Bradford Teaching Hospitals NHS Trust

Bradford, United Kingdom

Bradford Teaching Hospitals NHS Trust

Bradford, United Kingdom
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Study shows fall in stillbirth rate across the UK – a step towards the Government target LEICESTER, 23-Jun-2017 — /EuropaWire/ — Research published today shows that the stillbirth rate in the UK has reduced by almost 8% over the period 2013 to 2015. A current Government ambition is to halve the rates of stillbirth and neonatal death in England by 2030. These findings indicate that things are moving in the right direction. The MBRRACE-UK report focuses on rates of stillbirth and neonatal death across the UK for babies born at 24 weeks of gestation or more. The report found that in 2015 the stillbirth rate was 3.87 per 1,000 total births, a fall from 4.20 per 1,000 total births in 2013. Nevertheless, despite this reduction UK stillbirth rates still remain high compared to many similar European countries and there remains significant variation across the UK that is not solely explained by some of the important factors that influence the rate of death such as poverty, mother’s age, multiple birth and ethnicity. The fall in the stillbirth rate was focussed in those born at term. Professor Elizabeth Draper, Professor of Perinatal and Paediatric Epidemiology at the University of Leicester said: “Whilst the overall findings are good news, as two thirds of all stillbirths are born preterm we need to identify the extent to which preterm stillbirths are avoidable to enable the development of practices and policies to prevent these stillbirths and to reduce any variation in the quality of care across the UK”. Over the same period the neonatal death rate has remained fairly static with a fall between 2013 and 2015 from 1.84 to 1.74 deaths per 1,000 live births, indicating that more work is required to prevent these deaths in the future. Data for the Neonatal Networks shows that neonatal mortality rates vary between 1.15 and 3.21 deaths per 1,000 live births. Much of this variation is accounted for by differences in the proportion of babies dying from a major congenital anomaly. Broadly similar NHS Trusts and Health Boards have been grouped together by their type of care or size in order to provide an appropriate comparison of their mortality rates. A traffic light system has been used to highlight those where action needs to be taken to improve outcomes. Dr Brad Manktelow, Associate Professor at the University of Leicester, who led the statistical analysis said: “Those Trusts and Health Boards identified with high rates of stillbirth or neonatal death rates should review the quality of the care they provide. Work commissioned by the Healthcare Quality Improvement Programme is underway to develop a standardised perinatal mortality review tool to support and improve the quality of review of all stillbirths and neonatal deaths within all Trusts and Health Boards in the future”. MBRRACE-UK* is a team of academics, clinicians and charity representatives (commissioned by the Healthcare Quality Improvement Partnership** as part of the Maternal, Newborn and Infant Clinical Outcome Review Programme) whose remit is to monitor and investigate these deaths. To read the full report, MBRRACE-UK Perinatal Mortality Surveillance Report 2015 and to read more about the work of MBRRACE-UK see *The Maternal, Newborn and Infant Clinical Outcome Review Programme is run by MBRRACE-UK, a collaboration led from the National Perinatal Epidemiology Unit in Oxford with members from the University of Leicester, who lead the perinatal aspects of the work, including this enquiry, and the Universities of Birmingham and University College London, Bradford Teaching Hospitals NHS Trust, a general practitioner, and Sands, the Stillbirth and neonatal death charity. **The Healthcare Quality Improvement Partnership (HQIP) is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices. HQIP’s aim is to promote quality improvement, and it hosts the contract to manage and develop the Clinical Outcome Review Programmes, one of which is the Maternal, Newborn and Infant Clinical Outcome Review Programme, funded by NHS England, the Welsh Government and, with some individual audits, also funded by the Health Department of the Scottish Government, DHSSPS Northern Ireland and the Channel Islands. The programmes, which encompass confidential enquiries, are designed to help assess the quality of healthcare, and stimulate improvement in safety and effectiveness by systematically enabling clinicians, managers and policy makers to learn from adverse events and other relevant data. More details can be found at:

