SEARCH · PubMed Health

Results for “Conversation analysis”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 127 records · Page 7Linked to original sources

PubMed1993

Induction of copper-zinc superoxide dismutase in gerbil hippocampus after ischemia.

To assess the role of Cu-Zn superoxide dismutase (CuZnSOD) in regulating cellular antioxidant defenses, we studied the induction of CuZnSOD mRNA by an in situ hybridization technique and of CuZnSOD protein by an immunocytochemical method in the gerbil hippocampus following 5 min of transient global ischemia. For hybridization, we synthesized 48-mer oligonucleotide (base 465-512) complementary to rat CuZnSOD mRNA. Northern blot analysis showed hybridization to a single band of molecular weight 0.65 kb. After 5 min of ischemia, the signal became stronger at 3 and 24 h and returned to the control level 3 days later. In situ hybridization histochemistry revealed an increase in labeling throughout the hippocampus, especially in the granular layer 3 h following ischemia. The increase was prolonged only in the CA1 pyramidal layer after 24 h and was eliminated within 3 days or later. Conversely, analysis by Western blotting revealed that the insult produced few effects on the induction of CuZnSOD protein. Immunocytochemistry for CuZnSOD revealed a reduced immunostaining in the CA1 pyramidal layer at 24 h of recirculation when the persistent expression of CuZnSOD mRNA was shown in the same area. Our findings suggest that the expression of endogenous CuZnSOD is temporarily stimulated by an ischemic insult without increasing the protein level. The prolonged increase in mRNA and the decrease in the protein of CuZnSOD in the CA1 neurons seem to imply an important role of the endogenous antioxidant enzyme that protects against the detrimental effects of superoxide radicals on delayed neuronal death.

Animals↗

PubMed2001

From nurse-centered health counseling to empowermental health counseling.

The main goals of this study were to examine aspects of the delivery and reception of advice and questions in interaction between nurses and patients and to describe linguistic features that constructed nurse-centered and empowermental health counseling. The research data, 38 health counseling sessions, were videotaped, transcribed verbatim, and analyzed by using an adaptation of conversational analysis. During nurse-centered discussions, the nurses' advice did not correspond to the patients' need for information. These counseling sessions began with check-up questions about the patients' condition and continued with factual questions about their illnesses and health care measures. During empowering health counseling, the nurses made use of the patients' knowledge of their circumstances and supported the patients' ability to reflect on their health behavior. Questioning and advising strategies were found to be crucial for building up empowermental conversation and enhancing the impact of health counseling.

Adolescent↗

PubMed1991

Increased ratio of targeted to random integration after transfection of chicken B cell lines.

Constructs of four different genetic loci were transfected into the avian leukosis virus-induced chicken B cell line DT40, which continues diversification of its rearranged light chain immunoglobulin gene by gene conversion. Analysis of stable transfectants revealed an unexpectedly high frequency of targeted integration into the homologous gene loci of DT40. Transcriptional activity of the target gene locus is not required, since a construct of the untranscribed ovalbumin gene also integrated predominantly by homologous recombination. A construct derived from the beta-actin locus was transfected into other chicken cell lines to determine the cell type specificity of the phenomenon. Targeted integration still occurred at high frequency in two other B cell lines that do not have the gene conversion activity. However, the ratios of targeted to random integration were reduced by at least one order of magnitude in three non-B cell lines.

Actins↗

PubMed1985

Intraoperative localization of parathyroid glands using methylthionine chloride / tetramethylthionine chloride in secondary hyperparathyroidism.

