Analyzing medical dialogues: strength and weakness of Roter's interaction analysis system (RIAS)

Roter's interaction analysis system (RIAS) is analyzed in this article. Ground rules of linguistic interaction analysis, emphasizing meaning as a product of interaction and turn taking as a basic principle for the understanding of interaction are briefly introduced. Specific aspects of the application of RIAS are discussed and a number of adjustments and/or specifications suggested: (1) utterances should be defined in terms of content and turn taking criteria; (2) the recording system should allow for registering interruptions; (3) pauses or silences should be scored on the basis of functional criteria and not as demarcation in the communication; (4) clear distinctions should be made between the categories of "backchannel" and "agree"; (5) questions should be coded according to function rather than linguistic form; (6) some of the socioemotional categories may appear too narrow, others too wide; (7) crying should be included in the coding scheme as a separate category.     

Smoking and symbolism: children, communication and cigarettes

Health promotion, with its concern with empowerment and autonomy, must recognize the agency of its target population. Based on 85 in-depth interviews with 10- to 11-year-old children throughout Northern Ireland, this paper argues that it is necessary to focus on the social relations of children if we are to understand and prevent childhood smoking. Addressing the complex issue of childhood agency, it is argued that regardless of various restrictions to their choices, children can act intentionally in constructing their identities. Instead of viewing the smoking children as communicating with the adult world, we focus on smoking as negotiation of status within the children's culture. Such negotiations utilize symbolism derived from and shared with the 'adult world'. It is important that those analyzing children's lives understand children's ideas and behaviour on their own terms. We must make sure that the very concepts in which the children's experiences are put are appropriate ones. It is suggested that the metaphor 'rite of passage' and terminology such as peer 'pressure' versus adult 'influence', commonly used to analyse the children's smoking behaviour, may actually conceal important aspects of childhood agency.     

PD-1 and PD-L1 Protein Expression Predict Survival in Completely Resected Lung Adenocarcinoma

Background

We assessed the prognostic value of programmed cell death 1 (PD-1) and programmed cell death ligand 1 (PD-L1) in patients with completely resected lung adenocarcinoma.

Psychometric validation of a multi-dimensional capability instrument for outcome measurement in mental health research (OxCAP-MH)

Background

Patient reported outcome measures (PROMs) are widely used in mental healthcare research for quality of life assessment but most fail to capture the breadth of health and non-health domains that can be impacted. We report the psychometric validation of a novel, multi-dimensional instrument based on Amartya Sen’s capability approach intended for use as an outcome measure in mental health research.

Methods

The Oxford Capabilities Questionnaire for Mental Health (OxCAP-MH) is a 16-item self-complete capability measure that covers multiple domains of functioning and welfare. Data for validation of the instrument were collected through a national randomised controlled trial of community treatment orders for patients with psychosis. Complete OxCAP-MH data were available for 172 participants. Internal consistency was established with Cronbach’s alpha; an interclass correlation coefficient was used to assess test-retest reliability in a sub-sample (N?=?50) tested one week apart. Construct validity was established by comparing OxCAP-MH total scores with established instruments of illness severity and functioning: EuroQol (EQ-5D), Brief Psychiatric Rating Scale (BPRS), Global Assessment of Functioning (GAF) and Objective Social Outcomes Index (SIX). Sensitivity was established by calculating standard error of measurement using distributional methods.

Results

The OxCAP-MH showed good internal consistency (Cronbach’s alpha 0.79) and test-retest reliability (ICC?=?0.86). Convergent validity was evidenced by strong correlations with the EQ-5D (VAS 0.52, p?<?.001) (Utility 0.45, p?<?.001), and divergent validity through more modest associations with the BPRS (?0.41, p?<?.001), GAF (0.24, p?<?.001) and SIX (0.12, p?=?ns). A change of 9.2 points on a 0–100 scale was found to be meaningful on statistical grounds.

Conclusions

The OxCAP-MH has demonstrable reliability and construct validity and represents a promising multi-dimensional alternative to existing patient-reported outcome measures for quality of life used in mental health research.

     

Threats and offers in community mental healthcare

Making threats and offers to patients is a strategy used in community mental healthcare to increase treatment adherence. In this paper, an ethical analysis of these types of proposal is presented. It is argued (1) that the primary ethical consideration is to identify the professional duties of care held by those working in community mental health because the nature of these duties will enable a threat to be differentiated from an offer, (2) that threatening to act in a way that would equate with a failure to uphold the requirements of these duties is wrong, irrespective of the benefit accrued through treatment adherence and (3) that making offers to patients raises a number of secondary ethical considerations that need to be judged on their own merit in the context of individual patient care. The paper concludes by considering the implications of these arguments, setting out a pathway designed to assist community mental healthcare practitioners to determine whether making a specific proposal to a patient is right or wrong.     

Moving the four habits model into dentistry. Development of a dental consultation model: Do dentists need an additional habit?

A consultation model for dentistry is presented, with communication skills in a didactic and structural format, applicable for most types of visits, patients and problems. A characteristic of the dental visit is its division into dialogue phases and clinical phases, which makes verbal exchange especially challenging. The original Four Habits Model (4H) has been adapted from medicine to the specific structure and content of a dental visit, and a modified model is proposed. The dental model consists of a structural core framework relevant for all dental consultations, and additional extensions applicable to commonly occurring issues. Facilitate Perceived Control has been added to the model, due to its crucial importance in dental visits, and we suggest naming the model “The Four + One Habits Model for Dental Visits (4 + 1HD).” The proposed model should have clinical relevance for improving patient care and patient experience, as well as easing the busy everyday life for dentists in a variety of clinical settings. It is also likely to be a flexible framework for communication skills training at all levels of dental education. More research is needed to validate and test the model in various clinical and educational settings.