content analysis scales measuring various neuropsychological dimensions. The scores are presented graphically in chronological sequence to illustrate the emotional interactions in these conversations. The graphic representations depicting sequences of computerized content analysis-derived scores for the mental reactions of the speakers in such conversations provide insights into the psychodynamics occurring in such stressful situations.

Adaptation, Psychological↗
PubMedDate not supplied

Group training in communication skills for carers of adults with aphasia.

This study describes a communication skills group programme for four carers of adults with aphasia that ran once a week for 6 consecutive weeks. The content of the group was based on an approach previously not described in the literature in any detail. Conversation analysis (CA) was used to guide individualized advice that was incorporated into the group by the use of written advice sheets. Intervention was motivated by the results of a newly developed assessment tool--the Conversation Analysis Profile for People with Aphasia (CAPPA)--and a quantitative and qualitative analysis of collaborative repair. The CAPPA utilizes the methodology of conversation analysis (CA) as a means of both characterizing and comparing the relationship between the carers' perception of the aphasia and what is occurring in natural conversation. During the group, accurate perceptions and strategies that minimized the disruption to the conversation were reinforced, while inaccurate perceptions and strategies that appeared to impede interaction were discouraged. The use of the CAPPA results and a quantitative/qualitative analysis of repair management to measure change pre- and post-group was explored. The post-intervention analyses examined three questions in particular: (1) did the carers demonstrate more accurate perceptions of their relatives' aphasia?; (2) did the carers report a decrease in the problem severity of the aphasia?; and (3) was there a change in the time taken to repair a trouble source and was this attributable to a change in the management of repair by the carer? The study was essentially an investigation of whether this type of approach was beneficial to the carers involved. The results suggested that focusing on individualized advice and targeting conversation management in the group setting was a useful way of providing advice to carers. Furthermore, the CAPPA and a quantitative/qualitative analysis of repair management seem to have the potential for motivating the individualized advice and measuring the effectiveness of an intervention.

Aged↗
PubMedDate not supplied

Conversational discourse analysis as a method for evaluating progress in aphasia: a case report.

The gains made by a woman with Broca's aphasia as documented by traditional measures were paralleled by changes in conversation, including increased verbal output and efficiency, and changes in conversation repair patterns. Her conversational partner decreased her verbal output, as predicted. The progress documented with conversational discourse analysis was not observable from other test measures. Clinical and theoretical implications are discussed.

Aphasia, Broca↗
PubMed1988

EEG frequency analysis in conversion and somatoform disorder.

Patients with "hysterical" neurologic symptoms have long puzzled neurologists and psychiatrists. "Hysteria" has recently been subdivided into conversion and somatoform disorder. We applied computerized EEG frequency analysis to 10 patients with diagnosed conversion disorder, 10 somatoform disorder patients, and 10 control subjects. One minute EEG samples composed of 4 sec epochs were recorded from left frontal (F7-C3), right frontal (F8-C4), left posterior (T5-01) and right posterior (T6-02) derivations. Spectral power was calculated for 4 bands (0.25-4HZ, 4.25-8Hz, 8.25-13Hz, and 13.25-30Hz), and for the full frequency range. Low (0.25-8Hz) and high (8.25-30Hz) frequency bands were compared to determine high/low power ratios on the left and right (PHLL) and (PHLR), ratios of left/right front (PLRF) and posterior (PLRP) power, mean alpha frequency deviation frontally (FLRF) and posteriorly (FLRP), and mobility of left and right frontal power (MOLF and MORF). No significant differences were found between conversion disorder patients and controls in PHLL, PHLR, PLRP, and MORF. PLRF, FLRF and MOLF differed significantly between patients and controls. Power and frequency ratios of right frontal mobilities suggested a decrease in high frequency power, reduction in mean alpha frequency, and lower predominant frequency in the right frontal area in somatoform disorder patients as compared to controls, but significance was not reached. Somatoform and conversion disorder patients differed significantly in these spectral measures. These observations suggest that the two "hysterical" disorders may have distinct pathophysiology, and may be due to eventually identifiable cerebral dysfunction in some cases.

Adult↗
PubMed2003

A conceptual framework for person-centred practice with older people.

