Measuring the Wobbliness of Scuba Divers

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In order to maintain balance, our body needs a number of structures to be working correctly. We need to know what the joints are doing, so that our muscles can make any necessary adjustments to keep us upright. We also need the signals from those joints to travel up the brain without interruption and then to be interpreted correctly. The signals from the brain have to go back down again and the muscles must be able to make any necessary corrections to maintain our posture. Additionally, the balance detectors located in our ears must also be working.

Most of the time though, we have another back-up source of information which we use to maintain balance, even if the above mechanisms are faulty – we keep our eyes open! So we instantly see if our balance is incorrect and adjust accordingly.

Balance testing and divers. 

Divers with decompression illness (DCI) can sustain an injury to the balance pathways. Sometimes these injuries can be subtle and the diver affected wouldn’t necessarily know he or she had a problem – because with the eyes open a balance problem wouldn’t be immediately apparent. Dive doctors test for this possibility by the use of the Sharpened Romberg Test. This test is performed with the eyes closed, so the compensatory visual mechanism is eliminated. But balance is a difficult skill. Even healthy individuals find themselves a bit wobbly with their eyes closed!

What are we doing at DIVE2014 (Birmingham NEC, October 2014)?

At the Dive Show (DIVE2014) from 25th/26th October 2014, I will be working with DDRC Healthcare inviting people to undertake a test with us on Stand 1436. We will ask participants to place one foot in front of the other, fold their arms across their chest, close their eyes and try to maintain balance for as long as possible. In order to measure the amount of wobble, we will ask volunteers to place a few sticky markers to their clothing. This will allow us to use a computer programme to measure the amount of postural sway – or in layman’s terms ‘wobble’!

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What will we be doing with the findings? 

Postural sway, or ‘wobble’ reflects instability. There’s a large natural variation between individuals, even in health. The data we gather will help us understand this natural variation. This will help diving doctors make their judgements about when people may have returned to their pre-DCI state.

What does the test result mean to individual divers? 

Apart from DCI there are lots of reasons why an individual may be wobbly in this test. The most common one is the natural variation between individuals! If you attempt the test and find you are more wobbly than expected, it doesn’t necessarily mean there is anything wrong. We won’t be attempting any on-the-spot diagnosis on our Dive Show volunteers!

For fun, we will make a note of the details of any willing participant who remains upright for 60 seconds, and analysis of their video will reveal the person with the least amount of ‘wobble’. The winner will receive a prize from DDRC!

For more information on DDRC Healthcare’ research work linked to the health of divers, including there most recent survey which focuses on Dental Health & UK Divers, visit http://www.ddrc.org/divingresearch/ 

By Sam Harding (DDRC Healthcare Chamber Team) and Dr Simon Williams (DDRC Healthcare Doctor)

Existence of benefit finding and posttraumatic growth in people treated for head and neck cancer: a systematic review

Sam has recently had a systematic review published in the open access journal PeerJ.  It is FREE for anyone to download.  Below is the abstract giving you an overview of the work, and it you have any questions then maybe the full article will be of interest.

Background. The impact of head and neck cancer (HNC) in long-term survivors differs widely among individuals, and a significant number of them suffer from the negative effects of disease, whereas others report significant positive effect. This systematic review investigated the evidence the implications of treatment for HNC and subsequent development of Benefit Finding (BF) or Posttraumatic Growth (PTG).
Purpose. To understand how differing medical, psychological and social characteristics of HNC may lead to BF/PTG and subsequently inform post-treatment interventions to encourage positive outcomes.
Method. In February 2012, five databases including Pubmed, and Psych Info, were searched, for peer-reviewed English-language publications. Search strings included key words pertaining to HNC, BF, and PTG. One thousand three hundred and sixty three publications were identified, reviewed, and reduced following Cochrane guidelines and inclusion/exclusion criteria specified by a group of maxillofacial consul-
tants and psychologists. Publications were then quality assessed using the CASP Cohort Critical Appraisal tool.
Findings. Five manuscripts met the search and selection criteria, and were sourced for review. All studies were identified as being level IIb evidence which is a medium level of quality. The majority of studies investigated benefit finding (80%) and were split between recruiting participant via cancer clinics and postal survey. They focused on the medical, psychological and social characteristics of the patient following completion of treatment for HNC.
Conclusion. Demographic factors across the papers showed similar patterns of relationships across BF and PTG; that higher education/qualification and cohabitation/marriage are associated with increased BF/PTG. Similarly, overlap with disease characteristics and psychosocial factors where hope and optimism were both positively correlated with increased reported BF/PTG.

