Kathryn Mccarthy

Kathryn Mccarthy
North Bristol NHS Trust

MB BS MD FRCS(Gen Surg)

About

82
Publications
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1,919
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Publications

Publications (82)
Article
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Background Frailty is associated with long-term physical deterioration after COVID-19. Mental health recovery has been less well investigated. Early studies have shown minimal effect from the virus, although studies have not focused on whether people living with frailty may have different psychiatric outcomes. We aimed to examine the effect of livi...
Article
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Background The reduced renal function has prognostic significance in COVID-19 and it has been linked to mortality in the general population. Reduced renal function is prevalent in older age and thus we set out to better understand its effect on mortality. Methods Patient clinical and demographic data was taken from the COVID-19 in Older People (CO...
Article
Background In response to the COVID-19 pandemic, many countries mandated staying at home to reduce transmission. This study examined the association between living arrangements (house occupancy numbers) and outcomes in COVID-19. Methods Study population was drawn from the COPE Study, a multicentre cohort study. House occupancy was defined as: livi...
Article
Our increasingly aging population is associated with older people being admitted to surgical wards at a rate surpassing population growth. 1 Although frailty is not exclusive to older adults, its prevalence is positively associated with age. 2 Hewitt et al. observed frailty to independently predict increased length of hospital stay (LOS), 30-day an...
Article
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Background C-reactive protein (CRP) is a non-specific acute phase reactant elevated in infection or inflammation. Higher levels indicate more severe infection and have been used as an indicator of COVID-19 disease severity. However, the evidence for CRP as a prognostic marker is yet to be determined. The aim of this study is to examine the CRP resp...
Article
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Background Whilst there is literature on the impact of SARS viruses in the severely immunosuppressed, less is known about the link between routine immunosuppressant use and outcome in COVID-19. Consequently, guidelines on their use vary depending on specific patient populations. Methods The study population was drawn from the COPE Study (COVID-19...
Article
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Prostate cancer is the second major cause of male cancer deaths. Obesity, type 2 diabetes, and cancer risk are linked. Insulin-like growth factor II (IGF-II) is involved in numerous cellular events, including proliferation and survival. The IGF-II gene shares its locus with the lncRNA, H19. IGF-II/H19 was the first gene to be identified as being “i...
Preprint
Full-text available
Background: Prostate cancer is the most frequently diagnosed cancer type and the second major cause of cancer deaths amongst men. A link exists between obesity, type 2 diabetes, and cancer risk. Insulin-like growth factor II (IGF-II) plays a role in numerous cellular events, including proliferation and survival. The IGF-II gene shares its locus wit...
Article
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Objective: During the COVID-19 pandemic the continuation or cessation of angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs) has been contentious. Mechanisms have been proposed for both beneficial and detrimental effects. Recent studies have focused on mortality with no literature having examined length of hosp...
Article
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Background 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. Methods...
Article
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Background: The impact of surgery compared to non-surgical management of older general surgical patients is not well researched. Methods: We examined the association between management and adverse outcomes in a cohort of emergency general surgery patients aged > 65 years. This multi-center study included 727 patients (mean+/-SD, 77.1 ± 8.2 years, 5...
Article
Introduction: This protocol describes an observational study which set out to assess whether frailty and/or multimorbidity correlates with short-term and medium-term outcomes in patients diagnosed with COVID-19 in a European, multicentre setting. Methods and analysis: Over a 3-month period we aim to recruit a minimum of 500 patients across 10 ho...
Article
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Frailty assessed using Clinical Frailty Scale (CFS) is a good predictor of adverse clinical events including mortality in older people. CFS is also an essential criterion for determining ceilings of care in people with COVID-19. Our aims were to assess the prevalence of frailty in older patients hospitalised with COVID-19, their sex and age distrib...
Article
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Background/aim: Stomal metastases from a primary rectal adenocarcinoma are rare, therefore, clear guidelines on treatment options are limited. We performed a systematic review including a case report on this subject with the primary objective of identifying the total number of cases in the literature. The secondary objective was to assess median s...
Article
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Coronavirus disease 2019 (COVID-19) infection causes acute lung injury, resulting from aggressive inflammation initiated by viral replication. There has been much speculation about the potential role of non-steroidal inflammatory drugs (NSAIDs), which increase the expression of angiotensin-converting enzyme 2 (ACE2), a binding target for severe acu...
