Background: The lack of a validated symptom assessment instrument in Spanish for patients with cancer and heart failure (HF) can affect the care and impede the recruitment and participation of Spanish-speaking patients in clinical trials. Spanish is the second most common language spoken by the largest and most rapidly growing racial/ethnic minority group in the United States. To bridge the language barrier and improve symptom management in Spanish-speaking patients with cancer and HF, the MD Anderson Symptom Inventory-Heart Failure (MDASI-HF) was translated to Spanish (MDASI-HF-Spanish). Aim: To validate the MDASI-HF-Spanish symptom assessment instrument. Methods: Following standard forward and backward translation of the original and previously validated English version of the MDASI-HF, a cognitive debriefing with nine native Spanish speaking participants was conducted to evaluate the participants' understanding and comprehension of the MDASI-HF-Spanish. To examine the comprehensibility, acceptability and psychometric properties of the translated instrument, the MDASI-HF-Spanish was tested in a convenience sample of 50 Spanish speaking patients with a diagnosis of cancer and HF. Evidence for the psychometric validity of the MDASI-HF-Spanish was demonstrated via its internal consistency reliability and known-group validity. Results: Overall, the participants had no problems with the understandability, readability, or number of questions asked. The MDASI-HF-Spanish subscales showed good internal consistency reliability, with a Cronbach's coefficient alpha of 0.94 (13 core cancer symptoms), 0.92 (8 heart failure symptoms), and 0.90 (6 interference items) respectively. The MDASI-HF-Spanish was able to differentiate the functional status between patients based on the New York Heart Association (NYHA) functional classification. Conclusions: The MDASI-HF-Spanish is linguistically and psychometrically valid with ease of completion, relevance, and comprehensibility among the participants, and it can be a useful tool for clinical management and research purposes.

Quite frankly, I am surprised that the bullying in the article, "When bullying affects patient safety" (July 2018, Vol 108, No 1), was allowed to continue by managers. The nurses, preceptor included, should have been reprimanded as well. The surgeon should have been reprimanded for not listening and for throwing instruments across the room; this is wrong for so many reasons. He would have been removed from the OR where I work.As stated in this article, a nurse, new or not, is a patient advocate. If she saw the clamp dragged into the incision site, everyone in that room should have been happy it was retrieved before closing. She should have been thanked for saying something and encouraged to keep up the good work. The lawsuit that could have ensued because of negligence would have been something no one in that room would have forgotten, especially if the patient had died because of sepsis or a perforated bowel. Surgeons should remember that their arrogance would not help them in court. Blaming someone else would not help either.