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Background: Endoscopic submucosal dissection is minimal invasive endoscopic procedure to deal with gastric tumor. Initially, it was developed to resect mucosal neoplasm since 2000 and extended its application to submucosal tumor in the following years. Although the basic ESD skills are similar in gastric mucosal tumor and subepithelial tumor, the success rate, complication may be different between the two types of gastric tumor resection. This retrospective study is conducted to analyze the ESD procedure in gastric mucosal tumor and subepithelial tumor. Methods: From 2007 to 2016, we reviewed all patients who underwent endoscopic submucosal dissection for gastric mucosal tumor and subepithelial tumor in Kaohsiung Medical University Hospital. Results: Totally, 35 patients with gastric subepithelial tumor and 41 patients with gastric mucosal tumor received endoscopic submucosal dissection are enrolled. Among 35 patients with subepithelial tumor, 32 (91.4%) patients achieved curative treatment. 1 patient received emergent operation and 2 patients received salvage operation to complete tumor resection. 8 patients (22.9%) occurred perforation and no delay bleeding was found. Among 41 patients with mucosal neoplasm, 30 (71.4%) patients achieved curative treatment. 2 patients received emergent operation and 9 patients received salvage operation to complete tumor resection. 9 patients (21.9%) occurred complication, 6 patients occurred delay bleeding and 3 patients had perforation. Conclusions: Comparing ESD between gastric mucosal tumor and subepithelial tumor, ESD had similar efficiency in curative treatment. However, ESD in subepethelial tumor encountered higher perforation and lesser delay bleeding., Competing Interests: Competing Interests: The authors have declared that no competing interest exists., (© The author(s).)

Gastroesophageal reflux disease (GERD) can cause several upper airway symptoms and alter the physiology of nasopharyngeal mucosa, while upper airway diseases in turn might also exacerbate GERD symptoms. For a long time, asthma was considered a risk factor of GERD in the literature. Asthma and allergic rhinitis (AR) are usually identified as united airway disease according to similar epidemiology and pathophysiology; however, the association between AR and GERD is less elucidated. We aimed to evaluate whether AR would increase the development of GERD. Patients diagnosed as AR were identified from the National Health Insurance Research Database between January 1, 2000 and December 31, 2005 without prior history of gastroesophageal reflux disease. The outcome of interest was new-onset GERD. Cox regression models were applied to calculate the hazard ratio (HR) of GERD. We analyzed the data of 193,810 AR patients aged 18 years or older and being free of AR at baseline. The AR cohort (n = 96,905) had a significantly increased risk of GERD over a non-AR cohort (n = 96905) (adjusted HR (aHR) 1.94; 95% CI = 1.88-1.99, p < 0.001). AR may have stronger correlation with GERD than does asthma, although asthma might increase GERD risk by means of certain pathways shared with AR.

The management of proton pump inhibitor-refractory GERD (rGERD) is a challenge in clinical practice. Since up to one-third of patients with typical GERD symptoms (heartburn and/or acid regurgitation) are not satisfied with proton pump inhibitor (PPI) therapy, new drug development targeting different pathophysiologies of GERD is imperative. At present, no other drugs serve as a more potent acid suppression agent than PPIs. As an add-on therapy, histamine type-2 receptor antagonists, alginates, prokinetics and transient lower esophageal sphincter relaxation inhibitors have some impact on the subgroups of rGERD, but greater effectiveness and fewer adverse effects for widespread use are required. Visceral hypersensitivity also contributes to the perception of GERD symptoms, and neuromodulators including antidepressants play a role in this category. Esophageal pH-impedance monitoring helps to distinguish functional heartburn from true GERD, and psychologic medication and cognitive behavior therapy are further therapy options instead of PPIs.

