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Newell R, George S, Patel M, Dawe H, Roelas M, Wedmore F, Morris M. Improving the quality of translation for patients with language barriers. Eur J Public Health 2022; 32:ckac129.639. [PMCID: PMC9593623 DOI: 10.1093/eurpub/ckac129.639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2024] Open
Abstract
Background Patients with language barriers have worse health outcomes. To promote equitable care, efforts must be made to ensure effective communication with patients, including providing professional translation. In a busy, overstretched health service this can be difficult to achieve. Language translators can reduce barriers, improve safety and ensure impartiality. Description of the Problem Aims - To understand the quality of translation and explore interventions that could improve this in a busy diverse hospital in East London. Methods A quality improvement project in the Medical Admissions Unit of the Royal London Hospital was completed over two years. Patients with language barriers were identified, methods of translation were analysed and interventions to improve access to independent translation were introduced. Results Cycle 1- All medical admissions over a two-week period were analysed. 36 patients had documented evidence of a language barrier with 7 (19.4%) having independent professional translation. 20 (55.6%) patients had family members providing translation, for 4 patients limited English was used and previous documentation was used for 3 patients. Cycle 2- Posters and information leaflets were disseminated regarding how to access translation services. There was no improvement in the types of translation used. Only 1 patient had impartial professional translation, out of 43 patients identified. Cycle 3- Advocates (Bengali speaking professional translators) were made available on the ward twice a week. Results showed no significant improvement, with only 6 (10%) identified having impartial professional translation. However staff and patient feedback has been positive. Lessons Impartial professional translation is essential in reducing barriers and delivering equitable health care. This can be difficult to achieve in busy healthcare services. Education alone is not enough. Good accessibility to translation services is paramount in promoting usage. Key messages • Healthcare services often fall short of providing impartial professional translation. • Education alone is not enough. Good accessibility to translation services is paramount in promoting usage.
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Affiliation(s)
- R Newell
- Acute Medicine, Barts Health NHS Trust, London, UK
| | - S George
- Acute Medicine, Barts Health NHS Trust, London, UK
| | - M Patel
- Acute Medicine, Barts Health NHS Trust, London, UK
| | - H Dawe
- Acute Medicine, Barts Health NHS Trust, London, UK
| | - M Roelas
- Acute Medicine, Barts Health NHS Trust, London, UK
| | - F Wedmore
- Acute Medicine, Barts Health NHS Trust, London, UK
| | - M Morris
- Acute Medicine, Barts Health NHS Trust, London, UK
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Mahtani K, Parker M, Maclean E, Vyas R, Bo Wang R, Roelas M, Zemrak F, Muthumala A, Moore P, Sporton S, Chow A, Monkhouse C. Emergency pacemaker implantation in nonagenarians with complete heart block: is single chamber pacing sufficient? Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In ambulatory patients with complete heart block and preserved sinus node activity (CHBs), dual chamber pacing confers well-established physiological benefits versus single chamber pacing. There is limited evidence as to whether these benefits extend to very frail patients, especially those over 90 years of age.
Purpose
In nonagenarians presenting with emergent CHBs from 2016–2019, we compared the clinical characteristics of patients selected for single versus dual chamber pacemakers (PPM), and evaluated the symptomatic and prognostic implications of these devices.
Methods
Baseline characteristics were discerned from electronic records, and physiological data extracted from serial PPM interrogations. Frailty was quantified according to the Rockwood clinical frailty scale (1–9). Cause of death was provided by the patients' General Practitioner. Cox proportional hazards analysis (HR, 95% CI) examined associations with all-cause mortality and death from congestive cardiac failure (CCF).
Results
168 consecutive patients were included (44.3% Male, Median age: 91 (2) years) and followed-up for 26.9±14.6 months. 22 patients (13.1%) were implanted with single chamber pacemakers (all programmed VVIR); when compared with patients receiving dual chamber devices, these patients had similar median age (93 (3) versus 91 (2) years, p=0.15) and LV systolic function (LVEF: 49.2% ±9.7 versus 50.7% ±10.1, p=0.71), but were more frail (Rockwood scale: 5.2±1.8 versus 4.3±1.1, p=0.004) and more likely to have severe cognitive impairment (27.3% versus 9.2%, p=0.018). Post implant, patients who received single chamber devices had higher average respiratory rates (21.3±2.4 breaths per minute versus 17.5±2.6 breaths per minute, p=0.002), lower average heart rates (65.5±10.1 bpm versus 71.9±8.6 bpm, p=0.002), and lower daily activity levels (0.57±0.3 hours of activity versus 1.5±1.1 hours of activity, p=0.016) than those with dual chamber devices. Death from CCF was more common in patients receiving single chamber devices (40.9% versus 6.2%, log rank p<0.0001); this association persisted when adjusting for age, frailty and cognitive impairment (adjusted HR: 6.2 (2.2–17.3, p=0.0005). However, in this age group, single chamber pacing was not independently associated with all-cause mortality when compared with dual chamber pacing (adjusted HR: 1.9 (0.95–3.6, p=0.07).
