Medical Interpretation Research Articles

Prevalent practices amongst healthcare professionals in paediatric settings in using medical interpreters for families with limited national language proficiency: A narrative scoping review.

Where language barriers exist, trained medical interpreters provide more accurate and comprehensive communication between clinicians and service users compared to ad hoc interpreters or no interpreter at all. The nature and extent of research evidence about when and how medical interpreters are used by health professionals in paediatric settings to mediate communication with families who do not speak the national language proficiently have not yet been published. To examine the potential size and scope of available research literature about the prevalent practices of healthcare professionals in using medical interpreters in paediatric settings for families with limited national spoken language proficiency. We used an established framework for scoping reviews, including suggested modifications by JBI. Precise eligibility criteria were identified, and a comprehensive search strategy was applied. Sources of evidence were confined to primary research that spoke specifically to the research question. The process of study selection and results are presented narratively and in tabular form. Two reviewers independently engaged in the screening process, and two reviewers undertook a full paper review of the included articles, with a third consulted where an additional opinion was required. We included 21 studies published between 2000-2022, most using (quantitative) survey methods. Key results captured in six themes are as follows: medical interpreters tended to be underused by health professionals, especially nurses; time was the greatest impediment to their use, but so too were difficulties with the perceived quality of interpreter services; technology was used for medical interpreting at some study sites with mixed responses; use of unauthorised interpreters was widespread; language barriers impacted on the care provider and family relationship; and cost of interpreter services tended not to be reported as a barrier to their use. Further scholarship is needed to understand the use of medical interpreter services with reference to the complexity of health work, as well as the social context of inequality for many families with limited national language proficiency accessing paediatric healthcare. Recent developments in video technology offer promise in improving interpreter use but require oversight for quality. We have highlighted the need for better training for and regulation of medical interpreters and clinical guidelines on the use of interpreters by healthcare professionals.

Barriers to family history collection among Spanish-speaking primary care patients: a BRIDGE qualitative study.

Family history is an important tool for assessing disease risk, and tailoring recommendations for screening and genetic services referral. This study explored barriers to family history collection with Spanish-speaking patients. This qualitative study was conducted in two US healthcare systems. We conducted semi-structured interviews with medical assistants, physicians, and interpreters with experience collecting family history for Spanish-speaking patients. The most common patient-level barrier was the perception that some Spanish-speaking patients had limited knowledge of family history. Interpersonal communication barriers related to dialectical differences and decisions about using formal interpreters vs. Spanish-speaking staff. Organizational barriers included time pressures related to using interpreters, and ad hoc workflow adaptations for Spanish-speaking patients that might leave gaps in family history collection. This study identified multi-level barriers to family history collection with Spanish-speaking patients in primary care. Findings suggest that a key priority to enhance communication would be to standardize processes for working with interpreters. To improve communication with and care provided to Spanish-speaking patients, there is a need to increase healthcare provider awareness about implicit bias, to address ad hoc workflow adjustments within practice settings, to evaluate the need for professional interpreter services, and to improve digital tools to facilitate family history collection.

“We need a little help”: a qualitative study on distress and coping among pediatric medical interpreters

“We need a little help”: a qualitative study on distress and coping among pediatric medical interpreters

Psychosocial Considerations in Management of Corticobasal Degeneration in Indian American Population

