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El Ansari W, Saad MO. Virtual Care? Telepharmacy in Critical Care Settings for Patient-Centered Care and Multidisciplinary Collaboration: A Scoping Review of Activities, Benefits, Economic Impact, Challenges, and Knowledge Gaps. Telemed J E Health 2024; 30:21-35. [PMID: 37406291 DOI: 10.1089/tmj.2023.0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
Background: Very few studies have investigated telepharmacy (TP) in critical care. This scoping review undertook this task. Methods: We searched the following five electronic databases (PubMed, Embase, WoS, Scopus, CINAHL). Data were extracted from the articles and mapped out. Arksey and O'Malley's 6-step framework was used, and data synthesis identified activities, benefits, economic impact, challenges, and knowledge gaps of TP in critical care. Results: Out of 77 reports retrieved, 14 were included in the review as per inclusion criteria. Eight studies (57%) were published since 2020, and 9 (64%) were from the United States. Tele-ICU was in place before TP implementation in six studies (43%). TP used a range of synchronous/asynchronous communications. Studies reported wide assortment of reactive/scheduled TP activities. Patient outcomes were evaluated in one study of sedation-related TP interventions but they were not different despite improved compliance with sedation protocol. Most common clinical interventions/drugs included glycemic, electrolyte, and antimicrobial therapy management and antithrombotic agents among others. Acceptance of TP interventions was 75% or more in four studies and 51-55% in two studies. Benefits of TP included resolved drug-related problems, increased compliance with guidelines, maintained interactions with other health care providers, and patient safety among others. Three studies (21%) reported cost avoidance with TP interventions. Challenges included communication, intervention documentation, tracking implementation of recommendations, and monetary/financial and legislative/regulatory issues. Knowledge gaps comprised lack of frameworks for implementation/evaluation of TP in critical care, methodological aspects, lack of patient-specific outcomes, as well as institution/health-system aspects, and documentation systems, cost, legislative, and sustainability issues. Conclusions: TP in critical care is underpublished, and comprehensive frameworks for its implementation and evaluation remain lacking. Assessments are needed to evaluate the effect of TP in critical care on patient-specific outcomes, its economic and legal dimensions, methods to sustain it, as well as the role of documentation systems, collaboration models, and institutional characteristics.
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Affiliation(s)
- Walid El Ansari
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
- Weill Cornell Medicine-Qatar, Doha, Qatar
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El Ansari W, Arafa M, Elbardisi H, Majzoub A, Mahdi M, Albakr A, AlRumaihi K, Al Ansari A. Scoping review of sexual and reproductive healthcare for men in the MENA (Middle East and North Africa) region: a handful of paradoxes? BMC Public Health 2023; 23:564. [PMID: 36973770 PMCID: PMC10040932 DOI: 10.1186/s12889-022-14716-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/24/2022] [Indexed: 03/28/2023] Open
Abstract
Background No study appraised the knowledge gaps and factors impacting men’s sexual and reproductive health (SRH) in MENA (Middle East and North Africa). The current scoping review undertook this task. Methods We searched PubMed and Web of Science (WoS) electronic databases for original articles on men’s SRH published from MENA. Data was extracted from the selected articles and mapped out employing the WHO framework for operationalising SRH. Analyses and data synthesis identified the factors impacting on men’s experiences of and access to SRH. Results A total of 98 articles met the inclusion criteria and were included in the analysis. The majority of studies focused on HIV and other sexually transmissible infections (67%); followed by comprehensive education and information (10%); contraception counselling/provision (9%); sexual function and psychosexual counselling (5%); fertility care (8%); and gender-based violence prevention, support/care (1%). There were no studies on antenatal/intrapartum/postnatal care and on safe abortion care (0% for both). Conceptually, there was lack of knowledge of the different domains of men’s SRH, with negative attitudes, and many misconceptions; as well as a deficiency of health system policies, strategies and interventions for SRH. Conclusion Men’s SRH is not sufficiently prioritized. We observed five ‘paradoxes’: strong focus on HIV/AIDS, when MENA has low prevalence of HIV; weak focus on both fertility and sexual dysfunctions, despite their high prevalence in MENA; no publications on men’s involvement in sexual gender-based violence, despite its frequency across MENA; no studies of men’s involvement in antenatal/intrapartum/postnatal care, despite the international literature valuing such involvement; and, many studies identifying lack of SRH knowledge, but no publications on policies and strategies addressing such shortcoming. These ‘mismatches’ suggest the necessity for efforts to enhance the education of the general population and healthcare workers, as well as improvements across MENA health systems, with future research examining their effects on men’s SRH. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14716-2.
