Effectiveness and Safety of a Very Low-Calorie Ketogenic Diet on Weight Regain Following Bariatric Surgery.

PURPOSE: Obesity is one of the major public health problems worldwide and bariatric surgery is considered the gold standard treatment for severe obesity. Although the literature supports the safety and efficacy of the very low-calorie ketogenic diet (VLCKD) in patients with obesity, there is no study analyzing the use in case of failure or weight regain after bariatric surgery. This work has the purpose of assessing the response to a VLCKD (Pnk® method) in this population. METHODS: We have conducted an observational, retrospective, and descriptive study with the analysis of medical charts of private offices where patients were examined between 2014 and 2019, totalizing 11 participants who underwent Roux-en-Y gastric bypass (RYGB) without a reduction of 50% in body weight excess or any weight regain after the surgery. The patients followed the first stage of a commercial weight loss program (Pnk® method) which consists of a VLCKD (600-800 kcal/day), low in carbohydrates and lipids. RESULTS: A significant reduction was observed (p-value < 0.05) in weight, body mass index (BMI), abdominal circumference (AC), and glycated hemoglobin (A1C) post-ketogenic diet. Uric acid, transaminases, urea, and creatinine values did not show differences between pre- and post-ketosis. During the course of the study, no serious adverse events were reported. CONCLUSION: This study has shown that the ketogenic diet can be recommended as an effective and safe treatment for patients who progressed with insufficient weight loss or regain after bariatric surgery.

Delirium em terapia intensiva: utilização do Confusion Assessment Method for the Intensive Care Unit pelo enfermeiro / El delirio en cuidados intensivos: confusión con el Método de Evaluación de la Unidad de Cuidados Intensivos por las enfermeras / Delirium in intensive care: use of the ‘Confusion Assessment Method for theIntensive Care Unit’ by the nurse

Objective: the study’s goal has been to gain further understanding regarding the nurses’ grasp about the critical patient undergoing delirium events, and also the use of the Confusion Assessment Method for the Intensive Care Unit. Methods: It is a descriptive-exploratory study, also prospective and with both qualitative and quantitative approach. The sampling was the nurses of an Intensive Care Unit; the sample consisted of 16 nurses who accepted to participate in all stages of the research. A pretest and another post-test were performed applying the data collection instrument consisting of 1 discursive question and 8 objective ones. In order to perform the data analysis were used content analysis and basic statistics. The research was approved by the Research Ethics Committee from the Hospital Universitário Pedro Ernesto, under the Legal Opinion No. 1.360.441. Results: In a comparison between the pretest and post-test, it was noticed that after the test the group was more prepared to identify delirium and with a higher degree of knowledge about the topic. Conclusion: The content update was shown as a tool for transforming clinical practice. It is very important to emphasize the need of continuing education in order to ensure the promotion of knowledge and quality in nursing care.

Objetivo: compreender o conhecimento dos enfermeiros sobre o delirium no paciente crítico e a utilização do Confusion Assessment Method for the Intensive Care Unit. Métodos: Estudo exploratório-descritivo, prospectivo, com abordagem mista. Teve-se como população os enfermeiros de uma unidade de terapia intensiva, a amostra constituiu-se de 16 enfermeiros que aceitaram participar de todas as etapas da pesquisa. Realizou-se um pré e pós teste aplicando-se o instrumento de coleta de dados constituído de 1 pergunta discursiva e 8 objetivas, para análise usou-se análise e conteúdo e estatística básica. A pesquisa foi aprovada pelo comitê de ética em pesquisa do Hospital Universitário Pedro Ernesto, sob o parecer de nº 1.360.441. Resultados: Num comparativo entre o pré e pós-teste, o grupo se mostrou mais preparado para identificar o delirium e com maior grau de conhecimento acerca da temática. Conclusão: atualização mostrou-se como uma ferramenta de transformação da prática clínica. Destacando-se a importância da educação permanente para garantir a qualidade na assistência de enfermagem.

Objetivo: comprender el conocimiento del delirio de las enfermeras en los pacientes críticamente enfermos y el uso de la Confusión Método de Evaluación de la Unidad de Cuidados Intensivos. Métodos: Estudio prospectivo exploratorio y descriptivo, con enfoque cualitativo y cuantitativo. Tuvo como enfermeras población una unidad de cuidados intensivos, la muestra está formada por 16 enfermeras que aceptaron participar en todas las etapas de la investigación. Se realizó una pre-y post-test mediante la aplicación del instrumento de recolección de datos que consta de una cuestión discursiva y 8 objetiva para el análisis utilizado para el análisis y el contenido y las estadísticas básicas. El estudio fue aprobado por el Comité de Ética en Investigación del Hospital Universitario Pedro Ernesto, en opinión de nº 1.360.441. Resultados: En una comparación entre el pre y post-test, el grupo estaba más preparado para identificar el delirio y con un mayor grado de conocimiento sobre el tema. Conclusión: La actualización se muestra como una herramienta de transformación en la práctica clínica.la importancia de continuar el resaltado de la educación para garantizar la promoción del conocimiento y la calidad de los cuidados de enfermería.