Access in AAC means the way a person makes their communication system work. Directly touching a screen with a finger is the easiest way to make a device work, but for people who are unable to do this there are different access methods that can be explored.

Direct touch access

Direct touch access means using your finger to select icons on a touchscreen device, such as a smartphone or tablet. This is a common AAC access method because it is the easiest way to make a selection. 

To make touch access easier, the device accessibility settings can be used. For example, press and holding for a set time to select, ignoring accidental touches or making the text bigger. 

Some AAC users use a keyguard, which is a thick plastic cover with holes that sits on the screen. Keyguards can help guide your finger to the right place and make it easier to select what you want without errors.

Partner assisted scanning (PAS)

Pointer control

Pointer control works like a computer mouse, where the cursor freely moves across the screen of a communication device using tools such as:

• joystick
• trackball 
• mouse
• trackpad
• head mouse (allows you to control the cursor by moving your head)

This access method allows AAC users to navigate a communication aid without needing to touch the screen directly. Pointer control tools come in a range of size, shapes and sensitivities, to suit different needs. 

Eye pointing

Eye gaze

Switch access

A switch is something you press, touch or move near to make an electronic device do something. For example, to turn on a light, control your TV or to access a communication aid. There are many different kinds of switches. They work in different ways, need different amounts of pressure and can be used by different parts of the body. The photo below shows a small selection of switches and examples of how people might use them. 

Photo description: 

1. Ping-pong switch: Only requires light action. Is water and moisture resistant. Ideal for use as a head switch. 
2. Buddy button with softy top – Durable and highly responsive switch. Gives auditory and tactile feedback with a click on activation. Using a softy top can reduce discomfort and improves tactile feedback.
3. Wobble switch – Sprung switch that activates with light touch in any direction. 
4. Finger mouse – Handheld mouse that can be used as a switch. Also used as a pointer for computer access. 
5. FingerButton switch – Highly responsive with small activation area and very little force required to activate. Can be wraped around a finger.
6. Pal pad switch – Ultra-sensitive and low-profile. Is durable and rigid. 
7. Puff switch – Can be used hands-free. Use a puff (breath) to activate. 
8. Pillow switch – Soft and smooth suitable for head or cheek activation.

To use a switch with a communication aid the switch can be used to move the highlight around the screen and then select what you want. To see how this works watch the video below. 

WAMS is a specialist service supporting people living with obesity who are motivated to explore behavioural, medical and/or surgical management of their weight.

We are a friendly team offering support and guidance to help you lose weight and improve your health and wellbeing. 

The team includes consultant endocrinologists (medical doctors), dietitians, psychologists, a pharmacist, and office staff. 

How does the service work?

WAMS is a 12 month service where you will be offered an assessment appointment followed by a support plan. This will be tailored to you. 
As you progress through the service, the team will discuss your care to find the best way to continue supporting you.

Our approach

We hope that you feel respected and valued during your time in our service. We are not here to shame or blame. Our approach is to view obesity as a complex, long-term health condition. 

Please be reassured that we would like to hear about what is actually happening in your life, rather than what you think we might want to hear. We are here to listen and help you to achieve the most positive outcomes that you can, and this is only really possible if you feel able to be open and honest about your situation.

What can you expect at your initial assessment?

At your first appointment you will speak with a consultant endocrinologist who will check for any medical causes for obesity and check other medical problems that may need treatment. You may be referred for further tests if considered necessary. These may include: blood tests, CT scans, camera investigations (endoscope). 

You will speak to a dietitian to understand your eating habits and explore your relationship with food, both now as well as in the past. We understand this can be difficult, but we encourage you to share what you can so that we can help you as best as possible. 

You may also see a psychologist who will ask about your wellbeing and help you to identify how your thoughts and feelings may be affecting your weight. They might make some suggestions to help you with your mood and work towards making changes.

What can you expect after your initial assessment?

After these first meetings, we will agree on a weight management plan for you. Sometimes we will need to signpost people onto other services before we can offer support. This is so that they are ready and able to work on their goals with our team. 

Most of our interventions are offered in an online group format, for example:

The Mood and Food programme

A blend of nutrition advice and support with the psychological aspects of eating – jointly run by dietitians and psychologists.

Our Coping with Emotion programme

A space in which to develop coping strategies for emotional eating behaviours – run by the psychology team.

