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National supply shortage of your medicine

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Why have I been given this information? 

You have been given this information as you are currently taking or about to start taking one or more of the following medicines:

  • Rifampicin.
  • Rifinah® 300 tablets (rifampicin 300mg / isoniazid 150mg).
  • Rifater® tablets (rifampicin 120mg / isoniazid 50mg / pyrazinamide 300mg).
  • Voractiv® tablets (rifampicin 150mg / isoniazid 75mg / pyrazinamide 400mg / ethambutol 275mg).
  • Pyrazinamide 500mg tablets.

At the moment these medicines are in short supply across the UK.

 What are these medicines used for?

All of these medicines are used to treat tuberculosis (TB). 

Rifampicin may also treat other infections like Non-Tuberculous Mycobacteria (NTM) or infections affecting bones or joints.

Why are there shortages? 

Shortages can be caused by many reasons. For example, because of problems with making them or more people needing them. 

 How long will the shortages last? 

We expect the shortages will last until at least the end of 2025, but this date may change. 

Will my treatment need to change? 

The shortages may affect different medicines at different times. 

Your specialist team may need to change you to a different medicine(s) if we do not have supplies of your usual medicine(s). The medicine(s) you receive may be

  • The same medicine, but from a different country. This is called an “unlicensed” medicine. There is information about unlicensed medicines at the bottom of this page. This medicine might look different to your usual medicine or have information that is in a different language. If the information is in a different language, we will give you a separate leaflet with this information in English.
    The medicine will always have the same active ingredient as your usual medicine, but may have different ingredients to those listed in the English leaflet. If you have any questions or worries about this please ask your specialist team or the hospital pharmacy.
  • The same medicine, but a different strength. This will mean that you need to take a different number of tablets or capsules to give your usual dose.
  • A different medicine. Sometimes this might mean taking more than one medicine in the place of your usual medicine if this was a combination product, for example Rifinah®, Rifater® or Voractiv®.

Any change that needs to be made to your medicine(s) will be discussed with you by your specialist team.

What does this mean for me? 

It is important that you continue to take your medicine(s) as prescribed for you – do not change how much you take unless your specialist team have told you to do this. Please do not stop taking your medicine(s).

If you think something is different about your medicine(s), please ask your specialist team or contact the hospital pharmacy. 

How will I get my medicine(s)?

The medicine(s) affected by the supply shortages are all prescribed by your specialist team and supplied by the hospital pharmacy. 

We are working to make sure we have enough supplies for everyone. To do this, we need to supply your medicine(s) in smaller amounts and more often – known as “instalment supplies”.

We will supply your medicine(s) in 4-week amounts (instalments), every 4 weeks until the prescription is complete. 

For North Bristol Trust (NBT) patients, the hospital pharmacy will automatically get these supplies ready for you to collect from the pharmacy in Southmead Hospital every 4 weeks. 

For University Hospitals Bristol and Weston (UHBW) patients the hospital pharmacy will automatically get these supplies ready for you to collect every 4 weeks. Please confirm with your specialist team where you need to collect these from – this will usually be the hospital pharmacy or the TB clinic.

Please put a reminder in your diary to collect your new supplies at least 1 week before you run out of your medicine(s).

Hospital pharmacy contact numbers and opening hours

LocationPhone numberWeekdaysWeekends and bank holidays
NBT (Southmead Hospital)0117 414 2236 09:00 – 18:00  09:00 – 16:00
Bristol Royal Infirmary (BRI)0117 923 000008:30 – 19:0009:00 – 17:00
Weston General Hospital01934 414 58409:00 – 18:00

Saturday 09:00 – 17:00

Sunday and bank holidays closed

If you are not able to collect your medicine before you run out, please contact your specialist team immediately.

Who can I speak to if I have any questions or worries?

About unlicensed medicines

This information explains what it means when medicines do not have a licence. 

Because of supply shortages with your medicine(s) we may need to give you an unlicensed medicine instead. We want to reassure you that we have thought very carefully about the best medicine for you.

Why are medicines “licensed”?

The makers of medicines must ask the government for a ‘Marketing Authorisation’ or ‘Product Licence’ if they want to sell their medicines in the UK. They show evidence to the government’s Medicines and Healthcare products Regulatory Agency (MHRA) that their medicine works for the illness to be treated, does not have too many side effects or risks, and has been made to a high standard.

