North Bristol NHS Trust

About: North Bristol NHS Trust is a healthcare organization based out in Bristol, United Kingdom. It is known for research contribution in the topics: Population & Medicine. The organization has 2204 authors who have published 2811 publications receiving 61110 citations.

A care-bundles approach to improving standard of care in AECOPD admissions: results of a national project

Abstract: This report describes a care bundles implementation project for COPD undertaken during 2013 in England and Wales. High-level data were collected on outcomes of care for 11 748 patients admitted with an acute exacerbation of COPD (AECOPD). Patient-level data on processes and outcomes of care were collected on 3272 COPD admissions, among which 1174 bundles were delivered. Analysis demonstrated a statistically significant reduction in mortality and length of hospital stay from some bundle elements. Outcomes, including bundle completion rates, were better when specialist respiratory review occurred. The results support wider use of care bundles for AECOPD.

Does measuring the range of motion of the hip and knee add to the assessment of disability in people undergoing joint replacement

Abstract: Background and hypothesis Range of motion (ROM) is a core component of some commonly used measures of disability, such as the American Knee Society Score and Harris Hip Score. However, the relationship between ROM and function is contested. The aim of this cross-sectional analysis was to investigate the relationship between pre-operative range of motion (ROM) and disability in patients undergoing hip and knee joint replacement. Patients and methods Two hundred and forty-nine patients recorded on NHS records as listed for joint replacement completed a range of measures prior to surgery. Pre-operative hip or knee ROM was measured by a trained research nurse using a hand-held goniometer. Joint pain severity was assessed using the WOMAC Pain Scale. Self-report activity limitations and participation restrictions were measured with the WOMAC Function Scale and the Aberdeen Impairment, Activity Limitation and Participation Restriction Measure. Observed activity limitations were assessed through three performance tests: 20-metre timed walk, sit-to-stand-to-sit, and 20-cm step tests. Results Pre-operative hip and knee ROM correlated weakly with self-report activity limitations (0.11 to 0.43), observed activity limitations (0.09 to 0.39) and self-report participation restrictions (−0.32 to 0.06). In comparison to ROM, correlations between joint pain and self-report activity limitations and participation restrictions were consistently moderate-high (−0.53 to 0.80). However, patients with restricted knee joint flexion ( 95°). Discussion This study suggests that modest restrictions of ROM are of little relevance to functional ability but that a certain amount of flexion is required for adequate function. We recommend that ROM is not the best means of assessing patients’ disability prior to surgery. Level of evidence III – cohort study.

South-West of England's Experience of the Safety and Tolerability Pirfenidone and Nintedanib for the Treatment of Idiopathic Pulmonary Fibrosis (IPF).

Abstract: Purpose: Pirfenidone and nintedanib are two novel antifibrotic agents licensed for the treatment IPF. Prior to being approved for use in England for patients with FVC >50% and <80%, these were made available for all IPF patients under the Mild Patient Program (MPP) and Patient In Need Scheme (PIN). Prescribing of these medications is restricted to specialist centers. We sought to characterize the population of patients prescribed antifibrotics and determine the drug tolerability of these medications in the Northern hub of the Southwest of England regional ILD network. Methods: A retrospective analysis of all patients treated with antifibrotics between August 2012 and July 2017 was undertaken. Baseline characteristics including patient demographics and pulmonary physiology, in addition to drug tolerability and reasons for treatment cessation were collated. Data were compared using unpaired student's t-test, Chi-squared, Mann-Whitney rank sum or ANOVA as appropriate. Logistic regression analysis evaluated clinical characteristics associated with discontinuation of pirfenidone therapy. P < 0.05 was considered statistically significant. Findings: A total of 164 patients, all with consensus diagnoses of IPF, were identified. Of these, 70.1% (115/164) received pirfenidone as their initial therapy. Baseline age, gender and pulmonary physiology did not differ significantly between groups. Drug discontinuation occurred most commonly due to adverse drug reactions events (ADRs) for both pirfenidone [40.0% (46/115)] and nintedanib [16.3% (8/49)]. Anorexia, rash and gastrointestinal disturbance were reported most commonly as the reason for cessation of pirfenidone; anorexia, nausea and weight loss for nintedanib. Duration of therapy prior to discontinuation because of ADRs did not differ significantly between medication groups but patients with a baseline FVC < 65% predicted, had a significantly shorter duration of pirfenidone prior to discontinuation due to ADRs, compared to those with a FVC 65-80% predicted. Multivariate logistic regression did not identify any independent baseline characteristics that predicted discontinuation of pirfenidone therapy prior to 52 weeks. Implications: Idiopathic pulmonary fibrosis (IPF) patients treated with nintedanib had comparable treatment emergent adverse event (TEAE) profiles in clinical practice to those reported in clinical trials. The TEAE profile of pirfenidone was higher than clinical trial data would suggest, although comparable to real-world datasets. Further work is required to explore the possible reasons underpinning this finding, including whether this is related to population co-morbidities or center threshold. No new safety concerns were identified.

