Can Psychology help the Leaning Tower of Pisa?

leaning-tower-of-pisa

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!

Uncovering Strengths and Building Resilience

I recently attended a Mental Health Update workshop entitled: Uncovering Strengths and Building Resilience with CBT: A four Step Model. I wasn’t sure what to expect as Cognitive Behavioural Therapy is not an area I have worked in. I think the workshop description outlines it better than I could:

Strenght and ResilienceResilient 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.

PEGs are not just for hanging out the laundry!

peg_3

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.

peg_poster_pictureTen 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.

Journal Letters – continuing a saga

When you write a journal article you are trying to do a number of things. You are;

  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.

Diving Diseases Research at Dive 2008

I have had the pleasure of working at the ‘Diving Diseases Research Centre’ for more than 9 years.

One of the things that I have been involved in numerous times over that period is staffing the stand at the national dive shows. DDRC’s introduction to the world reads ‘DDRC – Is a charity providing support and education for divers and research into the effects of altered pressure environments on humans. It is one of the UK’s busiest recompression facility, and has seen over fifty diving casualties in the past 12 months. DDRC is able to offer internationally recognised training from diving first aid and oxygen administration to hyperbaric medicine and recompression chamber operation. We will have a team (including me) of helpful and informative staff onsite at the dive show to answer any questions you may have about training, research or the work we do.’

On the day we will have some interesting bits of research for you to get involved in.  Graham Samson will be introducing some of his research, which is going towards a PhD.

I’ll be asking people to judge wither they think a number of factors might cause decompression illness.  It is a simple card sorting task with no hard and fast right or wrong responses just subjective judgements.  If you have the chance to visit us at the NEC that would be great.  If you can’t make it then I know all the researchers at DDRC would love your input, and I know I would appreciate you completing my online survey.

See you on the 1st or 2nd of November at the NEC

or please complete my online survey!

(Opens new window and takes you to SurveyGizmo)

Publications – Just like buses!

Image by Sarge-Jack

Sometimes you can be working on projects for years and you can feel that no substantial outputs are ever going to come from them. Then all of a sudden stuff happens! Sometimes the stuff is further funding, sometimes it is conference abstracts, posters or oral presentations and sometimes you get publications. That is the case here; projects I have been involved with since 2001 have finally got to the point that academic peer review journals are accepting articles for publication.

I have had the good fortune to have four articles accepted so far this year. I have written about the first three and the abstracts can be read in earlier blogs (1 – QoL & Maxillofacial Cancer Patients: 2 – Educational Impact of Pulmonary Rehabilitation: 3 – Personality as a predisposing factor for DCI) on this site and references found on the research page.

The latest article (No. 4) has been accepted for publication in the ‘Journal of Cardiopulmonary Rehabilitation and Prevention’ is and entitled:

The prevalence of posttraumatic stress disorder in patients undergoing pulmonary rehabilitation and changes in PTSD symptoms following rehabilitation

Authors: Jones, RCM., Harding, SA., Chung, M., & Campbell, J.

Abstract: Posttraumatic Stress Disorder (PTSD) is a common serious condition which, although treatable, is often undetected. We aimed to investigate the prevalence of PTSD in patients with chronic obstructive pulmonary disease (COPD) referred to pulmonary rehabilitation and the impact of rehabilitation on PTSD symptoms. Design: cross-sectional and longitudinal surveys. Participants: Patients with COPD attending pulmonary rehabilitation programmes in South West England. Outcome measures:The Posttraumatic Diagnostic Scale (PDS), Impact of Events scale (IES-R), the incremental shuttle walking test, Medical Outcomes Short Form 12 (SF-12), Hospital Anxiety and Depression scale (HADS) and Chronic Respiratory Questionnaire (CRQ-SR). Questionnaires were completed at face to face interviews with participants one week prior to commencing pulmonary rehabilitation and at the end of the programme. 100 participants took part, mean age 68yrs; 65 male. 70% completed the pulmonary rehabilitation programme. Seventy four out of one hundred participants reported traumatic experiences, 37 of which were related to their lung disease. Eight out of 100 participants met diagnostic criteria for PTSD. Participants with PTSD reported worse health status than those without PTSD. After pulmonary rehabilitation, exercise capacity and quality of life scores improved significantly, but PTSD symptom severity did not change. PTSD was present in 8% of COPD patients referred for pulmonary rehabilitation. After rehabilitation, participants with PTSD improved more in respect of anxiety and disease specific health status than those without PTSD. PTSD symptoms did not improve following rehabilitation, despite its positive effects on HADS scores, exercise and health status in this cohort.

