RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1 NAME OF THE CANDIDATE

ADDRESS

Ms. DAWN HELEN SEBASTIAN

GAYATHRI COLLEGE OF NURSING.KOTTIGEPALYA BANGALORE.

2 NAME OF THE INSTITUTIONGAYATHRI COLLEGE OF NURSING.KOTTIGEPALYA BANGALORE.

3 COURSE OF THE STUDY AND

SUBJECT

FIRST YEAR M.Sc NURSING

MEDICAL SURGICAL NURSING

4 DATE OF ADMISSION TO COURSE

09-06-2011

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5. TITLE OF TOPIC

“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED

TEACHING PROGRAMME (STP) REGARDING PERFUSION TECHNOLOGY

AS A SUPPORTIVE MODALITY IN TERMS OF KNOWLEDGE AMONG

STAFF NURSES OF A SELECTED PRIVATE HOSPITAL AT BANGALORE.’’

6.BRIEF RESUME OF AN INTENDED WORK

INTRODUCTION

In physiology, perfusion is the process of nutritive delivery of arterial blood to a

capillary bed in the biological tissue. The word is derived from the French verb

"perfuser" meaning to "pour over or through."

Perfusion technology majors learn how to run machinery that assists or replaces a

patient’s own respiratory or circulatory system during an operation or other medical

procedure. Topics of study include equipment operation, patient monitoring, and the

physiology of respiration and circulation. They go on to work under the supervision of

doctors and nurses.

Cardiovascular Perfusion Technology involves the study of physiology, pathology and

associated equipment used to support and/or assume the function of the heart and/or

lungs during medical procedures. The perfusion technologist prepares and operates the

heart-lung machine and other sophisticated equipment as directed by healthcare

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physicians. The perfusionist measures various blood and other parameters to identify

appropriate mechanical, pharmacological and thermal manipulation to maintain tissue

viability. To perform these tasks the perfusionist must have a thorough understanding of

the both respiratory and circulatory systems and be able to operate complex equipment.

Additionally the perfusionist must be capable of handling stressful situations, pay great

attention to detail, communicate effectively, and be willing to stay abreast of new

developments in the profession.

While most perfusionists are employed by medical centers they may also be hired by

individual surgeons, or perfusion company's. Clinical perfusion often requires on-call

responsibilities at night, on weekends and holidays. Perfusionists also work in

educational institutions as teachers and/or researchers. Further, some perfusionists are

hired by industry that manufacture various perfusion related supplies and equipment.

Perfusion Technology has developed an ultrasound system that uses a headset with

ultrasound transducers directed at the penumbra, the region surrounding the tumor, in

order to penetrate the blood brain barrier (BBB) and allow the delivery of drugs to the

healthy brain tissue. The system is designed to address the challenges of treating

malignant brain tumors, which are difficult to reach because of the cancerous cells that

have migrated away from the bulk tumor and can neither be removed surgically nor

accessed by most therapeutics. The low intensity, unfocused ultrasound penetration is

noninvasive and reversible, allowing for the procedure to be conducted in an outpatient

setting for regular drug infusion treatments.

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Ailments that use perfusion technology include coronary heart disease,

heart attack, heart failure, heart valve disease, respiratory failure, kidney failure and

heart, lung or kidney transplants. Perfusionists insert sterile tubes called cannulas into the

patient's bloodstream. These cannulas are attached to the perfusion machine, which

regulates the circulation of blood during surgery. The perfusion machine acts as an

artificial organ--heart, lungs, liver or kidney--and controls the rate of circulation.

Perfusion technology can be used to stop blood flow to a limb when drugs must be

injected directly into the bloodstream.

6.1 NEED FOR THE STUDY

Perfusion technology is not a major supportive technique which is using in all

the

medical intervention .Instead it is a fastly moving and growing economy in the hospital

scenario.