Conclusions
In nonagenarians with CHBs, dual chamber pacing was associated with improved symptomatic outcomes and a reduced risk of death from CCF, but did not affect all-cause mortality when compared with single chamber pacing.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- K Mahtani
- St Bartholomew's Hospital , London , United Kingdom
| | - M Parker
- St Bartholomew's Hospital , London , United Kingdom
| | - E Maclean
- St Bartholomew's Hospital , London , United Kingdom
| | - R Vyas
- St Bartholomew's Hospital , London , United Kingdom
| | - R Bo Wang
- St Bartholomew's Hospital , London , United Kingdom
| | - M Roelas
- St Bartholomew's Hospital , London , United Kingdom
| | - F Zemrak
- St Bartholomew's Hospital , London , United Kingdom
| | - A Muthumala
- St Bartholomew's Hospital , London , United Kingdom
| | - P Moore
- St Bartholomew's Hospital , London , United Kingdom
| | - S Sporton
- St Bartholomew's Hospital , London , United Kingdom
| | - A Chow
- St Bartholomew's Hospital , London , United Kingdom
| | - C Monkhouse
- St Bartholomew's Hospital , London , United Kingdom
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Roelas M, Vyas R, Maclean E, Mahtani K, Butcher C, Ahluwalia N, Honarbakhsh S, Finlay M, Chow A, Earley MJ, Sporton S, Lambiase PD, Schilling RJ, Hunter RJ, Segal OR. Transseptal puncture for left atrial ablation: risk factors for cardiac tamponade and a proposed causative classification system. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cardiac tamponade is a high morbidity complication of transseptal puncture (TSP).
Purpose
We examined the associations of TSP-related cardiac tamponade (TRCT) for all patients undergoing left atrial ablation at our centre from 2016–2020.
Methods
Patient and procedural variables were extracted retrospectively. Cases of cardiac tamponade were scrutinised to adjudicate TSP culpability. Adjusted multivariate analysis examined predictors of TRCT.
Results
3,239 consecutive TSPs were performed; cardiac tamponade occurred in 51 patients (incidence: 1.6%) and was adjudicated as TSP-related in 35 (incidence: 1.1%; 68.6% of all tamponades). Patients of above-median age (OR 2.4 (1.19–4.2), p=0.006) and those undergoing re-do procedures (OR 1.95 (1.29–3.43, p=0.042) were at higher risk of TRCT. Of the operator-dependent variables, choice of transseptal needle (Endrys vs Brockenbrough, p>0.1) or puncture sheath (Swartz vs Mullins vs Agilis vs Vizigo vs Cryosheath, all p>0.1) did not predict TRCT. Adjusting for operator, equipment and demographics, failure to cross the septum first pass increased TRCT risk (OR 4.42 (2.45–8.2), p=0.001), whilst top quartile operator experience (OR 0.4 (0.17–0.85, p=0.002), transoesophageal echocardiogram (TOE prevalence: 26%, OR 0.51 (0.11–0.94), p=0.023), and use of the SafeSept guidewire (OR 0.22 (0.08–0.62), p=0.001) reduced TRCT risk. An increase in SafeSept wire use over time (2016: 15.6%, 2020: 60.2%) correlated with an annual reduction in TRCT (R2=0.72, p<0.001) and was associated with a relative risk reduction of 70%.
