Umbilical cord blood banking by UQFHS4R

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									SYNOPSIS FOR REGISTRATION OF
 SUBJECT FOR DISSERTATION

            SUBMITTED BY:

    Ms. ELIZABETH MATHEW
            I M.Sc. NURSING



OBSTETRIC AND GYNAECOLOGICAL
           NURSING
           (2010-2012 BATCH)

 FORTIS INSTITUTE OF NURSING
 #20/5, YELACHENAHALLI, KANAKAPURA ROAD
          BANGALORE – 560 078
                                                           1


     SYNOPSIS FOR REGISTRATION OF SUBJECT FOR
                   DISSERTATION


1. NAME OF THE          Ms. ELIZABETH MATHEW,
  CANDIDATE AND         1ST YEAR M. Sc NURSING,
  ADDRESS               FORTIS INSTITUTE OF NURSING,
                        #20/5, YELACHENAHALLI,
                        KANAKAPURA MAIN ROAD,
                        BANGALORE - 560078.
2. NAME OF THE          FORTIS INSTITUTE OF NURSING,
  INSTITUTION           BANGALORE.

3. COURSE OF THE        MASTER’S DEGREE IN NURSING,
  STUDY AND SUBJECT     OBSTETRIC AND GYNAECOLOGICAL
                        NURSING
4. DATE OF ADMISSION    31 MAY 2010
  TO COURSE
5. TITLE OF THE TOPIC   “A     STUDY      TO    ASSESS     THE
                        EFFECTIVENESS      OF     STRUCTURED
                        TEACHING          PROGRAMME         ON
                        KNOWLEDGE REGARDING UMBILICAL
                        CORD      BLOOD    BANKING       AMONG
                        ANTENATAL MOTHERS IN SELECTED
                        HOSPITAL, BANGALORE.”
                                                                             2


6.0 BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

      “Nature offers the ability to create food; out of itself, by itself, for
itself to all organisms for survival and self sufficiency.”

      Scientists have been interested in cell biology since the advent of
microscopes in 1800’s. Cell propagation and differentiation were witnessed
for the first time and cells were recognized as the building blocks of life,
capable of giving rise to other cells and key to understanding human
development.11

       In the early 1900’s European researchers realized that the various
type of blood cells e.g. white blood cells, red blood cells and platelets all
came from a particular ‘stem cell’. Stem cells have an amazing ability to
create different kinds of tissues when they divide and develop. This power to
produce different kinds of specialized cells makes them so unique and potent
for medical therapy. In 1963, the first quantitative descriptions of the self-
renewing activities of bone marrow cells were documented by Canadian
researchers Ernest A McCulloch and James E Till. Bone marrow transplants
– actually a transplant of adult stem cells – have been used in patients
receiving radiation and chemotherapy since the 1950’s. Developments in
biotechnology in 1980s and 1990s saw the introduction of methods for
growing human cells in the laboratory. These advances really opened the
doors for human stem cell research. The discovery of stem cells was one of
the greatest achievements of modern medicine.11
                                                                              3


      Bone marrow transplantation has been used as a means to cure
hematological disease, heamatological malignancy, malignant solid tumors,
congenital immunodeficiency syndrome, and some metabolic diseases.
When matched family donors for bone marrow are not available, the next
line of preferable donors currently is matched unrelated donors. Searches for
these donors are usually made through national and international bone
marrow donor registries.6 The un-availability of bone marrow donors and the
problems related to bone marrow transplantation including graft failure and
graft- versus- host disease, have urged the search for alternative sources for
marrow cells. Until recently, the placenta representing a significant source of
fetal blood stem cells was discarded after birth. Since the evaluation by
researchers of umbilical cord blood being a potential source for
haemopoietic stem cells (HPSC), and the evidence of advantages over bone
marrow, attention has shifted to the establishment of umbilical cord blood
banks.2

      In brief, the procedure of the umbilical cord blood banking involves
the cutting and clamping of the umbilical cord. A specialized blood bag is
then bar-coded for collection of cord blood. For the collection step, the
needle of the blood bag is inserted into the umbilical vein and the bag is held
at a lower level in order to allow the blood to drain into the bag. Stem cells
are then harvested from the cord blood and stored in cryo-vials at -1960 C in
liquid nitrogen. Molecular tests are conducted for tissue (HLA) typing.7

