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Conference Programme in detail

 

Thursday 6th October

10.00 Keynote Address

Dr Mary Archer

Shared decision making –
Innovative communication in healthcare

Dr Mary Archer

SDM aims  “To embed shared Decision Making in routine NHS care."

The greatest change that Shared Decision Making can bring about is a change of culture of clinicians and a radical shift in empowerment of patients.  The Urology IDM project, which was an SDM pioneer for the NHS, opened the door to other patient decisions being informed not just at big decision time – about treatment options – but about everything along the patient pathway.  The project has also exposed the issues of clinical engagement.

The side effect for this is the whole way we communicate with patients, staff, and the public and the need to recognise the different ways that people receive information successfully (staff and patients)  – we do not all respond well to information on websites and some will need graphics and hard copies and cartoons and a whole range of other media.

This talk will explore these issues and where the new national programme on SDM has got to.

Mary Archer is Chairman of Cambridge University Hospitals NHS Foundation Trust. She is also convenor of the UK University Hospitals Chairs Group and a trustee of the UK Stem Cell Foundation. She is deputy chairman of ACT (Addenbrooke's Charitable Trust) and her other CUH-related commitments include membership of the Cambridge Bioresource Oversight Committee, the Executive Board of the Wellcome Trust Clinical Research Facility and the Cambridge Cancer Centre Steering Committee.

She taught chemistry in the University of Cambridge for ten years before developing a wider portfolio of interests.  Her scientific research interests lie in the field of solar energy utilisation, on which she has published three books. She chaired the National Energy Foundation for ten years, and is now its President. She is also President of the UK Solar Energy Society and the Guild of Church Musicians, a non-executive director of the Britten Sinfonia and a director of the career development organisation CRAC. She is a Companion of the Energy Institute, and was awarded the Institute’s Melchett Medal in 2002, and the Eva Philbin award of the Institute of Chemistry of Ireland in 2007.

We are delighted to have Dr Archer as our Keynote Speaker for the institute's 44th Annual conference.

 

10.30 Julie Dorrington New Voices session

Introduced by Andrew Johnson, IMI Chairman

Session Chair: Simon Brown.

10.35 Examining the effectiveness of different imaging modalities used for recording pigmented skin lesions

Jessica Oliver

Dermatological conditions lend themselves to photography due to their visual nature. In addition to conventional photography there are alternative imaging modalities that can be used to compliment standard visual recordings, offering different perspectives.

This presentation will explore a number of imaging modalities that can be used to record pigmented skin lesions. The benefits and limitations of these imaging techniques will be compared and discussed to evaluate the advantages of implementing such techniques and whether they have any potential to aid in diagnosis and contribute to patient care

10.50 Imaging Modalities in Glaucoma

Nichola Toothill

The presentation is an evaluation of three ophthalmic imaging techniques potentially applied to the monitoring of Glaucoma.

There are 4 main types of glaucoma, of which Open Angle Glaucoma (OAG) is the most common, affecting 2 percent of over 40 year olds in the UK1. Glaucoma is characterized by fluctuations in the intra ocular pressure (IOP), caused by abnormal production or drainage of vitreous fluid. These fluctuations in IOP can cause irreversible damage to the retinal nerve fibre layer (RNFL) and optic disc. Early diagnosis and treatment is therefore crucial to halt further progression of the disease and preserve sight.

Ophthalmic imaging is a valuable component in the early identification of Glaucoma and optic disc photography is notably included in the National Institute for Health and Clinical Excellence (NICE) guidelines for the monitoring of the disease.

The NICE recommendations for optic nerve head images consider the impact of available resources on service provision. Stereo disc photography is recognized as the gold standard2 for diagnostic imaging in glaucoma but is not necessarily accessible to all ophthalmic clinics. Alternative imaging modalities such as Heidelberg Retinal Tomography (HRT) and Optical Coherence Tomography (OCT) may be employed in monitoring glaucoma patients where time and financial resources allow.

Stereoscopic photography, OCT and HRT imaging will be presented and evaluated in terms of the diagnostic value, financial and time constraints and patient needs involved in the use of each modality in glaucoma monitoring.

