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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
21

The Relationship of Self-efficacy and Weight Loss Maintenance in Post-operative Bariatric Patients

McAllen, Patricia Ann 15 April 2009 (has links)
No description available.
22

Förändrad men fortfarande densamma. : Patienters upplevelse av hur livet påverkas efter genomgången obesitaskirurgi. / Tranformed but still the same. : Patients experiences of life effects after bariatric surgery.

Rönnholm, Matilda, Bergström, Emma January 2016 (has links)
Bakgrund: Försämrade levnadsvanor i samhället har inneburit en ökning av fetma bland befolkningen. Sjuklig övervikt behandlas bland annat genom obesitaskirurgi. Syfte: Litteraturstudiens syfte var att belysa patienters upplevelse av hur livet påverkas efter genomgången obesitaskirurgi. Metod: En litteraturstudie genomfördes där nio kvalitativa studier granskades, analyserades och sammanställdes med hjälp utifrån en innehållsanalys. Resultat: I litteraturstudiens resultat presenteras att genomgången obesitaskirurgi innebar en omfattande kroppslig förändringsprocess för patienterna. Operationen medförde nya fysiska förutsättningar men även oväntade negativa effekter. Till följd av förändringen lärde sig patienterna att hantera viktminskningen och vidare beskrevs en återupptäckt av sig själv. Att vara en individ utanför normen innebar upplevelser av en förändrad stigmatisering och ett engagemang från omgivningen. Positiva och negativa upplevelser presenteras bland patienter av både manligt och kvinnligt kön. Konklusion: Litteraturstudiens resultat visade att genomgången obesitaskirurgi var en livsomvälvande upplevelse som innebar både fysiska och psykiska förändringar bland patienterna. / Background: Various elements in the society and bad habits have resulted in an increased number of people living with obesity. One method to treat obesity today is to undergo bariatric surgery. Aim: The aim of this literature study was to highlight patients’ experiences of life effects after bariatric surgery. Methods: A literature study was conducted and nine qualitative scientific articles were reviewed, analysed and compiled with a content analysis. Results: In the result of the literature study it was presented that bariatric surgery were an extensive process of bodily change. The operation induced new physical preconditions but also negative and unexpected side effects of the surgery. As a result of the process the patients had to handle the weight loss and further rediscover oneself. To be an individual outside the criterion meant an altered stigmatization and dedication of the surroundings. Positive and negative experiences were described among both male and female patients. Conclusion: To undergo bariatric surgery was a life changing experience, which involved both physical and psychological changes.
23

Towards an understanding of what changes, and how people cope, following bariatric surgery

Henderson, Kari January 2014 (has links)
Introduction: Bariatric surgery (BS) is currently the most effective treatment for morbid obesity. However, many individuals fail to lose or maintain adequate weight loss. It is a challenge to understand why some individuals can make the required changes following BS and some cannot. Evidence suggests that emotional eating (EE) may be associated with poorer outcome. However, there is as yet no conclusive research or review of the research in this area. Method: A systematic review was conducted with the aim to examine how EE relates to BS outcome. This review was complimented by a qualitative research project examining the experiences of individuals following weight loss surgery, with a particular focus on what changes and emotional coping. Results: Systematic review results suggest that EE is associated to poorer weight loss following BS. Six superordinate themes emerged from the qualitative research project; Surgery Outcome, Changing Views of the Self, Coping with Emotions, Being Judged Negatively, Being Obese is a Barrier to Living and It’s a Different Addiction. Discussion The overall results suggest that EE is an ongoing issue following bariatric surgery. BS seems to initiate various changes in behaviour, and cognition, together with increased sense of control. However, such changes seem to be attributed to BS, which is suggestive of an underestimation of self efficacy. Perceptions of obesity being the result of an addiction and emphasis on the difficulties associated with losing weight further highlight the issue of reduced self efficacy. This study also highlights that for many, having surgery does not cure all difficulties associated with eating. There are possibly underlying difficulties associated with obesity, such as neurocircuitry pathways that increase desire for food, whilst reducing control and attachment difficulties that reduce emotion regulation capacity. However, much work is required to understand such explanations and develop appropriate psychological interventions. Conclusion: The overall results from this thesis provide support for the view that EE and associated emotion regulation difficulties are related to poorer BS outcome. What seems clear from this research is that, although BS provides many positive changes, the battle against obesity continues for most and services are currently limited in their resources to intervene.
24

