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.

Ocular microtremor during general anesthesia: results of a multicenter trial using automated signal analysis.

Abstract: Ocular microtremor (OMT) is a fine physiologic tremor of the eye related to neuronal activity in the reticular formation of the brainstem. The frequency of OMT is suppressed by propofol and sevoflurane and predicts the response to command at emergence from anesthesia. Previous studies have relied on post hoc computer analysis of OMT wave forms or on real-time measurements confirmed visually on an oscilloscope. Our overall aim was to evaluate an automated system of OMT signal analysis in a diverse patient population undergoing general anesthesia. In a multicenter trial involving four centers in three countries, we examined the accuracy of OMT to identify the unconscious state and to predict movement in response to airway instrumentation and surgical stimulation. We also tested the effects of neuromuscular blockade and patient position on OMT. We measured OMT continuously by using the closed-eye piezoelectric technique in 214 patients undergoing extracranial surgery with general anesthesia using a variety of anesthetics. OMT decreased at induction in all patients, increased transiently in response to surgical incision or airway instrumentation, and increased at emergence. The frequency of OMT predicted movement in response to laryngeal mask airway insertion and response to command at emergence. Neuromuscular blockade did not affect the frequency of OMT but decreased its amplitude. OMT frequency was unaffected by changes in patient position. We conclude that OMT, measured by an automated signal analysis module, accurately determines the anesthetic state in surgical patients, even during profound neuromuscular blockade and after changes in patient position.

Multiprofessional Team Simulation Training, Based on an Obstetric Model, Can Improve Teamwork in Other Areas of Health Care:

Abstract: This interrupted time-series study evaluated the impact of multiprofessional scenario-based training on the safety culture and teamwork climate of 3 surgical wards during a time of reduced financial resources. The authors ran 22 team training sessions for teams of 4 to 5 medical and nursing staff over a 4-month period on 3 surgical wards, using 2 scenarios based on a previously successful obstetric training program. Safety culture was measured before and after training using a validated psychometric questionnaire. After training there was a statistically significant improvement in safety culture (P = .036) on the wards. Teamwork climate improved, but the evidence was not as strong (P = .052). Perceptions of hospital management and adequacy of staffing levels showed significant deterioration. Simple, low-resource interventions can have a significant positive impact on safety culture and possibly teamwork climate on surgical wards. This could be of great value in maintaining patient safety at times of financial constraint.

Epidemiology of pleural empyema in English hospitals and the impact of influenza.

Abstract: Pleural empyema represents a significant healthcare burden due to extended hospital admissions and potential requirement for surgical intervention. This study aimed to assess changes in incidence and management of pleural empyema in England over the past 10 years and the potential impact of influenza on rates.Hospital Episode Statistics data were used to identify patients admitted to English hospitals with pleural empyema between 2008 and 2018. Linear regression was used to analyse the relationship between empyema rates and influenza incidence recorded by Public Health England. The relationship between influenza and empyema was further explored using serological data from a prospective cohort study of patients presenting with pleural empyema.Between April 2008 and March 2018 there were 55 530 patients admitted with pleural empyema. There was male predominance (67% versus 33%), which increased with age. Cases have increased significantly from 4447 in 2008 to 7268 in 2017. Peaks of incidence correlated moderately with rates of laboratory-confirmed influenza in children and young adults (r=0.30). For nine of the 10 years studied, the highest annual point incidence of influenza coincided with the highest admission rate for empyema (with a 2-week lag). In a cohort study of patients presenting to a single UK hospital with pleural empyema/infection, 24% (17 out of 72) had serological evidence of recent influenza infection, compared to 7% in seasonally matched controls with simple parapneumonic or cardiogenic effusions (p<0.001).Rates of empyema admissions in England have increased steadily with a seasonal variation that is temporally related to influenza incidence. Patient-level serological data from a prospective study support the hypothesis that influenza may play a pathogenic role in empyema development.