AbstractBackgroundCorticobasal degeneration (CBD) is a neurodegenerative tauopathy primarily affecting the cerebral cortex and basal ganglia, often featuring cognitive decline and parkinsonism. With no proven treatments for this rare condition, the goals of management are to improve patients' quality of life. We evaluate here the unique psychosocial factors that were considered for two women of Asian Indian descent with CBD.MethodPatient 1 was a 77‐year‐old woman who exhibited short‐term memory loss, and then suffered an acute left anterior cerebral artery territory ischemic stroke with right‐sided hemiparesis and neurogenic pain. MRI Brain confirmed the stroke’s location, but did not account for cognitive decline. Patient 2 was a 75‐year‐old woman who initially experienced dysphagia, and then developed right‐sided hemiparesis, right neck spasms, unstable gait, and short‐term memory loss. MRI Brain and Cervical Spine revealed only showed mild chronic microvascular changes and multilevel cervical spondylosis.ResultsPET‐FDG Brain studies were performed for both patients. Patient 1’s study revealed severe hypometabolism affecting bilateral basal ganglia, bilateral thalami, and left supplementary motor cortex, out of proportion to the known stroke and consistent with CBD. Patient 2’s study revealed mild hypometabolism at the left frontal and parietal lobes, sparing the precuneus and posterior cingulate, also consistent with CBD and helping to explain the right‐sided hemiparesis.ConclusionVarious psychosocial factors were considered during the evaluation and management for both patients. Both had limited English proficiency, so cognitive testing was performed with the aid of a medical interpreter to ensure accurate results. Symptomatic treatment was tailored for each patient: Patient 1 received carbidopa/levodopa for parkinsonian tremors, and Patient 2 received cyclobenzaprine for intermittent muscle spasms. Both patients had multigenerational households, and results and prognoses were discussed with multiple relatives so they could coordinate responsibilities. Both families initially resisted recommendations to have home health aides, expressing their cultural belief that families should take care of their relatives on their own. As we discussed this belief over time, and explained the expected progression of symptoms over time, both families came to be more accepting of introducing home health aides, seeing them as a supplement, and not a replacement, for the family’s role.

Investigating Transfer Learning Performances of Deep Learning Models for Classification of GPR B-Scan Images

Recent advances in deep learning models have made them the state-of-the art method for image classification. Due to this success, they have been applied to many areas, such as satellite image processing, medical image interpretation, video processing, etc. Recently, deep learning models have been utilized for processing Ground Penetrating Radar (GPR) data as well. However, studies general focus on building new Convolutional Neural Network (CNN) models instead of utilizing baseline ones. This paper investigates the usefulness of existing baseline CNN models for classifying GPR B-scan images and aims to determine how well pre-trained models perform. To that end, a real bridge deck GPR data, DECKGPRHv1.0 dataset was used to evaluate the transfer learning performances of various CNN models. Different variants of the models in terms of varying depths and number of parameters were also considered and evaluated in a comparative manner. Although it is an older model, ResNet achieved the best results with 0.998 accuracy. The experimental results showed that there is generally a direct correlation between the simplicity of the model and its success. Overall, it is concluded that near perfect results are possible by just adapting pre-trained models to the problem without fine-tuning.

Apocalyptic Pandemic in Yana Vagner’s To The Lake

The article offers an analysis of Yana Vagner’s bestselling novel To the Lake (Epidemiia) focusing on the ways in which this speculative text reflects on contemporary apocalyptic anxieties and fascinations unleashed by the global COVID-19 pandemic. Following Priscilla Wald’s contention that over the last hundred-plus years the knowledge about epidemics within different realms has been shaped by the “outbreak narrative” that arrives in “scientific, journalistic, and fictional incarnations,” I consider how the novel spotlights the mutually reinforcing relation between a long-standing and increasingly globalised cultural imagination about contagion and the medical and political interpretations of an actual pandemic.

Improving Patient Experience Scores Using Simultaneous Interpretation on Family-Centered Rounds.

