Empire Chick

Yup. I took my assignment (RN to BSN) and tailored it to something that interested me deeply. Since I'm already doing research for a morificecript I really wanted to learn how to put together an evidence based paper. Lucky me, it was the focus of my fall semester class. Two birds.. One stone. :)

Holiday season is upon us. The struggle is real. I'm still fighting the good old battle of weight loss and at 300 to 305 and my body may be hanging out in plateau island again. It's time to reevaluate my eating habits, drink more water, get more sleep and see when the scale will budge. So here I am and despite the insanity... and... I finished my evidence based paper. It got a good grade and I have corrected it according to my Professors recommendations. No matter what I have done...It's not what I want it to be. I'll explain. Evidence based research is best when you have data points that encompass and answer your question, or what it is you seek. You form a PICOT question and you search for peer reviewed journals preferably with a shelf life of no more than three to five years. A PICOT question is Patient populationIntervention or issue of interestComparison intervention or groupOutcomeTime frameMy Original one was: (P) For patients with obesity (BMI > 30)(I) Does nutritional education , diet and exercise© Compared to nutritional education and endoscopic bariatric surgical intervention(O) have better outcomes in terms of both overall weight loss and the ability to keep it off within 5 years? 10 Years? 15 Years?I had the worse time finding research that was peer reviewed and not over 5 years old that followed patients with a BMI of over 30 over 5, 10, 15 years post surgical intervention. I also wanted more solid data on weight loss along with diet and exercise. I don't think anyone has followed a group of people around long after they reached their goal weight. I understand to make a study viable you have to keep in touch with many people over a long period of time. Eventually you loose numbers and people here and there. What I present to you is what I found within the time constraints of my assignment. I modified my window to 3 years and used the data points at the highest and lowest outcomes. I'm not happy with it because there has to be more evidence for diet and exercise out there with more optimistic numbers. I want to dig deeper. I want to know more. I need to be more specific in my question also. I need to break it down to women, men, ages. The research had individuals broken down by age, gender, ethnicity, co morbidities. All I wanted was an overall with age, gender and timeline. There will be a revision of this paper sometime in the future but as promised here it is in it's entirety. The APA formatting went to H E Double hockey sticks but that's ok. I'm not encouraging plagiarization. I am merely presenting information. I hope you enjoy it : ***** Which is More Effective in Treating Obesity? Nursing Research and Statistics Which is More Effective in Treating Obesity? IntroductionObesity has gripped the world and the battle against it is spread across medical journals, beauty magazines, infomercials and more. Patients are flooded with get quick schemes and lulled by work out routines with gadgets that promise quick unbelievable results. Health care professionals scramble to find alternate means of weight loss that is not only safe but effective for the thousands of people coming to grip with the reality that something must be done.. It was estimated by the Oxford Journal of Medicine &Health that by " 2015, 75% of adults would be overweight or obese, and 41% will be obese" (Yang & Beydoun, 2007). Their estimation was not too far off. In 2014 the CDC concluded 36.5% of adults were obese having a BMI> 30 ("Adult Obesity facts," 2014). So the question is how do we successfully treat obesity and in essence provide the patient with the most effective outcome in the long run? (P) For patients with obesity (BMI > 30) (I) Does nutritional education, diet and exercise © Compared to nutritional education and surgical intervention (O) have better outcomes in terms of both overall weight loss and the ability to keep it off within 1-3 years. Summary of the problemObesity and it's many health risks are increasing in prevalence as the years tick by. Patients are looking for ways to lose