Information Needs and Information-Seeking Behavior of Italian Neurologists: Exploratory Mixed Methods Study.

BACKGROUND: Current medical professions involve an extensive knowledge of the latest validated scientific data to implement disease diagnosis, therapeutic strategies, and patient care. Although clinicians can refer to a growing number and type of information sources to keep current with new scientific achievements, there are still various concerns about medical information validity, quality, and applicability into clinical practice. Novel strategies are required to identify physicians' real-life needs with the final aim to improve modern medical information delivery. OBJECTIVE: Our research used an innovative tool to collect real-time physician queries in order to investigate information needs and seeking behavior of Italian neurologists treating patients with multiple sclerosis (MS) and migraine. METHODS: The study was designed as an exploratory mixed methods (ie, qualitative and quantitative) study involving 15 consecutive days of observation. A total of 50 neurologists (n=25 MS and n=25 migraine specialists) were recruited. Data were collected using an instant messaging mobile app designed for this research. At each information-seeking event, moderators triggered a computer-assisted personal interview including both semistructured interview and close-ended questions. Interactions and physician queries collected using the mobile app were coded into emerging themes by content analysis. RESULTS: Neurologist queries were relevant to the following major themes: therapy management (36/50, 71%) and drug-related information (34/50, 67%), followed by diagnostic strategies and procedures (21/50, 42%). Quantitative analysis indicated online resources were preferentially used by clinicians (48/50, 96%) compared with offline sources (24/50, 47%). A multichannel approach, in which both online and offline sources were consulted to meet the same need, was adopted in 33% (65/198) of information-seeking events. Neurologists more likely retrieved information from online relative to offline channels (F=1.7; P=.01). MS specialists were 53% more likely to engage in one information-seeking event compared with migraine neurologists (risk ratio 1.54; 95% CI 1.16-2.05). MS specialists tended to be more interested in patient-related content than migraine clinicians (28% [7/25] vs 10% [2/25], P=.06), who conversely more likely sought information concerning therapy management (85% [21/25] vs 60% [15/25], P=.05). Compared with MS clinicians, migraine specialists had a harder time finding the required information, either looking at online or offline channels (F=12.5; P=.01) and less frequently used offline channels (30% [8/25] vs 60% [15/25] of information-seeking events, P=.02). When multiple sources needed to be consulted to retrieve an information item, a reduced satisfaction rate was observed both among migraine and MS specialists (single source vs multiple sources P=.003). CONCLUSIONS: This study provides a detailed description of real-life seeking behavior, educational needs, and information sources adopted by Italian MS and migraine neurologists. Neurologist information needs and seeking behavior reflect the specific characteristics of the specialty area in which they operate. These findings suggest identification of time- and context-specific needs of clinicians is required to design an effective medical information strategy.

The production of the oral mucosa of antiendomysial and anti-tissue-transglutaminase antibodies in patients with celiac disease: a review.

Celiac disease (CD) is a lifelong, T cell-mediated enteropathy, triggered by the ingestion of gluten and related prolamins in genetically susceptible subjects, resulting in minor intestinal mucosal injury, including villous atrophy with crypt hyperplasia and intraepithelial lymphocytosis, and subsequent nutrient malabsorption. Although serological tests for antiendomysial (EMA) and anti-tissue transglutaminase (anti-tTG) autoantibodies are used to screen and follow up on patients with CD, diagnostic confirmation is still based on the histological examination of the small intestinal mucosa. Although the small intestinal mucosa is the main site of the gut involved in CD, other mucosal surfaces (such as gastric, rectal, ileal, and esophageal) belonging to the gastrointestinal tract and the gut-associated lymphoid tissue (GALT) can also be involved. A site that could be studied less invasively is the mouth, as it is the first part of the gastrointestinal system and a part of the GALT. Indeed, not only have various oral ailments been reported as possible atypical aspects of CD, but it has been also demonstrated that inflammatory changes occur after oral supramucosal application and a submucosal injection of gliadin into the oral mucosa of CD patients. However, to date, only two studies have assessed the capacity of the oral mucosa of untreated CD patients to EMA and anti-tTG antibodies. In this paper, we will review studies that evaluate the capacity of the oral mucosa to produce specific CD autoantibodies. Discrepancies in sensitivity from the two studies have revealed that biopsy is still not an adequate procedure for the routine diagnostic purposes of CD patients, and a more in-depth evaluation on a larger sample size with standardized collection and analysis methods is merited. However, the demonstration of immunological reactivity to the gluten ingestion of the oral mucosa of CD, in terms of IgA EMA and anti-tTG production, needs to be further evaluated in order to verify whether the oral mucosa is colonized by lymphocytes activated in the intestine or if gluten could stimulate naïve lymphocytes directly in the oral mucosa. This would have important implications for the pathogenesis, diagnosis, and treatment of CD.

Estimate of renal function in oldest old inpatients by MDRD study equation, Mayo Clinic equation and creatinine clearance.