Patients speaking a primary language other than English face barriers to equitable care, particularly patient-provider communications. There is no gold standard for providing inpatient medical interpretation on family-centered rounds (FCR). We aimed to implement simultaneous, in-person interpretation of FCR for Spanish-speaking families and hypothesized improved satisfaction in care. In-person, Spanish Equipment-Assisted Simultaneous Medical Interpretation (EASMI) was implemented in March 2018 on FCR. Child Hospital Consumer Assessment of Healthcare Providers and Systems (Child HCAHPS) experience scores on communication domains were analyzed for Spanish and English-speaking families pre- (n = 118) and postimplementation (n = 552). Postimplementation, we conducted medical team surveys (n = 104) and semistructured interviews with Spanish-speaking families (n = 25) to determine satisfaction with interpretation modalities (phone, video, and EASMI). Spanish-speaking families exhibited statistically significant improvements in Child HCAHPS top box scores compared to English-speaking families in multiple communication and informed care-related domains. For example, "How often did your child's doctors explain things to you in a way that was easy to understand?" top box scores improved from 58% to 95% for Spanish-speaking families, compared to 85% to 83% for English speakers, with the differential effect of the intervention showing statistical significance (P = .001). Medical team surveys demonstrated high satisfaction with EASMI. Qualitative themes from interviews and open-ended survey responses emphasized multiple care benefits with EASMI, including a perceived reduction of communication errors and increased family participation. EASMI was associated with significant improvements in Child HCAHPS scores in communication domains and increased medical team and family members' satisfaction with interpretation. EASMI presents a novel method for equitable FCR for Spanish-speaking families.

Patient informed choice in the age of evidence-based medicine: IVF patients' approaches to biomedical evidence and fertility treatment add-ons.

With the increasing offer of fertility treatment by a largely privatised sector, which has involvedthe proliferation of treatment add-ons lacking evidence of effectiveness, In-Vitro Fertilisation (IVF) patients are expected to make informed choices on what to include in their treatment. Drawing on interviews with 51 individuals undergoing fertility treatment, this article explores patients' approaches to medical evidence interpretation and its role in their decisions to include add-ons. While most IVF patients share understandings of what counts as medical evidence, our findings show how their approaches also differ. Our analysis focuses on how patients negotiate the notion of medical evidence and its relation to other forms of experience or knowledge.We present four different approaches to evidence in IVF: (1) delegating evaluations of evidence to experts; (2) critically assessing available evidence; (3) acknowledging the process of making evidence; and (4) contextualising evidence in their lived experience of infertility. We suggest that patients' choice to include add-ons is not due to a lack of information on or understanding of evidence, but rather should be interpreted as part of the complexity of patients' experiences of infertility.

Enhancing patient-centered care for limited English proficiency patients through Tell Me More®: A student-driven initiative to explore the patient as a person and develop students’ communication skills

Tell Me More® (TMM) is a medical student-driven initiative to build rapport between patients, students, and the healthcare team through patient interviews and collaboratively created posters. Patients with limited English proficiency (LEP) often experience impaired communication with providers. TMM has the potential to address the loss of patient-centered dialogue in interpreter-mediated communications. In this exploratory pilot study, we aimed to include LEP patients in TMM by using medical interpreter phones (MIPs) at Long Island Jewish Medical Center, Northwell Health. Our objectives were to: (1) evaluate the feasibility of this approach, (2) compare TMM engagement between LEP and English-speaking (ES) patients, and (3) document the impact of this initiative on the medical student. Following the standardized TMM interview structure, the student used the MIP to interview LEP patients about who they are as people beyond their illnesses. This expanded social history was transcribed to bedside posters to enhance patient connection with the healthcare team. At the end of interviews, patients rated TMM’s impact on their hospital stay. Additionally, medical student reflections were recorded weekly. Our quantitative results from 12 LEP and 49 ES patients support significantly higher TMM participation for LEP compared to ES patients. Qualitative examination of student reflections suggests that TMM enriches medical education by promoting understanding of the LEP patient experience. Our results demonstrate that MIP-supported TMM is a feasible approach to enhance patient-centered care for LEP populations. Further research is needed to explore inclusion of LEP patients in patient-centered care initiatives such as TMM.

Does interpretation bias moderate the relationship between pain and fear of cancer recurrence?