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Affiliation(s)
- Walid El Ansari
- grid.413548.f0000 0004 0571 546XDepartment of Surgery, Hamad Medical Corporation, Doha, Qatar
- grid.412603.20000 0004 0634 1084College of Medicine, Qatar University, Doha, Qatar
- grid.416973.e0000 0004 0582 4340Weill Cornell Medicine – Qatar, Doha, Qatar
| | - Mohamed Arafa
- grid.416973.e0000 0004 0582 4340Weill Cornell Medicine – Qatar, Doha, Qatar
- grid.413548.f0000 0004 0571 546XUrology Department, Hamad Medical Corporation, Doha, Qatar
- grid.7776.10000 0004 0639 9286Andrology Department, Cairo University, Cairo, Egypt
| | - Haitham Elbardisi
- grid.412603.20000 0004 0634 1084College of Medicine, Qatar University, Doha, Qatar
- grid.416973.e0000 0004 0582 4340Weill Cornell Medicine – Qatar, Doha, Qatar
- grid.413548.f0000 0004 0571 546XUrology Department, Hamad Medical Corporation, Doha, Qatar
| | - Ahmad Majzoub
- grid.416973.e0000 0004 0582 4340Weill Cornell Medicine – Qatar, Doha, Qatar
- grid.413548.f0000 0004 0571 546XUrology Department, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed Mahdi
- grid.413548.f0000 0004 0571 546XUrology Department, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Albakr
- grid.413548.f0000 0004 0571 546XUrology Department, Hamad Medical Corporation, Doha, Qatar
| | - Khalid AlRumaihi
- grid.412603.20000 0004 0634 1084College of Medicine, Qatar University, Doha, Qatar
- grid.416973.e0000 0004 0582 4340Weill Cornell Medicine – Qatar, Doha, Qatar
- grid.413548.f0000 0004 0571 546XUrology Department, Hamad Medical Corporation, Doha, Qatar
| | - Abdulla Al Ansari
- grid.413548.f0000 0004 0571 546XDepartment of Surgery, Hamad Medical Corporation, Doha, Qatar
- grid.416973.e0000 0004 0582 4340Weill Cornell Medicine – Qatar, Doha, Qatar
- grid.413548.f0000 0004 0571 546XUrology Department, Hamad Medical Corporation, Doha, Qatar
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El Ansari W, Elhag W. Preoperative Prediction of Body Mass Index of Patients with Type 2 Diabetes at 1 Year After Laparoscopic Sleeve Gastrectomy: Cross-Sectional Study. Metab Syndr Relat Disord 2022; 20:360-366. [PMID: 35506900 DOI: 10.1089/met.2021.0153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Very few models predict weight loss among type 2 diabetes mellitus (T2D) patients after laparoscopic sleeve gastrectomy (LSG). This retrospective study undertook such a task. Materials and Methods: We identified all patients >18 years old with T2D who underwent primary LSG at our institution and had complete data. The training set comprised 107 patients operated upon during the period April 2011 to June 2014; the validation set comprised 134 patients operated upon during the successive chronological period, July 2014 to December 2015. Sex, age, presurgery BMI, T2D duration, number of T2D medications, insulin use, hypertension, and dyslipidemia were utilized as independent predictors of 1-year BMI. We employed regression analysis, and assessed the goodness of fit and "Residuals versus Fits" plot. Paired sample t-tests compared the observed and predicted BMI at 1 year. Results: The model comprised preoperative BMI (β = 0.757, P = 0.026) + age (β = 0.142, P < 0.0001) with adjusted R2 of 0.581 (P < 0.0001), and goodness of fit showed an unbiased model with accurate prediction. The equation was: BMI value 1 year after LSG = 1.777 + 0.614 × presurgery BMI (kg/m2) +0.106 × age (years). For validation, the equation exhibited an adjusted R2 0.550 (P < 0.0001), and the goodness of fit indicated an unbiased model. The BMI predicted by the model fell within -3.78 BMI points to +2.42 points of the observed 1-year BMI. Pairwise difference between the mean 1-year observed and predicted BMI was not significant (-0.41 kg/m2, P = 0.225). Conclusions: This predictive model estimates the BMI 1 year after LSG. The model comprises preoperative BMI and age. It allows the forecast of patients' BMI after surgery, hence setting realistic expectations which are critical for patient satisfaction after bariatric surgery. An attainable target motivates the patient to achieve it.
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Affiliation(s)
- Walid El Ansari
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar.,College of Medicine, Qatar University, Doha, Qatar.,Weill Cornell Medicine-Qatar, Doha, Qatar.,Schools of Health and Education, University of Skovde, Skövde, Sweden
| | - Wahiba Elhag
- Department of Bariatric Surgery/Bariatric Medicine, Hamad Medical Corporation, Doha, Qatar
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van der Ven RGFM, de Vos R, Lodewijks Y, van Hout GCM, Lichthart S, Nienhuijs SW. Additional preconditioning program for bariatric surgery: Any benefits? A large cohort study. Clin Obes 2022; 12:e12507. [PMID: 35040265 DOI: 10.1111/cob.12507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/25/2021] [Accepted: 12/19/2021] [Indexed: 11/30/2022]
Abstract
Postbariatric outcomes may improve by providing an additional preconditioning program (APP) in targeted patients. However, APPs are a demand for health resources while only little and inconsistent evidence consists to support their effectiveness. This cohort study aims to evaluate the effectiveness of APP, by comparing outcomes of patients with and without such APP. We carried out a retrospective single-centre cohort study in a before-after design. Patients signing up for primary gastric bypass or sleeve gastrectomy and eligible for surgery were included if screened as vulnerable patients. Vulnerable patients screened between September 2017 and March 2018 followed an APP and formed the APP-group. Due to a policy change, APPs were no longer performed since September 2018. Vulnerable patients screened between September 2018 and March 2019 thus did not receive an APP (comparator-group). Multidisciplinary follow-up remained unchanged. Endpoints included percentage total weight loss (%TWL), bodyweight, evolution of comorbidities, protein intake, and number of no-shows. The APP-group comprised 231 patients and the comparator-group 153. %TWL differed statistically significantly at 7 (Δ1.5%, p = .01) and 12 months postoperative (Δ2.8%, p < .01) in favour of the comparator-group, as did bodyweight 12 months postoperative (Δ1.8 kg, p < .01). Statistically significant differences were also found in the evolution of comorbidities, protein intake, and the number of no-shows, most in favour for the comparator-group. APP proofed not to be superior to Non-App. It is debatable whether statically significant differences are clinically relevant given their small magnitude. A care pathway without an APP seems at least as effective as a care pathway without.