After the honeymoon period : an interpretative phenomenological analysis of the experiences of bariatric surgery patients 12 months to three years post operatively

Parkes, Claire January 2015 (has links)
The role of a psychologist within bariatric services is predominately focussed on the completion of preoperative psychological assessments (NICE, 2006; Ratcliffe et al, 2014). This role requires the psychologist to determine the suitability of the patient for surgery (Bauchowitz et al., 2005; Fabricatore et al., 2006; Sogg & Mori, 2004; UK Faculty of clinical health psychology; Psychologists in weight management network meeting, 2013), however no research to date has been able to reliably determine which variables could be associated with sub optimal weight loss (Sarwer, Wadden, & Fabricatore, 2005; Van Hout, Verschure, and van Heck, 2005; Wadden, Sarwer, Fabricatore, 2007). The first part of this study examines the empirical evidence for a range of variables considered by professionals to be clear contraindications to surgery. The variables were collated from surveys conducted in America (Bauchowitz et al., 2005; Fabricatore et al., 2006). Due to conflicting evidence and various problems with the studies it is difficult for a clinician to draw any firm conclusions from the review. Therefore, an ideographic approach is suggested, which leads onto the second part of the researcher dossier. The empirical chapter presents an interpretative phenomenological analysis (IPA) of interviews with 14 bariatric participants who were 12 months to three years post-operative to explore their experience of - 21 surgery. This time frame was chosen to capture the participants after the ‘honeymoon phase’ when the participants have hit their weight plateau (Yale & Weiler, 1991; Brolin, 1992). The themes from the study were ‘pre op’ ‘phases’ weight maintenance’ ‘impact of the operation’ and an overall psychological theme of ‘locus of control’. Support was a key area for the participants, they described the lack of support they felt from professionals and means of seeking support elsewhere. The themes also highlighted the psychological struggle the participants go through post operatively with eating, however, this is balanced with the positive changes in identity and their ability to engage with life, no longer impeded by their weight. Recommendations from the study suggest the importance of psychologists being available to bariatric patients, in accordance with NICE guidance, and that all bariatric patients start their journey to surgery in a level three service (which is a weight management service with consists of a multi-disciplinary team) before being referred to the tier four surgical team. Finally weight loss prior to surgery is recommended, with an alternative method of achieving this than that presented in the recent British Obesity and Metabolic Surgery Society (2014) publication.
25

Avaliação do Limiar de Dor a Pressão (LDP) e capacidade mastigatória de pacientes obesos com indicação para cirurgia bariátrica / Evaluation of Pressure Pain Threshold (LDP) and masticatory capacity of obese patients referred for bariatric surgery

