scholarly journals Post-bariatric surgery lab tests: are they excessive and redundant?

2019 ◽  
Vol 34 (10) ◽  
pp. 4626-4631
Author(s):  
Terri Menser ◽  
Jose Muniz Castro ◽  
Adriana Lopez ◽  
Stephen L. Jones ◽  
Bita A. Kash ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Logistic Regression ◽  
Nutritional Deficiency ◽  
Nutritional Deficiencies ◽  
Multiple Time ◽  
Time Points ◽  
Bariatric Patients ◽  
Lab Test ◽  
Over Time

Abstract Introduction Following bariatric surgery, ongoing postoperative testing is required to measure nutritional deficiencies; the purpose of this study was to quantify the prevalence of these nutritional deficiencies based on two-year follow-up tests at recommended time points. Methods and procedures A retrospective data analysis was conducted of all laboratory tests for bariatric patients who underwent surgery between May 2016 and January 2018 with available lab data (n = 397). Results for nine different nutritional labs were categorized into six recommended postoperative time periods based on time elapsed since the procedure date. Binary variables were created for each laboratory result to calculate descriptive statistics of abnormalities for each lab test over time and used in the individual GEE logistic regression models. Grouped logistic regression examined the total nutritional deficiencies of the nine combined nutrients considering total available labs. Results Multiple lab tests indicated a very low frequency of abnormalities (e.g., Vitamin A, Vitamin B12, Copper, and Folate). Many of the nine included nutritional labs had an average deficiency of less than 10% across all time points. The grouped logistic model found preoperative nutritional deficiency to be predictive of postoperative nutritional deficiency (OR 3.70, p < 0.001). Conclusions We found the vast majority of routine lab test results to be normal at multiple time points. Current practice can add up to significant lab expenses over time. The frequency of postoperative testing in this population may be redundant and of very little value. Unnecessary follow-up laboratory testing costs the patients and the health care system in both time and resources. Patients with preoperative deficiencies appear to be at higher risk for nutritional deficiencies when compared to bariatric surgery patients that did not have preoperative nutritional deficiencies. Future research should focus on defining cost effective postoperative lab testing guidelines for at risk bariatric patients.

scholarly journals Verificação de Anemia em Pacientes Submetidos à Gastroplastia Redutora Tipo Y de Roux

2015 ◽  
Vol 8 (1) ◽  
pp. 27 ◽  
Author(s):  
Mauro Akira Suizu ◽  
Romir Rodrigues ◽  
Juliana Isa Beraldo
Keyword(s):  
Bariatric Surgery ◽  
Gastric Bypass ◽  
Complex Disease ◽  
Nutritional Deficiencies ◽  
Obese People ◽  
Operation Period ◽  
Post Operation ◽  
Bariatric Patients ◽  
Treatment Of Obesity

