Base de dados : MEDLINE
Pesquisa : E02.570.500.062.750 [Categoria DeCS]
Referências encontradas : 3928 [refinar]
Mostrando: 1 .. 10   no formato [Detalhado]

página 1 de 393 ir para página                         

  1 / 3928 MEDLINE  
              next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:29340677
[Au] Autor:Reges O; Greenland P; Dicker D; Leibowitz M; Hoshen M; Gofer I; Rasmussen-Torvik LJ; Balicer RD
[Ad] Endereço:Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel.
[Ti] Título:Association of Bariatric Surgery Using Laparoscopic Banding, Roux-en-Y Gastric Bypass, or Laparoscopic Sleeve Gastrectomy vs Usual Care Obesity Management With All-Cause Mortality.
[So] Source:JAMA;319(3):279-290, 2018 01 16.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Bariatric surgery is an effective and safe approach for weight loss and short-term improvement in metabolic disorders such as diabetes. However, studies have been limited in most settings by lack of a nonsurgical group, losses to follow-up, missing data, and small sample sizes in clinical trials and observational studies. Objective: To assess the association of 3 common types of bariatric surgery compared with nonsurgical treatment with mortality and other clinical outcomes among obese patients. Design, Setting, and Participants: Retrospective cohort study in a large Israeli integrated health fund covering 54% of Israeli citizens with less than 1% turnover of members annually. Obese adult patients who underwent bariatric surgery between January 1, 2005, and December 31, 2014, were selected and compared with obese nonsurgical patients matched on age, sex, body mass index (BMI), and diabetes, with a final follow-up date of December 31, 2015. A total of 33 540 patients were included in this study. Exposures: Bariatric surgery (laparoscopic banding, Roux-en-Y gastric bypass, or laparoscopic sleeve gastrectomy) or usual care obesity management only (provided by a primary care physician and which may include dietary counseling and behavior modification). Main Outcomes and Measures: The primary outcome, all-cause mortality, matched and adjusted for BMI prior to surgery, age, sex, socioeconomic status, diabetes, hyperlipidemia, hypertension, cardiovascular disease, and smoking. Results: The study population included 8385 patients who underwent bariatric surgery (median age, 46 [IQR, 37-54] years; 5490 [65.5%] women; baseline median BMI, 40.6 [IQR, 38.5-43.7]; laparoscopic banding [n = 3635], gastric bypass [n = 1388], laparoscopic sleeve gastrectomy [n = 3362], and 25 155 nonsurgical matched patients (median age, 46 [IQR, 37-54] years; 16 470 [65.5%] women; baseline median BMI, 40.5 [IQR, 37.0-43.5]). The availability of follow-up data was 100% for all-cause mortality. There were 105 deaths (1.3%) among surgical patients during a median follow-up of 4.3 (IQR, 2.8-6.6) years (including 61 [1.7%] who underwent laparoscopic banding, 18 [1.3%] gastric bypass, and 26 [0.8%] sleeve gastrectomy), and 583 deaths (2.3%) among nonsurgical patients during a median follow-up of 4.0 (IQR, 2.6-6.2) years. The absolute difference was 2.51 (95% CI, 1.86-3.15) fewer deaths/1000 person-years in the surgical vs nonsurgical group. Adjusted hazard ratios (HRs) for mortality among nonsurgical vs surgical patients were 2.02 (95% CI, 1.63-2.52) for the entire study population; by surgical type, HRs were 2.01 (95% CI, 1.50-2.69) for laparoscopic banding, 2.65 (95% CI, 1.55-4.52) for gastric bypass, and 1.60 (95% CI, 1.02-2.51) for laparoscopic sleeve gastrectomy. Conclusions and Relevance: Among obese patients in a large integrated health fund in Israel, bariatric surgery using laparoscopic banding, gastric bypass, or laparoscopic sleeve gastrectomy, compared with usual care nonsurgical obesity management, was associated with lower all-cause mortality over a median follow-up of approximately 4.5 years. The evidence of this association adds to the limited literature describing beneficial outcomes of these 3 types of bariatric surgery compared with usual care obesity management alone.
[Mh] Termos MeSH primário: Gastrectomia/mortalidade
Derivação Gástrica/mortalidade
Gastroplastia/mortalidade
Laparoscopia
Obesidade Mórbida/mortalidade
Obesidade Mórbida/terapia
[Mh] Termos MeSH secundário: Adulto
Feminino
Gastrectomia/métodos
Seres Humanos
Estimativa de Kaplan-Meier
Masculino
Meia-Idade
Obesidade Mórbida/cirurgia
Modelos de Riscos Proporcionais
Estudos Retrospectivos
Perda de Peso
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180311
[Lr] Data última revisão:
180311
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180118
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.20513