Andrade, Francisco Juliherme Pires de 24 April 2013 (has links)
Este estudo transversal teve como objetivo avaliar o Limiar de Dor a Pressão (LDP) e a capacidade mastigatória de pacientes obesos com indicação para cirurgia bariátrica. Foi composto por 90 pacientes, sendo 60 com perda de elementos dentários que indiquem reabilitação oral (grupo experimental-GE) e 30 totalmente dentados (grupo controle-GC). A coleta de dados foi realizada em dois períodos para o grupo experimental, antes e após a confecção da prótese segundo sua indicação. Já no grupo controle a coleta foi realizada em tempo único. A coleta compreendeu os teste de Limiar de dor a pressão (LDP), escala de análise visual (EAV) para sensação dolorosa, teste de fadiga muscular, capacidade e eficiência mastigatórias e análise da qualidade de vida por meio do Oral Health Impact Profile (OHIP-14). Após verificada a normalidade das variáveis, o teste t de Student foi utilizado para avaliar as diferenças entre os grupos de dentados e desdentados e para avaliação do inicial para o final do grupo experimental. Para avaliar as diferenças entre os períodos dos testes de fadiga mastigatória foi realizada ANOVA para medidas repetidas seguida pelo teste de Tukey. O LDP conservou-se com características de normalidade antes e após a instalação da prótese dentária, apesar da redução do limiar para alguns grupos musculares. Ao se comparar ao grupo controle não houve distinções, com exceção do músculo masseter (p=0,012). Apesar de não haver queixa de dor a EAV obteve uma redução estatística (p=0,000) após a instalação da prótese para o GE, se tornando ainda mais reduzida. O teste de fadiga mastigatória se apresentou similar entre os grupos, entretanto, o LDP e a EAV no decorrer do teste indicaram modificações entre os tempos, porém os aspectos de normalidade foram mantidos. A capacidade e eficiência mastigatória do GE evoluiu após o tratamento protético (p=0,000), embora o grupo controle (dentados) continuasse superior (p=0,000). A análise do OHIP, para ambos os grupos, demonstrou que a condição bucal desses pacientes não interfere em sua qualidade de vida. Concluiu-se que a análise do limiar de dor a pressão demonstrou que a condição dentária, presença ou ausência de dentes, em pacientes obesos mórbidos obteve níveis considerados normais para pacientes assintomáticos para dor orofacial. A capacidade e eficiência mastigatória apresentaram uma melhora significativa após a reabilitação oral, entretanto, não atingiram níveis semelhantes ao do grupo controle. Os pacientes obesos mórbidos indicados à cirurgia bariátrica devem ser submetidos ao tratamento odontológico, especialmente à reabilitação oral, antes e após a cirurgia, colaborando com a nova condição sistêmica do paciente. / This cross-sectional study aimed to evaluate the Pain Threshold Pressure (PTP) and masticatory capacity of obese patients referred for bariatric surgery. It was composed of 90 patients, 60 with tooth loss indicating oral rehabilitation (EG-experimental group) and 30 fully dentate (control group-CG. Data collection was conducted in two periods for the experimental group before and after the making of the prosthesis according to his statement. In the control group, the collection was performed in one time. The collection comprised the test pressure pain threshold (PTP), visual analysis scale (VAS) for pain sensation, muscle fatigue test, ability and masticatory efficiency and analysis of quality of life using the Oral Health Impact Profile (OHIP -14). After verified the normality of the variables, the Student\'s t test was used to assess differences between the groups of toothed and toothless and for evaluating the initial to the end of the experimental group. To evaluate the differences between the periods of masticatory fatigue testing was performed ANOVA for repeated measures followed by the Tukey test. The PTP kept up with normal characteristics before and after installation of dental prosthesis, despite the lowering of the threshold for some muscle groups. Comparied to the control group there were no distinctions, except the masseter (p = 0.012). Although there was no complaint of pain VAS scores a statistical reduction (p = 0.000) after installation of the prosthesis for GE, becoming even smaller. The masticatory fatigue test appeared similar between groups, however, the PTP and the VAS during the test indicated changes between times, but aspects of normality were kept. The ability and masticatory efficiency of GE evolved after prosthetic treatment (p = 0.000), although the control group (toothed) remained higher (p = 0.000). The analysis of OHIP, for both groups, showed that oral condition of these patients does not interfere with their quality of life. It was concluded that the analysis of the pressure pain threshold showed that the dental status, presence or absence of teeth, in morbidly obese patients achieved normal levels for asymptomatic patients for orofacial pain. The ability and masticatory efficiency showed a significant improvement after oral rehabilitation, however, did not reach levels similar to the control group. The morbidly obese patients referred for bariatric surgery should undergo dental treatment, especially oral rehabilitation before and after surgery, collaborating with the new systemic condition of the patient.
26

