Patient-centered care in telemedicine - An experimental-design study.

BACKGROUND: Patients using telemedicine expect health providers to meet their expectations and are concerned about losing interpersonal contact. Studies on tailoring telemedicine to patient expectations are scant. This experimental design starts to close the gap in the state-of-the-art testing of patient expectations of communication with healthcare providers in telemedicine based on the patient-centered approach. The study was conducted from June 2021 through September 2021. METHODS: The convenience sample comprised 677 students, 298 females and 379 males, ages 18 to 64 who are all patients of one of four national health funds in Israel, using telemedicine. We used a conjoint-based experimental design. Each respondent evaluated a unique set of 24 vignettes of messages. The dependent variable was patient expectations of communication with healthcare providers in Telemedicine. The independent variables were four acknowledged categories of patient expectations of provider-patient communication. RESULTS: Coefficients for the total panel suggest no significant differences. Applying mathematical clustering, three mindsets emerged. A Post-hoc ANOVA test indicated that the mindsets are significantly different. Members of Mindset 1 expect the provider to walk them through the change process. Members of Mindset 2 expect healthcare providers to refer them to a reliable source of information to enhance their healthcare literacy. Members of Mindset 3 expect respect, both in non-verbal conduct and for their time. We developed a prediction tool enabling to identify the mindset-belonging of each patient in the population to a mindset in the sample. CONCLUSIONS: Findings call healthcare providers to communicate with patients via telemedicine based on mindset-tailored messages rather than based on socio-demographics for optimum patient-centered communication. Using the prediction tool, providers may identify the mindset-belonging of each patient. To enhance patient-centered care via telemedicine, providers are called upon to meet expectations by using mindset-tailored communication that structures the communication with greater specificity enhancing patient-centered care.

High levels of glucocorticoid receptors in patients with active Crohn's disease may predict steroid resistance.

Up to 20% of Crohn's disease (CD) patients respond poorly to glucocorticoids (GC). A product of an alternative splicing of the glucocorticoid receptor (GR) premRNA, GRbeta, may play a role as a dominant inhibitor of the glucocorticoid response. Increasing evidence suggests that inflammatory cytokines such as interleukin (IL)-18 alternate the splicing of the primary transcript between the two isoforms GRbeta and GRalpha in hGR gene of CD patients. The aim of this study is to assess the expression of GRalpha and GRbeta in patients with CD and to look for a possible correlation between these receptors and the response to glucocorticoid treatment. Forty-two CD patients and 17 healthy volunteers were studied. Quantitative reverse transcription-polymerase chain reaction (RT-PCR) was performed using real-time PCR techniques. Serum IL-18 protein levels were measured by enzyme-linked immunosorbent assay (ELISA). The amount of hGRalpha-mRNA in patients in remission was significantly lower than in controls (P < 0.05). The amount of hGRbeta-mRNA was significantly higher in GC-resistant patients in the active stage of disease compared with all other groups (P < 0.05). Patients in the active stage of the disease had higher levels of IL-18 than patients in remission and both had higher levels than controls (P < 0.05). The amounts of IL-18 were directly correlated with the amount of hGRbeta mRNA in GC-resistant patients with an active disease. High levels of hGRbeta might be connected to GC resistance. IL-18 might participate in the alternative splicing of the hGR preliminary mRNA of CD patients. The results support the theory that augmented hGRbeta mRNA expression level in PBMC is connected with GC-resistance of CD patients.

Expression of bcl-2 in autoimmune and Helicobacter pylori-associated atrophic gastritis.

Chronic atrophic gastritis can be induced either by H. pylori or by an autoimmune process. The protein product of bcl-2, which is a protooncogene, blocks apoptosis. Aberrant bcl-2 expression has been found in 68% of atrophic gastritis patients. The aim of this study was to compare bcl-2 expression in 20 autoimmune atrophic gastritis patients to that in 20 H. pylori-associated atrophic gastritis patients. Twenty patients with H. pylori antral gastritis but without atrophy served as controls. The bcl-2 expression was assessed by immunohistochemical staining of gastric biopsies, using mouse anti-human bcl-2 monoclonal antibodies. Autoimmune atrophic gastritis patients were younger, mainly females, with a significantly higher serum gastrin level than the H. pylori-associated atrophic gastritis group (P < 0.001). The bcl-2 was expressed in 10/20 (50%) of autoimmune atrophic gastritis patients, in 9/20 (45%) of H. pylori-associated atrophic gastritis patients (P = 0.73), and in 2/20 (10%) of controls. There was no correlation between bcl-2 expression and the presence of intestinal metaplasia (P = 0.35). Our findings confirm that H. pylori-associated atrophic gastritis and autoimmune atrophic gastritis are two different conditions, but with equal expression of bcl-2. Excessive expression of bcl-2 is found only in atrophic gastritis, but not in H. pylori antral gastritis without atrophy.

