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We use conversation analysis to both qualitatively and quantitatively demonstrate that, in a specific action context, an answerer's gaze orientation at the end of their answer's first verbal turn-constructional unit (TCU) is one cooperating element of a multi-resource gestalt for managing the answer-turn's transition relevance. Specifically, gazing at (vs. away from) a questioner claims that the initial TCU is (or is not yet) transition-relevant. Findings suggest that an additional resource is prior context in the form of the amount of delay (in milliseconds) of an answer relative to its question. Other potential resources, such as the TCU's type conformity generally and its specific status as a "Yes"- or "No"-type answer, were not associated with transition relevance. Data are 274 polar, question–answer sequences—representing the very delimited social action of relatively genuine information-seeking—drawn from videotapes of completely unstructured, face-to-face interactions between dyads of native English-speaking, adult close friends. [ABSTRACT FROM AUTHOR]

Extending Jefferson's analysis of the limited utility of turn-constructional-unit (TCU)-initial particles in managing overlapping talk, this article limits itself to a similar turn-taking context/position in which current speakers bring TCUs to places of possible completion when it is relevant for next speakers to take a turn of talk. This article examines situations in which current speakers continue to audibly inhale in the transition space, arguing that inhalations (a) are pre-beginning actions; (b) bestow a weaker right to speak next than does talk; (c) are not accountable for obscuring next speakers' talk (if it eventuates); (d) allow for beginning TCUs while monitoring for next speakers' talk, thereby allowing inhalers to proceed contingently based on next speakers' unfolding conduct; and (e) are used to mitigate the systemic turn-taking troubles of "no person speaking at a time" and "more than one person speaking at a time." Data are videotapes of mundane, dyadic, American English conversation. [ABSTRACT FROM AUTHOR]

Introduction: Trauma center radiologists vary widely in the degree to which they provide secondary interpretations for transferred patients' advanced imaging. A general perception of uncertainty over reimbursement for these exams often results in reluctance to provide routine overreads. The purpose of this study is to assess the difference in reimbursement rates between primary interpretations and secondary interpretations in the emergency department (ED) setting. Materials and methods: Billing records for the three CT procedures most commonly performed in a single, major level 1 trauma center ED from January 1, 2021, to December 31, 2021, constituted the dataset. Gross charges, total receipts, and payer status were recorded for each exam, and reimbursement rates calculated. Results: In total, 19,754 exams met the inclusion criteria. Primary interpretation was performed on 16,507 (83.6%) exams and secondary interpretation on 3247 (16.4%). For the three CPT codes examined, the average reimbursement percentage was 32.9% for primary interpretation and 43.5% for secondary interpretation. The average reimbursement percentage for commercial payers was 56.5% for primary interpretation and 65.9% for secondary interpretation. The average reimbursement percentage for Health Insurance Exchange payers was 58.5% for primary interpretation and 59.5% for secondary interpretation. The average reimbursement percentage for Medicaid was 24.7% for primary interpretation and 39.9% for secondary interpretation. The average reimbursement percentage for Medicare was 31.1% for primary interpretation and 30.2% for secondary interpretation. The average reimbursement percentage for self-paying patients was 2.3% for primary interpretation and 3.5% for secondary interpretation. Conclusion: Regardless of payer status, reimbursement for secondary interpretation of the three most common transfer patients' CT exams is near or greater than that of primary interpretations. [ABSTRACT FROM AUTHOR]

Objective: To evaluate receipt fidelity of communication training content included in a multifaceted intervention known to reduce antibiotic over-prescribing for pediatric acute respiratory tract infections (ARTIs), by examining the degree to which clinicians implemented the intended communication behavior changes.Methods: Parents were surveyed regarding clinician communication behaviors immediately after attending 1026 visits by children 6 months to < 11 years old diagnosed with ARTIs by 53 clinicians in 18 pediatric practices. Communication outcomes analyzed were whether clinicians: (A) provided both a combined (negative + positive) treatment recommendation and a contingency plan (full implementation); (B) provided either a combined treatment recommendation or a contingency plan (partial implementation); or (C) provided neither (no implementation). We used mixed effects multinomial logistic regression to determine whether these 3 communication outcomes changed between baseline and the time periods following each of 3 training modules.Results: After completing the communication training, the adjusted probability of clinicians fully implementing the intended communication behavior changes increased by an absolute 8.1% compared to baseline (95% Confidence Interval [CI]: 2.4%, 13.8%, p = .005).Conclusions: Our findings support the receipt fidelity of the intervention's communication training content.Practical Implications: Clinicians can be trained to implement communication behaviors that may aid in reducing antibiotic over-prescribing for ARTIs. [ABSTRACT FROM AUTHOR]

Sacks, Schegloff, and Jefferson argued that the rules for turn taking for conversation involve a confluence of pressures that bias turn size toward single turn constructional units (TCUs), which leads to an empirical prediction that turns are more likely to be composed of single (vs. multiple) TCUs. We directly test and confirm this "single-TCU bias" by using conversation analysis, corpus linguistics, and Bayesian statistics to assess the conversational subcorpus of the British National Corpus (BNC-C), which contains 475,509 turns of talk. Our results confirm this bias, showing that 67% of turns are composed of single TCUs; we discuss why this estimate is conservative. The mean word length for single-TCU turns was 4.5 (SD = 3.4), compared to 19.9 (SD = 22.6) for multi-TCU turns. Our findings reinforce the ideas that the natural habitat for an accountable social action is the single TCU (vs. the turn), and that interaction is fundamentally organized (i.e., both produced and understood) on an action-by-action basis, which is a TCU-by-TCU basis. Data are in British English. [ABSTRACT FROM AUTHOR]

