Introducing supported self-management

North Bristol NHS Trust (NBT) has introduced supported self-management and remote monitoring. This is done using a website called My Medical Record (MMR). This can be used to manage your follow-up care securely.

Regular follow-up appointments can involve organising travel and time off work, which can be costly and inconvenient. Although some people find these appointments useful and reassuring, some find them unnecessary unless they have something specific to discuss.

If individuals report symptoms and concerns as they occur, rather than waiting for a routine appointment, this can help address concerns more quickly.

Following breast cancer treatment, you will be followed up for a period of time (usually 5 years) when you can contact your Breast Care Team directly if you have any queries or concerns.

What does supported self-management and remote monitoring mean?

• Supported self-management: This enables you to take a leading role in your follow-up with support as needed.
• Remote monitored: The Breast Care team can monitor your health and plan of care even when you are not in a face-to-face appointment.

The main aim is to enable you to develop the skills and knowledge to:

• Make positive choices about your health.
• Manage the physical and emotional impact of breast cancer and its treatment.
• Make healthy lifestyle changes.

Follow-up after breast cancer treatment

Depending on the type of treatment you have had, you may have a plan of regular mammograms or other imaging.

At NBT we use MMR to provide you with your monitoring plan, test results, and useful resources.

You can use it to message your cancer support team securely with non-urgent queries.

After finishing treatment, a Breast Clinical Nurse Specialist will discuss your monitoring plan and how self-supported management works.

Once introduced to MMR, you will be offered access to the website. You can access the website from your smart phone, tablet, or computer at any time.

Here is a short film about MMR: 

After watching this video, if you would like to use MMR, you will be provided with login details. You can also choose not to use MMR, your monitoring will continue with routine telephone appointments.

What tests will I have?

• Yearly mammogram or MRI depending on your follow-up plan. We call this surveillance. Usually this is for 5 years.
• Depending on your treatment pathway, you may be prescribed anti-hormone tablets. We call this endocrine therapy.
• At the end of your monitoring period, you may continue to have imaging tests under the National Breast Screening Programme, depending on your age.

Imaging appointments will be arranged by the Radiology Administrative Team.

You will receive an appointment to attend the hospital typically 1 year from when you had your surgery, and yearly afterwards for the monitoring period.

Your mammograms will be carried out by the Radiology department at the Breast Care Centre during your period of follow-up.

MMR will show when future tests are due.

• If your test results are normal, a digital letter confirming this will be available on MMR, as well as the date of your next test.
• If your test results are abnormal, the Breast Cancer Team will contact you. You will likely be asked to come to an appointment at the Breast Care Centre.

Picture of the MMR homepage

Useful resources available on MMR

Information resources including websites, leaflets and videos are available on MMR. These cover topics such as:

• Managing the side effects of treatment.
• Self-examination.
• Healthy lifestyle.
• Support groups.

Contact information

© North Bristol NHS Trust. This edition published February 2026. Review due February 2029. NBT003691

Introduction

This page will tell you about Exclusive Enteral Nutrition (EEN). It will answer some questions you may have about it.

What is Crohn’s disease?

Crohn’s disease can affect any part of your gut. It causes inflammation, ulcers, swelling and soreness on the lining of your gut.

When symptoms are under control, it is known as remission. When symptoms are more active, it’s called a flare-up.

Crohn's disease is a lifelong illness. It currently has no known cure. However, medications, surgery, or a mix of the two can help you stay well.

Symptoms of Crohn’s disease can include:

• Feeling tired. 
• Diarrhoea.  
• Blood in your poo.  
• Constipation.  
• Bloating and wind. 
• Tummy pain.  
• Joint problems and/or weaker bones.  

What is EEN?

It is a liquid only diet. The aim is to put your Crohn’s into remission or to reduce your symptoms. The diet is followed for a short time of 6-8 weeks.

It replaces all food and most drinks with prescribed drinks. These drinks will provide all you need to stay healthy. These drinks come in a range of flavours. Your dietitian will tell you how many drinks you need.

We don’t fully know how it works. One idea is that it helps the gut ‘rest’. Some studies have shown it works for 45-75% of patients.

Sometimes you will need to follow it if you have a narrowing in your gut called a stricture. Your doctor will tell you if you have this.

How long will I need to follow EEN?

• It should usually be followed strictly for 6-8 weeks. This depends on your response. 
• Once you start to eat food again, you may need to continue some of the drinks. Your dietitian will advise on this.  