Once again I hope you find this of interest and as always please get in touch if you want to discuss or comment about anything in the article.

New Publication – Personality as a predisposing factor for DCI: A pilot study

As you may have read in my short biography (home page), I have had a long interest in the psychology of SCUBA diving. I have undertaken a couple of projects in this area and this is one of those. The work was part of my MSc in Psychological Research Methods, undertaken at the University of Plymouth, and sponsered by the Diving Diseases Research Centre (DDRC).

Krug Chamber at DDRC (www.ddrc.org)

At the time I did not intend to write it up for publication in a peer review journal, but following some positive feedback from Academics, Specalist Diving Physicians and Researchers, and the Editor of a Journal, I grasped the thistle.

Below is the abstract from the article accepted for publication by ‘Diving and Hyperbaric Medicine‘, which is ‘The combined journal of the South Pacific Underwater Medicine Society’ and the ‘European Underwater and Baromedical Society’. The paper will be available in the next edition of the journal (October 2008). I hope you find it of interest and I look forward to discussing the work with anyone who wants to get in touch.

Personality as a predisposing factor for DCI: A pilot study

Authors: Sam Harding & Phil Gee

This study aimed to identify differences in personality characteristics related to Decompression Illness (DCI) in recreational SCUBA divers. A matched control group of 9 divers (without DCI) and research group of 9 divers (with DCI) were recruited. Following a chamber dive (control group), or post-treatment for DCI (research group), three psychometric scales; Locus of Control (LoC), Sensation Seeking Scale, and Eysenck’s Personality Questionnaire – Revised (EPQ-R) were administered together with a Diving History Questionnaire and questions on motoring. One significant difference was identified and lay between engine sizes, with those experiencing DCI having cars with larger engines (p < .01). The data were inconsistent with previous research that suggested a relationship between sensation seeking and risk taking. Further research is needed to elucidate the relationship between diving injury and personality.

Cambridge Folk Festival 2008

Photo by Clare Borley
Photo by Clare Borley

The Cambridge Folk Festival might be a strange topic for this blog, but it is a function I have been working for the past sixteen years!  Most people attend events such as this to watch great bands performing live.  They get to enjoy the atmosphere and attempt to dance between the rain drops. I however am there to work!  Obviously many people are there to work; security, general helping staff, vendors, bar staff, stage hands, electricians, gas engineers, not to mention the performers, but as it is often said an army marches on its stomach.  That is where I come in……

I meet up with a select team of people each year under Bob the chef as part of the ‘Quintessential Cuisine’ team tasked with providing food for the “Staff and Artists”.  This merry band of 5 produce breakfast, lunch and evening meals for 2000 people over a four day period.  I am part of this team, but I also specifically look after the artists and their riders.

A contract rider includes specifications on stage design, sound systems, lighting rigs, as well as an artist’s wish list-from transportation and billing to dressing room accommodations and meals. At some festivals, a promoter will refuse a demand (crossing out the request on the document), but at Cambridge the stars usually get what they want, whether it’s new black cotton soaks, or a box full of fruit so they can prepare their own smoothies.

So I spend considerable amount of time preparing special meals for some artists and vast numbers of sandwiches and deli platers for others.  What this does mean is that when the rest of the catering team are not working I am in the kitchen trying to get on top of things so that when the main rush hits, I can help out with the staff meals and coordinating service times.

