Expanding the role of pneumatic dilation for nonachalasia patients: a comparative study.

BACKGROUND AND AIMS: Treatment options for nonachalasia obstructive disorders of the esophagogastric junction (EGJ) are limited. The aim of this study was to assess the treatment efficacy of pneumatic dilation (PD) for the disorders of EGJ outflow obstruction (EGJOO) and postfundoplication EGJ obstruction (PF-EGJO) and to assess attitudes regarding training in PD. METHODS: This was a 2-part study. The main study was a prospective, single-center study comparing treatment outcomes after PD in patients with EGJOO and PF-EGJO, defined using manometry criteria, versus achalasia. Treatment success was defined as a post-PD Eckardt score (ES) of ≤2 at the longest duration of follow-up available. In a substudy, a 2-question survey was sent to 78 advanced endoscopy fellowship sites in the United States regarding training in PD. RESULTS: Of the 58% of respondents to the advanced endoscopy program director survey, two-thirds reported no training in PD at their program. The primary rationale cited was lack of a clinical need for PD. Sixty-one patients (15 achalasia, 32 EGJOO, and 14 PF-EGJO) were included in the main study with outcomes available at a mean follow-up of 8.8 months. Overall, mean ES decreased from 6.30 to 2.89 (P < .0001), and a mean percentage of improvement in symptoms reported by patients was 55.3%. ES ≤2 was achieved by 33 of 61 patients (54.1%). CONCLUSIONS: PD is an effective treatment for the nonachalasia obstructive disorders of the EGJ. There may be a current gap in training and technical expertise in PD.

Using Second Life to enhance ACCEL an online accelerated nursing BSN program.

To create a presence in Second Life (SL) the university college of nursing (CON) purchased four virtual islands in December 2007. The intent was to enhance distance education with immersion learning experiences for nursing students in SL. The Pollock Alumni House, classrooms, faculty offices, a library, a student welcome center, a public health office, a disaster scenario, a clinic, a hospital, and several patient avatars were created. Houses are being built for nursing students to experience different patient care scenarios during home visits. At least 20 nursing faculty and academic staff and three cohorts of accelerated nursing students (77) have avatars and have experienced class sessions. Faculty and students schedule office hours, engage in synchronous chats, and utilize the public health department and SL support groups for class exercises. Current exercises in the public health department include a module in which the student learns the role of the sanitarian. Students use a checklist to inspect restaurants and bars in SL. They are also able to view a video of an interview with a sanitarian. Another module introduces them to the WIC (Women, Infants, and Children) program. Future student activities related to public health include disaster planning, bioterrorism, evacuations, community assessment, windshield surveys, fund raising, and health education as well as other activities suggested by public health nurses and students. The possibilities are limitless because of the resources that exist in the virtual world, SL. The purchase of the first two islands, the initial buildings, and the creation of the public health department was funded by a research grant. Virtual environments offer many advantages for nursing education. Many nursing students say they learn best when they actually "do something," which indicates that they often prefer experiential learning. Rare but life-threatening patient situations can be experienced since the clinical environment can be realistically simulated. The student has the opportunity to practice repeatedly without causing harm to patients. During these simulations, active learning takes place, immediate feedback can be given for both correct and incorrect actions, errors can be corrected, and consistent experiences can be reproduced for all students. This technology is revolutionizing education and will meet the needs of the media savvy generations to come. It can also provide virtual experiences that nursing students may encounter in the clinical setting which are high risk and low volume, thus enhancing patient safety.