published_or_final_version / Community Medicine / Master / Master of Public Health

Thesis (M.P.H.)--University of Hong Kong, 2009. / Includes bibliographical references (p. 72-78).

Colorectal cancer is one of the most common cancers in Hong Kong and there is an upward trend on the incidence rate. Lots of literatures found that colonoscopy is a relatively effective method for the screening of colorectal cancer. Optimal visualization of entire colonic mucosa is mainly affected by the quality of bowel cleansing. However, poor bowel cleansing is found to be a common problem for patients undergoing colonoscopy. As no evidence-based guideline was found on enhancing the quality of bowel cleansing, this dissertation aims at formulating an evidence-based guideline on it. In constructing this guideline regarding the enhancement of quality of bowel cleansing, a systemic search of relevant literatures was performed in several databases. Six studies were identified and critically appraised by using quality appraisal tool. Scottish Intercollegiate Guideline Network (SIGN). After that, the evidences were summarized, synthesized and translated into four recommendations. An evidence-based guideline to enhance the quality of colonic cleansing for adult patients undergoing colonoscopy was developed and its implementation potential was evaluated. In the phase of implementation, a communication plan was developed to initiate, guide and sustain the change. A pilot test was then established to examine the feasibility of actual implementation. An evaluation plan was made to assess the effectiveness of the proposed guideline on achieving the expected main outcomes, in patient, healthcare provider and system aspects. It is anticipated that with the use of this guideline, the quality of colonic cleansing for adult patients undergoing colonoscopy will be enhanced. The hospital involved will thus improve the quality of care and contribute to the whole health care system. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Introduction: In recent years, the incidence of colorectal cancer in Hong Kong has risen to become the most frequent cancer type whereas its mortality ranks second. As effective screening is demonstrated to improve survival outcomes, the government in response proposed a mass population colorectal cancer screening program for high-risk groups; screening methods include fecal occult blood test, flexible sigmoidoscopy, and colonoscopy. Because colonoscopy is a highly operator-dependent and is therefore very prone to human error, processes to ensure it is performed safely include credentialing and defining scope of practice. As this concept is relatively new in Hong Kong, this study aims to investigate its applicability specific to colonoscopy in the city’s medical profession through determining competency indicators in the procedure. Methods: A systematic review was performed using online databases—PubMed and Google Scholar—to retrieve sources of information. Aside from academic research, guidelines from professional associations from three countries were also incorporated in this paper; they are the Gastroenterological Society of Australia, the Canadian Association of Gastroenterology, and the American Society for Gastrointestinal Endoscopy. Results: Technical aspects for competency include a mean withdrawal time of over 6 minutes;; first time examination adenoma detection rate of ≥ 25% and ≥ 15% in asymptomatic men and women ages > 50, respectively; ≥ 90% cecal intubation rate in all cases; perforation and post-polypectomy bleeding complication rates at < 1/1,000 and < 1/100 cases respectively;; and annual volume rates between 100 to 150 procedures. Experience is a significant factor in improving technical competency. Cognitive competency include correctly identifying and managing abnormalities, and knowledge of appropriate patient indications and contraindications for screening colonoscopy, risk management, and intervals for the procedure. . Conclusion: Guidelines recommend annual volume rates to be used as the primary indicator of technical competency, whereas the minimum medical academic qualification is recommended to have residency in endoscopic surgery. As colonoscopy is provided in both the public and private healthcare sector, the credentialing committee should have authority to influence colonoscopy providers in both sectors. A suitable agency is the Hong Kong Academy of Medicine, as they accredit specialists, and colonoscopy overseas is typically performed by endoscopists having received specialty training. / published_or_final_version / Public Health / Master / Master of Public Health

