Currently, sedation anesthesia is increasingly used in many medical fields, from gastroscopy to medical imaging. The demand for sedation anesthesia is expected to increase gradually with increasing number of day surgeries and increased expectations from medical services. The demand for sedation anesthesia is considerably higher than the available pool of anesthesiologists; therefore, in a significant number of cases, sedation anesthesia is induced by non-anesthesiologists. However, there is no systematic provision of education or expertise for non-anesthesiologists in delivering sedation anesthesia. In cases of non-anesthesiologists inducing anesthesia, social controversy is often caused by medical accidents and substance abuse. In this review, I have briefly summarized what non-anesthesiologists should know about sedation anesthesia and have presented guidelines simplifying sedation anesthesia for non-anesthesia medical personnel.
Ambulatory Surgical Procedures ; Anesthesia ; Dexmedetomidine ; Diagnostic Imaging ; Education ; Etomidate ; Gastroscopy ; Hypnotics and Sedatives ; Ketamine ; Propofol ; Substance-Related Disorders

BACKGROUND/AIMS: In endoscopic submucosal dissection (ESD) training, only a flat target lesion can usually be simulated in the normal mucosa. This study aimed to evaluate the feasibility of simulated targets in the stomachs of live pigs for complete training. METHODS: Six trained endoscopists with hands-on experience with ex vivo, isolated pig stomachs were enrolled in this pilot study. An endoscopic banding device was used to create a polyp that was snared, leaving an ulcerated lesion. This simulated target model was used to perform ESD in pigs. The en bloc resection rate, procedure time, complications, quality of resection, and participants' opinions on the simulated targets were compared with the conventional model. RESULTS: En bloc resections were achieved in all six simulated targets and six conventional models. The mean size of the resected specimens was 32.2 mm (range, 20 to 39 mm) in the simulated target group and 23.5 mm (range, 11 to 40 mm) in the conventional group. The target model had a high quality of resection and had a high satisfaction rate for margin identification and correct peripheral marking. CONCLUSIONS: Good identification of the lesion and ease of periphery marking in the target model may improve resection quality.
Adult ; Animals ; *Clinical Competence ; Dissection/*education ; Feasibility Studies ; Female ; Gastric Mucosa/*surgery ; Gastroscopy/*education ; Humans ; Male ; Models, Anatomic ; Pilot Projects ; Stomach/surgery ; Stomach Neoplasms/surgery ; Sus scrofa

BACKGROUND: Esophagogastroduodenoscopy(EGD) is a useful diagnostic procedure and an important basic skill in family practice residency program. But currently we have no guidelines for EGD training in family practice residency program. METHODS: In March 1999, we mailed a self-administered questionnaire to the residency directors of all KAFM-accredited family practice residency programs. 63 out of 109 programs responded to the questionnaire(57.8%). RESULTS: Among the total of 63 hospitals that responded to the questionnaire, secondary hospitals were 55.6% and tertiary or university hospitals were 44.4%. 98.4% reported that their residents receive training to perform EGD. 57.1% of the total received training to perform EGD during internal medicine training. EGD was performed by family physicians in 38.1% of total family practice residency programs. In the majority of these programs(34.9%, cumulative percent 74.6%), the minimal requirements for technical skills in EGD training were 50 cases and for both technical skills and cognitive skills at least 100 cases of EGD(41.3%, cumulative percent 79.3% was necessary). The most difficult component during EGD procedure seemed to be esophageal intubation followed by retroflexed maneuver and entering the pylorus in series. CONCLUSION: To perform EGD in primary care, it is required for trainee to perform at least 50 cases of EGD under supervision in a family practice residency program.
Education ; Endoscopy, Digestive System* ; Family Practice* ; Gastroscopy ; Hospitals, University ; Humans ; Internal Medicine ; Internship and Residency* ; Intubation ; Organization and Administration ; Physicians, Family ; Postal Service ; Primary Health Care ; Pylorus ; Surveys and Questionnaires

