Effective teamworking in gastroenterology.
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ABSTRACT:
SUBMITTER: Haycock A
PROVIDER: S-EPMC5517257 | biostudies-other | 2012 Apr
REPOSITORIES: biostudies-other
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Project description:Objective:In situ simulation (ISS) is an effective training method for multiprofessional teams dealing with emergencies in high pressured environments. A regular ISS programme was organised for the multiprofessional gastroenterology team with a primary objective of identifying, classifying and addressing latent patient safety threats and secondary objectives of improving team confidence and individual role recognition. Method:22 unannounced ISS sessions (averaging approximately one session every 6?weeks and four participants per session) were conducted between February 2017 and August 2019 involving multiprofessional team members. The sessions centred around the following four common gastrointestinal emergency scenarios: massive upper gastrointestinal haemorrhage; biliary sepsis (cholangitis) and shock; postendoscopic retrograde cholangiopancreatography complications including perforation and cardiac arrest. Following the simulation, the faculty, which included nurses and doctors, facilitated a structured debrief session and action plan to identify and address latent errors. Results:96 participants from nursing, medical, physician associate and pharmacy backgrounds took part in the simulation programme. Analysis of collected latent safety threats identified the following four themes: education and training; equipment; medication and team working. Analysis of anonymously completed questionnaires identified that 95% of participants had a perceived better understanding of their role and 86% felt more confident in assessing an unwell patient. 96% of participants felt comfortable during the debrief. Conclusion:ISS provides a unique opportunity to train the multiprofessional gastroenterology team in their own high-pressured environment, helping identify and address latent patient safety threats and improve perceived participant confidence and role recognition.
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| S-EPMC7104018 | biostudies-literature
Project description:(1) Background: Burnout syndrome is a significant problem in nursing professionals but may be dependent on the type of care that they provide. The objectives of our study are to identify and explore risk factors associated with burnout among gastroenterology nurses. Identifying the risk factors involved is an essential element for prevention programs. (2) Methods: We performed an analytical descriptive cross-sectional study. Burnout was measured using an adapted version of the Maslach Burnout Inventory (MBI) questionnaire. Strength of association between burnout scores and risk factors was calculated using Fischer's exact test; (3) Results: Our subjects were all female nurses. Work-related risk factors, such as an increased workload and a large number of night shifts have been associated with burnout in nurses, together with a lack of physical activity. We found no significant associations with sociodemographic factors; (4) Conclusions: Gastroenterology nurses are affected by high levels of emotional exhaustion. Work-related risk factors and a sedentary lifestyle result in a greater prevalence of burnout. In this category of healthcare workers, preventive actions are needed. The physical activity outside work could be a protective factor for burnout, and an exercise program could contribute to the effectiveness of well-established burnout intervention programs.
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| S-EPMC3203001 | biostudies-literature
Project description:OBJECTIVE:Genomics and personalised medicine are increasingly relevant for patients with gastroenterological conditions. We aim to capture the current state of genomics training in gastroenterology to review current understanding, clinical experience and long-term educational needs of UK trainees. DESIGN AND SETTING:A web-based nationwide survey of all UK gastroenterology specialty trainees was conducted in 2017. RESULTS:100 trainees (14% of UK gastroenterology trainees) completed this survey. Only 9% and 16% of respondents believe that their local training programme adequately prepares them for the future clinical practice using genomic medicine and personalised medicine, respectively. Barriers identified include the need for greater trainee education (95%), inadequate clinical guidance to base interventions on the results of genomic testing (53%), concerns over misinterpretation by patients (43%) and overuse/misuse of testing by clinicians (34%).Survey respondents felt prepared to perform HFE genotyping (98%), assess TPMT status (97%) and interpret HLA subtyping for suspected coeliac disease (85%). However, only a minority felt prepared to perform the following investigations: polyposis screening (34%), hereditary pancreatitis screening (30%), testing for Lynch yndrome (33%) and KRAS testing for colorectal cancer (20%).Most respondents would support holding dedicated training days on genomic medicine (83%), formal training provisions for the mainstreaming of genomic testing (64%), an update to the UK gastroenterology specialty training curriculum and examinations (57%) and better-defined referral pathways for local genomic services (91%). CONCLUSION:Most gastroenterology trainees in this survey feel ill equipped to practise genomic and personalised medicine as consultants. We propose specific revisions to the UK gastroenterology specialty curriculum that addresses trainees needs.
