RAJIVE GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE
KARNATAKA
PERFORMA FOR REGISTRATION OF SUBJECCT FOR DISSERTATION
“ A STUDY TO ASSESS THE EFFECTIVENESS OF SELF INSTRUCTIONAL MODULE ON KNOWLEDGE REGARDING ENDOSCOPY AMONG PATIENTS WHO ARE UNDERGOING ENDOSCOPIC PROCEDURES IN SELECTED HOSPITALS OF KOLAR “
MR. FAISAL MANGALASSERI
M.Sc (N) 1ST Year
AE & CS PAVAN COLLEGE OF NURSING
BANGALORE CHENNAI BYE-PASS ROAD
KOLAR DIST, KARNATAKA-563101
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECTS
FOR DISSERTATION
1. / NAME OF THE CANDIDATE AND ADDRESS / MR. FAISAL MANGALASSERI1ST YEAR MSc NURSING,
AE&CS PAVAN COLLEGE OF NURSING, HAROHALLI GARDEN, BANGALORE-CHENNAI BYEPASS ROAD, KOLAR-563101
2. / NAME OF THE INSTITUTION / AE&CS PAVAN COLLEGE OF NURSING, KOLAR-563101
3. / COURSE OF STUDY AND SUBJECT / MASTER OF SCIENCE IN MEDICAL SURGICAL NURSING
4. / DATE OF
ADMISSION TO COURSE / 25/10/2010
5. / TITLE OF THE
TOPIC / A STUDY TO ASSESS THE EFFECTIVENESS OF SELF INSTRUCTIONAL MODULE ON KNOWLEDGE REGARDING ENDOSCOPY AMONG PATIENTS WHO ARE UNDERGOING ENDOSCOPIC PROCEDURES IN SELECTED HOSPITALS OF KOLAR
6. BRIEF RESUME OF THE INTENTED WORK
6.1 INTRODUCTION
“Take care; I am compliance itself, when I am not thwarted! No one more easily led, when I have my own way; but don’t put me in frenzy.”
-Richard Brinsley Sheridan
Belief about health and illness are major feature of every known culture. Health is often viewed as a continuum on which optimal wellness, at one end, is the highest level of function and illness at the other end result in death. Every person is somewhere on the continuum. As one’s health state changes, the location on the continuum changes 1.
Deviation from normal health state is known as illness. The process of defining oneself as ill is based on one’s own perception of others, or both. Each person reacts differently to illness. When assessing the illness experience, the nurse considers the type of illness and the change that make place in the client and the family when illness occurs. Illness has broader meaning than disease. Disease refers to a biologic or psychological alteration, such as peptic ulcer, gastritis chronic bowel syndrome, diabetes mellitus and hepatitis, which result in a malfunction of a body organ or system2.
The word Upper Gastro intestinal endoscopy is a procedure that uses a lighted, flexible endoscope to see inside the upperGastro intestinal tract. The upper GI tract includes the esophagus, stomach, duodenum and the first part of the small intestine. An endoscopy is a medical procedure used to view the digestive tract and other internal organs non surgically.
Through the use of an endoscopy, a flexible tube with a lighted camera attached, the internal body structure is seen on a color monitor by the physician or a procedure looking at the inside of body cavities, such as the esophagus or stomach.
