UBLICATION OF THE EDICAL IVISON OF THE MERICAN … · 2014. 8. 27. · Maria Rosdolsky continues her German to English contributions, this time with a substantial Neurological Examination

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SPRING 2007A PUBLICATION OF THE MEDICAL DIVISON OF THE AMERICAN TRANSLATORS ASSOCIATION

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9Long-Term /

Home Health

Respite /Custodial

Terminal /Rehabilitative

After Care /Acute Care

Urgent /Convalescent

In-Patient /Out-Patient

ICU-CCU-NICU - PICU

Trauma Center /ER / EMS

RN /LPN / LVN

Fellow /Resident / Intern

Hospitalist /Intensivist

MD / DO / DDSHouse Staff

Physician Asst /Nurse Practioner

From the Editor

Health CareGlossary

Pitfalls andCaveats

CONTENTS

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NeurologicalExamination18

Glossarium

Interpretersat Work

Bits - PiecesFacts -Figures

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Mid-YearConference22

The lead article in this issue is the beginning of an overalllook at health care terminology by breaking the overallsubject into categories such as: WHO, WHAT, WHERE andWHEN, which will appear, in this issue and subsequentones, in glossary format. This issue addresses the WHO inhealth care - referring to health care professionals and alliedpersonnel.

Dr. Elena Sgarbossa introduces us to the subject oftranslational medicine - an attempt at converting basicscientific health data into specific health strategies forpatient care.

Maria Rosdolsky continues her German to Englishcontributions, this time with a substantial NeurologicalExamination.

Zarita Araujo and Vonessa Phillips Costa give us an eyeopening introduction to a branch of health care interpretationwe hardly ever hear about - group therapy interpretation.

Our usual columns, Glossarium and Bits and Piecescomplete the current issue.

Spring 2007

Caduceus is a quarterly publicationof the Medical Division of the

American Translators Association, anon-profit organization dedicated to

promoting the recognition oftranslating and interpreting as

professions.

EditorRafael A. Rivera, M.D., FACP

[email protected]

Assistant EditorElena Sgarbossa, M.D.

Editorial StaffGilberto Lacchia, M.D.

ProofreadersDiane Howard

Esther DiazMaria Rosdolsky

Graphic DesignDeborah Sales

Please mail all correspondence andcontributions to:

[email protected]

Instructions to Authors

Submissions for publications must be sent electronically in Word format. Thedeadline for submissions for the Summer issue of Caduceus is 30 June, 2007.

Caduceus carefully reviews its content in order to eliminate any textual errors.Nevertheless, we apologize for any errors in grammar, punctuation, typographyand the like which may inadvertently appear on our pages.

Contents of this newsletter are the property of the Medical Division of ATA.Permission to use, or republish or reproduce information contained herein canbe obtained from the editor.

A PUBLICATION OF THE MEDICAL DIVISION OF ATA From the Editor | 2

As usual, we always invite contributions from Medical Divisionmembers. These could be an in-depth article or short materialsuitable for Bits and Pieces or Glossarium format.

If you run into an interesting website or medical source orreference, let us know about it. Crossword puzzle, wordscramble, book review, anecdote. Keep us in mind! Ed

For medical reasons I have stepped down from myother role as Administrator of the Medical Division, butwill continue producing our newsletter Caduceus.Acting Assistant Administrator, Patricia (Tricia)Yacovone, has assumed the Administrative Role. Shecan be reached at [email protected]

A PUBLICATION OF THE MEDICAL DIVISION OF ATA HEALTH CARE | 3

There are many definitions of health care or healthcare. One of the most concise is: provision ofservices that help individuals achieve an optimal state of well-being in any setting or stage in thehuman life cycle. An increasing number of professionals and allied personnel are involved in theprevention, treatment and management of illness and the preservation of physical and mental wellbeing In this issue we will start the process of identifying some of the WHO in a bilingual English—Spanish outline. Readers are invited to create the corresponding words in other languages and submitthem to Caduceus. Future issues of Caduceus will address the “What, Where and When”.

EN to ES Glossary ofHealth Care Professionals and Allied Personnel

by Suzanne Coutureedited by Rafael A. Rivera, M.D., FACP

HOHATHEREHEN

ABBR ENGLISH ESPAÑOL REFart therapist terapeuta de arte, terapeuta de oficio 1

attending physician médico de cabecera (de paciente hospitalizado) 3

blood bank technologist tecnólogo de hemoterapiatecnólogo banco de sangre

caregiver, care partner persona encargada de la atención del enfermo;acompañante (cuando de trata de serviciosambulatorios), usualmente se refiere a unmiembro de la familia o vecino, cuidador

5

child life specialist, ludotherapist, playtherapist, recreational therapist

especialista en vida infantil, ludoterapeuta 10

consulting physician médico consultor / consultante 3

family doctor médico de cabecera/de familia 4, 5



fellow ‘fellow’, corto para fellow-in-training, médicoque cursa una subespecialidad fellowship (i.e.,cardiología, gastroenterología, cirugía torácica,etc.) luego de haber completado la especialidadprimaria (i.e., Medicina Interna, Cirugía, etc. (Lapalabra fellow no tiene un equivalente establecidoen español. Con toda probabilidad se aceptarácomo tal en español en el futuro

full-time medical staff: full time salariedphysicians employed by the hospital.They usually run the various medicaldepartments of a hospital i.e., Radiology,Pathology, Anesthesiology, PhysicalTherapy, Occupational Therapy,Emergency Services, others

médicos de plantilla a tiempo completo, son losmédicos asalariados, directores de losdepartamentos usuales de un hospital i.e.,Radiología, Anestesia, Patología, Sala deEmergencias, etc., terapia física, terapiaocupacional

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genetic counselor consejero genético 10,11

health care provider - administrative,managed care term; initially referred tophysicians only; now the word is usedloosely for others who provide orparticipate in the care of patients.

