Spanish proficiency and interpreter use among emergency providers: a survey study

Mantu Gupta 1 ,Blair Gallante 2 ,Jacob N Bamberger 3 4 ,Johnathan Alexander Khusid 5 ,Egor Parkhomenko 6 7 ,Ryan Chandhoke 8 9 ,Jillian L Capodice 10 ,William Atallah 11

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Affiliations

1 Icahn School of Medicine at Mount Sinai, 5925, Urology, New York, New York, United States; mantu.gupta
mountsinai.org. 2 Icahn School of Medicine at Mount Sinai, 5925, Department of Urology, 425 W. 59th Street, Suite 9F, New York, New York, United States, 10019; blairgallante
gmail.com. 3 SUNY Downstate Medical Center College of Medicine, 74498, New York, New York, United States. 4 Icahn School of Medicine at Mount Sinai, 5925, Department of Urology, New York, New York, United States; jakebamberger
gmail.com. 5 Icahn School of Medicine at Mount Sinai, 5925, Urology, 1 Gustave Levy Pl., New York, New York, United States, 10029-6574; johnathan.khusid
mountsinai.org. 6 Boston University Medical Center, 1836, Boston, Massachusetts, United States. 7 Icahn School of Medicine at Mount Sinai, 5925, Urology, New York, New York, United States; Egor.Parkhomenko
bmc.org. 8 Kaiser Permanente San Diego Medical Center, 23551, Urology, San Diego, California, United States. 9 Icahn School of Medicine at Mount Sinai, 5925, Urology, New York, New York, United States; ryan.chandhoke
gmail.com. 10 Icahn School of Medicine at Mount Sinai, 5925, Urology, New York, New York, United States; jillian.capodice
mountsinai.org. 11 Icahn School of Medicine at Mount Sinai, 5925, Urology, New York, New York, United States; william.atallah

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Mantu Gupta 1 ,Blair Gallante 2 ,Jacob N Bamberger 3 4 ,Johnathan Alexander Khusid 5 ,Egor Parkhomenko 6 7 ,Ryan Chandhoke 8 9 ,Jillian L Capodice 10 ,William Atallah 11

Affiliations

1 Icahn School of Medicine at Mount Sinai, 5925, Urology, New York, New York, United States; mantu.gupta
mountsinai.org. 2 Icahn School of Medicine at Mount Sinai, 5925, Department of Urology, 425 W. 59th Street, Suite 9F, New York, New York, United States, 10019; blairgallante
gmail.com. 3 SUNY Downstate Medical Center College of Medicine, 74498, New York, New York, United States. 4 Icahn School of Medicine at Mount Sinai, 5925, Department of Urology, New York, New York, United States; jakebamberger
gmail.com. 5 Icahn School of Medicine at Mount Sinai, 5925, Urology, 1 Gustave Levy Pl., New York, New York, United States, 10029-6574; johnathan.khusid
mountsinai.org. 6 Boston University Medical Center, 1836, Boston, Massachusetts, United States. 7 Icahn School of Medicine at Mount Sinai, 5925, Urology, New York, New York, United States; Egor.Parkhomenko
bmc.org. 8 Kaiser Permanente San Diego Medical Center, 23551, Urology, San Diego, California, United States. 9 Icahn School of Medicine at Mount Sinai, 5925, Urology, New York, New York, United States; ryan.chandhoke
gmail.com. 10 Icahn School of Medicine at Mount Sinai, 5925, Urology, New York, New York, United States; jillian.capodice

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mountsinai.org. 11 Icahn School of Medicine at Mount Sinai, 5925, Urology, New York, New York, United States; william.atallah

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Purpose: Calcium oxalate(CaOx) stone formation is influenced by urinary oxalate excretion. Stone formers with elevated urinary oxalate are commonly prescribed a low-oxalate diet or oral supplementation with Vitamin B6 and magnesium to reduce urinary oxalate. This study aims to compare the effects of dietary modification versus supplementation versus a combination of both on urinary oxalate.

Materials and methods: We enrolled patients with a documented history of CaOx stones and newly diagnosed idiopathic hyperoxaluria. Patients were randomized into three treatment groups: low oxalate diet(D), supplementation with 25mg vitamin B6 and 400mg magnesium oxide(S), or both low oxalate diet and B6/magnesium supplementation(DS). Baseline and 3-month post-intervention 24-hour urine tests were obtained. The primary endpoint was change in 24-hour urinary oxalate(Ox24) at 12-weeks. Secondary endpoints included changes in other 24-hour urine parameters, compliance rates, and adverse effect rates.

Results: In total, 164 patients were recruited and 62, 47, and 55 were enrolled into the D, S, and DS groups, respectively. Of these, 99 patients completed the study (56.5% of the D, 72.3% of the S, and 54.6% of the DS groups, respectively). Significant differences were noted in median percent reduction in Ox24 values(-31.1% vs.-16.0% vs.-23.9%,p=0.007) in the D, S, and DS groups, respectively. Furthermore, the percentages of patients within each treatment arm who realized a decrease in Ox24 were also significantly different: D=91.4% vs. S=67.6% vs. DS=86.7%, p=0.027. No significant adverse events were observed in any of the study arms.

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Conclusion: Low oxalate diet is more effective than B6/magnesium supplementation at lowering urinary oxalate in idiopathic hyperoxaluric stone formers. Combination therapy did not produce greater reductions in urinary oxalate than either of the monotherapy arms suggesting it is of little clinical utility. Further study with long-term longitudinal follow-up is required to determine if these treatment strategies reduce recurrent stone events in this population.

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