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manual thai reflexology LINK 1 ENTER SITE >>> http://gg.gg/12bhfk <<< Download LINK 2 ENTER SITE >>> http://chilp.it/d0191a0 <<< Download PDF File Name:manual thai reflexology.pdf Size: 4337 KB Type: PDF, ePub, eBook Uploaded: 3 May 2019, 20:19 Rating: 4.6/5 from 617 votes. Status: AVAILABLE Last checked: 1 Minutes ago! eBook includes PDF, ePub and Kindle version In order to read or download manual thai reflexology ebook, you need to create a FREE account. ✔ Register a free 1 month Trial Account. ✔ Download as many books as you like (Personal use) ✔ Cancel the membership at any time if not satisfied. ✔ Join Over 80000 Happy Readers manual thai reflexology This book is divided into 10 sections covering selection of patient, preoperative predictors of outcome, technical considerations, specific situations, post-operative pathways, management of complications, revisional surgery, and perioperative nutritional aspects. It covers specific situations in bariatric surgery such as GERD, hernia repair, gallstone disease, PCOD, NAFLD and end-organ disease. Bariatric Surgical Practice Guide is a quick resource for practicing bariatric surgeons, young and experienced, to understand all practical aspects of this surgery which is gaining importance worldwide at a rapid pace. Recommendations are based on existing literature as well as opinions of the authors who work at state-of-the-art clinical facilities. He also secured his masters in Surgery and surgical gastroenterology from the National Board (DNB). He has been conferred with the Honorary Fellow in Advanced laparoscopy (FALS) by the Indian Association for Gastrointestinal Endosurgeons (IAGES). Currently, he is director at the GEM hospital group and heads the GEM Obesity and Diabetes Surgery Centre. His center is recognized by the Dr. MGR Medical University for conducting a tw- year fellowship program in bariatric surgery. Through his bi-annual training program, he has trained more than 150 surgeons in the field of bariatric surgery. Dr. Praveen Raj is currently the President of the Indian chapter of the International Excellence Federation of Bariatric Surgery. He and his center were the first in South India to be accredited as an International Center of Excellence by the Surgical Review Corporation, USA. He has authored several papers on laparoscopic and bariatric surgery and presents frequently at conferences. His recently completed NASHOST trial, aimed to study the influence of bariatric surgery on non-alcoholic fatty liver disease is the first registered clinical trial on bariatric surgery in the country. http://www.snhpartners.nl/userfiles/bunn-grinder-manual.xml manual thai reflexology, manual thai reflexology class, manual thai reflexology free, manual thai reflexology online, manual thai reflexology book. He has also commenced a trial on lower BMI metabolic surgery for the treatment of type 2 diabetes mellitus, which when completed will be the first of its kind in the world. He has also instituted international fellowship programs where physicians from abroad train with him in India. Dr. Saravana Kumar graduated in surgery from the Madurai Medical College, India. He has many international publications in the field of bariatric surgery and, along with Dr. Praveen Raj and Professor Palanivelu, is actively involved in training of surgeons. He is a member of the Obesity Surgery Society of India, Association of Minimal Access Surgeons of India, and also the International Federation for Surgery of Obesity. Dr Rachel Maria Gomes graduated and completed her surgical training with accolades from the Goa Medical College under the Goa University of India. She then further specialized in GI and Laparoscopic surgery at the Bhatia hospital and the Jaslok hospital at Mumbai. She has to her credit more than 50 peer-reviewed national and international publications and has delivered numerous presentations at national and international conferences with several awards for outstanding presentations. She is a member of the Association of Surgeons of India, the Indian Association of Surgical Gastroenterology and the Indian Association of Gastrointestinal and Endoscopic Surgeons. Through his bi-annual training program, he has trained more than 150 surgeons in the field of bariatric surgery.Dr. Praveen Raj is currently the President of the Indian chapter of the International Excellence Federation of Bariatric Surgery. She is a member of the Association