The nurse cares for the endoscopic patients as well as the equipment required to conduct endoscopy. It is essential that the nurse must be able to interpret the data and make clinical decisions based on that data. The nurse must know how to detect and prevent complications of this clinical tool.3
Risk associated with upper GI endoscopy include abnormal reaction to sedatives, bleeding from biopsy, accidental puncture of the upper GI tract, Patients who experience any of the following rare symptoms after upper GI endoscopy should contact their doctor immediately, Swallowing difficulties, throat, chest, and abdominal pain that worsens, vomiting, bloody or very dark stool and fever.4
Nursing care starts when the patient is advised to undergo endoscopy Upper gastrointestinal (GI) endoscopy is a procedure that uses a lighted, flexible endoscope to see inside the upper GI tract. To prepare for upper GI endoscopy, no eating or drinking is allowed for 4 to 8 hours before the procedure. Smoking isalso prohibited. Patients should tell their doctor about all health conditions they have and all medications they are taking. Driving is not permitted for 12 to 24 hours after upper GI endoscopy to allow the sedative time to wear off. Before the appointment, patients should make plans for a ride home. Before upper GI endoscopy, the patient will receive a local anesthetic to numb the throat. An intravenous (IV) needle is placed in a vein in the arm if a sedative will be given. During upper GI endoscopy, an endoscope is carefully fed into the upper GI tract and images are transmitted to a video monitor. Special tools that slide through the endoscope allow the doctor to perform biopsies, stop bleeding, and remove abnormal growths. After upper GI endoscopy, patients may feel bloated or nauseated and may also have a sore throat. Unless otherwise directed, patients may immediately resume their normal diet and medications.Possible risks of an upper GI endoscopy include abnormal reaction to sedatives, bleeding from biopsy, and accidental puncture of the upper GI tract.4
6.2. NEED FOR THE STUDY
Nursing as a profession is now responsible to account for its competence and performance. This has been the birth of the language of outcomes. Outcome is a mechanism to evaluate the quality, improve effectiveness and link practices to professional accountability.5
Gastro intestinal system support of critically ill patients requires non-invasive and invasive monitoring of physiological indicators of gastric function including factors that affect gastric performance (Digestion, Hydrochloric acid release) and the balance between food consumption and demand.6
Gastro intestinal surgeries are relatively very complicated in treatment and monitoring which needs a thorough understanding of condition where it always require continuous assessment and diagnosis of the complex conditions. This can be achieved only by good and sound knowledge in Hemodynamic monitoring.7
In the present day nursing there is a wide variation in the quality of assessment, monitoring, and documentation of these parameters, due to range of factors including intra and inter-observer reliability, equipments malfunction and patients preparation. Education of nurses and other health workers in the physiological and technical rationale under pinning the collection of vital signs data, and the significance of alteration in findings remains an important challenge.8
Nurse acting in her capacity as a monitor ,observes a patient, she decides whether his actual state is deviated from his individual homeostatic limits, she determines what actions must be taken to reduce any difference that she observes between the actual and desired states on this basis of the decision . She may take actions by herself or transmit the information to physician. The author highlights the importance of observation and decision making capacity on the part of nurses for which they should have clear knowledge regarding the procedure of monitoring.9
Two studies published inDigestive Diseases and Scienceshave demonstrated that an improved method for performing the standard upper endoscopy examination done on over eight million Americans with heartburn each year increases the detection of pre-cancerous cells in the esophagus by over 40 percent. Esophageal adenocarcinoma has increased by 600 percent over the last 25 years, making it the fastest growing form of cancer inthe United States. It is also one of the most lethal of cancers, with a five year survival rate of less than 20 percent.The two large nationwide multi-center studies found the addition of a specialized brush biopsy with computer-assisted laboratory analysis of the specimen to the standard upper endoscopy procedure, significantly increases the detection of both Barrett's esophagus and esophageal dysplasia (still-harmless, but pre-cancerous cells). This large increase in detection was found in the study that included academic centers and a second study that included community-based gastroenterology practices.10
The researcher believes that there is a need to educate the patients regarding endoscopy, so chosen this topic for investigation.