The presentation will look at each technique individually and comparatively with illustrative images and consideration of relevant national guidelines and local departmental resources. Analysis of the limitations and benefits of the three imaging modalities result in conclusions clearly predisposed to the accessibility of available resources.

1.    Sparrow, J. (Foreword) 2009.Glaucoma: Diagnosis and management of chronic open angle glaucoma and ocular hypertension [Online]. London: National Collaborating Centre for Acute Care. Available at: http://www.nice.org.uk/nicemedia/live/12145/43887/43887.pdf [Accessed: 2nd June 2011]

2.    Stein, D.M. Et al. 2004. Imaging in Glaucoma. Ophthalmol. Clin. North Am. 17(1), pp. 33-52.

11.05 Second Time Around

Nicola Riley

My presentation will be about my career as a clinical photographer, which originally commenced many years ago.  My life took various turns and I left that profession in the 1970s.  Today I would like to give you an insight into how I came to return to clinical photography and my experiences of undertaking the Staffordshire University Graduate Course in Clinical Photography as a mature student.

11.20 Location lighting for patient & public information photography

Melanie Yeneralski

Photography is used widely in the NHS for patient and publication, so images used need to portray our organisation need to be informative, clear and thoughtful. As Clinical photographers, we are used to photographing subjects to set protocols, which makes us our own harshest critics, if the outcome of our PR Photography is not as we would expect. In this presentation I will show and discuss some ideas for when you have limited time and for making use of ambient light, as opposed to clinical flash lighting.

Using flash on camera:
•    Making the most of small dark rooms.
•    Balancing flash with ambient light to achieve natural - look lighting.
•    Positioning of subjects.
•    Getting the most of flash in exterior shots.

Portable studio lighting:
•    Lighting set-ups in the clinical environment.
•    Making the most of ambient lighting whilst using flash heads and reflectors.
•    What to pack (essential spares)

Understanding the brief
•    Organising shoots, confirming details
•    The lighting recce
•    Working with client’s art directors/ graphic designers.

11.35 BSc (Hons) Clinical Photography – A Student's Perspective

Katie Rayner and Tamsin Fawn

This presentation is about students experience on the new BSc Clinical Photography degree course at the University of Westminster in London.

The course started in 2009 and in September 2011, it will be in its third year running. By July 2012 there should be eleven newly qualified clinical photography graduates, and similar numbers will follow in subsequent years. Two main questions to pose are; will we be ready for employment within medical photography departments and will employers be ready for us?

Throughout the presentation we hope to give you an insight into the content of the course, our experiences on it and our hopes and aspirations for our future careers in Clinical Photography.

We will provide information about the core modules within the course and this will include details for each year. The learning experience that we as students deem most valuable by far is the work placement modules. We undergo a work placement every year, the length of time spent on one increases as we progress throughout the course. A lot of medical photography departments have already accommodated our students for such placements and in this presentation we hope to discuss some of our experiences and express our gratitude towards those who have been involved.

Major projects will be a big factor for those of us entering our third and final year, ideas and plans are already in the making. We will present information about our projects aims and hopes.

 

11.50 Virtual Pathology Collection: A Pilot Study

Charlie James

Anatomical collections are an essential resource for students, lecturers and researchers. These collections are commonplace and can easily be supplemented by books and digital anatomical resources.
Although of similar importance, pathological collections tend to be much more sparse and piecemeal in their composition. This can be due to physical limitations, for example storage space, or because specimens are only acquired following a chance encounter with unusual anatomy or a pathology and access to these specimens can be difficult. Many are too rare or delicate to be routinely handled, depriving students and researchers the chance to study them. Even those that are well preserved are liable to degradation and limited to being in a single physical location.
A high quality virtual collection could resolve some of these issues. Websites or software mean access can be provided to larger numbers with no risk or degradation or loss of quality. Similarly, a digital resource provides a means for departments to pool together specimens and create a more comprehensive and wide ranging collection.
Previous studies have looked to develop websites and programmes that variously encompass photographs, histological slides, CT data and QTVR models. Whilst useful, the scope of these projects limits the usefulness and application of the material produced. In this study, a new resource is made, amalgamating existing techniques with novel approaches to create more comprehensive digital specimens.
Using a mixture of 3-dimensional models, photographs, artwork and animations, this project aims to take steps towards lessening the requirement on gaining physical access to specimens. In order to study the relative merits of the different formats, as well as refine the content of the final website, students and researchers were asked to evaluate the programme. This presentation discusses the process for creating the website, the results of the evaluations and offers guidelines for future development of digital pathological collections.

