RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

Ms.Jhansi.K Firs !"ar M.S#. N$rsin% O&s " ri#s an' G!na"#()(%i#a) N$rsin% Year 2010-2011 EAST WEST COLLEGE OF NURSING BEL Layout Off Maga ! Ma!" roa # $!%&'"ee a( )o%t Ba"ga*ore-+,0 0-1 RA.I$E GAN/0I UNI$ERSITY OF 0EALT0 SCIENCES BANGALORE# 1ARANATA1A2

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA PROFORMA FOR RESGISTRATION OF SUBJECTS FOR DISSERTATION

1.

NAME OF THE CANDIDATE & ADDRESS

Ms. Jhans .! I "#a$ M.S%. N&$s n' Eas( )#s( C*++#'# *, N&$s n' Eas( )#s( C*++#'# *, N&$s n'

-.

NAME OF THE INSTITUTION ./0 Ma'a1 R*a1. BEL +a"*&(, Ban'a+*$#231,Ka$na(a!a

COURSE OF STUDY AND SUBJECT

I "#a$ M.S%. N&$s n' O4s(#($ %s an1 G"n#%*+*' %a+ N&$s n'

5.

DATE OF ADMISSION TO COURSE

16276217

6.

TITLE OF THE STUDY

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/. BRIEF RESUME OF THE INTENDED )ORK>

/.1 INTRODUCTION>
Aging is an inevitable natural process and there is no treatment for aging process. Premenopausal women were defined as those women who had not yet reached menopause, but were experiencing menopause-related changes such as irregular periods or hot flashes. Aging process in women differs from men in more than one ways. Along with physical changes, there are several psychological and social changes to be dealt with.1 Menopause is the word that immediately comes to the mind when we say aging process in women. The woman s life is divided into two phases premenopausal and postmenopausal. The hormonal changes in the body invite many aging problems. The body starts losing out on bone mass and muscle strength. These wea!ened bones often result in osteoporosis and arthritis, The s!in becomes sun!en and sallow and eventually, wrin!les begin to appear. The immune system is no longer able to produce sufficient anti bodies, thereby ma!ing the body susceptible to various illnesses. Most vital organs show diminished performance, which affects the entire health of the woman." Again# menopause is the bu$$ word psychological changes. The hormonal changes during menopause bring about plethora of behavioral changes in a woman. %motional insecurity haunts their mind due to the fear that since she is no longer physically during aging process in women, their social life entirely depends upon their own attitude towards life and most importantly their health. &ome women, due to their poor health or some other reason, may completely shut themselves away from the world. 'hile the other, more outgoing group, may engage themselves in community activities or some hobbies and interests.. Thus, this period poses a golden chance for them to live the life for themselves."

The menopause normally occurs between the ages of () and )), although occasionally women may undergo a premature menopause much earlier in their reproductive lives. An *artificial menopause+ may be brought about by hysterectomy. 'hen only the uterus is removed in a pre-menopausal woman, the cyclical changes continue in the ovaries and the subse,uent decline of ovarian hormone secretion ta!es its natural course. -owever, if the ovaries are removed at the same time, which is often advised in the late forties.. &ome of the /ommon problems of premenopausal women are0 1ac!ache and pelvic and ,-eadache, 2oint pain, C*ns( <a( *n C$a;<, 3eep vein thrombosis, Fa n(n#ss 4ncontinence I(%h n', N*s# 4+##1s Pass n' 9a(#$ *,(#n

Piles 5hemorrhoids6 &evere itching and S! n an1 ha $ %han'#s S+##<+#ssn#ss.( &creening and gynecological investigations are 1iopsy, biopsy involves

1one density test for osteopenia 1reast biopsy for abnormality in the breast. cervical biopsy is performed to evaluate abnormal cervical tissue. /olposcopy is this test is usually done if the cervix, %ndometrial or uterine biopsy this test, done to find out infections in vegina. Pelvic ultrasound this test produces an image of your pelvic organs, 11Toluidine blue dye test is This test is used to evaluate abnormal changes in the vulva. 1rest self examination - 1reast self-examination 51&%6 is a screening method used in an attempt to detect early breast cancer. 3ilation 5or dilatation6 and curettage 537/6 refers 4t is a therapeutic gynecological procedure -ysteroscopy is a valid alternative ) -ealth of women has been a global concern for many decades. 4n recent times, the health of elderly women has drawn attention of the researchers and policyma!ers because there is a global trend of increase in number and life expectancy of this population. 4n 4ndia, during the last 18 years, there has been a numerical increase in elderly. population 5aged () years and above6 and presently around "8.19 of women fall in this age group.: According to a survey distributed by The ;orth American Menopause &ociety 5;AM&6, while <= percent of women who participated consider bone strength to be an

important health concern, nearly half 5() percent6 of these women reported that osteoporosis was not addressed during their last routine obstetrics and gynecological visit.>

