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1.
Obes Surg ; 30(11): 4179-4186, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32623686

RESUMO

COVID-19 (Coronavirus disease 2019) caused by SARS-CoV-2 has become a global pandemic. Obesity is a risk factor for severe disease, and the practice of endoscopy poses special challenges and risks of SARS-CoV-2 transmission to patients and providers given the evolving role of the gastrointestinal tract in viral transmission and aerosol generation during endoscopic procedures. It is therefore necessary to distinguish between urgent interventions that cannot be postponed despite the risks during the pandemic and, in contrast, purely elective interventions that could be deferred in order to minimize transmission risks during a time of infection surge and limited access. Semi-urgent bariatric procedures have an intermediate position. Since the chronological course of the pandemic is still unpredictable, these interventions were defined according to whether or not they should be performed within a nominal 8-week period. In this position statement, the IFSO Endoscopy Committee offers guidance on navigating bariatric endoscopic procedures in patients with obesity during the COVID-19 pandemic, in the hope of mitigating the risk of SARS-CoV-2 transmission to vulnerable patients and healthcare workers. These recommendations may evolve as the pandemic progresses.


Assuntos
Bariatria , Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Endoscopia , Controle de Infecções/organização & administração , Obesidade Mórbida/cirurgia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Humanos , Seleção de Pacientes , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Guias de Prática Clínica como Assunto
3.
Arq Gastroenterol ; 57(1): 13-18, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32294730

RESUMO

BACKGROUND: Intragastric balloon (IGB) use is indicated for patients whose BMI precludes the option of bariatric surgery or who need to lose weight prior to undergoing surgery. It is a minimally invasive procedure and currently there are two main models of IGBs in use, the non-adjustable intragastric balloon (NIB), implanted for six months, and the adjustable intragastric balloon (AIB), implanted for up to 12 months. OBJECTIVE: Analyze clinical characteristics between patients receiving non-adjustable gastric balloon and the adjustable (prolonged implantation) intragastric balloon. METHODS: This was a cross-sectional study of 470 patients diagnosed as obese or overweight who had balloon implantation from October 2011 to July 2018. The associations between percentage excess weight loss versus clinical and demographic variables were calculated using the chi-squared test. Independent samples were submitted to the Student's t test to determine the quantitative variables, with a confidence interval of 95%. Calculation of excess weight was based on an estimated ideal weight that would correspond to a BMI of 24.99 kg/m2. RESULTS: A total of 414 patients completed the treatment achieving an average total body weight loss (%TBWL) of 15.4±7 with the NIB and 15.5±9.6 with the AIB. Overweight patients achieved higher excess weight loss (%EWL) values using AIBs (157.2±82.5) and obese patients did so with NIB use (56±29.7). Women achieved higher %EWL values (65.6±62.2) than men (48±27.1). Individuals who attended >4 consultations with a nutritionist (60.8%) achieved TBWL >18%. All of those P-values were <0.001. CONCLUSION: Obese individuals and women registered the greatest weight losses. Overweight patients achieved greater losses using AIB and obese patients did so using NIBs. NIB use was associated with higher EWL percentages. Nutritional accompaniment had a positive impact on the %TBWL.


Assuntos
Bariatria/métodos , Endoscopia/métodos , Balão Gástrico , Obesidade/cirurgia , Adolescente , Adulto , Idoso , Bariatria/efeitos adversos , Índice de Massa Corporal , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento , Perda de Peso , Adulto Jovem
4.
Am J Gastroenterol ; 115(4): 630, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32149779
11.
Br Dent J ; 227(1): 38-42, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31300782

RESUMO

Introduction Levels of obesity in the UK are increasing. The suitability and safety of dental care delivery can be affected by obesity. When patients' weight exceeds that of a normal dental chair, referral to specialist settings can be appropriate, yet no research has explored the process of care for this group.Aims This study aimed to explore the experiences of patients and dentists regarding referral to bariatric dental care facilities.Method Semi-structured interviews were completed with patients referred to a bariatric dental service and referring dentists. Interview transcripts were analysed thematically.Results Twelve dentists and eight patients participated. Both groups were aware that obesity influenced care and had concerns about the safety of treatment. Dentists were cautious about discussing weight though patients were willing to discuss this. The challenges in identifying weight and organising appropriate care were key issues affecting both patients and dentists.Conclusion Dentists should engage in discussions regarding obesity without hesitation, where appropriate. Redesigned patient-focused care pathways to direct patients to accessible services would help reduce stigma and improve safety for patients with obesity.


