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Patient knowledge and perception on laparoscopic cholecystectomy: a questionnaire based study for optimizing informed consent

Yıl 2009, Cilt: 31 Sayı: 4, 374 - 387, 11.10.2009

Öz

Abstract

Aim. Laparoscopic cholecystectomy (LC) is one of the most commonly performed operations in surgical practice. Reports on surgical outcomes of this operation are in excess in the literature. However, studies designed to understand perceptions of patients, and vital points of informed consent about this operation are still lacking. We aimed to analyze the knowledge and perception of patients about LC in order to understand the topics that should be emphasized before surgery. Methods. Patients admitted to outpatient clinic for gallbladder disease requiring surgery were considered for enrollment. Individuals consenting to participate were given a questionnaire about demographics, and basic measures of LC. Each statement had a 4 point scale. They were also asked the source of information, type of operation they would prefer to undergo, and their reasons for that. Results. Our patients had adequate knowledge regarding the technical equipment, surgical education, and experience required for LC compared to open cholecystectomy (71%, 45%, and 59%, respectively). A significant number of participants had knowledge on pain, hospitalization period, and infection, (64%, 74%, 63.7%, respectively). Expense of the operation, postoperative adhesion and hernia formation were significantly unknown among participants (36.7%, 47%, and 47.7%, respectively). Eighty percent of participants preferred to undergo laparoscopic surgery. However, 17.3% percent of those had no preference on the type of surgery. The main reasons given for preferring LC were less pain and shorter incision (53.3% and 31%, respectively). Source of information was family and relatives in more than half of the cases and these sources were more common among primary educated. One fourth of our patients (24.7%) thought that LC is done only for stone removal, and almost half of participants (46%) had no idea on gallbladder or stone removal. Patients obtaining information from the Internet had a better knowledge compared to others. Conclusion. We conclude that, a) effects of LC on postoperative adhesion, and hernia formation are significantly unknown among patients, b) patients obtaining information from family or relatives, and those with low education level think that LC, apart from conventional OC offers the possibility of removing stones only, and leaving the gallbladder in situ, and c) informed consent for LC should be personalized, emphasizing postoperative adhesion, hernia formation, and gallbladder removal.

Keywords: Laparoscopic cholecystectomy, public knowledge, perception, informed consent.

 

Özet

Amaç. Laparoskopik kolesistektomi (LK) cerrahi uygulamaları içinde en sık yapılan ameliyatlardan biridir. Bu ameliyatın cerrahi sonuçları hakkında çok sayıda yayın varlığına rağmen, LK için hastaların bakış açıları ve aydınlatılmış onamın önemli noktaları ile ilgili çalışmalar halen eksiktir. Biz ameliyat öncesi aydınlatılmış onamda vurgulanması gereken noktaları anlayabilmek amacıyla, hastalarımızın bu ameliyat hakkındaki bilgilerini ve bakış açılarını incelemeyi amaçladık. Yöntem. Cerrahi uygulama gerektiren safra kesesi hastalığı nedeniyle başvuran ve çalışmaya katılmayı kabul eden hastalara demografik bilgileri ve LK'nin temel yönleri ile birlikte bilgi kaynağı, olmak istedikleri ameliyat tipi ve bunun için nedenlerini sorgulayan bir anket uygulandı. Her soruya ait çoktan seçmeli 4 şık sunuldu. Ayrıca, bilgi kaynakları, olmak istedikleri ameliyat tipi ve bunun nedenleri de sorgulandı. Bulgular. Anlamlı sayıda hasta açık cerrahiye kıyasla LK açısından teknik donanım, cerrahi eğitim ve cerrahi deneyim (sırası ile %71, %45 ve %59) konularında bilgi sahibi idi. Anlamlı sayıda hasta ağrı, hastanede yatış süresi ve enfeksiyon hakkında bilgili idi (sırası ile %64, %74, %63,7). Ameliyat ücreti, yapışıklıklar ve fıtık gelişimi anlamlı oranlarda hastalar tarafından bilinmeyen konulardı (sırası ile %36,7, %47, %47,7). Hastaların %80'i LK ameliyatı olmayı tercih etti. Ne var ki, %17,3'ünün herhangi bir ameliyat tercihi olmadı. LK'yi tercih etmenin temel nedenleri daha az ağrı ve daha küçük kesi idi (sırası ile %53,3 ve %31). Hastaların yarısından fazlasında bilgi kaynağı aile ve akrabalar idi ve bu durum ilkokul mezunlarında daha sık idi. Hastaların dörtte biri LK ameliyatının sadece taşları çıkarmak için yapıldığını düşünürken, hastaların yaklaşık yarısı safra kesesi veya taş çıkarımı hakkında bilgi sahibi değildi. İnterneti kaynak gösteren hastaların bilgi düzeyleri diğerlerine göre daha iyi idi. Sonuç. LK ameliyatı için a) ameliyat sonrası yapışıklık ve fıtık gelişimi hastaların anlamlı bir bölümü tarafından bilinmemektedir, b) aile ve yakın çevresinden bilgi alanlar ve düşük eğitim seviyesine sahip olan hastalar LK'nin açık cerrahiden farklı olarak sadece taşları alıp, safra kesesini yerinde bırakma avantajına sahip olduğunu düşünmektedir ve c) alınacak aydınlatılmış onamın yapışıklık, fıtık gelişimi ve safra kesesinin çıkarılacağı vurgulanarak kişiselleştirilmesi gerektiği kanaatindeyiz.