The next phase of cardiopulmonary bypass enhanced the skills of the

perfusionist

and enabled cardiac surgery to grow by leaps and bounds .Because of complexity of

artificial

circulation and the importance of the science perfusion technology , we have gained

respect in

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the surgical arena ,but at the same time our risk is regarded as insidious ,owing to its

effect on

inflammatory response .

The aberrations of normal physiology associated with cardiopulmonary

bypass

often bring criticism to its use ; however , the fact that some patients have no ill effects

from the

procedure complicates this perception . After years of clinical investigation and

publication ,

cardiopulmonary bypass has been deemed necessary in a controlled environment

involving

perfusionists , surgeons ,and anesthesiologists .

Though knowledge in cardiovascular perfusion technology enables the

proffessionels to provide the detailed foundation and analytical skills that are necessary to

understand the

interplay between the science of extracorporeal technology and the related anatomic and

physiologic principles necessary to consider during the initiation, maintenance, and

termination

of both temporary extracorporeal circulatory support, as well as long-term circulatory

support.

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They will understand the basic diagnostic principles involved in determining the nature

and

extent of the disease process necessitating surgical intervention. Primarily, the cardiac,

renal, and

pulmonary systems are covered in this course. Students will examine the relationship

between

blood flow within and outside of the body, and the cardiovascular devices utilized to

facilitate

extracorporeal circulatory support.

These findings impaired the researcher to take topic for the study so as to

provided

these information.

6.2 REVIEW OF LITERATURE

The review of literature is a board, comprehensive in depth, systematic and

critical review of the scholarly publications, unpublished scholarly print materials, audio-

visual material and personal communication

A Review of Literature involves a systematic identification, location, scrutinization and

summary of written materials that contains information on a research problem.

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According to Pilot and Beck, Review of literature is a written summary of the existing

knowledge on a research problem.

The review of available literature was organized under the following headings

Studies related to perfusion technology.

Studies related to effectiveness of perfusion technology.

Studies related knowledge of staff nurses regarding perfusion technology.

1. STUDIES RELATED TO PERFUSION TECHNOLOGY

Ogella D A (1999) conducted a study regarding Advances in perfusion

technology . The introduction of minimally invasive approaches to cardiac surgery

offered the opportunity to reduce patient's pain associated with median stemotomy as

well as infection and postoperative bleeding. This technique required the use of one small

venous cannula necessitating the implementation of kinetic assisted venous drainage

(KAVD). However, KAVD proved costly due to the use of a centrifugal pump and could

be de-primed if air was introduced into the venous line. Vacuum assisted venous drainage

(VAVD), an easy to learn technique, was proved to be a better, safe and less expensive

alternative as it required lower prime and small cannulae. Blunt trauma could also be

avoided as large cannulae were not us 1

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Robert O Bonow (2008) was done a study on High speed myocardial

perfusion imaging . The purpose of this study was to compare myocardial perfusion

imaging (MPI) with high-speed single-photon emission computed tomography (SPECT)

with conventional SPECT imaging for the evaluation of myocardial perfusion in patients

with known or suspected coronary artery disease. A total of 44 patients (39 men)

underwent same-day Tc-99m sestamibi stress/rest MPI. High-speed SPECT images were

performed within 30 min after conventional SPECT. Stress and rest acquisition times

were 16 and 12 min for conventional imaging and 4 and 2 min for high-speed SPECT,

respectively. Myocardial counts/min (cpm) were calculated for both conventional SPECT

and high-speed SPECT. Images were visually analyzed, and the summed stress score

(SSS) and summed rest score (SRS) were calculated. Image quality and diagnostic

confidence were qualitatively assessed.High-speed SPECT provides fast MPI with high

image quality and up to 8 times increased system sensitivity. The amount of perfusion

abnormality visualized by high-speed SPECT is highly correlated to conventional

SPECT, with an equivalent level of diagnostic confidence.2

Candace L Palmer (2000) conducted a study regarding Perfusion-assisted

direct coronary artery bypass. Hemodynamic instability during multivessel off-pump

coronary artery bypass grafting can lead to hypotension, progressive myocardial

ischemia, further hypotension, and the need for urgent cardiopulmonary bypass.

