Accommodating obese patients consolidating debt for

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Anderson, MSN, RN, ACM; Martha Engelke, Ph D; Mary K. Pokorny, RN, MSN, Ph D; and Mary Ann Rose, MSN, Ed D Objectives: To identify barriers encountered by case managers in hospitals, home care agencies, and nursing homes in the transition of the obese patient from the hospital to the community.Kirkpatrick, RN, MSN, Ed D; Mary Lisa Pories, MSW; Wanda G. Study Design: Exploratory descriptive design was used."I can tell you that for the population I care for, critically ill patients, patients are generally larger, and their relative size is bigger than they were in the past," he says. Warner says doctors are having to use "clinical intuition" instead.According to the Canadian Obesity Network more than 1 in 4 adults in Canada has obesity. "When patients are of certain dimensions, it becomes harder for us to assess them effectively, to examine them, to even do tests on them that can help us establish the appropriate diagnosis, and then subsequent treatment," he says. Another obstacle is imaging machines, which are manufactured for standard-size patients, so most patients with obesity can't fit in them."As a clinician it was really clear we were not trained properly or had the proper equipment available to us to be able to provide good quality care for patients coming in who were also living with obesity," she says.Obesity is a chronic disease and is linked to other diseases such as diabetes, hypertension, heart disease and arthritis. Michael Warner has experienced the challenges first-hand at Toronto's Michael Garron Hospital, where he's worked in the intensive care unit for the past decade. And we're also not sure whether the treatments that we're using, specifically medications, are dosed appropriately for a patient when they are of a certain size." That's because there is little obesity research to guide them when it comes to proper dosage.The survey instrument was designed by the investigators based on variables identified in the literature or encountered within their practice.

"Over the past decade, the issue has become more and more prevalent, with more and more people living with obesity and coming in for health-care services, but the system doesn't respond as quickly as we need to," Forhan tells CBC News.Some wheelchairs have larger dimensions, and blood pressure cuffs accommodate patients with larger arms.Each floor of Humber River Hospital in Toronto has rooms designed specifically for patients with obesity, including one room in the maternity unit. At the University of Alberta, where professor Forhan conducts her research, a state-of-the-art bariatric specialty suite is used to train health-care workers to care for patients living with obesity."We're almost working with one arm tied behind our back in the era of modern medicine," Warner says."We're not able to use all of the tools in our armamentarium to provide patients with the most effective way to determine the diagnosis and any effective treatment." The consequences can be fatal, he says.

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