# Diabetes — GCMD Library living collection

Everything in the library about diabetes — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 69 cited statements

## Episodes
### Surgical Management
- [Kanika Bowen-Jallow, MD and Faisal Qureshi, MD - 2024 Pediatric Bariatric Surgery Update Course](https://qa.library.globalcastmd.com/watch/kanika-bowen-jallow-md-and-faisal-qureshi-md-2024-pediatric-bariatric-surgery-up-7958) — video · 19:25 · [machine version](https://qa.library.globalcastmd.com/watch/kanika-bowen-jallow-md-and-faisal-qureshi-md-2024-pediatric-bariatric-surgery-up-7958.md)

### Evidence & Research
- [Adolescent Bariatric Surgery: Pediatric Obesity 2017](https://qa.library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371) — video · 32:47 · [machine version](https://qa.library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371.md)

### Long-Term Care
- [Transition of Care - A general overview by Silja Kosolove](https://qa.library.globalcastmd.com/watch/transition-of-care-a-general-overview-by-silja-kosolove-7652) — video · 21:33 · [machine version](https://qa.library.globalcastmd.com/watch/transition-of-care-a-general-overview-by-silja-kosolove-7652.md)

## Chapters
- [0:00](https://qa.library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=0) Introduction and Study Overview (Ep 1)
- [4:00](https://qa.library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=240) Rationale for Aggressive Treatment and Mortality Risk (Ep 1)
- [8:00](https://qa.library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=480) Cincinnati FAS-5 Study Design and Retention (Ep 1)
- [13:00](https://qa.library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=780) FAS-5 Weight Loss Outcomes and BMI Trajectories (Ep 1)
- [17:00](https://qa.library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=1020) Comorbidity Remission and Incidence Rates (Ep 1)
- [20:00](https://qa.library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=1200) Residual BMI and Metabolic Harm (Ep 1)
- [23:00](https://qa.library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=1380) Micronutrient Deficiencies in FAS-5 (Ep 1)
- [24:00](https://qa.library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=1440) Swedish AMOS Study Design and Weight Outcomes (Ep 1)
- [28:00](https://qa.library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=1680) AMOS Comorbidity Resolution and Complications (Ep 1)
- [30:00](https://qa.library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=1800) Teen Labs Consortium: Current Status and Future Aims (Ep 1)
- [34:00](https://qa.library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=2040) Summary and Window of Opportunity (Ep 1)
- [0:01](https://qa.library.globalcastmd.com/watch/transition-of-care-a-general-overview-by-silja-kosolove-7652?t=1) Introduction and the case against abrupt transfer (Ep 2)
- [3:00](https://qa.library.globalcastmd.com/watch/transition-of-care-a-general-overview-by-silja-kosolove-7652?t=180) The CALMER framework: Clinical and Age considerations (Ep 2)
- [7:00](https://qa.library.globalcastmd.com/watch/transition-of-care-a-general-overview-by-silja-kosolove-7652?t=420) Developmental mismatch and brain maturation (Ep 2)
- [12:00](https://qa.library.globalcastmd.com/watch/transition-of-care-a-general-overview-by-silja-kosolove-7652?t=720) Life circumstances and the adolescent perspective (Ep 2)
- [15:00](https://qa.library.globalcastmd.com/watch/transition-of-care-a-general-overview-by-silja-kosolove-7652?t=900) System approach: Transfer versus transition process (Ep 2)
- [19:00](https://qa.library.globalcastmd.com/watch/transition-of-care-a-general-overview-by-silja-kosolove-7652?t=1140) Education and youth-friendly healthcare principles (Ep 2)
