Obesity-related knee osteoarthritis: a role for the rheumatology advanced nurse practitioner in Ireland.

Arthritis is the leading cause of disability in Ireland with knee osteoarthritis the most common presentation. One in five women and one in 10 men over the age of 60 in Ireland are diagnosed with osteoarthritis. The causative factors are multifactorial, but the increasing incidence of obesity is contributing greatly to the occurrence of osteoarthritis of the weight-bearing joints. The rheumatology advanced nurse practitioner is an autonomous clinical practitioner and potential solution to the growing numbers of people needing interventions for osteoarthritis, due to their ability to assess, diagnose, treat, and discharge these patients who ordinarily would be assessed from a medical waiting list. As obesity is becoming increasingly prevalent, it is important to address this with the patient cohort to try to reduce the burden of disease and treat not only the symptomatic knee osteoarthritis but the causative factors and provide patient-centred care.

Carteira de serviços da atenção primária à saúde: com recorte no cuidado do sobrepeso e obesidade dos municípios de Mato Grosso do Sul / Portfolio of primary health care services: with cut in the care of overweight and obesity in the municipalities of Mato Grosso do Sul

A carteira de serviços para o cuidado do sobrepeso e obesidade é de extrema importância devido à crescente prevalência dessas condições em todo o mundo e aos seus impactos significativos na saúde pública e na qualidade de vida dos indivíduos afetados. Essa ferramenta estratégica na Atenção Primária à Saúde (APS) desempenha um papel crucial em enfrentar esse desafio global de saúde, oferecendo serviços especializados e abordagens multidisciplinares para prevenir, diagnosticar e tratar o sobrepeso e a obesidade.

Care home staff's experiences and views of supporting the dietary management and choices of older residents with obesity.

BACKGROUND: Rising numbers of older people with obesity living in care homes is an international phenomenon. Addressing dietary management of residents with obesity is a cause of debate and controversy. On one hand, the 'obesity paradox' suggests obesity protects against morbidity in frail older people. On the other hand, obesity reduces functional status and restricts activity for this group. This paper considers care home staff's experience and views of supporting dietary management and choice for residents with obesity within the context of this controversy. DESIGN: In this qualitative study, 33 staff from seven care homes in the North East England participated in focus groups, and data were analysed using Braun and Clarkes's (2006) six-phase thematic analysis approach. FINDINGS: Findings indicate that participants' support of dietary management and choice for residents with obesity may be strongly influenced by the care home environment. Care priorities, dietary management approaches, care home life and family involvement in residents' dietary intake facilitate and encourage weight gain, and as such, pose challenges for staff attempting to support weight management of residents with obesity. CONCLUSION: Findings suggest that in the care home setting, nutrition policy, guidelines and service commissioning processes and staff nutrition education should include management of obesity. Furthermore, families should be supported to understand the implications of their own caring behaviours on residents' nutritional status.

Providing Weight Loss Support to Patients Who Are Obese in Preparation for Colorectal Cancer Surgery to Reduce Surgical Site Infection Risk: A Mixed-methods Study.

Obesity increases the risk of surgical site infections (SSIs) after colorectal cancer surgery, but strategies to support weight loss in obese patients who have colorectal cancer have not been established. PURPOSE: This mixed-methods study, using retrospective and prospective data, aimed to explore inhibitors and facilitators of preoperative weight loss in obese patients with colorectal cancer and the potential impact of preoperative weight loss support on SSIs. METHODS: Patients with a body mass index (BMI) of ≥ 25 kg/m2 were eligible to participate in the weight loss support program. Patient demographic, history, surgical, and outcomes variables were abstracted from the records. Five (5) nurses who provided weight loss support participated in a focus group interview method to explore weight loss inhibitory and promotional factors. Descriptive statistics and qualitative analysis methods were used to examine the data. RESULTS: Twenty-six (26) patients participated in the program for a mean of 45.5 days (SD ± 25.3). Body weight decreased from 79.8 kg (SD ± 15.6) to 75.7 kg (SD ± 14.3), and BMI decreased from 30.4 kg/m² (SD ± 4.7) to 29.4 kg/m² (SD ± 5.0) (P < .05). The average weight loss percentage was 4.9% (SD ± 3.4). In 14 patients, the weight loss percentage was 5% or more. SSIs occurred in 5 of 26 patients (19.2%). Additionally, 4 of 26 patients (15.4%) who had 8.8% or more weight loss did not manifest SSIs. Previous weight loss before the preoperative surgery visits, lack of motivation for weight loss, and time and duration required for weight loss were identified as inhibitory factors, whereas history of successful weight loss experience, knowledge acquisition, family support, and reduced knee and lower back pain were identified as promotional factors for weight loss. CONCLUSION: Patients in this program lost weight prior to colorectal surgery. Research to further explore the safety and effects of preoperative weight loss in obese patients with colorectal cancer as well as inhibitory and promotional factors for participation and success is needed.