How do the manufacturers test medicines?

To be sure that a medicine works and is safe the maker must try it first on a small number of people in what is called a ‘clinical trial’. Information from clinical trials is given to the MHRA when the maker asks for a Product  in the UK.

 

Why don’t my medicines have a UK licence?

Due to stock shortages in the UK, we may need to buy your medicine from another country. The medicines we buy are licensed in the country we buy them from, but do not have a license in the UK. This makes them unlicensed in the UK. 

How do I know that these medicines are safe and will work?

The hospital pharmacy will ensure that the unlicensed medicine has been made to a good standard and is safe for you to take.

Should I be worried about taking these medicines?

If you are still worried after reading this information, please talk to your specialist team. They are looking after you and have thought carefully about the best medicine for you. 

What if I don’t want to take an unlicensed medicine?

Please talk to your specialist team and tell them what you are worried about. They can give you more information about the medicine. They can also tell you if there are other treatments that might be available and why they think this unlicensed medicine is the best one for you.

Can I get more information about my unlicensed medicine?

All medicines come with a leaflet inside the box (a “Patient Information Leaflet”) which explains about the medicine, including how to take it and what side effects might happen. For some unlicensed medicines the information in the box may be in a different language. If this is the case with your medicine, we will give you a separate leaflet with this information in English.

If you have questions after reading this information, please talk to your specialist team.

© North Bristol NHS Trust. This edition published August 2025. Review due August 2028. NBT003466.

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See the impact we make across our hospitals and how you can be a part of it. 

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Find out about shared decision making at NBT. 

Being accepted onto the FAST MRI DYAMOND study

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Thank you so much if you have already signed up for the FAST MRI DYAMOND study.

The second stage of the FAST MRI DYAMOND study involves having the FAST MRI scan. A member of the research team will contact you to give you the information about Stage 2. They will discuss the study with you. If you can have the scan and would like to, they will book you a scan appointment. The scan itself takes just 3-5 minutes, but the whole appointment would last up to 45 minutes. Scans are provided at a Hospital associated with your local breast screening service.

Stage 2 - Participant Information

Why have I been asked to take part in this study?

Following your first mammogram, we invited you to take part in Stage 1 of the DYAMOND study: to measure your breast density and to check your breast screening results. Your images have now been checked and we think you could be eligible to join Stage 2 of the study to have a FAST MRI scan. 

Do I have to take part?

No, it’s up to you to decide whether to take part. If you choose not to, be reassured that your clinical care will not be affected. You will still be offered your routine screening mammograms every 3 years until you turn 71. 

What does taking part involve?

We have designed the study to be as convenient as it can be, so that as many people can be involved as possible. If you decide to take part, we will:

  • Ask you some questions about your health
  • Check that you can have a FAST MRI scan
  • Book a FAST MRI scan at a time convenient to you
  • Ask you to complete a survey about your experience

Some people may also be invited to take part in an interview about their experience.

We expect a small proportion of people having a FAST MRI scan to be invited for another scan after a year or be referred for further investigations.

What do I do next if I am interested in taking part?

A Research Nurse will contact you to discuss this part of the study and answer any questions you may have. If you would like to join the study, they will ask you some questions about your health to make sure that you are safe to have the FAST MRI scan. They will help you complete an online consent form and book you in for your scan at a time convenient to you. This will need to be between day 6 and 16 of your cycle if you are still having regular periods.

What would stop me from having a FAST MRI scan?

Please let the Research Nurse know if you are affected by any of the below as these things may prevent you having an MRI scan:

  • If you are or may be pregnant or if you are breast feeding
  • If you have ever had a penetrating eye injury
  • If you have ever had brain surgery
  • If you have a pacemaker or defibrillator
  • If you have an implanted neurostimulator
  • If you have a cochlear implant
  • If you have ever had a shrapnel injury
  • If you are claustrophobic
  • If you have had conditions associated with your kidneys
  • If you wear a sensor to measure your blood sugars (e.g. a “continuous glucose monitor”), this will need to be removed for the scan. We will try to arrange your scan around the time when you are due to change your sensor.

What is it like to have a FAST MRI scan?

