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Lee Y, Hircock C, Dang J, Jung J, Zevin B, Elnahas A, Khamar J, Vergis A, Tahir U, Hardy K, Samarasinghe Y, Gill R, Gu J, McKechnie T, Pescarus R, Biertho L, Lam E, Neville A, Ellsmere J, Karmali S, Jackson T, Okrainec A, Doumouras A, Kroh M, Hong D. Assessment of guidelines for bariatric and metabolic surgery: a systematic review and evaluation using appraisal of guidelines for research and evaluation II (AGREE II). Int J Obes (Lond) 2024:10.1038/s41366-024-01559-7. [PMID: 38890403 DOI: 10.1038/s41366-024-01559-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 05/01/2024] [Accepted: 05/31/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND In recent years, multiple guidelines on bariatric and metabolic surgery were published, however, their quality remains unknown, leaving providers with uncertainty when using them to make perioperative decisions. This study aims to evaluate the quality of existing guidelines for perioperative bariatric surgery care. METHODS A comprehensive search of MEDLINE and EMBASE were conducted from January 2010 to October 2022 for bariatric clinical practice guidelines. Guideline evaluation was carried out using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) framework. RESULTS The initial search yielded 1483 citations, of which, 26 were included in final analysis. The overall median domain scores for guidelines were: (1) scope and purpose: 87.5% (IQR: 57-94%), (2) stakeholder involvement: 49% (IQR: 40-64%), (3) rigor of development: 42.5% (IQR: 22-68%), (4) clarity of presentation: 85% (IQR: 81-90%), (5) applicability: 6% (IQR: 3-16%), (6) editorial independence: 50% (IQR: 48-67%), (7) overall impressions: 48% (IQR: 33-67%). Only six guidelines achieved an overall score >70%. CONCLUSIONS Bariatric surgery guidelines effectively outlined their aim and presented recommendations. However, many did not adequately seek patient input, state search criteria, use evidence rating tools, and consider resource implications. Future guidelines should reference the AGREE II framework in study design.
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Affiliation(s)
- Yung Lee
- Division of General Surgery, McMaster University, Hamilton, ON, Canada
| | - Caroline Hircock
- Division of General Surgery, McMaster University, Hamilton, ON, Canada
| | - Jerry Dang
- Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - James Jung
- Division of General Surgery, University of Toronto, Toronto, ON, Canada
| | - Boris Zevin
- Department of Surgery, Queen's University, Kingston, ON, Canada
| | - Ahmad Elnahas
- Division of General Surgery, Western University, London, ON, Canada
| | - Jigish Khamar
- Division of General Surgery, McMaster University, Hamilton, ON, Canada
| | - Ashley Vergis
- Division of General Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Umair Tahir
- Division of General Surgery, McMaster University, Hamilton, ON, Canada
| | - Krista Hardy
- Division of General Surgery, University of Manitoba, Winnipeg, MB, Canada
| | | | - Richdeep Gill
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Jeffrey Gu
- Division of General Surgery, University of Saskatchewan, Saskatoon, SK, Canada
| | - Tyler McKechnie
- Division of General Surgery, McMaster University, Hamilton, ON, Canada
| | - Radu Pescarus
- Division of General Surgery, University of Montreal, Montreal, QC, Canada
| | - Laurent Biertho
- Department of Surgery, Laval University, Quebec City, QC, Canada
| | - Elaine Lam
- Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Amy Neville
- Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | - James Ellsmere
- Division of General and Gastrointestinal Surgery, Dalhousie University, Halifax, NS, Canada
| | - Shahzeer Karmali
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Timothy Jackson
- Division of General Surgery, University of Toronto, Toronto, ON, Canada
| | - Allan Okrainec
- Division of General Surgery, University of Toronto, Toronto, ON, Canada
| | | | - Matthew Kroh
- Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Dennis Hong
- Division of General Surgery, McMaster University, Hamilton, ON, Canada.
