Academic literature on the topic 'Glasgow Royal Infirmary. Burns Unit'

In 1981 we described the introduction and development of a coma scale for use in Head Injured patients. The scale has become adopted for routine use in the Accident and Emergency Unit at Pinderfields General Hospital, Wakefield, and at other centers, for example the Emergency Department at the Glasgow Royal Infirmary finds the scale more sensitive than its own Glasgow Coma Scale in monitoring the course of accident victims.

AbstractObjectives:To investigate the benefit of a hospitalwide feedback program regarding methicillin-resistant Staphylococcus aureus (MRSA), using annotated statistical process control charts.Design:Retrospective and prospective analysis of MRSA rates using statistical process control charts.Participants:Twenty-four medical, medical specialty, surgical, intensive care, and cardiothoracic care wards and units at four Glasgow Royal Infirmary hospitals.Methods:Annotated control charts were applied to prospective and historical monthly data on MRSA cases from each ward and unit during a 46-month period from January 1997 through September 2000. Results were fed back from December 1999 and then on a regular monthly basis to medical staff, ward managers, senior managers, and hotel services.Results:Monthly reductions in the MRSA acquisition rate started 2 months after the introduction of the feedback program and have continued to the present time. The overall MRSA rate currently is approximately 50% lower than when the program began and has become more consistent and less variable within departments throughout Glasgow Royal Infirmary. The control charts have helped to detect rate changes and manage resources more effectively. Medical and nursing staff and managers also report that they find this the most positive form of MRSA feedback they have received.Conclusions:Feedback programs that provide current information to front-line staff and incorporate annotated control charts can be effective in reducing the rate of MRSA.

AbstractThe use of a tracheo-oesophageal voice prosthesis was introduced to the Glasgow Royal Infirmary Otolaryngology, Head and Neck Surgery unit in 1986. Although it was the authors' impression that most total laryngectomees since then had been offered this method of voice restoration, it was thought that long standing laryngectomees were seldom offered tracheo-oesophageal fistula (TOF) speech. Therefore all 58 total laryngectomees currently attending the combined head and neck surgery/radiotherapy clinic were assessed. Thirtytwo had a tracheo-oesophargeal fistula with voice prosthesis. All of these patients had undergone their total laryngectomy since 1986 and 83 per cent had achieved TOF speech. The remaining 26 patients (who mostly had their laryngectomy before 1986) had not been offered TOF speech. An outpatient consultation was arranged for these patients and 63 per cent of those offered, accepted TOF creation and a voice prosthesis. When compared to those who refused, it was found that good oesophageal speech, age or interval since laryngectomy were not good predictors of likely refusal. This study indicates that all fit long standing laryngectomees should be offered secondary TOF creation.

ObjectiveHealthcare faces the continual challenge of improving outcome while aiming to reduce cost. The aim of this study was to determine the micro cost differences of the Glasgow non-operative trauma virtual pathway in comparison to a traditional pathway.DesignDiscrete event simulation was used to model and analyse cost and resource utilisation with an activity-based costing approach. Data for a full comparison before the process change was unavailable so we used a modelling approach, comparing a virtual fracture clinic (VFC) with a simulated traditional fracture clinic (TFC).SettingThe orthopaedic unit VFC pathway pioneered at Glasgow Royal Infirmary has attracted significant attention and interest and is the focus of this cost study.Outcome measuresOur study focused exclusively on patients with non-operative trauma attending emergency department or the minor injuries unit and the subsequent step in the patient pathway. Retrospective studies of patient outcomes as a result of the protocol introductions for specific injuries are presented in association with activity costs from the models.ResultsPatients are satisfied with the new pathway, the information provided and the outcome of their injuries (Evidence Level IV). There was a 65% reduction in the number of first outpatient face-to-face (f2f) attendances in orthopaedics. In the VFC pathway, the resources required per day were significantly lower for all staff groups (p≤0.001). The overall cost per patient of the VFC pathway was £22.84 (95% CI 21.74 to 23.92) per patient compared with £36.81 (95% CI 35.65 to 37.97) for the TFC pathway.ConclusionsOur results give a clearer picture of the cost comparison of the virtual pathway over a wholly traditional f2f clinic system. The use of simulation-based stochastic costings in healthcare economic analysis has been limited to date, but this study provides evidence for adoption of this method as a basis for its application in other healthcare settings.

3611 Background: There is now good evidence that, in addition to TNM stage, the pre-operative combination of the standardised measurements of C-reactive protein and albumin, the Glasgow Prognostic Score (mGPS) provides valuable prognostic information. The aim of the present study was to examine the clinical application of the pre-operative mGPS in a large mature cohort of patients undergoing potentially curative resection for colorectal cancer. Methods: From a prospectively maintained database, consecutive patients (n= 797) with histologically proven colorectal cancer who were considered to have undergone potentially curative resection between January 1997 and December 2010 in a single surgical unit at the Royal Infirmary, Glasgow were included in the study. Results: Patients with an elevated mGPS were more likely to be older (p<0.001), female (p<0.05), have colonic tumours (<0.001), present as an emergency (p<0.001), had higher TNM stage (p<0.05) and more likely to die of their disease (p<0.01). The median follow-up was 66 months and using 3 year cancer-specific mortality as an endpoint, the area under the receiver operator curve was 0.652 (95% CI, 0.591–0.714; p<0.001) for the mGPS and 0.668 (95% CI, 0.610–0.727; p<0.001) for TNM stage. The cancer-specific survival, at 3 years, varied between 86% and 64% according to the mGPS and between 88% and 72% according to TNM stage. The cancer-specific survival, at 3 years, in patients with a mGPS 0 was 91% and 81% for TNM stage II and III respectively. The cancer-specific survival, at 3 years, in patients with a mGPS 1 was 89% and 66% for TNM stage II and III respectively. The cancer-specific survival, at 3 years, in patients with a mGPS 2 was 77% and 43% for TNM stage II and III respectively. Conclusions: The results of the present study show the clinical utility of the pre-operative mGPS in predicting cancer specific survival of potentially curative surgery for colorectal cancer.

