Study protocol for improving asthma outcomes through cross-cultural communication training for physicians: a randomized trial of physician training

Abstract Background Massive resources are expended every year on cross-cultural communication training for physicians. Such training is a focus of continuing medical education nationwide and is part of the curriculum of virtually every medical school in America. There is a pressing need for evidence regarding the effects on patients of cross-cultural communication training for physicians. There is a need to understand the added benefit of such training compared to more general communication. We know of no rigorous study that has assessed whether cross-cultural communication training for physicians results in better health outcomes for their patients. The current study aims to answer this question by enhancing the Physician Asthma Care Education (PACE) program to cross cultural communication (PACE Plus), and comparing the effect of the enhanced program to PACE on the health outcomes of African American and Latino/Hispanic children with asthma. Methods/Design A three-arm randomized control trial is used to compare PACE Plus, PACE, and usual care. Both PACE and PACE Plus are delivered in two, two-hour sessions over a period of two weeks to 5–10 primary care physicians who treat African American and Latino/Hispanic children with asthma. One hundred twelve physicians and 1060 of their pediatric patients were recruited who self-identify as African American or Latino/Hispanic and experience persistent asthma. Physicians were randomized into receiving either the PACE Plus or PACE intervention or into the control group. The comparative effectiveness of PACE and PACE Plus on clinician’s therapeutic and communication practices with the family/patient, children’s urgent care use for asthma, asthma control, and quality of life, and parent/caretaker satisfaction with physician performance will be assessed. Data are collected via telephone survey and medical record review at baseline, 9 months following the intervention, and 21 months following the intervention. Discussion This study aims to reduce disparities in asthma outcomes among African American and Latino/Hispanic children through cross-cultural communication training of their physicians and assessing the added value of this training compared to general communication. The results of this study will provide important information about the value of cross-cultural training in helping to address persistent racial disparities in outcomes. Trial registration ClinicalTrials.gov: NCT01251523 December 1, 2010http://deepblue.lib.umich.edu/bitstream/2027.42/109533/1/12909_2014_Article_948.pd

Effects of Wildfires and Ash Leaching on Stream Chemistry in the Santa Ynez Mountains of Southern California

Wildfires can change ecosystems by altering solutes in streams. We examined major cations in streams draining a chaparral-dominated watershed in the Santa Ynez Mountains (California, USA) following a wildfire that burned 75 km2 from July 8 to October 5, 2017. We identified changes in solute concentrations, and postulated a relation between these changes and ash leached by rainwater following the wildfire. Collectively, K+ leached from ash samples exceeded that of all other major cations combined. After the wildfire, the concentrations of all major cations increased in stream water sampled near the fire perimeter following the first storm of the season: K+ increased 12-fold, Na+ and Ca2+ increased 1.4-fold, and Mg2+ increased 1.6-fold. Our results suggested that the 12-fold increase in K+ in stream water resulted from K+ leached from ash in the fire scar. Both C and N were measured in the ash samples. The low N content of the ash indicated either high volatilization of N relative to C occurred, or burned material contained less N