Anahtar kelimeler: Laparoskopik kolesistektomi, toplum bilgisi, algılama, bilgi, aydınlatılmış onam.

Kaynakça

  • Gaskin TA, Isobe JH, Mathews JL, Winchester SB, Smith RJ. Laparoscopy and the general surgeon. Surg Clin North Am 1991; 71: 1085-97.
  • Escarce JJ, Bloom BS, Hillman AL, Shea JA, Schwartz JS. Diffusion of laparoscopic cholecystectomy among general surgeons in the United States. Med Care 1995; 33: 256- 71.
  • Tuveri M, Tuveri A. Laparoscopic cholecystectomy: complications and conversions with the 3-trocar technique: a 10-year review. Surg Laparosc Endosc Percutan Tech 2007; 17: 380-4.
  • Marakis GN, Pavlidis TE, Ballas K, Aimoniotou E, Psarras K, Karvounaris D, Rafailidis S, Demertzidis H, Sakantamis AK. Major complications during laparoscopic cholecystectomy. Int Surg 2007; 92: 142-6.
  • Walsh RM, Henderson JM, Vogt DP, Brown N. Long-term outcome of biliary reconstruction for bile duct injuries from laparoscopic cholecystectomies. Surgery 2007; 142: 450-6.
  • Korolija D, Sauerland S, Wood-Dauphinée S, Abbou CC, Eypasch E, Caballero MG, Lumsden MA, Millat B, Monson JR, Nilsson G, Pointner R, Schwenk W, Shamiyeh A, Szold A, Targarona E, Ure B, Neugebauer E; European Association for Endoscopic Surgery. Evaluation of quality of life after laparoscopic surgery: evidence-based guidelines of the European Association for Endoscopic Surgery. Surg Endosc 2004; 18:
  • Turienzo-Santos EO, Rodríguez-García JI, Trelles-Martín A, Aza-González J. Integral management of the process of laparoscopic cholecystectomy. Cir Esp 2006; 80: 385-94.
  • Nair K, Dolovich L, Cassels A, McCormack J, Levine M, Gray J, Mann K, Burns S. What patients want to know about their medications. Focus group study of patient and clinician perspectives. Can Fam Physician 2002; 48, 104-10.
  • Cingi A, Dusunceli F, Gulluoglu BM, Yegen C, Aktan AO, Yalin R. Laparoscopic Cholecystectomy: Is It a Conscious Preference among Turkish Patients with Symptomatic Gallstones? - Prospective Study. World J Surg 2004; 28: 1053-1056.
  • Hendolin HI, Paakonen ME, Alhava EM, Tarvainen R, Kemppinen T, Lahtinen P. Laparoscopic or open cholecystectomy: a prospective randomised trial to compare postoperative pain, pulmonary function, and stress response, Eur J Surg 2000; 166: 394 – 9.
  • McMahon AJ, Russell IT, Baxter JN, Ross S, Anderson JR, Morran CG, Sunderland G, Galloway D, Ramsay G, O'Dwyer PJ. Laparoscopic versus minilaparotomy cholecystectomy: a randomised trial. Lancet 1994; 343:135-8.
  • Barkun JS, Barkun AN, Sampalis JS, Fried G, Taylor B, Wexler MJ, Goresky CA, Meakins JL. Randomised controlled trial of laparoscopic versus mini cholecystectomy. The McGill Gallstone Treatment Group. Lancet 1992; 340: 1116 –9.
  • Porte RJ, De Vries BC. Laparoscopic versus open cholecystectomy:a prospective matched-cohort study. HPB Surg 1996; 9: 71–5.
  • Lujan JA, Parrilla P, Robles R, Marin P, Torralba JA, Garcia-Ayllon J. Laparoscopic cholecystectomy vs open cholecystectomy in the treatment of acute cholecystitis: a prospective study. Arch Surg 1998; 133: 173–5.
  • Jatzko GR, Lisborg PH, Pertl AM, Stettner HM. Multivariate comparison of complications after laparoscopic cholecystectomy and open cholecystectomy. Ann Surg 1995; 221: 381-6.
  • Topcu O, Karakayali F, Kuzu MA, Ozdemir S, Erverdi N, Elhan A, Aras N. Comparison of quality of life after laparoscopic and open cholecystectomy. Surg Endosc 2003; 17: 291-5.
  • Bruera E, Sweeney C, Calder K, Palmer L, Benisch-Tolley S. Patient preferences versus physician perceptions of treatment decisions in cancer care. J Clin Oncol 2001; 19: 2883- 5.
  • Benbassat J, Pilpel D, Tidhar M. Patients’ preferences for participation in clinical decision making: A review of published surveys. Behav Med 1998; 24: 81-88.
  • Laine C, Davidoff F. Patient-centered medicine; a professional evolution. JAMA 1996; 275:152-6.
  • Deber RB, Kraetschmer N, Irvine J. What role do patients wish to play in treatment decision-making? Arch Intern Med 1996; 156: 1414-20.
  • Charles C, Gani A, Whelan T. Shared decision-making in the medical encounter: What does it mean? (Or it takes at least two to tango). Soc Sci Med 1997; 44:681-92.
