20 research outputs found
Impact of a novel, resource appropriate resuscitation curriculum on Nicaraguan resident physician’s management of cardiac arrest
Language assistance for limited English proficiency patients in a public ED: determining the unmet need
Abstract Background Many patients who present to public Emergency Departments (EDs) have Limited English Proficiency (LEP). LEP patients have worse understanding of their conditions and high rates of ED recidivism. LEP patients are entitled to language assistance under Title IV of the 1964 Civil Rights Act. The objective of this study is to characterize the unmet need for language assistance in a public ED. Methods Retrospective chart review of 48 h of successive patient encounters in a public ED. Registration workers asked each patient their preferred language and whether they would like an interpreter. On recent implementation of a new electronic health record (EHR), however, providers were unable to see the responses recorded. When discovered, this created a natural experiment to compare patient request for language assistance with documented practice of the providers who were unaware of the patient’s stated preference at registration. The study was set in a public, urban ED, annual census of 50,000 visits, with language assistance services available 24/7 via video units and phone line. The subjects included all patients presenting to the ED for a 48-h period. Those with altered level of consciousness and those who left before being seen were excluded. Age, race, ethnicity, preferred language, preference for language assistance, status of the provider as certified bilingual, documentation of language assistance use, type of language assistance used (video, phone, bilingual staff or ad hoc) were captured. Descriptive statistics were used with proportions and 95% CIs to describe the unmet need. Results In total, 253 encounters met inclusion criteria. Mean age was 41 years, 201/253 (79.5%) were Hispanic or Latino, and 134/253 (53%) preferred to use a language other than English (97% Spanish, 2% Armenian and 0.8% Tagalog). Of the 110/253 (43%) patients requesting an interpreter, 12/110 (10.9%) were seen by a certified bilingual provider and 5/110 (4.6%) had written documentation by the primary provider that language assistance was used. The calculated unmet need for spoken language assistance was 93/110 (84.5%) of patients requesting language assistance or 93/253 (36.8, 95%CI 31–42.9%) of total ED patients. Conclusions In this public ED, there is a large unmet need for language assistance for LEP patients
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Hospital and Health System-Level Interventions to Improve Care for Limited English Proficiency Patients: A Systematic Review.
Although federal legislation mandates the provision of qualified interpreters for limited English proficiency (LEP) patients, language services are consistently underutilized by health care providers even when readily available. The objective of this study was to systematically review the literature and summarize evidence for interventions at the hospital or health system level that improve communication with, quality of care for, or health outcomes of LEP patients.The literature was systematically reviewed according to PRISMA guidelines to answer the following question: "For patients with limited English proficiency, which interventions at the hospital or health system level will result in improved communication, quality of care, or health outcomes?"The search yielded an initial 16,686 references, 19 of which met the inclusion criteria. Baseline rates of language service utilization were extremely low and remained at low levels postintervention in multiple studies. Most studies focused on language service utilization, patient communication, metric tracking, and access to care, whereas few studies evaluated quality of care or health outcomes of LEP patients. Multifaceted interventions that include elements of administrative emphasis, process evaluation, and education appear to improve language service use and communication.This review revealed large gaps in the evidence to guide hospital and health system improvement strategies for LEP patient care. Given the large and persistent performance gaps in the provision of language assistance for LEP patients, hospitals, health systems, and granting agencies should invest in implementation and dissemination research focused on language service use
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Hospital and Health System-Level Interventions to Improve Care for Limited English Proficiency Patients: A Systematic Review.
Although federal legislation mandates the provision of qualified interpreters for limited English proficiency (LEP) patients, language services are consistently underutilized by health care providers even when readily available. The objective of this study was to systematically review the literature and summarize evidence for interventions at the hospital or health system level that improve communication with, quality of care for, or health outcomes of LEP patients.The literature was systematically reviewed according to PRISMA guidelines to answer the following question: "For patients with limited English proficiency, which interventions at the hospital or health system level will result in improved communication, quality of care, or health outcomes?"The search yielded an initial 16,686 references, 19 of which met the inclusion criteria. Baseline rates of language service utilization were extremely low and remained at low levels postintervention in multiple studies. Most studies focused on language service utilization, patient communication, metric tracking, and access to care, whereas few studies evaluated quality of care or health outcomes of LEP patients. Multifaceted interventions that include elements of administrative emphasis, process evaluation, and education appear to improve language service use and communication.This review revealed large gaps in the evidence to guide hospital and health system improvement strategies for LEP patient care. Given the large and persistent performance gaps in the provision of language assistance for LEP patients, hospitals, health systems, and granting agencies should invest in implementation and dissemination research focused on language service use
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A Pragmatic Assessment of Google Translate for Emergency Department Instructions.