12.05 The importance of colour in the understanding of 3D visualisations of the applications of stem cell research in therapies for liver disease

Jennifer Colquhoun

 

Medical and scientific artwork is not as prevalent as it once was. Since the invention of cameras, and a certain amount of ‘scientific snobbery’, art has been widely considered to be the domain of the abstract, the scenic, or that of science fiction, and not suitable as an informed explanation. Generally the scientist has taken control of any ‘artwork’ created, and whilst this generates technically accurate images, aspects such as composition and, in particular; colour palette are ignored.
Now in an age where discoveries of gross anatomical structures are largely exhausted, research into the human body is becoming microscopic. In 2007 Kazutoshi Takahashi and Shinya Yamanaka developed a method of inducing adult human fibroblasts (skin cells) to express the same proteins as embryonic stem cells. In short; they had created viable human stem cells, which, in theory, will act exactly as their embryonic counterparts but without any ethical concerns, and with a host of new benefits, such as the virtual elimination of rejection. These induced Pluripotent Stem Cells (iPSCs) can only be studied through a microscope, so in order to gain access to the inner workings of these amazing little cells; scientists have turned full circle, and are looking to art.
Working with Cambridge University I will be creating a short 3D animation detailing cell differentiation from a fibroblast to a hepatocyte (liver cell). The animation will explain the how iPSCs are engineered, and then how they are instructed to become specialised human cells. In order to explore how the uses of colour affect both human understanding and acceptance, the animation will be rendered using four separate colour palettes; realistic (i.e. little to no colour), high colour (the bright, harsh colours often used to demonstrate separate cell structures), neutral, and a ‘fluorescent’ palette which mimics the protein tags used to visualise changes in the cell structure. The animation will be screened in each of these four palettes to audiences knowledgeable about iPSCS and their differentiation, who will then be asked to complete a survey.
Analysis of the results should further the understanding of what effect, if any, colour has on the presentation of scientific research. It is my hope that furthering this understanding will help us get that little bit closer to bringing art back to science.

Plenary session

Session Chair: Jerry Nayler

13.30 Media Tools for Shared Decision Making

Tom Kidder

Over the past decade, health organizations have been promoting a patient centered approach to health care decisions that rely on an enlightened partnership between physician and patient.  The Shared Decision Making Center at Dartmouth-Hitchcock Medical Center, the Foundation for Medical Decision Making, and Health Dialog are three related organizations that facilitate and promote the delivery of objective medical information, based on outcomes and current research and designed to help patients make informed medical decisions with their doctors.  These organizations have developed DVD’s, booklets, and interactive Web sites to help patients with decisions about treatments for breast cancer, obesity, joint replacement, and back pain, to name a few.  This session will present samples of these media tools along with a discussion about the production process and the application of the media tools for patients.

13.50 Training for non-photographers in clinical records and trials

Simon Brown

 

 

Simon has been involved in the training of non-photographers, such as HCAs, nurses, podiatrists and anaesthetists. These have all needed to use standard consumer cameras to take routine photographs for clinical projects, recording clinical conditions in patients' homes and for standardised before-and-after pictures for non-surgical treatments.

This paper will describe the training approach taken and the outcomes.

14.10 Making Scanning Electron Micrographs into exciting imagery

Spike Walker

While most photomicrography, certainly by ‘professionals’, is largely concerned with the recording of work-in-progress, or for purely illustrative purposes, there have always been those who have recognised and exploited its considerable creative potential and, for the last sixty years, probably none with more enthusiasm than Spike Walker, winner of the Royal Microscopical Society’s ‘Glauert’ and the RPS ‘Combined Royal Medical Colleges’ medals and scores of other awards.