Avaliação do Limiar de Dor a Pressão (LDP) e capacidade mastigatória de pacientes obesos com indicação para cirurgia bariátrica / Evaluation of Pressure Pain Threshold (LDP) and masticatory capacity of obese patients referred for bariatric surgery

Francisco Juliherme Pires de Andrade 24 April 2013 (has links)
Este estudo transversal teve como objetivo avaliar o Limiar de Dor a Pressão (LDP) e a capacidade mastigatória de pacientes obesos com indicação para cirurgia bariátrica. Foi composto por 90 pacientes, sendo 60 com perda de elementos dentários que indiquem reabilitação oral (grupo experimental-GE) e 30 totalmente dentados (grupo controle-GC). A coleta de dados foi realizada em dois períodos para o grupo experimental, antes e após a confecção da prótese segundo sua indicação. Já no grupo controle a coleta foi realizada em tempo único. A coleta compreendeu os teste de Limiar de dor a pressão (LDP), escala de análise visual (EAV) para sensação dolorosa, teste de fadiga muscular, capacidade e eficiência mastigatórias e análise da qualidade de vida por meio do Oral Health Impact Profile (OHIP-14). Após verificada a normalidade das variáveis, o teste t de Student foi utilizado para avaliar as diferenças entre os grupos de dentados e desdentados e para avaliação do inicial para o final do grupo experimental. Para avaliar as diferenças entre os períodos dos testes de fadiga mastigatória foi realizada ANOVA para medidas repetidas seguida pelo teste de Tukey. O LDP conservou-se com características de normalidade antes e após a instalação da prótese dentária, apesar da redução do limiar para alguns grupos musculares. Ao se comparar ao grupo controle não houve distinções, com exceção do músculo masseter (p=0,012). Apesar de não haver queixa de dor a EAV obteve uma redução estatística (p=0,000) após a instalação da prótese para o GE, se tornando ainda mais reduzida. O teste de fadiga mastigatória se apresentou similar entre os grupos, entretanto, o LDP e a EAV no decorrer do teste indicaram modificações entre os tempos, porém os aspectos de normalidade foram mantidos. A capacidade e eficiência mastigatória do GE evoluiu após o tratamento protético (p=0,000), embora o grupo controle (dentados) continuasse superior (p=0,000). A análise do OHIP, para ambos os grupos, demonstrou que a condição bucal desses pacientes não interfere em sua qualidade de vida. Concluiu-se que a análise do limiar de dor a pressão demonstrou que a condição dentária, presença ou ausência de dentes, em pacientes obesos mórbidos obteve níveis considerados normais para pacientes assintomáticos para dor orofacial. A capacidade e eficiência mastigatória apresentaram uma melhora significativa após a reabilitação oral, entretanto, não atingiram níveis semelhantes ao do grupo controle. Os pacientes obesos mórbidos indicados à cirurgia bariátrica devem ser submetidos ao tratamento odontológico, especialmente à reabilitação oral, antes e após a cirurgia, colaborando com a nova condição sistêmica do paciente. / This cross-sectional study aimed to evaluate the Pain Threshold Pressure (PTP) and masticatory capacity of obese patients referred for bariatric surgery. It was composed of 90 patients, 60 with tooth loss indicating oral rehabilitation (EG-experimental group) and 30 fully dentate (control group-CG. Data collection was conducted in two periods for the experimental group before and after the making of the prosthesis according to his statement. In the control group, the collection was performed in one time. The collection comprised the test pressure pain threshold (PTP), visual analysis scale (VAS) for pain sensation, muscle fatigue test, ability and masticatory efficiency and analysis of quality of life using the Oral Health Impact Profile (OHIP -14). After verified the normality of the variables, the Student\'s t test was used to assess differences between the groups of toothed and toothless and for evaluating the initial to the end of the experimental group. To evaluate the differences between the periods of masticatory fatigue testing was performed ANOVA for repeated measures followed by the Tukey test. The PTP kept up with normal characteristics before and after installation of dental prosthesis, despite the lowering of the threshold for some muscle groups. Comparied to the control group there were no distinctions, except the masseter (p = 0.012). Although there was no complaint of pain VAS scores a statistical reduction (p = 0.000) after installation of the prosthesis for GE, becoming even smaller. The masticatory fatigue test appeared similar between groups, however, the PTP and the VAS during the test indicated changes between times, but aspects of normality were kept. The ability and masticatory efficiency of GE evolved after prosthetic treatment (p = 0.000), although the control group (toothed) remained higher (p = 0.000). The analysis of OHIP, for both groups, showed that oral condition of these patients does not interfere with their quality of life. It was concluded that the analysis of the pressure pain threshold showed that the dental status, presence or absence of teeth, in morbidly obese patients achieved normal levels for asymptomatic patients for orofacial pain. The ability and masticatory efficiency showed a significant improvement after oral rehabilitation, however, did not reach levels similar to the control group. The morbidly obese patients referred for bariatric surgery should undergo dental treatment, especially oral rehabilitation before and after surgery, collaborating with the new systemic condition of the patient.
27