Over an 18 month interval at the University of Louisville Affiliated Hospitals, 40 patients were evaluated in a nonrandomized prospective study to determine the value of methylthionine chloride / tetramethylthionine chloride (methylene blue--MB) as an aid for the rapid intraoperative identification of parathyroid hyperplasia of end-stage renal disease (ESRD). Patients assigned to the MB infusion subgroup had infusion of 1 per cent MB (5.5 milligrams per kilogram) over a time interval of 25 to 60 minutes (mean of 43.9) prior to anesthetic induction. A total of 159 glands were identified in both the control and MB infusion groups (3.98 glands per patient) of which the predominant histopathologic diagnosis on frozen section was chief cell hyperplasia (78.3 per cent). Of 91 hyperplastic glands submitted for analysis after subtotal parathyroidectomy in those in the MB infusion group, 82 glands (90.1 per cent) were observed to have positive staining with identifiable differentiation from surrounding tissues. Analyses of the correlation of the serum calcium value and probability of MB staining or its relation to serum intact parathyroid hormone (intact-PTH) values were not statistically significant (p greater than 0.05, correlation coefficient equals 0.149). Furthermore, no relationship existed between the glandular size (millimeter to the third power) and probability of MB staining (chi-square equals 1.750, p greater than 0.05) or between hyperplastic size and serum intact-PTH value (correlation coefficient equals 0.068). Conversely, analysis of MB gland staining with regard to intact PTH concentration disclosed 59 of 59 glands stained intensely with MB when intact-PTH concentration was not less than 700 picograms per milliliter (p less than 0.01). Non-staining of hyperplastic parathyroid tissue was observed in 28.1 per cent of glands submitted for histopathologic analysis in which preoperative intact PTH values were more than 699 picograms per milliliter. Time of operation was reduced from 119.0 +/- 47.53 minutes (mean +/- S.E.M.) in control patients to 92.1 +/- 20.12 minutes (mean +/- S.E.M.) for the MB infusion group (V per cent equals 21.85, p less than 0.01). Furthermore, this technique appears to have value in the detection of ectopically located parathyroid tissue as demonstrated by the in vivo staining of seven ectopic glands in six patients of the infused group. Complications were restricted to the patients in the MB infusion group (21.7 per cent) and included: pseudo-cyanosis in three; pain in the infusion site in two, wound hematoma in one patient, pancreatitis in one and angina in one.(ABSTRACT TRUNCATED AT 400 WORDS)

Calcium↗

PubMed2004

Talking the talk: a discourse analysis of mental health nurses talking about their practice.

Mental Health nursing exists as a discipline in the UK within the wider contemporary health care establishment. Throughout its history it has attempted to define itself in ways that differentiate mental health nursing practice from other health care professions and fields of nursing. However, it is not surprising in this climate of contemporary healthcare for individual professional identities to become 'lost' in the melange of interdisciplinary practice. This research presents a discourse analysis of individual mental health nurses' rhetorical constructions of their professional role(s) as they emerge in their talk with each other in focus group discussions. In particular, the focus in this paper is their discursive repertoires related to the historical legacy of mental health nursing and how this sits with what they consider to be a 'custodial and controlling' element of their role. The particular discourse analytic approach adopted in this study illustrates how individuals use language in a particular way to make justifications and explanations of mental health nursing identities. This analytic approach is ensconced within the domain of social psychology and lies at the interface of ethno-methodology and conversation analysis. It is concerned with structural units of discourse, beyond the level of the sentence, that emerge as the nurse participants engage in talking about their practice (Potter and Wetherell, 1987 p.53).

Attitude of Health Personnel↗

PubMed1990

Meiotic gene conversion and crossing over: their relationship to each other and to chromosome synapsis and segregation.

The yeast mer1 mutant produces inviable spores and is defective in both meiotic recombination and chromosome pairing. A gene called MER2 partially suppresses the mer1 phenotype when present in high copy number. Both gene conversion and chromosome pairing are completely restored in mer1 strains overexpressing MER2; however, reciprocal crossing over and spore viability are not restored. The data presented are consistent with a model in which chromosome pairing is a direct consequence of a homology search mediated through gene conversion. Analysis of random viable spores indicates that the crossovers that occur in mer1 strains overexpressing MER2 are more effective in ensuring meiosis I disjunction than those that occur in mer1 strains. One interpretation of this result is that only those crossovers that occur in the context of the synaptonemal complex lead to the establishment of functional chiasmata. The MER2 gene product is essential for meiosis.

Cell Nucleus↗

PubMed1999

Photomodulation of conformational states. Synthesis of cyclic peptides with backbone-azobenzene moieties.

The search for photoresponsive conformational transitions accompanied by changes in physicochemical and biological properties led us to the design of small cyclic peptides containing azobenzene moieties in the backbone. For this purpose, (4-aminomethyl)phenylazobenzoic acid (H-AMPB-OH) and (4-amino)phenylazobenzoic acid (H-APB-OH) were synthesized and used to cyclize a bis-cysteinyl-octapeptide giving monocyclic derivatives in which additional conformational restriction could be introduced by conversion to bicyclic structures with a disulphide bridge. While synthesis with H-AMPB-OH proceeded smoothly on a chlorotrityl-resin with Fmoc/tBu chemistry, the poor nucleophilicity of the arylamino group of H-APB-OH required special chemistry for satisfactory incorporation into the peptide chain. Additional difficulties were encountered in the reductive cleavage of the S-tert-butylthio group from the cysteine residues since concomitant reduction of the azobenzene moiety took place at competing rates. This difficulty was eventually bypassed by using the S-trityl protection. Side-chain cyclization of the APB-peptide proved to be difficult, suggesting that restricted conformational freedom was already present in the monocyclic form, a fact that was fully confirmed by NMR structural analysis. Conversely, the methylene spacer in the AMPB moiety introduced sufficient flexibility for facile and quantitative side-chain cyclization to the bicyclic form. Both of the monocyclic peptides and both of the bicyclic peptides are photoresponsive molecules which undergo cis/trans isomerization reversibly.

