Faculty Bibliography

BACKGROUND:Laparoscopic adjustable gastric band (LAGB) management continues to be an important part of many metabolic and bariatric surgery practices. OBJECTIVES/OBJECTIVE:To replace the existing American Society for Metabolic and Bariatric Surgery (ASMBS) LAGB adjustment credentialing guidelines for physician extenders with consensus statements that reflect the current state of LAGB management. SETTING/METHODS:ASMBS Integrated Health Clinical Issues Committee. METHODS:A modified Delphi process using a 2-stage consensus approach was conducted on LAGB management. Thirty-four consensus statements were developed following a literature search on a wide range of LAGB topics. A 5-point Likert scale was implemented to measure consensus agreement with a Delphi panel of 39 expert participants who were invited and agreed to participate in 2 rounds of Delphi questionnaires. Consensus was set a priori at 75% agreement, defined as the proportion of participants responding with agreement (i.e., 4 or 5) or disagreement (i.e., 1 or 2) on the Likert scale. RESULTS:Consensus was reached on 74% (25 of 34) of the LAGB management statements. In Delphi round 1, 95% (37 of 39) of the participants responded to 34 consensus statements; 21 of the statements (62%) met the 75% criteria for consensus. Thirty-one participants (80%) responded in round 2, shifting the agreement on 4 more statements to the 75% threshold. CONCLUSION/CONCLUSIONS:The ASMBS consensus statement on LAGB management is intended to guide practice with current evidence-based knowledge and professional experience. The ASMBS is not a credentialing body and does not seek to guide credentialing with this document.

The role of a mental health professional working with surgical weight-loss patients is diverse. Primary responsibilities include the provision of patients' evaluations prior to surgery and either individual or group counseling after surgery. Consultation with the surgeon at various points of patient care is also common. While there is no consensus regarding the content of pre-surgical evaluations or the criteria used to exclude patients from surgery, it is generally accepted that the evaluation is necessary and beneficial. Research supports the benefits of post-surgical mental health services as well. This article suggests pre-surgical evaluations should not primarily focus on psychopathology but on patient expectations and preparedness for the behavioral and emotional changes following surgery. Common reasons patients present for post-operative psychotherapy are reviewed and a stage model of psychological change following surgery is presented.

Organizational Behavior Management (OBM) has improved staff performance in mental hospitals and homes for the mentally retarded. In the present study, OBM techniques of goal-setting, feedback, and positive reinforcement were used to improve staff behavior and patient outcomes in four private adult group homes for chronic mental patients. Four therapists (aged 29-38) and 37 patients (aged 30-66) served as Ss. After a 10 or 20 week multiple baseline, the therapists received training in setting measurable goals, providing verbal and graphic feedback, and praising patients. In addition, therapists received written and verbal feedback, praise and contingent monetary reinforcement. Results revealed large increases in the number of goals addressed weekly and in the quality of treatment plan reviews during treatment. There was a significant increase in patient goal progress and patient activity level, and a significant decrease in therapists' time to submit applicable paperwork during treatment. These results suggest that OBM techniques call improve therapist performance and patient outcomes in group homes for chronic mental patients.