Gastric Band Slippage: The Impact of a Change in Education and Band Filling.

BACKGROUND: Gastric band slippage is a significant challenge in gastric band surgery and can result in poor weight loss, pain and dysphagia, often requiring re-operation. The Royal Berkshire Hospital is one of 49 UK centres performing bariatric surgery. We audited our band slippage rates. METHODS: All patients undergoing gastric banding from February 2007 to December 2013 were included (follow-up until December 2014). Slip rate was calculated and compared to an audit standard (3.9 %). The impact of two interventions altering the method of band filling and post-operative dietary advice was studied. RESULTS: Initial slippage rates were high (17 %). Rates decreased following the interventions: 8.5 % by July 2012 (p = 0.05); 2.7 % by December 2014 (p = 0.2). CONCLUSIONS: Two simple, low-risk interventions have reduced complication rates in a high-risk population.

Caregiver experiences of supporting adults with intellectual disabilities in pain.

BACKGROUND: Caregivers have an intimate knowledge of the individuals they care for and are therefore an important source of information on pain experiences. They are often relied upon to recognize pain-related behaviours and report them, but little is known as to how they experience their role. METHODS: Information was collected from 11 caregivers using semi-structured interviews about their experiences of caring for adults with intellectual disabilities who were suspected or definitely in pain. Transcripts were analysed using Interpretative Phenomenological Analysis. RESULTS: Six superordinate themes were identified from participants' experiences: suffering in silence; searching for meaning to explain the complaint; knowledge and skills needed to recognize and manage pain; perceptions of the pain experience; acting to try and reduce pain; and the emotional impact of pain. CONCLUSIONS: There seems an art to detect pain using existing skills and knowledge of the individual's ways of expressing pain. Despite best efforts, recognizing and treating pain was experienced as complex and ambiguous. Some caregivers described a negative emotional impact and dissatisfaction with the management of pain by health care services.