proveedor de servicios médicos: 3

health sciences librarian bibliotecario de ciencias de la salud

hospitalist, a specialist in HospitalMedicine, the care of hospitalizedpatients. There are training programs forthis specialty.

hospitalista

house staff médicos en formación, término inclusivo /colectivo para referirse a todos los médicos de unhospital de enseñanza que cursan algún nivel deformación posgraduada. Cuidado de no confundircon ‘medical staff’

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intake coordinator coordinador de ingresos / admisiones

intensivist intensivista. A physician who practices intensivecare /critical care medicine, usually in unitsdesignated for such care - ICU or CCU, medicalor surgical. There are training programs in thisspecialty (fellowships) .

intern interno, doctor que cursa el primer año clínicoposgraduado, PGY-1

ABBR ENGLISH ESPAÑOL REF


ABBR ENGLISH ESPAÑOL REF15

medical student estudiante de medicina 2

nurse case manager enfermera a cargo del manejo / la supervisión delcaso. No presta servicios o cuidados directos alpaciente, sino que coordina el manejo total, citas,consultas, exámenes, seguimiento luego del alta.

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nursing assistant ayudante de enfermería 1

patient advocate defensor del paciente

perfusionist técnico perfusionista, perfusionista 1, 10

pharmacist farmacéutico

referral recomendación, derivación, remisión, referido 5, 1, 7, 8

registered professionals: nurses, pharmacists, dietitians, physical therapists (Profesionalesdiplomados / graduados / titulados) and others are some of the registered professionals we arefamiliar with in the U.S. The word "registered" often raises confusion when a translation isneeded. Registered is not equivalent to licensed or certified for the purposes of translation. Ifone looks closely at the education and training of any of these professionals, one finds thefollowing similarities: a) a university degree (bachelors or above), b) an extended period ofsupervised practical training, and c) a certifying exam given by the sponsoring nationalorganization. In Spanish, diplomado, graduado or titulado seem to work best. RAR

medical staff (médicos de plantilla) refers to all the physician members of the hospital staff.Licensed physicians in the community apply to a particular hospital for membership.Following a process of credentialization - review and verification of credentials - they areaccepted and become members of the medical staff. What functions they can perform in thehospital are delineated as “privileges”. For example, being able to admit patients to the hospitalfor inpatient care is called ‘admitting privileges’. Some physicians, like neurologists anddermatologists, only wish to act as consultants for hospitalized patients, so they are granted‘consulting privileges’. The physicians with admitting privileges are collectively called theattending staff.

rehabilitation therapist 10Fisioterapeuta / fisioterapista en rehabilitación

resident residente; médico que cursa una especialidadprimaria (i.e., medicina interna, cirugía, pediatría,etc.), PGY2 – PGY6


ABBR ENGLISH ESPAÑOL REFtherapist terapeuta o terapista. Búsqueda de Google –

cientos de resultados para ambos. Terapista no esuna palabra reconocida oficialmente en español,pero es una expresión muy común en EEUU, PRy otras comunidades hispanohablantes.

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ARNP Advanced Registered Nurse Practitioner enfermera especialista (nurse practitioner) queprosigue una de varias especialidades e.g.,anestesista /comadrona/ salud mental / etc.,enfermera especialista con estudios avanzados.

12, 16

CCM Certified Case Manager administrador de manejo de casos certificado

CMA Certified Medical Assistant asistente médico certificado

CNA Certified Nursing Assistant asistente de enfermería certificado 2

CNM Certified Nurse Midwife enfermera comadrona / matrona / partera,certificada. Provee cuidados obstétricos durante elembarazo hasta el alumbramiento.

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CNP Certified Nurse Practitioner enfermero especialista certificado

CNS Clinical Nurse Specialist enfermero clínico especialista. Este es unenfermero con título de maestría y preparacióncomo Advanced Practice Nurse, que enfoca susservicios profesionales en alguna categoríaespecífica de pacientes y servicios, por ejemplo:quirúrgicos, diabéticos, cuidados intensivos, salade emergencias, geriatría y salas de cuidadointensivo neonatal (NICU – Neonatal IntensiveCare Unit).

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CRNA Certified Registered Nurse Anesthetist enfermera graduada especialista en anestesia.Como lo indica la clasificación, es una enfermeragraduada especializada en el campo de laanestesia quirúrgica.

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CRT Certified Respiratory Therapy Technician técnico certificado en terapia respiratoria 1

DO Doctor of Osteopathy Doctor en Osteopatía 1

FNP Family Nurse Practitioner enfermero especialista en la familia

HMO Health Maintenance Organization organización de atención médica administrada

LPN Licensed Practical Nurse enfermero practicante certificado. Cuidado con lapalabra licenciado* explicación abajo

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* licenciado en España y otras areas hispanas es un graduado de estudios universitarios, equivalente al baccalaureateinglés. Licenciado en EEUU es aquel que tiene licencia estatal (permiso del estado para ejercer su oficio oprofesión.)


ABBR ENGLISH ESPAÑOL REFM.D. Stands for Medicinae Doctoris (Lat for

Doctor of Medicine) allopathic physician(Allopathic Medicine / ConventionalMedicine / Orthodox Medicine / WesternMedicine)

médico alópata (medicina alopática /convencional / ortodoxa / occidental)

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Doctor of Medicine Doctor en Medicina

MSW Medical Social Worker trabajador social médico

NP Nurse Practitioner enfermera especialista (title adopted by theAmerican Academy of Nurse Practitioners)

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PA Physician Assistant asociado médico (title adopted by the AmericanAcademy of Physician Assistants)

2

PCP Primary Care Physician, Primary CareProvider

médico de cuidados primarios / de atenciónprimaria / de servicios primarios / de cabecera

2, 3, 4, 5

PNP Pediatric Nurse Practitioner enfermero especialista en pediatría

RD Registered Dietitian (See previous entryon Registered Professionals

dietista / nutricionista titulado / diplomado /graduado. Experto en el área de los alimentos y ladieta. El término nutricionista se usa también,pero no hay requisitos académicos relacionadoscon este título.