:.". NEED FOR STUDY0

Menopause is a term used to describe the permanent cessation of the primary functions of the human ovaries0 the ripening and release of ova and the release of hormones that cause both the creation of the uterine lining and the subse,uent shedding of the uterine lining 5a.!.a. the menses6. Menopause typically 5but not always6 occurs in women in midlife, during their late (8s or early )8s, and signals the end of the fertile phase of a woman s life.= Menopause literally means the ?end of monthly cycles? from the Greek word pausis 5cessation6 and the root men- 5month6, because the word ?menopause? was created to describe this change in human females, where the end of fertility is traditionally indicated by the permanent stopping of monthly menstruation or menses. Menopause is an unavoidable change that every woman will experience, assuming she reaches middle age and beyond. 4t is helpful if women are able to learn what to expect and what options are available to assist the transition, if that becomes necessary.< Menopause can be officially declared 5in an adult woman who is not pregnant, is not lactating, and who has an intact uterus6 when there has been amenorrhea 5absence of any menstruation6 for one complete year. -owever, there are many signs and effects that lead up to this point, many of which may extend well beyond it too. These include0 irregular menses, vasomotor instability 5hot flashes and night sweats6, atrophy of genitourinary tissue, increased stress, breast tenderness, vaginal dryness, forgetfulness, mood changes, and in certain cases osteoporosis and@ or heart disease. These effects are related to the hormonal changes a woman+s body is going through, and they affect each woman to a different extent.18 Menopause is an unavoidable change that every woman will experience, assuming she reaches middle age and beyondr. -owever, there are many signs and effects that lead up to this point, many of which may extend well beyond it too. These include0 irregular menses, vasomotor instability 5hot flashes and night sweats6, atrophy
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of genitourinary tissue, increased stress, breast tenderness, vaginal dryness, forgetfulness, mood changes, and in certain cases osteoporosis and@ or heart disease.These effects are related to the hormonal changes a woman+s body is going through, and they affect each woman to a different extent.11 The research studies related to early gynecological condition is A study done on the techni,ue, feasibility and early complications of ?Aome pouch? urinary diversion. Thirty-five consecutive patients affected by advanced or recurrent gynecological cancers who re,uired anterior or total pelvectomy entered the study. Bebrile morbidity occurred in ": patients 5>(96. 'ound complications and pelvic collection were found in > 5"896 and : 51>96 patients, respectively. This techni,ue showed low rate of medical and early urologic complications. The simplicity of performing the procedure and the reduced operating time are the best goals reached by Aome pouch techni,ue.1" Aeddy, Aani and others 5"8886 surveyed ">( adolescent school going girls in Tirupati town of Andhra Pradesh to study awareness and perception about menarche, and menstrual problems. "88 of the "." post menarcheal girls reported "." problems experienced before menstruation. 3ysmenorrhoea 5bac!ache6 was felt by )89 of the adolescents prior to as well as during menstruation. 1ad odour of menstrual blood was the prominent problem reported by )>9 of the adolescent girls. Profuse menstrual bleeding was complained by .19 of the adolescent girls. /alf muscle pain was the number one complaint felt prior to as well as during menstruation by more than a ,uarter of the adolescent girls. Tiredness was the number two problem experienced prior to the menstruation by "8.)9 of the adolescent girls and this complaint had declined to :9 during menstruation. 4rritability was third in ran! reported by "8.)9 adolescent girls before and "1..9 girls during menstruation. 1) &ince the pre menopausal women may have the ris! of certain gynecological problems, it is essential to have !nowledge regarding gynecological problems and protection of women health in menopausal period. Many studies revealed that the pre menopausal women have limited !nowledge regarding the early gynecological investigations. 1y considering these factors the researcher felt that there is need to

assess the !nowledge of pre menopausal women regarding early gynecological investigations. Therefore selecting study was planned to underta!e.1:

