The increase in body mass index observed after lung volume reduction may act as surrogate marker of improved health status

OBJECTIVE: To assess the effects of lung volume reduction surgery (LVRS) on body mass index (BMI). METHODS: Prospective data was collected on a series of 63 patients undergoing LVRS (bilateral in 22 patients, unilateral in 41 patients). Median age was 58 (41-70) years. The peri-operative effects of LVRS on BMI, lung function and health status (assessed by SF 36 questionnaire) were recorded at 3, 6, 12 and 24 months. RESULTS: We found an overall increase in BMI after LVRS, which was significant up to 2 years. These changes correlated with the changes in FEV1 (R = 0.3, P < 0.01 6 months after LVRS) and diffusing capacity for carbon monoxide (DLCO) (R = 0.5, P < 0.01 6 months after LVRS). At 6 months, when the best results in health status were found, the patients were divided in a responders group (improved SF 36 score) and a non-responders group (same or worse SF 36 score) for each of the 8 domains of the SF 36. In 6 domains the non-responders showed no increase in BMI. In 6 domains the responders showed a significant increase in BMI. CONCLUSION: LVRS significantly improves postoperative BMI, which correlates with improvements in DLCO and reflects changes in health status.     

Generating Dialogical Practices in Mental Health: Experiences from Southern Norway, 1998–2008

In Norway and many other countries, political guidelines prescribe the development of mental health strategies with both a service user’s perspective and a treatment system established by the local authority. The development of new strategies frequently involves challenges regarding procedures and treatment as well as a view of knowledge and humanity. Dialogical practices might provide a solution for these challenges not only because of its procedures but also due to its attitudes toward service users. The aim is to explore the implementation of three dialogical practice programs in Southern Norway from 1998 to 2008 and to critically analyze and discuss the authors’ experiences during the implementation process. Three different programs of dialogical practices were initiated, established, and evaluated within the framework of participatory action research. Sustainable changes succeed individually and organizationally when all participants engage as partners during the implementation of new mental health practices. Generating dialogic practice requires shared understanding of the Open Dialogue Approach (ODA) and collaboration between professional networks and among the leaders. Developing a collaboration area that includes service users in all stages of the projects was one of the essential implementation factors. Other factors involved a common vision of ODA by the leaders and the actors, similar experiences, and a culture of collaboration. However, ODA challenged traditional medical therapy and encountered obstacles to collaboration. Perhaps the best way of surmounting those obstacles is to practice ODA itself during the implementation process.     

A retrospective study on telephone follow-up of anterior colporrhaphy by a specialized nurse

Introduction and hypothesis

The aim of the study was to evaluate a new follow-up practice after anterior colporrhaphy for central cystocele involving nurse telephone follow-up.

Methods

A retrospective follow-up of all 84 patients with an anterior colporrhaphy operation during 2011 was performed. Standard postoperative procedure in uncomplicated cases of cystocele operation (first-time cystocele operation, no preoperative incontinence or voiding difficulties, and no immediate postoperative complications) was a telephone interview performed by a continence nurse 3 months after patient surgery. A local checklist comprising questions concerning complications, voiding dysfunction, and sexual life, as well as questions from the International Consultation on Incontinence Vaginal Symptoms (ICIQ-VS) and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) were used. Complex cases were followed by the surgeon with a consultation including gynecological examination after 3 months.

Results

Out of 84 patients with a cystocele operation, 59 were uncomplicated and had a telephone follow-up. Forty-four (75 %) were satisfied and needed no further consultation in the hospital. One patient could not be contacted. Fourteen patients had a consultation, three before the telephone consultation because of bleeding, five because of anxiety, and one each because of voiding dysfunction and prolapse symptoms. Four patients had persisting urinary incontinence and were incorrectly scheduled for a telephone interview.

Conclusions

Selecting uncomplicated cases for a nurse telephone follow-up after cystocele operation is feasible in a majority of cases. This allows doctors to see more new patients and focus on difficult cases, as well as saving time and money.