Including migrant oncology patients in research : a multisite pilot randomised controlled trial testing consultation audio-recordings and question prompt lists

Background: Oncology patients who are migrants or refugees face worse outcomes due to language and communication barriers impacting care. Interventions such as consultation audio-recordings and question prompt lists may prove beneficial in mediating communication challenges. However, designing robust research inclusive of patients who do not speak English is challenging. This study therefore aimed to: a) pilot test and assess the appropriateness of the proposed research design and methods for engaging migrant populations, and b) determine whether a multi-site RCT efficacy assessment of the communication intervention utilising these methods is feasible. Methods: This study is a mixed-methods parallel-group, randomised controlled feasibility pilot trial. Feasibility outcomes comprised assessment of: i) screening and recruitment processes, ii) design and procedures, and iii) research time and costing. The communication intervention comprised audio-recordings of a key medical consultation with an interpreter, and question prompt lists and cancer information translated into Arabic, Greek, Traditional, and Simplified Chinese. Results: Assessment of feasibility parameters revealed that despite barriers, methods utilised in this study supported the inclusion of migrant oncology patients in research. A future multi-site RCT efficacy assessment of the INFORM communication intervention using these methods is feasible if recommendations to strengthen screening and recruitment are adopted. Importantly, hiring of bilingual research assistants, and engagement with community and consumer advocates is essential. Early involvement of clinical and interpreting staff as key stakeholders is likewise recommended. Conclusion: Results from this feasibility RCT help us better understand and overcome the challenges and misconceptions about including migrant patients in clinical research

Expectations and reality: the Italian economy under Berlusconi

Upon leading his centre-right government to power in 2001 Silvio Berlusconi and senior members of his government made important economic programme promises, raised expectations about the management of the economy and the direction it would take. The promise of 1,500,000 jobs, tax reductions and economic growth have all appeared on the list of measures that would be implemented by this new government. Berlusconi in fact went as far as entering a public Contratto con gli Italiani (contract with the Italians), adding that if he did not respect at least four of the five measures during his term in government he would not seek re-election in 2006.Since 2001 much of the news about and analysis of the Italian government has been dominated by Berlusconi's 'conflict of interest', and not so ethical conduct. Much less debate has centred around policies related to management of the economy. Why is the Italian economy doing so poorly, and how much can be blamed on the Berlusconi government? Most importantly, how has confidence, both managerial and public, altered over the period of the Berlusconi administration? This paper seeks to take a critical view of the economic policies and outcomes at the end of Berlusconi's term in government and compare them with the expectations and promises made in 2001

Whither the Democratici di Sinistra?

In 1991 the Democratic Party of the Left (PDS) embraced social democracy in an unambiguous fashion with its transformation from the Italian Communist Party (PCI). This represented a break with the communist tradition and ideology, and allowed the PDS to wholeheartedly dedicate itself to developing its social democratic strategies. The origins of this political change can be traced back to the mid-1970s when the PCI embarked on a political trajectory which would see it change name to the PDS after the geo-political convulsions which shook Europe following the fall of the Berlin Wall in 1989. As a result of this endeavour, the leadership of the PDS expected large sections of the Italian population to embrace the new social democratic party, one with a progressive image and platform. However, this expectation failed to materialise. Although the PDS remained the largest party of the left, and of the political area loosely defined as centre-left, it failed to obtain the electoral support its predecessor, the PCI, achieved in the 1970s and 1980s. Hence the PDS failed to achieve and consolidate stable representation in government, and become the progressive party of the Italians. [Introduction

Does English proficiency impact on health outcomes for inpatients undergoing stroke rehabilitation?

Purpose: To determine whether English proficiency and/or the frequency of interpreter use impacts on health outcomes for inpatient stroke rehabilitation. Method: Study design: Retrospective case–control study. Participants: People admitted for inpatient stroke rehabilitation. A high English proficiency group comprised people with native or near native English proficiency (n?=?80), and a low English proficiency group comprised people who preferred a language other than English (n?=?80). Outcome measures: Length of stay (LOS), discharge destination and Functional Independence Measure (FIM). Results: The low English proficiency group showed a greater improvement in FIM from admission to discharge (p?=?0.04). No significant differences were found between groups in LOS, discharge destination and number of encounters with allied health professionals. Increased interpreter usage improved FIM efficiency but did not significantly alter other outcomes. Conclusion: English proficiency does not appear to impact on health outcomes in inpatient rehabilitation with a primarily in-house professional interpreter service. However, there is a need for a larger powered study to confirm these findings.Implications for rehabilitationPeople with low English proficiency undergoing inpatient stroke rehabilitation in a setting with a primarily in-house professional interpreter service, achieved similar outcomes to those with high English proficiency irrespective of frequency of interpreter usage.A non-significant increase of 4 days length of stay was observed in the low English proficiency group compared to the high English proficiency group.For patients with low English proficiency, greater change in Functional Independence Measure efficiency scores was observed for those with higher levels of interpreter use relative to those with low interpreter use. Clinicians should optimise use of interpreters with patients with low English proficiency when possible

Additional file 1 of Frequent hospital presenters’ use of health information during COVID-19: results of a cross-sectional survey

Additional file 1