Clinical scenario:Bariatric surgery

NURS1007 :Investigate the Clinical Scenario -Nursing AssignmentClinical scenario 2017 :You are an obesity service nurse working in a large metropolitan hospitals outpatient service. One of your patients has diabetes and is eligible for bariatric surgery. She is very motivated to lose weightin the hope of curing her diabetes. But all bariatric surgery come with risks and your patient is wondering how much more effective is bariatric surgery than dieting.On reflection you wonder if the addition of bariatric surgery provides any diabetic/glycemic control benefits beyond a moreconservative/usual care approach which combines diet with exercise. Diets used may include very lowcalorie/carbohydrate/energy diets.There was a good quality systematic review on this topic publishedin 2013 but it’s a bit out of date now as its search stopped in June 2013. It only found 4 trials but did find that surgery was more likely to cause diabetic remission (Gloy et al BMJ 2013;347:f5934 doi:10.1136/bmj.f5934). Your job is to update this systematic review, synthesize your findings and make a clear clinical recommendation for your patient.Case Study:Febrile convulsions are the most common paediatric seizure, affecting up to 4% of children under five (Hampers & Spina, 2011). Convulsions occur in febrile children because developing neurons can malfunction at high temperatures (Ferrier Innes, 2015); when febrile children present to hospital, they are therefore cooled to prevent seizures. Cooling regimes usually include antipyretic medication, and although tepid sponging is anecdotally recommended, its efficacy is debated (Thomas, Vijaykumar, Moses, & Antonisamy, 2009). This report investigates whether tepid sponging in conjunction with antipyretic medication is more effective than medication alone in reducing elevated temperatures in children, and thereby preventing convulsions.Questions :In adult obese patients with type II diabetes does bariatric surgeryor dietary approaches alone cause greater likelihood of diabeticremission?Taking account of the clinical scenario and question provided, you will need to design a search strategy to find the relevant and appropriate research literature to respond to the question.You will conduct a search of the literature, appraise (critically evaluate) the research evidence generated from the search and synthesize the results of the retrieved studies in order to answer the question you have been asked and provide an evidence-based recommendation.

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