PURPOSE: Quality indicators of the National Endoscopy Quality Improvement Program (NEQIP) and outcome measures of endoscopy in the National Cancer Screening Program (NCSP) in Korea are not clear. We evaluated the quality indicators of the revised NEQIP and outcome measures of endoscopy at different types of healthcare facilities participating in the NCSP. MATERIALS AND METHODS: This study was conducted between March and August 2018 in primary, secondary, and tertiary healthcare facilities that perform endoscopy as a part of the NCSP. Representative endoscopists completed a questionnaire for quality indicators of the NEQIP and provided data on outcome measures for endoscopy. RESULTS: Quality indicators of the NEQIP were mostly acceptable. However, the quality indicators for annual volume of esophagogastroduodenoscopy (EGD) and colonoscopy, training for endoscopy quality improvement by endoscopy nursing staff, colonoscopy reports, documentation of pathologic lesions, quality of endoscopy reprocessing areas, and completion of endoscopy reprocessing education programs were suboptimal. For outcome measures of EGD, the number of photo-documentations and total procedure time were higher at tertiary healthcare facilities than at other facilities (p<0.001 and p=0.023, respectively). For the outcome measures of colonoscopy, colonoscopy completion rate and waiting times for colonoscopy were significantly higher at tertiary healthcare facilities than at other facilities (both p<0.001). CONCLUSION: Outcome measures of endoscopy should be included as quality indicators of NCSP. However, universal outcome measures for all types of healthcare facilities should be established because performance levels of some outcome measures differ among individual healthcare facility types.
Colonoscopy ; Delivery of Health Care ; Early Detection of Cancer ; Education ; Endoscopy ; Endoscopy, Digestive System ; Gastroscopy ; Humans ; Korea ; Mass Screening ; Nursing Staff ; Outcome Assessment (Health Care) ; Quality Improvement ; Tertiary Healthcare

This study was conducted in July-August, 1984, to define the causes of chronic gastrointestinal symptoms in rural population and to provide data for the management of such patients. A household survey was conducted to identify all the residents of Youngchun and Sungju counties in Kyungpook province who were over 20 years of age, had chronic upper gastrointestinal symptoms for over the last 6 months, never had medical examination for the symptoms, and volunteered to participate in the gastroscopic examination. Gastroscopy was done for 106 males and 108 females. Gastric ulcer was found in 16.8% of all the examinees, duodenal ulcer in 15.4%, gastritis in 14.0%, and gastric cancer in 3.7%. No lesion was found by gastroscopy in 52.3%. Gastric ulcer more common in male(26.4%) than in female(7.4%) (p<0.01) and the same was true for duodenal ulcer(20.8% of male, 10.2% of female). Gastric cancer was found in 7.5% of the male while none of the female had gastric cancer. A higher proportion of the female(68.5%) showed normal finding in the gastroscopy than the male(35.9%) (p<0.01). No significant association was found between the upper gastrointestinal symptoms and the gastroscopic findings. The higher prevalence rate of gastric ulcer than that of duodenal ulcer in this study which is the reverse of the study findings of urban area in Korea and western countries may be related in part with the dietary habit and social environment of the rural population. Although early diagnosis is the most important for the treatment of gastric cancer, many of the people with chronic upper gastrointestinal complaints defer the diagnosis and treatment. It is may be due to lack of the knowledge of disease and the health care attitude of the rural people. A national program for the health education and mass screening for the gastric cancer should be developed.
Delivery of Health Care ; Diagnosis ; Duodenal Ulcer ; Early Diagnosis ; Family Characteristics ; Female ; Food Habits ; Gastritis ; Gastroscopy ; Gyeongsangbuk-do ; Health Education ; Humans ; Korea ; Male ; Mass Screening ; Prevalence ; Rural Population ; Social Environment ; Stomach Neoplasms ; Stomach Ulcer