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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.


Flin R.,University of Aberdeen | Patey R.,University of Aberdeen | Glavin R.,Victoria Infirmary | Maran N.,Royal Infirmary
British Journal of Anaesthesia | Year: 2010

This review presents the background to the development of the anaesthetists' non-technical skills (ANTS) taxonomy and behaviour rating tool, which is the first non-technical skills framework specifically designed for anaesthetists. We share the experience of the anaesthetists who designed ANTS in relation to applying it in a department of anaesthesia, using it in a simulation centre, and the process of introducing it to the profession on a national basis. We also consider how ANTS is being applied in relation to training and research in other countries and finally, we discuss emerging issues in relation to the introduction of a non-technical skills approach in anaesthesia. © The Author [2010].


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

Situation awareness (SA) is one of the essential non-technical skills for effective and safe practice in high-risk industries, such as healthcare; yet, there is limited research of its significance in anaesthetic practice. In this paper, we review this scant research that focuses on SA as patient monitoring alone and advocate for a more comprehensive view of SA in anaesthetic practice and training that extends beyond monitoring, namely, a distributed cognition approach. We identify further factors influencing anaesthetists' SA and provide a case that resulted in an anaesthetic fatality to illustrate the application of an alternative view of SA in anaesthesia. Distributed SA in anaesthetic practice provides the foundation for further research that may in turn influence the teaching and assessment of this important non-technical skill. © The Author [2010].


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.


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.


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.


Larkin J.,Victoria Infirmary
Scottish Medical Journal | Year: 2012

Fibromyalgia has always struggled to be taken seriously. The vague mixture of aches, pains, stiffness and fatigue with no clear clinical or investigational findings has led many to doubt its very existence. Evidence is accumulating, however, of demonstrable abnormalities of pain processing and psychosocial factors in fibromyalgia subjects. These may 'prove' its existence, but do they suggest it is rheumatological?


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.


Kallachil T.,Victoria Infirmary
Indian Journal of Surgery | Year: 2015

There are several techniques and variations described for tying a Surgeon’s knot, all with the intention of getting a secured and square knot. A new, safe, quick and scientific approach to making a Surgeon’s knot is presented here. Three basic techniques have been described in the literature for tying a Surgeon’s knot: using the instrument, one-handed technique and two-handed technique. A two-handed technique for putting the initial double throw in a Surgeon’s knot is described here. The number of throws can be increased as the situation demands. The basic idea is similar to the knotting steps described using an instrument, usually the needle holder. Two fingers of one hand are used in a similar fashion as the tip of needle holder in making the knot. This technique is simple, rapid and secure in making the initial double throw, and the subsequent knotting can be done as described in the literature. The advantage of this technique is that the number of throws can be increased using the same steps. This method is simpler and less time consuming compared to the existing methods. © 2015, Association of Surgeons of India.


Glavin R.J.,Victoria Infirmary
British Journal of Anaesthesia | Year: 2010

Medication errors are common throughout healthcare and result in significant human and financial cost. Prospective studies suggest that the error rate in anaesthesia is around one error in every 133 anaesthetics. There are several categories of medication error ranging from slips and lapses to fixation errors and deliberate violations. Violations may be more likely in organizations with a tendency to blame front-line workers, a tendency to deny the existence of latent conditions, and a blinkered pursuit of productivity indicators. In these organizations, borderline-tolerated conditions of use may occur which blur the distinction between safe and unsafe practice. Latent conditions will also make the error at the 'sharp end' more likely to result in actual patient harm. Several complementary strategies are proposed which may result in fewer medication errors. At the organizational level, developing a safety culture and promoting robust error reporting systems is key. The individual anaesthetist can play a part in this, setting an example to other members of the team in vigilance for errors, creating a safety climate with psychological safety, and reporting and learning from errors. © The Author [2010].

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