The gut microbiota is a complex community of bacteria residing in the intestine. Animal models have demonstrated that several factors contribute to and can significantly alter the composition of the ...gut microbiota, including genetics; the mode of delivery at birth; the method of infant feeding; the use of medications, especially antibiotics; and the diet. There may exist a gut microbiota signature that promotes intestinal inflammation and subsequent systemic low-grade inflammation, which in turn promotes the development of type 2 diabetes. There are preliminary studies that suggest that the consumption of probiotic bacteria such as those found in yogurt and other fermented milk products can beneficially alter the composition of the gut microbiome, which in turn changes the host metabolism. Obesity, insulin resistance, fatty liver disease, and low-grade peripheral inflammation are more prevalent in patients with low α diversity in the gut microbiome than they are in patients with high α diversity. Fermented milk products, such as yogurt, deliver a large number of lactic acid bacteria to the gastrointestinal tract. They may modify the intestinal environment, including inhibiting lipopolysaccharide production and increasing the tight junctions of gut epithelia cells.
Objective
Loss‐of‐control (LOC) eating postoperatively is a consistent predictor of suboptimal longer‐term bariatric surgery outcomes. This randomized controlled trial examined the effectiveness of ...two guided self‐help treatments (cognitive behavioral therapy gshCBT and behavioral weight loss gshBWL) compared with a control (CON) for reducing LOC eating and weight.
Methods
A total of 140 patients with recurrent LOC eating approximately 6 months after bariatric surgery were randomly assigned (5:5:2 ratio) to one of three conditions: gshCBT (n = 56), gshBWL (n = 60), or CON (n = 24). Three‐month treatments were delivered by trained allied health clinicians to increase generalizability to bariatric surgery settings. Independent assessments were performed by doctoral research‐clinicians using established interviews/measures; posttreatment outcomes were obtained for 89% of patients.
Results
Mixed models revealed significant improvements for LOC eating frequency and weight loss but no significant differences between treatments; race neither predicted (main effect) nor moderated (interaction effect) treatment outcomes. Intent‐to‐treat categorical analyses of abstinence from LOC eating (30% for gshCBT, 27% for gshBWL, 38% for CON) and proportion attaining 5% weight loss (20%, 22%, 17%) revealed no significant differences between treatments; non‐White participants had a higher proportion achieving LOC eating abstinence but a lower proportion attaining 5% weight loss compared with White participants.
Conclusions
In this 12‐week randomized controlled trial following bariatric surgery, significant LOC eating reductions and weight loss did not differ significantly between treatments. Race was associated with posttreatment categorical outcomes.
Background
Loss‐of‐control (LOC)‐eating postoperatively predicts suboptimal longer‐term outcomes following bariatric surgery. This study examined longer‐term effects through 24‐month follow‐ups after ...completing treatments in a randomized controlled trial testing guided‐self‐help treatments (cognitive‐behavioral therapy gshCBT and behavioral weight‐loss gshBWL) and control (CON) delivered postoperatively for LOC‐eating.
Methods
140 patients with LOC‐eating 6 months after bariatric surgery were randomized (5:5:2 ratio) to 3‐months of gshCBT (n = 56), gshBWL (n = 60), or CON (n = 24) delivered by trained allied‐health clinicians. Independent assessments were performed throughout/after treatments and at 6‐, 12‐, 18‐, and 24‐month follow‐ups; 83% of patients were assessed at 24‐month follow‐up.
Results
Intention‐to‐treat analyses comparing the three groups (gshCBT vs. gshBWL vs. CON) in LOC‐eating abstinence at posttreatment (30%, 27%, 38%), 12‐month follow‐up (34%, 32%, 42%), and 24‐month follow‐up (45%, 32%, 38%) revealed no significant differences. Mixed‐models revealed significantly reduced LOC‐eating frequency through posttreatment, no significant changes in LOC‐eating frequency during follow‐up, and no differences between the three groups. Weight reduced significantly, albeit modestly, through posttreatment but increased significantly and substantially during follow‐ups, with no differences between groups.
