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INTRODUCTION: The quality of hospital care, especially surgery, is traditionally assessed using indicators derived from healthcare databases or safety indicators. Given the growing importance of placing the patient at the heart of care evaluation, the use of questionnaires such as the Patient-Reported Experience Measures and Patient-Reported Outcome Measures has become widespread in recent years. However, these tools-addressing factors such as satisfaction, pain management or wait times-only imperfectly reflect the patient's experience, and all such attempts at patient-centred care quality assessment rely on questions or indicators defined in advance by healthcare providers and health authorities. A biopsychosocial model may allow to better understand the patient experience and to improve care pathways. This study seeks to construct a narrative of the bariatric surgical care journey with instruments from narrative inquiry, propose a metanarrative that can serve as a basis for more sophisticated and reliable patient-focused care quality models and define indicators linked to patients' feelings and stories. METHODS AND ANALYSIS: To achieve these aims, 16 bariatric surgical patients at the hospital of Créteil, France (Centre Hospitalier Intercommunal de Créteil), will be included and interviewed once before and twice after surgery, at months 3 and 6. Narratives collected will be used to construct a metanarrative intended to encompass all possible narratives. This metanarrative may ultimately inform new patient care quality indicators, furthering care focused on patients and tailored to their needs and predispositions. ETHICS AND DISSEMINATION: The study is funded by the Group of Clinical Research and Innovation in Île-de-France and was approved by CPP SUD-EST VI Clermont-Ferrand (France) Research Ethics Committee. The results will be submitted for publication in peer-reviewed journals. The patient associations will be approached for the dissemination of the study results. TRIAL REGISTRATION NUMBER: NCT05092659.

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BACKGROUND: As the prevalence of obesity in adolescents has reached an alarming level of 16%, the rate of metabolic bariatric surgery (MBS) in this population is also rising in several countries. OBJECTIVES: This study aimed to compare the trends in types of MBS, short-term safety, and revisional rates, in younger adolescents aged < 18 years, compared with older adolescents (aged 18-19 yr) and adults aged >20 years. SETTING: Clinical research center, general hospital in France. METHODS: Using a national administrative database (Programme de Médicalisation des Systèmes d'Information [PMSI]), data regarding all patients undergoing MBS between 2008 and 2018 in France were examined. Demographic parameters, body mass index (BMI), co-morbidities, types of surgery, early complications, and long-term revisional rates were analyzed, comparing younger adolescents (<18 yr), older adolescents (18-19 yr), and adults (≥20 yr). RESULTS: The number of bariatric procedures in adolescents initially increased from 59 in 2008 to 135 in 2014, and then progressively declined to 56 procedures in 2018. Adjustable gastric banding (AGB) decreased from 83.1% (n = 49) of procedures to 32.1% (n = 18) of procedures during the study period, while sleeve gastrectomy (SG) increased from 6.8% (n = 4) to 46.4% (n = 26). In the early postoperative period, younger adolescents undergoing MBS experienced fewer episodes of reoperation (1.0% versus 1.3% in older adolescents and 2.6% in adults, P < .001) and intensive care unit (ICU) stays (.2% versus .2% in older adolescents and .6% in adults, P < .001), and no deaths were observed in younger adolescents (.02% in older adolescents and .1% in adults, P = .18). At 10 years, the AGB removal rate was lower in younger adolescents (24.8%) compared with that in older adolescents (29.6%) and adults (50.3%, P < .001). Similarly, rates of revisional surgery after SG were different in the 3 groups: 2.9%, 4.6% and 12.2% in younger adolescents, older adolescents, and adults, respectively. CONCLUSION: Despite significantly lower early complication rates and long-term revisional rates in young adolescents (<18 yr), we observed a progressive decrease in the utilization of MBS in this population in France, compared with adults (≥20 yr) and older adolescents (18-19 yr).

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Obese patients are increasingly being offered weight loss surgery, the success of which depends in part on the quality of a long-term follow-up after the procedure. A study was conducted with a cohort of 207 patients operated on in 2007 and 2008 who received follow-up care in a specialized nutrition department, with the aim of identifying factors affecting their adherence to their post-operative care agenda. Factors strongly linked to a lower level of adherence were the type of surgery and a patient's place of residence. These results enable us to discuss the importance of using care coordination to optimize post-operative monitoring.

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The proportion of people affected by obesity is increasing and this finding emphasizes several issues in oncology: obesity as a risk factor for cancer, prognostic value of obesity in cancer patients, nutritional assessment in overweight patients and impact of obesity on treatment management. It is important to remember the common underevaluation of malnutrition in overweight or obese patients. Every caregiver must be especially careful about the management of comorbidities in these patients.

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Weight loss surgery requires multidisciplinary preparation and support. The risks of a failure in the follow-up and complications are significant. Consequently, caregivers and patients must follow a more clearly defined pathway which involves both and takes account of their expectations.

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AIM: Mobile applications represent promising tools in management of chronic diseases, both for patients and healthcare professionals, and especially in oncology. Among the large number of mobile health (mhealth) applications available in mobile stores, it could be difficult for users to identify the most relevant ones. This study evaluated the business model and the scientific validation for mobile applications related to oncology. METHODS: A systematic review was performed over the two major marketplaces. Purpose, scientific validation, and source of funding were evaluated according to the description of applications in stores. Results were stratified according to targeted audience (general population/patients/healthcare professionals). RESULTS: Five hundred and thirty-nine applications related to oncology were identified: 46.8% dedicated to healthcare professionals, 31.5% to general population, and 21.7% to patients. A lack of information about healthcare professionals' involvement in the development process was noted since only 36.5% of applications mentioned an obvious scientific validation. Most apps were free (72.2%) and without explicit support by industry (94.2%). CONCLUSIONS: There is a need to enforce independent review of mhealth applications in oncology. The economic model could be questioned and the source of funding should be clarified. Meanwhile, patients and healthcare professionals should remain cautious about applications' contents. Key messages A systematic review was performed to describe the mobile applications related to oncology and it revealed a lack of information on scientific validation and funding. Independent scientific review and the reporting of conflicts of interest should be encouraged. Users, and all health professionals, should be aware that health applications, whatever the quality of their content, do not actually embrace such an approach.

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Interested, since she first qualified as a nurse, in the complex care of people with chronic diseases, Marina Vignot has focused on the coordination of care pathways throughout her career. She now shares her expertise by teaching the follow-up of patients with cardio-metabolic diseases.

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New information technologies and communication in health or "eHealth" is a way of improvement for management of chronic diseases. EHealth can improve patient care and care coordination especially in cancer patients who require a multidisciplinary approach. Treatments in oncology are complex and can result in new toxicities. Information of patients and of caregivers is a crucial issue. The patients require to be monitored and the caregivers need up-to-date information. The mobile component of eHealth: the mobile health or "mHealth" could provide to this need. This paper proposes to expose the principles of eHealth and its mobile component mHealth then to discuss their place in the management of cancer, for patients and caregivers.

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