Patient With Rectal Bleeding Case Study

Table of Contents

Case Study Of Patient With Rectal Bleeding
Impact Of Advanced Clinical Practice
The Key Concepts Involved In Advanced Clinical Reasoning And Decision Making
Critical Analysis Of The Clinical Endoscopist Role
Differential Diagnosis
Reflection
Reflection

2726 Pages 6543 Words

Case Study Of Patient With Rectal Bleeding

Get free written samples by our Top-Notch subject experts and Online Assignment Help team.

Introduction

As per the case study Mrs. White was released from the medical facility due to the massive surge of covid-19 pandemic. But the medical professionals maintained constant telephonic consultation with her. She upon consultation reported that she is bloating and a constant persistence of pain in the lower abdomen. She also reported that she is experiencing nausea but no vomiting. She also reported that she is suffering from loss of appetite and a stable weight loss. She also informed the telephone consultant that she suffered from covid-19 during April. She is also on her hypertension and depression medication. She stated that she has seen a considerable amount of blood in the stool. So by accounting her condition the doctor recommended having a check up to find out whether she's affected with rectal cancer. Mrs. White has reported encountering some sort of discomfort in the abdominal area, especially in the rectum site. Symptoms include excessive loss of weight along with blood in the stool and discomfort while bowel movements. Apart from the primary analysis, it was seen that the patient is suffering from hypertension and is in her late sixties. This was considered to be the symptom of having rectal cancer. According to the NHS recommendation, the susceptibility of having rectal cancer during the late years is high. The general symptom of rectal cancer includes loss of weight along with the presence of blood in the stool. A similar symptom was shown by Mrs. White. At first, due to the covid-19 and the critical condition of the patient the doctor advised providing primary intervention in the home. But after some time it was seen that the condition of the patient was getting worse. By assessing the complexity of the situation the doctors have started to admit Mrs. White into a nearby medical facility. Upon presenting in the medical facility the patient reported that she once suffered from covid-19 infection. So it is evident that the immunity of the patient is quite suppressed. By analysing the condition of the patient the doctors have recommended performing in the script to find any presence of carcinoma in the rectal walls. According to the guidelines provided by the joint research of NHS and NIC, it was found that the doctors have to rule out the presence of critical disease at first. This process is highly beneficial as the presence of any critical disease can cause significant damage to the patient if not provided primary intervention during the first instance. Endoscopy includes analysing the internal walls of the rectum. This process is highly beneficial as it will provide a detailed picture that can be used as a diagnosis for the presence of carcinoma. Other than this endoscopy also includes diagnosis of any presence of haemorrhage in the rectal walls.

Discussion

Impact Of Advanced Clinical Practice

This case study of the huge impact on advanced clinical practice. Upon the preliminary understanding the doctor recommended having a proper diagnosis regarding the presence of rectal cancer (Rodriguez-Justo et al., 2019). According to the guidelines issued by the NHS the disease which has greater susceptibility to become fetal in nature must be eliminated or diagnosed first. Apart from this the symptoms shown by Mrs white are quite well aligned with the symptoms of rectal cancer. This kind of approach is highly important to save some crucial time for the patient who is suffering from any life threatening disease.

The Key Concepts Involved In Advanced Clinical Reasoning And Decision Making

The clinical reasoning or decision making process is quite complex and must be well aligned with the guidelines issued by the government or other such governmental agencies. The medical facility firstly rules out the possibility of having life straightening disease which requires proper timely interventions such as carcinoma (Mowat et al., 2020). For this reason the Endoscopist recommended diagnosing any presence of carcinoma tissue in the rectal walls. The symptoms like abnormal weight loss associated with presence of blood in the stool can be taken as well noted evidence to have a proper diagnosis is adding the presence of Cancer tissue. By the help of the diagnostic test the medical team can get a detailed picture of the lower gastrointestinal tract which generally comprises ileum ascending colon transverse colon descending colon sigmoid colon and rectum. By the help of the imaging if any presence of carcinoma cells are found in the rectal area it can be removed or taken to the biopsy. In spite of all the safety procedures there is still some underlying risk in the process of endoscopy. According to the findings of Lancet magazine the average complication rate of this diagnostics test lies in the range of 5% to 10%.

