G Dean Roye

Alpert Medical School - Brown University, Providence, Rhode Island, United States

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Publications (18)55.2 Total impact

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    ABSTRACT: Background Habitual physical activity (PA) may help to optimize bariatric surgery outcomes; however objective PA measures show that most patients have low PA preoperatively and make only modest PA changes postoperatively. Patients require additional support to adopt habitual PA. Objectives Test the efficacy of a preoperative PA intervention (PAI) versus standard pre-surgical care (SC) for increasing daily moderate-to-vigorous PA (MVPA) in bariatric surgery patients. Setting University Hospital, United States. Methods Outcomes analysis included 75 participants (86.7% women; 46.0±8.9 years; Body Mass Index [BMI]=45.0±6.5 kg/m2) who were randomly assigned preoperatively to 6 weeks of PAI (n=40) or SC (n=35). PAI received weekly individual face-to-face sessions with tailored instruction in behavioral strategies (e.g., self-monitoring, goal-setting) to increase home-based walking exercise. The primary outcome, pre- to post-intervention change in daily bout-related (≥10-min bouts) and total (≥1-minute bouts) MVPA minutes, was assessed objectively via a multi-sensor monitor worn for 7 days at baseline- and post-intervention. Results Retention was 84% at the post-intervention primary end point. In intent-to-treat analyses with baseline value carried forward for missing data and adjusted for baseline MVPA, PAI achieved a mean increase of 16.6±20.6 minutes/day in bout-related MVPA (baseline: 4.4±5.5 to post-intervention: 21.0±21.4 minutes/day) compared to no change (-0.3±12.7 minutes/day; baseline: 7.9±16.6 to post-intervention: 7.6±11.5 minutes/day) for SC (p=0.001). Similarly, PAI achieved a mean increase of 21.0±26.9 minutes/day in total MVPA (baseline: 30.9±21.2 to post-intervention: 51.9±30.0 minutes/day), whereas SC demonstrated no change (-0.1±16.3 minutes/day; baseline: 33.7±33.2 to post-intervention: 33.6±28.5 minutes/day) (p=0.001). Conclusions With behavioral intervention, patients can significantly increase MVPA before bariatric surgery compared to SC. Future studies should determine whether preoperative increases in PA can be maintained postoperatively and contribute to improved surgical outcomes.
    Surgery for Obesity and Related Diseases 01/2014; · 4.12 Impact Factor
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    ABSTRACT: PURPOSE: The purpose of this study was to evaluate associations between obstructive sleep apnea (OSA) severity and self-reported sleepiness and daytime functioning in patients considering bariatric surgery for treatment of obesity. METHODS: Using a retrospective cohort design, we identified 342 patients who had sleep evaluations prior to bariatric surgery. Our final sample included 269 patients (78.6 % of the original cohort, 239 females; mean age = 42.0 ± 9.5 years; body mass index = 50.2 ± 7.7 kg/m(2)) who had overnight polysomnography and completed the Epworth Sleepiness Scale (ESS) and the Functional Outcomes of Sleep Questionnaire (FOSQ). Patients' OSA was classified as none/mild (apnea-hypopnea index (AHI) < 15, n = 112), moderate (15 ≤ AHI < 30, n = 77), or severe (AHI ≥ 30, n = 80). We calculated the proportion of unique variance (PUV) for the five FOSQ subscales. ANOVA was used to determine if ESS and FOSQ were associated with OSA severity. Unpaired t tests compared ESS and FOSQ scores in our sample with published data. RESULTS: The average AHI was 29.5 ± 31.5 events per hour (range = 0-175.8). The mean ESS score was 6.3 ± 4.8, and the mean global FOSQ score was 100.3 ± 18.2. PUVs for FOSQ subscales showed moderate-to-high unique contributions to FOSQ variance. ESS and global FOSQ score did not differ by AHI group. Only the FOSQ vigilance subscale differed by OSA severity with the severe group reporting more impairment than the moderate and none/mild groups. Our sample reported less sleepiness and daytime impairment than previously reported means in patients and controls. CONCLUSIONS: Subjective sleepiness and functional impairment were not associated significantly with OSA severity in our sample of patients considering surgery for obesity. Further research is needed to understand individual differences in sleepiness in patients with OSA. If bariatric patients underreport symptoms, self-report measures are not an adequate substitute for objective assessment and clinical judgment when evaluating bariatric patients for OSA. Patients with severe obesity need evaluation for OSA even in the absence of subjective complaints.