My target for EEN

• Extra fluid you need: 
• Provides:
  • kcal:
  • g of protein:
  • ml fluid:

Following this diet can be hard! Here are some tips to make it easier:

• Freeze your drinks into ice lollies.
• Try lots of flavours. Your dietitian can discuss this with you.
• Spread your drinks throughout the day.
• Sip on the drinks slowly to make them last longer.

Contact your dietitian if you can’t finish all your drinks.

How do I know if EEN is working?

The treatment goal includes:

• Remission.
• Normal bloods.
• Healing of your gut.
• Better quality of life.

We can use The Harvey-Bradshaw Index to see if the diet is working. 

This table is at the back of the sheet for you to fill out. Please fill it out before, during, and after your diet. 

If you have an appointment with a dietitian, please take this completed with you.  

What happens after your EEN diet?

After following EEN for a minimum of 6 weeks, you can slowly reintroduce food over 5 days. This is an example based on a total based on total 2400kcal.

• Day 1 - breakfast, 7 nutritional drinks.
• Day 2 - breakfast, lunch, 5 nutritional drinks.
• Day 3 - breakfast, lunch, dinner, 3 nutritional drinks.
• Day 4 - breakfast, mid-morning snack, lunch, afternoon snack, dinner, 1 nutritional drink.
• Day 5 after EEN - follow your normal diet. You may need to continue the nutritional drinks for weight gain or support. You can discuss this with your dietitian.

Going forward

There is no specific diet you need to follow when your Crohn’s is in remission. No diet has been proven to help keep you in remission. Also, no foods can cause flare-ups. Some foods may trigger symptoms, but they can’t cause a flare-up. If that happens, use the food and symptom diary at the back of this booklet. It may help you spot trigger foods when you are in remission.

Key points for diet in remission

• Aim for a healthy, balanced diet that gives you all the nutrients you need to stay healthy.
• Avoid cutting out foods or food groups, as you would miss out on important nutrients.
• Try to eat a variety of fruits, vegetables, nuts, seeds, proteins, and whole grains.
• Limit high-fat, high-sugar, and high-salt foods, especially animal fats and processed meats.
• You don't need to cut back on fibre unless you have a narrowing in your gut (called a stricture).

Always talk to your GP, IBD team, or dietitian before making major changes to your diet.

Harvey-Bradshaw Index for Crohn’s

Food and symptom diary

© North Bristol NHS Trust. This edition published February 2026. Review due February 2029. NBT003821

This page has information for people who have been referred by your GP or specialist to the Bristol M.E. Service for an assessment.

What happens now?

Your first appointment normally takes about an hour. We can offer face to face, video, and telephone assessments. We hope to offer a time that works for you. If you need to take a break part way through your assessment, please let us know.

The assessment appointment will give us more information about your health problem and the effect this has on your everyday life. It does not involve any kind of physical tests.

We will also send you a link to some questionnaires which include the questions we ask in the assessment so you have time to think about your answers. This is so that we can build up a clearer picture of your difficulties, and answer any questions you may have. We can then work out with you the best way to take things forward.

We offer a variety of approaches depending on your needs. Our main focus is to help you develop a range of coping strategies to improve your quality of life. You may be offered one or more of the following:

• Individual contact based on your needs. 
• Group self-management programme using video conferencing/calls. 
• Us giving advice to existing services or organisations involved in your care. Face to face, video, or telephone appointments.
• Face to face, video, or telephone appointments.

Who is involved in running the service?

This service includes:

• Occupational therapists
• Physiotherapists
• Psychologists
• Specialist dietitians

All these professionals are specialists in helping people to manage ME/CFS and post viral fatigue syndromes such as long COVID. We are all committed to understanding your individual difficulties. Fatigue and other symptoms can affect your life in many ways and this varies between people. Because of this we tailor our approach to meet your needs.

Where can you find out more about ME/CFS, post viral fatigue syndrome and long COVID?

You might find these web pages from our website to be helpful:

• Foundation Phase Online Course
• Long Covid Information 
• Employment with Fatigue and Pain Online Course 
• ME/CFS Useful Resources

Please note that not everyone that we assess will have (or be given) a diagnosis of ME/CFS, post viral fatigue syndrome, or long COVID. So, please be aware that this information might not be appropriate to everyone referred to the Service.

© North Bristol NHS Trust. This edition published February 2026. Review due February 2029. NBT003856

Don’t

Do not move around existing vocabulary cells – there is a lot of research behind where cells are placed. Moving cells also impacts on the motor patterns the AAC user has learnt.