significant amounts of weight and keep it off. Diet schemes that dehydrate a patient or provide quick and short term weight loss become more of a problem than a solution. Weight loss may trigger hormones that fuel weight to return. According to the New England Journal of Medicine, hunger-related hormones disrupted by dieting and weight loss can remain at altered levels for at least a year"(MacMillan, 2011). The most recommended method for weight loss, particularly in obese patients by physicians is nutritional education, diet and exercise . Surgical intervention requires conventional weight loss before the procedure , counseling, nutritional education and screening to determine if surgery will be the safest option. Generally there is a 3-18 month insurance mandated preoperative dietary weight loss before bariatric surgery (Kim, Rogers, Ballem, & Schirimer, 2016). Relevance to practiceAccording to the CDC "The estimated annual medical cost of obesity in the U.S. was $147 billion in 2008 U.S. dollars" and there were many health risks like certain types of cancer, Type II Diabetes and heart conditions from obesity that became the "leading causes of preventable death"("Adult Obesity facts," 2014). To give patients the correct tools to bring down their weight into a healthy range for their height and age not only improves their quality of life but it impacts the health care system on a fiscal level and physical level. If we could reduce preventable diagnosis by implementing weight loss strategies that work we could possibly increase the length and quality of our patients lives. Search methodThe following studies and articles were used using the online library archive for the University of Texas at El Paso's library website, utilizing Google Scholar and browsing available journals through the American Nurses Association website. Searches were conducted using key words such as weight loss, obesity, diet and exercise, surgical intervention, gastric sleeve, bypass, lap-band ,long term outcome, 5-10-15 years. A total of 4 articles were utilized in this paper. This combined with a lifetime of dieting and consistently dealing dealing with obesity on a personal level have contributed to this paper. The PICOT question has been modified to fit the findings with an outcome window of 1-3 years post weight loss. Summary of findingsUsing all the studies in the chart below the highest start BMI with the percentage of excess weight loss at 1 and three years respectively and the average BMI at these times were utilized for this paper .The timeline was modified for the Kritchevsky study using its end time at 27 months. There were different surgical interventions that used the band or sleeve that are not mentioned. The highest rate was recorded, with the most successful intervention in each study to compare all findings. The BMI scale used is as follows. BMI Obese. Under the Coleman study the BMI average at start was 39 kg/m2. After 1 year post surgical intervention with Roux-en-y gastric bypass there was a 50% reduction in excess weight yielding a BMI of 19.5. After 3 years there was a 46% excess weight loss yielding a BMI of 21.06. Under the Sczepaniak study the starting BMI was 47 Kg/m2 and in 6 months post surgical intervention there was a 50% reduction in overall weight yielding a BMI of 23.5. In one year post surgical intervention there was a loss of 60.2% overall body weight yielding a BMI of 18.70.This method utilized the sleeve gastronomy. Both surgical interventions brought the BMI of individuals in the mean data to normal BMI range as early as 6 months and in the 3 year post marker there was still a maintenance in a normal BMI. In the Kritchevsky study the starting BMI was 46 K/m2 There are no results at the one year margin . There was an overall goal of 5-10% of overall reduction of body weight. The end result at the latest was a 27 month window (2 years and 3 months) with a total ending BMI of 41.4. The study was a success as it met it's initial goal however it fails to show surpassing data in regards to weight loss with diet and exercise. In the Foster-Schubert study the participants started at a mean BMI of 30.9 Kg/m2 and had a 13.5% decrease in overall weight over one year. Data for 6 months was not available. The resulting BMI would be 26.72 which is still considered overweight but not obese. it