Automated Extraction of Physical Examination Interactions in General Practice Consultations: A Multi-Modal Using Images and Text Base Approaches.

Teleconsultation, which proliferated during the COVID-19 pandemic, is projected to keep evolving in primary care; however, virtual physical examinations continue to hinder telehealth development. This study aimed to automatically recognise physical examinations performed during in-person GP consultations by text and image-based recognition. Text-based methods used regular expressions on transcript keywords to identify physical examinations, while image-based methods utilised transfer learning (fine-tuning the Resnet-18 model) to detect physical examination interactions.

How option-listing influences decision-making in orthopedic consultations: a conversation analytic study.

OBJECTIVES: Examine which practices orthopedists use to do option-listing, a technique that can facilitate shared decision-making (SDM). METHODS: A conversation analytic study of 35 orthopedic consultations with newly referred patients with hip and/or knee osteoarthritis. RESULTS: Orthopedists implement option-listing in consultations using two organizational principles: 1) A fixed order of options that constitutes a scale (based on the severity of treatment). Presenting this scale (in two possible orders) encodes this fixed order; 2) Options are presented in relation to each other, rather than as individual options to be discussed incrementally. This format provides orthopedists with interactional slots to formulate their professional stance by presenting options as considered but rejected. Patients co-construct this list by taking a recipient role and not responding to the individual items of the list. CONCLUSIONS: Option-listing can facilitate SDM, allowing patients to choose amongst options. A drawback is that, while the organizational principles of option-listing allow orthopedists to express a professional opinion, they also place patients in an interactional position in which they have to address the orthopedists' epistemic stance. On the other hand, patients can use the scale to propose their own preferences. PRACTICAL IMPLICATIONS: Awareness of the interactional consequences of option-listing might optimize SDM.

Harnessing the power of language to enhance patient experience of the NHS complaint journey in Northern Ireland: a mixed-methods study.

Background: Good communication is consistently recognised as essential for effective complaint handling, while failures in communication correlate with risk of escalation. Nonetheless, communication in National Health Service complaint handling remains underexamined. Objectives: To examine complainants' lived experience of the complaints journey through (1) micro-analysis of their communication with National Health Service representatives; (2) their self-reported expectations and experiences throughout the complaints journey; to survey patient perceptions of the culture of the National Health Service; to develop 'Real Complaints' - an evidence-based communication training resource. Design: The project triangulates microlevel conversation analysis and discourse analysis of spoken and written complaints encounters with complainants' appraisals of those encounters in longitudinal case studies. This is underpinned by an audit of patient views of the cultural-institutional context of the National Health Service. Setting and participants: Data were gathered in the complaints-handling services of two National Health Service trusts and a Patient Advocacy Service in Northern Ireland. Twenty-three complainants consented to longitudinal data collection and 58 to initial encounter recording; 115 members of the Patient Advocacy Service mailing list completed the cultural audit; 3 trust complaint handlers, 1 Patient Advocacy Service complaint handler and 2 trust complaints managers were interviewed. Data sources: This yielded 1155 minutes of recorded calls, 113 written encounters, 36 diaries, 6 meetings, 23 interviews and 115 cultural audit responses collected over a period of 24 months. Results: Our analysis illuminates the dual nature of complaints: as personal expressions of dissatisfaction and as systemic critiques. The complaint experience is a dynamic journey with evolving narratives reflecting complainants' shifting perceptions, expectations and experiences of the 'system', both moment-by-moment and encounter-by-encounter in the overall journey. Key interpersonal priorities for complainants significantly affected complaint outcomes, most important of which was the need to be respected as a 'reasonable complainant'. Also key is the conversation analytic concept of affiliation, which involves taking a stance towards the event(s) being described that matches the complainant's stance. Use of affiliation by call handlers supported effective and efficient person-centred complaints handling, while absence of affiliation typically led to escalation of the scope, scale and emotional intensity of the complaint, sometimes to the point of an expressed intention to litigate (particularly in the case of written responses). Viewed holistically, successful complaints communication requires person-centredness, and affiliative interactions framed by shared expectations. These findings were applied in the development of Real Complaints Training and Guidance for spoken and written complaints communication. Limitations: The COVID pandemic significantly constrained trust participation, particularly the participation of front-line clinical staff, and one trust introduced 'telephone resolution' to which we were not given access. Additionally, calls viewed by staff as 'challenging' and ethnic minority communities are both under-represented in the final data set. Conclusions: Addressing the complainant's desire to be perceived as reasonable was revealed as crucial for fostering a more person-centred approach to handling complaints and addressing the gap between expectations and experience. This finding holds particular significance for recommendations, guidance and training relating to both spoken and written communication. Future work: Direct extensions of the project include the piloting and evaluation of Real Complaints Training and further primary research involving communication between complainants and front-line service/clinical staff and complaint handling by ombudsman complaints investigators. An emerging question relates to social exclusion and access to complaints procedures. Study registration: This study is registered as Research Registry: researchregistry5049. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR127367) and is published in full in Health and Social Care Delivery Research Vol. 12, No. 33. See the NIHR Funding and Awards website for further award information.

