***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Growth of the foreign-born population in the U.S. has led to increasing numbers of limited-English-proficient ( LEP ) patients .  Innovative medical interpreting strategies , including remote simultaneous medical interpreting ( RSMI ) , have arisen to address the language barrier . This study evaluates the impact of interpreting method on patient satisfaction . Methods 1,276 English- , Spanish- , M and arin- , and Cantonese-speaking patients attending the primary care clinic and emergency department of a large New York City municipal hospital were screened for enrollment in a r and omized controlled trial . Language -discordant patients were r and omized to RSMI or usual and customary ( U&C ) interpreting . Patients with language -concordant providers received usual care . Demographic and patient satisfaction question naires were administered to all participants . Results 541 patients were language -concordant with their providers and not r and omized ; 371 were r and omized to RSMI , 167 of whom were exposed to RSMI ; and 364 were r and omized to U&C , 198 of whom were exposed to U&C. Patients r and omized to RSMI were more likely than those with U&C to think doctors treated them with respect ( RSMI 71 % , U&C 64 % , p < 0.05 ) , but they did not differ in other measures of physician communication/care . In a linear regression analysis , exposure to RSMI was significantly associated with an increase in overall satisfaction with physician communication/care ( β 0.10 , 95 % CI 0.02–0.18 , scale 0–1.0 ) . Patients r and omized to RSMI were more likely to think the interpreting method protected their privacy ( RSMI 51 % , U&C 38 % , p < 0.05 ) . Patients r and omized to either arm of interpretation reported less comprehension and satisfaction than patients in language -concordant encounters . Conclusions While not a substitute for language -concordant providers , RSMI can improve patient satisfaction and privacy  among LEP patients . Implementing RSMI should be considered an important component of a multipronged approach to addressing language barriers in health care Appropriate interpretation is imperative for families with limited English proficiency ( LEP ) . We compared throughput times for ED visits involving families with LEP based on type of interpretation provided : in-person interpretation , remote telephonic interpretation or bilingual providers . This study is a secondary analysis of a prospect i ve study of caretaker satisfaction with different interpreter modalities . We queried the medical record for event time stamps , clinical factors and disposition . The in-person cohort ( 116 min ) had a significantly shorter total throughput time than telephonic ( 141 min ) and bilingual provider ( 153 min ) cohorts ( P < 0.0001 ) , due to a difference in time seen by provider to disposition . Time seen by provider to disposition remained statistically significantly shorter for the in-person cohort when compared to telephonic interpretation when controlling for potential confounders such as admission rate ( P = 0.006 ) . In-person interpretation significantly decreased ED throughput times and may be an important consideration in the choice of interpreter modality Background Ethnic minorities report poorer evaluations of primary health care  compared to White British patients . Emerging evidence suggests that when a doctor and patient share ethnicity and /or language this is associated with more positive reports of patient experience . Whether this is true for adults in English general practice s remains to be explored . Methods We analysed data from the 2010/2011 English General Practice Patient Survey  , which were linked to data from the NHS Choices website to identify language s which were available at the practice . Our analysis was restricted to single-h and ed practice s and included 190,582 patients across 1,068 practice s. Including only single-h and ed practice s enabled us to attribute , more accurately , reported patient experience to the language s that were listed as being available . We also carried out sensitivity analyses in multi-doctor practice s . We created a composite score on a 0 - 100 scale from seven survey items assessing doctor-patient communication . Mixed-effect linear regression models were used to examine how differences in reported experience of doctor communication between patients of different self-reported ethnicities varied according to whether a South Asian language concordant with their ethnicity was available in their practice . Models were adjusted for patient characteristics and a r and om effect for practice . Results Availability of a concordant language had the largest effect on communication ratings for Bangladeshis and the least for Indian respondents ( p < 0.01 ) . Bangladeshi , Pakistani and Indian respondents on average reported poorer communication than White British respondents [ -2.9 ( 95%CI -4.2 , -1.6 ) , -1.9 ( 95%CI -2.6 , -1.2 ) and -1.9 ( 95%CI -2.5 , -1.4 ) , respectively ] . However , in practice s where a concordant language was offered , the experience reported by Pakistani patients was not substantially worse than that reported by White British patients ( -0.2 , 95%CI -1.5,+1.0 ) , and in the case of Bangladeshi patients was potentially much better ( + 4.5 , 95%CI -1.0,+10.1 ) . This contrasts with a worse experience reported among Bangladeshi ( -3.3 , 95%CI -4.6 , -2.0 ) and Pakistani ( -2.7 , 95%CI -3.6 , -1.9 ) respondents when a concordant language was not offered . Conclusions Substantial differences in reported patient experience exist between ethnic groups . Our results suggest that patient experience among Bangladeshis and Pakistanis is improved where the practice offers a language that is concordant with the patient ’s ethnicity Background Supporting 21st century health care and the practice of evidence -based medicine ( EBM ) requires ubiquitous access to clinical information and to knowledge-based re sources to answer clinical questions . Many questions go unanswered , however , due to lack of skills in formulating questions , crafting effective search strategies , and accessing data bases to identify best levels of evidence . Methods This r and omized trial was design ed as a pilot study to measure the relevancy of search results using three different interfaces for the PubMed search system . Two of the search interfaces utilized a specific framework called PICO , which was design ed to focus clinical questions and to prompt for publication type or type of question asked . The third interface was the st and ard PubMed interface readily available on the Web . Study subjects were recruited from interns and residents on an inpatient general medicine rotation at an academic