Book: Psyche on the Skin

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Psyche on the Skin

"Psyche on the Skin charts the secret history of self-harm. The book describes its many forms, from sexual self-mutilation and hysterical malingering in the late Victorian period, to self-castrating religious sects, to self-mutilation and self-destruction in art, music and popular culture. Sarah Chaney’s refreshing historical approach refutes the notion that self-harm has any universal meaning – that it necessarily says something specific about an individual or group, or that it can ever be understood outside the historical and cultural context of a particular era. " Reaktion Books

Sarah Chaney‏ @kentishscribble

My source:
RCN BULLETIN, February 2017, p.11.

Paper: "Defining Health in the Era of Value-based Care ..." mapped to Hodges' model

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Q. What is value? Demand (Individual) freedom to lead lives they have reason to value [Why we need a global generic conceptual framework:  Self care =  transformation of Demand into Supply] Patient Reported Outcome Measures (PROMs) 'benefit' across Hodges' model? 'harm done' across Hodges' model? Shared Decision Making -  patient centred care,  choice, autonomy,  Right Care, Right Time, Right Place?*

A's.  Value = outcomes achieved – money spent (Porter) 1.Allocative value – how to allocate resources equitably in such a way that maximum value for the whole population is obtained 2.Technical value – increased value associated with improvements in quality and safety of healthcare 3.Personalised value – individual patient values, in combination with best evidence and assessments of the person’s condition. (Gray) Supply - Outcomes PROMS: hip replacement, knee replacement, groin hernia and varicose veins Right Care, Right Time, Right Place Chronic disease Improving medical technology

Demand Social determinants of health "Unlimited healthcare intervention provision may lead to increased harm." Friends and Family Test Person- and community-centred approaches, such as peer support, self-management education, health coaching, group activities and asset-based approaches. Local - Community - National Porter recommends classification of outcomes in three tiers [16]. Tier one is ‘Health status achieved or retained’, including measures such as survival at one or five years, or for those with life-limiting conditions, the degree of health or recovery achieved or maintained. Tier two, ‘Process of recovery’, includes the time taken to return to normal activities and disutility of care, such as errors and adverse events in care, incorrect diagnosis, and discomfort. Tier three is ‘Sustainability of health’ and includes recurrence and long-term consequences of treatment.

"The definition proposed by Gray ... defines value in healthcare as ‘the net benefit, that is the difference between the benefit and the harm done by a service, taking into account the amount of resources invested’" Supply - Outcomes Health Economics limited healthcare budgets Governments - Industries Relationships demand - drug costs Moving FROM: cost-effectiveness and pay for performance TO: Value-based pricing Healthcare-associated harm Value-based healthcare has the potential to be used in local and national priority setting and policy development.

*This brief paper provides a very good outline of value-based care. 'Mental' in this paper is mentioned early on in a definition of health, thereafter you will find 'mental' in funda-mental, environ-mental plus incre-mental. 'Mental health' and values-based care will no doubt be discussed elsewhere. This brief paper suggests however, that we really do need a generic conceptual framework for health and social care. To be fully-realised value-based care must also reach, encompass and incorporate mental health and public mental health.


Gentry S, Badrinath P (March 06, 2017) Defining Health in the Era of Value-based Care: Lessons from England of Relevance to Other Health Systems. Cureus 9(3): e1079. DOI 10.7759/cureus.1079

Editorial: Exploring the relationship of threshold concepts and Hodges’ model of care from the individual to populations and global health

At the end of July I was contacted by the editor of the journal Revista CUIDARTE published by Programa de Enfermería de la Universidad de Santander UDES and invited to write an editorial. There were publication guidelines and a deadline: two weeks. Despite my astronautic aspirations my feet remained on the ground as I realised that I am surely filling a gap.

There were other family pressures at the time, but I already had the draft paper on Hodges' model and threshold concepts. After some thought and work the draft was reduced from 5600 words and 56 references to 3600 and 20 references. The example of Deprivation of Liberty was removed to include more generic subject matter in the themes of global health and development.