Myocardial perfusion was successfully enhanced via one or two grafts in all 10 patients

with an average graft flow of 98 ± 8 mL/min. In 3 patients, a 27% increase in perfusion

pressure led to a 59% increase in perfusate flow. All patients were hemodynamically

stable after initiation of selective graft perfusion. Based on this preliminary patient series,

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the selective perfusion of grafted vessels seems to facilitate multivessel off-pump

coronary artery bypass grafting by promoting rapid recovery of grafted segments, by

enhanced hemodynamic stability during subsequent anastomoses, and by providing

increased flexibility in the sequence of grafting.

Michel A (2002) conducted a study regarding successful extracorporeal

procine liver perfusion extracorporeal porcine liver perfusions were performed, each with

a duration of 72 hr. Hepatectomy was performed, followed by cold preservation,

cannulation of vessels, and initiation of perfusion with normothermic, oxygenated

porcine blood. Organ viability was assessed by metabolic, synthetic, hemodynamic, and

histologic parameters. After 72 hr of normothermic, extracorporeal perfusion, the isolated

livers demonstrated maintenance of normal physiological levels of pH and electrolytes.

Continued hepatic protein synthesis (complement and factor V) was maintained

throughout the perfusion. Hemodynamic parameters remained within normal

physiological range. Histology demonstrated good preservation of the liver with no

overall architectural change.4

2. STUDIES RELATED TO EFFECTIVENESS OF PERFUSION TECHNOLOGY

Christian Algermissen (2008) conducted a pilot study regarding Visualization

of Brain Perfusion With Harmonic Gray Scale and Power Doppler Technology. It is

unclear which harmonic imaging mode (power Doppler or gray-scale imaging) is

superior and which measuring method is the most robust for the description of brain

perfusion. With harmonic gray-scale imaging, a homogeneous increase in echo contrast

of the brain parenchyma was observed. The effect was dose dependent, resulting in a

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significant increase in PI as well as an insignificant increase of the AUC with 0.3 mL

versus 0.15 mL contrast agent (P=0.03 and P=0.65, respectively; n=5). With harmonic

power Doppler, injection of the 3 different doses resulted in a nonsignificant increase in

PI and AUC P=0.17, n=6 for both). After normalization of the brain signal to the peak

arterial signal in individual dogs, a significant increase could be demonstrated (P=0.03

and P=0.01, respectively; n=6). The signal pattern of harmonic power Doppler was

inhomogeneous, with stronger signal increases in the anterior part of the brain. 5

Dirk.j.Grunhagen ( 2005 ) studied utility of TNF- -based isolated limb

perfusion to avoid amputation of irresectable tumors of the extremities. Isolated limb

perfusion (ILP) with melphalan is effective in the treatment of small multiple melanoma

intransit metastases and is utilized widely for this indication. The treatment is much less

effective against bulky melanoma metastases and has uniformly failed in the treatment of

irresectable extremity soft tissue sarcomas. The addition of tumor-necrosis factor-

(TNF- ) to this treatment approach has changed the situation dramatically. High response

rates and limb-salvage rates have been reported in multicenter trials that combined ILP

with TNF- plus melphalan; these trials resulted in the approval of TNF- for bulky

melanoma metastases and soft tissue sarcomas in Europe in 19986

Harrigan, Mark R. (2005) was done a study on Computed Tomographic

Perfusion in the Management of Aneurysmal Subarachnoid Hemorrhage. A total of 17

CT perfusion studies were performed. Five studies showed evidence of cerebral ischemia,

leading to endovascular treatment of vasospasm. Eight studies excluded cerebral

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ischemia, and two studies identified cerebral hyperemia, resulting in adjustments in