Conclusions
Overall, the 12‐week scalable guided‐self‐help treatments did not differ from each other or control, were associated with significantly reduced frequency of LOC‐eating and modest weight loss at posttreatment but were followed by significant weight gain during the 24‐month follow‐up. Weight gain was substantial and nearly universal whereas the frequency of LOC‐eating did not change over time (i.e., LOC‐eating reductions and abstinence rates were well maintained through 24‐moth follow‐ups). Patients with postoperative LOC‐eating require more intensive adjunctive treatments.
Public significance
Loss‐of‐control (LOC) eating postoperatively predicts poorer bariatric surgery outcomes and the longer‐term effects of postoperative adjunctive postoperative interventions for LOC eating are unknown. In this 24‐month follow‐up of a controlled study of scalable guided‐self‐help treatments and a control condition, improvements in LOC‐eating frequency, eating‐disorder psychopathology, and depression during treatment were maintained well, with no differences between the three groups. Proportion of patients achieving abstinence from LOC‐eating at the 24‐month follow‐up ranged from 38% to 45% across the three groups. In contrast, weight increased significantly during the 24‐month follow‐ups, with no differences between the three groups. Findings suggest LOC‐eating following bariatric surgery might represent a “marker” for a subgroup of patients that are at risk for substantial weight gains over time. LOC eating following bariatric surgery is challenging to treat with low‐intensity scalable treatments and may require more intensive specialist treatments.
While some bariatric surgery outcomes vary by race/ethnicity, less is known about racial/ethnic differences in loss-of-control (LOC) eating and psychosocial outcomes post-surgery.
This prospective ...study examined and extended initial short-term findings regarding racial differences in post-bariatric surgery LOC eating and weight loss to longer-term outcomes through 24-month follow-ups.
Academic medical center in the United States.
Participants were 140 patients (46.4% non-White) in a 3-month randomized, controlled trial for LOC eating performed about 6 months after bariatric surgery. Participants were reassessed at 6, 12, 18, and 24 months after treatment ended (about 33 mo after surgery). Doctoral assessors administered the Eating Disorder Examination-Bariatric Surgery Version interview to assess LOC eating and eating-disorder psychopathology at 12- and 24-month follow-ups. The Beck Depression Inventory II was repeated, and measured weight was obtained at all follow-ups.
White patients had significantly greater percent excess weight loss at all follow-ups than non-White patients (p < .03). White patients reported significantly more LOC eating at 12- (p = .004) and 24-month (p = .024) follow-ups and significantly greater eating disorder psychopathology at 12-month follow-up (p < .028). Racial groups did not differ significantly in eating disorder psychopathology at 24-month follow-ups or in Beck Depression Inventory II depression scores at any follow-ups.
Our findings suggest that among patients with LOC eating after bariatric surgery, non-White patients attain a lower percent excess weight loss than White patients but have comparable or better outcomes in LOC eating, associated eating disorder psychopathology, and depression over time.
Through an analysis of relevant literature and open-ended survey responses from 2501 Singaporeans, this article proposes a conceptual framework to understand how individuals authenticate the ...information they encounter on social media. In broad strokes, we find that individuals rely on both their own judgment of the source and the message, and when this does not adequately provide a definitive answer, they turn to external resources to authenticate news items.
Gallbladder Disorders: A Comprehensive Review Lam, Robert; Zakko, Alan; Petrov, Jessica C. ...
Disease-a-month,
July 2021, 2021-Jul, 2021-07-00, 20210701, Letnik:
67, Številka:
7
Journal Article
Recenzirano
Gallbladder disorders encompass a wide breadth of diseases that vary in severity. We present a comprehensive review of literature for the clinical presentation, pathophysiology, diagnostic ...evaluation, and management of cholelithiasis-related disease, acute acalculous cholecystitis, functional gallbladder disorder, gallbladder polyps, gallbladder hydrops, porcelain gallbladder, and gallbladder cancer.
