Management of iron deficiency and anemia after Roux-en-Y gastric bypass surgery: an observational study.

BACKGROUND: Iron deficiency (ID) is common after Roux-en-Y gastric bypass surgery (RYGB). Optimal iron management in this population is unclear. The objective of this study was to assess our management of RYGB patients with ID and anemia. METHODS: Clinic visit records of RYGB patients with ID or anemia from January 1, 2008, to February 1, 2010 were evaluated. Demographic characteristics, postsurgery iron and anemia indices, and prescribed treatments were recorded. Three separate definitions for ID and anemia were used (standard textbook, ASBMS, and recent literature). An intravenous iron protocol was later implemented, and follow-up laboratory values were obtained. RESULTS: A total of 125 with ID or anemia (89% female, 86% Caucasian), mean (SD) age 44.7 (8.6) years, and BMI 47.3 (10.8) kg/m(2) at time of RYGB, were included. Proportion of values meeting criteria for ID or anemia at first follow-up: standard textbook, hemoglobin (Hb, 35%), transferrin saturation (Tsat, 48%), ferritin (28%); ASBMS, ferritin (43%); recent literature, ferritin (58%), serum iron (21%). At mean follow-up of 45.7 (43) months, oral iron (n = 49) or intravenous iron (n = 4) had been prescribed for 53 (42.4%) patients, and 32 (25.6%) patients received multiple blood transfusions. Nine patients received intravenous iron using the new protocol (400-1400 mg), resulting in increases in Hb (1.8 g/dL; P<.05) and ferritin (31.8 ng/mL; P< .002). CONCLUSION: Iron management was inadequate. Hematologic values often were deficient for sustained periods. Initially, few patients received intravenous iron after oral iron failure, many received no iron supplementation, and there was high use of blood transfusions. Subsequently, administration of intravenous iron was beneficial.

Use of Orlistat 60 mg in the management of weight loss before bariatric surgery.

BACKGROUND: Patients undergoing gastric bypass surgery are usually required to lose weight during the preoperative phase of their management. For some individuals, this is difficult to achieve with diet and exercise alone, and the use of weight loss medication may be considered a treatment option. OBJECTIVE: To evaluate the use of orlistat 60 mg taken up to 3 times daily as an adjunct to achieve the 10% preoperative weight loss recommended in this bariatric program prior to gastric bypass surgery. METHODS: The aim was to recruit 50 patients (25 treatment, 25 controls) who were in the preoperative phase of their bariatric program. Patients were referred by their physician. Control subjects were selected from individuals who were eligible but not interested in participating in the study during the same period. All patients received usual care. RESULTS: Nineteen patients (5 males) and 19 age- and sex-matched controls were included. The mean (SD) initial body mass index for the treatment versus control group was, respectively, 49.5 (10.5) versus 47.2 (4.9) kg/m(2) (p = 0.559). At 3 months, the percent excess weight (EW) loss was 2.4 (3.8) (n = 15) versus 5.5 (7.6) (n = 19) (p = 0.111) and the percent total body weight (TBW) loss was 1.2 (1.9) versus 2.9 (4.1) (p = 0.103). At 6 months, the percent EW loss was 3.6 (6.4) (n = 9) versus 10.2 (8.0) (n = 16) (p = 0.036) and the percent TBW loss was 2.0 (3.4) versus 5.4 (4.2) (p = 0.048). CONCLUSIONS: Some patients felt that orlistat was beneficial for weight loss; however, overall, they did not show benefit from its addition to their preoperative weight loss management.

Simulated dyslexia in postsecondary students: description and detection using embedded validity indicators.

The current investigation identified characteristics that discriminated authentic dyslexia from its simulation using measures common to postsecondary learning disability evaluations. Analyses revealed accurate simulation on most achievement measures but inaccurate feigning on neurolinguistic processing measures, speed on timed tasks, and error quantity. The largest group separations were on rapid naming, speeded orthographic, and reading fluency tasks. Simulators accurately feigned dyslexia profiles on cut-score and discrepancy diagnostic models but not on the more complex aspects of the clinical judgment model. Regarding simulation detection, a multivariate rule exhibited the greatest classification accuracy, followed by univariate indices developed from rapid naming tasks. The findings of the current study suggest that aspects of a comprehensive evaluation may aid in the detection of simulated dyslexia.

Passageless comprehension on the Nelson-Denny reading test: well above chance for university students.

The comprehension section of the Nelson-Denny Reading Test (NDRT) is widely used to assess the reading comprehension skills of adolescents and adults in the United States. In this study, the authors explored the content validity of the NDRT Comprehension Test (Forms G and H) by asking university students (with and without at-risk status for learning disorders) to answer the multiple-choice comprehension questions without reading the passages. Overall accuracy rates were well above chance for both NDRT forms and both groups of students. These results raise serious questions about the validity of the NDRT and its use in the identification of reading disabilities.

The diagnostic accuracy of symptom validity tests when used with postsecondary students with learning disabilities: a preliminary investigation.

The current exploratory investigation examined the diagnostic accuracy of the Word Memory Test (WMT), Test of Memory Malingering (TOMM), and Word Reading Test (WRT) with three groups of postsecondary students: controls, learning disability (LD) simulators, and a presumed honest LD group. Each measure achieved high overall diagnostic accuracy, yet each contributed differently to suboptimal effort detection. False-negative classifications varied by measure, yet no simulator went undetected by all three tests. The WMT and WRT identified different members of the presumed honest LD group as demonstrating poor effort, whereas the TOMM identified none. Each measure contributed unique variance in a logistic regression, with effort status best predicted by WMT Consistency. Findings provided preliminary evidence that all three measures may be useful when assessing effort during postsecondary LD evaluations. Implications for future practice and research are discussed.