Quotes from people who have attended sessions:

• “The group sessions I have attended have been excellent and very informative.”
• “Positive environment, non-judgemental, non-prescriptive. Lots of really useful advice and tips.”

There is the possibility of 1-1 sessions if the team feel that there are strong reasons for this. These may be online, via the phone, or in-person, depending on the situation.

Medical management of weight

Some people may be able to have medication to support weight loss. When available, this will be prescribed in line with local and National Institute for Health and Care Excellence (NICE) guidelines. 

People who are being prescribed medication for weight management by our team are able to receive this support for up to two years. 

Bariatric surgery (‘weight loss surgery’)

We work closely with members of the bariatric surgery service which is made up of surgeons, dietitians, psychologists and a nurse specialist.
Some people in the weight management service are interested in bariatric surgery, others are not, and some people are unable to have it for various reasons. 

It is normal for people to need support and preparation to make sure that they are ready for surgery. Our aim is to prepare people for the significant dietary and psychological changes which are required for surgery to be effective and safe.
Please note that completing your weight management plan in the WAMS service does not necessarily guarantee that you would be eligible for bariatric surgery. 

It is our policy that people who miss appointments without giving any notice, or cancel more than two consecutive appointments, may be discharged back to the care of their GP.

© North Bristol NHS Trust. This edition published May 2026. Review due May 2029. NBT002960.

This is a searchable database of information about tests offered by Severn Pathology. You can browse the index, enter a test name, part of a test name, abbreviation or clinical indication below.

Information available depends on the type of assay and department, but generally consists of alternative names, clinical indications, patient preparation (where appropriate), special precautions, department responsible for the test and reference ranges (where applicable).

The containers listed refer to those used to collect samples from adults locally in GP practices and hospital wards/outpatients. Details of the containers used for neonates, children and in the emergency zone (ED, AAU, ITU) can be found here Tube Guide and Recommended Order of Draw.

You may also find Lab Tests Online UK useful an additional resource for help you understand the many clinical laboratory tests that are used in diagnosis, monitoring and treatment of disease.

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

Standard Operating Procedures

Templates

Research Ethics

Medical Same Day Emergency Care (SDEC) 

Medical Same Day Emergency care (SDEC) is situated at Gate 36, Level 1, within the Emergency Zone, Brunel building.

The Same Day Emergency Care Unit provides:

• assessment
• investigation
• diagnosis
• management of patients with an acute illness within 1 day.

The Same Day Emergency Care team consists of consultants, nurses, pharmacists, junior doctors, advanced practitioners, and physician associates. Support is provided to the team by specialist nurses and doctors in other specialties.

Aciclovir

Amikacin

Benzylpenicilin (Penicillin G)

Chloramphenicol

Ciprofloxacin

Colistin

Cycloserine

Daptomycin

Ethambutol

Flucloxacillin

Fluconazole

Flucytosine

Ganciclovir

Gentamicin

Isavuconazole

Isoniazid (+ N-Acetyl-Isoniazid)

Itraconazole

Levofloxacin

Linezolid

Meropenem

Moxifloxacin

Posaconazole

Rifabutin

Rifampicin

Streptomycin

Sulphamethoxazole in (Co-trimoxazole)

Teicoplanin

Tobramycin

Trimethoprim in (Co-trimoxazole)

Vancomycin

Voriconazole

What is pulmonary fibrosis?

Pulmonary fibrosis is when normal lung tissue is replaced by scar tissue and/or inflammation. This makes the lungs stiff and not work as well.

• Pulmonary is the medical term for your lungs.
• Fibrosis means scarring.

We know what causes some types of pulmonary fibrosis. But sometimes we cannot find a cause, including in Idiopathic Pulmonary Fibrosis (IPF). We do know that it is not a form of cancer or cystic fibrosis, and it is not contagious.

How common is IPF?

IPF is rare - only around 14 to 43 people out of 100,000 have IPF. It can affect anyone but is much more common in older people.

What are the symptoms?

At first, people with IPF can have no or only mild symptoms. If the pulmonary fibrosis worsens then you may have:

• Difficulty breathing.
• Dry cough.
• Feeling tired.
• Poor appetite.

IPF can cause weight loss. You should weigh yourself regularly and speak to your GP or team if you are losing weight over time.

What tests will I have?

