Identification of Limited English Proficient Patients in Clinical Care

BackgroundStandardized means to identify patients likely to benefit from language assistance are needed.ObjectiveTo evaluate the accuracy of the U.S. Census English proficiency question (Census-LEP) in predicting patients' ability to communicate effectively in English.DesignWe investigated the sensitivity and specificity of the Census-LEP alone or in combination with a question on preferred language for medical care for predicting patient-reported ability to discuss symptoms and understand physician recommendations in English.ParticipantsThree hundred and two patients > 18 who spoke Spanish and/or English recruited from a cardiology clinic and an inpatient general medical-surgical ward in 2004-2005.ResultsOne hundred ninety-eight (66%) participants reported speaking English less than "very well" and 166 (55%) less than "well"; 157 (52%) preferred receiving their medical care in Spanish. Overall, 135 (45%) were able to discuss symptoms and 143 (48%) to understand physician recommendations in English. The Census-LEP with a high-threshold (less than "very well") had the highest sensitivity for predicting effective communication (100% Discuss; 98.7% Understand), but the lowest specificity (72.6% Discuss; 67.1% Understand). The composite measure of Census-LEP and preferred language for medical care provided a significant increase in specificity (91.9% Discuss; 83.9% Understand), with only a marginal decrease in sensitivity (99.4% Discuss; 96.7% Understand).ConclusionsUsing the Census-LEP item with a high-threshold of less than "very well" as a screening question, followed by a language preference for medical care question, is recommended for inclusive and accurate identification of patients likely to benefit from language assistance

Workup of the Newly Discovered Hypertensive Patient

Newly discovered hypertensives should be evaluated to determine type of hypertension, to identify coexisting conditions that may alter therapy, and to search for correctable underlying causes. Workup should be minimal, rapid, and inexpensive. Intravenous pyelography should not be done routinely

Inulin Labeled With Chromium 51 for Determination of Glomerular Filtration Rate

Glomerular filtration rate (GFR) was determined in 12 patients by simultaneous clearance of inulin and inulin labeled with chromium 51 (inulin51Cr). Paired GFRs calculated by the classic C=UV/P formula showed excellent correlation (r±0.995; P<0.001; y =1.01x - 2.03, where y indicates clearance of inulin5Cr, and x indicates clearance of inulin). The clearance ratio was 0.975. Determination of GFR with inulin51Cr proved to be faster, cheaper, and more practical than with inulin. This compound makes GFR determinations readily available for clinical use

Antihypertensive effectiveness of oxprenolol administered twice daily

Oxprenolol, a beta‐blocker, is an effective antihypertensive when administered 3 or 4 times daily. We evaluated the antihypertensive effect of oxprenolol given twice daily (bid). The subjects were 15 ambulatory men whose standing diastolic blood pressure (BP) was at least 100 mm Hg after 3 wk of treatment with hydrochlorothiazide and oxprenolol placebo. Oxprenolol 40 mg twice daily was then substituted for the placebo. On subsequent weekly visits oxprenolol was titrated to 80 and 160 mg bid if the standing diastolic BP was greater than 90 mm Hg. Blood pressures on the last visit on placebo were compared to those on the last visit on oxprenolol. Standing BP declinedfram 145 ± 4/108 ± 1 to 130 ± 4/98 ± 4 on a mean dose of 256 mg of oxprenolol (p < 0.001 syst.; p < 0.01 diast.). Recumbent BP fell from 146 ± 4/107 ± I to 138 ± 5/93 ± 2 (p < 0.06 syst.; p < 0.01 diast.). During the final week, 13 of the 15 patients were admitted to the hospital for 24‐hr monitoring of BP. The 24‐hr BP readings showed a mean coefficient of variation of 6.6% recumbent and 7.2% standing. We conclude that bid oxprenolol will maintain 24 hr BP control in most patients