In the Netherlands, parents of newborns typically participate in two-, four-, and eight-week medical consultations to monitor their children’s development and discuss vaccinations, which will not be administered before eight weeks. During these visits, healthcare professionals routinely ask parents if they intend to vaccinate their children (i.e. to participate in the National Immunization Program). Using Conversation Analysis, we examine 62 videotaped consultations and present two lines of evidence to argue that the sequence initiated by professionals wherein they solicit parents’ intent to vaccinate is dispreferred. First, this action is routinely deferred by preliminary sequences. Second, when professionals eventually initiate this action (i.e. if it is not preempted by parents during pre-sequences), they orient to its dispreferred status, for example by highlighting benefactive details of vaccination. We discuss the possible existence of asymmetrical (initiator-sided) pre-sequences, why soliciting parents’ vaccination intent might be dispreferred, and implications for the design of communication interventions. [ABSTRACT FROM AUTHOR]

This study uses data from a shoe-repair shop, supplemented by data from medical and mundane contexts, to analyze three progressively minimal grammatical formats used to implement offers and requests in interaction (i.e. do you want...?, you want...?, and want...?). We argue that this cline of minimality reflects a cline of the action-initiator's stance, from relatively weak to strong (respectively), regarding their expectation that the action will be accepted or complied with. In doing so, we illustrate that, as part of the design of requests and offers, participants rely on more granular distinctions than a simple binary between interrogative and declarative morphosyntax. We conclude with a discussion of the interactional logic that undergirds the normative use of these grammatical formats, and of our findings' implications for action formation and preference organization. (Conversation analysis, interactional linguistics, offer, request, stance, grammar, morphosyntax) [ABSTRACT FROM AUTHOR]

There is little doubt that Sacks's notion of the "preference for agreement" is generally valid. However, that it is valid does not tell us how it is valid. This article further unpacks the preference for agreement by conversation-analytically grounding one of its many underlying mechanisms. Specifically, this article examines the practice of formatting an action—in this case, a type of information seeking—as a positively formatted polar interrogative without polarity items (e.g., Did you go fishing?). This article demonstrates that doing so enacts a speaker stance that the question's proposed state of affairs (e.g., that the recipient went fishing) is probable and thus that a response is more likely to constitute affirmation than disaffirmation. Additionally, this article describes the preference-organizational effects of such formatting on some aspects of response construction. Data are gathered from videotapes of unstructured, face-to-face conversations, included 289 interrogatives, and are in American English. [ABSTRACT FROM AUTHOR]

Purpose: Occasionally, a patient requiring computed tomography (CT) with poor venous access or in an unstable condition may have a sheath as their only form of IV access. Many institutions prohibit contrast power injection through the side ports, for concern for rupture. We hypothesize that under conditions encountered in CT scanning, the side arm of the sheath introducer is safe for power injection of contrast material.Methods: In this in vitro study, we injected contrast at different flow rates varying from 2 to 8 ml/s, through the side port of the sheath. Time-pressure graphs were obtained for each injection from the injector display. The assembly was observed for any signs of leakage or material failure.Results: There was not a single event of leak, rupture, or displacement. Maximum pressures were within the range of conventional contrast administrations.Conclusion: This study suggests that iodinated contrast can safely be injected through the side port of a venous sheath. [ABSTRACT FROM AUTHOR]

Quantitative studies applying conversation analysis to the study of the timing of answers to sequence-initiating actions expose anomalies in terms of what is known about preference organization. After briefly describing preference organization, anomalies in answer-timing research, and one explanation for such anomalies, this article presents one qualitative and one quantitative study of responses to one thickly contextualized action: positively formatted polar interrogatives implementing information seeking with a relatively 'unknowing' stance. Data include 249 questions gathered from videotapes of unstructured conversations. Qualitative results suggest that, rather than two basic answer types (i.e., affirmation/disaffirmation), there may be three: unconditional affirmation, unconditional disaffirmation, and conditional. Quantitative analyses of time to answer, eyeball shifting, and pre-beginning behavior suggest that unconditional disaffirmation may not be dispreferred relative to unconditional affirmation. Instead, conditional answers may be dispreferred. Results begin to reconcile anomalies and expand our current understanding of preference organization. Data are in American English. [ABSTRACT FROM AUTHOR]

In the context of the 2016 U.S. Republican primary election debates, the qualitative method of Conversation Analysis is used to describe a discourse/rhetorical strategy candidates use to control the agenda when answering questions. By prefacing answers with First of all, First, or First off, candidates claim that the immediately next talk will constitute something other than a relevant response to the question, but that one will be forthcoming after first matters are resolved. Findings contribute to agenda setting generally, and specifically to candidates' strategies for controlling the agenda by variously evading questions' agendas in order to make space for other political actions (e.g., policy support, acclaim, attack, rebuttal), and doing so in a way that manages public accountability associated with evasion. [ABSTRACT FROM AUTHOR]

Purpose: Growing numbers of patient with advanced imaging being transferred to trauma centers has resulted in increased numbers of outside CT scans received at trauma centers. This study examines the degree of agreement between community radiologists' interpretations of the CT scans of transferred patients and trauma center radiologists' reinterpretation.Methods: All CT scans of emergency transfer patients received over a 1 month period were reviewed by an emergency radiologist. Patients were classified as trauma or non-trauma and exams as neuro or non-neuro. Interpretive discrepancies between the emergency radiologist and community radiologist were classified as minor, moderate, or major. Major discrepancies were confirmed by review of a second emergency radiologist. Discrepancy rates were calculated on a per-patient and per exam basis.Results: Six hundred twenty-seven CT scans of 326 patients were reviewed. Major discrepancies were encountered in 52 (16.0%, 95% CI 12.2-20.5) patients and 53 exams (8.5%, 95% CI 6.5-10.5). These were discovered in 46 trauma patients (21.6%, 95% CI 16.4-27.9) compared to six non-trauma patients (5.3%, 95% CI 2.2-11.7) (P < 0.001). A significant difference in the major discrepancy rate was also found between non-neuro and neuro exams (12.4 vs 3.3%, respectively, P < 0.001), primarily due to discrepancies in trauma patients, rather than non-trauma patients.Conclusions: Potentially management-changing interpretive changes affected 16% of transferred patients and 8.5% of CT exams over a 1 month period. Trauma center reinterpretations of community hospital CT scans of transferred patients provide valuable additional information to the clinical services caring for critically ill patients. [ABSTRACT FROM AUTHOR]