This paper presents a conceptual framework for person-centred practice with older people. The research from which the framework was developed was guided by hermeneutic philosophy and integrated processes of conversation analysis and reflective conversation in data collection and analysis. The research findings suggested that nurses need to be able to particularize the person that the patient is, the relationship that exists between them and the patient, and the understandings and expectations implicit in the relationship. From these findings a conceptual framework for person-centred practice was developed. In the framework, person-centredness is premised on the concept of authentic consciousness and is operationalized through five imperfect duties. The factors that enable person-centredness to operate in practice are identified as the patient's values, the nurse's values and the context of the care environment. Considerations for implementing the model in practice are highlighted.

Aged↗
PubMed1994

Assessing functional communication in aphasia: clinical utility and time demands of three methods.

A variety of methods has recently been used to assess everyday communication abilities in aphasic adults. This study compares three such methods for their clinical utility and the amount of a therapist's time they use. The three methods employed a standard rating schedule completed by relatives, analysis of speech elicited through role-play and a partial analysis of everyday conversation samples. The utility of these assessments as a clinical tool was measured in terms of the therapist's time needed, and the assessment's ability to show stability or change of communicative effectiveness on test-re-test measures and to illuminate areas for therapeutic intervention. Eight aphasic adults (five acute and three chronic) were tested on all three assessments, then re-tested after a period of 3 months. The results suggested that, although more time-consuming, the partial conversational analysis was a more sensitive measure of stability or change of communicative effectiveness over time than the other two measures, and had the potential advantage for indirect intervention of revealing conversational strategies used by the partner as well as those used by the aphasic individual.

Acute Disease↗
PubMed1995

Complete nucleotide sequence of RNA segment 3 of bluetongue virus serotype 2 (Ona-A). Phylogenetic analyses reveal the probable origin and relationship with other orbiviruses.

The nucleotide sequence of the RNA segment 3 of bluetongue virus (BTV) serotype 2 (Ona-A) from North America was determined to be 2772 nucleotides containing a single large open reading frame of 2703 nucleotides (901 amino acid). The predicted VP3 protein exhibited general physiochemical properties (including hydropathy profiles) which were very similar to those previously deduced for other BTV VP3 proteins. Partial genome segment 3 sequences, obtained by polymerase chain reaction (PCR) sequencing, of BTV isolates from the Caribbean were compared to those from North America, South Africa, India, Indonesia, Malaysia and Australia, as well as other orbiviruses, to determine the phylogenetic relationships amongst them. Three major BTV topotypes (Gould, A.R. (1987) Virus Res. 7, 169-183) were observed which had nucleotide sequences that differed by approximately 20%. At the molecular level, geographic separation had resulted in significant divergence in the BTV genome segment 3 sequences, consistent with the evolution of distinct viral populations. The close phylogenetic relationship between the BTV serotype 2 (Ona-A strain) from Florida and the BTV serotypes 1, 6 and 12 from Jamaica and Honduras, indicated that the presence of BTV serotype 2 in North America was probably due to an exotic incursion from the Caribbean region as previously proposed by Sellers and Maaroof ((1989) Can. J. Vet. Res. 53, 100-102) based on trajectory analysis. Conversely, nucleotide sequence analysis of Caribbean BTV serotype 17 isolates suggested they arose from incursions which originated in the USA, possibly from a BTV population distinct from those circulating in Wyoming.

Amino Acid Sequence↗
PubMed1994

Meiotic gene conversion tract length distribution within the rosy locus of Drosophila melanogaster.

Employing extensive co-conversion data for selected and unselected sites of known molecular location in the rosy locus of Drosophila. we determine the parameters of meiotic gene conversion tract length distribution. The tract length distribution for gene conversion events can be approximated by the equation P(L > or = n) = phi n where P is the probability that tract length (L) is greater than or equal to a specified number of nucleotides (n). From the co-conversion data, a maximum likelihood estimate with standard error for phi is 0.99717 +/- 0.00026, corresponding to a mean conversion tract length of 352 base pairs. (Thus, gene conversion tract lengths are sufficiently small to allow for extensive shuffling of DNA sequence polymorphisms within a gene). For selected site conversions there is a bias towards recovery of longer tracts. The distribution of conversion tract lengths associated with selected sites can be approximated by the equation P(L > or = n/ selected) = phi n(1 - n + n/phi), where P is now the probability that a selected site tract length (L) is greater than or equal to a specified number of nucleotides (n). For the optimal value of phi determined from the co-conversion analysis, the mean conversion tract length for selected sites is 706 base pairs. We discuss, in the light of this and other studies, the relationship between meiotic gene conversion and P element excision induced gap repair and determine that they are distinct processes defined by different parameters and, possibly, mechanisms.