Sobrepeso, obesidad y actividad física en estudiantes de enfermería pregrado de una universidad privada 2017 / Overweight, obesity and physical activity in undergraduate nursing students from a private university

INTRODUCCIÓN: La obesidad es un factor de riesgo directo para la aparición y desarrollo de patologías crónicas no transmisibles, como la diabetes, hipertensión, enfermedad renal y cardiovascular. El sobrepeso y obesidad están relacionados entre otros factores a la inactividad física en los diferentes grupos etáreos, lo cual genera un problema de salud pública que requiere atención oportuna y estrategias de prevención y control en la población. OBJETIVOS: Determinar el sobrepeso, obesidad y su relación con la actividad física, en los estudiantes de enfermería pre grado de la Universidad Peruana Cayetano Heredia, 2017. MATERIAL Y MÉTODO: Estudio descriptivo transversal y analítico, con una muestra aleatoria extraída de 198 alumnos, a quienes se les aplicó el instrumento validado Cuestionario Internacional de Actividad Física, previamente se tomaron medidas de peso, talla y calculó el Índice de Masa Corporal (IMC). Los estadísticos utilizados para medir la asociación fueron Tau-C de Kendall y coeficiente D de Somers. RESULTADOS: Del total de la muestra, el 14,1 % tienen obesidad, 31,7% sobrepeso, y el 52,8% están en condición normal. Respecto a la actividad física los estudiantes realizan actividad física baja y moderada con el 40,8% y 53,5% respectivamente, el 5,6% de los participantes realiza actividad física alta, destacando el sexo femenino en mayor proporción. CONCLUSIÓN: Existe una relación inversa entre la actividad física y las categorías de IMC, a mayor IMC se evidencia baja actividad física en la población de estudio

INTRODUCTION: Obesity is a direct risk factor for the appearance and development of chronic non-communicable diseases, such as diabetes, hypertension, renal and cardiovascular disease. Overweight and obesity are related among other factors to physical inactivity in the different age groups, which generates a public health problem that requires timely attention, and population prevention and control strategies. OBJECTIVES: To determine overweight, obesity and the relationship with physical activity in undergraduate nursing students at the Universidad Peruana Cayetano Heredia during 2017. MATERIAL AND METHOD: Descriptive, cross-sectional and analytical study, with a random sample of 198 students, to whom the validated International Physical Activity Questionnaire was applied, previously taking measurements of weight, height and calculating the Body Mass Index (BMI). The statistics used to measure the association were Kendall's Tau-C and Somers' D coefficient. RESULTS: Of the total sample, 14.1% are obese, 31.7% overweight, and 52.8% are in normal condition. Regarding physical activity, students carry out low and moderate physical activity with 40.8% and 53.5%, respectively. 5.6% of the participants perform high physical activity, having females a higher proportion. CONCLUSION: There is an inverse relationship between physical activity and BMI categories. The higher the BMI value, the lower the level of physical activity in the study population

Atitudes de enfermeiros de equipe da Saúde da Família em relação à obesidade / Attitudes of nurses from the Family Health Team (eSF) towards obesity

