We are trialing Ambient Voice Technology in some Outpatient appointments 

From March 2026, we are running a 12-month trial of Ambient Voice Technology (AVT) in some of our Outpatient appointments. 

Ambient Voice Technology (AVT) is like having a smart helper that, with your permission, listens to you and your clinician’s conversation during your consultation, automatically turning the conversation into notes.   

This trial is starting with a small number of clinicians in Gynaecology, Urology, Neurology, Gastroenterology and Hepatology Outpatient clinics. 

If your clinic has the option to use AVT, you will be informed at the start of your appointment. We will only use AVT with your consent. If you choose not to consent to the use of AVT, your appointment will continue as normal. 

What is AVT?

AVT is a smart tool that helps your healthcare team take notes during your appointment. 

• It only listens to what you and your clinician talk about if you give consent, and it never records. 
• It captures your conversation in real time and turns it into notes and letters for your health record.  
• Your clinician checks everything to make sure it’s correct. 

You might have seen something like this if you’ve ever talked to your phone, used voice commands in a car, or asked a smart speaker to do something. 

What will happen if you say yes to AVT? 

• A microphone, mobile device, or laptop will listen to what you and your clinician say during your appointment.  
• Your appointment will feel the same, but your clinician won’t need to type as much – they can focus more on you.  
• The AVT captures your words into text straight away and creates a summary and clinic letter.   
• After your appointment, your clinician checks the notes and letters to make sure they are correct before adding them to your health record. 

Why are we trialing AVT? 

We want to see if AVT helps our patients and clinical teams. 

• It lets clinicians spend more time talking to you instead of typing notes. 
• It writes while you talk in real time, so your health records are more accurate and ready faster. 
• This could mean letters or referrals get sent to your GP or other healthcare services more quickly after your appointment. 

Your privacy is really important. At the start of your appointment, your clinician will tell you if AVT is an option. You can choose to have your appointment with or without AVT. 

Your information is always encrypted and securely handled meeting GDPR and NHS standards. Only authorised staff at the hospital access it.

Do you store recordings of my appointment?

Can I choose not to have AVT during my appointment?

Who can I contact if I have questions about AVT before my appointment?

More information

For details on how we collect, use and store personal information, including data collected via digital tools in outpatient settings, please visit our Privacy Policy and Data Protection webpage.

Introduction

You have been asked to follow a low insoluble fibre diet. This can help improve symptoms, give your bowel time to rest after surgery, or help prevent a blockage in your bowel. 

You may only need this diet for a short time. If your doctor says you need to follow it for longer than a month, we might suggest taking a daily multivitamin to make sure you get all the nutrients you need. 

If you have any questions or worries about this diet, ask your doctor or healthcare professional.

Types of fibre

There are different types of fibre in the foods we eat. The two main types are called "soluble fibre" and "insoluble fibre."

Soluble fibre

Soluble fibre mixes with water in your gut and turns into a gel-like substance that your gut bacteria can break down. It can help with both diarrhoea and constipation. Soluble fibre is usually safe for you to eat.

Here are some examples of foods with soluble fibre:

• Milled or ground oats, like Quaker Oat So Simple or Ready Brek.
• Fruit without the peel, seeds, or skin.
• Vegetables without the peel, seeds, or skin.

Insoluble fibre

Insoluble fiber is the "roughage" in our food. It does not get broken down by our body and helps make our stools bigger and easier to pass.

Here are some examples of foods with insoluble fiber:

• Wholegrain foods like brown or seeded bread, cereal, rice, pasta, and couscous.
• Skins of vegetables, fruits, beans, and pulses
• Pith, seeds, and stringy parts of fruits and vegetables.
• Nuts and seeds.
• Salad and leafy greens.

Removing insoluble fibre

Many foods, like some fruits, vegetables, beans, and lentils, have both soluble and insoluble fibre. To make these foods easier for you to eat, you need to remove the insoluble fibre.

Here’s how you can do that:

• Peel the skins and cook vegetables until they’re soft.
• Peel the skins and stew fruits until they’re soft.
• Peel and remove seeds, then blend vegetables into a smooth soup or sauce, or fruits into a smoothie.
• If you can’t peel or remove seeds, blend the fruit or vegetable and then use a sieve to strain out the “bits”.

