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2020 NIHR ACF PES Bristol Older People and Complex Health Needs



2020 NIHR Academic Clinical Fellowship in Priority Research Themes

HEE Local Office: South West
Medical School: University of Bristol
Research Theme: Complex Needs in Age-Related and Chronic Disease
Specialty Options: Cardiology or Geriatric Medicine or Renal Medicine

Plain English Summary

Multiple active research areas within the University of Bristol offer opportunities suitable for an ACF in geriatric medicine, cardiology or renal medicine within the Complex Needs in Age-Related and Chronic Disease Priority Research Theme. Specific projects will be tailored to the trainee and their training goals, with the longer-term aim of providing the platform for a successful PhD fellowship application. The academic component of the ACF post will be hosted at Research Institute for the Care of Older People (RICE) in Bath.

Potential project areas include:

1. Blood pressure, heart failure and dementia
The ACF would join a research programme examining the links between blood pressure variability, heart failure and dementia. This would build on previous work examining the treatment of hypertension in people with dementia and the use of ambulatory blood pressure monitoring in this group. There is also the opportunity to link with the Cardionomics Research Group at the Bristol Heart Institute, where there is ongoing research into mechanisms contributing to transition from hypertension to heart failure with a focus on autonomic activation, inflammation and LV remodeling.

2. Sarcopenia
For this project, the ACF would examine the relationships between skeletal muscle function (using grip strength, timed get-up-and-go) and muscle mass (measured by DXA scanning) with impaired cardiac function (echocardiography) in the context of cognitive frailty. A representative sample of memory clinic attendees with diagnoses of heart failure and cognitive impairment would undergo a systematic battery of standardised assessments. Analyses would quantify associations between skeletal and cardiac muscle function with the aim of identifying clinical risk factors for skeletal muscle loss/dysfunction and ultimately a sub-group to target in future intervention studies.

3. Movement disorders
The ACF would work alongside the team delivering clinical trials in Parkinson’s disease. As a sub-study of either the CHIEF-PD or PRIME-PD trial cohorts, people with Parkinson’s would undergo 24-hour ambulatory blood pressure monitoring and detailed neuropsychiatric assessment. Associations between variability, cognitive function and gait would be tested. This project would potentially provide a basis for further work exploring the cerebrovascular risk factors for the development of cognitive impairment in people with Parkinson’s disease.

Geriatric Medicine
Clinical training would occur collaboratively between the Research Institute for the Care of Older People and the Royal United Hospitals Bath NHS Foundation Trust and the University of Bristol.  Trainees would have the opportunity to gain skills in the sub-specialty areas of dementia care, orthogeriatrics and movement disorders. The post is overseen by academic lead Dr Tom Welsh (

The ACF would be based at the Bristol Heart Institute under Dr Angus Nightingale ( for clinical training where they would join the current ACF and ACL in acquiring general cardiology skills including echocardiography, pacing and coronary angiography.

Clinical training in renal medicine will take place at Southmead Hospital in Dr Simon Satchell ( The ACF will rotate through periods in ward duties, daytime emergency duties as the on-call bleep holder, outpatient clinics (including transplantation, dialysis, general and sub-specialist nephrology and satellite clinics) and procedures.