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.

Business Support Simplification – an analysis

Uploaded on November 2, 2006 by Paul Mannix
Uploaded on November 2, 2006 by Paul Mannix

Is it possible for a Government to provide simple support to businesses?

Well the UK Government thinks it is, but recognises that it hasn’t been very good at the simple part. A few years ago some wag pointed out that there were over 3,000 different grants, programmes, schemes, advice networks, etc (nobody really knew the exact number), and that it was something of a mess. In the 2006 Budget the Government promised to reduce this to around 100. The latest plan is to get this down to 30.

As Dan Martin over at businesszone.co.uk more recently pointed out, this simple list of 30 has already become less simple.

As part of an application to the recent SWRDA post for Head of Business Innovation, I thought I’d revisit BSSP from a more strategic perspective. While I have dealt directly with several of the individual ‘products’ (as they’re called) and have been involved in various briefing and discussion around the rest, I’ve not formally reviewed the whole documentation associated with these changes.

Enter Nigel Legg at Katugas Lex. I emailed over three documents: Solutions for business: supporting success, The economic drivers of Government-funded business support: supporting analysis for ‘Solutions for business: supporting success’ and the South West Regional Development Agency’s Regional Economic Strategy. I asked Nigel to see what the key themes and constructs that emerged from within these three documents, but didn’t set any specific boundaries or expectations.

After a couple of days Nigel emailed to say he’d finished and invited me round for a presentation and discussion.

A note on the analysis method before getting into the findings. Each document was broken down and repeating words found, for each document the top 30 to 40 words were included in the supporting excel report. These words were then grouped to identify key themes with around 13 per document. Because of the way the statistics works, you don’t receive an absolute measure of thematic importance. For example, with the Economic Drivers the most connected theme was “business” with “market” being 73% as connected as “business” and “information” being 50% as connected as “business”. So you do get a very good internal feel for the focus and thrust of the document, Nigel also included a combined report of all three documents.

The economic drivers of Government-funded business support
The economic drivers of Government-funded business support

As you’d expect the dominant themes are around business, support, innovation, economics with a heavier weighting towards regional and south west for the SWRDA document. What was more interesting was what wasn’t there.

The market was clearly front and centre in the economic justification. Innovation is clearly linked to productivity and there’s a reasonable focus on benefits (through examples). Unfortunately “profit” or “finance” didn’t make the ranking for any of the documents.

Providing information is clearly seen as a benefit and service to inform the businesses understanding of the market and various support available. As I understand it this is a core function of the Business Links through their IDB (Infomation, Diagnosis & Brokerage).

Despite having a whole chapter on Skills (Chapter 3), they don’t show up as a key theme. The two main ‘products’ here are Train to Gain and the Manufacturing Advisory Service. Hidden away is a very interesting sounding service “Coaching for High Growth”.

The actual semanic map of the BSSP document wasn’t that surprising on its own. The main focus was around businesses and economic achievement, with a sizable grouping around Government Support, the schemes themselves and eligibility.

SWRDA Regional Economic Strategy
SWRDA Regional Economic Strategy
Its worth noting at the outset that the SWRDA Regional Economic Strategy goes much wider than business innovation or government support for businesses. There were quite sizable thematic groupings around people and future communities and their connection to the broad economy of the region. There was also consideration on the challenges and changes associated with growth.

The focus in general has moved away from a historical focus on employment toward productivity (at least as far as business is concerned). Interestingly, important and business are closely linked themes.

Possibly the most noticeable shift between the two maps is the disappearances of “market”, “innovation” and “enterprise” as top level themes.

Some thoughts

  • Personally I would have liked to have seen more evidence of developing market understanding and providing solutions to problems in the market.
  • I’d also have liked to see more emphasis on developing the higher skills for entrepreneurship and innovation (principally team building).
  • The emphasis on innovation & enterprise at the national level is excellent, as is the lack government focus on specific sectors (though this has already changed with the various sector bail-outs).
  • It would have been nice to see more innovation & enterprise focus in the SWRDA RES, but moving from an employment focus to productivity is a start

Sir Ken in his element

Are you passionately doing something you’re good at?

That was Sir Ken Robinson‘s challenge to us (and everyone really) last night at the Arnolfini. I hadn’t seen his TED2006 presentation, you should, its just there on the right.