    Sleep And Breathing 04/2012; · 2.26 Impact Factor
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    ABSTRACT: Objective quantification of physical activity (PA) is needed to understand PA and sedentary behaviors in bariatric surgery patients, yet it is unclear whether PA estimates produced by different monitors are comparable and can be interpreted similarly across studies. We compared PA estimates from the Stayhealthy RT3 triaxial accelerometer (RT3) and the Sensewear Pro(2) Armband (SWA) at both the group and individual participant level. Bariatric surgery candidates were instructed to wear the RT3 and SWA during waking hours for 7 days. Participants meeting valid wear time requirements (≥4 days of ≥8 h/day) for both monitors were included in the analyses. Time spent in sedentary (<1.5 METs), light (1.5-2.9 METs), moderate-to-vigorous (MVPA; ≥3.0 METs), and total PA (TPA; ≥1.5 METs) according to each monitor was compared. Fifty-five participants (BMI 48.4 ± 8.2 kg/m(2)) met wear time requirements. Daily time spent in sedentary (RT3 582.9 ± 94.3; SWA 602.3 ± 128.6 min), light (RT3 131.9 ± 60.0; SWA 120.6 ± 65.7 min), MVPA (RT3 25.9 ± 20.9; SWA 29.9 ± 19.5 min), and TPA (RT3 157.8 ± 74.5; SWA 150.6 ± 80.7 min) was similar between monitors (p > 0.05). While the average difference in TPA between the two monitors at the group level was 7.2 ± 64.2 min; the average difference between the two monitors for each participant was 45.6 ± 45.4 min. At the group level, the RT3 and SWA provide similar estimates of PA and sedentary behaviors; however, concordance between monitors may be compromised at the individual level. Findings related to PA and sedentary behaviors at the group level can be interpreted similarly across studies when either monitor is used.
    Obesity Surgery 08/2011; 22(3):347-52. · 3.10 Impact Factor
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    ABSTRACT: Bariatric surgery for management of obesity is being used with increasing frequency. Stress testing with myocardial perfusion imaging is often employed as part of the workup prior to anticipated bariatric surgery. The incidence of clinically significant abnormalities on stress MPI performed for this indication, however, has not been established. We retrospectively reviewed a series of 383 consecutive stress MPI studies performed on patients undergoing workup prior to planned bariatric surgery. The study population had a mean age 42 ± 10 years, and was 83% female, with a body mass index of 49 ± 8. The majority of patients (81%) were able to exercise using either the Bruce or Modified Bruce protocol, and 67% underwent stress-only imaging. Overall SPECT MPI findings were normal in 89% and equivocal in 6% of patients. The incidence of abnormal findings on MPI was 5% (3% mild and 2% moderate-to-severe abnormalities). At 1 year, overall survival was 99.5%, with no difference between those with and without MPI abnormalities. Similarly, the incidence of post-operative cardiac events was very low (2%), and mostly due to atrial arrhythmias or borderline elevations of troponin. In a typical pre-bariatric surgery population, the incidence of abnormal stress MPI is low. The majority of patients were able to use a stress-only strategy for assessment of perfusion. At 1 year the incidence of adverse cardiovascular outcomes is very low. Additional studies should be focused on determining whether any subgroup of such patients may benefit more from pre-operative stress testing.
