Patient Portals: Objectives, Acceptance, and Effects on Health Outcome - A Scoping Review of Reviews.

Patient portals provide patients access to their electronic health record and other functions as secure messaging. For over a decade, more and more patient portals are developed for various settings. The aim of this scoping review of reviews is to systematically search the literature for existing reviews to provide an overview of patient portals' objectives, acceptance and effects on outcome. We followed the PRISMA Statement and its extension for scoping reviews, and searched for articles published in 2011-2021. The 19 included articles were considerably heterogeneous concentrating on health outcome or patient portal facilitators and barriers.

The tissue renin-angiotensin system (tRAS) and the impact of its inhibition on inflammation and bone loss in the periodontal tissue.

Recently, the existence of the tissue renin-angiotensin system (tRAS) has been described for multiple tissues in humans, suggesting its fundamental role in the progression of inflammation and fibrosis. Evidence arises that tRAS might have an impact on the progression of periodontitis and bone loss. However, neither the role of tRAS nor its impact as a therapeutic target have been systematically evaluated for periodontal tissue. The present study sought to characterise tRAS in the periodontal tissue and the effect of its inhibition on periodontal inflammation and bone loss. This systematic review was performed according to the preferred reporting items for systematic reviews and meta analyses (PRISMA) statement. Literature was searched using Web of Science core collection (Web of Science), Medline (Ovid), Cochrane central register of controlled trials (Ovid), Cochrane database of systematic reviews (Ovid), Google Scholar databases and the references of the retrieved studies in March 2020. Information on study design, sample size, population, procedure, type of intervention, observation time, as well as information on sources of bias, was extracted and evaluated. From 455 identified articles, 17 were included in the qualitative synthesis and 11 were included in the quantitative synthesis. Outcomes of studies indicated that the inhibition of tRAS components led to a reduction of periodontal bone loss and inflammation, dependent on the inhibitor used. The findings suggested an important role of tRAS in the periodontal tissue and indicate a potential therapeutic approach for periodontal diseases.

[Communication Test for Foreign Physicians in Germany: The Patient Communication Test]. / Kommunikationsprüfung ausländischer Ärzte in Deutschland: Patientenkommunikationstest.

INTRODUCTION: The number of foreign doctors in Germany has increased steadily in recent years. To obtain the German medical license, sufficient language competence is mandatory. Nevertheless, in practice, foreign doctors have considerable difficulties in their communication with patients, medical colleagues and other health professionals. This can lead to misunderstandings and thus impair patient safety. To overcome this problem, the "patient communication test" was developed and piloted as an additional requirement to be granted license to practice medicine in Germany. The aim of this study is to present our results in the development and piloting of this test. METHODS: 3 OSCE stations (Objective Structured Clinical Examination) were designed, which evaluate communication skills in 3 medical competences: history taking, case presentation and explaining to patients before obtaining informed consent. After extensive instruction of actors as patients and raters on the basis of the evaluation criteria, the communication test was subjected to pilot studies in 6 different cities (Freiburg, Jena, Mainz, Mannheim, Tübingen, and Ulm). RESULTS: In 2013, 639 foreign doctors participated in the test; 461 (72.14%) of these doctors passed the test on their first try, 51 (7.98%) on their second attempt and 6 (0.93%) on their third try. CONCLUSION: The patient communication test evaluates the communication skills of foreign doctors in OSCE-setting using standardized actor-patients. This improves the communication skills and enhances patient safety in the German health care system by smooth inter-professional and patient-centered communication.

[Evaluation of an internet-based e-learning ophthalmology module for medical students]. / Evaluation eines internetbasierten E-Learnings für den Studentenunterricht im Fach Augenheilkunde.

BACKGROUND: In 2006, the University Eye Hospital Freiburg (Germany) introduced an Internet-based e-learning module as part of the ophthalmology training for medical students. METHODS: In the e-learning module, the students encounter the same cases as discussed during lectures and seminars. The case presentation is based on an interactive question-and-answer game. Content, format, usability, and effectiveness of the e-learning module were evaluated by the students over two terms. RESULTS: Of 307 students, 272 used the e-learning module. On average, 94% of the content was processed per student. More than 75% stated that they had fun working with the e-learning module. Students with frequent e-learning use tended to achieve higher marks in their final ophthalmology exams. CONCLUSION: E-learning represents a sensible addendum to the established ophthalmology training for medical students. It is comparably easy to integrate into the curriculum and is well accepted by medical students.

[E-learning in the education and training of physicians. Methods, results, evaluation]. / E-Learning in der ärztlichen Aus- und Weiterbildung. Methoden, Ergebnisse, Evaluation.