Whatever the reason (and editors please note...) I greatly appreciate this opportunity to further disseminate Hodges' model and threshold concepts. Greater still is the privilege to contribute to a community who provided me with one of the highlights of my nursing career in 2011.

Here is a video introduction (English):

Exploring the relationship of threshold concepts and Hodges’ model: https://t.co/BRMJRjguwK a través de @YouTube

— Revista CUIDARTE (@RevCuidarteUDES) August 31, 2017

Jones, P. (2017) Exploring the relationship of threshold concepts and Hodges’ model of care from the individual to populations and global health. Revista Cuidarte. 8(3): 1697-720.

Every Third Thought

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Every Third Thought	First ...
Fourth.	Second ...

My source: Lewis, R. (2017) An immense personal insult - how the baby boomers see death. Saturday Review, The Times. p.13.

"Mapping the drivers of overdiagnosis to potential solutions" (re-)mapped to Hodges' model

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the patient  Beliefs: “More is better,” “new is better,” “early is better,” “wants to know/screen”—even if currently healthy, imperative of possibility (we have to test because we can) overtreatment - emotional cost Ethics: medical awareness of benefits vs harms risk of overtreatment - as psycho-(somaticpathology)	the patient  the health system industry, professionals Rigorous assessment of impact of ever more precise tests and investigations Medicalisation of life;  fear of ageing, sickness, or death QUANTITY (less is more) Update medical curricula and -
culture - Beliefs: “More is better,” “new is better,” “early is better,” “wants to know - screen”—even if currently healthy, imperative of possibility (we have to test because we can) patients and the public awareness (social evolution of 'illness behaviour'?) QUALITY - outcomes overtreatment - social cost Role of social media	- continuing education   Ecological economics to frame overdiagnosis as overconsumption Application of the 'precautionary principle' (as adopted as a universal policy foundation?) industry, professionals medicolegal concerns regards  missing or delayed diagnosis overtreatment - economic cost

KEY:
drivers of overdiagnosis
solutions of overdiagnosis
 (I have overlapped these.)

The medicalisation of life also fits with Hodges' model and the concept of the 'health career'.

http://www.bmj.com/content/bmj/358/bmj.j3879.full.pdf

See also: BBC Radio 4 22 August 2017
Too Much Medicine? The Problem of Overtreatment

My source:

Dear List
Ray Moynihan, a member of our list, sent me the following email about his very important work on Overdiagnosis:
---------- Forwarded message ----------
From: Ray Moynihan
...
Hi Mohammad,
Just wondering if you wanted to send this to the email list/s you run - we've put a bit of work into it- and it may be of interested to many of the people on the list.

Dear colleagues,
This piece of BMJ Analysis, based on explicit search of literature, just out in BMJ this morning, may be of interest:
Mapping the drivers of overdiagnosis to potential solutions

http://www.bmj.com/content/358/bmj.j3879

Cheers, Ray

Mohammad Zakaria Pezeshki, M.D.
Associate Professor
Department of Community Medicine,
Tabriz Medical School, Golgasht Avenue, Tabriz, Iran,

Book: Knowledge and Action (open access)

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KNOWLEDGE	ACTION

Knowledge and Action

There are of course many types of knowledge. There must be if our muscles can also be said to have a 'memory'. Here I am referring to the cognitive phenomena of an individual's possession of knowledge and how this is elicited, assessed and expressed clinically, educationally and in our day-to-day experiencesl. Clearly knowledge is, or should be translated into practice with evidence in the actions that follow.

This new, open access book on "Knowledge and Action" is a valuable and timely arrival. Timely as chapter 12 - Semantic Knowledge, Domains of Meaning and Conceptual Spaces is by Prof. Peter Gärdenfors. It is already a year since the last Conceptual Spaces Workshop in Sweden.