Other than these the patient may suffer from presence of hemorrhoids in the rectal wall. So it must be diagnosed if it is found that there is absence of any carcinoma cells in the rectal walls.

Critical Analysis Of The Clinical Endoscopist Role

The endoscopist performs a great role in this procedure. He works under the guidance of the NHS to improve the standard of service that he is providing. According to the guidelines the endoscopies have the full authority to prioritise the cases according to their complexity. In the case of Mrs white endoscopist played a great role in providing primary diagnosis by analysing the tissues in the rectal wall to see any presence of carcinoma in it (Quigley et al., 2018). As mentioned before it is quite under the rule of the NHS that endoscopists have to diagnose the presence of any life treating diseases.

So from the preliminary analysis it will be very safe to justify that the person who was in charge of performing endoscopy has done his job quite well according to the rule and regulation as well as the ethical consideration of the medical profession.

Endoscopic Findings Based

Anatomy

Mrs white is a 75 year old woman who has suffered from covid-19. So it can be said that her immune system is quite sufficient. Other than this there are few complexities that come along with age (Ford et al., 2017). According to the NHS the risk of developing rectal carcinoma increased as per the age. Apart from having cancer there are also chances of developing diverticulitis or hemorrhoids in the rectal wall. This may also result in abnormal rectal bleeding.

Medical History

The medical history of an individual dolphin plays a great role in the process of developing diseases. Mrs white just recovered from covid-19 which signifies that she is in an highly immuno compressed state. She also has a history of bleeding. Recently she also stated that there is a change in the bowel habit accompanied by acute constipation and abdominal pain. These whole signs and symptoms can be considered as the primary symptoms of having rectal cancer.

Lower Gastrointestinal Tract

By the help of the endoscopy the medical team can get proper imaging of the internal wall of the rectal canal. This can be quite helpful in order to have an idea regarding the carcinoma cells and other complexities in the rectal wall. As per the case study of the patient there is a presence of blood in the stool of the patient (Edwards et al., 2020). This signifies that the rectal wall is bruised and may contain some hemorrhoids in it. Other than the presence of carcinoma and hemorrhoids there may be additional complications such as perforation in the air pressure, sigmoid looping, diverticulosis and also ulcers in the lower jejunum. Each of the diseases mentioned above exhibit similar signs and symptoms like bleeding for feeling of nausea.

Differential Diagnosis

Other than having carcinoma in the rectal walls Mrs white can suffer from hemorrhoids. It is often seen that the individual at their late 70 having hypertension can develop clotting of blood in the rectal walls (Arikan et al., 2018). As per the case study Mrs white also suffers from hypertension and on constant medication. Other than these the hemorrhoid can also cause bleeding in the stool. So the medical professionals other than searching for carcinoma cells also identify the presence of hemorrhoids in the rectal walls. The presence of hemorrhoids in humans increases exponentially according to their age. Other physiological conditions such as hypertension or suppressed immunity can also increase the susceptibility of an individual to this kind of blood clotting. By the help of the differential diagnosis test such as complete blood test along with an ultrasonography of the lower gastrointestinal tract can be helpful in order to find in ulcers our infection that are causing the hemorrhoids in the rectal wall. If it is found that the presence of hemorrhoids is quite low then it can be properly treated with the help of the anticoagulant medicines. According to the evidence based practices in some rare cases where the internal walls of the rectum are completely filled with hemorrhoids in those cases the surgical intervention can be one of the most possible options. By the help of the surgery the open blood vessels can be reconstructed which can be helpful in order to control the gastrointestinal bleeding. And if it is found that Mrs White is not in a good condition for surgery The other treatment procedures and radiography can be helpful.

Recommend Further Investigations

The usage of "ultrasonography” can also be a proper investigation option for the medical personnel. If it is seen that there is no prevalence of carcinoma or hemorrhage in the rectal walls there may be some sort of infection in the internal organs which are causing bleeding in the stool.

Evidence-based Management Plan And Holistic Care

As per the recommendation of the NHS and "World health organisation" the process of endoscopy has been done with extreme care. Previously It is seen that during the process of endoscopy there is unusual bleeding (Shields et al., 2017). So in order to avoid this kind of scenario endoscopists have provided Mrs white with anticoagulants. This can cause any further hemorrhoids in the rectal walls.