Petherick E.S.,University of Bradford | Tuffnell D.,Bradford Teaching Hospitals NHS Foundation Trust | Wright J.,Bradford Teaching Hospitals NHS Trust
BMC Pregnancy and Childbirth | Year: 2015

Background: Observing the fast during the holy month of Ramadan is one of the five pillars of Islam. Although pregnant women and those with pre-existing illness are exempted from fasting many still choose to fast during this time. The fasting behaviours of pregnant Muslim women resident in Western countries remain largely unexplored and relationships between fasting behaviour and offspring health outcomes remain contentious. This study was undertaken to assess the prevalence, characteristics of fasting behaviours and offspring health outcomes in Asian and Asian British Muslim women within a UK birth cohort. Methods: Prospective cohort study conducted at the Bradford Royal Infirmary UK from October to December 2010 comprising 310 pregnant Muslim women of Asian or Asian British ethnicity that had a live singleton birth at the Bradford Royal Infirmary. The main outcome of the study was the decision to fast or not during Ramadan. Secondary outcomes were preterm births and mean birthweight. Logistic regression analyses were used to investigate the relationship between covariables of interest and women's decision to fast or not fast. Logistic regression was also used to investigate the relationship between covariables and preterm birth as well as low birth weight. Results: Mutually adjusted analysis showed that the odds of any fasting were higher for women with an obese BMI at booking compared to women with a normal BMI, (OR 2.78 (95% C.I. 1.29-5.97)), for multiparous compared to nulliparous women(OR 3.69 (95% C.I. 1.38-9.86)), and for Bangladeshi origin women compared to Pakistani origin women (OR 3.77 (95% C.I. 1.04-13.65)). Odds of fasting were lower in women with higher levels of education (OR 0.40 (95% C.I. 0.18-0.91)) and with increasing maternal age (OR 0.87 (95% C.I. 0.80-0.94). No associations were observed between fasting and health outcomes in the offspring. Conclusions: Pregnant Muslim women residing in the UK who fasted during Ramadan differed by social, demographic and lifestyle characteristics compared to their non-fasting peers. Fasting was not found to be associated with adverse birth outcomes in this sample although these results require confirmation using reported fasting data in a larger sample before the safety of fasting during pregnancy can be established. © 2014 Petherick et al.; licensee BioMed Central Ltd.

Mannan A.,Bradford Teaching Hospitals NHS Trust | Smith T.O.,University of East Anglia
Knee | Year: 2016

Background: Implant malposition in total knee arthroplasty (TKA) often results in unsatisfactory outcomes. Rotational malalignment leads to impaired patellar tracking, stability and joint biomechanics. Patient-specific instrumentation aims to improve three-dimensional implant positioning while reducing overall costs of instrumentation. Methods: A PRISMA compliant search of all relevant literature between 2000 and 2014 was performed. The primary outcome of interest was deviation from a neutral femoral and tibial axial alignment of patient-specific instrumentation (PSI) vs conventional instrumentation. Femoral rotation was measured with reference to the transepicondylar axis. Tibial rotation was reported with reference to the anterior tibial tuberosity and a "best fit" with the anterior tibial cortex. Results: Six randomised studies met the inclusion criteria reporting on a total of 444 knees. Computed tomography (CT) based PSI systems were used exclusively in three studies, and two further studies in association with magnetic resonance imaging (MRI). MRI was used exclusively in one study. Mean femoral rotation in the conventional group was: - 1.7 to 1.6° (vs - 1.7 to 1° in the PSI group). Meta-analysis demonstrated a significant treatment effect favouring PSI with increased accuracy in "three-degree outliers" with femoral rotation: Z = 2.07, P = 0.04. A single study reported tibial rotational outcomes with no significant difference demonstrated in conventional instrumentation vs PSI. Conclusions: This Level 1 meta-analysis demonstrates favourable femoral rotational alignment outcomes in PSI knee arthroplasty. Only limited data is available for tibial rotational outcomes. Further studies with standardised "gold-standard" measurement criteria are required to clarify tibial rotational outcomes in PSI TKA. Level of evidence: 1. © 2015 Elsevier B.V.