  2 / 3928 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:28451931
[Au] Autor:Casajoana A; Pujol J; Garcia A; Elvira J; Virgili N; de Oca FJ; Duran X; Fernández-Veledo S; Vendrell J; Vilarrasa N
[Ad] Endereço:Bariatric Surgery Unit, Bellvitge University Hospital-IDIBELL, c/ Feixa Llarga s/n, 08907, Barcelona, L'Hospitalet de Llobregat, Spain.
[Ti] Título:Predictive Value of Gut Peptides in T2D Remission: Randomized Controlled Trial Comparing Metabolic Gastric Bypass, Sleeve Gastrectomy and Greater Curvature Plication.
[So] Source:Obes Surg;27(9):2235-2245, 2017 Sep.
[Is] ISSN:1708-0428
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Our aim was to determine the predictive value of gut hormone changes for the improvement of type 2 diabetes (T2D) following metabolic Roux-en-Y gastric bypass (mRYGB), sleeve gastrectomy (SG), and greater curvature plication (GCP) in a randomized controlled trial. Contradictory results have been obtained regarding the role of gastrointestinal hormones (in particular GLP-1) in beneficial metabolic bariatric surgery outcomes. METHODS: Forty-five patients with T2D (mean BMI 39.4 ± 1.9 kg/m ) were randomly assigned to mRYGB, SG, or GCP. Anthropometric and biochemical parameters, fasting concentrations of PYY, ghrelin, glucagon, and area under the curve (AUC) of GLP-1 after a standard meal test were determined prior to and at months 1 and 12 after surgery. RESULTS: Twelve months after surgery, total weight loss percentage was higher and HbA1c lower in the mRYGB group than in the SG and GCP groups (-35.2 ± 8.1 and 5.1 ± 0.6% vs. -27.8 ± 5.4 and 6.2 ± 0.8% vs. -20.5 ± 6.8 and 6.6 ± 1.3%; p = 0.007 and p < 0.001, respectively). Moreover, GLP-1 AUC at months 1 and 12 was greater and T2D remission was higher in mRYGB (80 vs. 53.3 vs. 20%, p < 0.001). Insulin treatment (odds ratio (OR) 0.025, p = 0.018) and the increase in GLP-1 AUC from baseline to month 1 (OR 1.021, p = 0.013) were associated with T2D remission. CONCLUSIONS: mRYGB achieves a superior rate of weight loss and T2D remission at month 12. Enhanced GLP-1 secretion 1 month after surgery was a determinant of glucose metabolism improvement. Registration number ( http://www.clinicaltrials.gov ): NCT14104758.
[Mh] Termos MeSH primário: Diabetes Mellitus Tipo 2/cirurgia
Gastrectomia/métodos
Derivação Gástrica/métodos
Gastroplastia/métodos
[Mh] Termos MeSH secundário: Adulto
Diabetes Mellitus Tipo 2/complicações
Feminino
Hormônios Gastrointestinais/metabolismo
Peptídeo 1 Semelhante ao Glucagon/metabolismo
Seres Humanos
Masculino
Meia-Idade
Obesidade Mórbida/complicações
Obesidade Mórbida/cirurgia
Indução de Remissão
Estômago/cirurgia
Perda de Peso
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Gastrointestinal Hormones); 89750-14-1 (Glucagon-Like Peptide 1)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1007/s11695-017-2669-7