/.0 CONCEPTUAL FRAME )ORK>

/onceptual framewor! is interrelated concept or abstractions that are assembled together in some rational scheme by virtue of relevance to a common theme, some time refer to as conceptual scheme. /onceptual framewor! selected for the study is based CDeneral system theory by Eudwingwen 1ertlanffy F1<:=GH, According to general system theory Cscience of wholeness and its purpose is to unit scientific thin!ing across the discipline and which provide framewor! for analy$ing the whole of any system. The system has a specific purpose to achieve that goal. A system activity can be resolved into a aggregation of feedbac! circuits such as0 4nput. Throughput. Iutput. 1. In<&(> Aefers to any form of information, energy of material, that lead into the

system through its boundary. 4n this study, input refers to the personal characteristics. -. Th$*&'h<&(> Aefers to where by the system transforms, create and organi$es input. 4n this study throughput refers to the !nowledge and attitude regarding the early gynecological investigation. 0. O&(<&(> output refers to energy, information or matter that is transformed to the environment. Iutput in this study refers to the !nowledge and attitude of regarding the early gynecological investigation"8.

/.5 REVIE) OF LITERATURE0

Aeview of literature is a !ey step in research process. Aeview of literature is a critical summary of research on a topic of interest generally prepared to put a research problem in paper content to identify gaps and wea!ness on previous studies to 2ustify a new investigation. -ere, the investigator reviewed previous studies, related research and nonresearch literature to broaden the understanding and gain insight into the problem study. 4n this study the investigator gather total seven reviews of literature related to present study. The review of literature for the present study has been divided into the following sections0 &tudies on !nowledge regarding gynecological investigations. &tudies on advantages of gynecological investigations &tudies on attitude of women to gynecological investigations &tudies on gynecological investigations among premenopausal women. S(&1 #s *n !n*9+#1'# $#'a$1 n' '"n#%*+*' %a+ n:#s( 'a( *ns> The study was conducted on compare manifestations of somatic disturbances in early pre menopause in women after physiological and surgical menopause. This prospective study included :8 women, age (1-)) years. %xtrasistolyc heart excursion was a common symptom in both study groups. An analysis of the body mass index 51M46 showed that the women in both groups were obese 51M4 J ")6. The lipids analysis confirmed the predomination of hyperlipoproteinemia type 44a in the group with physiologic menopause and type 44b after induced menopause. More intensive follow-up in patients after surgical removing of the ovarian is necessary in order to improve the ,uality of life in these patients.1>

S(&1 #s *n a1:an(a'#s *, '"n#%*+*' %a+ n:#s( 'a( *ns> The study compares the preoperative morbidity and mortality rates of elderly 5J or K>8 years6 and younger 5L >8 years6 patients. The study cohort consisted of 1>1 women undergoing explorative laparotomy due to uterine or ovarian cancer. Participants were divided to 18= 5:.."96 patients with uterine cancer and :. 5.:.=96 patients with ovarian cancer. /hronological age by itself should not be a contraindication for the treatment of elderly women with gynecological malignancy since it is a poor predicting factor for preoperative morbidity. 1< &tudy is to report our experience with incidental ovarian tumors in patients during Aoux-en-M gastric bypass. 3etails of operative treatment and outcomes are reported here. (:8 women underwent during the study period. Although infre,uent, incidental ovarian tumours may be discovered in patients undergoing bariatric surgery, emphasi$ing the importance of thorough exploration of the abdominal cavity. /onsultation with a gynecologist is warranted in most instances, and treatment should be on a patient-by-patient basis, especially in women of child-bearing age.1? S(&1 #s *n a(( (&1# *, 9*;#n (* '"n#%*+*' %a+ n:#s( 'a( *ns3 The aim of the study was to describe and analy$e the attitude of Arabicspea!ing women to gynecological examinations, with particular focus on the importance of the sex of the examining doctor. An Arabic ,uestionnaire was given to the participants and a 3anish translation for second generation immigrants was also attached. A total of one hundred ,uestionnaires were collected. 4n half the cases, a female doctor was sent for. There was a connection between the refusal of the D% by a male doctor and the length of time the women had lived in 3enmar!. Most of those who were examined by a male doctor have lived in 3enmar! longer than those who refused the same D%11. S(&1 #s *n '"n#%*+*' %a+ n:#s( 'a( *ns a;*n' <$#;#n*<a&sa+ 9*;#n> This study evaluated the discrepancy between promote diagnoses and postmortem diagnoses in a cohort of gynaecological cancer patients. The records of all patients with a diagnosis of gynaecological cancer that were followed by the 3epartment of Ibstetrics and Dynaecology at the Nniversity of Texas Medical 1ranch. Ine hundred and seventy eight I1@DM; patients died in the -ospital within the study

