Multilingual healthcare communication: Stumbling blocks,solutions, recommendations

ObjectiveTo provide guidance on multilingual and language discordant healthcare communication.DiscussionWe provide a critical reflection on common stumbling blocks to securing (professional) language support, as well as on the currently available solutions to language discordance in healthcare. We discuss issues pertaining to i) the assessment of the patient and healthcare professional’s language proficiency, ii) the decision making on whether to seek language support, iii) the currently available options of language support and the development of skills that ensure their effective use, iv) the inclusion of professional interpreters in the interprofessional healthcare team, and v) the transition from single- to integrated language support solutions that allow for a more comprehensive approach to multilingual healthcare communication. We present a set of recommendations for good practice.ConclusionUnderstanding the needs, capabilities and shortcoming of the available language- support solutions and the implications arising from them can enable decision makers to make informed decisions that ensure the quality of communication and care. The integrated use of language-support solutions at different stages of care can create the conditions for effective communication, while promoting patient and family participation in the decision making process. Evidence-based interventions that can inform the implementation of solutions are required.     

Prepulse inhibition of the human startle eye blink response by visual food cues

We present a new paradigm to investigate cognitive processing of food cues. The study assessed if pictures of food induce prepulse inhibition (PPI) of startle eye blink, and if any such effect is sensitive to food deprivation. In a balanced cross-over design, 16 healthy male volunteers (mean age: 29 years) were tested on 2 days 1 week apart, either after a period of normal food intake (NFI) or after a 24 h period of food restriction (RFI). On each experimental day, 80 control and 20 food pictures (slides) were displayed. Noise stimuli were presented 250 ms after slide onset. Startle responses were assessed by EMG recordings of the right M. orbicularis oculi. Startle elicited during dark inter-slide periods served as control responses to calculate PPI effects. The arousing content of each picture was rated by all subjects at the end of the session. The perceived arousal effect of control slides was strongly related to their PPI effect; no impact of food access status on this association was detectable. After NFI, food slides significantly induced PPI of startle (mean: -14.5%). After RFI, arousal ratings for food pictures increased but PPI did not. These results are evidence for a pre-attentive mechanism operative in the processing of visual food cues.     

Patient opinion surveys in the hospital: revalidation and improvement of a questionnaire

Measures to improve quality of care in hospitals should best be based upon the results of patient surveys. The present paper reports in the validation of a questionnaire originally developed in the US in 658 patients from two Swiss hospitals in a tertiary care setting. Questionnaires were sent out two weeks after release from hospital, more than 75 percent of questionnaires were returned. Based upon the experience that feedback of many single items rarely results in distinct actions to improve quality of care a factor analysis followed by an analysis of reliability was undertaken to validate the instrument and to reduce the amount of information, to help hospital officials to deal with the data, and finally to reduce the number of items in the questionnaire. Factor analysis revealed a 3-factor-solution based upon 25 out of 37 deficit-oriented questions, explaining 34.4 % of total variance. The factors can be described as: 1. Patient information (9 items; explained variance: 13.0 %); 2. Patient involvement and shared decision making (11 items; explained variance: 11.2 %); 3. Nursing quality (5 items; explained variance: 10.2 %). Cronbach's alpha values of these scales are 0.75, 0.72, and 0.69, respectively. As further analyses show, reducing the item pool does not lead to the loss of relevant information. Single wards show substantial differences in scores based on these factors (e.g. between 10 and 27 percent deficit in factor 2). The sensitivity of the factors in describing specific profiles of single wards will help to target measures to improve quality of care to those wards where improvement is most utterly needed.     