    Journal of Nuclear Cardiology 07/2011; 18(5):886-92. · 2.85 Impact Factor
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    ABSTRACT: Bariatric surgery candidates spend very little time in moderate-to-vigorous intensity physical activity (≥ 3 metabolic equivalents [METs]). This study examined (1) how much of their remaining time is spent in sedentary behaviors (SB < 1.5 METs) compared to light-intensity activities (1.5–2.9 METs) and (2) whether sedentary time varies by BMI. Daily time (hours, %) spent in SB was examined in 42 surgery candidates (BMI = 49.5 ± 7.9 kg/m2) using the SenseWear Pro2 Armband. Participants were stratified by BMI to assess the relationship between degree of obesity and SB. Participants wore the armband for 5.4 ± 0.7 days and 13.3 ± 1.7 h/day. On average, 81.4% (10.9 ± 2.1 h/day)of this time was spent in SB. Participants with BMI ≥ 50 spent nearly an hour more per day in SB than those with BMI 35–49.9 (p = 0.01). Bariatric surgery candidates spend over 80%of their time in SB. Reducing SB may help to increase physical activity in these patients.
    Obesity Surgery 06/2011; 21(6):811-4. · 3.10 Impact Factor
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    ABSTRACT: We have previously reported that most women seeking bariatric surgery have had female sexual dysfunction (FSD) as defined by the validated Female Sexual Function Index (FSFI). The present study examined whether FSD resolves after bariatric surgery. A total of 54 reportedly sexually active women (43.3 ± 9.5 years) completed the FSFI preoperatively and 6 months postoperatively after a mean percentage of excess weight loss of 42.3% (laparoscopic adjustable gastric banding [n = 38], percentage of excess weight loss, 34.6% ± 15.7%; Roux-en-Y gastric bypass [n = 16], percentage of excess weight loss 60.0% ± 21.2%). The FSFI assesses sexual function across 6 domains, with higher scores indicating better sexual function. The summing of these scores yields a FSFI total score (range 2-36, with a score of ≤ 26.55 indicating FSD). Before surgery, 34 women (63%) had scores indicative of FSD. By 6 months postoperatively, the FSD had resolved in 23 (68%) of these 34 women, and only 1 woman had developed FSD postoperatively. In the entire sample, significant (P < .05) improvements occurred from before to after surgery on all FSFI domains. The FSFI total scores improved after laparoscopic adjustable gastric banding (from 24.2 ± 5.9 to 29.1 ± 4.1, P < .001) and Roux-en-Y gastric bypass (from 23.7 ± 7.7 to 30.0 ± 4.7, P < .001). In regression analyses, being married, younger age, and worse preoperative sexual function were related to greater sexual function improvements. Postoperatively, the participants' FSFI total scores were indistinguishable from those of published normative controls (29.4 ± 4.3 versus 30.5 ± 5.3, P = .18). FSD resolved in a large percentage of women after bariatric surgery. Sexual functioning in the entire sample improved to levels consistent with those of normative controls. This improvement in sexual function did not depend on surgery type or weight loss amount and appears to be an additional benefit for women undergoing bariatric surgery.
    Surgery for Obesity and Related Diseases 01/2011; 7(1):1-7. · 4.12 Impact Factor
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    ABSTRACT: Successful weight loss after bariatric surgery depends on the patient's adherence to prescribed eating and physical activity behaviors. However, few studies have assessed patients' adherence to the behavioral recommendations and most have used retrospective self-report measures. The present study is the first to use ecological momentary assessment (EMA) via a palmtop computer to assess bariatric surgery patients' eating and activity behaviors in real-time in the natural environment. The study was conducted at Miriam Hospital (Providence, RI). A total of 21 patients (14 laparoscopic adjustable gastric banding and 7 Roux-en-Y; 81% women; mean age 48.5 yr) were studied 6.1 ± 2.1 months postoperatively. The participants used a palmtop computer for 6 days to report on all eating and physical activity episodes as they occurred in the natural environment. All participants demonstrated good compliance with the EMA, using the device on ≥5 full days. Most participants (94.8%) adhered to the recommendation to not drink while eating, and most took their vitamin supplements and medication as prescribed (85.7% and 90.5%, respectively). Few (4.8%) participants ate the recommended ≥5 meals daily, most participants exceeded the recommended portion sizes during meals and snacks (100% and 72.0% of the participants, respectively), and 47.6% of the participants consumed ≥5 servings of fruit and vegetables daily. Only 15.8% regularly consumed adequate liquids. Only 23.8% of participants engaged in moderate to vigorous physical activity for ≥30 minutes daily, as recommended. The EMA results suggested that adherence to the recommended behaviors varied considerably, depending on the behavior, with greater adherence to simple versus complex behaviors. EMA might eventually be a useful tool to help optimize the outcomes of bariatric surgery by identifying behavioral targets for additional monitoring and intervention.