Objective To examine how clinicians communicate with parents about influenza vaccination and the effect of these communication behaviors on parental vaccine decision-making. Study design We performed a secondary analysis of data obtained from a cross-sectional observational study in which health supervision visits between pediatric clinicians and English-speaking parents of young children were videotaped. Eligible visits occurred during the 2011–2012 and 2013–2014 influenza seasons, included children ≥6 months, and contained an influenza vaccine discussion. A coding scheme of 10 communication behaviors was developed and applied to each visit. Associations between clinician communication behaviors and parental verbal vaccine acceptance and parental visit experience were examined using bivariate analysis and generalized linear mixed models. Results Fifty visits involving 17 clinicians from 8 practices were included in analysis. The proportion of parents who accepted influenza vaccine was higher when clinicians initiated influenza vaccine recommendations using presumptive rather than participatory formats (94% vs. 28%, p < 0.001; adjusted odds ratio 48.2, 95% CI 3.5–670.5). Parental acceptance was also higher if clinicians pursued ( vs . did not pursue) original recommendations when parents voiced initial resistance (80% vs. 13%, p < 0.05) or made recommendations for influenza vaccine concurrent with ( vs . separate from) recommendations for other vaccines due at the visit (83% vs. 33%, p < 0.01). Parental visit experience did not differ significantly by clinician communication behaviors. Conclusion Presumptive initiation of influenza vaccine recommendations, pursuit in the face of resistance, and concurrent vaccine recommendations appear to increase parental acceptance of influenza vaccine without negatively affecting visit experience. [ABSTRACT FROM AUTHOR]

More research is needed on the organization of mid-telling sequential environments wherein the normal turn-taking rules for speaker transition are typically suspended. While there is research on the type, function, and consequences of recipients' vocalized responses, we know less about bodily responsive behavior (e.g., nodding) and even less about how responses (or lack thereof) are organized around turn constructional unit boundaries. Using conversation analysis of face-to-face data captured by multiple, participant perspective camera angles, this article addresses these issues by documenting a relevance rule that organizes responsive behavior during international students' problem presentations to university advisors. Data are in American English. [ABSTRACT FROM AUTHOR]

Objective: Soliciting patients' complete agendas of concerns (aka. 'agenda setting') can improve patients' health outcomes and satisfaction, and physicians' time management. We assess the distribution, content, and effectiveness of physicians' 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 physicians' questions, their linguistic format, position within visits, likelihood of being responded to, and the nature of such responses.Results: Physicians' questions designed to solicit concerns additional to chief concerns occurred in only 32% of visits (p<.001). Compared to questions whose communication format explicitly solicited 'questions' (e.g., "Do you have any questions?"), those that were formatted so as to allow for 'concerns' (e.g., "Any other concerns?") were significantly more likely to generate some type of agenda item (Chi(2) (1, N=131)=11.96, p=.001), and to do so more frequently when positioned 'early' vs. 'late' during visits (Chi(2) (1, N=73)=4.99, p=.025).Conclusions: Agenda setting is comparatively infrequent. The communication format and position of physicians' questions affects patients' provision of additional concerns/questions.Practice Implications: Physicians should increase use of optimized forms of agenda setting. [ABSTRACT FROM AUTHOR]

In the more than 1 billion primary-care visits each year in the United States, the majority of patients bring more than one distinct concern, yet many leave with “unmet” concerns (i.e., ones not addressed during visits). Unmet concerns have potentially negative consequences for patients’ health, and may pose utilization-based financial burdens to health care systems if patients return to deal with such concerns. One solution to the problem of unmet concerns is the communication skill known asup-front agenda setting, where physicians (after soliciting patients’ chief concerns) continue to solicit patients’ concerns to “exhaustion” with questions such as “Are there some other issues you’d like to address?” Although this skill is trainable and efficacious, it is not yet a panacea. This article uses conversation analysis to demonstrate that patients understand up-front agenda-setting questions in ways that hamper their effectiveness. Specifically, we demonstrate that up-front agenda-setting questions are understood as making relevant “new problems” (i.e., concerns that are either totally new or “new since last visit,” and in need of diagnosis), and consequently bias answers away from “non-new problems” (i.e., issues related to previously diagnosed concerns, including much of chronic care). Suggestions are made for why this might be so, and for improving up-front agenda setting. Data are 144 videotapes of community-based, acute, primary-care, outpatient visits collected in the United States between adult patients and 20 family-practice physicians. [ABSTRACT FROM PUBLISHER]

This is the 30th installment of a series that will highlight one case per publication issue from the bank of cases available online as part of the American Society of Emergency Radiology (ASER) educational resources. Our goal is to generate more interest in and use of our online materials. To view more cases online please visit the ASER Core Curriculum and Recommendations for Study online at: http://www.erad.org/page/CCIP_TOC . A Stieda fracture is an avulsion injury from the medial femoral condyle of the origin of the medial collateral ligament. The medial collateral ligament originates superiorly from the medial femoral condyle and has superficial and deep fibers. On radiographs, the avulsion fracture at or near the medial femoral condyle near the attachment site of the medial collateral ligament is usually characteristic. Isolated partial or complete MCL injuries can be treated nonoperatively with good outcomes. Reconstruction of the medial ligamentous structures of the knee is usually performed if there is persistent valgus laxity or anteromedial rotatory instability after nonoperative management. [ABSTRACT FROM AUTHOR]

