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Objective. To describe translation and cultural adaptation procedures, and examine the degree of equivalence between the Spanish and English versions of the Agency for Healthcare Research and Quality's (AHRQ) Consumer Assessments of Healthcare Providers and Systems (CAHPS[R]) Hospital Survey (H-CAHPS[R]) of patient experiences with care. Data Sources. Cognitive interviews on survey comprehension with 12 Spanish-speaking and 31 English-speaking subjects. Psychometric analyses of 586 responses to the Spanish version and 19,134 responses to the English version of the H-CAHPS survey tested in Arizona, Maryland, and New York in 2003. Study Design. A forward/backward translation procedure followed by committee review and cognitive testing was used to ensure a translation that was both culturally and linguistically appropriate. Responses to the two language versions were compared to evaluate equivalence and assess the reliability and validity of both versions. Data Collection/Extraction Methods. Comparative analyses were carried out on the 32 items of the shortened survey version, focusing on 16 items that comprise seven composites representing different aspects of hospital care quality (communication with nurses, communication with doctors, communication about medicines, nursing services, discharge information, pain control, and physical environment); three items that rate the quality of the nursing staff, physician staff, and the hospital overall; one item on intention to recommend the hospital. The other 12 items used in the analyses addressed mainly respondent characteristics. Analyses included item descriptives, correlations, internal consistency reliability of composites, factor analysis, and regression analysis to examine construct validity. Principal Findings. Responses to both language versions exhibit similar patterns with respect to item-scale correlations, factor structure, content validity, and the association between each of the seven qualifies of care composites with both the hospital rating and intention to recommend the hospital. Internal consistency reliability was slightly, yet significantly lower for the Spanish-language respondents for five of the seven composites, but overall the composites were generally equivalent across language versions. Conclusions. The results provide preliminary evidence of the equivalence between the Spanish and English versions of H-CAHPS. The translated Spanish version can be used to assess hospital quality of care for Spanish speakers, and compare results across these two language groups. Key Words. Survey translation and adaptation, patient survey, language equivalence, hospital care quality, Spanish-language survey, The United States is an increasingly diverse country where 45 million people, representing 18 percent of the population, speak a language other than English at home. Among the more than [...]

Objective: To examine students' knowledge, barriers to access, and use of services at two school-based health centers. Design: In-person survey. Settings: Two urban public schools in Baltimore, Md. Participants: One hundred forty-nine middle school and 131 high school African-American students. The response rate was 84%. Main Outcome Measures: Knowledge about center operations and services, reported barriers to access to the center, and reported use of the center. Results: Knowledge about center operations and services was generally high. However, knowledge was low with respect to the need for an appointment for nonemergency visits (40% correct) and the availability of dental service referrals (51% correct). One fifth of students incorrectly reported their enrollment status. Boys were more likely to report that they knew about the availability of sports physical examinations (odds ratio, 3.7), and girls were more likely to report that they knew about reproductive services (odds ratio, 3.0). The most frequently identified barriers to access were difficulty in obtaining a teacher's permission to leave class (55%), requiring parental permission for enrollment (3 1%), and concern about confidentiality (26%). Barriers to access were reported more frequently by students in the middle school than by students in the high school. Seven eighths of enrolled students reported that they had used the center in the past year, but only a third would use it if they woke up on a Monday with a bad cough and needed to see a physician or nurse. Conclusion: Despite increasing the availability of primary care services by locating health centers in schools, some barriers to access remain. School-based health centers could more actively promote awareness of their operation and services among students and their parents. (Arch Pediatr Adolesc Med. 1996;150:175-180), Lack of knowledge and other barriers may prevent optimal use of school-based health clinics. A group of 149 inner-city middle-school and 131 high-school students attending a middle-school and a high school with on-site health clinics responded to a questionnaire. Knowledge of operations and services was generally good, but only 40% of the group knew an appointment was needed for nonemergency visits. One-third of the group did not know that mental health services were available and half did not know dental referrals could be made. Sixty-two percent of boys versus 83% of girls knew reproductive health care was available. Over half the students reported that getting permission to leave class was a barrier to obtaining health care services, and nearly one-third reported the need to get parental consent to enroll. About one-quarter had concerns about confidentiality or found clinic hours a barrier. Parental consent problems usually arose from a lack of involvement or failure to return forms, not parental refusal.

