The low carb program for people with type 2 diabetes and pre-diabetes – a mixed methods feasibility study of signposting from general practice

BackgroundEvidence shows type 2 diabetes mellitus (T2DM) can be effectively treated with a reduced-carbohydrate diet to support weight loss. Digital apps are increasingly used to support weight loss, yet little is known about their use as part of general practice diabetes care.AimDetermine the feasibility of signposting from routine NHS general practice to a digital weight management tool (Low Carb Program) for patients with T2DM and pre-diabetes.Design/settingMixed-methods feasibility study implemented within routine general practice consultations at four practices in the Midlands, England.MethodsGeneral practices offered signposting to eligible patients attending consultations of any type during a four-week recruitment period. Rates of offering and accepting signposting were recorded, with program registration, program completion and self-reported health outcomes (weight, HbA1c).ResultsSignposting was offered to 351 patients; 160 (45.6%) accepted, 103 (29.3%) registered with the intervention and 43 (26.9% of patients accepting signposting) completed the programme. GPs reported that signposting added between 1–4 minutes to the consultation length. Patients completing the programme reported greater weight loss (7.2 kg vs 1.6 kg, P<.001) and HbA1c improvements (–9.1 mmol/mol vs 1.7 mmol/mol, P<.001) compared to those who did not, and were more likely to reduce the number of general practice-prescribed diabetes medications.ConclusionsSignposting from real-world general practice to the Low Carb Programme is feasible and can potentially improve diabetes outcomes. Further research should explore whether the process of signposting can be enhanced to increase registration, identify whether additional practice-led support leads to increased programme completion, and confirm the intervention’s clinical and cost-effectiveness.

Study Protocol: A Six-Session Mindfulness-Based Training to Support Weight Management in Hispanics Post Bariatric Surgery – Lessons Learned From a Pilot Study

Objectives Objective: To evaluate the recruitment, retention, and acceptability of a mindfulness-based group intervention to support weight management in Hispanics after bariatric surgery. Background: Mindfulness-based approaches may support improvement of problematic eating behaviors post- bariatric surgery. Such approaches have been explored with promising results in Non-Hispanic; however their impact on bariatric clients of Hispanic origin has not been investigated. The purpose of this pilot study was to evaluate the feasibility of a six-session mindfulness-based training for bariatric clients of Hispanic origin. Methods This was an intervention-one group pre/post-test pilot study. Participants were Hispanics (≥ 21 years), who had surgery 12–36 months prior to baseline. Recruitment was over a one-month period, through flyers available in a dietetics practice and through snowball sampling. Interested individuals were screened via telephone. Group training was delivered over six consecutive weeks, participants were asked to complete four questionnaires including: Perceived Stress Questionnaire, Acceptance and Committed Action-II Questionnaire, Intuitive Eating Scale-2, and Short-Form Five Facet Mindfulness Questionnaire at baseline, week six, and ten. A group exit interview was conducted on week six. Incentives and refreshments were provided at each meeting, training was free of charge. Results For recruitment in the first cohort, 60 people screened, 55 (92%) were eligible and 7 (13%) consented, meeting the recruitment objective of 7–10 participants. Out of the eligible, 42 (76%) were willing but not able at this time. There was 100% participation in all sessions and assessment visits which exceeded the adherence criteria of attendance at 4/6 sessions. Three participants were recruited from flyers, four from snowball sampling. Conclusions This pilot study was feasible; Hispanics were willing to participate, retention and adherence was at a maximum. Multiple sources for recruitment could increase the efficacy of the recruitment. Funding Sources None.

Discussing weight loss opportunistically and effectively in family practice: a qualitative study of clinical interactions using conversation analysis in UK family practice

