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Arpin-Gemme K, Noah Gelgoot E, Miklavcic A, Jarvis GE. Documenting language barriers in a general hospital psychiatry setting. Transcult Psychiatry 2023; 60:675-689. [PMID: 37097920 DOI: 10.1177/13634615231163993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
Previous research has demonstrated that without the use of professional interpreters, language barriers interfere with patient care. The literature recommends documenting the presence of language barriers in medical charts. To our knowledge, this mixed methods study is the first to examine language documentation practices in a Canadian inpatient psychiatry setting. The research team interviewed 122 patients admitted to a tertiary care psychiatry ward in Montreal, Canada between 2016-2017 to assess their ability to communicate in the healthcare establishment's languages (English/French). Nineteen participants identified as having a language barrier were selected for a qualitative analysis of the retrospective audit of their medical charts. The presence of a language barrier was reflected in 68% of these charts. When a language barrier was documented, professional interpreters were never used. Our qualitative analysis, informed by literature on medical discourse, aimed to provide clinical, administrative, and organizational recommendations to optimize the utilization of interpreting services in psychiatric wards. Documentation of language data was inconsistently collected, often vague, and shed light on the clinical challenges involved in differentiating language barriers from psychopathology. Normalization of limited care for language diverse patients was reflected in the clinical notes. Findings show that a change of organizational culture is imperative to provide optimal care to language diverse patients. We recommend clinician education and standardization of documentation practices, along with institutional policies supporting the systematic use of professional interpreters in mental healthcare settings, to maximize human rights and patient safety, and to bring medical practices to an acceptable standard of care.
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Affiliation(s)
- Krystel Arpin-Gemme
- Division of Social and Transcultural Psychiatry, McGill University
- Culture and Mental Health Research Unit, Sir Mortimer B. Davis Jewish General Hospital, Institute of Community and Family Psychiatry, Montreal, Canada
| | - Eden Noah Gelgoot
- Division of Social and Transcultural Psychiatry, McGill University
- Culture and Mental Health Research Unit, Sir Mortimer B. Davis Jewish General Hospital, Institute of Community and Family Psychiatry, Montreal, Canada
| | - Alessandra Miklavcic
- Division of Social and Transcultural Psychiatry, McGill University
- Culture and Mental Health Research Unit, Sir Mortimer B. Davis Jewish General Hospital, Institute of Community and Family Psychiatry, Montreal, Canada
| | - G Eric Jarvis
- Division of Social and Transcultural Psychiatry, McGill University
- Culture and Mental Health Research Unit, Sir Mortimer B. Davis Jewish General Hospital, Institute of Community and Family Psychiatry, Montreal, Canada
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Shiner CT, Bramah V, Wu J, Faux SG, Watanabe Y. Health care interpreter use in an inpatient rehabilitation setting: examining patterns of use and associated clinical outcomes. Disabil Rehabil 2022:1-11. [PMID: 35705483 DOI: 10.1080/09638288.2022.2086637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Professional interpreters can improve healthcare quality and outcomes when there is language discordance between patients and health care providers. Multidisciplinary rehabilitation relies on nuanced communication; however, the use of interpreters in rehabilitation is underexplored. This study aimed to examine patterns of health care interpreter use in an inpatient rehabilitation setting. METHODS A retrospective cohort study was conducted including patients admitted for subacute rehabilitation during 2019-2020 identified as having limited English proficiency. Patterns of interpreter use (professional and "ad hoc") and rehabilitation outcomes were evaluated via medical record review. RESULTS Eighty-five participants were included. During inpatient rehabilitation (median 17 [12-28] days), most clinical interactions (95%) occurred without an interpreter present. Patterns of interpreter use were variable; with greater use of ad hoc versus professional interpreters (received by 60% versus 49% of the cohort, respectively). Those who interacted with a professional interpreter had a longer length-of-stay, larger Functional Independence Measure (FIM) gain, and lower rate of hospital readmission six months post-discharge. The number of professional interpreter sessions correlated positively with FIM gain. CONCLUSIONS Access to professional interpreters in inpatient rehabilitation was variable, with some patients having no or minimal access. These findings provide preliminary evidence that professional interpreter use may be associated with clinical rehabilitation outcomes. Implications for rehabilitationProfessional health care interpreters can be used to overcome language barriers in rehabilitation.In an inpatient rehabilitation setting, professional interpreters appeared to be underutilized, with many patients having no or minimal access to interpreters.Use of ad hoc, untrained interpreters and informal communication strategies was common during rehabilitation.Use of professional interpreters appeared to be associated with favorable rehabilitation outcomes.