One-stage exchange for prosthetic joint infection of the hip.

Abstract: Exchange arthroplasty remains the gold standard of treatment of established prosthetic joint infection. This can be achieved using a one or two stage approach. The ENDO-Klinik, in Hamburg, has pioneered the one-stage technique since 1970 utilising antibiotic loaded acrylic cement (ALAC). This editorial discusses the relevant literature and describes the indications and surgical technique employed by the ENDO-Klinik Hamburg.

The burden of Progressive Fibrotic Interstitial lung disease across the UK

Abstract: While Idiopathic pulmonary fibrosis (IPF) remains the exemplar progressive fibrotic lung disease, there remains a cohort of non-IPF fibrotic lung diseases (fILD) which adopt a similar clinical behaviour to IPF despite therapy [1]. This phenotypically related group of conditions, where progression of disease is similar to that seen in IPF, have recently been described as Progressive Fibrotic Interstitial Lung diseases (PF-ILD) [2]. Historically treatments for these cases have been limited though given the phenotypic similarities many cases may have been given a multidisciplinary working diagnosis of IPF based on their disease behaviour [3]. The INBUILD trial broadened the scope of treatable fILD by demonstrating a significant benefit of Nintedanib in patients with fILD and progressive disease [4]. In response to this the European Commission (EC) approved an additional indication for Nintedanib in adults for the treatment of PF-ILD in July 2020. Footnotes This manuscript has recently been accepted for publication in the European Respiratory Journal . It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article. Conflict of interest: Dr. Simpson reports non-financial support from Boehringer Ingelheim, outside the submitted work. Conflict of interest: Dr. Barratt reports personal fees from Boehringer Ingelheim, grants, personal fees and non-financial support from Boehringer Ingelheim, outside the submitted work. Conflict of interest: Dr. Beirne reports personal fees from Boehringer-Ingelheim Pharmaceuticals, non-financial support from Boehringer-Ingelheim Pharmaceuticals, outside the submitted work. Conflict of interest: Dr. Chaudhuri reports grants from Boehringer Ingelheim, personal fees from Boehringer Ingelheim, personal fees from Roche, outside the submitted work. Conflict of interest: Dr. Crawshaw reports I have received honoraria from Boehringer Ingelheim for educational meetings (chair/talks) and grant for virtual attendance at international conferences. Conflict of interest: Dr. Crowley has nothing to disclose. Conflict of interest: Dr. Fletcher has nothing to disclose. Conflict of interest: Dr. Gibbons reports that he has served on advisory boards and received support to attend conferences from Roche and Boehringer-Ingelheim. Conflict of interest: Dr. Hallchurch has nothing to disclose. Conflict of interest: Dr. Horgan has nothing to disclose. Conflict of interest: Dr. Jakaityte has nothing to disclose. Conflict of interest: Dr. Lewis has nothing to disclose. Conflict of interest: Dr. McLellan reports grants from Unrestricted Educational Grant (Boehringer Ingelheim), outside the submitted work. Conflict of interest: Dr. Myall has nothing to disclose. Conflict of interest: Dr. Miller has nothing to disclose. Conflict of interest: Dr. Smith has nothing to disclose. Conflict of interest: Dr. Stanel has nothing to disclose. Conflict of interest: Dr. Thillai has nothing to disclose. Conflict of interest: Dr. Thompson has nothing to disclose. Conflict of interest: Dr. Wallis has nothing to disclose. Conflict of interest: Dr. Wu has nothing to disclose. Conflict of interest: Dr. Molyneaux, via his institution received industry-academic funding from AstraZeneca and has received speaker and consultancy fees from Boehringer Ingelheim and Hoffman-La Roche outside the submitted work.Dr. Molyneaux reports personal fees from Boehringer Ingelheim, personal fees from Hoffman-La Roche, other from AstraZeneca, outside the submitted work. Conflict of interest: Dr. West has nothing to disclose.