Understanding the Impact of Language Barriers and Visit Duration on Caregiver Satisfaction in Pediatric Primary Care

Abstract: Problem. Children from households that speak languages other than English (LOE) face significant challenges in accessing healthcare, which can lead to poorer health outcomes and inadequate medical care (Flores et al., 2005). Language barriers contribute to these disparities, often resulting in diminished communication between healthcare providers and families (Ramirez et al., 2023). In pediatric primary care, visit duration—defined as the amount of time between when a patient is checked into and out of the clinic—may play a crucial role in facilitating effective communication and improving patient satisfaction (Tsiga et al., 2013). Physicians experience significant time pressure and productivity expectations, but shorter visits that enhance efficiency are associated with lower patient satisfaction (Tocher et al., 1999). While some studies suggest physician spend similar time with LOE and English-speaking patients (Tocher et al. 1999), other suggest longer visit duration in LOE appointments (Kravitz et al., 2000). But, interpreter-facilitated visits are likely to require twice as much time as language-congruent medical visits, since interpretation requires everything to be repeated at least once. This study explores how language barriers affect visit satisfaction in pediatric primary care and whether visit duration acts as a mediator. We hypothesize that caregivers of patients from LOE households will have comparable visit durations than those from English-preferring households; however, because they are likely to have received less information in that same period of time, we expect they will report less satisfaction with their visit.https://scholarworks.uark.edu/coesym25/1002/thumbnail.jp

Understanding the Impact of Language Barriers and Visit Duration on Caregiver Satisfaction in Pediatric Primary Care

Abstract: Problem. Children from households that speak languages other than English (LOE) face significant challenges in accessing healthcare, which can lead to poorer health outcomes and inadequate medical care (Flores et al., 2005). Language barriers contribute to these disparities, often resulting in diminished communication between healthcare providers and families (Ramirez et al., 2023). In pediatric primary care, visit duration—defined as the amount of time between when a patient is checked into and out of the clinic—may play a crucial role in facilitating effective communication and improving patient satisfaction (Tsiga et al., 2013). Physicians experience significant time pressure and productivity expectations, but shorter visits that enhance efficiency are associated with lower patient satisfaction (Tocher et al., 1999). While some studies suggest physician spend similar time with LOE and English-speaking patients (Tocher et al. 1999), other suggest longer visit duration in LOE appointments (Kravitz et al., 2000). But, interpreter-facilitated visits are likely to require twice as much time as language-congruent medical visits, since interpretation requires everything to be repeated at least once. This study explores how language barriers affect visit satisfaction in pediatric primary care and whether visit duration acts as a mediator. We hypothesize that caregivers of patients from LOE households will have comparable visit durations than those from English-preferring households; however, because they are likely to have received less information in that same period of time, we expect they will report less satisfaction with their visit.https://scholarworks.uark.edu/coesym25/1002/thumbnail.jp

Diabetes-free survival among living kidney donors and non-donors with obesity: A longitudinal cohort study

BackgroundApproval of living kidney donors (LKD) with end-stage kidney disease (ESKD) risk factors, such as obesity, has increased. While lifetime ESKD development data are lacking, the study of intermediate outcomes such as diabetes is critical for LKD safety. Donation-attributable diabetes risk among persons with obesity remains unknown. The purpose of this study was to evaluate 10-year diabetes-free survival among LKDs and non-donors with obesity.MethodsThis longitudinal cohort study identified adult, LKDs (1976-2020) from 42 US transplant centers and non-donors from the Coronary Artery Risk Development in Young Adults (1985-1986) and the Atherosclerosis Risk in Communities (1987-1989) studies with body mass index ≥30 kg/m2. LKDs were matched to non-donors on baseline characteristics (age, sex, race, body mass index, systolic and diastolic blood pressure) plus diabetes-specific risk factors (family history of diabetes, impaired fasting glucose, smoking history). Accelerated failure time models were utilized to evaluate 10-year diabetes-free survival.FindingsAmong 3464 participants, 1119 (32%) were LKDs and 2345 (68%) were non-donors. After matching on baseline characteristics plus diabetes-specific risk factors, 4% (7/165) LKDs and 9% (15/165) non-donors developed diabetes (median follow-up time 8.5 (IQR: 5.6-10.0) and 9.1 (IQR: 5.9-10.0) years, respectively). While not significant, LKDs were estimated to live diabetes-free 2 times longer than non-donors (estimate 1.91; 95% CI: 0.79-4.64, p = 0.15).ConclusionsLKDs with obesity trended toward living longer diabetes-free than non-donors with obesity, suggesting within the decade following donation there was no increased diabetes risk among LKDs. Further work is needed to evaluate donation-attributable diabetes risk long-term