SWOT Analysis

Strength	Weakness
? The basic strength of this scenario is highly advanced medical institutes present in the United Kingdom. ? As the patient is admitted to the emergency section so she can get immediate medical assistance (Rodriguez-Justo et al., 2019). ? The guides which are followed by the medical institute in the United Kingdom are highly modernized and can be used in order to provide primary interventions during any such cases of emergency. ? The usage of the endoscopy technique can shed some light on the internal walls of the rectum to diagnose any presence of rectum cancer.	? The weakness in this section is the age of the patient. As per the studies, the patient at this age is highly susceptible to develop carcinoma in the rectal section. This can cause a source of trouble for the medical teams. ? It is also seen that endoscopy is a good option for detecting carcinoma cells but it still has some problems in finding the cells which are not present in the cluster formation (Mowat et al., 2020). ? Apart from this, this diagnostic test fails to provide any support to detect the stages of carcinoma.
Opportunity	Threat
? The principal opportunity for the patient here is the advanced medical support that she will receive in the medical facilities. ? The emergency facility fully runs under the constant supervision of any changes which ensure that the patient will receive the optimum care while visiting there (Quigley et al., 2018). ? Due to the telephonic follow up the doctors are now having a clear Idea regarding the previous medical condition of Mrs. White. This will have a fruitful effect on the process of providing primary intervention. ? Do rectum cancer can be slightly life-threatening but providing proper treatment at the correct time can diminish the fatal outcome. ? Due to the covid-19 pandemic, the medical facilities all-round the United Kingdom is provided with highly modernized infrastructure. This can be helpful in providing a proper diagnosis.	? The principal threat of the patient is the age of the patient. Along with these the prior study also suggests the patient is suffering from hypertension. This can be quite a problem for the medical team as this kind of patient can deteriorate at any moment. ? In spite of the fact that the pause process of endoscopy is performed under the proper guidance of the trained personnel and supervision of the NHS, there is still some threat that this person can cause damage to the internal walls of the rectum.

Table 1: SWOT Analysis

(Source: Self Created)

Action Plan

Providing Emergency Care

At first, Mrs. White must be provided with proper emergency care. The main principle of providing emergency care is to cause a significant halt in the presence of blood in the stool. The use of coagulants can be quite productive in this procedure. It is often seen that during this kind of period there is a sudden fluctuation of blood pressure which can cause significant damage to the internal walls of veins and arteries. To minimise the complexities due to this factor the medical team must provide a proper intervention policy so that the blood pressure of the patient can get stabilized (Koulaouzidis et al., 2019).

Performing Diagnostic Procedure

Then the patient must undergo the proper diagnostic procedure. This process is highly important as it can provide a proper Idea regarding the complexity of the patient full stop in this case in order to analyse any presence of carcinoma cells in the rectal as the doctors have advised administering Mrs. White with endoscopy. This diagnostic test is also helpful in detecting any presence of haemorrhoids in the rectal wall.

Analysing the result

The results of the diagnostic test, which is mainly the picture of the internal walls of the rectum, must be analysed in order to get some idea regarding their conditions. If it is seen that the walls have an unnecessary cluster of cells then it might suggest the presence of carcinoma. Other than this, haemorrhage or internal injury can also be evident.

Drawing treatment procedure

By analysing the endoscopy the medical team can decide to opt-out for the optimum treatment procedure. This is highly important as if any carcinogenic cells are present in the rectal wall it can cause significant damage if left unchecked (Ford et al., 2017).

Performing Follow up

Depending on the success of the treatment procedure the medical team can design follow up which include system analysis of the vitals. This process is highly important as many times it is seen there is still a presence of complexity even if the process of shipment is successful.

Interview Records

Analysing the interview report is very beneficial for the treatment procedure of Mrs. White. As per the guidelines stated by the NHS the medical team must confirm the patient and try to have an idea regarding the past medical stature. As per the interview conducted on Mrs. White regarding her medical history, it was found that she had suffered from covid-19 infection and has a significant history of hypertension (Slade et al., 2018). This ability of the issues gets further highlighted due to our age Aaj and chronic presence of bowel diseases. so by analysing the condition of Mrs. White the medical team can state up a highly efficient medical procedure for her (Edwards et al., 2020).