Dose-related adverse cardiopulmonary events associated with conventional intravenous sedation accounted for most of the complications during colonoscopy. This thesis described clinical trials to look for a safer sedative method (patient-controlled sedation, PCS) and possible ways to reduce the need of sedative medications during colonoscopy. / One hundred elderly patients (over 65 years old) were randomised to receive either PCS (a combination of propofol and alfentanil) or conventional intravenous sedation (a combination of diazemuls and pethidine) during colonoscopy. The patients in the PCS group experienced significant less adverse cardiopulmonary events. Other parameters, however, were similar in both groups. The use of PCS for colonoscopy thus appeared safer when compared to conventional intravenous sedation. In a subsequent large scale prospective study (N=500), twenty-two percent of the patients were unwilling to use PCS for colonoscopy; and that the younger patient (&lt;50 years old), female gender, a higher mean dose of sedatives consumed, a lower satisfaction score expressed, and the presence of delayed side effects were independent factors identified to predict the unwillingness of using PCS for colonoscopy. / The use of adjunct sedation such as audiovisual distraction was proposed as a way to reduce sedative requirements during colonoscopy. By using PCS as a quantitative outcome measure, audio distraction (in the form of music) was found to be able to decrease sedative requirements by 28%. The use of visual distraction alone, however, failed to decrease the sedative requirements; but nonetheless improved the acceptance of colonoscopy. Finally, a randomised comparison on the use of conventional endoscopes with that of the newly available variable stiffness endoscope used for colonoscopy was performed; and found that the latter was associated with less procedure-related pain and hence the consumption of sedative medications. / To conclude, PCS for colonoscopy was safe, feasible and acceptable. The use of adjunct sedation (audio distraction) and the newly available variable stiffness endoscope might decrease the need of sedative medications during the procedure. / Lee Wai Hung, Danny. / "September 2005." / Adviser: S. C. S. Chung. / Source: Dissertation Abstracts International, Volume: 67-07, Section: B, page: 3694. / Thesis (M.D.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (p. 256-280). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / School code: 1307.

Thesis (M.S.)--University of North Texas, August, 2009. / Title from title page display. Includes bibliographical references.

Objetivo: Determinar si la localización y el tamaño de los adenomas de colon se asocian con la presencia de displasia de alto grado en los pacientes de un hospital peruano. Materiales y Métodos: Se realizó un estudio trasversal mediante la revisión de informes de colonoscopías de los años 2014-2015 del Hospital Nacional Daniel Alcides Carrión, incluyéndose los pólipos de pacientes mayores de 18 años; y excluyéndose los de pacientes con cáncer de colon, antecedente de cirugía oncológica, enfermedad inflamatoria intestinal y poliposis (6 o más). Se extrajeron los datos de localización (colon proximal y distal, división a partir del ángulo esplénico), tamaño (menos de 10 mm y 10 mm o más), forma (pediculados y sésiles) y grado de displasia (bajo y alto grado). Se calculó la fuerza de asociación mediante OR, se determinó si existía asociación a través de la prueba Chi cuadrado, con nivel de significancia menor a 0,05. Resultados: De un total de 1710 informes de colonoscopías revisadas, 378 personas tuvieron pólipos, calculando una tasa de detección de adenomas de 22,1%. De los 458 pólipos encontrados 254 fueron adenomas. Se demostró una asociación significativa entre la localización en colon distal y displasia de alto grado (OR 2,68 IC 1,12-6,42, p<0.05); asimismo, los adenomas mayores o iguales a 10 mm tuvieron más riesgo de displasia de alto grado (OR 7,75 IC 3,05-19,69, p<0.05). No se encontró asociación entre la forma de los adenomas y grado de displasia. Conclusión: Se concluye que el tamaño de 10 mm o más y la localización en colon distal se asocian a displasia de alto grado en los adenomas. / Objective: To determine whether localization and size are related to the presence of high-grade dysplasia of colon adenomas in patients of a Peruvian hospital. Materials and methods: This is a descriptive transversal study. We checked colonoscopy reports of 2014-2015 years of Hospital Daniel Alcides Carrion, we included the polyps found in patients older than 18 years old, and excluded reports from patients with colorectal cancer, an antecedent of oncological surgery, inflammatory bowel disease and polyposis (6 or more). We used data based on localization (proximal and distal colon, based on the splenic angle), size (less than 10 mm and 10 mm or more), shape (pediculate and sessile) and grade of dysplasia (low and high-grade). We calculated the strength of association by OR, and we determined whether there was association by Chi-square test with a significance value less than 0.05. Results: We reviewed a total of 1710 of colonoscopy reports, 378 patients had polyps, so the adenoma detection rate was 22.1%. There were 458 polyps, from which 254 were adenomas. From these adenomas, we found an association between distal colon localization and high-grade dysplasia (OR 2.68 IC 1.12-6.42, p<0.05); likewise, there was an association between the size of the adenomas and high-grade dysplasia (OR 7.75 IC 3.05-19.69, p<0.05). We did not find any association between the shape and grade of dysplasia. Conclusion: This study concludes that there is an association between the size of 10 mm or more and localization in the distal colon with high-grade dysplasia of adenomas.

Thesis (M.S.)--University of Michigan, 1987.

Thesis (M.S.)--University of Michigan, 1987.

No description available.