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This study focuses on the assessment and treatment of the conversations of a couple where one partner has aphasia. The assessment and treatment, informed by conversation analysis, are described, and some implications for the relation between language and psychosocial issues discussed.
Inaccuracy in reporting dietary intakes is a major problem in managing diet-related disease. There is no single best method of dietary assessment, but the diet history lends itself well to the clinical setting. In many diet histories data are collected orally, so analysis of interviews can provide insights into reporting behaviors. Conversation analysis is a qualitative method that describes the systematic organization of talk between people. Patterns are identified and checked for consistency within and among individual interviews. The aim of this study was to describe consistent ways of reporting diet histories and to identify conversational features of problematic reporting. Diet history interviews from 62 overweight and insulin-resistant adult volunteers (50 women, 12 men) attending an outpatient clinic and 14 healthy volunteers (7 men, 7 women) participating in an energy balance study were audiotaped and transcribed. Conversation analysis identified a remarkably consistent pattern of reporting diet histories and 3 conversational features that indicated problematic reporting: "it depends," denoting variability (least of all at breakfast); "probably," suggesting guesswork (related to portion sizes); and elaborated talk on certain foods, distinguishing sensitive topics (e.g., alcohol, chocolate, butter/margarine, take-out foods) from safe topics. These findings indicate that there are ways in which dietetics practitioners may conduct the diet history interview to foster more accurate reporting.
This paper explores the impact of linguistic impairments on conversational ability in aphasia using conversation analysis (CA). Using a combination of quantitative and qualitative techniques, an analysis of the distribution of turns at talk in three aphasic participants' conversations with a relative and with the researcher is described. Using extracts from the conversations for illustration, three major factors are proposed which influence the sharing of conversational turns: (1) shared knowledge of interlocutors, (2) the manifestations of linguistic impairments in conversation, and (3) individual discourse styles. Finally, the implications of the findings for remediation are considered.
This single case study investigated the use of Conversation Analysis (CA) in assessing pragmatic language difficulties after closed head injury (CHI). The aim was to see if CA captures the types of communication breakdown observed after CHI and whether results from CA can be directly related to scores on formal tests more typically applied after CHI. The results suggested that CA was a sensitive tool for identifying and investigating pragmatic deficits in this case. It facilitated an exploration of whether language impairments identified on formal tests manifest themselves in functional communication; it revealed how different interlocutors adapt to these language difficulties in conversation and also explained why some conversational partners were more successful than others. Considered together, formal test results and CA insights facilitated an in-depth analysis into the precise nature of the communicative impairments of the speaker in this exploratory study, suggesting that CA is a promising approach to the assessment of pragmatic impairments in the CHI population.
The study analysed the dynamics of a mediated medico-legal interview using conversation analysis (CA) as a key methodology. The aim of using CA was to identify both facilitators and inhibitors of a successfully mediated interview, using a detailed microscopic analysis of the dynamics involved. A 45-minute interview with the client's parents, the speech pathologist and the interpreter was tape recorded and analysed according to CA principles. Results revealed several facilitators, including equal and active roles, use of code switching, familiarity between the interviewer and interpreter, and use of repetition. Inhibitors included different agendas, complicated repair trajectories and interruptions. In addition, aspects such as cultural brokerage were identified that could be considered neither as facilitators nor as inhibitors. Each area is discussed in detail using extracts from the transcription.
As governmental priorities worldwide continue to emphasise the inclusion of patients in healthcare consultations, there is a pressing need for a research approach that accurately captures the contribution of both participants within nurse-patient interaction. With this in mind, this paper examines, via selective data extracts, the contribution that conversation analysis (CA) could make to this area of nursing research. In the United Kingdom (UK) over the last two decades, CA has been neglected as a method for exploring nurse-patient communication, and a case is made here for its entry into the mainstream of nursing research. The case is made particularly persuasive in the light of conversation analysts' use of naturally occurring research data, a form of data that is regrettably lacking in much of the published research on nurse-patient interaction.
BACKGROUND: It is clear that much of the success of health-care provision depends on the quality of interactions between health professionals and patients. For instance, it is widely recognized that patients are more likely to take medication effectively if they have been involved in discussions about treatment options, and understand and support the decision about what is prescribed (patient concordance). Hence, patient participation is important for the success of medical outcomes. The key is to explore how communicative choices made by health professionals impact on the quality of interactions in general, and of patient participation in particular. However, to date there has not been an appropriate method for investigating this connection or impact. OBJECTIVE: To outline the perspective and method of Conversation Analysis (CA). Developed within sociology and linguistics, CA offers a rigorous method (applicable to large data sets) to the study of interaction in health settings. STRATEGY: The method of CA is illustrated through a review of CA studies of doctor-patient interactions. Two such studies, one from the US and the other from Finland, are reviewed, in order to show how CA can be applied to identifying both forms of patient participation, and the interactional conditions which provide opportunities for patient participation. These studies focus principally on the medical examination and diagnostic stages of the consultation. Further research will examine the forms and conditions of patient participation in decision-making.