Bryant M.,University of Leeds | Bryant M.,Bradford Teaching Hospitals NHS Trust | Sahota P.,Leeds Beckett University | Santorelli G.,Bradford Teaching Hospitals NHS Trust | Hill A.,University of Leeds
Public Health Nutrition | Year: 2015

Objective Knowledge of the types and quantities of foods and drinks available in family homes supports the development of targeted intervention programmes for obesity prevention or management, or for overall diet improvement. In the UK, contemporary data on foods that are available within family homes are lacking. The present study aimed to explore home food and drink availability in UK homes. Design An exploratory study using researcher-conducted home food availability inventories, measuring all foods and drinks within the categories of fruits, vegetables, snack foods and beverages. Setting Bradford, a town in the north of the UK. Subjects Opportunistic sample of mixed ethnicity families with infants approximately 18 months old from the Born in Bradford birth cohort. Results All homes had at least one type of fruit, vegetable and snack available. Fresh fruits commonly available were oranges, bananas, apples, satsumas and grapes. Commonly available fresh vegetables included potatoes, cucumber, tomatoes and carrots. The single greatest non-fresh fruit available in homes was raisins. Non-fresh vegetables contributing the most were frozen mixed vegetables, tinned tomatoes and tinned peas. Ethnic differences were found for the availability of fresh fruits and sugar-sweetened beverages, which were both found in higher amounts in Pakistani homes compared with White homes. Conclusions These data contribute to international data on availability and provide an insight into food availability within family homes in the UK. They have also supported a needs assessment of the development of a culturally specific obesity prevention intervention in which fruits and vegetables and sugar-sweetened beverages are targeted. © 2014 The Authors.

Getgood A.,University of Cambridge | Bollen S.,Bradford Teaching Hospitals NHS Trust
Cell and Tissue Banking | Year: 2010

Tendon and osteochondral allograft are key requirements for reconstructive orthopaedic surgery. Their successful use has been published repeatedly, however, they are associated with potential significant problems, which both patients and surgeons should be aware of. This review highlights the advantages and disadvantages associated with the clinical use of both tendon and osteochondral allograft. Particular emphasis is paid to graft immunogenicity, viability, incorporation and disease transmission, with specific examples from the literature illustrating each point. © 2009 Springer Science+Business Media B.V.

Currie S.,Leeds and West Yorkshire Radiology Academy | Galea-Soler S.,Queen Elizabeth Medical Center | Barron D.,Leeds and West Yorkshire Radiology Academy | Chandramohan M.,Bradford Teaching Hospitals NHS Trust | Groves C.,Bradford Teaching Hospitals NHS Trust
Clinical Radiology | Year: 2011

Spondylitis is the most common osseous manifestation of Mycobacterium tuberculosis infection. Although treatable, it continues to cause significant mortality and morbidity. Early diagnosis through familiarity with its imaging characteristics is essential to permit rapid treatment and prevent potential life-limiting consequences. In this review, we demonstrate the key magnetic resonance imaging features of this disease. © 2011 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Tang T.,Bradford Teaching Hospitals NHS Trust
Cochrane database of systematic reviews (Online) | Year: 2012