Introduction Laparoscopic virtual reality simulators are becoming a ubiquitous tool in resident training and assessment. These devices provide the operator with various levels of realism, including ...haptic (or force) feedback. However, this feature adds significantly to the cost of the devices, and limited data exist assessing the value of haptics in skill acquisition and development. Utilizing the Laparoscopy VR (Immersion Medical, Gaithersburg, MD), we hypothesized that the incorporation of force feedback in the simulated operative environment would allow superior trainee performance compared with performance of the same basic skills tasks in a non-haptic model. Methods Ten medical students with minimal laparoscopic experience and similar baseline skill levels as proven by performance of two fundamentals of laparoscopic surgery (FLS) tasks (peg transfer and cutting drills) voluntarily participated in the study. Each performed two tasks, analogous to the FLS drills, on the Laparoscopy VR at 3 levels of difficulty, based on the established settings of the manufacturer. After achieving familiarity with the device and tasks, the students completed the drills both with and without force feedback. Data on completion time, instrument path length, right and left hand errors, and grasping tension were analyzed. The scores in the haptic-enhanced simulation environment were compared with the scores in the non-haptic model and analyzed utilizing Student's t -test. Results The peg transfer drill showed no difference in performance between the haptic and non-haptic simulations for all metrics at all three levels of difficulty. For the more complex cutting exercise, the time to complete the tasks was significantly shorter when force feedback was provided, at all levels of difficulty (158 ± 56 versus 187 ± 51 s, 176 ± 49 versus 222 ± 68 s, and 275 ± 76 versus 422 ± 220 s, at levels 1, 2, and 3, respectively, P < 0.05). Data on instrument path length, grasping tension, and errors showed a trend toward a benefit from haptics at all difficulty levels, but this difference did not achieve statistical significance. Conclusions In the more advanced tasks, haptics allowed superior precision, resulting in faster completion of tasks and a trend toward fewer technical errors. In the more basic tasks, haptic-enhanced simulation did not demonstrate an appreciable performance improvement among our trainees. These data suggest that the additional expense of haptic-enhanced laparoscopic simulators may be justified for advanced skill development in surgical trainees as simulator technology continues to improve.
Background
Esophageal dilatation and dysmotility are known complications of the laparoscopic adjustable gastric band (LAGB), but their incidence varies widely in the literature. There are no formal ...recommendations guiding surveillance for these potentially underdiagnosed pathologies. This study demonstrates the utility and outcomes of a yearly upper gastrointestinal series screening protocol to detect and manage esophageal dysfunction after LAGB.
Methods
We reviewed charts for all patients presenting for an outpatient surgical encounter related to LAGB between January 1, 2015 and December 31, 2017. Exclusion criteria included failure to undergo UGIS 6 months or more after band placement, or having undergone band placement in combination with another bariatric procedure. Descriptive statistics were used to characterize demographics, imaging findings and surgical outcomes. All imaging classifications were based on final radiologist report. Means were compared using a Student’s
t
test.
Results
A total of 322 records were reviewed with 39 patients excluded; 31 without UGIS and 8 with concomitant gastric bypass. 85% were female with an average age of 50 years. 66.8% identified as white or Caucasian with 24.7% black/African-American. Greater than 75% of the cohort had at least 5-year follow-up interval. UGIS was performed for symptoms in 66.1% and for routine screening in 33.9%. Of asymptomatic patients, 47.9% demonstrated esophageal dilatation or dysmotility on UGIS, similar to 51.3% of symptomatic patients. 96.8% of all patients went on to band removal. Sixty-four patients had repeat UGIS an average of 8 months following band removal, of which 40.6% were persistently abnormal.
Conclusions
The incidence of esophageal pathology was significantly higher than most reported series, as was the number of patients with persistently abnormal UGIS despite band removal. The data supports our policy of yearly UGIS for all post-LAGB patients, with strong recommendation for band removal if esophageal dilatation or dysmotility is found.
Background
Excessive opioid prescribing creates risk for abuse and adverse effects, but must be balanced against individualized pain control. Minimal literature exists to guide providers in the ...postoperative bariatric surgical setting.