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Amelung S, Bender B, Meid A, Walk-Fritz S, Hoppe-Tichy T, Haefeli WE, Seidling HM. [How complete is the Germany-wide standardised medication list ("Bundeseinheitlicher Medikationsplan")? An analysis at hospital admission.]. Dtsch Med Wochenschr 2020; 145:e116-e122. [PMID: 33022741 PMCID: PMC7575356 DOI: 10.1055/a-1212-2836] [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] [Indexed: 11/13/2022]
Abstract
Einleitung
Bei stationärer Aufnahme scheint die Aktualität und Vollständigkeit des Bundeseinheitlichen Medikationsplans häufig nicht gegeben. Ebenso ist unklar, welche Charakteristiken der Pläne die Wahrscheinlichkeit für Diskrepanzen erhöhen.
Methoden
Retrospektiv wurden deshalb 100 Pläne, die zur Arzneimittelanamnese elektiver Patienten einer chirurgischen Klinik mitgebracht wurden, geprüft, ob und welche Abweichungen bestanden. Die Abweichungen wurden 7 Kategorien zugeordnet: Arzneimittel, das in der Anamnese erfasst wurde, fehlt auf dem Plan, Arzneimittel auf dem Plan wird nicht mehr eingenommen, Stärke oder Dosierung fehlt auf dem Plan bzw. ist falsch oder die Darreichungsform ist falsch dokumentiert. Hinweise zur Arzneimitteltherapiesicherheit, involvierte Arzneimittel und -formen wurden ebenfalls erfasst. Mithilfe multivariater Analysen wurde der Einfluss der Aktualität, der Anzahl der Arzneimittel und der ausstellenden Facharztdisziplin der Pläne auf die Art und Anzahl an Diskrepanzen untersucht.
Ergebnisse
Zur Arzneimittelanamnese wiesen 78 % (78/100) der Pläne Abweichungen auf. Insgesamt wurden 226 Abweichungen (2,3 ± 0,6 Abweichungen/Anamnese) dokumentiert. Am häufigsten fehlte ein Arzneimittel auf dem Plan (n = 103). Von allen Hinweisen und Empfehlungen betrafen 64 % (83/177) das perioperative Management von Antithrombotika (n = 55) und Antidiabetika (n = 28). In der multivariaten Analyse stieg nur das Risiko für fehlerhafte Angaben bei Stärke und Dosierung mit dem Alter der Pläne signifikant (p = 0,047) und war um mehr als das 2-fache erhöht, wenn der Plan älter als einen Monat war.
Diskussion
Die Aktualität, Vollständigkeit und Aspekte der Arzneimitteltherapiesicherheit des Bundeseinheitlichen Medikationsplans sollten umfassend und gezielt im Anamnesegespräch validiert werden. In der Praxis sollten Pläne, die älter als 1 Monat sind, besonders kritisch hinsichtlich Angaben zu Stärke und Dosierung geprüft und der Plan entsprechend regelmäßig aktualisiert werden.