  • Aurora NK, McHorney CA. Patient preferences for medical decision making: Who really wants to participate? Med Care 2000; 38: 335-412.
  • Le Blanc-Louvry I, Coquerel A, Koning E, Maillot C, Ducrotté P. Operative stress response is reduced after laparoscopic compared to open cholecystectomy: the relationship with postoperative pain and ileus. Dig Dis Sci 2000; 45: 1703-13.
  • Hart A, Henwood F, Wyatt S. The role of the Internet in patient-practitioner relationships: findings from a qualitative research study. J Med Internet Res 2004; 6: e36.
  • Ortega AE, Peters JH, Incarbone R, Estrada L, Ehsan A, Kwan Y, Spencer CJ, Moore- Jeffries E, Kuchta K, Nicoloff JT. A prospective randomized comparison of the metabolic and stress hormonal responses of laparoscopic and open cholecystectomy. J Am Coll Surg 1996; 183: 249-56.
  • Mealey K, Gallagher H, Barry M, Lennon F, Traynor O, Hyland J. Physiological and metabolic responses to open and laparoscopic cholecystectomy. Br J Surg 1992; 79:
  • Cuschieri A. Whither minimal access surgery: tribulations and expectations. Am J Surg 1995; 169: 9-19.
  • Dent TL. Training, credentialling, and granting of clinical privileges for laparoscopic general surgery. Am J Surg 1991; 161: 399-403.
  • European Association of Endoscopic Surgeons. Training and assessment of competence. Surg Endosc 1994; 8: 721-2.
  • Hasson HM. Core competency in laparoendoscopic surgery. JSLS 2006; 10: 16-20.
  • Allen JW, Polk HC Jr. A study of added costs of laparoscopic cholecystectomy based on surgery preference cards. Am Surg 2002; 68: 474-6.
  • Carbonell AM, Lincourt AE, Kercher KW, Matthews BD, Cobb WS, Sing RF, Heniford BT. Do patient or hospital demographics predict cholecystectomy outcomes? Surg Endosc 2005; 19: 767-73.
  • Sanabria JR, Clavien PA, Cywes R, Strasberg SM. Laparoscopic versus open cholecystectomy: a matched study. Can J Surg 1993; 36: 330-6.
  • Porte RJ, De Vries BC. Laparoscopic versus open cholecystectomy: a prospective matched-cohort study. HPB Surg 1996; 9: 71-5.
  • Biscione FM, Couto RC, Pedrosa TM, Neto MC. Comparison of the risk of surgical site infection after laparoscopic cholecystectomy and open cholecystectomy. Infect Control Hosp Epidemiol 2007; 28: 1103-6.
  • Den Hoed PT, Boelhouwer RU, Veen HF, Hop WC, Bruining HA. Infections and bacteriological data after laparoscopic and open gallbladder surgery. 1: J Hosp Infect 1998; 39: 27-37.
  • Coda A, Bossotti M, Ferri F, Mattio R, Ramellini G, Poma A, Quaglino F, Filippa C, Bona A. Incisional hernia and fascial defect following laparoscopic surgery. Surg Laparosc Endosc Percutan Tech 2000; 10: 34-8.
  • Sanz-López R, Martínez-Ramos C, Nşñez-Peña JR, Ruiz de Gopegui M, Pastor-Sirera L, Tamames-Escobar S. Incisional hernias after laparoscopic vs open cholecystectomy. Surg Endosc 1999; 13: 922-4.
  • Finan KR, Leeth RR, Whitley BM, Klapow JC, Hawn MT. Improvement in gastrointestinal symptoms and quality of life after cholecystectomy. Am J Surg 2006; 192: 196-202.
  • Bass G. Extrajudicial medicolegal opinions. Gynakol Geburtshilfliche Rundsch 2003; 43: 254-7.
  • Wijtenburg E, Navez B, Cambier E, Guiot P. Patient’s opinion about written information before laparoscopy: a consecutive series of 100 cases. Acta Chir Belg 2002; 102: 17-9.
  • Ghulam AT, Kessler M, Bachmann LM, Haller U, Kessler TM. Patients’ satisfaction with the preoperative informed consent procedure: a multicenter questionnaire survey in Switzerland. Mayo Clin Proc 2006; 81: 307-12.
  • Rougé C, Tuesch JJ, Casa C, Ludes B, Arnaud JP. Patient information and obtaining informed consent in laparoscopic surgery. J Chir 1997; 134: 340-4.
  • Stergiopoulou A, Birbas K, Katostaras T, Diomidous M, Mantas J. The effect of a multimedia health educational program on the postoperative recovery of patients undergoing laparoscopic cholecystectomy. Stud Health Technol Inform 2006; 124: 920-5.
  • Stergiopoulou A, Birbas K, Katostaras T, Mantas J. The effect of interactive multimedia on preoperative knowledge and postoperative recovery of patients undergoing laparoscopic cholecystectomy. Methods Inf Med 2007; 46: 406-9.

