Anxiety and depression in association with morbid obesity: changes with improved physical health after duodenal switch

Background Patients with morbid obesity have an increased risk for anxiety and depression. The "duodenal switch" is perhaps the most effective obesity surgery procedure for inducing weight loss. However, to our knowledge, data on symptoms of anxiety and depression after the duodenal switch are lacking. Furthermore, it has been hypothesized that self-reported physical health is the major predictor of symptoms of depression in patients with morbid obesity. We therefore investigated the symptoms of anxiety and depression before and after the duodenal switch procedure and whether post-operative changes in self-reported physical health were predictive of changes in these symptoms. Methods Data were assessed before surgery (n = 50), and one (n = 47) and two (n = 44) years afterwards. Symptoms of anxiety and depression were assessed by the "Hospital Anxiety and Depression Scale", and self-reported physical health was assessed by the "Short-Form 36" questionnaire. Linear mixed effect models were used to investigate changes in the symptoms of anxiety and depression. Correlation and linear multiple regression analyses were used to study whether changes in self-reported physical health were predictive of post-operative changes in the symptoms of anxiety and depression. Results The symptom burden of anxiety and depression were high before surgery but were normalized one and two years afterwards (P < 0.001). The degree of improvement in self-reported physical health was associated with statistically significant reductions in the symptoms of anxiety (P = 0.003) and depression (P = 0.004). Conclusions The novelty of this study is the large and sustained reductions in the symptoms of anxiety and depression after the duodenal switch procedure, and that these changes were closely associated with improvements in self-reported physical health

The Norse Feedback in a population of patients undergoing bariatric surgery—Psychometric properties of a digital computer-adaptive questionnaire assessing mental health

The Norse Feedback (NF) is a questionnaire developed for patient-reported outcome monitoring with a clinical feedback system (PRO/CFS). As mental health is a concern after bariatric surgery, the use of the NF as part of PRO/CFS may be beneficial. The aim of this study is to test the reliability and validity of the NF in patients who have been accepted for or have undergone bariatric surgery. We performed separate robust confirmatory factor analyses (CFAs) to test the unidimensionality on 19 of the NF scales. We also performed correlation analyses on 19 of the NF scales with the Obesity-related Problems scale (OP). We included 213 patients. In the CFA analyses, three out of 12 scales with four or more items showed satisfactory psychometric properties in all goodness of fit indices (Suicidality, Need for Control and Self-Criticism). Four scales showed satisfactory psychometric properties in all indices but RMSEA (Somatic Anxiety, Substance Use, Social Safety and Cognitive Problems). Several of the scales demonstrated floor effects. In the correlation analyses, 18 of the 19 scales showed small-to-moderate correlation coefficients with the OP. Our demonstration of satisfactory psychometric properties on several important scales of the NF suggests that this tool may prove valuable in the routine follow-up of mental health in this population. However, further work is needed to innovate the NF for patients undergoing bariatric surgery.publishedVersio

Eating self-efficacy as predictor of long-term weight loss and obesity-specific quality of life after sleeve gastrectomy: A prospective cohort study

Under embargo until: 15.12.2019Background: A person's confidence to control eating, eating self-efficacy (ESE), has been identified as a target for long-term weight management in nonsurgical weight loss interventions, but has to a limited extent been studied after bariatric surgery. Objective: We investigated the association between ESE, weight loss, and obesity-specific quality of life (QOL) after sleeve gastrectomy (SG). Setting: A single-center longitudinal study. Methods: Data from adult patients were collected before SG, and at mean 16 months (±standard deviation 4 mo) and 55 (±4) months postoperatively. ESE was measured by the Weight Efficacy Lifestyle Questionnaire Short-Form. Multiple regression analyses were performed with excess body mass index loss (%EBMIL) and obesity-specific QOL as dependent variables. Age, sex, and other preoperative values were covariates in all models. Results: Of 114 preoperative patients, 91 (80%) and 84 (74%) were available for follow-up 16 and 55 months after SG, respectively. Mean %EBMIL from baseline to 16 and 55 months was 76% (95% confidence interval: 71.9, 79.6) and 67% (95% confidence interval: 61.9, 72.2), respectively. Preoperative ESE scores improved significantly at both 16 and 55 months (P = .002) but did not predict postoperative %EBMIL or QOL at 55 months (β = −.08, P = .485). Greater change in ESE from 0 to 16 months predicted higher %EBMIL (β = .34, P = .013) at 55 months, and improvements in ESE from 0 to 55 months were significantly associated with higher %EBMIL (β = .46, P = .001) and obesity-specific QOL (β = .50, P < .001) 55 months after SG. Conclusion: Significant improvements in ESE were seen at 16 months, and remained high at 55 months after SG in this cohort. Patients who improved their ESE the most also experienced the highest weight loss and obesity-specific QOL 5 years postoperatively. Future research should address whether enhancement of ESE corresponds to sustained improvements in eating behavior after bariatric surgery.acceptedVersio

