The Value of Tracking Data on the Behavior of Patients Who Have Undergone Bariatric Surgery:Explorative Study

Background: To maintain the benefits of a bariatric procedure, patients have to change their lifestyle permanently. This happens within a context of coresponsibilities of health care professionals and their social support system. However, most interventions are focused on the patient as an individual. In this explorative pilot study, behavioral, contextual, and experiential data were gathered to obtain insight on coresponsibility. Objective: The aim of this study is to explore the use of trackers by patients who have undergone bariatric surgery in a data-enabled design approach. Methods: Behavioral and contextual data on the households of patients who have undergone bariatric surgery were explored using a smartphone with an interactive user interface (UI), weight scale, activity bracelet, smart socket, accelerometer motion sensor, and event button to find examples of opportunities for future interventions. Results: A total of 6 households were monitored. Approximately 483,000 data points were collected, and the participants engaged in 1483 conversations with the system. Examples were found using different combinations of data types, which provided the obesity team a better understanding of patient behaviors and their support system, such as a referral to a family coach instead of a dietician. Another finding regarding the partners was, for example, that the conversational UI system facilitated discussion about the support structure by asking for awareness. Conclusions: An intelligent system using a combination of quantitative data gathered by data tracking products in the home environment and qualitative data gathered by app-enhanced short conversations, as well as face-to-face interviews, is useful for an improved understanding of coresponsibilities in the households of patients who have undergone bariatric surgery. The examples found in this explorative study so far encourage research in this field.</p

The Value of Tracking Data on the Behavior of Patients Who Have Undergone Bariatric Surgery:Explorative Study

Background: To maintain the benefits of a bariatric procedure, patients have to change their lifestyle permanently. This happens within a context of coresponsibilities of health care professionals and their social support system. However, most interventions are focused on the patient as an individual. In this explorative pilot study, behavioral, contextual, and experiential data were gathered to obtain insight on coresponsibility. Objective: The aim of this study is to explore the use of trackers by patients who have undergone bariatric surgery in a data-enabled design approach. Methods: Behavioral and contextual data on the households of patients who have undergone bariatric surgery were explored using a smartphone with an interactive user interface (UI), weight scale, activity bracelet, smart socket, accelerometer motion sensor, and event button to find examples of opportunities for future interventions. Results: A total of 6 households were monitored. Approximately 483,000 data points were collected, and the participants engaged in 1483 conversations with the system. Examples were found using different combinations of data types, which provided the obesity team a better understanding of patient behaviors and their support system, such as a referral to a family coach instead of a dietician. Another finding regarding the partners was, for example, that the conversational UI system facilitated discussion about the support structure by asking for awareness. Conclusions: An intelligent system using a combination of quantitative data gathered by data tracking products in the home environment and qualitative data gathered by app-enhanced short conversations, as well as face-to-face interviews, is useful for an improved understanding of coresponsibilities in the households of patients who have undergone bariatric surgery. The examples found in this explorative study so far encourage research in this field.</p

Ekstrak Virgin Coconut Oil Sebagai Sumber Pangan Fungsional

Virgin Coconut Oil (VCO) merupakan salah satu jenis minyak nabati yang dapat bermanfaat dari aspek medis dan nutrisi karena dapat mencegah dan membantu mengobati penyakit tertentu serta dapat mempermudah proses pencernaan makanan dan penyerapan gizi. VCO dapat bertindak sebagai antioksidan dan antifotooksidan yang disebabkan oleh kandungan komponen minor (mikronutrien). Tujuan penelitian ini adalah mengekstrak komponen minor VCO menjadi produk untuk pangan fungsional yang mampu berperan sebagai antioksidan dan mengetahui peran VCO sebagai antiradikal bebas secara in vitro. Penelitian ini menggunakan metode eksperimental dengan 3 tahap yaitu: 1. Ekstraksi VCO menggunakan pelarut etanol dan metanol, 2. Pengujian penangkapan radikal bebas ekstrak VCO secara in vitro dengan metode 1,1-difenil-2-pikrilhidrazil (DPPH), 3. Identifikasi dan pengujian komponen kimia pada ekstrak VCO, identifikasi dan pengujian komponen minor pada ekstrak VCO dengan menggunakan High Performance Liquid Chromatography (HPLC). Hasil penelitian ini menunjukkan bahwa rendemen ekstrak VCO semakin tinggi dengan semakin tingginya persentase pelarut, ekstraksi dengan menggunakan etanol menghasilkan rendemen ekstrak yang lebih tinggi dibanding dengan menggunakan metanol. Aktivitas antioksidan dan kandungan total tokoferol dari ekstrak VCO semakin tinggi dengan semakin tingginya persentase pelarut yang digunakan. Salah satu senyawa tokoferol yang terdapat dalam VCO adalah -tokoferol. Berdasarkan analisa statistik menunjukkan bahwa etanol dan metanol menghasilkan sifat kimia ekstrak yang relatif sama, sehingga dapat direkomendasikan bahwa untuk mengekstraksi komponen minor dari VCO dapat menggunakan etanol karena di samping aman dari aspek kesehatan juga dapat menghasilkan rendemen ekstrak yang lebih tinggi