of Surgeons of India, the Indian Association of Surgical Gastroenterology and the Indian Association of Gastrointestinal and Endoscopic Surgeons. Laparoscopic Surg, FBMS (et al.). To browse Academia.edu and the wider internet faster and more securely, please take a few seconds to upgrade your browser. http://www.wetheralvillagehalls.org.uk/userfiles/f350-manual-transmission-conversion.xml Help Center less Academia hosts open access papers, serving our mission to accelerate the world’s research. Read Paper Bariatric Surgical Practice Guide Download Loading Preview Sorry, preview is currently unavailable. You can download the paper by clicking the button above. By Aristotelis Kalyvas Download pdf About Press Blog People Papers Job Board Advertise We're Hiring. This book provides a comprehensive review of literature of various aspects of bariatric surgery arriving at practical recommendations for simplifying day to day practice. It covers specific situations in bariatric surgery such as GERD, hernia repair, gallstone disease, PCOD, NAFLD and end-organ disease.Bariatric Surgical Practice Guide is a quick resource for practicing bariatric surgeons, young and experienced, to understand all practical aspects of this surgery which is gaining importance worldwide at a rapid pace. Recommendations are based on existing literature as well as opinions of the authors who work at state-of-the-art clinical facilities. This book is divided into 10 sections covering selection of patient, preoperative. Posted on March 5, 2017 March 5, 2017 by admin. 05 Mar. Praveen Raj. Description. This book provides a comprehensive review of literature of various aspects of bariatric surgery arriving at practical recommendations for simplifying day to day practice. This book is divided into 10 sections covering selection of patient, preoperative predictors of outcome, technical considerations, specific situations, post-operative. He has also instituted international fellowship programs where physicians from abroad train with him in India.Dr. Saravana Kumar graduated in surgery from the Madurai Medical College, India. He is a member of the Obesity Surgery Society of India, Association of Minimal Access Surgeons of India, and also the International Federation for Surgery of Obesity. https://skazkina.com/ru/engineering-mechanics-dynamics-meriam-and-kraige-solutions-manual Dr Rachel Maria Gomes graduated and completed her surgical training with accolades from the Goa Medical College under the Goa University of India. She is a member of the Association of Surgeons of India, the Indian Association of Surgical Gastroenterology and the Indian Association of Gastrointestinal and Endoscopic Surgeons. Um diese Art von Buchern lesen zu konnen wird entweder eine spezielle Software (App) fur Computer, Tablets und Smartphones oder ein E-Book Reader benotigt. Auch ist die Menge der Downloads auf maximal 5 begrenzt. 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This book is divided into 10 sections covering selection of patient, preoperative predictors of outcome, technical considerations, specific situations, post-operative pathways, management of complications, revisional surgery, and perioperative nutritional aspects. It covers specific situations in bariatric surgery such as GERD, hernia repair, gallstone disease, PCOD, NAFLD and end-organ disease. nBariatric Surgical Practice Guide is a quick resource for practicing bariatric surgeons, young and experienced, to understand all practical aspects of this surgery which is gaining importance worldwide at a rapid pace. Recommendations are based on existing literature as well as opinions of the authors who work at state-of-the-art clinical facilities.nFeatures: Search It Here. By doing this, you will increase your chances of staying healthy and reduce complications that can arise from bariatric surgery. If you are struggling, discuss this with your original specialist team or, if you have been discharged, with your primary care provider. After this, there is a natural increase in weight that occurs. If you are gaining excessive amounts of weight, discuss this with your bariatric team or primary care provider. Appuyez Obesite Canada. Learn More. To ensure long-term postoperative success, patients must be prepared to adopt comprehensive lifestyle changes. This review summarizes the current evidence and expert opinions with regard to nutritional care in the perioperative and long-term postoperative periods. A literature search