The interaction of the T cell receptor for antigen (TCR) with its antigen-major histocompatibility complex ligand is difficult to study because both are cell surface multimers. The TCR consists of two chains (alpha and beta) that are complexed to the five or more nonpolymorphic CD3 polypeptides. A soluble form of the TCR was engineered by replacing the carboxyl termini of alpha and beta with signal sequences from lipid-linked proteins, making them susceptible to enzymatic cleavage. In this manner, TCR heterodimers can be expressed independently of the CD3 polypeptides and in significant quantities (0.5 milligram per week). This technique seems generalizable to biochemical and structural studies of many other cell surface molecules as well.
BACKGROUND: Language barriers disrupt communication and impede informed consent for patients with limited English proficiency (LEP) undergoing healthcare procedures. Effective interventions for this disparity remain unclear. OBJECTIVE: Assess the impact of a bedside interpreter phone system intervention on informed consent for patients with LEP and compare outcomes to those of English speakers. DESIGN: Prospective, pre-post intervention implementation study using propensity analysis. SUBJECTS: Hospitalized patients undergoing invasive procedures on the cardiovascular, general surgery or orthopedic surgery floors. INTERVENTION: Installation of dual-handset interpreter phones at every bedside enabling 24-h immediate access to professional interpreters. MAIN MEASURES: Primary predictor: pre-vs. postimplementation group; secondary predictor: postimplementation patients with LEP vs. English speakers. Primary outcomes: three central informed consent elements, patient-reported understanding of the (1) reasons for and (2) risks of the procedure and (3) having had all questions answered. We considered consent adequately informed when all three elements were met. KEY RESULTS: We enrolled 152 Chinese-and Spanishspeaking patients with LEP (84 pre-and 68 postimplementation) and 86 English speakers. Postimplementation (vs. pre-implementation) patients with LEP were more likely to meet criteria for adequately informed consent (54% vs. 29%, p = 0.001) and, after propensity score adjustment, had significantly higher odds of adequately informed consent (AOR 2.56; 95% CI, 1.15-5.72) as well as of each consent element individually. However, compared to post-implementation English speakers, post-implementation patients with LEP had
BACKGROUND:Patient whiteboards can serve as a communication tool between hospital providers and as a mechanism to engage patients in their care, but little is known about their current use or best practices.METHODS:We surveyed bedside nurses, internal medicine housestaff, and hospitalists from the medical service at the University of California, San Francisco. A brief survey about self‐reported whiteboard practices and their impact on patient care was administered via paper and a commercial online survey tool.RESULTS:Surveys were collected from 104 nurse respondents (81% response rate), 118 internal medicine housestaff (74% response rate), and 31 hospitalists (86% response rate). Nurses were far more likely to use and read whiteboards than physicians. While all respondents highly valued the utility of family contact information on whiteboards, nurses valued the importance of a “goal for the day” and an “anticipated discharge date” more than physicians. Most respondents believed that nurses should be responsible for accurate and updated information on whiteboards, that goals for the day should be created by a nurse and physician together, and that unavailability of pens was the greatest barrier to use.DISCUSSION:Despite differences in practice patterns of nurses and physicians in using whiteboards, our findings suggest that all providers value their potential as a tool to improve teamwork, communication, and patient care. Successful adoption of whiteboard use may be enhanced through strategies that emphasize a patient‐centered focus while also addressing important barriers to use. Journal of Hospital Medicine 2010;5:234–239. © 2010 Society of Hospital Medicine.
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