Gastrointestinal Permeability After Bariatric Surgery: A Systematic Review.

Gastrointestinal permeability refers to the movement of substances across the gut wall. This is mediated by endotoxemia (bacterial products entering the systemic circulation), and is associated with metabolic disease. The effect of bariatric surgery on permeability remains uncertain; the associated dietary, metabolic and weight changes are suggested to influence, or trigger, altered permeability. The primary aim of this study is to synthesize evidence and analyze the effect of bariatric surgery on permeability. A systematic review was performed, searching MEDLINE, EMBASE, and Scopus until February 2023, using MESH terms "intestinal permeability", "bariatric", for studies reporting in vivo assessment of permeability. Three cohort studies and two case series were identified (n=96). Data was heterogeneous; methodology and controls preclude meta-analysis. Gastroduodenal permeability reduced post-sleeve gastrectomy (SG). Two studies showed an increase in small intestinal permeability after biliopancreatic diversion. Two studies revealed a decrease in post-Roux-en-Y gastric bypass. One study identified increased colonic permeability six months post-SG. Evidence regarding permeability change after bariatric surgery is conflicting, notably for the small intestine. Impaired colonic permeability post-SG raises concerns regarding colonic protein fermentation and harmful dietary sequelae. There are multiple interacting variables confounding gastrointestinal permeability change; procedure type, altered microbiota and metabolic response to surgery. Further understanding of this important aspect of obesity is required, both before and after bariatric surgery.

Evaluation of a Modified BOOST Tool in the Acute Care Setting: A Retrospective Analysis.

Several readmission risk prediction tools exist but have had varying success in identifying patients at risk for readmission. The purpose of this project was to evaluate the effectiveness of a tool available within Project BOOST, Better Outcomes by Optimizing Safe Transitions, from the Society of Hospital Medicine. The tool was modified within the institution to include risk stratification scores in order to better identify the highest-risk patients. The modified risk tool may assist in predicting the risk of readmission in those patients with heart failure and chronic obstructive pulmonary disease who are discharged home.

Utilization of the Arkansas Prescription Monitoring Program to Combat Prescription Drug Abuse.

OBJECTIVE: The Arkansas Prescription Monitoring Program (AR PMP) was implemented in 2013 to combat prescription drug abuse. All enrollees were invited to participate in a user survey available in February 2014, to identify makeup of users, utilization of the program, and changes made to health care practices after implementation of the program. METHODS: Of the 3,694 individual enrollees invited to participate, 1,541(41.7%) completed the survey. Data collected were analyzed to identify changes in health care practices by program frequency of use and user profession. RESULTS: Medical doctors, advanced practice nurses, and pharmacists are the professions who use the program most frequently. Daily AR PMP users are considerably more likely than infrequent users to be prompted to access the program by the involvement of a controlled substance (CS) prescription or by office/facility policy requirements. Increased frequency of use of the AR PMP results in positive impacts on CS prescribing and dispensing practices. CONCLUSION: Compelling more users of the AR PMP to be prompted to access the program by the involvement of a CS prescription or by requirements per office/facility policy may increase frequency of use of the program and thereby changes in health care practices to combat prescription drug abuse.

Predictive validity of the Family Attitude Scale in people with psychosis.

Expressed Emotion (EE) strongly predicts relapse in mental disorders, but there remains a need to develop and refine brief, self-report measures. This article describes two studies testing the validity of a self-report measure of criticism or burden, the Family Attitude Scale (FAS), in relatives of patients with psychosis. Study 1 had 54 families of patients with psychosis and a substance use disorder, while Study 2 had 61 families of patients at an early psychotic episode. In Study 1, a consensus FAS was obtained; in Study 2 separate parental scores were used. The FAS was positively associated with EE, and with relationship negativity. Associations with negative caregiving experiences or stress were restricted to maternal or consensual FAS ratings. FAS scores predicted relapse in both studies, although prediction at the optimal cutoff (>or=60) only reached statistical significance in Study 2, and time to relapse was only predicted by the FAS in Study 1. Prediction of relapse from the CFI was stronger, and the FAS did not add to that prediction. Results supported the utility of the FAS, but confirmed the pre-eminence of the CFI as a household-related predictor of relapse.