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RN Registered Nurse enfermero titulado / diplomado / graduado

RT Respiratory Therapist terapeuta respiratorio 10

SLP Speech Language Pathologist logopeda, terapeuta del habla o del lenguaje 1, 10

CHECK OUT THESE WEBSITES

www.Journal of Health Care for the Poor and Underserved (Google)The only professional journal in the US that deals exclusively in contemporary health care issues oflow income, under-represented and other medically-underserved communities. It deals with issues likeaccess, quality, costs, legislation, regulation, promotion and disease prevention. It is the officialjournal of the Association of Clinicians for the Underserved.

www.clinicians.org Association of Clinicians for the UnderservedReview of this site does not reveal any information regarding Limited EnglishProficiency, medical translation or medical interpretation. Anybody interested inpursuing this issue?


ReferenceNumber

Title/Organization Web site (if applicable)

1 Diccionario Mosby de Medicina

2 CCHCP English-Spanish Medical Glossary

3 R. A. Rivera. “Matters of Life and Death. Endof Life Glossary.” The ATA Chronicle. August2004.

4 G. T. Rogers. English-Spanish MedicalDictionary.

5 Apuntes. Volumen 9, Número 2. Primavera de2001.

6 Spanish Terminology for the Dental Team Paperback, 352 pages, publication date:DEC-2003ISBN-13: 978-0-323-02536-2ISBN-10: 0-323-02536-6Imprint: MOSBY

7 H. Mikkelson. The Interpreter’s Companion.Acebo.

8 McElroy and Grabb. Spanish-English MedicalDictionary.

9 Centers for Disease Control www.cdc.gov/ncbddd/ehdi/documents/SLPQUE.pdf

10 Navarro. Diccionario de dudas críticas demedicina. 2ª edición.

11 Genetic Counseling Glossary, 3rd edition

12 NCIHC list serve response provided by E.Gonzalez on 2/26/07

13 American Cancer Society http://www.cancer.org/docroot/ESP/content/ESP_2_1x_Glosario_A-I.asp?sitearea=ESP&viewmode=print&

14 SPD listserv

15 Caduceus, Fall 2006, Part II

16 R. Rivera. Intercambios. Vol. 9 Issue 4.December 2005.


REFERENCES

A PUBLICATION OF THE MEDICAL DIVISION OF ATA PITFALLS AND CAVEATS | 9

Insights from translational research intodisease prevention and healthy living

n the last issue of Caduceus we introduced theterm translational medicine. Translationalmedicine is a new discipline that has emergedto bridge the chasm between what is known and

what is offered to patients. This is accomplished byfocusing on the transfer of scientific discoveries intomedical treatments.

This emphasis on the efficient transfer of knowledge“from bench to bedside” has resulted in a re-appreciation of the role of preventive medicine onhealth. Adequate prevention -research shows - leadsto a reduction of fatal conditions such ascardiovascular disease and cancer. In addition, theincidence and severity of common conditions isreduced and the quality of life improved.

For people with no specific diseases or disabilities,effective prevention entails simply leading a healthylifestyle. This goal becomes easier to achieve if oneis familiar with a few medical concepts recentlyclarified by translational research. These concepts arethe object of the first part of this article (that I hadplanned as a presentation for our upcoming Mid-Year conference in Cleveland but unfortunately I willbe unable to attend).

PART I

1 . N u t r i e n t s a n d M e t a b o l i s m

CholesterolCholesterol is a type of fat essential for good health.Cholesterol is present in food (such as egg yolks andred meat) and can be produced by the body.

The type of blood cholesterol considered “bad” iscalled low-density lipoprotein or LDL cholesterol.Excessive amounts of LDL cholesterol can build upin the inner walls of the arteries –mainly the coronary

and cerebral arteries. With time, LDL cholesteroland other substances form plaque which obstructsthe arteries. The process leads to atherothrombosis.Its clinical manifestations may be a heart attack or astroke.

Cholesterol is also carried in the blood by high-density lipoprotein (HDL). HDL cholesterol isconsidered the "good" cholesterol. As its levelincreases, the risk for cardiovascular eventsdecreases. Ongoing research suggests that HDLtransports cholesterol from the arteries to the liverfor excretion. In addition, HDL cholesterol mayhave direct anti-inflammatory and antioxidanteffects.

Blood levels of both HDL cholesterol and LDLcholesterol can be measured to evaluate the risk ofcardiovascular events. The optimal values of bloodcholesterol vary depending on whether othercardiovascular risk factors are also present. Thecondition associated with the lowest level of HDLcholesterol is the insulin-resistance “metabolicsyndrome.”

TriglyceridesTriglycerides are fats in food and in the body.Blood triglycerides derive from ingested animal orplant fats, and are also produced from ingestedcarbohydrates. The excess of triglycerides in bloodis called hypertriglyceridemia; it is common inpatients with type II diabetes. Hypertriglyceridemiais a risk factor for cardiovascular disease.

Fats can be saturated or unsaturated.

Saturated fatsSaturated fats are animal fats such as butter andlard. They are solid at room temperature. Allsaturated fatty acids in food (except stearic acid)raise blood levels of LDL cholesterol.

by Elena Sgarbossa, M.D.

A PUBLICATION OF THE MEDICAL DIVISION OF ATA PITFALLS AND CAVEATS | 10

Unsaturated fats

Unsaturated fats include monounsaturated andpolyunsaturated fatty acids (PUFA). They are liquidat room temperature and include oils such as olive,sunflower and soybean. Omega 3-fatty acids andtheir major plant precursor, alpha linolenic acid, arepresent in fatty fish such as salmon and white tuna.Most nuts also contain unsaturated fats.

Unsaturated fats have been mistakenly labeled insome websites as "bad fats." Ingested in moderateamounts, however, they are beneficial. Unsaturatedfats decrease LDL cholesterol; higher intakes alsoraise HDL cholesterol. Unsaturated fats also reducehigh blood pressure.

