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Ueter S, Taebi N, Weiß C, Hetjens M, Reissfelder C, Blank S, Otto M, Yang C. Study protocol for a non-inferiority, multicenter, randomized study to evaluate a smartphone app-based follow-up program after bariatric surgery (BELLA plus trial). Contemp Clin Trials 2024; 144:107615. [PMID: 38944339 DOI: 10.1016/j.cct.2024.107615] [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] [Received: 04/22/2024] [Revised: 06/24/2024] [Accepted: 06/26/2024] [Indexed: 07/01/2024]
Abstract
INTRODUCTION Adherence to follow-up (FU) care after bariatric surgery is poor despite strong recommendations. In our pilot Bella trial, we demonstrated that a completely remote follow-up program via smartphone is feasible and safe for patients after bariatric surgery. Building on this, we aim to verify our results in a multicenter, randomized controlled setting. METHODS This trial plans to enroll 410 participants undergoing primary bariatric surgery in seven German bariatric centers. Participants are randomized into two groups: a control group receiving in-person FU according to the standard in the bariatric centers, and an interventional group monitored using a smartphone application (app). The app sends standardized questionnaires and reminders regarding regular vitamin intake and exercises. The built-in messaging function enables patients to communicate remotely with medical care professionals. After one year, all participants are evaluated at their primary bariatric centers. The primary outcome is weight loss 12 months after surgery. The secondary outcomes include obesity-related comorbidities, quality of life, serum values of vitamins and minerals, body impedance analysis, visits to the emergency department or readmission, patient compliance, and medical staff workload. DISCUSSION The current study is the first prospective, individually randomized-controlled, multicenter trial where a mobile application completely replaces traditional in-person visits for post-bariatric surgery follow-ups in bariatric centers.
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Affiliation(s)
- Sophie Ueter
- Department of Surgery, University Medicine Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Niki Taebi
- Department of Surgery, University Medicine Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Christel Weiß
- Department of Medical Statistics and Biomathematics, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Michael Hetjens
- Department of Medical Statistics and Biomathematics, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Christoph Reissfelder
- Department of Surgery, University Medicine Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Susanne Blank
- Department of Surgery, University Medicine Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Mirko Otto
- Department of Surgery, University Medicine Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Cui Yang
- Department of Surgery, University Medicine Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
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Krietenstein L, Koschker AC, Miras AD, Kollmann L, Gruber M, Dischinger U, Haubitz I, Fassnacht M, Warrings B, Seyfried F. Characteristics of Patients Lost to Follow-up after Bariatric Surgery. Nutrients 2024; 16:2710. [PMID: 39203846 PMCID: PMC11357598 DOI: 10.3390/nu16162710] [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] [Received: 07/25/2024] [Revised: 08/04/2024] [Accepted: 08/06/2024] [Indexed: 09/03/2024] Open
Abstract
After bariatric surgery lifelong follow-up is recommended. Evidence of the consequences and reasons for being lost to follow-up (LTFU) is sparse. In this prospective study follow-up data of all patients who underwent bariatric surgery between 2008 and 2017 at a certified obesity centre were investigated. LTFU patients were evaluated through a structured telephone interview. Overall, 573 patients (female/male 70.9%/29.1%), aged 44.1 ± 11.2 years, preoperative BMI 52.1 ± 8.4 kg/m2 underwent bariatric surgery. Out of these, 33.2% had type 2 diabetes mellitus and 74.4% had arterial hypertension. A total of 290 patients were LTFU, of those 82.1% could be reached. Baseline characteristics of patients in follow-up (IFU) and LTFU were comparable, but men were more often LTFU (p = 0.01). Reported postoperative total weight loss (%TWL) and improvements of comorbidities were comparable, but %TWL was higher in patients remaining in follow-up for at least 2 years (p = 0.013). Travel issues were mentioned as the main reason for being LTFU. A percentage of 77.6% of patients reported to regularly supplement micronutrients, while 71.0% stated regular monitoring of their micronutrient status, mostly by primary care physicians. Despite comparable reported outcomes of LTFU to IFU patients, the duration of the in-centre follow-up period affected %TWL. There is a lack of sufficient supplementation and monitoring of micronutrients in a considerable number of LTFU patients.
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Affiliation(s)
- Laura Krietenstein
- Department of General, Visceral, Transplantation, Vascular and Paediatric Surgery, University Hospital Würzburg, 97080 Würzburg, Germany (L.K.); (M.G.)
| | - Ann-Cathrin Koschker
- Department of Internal Medicine I, Division of Endocrinology and Diabetology, University Hospital Würzburg, 97080 Würzburg, Germany; (A.-C.K.); (U.D.); (M.F.)
| | | | - Lars Kollmann
- Department of General, Visceral, Transplantation, Vascular and Paediatric Surgery, University Hospital Würzburg, 97080 Würzburg, Germany (L.K.); (M.G.)
| | - Maximilian Gruber
- Department of General, Visceral, Transplantation, Vascular and Paediatric Surgery, University Hospital Würzburg, 97080 Würzburg, Germany (L.K.); (M.G.)
| | - Ulrich Dischinger
- Department of Internal Medicine I, Division of Endocrinology and Diabetology, University Hospital Würzburg, 97080 Würzburg, Germany; (A.-C.K.); (U.D.); (M.F.)
| | - Imme Haubitz
- Department of General, Visceral, Transplantation, Vascular and Paediatric Surgery, University Hospital Würzburg, 97080 Würzburg, Germany (L.K.); (M.G.)
| | - Martin Fassnacht
- Department of Internal Medicine I, Division of Endocrinology and Diabetology, University Hospital Würzburg, 97080 Würzburg, Germany; (A.-C.K.); (U.D.); (M.F.)
| | - Bodo Warrings
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Centre for Mental Health, University Hospital Würzburg, 97080 Würzburg, Germany;
| | - Florian Seyfried
- Department of General, Visceral, Transplantation, Vascular and Paediatric Surgery, University Hospital Würzburg, 97080 Würzburg, Germany (L.K.); (M.G.)
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Herberg R, Smith B, Edsall A, Bennie B, Grover B, Mellion K, Pfeiffer J. Patient proximity to follow-up care after bariatric surgery: Does it matter? Am J Surg 2024; 238:115842. [PMID: 39024727 DOI: 10.1016/j.amjsurg.2024.115842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 06/13/2024] [Accepted: 07/09/2024] [Indexed: 07/20/2024]
Abstract
One factor that may play a significant role in the follow-up care compliance and long-term weight loss of post-bariatric surgery patients is the geographical distance from the surgery center to the patient's home address. This is a retrospective review which aims to evaluate whether the distance from a patient's home address to two Gundersen Health System (GHS) facilities (La Crosse and Onalaska, Wisconsin) is predictive of follow-up appointment compliance and subsequent long-term weight loss. 1336 patients undergoing bariatric surgery at GHS between October 15, 2013 and Dec 31, 2022 were included. Patients were grouped according to the distance between their home addresses and GHS with 60 % of patients living less than 30 miles from GHS, 33 % living 30 to 60 miles from GHS, and the remaining 7.3 % living >60 miles away. No significant difference was observed in the distribution of patients falling short, meeting, or exceeding the recommended number of post-operative appointments with a surgery provider based on proximity (p = 0.10). As distance increased, the number of nutrition and behavioral health appointments completed per year decreased [nutrition/dietary appointments (p = 0.046); behavioral health appointments (p = 0.040)]. The pattern of percent excess weight loss (%EWL) over time was significantly different based on distance from home (p < 0.001). Specifically, we found a similar %EWL among all groups in the first year post-operatively but an 18.8 % higher %EWL in the >60-mile group compared to the <60-mile group at 5 years (SE = 5.4, P = 0.0014). The lower number of post-op nutrition and behavioral health visits among patients living farther from the surgery center was an expected result, given potentially greater inconvenience of follow-up appointments for these patients. However, there was a paradoxical finding of significantly increased %EWL among patients living >60 miles from the surgery center. Greater distance from the bariatric surgical center was therefore not found to represent a barrier to favorable weight loss outcomes.
