Perceptions of Weight Loss Experience Between African-Americans and Caucasians: A Pilot Study

Background

Obesity is a growing epidemic in the USA, which leads to comorbidities associated with diseases such as hypertension, diabetes, sleep apnea, cardiovascular disease, osteoarthritis, cancer, gallbladder disease, and dyslipidemia. The purpose of this study is to identify perceptions of weight loss experience between African-American (AA) and Caucasian patients undergoing bariatric surgery.

Methods

A convenience sample of 31 patients participated in this study from May to June 2013. The sample size consisted of 16 AA and 15 Caucasians from two fully accredited and licensed bariatric clinics in metropolitan Detroit.

Results

The sample (N?=?31) consists of eligible AA and Caucasian presurgical bariatric patients on their first preoperative appointment. Snacking and sexual satisfaction showed a significant difference (p?<?0.05), lower amongst Caucasians than amongst the AA. The results revealed that salary within the AA population was significantly lower than that of the Caucasians, especially in the $26.000 to $36,000 category as well as in the over $40,000 category.

Conclusions

The discrepancy widened as the variables of snacks, sexual satisfaction, and salary revealed a significant difference for Caucasians than AA. It is prudent that health-care providers become part of the obesity management solution by examining these variables when planning weight loss interventions.     

Enhanced Recovery After Bariatric Surgery (ERABS): Clinical Outcomes from a Tertiary Referral Bariatric Centre

There is paucity of data on Enhanced Recovery After Bariatric Surgery (ERABS) protocols. This feasibility study reports outcomes of this protocol utilized within a tertiary-referral bariatric centre. Data on consecutive primary procedures (laparoscopic gastric bypasses, sleeve gastrectomies and gastric bands) performed over 9 months within an ERABS protocol were prospectively recorded. Interventions utilized included shortened preoperative fasts, intra-operative humidification, early mobilization and feeding, avoidance of fluid overload, incentive spirometry, use of prokinetics and laxatives. Data collected included demographics, co-morbidities, morbidity, mortality, length of stay (LOS) and re-admissions. A total of 226 procedures (age [mean ± SD], 45?±?11 years, median [interquartile range] BMI 44.9 [41.0–49.0] kg/m²) were undertaken: 150 (66 %) bypasses, 47 (21 %) sleeves and 29 (13 %) bands. Hypertension, diabetes mellitus, sleep apnea and limited mobility were present in 40 %, 34 %, 24 % and 9 % of patients, respectively. No anastomotic or staple line leaks/bleeds were encountered. Ten (4.4 %) patients developed postoperative morbidity (mainly respiratory complications). One death occurred from massive pulmonary embolus in a high-risk patient (despite insertion of preoperative-IVC filter). Respective mean ± SD LOS for bypasses, sleeves and bands were 1.88?±?1.12, 2.30?±?1.69 and 0.69?±?0.81 days. Successful discharge on the first postoperative day was achieved in 37 % and 28 % of bypasses and sleeves, respectively. Day-case gastric bands were performed in 48 %. Thirty-day hospital re-admission occurred in six (2.7 %) patients. Applying an ERABS protocol was feasible, safe, associated with low morbidity, acceptable LOS and low 30-day re-admission rates. The presence of multiple medical co-morbidities should not preclude use of an ERABS protocol within bariatric patients.     

Diagnosis of sacroiliac joint pain: validity of individual provocation tests and composites of tests

Previous research indicates that physical examination cannot diagnose sacroiliac joint (SIJ) pathology. Earlier studies have not reported sensitivities and specificities of composites of provocation tests known to have acceptable inter-examiner reliability. This study examined the diagnostic power of pain provocation SIJ tests singly and in various combinations, in relation to an accepted criterion standard. In a blinded criterion-related validity design, 48 patients were examined by physiotherapists using pain provocation SIJ tests and received an injection of local anaesthetic into the SIJ. The tests were evaluated singly and in various combinations (composites) for diagnostic power. All patients with a positive response to diagnostic injection reported pain with at least one SIJ test. Sensitivity and specificity for three or more of six positive SIJ tests were 94% and 78%, respectively. Receiver operator characteristic curves and areas under the curve were constructed for various composites. The greatest area under the curve for any two of the best four tests was 0.842. In conclusion, composites of provocation SIJ tests are of value in clinical diagnosis of symptomatic SIJ. Three or more out of six tests or any two of four selected tests have the best predictive power in relation to results of intra-articular anaesthetic block injections. When all six provocation tests do not provoke familiar pain, the SIJ can be ruled out as a source of current LBP.     

Telephone nursing: an emerging practice area

Governments across Canada and internationally are implementing nurse telephone advice services to their populations as a means to address healthcare access issues. This paper briefly reviews the international and Canadian history of telephone nursing services and outlines the research that has established the relative safety of these services to patients. The standards, competencies and decision systems that support safe tele-practice are reviewed. The paper focuses on the realities of this emerging nursing practice. A number of concerns related to the marriage of clinical practice and call centres are identified that require further dialogue, research and debate within the profession. The call centre environment can lead to a focus on efficiency measures, such as call length and quick turnaround to the next call, without evidence to ensure that these are safe or desirable standards. Quality of work life for staff in call centres is also raised as an issue that requires more research and dialogue. Other issues include cross-jurisdictional licensure, patient safety, privatization and the differing models of telephone nursing services that are being implemented in Canada.     

