Addressing Language Barriers in the Intensive Care Unit: A Case-Based Reflection and Brief Appraisal of the Literature.

At present, a substantial number of individuals in the US face limited English proficiency (LEP), posing difficulties for healthcare providers. Language barriers between healthcare providers and patients can lead to poor quality of care, especially in patients with hyperacute conditions such as stroke, myocardial infarction, acute trauma, and more. In the intensive care unit (ICU), diagnosis and rapid treatment decision-making rely on taking an accurate patient history and physical exam. While in-person interpreters are the gold standard for patients with LEP, the fast-paced nature of the ICU may require alternate modes of using interpreting services to fit ICU workflows. We present a case-based reflection of a patient with LEP who presented to our ICU after a motor vehicle accident. We present this case from the perspective of a third-year medical student caring for a patient while rotating in an ICU service. We illustrate how language interpretation impacted the patient's care. We conclude by appraising the ICU literature and providing solutions to addressing language barriers for ICU patients with LEP to deliver patient-centered, high-quality care.

Diabetes care in the pandemic era in the Midwestern USA: a semi-structured interview study of the patient perspective.

OBJECTIVES: To understand patients' experiences with diabetes care during the COVID-19 pandemic, with an emphasis on rural, medically underserved, and/or minoritised racial and ethnic groups in the Midwestern USA. DESIGN: Community-engaged, semi-structured interviews were conducted by medical student researchers trained in qualitative interviewing. Transcripts were prepared and coded in the language in which the interview was conducted (English or Spanish). Thematic analysis was conducted, and data saturation was achieved. SETTING: The study was conducted in communities in Eastern and Western Iowa. PARTICIPANTS: Adults with diabetes (n=20) who were fluent in conversational English or Spanish were interviewed. One-third of participants were residents of areas designated as federal primary healthcare professional shortage areas and/or medically underserved areas, and more than half were recruited from medical clinics that offer care at no cost. RESULTS: Themes across both English and Spanish transcripts included: (1) perspectives of diabetes, care providers and care management; (2) challenges and barriers affecting diabetes care; and (3) participant feedback and recommendations. Participants reported major constraints related to provider availability, costs of care, access to nutrition counselling and mental health concerns associated with diabetes care during the pandemic. Participants also reported a lack of shared decision-making regarding some aspects of care, including amputation. Finally, participants recognised systems-level challenges that affected both patients and providers and expressed a preference for proactive collaboration with healthcare teams. CONCLUSIONS: These findings support enhanced engagement of rural, medically underserved and minoritised groups as stakeholders in diabetes care, diabetes research and diabetes provider education.

Perceived physical exertion is a good indicator of neuromuscular fatigue for the core muscles.

Although several studies have assessed core training, specific prescription recommendations remain lacking. The purpose of the present study was to determine the association between the rate of perceived exertion (RPE) and neuromuscular fatigue of the core muscles during the prone bridging endurance test. Fifteen healthy and moderately active subjects participated. Neuromuscular fatigue was assessed with surface electromyography on the rectus abdominis (RA), external oblique, internal oblique, and lumbar erector spinae. Participants rated the RPE (Borg CR 10) every 5 s. The time to failure was 123.7 ±â€¯58.1 s. From the midpoint of the time to failure, the RPE significantly increased (p < 0.05). The RA muscle showed increased neuromuscular fatigue during the second half of the time to failure (p < 0.05). The other core muscles showed increased neuromuscular fatigue during the last 30% of the time to failure (p < 0.05). The RA muscle showed a strong correlation between neuromuscular fatigue and the RPE (R2 0.85). The other core muscles showed a moderate correlation between neuromuscular fatigue and RPE (R2 0.50-0.69). The measured RPE and neuromuscular fatigue were closely linked for the RA muscle and moderately linked for the other core muscles during the prone bridging endurance test.