      In Vitro studies have shown that enough stem cells appear to be
present in 60-100 ml of cord blood obtained after delivery of the infant. For
this purpose, umbilical cord blood is collected after delivery of the baby,
from the residual blood in placental cord unit. The blood volume of term
                                                                               4


baby is about 70 ml/kg while the placenta contains 45ml of blood per kg of
fetal weight.1

      The first clinically documented use of cord blood stem cells was in the
successful treatment of a six-year-old boy afflicted by Fanconi’s anemia by
Dr. Elaine Gluckmen in 1988, in Paris. Since then, cord blood has become
increasingly recognized as a source of stem cells that can be used in stem
cell therapy.7

      Umbilical cord blood contains the same kind of stem cells as found in
bone marrow. It is thought that because the umbilical cord cells are
immature immunologically, they adapt to the patient’s body better than
mature bone marrow cells and thus don’t cause as many immunological
problems. Umbilical cord cells are in abundance, are immunologically
flexible, and can be used as a truly ethical therapy.7

      Twenty years ago, only one disease could be treated with umbilical
cord stem cells; ten years ago only a handful. Today, umbilical cord stem
cells have been successfully used in the treatment of more than 80 life-
threatening diseases (primarily blood diseases). The amazing speed of
research and clinical trials using umbilical cord stem cells has led to diseases
being treated that no one could have predicted. Many of these new
treatments use the patient’s own stem cells.12

6.1 NEED FOR THE STUDY

      Cord blood is a biological insurance against diseases. The umbilical
cord blood is a rich source of stem cells that can be derived from two
sources: cord blood and cord tissue. The stem cells derived from the cord
blood are called hematopoietic stem cells- these have immense potential in
                                                                             5


curing blood related disorders like blood cancer, thalassemia etc. the cells
derived from the cord tissue are called mesenchymal stem cells- these can be
useful in treating tissue related disorders of heart, bone, spinal cord, etc.9
Investigators also speculate that cord blood stem cells could be used to
revitalize a damaged immune system, making them nearly as versatile as
embryonic stem cells for treating such immune disorders as type 1 diabetes
and rheumatoid arthritis.7

      Kang et al have reported the use of cord blood stem cells to restore
‘feeling and mobility’ to a spinal cord injury patient, who had been a
paraplegic for 19 years due to an accident. Forty-one days after stem cell
transplantation, ‘test’ showed the regeneration of the spinal cord at the
injured site and below it.7

      As stem cell therapy breaks new ground and stem cells derived from
the umbilical cord blood are proving to be such a boon to stem cell therapy,
it is natural that the prospect of preservation of umbilical cord blood is
gaining momentum. Thus, so called, umbilical cord blood banking is being
touted as insurance for life. Storage of the stem cells derived from umbilical
cord blood means one can preserve and use genetically matched stem cells
on hand, in case the child or someone else in the family suffers from a
treatable blood disorder or needs a bone marrow transplant. There is a 25%
genetic match between the siblings and parents, which proves to be the most
alluring prospect for expectant couples to bank their child’s cord blood (thus
ultimately their stem cells). The use of these stem cells more or less ensures
absence of graft versus host reaction, which is a huge drawback in cases of
organ transplantation. In India, there are approximately 72000 births daily,
which results in discarding 72000 umbilical cords a day. The storage of stem
                                                                          6


cell rich blood derived from these umbilical cords can prove to be the best
possible insurance against life threatening diseases.7

      Umbilical cord cells show great promise of being an effective
treatment for heamatological malignancies. Normally, leukemia patients
must rely on receiving bone marrow transplants from donors, and the donor
must be a close match or the patient develops serious immunological
problems. Closely related donors, such as siblings, have the best chance of
being a good match. Laughlin et al conducted a study of 68 patients with
leukemia or with other blood disorders. Most of the patients received
transplants of umbilical cord cells from unrelated donors. About 90% of the
patients grew new, healthy blood cells from the “mismatched” cord blood
cells. Only 20% of the patients developed severe immunity problems
compared to 55% of the patients who developed such problems after
receiving perfectly matched bone marrow.4

      As there is increasing number of options regarding collection and
banking of umbilical cord blood, more pregnant women are likely to be
asked to make decision about umbilical cord blood banking. A study found
that, while feeling confident in making an anticipatory decision about cord
blood banking, women expressed a clear desire to learn much more about
collection, storage, and use of umbilical cord blood banking.3

      The studies have shown that, though most women want to do the best
for their children, they lack information on the benefit of umbilical cord
blood collection and banking. So encouragement during antenatal period is
very important.
                                                                            7


      So, by the above statements and previous clinical experience, to
impart scientific information on umbilical cord blood banking the
investigator rightly justifies the need for preparing a teaching programme on
umbilical cord blood banking.

