Institution
North Bristol NHS Trust
Healthcare•Bristol, United Kingdom•
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.
Papers published on a yearly basis
Papers
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TL;DR: Palliative care services are underused in ILD and a supportive care decision aid can prompt consideration of palliative and supportive care needs, a single centre study in a UK ILD centre suggests.
Abstract: Objectives Palliative care is underused in non-malignant respiratory diseases, including interstitial lung diseases (ILDs). We investigated current practices around palliative and supportive care and explored the impact of a supportive care decision aid tool. Methods This was a single centre study in a UK ILD centre. Retrospective analysis of hospice referrals and patients with idiopathic pulmonary fibrosis (IPF) under the Bristol ILD (BILD) service were used to identify unmet palliative and supportive care needs. Using quality improvement methodology, we explored the impact of a supportive care decision aid on clinician behaviours for patients with ILD. Results 108 patients with ILD were referred for hospice care between 2010 and 2015, representing 0.15% of all referrals, compared with a population prevalence of IPF of 0.9%. The median interval between referral and death was 124 days. Records were reviewed for 64 deceased and 89 living patients with IPF seen on July–December 2014. The decision aid was prospectively assessed with 73 patients. The deceased patients had greater markers of severity. There were no other differences between the groups. After introduction, the decision aid tool was completed for 49.3% of patients and resulted in significant increases in documented discussion of referral to palliative care (11.2%vs53.6%, p Conclusion Palliative care services are underused in ILD and a supportive care decision aid can prompt consideration of palliative and supportive care needs.
21 citations
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TL;DR: The number of respiratory particles produced by breathing, coughing, and speaking or generated during medical procedures serve as important routes for disease transmission as mentioned in this paper, and the number of particles generated by these activities is a good indicator of disease transmission.
Abstract: Respiratory particles produced by breathing, coughing, and speaking or generated during medical procedures serve as important routes for disease transmission. Characterizing the number of particles...
21 citations
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University of Lisbon1, Stanford University2, University of North Carolina at Chapel Hill3, North Bristol NHS Trust4, University College London5, University of Western Australia6, University of British Columbia7, University of São Paulo8, GeneDx9, University of Western Ontario10, Masaryk University11, University of Paris12, Erasmus University Rotterdam13, Cardiovascular Institute of the South14
TL;DR: In this paper, the authors provided consensus recommendations for the most common FH-associated gene, LDLR, where >2300 unique FHassociated variants have been identified, and developed LDLR-specific modifications of ACMG/AMP guidelines.
21 citations
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TL;DR: Patients were fearful of reducing the dose of their bDMARDs, having previously experienced uncontrollable symptoms, but most were willing to try, provided that there was a clear rationale and that it was in their best interests, with opportunities for collaboration and dose control.
Abstract: © 2018 John Wiley & Sons, Ltd. Objective: Successful biologic disease-modifying anti-rheumatic drug (bDMARD) dose reduction appears increasingly possible from clinical trials. The present study aimed to understand the patient perspective of bDMARD dose reduction. Methods: Patients with rheumatoid arthritis, ankylosing spondylitis or psoriatic arthritis who were self-administering subcutaneous bDMARDs therapy at two National Health Service trusts participated in semi-structured interviews. To capture multiple experiences, patients were purposefully sampled for a range of age, gender, disease duration, reducing/not reducing bDMARDs and either within 3–12months of bDMARD initiation or ≥12months and in remission/low disease activity. Inductive thematic analysis was utilized. Results: Fifteen patients were interviewed (six on dose reduction). Five overarching themes were identified. When thinking about dose reduction, patients reflected on their difficult life before bDMARDs (“Where I was then”) compared with their transformative effects (“Where I am now”). All raised concerns that a dose reduction would take them back to where they used to be (“Fears for the future”) and most believed it to be a cost-cutting exercise. Most had “Hopes for the future”, that a reduction would lower their risk of side effects, and release funds for other patients. They wanted a clear rationale for reduction, collaborative decision making, and control over flexible dosing (“Information needs”). Conclusion: Patients were fearful of reducing the dose of their bDMARDs, having previously experienced uncontrollable symptoms. However, most were willing to try, provided that there was a clear rationale and that it was in their best interests, with opportunities for collaboration and dose control. These patient perspectives will inform the provision of patient information to guide clinical discussions.
21 citations
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University of Manchester1, University of Salford2, North Bristol NHS Trust3, King's College London4, University of Modena and Reggio Emilia5, University Hospital of Wales6, Aneurin Bevan University Health Board7, Alexandra Hospital8, Glasgow Royal Infirmary9, South London and Maudsley NHS Foundation Trust10, University of Aberdeen11, Cardiff University12
TL;DR: Pre-admission frailty was strongly associated with the need for an increased level of care at discharge for patients admitted to hospital with COVID-19, and frailty screening should be utilised for predictive modelling and early individualised discharge planning.
Abstract: The COVID-19 pandemic has placed significant pressure on health and social care. Survivors of COVID-19 may be left with substantial functional deficits requiring ongoing care. We aimed to determine whether pre-admission frailty was associated with increased care needs at discharge for patients admitted to hospital with COVID-19. Patients were included if aged over 18 years old and admitted to hospital with COVID-19 between 27 February and 10 June 2020. The Clinical Frailty Scale (CFS) was used to assess pre-admission frailty status. Admission and discharge care levels were recorded. Data were analysed using a mixed-effects logistic regression adjusted for age, sex, smoking status, comorbidities, and admission CRP as a marker of severity of disease. Thirteen hospitals included patients: 1671 patients were screened, and 840 were excluded including, 521 patients who died before discharge (31.1%). Of the 831 patients who were discharged, the median age was 71 years (IQR, 58–81 years) and 369 (44.4%) were women. The median length of hospital stay was 12 days (IQR 6–24). Using the CFS, 438 (47.0%) were living with frailty (≥ CFS 5), and 193 (23.2%) required an increase in the level of care provided. Multivariable analysis showed that frailty was associated with an increase in care needs compared to patients without frailty (CFS 1–3). The adjusted odds ratios (aOR) were as follows: CFS 4, 1.99 (0.97–4.11); CFS 5, 3.77 (1.94–7.32); CFS 6, 4.04 (2.09–7.82); CFS 7, 2.16 (1.12–4.20); and CFS 8, 3.19 (1.06–9.56). Around a quarter of patients admitted with COVID-19 had increased care needs at discharge. Pre-admission frailty was strongly associated with the need for an increased level of care at discharge. Our results have implications for service planning and public health policy as well as a person's functional outcome, suggesting that frailty screening should be utilised for predictive modelling and early individualised discharge planning.
21 citations
Authors
Showing all 2226 results
Name | H-index | Papers | Citations |
---|---|---|---|
Debbie A Lawlor | 147 | 1114 | 101123 |
Stephen T. Holgate | 142 | 870 | 82345 |
Paul Jackson | 141 | 1372 | 93464 |
E. Thomson | 103 | 992 | 51777 |
Paul Abrams | 91 | 505 | 51539 |
Susan M. Ring | 91 | 268 | 45339 |
Richard Baker | 83 | 514 | 22970 |
Seth Love | 74 | 344 | 30535 |
Kenneth R Fox | 70 | 269 | 19099 |
Evan L. Flatow | 70 | 245 | 15692 |
Paul Roderick | 67 | 392 | 20741 |
Robert J. Hinchliffe | 66 | 298 | 14818 |
Tim Cook | 61 | 340 | 14170 |
Jasmeet Soar | 57 | 252 | 20311 |
Salomone Di Saverio | 55 | 338 | 9123 |