Assuntos
Bariatria , Assistência Odontológica para Crianças , Atitude do Pessoal de Saúde , Criança , Assistência Odontológica , Odontólogos , Inglaterra , Humanos , Padrões de Prática Odontológica , Encaminhamento e Consulta
13.
Int Wound J ; 16(4): 932-939, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30938101

RESUMO

Postoperative wound-healing problems are relatively high in post-bariatric body-contouring procedures, partly because of electrosurgery and the associated thermal tissue damage. This study is a retrospective randomised evaluation of the effect of a low-thermal plasma dissection device (PEAK PlasmaBlade, Medtronic, Minneapolis, Minnesota) in comparison with conventional electrosurgery. A total of 24 patients undergoing upper arm or medial thigh lifting were randomised to PEAK PlasmaBlade on one side and to monopolar electrosurgery on the other side of the same patient. Wounds of 10 patients were examined histologically for acute thermal injury depth. Significantly lower total volume of drain output (61,1 ± 70,2 mL versus 95,1 ± 176,0 mL; P = .04) was found on the PEAK PlasmaBlade side compared with the electrosurgery side. Furthermore, the PEAK PlasmaBlade side showed fewer seromas (no case of seroma versus three seromas in the electrosurgery group) and less thermal damage (40% versus 70%; P = .26). Acute thermal injury depth from the PEAK PlasmaBlade was less than from monopolar electrosurgery (425 ± 171 µm versus 686 ± 1037 µm; P = .631). PEAK PlasmaBlade appears to be superior to traditional monopolar electrosurgery for post-bariatric body-contouring procedures because it demonstrated less tissue damage, lower total volume of drain output, and fewer postoperative seromas resulting in faster wound healing.


Assuntos
Bariatria/métodos , Dissecação/instrumentação , Eletrocirurgia/métodos , Seroma/prevenção & controle , Cicatrização/fisiologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
16.
Catheter Cardiovasc Interv ; 93(3): 371-372, 2019 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-30770664

RESUMO

Left gastric artery embolization acutely lowers ghrelin levels and is associated with modest weight loss sustainable for 1 year in morbidly obese patients. The procedure is relative quick, free of access complications when done via the radial artery, but long-term sequelae and the durability of ischemic injury to the fundus of the stomach is uncertain. Present reports provide pilot and proof-of-concept data that should fashion further study, but application to routine practice today is premature.


Assuntos
Bariatria , Obesidade Mórbida , Cateteres , Artéria Gástrica , Humanos , Projetos Piloto , Pensamento
17.
Rev. esp. enferm. dig ; 111(2): 140-154, feb. 2019. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-182197

RESUMO

Durante los últimos años estamos asistiendo a un importante incremento en el número y tipo de técnicas endoscópicas bariátricas: se han propuesto distintos modelos de balones, sistemas de suturas, inyección de sustancias, colocación de prótesis, etc. También se han incorporado técnicas endoscópicas de revisión para aquellos casos de pacientes intervenidos de cirugía bariátrica que presentan recuperación ponderal. Todo ello obliga a la necesidad de protocolizar, posicionar y regularizar todas estas técnicas, mediante un consenso que permita su aplicación clínica con el máximo rigor médico y evidencia científica disponibles. Tras editar una primera parte de Consideraciones Generales, en esta segunda revisaremos las indicaciones, metodología y resultados de cada una las principales técnicas que se realizan en nuestro país, con intención de establecer una base y unos requisitos mínimos que faciliten y favorezcan la correcta práctica diaria de estos procedimientos en las Unidades de Endoscopia Bariátrica