Azo Compounds↗

PubMed2006

The effect of the direction of gaze on the kinematics of the squat exercise.

The purpose of this study was to determine whether the direction of gaze influences the kinematics of the squat exercise. Ten men experienced in the squat exercise performed a total of 30 repetitions of the squat in the form of 2 sets of 5 repetitions under 3 different conditions. Conditions varied with respect to the direction of the subjects' gaze as they performed the exercise. Condition D entailed gazing downward at the intersection of the facing wall and the floor throughout the exercise. Condition S required subjects to gaze straight ahead at their own reflection (eyes) in the mirror on the wall directly in front of them. Condition U involved gazing upward at the intersection of the facing wall and the ceiling throughout the exercise. Dependent variables included the linear displacement of the bar and hip, linear velocity of the bar, and the angular displacement/position and velocity of the head, trunk, hip, and knee. The mean data were subjected to a repeated measures analysis of variance, and, where appropriate, pairwise comparisons using Tukey's Studentized Range Test. The results revealed overall similarity in movement kinematics when performing the squat exercise using the 3 different gaze directions. In particular, the upward and straight gaze conditions were not differentiated by the analysis. Conversely, the downward gaze was shown to increase the extent of hip flexion (F[2, 9] = 4.82, p < .05), especially relative to the upward gaze, and possibly trunk flexion as well (F[2, 9] = 3.02, p = .07). In terms of the practical application, because excessive hip and trunk flexion in the squat are contraindicated, cautioning athletes against allowing the head or direction of gaze to drop below a neutral position appears to be warranted.

Adult↗

PubMed1983

Liquid-chromatographic assay and identification of mono- and diester conjugates of bilirubin in normal serum.

This liquid-chromatographic procedure for determining bilirubin mono- and diester conjugates in normal serum is based on pre-analysis conversion of bilirubin monosugar and disugar conjugates to the corresponding methyl esters by alkaline methanolysis. Here, extracted unconjugated bilirubin, bilirubin monomethyl esters, bilirubin dimethyl ester, and internal standard are separated on a reversed-phase column within 15 min, detected in the effluent at 436 nm, and quantified from their peak areas. Carotenoids do not interfere. Within-day and day-to-day CVs range from 5 to 13%. The smallest concentrations of monoconjugated and diconjugated pigments that are detectable and measurable are about 10 and 20 nmol/L, respectively. Such data are given for sera from 43 healthy adults. Total bilirubin concentrations in serum tended to be lower in women than in men, but the relative amounts of the various bilirubin fractions in sera from men and women were comparable. Analysis of ethyl anthranilate azoderivatives from serum permitted identification of the bilirubin ester conjugates in normal serum as bilirubin 1-O-acyl glucuronides.

Adult↗

PubMed2002

BALSA: Bayesian algorithm for local sequence alignment.

The Smith-Waterman algorithm yields a single alignment, which, albeit optimal, can be strongly affected by the choice of the scoring matrix and the gap penalties. Additionally, the scores obtained are dependent upon the lengths of the aligned sequences, requiring a post-analysis conversion. To overcome some of these shortcomings, we developed a Bayesian algorithm for local sequence alignment (BALSA), that takes into account the uncertainty associated with all unknown variables by incorporating in its forward sums a series of scoring matrices, gap parameters and all possible alignments. The algorithm can return both the joint and the marginal optimal alignments, samples of alignments drawn from the posterior distribution and the posterior probabilities of gap penalties and scoring matrices. Furthermore, it automatically adjusts for variations in sequence lengths. BALSA was compared with SSEARCH, to date the best performing dynamic programming algorithm in the detection of structural neighbors. Using the SCOP databases PDB40D-B and PDB90D-B, BALSA detected 19.8 and 41.3% of remote homologs whereas SSEARCH detected 18.4 and 38% at an error rate of 1% errors per query over the databases, respectively.

