Does Spanish instruction for emergency medicine resident physicians improve patient satisfaction in the emergency department and adherence to medical recommendations?

BACKGROUND: After emergency department (ED) discharge, Spanish-speaking patients with limited English proficiency are less likely than English-proficient patients to be adherent to medical recommendations and are more likely to be dissatisfied with their visit. OBJECTIVES: To determine if integrating a longitudinal medical Spanish and cultural competency curriculum into emergency medicine residency didactics improves patient satisfaction and adherence to medical recommendations in Spanish-speaking patients with limited English proficiency. METHODS: Our ED has two Emergency Medicine Residency Programs, University Campus (UC) and South Campus (SC). SC program incorporates a medical Spanish and cultural competency curriculum into their didactics. Real-time Spanish surveys were collected at SC ED on patients who self-identified as primarily Spanish-speaking during registration and who were treated by resident physicians from both residency programs. Surveys assessed whether the treating resident physician communicated in the patient's native Spanish language. Follow-up phone calls assessed patient satisfaction and adherence to discharge instructions. RESULTS: Sixty-three patients self-identified as primarily Spanish-speaking from August 2014 to July 2015 and were initially included in this pilot study. Complete outcome data were available for 55 patients. Overall, resident physicians spoke Spanish 58% of the time. SC resident physicians spoke Spanish with 66% of the patients versus 45% for UC resident physicians. Patients rated resident physician Spanish ability as very good in 13% of encounters - 17% for SC versus 5% for UC. Patient satisfaction with their ED visit was rated as very good in 35% of encounters - 40% for SC resident physicians versus 25% for UC resident physicians. Of the 13 patients for whom Spanish was the language used during the medical encounter who followed medical recommendations, ten (77%) of these encounters were with SC resident physicians and three (23%) encounters were with UC resident physicians. CONCLUSION: Preliminary data suggest that incorporating Spanish language and cultural competency into residency training has an overall beneficial effect on patient satisfaction and adherence to medical recommendations in Spanish-speaking patients with limited English proficiency.

[Transperitoneal percutaneous cholecystolithotomy]. / Colecistolitotomía percutánea transperitoneal.

Transperitoneal percutaneous cholecystolithotomy is a surgical technique for gallstone removal in the otherwise healthy gallbladder. It is a one-stage, alternative surgical procedure to extracorporeal lithotripsy. ESWL treatment of gallstones permits preservation of the compromised organ but has not been reported to achieve the potential good results. We describe the principles of the technique--similar to that of percutaneous renal surgery--and highlight specific aspects in this condition.

[Massive lower digestive hemorrhage caused by typhoid fever]. / Hemorragia digestiva baja de carácter masivo por fiebre tifoidea.

A case is presented of massive lower intestinal bleeding due to typhoid fever. Because of uncontrollable bleeding, emergency right hemicolectomy and resection of the last 50 cm of the distal ileum was performed after endoscopy and arteriography, both of which were negative. The histology of the lesions typical of this disease is described.