Having graduated in the Biological Sciences, he combined full-time teaching in Staffordshire schools and colleges with freelance photomicrography before taking early retirement twenty-two years ago with a view to spending more time with his microscopes (twenty-seven of them – mostly skip survivors - at the last count).

The purpose of the lecture is to show images of a very wide range of materials made with the aid of conventional optical microscopes and almost every form of contrast enhancement.

Concurrent session A, in the Goddard Room

Session Chair: Jane Fallows

 

14.45 Understanding illness and its response to treatment:
a role for the artist?

Helen Carruthers

This presentation will investigate the role of colour and imagery in relation to response to hypnotherapy treatment in patients with irritable bowel syndrome (IBS). Hypnotherapy improves the symptoms of approximately two thirds of IBS sufferers but is very expensive to provide. Therefore, a way of predicting those most likely to respond could lead to the more efficient use of this form of treatment.

Initially, a system, known as ‘The Manchester Colour Wheel’, was developed for allowing individuals to identify colours in response to particular questions and in the case of this study relating it to mood. Subsequently, in a study on healthy, anxious and depressed people, it was found that dividing colours into positive neutral and negative shades was the best way of relating colour to mood and this method was used in all subsequent research. Colour perception was then assessed in patients with IBS who were undergoing hypnotherapy treatment by asking them to relate their mood to a colour. It was found that colour choice had a strong predictive value with those patients relating their mood to a positive colour at the beginning of treatment being nine times more likely to respond than those who did not.

With regard to imagery, half the patients had an image of their IBS before treatment with a wide variety of images being described. Watercolour paintings were made of these images and it was found that these gave unique insights into their symptoms as well as also providing another guide to hypnotherapeutic outcome.  Patients who had an image of their disease were more likely to respond to hypnotherapy and the images, which were initially very graphic, became much more abstract in those individuals whose symptoms settled down following treatment.  In a subsequent study, four of these images of IBS together with eight other images depicting neutral and painful experiences, were shown to a group of IBS patients and healthy volunteers and it was observed that individuals with IBS differed in that they reacted to all these images in an exaggerated way irrespective of the type of image. This observation adds to an increasing body of evidence suggesting that IBS patients exhibit a generalised ‘over-reactivity’ of their nervous system.

The results of these studies indicate that the ‘Colour Wheel’ approach offers a unique way of gauging mood by relating the response to a colour and therefore avoiding the necessity for people having to respond to a complex set of questions.  Consequently, it may be especially useful in children or in individuals with language difficulties.  In addition, the use of imagery may have a variety of applications in clinical medicine such as providing insights into the patients’ fears and concerns about their illness as well as helping non-sufferers to understand what they are going through.

 

15.15 Medical Publishing: From printed page to iPad

Norm Barker and Bona Kim 

The Faculty from Johns Hopkins School of Medicine produces literally hundreds of books a year. The traditional medical textbook and medical publishing are undergoing unprecedented change in a very short period of time. Does this mean the death of the traditional textbook? With so many modes of communication, what's the best way to communicate complicated information in 21st Century healthcare? This presentation covers the challenges and opportunities of making the transition from litho-plate to electronic screen. Picking the right tool for the job and evaluating the pros and cons will be considered. A project for using a module on the Mac iPad for teaching pancreatic cancer diagnostics for pathology residents and medical students will be examined.