The aim of this project was to make the experience of complaining to the National Health Service better for patients and their families and improve the outcomes for the National Health Service. Complaints can be positive for the National Health Service because they help improve services for other patients. However, if a complaint escalates, it could be costly for the National Health Service and stressful for the patient. We analysed phone calls and letters between the National Health Service and patients or their family. Some patients took part in the study over a long period of time: from when their complaint was lodged until it was complete. We also used online diaries and interviews to analyse how this communication affected the hopes and expectations of the patient throughout the complaints journey. Our research found that people making complaints have particular needs: to be listened to, to tell their whole story (including how the bad experience has impacted on their lives), to be treated as reasonable and for their complaint to be taken seriously. If they feel that these needs are not being met, the complaint often becomes more serious; the patient may even talk about pursuing legal action. We observed that call handlers can use communication skills to ensure that patients feel listened to and taken seriously when they make a complaint. We also found that receiving written responses to their complaint (often at the end of the complaint journey) is when patients feel most dissatisfied. We identified which responses to a complaint are viewed negatively (avoiding blame, insincere apologies) and which are viewed positively (accepting responsibility, recognising the impact of the events). Our findings were then used to develop training materials using real examples from our data. This will help complaint handlers reflect on how their communication impacts on patients making complaints and will lead to a better experience of the complaints process.

Just go with your body? A conversation analytic study of the transition from first to second stage of labor in UK midwife-led care.

BACKGROUND: The transition from first to second stage of labor is poorly understood. While the onset of second stage is defined by cervical measurement, dilation cannot be directly sensed or externally observed. Thus, uncertainty exists when women report pushing urges before dilation is confirmed. This study aimed to explore how sensations of pushing and uncertainty over progress are interactionally managed. METHODS: We audio/video recorded the labors of 37 women in two midwife-led units in England. Our analysis focused on a subset of 28 recordings that featured discussion of transition from first to second stage of labor. The interactions between midwives, laboring women and their birth partners were transcribed and analyzed using conversation analysis. RESULTS: We identified a 'pushing until proven otherwise' rule granting temporary, contingent authority to bodily urges to push while tracking progress over time. Specifically, midwives supported reported pushing sensations without insisting on examinations. Caution was occasionally expressed in distinguishing between irresistible and forced pushing. Across multiple contractions, midwives watched and waited for alignment of sensations with signs of descent. Where signs of progress were absent over time, examinations were treated as clinically indicated. DISCUSSION: Thus, a complex interplay of women's sensations and midwifery expertise produced care. Compared to past research, our analysis demonstrates increased validation of embodied experience in contemporary midwife-led practice. However, uncertainty still requires navigation through collaborative work. We evidence how this navigation is accomplished in real-time interactions.

Remembering conversation in group settings.

Individuals can take on various roles in conversation. Some roles are more active, with the participant responsible for guiding that conversation in pursuit of the group's goals. Other roles are more passive, like when one is an overhearer. Classic accounts posit that overhearers do not form conversational common ground because they do not actively participate in the communication process. Indeed, empirical findings demonstrate that overhearers do not comprehend conversation as well as active participants. Little is known, however, about long-term memory for conversations in overhearers. Overhearers play an important role in legal settings and dispute resolution, and it is critical to understand how their memory differs in quality and content from active participants in conversation. Here we examine - for the first time - the impact of one's conversational role as a speaker, addressee, or overhearer on subsequent memory for conversation. Data from 60 participants recalling 60 conversations reveal that after a brief delay, overhearers recall significantly less content from conversation compared to both speakers and addressees, and that the content they do recall is less accurately sourced to its actual contributor. Mnemonic similarity is higher between active conversational participants than between active participants and overhearers. These findings provide key support for the hypothesis that the process of forming common ground in interactive conversation shapes and supports memory for that conversation.

A conversation analytical study of call openings in Emergency Medical Service calls where the patient is at imminent risk of out-of-hospital cardiac arrest.

