Monday, October 6, 2014

Obesity Tip Sheet For Occupational Therapists

OT obesity tip sheet AHS Oct 2014

October is Occupational Therapist Month, an event celebrated by the Canadian Association of Occupational Therapists in a nation-wide campaign involving billboards and bumper stickers.

Reason enough to turn my readers attention to a “tip sheet” developed by members of the Alberta Health Services’ Bariatric Resource Team that explains when to refer their patients with obesity to an occupational therapist.

The preamble to this sheet notes that,

“Occupational therapists promote health and well being for people with obesity by facilitating engagement in occupations of everyday life, including addressing occupational performance issues in the areas of self-care, productivity and leisure. This can impact quality of life, including how people with obesity participate in their daily lives and in health and weight management activities.”

Occupational therapy referral may be indicated for a person with obesity presenting with challenges ranging from occupational engagement to completing simple activities of daily living.

To download this OT referral tip sheet click here.

Happy OT month!

@DrSharma
Hamilton, ON

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Wednesday, September 24, 2014

Obesity Tip Sheet For Physiotherapists

PT Tip Sheet Octb2013

Many people living with obesity experience significant physical limitations that can be addressed with appropriate physical therapeutic approaches.

Now, the Bariatric Resource Team of Alberta Health Services has compiled a “Tip Sheet that briefly highlights the role of physiotherapeutic interventions in the care of people with obesity.

The sheet includes recommendations on the following topics:

- Challenges With Movement, Pain or Daily Function

- Obesity Related Co-morbidities that Affect Daily Function

- Energy Management

- Posture and Positioning Issues

- Activity Counselling Needs

- Equipment Issues

- Access to Community Resources

This “Tip Sheet” should be helpful to anyone involved in the care of bariatric patients.

@DrSharma
Winnipeg. MB

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Thursday, August 28, 2014

Call For Abstracts: Canadian Obesity Summit, Toronto, April 28-May 2, 2015

COS2015 toronto callBuilding on the resounding success of Kananaskis, Montreal and Vancouver, the biennial Canadian Obesity Summit is now setting its sights on Toronto.

If you have a professional interest in obesity, it’s your #1 destination for learning, sharing and networking with experts from across Canada around the world.

In 2015, the Canadian Obesity Network (CON-RCO) and the Canadian Association of Bariatric Physicians and Surgeons (CABPS) are combining resources to hold their scientific meetings under one roof.

The 4th Canadian Obesity Summit (#COS2015) will provide the latest information on obesity research, prevention and management to scientists, health care practitioners, policy makers, partner organizations and industry stakeholders working to reduce the social, mental and physical burden of obesity on Canadians.

The COS 2015 program will include plenary presentations, original scientific oral and poster presentations, interactive workshops and a large exhibit hall. Most importantly, COS 2015 will provide ample opportunity for networking and knowledge exchange for anyone with a professional interest in this field.

Abstract submission is now open – click here

Key Dates

  • Abstract submission deadline: October 23, 2014
  • Notification of abstract review: January 8, 2014
  • Early registration deadline: March 5, 2015

For exhibitor and sponsorship information – click here

To join the Canadian Obesity Network – click here

I look forward to seeing you in Toronto next year!

@DrSharma
Montreal, QC

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Tuesday, November 26, 2013

Managing Chronic Post-Surgical Pain Syndromes

sharma-obesity-surgery3Chronic post-surgical pain (CPSP) at the surgery site can occur in up to one out of five patients undergoing surgery – particularly in those with surgery of the chest wall, breast, total joint replacements and iliac crest bone harvest. It can, however, occur after any type of surgery including minor procedures.

This problem and possible management strategies for the non-pain specialist are now reviewed in a paper by my colleagues Saifee Rashiq and Bruce Dick from the University of Alberta, in a paper published in the Canadian Journal of Anaesthesiology.

