Melanie Lauti

Definition determines weight regain outcomes after sleeve gastrectomy

BACKGROUND Sleeve gastrectomy (SG) is one of the most commonly undertaken bariatric procedures. Weight regain after bariatric surgery, when significant, may be associated with recurrence of diabetes and deterioration in quality of life. Furthermore, it may be more common after SG than bypass procedures. Yet the understanding of the significance of weight regain is hampered by poor reporting and no consensus statements or guidelines. OBJECTIVES To illustrate how the lack of a standard definition significantly alters reported SG outcomes and to contribute to the discussion of how weight regain should be defined. SETTING Counties Manukau Health, a public teaching hospital that performs over 150 bariatric procedures per year. METHODS A retrospective cohort of SG patients followed up at 5 years was used to illustrate how the presence of multiple definitions in the literature significantly affects outcome reporting for weight regain. Post hoc analyses were used to explore the relationship between weight change and clinical outcomes. RESULTS Applying 6 definitions of weight regain to a retrospective cohort of SG patients resulted in 6 different rates ranging from 9%-91%. Post hoc analyses revealed significant associations between weight change and the Bariatric Analysis Reporting Outcome System (BAROS) score as well as patient opinion. CONCLUSION The nonuniform reporting of weight regain appears to significantly affect SG outcome reporting. Development of consensus statements and guidelines would ameliorate this problem. Ideally, research groups with access to large robust databases would aid in the development of any proposed weight regain definitions. In the interim, bariatric literature would benefit by all published series clearly reporting how weight regain is defined in the study population.

Intravenous lignocaine in colorectal surgery: a systematic review

Colorectal surgery leads to morbidity during recovery including pain and fatigue. Intravenous (IV) lignocaine (IVL) has both analgesic and anti‐inflammatory effects that may improve post‐operative pain and recovery. The aim of this review is to compare the effectiveness of IVL to other perioperative analgesia regimens for reducing pain and opioid consumption following colorectal surgery.

Derivation and validation of the APPEND score: an acute appendicitis clinical prediction rule

Although many clinical prediction rules (CPRs) for appendicitis exist, none have been developed for a New Zealand population presenting with right iliac fossa (RIF) pain. The aim of this study was to derive and validate an appendicitis CPR for our population.

Definition determines weight regain outcomes following sleeve gastrectomy

Journal Bariatric Surgery BT001 DETAILED DESCRIPTION OF THE RESPONSE OF THE METABOLIC SYNDROME TO PROGRESSIVE WEIGHT LOSS IN THE OBESE FOLLOWING BARIATRIC SURGERY GERALDINE OOI, TIFFANY TIE, ARUL EARNEST, PAUL BURTON, PAUL O’BRIEN

Preparing a presentation.

Giving a presentation is often a dreaded part of surgical training and ongoing academic development. It requires a set of practiced skills which are not formally addressed during training. Once presentation skills are developed, however, speakers gain confidence and may even enjoy giving future presentations. The purpose of this mini review of educational psychology and communication research is aimed to provide practical tips for optimizing presentation design, delivery and effectiveness. A useful educational theory that is helpful in understanding effective learning from presentations is cognitive load theory. This theory acknowledges the limitation of the temporary or working memory (WM) to hold only seven to nine novel items at one time. These items will be lost permanently if not rehearsed or if there is not enough WM free to process the information into the long-term memory (LTM). Therefore, reducing the cognitive load or content of our slides could facilitate enhanced learning of new material. An evidence-based method to reduce content on slides in order to increase effective learning is chunking theory. This centres around how information can be chunked in meaningful ways to facilitate recall in smaller units. For example, take the four fat soluble vitamins – A, D, E and K – which could either occupy half or more of the WM capacity or be chunked into a single unit. Chunking these into one unit frees up the other six units to process this information meaningfully into the LTM. For instance, one might recall that there used to be a department store named DEKA and this encompasses all of the fat-soluble vitamins. Grouping multiple information sources together in similar spatial proximity reduces the audience’s mental effort needed to learn. Figure 1 illustrates visuospatially scattered text, numbers and graphics that need higher mental effort by the viewers as they attempt to integrate these elements whilst listening to the presenter. This cognitive loading or split attention is minimized by grouping these elements together as demonstrated on the left side of the figure. This reduces the WM load which facilitates processing the information into the LTM. The same principle can be applied to presenting photos, illustrations and graphs. Cognitive load research demonstrates that the audience will learn better from visuals and verbal narration than from visuals, narration and text together. A good example of this is watching a subtitled movie. As we try to listen, follow the scenes and read subtitles, we are bound to concentrate less on one of them. Once we turn the subtitles off, the experience is much improved. Therefore, where possible, refrain from using redundant text to improve the audience’s attention on you as the presenter. The redundancy principle is simple to remember, less is more! This principle suggests that people learn better from animation and verbal narration than from animation and on-screen text. Therefore, you could replace on-screen text with your narrative as the animation plays. Practical tips for slide design are given in Table 1. As the purpose of presentations is to convey knowledge, avoid puzzling the audience with vague and long titles. Choose a title that is brief and to the point. Brainstorm your main ideas about the topic on a piece of paper before reaching out to your computer. Then, link these ideas aiming for an easy flow as this facilitates your speech making as well as slide design and layout. Sometimes, it is useful to summarize each idea into one sentence as if this was the ‘take home message’ from each idea. It may be useful to search the internet for other presentations on your topic to optimize your structures and ideas. Audience engagement can be enhanced by contextualization of your talk. For example, in a lecture on an obscure and potentially boring pathological topic, wrap the topic in a clinical case. Choose emotionally rich cases to maximize the audience’s attention and engagement. The software programmes available for slide design offer an increasing amount of themes templates and animations. While it may be tempting to employ exotic slide themes and animations, these are more often not distracting and may actually malfunction on the day of your presentation. As far as possible, minimize the complexity of your slides. Slide backgrounds or themes work best as a solid colour with no underlying pattern. Use a contrasting colour for your font and ensure your colour combination facilitates easy reading. Some good examples are black on white, yellow on blue and white on black. Often your institution or funding body requires you to brand your presentation with their logos. Do comply with the branding guidelines of your institution, but where possible minimize the presence of branding logos to title slides only to minimize visual cognitive loading. Font and bullet point formatting need to be carefully considered. Ensure your chosen font is easily legible. Your font size should be as large as possible to allow readability for those most far away from the projection. Bullet points should be double-spaced and kept as succinct as possible. There is no exact consensus in the literature as to how many bullet points or how many words per bullet point are ideal. Opinions range from four bullet points with four words each to seven bullets points with seven words in each. An easy rule is the ‘triple-seven’ rule by Pratt which says ‘no more than seven bullets, no more than seven words per bullet, no more than seven lines per bulleted slide’. Loading bullet points individually