MedWorm provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest medical blog items that have been tagged with 'interdisciplinary'. Sat, 03 Sep 2011 02:32:19 +0100 http://www.medworm.com/index.php?rid=5140334&cid=t_183752_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F08%2F18%2Feducation-or-a-cognitive-behavioural-approach%2F In this study by Day, Thorn & Kapoor, the two approaches were used with a group of people from a rural area, with relatively low socio-economic status, and a reading grade level of about 8.  Both groups received a group-based programme of 10 sessions of 90 minutes.  They both received a workbook and additional reading material.  The CBT group had home-learning and also participated in behavioural activities such as relaxation in-session, while the education group did not. Interestingly, this study presents qualitative information on how participants experienced the sessions, rather than outcomes measures, so it’s difficult to establish whether pain, disability, mood or acceptance were influenced.  Instead it presents thematic analysis from in-depth interviews of the participa... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=5140334 Wed, 17 Aug 2011 19:35:42 +0100 5140334 http://www.medworm.com/index.php?rid=5119027&cid=t_183752_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F08%2F12%2Fnot-just-neural-plasticity-health-system-plasticity%2F In chronic pain management there seems to be a pretty consistent pathway for people to finally get to interdisciplinary treatment.  First a referral from the primary care physician or GP to one or more specialist medical people – maybe an orthopaedic surgeon, or a rheumatologist, or a psychiatrist, or a neurologist.  This person will carry out investigations, get the results, make a determination that the problem is “not theirs” – and suggest some kind of management, or a referral to another kind of orthopaedic surgeon, or a rheumatologist, or a psychiatrist, or a neurologist… who will repeat the same. Finally, after many investigations and referrals and consultations, around 3 years later, the person makes it to a chronic pain management centre.  (btw I am... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=5119027 Thu, 11 Aug 2011 20:17:04 +0100 5119027 http://www.medworm.com/index.php?rid=5062519&cid=t_183752_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F07%2F25%2Fusing-the-chronic-pain-acceptance-questionnaire%2F Over the past few months I’ve been using the Chronic Pain Acceptance Questionnaire (CPAQ-8) as part of a battery of questionnaires used at intake and outcome measures.  Along with the CPAQ-8, we use the Tampa Scale for Kinesiophobia, the Depression Anxiety Stress Scale, the Pain Anxiety Symptoms Scale, the Pain  Catastrophising Scale, Pain Self Efficacy Questionnaire, and Pain Disability Index. The CPAQ-8 consists of two subscales: Pain Willingness and Activity Engagement.  Together they measure “acceptance” or psychological flexibility associated with chronic pain. Let me pull this apart a bit.  Pain Willingness refers to how prepared a person might be to experience an increase in pain so they can get something important done.  For example, I love to dance and I&#82... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=5062519 Sun, 24 Jul 2011 19:15:16 +0100 5062519 http://www.medworm.com/index.php?rid=4945248&cid=t_183752_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F06%2F17%2Fwhat-to-do-about-catastrophising-even-when-youre-not-a-psychologist%2F In this study, 25.9% of those reporting acute pain, and 51.3% of those reporting chronic pain endorsed catastrophising beliefs.  And this group of people were not seeking treatment (as an aside, this is one of few studies to look at non-treatment-seeking people)!  The study also found that in those with high levels of catastrophising, mental health problems were more prevalent, and that catastrophising explained a good proportion of work disability.  In other words, even in this very healthy group of people, catastrophising was associated with greater vulnerability to having difficult managing pain and keeping mentally healthy.  If this finding is identified in other non-treatment-seeking people, I think we can confidently draw the conclusion that catastrophising may be one of the more... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4945248 Thu, 16 Jun 2011 23:24:01 +0100 4945248 http://www.medworm.com/index.php?rid=4803558&cid=t_183752_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F05%2F10%2Fcatastrophising-and-maybe-what-to-do-about-it-for-subacutechronic-pain%2F This study is also an excellent one for looking at process, or how people change over time using a daily diary method. The finding in this paper suggests that one way for helping people be more resilient and modify their tendency towards catastrophising might be to help them identify and then pursue positive experiences during each day.  