scholarly journals Deep sedation and anaesthesia in complex gastrointestinal endoscopy: a joint position statement endorsed by the British Society of Gastroenterology (BSG), Joint Advisory Group (JAG) and Royal College of Anaesthetists (RCoA)

2019 ◽  
Vol 10 (2) ◽  
pp. 141-147 ◽  
Author(s):  
Reena Sidhu ◽  
David Turnbull ◽  
Mary Newton ◽  
Siwan Thomas-Gibson ◽  
David S Sanders ◽  
...  
Keyword(s):  
Negative Impact ◽  
Anaesthetic Agent ◽  
Deep Sedation ◽  
Position Statement ◽  
Therapeutic Endoscopy ◽  
Patient Comfort ◽  
British Society ◽  
Advisory Group ◽  
Endoscopic Procedures ◽  
The Uk

In the UK, more than 2.5 million endoscopic procedures are carried out each year. Most are performed under conscious sedation with benzodiazepines and opioids administered by the endoscopist. However, in prolonged and complex procedures, this form of sedation may provide inadequate patient comfort or result in oversedation. As a result, this may have a negative impact on procedural success and patient outcome. In addition, there have been safety concerns on the high doses of benzodiazepines and opioids used particularly in prolonged and complex procedures such as endoscopic retrograde cholangiopancreatography. Diagnostic and therapeutic endoscopy has evolved rapidly over the past 5 years with advances in technical skills and equipment allowing interventions and procedural capabilities that are moving closer to minimally invasive endoscopic surgery. It is vital that safe and appropriate sedation practices follow the inevitable expansion of this portfolio to accommodate safe and high-quality clinical outcomes. This position statement outlines the current use of sedation in the UK and highlights the role for anaesthetist-led deep sedation practice with a focus on propofol sedation although the choice of sedative or anaesthetic agent is ultimately the choice of the anaesthetist. It outlines the indication for deep sedation and anaesthesia, patient selection and assessment and procedural details. It considers the setup for a deep sedation and anaesthesia list, including the equipment required, the environment, staffing and monitoring requirements. Considerations for different endoscopic procedures in both emergency and elective setting are also detailed. The role for training, audit, compliance and future developments are discussed.

scholarly journals Trends in UK endoscopy training in the BSG trainees’ national survey and strategic planning for the future

2017 ◽  
Vol 9 (3) ◽  
pp. 200-207 ◽  
Author(s):  
Sujata Biswas ◽  
Laith Alrubaiy ◽  
Louise China ◽  
Melanie Lockett ◽  
Antony Ellis ◽  
...  
Keyword(s):  
British Society ◽  
Endoscopic Management ◽  
Advisory Group ◽  
Subspecialty Training ◽  
Training Experience ◽  
Training Time ◽  
Endoscopy Training ◽  
Therapeutic Modalities ◽  
Training Programmes ◽  
The Uk

BackgroundImprovements in the structure of endoscopy training programmes resulting in certification from the Joint Advisory Group in Gastrointestinal Endoscopy have been acknowledged to improve training experience and contribute to enhanced colonoscopy performance.ObjectivesThe 2016 British Society of Gastroenterology trainees’ survey of endoscopy training explored the delivery of endoscopy training - access to lists; level of supervision and trainee’s progression through diagnostic, core therapy and subspecialty training. In addition, the barriers to endoscopy training progress and utility of training tools were examined.MethodsA web-based survey (Survey Monkey) was sent to all higher specialty gastroenterology trainees.ResultsThere were some improvements in relation to earlier surveys; 85% of trainees were satisfied with the level of supervision of their training. But there were ongoing problems; 12.5% of trainees had no access to a regular training list, and 53% of final year trainees had yet to achieve full certification in colonoscopy. 9% of final year trainees did not feel confident in endoscopic management of upper GI bleeds.ConclusionsThe survey findings provide a challenge to those agencies tasked with supporting endoscopy training in the UK. Acknowledging the findings of the survey, the paper provides a strategic response with reference to increased service pressures, reduced overall training time in specialty training programmes and the requirement to support general medical and surgical on-call commitments. It describes the steps required to improve training on the ground: delivering additional training tools and learning resources, and introducing certification standards for therapeutic modalities in parallel with goals for improving the quality of endoscopy in the UK.