Algorithms↗

PubMed1999

Evaluation of the components of insulin-like growth factor (IGF)-IGF binding protein (IGFBP) system in adolescents with type 1 diabetes and persistent microalbuminuria: relationship with increased urinary excretion of IGFBP-3 18 kD N-terminal fragment.

OBJECTIVE: IGFs and their binding proteins (IGFBPs) have an important role in controlling glucose homeostasis and there is evidence to support their involvement in complications related to type I diabetes. The aim of this study was to evaluate the components of the IGF-IGFBP system in adolescents with type 1 diabetes that had developed persistent microalbuminuria (MA). DESIGN AND PATIENTS: A cohort of 49 adolescents with type 1 diabetes were enrolled in the study. Patients were evaluated at baseline and 1 year later (follow-up). Twenty-six patients with persistent urinary albumin excretion (UAE) of more than 20 microg/min/1.73 m2 (21.6-109. 4 microg/min/1.73 m2) in three different nocturnal urinary collections within 6 months were considered to have MA (baseline mean: 41.9 +/- 22.3 microg/min/1.73 m2; follow-up: 55.9 +/- 24.8 microg/min/1.73 m2). Twenty-three patients with UAE of less than 20 microg/min/1.73 m2 were assigned to the group without MA (baseline mean: 8.6 +/- 3.7 microg/min/1.73 m2; follow-up: 11.8 +/- 4.2 microg/min/1.73 m2). Fasting serum levels of IGFBP-1, IGFBP-2, IGFBP-3, IGF-I and free-IGF-I were determined using appropriate immunoenzymatic, radioimmuno- or immunoradiometric assays. Overnight 12-h urinary collections were obtained and assessed for IGFBP-3 levels, determined by immunoradiometric assay. Urinary and circulating immunoreactive IGFBP-3 forms were determined by Western-immunoblotting (WIB) analysis using a specific polyclonal antibody and monoclonal antibodies directed against N-terminal and C-terminal epitopes of IGFBP-3. IGFBP-3 protease activity was determined using protease assay and by analysis of the intact over the fragmented immunoreactive forms of IGFBP-3 determined by WIB analysis. RESULTS: Patients with MA showed higher levels of urinary IGFBP-3 (649 +/- 440 ng/h/m2) than patients without MA (398 +/- 229 ng/h/m2; P < 0.05). Urinary levels of IGFBP-3 were directly correlated to UAE (P < 0.001). WIB analysis, using monoclonal antibodies directed against characterized N-terminal and C-terminal IGFBP-3 epitopes, determined that the immunoreactive form of IGFBP-3 found in urine from patients with diabetes was an N-terminal 18 kD fragment. Serum IGFBP-3 levels were lower in patients with MA (baseline: 3613 +/- 598 microg/l; one year follow-up: 3347 +/- 624 microg/l) compared with patients without MA (baseline: 4701 +/- 1484 microg/l; follow-up: 4177 +/- 703 microg/l; P < 0.001). In serum from patients with MA, intact IGFBP-3 was decreased, as indicated by WIB analysis. Conversely, IGFBP-3 proteolysis was increased in patients with MA (baseline: 131 +/- 21% of control; follow-up: 130 +/- 23% of control), compared to patients with normal UAE (baseline: 96 +/- 23% of control; follow-up: 96 +/- 14% of control; P < 0.001). Serum IGFBP-3 protease activity was directly correlated to urinary IGFBP-3 levels (P < 0.001). Serum IGFBP-1 levels were increased in patients with MA (baseline: 36 +/- 20 microg/l; follow-up: 36 +/- 17 microg/l) compared with patients without MA (baseline: 17 +/- 11 microg/l; follow-up: 18 +/- microg/l; P < 0.05). Serum IGFBP-2 levels were also persistently increased in patients with MA (baseline: 503 +/- 134 microg/l; follow-up: 484 +/- 166 microg/l) compared with patients without MA (baseline: 375 +/- 83 microg/l; follow-up: 390 +/- 85 microg/l; P < 0.05). On the other hand, free IGF-I levels were decreased in patients with MA (baseline: 2.3 +/- 1. 5 microg/l; follow-up: 2.5 +/- 1. (ABSTRACT TRUNCATED)

Adolescent↗

PubMed2003

Prognostic significance of K-ras, p53, bcl-2, PCNA, CD34 in radically resected non-small cell lung cancers.

