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Objective This study aimed to identify the types, frequency, and clinical significance of altered interpreta-tion in clinical settings.Methods Routine outpatient encounters involving Portuguese-speaking Brazilian patients, Japanese doctors, and hospital-provided interpreters were digitally recorded and transcribed. Segments of consecutively interpreted utterances were coded as “altered,” in which the interpreter changed the meaning of the source utterance, or “unaltered (accurate),” and the types and frequency of occurrence were analyzed. Altered interpretations were categorized as clinically negative or positive and classified into four categories: omission, addition, substitution, or voluntary intervention. Incidents resulting from alterations were investigated. Reliability was assessed by examining the correlation between random independently coded samples.Results In total, 111 encounters were analyzed. The mean segments per encounter was 67.9 (range 14-186), and the mean frequency (standard deviation) of altered interpretations per 100 segments was 46.7 (14.3) for accurate interpretations; 46.1 (17.9) for negative or not significant alterations, including 27.2 (10.3) for omissions, 6.0 (5.0) for additions, 10.4 (6.9) for substitutions, and 2.5 (2.7) for voluntary interventions; 0.0 (0.2) for alterations potentially leading to an incident; and 26.2 (11.9) for positive alterations, including 1.8 (2.6) for positive omissions, 7.7 (4.7) for positive additions, 7.8 (6.3) for positive substitutions, and 8.8 (5.2) for positive voluntary interventions. The frequency of negative alterations was weakly negatively correlated with number of segments per minute (r＝−0.339). Conclusion Trained healthcare interpreters with fewer clinically significant altered interpretations were effective. Professional medical providers should recognize the importance of positive alterations by healthcare interpreters and collaborate with them to provide safe medical care for foreign patients. To facilitate the provision of appropriate medical care to a growing foreign population with diverse cultural and linguistic needs, undergraduate medical education should teach aspiring medical professionals how to collaborate with healthcare interpreters and foreign patients.
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We have conducted an active learning session for participants in various fields using a scenario in which university students encountered a great earthquake during a field trip. The program was unique because it not only gave participants an opportunity to simulate providing support, it also allowed them to simulate receiving support.
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A study was conducted to clarify the effect of hyperoxia (HO) on exercise tolerance andhemodynamics in patients with ischemic heart disease (IHD) . The subjects were 10 patients with serious IHD who showed ischemic ST depression during low-intensity exercise testing. In all subjects, cardiopulmonary exercise testing (CPX) was performed using two types of inhalation : normoxia (NO) and HO (O<SUB>2</SUB>: 60%, N<SUB>2</SUB>: 40%) . Heart rate (HR), blood pressure (BP), rating of perceived exertion (RPE), elapsed exercise duration and pressure rate product (PRP) were measured, and ECG was recorded during CPX according to the Bruce protocol. The peak oxygen uptake (VO<SUB>2</SUB>peak) was calculated using the appropriate formula. These data were compared between the NO and HO groups, and the following results were obtained.<BR>ST depressions on ECG, BP, HR and PRP after 20 min of rest showed no changes under NO. The other hand, only ST depression was improved after 20 min of rest under HO. The exercise duration in HO group was longer than in the NO group, and the VO<SUB>2</SUB>peak in the HO group was higher than in the NO group. However, peak RPE showed no significant difference between the HO and NO groups. The incidence of ST depression as an endpoint of CPX showed no significant difference between the two groups. BP, HR and PRP at the CPX endpoint showed no significant differences between the HO and NO groups. In patients whose exercise duration was prolonged beyond the mean value by HO, peak HR and PRP were increased significantly. However, this tendency was not seen in patients whose exercise was prolonged for less than the mean value.<BR>In conclusion, these results suggest that an increase in the oxygen supply to peripheral working muscles may play an important role in increasing exercise tolerance under HO in IHD patients.