6.3. REVIEW OF LITERATURE
Studies related to knowledge on endoscopic procedure
Studies related to trends and impact of endoscopic procedure on patients
Studies related to effectiveness of self instructional module
STUDIES RELATED TO KNOWLEDGE ON ENDOSCOPIC PROCEDURE
Case seriesdesign was used to describe a simple technique that uses the pulley method to facilitate ESD procedures in the excision of large early-stage gastric cancers. Study was conducted in Tertiary medical center in Taiwan. The pulley method with standard clips and dental floss was used to provide traction to improve visualization of the dissection plane during ESD. The study findings reveled that En bloc resection of the lesion was achieved in 11 patients. No perforation or emergent surgery was noted. Study was concluded by saying the pulley method seems to facilitate en bloc ESD of early-stage gastric cancers >20 mm.11
Retrospective population-based study was conducted using the National Cancer Screening Program (NCSP) database. We evaluated GC detection rates, sensitivity, specificity, and positive predictive value (PPV) of endoscopic screening program for the average-risk Korean population aged 40 years and older, who underwent NCSP from 2002 through 2005. The detection rates of GC by endoscopy in the first and subsequent rounds were 2.71 and 2.14 per 1,000 examinations, respectively. Localized cancer accounted for 45.7% of screen-detected GC cases. The sensitivity of endoscopy was 69.0% (95% CI: 66.3-71.8). The endoscopic screening was less sensitive for the detection of localized GC (65.7%; 95% CI=61.8-69.5) than for regional or distant GC (73.6%; 95% CI=67.4-79.8). In the multiple logistic models for localized GCs and all combined GCs, whereas the OR of sensitivity for the mixed type was lower than that for the differentiated type. The sensitivity of endoscopic test in a population-based screening was slightly higher for detection of regional or distant GC than for localized GC. Further evaluation of the impact of endoscopic screening should take into account the balance of cost and mortality reduction.12
Healthcare costs, which now comprise 13.4% of the United States gross national product, continue to increase. President Clinton has placed healthcare reform on the national agenda, sparking nationwide debate. The President's plan will have an impact on all healthcare providers. As a result of this proposal, changes in the health care delivery system are occurring. The endoscopy setting will not be immune to these changes. In this article, the authors explore the possible impact of healthcare reform on nurses in general and, in particular, nurse in the endoscopy setting.13
The aim was to compare acute strength of various endoscopic colonic closure techniques by assessing air leak pressures in a previously described ex vivo experimental apparatus. Methodology was standardized colonic perforations were created using fresh porcine colon and subsequently closed on a bench. Results showed Mean colostomy leak pressures in millimeters of mercury (mmHg) and difference (with 95% confidence intervals [CI]) between each technique and the gold standard were: Quick Clips 85.1 (difference -1.8; 95% CI -7.0 to 3.9); T-tags 53.9 (difference -33.0; -39.0 to -27.0); OTSC 90.3 mmHg (difference 3.4; -6.1 to 12.9); 15-mm shaft stapler 98.5 mmHg (difference 9.7; 0.8 to 18.5) and 8-mm shaft stapler 96.6 mmHg (difference 11.6; 1.5 to 21.7). Study concluded saying that OTSCs, Quick Clips, and both flexible staplers produced results comparable to hand-sewn colostomy closure in this ex vivo porcine colonic model. These devices seem to be prime candidates for further evaluation in survival animal studies.14
Retrospective study was conducted with the aim of to investigate the safety of capsule endoscopy systems. A standardized questionnaire was sent to high volume centers in Germany and in Austria. The study findings reveled Data from 62 patients were retrieved for this study. Capsules used were Given Imaging (n=58; M2A, M2Aplus, Pill Cam SB2), Olympus EndoCapsule (n=3), Given PillCam Colon (n=1). The collective included patients with pacemakers/ICDS from seven brands (Biotronik, Medtronic, St. Jude Medical, Guidant, Boston Scientific, Ela Sorin, Vitatron) with a total of 19/8 (pacemaker/ICD) different types. In two patients interference between capsule endoscopy and telemetry (loss of images/gaps in video) was recorded. None of the cardiac pacemakers or ICDs was impaired in function. No clinically evident event was observed in any of these patients. At last study concluded saying Clinical use of these CE types is safe in patients with cardiac pacemakers and ICDs. Interference can occur between CE and ECG-telemetry leading to loss of images or impaired quality of video.15
Aprospective, multicenter, randomized, controlled study to evaluate tolerance and degree of intestinal cleanliness during CE following three types of bowel preparation.The degree of cleanliness of the small bowel was classified by blinded examiners according to four categories (excellent, good, fair or poor). The degree of patient satisfaction, gastric and small bowel transit times, and diagnostic yield were measured. Study finding reveled that The degree of cleanliness did not differ significantly between the groups (P=0.496). Interobserver concordance was fair (k=0.38). No significant differences were detected between the diagnostic yields of the CE (P=0.601). Gastric transit time was 35.7±3.7min (group A), 46.1±8.6min (group B) and 34.6±5.0min (group C) (P=0.417). Small-intestinal transit time was 276.9±10.7min (group A), 249.7±13.1min (group B) and 245.6±11.6min (group C) (P=0.120). CL was the best tolerated preparation. Compliance with the bowel preparation regimen was lowest in group C (P=0.008). the study concluded stating that a clear liquid diet and overnight fasting is sufficient to achieve an adequate level of cleanliness and is better tolerated by patients than other forms of preparation.16
