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The image of United Bristol Healthcare trust is changing; its rating has risen from zero stars to two. The new management team is struggling with tight finances, but the trust must break even. UBHT managers are aiming to develop a more corporate culture.
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Surface enamel fluoride levels were measured in deciduous canine teeth from Bristol, with non-fluoridated water supplies, and Birmingham, with fluoridated water supplies. Three populations studied were from Bristol (teeth shed before 1960), Bristol (after 1975) and Birmingham (after 1975). Up to 75 micron from the enamel surface, fluoride concentrations of post-1975 Bristol and Birmingham teeth were, respectively, X 1.3 and 3.4 greater than those of pre-1960 Bristol teeth. The increase in the Bristol teeth is presumably due mainly to the increased use of fluoride-containing toothpastes, that in Birmingham to fluoridated water plus the use of fluoride toothpastes. No difference in the rates of penetration into enamel of acid-gel induced, caries-like lesions were found between the two Bristol populations; Birmingham teeth showed a reduction of 10 per cent in penetration rate. It is suggested that raised fluoride levels in surface enamel do not reduce solubility sufficiently to account, by themselves, for the recent nationwide marked reduction in caries in children. Possibly, the raising of plaque fluoride levels is a more important factor, affecting demineralization, remineralization and bacterial activity.
Activities of daily living scales can be a useful tool in assessing change in people with dementia, either as the disease progresses or in response to treatment. However, little data exist as to the sensitivity to change of instruments used. The Bristol Activities of Daily Living Scale was developed with assistance from the carers of community dwelling people with dementia to be completed by such people and has been shown to have internal consistency as well as face and construct validity. This study aimed to analyse the sensitivity to change of the Bristol Activities of Daily Living Scale in people with Alzheimer's disease receiving anticholinesterase medication. Using the Clinician's Global Rating of Change as a gold standard for change, differences between Bristol Activities of Daily Living Scale scores before and after medication were compared with change in Mini-Mental State Examination, Alzheimer's Disease Assessment Scale - Cognitive and the Nurses Observation Scale for Geriatric Patients, in 61 older adults receiving anticholinesterase medication for Alzheimer's disease. Both the Bristol Activities of Daily Living Scale and the Nurses Observation Scale for Geriatric Patients are sensitive and specific in predicting improvement or stability as measured by the clinician's global rating of change. However, unlike the Nurses Observation Scale for Geriatric Patients, change over time in the Bristol Activities of Daily Living Scale significantly correlates with change in the Mini-Mental State Examination and the Alzheimer's Disease Assessment Scale - Cognitive. The Bristol Activities of Daily Living Scale is sensitive to change in activities of daily living and shows the expected and desirable relationship with measures of cognition.
BACKGROUND: Reports of high mortality after paediatric cardiac surgery at the Bristol Royal Infirmary, UK, led to the establishment of an independent public inquiry. A key question was whether or not the mortality statistics in Bristol were unusual compared with other specialist centres. To answer this question, we did a retrospective analysis of mortality in the UK using two datasets. METHODS: Data from the UK Cardiac Surgical Register (CSR; January, 1984, to March, 1996) and Hospital Episode Statistics (HES; April, 1991, to December, 1995) were obtained for all 12 major centres in which paediatric cardiac surgery is done in the UK. The main outcome measure was mortality within 30 days of a cardiac surgical procedure. We estimated excess deaths in Bristol using a random-effects model derived from the remaining 11 centres. Additionally, a sensitivity analysis was done and case-mix examined. FINDINGS: For children younger than 1 year, in open operations, the mortality rate in Bristol was around double that of the other centres during 1991-95: within the CSR, there were 19.0 excess deaths (95% interval 2-32) among 43 deaths; and in HES, there were 24.1 excess deaths (12-34) among 41 deaths recorded. There was no strong evidence for excess mortality in Bristol for closed operations or for open operations in children older than 1 year. INTERPRETATION: Our results suggest that Bristol was an outlier, and we do not believe that statistical variation, systematic bias in data collection, case-mix, or data quality can explain a divergence in performance of this size.
Consecutive patients with maxillofacial fractures who attended departments of maxillofacial surgery in Bristol and Bordeaux during 1985-1986 were surveyed prospectively to determine differences in demography and aetiology and patterns of injury. 1,652 patients were included: 1,146 in Bordeaux and 506 in Bristol. Significantly more patients with nasal complex fractures were treated in Bordeaux reflecting management of these injuries by oto-rhino-laryngologists in Bristol. Maxillary fractures were comparatively more frequent in Bordeaux, reflecting a higher incidence of road accidents. Significantly more assault victims were treated by maxillofacial surgeons in Bristol, though per capita alcohol consumption by age and sex matched individuals was greater in France than in the U.K. Incidence of fracture was 18/100,000 hospital catchment population/year in Bordeaux, compared to 32/100,000 population/year in Bristol; reflecting that in contrast to Bristol, specialists in private practice outside the regional centre treated patients with fractures in S. W. France. Differences in aetiology of injury could be explained by cultural factors. Formal twinning arrangements and EEC membership provide excellent opportunities for postgraduate education, training and collaborative clinical research.
The General Medical Council hearing into events at the Bristol Royal Infirmary resulted in verdicts of serious professional misconduct against three senior doctors. After the longest-running hearing in the GMC's history the press response was fierce. This paper reviews the reporting of the Bristol case (and issues arising from it) in the main broadsheet and tabloid national newspapers (dailies and Sundays) in the 5-week period around the GMC's delivery of the verdicts and subsequent sentencing. The aim was to describe the main themes emerging from the press coverage and to assess the implications for future debates over clinical performance and accountability. Media interest in the Bristol case was intense (184 published items in 5 weeks). The reporting was emotive and largely hostile, raising doubts about not just isolated lapses of care but also the possibility of more systematic failings. Diminished trust and reduced public confidence were recurrent themes, powerfully expressed. Professional self-regulation received scathing criticism, with calls for more public access to individual performance data. Future debates about clinical governance will need to take account of the new public context in the wake of Bristol. Arguments about the relative merits of self-regulation or data-driven performance management systems now need to be played out for a knowing and openly sceptical print media.
We investigated the ability of the transposable element Tc1 to excise from the genome of the nematode Caenorhabditis elegans var. Bristol N2. Our results show that in the standard lab strain (Bristol), Tc1 excision occurred at a high frequency, comparable to that seen in the closely related Bergerac strain BO. We examined excision in the following way. We used a unique sequence flanking probe (pCeh29) to investigate the excision of Tc1s situated in the same location in both strains. Evidence of high-frequency excision from the genomes of both strains was observed. The Tc1s used in the first approach, although present in the same location in both genomes, were not known to be identical. Thus, a second approach was taken, which involved the genetic manipulation of a BO variant, Tc1(Hin). The ability of this BO Tc1(Hin) to excise was retained after its introduction into the N2 genome. Thus, we conclude that excision of Tc1 from the Bristol genome occurs at a high frequency and is comparable to that of Tc1 excision from the Bergerac genome. We showed that many Tc1 elements in N2 were apparently functionally intact and were capable of somatic excision. Even so, N2 Tc1s were prevented from exhibiting the high level of heritable transposition displayed by BO elements. We suggest that Bristol Tc1 elements have the ability to transpose but that transposition is heavily repressed in the gonadal tissue.