Polycystic ovary syndrome (PCOS) is characterised by infrequent or absent ovulation (anovulation), high levels of male hormones (hyperandrogenaemia) and high levels of insulin (hyperinsulinaemia secondary to increased insulin resistance). Hyperinsulinaemia is associated with an increase in cardiovascular risk and the development of diabetes mellitus. Insulin-sensitising agents such as metformin may be effective in treating the features of PCOS, including anovulation. To assess the effectiveness of insulin-sensitising drugs in improving reproductive outcomes and metabolic parameters for women with PCOS. We searched the Cochrane Menstrual Disorders and Subfertility Group Trials Register (October 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 3rd Quarter 2011), CINAHL (October 2011), MEDLINE (January 1966 to October 2011), and EMBASE (January 1985 to October 2011). Randomised controlled trials of insulin sensitising drugs compared with either placebo, no treatment, or an ovulation induction agent for women with PCOS, menstrual disturbance and subfertility. Two review authors independently assessed studies for inclusion and trial quality, and extracted data.   Forty-four trials (3992 women) were included for analysis, 38 of them using metformin and involving 3495 women.There was no evidence that metformin improved live birth rates, whether it was used alone (pooled OR 1.80, 95% CI 0.52 to 6.16, 3 trials, 115 women) or in combination with clomiphene (pooled OR 1.16, 95% CI 0.85 to 1.56, 7 trials, 907 women). However, clinical pregnancy rates were improved for metformin versus placebo (pooled OR 2.31, 95% CI 1.52 to 3.51, 8 trials, 707 women) and for metformin and clomiphene versus clomiphene alone (pooled OR 1.51, 95% CI 1.17 to 1.96, 11 trials, 1208 women). In the studies that compared metformin and clomiphene alone, there was evidence of an improved live birth rate (pooled OR 0.3, 95% CI 0.17 to 0.52, 2 trials, 500 women) and clinical pregnancy rate (pooled OR 0.34, 95% 0.21 to 0.55, 2 trials, 500 women) in the group of obese women who took clomiphene.Metformin was also associated with a significantly higher incidence of gastrointestinal disturbances than placebo (pooled OR 4.27, 95% CI 2.4 to 7.59, 5 trials, 318 women) but no serious adverse effects were reported. In agreement with the previous review, metformin was associated with improved clinical pregnancy but there was no evidence that metformin improves live birth rates whether it is used alone or in combination with clomiphene, or when compared with clomiphene. Therefore, the role of metformin in improving reproductive outcomes in women with PCOS appears to be limited.

Crocker T.,Bradford Teaching Hospitals NHS Trust
Cochrane database of systematic reviews (Online) | Year: 2013

The worldwide population is progressively ageing, with an expected increase in morbidity and demand for long-term care. Physical rehabilitation is beneficial in older people, but relatively little is known about effects on long-term care residents. This is an update of a Cochrane review first published in 2009. To evaluate the benefits and harms of rehabilitation interventions directed at maintaining, or improving, physical function for older people in long-term care through the review of randomised and cluster randomised controlled trials. We searched the trials registers of the following Cochrane entities: the Stroke Group (May 2012), the Effective Practice and Organisation of Care Group (April 2012), and the Rehabilitation and Related Therapies Field (April 2012). In addition, we searched 20 relevant electronic databases, including the Cochrane Central Register of Controlled Trials (The Cochrane Library, 2009, Issue 4), MEDLINE (1966 to December 2009), EMBASE (1980 to December 2009), CINAHL (1982 to December 2009), AMED (1985 to December 2009), and PsycINFO (1967 to December 2009). We also searched trials and research registers and conference proceedings; checked reference lists; and contacted authors, researchers, and other relevant Cochrane entities. We updated our searches of electronic databases in 2011 and listed relevant studies as awaiting assessment. Randomised studies comparing a rehabilitation intervention designed to maintain or improve physical function with either no intervention or an alternative intervention in older people (over 60 years) who have permanent long-term care residency. Two review authors independently assessed risk of bias and extracted data. We contacted study authors for additional information. The primary outcome was function in activities of daily living. Secondary outcomes included exercise tolerance, strength, flexibility, balance, perceived health status, mood, cognitive status, fear of falling, and economic analyses. We investigated adverse effects, including death, morbidity, and other events. We synthesised estimates of the primary outcome with the mean difference; mortality data, with the risk ratio; and secondary outcomes, using vote-counting. We included 67 trials, involving 6300 participants. Fifty-one trials reported the primary outcome, a measure of activities of daily living. The estimated effects of physical rehabilitation at the end of the intervention were an improvement in Barthel Index (0 to 100) scores of six points (95% confidence interval (CI) 2 to 11, P = 0.008, seven studies), Functional Independence Measure (0 to 126) scores of five points (95% CI -2 to 12, P = 0.1, four studies), Rivermead Mobility Index (0 to 15) scores of 0.7 points (95% CI 0.04 to 1.3, P = 0.04, three studies), Timed Up and Go test of five seconds (95% CI -9 to 0, P = 0.05, seven studies), and walking speed of 0.03 m/s (95% CI -0.01 to 0.07, P = 0.1, nine studies). Synthesis of secondary outcomes suggested there is a beneficial effect on strength, flexibility, and balance, and possibly on mood, although the size of any such effect is unknown. There was insufficient evidence of the effect on other secondary outcomes. Based on 25 studies (3721 participants), rehabilitation does not increase risk of mortality in this population (risk ratio 0.95, 95% CI 0.80 to 1.13). However, it is possible bias has resulted in overestimation of the positive effects of physical rehabilitation. Physical rehabilitation for long-term care residents may be effective, reducing disability with few adverse events, but effects appear quite small and may not be applicable to all residents. There is insufficient evidence to reach conclusions about improvement sustainability, cost-effectiveness, or which interventions are most appropriate. Future large-scale trials are justified.