BackgroundBecause many hospitals have no mechanism for written translation, ED providers resort to the use of automated translation software, such as Google Translate (GT) for patient instructions. A recent study of discharge instructions in Spanish and Chinese suggested that accuracy rates of Google Translate (GT) were high.Study objectiveTo perform a pragmatic assessment of GT for the written translation of commonly used ED discharge instructions in seven commonly spoken languages.MethodsA prospective assessment of the accuracy of GT for 20 commonly used ED discharge instruction phrases, as evaluated by a convenience sample of native speakers of seven commonly spoken languages (Spanish, Chinese, Vietnamese, Tagalog, Korean, Armenian, and Farsi). Translations were evaluated using a previously validated matrix for scoring machine translation, containing 5-point Likert scales for fluency, adequacy, meaning, and severity, in addition to a dichotomous assessment of retention of the overall meaning.ResultsTwenty volunteers evaluated 400 google translated discharge statements. Volunteers were 50% female and spoke Spanish (5), Armenian (2), Chinese (3), Tagalog (4), Korean (2), and Farsi (2). The overall meaning was retained for 82.5% (330/400) of the translations. Spanish had the highest accuracy rate (94%), followed by Tagalog (90%), Korean (82.5%), Chinese (81.7%), Farsi (67.5%), and Armenian (55%). Mean Likert scores (on a 5-point scale) were high for fluency (4.2), adequacy (4.4), meaning (4.3), and severity (4.3) but also varied.ConclusionGT for discharge instructions in the ED is inconsistent between languages and should not be relied on for patient instructions
Impact of a novel, resource appropriate resuscitation curriculum on Nicaraguan resident physician’s management of cardiac arrest
Purpose: Project Strengthening Emergency Medicine, Investing in Learners in Latin America (SEMILLA) created a novel, language and resource appropriate course for the resuscitation of cardiac arrest for Nicaraguan resident physicians. We hypothesized that participation in the Project SEMILLA resuscitation program would significantly improve the physician’s management of simulated code scenarios. Methods: Thirteen Nicaraguan resident physicians were evaluated while managing simulated cardiac arrest scenarios before, immediately, and at 6 months after participating in the Project SEMILLA resuscitation program. This project was completed in 2014 in Leon, Nicaragua. The Cardiac Arrest Simulation Test (CASTest), a validated scoring system, was used to evaluate performance on a standardized simulated cardiac arrest scenario. Mixed effect logistic regression models were constructed to assess outcomes. Results: On the pre-course simulation exam, only 7.7% of subjects passed the test. Immediately post-course, the subjects achieved a 30.8% pass rate and at 6 months after the course, the pass rate was 46.2%. Compared with pre-test scores, the odds of passing the CASTest at 6 months after the course were 21.7 times higher (95% CI 4.2 to 112.8, P<0.001). Statistically significant improvement was also seen on the number of critical items completed (OR=3.75, 95% CI 2.71-5.19), total items completed (OR=4.55, 95% CI 3.4-6.11), and number of “excellent” scores on a Likert scale (OR=2.66, 95% CI 1.85-3.81). Conclusions: Nicaraguan resident physicians demonstrate improved ability to manage simulated cardiac arrest scenarios after participation in the Project SEMILLA resuscitation course and retain these skills
Fibronectin Peptides that Bind PDGF-BB Enhance Survival of Cells and Tissue under Stress
Stressors after injury from a multitude of factors can lead to cell death. We have identified four fibronectin (FN) peptides: two from the first FN type III repeat (FNIII1), one from the 13th FN type III repeat (FNIII13), and one from FN variable region (IIICS), which when tethered to a surface acted as platelet-derived growth factor-BB (PDGF-BB) enhancers to promote cell survival. One of the FNIII1 peptides and its smallest (14-mer) bioactive form (P12) were also active in solution. Specifically, P12 bound PDGF-BB (KD=200 nM), enhanced adult human dermal fibroblast (AHDF) survival under serum starvation, oxidative or endoplasmic reticulum stressors, and limited burn-injury progression in a rat hot comb model. Furthermore, P12 inhibited endoplasmic reticulum stress-induced c-Jun N-terminal kinase (JNK) activation. Although many growth factors have been found to bind FN directly or indirectly, here we identify peptide sequences of growth factor-binding sites in FN. The finding of these peptides further delineated how the extracellular matrix protein FN can support cell survival. As the peptide P12 is active in either soluble form or tethered to a substrate, it will have multifactorial uses as a bioactive peptide by itself or in tissue engineering