- [20:20](https://qa.library.globalcastmd.com/watch/transition-of-care-a-general-overview-by-silja-kosolove-7652?t=1220) Resources and multidisciplinary requirements (Ep 2)
- [21:17](https://qa.library.globalcastmd.com/watch/transition-of-care-a-general-overview-by-silja-kosolove-7652?t=1277) Closing summary (Ep 2)
- [0:00](https://qa.library.globalcastmd.com/watch/kanika-bowen-jallow-md-and-faisal-qureshi-md-2024-pediatric-bariatric-surgery-up-7958?t=0) Introduction and Preoperative ERAS Protocol (Ep 3)
- [3:49](https://qa.library.globalcastmd.com/watch/kanika-bowen-jallow-md-and-faisal-qureshi-md-2024-pediatric-bariatric-surgery-up-7958?t=229) Intraoperative Management and Pain Control (Ep 3)
- [6:25](https://qa.library.globalcastmd.com/watch/kanika-bowen-jallow-md-and-faisal-qureshi-md-2024-pediatric-bariatric-surgery-up-7958?t=385) Postoperative Care and Early Recovery (Ep 3)
- [11:34](https://qa.library.globalcastmd.com/watch/kanika-bowen-jallow-md-and-faisal-qureshi-md-2024-pediatric-bariatric-surgery-up-7958?t=694) Diet Advancement Protocol (Ep 3)
- [15:09](https://qa.library.globalcastmd.com/watch/kanika-bowen-jallow-md-and-faisal-qureshi-md-2024-pediatric-bariatric-surgery-up-7958?t=909) Technical Discussion and Procedure Volume (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- FAS-5 study achieved 81% participation (58 of 74 eligible) at 8-year follow-up, mostly with in-person research visits. — Thomas Inge (clinical) [Ep 1 · 8:00](https://qa.library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=480)
- At 8-year mean follow-up, gastric bypass patients had a mean BMI decline of 29%. — Thomas Inge (clinical) [Ep 1 · 13:00](https://qa.library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=780)
- Baseline BMI strongly correlates (R=0.75) with follow-up BMI: patients starting with BMI in the 60s end above 40, while those starting in the 40s reach near-normal BMI. — Thomas Inge (clinical) [Ep 1 · 15:00](https://qa.library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=900)
- Remission rates at 8 years: 88% for diabetes, 64% for dyslipidemia, 75% for hypertension. — Thomas Inge (clinical) [Ep 1 · 17:00](https://qa.library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=1020)
- Among those without baseline comorbidities, incidence rates were 0% for diabetes, 50% for dyslipidemia (small denominator), and 3 of 29 developed hypertension. — Thomas Inge (clinical) [Ep 1 · 18:00](https://qa.library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=1080)
- Follow-up BMI predicts probability of hypertension, dyslipidemia, high CRP, high insulin, insulin resistance, and low HDL; higher residual BMI is metabolically harmful. — Thomas Inge (clinical) [Ep 1 · 20:00](https://qa.library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=1200)
- At 8 years, FAS-5 cohort showed low iron stores with anemia, elevated PTH, and low vitamin D in substantial numbers. — Thomas Inge (clinical) [Ep 1 · 23:00](https://qa.library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=1380)
- AMOS had high internal hernia rates due to unclosed mesenteric defects at laparoscopic gastric bypass; closing defects prevents this complication. — Thomas Inge (clinical) [Ep 1 · 29:00](https://qa.library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=1740)
- Teen Labs enrolled 242 adolescents (161 bypass, 67 sleeve, 14 band) at 5 centers; median age now 24, with 203 completing 5-year visits (72% in-clinic, 17% field). — Thomas Inge (clinical) [Ep 1 · 31:00](https://qa.library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=1860)