Lessons Learned from Telemonitoring in an Outpatient Bariatric Surgery Pathway-Secondary Outcomes of a Patient Preference Clinical Trial

Background: Remote monitoring is increasingly used to support postoperative care. This study aimed to describe the lessons learned from the use of telemonitoring in an outpatient bariatric surgery pathway. Materials and Methods: Patients were assigned based on their preference to an intervention cohort of same-day discharge after bariatric surgery. In total, 102 patients were monitored continuously for 7 days using a wearable monitoring device with a Continuous and Remote Early Warning Score–based notification protocol (CREWS). Outcome measures included missing data, course of postoperative heart and respiration rate, false positive notification and specificity analysis, and vital sign assessment during teleconsultation. Results: In 14.7% of the patients, data for heart rate was missing for &gt; 8 h. A day-night-rhythm of heart rate and respiration rate reappeared on average on postoperative day 2 with heart rate amplitude increasing after day 3. CREWS notification had a specificity of 98%. Of the 17 notifications, 70% was false positive. Half of them occurred between day 4 and 7 and were accompanied with surrounding reassuring values. Comparable postoperative complaints were encountered between patients with normal and deviated data. Conclusion: Telemonitoring after outpatient bariatric surgery is feasible. It supports clinical decisions, however does not replace nurse or physician care. Although infrequent, the false notification rate was high. We suggested additional contact may not be necessary when notifications occur after restoration of circadian rhythm or when surrounding reassuring vital signs are present. CREWS supports ruling out serious complications, what may reduce in-hospital re-evaluations. Following these lessons learned, increased patients’ comfort and decreased clinical workload could be expected. Trial Registration: ClinicalTrials.gov. Identifier: NCT04754893. Graphical Abstract: [Figure not available: see fulltext.]</p

The Metabolic Health Index Identifies Patients That Will Benefit From Metabolic Surgery

Introduction: Metabolic syndrome is a modern world's major health hazard related to comorbidities like type 2 diabetes and cardiovascular disease. Bariatric surgery is well known to lower this health risk in patients with obesity. There is a need for an objective measure to assess the intended reduction in health hazard and indirectly the eligibility for bariatric surgery. The Metabolic Health Index (MHI) quantitatively summarizes the cumulative impact of the metabolic syndrome on health status on a scale from 1 to 6. This study describes the use of the MHI as a supportive tool in the decision for and outcome assessment of bariatric surgery. Methods: The general usability of the MHI was tested by extending its application to patient data of five other bariatric centers in the Netherlands. Retrospective laboratory and national bariatric quality registry data of 11,501 patients were collected. Results: The quantification of (improvement in) metabolic health burden as measured by the MHI was independent of the dataset that was used to derive the MHI model. Patients with MHI &gt; 2.8 prior to surgery improved significantly more in MHI 12 mo after surgery compared to patients with MHI ≤ 2.8 (1.1 compared to 0.4 MHI points, respectively; P &lt; 0.001). Conclusions: The MHI is robust between centers and is suitable for general use in clinical decision-making. As changes in MHI over time reflect metabolic health alterations, it is suitable as an outcome measure of surgery. An MHI cut-off value of 2.8 helps to predict the likelihood of significant improvement after surgery, independent of body mass index and known metabolic comorbidities.</p

Postoperative circadian patterns in wearable sensor measured heart rate:a prospective observational study