Introdução: A obesidade é uma doença multifatorial, crônica e um grande problema de saúde pública. Há muitos estigmas e estereótipos empregados à essa patologia e os pacientes obesos são, muitas vezes, considerados preguiçosos, incompetentes e responsáveis pelo seu ganho de peso. Os profissionais de saúde são relatados pelos pacientes como uma das principais fontes de aplicação desse estigma. Objetivo: Avaliar as atitudes dos enfermeiros em relação aos indivíduos obesos. Método: Foram convidados todos os enfermeiros das 66 equipes de Saúde da Família de Blumenau ­ SC para a participação na pesquisa. A coleta de dados incluiu a aplicação da Escala de Atitudes Antiobesidade com 34 questões, além de um questionário de entrevista estruturada elaborado pelos autores e auto preenchido com dados sociodemográficos e de saúde, com 14 questões, dentre elas peso e altura relatados pelos participantes para cálculo do Índice de Massa Corporal. Resultados: Participaram 42 enfermeiros, com predomínio do sexo feminino, estado nutricional prevalente de sobrepeso e a maioria relatou histórico de sobrepeso ou obesidade. Na Escala de Atitudes Antiobesidade, a maior média foi da subescala 'controle de peso e culpa', havendo associação estatisticamente significativa à afirmação 'a maioria dos gordos compram muita besteira ('junkfood')' com o fato de os participantes se considerarem com excesso de peso atualmente (p<0,05). Conclusão: Os resultados sugerem que os profissionais apresentam algumas atitudes antiobesidade frente a obesidade. (AU)

Introduction: Obesity is a multifactorial, chronic disease and a major public health problem. There are many stigmas and stereotypes used in this pathology and obese patients are often considered lazy, incompetent and responsible for their weight gain. Health professionals are reported by patients as one of the main sources of application of this stigma. Objective: To evaluate nurses' attitudes towards obese individuals. Method: All nurses from the 66 Family Health teams in Blumenau - SC were invited to participate in the research. Data collection included the application of the Antifat Attitude Test with 34 questions, in addition to a structured interview questionnaire prepared by the authors and self-completed with sociodemographic and health data, with 14 questions, including weight and height reported by the participants for calculation of the Body Mass Index. Results: 42 nurses participated, with a predominance of females, prevalent nutritional status of overweight and most reported a history of overweight or obesity. In the Antifat Attitude Test, the highest average was from the subscale 'Weight Control/Blame' associated with the statement 'most fat people buy too much junk food' with the fact that the participants consider themselves to be overweight (p <0.05). Conclusion: The results suggest that professionals have some anti-obesity attitudes towards obesity. (AU)

Impact of a nurse-led limited risk factor modification program on arrhythmia outcomes in patients with atrial fibrillation undergoing catheter ablation.

BACKGROUND: We have previously demonstrated the feasibility of a nurse-led risk factor modification (RFM) program for improving weight loss and obstructive sleep apnea (OSA) care among patients with atrial fibrillation (AF). OBJECTIVE: We now report its impact on arrhythmia outcomes in a subgroup of patients undergoing catheter ablation. METHODS: Participating patients with obesity and/or need for OSA management (high risk per Berlin Questionnaire or untreated OSA) underwent in-person consultation and monthly telephone calls with the nurse for up to 1 year. Arrhythmias were assessed by office ECGs and ≥2 wearable monitors. Outcomes, defined as Arrhythmia control (0-6 self-terminating recurrences, with ≤1 cardioversion for nonparoxysmal AF) and Freedom from arrhythmias (no recurrences on or off antiarrhythmic drugs), were compared at 1 year between patients undergoing catheter ablation who enrolled and declined RFM. RESULTS: Between 1 November 2016 and 1 April 2018, 195 patients enrolled and 196 declined RFM (body mass index, 35.1 ± 6.7 vs 34.3 ± 6.3 kg/m2 ; 50% vs 50% paroxysmal AF; P = NS). At 1 year, enrolled patients demonstrated significant weight loss (4.7% ± 5.3% vs 0.3% ± 4.4% in declined patients; P < .0001) and improved OSA care (78% [n = 43] of patients diagnosed with OSA began treatment). However, outcomes were similar between enrolled and declined patients undergoing ablation (arrhythmia control in 80% [n = 48] vs 79% [n = 38]; freedom from arrhythmia in 58% [n = 35] vs 71% [n = 34]; P = NS). CONCLUSION: Despite improving weight loss and OSA care, our nurse-led RFM program did not impact 1-year arrhythmia outcomes in patients with AF undergoing catheter ablation.

Knowledge and Attitudes Towards Obesity and Bariatric Surgery in Chinese Nurses.

