Psychosocial predictors of intentions to comply with bariatric surgery guidelines Prospective Validation of American Diabetes Association Risk Tool for Predicting Pre-Diabetes and Diabetes in Taiwan–Taichung Community Health Study Does cognitive behavioral therapy strengthen the effect of bariatric surgery for obesity? Design and methods of a randomized and controlled study. When is the best time to deliver behavioral intervention to bariatric surgery patients: before or after surgery? The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT): a new tool for the psychosocial evaluation of pre-transplant candidates. The impact of a bariatric rehabilitation service on weight loss and psychological adjustment - study protocol An evidence-based gamified mHealth intervention for overweight young adults with maladaptive eating habits: study protocol for a randomized controlled trial Effect of Vocal Fold Medialization on Dysphagia in Patients with Unilateral Vocal Fold Immobility Does bariatric surgery improve the patient's quality of life? Assessing pain in persons with dementia: relationships among the non-communicative patient's pain assessment instrument, self-report, and behavioral observations. Eating pathology before and after bariatric surgery: a prospective study. Preliminary validation of the Yale Food Addiction Scale A mindfulness-based intervention to control weight after bariatric surgery: Preliminary results from a randomized controlled pilot trial. Innovative tools for quality assessment: integrated quality criteria for review of multiple study designs (ICROMS). Magnetic sphincter augmentation: a viable rescue therapy for symptomatic reflux following bariatric surgery The development of a population-level clinical screening tool for self-harm repetition and suicide: the ReACT Self-Harm Rule. Assessment of pain in cognitively impaired older adults: a comparison of pain assessment tools and their use by nonprofessional caregivers. Vertical Banded Gastroplasty Versus Standard or Distal Roux-en-Y Gastric Bypass Based on Specific Selection Criteria in the Morbidly Obese: Preliminary Results Effectiveness of exercise interventions on physical function in community-dwelling frail older people: an umbrella review of systematic reviews A pilot study investigating the efficacy of postoperative dietary counseling to improve outcomes after bariatric surgery. Predictors of utilization of an IVR self-monitoring program by problem drinkers with recent natural resolutions. STOPP (Screening Tool of Older Persons' potentially inappropriate Prescriptions): application to acutely ill elderly patients and comparison with Beers' criteria. Psychological treatment of insomnia in hypnotic-dependant older adults.
An increasing body of research suggests that many patients have difficulty adopting the eating guidelines after weight-loss surgery , thereby reducing the long-term success of the procedure . Given such difficulties , it is possible that the typical preoperative education regarding post-surgical eating behavior guidelines is ineffective in motivating some individuals to comply . Presently , no accurate predictors of intentions to comply with post-bariatric surgery guidelines have been identified . In the present pilot study , a psychosocial intervention based on protection motivation theory ( PMT ) was presented to patients undergoing bariatric surgery .  PMT is a well-established preventive health model that has been utilized in a variety of health domains . Participants for this study were recruited before undergoing bariatric surgery , and were r and omly assigned to one of two groups : PMT group vs. control . In addition to routine messages from the bariatric surgeon , participants in the PMT group received an intervention based in PMT that focused on the importance of adhering to post-surgical eating behavior guidelines and how best to adhere to these guidelines . Participants in the control group received st and ard of care information from the bariatric surgeon . Results indicated that the PMT intervention did not have a significant impact . However , follow-up analyses revealed that two aspects of PMT , perceived self-efficacy and perceived threat of not following the guidelines , predicted patients ' intentions to comply with post-surgical guidelines . Findings are discussed in terms of the method ological compromises that result ed from the applied research setting as well as promising avenues for future investigation Background A simple diabetes risk tool that does not require laboratory tests would be beneficial in screening individuals at higher risk . Few studies have evaluated the ability of these tools to identify new cases of pre-diabetes . This study aim ed to assess the ability of the American Diabetes Association Risk Tool ( ADART ) to predict the 3-year incidence of pre-diabetes and diabetes in Taiwanese . Methods This was a 3-year prospect i ve study of 1021 residents with normoglycemia at baseline , gathered from a r and om sample of residents aged 40–88 years in a metropolitan city in Taiwan . The areas under the curve ( AUCs ) of three models were compared : ADART only , ADART plus lifestyle behaviors at baseline , and ADART plus lifestyle behaviors and biomarkers at baseline . The performance of ADART was compared with that of 16 tools that had been reported in the literature . Results The AUCs and their 95 % confidence intervals ( CIs ) were 0.60 ( 0.54–0.66 ) for men and 0.72 ( 0.66–0.77 ) for women in model 1 ; 0.62 ( 0.56–0.68 ) for men and 0.74 ( 0.68–0.80 ) for women in model 2 ; and 0.64 ( 0.58–0.71 ) for men and 0.75 ( 0.69–0.80 ) for women in model 3 . The AUCs of these three models were all above 0.7 in women , but not in men . No significant difference in either women or men ( p = 0.268 and 0.156 , respectively ) was observed in the AUC of these three models . Compared to 16 tools published in the literature , ADART had the second largest AUC in both men and women . Conclusions ADART is a good