In the context of breast-cancer care, there is extremely little research on the association between observed (i.e., taped and coded) communication behaviors and patients’ health outcomes, especially those other than satisfaction. In the context of presurgical consultations between female breast cancer patients and a surgeon, the aim of this exploratory study was to test the association between communication-based participation behaviors and pre–post consultation changes in aspects of patients’ mental adjustment to cancer (i.e., coping). Participants included 51 women newly diagnosed with breast cancer and a surgical oncologist from a National Cancer Institute (NCI)-designated cancer center in the northeastern United States. Outcomes were changes in patients’ fighting spirit, helplessness/hopelessness, anxious preoccupation, cognitive avoidance, and fatalism (measured immediately before and after consultations via survey), and the main predictors were three communication-based participation behaviors coded from videotapes of consultations: patient question asking, patient assertion of treatment preferences, and surgeon solicitation of patient question/concern/opinion. Patients who more frequently asserted their treatment preferences experienced increases in their fighting spirit (p= .01) and decreases in their anxious preoccupation (p= .02). When companions (e.g., sister, spouse) asked more questions, patients experienced decreases in their anxious preoccupation (p= .05). These findings suggest that, in the present context, there may be specific, trainable communication behaviors, such as patients asserting their treatment preferences and companions asking questions, that may improve patients’ psychosocial health outcomes. [ABSTRACT FROM PUBLISHER]

In this article, we discuss the notion of a ‘conversation analytic intervention,’ focusing on the role of conversation analysis in the major stages of intervention research, epitomized by the randomized controlled trial, the gold standard for intervention in the medical sciences. These stages embrace development, feasibility and piloting, evaluation, and implementation. We describe how conversation analytic methods are used as part of the first two stages and how a conversation analytic skill base and sensibility must be deployed in managing the last two stages. Through a review of practical requirements for successful, externally-funded intervention research, we provide suggestions for how to maximize the potential for basic, conversation analytic research to eventuate in intervention. Data are in American English. [ABSTRACT FROM AUTHOR]

When studying how conversationalists assess mutual understanding, research has focused on one type of evidence: next-turn talk. This article identifies another, antecedent type of evidence involving how talk is produced by reference to repair-opportunity spaces that are systematically provided for by conversation’s generic organization of repair. As current speakers talk, recipients claim understandingex silentioon an action-by-action basis as they forgo each next repair-opportunity space—that is, as they ‘withhold’ talk at each next transition-relevance place. This conversation-analytic article supports its argument through an analysis of multi-action/TCU turns generally, and specifically when recipients initiate repair on such turns with: “What?” In these cases, people respond by repairing only the most proximate action in their prior turn, which indexes their understanding that people who initiated repair understood relatively distal actions. Data are drawn from naturally occurring, ordinary, telephone conversations between friends and family members. Data are in American and British English. [ABSTRACT FROM AUTHOR]

This article describes an adjacency-pair organized course of action in the institutional context of customers calling an electronics repair facility to request the status of equipment they have previously sent in for repair. Relative to the majority of adjacency-pair sequences described in previous research, this course of action is rare in that it is essentially (vs contingently) composed of three (vs two) turns, including status solicitation, status response, and acceptance/rejection of status response. After defending this finding, we situate and discuss its significance relative to prior research – in both ordinary and institutional contexts – on adjacency-pair sequence organization, including implications for sequence-based relevance rules, such as preference organization. Finally, we outline a possible general explanation for why some initiating actions set in motion essentially three-turn (vs two-turn) courses of action, and offer a candidate example in ordinary conversation. [ABSTRACT FROM PUBLISHER]

Abstract: Objective: To determine the feasibility of using direct observation of provider–parent immunization discussions and to characterize provider communication practices with vaccine-hesitant parents. Methods: Over a 6 month period in 2010, we videotaped immunization discussions between pediatric providers and vaccine-hesitant parents during health supervision visits involving children 2–15 months old (N =24) in the Seattle area, Washington, USA. Videotapes were analyzed using the qualitative method of conversation analysis. Results: We approached 96 parents seen by 9 different providers. Of those who were eligible (N =56), we enrolled 43% (N =24). Four videotaped visits were excluded from analysis for failure to obtain parental HIPAA authorization. Of the remaining 20 visits, there were ≥2 visits each that involved children aged 2, 4, 6, 9, 12, and 15 months, and all videotaped visits contained at least a brief immunization discussion. We identified 6 communication practices and several behavior types within each practice relevant to immunization: Practice 1, providers’ initiations of the topic of vaccination; Types: participatory or presumptive format; Practice 2, parents’ responses to providers’ topic initiations; Types: strong or weak acceptance or resistance; Practice 3, providers’ follow-ups to parent''s responses; Types: no, immediate, or delayed pursuit; Practice 4, parents’ vaccine-related questions or statements; Types: fact- or concern-based; Practice 5, providers’ explicit solicitations of parent''s questions/concerns; Types: designed to discourage or encourage discussion; and Practice 6, parents’ responses to providers’ solicitations of questions/concerns; Types: no question or fact- or concern-based inquiry. Conclusion: Direct observation of immunization discussions in the primary care pediatric setting is feasible and yields insight into several provider–parent immunization communication practices that are worthy of further study to determine which are effective at improving parental acceptance of immunization. [Copyright &y& Elsevier]