Livskvalitet etter fedmekirurgi

Background: Severe obesity is a chronic condition associated with a range of comorbidities and reduced quality of life. The only treatment documented to provide sustained weight loss in patients with severe obesity is bariatric surgery. Biliopancreatic diversion with duodenal switch (BPDDS) is the surgery that leads to the greatest weight loss. However, long-term data on quality of life after BPDDS are scarce. Aims: The primary aim of this thesis was to evaluate changes in quality of life from baseline to ten-year follow-up in patients who had undergone BPDDS. A secondary aim was to translate the Obesity-Related Problems Scale (OP), an obesity-specific measure of quality of life, into the Norwegian language and test its reliability, validity and responsiveness in a Norwegian sample. Methods: The sample consisted of 50 patients with severe obesity (mean BMI 51.7, ± 7.5) who underwent BPDDS in a prospective cohort study. Patients were included consecutively from 2001 to 2004. Their mean age was 37.8 (± 8.1), and 27 (54 %) of the patients were women. The inclusion criteria for this surgery were as follows: age between 18 and 60 years, body mass index (BMI) ≥ 40.0 or 35.0-39.9 with obesity- related comorbidities, no alcohol or drug problems, no active psychosis and previous failure to lose weight through other methods. Quality of life was measured with self- reported questionnaires (Short Form-36, OP, Cantril Ladder) before surgery and after one, two, five, and ten years. Data on symptoms of anxiety and depression were also collected from baseline to the five-year follow-up. For the primary aim, the main outcome was ten-year follow-up scores on the physical component summary (PCS) and the mental component summary (MCS) of the SF-36. We used linear mixed- effect models based on restricted maximum likelihood estimation with random intercept for patients to estimate changes over time. The SF-36 scores of the sample were compared with a Norwegian population norm, adjusted for age, gender and BMI. For the secondary aim, the OP questionnaire was translated from the original language (Swedish) into Norwegian. We included patients with severe obesity (mean BMI 45 ± 6.9, mean age 43.1 ± 12.5 years) who were accepted for Sleeve Gastrectomy. Baseline analyses were based on 181 patients (123 women), and follow-up analyses at one year were based on 130 patients. Internal consistency was evaluated using Cronbach’s α. Construct validity was tested by correlating the OP with the Cantril Ladder and the SF-36 using the Pearson correlation coefficient. We used exploratory and confirmatory factor analyses to test the unidimensionality of the OP. Paired sample t-tests were used to test the responsiveness of the OP by assessing changes in the OP from baseline to one-year follow-up. Written informed consent was obtained from the participants and ethical approval was obtained from the Regional Committee for Medical and Health Research Ethics for Western Norway (registration number 234.03 and 2009/2174). Results: Thirty-five patients completed the ten-year follow-up after BPDDS. We found no significant differences in demographic characteristics, BMI, or SF-36 scores at baseline or at five-year follow-up between those who submitted ten-year SF-36 data and those who did not. The mean BMI at ten years was 34.3 (95 % CI, 32.4, 36.2), the mean percent excess body mass index loss was 66.2 % (± 22.2) and the average percent total weight loss was 33.4 % (± 11.3) at ten-year follow-up. The PCS score improved significantly from 32.6 (95 % CI, 29.7, 35.5) at baseline to 44.2 (95 % CI, 40.9, 47.5) at the ten-year follow-up (p&lt 0.001). MCS also improved significantly from 37.8 (95 % CI, 34.2, 41.3) at baseline 46.0 (95 % CI, 41.9, 50.0) at the ten-year follow-up (p&lt 0.001). However, the scores were significantly lower than the normative data ten years after surgery. A total of 130 patients completed the OP at one-year follow-up after sleeve gastrectomy. Internal consistency was high at baseline (Cronbach’s α 0.91). Exploratory and confirmatory factor analyses identified a single factor which explained 62.2 percent of the variance. Correlations between OP at baseline, Cantril Ladder, SF-36 and BMI were statistically significant and in the predicted direction to support validity of the Norwegian version of the OP. After one year, correlations between the change in OP and the change in Cantril Ladder, SF-36 scores and BMI were also statistically significant, except for the change in Role Physical Scale. The OP showed greater responsiveness than either the Cantril Ladder or SF-36. Conclusion: Ten years after BPDDS the patients’ quality of life was significantly improved from preoperative values, with approximately 60 % of the improvements having been maintained from the one-year follow-up. Given the scarcity of long-term studies of quality of life after bariatric surgery, especially those studying BPDDS, further studies should be performed to confirm these findings. In addition, this Norwegian version of the OP is a valid and reliable instrument for measuring psychosocial functioning in a sample with clinically severe obesity

