No difference in emergency department length of stay for patients with limited proficiency in English.

OBJECTIVES: The population of the United States continues to diversify, with an increasing percentage of individuals who have limited English proficiency (LEP). A major concern facing emergency departments (EDs) around the country is increasing length of stay (LOS). Although multiple studies have shown racial and ethnic disparities in waiting time and LOS, no studies have examined specifically whether patients with LEP have a different LOS than English-speaking (ES) patients. In addition, no studies have examined whether the use of interpreters by patients with LEP has a significant impact on LOS. We hypothesized that there was a significant difference in LOS when comparing patients with LEP and ES patients and patients with LEP who used interpreters versus patients with LEP who did not. METHODS: This was a prospective cohort study with LOS data collected from a level I ED patient tracking software program from October 2011 to December 2011. The primary language preferred by the patient was indicated at the time of triage and registration and the patient's use of an interpreter also was recorded. The patient's demographic data, ED visit information, and LOS were prospectively entered into an Excel spreadsheet. Percentages were compared using 95% confidence intervals and LOS was analyzed using the Student t test. With >100 subjects per group, our study had 80% power (ie, a power of 0.8) to determine a 15% difference in proportions between groups or a difference of 120 minutes (assuming a standard deviation of 300 minutes on both means). RESULTS: Data were collected from a total of 121 ES patients and 124 patients with LEP. In the LEP group were the languages of Spanish, Navajo, Vietnamese, Chinese, Arabic, and American Sign Language. Fifty-eight percent of patients with LEP used an interpreter. There were no differences between ES patients and patients with LEP in age, sex, mode of arrival, chief complaints, acuity, percentage admitted, percentage pediatric patients, or percentage of Medicaid/Medicare recipients. More patients with LEP were self-pay (36% vs 20%, diff 16, 95% confidence interval 2-31). There were no differences in mean LOS from time of arrival to time to being seen by a provider when comparing ES patients with patients with LEP or time of arrival to time to discharge or admission request. Comparing the patients with LEP who used interpreters with those who did not use interpreters, there was a significantly different LOS from time of arrival to time of discharge or admission request (958 ± 644 vs 628 ± 595 minutes, diff 330, 95% confidence interval 84-576). CONCLUSIONS: There was no difference in LOS for patients with LEP; however, patients with LEP who used interpreters had a significant increase in LOS compared with those who did not use interpreters.

COVID-19 Education for Health Professionals Caring for Spanish-Speaking Patients.

Introduction: The COVID-19 pandemic has disproportionately affected Hispanics in the United States, who make up 18% of US inhabitants but 29% of COVID-19 cases as of June 2021. Recent studies have attributed higher COVID-19 infection, hospitalization, and death rates among Hispanics to social determinants of health. Given that the majority of US Hispanics are bilingual or Spanish-dominant, it is imperative for health care providers to be prepared to discuss COVID-19 prevention and treatment in Spanish. Methods: We developed an interactive workshop aimed at increasing health professionals' confidence in discussing COVID-19 prevention, risk factors, and treatments with Spanish-speaking patients. Learners were expected to have an intermediate level or higher proficiency in medical Spanish. The workshop consisted of a PowerPoint presentation and English/Spanish scripts to facilitate interactive learning. The workshop was evaluated using a postworkshop questionnaire to assess learners' perceived confidence in communicating with Spanish-speaking patients. Results: The workshop was implemented with 70 participants, who had diverse ethnoracial identities and professional roles, at five different medical schools. Fifty-three participants completed the postworkshop questionnaire. More than 50% reported near complete to complete confidence in meeting the three learning objectives. Discussion: With Hispanics being the largest non-White ethnoracial group in the US and being disproportionally affected by COVID-19, it is essential for health professionals to access training tools that allow them to practice medical Spanish. This module can uniquely aid in the preparation of health professionals caring for Spanish-speaking patients who present with COVID-19 symptoms.

A gene family of putative immune recognition molecules in the hydroid Hydractinia.

Animal taxa display a wide array of immune-type receptors that differ in their specificities, diversity, and mode of evolution. These molecules ensure effective recognition of potential pathogens for subsequent neutralization and clearance. We have characterized a family of putative immune recognition molecules in the colonial hydroid Hydractinia symbiolongicarpus. A complementary DNA fragment with high similarity to the sea urchin L: -rhamnose-binding lectin was isolated and used to screen 9.5 genome equivalents of a H. symbiolongicarpus bacterial artificial chromosome library. One of the resulting 19 positive clones was sequenced and revealed the presence of a 5,111-bp gene organized in 13 exons and 12 introns. The gene was predicted to encode a 726-amino acid secreted modular protein composed of a signal peptide, an anonymous serine-rich domain, eight thrombospondin type 1 repeats, and a L: -rhamnose-binding lectin domain. The molecule was thus termed Rhamnospondin (Rsp). Southern hybridization and sequence analyses indicated the presence of a second Rsp gene. The cDNA from both Rsp genes was sequenced in 18 individuals, revealing high levels of genetic polymorphism. Nucleotide substitutions were distributed throughout the molecule and showed a significantly higher number of synonymous substitutions per synonymous sites than its nonsynonymous counterparts. Whole-mount in situ hybridization and semi-quantitative reverse transcription polymerase chain reaction of microorganism-challenged colonies indicated that Rsp molecules were specifically and constitutively expressed in the hypostome of gastrozooids' mouth. Thus, the combination of (1) comparative analysis on domain composition and function, (2) polymorphism, and (3) expression patterns, suggest that Rsp genes encode a family of putative immune recognition receptors, which may act by binding microorganisms invading the colony through the polyp's mouth.