418 research outputs found
Problems and prospects in the study of physician-patient interaction: 30 years of research
â Abstract Working within the functionalist perspective that he did so much to develop, Parsons (1951) conceptualized the physician-patient relationship according to a normative framework defined by the pattern variable scheme. As Parsons clearly recognized, this normative conceptualization was one that empirical reality at best only approximates. In the 1970s, two major studies established doctor-patient interaction as a viable research domain. In the present review, we consider approaches to the medical interview developing from these initiatives and that have a primary focus on observable features of doctor-patient interaction. Within this orientation, we consider literature dealing with social, moral, and technical dilemmas that physicians and patients face in primary care and the resources that they deploy in solving them. This literature embodies a steady evolution away from a doctor-centered emphasis toward a more balanced focus on the conduct of doctors and patients together
The impact of using computer decision-support software in primary care nurse-led telephone triage:Interactional dilemmas and conversational consequences
Telephone triage represents one strategy to manage demand for face-to-face GP appointments in primary care. Although computer decision-support software (CDSS) is increasingly used by nurses to triage patients, little is understood about how interaction is organized in this setting. Specifically any interactional dilemmas this computer-mediated setting invokes; and how these may be consequential for communication with patients. Using conversation analytic methods we undertook a multi-modal analysis of 22 audio-recorded telephone triage nurse-caller interactions from one GP practice in England, including 10 video-recordings of nurses' use of CDSS during triage. We draw on Goffman's theoretical notion of participation frameworks to make sense of these interactions, presenting 'telling cases' of interactional dilemmas nurses faced in meeting patient's needs and accurately documenting the patient's condition within the CDSS. Our findings highlight troubles in the 'interactional workability' of telephone triage exposing difficulties faced in aligning the proximal and wider distal context that structures CDSS-mediated interactions. Patients present with diverse symptoms, understanding of triage consultations, and communication skills which nurses need to negotiate turn-by-turn with CDSS requirements. Nurses therefore need to have sophisticated communication, technological and clinical skills to ensure patients' presenting problems are accurately captured within the CDSS to determine safe triage outcomes. Dilemmas around how nurses manage and record information, and the issues of professional accountability that may ensue, raise questions about the impact of CDSS and its use in supporting nurses to deliver safe and effective patient care
Seeing the way: visual sociology and the distance runner's perspective
Employing visual and autoethnographic data from a twoâyear research project on distance runners, this article seeks to examine the activity of seeing in relation to the activity of distance running. One of its methodological aims is to develop the linkage between visual and autoethnographic data in combining an observationâbased narrative and sociological analysis with photographs. This combination aims to convey to the reader not only some of the specific subcultural knowledge and particular ways of seeing, but also something of the runner's embodied feelings and experience of momentum en route. Via the combination of narrative and photographs we seek a more effective way of communicating just how distance runners see and experience their training terrain. The importance of subjecting mundane everyday practices to detailed sociological analysis has been highlighted by many sociologists, including those of an ethnomethodological perspective. Indeed, without the competence of social actors in accomplishing these mundane, routine understandings and practices, it is argued, there would in fact be no social order
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Native freshwater wetland plant associations of northwestern Oregon
This guide provides keys, descriptions, and stand tables for 122 native freshwater plant associations (14 forest and woodland, 28 shrub, 78 herbaceous, 2 nonvascular) in northwestern Oregon, based on analysis of data from 1,992 plots distributed throughout the study area. Descriptions are provided for eight other plant associations for which there are no plot data. Data were also not available for 114 additional associations reported from the study area (Kagan et al. 2000). The study area includes the north half of both the Coast Range and Western Cascade ecoregions, and all of the Willamette Valley. Vegetation is classified according to the National Vegetation Classification System, and plant associations are assigned to ecological systems that are currently being developed on a nationwide level