Background Durable mechanical support devices are prohibitively expensive in our health system and may be unsuitable for critically ill patients. CentriMag is an alternative bridge to transplantation or recovery.Methods We retrospectively reviewed 28 patients (23 males) aged 13–60 years who received CentriMag support. The etiology was ischemic in 13 (46%), dilated cardiomyopathy in 8 (29%), and others in 7 (25%). All patients were in Interagency Registry for Mechanically Assisted Circulatory Support class I, and 27 (96%) had multiorgan failure; 2 (7%) were post-cardiotomy and 12 (43%) had a previous cardiac arrest (mean arrest time 21?±?17?min).Results Thirty-day post-implant survival was 79% (22 patients). Twenty (71%) patients were successfully bridged to transplantation or recovery. The mean support time was 40 days; 12 (43%) patients had >4-weeks’ support (longest was 292 days). Eight (29%) patients died on support. Complications included bleeding in 10 (36%) cases, immediate stroke in 4 (14%), and dialysis in 8 (29%). There was no stroke during subsequent support. Eighteen (64%) patients underwent transplantation, and 17 of them were discharged. Two (7%) patients recovered and were discharged. Two-year survival was 62%?±?10%. Mean follow-up was 21 months (total follow-up 579 months). Two (7%) patients died during follow-up. All survivors were in New York Heart Association class I.Conclusions CentriMag is useful for medium-term support for cardiogenic shock in a developing country. Support for >4 weeks is feasible. The stroke rate is low during support. The major drawback is prolonged intensive care unit stay.

The US Centers for Medicare & Medicaid Services assess patient experiences of care as part of the end-stage renal disease prospective payment system and Quality Incentive Program. This article describes the development and evaluation of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) In-Center Hemodialysis Survey.

Silver impregnation with silver-protein compounds is widely used for staining tissue sections and cell cultures. Some authors report that the results obtained with these methods have not always been reproducible because the reagent's composition varies according to the manufacturer. To avoid this problem in the method described in this paper, a silver proteinate, produced in our own laboratory is used. Although our method is based on Bodian's, the modifications we have made allows its use for both free-living cells (protozoa) and cells grown in culture (nerve cells). The significant modifications are 1) different fixation, 2) postfixation with Cajal's for-mol-bromide, 3) changes in the duration of the impregnation steps technique and 4) elimination of metallic copper. The method reported here enables us to use silver proteinate whenever we require it and to control the composition of the silver proteinate. This technique can be used for cells cultured in either plastic or glass.

In an effort to provide medical care that is both more effective and less costly, the new variants of managed care organizations have instituted a variety of incentives and administrative controls that impact on the types and quantity of care provided to patients. Evidence suggests that the early forms of managed care, namely prepaid group practices, showed particular promise in improving the primary care delivered to children, ie, care that is accessible, person-focused in the long term, comprehensive, coordinated, and oriented toward achieving better outcomes. However, recent evidence concerning the quality of care delivered to children in the newer variants of managed care is mixed and scant; the newer organizational forms may not facilitate and may even have a negative impact on the attainment of primary care. Managed care can have a positive effect on first contact care, because it contractually defines a primary care provider and reduces use of the emergency room as a source of care. It may, however, have mixed effects on other aspects of access and use, depending on the plan's particular characteristics. Longitudinality is threatened by the disruption of prior relationships with out-of-plan providers and by the instability of both enrollees and providers in managed care plans. Children's benefits in managed care arrangements tend to include more preventive services, but access to specialty services has generally been found to be more restrictive. Coordination of care is not inherent to managed care, and many plans are no more likely to foster communication than are traditional indemnity plans. Evidence for the superior clinical quality afforded to children by new variants of managed care is lacking. Because managed care arrangements are proliferating rapidly, better studies are needed to prove or refute the contention that managed care has a significant positive effect on quality of care.

Antibodies against cyclic citrullinated peptides (CCPs) are useful for diagnosing rheumatoid arthritis (RA). Antibodies to mutated citrullinated vimentin (MCV) were described recently in RA. The aims of this study were to evaluate the usefulness of anti-MCV for diagnosing RA in anti-CCP-negative patients and to monitor anti-MCV titres during infliximab therapy for RA.