Dinámica praxiológica, endoscópica y asistencial del residente de Gastroenterología en la atención a pacientes con neoplasias del sistema digestivo / Praxiologic, endoscopic and assistance dynamic of the gastroenterology resident in the care to patients with digestive system neoplasms

Introducción: En la formación del residente de Gastroenterología todavía se perciben limitaciones en cuanto al tratamiento, la prevención y la pesquisa de neoplasias del sistema digestivo, lo que indica la necesidad de un proceso pedagógico que tipifique y eleve la importancia de una praxis asistencial más coherente y comprometida con las necesidades de salud de la población. Desarrollo: Los referentes epistemológicos sobre este tema revelan una limitada sistematización de la dimensión asistencial respecto a la atención a pacientes con tumores digestivos, pues no se ha logrado integrar el diagnóstico, la prevención y la terapéutica en la intervención holística endoscópica de los especialistas de esta rama de la medicina. Conclusiones: La dinámica praxiológica, endoscópica y asistencial que se propone en esta investigación deviene lógica de sistematización formativa que favorece el perfeccionamiento de la práctica clinicoendoscópico-asistencial de este especialista en la atención holística a pacientes con neoplasias del tracto gastrointestinal.

Introduction: In the training of the Gastroenterology resident are still limitations perceived as for the treatment, prevention and investigation of the digestive system neoplasms, what indicates the necessity of a pedagogic process that typifies and elevate the importance of a more coherent and committed assistance practice with the population's health needs. Development: The epistemological referents on this topic reveal a limited systematization of the assistance dimension regarding care to patients with digestive tumors, because it has not been possible to integrate the diagnosis, prevention and therapy in the holistic endoscopic intervention of the specialists of this branch of medicine. Conclusions: The praxiologic, endoscopic and assistance dynamic that is suggested in this investigation becomes logic of training systematizing that favors the improvement of this specialist's clinicoendoscopic-assistance practice in the holistic care to patients with gastrointestinal tract neoplasms.

Effect of Balint training in gastroenterology intern nurse practitioners: A systematic review protocol.

BACKGROUND: This study aims to assess the effect of Balint training (BT) in gastroenterology intern nurse practitioners (GINP) systematically. METHODS: This study will search EMBASE, MEDLINE, PsycINFO, Web of Science, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, and China National Knowledge Infrastructure from inception to the September 30, 2019 with no language limitation. In addition, we will also search grey records, such as conference abstracts and dissertations. Study quality will be checked using Cochran risk of bias tool. Statistical analysis will be performed using RevMan 5.3 software. RESULTS: This study will systematically evaluate the effect of BT in GINP and will provide evidence to judge whether BT is effective for GINP clinically. CONCLUSION: The results of this study may provide helpful evidence of BT in GINP in the clinical training.

Clinical nutrition in the hepatogastroenterology curriculum.

Gastroenterology (GE) used to be considered a subspecialty of internal medicine. Today, GE is generally recognized as a wide-ranging specialty incorporating capacities, such as hepatology, oncology and interventional endoscopy, necessitating GE-expert differentiation. Although the European Board of Gastroenterology and Hepatology has defined specific expertise areas in Advanced endoscopy, hepatology, digestive oncology and clinical nutrition, training for the latter topic is lacking in the current hepatogastroenterology (HGE) curriculum. Given its relevance for HGE practice, and being at the core of gastrointestinal functioning, there is an obvious need for training in nutrition and related issues including the treatment of disease-related malnutrition and obesity and its associated metabolic derangements. This document aims to be a starting point for the integration of nutritional expertise in the HGE curriculum, allowing a central role in the management of malnutrition and obesity. We suggest minimum endpoints for nutritional knowledge and expertise in the standard curriculum and recommend a focus period of training in nutrition issues in order to produce well-trained HGE specialists. This article provides a road map for the organization of such a training program. We would highly welcome the World Gastroenterology Organisation, the European Board of Gastroenterology and Hepatology, the American Gastroenterology Association and other (inter)national Gastroenterology societies support the necessary certifications for this item in the HGE-curriculum.

Toward enteral nutrition for the treatment of pediatric Crohn disease in Canada: a workshop to identify barriers and enablers.

