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Doctor-Patient contact time is vitally important for diagnosis and treatment.  To aid doctors thousands of ‘tools’ have been developed for use in various fields of medical practice.  But as new technology (including physical assessment and validated questionnaires) is introduced assessment tools become redundent and others are introduced. However technological advances tend to be expensive and time consuming to train medical staff to use.  It is also the case that they often require additional physical space, time to administer and a level of health of the patient.

The aim of Dr Rupert Jones and collegues (including me) was to derive a multi-component assessment index for use with patients with COPD to gain a measure of severity. The index was intended to include items that are clinically important, applicable to all grades of disease severity and all healthcare settings, and simple and clear to use.

Traditionally, the forced expiratory volume in one second (FEV1) has been the main measure of COPD severity for clinicians and still has a prominent place in international guidelines. While patients are mainly concerned with symptoms, exacerbations and functional capacity, airflow obstruction is important to clinicians in order to measure the lung damage and determine treatment. A composite measure could account for various dimensions of the disease, and take into account both the patient’s and the physician’s perspectives.

One highly regarded composite measure is the BODE index which was originally designed to predict mortality in COPD. However, the BODE index involves a Six Minute Walking Test (6MWT) which limits its use in routine clinical settings as it takes time, supervision, and space. Another validated prognostic index, the COPD Prognostic Index is also cumbersome to use in routine clinical settings as it includes seven items, one of which is a health status questionnaire.

Therefore we have derived and validated a composite index of severity in chronic obstructive pulmonary disease, which has recently been accepted for publication by the American Journal of Respiratory and Critical Care Medicine.  We hope the index will be widley adopted by the medical profession.

If you are unsure of its relevance or usfulness to your practice, below is the abstract associated with the journal article.

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Rationale: COPD is increasingly recognized as a multi-component disease with systemic consequences and effects on quality of life. Single measures such as lung function provide a limited reflection of how the disease affects patients. Composite measures have the potential to account for many of the facets of COPD.

Objective: To derive and validate a multi-component assessment tool of COPD severity which is applicable to all patients and healthcare settings.

Methods/ Measurements: The index was derived using data from 375 COPD patients in primary care. Regression analysis led to a model explaining 48% of the variance in health status as measured by the Clinical COPD questionnaire with four components: dyspnea (D), airflow obstruction (O), smoking status (S) and exacerbation frequency (E). The DOSE index was validated in cross-sectional and longitudinal samples in different healthcare settings in Holland, Japan, and the United Kingdom.

Main results: The DOSE index correlated with health status in all datasets. A high DOSE index score (> = 4) was associated with a greater risk of hospital admission (odds ratio 8.3 (4.1 – 17) or respiratory failure 7.8 (3.4 – 18.3). The index predicted exacerbations in the subsequent year (p ≤ 0.014).

Conclusions: The DOSE index is a simple valid tool for assessing the severity of COPD. The index is related to a range of clinically important outcomes such as healthcare consumption and predicts future events.

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.

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!

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:

Resilient 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.