We encourage you to watch this video to see what it is like to have a FAST MRI scan. 

Your FAST MRI scan appointment will take up to 45 minutes.

When you arrive, the radiographer will ask some questions to confirm that it’s safe for you to have the scan and ask you to sign a standard safety checklist. 

You will be asked to change into a hospital gown. 

You will have a cannula (a small, soft plastic tube) placed into a vein in your arm. This is necessary so that the radiographer can inject dye during your scan, which makes a cancer show up clearly if it’s there. The injection of dye is not painful. 

The radiographer will explain what is going to happen during the scan, which we expect to take between 3 and 5 minutes.

Once you have had the scan and your cannula has been removed, you will be free to go. Your scans will be sent to specialists who look at them in detail and check the findings. This means we can’t give you the results on the day of your scan.  

How will you get the results of your FAST MRI?

We will let you know the results of your FAST MRI scan 3-4 weeks after your scan date. 

If your scan is clear, you will receive your scan results by letter. 

Some people with a clear FAST MRI scan may be invited to have another scan in a year's time. This is because their scan is most likely normal but we would like to see if it has changed over time, as we are still learning which appearances on FAST MRI we can confidently call “clear”. We expect that all the people invited to have this second scan will then have a clear result.

If your scan shows that further investigations are needed, a Research Nurse will contact you by telephone to explain the results and what will happen next. The Research Nurse will arrange an appointment at the Breast Care Clinic. Appointments are usually offered within about 2 weeks of referral. This does not necessarily mean that you have a breast cancer, just that you need to have additional tests. You will receive a letter confirming the FAST MRI scan results.   

At these appointments a healthcare professional will look at your mammogram and FAST MRI scan results and will ask for more tests to be done, including another scan and possibly a biopsy. If you have a biopsy, we may ask you if we can collect an extra sample to donate to a tissue bank to help support future research. Information about this option will only be sent to you if you need further investigations following your FAST MRI.

They may also discuss your case with a team of other professionals after your appointment to help decide if more investigations are needed, which could include deciding to perform a full MRI. If you do need further tests, your care team will explain why each test is important and what having the test would involve for you. Any extra tests you may have will help the team decide if what was seen on the FAST MRI is a cancer or not.

We expect that if 100 people have a FAST MRI scan, 5 of those people will be called back for further investigations. Of those 5 people, we expect that only around 1 participant will be diagnosed with a cancer.

What are the possible benefits of taking part?

Taking part in the FAST MRI DYAMOND Study gives you access to a new test (a FAST MRI scan).

We do not know if your FAST MRI scan will pick up a cancer that was not found on your first mammogram. If it does, it is possible that you will have a better outcome, because the cancer will have been found earlier than it would have been if you had not taken part in the study. 

By taking part in this important study, you will be making a difference by helping us plan more research to improve breast screening for everyone in the future.

What are the possible disadvantages and risks of taking part?

We expect that the potential advantages of taking part will outweigh any disadvantages or risks.

Having an MRI scan is painless, and it’s one of the safest medical procedures available, but there are some risks. For example, there are increased risks to people with certain implants or foreign bodies. The Research Nurse and Radiographer will ask you questions about your medical history to check that you can have the scan. 

Some patients occasionally experience a tingling sensation or feel hot from being in the MRI scanner. These effects only last a short while and should ease as soon as the scan is over.

The scan involves having an injection of dye which is used to highlight any cancer cells (if a cancer is there). The risks associated with this injection are small and are well known: 

  • About 1 in every 100 people may have a mild reaction to this dye (such as pain at the injection site, nausea or headache)
  • About 1 in 1000 people may experience vomiting and/or an itchy rash   
  • A more severe allergic rection is very rare, affecting about 1 in 10,000 people.  The radiographers who will be looking after you during your FAST MRI scan are trained to support individuals if this happens, and appropriate medical care will be given.  The dye is not recommended for people who are pregnant or breast feeding.
  • Tiny amounts of dye can stay in the body for a long time after the scan but this has never been shown to cause any problems.   

If you take part in this study, you will have had mammograms, and some may have follow-up imaging and biopsy. These will be extra to those that you would have if you did not take part. These procedures use ionising radiation to form images of your body and provide your doctor with other clinical information. Ionising radiation can cause cell damage that may, after many years or decades, turn cancerous. 