BACKGROUND: Patients older than 85 years are increasingly admitted to hospital care settings. Despite this, the clinical employment of equations for estimating glomerular filtration rate (GFR) has been scarcely investigated so far in this age group. Our study compared 2 commonly employed equations to estimate GFR, as well as measured 24-hour creatinine clearance (CrCl), in patients aged >or=85 years. METHODS: Seventy-three patients consecutively admitted over 4 months to our Internal Medicine Department had an accurate 24-hour urinary collection, as well as serum and urinary creatinine determinations. Measured CrCl was compared with the GFR values estimated by the Modification of Diet in Renal Disease (MDRD) Study and Mayo Clinic quadratic (MCQ) equations. RESULTS: GFR values derived by MDRD and MCQ equations and CrCl significantly differed from each other in the whole sample. CrCl negatively correlated with age (r=-0.389, p<0.001), at variance with GFR levels obtained by both the MDRD and the MCQ equations. The 3 estimates of renal function significantly correlated with each other, these correlations persisting after correcting for age, serum albumin and 24-hour urinary creatinine. Despite the visual impression of Bland and Altman plots, the overall agreement between methods was poor. Moreover, the proportion of patients classified by the 3 GFR estimates into each stage of kidney disease as specified in the Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines significantly differed. CONCLUSIONS: In patients older than 85 years, the tested equations for estimation of GFR and the measured 24-hour CrCl provide significantly different results, so that they may not be used interchangeably in clinical practice.

Oral manifestations of celiac disease.

INTRODUCTION: Contrary to early beliefs, celiac disease (CD) is relatively common; however, it still remains underdiagnosed since most cases are atypical, with few or no gastrointestinal symptoms and predominance of extraintestinal manifestations. As a consequence, the diagnosis of the disorder often requires a multidisciplinary approach. Also some oral ailments have been described in celiac patients. In this study, we review the papers that have reported oral manifestations in subjects with CD. METHODS: A comprehensive literature search was conducted in Medline and Embase databases using appropriate key words. Additional papers were selected by cross-referencing from the retrieved articles. RESULTS: Dental enamel defects are the oral lesions most closely related to CD. There are conflicting data on the association between CD and recurrent aphthous stomatitis. A correlation of CD with atrophic glossitis has been reported, although robust evidence in support of it is lacking. Patients with CD have caries indexes seemingly lower than healthy individuals, but they may experience delay in tooth eruption. Occurrence of other oral mucosal lesions in CD subjects is likely occasional. CONCLUSIONS: Patients with systematic dental enamel defects should be screened for CD even in the absence of gastrointestinal symptoms. CD screening tests for patients with oral aphthae or idiopathic atrophic glossitis should be selectively considered during a medical evaluation that focuses on all aspects of the patient's status.

Effect of p63 expression on survival in oral squamous cell carcinoma.

BACKGROUND: P63 is the protein codified by p63 gene, a p53 gene homolog, known for its pivotal role in cell cycle regulation, and involved in the tumor differentiation. Aims of the present study were to assess the frequency and pattern of p63 protein expression in oral squamous cell carcinoma (OSCC) in relation to the main tumour characteristics and to verify whether p63 can be considered a marker of prognosis in patients with OSCC. MATERIAL AND METHODS: In a retrospective study, a cohort of 64 OSCC patients was investigated for p63 protein expression and its cellular localization by immunohistochemistry (monoclonal mouse anti-human p63 protein-clone 4A4). After grouping by p63 expression, OSCCs were statistically analyzed for the variables age, gender, histological grading (G), TNM, staging, recurrence, and overall survival rate. RESULTS: The overall frequency of p63 overexpressed was of 57.8 percent. Various p63 staining patterns were observed according to G score, with a significant correlation between p63 overexpression and the lowest G score (P < 0.0001). No statistically significant difference was found between p63 pattern expression and age, sex, staging. OSCC patients with p63 overexpressed were found to have a poorer survival rate with respect to OSCCs with a normal pattern of expression (P = 0.024). CONCLUSIONS: On the basis of these results, it is possible to suggest p63 pattern expression as a reliable indicator of histological grading and an early marker of poor prognosis.

Vulvostomatodynia.

Burning mouth syndrome associated to vulvodynia (Vulvostomatodynia) is a rare condition and is often difficult to diagnose and treat. Tongue, lips, vestibule and others mucosal sites may be affected by a tiresome burning sensation, especially in menopausal and postmenopausal women. Patients seldom report genital symptoms to the dentist and dentists do not generally investigate about genital symptoms. Delays in diagnosis may affect the quality of life. We report the clinical features of five new cases of vulvostomatodynia. A thorough multidisciplinary medical management is necessary to improve symptoms and prevent from psychologic distress. Counselling and an understanding between patient and clinician/therapist are important for long-term results.

Incidence and risk factors for gallstones in patients with inflammatory bowel disease: a large case-control study.

