Impact of routine and long-term follow-up on weight loss after laparoscopic gastric bypass

BACKGROUND: Weight loss after gastric bypass varies among patients. It is difficult to maintain contact with patients who have undergone surgery several years previously. Continued and long-term follow-up care at a bariatric surgery clinic might be a factor affecting long-term excess weight loss (EWL). METHODS: Patients with 3-4 years of follow-up data after laparoscopic gastric bypass were included in this retrospective analysis. The patients were divided into 3 groups: group 1 patients had attended every scheduled postoperative appointment, group 2 patients had attended every appointment for 1 year before being lost to follow-up, and group 3 patients had been lost to follow-up before 1 year. Comparisons were made to determine the relationship between the length of follow-up and EWL. RESULTS: We identified 34 group 1 patients and 51 group 2 or 3 patients of 130 patients eligible to be included as determined by their date of surgery. The interval since surgery was similar at approximately 3 years. Although the EWL did not differ at 1 year of follow-up (mean EWL 70% for group 1 versus 65% for group 2, P >.05), a significant difference in the EWL was observed at 3-4 years (74% for group 1 versus 61% for group 2 versus 56% for group 3; P <.05). The distance traveled to the clinic was similar for all 3 groups. The most common explanation for missed follow-up appointments was a lack of insurance coverage. CONCLUSION: Laparoscopic gastric bypass patients who attended all scheduled follow-up appointments experienced greater long-term weight loss than those who did not. On-going, multidisciplinary care is likely a critical component in maintaining the benefit after surgery. Patients must be encouraged to continue to attend their bariatric medical appointments, and payors should provide coverage for these visits.     

The second stage of labor and stress urinary incontinence

OBJECTIVE: This study was undertaken to investigate the potential association between prolonged second stage of labor and stress urinary incontinence. STUDY DESIGN: A retrospective, population-based study was performed. A random, case-controlled sample of 85 cases and 88 controls was identified by means of a standard computerized patient database. Subjects were identified by International Classification of Diseases, Ninth Revision codes, and medical records were reviewed. The median follow-up time from delivery was 7.8 years for cases and 7.2 years for controls. Multiple logistic regression was performed to test for an association between stress urinary incontinence and variables of interest. RESULTS: The data suggest that for all women who labored the length of the second stage of labor for the first delivery was not associated with stress urinary incontinence (odds ratio, 1.07; P =.42; 95% confidence interval, 0.9-1.3). However, forceps delivery was associated with a significant increase in stress urinary incontinence risk (odds ratio, 10.4; P =.04; 95% confidence interval, 1.2-93.4). CONCLUSION: Length of second stage of labor was not associated with stress urinary incontinence. However, the odds of having a later diagnosis of stress urinary incontinence was 10 times higher for women who underwent forceps delivery.     

Treatment and control of blood pressure in patients with diabetes mellitus.

PURPOSE: A study was conducted to characterize the prevalence of hypertension in patients with diabetes mellitus and the percentage of patients with diabetes and hypertension who achieved a targeted blood pressure goal (<135/80 mm Hg). METHODS: A retrospective, cross-sectional study was conducted in an ambulatory care clinic. Eligible patients were those individuals being managed for type 2 diabetes mellitus at least once each year for two consecutive years. Blood pressure measurements that were recorded in the medical chart or written diagnoses of hypertension were used to determine the presence of comorbid hypertension. Data were collected from the chart and electronic record using a standardized form. Clinic visits over the previous 12 months were reviewed to evaluate hypertension criteria. A blood pressure of > or = 135/80 mm Hg was used to define hypertension. RESULTS: A final sample of 362 patients with type 2 diabetes mellitus was included in the study. Of these, 79% had concomitant diabetes and hypertension. Blood pressure was controlled in 175 of 270 (65%) patients. Patients who met the blood pressure goal tended to be older and weigh less than those who did not. The adjusted odds of achieving the blood pressure goal were 1.9 times higher in those patients who also achieved their low-density-lipoprotein cholesterol goal. Most patients were on at least one antihypertensive agent; approximately 39% of the 89 patients treated with monotherapy were above the blood pressure goal. Combination therapy was used in 164 patients; approximately 32% of patients treated with combination therapy were above the blood pressure goal. CONCLUSION: Among ambulatory care patients with diabetes, 79% also had hypertension. Hypertension was controlled in 65% of patients with that disorder.     

Moving from preconditions for action to developing a cycle of continued social change: tapping the potential of mini‐grant programs

One way in which community‐based initiatives have sought to overcome challenges to resident participation in neighborhood change processes is through the implementation of neighborhood mini‐grant programs. However, the mechanisms by which these grants function and any related limitations have not yet been empirically evaluated. This paper seeks to close this gap in the literature. Findings from an evaluation of one mini‐grant project are reported. Overall, it was found that mini‐grants were successful at generating preconditions for action in targeted neighborhoods. However, sustained resident involvement in neighborhood change activities was only engendered by a small number of mini‐grant projects. Recipients of these particularly impactful grants shared similar key characteristics. Implications for practice are discussed. © 2009 Wiley Periodicals, Inc.