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Port Glasgow, United Kingdom

Glavin R.,Victoria Infirmary | Flin R.,University of Aberdeen
Canadian Journal of Anesthesia | Year: 2012

Purpose: We look at the changing nature of medical education in the developed world with particular reference to those areas of the new curriculum frameworks which have introduced topics from the psychosocial realm. Principle findings: Research in the branch of psychology dealing with human factors has developed a useful body of working knowledge which applies to other industries where humans interact with the complex systems in which they function. Some findings are already being applied to facets of anesthesia performance, including situation awareness, effective teamwork, countermeasures against active errors and latent pathogens, and limitations of human performance. However, existing lessons and practices from industrial or military research may not translate directly into effective strategies for anesthesiologists. Collaborative studies between psychologists and clinicians should continue in order to provide the anesthetic curriculum with an effective body of knowledge for each role of the anesthesiologist. Although individual anesthesiologists have made important contributions in this field, such material has not been formally incorporated into the curricula serving anesthesiologists in the developed world. Conclusions: There is a gap between the human factors psychologists now know and the human factors anesthesiologists need to know. As that gap closes, anesthesiologists may come to think more like human factor psychologists as well as biomedical scientists. © 2011 Canadian Anesthesiologists' Society. Source

Fioratou E.,University of Aberdeen | Flin R.,University of Aberdeen | Glavin R.,Victoria Infirmary
Anaesthesia | Year: 2010

Fixation errors occur when the practitioner concentrates solely upon a single aspect of a case to the detriment of other more relevant aspects. These are well recognised in anaesthetic practice and can contribute significantly to morbidity and mortality. Improvement in patient safety may be assisted by development and application of countermeasures to fixation errors. Cognitive psychologists use 'insight problems' in a laboratory setting, both to induce fixation and to explore strategies to escape from fixation. We present some results from a series of experiments on one such insight problem and consider applications that may have relevance to anaesthetic practice. © 2009 The Authors. Source

Wellington B.,Victoria Infirmary
International Journal of Orthopaedic and Trauma Nursing | Year: 2010

Small but significant numbers of adults sustain a traumatic brachial plexus injury, often resulting in devastating disability affecting their physical and psychological well being. There is limited evidence of qualitative research available and this paper reports on a study that considers the patient's own experience of living with this injury. Patients were selected using purposive sampling from those who were on the database for the Scottish National Brachial Plexus Injury Service. Five patients were finally selected and data collected using semi-structured audio taped interviews and field notes. Similar themed categories were identified from the experiences described by the patients including employment, pain, body image and sexuality/emotions.Recommendations include timely and ongoing pain management reviews and initial counselling sessions for all new patients. © 2009 Elsevier Ltd. Source

Glavin R.J.,Victoria Infirmary
Best Practice and Research: Clinical Anaesthesiology | Year: 2011

A key role in anaesthetic practice is gathering and assimilating information from a variety of sources to construct and maintain an accurate mental model of what is happening to the patient, a model that will influence subsequent decisions made by the anaesthetist on the patient's behalf, as part of a larger team. Effective performance of this role requires a set of mental functions that place great demands upon the physiology and psychology of anaesthetists, functions that are vulnerable to a wide range of factors including those affecting team performance and those affecting the anaesthetist specifically. The number of tasks, their complexity, the physical and mental demands of the job, the underlying health and well-being of the anaesthetist and the environment and context within which the team attempt to meet the demands placed on them will influence the outcome of patient care. © 2011 Elsevier Ltd. All rights reserved. Source

Lund K.,Royal Infirmary | Gaffney D.,Royal Infirmary | Spooner R.,Royal Infirmary | Etherington A.M.,Glasgow and Clyde Anticoagulant Service | And 2 more authors.
British Journal of Haematology | Year: 2012

Poor warfarin control with resultant high International Normalized Ratios (INRs) and bleeding events is most common during the first months of treatment. The effects of genetic polymorphisms at the vitamin K epoxide reductase [VKORC1] and cytochrome P450 2C9 [CYP2C9] loci have been increasingly acknowledged as contributory factors of enhanced warfarin sensitivity. In our prospective, blinded study, 557 patients (49·1% male, mean age 65·4 years, range 18-91 years) commencing warfarin (target INR 2·5) were genotyped and monitored through the first 3 months of anticoagulation. Homozygosity for the -1639 G>A single nucleotide functional promoter polymorphism of the VKORC1 gene (genotype AA; 14·5% of cases) was associated with a significantly shortened time to therapeutic INR ≥ 2 (P < 0·01), reduced stable warfarin dose (P < 0·01), and an increased number of INRs > 5 (P < 0·001) and occurrence of bleeding events (P < 0·01) during the first month, as compared to the GG genotype. CYP2C9 genetic variations *2 and *3 were not associated with significant effect on these factors. Neither VKORC1 nor CYP2C9 polymorphisms influenced these parameters beyond the first month of treatment. These findings imply possible benefits of assessing VKORC1 polymorphisms prior to anticoagulation, particularly as a low dose induction regime in VKORC1 AA individuals appears to reduce the incidence of high INRs. © 2012 Blackwell Publishing Ltd. Source

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