Antihypertensive effectiveness of oxprenolol administered twice daily

Oxprenolol, a beta‐blocker, is an effective antihypertensive when administered 3 or 4 times daily. We evaluated the antihypertensive effect of oxprenolol given twice daily (bid). The subjects were 15 ambulatory men whose standing diastolic blood pressure (BP) was at least 100 mm Hg after 3 wk of treatment with hydrochlorothiazide and oxprenolol placebo. Oxprenolol 40 mg twice daily was then substituted for the placebo. On subsequent weekly visits oxprenolol was titrated to 80 and 160 mg bid if the standing diastolic BP was greater than 90 mm Hg. Blood pressures on the last visit on placebo were compared to those on the last visit on oxprenolol. Standing BP declinedfram 145 ± 4/108 ± 1 to 130 ± 4/98 ± 4 on a mean dose of 256 mg of oxprenolol (p < 0.001 syst.; p < 0.01 diast.). Recumbent BP fell from 146 ± 4/107 ± I to 138 ± 5/93 ± 2 (p < 0.06 syst.; p < 0.01 diast.). During the final week, 13 of the 15 patients were admitted to the hospital for 24‐hr monitoring of BP. The 24‐hr BP readings showed a mean coefficient of variation of 6.6% recumbent and 7.2% standing. We conclude that bid oxprenolol will maintain 24 hr BP control in most patients

Antihypertensive effects of oxprenolol and propranolol

The antihypertensive effects of the beta blockers oxprenolol and propranolol were compared in a randomized double‐blind study of patients with standing diastolic pressures (SDP) exceeding 99 mm Hg when receiving hydrochlorothiazide alone. After 3 wk of hydrochlorothiazide with placebo, the latter was replaced with oxprenolol (n = 12) or propranolol (n = 12), 20 mg three times daily. Beta blocker was increased subsequently to 40 and 80 mg three times daily if SDP exceeded 89 mm Hg. Nine oxprenolol and 7 propranolol subjects were hospitalized for 24‐hr monitoring. With oxprenolol, standing pressure declined from 135 ± 2 (S£)/104 ± 1 mm Hg to 128 ± 3/90 ± 2. SDP declined to under 91 mm Hg in 7 of 12 subjects, and to from 91 to 95 in 3 subjects. With propranolol, findings were 138 ± 3/106 ± 2 to 123 ± 3/89 ± 3; in 7 of 12 to less than 91 mm Hg and from 91 to 95 in 4 subjects. Decrements in supine and SDP were slightly (4 mm Hg) greater for propranolol than for oxprenolol. Both drugs gave similar 24‐hr blood pressure control. We conclude that oxprenolol and propranolol used to supplement hydrochlorothiazide provide comparable reductions in blood pressure and smooth control over a 24‐hr period in most patients with hypertension

Variability in Cancer Risk and Outcomes Within US Latinos by National Origin and Genetic Ancestry.

Latinos have lower rates for most common cancer sites and higher rates of some less common cancers (gallbladder, liver, gastric, and cervical) than other ethnic/racial groups. Latinos are a highly heterogeneous population with diverse national origins, unique genetic admixture patterns, and wide spectrum of socio-demographic characteristics. Across the major cancers (breast, colorectal, prostate, lung, and liver) US-born Latinos have higher incidence and worse survival than foreign-born, and those with low-socioeconomic status have the lowest incidence. Puerto Rican and Cuban Latinos have higher incidence rates than Mexican Latinos. We have identified the following themes as understudied and critical to reduce the cancer burden among US Latinos: (1) etiological studies considering key sources of heterogeneity, (2) culturally sensitive cancer prevention strategies, (3) description of the molecular tumor landscape to guide treatments and improve outcomes, and (4) development of prediction models of disease risk and outcomes accounting for heterogeneity of Latinos

Abstract A68: What do they do? The art and science of patient navigation among underserved Latina minorities: The significance of language