The treatment armamentarium in pediatric Crohn disease (CD) is very similar to adult-onset CD with the notable exception of the use of exclusive enteral nutrition (EEN [the administration of a liquid formula diet while excluding normal diet]), which is used more frequently by pediatric gastroenterologists to induce remission. In pediatric CD, EEN is now recommended by the pediatric committee of the European Crohn's and Colitis Organisation and the European Society for Paediatric Gastroenterology Hepatology and Nutrition as a first-choice agent to induce remission, with remission rates in pediatric studies consistently >75%. To chart and address enablers and barriers of use of EEN in Canada, a workshop was held in September 2014 in Toronto (Ontario), inviting pediatric gastroenterologists, nurses and dietitians from most Canadian pediatric IBD centres as well as international faculty from the United States and Europe with particular research and clinical expertise in the dietary management of pediatric CD. Workshop participants ranked the exclusivity of enteral nutrition; the health care resources; and cost implications as the top three barriers to its use. Conversely, key enablers mentioned included: standardization and sharing of protocols for use of enteral nutrition; ensuring sufficient dietetic resources; and reducing the cost of EEN to the family (including advocacy for reimbursement by provincial ministries of health and private insurance companies). Herein, the authors report on the discussions during this workshop and list strategies to enhance the use of EEN as a treatment option in the treatment of pediatric CD in Canada.

Clinic of Gastroenterohepatology--overview of activities.

CThe Clinic of Gastroenterohepatology is a part of the Medical Faculty Skopje and University "St. Cyril and Methodius University, Skopje". It is organized as an educational, scientific and medical care institution. CThere are four diagnostic departments: an out-patients department, endoscopic department, ultrasound department and X-ray department. During Over the last several decades, the Clinic of Gastroenterohepatlogy Clinic has been intensively developed, primarily because of introducing the most recent and modern knowledge in gastroenterology, continuous medical education of the personneal as well education of the doctors and other medical personal from the other medical centrers in Macedonia and neighbouring countries. The hospital part of the Clinic is organized in three divisions, including an intensive care unit. In the department of Ultrasound are performed The most modern diagnostic and therapeutic procedures are performed in the Ultrasound department for: different various liver diseases, benign and malignant liver diseases, bilirye ducts obstructions, pancreas diseases, spleen diseases, and various abdominal and kidney diseases.

Sexual abuse history in GI illness, how do gastroenterologists deal with it?

INTRODUCTION: Data support an increased prevalence of sexual abuse (SA) among patients with gastrointestinal (GI) complaints. Sexual abuse causes multiple symptoms related to pelvic floor and stress mediated brain-gut dysfunctions. Treating these patients asks for a holistic approach, using centrally targeted interventions. However, gastroenterologists have never been surveyed regarding their practice patterns and constraints about inquiring into SA. AIM: To evaluate whether gastroenterologists address SA in their daily practice and to evaluate their knowledge regarding the implications of SA in GI illness. METHODS: A 42-item anonymous questionnaire was mailed to all 402 members of the Dutch Society of Gastroenterology (gastroenterologists and fellows in training). The questionnaire addressed SA and pelvic-floor-related complaints. MAIN OUTCOME MEASURES: The results of this survey. RESULTS: One hundred eighty-three of the 402 (45.2%) questionnaires were returned. Overall, 4.7% of the respondents asked their female patients regularly about SA; in males, this percentage was 0.6%. Before performing a colonoscopy, these percentages were even smaller (2.4% and 0.6%, respectively). When patients presented with specific complaints, such as chronic abdominal pain or fecal incontinence, 68% of the gastroenterologists asked females about SA and 29% of the males (P < 0.01). The majority of respondents stated it as rather important to receive more training on how to inquire about SA and its implications for treatment. CONCLUSION: Gastroenterologists do not routinely inquire about a history of SA and they rarely ask about it before performing colonoscopy. There is a need for training to acquire the skills and knowledge to deal with SA.

Future role of gastroenterologists in digestive oncology in the Asia Pacific region: Panir Chelvam Memorial Lecture, Asian Pacific Digestive Week 2010.

There is an increasing burden in digestive cancer in the coming years. With the advancement of endoscopic therapy, new molecular target therapy and minimally invasive ablation therapy, the treatment of digestive cancer will become more complicated. In Asia where gastric cancer and hepatocellular carcinoma are still prevalent and colorectal cancer is rapidly on the rise, the need in digestive oncology will be even higher. A new subspecialty of digestive oncology will be needed from the patient's perspective, from the healthcare authority's viewpoint and for the future development of gastroenterology.

Training innovations in gastroenterology and educational resources: a new vision of gastrointestinal education across Europe.