Helicobacter pylori: the Middle East scenario.

A review of Helicobacter pylori in the Middle East is presented. Prevalence studies have been performed in asymptomatic population groups from Algeria, Israel, Saudi Arabia and Turkey. These showed that the prevalence of H. pylori is similar to that of the developing countries of the world with a high level of infection in childhood (40 to 70 percent), which increases with age to 85 to 90 percent. Israel, however, has a low prevalence in children (10 percent), but there is a rapid rise in the second decade of life to 39 percent, reaching 79 percent in those over 60 years old. The prevalence rates were higher in those living in communal settlements (72 percent) than in urban dwellers (65 percent). The infection rates were higher in persons of Mediterranean and Asian origin (89 percent) compared to those of Western European/North American origin (57 percent). The prevalence rate of H. pylori infection in patients undergoing endoscopy for upper gastrointestinal symptoms has now been reported from many Middle Eastern countries, including Egypt, Iran, Israel, Oman, Saudi Arabia, the United Arab Emirates and Yemen. These studies showed that patients with gastritis and peptic ulcer disease had similar rates of infection as reported from Europe, United States and Africa (71 to 92 percent). However, patients with non-ulcer dyspepsia had higher rates of infection (61 to 89 percent). The H. pylori scenario from the prevalence rates, treatment protocols and responses to treatment does not differ very much from other developing areas of the world.

Helicobacter pylori infection in rural settlements (Kibbutzim) in Israel.

BACKGROUND: Helicobacter pylori (HP) is accepted as a major cause of type B gastritis, which is strongly associated with peptic ulcer disease. Epidemiological studies have indicated a correlation of HP infection and socioeconomic class. METHODS: To determine the prevalence of HP infection and to evaluate symptoms and risk factors associated with HP infection in a rural population, 377 asymptomatic individuals were studied out of a random sample of 453 people. Subjects were randomly chosen in a ratio of 1:4 of all the adults over 30 years, living in eight communal settlements in Israel. Blood samples were taken and subjects answered a questionnaire in which sociodemographic information, clinical gastrointestinal background and the use of medication were included. A sensitive enzyme-linked immunoassay was used to determine antibodies to HP in serum. RESULTS: The overall prevalence of HP infection was 72%. In a multivariant discriminant analysis: age, country of origin and ethnic group were found to be the most closely associated variables for HP infection and the discriminant analysis succeeded in predicting correctly, in 62% of the population, whether they had or did not have HP infection. There was no significant difference with gender, occupation, educational level, blood group, smoking, gastrointestinal symptoms and use of medication. CONCLUSIONS: The prevalence of HP infection was higher than that in industrialized countries, but lower than in developing countries. The prevalence in a rural population was slightly higher than that of an urban population in Israel (65%). The country of origin and ethnic group influenced the prevalence of HP infection and not birth and growing up on the Kibbutz.

Two point analysis 15-minute 14C-urea breath test for diagnosing Helicobacter pylori infection.

The value of a two point analysis (double sample) 14C-urea breath test in diagnosing Helicobacter pylori (HP) infection in patients with suspected acid peptic disease has been studied and compared to histology and to a rapid agar plate urease test in 76 patients. Using the histological finding of HP as the gold standard, the 14C-breath test was positive in 59 of the 61 histologically confirmed infected patients and in 3 of the 15 noninfected ones, giving a sensitivity of 97% and specificity of 80%. In 12 patients, a smaller dose of 3 mu Ci 14C-urea was used. The results correlated well with those in whom the higher dose of 10 mu Ci was used. We conclude that a two point 14C-urea breath test with analysis at 5 and 15 min is effective in diagnosing HP infection thus obviating the need for endoscopy and biopsy.