Singh Y.,University of Cambridge | Singh Y.,Bradford Teaching Hospitals NHS Trust | Oddie S.,Bradford Teaching Hospitals NHS Trust
Resuscitation | Year: 2013

Background: The International Liaison Committee on Resuscitation (ILCOR) and UK Resuscitation Council (UKRC) updated guidance on newborn resuscitation in late 2010. Objectives: To describe delivery room (DR) practice in stabilisation following very preterm birth (<32 weeks gestation) in the UK. Methods: We emailed a national survey of current DR stabilisation practice of very preterm infants to all UK delivery units and conducted telephone follow-up calls. Results: We obtained 197 responses from 199 units (99%) and complete data from 186 units. Tertiary units administered surfactant in the DR (93% vs. 78%, P= 0.01), instituted DR CPAP (77% vs. 50%, P= 0.0007), provided PEEP in the delivery room (91% vs. 69%, P= 0.0008), and started resuscitation in air or blended oxygen (91% vs. 78%, P= 0.04) more often than non-tertiary units. Routine out of hours consultant attendance at very preterm birth was more common in tertiary units (82% vs. 55%, P= 0.0005). Conclusions: Marked variation in DR stabilisation practice of very preterm infants persisted one year after the publication of revised UKRC guidance. Delivery room care provided in non-tertiary units was less consistent with current international guidance. © 2013 The Authors.

McClean S.,Bradford Teaching Hospitals NHS Trust | Farrar D.,Bradford Teaching Hospitals NHS Trust | Kelly C.A.,Bradford Teaching Hospitals NHS Trust | Tuffnell D.J.,Bradford Teaching Hospitals NHS Trust | Whitelaw D.C.,Bradford Teaching Hospitals NHS Trust
Diabetic Medicine | Year: 2010

Aims To review postpartum glucose tolerance in women with gestational diabetes and evaluate the role of formal 75 g oral glucose tolerance testing vs. fasting plasma glucose in screening for persistent abnormalities. Methods Retrospective study of 985 pregnancies over a 10 year period in a mixed ethnic cohort of women who underwent follow-up glucose tolerance testing at 6 weeks postpartum. Diagnosis obtained by oral glucose tolerance test was tested against that from the fasting plasma glucose value. Results There were 272 abnormal postpartum oral glucose tolerance test results (27.6%), with 109 women identified as having frank diabetes. Eleven of these (10%) had fasting plasma glucose ≤6.0 mmol/l, as did 62 of 114 cases of impaired glucose tolerance. A fasting plasma glucose concentration of ≥6.1 mmol/l correctly identified abnormal glucose tolerance in 199 of 272 cases (sensitivity 0.73). South Asian women were much more likely to have persistent abnormalities of glucose tolerance than were Europeans (32 vs. 15%, χ2P < 0.0001). Conclusions A postpartum fasting plasma glucose measurement alone is not sensitive enough in our population to classify glucose tolerance status accurately. A formal postpartum oral glucose tolerance test is therefore needed to facilitate early detection and treatment. © 2010 Diabetes UK.

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