Ingen feil er lov : Høgskulen i Sogn og Fjordane har totalt tre prøver i medikamentrekninga

I ny rammeplan og forskrift for sykepleierutdanning i 2000 ble et lite fagområde spesifisert: "Det skal gjennomføres minst en intern prøve i medikamentrekning. Prøven skal vere feilfri for at studenten skal kunne håndtere legemidler i praksis". Høgskulen i Sogn og Fjordane har totalt tre prøver i medikamentrekninga

Five-year Changes in Health-Related Quality of Life after Biliopancreatic Diversion with Duodenal Switch

Background: Long-term data of health-related quality of life (HRQL) after biliopancreatic diversion with duodenal switch (BPDDS) procedure are lacking. The aim of this study was to evaluate changes in HRQL from baseline to 5 years after BPDDS. Methods: Fifty morbidly obese patients were followed for 5 years after BPDDS procedure. The sample consisted of 27 women and 23 men, the mean age was 37.8 years, and the mean body mass index (BMI) was 51.7 units. HRQL was measured with the Short Form 36 questionnaire (SF-36). Anxiety and depression were measured with the Hospital Anxiety and Depression Scale (HADS). Linear mixed model was used to investigate the change scores. The SF-36 scores and HADS scores of the sample were also compared with a Norwegian population norm, adjusted for age, gender, and BMI. Results: Mental summary scores (MCS) and physical summary scores (PCS) were very low preoperatively but significantly improved (P < 0.05) 5 years after surgery. The PCS was comparable to the population norm, while MCS was lower. Depression improved significantly from baseline to the 5-year follow-up (P = 0.004), but anxiety did not (P = 0.595). Conclusions: This study demonstrates a sustained weight loss and improved, although somewhat fading, HRQL scores 5 years after BPDDS. The study also shows that BPDDS is associated with a sustained reduction in depression symptoms but not in anxiety symptoms

[Ingen feil er lov]

<p>Training of nurse students at Sogn og Fjordane University College, Norway in administration and calculation of medication.</p

A new model of patient-reported outcome monitoring with a clinical feedback system in ostomy care: rationale, description and evaluation protocol

