Harnessing health information technology to promote equitable care for patients with limited English proficiency and complex care needs.

BACKGROUND: Patients with language barriers encounter healthcare disparities, which may be alleviated by leveraging interpreter skills to reduce cultural, language, and literacy barriers through improved bidirectional communication. Evidence supports the use of in-person interpreters, especially for interactions involving patients with complex care needs. Unfortunately, due to interpreter shortages and clinician underuse of interpreters, patients with language barriers frequently do not get the language services they need or are entitled to. Health information technologies (HIT), including artificial intelligence (AI), have the potential to streamline processes, prompt clinicians to utilize in-person interpreters, and support prioritization. METHODS: From May 1, 2023, to June 21, 2024, a single-center stepped wedge cluster randomized trial will be conducted within 35 units of Saint Marys Hospital & Methodist Hospital at Mayo Clinic in Rochester, Minnesota. The units include medical, surgical, trauma, and mixed ICUs and hospital floors that admit acute medical and surgical care patients as well as the emergency department (ED). The transitions between study phases will be initiated at 60-day intervals resulting in a 12-month study period. Units in the control group will receive standard care and rely on clinician initiative to request interpreter services. In the intervention group, the study team will generate a daily list of adult inpatients with language barriers, order the list based on their complexity scores (from highest to lowest), and share it with interpreter services, who will send a secure chat message to the bedside nurse. This engagement will be triggered by a predictive machine-learning algorithm based on a palliative care score, supplemented by other predictors of complexity including length of stay and level of care as well as procedures, events, and clinical notes. DISCUSSION: This pragmatic clinical trial approach will integrate a predictive machine-learning algorithm into a workflow process and evaluate the effectiveness of the intervention. We will compare the use of in-person interpreters and time to first interpreter use between the control and intervention groups. TRIAL REGISTRATION: NCT05860777. May 16, 2023.

Development and Preliminary Validation of an Equine Brief Pain Inventory for Owner Assessment of Chronic Pain Due to Osteoarthritis in Horses.

An owner-completed questionnaire was designed to monitor the level of chronic pain and impact on quality of life in horses with osteoarthritis (OA). A standardized approach to develop and validate subjective-state scales for clinical use was followed. Scale items were generated through literature review, focus group meetings, and expert panel evaluation. The draft tool was tested for reading level and language ambiguity and piloted in 25 owners/caregivers of horses with osteoarthritis, with factor analysis performed on responses. The resulting revised questionnaire is currently undergoing validation in a larger sample population of 60 OA and 20 sound control horses. In the pilot group, 21 people (84%) found the questionnaire easy to complete and 22 people (88%) found it useful. It could be completed within 5 min by all participants. Readability scores (Flesch Reading Ease Score, Flesch-Kincaid grade level, SMOG index) indicated an English language reading level comparable to that of 6th to 7th grade in the U.S. system (age 11-12 years). Cronbach's alpha of all items in the tool was 0.957, indicating excellent inter-item correlation. Interim analysis for 23 OA horses from the sample population showed good test-retest reliability and higher scores compared to 5 control horses. Full validation must be completed for the instrument to be used in clinical practice.

Detection of blood on clothing laundered with sodium percarbonate.

Laundering clothes with modern detergents containing sodium percarbonate can result in false negative results when certain presumptive and confirmatory tests are used to detect the presence of blood. This is problematic as blood evidence can be inadvertently overlooked and criminal activity concealed, simply by laundering bloodstained clothes in detergent. The aim of this research was to determine if the incidence of positive results using tetramethylbenzidine (TMB) reagent, luminol, Bluestar® Magnum, ABAcard® Hematrace® and RSID™-Blood was affected by treatment in hot and cold water, with and without the detergent, sodium percarbonate. This study identified that RSID-Blood consistently produced positive results irrespective of water temperature or the addition of sodium percarbonate. All other reagents returned positive results in the absence of sodium percarbonate, regardless of water temperature. The introduction of sodium percarbonate initiated negative results regardless of water temperature when testing with tetramethylbenzidine reagent, Bluestar® Magnum and ABAcard® Hematrace®. Luminol in the presence of sodium percarbonate responded differently to the temperature change of the water. Cold water returned positive results, however, hot water returned negative results. This research indicates that RSID™-Blood surpassed other blood screening tests identifying blood on sodium percarbonate treated cotton fabric. The results for luminol were varied depending on water temperature, however, luminol performed better as a presumptive test than TMB or Bluestar® Magnum.

