Higher Periwound Temperature Associated with Wound Healing of Pressure Ulcers Detected by Infrared Thermography.

Visual and empirical assessments do not enable the early detection of wound deterioration or necroses. No suitable objective indicator for predicting poor wound-healing is currently available. We used infrared thermography to determine the association between wound temperature and pressure-wound healing. We examined patients with grades 2-4 pressure ulcers from a medical center in southern Taiwan and recorded the temperatures of the wound bed, periwound, and normal skin using infrared thermographic cameras. A total of 50 pressure ulcers and 248 infrared-thermography temperature records were analyzed. Normal skin temperature was not related to pressure ulcer wound healing. In a multivariate analysis, higher malnutrition universal-screening-tool scores were associated with poor wound-healing (p = 0.020), and higher periwound-temperature values were associated with better wound-healing (p = 0.028). In patients who had higher periwound-skin temperature than that of the wound bed, that result was also associated with better wound-healing (p = 0.002). Wound-bed and periwound temperatures differed significantly with the grade of the pressure ulcer, and a high periwound temperature was positively correlated with wound healing. Infrared thermography can objectively serve as indicators for assessing pressure-ulcer healing.

Postoperative Showering for Clean and Clean-contaminated Wounds: A Prospective, Randomized Controlled Trial.

OBJECTIVE: To evaluate wound infection rates, pain scores, satisfaction with wound care, and wound care costs starting 48 hours after surgery. BACKGROUND: Showering after surgery is a controversial issue for wound care providers and patients. We investigated the benefits and detriments of showering for postoperative wound care. METHODS: Patients undergoing thyroid, lung, inguinal hernia, and face and extremity surgeries with clean or clean-contaminated wounds were included. The patients were randomized to allow showering (shower group) or to keep the wound dry (nonshower group) for postoperative wound care starting 48 hours after surgery. The primary endpoint was the rate of surgical wound infection. The secondary endpoints included the wound pain score, satisfaction with wound care, and cost of wound care. RESULTS: Between May 2013 and March 2014, there were 222 patients randomized to the shower group and 222 to the nonshower group. Two patients in each group were lost to follow-up. There were 4 superficial surgical site infections in the shower group and 6 in the nonshower group (4/220, 1.8% vs 6/220, 2.7%, P = 0.751). Postoperative pain scores were comparable between the 2 groups. Patients in the shower group were more satisfied with their method of wound care, and their wound care costs were lower when compared with the nonshower group. CONCLUSIONS: Clean and clean-contaminated wounds can be safely showered 48 hours after surgery. Postoperative showering does not increase the risk of surgical site complications. It may increase patients' satisfaction and lower the cost of wound care.

Fever presentation and associated factors in patients with healthcare-associated bacteraemia.

Bacteraemia is a systemic infection associated with strong febrile immune reactions. Fever definitions, fever intensity and other factors might affect the recognition, management and prognosis of patients with bacteraemia. A prospective observational design was used to study 412 consecutive Taiwanese patients with healthcare-associated bacteraemia. The study variables were fever intensity, factors related to fever intensity, the association of physical function to thermogenic capacity and the sensitivity of three definitions of fever for identifying patients with bacteraemia. Age, Charlson comorbidity index (CCI) score, chills and pathogen types were predictors of fever intensity. Barthel index score, CCI score and pathogen types were predictors of chills, an indicator of thermogenic capacity. The sensitivity of three fever definitions (basal body temperature plus 1°C, ≥ 38°C and ≥ 38.3°C) to identify patients with bacteraemia was 93.3%, 83.5% and 71.4%, respectively. Clinicians can target patients with factors associated with blunted febrile response to bacteraemia for closer monitoring.

A Qualitative Study of Family Caregiver Experiences of Managing Incontinence in Stroke Survivors.

