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SOARD Category 1 CME Credit Featured Articles, Volume 9, January–February 2013
SOARD Category 1 CME Credit Featured Articles, Volume 9, January–February 2013 Effects of bariatric surgery on diabetic nephropathy after 5 years follow-up. Heneghan HM, Cetin D, Navaneethan SD, Orzech N, Brethauer SA, Schauer PR. Surg Obes Relat Dis 2013;9:7–14.
Does bariatric surgery reduce the risk of major cardiovascular events? A retrospective cohort study of morbidly obese surgical patients. Scott JD, Johnson BL, Blackhurst DW, Bour ES. Surg Obes Relat Dis 2013;9:32–9.
Objectives: After reading the featured articles published in this issue of Surgery for Obesity and Related Diseases (SOARD) participants in the SOARD CME program should be able to demonstrate increased understanding of the material specific to the article featured and be able to apply relevant information to clinical practice. Objectives are stated at the beginning of each featured article; the questions follow with four or five response choices, and a critique discussing the objective. Disclosure Statement: It is the policy of the American Society for Metabolic and Bariatric Surgery that speakers and/or anyone in control of content of a CME Category 1 event must disclose any financial or other relationship with (1) any manufacturer(s) of commercial products that may be discussed in the speaker’s presentation and/or (2) commercial supporters of the event. All disclosures are included under the list of author names. There was no commercial support received for this activity. Accreditation Statement: The American Society for Metabolic and Bariatric Surgery (ASMBS) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for
physicians. The American Society for Metabolic and Bariatric Surgery (ASMBS) designates this educational activity for a maximum of 2 AMA PRA Category 1 Credits. Physicians should only claim credit commensurate with the extent of their participation in the activity. SOARD CME Online provides two articles from each issue for 2 credits per month; 1 credit per article. The articles this month on SOARD CME Online are: Effects of bariatric surgery on diabetic nephropathy after 5 years follow-up. Heneghan HM, Cetin D, Navaneethan SD, Orzech N, Brethauer SA, Schauer PR. Surg Obes Relat Dis 2013;9:7–14.
Does bariatric surgery reduce the risk of major cardiovascular events? A retrospective cohort study of morbidly obese surgical patients. Scott JD, Johnson BL, Blackhurst DW, Bour ES. Surg Obes Relat Dis 2013;9:32–9.
1550-7289/13/$ – see front matter r 2013 Published by Elsevier Inc. on behalf of American Society for Metabolic and Bariatric Surgery. http://dx.doi.org/10.1016/j.soard.2012.12.001
Continuing Medical Education Program / Surgery for Obesity and Related Diseases 9 (2013) 154–157
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Continuing Medical Education Program / Surgery for Obesity and Related Diseases 9 (2013) 154–157
ARTICLE 1 Effects of bariatric surgery on diabetic nephropathy after 5 years follow-up. Heneghan HM, Cetin D, Navaneethan SD, Orzech N, Brethauer SA, Schauer PR.
in a proportion of obese diabetic patients. This was achieved in: A. B. C. D.
o10% of patients 10%-20% of patients 50-60% of patients 90-100% of patients
Surg Obes Relat Dis 2013;9:7–14. Question 4 Learning Objectives After reading this article, the reader should be aware of the beneficial effects of bariatric surgery on glycemic control and on the end-organ complications of diabetes mellitus. Specifically, this article demonstrates that obese diabetic patients can experience remission of diabetic nephropathy (DN) for at least 5 years after bariatric surgery. Among obese diabetics who do not have diabetic nephropathy at the time of undergoing bariatric surgery, the progression to DN, which would usually occur in as many as 50% of patients over 5 years, may be prevented. Remission of DN appears to be related to maintaining good glycemic control and to tight control of blood pressure.
In this study, the remission of diabetic nephropathy was associated with: A. B. C. D.
Remission of hyperlipidemia Good blood pressure control Resolution of GERD (gastroesophageal reflux) symptoms Improvement in renal function as measured by creatinine clearance or glomerular filtration rate (GFR)
ARTICLE 2 Does bariatric surgery reduce the risk of major cardiovascular events? A retrospective cohort study of morbidly obese surgical patients. Scott JD, Johnson BL, Blackhurst DW, Bour ES.
Question 1
Surg Obes Relat Dis 2013;9:32-39.