Scheduling pleasant or enjoyable events as part of a daily routine is certainly something any clinician can do, and often those pleasant events can be physical, such as going for a walk, playing with the kids, or even doing some stretches. Finally (but not the final word!), a study by McKnight and colleagues looked at the mediating effect of self efficacy on the relationship between catastrophising and disability.  In this study, participants with early ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4803558 Tue, 10 May 2011 02:18:40 +0100 4803558 http://www.medworm.com/index.php?rid=4780495&cid=t_183752_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F05%2F04%2Fmore-psychological-stuff-isnt-in-my-scope-of-practice-so-what-can-i-do%2F I promised there would be more on this topic – it’s a popular one and full of vexing questions.  I left off yesterday, after making four points that IMHO might help incorporate some of the psychosocial management to a nonpsychological practice.  They were: Give precise advice about what to do. Give reasons for your advice. Ask the person about their understanding of their pain. Make sure you give clear timeframes for any activity restrictions. The underlying rationale for each of these is to counter two main problems that appear to underpin the development of longterm disability associated with pain: catastrophising, or ‘thinking the worst’, and avoidance. This point is really important, so listen up! It’s not the presence of pain alone that is the problem.�... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4780495 Tue, 03 May 2011 19:32:40 +0100 4780495 http://www.medworm.com/index.php?rid=4775617&cid=t_183752_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F05%2F03%2Fpsychological-stuff-isnt-in-my-scope-of-practice-so-what-can-i-do%2F A common cry from various clinicians who work in the field of pain management but who are not psychologists is “but now what?” when they recognise that a key factor in recovery is something psychosocial. The answer is not, I suspect, heading off to become a psychologist! For several reasons, I think it’s critical for non-psychologists to get comfortable with psychosocial language and principles. All clinicians use psychological principles in their interactions with patients.  Like it or not, when we give advice or encouragement we’re using knowledge gleaned from psychological study.  We might call it something like “developing rapport”, but no matter what we call it, these interpersonal skills are psychosocial in nature.  If we use these approaches, ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4775617 Tue, 03 May 2011 00:22:24 +0100 4775617 http://www.medworm.com/index.php?rid=4677137&cid=t_183752_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F04%2F05%2Fwhat-is-coping%2F When we use the word ‘coping’, what do we mean? Recently, I’ve been reviewing the whole concept of coping in chronic pain.  I’m trying to establish how people with chronic pain view this term, and what they include in their repertoire of ways to cope.  My research is looking at the ways that people who cope well with their pain, and never need input from a chronic pain management team, do so.  And in doing this research, I’m hitting some conceptual snags. The thing is, coping as a concept isn’t defined all that well.  Some definitions refer to the outcome of coping: “he coped well with that” meaning “he managed that stressor in a positive way and the outcome was good”; some definitions refer to the process of coping and don&#8... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4677137 Tue, 05 Apr 2011 06:55:06 +0100 4677137 http://www.medworm.com/index.php?rid=4653616&cid=t_183752_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F03%2F30%2Fwhat-do-people-expect-when-they-get-referred-to-a-pain-management-centre%2F This study also found that many people didn’t feel they had been heard, or taken seriously prior to being referred. Participants in their study “needed to feel legitimated in the sick role, and part of the reason for wanting to know the cause of the pain was a desire to seek legitimacy in the eyes of others.” They made an interesting observation in that participants ranked the statement “I would like to have a better understanding of my pain” fifth on the list of 10 statements, and in the focus group discussion, identified having a diagnostic label as something different from having a better understanding. Allcock, Elkan and Williams suggest that “It was not so much personal understanding of their pain that they needed to legitimise it, as a diagnostic l... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4653616 Tue, 29 Mar 2011 18:25:34 +0100 4653616 http://www.medworm.com/index.php?rid=4536195&cid=t_183752_122_f&fid=35066&url=http%3A%2F%2Fneurodudes.com%2F2011%2F03%2F02%2Fmemory-oriented-computing-and-from-microprocessors-to-nanostores%2F I’ve only skimmed this article by Ranganathan, but I find it notable because of the discussion of memory-oriented computing, in which processors are colocated with storage (he uses the word “nanostores”, which additionally implies that the memory is nonvolatile). One of the most important distinctions between neural architecture and present-day computing architecture is that brains appear to be built out of computing elements that do both processing and memory storage, whereas present-day computers have separate memory and CPU components (this separation is a key feature of what is called the “von Neumann” architecture). This separation means that computation is often rate-limited by the speed at which information can be transferred between memory and the CPU... neurodudes blogs http://www.medworm.com/rss/comments.php?id=4536195 Wed, 02 Mar 2011 05:26:10 +0100 4536195 http://www.medworm.com/index.php?rid=4455498&cid=t_183752_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F02%2F09%2Fmore-on-choosing-chronic-pain-questionnaires%2F Mood and anxiety - depression, anxiety and pain-specific anxiety were chosen because of their importance to outcomes, and the need to treat psychopathology Catastrophising – because this is thought to be one of the most important aspects of cognition that needs to be addressed Pain-related anxiety and avoidance – because this appears to be one of the strongest predictors of ongoing disability Acceptance – this domain has been emerging as an increasingly important treatment process variable, and may be a target for intervention Pain location and intensity - yes, we do ask, just in case you wondered! Pain self efficacy – again, this seems to be an important process variable, and a target for treatment.  It’s also associated with higher levels of disability. Pain-related disability... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4455498 Wed, 09 Feb 2011 08:56:40 +0100 4455498 http://www.medworm.com/index.php?rid=4450530&cid=t_183752_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F02%2F09%2Fchoosing-chronic-pain-questionnaires-2%2F In my last post I started to discuss the questionnaire domains that can be used in a battery of questionnaires for chronic pain.  Today it’s time to turn to the specific measures that we’ve chosen as part of a set that a group working across the public health system in New Zealand have selected.  It’s hoped that eventually the responses from these questionnaires will be as available within the national DHB patient information system as the results from radiology and lab tests.  Imagine that! Below are the domains as I indicated yesterday. Mood and anxiety - depression, anxiety and pain-specific anxiety were chosen because of their importance to outcomes, and the need to treat psychopathology Catastrophising – because this is thought to be one of the most important as... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4450530 Tue, 08 Feb 2011 18:31:33 +0100 4450530 http://www.medworm.com/index.php?rid=4446048&cid=t_183752_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F02%2F07%2Fchoosing-chronic-pain-questionnaires%2F Choosing a set of questionnaires for an assessment battery can be a task fraught with all kinds of traps, because if there is one thing bound to get clinical tongues flapping, it’s the idea that their favourite questionnaire will be left out of the mix! And to complicate matters for us Southern Hemispherians, most of the research into normative data for questionnaires is North American, so it can be a long, quite tedious and epic job to arrive at a set that covers all the basic domains, doesn’t give the client questionnaire-fatigue, and uses psychometrically-sound  instruments. At the Centre where I work, the set of questionnaires has just been reviewed and, working with a number of clinicians from around the country, we have arrived at a set that seems to be a reasonably work... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4446048 Mon, 07 Feb 2011 05:53:13 +0100 4446048 http://www.medworm.com/index.php?rid=4419467&cid=t_183752_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F02%2F01%2Foccupational-therapy-the-cognitive-behavioural-approach-for-pain-management-ii%2F In the first post on my commentary of Robinson, Kennedy and Harmon’s review of occupational therapy for chronic pain, I argued that they have misinterpreted the cognitive behavioural approach to pain management, and in particular, that they appear to hold an outmoded view of pain as either biological/organic or psychological, and refute the place of psychosocial models in occupational therapy practice. Yesterday I distinguished between cognitive behavioural therapy and a cognitive behavioural approach - while the therapy is often primarily concerned with ‘talk’ therapy followed by behavioural changes to improve mood for example, a cognitive behavioural approach is a broader concept that is based upon the assumption that people are able to make changes in the way they unde... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4419467 Mon, 31 Jan 2011 17:46:19 +0100 4419467 http://www.medworm.com/index.php?rid=4419468&cid=t_183752_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F01%2F30%2Foccupational-therapy-the-cognitive-behavioural-approach-for-pain-management%2F I have always resisted being labelled. I am much more than my gender, my marital status, my diagnosis, my professional background.  