E-learning has been established in the education and training of physicians in various types: linear sequential and hyper-textual forms of multimedia presentations and texts, tutorial systems and simulations. Case-based e-learning systems are of special importance in medicine because they allow for mediation of process and practical knowledge by presentation of authentic medical cases in a simulated environment. The integration into the medical education and advanced professional training is crucial for the long-term success of e-learning; in case-based systems this can be accomplished by blended learning approaches which combine elements of traditional teaching with e-learning. Learning management systems (LMS) support integration of traditional teaching and e-learning by serving as an organizational platform for content of teaching. Further, they provide means of communication for trainers and trainees, authoring tools, interactive components, course management and role-based sharing concept. The dissemination of e-learning can be fostered by attention to requirements and user analysis, early adoption to organizational structures, curricular integration and continuous cooperation with students. Summarized, didactic and organizational aspects determine the success of our own e-learning offers as well as they influence the general further development of e-learning more than technical features.

Quantification of B, T and null lymphocyte subpopulations in the blood and lymphoid organs of the pig.

Research on the pig's immune system is not only of general biological interest; the pig is also becoming more important as a large animal model in human biomedical research, e.g. as a donor for xeno-transplantation. With the increasing panel of monoclonal antibodies against porcine lymphocyte markers it is possible to gain more insight into the distribution and phenotype of lymphocyte subpopulations in the pig. In this study we investigated B cells (surface IgG: sIgG, sIgM and sIgA) and T cells (CD2, CD4, CD8, 8/1, MAC320) in the peripheral blood (pBL), thymus, spleen, tonsil, mesenteric and inguinal lymph nodes (mLN, iLN), jejunal and ileal Peyer's patches (jejPP, ilPP) in Göttingen minipigs. A flow cytometric technique was employed which enabled three color indirect immunofluorescence. B cell stained for surface IgG and surface IgA were found only in small percentages. Surface IgM positive cells were distributed at higher rates, with up to 24.9% in the iLN. Up to 64.2% of CD4+ and up to 73.1% of CD8+ cells were observed in the thymus. Most of the CD4+ cells were CD4/CD8 double positive cells. These cells were mostly triple positive in combination with CD2. A larger fraction of CD2- were CD8- which are taken to be NK cells. MAC320, a marker for a subtype of gamma/delta T cells, was predominantly found on cells in the pBL. The standardized flow cytometric technique produced comparable data on the distribution of major lymphocyte subpopulations in the blood and different lymphoid organs of the pig. The results provide a basis for future studies using the pig as animal model.

Rapid expression of the CD69 antigen on T cells and natural killer cells upon antigenic stimulation of peripheral blood mononuclear cell suspensions.

The CD69 antigen has been identified as the earliest activation marker on the surface of cytokine- or mitogen-activated lymphocytes. The expression of this molecule may be a useful early marker of antigen- or allergen-specific activation of lymphocytes in vitro. We evaluated the expression of the CD69 and CD25 antigens on antigen- or allergen-stimulated lymphocytes and the proliferative responses as detected by thymidine incorporation. Peripheral blood mononuclear cells (PBMC) of allergic patients sensitized to Dermatophagoides pteronyssinus, bovine casein, or nickel sulfate were cultured in the absence or presence of clinically relevant allergens, tetanus toxoid, or recombinant interleukin (IL)-2. The respective binding of CD69 or CD25 antibodies to PBMC and thymidine incorporation were measured. An early expression of CD69, but not of CD25, antigen was detectable after 24-72 h of stimulation on up to 80% of natural killer (NK) cells and up to 10% of CD4+ T cells in PBMC cultures. Anti-IL-2 antibodies inhibited these increases of CD69 on NK cells and T cells by up to 60%. After 6 days of antigenic stimulation, the rates of both CD25+ and CD69+ lymphocytes were higher. Seventy-four percent of the CD25+ PBMC but only 55% of the CD69+ cells were CD3+ T lymphocytes at this time. No qualitative differences were detectable in allergen- or tetanus-toxoid-stimulated PBMC from allergic patients. The high expression of CD69 on NK cells in antigen-stimulated cultures suggests that these cells are easily activated by cytokines from antigen-stimulated T cells. CD69+ NK cells may serve as early-indicator cells in cultures with antigen- or allergen-stimulated mononuclear cells.

Milk-responsive atopic dermatitis is associated with a casein-specific lymphocyte response in adolescent and adult patients.

BACKGROUND: Specific T-cell responses to food antigens have been described in children with atopic dermatitis (AD). However, a subgroup of adolescent and adult patients still experiences food-responsive AD. OBJECTIVE: This study was designed to evaluate lymphocyte responses to bovine casein in adult patients with AD. METHODS: The stimulatory capacity of lipopolysaccharide-depleted bovine casein was tested in proliferation assays and in limiting dilution assays. Casein-specific T-cell clones (TCCs) were generated and characterized. RESULTS: Higher proliferative responses to casein and modulation of cytokine receptors were observed in patients with milk-responsive AD compared with individuals without clinical reactions on milk ingestion. The results did not correlate with the amount of casein-specific IgE in the serum. The frequencies of T cells that grew in the presence of casein or house dust mite antigens were similar. Only 27% of CD4+ casein-specific TCCs from these patients, but the majority of house dust mite-specific TCCs, produced IL-4 on mitogen stimulation. Interferon-gamma, on the other hand, was produced by the majority of TCCs with both specificities. CONCLUSION: A specific T-cell-mediated immune response to casein can be found in the blood of adolescent and adult patients with milk-related exacerbation of AD. In contrast to house dust mite-specific T cells, casein-specific T cells of adult patients who respond to cow's milk with worsening of AD produce little or no IL-4.