During the last years we have been witnessing a significant increase in the number and type of bariatric endoscopic techniques: we have different types of balloons, suture systems, injection of substances and malabsorptive prosthesis, etc. Also, some endoscopic revisional procedures for patients with weight regain after bariatric surgery have been incorporated. This makes it necessary to protocolize, position and regularize all these techniques, through a consensus that allows their clinical application with the maximum medical rigor and scientific evidence available


Assuntos
Humanos , Obesidade/cirurgia , Endoscopia Gastrointestinal/métodos , Cirurgia Bariátrica/métodos , Bariatria/normas , Seleção de Pacientes
18.
Handchir Mikrochir Plast Chir ; 51(4): 255-261, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-30669169

RESUMO

One of the most important parts of result evaluation in plastic surgery, especially postbariatric and body-contouring surgery, is the appraisal of changes in patients' quality of life after treatment. Standardised assessments of patient-reported outcomes (PROs) are indispensable.BODY-Q (A. Klassen et al.) is a multifaceted, valid PRO instrument comprising a total of 26 scales for the evaluation of multiple factors of everyday life in order to quantify well-being, satisfaction and functionality. Each scale contains 4-10 statements, which have to be rated by patients.The BODY-Q was created pursuant to ISPOR (International Society for Pharmacoeconomics and Outcomes Research) standards and subjected to psychometric tests with great results. It is considered a standard PRO instrument for quality of life in postbariatric and body-contouring surgery.In order to expand the applicability of standardised questionnaires, ISPOR established linguistic validation guidelines, which have been applied to the BODY-Q in Dutch, Danish, Finnish and Polish.In this study, German linguistic validation was completed applying the standardised guidelines. First the BODY-Q was translated in consensus with medical expertise. Then a certified translator produced a backwards translation, which was commented on by the author. After appropriate changes were made in due consideration of these comments, interviews with patients were conducted to remove any sources of content-related misconception. Finally, the translated version was applied on patients. All the scales were translated to an easily understandable questionnaire reliable in form and content. An international collaboration aiming to centralise the results has started. Further linguistic validation procedures in other languages have been initiated, and an international cohort structure is planned to be established for body-contouring procedures in order to systematically improve treatment quality in plastic surgery.


Assuntos
Cirurgia Bariátrica , Bariatria , Medidas de Resultados Relatados pelo Paciente , Humanos , Linguística , Psicometria , Qualidade de Vida , Inquéritos e Questionários
19.
Obes Surg ; 29(1): 40-47, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30209668

RESUMO

PURPOSE: No-shows of patients to their scheduled appointments have a significant impact on healthcare systems, including lower clinical efficiency and higher costs. The purpose of this study was to investigate the factors associated with patient no-shows in a bariatric surgery clinic. MATERIALS AND METHODS: We performed a retrospective study of 13,230 records for 2660 patients in a clinic located in Rio de Janeiro, Brazil, over a 17-month period (January 2015-May 2016). Logistic regression analyses were conducted to explore and model the influence of certain variables on no-show rates. This work also developed a predictive model stratified for each medical specialty. RESULTS: The overall proportion of no-shows was 21.9%. According to multiple logistic regression, there is a significant association between the patient no-shows and eight variables examined. This association revealed a pattern in the increase of patient no-shows: appointment in the later hours of the day, appointments not in the summer months, post-surgery appointment, high lead time, higher no-show history, fewer numbers of previous appointments, home address 20 to 50 km away from the clinic, or scheduled for another specialty other than a bariatric surgeon. Age group, forms of payment, gender, and weekday were not significant predictors. Predictive models were developed with an accuracy of 71%. CONCLUSION: Understanding the characteristics of patient no-shows allows making improvements in management practice, and the predictive models can be incorporated into the clinic dynamic scheduling system, allowing the use of a new appointment policy that takes into account each patient's no-show probability.


Assuntos
Bariatria , Pacientes não Comparecentes/estatística & dados numéricos , Obesidade Mórbida/epidemiologia , Instituições de Assistência Ambulatorial , Brasil/epidemiologia , Humanos , Estudos Retrospectivos
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