Next in bariatric surgery : the role of lifestyle and adequate information to improve patients’ quality of life and health

Aim: The overall aim of this doctoral thesis is to increase the knowledge about how behavioral modification and information can improve the individual results following bariatric surgery or conventional weight loss treatment. Background: Obesity is a growing health issue often affecting quality of life and morbidity. Bariatric surgery is since many years acknowledged to lead to successful long-term weight loss. Its effect on weight loss is more pronounced in the beginning post-surgery and thereafter some weight regain is to be expected. To counteract this, it is of importance to explore possible ways to support lifestyle changes among patients who choose to undergo bariatric surgery. Digital solutions may be useful in supporting lifestyle changes pre- or post-surgery, but they have to be scientifically evaluated. Methods and materials: In Paper I, 250 women with obesity from Finland, Norway, Germany, Sweden and the Netherlands were asked about their main reasons to seek surgery and their expectation on post-surgery weight loss result. In Paper II, at 1-year post-surgery the Swedish participants from paper I (n=50) were asked which issue they felt most satisfied with post-surgery, and if they were satisfied with their post-surgery weight loss. In Paper III, a cohort of 23,233 persons were recruited within a Web-based weight loss program (viktklubb.se) and the participants eating behavior were measured with TFEQ-R18 at baseline, 3- and 6-months. In Paper IV, 146 out of 201 patients accepted for bariatric surgery were randomized either to standard care or to standard care plus a 3-month-smartphone app intervention to increase their level of moderate-to-vigorous physical activity post-surgery. Results: The main reason to seek bariatric surgery was weight loss. The odds ratio for certain reasons like less co-morbidity, less medication, and longevity was dependent on if the participants had co-morbidities. The participants expected to lose almost 80% of their excessive weight post-surgery. The issue of most satisfaction 1-year post-surgery was improved selfesteem. Only those with a weight loss of more than 80% of their excessive weight were satisfied with their post-surgery weight loss. A change in eating behavior was associated with a greater weight loss in the Web-based weight loss program. The uncontrolled eating score decreased and the cognitive restrained eating score increased in both men and women, whereas a reduction in the emotional eating score only was seen among men. A smartphone app intervention led to a significant increase in minutes/day of moderate-to-vigorous physical activity in the intervention group, compared to the control group receiving standard care postsurgery. Conclusions: To address patient expectations before bariatric surgery may improve postsurgery satisfaction. Individualized pre-surgery information and post-surgery care could be of importance for the lifestyle changes required after bariatric surgery. Technology like Webbased or app-based programs may serve as interactive solutions to support lifestyle changes and the need for individualized information

Registered nurses' perceptions of their career - An interview study

Aim We aim to explore registered nurses' perceptions of their career. Background Career development options have been found to increase attraction to nursing and support nurses' engagement with their organization and profession. Methods We collected qualitative individual interviews with 23 registered nurses; data were analysed with thematic analysis and reported according to the consolidated criteria for reporting qualitative research (COREQ) criteria. Results Three themes emerged: career choices, career engagement and career development. Participants had chosen a nursing career because they perceived it as humane, people oriented, meaningful, diverse and secure work. Participants' engagement in their career was connected to the content of the work, in which direct patient care was central. Nurses connected career development with high competency, independence, influence and meaningful working life experience. However, they perceived career development opportunities as minute within direct patient care. Conclusions Career development opportunities for nurses in direct patient care are needed to foster their career engagement and the attractiveness of the nursing profession. Further research is needed on the career planning and development of nurses working in patient care. Implications for Nursing Management Nurse managers must play a central role in engaging nurses in their careers and promoting their competency and career planning and development in organizations.</p

Registered nurses' perceptions of having a calling to nursing: A mixed-method study