Reflection

According to my This process of providing primary treatment to Mrs. White is highly efficient. According to the guidelines stated by the NHS, the medical team at first tries to understand the past medical record. As per my studies, this process is highly beneficial to get an overview regarding the basic condition of Mrs. White. Then by further analysing the NHS guidelines the medical facility first tries to rule out the presence of carcinoma in the rectal walls. In my opinion, this procedure is highly crucial as the diagnosis of a disease like cancer in its preliminary stage can buy some time for the proper treatment. Other than these the medical team also diagnosed the presence of haemorrhage or any internal damage to the rectal walls. This process is very much necessary to provide optimum care for Mrs. White.

JAG BSC certification

JAG BSC Certification is highly important for a person who is in charge of administering endoscopy to the patient. Previously It is seen that due to the wrong procedure of providing this kind of Diagnostic test there are several cases of damage in the rectal walls. In order to minimise this kind of mishap in the medical field, the Government of the United Kingdom along with the help of agencies like NICE have produced a code to train the persons to administer the Diagnostic test with dexterity. The principal focus of this certification is to enhance the capability e of an individual to administer endoscopy and other gastrointestinal Diagnostic tests. It provides necessary value, suggests how to handle the patient and provides necessary information regarding the different stages of the Diagnostic test (Arikan et al., 2018). Likely because of Mrs. White The person who is in charge of endoscopy administers certain medication which will make the process more smooth and free from having any unfortunate outcomes.

OSCAR

OSCE certification is highly important especially for the nursing team. It enhances the skills of the nurses by training them with the help of evidence-based analysis. Under this certification, the nurses are provided with some hypothetical or real-life scenario and they become the supervising body as well as they are in charge of determining the correct part of the primary intervention and follow up process. As per the vision of the health department of the United Kingdom, this kind of training can help to enhance the value as well as the attitude towards the patient from the nurse. It includes a proper communication module which can be used in order to get some help when Old person like Mrs. White comes up with an emergency. The nurses can set up a communication channel that will help the medical team to get to know about her medical history (Shields et al., 2017). As per the guidelines stated by the NHS having a proper medical history of a patient is highly useful prior to administering any primary intervention policies.

Reflection

I have come to know that this kind of certification is highly necessary in case of providing optimum care to the patient. Previously the process of endoscopy was known to be highly dangerous and the patient is susceptible to develop injury during any negligence and by the person who is in charge of administering his diagnosis test. Other than that, I also came to know that the efficiency of the technician is also important in order to get a conclusive result during the process of analysis. In my opinion, certificate courses like JAG under the guidance of a proper governmental medical board are highly necessary in order to provide optimum training to enhance the skills and values of the technician who is in charge of endoscopy and other crucial Diagnostic tests. I also saw that courses like OSCE can be set to have a highly beneficial role in order to create a communication channel between the nurses and the patient in order to get some idea regarding the previous medical condition of the patient.

Training Records

The medical team has demonstrated excellent competence according to their training. At first the training provided to the emergency medical team was found to be beneficial in order to provide primary medical intervention to Mrs. White (Yasin et al., 2019). It was found that to avoid any such complication in the hospital scenario Mrs. White is put on proper care in the home. The telephonic medical team are the team word in charge of taking proper follow up of Mrs. White when she is put on care in the home and also done remarkable work. By understanding the current condition of Mrs. White the team has recommended hard to visit the nearby medical facility and underwent a proper analysis. This was highly important. As per the training provided to the medical team this is quite a complex case at this age and it is quite crucial to provide proper primary intervention in time.

Then the medical team, by analysing the signs and symptoms exhibited by Mrs. White found that she may be suffering from rectal cancer. As per the guidelines issued by the NHS and the training provided to the medical team suggest that it is always the first priority for the diagnostic test to identify the presence of complex diseases such as carcinoma. In order to have a proper diagnosis Mrs. White was put on endoscopy (Kamada et al., 2020). This process is highly beneficial in order to detect the presence of carcinoma aur even traces of hemorrhoids in the internal wall of rectum. Due to the proper training provided to the technician the technician administered Mrs. White with anticoagulant which will be highly beneficial to minimise the chance of excessive bleeding during any case of unfortunate circumstances.

Slate Certification

SLATE Certification Is like communication training provided to the nurses and other medical steps in order to have a proper understanding among themselves. Previously it was seen that due to the lack of communication among the medical staff there was serious delay in providing primary intervention to the patients who are suffering from complex diseases. So by having proper training and certification from a renowned governmental facility which is regulated by the guide provided by NICE can be an important step (Mehta et al., 2020).