hyperdynamic therapy. CT perfusion was used to help predict a poor prognosis and

withhold aggressive intervention in two patients with poor Hunt and Hess grades. Time-

to-peak values identified regions of cerebral ischemia more readily than CBF or cerebral

blood volume values.7

Claudio Marcassa (2005) conducted a study on Clinical value, cost-

effectiveness, and safety of myocardial perfusion scintigraphy. Myocardial perfusion

scintigraphy (MPS) provides a highly cost-effective tool for the early detection of

obstructive CAD in symptomatic individuals and contributes substantially to stratification

of patients according to their risk of cardiac death or nonfatal myocardial infarction. MPS

also provides valuable information that assists clinical decision-making with regard to

medical treatment and intervention. A large body of evidence supports the current

applications of MPS, which has become integral to several guidelines for clinical

practice. 8

Wight J and Chilcott J (2003) conducted a study on the clinical and cost-

effectiveness of pulsatile machine perfusion versus cold storage of kidneys for

transplantation retrieved from heart-beating and non-heart-beating donors. The baseline

analysis indicated that in the long-term MP would be expected to be cheaper and more

effective than CS for both HBD and NHBD recipients. A definitive study of the clinical

benefit of MP in order to establish its effect on DGF and longer term graft survival would

be valuable, together with an economic evaluation of the benefits. While direct evidence

relating to improvements in graft survival would be preferable, the small predicted

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improvement indicates that a very large sample size would be required. In addition to

seeking direct evidence of the impact on DGF, research quantifying the impact of DGF

on graft survival in this technology is required.9

3. STUDIES RELATED TO THE KNOWLEDGE OF STAFF NURSES

REGARDING PERFUSION TECHNOLOGY

David A.  Palanzo CCP (1997) conducted a study regarding Perfusion safety:

Past, present, and future. Safe cardiopulmonary bypass has been paramount from its first

use in the early 1950s until the present. The original perfusion circuits incorporated

complex feedback loops and multiple safety devices. As circuits improved and became

simpler to operate, advances in safety did not always keep pace. Surveys have illustrated

areas that needed improvement and extra attention has been focused on those problems.

As the field of perfusion evolved, so has the perfusionist. Perfusion has progressed from

on-the-job training to formalized training, certification, and accreditation, and is now

approaching national standardization. As the computer age proceeds, the use of safety

devices and feedback mechanisms whose developments have been aided by the newly

available technologies increases. As the 21st century approaches, cardiopulmonary

bypass will continue to become safer, but the perfusionist must continue to stay up-to-

date in education and remain vigilant while in the operating room.10

Stammers  A. H. (2008) was done a study regarding perfusion education . The

challenges facing institutions charged with the delivery of health care have also affected

the delivery of education in the health sciences. The establishment and maintenance of a

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profession can only be secured through the creation of standards that guide educational

facilities in the delivery of formalized instruction in a discipline. Perfusion education

programs continue to meet these standards but are doing so at a time where resources

continue to dwindle and quantitative assessment of manpower issues are fuzzy, at best.

Individual programs are challenged by the reordering of university and community

hospital structures, which often results in critical reviews of resource allocation to

perfusion programs. The health of the perfusion profession remains deeply tied to the

success of perfusion education programs. Likewise, the health of these programs can only

be assured by means of continued solicitation of support and guidance from practitioners

who serve as stewards of perfusion technology11

Harper, John P. MSN (2004) conducted a study regarding Post-Anesthesia

Care Unit Nurses' Knowledge of perfusion technology. The purpose of this study was to

assess post-anesthesia care unit (PACU) nurses' knowledge of perfusion technology . A

convenience sample of 19 nurses completed a 32-item questionnaire that included a 20-

item true-false test on perfusion technology. Overall, nurses demonstrated a knowledge

deficit in perfusion technology. Competency in the use of perfusion technology is vital to

ensure a positive clinical outcome. Nurse educators are responsible for identifying

knowledge deficits among staff and implementing strategies to correct these deficits. It is

incumbent on nurse educators to provide research-based education on perfusion

technology and opportunities to participate in continuing education.19

Linda M. MSc, ANP, RN(2006) was done a study regarding Knowledge

of Perfusion technology among Critical Care Nurses. A perfusion technology knowledge