screening tool for predicting the three-year incidence of pre-diabetes and diabetes in females of a Taiwanese population . The performance of ADART in men was similar to the results with other tools published in the literature . Its performance was one of the best among the tools reported in the literature BACKGROUND ( Extreme ) obesity is a chronic harmful condition with high risk of medical comorbidities and negative social and emotional consequences . Bariatric surgery is an effective intervention for obesity , but approximately 20 to 30 % of the patients experience adverse outcomes after surgery and there is a need for augmentation of current treatment strategies . This study examines the added value of pre-operative cognitive behavioral therapy ( CBT ) focused on modification of thoughts and behaviors in terms of eating behavior and physical exercise as well as preparation for surgery and postoperative life style . We hypothesize that pre-operative CBT will result in better weight loss maintenance , reduction of maladaptive eating behavior and better adherence to postoperative lifestyle on the long term as compared to bariatric surgery alone . METHODS One hundred and twenty eight patients that are on a waiting list for bariatric surgery are r and omly assigned to the control or treatment condition . Patients in the treatment condition receive 10 sessions of CBT before surgery aim ed at modifying dysfunctional eating habits and behaviors and developing more rational weight and body-related beliefs in order to enable long term maintenance of a healthier lifestyle after surgery . Weight loss , eating behavior , eating disorders , depression , quality of life and psychological distress are assessed before and after treatment , as well as 1 , 3 , and 5 year following surgery BACKGROUND Many comprehensive bariatric surgery programs have implemented preoperative behavioral interventions for patients presenting with problematic eating behaviors in an effort to enhance postoperative weight loss and improve psychosocial adjustment . However , it is unknown whether these interventions are best delivered pre- or postoperatively . The purpose of this study was to determine when bariatric surgery patients are most receptive to a behavioral intervention , before or after surgery . METHODS A total of 32 pre- and postoperative patients were referred to a 10-week intervention design ed to reduce eating behaviors associated with postoperative weight gain ( e.g. ,  loss  of control while eating , grazing )  . The sample was 78.1 % female and 84.4 % white , with an average age of 49.43 + /- 9.13 years and a body mass index of 44.22 + /- 6.48 kg/m(2 ) . Of the 32 patients , 21 were referred preoperatively and 11 were referred postoperatively ( 5.63 + /- 2.91 months after surgery ) . These patients were tracked prospect ively to determine whether pre- or postoperative patients were more likely to attend and complete the behavioral intervention . RESULTS Compared with the preoperative patients , the postoperative patients were more likely to follow-up with their referral and initiate treatment [ chi(2)(1 ) = 10.06 , P = .002 ] . Of the postoperative patients , 100 % attended the first intervention session  compared with only 43 % of preoperative patients . The postoperative patients also attended more intervention sessions [ t(18 ) = 2.51 , P = .02 ] and were more likely to complete the intervention [ chi(2)(1 ) = 7.21 , P = .007 ] . Only 14 % of the preoperative referral patients completed the program compared with 91 % of the postoperative patients . CONCLUSION Comprehensive bariatric surgery programs ought to consider balancing the needs of the preoperative patients presenting with maladaptive eating behavior with the likelihood of them participating in a behavioral intervention before surgery BACKGROUND While medical criteria have been well established for each end-organ system , psychosocial listing criteria are less st and ardized . To address this limitation , we developed and tested a new assessment tool : the  Stanford Integrated Psychosocial Assessment for Transplantation ( SIPAT ) . METHODS The SIPAT was developed from a comprehensive review of the literature on the psychosocial factors that impact transplant outcomes . Five examiners blindly applied the SIPAT to 102 r and omly selected transplant cases , including liver , heart , and lung patients . After all subject 's files had been rated by the examiners , the respective transplant teams provided the research team with the patient 's outcome data . RESULTS Univariate logistic regression models were fit in order to predict the transplant psychosocial outcome ( positive or negative ) using each rater 's SIPAT scores . These results show that SIPAT scores are highly predictive of the transplant psychosocial outcome ( P < 0.0001 ) . The instrument has excellent inter-rater reliability ( Pearson 's correlation coefficient = 0.853 ) , even among novice raters . CONCLUSIONS The SIPAT is a comprehensive screening tool to assist in the psychosocial assessment of organ transplant c and i date s. Its strengths includes the st and ardization of the evaluation process and its ability to identify subjects who are at risk for negative outcomes after the transplant , in order to allow for the development of interventions directed at improving the patient 's c and idacy . Our goal is that the SIPAT , in addition to a set of agreed upon minimal psychosocial listing criteria , would be used in combination with organ-specific medical listing criteria in order to establish st and ardized criteria for the selection of transplant recipients Background Bariatric surgery is currently the most effective form of obesity management for those whose BMI is greater than 40 ( or 35 with co morbidities ) . A minority of patients , however , either do not show the desired loss of excess weight or show weight regain by follow up . Research highlights some of the reasons for this variability , most of which