J Natl Med Assoc
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Hispanic patients comprise the largest minority population in the United States. The federal government mandates that healthcare providers be able to communicate with those patients who have limited English ability. The primary purpose of this study was to assess the English-language proficiency of self-declared English-speaking Hispanic patients in the emergency department (ED). The secondary purpose was to determine concordance between patients' tested English proficiency and perceived proficiency by nurses and physicians. We hypothesized that many patients who state that they are able to speak English do not in fact possess sufficient ability to communicate in English. ⋯ This study demonstrated that a significant number of patients who report English proficiency have an inadequate level of English health literacy and therefore English-language ability. Furthermore, there was a discrepancy between level of English competency found in the study and in the perceived English competency of the patients in the judgment of the physicians and nurses in the ED. This study demonstrated that that there was significant lack of English-language ability of self-declared Hispanic patients, suggesting that a more liberal use of interpreters may be indicated.
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Inhaled corticosteroids (ICSs) are the most effective medications available for patients with persistent asthma of all severities and currently are recommended as the preferred asthma controller therapy by the National Heart, Lung and Blood Institute. Nevertheless, lingering concerns about potential adverse systemic effects of ICSs contribute to their underuse. This review discusses the safety of ICSs with respect to potential systemic effects of most concern to physicians and patients. ⋯ ICSs have minimal systemic effects in most patients when taken at recommended doses. The benefits of ICS therapy clearly outweigh the risks of uncontrolled asthma, and ICSs should be prescribed routinely as first-line therapy for children and adults with persistent disease.
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Affective correlates of hair pulling were investigated in a sample of 43 African-American women with trichotillomania. The relationship among affective correlates and dimensions of racial identity was also examined. Via phone interview, participants completed the hair-pulling survey on which they rated the intensity of 10 different affective states across three different points in the hair-pulling episode (before, during and after). ⋯ Negative correlations were found among the racial identity dimension of private regard and the affective correlates of happy and relief that were experienced during and after pulling. Negative correlations were found between the racial identity dimension of humanist ideology and relieved affect as well as humanist ideology and relieved affect during a pulling episode. In light of the results, the importance of understanding and assessing cultural factors in the affective experience of African-American women with trichotillomania is discussed.
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To evaluate knowledge, perceptions and the effectiveness of different sources of information about sickle cell trait (SCT) and sickle cell disease (SCD); to determine individual knowledge of SCT status. ⋯ Despite a screening history in the 1970s fraught with controversy, sickle cell disease management and detection can be a model for the empowerment of communities in making informed decisions about theirs and their families' futures, given the burgeoning of genetic information.
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Delirium is a transient global disorder of cognition. Almost any medical illness or medication can cause delirium. Here, we report a 71-year-old male who presented to the emergency department with a sudden change in mental status, which later resolved. ⋯ The patient subsequently became hypotensive, and treatment was again changed to olanzapine. He returned to full consciousness with olanzapine treatment. When the potential hypotensive effects of haloperidol and risperidone are taken into consideration, in patients with high cardiac risk, olanzapine may provide a better option for the treatment of delirium.