Impact of Routine and Long-Term Follow-Up on Weight Loss after Bariatric Surgery.

BACKGROUND: Weight loss after bariatric surgery varies among patients. Patients who do not complete long-term follow-up are considered to loose less weight than those with regular follow-up visits. OBJECTIVE: To evaluate the influence of patients' follow-up compliance on long-term excess weight loss (%EWL) and total weight loss (%TWL) after bariatric surgery, comparing results between gastric bypass (GB) and sleeve gastrectomy (SG). METHODS: Patients with up to 5 years of follow-up data after bariatric surgery were included in this retrospective analysis. Patients were divided in 2 groups: those in group 1 who had attended every scheduled postoperative appointment and those in group 2 who had been lost to follow-up before 1 year and were later contacted by telephone. %EWL and %TWL were compared to determine the possible relationship between type of surgery and regularity of the follow-up. RESULTS: A total of 385 patients were included. A significant difference in EWL was observed at 5 years in the SG group (78% for group 1 versus 39% for group 2; p = 0.02) and GB group (75% for group 1 versus 62% for group 2; p = 0.01). No significant differences between surgeries were found when comparing long-term EWL in group 1 patients 77% for SG versus 75% for GB. For group 2 patients, GB achieved greater EWL than SG; p = 0.005. %TWL patients in group 2 showed significant differences in all periods of study (p < 0.05). CONCLUSION: Bariatric surgery patients who attended all scheduled follow-up appointments experienced significantly greater long-term EWL and TWL than those who did not. GB has apparent increased benefits for weight loss in long-term follow-up when compared with SG for patients who did not attend long-term follow-up. Therefore, continued long-term follow-up of bariatric patients should be encouraged to increase postoperative weight loss results.

La gestión del proceso de fibrilación auricular: un abordaje integral / Managing the atrial fibrillation process: An integral approach

Objetivos. El estudio se ha desarrollado en 3 fases cuyos respectivos objetivos han sido: definir el proceso de gestión más adecuado para la fibrilación auricular (FA) desde el punto de vista de profesionales y pacientes. Conocer cómo se gestiona en la práctica diaria. Identificar los cambios necesarios para que esta práctica diaria se aproxime a una gestión adecuada del proceso. Material y métodos. Diseño: 1.a fase: se han utilizado técnicas de consenso, un análisis de modos de fallo y sus efectos (AMFE) y un grupo focal con pacientes. 2.a fase: se ha desarrollado mediante encuesta. 3.a fase: se han realizado 3 grupos nominales y 3 grupos focales. Emplazamiento: Atención Primaria y Cardiología. Participantes: en la primera fase médicos de familia, cardiólogos y pacientes. En la segunda y tercera, médicos de familia. Mediciones principales: 1.a fase: se ha definido el diagrama de flujo, con sus notas explicativas, del proceso correcto de atención para la FA. 2.a fase: se ha investigado como se atiende en la práctica en la actualidad. 3.a fase: se han identificado las barreras para una correcta atención del proceso y se han definido propuestas para su mejora. Resultados. Casi el 40% de los médicos de familia se implicó en el diagnóstico y tratamiento de sus pacientes con FA. Se identificó la formación, la colaboración entre especialidades, motivación, trabajo en equipo con enfermería y cambios organizacionales como factores imprescindibles para una correcta gestión del proceso. Conclusiones. La FA puede ser gestionada desde Atención Primaria. Para ello son necesarios cambios relevantes en la organización de la asistencia. Se ven como imprescindibles tanto la formación como el apoyo y comunicación entre niveles(AU)

Objectives. The study was developed in 3 phases, with the following aims: To define the most appropriate management process for atrial fibrillation (AF) from the point of view of the health professionals and the patients. To determine how it is managed in daily practice. To identify the changes required in order that this daily practice may come closer to that of an appropriate management process. Material and methods. Design: 1st phase: consensus techniques were used, as well as a failure modes and effects analysis (FMEA), and a focus group with patients. 2nd phase: included a questionnaire. 3rd phase: 3 nominal groups and 3 focus groups were formed. Setting: Primary Care and Cardiology. Participants: Family doctors, cardiologists, and patients, in the first phase, and family doctors in the second and third phases. Main measurements: 1st phase: a flow diagram was designed with its explanatory notes on the correct care process for AF. 2nd phase: how AF was managed in current practice. 3rd phase: barriers for using the correct care process were identified, and proposals for their improvement were defined. Results. Almost 40% of the family doctors were involved in the diagnosis and treatment of their patients with FA. Training, cooperation between specialties, motivation, working in a team with nursing, and organisational changes were identified as essential factors for a proper management process. Conclusions. AF can be managed from Primary Care. To do this, important changes are required in the care organisation. Training, along with support and communication between care levels are also seen as necessary(AU)

[Managing the atrial fibrillation process: an integral approach]. / La gestión del proceso de fibrilación auricular: un abordaje integral.