Study Design
We compare opioid prescribing practice for minimally invasive bariatric surgery in a university hospital with self-reported patient use and satisfaction. This data is used to create practice guidelines for postoperative prescriptions. A 10-question survey was administered at the first postoperative office visit. All patients at this visit were eligible. None declined or excluded. We analyzed 115 patients for 3 procedures: laparoscopic sleeve gastrectomy (LSG;
n
= 53), laparoscopic roux-en-Y gastric bypass (LRYGB;
n
= 50), and laparoscopic adjustable gastric band removal (LAGBR;
n
= 12). Outcomes included number of pills prescribed (verified), proportion used, duration of use, satisfaction with pain control, and non-narcotic analgesic use.
Results
An average of 27 ± 10 pills were dispensed for LSG, average 4.1 days of use; 28 ± 7 pills for LRYGB, 4.6 days; and16 ± 9 pills for LAGBR, 2.6 days. Fifty to 74% retained more than half or all of their opioids at 2 weeks. Fifty-four percent utilized non-narcotic analgesics. Overall, 91.3% reported adequate pain control. For each procedure, average number of pills used was calculated with representative values for “less than half left” (75% of average number of pills prescribed) and “more than half left” (25% of average number of pills prescribed). For LSG, an average of 9 pills were used; LRYGB 14 pills, and LAGBR 7 pills.
Conclusions
Opioids are overprescribed following most common surgical procedures, but only one study has evaluated patterns after bariatric surgery. Our survey-based tool examines prescribing, utilization and satisfaction following common minimally invasive bariatric procedures. Opioid prescriptions were variable, and excessive for most patients. We now recommend prescribing no more than 15 pills after these operations.
Introduction Simulation training for surgical residents can shorten learning curves, improve technical skills, and expedite competency. Several studies have shown that skills learned in the simulated ...environment are transferable to the operating room. Residency programs are trying to incorporate simulation into the resident training curriculum to supplement the hands-on experience gained in the operating room. Despite the availability and proven utility of surgical simulators and simulation laboratories, they are still widely underutilized by surgical trainees. Studies have shown that voluntary use leads to minimal participation in a training curriculum. Although there are several simulation tools, there is no clear evidence of the superiority of one tool over the other in skill acquisition. The purpose of this study was to explore resident perceptions, training experiences, and preferences regarding laparoscopic simulation training. Our goal was to profile resident participation in surgical skills simulation, recognize potential barriers to voluntary simulator use, and identify simulation tools and tasks preferred by residents. Furthermore, this study may help to inform whether mandatory/protected training time, as part of the residents’ curriculum is essential to enhance participation in the simulation laboratory. Methods A cross-sectional study on general surgery residents (postgraduate years 1-5) at Yale University School of Medicine and the University of Toronto via an online questionnaire was conducted. Overall, 67 residents completed the survey. The institutional review board approved the methods of the study. Results Overall, 95.5% of the participants believed that simulation training improved their laparoscopic skills. Most respondents (92.5%) perceived that skills learned during simulation training were transferrable to the operating room. Overall, 56.7% of participants agreed that proficiency in a simulation curriculum should be mandatory before operating room experience. The simulation laboratory was most commonly used during work hours; lack of free time during work hours was most commonly cited as a reason for underutilization. Factors influencing use of the simulation laboratory in order of importance were the need for skill development, an interest in minimally invasive surgery, mandatory/protected time in a simulation environment as part of the residency program curriculum, a recommendation by an attending surgeon, and proximity of the simulation center. The most preferred simulation tool was the live animal model followed by cadaveric tissue. Virtual reality simulators were among the least-preferred (25%) simulation tools. Most residents (91.0%) felt that mandatory/protected time in a simulation environment should be introduced into resident training protocols. Conclusions Mandatory and protected time in a simulation environment as part of the resident training curriculum may improve participation in simulation training. A comprehensive curriculum, which includes the use of live animals, cadaveric tissue, and virtual reality simulators, may enhance the laparoscopic training experience and interest level of surgical trainees.
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