- Adding 33 sleeve gastrectomy patients to Teen Labs will provide 80% power to compare bypass vs. sleeve for outcomes including blood pressure, PTH, HDL, and BMI. — Thomas Inge (clinical) [Ep 1 · 32:00](https://qa.library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=1920)
- Severely obese patients have greater bone mineral density due to loading; rapid weight loss after bariatric surgery drops bone mass, raising the question of whether it stabilizes or continues to decline (bariatric bone disease). — Thomas Inge (clinical) [Ep 1 · 34:00](https://qa.library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=2040)
- Operating earlier after diagnosis of severe obesity may yield lower residual BMI and better long-term metabolic outcomes. — Thomas Inge (opinion) [Ep 1 · 32:47](https://qa.library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=1967)
- FAS-5 study had a residual mean BMI of 38 at 8 years, with many patients remaining severely obese; this residual obesity is metabolically harmful. — Thomas Inge (clinical) [Ep 1 · 32:47](https://qa.library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=1967)
- The 33 new sleeve patients can be enrolled within a year from consortium sites with ongoing clinical follow-up, enabling long-term comparisons. — Thomas Inge (clinical) [Ep 1 · 32:17](https://qa.library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=1937)
- Aprepitant is given 1-2 hours prior to surgery in pre-op and has become standard in patients with high risk for post-operative nausea — Kanika Bowen-Jallow (clinical) [Ep 3 · 1:40](https://qa.library.globalcastmd.com/watch/kanika-bowen-jallow-md-and-faisal-qureshi-md-2024-pediatric-bariatric-surgery-up-7958?t=100)
- Pills given in pre-op area have never been observed in the stomach during intraoperative scoping in sleeve gastrectomy cases — Kanika Bowen-Jallow (clinical) [Ep 3 · 2:10](https://qa.library.globalcastmd.com/watch/kanika-bowen-jallow-md-and-faisal-qureshi-md-2024-pediatric-bariatric-surgery-up-7958?t=130)
- Minimizing narcotics helps prevent postoperative nausea, achieved by running medications like propofol at low baseline during anesthesia — Kanika Bowen-Jallow (clinical) [Ep 3 · 3:49](https://qa.library.globalcastmd.com/watch/kanika-bowen-jallow-md-and-faisal-qureshi-md-2024-pediatric-bariatric-surgery-up-7958?t=229)
- Aprepitant is given in preoperative holding before surgery, while Zofran is used in the OR prior to extubation, to achieve synergistic anti-emetic effect — Kanika Bowen-Jallow (clinical) [Ep 3 · 4:00](https://qa.library.globalcastmd.com/watch/kanika-bowen-jallow-md-and-faisal-qureshi-md-2024-pediatric-bariatric-surgery-up-7958?t=240)
- The number one concern after sleeve gastrectomy is nausea, retching, and vomiting — Kanika Bowen-Jallow (clinical) [Ep 3 · 4:20](https://qa.library.globalcastmd.com/watch/kanika-bowen-jallow-md-and-faisal-qureshi-md-2024-pediatric-bariatric-surgery-up-7958?t=260)
- Haldol is not used for anti-emetic purposes due to sedative effects that interfere with waking patients in the PACU — Kanika Bowen-Jallow (clinical) [Ep 3 · 4:44](https://qa.library.globalcastmd.com/watch/kanika-bowen-jallow-md-and-faisal-qureshi-md-2024-pediatric-bariatric-surgery-up-7958?t=284)
- 80% of pediatric bariatric patients spend one night in the hospital — Faisal Qureshi (epidemiological) [Ep 3 · 7:10](https://qa.library.globalcastmd.com/watch/kanika-bowen-jallow-md-and-faisal-qureshi-md-2024-pediatric-bariatric-surgery-up-7958?t=430)
- Expected postoperative pain level is 3 out of 5 — Faisal Qureshi (clinical) [Ep 3 · 7:25](https://qa.library.globalcastmd.com/watch/kanika-bowen-jallow-md-and-faisal-qureshi-md-2024-pediatric-bariatric-surgery-up-7958?t=445)
