Midterm Follow Up For Knee Replacement: How Well Do We Follow Our Patients?

The lost to follow up rate specifically for five year post surgical UKAs is significantly higher for this population subset than the most recent published average as seen in a meta analysis review (Callahan et al. 1995). Follow up visits allow for proper assessment of complications such as wear and osteolysis which need early intervention to improve long-term outcomes and reduce the overall cost of care (Bhandari et al. 2012). Eleven patients, 27.5% of those that were lost to follow up, were without a correct or working phone number, which presents a significant barrier to care. Maintaining updated patient contact information and educating patients about the importance of intermittent follow up may aid in compliance. Further research is required to better characterize patients with poor follow up rates so that systematic surveillance methods can be developed to improve the quality of care

Improving metabolic parameters of antipsychotic child treatment (IMPACT) study: rationale, design, and methods

BACKGROUND: Youth with serious mental illness may experience improved psychiatric stability with second generation antipsychotic (SGA) medication treatment, but unfortunately may also experience unhealthy weight gain adverse events. Research on weight loss strategies for youth who require ongoing antipsychotic treatment is quite limited. The purpose of this paper is to present the design, methods, and rationale of the Improving Metabolic Parameters in Antipsychotic Child Treatment (IMPACT) study, a federally funded, randomized trial comparing two pharmacologic strategies against a control condition to manage SGA-related weight gain. METHODS: The design and methodology considerations of the IMPACT trial are described and embedded in a description of health risks associated with antipsychotic-related weight gain and the limitations of currently available research. RESULTS: The IMPACT study is a 4-site, six month, randomized, open-label, clinical trial of overweight/obese youth ages 8–19 years with pediatric schizophrenia-spectrum and bipolar-spectrum disorders, psychotic or non-psychotic major depressive disorder, or irritability associated with autistic disorder. Youth who have experienced clinically significant weight gain during antipsychotic treatment in the past 3 years are randomized to either (1) switch antipsychotic plus healthy lifestyle education (HLE); (2) add metformin plus HLE; or (3) HLE with no medication change. The primary aim is to compare weight change (body mass index z-scores) for each pharmacologic intervention with the control condition. Key secondary assessments include percentage body fat, insulin resistance, lipid profile, psychiatric symptom stability (monitored independently by the pharmacotherapist and a blinded evaluator), and all-cause and specific cause discontinuation. This study is ongoing, and the targeted sample size is 132 youth. CONCLUSION: Antipsychotic-related weight gain is an important public health issue for youth requiring ongoing antipsychotic treatment to maintain psychiatric stability. The IMPACT study provides a model for pediatric research on adverse event management using state-of-the art methods. The results of this study will provide needed data on risks and benefits of two pharmacologic interventions that are already being used in pediatric clinical settings but that have not yet been compared directly in randomized trials. TRIAL REGISTRATION: Clinical Trials.gov NCT0080623

Outcomes for Conversion of a Roux en-Y Gastric Bypass to a Biliopancreatic Diversion with Duodenal Switch

Micah Mabe Shillington PA1, Stephan Myers Sinking Spring PA1, John Fam Wyomissing PA1Tower Health1 Serious weight regain or inadequate weight loss following a gastric bypass operation is a challenging problem. In an attempt rectify this, 15 patients were converted from a Roux en-Y gastric bypass to a Biliopancreatic Diversion with duodenal switch and evaluated in a retrospective review. The average age was 52.6 years with 86.6% female. 12 were single anastomosis (SADI) with 3 classic dual anastomoses. 11 cases were completed robotically and 4 had planned open operations. The average operative time was 329.8 minutes (range 239-410 mins). 10 of the 15 were found to have an inadequate gastric pouch from the initial gastric bypass on endoscopy and the gastric reconstruction was accomplished with a jejunal interposition. The average weight loss at 1 year was 62 lbs with BMI decreased by an average of 10.6. The average percent excess weight loss was 36.7% with a average total body weight loss of 19.7%. There were no mortalities. 5 patients had complications with 3 leaks (20%) of which one required a return to the OR, 1 Pulmonary embolism and 1 surgical site infection. The mean LOS was 3 days for those without a leak and 30 days if a leak occurred for an overall average LOS of 8.9 days. Conclusion: Conversion of a RYGB to a BPD-DS is an effective but high risk solution for this difficult problem