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Affiliation(s)
- Christine T Shiner
- Department of Rehabilitation, St Vincent's Hospital Sydney, Darlinghurst, Australia.,Faculty of Medicine, St Vincent's Clinical School, University of New South Wales, Sydney, Australia
| | - Valerie Bramah
- Department of Rehabilitation, St Vincent's Hospital Sydney, Darlinghurst, Australia
| | - Jane Wu
- Department of Rehabilitation, St Vincent's Hospital Sydney, Darlinghurst, Australia
| | - Steven G Faux
- Department of Rehabilitation, St Vincent's Hospital Sydney, Darlinghurst, Australia.,Faculty of Medicine, St Vincent's Clinical School, University of New South Wales, Sydney, Australia
| | - Yuriko Watanabe
- Department of Rehabilitation, St Vincent's Hospital Sydney, Darlinghurst, Australia
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Gutman CK, Lion KC, Fisher CL, Aronson PL, Patterson M, Fernandez R. Breaking through barriers: the need for effective research to promote language-concordant communication as a facilitator of equitable emergency care. J Am Coll Emerg Physicians Open 2022; 3:e12639. [PMID: 35072163 PMCID: PMC8759339 DOI: 10.1002/emp2.12639] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/10/2021] [Accepted: 12/14/2021] [Indexed: 02/05/2023] Open
Abstract
Individuals with limited English proficiency (LEP) are at high risk for adverse outcomes in the US health care system. This is particularly true for patients with LEP seeking care in the emergency department (ED). Although professional language interpretation improves the quality of care for these patients, it remains underused. The dynamic, discontinuous nature of an ED visit poses distinct challenges and opportunities for providing equitable, high-quality care for patients with LEP. Evidence-based best practices for identifying patients with LEP and using professional interpretation are well described but inadequately implemented. There are few examples in the literature of rigorous interventions to improve quality of care and outcomes for patients with LEP. There is an urgent need for high-quality research to improve communication with patients with LEP along the continuum of emergency care in order to achieve equity in outcomes.
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Affiliation(s)
- Colleen K Gutman
- Department of Emergency Medicine University of Florida College of Medicine Gainesville Florida USA
| | - K Casey Lion
- Department of Pediatrics University of Washington School of Medicine Seattle, Washington USA
- Center for Child Health, Behavior, and Development Seattle Children's Research Institute Seattle, Washington USA
| | - Carla L Fisher
- STEM Translational Communication Center University of Florida College of Journalism and Communication Gainesville Florida USA
- UF Health Cancer Center, Center for Arts in Medicine University of Florida Gainesville Florida USA
| | - Paul L Aronson
- Department of Pediatrics Yale School of Medicine New Haven Connecticut USA
- Department of Emergency Medicine Yale School of Medicine New Haven Connecticut USA
| | - Mary Patterson
- Department of Emergency Medicine University of Florida College of Medicine Gainesville Florida USA
- Center for Experiential Learning and Simulation University of Florida College of Medicine Gainesville Florida USA
| | - Rosemarie Fernandez
- Department of Emergency Medicine University of Florida College of Medicine Gainesville Florida USA
- Center for Experiential Learning and Simulation University of Florida College of Medicine Gainesville Florida USA
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Lor M, Badenoch N, Yang MJ. Technical Meets Traditional: Language, Culture, and the Challenges Faced by Hmong Medical Interpreters. J Transcult Nurs 2022; 33:96-104. [PMID: 34404302 PMCID: PMC10711740 DOI: 10.1177/10436596211039553] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Ineffective intercultural communication can occur due to inaccurate medical interpreting for limited English proficiency (LEP) patients. Research shows that Hmong patients experience poorer quality interpreter services than other LEP populations. This study's purpose is to understand Hmong medical interpreters' perceptions of the factors that affect their ability to make accurate medical interpretations during clinical encounters. METHOD A qualitative study was conducted with Hmong-speaking medical interpreters. The interviews were semistructured, audio recorded, and analyzed using conventional content analysis. RESULTS 13 interpreters aged 29 to 49 years participated in the study. Three factors affected the interpreters' ability to make accurate medical interpretations for Hmong-speaking patients: (a) matched gender between the interpreter and patient, (b) culturally taboo topics in communicating about reproductive body parts and sexual health/activity, and (c) culture and generational language differences between interpreters and Hmong patients. DISCUSSION Clinical encounters that match patient-interpreter ages, gender, and/or local culture may reduce communication barriers.
