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Master's Dissertation
DOI
10.11606/D.5.2011.tde-24052011-123302
Document
Author
Full name
Vivian Mayumi Ussui
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2011
Supervisor
Committee
Hashimoto, Claudio Lyoiti (President)
Guarita, Dulce Reis
Zeitune, Jose Murilo Robilotta
Title in Portuguese
Estudo dos parâmetros de tolerância relacionados à colonoscopia
Keywords in Portuguese
Colonoscopia
Comportamento cooperativo
Dor abdominal
Tolerância
Abstract in Portuguese
Os exames endoscópicos são considerados procedimentos invasivos, desconfortáveis e estressantes. A colonoscopia, em virtude da necessidade de laxantes para o preparo do cólon, de sua complexidade técnica e do constrangimento devido à maior exposição, causa ansiedade, preocupação e preconceito. No entanto, a colonoscopia é, atualmente, o procedimento de escolha para investigação de enfermidades do intestino grosso de elevada acurácia e possibilidade de realização de procedimentos terapêuticos, mas requer elevada colaboração e tolerância dos pacientes. A tolerância pode ser interpretada de várias maneiras, como aceitação, nível de satisfação e conforto durante o exame, ou disposição para repetir o procedimento. Foi realizado no Centro de Diagnóstico do Serviço de Gastroenterologia Clínica do Instituto Central do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, um estudo observacional prospectivo, longitudinal, com o objetivo de avaliar o nível de tolerância do paciente submetido à colonoscopia e os fatores intervenientes na tolerância. No período de março a dezembro de 2008, foram avaliados 373 pacientes adultos consecutivos, submetidos à colonoscopia eletiva. Foram incluídos pacientes submetidos a exames eletivos, com idade acima de 18 anos, com compreensão e aceitação da entrevista e do procedimento, e que assinaram o termo de consentimento livre e esclarecido. Um inquérito foi aplicado antes, durante e após o exame, a partir de dois questionários: formulário do paciente, preenchido pelo médico pesquisador; e ficha de avaliação médica, preenchido pelos médicos pesquisador e executante. No presente estudo considerou-se tolerância como a disposição do paciente para repetir o exame. Esse questionamento foi aplicado imediatamente na pré-alta, com o indivíduo desperto e orientado, no mínimo duas horas após o procedimento. Os fatores avaliados no pré-exame, durante o exame e no pós-exame foram comparados entre o grupo de pacientes tolerantes e os não tolerantes. Noventa e um por cento dos pacientes avaliados mostraram-se tolerantes à colonoscopia. Maiores níveis de tolerância foram observados em pacientes do sexo masculino (p=0,005; OR=14,8), com idade entre 41 anos e 60 anos (p=0,003; OR=56,92), colaborativos durante o exame (p=0,013; OR=6,15) e que não apresentaram cólica durante o preparo intestinal (p=0,013; OR=5) ou dor abdominal após o procedimento (p=0,032; OR=3,25). Um dos fatores limitantes do presente estudo foi o desconhecimento da razão pela qual o paciente não faria novamente o exame. A diferente graduação dos médicos colonoscopistas, a inclusão de pacientes ambulatoriais e internados submetidos à cirurgia colorretal tornaram a amostra heterogênea, porém mais representativa da prática clínica. Nessa amostra, a dor abdominal associada à colonoscopia foi o elemento mais significativo na caracterização da tolerância
Title in English
Study of colonoscopy-related tolerance parameters
Keywords in English
Abdominal pain
Colonoscopy
Cooperative behavior
Tolerance
Abstract in English
Endoscopic assessments are considered invasive, uncomfortable and stressful procedures. The colonoscopy, due to the need for laxative use for colon preparation, its technical complexity and the embarrassment caused by privacy exposure, results in anxiety, concern and prejudice. However, the colonoscopy is currently the procedure of choice to investigate large bowel disorders, due to its high accuracy and the possibility of performing therapeutic procedures during the examination, but it requires a high degree of collaboration and compliance on the part of the patient. Tolerance can be interpreted in different ways, such as acceptance, level of satisfaction, and comfort during the examination, or willingness to have the procedure repeated. A prospective observational study was carried out at the Diagnostic Center of the Service of Clinical Gastroenterology of Instituto Central of Hospital das Clínicas of the School of Medicine of the University of São Paulo (HCFMUSP), aiming at evaluating the level of tolerance of patients submitted to colonoscopy and the factors that interfere with this tolerance. A total of 373 consecutive adult patients submitted to elective colonoscopy were studied from March to December 2008. The inclusion criteria consisted of patients submitted to elective examinations, aged 18 and older, which understood and agreed with the interview and the procedure and signed the Free and Informed Consent Form. A survey was applied before, during and after the examination, based on two questionnaires: the patients questionnaire, filled out by the medical researcher and the medical assessment file, filled out by the medical researcher and the attending physician. The present study considered the patients tolerance as the willingness to have the procedure repeated. This survey was applied immediately at the pre-hospital discharge, when the patient was conscious and oriented, at least two hours after the procedure. The factors assessed before, during and after the examination were compared between the groups of compliant and non-compliant patients. A total of 91% of the assessed patients showed to be compliant with the colonoscopy. Higher levels of tolerance were observed in male patients (p=0.005; OR=14.8), aged 41 to 60 years (p=0.003; OR=56.92), who collaborated during the examination (p=0.013; OR=6.15) and did not have colic during the intestinal preparation (p=0.013; OR=5) or abdominal pain after the procedure (p=0.032; OR=3.25). One limitation of the present study was the lack of information on why the patient would not have the procedure repeated. The varied degrees of skill presented by colonoscopists, the inclusion of outpatients and inpatients submitted to colorectal surgery made the sample a more heterogeneous one, albeit more representative of clinical practice. In this sample, abdominal pain associated with the colonoscopy was the most significant element in the characterization of tolerance
 
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Publishing Date
2011-05-25
 
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