Midazolam effects on prepulse inhibition of the acoustic blink reflex

AIMS: The eye-blink response following sudden acoustic noise bursts is part of the startle reflex. The magnitude of the startle response can be attenuated by presentation of a weak stimulus before the 'startle-eliciting' stimulus (prepulse inhibition, PPI). PPI is a stable finding in awake humans but may be altered by anaesthetic drugs. We investigated whether the application of benzodiazepines altered the magnitude of PPI in healthy male volunteers. METHODS: In an open-label noncontrolled investigation, the effect of the benzodiazepine agonist midazolam on PPI was assessed in the absence and presence of the antagonist flumazenil. After an initial control period of 60 min three consecutive periods, each of 60 min, with progressively increasing concentrations of midazolam were studied (0. 02, 0.06, 0.14 mg kg-1 h-1 ). A final 60 min period during the administration of flumazenil (0.004 mg kg-1 h-1 ) and while the agonist was still present was also studied. Drug was administered intravenuously as a combination of bolus, 50% of total dose and continuous infusion over the 60 min period. Electromyographic (EMG) response of the right orbicularis oculi muscle was used to assess the startle response to noise bursts of 50 ms duration (95 dB(A)). Noise bursts were randomly preceded by nonstartling prepulses (800 Hz sinus, 50 ms duration, 65 dB(A), prepulse to noise interval 120 ms). The magnitude of PPI was calculated by dividing the EMG response to nonprepulsed stimuli by the response to prepulsed stimuli for each individual and period. Eleven subjects participated in the study, two of them were excluded from the statistical analysis because startle responses could not be reliably elicited (final sample size n=9). RESULTS: The magnitude of PPI was inversely related to the concentration of midazolam. This relationship was described by a sigmoidal Emax model, giving an Emax of 0.65+/-0.13, an ED50 of 33.9+/-10.9 ng ml-1 and gamma of 3.5+/-1.0. During infusion of flumazenil and in the presence of midazolam, the magnitude of PPI increased by 0.11 (95% CI, 0-0.22, P相似文献   

Changes in sympathetic and parasympathetic cardiac activation during mental load: an assessment by spectral analysis of heart rate variability.

Spectral analyses of heart rate (HR) and blood pressure (BP) fluctuations yield three typical peaks at a low (0.02-0.06 Hz), a mid (0.07-0.14 Hz) and a high (around the respiratory frequency) frequency area. These so-called bands attract the interest of researchers because they seem to offer the facility of non-invasively studying autonomic cardiovascular control mechanisms. The high frequency component is solely under vagal control, the influence of sympathetic/vagal efferents on the low and mid frequency band is unclear. We therefore investigated in a single case study (23 year old male) the effects of propanol (0.06 mg/kg, 30 min. interruption, 0.12 mg/kg i.v.), dobutamine (1.14 micrograms/kg/min for 30 minutes, then 2.21 micrograms/kg/min i.v., then 4.42 micrograms/kg/min), atropine (0.01 mg/kg within 5 minutes, 30 minutes later 0.02 mg/kg within 5 minutes), and carbachol (0.125 mg, 30 min. interruption, 0.25 mg s.c.) upon HR, HR-variability spectra, BP and respiratory parameters at rest and during 5 minutes of a mental task. Under all four drug conditions BP is elevated at rest and mental stress, the latter always giving higher results than the former. Atropine shortens interbeat intervals (IBI) by almost 50 percent (from 939 msec to 514 msec), the high dose of dobutamine reduces IBI from 725 to 580 msec, propranolol increases interval length by 10 percent. Drug effects on spectral bands give clear results with atropine: It reduces spectral energy in all three frequency bands at rest and during mental stress. The other drugs show no clear-cut effects on HR-variability spectra. Even though results of a single case study should be interpreted with great caution we believe that the following conclusion can be made: At rest and during short-lasting mental stress all frequency bands in HR-variability spectra are to a large extent under parasympathetic control.     

Bridging the gap: how traditional healers interact with their patients. A comparative study in Cameroon

Objective To compare traditional healers (TH) and Cameroonian representatives of Western medicine (Western providers (WP)) in terms of patient characteristics and communication patterns during the consultation in rural Cameroon. Methods A facility‐based comparative study was conducted. Seven TH were compared to eight WP in the same district. Patients (five per provider) provided detailed socio‐demographic data. Recorded consultations were analysed with the Roter Interaction Analysis System (RIAS). Results Patients were similar in socio‐demographic characteristics except for age, where TH patients were on average 9 years younger (P < 0.05). Patients of TH travelled 2.5 times as far to their provider as did patients in the WP group (79 vs. 31 km; P < 0.05) and paid 12 times more for their treatment (123 vs. 10 Euros; P < 0.05). Consultations of TH were shorter (5.6 vs. 10.3 min, P < 0.01), had fewer utterances (100 vs. 166, P < 0.05) and the patient’s share in the communication was smaller (P < 0.01). TH had a higher percentage of lifestyle and psychosocial information at the expense of medical information (P < 0.05) and communicated more emotionally (P < 0.001). They asked more frequently for their patients’ opinion (P < 0.01) and explicitly discussed their patients’ concept of illness (P < 0.001). Patients of TH responded with a higher percentage of active communication (P < 0.05) i.e. question asking (P < 0.01). Conclusions Our data contradict the idea that the lack of money or geographical access to Western health care in rural Africa is the main reason for people to consult traditional healers. Compared to WP, TH interacted very differently with their clients, using a more patient‐centred communication style, to seek common ground with patients. This different type of interaction could be a relevant factor contributing to the popularity of traditional healers in Cameroon.