Abstract Context: Docosahexaenoic acid (DHA) is an important fatty acid required for neurological development but its importance during early fetal neurological organogenesis is unknown. Objective: This study aimed to assess plasma fatty acid changes in early pregnancy in women undergoing natural cycle-frozen embryo transfer as a means of achieving accurately timed periconceptual sampling. Design: Women undergoing frozen embryo transfer were recruited and serial fasting blood samples were taken pre-luteinizing hormone (LH) surge, and at 18, 29, and 45 d post-LH surge and fatty acids were analyzed using gas chromatography. Setting: This study took place at the Assisted Conception Unit, Glasgow Royal Infirmary, Scotland. Main Outcome Measures: Plasma fatty acid concentrations and influence of twin pregnancies on DHA plasma concentration were measured. Results: In pregnant women, there was a rapid, early increase in the maternal rate of change of plasma DHA concentration observed by 29 d post-LH surge (mean ± SD, from 0.1 ± 1.3 to 1.6 ± 2.9 nmol DHA per mL plasma per day). This early pressure to increase plasma DHA concentration was further emphasized in twin pregnancies where the increase in DHA concentration over 45 d was 2-fold higher than in singleton pregnancies (mean ± SD increase, 74 ± 39 nmol/mL vs 36 ± 40 nmol/mL). An index of delta-6 desaturase activity increased 30% and positively correlated with the rate of change of DHA concentration between 18 and 29 d post-LH surge (R2 adjusted = 41%; P = .0002). DHA was the only fatty acid with a continual accelerated increase in plasma concentration and a positive incremental area under the curve (mean ± SD, 632 ± 911 nmol/mL × d) during the first 45 d of gestation. Conclusions: An increase in maternal plasma DHA concentration is initiated in human pregnancy prior to neural tube closure which occurs at 28 d gestation.

Abstract Bone marrow transplantation (BMT) is known to be both a physically and emotionally stressful procedure, due to the significant associated risk of developing life-threatening complications, and because of behavioural treatment related factors such as the post-transplant isolation period. BMT recipients have therefore been found to be at increased risk of experiencing a variety of psychosocial difficulties and factors that impact negatively on their quality of life. Identified factors include anxiety, depression, sexual difficulties, fatigue, interpersonal stressors and sleep disturbance. Psychosocial difficulties have been identified throughout the transplant process and into the recovery phase of treatment. Even disease-free BMT survivors report significantly disrupted cognitive, occupational and interpersonal functioning. Reported prevalence of psychosocial difficulties varies between 28% and 41% depending on the adopted diagnostic criteria and stage of transplant. Problems such as anxiety and depression are known often to go unrecognised in hospital settings. Unrecognised, or untreated psychosocial difficulties in the context of BMT are known to interfere with medical treatment and have been associated with reduced survival. It is therefore important that psychosocial difficulties in this patient group are identified at the earliest opportunity, and pro-actively addressed. In the BMT Unit at Glasgow Royal Infirmary, a nurse-led psychosocial screening programme has been established under the supervision of a clinical psychologist. All BMT recipients are now interviewed using a semi-structured interview prior to their transplant, to screen for psychological predictors of poor psychosocial outcome. Psychometric measures are also taken at this time. Measures comprise the Hospital Anxiety Depression Scale, The Brief Symptom Iventory-18, and the National Cancer Comprehensive Network ‘distress thermometer’, which assesses domains associated with quality of life. Repeat assessment is performed at day +14 and +100 post-transplant, in order to monitor potential change in presentation. Data collected from the first twenty-six consecutive BMT recipients are presented. Clinically significant psychological morbidity was identified in 43% of this sample. Levels of anxiety and depression were generally high and stable, before, during and after the transplant process. Formal contact with a clinical psychologist was required by 53% of the sample. Data from the measure of distress revealed that emotional and physical problems were most commonly reported and most highly rated. Consistent themes that emerged through interview included overt anticipatory fear regarding the transplant process, systemic family issues, the importance of family support, and the prospect of financial difficulties post-transplant. Many patients held unrealistically positive views regarding post-transplant quality of life, or were relying on positive thoughts to help them through the process. In conclusion, the prevalence of psychological morbidity in this population of BMT recipients was found to be high and stable. A psychosocial screening programme has aided the identification and treatment of ‘at risk’ cases. This highlights the need for continued awareness of psychosocial issues in this population, and the importance of ongoing formal, psychosocial support services for BMT recipients. Screening programmes are recommended for initial and ongoing assessment of psychosocial difficulties in this population.