Aim: To explore how nurses perceived having a calling to nursing.Design: A mixed-method study.Methods: Survey data collected in autumn 2020 and semi-structured individual interview data collected in spring 2021. The 7925 survey respondents were care professionals and 414 of them were registered nurses. The 23 interview participants were registered nurses who responded to the survey. We examined the survey results using analysis of variance and t-tests and the interview data with qualitative thematic analysis.Results: Registered nurses had a lower calling than other care professionals. Based on the interviews, having a calling to nursing produce four key findings. Nurses with a calling experienced their work as meaningful. They also adopted a humane and holistic approach to their work. However, their calling could change during their professional career. Due to its historical roots, having a calling was seen as a risk for the nursing profession, as it meant nurses had an oppressed position in society and nurses associated it with poor working conditions and low pay.Conclusion: Our study showed that having a calling to nursing had multidimensional benefits for the individual nurse, their patient, colleagues, organization and society, but showed strong association between calling and nurses' poor working conditions and low pay.Impact: We found that nurses had a lower calling than other care professionals. Calling still exists, but it can produce tension in modern nursing. Organizations and society need to focus on how calling can be seen as a more positive attribute of nursing and improve nurses' working conditions and pay.</p

Nurses' substance use disorder in disciplinary procedures: A retrospective document analysis

Aim and objectives: To describe nurses with substance use disorder (SUD) in authority disciplinary actions.Background: Nurses with SUD risk patient safety. Research evidence on the identification of nurses’ SUD and related management procedures is currently sparse.Design: Retrospective document analysis of decisions related to SUD in nurses’ disciplinary actions.Method: Decisions on nurses (N= 171) made by the Finnish National Supervisory Authority for Welfare and Health in Finland during 2007– 2016 were used as data. An electronic extraction sheet was developed for data collection including variables (N= 34), of which 18 were analysed in this study with descriptive statistical methods and chi-squared statistics. The study reported in accordance with the STROBE checklist for cross-sectional studies.Results: The mean age of the nurses was 43 years (SD 8.7). The most mentioned reasons for notifications leading to disciplinary actions were substance abuse with working while intoxicated and drug theft. The most mentioned intoxicants used were medicines and alcohol. On average, the first disciplinary decision was given at 6.4 months (SD 3.9) and the final decision was given at 17.9 months (SD 13.1). The most common decision was restriction of the right to practice.Conclusion: The results supported findings from previous decades and different continents, showing similar trends are prevalent globally and continue today. In future studies, countries’ registers of nurses with SUD could be used to clarify the profile of nurses and develop appropriate procedures. Qualitative studies could be conducted to investigate to shed light on concealment of the phenomenon.Relevance to clinical  practice:  There is a need for early identification, intervention and referral to treatment as well as effective protocols for reducing nurses’ risks of disciplinary actions related to SUD. It is important to be aware of the signs and symp-toms of SUD and training for this is needed.</p

Health and work well-being associated with employment precariousness among permanent and temporary nurses: A cross-sectional survey

Nursing is at risk of becoming precarious employment with low wages, poor working conditions, heavy workload and underdeveloped career development possibilities. This study aimed to explore employment precariousness, health and work well-being among permanent and temporary practical nurses and registered nurses. The data were collected from Finnish nurses (n = 5867) using an online questionnaire in autumn 2020. This cross-sectional study was reported by applying the STROBE guidelines. Temporary nurses perceived their health and work well-being as being better than permanent nurses; however, they also perceived higher employment precariousness. Vulnerability, such as being treated in an authoritarian manner, had the strongest negative association with health and work well-being among permanent and temporary nurses. Practical nurses and registered nurses perceived employment precariousness in several dimensions, but this needs to be further studied because the results of this study are somewhat contradictory. Also, further studies are required to survey post-COVID-19 care work, as the pandemic likely affected the study, resulting in higher experiences of precariousness.</p

Cost-effectiveness calculators for health, well-being and safety promotion: a systematic review

