Medida del conocimiento del paciente sobre su medicación antidiabética: revisión sistemática / Measurement of the patient's knowledge about his antidiabetic medication: system¬atic review

INTRODUCCIÓN: El conocimiento que tiene el paciente sobre su medicación antidiabética (CPMA) influye en la adherencia al tratamiento. Por eso es necesario cuantificarlo. OBJETIVO: El objetivo de este estudio fue identificar las distintas formas en que se ha medido el CPMA MÉTODO: Se realizó una revisión sistemática en las bases de datos de Medline, Escopus, Cinahl y Psycinfo. Se utilizó como guía las recomendaciones PRISMA para realizar esta revisión. RESULTADOS: Se incluyeron 3 artículo. Dos de ellos utilizaban cuestionarios para medir el CPMA y el otro utilizó una demostración práctica por parte del paciente. CONCLUSIONES: Ninguna de las formas de medición del CPMA aporto datos de validez y fiabilidad. Es necesario definir el CMPA consensuado a nivel internacional y diseñar una herramienta de medida valida y fiable basada en esta definición

INTRODUCTION: The patient's knowledge about the antidiabetic medication (PKAM) influences medication adherence. That is why it is necessary to quantify it. AIM: The aim of the study was to identify the different ways in which PKAM has been measured. METHOD: A systematic review was carried out in the Medline, Scopus, Cinahl and Psycinfo databases. The PRISMA recommendations were used to perform this review. RESULTS: 3 articles were included. Two of them used questionnaires to measure PKAM and the other used a practical demonstration by the patient. CONCLUSIONS: None of the PKAM measurement methods provided validity and reliability data. It is nec-essary to define the PKAM agreed at an international level and design a valid and reliable measurement tool based on this definition

Willingness to Change Medications Linked to Increased Fall Risk: A Comparison between Age Groups.

OBJECTIVE: To describe and compare two age groups' knowledge of medications linked to falls and willingness to change these medications to reduce their fall risk. METHOD: We analyzed data from community-dwelling adults age 55 and older (n = 1812): 855 adults aged 55 to 64 years and 957 older adults (65 and older) who participated in the 2016 summer wave of the ConsumerStyles survey, an annual Web-based survey. The data are weighted to match the US Current Population Survey proportions on nine US Census Bureau demographic characteristics. MEASUREMENTS: Survey respondents were asked about medication use, knowledge of side effects, their willingness to change their medications to reduce fall risk, communication in the previous year about fall risk with their healthcare provider, and their comfort in discussing fall risk with their healthcare provider. All data were weighted to match the 2016 population estimates. Descriptive statistics and χ2 (p ≤ .05) were used to identify differences between the two age groups. RESULTS: About one-fifth of all respondents reported using at least one class of medication that increases fall risk. Older adults were less likely to report using medications for mood or sadness, less likely to report knowing the side effects of pain medications, and more willing to change their sleep medications compared with their younger counterparts. Among all respondents using these medication classes, less than one-third knew the potential fall-related side effects. However, most of them expressed willingness to change their medication if advised by their healthcare provider. CONCLUSION: Most older adults were unaware of potential fall risks associated with medications prescribed to address pain, difficulty sleeping, mood or sadness, and anxiety- or nervousness-related health issues. However, most were willing to change their medication if recommended by a healthcare provider. J Am Geriatr Soc 67:527-533, 2019.

Implications of involving pharmacy technicians in obtaining a best possible medication history from the perspectives of pharmaceutical, medical and nursing staff: a qualitative study.