    Surgery for Obesity and Related Diseases 11/2010; 7(2):206-12. · 4.12 Impact Factor
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    ABSTRACT: More women than men pursue bariatric surgery for treatment of obesity. Untreated obstructive sleep apnea (OSA) in bariatric patients increases perioperative morbidity and mortality, and, therefore, most bariatric surgeons screen for OSA with polysomnography (PSG). We sought to develop a model for predicting OSA in women seeking bariatric surgery in order to use this diagnostic resource most efficiently. We identified 296 women who had PSG in preparation for bariatric surgery. Regression and logistic regression analyses were used to assess the relationship between history and physical examination findings and OSA severity. After developing best statistical models, we constructed a summary index to identify patients exceeding clinical thresholds for mild (apnea-hypopnea index [AHI] ≥ 5) and moderate to severe disease (AHI ≥ 15). In our sample, most women (86%) had OSA, and more than half (53%) had moderate to severe disease. Multiple logistic regression showed that age, body mass index (BMI), neck circumference, hypertension, witnessed apneas, and snoring predicted AHI. Diabetes mellitus and daytime sleepiness measured with the Epworth Sleepiness Scale (ESS) were not significant predictors of OSA. Prediction models were statistically significant but had poor specificity for predicting OSA severity. OSA is highly prevalent in symptomatic and asymptomatic women planning bariatric surgery for obesity. Best prediction models based on clinical characteristics did not predict disease severity under conditions superior to those in which they might be applied. In light of the perioperative risks associated with OSA in bariatric patients, all women considering bariatric surgery for obesity should be evaluated for OSA with PSG.
    Journal of Women s Health 10/2010; 19(10):1833-41. · 1.42 Impact Factor
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    ABSTRACT: Bariatric surgery patients report significant pre- to postoperative increases in physical activity (PA). However, it is unclear whether objective measures would corroborate these changes. The present study compared self-reported and accelerometer-based estimates of changes in moderate-to-vigorous intensity PA (MVPA) from pre- (pre-op) to 6 months postsurgery (post-op). Twenty bariatric surgery (65% laparoscopic-adjustable gastric banding, 35% gastric bypass) patients (46.2 ± 9.8 years, 88% female, pre-op BMI = 50.8 ± 9.7 kg/m(2)) wore RT3 accelerometers as an objective measure of MVPA and completed the Paffenbarger Physical Activity Questionnaire (PPAQ) as a subjective measure before and 6 months after bariatric surgery. Time (min/week) spent in MVPA was calculated for the PPAQ and RT3 (≥ 1-min and ≥ 10-min bouts) at pre-op and post-op. Self-reported MVPA increased fivefold from pre-op to post-op (44.6 ± 80.8 to 212.3 ± 212.4 min/week; P < 0.005). By contrast, the RT3 showed nonsignificant decreases in MVPA for both ≥ 1-min (186.0 ± 169.0 to 151.2 ± 118.3 min/week) and ≥ 10-min (41.3 ± 109.3 to 39.8 ± 71.3 min/week) bouts. At pre-op, the percentage of participants who accumulated ≥ 150-min/week of MVPA in bouts ≥ 10-min according to the PPAQ and RT3 was identical (10%). However, at post-op, 55% of participants reported compliance with the recommendation compared to 5% based on RT3 measurement (P = 0.002). Objectively-measured changes in MVPA from pre-op to 6 months post-op appear to be much smaller than self-reported changes. Further research involving larger samples is needed to confirm these findings and to determine whether self-report and objective PA measures are differentially associated with surgical weight loss outcomes.