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Affiliation(s)
- Russell Herberg
- Department of Surgery, Gundersen Health System, La Crosse, WI, USA
| | - Brandon Smith
- Department of Surgery, Gundersen Health System, La Crosse, WI, USA
| | - Andrew Edsall
- Department of Surgery, Gundersen Health System, La Crosse, WI, USA
| | - Barbara Bennie
- Department of Surgery, Gundersen Health System, La Crosse, WI, USA
| | - Brandon Grover
- Department of Surgery, Gundersen Health System, La Crosse, WI, USA
| | - Katelyn Mellion
- Department of Surgery, Gundersen Health System, La Crosse, WI, USA
| | - Joshua Pfeiffer
- Department of Surgery, Gundersen Health System, La Crosse, WI, USA.
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Jawara D, Alagoz E, Lauer KV, Voils CI, Funk LM. Exploring Social Support Dynamics After Bariatric Surgery: Insights From Patients and Providers. J Surg Res 2024; 299:1-8. [PMID: 38677002 PMCID: PMC11189728 DOI: 10.1016/j.jss.2024.03.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/25/2024] [Accepted: 03/12/2024] [Indexed: 04/29/2024]
Abstract
INTRODUCTION Weight loss after bariatric surgery is impacted by several factors, and social support is one of them. Our objective was to characterize patient and provider perceptions about social support after bariatric surgery. METHODS We reported a secondary analysis of qualitative data acquired from semi-structured interviews conducted from January-November 2020 with bariatric surgery patients and providers. Participants included primary care providers, health psychologists, registered dietitians, bariatric surgeons, and patients with at least 1 y of follow-up after their bariatric procedure. Interview guides were designed using a hybrid of Andersen's Behavioral Model of Health Services and Torain's Framework for Surgical Disparities. Using directed content analysis, study team members generated codes, which were categorized into themes about social support pertaining to dietary habits, physical activity, and follow-up care. RESULTS Forty-five participants were interviewed, including 24 patients (83% female; 79% White; mean age 50.6 ± 10.7 y) and 21 providers (six primary care providers, four health psychologists, five registered dieticians, and six bariatric surgeons). We identified four themes relating to social support affecting weight loss after surgery: (1) family involvement in helping patients adjust to the bariatric diet, (2) engagement in activities with partners/friends, (3) help with transportation to appointments, and (4) life stressors experienced by patients within their social relationships. CONCLUSIONS Continued assessment of interpersonal factors after bariatric surgery is essential for weight loss maintenance. Providers can contribute by reinforcing the facilitators of social support and making referrals that may help patients overcome barriers to social support for sustained weight loss after surgery.
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Affiliation(s)
- Dawda Jawara
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Esra Alagoz
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Kate V Lauer
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Corrine I Voils
- Department of Surgery, University of Wisconsin, Madison, Wisconsin; Department of Surgery, William S. Middleton Memorial Veterans Administration Hospital, Madison, Wisconsin
| | - Luke M Funk
- Department of Surgery, University of Wisconsin, Madison, Wisconsin; Department of Surgery, William S. Middleton Memorial Veterans Administration Hospital, Madison, Wisconsin.
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Jacobs A, Monpellier VM, Torensma B, Antoniou EE, Janssen IMC, Tollenaar RAEM, Jansen ATM. Influence of mental and behavioral factors on weight loss after bariatric surgery: A systematic review and meta-analysis. Obes Rev 2024; 25:e13729. [PMID: 38450930 DOI: 10.1111/obr.13729] [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: 12/02/2022] [Revised: 12/16/2023] [Accepted: 01/12/2024] [Indexed: 03/08/2024]
Abstract
INTRODUCTION Multiple factors are related to lower weight loss after bariatric surgery. This review and meta-analysis evaluates the influence of several mental and behavioral factors on weight loss. METHOD Six electronic databases were searched. Percentage excess weight loss (%EWL) was calculated for all moderator and non-moderator groups of the variables: symptoms of depression, anxiety and binge eating, compliance, physical activity, quality of life, and body image. All moderators, surgery types, and follow-up moments were analyzed separately. RESULTS In total, 75 articles were included in the review; 12 meta-analyses were conducted. Higher postoperative compliance to follow-up was associated with 6.86%-13.68% higher EWL. Preoperative binge eating was related to more weight loss at 24- and 36-month follow-up (7.97% and 11.79%EWL, respectively). Patients with postoperative binge eating symptoms had an 11.92% lower EWL. Patients with preoperative depressive symptoms lost equal weight compared to patients without symptoms. CONCLUSION Despite the high heterogeneity between studies, a trend emerges suggesting that the presence of postoperative binge eating symptoms and lower postoperative compliance may be associated with less weight loss after bariatric-metabolic surgery. Additionally, preoperative depressive symptoms and binge eating do not seem to significantly impact weight loss.
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Affiliation(s)
- Anne Jacobs
- Nederlandse Obesitas Kliniek (Dutch Obesity Clinic), Utrecht, The Netherlands
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | | | - Ignace M C Janssen
- Nederlandse Obesitas Kliniek (Dutch Obesity Clinic), Utrecht, The Netherlands
| | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Anita T M Jansen
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
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Tikouk J, Ait Boubkr A. Transportation and Access to Healthcare in Morocco: An Exploratory Study of Guelmim-Oued Noun Region. Ann Glob Health 2024; 90:11. [PMID: 38344006 PMCID: PMC10854410 DOI: 10.5334/aogh.4063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 01/07/2024] [Indexed: 02/15/2024] Open
Abstract
Objective The aim of this study was to examine the correlation between accessibility to healthcare facilities and transportation in the Guelmim Oued Noun region of Morocco, where transportation barriers continue to pose a major challenge to accessing healthcare, despite efforts aimed at reducing access barriers. Methods Data collection for this study involved the administration of a survey among 328 outpatients residing in the Guelmim Oued Noun region, Morocco. The utilization of canonical correlation served as the analytical method, employed to quantify and assess the relationship between transportation related barriers and the access of healthcare services in the specified region. Results Our research reveals that transportation factors account for approximately 25% of the variation in access to healthcare services. The number of transportation modes utilized by outpatients and the affordability of transportation were found to be significant contributors to the transportation dimension. These findings confirm the significant relationship between transportation and access to healthcare facilities in the region under investigation. Conclusion Further research is recommended to specifically address transportation barriers to healthcare access services among socially excluded populations, with a focus on promoting mobility inclusivity.
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Affiliation(s)
- Jamal Tikouk
- Applied Modeling in Economics and Management Laboratory, University of Hassan II Casablanca, Casablanca, Morocco
| | - Asmaa Ait Boubkr
- Applied Modeling in Economics and Management Laboratory, University of Hassan II Casablanca, Casablanca, Morocco
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Zil-E-Ali A, Dogbe L, Habib Samaan FS, Aziz F, Sardesai S, Aziz F. Patients living farther from a tertiary care center are more likely to undergo peripheral arterial bypass for acute and chronic limb-threatening ischemia. J Vasc Surg 2024; 79:120-127.e2. [PMID: 37741589 DOI: 10.1016/j.jvs.2023.09.020] [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] [Received: 06/25/2023] [Revised: 09/07/2023] [Accepted: 09/14/2023] [Indexed: 09/25/2023]
Abstract
OBJECTIVE The aim of this study was to assess the association between the proximity to the tertiary care hospital and the severity of peripheral arterial disease (PAD) at the time of lower extremity bypass (LEB) in a rural-urban mix region. METHODS Patients undergoing LEB from 2010 to 2020 at Penn State Milton S. Hershey Medical Center were reviewed and stratified into two study groups based on a median distance from hospital (ie, Group I: ≥34 miles and Group II: <34 miles). Patients' demographic features, preoperative data including comorbidities, and medications were analyzed. A univariate analysis for the patient characteristics between the two study groups, along with evaluation of postoperative outcomes, and a multivariate predictive modeling to study the PAD stage as the indication of LEB was performed. A P-value of < .05 was set as a significant difference between the groups for all the analyses. RESULTS There were 175 patients (49.9%) in Group I and 176 patients (50.1%) in Group II with a mean age of 65 ± 11.92 years (median, 64.61 years). No significant difference was observed in gender (P = .530), age (P = .906), and functional status (P = .830) between study groups. It was observed that patients in Group I were more likely to be overweight or obese (71.3% vs 57%; P = .007) and had a prior history of myocardial infarction (24.3% vs 15.3%; P = .036) in comparison to Group II. No postoperative outcomes were found to be statistically different between the study groups. The multivariate analyses based on various confounders displayed that patients in Group I had 56% higher likelihood of LEB for chronic limb-threatening ischemia (adjusted odds ratio, 1.56; 95% confidence interval, 0.92-2.62; P = .042). Group I patients also had five times higher odds of LEB for acute limb ischemia (adjusted odds ratio, 5.07; 95% confidence interval, 1.42-18.13; P = .012) as compared with those in the Group II. CONCLUSIONS Patients' proximity to a major tertiary hospital may have implications on the disease progression for patients with PAD and could also be related to inadequate vascular services in primary and secondary hospitals. Lack of preventive care and disease management in regions afar from a tertiary hospital could be other implicating factors and highlights the need for outreach programs, along with distribution of vascular specialists, to reduce geographical disparities and ensure equity in access to care.