Iron Behaving Badly: Inappropriate Iron Chelation as a Major Contributor to the Aetiology of Vascular and Other Progressive Inflammatory and Degenerative Diseases

The production of peroxide and superoxide is an inevitable consequence of aerobic metabolism, and while these particular "reactive oxygen species" (ROSs) can exhibit a number of biological effects, they are not of themselves excessively reactive and thus they are not especially damaging at physiological concentrations. However, their reactions with poorly liganded iron species can lead to the catalytic production of the very reactive and dangerous hydroxyl radical, which is exceptionally damaging, and a major cause of chronic inflammation. We review the considerable and wide-ranging evidence for the involvement of this combination of (su)peroxide and poorly liganded iron in a large number of physiological and indeed pathological processes and inflammatory disorders, especially those involving the progressive degradation of cellular and organismal performance. These diseases share a great many similarities and thus might be considered to have a common cause (i.e. iron-catalysed free radical and especially hydroxyl radical generation). The studies reviewed include those focused on a series of cardiovascular, metabolic and neurological diseases, where iron can be found at the sites of plaques and lesions, as well as studies showing the significance of iron to aging and longevity. The effective chelation of iron by natural or synthetic ligands is thus of major physiological (and potentially therapeutic) importance. As systems properties, we need to recognise that physiological observables have multiple molecular causes, and studying them in isolation leads to inconsistent patterns of apparent causality when it is the simultaneous combination of multiple factors that is responsible. This explains, for instance, the decidedly mixed effects of antioxidants that have been observed, etc...Comment: 159 pages, including 9 Figs and 2184 reference

A prospective observational study of iron isomaltoside in haemodialysis patients with chronic kidney disease treated for iron deficiency (DINO).

Iron deficiency is frequent in haemodialysis (HD) patients with chronic kidney disease (CKD), and intravenous iron is an established therapy for these patients. This study assessed treatment routine, effectiveness, and safety of iron isomaltoside (IIM) 5% (Diafer®) in a HD cohort.This article is freely available via Open Access. Click on the link to the publisher's site to access the full-text

Book review: Good company: A study of Nyakyusa age-villages, Monica Wilson, 1963

Review of the book Good Company: A Study of Nyakyusa Age-Villages by Monica Wilson (XII, 278 p., Beacon Press, 1963

Implementation of a capstone course with Formative OSCEs to evaluate preparedness for Advanced Pharmacy Practice Experiences (APPE)

Background: Capstone courses are well documented in pharmacy programmes, but vary in content, methods, and assessment.        Aim: To describe the development and implementation of a capstone course for pharmacy students.    Description: Components of the capstone course included clinical reviews, pre-tests, calculations, cases, and formative and summative objective structured clinical examinations (OSCEs). Formative OSCEs were a unique aspect of this capstone course, and were used to help students identify clinical strengths and recognise areas of weakness prior to advanced pharmacy practice experiences (APPE).      Evaluation: A total of 72 students completed the capstone course in spring 2018.  Student survey data indicated that the format of the course was conducive to learning, particularly the use of formative OSCEs.      Conclusion: A capstone course was successfully designed and implemented that assessed a variety of pharmacy knowledge and skills prior to APPE. Student feedback and performance in the course provided insight that led to revisions in the pre-APPE curriculum.</jats:p