Philip Braude

Philip Braude
North Bristol NHS Trust · Southmead Hospital

Bachelor of Medicine

About

44
Publications
3,286
Reads
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1,059
Citations
Introduction
I am a consultant geriatrician at North Bristol NHS Trust working in geriatric perioperative care and front door acute frailty admissions. My research focus is with older people living with frailty in the perioperative period.
Additional affiliations
September 2019 - present
North Bristol NHS Trust
Position
  • Consultant
Description
  • Perioperative Geriatrician.
August 2015 - August 2019
Guy's and St Thomas' NHS Foundation Trust
Position
  • Medical Doctor

Publications

Publications (44)
Article
Background Older people are at the greatest risk of poor outcomes after serious injury. Evidence is limited for the benefit of assessment by a geriatrician in trauma care. We aimed to determine the effect of geriatrician assessment on clinical outcomes for older people admitted to hospital with serious injury. Methods In this multicentre observati...
Article
Full-text available
Background Older people are the largest group admitted to hospital with serious injuries. Many older people are living with frailty, a risk factor for poor recovery. We aimed to examine the effect of preinjury frailty on outcomes. Methods In this multicentre observational study (FiTR 1), we extracted prospectively collected data from all 23 adult...
Article
Background Victim-survivors of domestic violence and abuse (DVA) present to secondary care with isolated injuries to the head, limb or face. In the UK, there are no published studies looking at the relationship of significant traumatic injuries in adults and the relationship to DVA. The primary objective was to assess the feasibility of using a tai...
Preprint
The Covid-19 pandemic resulted in significant challenges to the provision of face-to-face clinics in geriatric perioperative care (G-POC). There are no studies evaluating the use of telemedicine in this population. A pilot study at North Bristol NHS Trust demonstrated that delivery of GPOC clinics via video consultation was feasible, but did not re...
Article
Background: Older people are more likely to have a stoma postabdominal surgery than younger people. Few studies have examined the effect of a stoma on older people. The aim of this review was to explore the effect of a stoma on functional independence of an older person. We explored secondary outcomes of poststoma formation length of hospital stay...
Article
Full-text available
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
Introduction Frailty and geriatric syndromes are becoming common place in surgical services. In general surgery, frailty has been shown to be associated with longer length of hospital stay. The effect of frailty on outcomes in Urology patients is not well described. We aimed to evaluate the effect of frailty and multimorbidity on length of stay in...
Article
Introduction Comprehensive Geriatric Assessment (CGA) is associated with reduced length of stay and perioperative complications in older orthopaedic, gastrointestinal and vascular surgical patients [1,2,3]. Limited published data from a single UK centre [4] reports reproducing these outcomes in a urological setting. It is unclear whether these outc...
Article
Full-text available
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
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Introduction: A chronic subdural haematoma (cSDH) is a collection of altered blood products between the dura and brain resulting in a slowly evolving neurological deficit. It is increasingly common and, in high income countries, affects an older, multimorbid population. With changing demographics improving the care of this cohort is of increasing...
Preprint
Full-text available
A protocol for a retrospective observational study to investigate the effect of frailty on outcomes of older adults admitted with major trauma. Patient data will be examined held within the Trauma and Audit Research Network (TARN) database, from 23 Major Trauma Centres in England, between April 2019 and March 2020. The two research questions are: 1...
Article
Full-text available
Introduction Comprehensive geriatric assessment (CGA) is an intervention that has been deployed in the perioperative setting with the aim to improve outcomes for older patients admitted to hospital. Older patients undergoing surgery are more likely to have postoperative complications, a longer hospital stay and be discharged to a care facility. Des...
Article
Background: Acute effects of COVID-19 can be devastating and life-threatening. Alterations in mental health during the active infection have been documented, but the long-term consequences are less clear. Method: A systematic review was undertaken to investigate the effect of COVID-19 on long-term mental health outcomes. Three databases [PubMed, Me...
Article
Abstract Background Frailty is known to affect how people admitted with traumatic injuries recover during their inpatient stay and shortly after discharge. However, few studies have examined the effect of frailty on long-term mortality when adjusted for significant factors including age. We aimed to determine the effect of frailty on 1-year moralit...
Article
Spinal fractures are the third most common traumatic injury in older people, of which cervical spine injuries make up around 15%. They are predominantly seen in people living with frailty who fall from standing height. Spinal fractures in this patient group are associated with substantial morbidity and mortality (over 40% at 1 year). For many older...
Article
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 ag...
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Full-text available
Background: To inform clinical practice and policy, it is essential to understand the lived experience of health and social care policies, including restricted visitation policies towards the end of life. Aim: To explore the views and experiences of Twitter social media users who reported that a relative, friend or acquaintance died of COVID-19...
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
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...
Article
The National Emergency Laparotomy Audit highlighted that older people living with frailty have poorer outcomes from emergency laparotomies. This editorial discusses some improvements in care that are needed to improve outcomes in this group of patients.
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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...
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Full-text available
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
Full-text available
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
Full-text available
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
The number of older people undergoing surgery is increasing yearly. Older adults are more likely to present for emergency surgery than undergo an elective operation. Advanced age, frailty, multimorbidity, cognitive impairment, and urgency of surgery are all predictors of poor outcome, including functional and cognitive decline. A new field led by g...
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
Background: Frailty assessment using the Clinical Frailty Scale (CFS) has been mandated for older people admitted to English major trauma centres (MTC) since April 2019. Little evidence is available as to CFS-associated outcomes in the trauma population. Objective: To investigate post-injury outcomes stratified by the CFS. Methods: A single ce...
Article
Frailty assessment is increasingly used to guide clinical decision-making.6 In the perioperative setting it can be used to inform decisions about appropriate levels of care, such as the need for postoperative intensive care admission. It is therefore imperative that clinicians undertaking frailty assessments are competent in the use of frailty asse...
Article
Full-text available
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
Full-text available
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]...
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Full-text available
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
Full-text available
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
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 appro...
Article
Objective: To assess the impact of introducing and embedding a structured geriatric liaison service, POPS-Urology, using comprehensive geriatric assessment methodology, on an inpatient urology ward. Patients and methods: A phased quality improvement project was undertaken using stepwise interventions. Phase 1 - A before-and-after study with init...
Article
Full-text available
The demand for surgical intervention in older people is rising due to the growing older population with multimorbidity. Yet older people continue to have reduced access to surgery and have more adverse postoperative outcomes than younger people. Current models of preoperative risk assessment and optimisation are poorly suited to this complex surgic...
Article
Background: geriatrics encompasses diverse medical, social and ethical challenges requiring a multidimensional, interdisciplinary approach. Recent reports have highlighted failings in the care of older people. It is therefore vital that trainees in geriatrics are afforded opportunities to develop skills in managing this complex population. Simulat...
Article
The technique of embolization of pulmonary arteriovenous malformations (PAVMs) with the Amplatzer vascular plug (AVP) has been reported, but no large series has evaluated the effectiveness of this relatively new embolic device. The purpose of this study is to assess the role of AVPs in the treatment of PAVMs. Sixty-nine consecutive patients underwe...

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