6.2 REVIEW OF LITERATURE

        Review of literature for the present study has been organized under
the following headings.

6.2.1 Studies related to knowledge of antenatal mothers on umbilical cord
        blood banking.
6.2.2 Studies related to effectiveness of structured teaching programme.

6.2.1 STUDIES RELATED TO KNOWLEDGE OF ANTENATAL
        MOTHERS ON UMBILICAL CORD BLOOD BANKING
      Patricia E. Palten and Joachim W. Dudenhausen (2010) conducted a
study among 300 German speaking pregnant women in Berlin to know
whether a correlation between women’s knowledge about umbilical cord
blood banking and level of education. The data collected by using
anonymous questionnaire. Among them 3 quarters of the population heard of
umbilical cord blood banking, most had no further knowledge about the
method. Only one third of the interviewed women were informed about
whether certain diseases had been treated with umbilical cord blood banking
by the time the survey was being conducted, whereas 50-60% did not know
how to answer these questions.5

      Dinc H. and Sahin N.H (2009) conducted an exploratory descriptive
study among 334 pregnant women to determine pregnant women’s
knowledge and attitudes about stem cells and cord blood banking in
                                                                             8


Istanbul, Turkey. The data collected through interviews. The study revealed
that majority of participants had lack of knowledge regarding stem cells and
cord blood banking and wanted more information.10

      Conrad V. Fernandez, Kevin Gordon et al (2001) conducted a study
among 443 pregnant women on knowledge and attitudes with regard to
collection, testing and banking of cord blood stem cells in antenatal
assessment clinics at the IWK Health Centre, Halifax, NS. Data collected by
structured questionnaire. The study revealed that about 70% of the women
reported poor or very poor knowledge about cord blood banking.8

6.2.2 STUDIES         RELATED          TO       EFFECTIVENESS             OF
        STRUCTURED TEACHING PROGRAMME.
      Yanichin(2002) conducted a study to assess the effectiveness of
structured teaching programme on knowledge and practice of breast feeding
among primi-postnatal mothers of maternity wards in C.M.C Vellore
hospital, research design employed descriptive survey method, simple
random sampling used, sample size were 100 primi-postnatal mothers, tools
used were observation checklist and interview guide. The study’s results
shows that mother who had teaching programme showed highly significant
knowledge gain, good practice of breast feeding(P<0.01).15

      Poornaranjitham(2001) conducted an experimental study to determine
the effectiveness of pre-natal structured teaching on knowledge, attitude, and
practice of breast feeding among primi-para mothers, design is experimental
design setting in C.M.C Vellore hospital, sample 37 mothers at term, sample
size 60 women, 30 for experimental and 30 for control group, sample
selection by random number table, tool prepared based on Tamilnadu health
                                                                             9


development forum 1993, data collection done for 6 weeks. A paired T-test
revealed that there was significant difference on knowledge, attitude and
practice in the experimental group after structured teaching on breast feeding
(P< 0.05).13

      Sarojamma(2000) conducted a study to assess the effectiveness of
structured teaching programme on knowledge and practice of breast feeding
and its problems among lactating mothers in Vani Villas Hospital,
Bangalore. A descriptive evaluation study was conducted on 20 lactating
mothers of hospitalized children, data collection done using a structured
interview schedule and observational checklist, analysis of data revealed that
50% of mothers had satisfactory level of knowledge about the advantages of
colostrums. The desirable mothers and child relationship before was 15%
and after instruction was 50%, significant at P<0.01 level.14


6.3 STATEMENT OF THE PROBLEM
      “A       STUDY    TO     ASSESS       THE     EFFECTIVENESS         OF
STRUCTURED         TEACHING         PROGRAMME          ON       KNOWLEDGE
REGARDING UMBILICAL CORD BLOOD BANKING AMONG
ANTENATAL MOTHERS IN SELECTED HOSPITAL, BANGALORE.”