PATIENT KNOWLEDGE AND PERCEPTION ON LAPAROSCOPIC CHOLECYSTECTOMY; A QUESTIONNAIRE BASED STUDY FOR OPTIMIZING INFORMED CONSENT

Yıl 2009, Cilt: 31 Sayı: 4, 374 - 387, 11.10.2009

Öz

 

 

 

Kaynakça

  • Gaskin TA, Isobe JH, Mathews JL, Winchester SB, Smith RJ. Laparoscopy and the general surgeon. Surg Clin North Am 1991; 71: 1085-97.
  • Escarce JJ, Bloom BS, Hillman AL, Shea JA, Schwartz JS. Diffusion of laparoscopic cholecystectomy among general surgeons in the United States. Med Care 1995; 33: 256- 71.
  • Tuveri M, Tuveri A. Laparoscopic cholecystectomy: complications and conversions with the 3-trocar technique: a 10-year review. Surg Laparosc Endosc Percutan Tech 2007; 17: 380-4.
  • Marakis GN, Pavlidis TE, Ballas K, Aimoniotou E, Psarras K, Karvounaris D, Rafailidis S, Demertzidis H, Sakantamis AK. Major complications during laparoscopic cholecystectomy. Int Surg 2007; 92: 142-6.
  • Walsh RM, Henderson JM, Vogt DP, Brown N. Long-term outcome of biliary reconstruction for bile duct injuries from laparoscopic cholecystectomies. Surgery 2007; 142: 450-6.
  • Korolija D, Sauerland S, Wood-Dauphinée S, Abbou CC, Eypasch E, Caballero MG, Lumsden MA, Millat B, Monson JR, Nilsson G, Pointner R, Schwenk W, Shamiyeh A, Szold A, Targarona E, Ure B, Neugebauer E; European Association for Endoscopic Surgery. Evaluation of quality of life after laparoscopic surgery: evidence-based guidelines of the European Association for Endoscopic Surgery. Surg Endosc 2004; 18:
  • Turienzo-Santos EO, Rodríguez-García JI, Trelles-Martín A, Aza-González J. Integral management of the process of laparoscopic cholecystectomy. Cir Esp 2006; 80: 385-94.
  • Nair K, Dolovich L, Cassels A, McCormack J, Levine M, Gray J, Mann K, Burns S. What patients want to know about their medications. Focus group study of patient and clinician perspectives. Can Fam Physician 2002; 48, 104-10.
  • Cingi A, Dusunceli F, Gulluoglu BM, Yegen C, Aktan AO, Yalin R. Laparoscopic Cholecystectomy: Is It a Conscious Preference among Turkish Patients with Symptomatic Gallstones? - Prospective Study. World J Surg 2004; 28: 1053-1056.
  • Hendolin HI, Paakonen ME, Alhava EM, Tarvainen R, Kemppinen T, Lahtinen P. Laparoscopic or open cholecystectomy: a prospective randomised trial to compare postoperative pain, pulmonary function, and stress response, Eur J Surg 2000; 166: 394 – 9.
  • McMahon AJ, Russell IT, Baxter JN, Ross S, Anderson JR, Morran CG, Sunderland G, Galloway D, Ramsay G, O'Dwyer PJ. Laparoscopic versus minilaparotomy cholecystectomy: a randomised trial. Lancet 1994; 343:135-8.
  • Barkun JS, Barkun AN, Sampalis JS, Fried G, Taylor B, Wexler MJ, Goresky CA, Meakins JL. Randomised controlled trial of laparoscopic versus mini cholecystectomy. The McGill Gallstone Treatment Group. Lancet 1992; 340: 1116 –9.
  • Porte RJ, De Vries BC. Laparoscopic versus open cholecystectomy:a prospective matched-cohort study. HPB Surg 1996; 9: 71–5.