OBJECTIVES: In recent years, the involvement of pharmacy technicians in medication reconciliation has increasingly been investigated. The aim of this study was to assess the implications on professional roles and collaboration when a best possible medication history (BPMH) at admission is obtained by pharmacy technicians. DESIGN: Qualitative study with semistructured interviews. Data were analysed using a qualitative content analysis approach. SETTING: Internal medicine units in two mid-sized Swiss hospitals. PARTICIPANTS: 21 staff members working at the two sites (6 pharmacy technicians, 2 pharmacists, 6 nurses, 5 physician residents and 2 senior physicians). RESULTS: Pharmacy technicians generally appreciated their new tasks in obtaining a BPMH. However, they also experienced challenges associated with their new role. Interviewees reported unease with direct patient interaction and challenges with integrating the new BPMH tasks into their regular daily duties. We found that pharmacists played a key role in the BPMH process, since they act as coaches for pharmacy technicians, transmit information to the physicians and reconcile preadmission medication lists with admission orders. Physicians stated that they benefitted from the delegation of administrative tasks to pharmacy technicians. Regarding the interprofessional collaboration, we found that pharmacy technicians in the study acted on a preliminary administrative level and did not become part of the larger treatment team. There was no direct interaction between pharmacy technicians and physicians, but rather, the supervising pharmacists acted as intermediaries. CONCLUSION: The tasks assumed by pharmacy technicians need to be clearly defined and fully integrated into existing processes. Engaging pharmacy technicians may generate new patient safety risks and inefficiencies due to process fragmentation. Communication and information flow at the interfaces between professional groups therefore need to be well organised. More research is needed to understand if and under which circumstances such a model can be efficient and contribute to improving medication safety.

Accuracy of medication information sources compared to the best possible medication history for patients presenting to the emergency department.

OBJECTIVE: To assess the accuracy of medication information sources available for adult patients presenting to the ED, compared to a best possible medication history (BPMH). METHODS: This prospective observational study was undertaken in the ED of a major tertiary-referral teaching hospital. A convenience sample of consecutive adult patients taking one or more regular medications was included. A BPMH was ascertained using patient/carer interviews, where available, and confirmed with one or more other sources. For residential care facility (RCF) patients, the RCF medication chart and at least one other source were used. Information sources compared with the BPMH were community pharmacy dispensing history, patient's own medications, patient's medication list, general practitioner letter, medications stored in and labelled on dose administration aids (DAAs) and the RCF chart. Number of discrepancies per patient for each source was determined by comparing medications and dose regimens to those documented in the BPMH. RESULTS: A total of 455 patients (median age 71 years) took a median of six 'regular' and two 'as required' medications. The median number (range) of discrepancies per patient for regular medication names and dosages were RCF chart 0 (0-3), DAA contents 2.0 (0-9), patient's medication list 2.5 (0-16), DAA medications label 3.0 (0-7), community pharmacy history 3.0 (0-19), general practitioner letter 3.0 (0-18) and patient's own medications 4.0 (0-16). Overall, 40.4% of discrepancies were deemed 'moderate' or 'high' clinical significance. Omission errors accounted for 55.6% of discrepancies. CONCLUSIONS: A combination of sources is essential to determine the BPMH. RCF charts provided the most accurate information. Other sources had two to four regular medication-related discrepancies per patient.

Toxicidad por metotrexato: algo más que recordatorios / Methotrexate toxicity: More than just reminders

No disponible

Awareness of physicians and pharmacists of aldosterone antagonists in heart failure and myocardial infarction in Jordan

Objective: to evaluate physicians and clinical pharmacists' awareness and practices regarding use of aldosterone antagonists in heart failure (HF) and post-myocardial infarction (MI). Methods: First, we reviewed the prescription of aldosterone antagonists among 408 patients presenting to the cardiology clinic at a major hospital in Jordan. Second, physicians and pharmacists working in cardiovascular departments completed a questionnaire related to use of aldosterone antagonists in HF and post-MI. Results: Thirty patients (7.59%) were eligible for aldosterone antagonist; only 4 received them at discharge (13.3%). The survey was completed by 153 professionals (response rate 76.12%). About 72.1% of participants were aware of studies regarding use of aldosterone antagonists post-MI and in HF. Moreover, 10.45%/53.6% of participants strongly agreed/agreed that these agents are useful in normotensive post-MI and HF patients. Spironolactone was the most prescribed drug by 92.1% of participants. About 41.8% of participants reported use of spironolactone in post-MI and HF. With respect to guidelines, only 39.2% of participants agreed that adding spironolactone to standard therapy in HF is recommended, and 48.3% agreed on adding it directly post-MI. Clinical pharmacists and cardiologists were generally more aware of guidelines than pharmacists, cardiac surgeons and residents/fellows. Conclusions: there is an under-use of aldosterone antagonists in HF and post-MI patients, and a lack of detailed awareness of current guidelines among health care providers. Dissemination of evidence-based guidelines and usage protocols may improve management of post-MI and HF (AU)