centres on the absence of any psychological support with patients describing how although surgery fixes their body , psychological issues relating to dietary control , self esteem , coping and emotional eating remain neglected . The present study aims to evaluate the impact of a health psychology led bariatric rehabilitation service ( BRS ) on patient health outcomes . The bariatric rehabilitation service will provide information , support and mentoring pre and post surgery and will address psychological issues such as dietary control , self esteem , coping and emotional eating . The package reflects the rehabilitation services now common place for patients post heart attack and stroke which have been shown to improve patient health outcomes . Methods / Design The study is a r and omised control trial and patients will be allocated to receive either usual care or the bariatric rehabilitation service pre and post bariatric surgery . Follow up measures of weight loss and psychological issues will be taken at baseline ( 2 weeks preoperatively ) , 3 , 6 and 12 months postoperatively . The contents of the bariatric service and the follow up measures are based on previous pilot work and have been developed further by the research team working closely with two patient support groups ( BOSPA & WLSinfo ) . This study will take place in St Richard 's Hospital in Chichester in the UK . Discussion It is predicted that a bariatric rehabilitation service will improve weight loss following surgery and will also facilitate changes in other psychological variables such as quality of life , dietary control , self esteem , coping and emotional eating . This also has cost implication s for the NHS and other healthcare providers as improved effectiveness of bariatric surgery reduces the health costs of obese patients in the longer term . Trial registration Clinical Trials.gov NCT01264120 Background Cognitive behavior therapy ( CBT ) is the first-line of treatment for overweight and obesity patients whose problems originate in maladaptive eating habits ( e.g. , emotional eating ) . However , in-person CBT is currently difficult to access by large segments of the population . The proposed SIGMA intervention ( i.e. , the Self-help , Integrated , and Gamified Mobile-phone Application ) is a mHealth intervention based on CBT principles . It specifically targets overweight young adults with underlying maladaptive behaviors and cognitions regarding food . The SIGMA app was design ed as a serious game and intended to work as a st and alone app for weight maintenance or alongside a calorie-restrictive diet for weight loss . It uses a complex and novel scoring system that allows points earned within the game to be supplemented by points earned during outdoor activities with the help of an embedded pedometer . Methods / design The efficacy of the SIGMA mHealth intervention will be investigated within a r and omized , placebo-controlled trial . The intervention will be set to last 2 months with a 3-month follow-up . Selected participants will be young overweight adults with non- clinical maladaptive eating habits embodied by food cravings , binge eating , and emotional eating . The primary outcomes will be represented by changes in ( 1 ) self-reported maladaptive thoughts related to eating and body weight , ( 2 ) self-reported maladaptive eating behaviors in the range of urgent food cravings , emotional eating or binge eating , ( 3 ) as well as biased attentional processing of food items as indexed by reaction times . Secondary outcomes will be represented by changes in weight , Body Mass Index , general mood , and physical activity as indexed by the number of steps per day . Discussion Through an evidence -based cognitive behavioral approach and a user-friendly game interface , the SIGMA intervention offers a significant contribution to the development of a cost-effective and preventive self-help tool for young overweight adults with maladaptive eating habits . Trial registration IS RCT N , ID : 70907354 . Registered on 6 February 2017 . The IS RCT N registration is in line with the World Health Organization Trial Registration Data Set . The present paper represents the original version of the protocol . Any changes to the protocol will be communicated to IS RCT Objective The effect of vocal fold medialization ( VFM ) on vocal improvement in persons with unilateral vocal fold immobility ( UVFI ) is well established . The effect of VFM on the symptom of dysphagia is uncertain . The purpose of this study is to evaluate dysphagia symptoms in patients with UVFI pre- and post-VFM .  Study Design Case series with chart review . Setting Academic tertiary care medical center . Subjects and Methods The charts of 44 persons with UVFI who underwent VFM between June 1 , 2013 , and December 31 , 2014 , were abstract ed from a prospect ively maintained data base at the University of California , Davis , Voice and Swallowing Center . Patient demographics , indications , and type of surgical procedure were recorded . Self-reported swallowing impairment was assessed with the vali date d 10-item Eating Assessment Tool ( EAT-10 ) before and after surgery . A paired sample s t test was used to compare pre- and postmedialization EAT-10 scores . Results Forty-four patients met criteria and underwent either vocal fold injection ( 73 % ) or thyroplasty ( 27 % ) . Etiologies of vocal fold paralysis were iatrogenic ( 55 % ) , idiopathic ( 29 % ) , benign or malignant neoplastic ( 9 % ) , traumatic ( 5 % ) , or related to the late effects of radiation ( 2 % ) . EAT-10 ( mean ± SD ) scores improved from 12.2 ± 11.1 to 7.7 ± 7.2 after medialization ( P < .01 ) with a follow-up of 119 ± 65 days . Conclusion Patients with UVFI suffer from dysphagia and report significant improvement in swallowing symptoms following VFM . The symptomatic improvement appears to be durable over time OBJECTIVE The aim of this investigation was to assess the effect of malabsorptive bariatric surgery ( BS ) on the quality of life ( QoL ) , applying the Nottingham Health Profile ( NHP ) and the bariatric analysis and reporting outcome system ( BAROS ) . DESIGN A prospect i ve cohort study was performed in 100 adult patients ( > 18 years ) undergoing bariatric surgery by malabsorptive technique for one year . RESEARCH METHODS AND PROCEDURES Patients were monitored from the beginning of the BS program until a year after the intervention , applying the NHP and the BAROS test . At baseline , the mean weight of the women was 132 ± 22 kg and the Body Mass Index ( BMI ) was 50.7 kg/m² . RESULTS The values obtained from different areas applying the NHP question naire showed statistical significant differences ( p < 0.001 ) with respect to baseline values . According to the BAROS test , 48 % of patients lost 25 - 49 % of weight excess and 80.8 % had resolved major comorbidities at 1 yr . According to the Moorehead-Ardelt QoL score , there were major improvements in employment and self-esteem in 89 % and 87 % of patients , respectively , and improvements in physical activity , sexual and social relationships . According to the total mean BAROS score , the outcome was considered " very good " . CONCLUSION NHP and BAROS question naires appear to be useful and easily applicable tools to assess the QoL of obese patients Pain is a common problem for many older adults , with up to 50 % of community-dwelling and 70 % to 80 % of nursing home residents experiencing pain regularly . Effective  pain  management requires thorough assessment , appropriate intervention , and systematic re assessment . Pain assessment , however , is complicated by dementia , which impairs memory , reasoning , recognition , and communication , and affects elders ' ability to verbally report pain . As such , observational measures are needed to assess pain in this vulnerable population . The Non-communicative Patient 's Pain Assessment Instrument ( NOPPAIN ) was developed for this purpose , but more validation of this measure is needed . Thus , the purpose of this study was to ( 1 ) evaluate reliability of the NOPPAIN tool when used by nurses and to ( 2 ) compare NOPPAIN ratings with self-report and other well-established behavioral rating procedures . Forty participants ( 20 cognitively intact and 20 impaired ) were r and omly selected for this study from a larger sample . In the parent study , participants were asked to perform everyday activities ( i.e. , sit , st and , walk in place , transfer in and out of bed ) while being videotaped . The tapes , all previously scored using microanalytic observational coding , were rated again by naïve raters using the NOPPAIN measure . Results indicated ( 1 ) high inter- and intrarater reliability of the NOPPAIN and ( 2 ) significant correlations of the NOPPAIN with self-reported pain and detailed behavioral coding . Findings support the reliability and validity of the NOPPAIN measurement tool and suggest this easy-to-use tool may be adequate for measuring pain indicators in older adults OBJECTIVE The objectives of the study were ( 1 ) to determine the prevalence of eating pathology in patients before bariatric surgery and at follow-up ; ( 2 ) to assess the relationship of presurgical eating pathology to various measures of psychopathology ; and ( 3 ) to assess the relationship between presurgical eating pathology and outcome . METHOD One hundred sixteen patients were evaluated prior to surgery and at follow-up an average of 5.5 years after surgery . RESULTS Preoperative binge eating occurred in 52 % of patients , 16 % met criteria for binge eating disorder , and 10 % had the night eating syndrome . All three forms of presurgical eating pathology were statistically associated with cognitive distortions . At follow-up , 33 % of patients were vomiting at least weekly . There was no relationship between presurgical eating pathology and weight outcome or presence of vomiting at follow-up . DISCUSSION Although postoperative vomiting usually does not represent purge behavior , it may represent failed attempts to binge Previous research has found similarities between addiction to psychoactive substances and excessive food consumption . Further exploration is needed to evaluate the concept of " food addiction , " as there is currently a lack of psychometrically vali date d measurement tools in this area . The current study represents a preliminary exploration of the Yale Food Addiction Scale ( YFAS ) , design ed to identify those exhibiting signs of addiction towards certain types of foods ( e.g. , high fat and high sugar ) . Survey data were collected from 353 respondents from a stratified r and om sample of young adults . In addition to the YFAS , the survey assessed eating pathology , alcohol consumption and other health behaviors . The YFAS exhibited adequate internal reliability , and showed good convergent validity with measures of similar constructs and good discriminant validity relative to related but dissimilar constructs . Additionally , the YFAS predicted binge-eating behavior above and beyond existing measures of eating pathology , demonstrating incremental validity . The YFAS is a sound tool for identifying eating patterns that are similar to behaviors seen in classic areas of addiction . Further evaluation of the scale is needed , especially due to a low response rate of 24.5 % and a non- clinical sample , but confirmation of the reliability and validity of the scale has the potential to facilitate empirical research on the concept of " food addiction " OBJECTIVE This study aim ed to develop and test a novel mindfulness-based intervention ( MBI ) design ed to control weight after bariatric surgery . DESIGN R and omized , controlled pilot trial . SETTING Beth Israel Deaconess Medical Center , Boston , MA , USA . INTERVENTIONS Bariatric patients 1 - 5 years post-surgery ( n=18 ) were r and omized to receive a 10-week MBI or a st and ard intervention . MAIN OUTCOME MEASURES Primary outcomes were feasibility and