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Affiliation(s)
- Ahsan Zil-E-Ali
- Division of Vascular Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA.
| | - Leana Dogbe
- Office of Medical Education, Penn State University College of Medicine, Hershey, PA
| | | | - Faizaan Aziz
- Division of Vascular Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Sahil Sardesai
- Office of Medical Education, Penn State University College of Medicine, Hershey, PA
| | - Faisal Aziz
- Division of Vascular Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA
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Pratt KJ, Miller HJ, Hanks AS, Focht BC, Noria S, Brethauer S, Needleman B. Transportation Factors and Postoperative Attendance and Weight Loss Through 24 Months. Obes Surg 2024; 34:114-122. [PMID: 38015330 DOI: 10.1007/s11695-023-06906-7] [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] [Received: 09/04/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE Transportation, access to follow-up care, and association with weight loss are understudied in the bariatric population. The objective of this study was to determine how transportation variables associate with postoperative attendance and weight loss through 24 months. MATERIALS AND METHODS Seven hundred eighty-seven patients (81.3% female; 59.1% White) who had primary surgery (48.6% gastric bypass) from 2015 to 2019 were included. Sidewalk coverage and number of bus stops from patients' homes, driving distance in miles and minutes from patients' homes to the nearest bus stop and the clinic were measured. Bivariate analyses were conducted with the transportation variables and attendance and %TWL at 2 or 3, 6, 12, and 24 months. One mixed multilevel model was conducted with dependent variable %TWL over 24 months with visits as the between-subjects factor and covariates: race, insurance, surgical procedure, and driving distance to the clinic in minutes, attendance, and %TWL over 24 months; an interaction between distance, attendance, and visits. RESULTS There were no significant differences between the majority of the transportation variables and postoperative attendance or %TWL. Patients who had perfect attendance had improved %TWL at 12 months [t(534)=-1.92, p=0.056] and 24 months [t(393)=-2.69, p=0.008] compared to those who missed at least one appointment. Patients with perfect attendance and who had shorter driving times (under 20 min) to the clinic had greater weight loss through 24 months [F(10, 1607.50)=2.19, p=0.016)]. CONCLUSIONS Overall, transportation factors were not associated with attendance and weight loss, with the exception of the interaction between shorter driving minutes to follow-up and perfect attendance.
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Affiliation(s)
- Keeley J Pratt
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave, Columbus, OH, 43210, USA.
- Department of General Surgery, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA.
| | - Harvey J Miller
- Department of Geography, Center for Urban and Regional Analysis, The Ohio State University, Columbus, OH, 43210, USA
| | - Andrew S Hanks
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave, Columbus, OH, 43210, USA
| | - Brian C Focht
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave, Columbus, OH, 43210, USA
| | - Sabrena Noria
- Department of Geography, Center for Urban and Regional Analysis, The Ohio State University, Columbus, OH, 43210, USA
| | - Stacy Brethauer
- Department of Geography, Center for Urban and Regional Analysis, The Ohio State University, Columbus, OH, 43210, USA
| | - Bradley Needleman
- Department of Geography, Center for Urban and Regional Analysis, The Ohio State University, Columbus, OH, 43210, USA
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Bennett DJ, Bango J, Rothkopf DM. Hand Therapy after Flexor and Extensor Tendon Repair: Assessing Predictors of Loss to Follow-up. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4941. [PMID: 37124389 PMCID: PMC10132707 DOI: 10.1097/gox.0000000000004941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 02/23/2023] [Indexed: 05/02/2023]
Abstract
Postoperative hand therapy (HT) is important for regaining function and preventing complications in patients undergoing tendon repair of the hand and wrist. Loss to follow-up (LTFU) can hinder this process; so we sought to determine factors that predict attrition of these patients. Methods Charts were retrospectively reviewed for patients who underwent extensor or flexor tendon repair of the hand, wrist, or forearm between 2014 and 2019. Demographic data, including age, sex, zip code, employment status, education level, and insurance type, were collected, and the rate of LTFU was calculated. Logistic regression was used to analyze factors. Results A total of 149 patients were identified and analyzed. The rate of LTFU was 42%. Factors that predicted loss were younger age, male gender, lower educational degree, and a documented psychiatric history. Employment status, insurance type, and distance from the HT center did not predict attrition. The number of HT weeks recommended by the occupational therapist did not differ between those who were lost and those who were not. Lost patients completed, on average, 57% of their suggested HT course. Conclusions The current study identified demographic factors associated with attrition in patients undergoing tendon repair of the distal upper extremity. Factors included patients who were younger, male gender, less educated, and had a documented psychiatric history. By identifying factors that predict LTFU, specific strategies can be developed to reduce attrition rates, particularly for at-risk populations, to improve patient care after tendon repair.
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Affiliation(s)
- Desmond J. Bennett
- Division of Plastic Surgery, University of Massachusetts Medical School, Worcester, Mass
| | - Jugert Bango
- Department of Orthopedic Surgery, University of Florida College of Medicine – Jacksonville, Jacksonville, Fla
| | - Douglas M. Rothkopf
- Division of Plastic Surgery, University of Massachusetts Medical School, Worcester, Mass
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Auge M, Dejardin O, Menahem B, Lee Bion A, Savey V, Launoy G, Bouvier V, Alves A. Analysis of the Lack of Follow-Up of Bariatric Surgery Patients: Experience of a Reference Center. J Clin Med 2022; 11:jcm11216310. [PMID: 36362536 PMCID: PMC9658876 DOI: 10.3390/jcm11216310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 11/16/2022] Open
Abstract
Few studies have evaluated the association between non-clinical and clinical determinants in terms of discontinuing follow-up after bariatric surgery. This cohort study aims to assess these associations. Data were collected from a prospectively maintained database of patients who underwent laparoscopic bariatric surgery from January 2012 to December 2019. The Cox model was used to assess the influence of preoperative determinants on follow-up interruptions for more than one year. Multilevel logistic regression was used to evaluate the association between clinical factors and post-operative weight loss with the regularity of follow-up. During the study period, 9607 consultations were performed on 1549 patients. The factors associated with a follow-up interruption from more than 365 days included male gender (HR = 1.323; CI = 1.146−1.527; p = 0.001) and more recent years of intervention (HR = 1.043; CI = 1.012−1.076; p = 0.0068). Revisional bariatric surgery was associated with a lower risk of follow-up interruption (HR = 0.753; CI = 0.619−0.916; p = 0.0045). Independent risk factors of an irregular follow up were higher age (HR = 1.01; CI = 1.002−1.017; p = 0.0086); male gender (OR = 1.272; CI = 1.047−1.545; p = 0.0153); and higher %TWL (Total Weight Loss) (OR = 1.040 CI = 1.033−1.048 p < 0.0001). A higher preoperative BMI (OR = 0.985; CI = 0.972−0.998; p = 0.0263) and revisional surgery (OR = 0.707; CI = 0.543−0.922; p = 0.0106) were protective factors of irregularity. This study suggests that the male gender and most recent dates of surgery are the two independent risk factors for follow-up interruption. Older age, male gender, and higher weight loss were all independent risk factors of an irregular follow-up. Revision bariatric surgery is a protective factor against interruption and irregular follow-up with a higher preoperative BMI. Further studies are needed to obtain long-term results in these patients with discontinued follow-ups.
