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.

The prevalence of frailty and its association with clinical outcomes in general surgery: a systematic review and meta-analysis.

Abstract: Objectives to investigate the prevalence and impact of frailty for general surgical patients. Research design and methods we conducted a systematic review and meta-analysis. Studies published between 1 January 1980 and 31 August 2017 were searched from seven databases. Incidence of clinical outcomes (mortality at Days 30 and 90; readmission at Day 30, surgical complications and length of stay) were estimated by frailty subgroup (not-frail, pre-frail and frail). Results 2,281 participants from nine observational studies were included, 49.3% (1013/2055) were males. Mean age ranged from 61 to 77 years old. Eight studies provided outcome data and were quality assessed and of fair or good quality, and one study only provided an estimate of prevalence and was not quality assessed. The prevalence estimate ranged between 31.3 and 45.8% for pre-frailty, and 10.4 and 37.0% for frailty. After pooling, Day 30 mortality was 8% (95% CI: 4–12%; I2 = 0%) for frail compared to 1% for non-frail patients (95% CI: 0–2%; I2 = 75%). Due to heterogeneity the Day 90 mortality was not pooled. Readmission rates were lower in the non-frail groups but were not pooled. Complications for the frail patients were 24%, (95% CI: 20–31%;I2 = 92%), pre-frail subgroup 9% (95% CI: 5–14%; I2 = 82%) and non-frail 5% (95% CI: 3–7%; I2 = 70%). The mean length of stay in frail people was 9.6 days (95% CI: 6.2–12.9) and 6.4 days (4.9–7.9) non-frail. Conclusions frailty is associated with adverse post-operative outcomes in general surgery.

A prospective observational study of falling before and after knee replacement surgery

Abstract: Background: knee arthritis is a risk factor for falling. Increasing numbers of people are receiving total knee arthroplasty (TKA) but the natural history of falling before and after TKA is unknown. Objective: to prospectively monitor falls in pre- and post-operative TKA patients and to identify independent risk factors for post-operative falling. Design: a prospective observational study with a 1-year follow-up. Participants: community-dwelling older people recruited from a regional orthopaedic centre. Methods: consecutive patients added to the TKA waiting list who completed monthly falls diaries, pre-operatively and 1 year post-operatively. Data on knee status (WOMAC: pain, stiffness and function), balance confidence (the Activities Balance Confidence Scale-UK—ABC-UK) and mood (Geriatric Depression Scale—GDS) were collected at quarterly intervals. Results: ninety-nine patients received a primary TKA. 24.2% fell in the last pre-operative quarter (24 patients reported 44 falls) and this decreased to 11.7‐11.8% in the first four post-operative quarters. 45.8% of people who fell pre-operatively fell again in the first post-operative year. Higher pre-operative GDS scores and a history of falling were significant independent predictors of post-operative falling. Conclusion: a recent history of falling is common in people undergoing TKA and ∼45% of patients fall again in the year following surgery. Patients being considered for TKA should be asked about falls history and undergo falls risk assessment and intervention.

Parental high concern and adolescent-onset anorexia nervosa. A case-control study to investigate direction of causality.

Abstract: Background Robust evidence that anorexia nervosa is preceded rather than accompanied by high-concern (overprotective) parenting is limited. Aims To look for evidence of parental high concern occurring before any onset of disorder. Method Forty consecutive referrals of adolescent girls with DSM-III-R anorexia nervosa were compared with matched controls using obstetric records and maternal interviews. Results Index mothers reported higher rates of: near-exclusive child care ( P =0.02), infant sleep difficulties ( P =0.018), severe distress at first regular separation ( P =0.048), high maternal trait anxiety levels ( P =0.008) and later age for first sleeping away from home ( P =0.009). More index families had experienced a severe obstetric loss prior to their daughter's birth ( P =0.066). Conclusions This study lends evidence to the clinical contention that high-concern parenting in infancy is associated with the later development of anorexia nervosa. This may derive, in part, from aspects of unresolved grief.