Managing women in pregnancy after bariatric surgery: The midwife as the co-ordinator of care

Bariatric surgery is a recommended, cost-effective, evidenced-based intervention to reduce weight and associated comorbidities in severely obese people. People with a BMI of 40 kg/m2 or more, or a BMI between 35–40 kg/m2 with other medical conditions such as diabetes, hypertension, high cholesterol and obstructive sleep apnoea meet the criteria to be considered for bariatric surgery. Over the past 10 years, bariatric surgery in the UK has been more widely accessible and consequently midwives may be required to care for pregnant women who have undergone bariatric surgery such as a gastric band, sleeve gastrectomy and gastric bypass. Midwives are required to work co-operatively, recognising and working within the limits of their competence and providing leadership. The aim of this article is to consider the midwife's role as co-ordinator of care for pregnant women who have undergone bariatric surgery. It outlines the most common bariatric procedures and specific considerations, including nutritional supplementation required when providing care to women in the antenatal and postnatal period

Ophthalmic Complications of Bariatric Surgery

Obesity is increasing vastly in the world, and the number of bariatric surgeries being performed is also increasing. Patients being submitted to bariatric surgeries, especially malabsorptive procedures, have an increased risk of developing nutrient deficiencies, which can culminate in symptomatic hypovitaminosis, if supplementation is not done correctly. The eye and the optic system need an adequate level of several vitamins and minerals to perform properly, especially vitamin A, and this article wants to cover the main nutrients involved, the possible ophthalmic complications that can arise by their deficiency, and the management of those complications

Psychological Aspects of Bariatric Surgery as a Treatment for Obesity

PURPOSE OF REVIEW: Little is known about the psychological effects on life after bariatric surgery despite the high prevalence of psychological disorders in candidates seeking this procedure. Our review discusses the literature around the psychological impact of bariatric surgery, exploring whether the procedure addresses underlying psychological conditions that can lead to morbid obesity and the effect on eating behaviour postoperatively.RECENT FINDINGS: Findings show that despite undisputed significant weight loss and improvements in comorbidities, current literature suggests some persisting disorder in psychological outcomes like depression and body image for patients at longer term follow-up, compared to control groups. Lack of postoperative psychological monitoring and theoretical mapping limits our understanding of reasons behind these findings. Reframing bariatric approaches to morbid obesity to incorporate psychological experience postoperatively would facilitate understanding of psychological aspects of bariatric surgery and how this surgical treatment maps onto the disease trajectory of obesity

Reliability of trial information across registries for trials with multiple registrations: a systematic review

Importance: Clinical trial registries are key for gaining an overview of ongoing research efforts and for deterring and identifying publication bias and selective outcome reporting. It is uncertain how reliable the information in trial registries is. Objective: To assess the reliability of information across registries for trials with multiple registrations. Evidence Review: We had access to 360 protocols of randomized controlled trials (RCTs) approved by research ethics committees in Switzerland, UK, Canada, or Germany in 2012. Clinical trial registries were searched between March 2019 and September 2019 for corresponding registrations of these RCTs. We identified 197 RCTs that were registered in more than one registry. We extracted in duplicate key trial characteristics that should be identical amongst all trial registries (i.e. sponsor, funding source, primary outcome, target sample size, trial status, and date of first patient enrolment, results available, main publication indexed). Agreement between the different trial registries for these key characteristics was analyzed descriptively (analyses conducted May 2020 until November 2020). Representatives from clinical trial registries were interviewed to discuss the study findings between February 2021 and March 2021. Findings: The included 197 RCTs were registered in two (n=151) or three (n=46) trial registries (i.e. 188 in ClinicalTrials.gov; 185 in EudraCT; 20 in ISRCTN; 47 in other registries). The agreement of key information across all registries was as follows: 90% (178/197; 95% confidence interval [CI], 85%-94%) for sponsor, 90% for funding source (18/20; 95% CI, 68-99%; funding not reported on ClinicalTrials.gov), 78% (154/197; 95% CI, 72-84%) for the primary outcome, 46% (90/197; 95% CI, 39-53%) for the trial status, 62% (122/194; 95% CI, 39-53%) for the target sample size, and 75% for the date of first patient enrolment (43/57; 95% CI, 62-86%; date of first patient enrolment not reported on EudraCT) when the comparison time window was broadened to 30 days. The agreement with respect to results availability on trial registry was 62% (122/197; 95% CI, 55-69%) and 46% (91/197; 95% CI, 39-53%) when assessing whether a publication of the main results was indexed. Different legal requirements were stated as main reason for inconsistencies by representatives of clinical trial registries. Conclusions and relevance: For a substantial proportion of RCTs registered, information about key trial characteristics was inconsistent across trial registries, raising concerns about the reliability. Further dialogue and harmonization across clinical trial registries is necessary to increase their usefulness