All entries for March 2011

March 31, 2011

The emotional burden of diabetes and its impact on healthcare provision

Diabetes UK is holding its annual professional conference at the Internatinal Convention Centre, London ExCeL this week and Warwick Medical School has a stand in Hall A18.

Hands holding syringe of insulinThe emotional burden of diabetes is often greatly under-diagnosed and can manifest itself as depression, eating disorders, anxiety, needle phobia and severe mental health conditions. These negatively impact on self-care which leads to poorer glycaemic control and long term complications for the patient. The cost of diabetes care for someone with severe depression is 251 per cent higher than the standard cost.

Based at University Hospital Coventry, the WISDEM clinical service has developed the Diabetes Listener Service. The service, lead by Dr Jackie Sturt from Warwick Medical School, provides psychological care and up-skilling for diabetes clinicians who have no specialist psychological care training. Jackie is supported by the Trust’s Clinical Psychology service.

The Diabetes Listener Service offers up to six 45 minute appointments for people who are struggling to cope with their diabetes. These individuals are most often identified by other team members in their routine clinical consultations and a referral made if appropriate. People with diabetes experiencing high distress levels are also identified through screening using the PAID scale in specialist clinics such as the Acute Diabetic Foot service.

In the first 6 months of this service, 135 patients were screened for diabetes-specific distress using the PAID scale. On the PAID scale a normal/healthy outpatients score would be 20-33. A score of 40 to 50 indicates sub-clinical depression and over 50 indicates a diagnosis of clinical depression. From our screened population a quarter of patients scored over 50 indicating severe diabetes-specific distress and probably clinical depression.

In the same period, 29 people were referred to the Diabetes Listener Service of which 15 (over half the referred population) scored 50 and above only eight were found to be in the emotionally healthy range. This data indicates that the WISDEM diabetes clinicians demonstrate skill in identifying emotional distress in their patients although by the time the patient is referred, the distress levels are very high. So what’s needed may be annual screening which could enable us to identify and respond to this distress at an earlier stage.

Evaluation of the Diabetes Listener Service continues and we hope to present the findings at Diabetes UK APC 2012.

Dr Jackie Sturt is Associate Professor in Social and Behavioural Sciences at Warwick Medical School Warwick Institute for Diabetes, Endocrinology and Metabolism

The Warwickshire Institute for Diabetes, Endocrinology and Metabolism (WISDEM) – a specialist Centre providing treatment and support for the more complex cases of diabetes, endocrine and metabolic conditions was officially opened in January 2007 in the East Wing of University Hospital, Coventry.


March 15, 2011

Please sir, can I have some more?

Dr Jane Kidd, Associate Professor Clinical Communication, gives an insight into how first year medical students cope with their training with ‘simulated patients’

Ask any first year student studying effective communication, which aspect of teaching they want more of, and the answer is nearly always to conduct a consultation with someone ‘pretending’ to be a patient or what's known as a 'simulated' patient.

Our first years have just completed their first session with a simulated patient in the safe environment of our Medical Teaching Centre. The students are presented with various patients with a variety of symptoms and our would-be doctors are assessed on their performance. Feedback is provided around the content and communication related to three of the tasks of the consultation: opening the consultation, gathering information and establishing a relationship with the patient.

Although initially the thought of performing an interview which is being recorded is daunting for many students, this is a way of bringing together the medical theory they have studied so far, and combine it with communication skills to practice and hone their talent in a safe, observed environment.

Without a white coat in sight (that’s one urban myth I want to dispel: no-one wears them as they are an infection risk) they work in small groups of four with each student taking turns in being both an observer and conducting a consultation.Peer observation is a great way of picking up ideas and techniques on how to improve their own style and conduct and it’s great to see the progress made by students as their confidence grows.

While the students have usually had very little experience of working in this way, our pool of pretend patients are, in contrast, very experienced. The people we use have a knack of presenting very realistic symptoms ranging from headaches with blurred vision to abdominal pain. Their part in the assessment process is also very valuable and they give feedback from a patient’s perspective, reflecting on their experience during the consultation and take into consideration the student’s non-verbal behaviour, their language and explanation.

Students understand that perfection is not expected at this early stage… training to be a doctor takes time. But one thing is guaranteed: whenever we host the simulated patient sessions, our students always ask for more!

Dr Jane Kidd's role is to work with our students to enhance the effective communication skills that our graduates arrive with and develop the clinical communication skills that will enable our future doctors to perform in a way that their patients and colleagues will expect of a 21st century practitioner.


March 07, 2011

It’s okay to talk about mental health – honest

Model of brain with mental health related headlines behind

By Dr. Matthew Broome, Associate Clinical Professor of Psychiatry at Warwick Medical School

Last week the Psychology Society hosted ‘mental health awareness week’ on campus and I was delighted to see mental health being discussed and debated out in the open. So often, issues such as sectioning, depression or schizophrenia are things which are never mentioned – even among close family members.

The area of mental health in which I work both clinically and academically is Early Intervention and I look at ways of delivering services for young people with early psychosis.

Psychosis is the term given to certain signs and symptoms such as delusions or hallucinations. There are many ways to be ‘psychotic’ including mental illnesses like schizophrenia and bipolar affective disorder, but other causes such as dementia, drug intoxication or withdrawal, and neurological illnesses such as epilepsy can also present to health professionals with these symptoms.

In addition to my academic post at Warwick Medical School, I am Consultant Psychiatrist to the Coventry Early Intervention Team and as such see all young people who develop a psychotic illness in Coventry. The tricky part is that there is no sharp divide between psychosis and non-psychosis; many people who would be considered to be functioning well, are not distressed, may too have psychotic experiences, albeit less intense and frequently, and not accompanied by depression and anxiety. Schizophrenia, by contrast, is defined by a certain combination of psychotic symptoms, but with a level of intensity that persists for at least one month, and is accompanied by functional impairment.

The aims of Early Intervention services nationally, and one we are particularly passionate about in our team in Coventry, is to be flexible in our approach and to see young people in non-stigmatising settings at times that suit them. The hope is that with rapid recognition of psychosis and early treatment, using both pharmacological and psychological interventions, that the outcome and prognosis improves markedly.

Data over the last 10 years has shown that Early Intervention is not only effective clinically but also is highly cost-effective, saving the NHS about £5,000 per patient per year compared with having to treat someone whose illness has been allowed to develop unchecked, and access standard services at a later date.

Psychosis and schizophrenia, despite the advances made, continue to be disorders that hit young people at crucial times of their lives: late adolescence and early adulthood, when exams are taken, they start university and make a transition to independence. At this crucial time, recognising the earliest signs of potentially serious mental illness is crucial as, if effective treatment is given early, a lifetime of suffering may be averted.

So my advice would always be: don’t be afraid or embarrassed to seek help. One in four of us is likely to suffer from some form of mental health issue in our lifetime, so do not merely brush symptoms aside – there are people who can help and make a difference.

For more information see:


March 2011

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