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Affiliation(s)
| | - Rien de Vos
- Department of Clinical Epidemiology and Biostatistics, Department of Medical Education, Amsterdam University Medical Center, The Netherlands
| | - Yentl Lodewijks
- Department of Surgery, Obesity Center Catharina Hospital, Eindhoven, The Netherlands
| | - Gerbrand C M van Hout
- Department of Psychology, Obesity Center Catharina Hospital, Eindhoven, The Netherlands
| | - Sacha Lichthart
- Department of Dietetics, Obesity Center Catharina Hospital, Eindhoven, The Netherlands
| | - Simon W Nienhuijs
- Department of Surgery, Obesity Center Catharina Hospital, Eindhoven, The Netherlands
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Elhag W, El Ansari W. Effectiveness and Safety of Liraglutide in Managing Inadequate Weight Loss and Weight Regain after Primary and Revisional Bariatric Surgery: Anthropometric and Cardiometabolic Outcomes. Obes Surg 2022; 32:1005-1015. [DOI: 10.1007/s11695-021-05884-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/30/2021] [Accepted: 12/30/2021] [Indexed: 11/24/2022]
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Clinical Impact of Mediterranean Diet Adherence before and after Bariatric Surgery: A Narrative Review. Nutrients 2022; 14:nu14020393. [PMID: 35057574 PMCID: PMC8781914 DOI: 10.3390/nu14020393] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/11/2022] [Accepted: 01/14/2022] [Indexed: 02/01/2023] Open
Abstract
The population suffering from obesity is rapidly increasing all over the world. Bariatric surgery has shown to be the treatment of choice in patients with severe obesity. A Mediterranean diet has long been acknowledged to be one of the healthiest dietary patterns associated with a lower incidence of many chronic diseases. The aim of the present narrative review is to summarize the existing research on the clinical impact of a Mediterranean diet before and after bariatric surgery, focusing on its effects on weight loss and improvement in comorbidities. Although the current knowledge is limited, this information could add value and emphasize the importance of adopting a Mediterranean diet before and after bariatric surgery.
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Nutritional Deficiencies Among Adolescents Before and After Sleeve Gastrectomy: First Study with 9-Year Follow-up. Obes Surg 2021; 32:284-294. [PMID: 34773598 DOI: 10.1007/s11695-021-05767-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/12/2021] [Accepted: 10/28/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Globally, only two studies appraised the long-term nutritional status of adolescents after laparoscopic sleeve gastrectomy (LSG). METHODS Retrospective chart review of all adolescents aged ≤ 18 years who underwent LSG with ≥ 5 years follow-up and had no subsequent revisional surgery (N = 146). We assessed 15 nutritional parameters preoperatively and at 1, 3, 5, 7, and 9 years post surgery. RESULTS Mean age was 16.51 ± 1.29 years, 51% were males. We identified three patterns: 1) Significant worsening of preoperative deficiencies: 4.7% and 0.8% of the sample exhibited zinc and vitamin B12 deficiencies, worsening to 20.8% and 12.8% at 1 year, respectively. Likewise, 0.7% of the sample had low total protein, worsening to 8.3% at year 3. A total of 32.4% of females had preoperative low hemoglobin worsening to 57.9% at year 5. 2) Significant improvement: the percentage of males with preoperative low hemoglobin (5.6%) was reduced to 4.1% and 5.1% at years 1 and 3, respectively. 3) Persistent deficiency: all (100%) of adolescents had preoperative vitamin D deficiency that persisted through years 3 and 9 at 90.5% and 100%, respectively. The most common complications were food intolerance (51%), vomiting (47.5%), gastritis/ esophagitis (35.7%), and gastroesophageal reflux disease (20.3%). We observed one case of Wernicke's encephalopathy. Across the 9 years, 15.4% of the adolescents underwent intra-abdominal surgeries where 12.6% had cholecystectomy and one patient had appendectomy. CONCLUSION Adolescents had several preoperative nutritional deficiencies, most of which worsened or persisted on the long term. This is the first study among adolescents to assess such deficiencies beyond 5 years.
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