Development of a list of minimum procedures for certifying competence in gastrointestinal endoscopy by the Delphi method

BACKGROUND

within the frame of reference of any medical specialty, having a consensus list of the type and number of practices characterizing its professional work is key. Thus, the goal of this study was to define a list of minimum procedures to ensure competence in gastrointestinal endoscopy based on a structured consensus process, and to explore the views of leading experts in gastrointestinal endoscopy regarding endoscopist training in Argentina and the need for competence certification.

MATERIALS AND METHODS

this research entailed a mixed-methods prospective study including using the Delphi method as focus group qualitative research technique, followed by a structured survey.

RESULTS

the final consolidated list included 17 procedures deemed essential for competence certification in gastrointestinal endoscopy. Given the dispersion found in the range of minimum numbers required for competence a decision was made to use the median value. For upper gastrointestinal endoscopy the minimum number of procedures was set at 200, whereas 150 was established for videocolonoscopy.

CONCLUSION

this list is a key item in the development of a gastrointestinal endoscopy training framework and competence certification program.

Radiotherapy for malignant pleural mesothelioma

BACKGROUND

Malignant pleural mesothelioma is a relatively uncommon disease, but the incidence is increasing and is expected to peak in many developed countries in the next two decades. The management of patients with malignant mesothelioma is controversial. Very few patients are suitable for any potentially curative treatment and the effectiveness of radical therapy with surgery, radiotherapy and/or chemotherapy in curing patients or prolonging survival is uncertain. The role of radiotherapy is controversial although it has been used as part of multimodal therapy. The present review will try to clarify these uncertainties.

OBJECTIVES

To assess the effectiveness and safety of radiotherapy on patients with malignant pleural mesothelioma in any stage of the disease.

SEARCH STRATEGY

Both electronic and handsearches were conducted. All randomised controlled clinical trials were searched in electronic databases such as: Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE. Handsearching was aimed at the identification of evidence by reviewing journals not indexed in databases, proceedings of conferences and/or scientific meetings.

SELECTION CRITERIA

All randomised controlled clinical trials using radiotherapy for malignant pleural mesothelioma in any stage, alone or combined with other therapies in patients of either sex and any age, were included. Studies without a control group were excluded.

DATA COLLECTION AND ANALYSIS

There were no studies that fulfilled the inclusion criteria.

MAIN RESULTS

To date we have not found any reports of randomised comparisons of radiotherapy alone or combined for patients with malignant pleural mesothelioma.

AUTHORS' CONCLUSIONS

As radiotherapy has never been compared to chemotherapy or surgery or to best supportive care (as part of combination therapy) in a prospective, randomised trial, no data exist supporting one or the other treatment as a better option for patients with malignant pleural mesothelioma. There is a need for multicentre controlled randomised trials assessing the role of radiotherapy in the radical treatment of malignant pleural mesothelioma. The studies should be limited to patients with malignant pleural mesothelioma, classified by stage, cytology and type of radiotherapy. The type of radiotherapy should be defined in advance and variables of radiotherapy dose definition and delivery should be carefully controlled.