Trans fats

Trans fats are unsaturated fats, mono- orpolyunsaturated. Also called “partially hydrogenatedoils,” unsaturated fats are manufactured by addinghydrogen to vegetable oil; this allows the fat to besolid at room temperature.

Among substances that affect cardiovascular health,trans fats are probably the most harmful. Trans fatsraise blood levels of LDL cholesterol, decrease thoseof HDL cholesterol, and raise triglycerides. Theyalso increase inflammation in the body and damagethe inner lining of cells in blood vessels(endothelium). A review of many studies publishedin The New England Journal of Medicine estimatedthat a drastic reduction in the consumption ofartificially produced trans fats would avert, annually,between 72,000 and 228,000 heart attacks and deathsfrom coronary heart disease in the United States.

Contrary to other triglycerides, trans fats have zeronutritional value. Why are they consumed? Themain reasons are that trans fats add flavor to foodsand help prolong their shelf life; they are alsoinexpensive.

Foods with a high content of trans fats includeFrench fries, crackers, cookies and doughnuts.

People in theU.S. consumed a i l y a naverage of 2to 3 percent ofcalories astrans fats.T h a t i sequivalent to40 to 60calories in a2,000-caloriediet. Trans

fats should be limited to less than 0.5 percent ofdaily calories, or about 10 calories (with 9 caloriesprovided by one gram of trans fat). Whenestimating one’s daily ingestion of trans fats, itshould be considered that trans fats remain commonin prepared foods (sold in grocery stores andrestaurants). In addition, food labeling can bedeceiving. If the amount of trans fat does notexceed 0.5 grams per serving, under FDAregulations the label may list a trans fat value ofzero. If the label includes trace amounts ofingredients such as "partially hydrogenatedvegetable oil," "hydrogenated vegetable oil" or"vegetable shortening," however, the food containstrans fat.

To be continued

A PUBLICATION OF THE MEDICAL DIVISION OF ATA GLOSSARIUM | 11

next of kin -- this phrase, usually found in consentforms, refers to the nearest or closest relative / familymember to the patient // familiar o pariente mas

c e r c a n o oa l l e g a d o .K i n d r e d o rrelatedness is oftwo possiblekinds: either a)blood / genetic /familial relation,also known asconsanguini ty(SEE FIGURE) , orb) affinity /

legal / contractual relation, such as in marriage.Genetic relationship is usually categorized indegrees. First degree relatives refers to parents /children and siblings // padres, hijos y hermanos whoshare their genetic load, half from mother and halffrom father. Second degree relatives includes aunts,uncles and cousins / tias, tios y primos. Theseindividuals share half of their genetic load and theother half comes from a new person.

Medically speaking a ‘family history’ / antecedentesfamiliares of a certain disease implies a geneticrelation. For legal purposes related to consent formsthe contractual marriage relation understandablysupersedes any other. Also, bear in mind that thenearness or closeness of a next of kin is ofteninterpreted as physical proximity rather than familial.That is to say, who is the family member that livesclosest to the patient who can be reached morereadily in case of emergency or need-to-know.

doctor vs physician -- in daily conversation doctorand physician // doctor y médico are words usedinterchangeably by physicians and patients.However, there is a distinct legal difference. Doctoris a degree, whereas physician refers to a doctorlicensed to practice medicine. You may have notedthat whenever there is some suspicion of malpracticethe first question raised is, “Is he/she a licensedphysician?” Which would be a redundancy butunderlines the legality issue.

bleeding-- is usually translated variously to Spanishas sangría, sangrado, sangramiento andhemorragia. Medically speaking, hemorragia /hemorrhage should only be used for excessivebleeding.

little people vs dwarfism -- two ways of referringto the same subject: people of short stature. “Little

people” is apreferred termthat is lesspejorative andmore conduciveto learn about thenormal lives andaccomplishmentsof people of shortstature Short

stature is generally caused by more than 200medical conditions. The Little People of Americawebsite is an excellent source for information onany aspect of dwarfism, medical and otherwise.http://www.lpaonline.org/search.html

differential diagnosis -- medical term that refers toall possible or likely diagnostic possibilities for aparticular case. Once the history and physical examare completed the physician usually writes hisworking diagnosis and follows with a “differential”,a short mention of other likely possibilities to beruled out.

rule in or rule out -- common medical expressionsmeaning that this or that particular diagnosis orclinical event needs to be confirmed (ruled in) orexcluded (ruled out).

physician extender -- is the terminology used invarious sources to refer to an advanced nursepractitioner or a physician assistant. Only these twomedical professionals are legally allowed to writeprescriptions and medical orders in the record of ahospitalized patient. They also carry malpracticeinsurance. Ref: various internet sources

A PUBLICATION OF THE MEDICAL DIVISION OF ATA

event -- it is quite common these days to see theword event used in clinical medicine - as in acardiac event or a gastrointestinal event - to mean aclinical episode, an alteration, a medical problemrelated to a particular organ or system, ex., “ ..thepatient did not have a coronary occlusion, someother cardiac event (problem) needs to be ruledout.”

