Surveillance for respiratory viral infections is an important public health activity as they cause substantial morbidity and mortality, particularly during the winter months. Before 2020, monitoring of influenza activity in hospitals involved capturing detailed data on all patients admitted to the intensive care unit with confirmed influenza infection.

With the emergence of SARS-CoV-2, there are now multiple respiratory viral pathogens of interest. Very low levels of influenza activity were observed last winter, likely due to behavioural and environmental interventions, such as physical distancing, limited foreign travel, as well as higher rates of influenza vaccination. However, with the easing of COVID-19 mitigation measures, and increase in mixing and travel, a resurgence of influenza and other respiratory viruses this autumn/winter is anticipated.

A syndromic approach to severe acute respiratory illness (SARI) surveillance encompassing rapid testing of flu and SARS-CoV-2 is needed to understand the evolving epidemiology of two viruses and their contribution to adult hospital admissions this winter. Additionally, early diagnosis of influenza & SARS-CoV-2 is crucial to allow clinicians to institute appropriate and timely treatment, and to ensure infection control measures are instituted to limit nosocomial transmission.

Scope: In this clinically-lead feasibility project, we will validate a Deep Learning approach for fracture detection in peripheral limb X-Rays. The classifiers will use multiple radiographic views to predict presence and identify location of a fracture. We will work with key stakeholders to ensure the safety and scalability of our approach.

Technical Specifications: Ground-truth labels will be extracted from text-based reports and corresponding images will be labeled as Fracture/No Fracture. Deep Learning classifiers, including mobile-friendly models, will be evaluated on the supplied datasets. Finally, a heatmap will be used to highlight fracture localisations.

The C-19 Assessment tool has been co-developed with NES Digital, NHS GGC eHealth, Daysix and the DHI. In response to the COVID-19 pandemic the team have rapidly developed a tool to enable clinicians to assess patients across a number of settings:

• Emergency Department
• Assessment Centres
• Daily Ward Round

The structured tool facilitates rapid data collection utilising the data dictionaries from the WHO and based on the ISARIC research collection form. Fields are bound to SNOMED for rapid interoperability and a PowerBI integration allows realtime visualisation.

Roll out of the tool in Glasgow will enable clinicians and researchers to collect data to inform current and future care.

COVID-19 [SARS-COV-2] has placed a huge challenge on the world. In response to the crisis, Thales is engaged in a number of initiatives, including one aimed at the possible application of thermal imaging cameras to detect people with a fever and hence those who may be suffering from COVID-19. This initiative has received encouraging feedback from prospective users around the world who are looking, not only at the immediate issue in the hospitals, but also forward to a time beyond the current lockdowns, when cost effective techniques for surveying groups of people for potential COVID-19 sufferers will be required. This surveillance, for example, could be in hospitals, at airport gates, in buildings or outside in streets. As part of the initiative Thales Glasgow has been performing analysis and experiments using cameras looking at faces to confirm what temperature differences can be measured.

What Thales lacks is real world thermal images of patients suffering fever and access to clinicians who can advise on the medical aspects of the work. EmQuire has developed a feasibility study to explore the use of the technology within this application. Future validation and clinical evaluation studies will follow…

Attending an Emergency Department (ED) is a daunting process for patients. It is important, as ED clinicians, that we remain cognizant that attendance to hospital is an irregular occurrence for most people and is associated with considerable anxiety.

To improve patient experience an enhanced understanding of patient needs is crucial. The Picker Institute developed the Always Event  (AE) to address this which is defined as a “clear, action-oriented, and pervasive practice or set of behaviours” with the aim of engaging patients and relatives with an ongoing commitment to patient-centred care and excellent patient experience that is feasible in day to day practice.This is in line with recent pushes that highlight person-centred care as a key way of improving patient experience.

AEs require a reflective approach to feedback allowing for patients to express what is important to them in their healthcare experience.

Traditionally in the Emergency Department if a patient presents with exacerbation of COPD severe enough to require nebulisers they will be treated using a jet nebuliser which is driven through either air or Oxygen. Another type of nebuliser (Vibrating mesh nebuliser) is available, which silently creates a finer aerosol for delivery of drugs.

BRAVE (Borg score outcomes in Respiratory compromised Acute exacerbating COPD patients receiving treatment via vibrating mesh nebuliser Versus jet nebuliser in the Emergency department) is a trial which aims to compare outcomes in patients with acute exacerbation of COPD when treated using a traditional jet nebuliser versus a vibrating mesh nebuliser. It measures outcomes using a Borg score (Pt self assessment of how they are feeling) and Impulse Oscillometry (used to measure lung function). These outcomes can then be analysed to ascertain which delivery method yields the best outcomes for patients, thereby allowing for innovation and development of current practices.

Fighting COPD with Innovative Predictive Technology

This study evaluates the safety and efficacy of using the Hemolung RAS to provide low-flow extracorporeal carbon dioxide removal (ECCO2R) as an alternative or adjunct to invasive mechanical ventilation for patients who require respiratory support due to an acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD). It is hypothesized that the Hemolung RAS can be safely used to avoid or reduce time on invasive mechanical ventilation compared to COPD patients treated with standard-of-care mechanical ventilation alone. Eligible patients will be randomized to receive lung support with either the Hemolung RAS plus standard-of-care mechanical ventilation, or standard-of-care mechanical ventilation alone.