BACKGROUND: Incontinence is a common problem faced by family caregivers that is recognized as a major burden and predictor of institutionalization. However, few studies have evaluated the experiences of family caregivers caring for stroke survivors with incontinence. PURPOSE: To describe experiences of caregivers managing incontinence in stroke survivors. DESIGN: This qualitative descriptive study employed a grounded-theory approach. METHODS: Semi-structured in-depth interviews with ten family caregivers of stroke survivors with incontinence were conducted during 2011. Audiotaped interviews were transcribed and analyzed using content analysis. FINDINGS: Data analysis identified four themes: chaos, hypervigilance, exhaustion, and creating a new life. There were nine related subcategories: fluster, dirtiness, urgency, fear of potential health-hazard, physically demanding and time-consuming, mentally draining, financial burden, learning by doing, and attitude adjustment. Together, these described a process of struggling to cope with the care of stroke survivors with urinary/fecal incontinence. Of the four categories, "creating a new life" developed gradually over time to orient caregivers to their new life, while the other three categories occurred in a chronological order. CONCLUSION: The research highlighted unique caring experiences of family caregivers of stroke patients, which focused solely on the 'incontinence issue'. Understanding these experiences may help nurses provide better support and resources for family caregivers when caring for stroke survivors with incontinence.

Gastro-intestinal Quality of Life After Metabolic Surgery for the Treatment of Type 2 Diabetes Mellitus.

BACKGROUND: Emerging evidence has shown that bariatric/metabolic surgery ameliorates type 2 diabetes (T2DM) in mildly obese patients (BMI < 35 kg/m(2)) but long-term data is inadequate. We investigated the change of the quality of life after metabolic surgery in not well-controlled T2DM patients with BMI < 35 kg/m(2). METHODS: The quality of life was measured by the gastrointestinal quality of life index (GIQLI), a 36-item questionnaire divided into three domains of general health and one domain of specific gastro-intestinal symptoms, administered before operation, at 3, 6, and 12 months after surgery. A control group matched in age, gender, and BMI was recruited for comparison. RESULTS: A total of 86 patients were enrolled, and the preoperative BMI and HbA1C (mean ± SD) were 30.7 ± 2.8 kg/m(2) and 9.3 ± 2.1 %, respectively. At 1 year after surgery, the BMI and HbA1C were 24.3 ± 2.3 kg/m(2) and 6.2 ± 1.1 %, respectively. There was a significantly improvement in all of the measures of glucose metabolism. Complete remission (HbA1C < 6.0 %) was achieved in 56 subjects (65 %) at 12 months. The GIQLI score was significantly impaired in T2DM patients before surgery compared with the control group. The GIQLI score significantly increased from 109.2 ± 20.0 to 116.1 ± 14.2 points 1 year after surgery. The patients had improvement in the three domains of general health (social, physical, and emotional function) without a difference with the normal control but deteriorated in the domain of specific symptoms. Most of the patients experienced symptoms including abdominal pain, bloating, flatulence, belching, abdominal noise, regurgitation, dysphagia, slow eating speed, nausea, bowel urgency, and incontinence after metabolic syndrome. CONCLUSIONS: Health-related QOL improved dramatically after metabolic surgery for not well-controlled T2DM patients with BMI < 35 kg/m(2), but patients might develop specific gastro-intestinal symptoms after surgery.

Communication dysfunction, body image, and symptom severity in postoperative head and neck cancer patients: factors associated with the amount of speaking after treatment.

PURPOSE: The purpose of this study was to determine the relationships of communication dysfunction, body image, and amount of speaking in patients who were treated for head and neck cancers (HNCs). METHODS: This was a cross-sectional study of postoperative HNC patients at the otolaryngology outpatient departments of two leading medical centers in northern Taiwan. Data were collected using questionnaires to assess perceived communication dysfunction, body image, symptom severity, and amount of speaking after treatment. RESULTS: A total of 130 HNC patients were included in the analysis, and 70.8 % of patients reported speaking less after surgery as compared to the period before having HNC surgery. Overall, patients perceived a moderate level of communication dysfunction. Those with higher distress over their body image, higher symptom severity, and with hypopharyngeal and laryngeal cancer reported speaking less. Patients with advanced stage cancer and a tumor in a facial area and those that received reconstructive surgery were more likely to have a negative body image. CONCLUSIONS: Dissatisfaction with body image, greater symptom severity, and hypopharyngeal and laryngeal cancer are predictive of the amount HNC patients speak, as compared with the amount they spoke before having HNC. Clinicians should be aware of and systematically assess communication problems of HNC patients to promote their social function. Further research on interventions that facilitate the development of a positive body image and communication is strongly suggested.