acceptability of the MBI . Secondary outcomes included changes in weight , eating behaviors , psychosocial outcomes , and metabolic and inflammatory biomarkers . Qualitative exit interviews were conducted post-intervention . Major themes were coded and extracted . RESULTS Attendance was excellent ( 6 of 9 patients attended ≥7 of 10 classes ) . Patients reported high satisfaction and overall benefit of the MBI . The intervention was effective in reducing emotional eating at 6 months ( -4.9±13.7 in mindfulness vs. 6.2±28.4 in st and ard , p for between-group difference=0.03 ) but not weight . We also observed a significant increase in HbA1C ( 0.34±0.38 vs. -0.06±0.31 , p=0.03 ) . Objective measures suggested trends of an increase in perceived stress and symptoms of depression , although patients reported reduced stress reactivity , improved eating behaviors , and a desire for continued mindfulness-based support in qualitative interviews . CONCLUSIONS This novel mindfulness-based approach is highly acceptable to bariatric patients post-surgery and may be effective for reducing emotional eating , although it did not improve weight or glycemic control in the short term . Longer-term studies of mindfulness-based approaches may be warranted in this population . CLINICAL TRIAL REGISTRATION Clinical Trials.gov identifier NCT02603601 OBJECTIVES With the aim to facilitate a more comprehensive review process in public health including patient safety , we established a tool that we have termed ICROMS ( Integrated quality Criteria for the Review Of Multiple Study design s ) , which unifies , integrates and refines current quality criteria for a large range of study design s including qualitative research . STUDY DESIGN Review , pilot testing and expert consensus . METHODS The tool is the result of an iterative four phase process over two years : 1 ) gathering of established criteria for assessing controlled , non-controlled and qualitative study design s ; 2 ) pilot testing of a first version in two systematic review s on behavioural change in infection prevention and control and in antibiotic prescribing ; 3 ) further refinement and adding of additional study design s in the context of the European Centre for Disease Prevention and Control funded project ' Systematic review and evidence -based guidance on organisation of hospital infection control programmes ' ( SIGHT ) ; 4 ) scrutiny by the pan-European expert panel of the SIGHT project , which had the objective of ensuring robustness of the systematic review . RESULTS ICROMS includes established quality criteria for r and omised studies , controlled before- and -after studies and interrupted time series , and incorporates criteria for non-controlled before- and -after studies , cohort studies and qualitative studies . The tool consists of two parts : 1 ) a list of quality criteria specific for each study design , as well as criteria applicable across all study design s by using a scoring system ; 2 ) a ' decision matrix ' , which specifies the robustness of the study by identifying minimum requirements according to the study type and the relevance of the study to the review question . The decision matrix directly determines inclusion or exclusion of a study in the review . ICROMS was applied to a series of systematic review s to test its feasibility and usefulness in the appraisal of multiple study design s. The tool was applicable across a wide range of study design s and outcome measures . CONCLUSION ICROMS is a comprehensive yet feasible appraisal of a large range of study design s to be included in systematic review s addressing behaviour change studies in patient safety and public health . The tool is sufficiently flexible to be applied to a variety of other domains in health-related research . Beyond its application to systematic review s , we envisage that ICROMS can have a positive effect on research ers to be more rigorous in their study design and more diligent in their reporting Introduction Laparoscopic sleeve gastrectomy ( LSG ) and laparoscopic Roux-en-Y gastric bypass ( LRYGB ) are commonly performed bariatric procedures in obesity management . Gastroesophageal reflux disease ( GERD ) in this population has reported rates of 23–100 % . GERD after LSG has been noted with recent studies demonstrating de novo reflux or symptom exacerbation despite weight loss . Fundoplication is not an option , and medically refractory GERD after LSG is usually treated with conversion to RYGB . GERD post-RYGB is a unique entity , and management poses a clinical and technical challenge . We evaluate safety and effectiveness of magnetic sphincter augmentation after bariatric surgery . Material s and methods A retrospective review of a prospect ively maintained data base was performed identifying patients that underwent LINX placement for refractory GERD after LSG , LRYGB , or duodenal switch across three institutions . Outcomes included complications , length of stay , PPI use , GERD-HRQL scores , and patient overall satisfaction . Results From March 2014 through June 2018 , 13 identified patients underwent LINX placement after bariatric surgery : 8 LSG , 4 LRYGB , and 1 duodenal switch .  The patients were 77 % female , with mean age 43 and average BMI 30.1 .  Average pre-operative DeMeester score was 24.8 . Pre-operatively , 5 patients were on daily PPI , 6 on BID PPI , and 1 on PPI + H2 blocker . We noted decreased medication usage post-operatively , with 4 patients taking daily PPI , and 9 off medication completely . A GERD-HRQL score was obtained pre- and post-operatively in 6 patients with average reduction from 25 to 8.5 ( p value 0.002 ) . Two patients experienced complications requiring endoscopic dilation after LINX placement . 