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Affiliation(s)
- Marie Auge
- Department of Digestive Surgery, University Hospital of Caen, CEDEX 9, 14033 Caen, France
| | - Olivier Dejardin
- L’Unité Anticipe (Inserm U1086), CEDEX 5, 14076 Caen, France
- Department of Research, University Hospital of Caen, CEDEX 9, 14033 Caen, France
| | - Benjamin Menahem
- Department of Digestive Surgery, University Hospital of Caen, CEDEX 9, 14033 Caen, France
- Correspondence:
| | - Adrien Lee Bion
- Department of Digestive Surgery, University Hospital of Caen, CEDEX 9, 14033 Caen, France
| | - Véronique Savey
- Department of Digestive Surgery, University Hospital of Caen, CEDEX 9, 14033 Caen, France
| | - Guy Launoy
- L’Unité Anticipe (Inserm U1086), CEDEX 5, 14076 Caen, France
- Department of Research, University Hospital of Caen, CEDEX 9, 14033 Caen, France
- Registre des Tumeurs Digestives du Calvados, CEDEX 5, 14076 Caen, France
| | - Véronique Bouvier
- L’Unité Anticipe (Inserm U1086), CEDEX 5, 14076 Caen, France
- Department of Research, University Hospital of Caen, CEDEX 9, 14033 Caen, France
- Registre des Tumeurs Digestives du Calvados, CEDEX 5, 14076 Caen, France
| | - Arnaud Alves
- Department of Digestive Surgery, University Hospital of Caen, CEDEX 9, 14033 Caen, France
- L’Unité Anticipe (Inserm U1086), CEDEX 5, 14076 Caen, France
- Department of Research, University Hospital of Caen, CEDEX 9, 14033 Caen, France
- Registre des Tumeurs Digestives du Calvados, CEDEX 5, 14076 Caen, France
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11
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Feig EH, Harnedy LE, Thorndike AN, Psaros C, Healy BC, Huffman JC. A Positive Emotion-Focused Intervention to Increase Physical Activity After Bariatric Surgery: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e39856. [PMID: 36201380 PMCID: PMC9585441 DOI: 10.2196/39856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 09/05/2022] [Accepted: 09/21/2022] [Indexed: 11/24/2022] Open
Abstract
Background Physical activity levels after bariatric surgery are usually low, despite the significant protective health benefits of physical activity in this population. Positive psychological well-being is associated with improved adherence to health behaviors, but bariatric surgery patients often have negative associations with physical activity that prevent sustained engagement. Objective The Gaining Optimism After weight Loss Surgery (GOALS) pilot randomized controlled trial is aimed at testing a novel intervention to increase physical activity after bariatric surgery, which incorporates positive psychological skill-building with motivational interviewing and goal-setting. Methods The GOALS trial is a 2-arm, 24-week pilot randomized controlled trial that aims to enroll 58 adults who report less than 200 minutes per week of moderate to vigorous physical activity and a desire to become more active 6-12 months after bariatric surgery. GOALS is testing the feasibility, acceptability, and preliminary efficacy of a positive psychology–motivational interviewing telephone intervention targeting to increase physical activity and associated positive affect. Intervention components include positive psychology, goal-setting, self-monitoring via provided Fitbits, and motivational interviewing to overcome barriers and increase motivation. The intervention is compared to a physical activity education control that includes mailings with psychoeducation around physical activity and provision of a Fitbit. The primary outcomes of the pilot trial are feasibility and acceptability, measured as session completion rates and participant ratings of ease and helpfulness of each session. The main secondary outcome is change in accelerometer-measured moderate to vigorous physical activity post intervention and at 24-week follow-up. Additional outcomes include changes in attitudes related to physical activity, psychological well-being, and physical health measures. Results This multiphase project was funded in 2020 and institutional review board approval was obtained for the proposed trial in 2021. Recruitment for the randomized controlled trial began in July 2022. Upon completion of the pilot trial, we will examine the feasibility, acceptability, and preliminary efficacy of the intervention. Conclusions Although bariatric surgery is the most effective treatment available for severe obesity, weight regain occurs, often in the context of low psychological well-being. Many individuals would benefit from learning strategies to increase positive psychological well-being after bariatric surgery, which could help them maintain lifestyle changes. Positive psychology is a novel approach to improve adherence by increasing positive associations with health behaviors including physical activity. The GOALS pilot trial will determine whether this type of intervention is feasible and acceptable to this population and will provide a foundation for a future full-scale randomized controlled efficacy trial. Trial Registration ClinicalTrials.gov NCT04868032; https://clinicaltrials.gov/ct2/show/NCT04868032 International Registered Report Identifier (IRRID) PRR1-10.2196/39856
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Affiliation(s)
- Emily H Feig
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Lauren E Harnedy
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Anne N Thorndike
- Harvard Medical School, Boston, MA, United States.,Department of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Christina Psaros
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Brian C Healy
- Harvard Medical School, Boston, MA, United States.,Department of Neurology, Brigham and Women's Hospital, Boston, MA, United States
| | - Jeff C Huffman
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
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12
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Adherence of Obese Patients from Poland and Germany and Its Impact on the Effectiveness of Morbid Obesity Treatment. Nutrients 2022; 14:nu14183880. [PMID: 36145256 PMCID: PMC9505872 DOI: 10.3390/nu14183880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 11/17/2022] Open
Abstract
This study aimed to investigate and compare the adherence of patients treated for morbid obesity living in Poland and Germany. Methods: A cross-sectional international multicenter survey design was adopted. The study involved 564 adult subjects treated for morbid obesity at selected healthcare facilities in Germany (210 participants) and Poland (354 participants). A validated, custom-made questionnaire based on the literature related to this issue was used. Results: The degree of adherence was higher, but not statistically significant, among Polish patients (83.82% vs. 78.33%, p = 0.26140). Patient adherence was associated with gender, age, level of education, duration of obesity, number of health professionals involved in obesity treatment, and type of obesity treatment (p < 0.05). A positive correlation was observed in the case of age, level of education, and a growing number of health professionals involved in obesity treatment, whereas a negative correlation was observed in the case of the duration of obesity. Patients who underwent bariatric surgery significantly more often followed medical recommendations regarding lifestyle changes, compared to obese participants treated only conservatively. Adherence in the field of obesity treatment significantly increases the percentage of total weight loss and excess weight loss due to applied obesity treatment among both Polish and German groups (p < 0.001). Both the percentage of total weight loss and that of excess weight loss were significantly higher in the group of adherent patients compared to the nonadherent patients (p < 0.00001). The levels of perceived anxiety, stress, and depression were significantly higher in nonadherent patients in both countries. Conclusions: These findings confirm the role of adherence in the effective and satisfactory treatment of morbid obesity. There is a great need to improve patient adherence to overcome the consequences of the obesity pandemic.
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13
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Reiber BMM, Barendregt R, de Vries R, Bruin SC, van der Peet DL. Is Adherence to Follow-Up After Bariatric Surgery Necessary? A Systematic Review and Meta-Analysis. Obes Surg 2022; 32:904-911. [PMID: 35020125 PMCID: PMC8866276 DOI: 10.1007/s11695-021-05857-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 12/14/2021] [Accepted: 12/17/2021] [Indexed: 11/15/2022]
Abstract
The association of adherence to follow-up (FU) after laparoscopic gastric bypass - and gastric sleeve with weight loss (WL) is unclear. The aim of this study was to evaluate this association. Fourteen full text articles were included in the systematic review. Eight studies were included in the meta-analysis concerning FU up to 3 years postoperatively and 3 for the FU between 3 and 10 years postoperatively. Results showed a significant association between adherence to FU 0.5 to 3 years postoperatively and percentage excess WL (%EWL) but did not demonstrate a significant association between FU > 3 years postoperatively and total WL (%TWL). In conclusion, adherence to FU may not be associated with WL and therefore stringent lifelong FU in its current form should be evaluated.