No disponible

A circle of silence: The attitudes of patients older than 65 years of age to ceasing long-term sleeping tablets.

BACKGROUND: Nocturnal benzodiazepines have a significant negative health impact on the elderly, yet they continue to be used. OBJECTIVE: The aim of this study was to assess elderly patients' use and knowledge of nocturnal benzodiazepines, and their attitudes to cessation. METHODS: Semi-structured telephone interviews were conducted with elderly patients (n = 17) from four general practices in Australia. RESULTS: Our study found that the initiation of benzodiazepine use was often at a time of stress for the patient. Long-term use was not in-tended, and patients conveyed poor awareness of the side effects and addictive potential of benzodiazepines. Patients' perceived attitudes of their general practitioner (GP) to prescribing benzodiazepines and lack of awareness of alternative therapies were key to continuation. Confounding factors such as pain often contributed to sleep disturbance. Many patients expressed a willingness to cease nocturnal benzodiazepine use. DISCUSSION: These data assist in raising GPs' awareness of patients' attitudes to cessation of nocturnal benzodiazepine use. More time spent with patients presenting for repeat prescriptions, explaining side effects, discussing alternative options and investigating reasons for not sleeping could reduce benzodiazepine use among the elderly.

Validation of scores of use of inhalation devices: valoration of errors.

OBJECTIVE: To validate two scores quantifying the ability of patients to use metered dose inhalers (MDIs) or dry powder inhalers (DPIs); to identify the most common errors made during their use; and to identify the patients in need of an educational program for the use of these devices. METHODS: This study was conducted in three phases: validation of the reliability of the inhaler technique scores; validation of the contents of the two scores using a convenience sample; and testing for criterion validation and discriminant validation of these instruments in patients who met the inclusion criteria. RESULTS: The convenience sample comprised 16 patients. Interobserver disagreement was found in 19% and 25% of the DPI and MDI scores, respectively. After expert analysis on the subject, the scores were modified and were applied in 72 patients. The most relevant difficulty encountered during the use of both types of devices was the maintenance of total lung capacity after a deep inhalation. The degree of correlation of the scores by observer was 0.97 (p < 0.0001). There was good interobserver agreement in the classification of patients as able/not able to use a DPI (50%/50% and 52%/58%; p < 0.01) and an MDI (49%/51% and 54%/46%; p < 0.05). CONCLUSIONS: The validated scores allow the identification and correction of inhaler technique errors during consultations and, as a result, improvement in the management of inhalation devices.

Validation of scores of use of inhalation devices: valoration of errors / Validação de escores de uso de dispositivos para inalação: valoração dos erros cometidos

AbstractObjective: To validate two scores quantifying the ability of patients to use metered dose inhalers (MDIs) or dry powder inhalers (DPIs); to identify the most common errors made during their use; and to identify the patients in need of an educational program for the use of these devices.Methods: This study was conducted in three phases: validation of the reliability of the inhaler technique scores; validation of the contents of the two scores using a convenience sample; and testing for criterion validation and discriminant validation of these instruments in patients who met the inclusion criteria.Results: The convenience sample comprised 16 patients. Interobserver disagreement was found in 19% and 25% of the DPI and MDI scores, respectively. After expert analysis on the subject, the scores were modified and were applied in 72 patients. The most relevant difficulty encountered during the use of both types of devices was the maintenance of total lung capacity after a deep inhalation. The degree of correlation of the scores by observer was 0.97 (p < 0.0001). There was good interobserver agreement in the classification of patients as able/not able to use a DPI (50%/50% and 52%/58%; p < 0.01) and an MDI (49%/51% and 54%/46%; p < 0.05).Conclusions: The validated scores allow the identification and correction of inhaler technique errors during consultations and, as a result, improvement in the management of inhalation devices.

