Factors influencing patient satisfaction with GI endoscopy.

BACKGROUND: A modified Group Health Association of America-9 survey (mGHAA-9) was recently proposed for measurement of patient satisfaction with endoscopy. It is unknown whether the mGHAA-9 addresses the issues most important to this outcome. METHODS: A 15-item survey of factors potentially important to patient satisfaction with endoscopy was developed, including the 6 core mGHAA-9 items. Respondents were asked to rank the factors from 1 to 15 (1 = most important to l5 = least important to satisfaction). Two groups were surveyed: (1) patients with prior endoscopy experience and (2) physician endoscopists. Item rank distributions overall and by patient age, gender, and procedure experience were examined. RESULTS: Of 559 outpatients surveyed, 437 (78%) provided complete responses. The mean patient age was 59 years (48.7% female, 45.3% male, 6% not stated). The number 1 ranked factor was the endoscopist's technical skills (median ranking (mr) = 1), an item included in the mGHAA-9. Pain control, a factor not assessed by the mGHAA-9, was second (mr = 4), and ranked number 1 by 16% of patients. Item rankings were consistent across patient subgroups. Relative to patients, endoscopists underprioritized preprocedure and postprocedure communication. CONCLUSIONS: The mGHAA-9 has inadequate content validity for measurement of patient satisfaction with endoscopy because it does not assess pain control. However, endoscopy satisfaction measurement with a single, universally applied instrument appears feasible.

Quality of life measurement in gastroenterology: what is available?

Monitoring and enhancement of a patient's health-related quality of life (HRQL) is an important element of research and medical care. In a previous article, we provided an overview of HRQL measurement. Now we will review the structure and properties of the most commonly used generic and digestive disease-specific HRQL instruments and illustrates their use in the gastroenterology and hepatology literature. Generic measures have been used to study specific diseases as well as to compare HRQL in GI and nongastrointestinal disease. Disease specific instruments have been developed for inflammatory bowel disease, irritable bowel syndrome, dyspepsia, gastroesophageal reflux disease, liver disease, and GI malignancy. Further work is needed to compare disease-specific instruments and to define the most appropriate uses of HRQL measurement in clinical trial and community practice settings.

Improved diagnostic yield of endoscopic biliary brush cytology by digital image analysis.

OBJECTIVE: To evaluate the accuracy of digital image analysis (DIA) for distinguishing between benign and malignant strictures of the biliary tract. PATIENTS AND METHODS: Our pathology databank was used to identify all biliary brush cytology specimens obtained during endoscopic retrograde cholangiopancreatography between June 1997 and June 1999. Corresponding medical records were reviewed to determine whether patients had benign or malignant strictures. Strictures were further classified into benign strictures with negative routine cytology, malignant strictures with negative routine cytology, and malignant strictures with positive routine cytology. Papanicolaou-stained smears of available brush cytology specimens were destained and then restained with Feulgen dye. Nuclear images were quantified for DNA content without knowledge of stricture type. DNA histograms were generated and ploidy results compared with the class of stricture. RESULTS: We analyzed 27 specimens from 69 confirmed benign or malignant strictures. Assuming that the presence of any aneuploid cells indicated malignancy, the sensitivity of DIA was 85%. Furthermore, aneuploid cells were detected by DIA in 13 of 16 specimens in which routine cytology was unrevealing. CONCLUSION: Ploidy assessment by DIA has potential to enhance the sensitivity of diagnosing malignant strictures compared with routine cytology alone.

Prospective comparison of endoscopy patient satisfaction surveys: e-mail versus standard mail versus telephone.

OBJECTIVES: The dramatic growth of the Internet holds potential for use in survey distribution. Comparisons of electronic mail (e-mail) to traditional survey techniques are lacking. We compared standard mail, telephone, and e-mail modes of endoscopy satisfaction survey administration with respect to response rate, timeliness of response, response content, and cost-efficiency of responses. METHODS: An endoscopy satisfaction questionnaire consisting of seven core items from the modified Group Health Association of America-9 survey was distributed to patients after routine outpatient endoscopy. Patients were randomized to receive the questionnaire by standard mail, telephone, or e-mail. Response rates and findings in the three groups were compared. The "nonresponders" to the standard mail and e-mail surveys were subsequently contacted by telephone to determine their level of satisfaction. RESULTS: The phone survey response rate (90%) was higher than e-mail (70%) or standard mail (85%), although e-mail was the most cost-efficient mode of survey delivery. There was no significant difference in satisfaction scores among the three groups. Nonresponders were significantly more satisfied than "responders." CONCLUSIONS: A survey technique utilizing e-mail with subsequent follow-up by telephone to nonresponders appears to be the most cost-efficient way to deliver a questionnaire. The satisfaction levels of the responders may underestimate the overall satisfaction of the population being surveyed.

