Thursday, 8 December 2011

Microcurrent Therapy – Evidenced practice or another way to rip offpatients?

Electrotherapy – the use of electrical currents to treat medical problems and diseases – has a long history in the medical and therapy based professions. By way of illustration, it is often cited that the Romans used electric eels as a means to bring about pain relief. Just because the Romans did it does not necessarily mean that it was a good, nor necessarily an effective way of dealing with a medical problem! In more recent times – say the last 100 years – there have been a plethora of ‘treatments’ using a wide range of electrical, electromagnetic and associated energies as a means to treat a wide range of clinical problems, ranging from obesity through depression to arthritis and sporting injuries. Some of these therapies have a substantial research base whilst others are rather more weakly supported.

There is a trend at the moment for ‘home based’ therapy devices : patients purchase their own machine and carry out their own treatments at home – reducing the need to attend therapy clinics or hospitals in order to be ‘treated’. This can indeed be a very effective way to get an effective treatment at low cost and with minimal disruption to work, sporting or social activities and the reduce the burden on an overstretched Health Service. TENS (Transcutaneous Electrical Nerve Stimulation) has become a popular application for DIY pain relief. Machines can be easily purchased in high street pharmacies or from web based retailers. There is a good evidence base for its efficacy and is used by therapists and pain specialists the world over on this basis.

Microcurrent therapy is a ‘modern’ version of an electrical stimulation application. It employs a very small electric current (less than one thousandth of an amp) delivered through electrodes placed on the skin. The current is so small, the patient does not actually feel anything. In principle, this small current is designed to stimulate, or enhance, the small, naturally occurring currents in the body which appear to be disrupted on injury, and furthermore, appear to be part of the tissue healing process.

If these small natural electric currents are as important as some of the research suggests that they are, it is logical to use an external device to support their effects, especially when healing is disrupted or stalled as we see in many patients coming to therapy.

There are many types of microcurrent machine. They are relatively inexpensive (from less than a hundred pounds), they are usually small, portable, battery powered and easy to use. This makes them very attractive as a home based therapy device, and the commercial world has recognised this, and the market is getting flooded with machines which are claimed to treat just about everything from pain relief in arthritis through to treating depression and just about everything in between.

There is good research evidence to support their use for various wounds (leg ulcers for example) and for bone fractures which are not healing well. We have been researching the use of microcurrent therapy in other clinical problems such as Tennis Elbow, and some work about to start with low back pain. It would seem that there is an advantage to using these devices, and also support for their use as a home based therapy. That having been said, we did not find that the more expensive machines necessarily provided ‘better’ therapy, nor that the ‘complex’ and ‘patterned’ stimulation sequences gave better results. In fact, it is not actually known yet which is the best way to use these devices, nor do we know for sure, which parts of the microcurrent therapy systems are the most important – time, strength of the current or how it is delivered etc.

Our results to date, certainly with the Tennis Elbow study would suggest that using a small amount of current over a prolonged period of time (hours a day as opposed to minutes) seems to give the best results. This would be in line with the findings from other research groups around the world.

Buying an expensive machine does not necessarily provide value for money – in that more costly does not mean that you will necessarily get better faster. Machines which offer special features – all the bells and whistles – do not necessarily give better results. Some patients are certainly being asked to part with a lot of money for a machine that simply does not do what it says on the label. The treatment therefore gets a ‘bad press’ and is labelled as ‘mumbo jumbo’. To some extent, that is fair enough in that there are claims made which are not supported by the research BUT that does not mean that the whole of microcurrent therapy is ineffective – just that you have to get it right – just like any drug based therapy or exercise or any other treatment.

We are seriously looking at what it is about microcurrent therapy that makes it effective, what it is most effective for and how it should be best used. If it works and is a research supported treatment, it makes sense to use it. If it is simply a way of getting patients in pain to part with their hard earned cash, then it should be dropped and people should not be ‘conned’ into buying the machines.

At the present time, it looks like it is effective for treating some medical problems. Once we know the most effective way of using the therapy, we can be more focussed. In the meantime, there will, inevitably, be retailers who will sell the machines to anybody willing to part with some money. Hopefully, we will be able to find out the real story before another type of electrical treatment gets wrongly labelled as being all ‘smoke and mirrors’ and before patients are tricked into spending money on a treatment that is not really effective.