Background GPs are encouraged to make brief interventions to support weight loss, but they report concern about these conversations, stating that they need more details on what to say. Knowing how engage in these conversations could encourage GPs to deliver brief interventions for weight loss more frequently. Objective To examine which specific words and phrases were successful in achieving conversational alignment and minimizing misunderstanding, contributing to effective interventions. Methods A conversation analysis of English family practice patients participating in a trial of opportunistic weight-management interventions, which incorporated the offer of referral to community weight-management services (CWMS). Qualitative conversation analysis was applied to 246 consultation recordings to identify communication patterns, which contributed to clear, efficient interventions. Results Analysis showed variation in how GPs delivered interventions. Some ways of talking created misunderstandings or misalignment, while others avoided these. There were five components of clear and efficient opportunistic weight-management referrals. These were (i) exemplifying CWMS with a recognizable brand name (ii) saying weight-management ‘programme’ or ‘service’, rather than ‘group’ or ‘club’ (iii) stating that the referral is ‘free’ early on (iv) saying the number CWMS visits available on referral (v) stating that the CWMS programme available was ‘local’. Conclusions When making a brief opportunistic intervention to support weight loss, clinicians can follow these five steps to create a smooth and efficient intervention. Knowing this may allay clinicians’ fears about these consultations being awkward and improve adherence to guidelines.

Auricular Acupuncture with Beads Supports Sustained Weight Loss

Obesity causes serious long-term health problems in people worldwide. Since the effect of dietary advice is possibly limited, weight loss can be a major challenge; therefore, additional weight control techniques may be beneficial. We conducted four experiments to evaluate if auricular acupuncture point stimulation with simple metal beads (AA) rather than the popular use of intradermal needle (DA) to stimulate auricle would support weight loss. In this retrospective study, weight change in Japanese women (aged 18 to 78) was confirmed based on changes in body composition after receiving auricular acupuncture with AA for three months. Furthermore, as a prospective study, we compared three groups—AA, DA, and non-intervention groups—to evaluate if AA, which is simpler than DA, can adjust hunger and reduce food intake and snacking (n = 58). We evaluated the effect of treatment using a questionnaire that recorded changes in weight, number of snacking time, and the amount of food intake (appetite suppression monitoring study). Furthermore, to evaluate changes in post-prandial blood glucose by AA stimulation by comparing groups, we switched AA and non-intervention periods every 24 h to measure changes in blood glucose by the AA. Finally, to evaluate long-term weight loss, we conducted a follow-up study 6 months after AA intervention. The rate of weight loss in subjects who received AA intervention (n = 1362) was -11.15%, confirming a significant decrease. By comparing people who underwent AA with people who did not, we demonstrated that AA reduces snacking between meals and improves satiety. Compared to the non-intervention group (42.75 (65.23) times), the AA (6.6 (10.53) times) and DA (7.93 (4.92) times) groups saw significant decrease in the number of snacking times (p = 0.04 and p = 0.05). The rate of weight loss was -3.57%, -2.74%, and -1.38% in the AA, DA, and untreated groups, respectively; thus, presenting a significant difference (p = 0.02). Glucose decreased in the intervention group, where a significant difference was observed for the median value at 90 and 105 min (p = 0.05, p = 0.007, respectively). Interestingly, weight loss by AA was maintained for six months after the end of treatment. AA had effects equivalent to or even better than DA while being safe and simple. Thus, it can effectively support weight loss and maintain body weight.

Enrichment of Polyunsaturated fatty acids from catfish oil with immobilized Rhizopus oryzea lipase

Nowadays, Pangasius hypophthalmus fillet is one of the main marine products in Vietnamese Mekong River Delta with over three hundred thousand tons per year. One of the byproducts of this industry is fat, about one hundred thousand tons per year. That byproduct has been only used in animal foodstuff industry after oil extracting or it becomes waste. In order to increase the quality of Pangasius hypophthalmus oil, we have enriched PUFA in the oil by hydrolysis with immobilized Rhizopus oryzea lipase. Lipase has been immobilized on celite by absorption method. Immobilization experiments have been designed in a two-level full factorial model with three factors. The fish oil has been hydrolyzed with immobilized lipase to enrich PUFA with optimized parameters found out: the ratio of enzyme to support of 1:10 g/g, the ratio of phosphate buffer volume to support weight of 30.55 ml/g, incubation time of 5.15 hours. The result has showed that 60-minute hydrolysis is the most appropriate. Additionally, the oil iodine value has increased from 71.4 to 97.4, and DHA concentration has risen from 1156mg/kg to 1916mg/kg.

