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

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.

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.

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.

The 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.

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.

As part of Sam’s interest and research into the effect of Oral and Maxillofacial Cancer, and its treatment on patients, she has been investigating the knowledge and attitudes of General Dental Practitioners (GDP).  In particular she was interested in GDP’s expereince of treatment of this patient group following completion of their cancer treatment. So she performed a small postal survey. The results of which have been submitted and accepted for presentation at two conferences (British Assocation of Oral Maxillofacial Surgeon Annual Conference & European Health Psychology Conference Annual Conference).

The abstract accepted for these conferences tell you about the study and the results:

Incidents of Oral Cancer are increasing, coupled with campaigns to raise the awareness of symptoms, diagnosis and treatment. To date, no study has investigated the General Dental Practitioner’s (GDP) frequency of exposure to this type of patient or their current knowledge and attitudes in relation to the treatment and potential complications of these patients post cancer. This study investigated these areas and the requirements/requests for further training and education. A questionnaire was constructed and posted to 183 GDP in the South West (UK), with a stamped returned addressed envelop. A subsequent posting was sent out a month later to the non-respondents. The analysis of numerical data was limited to descriptive statistics using SPSS V16. Free text was analysed using content analysis with the aid of NUD*IST V5. A total of sixty-one percent (n=114) of potential participants responded. On average they had been qualified and registered as GDP’s for 20.5 years. Seventy-Six percent (n=87) of respondents reported having a patient post treatment for oral cancer. Thirty-five percent were not confident treating these patients (depending on their morbidities). The reasons given could be categorised from free text responses as due to; 1) Lack of Training, 2) Poor Communication with the hospital, 3) Finance. A minority of GDPs reported the need for further education on the treatment of these patients and for better communication between themselves and hospital consultants. The findings suggest the need for a larger study to validate this pilot and indicate future interventions with GDPs.

We hope you find this research as interesting as we do, as it has implications for the training of future GDP, and improving the communication betwen patients, GDP and hospital based dentists and surgeons. The hope is that it will improve the treatment of this patient group, reduce the amount of time they have to wait for treatment, as well as the lenght of time they need to have assisted feeding through things such as Percutaneous Endoscopic Gastronomy (PEG) feeding tubes.

As for Psychology helping the Leaning Tower of Pisa. This research probably won’t help, but we’ll keep you informed as to it’s progress once the conference is over!

Resilient people face and manage positive and negative life events. They persist in the face of obstacles and when necessary, accept circumstances that cannot be changed. Resilience provides a buffer to protect us from psychological and physical health consequences during difficult times. Clearly, resilience is a desirable quality and yet all of us experience fluctuations in resiliency throughout our lifetime. Some people never develop resilience. Others are quite resilience but don’t recognise it; they may avoid challenges they could easily surmount. Sometimes resilience is worn down by multiple stressors and challenges.

As with a lot of psychology it seems very obvious when people say it, but it is not until it is clearly thought through and stylishly presented that it really does seem like something anyone could have said.  That is exactly what happened during this workshop. The approach covered integrated knowledge from resilience research and traditional CBT approaches.  If this is an area you practice in I would recommend Christine Padesky book (and if it’s run again the workshop), as it was clearly delivered, making it appear simple to apply the developed models. I will definitely be feeding and sharing the references and resources with my clinical psychology colleagues.  This may not be an approach we use, but as with all good ideas their are elements that I am sure I can and will use, especially in designing future research projects.

The clothes peg is a commonly used (at least in the summer) household object. Most of us have them, though we rarely regard them. They are so basic yet so useful, they have the ability of serving many functions in addition to it’s original one. It can be used to hang stuff, to hold, to fasten, endless number of uses.  The peg is a simple object.

However if you talk to many people within the medical profession a PEG is something very different.

The Percutaneous Endoscopic Gastrostomy (PEG) feedback tube is a safe and effective way to provide food, liquids and medications (when appropriate) directly into the stomach. The procedure is carried out for patients who are having difficulty swallowing. Irrespective of the age of the patient or their medical condition, the purpose of PEGs is to provide fluids and nutrition directly into the stomach.

I’ve been investigating the impact of medical treatment on patients that have had treatment for Oral and Maxillofacial Cancers. Part of this treatment may be the placement of a PEG feeding tube. So how does having a PEG feeding tube effect the Quality of Life (QoL) of this patient group.  I undertook a study to find out, which was presented at conference (2008 British Assocaition of Oral and Maxillofacial Surgeon Annual Conference, 22nd Annual Conference of the European Health Psychology Society and 6th International Head & Neck Quality of Life Workshop).  An overview of this study is given below.

A Qualitative Investigation into the Impact of PEGs

Research by the Maxillofacial Department at Derriford Hospital in Plymouth has shown an initial reduction in QoL due to the effects and demands of treatment as measured by the questionnaires. But patients want to add detail about specific areas of concern to themselves. One of these issues is the use of PEGs. The aim of this work was to explore the views of patients regarding the impact of having a PEG in-situ.

Ten patients were recruited prior to treatment for Head and Neck Cancer. They participated in a semi-structured interview and then completed the University of Washington and EORTC-C30 and HN35 QoL questionnaires to ensure comparability with previous studies. Follow-up data was collected at 1, 3, and 6 months post treatment.

Data revealed that those participants with a PEG in-situ had issues with clothing, activities, and sex, which were not apparent in those non-PEG participants. All rationalised the placement of the PEG, but expressed a desire for the PEG to be removed in order to more freely socialise, not be restricted in activity and start ‘feeling normal’. Communication with clinicians about the expected duration of use was described as poor. Patients needing new dentures prior to removal of the PEG reported feeling ‘abandoned’ by the hospital and ‘not confident in their dentists’.

This research shows the benefit of interview in adding flesh to the bones of questionnaires. It reveals adverse psychological effects of PEGs and need for better communication between patients and professionals. Investigation into oral rehabilitation is required.

So what next?

As noted, there needs to be better communication between patients and professionals. But the professionals need to be aware of the issues their patients may have.  Therefore this work is currently being written up for publication in peer review journals, and other work is ongoing to investigate the knowledge base of professionals such as General Dental Practitioners that work outside of hospital settings, but that can still have a significant impact of the length of time this patient group require PEG feeding tubes.

1. Disseminating the information you have gathered
2. Keeping the literature up to date
3. Telling your story and defending your position
4. Putting your head above the parapet

Having written your article and had it accepted you feel very pleased with yourself. Even though you have written it for all the above reasons you never really think that anybody is going to read it and take you seriously. But then two things happen:

1. Someone emails you and asks you for a copy of your article
2. You get an email from the journal saying that someone has written to them about your article and asking if you would like to respond

The first feels like flattery, and sometimes leads to conversations and the development of new projects. The second feels like an attack. As such I find it best to read the letter and then sleep on it. Any response that you write needs to be as carefully written as the original article. As with most academic writing it should be reporting of the facts, a justification of the methodology, and a defense of your interpretation of the findings.

Having written your response and sent it back to the journal you still have to wait to see if the editor will accept it for publication and then go through the whole proof reading process.

This is our (jbsh) current position following the publication of: The Ameliorating Effects of Hyperbaric Oxygen Therapy (HBO2) on Quality Of Life in Patients with Maxillofacial Soft Tissue- and Osteo-Radionecrosis.

What happens next? We wait to see if further letters follow, or if future publications support or refute our position. Academia is not a quiet pond of thought and introspection, it is a tempest of investigation driven by desire.