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Affiliation(s)
- Stefanie Amelung
- Apotheke des Universitätsklinikums Heidelberg, Heidelberg, Deutschland.,Kooperationseinheit Klinische Pharmazie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland.,Abteilung Klinische Pharmakologie und Pharmakoepidemiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Bianca Bender
- Apotheke des Universitätsklinikums Heidelberg, Heidelberg, Deutschland
| | - Andreas Meid
- Abteilung Klinische Pharmakologie und Pharmakoepidemiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Stefanie Walk-Fritz
- Apotheke des Universitätsklinikums Heidelberg, Heidelberg, Deutschland.,Kooperationseinheit Klinische Pharmazie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Torsten Hoppe-Tichy
- Apotheke des Universitätsklinikums Heidelberg, Heidelberg, Deutschland.,Kooperationseinheit Klinische Pharmazie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Walter E Haefeli
- Kooperationseinheit Klinische Pharmazie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland.,Abteilung Klinische Pharmakologie und Pharmakoepidemiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Hanna M Seidling
- Kooperationseinheit Klinische Pharmazie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland.,Abteilung Klinische Pharmakologie und Pharmakoepidemiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
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3
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Graham YNH, Earl-Sinha C, Parkin L, Callejas-Diaz L, Fox A, Tierney C, Mahawar K, Hayes C. Evaluating a potential role for community pharmacists in post-bariatric patient nutritional support. Clin Obes 2020; 10:e12364. [PMID: 32351027 DOI: 10.1111/cob.12364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 12/12/2022]
Abstract
Physiological changes to the body from bariatric surgery necessitate lifelong vitamin and mineral supplementation to prevent potential nutritional deficiencies. Presently, there is no consensus on appropriate long-term follow-up in community settings for people who have undergone bariatric surgery. Current UK guidelines recommend annual monitoring of nutritional status, but little else. Semi-structured interviews were carried out with members of a high volume bariatric surgical unit and community pharmacists working in a variety of settings and locations. Data were collected between June and August 2018 and analysed using a thematic analytic framework. Twenty-five participants were recruited. Bariatric staff (n = 9) reported negligible interaction with community pharmacists but felt establishing communication and developing a potential pathway to collaborate, would provide additional support and potentially improved levels of patient compliance. Community pharmacists (n = 16) reported poor knowledge of bariatric surgery, indicating they were unable to routinely identify people who had bariatric surgery, but understood issues with absorption of vitamins. There is evident potential to involve community pharmacists in post-bariatric patient care pathways. Pharmacists possess knowledge of absorption and metabolism of supplements which could be used to actively support people who have had bariatric surgery in their changed physiological status. Education ought to focus on the functional impact of bariatric surgical procedures and interventions and the consequent nutritional recommendations required. Communication between bariatric units and community pharmacies is needed to construct a clear and formalized infrastructure of support, with remuneration for pharmacy specialist expertise agreed to ensure both financial viability and sustainability.
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Affiliation(s)
- Yitka N H Graham
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
- Bariatric Surgical Unit, Directorate of Surgery, Sunderland Royal Hospital, Sunderland, UK
- Faculdad de Psicologia, Universidad Anahuac Mexico, Mexico
| | - Charlotte Earl-Sinha
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
| | - Lindsay Parkin
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
- Directorate of Pharmacy, Sunderland Royal Hospital, Sunderland, UK
| | | | - Ann Fox
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
- Sunderland Clinical Commissioning Group, Pemberton House, Sunderland, UK
| | - Callum Tierney
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
| | - Kamal Mahawar
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
- Bariatric Surgical Unit, Directorate of Surgery, Sunderland Royal Hospital, Sunderland, UK
| | - Catherine Hayes
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
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Gabbard J, Breznau C, Marterre B. Palliative Management Pearls for Postbariatric Surgery Patients #373. J Palliat Med 2019; 22:591-592. [PMID: 31063445 DOI: 10.1089/jpm.2019.0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Bui AH, Feldman DL, Brodman ML, Shamamian P, Kaleya RN, Rosenblatt MA, D'Angelo D, Somerville D, Mudiraj S, Kischak P, Leitman IM. Provider preferences for postoperative analgesia in obese and non-obese patients undergoing ambulatory surgery. J Pharm Policy Pract 2018; 11:9. [PMID: 29796284 PMCID: PMC5956826 DOI: 10.1186/s40545-018-0138-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 03/22/2018] [Indexed: 11/30/2022] Open
Abstract
Background Few guidelines exist on safe prescription of postoperative analgesia to obese patients undergoing ambulatory surgery. This study examines the preferences of providers in the standard treatment of postoperative pain in the ambulatory setting. Methods Providers from five academic medical centers within a single US city were surveyed from May–September 2015. They were asked to provide their preferred postoperative analgesic routine based upon the predicted severity of pain for obese and non-obese patients. McNemar’s tests for paired observations were performed to compare prescribing preferences for obese vs. non-obese patients. Fisher’s exact tests were performed to compare preferences based on experience: > 15 years vs. ≤15 years in practice, and attending vs. resident physicians. Results A total of 452 providers responded out of a possible 695. For mild pain, 119 (26.4%) respondents prefer an opioid for obese patients vs. 140 (31.1%) for non-obese (p = 0.002); for moderate pain, 329 (72.7%) for obese patients vs. 348 (77.0%) for non-obese (p = 0.011); for severe pain, 398 (88.1%) for obese patients vs. 423 (93.6%) for non-obese (p < 0.001). Less experienced physicians are more likely to prefer an opioid for obese patients with moderate pain: 70 (62.0%) attending physicians with > 15 years in practice vs. 86 (74.5%) with ≤15 years (p = 0.047), and 177 (68.0%) attending physicians vs. 129 (83.0%) residents (p = 0.002). Conclusions While there is a trend to prescribe less opioid analgesics to obese patients undergoing ambulatory surgery, these medications may still be over-prescribed. Less experienced physicians reported prescribing opioids to obese patients more frequently than more experienced physicians.