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Affiliation(s)
- Beata M M Reiber
- Department of Gastro-Intestinal Surgery, Amsterdam UMC, Location VUmc, de Boelelaan 1118, 1081 HV, Amsterdam, the Netherlands.
| | - Rosalie Barendregt
- Department of Gastro-Intestinal Surgery, Amsterdam UMC, Location VUmc, de Boelelaan 1118, 1081 HV, Amsterdam, the Netherlands
| | - Ralph de Vries
- Medical Library, Vrije Universiteit, de Boelelaan 1118, 1081 HV, Amsterdam, the Netherlands
| | - Sjoerd C Bruin
- Department of Bariatric Surgery, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, the Netherlands
| | - Donald L van der Peet
- Department of Gastro-Intestinal Surgery, Amsterdam UMC, Location VUmc, de Boelelaan 1118, 1081 HV, Amsterdam, the Netherlands
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14
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Kurz D, Befort C. Travel burden in a rural primary care behavioral weight loss randomized trial: Impact on visit attendance and weight loss. J Rural Health 2022; 38:980-985. [DOI: 10.1111/jrh.12652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Daniel Kurz
- Department of Population Health University of Kansas School of Medicine Kansas City Kansas USA
| | - Christie Befort
- Department of Population Health University of Kansas School of Medicine Kansas City Kansas USA
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15
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Zhang R, Liu S, Li M, He X, Zhou C. The Effect of High-Density Built Environments on Elderly Individuals' Physical Health: A Cross-Sectional Study in Guangzhou, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910250. [PMID: 34639550 PMCID: PMC8508494 DOI: 10.3390/ijerph181910250] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/20/2021] [Accepted: 09/26/2021] [Indexed: 12/28/2022]
Abstract
The built environment refers to the objective material environment built by humans in cities for living and production activities. Existing studies have proven that the built environment plays a significant role in human health, but little attention is paid to the elderly in this regard. At the same time, existing studies are mainly concentrated in Western developed countries, and there are few empirical studies in developing countries such as China. Based on POI (point of interest) data and 882 questionnaires collected from 20 neighborhoods in Guangzhou, we employ multilevel linear regression modeling, mediating effect modeling, to explore the path and mechanism of the impact of the built environment on elderly individuals' physical health, especially the mediating effects of physical and social interaction activity. The results show that the number of POIs, the distance to the nearest park and square, and the number of parks and squares are significantly positively correlated with the physical health of the elderly, while the number of bus and subway stations and the distance to the nearest station are significantly negatively correlated. Secondly, physical activity and social networks play a separate role in mediating the effect of the built environment on elderly individuals' physical health. The results enrich the research on the built environment and elderly individuals' health in the context of high-density cities in China and provide some reference basis for actively promoting spatial intervention and cultivating a healthy aging society.
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16
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Lima RCD, Rodrigues TMDS, Scheibe CL, Campelo GP, Pinto LEV, Valadão GJC, Carvalho GPCD, Machado Junior MRD, Valadão JA, Lima PCRD, Leal PDC, Oliveira CMBD, Moura ECR. Weight loss and adherence to postoperative follow-up after vertical gastrectomy for obesity treatment. Acta Cir Bras 2021; 36:e360203. [PMID: 33624720 PMCID: PMC7902054 DOI: 10.1590/acb360203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 01/11/2021] [Indexed: 11/22/2022] Open
Abstract
Purpose To analyze the effectiveness of vertical gastrectomy in the treatment of
obese patients, adherence to clinical follow-up and the influence of factors
such as gender and age. Methods This is a retrospective, observational and descriptive study, conducted with
patients undergoing vertical gastrectomy, operated at Hospital São Domingos,
between January 2016 and July 2018. Results Most patients undergoing vertical gastrectomy were female (n = 193, 72.28%)
and had a mean age of37.11 ± 8.96 years old. The loss of follow-up was
56.18%. Among adherent patients (n = 117; 43.82%), most patients were female
(n = 89; 76.07%) and had a mean age of 37.92 ± 9.85 years old. The mean body
mass index (BMI) of the adherents in the preoperative was 37.85 ± 3.72
kg/m2. Both BMI and excess weight (EW) showed a statistically
significant difference between pre- and postoperative period. Percentage of
excess weight loss (% EWL) was satisfactory for 96.6% of adherent patients.
Older patients had a statistically significant lower % EWL compared to the
other groups. Conclusions Vertical gastrectomy was effective in the treatment of obese patients, with
significant weight loss.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Plinio da Cunha Leal
- Universidade Federal de São Paulo, Brazil; Universidade Federal do Maranhão, Brazil
| | | | - Ed Carlos Rey Moura
- Universidade Federal de São Paulo, Brazil; Universidade Federal do Maranhão, Brazil
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17
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Lujan J, Tuero C, Landecho MF, Moncada R, A Cienfuegos J, Rotellar F, Silva C, Lapuente F, Martínez P, Frühbeck G, Valenti V. Impact of Routine and Long-Term Follow-Up on Weight Loss after Bariatric Surgery. Obes Surg 2020; 30:4293-4299. [PMID: 32583298 DOI: 10.1007/s11695-020-04788-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 06/11/2020] [Accepted: 06/17/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Weight loss after bariatric surgery varies among patients. Patients who do not complete long-term follow-up are considered to loose less weight than those with regular follow-up visits. OBJECTIVE To evaluate the influence of patients' follow-up compliance on long-term excess weight loss (%EWL) and total weight loss (%TWL) after bariatric surgery, comparing results between gastric bypass (GB) and sleeve gastrectomy (SG). METHODS Patients with up to 5 years of follow-up data after bariatric surgery were included in this retrospective analysis. Patients were divided in 2 groups: those in group 1 who had attended every scheduled postoperative appointment and those in group 2 who had been lost to follow-up before 1 year and were later contacted by telephone. %EWL and %TWL were compared to determine the possible relationship between type of surgery and regularity of the follow-up. RESULTS A total of 385 patients were included. A significant difference in EWL was observed at 5 years in the SG group (78% for group 1 versus 39% for group 2; p = 0.02) and GB group (75% for group 1 versus 62% for group 2; p = 0.01). No significant differences between surgeries were found when comparing long-term EWL in group 1 patients 77% for SG versus 75% for GB. For group 2 patients, GB achieved greater EWL than SG; p = 0.005. %TWL patients in group 2 showed significant differences in all periods of study (p < 0.05). CONCLUSION Bariatric surgery patients who attended all scheduled follow-up appointments experienced significantly greater long-term EWL and TWL than those who did not. GB has apparent increased benefits for weight loss in long-term follow-up when compared with SG for patients who did not attend long-term follow-up. Therefore, continued long-term follow-up of bariatric patients should be encouraged to increase postoperative weight loss results.
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Affiliation(s)
- J Lujan
- Department General Surgery, Bariatric and Metabolic Surgery, Clínica Universidad de Navarra, Avenida Pio XII 36, 31008, Pamplona, Navarra, Spain
| | - C Tuero
- Department General Surgery, Bariatric and Metabolic Surgery, Clínica Universidad de Navarra, Avenida Pio XII 36, 31008, Pamplona, Navarra, Spain
| | - M F Landecho
- Department of Internal Medicine, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - R Moncada
- Department of Anesthesiology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain.,Department of Endocrinology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Pamplona, Navarra, Spain
| | - J A Cienfuegos
- Department General Surgery, Bariatric and Metabolic Surgery, Clínica Universidad de Navarra, Avenida Pio XII 36, 31008, Pamplona, Navarra, Spain.,Department of Endocrinology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - F Rotellar
- Department General Surgery, Bariatric and Metabolic Surgery, Clínica Universidad de Navarra, Avenida Pio XII 36, 31008, Pamplona, Navarra, Spain.,Department of Endocrinology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
| | - C Silva
- Department of Endocrinology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain.,Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, Spain
| | - F Lapuente
- Department General Surgery, Bariatric and Metabolic Surgery, Clínica Universidad de Navarra, Avenida Pio XII 36, 31008, Pamplona, Navarra, Spain
| | - P Martínez
- Department General Surgery, Bariatric and Metabolic Surgery, Clínica Universidad de Navarra, Avenida Pio XII 36, 31008, Pamplona, Navarra, Spain
| | - G Frühbeck
- Department of Endocrinology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Pamplona, Navarra, Spain.,Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, Spain
| | - Victor Valenti
- Department General Surgery, Bariatric and Metabolic Surgery, Clínica Universidad de Navarra, Avenida Pio XII 36, 31008, Pamplona, Navarra, Spain. .,Department of Endocrinology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain. .,CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Pamplona, Navarra, Spain.