There are also two chapters related to healthcare.

Part of the utility of Hodges' model lies in how it can encompass knowledge (in all its forms), action AND space, the latter is also a key focus of the text. In addition I often added the concepts of subjectivity and objectivity to posts. The quote below from the book which I am citing at length to retain the meaning is also interesting as it could apply to Hodges' model as a whole. Hodges' model is multicontextual and situated. In addition:

We might also say that healthcare is invariably intersubjective; into which the evidence-based ethos would have us inject the largest dose possible of objectivity through scientific and/or political means(?).

Please see the specific chapter for the references in what follows:

Current theories of practice constitute an effort to reformulate the Aristotelian conception of phronesis, which implies that practice is seen as the basis and purpose of theoretical knowledge (Flyvbjerg, 2001). That conception also implies an escape from the dualism of the subjective and objective (Bernstein, 1971; Stern, 2003, p. 185). Schatzki is seen as one of the leading thinkers in this approach, and he bases his practice theory on a new societal social ontology in which the dualism of ontological individualism and holism is overcome (Schatzki, 2006). He calls his new ontology site ontology, defining site as a type of context in which human coexistence takes place and which also includes the social entities themselves. Social events can thus be understood only through an analysis of this site. The close relationship between this concept of site and the geographic concept of place^# (Tuan, 2001) is evident:  

    Practice theory places practices at the center of the socio-human sciences instead of traditional structures, systems, events, actions. None of the practices can be reduced to a sum of its elements, which are of a complex character: they are mental and material, factual and relational, human and material, individual and supra-individual, etc. This conception also overcomes the dualism action/structure, … Each practice then operates in a typical regime, according to particular scenarios, it has its inherent normativity, etc. (Višňovský, 2009, p.391).

As an open access text this is valuable source, which I will revisit again soon.

Huib Ernste (2017) Rationality and Discursive Articulation in Place-Making. Chapter 3. In Knowledge and Action. editors: Peter Meusburger, Benno Werlen, Laura Suarsana. Vol 9. Online: Springer (Open) International Publishing.

^# I have wondered about this combination of cognition and geography -
https://hodges-model.blogspot.co.uk/search/label/cogneography
There is existing work on 'psychogeography' post to follow.

My source for this book with thanks: Library | Lancaster University

A primitive Pythagorean triple

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	Today's date is a primitive Pythagorean triple. pic.twitter.com/2j0BAwUtkS — Algebra Fact (@AlgebraFact) August 15, 2017

Happy 40th to me #NHS!

Fences too far? Prevention, Health Education and Promotion

On my community visits I see many horses out in the fields. There are 'horses' in information systems too:

What are "horses"?

“As an intentional nod to Clever Hans, a 'horse' is just a system that is not actually addressing the problem it appears to be solving.” (Sturm, 2014).

In healthcare we keep talking about the need for more emphasis on prevention, health education and promotion. So much of what we do is not futile, despite the growing^* debate on euthanasia, but as a 'system' that incorporates and enacts prevention, health education and health promoting principles (and literacies) we continue to fail. In short, the healthcare system is a horse as defined by Sturm.

I'm certain - even without evidence (intuition influenced by the quality^# media?) that public health AND public mental health have been going backwards. Or if you like, the politicians keep talking the talk but this is limited to the political domain (or paddock)? So many promises in the form of committees, consultations, green, white papers that could be betting slips. In fact the government seems to favour those betting slips or the associated behaviours that produce tax revenue as opposed to the 25 year cross-party plan that would really herald change. This level of change will take longer and would be realised in younger people. Perhaps there are signs of change as many young adults eschew drugs and alcohol (UK)..?

There are two ways in which Hodges' model is a horse; or not:

1. Firstly, there is (still) no information system based on Hodges' model that might appear to be solving a problem.
2. Secondly, Hodges' model has not really had the opportunity to address the health and social care problem. As such it cannot be judged in such equestrian terms.