was performed with the use of different lines of searches for narrative reviews. Nutritional recommendations are divided into 3 main sections: 1 ) presurgery nutritional evaluation and presurgery diet and supplementation; 2 ) postsurgery diet progression, eating-related behaviors, and nutritional therapy for common gastrointestinal symptoms; and 3 ) recommendations for lifelong supplementation and advice for nutritional follow-up. We recognize the need for uniform, evidence-based nutritional guidelines for bariatric patients and summarize recommendations with the aim of optimizing long-term success and preventing complications. Keywords: obesity, bariatric surgery, nutrition care, eating-related behaviors, dietary supplements Introduction Obesity is a major public health burden of pandemic proportions ( 1 ). Bariatric surgery is currently the most effective treatment modality for morbid obesity when compared with nonsurgical interventions ( 3 ). The main benefits of this procedure include prolonged weight loss and improved obesity-associated comorbidities and quality of life ( 4 ). Several surgical procedures are currently available: laparoscopic adjustable gastric banding (LAGB) 13, laparoscopic sleeve gastrectomy (LSG), laparoscopic Roux-en-Y gastric bypass (RYGB), laparoscopic biliopancreatic diversion with (BPD-DS) or without (BPD) duodenal switch ( 5 ), and single-anastomosis gastric bypass ( 6 ). Laparoscopic bariatric surgery has been performed since the 1990s and has quickly surpassed open surgery in popularity due to its substantially lower risk of wound infection, incisional hernia ( 7 ), venous thromboembolism ( 8 ), and pulmonary complications ( 9 ). In the past several years, there has been a dramatic decrease in the popularity of LAGB due to disappointing long-term outcomes and high reoperation rates secondary to complications (e.g., slippage, pouch dilatation, dysphagia, and erosion). Meanwhile, LSG has gained in popularity ( 12 ). The total number of bariatric procedures performed worldwide in 2013 was 468,609; 45 were RYGB surgeries, 37 LSG, and 10 LAGB ( 1 ). No other single procedure exceeded the threshold of 2.5 ( 1 ). In Israel, almost 9000 people with morbid obesity underwent bariatric surgery in 2014 and LSG was the most common procedure ( 13 ). Currently, the greatest number of bariatric procedures as a function of total population (0.14) have been performed in Israel ( 1 ). Dietitians play a vital role in the multidisciplinary team before and after bariatric surgery. Previous studies have shown that adherence to a regular nutritional follow-up contributes to weight reduction postsurgery ( 14, 15 ) and prevents weight regain ( 16 ). However, this association remains controversial ( 17, 18 ). The aim of this narrative review was to summarize the current scientific literature and to present a protocol for nutrition care in bariatric patients to enhance quality of care, set uniform guidelines, and ensure safe practice. Literature Search A literature search was performed for the present study on different lines of searches for narrative reviews. The search included 3 electronic databases—PubMed, Google Scholar, and the Cochrane Library—and articles published up to 2016 were selected. Combinations of key words such as “bariatric surgery,” “obesity surgery,” “nutrition care,” “supplements,” and “postoperative follow up” were used. The lists of the articles obtained were manually searched for additional references. The inclusion criteria consisted of all types of articles related only to humans. The exclusion criteria included articles for which the full text was not available or that were not in English or Hebrew. Current Status of Knowledge Presurgery nutritional care Nutritional evaluation. When a candidate meets the NIH consensus criteria for bariatric surgery, assessment is carried out by a multidisciplinary team with regard to the suitability of the candidate ( 5 ). Proper candidate selection, adequate nutritional assessment, and behavioral dietary guidance are essential in preparing for surgery and are key in achieving optimal surgical outcomes ( 19, 20 ). To date, there are no evidence-based or uniform protocols for choosing the most appropriate type of bariatric surgery. For the most part, the type of surgery chosen is determined by the patient’s request together with the surgeon’s experience, taking into consideration existing comorbidities ( 21 ). Surgeons should take extra caution when recommending the