also only utilized post menopausal women. With the lack of viable information and/ or studies supporting normal weight loss not utilizing surgical intervention and their long term outcomes it can only be concluded that the most successful way to reduce BMI and promote overall health in a 1-3 year outcome is surgical intervention. Implications for practiceIt is still highly recommended that before surgical intervention a proper diet and exercise routine be implemented into the routine of an obese patient. Further patient education and monitoring can take place to pinpoint areas that may need reinforcement. Once a percentage of the weight is lost the patient care team can move ahead in planning surgical intervention for a better long term outcome in weight loss for obese patients. PICO Question : (P) For patients with obesity (BMI > 30) (I) Does nutritional education , diet and exercise © Compared to nutritional education and surgical intervention (O) have better outcomes in terms of both overall weight loss and the ability to keep it off within 1-3 years? Authors, Date and TitlePurposeDesign & Research MethodSetting and SampleMeasurements and OutcomesCommentsLevel Of Evi-denceColeman , K. J., Huang, Y., Hendee, F., Watson, H. L., Casillas, R. A., & Brookey, J. (2014, February 6). Three-year weight outcomes from a bariatric surgery registry in a large integrated healthcare system. Surgery for Obesity and Related Diseases , 10(), 396-404.To outline patients from 2004 to 2013 who had procedures for weight loss. The object was to present 3 year weight loss outcomes.Patients were passively enrolled into registry with criteria of bariatric procedure for eight loss from Jan1 2004 and actively enrolled in health plan at time of surgery.Setting was all patients who had a bariatric procedure from Jan 2004 to 2013 Sample were Hispanic, Non Hispanic white and non-Hispanic Black participants and three different proceduresRoux-en-Y gastric bypass patients lost more weight than any other procedure in 3 year outcome. Non Hispanic whites had a higher percentage of weight loss than non Hispanic Blacks overall on RYGB.The article broke down individuals by race where I was looking for more of a percentage of body weight loss and maintained over three years to compare to general diet and exercise data in other studiesVKritchevsky, S. B., Beavers, K. M., Miller, M. E., Shea, M. K., Houston, D. K., Kitzman, D. W., & Nicklas, B. J. (2015, February 10). intentional Weight Loss and All-Cause Mortality: A Meta-Analysis of Randomized Clinical Trials. PlOS ONE.RTC's of weight loss used to clarify results of intentional weight loss on mortalityAbstracts and data was viewed in PUBMED yielding 15 RTC's. The authors used other case studies instead of using their own.Females and Males with a mean age of 52 years old. Follow up times ranged from 18 months to 12.6 years. Mean was 27 months. Weight loss interventions were all lifestyle based and not surgical. There was a control set of men and women who was not in a weight loss group.The weight loss groups experienced 15 percent lower all-cause mortality risk. So losing weight only saved you 15% lower risk of dying sooner.This study focused more on how much longer an individual can survive if they lost weight compared to those that did not however I can use the weight loss data over time to compare to my 3 year individuals with surgical intervention.IISczepaniak, J. P., Owens , M. L., Shukla, H., Periegos, J., & Garner , W. (2014, 14 November ). Comparability of Weight Loss Reporting After Gastric Bypass and Sleeve Gastrectomy 2008-2011. Obesity Surgery , 25(5), 788-795. Comparability of Weight Loss Reporting After Gastric Bypass and Sleeve Gastrectomy Using BOLD Data 28-211 | SpringerLinkTo measure total weight loss after surgical intervention using Gastric bypass and Sleeve GastrectomyBOLD Data was accessed from 2008-2011 for over 200K patients who underwent the two surgical procedure164,247 patients were utilized after removal of errors and missing data. Demographics Female, Male, height, age, weight. Hispanic, white, black, weight at 6 and 12 months.The greatest outcome after a year came from the sleeve gastrectomy patients 60.2% of total body weight loss.This study did not focus on how much physical weight was loss but placed it in total body percentage lost with different