The aim of this study was to investigate the prognostic significance of a panel of biological parameters in patients with radically resected non-small cell lung cancers (NSCLC). 269 cases with pathological stage I-IIIA NSCLC were retrospectively analysed. Immunohistochemistry was performed to detect protein expression of p53, bcl-2, proliferating cell nuclear antigen (PCNA) and CD34. Polymerase chain reaction (PCR)/direct nucleotide sequencing method was used to detect mutations in K-ras (codons 12, 13, 61, exons 1-2). The Kaplan-Meier estimates of survival were calculated for clinical and biological variables using the Cox model for multivariate analysis. Histological subtype and the pathologic tumour extension (pT) were the most powerful clinical-pathological prognostic factors for survival (P=0.030 and P=0.031, respectively), whereas among the biological parameters, p53 overexpression (P=0.032) and K-ras mutation (P=0.078) had a negative prognostic role, as demonstrated by multivariate analysis. Conversely, bcl-2, PCNA and CD34 expression were not correlated with survival. Statistically significant associations between p53 expression and the squamous cell carcinoma (SCC) subtype, bcl-2 expression and SCC subtype, K-ras mutation and p53 negative expression, p53 and bcl-2, bcl-2 and PCNA overexpression were observed. In conclusion, some biological characteristics such as the K-ras and p53 status may provide useful prognostic information in resected NSCLC patients, in addition to the classical clinico-pathological parameters. However, further studies are needed to clarify the value of adopting biological prognostic factor into clinical practice.

Adult↗

PubMed1997

Measures of line jaggedness and their use in foods textural evaluation.

The jaggedness of signatures, such as the force-displacement curves of brittle cereal-based foods, can be a manifestation of physical processes. Consequently, it should be regarded as an inherent property of the system rather than noise that should be discarded. Changes in the degree of jaggedness can provide useful information on the system's performance or on how it is affected by external conditions, such as exposure to moisture. Quantitative assessment of the degree of jaggedness can be done by methods that include statistical analysis, conversion of the record into a Fourier power spectrum, and determination of its apparent fractal dimension. Most can be performed with microcomputers and commercially available software. It is recommended that the jaggedness of any experimental curve or signature be determined by at least two methods or algorithms simultaneously for mutual verification. The magnitude of any single measure of jaggedness is determined by the signature's fluctuations amplitude and frequency. While the amplitude effect can be accounted for by normalization, the frequency cannot. Consequently, only curves having about the same number of points at the pertinent interval can be meaningfully compared. There is, however, a mathematical method, at this time still empirical, that allows meaningful comparison of the jaggedness of signatures obtained at different sampling rates. When several or numerous jagged signatures are recorded simultaneously, as in the case of brittle particulates compressed in bulk, the resulting combined signature is considerably smoothed. This is primarily the result of averaging caused by mutual cancellation of peaks in different directions and reducing the relative weight of any large peak. However, there are mathematical methods, some partly empirical, that enable restoration of the jaggedness of the original signatures.

Algorithms↗

PubMed2003

Laparoscopic compared with conventional treatment of acute adhesive small bowel obstruction.

BACKGROUND: Although laparoscopy may be associated with fewer intra-abdominal adhesions and quicker recovery of bowel function, it remains unclear whether patients with acute small bowel obstruction (SBO) might benefit from laparoscopic techniques. METHOD: The results of patients with acute SBO treated laparoscopically (LAP; n = 52) and conventionally (CONV; n = 52) were compared in a retrospective matched-pair analysis. Conversions were included in the laparoscopic group. RESULTS: Complete laparoscopic treatment was performed in 25 patients (48.1 per cent). Major intraoperative complications occurred in 15 patients in the LAP group and eight in the CONV group (P = 0.156). Intraoperative perforations were more frequent in patients who had undergone more than one previous laparotomy (P = 0.066). Postoperative complications occurred in ten patients (19.2 per cent) in the LAP group and in 21 patients (40.4 per cent) who had conventional surgery (P = 0.032). Bowel movements started 3.5 days after operation in the LAP group and 4.4 days after conventional operation (P = 0.001). The length of hospital stay was 11.3 and 18.1 days respectively (P < 0.001). CONCLUSION: Laparoscopic treatment of acute SBO was feasible in about half of these patients. Postoperative recovery was improved after laparoscopic procedures but the risk of intraoperative complications increased. A laparoscopic approach seems justified in a subset of patients.

Acute Disease↗

PubMed1991

Communication between Spanish-speaking patients and their doctors in medical encounters.