Representing the BPS

Yet another busy month has passed for us all, but I thought I would take this time to write a short piece about a couple of events, at which I represented the British Psychology Society (BPS).

Exeter University Psychology Society Careers Event

Midweek on what turned out to be a wet, and chilly March day, Exeter University Psychology Society organised a careers fair.  They invited myself and a number of colleagues to cover the various areas of psychological practice.  I was there to, as mentioned, represent the BPS, but also to talk about work in the field of Health Psychology.  Other speakers included; Dr Andy Allen, Dr Craig Knight, Dr Varuni Wilamasari, Dr Barry Cripps, Amy McAndrew and Josie Bannon.  Our brief was to talk about our experience and knowledge of how to get into our field and what it is like to work in it.

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  • I aimed to enlightened the students on topic of Health Psychology.  It is a rapidly expanding but relatively new area of psychology which promotes well-being
  • Educational Psychologist, Dr Andy Allen, talked about the experience of working in both the public and private sector, and gave advice on cross-sector working
  • Dr Craig Knight, an Occupational Psychologist, talked about his work to help businesses maximise the potential of their office spaces by using his expertise in the effects of office layout on productivity and efficiency
  • Dr Varuni Wilamasari, a lecturer at Exeter University and an Occupational Psychologist, discussed how psychology can be implemented into practical settings by showing how her knowledge is applied to decision making
  • Sports Psychologist, Dr Barry Cripps described his extensive career working with athletes across many disciplines
  • Amy McAndrew, an Exeter PhD student gave practical advice on applying for an MSc or a PhD and funding opportunities available to students
  • Joise Bannon, introduced the audience to Wellbeing practitioners. A job involving using low intensity cognitive behavioural therapy to help those with mild or moderate depression and outlined the differences between a wellbeing practitioner and a clinical psychologist.

Following each of us giving a 5 minute presentation we were individually set upon by the assembled students to in the form of a lively question and answer session with students raising questions about aspirations, opportunities in the field and the career processes needed.  All the speakers gave enthusiastic and insightful talks about working in psychology.  It also provided an great opportunity for the undergraduates to clarify thoughts about potential careers.  I personally found it a really great experience. It allowed me to talk on a topic about which I am passionate to people that were interested and asking insightful questions.  This in turn challenged my understanding of the students basic level of knowledge and expectations that they carry during their years of study.  Fingers crossed this will be first of an annual event at this University.

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The second event I helped support was the;

South West Undergraduate Psychology Conference

Bath University Psychology student helpers
Bath University Psychology student helpers

Each year the South West Branch Committee of the BPS sponsor and help organise an undergraduate student conference for the seven universities based in the region (Bath Spa University, Open University, University of Bath, University of Bristol, University of Exeter, University of Plymouth, and the University of the West of England). The conference is an opportunity for students and their lecturers to share experiences, research, discuss ideas, feedback and network with each other and particularly with practising psychologists. The universities take it in turns to host the event and this year it was the University of Bath’s turn.

Dr Michael Proulx
Dr Michael Proulx

So at 10:30 on a grey and drizzly Saturday approximately 120 students and staff convened at the conference venue.  Welcomed with much needed warm drinks and cookies by a group of Psychology students, it became clear from the level of chatter that we were in for a very interesting and engaging day of research dissemination. With the 21 poster presentations hung, we split into streams to watch the first of the 24 oral presentations.  Each oral presentation consisted of a 10 minute talk, supplemented with PowerPoint or Prezi, and a subsequent 5 minute question & answer opportunity. Mid-way through the presentation schedule, lunch provided the opportunity to view posters, chat to authors and network with peers.  The presentations resumed until 15:45 when we were treated to a keynote presentation by Dr Michael Proulx. He gave a fascinating presentation covering his work examining some of the fundamental issues in cognition through the study of multiple sensory modalities. This focused on how developments in psychology and engineering are allowing significant advancements to be made in augmenting hearing devices and subsquently aid visual impaired people.