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Affiliation(s)
- Maichou Lor
- University of Wisconsin–Madison, Madison, WI, USA
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Do Standardized Scripts Improve Interpreter Use by Spanish-Speaking Patients? J Immigr Minor Health 2021; 23:1021-1025. [PMID: 33837473 DOI: 10.1007/s10903-021-01195-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2021] [Indexed: 10/21/2022]
Abstract
Patients with limited English-proficiency (LEP) who need but do not receive interpreters have lower satisfaction and poorer understanding. A knowledge gap remains regarding the optimal way to offer interpreters. Using standardized scripts, we will determine whether the questions we use to offer interpreters increase utilization. Pilot prospective cohort study of postpartum mothers with LEP. Subjects were assigned one of three unique scripted question offering an interpreter. Data were analyzed using ANOVA, chi-square test, and Fisher's exact test. Fifty-five LEP patients were randomized into three study arms with similar sociodemographics. Overall interpreter use was 80% (44/55). There was a significant difference in interpreter utilization: 82.4%, 63.6%, 100%, respectively by arm (p = 0.015). Highest interpreter utilization occurred with "In what language do you prefer to receive your medical care?". There is opportunity for providers to refine the way they offer interpreters to optimize utilization.
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Krystallidou D, Langewitz W, van den Muijsenbergh M. Multilingual healthcare communication: Stumbling blocks, solutions, recommendations. PATIENT EDUCATION AND COUNSELING 2021; 104:512-516. [PMID: 32988684 DOI: 10.1016/j.pec.2020.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/04/2020] [Accepted: 09/12/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To provide guidance on multilingual and language discordant healthcare communication. DISCUSSION We provide a critical reflection on common stumbling blocks to securing (professional) language support, as well as on the currently available solutions to language discordance in healthcare. We discuss issues pertaining to i) the assessment of the patient and healthcare professional's language proficiency, ii) the decision making on whether to seek language support, iii) the currently available options of language support and the development of skills that ensure their effective use, iv) the inclusion of professional interpreters in the interprofessional healthcare team, and v) the transition from single- to integrated language support solutions that allow for a more comprehensive approach to multilingual healthcare communication. We present a set of recommendations for good practice. CONCLUSION Understanding the needs, capabilities and shortcoming of the available language- support solutions and the implications arising from them can enable decision makers to make informed decisions that ensure the quality of communication and care. The integrated use of language-support solutions at different stages of care can create the conditions for effective communication, while promoting patient and family participation in the decision making process. Evidence-based interventions that can inform the implementation of solutions are required.
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Affiliation(s)
- Demi Krystallidou
- University of Surrey, Centre for Translation Studies, School of Literature and Languages, Guildford, Surrey, GU2 7XH, UK; KU Leuven, Faculty of Arts, Sint Andries Campus, B-2000 Antwerp, Belgium.
| | - Wolf Langewitz
- University and University Hospital Basel, Dept. Psychosomatic Medicine, Clinical Communication, Switzerland.
| | - Maria van den Muijsenbergh
- Radboud University Medical Centre Department of Primary and Community Care Nijmegen, the Netherlands; Pharos, Dutch Centre of Expertise on Health Disparities, Utrecht the Netherlands.
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Abstract
Immigrant and refugee patients may have limited English proficiency. Effective use of professional interpreter services reduces clinically significant errors and increases the quality of care. A multitude of professional interpreter services are available, and clinicians should carefully select the preferred modality of interpretation based on the type of encounter. Ad hoc interpreters, such as family members, are least preferred because of concerns of privacy and evidence of poorer outcomes. Children less than 18 years of age should only be used as interpreters in emergency situations. Professional telephonic, video, or in-person interpreters each have distinct advantages in specific clinical situations.