The Cancer Threat Interpretation model proposes that clinically significant fear of cancer recurrence/progression (FCR/P) can occur when people misinterpret ambiguous physical symptoms as a sign of recurrence. The aim of this research is to test whether interpretation biases moderate the relationship between pain and FCR/P in women with breast cancer, as predicted. One hundred forty-seven women with breast cancer completed questionnaire measures of demographic and medical information, FCR/P, interpretation bias, and symptom burden, as well as other known predictors of FCR/P. Women with clinically significant levels of FCR/P were more likely to interpret ambiguous words as health-related and experienced more pain than women with levels of FCR/P in the nonclinical range. FCR was associated with both pain (r = .40, p < .001) and interpretation bias (r = .45, p < .001). Interpretation bias and pain (r = .31, p < .001) were also associated with each other. Moderation analyses confirmed that interpretation bias moderated the relationship between pain and FCR (F(1, 143) = 5.76; p = .01). However, this was not the case with FOP (F(1, 143) = .21; p = .65). We found that women with breast cancer with clinically significant FCR/P interpreted ambiguous words as health-related more often and experienced more pain than those with nonclinical FCR/P. Moreover, we found that among those with higher levels of pain, FCR was also higher only among those with higher levels of interpretation bias, as the threat interpretation model predicts. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Theory-Based Approaches to Support Dermoscopic Image Interpretation Education: A Review of the Literature.

Efficient interpretation of dermoscopic images relies on pattern recognition, and the development of expert-level proficiency typically requires extensive training and years of practice. While traditional methods of transferring knowledge have proven effective, technological advances may significantly improve upon these strategies and better equip dermoscopy learners with the pattern recognition skills required for real-world practice. A narrative review of the literature was performed to explore emerging directions in medical image interpretation education that may enhance dermoscopy education. This article represents the first of a two-part review series on this topic. To promote innovation in dermoscopy education, the International Skin Imaging Collaborative (ISIC) assembled a 12-member Education Working Group that comprises international dermoscopy experts and educational scientists. Based on a preliminary literature review and their experiences as educators, the group developed and refined a list of innovative approaches through multiple rounds of discussion and feedback. For each approach, literature searches were performed for relevant articles. Through a consensus-based approach, the group identified a number of emerging directions in image interpretation education. The following theory-based approaches will be discussed in this first part: whole-task learning, microlearning, perceptual learning, and adaptive learning. Compared to traditional methods, these theory-based approaches may enhance dermoscopy education by making learning more engaging and interactive and reducing the amount of time required to develop expert-level pattern recognition skills. Further exploration is needed to determine how these approaches can be seamlessly and successfully integrated to optimize dermoscopy education.

Instructional Strategies to Enhance Dermoscopic Image Interpretation Education: a Review of the Literature.

In image interpretation education, many educators have shifted away from traditional methods that involve passive instruction and fragmented learning to interactive ones that promote active engagement and integrated knowledge. By training pattern recognition skills in an effective manner, these interactive approaches provide a promising direction for dermoscopy education. A narrative review of the literature was performed to probe emerging directions in medical image interpretation education that may support dermoscopy education. This article represents the second of a two-part review series. To promote innovation in dermoscopy education, the International Skin Imaging Collaborative (ISIC) assembled an Education Working Group that comprises international dermoscopy experts and educational scientists. Based on a preliminary literature review and their experiences as educators, the group developed and refined a list of innovative approaches through multiple rounds of discussion and feedback. For each approach, literature searches were performed for relevant articles. Through a consensus-based approach, the group identified a number of theory-based approaches, as discussed in the first part of this series. The group also acknowledged the role of motivation, metacognition, and early failures in optimizing the learning process. Other promising teaching tools included gamification, social media, and perceptual and adaptive learning modules (PALMs). Over the years, many dermoscopy educators may have intuitively adopted these instructional strategies in response to learner feedback, personal observations, and changes in the learning environment. For dermoscopy training, PALMs may be especially valuable in that they provide immediate feedback and adapt the training schedule to the individual's performance.