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survey was conducted with 551 experienced critical care nurses at the 2002 American

Association of Critical Care Nurses National Teaching Institute in Atlanta, GA. Results

of this survey indicated

an increased level of knowledge about SpO2 technology and monitoring compared to that

reported in previous studies. These findings are important, because critical care nurses are

responsible for providing care to the most critically ill patients. Critically ill patients are

most likely to have decreases in their oxygen level values that require immediate

interventions. In addition, critically ill patients are also the most likely group of patients

to exhibit the clinical conditions that adversely affect perfusion machine signal quality,

including low perfusion and patient motion artifact. The ability of critical care nurses to

correctly assess pulse oxygen values within the context of the technology limitations and

the critical care environment is important in providing optimal care to critically ill

patients.

6.3 STATEMENT OF THE PROBLEM

“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING

PROGRAMME (STP) REGARDING PERFUSION TECHNOLOGY AS A

SUPPORTIVE MODALITY IN TERMS OF KNOWLEDGE AMONG STAFF

NURSES OF A SELECTED PRIVATE HOSPITAL AT BANGALORE”.

6.4 OBJECTIVES OF STUDY

1. To assess the level of knowledge of staff nurses regarding perfusion technology

as a supportive modality

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2. To identify the practice of staff nurses regarding perfusion technology as a

supportive modality

3. To evaluate the effectiveness of structured teaching programme (STP) on

perfusion technology as a supportive modality

4. To find out the relationship between the following.

Pre-test knowledge score and pre-test practice scores.

Post-test knowledge score and post-test practice scores.

5. To find out the association between the following.

. Post test knowledge score with selected demographic variables.

. Post test practice score with selected demographic variables.

6.5 HYPOTHESIS

All hypotheses will be tested at 0.05 level of significance

H1- Mean post test knowledge score of staff nurses who received structured

teaching

programme (STP) regarding perfusion technology as a supportive modality

will be significantly higher than the mean pre-test knowledge score.

H2- Mean post test practice score of staff nurses who received structured

teaching programme (STP)

regarding perfusion technology as a supportive modality will be significantly higher

than the mean pre-test practice score.

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H3- a. There will be significant relationship between pre-test knowledge score

and pre-test practice score among staff nurses, who received structured teaching

programme (STP) regarding perfusion technology as a supportive modality

b There will be significant relationship between post-test knowledge score and

post- test practice score among staff nurses, who received structured

teaching programme (STP) regarding perfusion technology as a supportive

modality.

H4a. There will be significant association between post-test knowledge score and

selected demographic variables among staff nurses, who received structured

teaching programme (STP) regarding perfusion technology as a supportive

modality.

b. There will be significant association between post-test practice score and

selected demographic variables among staff nurses who received structured

teaching programme (STP) regarding perfusion technology as a supportive

modality.

6.6 OPERATIONAL DEFINITIONS

Effectiveness : In this study ‘effectiveness’ means it is the outcome of Structured

Teaching Programme (STP) regarding perfusion technology as a supportive

modality, which is measurable in terms of gaining in knowledge score of staff

nurses based on given questionnaire.

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(STP)- Structured Teaching Programme : It refers to well planned teaching

material regarding perfusion technology as a supportive modality given through

lecture and discussion . It will be here after referred as STP.

Perfusion Technology: An artificial instrument which supports the respiratory

function while a surgical procedure or any invasive procedure.

Supportive modality: A technique which helps to sustain the oxygen saturation

when undergoing a surgery or any therapeutic intervention which is invasive in

nature.

Knowledge: It refers to the written responses of staff nurse regarding perfusion

technology as a supportive modality as measured by knowledge questionnaire.