I also feel quite uncomfortable about being told what I may or may not do (maybe that’s where my kids get it from?!). I don’t like being told what is and isn’t ‘my role’ or someone else’s role.  I’m interested in what works and doing it well and at the right time for the right reason.  Today’s post is the first of a two-part commentary on a paper by Robinson, Kennedy and Harmon published in the American Journal of Occupational Therapy this month in which it is argued that occupational therapists who offer cognitive behavioural therapy ‘without sufficient attention to occupational therapy’s professi... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4419468 Sat, 29 Jan 2011 19:00:53 +0100 4419468 http://www.medworm.com/index.php?rid=3133702&cid=t_183752_122_f&fid=35066&url=http%3A%2F%2Fneurodudes.com%2F2009%2F12%2F30%2Fnew-brain-model-applied-to-%25e2%2580%259cpythagorean-harmonics%25e2%2580%259d%2F Neurodudes kindly allowed me to post links to my “alternative brain models” in 2006 ( http://neurodudes.com/2006/09/14/new-brainmind-theory/ ) and 2007 ( http://neurodudes.com/2007/02/24/more-on-quad-nets-new-brainmind-theory/ ) and I hope a third occasion is permitted as there is no comparable resource for a person like me.  I am an amateur in brain science but have a solid technical background (B.S.E.E. MIT; M.A. Physics/Materials Science, UC Berkeley). I have developed a new class of proposed devices called “timing devices.”  Timing devices are idealized models of neurons, with a variety of forms and components.  The timing devices system resembles that of components (resistances, capacitances, transistors, etc.) used in standard electronic circuits.  In both cases, there is... neurodudes blogs http://www.medworm.com/rss/comments.php?id=3133702 Wed, 30 Dec 2009 17:51:53 +0100 3133702 http://www.medworm.com/index.php?rid=2836350&cid=t_183752_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F09%2F28%2Ffibromyalgia-time-for-the-rheumatologists-to-hand-over%2F The American College of Rheumatologists developed diagnostic criteria for fibromyalgia in 1990, the culmination of many years of debate and disparagement of the existence of this pain problem.  At the time, it was thought that it was a rheumatic complaint due to the presence of body pain and soft tissue tenderness, so the diagnosis and management of it was firmly in the rheumatologists camp.  Research over the last few years shows that it is in fact a pain syndrome centered in the nervous system. Two rheumatologists now suggest that fibromyalgia should no longer be managed by rheumatologists and it should be handed over to…primary care physicians. The information above is drawn from an editorial by Shir and Fitzcharles, in The Journal of Rheumatology 2009; 36:4.  What does this st... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2836350 Sun, 27 Sep 2009 18:33:09 +0100 2836350 http://www.medworm.com/index.php?rid=2705211&cid=t_183752_122_f&fid=35066&url=http%3A%2F%2Fneurodudes.com%2F2009%2F08%2F16%2Ffrontiers-in-neuroscience-journal%2F The journal, Frontiers in Neuroscience, edited by Idan Segev, has made it Volume 3, issue 1.  Launching last year at the Society for Neuroscience conference, its probably the newest Neuroscience-related journal. I’m a fan of it because it is an open-access journal featuring a “tiered system” and more.  From their website: The Frontiers Journal Series is not just another journal. It is a new approach to scientific publishing. As service to scientists, it is driven by researchers for researchers but it also serves the interests of the general public. Frontiers disseminates research in a tiered system that begins with original articles submitted to Specialty Journals. It evaluates research truly democratically and objectively based on the reading activity of the scienti... neurodudes blogs http://www.medworm.com/rss/comments.php?id=2705211 Sun, 16 Aug 2009 21:02:16 +0100 2705211 http://www.medworm.com/index.php?rid=2667558&cid=t_183752_122_f&fid=34736&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FChannelN-PodcastsPoweredByOdiogo%2F%7E5%2FPI6HXcjX_nE%2Fav-npi-rs8 [Image by Ben Harris-Roxas] Bringing Psychology’s “Positive Psychology” to Psychiatry Bridging a gap between psychologists and psychiatrists to apply lessons from positive psychology. A bit slow-paced but a good perspective. Direct video link, or listen to the preview podcast. (Source: Channel N) Channel N blogs http://www.medworm.com/rss/comments.php?id=2667558 Tue, 04 Aug 2009 02:28:21 +0100 2667558 http://www.medworm.com/index.php?rid=2442923&cid=t_183752_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F05%2F26%2Fthe-complexities-of-interdisciplinary-teams%2F Pain management, especially chronic pain management, is characterised by using an interdisciplinary approach rather than a multidisciplinary one. Distinguishing between the two can be a case of splitting hairs at times, but the fundamental difference is that in multidisciplinary teams, treatment is carried out by different team members who may work with the patient concurrently, but not necessarily