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

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.

The Importance of Supporting the Social-Emotional Skills of Teacher Educators in the Post-COVID Era

The COVID-19 pandemic affected education on all fronts. Most troubling was the effect on students' social emotional learning (SEL) across all education sectors. The implications are yet to be fully understood; however, ongoing research points to further exploration. This chapter supports the redesigning of educator preparation programs (EPPs) to include courses dedicated to exploring SEL. In a post-COVID-19 era, it will be essential to integrate SEL in the EPP curriculum to build awareness of these needed skills in future educators, to build capacity to support students during challenging times. This chapter also encourages universities to consider the addition of SEL development for their EPPs. The authors developed specific action steps for EPPs to use in incorporating SEL within their curriculum. These steps include integrating SEL across coursework, recognizing challenges and stressors, practicing collaboration, encouraging independent practice and critical thinking, using pre and post-assessments to measure SEL improvement, and incorporating mindfulness and emotional regulation.

EFEKTIVITAS DAUN BANGUN-BANGUN DALAM MENINGKATKAN PRODUKSI ASI PADA IBU NIFAS

Exclusive breastfeeding is breastfeeding for the first 6 months of the baby's life without the intake of other food or drinks except vitamins, drugs and ORS. Bangun-bangun plant (Coleus Amboinus Lour) is one of the types of plants consumed by new mothers in North Sumatra, especially by the Batak tribe. The purpose of this study was to determine the effectiveness of the leaves of Bangun-bangun in increasing milk production in the Independent Practice of Midwife Rismayani Harahap, S.Tr.Keb. The research method uses the Quasi Experiment Design method using the Non-Equevalent Control group approach. The study used the Independent T-Test test, namely P = 0.000, which means that there is an Effectiveness of Giving Bangun-bangun Leaves to Increase Breast Milk Production in Postpartum Mothers

GAMBARAN TEKNIK RELAKSASI NAFAS PADA IBU BERSALIN DI PRAKTIK MANDIRI BIDAN “N” TAHUN 2021

Nyeri dalam persalinan dapat memiliki dampak yang berbahaya pada ibu dan janin yaitu hiperventilasi. Berdasarkan survey awal yang dilakukan di Praktik Mandiri Bidan N Cipaku pada bulan Januari tahun 2021, ditemukan 7 dari 10 ibu bersalin mengalami nyeri yang luar biasa dan tidak tertahankan. Tujuan penelitian ini adalah untuk mengetahui Gambaran Teknik Relaksasi Nafas Pada Ibu Bersalin di Praktik Mandiri Bidan “N” Periode April Tahun 2021. Metode penelitian ini menggunakan metode penelitian deskriptif dengan jumlah sempel sebanyak 35 orang. Pengambilan sampel yang digunakan dalam penelitian ini adalah metode total Sampling. Diketahui Lebih dari setengahnya responden melakukan teknik relaksasi nafas pada proses persalinannya secara baik sebanyak 19 orang (54,3%) dan kurang dari setengahnya responden melakukan teknik relaksasi nafas secara sedang pada proses persalinannya sebanyak 11 orang (31,4%) dan sebagian kecil responden melakukan teknik relaksasi nafas pada proses persalinannya secara kurang sebanyak 5 orang (14,3%). Lebih dari setengahnya responden melakukan teknik relaksasi nafas pada proses persalinannya secara baik.Saran: Diharapkan Tenaga kesehatan khusunya bidan sebagai penolong persalinan dapat membantu ibu bersalin dalam memenuhi kebutuhan ibu akan rasa nyaman dalam pengontrolan nyeri dan dapat meningkatkan kegiatan penyuluhan tentang teknik relaksasi nafas pada proses persalinan yang dapat membantu ibu bersalin mengurangi nyeri pada saat persalinan.Background: Pain in labor can have a dangerous impact on the mother and fetus, namely hyperventilation.4 Based on an initial survey conducted at the Independent Practice of Midwives N Cipaku in January 2021, it was found that 7 out of 10 maternity mothers experienced excruciating pain and did not experience pain. bearable.Objective: The purpose of this study was to find out the description of the Breath Relaxation Technique in Maternity in the Midwife Independent Practice "N" for the April 2021 Period. Methods: This research method used a descriptive research method with a sample of 35 people. The sampling used in this study is the total sampling method. The results: It is known that more than half of the respondents performed breath relaxation techniques during labor well as many as 19 people (54.3%) and less than half of the respondents performed moderate breathing relaxation techniques during labor as many as 11 people (31.4%) and a small proportion of respondents performed breathing relaxation techniques in the process of delivery less than 5 people (14.3%.Conclusion: More than half of the respondents performed the breath relaxation technique well in the labor process.Suggestion: It is expected that health workers, especially midwives as birth attendants, can help birth mothers in meeting the mother's need for comfort in pain control and can increase counseling activities about breath relaxation techniques in the labor process that can help mothers in labor reduce pain during labor.

