Alpha-Fetoprotein Detection of Hepatocellular Carcinoma Leads to a Standardized Analysis of Dynamic AFP to Improve Screening Based Detection.

Detection of hepatocellular carcinoma (HCC) through screening can improve outcomes. However, HCC surveillance remains costly, cumbersome and suboptimal. We tested whether and how serum Alpha-Fetoprotein (AFP) should be used in HCC surveillance. Record linkage, dedicated pathways for management and AFP data-storage identified i) consecutive highly characterised cases of HCC diagnosed in 2009-14 and ii) a cohort of ongoing HCC-free patients undergoing regular HCC surveillance from 2009. These two well-defined Scottish patient cohorts enabled us to test the utility of AFP surveillance. Of 304 cases of HCC diagnosed over 6 years, 42% (129) were identified by a dedicated HCC surveillance programme. Of these 129, 47% (61) had a detectable lesion first identified by screening ultrasound (US) but 38% (49) were prompted by elevated AFP. Despite pre-HCC diagnosis AFP >20kU/L being associated with poor outcome, 'AFP-detected' tumours were offered potentially curative management as frequently as 'US-detected' HCCs; and had comparable survival. Linearity of serial log10-transformed AFPs in HCC cases and in the screening 'HCC-free' cohort (n = 1509) provided indicators of high-risk AFP behaviour in HCC cases. An algorithm was devised in static mode, then tested dynamically. A case/control series in hepatitis C related disease demonstrated highly significant detection (p<1.72*10-5) of patients at high risk of developing HCC. These data support the use of AFP in HCC surveillance. We show proof-of-principle that an automated and further refine-able algorithmic interpretation of AFP can identify patients at higher risk of HCC. This approach could provide a cost-effective, user-friendly and much needed addition to US surveillance.

Impact of visual art in patient waiting rooms: survey of patients attending a transplant clinic in Dumfries.

BACKGROUND: The clinic waiting area in Dumfries received the highest score among nine units offering transplant follow-up (p < 0.001 for differences between units) in the recent Quality Improvement Scotland Renal Transplant Survey. DESIGN: The purpose of the present study was to determine which aspects of the Dumfries waiting area patients considered important to their outpatient experience. METHODS: We posted a questionnaire to all 44 renal transplant patients attending the Dumfries Renal Unit in October 2009 in which we asked patients to rate seven aspects of their clinic environment on a scale from 1 (not at all important) to 5 (very important). These were, in random order, comfy chairs, magazines and puzzle books, paintings on the wall, a 42-inch plasma screen TV, views from the windows, potted plants and computers with Internet access. RESULTS: Thirty-nine (89%) patients responded. The most highly rated feature of our clinic waiting room was the comfy chairs with an average score of 4.4. This was followed by the magazines and puzzle books (3.6), the plasma screen TV (3.6) and the paintings on the walls (3.4). The views from the windows (3.1), the computer (3.0) and the potted plants (2.9) were less highly rated. Respondents expressed a preference for landscapes/nature scenes (84%) and paintings of animals/birds (84%). Fewer wished to look at abstract paintings (27%) or portraits (24%). CONCLUSION: The QIS transplant survey has shown large differences in the quality of the environment of the transplant follow-up clinics in Scotland. Our survey of renal transplant patients attending the Dumfries Renal Unit suggests that the paintings we chose to display in our clinic waiting room contributed positively to their outpatient experience.

Visual art in hospitals: case studies and review of the evidence.

In 2006 a Department of Health Working Group on Arts and Health reported that the arts have 'a clear contribution to make and offer major opportunities in the delivery of better health, wellbeing and improved experience for patients, service users and staff alike'. In this review we examine the evidence underpinning this statement and evaluate the visual art of three of Scotland's newest hospitals: the Royal Infirmary of Edinburgh, the new Stobhill Hospital, and the new Victoria Infirmary in Glasgow. We conclude that art in hospitals is generally viewed positively by both patients and staff, but that the quality of the evidence is not uniformly high. Effects may be mediated by psychological responses to colour hue, brightness and saturation. Colours that elicit high levels of pleasure with low levels of arousal are most likely to induce a state of calm, while those causing displeasure and high levels of arousal may provoke anxiety. The fact that patients frequently express a preference for landscape and nature scenes is consistent with this observation and with evolutionary psychological theories which predict positive emotional responses to flourishing natural environments. Contrary to a view which may prevail among some contemporary artists, patients who are ill or stressed about their health may not always be comforted by abstract art, preferring the positive distraction and state of calm created by the blues and greens of landscape and nature scenes instead.