Author Archives: SamH

Oct 25

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

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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. :)

Sep 06

Can Psychology help the Leaning Tower of Pisa?

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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!

Jun 19

Uncovering Strengths and Building Resilience

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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.

May 30

PEGs are not just for hanging out the laundry!

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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.

Nov 18

Journal Letters – continuing a saga

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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.