PELAKSANAAN KEGIATAN HYPNOBREASTFEEDING PADA IBU MENYUSUI YANG MEMPUNYAI BAYI < 3 BULAN DI PRAKTIK MANDIRI BIDAN RISMA DELI SERDANG TAHUN 2019

Breast milk is the only perfect and best food for babies, because it contains the nutritional elements needed by babies for infant growth and development in order to achieve optimal baby growth and development. The reality in the field is that there are still many mothers who experience obstacles/constraints to exclusively breastfeed their babies for 6 full months, even though breastfeeding is a natural condition. One solution that can help overcome barriers to exclusive breastfeeding is hypnobreastfeeding. The purpose of this community service is to increase mother's knowledge about exclusive breastfeeding and mother's confidence to be able to meet the adequacy of breastfeeding through Hypnobreastfeeding techniques in infants as an effort to increase milk production and expenditure The methods used in this Community Service activity are lectures, questions and answers, demonstrations and practices carried out by the instructor and assignments carried out by postpartum mothers who gave birth at the Independent Practice Midwife Risma as many as 15 people. The implementation of Hypnobreastfeeding activities is carried out routinely every day 5 (five) times a week by listening to Hypnobreastfeeding audio recordings for ± 30 minutes, carried out independently by the participants. The results obtained provided enormous benefits for the participants, including they felt that the baby was not fussy, slept soundly, urinated more than 6 times a day and the baby's weight increased. From this activity, it can be concluded that through counseling activities, demonstrations of correct breastfeeding methods/techniques and Hypnobreastfeeding, it can increase knowledge, skills and increase production of breast milk production and fulfill breast milk adequacy in mothers who breastfeed babies aged 3 months at the Independent Practice of Midwife Risma.

Pilot prospective study on formal training in per-oral endoscopic myotomy (POEM) during advanced endoscopy fellowship

Background and study aims Gastroenterology societies have recently proposed core curricula for training in per-oral endoscopic myotomy (POEM) based on expert opinion with limited data on its applicability for advanced endoscopy fellowship (AEF) trainees. We prospectively evaluated the feasibility of a structured POEM training curriculum during a dedicated AEF and the trainee’s performance during independent practice. Methods This was a single-center prospective study evaluating a trainee’s performance of POEM using a structured assessment tool (POEMAT) to assess core cognitive and technical skills. The trainee’s performance was then prospectively assessed during the first 12 months of independent practice. Results The trainee, who had not prior background in submucosal endoscopy, first observed 22 POEM cases followed by 35 hands-on procedures during his advanced endoscopy fellowship. Based on the POEMAT, submucosal entry and mucosal incision closure were the most challenging technical aspects, while cognitive skills were uniformly attained early in training. Overall, the trainee was able to cross the threshold for competence in his POEMAT performance score in 15 of his last 18 cases (83.3 %). The trainee performed 16 POEMs (baseline mean Eckardt 7.2) in his first 12 months of independent practice. Mean procedural time was 79.8 minutes (interquartile range: 67–94 minutes minutes) with no adverse events. Clinical success (Eckardt score < 3) was achieved in 100 % of the cases at a median follow-up of 20 weeks. Conclusions Results from this pilot study support the adoptability of the recently proposed core curricula for POEM training within the context of a dedicated AEF and provide a potential blueprint for future studies of performance in POEM among trainees.

Psychotherapists Working in Private Practice During a Pandemic: A Literature Review

Psychotherapists in private practice provide services to an ever-growing client population. The 2020 novel Corona Virus (COVID-19) pandemic was a catalyst for emerging and exasperated mental health concerns among the U.S. population. The result was an increase in demand for services and private practitioners stepping up to meet this growing need. Little is known about the psychotherapists who embark on independent practice and less is known about the nuances of practicing during a global pandemic. The aim of this review was to exhaust the literature on private practice psychotherapy and the practice of psychotherapy during COVID-19, synthesize the findings, report on themes in the literature, and provide recommendations for future lines of inquiry. Themes from this review included the impact of COVID-19 on public mental health, telemental health, private practice shifts, and private practice careers.

Pendidikan Kesehatan (Buku KIA 2020) Khusus Ibu di Masa Pandemi Covid-19 di PMB Bumi Cinta Gorontalo

Knowledge of mothers about the use of Maternal and Child Health (MCH) books, which is still considered only as a health record book for health workers, is an obstacle in shaping the health behavior of pregnant women about the importance of routine pregnancy check-ups, understanding the danger signs of early pregnancy, the importance of taking Fe tablets regularly, as well as daily health care. According to the initial survey of the service team, we see that knowledge and understanding have an impact on the awareness of pregnant women about the contents of the MCH book, especially now that the MCH book has been revised so that the importance of health education on MCH books needs to be explained again in the independent practice of the midwife of the love of Gorontalo. The method of service is through lectures/counseling, discussion and question and answer. As a result of our dedication, we get the enthusiasm of pregnant women in listening to our explanations and asking important things they want to know