- TAP blocks have improved pain control and reduced nausea compared to non-exparel or exparel local anesthetic at port sites, with most patients going home the next day — Faisal Qureshi (clinical) [Ep 3 · 7:35](https://qa.library.globalcastmd.com/watch/kanika-bowen-jallow-md-and-faisal-qureshi-md-2024-pediatric-bariatric-surgery-up-7958?t=455)
- Pure exparel diluted with normal saline is used for TAP blocks, performed immediately after camera insertion and epigastric port placement, adding only 3-5 minutes to case time — Faisal Qureshi (clinical) [Ep 3 · 7:59](https://qa.library.globalcastmd.com/watch/kanika-bowen-jallow-md-and-faisal-qureshi-md-2024-pediatric-bariatric-surgery-up-7958?t=479)
- Ice chips are started within 4-6 hours postoperatively — Faisal Qureshi (clinical) [Ep 3 · 8:30](https://qa.library.globalcastmd.com/watch/kanika-bowen-jallow-md-and-faisal-qureshi-md-2024-pediatric-bariatric-surgery-up-7958?t=510)
- Hematocrit is checked approximately 6 hours postoperatively — Faisal Qureshi (clinical) [Ep 3 · 8:40](https://qa.library.globalcastmd.com/watch/kanika-bowen-jallow-md-and-faisal-qureshi-md-2024-pediatric-bariatric-surgery-up-7958?t=520)
- Sequential compression devices and Lovenox are used for DVT prophylaxis — Faisal Qureshi (clinical) [Ep 3 · 8:50](https://qa.library.globalcastmd.com/watch/kanika-bowen-jallow-md-and-faisal-qureshi-md-2024-pediatric-bariatric-surgery-up-7958?t=530)
- Clear liquids are started on postoperative day one, with patients circling 1 ounce of liquids every 15 minutes for 3-4 hours; if no nausea or significant pain, patients are discharged home without narcotics — Faisal Qureshi (clinical) [Ep 3 · 9:05](https://qa.library.globalcastmd.com/watch/kanika-bowen-jallow-md-and-faisal-qureshi-md-2024-pediatric-bariatric-surgery-up-7958?t=545)
- TAP block provides pain control for 2-3 days postoperatively — Faisal Qureshi (clinical) [Ep 3 · 9:40](https://qa.library.globalcastmd.com/watch/kanika-bowen-jallow-md-and-faisal-qureshi-md-2024-pediatric-bariatric-surgery-up-7958?t=580)
- Patients are instructed to shower the next day and pat themselves dry, with no swimming or baths in hot tubs for 4 weeks — Faisal Qureshi (clinical) [Ep 3 · 10:00](https://qa.library.globalcastmd.com/watch/kanika-bowen-jallow-md-and-faisal-qureshi-md-2024-pediatric-bariatric-surgery-up-7958?t=600)
- Patients return to school within 5 days to 1 week postoperatively — Faisal Qureshi (clinical) [Ep 3 · 10:32](https://qa.library.globalcastmd.com/watch/kanika-bowen-jallow-md-and-faisal-qureshi-md-2024-pediatric-bariatric-surgery-up-7958?t=632)
- The primary reason for avoiding straws is to prevent patients from drinking too quickly rather than concerns about air ingestion — Faisal Qureshi (opinion) [Ep 3 · 10:00](https://qa.library.globalcastmd.com/watch/kanika-bowen-jallow-md-and-faisal-qureshi-md-2024-pediatric-bariatric-surgery-up-7958?t=600)
- Week one diet consists of 1 ounce of fluid every 15 minutes with targets of at least 40 ounces of liquids and 40 grams of protein — Faisal Qureshi (clinical) [Ep 3 · 13:43](https://qa.library.globalcastmd.com/watch/kanika-bowen-jallow-md-and-faisal-qureshi-md-2024-pediatric-bariatric-surgery-up-7958?t=823)
- Week two diet advances to blended soups consistency with no lumps, bumps, or chunks, targeting 60 grams of protein and 60 ounces of fluids — Faisal Qureshi (clinical) [Ep 3 · 14:10](https://qa.library.globalcastmd.com/watch/kanika-bowen-jallow-md-and-faisal-qureshi-md-2024-pediatric-bariatric-surgery-up-7958?t=850)
- Weeks 3-6 diet consists of soft foods (applesauce, mashed potatoes consistency) with targets of 60 grams protein, 64 ounces water, 600-800 calories, and beginning exercise — Faisal Qureshi (clinical) [Ep 3 · 14:30](https://qa.library.globalcastmd.com/watch/kanika-bowen-jallow-md-and-faisal-qureshi-md-2024-pediatric-bariatric-surgery-up-7958?t=870)