Do not give out the guided access code (if the device has one) to a young AAC user or others who may not understand these guidelines around editing.

Do not delete words or phrases – your AAC user or someone who models on the device may still need access to these.

Do not duplicate words or phrases to another part of the vocabulary without a good reason – check this with your local SLT.

Do not have lots of different people editing the device – this can quickly make the vocabulary disorganised and confusing.

Do

Get your AAC user involved in suggestions of what words and phrases they would like on their device.

Ask for vocabulary suggestions from other places your AAC user spends time – family members, friends, day centres, clubs etc.

Have a system in place for reviewing your AAC user’s vocabulary and do this regularly – at least every term.

Ask for support from AAC WEST (if the AAC user is still being seen by them) or your local SLT.

Agree on a main device editor – others can still be involved in contributing, via email, a shared notebook, whatever works for you.

Understand the colour coding system for different word types on your vocabulary. Ask AAC WEST or your local SLT for more information. It’s important to stick with this system for new words you are adding to help your AAC user learn them.

Attend AAC WEST Software Training to help you learn/refresh your editing skills.

Attend AAC WEST Keeping Vocabulary Updated training for further resources and information about how to ensure your AAC user has access to words they need.

What is hypersensitivity pneumonitis? 

Hypersensitivity pneumonitis is a condition in which your lungs develop an immune response (hypersensitivity) to something you breathe in and results in inflammation of the lung tissue (pneumonitis).

What are the causes of hypersensitivity pneumonitis?

What are the symptoms of hypersensitivity pneumonitis?

What tests will I have?

What happens to patients with hypersensitivity pneumonitis?

How is hypersensitivity pneumonitis treated?

How can I help myself?

Resources

© North Bristol NHS Trust. This edition published June 2023. Review due June 2026. NBT002702

We run regular training days and facilitate peer supervision sessions. These are open to statutory professionals in the South West of England (independent and out of area professionals may express interest via the forms below). Click the links below for more information, dates and to book a place. 

Paeds/ALD  

• AAC Assessment  
• AAC Implementation 
• Peer supervision sessions 
• Accredited referrer training 

Adult Neuro  

• AAC Assessment and Implementation 
• Peer supervision sessions 

AAC Link Therapists 

Each Local SLT team has an AAC Link Therapist. We run biannual Link Therapy Days. Link therapists should join the RCSLT AAC WEST (South West Link Therapists) Professionals Network to find out about upcoming Link Therapy Days and resources. (Please turn on notifications so you don’t miss posts).  We also encourage Link Therapists to use the forum for peer discussion and resource sharing. 

Clinical Guidelines

For guidance on hyperlipidaemia treatment guidelines and monitoring patients on lipid lowering therapy please see advice on Remedy

BNSSG Adult Vitamin D Prescribing Guidance

Blood Tests

Urine and Other Tests

Please see these frequently asked questions below to find out more about using North Bristol My Medical Record (MMR). 

Logging in

I have trouble accessing the login page, is there an easy way to access it?

The best way to access MMR is through the link provided on email registration. You can also access My Medical Record by clicking on this link My medical record or by scanning the QR code below:

How do I reset my password?

Can my family or carers log in? How do I do this?

Results

Will I receive notifications when my results are available?

Will I be able to view historical results on My Medical Record?

The dates of my blood results and scans are wrong, what should I do?

How do I book my follow up blood tests or scans?

Other

I have used the message feature, when will I get a reply?

I have changed my mind, am I able to delete my account?

What happens when I reach the end of the MMR protocol?

© North Bristol NHS Trust. This edition published January 2026. Review due January 2029. NBT003855 

Members of the public and staff can attend our Trust Board meetings in public. If you would like to attend, please let us know by emailing trust.secretary@nbt.nhs.uk and we can provide details of the location, and print papers if required. If you wish, you can ask a question to the Trust Board.

Papers are available around one week before the meetings. These papers carry a general and press embargo until after the Board of Directors meeting has been held and no discussion concerning them will be entered into until that time.