100 % of patients reported overall satisfaction post procedure . Conclusion LINX placement is a safe , effective treatment option for surgical management of refractory GERD after bariatric surgery . It can relieve symptoms and obviate the requirement of high-dose medical management . Magnetic lower esophageal sphincter augmentation should be another tool in the surgeon ’s toolbox for managing reflux after bariatric surgery in select patients BACKGROUND Self-harm is a common reason for Emergency Department ( ED ) attendance . We aim ed to develop a clinical tool to help identify patients at higher risk of repeat self-harm , or suicide , within 6 months of an ED self-harm presentation . METHOD The tool , the ReACT Self-Harm Rule , was derived using multicentre data from a prospect i ve cohort study . Binary recursive partitioning was applied to data from two centres , and data from a separate centre were used to test the tool . There were 29 571 self-harm presentations to five hospital EDs between January 2003 and June 2007 , involving 18 680 adults aged ⩾16 years . We estimated sensitivity , specificity and positive and negative predictive values to measure the performance of the tool . RESULTS A self-harm presentation was classified as higher risk if at least one of the following factors was present : recent self-harm ( in the past year ) , living alone or homelessness , cutting as a method of harm and treatment for a current psychiatric disorder . The rule performed with 95 % sensitivity [ 95 % confidence interval ( CI ) 94 - 95 ] and 21 % specificity ( 95 % CI 21 - 22 ) , and had a positive predictive value of 30 % ( 95 % CI 30 - 31 ) and a negative predictive value of 91 % ( 95 % CI 90 - 92 ) in the derivation centres ; it identified 83/92 of all subsequent suicides . CONCLUSIONS The ReACT Self-Harm Rule might be used as a screening tool to inform the process of assessing self-harm presentations to ED . The four risk factors could also be used as an adjunct to in-depth psychosocial assessment to help guide risk formulation . The use of multicentre data helped to maximize the generalizability of the tool , but we need to further verify its external validity in other localities OBJECTIVES To compare self-reporting of pain by cognitively impaired ( CI ) older adults living in the community with reports of their caregivers ; to identify the factors associated with differences in agreement ; and to identify those pain assessment tools that are most useful to nonprofessional caregivers . DESIGN Prospect i ve observational cohort of patients with dementia and their caregivers . SETTING In-home assessment s of community-dwelling CI older adults and family members , adult foster care providers , or aides in residential care facilities . All CI subjects were enrolled in a Program for All-inclusive Care of the Elderly program ( ElderPlace ) in Portl and , Oregon . PARTICIPANTS A total of 156 CI adults and their caregivers . METHODS St and ardized  pain assessment instruments were administered to the CI subjects and their caregivers in the subject 's home by trained research assistants between June and October 1998 . CI subjects were assessed with the  Nonverbal Visual Analog scale ( " line " ) , the  Faces Pain Scale ( " faces " ) , and the  Philadelphia Pain Intensity Scale ( PIS ) . Research assistants observed pain behaviors in the CI subjects using the Hospice Approach Discomfort Scale . The CI subject 's caregivers completed the " line , " " faces , " PIS , and Cornell Scale for Depression in Dementia . A baseline Mini-Mental State Exam , Functional Assessment Stage Test , and Geriatric Depression Scale were performed on all CI subjects by ElderPlace medical , nursing , or social work staff . RESULTS The mean age of the CI subjects was 83 , and 83 % were women . The mean Mini-Mental State Exam score was 15.7 . One-third of the CI subjects were unable to complete any of the three pain assessment tools . Of the 104 subjects completing at least one tool , 13 ( 12.5 % ) reported no pain and 91 ( 87.5 % ) reported some pain . Sixteen ( 10 % ) of the subjects were depressed as measured with the GDS or Cornell instrument . In 70 of the 104 subjects ( 67 % ) able to complete any tool , the caregiver and CI subject agreed as to the level of pain experienced by the CI subject . The number of tools completed by the CI subjects decreased with increased cognitive impairment . The Pain Intensity Scale was the tool most likely to be completed by both CI subjects and caregivers . The means of test scores were not significantly different for the paired groups of CI subject and caregiver , and the nonparametric correlation of each tool was significant : " faces " ( Spearman 's rho ( p ) = .417 ) ; " line " ( p = .420 ) ; and PIS ( p = .452 ) . The Hospice Approach Discomfort Scale did not correlate well with other tools . The Pain Intensity Scale seems to be more useful than other pain assessment tools in assessing pain in cognitively impaired patients and can be used by nonprofessional caregivers in a community-based care setting Background : Predicting successful outcomes after  bariatric surgical procedures  has been difficult , and the establishment of specific selection criteria has been a subject of ongoing research . In an effort to choose the most appropriate surgical procedure for each patient , we have established a specific set of selection criteria for each procedure based on degree of obesity , preoperative dietary habits , eating behavior , and various metabolic features . Methods : From June 1994 to December 1998 , 90 bariatric surgical procedures were performed at the authors ' institution by a single surgeon ( F.K. ) based on specific selection criteria . Vertical b and ed gastroplasty ( VBG ) was performed in 35 patients , st and ard Roux-en-Y gastric bypass ( RYGB ) in 38 patients , and distal RYGB in 17 patients . All patients were monitored postoperatively 1 , 3 , 6 , and 12 months and once per year thereafter , with an additional visit at 18 months in distal RYGB patients . Results : Early postoperative morbidity ( < 30 days ) did not differ significantly between the three groups and averaged 9 % of total patients . Long-term postoperative morbidity ( > 30 days ) included 9 