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Affiliation(s)
- Anthony H Bui
- 1Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA
| | - David L Feldman
- 1Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA.,Hospitals Insurance Company, New York, NY USA
| | | | - Peter Shamamian
- 3Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY USA
| | | | - Meg A Rosenblatt
- 1Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA
| | | | | | | | | | - I Michael Leitman
- 1Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA.,5Department of Surgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1076, New York, NY 10029 USA
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6
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Bland CM, Quidley AM, Love BL, Yeager C, McMichael B, Bookstaver PB. Long-term pharmacotherapy considerations in the bariatric surgery patient. Am J Health Syst Pharm 2016; 73:1230-42. [PMID: 27354038 DOI: 10.2146/ajhp151062] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Pharmacists' role in optimizing long-term pharmacotherapy for bariatric surgery patients is detailed. SUMMARY Bariatric surgery patients provide a difficult challenge in terms of many pharmacotherapy issues, especially in the chronic care setting, where data on long-term effects of bariatric surgery are limited. The most common procedures are Roux-en-Y gastric bypass (RYGB), adjustable gastric banding, and sleeve gastrectomy. Sleeve gastrectomy has become the most common procedure in the United States, primarily because it has less overall chronic malabsorption effects than RYGB. Pharmacotherapy management is complicated by rapid weight loss combined with a number of pharmacokinetic changes, such as decreased absorption of some medications due to altered gastrointestinal tract anatomy and potentially increased concentrations of some medications due to a decreased volume of distribution resulting from weight loss. Nutritional and metabolic supplementation are of the utmost importance in order to limit deficiencies that can lead to a number of conditions. Many chronic diseases, including hypertension, diabetes, gastroesophageal reflux disease, and urinary incontinence, are improved by bariatric surgery but require close monitoring to ensure the effectiveness of maintenance pharmacotherapy and avoidance of adverse effects. Psychotropic medication management is also an important pharmacotherapy concern, as evidenced by antidepressants being the most commonly used medication class among preoperative bariatric surgery patients. CONCLUSION Pharmacists have an increasing role in the chronic management of the bariatric surgery patient due to their knowledge of medication dosage forms and expertise in disease states affected by bariatric surgery.
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Affiliation(s)
- Christopher M Bland
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Southeastern Campus, Savannah, GA.