15.35 The Value of H3. Tribute to a Quiet Genius

Cedric Gilson

Professor Harold Horace Hopkins, “The Quiet Genius”, held the Chair in Applied Optics at the University of Reading from 1967 to 1984.  Because of his repeating initials, he was fondly re-ferred to by his students and colleagues as “H-cubed”. He was an unassuming person (hence “quiet”) of huge personal accomplishments with a very precise and captivating way of speaking. Hopkins was an inspired theoretician and optical designer (hence “genius”). His theoretical works include The Wave Theory of Aberrations, a seminal work, and determination of the Optical Transfer Function (OTF), which is now a universally accepted measure of the discrimination of a lens. While working in industry, his early contemplations led to the design of the first zoom (vari-focal) lens for television. Always fascinated by problems in medical optics and concerned to assist clinical medicine, he was the originator of the rod lens rigid endoscope, where the customary thin lens-air space image relay configuration was replaced by the inverse—a glass rod-thin air lens arrangement—that increased light transmission and reduced aberrations. This improved the performance of rigid endoscopes, such as bronchoscopes and cystoscopes. Regarding fibre optic bundles for conducting images around curvatures, he realized the arrangement of threads should be coherent; meaning that the locus of a given thread in the bundle should be the same at both proximal and distal ends, or else the image would be “scrambled” or incoherent. Hopkins also discerned that light loss from optical fibres could be reduced by coating each thread with glass of a lower refractive index. This caused total internal reflection, so that images could be conveyed with negligible light loss. Such discoveries perfected the design of flexible fibre optic endoscopes and made them practically useful. It even made photography and filming possible for the first time! The OTF, zoom lens and both rigid and flexible endoscopes now are taken for granted in optics and clinical medicine, their present users probably having no knowledge or impression of their creator. Hopkins’ theoretical and optical design work was done before the age of computers or even electronic calculators. He was frequently to be found at his desk, intrepidly covering many sheets of paper with manual equations. He undertook design tasks that many considered unfeasible, his pure intellect and determination surmounting any difficulty. H-cubed also was a consummate teacher, many of his PhD students going on to great accomplishments of their own. As legacies to his contributions to science and medicine, a new research building at the University of Reading is named after Harold Hopkins and a clinical examination and treatment unit in urology carry his name in the nearby Royal Berkshire Hospital. 

15.55 New Opportunities: connecting with arts and media production across your institution 

John Davies

With increasing emphasis on healing environments, what role can clinical media and medical photography departments play? How can they integrate their activities with artistic projects and maximise funding and productivity in a healthcare institution? Over the last four years visual artist Sue Ridge and writer, poet and film maker John Davies have worked together on a number of major projects in hospitals with the aim of using arts to engage with the public and enhance the healing environment. Together they will present some key learning points from their experience. What are the implications of new technology? How can professionals in bio-communications connect with bio-arts projects? Why are bio-arts projects important? How can you communicate their value and involve people?

Visual artist SueRidge is an artist, Senior Lecturer at ChelseaCollegeof Art & Design and a member of London Arts & Health Forum Executive Committee. In 2010, poet, writer and film maker John Davies won the Holly Harrington Award at HESCA 2010 and the Platinum Best of Show Award at the UK IMI Awards. In 2008 his work won the Elmer Friman Best of Show Award. Sue and John have worked together on a number of major bio-arts projects at hospitals in the UK.

 

16.15 From Filing Cabinets to File Servers: Dealing with our growing digital footprints

Jason Candlin & Richard Everett

This presentation will look at the challenges, issues and problems of working with large amounts of digital images, how we work with them, manage, store, back up and retrieve them. Although the authors work in slightly different areas the problems related to their digital data are comparable and could have similar negative outcomes if handled badly. Working in collaboration and sharing good practice is beneficial to those working in both medical illustration and the cultural heritage fields and photography in general.
 
The Wellcome Trust generates a massive amount of digital images as part of it's on-going programme of digitisation, these images need to be delivered in a number of formats and must be kept safe for future generations. Images produced in a medical illustration environment must also be kept safe and accessible for both ongoing patient care and potential medico-legal uses.

The increasing size of our respective digital footprints and the integrity of these images has presented the authors with the same issues albeit in different sizes and time-scales, nevertheless this problem isn't going away, its just likely to get bigger and closer.

The hope is that this presentation will spark further debate around these issues, and lead on to discussion outside of this arena.


Concurrent session B, in the Cotton Room

14.45 Through the Keyhole – Introducing Laparoscopic Surgery in Tanzania

Colin Dobbyne and Liam Horgan

In 1999, a partnership between Hexham General Hospital in Northumberland and the Kilimanjaro Christian Medical Centre (KCMC) in Tanzania was launched, with a vision to revolutionalise the delivery of healthcare to the Tanzanian people.  More than ten years later, two of the partnership’s key players, Colin Dobbyne and Liam Horgan, have just come back from a return visit to KCMC to see how the laparoscopic element of the partnership is progressing and witness an exciting new development.