Design and Analysis of double- stacked Heat Exchanger for Brewery Application

A heat exchanger is a device intensively used for enhancing the transfer of heat energy between two or more working fluids at different temperature, which are in thermal contact. The optimal design and efficient operation of heat exchanger and heat transfer network are of a great significance in any of the process industry. The heat transfer efficiency depends on both design of heat exchanger and property of working fluid. From various types of heat exchanger, the double stacked shell and tube heat exchanger with straight tube and single pass is to be under study. Here the redesign of heat exchanger takes place with the key objectives of optimizing the pressure drop, optimizing the heat transfer rate and reducing the saddle support weight used for cooling purpose in brewery application. The design calculations are carried out using the Kerns and Bell Delwar method and other important parameters dealing with material selection and geometries are also taken into consideration. FEA analysis for optimizing the saddle support weight is carried out using Dassault systeme’s Solidworks while the CFD analysis for optimizing pressure drop and heat transfer rate is carried out using Dassault systeme’s Solidworks analysis software and the design and working of Shell and tube heat exchanger is determined in terms of variables such as pressure ,temperature ,mass flow rate ,flow rate ,energy input output that are of particular interest in Shell and tube heat exchanger analysis.

Transforming with partner patients a program of preparation for bariatric surgery

Introduction: The current collective preparation program for obesity surgery is performed by an interdisciplinary team over four non-consecutive days. In order to optimize the delays of the program and to improve the educational offer a temporal condensation of this service in the proximity of the intervention was decided. The objective of this study is to describe the creation process of the new obesity surgery preparation program based on the needs of partner patients. Materials and methods: We conducted semi-structured focus groups with 50 patients over 3 successive stages of the surgical journey: at the beginning and end of the collective preparation and then 2 to 14 months after the surgery. The analysis crosses by theme the needs identified. Results and discussion: Our study allowed to authenticate a central need of sharing with witnesses, a need for information (medical, dietary, behavioral), and a need for longer-term projection (transformations, investment axes to support weight loss). Conclusion: The preparatory needs identified by the partner patients served as a guide for the transformation of the existing program. This experiment paves the way for a partnership with patients established and recognized by the institution of care in the evaluation process of this program.

STructured lifestyle education for people WIth SchizophrEnia (STEPWISE): mixed methods process evaluation of a group-based lifestyle education programme to support weight loss in people with schizophrenia

Background STEPWISE is a theory-informed self-management education programme that was co-produced with service users, healthcare professionals and interventionists to support weight loss for people with schizophrenia. We report the process evaluation to inform understanding about the intervention and its effectiveness in a randomised controlled trial (RCT) that evaluated its efficacy. Methods Following the UK Medical Research Council (MRC) Guidelines for developing and evaluating complex interventions, we explored implementation quality. We considered causal mechanisms, unanticipated consequences and contextual factors associated with variation in actual and intended outcomes, and integrated treatment fidelity, using the programme theory and a pipeline logic model. We followed a modified version of Linnan and Steckler’s framework and single case design. Qualitative data from semi-structured telephone interviews with service-users (n = 24), healthcare professionals delivering the intervention (n = 20) and interventionists (n = 7) were triangulated with quantitative process and RCT outcome data and with observations by interventionists, to examine convergence within logic model components. Results Training and course materials were available although lacked co-ordination in some trusts. Healthcare professionals gained knowledge and some contemplated changing their practice to reflect the (facilitative) ‘style’ of delivery. They were often responsible for administrative activities increasing the burden of delivery. Healthcare professionals recognised the need to address antipsychotic-induced weight gain and reported potential value from the intervention (subject to the RCT results). However, some doubted senior management commitment and sustainability post-trial. Service-users found the intervention highly acceptable, especially being in a group of people with similar experiences. Service-users perceived weight loss and lifestyle benefits; however, session attendance varied with 23% (n = 47) attending all group-sessions and 17% (n = 36) attending none. Service-users who lost weight wanted closer monitoring and many healthcare professionals wanted to monitor outcomes (e.g. weight) but it was outside the intervention design. No clinical or cost benefit was demonstrated from the intermediate outcomes (RCT) and any changes in RCT outcomes were not due to the intervention. Conclusions This process evaluation provides a greater understanding of why STEPWISE was unsuccessful in promoting weight loss during the clinical trial. Further research is required to evaluate whether different levels of contact and objective monitoring can support people with schizophrenia to lose weight. Trial registration ISRCTN, ISRCTN19447796. Registered 20 March 2014.