Practice: It refers to techniques followed by staff nurses while handling central

line inserted patients.

Staff Nurse: In this study it refers to those who have completed Diploma in nursing

and midwifery and who are engaged in direct patient care.

Hospital : It refers to a private hospital at Bangalore.

6.7 ASSUMPTIONS

The study is based on the assumption.

Knowledge influence behavior

Nurses play vital role in providing perfusion technology.

Lack of practice leads to complications.

6.8 DELIMITATIONS

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Study is limited to

Staff nurses who have completed Diploma in nursing and midwifery (GNM)

Staff nurses who are engaged in direct patient care.

Staff nurses working in emergency, ICU, and wards.

6.9 PROJECTED OUTCOME

It is expected that STP on knowledge regarding perfusion technology as a

supportive modality among staff nurses helps to gain knowledge those who

underwent teaching programme.

7 MATERIAL AND METHODS

7.1 SOURCES OF DATA : Staff nurses working in a selected private hospital at

Bangalore

7.1.1 RESEARCH DESIGN

One group pre-test post-test design.

7.1.2 SETTING

Selected ICU of private hospital , Bangalore.

7.1.3 POPULATION

The population comprises of 30 staff nurses of a selected urban hospital at

Bangalore.

7.1.4 RESEARCH APPROACH

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Evaluate approach.

7.2 METHOD OF COLLECTION OF DATA

7.2.1 SAMPLING PROCEDURE : Purposive sampling

7.2.2 SAMPLE SIZE : 30 staff nurses

7.2.3 INCLUSION CRITERIA

Staff nurses who have completed Diploma in nursing and midwifery (GNM)

Staff nurses of both sexes.

Staff nurses between 20-45 years.

Staff nurses who are willing to participate in the research study.

Staff nurses who are working in ICU, emergency and wards.

7.2.4 EXCLUSION CRITERIA

Staff nurses who are engaged in administrative work such as ward sister,

nursing supervisor, and superintendent.

Staff nurses of other categories like ANM , B.Sc(N) and trained workers.

Staff nurses who are not willing to participate.

Staff nurses who are working in other than ICU, emergency and wards.

7.2.5 DATA COLLECTION METHOD

A structured questionnaire will be used for data collection. The study will be

conducted after obtaining permission from the concerned authority.

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7.2.6 DATA COLLECTION TOOL

TOOL 1: Structured knowledge questionnaire.

Part 1:It consist of demographic variables such as age, educational

qualifications ,sex ,department of working .

Part 2: It has 20-25 multiple choice questions to assess the knowledge of staff nurses

regarding perfusion technology as a supportive modality.

Part 3: It has 20 components to assess the level of attitude regarding the stress and

coping strategies.

7.2.7 PILOT STUDY

Pilot study will be conducted with frame the structure properly sample the

purpose of pilot study is to find out the feasibility of conducting study and design on

plan of statistical analysis.

7.2.8 DATA ANALYSIS PLAN

Descriptive statistics : Mean, Standard deviations, range and mean score of

subject will be used to quantify the level of knowledge and skill of staff

nurses regarding perfusion technology as a supportive modality.

Inferential statistics : Post test will be used to examine the effectiveness of

Structured Teaching Programme by comparing pre test score and post test

score

Chi square test will be worked out to determine the association of

demographic variables

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7.3 DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR

INTERVENTIONS TO BE CONDUCTED ON PATIENT OR OTHER

HUMAN OR ANIMALS

Yes ,The study requires intervention in the form of a structured teaching

programme, no other interventions which cause any physical harm will not be

done for the subject.

7.4 HAS ETICAL CLERANCE BEEN OBTAINED FROM YOUR

INSTITUTION ?

YES

1. Confidentiality and anonymity of the subject will be maintained.

2. A written permission from institutional authority will be maintained.

8. LIST OF REFERENCES

1. Ogella DA. Perfusion Services, Cleveland Clinic Foundation, USA.J Indian Med

Assoc.

