Safe sedation practices among gastroenterology registrars: do we need more training?
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ABSTRACT:
SUBMITTER: Mohanaruban A
PROVIDER: S-EPMC5369579 | biostudies-other | 2015 Jul
REPOSITORIES: biostudies-other
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Project description:Despite the clear importance of nutritional knowledge for health professionals, such education has long been notoriously patchy at both undergraduate and postgraduate levels. Gastroenterologists in particular have a special responsibility to provide advice and expertise, not only in general nutrition but also in artificial nutrition support in the setting of extreme risk of malnutrition and intestinal failure. Recently, with the restructuring of undergraduate medical teaching and the advent of modernising medical careers, curricula have been examined in detail and training programmes have become competency based. These changes, together with increasing public expectations regarding both the importance of nutrition and ability of doctors to provide advice and guidance, have provided an opportunity to reassess nutritional training at all levels of medical education. In this review, the authors consider the factors which may have hindered the progression of nutritional education for doctors, and gastroenterologists in particular, as well as the steps which have been taken in recent years to address these issues and move such training forward. There is now a real opportunity to improve the quality of nutrition training in gastroenterology. If this can be achieved, all gastroenterologists of the future, instead of shrinking from difficult nutritional issues, should be able to manage them with confidence and enthusiasm no matter what their subspecialty; indeed, an increasing proportion may become nutrition subspecialists in their own right.
| S-EPMC5517154 | biostudies-other
Project description:Individuals with cystic fibrosis (CF) now have an increased life expectancy, due to advances in care provided by a multidisciplinary team. The care model has expanded over time to include multiple subspecialties. The Cystic Fibrosis Foundation conducted a survey of Care Center Directors and identified a need for pediatric and adult gastroenterologists with expertise in the diagnosis and treatment of intestinal, pancreatic and hepatic complications of CF. To address this need, the Developing Innovative GastroEnterology Specialty Training (DIGEST) program was created. The development, implementation, and early results of this training program are reported herein.
| S-EPMC7387932 | biostudies-literature
Project description:BACKGROUND:Specialist training in gastroenterology and hepatology is not standardised in different European countries. AIM:The aim of this survey was to assess the different teaching and socioeconomic aspects of training programmes in Europe. METHODS:Seventy questionnaires were distributed to last year trainees or newly graduated gastroenterologists. Forty two respondents (60%) from 34 major training centres in 10 different European countries replied. RESULTS:Overall, the data revealed major diversity for all aspects analysed, between and within the different European countries. Both the duration of training (range 4-10.4 years) and workload (range 48.5-89.2 hours per week) differed markedly between countries. The average number of endoscopic procedures (gastroscopies, range 300-2600; colonoscopies, range 73-550; endoscopic retrograde cholangiopancreatographies, range 1-385) differed also. One third of last year trainees reported that they felt uncertain in some endoscopic procedure. The European trainee was on call for 5-6 nights a month on average (range 1-8). Monthly wages differed considerably between countries, ranging from 767 to 2180 Euro. CONCLUSION:We found major differences in the professional aspects and socioeconomic conditions of gastroenterologist/hepatologist training in 10 different European countries, probably leading to differences in quality of training. In several countries or centres the average number of procedures was below the threshold issued by the European Board of Gastroenterology or the American Gastroenterological Association. Issuing a European diploma for gastroenterology is a valuable effort towards meeting this problem. Further studies are needed to re-evaluate the training programmes in Europe and to define threshold numbers and technical end points for assessment of endoscopic skills.
