Sep 25

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.

Jan 22

How smart are your houses?

© 2011 The Intelligent Business Company, publisher of Housing Technology magazine

A number of years ago, when I was the Business Manager for Futurelab Education, we looked at a couple of projects around technology in social housing and how internet access could transform lives. I began talking to George Grant (Founder, Housing Technology) about several projects across Bristol that were refurbishing PCs and providing them to communities at no, or very low, cost. This great work is continuing with ByteBack and the associated projects through Connecting Bristol.

Anyhow, I stayed in touch with George from those conversations and always looked forward to the latest issue of Housing Technology. One of the keys to being a good connector of business opportunities is to be aware of what’s going on in sometimes seemingly unconnected sectors. Those sectors connected towards the end of 2010 when George and I were catching up over a coffee in Hamilton House and I mentioned a couple of recent technology innovations that I’d become aware of.

George suggested that I write some of my thoughts down about how the massive potential of social games and device level smart metering could be used to bring about motivated social change. That rather than trying to make people feel guilty about their energy consumption through financial penalties, we use anthropomorphism and social games to align energy efficiency with game design strategies.

So I did, you can download the full article as part of the January issue of Housing Technology or read the png file linked from the thumbnail.

Sep 06

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!

May 30

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.

Sep 13

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.