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.

Apr 23

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
Feb 06

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.

Nov 27

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.

Nov 18

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.