Correlação entre dados demográficos, nutricionais e bioquímicos e consumo de serviços hospitalares em pacientes submetidos à cirurgia da obesidade / Correlation between demografic, nutritional and biochemical measurements and consumption of hospital services by patients undergoing bariatric surgery

Hayashi, Silvia Yoko 27 June 2011 (has links)
Em decorrência do sucesso da cirurgia bariátrica para o tratamento da obesidade grau III e de suas comorbidades associadas, esta cirurgia vem se tornado cada vez mais indicada. A redução do consumo de cuidados com a saúde tem sido relatada após o tratamento cirúrgico, entretanto a utilização de serviços hospitalares não tem sido bem documentada. O conhecimento do consumo destes serviços na cirurgia bariátrica é importante para dimensionar serviços de saúde e custos resultantes desta cirurgia. Objetivos: Analisar o consumo dos serviços hospitalares e de exames bioquímicos em pacientes submetidos à cirurgia bariátrica. Métodos: O estudo foi retrospectivo. A amostra foi constituída por indivíduos do sexo feminino por ser a predominante na população bariátrica. O consumo de serviços hospitalares foi analisado pela quantidade de atendimentos ambulatoriais, hospitalizações, atendimento em pronto-socorro e exames bioquímicos realizados durante quatro anos pós-operatórios e comparados com o período pré-operatório. Os exames bioquímicos analisados foram hemograma completo, colesterol total e frações, triglicérides, albumina, glicemia, insulina, hemoglobina A1c, uréia e creatinina. Estas variáveis foram comparadas com grupos de obesos em tratamento clínico e pacientes cirúrgicos submetidos à cirurgia curativa de câncer colo-retal. Resultados: A quantidade de consultas ambulatoriais não se modificou ao longo do tempo em todos os grupos. O grupo de obesos em tratamento clínico teve maior demanda para esta variável, seguido pelo grupo bariátrico e cirúrgico respectivamente. Hospitalizações aumentaram no grupo bariátrico, entretanto não houve diferenças significativas quando comparadas com os outros grupos. Atendimentos em pronto-socorro não se alteraram durante o estudo e também não houve diferenças para esta variável entre os grupos. O grupo de obesos em tratamento clínico teve maior demanda de exames bioquímicos durante o período, não havendo alteração ao longo do estudo. Já nos grupos bariátrico e cirúrgico esta variável foi reduzida após a cirurgia. O colesterol total e HDL pré-operatório de todos os grupos se apresentaram com valores alterados e houve melhora somente no grupo bariátrico. Triglicérides não estavam elevados no grupo bariátrico e com a cirurgia houve também redução. Valores de glicemia, insulina, hemoglobina A1c e leucócitos (inflamação sistêmica) reduziram-se somente no grupo bariátrico. A creatinina diminuiu nos grupos bariátrico e de obesos em tratamento clínico. Albumina e uréia permaneceram inalteradas em todos os grupos. O Índice de Massa Corporal (IMC) inicial manifestou diferenças entre os grupos, sendo maior no grupo bariátrico, seguido pelos obesos em tratamento clínico e por último o grupo cirúrgico. Somente o grupo bariátrico teve seus valores reduzidos. Conclusão: A cirurgia bariátrica foi capaz de melhorar a maioria das variáveis laboratoriais, juntamente com a perda de peso. Entretanto, há um grande impacto no consumo de visitas ambulatoriais mantendo-se em níveis elevados até o quarto ano após a cirurgia, exceto para a demanda de exames