The laparoscopic development project started in 2004 when Liam performed the first laparoscopic cholecystectomy in Tanzania. The short, relatively painless recovery of the patient with minimal risk of infection proved that keyhole surgery would be ideal for patients at KCMC, if only surgeons there could have the necessary equipment and access to training.  Equipment could be provided, but training represented a problem, since UK surgeons could only realistically visit for one week a year, and for the plan to succeed, the Tanzanian surgeons needed ongoing help and support.  To overcome this, Colin developed an innovative and unique video link, utilizing poor and unreliable internet provision to allow live video mentoring of the Tanzanian surgeons from their counterparts in the UK while operations were underway.  With this support, laparoscopic surgery began to be carried out regularly and successfully at KCMC.

Since then, work at the hospital has continued to go from strength to strength, and earlier this year the link was improved by the establishment of a much anticipated fibre optic link, installed across the region by the Tanzanian Telecommunications Company, TTCL. The fibre optic link provides considerably faster internet, which will facilitate much better quality images and gives scope to include several different training scenarios, such as the webcasting of training seminars from the UK to KCMC.

In March this year, Colin and Liam flew out to see the launch of this new link, and catch up on how the telemontoring project is progressing. Whilst in Tanzania, the team from the UK ran a laparoscopic training course for surgeons from all over Tanzania, some travelling from as far away as Dar Es Salaam. This was the third annual national course and combined live operative observation, simulation and lectures.

This presentation will include a DVD filmed in Tanzania, followed by a Q & A session with Colin and Liam.

 

15.15 Where will you be in an Emergency?

Jane Tovey

In 2010 the Clinical Photography department of the University Hospital Birmingham NHS Foundation Trust (UHB) moved into the new Queen Elizabeth Hospital Birmingham (QEHB). With a capacity of 1,213 beds, 30 operating theatres, and a 100 bed critical care unit (the largest in Europe) it was surprising to see the clinical photography patient numbers fall by over 100 per month!
This paper describes the journey to discover why; and the subsequent clinical photography trial that was undertaken in the Emergency Department of this prestigious new hospital, in a search to understand the innovative way of working and challenges caused by this fresh environment.
Although some of the aims and outcomes ended up being different, valuable lessons were learned along the way.

 

15.35 Surviving and thriving in the downturn

Roddy McColl

The Government’s plan to reform the NHS is now in full flow.  The pressure is on all Trusts to increase quality and productivity whilst working within a reduced budget.  As a result Trusts are constantly reviewing services, introducing cost improvement programmes (CIP), and stripping out underperforming services.  Indeed, many Medical Illustration departments are being scrutinised, their budgets cut and posts frozen or reduced.  This paper looks at how to counter such threats and how to ensure on-going support for your service by demonstrating the value it adds to the organisation.

 

15.55 A QIPP, Clinical Photographs Saving Consultations and Improving Clinical Pathway Progression

Joanne Dunlop and Stephen Moore

QIPP stands for Quality, Innovation, Productivity and Prevention and has been described as the most important challenge facing the NHS for the foreseeable future.

For the Gloucestershire health community this means the radical re-design of services to ensure that we;
•    continue to live within our means and achieve maximum value from the resources available
•    focus on the quality of clinical care
•    meet the growing demand for healthcare
services

The Trust has asked all departments to submit proposals that deliver quality improvements and reduce costs. Medical Photography at Gloucestershire Hospitals NHS Foundation Trust has considered how it can contribute to QIPP.

Clinical photography may be used to replace face-to-face patient and clinician contact. This has the potential to speed up the pathway from referral to treatment.

Over the past few months there has been a visible increase in the number of ward calls to photograph wounds. A high percentage of the requests have been for onward referral, the majority being for Plastic Surgery. We have looked at why there has been an increase in these requests, the benefits and drawbacks to both trusts involved and to the patient.

It is hoped that this style of ‘telemedicine’ consultation using clinical photographs will reduce the requirement for patients to travel to Plastic Surgery consultations some 50miles away, reduce consultant sessions and bring about more rapid decisions to treat. Other clinical specialities may benefit in similar ways though the substitution of photographs for clinician face to face sessions.

