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Article: Harnessing the force of post-F2 doctors - a medical clinical fellow post that transformed locally employed doctor recruitment.

Haggie, Rebecca / Scott, Rachel / Hughes, Rhiannon / Braude, Philip / Woodcraft, Heather

2023 Volume 10, Issue 2, Page(s) 154–156

Abstract: In 2018, North Bristol Trust (NBT) faced difficulties recruiting clinical fellows. In response, a new programme was introduced that includes opportunities for non-clinical time, supervision, and a study budget, as well as flexibility of contract duration ...

Abstract	In 2018, North Bristol Trust (NBT) faced difficulties recruiting clinical fellows. In response, a new programme was introduced that includes opportunities for non-clinical time, supervision, and a study budget, as well as flexibility of contract duration and on-call commitment. This has significantly improved the application ratios, with a 94% fill rate in August 2021 and competition ratios of 2.5:1. Not only has it been successful for staffing medical rotas, but clinical fellows also report positive experiences, have gained opportunities that would not be available in a training role and feel the role will benefit their future job applications. This report outlines the new programme and analyses it from the clinical fellow and Trust perspective. We hope that by sharing this successful new programme, other organisations can take inspiration to harness the potential of the high proportion of doctors taking a break from training post-foundation programme.
Language	English
Publishing date	2023-10-02
Publishing country	England
Document type	Journal Article
ZDB-ID	3016427-8
ISSN	2514-6653 ; 2514-6645
ISSN (online)	2514-6653
ISSN	2514-6645
DOI	10.7861/fhj.2022-0043
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Article ; Online: Geriatrician assessment and immortal time bias in the FiTR 2 study - Authors' reply.

Braude, Philip / Short, Roxanna / Bouamra, Omar / Lecky, Fiona / Carter, Ben

The Lancet. Healthy longevity

2022 Volume 3, Issue 11, Page(s) e736

MeSH term(s)	Humans ; Geriatricians ; Bias ; Time Factors
Language	English
Publishing date	2022-11-10
Publishing country	England
Document type	Letter
ISSN	2666-7568
ISSN (online)	2666-7568
DOI	10.1016/S2666-7568(22)00223-9
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Article ; Online: Amputation and advance care plans: An observational study exploring decision making and long-term outcomes in a vascular centre.

Grange, Robert / Carter, Ben / Chamberlain, Charlotte / Brooks, Marcus / Nitharsan, Ramya / Twine, Christopher / Braude, Philip

Vascular

2023 , Page(s) 17085381231162733

Abstract: Background: Half of those undergoing major lower limb amputation for peripheral arterial disease die within 1 year. Advance care planning reduces days in hospital and increases the chance of dying in a preferred place.: Aim: To investigate the ... ...

Abstract	Background: Half of those undergoing major lower limb amputation for peripheral arterial disease die within 1 year. Advance care planning reduces days in hospital and increases the chance of dying in a preferred place. Aim: To investigate the prevalence and content of advance care planning for people having a lower limb amputation due to acute or chronic limb-threatening ischaemia or diabetes. Secondary aims were to explore its association with mortality, and length of hospital stay. Design: A retrospective observational cohort study. The intervention was advance care planning. Setting/participants: Patients admitted to the South West England Major Arterial Centre between 1 January 2019 and 1 January 2021 who received unilateral or bilateral below, above, or through knee amputation due to acute or chronic limb-threatening ischaemia or diabetes. Results: 116 patients were included in the study. 20.7% ( Conclusions: Despite a high risk of death for all patients in the months following amputation, advance care planning occurred in fewer than half of people and mostly focused on resuscitation.
Language	English
Publishing date	2023-03-08
Publishing country	England
Document type	Journal Article
ZDB-ID	2137151-9
ISSN	1708-539X ; 1708-5381
ISSN (online)	1708-539X
ISSN	1708-5381
DOI	10.1177/17085381231162733
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Zs.A 4277: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Frailty is associated with long-term outcomes in older trauma patients: A prospective cohort study.

Ibitoye, Sarah / Bridgeman-Rutledge, Lily / Short, Roxanna / Braude, Philip / Pocock, Lucy / Carter, Ben

Injury

2023 Volume 55, Issue 2, Page(s) 111265

Abstract: Background: Most major trauma admissions are older adults, many of whom are living with frailty - a recognised risk factor for post-injury mortality.: Objectives: To describe the effect of frailty, and geriatrician review on mortality up to 4-years ... ...