We are all at risk of developing cancer during our lifetime. The normal risk is that this will happen to about 50% of people at some point in their life. The chances of this happening to you, as a consequence of taking part in this study, are up to 0.022 %, depending on the imaging required.

Will my GP be informed that I am taking part in the FAST MRI DYAMOND study?

If you decide to take part in the study, we will let your GP know and we will tell them the results of your scan when they are available.

Expenses and payments

You will not be paid for taking part in the FAST MRI DYAMOND study but reasonable expenses (up to £10) to attend your FAST MRI scan will be covered. Your Research Nurse will give you this information.

How do I consent to Stage 2 of the study?

If you are eligible to proceed to the next stage of the trial you will receive an email from the study team with a link to the online consent form. 

Please contact FASTMRI@nbt.nhs.uk if you have any queries.

Further information about the FAST MRI DYAMOND study

In this study we will use information from you and from your medical records. We will only use information that we need for the research study. We will let very few DYAMOND team members know your name or contact details, and only if they really need it for this study. This includes research staff at Royal Surrey Hospital who are providing the Consent Form website. Everyone involved in this study will keep your data safe and secure. We will also follow all privacy rules.  At the end of the study, we will save some of the data for up to 5 years after the study closes, in case we need to check it and for future research (if you have given us permission). We will make sure no-one can work out who you are from the reports we write. Please contact us on the details below for more information about this. 

This study is run by Dr Lyn Jones (Consultant Radiologist) at the FAST MRI Programme Team at North Bristol NHS Trust and a Consultant Radiologist at your local Hospital.

Having a Breast MRI

 

 

FAST MRI DYAMOND - Consent Website

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FAST MRI DYAMOND - Stage 1 Information

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TWOC (Trial Without Catheter) Clinic

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Information for patients referred to have a trial without a catheter

You have had a catheter placed but the health professional who has placed it has assessed you and feels there is a chance that you may still pass urine without a catheter. In some situations a trial without catheter may be undertaken in the community but if this is not suitable you will be seen in the urology department for this.

The following information is provided to give you an understanding of what will happen at this appointment in the urology department.

Before the appointment

It is important that you confirm that you will be attending.

  • You may have been prescribed medication called an alpha blocker to take. It is important that you start taking these tablets at least three days before you attend and you continue to take these every day until you attend this clinic. If you need more tablets before your appointment you should request them from your GP.
  • You can eat, drink and take your usual medication. Please ensure you are well hydrated in the few days prior to the appointment.
  • Constipation is sometimes a reason for not being able to pass urine normally so if this is an issue for you, please speak to your local pharmacist or GP.
  • You will be in the department for several hours. You will be asked to drink water once your catheter has been removed, if you prefer to bring your own choice of cold drinks you may.
  • As the appointment may take some time, you should bring a snack with you. This is especially important if you suffer from diabetes.
  • Please bring a list of any regular medication that you take.
  • You may wish to bring a book or something to read.

During the appointment

This is a nurse led clinic. You will be asked about your past medical history. A small number of patients at higher risk of infection may be given an antibiotic before the catheter is removed. 

You will be asked to drink to continue to fill your bladder. When you feel the need to pass urine you will be asked to use a bowl each time so that the amount of urine passed can be measured. Once you have passed urine several times you will have your bladder scanned to make sure it is empty. This is painless. 

During the appointment you may also be asked to complete a questionnaire about your bladder symptoms. 

If you are unable to empty your bladder and it becomes uncomfortable you should tell the nurse. He/she will discuss the options with you and make you comfortable. This may involve having a new catheter placed. If this happens, an appointment will be made for either a further attempt of trial without catheter (if suitable) or a clinic appointment to see a doctor to discuss future management. Some patients may be suitable to learn how to pass a catheter intermittently themselves and if you are unable to pass urine after the indwelling catheter is removed, the nurse may offer to teach you how to do this. 

Our aim is to provide you with as much information as we can about your condition and treatment options so you know exactly what will happen before you leave the department. 

If you have questions at any stage during your appointment please feel free to ask.

© North Bristol NHS Trust. This edition published December 2023. Review due December 2026. NBT002593

Support your local hospital charity

Southmead Hospital Charity logo

See the impact we make across our hospitals and how you can be a part of it. 