scholarly journals Impact of COVID-19 pandemic on key performance indicators in pancreatobiliary endoscopy: prioritise, minimise risk, keep scoping and training

2020 ◽  
pp. flgastro-2020-101701
Author(s):  
Shiran Esmaily ◽  
Chia Chuin Yau ◽  
Deepak Dwarakanath ◽  
John Hancock ◽  
Vikramjit Mitra
Keyword(s):  
Performance Indicators ◽  
Key Performance Indicators ◽  
Needle Aspiration ◽  
British Society ◽  
Advisory Group ◽  
National Guidelines ◽  
Retrospective Audit ◽  
The Uk ◽  
The Impact ◽  
Related Mortality

BackgroundThe COVID-19 pandemic has profoundly affected endoscopy services including pancreatobiliary (PB) endoscopy across the UK. The British Society of Gastroenterology and Joint Advisory Group have issued guidance for managing endoscopy services safely throughout this period. There have been perceived concerns among the PB endoscopists that wearing full personal protective equipment might have an adverse impact on key performance indicators (KPIs) in endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) procedures leading to non-compliance with the national guidelines. The aim of the study was to assess the impact of COVID-19 pandemic on KPIs in ERCP and EUS and ascertain the risk of procedure-related complications.MethodsA retrospective audit of a prospectively maintained endoscopy database was carried out between 18 March and 31 July 2020.Results146 ERCP procedures (common bile duct (CBD) cannulation rate of naïve papilla 89.2%, complete CBD stone extraction rate at first ERCP 88.2%, biliary stricture decompression rate 91%) and 87 EUS procedures (diagnostic accuracy of EUS-fine needle aspiration 92%) were carried out during this period. ERCP-related complications included pancreatitis (4.8%), bleeding (0.68%) and cholangitis (0.68%). 30-day ERCP procedure-related mortality was 0.68%. There were no complications or procedure-related mortality in the EUS group.ConclusionThis is the first study looking at the impact of COVID-19 on KPIs and procedure-related complications in ERCP and EUS in the literature. Our study confirms that a high-quality PB endoscopy service can be delivered safely and effectively during the COVID-19 pandemic.

scholarly journals UK Joint Advisory Group consensus statements for training and certification in endoscopic retrograde cholangiopancreatography

2022 ◽  
Vol 10 (01) ◽  
pp. E37-E49
Author(s):  
Keith Siau ◽  
Margaret G Keane ◽  
Helen Steed ◽  
Grant Caddy ◽  
Nick Church ◽  
...  
Keyword(s):  
Endoscopic Retrograde Cholangiopancreatography ◽  
British Society ◽  
Advisory Group ◽  
Evidence Based ◽  
Independent Practice ◽  
Endoscopic Retrograde ◽  
Advisory Committees ◽  
Modified Delphi ◽  
Consensus Statements ◽  
The Uk

Abstract Background and study aims Despite the high-risk nature of endoscopic retrograde cholangiopancreatography (ERCP), a robust and standardized credentialing process to ensure competency before independent practice is lacking worldwide. On behalf of the Joint Advisory Group (JAG), we aimed to develop evidence-based recommendations to form the framework of ERCP training and certification in the UK. Methods Under the oversight of the JAG, a modified Delphi process was conducted with stakeholder representation from the British Society of Gastroenterology, Association of Upper Gastrointestinal Surgeons, trainees and trainers. Recommendations on ERCP training and certification were formulated after formal literature review and appraised using the GRADE tool. These were subjected to electronic voting to achieve consensus. Accepted statements were peer-reviewed by JAG and relevant Specialist Advisory Committees before incorporation into the ERCP certification pathway. Results In total, 27 recommendation statements were generated for the following domains: definition of competence (9 statements), acquisition of competence (8 statements), assessment of competence (6 statements) and post-certification support (4 statements). The consensus process led to the following criteria for ERCP certification: 1) performing ≥ 300 hands-on procedures; 2) attending a JAG-accredited ERCP skills course; 3) in modified Schutz 1–2 procedures: achieving native papilla cannulation rate ≥80%, complete bile duct clearance ≥ 70 %, successful stenting of distal biliary strictures ≥ 75 %, physically unassisted in ≥ 80 % of cases; 4) 30-day post-ERCP pancreatitis rates ≤5 %; and 5) satisfactory performance in formative and summative direct observation of procedural skills (DOPS) assessments. Conclusions JAG certification in ERCP has been developed following evidence-based consensus to quality assure training and to ultimately improve future standards of ERCP practice.