BACKGROUND: PEG disruptions during conversions to skin-level gastrostomy devices have been described, but specific risk factors have not been reported. In this study, possible risk factors for tract disruption in a pediatric population were identified, and management of complications described. METHODS: The medical records of patients who underwent gastrostomy conversions during 1994 were reviewed. Statistical analysis was performed using two-tailed student's t test, and risk ratios with 95% confidence limits were calculated. RESULTS: Gastrostomy tract disruption occurred in 6 to 30 (20%) of tube conversions. Complicated and uncomplicated cases did not differ with regard to age, sex, primary or associated diagnoses, pregastrostomy or postgastrostomy nutritional status, tract maturity, or percutaneous gastrostomy tube type. The use of an 18F obturator-type skin-level gastrostomy tube increased the risk for gastric separation 4.8-fold. Tract disruptions were managed by fluoroscopic gastrostomy tube replacement, repeat PEG, or exploratory laparotomy with open gastrostomy. CONCLUSIONS: The use of obturator-type skin-level gastrostomy tubes was associated with an increased risk of tract disruption. Fluoroscopic verification of intragastric placement is warranted after initial conversions to skin-level gastrostomy tubes.
The utility of the amide II absorption band at 1537 cm-1 as internal reference for calculation of monomer conversion in urethane dimethacrylates (UDMA)-based dental restorative materials and sealants by means of Fourier transform infrared spectroscopy (FTIR) is demonstrated in this paper.
Composite restorative material has undergone gradual change in composition since its introduction in the 1960's. Early commercial resins were mixtures of BIS-GMA and TEGDMA. Today, these mixtures are still present, but urethane dimethacrylates and large oligomeric structures of BIS-GMA-urethanes exist. Because of these changes in composition, the past methods of calculating monomer conversion by means of infrared spectroscopy may need modification. This research investigates different methods used to formulate calibration curves for determination of monomer conversion by infrared spectroscopy of contemporary commercial composites containing aromatic structures. Conversion calibration procedures using various baseline methods with BIS-GMA, Bisphenol-A/TEGDMA, and a hydrogenated bonding resin were established. Both peak and area infrared absorptions were determined. One particular baseline method proved the best fit to the Beer-Lambert law. Bisphenol-A was found unsuitable as an infrared calibration model for resin composites. The BIS-GMA/TEGDMA calibration model closely simulates conversion values obtained when a hydrogenated commercial resin model was used.
Through analysis of video data of interaction between staff and clients with learning disabilities and limited vocal skills, it was possible to demonstrate that clients used gaze and body orientation to display a readiness that was often not responded to by staff. Yet staff could recognize that readiness from the videos. Video analysis was therefore developed as a medium for education and training where staff were helped to become more aware of strategies for non-vocal communication, which could help them achieve their policies of supporting clients more successfully. The study also allowed development of methodology in the field of services for people with learning disabilities.
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This paper uses the methodology and analytical findings of conversation analysis to investigate the notion that aphasic grammar may be understood at least partly in the context of the demands of turns at talk in conversation. An investigation of the conversation of an English-speaking person with aphasia reveals two distinct grammatical phenomena, and it is suggested that their use may be interactionally motivated by the need to take a relatively unproblematic turn at talk despite the constraints of non-fluent aphasia. The grammatical patterns that are revealed by this analysis look considerably different from those elicited by standard methods of data sampling. The possibility that interactional grammatical phenomena are not visible in the language data elicited by clinical assessments is raised. This question is addressed via an in-depth comparison of the same speaker's interactional and elicited grammar in a linked article. It is suggested that the tool of conversation analysis provides researchers with a new and fruitful approach to the study of grammatical abilities in aphasia.
PURPOSE: To determine if evidence of the persistence of a sense of self or personal identity could be found in people in the middle and late stages of Alzheimer's disease. The theme of diminishing self pervades both the popular and professional literature on Alzheimer's disease. DESIGN: Qualitative using conversational analysis. The purposive sample was 23 residents of two urban nursing homes in the southeastern United States who were in the middle and late stages of Alzheimer's disease. Their mean Mini-Mental State examination score was 10.65. Nineteen subjects were women, four were men in this 1993-1997 study. METHODS: Analysis of 45 conversations lasting 30 minutes with nursing home residents with a diagnosis of probable Alzheimer's disease. Use of the first person indexical and other evidence, such as awareness and reactions to the changes that had taken place, in support of and counter to the notion of persistence of self, were sought in conversational analysis. FINDINGS: Respondents used the first person indexical frequently, freely, and coherently. Evidence was also present that participants were aware of their cognitive changes. Many struggled to provide an explanation, but none mentioned Alzheimer's disease. CONCLUSIONS: Evidence suggests the persistence of awareness of self into the middle and late stages of Alzheimer's disease. Failure to recognize the continuing awareness of self and the human experience of the person in the middle and late stages can lead to task-oriented care and low expectations for therapeutic interventions. The bafflement noted in respondents suggests that people should be told their diagnosis and offered an explanation of what this diagnosis means.
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.
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.