Animals↗
PubMed2004

Structuring health needs assessments: the medicalisation of health visiting.

This paper draws on Foucault to understand the changing discourse and impact of structured 'health needs assessments' on health visiting practice. Literature about this activity makes little mention of the long-standing social purposes of health visiting, which include surveillance of vulnerable and invisible populations, providing them, where needed, with help and support to access protective and supportive services. Instead, the discourse has been concerned primarily with an epidemiological focus and public health, which is associated with risk factors and assessments. The use of pre-defined needs assessment schedules suggests that health visiting activity can be sanctioned and clients' needs serviced only if they reach the threshold of pre-determined, epidemiologically-defined risk. Their effect on practice is examined through a conversation analysis of ten health visitor/client interactions using two different structured needs assessment tools. The study indicates that the health visitors, like their clients, were controlled by institutional expectations of their role; analysis of their conversations shows how they achieved the requirements of the organisational agenda. Structuring client needs and health visiting practice through the use of formal needs assessment tools emphasises the epidemiological focus of the health service above the need to arrange support for vulnerable individuals. In this respect, it serves as a marker in the continued medicalisation of health visiting.

Attitude of Health Personnel↗
PubMed1987

A comparison of four modes of evaluating depth of cure of light-activated composites.

Four commonly used methods for evaluating depth of cure in light-activated composites were compared. Optical and scraping methods correlate well, but severely overestimate depth of cure as compared with hardness testing or degree of conversion analysis. Degree of conversion appears to be the most sensitive test of depth of cure.

Chemical Phenomena↗
PubMed2001

Broadcasting the royal role: constructing culturally situated identities in the Princess Diana Panorama interview.

We examine critically the two traditions of work that have informed discursive approaches to identity: social constructionism and conversation analysis. Within both strands, identity is theorized as a flexible phenomenon that is situated in conversations. But although constructionists locate identity within the social, such work remains at a theoretical and rather abstract level and often fails to interrogate the discursive practices through which identity is constituted. Conversely, this attention to the occasioning of identity in everyday talk is precisely the focus of the second, conversation analytic strand of work. Whereas constructionists attend to the wider cultural positioning of identities, conversation analysts resist commenting upon the social significance of what is constructed in interaction. Conversation analysis is therefore limited by its restricted notion of culture in the study of the situated social self. Despite the apparent conflict between these approaches, we suggest that a synthesis of the two provides a comprehensive framework for analysing identity. Drawing upon the BBC Panorama interview between Martin Bashir and Princess Diana, we explore how culturally situated identities are located in this conversational context. We conclude that analysts must not only attend to the micro-level organization of identities but also engage in a wider understanding of the cultural framework within which they are located.

Cultural Characteristics↗
PubMed2001

Gatekeeping and legitimization: how informal carers' relationship with health care workers is revealed in their everyday interactions.

AIM(S) OF THE STUDY: This study explores the relationship between informal carers of older people, and health care workers within the context of a hospital ward. Through an analysis of their language-based encounters the purpose of the study was to identify the discursive processes involved in face-to-face informal carer-health care worker interactions, during the course of carers' visits to one elderly care rehabilitation hospital ward. DESIGN: An ethnomethodological research design, which encompassed the concerns of conversation analysis and the study of institutional interaction, was used. The study involved videotape recording informal carers naturally occurring spontaneous interactions with a range of health care workers on the ward. Data collection was carried out for between 1 and 3 hours, two to three times a week over a period of 3 months. The data comprised: 30 dyadic and group interactions involving 19 different carers and 25 different health care workers, including nurses (qualified and unqualified), physiotherapists, occupational therapists, dieticians, ambulance personnel, housekeepers and nursing auxiliaries. Detailed transcriptions of the data were produced and analysis was undertaken using a modified conversation analysis approach. FINDINGS: Analysis revealed that a central aspect of the way the relationship between informal carers and health care workers is framed is by the way information and access to information is obtained. This paper examines some of the aspects of informal carer-health care worker discourse, which denote both parties as gatekeepers. In doing so it considers the roles that legitimatization of competence and knowledgeability have in facilitating informal carers interactions with health care workers. CONCLUSIONS: We conclude that the accomplishment of legitimacy is largely a collaborative undertaking on behalf of health care workers and informal carers. The implications of these findings for carers, health care workers, policy and future research are discussed.

Adult↗