Immunomodulatory properties of antineoplastic drugs administered in conjunction with GM-CSF-secreting cancer cell vaccines.

Cancer cells genetically modified to secrete immunoregulatory cytokines offer great promise for human cancer treatment as tumor vaccines. However, in preclinical animal studies, large established cancer burdens have appeared difficult to eradicate with such vaccines. For example, lethally-irradiated GM-CSF-secreting CT26 colon carcinoma cell vaccine therapy tends to cure only animals bearing 1 x 10(5) wild-type CT26 cells or less. For many human cancers, antineoplastic chemotherapy can often significantly reduce systemic cancer burdens. Unfortunately, for most advanced metastatic solid organ cancers, such as cancers of the breast, colon, and prostate, antineoplastic drug treatments generally fail to effect cancer cures. Treatment regimens combining genetically-modified cancer cell vaccine therapy and antineoplastic chemotherapy have the potential to increase advanced cancer cure rates if antineoplastic drugs and drug combinations that do not inhibit vaccine-induced immune responses can be identified. To assess the potential immunomodulatory properties of commonly-used antineoplastic drugs that might be used in combination with cancer vaccine treatments, we studied the effects of the drugs on antitumor immune responses manifest by animals receiving lethally-irradiated GM-CSF-secreting CT26 cell vaccines. Immunomodulatory properties of the antineoplastic drugs were evaluated i) by monitoring drug effects on the generation of tumor-specific CD8+ cytotoxic T-lymphocytes (CTLs) in response to GM-CSF-secreting CT26 vaccine administration, ii) by determining drug effects on the resistance of vaccinated animals to subsequent challenge with lethal inoculac of CT26 cells, and iii) by evaluating combination drug and vaccine treatment efficacy against established CT26 tumors. Using this approach, doxorubicin was found to possess apparent immunostimulatory activities, depending on the dose and schedule of administration, while cyclophosphamide appeared immunosuppressive. The different immunomodulatory properties of doxorubicin and cyclophosphamide may be clinically relevant: combination doxorubicin and vaccine treatment of established CT26 cancers increased cure rates over that achieved with either agent alone, while combination cyclophosphamide and vaccine treatment of animals carrying CT26 tumors was no better in curing the animals than drug treatment alone.

A developmental analysis of differences in the uptake of [123I]isopropyliodoamphetamine versus 99mTc-pertechnetate by the choroid plexus and brain.

The uptake of intravascular [123I]isopropyliodoamphetamine (IMP) and 99mTc-pertechnetate into choroid plexus (CP) and brain (frontal cortex) was studied by an indicator fractionation method applied to immature, ketamine-anesthetized Sprague-Dawley rats (1.5, 2, and 3 wk). Assessment of the rate and extent of uptake of these indicators provides functional information (eg blood flow; transport) about various regions of the developing CNS. IMP uptake by lateral ventricle CP was 1.15 ml/g/min in 1.5-wk-old infant rats and gradually increased to 3.9 mg/g/min by adulthood (7-8 wk) (P < 0.05); over the same postnatal period, 99mTc uptake went from 2.82 to 3.18 ml/g/min. IMP uptake by cortex was 0.39 and 0.99 ml/g/min in infants and adults, respectively (P < 0.05); however, 99mTc uptake by cortex was only 0.07 +/- 0.01 ml/g/min at all ages, reflecting early development of blood-brain barrier (BBB) to pertechnetate. Overall, our findings indicated a progressive increase with age in the rate of uptake of IMP by CP and brain; and that 99mTc penetration into CP was relatively constant and substantially greater than into cortex at all developmental stages. Thus the nature of uptake of IMP, relative to 99mTc, was markedly different at the blood-cerebrospinal fluid barrier (i.e., CP) vs. the blood-brain barrier.