Hereditary angioedema is a rare inherited disorder characterized by recurrent episodes of the accumulation of fluids outside of the blood vessels, blocking the normal flow of blood or lymphatic fluid and causing rapid swelling of tissues in the hands, feet, limbs, face, intestinal tract, or airway. Swelling of the gastrointestinal tract leads to cramping. These symptoms develop as the result of deficiency or improper functioning of certain proteins that help to maintain the normal flow of fluids through very small blood vessels (capillaries).

The aim of the EHA trial (Epidemiological Analysis for Hereditary Angioedema Disease) is to identify those patients whose presentations with recurrent abdominal pain may be as a result of this condition. HAE is exceptionally rare and is therefore not often considered as a diagnosis in patients with recurring abdominal pain. This trial therefore aims to assess the feasibility of using a dried blood spot sample in these patients to facilitate diagnosis. The overall objective is that this will prevent both further hospitalisations and further unnecessary investigations on these patients, and also provide answers to those patients who have no current cause for their recurrent issues.

Comparison of the improved oxygenation achieved by three different O₂ flow rates using oxygen delivered by nasal high flow therapy  in patients with acute respiratory failure receiving low, medium or high conventional oxygen therapy.

Oxygen delivered by nasal high flow therapy (HFNO2) is gaining prominence as a therapy for respiratory support in critically ill patients.  In contrast to low flow oxygen devices e.g. the simple face mask or venturi mask, high flow nasal devices are able to deliver flow rates of up to 60 litres/minute. There is less entrainment of room air resulting in an inspired oxygen concentration (FiO₂) delivered that is equal to that set on the device. High flow nasal oxygen is also well tolerated as inspired gas is warmed to 37°C and completely humidified which preserves mucociliary function.  High flow nasal oxygen has been shown to generate of low levels of positive pressure in the upper airways which reduces alveolar collapse and increases lung volume.  Improved efficiency of respiratory effort and decreased work of breathing result from a reduction in respiratory dead space and flushing out of carbon dioxide from the upper airway

The aim of this study is to determine in patients with different severities of respiratory failure, and using HFNO2, the FiO₂ required to maintain low normal oxygen saturations and a respiratory rate that is not excessively high.

QEUH ED welcomed two Navigators in July 2018, and we are proud to have Sam and Tam as part of our team.  The Navigators intervene where violence and hopelessness are intertwined with a patients attendance at the ED.  With support from Police Scotland’s Violence Reduction Unit, NHS Scotland and Medics against violence, the Navigator project has played a part in Glasgow’s success story in reducing violence and its consequences.  The Guys in pink have the skills and experience to de-escalate tensions and bring a unique knowledge to patients and families touched by violence.

CollectioN Of Venous and capillary blood samples for the development of nEw diagnostic devices for cardiovascuLar conditions

At present, if one needs to perform a blood test for cardiovascular investigation (for example troponin, D-dimer, CRP) a full bottled blood sample must be taken and sent to a laboratory for testing. Getting a result can be a lengthy process, during which appropriate management/diagnosis may be delayed.

Lumira have developed a point of care testing tool which can provide results for a number of cardiovascular biomarkers within minutes, therefore allowing for more rapid diagnosis and more efficient management of these patients. The purpose of this study is to correlate the results of bottled blood tests with those of the fingerprick tests to ensure accuracy of results. The eventual aim is that this point of care testing can be used in a variety of clinical settings, reducing the overall cost and time burden of running all of these tests in a laboratory.

OCTS is a project designed to look at patient outcomes following rib fractures. The purpose is to trial a new PROM (Patient reported outcome measures) for patients who have suffered broken ribs from chest trauma – this will take the form of a questionnaire immediately post injury, at 90 days and at 104 days. This will help to identify the issues that are important to patients during the recovery from rib fractures, and will therefore allow for improved patient care and experience in the future.

There exists continued controversy over the use of propofol in ED PSA, this is despite its widespread existence in clinical practice for at least a decade. These concerns are not limited to the ED setting and are primarily related to the pharmacological properties of the drug itself and its potential for harm. The bolus administration of propofol, aimed at a target of sedation, offers several advantages over more traditional agents, yet these advantages are also its limitations. The use of a target-controlled infusion may provide the seditionist with greater control over the pharmacokinetics of propofol and thus reduce the rate of adverse incident. This study aims to use a pragmatic design to test the safety and efficacy of propofol TCI against usual PSA care in the ED.

This study aims to investigate the effect of early computed tomography coronary angiography (CTCA) in patients with suspected or confirmed ACS upon interventions, event rates and health care costs in a pragmatic clinical trial and economic evaluation up to 1 year after the trial intervention. The primary objective will be to investigate the effect of the intervention on the proportion of patients with all-cause death or recurrent non-fatal type 1 and 4b Myocardial Infarction at one year.

An open, prospective, parallel-group, randomised controlled trial of CTCA in patients presenting to the Emergency Department or Medical Assessment Unit with suspected or confirmed acute coronary syndrome (ACS) in 30 NHS tertiary and district hospitals (with and without on-site coronary angiography facilities) with emergency departments, acute medical, radiology and cardiology services.