Article
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The ACPGBI have recently released recommendations for re‐starting elective colorectal surgery to address the concerns that significant numbers of patients have been deferred during this pandemic worldwide (1). It is a credit to the specialty that most units have managed to continue with urgent cancer surgery through the pandemic, with leading units...
Preprint
Full-text available
Background: Whilst there is literature on impact of the SARS viruses in the severely immunosuppressed, and those who develop exaggerated immune response, less is known about the link between routine immunosuppressant use and outcome in COVID-19. Consequently, guidelines on their use vary depending on specific patient populations. Methods: The study...
Article
Full-text available
Introduction Hospital admissions for non-COVID-19 pathology have significantly reduced. It is believed that this may be due to public anxiety about acquiring COVID-19 infection in hospital and the subsequent risk of mortality. There is an urgent need for clarity regarding patients who acquire COVID-19 in hospital (nosocomial COVID-19 infection [NC]...
Article
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on behalf of the COPE Study Collaborators* Summary Background The COVID-19 pandemic has placed unprecedented strain on health-care systems. Frailty is being used in clinical decision making for patients with COVID-19, yet the prevalence and effect of frailty in people with COVID-19 is not known. In the COVID-19 in Older PEople (COPE) study we aimed...
Article
There are now over 30 000 emergency laparotomies under taken in the UK every year, a figure that is increasing year on year. Over half of these people are aged over 70 years old. Frailty is commonly seen in this population and becomes increasingly common with age and is seen in over 50% of elderly emergency laparotomies in people aged over 85 years...
Article
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Background The COVID-19 pandemic has placed unprecedented strain on health-care systems. Frailty is being used in clinical decision making for patients with COVID-19, yet the prevalence and effect of frailty in people with COVID-19 is not known. In the COVID-19 in Older PEople (COPE) study we aimed to establish the prevalence of frailty in patients...
Article
Full-text available
We write in response to the COVID-19 pandemic and the important recognition of co-existing frailty [COVID-19 rapid guideline: critical care in adults; NICE NG159] [...]
Article
Background Older patients account for a significant proportion of patients undergoing colorectal cancer surgery and are vulnerable to a number of preoperative risk factors that are not often present in younger patients. Further, three preoperative risk factors that are more prevalent in older adults include frailty, sarcopenia, and malnutrition. Al...
Article
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Background: With an ageing population, an increasing number of older adults are admitted for assessment to acute surgical units. Older adults have specific factors that may influence outcomes, one of which is delirium (acute cognitive impairment). Objectives: To establish the prevalence of delirium on admission in an older acute surgical populat...
Article
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Background In the United Kingdom, the 2010 National Confidential Enquiry into Patient Outcome and Death report ‘An Age Old Problem’ outlined significant shortcomings in the perioperative care of older people. Other than hip fractures, the care of older patients under surgical specialities is largely devoid of routine geriatrician input. In August 2...
Article
Background: Cognitive impairment is prevalent in older surgical patients; however, the condition is greatly under-recognized, and outcomes associated with it are poorly understood. Methods: This is a prospective multicenter cohort study of unselected consecutive older adults admitted to 5 emergency general surgical units across the United Kingdom...
Article
Background: Low albumin is a prognostic factor associated with poor surgical outcomes. We aimed to examine the predicative ability of easily obtainable point-of-care variables in combination, to derive a practical risk scale for predicting older adults at risk of poor outcomes on admission to the emergency general surgical setting. Methods: This i...
Article
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...
Data
Table S1 Information box of the criteria used to quantify conditions to define multimorbidity in the current study. Table S2 The Canadian Study of Health and Aging (CSHA) frailty scale used to define the level of frailty of each patient during hospital admission. Figure S1 The Confusion Assessment Method Diagnostic Algorithm used to define the pr...
Article
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Aim: The determinants of cognitive impairment and delirium during acute illness are poorly understood, despite being common among older people. Anemia is common in older people, and there is ongoing debate regarding the association between anemia, cognitive impairment and delirium, primarily in non-surgical patients. Methods: Using data from the...
Article
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Background With increasing numbers of older people being referred for elective colorectal surgery, cognitive impairment is likely to be present and affect many aspects of the surgical pathway. This study is aimed to determine the prevalence of cognitive impairment and assess it against surgical outcomes. Methods The Montreal Cognitive Assessment (...