bioquímicos que se reduziu. O consumo de serviços hospitalares destes pacientes é comparável ao de outros pacientes submetidos a cirurgia abdominal de grande porte. A administração hospitalar bem como autoridades de saúde pública devem ficar atentos para as peculiaridades desta demanda face às dimensões do atual problema com a obesidade. / Due to the success of bariatric surgery in the treatment of obesity class III and associated comorbidities, this surgery is becoming more common. Consumption of healthcare has been shown to diminish after surgical treatment but utilization of hospital services has not been well documented. The knowledge of consumption of this service in bariatric surgery is important to project the requirement for health services and the costs resulting from this surgery. Objectives: Analyze the consumption of hospital services and biochemical tests by patients submitted to bariatric surgery. Methods: Retrospective study. Sample was constituted by female individuals because they are predominant in bariatric population. Consumption of hospital services was analyzed by documentation of outpatient visits, hospitalizations, emergency department visits and biochemical tests during four years in the postoperative period, compared to the preoperative year. Variables included hematologic counts, total cholesterol and fractions, triglycerides, albumin, blood glucose, insulin, hemoglobin A1c, urea and creatinine. These variables were compared to conservatively managed obese cases and to surgical patients submitted to curative colorectal cancer operation. Results: Obese nonsurgical participants displayed the highest demand for outpatient visits, followed by bariatric and surgical cases respectively. Hospitalizations increased in bariatric group, however they did reach statistical difference concerning other groups. Emergency visits did not alter along the study and did not have differences between the groups. Obese cases receiving clinical treatment had the highest demand of biochemical tests, without modification along the study. Bariatric and surgical groups demonstrated decrease of this variable after surgery. Preoperatively cholesterol and HDL was abnormal in all groups, subsequent reduction occurring in bariatric group only. Triglycerides were not elevated but again diminished in bariatric group only. Blood glucose, insulin, Hemoglobin A1c and white blood cell count (systemic inflammation) decreased in bariatric subjects only. Creatinine was reduced in bariatric and obese nonsurgical patients. Albumin and urea remained stable in all groups. Initial Body Mass Index was different in all groups, being highest in bariatric group, followed by obese submitted to clinical treatment and colorectal surgical group respectively. Just bariatric subjects had reduction in their values. Conclusion: Bariatric intervention was able to ameliorate most variables, simultaneously to weight loss. However, it has a significant impact on outpatient visits, which maintained high values until four years after surgery. The opposite occurred with biochemical tests which decreased in the follow-up period. Consumption of hospital services by bariatric subjects was comparable to patients requiring major abdominal operations such as colorectal interventions. Hospital administration and public health authorities should consider the characteristics of such demand, since obesity is a significant problem in our days.
28