UNLABELLED: The risk for gallstones (GD) in inflammatory bowel diseases and the factors responsible for this complication have not been well established. We studied the incidence of GD in a cohort of Crohn's disease (CD) and ulcerative colitis (UC) patients and investigated the related risk factors. A case-controlled study was carried out. The study population included 634 inflammatory bowel disease (IBD) patients (429 CD, 205 UC) and 634 age-matched, sex-matched, and body mass index (BMI)-matched controls free of GD at enrollment, who were followed for a mean of 7.2 years (range, 5-11 years). The incidence of GD was calculated by dividing the number of events per person-years of follow-up. Multivariate analysis was used to discriminate among the impact of different variables on the risk of developing GD. The incidence rates of GD were 14.35/1,000 persons/year in CD as compared with 7.75 in matched controls (P=0.012) and 7.48/1000 persons/year in UC patients as compared with 6.06 in matched-controls (P=0.38). Ileo-colonic CD location (OR, 2.14), disease duration>15 years (OR, 4.26), >3 clinical recurrences (OR, 8.07), ileal resection>30 cm (OR, 7.03), >3 hospitalizations (OR, 20.7), multiple TPN treatments (OR, 8.07), and long hospital stay (OR, 24.8) were significantly related to GD in CD patients. CONCLUSION: Only CD patients have a significantly higher risk of developing GD than well-matched hospital controls. Site of disease at diagnosis, lifetime surgery, extent of ileal resections, number of clinical recurrences, TPN, and the frequency and duration of hospitalizations are independently associated with GD.

Peno-gingival lichen planus.

BACKGROUND: Lichen planus with simultaneous oral and genital involvement in males is a quite rare condition and often difficult to diagnose. The prevalence, treatment options, and management for this condition are far from being established, and research in this area primarily relies on anecdotes. We present the clinical features of eight cases of peno-gingival lichen planus and propose a management algorithm for this condition based on the best available published evidence. METHODS: Personal medical history was collected for all cases. Following careful examination of the oral and genital mucosae, pathology was obtained, previous treatments and duration of mucosal lesions ascertained, treatment initiated, and response evaluated at 8 weeks on both oral and genital lesions. The first-line drug was topical clobetasol propionate 0.05% cream in all cases; in case of failure, topical cyclosporin was used. A review of the literature on treatment options for this rare condition was performed based upon standard literature review practices. RESULTS: Five cases presented gingival lesions that clinically resembled lichen planus. Glans penis was involved in all patients. All patients responded to treatment except for one. Oral candidiasis was the only observed side effect. CONCLUSIONS: Genital lichen planus may be suspected in males when atrophic-erosive gingival lichen planus is found. A thorough multidisciplinary medical management and active early treatment are necessary to improve symptoms and prevent genital sequelae and, given the risk of squamous cell carcinoma, as a preventative strategy, although this area still needs investigation. Therapeutic trials relating to the treatment of peno-gingival lichen planus may be undertaken considering that current management relies exclusively on observations of case reports.

[A survey of preventive measures against infection risk in dental surgery]. / Indagine conoscitiva sulla prevenzione del rischio infettivo negli studi odontoiatrici.

In dental healthcare surgeries, both workers and patients are regularly exposed to various infectious agents. It is essential therefore that dental healthcare workers have a good knowledge of disinfection systems and that dentists' surgeries be effectively managed so as to reduce or even eliminate the risk of cross infections. In order to evaluate infectious risk prevention methods and describe the procedures used by dental healthcare workers on a daily basis, a sample of dentists who work in public surgeries were asked to anonymously fill up a questionnaire. The results of this survey show that dental healthcare workers are sufficiently well-informed about the infectious hazards present in the workplace and are aware of the high risk of exposure to infections but seem to be especially concerned about blood-borne infections (hepatitis, AIDS). Only 67.5%, however, are immunised against HBV. Individual safety devices are used correctly while there seems to be a lack of knowledge about the proper use of disinfection and sterilization systems. In addition, some dental healthcare workers still today refuse to treat HIV-positive patients.

[Importance of oral signs in the diagnosis of atypical forms of celiac disease]. / Importanza dei segni orali nella diagnosi di forme atipiche di malattia celiaca.

The dramatic improvement in knowledge concerning celiac disease (CD) has disclosed the pattern of the associated clinical manifestations and the often atypical or silent presentation of this disease, which makes clinical diagnosis difficult. Also oral manifestations, mostly recurrent apthous stomatitis (RAS) and dental enamel hypoplasia, are atypical signs of CD. Our opinion about the possibility of performing mass-screening to reveal atypical or silent CD is in agreement whit who is asserting that a sistematical case-finding is, at present, the most suitable epidemiological approach. So, we think that patients affected by RAS, or dental enamel hypoplasia, should be considered, even in the absence of any gastrointestinal symptom, at-risk subjects, and should therefore undergo diagnostic procedure for CD.