Impairment of gastrointestinal quality of life in severely obese patients.

AIM: To investigate the common gastro-intestinal symptoms and quality of life in severely obese subjects. METHODS: We prospectively recruited 340 severely obese patients [mean age 30.5 ± 7.8 years; mean body mass index (BMI) 42.9 ± 6.1 kg/m(2)] and 340 healthy persons (mean BMI 23.1 ± 3.8 kg/m(2)) matched in sex, age, marriage and education. The quality of life was studied using a specific gastrointestinal quality of life index (GIQLI) questionnaire. The 36 items and four functional domains of the GIQLI were compared and analyzed between the groups. The possible correlation of GIQLI scores with specific clinical variables in severely obese patients was assessed by measuring Pearson's coefficient of correlation. RESULTS: The mean GIQLI score of severely obese patients was lower than the normal control group (108.5 ± 17.1 vs 123.2 ± 14.8, P < 0.01). Severely obese patients had decreased scores in the domains of general health, including physical (17.3 ± 6.0 vs 22.4 ± 3.1, P < 0.01), emotional (12.6 ± 4.3 vs 16.6 ± 3.1, P < 0.01) and social function (14.7 ± 3.9 vs 17.9 ± 2.5, P < 0.01), and in the domain of gastrointestinal symptoms (63.9 ± 6.7 vs 66.3 ± 7.2, P < 0.05). A significantly decreased score was found in nine items, and there was an increased score in one out of the 19 items in the domain of symptoms of the GIQLI questionnaire. The decreased score in the domain of symptoms was correlated with increasing glycosylated hemoglobin (HbA1c) levels. CONCLUSION: Severe obesity resulted in a significant impairment of the quality of life and caused specific gastrointestinal symptoms compared with normal controls. The development of gastrointestinal symptoms is correlated increasing HbA1c, suggesting that a poor control of hyperglycemia might be the etiology.

Changes in quality of life and its related factors in liver cancer patients receiving stereotactic radiation therapy.

PURPOSE: Due to the increasing use of stereotactic radiotherapy (SRT) in treating advanced liver cancer patients, the purpose of this longitudinal study was to explore the changes and factors related to quality of life (QOL) in patients receiving SRT treatment. MATERIALS AND METHODS: Liver cancer patients receiving SRT in northern Taiwan were recruited. The patients were followed up during the baseline pre-SRT and the first 6 weeks of SRT (T0 to T6) in assessing functional status and symptom severity, while depression, selected laboratory data, and QOL were assessed every 3 weeks (T0, T3, and T6). Generalized estimating equations (GEE) analysis was used to explore the significant factors related to the change in QOL. RESULTS: Ninety-nine patients with advanced liver cancer completed seven interviews. The results showed that QOL during SRT was moderate and relatively stable. Performance functional status, depression, the level of albumin, and overall symptom severity were significantly associated with changes in QOL. A further analysis of the relationships between individual symptom severity and QOL revealed that fatigue, lack of appetite, pain, and nausea were the symptoms most affecting QOL across the 6 weeks of SRT. CONCLUSION: Liver cancer patients had stable and moderate levels of QOL during SRT. Factors related to QOL across the 6 weeks were multi-dimensional. Both overall symptom severity and selected individual symptoms were important to patients' QOL. These factors should all be carefully assessed and clinically treated to enhance liver cancer patients' QOL during SRT.

