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Background: The COVID-19 pandemic travel restrictions triggered a rapid alteration in the interview process for fellowships this spring. We describe our initial experience with virtual interviews for Advanced Gastrointestinal (GI) Minimally Invasive Surgery Fellowships and assess the value and limitations via a post-interview applicant survey., Study Design: Twenty candidates were interviewed via Zoom teleconferencing during March and April 2020 using combined group and breakout rooms. An anonymous post-interview Likert and free text survey was sent to candidates with questions regarding feasibility, appropriateness, and acceptability of this method., Results: Seventeen of 20 candidates (85%) responded to the survey. The candidates rated ease of interaction with the program director, faculty surgeons, and the current fellow highly: 94%, 83%, and 89%, respectively. The majority (53%) stated the virtual interviews exceeded or met expectations. Only a minority, 12%, reported the virtual platform was short of expectations. Approximately 70% noted little to no impact of not being able to conduct these interviews in-person and not being able to physically see the program institution. Overall, 94% were satisfied with their experience, and only 6% were neutral, with no respondents reporting dissatisfaction. Finally, 76% would recommend a virtual interview in the future. Most negative open response comments were secondary to issues with software rather than the lack of the in-person traditional interviews., Conclusions: The use of a remote teleconferencing platform provides a favorable method for conducting fellowship interviews and results in a high degree of candidate satisfaction. Virtual interviews will likely be increasingly substituted for in-person interviews across the spectrum of medical training., (Copyright © 2020 American College of Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: Postoperative nausea and vomiting (PONV) is known to occur after bariatric surgery, with over two thirds of patients affected. However, variability exists in how to objectively measure PONV., Objectives: The goals of the present study were to use a validated, patient-centered scoring tool, the Rhodes Index of Nausea, Vomiting, and Retching to measure the severity of PONV after bariatric surgery, to directly compare PONV between patients who underwent laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB), and to identify risk factors for the development of PONV after bariatric surgery., Setting: Barnes-Jewish Hospital/Washington University School of Medicine, St. Louis, Missouri, United States of America., Methods: The Washington University Weight Loss Surgery team prospectively surveyed patients from January 1, 2017 to December 1, 2018 at the following 6 different timepoints: postoperative day (POD) 0, POD 1, POD 2, POD 3 to 4, the first postoperative outpatient visit (POV 1: POD 5-25), and the second postoperative visit (POV 2: POD 25-50). At each timepoint, a cumulative Rhodes score was calculated from the sum of 8 questions. The American Society for Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database was used to collect patient demographic characteristics and perioperative clinical data., Results: A total of 274 patients met study criteria and completed 605 Rhodes questionnaires. Two hundred fifty Rhodes questionnaires were completed by patients after SG and 355 were completed by patients after LRYGB. Total Rhodes scores are statistically higher in LSG patients compared with patients who underwent LRYGB (LSG = 5.45 ± 6.27; LRYGB = 3.08 ± 4.19, P = .0002). Additionally, at the earlier timepoints, scores were higher among patients who underwent LSG than those who had undergone LRYGB as follows: POD 0 (LSG = 6.96 ± 6.50; LRYGB = 2.89 ± 2.90, P = .0115), POD 1 (LSG = 8.20 ± 6.76; LRYGB = 2.88 ± 3.44, P < .0001), and POD 2 (LSG = 4.05 ± 4.88; LRYGB = 2.06 ± 3.43, P = .05). On subset analysis, examining patients who either underwent an LSG or LRYGB, both procedures had a statistically significant PONV peak emerge on POV 2. Last, overall Rhodes scores were statistically higher in female patients compared with male patients (female: 4.43 ± 5.46; male: 2.35 ± 3.90, P = .021). Although the magnitude of the difference varied somewhat across POD time intervals, the difference was most pronounced at POV 2., Conclusions: This is the largest study using a validated nausea and vomiting questionnaire to objectively measure PONV after bariatric surgery. The factors found to be most associated with increased PONV were LSG and female sex. Ultimately, these data can help bariatric surgery programs, including Washington University Weight Loss Surgery, identify patients who may require more intensive treatment of PONV, particularly POD 0 to 2, and help to identify patients that continue to struggle with PONV in the later surgical recovery phase., (Copyright © 2020 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Bariatric (weight loss) surgery is more popular than ever. The American Society for Metabolic and Bariatric Surgery in 2016 reported that 216,000 bariatric procedures were performed in the United States. Bariatric surgery has major physiological benefits; its use is expected to increase globally. However, patients may not anticipate the profound impact that rapid and massive weight loss may have on their body image after bariatric surgery. The construct of body image in this population needs to be explicated to facilitate continued research regarding this increasingly prevalent healthcare procedure. This article describes the formulation of a model of relevant concepts and dimensions within the construct of body image in the bariatric surgery patient. In the process of creating the model, we identified many factors influencing body image in patients before and after bariatric surgery, summarized eight measures, and developed a new definition based on prior work. Theoretical considerations are discussed. The long-term objective of this model building approach is to encourage researchers and clinicians to test the feasibility of systematic clinical measurement of body image at office visits before as well as multiple times after bariatric surgery., (Copyright © 2018 Elsevier Inc. All rights reserved.)