Abstract: An important rule of turn taking is that, once a person gains the right to speak they are normally entitled to produce a single unit of talk, such as a single word, phrase, clause, or sentence. Conversation analysis has long recognized that, and attempted to describe how, this normal entitlement can be modified by pragmatic exigencies. Along these lines, this article demonstrates that a particular type of initiating action (referred to as a status inquiry) makes conditionally relevant a particular type of compound action unit () that minimally contains two ordered pieces of information, each of which occupies at least one sentential unit. Data are audiotapes of 193 calls between one of five customer-service representatives and customers calling an electronics organization to check on the status of equipment that they have previously sent in for repair. This article contributes to our understanding of how pragmatic concerns can uniquely structure participants’ understandings of what constitutes a possibly complete ‘unit’ of talk, as well as ‘allowable’ places for speakership. [Copyright &y& Elsevier]

This article investigates the action of directly soliciting accounts with why- interrogatives (e.g., Why did you do that?). Using conversation analysis, this article argues that why- interrogatives are Janus-faced. On one hand, as types of questions, they index an epistemic gap between questioners and answerers and thus the possibility that answerers are able to provide accounts that questioners did not previously know about. On the other hand, why- interrogatives claim some epistemic access to the accountable event and communicate a stance that it does not accord with common sense and thus is inappropriate or unwarranted. Why- formatted interrogatives display a challenging stance toward the accountable event and responsible agent(s) and are, thus, frequently coimplicated in complaining, criticizing, and blaming. [ABSTRACT FROM AUTHOR]

This article extends prior conversation analytic research on the preference organization of sequence-initiating actions. Across two languages (English and Russian), this article examines one such action: explicitly soliciting an account for human conduct (predominantly with why-type interrogatives). Prior work demonstrates that this action conveys a challenging stance towards the warrantability of the accountable event/conduct (Bolden and Robinson, forthcoming). When addressees are somehow responsible for the accountable event/conduct, explicit solicitations of accounts are frequently critical of, and thus embody disaffiliation with, addressees. This article demonstrates that, when explicit solicitations of accounts embody disaffiliation, they are systematically 'withheld' and, thus, can be characterized as 'dispreferred' actions. This article also examines: a) deviant cases, where account solicitations are not withheld, which is a practice for embodying aggravated disaffiliation; and b) negative cases, where account solicitations actually embody affiliation, and as such are typically treated as preferred actions and not withheld. [ABSTRACT FROM AUTHOR]

Objective: In the context of patients visiting cancer specialists, the objective is to test the association between both patient-centered communication (including Affective Behavior and Participation Behavior) and Instrumental Behavior and patients’ post-visit satisfaction with a variety of visit phenomena. Methods: Meta-analysis of 25 articles representing 10 distinct data sets. Results: Both patient-centered- and instrumental behavior are significantly, positively associated with satisfaction, with patient-centered communication having a relatively stronger association. Conclusion: There is an evidence base for the efficacy of patient-centered care. Practice implications: Cancer specialists need to train to improve their patient-centered communication. [Copyright &y& Elsevier]

This article is a conversation-analytic examination of situations where one speaker responds to another in a way that publicly exposes that the two speakers hold an incompatible position on a same matter, and in a way that claims that the respondent holds epistemic authority over the matter. These types of responsive actions (i.e., counterinformings) solicit accepting or rejecting responses, and normally include information (e.g., an explanation) that facilitates the other speaker's ability to reconcile the speakers' positional incompatibility. Withholding such information from a counterinforming can be an interactional control tactic. This article focuses on these types of withholding counterinformings and their management by the other speaker. Specifically, this article describes an interactional practice used to solicit reconciliatory information. Zhaiyao Résumé La gestion des contre-informations : une pratique interactionnelle de sollicitation d'information facilitant la conciliation des positions incompatibles des interlocuteurs Acknowledgements: The author thanks Galina Bolden, John Heritage, Jake Harwood (Editor), and three anonymous reviewers for comments on previous drafts. [ABSTRACT FROM AUTHOR]

Context: In primary, acute-care visits, patients frequently present with more than 1 concern. Various visit factors prevent additional concerns from being articulated and addressed.Objective: To test an intervention to reduce patients' unmet concerns.Design: Cross-sectional comparison of 2 experimental questions, with videotaping of office visits and pre and postvisit surveys.Setting: Twenty outpatient offices of community-based physicians equally divided between Los Angeles County and a midsized town in Pennsylvania.Participants: A volunteer sample of 20 family physicians (participation rate = 80%) and 224 patients approached consecutively within physicians (participation rate = 73%; approximately 11 participating for each enrolled physician) seeking care for an acute condition.Intervention: After seeing 4 nonintervention patients, physicians were randomly assigned to solicit additional concerns by asking 1 of the following 2 questions after patients presented their chief concern: "Is there anything else you want to address in the visit today?" (ANY condition) and "Is there something else you want to address in the visit today?" (SOME condition).Main Outcome Measures: Patients' unmet concerns: concerns listed on previsit surveys but not addressed during visits, visit time, unanticipated concerns: concerns that were addressed during the visit but not listed on previsit surveys.Results: Relative to nonintervention cases, the implemented SOME intervention eliminated 78% of unmet concerns (odds ratio (OR) = .154, p = .001). The ANY intervention could not be significantly distinguished from the control condition (p = .122). Neither intervention affected visit length, or patients'; expression of unanticipated concerns not listed in previsit surveys.Conclusions: Patients' unmet concerns can be dramatically reduced by a simple inquiry framed in the SOME form. Both the learning and implementation of the intervention require very little time. [ABSTRACT FROM AUTHOR]

This article investigates two types of preference organization in interaction: in response to a question that selects a next speaker in multi-party interaction, the preference for answers over non-answer responses as a category of a response; and the preference for selected next speakers to respond. It is asserted that the turn allocation rule specified by Sacks, Schegloff & Jefferson (1974) which states that a response is relevant by the selected next speaker at the transition relevance place is affected by these two preferences once beyond a normal transition space. It is argued that a ‘second-order’ organization is present such that interactants prioritize a preference for answers over a preference for a response by the selected next speaker. This analysis reveals an observable preference for progressivity in interaction. [ABSTRACT FROM AUTHOR]