- Week 4 onwards maintains 60 grams protein, 64 ounces water, 600-800 calories, and 60 minutes of exercise daily — Faisal Qureshi (clinical) [Ep 3 · 14:55](https://qa.library.globalcastmd.com/watch/kanika-bowen-jallow-md-and-faisal-qureshi-md-2024-pediatric-bariatric-surgery-up-7958?t=895)
- After week 6, patients advance to regular diet with small portions, moist cooking methods, and 1/4 to 1/2 cup portion sizes — Faisal Qureshi (clinical) [Ep 3 · 15:09](https://qa.library.globalcastmd.com/watch/kanika-bowen-jallow-md-and-faisal-qureshi-md-2024-pediatric-bariatric-surgery-up-7958?t=909)
- Levsin (hyoscyamine) is effective as a smooth muscle relaxant for patients struggling with fluid intake in the first few days after surgery — Mark (clinical) [Ep 3 · 15:09](https://qa.library.globalcastmd.com/watch/kanika-bowen-jallow-md-and-faisal-qureshi-md-2024-pediatric-bariatric-surgery-up-7958?t=909)
- Levsin is used as needed for patients having difficulty swallowing or getting down fluids, either in hospital or at home (clinical) [Ep 3 · 15:47](https://qa.library.globalcastmd.com/watch/kanika-bowen-jallow-md-and-faisal-qureshi-md-2024-pediatric-bariatric-surgery-up-7958?t=947)
- Adult bariatric surgeons use Air Seal technology to maintain stable insufflation pressure second-to-second, allowing procedures at 10 mmHg pressure compared to typical 15 mmHg or higher — Kanika Bowen-Jallow (clinical) [Ep 3 · 16:31](https://qa.library.globalcastmd.com/watch/kanika-bowen-jallow-md-and-faisal-qureshi-md-2024-pediatric-bariatric-surgery-up-7958?t=991)
- Stryker or Storz insufflators can be set to pediatric mode to check pressure more frequently, similar to Air Seal technology — Mark (clinical) [Ep 3 · 18:00](https://qa.library.globalcastmd.com/watch/kanika-bowen-jallow-md-and-faisal-qureshi-md-2024-pediatric-bariatric-surgery-up-7958?t=1080)
- Higher laparoscopic pressures may be necessary in adolescents due to different abdominal wall physical properties, particularly in women compared to men (opinion) [Ep 3 · 18:46](https://qa.library.globalcastmd.com/watch/kanika-bowen-jallow-md-and-faisal-qureshi-md-2024-pediatric-bariatric-surgery-up-7958?t=1126)
- Sleeve gastrectomy comprises 90% of pediatric bariatric procedures performed — Kanika Bowen-Jallow (epidemiological) [Ep 3 · 19:09](https://qa.library.globalcastmd.com/watch/kanika-bowen-jallow-md-and-faisal-qureshi-md-2024-pediatric-bariatric-surgery-up-7958?t=1149)
- If adolescents are left to survive on their own without structured transition, they will not adhere to care in adult hospitals, their health outcomes will diminish, and many will not survive. — Silja Kosolove (clinical) [Ep 2 · 0:01](https://qa.library.globalcastmd.com/watch/transition-of-care-a-general-overview-by-silja-kosolove-7652?t=1)
- Abrupt transfer without transition is more expensive due to emergency admissions and unplanned procedures compared to planned care. — Silja Kosolove (epidemiological) [Ep 2 · 1:00](https://qa.library.globalcastmd.com/watch/transition-of-care-a-general-overview-by-silja-kosolove-7652?t=60)
- In many countries the age limit from pediatric to adult care has risen and is now most often 18 years. — Silja Kosolove (guideline) [Ep 2 · 4:00](https://qa.library.globalcastmd.com/watch/transition-of-care-a-general-overview-by-silja-kosolove-7652?t=240)
- In Finland the general limit of pediatrics is still 16 years. — Silja Kosolove (guideline) [Ep 2 · 4:20](https://qa.library.globalcastmd.com/watch/transition-of-care-a-general-overview-by-silja-kosolove-7652?t=260)