ResumoObjetivo: Validar dois escores para medir a habilidade de pacientes em utilizar inaladores pressurizados (IPs) ou inaladores de pó (IPos), verificar os erros mais comuns na sua utilização e identificar os pacientes que necessitam de um programa educacional para o uso desses dispositivos.Métodos: Este estudo foi realizado em três etapas: validação da confiabilidade dos escores de uso dos dispositivos inalatórios; validação do conteúdo dos escores utilizando-se uma amostra de conveniência; e realização de testes para a validação de critério e a validação discriminante desses instrumentos em pacientes que preenchiam os critérios de inclusão do estudo.Resultados: A amostra de conveniência foi composta por 16 pacientes, e houve discordância interobservador em 19% e 25% para os escores de IPo e IP, respectivamente. Após a análise de expertos no assunto, os escores sofreram modificações e foram aplicados em 72 pacientes. A dificuldade mais relevante no uso de ambos os dispositivos foi a manutenção da capacidade pulmonar total após inspiração profunda. O grau de correlação dos escores por observador foi de 0,97 (p < 0,0001). Houve boa concordância interobservador na classificação dos pacientes como aptos/não aptos para uso de IPo (50%/50% e 52%/58%; p < 0,01) e de IP (49%/51% e 54%/46%; p < 0,05).Conclusões: Os escores validados permitem identificar e corrigir os erros da técnica inalatória ao longo das consultas e, em consequência, melhorar o manejo dos dispositivos para inalação.

Diseño y pilotaje de un proceso estructurado para el servicio de dispensación de medicamentos / Design and piloting of a structured service medication dispensing process

OBJETIVO: Diseñar y pilotar un protocolo para el servicio de dispensación de medicamentos. DISEÑO: Se partió de los requisitos propuestos en el Consenso de Atención Farmacéutica del Ministerio de Sanidad, se realizó una búsqueda bibliográfica y se aplicaron técnicas cualitativas de consenso. Para el pilotaje se realizó un estudio observacional transversal de marzo a junio de 2009. Emplazamiento: 53 farmacias comunitarias de 24 provincias españolas. PARTICIPANTES: Pacientes que solicitaron uno o varios medicamentos concretos con o sin receta médica para uso propio o para alguien a su cuidado. MEDICIONES PRINCIPALES: La información personalizada sobre el medicamento (IPM), los problemas relacionados con los medicamentos (PRM) y los resultados negativos asociados a la medicación (RNM) detectados por el farmacéutico en cada dispensación, así como la percepción de operatividad del farmacéutico sobre el protocolo. RESULTADOS: Se realizaron 870 dispensaciones, se detectaron 423 (48,6%) casos de falta de información en los que se ofreció IPM. En un 10,11% de las dispensaciones realizadas se detectaron PRM y 68 sospechas de RNM (7,81%): de seguridad (n = 35; 51,5%), efectividad (n = 29; 42,6%) y necesidad (n = 4; 5,8%). El 65,21% de los farmacéuticos afirmaron que el proceso estructurado es operativo. CONCLUSIONES: El protocolo diseñado permite detectar las carencias de información del paciente sobre sus medicamentos, así como los PRM y RNM siendo una herramienta fácil de utilizar y aplicable