| S-EPMC6830597 | biostudies-literature
Project description:BackgroundTransfusion-associated circulatory overload (TACO) is a rare life-threatening event associated with transfusion. This study aimed to identify any case of TACO in a large cohort of highly transfused patients with gastrointestinal tract (GI) bleeding.Materials and methodsData from patients who underwent an oesophago-gastro-duodenoscopy (OGD) were collected over one year from the gastroenterology service of a regional hospital.ResultsA total of 278 patients were identified, of which 81 required transfusion. In total, 811 blood components were transfused (red cell concentrate, platelets, plasma), leading to a cumulative TACO incidence of 12.3%. The probability of developing TACO was greater for patients aged ≥80 years (OR=3.9%; p=0.0058), with renal disease (OR=1.9%, p=not significant) and with cardiac disease (OR 11.1%; p=0.003). Patients with TACO had a lower overall survival (52 vs 20% at 3 years, p=0.034, HR=2.19, 95% CI: 1.04-4.63) compared to patients with cirrhosis without TACO (57 vs 28% at 3 years, p=0.003, HR=2.20, 95% CI: 1.30-3.72). Patients with an advanced stage of liver cirrhosis (Child Pugh c10 or more) were most likely to develop TACO.DiscussionThis study shows that within the GI setting TACO may be markedly under-reported. Clinical awareness for potential TACO development in GI patients with cardiac or renal disease or age >80 years is now required.
| S-EPMC8092035 | biostudies-literature
Project description:Artificial intelligence (AI) using deep-learning (DL) has emerged as a breakthrough computer technology. By the era of big data, the accumulation of an enormous number of digital images and medical records drove the need for the utilization of AI to efficiently deal with these data, which have become fundamental resources for a machine to learn by itself. Among several DL models, the convolutional neural network showed outstanding performance in image analysis. In the field of gastroenterology, physicians handle large amounts of clinical data and various kinds of image devices such as endoscopy and ultrasound. AI has been applied in gastroenterology in terms of diagnosis, prognosis, and image analysis. However, potential inherent selection bias cannot be excluded in the form of retrospective study. Because overfitting and spectrum bias (class imbalance) have the possibility of overestimating the accuracy, external validation using unused datasets for model development, collected in a way that minimizes the spectrum bias, is mandatory. For robust verification, prospective studies with adequate inclusion/exclusion criteria, which represent the target populations, are needed. DL has its own lack of interpretability. Because interpretability is important in that it can provide safety measures, help to detect bias, and create social acceptance, further investigations should be performed.
| S-EPMC6465941 | biostudies-literature
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 and study aims Endoscopy-related injury (ERI) is widespread among practicing gastroenterologists. However, less is known about the incidence among trainees. This study assesses the rate of self-reported ERI occurrence, patterns of injury, and knowledge of preventive strategies in a nationally representative sample of gastroenterology fellows. Methods A 38-item electronic survey was sent to members of the American College of Gastroenterology. One hundred and sixty-eight gastroenterology fellows were included in analyses. Descriptive and univariate analyses evaluated the likelihood of ERI by workload parameters and gender. Results ERI was reported by 54.8 % of respondents. ERI was most common in the thumb (58.7 %), hand/finger (56.5 %), and wrist (47.8 %). There was no significant difference in the reported occurrence of ERI between male and female gastroenterology fellows. However, female fellows were significantly more likely to report a greater number of body areas affected by ERI, and male fellows were more likely to report elbow pain. Most respondents (85.1 %) reported discussion about, or training in, ergonomic strategies during gastroenterology fellowship. Conclusions ERI is reported to occur as early as gastroenterology fellowship. Results of this study support this finding and highlight the need for ongoing implementation and monitoring of a formal ergonomics training program as well as development of ergonomically appropriate instruments. Implications of these findings likely extend to trainees in other procedural related specialties like orthopedics and general surgery, though further research is required. Ergonomics training in gastroenterology fellowship and monitoring of its impact on trainees reported ERI is important due to negative effects on productivity and career longevity.
| S-EPMC9403520 | biostudies-literature