incisional hernias ( 2 in the VBG group , 5 after RYGB , and 2 in the distal RYGB group ) . There were 6 cases of staple-line disruption , 4 after VBG and 2 after st and ard RYGB , 1 of which result ed in stomal ulcer . Early postoperative mortality was 0 % , and long-term mortality was 1.1 % , which was due to pulmonary embolism in 1 st and ard RYGB patient on the 65th postoperative day . Average percentage of excess weight loss ( % EWL ) was 62 % the first year , 61 % the second year , and 50 % the third year in VBG patients , and 63.6 % , 65 % , and 63.3 % , respectively , in st and ard RYGB patients . In distal RYGB patients , where the patient number was significantly smaller , the % EWL at 1 and 2 years , respectively , was 51 % and 53 % . The most significant metabolic/nutritional complication was the appearance of hypoproteinemia ( hypoalbuminemia ) in 1 distal RYGB patient 20 months after surgery , which was corrected by total parenteral nutrition and subsequent increase in dietary protein intake . Significant improvement or resolution of pre-existing comorbid conditions was observed in all patient groups . The postoperative quality of eating , as evaluated by variety of food intake and frequency of vomiting , was significantly better in RYGB patients . Conclusions : These results show that selection of the bariatric surgical procedure to be performed in each patient based on specific criteria leads to acceptable weight loss , improvement in preexisting comorbid conditions , and a high degree of patient satisfaction in most patients . On the basis of our own observations as well as those of others , our selection criteria have become more strict over time and our selection of VBG as the operation of choice increasingly infrequent Objectives : This umbrella review aim ed to determine the effectiveness of exercise interventions , alone or in combination with other interventions , in improving physical function in community-dwelling older people identified as pre-frail or frail . Introduction : Exercise is said to have a positive impact on muscle mass and strength which improves physical function and hence is beneficial for the treatment of frailty . Several systematic review s discuss the effects of exercise interventions on physical function parameters , such as strength , mobility , gait , balance and physical performance , and indicate that multi-component exercise , including resistance , aerobic , balance and flexibility training , appears to be the best way in which to improve physical function parameters in frail older people . However , there is still uncertainty as to which exercise characteristics ( type , frequency , intensity , duration and combinations ) are the most effective and sustainable over the long-term . Inclusion criteria : Participants were adults , 60 years or over , living in the community and identified as pre-frail or frail . Quantitative systematic review s , with or without meta- analysis that examined the effectiveness of exercise interventions of any form , duration , frequency and intensity , alone or in combination with other interventions design ed to alter physical function parameters in frail older people , were considered . The quantitative outcome measures were physical function , including muscular strength , gait , balance , mobility and physical performance . Methods : An iterative search strategy for ten bibliometric data bases and gray literature was developed . Critical appraisal of seven systematic review s was conducted independently by two review ers using a st and ard Joanna Briggs Institute tool . Data was extracted independently by two review ers using a st and ard Joanna Briggs Institute data extraction tool and summarized using a narrative synthesis approach . Results : Seven systematic review s were included in this umbrella review , with a total of 58 relevant r and omized controlled trials and 6927 participants . Five systematic review s examined the effects of exercise only , while two systematic review s reported on exercise in combination with a nutritional approach , including protein supplementations , as well as fruit and dairy products . The average  exercise frequency was 2–3 times per week ( mean 3.0 ± 1.5 times per week ; range 1–7 weekly ) for 10–90 minutes per session ( mean of 52.0 ± 16.5 mins ) and a total duration of 5–72 weeks with the majority lasting a minimum of 2.5 months ( mean 22.7 ± 17.7 weeks ) . Multi-component exercise interventions can currently be recommended for pre-frail and frail older adults to improve muscular strength , gait speed , balance and physical performance , including resistance , aerobic , balance and flexibility tasks . Resistance training alone also appeared to be beneficial , in particular for improving muscular strength , gait speed and physical performance . Other types of exercise were not sufficiently studied and their effectiveness is yet to be established . Conclusions : Interventions for pre-frail and frail older adults should include multi-component exercises , including in particular resistance training , as well as aerobic , balance and flexibility tasks . Future research should adopt a consistent definition of frailty and investigate the effects of other types of exercise alone or in combination with nutritional interventions so that more specific recommendations can be made BACKGROUND Bariatric surgery is a powerful treatment of severe obesity . During the past several years , a greater appreciation for the need for multidisciplinary care to optimize outcomes has developed , and a number of studies have been started to examine the role of postoperative interventions used in combination with surgery . The purpose of the present study was to investigate the hypothesis that the provision of postoperative dietary counseling , delivered by a registered dietitian , would lead to greater weight loss and more positive improvements in dietary intake and eating behavior compared with st and ard postoperative care . The study was performed at an academic medical center . METHODS Eighty-four individuals who underwent bariatric surgery were r and omly assigned to receive either dietary counseling or st and ard postoperative care for the first 4 months after surgery . The participants completed measures of macronutrient intake and eating behavior at baseline and 2 , 4 , 6 , 12 , 18 , and 24 months after surgery . RESULTS The patients who received dietary counseling achieved greater weight loss than those who received st and ard postoperative care that did not involve this counseling , although this difference did not reach statistical significance . Patients in the dietary counseling arm did report significant changes in several eating behaviors believed to be important to successful long-term weight maintenance . CONCLUSION The results of our pilot study provide some support for the efficacy of early postoperative dietary counseling to improve outcomes after bariatric surgery BACKGROUND As part of a r and omized controlled trial , problem drinkers who recently initiated natural recovery on their own were offered access to an interactive voice response ( IVR ) self-monitoring ( SM ) system as a sobriety maintenance tool during early recovery when relapse risk is high . Because observed IVR utilization was variable , predictors of utilization were evaluated to inform knowledge of population s likely to access and use IVR services . METHODS Participants were 87 untreated community-dwelling adults who recently initiated sobriety following longst and ing high-risk drinking practice s and alcohol-related problems ( M=16.58 years , SD=10.95 ) . Baseline interviews assessed pre-resolution drinking practice s and problems , and behavioral economic ( BE ) measures of reward preferences ( delay discounting , pre-resolution monetary allocation ) . Participants had IVR access for 24 weeks to report daily drinking and to hear weekly recovery-focused messages . RESULTS IVR use ranged from 0 to 100 % . Frequent ( n=28 ) , infrequent ( n=42 ) , and non-caller ( n=17 ) groups were identified . Non-callers tended to be younger and to report heavier pre-resolution drinking . Frequent callers ( ≥70 % of IVR days ) tended to be older , male non-smokers with higher/stable socio-economic status and lower delay discounting compared to infrequent callers . Premature drop-out typically occurred fairly abruptly and was related to extended binge drinking . CONCLUSIONS Characteristics common in the untreated problem drinker population were associated with higher IVR utilization . This large under-served population segment can be targeted for lower intensity alcohol interventions using an IVR platform INTRODUCTION STOPP ( Screening Tool of Older Persons '  potentially inappropriate Prescriptions ) is a new , systems-defined medicine review tool . We compared the performance of STOPP to that of established Beers ' criteria in detecting potentially inappropriate medicines ( PIMs ) and related adverse drug events ( ADEs ) in older patients presenting for hospital admission . METHODS we prospect ively studied 715 consecutive acute admissions to a university teaching hospital . Diagnoses , reason for admission and concurrent medications were recorded . STOPP and Beers ' criteria were applied . PIMs with clear causal connection or contribution to the principal reason for admission were determined . RESULTS median patient age ( interquartile range ) was 77 ( 72 - 82 ) years . Median number of prescription medicines was 6 ( range 0 - 21 ) . STOPP identified 336 PIMs affecting 247 patients ( 35 % ) , of whom one-third ( n = 82 ) presented with an associated ADE . Beers ' criteria identified 226 PIMs affecting 177 patients ( 25 % ) , of whom 43 presented with an associated ADE . STOPP-related PIMs contributed to 11.5 % of all admissions . Beers ' criteria -related PIMs contributed to significantly fewer admissions ( 6 % ) . CONCLUSION STOPP criteria identified a significantly higher proportion of patients requiring hospitalisation as a result of PIM-related adverse events than Beers ' criteria . This finding has significant implication s for hospital geriatric practice BACKGROUND The existing literature does not address the question of whether cognitive-behavioral therapy would have an impact on  insomnia in older adults who are chronic users of sleep medication and have current insomnia , but are also stable in their quantity of medication usage during treatment . The present report seeks to answer this question . METHODS Hypnotic-dependant older adults , who were stable in their amount of medication usage and still met the criteria for chronic insomnia put forth by American Academy of Sleep Medicine , were treated using a cognitive-behavioral intervention for insomnia . The three-component treatment included relaxation training , stimulus control , and sleep hygiene instructions . Participants were r and omly assigned to either the active treatment group or a comparably credible placebo control group , and were instructed not to alter their pattern of hypnotic consumption during treatment . RESULTS The active treatment group had significantly better self-report measures of sleep at post-treatment . Statistically significant improvement was paralleled by clinical ly meaningful improvement for key sleep variables . As planned , there was no significant change in sleep medication usage from pre- to post-treatment . CONCLUSIONS The findings support the use of cognitive-behavioral therapy for insomnia in hypnotic-dependant older adults
Validity varied extensively and there was a widespread lack of information regarding measurement of change over time and patient burden .
According to the evaluation criteria , there was adequate support for two tools .
The present study aims to identify the range of  eating behavior self- assessment tools reported in the adult bariatric surgery literature and evaluate the measurement properties of these tools using pre-established criteria .