Little research in patient-doctor communication addresses the profound difficulties that emerge as Spanish-speaking patients seek medical services in the U.S. This study examines the interaction of language and culture in medical encounters between Spanish-speaking Latino patients and their doctors who have a range of Spanish language ability and a variety of cultural backgrounds. Initial ethnographic fieldwork investigated Spanish-speaking patients' perceptions of doctors' Spanish language skill as it relates to their medical service. To elaborate on these fieldwork findings, medical encounters were audiotaped for detailed conversational analysis. Data from the two methods illustrate how language and culture interact in accomplishing communicative tasks as doctors attend Spanish-speaking patients.

Central America↗

PubMed2004

Does intubation really equal death in cirrhotic patients? Factors influencing outcome in patients with liver cirrhosis requiring mechanical ventilation.

OBJECTIVE: It is not known whether the poor outcome of ventilated cirrhotic patients is related to the severity of the underlying liver disease or to the severity of the acute illness for which ICU care is required. This study examines parameters both of chronic liver disease and of acute illness with regard to their influence on outcome in mechanically ventilated cirrhotic patients. DESIGN AND SETTING: Retrospective observational case series in a 9-bed medical ICU in an academic tertiary care center. PATIENTS AND MEASUREMENTS: Seventy-six consecutive cirrhotic patients who received mechanical ventilation were identified. Clinical and laboratory parameters were compared between ICU survivors and ICU deaths. RESULTS: There were 45/76 (59%) patients who died during their ICU stay. By univariate analysis, the Child-Pugh score, its components (serum bilirubin, prothrombin time), ALT, creatinine concentration, a clinical suspicion of infection, and the APACHE II score, but not the acute physiology score (APS), differed significantly between ICU survivors and ICU non-survivors. The Child-Pugh score was highly correlated to ICU mortality both in logistic regression analysis and receiver-operating characteristics analysis. Conversely, markers of acute illness, in particular the APS component of the APACHE II score, did not predict ICU survival. CONCLUSIONS: Markers of advanced chronic liver disease but not of the severity of acute illness are correlated to ICU outcome in ventilated cirrhotic patients. The outcome of advanced cases (Child-Pugh score of 12 and above) is poor.

Adolescent↗

PubMed2000

Hodgkin/Reed-Sternberg cells and Hodgkin's disease in patients with B-cell chronic lymphocytic leukaemia: an immunohistological, molecular and clinical study of four cases suggesting a heterogeneous pathogenetic background.

We report the immunohistological, molecular and clinical findings in four patients affected by B-cell chronic lymphocytic leukaemia (CLL) who developed "Richter's syndrome with Hodgkin's disease (HD) features" or "CLL with Hodgkin's transformation", all characterised by the presence of typical Hodgkin/Reed-Sternberg (H/RS) cells in lymph node biopsies. In three cases the nodal involvement by CLL was demonstrated both by the presence of a predominant background of CD5/CD19/CD23+ small lymphocytes and an IgH monoclonal rearrangement revealed by PCR analysis. Conversely, in the remaining case there was neither immunohistological nor molecular evidence of lymph node involvement by CLL. In all four cases H/RS cells were Epstein-Barr virus (EBV) latent membrane protein (LMP-1) positive. These findings suggest that the presence of H/RS cells in the first three patients, who had CLL/HD nodal involvement, might be related to transformation or clonal evolution of CLL cells in H/RS cells, which is in keeping with use of the term "CLL with Hodgkin's transformation". In the fourth case a de novo HD may be postulated, representing a second malignancy presumably not clonally related to CLL. In all cases a key pathogenetic role of EBV is suggested by the expression of LMP-1 in H/RS cells. Our findings indicate that the presence of typical H/RS cells in lymph node biopsies in CLL patients may reflect a heterogeneous pathogenetic background. The different clinico-pathologic settings should be taken into consideration because of their possible implications for patients' treatment and prognosis.

Aged↗

PubMed2005

Doctor's expertise and managing discrepant information from other sources in genetic counseling: a conversation analytic perspective.

The study examines a recurrent interactional pattern in genetic counseling. It describes clinical geneticists' responses in situations in which clients have presented information from other sources that is potentially discrepant with information given by the doctor. The data consists of 12 video-recorded sessions of genetic counseling in Finland, and the method is conversation analysis. There are two primary ways the doctors respond: either they accept the client's information as such, but show that it is not discrepant with the doctor's information, or they reject the client's information. In the latter case they mitigate the 'wrongness' of the client's information. The clinical geneticists seem to be working with a dilemma: they need to find a balance between ensuring correct understanding of the information and showing respect for the expertise of others. A particularly complex case is also analyzed and reflected on.

Clinical Competence↗