It's okay to ask

Illustration of 3 clinicians wearing blue scrubs with stethoscopes around necks

Find out about shared decision making at NBT. 

Mr Luke Hopkins - Vascular Surgery

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GMC Number: 7081850

Year of first qualification: 2010, Cardiff University

Specialty: Vascular Surgery

Clinical interests:  Thoracic outlet syndrome, lower limb revascularisation, carotid endarterectomy, aortic aneurysm repair

Secretary: Imogen Mills

Telephone: 0117 414 0798

Mr Luke Hopkins trained in Vascular and Endovascular Surgery in Wales and Bristol.

He has a special interest in thoracic outlet syndrome and revascularisation for chronic limb threatening ischaemia.

He is the Educational Lead for Vascular Surgery, a Fellow of the Royal College of Surgeons of England and a member of the Vascular Society of Great Britain and Ireland.
 

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Hopkins

Understanding Research

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Considering taking part in Research?

The videos below will guide you through everything you need to know about clinical research. If you have any questions, please don’t hesitate to ask your research study team.

Informed consent

What is Consent?

(Video opens in new window)

The video explains what informed consent means and why it’s important when you’re asked to take part in clinical research. It shows how doctors and researchers should clearly explain everything so you can understand and decide what’s best for you. The video uses examples to help you know your rights and what to expect when giving permission.

This video is also available in English BSL, Punjabi, Polish, Romanian and Welsh. 

Randomisation Video

Who decides what treatment I get? 

(Video opens in new window)

The video explains what randomisation means — it’s when people are placed into different groups by chance, like a lottery, to keep research fair. It shows how participants are randomly placed into different groups so the results are unbiased and trustworthy. The video uses examples to help you understand how this process protects your rights and keeps research honest.

This video is also available in English BSL, Punjabi, Polish, Romanian and Welsh.

Safety Video

Is it safe to take part in a study? 

(Video opens in new window)

The video explains why safety is very important in clinical research. It shows the steps taken to protect people from harm and make sure everything is done carefully. The video uses examples to help you understand how researchers keep you safe during studies.

This video is also available in English BSL, Punjabi, Polish, Romanian and Welsh.

What is Research? - Inclusion is Everything 

This video highlights the importance of inclusivity in research. It emphasises that research should involve diverse groups of people to ensure that findings are relevant and beneficial to everyone. The video promotes the idea that including all communities leads to more accurate and equitable outcomes in research.

Breaking social barriers - No one should be left out 

This video discusses the importance of inclusivity in research. It highlights the need to ensure that all communities, especially underserved ones, are represented to achieve fair and equitable outcomes. The video advocates for breaking down social barriers to make research accessible and beneficial for everyone.

Your data matters - Privacy, trust and protection 

Health data is information collected about people’s health, like medical records or test results. This data is really important for research because it helps scientists understand diseases better and discover new treatments. Researchers take privacy, trust, and protection very seriously to keep your information safe and secure. By using health data carefully and respectfully, researchers can find better ways to keep people healthy and improve medical care for everyone.

Reasons to trust research - Acknowledging the past, changing the future

This video uncovers the importance of recognizing historical injustices in research to build trust with underserved communities. It highlights that acknowledging past wrongs is a crucial step toward ensuring ethical and inclusive research practices

Research Policies & Forms

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From writing your initial proposal to statistical requests and patient & public involvement, here you will find all the documents, forms and standard operating procedures you will need to develop and set up your research idea at North Bristol NHS Trust.

Our Standard Operating Procedures (SOPs) should be used by Chief and Principal Investigators, Research Nurses and all other research personnel. They provide detailed guidance on all aspects of research study management from design through to completion.

If you are an NBT staff member, the current research SOPs should first be accessed via our Managed Learning Environment (MLE) in accordance with the Research Staff Training SOP. This will provide you with an electronic training record to evidence that you have read each SOP.

It is the responsibility of all staff who carry out research to ensure you are using the latest SOP.

Some of the documents are available online below. If you would like a document that is not available online, please contact:  research@nbt.nhs.uk.