When analysing the case study it is found that the communication between the emergency medical team and diagnostic team is found to be highly crucial in order to provide timely primary intervention to Mrs. White. At first the emergency team provided adequate interventions in order to restrict the presence of blood in the stool. Then the nursing team takes a brief account of the previous physical condition of the patient. This is found to be highly beneficial to provide the proper treatment procedure. Then the medical team analyse the symptoms of the patient proper diagnostic test. The whole scenario exhibits a well functioning communication channel between the various departments inside the medical facility (Cloitre et al., 2019).

Hee Ce Competencies

This is a highly complex training provided to the technician who administers endoscopy. It was seen that while performing the diagnostic test due to the inefficiency of the technician the patient had to suffer some physical injury in the internal soft tissues. So nowadays according to the guidelines stated by the Government of the United Kingdom it is very important that all the technicians who are incharge of performing endoscopy have to undergo the process. In the case study it was seen that Mrs. White is administered with medication which can prevent the excessive blood loss when the tube is inserted through the rectum wall. Other than these two technicians also briefed her about the process and the probable outcome they are expecting. This process is highly important in order to increase the confidence and trust of the patient towards technicians (Idowu. and Okedere, 2020).

Formative Presentation

The formative presentation is highly beneficial for the case study. The presentation allows one to get a better idea regarding the condition of the patient. At first the patient is provided with the support via telephone. After the purpose is over the condition of the patient is debriefed and reported to the medical team. This process is beneficial to provide the optimum medical care to Mrs. White. The highly formative design also makes the process of performing endoscopy quite helpful. It is also seen that the nurses also played a great role in order to get an idea regarding the medical history of the patient (Corazza et al., 2019).

Reflection

According to my view the protocol used by the medical facility in order to provide the time for the primary intervention towards Mrs. White is highly competent. The proper intervention is provided according to the guidelines instituted by the department of the health care of the United Kingdom. I have seen at first according to the new protocol initiated by the government due to the pandemic of covid-19 Mrs. White is provided proper check up at home. Principal vision behind this guideline is to minimise the chances of duty in affected by the virus for the already immunocompetent patient. I saw that when the medical team came to know that there is slight complexity in the health of Mrs. White and she is showing signs of blood in the stool , the medical team quickly recommended her to go for the local medical facilities where she can get emergency health Care (Khajehgoodari et al., 2019). I have also found that according to the guidelines instituted by the NHS the nurses at the facility at first try to get an overview regarding the medical history of the patient. I have found that this kind of practice can be helpful in order to get an idea about the health condition of the patient as well as creating a good communication channel with them (Renoux et al., 2018). Then I found that by analysing the signs and symptoms shown by the patient the medical team went to perform a proper diagnostic test which is highly helpful for understanding the condition of the patient. As per the medical guidelines suggest it is the first priority to rule out the presence of any critical disease. Due to this reason the principle behind the endoscopy was to detect the presence of cancer in the rectal walls. The technician in charge of administering endoskopi is highly competent as he is trained according to the guidelines instituted by the federal government (Mori et al., 2019).

Conclusion

As per the case study the process of endoscopy to detect the presence of carcinoma cells in the rectal walls was a good move. Presence of carcinoma in the rectal walls with respect to the age of the patient can have a fatal outcome. Other than this it must be recommended that the medical professional must try to detect the presence of hemorrhoids In The rectal Wall as it can sometimes have similar kinds of symptoms. All the legal as well as the ethical procedure for the diagnosis of the disease have been performed with care. So it can be said that the medical professionals have provided the proper primary intervention on time. In order to conclude the portfolio it must be stated that Mrs. White received a proper health Care intervention from the medical facility. The government has done quite a remarkable work in order to generate the necessary protocols and guidance for the medical facilities in order to provide proper health care for the patient. At first Mrs. White when administered the treatment in the home setup in order to avoid any infection due to the virus. When things got slightly complex and Mrs. White kept on showing the signs and symptoms of developing a rectal cancer she was quickly transferred to local medical facilities and put on emergency health Care. The Nazis, according to the training they received, provided the best communication channel and tried to get some idea regarding the previous medical record of Mrs. White. This process is found to be beneficial to enhance the primary intervention policy. By the help of the endoscopy it is possible to generate the treatment procedure for her.