| S-EPMC1773215 | biostudies-literature
Project description:BackgroundGastroenterology training in Canada is guided by the Royal College of Physicians and Surgeons of Canada. Resident perspectives on training and the degree of heterogeneity across training programs have not been previously surveyed.AimThis study aims to evaluate the current Canadian adult gastroenterology training experience from a resident perspective and provide insight into the heterogeneity among training programs.MethodA survey designed by three current gastroenterology residents was distributed to trainees attending the Gastroenterology Residents-in-Training course at Canadian Digestive Diseases Week 2018. Categorical data from the survey was analyzed in table format. Other continuous data was converted to dichotomous data and analyzed in groups of small and large programs, the large program defined as greater than six trainees.ResultsThe overall response rate was 45 of 56 (80%), representing 13 of 14 accredited training sites. Mandatory rotations and core procedures varied widely across respondents, with only inpatient training consistent across all sites. Small programs had a higher call burden (P=0.039), but staff were more likely to be available to cover call if the resident coverage was unavailable (P=0.002). There were nonsignificant trends in small programs in the inability to take a post-call day (P=0.07) and a resident perception of being well trained (P=0.07).ConclusionsThere is heterogeneity across programs in mandatory rotations and core procedures. With the upcoming shift to competency-based medical education, it is an opportune time to re-evaluate and perhaps standardize how gastroenterology training is delivered in Canada.
| S-EPMC6507274 | biostudies-literature
Project description:PurposeTo compare the performance in oral, craniomaxillofacial, and facial plastic surgery (CMF)-specific surgical skills between medical students (MS) and dental students (DS) and hence adjust the current CMF training to student-specific needs. The investigators hypothesized that there would be no performance differences between MS and DS.MethodsThe investigators implemented a comparative retrospective item-based analysis of student performance in a CMF-specific objective structured clinical examination (OSCE) from 2008 to 2015. The sample was composed of 1010 MS and 225 DS who completed a standardized CMF training and OSCE. Three OSCE scenarios [management mandible fracture (MMF), management zygomatic fracture (MZF), and structured facial examination (SFE)] were included in the study because learning objectives were equal. Descriptive and bivariate statistics were computed and the p value was set at 0.05.ResultsIn all of the analyzed OSCE scenarios, DS significantly outperformed MS (MMF p<0.001; MZF p=0.013; SFE p<0.001). DS especially appeared to be better in the correct interpretation of radiological findings (five of seven items, MMF) and the correct allocation of anatomical structures (four of five items, MZF) as well as the symptom-oriented examination of the eye (three of three items, SFE).Discussion and conclusionDS overall seem to be perform better in typical CMF skills. The reasons for this performance gap could be a more profound knowledge of the facial anatomy as well as a higher awareness for CMF as a related specialty to dentistry. CMF should be included in medical curricula in a larger scale, and possible career paths should be highlighted to MS and DS to raise attraction for the specialty. Further studies should focus on the implementation of modern teaching methods in CMF education.
| S-EPMC6754024 | biostudies-literature
Project description:ObjectiveDengue and chikungunya virus diseases are becoming an increasingly important global health threats and are continuously expanding their geographical range. The study aims to investigate knowledge and diagnostic practice of dengue and chikungunya fever among healthcare workers in Moshi Municipality.ResultsMost of healthcare workers heard of chikungunya and dengue 146 (71.2%) and 203 (99%) respectively. Ninety-five (46.3%) and 152 (74.1%) had good knowledge regard chikungunya and dengue respectively. One hundred and twenty-two of HCWs 122 (59.5%) reported that there is no vaccination for dengue virus. Most HCWs 199 (97.0%) reported that the absence of diagnostic tool for dengue virus lead to difficult in managing the infection. The finding of this study showed that there is insufficient knowledge regarding chikungunya while knowledge regarding dengue is relatively fair. This calls for training regarding these infections.