| | | | - Bryan L Love
- Department of Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, University of South Carolina, Columbia, SC
| | - Catherine Yeager
- Family Medicine and Outpatient Behavioral Health Services, Eisenhower Army Medical Center, Fort Gordon, GA
| | | | - P Brandon Bookstaver
- Department of Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, University of South Carolina, Columbia, SC
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Sampaio-Neto J, Branco-Filho AJ, Nassif LS, Broska AC, Kamei DJ, Nassif AT. COMPLICATIONS RELATED TO GASTRIC BYPASS PERFORMED WITH DIFFERENT GASTROJEJUNAL DIAMETERS. ACTA ACUST UNITED AC 2016; 29Suppl 1:12-14. [PMID: 27683767 PMCID: PMC5064265 DOI: 10.1590/0102-6720201600s10004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 05/20/2016] [Indexed: 01/27/2023]
Abstract
Background: Among the options for surgical treatment of obesity, the most widely used has
been the Roux-en-Y gastric bypass. The gastrojejunal anastomosis can be
accomplished in two ways: handsewn or using circular and linear stapled. The
complications can be divided in early and late. Aim: To compare the incidence of early complications related with the handsewn
gastrojejunal anastomosis in gastric bypass using Fouchet catheter with different
diameters. Method: The records of 732 consecutive patients who had undergone the bypass were
retrospectively analyzed and divided in two groups, group 1 with 12 mm anastomosis
(n=374), and group 2 with 15 mm (n=358). Results: The groups showed anastomotic stenosis with rates of 11% and 3.1% respectively,
with p=0.05. Other variables related to the anastomosis were also analyzed, but
without statistical significance (p>0.05). Conclusion: The diameter of the anastomosis of 15 mm was related with lower incidence of
stenosis. It was found that these patients had major bleeding postoperatively and
lower surgical site infection, and in none was observed presence of anastomotic
leak.
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Affiliation(s)
- José Sampaio-Neto
- Bariatric Surgery and Metabolic Service of Holy House Hospital of Curitiba, Curitiba PR, Brazil
| | | | - Luis Sérgio Nassif
- Bariatric Surgery and Metabolic Service of Holy House Hospital of Curitiba, Curitiba PR, Brazil
| | - Anne Caroline Broska
- Bariatric Surgery and Metabolic Service of Holy House Hospital of Curitiba, Curitiba PR, Brazil
| | - Douglas Jun Kamei
- Bariatric Surgery and Metabolic Service of Holy House Hospital of Curitiba, Curitiba PR, Brazil
| | - André Thá Nassif
- Bariatric Surgery and Metabolic Service of Holy House Hospital of Curitiba, Curitiba PR, Brazil
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Obesity and chronic pain: systematic review of prevalence and implications for pain practice. Reg Anesth Pain Med 2015; 40:91-111. [PMID: 25650632 DOI: 10.1097/aap.0000000000000218] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The combination of obesity and pain may worsen a patient's functional status and quality of life more than each condition in isolation. We systematically searched PubMed/MEDLINE and the Cochrane databases for all reports published on obesity and pain. The prevalence of combined obesity and pain was substantial. Good evidence shows that weight reduction can alleviate pain and diminish pain-related functional impairment. However, inadequate pain control can be a barrier to effective lifestyle modification and rehabilitation. This article examines specific pain management approaches for obese patients and reviews novel interventional techniques for treatment of obesity. The infrastructure for simultaneous treatment of obesity and pain already exists in pain medicine (eg, patient education, behavioral medicine approaches, physical rehabilitation, medications, and interventional treatment). Screening for obesity, pain-related disability, and behavioral disorders as well as monitoring of functional performance should become routine in pain medicine practices. Such an approach requires additional physician and staff training. Further research should focus on better understanding the interplay between these 2 very common conditions and the development of effective treatment strategies.
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Barros LM, Moreira RAN, Frota NM, Caetano JÁ. Identificação dos diagnósticos de enfermagem da classe de respostas cardiovasculares/pulmonares em pacientes submetidos à cirurgia bariátrica. AQUICHAN 2015. [DOI: 10.5294/aqui.2015.15.2.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
O objetivo deste estudo foi identificar as respostas humanas apresentadas por pacientes no pós-operatório de cirurgia bariátrica que se configurem como diagnósticos de enfermagem da classe respostas cardiovasculares/pulmonares. Estudo observacional de caráter transversal realizado no período de julho de 2010 a maio de 2011, em um hospital referência em cirurgia bariátrica em Fortaleza-CE. Os diagnósticos de enfermagem identificados foram: risco de perfusão gastrintestinal ineficaz (87,9%), risco de intolerância à atividade (70,7%), perfusão tissular periférica ineficaz (67,2%), risco de choque (63,8%), débito cardíaco diminuído (60,3%), risco de perfusão tissular cardíaca diminuída (58,6%), intolerância à atividade (51,7%), risco de perfusão tissular cerebral ineficaz (48,3%), ventilação espontânea prejudicada (46,5%), risco de perfusão renal ineficaz (43,1%), padrão respiratório ineficaz (37,9%) e resposta disfuncional ao desmame ventilatório (36,2%). Assim, com base nesses resultados será possível direcionar a assistência de enfermagem prestada aos pacientes submetidos à cirurgia bariátrica e, consequentemente, reduzir complicações pós-operatórias.