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18
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Mahawar KK, Hayes C, Graham YN. Ascertaining Areas for Long-Term Follow-Up of Bariatric Surgical Patients for Primary Care: A Narrative Review. Bariatr Surg Pract Patient Care 2020. [DOI: 10.1089/bari.2019.0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kamal K. Mahawar
- Bariatric Surgical Unit, Sunderland Royal Hospital, Sunderland, United Kingdom
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, United Kingdom
| | - Catherine Hayes
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, United Kingdom
| | - Yitka N.H. Graham
- Bariatric Surgical Unit, Sunderland Royal Hospital, Sunderland, United Kingdom
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, United Kingdom
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19
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Monfared S, Martin A, Selzer D, Butler A. Travel distance reduces follow-up compliance but has no effect on long-term weight loss success in bariatric patients. Surg Endosc 2020; 35:1579-1583. [PMID: 32297055 DOI: 10.1007/s00464-020-07535-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 03/31/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patients seeking bariatric surgery are traveling longer distances to reach Bariatric Centers. The purpose of this study was to evaluate the impact of travel distance on adherence to follow-up and outcomes after bariatric surgery. METHODS A retrospective review of all consecutive patients who had undergone bariatric surgery from June 2013 to May 2014 was performed, and the patients were divided into two groups: those who traveled 50 miles or less and those who traveled more than 50 miles. Primary outcome assessed was the influence of distance on post-operative follow-up attrition over 4-year period. Secondary outcomes assessed were excess weight loss, length of stay (LOS), complications and readmission rates. RESULTS A total of 228 patients underwent bariatric surgery with 4 years of follow-up available. Of these, 145 patients traveled 50 miles or less and 83 patients traveled greater than 50 miles. Patient demographics were similar between the two groups. Those who traveled more had statistically higher probability of attrition up to 3-year follow-up mark. There was no difference in percent excess weight loss at each follow-up visit between the two cohorts. Furthermore, there was no difference in readmission rates (2% vs 5%), minor complications (14% vs 10%), major complications (3% vs 2%) and LOS (2.6 days vs 2.6). CONCLUSION The distance patients traveled for bariatric surgery did not affect their weight loss success, length of stay, postsurgical complications or readmission rate. Despite the lack of influence on postoperative outcomes, follow-up compliance was statistically affected by distance.
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Affiliation(s)
- Sara Monfared
- Department of Surgery, Division of Bariatric and Minimally Invasive Surgery, Indiana University School of Medicine, 545 Barnhill Drive, Emerson Hall 122, Indianapolis, IN, 46202, USA.
| | - Anna Martin
- Purdue University School of Science, West Lafayette, USA
| | - Don Selzer
- Department of Surgery, Division of Bariatric and Minimally Invasive Surgery, Indiana University School of Medicine, 545 Barnhill Drive, Emerson Hall 122, Indianapolis, IN, 46202, USA
| | - Annabelle Butler
- Department of Surgery, Division of Bariatric and Minimally Invasive Surgery, Indiana University School of Medicine, 545 Barnhill Drive, Emerson Hall 122, Indianapolis, IN, 46202, USA
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20
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Murphy J, Uttamlal T, Schmidtke KA, Vlaev I, Taylor D, Ahmad M, Alsters S, Purkayastha P, Scholtz S, Ramezani R, Ahmed AR, Chahal H, Darzi A, Blakemore AIF. Tracking physical activity using smart phone apps: assessing the ability of a current app and systematically collecting patient recommendations for future development. BMC Med Inform Decis Mak 2020; 20:17. [PMID: 32013996 PMCID: PMC6998214 DOI: 10.1186/s12911-020-1025-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 01/14/2020] [Indexed: 12/29/2022] Open
Abstract
Background Within the United Kingdom’s National Health System (NHS), patients suffering from obesity may be provided with bariatric surgery. After receiving surgery many of these patients require further support to continue to lose more weight or to maintain a healthy weight. Remotely monitoring such patients’ physical activity and other health-related variables could provide healthworkers with a more ‘ecologically valid’ picture of these patients’ behaviours to then provide more personalised support. The current study assesses the feasibility of two smartphone apps to do so. In addition, the study looks at the barriers and facilitators patients experience to using these apps effectively. Methods Participants with a BMI > 35 kg/m2 being considered for and who had previously undergone bariatric surgery were recruited. Participants were asked to install two mobile phone apps. The ‘Moves’ app automatically tracked participants’ physical activity and the ‘WLCompanion’ app prompted participants to set goals and input other health-related information. Then, to learn about participants’ facilitators and barriers to using the apps, some participants were asked to complete a survey informed by the Theoretical Domains Framework. The data were analysed using regressions and descriptive statistics. Results Of the 494 participants originally enrolled, 274 participants data were included in the analyses about their activity pre- and/or post-bariatric surgery (ages 18–65, M = 44.02, SD ± 11.29). Further analyses were performed on those 36 participants whose activity was tracked both pre- and post-surgery. Participants’ activity levels pre- and post-surgery did not differ. In addition, 54 participants’ survey responses suggested that the main facilitator to their continued use of the Moves app was its automatic nature, and the main barrier was its battery drain. Conclusions The current study tracked physical activity in patients considered for and who had previously undergone bariatric surgery. The results should be interpreted with caution because of the small number of participants whose data meet the inclusion criteria and the barriers participants encountered to using the apps. Future studies should take note of the barriers to develop more user-friendly apps. Trial registration ClinicalTrials.gov- NCT01365416 on the 3rd of June 2011.
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Affiliation(s)
- J Murphy
- Department of Surgery, Cancer and Investigative Medicine, Imperial College London, London, UK
| | - T Uttamlal
- Warwick Business School, University of Warwick, Coventry, UK
| | - K A Schmidtke
- Psychology Department, Manchester Metropolitan University, Manchester, UK
| | - I Vlaev
- Behavioural Science Group, Warwick Business School, University of Warwick, Coventry, UK.
| | - D Taylor
- Department of Surgery, Cancer and Investigative Medicine, Imperial College London, London, UK
| | - M Ahmad
- Big Data Analytical Unit, Imperial College London, London, UK
| | - S Alsters
- Section of Investigative Medicine, Division of Diabetes, Endocrinology, and Metabolism, Department of Medicine, Imperial College London, London, UK
| | - P Purkayastha
- Department of Surgery, Cancer and Investigative Medicine, Imperial College London, London, UK
| | - S Scholtz
- Imperial Weight Centre, Imperial College Healthcare NHS Trust, St. Mary's Hospital, London, UK
| | - R Ramezani
- Wireless Health Institute, University of California, Los Angeles, USA
| | - A R Ahmed
- Imperial Weight Centre, Imperial College Healthcare NHS Trust, St. Mary's Hospital, London, UK
| | - H Chahal
- Imperial Weight Centre, Imperial College Healthcare NHS Trust, St. Mary's Hospital, London, UK
| | - A Darzi
- Department of Surgery, Cancer and Investigative Medicine, Imperial College London, London, UK
| | - A I F Blakemore
- Section of Investigative Medicine, Division of Diabetes, Endocrinology, and Metabolism, Department of Medicine, Imperial College London, London, UK.,Department of Life Sciences, Brunel University London, London, UK
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21
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Shilton H, Gao Y, Nerlekar N, Evennett N, Ram R, Beban G. Pre-operative Bariatric Clinic Attendance Is a Predictor of Post-operative Clinic Attendance and Weight Loss Outcomes. Obes Surg 2019; 29:2270-2275. [PMID: 30903430 DOI: 10.1007/s11695-019-03843-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
AIM Our primary aim was to determine whether non-attendance at pre-operative clinics were associated with non-attendance at post-operative clinics and its influence on weight loss. We also sought to examine the relationship between gender, ethnicity and post-operative clinic attendance with respect to weight loss post-bariatric surgery. METHODS A retrospective audit was performed for patients undertaking the bariatric surgery program at the Auckland City Hospital between 2013 and 2016. RESULTS One hundred and eighty-four patients completed our program, with a mean age of 46.1 years. Mean weight at commencement was 133.3 kg, with a BMI of 47.4. At 2 years follow-up (n = 143), excess weight loss was 70.8% following RYGB and 68.0% following LSG (p = 0.5743). More patients attended all pre-operative than post-operative clinics (67.4% vs 37.5% p = < 0.001). One pre-operative clinic non-attendance was associated with less weight loss at 2 years and it increases the risk of missing at least 50% of post-operative clinics with a risk ratio of 2.73, p = 0.005. Non-attendance of at least 50% of post-operative clinics was also associated with less weight loss at 2 years (33.4 kg vs 44.3 kg, p = 0.040). Although Maori and Pacific Islanders more frequently missed > 50% of post-operative clinics, weight loss was similar between European, Maori and Pacific Islander populations (2-year weight loss 44.2 kg vs 40.74 kg vs 44.1 kg, respectively, p = 0.8192). CONCLUSION Pre-operative clinic non-attendance helps predict post-operative clinic non-attendance. Missing any pre-operative clinics and at least 50% of scheduled post-operative clinics is associated with poorer weight loss outcomes.
