BACKGROUND:Prelicensure nursing students face significant stress and retention challenges. Understanding how students perceive their resources versus demands, academic resilience, grit, and stress may improve their persistence and success in nursing programs. AIM:Explore the prevalence of and relationships among academic resilience, grit, perceived stress, and threat appraisal in first-semester students. METHOD:This study utilized a cross-sectional, observational research design in a sample of 68 nursing students enrolled in three large undergraduate universities in the southwestern United States. RESULTS:Average perceived stress stores were higher than the normed average. There was a significant correlation between academic resilience and both stress ( p < .001) and grit ( p < .001). After controlling for resilience and grit, higher stress significantly increased the likelihood of a threat state. CONCLUSION:Strategies to reduce stress and boost academic resilience may enhance nursing students' performance by using the academic threat appraisal scale to identify and support struggling students.

We recently developed the CARS score, an endoscopic scoring system for achalasia that is based on four common endoscopic findings of the disease (i.e., esophageal Contents, Anatomy, Resistance at the LES, and Stasis). We have shown that the CARS score performs well in predicting the presence of achalasia. Now, we aimed to find whether the CARS score improves after treatment of achalasia or EGJ outflow obstruction (EGJOO) with peroral endoscopic myotomy (POEM). We reviewed our Center for Esophageal Diseases clinical database for patients who had POEM performed for treatment of achalasia or EGJ outflow obstruction between January 2020 and December 2022. Such patients underwent a comprehensive work up for their motility disorders including endoscopy with calculation of CARS score before and after POEM. Patients with suspected or known achalasia were instructed to be on a 1–5 day liquid diet prior to their endoscopic procedures. Eighty nine patients treated with POEM meet inclusion criteria; 74 patients had achalasia (9 type 1, 46 type 2, 19 type 3), and 15 had EGJOO. The CARS score decreased significantly after POEM (3.5 vs 1.7, p < 0.01). Subset analyses of CARS subscores revealed significant reductions in contents (mean reduction 0.25, p < 0.05), resistance at the LES (mean reduction 1.3, p < 0.01) and stasis (mean reduction 0.3, p < 0.01). Patients with Type 1/2 achalasia had improvement in all CARS subscores whereas those with EGJOO/Type 3 achalasia had improvement primarily in LES resistance. We found significant reductions in the endoscopic CARS score in patients treated with POEM. Reductions in total CARS scores were driven primarily by improvements in the endoscopic assessment of Contents, Resistance-LES and Stasis subscores. Improvement in CARS subscores appear to differ depending on HRM diagnosis. Further studies are needed to determine whether improvement in the CARS score.

INTRODUCTION:Functional lumen imaging probe (FLIP) planimetry performed during peroral endoscopic myotomy (POEM) evaluates esophagogastric junction (EGJ) metrics. The 16 cm FLIP catheter allows for topographical assessment of the esophageal body, and previous intraoperative studies have only utilized the 8 cm catheter or combined data from both catheters. Our aim was to characterize the utility of the 16 cm catheter during POEM with respect to intraoperative tailoring of the myotomy length and intermediate outcomes after POEM. METHODS:We conducted a retrospective review of procedural and follow-up information of consecutive patients who underwent POEM with an intraoperative 16 cm catheter between January 2020 and September 2023. RESULTS:In 100 patients with intraoperative FLIP, the mean myotomy length was 8.2 cm. A tailored short myotomy (≤ 4 cm) using FLIP was performed in 10% of cases with comparable outcomes in LES obstruction and GERD metrics compared to > 4 cm myotomy length. On the basis of topographical FLIP findings, the myotomy was extended to capture spastic body features in 32% of cases including Type 2 achalasia (5), epiphrenic diverticulum (3) and prior myotomy (10). In intervention-naive patients, 70.5% achieved clinical success (Eckardt ≤ 3) at median follow-up of 30.9 months (IQR 6.5-40.9 months) with improvement in LES obstruction and GERD metrics among the intermediate follow-up cohort. An intraoperative post-myotomy EGJ diameter of ≥ 16 mm was associated with a lower rate of repeat intervention (2 vs. 5 patients, p = 0.038) and not associated with increased reflux outcomes. CONCLUSION:Intraoperative FLIP using the 16 cm catheter during POEM enables a tailored myotomy guided by both EGJ metrics and topographical assessment.