BPD procedure to their patients due to the greater nutritional risks related to the large malabsorptive component ( 5 ). Most nutritional evaluations involve a clinical interview that includes many topics related to the surgery to assess bariatric knowledge, surgery expectations, eating behaviors (e.g., number and types of meals per day, liquid intake), and eating patterns (e.g., grazing, binge eating). Weight-management history includes the onset of obesity, family history of obesity, previous weight-loss regimens, and physical activity habits. In addition, psychosocial assessment is conducted to assess mood, social and family support, substance use, cognitive function, psychosocial status, motivation, and willingness to undertake behavioral changes ( 19, 24 ). It is advised to determine the patients’ awareness and understanding of the planned operation, potential operational risks, postoperative adverse effects and benefits, and lifestyle changes required to achieve the most favorable outcomes ( 21 ). Weight-loss expectations should be discussed presurgery, and they should be pertinent to the reported average excess weight loss after each procedure ( 19, 25 ). Unrealistic expectations of weight loss are prevalent in obese patients and can negatively affect their adherence to dietary and health goals ( 26 ). In addition, patients should be encouraged to consider other benefits of the surgery beyond weight loss, including substantial improvement in obesity-related comorbidities and quality of life. Preoperative weight management. Before bariatric surgery, a supervised weight-management program, including a low-calorie diet, is recommended. However, success in preoperative weight loss should not be a condition for approving surgery ( 23 ). A large-scale study based on data from the Scandinavian Obesity Registry showed that weight loss of 9.5 before RYGB was associated with a marked reduction in important postoperative complications, such as anastomotic leakage, deep infection or abscess, and minor wound complications. Preoperative weight loss leads to an improved glycemic state before surgery ( 32 ). Given the known correlation between preoperative hyperglycemia and postoperative complications, this finding is highly relevant ( 32 ). Weight reduction before surgery also provides a protective effect in patients who suffer from nonalcoholic fatty liver disease, who represent 90 of patients with morbid obesity ( 33 ). These patients present an enlarged left lobe of the liver that may disturb the visual field of the surgeon and that is particularly susceptible to bleeding ( 34 ). To date, there is no consensus with regard to the recommended duration of preoperative diet and its macronutrient composition ( 22, 35, 36 ). When several preoperative diets were compared, a “low-carbohydrate diet” was found to be more effective than a “low-fat diet” with regard to short-term weight loss, improvement in insulin sensitivity, and reduction in lipid concentrations. It was also found to be a positive factor for improving cardiovascular risk factors in diabetic patients ( 32 ). However, the use of a very-low-calorie diet as a sole method for multiple weeks may induce a catabolic state, which could potentially harm recovery after surgery ( 40 ). According to the American Society for Metabolic and Bariatric Surgery, the maximum length of a preoperative diet is 3 mo in order to maintain high compliance rates among patients. A longer period may decrease motivation. The specific dietary components should be tailored for each patient by the bariatric medical team ( 35 ). Supplementation to prevent nutritional deficiencies. The causes of nutritional deficiencies in obesity are multifactorial and include the following: high intake of calorically dense foods with low nutritional quality ( 43, 44 ), limited bioavailability of some nutrients (e.g. , vitamin D) ( 45 ), chronic inflammation status that affects iron metabolism, and small intestinal bacterial overgrowth (SIBO), which can lead to deficiencies in some vitamins (e.g., thiamin, vitamin B-12, and fat-soluble vitamins) ( 44 ). This evidence supports the need to identify and correct preoperative nutritional deficiencies as part of the comprehensive preoperative evaluation ( 5 ). Impaired presurgery nutritional status is found to be related to postoperative nutritional deficiencies as well and is associated with metabolic complications ( 4, 53 ). Therefore, daily multivitamin supplementation is recommended