Policies & Guidance

R&I - (PO1) Commercial Research Policy

R&I - (PO2) Sponsorship & Central Trial Management Fees Policy

R&I – (P03) Excess Treatment Costs In Research at NBT has been suspended. All new research projects with excess treatment costs require approval from the General Manager/Clinical Director.

R&I - (PO4) NIHR Research Funding Recovery Policy

R&I - (PO5) - PPI in Research Payment Policy

RD - (P06) Research Misconduct Policy

NBT (CG-134) Adult Safeguarding Policy

NBT (CG-197) Safeguarding Children Policy

NBT (PEO-33) Fairness at Work Policy

Study Set-Up

Guidance on Allocation of Research SPA time for Consultants

R&I NBT HRA Checklist

R&I Making amendments to NBT Sponsored studies that have HRA approval

R&I Setting up new studies where NBT are sponsor

Standard Operating Procedures

Ref: RD/QMS/SOP/001 : Preparation of Research Standard Operation Procedures

Ref: RD/QMS/SOP/002 : Obtaining R&D Confirmation for Research to Start

Ref: RD/QMS/SOP/003 : Research Study Amendments

Ref: RI/QMS/SOP/004 : Maintenance of Research Equipment SOP

Ref: RD/QMS/SOP/005 : Research Staff Training

Ref: RI/QMS/SOP/006 : Honorary Research Contract Letters of Access SOP
Ref: RI/QMS/SOP/006a External Researcher Information Form

Ref: RI/QMS/SOP/007 : Applying for NBT Sponsorship SOP
Ref: RI/QMS/SOP/007a Sponsorship Request Form
Ref: RI/QMS/SOP/007b NBT Terms of Sponsorship
Ref: RI/QMS/SOP/007c Delegation of Responsibilities
Ref: RI/QMS/SOP/007e Declaration Form
Ref: RI/QMS/SOP/008 : Writing a Protocol for ctIMPs
Ref: RI/QMS/SOP/009 R&I Periodic Reporting to Regulatory Authorities
Ref: RI/QMS/SOP/010 : Archiving
Ref: RI/QMS/SOP/011: R&I Closing Suspending and Terminating Research

Ref: RI/QMS/SOP/012 : R&I Managing Breaches of GCP or the Protocol
Ref: RI/QMS/SOP/012a : ICH GCP NonCompliance Report Form
Ref: RI/QMS/SOP/012b Identifying & preventing noncompliance with Good Clinical Practice or the protocol
Ref: RI/QMS/SOP/012c : Protocol Deviation Review & Analysis Form
Ref: RI/QMS/SOP/013 : R&I Safety Reporting
Ref: RI/QMS/SOP/014 : R&I Monitoring
Ref: RI/QMS/SOP/015 : R&I Computer System Validation & Backup
Ref: RI/QMS/SOP/016 : R&I Research Contracts & Vendor Selection
Ref: RI/QMS/SOP/017 : R&I Data Management
Ref: RI/QMS/SOP/018: R&I Management of Fridges & Freezers
Ref: RI/QMS/SOP/019 : R&I RESTART During urgent public health emergencies
Ref: RI/QMS/SOP/020 : Management of healthy volunteers in research
Ref: RI/QMS/SOP/021 : R&I Informed Consent in Adult Research Setting

Research Ethics

At North Bristol NHS Trust, we are committed to ensuring that all research conducted within our organisation upholds the highest standards of ethical integrity, safeguarding the rights, dignity, safety and wellbeing of everyone involved.

We support high-quality, ethical research that contributes to improving patient care, public health, and service delivery.

Ethical Review Process

All research involving our patients, staff, data or facilities must receive appropriate ethical review and approval before it begins. This may include:

  • Review by a Health Research Authority (HRA) Research Ethics Committee (REC) – required for most research involving patients or identifiable NHS data.
  • Local review through the Trust’s Research & Development (R&D) Department, which ensures projects meet NHS and Trust-specific governance requirements.

We work closely with the HRA to ensure compliance with the UK Policy Framework for Health and Social Care Research and all relevant legal and ethical standards, including GDPR and the Declaration of Helsinki. 

The HRA provides comprehensive guidance on the ethical review process, including the roles and responsibilities of RECs to ensure that we protect the rights, safety, dignity and wellbeing of participants.

This centralised approach ensures consistency and rigour in the ethical review of health and social care across the UK.