Cognitive assessments among children with cerebral palsy in Sweden and the use of augmentative and alternative communication and interpreters: a cross-sectional registry study

Purpose Children with cerebral palsy (CP) have an increased risk of cognitive difficulties and should be offered cognitive assessments. In Sweden, the CPCog protocol recommends children with CP undergo cognitive assessments at the start of primary and secondary school. To assess children with CP can be challenging, in particular when children are non-vocal or do not speak the local language. In such instances, augmentative and alternative communication (AAC) and qualified medical interpreters should be considered. The purpose of this study was to monitor the implementation and equitable delivery of the CPCog protocol in Sweden between the years 2017–2020. Materials and Methods In this cross-sectional study, registry data were extracted from the combined follow-up program and national registry for individuals with CP (CPUP), and a convenience sample of psychologists responded to an online survey. Results and Conclusions Each year, less than 5% of eligible children had registered cognitive assessments in CPUP. There was underuse of AAC during assessments and a discrepancy between the registered versus reported use of interpreters. Psychologists perceived AAC as more reliable for cognitive assessments than interpreters. Greater availability of and capacity to offer cognitive assessments in other formats and languages could help increase test accessibility for all children with CP. Implications for Rehabilitation The cognitive assessment of children with cerebral palsy (CP) is a complex but important issue within disability and re/habilitation. Individualized cognitive assessments should be offered and carried out by psychologists. Rehabilitation centers should strive to be inclusive through reliable test adaptations for functional abilities, means of communication, and language. Greater availability of- and capacity to offer cognitive assessments in more formats and languages could help increase test accessibility for children with disabilities.

Exorcisme catholique en France contemporaine, entre thérapeutique et régulation institutionnelle

This article proposes to study the contemporary implementation of Catholic exorcism rituals in France. It is a growing demand that challenges the Catholic Church and expresses discomforts in contemporary society. Based on a study conducted in France between 2016 and 2020, the research is spread over various dioceses and works with diverse actors (priests, exorcists, ritual requesters, lay collaborators) belonging to plural groups. Using qualitative strategies – mainly ethnography, active interviews and document analysis – this article analyses the population requesting exorcism, and attempts to understand the environments in which the practices are anchored and the work of the exorcists. This article shows the dialogue established between the practice of exorcism and medical interpretations, and the deployment of a new listening and regulation of the Church towards an increased demand which is related to indeterminate misfortunes linked to the field of health and healing.

Assessing Adult Patients’ Understandings of Secondary Malignancy Risk Terms in Radiation Therapy Consent

<h3>Purpose/Objective(s)</h3> Informed consent is an essential component of cancer care. The terms "second tumors" or "secondary tumors" are sometimes used in radiation therapy consent. Their incidences are sometimes described as "rare," although vary greatly from nearly negligible in patients treated with palliative intent, to 20% in young patients undergoing myeloablative total body irradiation. We evaluated whether patients without prior knowledge of radiation therapy interpret the terms in a way consistent with physician intent. <h3>Materials/Methods</h3> We screened 164 adult subjects who did not require medical interpreters at a university-affiliated family medicine clinic, excluding cancer patients and those with any prior knowledge of or experience with radiation treatment. One hundred subjects were eligible for and completed a 12-question multiple choice questionnaire, which assessed their understanding of the term "secondary tumor" or "second tumor", and how they would interpret the terms "small chance" or "rare" in the context of a "bad side effect." <h3>Results</h3> Twenty-nine percent of subjects correctly identified that "secondary tumors" referred to new and different tumors caused by treatment. Forty-nine percent thought the term referred to their original tumor recurring, and 22% thought the term referred to new and different tumors not caused by radiation therapy. Subjects with college degrees were not more likely to choose the correct answer than subjects without college degrees p=0.63. College degree status was not available for 5 subjects. Given choices between 1:10, 1:100, 1:1000, and 1:100,000, subjects associated "rare" with 1:1000 or 1:100,000 82% of the time. The term "small chance" was associated with 1:1000 or 1:100,000 59% of the time. <h3>Conclusion</h3> Adult non-cancer patients have a demonstrably different understanding than radiation oncologists of the terms "second tumor" or "secondary tumor." Additionally, patient understanding of the terms "rare" or "small chance" varies from secondary malignancy incidences in many clinical scenarios. Radiation oncologists should use clearer terms for secondary malignancies and their incidence.

