John M. Hollier

Human papillomavirus and the risk of Barrett’s esophagus

Human papillomavirus (HPV) is strongly associated with squamous esophageal cancer. The potential role of HPV in Barretts esophagus (BE) has been examined but remains unclear. The aim of the study was to determine the prevalence of HPV in esophageal and gastric tissues obtained from patients with and without BE. We designed a cross-sectional study was conducted with prospective enrollment of eligible patients scheduled for esophagogastroduodenoscopy (EGD). All participants had biopsies of endoscopic BE, squamous-lined esophagus, and stomach. Immunohistochemistry (IHC) on formalin-fixed and paraffin-embedded tissue was conducted using monoclonal antibodies. Polymerase chain reaction (PCR) for HPV was performed on DNA extracted from esophageal biopsies snapped frozen within 30 minutes after endoscopic capture. The Roche HPV Linear Array Assay with PGMY primers that has high sensitivity for detecting 37 types of HPV was used. A total of 127 subjects were included: 39 with definitive BE had IHC done on samples from non-dysplastic BE, squamous esophagus, gastric cardia, and gastric body; and 88 control patients without BE had IHC done on squamous esophageal samples, gastric cardia, and gastric body. HPV was not detected in any of the samples in either group. For confirmation, HPV DNA PCR was performed on randomly selected samples from 66 patients (both esophagus and BE from 13 patients with BE, and 53 esophagus from patients without BE); no sample had HPV DNA detected via PCR in the presence of adequate quality control. HPV infection does not play a role in the formation of non-dysplastic Barretts esophagus in men in the United States.

Clinical and psychosocial variables associated with behavioral intentions to undergo surveillance endoscopy.

BackgroundMany patients with Barrett’s esophagus do not adhere to guideline-recommended endoscopic surveillance. Among patient factors related to cancer prevention behaviors, patients’ stated behavioral intention is a strong predictor of behavior performance. Little is known about the patient factors associated with having a strong behavioral intention to pursue surveillance endoscopy. This study explores the association of clinical and psychosocial variables and behavioral intention to pursue surveillance endoscopy among patients with Barrett’s Esophagus and no or low-grade dysplasia.MethodsPotential subjects were screened using electronic medical records of a regional Veterans Affairs Medical Center and a pathologically confirmed Barrett’s esophagus registry. Eligible participants were recruited by a mailer or phone call and completed a questionnaire to measure six distinct psychosocial factors, their behavioral intention to undergo surveillance endoscopy, and various demographic and clinical variables. Univariate and multivariate linear regression identified the relation of behavioral intention with each of six psychosocial variables.ResultsOne-hundred and one subjects consented and returned surveys. The analytical sample for this study consists of the 94% of surveys with complete responses to the behavior intention items. Three of the six psychosocial domains were statistically significant predictors of intention in both univariate and adjusted univariate analysis (salience/coherence β = 0.59, 95% CI = 0.45-0.76, P <0.01; self-efficacy β = 0.30, 95% CI = 0.10-0.51, P <0.01; and social influence β = 0.20, 95% CI = 0.08-0.33, P <0.01). In a multivariate analysis only salience/coherence (β = 0.65, 95% CI = 0.42-0.88, P <0.01) remained statistically significant predictor of intention.ConclusionThis study established the validity of a scale to measure psychosocial variables associated with behavioral intentions to undergo surveillance endoscopy. Results demonstrate the importance of assessing self-efficacy, social influences, and bottom-line belief in the value of surveillance endoscopy when evaluating a patient’s likelihood of completing surveillance endoscopy.

No Variation in Patient Care Outcomes After Implementation of Resident Shift Work Duty Hour Limitations and a Hospitalist Model System

This study examines whether implementing a resident shift work schedule (RSWS) alone or combined with a hospitalist-led model system (HMS/RSWS) affects patient care outcomes or costs at a pediatric tertiary care teaching hospital. A retrospective sample compared pre- and postintervention groups for the most common primary discharge diagnoses, including asthma and cellulitis (RSWS intervention) and inflammatory bowel disease and diabetic ketoacidosis (HMS/RSWS intervention). Outcome variables included length of stay, number of subspecialty consultations, and hospitalization charges. For the RSWS intervention, the preintervention (n = 107) and postintervention (n = 92) groups showed no difference in any of the outcome variables. For the HMS/RSWS intervention, the preintervention (n = 98) and postintervention (n = 69) groups did not differ in demographics or length of stay. However, subspecialty consultations increased significantly during postintervention from 0.83 to 1.52 consults/hospitalization (P < .01) without significantly increasing hospitalization charges. Neither the RSWS nor HMS/RSWS intervention affected patient care outcomes at a pediatric tertiary care teaching hospital.