Advances in perfusion technology. 1999 Oct;97(10): s436-7, 441.

2. Robert O Bonow(2008). JACC: Cardiovascular Imaging, Volume 1, Issue 2, March

2008,

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Pages 164-166,

3. Candace L Palmer (2000) Issue 1Division of Cardiothoracic Surgery, Department of

Surgery, Carlyle Fraser Heart Center, Emory University School of Medicine, Atlanta,

Georgia,

USA. January 2000, Pages 171-175

4. Michel A (2002). Extracorporeal perfusion technology . 27 April 2002 - Volume 73 -

Issue 8

pp 1212-1218 . Experimental Transplantation

5. Christian Algermissen 2008. Correspontence to Priv-Doz Dr Günter Seidel, MD,

Department

of Neurology, Medical University at Lübeck, Ratzeburger Allee 160, D-23538

Lübeck,

Germany. E-mail seidel_g@neuro.mu-luebeck.de

6. Dirk J Grünhagen, Correspondence Nature Clinical Practice Oncology (2006) 3, 94-

103

doi:10.1038/ncponc0426  

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Received 13 August 2005 | Accepted 14 Email a.m.m.eggermont@erasmusmc.nl

7. Harrigan, Mark R. Neurosurgery:

February 2005 - Volume 56 - Issue 2 - pp 304-317

Techniques and Applications: CEREBROVASCULAR: IMAGING

8. Claudio Marcassa 1Cardiology Department, S. Maugeri Foundation, IRCCS, Scientific

Institute of Veruno, V. Revislate 13, 28010 Veruno, NO, Italy

9. Wight J and Chilcott J .2003. Health Technology Assessment (Winchester, England)

[2003,

7(25):1-94] Type:  Journal Article, Meta-Analysis, Review.

10. David A. Palanzo CCP. Journal of Cardiothoracic and Vascular Anesthesia

Volume 11, Issue 3, May 1997, Pages 383-390

11. Stammers A. H. (2008) Division of Clinical Perfusion Education, University of

Nebraska

Medical Center, Omaha, Nebraska, ETATS-UNIS

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12. Potter-Perry. Fundamental of Nursing.7th ed. India; Mosby; 2009.

13. Joyce M Black. Medical and Surgical nursing. 7th ed. India ; Elsevier 2005.

14. Sr.Nancy. Principles and Practice of Nursing volume 1. 5nd ed. India;Stephanie’s

2004.

15. Brunner and Suddarth’s. Medical and Surgical nursing. 12th ed. Philadelphia

Lippincott

16.Joyce M .Black, Jane Hokanson Hawks .Volume 2 seventh edition .Medical surgical

nursing

.page no:1765-1766

17. Brunner and Suddarth’s .Text book of Medical surgical nursing .page no :125-139

18. Linda M. MSc, ANP, RN. Dimensions of Critical Care Nursing:

January/February 2006 - Volume 25 - Issue 1 - pp 44-4.Research DIMENSION

19. Harper, John P. MSN, RN,BC. Journal for Nurses in Staff Development - JNSD:

July/August 2004 - Volume 20 - Issue 4 - pp 177-18

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ELECTRONIC MEDIA

1. www.google.com

2. www.pubmed.com

3. www.nursingtimes.com

4. www.medscape.org

5. www.wikipedia.com

6. www.ncbi.nlm.nih.gov

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1. SIGNATURE OF THE STUDENT :

2. GUIDE NAME : MRS. VANMATHI T

REMARKS OF THE GUIDE : GOOD

SIGNATURE OF THE GUIDE

3. CO-GUIDE NAME :

SIGNATURE OF CO-GUIDE:

4.HEAD OF THE DEPARTMENT :

SIGNATURE OF THE HOD :

5. PRINCIPAL NAME:

REMARKS OF THE PRINCIPAL:

PRINCIPAL SIGNATURE:

s

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