A obesidade, doença crônica e complexa, acomete cada vez mais a população. Devido ao tratamento difícil, a cirurgia bariátrica, quando indicada, é eficiente, pois apresenta baixos riscos aos pacientes e boa manutenção da perda de peso. Entretanto, deve-se ter atenção no pós-operatório, devido aos efeitos colaterais promovidos pela cirurgia, resultando em modificações metabólicas e falhas nutricionais, decorrente da má absorção de nutrientes, dentre eles, o ferro. O objetivo da pesquisa foi avaliar a prevalência de anemia ferropriva no período de junho a outubro de 2013, com 32 pacientes submetidos à cirurgia bariátrica do tipo Y de Roux, pertencentes à Associação dos Obesos Operados Bariátricos de Paranavaí e Região (AOOB). Após realizarmos um comparativo parcial com os 32 bariátricos da comunidade, verificarmos deficiências nutricionais. Nos 32 pacientes da comunidade, 50% manifestaram anemia, com IMC 23,37 kg/m2 (21,41 ± 25,33) e idade média de 43 anos. Já na AOOB, 31,25% apresentaram anemia (com maior prevalência dois anos após a cirurgia), IMC 29,02 kg/m2 (24,80 ± 33,24) e idade média de 42,96 anos. Nos associados da AOOB, 46,87% possuem intolerância a carne vermelha; 65% usam suplementos nutricionais e a participação nas reuniões mensais variou de 113 a 32 presenças. Apesar do estudo ter revelado índices relevantes de anemia é essencial o acompanhamento pós-operatório, como o realizado pela AOOB, melhorando a qualidade de vida dos pacientes. No entanto, é necessário um estudo mais abrangente, com espaço amostral e período de tempo maior para solidificação das evidências aqui estudadas. Verification of Anemia in Patients with Bariatric Surgery (Roux-En-Y Gastric Bypass) Obesity, a chronic and complex disease, is more and more common in the population. Due to difficult treatment of obesity, bariatric surgery is efficient since it provides a good weight loss with few risks to patients. The post-operation period is important due to the side effects caused by metabolic modifications and nutritional flaws from a bad absorption of nutrients, especially iron. Current research, undertaken between June and October 2013, assesses the prevalence of iron-insufficiency anemia in 32 patients who underwent Roux-en-Y gastric bypass, belonging to the Association of Operated Obese People (AOOB) from the region of Paranavaí PR Brazil. Partial comparative exam with 32 bariatric patients showed nutritional deficiencies, or rather, 50% suffered from anemia, with BMI = 23.37 kg/m2 (21.41 ± 25.33) and average age 43 years, whereas in AOOB, 31.25% were anemic (after two years of surgery), IMC = 29.02 kg/m2 (24.80 ± 33.24) and mean age 42.96 years. Further, 46.87% of AOOB associates were non-tolerant to beef; 65% used nutrition supplements and participation in monthly meetings varied between 113 and 32. In spite of high anemia percentages, the post-operational follow-up is highly important since it improves the patients ́ lifestyle. However, a more comprising analysis is required with a bigger sample and a longer time span for the establishment of evidences.

scholarly journals Quantitative Checklist for Autism in Toddlers (Q-CHAT). A population screening study with follow-up: the case for multiple time-point screening for autism

2021 ◽  
Vol 5 (1) ◽  
pp. e000700
Author(s):  
Carrie Allison ◽  
Fiona E Matthews ◽  
Liliana Ruta ◽  
Greg Pasco ◽  
Renee Soufer ◽  
...  
Keyword(s):  
Phase 1 ◽  
Autism Spectrum ◽  
Population Screening ◽  
Diagnostic Assessment ◽  
Test Accuracy ◽  
Multiple Time ◽  
Phase 2 ◽  
Time Points ◽  
Screening Study

ObjectiveThis is a prospective population screening study for autism in toddlers aged 18–30 months old using the Quantitative Checklist for Autism in Toddlers (Q-CHAT), with follow-up at age 4.DesignObservational study.SettingLuton, Bedfordshire and Cambridgeshire in the UK.Participants13 070 toddlers registered on the Child Health Surveillance Database between March 2008 and April 2009, with follow-up at age 4; 3770 (29%) were screened for autism at 18–30 months using the Q-CHAT and the Childhood Autism Spectrum Test (CAST) at follow-up at age 4.InterventionsA stratified sample across the Q-CHAT score distribution was invited for diagnostic assessment (phase 1). The 4-year follow-up included the CAST and the Checklist for Referral (CFR). All with CAST ≥15, phase 1 diagnostic assessment or with developmental concerns on the CFR were invited for diagnostic assessment (phase 2). Standardised diagnostic assessment at both time-points was conducted to establish the test accuracy of the Q-CHAT.Main outcome measuresConsensus diagnostic outcome at phase 1 and phase 2.ResultsAt phase 1, 3770 Q-CHATs were returned (29% response) and 121 undertook diagnostic assessment, of whom 11 met the criteria for autism. All 11 screened positive on the Q-CHAT. The positive predictive value (PPV) at a cut-point of 39 was 17% (95% CI 8% to 31%). At phase 2, 2005 of 3472 CASTs and CFRs were returned (58% response). 159 underwent diagnostic assessment, including 82 assessed in phase 1. All children meeting the criteria for autism identified via the Q-CHAT at phase 1 also met the criteria at phase 2. The PPV was 28% (95% CI 15% to 46%) after phase 1 and phase 2.ConclusionsThe Q-CHAT can be used at 18–30 months to identify autism and enable accelerated referral for diagnostic assessment. The low PPV suggests that for every true positive there would, however, be ~4–5 false positives. At follow-up, new cases were identified, illustrating the need for continued surveillance and rescreening at multiple time-points using developmentally sensitive instruments. Not all children who later receive a diagnosis of autism are detectable during the toddler period.

