Cold endoscopic mucosal resection of large sessile serrated polyps at colonoscopy (with video)

The optimal technique for the resection of sessile serrated polyps (SSPs) is unknown, with established limitations and risks with conventional polypectomy. Although cold snare polypectomy is safe, the efficacy of piecemeal resection for large lesions is untested. In this study, we evaluate the safety and efficacy of cold endoscopic mucosal resection (EMR) for large SSPs.Patients presenting for elective colonoscopy at an academic endoscopy center with 1 or more SSPs ≥10mm in size were enrolled, excluding those on anticoagulants or antiplatelets other than aspirin. Lesions were resected with a cold EMR technique comprising submucosal injection of succinylated gelatin and dilute methylene blue before piecemeal cold snare resection of all visible polyp with a margin of normal tissue. Outcomes were the presence of residual serrated neoplasia in biopsies from the defect margin, and findings on surveillance colonoscopy.Cold EMR was performed on 163 SSPs during 105 procedures in 99 patients (97% female; median age 57 years). The mean size was 17.5 mm: 61 SSPs were ≥20 mm, 13 SSPs ≥30 mm, and 97.5% were in the proximal colon. Cytological dysplasia was present in 2 (1.2%). Margin biopsies were positive in 2 (1.2%) lesions. Surveillance colonoscopy for 82% of lesions (median 5 months) showed residual serrated tissue in 1, treated with cold snare, but no evidence of recurrence in the remainder. Minor adverse events were seen in 3 patients; no delayed bleeding was observed.Cold EMR is a safe and effective method for the removal of large SSPs

Nursing students' attitudes towards climate change and sustainability: A cross-sectional multisite study

Background: Education is a social tipping intervention necessary for stabilising the earth's climate by 2050. Integrating sustainable healthcare into healthcare professions curricula is a key action to raise awareness. Objectives: This study aimed to: i) investigate nursing students' attitudes towards and awareness of climate change and sustainability issues and its inclusion in nurse education, ii) explore differences across a range of countries, and iii) compare attitudes in 2019 with those of a similar sample in 2014. Design: A cross-sectional multicentre study. Data were collected through the Sustainability Attitudes in Nursing Survey (SANS_2) questionnaire. Settings: Seven different universities and schools of nursing in five countries (UK, Spain, Germany, Sweden, and Australia). Participants: A convenience sample of first-year undergraduate nursing students. Methods: The SANS_2 questionnaire was self-administered by nursing students at the seven participating universities at the start of their undergraduate degree, between September 2019 and February 2020. Results: Participants from all seven universities (N = 846) consistently showed awareness and held positive attitudes towards the inclusion of climate change and sustainability issues in the nursing curriculum (M = 5.472; SD: 1.05; min-max 1–6). The relevance of climate change and sustainability to nursing were the highest scored items. Esslingen-Tübingen students scored the highest in the ‘inclusion of climate change and sustainability in the nursing curricula’. Students at all universities applied the principles of sustainability to a significant extent at home. Nursing students' attitudes towards climate change and sustainability showed significantly higher values in 2019 (Universities of Plymouth, Brighton, Esslingen-Tübingen, Jaen, Murcia, Dalarna, and Queensland) than in 2014 (universities of Plymouth, Jaen, Esslingen, and Switzerland). Conclusions: Nursing students have increasingly positive attitudes towards the inclusion of sustainability and climate change in their nursing curriculum. They also recognise the importance of education regarding sustainability and the impact of climate change on health, supporting formal preparation for environmental literacy. It is time to act on this positive trend in nursing students' attitudes by integrating these competencies into nursing curricula.</p

The use of made-up users

While the existence of fictitious users of financial statements has been confirmed in previous research, our study investigates how this powerful yet ‘made-up’ construct is deployed within the discourses of the main stakeholders as they shape regulatory debates in the international accounting standard-setting arena, including ‘real’ users themselves. Our study draws on Bourdieu’s theorization of dominant discourse as a form of power, and extends it with the phraseological theory of meaning, specifically the linguistic concept of collocation, which focuses on the habitual choices of words in discourse. Using this framework, we conduct a comparative analysis of the recurrent language choices around the term ‘user’ in comment letters submitted on the selected IASB’s regulatory proposals. We provide empirical evidence for the existence of commonalties and subtle differences in the ways in which made-up users are discursively operationalized by the four key accounting constituent groups, the accounting profession, prepares, regulators and ‘real’ users of financial statements. At the theoretical and methodological level, our study showcases the explanatory power of the concept of collocation to identify and interrogate implicit patterns of dominant discourse as set forth by Bourdieu. We also show that the close investigation of how the dominant discourse of the made-up users works generates a series of new why questions regarding the ‘real’ users’ role in accounting standard setting

Measuring reflective thinking and self-efficacy after high fidelity simulation to optimise the reflective capacity of final year nursing students

Reflection is a cornerstone of effective registered nursing practice. This study developed a reliable and valid tool to measure critical reflection self-efficacy that was used in combination with a reflective thinking instrument to determine nursing students' reflective capacity. The balanced reflective practitioner model described by this study provided insight to both nursing students and educators about student's growth as reflective practitioners. The incorporation of nursing students in the debrief facilitator role had a significant effect on the ability of these students to reflectively think. This challenges the standard practice of academics as simulation debrief facilitators