This article uses conversation analysis to develop a typology of questions that physicians use to solicit patients' problems and then tests question–format effects on patients' subsequent problem presentations. Data are videotapes of 302 primary-, acute-, and outpatient-care visits involving 77 physicians in 41 urban and rural clinics, as well as pre- and postvisit questionnaires. The most frequent question formats were general inquiries (62%; e.g., "What can I do for you today?") and requests for confirmation (27%; e.g., "I understand you're having some sinus problems today?"). Compared to confirmatory questions, general inquiries were associated with significantly longer problem presentations ( < .0001) that included more discrete symptoms ( < .0001). Physicians were more likely to use confirmatory questions in the urban setting ( = .003). [ABSTRACT FROM AUTHOR]

Abstract: Objective: To determine the association between the format of physicians’ opening questions that solicit patients’ presenting concerns and patients’ post-visit evaluations of (i.e., satisfaction with) the affective-relational dimension of physicians’ communication. Methods: Videotape and questionnaire data were collected from visits between 28 primary-care physicians and 142 adult patients with acute problems. Factor analysis resulted in three dependent variables derived from the 9-item Socioemotional Behavior subscale of the Medical Interview Satisfaction Scale. Results: Question format was significantly, positively associated with patients’ evaluations of physicians’ listening (p =.028) and positive affective-relational communication (p =.046). Conclusion: Patients desire opportunities to present concerns in their own time and terms regardless of how extensively they act on this opportunity. Practice implications: Visits should be opened with general inquiries (e.g., What can I do for you today?) versus closed-ended requests for confirmation (e.g., Sore throat, huh?). [Copyright &y& Elsevier]

This article uses conversation analysis to investigate the problem-presentation phase of 302 visits between primary-care physicians and patients with acute problems. It analyzes the social-interactional organization of problem presentation, focusing on how participants recognize and negotiate its completion. It argues that physicians and patients mutually orient to the presentation of current symptoms-that is, concrete symptoms presented as somehow being experienced in the here-and-now-as a locus of transition between the patient-controlled problem-presentation phase of the visit and the physician-controlled information-gathering phase. This is a resource for physicians to distinguish between complete and incomplete presentations, and for patients to manipulate this distinction. [ABSTRACT FROM AUTHOR]

In this article, I use the method of conversation analysis and data from American- and British-English conversation to analyze the sequential organization of &lddquo;explicit” apologies (e.g., I'm sorry, and I must apologize). I demonstrate that (a) apologies can occupy a number of different sequential positions, with different ramifications for the organization of apologizing as an action; (b) apologies can be first parts of adjacency-pair sequences; (c) apologies index particular offenses and embody a claim to have offended someone; (d) As first-pair parts, apologies have a preference organization such that preferred responses mitigate or undermine, and dispreferred responses endorse, apologies' claims to have caused offense; and (e) apology terms can be used to accomplish nonapology actions. In this article, I contribute to our understanding of the social and sequential organization of talk in interaction as well as communication practices dealing with the maintenance of social/relational harmony. [ABSTRACT FROM AUTHOR]

This investigation assesses interobserver agreement on conversation analytic (CA) transcription. Four professional CA transcribers spent a maximum of 3 hours transcribing 2.5 min- utes of a previously unknown, naturally occurring, mundane telephone call. Researchers unitized transcripts into words, sounds, silences, inbreaths, out breaths, and laugh tokens, and then coded each of 1,827 units on as many as 15 transcription dimensions. Agreement was assessed using Cohen's kappa for nominal level data: Speaker designation, unit sequencing, semantics, orthography, cutoff, and plosiveness reached the level of "substantial" agreement (90% or greater accuracy). Pitch, overlap, doubt, and smile voice reached the level of "moderate" agreement (80-89% accuracy), while pace, sound stretch, underline/amplitude, and intonation fell below acceptability except when examined post hoc as presence versus absence of the feature. Silence lengths, examined as ratio-level data, were reliable at the "acceptable" level (alpha ≥ .70) among those using a counting method (as opposed to stopwatch or other mechanical means). We make recommendations for transcription training. [ABSTRACT FROM AUTHOR]

This article reviews the relation between social support and elder health, the social-support dimensions of religion, the relation between church attendance and elder health, the place of religion in the biopsychosocial model of medicine,and medical education's position on physician-patient communication about religion, It then examines the emergence of the topic of religion in actual visits. Data are 71 videotaped and transcribed, chronic-routine visits between 12 internal medicine physicians and their older patients. Religion was raised as a topic in 9 visits (13%). In every case, the topic was initiated by patients. The most frequent topic was church attendance (7 of 9 topics). Which patients typically used as a contextualizing framework to relate and describe somatic problems. In no cases did physicians make efforts to support or facilitate patients' church attendance, as is advocated by medical education. Implications for medical education and the biopsychosocial model are discussed. [ABSTRACT FROM AUTHOR]

This pilot study examined the covariation of patients' self-reports of instrumental and affective aspects of communication during physician-patient visits with 2 other sources of data: medical chart records and audio/videotapes. Participants were 17 community-based (nonuniversity) primary-care physicians and 77 of their patients, ages 50 to 80. Patients were interviewed by telephone within 1 week after their medical visits. Thirty-five of these visits were audio- and videotaped. Patients were asked to report on their receipt of specific cancer screening in the previous 2 years, the occurrence of instrumental communication events during the visit (e.g., recommendations), their affect, and their visit experiences and communication with their physicians. Results showed (a) noteworthy disagreements between patients' self-reports and medical charts regarding cancer screening; (b) better agreement of patients' self-reports with videotape records than with chart records regarding physicians' recommendations; (c) accurate recognition of patients' self-reported affect, communication, and visit experiences by third-party raters of both audiotapes and videotapes; and (d) similar correlations of audio- and videotape ratings with patients' self-reports as well as substantial correlations between audio and video ratings. The implications of these findings are discussed, and recommendations are made for future research. [ABSTRACT FROM AUTHOR]