scholarly journals Global Sensory Impairment Independently Predicts Decreased Social Function Over Time

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 414-414
Author(s):  
Anna Huang ◽  
Kristen Wroblewski ◽  
Ashwin Kotwal ◽  
Linda Waite ◽  
Martha McClintock ◽  
...  
Keyword(s):  
Mental Health ◽  
Logistic Regression ◽  
Cognitive Function ◽  
Social Engagement ◽  
Social Function ◽  
Ordinal Logistic Regression ◽  
Sensory Function ◽  
Sensory Impairment ◽  
Over Time

Abstract The classical senses (vision, hearing, touch, taste, and smell) play a key role in social function by allowing interaction and communication. We assessed whether sensory impairment across all 5 modalities (global sensory impairment [GSI]) was associated with social function in older adults. Sensory function was measured in 3,005 home-dwelling older U.S. adults at baseline in the National Social Life, Health, and Aging Project and GSI, a validated measure, was calculated. Social network size and kin composition, number of close friends, and social engagement were assessed at baseline and 5- and 10-year follow-up. Ordinal logistic regression and mixed effects ordinal logistic regression analyzed cross-sectional and longitudinal relationships respectively, controlling for demographics, physical/mental health, disability, and cognitive function (at baseline). Adults with worse GSI had smaller networks (β=-0.159, p=0.021), fewer close friends (β=-0.262, p=0.003) and lower engagement (β=-0.252, p=0.006) at baseline, relationships that persisted at 5 and 10 year follow-up. Men, older people, African-Americans, and those with less education, fewer assets, poor mental health, worse cognitive function, and more disability had worse GSI. Men and those with fewer assets, worse cognitive function, and less education had smaller networks and lower engagement. African-American and Hispanic individuals had smaller networks and fewer close friends, but more engagement. Older respondents also had more engagement. In summary, GSI independently predicts smaller social networks, fewer close friends, and lower social engagement over time, suggesting that sensory decline results in decreased social function. Thus, rehabilitating multisensory impairment may be a strategy to enhance social function as people age.

T3 Are Burns a Chronic Condition: Examining Physical and Mental Functioning up to 20 Years After Injury

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S2-S3
Author(s):  
Callie Abouzeid ◽  
Audrey E Wolfe ◽  
Gretchen J Carrougher ◽  
Nicole S Gibran ◽  
Radha K Holavanahalli ◽  
...  
Keyword(s):  
Mental Health ◽  
Hospital Stay ◽  
National Database ◽  
Time Points ◽  
Patient Reported ◽  
Burn Survivors ◽  
Population Demographic ◽  
The Impact ◽  
Over Time