STUDIES RELATED TO TRENDS AND IMPACT OF ENDOSCOPIC PROCEDURE ON PATIENTS
In a symposium in the 79th Annual Meeting of the Japan Gastroenterological Endoscopy Society colorectal tumor is closely observed using the recent high-resolution videocolonoscopy, a pit-like pattern on the tumor can be observed to a certain degree without magnification. In the symposium we could have a consensus that we will name the pit-like pattern as 'surface pattern.' Using the NBI system, the microvessels on the tumor surface can also be recognized to a certain degree. This group has developed a simple category classification (NBI international colorectal endoscopic [NICE] classification), which classifies colorectal tumors into types 1-3 even by closely observing colorectal tumors using a high-resolution videocolonoscopy (Validation study is now ongoing by Colon Tumor NBI Interest Group.). The key advantage of this is simplification of the NBI classification. Although the magnifying observation is the best for getting detailed NBI findings, both close observation and magnifying observation using the NICE classification might give almost similar results. Of course the NICE classification can be used more precisely with magnification. In this report we also refer the issues on NBI magnification, which should be solved as early as possible.17
The screening of the small intestine has become painless and easy with wireless capsule endoscopy (WCE) that is a revolutionary, relatively non-invasive imaging technique performed by a wireless swallowable endoscopic capsule transmitting thousands of video frames per examination. The average time required for the visual inspection of a full 8-h WCE video ranges from 45 to 120min, depending on the experience of the examiner. In this paper, we propose a novel approach to WCE reading time reduction by unsupervised mining of video frames. The proposed methodology is based on a data reduction algorithm which is applied according to a novel scheme for the extraction of representative video frames from a full length WCE video. It can be used either as a video summarization or as a video bookmarking tool, providing the comparative advantage of being general, unbounded by the finiteness of a training set. The number of frames extracted is controlled by a parameter that can be tuned automatically. Comprehensive experiments on real WCE videos indicate that a significant reduction in the reading times is feasible. In the case of the WCE videos used this reduction reached 85% without any loss of abnormalities.18
In a article it as stated that wireless capsule endoscopy is a revolutionary technology that allows physicians to examine the digestive tract of a human body in the minimum invasive way. Physicians can detect diseases such as blood-based abnormalities, polyps, ulcers, and Crohn's disease. Although this technology is really a marvel of our modern times, currently it suffers from two serious drawbacks: 1) frame rate is low (3 frames/s) and 2) no 3-D representation of the objects is captured from the camera of the capsule. In this paper we offer solutions (methodologies) that deal with each of the above issues improving the current technology without forcing hardware upgrades. They also extract and represent the texture of the surface of the digestive tract in 3-D. Thus the purpose of our methodology is not to reduce the time that the gastroenterologists need to spend to examine the video. On the contrary, the purpose is to enhance the video and therefore improve the viewing of the digestive tract leading to a more qualitative and efficient examination. The proposed work introduces 3-D capsule endoscopy textured results that have been welcomed by Digestive Specialists.19
In a article it as stated that Over the past decade Wireless Capsule Endoscopy (WCE) technology has become a very useful tool for diagnosing diseases within the human digestive tract. Physicians using WCE can examine the digestive tract in a minimally invasive way searching for pathological abnormalities such as bleeding, polyps, ulcers and Crohns disease. To improve effectiveness of WCE researchers have developed software methods to automatically detect of these diseases at a high rate of success. This paper proposes a novel synergistic methodology for automatically discovering polyps (protrusions) and perforated ulcers in WCE video frames. Finally, results of the methodology are given and statistical comparisons are also presented relevant to other works.20
Wireless Capsule Endoscopy (WCE) is a revolutionary technology that allows physicians to examine the patients whole gastrointestinal tract, especially the small intestine. However, reviewing capsule endoscopic video is a labor intensive task and very time consuming. In this paper we propose a novel method to detect key frames with abnormalities. It is based on the adaptive non-parametric corner detection approach using both the color and texture features. Real world patient videos including abnormal findings are adopted to evaluate the performance of the proposed method. The experimental results demonstrate that the proposed approach leads to the reduction of the number of frames in the WCE video without losing critical information.21