“avian flu epidemic” -- this erroneous phrase isoften seen in newspaper articles referring to thespread of the avian viral illness within the birdpopulations of a particular country or region of the

world. An ‘epidemic’refers to a rapid andextensive spreadamong humans only.The equivalent termfor the same kind ofspread in animals is an

‘enzootic’. However, this term is far above thecolloquial register.

minimally conscious state -- those who care forend of life patients in a persistent vegetative state(PVS) on a daily basis say that, at least for verybrief moments, they seem to recognize someone orregain some level of awareness. In a recent casefrom Colorado Springs a woman in coma for sixyears awoke for three days and spoke with herfamily and a television station crew before slippingback into unconsciousness. She had awakened forbriefer periods of time on four other occasions sincesuffering a heart attack six years previously. Asmall number of such cases are now welldocumented and are referred to as ‘minimallyconscious state’. There is no real neurologicalexplanation for these cases. Clinically, they are justone step above the PVS.

off-label use of pharmaceuticals -- normally newdrugs come into the market following FDAapproval after controlled studies show the

GLOSSARIUM | 12

medication to be safe and effective for a particulardisease or specific medical condition. These arecalled indications. Once the prescribing experiencewith the drug grows there is room for physicians toconsider prescribing the drug for different purposesother than the original indications. For examplet r i c y c l i cantidepressantsinitially enteredthe market tobe used forc l i n i c a ld e p r e s s i o n .H o w e v e r ,experience - byi n t e n t o rserendipity -showed these medications to be also useful forcontrol of pain. Nowadays these tricyclics are notused so much for clinical depression because oftheir side effects, yet they are effective asanalgesics. FDA regulations permit such off-labeluse based on the professional judgment of thetreating physician.

A PUBLICATION OF THE MEDICAL DIVISION OF ATA INTERPRETERS AT WORK | 13

Few interpreters have received specializedtraining in group therapy. As a result, thereare many different opinions regarding the“best” interpreting mode and arrangement forforeign language interpreters working in groupsettings.

When it comes to setting the stage for the interpretedgroup interaction, one view is that remoteinterpretation, with the LEP group participantlistening in with headphones, is best. In this manner,some argue, the interpreter’s voice does not interferewith the group dynamic.

In contrast, others have experienced successfulgroup interactions in which the interpreter isphysically present and no electronic equipment isused. These individuals comment that if the groupleader openly discusses the possible discomfortresulting from the unfamiliar sounds of chuchotage(“whisper” interpretation), the group will begin toaccept the interpreter and with time the sounds ofchuchotage will “fade” from the collectiveconsciousness of the group until the interpreter isbarely noticed. (Note that such interactions generallyinvolve groups in which there is just one foreignlanguage represented by a single interpreter.)

There are also conflicting opinions in regard tochoosing a mode of interpretation for group therapy.One view is that the interpreter should exclusivelypractice the simultaneous mode. Others feel that a

group is best served when the interpreter is able tonavigate between modes, applying bothsimultaneous and consecutive techniques, and insome cases, a summarization of thought whilepreserving key points of meaning.

A closer look at the basic principles of group therapycan help the interpreter to make an informeddecision regarding the appropriate mode andarrangement for each type of group interaction.Although there are many different types of groups,most share similar development stages, regardless ofwhether they are monolingual or multilingual.According to experts James Garland, et al. (1973),there are five main stages through which a groupwill progress:

1. Pre-Affiliation2. Power and Control3. Intimacy4. Differentiation5. Separation

PRE-AFFILIATION is the beginning stage of anygroup. This is when group members introducethemselves and begin the process of connecting withother group members and with the group leader. InPre-Affiliation, members will limit intimacy with aview to protect ing themselves f rommisunderstanding and attack. Often, individualmembers will compare the current group leader toleaders of past groups in which they had participatedand there is some ambivalence in the decision tocontinue with (or leave) the present group.

In Pre-Affiliation, the group leader is key to creatingan environment in which members can maintainsome distance while beginning to develop a level oftrust. The development of trust occurs primarilythrough dialogue in which group dynamics areexplored, expectations revealed and cooperativeplanning encouraged. In multilingual groups, it iscrucial that the group leader use this time tointroduce the interpreter and to acknowledge the

by Zarita Araujo - Lane LICSWand Vonessa Phillips CostaInterpreting in Group Therapy


possibility of discomfort among some groupmembers in regard to chuchotage and the presenceof the interpreter.

Many clinicians invite the interpreter to explain his/her role during the first session of a new group. Atthis point, the group leader may want to refer to thepurpose of the group while stating that althoughgroup members may experience an initial awarenessof a language barrier, they will soon realize that theyshare similar issues and concerns.

The second stage of most groups can be called“POWER AND CONTROL”. This occurs when thegroup loses its initial reserve and members begin toexpress a range of emotions. Members will takeopposing positions on the issues in discussion, andthere is a tendency to develop “cliques” in whichcertain members form alliances against other alliedmembers.

Group leaders and interpreters need to be aware ofthis struggle for power and control. It is in this stagethat members may complain that the presence of theinterpreter is an impediment to forging a realintimacy with the LEP participant. The group leaderand interpreter many want to rethink the logistics ofthe interpreting environment. Should seatingarrangements be altered? Might the interpreterexperiment with switching from the simultaneousmode to summarization when it is important that agroup member not be interrupted? Would it behelpful if the LEP participant were specificallyinvited to express his/her fears to the group?

Often the LEP patient’s expression of beingmisunderstood by society in general (and by thegroup in question) does much towards stimulatingthe other members to connect around the issues thatbrought them together in the first place. This canlead to INTIMACY, a stage in which group membersbegin to feel safer about sharing personalinformation. During Intimacy, participants maybegin to believe that their openness as individualswill bring some resolution to the group as a whole.There is a growing awareness of the importance ofthe group as a functioning unit.

At this point, the therapist will often begin toimplement a more confrontational form ofquestioning. The interpreter must be careful tomirror the group leader’s tone and intent, and toresist the “pull” of the group for the interpreter to“participate” as if he/she were a true group member.

The next stage is DIFFERENTIATION, a time inwhich group members, while recognizing theimportance of the group as a functioning unit, beginto appreciate each other as individuals. A mutualrespect is present when differences arise, andparticipants begin to develop relationships outsidethe group.

At some point in the Differentiation process, thegroup leader will facilitate a clarification of groupidentity, echoing the pariticipants’ reflections onhow the group evolved and how it impacted the livesof its members. This is a good time in which torevisit the presence of the interpreter throughout thetreatment process.