You can find out more information here: 

 

Supporting Researchers

Our R&D team offers support and guidance throughout the ethical approval process. We help researchers:

  • Identify the appropriate level of ethical review
  • Prepare and submit applications via the Integrated Research Application System (IRAS), including development of the required submission documents such as research protocol, participant information sheets and consent forms.
  • Understand key ethical considerations such as consent, confidentiality, risk, and public involvement.

If you are planning a research project, please contact our R&D team early in your planning process to ensure ethical requirements are met, as part of our sponsorship review process.

Contact Us

For further information or support with research ethics, please contact:

Research and Development

Research Sponsor
North Bristol NHS Trust
Email: researchsponsor@nbt.nhs.uk
Phone: 0117 414 9330

View Our Research

Doctor conducting research at NBT

Explore the ground-breaking research currently taking place at North Bristol NHS Trust.

About Research & Development

NBT Researcher

Find out more about our research and how we're working to improve patient care.

Contact Research

Research & Development
North Bristol NHS Trust
Level 3, Learning & Research building
Southmead Hospital
Westbury-on-Trym
Bristol, BS10 5NB

Telephone: 0117 4149330
Email: research@nbt.nhs.uk

Important Information for Overseas Visitors: Understanding NHS Healthcare Charges

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At North Bristol NHS Trust, we are proud to provide high-quality care to all who need it.  And visitors from abroad can expect the same high standards. However, it’s important for overseas visitors to understand that not all NHS healthcare is free.

If you are not “ordinarily resident” in the UK, meaning you do not live here on a lawful and settled basis, you may be charged for some NHS services. This applies to visitors, tourists, former UK residents now living abroad, and some students or workers on short-term visas.

At North Bristol NHS Trust, we are committed to treating all patients with compassion and respect. Understanding your healthcare rights helps ensure a smooth and stress-free experience during your time in the UK.

Please visit the NHS England website to understand which of our services are free to overseas patients and find out more about NHS charges.

Assisted birth videos

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This page has a series of videos about having an assisted vaginal birth, including what they are, what to expect, and how to decide if an assisted birth is right for you. 

An overview of assisted vaginal birth

Assisted vaginal birth and you

Assisted vaginal birth and your baby

After an assisted vaginal birth

Where you can have an assisted birth 

Deciding if an assisted birth is right for you

Dr Shalini Janagan - Rheumatology

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GMC Number: 7822307

Year of first qualification: 2011, University of Colombo

Specialty: Rheumatology

Clinical interests: Metabolic bone disease, Young adult rheumatology and connective tissue diseases

Secretary: Jessica Goodwin

Telephone number: 0117 414 2849

Dr Shalini Janagan is involved in all aspects of adult rheumatology.

Dr Janagan has particular interests Metabolic bone disease, Young adult rheumatology and connective tissue disease.

She is a member of the British Society for Rheumatology and the Royal College of Physicians

Related links

Janagan

Cellular Immunology / Immunophenotyping Laboratory

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Leukaemia and Non-Hodgkin Lymphoma Diagnosis and Monitoring

The laboratory provides a comprehensive service in the investigation of Leukaemia and Non-Hodgkin Lymphoma. Immunophenotyping provides additional information to morphology and cytogenetics in the diagnosis, classification and monitoring of these disorders.

HIV Monitoring
Immunophenotyping is used serially to monitor CD4 levels.

Investigation of Cellular Immunodeficiency Disease
Wrong choice of tests, especially in the paediatric setting, can mean rare cases of immunodeficiency are missed. Vital information includes type and site of infections, family history, other pathology results, X-rays and clinical features. Please refer to the Clinical Immunologists; ward or clinic referral is the ideal.

  • Immunophenotyping

Identifies numerical defects in lymphocyte subsets, inherited or acquired, and are indicated in cases with recurrent viral, fungal or mycobacterial infection.

  • PNH Testing

​PNH testing performed on peripheral blood samples looking for the absence of GPI-linked proteins on neutrophils, monocytes and red blood cells.

  • Functional Leucocyte Assays

These assays are technically complex and require prior discussion with the laboratory. Abnormalities are rare, most commonly due to poor sample quality, testing during drug therapy or intercurrent infection.  Abnormal findings should always be confirmed on a second sample.  True abnormalities may need further, more specialised tests to specify the disorder.

