Global variations in preoperative practices concerning patients seeking primary bariatric and metabolic surgery (PACT Study): A survey of 634 bariatric healthcare professionals.

BACKGROUND: Bariatric and Metabolic Surgery (BMS) is a popular weight loss intervention worldwide, yet few scientific studies have examined variations in preoperative practices globally. This study aimed to capture global variations in preoperative practices concerning patients planned for BMS. METHODS: A 41-item questionnaire-based survey was designed and the survey link was freely distributed on social and scientific media platforms, email groups and circulated through personal connections of authors. The survey included eight parts: basic information; criteria for BMS; preoperative nutritional screening; preoperative weight loss; preoperative diets for liver size reduction; preoperative glycemic control; other laboratory investigations and preparations; decision making, education, and consents. Descriptive statistics were used to analyse data and graphs were used for representation where applicable. RESULTS: Six hundred thirty-four bariatric healthcare professionals from 76 countries/regions completed the survey. Of these, n = 310 (48.9%) were from public hospitals, n = 466 (73.5%) were surgeons, and the rest were multidisciplinary professionals. More than half of respondents reported using local society/association guidelines in their practice (n = 310, 61.6%). The great majority of respondents routinely recommend nutritional screening preoperatively (n = 385, 77.5%), mandatory preoperative diets for liver size reduction (n = 220, 53.1%), routine screening for T2DM (n = 371, 90.7%), and mandate a glycemic control target before BMS in patients with T2DM (n = 203, 55.6%). However, less than half (n = 183, 43.9%) recommend mandatory preoperative weight loss to all patients. Most respondents (n = 296, 77.1%) recommend psychological intervention before surgery for patients diagnosed with psychological conditions. Variations were also identified in laboratory investigations and optimisation; and in the aspects of decision making, education and consent. CONCLUSIONS: This survey identified significant global variations in preoperative practices concerning patients seeking primary BMS. Our findings could facilitate future research for the determination of best practice in these areas of variations, and consensus-building to guide clinical practice while we wait for that evidence to emerge.

Impact of COVID-19 on Obesity Management Services in the United Kingdom (The COMS-UK study).

Coronavirus Disease-2019 (COVID-19) has had a severe impact on all aspects of global healthcare delivery. This study aimed to investigate the nationwide impact of the pandemic on obesity management services in the UK in a questionnaire-based survey conducted of professionals involved in the delivery. A total of 168 clinicians took the survey; the majority of which maintained their usual clinical roles and were not redeployed except physicians and nurse specialists. Nearly all (97.8%) elective bariatric surgery was cancelled, 67.3% of units cancelled all multidisciplinary meeting activity, and the majority reduced clinics (69.6%). Most respondents anticipated that the services would recommence within 1-3 months. This study found that the COVID-19 pandemic has had a severe impact on the services involved in the management of patients suffering from severe, complex obesity in the UK.

British Obesity Metabolic Surgery Society endorsed guidelines for psychological support pre- and post-bariatric surgery.

Research teams have argued that some bariatric patients require psychological input pre- and post-surgery and that weight loss surgery should only be undertaken by a multidisciplinary team (MDT) that can provide psychological support. To date, no guidelines exist for the provision of psychological support pre- and post-bariatric surgery. The authors were approached by British Obesity Metabolic Surgery Society (BOMSS) in September 2017 to produce guidelines for the provision of psychological support for patients pre- and post-bariatric surgery. These guidelines were developed using seven stages: (a) review of evidence base; (b) expert input; (c) feedback from BOMSS delegates; (d) feedback from the special interest group; (e) service user feedback; (f) presentation to BOMSS council; and (g) presentation to the Association for the Study of Obesity. The guidelines describe two stepped care service models for the delivery of psychological support pre-surgery and 6 to 9 months post-surgery involving online resources, group workshops and one-to-one with a clinical psychologist. They are founded upon the following principles: (a) a living document to be modified over time; (b) flexible and pragmatic; (c) advisory not prescriptive; (d) broad based content; (e) skills based delivery. These guidelines are feasible for use across all services and should minimize patient risk and maximize patient health outcomes.

The utility of CPD for older adult mental health nurses.

AIM: To investigate how mental health nurses working with older adults perceive the benefits and realities of developing the outcomes of current continuing professional development training into actual clinical practice. METHOD: A structured questionnaire was used with a convenience sample of nursing staff. Qualitative analysis was performed using a grounded theory approach in order to identify emergent themes, concepts and categories of data. Four randomly selected nurses were subjected to a voluntary semistructured interview using the questionnaire as a basis for information gathering. RESULTS: The main reason for attending courses was developing skills. Of those attending courses, 42 per cent of qualified and 35 per cent of unqualified staff had a personal development plan (PDP) or individual performance review (IPR). Significantly, all unqualified staff who had not been on a course had no PDP or IPR. Learning was described as applicable to practice by 85 per cent of unqualified and 70 per cent of qualified staff. However, 28 per cent of unqualified staff and 20 per cent of qualified staff felt their practice had not changed as a result of their learning. CONCLUSION: CPD can be a positive experience, providing nurses with the opportunity to direct their professional development.