Clichéd as it maybe, once again, the students’ contributions were of a remarkably high standard. This made it difficult for the judges (academic representatives from the attending universities and the author) to decide upon the BPS ‘Best Poster’ and ‘Best Oral Presentation’.  We ended up selecting 2 posters and 5 oral presentations for commendations. In no particular order, poster commendations:

  1. Alessandro Firetto (University of Plymouth) Out of Sync. The effects of social exclusion through music synchrony
  2. Natalya Smith (University of Bath) Anxiety and gender: how do they affect chronic pain patients’ outcomes following a pain management programme?

Oral presentation commendations:

  1. Tamsyn Hawken (University of Bath) Exploring earthquake related distress: A qualitative analysis
  2. Claire Mason (University of Bath) Project REACH; A study into the risky health behaviours of childhood cancer survivors
  3. Claire O’Reilly (University of Exeter) Evidence for an understanding of string-pulling in an Alaskan coastal brown bear (Ursus arctos sitkensis)
  4. Jennifer Riddell (University of Bristol) Axes of time representation in English and Mandarin speakers
  5. Carys Weeds (University of Bristol) Just noticeable differences in sharpness

Winners of the best poster were: Bathany Isaacs, Zeena-Britt Sanders, Haline Schendam & Viktoria Vianeva (University of Plymouth) Behavioural Congruency and electrical brain potentials dissect knowledge, decision and action contributions to implicit memory

Winner of the best oral presentation was: Rebecca Griggs (University of Bristol) The effects of expectancy information on cephalic phase responses to food

The abstracts for these presentations and the others from the conference can be read in the summer edition of the South West Branch of the BPS review.  Next year the conference will be held on the 22nd March at the University of Exeter, but if you want to know more or wish to be directly emailed about this event please contact me at samh@jbsh.co.uk.

So, those were a couple of events I attended in March, both engaging and exciting and I am looking forward to doing more to help undergraduates develop themselves and the field of Psychology.

The Effects of Hyperbaric Oxygen Therapy on Quality Of Life in Maxillofacial Patients with Type III Osteoradionecrosis

I strongly believe that if you ask people to take part in research you are subsequently obliged to disseminate the findings of that research.  The effort and time that this can take is substantial, and all to often researchers stop at conference posters or oral presentations.  These reach a limited audience and have very little if any impact on practice. 

So I am delighted that a piece of research I have been associated with for more than ten years has been accepted for publication in the Journal of Oral and Maxillofacial Surgery.   The data was collected at the Hyperbaric Medical Centre (Diving Disease Research Centre), in Plymouth and is entitled: The Effects of Hyperbaric Oxygen Therapy on Quality Of Life in Maxillofacial Patients with Type III Osteoradionecrosis, it is for a specialised audience, but hopefully it is written in such a way that it is accessible to one and all.  The PMID of my article is -PMID: 22705224. Depending on your institutional or personal access you maybe able to access the whole article from this link.

Abstract – Purpose: Over a four year period, 18 patients with Type III osteoradionecrosis that were an average of 55 months post radiotherapy treatment for head and neck cancers, were referred for Hyperbaric Oxygen Therapy (HBO2)

Methods: Participants complete a questionnaire battery pre & post HBO2 including the European Organization for Research and Treatment of Cancer (EORTC) Core 30, EORTC Head & Neck 35 (HN35) and Medical Outcomes Short Form 36 (SF-36)

Results: The EORTC Core 30 questionnaire found significant improvements in ‘Emotional Functioning’ and ‘Insomnia’ (P≤0.01 and P≤0.01).  An improvement was also found in the ‘Social Eating’ (P≤0.01) and ‘Teeth’ (P≤0.01) domains of the EORTC HN35 questionnaire.  These beneficial outcomes might in part be explained by the social environment of being in a specific treatment group with similar patients.  However, SF-36 found significant decline in ‘Social Functioning’ (P≤0.01).  The patient group in this study did not undergo any surgical intervention between the two time points and no other interventions could be connected with the improvements, particularly in relation to ‘teeth’.  In addition, clinical follow up confirmed stabilisation of the patient clinical conditions.

Conclusion: The findings of this study support the hypothesis that HBO2 has positive physiological and psychological impact on a number of factors for this patient group.

Psychology in the Pub – Bristol

At the start of the year (2012) the SouthWest Branch of the British Psychology Society created the first of several local hubs conceptualised to facilitate meeting and improved communication between the regions psychologists.  The initial hub was in Bristol, with others to follow in Exeter, Plymouth, Truro and the Channel Isles. The meetings at each of the hubs follows the popular ‘Psychology in the Pub’ format consisting of a short talk from a guest speaker/s, followed by an opportunity to network with other local Psychologists.