Purpose: To better understand policy/advocacy concepts and methodology utilized in all levels of nursing educational programs and develop clarity concerning structure of policy content and integration across all levels of education., Design and Methods: Cross-sectional analysis of data obtained from a survey sent to 19,043 nursing faculty in the United States; 598 total responses; 514 complete responses. Quantitative data points were analyzed using SPSS and qualitative data was grouped and analyzed by theme., Findings: Barriers and perceptions of student engagement and student learning outcomes along with institutional and faculty development barriers were explored in baccalaureate, masters, and doctoral level nursing programs. Thirty-six percent of respondents reported having experience in development and implementation of policy, ranging from local to international spheres and 21% reported active involvement in current state and federal policy development. Seventy percent of respondents have advocated for the nursing profession through professional organizations while 44% report current activity in legislative advocacy., Conclusions: The value of nursing policy education, advocacy, and analysis must be valued in higher education., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objective: This study explores the mechanisms of tailoring within the context of RU@Risk a brief Web-based intervention designed to promote sexually transmitted disease (STD) testing among young adults. This is one of a few studies to empirically examine theorized message processing mechanisms of tailoring and persuasion outcomes in a single model., Method: Sexually active college students (N = 1065) completed a pretest, were randomly assigned to explore a tailored or nontailored website, completed a posttest, and were offered the opportunity to order a free at-home STD test kit. As intervention effects were hypothesized to work via increases in perceived risk, change in perceived risk from pretest to posttest by condition was examined. Hypothesized mechanisms of tailoring (perceived personal relevance, attention, and elaboration) were examined using structural equation modeling (SEM). All analyses controlled for demographic variables and sexual history., Results: As predicted, perceived risk of STDs increased from pretest to posttest, but only in the tailored condition. Results revealed that exposure to the tailored (vs. nontailored) website increased perceived personal relevance, attention to, and elaboration of the message. These effects in turn were associated with greater perceived risk of STDs and intentions to get tested. Additionally, participants in the tailored condition were more likely to order a test kit., Conclusions: Findings provide insight into the mechanisms of tailoring with important implications for optimizing message design. (PsycINFO Database Record, ((c) 2016 APA, all rights reserved).)

Purpose: This study examined factors aligned with advocacy among advanced practice registered nurses (APRNs) by examining the relationships among demographics, years of RN and APRN experience, education levels, affiliations with professional organizations, perceptions of barriers to practice, political activism, and willingness to speak to the media., Data Sources: This was a secondary analysis of online survey data (N = 884) from APRNs in Florida. All APRNs with an e-mail address with the state nursing board or a Florida Coalition of Advanced Practice Nurses' membership organization received an e-mail requesting their participation to the survey., Conclusions: Having a high educational level and involvement in a professional organization are each individually statistically associated with perceiving practice barriers, engaging in political activism, and willingness to speak with media. Emerging nurse leaders need an understanding of policy issues, an appreciation of the potential of the profession, and enhanced advocacy skills., Implications for Practice: To address the nation's health needs, APRNs need to recognize practice barriers, develop advocacy skills, and take action for policy changes to enhance the legal authority to practice to full extent of APRNs' education and training., (©2014 American Association of Nurse Practitioners.)

Purpose: The purpose of this quality improvement project was to increase the healthcare personnel (HCP) influenza vaccine uptake at a university student health center., Data Sources: A descriptive design was used. A preintervention survey identified facilitators and barriers to HCP's uptake of influenza vaccine. Based on the results of this survey, four interventions were implemented. The postintervention survey was administered to assess for intervention effectiveness., Conclusions: The most common facilitators for influenza vaccination uptake on the preintervention survey were as follows: (a) protect self/family, (b) free vaccine, (c) recommended by experts, and (d) convenient vaccination process. The most common barrier was concern about vaccine side effects. Postintervention, the vaccination uptake increased from 71% in 2008-2009 to 77% in 2009-2010. Free vaccine and convenient vaccination process were rated as the most effective interventions. Education and the declination form used for the project were rated less favorably., Implications for Practice: Factors influencing vaccine uptake may be different across practice settings. It is important to identify facilitators and barriers that are unique to health centers to better plan and implement interventions to improve vaccination rates. Furthermore, at a time when resources are limited, it is critical to identify the most effective strategies to maximize outcomes., (©2013 The Author(s) ©2013 American Association of Nurse Practitioners.)

Social media are changing the ways people communicate and influencing their approaches to meeting their healthcare needs. The Institute of Medicine recommends utilization of information technologies to improve the delivery of patient-centered care. Little is known about how nurses have adopted the use of social media, however. The researchers conducted an online survey to provide a preliminary review of the characteristics of nurses who do and do not use social media. Also, nurses' preferences for using six different types of social media were analyzed and reported. Nurses from 43 states participated in this study, and the sample represented mostly advanced practice nurses who utilized the Internet regularly and confidently. About 94% of the participants indicated that they use social media, whereas fewer than 1% of the participants reported that they do not know how to use social media. Among those who use social media, social networking sites (90.33%) and podcasts (76.24%) were the most popular, followed by social question and asking sites (37.86%), blogs (31.85%), Twitter (19.06%), and SlideShare (9.92%). Social media can be a powerful tool to reach an intended audience quickly and globally. More research is needed to understand how nurses utilize social media to improve the delivery of patient-centered care.