PurposeTo evaluate the effects of person-centred support via telephone in two chronically ill patient groups, chronic obstructive pulmonary disease (COPD) and/or chronic heart failure (CHF).Method221 patients ≥ 50 years with COPD and/or CHF were randomized to usual care vs. usual care plus a person-centred telephone-support intervention and followed for six months. Patients in the intervention group were telephoned by a registered nurse initially to co-create a person-centred health plan with the patient and subsequently to discuss and evaluate the plan. The primary outcome measure was a composite score comprising General Self-Efficacy (GSE), re-hospitalization and death. Patients were classified as deteriorated if GSE had decreased by ≥ 5 points, or if they had been re-admitted to hospital for unscheduled reasons related to COPD and/or CHF or if they had died.ResultsAt six-month follow-up no difference in the composite score was found between the two study groups (57.6%, n = 68 vs. 46.6%, n = 48; OR = 1.6, 95% CI: 0.9–2.7; P = 0.102) in the intention-to-treat analysis (n = 221); however, significantly more patients in the control group showed a clinically important decrease in GSE (≥ 5 units) (22.9%, n = 27 vs. 9.7%, n = 10; OR = 2.8, 95% CI: 1.3–6.0; P = 0.011). There were 49 clinical events (14 deaths, 35 re-admissions) in the control group and 41 in the intervention group (9 deaths, 32 re-admissions). Per-protocol analysis (n = 202) of the composite score showed that more patients deteriorated in the control group than in the intervention group (57.6%, n = 68 vs. 42.9%, n = 36; OR = 1.8, 95% CI 1.0–3.2; P = 0.039).ConclusionPerson-centred support via telephone mitigates worsening self-efficacy without increasing the risk of clinical events in chronically ill patients with CHF and/or COPD. This indicates that a patient-healthcare professional partnership may be established without the need for face-to-face consultations, even in vulnerable patient groups.Trial registrationISRCTN.com ISRCTN55562827.

The conception of the relationship between social context and communicative practices is a critical element of social science theorizing. What is at stake is, amongst other things, the balance between accounting for stable institutional practices, on the one hand, and the occasioned nature of interactional accomplishments, on the other. This analytical issue is discussed in the context of talk in a particular institutional setting, an employment office, with particular reference to the use of categories, a rather neglected topic in discourse analysis. In this setting, participants invoke specific traditions of argumentation and ways of reasoning through their use of categories (and categorical knowledge), and such resources are essential for the accomplishment of interaction. This implies, amongst other things, that for the analyst to be able to account for the accomplishment of in situ talk, familiarity with traditions of argumentation and their constituting possibilities within institutional practices is essential.

This article analyses the dynamics of the use of institutional categories in institutional encounters. The focus is on documenting how categories are invoked to index what is relevant to situated knowing in interactional sequences where there is a need to bridge the gap between action and expectation. This general problem has been studied in the context of interactions between job applicants and vocational guidance officers in a public employment agency. Institutional categories are inference-rich, and they work as flexible tools that allow participants to recontextualize and negotiate the issues at stake. In this sense, categories serve as constitutive tools that can be crafted to fit into a broad range of circumstances. However, in order to produce a relevant account, participants’ ways of reasoning need to fit into the institutionally specific traditions of argumentation and the practical outcomes which need to be produced. In this sense, the focus on accounting practices is illuminating when attempting to understand the situated knowing that maintains institutional practices.

Much of the research on students' understanding of the greenhouse effect and global warming reports poor results. Students are claimed to hold misconceptions and naïve beliefs, and the impact of teaching on their conceptions is also low. In the present study, these results are called into question, and it is argued that they may to a large extent be seen as artifacts of the research methods deployed, in particular when written questionnaires are used. When following students' project work in school over a long period, many of the misunderstandings reported in the literature do not appear. It is argued that the appropriation and use of scientific language when discussing complex socioscientific issues is a gradual process. When observing the language and mediational means students use over time, it is obvious that they are able to identify and use central distinctions in their interactions. They are also able to make productive use of texts and other materials that allow them to successively approximate scientific modes of reasoning. Thus, what students know emerges in communicative practices where they interact with others and with cultural tools in a focused activity. It is argued that students' knowledge of complex

ObjectiveThis paper reports on how the clinical consultation in primary care is performed under the new premises of patients’ daily self-reporting and self-generation of data. The aim was to explore and describe the structure, topic initiation and patients’ contributions in follow-up consultations after eight weeks of self-reporting through a mobile phone-based hypertension self-management support system.DesignA qualitative, explorative study design was used, examining 20 audio- (n = 10) and video-recorded (n = 10) follow-up consultations in primary care hypertension management, through interaction analysis. Clinical trials registry: ClinicalTrials.gov NCT01510301.SettingFour primary health care centers in Sweden.SubjectsPatients with hypertension (n = 20) and their health care professional (n = 7).ResultsThe consultations comprised three phases: opening, examination and closing. The most common topic was blood pressure (BP) put in relation to self-reported variables, for example, physical activity and stress. Topic initiation was distributed symmetrically between parties and BP talk was lifestyle-centered. The patients’ contributed to the interpretation of BP values by connecting them to specific occasions, providing insights to the link between BP measurements and everyday life activities.ConclusionPatients’ contribution through interpretations of BP values to specific situations in their own lives brought on consultations where the patient as a person in context became salient. Further, the patients’ and health care professionals’ equal contribution during the consultations showed actively involved patients. The mobile phone-based self-management support system can thus be used to support patient involvement in consultations with a person-centered approach in primary care hypertension managementKey points  The clinical consultation is important to provide opportunities for patients to gain understanding of factors affecting high blood pressure, and for health care professionals to motivate and promote changes in life-style. This study shows that self-reporting as base for follow-up consultations in primary care hypertension management can support patients and professionals to equal participation in clinical consultations.Self-reporting combined with increased patient–health care professional interaction during follow-up consultations can support patients in understanding the blood pressure value in relation to their daily life.These findings implicate that the interactive mobile phone self-management support system has potential to support current transformations of patients as recipients of primary care, to being actively involved in their own health.