Within the context of primary-care, physician-patient visits, researchers have documented both patients' low levels of communicative participation (e.g., question asking) and the advantages of such participation to healthcare (e.g., improved physical health and satisfaction). Prior research has offered a variety of partial, non-exclusive explanations for patients' low levels of participation. This article investigates one underdeveloped source of explanation: the organization of interaction itself. This article argues that the establishment of new medical problems in acute visits makes relevant an organized structure of social action that is composed of an ordered series of medical activities: establishing the reason for the visit, physicians gathering additional information (i.e., history taking and physical examination), physicians delivering diagnoses, and physicians providing treatment recommendations. This "project" of medical activity shapes physicians' and patients' understanding and production of communicative behavior. Using the method of conversation analysis, and analyzing transcribed audio- and videotape data of actual acute visits, this article describes and grounds this project and discusses its implications for research, theory, and improvement on patient participation. [ABSTRACT FROM AUTHOR]

Examines the implication of physician-patient encounters for the expression of unstated concerns of the patients. Use of the conversation analysis; Description of the interactional organization of the physician-initiated communication practices; Topicalization of concerns.

Purpose: To determine the rate and nature of significant discordances between community and subspecialist emergency radiologists' interpretations of cross-sectional exams performed on patients transferred to our trauma center. Methods: Outside hospital CT and MRI exams performed on transfer trauma patients are routinely overread by subspecialist emergency radiologists, specifying either concordance or discordance with the interpretation by the community radiologist. We evaluated the discordant reports for clinical significance, defined as an additional finding or difference in interpretation which was likely to affect patient management. The total rate of significant discordances, rate by modality, rate by body region, and rate per patient transferred were calculated. The most common errors were identified, and the distribution of errors among individual community radiologists was examined. Results: 9175 exams were reviewed. Significant discordances were encountered in 4.1% of exams: 3.9% for CT and 6.7% for MRI; 5.1% for head and neck exams, 3.3% for spine, 3.8% for torso, and 2.9% for extremities. The discordance rate per patient transferred was 7.7%. The most common discordances involved missing injuries to the cranio-cervical junction, missing or misinterpreting vascular injuries in the neck, and incompletely characterizing facial fractures. Discordances were evenly spread among 220 community radiologists. Conclusion: There is frequent discordance between community and emergency radiologists' interpretations of CT and MRI exams, leading to a change in transferred patient management. Thus, trauma center radiologists provide added value overreading these patients' exams. It is difficult to predict which patients or exams will contain discordances, justifying routine overreading of all such exams. [ABSTRACT FROM AUTHOR]

Research continues to delineate and clarify specific communication behaviors associated with improved patient outcomes. In the context of breast cancer surgery, this exploratory study examined the effect of breast surgeon information provision on the immediate post-visit outcomes of patients' anxious preoccupation, intention to adhere to treatment recommendations, and treatment plan satisfaction. Participants included 51 newly diagnosed breast cancer patients receiving care from one breast surgeon at a National Cancer Institute-designated cancer center in the northeastern United States. Participants completed pre- and post-visit questionnaires. Medical interactions were recorded, transcribed, and analyzed via multidimensional analysis, a method of linguistic analysis that uses exploratory factor analysis to identify how specific types of words are patterned and work to accomplish communicative goals (Biber, 1988). The multidimensional analysis identified constellations of language used by providers and patients. Although five linguistic dimensions emerged, one dimension, impersonal information provision, is of unique interest in understanding how providers communicate with patients. Impersonal information provision encompasses the ways in which the provider, using an impersonal tone, discussed the logistics, details, and implications of treatment options. Increased impersonal information provision was associated with patients' decreased anxious preoccupation (β = –.22, t = −2.82, p =.007), increased treatment plan satisfaction (β =.36, t = 2.54, p =.012), and increased intention to adhere to treatment recommendations (β =.34, t = 2.45, p =.018). Findings suggest that specific provider behavior and types of information provided have unique and important effects on patients' health outcomes. [ABSTRACT FROM AUTHOR]

Core Curriculum Illustration: [blunt thoracic aortic pseudo aneurysm]. This is the [40th] installment of a series that will highlight one case per publication issue from the bank of cases available online as part of the American Society of Emergency Radiology (ASER) educational resources. Our goal is to generate more interest in and use of our online materials. To view more cases online, please visit the ASER Core Curriculum and Recommendations for Study online at: http://www.aseronline.org/curriculum/toc.html. [ABSTRACT FROM AUTHOR]

Delay or refusal of childhood vaccines is common and may be increasing. Pediatricians are parents' most trusted source for vaccine information, yet many struggle with how to communicate with parents who resist recommended vaccines. Evidence-based communication strategies for vaccine conversations are lacking. In this manuscript, we describe the development and perceived usefulness of a curriculum to train clinicians on a specific vaccine communication strategy as part of the PIVOT with MI study, a cluster randomized trial testing the effectiveness of this communication strategy on increasing childhood vaccination uptake among 24 pediatric practices in Colorado and Washington. The communication strategy is based on the existing evidence-based communication strategies of a presumptive format for initiating vaccine conversations and use of motivational interviewing if hesitancy persists. Focus groups and semi-structured interviews with pediatric clinicians helped inform the development of the training curriculum, which consisted of an introductory video module followed by 3 training sessions. Between September 2019 and January 2021, 134 pediatric clinicians (92 pediatricians, 42 advanced practice providers) participated in the training as part of the PIVOT with MI study. Of these, 92 % viewed an introductory video module, 93 % attended or viewed a baseline synchronous training, 82 % attended or viewed a 1st refresher training, and 77 % attended or viewed a 2nd refresher training. A follow-up survey was administered August 2020 through March 2021; among respondents (n = 100), >95 % of participants reported that each component of the training program was very or somewhat useful. These data suggest that the PIVOT with MI training intervention is a useful vaccine communication resource with the potential for high engagement among pediatric clinicians. [ABSTRACT FROM AUTHOR]

Examines how physicians and patients interactionally accomplish the transition from the activity of history taking to that of physical examination. Relationship between verbal and nonverbal communication and social meaning; Activity transitions in physician-patient interaction; Utilization of methodology of conversation analysis.