Which of the following mechanisms is not implicated in the development of obesity-related nephropathy:
Learning Objectives
A. B. C. D.
Increased intra-abdominal pressure Diabetic neuropathy Pro-inflammatory state Insulin resistance
After review of this article, the reader should be able to compare the effect of bariatric surgery on major cardiovascular events such as myocardial infarctions, strokes, and death as compared to other non-bariatric surgical patients with reasonably comparable baseline characteristics.
Question 2 To date, three randomized controlled trials have directly compared the effects of medical versus surgical treatment of type 2 diabetes in obese individuals. Which of the following findings was common to all 3 studies: A. Medical and surgical therapies were equivalent at inducing remission of Type 2 diabetes in obese diabetic patients B. Weight loss surgery, in any form (gastric banding, sleeve gastrectomy, gastric bypass), was far superior to medical treatment C. Adjustable gastric banding was the most effective surgical treatment for inducing diabetes remission D. Sleeve gastrectomy was more effective than gastric bypass at inducing remission of diabetes in obese diabetic patients Question 3 In the present study it was observed that bariatric surgery could induce remission of diabetic nephropathy
Question 1 The primary end point of this study is: A. The time-to-occurrence of the composite outcome of myocardial infarction, stroke, or death. B. Myocardial infarction or stroke in a South Carolina hospital C. Death as determined by the Social Security Death Index D. The presence of hypertension, diabetes, or dyslipidemia Question 2 This retrospective review compared outcomes in bariatric patients as compared to: A. All obese patients in South Carolina treated with medical therapy B. Obese patients who underwent gastrointestinal surgery or orthopedic surgery during the same time frame
Continuing Medical Education Program / Surgery for Obesity and Related Diseases 9 (2013) 154–157
C. Surgical patients who had previously experienced a heart attack or stroke D. Patients who desired surgery but did not have insurance coverage Question 3 The limitations of using administrative billing data include all the following EXCEPT: A. Lack of key diagnostic and empiric data B. The data is subject to misclassification and omission C. The data always includes confounding data such as smoking history and use of NSAIDS D. Diagnosis codes are often stratified based on reimbursement properties
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E. The data provided often fails to demonstrate a causal relationship for the overall trends seen in analysis Question 4 One method used to reduce the bias effect of a nonbariatric surgical control group: A. Selection of three control groups: medical patients, orthopedic patients, and GI surgical patients B. Selection of two separate non-bariatric surgical control groups that had reasonably similar baseline characteristics as bariatric surgical patients C. Randomization of patients prior to performance of their surgery D. Limiting our study to patients who had all their procedures and follow up care performed in South Carolina
Does bariatric surgery reduce the risk of major cardiovascular events? A retrospective cohort study of morbidly obese surgical patients. Scott JD, Johnson BL, Blackhurst DW, Bour ES. Surg Obes Relat Dis 2013;9:32–9.
Objectives: After reading the featured articles published in this issue of Surgery for Obesity and Related Diseases (SOARD) participants in the SOARD CME program should be able to demonstrate increased understanding of the material specific to the article featured and be able to apply relevant information to clinical practice. Objectives are stated at the beginning of each featured article; the questions follow with four or five response choices, and a critique discussing the objective. Disclosure Statement: It is the policy of the American Society for Metabolic and Bariatric Surgery that speakers and/or anyone in control of content of a CME Category 1 event must disclose any financial or other relationship with (1) any manufacturer(s) of commercial products that may be discussed in the speaker’s presentation and/or (2) commercial supporters of the event. All disclosures are included under the list of author names. There was no commercial support received for this activity. Accreditation Statement: The American Society for Metabolic and Bariatric Surgery (ASMBS) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for
physicians. The American Society for Metabolic and Bariatric Surgery (ASMBS) designates this educational activity for a maximum of 2 AMA PRA Category 1 Credits. Physicians should only claim credit commensurate with the extent of their participation in the activity. SOARD CME Online provides two articles from each issue for 2 credits per month; 1 credit per article. The articles this month on SOARD CME Online are: Effects of bariatric surgery on diabetic nephropathy after 5 years follow-up. Heneghan HM, Cetin D, Navaneethan SD, Orzech N, Brethauer SA, Schauer PR. Surg Obes Relat Dis 2013;9:7–14.
Does bariatric surgery reduce the risk of major cardiovascular events? A retrospective cohort study of morbidly obese surgical patients. Scott JD, Johnson BL, Blackhurst DW, Bour ES. Surg Obes Relat Dis 2013;9:32–9.
