Testing of a verbal assessment tool of English proficiency for use in the healthcare setting

OBJECTIVE: The purpose of the study is to test a verbal test of English comprehension for use in the healthcare setting. The BEST (Basic English Skills Test) oral interview test is a verbal test to determine language competency. There is currently no verbal test for determination of English language competency used in healthcare. Currently, the STOFHLA (Short Test of Functional Health Literacy Assessment) is used; however, it measures health literacy using a written exam, which does not measure language competency. METHODS: A convenience sample was used to conduct the study in an urban level-1 pediatric and adult trauma center with 45,000 annual visits. The two tests, STOFHLA and BEST, were administered by trained research fellows in patient rooms to 100 patients, 52% who were English speakers and 48% whom self-declare they spoke English as a second language. Participants include adult patients aged > 18, who were medically stable and able to give consent and who presented to the emergency department from May of 2004 to November of 2004. The study was approved by the institutional review board. RESULTS: Using an ANOVA test with a significance of < or = 0.05, the BEST exam showed a difference between native speakers and ESL with F = 16.718 significant at 0.01. The STOFHLA also showed a difference between the two groups with F = 5.890 significant at 0.017. There was a significant relationship, p value of 0.000, between those passing the BEST exam and those individuals with passing the STOFHLA exam, thus showing that those who passed STOFHLA also passed the BEST exam. CONCLUSIONS: The oral interview BEST test can be used in the ED to determine English competency. The results of the BEST test could be used to independently determine the need for a translator within the emergency department. A modified version based on results of this study may be administered to quickly determine English competency. The BEST test and STOFHLA test results, despite measuring different types of skills, were significantly related at the 0.05 level. This may indicate that an underlying factor such as educational levels plays a significant role in determining both types of competency.     

Refinement, scoring, and validation of the Family Satisfaction in the Intensive Care Unit (FS-ICU) survey

OBJECTIVES: To refine the Family Satisfaction in the Intensive Care Unit (FS-ICU) survey and develop a validated method for scoring the instrument. DESIGN: Instrument development study, using data from two prospective cohort studies. SETTING: Intensive care units in seven university-affiliated hospitals (six Canadian, one United States). SUBJECTS: Family members of ICU patients. INTERVENTIONS: Based on a priori criteria, items were tagged for potential removal and discussed with the FS-ICU developers. Factor analysis was used to test the conceptual structure of the instrument and develop a scoring method based on scales and subscales. The new scoring method was validated in the U.S. cohort using the Quality of Dying and Death (QODD) instrument and nurse-assessed quality indicators. MEASUREMENTS AND MAIN RESULTS: A total of 1,038 family members completed the FS-ICU across seven sites. Fifteen items were initially tagged for possible removal. After consensus with the developers, ten items were dropped (and 24 were retained in the final instrument). Factor analysis explained 61.3% of the total variance using a two-factor model. The first factor pertained to satisfaction with care (14 items). The second factor encompassed satisfaction with decision making (10 items). A scoring method was developed based on this conceptual model. In validity testing, the FS-ICU was significantly correlated with the Family-QODD total score (Spearman's .56, p < .001) as well as individual QODD items such as quality of care by all providers (.64, p < .001). The FS-ICU also correlated significantly with multiple nurse-assessed quality indicators. CONCLUSIONS: The shortened FS-ICU measures two main conceptual domains-satisfaction with care and satisfaction with decision making. Scores on the FS-ICU show good validity against other indicators of ICU quality. The instrument holds promise as a useful outcome measure in studies that attempt to improve this component of ICU care.     

Prevalence and severity of hypertension in a dental hygiene clinic

AIM: The purpose of this study was to assess the prevalence and severity of hypertension in a dental hygiene clinic and evaluate factors related to the disease. METHODS AND MATERIALS: Records of 615 patients, treated by dental hygiene students during 2003, were reviewed. Data collected included systolic and diastolic blood pressure, presence of diabetes and renal disease, non-modifiers (race, gender, and age), and modifiers (marital status, smoking habits, and occupation). RESULTS: According to the Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7) classification, 154 (25%) of the subjects had normal blood pressure readings, 374 (60.8%) had prehypertension, and 87 (14.1%) had stage 1 hypertension. Statistical analysis showed a significant difference in the JNC7 classification between groups when considering the non-modifiers' race (p=.02) and the modifiers' smoking habits (p=.03) and occupation (p=.01). A statistically significant difference in the JNC7 classification existed between groups with diabetes (p=.00). The majority of patients had blood pressure readings in the prehypertension stage. CONCLUSION: Based on these results, the researchers recommend clinical policy modifications which include: additional documentation for blood pressure readings in the prehypertension stage, lowering the systolic reading from 160 mmHg to 140 mmHg when adding hypertension alert labels, and noting prehypertension/hypertension on the dental hygiene care plan with the appropriate interventions.