Repetition and the prosody-pragmatics interface
Repetition poses certain problems for pragmatics, as evidenced by Sperber and Wilsonâs claim that ââthe effects of repetition on utterance interpretation are by no means constantââ. This is particularly apposite when we examine repetitions produced in naturally occurring talk. As part of an ongoing study of how phonetics relates to the dynamic evolution of meaning within the sequential organisation of talk-in-interaction, we present a detailed phonetic and pragmatic analysis of a particular kind of self- repetition. The practice of repetition we are concerned with exhibits a range of forms: ââhave another go tomorrow . . . have another go tomorrowââ, ââit might do . . . it might doââ, ââitâs a shame . . . itâs a shameââ. The approach we adopt emphasises the necessity of exploring participantsâ displayed understandings of pragmatic inferences and attempts not to prejudge the relevance of phonetic (prosodic) parameters. The analysis reveals that speakers draw on a range of phonetic features, including tempo and loudness as well as pitch, in designing these repetitions. The pragmatic function of repetitions designed in this way is to close sequences of talk. Our findings raise a number of theoretical and methodological issues surrounding the prosodyâ pragmatics interface and participantsâ understanding of naturally occurring discourse
Challenges in the Analysis of Historic Concrete:Understanding the Limitations of Techniques, the Variability of the Material and the Importance of Representative Samples
Rare, Threatened and Endangered Plants and Animals of Oregon
Extinction is a natural process. Today, however, plant and animal species are disappearing world-wide at an accelerated pace. Based on current trends, half of the species on earth will be extinct within the next 100 years. The major cause of this phenomenon is large-scale destruction of native habitats, which has increased since European settlement began in the mid 1800\u27s - in Oregon and throughout the New World.
Once lost, a species can never be recovered, and there is no way of knowing how useful it may have been. We do know that human beings and many of their industries depend on plant and animal products. About 50% of all pharmaceuticals have a natural component as an active ingredient, yet less than one percent of the world\u27s species have been chemically analyzed and tested. Many invertebrates and plants contain undescribed and highly functional compounds. Limnanthes floccosa subsp. grandiflora, or wooly meadow-foam, a rare plant that grows in southwest Oregon, has been recently found to produce a hybrid with the more common member of the genus, Limnanthes alba. This hybrid grows well in the poorly drained soils of the Willamette Valley and produces a valuable oil used for soaps, plastic and rubber production. In addition, the new hybrid meadow-foam does not require the field burning necessary for other crops. This species, and many other Oregon natives, will be lost without intervention. The purpose of this book is to provide land managers, owners and interested parties with a list of those species in Oregon which are in greatest jeopardy
Agenda-setting revisited: When and how do primary-care physicians solicit patientsâ additional concerns?
Objective: Soliciting patientsâ complete agendas of concerns (aka. âagenda settingâ) can improve patientsâ health outcomes and satisfaction, and physiciansâ time management. We assess the distribution, content, and effectiveness of physiciansâ post-chief-complaint, agenda-setting questions. Methods: We coded videotapes/transcripts of 407 primary-, acute-care visits between adults and 85 general-practice physicians operating in 46 community-based clinics in two states representing urban and rural care. Measures are the incidence of physiciansâ questions, their linguistic format, position within visits, likelihood of being responded to, and the nature of such responses. Results: Physiciansâ questions designed to solicit concerns additional to chief concerns occurred in only 32% of visits (p \u3c .001). Compared to questions whose communication format explicitly solicited âquestionsâ (e.g., âDo you have any questions?â), those that were formatted so as to allow for âconcernsâ (e.g., âAny other concerns?â) were significantly more likely to generate some type of agenda item (Chi2 (1, N = 131) = 11.96, p = .001), and to do so more frequently when positioned âearlyâ vs. âlateâ during visits (Chi2 (1, N = 73) = 4.99, p = .025). Conclusions: Agenda setting is comparatively infrequent. The communication format and position of physiciansâ questions affects patientsâ provision of additional concerns/questions. Practice implications: Physicians should increase use of optimized forms of agenda setting
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