Musculoskeletal ultrasound imaging standards in the UK: British Society of Skeletal Radiologists (BSSR) position statement

2021 ◽  
pp. 20210198
Author(s):  
Danoob Dalili ◽  
Andrew Carne ◽  
James MacKay ◽  
Philip O'Connor ◽  
David Silver ◽  
...  
Keyword(s):  
Ultrasound Imaging ◽  
Education And Training ◽  
Position Statement ◽  
Clinical Governance ◽  
Professional Standards ◽  
Musculoskeletal Ultrasound ◽  
British Society ◽  
The Uk ◽  
And Training ◽  
Medicolegal Issues

There has been some concern expressed by UK regulator, the Professional Standards Authority regarding the risks arising from Independent sonographer practices. The Professional Standards Authority presented evidence demonstrating that there are instances of harm occurring because of errors made by non-radiologists performing musculoskeletal ultrasound (MSKUS), particularly MSKUS-guided interventions. This document summarises British Society of Skeletal Radiologists position for Musculoskeletal use of ultrasound in UK, representing the agreed consensus of experts from the British Society of Skeletal Radiologists Ultrasound committee. The purpose of this position statement is to review the current practices affecting the delivery of MSKUS. Recommendations are given for education and training, audit and clinical governance, reporting, and medicolegal issues.

scholarly journals P-BN12 Impact of covid-19 on ugi (upper gastrointestinal) tract stenting and dilatation services- prioritise, keep scoping and training

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Chia Chuin Yau ◽  
Shiran Esmaily ◽  
Deepak Dwarakanath ◽  
John Hancock ◽  
Vikramjit Mitra
Keyword(s):  
Gastrointestinal Tract ◽  
Upper Gastrointestinal Tract ◽  
British Society ◽  
Entire Study ◽  
Endoscopic Procedures ◽  
Peptic Stricture ◽  
Oesophageal Dilatation ◽  
The Uk ◽  
The Impact ◽  
Upper Gastrointestinal

Abstract Background The COVID-19 pandemic profoundly affected endoscopy services including therapeutic gastroscopy across the UK. The BSG (British Society of Gastroenterology) issued guidance for managing endoscopy services safely throughout this period. At the beginning of the pandemic in March 2020, a symptom-based questionnaire was used to screen patients for COVID-19 prior to their endoscopic procedures in our hospital (COVID-19 swabs were only carried out if patients presented with COVID-19 symptoms). From 18 May 2020 onwards, in addition to the above approach, all patients attending endoscopic procedures underwent a SARS-CoV-2 nasopharyngeal swab 1-3 days prior to the procedure. We describe our experience of UGI stenting and dilatation during the initial wave of COVID-19 pandemic in the UK.  Aims To assess the impact of COVID-19 pandemic on technical and clinical success of luminal dilatation and stenting in the UGI tract and ascertain the risk of procedure related complications. Methods A retrospective audit of a prospectively maintained endoscopy database was carried out between 18th March and 31st July. All patients were followed for 30 days. Full PPE were used. Results 42 procedures [31 were oesophageal dilatation (21 peptic stricture, 9 radiotherapy stricture, 1 achalasia), 8 oesophageal stent insertion (6 for primary oesophageal cancer, 1 metastatic cancer and 1 secondary to external compression from lung cancer) and 3 pyloric dilatation all benign] were carried out-mean age 65 years, 64.3% males, 81% of procedures were carried out as outpatients. All procedures were performed under fluoroscopy. 41/42(97.6%) patients had a confirmed histology prior to their procedure – one patient who underwent oesophageal dilatation had a peptic stricture on endoscopy (no biopsy or imaging). 39/42(92.9%) patients had undergone CT scan and/or barium swallow prior to their first procedure. All procedures were technically and clinically successful (100%).There were no procedure related complications or mortality. There were no COVID positive swabs in the 30-day post procedure period during the entire study period. Trainees were present in 21/42 (50%) of the procedures. None of the endoscopists who were involved with these procedures were diagnosed with COVID-19 during this period. One of the nursing staff, who regularly assisted in the fluoroscopy room, was involved in a non-fluoroscopic endoscopic procedure in a COVID-19 patient (not known at the time of the procedure) and subsequently tested positive.  Conclusions Our study confirms that a high quality stenting and dilatation service of the upper gastrointestinal tract together with specialist registrar training can be delivered safely and effectively during the COVID-19 pandemic in appropriately prioritised symptomatic patients. 

