Updates on obesity managment including basics and recent updates of 5 As of Canadian Obesity network
If any one needs this presentation you can email me Tarek1.mohamed@mu.edu.eg
My seminar Obesity by Hani
Obesity is a public health and policy problem because of its increase prevalence, costs and health effect. (WHO, 2012, National heart lung and blood institute. 2012)
. The risk factor for chronic disease are highly prevalence (Zindah, Belbeisi, Walke & Makdad 2008)
The obesity and the overweight are risk for number of chronic disease include diabetes cardio vascular disease and cancer (WHO,2010)
Updates on obesity managment including basics and recent updates of 5 As of Canadian Obesity network
If any one needs this presentation you can email me Tarek1.mohamed@mu.edu.eg
My seminar Obesity by Hani
Obesity is a public health and policy problem because of its increase prevalence, costs and health effect. (WHO, 2012, National heart lung and blood institute. 2012)
. The risk factor for chronic disease are highly prevalence (Zindah, Belbeisi, Walke & Makdad 2008)
The obesity and the overweight are risk for number of chronic disease include diabetes cardio vascular disease and cancer (WHO,2010)
CONCEPTION AFTER BARIATRIC SURGERY - dr Pushp, S.pptxDrPushpaSankhwar
conception after bariatric surgery is a high-risk case that needs close monitoring by a team of obstetricians, bariatric surgeons, nutritionists, and sonologists.
This ppt covers the role of diet in various diseases and the effects of excessive stress and gives an overview of the optimal diet in various non-communicable diseases.
Dr B Ravinder Reddy
Care Hospital, Hyderabad, India
Book Summary of The Longevity Diet: Discover the New Science Behind Stem Cell Activation and Regeneration to Slow Aging, Fight Disease, and Optimize Weight by Valter Longo
This presentation was delivered at Puri on 10th january 2015
on the occasion of annual Rotary District Conference along with IMA Puri. It highlights on metabolic syndrome and its surgical solution.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Explore our infographic on 'Essential Metrics for Palliative Care Management' which highlights key performance indicators crucial for enhancing the quality and efficiency of palliative care services.
This visual guide breaks down important metrics across four categories: Patient-Centered Metrics, Care Efficiency Metrics, Quality of Life Metrics, and Staff Metrics. Each section is designed to help healthcare professionals monitor and improve care delivery for patients facing serious illnesses. Understand how to implement these metrics in your palliative care practices for better outcomes and higher satisfaction levels.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
ICH Guidelines for Pharmacovigilance.pdfNEHA GUPTA
The "ICH Guidelines for Pharmacovigilance" PDF provides a comprehensive overview of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines related to pharmacovigilance. These guidelines aim to ensure that drugs are safe and effective for patients by monitoring and assessing adverse effects, ensuring proper reporting systems, and improving risk management practices. The document is essential for professionals in the pharmaceutical industry, regulatory authorities, and healthcare providers, offering detailed procedures and standards for pharmacovigilance activities to enhance drug safety and protect public health.
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
6. The Practical Guide; Identification, Evaluation and treatment of
Overweight and Obesity in Adults, Oct 2000, NIH Pub No 00-4084
7. BARIATRIC SURGERY
Bariatric surgery is more effective
than nonsurgical treatment for weight
loss and control of some comorbid
conditions in MORBID OBESE patients
9. Prior to surgery candidates should be carefully
assessed by a specialized multidisciplinary team
including:
Bariatrician (MD specializing in the care of the obese)
Surgeon
PCP
Social Worker/ Psychologist
Dietitian
Nurse
10. • During active weight management,
multicomponent interventions that are
delivered through multidisciplinary care may
be more effective than interventions delivered
by individual health professionals (Flodgren et
al. 2010; Tsai & Wadden 2009).
12. Pre-Surgical Goals
Improvement of nutritional status
• Correct vitamin/nutrient deficiencies (most common include:
iron, vitamin B12 and vitamin D)
Achievement of better control of nutrition- related
comorbidities
Development of lifestyle and eating habits that will
promote positive post-weight loss surgery outcomes
and weight loss maintenance
Promote 5-10% weight loss to reduce surgical risks
13. Post-Surgery
Nutrition Guidelines
• Dietary consult ordered upon admit
– Complete nutrition assessment
– Review diet progression with patient
– Work with in-patient team to identify & minimize
complications post-op
• For all procedures patients will follow the
same diet
15. Diet advanced from NPO to Stage 1 Bariatric Diet on
Post op Day 1
• Stage 1 - Water
– Typically start day of surgery; Duration < 1 day
– Nursing staff to administer 1oz water per hour via
medicine cup
• Instruct patient to sip slowly & stop if feeling full or
nauseous
– All medications to be administered in liquid/chewable
form
– IV Fluid until tolerating liquids
– Patient to begin tracking fluid intake on Patient Intake
Diary (provided by healthcare team)
16. • Stage 2 - Bariatric Clear Liquids
– Starts Post op Day1; Duration 1-2 days
– Non-carbonated liquids without calories, sugar, or
caffeine; includes broth, sugar-free (SF) ice pops, SF
gelatin, water, & ice chips
– Priority is hydration
– Instruct to sip slowly & stop if feeling full or nauseous
(avoid straws)
– Will receive 3oz Bariatric Clear Liquids 3 times a day on
meal trays
– Instruct to sip 2-4 oz Bariatric Clear Fluids per hour
between meals
– Will be expected to track intake on Patient Intake Diary
17. Stage 3 - Bariatric Full Liquids
• Starts Post op Day 1-2; duration 2-4 weeks
• Will receive 3oz Bariatric Full Liquids 3 times a day on meal trays
• Low-fat protein-rich liquids with (exp. Low-fat (LF) broth, LF milk,
protein shakes; light/LF yogurt, LF cottage cheese; LF/SF
pudding) juven/beneprotein
• Priority on hydration and protein intake (minimize loss of lean
body mass)
• Instruct to sip slowly & stop if feeling full or nauseous
• Instruct to sip 2-4 oz fluids per hour between meals
• Note: Patients will go home on this stage. You may not see
other stages unless patients are re-admitted
18. Stage 4 - Soft and Moist Protein
• Start 2 weeks post-op; Duration 4-6 weeks
As tolerated replace full liquids with soft & moist protein
foods (avoid dry or tough meats); ~2-4oz per meal
• May need to continue with protein shakes to meet protein
needs
• Instruct not to drink fluids with meals; wait 30 min before &
after each meal to have beverages
• If meeting protein goals may add well-cooked soft fruits &
vegetables
• Will begin taking chewable vitamin & mineral supplements
19. Stage 5
• Low Fat, Low Sugar, High Protein
• Start 6-8 weeks post-op; Duration lifelong
• Balanced solid food diet with protein, fruits, vegetables, and
whole grains. Can add raw foods as tolerated.