Delivering high-quality cardiopulmonary resuscitation in-hospital.

Abstract: This review discusses recent data relating to delivering high-quality cardiopulmonary resuscitation (CPR) to patients with in-hospital cardiac arrest. Recent findings: Delivering high-quality CPR requires interventions at a national, local, team and individual rescuer level. These include measuring patient outcomes, patient safety incident reporting, education, an increased emphasis on human factors, briefing and debriefing of resuscitation teams, and the use of sensing devices that provide real-time prompts or feedback to rescuers during CPR. Data from national registries, patient safety incident reports and mock codes can be used to identify areas for improving practice. Education of staff is essential in both technical and nontechnical resuscitation skills (human factors). Resuscitation team performance can be improved by ensuring teams brief and plan beforehand and also debrief using feedback data collected during resuscitation events. The use of feedback and prompt devices helps improve adherence to guidelines for chest compression quality but data are lacking in terms of showing improved patient outcomes. Summary: Delivering high-quality CPR in-hospital requires a multifaceted approach. Collecting data during arrests and feeding back in real time and postevent during debriefings can be used to improve delivery of high-quality CPR. There are few studies that show improvement in actual patient outcomes (e. g., survival to hospital discharge) with improvements in delivery of high-quality CPR. Recognizing the importance of both technical and nontechnical skills (human factors) to deliver high-quality CPR is essential.

Research priorities in fragility fractures of the lower limb and pelvis: a UK priority setting partnership with the James Lind Alliance.

Abstract: Objective To determine research priorities in fragility fractures of the lower limb and pelvis which represent the shared priorities of patients, their friends and families, carers and healthcare professionals. Design/setting A national (UK) research priority setting partnership. Participants Patients over 60 years of age who have experienced a fragility fracture of the lower limb or pelvis; carers involved in their care (both in and out of hospital); family and friends of patients; healthcare professionals involved in the treatment of these patients including but not limited to surgeons, anaesthetists, paramedics, nurses, general practitioners, physicians, physiotherapists and occupational therapists. Methods Using a multiphase methodology in partnership with the James Lind Alliance over 18 months (August 2016–January 2018), a national scoping survey asked respondents to submit their research uncertainties. These were amalgamated into a smaller number of research questions. The existing evidence was searched to ensure that the questions had not been answered. A second national survey asked respondents to prioritise the research questions. A final shortlist of 25 questions was taken to a multistakeholder workshop where a consensus was reached on the top 10 priorities. Results There were 963 original uncertainties submitted by 365 respondents to the first survey. These original uncertainties were refined into 88 research questions of which 76 were judged to be true uncertainties following a review of the research evidence. Healthcare professionals and other stakeholders (patients, carers, friends and families) were represented equally in the responses. The top 10 represent uncertainties in rehabilitation, pain management, anaesthesia and surgery. Conclusions We report the top 10 UK research priorities in patients with fragility fractures of the lower limb and pelvis. The priorities highlight uncertainties in rehabilitation, postoperative physiotherapy, pain, weight-bearing, infection and thromboprophylaxis. The challenge now is to refine and deliver answers to these research priorities.