Abstract	Background: Most major trauma admissions are older adults, many of whom are living with frailty - a recognised risk factor for post-injury mortality. Objectives: To describe the effect of frailty, and geriatrician review on mortality up to 4-years after hospitalisation following trauma. Methods: This prospective cohort study included patients 65 years or older admitted to North Bristol NHS Trusts' Major Trauma Centre from November 2018 to September 2019. The primary outcome was time-to-mortality, assessed with an adjusted multivariable Cox regression model. Analyses were adjusted for factors known to be associated with mortality including age, sex, comorbidities, injury factors, surgical procedure, and complications. Results: 573 patients were included: median age was 81 years; 67.5 % were living with frailty (Clinical Frailty Scale, CFS 4-8). Mortality was 45.2 % at the end of the study. Compared to fit patients (CFS 1-2), risk of death increased in those living with very mild frailty (CFS 4; aHR 3.22 [95 % CI 1.53-6.77]), mild frailty (CFS 5; aHR 4.97 [95 % CI 2.40-10.28]), moderate frailty (CFS 6; aHR 5.94 [95 % CI 2.83-12.44]), and moderate to severe frailty (CFS 7-8; aHR 9.63 [95 % CI 4.35-21.32]). Geriatrician review was associated with less mortality (aHR 0.55, 95 % CI 0.38-0.79). Conclusions: Frailty predicts long-term mortality in older trauma. Our findings have implications for clinician-patient discussions of prognosis and therapy goals. Furthermore, our results lend support to the routine provision of geriatrician input in trauma pathways.
MeSH term(s)	Humans ; Aged ; Aged, 80 and over ; Frailty ; Prospective Studies ; Hospitalization ; Prognosis ; Risk Factors ; Geriatric Assessment/methods ; Frail Elderly
Language	English
Publishing date	2023-12-10
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	218778-4
ISSN	1879-0267 ; 0020-1383
ISSN (online)	1879-0267
ISSN	0020-1383
DOI	10.1016/j.injury.2023.111265
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Zs.A 778: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article: Frailty in perioperative medicine.

Rogerson, Andrew / Braude, Philip

British journal of hospital medicine (London, England : 2005)

2019 Volume 80, Issue 6, Page(s) 357

MeSH term(s)	Aged ; Aged, 80 and over ; Frail Elderly ; Frailty/diagnosis ; Frailty/epidemiology ; Geriatric Assessment ; Humans ; Perioperative Care/methods ; Perioperative Medicine/methods
Language	English
Publishing date	2019-07-01
Publishing country	England
Document type	Journal Article
ISSN	1750-8460
ISSN	1750-8460
DOI	10.12968/hmed.2019.80.6.357
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Article ; Online: Developing a virtual geriatric perioperative medicine clinic: a mixed methods healthcare improvement study.

Joughin, Andrea / Ibitoye, Sarah / Crees, Amy / Shipway, David / Braude, Philip

Age and ageing

2021 Volume 50, Issue 4, Page(s) 1391–1396

Abstract: Background: the Geriatric Perioperative Care clinic at North Bristol NHS Trust was suspended in March 2020 during the COVID-19 pandemic. A virtual clinic was piloted to deliver preoperative health optimisation and shared decision-making for patients ... ...

Abstract	Background: the Geriatric Perioperative Care clinic at North Bristol NHS Trust was suspended in March 2020 during the COVID-19 pandemic. A virtual clinic was piloted to deliver preoperative health optimisation and shared decision-making for patients undergoing critical elective surgery. No literature existed on virtual preoperative clinics for older people to support the development. Objective: this healthcare improvement study describes the setup and delivery of the virtual clinic as its primary aim. Secondary aims included: assessing older people's access to technology and their digital literacy for virtual consultation; to describe barriers and facilitators for consultations, as well as evaluation of patient and clinician satisfaction with the consultations' mode of delivery and outcomes. Methods: a mixed methods healthcare improvement study was undertaken through plan-do-study-act cycles, semi-structure interviews, and quantitative service benchmarking. Results: the pilot evaluated 67 preoperative consultations (43.3% video, 56.7% telephone, mean age 75) with a mix of surgical pathology (vascular 88.1%, colorectal 10.4%, urological 1.5%). Patient feedback demonstrated improved understanding of conditions (90.6%), and adequate opportunity to express opinions and questions (96.2%). Clinicians preferred video consultations (adequate to deliver services: 89.7% video; 68.4% telephone). The greatest barriers to engagement, none of which were exclusions to participation, included cognitive impairment, sensory impairment, or needing technical assistance setting up video consultations (52.2%). Conclusions: delivering a virtual preoperative medical optimisation and shared decision clinic for older people is feasible. This study will aid other units in developing their own virtual preoperative clinics. Future work should evaluate perioperative outcomes of delivering a face-to-face versus virtual clinic.
MeSH term(s)	Aged ; COVID-19 ; Delivery of Health Care ; Humans ; Pandemics ; Perioperative Medicine ; SARS-CoV-2 ; Telemedicine
Language	English
Publishing date	2021-05-14
Publishing country	England
Document type	Journal Article
ZDB-ID	186788-x
ISSN	1468-2834 ; 0002-0729
ISSN (online)	1468-2834
ISSN	0002-0729
DOI	10.1093/ageing/afab066
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Zs.A 877: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Comprehensive geriatric assessment (CGA) in perioperative care: a systematic review of a complex intervention.