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Affiliation(s)
- Carina M Brown
- Department of Family Medicine, Cone Health Family Medicine Residency, University of North Carolina-Chapel Hill, 1125 North Church Street, Greensboro, NC 27401, USA.
| | - Scott Bland
- Cone Health Family Medicine Residency, 1125 North Church Street, Greensboro, NC 27401, USA
| | - Nadia Saif
- University of Virginia Family Medicine Residency, PO Box 800729, Charlottesville, VA 22908, USA
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Squires A, Miner S, Liang E, Lor M, Ma C, Witkoski Stimpfel A. How language barriers influence provider workload for home health care professionals: A secondary analysis of interview data. Int J Nurs Stud 2019; 99:103394. [PMID: 31479983 PMCID: PMC8273738 DOI: 10.1016/j.ijnurstu.2019.103394] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 07/31/2019] [Accepted: 08/01/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Increasingly, patients with limited English proficiency are accessing home health care services in the United States. Few studies have examined how language barriers influence provider role implementation or workload in the home health care setting. OBJECTIVES To explore home health care professionals' perspectives about how workload changes from managing language barriers influence quality and safety in home health care. DESIGN A qualitative secondary data analysis using a summative content analysis approach was used to analyze existing semi-structured interview data. SETTING A large urban home health care agency located on the East Coast of the United States. PARTICIPANTS Thirty five home health care providers [31 registered nurses, 3 physical therapists, 1 occupational therapist]. RESULTS A total of 142 discrete incidents emerged from the analysis. Overall, home health care providers experienced distinct shifts in how they implemented their roles that added to their workload and time spent with Limited English Proficiency patients and family members. Providers were concerned about interpretation accuracy and perceived it as potentially posing risks to patient safety. Changes in work patterns, therefore, sought to maximize patient safety. CONCLUSIONS Home health care providers decision-making about how they adapt practice when faced with a language barrier is a sequence of actions based on awareness of the patient's language preference and if they spoke another language. Subsequent choices showed proactive behaviors to manage increased workload shaped by their perceived risk of the threats posed by the quality of interpreter services. Future research should develop quantitative models examining differences in workload when caring for limited English proficiency versus English speaking patients as well as the relationship between visit length and patient outcomes to determine optimal quality models.
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Affiliation(s)
- Allison Squires
- Rory Meyers College of Nursing, New York University, 433 First Avenue, Office 658, New York, NY, 10010, USA.
| | - Sarah Miner
- Wegmans School of Nursing, St. John Fisher College, Rochester, NY, USA
| | - Eva Liang
- Rory Meyers College of Nursing, New York University, New York, USA
| | - Maichou Lor
- School of Nursing, Columbia University, New York, NY, USA
| | - Chenjuan Ma
- Rory Meyers College of Nursing, New York University, New York, USA
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O'Toole JK, Alvarado-Little W, Ledford CJW. Communication with Diverse Patients: Addressing Culture and Language. Pediatr Clin North Am 2019; 66:791-804. [PMID: 31230623 DOI: 10.1016/j.pcl.2019.03.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Effective communication is key when providing quality health care. The dynamics of communication within the health care team and with the patient and family can be challenging. These challenges stem from the sharing of complex information, highly emotional topics, and health literacy barriers. Linguistic and cultural barriers can further aggravate these challenges. This section provides an overview of linguistic and cultural challenges related to patient-provider communication, strategies for effective communication with patients with limited English Proficiency via the use of interpreter services, and tips for how to teach these skills to health care providers.
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Affiliation(s)
- Jennifer K O'Toole
- Departments of Pediatrics and Internal Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 5018, Cincinnati, OH 45229-3039, USA.