using the same underlying model or framework for treatment. In an interdisciplinary team, treatment is carried out by different team members using a common model to address common goals – working collaboratively and in close communication with each other. Interdisciplinary teams take time to develop. The members of the team learn more about each other’s professional roles the longer ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2442923 Mon, 25 May 2009 19:26:23 +0100 2442923 http://www.medworm.com/index.php?rid=2232622&cid=t_183752_122_f&fid=35066&url=http%3A%2F%2Fneurodudes.com%2F2009%2F03%2F03%2Fneuroengineering-in-wired%2F Rewiring the Brain: Inside the New Science of Neuroengineering. Interviews Boyden and Deisseroth. Follow the link a video of an optogenetically controlled mouse. (Source: neurodudes) neurodudes blogs http://www.medworm.com/rss/comments.php?id=2232622 Tue, 03 Mar 2009 04:27:15 +0100 2232622 http://www.medworm.com/index.php?rid=2188754&cid=t_183752_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F02%2F16%2Ftalking-about-roles-in-pain-management%2F If you’ve missed it before, you won’t in the future: I don’t like turf protection in pain management!  If there is one thing people experiencing pain really need, it’s consistency from all the people working with them - and the second thing they need is more people doing good pain management.  So IMHO there is no room for health professionals staking out an area and saying ‘its mine all mine’. Nevertheless, there are certain areas of greater or lesser specialisation, and I’m not suggesting pain management becomes an area like many mental health ones, of generic ‘case management’. What I am suggesting is elimination of the phrase ‘the [insert professional title here] role in pain management is…’ What I’d like to... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2188754 Sun, 15 Feb 2009 17:58:42 +0100 2188754 http://www.medworm.com/index.php?rid=1675520&cid=t_183752_122_f&fid=36582&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2FSharpBrains%2F%7E3%2F352747552%2F My brain is honoured to have been nominated to participate, together with the rest of my body of course, in a new initiative by the World Economic Forum. The Global Agenda Councils have a fascinating charter: - "Global Agenda Councils will challenge prevailing assumptions, monitor trends, map interrelationships and address knowledge gaps. Equally important, Global Agenda Councils will also propose solutions, devise strategies and evaluate the effectiveness of actions using measurable benchmarks." - "In a global environment marked by short-term orientation and silo-thinking, Global Agenda Councils will foster interdisciplinary and long-range thinking to address the prevailing challenges on the global agenda." The Inaugural Summit on the Global Agenda in Dubai (November... SharpBrains blogs http://www.medworm.com/rss/comments.php?id=1675520 Fri, 01 Aug 2008 16:17:04 +0100 1675520 http://www.medworm.com/index.php?rid=1458425&cid=t_183752_125_f&fid=34820&url=http%3A%2F%2Fwww.dentalblogs.com%2Farchives%2Fcranham%2Fmedical-and-dental-collaboration%2F There’s no question that when patients have problems with TMJ or occlusal issues causing pain, collaboration between medical doctors and dentists is imperative. Henry Gremillion, who is setting up the medical/dental arm of the Dawson Center curriculum, was the past director of the Facial Pain Center at University of Florida. He has some invaluable resources and knowledge about how ENTs, neurologists, and psychologists can assist a dentist in an interdisciplinary approach to deal with pain. When a physician or dentist focuses on his limited area of expertise, the patient can suffer. Some patients have many problems wrapped up in a set of symptoms. As we treat more complex problems, aligning ourselves with a good team that includes physicians will help the patient. I believe that this ... dental blog for dentists about dentistry blogs http://www.medworm.com/rss/comments.php?id=1458425 Tue, 20 May 2008 13:35:25 +0100 1458425 http://www.medworm.com/index.php?rid=1090451&cid=t_183752_122_f&fid=35066&url=http%3A%2F%2Fneurodudes.com%2F2007%2F12%2F12%2Fwhere-are-we-with-this-whole-free-will-thing%2F Haim Sompolinsky has written an excellent book chapter on the scientific view of free will and choice, pulling in good ideas from physics and neuroscience along with contemporary philosophical commentary. I think this chapter might be helpful for neuroscientists outside of the lab. Often a dinner table discussion has moved to the idea of “quantum consciousness” or “quantum free will”. Often, someone will mention Roger Penrose, who has become something of a poster boy for this idea that quantum indeterminacy (eg. Heisenberg’s uncertainty principle) is one possible way that free will is really free. And then, people look around and say, “Well, you’re a neuroscientist. Do we have free will?” (And that’s when I take another big drink or bi... neurodudes blogs http://www.medworm.com/rss/comments.php?id=1090451 Wed, 12 Dec 2007 14:31:43 +0100 1090451