This break from the routine of health/clinical psychology and research analysis is wonderful.  As a qualified chef, preparing food is a careful balance of colours, flavours, textures and presentation not to mention getting it on the table in time (no mean feat when you’re basically working on a camping gas stove).  I also experience a whole different side of humanity.

It essence it keeps me fresh and if you’re not going away on holiday then a change is as good as a rest!

New publication – Educational Impact of Pulmonary Rehabilitation

Photo by mistersnappy
Photo by mistersnappy

This (below) is the abstract from a piece of research that has taken quite some time to complete, but that is the joy of a multi-centre study.  The paper is available online ahead of hard copy publication.  So please have a read if the abstract is of interest and feel free to ask any questions you like.

Educational impact of pulmonary rehabilitation: Lung Information Needs Questionnaire.

Authors: Jones RC, Wang X, Harding S, Bott J, Hyland M.

Respiratory Research Unit, Peninsula Medical School, Devon, 1 Davy Road, Plymouth PL6 8BX, United Kingdom.

INTRODUCTION: The Lung Information Needs Questionnaire (LINQ) assesses, from the patient’s perspective, their need for education. This questionnaire yields a total score and scores in six domains: disease knowledge, medicine, self-management, smoking, exercise and diet. The aim of this study was to assess the sensitivity of the LINQ to change before and after pulmonary rehabilitation (PR). METHOD: PR programmes across the UK recruited 158 patients (male=94; 59%). The participants completed the LINQ and other measures as used by the individual sites pre- and post-PR, including the Shuttle Walking Test, Chronic Respiratory Disease Questionnaire, the Hospital Anxiety and Depression Scale. RESULTS: Data were analysed on 115 patients who completed data collection pre- and post-PR. The LINQ total scores, and subscales scores across all sites improved significantly with large effect sizes, except for the smoking domain as information needs about smoking were well met prior to PR. There were similar patterns of information needs at baseline and after PR in all sites. DISCUSSION: This study shows that the LINQ is a practical tool for detecting areas where patients need education and is sensitive to change after PR. The quality of the education component of PR can be assessed using the LINQ, which could be considered as a routinely collected outcome measure in PR. The LINQ may also be a useful tool for general practitioners to assess their patients’ educational needs.

Impact of perioperative hyperbaric oxygen therapy on the quality of life of maxillofacial patients who undergo surgery in irradiated fields

On the 8th April, I blogged about an article being accepted for publication in the International Journal of Oral and Maxillofacial Surgery. Today I received the digital object identifier (DOI) can be used to cite and link to electronic documents. The DOI never changes which makes it an ideal medium for citing articles. The DOI my article is – doi:10.1016/j.ijom.2008.04.004. Depending on your institutional or personal access you maybe able to access the whole article from this link. If not you should be able to view the abstract, although I have written it out below (with permission from the journal).

Abstract:

From 2001 to 2005, 66 patients referred for perioperative hyperbaric oxygen therapy (HBO2) for debridement of necrotic tissue or prevention of radionecrosis were assessed with quality of life measures, before and after completion of HBO2 and surgery. The Medical Outcomes Short Form 36 (SF-36) and Hospital Anxiety and Depression Scale (HADS) showed no significant changes. The European Organisation for Research and Treatment of Cancer Core (EORTC-C30) questionnaire showed significant improvement in pain, global health, and dyspnoea (p = 0.011; p = 0.027; p = 0.008, respectively). The Head and Neck sub-module (H&N35) identified significant improvements in teeth, dry mouth and social contact (p = 0.002; p = 0.038; p = 0.029, respectively). The University of Washington Scale (UW), showed significant changes in relation to chewing and shoulders (p = 0.031; p = 0.047). When sub-group analysis using ‘osteoradionecrosis’ and ‘dental extraction or implants’ was performed on the EORTC and UW data, variations in the patterns of significance were found. Adjunctive HBO2 should be considered for the treatment and prevention of some of the long-term complications of radiotherapy.