The introductory session was in January– and saw Jo Maddocks, Founder and Product Director of JCA Occupational Psychologists, speak on the topic of ‘Emotional Intelligence in the workplace – a heavily requested topic and one that is relevant to a range of Psychological disciplines’.  This was given to an audience of more than 75 local psychologists and interested individuals and was a well received start to the societies initiative.

March was the first meeting to be held at the now established ‘first Wednesday’ of the month.  Dave Alcock took the reins for this talk. He explored a range of experiences/issues encountered whilst working with elite athletes across a range of settings but primarily working in rugby union and rugby league. Whilst the contexts were fairly specialised, the issues addressed cut across applied sport psychology, and as such were of interest to all those involved in elite sport, those wanting to begin work in the elite domain, or those who are simply interested in working in challenging environments. Issues such as the applied sport psychologist as moral arbiter, Pavlov’s bell, water boy, therapist, “ideal” parent, discriminative stimulus, and work with clinical & sub-clinical issues were all addressed. Dave went on to explore the challenges and rewards of applied sport psychology work and brought to life using a range of Dave’s experiences in the field (sometimes literally “in the field”!).

In April – Rob Briner talked on ‘The psychological contract at work: Understanding the real deal between employer and employee.’  What do people want to give at work and what do they want to get back? What are the implicit promises employees feel their employer has made to them? What happens when promises are broken and when promises are fulfilled? How can each party renegotiate the deal? The idea of an implicit or psychological contract has emerged as one key way of answering such questions and also a way of thinking about a whole range of employee feelings and behaviours including motivation, ‘engagement’, withdrawal of effort, justice, commitment, absence and quitting. This presentation will review the history of the psychological contract idea, its main features, how it has been used to explain employee behaviour, the evidence for its effects and what organisations and employees can do, if anything, to manage it.

May bought a presentation from – Patrick Jordan ‘How to be happy: What is happiness, who is happy and why and what we can all do to bring more happiness into our lives’.  Looking at the area of happiness, this talk was based on the findings of positive psychology – an area of psychology which uses rigorous scientific methodology and analysis in order to investigate success, happiness and fulfillment. Findings about happiness were summarised and techniques described which can be used to increase levels of happiness.

The Bristol hub seems to have found its feet with at least 50 people attending each meeting and talk at Toto’s wine bar and it sounds like another good turn out is likely in June.  But before then there is the inaugural meeting in Exeter.

The Exeter hub is on the 30th May at the Mill on the Exe.  Dr Craig Knight from the Peninsula Medical School will talk on ‘The modern office: Cleverly designed space or a psychological bear trap?’.  Asking, how does your office affect your well-being? How does the freedom you have over your working environment impact your productivity? And does working in a clean, sparsely decorated, flexible office improve your effectiveness or compromise the business as a whole?

I hope that everyone who has attend an event to date has enjoyed it and that many more of your will come and try the events out for size.  Additioanlly if anyone wants to give a presentation, has a topic they would like to hear about, or want to let the committee know about anything else why not drop one of them a line http://southwest.bps.org.uk/southwest/meet-the-committee/meet-the-committee_home.cfm

 

Southwest Undergraduate Psychology Conference 2012

It was a glorious sunny day in Plymouth for the 2012 South West Undergraduate Psychology Conference.  The day took place in the Portland Square Building split between the three lecture theatres and the large open plan atrium called the Peninsula Arts Cube3 Gallery.  The conference is an opportunity for the regional universities, students and their lecturers to share experiences, research, discuss ideas, feedback and network with each other and particularly with practising psychologists.

Registration (programme_2012 and abstracts_2012) was in the Cube3 Gallery where the attendees could view Peter Fitzpatrick’s exhibit ‘Latitude 79 Degrees 5 Minutes South 11 Miles’ , and visit me on the BPS stand to find out about the Society.  All five universities from the region were represented, with people travelling up to 3 hours by train, coach, car and foot.  With the hundred or so delegates signed in, and with programmes in hand, the three streams of lectures commenced.

Forty-Two undergraduates delivered talks on topics ranging from the effect of biodiversity in exhibits effecting viewing time, to self perception of appearance in weight trainers.  The format was a standard academic style with the presenters briefed to talk for ten minuets and then the audience were given 5 minuets to ask questions.  The full range of presentation styles was demonstrated including slick delivery of the ‘by the book’ academic talk, through interactive group presentations, to a more free-form approach.  All included professional audio visuals, representing the thousands of hours of work undertaken by the presenters for their final year projects.