BackgroundThe health, well-being and safety of the general population are important goals for society, but forecasting outcomes and weighing up the costs and benefits of effective promotional programmes is challenging. This study aimed to identify and describe the cost-effectiveness calculators that analyze interventions that promote health, well-being and safety.MethodsOur systematic review used the CINAHL, PsycINFO, SocINDEX, EconLit, PubMed and Scopus databases to identify peer-reviewed studies published in English between January 2010 and April 2020. The data were analyzed with narrative synthesis.ResultsThe searches identified 6880 papers and nine met our eligibility and quality criteria. All nine calculators focussed on interventions that promoted health and well-being, but no safety promotion tools were identified. Five calculators were targeted at group-level initiatives, two at regional levels and two at national levels. The calculators combined different data sources, in addition to data inputted by users. This included empirical research and previous literature. The calculators created baseline estimates and assessed the cost-effectiveness of the interventions before or after they were implemented. The calculators were heterogeneous in terms of outcomes, the interventions they evaluated and the data and methods used.ConclusionThis review identified nine calculators that assessed the cost-effectiveness of health and well-being interventions and supported decision-making and resource allocations at local, regional and national levels, but none focussed on safety. Producing calculators that work accurately in different contexts might be challenging. Further research should identify how to assess sustainable evaluation of health, well-being and safety strategies.</p

Women's Reasons to Seek Bariatric Surgery and Their Expectations on the Surgery Outcome - a Multicenter Study from Five European Countries

Purpose Understanding patients' reasons for having bariatric surgery and their expectation on surgery outcomes is important to provide the best clinical practice and reduce unrealistic expectations. It is unknown if reasons and expectations differ between countries. We aimed to investigate the reasons for seeking bariatric surgery and expectations of surgical outcomes among patients in five European countries. Methods In total, 250 women accepted for bariatric surgery were recruited: 50 women each from Finland, Germany, Norway, Sweden, and the Netherlands. Participants ranked 14 reasons for seeking surgery, and reported the three primary reasons. They also reported expectations on weight loss and impact of surgery vs. lifestyle on weight loss outcomes. Results Mean age and body mass index were 42.9 +/- 11.5 years and 45.1 +/- 6.2 kg/m(2), respectively. Weight loss and improved co-morbidity were ranked as the most important reasons. Participants expected to lose between 70.8 and 94.3% of their excessive weight. The expected impact of surgery as a driver of weight loss was higher in Germany and the Netherlands compared to in Finland, Norway, and Sweden where participants expected lifestyle changes to also have an impact. Conclusion Weight loss and improved co-morbidities were the main reasons for undergoing bariatric surgery. Expectations on weight loss were generally very high, but expectations of surgery vs. lifestyle as the main driver of weight loss differed between countries. While some patients understand the importance of lifestyle change and maintenance of a healthy lifestyle after surgery in order to obtain a successful weight loss, other may need additional counselling.Peer reviewe

Kohdennettu ja ennakoitu hyvinvoinnin, terveyden ja turvallisuuden edistäminen: vaikutusten ja kustannusten arviointityökalut

Hankkeen tarkoituksena oli kuvata hyvinvoinnin, terveyden ja turvallisuuden edistämisen vaikutusten arviointiin käytettäviä työkaluja. Tutkimushankkeessa toteutettiin kansainvälinen systemoitu kirjallisuuskatsaus, verkkohaut, asiantuntijapaneeli sekä menestysanalyysi. Tutkimushankkeen tulosten mukaan paikalliselle, alueelliselle ja kansalliselle tasolle suunnatut hyvinvoinnin, terveyden ja turvallisuuden edistämisen arviointityökalut kohdistuvat yksilön toiminnan muutoksiin kansanterveyden ja elintapojen, sosiaalisen ja alueellisen hyvinvoinnin ja turvallisuuden sekä työpaikan terveyden ja turvallisuuden interventioissa. Näyttöön perustuvia arviointityökaluja on rajallisesti saatavilla ja niiden käyttöönotto edellyttää kansallisiin tarpeisiin sovittamista. Työkaluja voidaan hyödyntää paitsi taloudellisten vaikutusten arvioinnissa, myös tiedolla johtamisen välineenä ja ennaltaehkäisevän työn osoittamisessa. Työkalujen luotettavuutta ja käyttökelpoisuutta lisää se, että ne perustuvat tieteelliseen näyttöön ja niissä käytettävä tieto on vaivattomasti ja viiveettömästi saatavissa. Hyvinvoinnin, terveyden ja turvallisuuden edistämiseen kohdistuvien arviointityökalujen tarve lyhyen ja pitkän aikavälin suunnittelussa ja päätöksenteossa on ilmeinen. Jotta työkaluja voitaisiin käyttää ja kehittää pitkäjänteisesti, on niiden kansallinen arviointi, ohjaus ja koordinointi välttämätöntä.Tämä julkaisu on toteutettu osana valtioneuvoston selvitys- ja tutkimussuunnitelman toimeenpanoa (tietokayttoon.fi). Julkaisun sisällöstä vastaavat tiedon tuottajat, eikä tekstisisältö välttämättä edusta valtioneuvoston näkemystä