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Affiliation(s)
- Hamish Shilton
- Department of Surgery, Auckland City Hospital, 2 Park Rd, Grafton, Auckland, 1023, New Zealand.
| | - Yang Gao
- Department of Surgery, Auckland City Hospital, 2 Park Rd, Grafton, Auckland, 1023, New Zealand
| | - Nitesh Nerlekar
- Monash Cardiovascular Research Centre, Monash University, Wellington Road, Clayton, Victoria, 3800, Australia
| | - Nicholas Evennett
- Department of Surgery, Auckland City Hospital, 2 Park Rd, Grafton, Auckland, 1023, New Zealand
| | - Rishi Ram
- Department of Surgery, Auckland City Hospital, 2 Park Rd, Grafton, Auckland, 1023, New Zealand
| | - Grant Beban
- Department of Surgery, Auckland City Hospital, 2 Park Rd, Grafton, Auckland, 1023, New Zealand
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22
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Meleo-Erwin ZC. 'No one is as invested in your continued good health as you should be:' an exploration of the post-surgical relationships between weight-loss surgery patients and their home bariatric clinics. SOCIOLOGY OF HEALTH & ILLNESS 2019; 41:285-302. [PMID: 30474249 DOI: 10.1111/1467-9566.12823] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This article traces the post-surgical relationship between weight-loss surgery (WLS) patients and their home bariatric clinics. Following surgery, there is substantive drop off in patient attendance at both follow-up appointments and support groups. While barriers to follow-up are often discussed with the bariatric literature, patients themselves are typically defined as the problem. Based upon a thematic analysis of 217 blog posts and comments in two top patient-led online forums, I demonstrate that bariatric patients tell a more complex story about their post-surgical lives. I argue that WLS patients constitute a population with highly specialised medical needs that is caught between the requirements for living with surgically altered digestive systems and a lack of sufficient post-operative follow-up care from their home bariatric clinics. Although online forums provide spaces for patients to examine these post-operative social and clinical experiences in critical terms, seek information and get support, ultimately the conversations serve to underline the value of personal responsibility for post-operative outcomes-a framing that echoes that of the bariatric profession. This framing should be understood within a larger climate of weight-based stigma and discrimination as well as neoliberal healthism.
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Affiliation(s)
- Zoë C Meleo-Erwin
- Department of Public Health, William Paterson University, New Jersey, USA
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Bradley LE, Thomas JG, Hood MM, Corsica JA, Kelly MC, Sarwer DB. Remote assessments and behavioral interventions in post-bariatric surgery patients. Surg Obes Relat Dis 2018; 14:1632-1644. [DOI: 10.1016/j.soard.2018.07.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 06/21/2018] [Accepted: 07/09/2018] [Indexed: 12/14/2022]
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Doumouras AG, Saleh F, Hong D. The effect of distance on short-term outcomes in a regionalized, publicly funded bariatric surgery model. Surg Endosc 2018; 33:1167-1173. [PMID: 30116951 DOI: 10.1007/s00464-018-6383-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 08/10/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND While high-volume Centers of Excellence (COE) for bariatric surgery may have improved clinical outcomes, their disparate distribution results in longer travel distances for patients. The purpose of this study was to investigate effect of distance from COE on outcomes and readmission. METHODS This was a retrospective study of all adults, aged 18 years or older, receiving bariatric surgery from April 2009 to March 2012 in the province of Ontario. Main outcomes included 30-day complication rates and readmission. Multivariable logistic regression was used to examine the impact of distance from patients' primary residence to their bariatric COE on patient outcomes and readmissions. RESULTS Five thousand and seven patients were identified, two-thirds residing within 100 km of a COE with a mean distance of 117.2 km. The majority of patients did not reside within a Local Integrated Health Network (LHIN) that contained a COE, while 18.3% of patients lived in rural areas. Using multivariable adjustment, for every 10 km increase from the COE where surgery was performed, the Odds Ratio (OR) for complications was 1.00 [95% Confidence Interval (CI) 0.99-1.01; P = 0.747]. Additionally, both residing in a LHIN without a COE, OR 1.10 (95% CI 0.87-1.40; P = 0.434), and rural status, OR 0.97 (95% CI 0.77-1.23; P = 0.821) showed no increase in risk of complication. Similarly, further distances did not influence rate of readmission, OR 0.99 (95% CI 0.98-1.00; P = 0.077) nor did rural status OR 1.31 (95% CI 0.97-1.76; P = 0.076). CONCLUSION The COE model, where a few centers in high population areas service a large geographic region, is adequate in ensuring patients that live further away receive appropriate short-term care.
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Affiliation(s)
- Aristithes G Doumouras
- Division of General Surgery, St. Joseph's Healthcare, Hamilton, ON, Canada
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Fady Saleh
- Division of General Surgery, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Dennis Hong
- Division of General Surgery, St. Joseph's Healthcare, Hamilton, ON, Canada.
- Department of Surgery, McMaster University, Hamilton, ON, Canada.
- Division of General Surgery, St. Joseph's Healthcare, Room G814, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada.
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Belo GDEQMB, Siqueira LTDE, Melo Filho DAA, Kreimer F, Ramos VP, Ferraz ÁAB. Predictors of poor follow-up after bariatric surgery. ACTA ACUST UNITED AC 2018; 45:e1779. [PMID: 29846460 DOI: 10.1590/0100-6991e-20181779] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 03/01/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVE to identify predictive factors of loss of follow-up of patients submitted to Roux-en-Y gastric bypass and sleeve gastrectomy in a 48-month period. METHODS we conducted a retrospective, cohort study from January 2010 to December 2012. We analyzed thirteen variables and compared them to loss of follow-up. RESULTS among the 559 patients studied, there was a great reduction in the frequency (43.8%) of the consultations from the second postoperative year on, with a significant loss in the 4th year (70.8%). In the univariate analysis, only the variable "excess weight" was associated with loss of follow-up. The proportion of overweight (>49.95kg) was higher in the follow-up group with greater loss (>3 absences) (p=0.025). In the logistic regression, patients exposed to a greater excess weight (>49.95kg) presented a two-fold higher risk for loss of follow-up (>3 absences) (OR=2.04, 95% CI 1.15-3.62; p=0.015). In the univariate analysis, at the 48th postoperative month, only the variable "mesoregion of origin" was associated with loss of follow-up (p=0.012). CONCLUSION there was a progressive loss of follow-up from the second postoperative year on. Among the factors analyzed, only the variable "excess weight" greater than 49.95kg in the preoperative period was associated with loss of medical-surgical follow-up. In the 48th month of the postoperative period, there was a higher prevalence of loss of medical-surgical follow-up for patients outside the perimeter of the city of Recife (51%, p=0.052).
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Affiliation(s)
| | | | | | - Flávio Kreimer
- Department of Surgery, Federal University of Pernambuco, Recife, PE, Brazil
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Hood MM, Kelly MC, Feig EH, Webb V, Bradley LE, Corsica J. Measurement of adherence in bariatric surgery: a systematic review. Surg Obes Relat Dis 2018; 14:1192-1201. [PMID: 29853195 DOI: 10.1016/j.soard.2018.04.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 04/16/2018] [Accepted: 04/17/2018] [Indexed: 12/22/2022]
Abstract
After bariatric surgery, rates of adherence to behavioral recommendations, including attending regular appointments and following specific dietary, physical activity, and vitamin use recommendations, tend to be highly variable across studies. Lack of consistency in measurement of adherence is a likely contributor to this variability, making it challenging to determine the prevalence and impact of nonadherence in this population. PubMed was searched for articles measuring behavioral adherence or compliance in patients after bariatric surgery, resulting in 85 articles. Articles were reviewed for the definition and measurement of adherence in each area (appointment attendance, as well as dietary, physical activity, and vitamin use adherence), and on the use and reporting of recommended adherence measurement strategies. Over half of the articles measured adherence to appointment attendance. Significant variability was found across adherence definitions and measurement methods, and use of recommended adherence measurement strategies was poor. Adherence was mostly commonly measured via self-report (either verbal or written) using cutoffs for adherent versus nonadherent behavior. Over half of studies assessed adherence up to ≥2 years postsurgery. Recommendations for ways to improve adherence measurement in patients who have had bariatric surgery are outlined.