Nutritional status and health outcomes for older people with dementia living in institutions.

AIM: This paper is a report of a study to determine changes over a 3-month period among older people with dementia living in long-term care settings, related to: (1) changes in body mass index, and (2) health outcomes and associated factors. BACKGROUND: Nutritional deficiencies are common problems among older people, but frequently unrecognized, both in long-term care settings and in the community. METHOD: A cross-sectional design with repeated measures of body weights and medical record reviews was adopted. The study was conducted in 2003 in two long-term care facilities for older people with dementia in Taiwan. Fifty-five residents participated in the study. RESULTS: Eighteen percent of the residents were under-nourished (body mass index <18.5). There was a trend toward decreasing body mass index over the 3-month study period. Residents with low body mass index tended to need assistance at mealtimes. Nineteen residents, many receiving naso-gastric tube-feeding, experienced adverse health events during the study period. Dependency in eating was the major factor differentiating residents with normal or low body mass index values, and also in distinguishing those who experienced adverse health outcomes. CONCLUSION: Assessment of eating ability, mode of feeding and measurement of body weight can be used by nurses in long-term care settings for early identification of the nutritional status of older people with dementia.

Identifying the most efficient items from the Mini-Mental State Examination for cognitive function assessment in older Taiwanese patients.

AIMS: The purpose of the study was to identify the most efficient items from the Mini-Mental State Examination for assessment of cognitive function. BACKGROUND: The Mini-Mental State Examination is the most frequently used cognitive screening instrument. However, the Mini-Mental State Examination has been criticized for insensitivity to mild cognitive dysfunction, limited memory assessment and variability in level of difficulty of the individual items. METHOD: This study used secondary data analysis. Item response theory two-parameter model was used to analyse the data from the admission assessment of mental status by the Mini-Mental State Examination for 801 patients. RESULTS: By using item response analysis, 16 items were selected from the original 30-item Mini-Mental State Examination. The 16 items included mainly the measures of orientation, recall and attention and calculation. The internal consistency of the 16-item Mini-Mental State Examination was 0.84. The proposed new cut-off point for the 16-item Mini-Mental State Examination was 11. The correct classification rate was 0.94, the sensitivity was 100% and the specificity was 97.4%, when compared with the original 30-item Mini-Mental State Examination from the cut-off point of 24. This new cut-off point was determined for the purpose of over-identifying patients at risk so as to ensure early detection of and prevention from the onset of cognitive disturbance. CONCLUSION: Only a few items are needed to describe the subject's cognitive status. Using item response theory analysis, the study found that the Mini-Mental State Examination could be simplified. RELEVANCE TO CLINICAL PRACTICE: Deleting the items with less variation makes this assessment tool not only shorter, easier to administer and less strenuous for respondents, but also enables one to maintain validity as a cognitive function test for clinical setting.

Gastrointestinal quality of life following laparoscopic adjustable gastric banding in Asia.

BACKGROUND: Laparoscopic adjustable gastric banding (LAGB) is a safe and effective treatment for morbid obesity. Previous studies in Western countries disclosed a significant improvement in co-morbidities and health-related quality of life. Data from Asia and regarding the specific GI quality of life following LAGB are lacking. METHODS: From May 2002 to May 2005, 107 consecutive patients - 48 men and 59 women, with mean age 31.4 years (range 17-57 years) with morbid obesity (mean weight 115.8 kg, range 81-174 kg; mean BMI 41.3 kg/m(2), range 32.0-59.8 kg/m(2)) underwent LAGB in a prospective trial. All bands were placed via the pars flaccida technique. Quality of life was measured by the Gastrointestinal Quality of Life Index (GIQLI), a 36item questionnaire before LAGB, and at 3, 6, 12 and 24 months after surgery. RESULTS: All procedures were performed laparoscopically with no conversions. There was neither intra-operative complications nor major postoperative complications. Minor complications occurred in 3 patients (2.8%); all were transient stoma obstruction. At follow-up, only one band (0.94%) was removed at 3 months postoperatively because of the patient's intolerance. No gastric slippage occurred. 4 patients (3.7%) had tubing problems and required revision surgery for port adjustment. Mean BMI decreased from 41.3 to 33.1 after 2 years. Percent excess BMI loss averaged 48.1% at 2 years (range 6.7-139.2). All co-morbidities were eliminated significantly. 80% of patients were satisfied with the results at 2 years. However, the GIQLI score remained similar before and after surgery. Preoperative score was 110.8+15 points. The score became 116.2+13, 114.7+13, 108.5+14 and 107.2+17 at 3, 6, 12 and 24 months. The patients had improvement in 3 domains of general health (social, physical and emotional functions), but decrease in the domain of symptoms. CONCLUSION: Although LAGB was successful in weight loss and resolution of co-morbidities in morbidly obese patients, the GIQLI did not improve. This feature will be the major disadvantage of LAGB.