PURPOSE: This study aimed to describe the 24-hour cycle of wearable sensor-obtained heart rate in patients with deterioration-free recovery and to compare it with patients experiencing postoperative deterioration.METHODS: A prospective observational trial was performed in patients following bariatric or major abdominal cancer surgery. A wireless accelerometer patch (Healthdot) continuously measured postoperative heart rate, both in the hospital and after discharge, for a period of 14 days. The circadian pattern, or diurnal rhythm, in the wearable sensor-obtained heart rate was described using peak, nadir and peak-nadir excursions.RESULTS: The study population consisted of 137 bariatric and 100 major abdominal cancer surgery patients. In the latter group, 39 experienced postoperative deterioration. Both surgery types showed disrupted diurnal rhythm on the first postoperative days. Thereafter, the bariatric group had significantly lower peak heart rates (days 4, 7-12, 14), lower nadir heart rates (days 3-14) and larger peak-nadir excursions (days 2, 4-14). In cancer surgery patients, significantly higher nadir (days 2-5) and peak heart rates (days 2-3) were observed prior to deterioration.CONCLUSIONS: The postoperative diurnal rhythm of heart rate is disturbed by different types of surgery. Both groups showed recovery of diurnal rhythm but in patients following cancer surgery, both peak and nadir heart rates were higher than in the bariatric surgery group. Especially nadir heart rate was identified as a potential prognostic marker for deterioration after cancer surgery.</p

The Metabolic Health Index Identifies Patients That Will Benefit From Metabolic Surgery

Introduction: Metabolic syndrome is a modern world's major health hazard related to comorbidities like type 2 diabetes and cardiovascular disease. Bariatric surgery is well known to lower this health risk in patients with obesity. There is a need for an objective measure to assess the intended reduction in health hazard and indirectly the eligibility for bariatric surgery. The Metabolic Health Index (MHI) quantitatively summarizes the cumulative impact of the metabolic syndrome on health status on a scale from 1 to 6. This study describes the use of the MHI as a supportive tool in the decision for and outcome assessment of bariatric surgery. Methods: The general usability of the MHI was tested by extending its application to patient data of five other bariatric centers in the Netherlands. Retrospective laboratory and national bariatric quality registry data of 11,501 patients were collected. Results: The quantification of (improvement in) metabolic health burden as measured by the MHI was independent of the dataset that was used to derive the MHI model. Patients with MHI &gt; 2.8 prior to surgery improved significantly more in MHI 12 mo after surgery compared to patients with MHI ≤ 2.8 (1.1 compared to 0.4 MHI points, respectively; P &lt; 0.001). Conclusions: The MHI is robust between centers and is suitable for general use in clinical decision-making. As changes in MHI over time reflect metabolic health alterations, it is suitable as an outcome measure of surgery. An MHI cut-off value of 2.8 helps to predict the likelihood of significant improvement after surgery, independent of body mass index and known metabolic comorbidities.</p

Patient-reported outcomes during repetitive oxaliplatin-based pressurized intraperitoneal aerosol chemotherapy for isolated unresectable colorectal peritoneal metastases in a multicenter, single-arm, phase 2 trial (CRC-PIPAC)

BACKGROUND: CRC-PIPAC prospectively assessed repetitive oxaliplatin-based pressurized intraperitoneal aerosol chemotherapy (PIPAC-OX) as a palliative monotherapy (i.e., without concomitant systemic therapy in between subsequent procedures) for unresectable colorectal peritoneal metastases (CPM). The present study explored patient-reported outcomes (PROs) during trial treatment. METHODS: In this single-arm phase 2 trial in two tertiary centers, patients with isolated unresectable CPM received 6-weekly PIPAC-OX (92 mg/m(2)). PROs (calculated from EQ-5D-5L, and EORTC QLQ-C30 and QLQ-CR29) were compared between baseline and 1 and 4 weeks after the first three procedures using linear mixed modeling with determination of clinical relevance (Cohen’s D ≥ 0.50) of statistically significant differences. RESULTS: Twenty patients underwent 59 procedures (median 3 [range 1–6]). Several PROs solely worsened 1 week after the first procedure (index value − 0.10, p < 0.001; physical functioning − 20, p < 0.001; role functioning − 27, p < 0.001; social functioning − 18, p < 0.001; C30 summary score − 16, p < 0.001; appetite loss + 15, p = 0.007; diarrhea + 15, p = 0.002; urinary frequency + 13, p = 0.004; flatulence + 13, p = 0.001). These PROs returned to baseline at subsequent time points. Other PROs worsened 1 week after the first procedure (fatigue + 23, p < 0.001; pain + 29, p < 0.001; abdominal pain + 32, p < 0.001), second procedure (fatigue + 20, p < 0.001; pain + 21, p < 0.001; abdominal pain + 20, p = 0.002), and third procedure (pain + 22, p < 0.001; abdominal pain + 22, p = 0.002). Except for appetite loss, all changes were clinically relevant. All analyzed PROs returned to baseline 4 weeks after the third procedure. CONCLUSIONS: Patients receiving repetitive PIPAC-OX monotherapy for unresectable CPM had clinically relevant but reversible worsening of several PROs, mainly 1 week after the first procedure. TRIAL REGISTRATION: Clinicaltrials.gov: NCT03246321; Netherlands trial register: NL6426. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00464-021-08802-6