If the group leader and interpreter expertly managethe steps listed above, the general group feelingregarding exposure to interpreter services will likelybe quite positive. Not only has the interpreterfacilitated the experience of one LEP participant, he/she has also played a role in preparing each groupmember for the realities of daily life in amultilingual society, imbuing them with a newappreciation for the fact that with each difference,there are also commonalities that will join them toany individual in the world.

The final stage, SEPARATION, is often characterizedby a general regression in which members becomedistant and may display signs of anger, in manycases reliving some of the initial issues of power andcontrol. The group leader will echo these feelings,elicit clarification and make empathic statementsregarding the different ways in which individualsexperience endings. The leader will reaffirm thegroup’s readiness for separation and will encouragemembers to share their growing involvement withthe community. At this point, the group leader mayallow the interpreter to address the participants


directly with an expression of thanks for theirindividual and collective efforts towards making thegroup a safe area in which to practice the profession.The physical presence of the interpreter and thepractice of chuchotage, if expertly managed, will notprevent the group from experiencing the five stagesof progressive group therapy. In fact, as time goes byand participants move deeper into the groupexperience, the interpreter will naturally “fade” intothe background and participants will at times forgetthat the LEP participant is indeed speaking in adifferent language.

Over the course of treatment, a competent groupleader will address many things that make individualgroup members different from each other. Thesemay include race, gender, class, ethnicity, age,profession, and so on. From a therapist’s viewpoint,language is just one of the many facets of a patient’sindividuality. And as long as linguistic differencesare properly acknowledged, and the interpreter isgiven time to explain the mechanics of our craft, amultilingual group can be a great success.

REFERENCESGarland, James A., Jones, Hubert E., Kolodny, Ralph L., “A Model For Stages of Developmentin Social Work Groups” in Bernstein, Saul (ed.). Explorations In Group Work. Boston: MilfordHouse, Inc. 1973.

“When I went into grouptherapy, I was suffering

from low-leveldepression. Through the

group therapyexperience, I remember

feeling joy again.”

“My work prompted meto go into group therapy.Suddenly, as a manager I

was dealing with morepeople and needed to

improve my interpersonalcommunication skills.”

A PUBLICATION OF THE MEDICAL DIVISION OF ATA BITS — PIECES — FACTS — FIGURES | 16

A little bit of everything

Role of gastric acid in disease -- In our lastFall - Winter issue of Caduceus the basic features ofgastro-esophageal-reflux- disease (GERD) wereexplained and illustrated. Stomach acid that refluxesinto the lower esophagus irritates the lining andproduces typical symptoms. It is common clinicalpractice in primary care to recommend some form ofantacid medication to GERD patients not only torelieve symptoms but also, in so doing, confirm the

diagnosis. Inother words,relief ofsymptoms inresponse togastric acidi n h i b i t o rmedicationsshould bediagnostic ofGERD. Inorder toa c h i e v es c i e n t i f i cverificationo f t h i s

premise a study was recently conducted in whichrelief of symptoms was correlated with actual intra-esophageal pH (acidity) measurements in patientswith and without reflux symptoms.

The acid inhibitor medication used is part of thegroup known as PPI - proton pump inhibitors(Nexium, Losec, Protonix, others). These are themost potent and most widely sold class of gastricacid inhibitors. Their mechanism of action, as theirname implies, is to antagonize the H-2 receptorwithin the gastric-acid-producing epithelium.

The results of the study suggested that the PPI testwas of little value in distinguishing patients withproven GERD from those who did not have it. Notalways what seems clinically obvious stands truewhen subjected to closer examination.

The above findings bring to mind the similarhistorical fact that benign gastric and duodenalulcers were always thought to be due solely toexcess stomach acid, along with some accompanyingstress. That also seemed clinically obvious. Over thepast few years the likely culprit in most cases hasbeen established to be Helicobacter pylori (H.pylori) - a common bacterium that weakens theprotective mucous coating of the stomach andduodenum allowing gastric acid to ulcerate thelining.

Gardasil controversy heats up -- aspreviously mentioned in Caduceus, the medicallypraised, FDA-approved, human papilloma virus(HPV) vaccine – proven in controlled studies toprevent the vast majority of cases of cervicalcarcinoma with the attached morbidity and mortalitythat this cancer produces – is now available forclinical use in women ages 12 to 26. As expected,some states havemoved towardsm a k i n g t h evaccination notonly desirablebut mandatory.In order to conferfull protectiont h e v a c c i n es h o u l d b ereceived prior tot h e i n i t i a linfection withHPV, whichtranslates to ‘theearlier the better’or the ‘younger the better’. Surveys show that theaverage age for coitarche (first sexual contact) in theUS is 13 years. This fact has aroused serious concernamong conservative parents and religious groupswho believe the vaccination will be interpreted byyoung girls as an endorsement of sexualpromiscuity. The ethical and legal questions areformidable. To what degree should the Statemandate a medical intervention that contravenesparental wishes? Liberal social thinking believes the

vaccine will insure protection to a greater extent thanparental guidance, education and persuasion.Further, do parents have the right to exclude their

children fromp r o t e c t i o nagainst cervicalc a n c e r ? [ AGoogle searchunder mandatoryHPV vaccinationshows 275,000entries]

Does a GP exist today? -- this question wasraised in an international bio-scientific medicalforum recently. The translator asking the questionwondered if there is a formal specialty in the USknown as General Practice. There is not. Withoutdoubt there are physicians in the U.S. who dedicatetheir time and energy to look into just about any andall of the daily medical maladies that visit all of us.However, formal residency training is nowhere to befound. The AMA website does not include GeneralPractice within the list of medical specialties. TheAmerican Board of Medical Specialties does notshow a specialty board for a General Practicecategory and there is no national organizationbearing General Practice in its title. We do have in

the U.S. training programs in Family Medicinewhich would be the closest to a formal GP program.

In England, however, there is a:a. Formal General Practice residency http://

www.medscape.com/viewarticle/417849_4 ;b. A Royal College of General Practitioners http://

www.rcgp.org.uk/ and a British Journal forGeneral Practice;

c. There is also formal training in Family Practice.