Article
Background: Delirium is a common syndrome responsible for a large burden of morbidity and mortality. In surgical settings, research into risk factors for postoperative delirium has largely focused on elective orthopedic patients. We performed a systematic review and meta-analysis to evaluate the evidence surrounding risk factors for delirium in va...
Article
Aim: To assess the outcomes for patients with chronic idiopathic pelvic pain (CIPP) and associated pelvic floor disorders (PFDs) undergoing laparoscopic ventral mesh rectopexy (LVMR). Method: A prospective database identified patients referred from a specialist pain clinic undergoing LVMR. Primary outcomes included numerical rating scale (NRS) f...
Article
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Background: Colonoscopy is currently the gold standard for detection of colorectal lesions, but may be limited in anatomically localising lesions. This audit aimed to determine the accuracy of colonoscopy lesion localisation, any subsequent changes in surgical management and any potentially influencing factors. Methods: Patients undergoing colon...
Article
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Introduction Impaired preoperative kidney function is associated with an increase in post-procedural major complications and mortality in older elective surgical population. However, little is known about the impact of poor kidney function on outcomes in emergency surgical setting in this age group. This study aimed to quantify the effect of impair...
Article
Background Perineal wound healing is a significant challenge after extralevator abdominoperineal excision (ELAPE) due to a high rate of wound breakdown. Negative pressure therapy has proven benefits in open wounds, and recently a negative pressure system has been developed for use on closed wounds at high risk of breakdown, such as apronectomy and...
Article
Introduction Many older surgical patients are exposed to high risks of morbidity and mortality when undergoing both elective and emergency surgery. Methods We provide an overview of perioperative care teams and the educational opportunities available to surgeons who undertake surgery in the older person. Findings The number of older people underg...
Article
AIM: We assessed feasibility of the transanal minimally invasive surgery (TAMIS) procedure and quality of life postoperatively. PATIENTS AND METHODS: A total of 28 patients with rectal lesions were treated using TAMIS at Southmead Hospital, North Bristol NHS Trust. Outcome measures included feasibility of excision, negative margin (R0) resection ra...
Article
Background The purpose of the study is to examine the prevalence of hyperglycaemia in an older acute surgical population and its effect on clinically relevant outcomes in this setting. Methods Using Older Persons Surgical Outcomes Collaboration (OPSOC) multicentre audit data 2014, we examined the prevalence of admission hyperglycaemia, and its effe...
Article
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Objectives Multimorbidity is the presence of 2 or more medical conditions. This increasingly used assessment has not been assessed in a surgical population. The objectives of this study were to assess the prevalence of multimorbidity and its association with common outcome measures. Design A cross-sectional observational study. Setting A UK-based m...
Article
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Introduction: Older patients (>65 years of age) admitted as general surgical emergencies increasingly require improved recognition of their specific needs relative to younger patients. Two such needs are frailty and cognitive impairment. These are evolving research areas that the emergency surgeon increasingly requires knowledge of to improve shor...
Article
Background: Postoperative delirium (POD) is common after surgery. As age is a known risk factor, the increased ageing of the population undergoing surgery emphasizes the importance of the subject. Knowledge of other potential risk factors in older patients with surgical gastrointestinal diseases is lacking. The aim here was to collate and synthesi...
Article
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Background: Laparoscopic surgery is being increasingly offered to the older person. Objective: To systematically review the literature regarding laparoscopic colorectal cancer surgery in older people and compare to younger adult populations. Study selection: We included randomized controlled trials that compared open to laparoscopic colorectal canc...
Article
This review identifies and examines the clinical application of risk prediction tools, including the American Society of Anaesthesiology (ASA) Classification System and POSSUM-based scores, in the older general surgical patient. Predicting outcomes in this patient group remains difficult; it is challenging to design a risk prediction tool that will...
Article
Objectives: Rates of all surgical procedures are increasing at a faster rate than the population is ageing. However, this encouraging statistic, necessitates a robust evidence base. The epidemiological evidence base in acute general surgery in the older person is sparse. This is the first assessment of the prevalence of cognitive impairment measur...