    Obesity 04/2010; 18(12):2395-7. · 3.92 Impact Factor
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    ABSTRACT: Physical activity (PA) is an important component of weight loss programs and should be encouraged for severely obese patients undergoing bariatric surgery. However, few studies have determined the amount and intensity of activities undertaken preoperatively by bariatric surgery patients using objective measures. Using RT3 tri-axial accelerometers, the present study compared 38 bariatric surgery candidates and 20 normal weight controls on activity counts/hr; the number of minutes daily spent in moderate-to-vigorous intensity PA (MVPA) and vigorous intensity PA; and the level of compliance with national recommendations to accumulate 150 min/wk of MVPA in bouts of > or = 10 minutes. Surgery candidates, compared with controls, recorded significantly (P <.01) fewer activity counts/hr (13,799 +/- 3758 counts/hr versus 19,462 +/- 4259 counts/hr) and spent fewer minutes per day engaged in MVPA (26.4 +/- 23.0 min/d versus 52.4 +/- 24.7 min/d) and vigorous PA (1.2 +/- 3.4 min/d vs 11.8 +/- 9.0 min/d). More than two thirds (68%) of the surgery candidates versus 13% of the normal weight controls did not accumulate any MVPA in bouts of > or = 10 minutes and only 4.5% of obese patients met the weekly MVPA recommendation versus 40% of the controls. The results of our study have shown that bariatric surgery candidates have low PA levels and rarely engage in PA bouts of sufficient duration and intensity to maintain and improve health. Additional research is needed to determine how best to increase PA in bariatric surgery candidates.
    Surgery for Obesity and Related Diseases 09/2009; 6(1):72-8. · 4.12 Impact Factor
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    ABSTRACT: Sexual functioning has been shown to be impaired in women who are obese, particularly those seeking bariatric surgery. However, most previous studies evaluating sexual function in these populations have not used validated measures. We used the validated Female Sexual Function Index (FSFI) to assess the prevalence of female sexual dysfunction (FSD) in a sample of >100 women evaluated for bariatric surgery. The FSFI was administered to reportedly sexually active women during their preoperative evaluation. The scores for the individual FSFI domains (desire, arousal, lubrication, orgasm, satisfaction, and pain) ranging from 0 (or 1.2) to 6 were summed to produce a FSFI total score (range 2-36). A FSFI total cutoff score of <or=26.55 was used to identify participants with FSD. The participants' FSFI total and domain scores were compared with previously published norms available for women diagnosed with female sexual arousal disorder and healthy controls. Of the 102 women, 61 (59.8%) had FSFI total scores of <or=26.55, indicative of FSD. Older age and menopause were associated with FSD. Compared with published norms, bariatric surgery candidates had FSFI domain scores that were lower than those of the control group (all P values < 0.0001) but greater than those of the female sexual arousal disorder group (all P values < 0.0001), except for desire, for which the scores were similar. Women seeking bariatric surgery are clearly a population with substantial sexual function impairment, with 60% of participants reporting FSD. These findings highlight the need to initiate routine assessment of sexual functioning in this population and examine whether the weight loss after bariatric surgery contributes to a reversal of FSD.