Background To address the persistent nursing shortage, universities are increasingly focusing on nursing student retention. However, nursing students face numerous obstacles that hinder academic progress. In pre-nursing students who haven't started formal nursing education or clinical courses, a negative correlation exists between stress and persistence. Understanding the relationships between stress, extraversion, social support, and resilience will provide new insights into pre-nursing student well-being, success, and retention. Aim/objective The aim of this research study is to describe the differences between and relationships among perceived stress, extraversion, social support, and resilience levels in two groups of pre-nursing students taking an Introduction to Nursing course: those opting for a traditional, on-campus (OC) modality, and those choosing an accelerated online (AO) modality. Design/methods This IRB-approved study used a survey-based cross-sectional design with convenience sampling. Pre-nursing students preparing to apply to the University of Texas at Arlington were invited to participate during the fall of 2024. Results Participants (n = 319) were female (88.1 %), ethnically diverse (Hispanic 31.0 %, Black 22.6 %, Asian 22.3 %, White 21.3 %), first generation students (52.4 %), and a mean age of 23.3 years. Relationships among social support, stress, and resilience were statistically significant, and perceived support from friends was negatively associated with stress and positively associated with resilience. Conclusion The consistent findings between pre-nursing students and those in formal nursing programs suggest that aspects of well-being are present before entering nursing school, but research on how extraversion and social support influence pre-nursing student persistence and success is lacking. Focusing on psychosocial health and social support can help educators tailor early interventions for pre-nursing students to manage stress, increase resilience, and enhance social support, thereby promoting future nursing student success.

Background: Little is known about how students admitted to a single prelicensure program using either direct entry or traditional competitive entry routes compare on selected academic variables and program outcomes. Aim/Methods: An observational retrospective matched cohort study design (n =136) was used to explore differences among final nursing program GPA, program completion, RN Fundamental and Comprehensive ATI exam performance, and NCLEX-RN pass rates. Predictors of NCLEX-RN pass rates were also explored. Results: Direct entry students had significantly lower final nursing program GPAs (p = .026). No significant differences were noted on the Comprehensive ATI exam (p = .384) or NCLEX_RN pass rates (p = .440). Higher RN Fundamental (p = .013) and Comprehensive ATI scores (p < .001) significantly increased the likelihood of passing the NCLEX-RN. Conclusion: Direct entry students identified for program acceptance from high school who meet prerequisite courses benchmark criteria can be as successful on the NCLEX-RN as their competitive entry counterparts. Prelicensure programs may consider different admission criteria as a strategy to increase enrollment and retention. (c) 2024 Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Objective: People with previous incarceration and a mental disorder, a substance use disorder, or both are less likely to obtain employment than are those without these characteristics. Distance learning and education (DLE) systems are increasingly being integrated into clinical care and provide a pathway to disseminate vocational services. DLE systems can help reach people with barriers to accessing services, including people without transportation, experiencing homelessness, living in rural areas, or who are homebound. This study evaluated the effectiveness of one DLE system, the COMPASS program, in assisting formerly incarcerated veterans with a mental or substance use disorder to obtain employment. Methods: The authors used a randomized controlled trial to compare employment outcomes of 39 U.S. veterans receiving the COMPASS intervention with those of 43 veterans receiving a paper self-study vocational manual. All participants had previous legal convictions and had a mental disorder, a substance use disorder, or both. The COMPASS system provided vocational services through asynchronous (online practice assignments, reading, and videos) and synchronous (video and telephone practice interviews and live chats) methods. No in-person vocational services were provided in the COMPASS intervention. Results: At 6 months, participants assigned to receive the COMPASS intervention were more likely to have found employment, defined as 1 day of competitive employment, compared with those assigned to receive the self-study manual (64% vs. 35%, respectively)—and to have found employment faster. Conclusions: This study's findings provide evidence for the effectiveness of the COMPASS system in providing employment services and suggest that these services may benefit other vulnerable populations.

BACKGROUND AND AIMS: The advantages of esophageal hydraulic balloon dilation include the ability to dilate up to 30 mm without fluoroscopic guidance and real-time display of the esophagogastric junction diameter during dilation. We aimed to explore the safety and efficacy of esophageal hydraulic balloon dilation in patients with and without previous foregut surgery, as well as to evaluate for predictors of clinical success. METHODS: We reviewed our database for patients who had esophageal hydraulic balloon dilation, and patients were divided into those with and without previous foregut surgery. Clinical success was determined by improvement in Eckardt/Brief Esophageal Dysphagia Questionnaire scores or, if not available, by physician assessment documented in the medical records. Technical success was defined as the ability to successfully perform esophageal hydraulic balloon dilation with visualization of the waist and stabilization of the balloon. Univariate analysis and logistic regression were used to evaluate predictors of clinical success after dilation. RESULTS: Among 80 patients who had esophageal hydraulic balloon dilation (36 without and 44 with previous foregut surgery), clinical success was achieved in 48% of patients without previous foregut surgery (43% in achalasia and 73% in esophagogastric junction outflow obstruction) and 83% of patients with previous foregut surgery (87% in surgically treated achalasia and 80% in patients without achalasia with previous fundoplication). Technical success was achieved in 86% of patients without previous foregut surgery and 98% in patients with previous foregut surgery. There was 1 esophageal perforation (1.3%). Opiate use was a negative predictor of clinical success. CONCLUSION: Clinical success rates after esophageal hydraulic balloon dilation differ depending on the patient's foregut surgery history. Opiate users appear to have a lower clinical success rate compared with nonusers.