Article
Aim: Laparoscopic ventral mesh rectopexy (LVMR) has been used to treat rectal prolapse, obstructed defaecation (OD), faecal incontinence (FI) and multicompartment pelvic floor dysfunction. Its value in treating men has been questioned. The aim of the present study was to assess the results in male patients. Method: A password-protected electroni...
Article
Aim: The study assessed the efficacy of laparoscopic ventral mesh rectopexy (LVMR) for full thickness external rectal prolapse (ERP), including recurrent prolapse. Method: A prospective database identified all patients undergoing LVMR for ERP over the 16-year period to December 2013. Clinical outcome, Cleveland Clinic Incontinence Score (CCIS),...
Article
Full-text available
Background We assessed the prevalence of frailty in an older acute general surgical population and its correlation with length of hospital stay, readmission to hospital and 30 and 90 day mortality. Methods In three acute surgical admissions units we assessed consecutive participants aged over 65 years with general surgical conditions. We measured...
Article
In the UK, colorectal surgery has evolved from traditional open surgery to a minimally invasive approach. In 2001, a UK survey found only 11.3% of malignant colorectal resections and 10% of anterior resections were performed laparoscopically(1) . However, subsequent publications including the CLASICC trial that led to revised NICE guidelines, have...
Article
The acute abdomen is a common condition in older people. Half of all presentations to hospital require admission, with a third requiring immediate surgery. The Royal College of Surgeons of England have reported a worryingly high mortality rate in the over 80s undergoing emergency surgery, with a 3-fold difference in mortality throughout the England...
Article
We compared radiotherapy with chemotherapy and radiotherapy before surgery in rectal cancer. We looked at people who had rectal cancer that had spread to the lymph glands but not to the liver or other organs. We found that both groups had the same number of people alive after 5 years. In other words; neither treatment was better at making people li...
Article
Acute kidney injury (AKI) is a common, serious, but potentially treatable condition. Because AKI is often associated with acidosis, it has become common practice to recommend administration of sodium bicarbonate to correct acid imbalance. To assess the benefits and harms of the use of sodium bicarbonate for people with AKI. The primary outcome meas...
Article
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The mitogenic and anti-apoptotic effects of insulin-like growth factor-I (IGF-I) are regulated by a family of insulin-like growth factor binding proteins (IGFBPs), particularly IGFBP-3. Little is known about the IGF-independent role of IGFBP-3 in breast cancer and the mechanisms regulating its production. The expression of IGFBP-3 in paired maligna...
Article
Chinese medicine is becoming widely used in the UK to treat many medical conditions, including acne. We report a case in which Chinese medicine, Lian Qiao Bai Du Wan, was used to treat acne in a teenage boy. The patient then suffered severe diarrhoea with blood and mucus per rectum. Examination of the stool revealed Clostridium difficile infection....
Article
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Vitamin D has anti-proliferative and proapoptotic effects on several cell types, including breast cancer cells. There have been no studies quantifying the expression of the enzyme 25-hydroxyvitamin D-1-alpha-hydroxylase (1alphaOHase), which converts 25-hydroxyvitamin D to its active metabolite, in breast tissue. We performed real-time RT-PCR to qua...
Article
Over the last ten years, since I qualified as a doctor, I have had numerous calls from friends and family for medical advice. Mostly these have been common questions that are easily answerable by any doctor who has experience of working in accident and emergency (A&E). Most memorably I had a phone call on New Year's Eve from a friend snowboarding i...
Article
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The exit exam (intercollegiate specialty examination) is the final rite of passage for surgical trainees. 'Old-system' SpRs like us have spent many years as SHOs, several more years in research and are then lucky enough to become registrars. The final years of training have been spent developing specialist operative skills and gaining as much pract...
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The purpose of this study was to evaluate COX-2 mRNA expression with known clinical prognostic features of breast cancer, oestrogen/progesterone receptor status, tumour size and grade. Total RNA was extracted from 45 frozen breast tumour (invasive) and 22 normal breast tissue samples. COX-2 mRNA transcription was quantified using a real time RT-PCR...
Article
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IGF-binding protein-3 (IGFBP-3) has been reported to exert a protective influence on the pathogenesis of colorectal cancer. This may reflect its modulation of IGF-I bioactivity as well as IGF-I-independent effects on cell proliferation and apoptosis. Although local expression of IGF-I in the colon is increasingly recognised as having important regu...