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Dillon C, Peddle J, Twells L, Lester K, Midodzi W, Manning K, Murphy R, Pace D, Smith C, Boone D, Gregory D. Rapid Reduction in Use of Antidiabetic Medication after Laparoscopic Sleeve Gastrectomy: The Newfoundland and Labrador Bariatric Surgery Cohort (BaSCo) Study. Can J Hosp Pharm 2015; 68:113-20. [PMID: 25964682 DOI: 10.4212/cjhp.v68i2.1436] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patients who have undergone bariatric surgery generally need fewer medications as they experience improvement in, or even resolution of, various medical conditions, including type 2 diabetes mellitus, hypertension, and dyslipidemia. Published data on changes in medication use after laparoscopic sleeve gastrectomy, a type of bariatric surgery that is growing in popularity, are limited. OBJECTIVE To determine whether patients took fewer medications for management of type 2 diabetes, hypertension, and dyslipidemia after laparoscopic sleeve gastrectomy, relative to preprocedure medications. METHODS In this prospective, single-centre cohort study, a nurse practitioner used standard medication reconciliation and study data-extraction forms to interview adult patients who had undergone laparoscopic sleeve gastrectomy and determine their medication use and pertinent demographic data. The data were analyzed using generalized estimating equations and standard statistical software. Outcome measures included changes in the use of antidiabetic, antihypertensive, and antilipemic medications at 1, 3, and 6 months after the surgery. RESULTS A total of 65 patients who underwent laparoscopic sleeve gastrectomy between May 2011 and January 2014 met the study inclusion criteria. Before surgery, the 30 patients with type 2 diabetes were taking an average of 1.9 antidiabetic medications. One month after the procedure, 15 (50%) had discontinued all antidiabetic medications, with a further decline at 3 and 6 months (p < 0.001 at each time point). Among the patients who were taking antihypertensives (n = 48) and antilipemics (n = 33) before surgery, the decline in use occurred at a more modest rate, with 6 (12%) and 2 (6%), respectively, discontinuing these medication classes within 1 month, and 12 (25%) (p = 0.001) and 8 (24%) (p = 0.015) having discontinued by 6 months. CONCLUSIONS These findings suggest that patients with a history of type 2 diabetes mellitus, hypertension, and/or dyslipidemia who undergo laparoscopic sleeve gastrectomy are less likely to require disease-specific medications shortly after surgery.
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Affiliation(s)
- Carla Dillon
- BScPharm, ACPR, PharmD, is with the School of Pharmacy and Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador
| | - Justin Peddle
- BScPharm, PharmD, is with the School of Pharmacy, Memorial University of Newfoundland, St John's, Newfoundland and Labrador
| | - Laurie Twells
- BA, MSc, PhD, is with the School of Pharmacy and Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador
| | - Kendra Lester
- BSc, MSc, is with the Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador
| | - William Midodzi
- PhD, is with the Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador
| | | | - Raleen Murphy
- NP, MSc(A), BSc, is with Eastern Health, St John's, Newfoundland and Labrador
| | - David Pace
- BSc, MBA, MD, FRCSC, is with Eastern Health and the Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador
| | - Chris Smith
- BSc(Hons), MD, FRCSC, is with Eastern Health and the Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador
| | - Darrell Boone
- BMedSc, MD, FRCSC, is with Eastern Health and the Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador
| | - Deborah Gregory
- BN, MSc, PhD, is with the Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador
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