In addition to the talks, twenty-nine posters were on display throughout the day, with their authors ready, willing and able to answer questions from the other delegate over the lunch hour.  As with the presentations, the posters showed the spread of potential approaches with institutional templates following standard academic formats to individualistic representations with drawings and photographs from study participants.

The day was drawn to an end with the Keynote lecture, introduced by conference organiser Dr Bill Simpson, Prof Chris Mitchell gave a stimulating and amusing lecture entitles ‘Why Cognitive Psychology?’  I personally particularly enjoyed his dance representing the movement of E.coli from low to high glucose states.

The last formal aspect of the day was the presentation of the prizes.  Sponsored by the British Psychological Society South West Branch, Dr Simpson announced prizes of book tokens for winners and runners-up in categories of Best Presentation and Best Poster. The winners were;

–        Best Presentation; Katherine Wood (University of Bath, Theory of Mind and Anxiety: Their relationship in children and adolescents with autism)

–        Second Prize went to Thomas Davis (University of Bristol, Aggregation of Protean Prey Escape: Countershading confuses a predator’s visual tracking during attack)

–        Best Poster; James Nagata (University of Bristol, Strategies to overcome the neural and attentional demands of multiple object tracking)

–        Second Prize went to Jodie Nicholls (University of Plymouth, Dectection of abnormalities in synthetic mammogram backgrounds)

The day was rounded off with a final opportunity to congratulate all the attendees and do more networking.  This time with a glass of wine and the happy laid back feeling that comes with the final release of pressure felt after completing a good day’s work.  The day was a great demonstration of the vibrancy in psychology and the talent of the up and coming practitioners.  As a member of that community I hope that all the presenters got as much from the day as I did.

An exploratory study into HNC patients’ perceptions of their appearance

Every now and again we are fortunate enough to have an opportunity to under take a piece of research in an area that we are passionate about. For a number of years, I’ve been interested in how the treatment of head and neck cancer (HNC) affects a patient’s perceptions about their appearance. As part of my recent MSc in Health Psychology with the University of West of England, I was required to undertake a small research project and decided to scope an exploratory study into this topic. My supervisor Dr Tim Moss suggested that I include an investigation of the concept of ‘positivity’ (also refered to as posttraumatic growth).  The project has now been completed and written up.  Below is a copy of the abstract and if you are interested a PDF will be available in the near future.

The extent of Patients’ Positivity, Appearance Adjustment and Quality of Life following treatment for Head and Neck Cancer: An exploratory study

Background: Facial disfigurement is considered to be one of the most distressing aspects of head and neck cancer (HNC) and its treatment, but it has been the focus of little systematic study.  However there is a growing body of literature supporting the suggestion that such a stressful event may be a catalyst for positive psychosocial changes.  To date there are no existing studies looking at the relationship between quality of life (QoL), sense of appearance and positivity in this patient group.

Aim: To investigate how HNC affect patients’ QoL, sense of appearance and positivity.

Method: A Questionnaire battery containing the Medical Outcomes Short Form 12 (SF-12), Derriford Appearance Scale (DAS24) and Silver Lining Questionnaire (SLQ) was sent to 1,571 patients treated by the Maxillofacial Department in 2009.  The same measures with the inclusion of the University of Washington QoL Questionnaire (UoW), were posted to 299 HNC patients.  The study compares the Maxillofacial patients and HNC patients with reference data and explores associations with clinical factors.

Results: Reasons for non-completion of the questionnaires was given by a 118 patients.  Two hundred and thirty nine (15%) of the Maxillofacial patients and one hundred and thirty two (44%) of the HNC patients returned questionnaires.

The HNC patients had reported less distress and dysfunction related to appearance than age and gender matched norms.  They had similar QoL to other reported HNC patients, but worse than an age matched norm group.  Tumour stage was the only demographic to reveal a difference in relation to appearance.  The HNC patients also reported having a greater sense of positivity than the maxillofacial group and a similar level to previous data collected on lung cancer patients.

The complexity of the patient cohort has introduced many confounding variables, and the number of completed questionnaires was insufficient to identify the significance factors related to the data obtained on the measures.  Although there are indications that age and cancer staging may be particularly important.