Abstract Introduction Burn survivors often face many long-term physical and psychological symptoms associated with their injury. To date, however, few studies have examined the impact of burn injuries on quality of life beyond 2 years post-injury. The purpose of this study is to examine the physical and mental well-being of burn survivors up to 20 years after injury. Methods Data from the Burn Model System National Database (1997–2020) were analyzed. Patient-reported outcome measures were collected at discharge with a recall of preinjury status, and then at 5, 10, 15, and 20 years after injury. Outcomes examined were the Physical Component Summary (PCS) and Mental Component Summary (MCS) of the Short Form-12. Trajectories were developed using linear mixed methods model with repeated measures of PCS and MCS scores over time and controlling for demographic and clinical variables. The model fitted score trajectory was generated with 95% confidence intervals to demonstrate score changes over time and associations with covariates. Results The study population included 420 adult burn survivors with a mean age of 42.4 years. The population was mainly male (66%) and white (76.4%) with a mean burn size of 21.5% and length of hospital stay of 31.3 days. Higher PCS scores were associated with follow-up time points closer to injury, shorter hospital stay, and younger age. Similarly, higher MCS scores were associated with earlier follow-up time points, shorter hospital stay, female gender, and non-perineal burns. MCS trajectories are demonstrated in the Figure. Conclusions Burn survivors’ physical and mental health worsened over time. Such a trend is different from previous reported results for mental health in the general population. Demographic and clinical predictors of recovery over time are identified.

Long-Term Reactions to the Loss of a Close Friend in an Extreme Terror Incident

2018 ◽  
Vol 82 (3) ◽  
pp. 351-369 ◽  
Author(s):  
Iren Johnsen ◽  
Kari Dyregrov ◽  
Stig Berge Matthiesen ◽  
Jon Christian Laberg
Keyword(s):  
Longitudinal Studies ◽  
Quantitative Data ◽  
Close Friend ◽  
Traumatic Death ◽  
Time Points ◽  
Grief Reactions ◽  
Over Time ◽  
Avoidant Behavior

This article presents results from one of the first longitudinal studies exploring the effects of losing a close friend to traumatic death, focusing on complicated grief over time and how this is affected by avoidant behavior and rumination about the loss. The sample consists of 88 persons (76% women and 24% men, mean age = 21) who lost a close friend in the Utøya killings in Norway on July 22, 2011.Quantitative data were collected at three time-points; 18, 28, and 40 months postloss. Main findings are that bereaved friends are heavily impacted by the loss and their grief reactions are affected negatively by avoidant behavior and rumination. This indicates that close bereaved friends are a group to be aware of and that there is a need for better strategies for identifying individuals in need for follow-up.

scholarly journals A Very Rare Cause of Dilated Cardiomyopathy after Bariatric Surgery: Selenium Deficiency

2021 ◽  
pp. 1-3
Author(s):  
Gulay Kocak ◽  
Munevver Gul Avsar ◽  
Cansu Yazar ◽  
Aylia Yesilova ◽  
Gulcagri Yildiz ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Trace Elements ◽  
Sleeve Gastrectomy ◽  
Dilated Cardiomyopathy ◽  
Selenium Deficiency ◽  
Water Soluble ◽  
Nutritional Deficiencies ◽  
Reduced Ejection Fraction ◽  
Long Term Follow Up

Background: Sleeve gastrectomy for weight loss has increased significantly nowadays. Various complications may develop after this surgery that requires long-term follow-up of these patients. Nutrition is the most important aspect of the follow-up. The deficiency of trace elements, fat-soluble and water-soluble vitamins following bariatric surgeries have been well-described complications. Although nutritional supplementations are often initiated after bariatric surgery, the clinical outcomes related to the deficiency of trace elements have not been well known yet. Case Presentation: A 27-year-old woman who underwent a laparoscopic sleeve gastrectomy for surgical treatment of obesity 9 months ago presented to the emergency department with a signs of heart failure. Transthoracic echocardiography revealed dilated, poorly functioning left ventricle with reduced ejection fraction (28.9%) consistent with dilated cardiomyopathy. We assumed nutritional deficiencies secondary to sleeve gastrectomy as a cause of dilated cardiomyopathy, as the patient had inappropriate nutritional supplements after surgery. Laboratory tests revealed selenium and zinc deficiency that supported our hypothesis. Our patient completely recovered with adequate supplementation of selenium, zinc and thiamine. Conclusion: We highlighted that the early diagnosis of dilated cardiomyopathy due to selenium deficiency following bariatric surgery is of great importance since selenium deficiency is a cause of reversible cardiomyopathy.