In the meantime the horses remain in their respective paddocks. Some are racing about, others jumping, a group do dressage, while increasing others are out to pasture - they graze and neigh-say (everything is fine DO carry on)!

^*Whatever one's respective views this debate will grow - a consequence of demographics driven through the heart of the political divide.
^#A sticky wicket then?

B. L. Sturm, “A simple method to determine if a music information retrieval system is a 'horse',” IEEE Trans. Multimedia 16(6):1636–1644, 2014. Winner of the 2017 IEEE Transactions on Multimedia Prize Paper Award.

My source: B. L. Sturm email to: http://digitalhumanities.org/humanist

HORSE2017

On “Horses” in Applied Machine Learning

Research workshop, QMUL, London

Wednesday 20 September 2017, approx. 9h30-17h 

Location: Arts One Lecture Theatre, QMUL, London E1 4NS

http://c4dm.eecs.qmul.ac.uk/horse2017/

Planetarium, Mercury

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My source: The Times, June 9 2017, p.13.

Book: A Mind at Play

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A MIND AT PLAY	A MIND AT PLAY

I still have a collection of articles on information and information theory saved from old magazines, such as, PC World, Practical Computing, PC Magazine (British), PCW and Byte. I've some specific books too that might form a collection of sorts, once they gathered together and sorted. Maths helps, but you don't need a high level of math ability to grasp the basics. It is a fascinating field and now with quantum computing, AI ... the future isn't just beckoning we're caught in its tenacious gravity field - especially as we get older!

I still have the aspiration to write a follow-up to the paper below, combining information, health and complexity. Meanwhile this book looks good summer reading...

Jones, P. (1996) Humans, Information, and Science, Journal of Advanced Nursing, 24(3),591-598.


Image: Simon and Schuster = A Mind at Play

An Inconvenient Sequel: Truth To Power

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	Rainfall Sunshine Seasons Sea Levels Hotter - TEMPERATURES - Colder Agriculture

c/o BBC Radio 4 & Facts4Life - Balance Ball

The following is taken from the transcript of the BBC Radio 4 programme "Inside Health" which I heard today and an image from the resources of Facts4Life which featured as an item.

I have always wondered what is the youngest age at which Hodges' model might be taught. I have noted before how the model can be used implicitly - guiding the professional - or explicitly with the patient or group having insight into the model. The approach of Facts4Life is well worth publicising in the ability and intelligence that children can and should be credited with ...

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... We might have somebody else who’s representing emotions, you say oh I’m feeling a bit sad and grumpy, so their hand might come off.  As each hand comes off whilst the body or the ball wobbles it doesn’t actually fall but as more and more compromises are made, there’s more and more problems to encounter, then it could get to the point where they drop the ball altogether.  And that could be oh perhaps we need a bit of help here, what could we do to help get this body back in balance. ... Green

Around year three we’ll say okay homeostasis we can explain it by using a balance ball.  So a balance ball like a yoga ball.  And the ball represents the body and then we talk to the children about how an illness might look. ... Green  Traditionally there’s been a lot of focus around very black and white concepts that you have good drugs and bad drugs.  Adults tend to make things black and white because they think that’s simplifying things and actually children are really good at grappling with big ideas. Green

Facts4Life

Do you think historically that we have been too black and white then, that we’ve sort of had health in one pocket and illness in another and never the twain shall meet? Porter I do, as a profession yes and as a society there is at the moment an easy contract between the population, as it were, and the health professionals and the contract is that whatever’s wrong with people we will deliver a solution. Toft

I also note on Facts4Life's website, the audiences they are appealing to. I see Hodges' model as being applicable to:

Students - Learners (the research community)
Carers - members of the public
Teachers - Lecturers
Policy makers and Managers

So, if you need a conceptual balance ball: here + catch!