| S-EPMC6339411 | biostudies-literature
Project description:IntroductionProcedural sedation and analgesia allows the clinician to safely and efficiently administer sedation, analgesia, anxiolysis and sometimes amnesia to facilitate the performance of various procedures in the emergency centre. The aim of this study is to determine current sedation practices, common indications and major obstacles in selected emergency centres across Southern Gauteng, South Africa, with a view to improving future standards and practices.MethodsThis was a prospective, questionnaire based, cross-sectional interview of emergency centre managers or their designee of selected private-sector and public-sector hospitals in Southern Gauteng.ResultsOverall, 17 hospitals completed the interview, nine (53%) public-sector and eight (47%) private-sector hospitals, with 36% of hospitals being aligned to an academic institute. All hospitals performed procedural sedation in their emergency centre. Forty seven percent of managers had between ten and 19 years of clinical experience post internship. Although eleven (64.7%) managers achieved a postgraduate qualification in emergency medicine, only seven (41%) were accredited with a Fellowship of the College of Emergency Medicine (FCEM) qualification and only three (17.7%) centres employed three or more specialists. The majority of centres (52.3%) performed between ten and 30 procedures per month requiring sedation. Staff training in the practice of procedural sedation was mostly obtained internally (52.9%), from in-house seniors. Essential drugs, procedure monitors, resuscitation equipment and protocols were all available in 70.6% of centres.ConclusionAlthough the safe practice and awareness of procedural sedation and analgesia in both public-sector and private-sector emergency centres in Southern Gauteng appears to be on the increase, there is still a need to enhance practitioner training and promote awareness of current local and international trends, protocols and recommendations.
| S-EPMC6400002 | biostudies-literature
Project description: Not available
| S-EPMC10491935 | biostudies-literature
Project description:Background and study aims Training in endoscopy is a key objective of gastroenterology residency. There is currently no standardized or systematic training approach. This study evaluated and compared the current status of gastrointestinal endoscopy training programs in all teaching hospitals in the Netherlands from a resident perspective. Materials and methods A national online survey with open and closed questions on gastrointestinal endoscopy training was administered to all gastroenterology residents (N = 180) in the eight educational regions in the Netherlands. Results One hundred residents who had already started endoscopy training were included in the analyses. Sixty-five residents (65 %) were satisfied with their endoscopy training program. Participation in a preclinical endoscopy course was mandatory in seven of eight educational regions. Residents from the region without a mandatory endoscopy training course were significantly less likely to be satisfied with their endoscopy training program (32 %, P = .011). Criteria used to determine the level of supervision differed greatly between teaching hospitals (e. g. assessed endoscopy competence, predefined period of time or number of procedures). Only 26 residents (26 %) reported uniformity in teaching methods and styles between different supervising gastroenterologists in their teaching hospital. Conclusions Although most gastroenterology residents were satisfied with the endoscopy training program and endoscopy supervision in their teaching hospital, this study identified considerable local and regional variability. Future studies should be conducted to evaluate the trainers' perspective and trainers' behavior during endoscopy training sessions, which might eventually lead to the development of best practices regarding endoscopy training, including standardization of training programs and supervision methods.
| S-EPMC9754879 | biostudies-literature
Project description:BACKGROUND:Nurses are fundamental to the implementation of sedation protocols for patients receiving mechanical ventilation. A 2005 survey showed that nurses' attitudes toward sedation affected their sedation practices. Since then, updated guidelines on managing pain, agitation, and delirium have been published. OBJECTIVE:To explore nurses' self-reported attitudes and practices related to sedation and determine whether they have changed in the past decade. METHODS:Members of the American Association of Critical-Care Nurses were invited to complete the Nurse Sedation Practices Scale, which measures nurses' self-reported sedation practices and factors that affect them. Item and subscale responses were analyzed, and differences in item responses by respondent characteristics were determined. RESULTS:Respondents (N = 177) were mostly staff nurses (68%) with a bachelor's degree in nursing (63%). Nurses' attitudes toward the effectiveness of sedation in relieving patients' distress during mechanical ventilation correlated positively with their intention to administer sedatives (r s = 0.65). Sixty-six percent of nurses agreed that sedation was necessary for patients' comfort, and 34% agreed that limiting patients' recall was a desired outcome of sedation. Respondents with more experience or CCRN certification had a less positive evaluation of the effectiveness of sedation in minimizing distress. CONCLUSIONS:Nurses' attitudes toward sedating patients receiving mechanical ventilation have shifted in the past decade, with fewer nurses now believing that all patients should be sedated. However, more than half of nurses still agree that sedation is needed for patients' comfort, highlighting the need to consider nurses' attitudes when seeking to optimize sedation practices during mechanical ventilation.
| S-EPMC6760853 | biostudies-literature