BACKGROUND: Obesity has become a global epidemic. Surgical treatment of obesity and metabolic disorders in China is increasing rapidly, but it is still a new discipline even to health professionals. As an important member of the multidisciplinary team, the knowledge and attitudes of nurses provide crucial health care to the patients and support to surgeons. OBJECTIVES: To study the Chinese nurses' knowledge of obesity and metabolic disorders, and attitudes towards bariatric surgery and to improve their capability of work in this new discipline. METHODS: This is a multicenter study, with the questionnaire distributed to cooperative hospitals in the form of an electronic questionnaire by the First Affiliated Hospital of Jinan University in April 2018. A questionnaire was designed to investigate nurses' demographic, knowledge, and attitude towards obesity, weight loss, and bariatric surgery. RESULTS: A total of 5311 questionnaires were received, with an effective rate of 91.8% (4878 questionnaires); 65.2% of nurses had a normal BMI. Nurses generally had a high knowledge of obesity and related cardiovascular diseases (98.6%) and type 2 diabetes mellitus (90.2%). However, there was a lack of knowledge in other related aspects, for example its relations to carcinoma (49.5%), gastroesophageal reflux disease (40.1%), and psychological disorders (49.1%), which are controversial issues in bariatric surgery. It was found that education (p < 0.05) had an important influence to nurses' knowledge about the comorbidities of obesity. Female nurses had a higher tendency to choose weight loss than males, but male nurses did physical exercise more frequently than females (p < 0.05). Their acceptance of safety (25.1%) and efficacy (22.9%) of bariatric surgery is low, with concerns predominantly about postoperative complications and adverse effects. Surgical nurses had a more optimistic attitude towards surgery (p < 0.05). CONCLUSIONS: Chinese nurses have poor knowledge of obesity-related metabolic disorders and also have poor acceptance of surgical treatment modalities. Our findings suggest that it is crucial to enhance the continuing education of Chinese nurses for obesity, metabolic disorders, and bariatric surgery.

What predicts regression from pre-diabetes to normal glucose regulation following a primary care nurse-delivered dietary intervention? A study protocol for a prospective cohort study.

INTRODUCTION: Pre-diabetes is a high-risk state for the development of type 2 diabetes mellitus (T2DM) and cardiovascular disease. Regression to normoglycaemia, even if transient, significantly reduces the risk of developing T2DM. The primary aim of this mixed-methods study is to determine if there are clinically relevant differences among those with pre-diabetes and excess weight who regress to normoglycaemia, those who have persistent pre-diabetes and those who progress to T2DM following participation in a 6-month primary care nurse-delivered pre-diabetes dietary intervention. Incidence of T2DM at 2 years will be examined. METHODS AND ANALYSIS: Four hundred participants with pre-diabetes (New Zealand definition glycated haemoglobin 41-49 mmol/mol) and a body mass index >25 kg/m2 will be recruited through eight primary care practices in Hawke's Bay, New Zealand. Trained primary care nurses will deliver a 6-month structured dietary intervention, followed by quarterly reviews for 18 months post-intervention. Clinical data, data on lifestyle factors and health-related quality of life (HR-QoL) and blood samples will be collected at baseline, 6 months, 12 months and 24 months. Sixty participants purposefully selected will complete a semi-structured interview following the 6-month intervention. Poisson regression with robust standard errors and clustered by practice will be used to identify predictors of regression or progression at 6 months, and risk factors for developing T2DM at 2 years. Qualitative data will be analysed thematically. Changes in HR-QoL will be described and potential cost savings will be estimated from a funder's perspective at 2 years. ETHICS AND DISSEMINATION: This study was approved by the Northern A Health and Disability Ethics Committee, New Zealand (Ethics Reference: 17/NTA/24). Study results will be presented to participants, published in peer-reviewed journals and presented at relevant conferences. TRIAL REGISTRATION NUMBER: ACTRN12617000591358; Pre-results.

Intensive care nurses' implicit and explicit attitudes and their behavioural intentions towards obese intensive care patients.