References

Journals

Banks, M., Graham, D., Jansen, M., Gotoda, T., Coda, S., Di Pietro, M., Uedo, N., Bhandari, P., Pritchard, D.M., Kuipers, E.J. and Rodriguez-Justo, M., 2019. British Society of Gastroenterology guidelines on the diagnosis and management of patients at risk of gastric adenocarcinoma. Gut, 68(9), pp.1545-1575.

Cummins, G., Cox, B.F., Ciuti, G., Anbarasan, T., Desmulliez, M.P., Cochran, S., Steele, R., Plevris, J.N. and Koulaouzidis, A., 2019. Gastrointestinal diagnosis using non-white light imaging capsule endoscopy. Nature Reviews Gastroenterology & Hepatology, 16(7), pp.429-447.

de Andrade, G.B., Pedroso, V.S.M., Weykamp, J.M., da Silva Soares, L., de Siqueira, H.C.H. and Yasin, J.C.M., 2019. Palliative Care and the Importance of Communication Between Nurse and Patient, Family and Caregiver. Revista de Pesquisa: Cuidado e Fundamental, 11(3).

Digby, J., Strachan, J.A., McCann, R., Steele, R.J., Fraser, C.G. and Mowat, C., 2020. Measurement of faecal haemoglobin with a faecal immunochemical test can assist in defining which patients attending primary care with rectal bleeding require urgent referral. Annals of Clinical Biochemistry, 57(4), pp.325-327.

Dohi, O., Majima, A., Naito, Y., Yoshida, T., Ishida, T., Azuma, Y., Kitae, H., Matsumura, S., Mizuno, N., Yoshida, N. and Kamada, K., 2020. Can image?enhanced endoscopy improve the diagnosis of Kyoto classification of gastritis in the clinical setting?. Digestive Endoscopy, 32(2), pp.191-203.

Ford, A.C., Moayyedi, P., Chey, W.D., Harris, L.A., Lacy, B.E., Saito, Y.A. and Quigley, E.M., 2018. American College of Gastroenterology monograph on management of irritable bowel syndrome. Official journal of the American College of Gastroenterology| ACG, 113, pp.1-18.

Ghosh, A.M., Gupta, S. and Mehta, A.S., 2020. A Comparative Clinical Study between X-ray Nasopharynx and Nasal Endoscopy in the Diagnosis of Chronic Adenoiditis: Our Experience.

Hunt, R., Armstrong, D., Katelaris, P., Afihene, M., Bane, A., Bhatia, S., Chen, M.H., Choi, M.G., Melo, A.C., Fock, K.M. and Ford, A., 2017. World gastroenterology organisation global guidelines: GERD global perspective on gastroesophageal reflux disease. Journal of clinical gastroenterology, 51(6), pp.467-478.

Hyland, P., Karatzias, T., Shevlin, M. and Cloitre, M., 2019. Examining the discriminant validity of complex posttraumatic stress disorder and borderline personality disorder symptoms: results from a United Kingdom population sample. Journal of Traumatic Stress, 32(6), pp.855-863.

Idowu, B.M. and Okedere, T.A., 2020. Diagnostic radiology in Nigeria: a country report. Journal of Global Radiology, 6(1), p.4.

Kennedy, N.A., Jones, G.R., Lamb, C.A., Appleby, R., Arnott, I., Beattie, R.M., Bloom, S., Brooks, A.J., Cooney, R., Dart, R.J. and Edwards, C., 2020. British Society of Gastroenterology guidance for management of inflammatory bowel disease during the COVID-19 pandemic. Gut, 69(6), pp.984-990.

Lahner, E., Zagari, R.M., Zullo, A., Di Sabatino, A., Meggio, A., Cesaro, P., Lenti, M.V., Annibale, B. and Corazza, G.R., 2019. Chronic atrophic gastritis: Natural history, diagnosis and therapeutic management. A position paper by the Italian Society of Hospital Gastroenterologists and Digestive Endoscopists [AIGO], the Italian Society of Digestive Endoscopy [SIED], the Italian Society of Gastroenterology [SIGE], and the Italian Society of Internal Medicine [SIMI]. Digestive and liver disease, 51(12), pp.1621-1632.