    Surgery for Obesity and Related Diseases 08/2009; 5(6):698-704. · 4.12 Impact Factor
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    ABSTRACT: Previous studies show that slower habituation to taste stimuli is associated with reduced rates of satiation and greater energy intake. This study compared rates of salivary habituation to gustatory presentations of lemon juice in 34 severely obese bariatric surgery candidates [48.8 +/- 7.9 years, 85% female, body mass index (BMI) = 47.4 +/- 7.5 kg/m(2)] and 18 normal-weight controls (48.4 +/- 9.5 years, 88.9% female, BMI = 22.7 +/- 1.2 kg/m(2)). Parotid saliva was collected from cotton rolls positioned in the oral cavity during two baseline water trials and ten lemon juice trials. Data were condensed into trial blocks, representing mean values for the two baseline water trials and each of five pairs of lemon juice trials (i.e., blocks 1-5). Salivary change across lemon juice trials was calculated by subtracting values for blocks 1 through 5 from baseline. A significant interaction of group (bariatric surgery candidates/normal-weight controls) by blocked trials [F (4, 200) = 3.0; p < 0.05] indicated that the groups differed in their pattern of salivary responding, with bariatric surgery candidates' salivation (grams) failing to decrease significantly over the five blocked trials (-0.47 +/- 0.18, p = 0.12), unlike that of the normal-weight controls (-1.30 +/- 0.25, p < 0.001). These findings suggest that severely obese participants' rate of salivary habituation to a taste stimulus is delayed compared to normal-weight controls. This provides support that satiation in bariatric surgery candidates is impaired, possibly leading to increased energy intake and positive energy balance.
    Obesity Surgery 06/2009; 19(7):873-8. · 3.10 Impact Factor
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    ABSTRACT: To evaluate the sensitivity and specificity of eight previously reported computed tomography (CT) signs in diagnosing internal mesenteric hernia following Roux-en-Y gastric bypass surgery. Preoperative CT images of nine patients with surgically proven internal mesenteric hernia as a complication of gastric bypass surgery and 10 matched control patients were reviewed in a blinded fashion by three radiologists. The presence of eight previously reported signs of internal mesenteric hernia was assessed: mesenteric swirl sign, hurricane eye sign, mushroom sign, small bowel obstruction, clustered small bowel loops, small bowel other than duodenum located behind the superior mesenteric artery (SMA), presence of the jejunal anastomosis to the right of the midline, and engorged mesenteric lymph nodes. The sensitivity and specificity were calculated for each sign, as well as inter-observer reliability in recognizing these signs. Mesenteric swirl was the most predictive sign of internal hernia (sensitivity 78-100%, specificity 80-90%). Other CT signs showed good specificity (70-100%), but sensitivities were low (0-44%). The presence of a small-bowel obstruction and engorged mesenteric nodes was found to be 100% specific in predicting the presence of an underlying hernia. There was substantial inter-observer agreement in detecting mesenteric swirl sign (kappa=0.48-0.79), but agreement was relatively poor for all other signs. Mesenteric swirl is an easily recognized CT sign, and is the best indicator of internal hernia following Roux-en-Y gastric bypass surgery. Other reported CT signs are diagnostically insensitive. The presence of small-bowel obstruction with engorged mesenteric nodes is highly specific in diagnosing internal mesenteric hernia.
    Clinical radiology 05/2009; 64(4):373-80. · 1.65 Impact Factor
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    ABSTRACT: Obese women who become pregnant face many health risks, including gestational diabetes, pregnancy-induced hypertension, and pre-eclampsia. These women also have a greater incidence of preterm labor, cesarean sections, and perioperative morbidity. Infants born to obese women have increased rates of macrosomia and congenital anomalies, as well as life-long complications such as obesity and its associated morbidities. With the increase in numbers of weight loss operations being performed in women of child-bearing age, physicians will have to address patient concerns regarding the safety of pregnancy after surgery. Many of the proposed health benefits of weight loss after surgery could translate to decreased rates of complications experienced by obese pregnant women. Case reports and small series have emerged documenting pregnancy courses after bariatric surgery. We reviewed the studies that reported pregnancy outcomes compiled from PubMed and Ovid databases to help draw conclusions regarding the maternal, fetal, and infant safety in women after bariatric surgery. The observations from these studies have shown that the health risks experienced by obese women during pregnancy are reduced after weight loss surgery. Additionally, there does not appear to be any increased risk regarding fetal or infant outcome.
