Nonsurgical weight loss interventions: A systematic review of systematic reviews and meta-analyses.

Access to bariatric surgery to treat obesity is limited and has long wait times. Many adults are seeking nonsurgical weight loss support. Our study objective was to conduct a systematic review of nonsurgical weight loss interventions. PubMed, EMBASE, CINAHL, PsycInfo, and the CochraneLibrary were searched. Inclusion criteria were adults 18 + with a BMI > 25 enrolled in minimum a 3-month nonsurgical weight loss intervention. Studies were independently extracted and assessed for quality using A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR2). Pooled analyses were extracted, graded for evidence quality, and summarized. A total of 1065 studies were assessed for eligibility; 815 screened and 236 full-texts assessed. Sixty-four meta-analyses met eligibility criteria: 1180 RCTs with 184,605 study participants. Studies were categorized as diets (n = 13), combination therapies (n = 10), alternative (n = 16), technology (n = 10), behavioral (n = 5), physical activity (n = 6), and pharmacotherapy (n = 3). In 80% of studies, significant weight losses were reported ranging from 0.34-8.73 k in favor of the intervention. The most effective nonsurgical weight loss interventions were diets, either low-carbohydrate or low-fat diets, followed for 6 months; combination therapy including meal replacements plus enhanced support; and pharmacotherapy followed for 12 months. Although significant weight losses were reported for other types of interventions such as physical activity and technology, the majority of studies reported weight losses less than 2 kgs.

Is exam performance in anatomy influenced by teaching with prosected cadavers? An evidence-based study.

INTRODUCTION: Little empirical evidence substantiates the need to use cadavers to teach anatomy effectively. We investigated the effect of attendance at anatomy laboratories and cadaver use on .anatomy exam performance over a 12-year period (2006-2007 to 2018-2019) before and after a curricular change (2013-2014). MATERIALS AND METHODS: Anatomy exam performance data were collected from undergraduate files at Memorial University of Newfoundland, Canada, for 782 medical students over a 12-year period. Three groups emerged: (i) 6 years of the old curriculum using prosected specimens, N = 376; (ii) 3 years of the new curriculum using prosected specimens, N = 239; (iii) 3 years of the new curriculum using no prosected specimens, N = 240. For the 2018-2019 academic year, laboratory attendance was recorded, N = 80. RESULTS: The unplanned discontinuation of prosected specimens did not markedly impact anatomy instruction. Student performance under the new and old curricula (p = .0018) and with and without cadavers (p = .0117) is slightly, but significantly, different. Student performance is not associated with the number of missed laboratories (Spearman ρ = 0.145, p = .2). DISCUSSION: Although use of cadavers and prosected specimens continues in anatomy-wet laboratories, today's tech-savvy students want information at their fingertips 24/7. The three factors examined in this study suggest a surprisingly consistent performance on anatomy examinations despite changing conditions. Perhaps medical schools should offer as many quality resources as budgets allow, inform students of their availability and let students decide which learning methods work best for them individually, thus facilitating self-directed learning. CONCLUSION: Consistent exam performance can be achieved using a variety of teaching and learning methods.

Prioritization for bariatric surgery: capturing Canadian patient preference weights using a discrete choice experiment.

BACKGROUND: Bariatric surgery is an effective treatment for adults affected by obesity. Demand is greater than supply and a prioritization system for patients is needed. OBJECTIVE: Clinical practice guidelines recommends bariatric surgery as a management strategy for adults with severe obesity (body mass index ≥40 or 35-40 kg/m2 with co-morbidities). Eligible patient's access surgery on a first-come-first-serve basis and wait times can be several years. This study quantifies patient preferences toward attributes that could be evaluated when prioritizing patients for surgery. SETTING: A Canada-wide study of adults living with obesity. METHODS: A discrete choice experiment was conducted via email with a sample of Canadian adults with obesity. Six relevant attributes were identified through focus groups. Respondents completed 12 choice tasks and demographic and weight loss-related questions. A multinomial logit model was used to estimate preference weights of each attribute. RESULTS: A total of 515 individuals completed the survey. Fifty-nine percent were female, 97% made previous weight loss attempts, and 5% had bariatric surgery. On average patients prioritized individuals with significant problems with daily activities versus none (odds ratio [OR] 4.41; 95% confidence interval [CI] 4.31-4.52); 3 existing cardiovascular co-morbidities versus 0 (OR 4.24; 95%CI 4.12-4.36); extreme impact on mental health versus no impact (OR 3.73; 95%CI 3.64-3.84); 6 other co-morbidities versus 0 (OR 3.43; 95%CI 3.31-3.55); waiting 5 versus 1 year (OR 1.59; 95%CI 1.46-1.68); and a body mass index of 60 versus 40 (OR 1.52; 95%CI 1.43-.62). CONCLUSION: All 6 attributes were important to patients in the prioritization for bariatric surgery. However, the number of cardiovascular co-morbidities and the impact on daily activities were considered most important.

An approach to integrating interprofessional education in collaborative mental health care.

OBJECTIVE: This article describes an evaluation of a curriculum approach to integrating interprofessional education (IPE) in collaborative mental health practice across the pre- to post-licensure continuum of medical education. METHODS: A systematic evaluation of IPE activities was conducted, utilizing a combination of evaluation study designs, including: pretest-posttest control group; one-group pre-test-post-test; and one-shot case study. Participant satisfaction, attitudes toward teamwork, and self-reported teamwork abilities were key evaluative outcome measures. RESULTS: IPE in collaborative mental health practice was well received at both the pre- and post-licensure levels. Satisfaction scores were very high, and students, trainees, and practitioners welcomed the opportunity to learn about collaboration in the context of mental health. Medical student satisfaction increased significantly with the introduction of standardized patients (SPs) as an interprofessional learning method. Medical students and faculty reported that experiential learning in practice-based settings is a key component of effective approaches to IPE implementation. At a post-licensure level, practitioners reported significant improvement in attitudes toward interprofessional collaboration in mental health care after participation in IPE. CONCLUSION: IPE in collaborative mental health is feasible, and mental health settings offer practical and useful learning experiences for students, trainees, and practitioners in interprofessional collaboration.