解决关于结构化生活方式修改对代谢手术患者的作用的不确定性
Enda Murphy1, Francis M Finucane1
1Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Saolta Health Care Group, Galway, Ireland; HRB Clinical Research Facility, University of Galway and Saolta University Health Care Group, Ireland; Cúram, University of Galway, Ireland.
Metabolism: clinical and experimental
|November 20, 2023
概括
对肥胖手术患者的强制性术前生活方式计划缺乏证据,可能会有害. 将这些计划重新定义为教育机会对于患者赋权和更好的结果至关重要.
科学领域:
- 代谢和腹部手术的代谢和腹部手术
- 生活方式 医学 医疗
- 肥胖管理 肥胖管理
背景情况:
- 结构化的生活方式修改计划对代谢和心血管疾病有好处.
- 缺乏证据证明它们在接受代谢或肥胖手术的患者中具有特定的益处.
- 当前的指导方针和医疗保健系统经常要求在手术前实施这些计划,尽管没有足够的证据.
研究的目的:
- 在代谢和肥胖手术中批判性地评估结构化生活方式修改计划的证据.
- 要区分个性化护理和强制性计划.
- 建议对生活方式计划进行重新定义,将其视为教育和赋权,而不是适合性指标.
主要方法:
- 审查现有证据结构化生活方式修改计划在减肥手术患者.
- 对专家共识指南和当前医疗保健系统实践的分析.
- 确定研究缺口,并为未来的临床试验提出建议.
主要成果:
- 没有具体的证据支持强制性结构化生活方式计划的有效性,以改善代谢/肥胖手术患者的结果.
- 个性化的多学科护理和手术前减肥是有益的,但与强制性计划不同.
- 强制性课程可能会推迟手术并延续肥胖的耻辱.
结论:
- 代谢和肥胖手术患者护理需要重新定义:生活方式计划应该是教育性的,而不是守门.
- 需要大型,精心设计的试验来确定"手术加生活方式"与"手术加安慰剂"的益处.
- 未来的研究应该评估成本效益和影响反应异质性的因素.
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