OBJECTIVE: The aim of this article is to design and pilot a protocol for the dispensing of medications service. DESIGN:Using the requirements proposed in the Ministry of Health Pharmaceutical Care Consensus, a literature search was made applying qualitative consensus techniques. An observational, cross-sectional study was conducted from March to June 2009. SETTING: A total of 53 community pharmacies from 24 Spanish counties. Participant: Patients who requested one or more particular medications with or without medical prescription for their own use or for someone in their care. MAIN MEASUREMENTS: The personalised medication information (IPM), the problems associated with the medications (PRM), and the negative results associated with the medication (RNM), detected by the pharmacist each time medication was dispensed, as well as the perception of the pharmacist on the operability of the protocol were recorded. RESULTS: A total of 870 medications were dispensed, with 423 (48.6%) cases of lack of personalised medication information (IPM) being detected. PRM were detected in 10.11% of the dispensed medications, as well as 68 (7.81%) suspected RNM: safety (n = 35; 51.5%), effectiveness (n = 29; 42.6%) and necessity (n = 4; 5.8%). Almost two-thirds (65.21%) of the pharmacists said that the protocol is in operation. CONCLUSIONS: The designed protocol helped to detect deficiencies in the information to the patients about their medications, as well as the PRM and RNM, and is shown to be tool that is easy to use and apply

Trying to improve care: the Morbidity and Mortality Conference in a division of rheumatology.

OBJECTIVE: To describe the frequency and types of reported adverse events and system improvement recommendations in the Morbidity and Mortality Conference (M&MC) within the Division of Rheumatology at The Hospital for Sick Children, Toronto, Ontario, Canada (SickKids). METHODS: A 5-year retrospective review of the M&MC within the Division of Rheumatology at SickKids was completed. Descriptive data including the number and types of events reported were collected. Events were categorized using an adaptation of the National Coordinating Council for Medication Error Reporting and Prevention Index. Recommendations were classified according to the Institute for Safe Medication Practices Canada. RESULTS: Between January 2007 and December 2011, 30 regularly scheduled M&MC were held. Eighty-three cases were reviewed. The most common types of reported events were related to "miscommunication" (34.9%), "treatment/test/procedure" (22.9%), "adverse drug reactions" (12.0%), and "medication errors" (8.4%). Category A events ("an event that has the capacity to cause error") were the most common with 39.8% of the cases, followed by Category C events ("an event occurred that reached the patient, but did not cause harm") with 28.9%. Eighty-nine recommendations were made. Over half of these were classified as "information" (58.4%), followed by 11 "rules and policies" recommendations (12.4%). Of the 36 action items generated from these recommendations, most are either complete or ongoing. CONCLUSION: The M&MC within the Division of Rheumatology reviews a variety of events. Increased reporting of adverse events can lead to system improvements, and has the potential to improve and promote safer healthcare.

La calidad de vida en ancianos polimedicados con multimorbilidad / Quality of life in the elderly on polymedication and with multiple morbidities

Objetivos. Estimar los valores de las dimensiones de la calidad de vida mediante el cuestionario SF-12 en ancianos polimedicados con multimorbilidad e identificar variables asociadas. Material y métodos. Estudio transversal en una muestra de 393 enfermos elegidos en la población de mayores de 67 años que tomaban más de 5 medicamentos. El SF-12 se cumplimentó mediante entrevista personal en la consulta o en el domicilio del enfermo. Se calcularon medidas de tendencia central, dispersión y percentiles de las 8 dimensiones y de los componentes sumario físico y mental (CSF y CSM). Todos los enfermos por debajo del percentil 25 de los CSF y CSM fueron clasificados como enfermos con deterioro; mediante la regresión logística se determinaron qué variables se asocian con el deterioro de la calidad de vida. Resultados. Es una población con alta morbilidad. Los sujetos refieren puntuaciones muy bajas en las escalas salud general −media (DE): 25,7 (17,4)−; función física −32,6 (32,1)−; y CSF −37,8 (25,1)−. Las mujeres tienen en todas la escalas peor calidad de vida que los hombres. El sexo femenino, tener más 80 años, caídas frecuentes, dolor crónico, enfermedad cancerosa y depresión son las condiciones asociadas al deterioro de la calidad de vida relacionada con la salud (CVRS). Conclusión. Esta población tiene una mala CVRS sobre todo en las dimensiones físicas. El dolor crónico y la depresión junto con la edad y el sexo femenino son variables determinantes del deterioro de la CVRS (AU)