 

 

16.15 Electronic Requesting of Clinical Photography…would you like ICE with that?

Simon L.B. Dove

In the United Kingdom ICE (Integrated Care Environment) is used in over 90 acute national Trusts to meet ordering and reporting requirements. ICE Requesting provides a web-based service that enables pathology requests to be made from wards, clinics and GP surgeries.  Introduced to Norfolk & Norwich University Hospitals NHS Foundation Trust in 2002 for Radiology to revolutionise that way users requested X-rays for patients.
In 2006 the Medical Illustration department expressed an interest in this facility for the requesting of clinical photography with the objective of replacing the traditional paper request.  The process of this IT initiative is described including the recording the patients consent electronically.  
One of the major hurdles to overcome was streamlining and mapping the patient data detailed on the Web/ICE request to our own Data base (4D) and then mapping to the corresponding metadata fields on our image management system Fotostation.  
A three month pilot was undertaken from March – June 2011 to test the system in a clinical situation.  The system is now live and routinely receiving electronic requests for clinical photography from the Trusts Web/ICE facility.

Saturday 8th October

Plenary Session

Session Chair: Paul Crompton

09.30 Access for people with  communication difficulties

Debbie Stanton

The Royal College of Speech and Language Therapists (RCSLT) (2011) report that nearly 20% of the population may experience a communication disability at some point in their lives.  In an acute hospital the prevalence of problems with communication, both transient and long term is high.

Two thirds of medical beds in general hospitals are occupied by people over the age of 65 and around 30% of them will have dementia (Alzheimer’s society 2011).  5% of the population do not speak English as their primary language (census 2001).  Delirium affects 10-20% of all hospitalized adults, and 30-40% of elderly hospitalized patients and up to 80% of ICU patients (Ely, Shintani, Truman et al. 2004).  Anxiety and the side effects of some medications also influence people’s ability to absorb information in the way they are normally able to.  The British Institute of Learning Disabilities (2008) estimate that 1-2% of the population have learning disabilities.  The Stroke association report approximately 150,000 people in theUKhave a stroke every year.  One third of people surviving a stroke are affected by aphasia (Backheit et al 2007, van der Gaag 2005).

Aphasia is an acquired language disorder arising from damage to the areas of the brain responsible for language.  It affects a person’s ability to read, write, speak and understand.  It can also affect other modalities of communication such as gesture and drawing.  It is a long term and life changing condition with approximately half of those initially affected going on to have a long term condition (RCSLT 2011).

The World Health Organisation (2001) describes disability and health using four dimensions known as the International Classification of Functioning, Disability and Health (ICF).  Disability is an interaction between the impairment itself and the activities the person wants to engage in as well as the personal and environmental factors (eg negative attitudes, inaccessible transportation and public buildings, and limited social support).  The ICF does not view the disability as a ‘biological’ dysfunction alone but includes the impact of the environment on the persons functioning. 

Environmental adaptations to reduce the impact of physical disabilities are commonplace in the public domain.  If a person has a broken leg they will be provided with crutches, wheelchairs and can use disabled toilets, ramps and automatic doors.

People with communication or cognitive difficulties are disabled by the institutional barriers that are in public spaces (Parr, Pound, Lindsey and Woolf, 2000).  Barriers such as noise, lack of skilled communication partners, inaccessible patient literature and hard to read signage.  By understanding the nature of communication disabilities Speech and Language Therapists are able to advise on how to reduce these barriers and make the environment more accessible.

The use of pictures and symbols support information for people who cannot read or write (Cameron and Murphy, 2002).  At Addenbrooke’s stroke and rehabilitation unit colour coding and large print signs with symbols have been used to facilitate navigation.  Narratives collected following the refurbishment demonstrated it’s value ‘the signs are really good.  They weren’t here last time... not just the words but the symbols’ (patient). 

“When I returned to my own bay which is yellow I feel it’s like returning home..... it’s a way of making you feel safe and secure that yes you are in the right place”

The ward clerk had commented:
“Relabeling the files with the colour coding was a lot of work but I have more time to get on with my work now. I used to be constantly interrupted by patients asking me where their bed was. I rarely get asked now, the difference is really significant.”