AIMS: To examine qualified intensive care nurses' implicit and explicit attitudes towards obese intensive care patients and whether their attitudes are associated with their behavioural intentions towards these patients. BACKGROUND: Obese intensive care patients may experience more stress than do normal-weight patients. Intensive care nurses' attitudes and the way they address their care are thus vital. Despite a range of studies revealing that health professionals hold anti-fat attitudes towards obese patients, there is a lack of knowledge about intensive care nurses' implicit and explicit attitudes and if such attitudes are associated with behavioural intention. DESIGN: A cross-sectional survey. METHODS: From November 2017 - January 2018, a web-based survey was conducted with 159 qualified intensive care nurses (84.3% women, mean age 45.52 years) recruited through 16 intensive care units and Facebook. The survey consisted of implicit attitude tests, explicit bias scales, the Anti-fat Attitude questionnaire, vignettes measuring behavioural intention, and demographic questions. RESULTS: Intensive care nurses reported implicit preferences for thin over thick people and found obese individuals slightly 'worse' and 'lazy', comprising less willpower than thin individuals. Attitudes were not associated with behavioural intention. CONCLUSION: This study provides new knowledge about qualified intensive care nurses' anti-fat attitudes and behavioural intention towards obese intensive care patients. These findings should be acknowledged by policymakers, clinical healthcare providers and educators to secure optimal care for these patients. IMPACT STATEMENT: These results should be used in nursing attitude change programmes, in intensive care units, and among nursing educators, focusing on increasing nurses' knowledge of the complexities of obesity. Further research on obese intensive care patients' healthcare experiences and the impact that healthcare providers' anti-fat attitudes and behaviours has on patients' perceived care quality is needed.

Planning, implementation and evaluation of antenatal weight management programmes: What are the key components? A mixed methods study.

OBJECTIVE: To provide an understanding of the influential components required for the planning, delivery and evaluation of antenatal weight management programmes for women who are overweight or obese. DESIGN: Two phase sequential explanatory mixed methods design comprising of an online survey and one-to-one telephone interviews. SETTING AND PARTICIPANTS: All UK maternity services (n = 168) and local government councils (n = 417). FINDINGS: From the 378 responses, 49 maternity services and 28 local government councils reported having an antenatal weight management programme. Of the 62 responses that specified BMI as an inclusion criterion only two-fifths (40.3% n = 25) adhered to the recommended threshold to include women with a BMI ≥30 kg/m2. Although having a multi-disciplinary team was identified as fundamental when planning a programme, only 20.6% (n = 14/68) of the programmes involved service users during the planning phase. How the programme was communicated to a woman was a key factor which determined whether she partook in the programme or not. Having administrative support and staff with expertise in data collection were essential when evaluating a programme. Staff having protected time was identified as important when planning, delivering and evaluating a programme. Three overarching themes were identified from the individual interviews (n = 14) 'choices and decisions', 'demands and resources' and 'engagement and disengagement'. KEY CONCLUSIONS: National guidelines recommendations regarding service user involvement when planning programmes and the BMI threshold used for inclusion are not being met. In addition to having adequate time, personnel and finances, successful programmes are dependent on the confidence and communication skills of midwives to raise the issue of obesity with these women at the booking appointment. Without staff having the time and necessary knowledge and skills, evaluation, and hence demonstrating programme impact, will likely remain difficult. Organisational support is needed to release resources to plan, deliver and evaluate these programmes. Strategic communication strategies are needed to promote the programme to both women and staff within organisations. Future programmes need to ensure there is engagement with service users from the planning of the programme through to evaluation.

Health Effects of an Individualized Lifestyle Intervention for People with Psychotic Disorders in Psychiatric Outpatient Services: A Two Year Follow-up.

People with psychotic disorders experience to a great extent avoidable physical illnesses and early mortality. The aim of the study was to investigate the potential effects for this group of participating in a lifestyle intervention. A multi-component nurse-led lifestyle intervention using quasi-experimental design was performed. Changes in biomedical and clinical measurements, self-reported health, symptoms of illness and health behavior were investigated. Multilevel modeling was used to statistically test differences in changes over time. Statistically significant changes were found in physical activity, HbA1c and waist circumference. A lifestyle intervention for people with severe mental illness can be beneficial for increasing physical activity.

Addressing Food Insecurity and Overweight/Obesity in Hospitalized Low-Income Latino Patients.