First of all, Sir Ken is an exceptional speaker. Very self-depreciating sense of humour, great timing, stage presence, etc. If the message weren’t so profound we might have been in the Comedy Club.

After a pre-amble Sir Ken opened by noting that he hadn’t really followed a planned career, that he’d been opportunistic whilst following his personal true north. But then do any of us follow a planned career these days?

When we write our CV we impose a narrative retrospectively, or as Sir Ken put it:

…thus I moved from being a gardener to helicopter pilot…[pause]

as have so many before me…

He boiled his book down into 2 core principles for being “in your element”:

  1. Doing stuff which for which you have a natural aptitude
  2. and loving what you do

Everyone has many aptitudes, things we’re good at, that we get. The trouble is, because we ‘get it’ we assume that its obvious, that anyone could do it. The trick is to realise that, maybe, it’s not so obvious and actually we are genuinely better at that particular thing than others.

The example Sir Ken used was Terence Tao. At two, Terence taught himself to read, by 3 he was doing double-digit mathematics, by 9 he scored 99% in the Maths SAT, by 20 he had a PhD and by 30 he won the Field Medal for Maths. Terence was good at maths, he ‘got it’.

Not everyone can be as good at maths as Terence, arguably no one is. But there are things we’re good at, that we get, that others find difficult. Those are the things that Sir Ken is suggesting we find, discover and encourage in ourselves and others. In an aside (of which there were a few) the culture of corporate & organisational development was touched upon. A very powerful case was made for thinking of the organisation as an organism, to consider development more akin to gardening than engineering.

A good gardener creates the right conditions for plants to flourish, a good manager should create the right conditions for their people to flourish.

Sir Ken then moved on to the concept of loving what you do. He related a gig he went to many years ago. Afterwards they were having a drink with the band and he remarked to the keyboard player that he’d love to be in a band and playing keyboards. The response was “no you don’t”, after a bit the clarification was that Sir Ken liked the idea of being in a band, whereas the keyboard player loved it, would be doing it even if he wasn’t playing gigs.

When we find something we love doing that plays to our natural aptitudes, then we’re in our element.

Like natural resources, human resources are often buried. They’re not always lying right on the surface to pick up and run with. That should be the role of the education system. In the TED talk Sir Ken makes the point that the education system is designed to produce University Professors. Which is fine for University Professors, but of varying use for everyone else.

Another issue touched upon was that life is not linear but our education system assumes it is. You can’t plan the future of anything (the recent weather has re-taught us that) let alone people. Schooling kids at Primary / Kindergarten to prepare them for University is madness. A 3-year old is not half a 6-year old; a 6-year old is not half a 12-year old.

Unfortunately there wasn’t much on what Sir Ken’s education system would look like or how it would operate. Perhaps that’s in the book. A lot of people are working on similar ideas, most notably in Bristol the Enquiring Minds project with Futurelab and Microsoft but the systemic transformation is some way off.

Thanks go to Bristol Festival of Ideas for organising and the Arnolfini for hosting.

A real Live Guy

Dan Such bags a netbook
Dan Such bags a netbook

A variation of igFest‘s Moosehunt came to Bristol yesterday in the form of Vodafone’s LiveGuy, his mission (which it looks like he accepted with eagerness):

I’m travelling from the north to the south of Britain, laying down clues to my whereabouts. Your mission is to find me – and maybe even bag yourself a netbook. You’ve got two ways to win. Either Find LiveGuy in person or Find LiveGuy online.

<plug>All with the help of a very cool looking Dell Inspiron Mini 9 netbook connected to the Vodafone network and with a GPS chip giving location updates (delayed slightly for the purposes of giving LiveGuy a fighting chance).</plug>

Sam Machin catches up with LiveGuy
Sam Machin catches up with LiveGuy

Through the wonders of social media, Mike Coulter met with with LiveGuy at the start of his journey in Edinburgh. It was his blog & twitter stream that alerted me to the project. Mike then dm’d me to see if I wanted help drum up some interest around Bristol.

A few txt messsages, phone calls and emails led to an early morning rendevouz at a top secret location before the day’s excitment around Bristol. As well as bringing Liveguy and his support team (Alastair) up to speed with some of what’s going on around Bristol in the creative use of mobile & locative technology we also had a really good discussion over the future of such technologies and what you can achieve with them.

Obviously the creative and pervasive media projects going on around the Pervasive Media Studio were of interest along with the robotics research between the Universities, but what struck me was the genuine interest around communities, engagement and ways in which technology, and the service providers, can help facilitate that engagement.