Towards Equal Access to Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy and Survival in Patients with Isolated Colorectal Peritoneal Metastases:A Nationwide Population-Based Study

Background: Before 2016, patients with isolated synchronous colorectal peritoneal metastases (PMCRC) diagnosed in expert centers had a higher odds of undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) and better overall survival (OS) than those diagnosed in referring centers. Nationwide efforts were initiated to increase awareness and improve referral networks. Methods: This nationwide study aimed to evaluate whether the between-center differences in odds of undergoing CRS-HIPEC and OS have reduced since these national efforts were initiated. All patients with isolated synchronous PMCRC diagnosed between 2009 and 2021 were identified from the Netherlands Cancer Registry. Associations between hospital of diagnosis and the odds of undergoing CRS-HIPEC, as well as OS, were assessed using multilevel multivariable regression analyses for two periods (2009–2015 and 2016–2021). Results: In total, 3948 patients were included. The percentage of patients undergoing CRS-HIPEC increased from 17.2% in 2009–2015 (25.4% in expert centers, 16.5% in referring centers), to 23.4% in 2016–2021 (30.2% in expert centers, 22.6% in referring centers). In 2009–2015, compared with diagnosis in a referring center, diagnosis in a HIPEC center showed a higher odds of undergoing CRS-HIPEC (odds ratio [OR] 1.64, 95% confidence interval [CI] 1.02–2.67) and better survival (hazard ratio [HR] 0.80, 95% CI 0.66–0.96). In 2016–2021, there were no differences in the odds of undergoing CRS-HIPEC between patients diagnosed in HIPEC centers versus referring centers (OR 1.27, 95% CI 0.76–2.13) and survival (HR 1.00, 95% CI 0.76–1.32). Conclusion: Previously observed differences in odds of undergoing CRS-HIPEC were no longer present. Increased awareness and the harmonization of treatment for PMCRC may have contributed to equal access to care and a similar chance of survival at a national level.</p

Towards Equal Access to Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy and Survival in Patients with Isolated Colorectal Peritoneal Metastases:A Nationwide Population-Based Study

Background: Before 2016, patients with isolated synchronous colorectal peritoneal metastases (PMCRC) diagnosed in expert centers had a higher odds of undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) and better overall survival (OS) than those diagnosed in referring centers. Nationwide efforts were initiated to increase awareness and improve referral networks. Methods: This nationwide study aimed to evaluate whether the between-center differences in odds of undergoing CRS-HIPEC and OS have reduced since these national efforts were initiated. All patients with isolated synchronous PMCRC diagnosed between 2009 and 2021 were identified from the Netherlands Cancer Registry. Associations between hospital of diagnosis and the odds of undergoing CRS-HIPEC, as well as OS, were assessed using multilevel multivariable regression analyses for two periods (2009–2015 and 2016–2021). Results: In total, 3948 patients were included. The percentage of patients undergoing CRS-HIPEC increased from 17.2% in 2009–2015 (25.4% in expert centers, 16.5% in referring centers), to 23.4% in 2016–2021 (30.2% in expert centers, 22.6% in referring centers). In 2009–2015, compared with diagnosis in a referring center, diagnosis in a HIPEC center showed a higher odds of undergoing CRS-HIPEC (odds ratio [OR] 1.64, 95% confidence interval [CI] 1.02–2.67) and better survival (hazard ratio [HR] 0.80, 95% CI 0.66–0.96). In 2016–2021, there were no differences in the odds of undergoing CRS-HIPEC between patients diagnosed in HIPEC centers versus referring centers (OR 1.27, 95% CI 0.76–2.13) and survival (HR 1.00, 95% CI 0.76–1.32). Conclusion: Previously observed differences in odds of undergoing CRS-HIPEC were no longer present. Increased awareness and the harmonization of treatment for PMCRC may have contributed to equal access to care and a similar chance of survival at a national level.</p