The HOME study - Michael Sharpe s CBT for the elderly

It worries me that there is no mention of biopsychosocial lunch menus and biopsychosocial face flannels. The protocol looks incomplete to me.

 

Ok, thanks, that's clear now, the aim is not patients wellbeing, but expenditures cut.

 

This PPM rubbish is another complete waste of time and money.

From a report done by age uk:

full report here
https://www.ageuk.org.uk/globalasse...ischarge_from_hospital_briefing_june_2016.pdf

 

Spot on @Sly Saint

 

Yes, what is needed is the appropriate social care assessment and the necessary practical support put in place for the person returning home. How can this 'trial' not end up being confounded by other projects that are increasingly being rolled out by various NHS trusts and local authorities working together?

An example is the project happening in my area:

https://www.tsft.nhs.uk/about-your-...-reduced-thanks-to-new-home-first-initiative/

 

Michael Sharpe is NIHR Senior Investigator. Does this have something to do with the appalling standard of NIHR funded "research"?

 

Especially considering that biopsychosocial bare-faced flannel is hardly in short supply.

 

Relative worked in orthopaedics. Some patients were on the ward for months, 9 or more not being unusual, while they waited to be assigned a social worker. Once the social worker was involved the process went quickly but by then people who came in with mild dementia had become institutionalised. They would be transferred to a care home with programmes to keep them active and alert but it was too late.

So how would CBT help them?

 

From what I gather from looking at the protocol and associated papers, this isn't so much of an intervention as a brief psychiatric assessment (3-5 mins per patient, according to Desan et al 2011) and subsequent interdisciplinary collaboration. If that can really reduce inpatient stay and improve outcomes, then good luck to them - seems like a great idea!

Other papers mentioned are this one - Miani et al 2014 and Sledge et al 2015.

The main problem with the protocol though is that it is very light on any detail about what exactly their intervention is. Seems to be mostly a data-gathering exercise. Also seems difficult to control adequately - but I know 3 of the statisticians involved, so hopefully they've targetted all that.

 

So.... basically this is medicine-by-MBA? Just throwing corporate-speak buzzwords and random positive-sounding fluff? Also stop it with the dumb "holisting" and "broad" psychosocial approach. It's the most reductive, narrow model of medicine out there as it strictly focuses on imaginary psychology that is untestable, unquantifiable and unfalsifiable.

Apparently our psychosocial wizards have been hiding the fact that they invented the medical tricorder. Or a magic wand. Or maybe it's Parker's hand-feels?

I'm sorry that's not how any of this works. You can't just claim "this made-up thing will identify all problems". Those are precisely the kinds of claims that make pseudoscience laughable and it doesn't work any better here. You don't even need to spend more than 30 seconds reflecting on this to understand that it's complete BS. Ridiculous.

 

possibly detailed in the 'service manual', which unfortunately does not appear to be accessible.

 

My guess is giving consent to being discharged quicker, despite there being no support available afterward.

That's the psychosocial model in a nutshell: don't bother actually helping people, just convince them that you did and report that using a BS questionnaire and some statistical hand-waving. It's way more expensive overall but you can point at your own budget being slightly lower as proof of success. Externalities? What's that? No, see, if you only look at this account right here it looks cheaper. Great success!

 

I would guess that's fair as the trial is still ongoing. Someone might nick their idea and run it elsewhere.

 

short video MS explaining the Home study 20 May 2020

https://www.youtube.com/watch?v=ZcK3Hfh-6Bc

 

It's been published if anyones interested
The HOME Study: Statistical and economic analysis plan for a randomised controlled trial comparing the addition of Proactive Psychological Medicine to usual care, with usual care alone, on the time spent in hospital by older acute hospital inpatients

https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-020-04256-8

 

I think he said they've recruited two and a half thousand patients in Medical Wards (where you have to be very sick to be admitted) and most of them were cognitively impaired or had dementia.

So how could they give informed consent? Oh, of course, their relatives would have given it. They don't know about MS and his spurious "science".

Just my personal thoughts about myself - I'm sad that I'm older than MS, I'd love to see him in the position of those older people who he is taking advantage of to keep his career going. Well, I suppose it's something to keep me going till 100 for the chance!

 

Jees, just noticed that the Older People were only over 65. No hope for me then - over 70. Though I don't think my kids would leave me to the mercy of any trial run by or bigged up by MS - think I educated them about him as well as SW.

 

Changing protocol mid-trial again? I mean of course, this is typical of psychosomatic research. I though this practice was not possible anymore? The AllTrials thing? I'm sure they already have their exception lined up. I guess some people are just special like that and can do whatever they want.

Found this in reviewer comments:

That is indeed one small problem. You know, what is this thing even made of? That's just minor stylistic stuff. That same reviewer rated the manuscript exceptional. Hard to argue this isn't style over substance when a review finds it exceptional yet casually asks "by the way, what is this thing you're doing?"

Whew another reviewer found it important focus on the definition of ethnicity, which is clearly a very substantial element here.

I'm sure this will have no impact whatsoever in the "intervention" trying to convince patients that reducing their stay will lead to better outcomes. Actually this pretty much guarantees that this is the main focus of the "intervention". Hospital stay is very expensive. This will obviously lead to the appearance of savings, as long as you don't count externalities, which of course won't be counted. If you don't count it doesn't exist, right?

Reminder that the very first step of this magical treatment relies on magical abilities that do not exist in this universe:

They will identify ALL the patient's problems. Just like that. Why did no one think of this before we could save so much money if we just did that all the time. You just need gumption, I guess, call it like it is and gut-feeling and all of that.

Yup. If you make the end-point the main target of intervention you basically nullify the experiment because then the entire focus of the experiment will be to influence the end-point, but that's just a small detail.

Not sure I've ever seen a BPS experiment with less than 15% loss to follow-up.

This is clearly a cost-saving program. We already know that denying medical care to sick people is cheaper, but someone has to fabricate a convincing argument I guess. It's just a modest proposal, after all.

 

What changes from the protocol were there? The primary outcome looks the same as the trial registration but that was all I checked.

 

The outcome analysis? It's really not clear what changed since there is no change tracking feature but what I understood is that they added the statistical analysis plan and some more details of the "intervention". It's frankly hard to follow the timeline. And from the reviewer comments it seems they just added the details about what the "intervention" is at all. In a trial that seems under way but even that is unclear since it speaks of recruiting but this an experiment with a rolling recruitment during hospitalization, which can't be banked any more than pregnancies can.