The doctors will take a detailed medical history from you and do a physical exam. You may also have the following tests:

• Chest X-ray.
• Lung function tests – to see how well your lungs work. They can also monitor how your condition is progressing. This may include a walking test to see how breathless you get.
• CT scan – this will give us a detailed picture of your lungs including any scarring or inflammation.
• Blood tests – to rule out other causes of pulmonary fibrosis.
• If the diagnosis is still unclear, you might have surgery to take a lung biopsy (sample).

Will my lungs get worse?

In the past we thought all patients with IPF would get worse quickly. Now we know that some patients get worse more slowly, and some can stay the same for some time.

Unfortunately we cannot tell which patients will get worse and how quickly. This is an important area of research so we can understand this more and find better treatments.

If your symptoms change, that might mean your condition is getting worse. Speak to your respiratory team and mention any changes you have noticed.

If your symptoms suddenly get worse, speak to your GP.

How is IPF treated?

The fibrosis in IPF is permanent and cannot be cured but treatment can help slow progression or manage symptoms.

Medication

• Your specialist might suggest you try medications to slow the scarring - antifibrotic medications.
• They may suggest advise different medications to help your symptoms.

Pulmonary rehabilitation

• Pulmonary rehabilitation is a supervised exercise and education programme.
  • It helps you manage breathlessness, stay active, and improve strength and energy.
  • The team may include physiotherapists, nurses, dietitians, and doctors.

Supplemental oxygen

• Lung scarring can reduce the amount of oxygen that can get into your blood.
• Some people may need oxygen therapy if oxygen levels in the blood are low.
• This can improve breathlessness and help you stay active.

Clinical trials

• You can ask about clinical trials which test new treatments. Joining is voluntary.

Lung transplants

• A small number of patients may be referred for lung transplant assessment.

How can I help myself?

• Have your seasonal vaccinations (COVID-19 and flu) and the pneumonia vaccination (only once).
• You may be eligible for benefits like PIP (Personal Independence Payment) if you need help with personal care or getting about.
• Our specialist nurses runs a regular Pulmonary Fibrosis Support Group which is a space for discussion with other patients with similar lung conditions. Here we also aim to have presentations from a variety of guest speakers and charities.
• Keep active and do what you enjoy!

Resources and how to contact us

© North Bristol NHS Trust. This edition published April 2026. Review due April 2029. NBT003582

Welcome to the North Bristol Weight Management Service

This information is to help you prepare for your procedure. Take time to read it carefully, and we can answer any questions you have.

Important information:

• We are here to help you on your weight loss journey and think surgery will help your health and wellbeing.
• It is a big step, and we can help you make long-term habits to maintain your progress. We can support you for 2 years after surgery.
• We cannot offer this procedure to anyone who smokes or vapes – nicotine causes complications.
• We welcome your feedback and suggestions to improve our service.

Endoscopic Sleeve Gastroplasty (ESG)

• ESG is an endoscopy procedure to reduce the size of the stomach.
• We place stitches (sutures) on the inside of the stomach and pulling them tight to fold the stomach in on itself.
• This means your stomach holds less food, and you will feel full more quickly after eating.
• You will lose about 10-15% of your body weight usually in the first year.
• Your change in appetite means you can start new eating habits along with help getting the right nutrition.
• Endoscopic means we put a flexible tube down your throat to do the procedure. We won’t do any external incisions (cuts) so there are less complications than other types of weight loss surgery.

Complications

Diet before ESG

Many people who live with obesity have an enlarged liver. This can make the procedure more difficult and increase the risk of complications.

It is important you follow a low calorie and carbohydrate diet for 2 weeks before your operation. The diet helps shrink the size of the liver making the procedure easier and safer. It is sometimes called the Liver Reducing Diet.

This diet will encourage your body to use up its stores of glycogen (a form of stored sugar in the liver and muscles). This causes the liver to shrink rapidly.

This diet designed to reduce your risks from the surgery and should not be followed long term.

What does the diet involve?

• Each day aim to stick to between 800-1000 calories. This should include at least 60-80g protein.
• The diet is low calorie, low fat, low sugar, and low carbohydrate.
• You can choose to use food, shakes or a combination of both.
• We suggest you include at least 1 meal per day of normal food. This is so you can practice chewing your food thoroughly. You should chew each bite at least 20 times until it is soft/like a paste before swallowing.. This is an important part of eating after your surgery to make sure you get the best outcome.

Option 1: food

Option 2: meal replacement shakes