surgical procedure over a max of 12 months. If I strain my data from the other two I can answer my study question with a time span of one year by averaging my results from three years and dividing by three. This will not leave me with perfect results but a rough estimate.IIFoster-Schubert, K., Alfano, C. M., Duggan, C. R., Xiao, L., Campbell, K. L., Kong, A., ... McTiernan, A. (2012, April 14). Effect of diet and exercise, alone or combined, on weight and body composition in overweight-to-obese post-menopausal women. Obesity, 8(). Effect of Diet and Exercise, Alone or Combined, on Weight and Body Composition in Overweight-to-Obese Postmenopausal Women - Foster-Schubert - 212 - Obesity - Wiley Online LibraryTo measure total weight loss after non surgical intervention over 1 yearsPatients completed a questionnaire and were weighed to measure progress.Participants completed a series of questionnaires at their baseline screening visit prior to randomization, including demographic information, medical history, health habits, reproductive and body weight history, diet intakeThe greatest outcome after a year was a 13.5% decrease in BMIThe study focused on post menopausal women but it did show how diet and exercise could be combined to lose weight. The data was weak at best compared to surgical intervention. .IReferences Adult Obesity facts. (2014). Retrieved from Adult Obesity Facts | Overweight & Obesity | CDC Coleman , K. J., Huang, Y., Hendee, F., Watson, H. L., Casillas, R. A., & Brookey, J. (2014, February 6). Three-year weight outcomes from a bariatric surgery registry in a large integrated healthcare sustem . Surgery for Obesity and Related Diseases , 10(), 396-404. Foster-Schubert, K., Alfano, C. M., Duggan, C. R., Xiao, L., Campbell, K. L., Kong, A., ... McTiernan, A. (2012, April 14). Effect of diet and exercise, alone or combined, on weight and body composition in overweight-to-obese post-menopausal women. Obesity, 8(). Effect of Diet and Exercise, Alone or Combined, on Weight and Body Composition in Overweight-to-Obese Postmenopausal Women - Foster-Schubert - 212 - Obesity - Wiley Online Library Kim, J. J., Rogers, A. M., Ballem, N., & Schirimer, B. (2016, Aprin 18). ASMBS updated position statement on insurance mandated preoperative weight loss requirements . Surgery for Obesity and Related Diseases , 12(), 955-959. Kritchevsky, S. B., Beavers, K. M., Miller, M. E., Shea, M. K., Houston, D. K., Kitzman, D. W., & Nicklas, B. J. (2015, Feburary 10). intentional Weight Loss and All-Cause Mortality: A Meta-Analysis of Randomized Clinical Trials. MacMillan, A. (2011). After dieting, hormone changes may fuel weight regain . Retrieved from After dieting, hormone changes may fuel weight regain - CNN Sczepaniak, J. P., Owens , M. L., Shukla, H., Periegos, J., & Garner , W. (2014, 14 November ). Comparability of weight loss reporting after gastric bypass and sleeve gastrectomy 2008-2011. Obesity Surgery , 25(5), 788-795. Comparability of Weight Loss Reporting After Gastric Bypass and Sleeve Gastrectomy Using BOLD Data 28-211 | SpringerLink Yang, Y., & Beydoun, M. A. (2007). The obesity epidemic in the united states-Gender, Age, Socioeconomic, Racial/Ethnic, and Geographic Characteristics: a systematic review and meta-regression analysis. Oxford Journal of Medicine & Health , 29(1), 6-28. http://dx.doi.org/10.1093/epirev/mxm007

Thank you very much everyone for feedback. I am still compiling my paper and I can't seem to find solid research that shows consistent loss of weight with surgery vs conventional means and a outlook in 5,10,15 years. There seems to be no study that has followed patients past the point of an average of 24 months. I have hard data for at least 12 but we all know a year is nothing. You can backslide in a year. You can backslide in 5 . I am really interested to know which is more effective and what changed the effectiveness. Was it education? Support? Stress management in a healthy way not succumbing to food or other detrimental habits. Are there studies out there that followed a population, male and female over at least 5 years post surgery or normal weight loss? I think this is so important to explore because I don't want to be at a healthy weight for one year. I want the tools to be at a healthy weight for the rest of my life. I want to give those tools to others too.