Background: The Chain of Survival identifies the importance of early recognition of patients who are at imminent risk of out-of-hospital cardiac arrest. This research investigated the interaction between callers and call-takers during calls to the Emergency Medical Service; it specifically focussed on patients who were alive at the initiation of the EMS call, but who subsequently deteriorated into out-of-hospital cardiac arrest during the prehospital phase of care (i.e., before arrival at hospital). Methods: Conversation-analytic methods were used to examine the call openings of 38 Emergency Medical Service calls for patients who were at imminent risk of out-of-hospital cardiac arrest. Call openings centred on pre-triage questions designed to rapidly identify patients who are either in out-of-hospital cardiac arrest, or who are at imminent risk of out-of-hospital cardiac arrest. Results: Emergency Medical Service call openings did not facilitate efficient and accurate triage, thus delaying the identification of critically unwell patients by call-takers. In 50% of call openings, the caller wanted to give the reason for the call during the pre-triage questions. The caller and call-takers orientate to different agendas causing delays to call progression and risking information loss that impacts on effective call triage. Conclusions: The design of the Emergency Medical Service call opening can cause interactional trouble, thus impacting on call progression and risking critical information loss. Modifications to the Emergency Medical Service call opening to quickly align the caller and call-taker, communications training for call-takers and public education may support early identification of patients at imminent risk of out-of-hospital cardiac arrest.

Evaluating the efficacy of computer games-based learning intervention in enhancing English speaking proficiency.

The use of learning games in education, particularly for second language (L2) acquisition, has gained significant traction recently, establishing game-based learning as a notable academic discipline. This study examines how computer game-based learning influences ESL undergraduates' speaking abilities, comparing traditional teaching methods with game-based teaching techniques. The study employed action research utilizing a control-experimental groups technique with a sample of 60 learners. Data were collected through observation sessions, interviews, as well as pre-tests and post-tests on English speaking skills. Upon comparing the scores of the control and experimental groups, the experimental group showed greater improvement in speaking skills. This study provides significant insights into the area of game-based learning using computers, particularly among international students in ESL contexts.

The role of the body in SGD-mediated interactions.

Most research about augmentative and alternative communication (AAC) has focused on improving use of and access to speech generating devices (SGDs). However, many adults with significant physical and developmental disabilities express a preference for unaided, embodied forms of communication. This study used conversation analysis (CA) techniques to analyze the forms and functions of embodied communication that occurred during interactions between a young man who used unaided, embodied communication and an SGD to communicate with a familiar communication partner. Close analysis revealed that embodied resources were required for both unaided and aided forms of communication. Furthermore, both participants used their bodies to establish interactional spaces with different focal points during interaction, which placed different demands on the aided speaker. Unfortunately, when the SGD was the focal point, problematic demands were placed on the aided speaker, which in turn resulted in increased embodied effort on his part. The forms and functions of the body, differences in the participants' interactions when communication did and did not involve the SGD, and implications for research and practice are all reported and discussed.

[How to talk to relatives about corneal donation]. / Wie spreche ich mit Angehörigen über die Hornhautspende?

Corneal donation counselling is an important part of the process to inform and support potential donors and their relatives. In this article various aspects of the conversation techniques on corneal donation are discussed, including raising awareness of the importance of donation, clarifying questions and concerns, emphasizing the potential of donation and considering the emotional burden on the relatives of potential donors. Also emphasized is the role of the counsellor as a trustworthy and empathetic contact who can help family members of potential donors make an informed and positive decision. It is pointed out that a professional and empathetic approach to corneal donation can help to increase the willingness to donate and ultimately that a donation can help visually impaired or blind people regain their sight and quality of life through donation.

'They think we're just in God's waiting room': A discursive study on identity aloneness in stroke survivors.

This paper examines the rhetorical strategies used by stroke survivors to attend to identity aloneness, a phenomenon in which individuals experience a sense of disconnect from others as a consequence of identity change, for which stroke is known as an antecedent. Three stroke survivors, and their spouses, were interviewed about their stroke, social support, and experiences with loneliness and identity change. The data was transcribed using a simplified version of the Jeffersonian method and analysed using a critical discursive psychological approach. This made it possible to examine the way in which the psychological business of identity aloneness was managed in participants' talk via discursive devices such as metaphors and category entitlement, while also leaving room to consider how broader societal discourses were drawn upon. The analysis revealed two critical ways in which participants attended to the issue of identity aloneness: (1) by crafting and occupying a position of resilience; (2) by managing the impact of the post-stroke social world on their identities. These findings offer insight into how the issue of identity aloneness is made sense of by stroke survivors in the context of a discussion with an interviewer. Finally, findings informed future directions for research, including developing a comprehensive theory of identity aloneness using a grounded theory approach and developing and validating a psychometric measure of identity aloneness to be applied in a rehabilitative setting.