@Facts4Life
Inside Health - BBC Radio 4

How do you define person-centredness? Editorial c/o Dewing & McCormack

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Individual values, choices and preferences* What matters to the patient. person-centredness = hard to define? compassion (the 6Cs) PERSON-	"We believe that a focus on person-centredness provides an opportunity for nursing to rise above particular theoretical 'fan clubs' and work within a coherent set of principles that are multivariate, context nonspecific and trans-specialist." Dewing & McCormack (2017). measures?
measures? A certain type (quality) of nurse-patient relationship Community of Practice Culture - isolating?	-CENTREDNESS *You can - as a nurse - ask the questions about the above, but how you advocate, realise this in nursing is very complex and challenging. policy Services (workplace)? Organisational memory=Organisational respect?

"An example is needed and will be provided next. The intention is to demonstrate the potential utility of Hodges' model to conjoin ipseity, that is; the self, individual identity and personhood with the group and population. Further studies will seek to establish how Hodges’ model can be used in case formulation not just at an individual level – were social factors inform assessments and evaluations – but in community and global health development. Hodges’ model is further suited to this task as the model supports precontextualisation by helping us to anticipate the future and recontextualization in seeking to make sense of the past. Overarching this temporal dimension is the fact that Hodges’ model by being so general and independent of any particular discipline the model is transtheoretical. There is no single theory that can explain, predict or account for the validity of Hodges’ model."
[Draft notes for an editorial that might follow? PJ ]

As the editorial describes, amid women-centred, child-centred and family centred care in Hodges' model we can place whatever the situation, or context demands at the center of Hodges' model and thereby at the focus of our care deliberations whether reflective, theoretical or practice based.

My source:

Tell me, how do you define person-centredness? https://t.co/T9fh7h3cpY @ProfBrendan @JanDewing @jclinnursing @OxINMAHR @ppr

— Prof Debra Jackson (@debraejackson) August 4, 2017

http://onlinelibrary.wiley.com/doi/10.1111/jocn.13681/epdf

Dewing, J. and McCormack, B. (2017), Editorial: Tell me, how do you define person-centredness?. J Clin Nurs, 26: 2509–2510. doi:10.1111/jocn.13681

Nurses ... console, console, yes; but don't become one ...

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subjective	console noun ​ a surface on which you find the controls for a piece of electrical equipment or a machine: a gaming console
console verb ​ to make someone who is sad or disappointed feel better by giving them comfort or sympathy: He tried to console her, but she kept saying it was all her own fault. I tried to console her with a box of chocolates. I was consoling Liz on having broken up with her boyfriend.	objective [ political objectives? ]

My source:
Whiston Hospital: Accident & Emergency & Resus, Laminated FLACC.
Face, Legs, Activity, Cry and Consolability scale for assessing pain in infants and children

See also:
Crellin D.J., Harrison, D., Santamaria, N, & Babl, F.E. (2015). Systematic review of the Face, Legs, Activity, Cry and Consolability scale for assessing pain in infants and children: is it reliable, valid, and feasible for use? Pain. Nov;156(11):2132-51. doi: 10.1097/j.pain.0000000000000305.

Dictionary entries:
http://dictionary.cambridge.org/dictionary/english/console

Thought, Formulation, Thresholds and Coherence

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"The paradigms that guide our clinical thinking are necessary. They afford us, at a minimum, the comfort (and the benefits) of being in error, rather than thrashing about in confusion. And .... they provide us with the necessary consistency, coherence and vision. ...."  (Dumont, 1993, p. 203)	Dumont: "All that is visible must grow beyond itself, and extend into the realm of the invisible." TRON
Or: "All that is invisible must grow beyond itself, and extend into the realm of the visible."

Dumont, F. (1993). Inferential heuristics in clinical problem formulation: Selective review of their strengths and weaknesses. Professional Psychology: Research and Practice, 24, 196–205.

Dumont is cited in:

Vertue, F., & Haig, B. (2008). An abductive perspective on clinical reasoning and case formulation. Journal of Clinical Psychology, 64(9), 1046-68.