1550-7289/13/$ – see front matter r 2013 Published by Elsevier Inc. on behalf of American Society for Metabolic and Bariatric Surgery. http://dx.doi.org/10.1016/j.soard.2012.12.001
Continuing Medical Education Program / Surgery for Obesity and Related Diseases 9 (2013) 154–157
155
156
Continuing Medical Education Program / Surgery for Obesity and Related Diseases 9 (2013) 154–157
ARTICLE 1 Effects of bariatric surgery on diabetic nephropathy after 5 years follow-up. Heneghan HM, Cetin D, Navaneethan SD, Orzech N, Brethauer SA, Schauer PR.
in a proportion of obese diabetic patients. This was achieved in: A. B. C. D.
o10% of patients 10%-20% of patients 50-60% of patients 90-100% of patients
Surg Obes Relat Dis 2013;9:7–14. Question 4 Learning Objectives After reading this article, the reader should be aware of the beneficial effects of bariatric surgery on glycemic control and on the end-organ complications of diabetes mellitus. Specifically, this article demonstrates that obese diabetic patients can experience remission of diabetic nephropathy (DN) for at least 5 years after bariatric surgery. Among obese diabetics who do not have diabetic nephropathy at the time of undergoing bariatric surgery, the progression to DN, which would usually occur in as many as 50% of patients over 5 years, may be prevented. Remission of DN appears to be related to maintaining good glycemic control and to tight control of blood pressure.
In this study, the remission of diabetic nephropathy was associated with: A. B. C. D.
Remission of hyperlipidemia Good blood pressure control Resolution of GERD (gastroesophageal reflux) symptoms Improvement in renal function as measured by creatinine clearance or glomerular filtration rate (GFR)
ARTICLE 2 Does bariatric surgery reduce the risk of major cardiovascular events? A retrospective cohort study of morbidly obese surgical patients. Scott JD, Johnson BL, Blackhurst DW, Bour ES.
Question 1
Surg Obes Relat Dis 2013;9:32-39.
Which of the following mechanisms is not implicated in the development of obesity-related nephropathy:
Learning Objectives
A. B. C. D.
Increased intra-abdominal pressure Diabetic neuropathy Pro-inflammatory state Insulin resistance
After review of this article, the reader should be able to compare the effect of bariatric surgery on major cardiovascular events such as myocardial infarctions, strokes, and death as compared to other non-bariatric surgical patients with reasonably comparable baseline characteristics.
Question 2 To date, three randomized controlled trials have directly compared the effects of medical versus surgical treatment of type 2 diabetes in obese individuals. Which of the following findings was common to all 3 studies: A. Medical and surgical therapies were equivalent at inducing remission of Type 2 diabetes in obese diabetic patients B. Weight loss surgery, in any form (gastric banding, sleeve gastrectomy, gastric bypass), was far superior to medical treatment C. Adjustable gastric banding was the most effective surgical treatment for inducing diabetes remission D. Sleeve gastrectomy was more effective than gastric bypass at inducing remission of diabetes in obese diabetic patients Question 3 In the present study it was observed that bariatric surgery could induce remission of diabetic nephropathy
Question 1 The primary end point of this study is: A. The time-to-occurrence of the composite outcome of myocardial infarction, stroke, or death. B. Myocardial infarction or stroke in a South Carolina hospital C. Death as determined by the Social Security Death Index D. The presence of hypertension, diabetes, or dyslipidemia Question 2 This retrospective review compared outcomes in bariatric patients as compared to: A. All obese patients in South Carolina treated with medical therapy B. Obese patients who underwent gastrointestinal surgery or orthopedic surgery during the same time frame
Continuing Medical Education Program / Surgery for Obesity and Related Diseases 9 (2013) 154–157
C. Surgical patients who had previously experienced a heart attack or stroke D. Patients who desired surgery but did not have insurance coverage Question 3 The limitations of using administrative billing data include all the following EXCEPT: A. Lack of key diagnostic and empiric data B. The data is subject to misclassification and omission C. The data always includes confounding data such as smoking history and use of NSAIDS D. Diagnosis codes are often stratified based on reimbursement properties
157
E. The data provided often fails to demonstrate a causal relationship for the overall trends seen in analysis Question 4 One method used to reduce the bias effect of a nonbariatric surgical control group: A. Selection of three control groups: medical patients, orthopedic patients, and GI surgical patients B. Selection of two separate non-bariatric surgical control groups that had reasonably similar baseline characteristics as bariatric surgical patients C. Randomization of patients prior to performance of their surgery D. Limiting our study to patients who had all their procedures and follow up care performed in South Carolina