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This article explores how partners keep the conversation going with people living with dementia (PLWD) when speaking about shared memories. Remembering is important for PLWD and their families. Indeed, memory loss is often equated with identity loss. In conversation, references to shared past events (co-rememberings) can occasion interactional trouble if memories cannot be mutually recalled. This article analyses partners' interactional practices that enable progressivity in conversations about shared memories with a PLWD. In previous research, both informal and formal carers have reported that they can find interacting with PLWD difficult. Identifying practices used by partners is one way to begin addressing those difficulties. Analytical findings are based on over 26 hours of video data from domestic settings where partners have recorded their interactions with their spouse/close friend who is living with dementia. The focus is on 14 sequences of conversation about shared memories. We show how particular practices (candidate answers, tag questions and single-party memory of a shared event) structure the interaction to facilitate conversational progression. When partners facilitate conversational progressivity, PLWD are less likely to experience stalls in conversation. Our findings suggest the actual recall of memory is less relevant than the sense of shared connection resulting from the conversational activity of co-remembering, aiding maintenance of individual and shared identities. These findings have relevance for wider care settings. [ABSTRACT FROM AUTHOR]

Background: Actors portraying simulated patients are widely used in communication skills training in healthcare, but debates persist over the authenticity of these interactions. However, healthcare professionals value simulation‐based training because of the opportunity to think and react in real time, which alternatives cannot provide. Objective: To describe a method for the use of simulation which maximises authenticity by grounding training in real, observed, patterns of patient communication. Design: Naturally occurring care interactions were video recorded and analysed using conversation analysis (CA) to identify communication patterns. We focused on sites of recurring interactional trouble as areas for training, and identified more and less effective ways of dealing with these. We used the CA findings to train actors portraying simulated patients, based on the observed interactional patterns. Settings and Participants: Patients living with dementia and healthcare practitioners (HCPs) on two acute healthcare of the elderly wards in the English East Midlands. Outcome Measures: One month later HCPs reported using the skills learned in clinical practice. Masked‐ratings of before and after simulated patient encounters confirmed these self‐reports in relation to one key area of training. Results: The Conversation Analysis Based Simulation (CABS) method used in this setting showed positive results across a range of quantitative and qualitative outcome measures. What is significant for the transferability of the method is that qualitative feedback from trainees highlighted the ability of the method to not only illuminate their existing effective practices, but to understand why these were effective and be able to articulate them to others. Discussion/Conclusion: While the CABS method was piloted in the dementia care setting described here, it has potential applicability across healthcare settings where simulated consultations are used in communication skills training. Grounding simulated interaction in the observed communication patterns of real patients is an important means of maximising authenticity. Patient and Public Contribution: The VideOing to Improve dementia Communication Education (VOICE) intervention which piloted the CABS method was developed by a multidisciplinary team, including three carers of people with dementia. People living with dementia were involved in the rating of the before and after video simulation assessments. [ABSTRACT FROM AUTHOR]

The last decade has seen a wide range of experiments in health care reform intended to contain costs and promote effectiveness. In the USA, managed care and disease management have been major strategies in this endeavour. It has been argued that their apparent success has strong implications for reform in other countries. However, in this paper we ask whether they are so easily exportable. We explain the concepts involved and set the development of managed care and disease management programmes in the context of the USA. The constituent elements of disease management are identified and discussed. Disease management is considered from the perspectives of the major stakeholders in the United Kingdom, and the differences between the models of health care in the United Kingdom's National Health Service and the USA are noted. A review is presented of evaluations of disease management programmes and of the weaknesses they highlight. The prospects for disease management in Europe are also discussed.

To authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1467-9566.2009.01223.x Byline: Alison Pilnick (1), Jennifer Clegg (2), Elizabeth Murphy (3), Kathryn Almack (4) Keywords: intellectual disability; choice; self-determination; conversation analysis Abstract: Abstract For young people with intellectual disabilities (ID), the transition from children's to adult services has long been recognised as a challenging move. One of the aims of the White Paper Valuing People (2001) was to address some of the problems associated with this transition. This paper reports on data from a project which examines the impact of these service changes, and the ways in which transition is negotiated by carers, professionals and users. It presents a conversation analysis of eight tape-recorded formal review meetings at which transition to adult services is discussed. It takes as its starting point the existing interactional work on ID and the way in which this demonstrates the effects of the local and contextual specifics of particular kinds of interaction on the eventual outcomes (e.g. Rapley 2004, Antaki 2001, Maynard and Marlaire 1992). We show that an attempt to allow self-determination in the context of transitions can paradoxically result in undermining user choice and control. We also argue that, while a rule-based approach to practice may offer moral clarity for professionals, it can result in interactional and practical difficulties which cannot be easily reconciled. Author Affiliation: (1)School of Sociology and Social Policy, University of Nottingham (2)University of Nottingham and Nottinghamshire Healthcare NHS Trust (3)College of Social Science, University of Leicester (4)School of Nursing, University of Nottingham Article note: Address for correspondence: Alison Pilnick, School of Sociology and Social Policy, Nottingham University, University Park, Nottingham NG7 2RD, e-mail: alison.pilnick@nottingham.ac.uk

To authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1467-9566.2009.01194.x Byline: Alison Pilnick (1), Jon Hindmarsh (2), Virginia Teas Gill (3) Keywords: conversation analysis; doctor-patient interaction; healthcare interaction; communication Abstract: Abstract Three decades of conversation analytic investigations of medical interaction have produced a rich collection of findings of sociological interest, from a diverse array of encounters. This paper briefly outlines the development of this field to provide a context for the special issue. The paper discusses how studies of doctor-patient interaction have revealed the ways in which participants organise the medical visit to accomplish tasks such as diagnosing and recommending treatment for illness, and how doctors and patients address various interactional issues and dilemmas that arise as they undertake these tasks. It then highlights a growing number of CA studies that explore medical settings and activities beyond the doctor-patient encounter. In doing so, it charts the distinctive interactional practices that emerge, for example, where participants are engaging in hands-on treatment, medical practitioners are interacting with one another, or various technologies are employed during the encounter. Finally, papers in this special issue are introduced and shown to build upon this latter tradition. The papers address distinctive practical problems and institutional dilemmas that arise in healthcare encounters and medical settings beyond dyadic doctor-patient interaction, with a focus on the participants' orientations to policy, their distinctive modes of participation, and the use of technology. Author Affiliation: (1)School of Sociology and Social Policy, University of Nottingham (2)Department of Management, King's College London (3)Department of Sociology and Anthropology, Illinois State University, USA Article note: Address for correspondence: Alison Pilnick, School of Sociology and Social Policy, University of Nottingham, University Park, Nottingham NG7 2RD, e-mail: alison.pilnick@nottingham.ac.uk

To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1467-9566.2007.01071.x Byline: Alison Pilnick (1) Keywords: antenatal screening; informed choice; conversation analysis Abstract: Abstract Policies and practices around antenatal screening services have long been the subject of debate in a sociological context. However, existing research has largely overlooked the way in which the policies and practices that underpin antenatal screening services are enacted through talk between pregnant women and their health professionals. This paper focuses on one such policy, that of informed choice. It uses data from 14 tape-recorded pre-screening consultations with community midwives, forming part of a newly introduced nuchal translucency screening programme, to examine how the issue of choice is topicalised and discussed. It concludes that, whilst there is clear evidence that midwives are at pains to explicitly invoke the issue of decision making, there are other more subtle factors in the interactional presentation of screening tests that serve to undermine whether and how a recognition of choice is received by pregnant women. Author Affiliation: (1)School of Sociology and Social Policy, Nottingham University Article note: Address for correspondence: Alison Pilnick, School of Sociology and Social Policy, Nottingham University, University Park, Nottingham NG7 2RD, e-mail: alison.pilnick@nottingham.ac.uk

A video-based study of teamwork in preoperative anesthesia is presented. The importance of intercorporeal knowing in the real-time coordination of a team's work is highlighted and the coordination of work among anesthetic teams is considered.