The fundamentals: understanding the climate change crisis

This is the first of a series of nine commentaries, each of which is designed to stand alone but when read as a whole provide a broad overview of the status of the intersection between digestive health and climate change. The nine commentaries encapsulate a 9-webinar open-access climate course hosted by the World Gastroenterology Organisation March–June 2023

Endoscopic capacity in West Africa

Background: Levels of endoscopic demand and capacity in West Africa are unclear.Objectives: This paper aims to: 1. describe the current labor and endoscopic capacity, 2. quantify the impact of a mixed-methods endoscopy course on healthcare professionals in West Africa, and 3. quantify the types of diagnoses encountered.Methods: In a three-day course, healthcare professionals were surveyed on endoscopic resources and capacity and were taught through active observation of live cases, case discussion, simulator experience and didactics. Before and after didactics, multiplechoice exams as well as questionnaires were administered to assess for course efficacy. Also, a case series of 23 patients needing upper GI endoscopy was done.Results: In surveying physicians, less than half had resources to perform an EGD and none could perform an ERCP, while waiting time for emergency endoscopy in urban populations was at least one day. In assessing improvement in medical knowledge among participants after didactics, objective data paired with subjective responses was more useful than either alone. Of 23 patients who received endoscopy, 7 required endoscopic intervention with 6 having gastric or esophageal varices. Currently the endoscopic capacity in West Africa is not sufficient. A formal GI course with simulation and didactics improves gastrointestinal knowledge amongst participants.Keywords: Endoscopic capacity, endoscopic demand, West Africa, training cours

Endoscopic capacity in West Africa.

Background: Levels of endoscopic demand and capacity in West Africa are unclear. Objectives: This paper aims to: 1. describe the current labor and endoscopic capacity, 2. quantify the impact of a mixed-methods endoscopy course on healthcare professionals in West Africa, and 3. quantify the types of diagnoses encountered. Methods: In a three-day course, healthcare professionals were surveyed on endoscopic resources and capacity and were taught through active observation of live cases, case discussion, simulator experience and didactics. Before and after didactics, multiplechoice exams as well as questionnaires were administered to assess for course efficacy. Also, a case series of 23 patients needing upper GI endoscopy was done. Results: In surveying physicians, less than half had resources to perform an EGD and none could perform an ERCP, while waiting time for emergency endoscopy in urban populations was at least one day. In assessing improvement in medical knowledge among participants after didactics, objective data paired with subjective responses was more useful than either alone. Of 23 patients who received endoscopy, 7 required endoscopic intervention with 6 having gastric or esophageal varices. Currently the endoscopic capacity in West Africa is not sufficient. A formal GI course with simulation and didactics improves gastrointestinal knowledge amongst participants

Alpha Errors, Beta Errors and Negative Trials

Reports of negative trials arc increasing in number as standard therapy for many gastrointestinal diseases is refined. The validity of a negative report depends on the number of patients in the trial, the alpha and bern error and the difference in efficacy which the trial is able to detect. The relationship between these parameters is discussed and a formula given for the calculation of trial size. All reports of negative trials should include not only the number of patients involved and the level of significance of the results but also the beta error and the detectable difference in efficacy of the treatments