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  1. George E, Mohandas N, Duraisamy G, Adeeb N, Zainuddin ZA, Teng MS, et al.
    Med J Malaysia, 1988 Dec;43(4):327-31.
    PMID: 3241598
  2. Zhang YY, Vimala R, Chui PL, Hilmi IN
    Surg Endosc, 2023 Apr;37(4):2633-2643.
    PMID: 36369410 DOI: 10.1007/s00464-022-09724-7
    BACKGROUND: Pain is a contributing factor to the low compliance rate for performing a colonoscopy on screening for colorectal cancer.

    PURPOSE: This meta-analysis aimed to evaluate the effect of visual distraction on adults undergoing colonoscopy.

    METHODS: We searched PubMed, EMBASE, Web of Science, and Cochrane Library Database from their inception to February 2022. Randomized controlled trials comparing visual distraction with non-visual distraction were considered for inclusion. The fixed-effects and random-effects models were used to pool the data from individual studies and the Cochrane risk of bias assessment tool was used to determine the methodology quality.

    RESULTS: This meta-analysis included four studies (N = 301) for pain level and total procedure time, three studies (N = 181) for satisfaction score, three studies (N = 196) for anxiety level, and four studie (N = 402) for willingness to repeat the procedure. The pooled analysis shown that significantly lower pain levels (SMD, - 0.25; 95% CI - 0.47 to - 0.02; P = 0.03), higher satisfaction score with the procedure (SMD, 0.63; 95% CI, 0.33 to 0.93; P 

  3. Zhang YY, Vimala R, Chui PL, Hilmi IN
    Gastroenterol Nurs, 2023 06 20;46(5):393-403.
    PMID: 37347807 DOI: 10.1097/SGA.0000000000000759
    This systematic review aims to evaluate (1) the effectiveness of exercise therapy in bowel preparation for colonoscopy, and (2) the characteristics of exercise programs for bowel preparation. Systematic searches were done in PubMed, EMBASE, the Cochrane Library, Web of Science, and CINAHL from inception to November 2022. Randomized controlled trials and quasi-experimental studies assessing the efficacy of exercise during bowel preparation were included in this review. Two reviewers independently assessed the methodological quality using a modified Downs and Black checklist. A narrative synthesis was conducted. A total of five studies (1,109 participants) were included in this review. In all eligible studies, the characteristics of the exercise programs varied and included mainly two types of exercise (walking and yoga), various amount of exercise (3,000-10,000 steps or 0.5-1.9 hours), and two exercise timing (during and 1 hour after taking the laxative). Available evidence indicated that exercise therapy is effective in improving the quality of bowel preparation. However, there was insufficient high-quality evidence to conclude the effects on procedure-related indicators, adverse events, and willingness to repeat preparation. Exercise should be recommended as an important part of routine bowel preparation for patients undergoing colonoscopy to improve the quality of bowel preparation. More rigorous studies focusing on the effects on procedure-related indicators, adverse events, and willingness to repeat preparation are needed. To ensure the effectiveness and safety of the intervention, it is critical to establish a standard, well-structured exercise program for bowel preparation.
  4. Zhang YY, Vimala R, Chui PL, Hilmi IN
    Saudi J Gastroenterol, 2024 May 01;30(3):173-180.
    PMID: 38629327 DOI: 10.4103/sjg.sjg_387_23
    BACKGROUND: Older patients with constipation are at higher risk for inadequate bowel preparation, but there are currently no targeted strategies. This study aims to develop an abdominal vibration combined with walking exercise (AVCWE) program and assess its feasibility among older patients with constipation.

    METHODS: Phase I: Using the Delphi technique, eight experts across three professional fields were consulted to develop the AVCWE program. The experts evaluated and provided recommendations on demonstration videos and detailed descriptions of the preliminary protocol. Phase II: A single-arm feasibility study of the AVCWE program was conducted on 30 older patients with constipation undergoing colonoscopy at a tertiary hospital in China. A 10-point exercise program evaluation form and several open-ended questions were used to gather feedback from participants regarding the program. In both phases, content analysis was used to critically analyze and summarize qualitative suggestions for protocol modifications.

    RESULTS: Based on feedback from the expert panel, the AVCWE program developed in Phase I included two procedures during laxative ingestion: at least 5,500 steps of walking exercise and two cycles of moderate-intensity abdominal vibration (each cycle consisted of 10 min of vibration and 10 min of rest). The feasibility study in Phase II showed high positive patient feedback scores for the program, ranging from 9.07 ± 0.74 to 9.73 ± 0.52.

    CONCLUSION: The AVCWE program was developed by eight multidisciplinary experts and was well accepted by 30 older patients with constipation. Study participants believed that this program was simple, safe, appropriate, and helpful for their bowel preparation. The findings of this study may provide valuable information for optimizing bowel preparation in older patients with constipation.

  5. Foo ML, Tang LY, Vimala R, Chui PL, Chong MC
    J Contin Educ Nurs, 2017 Aug 01;48(8):347-352.
    PMID: 28759691 DOI: 10.3928/00220124-20170712-05
    BACKGROUND: Because nurses need to handle a broad range of issues related to patients' health status, it is necessary to make reliable and sound clinical judgments for professional accountability and the patients' safety.

    METHOD: A quasi-experimental pre- and posttest design with a control group was used to study the effectiveness of an educational intervention on the clinical judgment skills of 80 RNs from two district hospitals. The change in clinical judgment skills during a 6-week period was evaluated using a complex case-based scenario after the completion of the educational intervention.

    RESULTS: The mean scores of clinical judgment skills of the experimental group had significantly improved from 24.15 ± 6.92 to 47.38 ± 7.20. (p < .001). However, only a slight change was seen in mean scores for the control group (23.80 ± 5.77 to 26.50 ± 6.53).

    CONCLUSION: The educational intervention was effective postintervention. Continuing nursing education using a traditional and case-based method is recommended to improve clinical judgment skills in clinical settings. J Contin Educ Nurs. 2017;48(8):347-352.

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