Laparoscopic vertical banded gastroplasty: 5-year results.

BACKGROUND: Vertical banded gastroplasty (VBG) has been a popular bariatric operation for the past 2 decades, and this operation has evolved into a laparoscopic procedure. However, reports of laparoscopic VBG (LVBG) from large series with longer results are limited. METHODS: From October 1998 to May 2002, 612 consecutive patients underwent LVBG. Mean age was 30.1 years and mean BMI 43.0 kg/m2. Laparoscopic Mason gastroplasty was performed. The change of BMI, obesity-related co-morbidities, and GI quality-of-life index (GIQLI) were studied. RESULTS: The major and minor complication-rate was 1.14% and 4.58% respectively. The mortality-rate was 0.16%. Mean BMI fell from 43.1 kg/m2 to 31.2, 31.3, 31.4, 32.2, and 32.8 kg/m2 at 1, 2, 3, 4, and 5 years respectively, with 93% follow-up. Revision rate was 9.2%. GIQLI decreased from 113.0 to 106.6, 110.9, 111.9, 112.1, and 106.4 at 1, 2, 3, 4, and 5 years. CONCLUSION: LVBG is safe and effective in weight reduction. The GIQLI failed to improve postoperatively even with good resolution of obesity-related co-morbidities. In carefully selected patients with diligent postoperative follow-up, LVBG is a bariatric surgery option.

Laparoscopic Roux-en-Y versus mini-gastric bypass for the treatment of morbid obesity: a prospective randomized controlled clinical trial.

OBJECTIVES: This prospective, randomized trial compared the safety and effectiveness of laparoscopic Roux-en-Y gastric bypass (LRYGBP) and laparoscopic mini-gastric bypass (LMGBP) in the treatment of morbid obesity. SUMMARY BACKGROUND DATA: LRYGBP has been the gold standard for the treatment of morbid obesity. While LMGBP has been reported to be a simple and effective treatment, data from a randomized trial are lacking. METHODS: Eighty patients who met the NIH criteria were recruited and randomized to receive either LRYGBP (n = 40) or LMGBP (n = 40). The minimum postoperative follow-up was 2 years (mean, 31.3 months). Perioperative data were assessed. Late complication, excess weight loss, BMI, quality of life, and comorbidities were determined. Changes in quality of life were assessed using the Gastro-Intestinal Quality of Life Index (GIQLI). RESULTS: There was one conversion (2.5%) in the LRYGBP group. Operation time was shorter in LMGBP group (205 versus 148, P < 0.05). There was no mortality in each group. The operative morbidity rate was higher in the LRYGBP group (20% versus 7.5%, P < 0.05). The late complications rate was the same in the 2 groups (7.5%) with no reoperation. The percentage of excess weight loss was 58.7% and 60.0% at 1 and 2 years, respectively, in the LPYGBP group, and 64.9% and 64.4% in the LMGBP group. The residual excess weight <50% at 2 years postoperatively was achieved in 75% of patients in the LRYGBP group and 95% in the LMGBP group (P < 0.05). A significant improvement of obesity-related clinical parameters and complete resolution of metabolic syndrome in both groups were noted. Both gastrointestinal quality of life increased significantly without any significant difference between the groups. CONCLUSION: Both LRYGBP and LMGBP are effective for morbid obesity with similar results for resolution of metabolic syndrome and improvement of quality of life. LMGBP is a simpler and safer procedure that has no disadvantage compared with LRYGBP at 2 years of follow-up.