Food insecurity (FI), the limited or unreliable availability of safe and nutritious food, is a pressing public health concern affecting millions of U.S. citizens. Unfortunately, FI tends to impact those who are most vulnerable (e.g., low-income minorities) and potentially increases obesity risks, diet-sensitive disease risks (e.g., hypertension and type 2 diabetes), and hospital utilization. Low-income Latino patients may be particularly sensitive to adverse outcomes based on unaddressed socioeconomic needs. Nurses are in a prime position to assess and address FI in these patients. Our article will discuss how nurses can be advocates in combating FI in Latino patients with overweight/obesity.

CE: Obesity-Related Cancer in Women: A Clinical Review.

: There is mounting evidence that obesity is linked to numerous types of cancer that affect both sexes. But the incidence of obesity-related cancers is particularly high among women. Obesity is implicated not only in the development of cancer, but also in cancer recurrence, treatment complications, and poor patient outcomes. Nurses, particularly those caring for women, should be aware of these associations so they may provide effective patient teaching about preventing cancer and mitigating its adverse effects. The author discusses the role of obesity in the development and recurrence of cancer in women; describes weight loss interventions that may reduce cancer risk in overweight or obese patients; and suggests interviewing techniques to help nurses sensitively address the topic of overweight and obesity with their female patients.

To initiate the conversation - Public health nurses' experiences of working with obesity in persons with mobility disability.

AIM: Developing a theory explaining how public health nurses accomplish and adapt counselling in lifestyle habits to decrease obesity in people with mobility disability. DESIGN: Empirical research - qualitative. METHOD: Classic grounded theory with face-to-face interviews, 2017-2018, using inductive approach to understand public health nurses' intervening experiences with obesity patients. RESULTS: To initiate the conversation emerged as the main concern meaning having difficulties initiating conversations about obesity with patients. Public health nurses' facilitators to communicate lifestyle changes emerged as the pattern generating the theory, which consists of the categories; person-centeredness in the situation, experience and knowledge, strengthening conditions, access to other professionals and prioritization in everyday work. CONCLUSIONS: Public health nurses hesitate to raise topics of obesity in patients with mobility disability. They advocate increased integration with lifestyle changes in everyday work including multi-professional cooperation. The implication is testing the emerged theory at primary health care centres. IMPACT: Obesity is more common in people with mobility disability than in those without. There is a need to understand how public health nurses adapt counselling in lifestyle habits. Public health nurses hesitate to talk about obesity with patients in fear of offending anyone. Public health nurses did not distinguish between patients with or without mobility disability. Several facilitators could be helpful initiating conversation with the patients. Public health nurses need more time and resources to facilitate conversation with patients with mobility disability to counsel lifestyle changes.

Effect of remote nursing monitoring on overweight in women: clinical trial.

OBJECTIVE: to evaluate the effect of remote nursing monitoring on the improvement of anthropometric measurements of overweight women. METHOD: controlled, randomized clinical trial, carried out in a reference outpatient clinic for treatment of obesity. The baseline sample was composed of 101 women randomly assigned to two groups, 51 in the intervention group (IG) and 50 in the control group (CG). The IG received remote monitoring through telephone calls and conventional monitoring, and the CG received conventional monitoring. Women were assessed at the baseline and after three months of intervention. A paired t-test and analysis of covariance were used to evaluate intragroup differences in anthropometric measurements, and the statistical significance of 5% was adopted. Eighty one women completed the study. RESULTS: in the intergroup comparison after the intervention, a reduction of 1.66 kg in the mean weight (p = 0.017) and of 0.66 kg/m2 in the mean BMI (p = 0.015) was found in the intervention group. There was a borderline statistically significant (p = 0.055) reduction of 2.5 cm in WC with in the intervention group. CONCLUSION: the remote monitoring was beneficial in reducing anthropometric measurements. RBR-3hzdgv.

Implementation of a virtual patient-centered weight loss maintenance behavior competency assessment in adults with obesity.