An Expert Ranked List of Pro-nature Conservation Behaviours for Public Use

2019 ◽  
Author(s):  
Lea Barbett ◽  
Edward Stupple ◽  
Michael Sweet ◽  
Miles Richardson
Keyword(s):  
Nature Conservation ◽  
General Population ◽  
Mass Extinction ◽  
Negative Impact ◽  
Ecological Impact ◽  
Human Action ◽  
Short Paper ◽  
The Public ◽  
The Uk ◽  
Ranked List

The planet is facing an anthropogenic mass extinction of wildlife, which will have a grave impact on the environment and humans. Widespread human action is needed to minimize the negative impact of humans on biodiversity and support the restoration of wildlife. In order to find effective ways to promote pro-nature conservation behaviours to the general population, there is a need to provide a list of behaviours which will have worthwhile ecological impact and are worth encouraging. In a novel collaboration between psychologists and ecologists, 70 experts from practical and academic conservation backgrounds were asked to review and rate 48 conservation related behaviours. According to their judgement, this short paper presents a ranked list of pro-nature conservation behaviours for the public in the UK and similar landscapes. This includes behaviours people can engage in in their homes, their gardens, on their land, and in their roles as citizens.

scholarly journals EPEN-24. SIOP EPENDYMOMA II: CENTRAL EPENDYMOMA MANAGEMENT ADVISORY GROUP – THE UK EXPERIENCE

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii312-iii312
Author(s):  
Donald C Macarthur ◽  
Conor Mallucci ◽  
Ian Kamaly-Asl ◽  
John Goodden ◽  
Lisa C D Storer ◽  
...  
Keyword(s):  
Survival Rates ◽  
Target Volume ◽  
Advisory Group ◽  
Subtotal Resection ◽  
Str Analysis ◽  
Oncological Treatment ◽  
Beneficial Effects ◽  
Number Of Patients ◽  
Pathological Review ◽  
The Uk

Abstract Paediatric Ependymoma is the second most common malignant brain tumour of childhood with approximately 50% of cases recurring. It has been described as a “surgical” disease since patients who have undergone a gross total surgical resection (GTR) have a better prognosis than those who have a subtotal resection (STR). Analysis of the UKCCSG/SIOP 1992 04 clinical trial has shown that only 49% of cases had a GTR, with 5-year survival rates for STR of 22–47% and GTR of 67–80%. As part of the SIOP II Ependymoma trial the UK established a panel of experts in the treatment of Ependymoma from Neuro-oncology, Neuro-radiology and Neuro-surgery. Meeting weekly, cases are discussed to provide a consensus on radiological review, ensuring central pathological review, trial stratification and whether further surgery should be advocated on any particular case. Evaluation of the first 68 UK patients has shown a GTR in 47/68 (69%) of patients and STR in 21/68 (31%) of patients. Following discussion at EMAG it was felt that 9/21 (43%) STR patients could be offered early second look surgery. Following this 2nd look surgery the number of cases with a GTR increased to 56/68 (82%). There has been a clear increase in the number of patients for whom a GTR has been achieved following discussion at EMAG and prior to them moving forwards with their oncological treatment. This can only have beneficial effects in decreasing their risk of tumour recurrence or CSF dissemination and also in reducing the target volume for radiotherapy.

