15 research outputs found
Motion training on a validated mechanical ERCP simulator improves novice endoscopist performance of selective cannulation: a multicenter trial
No full textBackground and study aims Current data show that traditional training methods in endoscopic retrograde cholangiopancreatography (ERCP) fall short of producing competent trainees. We aimed to evaluate whether a novel approach to simulator-based training might improve the learning curve for novice endoscopists training in ERCP.Methods We conducted a multicenter, randomized controlled trial using a validated mechanical simulator (the Bokoski-Costamagna trainer). Trainees with no experience in ERCP received either standard cannulation training or motion training before undergoing standard cannulation training on the mechanical simulator. Trainees were timed and graded on their performance in selective cannulation of four different papilla configurations.Results Thirty-six trainees (16 in the motion training group, 20 in the standard group) performed 720 timed attempts at cannulating the bile duct on the simulator. Successful cannulation was achieved in 698 of 720 attempts (96.9%), with no significant difference between the two study groups ( P =0.37). Trainees in the motion training group had significantly lower median cannulation times compared to the standard group (36 vs. 48 seconds, P =0.001) and better technical performance on the first papilla type ( P =0.013).Conclusions Our findings suggest that motion training could be an innovative method aimed at accelerating the learning curve of novice trainees in the early phase of their training. Future studies are needed to establish its role in ERCP training programs
Combined Use of Clips and Nylon Snare (“Tulip-Bundle”) as a Rescue Endoscopic Bleeding Control in a Mallory-Weiss Syndrome
No full textMallory-Weiss syndrome (MWS) accounts for 6–14% of all cases of upper gastrointestinal bleeding. Prognosis of patients with MWS is generally good, with a benign course and rare recurrence of bleeding. However, no strict recommendations exist in regard to the mode of action after a failure of primary endoscopic hemostasis. We report a case of an 83-year-old male with MWS and rebleeding after the initial endoscopic treatment with epinephrine and clips. The final endoscopic control of bleeding was achieved by a combined application of clips and a nylon snare in a “tulip-bundle” fashion. The patient had an uneventful postprocedural clinical course and was discharged from the hospital five days later. To the best of our knowledge, this is the first case report showing the “tulip-bundle” technique as a rescue endoscopic bleeding control in the esophagus
Pharmaceutical principles of acid inhibitors: unmet needs
No full textDespite the well-established benefits of currently approved delayed-release proton pump inhibitors (PPIs) in the treatment of acid-related diseases, the unmet needs are still present and although often frustrating, they challenge clinicians. The unmet needs relate to the lack of complete control of acid secretion with oral PPI administration in the management of patients with gastroesophageal symptoms. These substantial groups of patients, who do not respond completely to standard doses of PPIs, are nonresponders, and their lack of response should be considered as PPI failure. Several mechanisms could explain PPI failure: differences in pharmacokinetics, PPI formulation, dosing time and diet, noncompliance, transient lower esophageal sphincter relaxations, esophageal hypersensitivity, and nocturnal acid breakthrough. To increase the quality of life of these patients and avoid multiple medical consultations and unnecessary investigations, we have to go one step forward and use combined therapy or look towards new treatments beyond acid suppression
Endoscopic ligation ("Loop-And-Let-Go") is effective treatment for large colonic lipomas: a prospective validation study
No full textBACKGROUND:
Colonic lipomas (CL) are rare benign adipose tumours usually found incidentally during colonoscopy. Endoscopic resection of symptomatic large CL remains controversial, since significant rates of perforation have been reported. In recent years, a novel technique for removal of large CL has been described, consisting of looping and ligating the lipoma with a nylon snare. The aim of our study was to evaluate the safety and efficacy of the "loop and let go" technique for large colon lipomas in a large case series. ----- METHODS:
Consecutive patients referred to our institution for colonoscopy were eligible for the study. The diagnosis of CL was confirmed endoscopically by "pillow" and "naked fat" signs. Following diagnosis, lipomas were looped and ligated by endoloop. Follow-up colonoscopies were scheduled at 1- and 3-months interval. ----- RESULTS:
A total of 11 patients with large CL were enrolled in study. The indications for the colonoscopy included altered bowel habits (7 patients, 64%), screening for colorectal neoplasm (3 pts, 27%) and lower gastrointestinal bleeding (1 pts, 9%). The median lesion size was 3 cm (range 2,5-6 cm). Lesions were located at the hepatic flexure in 4 patients (36%), cecum and ascending colon (4 pts, 36%), rectosigmoid (2 pts, 18%) and transverse colon (1 pts, 9%). There were no immediate and late complications. On follow-up (median follow-up time 11.9 months, range 8-24), there was one small residual lipoma (<1 cm). ----- CONCLUSION:
The results of this study confirm that "loop-and-let-go" technique is safe and efficacious treatment of large colonic lipomas
Historical review of Polish copyright legislation and recent developments of permitted use in educational establishments
