Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Effect of audio and visual distraction on patients undergoing colonoscopy: a randomized controlled study(Stuttgart : Georg Thieme Verlag KG, 2016) de Silva, A.P.; Niriella, M.A.; Nandamuni, Y.; Nanayakkara, S.D.; Perera, K.R.P.; Kodisinghe, S.K.; Subasinghe, K.C.E.; Pathmeswaran, A.; de Silva, H.J.BACKGROUND AND STUDY AIMS : Colonoscopy can cause anxiety and discomfort in patients. Sedation and analgesia as premedication can lead to complications in the elderly and those with comorbidities. This has led to an interest in the use of audio-visual distraction during the colonoscopy. We compared the effects of audio (AD) versus visual distraction (VD) in reducing discomfort and the need for sedation during colonoscopy. PATIENTS AND METHODS: Consecutive patients undergoing colonoscopy were randomized into three groups: one group was allowed to listen to the music of their choice (AD), the second group was allowed to watch a movie of their choice (VD), and the third group was not allowed either distraction during colonoscopy and acted as a control (C). Patient controlled analgesia and sedation were administered to all three groups. We used 25 mg of pethidine in 5-mg aliquots and 2.5 mg of midazolam in 0.5-mg aliquots. All patients were assessed for perceived pain and willingness to repeat the procedure. Number of "top-ups" of sedation and total dose of pethidine and midazolam were noted. Patient cooperation and ease of procedure were assessed by the colonoscopist. RESULTS: In total, 200 patients were recruited [AD, n = 66 (32 males, median age 57 years); VD, n = 67 (43 males, median age 58 years); C, n = 67 (35 males, median age 59 years)]. The AD group had significantly less pain (P = 0.001), better patient cooperation (P = 0.001) and willingness to undergo a repeat procedure (P = 0.024) compared with VD and C groups. CONCLUSIONS: AD reduces pain and discomfort, improves patient cooperation and willingness to undergo a repeat procedure, and seems a useful, simple adjunct to low dose sedation during colonoscopy.Item Is a six hour fast after a rice meal sufficient before upper gastrointestinal endoscopy?(American Gastroenterological Association(AGA) Institute, Published by Elsevier Inc., 2009) de Silva, A.P.; Niriella, M.A.; Perera, N.J.A.H.D.; Aryasingha, J.S.; Kalubowila, U.P.; Dassanayake, A.S.; Pathmeswaran, A.; Manchanayake, M.M.J.H.; Devanarayana, N.M.; de Silva, H.J.OBJECTIVE: Rice is the staple diet in many Asian countries. Current endoscopic guidelines advice a 6 h fast for solids and a 4 h fast for liquids before the procedure. However, these guidelines focus on a Western type diet. The aim of the study was to determine if a 6 h fast for rice is sufficient prior to upper gastrointestinal endoscopy (UGIE). PATIENTS AND METHODS: After informed consent, 212 patients referred for UGIE, who had no alarm symptoms, were randomized into two groups in preparation for UGIE. Fasting 6 h after a rice meal (R6) or fasting 10 h after a rice meal (R10). All meals contained lentils and an egg, and were isocaloric. Endoscopic vision was graded as poor, average, or good. RESULTS: In the R10 group (n = 107) vision was poor in 2 (1.9%), average in 7 (6.5%), and good in 98 (91.6%). While in the R6 group (n = 105) vision was poor in 30 (28.6%), average in 19 (18.1%), good in 56 (53.3%). The observed difference of percentages among the two groups for endoscopic vision was significant (M-H Chi-Square for trend = 25.67; df = 1; p < 0.001). CONCLUSIONS: Fasting for 6 h after a rice based meal seems inadequate for UGIE. Fasting for 10 h significantly improves endoscopic vision. Current guidelines need to be re-evaluated for populations where rice is the staple diet.