Employing retrospective process tracing in an international exploratory study

Abstract This paper reports on a RPT study which employed an adapted version of the three-stage method used by Herring (2018). The same stimulus and method were employed with two distinct populations (experienced medical interpreters in the USA and student interpreters in Poland), with the aim of refining RPT methods and exploring the feasibility of their use in multi-researcher, multi-site studies. The authors discuss the process of developing and carrying out a study design and procedure for use by two researchers across two sites and with two populations, critically address the effectiveness of the use of the method &amp; procedure by two researchers, and discuss recommendations for future studies employing similar designs and methods. The paper also presents preliminary analysis of the RPT data gathered as part of the study and suggests avenues for further research.

SIMCard: Toward better connected electronic health record visualization

SummaryRecently, several healthcare organizations use decision‐making systems based on electronic health record (EHR) data in order to guarantee patient's safety and improve the quality of healthcare. In essence, the evolutions of Internet of Things (IoT) technologies have been of great help for implementing an integrated and interoperable decision‐making system based on EHR and medical devices (MDs). Those IoT‐based systems allow Clinicians collecting real‐time health data and provide accurate patient's monitoring. Nevertheless, several studies have shown that it is hard to improve the quality of healthcare using the current EHR IoT‐based systems since they do not allow to easily express clinician needs. Interactive visualization tools have been proposed to improve the efficacy and utility of these EHR based systems. However, there is no framework that provides a visual summary of patient data to clinician for planning specific clinical tasks, subsequently evaluating clinician responses, visually exploring EHR data and MDs data, gaining insights, supporting dynamic coordination processes care, and forming and validating hypotheses and risks. This article addresses this problem and introduces SIMCard, an aggregation‐based connected EHR visualization framework for patient monitoring, interpreting and predicting with MDs. The proposed framework aims to synthesize patient's clinical data into a single aggregating model for both EHR and MD conforming to health standard and terminologies. It also allows to link the aggregating model to the relevant medical knowledge in order to provide a connected and dynamic care and preventive plan. Last but not least, it provides an aggregated visualization model capable of displaying graphically a patient's personal data from databases, healthcare devices and sensors to reduce cognitive barriers related to the complexity of medical information and interpretation of health data. To demonstrate the refinement and design of our system and to observe user's actual practice of visualizing and analyzing real‐world dataset, we evaluated our system and compare to existing ones.

Who is informed of trauma informed care? Patients' primary language and comprehensiveness of initial trauma assessment.

For patients with limited English proficiency, language poses a unique challenge in patient-provider communication. Using certified medical interpretation (CMI) can be difficult in time- and resource-limited settings including trauma. We hypothesized that there would be limited use of CMI during major trauma resuscitations, less comprehensive assessments, and less empathetic communication for Spanish-speaking patients (SSPs) with limited English proficiency compared with English-speaking patients (ESPs). We analyzed video-recorded encounters of trauma initial assessments at a Level 1 trauma center. Each encounter was evaluated from patient arrival until completion of the secondary survey per Advanced Trauma Life Support protocol. A standard checklist of provider actions was used to assess comprehensiveness of the primary and secondary surveys and communication events such as provider introduction, reassurances, and communicating next steps to patients. We compared the SSP and ESP cohorts for significant differences in completion of checklist items. Fifty patients with Glasgow Coma Scale scores of 14 and 15 were included (25 SSPs, 25 ESPs). The median age was 34 years (interquartile range, 25-65 years) for SSPs and 40 years (interquartile range, 29-54 years) for ESPs. In SSPs, 72% were male; in ESPs, 60% were male. Spanish-speaking patients received less comprehensive motor (48% complete SSPs vs. 96% ESPs, p < 0.001) and sensory (4% complete SSPs vs. 68% ESPs, p < 0.001) examinations, and less often had providers explain next steps (32% SSPs vs. 96% ESPs, p < 0.001) or reassure them (44% SSPs vs. 88% ESPs, p = 0.001). No patients were asked their primary language. Two SSP encounters (8%) used CMI; most (80%) used ad hoc interpretation, and 12% used English. We found significant differences in the initial care provided to trauma patients based on primary language. Inclusion of an interpreter as part of the trauma team may improve the quality of care provided to trauma patients with limited English proficiency. Therapeutic/Care Management; Level IV.

