Hedging,knowledge and interaction: Doctors’ and clients’ talk about medical information and client experiences in genetic counseling

Objectives

The article starts from the observation that professionals in genetic counseling deploy the strategy of ‘hedging’. It shows how hedging is used in a particular sequential position: doctors’ responses to clients’ presentations of personal information during information delivery sequences.

Methods

The data consist of video-recorded sessions of genetic counseling. The methodology is based on ethnomethodological conversation analysis. The analysis identifies interactional patterns in the counseling sessions.

Results

In their responses doctors display an orientation to different access to different kinds of knowledge. In particular, the doctors tread carefully when commenting on the situation of a particular client vis-á-vis the symptoms and prognosis of genetic conditions. Furthermore, the article shows that the doctors’ responses and hedging devices in them are fitted to the form and function of the clients’ presentations of personal experience.

Conclusion

While the focus of the article is narrow in that it concentrates on one type of an interactional sequence, its strength is that it shows how the doctor's talk can be intertwined with the client's contributions.

Practice implications

The results make it possible for genetic counselors to identify an interactional task they recurrently face and reflect on alternative ways of responding to it.     

ICU两种血氧饱和度探头脱落率检测的对比观察

目的探讨并观察危重病员使用粘贴式血氧饱和度探头与套入式血氧饱和度探头的脱落率,为临床安全使用血氧饱和度探头提供依据。方法将2012年11月-2013年4月在神经ICU救治的病员进行首次纳入评估,首次基线评估合格的病员纳入研究,根据抛硬币简单随机法将符合研究标准的117例病员随机分为观察组57例与对照组60例,观察组使用粘贴式血氧饱和度探头,接受巡视619例次;对照组使用套入式血氧饱和度探头,接受巡视579例次,两组病员均将血氧饱和度探头置于指端规定位置。对两组病员的临床资料和血氧饱和度探头脱落情况进行对比分析。结果观察组脱落发生率为0.81%,对照组脱落发生率为12.95%,两组脱落发生率差异有统计学意义(P0.05)。结论本研究显示ICU粘贴式血氧饱和度探头与套入式血氧饱和度探头相比可有效降低脱落的发生率,在临床使用中更安全有效,值得推广。     

Influenza B vaccine lineage selection—An optimized trivalent vaccine

Epidemics of seasonal influenza viruses cause considerable morbidity and mortality each year. Various types and subtypes of influenza circulate in humans and evolve continuously such that individuals at risk of serious complications need to be vaccinated annually to keep protection up to date with circulating viruses. The influenza vaccine in most parts of the world is a trivalent vaccine, including an antigenically representative virus of recently circulating influenza A/H3N2, A/H1N1, and influenza B viruses. However, since the 1970s influenza B has split into two antigenically distinct lineages, only one of which is represented in the annual trivalent vaccine at any time. We describe a lineage selection strategy that optimizes protection against influenza B using the standard trivalent vaccine as a potentially cost effective alternative to quadrivalent vaccines.     

通督调神针法结合行为干预治疗不寐的临床疗效观察

目的：观察通督调神针法结合行为干预治疗不寐的临床疗效。方法：将60例不寐患者随机分为通督调神针法结合行为干预治疗组和行为干预疗法对照组。结果：经匹兹堡睡眠质量量表（PSQI）评定,治疗前组间比较,t=0．49,P〉0．05,无统计学意义;治疗4W后组问比较,t=2．91,P〈0．0l,治疗组明显优于对照组;治疗前后组内比较,2组均有t〉4．08,P〈0．01,有非常显著性差异;治疗8W后组间比较,t=2．74,P〈0．01,治疗组明显优于对照组;治疗前后组内比较,2组均有t〉4．20,P〈0．01,有非常显著性差异。经中医症候标准评定,治疗4W后总有效率：治疗组73．3％,对照组56．7％;治疗8W后总有效率：治疗组83．3％,对照组60．O％;治疗组与对照组经Radit检验比较,治疗4W与治疗8W,P〈0．05。结论：通督调神针法结合行为干预治疗不寐效果显著,值得临床推广。