A search for Helicobacter pyloriin localized vulvodynia.

BACKGROUND: We noted that several patients presenting with both localized vulvodynia (vulvar vestibulitis) and peptic symptoms reported a resolution of dyspareunia after receiving a full treatment course for Helicobacter pylori. METHODS: Women with localized vulvodynia were interviewed regarding symptoms of peptic disease. Those with peptic symptoms underwent a blood test for the presence of antibodies to H. pylori and were referred to a gastroenterology consultation. In all women, vestibular biopsies were obtained and stained for H. pylori. Healthy vestibular tissues as well as archival negative and positive gastric tissues served as controls. RESULTS: Of the blood antibody tests, 12 (80%) were positive. None of the patients had evidence of H. pylori in the vestibule. Eleven women received triple therapy for eradication of H. pylori. Eight (73%) reported complete relief of dyspareunia and of gastric symptoms. CONCLUSION: Our study found no immunohistochemical evidence of H. pylori infection in the vestibule but suggested a possible role for anti-H. pylori treatment in localized vulvodynia.

Educating CAM practitioners about integrative medicine: an approach to overcoming the communication gap with conventional health care practitioners.

OBJECTIVE: To assess an educational initiative that teaches complementary and alternative medicine (CAM) students how to communicate more effectively with conventional physicians about CAM. DESIGN: We introduced an educational initiative in integrative medicine to CAM students in their final year of study, emphasizing evidence-based learning, patient-centered care, and communication skills with conventional health care providers. A precourse semistructured questionnaire and an anonymous open essay about the students' experiences at the end of the course were used as tools for assessment. The precourse questionnaires and the postcourse essays were evaluated, using content analysis for parallel responses to determine whether students' views changed during the course. RESULTS: We evaluated the experience in 62 students exposed to the initiative during 4 academic years, 2001-2005. We found that CAM students perceive that they need practical communication tools in order to communicate effectively with conventional practitioners. After the educational experience, the students confirmed that critical thinking training is important, and reported feeling more empowered and more confident in their work as well as in communicating with physicians. CONCLUSIONS: The results of this study suggest that CAM practitioners feel better equipped to communicate with conventional health care practitioners after exposure to a structured educational initiative that emphasizes critical thinking, patient-centered care, and communication skills with conventional practitioners.

Prevalence and characteristics of complementary medicine used by pediatric cancer patients in a mixed western and middle-eastern population.

Complementary alternative medicine (CAM) usage and physicians' attitude was evaluated by interviewing all 100 pediatric cancer patients' parents and adolescents seen in the last half of 2003 at Meyer Children's Hospital in Israel. Sixty-one percent of the patients used CAM, an average of 3 different treatments per patient. CAM use was higher: among parents having previous CAM experience (85% vs. 51%, P=0.001) and higher education (79% vs. 50%, P=0.024), and in nonreligious families (71% vs. 50%). Jews and Arabs had similar CAM use rates as with different types of therapies. Socioeconomic status does not affect the rate of CAM use (P=0.9) but does affect the type of treatments used: patients of the higher socioeconomic level mainly used chemi-biological remedies and homeopathy (24% and 28% of interviewees; P=0.002). Middle or lower socioeconomic patients mostly used traditional Arab treatments (32% and 54%, respectively; P=0.012). Only 36% discussed it with their physicians, and most discussions were initiated by parents (79%). Beneficial effect was reported by 69% of CAM users. Most interviewees were interested in getting CAM information and availability in the hospital. Most pediatric cancer patients, regardless of their ethnic origin, use CAM without informing their physicians. Physicians should be aware and know more about it, to be advisors for better integrated care.

Comparisons of American, Israeli, Italian and Mexican physicians and nurses on the total and factor scores of the Jefferson scale of attitudes toward physician-nurse collaborative relationships.

This cross-cultural study was designed to compare the attitudes of physicians and nurses toward physician-nurse collaboration in the United States, Israel, Italy and Mexico. Total participants were 2522 physicians and nurses who completed the Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration (15 Likert-type items, (Hojat et al., Evaluation and the Health Professions 22 (1999a) 208; Nursing Research 50 (2001) 123). They were compared on the total scores and four factors of the Jefferson Scale (shared education and team work, caring as opposed to curing, nurses, autonomy, physicians' dominance). Results showed inter- and intra-cultural similarities and differences among the study groups providing support for the social role theory (Hardy and Conway, Role Theory: Perspectives for Health Professionals, Appelton-Century-Crofts, New York, 1978) and the principle of least interest (Waller and Hill, The Family: A Dynamic Interpretation, Dryden, New York, 1951) in inter-professional relationships. Implications for promoting physician-nurse education and inter-professional collaboration are discussed.