Pseudo-V1 ECG lead recording with quality smartwatches and medical interpretation may be necessary for timely and accurate remote detection of atrial flutter/fibrillation

Abstract Background Remote rhythm monitoring with wearable devices is increasingly used especially for early detection of atrial fibrillation/flutter (AF/Afl), being the access to hospital discouraged, especially for frail elderly patients, due to the burden and risk of COVID-19 pandemic. Whereas devices using photo plethysmography (PPG) may misinterpret as AF pulse irregularities due to extrasystoles, patient-directed recording of a single (usually wrist-to-wrist) lead ECG (LEAD I) with hand-held devices or smartwatches have been developed to increase accuracy in AF detection. However, although recent studies validating such devices single-lead ECG recording have shown high sensitivity and specificity, false negative findings such as those reported here are still possible and must be prevented [1]. Purpose Given previous experience of diagnostic uncertainty or failure of the smartwatch ECG (SW-ECG) LEAD I to detect AF/Afl, we have tested if false negative diagnosis could be avoided by recording in addition at least one right precordial (pseudo-V1) lead analyzed by a trained healthcare professional. Method Over one calendar year observation, five patients with previous history of ablated supraventricular arrhythmias suffering sudden palpitations suspected of paroxysmal AF/Afl were instructed to record with their smartwatch at least one precordial lead in addition to LEAD I, to monitor ECG until the termination of symptoms. The SW-ECG strips were sent by telephone for professional interpretation. Diagnostic accuracy based on LEAD I and pseudo-V1 were independently validated by two cardiologists (diagnostic goldstandard - DGS). Results 22 AF/Afl events occurred. Pharmacological cardioversion to sinus rhythm (SR) was obtained in 64%. 192 ECG strips were transmitted. 43,7% of the strips were automatically classified as “not significant” (or “not valid”). Compared to DGS, out of 108 “valid” strips, correct automatic identification of AF/Afl was obtained in 36,4% with LEAD I, in 33,3% with pseudo V1 and in 54,5% with combined leads, respectively. Interestingly, the SW algorithm has wrongly diagnosed as SR, not only LEAD I, but also 39,4% of pseudo-V1 strips, despite clear-cut evidence of typical flutter waves (Figure 1), when RR intervals were regular due to high degree (e.g., 4:1) A-V block. Conclusions With simple instructions, patients (or their relatives) can easily record an additional precordial (pseudo-V1) SW-ECG lead, that may enhance sensitivity and specificity for remote detection of AF/Afl. However, at present, visual interpretation of SW-ECG by a trained healthcare professional is still needed to guarantee 100% correct diagnosis of AF/Afl, crucial to reduce thromboembolic risk and timely initiate the appropriate treatments. The automatic interpretation of SW's ECG could be improved by appropriate training of a machine learning approach to detect and analyze the atrial waveform provided by an additional pseudo-V1 lead. Funding Acknowledgement Type of funding sources: None.

325 Bridging the Gap: Medical Interpreter Utilization Workshop to Improve Communication

Patients with Limited English proficiency (LEP) experience disparities and inequitable care due to the language barrier. A qualified medical interpreter (QMI) is required by law to communicate in their primary language, yet there are inconsistencies in utilization practices. Using interpretation services effectively is an integral part of establishing a therapeutic relationship, improving patient outcomes, and providing culturally competent care. However, many institutions lack a curriculum that equips learners with training for using a professional interpreter.