    Surgery for Obesity and Related Diseases 01/2008; 4(3):464-71. · 4.12 Impact Factor
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    ABSTRACT: Many bariatric surgery programs include psychiatric evaluations as part of the pre-operative screening procedure. Surveys of surgeons and mental health professionals have found variability in opinion regarding what psychosocial problems warrant denial of clearance for surgery. Few studies have reported the number of patients who are not cleared for surgery due to psychiatric reasons, and no study has reported the reliability of decision making. The goals of the present study were to examine the reliability of decisions to clear candidates for surgery, determine the percentage of candidates who were not cleared for surgery, and detail the reasons candidates were not cleared for surgery. Five hundred candidates for bariatric surgery were evaluated from July 2004 until July 2006 with semistructured diagnostic interviews for DSM-IV Axis I and Axis II disorders supplemented by a module specific to this population. Reliability for determining clearance was evaluated in 73 patients. Reasons for not clearing patients were recorded on the Surgery Clearance Form. Eighteen percent (N = 92) of the patients were not cleared for surgery. The kappa coefficient of reliability of determining surgical clearance was 0.83. The most common reasons for the negative recommendation were overeating to cope with stress or emotional distress, current eating disorder, uncontrolled psychopathology, and the presence of significant life stressors. Only 1 patient was excluded for a lack of understanding of the potential risks of surgery. The decision whether to clear candidates for bariatric surgery can be made reliably. Approximately 1 in 5 surgical candidates did not pass the initial psychiatric screening, usually because of current eating pathology, other forms of uncontrolled psychopathology, or difficulty coping with current life stressors.
    The Journal of Clinical Psychiatry 11/2007; 68(10):1557-62. · 5.81 Impact Factor
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    ABSTRACT: Determining the success of technical skill training for surgery residents should include not only the efficacy of the training in terms of skills learned but also the cost of the facility where the training occurs and the cost of faculty participation. Traditional training occurs in the operating room, but the cost of faculty time and operating room time has not been well established. Assessing the cost of traditional training may allow us to put the cost of building and maintaining skills laboratories in perspective. To estimate the cost of traditional training we have recorded the time and interventions necessary for our senior residents to do a laparoscopic entero-enterostomy. Each senior resident (PGY3-5) was asked to perform a laparoscopic entero-enterostomy in its entirety as part of a laparoscopic gastric bypass. After cannulation of the abdomen and division of any adhesions, we timed the residents for the performance of the following group of tasks: finding the ligament of Treitz, dividing the bowel 50-60 cm downstream, and creating a 2-layer anastomosis at 125 or 200 cm distal to the ligament. We tracked total time and number of interventions, which are defined by the attending temporarily taking over the case. Twelve residents were tracked by this system. The average time to complete the task was 93.7 minutes (+/-11.9 SD). The average number of interventions per case was 1.5 (+/-1.1 SD). Nine residents completed more than 1 procedure. Seven residents reduced their operative time on the second attempt. Operative times between the first and second procedure showed a reduction of 4.4 minutes (+/-17.4 SD), although this was not statistically significant (p = 0.47). No adverse clinical sequelae developed in these small bowel anastomoses. Educational time was calculated by subtracting the resident time from the time it takes an attending or finishing laparoscopic fellow to complete this task (50 minutes). The educational time for each anastomosis was 43.7 minutes. Using the AAMC average salary for an assistant professor of surgery of $180,000 year and assuming a 60-hour work week, this is $45.52 in faculty costs per anastomosis. If the cost of an operating room is $2000 per hour, the educational cost is $1457 per anastomosis. In our program, providing our 15 senior residents an educational opportunity to perform 2 laparoscopic entero-enterostomies would cost $45,061 a year. Resident education is expensive. Knowledge of the cost of skills training in a traditional operative setting is necessary to put the costs associated with building and maintaining skills laboratories in perspective. Cost analyses and efficacy of teaching will allow us to rate the success of new educational techniques.
    Journal of Surgical Education 01/2007; 64(6):342-5. · 1.63 Impact Factor
  • Journal of Surgical Education 01/2007; 64(2):68–69. · 1.63 Impact Factor
  • G Dean Roye, David T Harrington
    Medicine and health, Rhode Island 03/2004; 87(2):36-7.