• Goals:
– 60-80 grams protein /day
– 64+ ounces fluid/ day (including protein drinks) sipped
between meals.
• Continue to separate fluids from your meals
• Can advance to supplements in tablet form if tolerated
21. • Dehydration
– Monitor for signs and symptoms of dehydration as
patients are at greater risk given their dietary restrictions.
Patients should strive for 64 ounces of liquids per day.
• Nausea and Vomiting
– Eating too quickly or too much, drinking with meals or
drinking too close to meals, not chewing thoroughly, or
advancing the diet too quickly can all lead to nausea
and/or vomiting. Persistent vomiting can lead to thiamin
deficiency.
– Encourage patients to drink and eat slowly, stop if feeling
full or nauseous, and take small bites and chew their foods
thoroughly.
22. • Dumping Syndrome
– Usually occurs ~30 minutes following a meal.
– Symptoms may be similar to the flu and include nausea,
sweating, bloating, abdominal cramps, and diarrhea.
– To avoid these symptoms patients should avoid high fat and
high sugar foods. or example instead of 100% fruit juice; dilute
1:1 with water.
• Diarrhea
– Some patients can develop post-operative lactose intolerance.
Symptoms could include bloating, abdominal cramps, excessive
gas, and diarrhea.
– Treatment includes following a lactose-free diet.
24. • Stomach
– Water, ethyl alcohol, copper, iodide, fluoride,
molybdemum, intrinsic factor
• Duodenum
– Calcium, iron, phosphorus, magnesium, copper,
selenium, thiamin, riboflavin, niacin, biotin, folate,
vitamins A, D, E, K
Shikora SA, Kim JJ, Tarnoff ME. Nutrition and gastrointestinal complications of bariatric
surgery. Nutr Clin Pract. 2007;22(1):29-40.
25. • Jejunum
– Thiamin, riboflavin, niacin, pantothenate, biotin,
folate, vit B6, vit C, vit A, D, E, K, dipeptides,
tripeptides, calcium, phosphorus, magnesium,
iron, zinc, chromium, manganese, molybdenum,
amino acids
• Ileum
– Vit C, folate, vit B12, vit D, vit K, magnesium, bile
salts/acids
28. • Gastric Bypass:
– Most common: Iron, Vitamin B-12,
Folic acid, Fat soluble Vitamins A, D, & E
– Thiamin (seen in patients with frequent vomiting)
– Calcium
– Protein malnutrition
• Gastric Banding:
– Except for folate, nutrition deficiencies are less
commonly seen post gastric banding
• Sleeve Gastrectomy
– Possible B-12
29. Iron deficiency and anemia
• As high as 49% of patients
• Multifactorial cause
– Low gastric acid levels prohibit iron cleavage from food
– Absorption inhibited because no nutrient exposure to
duodenum or proximal jejunum
– Decrease in iron-rich food consumption due to
intolerance
• Treat with oral supplementation of ferrous sulfate
or ferrous gluconate
30. Vitamin B12 deficiency
• Up to 70% of patients
• Lack of hydrochloric acid and pepsin in stomach
– Prevents B12 cleavage from food
– Affects secretion of intrinsic factor, thus B12
absorption
• Intolerance to meat and milk
• Oral supplementation usually adequate,
otherwise, IM injections used
31. Folate Deficiency
• 40% of gastric bypass patients
• Complete absorption requires B12
• Absorption dependent on HCl and upper 1/3
stomach
• Deficiency generally caused by decreased
consumption
• Oral supplementation
32. Vitamin D and Calcium Deficiency
• Vitamin D deficiency is common among obese
people
• Calcium absorption decreased because duodenum is
bypassed
• Intolerance to dairy, foods high in calcium
• Vitamin D is required for Ca++ absorption
• Prolonged deficiencies lead to
– Bone resorption, osteomalacia, osteoporosis
• Treat with calcium citrate supplementation and 2
weekly doses of Vitamin D
36. • Lifelong compliance with vitamin/ mineral
supplementation is important to reduce the
risk of serious nutrient deficiencies
• Self-monitoring intake and avoiding high
calorie foods and beverages to prevent weight
re-gain
• Remaining connected with post bariatric
surgery support groups
37. • Prevention is likely to be the most efficient
and cost-effective approach for tackling
overweight and obesity.
• However, many people already require
treatment, may have comorbidities and are at
risk of further weight gain (NPHT 2009).
44. “There is nothing wrong with our
metabolism… the problem is the
Environment and the fact that
food is no longer a survival issue
but mostly a source of pleasure”…
uiza Kent-Smith, 2007