Miller, Rachael Lucia / Barnes, Jonathan David / Mouton, Ronelle / Braude, Philip / Hinchliffe, Robert

BMJ open

2022 Volume 12, Issue 10, Page(s) e062729

Abstract: Objectives: Comprehensive geriatric assessment (CGA) is a complex intervention applied to older people with evidence of benefit in medical populations. The aim of this systematic review was to describe how CGA is applied to surgical populations in ... ...

Abstract	Objectives: Comprehensive geriatric assessment (CGA) is a complex intervention applied to older people with evidence of benefit in medical populations. The aim of this systematic review was to describe how CGA is applied to surgical populations in randomised controlled trials. This will provide a basis for design of future studies focused on optimising CGA as a complex intervention. Setting: A systematic review of randomised controlled trials. Participants: A systematic search was performed for studies of CGA in the perioperative period across Ovid MEDLINE, Ovid EMBASE, CINAHL and Cochrane CENTRAL, from inception to March 2021. Interventions: Any randomised controlled trials of perioperative CGA versus 'standard care' were included. Outcome measures: Qualitative description of CGA. Results: 12 121 titles and abstracts were screened, 68 full-text articles were assessed for eligibility and 22 articles included, reporting on 13 trials. 10 trials focused on inpatients with hip fracture, with 7 of these delivering CGA on a geriatric medicine ward, 3 on a surgical ward. The remaining three trials were in elective general surgery all delivering CGA on a surgical ward. CGA components, duration of intervention and personnel delivering the intervention were highly variable across the different studies. Trials favoured postoperative delivery of CGA (11/13). Only four trials reported data on adherence to the CGA intervention. Conclusions: CGA as an intervention is variably described and delivered in randomised controlled trials in the perioperative setting. The reporting of both the intervention and standard care is often poor with little focus on adherence. Future research should focus on clearly defining and standardising the intervention as well as measuring adherence within trials. Prospero registration number: CRD42020221797.
MeSH term(s)	Humans ; Aged ; Geriatric Assessment ; Hip Fractures/surgery ; Geriatrics ; Perioperative Care ; Elective Surgical Procedures
Language	English
Publishing date	2022-10-21
Publishing country	England
Document type	Systematic Review ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2022-062729
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Article ; Online: Geriatric Assessment Is Associated With Reduced Mortality at 1 Year for Older Adults Admitted to a Major Trauma Center: A Prospective Observational Study.

Ibitoye, Sarah E / Braude, Philip / Carter, Ben / Rickard, Frances / Deakin, Helen / Martin, Rebecca / Thompson, Julian / Walton, Benjamin / Shipway, David

Annals of surgery

2023 Volume 277, Issue 2, Page(s) 343–349

Abstract: Objective: To evaluate the effect of geriatrician review on 1-year mortality in older adults admitted with trauma.: Background: Comprehensive geriatric assessment (CGA) has been associated with improved outcomes in older adults with hip fracture, but ...

Abstract	Objective: To evaluate the effect of geriatrician review on 1-year mortality in older adults admitted with trauma. Background: Comprehensive geriatric assessment (CGA) has been associated with improved outcomes in older adults with hip fracture, but has not been evaluated in a broader trauma population. Methods: Trauma patients aged ≥ 65years admitted to an English Major Trauma Centre between November 2018 and September 2019 were included. Patients were divided into 3 cohorts: no geriatric assessment, reactive geriatric assessment, and proactive CGA. The primary outcome was time to mortality, secondary outcomes were time to discharge and frequency of complications. Analyses were adjusted for factors known to be associated with outcomes including age, frailty, injury severity, and complications. Results: Five hundred eighty-five patients were included (no geriatric assessment = 125; reactive geriatric assessment = 134; proactive CGA = 326): median age was 81 years (IQR 74-88); 326 (55.7%) were women; 297 (50.8%) were living with frailty (Clinical Frailty Scale ≥5). Median Injury Severity Score was 13 (IQR9-25). At 1-year follow-up, 147 (25.1%) patients had died. In multivariate analysis, both types of geriatric assessment were associated with reduced mortality [reactive aHR = 0.31, 95% CI 0.18-0.53; proactive adjusted hazard ratio (aHR) = 0.41, 95% CI 0.26-0.64]. There was no association between either type of geriatric assessment and length of stay (reactive aHR = 0.84, 95% CI 0.62-1.15; proactive aHR = 0.80, 95% CI 0.63-1.02). Conclusions: Geriatrician assessment is associated with reduced mortality in older adults admitted following trauma. Further research should focus on defining optimal models of geriatrician intervention.
MeSH term(s)	Aged ; Humans ; Female ; Aged, 80 and over ; Male ; Trauma Centers ; Frail Elderly ; Frailty ; Hospitalization ; Patient Discharge
Language	English
Publishing date	2023-01-10
Publishing country	United States
Document type	Observational Study ; Journal Article
ZDB-ID	340-2
ISSN	1528-1140 ; 0003-4932
ISSN (online)	1528-1140
ISSN	0003-4932
DOI	10.1097/SLA.0000000000005092
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Article ; Online: The implementation of a perioperative medicine for older people undergoing surgery service: a qualitative case study.