[Increasing the executive rate of standard central venous catheter care].

The purpose of this project was to increase the executive rate of standard nursing care of central venous catheters. The average rating of the procedure used by our nurses in caring for central venous catheters in our unit was 58.5%. Reasons why our rating failed to reach 100% included: (1) there was no clear, detailed explanation of the aseptic technique of standard nursing care of central venous catheters; (2) nurses were too busy to complete the detailed steps necessary to the procedure; (3) nurses were unfamiliar with standard nursing care of central venous catheters. Observation, analysis, literature review and discussions with the Infection Control Team were the measures we adopted to improve the standard nursing care of central venous catheters in our unit. Through the application of what we learned we increased our average rating of standard nursing care of central venous catheters to 100%.

Laparoscopic vertical banded gastroplasty and laparoscopic gastric bypass: a comparison.

BACKGROUND: Vertical banded gastroplasty (VBG) and gastric bypass (GBP) are the two bariatric procedures recommended by NIH consensus conference. Recent advancement in laparoscopic (L) techniques has made LVBG and LGBP alternatives for the conventional open approach. METHODS: From December 2000 to February 2002, 80 patients (24 men and 56 women; mean age 32 years, range 18-57) with morbid obesity (mean BMI 43.2 kg/m(2), range 36-59.8) were enrolled in a prospective trial and randomly assigned to LVBG or LGBP. Changes in quality of life were assessed using the Gastro-intestinal quality of life index (GIQLI). RESULTS: The conversion rate was zero for LVBG and 2.5% (1/40) for LGBP. There has been no mortality. Surgical time was significantly longer for LGBP (209 minvs 126 min for LVBG, P<0.001). Mean hospital stay was 3.5 days for the LVBG vs 5.7 days for LGBP (P<0.001). Postoperative analgesic usage was also less for LVBG patients (mean dose 1.4 vs 2.4, P<0.05). Early complication rate was higher in the LGBP group (17.8% vs 2.5%, P<0.001). All 3 major complications were in the LGBP group, of which 2 were related to anastomotic leakage (5%). Late complications consisted of upper GI bleeding, stenosis and others observed in 4 LGBP patients (10%) and 2 LVBG patients (5%). Mean follow-up was 20 months (range 18 to 30). BMI fell significantly in both groups, with significant improvement of obesity-related co-morbidities. LGBP had significantly better excess weight loss than LVBG (62.9% vs 55.4% at 1 year and 71.4% vs 53.1% at 2 years), as well as lower BMI than LVBG (29.6 vs 31.1 at 1 year and 28.5 vs 31.9 at 2 years). There was no difference in the reduction of obesity-related laboratory abnormalities at 1 year except a lower hemoglobin in LGBP (11.8 vs 13.8, P<0.05). Preoperative GIQLI scores were similar between the groups; however, at 1 year, LGBP patients had better GIOLI scores than LVBG patients (121 vs 106, P<0.01). LVBG had improvement in physical condition, social function and emotional conditioning but deterioration in GI symptoms which resulted in no increase in total GIQLI score. CONCLUSION: LGBP was a time-consuming demanding technique with a higher early complication rate compared with LVBG. Although both operations resulted in significant weight reduction and decrease in obesity-related co-morbidities, LGBP had a trend of greater weight loss and significantly better GIQLI than LVBG at the cost of a significant long-term trace element deficiency state. Each patient should be individualized for the operations according to the patient's decision.