No full textThis thesis was submitted for the degree of Master of Law and awarded by Brunel University.This dissertation examines the Polish Copyright legislation and recent developments of permitted use in educational establishments through a historical perspective. It focuses on legal history, codification processes and ways of unification reviewed in the context of successive periods during 1795-2012. The main issue being considered within this field of law is permitted use and its educational application. The dissertation seeks to answer the question whether developments in the scope of permitted use have been influenced by historical events and advancements in the education sector. It explores and analyzes those factors that help find a balance between providing wide access to educational materials, thus securing sustained input to education, as well as the authors’ rights to protect their works and creativity. The dissertation shows how the implementation of permitted use provisions in Polish education has traditionally been influenced by historical circumstances, national legal traditions and technological advancements in education, including publishing of educational materials. Permitted use has become increasingly significant as a result of the educational establishments’ dynamic progress during the political and societal transformation of the 1990s. Further, the dissertation defines the scope of permitted use implemented in educational establishments in Poland, discussing the factors that shape it and the extent that educational institutions are entitled to benefit from permitted use regulations. It assesses the impact of permitted use on schoolbook publishing by examining two cases studies, schoolbooks published by Ossolineum in the 1930s, and the “Switch on Poland” online schoolbook project of 2011. An evaluation of Polish permitted use regulations and comparison with those of the UK, France and Germany is provided. Polish permitted use regulations are further examined vis-à-vis the EU Information Society Directive (ISD, 2001/29/EC). There is no single or unified approach emerging as defining permitted use for educational purposes. Differences are identified in both understanding and balancing the societal need of accessing knowledge through education with protecting author copyright and creativity. This diversity of law flexibility among European countries, its implementation and current limitations occur as a result of different historical circumstances and societal needs shaping the scope of permitted use
A pilot study of transrectal endoscopic ultrasound elastography in inflammatory bowel disease
No full textBACKGROUND:
Using standard diagnostic algorithms it is not always possible to establish the correct phenotype of inflammatory bowel
disease which is essential for therapeutical decisions. Endoscopic ultrasound elastography is a new endoscopic procedure
which can differentiate the stiffness of normal and pathological tissue by ultrasound. Therefore, we aimed to investigate
the role of transrectal ultrasound elastography in distiction between Crohn's disease and ulcerative colitis. ----- METHODS:
A total 30 Crohn's disease, 25 ulcerative colitis, and 28 non-inflammatory bowel disease controls were included. Transrectal
ultrasound elastography was performed in all patients and controls. In all ulcerative coltis patients and 80% of Crohn's
disease patients endoscopy was performed to assess disease activity in the rectum. ----- RESULTS:
Significant difference in rectal wall thickness and strain ratio was detected between patients with Crohn's disease and
controls (p = 0.0001). CD patients with active disease had higher strain ratio than patients in remission (p = 0.02). In
ulcerative colitis group a significant difference in rectal wall thickness was found between controls and patients with
active disease (p = 0.03). A significant difference in rectal wall thickness (p = 0.02) and strain ratio (p = 0.0001) was
detected between Crohn's disease and ulcerative colitis patient group. Crohn's disease patients with active disease had a
significantly higher strain ratio compared to ulcerative colitis patients with active disease (p = 0.0001). ----- CONCLUSION:
Transrectal ultrasound elastography seems to be a promising new diagnostic tool in the field of inflammatory bowel
disease. Further study on a larger cohort of patients is needed to definitely assess the role of transrectal ultrasound
elastography in inflammatory bowel disease
La araña de Salette Tavares y la creación de caligramas: Análisis de un taller literario en educación primaria
No full textLiterary workshops allow students to be closer to experimental poets such as Salette Tavares, whose productions are halfway between literature and plastic arts. In this sense, we will present a calligram workshop that includes one of the best-known poems of this author. For this reason, we have done a qualitative investigation that is materialized in a case study carried out in a primary school in Catalonia in order to obtain data on the processes of reception and creation of experimental poetry. The results show that this type of intermedial literary workshop stimulates the students' creativity. However, students tend to prioritize visual language in the reception and creation of hybrid products.La realización de talleres literarios permite acercar a las aulas a poetas experimentales como Salette Tavares cuyas producciones nadan a medio camino entre la literatura y las artes plásticas. En este sentido, se presenta un taller de creación de caligramas que toma como punto de partida uno de los poemas más conocidos de esta autora. Se realiza, por tanto, una investigación cualitativa que se materializa en un estudio de caso realizado en una escuela de educación primaria de Catalunya. Este estudio tiene el propósito obtener datos sobre los procesos de recepción y creación de poesía experimental. Los resultados demuestran que la realización de talleres literarios de índole intermedial permite estimular la creatividad de los estudiantes. Existe, sin embargo, una tendencia por parte del alumnado a priorizar el lenguaje visual tanto en la recepción como en la creación de productos híbridos