The effectiveness of bariatric surgery has been well-studied. However, complications after bariatric surgery have been understudied. This review assesses <30-d major complications associated with bariatric procedures, including anastomotic leak, myocardial infarction and pulmonary embolism. This review included 71 studies conducted in the USA between 2003 and 2014 and 107,874 patients undergoing either gastric bypass, adjustable gastric banding or sleeve gastrectomy, with mean age of 44 years and pre-surgery body mass index of 46.5 kg m -2 . Less than 30-d anastomotic leak rate was 1.15%; myocardial infarction rate was 0.37%; pulmonary embolism rate was 1.17%. Among all patients, mortality rate following anastomotic leak, myocardial infarction and pulmonary embolism was 0.12%, 0.37% and 0.18%, respectively. Among surgical procedures, <30-d after surgery, sleeve gastrectomy (1.21% [95% confidence interval, 0.23-2.19%]) had higher anastomotic leak rate than gastric bypass (1.14% [95% confidence interval, 0.84-1.43%]); gastric bypass had higher rates of myocardial infarction and pulmonary embolism than adjustable gastric banding or sleeve gastrectomy. During the review, we found that the quality of complication reporting is lower than the reporting of other outcomes. In summary, <30-d rates of the three major complications after either one of the procedures range from 0% to 1.55%. Mortality following these complications ranges from 0% to 0.64%. Future studies reporting complications after bariatric surgery should improve their reporting quality., (© 2017 World Obesity Federation.)

Background: Intermittent, reversible intraabdominal vagal blockade (VBLOC® Therapy) demonstrated clinically important weight loss in feasibility trials. EMPOWER, a randomized, double-blind, prospective, controlled trial was conducted in USA and Australia., Methods: Five hundred three subjects were enrolled at 15 centers. After informed consent, 294 subjects were implanted with the vagal blocking system and randomized to the treated (n = 192) or control (n = 102) group. Main outcome measures were percent excess weight loss (percent EWL) at 12 months and serious adverse events. Subjects controlled duration of therapy using an external power source; therapy involved a programmed algorithm of electrical energy delivered to the subdiaphragmatic vagal nerves to inhibit afferent/efferent vagal transmission. Devices in both groups performed regular, low-energy safety checks. Data are mean ± SEM., Results: Study subjects consisted of 90 % females, body mass index of 41 ± 1 kg/m(2), and age of 46 ± 1 years. Device-related complications occurred in 3 % of subjects. There was no mortality. 12-month percent EWL was 17 ± 2 % for the treated and 16 ± 2 % for the control group. Weight loss was related linearly to hours of device use; treated and controls with ≥ 12 h/day use achieved 30 ± 4 and 22 ± 8 % EWL, respectively., Conclusions: VBLOC® therapy to treat morbid obesity was safe, but weight loss was not greater in treated compared to controls; clinically important weight loss, however, was related to hours of device use. Post-study analysis suggested that the system electrical safety checks (low charge delivered via the system for electrical impedance, safety, and diagnostic checks) may have contributed to weight loss in the control group.

The Large Scale Vocabulary Test (LSVT) was designed to evaluate how well the Metathesaurus plus planned additions to Meta covered the documentation needs of clinicians. Our consortium collected 10,538 clinical narratives from patient problem lists recorded at 65 Veterans Hospitals, internal medicine ambulatory care practices, diagnostic history and physical examination data elements from Iliad, and nursing shift notes and emergency transport patient records. The results showed 94% of submitted terms resulted in acceptable matches. 49% of submitted terms were judged to be synonymous with the match terms, 35% were judged to be more specific (usually due to modifiers), 2%, were less specific, and 6% had an associative relationship. In 8% of cases either no match was found by the LSVT interface or all proposed matches were rejected by the raters. The LSVT content was quite suitable for coding our narratives. Necessary improvements for an electronic record would include the ability to compose modifiers together with root concepts.