In obesity, I came to the crossroads many times on what to do for help. I have tried many diets, I have taken many pills. Any snake oil, charm, powder, pill, topical cream, a corset torture device, weird massager, infomercial 2 am promise you'll be thin in 30 days getup I have tried. I have spent a great deal of money and time in these endeavors and I have failed to achieve any measurable success. There is a level of frustration that comes will hitting the wall and the hard place and one day a person just breaks down. I wanted to get from point A to point B and there were two paths. Diet and Exercise or Surgery. But which is truly better? I've seen bad outcomes in both. I've had patients with dumping syndrome and GI issues post gastric bypass. I've seen Gastric sleeves that fail or people who don't break their habits gain the weight back after an incredible loss. I've also seen people come back from diet and exercise and gain more than they ever had before *raises hand *. So I wanted to know, which in the long term was more successful. I am currently in my Nursing Research and Statistics class for my BSN and I have to write an Evidence-Based Paper. We had to devise a PICOT question and delve into it. A PICOT question is Patient populationIntervention or issue of interestComparison intervention or groupOutcomeTime frameMine is : (P) For patients with obesity (BMI > 30) (I) Does nutritional education, diet and exercise © Compared to nutritional education and endoscopic bariatric surgical intervention (O) have better outcomes in terms of both overall weight loss and the ability to keep it off within 5 years? 10 Years? 15 Years?I will release that paper in its entirety for evaluation here. For now, I am focusing on methodologies for losing weight that have better outcomes. Later I will focus on pitfalls like food addiction and focus on neuro changes and comparisons in individuals with and without obesity. If you have any insight into studies that encompass this PICOT question I am all ears. I'm personally going the Diet and Exercise route this time around too. I've removed refined sugar intake, (went through a fun series of days enjoying withdrawal symptoms), reduced carbohydrates and introduced more vegetables. I eat all meats and balance my meals as best I can. The only drawbacks I've encountered is I switched to diet soda and I get cranky when I go a few days without it. I have at least one every other day. I need to kick it completely. I don't drink coffee anymore and want tea, I guess that's awesome. One sudden and terrible thing that has manifested in the last week: I crave cigarettes. About 9 years ago I went through about a month period where I chain smoked. Ironically it coincided with my divorce. I haven't since and I occasionally get a crazy craving to smoke. That craving is alive and well right now. I'm waiting till it blows over. I imagine there may be some deficiencies brewing and they are triggering these changes or my brain is desperate to cling to another coping mechanism. I'm keeping a journal and watching what I crave and eat. As I do more research I will pass on what I find. I imagine our patients go through more than what they tell us. They have more than just eat less and move more as their day to day struggle to lose weight. I know I do. I am hypersensitive to these changes because I am training myself to be. I aim to lose the rest of this weight (somewhere around 170 more lbs to go?) in the healthiest way possible and write about it as I go. For now, I will celebrate the little victories. One bite at a time. PS. I'm at 300lbs. That's 46 down and counting. *does a little shimmy and dance* That is all. Carry on.

So this morning I start off as I do most days. I scan my email, I look at job postings. I look at updates in my New Grad RN groups. Who's potentially hiring today? The desire for acute care employment is still in the forefront of my mind as it is with many New Grads. Everyone wants to be in a hospital. It's not so much a hospital as it is the number of hands-on with acute care. I am getting a level of experience in post-op/ skilled nursing. Everything encompassing care and communication is still covered but there just seems to be an overall desire to hire from acute care. Everyone asks for a year of acute care. And so an epiphany hit me this morning. I may not be considered a new grad anymore. This is good and inherently bad. A lot of hospital positions that do open up for those with no acute care want crisp fresh new grads to train. Sure they have anywhere from 3 to 25 openings and thousands of applications per round but that's what they desire. Zip experience elsewhere. Other places say at least one year of nursing experience in acute care. This closes two doors on me. One..I have experience, but not in acute care outside clinicals that were in *ahem* 2013. I am no longer looked at as a new bird. I passed my NCLEX in March of 2014. With my ACLS and PALS I thought I was more marketable. Not really. A lot of people went after that to make themselves more desirable too. So where do I stand? I am not a new grad and I have no acute care experience. I desire to eventually be an NP in Pediatrics and I work with geriatrics. Yes, on