Exploring the use of a participative design in the early development of a predictive test : the importance of physician involvement

In this study, we contribute to the personalized medicine and health care management literature by developing and testing a new participative design approach. We propose that involving gastroenterologists in the development of a predictive test to assist them in their clinical decision-making process for the treatment of inflammatory bowel diseases will increase the likelihood of their acceptance of the innovation. Based on data obtained from 6 focus groups across Canada from a total of 28 physicians, analyses reveal that current tools do not enable discriminating between treatment options to find the best fit for each patient. Physicians expect a new predictive tool to have the capability of showing clear reliability and significant benefits for the patient, while being accessible in a timely manner that facilitates clinical decisions. Physicians also insist on their key role in the implementation process, hence confirming the relevance and importance of participative designs in personalized medicine

Patients’ perception of their involvement in shared treatment decision making : key factors in the treatment of inflammatory bowel disease

Objectives This study aims to characterize the relationships between the quality of the information given by the physician, the involvement of the patient in shared decision making (SDM), and outcomes in terms of satisfaction and anxiety pertaining to the treatment of inflammatory bowel disease (IBD). Methods A Web survey was conducted among 200 Canadian patients affected with IBD. The theoretical model of SDM was adjusted using path analysis. SAS software was used for all statistical analyses. Results The quality of the knowledge transfer between the physician and the patient is significantly associated with the components of SDM: information comprehension, patient involvement and decision certainty about the chosen treatment. In return, patient involvement in SDM is significantly associated with higher satisfaction and, as a result, lower anxiety as regards treatment selection. Conclusions This study demonstrates the importance of involving patients in shared treatment decision making in the context of IBD. Practice implications Understanding shared decision making may motivate patients to be more active in understanding the relevant information for treatment selection, as it is related to their level of satisfaction, anxiety and adherence to treatment. This relationship should encourage physicians to promote shared decision making

Overexpression of Protein Tyrosine Phosphatase 1B in HepG2 Cells Ameliorates Insulin-mediated Suppression of Apolipoprotein B mRNA Translation Via Its Untranslated Regions

Background: The hepatic secretion of apolipoprotein B (apoB), containing lipoproteins, is known to be regulated by insulin, and the overproduction of these atherogenic lipoproteins occurs in insulin-resistant states. Protein tyrosine phosphatase 1B (PTP-1B) is a key regulator of hepatic insulin signaling and is also upregulated in insulin resistance. We aimed to investigate the role of PTP-1B in regulating apoB mRNA translational efficiency mediated by 5’/3’ untranslated regions (UTRs) under conditions of insulin stimulation. Methods: Human hepatoma HepG2 cells were transfected with a vector carrying the firefly luciferase reporter gene and either a chimeric apoB mRNA encoding the 5’/3’ untranslated region (5’LUC3’-pGL3) or a null sequence of length equivalent to apoB 5’ UTR (LUC-pGL3). The transfected cells were then infected with adenovirus carrying the mouse PTP-1B gene (AdPTP1B) in the absence or presence of insulin, and the cellular luciferase activity was determined. The RNA extracts from cells were transfected with constructs carrying 5’/3’ apoB UTR, or a null sequence was also translated in vitro in a rabbit reticulocyte translation system. Results: The luciferase activity of the cells transfected with constructs containing the apoB UTR sequences (5’LUC3’) was significantly higher than that of the control constructs carrying a null sequence (p<0.01, n=12). Similar results were observed following in vitro translation studies showing a significantly higher expression of the 5’/3’ UTR constructs (p<0.001, n=6). Treatment with 100 nM insulin led to a significant reduction in the luciferase activity of the constructs carrying apoB 5’/3’ UTR (p<0.0001, n=12). The down regulation of the apoB mRNA translation mediated by insulin was mediated by the apoB 5’/3’ UTR sequences since insulin did not affect the control constructs containing a null sequence. The infection of HepG2 cells expressing 5’LUC3’ or control constructs with AdPTP-1B attenuated the inhibitory effect of insulin and led to higher levels of luciferase activity compared to the Ad-gal infected control cells (p< 0.05, n=12). However, the activity was lower than that in the control cells infected with 5’LUC3’-pGL3 but not treated with insulin (p<0.05, n=12). Conclusion: Our data suggest that PTP-1B can potentially modulate apoB synthesis by blocking insulin-mediated inhibition of the apoB mRNA translation via its 5’/3’ UTR sequences. We hypothesize that the PTP-1B-mediated attenuation of the insulin action can lead to the upregulation of the apoB mRNA translation and contribute to a lipoprotein overproduction in conditions such as insulin resistance

Inflammatory bowel disease patient perceptions of diagnostic and monitoring tests and procedures

Abstract Background Inflammatory Bowel Disease (IBD) with its high incidence and prevalence rates in Canada generates a heavy burden of tests and procedures. The purpose of this study is to gain a better understanding of the transfer of information from physician to patient, as well as the patient understanding and perceptions about the tests and procedures that are ordered to them in the context of IBD diagnosis and monitoring. Methods An online questionnaire was completed by 210 IBD patients in Canada. Information on the five most-often used tests or procedures in IBD diagnosis/monitoring was collected. These include: general blood test, colonoscopy, colon biopsy, medical imaging and stool testing. Results The general blood test is both the most ordered and most refused tool. It is also the one with which patients are the least comfortable, the one that generates the least concern and the one about which physicians provide the least information. The stool test is the test/procedure with which patients are the most comfortable. Procedures raise more concerns among patients and physicians provide more information about why they are needed, their impact and the risks they present. Very little information is provided to patients about the risks of having false positives or negative tests. Conclusions This study provides an initial understanding of patient perceptions, the transfer of information from a physician to a patient and a patient’s understanding of the tests and procedures that will be required to treat IBD throughout what is a lifelong disease. The present study takes a first step in better understanding the acceptance of the test or procedure by IBD patients, which is essential for them to adhere to the monitoring process

Factors leading to acceptance of and willingness to pay for predictive testing among chronically Ill patients

Background: Personalized medicine can lower healthcare system costs and help ensure that chronic patients get the most appropriate treatment for their individual illness. However, individual factors leading to acceptance of personalized medicine technologies such as predictive testing by chronic patients remain largely unknown. Objectives: This study was aimed at identifying individual sociodemographic factors leading to the acceptance of predictive testing in chronic patients and their willingness to pay for these tests. Design and methods: A web survey was conducted with 210 Canadian patients affected by Inflammatory Bowel Disease (IBD). The data was processed using the SPSS software. Inferential statistical analyses were conducted using the chi square test. Results: Chronic patients were massively in favour of undergoing a genetic test that could predict response to treatment options, and the majority were in favour of paying for the test. While the population in general has concerns regarding genetic testing, the present study indicates that the seriousness of chronic illness along with side effects of treatments leads to a higher acceptance among patients. Only the yearly number of consultations was positively related to acceptance and willingness to pay. Conclusions: While previous studies have reported resistance to genomic technologies amongst the general population, the present study demonstrates that chronic patients are largely open to genetic predictive testing. Furthermore, a vast majority was even prepared to pay for such tests. Clinicians, healthcare organizations and pharmaceutical companies should take this result into consideration when building and promoting predictive testing options. Based on these findings, future studies are warranted for further investigating and characterizing patients’ perception towards genetic predictive testing across other chronic illnesses