Cost-effectiveness calculators on health and social services planning and evaluation: an explorative interview study of key informants

The aim of this study was to examine the views of key experts on developing and using cost-effectiveness calculators to plan and evaluate health and wellbeing promotion interventions in health and social services. Data for this qualitative interview study were collected from 14 Finnish experts in health and wellbeing coordina-tion, health and social service management and research and health economics in spring 2021. A semi-structured interview method with thematic analysis was used. The experts said that there is a need for cost-effectiveness evaluation tools that support local evidence-based decision-making. This would enable organiza-tions to plan and allocate scarce resources for interventions that promote equitable and effective health and wellbeing. However, practical tools and calculators that enable users to make decisions based on the best available evidence are not widely used. Local decision-makers, researchers and service providers all need to be involved in agreeing goals and selecting the right target groups and measures. They also need to make decisions about the best available data sources and how to use calculators to define and evaluate outcomes. Cost-effectiveness calculators are needed for local evidence-based decision-making, so that municipalities can allocate scarce resources to effective services that increase the wellbeing and equality of residents. This requires key stakeholders to work together to plan, develop and evaluate comprehensive, easy-to-use cost-effectiveness calculators.</p

Macroscopic appearance of the major duodenal papilla influences bile duct cannulation : a prospective multicenter study by the Scandinavian Association for Digestive Endoscopy Study Group for ERCP

Background and Aims: Certain appearances of the major duodenal papilla have been claimed to make cannulation more difficult during ERCP. This study uses a validated classification of the endoscopic appearance of the major duodenal papilla to determine if certain types of papilla predispose to difficult cannulation. Methods: Patients with a naive papilla scheduled for ERCP were included. The papilla was classified into 1 of 4 papilla types before cannulation started. Time to successful bile duct cannulation, attempts, and number of pancreatic duct passages were recorded. Difficult cannulation was defined as after 5 minutes, 5 attempts, or 2 pancreatic guidewire passages. Results: A total of 1401 patients were included from 9 different centers in the Nordic countries. The overall frequency of difficult cannulation was 42% (95% confidence interval [CI], 39%-44%). Type 2 small papilla (52%; 95% CI, 45%-59%) and type 3 protruding or pendulous papilla (48%; 95% CI, 42%-53%) were more frequently difficult to cannulate compared with type 1 regular papilla (36%; 95% CI, 33%-40%; both P <.001). If an inexperienced endoscopist started cannulation, the frequency of failed cannulation increased from 1.9% to 6.3% (P <.0001), even though they were replaced by a senior endoscopist after 5 minutes. Conclusions: The endoscopic appearance of the major duodenal papilla influences bile duct cannulation. Small type 2 and protruding or pendulous type 3 papillae are more frequently difficult to cannulate. In addition, cannulation might even fail more frequently if a beginner starts cannulation. These findings should be taken into consideration when performing studies regarding bile duct cannulation and in training future generations of endoscopists.Peer reviewe