2026/2027 meeting dates (meetings in common with the Board of Directors for University Hospitals Bristol and Weston NHS Foundation Trust):

• Tuesday 12 May 2026. This meeting will be held at The Park, Daventry Road, Knowle West, Bristol, BS4 1DQ
• Tuesday 14 July 2026. This meeting will be held at Lockleaze Sports Centre, Off Bonnington Walk, Lockleaze, Bristol, BS7 9XF
• Tuesday 8 September 2025. This meeting will be held at the Trinity Centre, Trinity Road, Bristol, BS2 0NW
• Tuesday 10 November 2025. This meeting will be held at Thornbury Active Lifestyle Centre, Alveston Hill, Thornbury, South Gloucestershire, BS35 3JB
• Tuesday 12 January 2027. This meeting will be held in Seminar Rooms 4 and 5 of the Learning and Research Centre, Southmead Hospital, Southmead Road, Westbury-on-Trym, Bristol, BS10 5NB
• Tuesday 9 March 2027. This meeting will be held in the Garden Room at Ham Green House, Chapel Pill Lane, Bristol, BS20 0HH.

This page contains information about having a contrast-enhanced mammogram (CEM). The information will also be explained by your medical team so if you have any questions or concerns, please let us know.

What is CEM?

A mammogram is an X-ray of the breast. CEM is a technique where a contrast medium (dye) is injected into a vein in your arm before the mammogram is taken. The dye highlights any areas of your breast that we might need to investigate further.

Why do I need a CEM?

CEM is part of your breast assessment. It gives us more detailed information than just using standard mammography as seen below. The image shows the lesions in the breast brighter on the CEM image than a standard 2D mammogram.

What happens during a CEM?

• When you arrive at the clinic you will complete a short questionnaire. This is to check you can have the test. The mammographer will then call you into the X-ray room and explain the procedure to you.
• When you are ready, a small needle attached to a flexible plastic tube (cannula) will be placed into a vein in your arm. The cannula will be used to inject the contrast. This may cause a warm sensation for a short while.
• You will then be asked to undress from the waist up.
  • Deodorant, antiperspirant, and talcum powder may affect the quality of the X-ray, so please do not use them on the day of your appointment. Or you can wash them off before the mammogram is taken.
• The mammographer will position your breasts, one at a time, in the mammogram machine. They will apply some compression and take the X-rays. The compression may be slightly uncomfortable but should not be painful, and is needed to get the best images.
• Mammograms will be taken of each breast from different angles.
• When the X-rays have been taken, can get dressed and return to the waiting room. You will be asked to stay in the department for around 30 minutes to make sure you are safe to go home. We will then remove the cannula from your arm.

How long will the test take?

The test itself should take no longer than 30 minutes. You will be in the department for about an hour.

Will I be able to resume my normal activities right away?

You can eat and drink normally and return to your usual activities straight away. You can continue with your normal medication as usual.

You are advised to drink plenty of fluids after a CEM test.

When can I expect my results?

The image will be reviewed by the radiology team, who may make further recommendations. You might need further tests, for example an ultrasound scan and/or a biopsy. Your consultant will tell you when you will receive the results of any tests you have, and if we need you to attend for any further investigations.

What are the risks of having a CEM?

• Radiation - All X-rays involve radiation. A mammogram uses very small doses of radiation but the benefit of detecting breast cancer at an early stage outweighs the risk of harm from the radiation exposure. The radiation dose from a CEM is slightly higher than a standard mammogram but is still well within the accepted safety guidelines.
• Allergic reaction - the contrast is safe and usually has no after-effects. A small number of people can have an allergic (anaphylactic) reaction or other side-effects. This can happen as soon as the contrast is injected or up to a day later.
  • Reaction to the contrast dye may include, nausea (feeling sick), vomiting, headache, a rash, and itchy skin. You may also feel lightheaded or faint, breathing difficulties, wheezing, a fast heartbeat (tachycardia), clammy skin, swelling, abdominal pain.
  • The mammographers are trained to recognise these reactions. We will check whether you have had any allergic reactions in the past before we give you the injection. If you are concerned you are having a reaction after leaving the department, please seek urgent medical advice or attend A&E.
• The dye we use for the test can affect the kidneys. This is uncommon, affecting less than 1 in every 100 people. To reduce the chances of this happening, we will not offer you the test if you have any of the risk factors listed below:
  • You are pregnant.
  • You are allergic to iodine.
  • You have renal (kidney) failure.
  • You have diabetes and/or take metformin.

After CEM

• Please drink plenty of fluids.
• Be aware of signs of allergic reactions detailed above. If you are worried you are having a reaction after leaving the department please seek urgent medical advice or go to the Emergency Department.

Who can I contact for further information?

If you have any further questions about anything covered on this page, please contact the breast admin team on:

• 0117 414 7000 (09:00 and 17:00, Monday to Friday)

They will be able to connect you with someone who can answer your question.

© North Bristol NHS Trust. This edition published January 2026. Review due January 2029. NBT003818