6.4 OBJECTIVES OF THE STUDY

 1. To assess the pre-test knowledge scores of antenatal mothers regarding
      umbilical cord blood banking.

 2. To find out the effectiveness of structured teaching programme
      regarding umbilical cord blood banking by assessing post test
      knowledge scores of antenatal mothers.
                                                                          10


3. To find out the association between pre-test and post-test knowledge
     scores regarding umbilical cord blood banking and selected
     demographic variables.

6.5 OPERATIONAL DEFINITIONS:
6.5.1 ASSESS
      Refers to measure the level of knowledge about umbilical cord blood
banking among antenatal mothers.
6.5.2 EFFECTIVENESS

     Refers to the significant improvement in knowledge regarding
umbilical cord blood banking among antenatal mothers after the
implementation of structured teaching programme.

6.5.3 STRUCTURED TEACHING PROGRAMME

      Refers to systematically developed instruction designed for a group of
antenatal mothers to provide information regarding umbilical cord blood
banking.

6.5.4 KNOWLEDGE

      Refers to acquiring information regarding umbilical cord blood
banking among antenatal mothers.

6.5.5 UMBILICAL CORD BLOOD BANKING

      Refers to the collection, processing, and cryopreservation of the
remaining blood within the umbilical and placental circulation following the
birth of a child and typically prior to placental delivery.
                                                                            11


6.5.6 ANTENATAL MOTHERS

      All pregnant mothers who are attending antenatal clinic of selected
hospital, Bangalore.

6.6 HYPOTHESIS

  H0-There is no significant difference between mean pre-test knowledge
        scores and post-test knowledge scores.

  H1-There is an increase in the mean post-test knowledge scores among the
        antenatal mothers compared to pre-test knowledge scores after the
        structured teaching programme.

6.7 VARIABLES IN THE STUDY

Independent variable: Structured teaching programme regarding umbilical
cord blood banking.

Dependent variable: Knowledge of antenatal mothers regarding umbilical
cord blood banking.

Demographic variables: Age, education, occupation, income, religion,
family type, place of residence and gravida.

7.0 MATERIALS AND METHODS

7.1.0 Source of data       :   Antenatal mothers in selected hospital,
                               Bangalore.
7.1.1 Research approach :      An evaluative research approach.
7.1.2 Research design      :    A quasi experimental research with one
                               group pre-test and post-test study design.
                                                                            12


7.1.3 Research setting      :      Selected hospital, Bangalore.
7.1.4 Population            :      Antenatal mothers.
7.1.5 Sample                :     Antenatal mothers attending antenatal clinic
                                  in selected hospital, Bangalore.
7.1.6 Sampling technique:         Non     probability    convenient   sampling
                                  technique.
7.1.7 Sample size           :     100 Antenatal mothers.
7.1.8 Sampling criteria
       Inclusion criteria : 1. Antenatal mothers who are willing to
                                  participate in this study.
                                2. Antenatal mothers who are available during
                                  the period of data collection.
       Exclusion criteria : 1. Antenatal mothers who are not willing to
                                  participate in this study.


7.2.0 TOOL FOR DATA COLLECTION

Data collection tool contain items on the following aspects

PART 1- Will contain the items of demographic characteristics of antenatal
mothers comprising age, education, occupation, religion, income, family
type, place of residence and parity.

PART 2- Knowledge assessment questionnaire regarding umbilical cord
blood banking.

7.2.1 METHOD OF DATA COLLECTION

      The data will be collected personally using structured questionnaire
on knowledge of antenatal mothers regarding umbilical cord blood banking.
                                                                         13


7.2.2 METHODS OF DATA ANALYSIS

      The investigator will analyze the data obtained, by using the
descriptive and inferential statistics.

The plan of data analysis as follows:
Descriptive statistics:
    Mean, mean%, Median, and standard deviation will be used for
      assessing the demographic characteristics.
Inferential statistics:
    Student’s paired T- test is used for measuring any enhancement or
      increase in knowledge level from pre-test to post-test.
    Chi-Square test for measuring association between knowledge level
      and selected demographic variables. The results will be statistically
      significant whenever P ≤ 0.05 level of significance.

7.3. DOES THE STUDY REQUIRE ANY INVESTIGATION OR
      INTERVENTION TO BE CONDUCTED ON OTHER HUMAN
      OR ANIMALS?
       -No-

7.4. HAS ETHICAL CLEARANCE BEEN OBTAINED FROM THE
      INSTITUTION?
      1. The ethical clearance is obtained from the research committee of
           Fortis institute of Nursing.
      2. Written permission will be obtained from concerned authorities of
           selected hospitals.
      3. Written permission will be obtained from the samples who are
           involved in the study before collecting the data.
                                                                        14


8. LIST OF REFERENCE

1. Bonilla Nayar, Deepika Deka, Vinod Kumar Paul, Deep Takkar. Effect on
   the newborn of umbilical cord blood collection at delivery. Obs and
   Gynae Today 2004 July; volume(7) 9:454-456.