  3 / 3928 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:29156183
[Au] Autor:Vargas EJ; Rizk M; Bazerbachi F; Abu Dayyeh BK
[Ad] Endereço:Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
[Ti] Título:Medical Devices for Obesity Treatment: Endoscopic Bariatric Therapies.
[So] Source:Med Clin North Am;102(1):149-163, 2018 Jan.
[Is] ISSN:1557-9859
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Endoscopic bariatric therapies (EBTs) are effective tools for the management of obesity. By mimicking restrictive and bypass surgery physiology, they provide a safe and effective treatment option with the added capabilities of reaching a broader population. Multiple efficacious medical devices, such as intragastric balloons, endoscopic suturing/plication devices, and bypass liners, at various stages of development are available in the United States. EBTs represent the newest addition to a multidisciplinary approach in obesity management. This article reviews several devices' safety and efficacy for primary care providers in the era of evolving obesity treatment.
[Mh] Termos MeSH primário: Cirurgia Bariátrica/métodos
Endoscopia Gastrointestinal/métodos
Balão Gástrico
Obesidade/cirurgia
[Mh] Termos MeSH secundário: Gerenciamento Clínico
Derivação Gástrica/métodos
Gastroplastia/métodos
Seres Humanos
Perda de Peso
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171212
[Lr] Data última revisão:
171212
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171121
[St] Status:MEDLINE


  4 / 3928 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:27771312
[Au] Autor:Rohner A; Widmer JD; Klasen J; Scheiwiller A; Muller D; Muller MK
[Ad] Endereço:Department of Surgery, Bariatric Reference Centre, Cantonal Hospital, Frauenfeld, Switzerland.
[Ti] Título:Long-term outcomes of gastric band removal without additional bariatric surgery.
[So] Source:Surg Obes Relat Dis;13(2):261-266, 2017 Feb.
[Is] ISSN:1878-7533
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: The outcomes of patients undergoing band removal alone without an additional bariatric procedure after laparoscopic gastric banding are not well reported. We seek to close this gap in the literature. SETTING: Cantonal Hospital & University Teaching Hospital, Switzerland METHODS: In this retrospective study, we investigated 21 patients who underwent band removal with a mean follow-up of 63 months. Weight regain, co-morbidities, and quality of life were assessed. RESULTS: The laparoscopic gastric bandings were implanted at a mean initial body mass index (BMI) of 44.6 kg/m . The bands remained in situ for an average of 87.7 months (range: 14-185 mo). The reasons for band removal included band slippage in 9 cases (42.9%), band penetration in 6 cases (28.6%), leakage, port infection, and patient request in 2 cases (9.5% each). The average BMI at the time of band removal was 34.9 kg/m . At 62.9 months after band removal, patients regained an average of 17.3 kg and attained a mean BMI of 41.0 kg/m . Co-morbidities such as type 2 diabetes, arterial hypertension, obstructive sleep apnea, and psychiatric disorders worsened during the follow-up period. Thirteen of 21 patients rated their quality of life as bad, 5 as mediocre, and only 3 as good. Only 2 patients said they would undergo a gastric banding procedure again. The patients achieved an average of-.6 points on the Moorehead-Ardelt quality of life score, which indicates a fair quality of life. CONCLUSION: This study finds that reversal of gastric banding procedures with removal of the banding system alone leads to weight regain, deterioration of physical and psychiatric co-morbidities, and low quality of life scores.
[Mh] Termos MeSH primário: Remoção de Dispositivo/métodos
Gastroplastia/métodos
Obesidade Mórbida/cirurgia
[Mh] Termos MeSH secundário: Adulto
Cirurgia Bariátrica/estatística & dados numéricos
Diabetes Mellitus Tipo 2/complicações
Falha de Equipamento/estatística & dados numéricos
Feminino
Gastroplastia/instrumentação
Seres Humanos
Hipertensão/complicações
Masculino
Transtornos Mentais/complicações
Obesidade Mórbida/complicações
Satisfação do Paciente
Qualidade de Vida
Recidiva
Reoperação/estatística & dados numéricos
Estudos Retrospectivos
Apneia Obstrutiva do Sono/complicações
Ganho de Peso/fisiologia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171128
[Lr] Data última revisão:
171128
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE


  5 / 3928 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:28938478
[Au] Autor:Harris LLS; Smith GI; Mittendorfer B; Eagon JC; Okunade AL; Patterson BW; Klein S
[Ad] Endereço:Center for Human Nutrition, Washington University School of Medicine, St. Louis, Missouri 63110.
[Ti] Título:Roux-en-Y Gastric Bypass Surgery Has Unique Effects on Postprandial FGF21 but Not FGF19 Secretion.
[So] Source:J Clin Endocrinol Metab;102(10):3858-3864, 2017 Oct 01.
[Is] ISSN:1945-7197
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Context: Fibroblast growth factor (FGF)19 and FGF21 are secreted by the intestine and liver in response to macronutrient intake. Intestinal resection and reconstruction via bariatric surgery may alter their regulation. Objective: We tested the hypothesis that weight loss induced by Roux-en-Y gastric bypass (RYGB) surgery, but not matched weight loss induced by laparoscopic adjustable gastric banding (LAGB), increases postprandial plasma FGF19 and FGF21 concentrations. Design: Glucose kinetics and plasma FGF19 and FGF21 responses to mixed meal ingestion and to glucose-insulin infusion during a hyperinsulinemic-euglycemic clamp procedure, with stable isotope tracer methods, were evaluated in 28 adults with obesity before and after 20% weight loss induced by RYGB (n = 16) or LAGB (n = 12). Results: LAGB- and RYGB-induced weight loss increased postprandial plasma FGF19 concentrations (P < 0.05). However, weight loss after RYGB, but not LAGB, increased postprandial plasma FGF21 concentrations (1875 ± 330 to 2976 ± 682 vs 2150 ± 310 and 1572 ± 265 pg/mL × 6 hours, respectively). The increase in plasma FGF21 occurred ∼2 hours after the peak in delivery of ingested glucose into systemic circulation. Glucose-insulin infusion increased plasma FGF21, but not FGF19, concentrations. The increase in plasma FGF21 during glucose-insulin infusion was greater after than before weight loss in both surgery groups without a difference between groups, whereas plasma FGF19 was not affected by either procedure. Conclusions: RYGB-induced weight loss has unique effects on postprandial FGF21 metabolism, presumably due to rapid delivery of ingested macronutrients to the small intestine and delivery of glucose to the liver.
[Mh] Termos MeSH primário: Anastomose em-Y de Roux
Fatores de Crescimento de Fibroblastos/sangue
Derivação Gástrica/métodos
Obesidade Mórbida/cirurgia
Período Pós-Prandial
[Mh] Termos MeSH secundário: Adulto
Feminino
Gastroplastia/métodos
Seres Humanos
Masculino
Refeições
Meia-Idade
Obesidade Mórbida/sangue
Obesidade Mórbida/metabolismo
Perda de Peso/fisiologia
[Pt] Tipo de publicação:CLINICAL TRIAL; COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (FGF19 protein, human); 0 (fibroblast growth factor 21); 62031-54-3 (Fibroblast Growth Factors)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171031
[Lr] Data última revisão:
171031
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170923
[St] Status:MEDLINE
[do] DOI:10.1210/jc.2017-01295


  6 / 3928 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:28791825
[Au] Autor:Sierzantowicz R; Lewko J; Hady HR; Kirpsza B; Trochimowicz L; Dadan J
[Ad] Endereço:Department of Surgical Nursing, Medical University of Bialystok, Poland.
[Ti] Título:Effect of BMI on quality of life and depression levels after bariatric surgery.
[So] Source:Adv Clin Exp Med;26(3):491-496, 2017 May-Jun.
[Is] ISSN:1899-5276
[Cp] País de publicação:Poland
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Studies conducted in Poland have found that 1% (~300,000) of Polish adults are obese. The degree of weight loss and reduction of discomfort associated with severe obesity are used to evaluate bariatric surgery outcomes. From the patient's point of view, QoL and mental health are the most important determinants of successful surgery, which is why interest in QoL assessment has increased. OBJECTIVES: To assess the effect of BMI on quality of life and depression levels depending on the type of bariatric surgery. MATERIAL AND METHODS: The group included 57 women and 43 men aged 20-60 years (mean age 40 years) with BMI from 36 to 40 (31%) and > 40 (69%). Twelve patients (12%) underwent laparoscopic adjustable gastric binding (LAGB), 58 (58%) sleeve gastrectomy, and 30 (30%) Roux-en-Y Gastric Bypass (RYGB). The Bariatric Analysis and Reporting Outcome System (BAROS) was used to assess QoL. The severity of mood disorders was assessed using the Self-Rating Scale of Depression and Anxiety. RESULTS: Six months or 1 year after bariatric surgery, the number of patients with BMI > 40 had decreased from 69 to 14%. We found that the time since bariatric surgery contributed to a significant (p < 0.01) difference in BAROS outcomes. In the long-term perspective, we observed better quality of life. CONCLUSIONS: MA-QoL II is a useful tool in assessing bariatric surgery, including quality of life. Long-term monitoring will be essential in determining psychological changes and the degree of weight loss.
[Mh] Termos MeSH primário: Depressão/fisiopatologia
Depressão/psicologia
Qualidade de Vida/psicologia
[Mh] Termos MeSH secundário: Adulto
Cirurgia Bariátrica/métodos
Índice de Massa Corporal
Feminino
Gastrectomia/métodos
Derivação Gástrica/métodos
Gastroplastia/métodos
Seres Humanos
Laparoscopia/métodos
Masculino
Meia-Idade
Obesidade Mórbida/fisiopatologia
Obesidade Mórbida/psicologia
Obesidade Mórbida/cirurgia
Polônia
Resultado do Tratamento
Perda de Peso/fisiologia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171004
[Lr] Data última revisão:
171004
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170810
[St] Status:MEDLINE
[do] DOI:10.17219/acem/62246