during the preoperative diet ( 23 ). The management of specific nutritional deficiencies is described in detail in the section entitled “Lifelong vitamin and mineral supplementation” section and in Table 1. Short-term nutritional recommendations Postsurgery diet progression. Postoperative dietary recommendations are based on gradual progression in food consistency and texture over 1 to 2 mo ( 54 ). In addition, they should drink liquids in small portions as tolerated, with no more than a half cup per serving. They are instructed to begin with smooth foods and slowly progress to less homogeneous mashed foods. During this phase, it is recommended to separate liquids from solids by avoiding drinking beverages 15 min before or 30 min after eating. At 2 wk postsurgery, patients can add soft food to their diet, such as soft meatballs; scrambled or boiled eggs; cooked, peeled vegetables; and soft peeled fruit. They can also add crackers to their diet. One month postsurgery, patients are instructed to add solid foods, including legumes, fresh vegetables, fresh fruit, and bread. It is recommended that patients progress to solid foods, because this encourages greater satiety and enhanced nutritional composition. Special attention must be given to patients who hesitate to progress to solid foods postoperatively for fear of gaining weight, pain, nausea, or vomiting ( 59 ). Given the high variability among patients with regard to their eating progression, individual consultations with a bariatric dietitian are necessary ( 57 ). Recommended macronutrient composition after surgery. Protein deficiency (serum albumin 60 ). The clinical manifestations of protein deficiency include hair loss, peripheral edema, poor wound healing, and loss of lean body mass ( 61 ). To achieve these recommendations, protein-rich foods (e.g., dairy products, eggs, fish, lean meat, soy products, and legumes) should be preferred over foods rich in carbohydrates or fats ( 61, 64 ). The quality of the protein source is also very important, particularly with respect to the quantity of leucine, which helps maintain lean tissue ( 61 ). The leucine content of foods varies markedly, but some foods are naturally high in leucine, including soy products, eggs, meat, lentils, and hard cheese ( 65 ). If a protein supplement is indicated, whey protein is probably the best choice for increasing leucine consumption ( 61 ). The avoidance of simple carbohydrates is recommended and the consumption of foods rich in dietary fibers should be increased. The consumption of simple carbohydrates may lead to dumping syndrome (DS), and fiber-rich foods, such as fruit, vegetables, and whole grains, should be consumed from 1 mo postsurgery to enable adequate weight loss and to enhance healthy eating ( 44, 58 ). Recommendations for fat intake after bariatric surgery are similar to those for the general population ( 62 ). The role of the dietitian is to estimate the amount of macronutrients consumed, construct a balanced diet, and advise the patient on needed behavioral changes. Various favorable eating-related behaviors. Solid foods should be preferred, because this helps provide greater satiety. Carbonated beverages should also be avoided. Liquids and solids should be separated by drinking 15 min before or 30 min after meals ( 54, 59, 62, 69, 70 ). Patients after bariatric surgery are prone to phytobezoar formation due to reduced gastric motility ( 71 ), loss of pyloric function, and hypoacidity ( 72 ). Finally, daily intakes of vitamin and mineral supplements must be maintained ( 5 ) ( Table 2 ). Special attention should be paid to grazing, which is considered an undesirable, negative eating pattern. The term “grazing” is frequently derived from “Western life” circumstances (e.g., eating when stressed or bored, eating while watching television or working on the computer) ( 59 ). It is well established that a grazing pattern of eating behavior after surgery reduces the long-term surgical success ( 59 ). Eating disorders are another highly important issue to be addressed by a dietitian, because they may emerge or re-emerge postsurgery and compromise surgery outcomes ( 59, 87, 88 ). However, this topic is beyond the scope of this review. Prevention and treatment methods of common gastrointestinal symptoms after bariatric surgery are presented in Table 3. DS represents a group of early and late gastrointestinal, vasomotor, or hypoglycemic symptoms occurring after sugar-rich or hyperosmotic food