period. Twelve charts were incomplete or the death certificates could not be identified. The ma2ority of the deaths 5<196 occurred on the Dynaecologic Incology service of which "<9 5((@1)16 underwent post-mortem examination. Iur findings further confirm the importance of the post-mortem examination in determining an accurate cause of death.1= The study shows paper studied the influence of several gynecological factors 5years since menopause 5M&M6, age at menarche and gynecological age or reproductive life6 simultaneously with anthropometric factors as determinants of bone mass in 1=< healthy postmenopausal women. Age at menarche correlated negatively with body mass index 51M36 /orti 5PL8.8)6 and gynecological age correlated positively with body mass index Trab 5PL8.8)6 Iur data stress the importance of years since menopause on body mass index Trab and body mass index /orti, of age at menarche on body mass index /orti and of gynecological age on body mass index Trab. -owever, years since menopause determines body mass index.1) The use of prophylactic antibiotics in gynecologic laparoscopic surgery is still popular and many gynecologic surgeons believe that prophylactic antibiotic therapy will decrease the incidence of postoperative infection complications. .88 women who underwent laparoscopic surgery for benign gynecological conditions were included in the study. Droup A 5n K 1)86 received " g of cefa$olin 5/efame$in# Pfi$er 4talia &rl, 4taly6 .8 min before surgery and group 1 5n K 1)86 received no antibiotic prophylaxis. Postoperative infection complications in laparoscopic gynaecologic surgery without antimicrobial prophylaxis are negligible and overlapping to those obtained with cefa$olin prophylaxis.1: is the gynecological factor that mainly

/.6 STATEMENT OF PROBLEM>

8A s(&1" (* ass#ss (h# #,,#%( :#n#ss *, s+ 1# sh*9 *n !n*9+#1'# $#'a$1 n' #a$+" '"n#%*+*' %a+ n:#s( 'a( *ns a;*n' <$# ;#n*<a&sa+ 9*;#n n s#+#%(#1 h*s< (a+ a( Ban'a+*$#.=

/./ AIM OF THE STUDY>

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To impart the !nowledge regarding early gynecological investigations.

/.@ OBJECTIVES OF STUDY>

1. To assess the pre test !nowledge score regarding early gynecological investigation among pre menopausal women. ". To assess the post test !nowledge score regarding early gynecological investigation among pre menopausal women. .. To compare the pre test and post test !nowledge score regarding early gynecological investigations among pre menopausal women. (. To associate mean !nowledge with selected socio-demographic variables of pre menopausal women. /.? OPERATIONAL DEFINITIONS 4n this present study the researcher has define the following terms0 1. E,,#%( :#n#ss> 4t refers to the outcome of slide show in increasing the !nowledge level among premenopausal women. -. S+ 1# sh*9> 4t means an audio-visual device which is use to give information about early gynecological investigations. .. Kn*9+#1'#> 4t refers to the amount of !nowledge the premenopausal women should have regarding early gynecological investigations. (. G"n#%*+*' %a+ n:#s( 'a( *n> 4t refers to the diagnostic examination procedures related to Dynecological problems. ). P$# ;#n*<a&sa+ 9*;#n> women before attaining the menopause after the age of ()years.

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/.3 HYPOTHESIS>
H12 There will be significant difference between the pre-test and post test !nowledge score regarding early gynecological investigation methods among premenopausal women. H-2 There will be significant association between the pre-test !nowledge score with the selected socio demographic variables of the participants.

/.17ASSUMPTIONS>
1. Pre menopausal women may need to reinforce to go for early health chec! up

@. METHODOLOGY> @.1 RESEARCH APPROACH0 Ouantitative evaluative approach. @.- RESEARCH DESIGNS> Ouasi experimental P one group pre test post test
design.

@.0 SETTING> IP3 or ward in selected maternity hospitals at 1engaluru. @.5 POPULATION> The population of the study will comprise all the pre
menopausal women who are attending IP3 or admitted in ward in a selected maternity hospital, 1engaluru.