The development of a mouse model of post-bariatric hyperinsulinemic hypoglycemia

Smith, Catherine Mary 12 July 2017 (has links)
BACKGROUND: Post-bariatric hypoglycemia (PBH), a complication of gastric bypass surgery, is characterized by postprandial hyperinsulinemic hypoglycemia. To date, the etiology of PBH has not been fully elucidated. OBJECTIVE: To develop a murine model of PBH by experimentally modifying candidate molecules identified in humans with PBH. METHODS: Gastric bypass patients were assigned to groups based on whether or not they suffered from hypoglycemia (PBH, n = 11; asymptomatic, n = 7). Patients underwent a mixed meal tolerance test with blood draws at baseline, 30 minutes, and 120 minutes postprandially. SOMAscan (Somalogic) was used to evaluate serum for protein levels. In parallel, mass spectrometry (Metabolon) was used to examine metabolite levels. Mice were treated with the Farnesoid X Receptor (FXR) agonist, fexaramine (Fex), or vehicle for 5 days before undergoing a glucose tolerance test (GTT). Mice were sacrificed with tissues collected immediately thereafter. PCR was performed to quantify expression of FXR target genes. A separate cohort of mice was treated with adenine or vehicle for 2 days before undergoing a GTT or an insulin tolerance test. RESULTS: FGF19 was the most significantly upregulated protein in the PBH group at all time points. At 120 minutes postprandially, FGF19 was 2.1-fold higher in the PBH group (p < 1x10-5). Adenine was >2-fold higher at all time points (p < 1x10-8). Treatment with Fex did not result in significant differences during GTT or in expression of FXR target genes. Treatment with adenine did not significantly impact glucose tolerance or insulin sensitivity between groups. CONCLUSIONS: The results of the human serum analyses established a strong foundation on which to develop a murine model of PBH. Though the mouse experiments failed to induce postprandial hypoglycemia, they have directed future experiments toward developing a murine model of PBH. / 2018-07-11T00:00:00Z
29

Inferior vena cava filters and postoperative outcomes in patients undergoing bariatric surgery: a meta-analysis / Inferior vena cava filters and bariatric surgery outcomes

Kaw, Roop, Pasupuleti, Vinay, Overby, D.Wayne, Deshpande, Abhishek, Craig I. Coleman Pharm, John P.A. Ioannidis, Hernández, Adrian V. 09 June 2014 (has links)
Background: Pulmonary embolism (PE) accounts for almost 40% of perioperative deaths after bariatric surgery. Placement of prophylactic inferior vena cava (IVC) filter before bariatric surgery to improve outcomes has shown varied results. We performed a meta-analysis to evaluate postoperative outcomes associated with the preoperative placement of IVC filters in these patients. Methods: A systematic review was conducted by three investigators independently in PubMed, EMBASE, the Web of Science and Scopus until February 28, 2013. Our search was restricted to studies in adult patients undergoing bariatric surgery with and without IVC filters. Primary outcomes were postoperative deep vein thrombosis (DVT), pulmonary embolism (PE), and postoperative mortality. Meta-analysis used random effects models to account for heterogeneity, and Sidik-Jonkman method to account for scarcity of outcomes and studies. Associations are shown as Relative Risks (RR) and 95% Confidence Intervals (CI). Results: Seven observational studies were identified (n=102,767), with weighted average incidences of DVT (0.9%), PE (1.6%), and mortality (1.0%) for a follow-up ranging from 3 weeks to 3 months. Use of IVC filters was associated with an approximately 3-fold higher risk of DVT and death that was nominally significant for the former outcome, but not the latter (RR 2.81, 95%CI 1.33-5.97, p=0.007; and RR 3.27, 95% CI 0.78-13.64, p=0.1, respectively); there was no difference in the risk of PE (RR 1.02, 95%CI 0.31-3.77, p=0.9). Moderate to high heterogeneity of effects was noted across studies. Conclusions: Placement of IVC filter before bariatric surgery is associated with higher risk of postoperative DVT and mortality. A similar risk of PE in patients with and without IVC filter placement cannot exclude a benefit, given the potential large imbalance in risk at baseline. Randomized trials are needed before IVC placement can be recommended. / Revisión por pares
30

Caracterização psicológica de pacientes com reganho de peso pós-cirurgia bariátrica