2. Ealias M, Choudhury N, Smit Sibinga CTh. Cord blood from collection to
   expansion: feasibility in a regional blood bank. Indian journal of
   paediatrics 2003 April; volume 70:327-336.

3. Jeremy Sugarman, Lyla Kaplan, Betty Cogswell, Janice Olson. Pregnant
   women’s perspectives on umbilical cord blood banking. Journal of
   women’s health 1998 August; 7(6):747-757.

4. Laughlin M J, Eapen M, Rubinsterin P et al. Outcomes after
    transplantation of cord blood or bone marrow from unrelated donors in
    adults with leukemia. N Engl J Med 2004; 351:2265-2275.

5. Patricia E Palten, Joachim W Dudenhausen. A great lack of knowledge
   regarding umbilical cord blood banking among pregnant women in
   Berlin, Germany. Journal of perinatal medicine 2010 November;
   Volume(6) 38:651-657.

6. Susumu Inoue. Cord blood transplant: current and future issues. Indian
   journal of paediatrics 1998; volume 65:163-171.

7. Umbilical cord blood banking [editorial]. The journal of obstetrics and
   gynaecology of India 2005 November/December; volume(6) 55:502-
   504.
                                                                           15


8. Conrad V Fernandez, Kevin Gordon, Michiel Van den Hof, Shaureen
      Taweeland Francoise Baylis. Knowledge and attitudes of pregnant
      women with regard to collection, testing and banking of cord blood stem
      cells 2001. Available from: URL:

      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC154914/

9. Cord blood. Available from: URL: www.relicord.com/AboutCord.aspx

10. Dinc H and Sahin N H. Pregnant women’s knowledge and attitudes
      about stem cells and cord blood banking. International Nursing Review
      2009       May;56(2):250-256.         Available          from      URL:
      http://www.ncbi.nlm.nih.gov/pubmed/19646176

11.     Stem    cell    research     [online].    Available     from:    URL:
       http://domain883347.sites.fasthosts.com/research/history.html

12.     Stem     cell   treatments    [online].    Available     from:   URL:
      en.wikipedia.org/wiki/Stem_cell_treatments

13. Poornaranjitham. Study to assess knowledge, attitude and practices of
       mothers regarding newborn care in CMC Vellore 2001.

14. Sarojamma. Study on the knowledge and practice of breast feeding in
       mothers of Hospitalized infants in Vanivilas Hospital Bangalore 2000.

15. Yanichin. Study to assess the effectiveness of organized instruction on
       knowledge skill and attitude of a practice of breast feeding in C.M.C
       Vellore 2002.
                                                        16


      9
9.    SIGNATURE OF THE   ELIZABETH MATHEW
      CANDIDATE
      1
10.   REMARKS OF THE     IT IS A SIGNIFICANT TOPIC TO
      GUIDE              BE STUDIED
11.   NAME AND           Mrs. SABITHA. S,
      DESIGNATION OF     ASSOCIATE PROFESSOR,
                         DEPARTMENT OF OBSTETRIC
      11.1 GUIDE         AND GYNAECOLOGICAL
                         NURSING.

      11.2 SIGNATURE     S SABITHA
                         Mrs. GOWRI SAYEE
      11.3 CO-GUIDE      ASSOCIATE PROFESSOR,
                         DEPARTMENT OF OBSTETRIC
                         AND GYNAECOLOGICAL
                         NURSING.

      11.4 SIGNATURE     S GOWRI
                         Mrs. GOWRI SAYEE,
      11.5 HEAD OF THE   ASSOCIATE PROFESSOR.
           DEPARTMENT

      11.6 SIGNATURE     S GOWRI
      s                  STUDY IS FEASIBLE, DEVELOPS
12.   REMARKS OF THE     AN AWARENESS AMONG
      PRINCIPAL          ANTENATAL MOTHERS
                         REGARDING UMBILICAL CORD
                         BLOOD BANKING.

      12.1 SIGNATURE     SHRIDHAR K. V.

								
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