scholarly journals T55. DETECTING SEMANTIC DISTANCE ABNORMALITIES IN PSYCHOSIS: QUANTIFICATION OF WORD ASSOCIATIONS USING SEMANTIC SPACE MODELING

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S252-S252
Author(s):  
Andrea Pintos ◽  
Charlton Cheung ◽  
Simon De Deyne ◽  
Christy L M Hui ◽  
Eric Y H Chen
Keyword(s):  
Word Association ◽  
Semantic Distance ◽  
Semantic Space ◽  
Psychotic Episode ◽  
Symptom Change ◽  
Time Points ◽  
Association Task ◽  
Cue Words ◽  
Over Time

Abstract Background Language Disorganisation is central to the conceptualization of psychosis. Disruptions in semantic processing have been observed both as a “state”, and a “trait” phenomena in psychotic disorders. Quantification of semantic abnormalities have been improved with recent advances in semantic modeling. The current study applied such computational methods on a word association task, using immediate response to cue words to explore semantic associations. We employed a longitudinal design to investigate semantic relationships during a psychotic episode compared with the same patients after remission six months later, in order to clarify the state-trait status of the semantic variables, and their relationships with clinical symptoms. We hypothesized that semantic distance would be significantly greater in patients than controls at baseline, and would decrease upon follow-up. Methods A continued word association task (WAT) was employed to elicit three associations per cue from a set of 200 cue-words. The set of cues were previously established as being representative of words in general speech, in terms of valence, concreteness and part-of-speech composition. The task was administered to 47 patients with schizophrenia spectrum disorders and 44 matched healthy control participants. Data was collected at two time points, at baseline when patients were actively psychotic and then at 6-months follow-up. In addition, extensive clinical and cognitive measures were collected at both time points. Patterns of word associations were explored using vector representations, derived from Word2Vec, that encompass semantic meaning. Semantic distance of each cue-response pairing is defined using the cosine angle of their vectors. Changes in semantic distance were further examined on their correlation with symptom change over time. Results There was a significant interaction between group and time point on semantic distance (F = 6.865, p = 0.009), where measures of the semantic distance of patients’ responses were significantly greater than healthy controls at both time-points (p &lt; 0.001).There is a significant time effect: the semantic distance reduced significantly over time (p &lt; 0.001). Within the patient group, a change in semantic distance was correlated with symptom change over time, specifically with general psychopathology (p =0.024), depressive (p = 0.046) and manic symptoms (p &lt; 0.01). Discussion Measures of semantic distance were significantly greater in patients both at baseline during a psychotic episode, and at follow-up upon clinical remission. There is a significant but not full normalization of semantic distance upon remission. Increase in semantic distance is therefore both a state and a trait marker in psychosis. We have employed a novel technique to quantify semantic distance of a word association task using Word2Vec to generate vector representations of responses in a high-dimensional semantic space. The findings illustrate the feasibility of applying Word2Vec to a word association task to detect subtle changes in language. Subsequent research possibilities using this approach includes exploration of the semantic content of responses, by grouping similar meaning responses into conceptual clusters, and its correlation with symptom change.

scholarly journals Prevalence of All-Cause Mortality and Suicide among Bariatric Surgery Cohorts: A Meta-Analysis

2018 ◽  
Vol 15 (7) ◽  
pp. 1519 ◽  
Author(s):  
Russell Lim ◽  
Melvyn Zhang ◽  
Roger Ho
Keyword(s):  
Bariatric Surgery ◽  
Analytical Study ◽  
Meta Analysis ◽  
Well Being ◽  
Mortality Rates ◽  
Pooled Prevalence ◽  
All Cause Mortality ◽  
Bariatric Patients ◽  
Post Bariatric Surgery

Introduction: Prior meta-analysis has reported mortality rates among post-operative bariatric patients, but they have not considered psychiatric factors like suicide contributing to mortality. Objectives: The current meta-analysis aims to determine the pooled prevalence for mortality and suicide amongst cohorts using reported suicides post bariatric surgery. It is also the aim of the current meta-analytical study to determine moderators that could account for the heterogeneity found. Results: In our study, the pooled prevalence of mortality in the studies which reported suicidal mortality was 1.8% and the prevalence of suicide was 0.3%. Mean body mass index (BMI) and the duration of follow-up appear to be significant moderators. Conclusions: Given the prevalence of suicide post bariatric surgery, it is highly important for bariatric teams to consider both the medical and psychiatric well-being of individuals pre- and post-operatively.