scholarly journals Mental Health, Information and Being Connected: Qualitative Experiences of Social Media Use during the COVID-19 Pandemic from a Trans-National Sample

Healthcare ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 735
Author(s):  
Schoultz Mariyana ◽  
Leung Janni ◽  
Bonsaksen Tore ◽  
Ruffolo Mary ◽  
Thygesen Hilde ◽  
...  
Keyword(s):  
Mental Health ◽  
Social Media ◽  
Health Information ◽  
Online Survey ◽  
Negative Impact ◽  
National Study ◽  
Free Text ◽  
Cross Sectional ◽  
Mental Health Information ◽  
The Uk

Background: Due to the COVID-19 pandemic and the strict national policies regarding social distancing behavior in Europe, America and Australia, people became reliant on social media as a means for gathering information and as a tool for staying connected to family, friends and work. This is the first trans-national study exploring the qualitative experiences and challenges of using social media while in lockdown or shelter-in-place during the current pandemic. Methods: This study was part of a wider cross-sectional online survey conducted in Norway, the UK, USA and Australia during April/May 2020. The manuscript reports on the qualitative free-text component of the study asking about the challenges of social media users during the COVID-19 pandemic in the UK, USA and Australia. A total of 1991 responses were included in the analysis. Thematic analysis was conducted independently by two researchers. Results: Three overarching themes identified were: Emotional/Mental Health, Information and Being Connected. Participants experienced that using social media during the pandemic amplified anxiety, depression, fear, panic, anger, frustration and loneliness. They felt that there was information overload and social media was full of misleading or polarized opinions which were difficult to switch off. Nonetheless, participants also thought that there was an urge for connection and learning, which was positive and stressful at the same time. Conclusion: Using social media while in a shelter-in-place or lockdown could have a negative impact on the emotional and mental health of some of the population. To support policy and practice in strengthening mental health care in the community, social media could be used to deliver practical advice on coping and stress management. Communication with the public should be strengthened by unambiguous and clear messages and clear communication pathways. We should be looking at alternative ways of staying connected.

scholarly journals Overt acts of perceived discrimination reported by British working-age adults with and without disability

2019 ◽  
Author(s):  
Eric Emerson ◽  
Allison Milner ◽  
Zoe Aitken ◽  
Lauren Krnjacki ◽  
Cathy Vaughan ◽  
...  
Keyword(s):  
Public Health ◽  
Negative Impact ◽  
Policy Research ◽  
Secondary Analysis ◽  
People With Disabilities ◽  
Public Health Problem ◽  
Health Staff ◽  
Cross Sectional ◽  
Increased Risk ◽  
The Uk

Abstract Background Exposure to discrimination can have a negative impact on health. There is little robust evidence on the prevalence of exposure of people with disabilities to discrimination, the sources and nature of discrimination they face, and the personal and contextual factors associated with increased risk of exposure. Methods Secondary analysis of de-identified cross-sectional data from the three waves of the UK’s ‘Life Opportunities Survey’. Results In the UK (i) adults with disabilities were over three times more likely than their peers to be exposed to discrimination, (ii) the two most common sources of discrimination were strangers in the street and health staff and (iii) discrimination was more likely to be reported by participants who were younger, more highly educated, who were unemployed or economically inactive, who reported financial stress or material hardship and who had impairments associated with hearing, memory/speaking, dexterity, behavioural/mental health, intellectual/learning difficulties and breathing. Conclusions Discrimination faced by people with disabilities is an under-recognised public health problem that is likely to contribute to disability-based health inequities. Public health policy, research and practice needs to concentrate efforts on developing programs that reduce discrimination experienced by people with disabilities.

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