BACKGROUND:Few data are available on functional lumen imaging probe (FLIP) findings specifically in obese patients. We aimed to evaluate FLIP metrics in obese patients who had not undergone bariatric surgery and in those who had sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB). We also sought correlations of FLIP abnormalities with esophageal symptoms and HRM findings. METHODS:We identified obese patients who had FLIP performed during workups either for a first bariatric operation (surgery-naïve patients), or for surgical revision of SG and RYGB operations that resulted in inadequate weight loss. We recorded esophageal symptoms, HRM data, and FLIP metrics. KEY RESULTS:We identified 228 eligible patients (87 surgery-naïve, 90 SG, 51 RYGB). Dysphagia and chest pain were frequent symptoms in all groups. Median EGJ diameter and EGJ-DI were similar in surgery-naïve and postsurgical patients, but subgroup analysis of symptomatic patients with no HRM diagnosis revealed reduced EGJ opening in 12%. Abnormal FLIP response patterns were common (69% surgery-naïve, 74% SG, 65% RYGB) with higher ACR rates in SG (46.7% vs. 29.9%, p = 0.026) and RYGB (41.2% vs. 29.9%, p = 0.189) and lower SRCR rates in SG (11.1% vs. 24.1%, p = 0.021) and RYGB (5.9% vs. 24.1%, p = 0.006) compared to surgically naïve patients. There were no significant associations between FLIP contractile response patterns and symptoms or HRM diagnoses. CONCLUSIONS:Dysphagia and chest pain are common in obese patients, and most obese patients (with or without bariatric surgery) have FLIP contractile response abnormalities that do not correlate with HRM findings. FLIP findings appear to be especially valuable in obese patients who have esophageal symptoms with no HRM diagnosis.

AIMS:Epicardial fat is a metabolically active adipose tissue depot situated between the myocardium and visceral pericardium that covers ∼80% of the heart surface. While epicardial fat has been associated with the development of atherosclerotic coronary artery disease, less is known about the relationship between epicardial fat and coronary vascular function. Moreover, the relations between excess epicardial fat and cardiac morphology and function remain incompletely understood. METHODS AND RESULTS:To address these knowledge gaps, we retrospectively analysed data from 294 individuals from our database of women with suspected ischaemia with no obstructive coronary disease (INOCA) who underwent both invasive coronary function testing and cardiac magnetic resonance imaging. Epicardial fat area, biventricular morphology, and function, as well as left atrial function, were assessed from cine images, per established protocols. The major novel findings were two-fold: first, epicardial fat area was not associated with coronary vascular dysfunction. Secondly, epicardial fat was associated with increased left ventricular concentricity (β = 0.15, P = 0.01), increased septal thickness (β = 0.17, P = 0.002), and reduced left atrial conduit fraction (β = -0.15, P = 0.02), even after accounting for age, BMI, and history of hypertension. CONCLUSION:Taken together, these data do not support a measurable relationship between epicardial fat and coronary vascular dysfunction but do suggest that epicardial fat may be related to concentric remodelling and diastolic dysfunction in women with suspected INOCA. Prospective studies are needed to elucidate the long-term impact of epicardial fat in this patient population.

Equity in student success is a valued objective of nursing programs. Prior research has identified a complex array of potential barriers to success among Hispanic nursing students. This retrospective comparative cohort study (N = 27,853) examined course outcomes (including course failures, drops, and withdrawals), academic variables, and demographics among Hispanic and non -Hispanic students enrolled in a large online accelerated RN-to-BSN nursing program from 2010 to 2019. Hispanic students had a significantly higher use of financial aid and had a significantly higher number of course withdrawals and failures than non -Hispanic students. There were no significant differences between Hispanic and non -Hispanic students in number of course drops. Identifying course behaviors and associated characteristics specific to Hispanic students may allow nursing programs to identify and intervene in areas of concern that may impact student success and improve student equity. (c) 2023 Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.

Background: During a program review, faculty identified that nurse practitioner (NP) students who received a C grade in Advanced Pathophysiology (Patho) and Advanced Pharmacology (Pharm) appeared to perform poorly in the later NP management courses and on other program outcomes.Purpose: The research aimed to determine whether grades in graduate Patho and Pharm courses could predict performance in NP management courses, program progression and completion, and certification pass rates.Methodology: This research included deidentified student data from 2016 to 2018 across seven NP specialty tracks (n = 4,575). Nonparametric and parametric tests were used in the analysis.Results: A significant correlation (p < .001) existed between Patho and Pharm grades. Lower grades in these two courses were significantly related to each other and to lower management course grades. Logistic regression showed that graduate pathophysiology grades significantly predicted certification examination performance, with lower grades associated with lower certification examination performance. Graduate pharmacology grades, pathophysiology grades, composite management course grades, and admission grade point average (GPA) significantly predicted final cumulative GPA, with lower grades associated with lower performance for all variables.Conclusions: Results of this research support the hypothesis that grades of C in Patho or Pharm courses significantly predict C performance in the management NP courses and lower certification success rates.Implications: The project model can be used in future research. Study findings can be helpful to NP faculty when considering curriculum decisions.