Background:
The Coronavirus Disease 2019 pandemic has forced major changes on healthcare systems. Maintaining regular patients’ surveillance became a major challenge. Telemedicine has been promoted ...as an economic and effective way for long distance patient care. Our aim was to study patients’ acceptance and perspectives on telemedicine.
Methods:
Patients scheduled for clinic appointments were offered telemedicine. Those who agreed were asked to fill in a questionnaire assessing their satisfaction with the medical consultation. Patients’ demographic characteristics and answers were collected and reviewed.
Results:
Out of 358 patients approached 71 agreed to use telemedicine. Of them, 59 completed the questionnaire and were included in the study. All patients’ basic demographic data were collected. Patients’ included in the study mean age was: 43 ± 16.3 years, 35 (59.3%) women. Patients who chose not to use telemedicine were significantly older, mean age: 61 ± 15.2 years (p = 0.036), 134 (46.7%) women. Most patients included (38; 64.4%) had inflammatory bowel disease (IBD). Most patients who chose not to use telemedicine were non-IBD patients (206, 72%). Fifty-one patients (86.4%) assessed their experience as ‘good’ or ‘excellent’. Satisfied patients had significantly less time under medical follow-up (3.7 versus 6.1 years, p = 0.028) and tended to be younger (p = non-significant). Women were statistically significantly more satisfied than men (33 versus 18, p = 0.05). Advantages reported were ‘time saving’ (31.3%), accessibility (26.1%), availability (25%). The main disadvantage was absence of physical examination (70%).
Conclusions:
Telemedicine gained a high satisfaction rate among patients under regular medical surveillance. Most patients stated this that method is convenient, time saving and increases their compliance. Patients who agreed to telecare were younger, and tended to be of female gender and experiencing IBD. Further studies are needed to characterize specific barriers to telecare usage.
The gut microbiome has been shown to influence the response of tumors to anti-PD-1 (programmed cell death-1) immunotherapy in preclinical mouse models and observational patient cohorts. However, ...modulation of gut microbiota in cancer patients has not been investigated in clinical trials. In this study, we performed a phase 1 clinical trial to assess the safety and feasibility of fecal microbiota transplantation (FMT) and reinduction of anti-PD-1 immunotherapy in 10 patients with anti-PD-1-refractory metastatic melanoma. We observed clinical responses in three patients, including two partial responses and one complete response. Notably, treatment with FMT was associated with favorable changes in immune cell infiltrates and gene expression profiles in both the gut lamina propria and the tumor microenvironment. These early findings have implications for modulating the gut microbiota in cancer treatment.
The field of gastroenterology (GI) is constantly evolving. It is essential to pinpoint the most pressing and important research questions. To evaluate the potential of chatGPT for identifying ...research priorities in GI and provide a starting point for further investigation. We queried chatGPT on four key topics in GI: inflammatory bowel disease, microbiome, Artificial Intelligence in GI, and advanced endoscopy in GI. A panel of experienced gastroenterologists separately reviewed and rated the generated research questions on a scale of 1-5, with 5 being the most important and relevant to current research in GI. chatGPT generated relevant and clear research questions. Yet, the questions were not considered original by the panel of gastroenterologists. On average, the questions were rated 3.6 ± 1.4, with inter-rater reliability ranging from 0.80 to 0.98 (p < 0.001). The mean grades for relevance, clarity, specificity, and originality were 4.9 ± 0.1, 4.6 ± 0.4, 3.1 ± 0.2, 1.5 ± 0.4, respectively. Our study suggests that Large Language Models (LLMs) may be a useful tool for identifying research priorities in the field of GI, but more work is needed to improve the novelty of the generated research questions.
Patients frequently have concerns about their disease and find it challenging to obtain accurate Information. OpenAI's ChatGPT chatbot (ChatGPT) is a new large language model developed to provide ...answers to a wide range of questions in various fields. Our aim is to evaluate the performance of ChatGPT in answering patients' questions regarding gastrointestinal health.
To evaluate the performance of ChatGPT in answering patients' questions, we used a representative sample of 110 real-life questions. The answers provided by ChatGPT were rated in consensus by three experienced gastroenterologists. The accuracy, clarity, and efficacy of the answers provided by ChatGPT were assessed.