Spontaneous cerebrospinal fluid rhinorrhoea and aspiration pneumonitis following initiation of continuous positive airway pressure treatment for obstructive sleep apnoea.

Continuous positive airway pressure (CPAP) therapy is very often the treatment of choice for obstructive sleep apnoea (OSA). The association between intracranial hypertension and spontaneous cerebrospinal fluid (CSF) rhinorrhoea is being increasingly recognized among patients with OSA. However, spontaneous CSF rhinorrhoea following initiation of CPAP therapy for OSA is very rarely documented in the literature. In this report, we describe a 53-year-old woman with severe OSA who, while being evaluated for possible intracranial hypertension, developed spontaneous CSF rhinorrhoea and CSF aspiration pneumonitis as a complication of CPAP therapy. Magnetic resonance imaging confirmed fluid tracks at the skull base, and a nasal swab demonstrated positive ß2-transferrin. Computer tomography (CT) chest showed findings consistent with CSF aspiration pneumonitis. Resolution of both CSF leak and pneumonitis were noted following treatment with azetozolamide and curative endoscopic trans-nasal surgery along with ventriculoperitoneal shunt.

Neurally adjusted ventilatory assist in neonates weighing <1500 grams: a retrospective analysis.

OBJECTIVE: To report our experience using neurally adjusted ventilatory assist (NAVA), which allows a patient to synchronize spontaneous respiratory effort with mechanical ventilation, in the neonatal intensive care unit in neonates weighing <1500 g. STUDY DESIGN: This was a retrospective review performed between May 2008 and May 2009. A total of 52 neonates on conventional ventilation were converted to NAVA. We compared ventilatory parameters and blood gas values during conventional ventilation and then at various time intervals during NAVA and evaluated for complications. Statistical analyses were performed using the 2-tailed Student t-test and the Z-test for proportions for demographic data and Hotelling's T(2) test to compare repeated measures (P < .05). RESULTS: Peak inspiratory pressure and fraction of inspired oxygen decreased, and pH and partial pressure of carbon dioxide improved during use of NAVA. These changes were sustained for 24 hours. CONCLUSION: Compared with standard conventional ventilation, in preterm neonates NAVA appears to provide better blood gas regulation with lower peak inspiratory pressure and oxygen requirements.

English language proficiency and lifetime mental health service utilization in a national representative sample of Asian Americans in the USA.

BACKGROUND: US Department of Health and Human Services reported that the lack of English language proficiency and the shortage of providers who possessed appropriate language skills were identified as major barriers to mental health service use for approximately half of the population of Asians and Pacific Islanders. The aim of this study was to examine the predictors of lifetime mental health service use in relation to English language proficiency among Asian Americans. METHODS: Data from 2095 Asian participants from the National Latino and Asian American Study were analyzed using logistic regression. RESULTS: Respondents with better English language proficiency and with a mental health diagnosis were more inclined to use mental health services. Participants who were born in the USA, who were widowed, separated or divorced, who sought comfort from religion, who reported worse physical and mental health self-ratings were more likely to use mental health services. The lack of health insurance coverage was not a significant predictor. CONCLUSIONS: The public health implications for behavioral health include the need to educate health-care providers working with Asian Americans regarding the benefits derived from seeking services and making interpreter services available in a culturally sensitive environment.

Insurance literacy in the United States.

Health insurance reform in the United States can be traced back to former President Theodore Roosevelt in 1912 who called for universal health coverage. Since that time, various U.S. Presidents attempted to intervene to cover all Americans with some form of compulsory insurance. The election of President Barack Obama in 2008 was believed to be a beginning of a new dialog to transform health care in the United States by redesigning the insurance system in the country. The issue of insurance literacy and the need to educate citizens on insurance terminology are the focus of this article.

Complications of diabetes in urban Indigenous Australians: the DRUID study.