- When a 16-year-old is transferred to adult care and engages in risky behavior, adult professionals are mostly not familiar with legal requirements of making child protection notifications. — Silja Kosolove (clinical) [Ep 2 · 4:35](https://qa.library.globalcastmd.com/watch/transition-of-care-a-general-overview-by-silja-kosolove-7652?t=275)
- Biological development is just one small part of adolescent development; psychological and social changes occur simultaneously. — Silja Kosolove (clinical) [Ep 2 · 7:00](https://qa.library.globalcastmd.com/watch/transition-of-care-a-general-overview-by-silja-kosolove-7652?t=420)
- Adolescents move from concrete thinking where rules apply uniformly to abstract thinking, though they still feel invulnerable ('you can walk in front of a truck and the truck is supposed to stop'). — Silja Kosolove (clinical) [Ep 2 · 7:30](https://qa.library.globalcastmd.com/watch/transition-of-care-a-general-overview-by-silja-kosolove-7652?t=450)
- Illness, nutrition, and stress affect adolescent development and may lead to the developmental conflict being greatest right at the time when young people should leave pediatric care. — Silja Kosolove (clinical) [Ep 2 · 10:20](https://qa.library.globalcastmd.com/watch/transition-of-care-a-general-overview-by-silja-kosolove-7652?t=620)
- The last bits of the human brain to develop are in the frontal lobe, where planning for the future, problem-solving, and emotional and behavioral control are learned. — Silja Kosolove (clinical) [Ep 2 · 11:00](https://qa.library.globalcastmd.com/watch/transition-of-care-a-general-overview-by-silja-kosolove-7652?t=660)
- Emotional centers develop earlier than frontal lobe, so young people have 'a car with really nice transmission but no brakes'—the brakes develop later. — Silja Kosolove (clinical) [Ep 2 · 11:40](https://qa.library.globalcastmd.com/watch/transition-of-care-a-general-overview-by-silja-kosolove-7652?t=700)
- Young people who appear noncompliant, defiant, and risk-taking are simultaneously very insecure, wondering whether they will be loved or find meaningful work. — Silja Kosolove (clinical) [Ep 2 · 12:10](https://qa.library.globalcastmd.com/watch/transition-of-care-a-general-overview-by-silja-kosolove-7652?t=730)
- Medical follow-up can resemble the relationship young people have with their parents, and as they struggle for autonomy they may rebel against medical care. — Silja Kosolove (clinical) [Ep 2 · 15:00](https://qa.library.globalcastmd.com/watch/transition-of-care-a-general-overview-by-silja-kosolove-7652?t=900)
- In many studies, both our own and from other centers, quality of life has always been better when judged by young people themselves than when judged by their parents or carers. — Silja Kosolove (epidemiological) [Ep 2 · 16:00](https://qa.library.globalcastmd.com/watch/transition-of-care-a-general-overview-by-silja-kosolove-7652?t=960)
- Transfer is simple moving of paper; transition is a process requiring preparation and a welcoming recipient on the other side. — Silja Kosolove (clinical) [Ep 2 · 17:00](https://qa.library.globalcastmd.com/watch/transition-of-care-a-general-overview-by-silja-kosolove-7652?t=1020)
- The recommended age to meet patients alone for at least part of the appointment is from age 12. — Silja Kosolove (guideline) [Ep 2 · 17:30](https://qa.library.globalcastmd.com/watch/transition-of-care-a-general-overview-by-silja-kosolove-7652?t=1050)
- Treatment advice should be given directly to the patient even if the parent is in the room. — Silja Kosolove (guideline) [Ep 2 · 17:50](https://qa.library.globalcastmd.com/watch/transition-of-care-a-general-overview-by-silja-kosolove-7652?t=1070)
- There is growing evidence that single days of coaching for transition have very low or no impact. — Silja Kosolove (epidemiological) [Ep 2 · 18:30](https://qa.library.globalcastmd.com/watch/transition-of-care-a-general-overview-by-silja-kosolove-7652?t=1110)