Abstract Background: Patient Navigation has evolved to reduce cancer health disparities by eliminating barriers to diagnosis, treatment, and survivorship services. Attempts have been made to describe barriers to care and navigator actions. Little attention has been paid to the unique needs of underserved minorities. Here we describe barriers to care reported by Latina survivors in the context of a social-ecological framework, actions taken by navigators to resolve those barriers, and the consequences of those activities. Methods: We evaluated 399 barriers to care reported by Latinas diagnosed with cancer as part of Redes En Acción: The National Latino Cancer Research Network from July 2008-January 2011. Navigators maintained monthly logs of encounters with patients and recorded reported barriers to care and actions taken to overcome each barrier. Spearman Correlation, Chi-squared analysis and Cox proportional hazards models were used to assess the barriers and actions. Results: The most common barrier to care was needed Spanish-English translation (55.6%). Personal (e.g. fear) and system barriers (e.g. insurance) accounted for the remainder. 85% of all Latinas reported one or more barriers; 37% reported more than one. Multiple (2+) barriers resulted in slightly longer time to treatment (aHR [adjusted Hazard Ratio]= 0.871; p < .05). However this disappeared when barriers were tallied without translation (aHR=0.964; p=.982). Many barriers not specifically reported to be language-based in nature were resolved by providing translation services in the social-ecological context of the reported problem. This was reflected in significant correlation between patient-reported barriers involving Health Education, Insurance issues, Fear, and Beliefs and navigator actions regarding translation services (all p < .05). For example, of 70 instances of “fear” reported as a barrier to care, 12 (17.1%) were resolved with a translation action. Conclusions: Barriers reported by Latinas are predominantly linguistic in nature. Multiple barriers appear to result in a delay between diagnosis and treatment initiation; however this effect disappears when accounting for the effects of a language barrier. Health care systems must attend to the special needs of underserved minorities when planning and improving programs. Citation Format: Amelie G. Ramirez, Eliseo J. Perez-Stable, Frank Penedo, Gregory A. Talavera, J. Emilio Carrillo, Maria Fernandez, Alan E. C. Holden, Edgar Munoz, Sandra San Miguel, Kipling Gallion. What do they do? The art and science of patient navigation among underserved Latina minorities: The significance of language. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr A68

Abstract 4450: Navigating Latinas with breast screen abnormalities to diagnosis: The Six Cities Study

BACKGROUND: Breast cancer is the leading cause of cancer-related deaths in Latinas, chiefly because of later diagnosis. The time from screening to diagnosis is critical to optimizing cancer care, yet the efficacy of navigation in reducing it is insufficiently documented. Here, the authors evaluate a culturally sensitive patient navigation program to reduce the time to diagnosis and increase the proportions of women diagnosed within 30 days and 60 days. METHODS: The authors analyzed 425 Latinas who had Breast Imaging Reporting and Data System (BI-RADS) radiologic abnormalities categorized as BI-RADS-3, BI-RADS-4, or BI-RADS-5 from July 2008 to January 2011. There were 217 women in the navigated group and 208 women in the control group. Women were navigated by locally trained navigators or were not navigated (data for this group were abstracted from charts). The Kaplan-Meier method, Cox proportional hazards regression, and logistic regression were used to determine differences between groups. RESULTS: The time to diagnosis was shorter in the navigated group (mean, 32.5 days vs 44.6 days in the control group; hazard ratio, 1.32; P = .007). Stratified analysis revealed that navigation significantly shortened the time to diagnosis among women who had BI-RADS-3 radiologic abnormalities (mean, 21.3 days vs 63.0 days; hazard ratio, 2.42; P < .001) but not among those who had BI-RADS-4 or BI-RADS-5 radiologic abnormalities (mean, 37.6 days vs 36.9 days; hazard ratio, 0.98; P = .989). Timely diagnosis occurred more frequently among navigated Latinas (within 30 days: 67.3% vs 57.7%; P = .045; within 60 days: 86.2% vs 78.4%; P = .023). This was driven by the BI-RADS-3 strata (within 30 days: 83.6% vs 50%; P < .001; within 60 days: 94.5% vs 67.2%; P < .001). A lack of missed appointments was associated with timely diagnosis. CONCLUSIONS: Patient-centered navigation to assist Latina women with abnormal screening mammograms appeared to reduced the time to diagnosis and increase rates of timely diagnosis overall. However, in stratified analyses, only navigated Latinas with an initial BI-RADS-3 screen benefited, probably because of a reduction in missed diagnostic appointments