Objectives. We investigated how provider vaccine communication behaviors influence parental vaccination acceptance and visit experience. Methods. In a cross-sectional observational study, we videotaped provider-parent vaccine discussions (n = 111). We coded visits for the format providers used for initiating the vaccine discussion (participatory vs presumptive), parental verbal resistance to vaccines after provider initiation (yes vs no), and provider pursuit of recommendations in the face of parental resistance (pursuit vs mitigated or no pursuit). Main outcomes were parental verbal acceptance of recommended vaccines at visit's end (all vs ≥ 1 refusal) and parental visit experience (highly vs lower rated). Results. In multivariable models, participatory (vs presumptive) initiation formats were associated with decreased odds of accepting all vaccines at visit's end (adjusted odds ratio [AOR] = 0.04; 95% confidence interval [CI] = 0.01, 0.15) and increased odds of a highly rated visit experience (AOR = 17.3; 95% CI = 1.5, 200.3). Conclusions. In the context of 2 general communication formats used by providers to initiate vaccine discussions, there appears to be an inverse relationship between parental acceptance of vaccines and visit experience. Further exploration of this inverse relationship in longitudinal studies is needed. [ABSTRACT FROM AUTHOR]

PURPOSE This study examined relationships between provider communication practices, antibiotic prescribing, and parent care ratings during pediatric visits for acute respiratory tract infection (ARTI). METHODS A cross-sectional study was conducted of 1,285 pediatric visits motivated by ARTI symptoms. Children were seen by 1 of 28 pediatric providers representing 10 practices in Seattle, Washington, between December 2007 and April 2009. Providers completed post-visit surveys reporting on children's presenting symptoms, physical examination findings, assigned diagnoses, and treatments prescribed. Parents completed post-visit surveys reporting on provider communication practices and care ratings for the visit. Multivariate analyses identified key predictors of prescribing antibiotics for ARTI and of parent visit ratings. RESULTS Suggesting actions parents could take to reduce their child's symptoms (providing positive treatment recommendations) was associated with decreased risk of antibiotic prescribing whether done alone or in combination with negative treatment recommendations (ruling out the need for antibiotics) [adjusted risk ratio (aRR) 0.48; 95% CI, 0.24-0.95; and aRR 0.15; 95% CI, 0.06-0.40, respectively]. Parents receiving combined positive and negative treatment recommendations were more likely to give the highest possible visit rating (aRR 1.16; 95% CI, 1.01-1.34). CONCLUSION Combined use of positive and negative treatment recommendations may reduce the risk of antibiotic prescribing for children with viral ARTIs and at the same time improve visit ratings. With the growing threat of antibiotic resistance at the community and individual level, these communication techniques may assist frontline providers in helping to address this pervasive public health problem. [ABSTRACT FROM AUTHOR]

BACKGROUND: One-third of outpatient antibiotic prescriptions for pediatric acute respiratory tract infections (ARTIs) are inappropriate. We evaluated a distance learning program's effectiveness for reducing outpatient antibiotic prescribing for ARTI visits. METHODS: In this stepped-wedge clinical trial run from November 2015 to June 2018, we randomly assigned 19 pediatric practices belonging to the Pediatric Research in Office Settings Network or the NorthShore University HealthSystem to 4 wedges. Visits for acute otitis media, bronchitis, pharyngitis, sinusitis, and upper respiratory infection for children 6 months to <11 years old without recent antibiotic use were included. Clinicians received the intervention as 3 program modules containing online tutorials and webinars on evidence-based communication strategies and antibioti c prescribing, booster video vignettes, and individualized antibiotic prescribing feedback reports over 11 months. The primary outcome was overall antibiotic prescribing rates for all ARTI visits. Mixed-effects logistic regression compared prescribing rates during each program module and a postintervention period to a baseline control period. Odds ratios were converted to adjusted rate ratios (aRRs) for interpretability. RESULTS: Among 72 723 ARTI visits by 29 762 patients, intention-to-treat analyses revealed a 7% decrease in the probability of antibiotic prescribing for ARTI overall between the baseline and postintervention periods (aRR 0.93; 95% confidence interval [CI], 0.90-0.96). Second-line antibiotic prescribing decreased for streptococcal pharyngitis (aRR 0.66; 95% CI, 0.50-0.87) and sinusitis (aRR 0.59; 95% CI, 0.44-0.77) but not for acute otitis media (aRR 0.93; 95% CI, 0.83-1.03). Any antibiotic prescribing decreased for viral ARTIs (aRR 0.60; 95% CI, 0.51-0.70). CONCLUSIONS: This program reduced antibiotic prescribing during outpatient ARTI visits; broader dissemination may be beneficial. [ABSTRACT FROM AUTHOR]

We examineI knowas a responding action, showing that it claims to accept the grounds of the initiating action but either resists that action as unnecessary or endorses it, depending on the epistemic environment created by the initiating action. First, in responding to actions that presume an unknowing addressee (e.g., correcting, advising), speakers deployI knowto resist the action as unnecessary while accepting its grounds. Second, in responding to actions that presume a knowing addressee (e.g., some assessments), speakers useI knowto endorse the action, claiming an independently reached agreement (in this way, doing “being on the same page”). Data are in American and British English. [ABSTRACT FROM AUTHOR]