  7 / 3928 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:28754410
[Au] Autor:Koh CY; Inaba CS; Sujatha-Bhaskar S; Hohmann S; Ponce J; Nguyen NT
[Ad] Endereço:Department of Surgery, University of California Irvine Medical Center, Orange, CA.
[Ti] Título:Laparoscopic Adjustable Gastric Band Explantation and Implantation at Academic Centers.
[So] Source:J Am Coll Surg;225(4):532-537, 2017 Oct.
[Is] ISSN:1879-1190
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The laparoscopic adjustable gastric band (LAGB) was approved for use in the US in 2001 and has been found to be a safe and effective surgical treatment for morbid obesity. However, there is a recent trend toward reduced use of LAGB nationwide. The objective of this study was to examine the prevalence and outcomes of primary LAGB implantation compared with revision and explantation at academic centers. STUDY DESIGN: Data were obtained from the Vizient database from 2007 through 2015. The ICD-9-Clinical Modification and ICD-10-Clinical Modification were used to select patients with a primary diagnosis of obesity who had undergone LAGB implantation, revision, or explantation. Prevalence and outcomes of primary LAGB implantation compared with revision or explantation were analyzed. Outcomes measures included length of stay, ICU admission, morbidity, mortality, and cost. RESULTS: From 2007 through 2015, a total of 28,202 patients underwent LAGB implantation for surgical weight loss. The annual number of LAGB implantation procedures decreased steadily after 2010. In the same time period, 12,157 patients underwent LAGB explantation. In 2013, the number of LAGB explantation procedures exceeded that of implantation. Laparoscopic adjustable gastric band revision rates remained stable throughout the study period. Mean length of stay, serious morbidity, and proportion of patients requiring ICU admission were higher for gastric band revision and explantation cases compared with primary LAGB implantation cases. There was no statistically significant difference in mortality or mean cost between the 2 groups. CONCLUSIONS: Since 2013, the number of gastric band explantation procedures has exceeded that of implantation procedures at academic centers. Laparoscopic adjustable gastric band revision or explantation is associated with longer length of stay, higher rate of postoperative ICU admissions, and higher overall morbidity compared with LAGB implantation.
[Mh] Termos MeSH primário: Remoção de Dispositivo
Gastroplastia/instrumentação
Hospitais de Ensino
Laparoscopia
Obesidade Mórbida/cirurgia
Complicações Pós-Operatórias/cirurgia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Feminino
Gastroplastia/efeitos adversos
Gastroplastia/estatística & dados numéricos
Seres Humanos
Masculino
Meia-Idade
Complicações Pós-Operatórias/epidemiologia
Reoperação
Resultado do Tratamento
Estados Unidos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171010
[Lr] Data última revisão:
171010
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170730
[St] Status:MEDLINE