BACKGROUND: Evidence shows that 95%-98% of individuals who undergo a diet for weight loss purposes will gain back their weight within 5 years. LOCAL PROBLEM: No standardized method exists to assess weight loss maintenance (WLM) behavior competencies in patients who lose weight within a telehealth nutritional counseling private practice. Incorporating this assessment can be used to increase patient self-efficacy and predict a patient's likelihood of long-term weight success. METHODS: A quality improvement project, implementing four rapid plan-do-study-act cycles, was conducted. Each cycle included tests of change related to team and patient engagement, implementation of a WLM assessment, and an audit adherence. Data were analyzed using run charts to evaluate the impact of interventions on outcomes. INTERVENTIONS: The clinical team submitted a weekly WLM competency survey. A patient intake form was completed to identify behavior risks, followed by implementation of a WLM assessment in weekly follow-ups. A team adherence audit was completed and submitted every week. RESULTS: Team WLM competency levels increased 32%, averaging 82% at study conclusion. Completion of the patient intake form reached and held at 100% for the entire duration. Team usage of the WLM assessment peaked at 97%, correlating to increased patient behavior competence by 27.5% as the patient advanced. Team adherence gradually increased, peaking at 100%. CONCLUSIONS: Patient screening forms and audit logs created a standardized process to collect, deliver, and better coordinate care. The findings suggest that patients who embodied higher behavioral competence will have a greater likelihood of sustaining their weight results and become the successful 2%-5% of weight maintainers.

Nurses as role models in health promotion: Piloting the acceptability of a social marketing campaign.

AIM: To pilot the acceptability to practising nurses of the concept of being healthy role models as regards obesity and weight. BACKGROUND: Nursing standards expect nurses to act as role models of professionalism, including maintaining a healthy lifestyle. Many healthcare employers wish to instigate values and social norms about professional behaviour in staff. METHODS: A mixed methods study comprising two stages. In Stage One, an online survey was used to develop an intervention, which was then evaluated by a rapid intercept survey with open-ended questions. Insights from 71 obese nurses, recruited at a 2016 nursing conference, were used to develop a social marketing campaign encouraging a social norm around professional behaviour as regards healthy lifestyles and obesity, with the message that "first impressions count" in staff-patient encounters. The campaign was tested with 79 nurses at three English hospitals. RESULTS: In Stage One, 58% agreed that nurses should be role models and 48% that being obese made the public less likely to trust their public health messages. In Stage Two, the campaign concept of "first impressions count" was widely understood and accepted, but nurses found the introduction of a professional expectation around personal behaviours unacceptable. CONCLUSION: Nurses accept an expectation that they are healthy role models but refute its value when confronted with real-life scenarios. Other aspects of identity were privileged to avoid engaging with the healthy role model message. Personal health behaviour was seen as part of a private domain and not part of their public presentation in professional life.

A Nurse-Led Limited Risk Factor Modification Program to Address Obesity and Obstructive Sleep Apnea in Atrial Fibrillation Patients.

Background Obesity and obstructive sleep apnea ( OSA ) are associated with atrial fibrillation ( AF ), yet these conditions remain inadequately treated. We report on the feasibility and efficacy of a nurse-led risk factor modification program utilizing a pragmatic approach to address obesity and OSA in AF patients. Methods and Results AF patients with obesity (body mass index ≥30 kg/m2) and/or the need for OSA management (high risk per Berlin Questionnaire or untreated OSA ) were voluntarily enrolled for risk factor modification, which comprised patient education, lifestyle modification, coordination with specialists, and longitudinal management. Weight loss and OSA treatment were monitored by monthly follow-up calls and/or continuous positive airway pressure ( CPAP ) unit downloads. Quality of life and arrhythmia symptoms were assessed with the SF -36 and AF Severity Scale at baseline and at 6 months. From November 1, 2016 to October 31, 2017, 252 patients (age 63±11 years; 71% male; 57% paroxysmal AF ) were enrolled, 189 for obesity and 93 for OSA . Obese patients who enrolled lost significantly greater percent body weight than those who declined (3% versus 0.3%; P<0.05). Among 93 patients enrolled for OSA , 70 completed sleep studies, OSA was confirmed in 50, and the majority (76%) started CPAP therapy. All components of quality of life and arrhythmia symptoms improved significantly from baseline to 6 months among enrolled patients. Conclusions A nurse-led risk factor modification program is a potentially sustainable and generalizable model that can improve weight loss and OSA in AF patients, translating into improved quality of life and arrhythmia symptoms.