ChatGPT was able to provide accurate and clear answers to patients' questions in some cases, but not in others. For questions about treatments, the average accuracy, clarity, and efficacy scores (1 to 5) were 3.9 ± 0.8, 3.9 ± 0.9, and 3.3 ± 0.9, respectively. For symptoms questions, the average accuracy, clarity, and efficacy scores were 3.4 ± 0.8, 3.7 ± 0.7, and 3.2 ± 0.7, respectively. For diagnostic test questions, the average accuracy, clarity, and efficacy scores were 3.7 ± 1.7, 3.7 ± 1.8, and 3.5 ± 1.7, respectively.
While ChatGPT has potential as a source of information, further development is needed. The quality of information is contingent upon the quality of the online information provided. These findings may be useful for healthcare providers and patients alike in understanding the capabilities and limitations of ChatGPT.
The coronavirus disease-19 (COVID-19) pandemic forced endoscopy units to enact major changes on daily practice and policy. The Chaim Sheba Medical Center is a tertiary referral center located in the ...center of Israel, and serves cities with high infection rates. Our aim was to review the policies enacted during this outbreak and study their influence on the performance of endoscopic procedures.
Following the revision of work protocols, personnel were divided into two permanent and physically separate working groups and screening procedures were rescheduled. Relevant data including the number of endoscopic examinations, type of procedure performed, and patient referrals and indications were taken from a computerized database and evaluated. The study included data for January-March 2018-2020, and a comparison among the data from each year was performed.
As of March 2020, the total number of endoscopic examinations performed reduced by 44% (p<0.0001) as compared to previous years, gastroscopy examinations reduced by 39% (p=0.02), and lower endoscopy procedures reduced by 57% (p<0.0001). Meanwhile, the number of advanced endoscopic procedures performed remained consistent with previous years. The indications for performance of gastroscopy and lower endoscopy were different in March 2020, while these remained unchanged for advanced endoscopic procedures.
The current policy appears to serve both our initial goals: protecting personnel and patients' safety and minimizing potential damage from delayed endoscopic procedures. A longer term follow-up study is needed in order to fully analyze our results.
Background:
The integration of artificial intelligence (AI) into healthcare has opened new avenues for enhancing patient care and clinical research. In gastroenterology, the potential of AI tools, ...specifically large language models like ChatGPT, is being explored to understand their utility and effectiveness.
Objectives:
The primary goal of this systematic review is to assess the various applications, ascertain the benefits, and identify the limitations of utilizing ChatGPT within the realm of gastroenterology.
Design:
Through a systematic approach, this review aggregates findings from multiple studies to evaluate the impact of ChatGPT on the field.
Data sources and methods:
The review was based on a detailed literature search of the PubMed database, targeting research that delves into the use of ChatGPT for gastroenterological purposes. It incorporated six selected studies, which were meticulously evaluated for quality using the Joanna Briggs Institute critical appraisal instruments. The data were then synthesized narratively to encapsulate the roles, advantages, and drawbacks of ChatGPT in gastroenterology.
Results:
The investigation unearthed various roles of ChatGPT, including its use in patient education, diagnostic self-assessment, disease management, and the formulation of research queries. Notable benefits were its capability to provide pertinent recommendations, enhance communication between patients and physicians, and prompt valuable research inquiries. Nonetheless, it encountered obstacles in decoding intricate medical questions, yielded inconsistent responses at times, and exhibited limitations in generating novel content. The review also considered ethical implications.
Conclusion:
ChatGPT has demonstrated significant potential in the field of gastroenterology, especially in facilitating patient–physician interactions and managing diseases. Despite these advancements, the review underscores the necessity for ongoing refinement, customization, and ethical regulation of AI tools. These findings serve to enrich the dialog concerning AI’s role in healthcare, with a specific focus on ChatGPT’s application in gastroenterology.