consumption in some patients who have undergone gastric surgery. DS develops largely after RYGB, with prevalences ranging from 40 to 76 ( 58, 89 ). Early DS is also seen in up to 30 of LSG patients when stimulated with an oral-glucose challenge ( 58, 89 ). Early DS usually occurs 30 to 60 min postprandially, and it can last for 60 min. Early DS occurs as a result of a rapid gastric emptying and the delivery of energy-dense foods to the small bowel followed by a shift of intravascular fluid to the intestinal lumen. This results in cardiovascular symptoms and the release of gastrointestinal and pancreatic hormones ( 58, 92 ). Symptoms include abdominal pain, diarrhea, nausea, dizziness, flushing, palpitations, tachycardia, and hypotension ( 58, 92 ). Symptoms include sweating, tremor, hunger, and confusion up to syncope ( 21, 58 ). The first line of treatment is to introduce dietary measures ( 21, 92 ). Patients who suffer from postprandial hypoglycemia, refractory to the standard nutritional recommendations for DS, should be referred to an endocrinologist. Usually, they are told to consume small amounts of sugar in the first postprandial hour (e.g., half cup of juice, containing 10 g sugar). The use of somatostatin or acarbose to relieve symptoms should also be considered ( 21, 90 ). Diarrhea and flatulence. Diarrhea is reported in up to 40 of patients after bariatric surgery ( 21 ). Patients after BPD-DS are especially prone to this adverse event. Some patients also suffer from steatorrhea as a result of fat malabsorption, which may lead to deficiencies in fat-soluble vitamins, zinc, copper, and magnesium ( 23, 58, 90 ). The nutritional treatment for diarrhea should focus on increased water intake and reduced dietary intake of lactose, fat, and fiber ( 90 ). The frequency of flatulence is higher after procedures that lead to malabsorption ( 93 ). Supplementation with probiotics, loperamide, and bile chelators ( 90 ) or pancreatic enzymes may aid in decreasing flatulence as well ( 94 ). Strategies exist to help reduce flatulence postsurgery. These include swallowing and eating slowly, the avoidance of chewing gum, and the elimination of gas-producing foods such as cauliflower and legumes ( 95 ). Risk factors for SIBO include a decrease in gastric acid secretion and a decline in intestinal motility, both of which may occur after bariatric surgery ( 96 ), which also is more common after malabsorptive procedures ( 97 ). In the case of SIBO, treatment remains empirical and generally broad-spectrum antibiotics are recommended for 2 wk (rifaximin, ciprofloxacin, amoxicillin, etc.) ( 98 ). When patients suffer from extremely watery diarrhea, foul flatus, and abdominal cramping, Clostridium difficile colitis or antibiotic-associated diarrhea should be ruled out ( 90 ). In BPD-DS patients who suffer long term from chronic diarrhea or excessive flatus and do not respond to any of the above treatment options, surgical intervention should be considered ( 90 ). Constipation. Constipation is a common side effect after LAGB, LSG, and RYGB and is rarely seen post-BPD ( 90 ). Its prevalence after bariatric procedures ranges between 7 and 39 ( 99 ). The etiology includes insufficient fluid intake in the postoperative diet, the use of vitamin and mineral supplements such as calcium and iron, and the use of narcotics as postoperative analgesics ( 90 ). Nutritional treatment should focus on higher consumption of water or noncarbonated sugary drinks and dietary fibers found in fruit, vegetables, and whole-grain cereals ( 90 ). Dysphagia. Dysphagia, or difficulty in swallowing, is associated with feeling pressure in the chest or tightness in the throat. When dysphagia occurs, patients should be instructed to discontinue eating to prevent regurgitation and vomiting. LAGB patients should progress gradually with regard to food texture to avoid dysphagia after band adjustment. If symptoms remain, band opening should be considered. In the case of vomiting after eating a specific food, it is recommended to reintroduce the food in the future, when the patient has acquired new nutritional skills. Refractory vomiting despite compliance to nutritional recommendations may indicate a surgical complication, such as band slippage, esophageal stricture, bowel obstruction, reflux, and gastric ulcers ( 101 ). In the case of LAGB patients, band opening may be helpful ( 102 ). Adequate and prolonged hydration maintenance is highly important as well ( 105 ). Food intolerance.