- There is growing evidence that joint consultations with pediatric and adult teams both present (even via Teams) builds trust and may lead to better outcomes. — Silja Kosolove (epidemiological) [Ep 2 · 18:45](https://qa.library.globalcastmd.com/watch/transition-of-care-a-general-overview-by-silja-kosolove-7652?t=1125)
- Great discrepancies in treatment plans between pediatric and adult teams should be built into a more uniform approach; this has been a struggle in liver and kidney transplant patients in Finland. — Silja Kosolove (clinical) [Ep 2 · 19:15](https://qa.library.globalcastmd.com/watch/transition-of-care-a-general-overview-by-silja-kosolove-7652?t=1155)
- In adult healthcare during the first couple of years after transition, consultations should be more frequent and longer than for other adult patients. — Silja Kosolove (guideline) [Ep 2 · 19:40](https://qa.library.globalcastmd.com/watch/transition-of-care-a-general-overview-by-silja-kosolove-7652?t=1180)
- Young people need one named contact person for questions between consultations; most times they don't call, so workload concerns are unfounded. — Silja Kosolove (clinical) [Ep 2 · 20:00](https://qa.library.globalcastmd.com/watch/transition-of-care-a-general-overview-by-silja-kosolove-7652?t=1200)
- From the perspective of general practice, continuity of care is key, with strong evidence for management continuity, information continuity, and relationship continuity leading to better outcomes. — Silja Kosolove (epidemiological) [Ep 2 · 20:20](https://qa.library.globalcastmd.com/watch/transition-of-care-a-general-overview-by-silja-kosolove-7652?t=1220)
- The process of transition cannot be on the shoulders of one single person; it must be a holistic approach in the whole hospital so that when that person retires or falls ill, transition continues. — Silja Kosolove (guideline) [Ep 2 · 20:50](https://qa.library.globalcastmd.com/watch/transition-of-care-a-general-overview-by-silja-kosolove-7652?t=1250)
- WHO has mapped adolescent medicine training availability in Europe; much of Europe is gray (no response), implying training is not happening. — Silja Kosolove (epidemiological) [Ep 2 · 19:00](https://qa.library.globalcastmd.com/watch/transition-of-care-a-general-overview-by-silja-kosolove-7652?t=1140)
- Youth-friendly healthcare must be acceptable, accessible, and affordable to youth. — Silja Kosolove (guideline) [Ep 2 · 19:20](https://qa.library.globalcastmd.com/watch/transition-of-care-a-general-overview-by-silja-kosolove-7652?t=1160)
- The most important attitude professionals working with young people need to show is respect; adolescents are very good at sensing whether you respect them. — Silja Kosolove (opinion) [Ep 2 · 19:35](https://qa.library.globalcastmd.com/watch/transition-of-care-a-general-overview-by-silja-kosolove-7652?t=1175)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- Cardiovascular mortality begins to climb in the overweight range and increases definitively for adolescents at or above the 95th percentile BMI, leading to early cardiovascular death. — Thomas Inge summarizing a resource [Ep 1 · 4:00](https://qa.library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=240)
- In AMOS study, non-surgical controls with severe obesity gained weight over 5 years (BMI 42→45). — Thomas Inge summarizing a resource [Ep 1 · 25:00](https://qa.library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=1500)
- AMOS gastric bypass patients had dramatic BMI reduction from 45 to 30, stable at 5 years, similar to adult controls and SOS cohort. — Thomas Inge summarizing a resource [Ep 1 · 26:00](https://qa.library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=1560)