OBJECTIVES: The study was developed in 3 phases, with the following aims: To define the most appropriate management process for atrial fibrillation (AF) from the point of view of the health professionals and the patients. To determine how it is managed in daily practice. To identify the changes required in order that this daily practice may come closer to that of an appropriate management process. DESIGN: 1st phase: consensus techniques were used, as well as a failure modes and effects analysis (FMEA), and a focus group with patients. 2nd phase: included a questionnaire. 3rd phase: 3 nominal groups and 3 focus groups were formed. SETTING: Primary Care and Cardiology. PARTICIPANTS: Family doctors, cardiologists, and patients, in the first phase, and family doctors in the second and third phases. MAIN MEASUREMENTS: 1st phase: a flow diagram was designed with its explanatory notes on the correct care process for AF. 2nd phase: how AF was managed in current practice. 3rd phase: barriers for using the correct care process were identified, and proposals for their improvement were defined. RESULTS: Almost 40% of the family doctors were involved in the diagnosis and treatment of their patients with FA. Training, cooperation between specialties, motivation, working in a team with nursing, and organisational changes were identified as essential factors for a proper management process. CONCLUSIONS: AF can be managed from Primary Care. To do this, important changes are required in the care organisation. Training, along with support and communication between care levels are also seen as necessary.

First cases of giant pseudocyst complicating inguinal hernia repair.

INTRODUCTION: Giant pseudocyst is a rare type of complication following incisional hernia repair and its correct management is still unknown. MATERIALS AND METHODS: Herein, we describe two unreported cases of giant pseudocyst after inguinal hernia repair. Both patients underwent surgical treatment with partial excision of the pseudocapsule. The two patients were free from recurrence after 6 and 10 months of follow up, respectively. CONCLUSION: Subtotal surgical removal of the pseudocapsule is a definitive treatment.

¿Qué hemos de hacer para cubrir las expectativas de nuestros pacientes?

No disponible

[Health care workers' expectations: what features of health centers do they value most? A qualitative and quantitative study]. / Las expectativas de los profesionales: 'qué aspectos valoran en un centro de salud? Un estudio cuali-cuantitativo.

OBJECTIVES: To identify features of health care centers valued by health care workers as positive, to group features into dimensions, and to determine their relative importance. DESIGN: Qualitative phase: focus groups and content analysis. Quantitative phase: survey with a questionnaire developed from the features identified in the qualitative phase. SETTING: Primary care services in Reus and Tarragona (Catalonia, northeastern Spain). PARTICIPANTS: Managers, medical care providers and admissions staff. A total of 33 workers took part in focus groups, and 136 questionnaires were distributed for the survey, with a 78.6% response rate. MAIN MEASURES: Identification by focus groups of the features to be evaluated. Features were grouped into dimensions at different levels by content analysis. Survey to determine the relative importance of different features. RESULTS: We identified 133 features to be evaluated by workers: 36 related with structural features of the center (architecture, staffing and equipment), 33 with organization (accessibility, team functioning), 23 with workers (knowledge and attitudes) 20 with the services provided (needs and information management, care services provided) and 21 with management. The most highly valued dimensions were workers´ attitudes and management. CONCLUSIONS: Relations with patients and colleagues, and management issues, were valued most highly by workers. Some problematic features such as shared decision-making, team work and minority cultures revealed different levels of awareness and sensitivity within the health care system.

[Expectations of patients: what aspects of a health centre do they value? A qualitative-quantitative study]. / Las expectativas de los pacientes: ¿qué aspectos valoran en un centro de salud? Un estudio cualicuantitativo.