Scientific Formula for Cutting Christmas Costs

With recent research showing that a massive 40% of shoppers are planning to spend less on Christmas this year, a North West shopping centre has taken the unique measure to step in and create the perfect shopping formula to help shoppers become festively frugal, without being seen as a ‘Scrooge’.

The ‘gift giver’ formula, commissioned by Warrington-based Golden Square Shopping Centre, has been developed by Professor Karen Pine to help people decide on the right amount to spend on everyone on their gift list this year, whether they’re having a cut-back Christmas or a festive blow-out.

“This is the time of year when most people feel under pressure to spend more than they should. The act of giving and receiving gifts has social and emotional significance and so it is a real danger area for over-spenders”, says the University of Hertfordshire Psychology Professor and author of Sheconomics, a book on the psychology of shopping.

“Many shoppers will be tempted to impulse buy, spend too much and risk going into debt – a real issue in the current economic climate.”

With UK households shown to spend most on Christmas in Europe with an average spend of £673.56, Golden Square’s ‘gift giver’ formula is an innovative way of helping apply a more logical approach to your spending budget for the Christmas season.

Ian Cox, Marketing Manager at Golden Square said: “We realise that it may sound strange that a shopping centre is helping shoppers to cut back on their Christmas budget, but this season is the time of year that sees most people slip into debt.

“The Golden Square ‘gift giver’ formula has been designed to help shoppers be practical with their budget this year and think responsibly about how much they can afford to indulge, while keeping the joy of the Christmas shopping experience alive.”

The formula takes into account two key factors: your current financial situation as well as the closeness to the person you are spending for to help cash-strapped customers budget wisely and not rely on debt to help them get through the season.

So what is the magic formula?

Average spend - Financial situation X Closeness = CHRISTMAS SPEND

To work this out you:

1. Take the average amount you spend on most gifts.

Do this by taking the total amount you spend and divide it by the number of people you buy for (exclude your partner or anyone you spend a lot more on).

2. Reduce the amount to take account of your financial situation.

Unless we’ve won the lottery, we should all take off 5% for austerity/inflation or up to 20% if you’ve hit harder times.

3. Adjust that amount for closeness*.

Add half as much again for someone you are very close to. But consider spending just a quarter of that amount for anyone you are buying for out of obligation.

*The Closeness Scale

See where the person you are buying for fits on the scale below. Then adjust the amount that you spend.

I’m just buying this person a present out of habit/obligation.I’m buying this person a present partly out of obligationI’m buying them a present because we are closeI’m buying them a present because we are very close
Divide by 4
Divide by 2

Multiply by 1.2

Multiply by 1.5

So, for example, a person spending £300 on 10 people last year, reduced 5% for inflation and buying it for a person partly out of obligation, should spend just £14.25 on their gift.

With ‘Panic Saturday’, traditionally the busiest day for Christmas shopping, around the corner on Saturday 17 December, this gift giver formula is sure to help savvy shoppers keep festive while analysing their spending habits.

Ian Cox, Marketing Manager at Golden Square said: “Our Golden Square ‘gift giver’ formula will help shoppers stick to their spending resolutions whilst still being able to enjoy the fun of gift giving over Christmas.

“We have some specially trained Customer Service representatives in the centre who are available during the festive season to help shoppers calculate what they should be spending.”

With so many people suffering job losses in the past twelve months the formula considers that if someone has been harder hit financially during the past year this should be reflected in a smaller spend on gifts and more consideration on stopping gift giving for people that we buy token gifts for purely out of obligation. Professor Pine’s retail rules consist of appropriateness, empathy and effort.

Professor Karen Pine concludes: “Gift giving is a social, cultural and economic experience that exists across all across human societies. It is extremely important for maintaining social relationships and expressing feelings. However, sometimes these feelings give way to a sense of obligation, buying for the sake of it, or even competitiveness, spending too much so as not to appear mean.

“Using the ‘gift giver’ formula will help to bring back the real meaning to gift giving. It reminds us to just give presents to those people we are close to. If that means not giving to those who have become an ‘obligation’, that makes sound economic sense.”

New Move to Use Robots for Stroke Rehabilitation

Researchers at the University of Hertfordshire have just begun a three-year project, which uses robots to help people to recover from strokes.

Dr Farshid Amirabdollahian, an expert in rehabilitation robotics and assistive technologies and a senior lecturer in adaptive systems at the University's School of Computer Science is co-ordinating a new FP7 European project called SCRIPT - Supervised Care and Rehabilitation Involving Personal Tele-robotics.

