Weight loss composition: the effects of exercise following obesity surgery as measured by bioelectrical impedance analysis.

BACKGROUND: Sudden weight loss following bariatric operations for morbid obesity, such as the duodenal switch (DS), can result in a concurrent decrease in lean body mass. Several methods for tracking body composition, such as bioelectrical impedance analysis (BIA), are available to monitor these changes. One method to offset the negative effects of sudden weight loss on body mass composition may be exercise. METHODS: 100 patients who had undergone the DS operation for morbid obesity were classified as exercisers and non-exercisers based on self-reporting. Their body mass compositions were measured using BIA preoperatively and at 0.75, 1.5, 3, 6, 9, 12, and 18 months postoperatively. RESULTS: At no study interval did postoperative percent changes in weight loss differ between the exercise and non-exercise groups. At 18 months postoperatively, the exercise group showed a 28% higher loss of fat mass and an 8% higher gain in lean body mass than the non-exercise group. CONCLUSION: Exercise positively influences body mass composition following the DS. BIA can be successfully employed to monitor changes, diagnose deficiencies, and formulate treatment recommendations.

Laparoscopic technique for performing duodenal switch with gastric reduction.

BACKGROUND: The duodenal switch procedure with gastric reduction (DS) is a hybrid procedure for morbid obesity that combines moderate intake restriction with moderate malabsorption. This report describes the laparoscopic hand-assisted technique for the duodenal switch procedure (LapDS). METHODS: Restriction is achieved via a greater curvature gastrectomy, reducing gastric capacity to 120 ml. The malabsorptive component is constructed by dividing the duodenum 4 cm distal to the pylorus and anastomosing the proximal duodenum to the distal 250 cm of ileum. The biliopancreatic limb is anastomosed to create a 100 cm common channel. Laparoscopic cholecystectomy, cholangiogram, liver biopsy and appendectomy are performed in conjunction with DS. RESULTS: 345 LapDS procedures (27 lap-assisted; 318 hand-assisted) were performed between September 1999 and February 2002. There were 299 women and 46 men with a mean age of 43 years (range 19-67 years). Mean BMI was 50 (range 36-118 kg/m(2)). Mean operating time was 201 minutes (range 105-480). The median length of hospital stay was 3.0 days (range 2-22 days, excluding one outlier). There were 7 conversions to open laparotomy, 14 reoperations, and 21 readmissions. There were 3 pulmonary emboli, 2 deep venous thromboses, and 4 perioperative proximal anastomotic strictures. There were no deaths. Mean percent excess weight loss at 6, 18, and 24 months was 51%, 89%, and 91%, respectively. CONCLUSION: Laparoscopic assisted duodenal switch procedure can be performed safely with acceptable operative times and without excess morbidity or mortality.

Nutritional markers following duodenal switch for morbid obesity.

BACKGROUND: Laparoscopic duodenal switch with gastric reduction (LapDS) is a minimally invasive hybrid operation combining moderate intake restriction with moderate malabsorption for treatment of morbid obesity. In LapDS, both the quantity of food ingested and the efficiency of digestion are reduced. METHODS: A cohort of 589 sequential LapDS patients had laboratory studies drawn annually. Serum markers for calcium, iron and protein metabolism and for hepatic function were analyzed using SAS statistical software. RESULTS: There were 95 men and 494 women. Mean age was 44 years, mean BMI 50 kg/m(2) and mean preoperative weight 142 kg. Although mean hemoglobin decreased below reference and mean parathyroid hormone (PTH) increased above reference, similar to abnormal values reported after Roux-en-y gastric bypass, both hemoglobin and calcium in LapDS readily returned to within the reference range following supplementation with iron and calcium respectively. Mean iron, corrected calcium, alkaline phosphatase, albumin, total protein, aspartate aminotransferase (AST), alanine transaminase (ALT), and bilirubin remained within the normal range. CONCLUSION: LapDS is not associated with broad nutritional deficiencies. Annual laboratory studies, which are required following any type of bariatric operation, appear to be sufficient to identify unfavorable trends. In selected patients, additional iron and calcium supplementation are effective when indicated.

Using gaming to help nursing students understand ethics.

The authors developed an ethics game that uses specially designed ethical situations for students to consider. Two students argue a course of action based on the scenario and defend that action using content discussed in class. Substantive issues include decision-making models, values as they pertain to the situation, professional responsibilities, ethical principles, social expectations, and legal requirements. Points are awarded based on how compelling each argument is. All students have an opportunity to participate. The benefits of using the game are that students gain confidence in their ability to defend an ethical decision, are able to see ethical situations from more than one perspective, and have an opportunity to clarify values. In addition, ethical principles and decision-making models are brought to life in a fun way. Difficulties involved in using the game include class size and limited time between the students learning course content and using it in the game.

The quest for meaning in aging.

A qualitative research design using narrative interviews was used to explore how a group of older adults experienced meaning and purpose in their lives. In-depth interviews conducted with 11 older adults ranging in age from 66 to 92 years revealed 6 dimensions through which meaning is experienced and created. Through the sharing of their narrative life stories, these individuals described how meaning in their lives contributed to a sense of self that allowed them to embrace life with a sense of purpose and enthusiasm.