| | - Wilma Alvarado-Little
- New York State Department of Health, Office of Minority Affairs and Health Disparities Prevention, 9th Floor Corning Tower, ESP, Albany, NY 12237, USA
| | - Christy J W Ledford
- Department of Family Medicine, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
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Ault R, Morales A, Ault R, Spitale A, Martinez GA. Communication pitfalls in interpreted genetic counseling sessions. J Genet Couns 2019; 28:897-907. [PMID: 31112366 DOI: 10.1002/jgc4.1132] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 04/19/2019] [Indexed: 01/20/2023]
Abstract
The impact of language interpretation on interactive communication in genetic counseling sessions is not well studied. We sought to determine whether interpretation affects communication in genetic counseling sessions using communication analysis. With a sample of pregnant patients of advanced maternal age, we audiotaped, analyzed, and compared seven Spanish-speaking patients with limited-English proficiency to seven English-speaking patients on length of session, English words spoken, and number of questions asked. An analysis of verbal listening cues, including back-channels and questions asked was performed to evaluate the level of engagement by both provider and patient. Session length did not differ between groups (p > 0.05), however, English-speaking sessions involved significantly more words (mean: 4,798 vs. 2,524) exchanged over the course of the conversation than interpreter-mediated sessions (p < 0.001). The number of back-channeling responses was significantly greater in English-speaking compared to Spanish-speaking sessions. We found the same information was covered, but there was less provider-patient interaction when the session was interpreter-mediated. The patient asked fewer questions and the genetic counselor spoke in condensed ideas. Overall, our observations suggest diminished levels of interactive communication in interpreter-mediated sessions. Our work highlights the need for further evaluation in how genetic counselors communicate during interpreter-mediated sessions.
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Affiliation(s)
- Rachel Ault
- Department of Human Genetics, The Ohio State University, Columbus, Ohio
| | - Ana Morales
- Department of Human Genetics, The Ohio State University, Columbus, Ohio
| | - Russell Ault
- Medical Scientist Training Program, The Ohio State University, Columbus, Ohio
| | - Allison Spitale
- Department of Maternal Fetal Medicine, The Ohio State University, Columbus, Ohio
| | - Glenn A Martinez
- Department of Spanish and Portuguese, The Ohio State University, Columbus, Ohio
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Kaufman M, Cruz A, Thompson J, Reddy S, Bansal N, Cohen JG, Wu Y, Vadgama J, Farias-Eisner R. A review of the effects of healthcare disparities on the experience and survival of ovarian cancer patients of different racial and ethnic backgrounds. ACTA ACUST UNITED AC 2019; 5. [PMID: 31236478 PMCID: PMC6590085 DOI: 10.20517/2394-4722.2018.25] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Ovarian cancer (OC) is a serious condition that often presents at advanced stages and has high mortality rates, with the current mode of early-stage screening lacking sensitivity and specificity. OC often presents asymptomatically, which renders early diagnosis difficult. Furthermore, many patients lack significant risk factors or family history of the disease. Five-year survival rates differ between patients with OC among racial, ethnic, and social groups as a result of different social barriers. This review article aims to present the currently existing data regarding health care disparities among OC patients of different ethnic, demographic, and socioeconomic backgrounds, and what next steps should be taken to better understand and eventually eliminate these potentially devastating health care disparities. Increasing data support the notion that a combination of genomic, socioeconomic status, social factors, and cultural differences lead to differential treatments and therefore health care disparities. While genomic and biological factors are important, language barriers, geographic and travel barriers, differences in comorbidity likelihood between populations, and different treatment plans seem to have a greater impact on 5-year survival rates of patients from diverse backgrounds. Language barriers limit a shared-decision model of care. Transportation limitations and geographic differences can lead to limited follow-up and insufficient care in resource and equipment restrictive settings. Patients with these barriers also tend to have a higher incidence of comorbidities that raise the mortality rate of OC. Further research needs to explore effective solutions to bridge health care disparities and understand why they occur.
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Affiliation(s)
- Matthew Kaufman
- Obstetrics and Gynecology, University of California, Los Angeles, CA 90024, USA
| | - Ana Cruz
- Obstetrics and Gynecology, University of California, Los Angeles, CA 90024, USA
| | - Janese Thompson
- School of Medicine, Meharry Medical College, Nashville, TN 37208, USA
| | - Srinivasa Reddy
- Obstetrics and Gynecology, University of California, Los Angeles, CA 90024, USA
| | - Nisha Bansal
- Obstetrics and Gynecology, University of California, Los Angeles, CA 90024, USA
| | - Joshua G Cohen
- Obstetrics and Gynecology, University of California, Los Angeles, CA 90024, USA
| | - Yanyuan Wu
- Internal Medicine, Charles Drew University, Los Angeles, CA 90059, USA
| | - Jay Vadgama
- Internal Medicine, Charles Drew University, Los Angeles, CA 90059, USA
| | - Robin Farias-Eisner
- Obstetrics and Gynecology, University of California, Los Angeles, CA 90024, USA
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