@.6 SAMPLING> pre menopausal women who fulfill the inclusion criteria. @./ Sa;<+# s A#> ;K:8 @.@ SAMPLING TECHNIBUE> Purposive sampling techni,ue. @.?. SAMPLING CRITERIA>
In%+&s *n %$ (#$ a>
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1. Pre menopausal women who are above (8 years of age. ". Pre menopausal women who are willing to participate in the study. .. Pre menopausal women who are attending maternity ward. (. Pre menopausal women who can understand Qannada or %nglish language. EC%+&s *n %$ (#$ a 1. Pre menopausal women who are critically ill. IP3 or who are admitted in

@.3. TOOL FOR DATA COLLECTION>

T**+ 1>&ocio demographic data will be prepared by the investigator. T**+ -> CA structured !nowledge ,uestionnaire on !nowledge regarding importance of early gynecological investigation among premenopausal women will be prepared by the investigator.H

>.18 VARIABLES>
In1#<#n1#n( :a$ a4+#> &lide show on !nowledge regarding early gynecological investigations. D#<#n1#n( :a$ a4+#s> !nowledge of the pre menopausal women. EC($an#*&s :a$ a4+#s> as, age, sex, education, designation, Mears of experience, previous experience with gynecological disorders.

@.11. METHOD OF DATA COLLECTION> 1y interview method.

@.1-. M#(h*1 *, 1a(a ana+"s s> The data collected will be analy$ed based on ob2ectives and hypotheses by using descriptive and inferential statistics. D#s%$ <( :# s(a( s( %s> Bre,uency and percentage distribution will be used to describe the demographic variables. Mean and standard deviation will be used to assess the

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!nowledge

regarding early gynecological diagnosis method among women from

selected hospital. In,#$#n( a+ s(a( s( %s> Paired*t+ test will be used to compare the pre and post test !nowledge regarding early gynecological investigation methods among women from selected maternity hospital and /hi - s,uare test will be used to associate pre test !nowledge with selected demographic variables.

@.10 DURATION OF DATA COLLECTION> : wee!s. @. 15 PROJECTED OUT COME0 The study will improve the !nowledge
regarding early gynecological diagnosis method among women from selected hospital.. 4t will be helping for women for early detection and !nowing about gynecological problems.

>.1) DELIMITATION> The study is delimited to pre menopausal women.

@.1: 3oes the study re,uire any investigations or interventions or other humans or animalsR Y#s >.1> Has #(h %a+ %+#a$an%# 4##n *4(a n#1 ,$*; "*&$ ns( (&( *nD Y#s, copy enclosed.

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?. LIST OF REFERENCES>
1. Anderson women.html ". /athelinaeCM#n*<a*&sa+Hhttp://www.nhs.uk/Planners/pregnancycareplanner/Pag es/Commonproblemshome.asp .. Eaufer N!eles and Pamela,H%h +1 4 $(h <$#<a$a( *nH http:// www. answers. com/ topic/ menopause-! (. Maya 3evi &ubedi,CMan&a+ *, M 19 ,#$"=,A.1st edition.Qathmandu ;epal0 Ma!alu boo!s and stationers publisher# "88). ). Eaufer N!eles and Pamela, CB $(h <$#<a$a( *n ,*$ an(#na(a+ ;*(h#$sH, "uke #ournal of gender law $ policy %&&%' %%: ()* +-,. :. 'orld -ealth Irganisation. Aesearch on the menopause in the1<<8s 5Aeport of a '-I scientific group, '-I Technical Aeport&eries, =::6. Deneva0 'orld -ealth Irganisation 1<<:. >. 3r Si2ayala!shmi %thira2 and Mrs. %sther Tohn CB $(h <$#<a$a( *n ,*$ an(#na(a+ ;*(h#$sH, http://www.menopause.org/menopauseflashes&-.%osteosurvey.asp =. 3r Si2ayala!shmi %thira2 and Mrs. %sther Tohn,C A s(&1" (* ass#ss (h# #,,#%( :#n#ss *, a s($&%(&$#1 (#a%h n' <$*'$a;;# *n B$a1+#" ;#(h*1 *, %h +1 4 $(h <$#<a$a( *n (* an(#na(a+ 9*;#nH, Pondicherry 2ournal of nursing "88<# 10 5.6 .(-.>. <. Dloria -offmann wold, CC*n(#;<*$a$" ;a(#$n (" n&$s n'H,1st edition. &t. Eouis 1altimore 1oston /arlsbad /hicago ;aples ;ew Mor!0 Mosby publishers# 1<<>. 18. 3r A Tudie, C1irth <$#<a$a( *nH, 4ndian 2ournal of holistic nursing "88=# (0 5.6 ":-"<. 11. 3iana 1ec!, Brances Danges, &usan Doldman and Phyllis Eong, C A $#,#$#n%# ;an&a+ *n %a$# *, (h# n#94*$nH, Q4;%T4Q 'ashington 3/0 &ave the children publishers# "88(. 1". Mrs.Malathi, CAss#ss;#n( *, !n*9+#1'# an1 a(( (&1# *n %h +1 4 $(h <$#<a$a( *n an1 ,a%(*$s <$*;*( n' (h# &( + (" *, s#$: %# a;*n' <$ ; '$a: 1a ;*(h#$sH, 4ndian 2ournal of holistic nursing "88<# )0 5(6 ":-"<.. CA' n' <$*%#ssH http://www.buzzle.com/articles/aging-process-in-