To define a new educational strategy for the United European Gastroenterology Federation (UEGF) to be followed and implemented in the near future. UEGF organized a consensus-based strategy meeting with stakeholders and key decision makers in European Gastroenterology on Training Innovations in Gastroenterology and Educational Resources. In May 2010, in an 'open-face conference' at Starnberg, Germany, 59 specialists in gastroenterology, hepatology, and related fields from 15 countries and 16 societies participated. Breakout sessions identified the key problem areas, possible solutions, and formulated statements subsequently voted upon in plenum. A majority of the formulated statements (59%) reached a strong agreement. Topics in which UEGF should focus are the future educational activities that include developing ways to advocate multidisciplinarity and integration between levels of care and specialties, ways to improve quality of care, and the development of training tools. The successful outcome of the Training Innovations in Gastroenterology and Educational Resources conference was achieved with the production of a strategy layout for new UEGF educational activities. There was an agreement that improvement in topics related to multidisciplinarity and professionalism, which is crucial for further development. An open-face conference, such as that embodied by the Training Innovations in Gastroenterology and Educational Resources meeting, was shown to be an effective tool in identifying the key problem areas in education and in formulating new strategies.

Teaching in small portions dispersed over time enhances long-term knowledge retention.

BACKGROUND: A primary goal of education is to promote long-term knowledge storage and retrieval. OBJECTIVE: A prospective interventional study design was used to investigate our research question: Does a dispersed curriculum promote better short- and long-term retention over a massed course? METHODS: Participants included 20 gastroenterology residents from the University of Calgary (N = 10) and University of Toronto (N = 10). Participants completed a baseline test of nutrition knowledge. The nutrition course was imparted to University of Calgary residents for 4 h occurring 1 h weekly over 4 consecutive weeks: dispersed delivery (DD). At the University of Toronto the course was taught in one 4h academic half-day: massed delivery (MD). Post-curriculum tests were administered at 1 week and 3 months to assess knowledge retention. RESULTS: The baseline scores were 46.39 +/- 6.14% and 53.75 +/- 10.69% in the DD and MD groups, respectively. The 1 week post-test scores for the DD and MD groups were 81.67 +/- 8.57%, p < 0.001 and 78.75 +/- 4.43, p < 0.001 which was significantly higher than baseline. The 3-month score was significantly higher in the DD group, but not in the MD group (65.28 +/- 9.88%, p = 0.02 vs. 58.93 +/- 12.06%, p = 0.18). The absolute pre-test to 1-week post-test difference was significantly higher at 35.28 +/- 7.65% among participants in the DD group compared to 25.0 +/- 11.80% in the MD group, p = 0.048. Similarly, the absolute pre-test to 3-month post-test difference was significantly higher at 18.9 +/- 6.7% among the participants in the DD group, compared to 6.8 +/- 11.8% in the MD group, p = 0.021. CONCLUSIONS: Long-term nutrition knowledge is improved with DD compared with MD.

Usefulness of warm water and oil assistance in colonoscopy by trainees.

BACKGROUND AND STUDY AIMS: Success rate of cecal intubation, endoscopist's difficulty, and procedure-related patient pain are still problems for beginners performing colonoscopy. New methods to aid colonoscopic insertion such as warm water instillation and oil lubrication have been proposed. The aim of this study is to evaluate the feasibility of using warm water or oil in colonoscopy. METHODS: Colonoscopy was performed in 117 unsedated patients by three endoscopists-in-training. Patients were randomly allocated to three groups, using a conventional method with administration of antispasmodics, warm water instillation, and oil lubrication, respectively. Success rate of total intubation within time limit (15 min), cecal intubation time, degree of endoscopist's difficulty, and level of patient discomfort were compared among the three groups. RESULTS: Cecal intubation time was shorter in the warm water group than in the conventional and oil groups. Degree of procedural difficulty was lower in the warm water group, and patient pain score was higher in the oil lubrication group, compared with the other groups. However, there was no significant difference in success rate of intubation within time limit among the three groups. CONCLUSIONS: The warm water method is a simple, safe, and feasible method for beginners. Oil lubrication may not be a useful method compared with conventional and warm water method.

European Society of Gastrointestinal and Abdominal Radiology (ESGAR): consensus statement on CT colonography.

Rapid clinical dissemination of CT colonography (CTC) is occurring in parallel with continued research into technique optimisation and diagnostic performance. A need exists therefore for current guidance as to basic prerequisites for effective clinical implementation. A questionnaire detailing CTC technique, analysis, training and clinical implementation was developed by the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) CTC committee and circulated to all faculty members of previous ESGAR "hands-on" CTC training courses. Responses were collated and a consensus statement produced. Of 27 invited to participate, 24 responded. Reasonable consensus was reached on bowel preparation, colonic distension, patient positioning, use of IV contrast and optimal scan parameters. Both primary 2D and primary 3D analysis were advocated equally, with some evidence that more experienced readers prefer primary 2D. Training was universally recommended, although there was no consensus regarding minimum requirements. CTC was thought superior to barium enema, although recommended for screening only in the presence of validated local experience. There was consensus that polyps 4 mm or less could be ignored assuming agreement from local gastroenterological colleagues. There is increasing consensus amongst European experts as to the current best practice in CTC.