- AMOS showed 83% dyslipidemia remission, 12 of 12 hypertension cases resolved, and 75% inflammation (CRP) resolved. — Thomas Inge summarizing a resource [Ep 1 · 28:00](https://qa.library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=1680)
- In AMOS, low vitamin D was found in >50% of gastric bypass patients and also in controls; low B12 and iron deficiency anemia were noted. — Thomas Inge summarizing a resource [Ep 1 · 30:00](https://qa.library.globalcastmd.com/watch/adolescent-bariatric-surgery-pediatric-obesity-2017-371?t=1800)
- ERAS recommendations for bariatric surgery include carbohydrate drink the night before surgery and clear liquids up to 2 hours prior to surgery — Kanika Bowen-Jallow summarizing the discussion [Ep 3 · 0:34](https://qa.library.globalcastmd.com/watch/kanika-bowen-jallow-md-and-faisal-qureshi-md-2024-pediatric-bariatric-surgery-up-7958?t=34)
- Sugar-free carbohydrate drinks should be used for diabetic patients — Kanika Bowen-Jallow summarizing the discussion [Ep 3 · 1:30](https://qa.library.globalcastmd.com/watch/kanika-bowen-jallow-md-and-faisal-qureshi-md-2024-pediatric-bariatric-surgery-up-7958?t=90)
- DVT prophylaxis with Lovenox or subcutaneous heparin is administered at the start of the case, but there is no standard recommendation and practices vary greatly among surgeons — Kanika Bowen-Jallow summarizing the discussion [Ep 3 · 3:00](https://qa.library.globalcastmd.com/watch/kanika-bowen-jallow-md-and-faisal-qureshi-md-2024-pediatric-bariatric-surgery-up-7958?t=180)
- ASMBS recommends using DVT prophylaxis intraoperatively and postoperatively before discharge, but most patients do not go home on DVT prophylaxis unless there is a specific indication such as family history — Kanika Bowen-Jallow summarizing the discussion [Ep 3 · 3:30](https://qa.library.globalcastmd.com/watch/kanika-bowen-jallow-md-and-faisal-qureshi-md-2024-pediatric-bariatric-surgery-up-7958?t=210)
- New literature demonstrates laparoscopic TAP block is not superior to local infiltration of incisions for pain control — Kanika Bowen-Jallow summarizing the discussion [Ep 3 · 4:20](https://qa.library.globalcastmd.com/watch/kanika-bowen-jallow-md-and-faisal-qureshi-md-2024-pediatric-bariatric-surgery-up-7958?t=260)
- Total daily acetaminophen dose should not exceed 4000 mg whether given IV or orally, requiring careful tracking of pre-op and post-op doses — Kanika Bowen-Jallow summarizing the discussion [Ep 3 · 5:20](https://qa.library.globalcastmd.com/watch/kanika-bowen-jallow-md-and-faisal-qureshi-md-2024-pediatric-bariatric-surgery-up-7958?t=320)
- Pure oxycodone immediate-release without acetaminophen is the ERAS-recommended narcotic option if needed, though typically not required or prescribed at discharge — Kanika Bowen-Jallow summarizing the discussion [Ep 3 · 6:00](https://qa.library.globalcastmd.com/watch/kanika-bowen-jallow-md-and-faisal-qureshi-md-2024-pediatric-bariatric-surgery-up-7958?t=360)
- Operating at lower insufflation pressures results in less TNF-alpha production and decreased postoperative pain — Kanika Bowen-Jallow summarizing the discussion [Ep 3 · 17:30](https://qa.library.globalcastmd.com/watch/kanika-bowen-jallow-md-and-faisal-qureshi-md-2024-pediatric-bariatric-surgery-up-7958?t=1050)
- Two Finnish colleagues described that cognitive skills develop logically but psychosocial skills take a dip during teenage years, with the timing and depth of the dip being very individual. — Silja Kosolove summarizing a resource [Ep 2 · 9:00](https://qa.library.globalcastmd.com/watch/transition-of-care-a-general-overview-by-silja-kosolove-7652?t=540)

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