Detection of a kappa-casein-specific lymphocyte response in milk-responsive atopic dermatitis.

BACKGROUND: Bovine casein leads to an expansion of lymphocytes expressing the cutaneous lymphocyte antigen and to specific lymphocyte proliferation in a subgroup of patients with milk-responsive atopic dermatitis (AD). The casein fraction is composed of different proteins with defined and completely different sequences. OBJECTIVE: To define the stimulatory capacity of the major casein protein (alpha, beta and kappa) in lymphocyte proliferation assays with cells from milk-allergic and non-allergic individuals. METHODS: Proliferative responses of peripheral blood mononuclear cells to lipopolysaccharide-depleted casein subfractions were measured by thymidine incorporation. Lymphocytes from milk-responsive patients with AD were compared with cells from non-responsive patients with AD and to non-atopic individuals. Atopic individuals with immediate symptoms following consumption of cow's milk were included as positive controls. Casein-specific T-cell clones (TCC) from four patients with milk-responsive AD were restimulated with unfractionated casein and kappa-casein. RESULTS: Higher proliferative responses to unfractionated casein and alpha-, beta- and kappa-casein were observed in milk-responsive patients compared with non-responders. Unfractionated casein and kappa-casein discriminated best between the milk-responsive patients with AD and non-responders. Twenty-five of 31 TCG from patients with milk-responsive AD reacted to the mixed casein preparation and kappa-casein. CONCLUSION: A pronounced kappa-casein-specific T-cell-mediated immune response is found in the blood of many patients with a history of milk-related exacerbation of AD.

The two mannose 6-phosphate receptors transport distinct complements of lysosomal proteins.

Mammalian cells express two different mannose 6-phosphate receptors (MPR 46 and MPR 300), which both mediate targeting of Man-6-P-containing lysosomal proteins to lysosomes. To assess the contribution of either and both MPRs to the transport of lysosomal proteins, fibroblasts were established from mouse embryos that were homozygous for disrupted alleles of either MPR 46 or MPR 300 or both MPRs. Fibroblasts missing both MPRs secreted most of the newly synthesized lysosomal proteins and were unable to maintain the catabolic function of lysosomes. The intracellular levels of lysosomal proteins decreased to < 20%, and undigested material accumulated in the lysosomal compartment. Fibroblasts lacking either MPR exhibited only a partial missorting and maintained, in general, half-normal to normal levels of lysosomal proteins. The same species of lysosomal proteins were found in secretions of double MPR-deficient fibroblasts as in secretions of single MPR-deficient fibroblasts, but at different ratios. This clearly indicates that neither MPR has an exclusive affinity for one or several lysosomal proteins. Furthermore, neither MPR can substitute in vivo for the loss of the other. It is proposed that the heterogeneity of the Man-6-P recognition marker within a lysosomal protein and among different lysosomal proteins has necessitated the evolution of two MPRs with complementary binding properties to ensure an efficient targeting of lysosomal proteins.

Multiparameter analyses of normal and malignant human plasma cells: CD38++, CD56+, CD54+, cIg+ is the common phenotype of myeloma cells.

Plasma cells obtained from bone marrow samples of 45 patients with MM, eight patients with MGUS, eight patients with Waldenström's macroglobulinaemia (WM), one patient with immunocytoma, and 12 controls were characterized by immunophenotyping, estimation of DNA content, and labeling index, as well as by morphological analysis. Plasma cells from 37/45 myeloma and 5/8 MGUS patients expressed CD38 and CD56 (N-CAM) on their surface but were negative for other NK cell-associated antigens such as CD16 (Fc gamma RIII) or CD2. All tumor cells of less-differentiated cell type (WM, immunocytoma) and normal polyclonal plasma cells were negative for CD56. CD56-specific mRNA was demonstrated in myeloma cells by northern blot analysis. Another adhesion molecule, ICAM-1 (CD54), was found on plasma cells from all patients and controls examined. Coexpression of CD19 (1/45), CD20 (9/45), or CD33 (3/45) was rare and CD10 with CD14 was expressed by a small tumor cell subpopulation of only one myeloma patient. The individual pattern of surface marker expression was not associated with a special-type myeloma protein isotype, stage or status of disease, LI or histological classification; however, a correlation between CD56 expression or histological classification and DNA content of the tumor cells was found.