Pereira, Janiele Francine 30 June 2017 (has links)
Submitted by Suzana Dias (suzana.dias@famerp.br) on 2018-11-08T16:45:48Z No. of bitstreams: 1 JanieleFrancine_dissert.pdf: 1508577 bytes, checksum: 82ecb074e63bbafbd5acb669e3055c75 (MD5) / Made available in DSpace on 2018-11-08T16:45:48Z (GMT). No. of bitstreams: 1 JanieleFrancine_dissert.pdf: 1508577 bytes, checksum: 82ecb074e63bbafbd5acb669e3055c75 (MD5) Previous issue date: 2017-06-30 / obesity is a multifactorial disease characterized by excessive body fat accumulation. Objectives: to describe sociodemographic profile of patients who underwent bariatric surgery more than 24 months ago, to investigate presence of symptoms and mental disorders and to assess the evolution of weight lost / gain after surgery. Method: the study was approved by FAMERP Ethics Committee. Patients who underwent bariatric surgery between July and December/2012 at Hospital de Base, São José do Rio Preto, SP, were invited to participate by filling a sociodemographic questionnaire, the Binge-Eating Scale (ECAP), the Hospital Anxiety and Depression Scale (HAD), the CAGE to assess the level of alcohol dependence screening test for problem drinking, the Sexual Addiction Screening Scale, and an analogic scale to assess patients´ satisfaction with surgery. Results: participants were 19 patients (mean age: 44.11 ± 8.90), predominantly females (n = 18), white, married, graduated from high school, working on the tertiary sector, with a family income of one and a half minimum wage, and from the Sao Jose do Rio Preto area. Eleven, of the 26 participants presented weight regain. Data from the questionnaires indicated binge eating 9,09% (n=1), anxiety symptoms 18,18% (n=2), depressive symptoms 18,18% (n=2), alcohol abuse 18,18% (n=2) and sex addiction 36,36% (n=4) on the post-operatory period for patients with weight regain. Conclusion: there was a predominance of females and high satisfaction with surgery. Important symptoms of mental disorders were identified and must receive attention since they may impair treatment adherence and patients’ quality of life. / A obesidade é considerada uma doença crônica de origem multifatorial, caracterizada pelo acúmulo excessivo de gordura corporal. Objetivos: descrever o perfil sociodemográfico de pacientes submetidos à cirurgia bariátrica há mais de 24 meses, investigar a presença de sintomas e de transtornos mentais, e avaliar a evolução da perda/ ganho de peso após a cirurgia. Método: após aprovação do projeto pelo Comitê de Ética em Pesquisa da FAMERP, pacientes submetidos à cirurgia bariátrica no período entre julho e dezembro de 2012, no Hospital de Base de São José do Rio Preto, SP, foram convidados a participar do estudo e responderam a um Questionário de dados sócio-demográficos, à Escala de Compulsão Alimentar Periódica (ECAP), Escala de Ansiedade e Depressão Hospitalar (HAD), Inventário CAGE para avaliação do nível de dependência de álcool, Escala de rastreamento de dependência de sexo e Escala Analógica para avaliar satisfação com a cirurgia. Resultados: participaram 19 pacientes, com idade entre 28 e 59 anos (média: 44,11; ± 8,90). Houve predomínio do sexo feminino (n = 18), cor branca e casadas, ensino médio completo, com profissão no setor terciário, renda familiar de um salário mínimo e meio e procedência da região de São José do Rio Preto. Dos pacientes analisados, 11 apresentaram reganho de peso. Os resultados dos instrumentos indicaram presença de sintomas de compulsão alimentar periódica 9,09% (n=1), sintomas de ansiedade 18,18% (n=2) e de depressão 18,18% (n=2), abuso de álcool 18,18% (n=2) e dependência de sexo 36,36% (n=4) no pós-operatório dos pacientes com reganho de peso. Conclusão: Houve predomínio do sexo feminino e alto grau de satisfação com a cirurgia. Foram identificados importantes sintomas de transtornos mentais, que devem receber atenção da equipe, pois podem prejudicar a adesão ao tratamento e a qualidade de vida do paciente.

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