OBJECTIVES: To identify the factors valued by users of health centres; to weigh the relative importance of each factor. DESIGN: Qualitative stage (4 focus groups) to identify the factors valued. Quantitative stage (questionnaire to 225 people) to weigh their relative importance. SETTING: Primary care. PARTICIPANTS: Citizens from middle-high and middle-low social classes, urban, rural and over 65, were chosen through key informants for their interest in the health services. They were recruited with the assistance of various residents' associations and town councils. METHOD: The factors valued were identified through focus groups and classified in categories. Their relative importance was weighed through a questionnaire and a factorial analysis to identify the main components was run. RESULTS: 60 factors that could be valued by patients were identified. Eight of these referred to the centre and concrete assets, nine to organisation and acessibility, 18 to relationship with the health professionals, and 25 to the services available. The most highly valued factor was: "The centre has sufficient material available for cures, minor surgery, bandages, etc." The factorial analysis confirmed the categories established. Organisation and accessibility, and relationship with professionals were the most highly valued dimensions. CONCLUSIONS: The combination of qualitative and quantitative methods seems very fitting for this kind of study. Although many of the factors were to be expected, other little-expected ones emerged. In addition, users seem to value certain factors in a different way from how the professionals do.

Las expectativas de los pacientes: ¿qué aspectos valoran en un centro de salud? Un estudio cualicuantitativo / Expectations of patients: what aspects of a health centre do they value? A qualitative-quantitative study

Objetivos. Identificar los aspectos que valoran los pacientes en los centros de salud. Ponderar la importancia relativa de cada uno de ellos. Diseño. Fase cualitativa (4 grupos focales) para identificar los aspectos que se valoran. Fase cuantitativa (encuesta a 225 ciudadanos) para ponderar su importancia relativa. Emplazamiento. Atención primaria. Participantes. Ciudadanos de clase social media-alta, media-baja, urbanos, rurales y mayores de 65 años, seleccionados a través de informantes clave por su interés en los servicios sanitarios. Se reclutaron con la colaboración de diferentes asociaciones de vecinos y ayuntamientos. Método. Mediante grupos focales se identificaron los aspectos que se valoran, y se clasificaron en categorías. Mediante encuesta se ponderó la importancia relativa de los mismos y se realizó un análisis factorial para identificar los componentes principales. Resultados. Se identificaron 60 aspectos valorables por los pacientes. De ellos, 8 se referían al centro y eran tangibles, 9 a organización y accesibilidad, 18 a relación con los profesionales y 25 a servicios disponibles. El aspecto más valorado fue: "el centro dispone de suficiente material para curas, pequeña cirugía, vendajes, etc.". El análisis factorial confirmó las categorías que se habían establecido. La organización y accesibilidad y las relaciones con los profesionales parecen ser las dimensiones más valoradas. Conclusiones. La combinación de métodos cualitativos y cuantitativos parece muy adecuada para este tipo de estudios. Aunque muchos de los aspectos eran de esperar, aparecen otros poco previsibles. Además, los clientes parecen valorar ciertos aspectos de manera distinta a como lo harían los profesionales (AU)

Cefminox versus Cefoxitin in Hysterectomy Prophylaxis : Clinical Efficacy and Serum and Tissue Concentrations.

This phase III, prospective, randomised, open, controlled clinical trial compared the efficacy of single-dose cefminox (2g) versus triple-dose cefoxitin (2g every 4 hours) as antibiotic prophylaxis in 112 women undergoing gynaecological surgery (vaginal or abdominal hysterectomy). Peak, intraoperative and trough serum concentrations were determined for both antibiotics, as well as their concentrations in myometrial tissue in a subset of patients from the study (22 patients from the cefminox group and 18 from the cefoxitin group). Clinical response was satisfactory in all women treated with cefminox (59 of 59) and in 52 of 53 patients treated with cefoxitin. Fever-related morbidity, hospital stay and adverse reactions were similar in both groups. Peak serum concentrations were 132.3 mg/L for cefminox and 82.2 mg/L for cefoxitin. 12-hour concentrations were 2.82 mg/L for cefminox and 2.17 mg/L for cefoxitin, and were higher than the respective minimum inhibitory concentrations (MICs) for pathogens commonly associated with this pathology. Uterine tissue concentrations were 24.5 and 41.6 mg/L for cefminox and cefoxitin, respectively, and also clearly exceeded MIC. It was shown that the use of a single preoperative dose of cefminox was similar in efficacy to 3 doses of cefoxitin administered every 4 hours, and that the serum and tissue concentrations attained provide adequate antibiotic coverage. In view of the general trend towards the use of a single dose for prophylaxis, cefminox offers a new alternative for antibiotic prophylaxis in gynaecological surgery.