Objectives. To estimate the values of the quality of life dimensions using the SF-12 questionnaire in the elderly on polymedication and with multiple morbidities, and identify the variables associated with it. Material and methods. A cross-sectional study on a sample of 393 patients selected from the elderly population over 67 years and who took more than 5 drugs. The SF-12 was complemented by a personal interview in the clinic or in the home of the patient. Central tendency, dispersion, and the percentiles of the 8 dimensions were calculated, as well as the SF-36 physical and mental component summary measures (PCS and MCS). All patients below the 25th percentile of the PCS and MCS were classified as patients with a deterioration. Logistic regression was used to determine the variables that were associated with the deterioration in the quality of life. Results. It is a population with high morbidity. The subjects showed very low scores on the general health scales −mean (SD): 25.7 (17.4)−; physical function −32.6 (32.1)−; and PCS: [(37.8 (25.1)]. Women had a worse quality of life than men in all the scales. Female sex, being over 80 years, frequent falls, chronic pain, cancerous disease, and depression, are variables that determine the health-related quality of life (HR-QoL). Conclusion. This population has a poor HR-QoL, particularly in the physical dimensions. Chronic pain and depression, together with age and being female are variables that determine the deterioration in the HR-Q (AU)

Seguimiento farmacoterapéutico ¿por dónde empiezo? / Pharmacotherpay follow-up. Where do I start?

Objetivos: Proporcionar los conocimientos y habilidades básicos para realizar Seguimiento Farmacoterapéutico (SFT) en el ámbito de la oficina de Farmacia. Promover la motivación y el cambio en la conducta hacia la realización del servicio de SFT en la farmacia. Método: Talleres limitados para 12 alumnos. Se desarrollan tres sesiones. En las dos primeras, celebradas en días consecutivos, se imparten los conocimientos básicos para realizar el SFT. Primera sesión: se realiza una entrevista real a un paciente. Después se elabora el estado de situación de este caso, participando todo el grupo. Segunda sesión: se realiza la fase de estudio, dividiéndose los alumnos en pequeños grupos por las patologías a estudiar. Tercera sesión: se desarrolla tres semanas después, para que el farmacéutico disponga del tiempo necesario para captar y hacer SFT a un paciente. Cada alumno hace una exposición de su caso de SFT. Resultados: Se han impartido tres Talleres, participando un total de 33 farmacéuticos. Resolución de casos de pacientes por los alumnos: RNM detectados: 76; Nº de intervenciones realizadas: 82; RNM resueltos: 56 Evaluación del Taller (duración, recursos materiales utilizados): Nota media: 9,31 Evaluación del Profesorado: Nota media: 9,77 Conclusiones: Los profesores detectan el cambio de los alumnos en su actitud profesional ante el paciente y su tratamiento. El posible beneficio clínico que se obtengalleva a plantear nuevas estrategias para el formato futuro de esta actividad formativa

Objectives: To provide the basic knowledge and skills to carry out a Pharmacotherapy Follow-up (SFT) within the Pharmacy field. Besides, to provote the motivation and a behaviour change related to the realization of the SFT service in the pharmacy. Method: Workshops limited to 12 students. There are three sessions. In the first two ones, held on consecutive days, the basic skills to carry out the SFT are taught. First session: we do a real interview to a patient. After, with the participation of the whole group, we determine the status of the case. Second session: the study phase is performed, dividing the students into small groups according to the pathologies that have to be studied. Third session: it is held three weeks later, so that the pharmacist can have sufficient time to capture and make SFT to a patient. Each student makes a presentation of his/her SFT case. Results: Three workshops have been given, involving a total of 33 pharmacists. Cases of patients resolved by pupils: NRM detected: 76; Nº of interventions performed: 82; NRM resolved: 56 Evaluation of the Workshop (duration, material resources used): average score: 9.31 Teachers evaluation: average score: 9.77 Conclusions: Teachers detect a change in the students professional attitude towards the patient and his/her therapy. The possible clinical benefit obtained leads to consider new strategies for the future format of this educational activity

Making pharmacists part of the multidisciplinary team.

