jbsh

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!

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.

Ten 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.

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.