The project team plans to develop robotic devices, which will facilitate repetitive movement of the hand and wrist to be delivered during the chronic phases of stroke rehabilitation.

"The project focus on hand and wrist exercise presents the least researched area in this field and has the potential to make a big contribution to personal independence," said Dr Amirabdollahian. “Our developed prototypes will be available for home use and in a motivating and engaging context, which should provide easier and more frequently available tools, which should in turn affect the patient recovery”.

Read more

Wednesday, 7 December 2011

New Research into Robotic Companions for Older People

Researchers at the University of Hertfordshire are developing a robotic system which will be a suitable companion for older people.

Dr Farshid Amirabdollahian, a senior lecturer in Adaptive Systems and expert in Rehabilitation Robotics and Assistive Technologies at the University is coordinating a new FP7 European project called ACCOMPANY – Acceptable Robotics Companions for Ageing Years – which will develop a robot to assist with everyday tasks in the home. The principal investigator for this project is Professor Kerstin Dautenhahn who has a substantial track record in human-robot interaction studies and companion robots.

Over the three-year period of the project, the researchers will carry out research in the University’s Robot House. They will use a Care-o-bot® 3 to carry out a wide range of studies with older people to assess their requirements and acceptance of the robot as part of an intelligent home environment. Results will then be fed back to adapt the technology so that it better suits user demands and preferences.

“The envisaged relationship between the user and the robot is that of co-learner, whereby the robot and user provide mutual assistance and so that the user is not dominated by technology, but feels empowered by it,” said Dr Amirabdollahian. “Our aim is to use the robot to increase independence and quality of life.”

 Read more

Investigating Food Safety Practices in UK Kitchens

Researchers at the Universities of Hertfordshire and Newcastle have been commissioned by the Food Standards Agency (FSA) to look at food safety practices in UK kitchens.

Dr Wendy Wills at the University’s Centre for Primary and Community Care will lead an 18 month project to explore what people do in their kitchens and how design, appliances and other resources like hot water influence how food is stored, prepared and eaten and whether this is related to the level of bacteria in domestic kitchens.

The researchers will use a variety of methods to fully interrogate the kitchen life of 20 case study households across the UK, including video recording, photography, drawing maps and swabbing for bacteria. The results will help the FSA in future activity and communication with a range of stakeholders about how rates of foodborne illness can be reduced.

“The importance of understanding domestic food safety practices has become a high priority for the FSA, particularly in relation to groups known to be vulnerable to foodborne disease, including the over 60s and pregnant women,” said Dr Wills. “In order to understand why people do what they do, we need to explore all aspects of the kitchen and the role it plays for the entire household.”

Tuesday, 6 December 2011

Care of chronic diseases is moving out of hospitals – but are patients happy with this?

Joan is a patient with diabetes who has been managed by the Diabetes Consultant at the hospital for many years. She has confidence in knowing that she is seen by a specialist. Then she is told that her care can be as well managed by her GP surgery. When she turns up at the surgery she finds that it is the Practice Nurse who will be mainly managing her care now. Joan frets that the standard of care may not be so good as she is no longer being seen by a “specialist”.

Primary care led diabetes management reflects a move of chronic disease care away from the hospital setting, and is seen as the most appropriate way of managing stable long term conditions. However, a paper recently published by myself and colleagues in the International Journal of Nursing Studies explores the response of patients to care being moved out of hospitals. We found that patients were more at ease with their chronic disease being managed by the hospital which they regarded as having specialist expertise in a particular chronic disease. When asked how they would feel if their care was to be managed mostly by a primary care based nurse who had received extra training in that condition, the response was commonly one of mistrust, but they would go onto say that it was probably more because they were just simply used to seeing a consultant.

There appears to be a fundamental issue with patients’ assumptions about who is competent and appropriate to review their condition. It seems that many of the public are not aware of the significant steps nursing has taken in advancing their competencies in chronic disease management. For example,  the majority of nurses working in this area are independent prescribers following extensive training. We suggest there is a need to increase public awareness about what to expect in the management of their condition and the qualifications and experience of those practitioners they are likely to encounter.

Dr Patricia Wilson is the Research Lead for Patient Experience & Public Involvement at the University of Hertfordshire's Centre for Research in Primary & Community Care.