Conclusions: The data collected in this study suggests that appearance issues are of less concern to HNC patients than the general population, and that they appear to be more positive, but further research is needed to investigate individual differences allowing for all the confounding variables.  Allowing for the lack of significant findings, we posit some hypotheses that would merit further investigation.  We also suggests that a follow up study, using the same validated questionnaires, over an extended patient group and longitudinally, may be able to identify significant co-variables. This may in turn inform the provision of support and information for patients to aid them in their difficult time.

The performance of junior doctors in applying clinical pharmacology knowledge and prescribing skills to standardised clinical cases

I have recently submitted a thesis for a masters of philosphy, entitled: The Design and Validation of assessment tools for use with Junior Doctors in Applying Clinical Pharmacology.  Part of this work has been written up and will be published in the next edition (June 2010) of the peer reviewed academic journal British Journal of Clinical Pharmacology.

Entitled: The performance of junior doctors in applying clinical pharmacology knowledge and prescribing skills to standardised clinical cases. This paper builds on the fact that safe prescribing is a core competency in undergraduate medical education. That a large proportion of undergraduate medical students and recently graduated doctors in the UK are not confident in their ability to effectively and safely prescribe and that errors are common in all healthcare settings and prescribing errors are the most common type.

This study produced twelve valid and statistically reliable assessments of Clinical Pharmacology and Therapeutics (CPT) knowledge and prescribing skills in areas that pose a high risk to patient safety. The findings show that a large proportion of Foundation Year 1 (FY1) doctors fail to demonstrate the level of CPT knowledge and prescribing ability judged by a subject matter expert (SME) panel to be required at this stage of their careers. My co-authors (Prof Nicky Britten & Dr David Bristow) suggest strategies and areas where teaching can be focused to improve the safety and effectiveness of FY1 doctors’ prescribing.

If this is an area of interest then below is the abstract related to the article and a link to the journal.

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Aims

Recent studies suggest a worryingly high proportion of final year medical students and new doctors feel unprepared for effective and safe prescribing.  Little research has been undertaken on UK junior doctors to see if these perceptions translate into unsafe prescribing practice.  We aimed to measure the performance of foundation year 1 (FY1) doctors in applying clinical pharmacology and therapeutics (CPT) knowledge and prescribing skills using standardised clinical cases.

Methods

A subject matter expert (SME) panel constructed a blueprint and from this twelve assessments focussing on areas posing high risk to patient safety and deemed as essential for FY1 doctors to know. Assessments comprised six Extended Matching Questions (EMQ) and six Written Unobserved Structured Clinical Examinations (WUSCE) covering seven CPT domains.  Two of each assessment types were administered over three time points to 128 FY1 doctors.

Results

The twelve assessments were valid and statistically reliable. Across seven CPT areas tested 51-75% of FY1 doctors failed EMQs and 27-70% failed WUSCEs. The WUSCEs showed three performance trends; 30% of FY1 doctors consistently performing poorly, 50% performing around the passing score, and 20% performing consistently well.  Categorical rating of the WUSCEs revealed 5% (8/161) of scripts contained errors deemed as potentially lethal.

Conclusions

This study shows that a large proportion of FY1 doctors fail to demonstrate the level of CPT knowledge and prescribing ability required at this stage of their careers. We identify areas of performance weakness that pose high risk to patient safety and suggest ways to improve FY1 doctors’ prescribing.

Clinical Assessment Tools need to be user friendly

Doctor-Patient contact time is vitally important for diagnosis and treatment.  To aid doctors thousands of ‘tools’ have been developed for use in various fields of medical practice.  But as new technology (including physical assessment and validated questionnaires) is introduced assessment tools become redundent and others are introduced. However technological advances tend to be expensive and time consuming to train medical staff to use.  It is also the case that they often require additional physical space, time to administer and a level of health of the patient.

CigarettesThe aim of Dr Rupert Jones and collegues (including me) was to derive a multi-component assessment index for use with patients with COPD to gain a measure of severity. The index was intended to include items that are clinically important, applicable to all grades of disease severity and all healthcare settings, and simple and clear to use.

Traditionally, the forced expiratory volume in one second (FEV1) has been the main measure of COPD severity for clinicians and still has a prominent place in international guidelines. While patients are mainly concerned with symptoms, exacerbations and functional capacity, airflow obstruction is important to clinicians in order to measure the lung damage and determine treatment. A composite measure could account for various dimensions of the disease, and take into account both the patient’s and the physician’s perspectives.