Effects of exercise training programs on walking competency after stroke: a systematic review

To determine the effectiveness of training programs that focus on lower-limb strengthening, cardiorespiratory fitness, or gait-oriented tasks in improving gait, gait-related activities, and health-related quality of life after stroke. Randomized controlled trials (RCTs) were searched for in the databases of Pubmed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, DARE, Physiotherapy Evidence Database (PEDro), EMBASE, Database of the Dutch Institute of Allied Health Care, and CINAHL. Databases were systematically searched by two independent researchers. The following inclusion criteria were applied: (1) participants were people with stroke, older than 18 yrs; (2) one of the outcomes focused on gait-related activities; (3) the studies evaluated the effectiveness of therapy programs focusing on lower-limb strengthening, cardiorespiratory fitness, or gait-oriented training; and (4) the study was published in English, German, or Dutch. Studies were collected up to November 2005, and their methodological quality was assessed using the PEDro scale. Studies were pooled and summarized effect sizes were calculated. Best-evidence synthesis was applied if pooling was impossible. Twenty-one RCTs were included, of which five focused on lower-limb strengthening, two on cardiorespiratory fitness training (e.g., cycling exercises), and 14 on gait-oriented training. Median PEDro score was 7. Meta-analysis showed a significant medium effect of gait-oriented training interventions on both gait speed and walking distance, whereas a small, nonsignificant effect size was found on balance. Cardiorespiratory fitness programs had a nonsignificant medium effect size on gait speed. No significant effects were found for programs targeting lower-limb strengthening. In the best-evidence synthesis, strong evidence was found to support cardiorespiratory training for stair-climbing performance. Although functional mobility was positively affected, no evidence was found that activities of daily living, instrumental activities of daily living, or health-related quality of life were significantly affected by gait-oriented training. This review shows that gait-oriented training is effective in improving walking competency after stroke.     

Trouble and repair during conversations of people with primary progressive aphasia

Background: Primary progressive aphasia (PPA) affects a range of language domains that impact on communication. Little is known about the nature of conversation breakdown in PPA. The identification of trouble in conversation, its repair and the success of repairs has been used effectively to examine conversation breakdown in neurogenic language disorders such as dementia of the Alzheimer type (DAT) and acute onset aphasia. This study investigated trouble and repair in the conversations of people with PPA.

Aims: The first aim of this study is to describe the contributions of individuals with PPA and their conversation partner to conversation. The second aim is to describe the trouble that occurs in dyadic conversations between three individuals with PPA and their communication partner. The third aim is to describe the repair behaviours used by the individuals with PPA and their communication partners.

Methods & Procedures: Dyadic conversations about everyday activities between three individuals with PPA and their partners and three control dyads were video recorded and transcribed. Number of words, number of turns and length of turns were measured and trouble-indicating behaviours (TIBs) and repair behaviours were categorised.

Outcomes & Results: Individuals with PPA had reduced mean length of turn but maintained their share of turn-taking. They demonstrated a variety of TIBs that differed from the noninteractive repairs, which do not require a response from the partner in the conversation and which have been observed in studies of conversation in DAT. Their partners bore the greater burden of highlighting trouble and need for repair using collaborative, interactive, TIBs. Three different conversational profiles were observed in the three PPA dyads, reflecting different patterns of language and cognitive impairment.

Conclusions: Individuals with PPA were active participants in conversation effectively indicating and responding to trouble. Understanding trouble and repair in the conversations of individuals with PPA has the potential to enhance assessment and inform clinical practice.     

Outpatient management of chronic heart failure

Critical to the success of managing heart failure is appropriate outpatient follow up. Various models of care integrate medical care, pharmacologic intervention, and patient education and support. Key factors in any program are frequent patient assessment with rapid response to even subtle changes in the patient's condition. As the disease progresses, alternative care options such as palliative care and hospice should be integrated into the patient's care regimen.     

Multiple complications and short length of stay are associated with postoperative readmissions

Background

The aim of this study was to characterize patients readmitted following inpatient general surgery procedures. We hypothesized that a decreased length of stay would increase risk for readmission.

Methods

We utilized our institutional National Surgical Quality Improvement Project database from 2006 to 2011. The main outcome of interest was 30-day readmission. Univariate and logistic regression analyses identified risk factors for readmission.

Results

We identified 3,556 patients, with 322 (9%) readmitted within 30 days after discharge. Multivariable analysis demonstrated age, dyspnea, and American Society of Anesthesiologists class to be independent risk factors for readmission. In addition, patients who suffered multiple complications had a decreased risk for readmission as length of stay increased. Patients with <2 postoperative complications had an increased risk for readmission as length of stay increased.

Conclusions

Contributors to postoperative readmissions are multifactorial. Perioperative factors predict risk for readmission and may help determine a target length of stay. Prevention of postoperative complications may reduce readmission rates.