Having pharmacists on the multidisciplinary team can help ensure that patients progress well in the hospital and that they follow their medication plan at home and avoid emergency department visits or readmissions. Pharmacists can review medication lists and correct problems as well as ensuring that patients receive the right doses and selections of medication for their ages, weights, and conditions. They can help case managers and social workers deal with complex prescription benefits plans and help with preauthorizations and other issues that can potentially delay filling prescriptions. Pharmacists can use their knowledge of medication to recognize when a patient may not be able to afford a medication and to suggest less expensive alternatives to the physician.

Frail elderly patients' experiences of information on medication. A qualitative study.

BACKGROUND: Older patients generally have only poor knowledge about their medicines. Knowledge is important for good adherence and for participating in decisions about treatment. Patients are entitled to be informed on an individual and adequate level. The aim of the study was to explore frail elderly patients' experiences of receiving information about their medications and their views on how the information should best be given. METHODS: The study was qualitative in design and was carried out in 2011. Twelve frail elderly (aged 68-88) participants taking cardiovascular medications participated in semi-structured interviews covering issues related to receiving information about prescribed medicines. The interviews were recorded, transcribed and subjected to content analysis, in which the text was analysed in five steps, inspired by Graneheim and Lundman. RESULTS: The results revealed that the experiences which the elderly participants had regarding the receiving of medical information fell into two main categories: "Comfortable with information" or "Insecure with information". The elderly felt comfortable when they trusted their physician or their medication, when they received enough information from the prescriber or when they knew how to find out sufficient information by themselves. They felt insecure if they were anxious, if the availability of medical care was poor or if they did not receive enough information. CONCLUSIONS: Factors that frequently caused insecurity about information and anxiety were too short consultations, lack of availability of someone to answer questions or of the opportunity to contact the physician if adverse effects are suspected. These factors could easily be dealt with and there must be improvements in the clinics if the patients' feelings of security are to be increased.

Performance of a new speech translation device in translating verbal recommendations of medication action plans for patients with diabetes.

BACKGROUND: Language barriers are significant hurdles for chronic disease patients in achieving self-management goals of therapy, particularly in settings where practitioners have limited nonprimary language skills, and in-person translators may not always be available. S-MINDS© (Speaking Multilingual Interactive Natural Dialog System), a concept-based speech translation approach developed by Fluential Inc., can be applied to bridge the technologic gaps that limit the complexity and length of utterances that can be recognized and translated by devices and has the potential to broaden access to translation services in the clinical settings. METHODS: The prototype translation system was evaluated prospectively for accuracy and patient satisfaction in underserved Spanish-speaking patients with diabetes and limited English proficiency and was compared with other commercial systems for robustness against degradation of translation due to ambient noise and speech patterns. RESULTS: Accuracy related to translating the English-Spanish-English communication string from practitioner to device to patient to device to practitioner was high (97-100%). Patient satisfaction was high (means of 4.7-4.9 over four domains on a 5-point Likert scale). The device outperformed three other commercial speech translation systems in terms of accuracy during fast speech utterances, under quiet and noisy fluent speech conditions, and when challenged with various speech disfluencies (i.e., fillers, false starts, stutters, repairs, and long pauses). CONCLUSIONS: A concept-based English-Spanish speech translation system has been successfully developed in prototype form that can accept long utterances (up to 20 words) with limited to no degradation in accuracy. The functionality of the system is superior to leading commercial speech translation systems.