Conclusions
During left atrial ablation, the independent predictors of TRCT were patient age, re-do procedure, operator experience, unsuccessful first pass, TOE-guidance, and use of the SafeSept wire. A novel classification system for the causes of cardiac tamponade is proposed (table 1); this may be of interest to clinical trialists or auditors evaluating patient safety.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Roelas
- Barts Heart Centre, St. Bartholomew's Hospital , London , United Kingdom
| | - R Vyas
- Barts Heart Centre, St. Bartholomew's Hospital , London , United Kingdom
| | - E Maclean
- Barts Heart Centre, St. Bartholomew's Hospital , London , United Kingdom
| | - K Mahtani
- Barts Heart Centre, St. Bartholomew's Hospital , London , United Kingdom
| | - C Butcher
- Barts Heart Centre, St. Bartholomew's Hospital , London , United Kingdom
| | - N Ahluwalia
- Barts Heart Centre, St. Bartholomew's Hospital , London , United Kingdom
| | - S Honarbakhsh
- Barts Heart Centre, St. Bartholomew's Hospital , London , United Kingdom
| | - M Finlay
- Barts Heart Centre, St. Bartholomew's Hospital , London , United Kingdom
| | - A Chow
- Barts Heart Centre, St. Bartholomew's Hospital , London , United Kingdom
| | - M J Earley
- Barts Heart Centre, St. Bartholomew's Hospital , London , United Kingdom
| | - S Sporton
- Barts Heart Centre, St. Bartholomew's Hospital , London , United Kingdom
| | - P D Lambiase
- Barts Heart Centre, St. Bartholomew's Hospital , London , United Kingdom
| | - R J Schilling
- Barts Heart Centre, St. Bartholomew's Hospital , London , United Kingdom
| | - R J Hunter
- Barts Heart Centre, St. Bartholomew's Hospital , London , United Kingdom
| | - O R Segal
- Barts Heart Centre, St. Bartholomew's Hospital , London , United Kingdom
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Maclean E, Mahtani K, Roelas M, Vyas R, Butcher C, Ahluwalia N, Honarbakhsh S, Creta A, Finlay M, Chow A, Earley MJ, Sporton S, Lowe MD, Sawhney V, Ezzat V, Ahsan S, Khan F, Dhinoja M, Lambiase PD, Schilling RJ, Hunter RJ, Segal OR. Transseptal puncture for left atrial ablation: risk factors for cardiac tamponade and a proposed causative classification system. J Cardiovasc Electrophysiol 2022; 33:1747-1755. [PMID: 35671359 PMCID: PMC9543389 DOI: 10.1111/jce.15590] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/28/2022] [Accepted: 04/06/2022] [Indexed: 12/01/2022]
Abstract
Aims Cardiac tamponade is a high morbidity complication of transseptal puncture (TSP). We examined the associations of TSP‐related cardiac tamponade (TRCT) for all patients undergoing left atrial ablation at our center from 2016 to 2020. Methods and Results Patient and procedural variables were extracted retrospectively. Cases of cardiac tamponade were scrutinized to adjudicate TSP culpability. Adjusted multivariate analysis examined predictors of TRCT. A total of 3239 consecutive TSPs were performed; cardiac tamponade occurred in 51 patients (incidence: 1.6%) and was adjudicated as TSP‐related in 35 (incidence: 1.1%; 68.6% of all tamponades). Patients of above‐median age [odds ratio (OR): 2.4 (1.19–4.2), p = .006] and those undergoing re‐do procedures [OR: 1.95 (1.29–3.43, p = .042] were at higher risk of TRCT. Of the operator‐dependent variables, choice of transseptal needle (Endrys vs. Brockenbrough, p > .1) or puncture sheath (Swartz vs. Mullins vs. Agilis vs. Vizigo vs. Cryosheath, all p > .1) did not predict TRCT. Adjusting for operator, equipment and demographics, failure to cross the septum first pass increased TRCT risk [OR: 4.42 (2.45–8.2), p = .001], whilst top quartile operator experience [OR: 0.4 (0.17–0.85), p = .002], transoesophageal echocardiogram [TOE prevalence: 26%, OR: 0.51 (0.11–0.94), p = .023], and use of the SafeSept transseptal guidewire [OR: 0.22 (0.08–0.62), p = .001] reduced TRCT risk. An increase in transseptal guidewire use over time (2016: 15.6%, 2020: 60.2%) correlated with an annual reduction in TRCT (R2 = 0.72, p < .001) and was associated with a relative risk reduction of 70%. Conclusions During left atrial ablation, the risk of TRCT was reduced by operator experience, TOE‐guidance, and use of a transseptal guidewire, and was increased by patient age, re‐do procedures, and failure to cross the septum first pass.
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Affiliation(s)
- E Maclean
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK.,William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - K Mahtani
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - M Roelas
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - R Vyas
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - C Butcher
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - N Ahluwalia
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - S Honarbakhsh
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - A Creta
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - M Finlay
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - A Chow
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - M J Earley
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - S Sporton
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - M D Lowe
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - V Sawhney
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - V Ezzat
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - S Ahsan
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - F Khan
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - M Dhinoja
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - P D Lambiase
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
| | - R J Schilling
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK.,William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - R J Hunter
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK.,William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - O R Segal
- Barts Heart Centre, St. Bartholomew's Hospital, W Smithfield, London, EC1A 4AS, UK
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