the healthcare continuum there are a lot of similarities between pediatric and geriatric patients with many of the same considerations for metabolization of medications, safety etc. There are many differences too. I'd like to be exposed to a level that is sort of specializing towards my goal. I drool at the possibility of working in a children's hospital. I also crave stability. Per diem work is awesome. My employer is awesome but let's face it, I need a solid constant. It would be a dream to land a three-year contract somewhere in acute care. It would provide the fundamental base for acquiring home for my Son and me, expanding my education for my BSN and eventually Masters. And this morning I am looking at these postings..and overlooking my four to eight a day applications and wondering is it a viable decision to go out of state? California is a dark cloud when it comes to New Grads in Nursing. They are making a killing and turning out hundreds of new grads every 16 weeks and the hospitals are begging for personnel.. with a year minimum of acute care experience. We are over saturated and picky. Everyone cries out about a nursing shortage but there are many of us who are not working yet because we don't meet the minimum criteria. It's like hospitals are looking for unicorns and all we are looking for is jobs. On the outskirts of all this, we have lives. Kids...families to support. It's a lot of pressure. And now I may not have that brand on my assets that marks me as minty new. I may not be seen as a New Grad. I have mixed emotions about this and just keep trucking. Any experience is good experience in my eyes. I learn something new every day and frankly, I love what I do irregardless. I will explore more options to get myself where I need to be. Even if it's not as a New Grad anymore. Two years later.... One of the greatest struggles I had as a new grad was just this. The search. As soon as the stress of getting into, getting through and passing the boards was over I was left with my hands in the air. Pick me...Pick me. And no one did. I worked per Diem for a little over 8 months driving six days a week more than an hour away (each way) to a position that I enjoyed but was not acute care. I was working all the shifts (all of them). 7AM to 3PM. Yup. 3-11... yup. 11-7? Also yes. Was I working doubles? More than once. People just didn't show sometimes and I was already there so as part of my naivety and not wanting to "abandon" my patients I would stay. Nights consisted of me, 54 patients, three CNA's and Jesus. Then I found out I was being paid at least 13 dollars less than staff..and I was registry. But I kept on. I loved the staff, loved the patients and just worked. I was tired. But an opening came in long term acute care and I ran at it full speed. I quickly found out... That place was hell. 9 patients (more like 10 to 12 realistically) one LVN and one CNA a night. Telemetry, Vents, Dialysis, Codes, Wound Vacs, Non-compliance with a touch of nightly threats and a police call or two and it was in that chaos that I became the best damn nurse I could have. I learned from hard-working nurses, and I learned how a team can make or break you. We were more than nurses ..we were family. A year passed... I went for my critical care and advanced EKG certificates while I was working. I applied for school to continue to my BSN. I was tired. In the summer...I landed my dream job in a prestigious magnet hospital in their ICU. The point of this article is..yes it will be hard to get your foot in the door. You go through over 200 applications..(280 for me). You will cry, you will be frustrated. Your family will say.."But I thought there was a nursing shortage." Refrain from snapping. Hold on. You worked so hard to get where you are but at the end, the hill just gets steeper and your resolve must get stronger. Your teacher told you nurses don't stop learning. We don't stop going to school, getting certificates. We don't stop specializing. You keep at it. Join nursing organizations, keep abreast of any and all best practices in your area of expertise or the area you aspire to enter. Read, interact and also know how and when to rest. Yet know you will put in so much and you will get out so much. My journey is far from done. I'm 2 classes away from my BSN, a few weeks away from taking my CCRN and looking at where to specialize for my MSN. I am always planning. I am always climbing. And I love every second of it. So know where you stand, and know where it is you want to be. Before you know it.. there you are. Last bit of info...I had an instructor once tell me all the requirements to get into nursing school were daunting...it seemed like such a big task, sort of like eating an elephant. How, she asked us, do you eat an entire elephant? One bite at a time.

There are nurses who will drive from four or more hours away and be there 2 hours early just to snag her spot and will stay at a hotel or sleep in the car and hit the gym for a shower and fresh scrubs for day two. I knew some who did this level of crazy just to get to work on time. Don't even get me started on inclement weather and what nurses will do to go to work on time. She would be toast at my work...just saying.