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.

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.

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!

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.

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.

Education shaped & Bristol Fashion

Disclosure: This was originally published on TechCrunch UK, I’ve made some edits at the end in response to comment on TC, Underscore, Twitter etc.

Uploaded on March 29, 2007 by pictopedia
Uploaded on March 29, 2007 by pictopedia

Its not all stovepipe hats and clay dogs in Bristol, these days its more location aware gaming, mobile media and building businesses. As a relative newcomer to the city (5yrs and loving it) this is a quick peek around some start-ups.

Two Bristol startups you will have heard about are Glasses Direct (James Murray Wells, a UWE graduate) and MyBuilder (Ryan Notz, a Bristol Uni graduate). But what else is going on…

The Watershed, a digital media & arts complex in the heart of the city, has been mixing up creativity and technology for over 20 years.The place for start-ups is their new Pervasive Media Studio, headed by Clare in partnership with HP Labs & with heavy involvement from both Bristol University & UWE. The Studio launched with it’s Media Sandbox competition. Several of the projects came from larger established companies (including Aardman, HMC, BDH, Plot, etc) but the winning project brought together two startup companies, Thought Den (Dan) and Mobile Pie (Richard), to create Happy Packages. After some early PR from the Guardian, Mobile Pie have knuckled down to turn out a number of games and have picked up some awards along the way. They’ve also since been confirmed as one of the first 4,000 iPhone developers and are working with Futurelab to find funding for an exciting e-learning project.

Another Sandbox success is the Comfort of Strangers from the eponymous Simon + Simon. Using a heavily modified mscapes platform, two teams have to ‘discover’ matched players while avoiding opponents. A soft voice in your ear is all that alerts you to the fact that ‘a dancer is nearby, you have lost a life point…’ This ARG team game has been showcased at New York’s Come Out & Play. They now organise the monthly igLab to explore collaborative and social gaming developments. 19-21 Sept they’re turning Bristol into one giant playground… everyone is playing – running, hiding, seeking, finding, escaping, tagging…. igFest.

Just north of the M5, Chris & Craig at BexMedia have been developing a video platform for mobile devices, recently expanding into interactive video after developing a mobile map & video experience for freshers to quickly acquaint themselves with Anglia Ruskin University. On a slightly bigger scale is the Visualise project from 3C Research to bring unprecedented levels of personalised streaming data & video to mobile devices at live sports events. Currently with the World Rally Championships, Nigel’s actively spinning out new startups to commercialise the software & services.

Round the beck end, The Web People started up coding websites like everyone else but Tom quickly developed a web-services management system that made it simple for him to manage lots of websites, with lots of different services, for lots of clients all in parallel. Co-founder Mark saw the opportunity, they’ve just launched an open beta, and on track for some stellar growth (clients are already beating a path to their door). Also working behind the scenes to spread and gather the word virally is Team Rubber with Andy at the helm. Though not strictly a startup, having survived the dot-com boom, Andy’s a staunch supporter and is actively helping the ‘new guys’ get off the ground.

Behind all these successes lies a growing entrepreneurial ecosystem mixing startups, future clients, partners and investors. This mixing covers everything from the fun & interesting (Dorkbot / igLab), learning & technical (Skillswap / BathCamp), business & sectoral (OpenCoffee / Media Tuesday) to University sponsored (BEN). Its not just the geeks & designers either, lawyers, accountants and exec recruiters are getting behind the start-up scene in Bristol like never before.

Update – following the TCUK comments, I’ve added some more thoughts below – Update

Matt Jukes pointed out the education leadership that Bristol has shown with the work of Futurelab and JISC in the region. He also got a name drop in for Beanbag Learning (where he’s based) and pointed up Science TV. BeanBag are getting more attention from Jemima Kiss at the Guardian’s tech blog which is great news.

Perhaps this is another focus area for Bristol to consider? There have been a couple posts on the education start-up scene including another guest post from Al Briggs on TCUK. The comments section of that post goes into some discussion on the UK education sector, including a great mini-post by David McAll from sums.co.uk. One of David’s points is the need to build relationships slowly which probably reflects most ‘real world’ applications but makes it harder to justify the hockey stick returns beloved of VCs.

I also advise Heliotrope, a start-up in the education sector. They’re based in Toronto, Canada and have been doing this slow burn relationship building for over 3 yrs (during the last 18 months we’ve been actively seeking investment). The first real success is just now beginning to take hold with a School Board in Quebec adopting Prelude for multi-school roll-out. It’ll be tight (and we’d still like the investment) but it looks like there’s a sustainable revenue model from this approach.

Bristol has a strong democracy and participatory culture, good technology and software development, and track record in educational innovation. Perhaps it would be a good primary focus for some of the city’s digital innovators? In the fields of informal learning, games as learning, soft skills, etc (i.e. non-curriculum examined subjects that translate well between geographies and school systems) there are opportunities.

With a global focus and patient investment, might this be the next big thing…?

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.

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.

Publishing Ethics – who should be named as an author?

People not involved in research may consider this a silly question, as the answer is obvious: the people that did the work or at least wrote it up for publication. But what happens when lots of people did something, or there is a senior member of the department who historically gets their names on the articles because of who they are? Indeed a question more often asked within departments is, ‘what is order of authors?’. But I would argue that many of the historical practices leading to multiple authors may be inaccurate and even inappropriate. Being the ‘boss’ or part of the larger team, does not entitle you to being a named author.

The International Committee Medical Journal Editors and Blackwell-Synergy publishing, say that the authorship criteria are;

1) substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data;
2) drafting the article or revising it critically for important intellectual content; and
3) final approval of the version to be published.
and that to be an author you should meet conditions 1, 2 and 3.

Whilst all other contributors who do not qualify as authors should be listed and their particular contribution described in an acknowledgement section.

I think these guidelines are very clear and consequently I would like this information to be more widely disseminated. This would be of great benefit to junior researchers who may have been left off papers and also as armoury to use with those higher in their institutions who feel they have the right to be included, but have made little or no contribution to the work.

In short what is important is your contribution, not your rank!