Plain language summary
Checking how ChatGPT works in gastroenterology: a detailed look at its uses, advantages, and challenges
Goal We looked at how ChatGPT, a computer program, is used in the study Gastroenterology. We wanted to understand what’s good about it, what’s challenging, and how it can help doctors and patients. How We Did It We searched for articles about ChatGPT in Gastroenterology on PubMed. We found six suitable articles and checked their quality using the Joanna Briggs Institute (JBI) critical appraisal tools. Then, we put all the information together to get a clear picture. What We Found Doctors and researchers use ChatGPT in many ways. Some use it to teach patients about their health, while others use it to help patients check their symptoms or manage their conditions. It can even help come up with research questions. The good things about ChatGPT are that it gives helpful advice, makes talking between doctors and patients easier, and helps come up with research topics. But, sometimes it doesn’t understand hard medical questions, gives different answers for the same question, or lacks new ideas. There are also concerns about using it the right way. What This Means ChatGPT can be a helpful tool in Gastroenterology, especially when talking with patients and managing their health. But, there are challenges that need to be fixed. Our review helps people understand how ChatGPT can be used in health care, especially in the field of Gastroenterology.
Background and Aims Evaluation of small-bowel patency is recommended before swallowing video capsule endoscopy to prevent capsule retention. This study aimed to evaluate the ability of magnetic ...resonance enterography (MRE) to predict patency capsule (PC) retention in patients with Crohn’s disease and to identify the most predictive imaging features for retention. Methods Fifty-seven patients prospectively underwent MRE and PC. Two radiologists predicted PC retention. Interrater reliability was determined by using Cohen’s κ coefficient. The sensitivity, specificity, and positive and negative predictive values were calculated for the predictions. Evaluation of the imaging features was done using the t test and receiver-operating characteristics; t-tests were also performed on the clinical parameters. Results The κ value for interrater reliability was 0.58. The sensitivity, specificity, PPV, and NPV for the predictions by the 2 radiologists were 92.3%, 59%, 40%, 96.3%, and 100%, 52.3%, 38.2%, 100%, respectively. The maximal stricture length (9.7 ± 3.66 cm vs 7.0 ± 3.08 cm, P = .04) and the number of prestenotic dilations (1.9 ± 1.07 vs 1.0 ± 1.38, P = .03) were associated with PC retention. The area under the receiver-operating characteristic curves was 0.69 for the maximal stricture length and 0.751 for the number of prestenotic dilations. The phenotype of the disease was the only clinical parameter significantly correlated with PC retention. Conclusions MRE has a high NPV and sensitivity for PC retention. When capsule retention is suggested by MRE, PC should be performed before the video capsule endoscopy examination. The maximal stricture length and the number of prestenotic dilations were found to be the most predictive imaging features for PC retention.
Celiac disease (CD) presents a complex interplay of both innate and adaptive immune responses that drive a variety of pathological manifestations. Recent studies highlight the role of immune-mediated ...pathogenesis, pinpointing the involvement of antibodies against tissue transglutaminases (TG2, TG3, TG6), specific HLA molecules (DQ2/8), and the regulatory role of interleukin-15, among other cellular and molecular pathways. These aspects illuminate the systemic nature of CD, reflecting its wide-reaching impact that extends beyond gastrointestinal symptoms to affect other physiological systems and giving rise to a range of pathological landscapes, including refractory CD (RCD) and, in severe cases, enteropathy-associated T cell lymphoma. The existing primary therapeutic strategy, a gluten-free diet (GFD), poses significant challenges, such as low adherence rates, necessitating alternative treatments. Emerging therapies target various stages of the disease pathology, from preventing immunogenic gluten peptide absorption to enhancing intestinal epithelial integrity and modulating the immune response, heralding potential breakthroughs in CD management. As the understanding of CD deepens, novel therapeutic avenues are emerging, paving the way for more effective and sophisticated treatment strategies with the aim of enhancing the quality of life of CD patients. This review aims to delineate the immunopathology of CD and exploring its implications on other systems, its complications and the development of novel treatments.
Despite encouraging data gathered in inflammatory bowel diseases (IBD) patients, Vedolizumabs' (VDZ) safety profile in pregnancy is not established.
Data of 330 consecutive pregnancies with IBD was ...prospectively collected.
Women with IBD were treated with: VDZ (n = 24), anti-tumor necrosis factors (n = 82) or conventional therapy (n = 224). Gravidity and parity were similar among the 3 groups. The VDZ group was comprised mostly of Crohn's disease patients who were all not naïve to biological treatment. They had significantly higher conception rates during active disease (P < 0.05), with fewer flares during pregnancy.
Although further study is needed, VDZ appears of low risk during pregnancy.
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