The consequences of CPSP on the patients is severe with staggering economic implications and powerful negative effects on the quality of life. CPSP also places a a significant burden on chronic pain treatment services.

Increased incidence of CPSP is seen in associated with younger age, obesity and female sex as well as certain psychological characteristics (anxiety, depression, stress, and catastrophizing).

Other risk factors include, “Capacity overload” in the six months prior to surgery (having had more to deal with in the psychological sense than the subject thought (s)he could handle) and/or  the presence of two or more indicators suggestive of stress (sleep disorder, exhaustibility/exhaustion, frightening thoughts, dizziness, tachycardia, feeling of being misunderstood, trembling hands, or taking sedatives or sleeping pills).

In addition, severe acute or chronic pain (even when unrelated to the surgical site) prior to surgery appears to be a predisposing factor.

Emerging evidence shows that the syndrome is not simply a consequence of local nerve injury but rather involves higher cognitive functions that influence events at the spinal cord by powerful descending control mechanisms.

Thus, CPSP is increasingly seen as a “multisystem illness that transcends the operative field and includes, most importantly, the patient’s psychological state and social circumstances“.

Based on their findings, the authors argue for better pain control prior to surgery as well as the use of regional anesthetic techniques, infiltration of local anesthetic, or preoperative use of gabapentin under special circumstances.

However, they also note that the ability of other known interrupters of afferent nociceptive transmission-commonly used to reduce CPSP when administered at the time of surgery remain currently unproven.

Given that obesity is a risk factor for this syndrome and many obese patients present with pre-surgical pain, clinicians working with this population should be aware of this problem and counsel patients accordingly.

If you have experienced this problem, I’d like to hear about it.

@DrSharma
Sudbury, ON

ResearchBlogging.orgRashiq S, & Dick BD (2013). Post-surgical pain syndromes: a review for the non-pain specialist. Canadian journal of anaesthesia = Journal canadien d’anesthesie PMID: 24185829

 

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Monday, November 25, 2013

BMI Does Not Affect Outcomes in Knee-Replacement Surgery

sharma-obesity-knee-arthtoplasty2One of the most pervasive “myths” amongst orthopaedic surgeons is that higher BMI is a contraindication to knee-replacement surgery.

Regular readers, however, will perhaps previous posts on this issue, suggesting that BMI is largely irrelevant in terms of outcomes and benefits for obese patients requiring knee replacements.

This previous finding is further supported by a new paper by David Murray and colleagues from The University of Oxford, UK, published in KNEE.

The researchers prospectively examined the impact of BMI on failure rate and clinical outcomes of 2,438 unicompartmental knee replacements in 378 patients with a BMI less than 25, 856 patients with a BMI 25 to 30, 712 patients with a BMI 30 to 35, 286 patients with a BMI 35 to 40, 126 patients with a BMI 40 to 45 and 80 patients with BMI greater than 45.

At a mean follow-up of 5 years (range 1–12 years) there was no significant difference in the Objective American Knee Society Score between BMI groups.

Although there was a slight trend to decreasing post-operative function scores with increasing BMI, patients with higher BMI had lower scores prior to surgery. Thus, overall higher BMIs were associated with a greater change in functional scores.

Thus, this study, further confirms the notion that obese individual have as much (if not more) to benefit from knee replacement surgery with little evidence that initial BMI adversely affects outcomes.

For clinicians this finding means that there is little evidence to deny knee replacement surgery to individuals with higher BMI levels or require that these patients lose weight prior to surgery.

If you have experience (positive or negative) with knee replacement surgery in overweight and obese patients, I’d like to hear from you.

@DrSharma
Edmonton, AB

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In The News

Diabetics in most need of bariatric surgery, university study finds

Oct. 18, 2013 – Ottawa Citizen: "Encouraging more men to consider bariatric surgery is also important, since it's the best treatment and can stop diabetic patients from needing insulin, said Dr. Arya Sharma, chair in obesity research and management at the University of Alberta." Read article

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