One highly regarded composite measure is the BODE index which was originally designed to predict mortality in COPD. However, the BODE index involves a Six Minute Walking Test (6MWT) which limits its use in routine clinical settings as it takes time, supervision, and space. Another validated prognostic index, the COPD Prognostic Index is also cumbersome to use in routine clinical settings as it includes seven items, one of which is a health status questionnaire.

Therefore we have derived and validated a composite index of severity in chronic obstructive pulmonary disease, which has recently been accepted for publication by the American Journal of Respiratory and Critical Care Medicine.  We hope the index will be widley adopted by the medical profession.

If you are unsure of its relevance or usfulness to your practice, below is the abstract associated with the journal article.

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Rationale: COPD is increasingly recognized as a multi-component disease with systemic consequences and effects on quality of life. Single measures such as lung function provide a limited reflection of how the disease affects patients. Composite measures have the potential to account for many of the facets of COPD.

Objective: To derive and validate a multi-component assessment tool of COPD severity which is applicable to all patients and healthcare settings.

Methods/ Measurements: The index was derived using data from 375 COPD patients in primary care. Regression analysis led to a model explaining 48% of the variance in health status as measured by the Clinical COPD questionnaire with four components: dyspnea (D), airflow obstruction (O), smoking status (S) and exacerbation frequency (E). The DOSE index was validated in cross-sectional and longitudinal samples in different healthcare settings in Holland, Japan, and the United Kingdom.

Main results: The DOSE index correlated with health status in all datasets. A high DOSE index score (> = 4) was associated with a greater risk of hospital admission (odds ratio 8.3 (4.1 – 17) or respiratory failure 7.8 (3.4 – 18.3). The index predicted exacerbations in the subsequent year (p ≤ 0.014).

Conclusions: The DOSE index is a simple valid tool for assessing the severity of COPD. The index is related to a range of clinically important outcomes such as healthcare consumption and predicts future events.

New Perspectives – Is the Leaning Tower of Pisa always inclined?

Recently I posted about an area of research I am interested in and mentioned that we were going to Pisa to present the results at the European Health Psychology Society Annual Conference.

I jokingly asked if Psychology could help the leaning tower and we concluded that the research I was offering up for scrutiny probably wouldn’t.

However the “Inclined Tower“, as a Swiss friend calls it, offers up an obvious, and visual, comparison with some of the benefits from attending conferences.

Its actually quite unusual to learn astounding new facts at academic conferences. Most of the formats involved are just too short and the programme too crowded to allow for a long and detailed examination of new research (that’s what Journal papers are really for). In Pisa there were nearly 1,300 separate pieces of research being presented, either in 15 min oral presentations, posters, symposia, or round table discussions. And all this over 4 days [programme in pdf format].

While you may not spend a lot of of time learning new material, you are forced to look at things from new angles and applying your thoughts and feelings in new ways.  In other words from a ‘New Perspective’!

You’re exposed to the work of people with very different, though equally valid, research philosophies.You can see how they tackled similar questions but from different perspectives (sometimes wildly different).

Studies in psychology provide and require multiple perspectives to be applied in order to understanding people as individuals and as individuals in a community. Research findings and implications about the mind and mental processes as well as studies of the development and behaviour, maintenance and change of socially significant behaviour are all of importance in understand and explaining (at least in part) the world we live in and how we situate ourselves within it.

p.s. John here, I sat in on some of the presentations and there were a couple of very interesting points. Traditionally the shift change in hospitals has been seen as a vulnerability and has resulted in a culture of long shifts. Some research indicated that safety might actually be improved with more shift changes, since they were more often catching problems than causing them. It was the act of explaining what was going on to someone new, a fresh pair of eyes, that caught these oversights. Equally, they sometimes gave people the impetus to make a decision. For a start up company that’s charging along eyes on the prize, taking time out occasionally to explain that bigger picture to an impartial observer, is a huge benefit.

It was also notable the lack of technology awareness in health care messages and communications. Not just the use of social media but viral gaming, mobile data capture & evaluation, and general webbiness. As I tweeted from the conference (I was in the minority having a mobile data device with me), online avatars working from fixed scripts do not make for very convincing ‘companions’. There is a lot this community could learn from places like the Pervasive Media Studio here in Bristol and the ecosystem around them.

For a technical civil engineering description of the tower and various attempts to ‘straighten’ it check out this page. 🙂