  • Lujan JA, Parrilla P, Robles R, Marin P, Torralba JA, Garcia-Ayllon J. Laparoscopic cholecystectomy vs open cholecystectomy in the treatment of acute cholecystitis: a prospective study. Arch Surg 1998; 133: 173–5.
  • Jatzko GR, Lisborg PH, Pertl AM, Stettner HM. Multivariate comparison of complications after laparoscopic cholecystectomy and open cholecystectomy. Ann Surg 1995; 221: 381-6.
  • Topcu O, Karakayali F, Kuzu MA, Ozdemir S, Erverdi N, Elhan A, Aras N. Comparison of quality of life after laparoscopic and open cholecystectomy. Surg Endosc 2003; 17: 291-5.
  • Bruera E, Sweeney C, Calder K, Palmer L, Benisch-Tolley S. Patient preferences versus physician perceptions of treatment decisions in cancer care. J Clin Oncol 2001; 19: 2883- 5.
  • Benbassat J, Pilpel D, Tidhar M. Patients’ preferences for participation in clinical decision making: A review of published surveys. Behav Med 1998; 24: 81-88.
  • Laine C, Davidoff F. Patient-centered medicine; a professional evolution. JAMA 1996; 275:152-6.
  • Deber RB, Kraetschmer N, Irvine J. What role do patients wish to play in treatment decision-making? Arch Intern Med 1996; 156: 1414-20.
  • Charles C, Gani A, Whelan T. Shared decision-making in the medical encounter: What does it mean? (Or it takes at least two to tango). Soc Sci Med 1997; 44:681-92.
  • Aurora NK, McHorney CA. Patient preferences for medical decision making: Who really wants to participate? Med Care 2000; 38: 335-412.
  • Le Blanc-Louvry I, Coquerel A, Koning E, Maillot C, Ducrotté P. Operative stress response is reduced after laparoscopic compared to open cholecystectomy: the relationship with postoperative pain and ileus. Dig Dis Sci 2000; 45: 1703-13.
  • Hart A, Henwood F, Wyatt S. The role of the Internet in patient-practitioner relationships: findings from a qualitative research study. J Med Internet Res 2004; 6: e36.
  • Ortega AE, Peters JH, Incarbone R, Estrada L, Ehsan A, Kwan Y, Spencer CJ, Moore- Jeffries E, Kuchta K, Nicoloff JT. A prospective randomized comparison of the metabolic and stress hormonal responses of laparoscopic and open cholecystectomy. J Am Coll Surg 1996; 183: 249-56.
  • Mealey K, Gallagher H, Barry M, Lennon F, Traynor O, Hyland J. Physiological and metabolic responses to open and laparoscopic cholecystectomy. Br J Surg 1992; 79:
  • Cuschieri A. Whither minimal access surgery: tribulations and expectations. Am J Surg 1995; 169: 9-19.
  • Dent TL. Training, credentialling, and granting of clinical privileges for laparoscopic general surgery. Am J Surg 1991; 161: 399-403.
  • European Association of Endoscopic Surgeons. Training and assessment of competence. Surg Endosc 1994; 8: 721-2.
  • Hasson HM. Core competency in laparoendoscopic surgery. JSLS 2006; 10: 16-20.
  • Allen JW, Polk HC Jr. A study of added costs of laparoscopic cholecystectomy based on surgery preference cards. Am Surg 2002; 68: 474-6.