Lymphocyte function studies are indicated in cases of recurrent viral, fungal and mycobacterial infections in whom no numerical lymphocyte defect has been defined. The investigation provides a measure of lymphocyte activation. Lymphocytes are cultured for 5 days with mitogens which mimic antigen activation.

Neutrophil function studies screen for defects in the metabolic burst and adhesion molecules and are indicated in cases with recurrent fungal or bacterial infection with a normal neutrophil count (>1x109/1).A normal result excludes major defects in neutrophil function.

 

Quantiferon Assay

The QuantiFERON-TB test is an interferon gamma release assay (IGRA) used for the diagnosis of latent Tuberculosis (TB). The assay requires special blood tubes and has specific sample handling requirements. The laboratory can issue guidance and sample tubes to requestors. Interpretation of the result needs to be in the context of clinical history and other laboratory and clinical investigations.  The antigens used in the test are absent from all BCG vaccine strains of TB and from most known non-tuberculoid mycobacteria, it is possible to have a reactions to M. kansasii, M. szulgai and M. marinarum.  If such infections are suspected, alternative testing should be sought.

The QuantiFERON-TB test (and other TB IGRAs) may give false negative results in immunosuppressed patients. The laboratory provides a positive control tube for all tests to ensure the validity of results. Where the positive control fails (indeterminate result) the laboratory may suggest alternative testing. Please see guide below for interpreting indeterminate results.

Guide to interpretation

•    Negative: A negative result indicates that latent infection with M. tuberculosis is NOT likely. This result does NOT exclude active TB infection. The investigation of suspected active TB requires clinical, radiological and microbiological assessment.
•    Positive: A positive result is consistent with latent or active TB. This result may be due to exposure to M.tuberculosis complex (except M. bovis BCG), M. kansasii, M. szulgai or M. marinarum.  IGRA should not be used for the investigation of suspected active TB. The investigation of suspected active TB requires clinical, radiological, and microbiological assessment.
•    Indeterminate: The likelihood of the patient having M. tuberculosis infection cannot be determined from the blood sample provided. Please see the guide to interpreting indeterminate results below:

Quick guide to interpreting Indeterminate QuantifFERON-TB results:

An indeterminate result from the QuantiFERON-TB assay means that the likelihood of the patient having M. tuberculosis infection cannot be determined from the blood sample provided.

The majority of indeterminate results are caused by a low T lymphocyte response to mitogen stimulation (reported as mitogen tube failure).  
This can be caused by:

•    An insufficient number of T lymphocytes in the blood sample. Is the patient immunosuppressed?
•    A functional inability of the patient’s lymphocytes to generate Interferon-gamma (IFN-γ) in response to mitogenic stimulation, for example if they are taking drugs that supress their immune system.
•    Reduced lymphocyte function due to improper sample handling.

Ideally repeat the QuantiFERON-TB test once with a fresh blood sample. If a mitogen tube failure is reported a second time, there is no value in repeating the QuantiFERON-TB test again until the underlying cause has been identified and resolved. 

Rarely a high background in the negative control (Nil) tube generates an indeterminate result. 
This can be caused by:

•    Excessive levels of circulating IFN-γ or the presence of heterophile antibodies in the sample. Stimulating the cells further as part of the QuantiFERON-TB test does not produce a further IFN-γ response.

Ideally repeat the QuantiFERON-TB test once with a fresh blood sample. If a high background is reported a second time, there is no value in repeating the QuantiFERON-TB test again until the underlying cause has been identified and resolved.

Other causes of indeterminate results can include:

•    Incorrect filling/mixing of the Lithium Heparin or QuantiFERON-TB tubes.
•    If the time between venepuncture and sample incubation in the laboratory is greater than 16 hours.

These indeterminate samples should be repeated using the correct sampling and handling procedures.

For further information please see:

https://www.qiagen.com/gb/tb-testing/what-is-quantiferon/how-does-qft-work/quantiferon-tb-test-result-interpretation

Related links

Test Information

Sample vials for testing

Includes details of sample types, volumes, special precautions, turnaround times & reference ranges.

Cellular Immunology/Immunophenotyping Laboratory
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