Lodge, Margot E / Dhesi, Jugdeep / Shipway, David Jh / Braude, Philip / Meilak, Catherine / Partridge, Judith / Andrew, Nadine E / Srikanth, Velandai / Ayton, Darshini R / Moran, Chris

BMC health services research

2024 Volume 24, Issue 1, Page(s) 345

Abstract: Background: The international scale and spread of evidence-based perioperative medicine for older people undergoing surgery (POPS) services has not yet been fully realised. Implementation science provides a structured approach to understanding factors ... ...

Abstract	Background: The international scale and spread of evidence-based perioperative medicine for older people undergoing surgery (POPS) services has not yet been fully realised. Implementation science provides a structured approach to understanding factors that act as barriers and facilitators to the implementation of POPS services. In this study, we aimed to identify factors that influence the implementation of POPS services in the UK. Methods: A qualitative case study at three UK health services was undertaken. The health services differed across contextual factors (population, workforce, size) and stages of POPS service implementation maturity. Semi-structured interviews with purposively sampled clinicians (perioperative medical, nursing, allied health, and pharmacy) and managers (n = 56) were conducted. Data were inductively coded, then thematically analysed using the Consolidated Framework for Implementation Research (CFIR). Results: Fourteen factors across all five CFIR domains were relevant to the implementation of POPS services. Key shared facilitators included stakeholders understanding the rationale of the POPS service, with support from their networks, POPS champions, and POPS clinical leads. We found substantial variation and flexibility in the way that health services responded to these shared facilitators and this was relevant to the implementation of POPS services. Conclusions: Health services planning to implement a POPS service should use health service-specific strategies to respond flexibly to local factors that are acting as barriers or facilitators to implementation. To support implementation of a POPS service, we recommend health services prioritise understanding local networks, identifying POPS champions, and ensuring that stakeholders understand the rationale for the POPS service. Our study also provides a structure for future research to understand the factors associated with 'unsuccessful' implementation of a POPS service, which can inform ongoing efforts to implement evidence-based perioperative models of care for older people.
MeSH term(s)	Humans ; Aged ; Perioperative Medicine ; Qualitative Research
Language	English
Publishing date	2024-03-15
Publishing country	England
Document type	Journal Article
ZDB-ID	2050434-2
ISSN	1472-6963 ; 1472-6963
ISSN (online)	1472-6963
ISSN	1472-6963
DOI	10.1186/s12913-024-10844-0
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Article: Collaborative working: who is responsible?

Braude, Philip / Fertleman, Michael / Dhesi, Jugdeep K

Future healthcare journal

2019 Volume 4, Issue 2, Page(s) 138–141

Abstract: As delivery of healthcare becomes more complex, there is an increasing need for collaborative working between specialty teams. Recognition of this need has led to new models of care, for example surgeons, anaesthetists and geriatricians working together ... ...

Abstract	As delivery of healthcare becomes more complex, there is an increasing need for collaborative working between specialty teams. Recognition of this need has led to new models of care, for example surgeons, anaesthetists and geriatricians working together in the perioperative pathway. Although there is emerging evidence that these collaborative approaches are effective, there is little guidance on who is responsible for the patient throughout the healthcare episode. Government policy and legislation has increasingly focused on the need for a single named clinician to be responsible for the entirety of a patient's episode of care, with overall liability resting with the hospital trust as the provider organisation. This discrepancy between delivery of healthcare by teams and responsibility resting with an individual raises questions: how can clinicians and hospital trusts ensure synergistic patient care while maintaining clear lines of responsibility? Who should provide information to patients throughout the pathway? Who should the patient expect to be the point of contact? This dichotomy emphasises the need for new guidance to support the patient, the clinician and the provider organisation as shared models of care evolve and become embedded into routine practice.
Language	English
Publishing date	2019-05-15
Publishing country	England
Document type	News
ZDB-ID	3016427-8
ISSN	2514-6653 ; 2514-6645
ISSN (online)	2514-6653
ISSN	2514-6645
DOI	10.7861/futurehosp.4-2-138
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