Predicting post-surgical cognitive disturbance in older Taiwanese patients.

The purpose of this study was to test a theoretical model to understand the influences of six predicting variables in post-surgical cognitive disturbance in older Taiwanese patients after elective surgery. The data were collected in a medical center in Taipei, Taiwan. Ninety-three patients were included in the final analysis. The findings showed that cognitive function at admission (beta=0.50, p<0.001), physical function at admission (beta=-0.34, p<0.001), and physiological stability (beta=-0.21, p<0.01) had direct effects on post-surgical cognitive disturbance. Physical function and cognitive function at admission also affected post-surgical cognitive disturbance indirectly through physiological stability. These variables accounted for 67% of the total variance of post-surgical cognitive disturbance. The findings from this study suggest that a careful and systematic assessment of the patient's condition at the time of admission is important. It is necessary to monitor and correct these variables at admission or before surgery to prevent or reduce the impact of post-operative delirium. It is also necessary to monitor these variables during the hospital stay to help nurses to distinguish the etiology of delirium. In each case, knowing when confusion is more likely to occur can assist in focusing more appropriate and effective efforts at detection, thereby reducing the consequences associated with confusion.

Postoperative cognitive changes among older Taiwanese patients.

The purpose of the study was to describe variations in cognitive/behavioural changes during the course of delirium among older Taiwanese patients after elective surgery. A total of 106 patients assessed four times (admission, onset of delirium, delirium day 3 and delirium day 5) by the Mini Mental State Examination (MMSE) were included in the analysis to understand the neurocognitive/behaviour change during the course of delirium. Repeated measures anova was used to analyse within-subject differences across these four time points for those who became delirious and those who did not. The findings showed that patients who experienced delirium had significantly (P < 0.01) lower MMSE scores than non-delirious patients. Scores for the delirious group were also significantly different across the four assessments (P < 0.01) within the group. The subscales of orientation to time, orientation to place, registration and recall were the major changes from time 1 (admission assessment) to time 2 (onset of delirium) for delirious patients. When scores for time 4 (delirium day 5) and time 1 (admission assessment) were compared, the subscales of orientation to time, orientation to place and visual construction showed the least improvement among the subscales at time 4. The findings of the study suggest that mental status assessments are important during the patient's admission and hospital stay. The repeated assessments can be incorporated into routine nursing care so that problems can be detected and appropriate nursing care implemented.

Gastrointestinal quality of life following laparoscopic vertical banded gastroplasty.

BACKGROUND: Laparoscopic vertical banded gastroplasty (LVBG) is a safe and effective treatment for morbid obesity. Previous studies disclosed a significant improvement in the health-related quality of life after substantial weight loss following VBG. Data regarding the specific gastrointestinal quality of life following LVBG is lacking. MATERIALS AND METHODS: 223 patients who underwent LVBG for morbid obesity were studied prospectively. Quality of life was measured by the Gastrointestinal Quality of life Index (GIQLI), a 36-item questionnaire before surgery, and at 6 months, 1 year and 2 years after surgery. The questionnaire is divided into 5 domains, and the maximum score is 144. RESULTS: After LVBG, weight loss has been good. Mean BMI decreased from 43.2 to 31.3 after 2 years. Co-morbidities were eliminated in 71%. 84.3% of patients were satisfied with the results. However, the score of GIQLI remained similar before and after surgery. Preoperative score was 106.2 +/- 19 points. The score became 116.6 +/- 9, 106.8 +/- 21, and 108.5 +/- 20 at 6 months, 1 year and 2 years after surgery respectively. The patients had improvement in 3 domains of the questionnaire (social function, physical status and psychological emotions) but decreased in domains of core symptoms and disease-specific items. CONCLUSION: Although LVBG was effective in reduction of weight and resolution of co-morbidities in morbidly obese patients, the specific gastrointestinal quality of life did not improve. Many patients developed some specific gastrointestinal symptoms in order to obtain weight reduction.