  8 / 3928 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:28703939
[Au] Autor:Rogers CA; Reeves BC; Byrne J; Donovan JL; Mazza G; Paramasivan S; Andrews RC; Wordsworth S; Thompson J; Blazeby JM; Welbourn R; By-Band-Sleeve study investigators
[Ad] Endereço:Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK.
[Ti] Título:Adaptation of the By-Band randomized clinical trial to By-Band-Sleeve to include a new intervention and maintain relevance of the study to practice.
[So] Source:Br J Surg;104(9):1207-1214, 2017 Aug.
[Is] ISSN:1365-2168
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Recruitment into surgical RCTs can be threatened if new interventions available outside the trial compete with those being evaluated. Adapting the trial to include the new intervention may overcome this issue, yet this is not often done in surgery. This paper describes the challenges, rationale and methods for adapting an RCT to include a new intervention. METHODS: The By-Band study was designed in the UK in 2009-2010 to compare the effectiveness of laparoscopic adjustable gastric band and Roux-en-Y gastric bypass for severe obesity. It contained a pilot phase to establish whether recruitment was possible, and the grant proposal specified that an adaptation to include sleeve gastrectomy would be considered if practice changed and recruitment was successful. Information on changing obesity surgery practice, updated evidence and expert opinion about trial design were used to inform the adaptation. RESULTS: The pilot phase recruited over 13 months in 2013-2014 and randomized 80 patients (79 anticipated). During this time, major changes in obesity practice in the UK were observed, with gastric band reducing from 32·6 to 15·8 per cent and sleeve gastrectomy increasing from 9·0 to 28·1 per cent. The evidence base had not changed markedly. The British Obesity and Metabolic Surgery Society and study oversight committees supported an adaptation to include sleeve gastrectomy, and a proposal to do so was approved by the funder. CONCLUSION: Adaptation of a two-group surgical RCT can allow evaluation of a third procedure and maintain relevance of the RCT to practice. It also optimizes the use of existing trial infrastructure to answer an additional important research question. Registration number: ISRCTN00786323 (http://www.isrctn.com/).
[Mh] Termos MeSH primário: Derivação Gástrica/métodos
Gastroplastia/métodos
Obesidade Mórbida/cirurgia
Ensaios Clínicos Controlados Aleatórios como Assunto/métodos
[Mh] Termos MeSH secundário: Assistência à Saúde/métodos
Derivação Gástrica/estatística & dados numéricos
Gastroplastia/estatística & dados numéricos
Seres Humanos
Seleção de Pacientes
Projetos Piloto
Padrões de Prática Médica/tendências
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170804
[Lr] Data última revisão:
170804
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170714
[St] Status:MEDLINE
[do] DOI:10.1002/bjs.10562


  9 / 3928 MEDLINE  
              first record previous record next record last record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:28684028
[Au] Autor:Beamish AJ
[Ad] Endereço:Department of Gastrosurgical Research and Education, Institute of Clinical Sciences, Gothenburg University, Gothenburg, Sweden.
[Ti] Título:Comment on: Long-term experience of laparoscopic adjustable gastric banding: are we learning lessons?
[So] Source:Surg Obes Relat Dis;13(8):1319-1320, 2017 08.
[Is] ISSN:1878-7533
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Gastroplastia
Obesidade Mórbida/cirurgia
[Mh] Termos MeSH secundário: Seres Humanos
Laparoscopia
Resultado do Tratamento
Perda de Peso
[Pt] Tipo de publicação:EDITORIAL; COMMENT
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170907
[Lr] Data última revisão:
170907
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170708
[St] Status:MEDLINE


  10 / 3928 MEDLINE  
              first record previous record
seleciona
para imprimir
Fotocópia
Texto completo
[PMID]:28655037
[Au] Autor:Ibrahim AM; Dimick JB
[Ad] Endereço:Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor.
[Ti] Título:Monitoring Medical Devices: Missed Warning Signs Within Existing Data.
[So] Source:JAMA;318(4):327-328, 2017 07 25.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Gastroplastia/instrumentação
Vigilância de Produtos Comercializados
[Mh] Termos MeSH secundário: Segurança de Equipamentos
Seres Humanos
Obesidade Mórbida/cirurgia
Vigilância de Produtos Comercializados/métodos
Reoperação/economia
Retirada de Dispositivo Médico Baseada em Segurança
Estados Unidos
United States Food and Drug Administration
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL; RESEARCH SUPPORT, U.S. GOV'T, NON-P.H.S.
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171127
[Lr] Data última revisão:
171127
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170628
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.6584



página 1 de 393 ir para página                         
   


Refinar a pesquisa
  Base de dados : MEDLINE Formulário avançado   

    Pesquisar no campo  
1  
2
3
 
           



Search engine: iAH v2.6 powered by WWWISIS

BIREME/OPAS/OMS - Centro Latino-Americano e do Caribe de Informação em Ciências da Saúde