Sites of interest regarding specialty andsubspecialty medical training in the US.

a) http://www.faqs.org/faqs/medicine/education-faq/part2/section-4.html

This site has a list of the major medical specialtiesand covers topics such asWhat is an internship?What is a residency? Lengths of some residenciesWhat is a fellowship?What does board certified mean?

b ) h t t p : / / w w w . a b m s . o r g / A b o u t _ A B M S /member_boards.aspx Site of the American Boards ofMedical Specialties. These 24 member Boards ofABMS are the organizations that create andadminister the Board examinations of theirrespective specialties.

A PUBLICATION OF THE MEDICAL DIVISION OF ATA BITS — PIECES — FACTS — FIGURES | 17

Two medical specialties that deserve separate additional information:

Hospitalist / hospitalista - a specialist in Hospital Medicine, a discipline concerned with the general medical care ofhospitalized patients. First mentioned in an article by Dr. Robert Wachter, et.al., in a 1996 article in the NEW ENGLANDJOURNAL OF MEDICINE. It is estimated that about 85% of hospitalists are trained in internal medicine, some withfellowships in various specialties of Internal Medicine.

www.ncbi.nlm.nig.gov/entrez/query.fcg?md=Retrieve&db=pubmed&dopt=Abstract&list_uids=8672160 www.en.wikipedia.org/wiki/Category”Medical_specialties www.hospitalmedicine.org/Content/NavigationMenu/AboutSHM/DefinitionofaHospitalist/

Definition_of_a_Hosp.htm

Intensivist/intesivista - a physician who practices intensive care medicine, also known as critical care medicine, usuallyin Intensive Care / Critical Care Units ICU/CCU. These units typically deal with heart attacks, poisoning, pneumonia,surgical complications, premature births, stroke, gunshot wounds, stabbing wounds and multiple trauma.

Http://en.wikipedia.org/wiki/Intensive_care_medicine

Despite modern imaging methods such as computer tomography and magneticresonance imaging, neurological examination is still a valuable diagnostic tool inpatients with diseases of the central or peripheral nervous system. With the help of theneurological examination, the location of the lesion or lesions can be determined inmany cases.

The following glossary contains the most important tests and findings but is far frombeing complete. Tests and findings are in the same list for compactness.

A PUBLICATION OF THE MEDICAL DIVISION OF ATA NEUROLOGICAL EXAMINATION | 18

by Maria Rosdolsky

NEUROSTATUS, NEUROLOGISCHEUNTERSUCHUNG

NEUROLOGICAL EXAMINATION,NEUROLOGICAL STATUS

BENÖTIGTE INSTRUMENTEReflexhammerStimmgabelTaschenlampeOphthalmoskop, Augenspiegel

EQUIPMENT NEEDEDReflex hammerTuning forkFlash lightOphthalmoscope

BEWUSSTSEINSLAGEBewusstseinsklarBewusstseinstrübungBewusstseinsgetrübt, somnolentBewusstlosKoma

STATE OF AWARENESSConscious, lucidClouding of consciousnessDrowsy, somnolentUnconsciousComa

ORIENTIERUNGZeitlich, örtlich und persönlich orientiert

ORIENTATIONOriented to time, place and person

SPRACHEAphasie

- motorische Aphasie- sensorische (rezeptive)Aphasie- amnestische (anomische, nominale)

Aphasie- Leitungsaphasie, zentrale Aphasie- tanskortikale Aphasie- globale (totale) Aphasie

DysarthrieBulbäre SpracheSkandierende SpracheVerwaschene (undeutliche) SpracheVerlangsamte Sprache, Bradyphasie

SPEECHAphasia

- motor aphasia- sensory (receptive) aphasia- amnesic (nominal) aphasia

- conduction (associative) aphasia- transcortical aphasia- global aphasia

DysarthriaBulbar speechScanning speechSlurred speechSlow speech, bradyphasia

GERMAN ENGLISH




HIRNNERVEN

I Nervus olfactoriusKaffee (Essig) spontan erkanntII Nervus opticusSehschärfe, VisusGesichtsfelder

- Fingerperimetrie,Konfrontationsperimetrie

- Gesichtsfeldausfall- Hemianopsie

Augenhintergrund, Fundus- Papille, Papilla nervi optici- scharf begrenzte Papille- unscharf begrenzte Papille- Stauungspapille- Optikusatrophie

III Nervus oculomotorius, IV Nervus trochlearis, VINervus abducensAugenmotilitätKonjugierte AugenbewegungenAugenbewegungen nicht konjugiertDoppelbilder beim Blick nach links (rechts)Pupillen

- Isokorie (gleichgroße Pupille)- Anisokorie (ungleichgroße Pupillen)- Lichtreaktion

V Nervus trigeminusSensibilität im GesichtKornealreflexMasseterkraft (Zusammenbeißen der Zähne)VII Nervus facialisZentrale FazialisparesePeriphere FazialispareseVIII Nervus vestibulocochlearisGrobe GehörprüfungNystagmus

- Endstellnystagmus,Endstellungsnystagmus

- rotatorischer NystagmusBaranyscher ZeigeversuchRomberg-VersuchUnterberger-TretversuchIX Nervus glossopharyngeus, X Nervus vagusWürgreflexGaumenreflexGaumensegellähmungXI Nervus accessoriusKraft des Musculus trapecius und Musculus

sternocleidomastoideusXII Nervus hypoglossusZungenlähmung, GlossoplegieZungenatrophie

CRANIAL NERVES

I Olfactory nervePt. can smell coffee (vinegar)II Optic nerveVisual acuity, visusVisual fields

- Finger perimetry, confrontationperimetry

- Visual field defect- Hemianopia

Fundus- optic nerve papilla, optic disk- distinct (sharp) edges of the papilla- blurred disk margins (edges)- papilledema, choked disk, discedema- optic atrophy