Nutritional Deficiencies and Bariatric Surgery

2018 ◽  
Author(s):  
Anthony B. Mozer ◽  
Konstantinos Spaniolas ◽  
Walter J. Pories
Keyword(s):  
Bariatric Surgery ◽  
Oral Intake ◽  
Emergency Department Visits ◽  
Nutritional Deficiencies ◽  
Vitamin Supplementation ◽  
Behavioral Modification ◽  
Poor Oral Intake ◽  
Preoperative Counseling ◽  
Disproportionate Number

Dietary intolerance and poor oral intake account for a disproportionate number of emergency department visits and readmissions after bariatric surgery. Micronutrient, vitamin, and protein deficiencies can occur after both malabsorptive and restrictive weight-loss operations, and they are best mitigated against by conscientious preoperative counseling and vigilance in follow-up. Routine vitamin supplementation can prevent the need for unnecessary laboratory testing, while symptoms of dumping syndrome can frequently be managed with dietary and behavioral modification alone. Alternative enteral feeding access for alimentary supplementation can be safely performed surgically or with assistance by interventional radiology, and should be considered in the management of perforation, early anastomotic leak, surgical revision, or patients with refractory malnourishment.

scholarly journals Changes of trace element status during aging: results of the EPIC-Potsdam cohort study

2019 ◽  
Vol 59 (7) ◽  
pp. 3045-3058 ◽  
Author(s):  
Julia Baudry ◽  
Johannes F. Kopp ◽  
Heiner Boeing ◽  
Anna P. Kipp ◽  
Tanja Schwerdtle ◽  
...  
Keyword(s):  
Reference Ranges ◽  
Linear Regression Models ◽  
Serum Samples ◽  
Time Points ◽  
Supplement Use ◽  
Healthy Elderly ◽  
Age Related ◽  
Longitudinal Variability ◽  
Over Time

Abstract Purpose We aimed to evaluate age-dependent changes of six trace elements (TE) [manganese (Mn), iron (Fe), zinc (Zn), copper (Cu), iodine (I), and selenium (Se)] over a 20-year period. Methods TE concentrations were determined using repeated serum samples taken at baseline and after 20 years of follow-up from 219 healthy participants of the EPIC-Potsdam study, using inductively coupled plasma tandem mass spectrometry. For each TE, absolute and relative differences were calculated between the two time points, as well as the proportion of individuals within normal reference ranges. Interdependence between age-related TE differences was investigated using principal component analysis (PCA). Relationships between selected factors (lifestyle, sociodemographic, anthropometric factors, and hypertension) and corresponding TE longitudinal variability were examined using multivariable linear regression models. Results Median age of our study sample was 58.32 years (4.42) at baseline and 40% were females. Median Mn, Zn, Se concentrations and Se to Cu ratio significantly decreased during aging while median Fe, Cu, I concentrations and Cu to Zn ratio significantly increased. A substantial percentage of the participants, at both time points, had Zn concentrations below the reference range. The first PCA-extracted factor reflected the correlated decline in both Mn and Zn over time while the second factor reflected the observed (on average) increase in both Cu and I over time. Overall, none of the investigated factors were strong determinants of TE longitudinal variability, except possibly dietary supplement use, and alcohol use for Fe. Conclusions In conclusion, in this population-based study of healthy elderly, decrease in Mn, Zn, and Se concentrations and increase in Fe, Cu, and I concentrations were observed over 20 years of follow-up. Further research is required to investigate dietary determinants and markers of TE status as well as the relationships between TE profiles and the risk of age-related diseases.

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