Fertility, pregnancy and post partum management after bariatric surgery: a narrative review.

•Of the women who gave birth in Australia in 2018, 47% had overweight or obesity, with obesity being associated with both maternal and fetal complications. •Bariatric surgery improves fertility and some pregnancy-related outcomes. •Following bariatric surgery, pregnancy should be delayed by at least 12-18 months due to adverse pregnancy outcomes associated with rapid weight loss. •Contraception should be prescribed after bariatric surgery, although the effectiveness of the oral contraceptive pill may be reduced due to malabsorption and contraceptive devices such as intrauterine devices should be considered as first line therapy. •After bariatric surgery, women should undergo close monitoring for nutritional insufficiencies before, during and after pregnancy. Expert opinion recommends these women undergo dietary assessment and supplementation to prevent micronutrient deficiencies. •Bariatric surgeons, bariatric medical practitioners, bariatric dieticians, the patient's usual general practitioner, obstetricians, and maternity specialists should be involved to assist in the multidisciplinary management of these complex patients.

Systematic review and meta-analysis of the association between diverticulosis of the appendix and neoplasia.

BACKGROUND: Diverticula of the appendix (DA) are infrequent and their clinical implications are often overlooked. Several studies have found a significantly increased prevalence of neoplasms in appendiceal specimens with diverticula. Despite the potential clinical implications, there is a paucity of literature. A systematic review and meta-analysis was performed to evaluate the prevalence of DA and its association with neoplasia. METHODS: A systematic search of literature (Cochrane, EMBASE, PubMed and Medline) reporting the prevalence of DA and association with neoplasia was performed in November 2019. Relevant articles were assessed in accordance with the PRISMA guidelines. Risk of bias assessment was carried out using modified Newcastle-Ottawa scale. Meta-analysis with risk ratio and random-effects model was performed using RevMan. RESULTS: The initial search identified 1122 potential articles of which 11 were appropriate for quantitative analysis. The prevalence rate of DA was 1.74%. The mean age of patients with DA and those without DA was 41.2 and 33.9 years, respectively. The ratio of male to female was 1.8:1. The prevalence of neoplasia in specimens without DA versus those with DA was 1.28% and 26.94%, respectively. Only four studies addressed the prevalence of locoregional neoplasia in the setting of DA compared to control. Meta-analysis with random-effects model demonstrated that pooled risk ratio was 25.46 (95% confidence interval 12.77-50.75, P < 0.00001). CONCLUSION: The strong association with neoplasia in this meta-analysis reinforces the clinical significance of DA. Surgeons, pathologists and radiologists should be mindful of this uncommon pathology and consider individualized patient management, until further evidence can direct clinical guidelines for the management of patients with DA.

Older people's experiences of acute hospitalisation: an investigation of how occupations are affected.

BACKGROUND/AIM: Few qualitative studies have investigated older people's experiences of hospital admission and none has done so from an occupational perspective. The purpose of this study was to examine older people's experience of acute hospitalisation. METHODS: In-depth semi-structured interviews were conducted with six participants recruited from the Alfred hospital, Melbourne, Victoria. Data were analysed using Colaizzi's (1978) approach to phenomenological analysis. RESULTS: Five themes describing older people's experience of acute hospitalisation emerged from the analysis: (i) not part of 'normal life'; (ii) undesirable, but for the good of my health; (iii) understanding my condition and abilities; (iv) subject to approval; and (v) getting back into life. The importance of the individual's occupational narrative emerged as a central theme in understanding the older person's experience of acute hospitalisation. CONCLUSIONS: Occupational therapists have a unique contribution to make in encouraging meaningful occupation on hospital wards. Identifying the manner by which occupational therapists can most effectively implement the assessment of occupational performance in the acute care setting should constitute a research priority for future investigations.