Lotfi, M., Zamanzadeh, V., Valizadeh, L. and Khajeh Godari, M., 2019. Assessment of nurse–patient communication and patient satisfaction from nursing care. Nursing open, 6(3), pp.1189-1196.

Montastruc, F., Loo, S.Y. and Renoux, C., 2018. Trends in first gabapentin and pregabalin prescriptions in primary care in the United Kingdom, 1993-2017. Jama, 320(20), pp.2149-2151.

Mori, Y., Kudo, S.E., Mohmed, H.E., Misawa, M., Ogata, N., Itoh, H., Oda, M. and Mori, K., 2019. Artificial intelligence and upper gastrointestinal endoscopy: Current status and future perspective. Digestive Endoscopy, 31(4), pp.378-388.

Noventa, M., Scioscia, M., Schincariol, M., Cavallin, F., Pontrelli, G., Virgilio, B., Vitale, S.G., Laganà, A.S., Dessole, F., Cosmi, E. and D’Antona, D., 2019. Imaging modalities for diagnosis of deep pelvic endometriosis: comparison between trans-vaginal sonography, rectal endoscopy sonography and magnetic resonance imaging. A head-to-head meta-analysis. Diagnostics, 9(4), p.225.

Owais, M., Arsalan, M., Choi, J., Mahmood, T. and Park, K.R., 2019. Artificial intelligence-based classification of multiple gastrointestinal diseases using endoscopy videos for clinical diagnosis. Journal of clinical medicine, 8(7), p.986.

Ozsoy, M., Ozsoy, Z., Sahin, S. and Arikan, Y., 2018. An alternative technique in the control of massive presacral rectal bleeding: fixation of GORE-TEX® aortic patch. Nigerian Journal of Surgery, 24(1), pp.60-62.

Pontes, H.M., Stavropoulos, V. and Griffiths, M.D., 2017. Measurement invariance of the internet gaming disorder scale–short-form (IGDS9-SF) between the United States of America, India and the United Kingdom. Psychiatry research, 257, pp.472-478.

Pun, J.K., Chan, E.A., Wang, S. and Slade, D., 2018. Health professional-patient communication practices in East Asia: An integrative review of an emerging field of research and practice in Hong Kong, South Korea, Japan, Taiwan, and Mainland China. Patient education and counseling, 101(7), pp.1193-1206.

RÎNJA, E., ILIE, M., ?ANDRU, V., DIACONU, I., HORTOPAN, A. and CONSTANTINESCU, G., 2018. THE ROLE OF CAPSULE ENDOSCOPY IN THE DIAGNOSIS OF DIGESTIVE HAEMORRHAGE.

Tetteh, L., Aziato, L., Mensah, G.P., Vehviläinen-Julkunen, K. and Kwegyir-Afful, E., 2020. Burns pain management: The role of nurse–patient communication. Burns.

Ueyama, H., Kato, Y., Akazawa, Y., Yatagai, N., Komori, H., Takeda, T., Matsumoto, K., Ueda, K., Matsumoto, K., Hojo, M. and Yao, T., 2021. Application of artificial intelligence using a convolutional neural network for diagnosis of early gastric cancer based on magnifying endoscopy with narrow?band imaging. Journal of gastroenterology and hepatology, 36(2), pp.482-489.

Weingart, S.N., Stoffel, E.M., Chung, D.C., Sequist, T.D., Lederman, R.I., Pelletier, S.R. and Shields, H.M., 2017. Delayed workup of rectal bleeding in adult primary care: examining process-of-care failures. The Joint Commission Journal on Quality and Patient Safety, 43(1), pp.32-40.

Xie, J., Li, W., Feng, Z., Ye, Z., Pan, J., Du, P., Ma, X., Gao, D., Wei, S. and Chen, W., 2019. Application of endoscopy in the diagnosis of hepatobiliary tumor in patients with hepatolithiasis.

Zhao, Y.Y., Xue, D.X., Wang, Y.L., Zhang, R., Sun, B., Cai, Y.P., Feng, H., Cai, Y. and Xu, J.M., 2019. Computer-assisted diagnosis of early esophageal squamous cell carcinoma using narrow-band imaging magnifying endoscopy. Endoscopy, 51(04), pp.333-341.