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1.. &M Mutiso , CCh +1 4 $(h <$#<a$a( *nH, %ast African medical 2ournal "88=# =)0 5:6 18 <. CA9h*nn.B $(h <$#<a$#1n#ss <+anH, Tournal of obstetric "88:# 1(0 5."=6 ""(. 18. ;inciU 3, Vi!iU 3, 4v!oviU-Qapicl T, MastiloviU Q/0 Ps"%h*<h"s *+*' % 1 s(&$4an%#s n #a$+" <*s(;#n*<a&s# n 9*;#n a,(#$ <h"s *+*' %a+ an1 s&$' %a+ ;#n*<a&s#=, ;ov "88:# :.51160<"<-.". 11. &aid AM, 'ielandt -1,CTh# a(( (&1# *, A$a4 %2s<#a! n' 9*;#n (* '"n#%*+*' %a+ #Ca; na( *ns=, "88" ;ov 1=# 1:(5(>60))1(-=. 1". Plotti F, Muzii L, Zullo MA, Manci N, Palaia I, Galluci M, Continent ileocolonic urinary diversion (Rome pouch) for gynecologic malignancies,technique and feasibility. 2007 Nov;107(2):19 !9. "#ub 2007 $u% &. 1.. C&e" SL, .a"e SW, Yu YM, 0%!e& YS, Discrepancy between physicians' perceptions and practices during pelvic examinations, in 'ai(an. "88< Tan#>(51601"(-<. %pic "88= Ict ). 1(. &antoso TT, Eee /M, Aronson T, CD s%$#<an%" *, 1#a(h 1 a'n*s s n '"n#%*+*'" *n%*+*'"=, "88: May#1815"60.11-(. %pub "88) 3ec 1. 1). 0er"4" e5 ER, Se6o C, Cort7%-8r!eto ., $!**a LF, Re9!**a M, R!6o 0.G"n#%*+*' %a+, 8,a%(*$s an1 4*1" ;ass n1#C as 1#(#$; nan(s *, 4*n# ;ass n n*$;a+ <*s(;#n*<a&sa+ 9*;#=, A study with peripheral ,uantitative computed tomography 5pO/T6. "888 Ict#<"5"601<.-=. 1:.Eitta P, &acco D, Tsiroglou 3, /osmi %, /iavattini A, C Is an( 4 *( % <$*<h"+aC s n#%#ssa$" n #+#%( :# +a<a$*s%*< % s&$'#$" ,*$ 4#n 'n '"n#%*+*' % %*n1 ( *nsH,"818#:<5"601.:-<. %pub "88< 3ec 1=. 1>. Qamins!i P, Da2ews!a M, 'ielgos M, &$ymusi! 4La<a$*s%*< % ;ana'#;#n( *, 1#$;* 1 %"s(s n <a( #n(s *, $#<$*1&%( :# a'#. "88: 3ec#">5:60=1=-"1. 1=. Don$ale$ A, -aines Q, Dallagher &B, &anders D, -offman M, Murr MM. Mana'#;#n( *, n% 1#n(a+ *:a$ an (&;*$s n <a( #n(s &n1#$'* n' 'as($ % 4"<ass 2 "88( Ict#1(5<601"1:-"1.

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1<. Be"-A(! I, $a:"!" ;, S6&"e! er /, 0a*)er!" R. P#$ *<#$a( :# ;*$4 1 (" an1 ;*$(a+ (" *, '"n#%*+*' %a+ *n%*+*' % s&$'#$" n #+1#$+" 9*;#n . "88: TanBeb#1:5160()"->. "8 "la)uvana bhas)a**a+. heory application in nursing practice.1st edition. ,ay#ee b*othe*.. 2010:17-!&"

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