AIMS: To accurately assess the management and complications of type 2 diabetes in urban Indigenous Australians and compare the risk of complications with a general Australian population (AusDiab Study). METHODS: The Darwin Region Urban Indigenous Diabetes (DRUID) Study included 1004 volunteers aged >/=15 years; diabetes status was classifiable for 866. The assessment of diabetic complications and metabolic control was performed in participants with known diabetes (KDM) and diabetes newly diagnosed by the study (NDM) using an interviewer-administered questionnaire and clinical examination. RESULTS: Among 172 DRUID participants eligible for complications assessment, 135 were assessed, including 99 KDM (mean age 53 years) and 36 NDM (mean age 47 years). Percentages of KDM participants meeting therapeutic targets were: HbA1c<7%, 29%; blood pressure<130/80mmHg, 45%; total cholesterol<5.5mmol/L, 65%. Among KDM, 39% had albuminuria, 21% retinopathy, 12% peripheral vascular disease (PVD), 9% neuropathy. Factors independently associated with diabetic complications were: albuminuria-HbA1c, systolic blood pressure; retinopathy-diabetes duration; PVD-age. Compared to AusDiab participants after adjusting for other risk factors, DRUID participants had 2-3-fold increased risk of albuminuria and PVD and a non-significant increased risk of neuropathy, but no increased risk of retinopathy. CONCLUSIONS: Urban Indigenous Australians with diabetes are relatively young and have poor glycaemic control. Compared to the general Australian population with type 2 diabetes, they have greater adjusted risk of albuminuria and PVD but not retinopathy. Urgent action is required to prevent diabetes at a population level and improve diabetes management in this high-risk population.

The performance of Medicare, Medicaid, and individual commercial products.

Medicare, Medicaid, and individual nongovernmental insurance products are marketed by commercial health insurance companies. We propose that the product offerings be viewed as a group rather than as separate products competing for internal company resources. A study population consisting of 35 Aetna plans in 24 states, 124 Blue Cross Blue Shield plans (BCBS) in 45 states and the District of Columbia, 43 Cigna plans in 28 states, and 23 UnitedHealth plans in 22 states was examined on 29 variables, including financial, marketing, and medical management data. The findings revealed that Medicaid and individual nongovernmental products were terminated more often than other products across all ownership types. When BCBS plans were analyzed across for-profit, nonprofit, and mutual ownership types, the companies had distinct preferences for product offerings. The study provided evidence that health plans will limit their exposure to Medicare, Medicaid, and individual nongovernmental products in preference to comprehensive/group products.

An MRA study of vascular stenosis in a pig model using CH3-DTPA-Gd (NMS60) and Gd-DTPA.

PURPOSE: This study used an experimental arterial stenosis model in pigs to evaluate the utility of a new medium-weight MRI contrast agent, NMS60 (a synthetic oligomeric Gd complex containing three Gd(3+) atoms, molecular weight of 2158 Da) compared to Gd-DTPA for contrast-enhanced MRA. MATERIALS AND METHODS: We used six male white hybrid pigs. Under anesthesia, one femoral artery was exposed and an inflatable cuff placed around it. The cuff was tightened around the vessel until 80-90% stenosis was achieved using digital subtraction angiography as a guide. Animals were then immediately transferred to the MRI scanner and images acquired pre- and postcontrast injection (0.1 or 0.2 mmol Gd/kg Gd-DTPA or NMS60, as a rapid bolus) using high-resolution and dynamic MRA. RESULTS: The dynamic MRA scans acquired during contrast bolus injection clearly showed the stenosed femoral artery as a segment of close to zero enhancement during the arterial phase of the bolus transit, while on the high-resolution scans the stenosis was difficult to detect due to venous signal contamination. The signal-to-noise at peak enhancement on the dynamic scans was significantly greater with 0.1 mmol Gd/kg NMS60 compared to 0.1 mmol Gd/kg Gd-DTPA (14.6 vs. 9.9, P < .05) and not significantly greater than 0.2 mmol Gd/kg (14.6 vs. 12.8). DISCUSSION AND CONCLUSION: This new medium-weight contrast agent demonstrated significantly greater enhancement than Gd-DTPA and may be valuable to aid detection of vascular stenosis in humans.