  • Carbonell AM, Lincourt AE, Kercher KW, Matthews BD, Cobb WS, Sing RF, Heniford BT. Do patient or hospital demographics predict cholecystectomy outcomes? Surg Endosc 2005; 19: 767-73.
  • Sanabria JR, Clavien PA, Cywes R, Strasberg SM. Laparoscopic versus open cholecystectomy: a matched study. Can J Surg 1993; 36: 330-6.
  • Porte RJ, De Vries BC. Laparoscopic versus open cholecystectomy: a prospective matched-cohort study. HPB Surg 1996; 9: 71-5.
  • Biscione FM, Couto RC, Pedrosa TM, Neto MC. Comparison of the risk of surgical site infection after laparoscopic cholecystectomy and open cholecystectomy. Infect Control Hosp Epidemiol 2007; 28: 1103-6.
  • Den Hoed PT, Boelhouwer RU, Veen HF, Hop WC, Bruining HA. Infections and bacteriological data after laparoscopic and open gallbladder surgery. 1: J Hosp Infect 1998; 39: 27-37.
  • Coda A, Bossotti M, Ferri F, Mattio R, Ramellini G, Poma A, Quaglino F, Filippa C, Bona A. Incisional hernia and fascial defect following laparoscopic surgery. Surg Laparosc Endosc Percutan Tech 2000; 10: 34-8.
  • Sanz-López R, Martínez-Ramos C, Nşñez-Peña JR, Ruiz de Gopegui M, Pastor-Sirera L, Tamames-Escobar S. Incisional hernias after laparoscopic vs open cholecystectomy. Surg Endosc 1999; 13: 922-4.
  • Finan KR, Leeth RR, Whitley BM, Klapow JC, Hawn MT. Improvement in gastrointestinal symptoms and quality of life after cholecystectomy. Am J Surg 2006; 192: 196-202.
  • Bass G. Extrajudicial medicolegal opinions. Gynakol Geburtshilfliche Rundsch 2003; 43: 254-7.
  • Wijtenburg E, Navez B, Cambier E, Guiot P. Patient’s opinion about written information before laparoscopy: a consecutive series of 100 cases. Acta Chir Belg 2002; 102: 17-9.
  • Ghulam AT, Kessler M, Bachmann LM, Haller U, Kessler TM. Patients’ satisfaction with the preoperative informed consent procedure: a multicenter questionnaire survey in Switzerland. Mayo Clin Proc 2006; 81: 307-12.
  • Rougé C, Tuesch JJ, Casa C, Ludes B, Arnaud JP. Patient information and obtaining informed consent in laparoscopic surgery. J Chir 1997; 134: 340-4.
  • Stergiopoulou A, Birbas K, Katostaras T, Diomidous M, Mantas J. The effect of a multimedia health educational program on the postoperative recovery of patients undergoing laparoscopic cholecystectomy. Stud Health Technol Inform 2006; 124: 920-5.
  • Stergiopoulou A, Birbas K, Katostaras T, Mantas J. The effect of interactive multimedia on preoperative knowledge and postoperative recovery of patients undergoing laparoscopic cholecystectomy. Methods Inf Med 2007; 46: 406-9.
Toplam 45 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Bölüm Dahili Tıp Bilimleri Araştırma Yazıları
Yazarlar

Alper Çelik

Murat Aksu

Namık Özkan

Faik Ersoy

Hüseyin Kayaoğlu

Yayımlanma Tarihi 11 Ekim 2009
Yayımlandığı Sayı Yıl 2009Cilt: 31 Sayı: 4

Kaynak Göster

AMA Çelik A, Aksu M, Özkan N, Ersoy F, Kayaoğlu H. Patient knowledge and perception on laparoscopic cholecystectomy: a questionnaire based study for optimizing informed consent. CMJ. Aralık 2009;31(4):374-387.