medical center in the US . Thirty-one subjects were r and omized to one of the three interfaces , given 3 clinical questions , and asked to search PubMed for a set of relevant articles that would provide an answer for each question . The success of the search results was determined by a precision score , which compared the number of relevant or gold st and ard articles retrieved in a result set to the total number of articles retrieved in that set . Results Participants using the PICO templates ( Protocol A or Protocol B ) had higher precision scores for each question than the participants who used Protocol C , the st and ard PubMed Web interface . ( Question 1 : A = 35 % , B = 28 % , C = 20 % ; Question 2 : A = 5 % , B = 6 % , C = 4 % ; Question 3 : A = 1 % , B = 0 % , C = 0 % ) 95 % confidence intervals were calculated for the precision for each question using a lower boundary of zero . However , the 95 % confidence limits were overlapping , suggesting no statistical difference between the groups . Conclusion Due to the small number of search es for each arm , this pilot study could not demonstrate a statistically significant difference between the search protocol s. However there was a trend towards higher precision that needs to be investigated in a larger study to determine if PICO can improve the relevancy of search results Background Cultural and language discordance between patients and providers constitutes a significant challenge to provision of quality healthcare . This study aims to evaluate minority patients ’ discharge from hospital to community care , specifically examining the relationship between patient – provider language concordance and the quality of transitional care . Methods This was a multi- method prospect i ve study of care transitions of 92 patients : native Hebrew , Russian or Arabic speakers , with a pre-discharge question naire and structured observations examining discharge preparation from a large Israeli teaching hospital . Two weeks post-discharge patients were surveyed by phone , on the transition from hospital to community care ( the Care Transition Measure ( CTM-15 , 0–100 scale ) ) and on the primary -care post-discharge visit . Results Overall , ratings on the CTM indicated fair quality of the transition process ( scores of 51.8 to 58.8 ) . Patient – provider language concordance was present in 49 % of minority patients ’ discharge briefings . Language concordance was associated with higher CTM scores among minority groups ( 64.1 in language -concordant versus 49.8 in non- language -concordant discharges , P < 0.001 ) . Other aspects significantly associated with CTM scores : extent of discharge explanations ( P < 0.05 ) , quality of discharge briefing ( P < 0.001 ) , and post-discharge explanations by the primary care physician ( P < 0.01 ) . Conclusion Language -concordant care , coupled with extensive discharge briefings and post-discharge explanations for ongoing care , are important contributors to the quality of care transitions of ethnic minority patients BACKGROUND Many health care providers do not provide adequate language access services for their patients who are limited English-speaking because they view the costs of these services as prohibitive . However , little is known about the costs they might bear because of unaddressed language barriers or the costs of providing language access services . OBJECTIVE To investigate how language barriers and the provision of enhanced interpreter services impact the costs of a hospital stay . DESIGN Prospect i ve intervention study . SETTING Public hospital inpatient medicine service . PARTICIPANTS Three hundred twenty-three adult in patients : 124 Spanish-speakers whose physicians had access to the enhanced interpreter intervention , 99 Spanish-speakers whose physicians only had access to usual interpreter services , and 100 English-speakers matched to Spanish-speaking participants on age , gender , and admission firm . MEASUREMENTS Patient satisfaction , hospital length of stay , number of inpatient consultations and radiology tests conducted in the hospital , adherence with follow-up appointments , use of emergency department ( ED ) services and hospitalizations in the 3 months after discharge , and the costs associated with provision of the intervention and any result ing change in health care utilization . RESULTS The enhanced interpreter service intervention did not significantly impact any of the measured outcomes or their associated costs . The cost of the enhanced interpreter service  was $ 234 per Spanish-speaking intervention patient and represented 1.5 % of the average hospital cost . Having a Spanish-speaking attending physician significantly increased Spanish-speaking patient satisfaction with physician , overall hospital experience , and reduced ED visits , thereby reducing costs by $ 92 per Spanish-speaking patient over the study period . CONCLUSION The enhanced interpreter service intervention did not significantly increase or decrease hospital costs . Physician – patient language concordance reduced return ED visit and costs . Health care providers need to examine all the cost implication s of different language access services before they deem them too costly The purpose of this study is to examine the association of ethnicity and language concordance with  physician-patient  agreement about physicians ' recommendations for patient health behavior in the following areas : diet , exercise , medication , smoking , stress , and weight . Twenty-seven resident physicians at the University of New Mexico 's internal medicine and family practice clinics and 427 of their patients participated . R and om effects models were used to estimate the influence of ethnicity and language concordance on whether patients and physicians agreed about specific recommended changes in patient behavior . Ethnicity concordance was not significantly associated with physician-patient agreement . Language concordance positively influenced the likelihood of agreement about exercise but negatively influenced agreement about medications . The lowest percentage of agreement occurred in the area of medication regimens ( 60 % ) . The results from this study indicate that language is an important barrier to physician-patient agreement , while ethnicity concordance has no effect . However , the influence of whether the physician and patient speak the same language on agreement is unclear and warrants further research 
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Discussion The findings of this review indicate that , in the majority of situations , language -concordant care improves outcomes .
Although most studies included were of good quality , none provided a st and ardized assessment of provider language skills .