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Affiliation(s)
- Megan M Hood
- Rush University Medical Center, Chicago, Illinois.
| | | | - Emily H Feig
- Rush University Medical Center, Chicago, Illinois
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Bariatric Surgery Among Obese Veterans: a Retrospective Review of Complications and Intermediate Term Results from a Single Institution. Obes Surg 2018; 26:1906-11. [PMID: 26712493 DOI: 10.1007/s11695-015-2033-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The purpose of this study was to compare the results and complications among obese veterans undergoing sleeve gastrectomy and gastric bypass at a low-volume center. MATERIALS AND METHODS This is a retrospective review of bariatric procedures performed by a single surgeon from 2009-2013. Outcomes of interest were mortality, complications, and length of stay. Weight loss and comorbidity resolution were compared between sleeve gastrectomy (SG) and Roux-y gastric bypass (RYGB). Length of stay and distance traveled to receive services were analyzed. Distributed groups were compared with Student's t test. Welch's correction was used where variances were unequal via ANOVA. Complications were compared using Fisher's exact test. RESULTS Eighty-five patients (SG = 51, RYGB = 34) were analyzed. Postoperatively, patients were seen in clinic, contacted by phone or email, and their electronic health care records were reviewed. Average length of follow-up was 114.3 weeks. Mortality was 0 %. Complication rates were comparable between groups. The percent total weight loss was 22.6 % for the SG and 27.5 % for the RYGB (p = 0.02). The percent excess weight loss was 49 % for SG and 55 % for RYGB (p = 0.149). Percent excess body mass index (BMI) loss was 54 and 61 % (p = 0.197) for SG and RYGB, respectively. Comorbidity resolution was similar between groups except for diabetes which was superior for RYGB (p = 0.03). Veterans lived an average of 141.3 miles from our VA, and all 85 patients were able to be contacted for follow-up. CONCLUSIONS Despite long travel distances for high-risk veterans, bariatric surgery can be performed safely even at a low-volume VA hospital with acceptable morbidity and mortality and excellent follow-up. There was no difference in morbidity or mortality between patients undergoing SG vs RYGB.
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Bradley LE, Forman EM, Kerrigan SG, Goldstein SP, Butryn ML, Thomas JG, Herbert JD, Sarwer DB. Project HELP: a Remotely Delivered Behavioral Intervention for Weight Regain after Bariatric Surgery. Obes Surg 2017; 27:586-598. [PMID: 27586525 DOI: 10.1007/s11695-016-2337-3] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Weight regain following bariatric surgery is common and potentially compromises the health benefits initially attained after surgery. Poor compliance to dietary and physical activity prescriptions is believed to be largely responsible for weight regain. Patients may benefit from developing specialized psychological skills necessary to engage in positive health behaviors over the long term. Unfortunately, patients often face challenges to physically returning to the bariatric surgery program for support in developing and maintaining these behaviors. Remotely delivered interventions, in contrast, can be conveniently delivered to the patient and have been found efficacious for a number of health problems, including obesity. To date, they have received little attention with bariatric surgery patients. The study aimed to evaluate a newly developed, remote acceptance-based behavioral intervention for postoperative weight regain. METHODS Patients at least 1.5 years out from surgery who experienced postoperative weight regain were recruited to receive the 10-week intervention. Participants were assessed at baseline, mid-treatment, post-treatment, and at 3-month follow-up. RESULTS Support for the intervention's feasibility and acceptability was achieved, with 70 % retention among those who started the program and a high mean rating (4.7 out of 5.0) of program satisfaction among study completers. On average, weight regain was reversed with a mean weight loss of 5.1 ± 5.5 % throughout the intervention. This weight loss was maintained at 3-month follow-up. Significant improvements in eating-related and acceptance-based variables also were observed. CONCLUSIONS This pilot study provides initial support for the feasibility, acceptability, and preliminary efficacy of a remotely delivered acceptance-based behavioral intervention for postoperative weight regain.
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Affiliation(s)
- Lauren E Bradley
- Department of Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd. Suite 400, Chicago, IL, 60625, USA.
| | - Evan M Forman
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | | | | | - Meghan L Butryn
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - J Graham Thomas
- Weight Control and Diabetes Research Center, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - James D Herbert
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - David B Sarwer
- Center for Obesity Research and Education, Temple University, Philadelphia, PA, USA
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Kelly C, Hulme C, Farragher T, Clarke G. Are differences in travel time or distance to healthcare for adults in global north countries associated with an impact on health outcomes? A systematic review. BMJ Open 2016; 6:e013059. [PMID: 27884848 PMCID: PMC5178808 DOI: 10.1136/bmjopen-2016-013059] [Citation(s) in RCA: 282] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To investigate whether there is an association between differences in travel time/travel distance to healthcare services and patients' health outcomes and assimilate the methodologies used to measure this. DESIGN Systematic Review. We searched MEDLINE, Embase, Web of Science, Transport database, HMIC and EBM Reviews for studies up to 7 September 2016. Studies were excluded that included children (including maternity), emergency medical travel or countries classed as being in the global south. SETTINGS A wide range of settings within primary and secondary care (these were not restricted in the search). RESULTS 108 studies met the inclusion criteria. The results were mixed. 77% of the included studies identified evidence of a distance decay association, whereby patients living further away from healthcare facilities they needed to attend had worse health outcomes (eg, survival rates, length of stay in hospital and non-attendance at follow-up) than those who lived closer. 6 of the studies identified the reverse (a distance bias effect) whereby patients living at a greater distance had better health outcomes. The remaining 19 studies found no relationship. There was a large variation in the data available to the studies on the patients' geographical locations and the healthcare facilities attended, and the methods used to calculate travel times and distances were not consistent across studies. CONCLUSIONS The review observed that a relationship between travelling further and having worse health outcomes cannot be ruled out and should be considered within the healthcare services location debate.
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Affiliation(s)
- Charlotte Kelly
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
- Institute for Transport Studies, University of Leeds, Leeds, UK
| | - Claire Hulme
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Tracey Farragher
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Hood MM, Corsica J, Bradley L, Wilson R, Chirinos DA, Vivo A. Managing severe obesity: understanding and improving treatment adherence in bariatric surgery. J Behav Med 2016; 39:1092-1103. [PMID: 27444752 DOI: 10.1007/s10865-016-9772-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 07/12/2016] [Indexed: 01/11/2023]
Abstract
Severe obesity (body mass index ≥40 kg/m2) is a chronic disease that is associated with significantly increased risk of serious and chronic health problems as well as impaired quality of life. For those with severe obesity, bariatric surgery is the most effective treatment for significant and long-term weight loss and resolution of comorbid medical conditions, particularly diabetes. Long-term success is thought to depend to some degree on the patient's ability to adhere to a complex set of behaviors, including regular attendance at follow up appointments and following stringent dietary, exercise, and vitamin recommendations. Here, we summarize the current research on behavioral adherence in patients with severe obesity presenting for bariatric surgery and we highlight challenges and make recommendations for improved self-management before and after surgery.
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Affiliation(s)
- Megan M Hood
- Department of Behavioral Sciences, Rush University Medical Center, 1645 W Jackson, Suite 400, Chicago, IL, 60612, USA.
| | - Joyce Corsica
- Department of Behavioral Sciences, Rush University Medical Center, 1645 W Jackson, Suite 400, Chicago, IL, 60612, USA
| | - Lauren Bradley
- Department of Behavioral Sciences, Rush University Medical Center, 1645 W Jackson, Suite 400, Chicago, IL, 60612, USA
| | - Rebecca Wilson
- Department of Behavioral Sciences, Rush University Medical Center, 1645 W Jackson, Suite 400, Chicago, IL, 60612, USA
| | - Diana A Chirinos
- Department of Behavioral Sciences, Rush University Medical Center, 1645 W Jackson, Suite 400, Chicago, IL, 60612, USA
| | - Amanda Vivo
- Department of Behavioral Sciences, Rush University Medical Center, 1645 W Jackson, Suite 400, Chicago, IL, 60612, USA
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