Bristol has as checkered a history at public engagement as any other city but in recent years a number of really good initiatives have shown what can be achieved. The flagship is probably the Knowle West Media Centre with a huge and expanding range of community programmes covering pretty much all aspects of digital media. These are so good they’re now running a social enterprise with clients including blue chips and local community companies. They’ve also engaged in a number of innovative mobile and locative technology projects exploring the ways in which civic engagement can be facilitated by technology.

Tom Dowding also spotted LiveGuy
Tom Dowding also spotted LiveGuy

We also talked about the Connecting Bristol project which came out of the Digital Challenge. This is another area where creative use of technology is being applied to wide civic challenges. Under the wing of the City Council, but operating independently out of the eOffice on Wine St, Stephen Hilton and Kevin O’Malley are part of 10 city collaboration. As well as news about the DC10 grouping of cities, Kevin regularly posts about other initiatives and news that is of interest for those at the intersection between technology and civic change (environment, education, planning, transport, are just some recent topics).

With that it was nearly time for LiveGuy to fire up twitter and hit the streets of Bristol, and for me to head off also. I’m staying in touch with Alastair so watch this space for more announcements.

Congratulations to Dan Such, Sam Machin, Tom Dowing and the online winner, Ruth Bailey.

Disclosure: Although I knew where Liveguy was starting his day in Bristol, I didn’t know the itinerary and chose not to take part in the Find Live Guy challenge. There is no business relationship between jbsh LLP, Vodafone or the agency behind LiveGuy.

Update 1: the picture links to Picassa didn’t seem to work – so I’ve copied the images to jbsh.co.uk and linked to them here.

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.

Key activity indicators of successful companies

What makes successful companies different? What a great research question, and one that the University of Strathclyde posited a couple years back. They followed up with 37 companies, in 8 EU countries and gathered over 1,000 stories (interview descriptions of processes and activities).

Catherine Maguire from Strathclyde was presenting their findings. They began with the CIM-OSA model of business processes (one I’m very familiar with as it formed a good chunk of my research career). Turns out my supervisor was on the advisory panel for this work also, small world!

Basically, CIM-OSA identified three key processes that all businesses do: Manage, Operate, and Support. The research focus has been around Operate (and to a lesser extent Support). The research group I was with in Plymouth did most of the early work developing a reference model for the Operate Process. Catherine was looking at the Manage process.

Being a very industry orientated researcher (probably why I wasn’t very good as an academic) I always suspected that the actually process maps were less interesting that the activities and practices they represented. In my own research I concentrated more on these activities and the social systems around them, than the formal modelling (drawing boxes & arrows).

Catherine’s group has now confirmed what we all ‘knew’ but hadn’t ‘proved’. The actual processes in successful companies are the same as for less successful companies. Successful companies are a bit more integrated; the big difference is in the “how”.

Hugh MacLeod from The Hughtrain
Hugh MacLeod from The Hughtrain

Or as the song goes, “It ain’t what you do it’s the way that you do it”…

There are a hundred+1 jobs to do when you’re running a business, and they’re all important. Fulfilling Orders and Getting Orders (to use process speak) are probably the most important, but I was talking to a HR exec a couple nights ago that insisted that hiring the best people was the most important because they’d then make the business work (might have been a vested interest there).

So where do you start?

The more successful companies were generally more mature in all their Manage activities but Strathclyde did find that there were around 15 activities that seemed to differentiate more successful from less successful companies.

What Catherine’s research has found is that given equal resources, and for their 37 companies, higher maturity in these 15 activities was a reliable indicator of a successful company. Catherine flashed the activities up on screen and they were largely around communication (as I’d expect) but I didn’t get a chance to write them down, hopefully I’ll be able to update this post shortly with that list.

I did ask if they’d looked at how the Manage Processes that these activities represented subsequently interacted with the Operate Processes. From a business change perspective you’re generally presented with a whole load of symptoms operationally and have to analyse your way back to root causes. This research could really help by making explicit some of the implicit links that are learned from practice.

I’m following up with Catherine to see if I can reproduce that list of Activities here together with links to the online tool they’ve developed to help companies self-rate themselves.

Personally I can’t hold 15 things in my head simultaneously; what 5 activities are embedded in your organisation that differenciate you from the competition?

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.

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.