People with aphasia are used to advise on the literature being developed by the stroke and rehabilitation unit, and hospital literature such as the welcome to Addenbrooke’s leaflet which now incorporates symbols and bullet points to ease access to patient information.  We are currently exploring hospital menus looking for a way to make menu choices accessible to people with communication and cognitive difficulties.

Hospital environments are considerate of physical disabilities.  At Addenbrooke’s Hospital we are keen to make the environment and literature considerate of communication and cognitive disabilities.  If the design is right for people with aphasia then everyone will benefit.

10.00 Web Video Tips for the Novice

Tom Kidder

Video has become an important component of many healthcare associated Web sites.  Most of these appear as short animations, instructional videos, health advice from providers, and interviews with patients.  Producing this kind of media can be a daunting task for someone with little or no experience in video, especially without the production budget it takes to do this professionally.  This talk by a professional video-maker offers suggestions for getting the images and audio that can make your video shine, even if you’re using a low cost, consumer grade camera like the Flip.  He’ll offer pointers on equipment purchase, composition and lighting, audio, and interview techniques.

10.30 Animating sequential photographs to demonstrate dynamic flap movement: an aid to teaching dermatological surgery and patient consent.

Dev Shah

It is our routine practice to take sequential photographs to record pre-operative, per-operative and post-operative views of patients undergoing surgical operations in our department.  The photographs are used to provide accurate and detailed records, as well as subsequently teaching trainees.

However, even sequential static images do not provide sufficient information to allow the novice dermatological surgeon to develop a clear understanding of the tissue movements undertaken in common flap surgery.

Using a vector graphics programme we have animated the static sequential images to create a dynamic and interactive presentation of flap repairs.  

The technology is easily applied to photographic images and is a novel way of improving understanding of dermatological surgery. It may also serve as a means of illustrating operations for patients prior to their surgical procedure.

We present a range of flap repairs which have been animated using this technique and believe that it is a valuable addition to the existing tools and tissue substitutes which are used to teach dermatological surgery to trainees.  

11.30 Major Incident Response and Resilience

Danielle Osborn

Since the introduction of the Civil Contingencies Act 2004, all NHS organisations have had to put in place plans to deal with, respond to and recover from Major Incidents and Disasters. This presentation looks at the types of incidents that have influenced and enhanced the plans in place, where the medical illustrators would fit into these plans and what’s being done to take this forward. It will also look at the resilience of your teams and how to prepare yourselves for the incident which may affect you and your teams. 

12.00 Ian Williams

Among the growing number of works of graphic fiction, a number of titles dealing directly with the patient experience of illness or caring for others with an illness are to be found. Thanks in part to the Medical Humanities movement many medical schools now encourage the reading of classic literature to gain insight into the human condition but until recently, the medium of comics (the term is used in the plural to refer to both the physical objects and the attendant philosophy and practice surrounding them) has received little attention from healthcare scholars, even though some authors argue that graphic fiction is, in fact, a form of literature. Similarly, the study of the aesthetic and semiotic properties of comics, particularly with regards to the portrayal of illness and disease is in its earliest of stages, and begs input from the Medical Illustration community. This talk suggests that comics and graphic novels have unique properties which make them a valuable medium for conveying medical narrative and information and might have a role in education, reflection, therapy and the iconography of disease. Graphic narratives can be an effective medium for the portrayal of patient/healthcare worker interaction, illustrating the subtleties of human communication in a mode that might be read more naturally than film or photography: some authors actually suggest that the way the human brain processes images is more akin to comics than either of these lens based media.

This talk will give an overview of the comics medium, mentioning some important works of 'graphic medicine' -a term I coined which has been taken up to signify the interaction between comics and medicine. It will also cover some of my own work in comics, made under the nom de plume Thom Ferrier, which deals with the day to day drama of life in a rural general practice.

SEE ALSO: SPEAKER BIOGRAPHIES (ABOVE RIGHT)

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Clinical photography, design and video in healthcare