Background Living with an ostomy can be challenging and adapting to life with an ostomy can be particularly complex, with regard to both the physical and psychosocial aspects. Follow-up with a stoma care nurse (SCN) is usually performed after surgery to support the adaptation process. In the present paper, we describe a new model of ostomy care, where a clinical feedback system (CFS) is implemented in order to improve the adaption process of patients with an ostomy. We also present a plan for evaluating patients experience with the CFS and their clinical outcomes. Methods In this study, we include patients who had recently performed colostomy, ileostomy, or urostomy surgery. The intervention includes self-reported measures for adaptation to life with an ostomy and health-related quality of life (HRQoL), as well as patient experiences and satisfaction recorded by the clinical feedback system. The measures are electronically assessed before each clinical consultation at 3, 6, and 12 months after surgery. The scores are instantly analysed and graphically presented for use during the consultation and the patient and the SCN can discuss the findings. Patient experiences and satisfaction with care will be measured with the Generic Short Patient Experiences Questionnaire. Adaptation to the life with ostomy will be measured with the Ostomy Adjustment Scale, and HRQoL with the Short Form 36. Discussion This study presents a novel approach that could lead to improved consultation, more patient involvement, and better adaptation to life with an ostomy

Psychometric Properties of New Subscales of the Ostomy Adjustment Scale: A Cross-Sectional Study

Background: The Ostomy Adjustment Scale (OAS), which consists of an overall sum score along with 34 single-item scores, has been frequently used to measure self-reported adjustment to life with an ostomy. However, it is unknown whether the OAS can be divided into meaningful thematic subscales that may make it easier to administer and to apply in a clinical feedback system. Purpose: The purpose of this study was to specify thematic OAS subscales and evaluate their psychometric properties. Patients and Methods: A cross-sectional study was conducted with 302 patients across Norway having colostomy, ileostomy, or urostomy. The OAS items were divided into different subscales by expert nurses and patients based on clinical and theoretical considerations. The overall structural validity of this analysis of the OAS was examined using robust confirmatory factor analysis. We evaluated the overall goodness of fit using the root mean square error of approximation (RMSEA), the comparative fit index (CFI) and the Tucker–Lewis index (TLI). Factor loadings from the confirmatory factor analysis were used to calculate composite reliability values for the new OAS scales. Results: The OAS was divided into seven subscales. The overall structure validity was acceptable with RMSEA = 0.053 (90% CI, 0.045– 0.060), CFI = 0.913 and TLI = 0.904. The composite reliability values of all scales were > 0.70. Conclusions: The OAS can be divided into seven clinically meaningful subscales with acceptable psychometric properties. Trial Register: ClinicalTrials.gov Registration Number: NCT03841071. Date 18. February 2019 retrospectively registered

Overall Treatment Satisfaction 5 Years After Bariatric Surgery

Introduction: Up to 30 % of patients undergoing bariatric surgery are dissatisfied with treatment outcomes in the long term. The aim of this study was to examine overall satisfaction with treatment 5 years after bariatric surgery and its association with body mass index (BMI) and health-related quality of life (HRQOL). Methods: Patients were surveyed 5 years after bariatric surgery; 108 patients had duodenal switch (DS) and 153 patients had laparoscopic sleeve gastrectomy (LSG). The main outcome was overall treatment satisfaction, assessed by a single question, and analyzed by multiple logistic regression. Estimates for continuous independent variables represent the odds ratios (OR) for a 2-standard deviation difference. Results: Five years after surgery, 82.4 % of the patients were very satisfied or satisfied, whereas 17.6 % were unsure or dissatisfied. The following variables assessed at 5 years were associated with being dissatisfied/unsure: a higher BMI (OR = 6.1, 95 % CI = 2.7–14.0, p < 0.001), reduced obesity-specific HRQOL (OR = 3.0, 95 % CI = 1.1–7.8, p = 0.03), and reduced mental HRQOL (OR = 0.3, 95 % CI = 0.1–0.8, p = 0.02). We also found that a higher proportion of patients who underwent LSG, compared to DS, reported being dissatisfied/unsure (OR = 3.3, 95 % CI = 1.3–8.8, p = 0.01). Conclusion: Reduced mental HRQOL and obesity-related HRQOL, as well as higher BMI, were associated with less satisfaction with overall treatment outcomes 5 years after bariatric surgery. Differences in overall treatment satisfaction by type of operation warrant further investigation