III Oculomotor nerve, IV trochlear nerve, VI abducensnerveOcular motilityConjugate eye movementsDysconjugate eye movementsDouble vision on gaze to the left (right)Pupils

- isocoria (equal size of pupils)- anisocoria (unequal size of pupils)- reaction to light

V Trigeminal nerveFacial sensibilityCorneal reflexForce of masseter muscle contractions (clenching teeth)VII Facial nerveCentral facial paresisPeripheral facial paresisVIII Vestibulocochlear nerveCrude hearing testNystagmus

- End-point nystagmus, end-positionNystagmus

- rotary nystagmusPast-pointing testRomberg’s testUnterberger’s test, Unterberger’s stepping testIX Glossopharyngeal nerve, X vagus nerveGag reflexPalatine reflexPalatine paralysisXI Accessory nerveStrength (force) of trapezius and sternocleidomastoid muscles

XII Hypoglossal nerveParalysis of the tongue, glossoplegiaAtrophy of the tongue




MOTORIK - MUSKULATURTrophikAtrophieMuskeltonus

- Spastizität- Rigor, Rigidität- schlaffer Muskeltonus

Unwillkürliche Bewegungen- Tremor- choreatische Bewegungen- dystonische Bewegungen- Faszikulationen

Kraft- Parese = Schwäche

- Plegie = vollständige Lähmung

- unvollständige Halbseitenlähmung,hemiparesis

- vollständige Halbseitenlähmung,Hemiplegie

- Quadriparese, Tetraparese- Quadriplegie, Tetraplegia

Diadochokinese- Eudiadochokinese

- Dysdiadochokinese,Hypodiadochokinese

Armvorhalteversuch, PositionsversuchReflexe, obere Extremitäten

- Bizepssehnenreflex, Bizepsreflex,BSR

- Trizepssehnenreflex, Trizepsreflex,TSR

- Radiusperiostreflex, RPR,Radiusreflex

Reflexe, untere Extremitäten- Patellarsehnenreflex, PSR,

Quadricepsreflex- Achillessehnenreflex, ASR, Triceps-

surae-ReflexReflexe werden ausgelöst und sind:

- mittellebhaft (normal)- lebhaft- gesteigert- gesteigert mit Klonus- vermindert, schwach auslösbar- fehlend

Pyramidenzeichen, obere Extremitäten- Trömner-Reflex- Knipsreflex, Hoffmann-Zeichen

Pyramidenzeichen, untere Extremitäten- Babinski-Reflex, Babinski-Phänomen

- Oppenheim-Reflex

MOTOR FUNCTION - MUSCLESTrophicityAtrophyMuscle tone

- spasticity- rigor, rigidity- flaccid muscle tone

Involuntary movements- Tremor- choreatic movements- dystonic movements- fasciculations

Strength- paresis = incomplete paralysis,weakness

- paralysis = loss or impairment ofmotor function

- hemiparesis

- hemiplegia

- quadriparesis, tetraparesis- quadriplegia, tetraplegia

Diadochokinesis- normal diadochokinesis- dysdiadochokinesis

Testing for pronator driftReflexes, upper extremities

- biceps reflex

- triceps reflex, elbow jerk

- brachioradial reflex

Reflexes, lower extremities- patellar reflex, quadriceps reflex, knee

jerk- Achilles reflex, triceps surae reflex,

ankle jerkReflexes are elicited and are:

- normal- brisk- exaggerated, hyperactive- hyperactive with clonus- diminished, hypoactive- absent

Pyramidal signs, upper extremities

- Trömner’s sign, Trömner’s reflex- Hoffmann’s sign

Pyramidal signs, lower extremities

- Babinski’s reflex, Babinski’s sign,plantar reflex

- Oppenheim’s reflex




SENSIBILITÄTOberflächensensibilität- Berührungsempfindung

- Hypästhesie- Hyperästhesie

Temperatursinn- Thermhypästhesie- Thermanästhesie- Thermhyperästhesie

Schmerzsinn, Noziperzeption- Hypalgesie, Hypalgie- Hyperalgesie- dissoziierte Sensibilitätsstörung

VibrationssinnLagesinnZweipunktdiskrimination

SENSIBILITY, SENSORY FUNCTIONSuperficial sensibility, superficial sensory function

- touch sensation, tactile sensation- (tactile) hypoesthesia- (tactile) hyperesthesia

Temperature sense, thermesthesia- thermhypesthesia- thermanesthesia- thermhyperesthesia

Pain sense, nociperception- hypalgesia, hypoalgesia, hypalgia- hyperalgesia- Dissociated (dissociation) anesthesia

Vibration sensePosition senseTwo-point discrimination

KOORDINATIONFinger-Nase-Versuch, FNVFinger-Finger-Versuch, FFVKnie-Hacken-Versuch, KHV

COORDINATIONFinger-nose-testFinger-finger testHeel-knee test

GAITMitschwingen der ArmeZehenhangFersengangBlindgangStrichgangSpastischer GangSteppergangAtaktischer GangKleinschrittiger Gang

GAITAssociated arm movementsToe walkingHeel walkingBlind gait, blind walkingStraight-line walkingSpastic gaitSteppage gaitAtaxic gaitSmall-step gait, small-step walking

A PUBLICATION OF THE MEDICAL DIVISION OF ATA MID-YEAR CONFERENCE | 22

MAY

31

Medical Division Mid Year ConferenceCleveland, Ohio

All about becoming a medical interpreter.

Legal - ethical issues in medical interpretation - a panel.

Understanding congenital heart defects.

Advances in thoracic and cardiovascular surgery.

Clinical Trials - an overview of terminology.

Understanding the unspeakable - psychoanalysis and psychotherapy research.

And much more…….

HOLLY MIKKELSON WILL DELIVER THE KEYNOTE ADDRESS

Documents

UBLICATION OF THE EDICAL IVISON OF THE MERICAN … · 2014. 8. 27. · Maria Rosdolsky continues her German to English contributions, this time with a substantial Neurological Examination