Recommended foods and foods to watch

Meal ideas

Tips 

• High insoluble fibre foods include:
  • Nuts
  • Pips
  • Piths
  • Seeds
  • Skins on fruits and vegetables
  • Wholemeal/grain
  • Leaves
• If you cannot peel a fruit or vegetable, like raspberries, they’re not suitable - unless blended into a smooth consistency. Sieve any remaining bits out.
• Prepare a sauce as usual (e.g. with onions, garlic, peppers), then blend and sieve to remove large bits. Cook meat or meat alternatives separately, then add the blended sauce.
• Blend onions, garlic, and ginger, then freeze in portions using an ice cube tray to add to meals later.
• Batch freeze peeled vegetables to save time later.
• Onion, garlic, and ginger powder can be used instead of whole onions, garlic, or ginger.
• Salad alternatives:
  • Cooled white pasta with smooth pesto or a smooth tomato sauce (such as passata).
  • White rice or couscous with peeled and roasted root vegetables.
  • Peeled white or sweet potato salad with a smooth dressing.
  • Add protein like cheese (such as feta, halloumi) or egg.

© North Bristol NHS Trust. This edition published January 2025. Review due January 2028. NBT003820

AAC charities 

• Communication Matters 
• ISAAC 
• 1 Voice 
• Ace Centre  

Assistive technology charities 

• Ability Net 
• Everyone Can (formerly known as Aidis Trust) 
• Special Effect 

Others 

• Sequal Trust 

AAC software and apps

AAC Suppliers

Access

Other useful links

Paper-based AAC resources

Powered AAC resources

Multilingual resources

AAC Assessment Tools

AAC Implementation Resources

AAC in education

These resources are for supporting people with aphasia to use AAC within a total communication approach with communication partner support. 

Paper-based AAC resources

Powered AAC resources (aphasia specific)

Multilingual resources

Articles, webinars and blogs for SLTs

AAC Assessment Tools

Support with AAC devices

Here is some information about what to do for some common issues with AAC devices.  

Please only contact AAC WEST about devices that we are responsible for. 

Our contact details are at the bottom of this page.  

Supplier contact details 

Check your device for the company name. Suppliers can support with a range of issues. If you give them consent they can have remote access to your device to provide support. 

• Smartbox (Grid)
  • info@thinksmartbox.com
  • 01684 578 868                   
  • www.thinksmartbox.com
• Jabbla UK (previously called Techess)
  • info@jabbla.co.uk
  • 01476 561 991
  • www.jabbla.co.uk
• Tobii Dynavox
  • support.uk@tobiidynavox.com
  • 0114 481 0011
  • www.uk.tobiidynavox.com
• Liberator
  • info@liberator.co.uk
  • 01733 370 470
  • www.liberator.co.uk 

AAC WEST contact details 

Please contact us if the above do not resolve your device issue. 

Admin

• For admin, appointments, and referral queries.
  • aacwestadmin@nbt.nhs.uk
  • 0117 414 5850

Tech Team

• For hardware issues like faulty batteries, broken screens, missing equipment, and frozen iPads.
• aacwesttech@nbt.nhs.uk                                     
• 0117 414 5850

Support

• Support for software issues like missing grid sets/cells, Dropbox/account issues, and connectivity.
• aacwestsupport@nbt.nhs.uk
• 0117 414 5850

© North Bristol NHS Trust. This edition published October 2025. Review due October 2028. NBT003817.

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 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 and EQUIVOCAL QuantifFERON-TB results

INDETERMINATE 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

EQUIVOCAL RESULTS

An equivocal reference range of 0.2 – 0.7 IU/mL is now applied to the Q-TB results generated when subtracting the negative control tube value (NIL) from the TB1 and TB2 tube results: TB1-NIL and TB2-NIL.

Where both TB1-NIL and TB2-NIL results are within the equivocal range (0.2 – 0.7), or where one result is equivocal (0.2 – 0.7) and one is true negative (<0.2) the Q-TB results will be reported as EQUIVOCAL with the following interpretation applied:

The significance of this result is uncertain. The risk of progression to active TB disease is likely to be different when compared to patients with clear positive (>0.7) or clear negative (<0.2) results. Suggest repeat testing if clinically indicated; approximately one third of patients with equivocal results will revert to either a clear positive or clear negative result when a fresh blood sample is analysed within six months. We would recommend repeat testing again in 4-8 weeks where practical. Where this is not practical, we would recommend a repeat test in weeks rather than days.

Why have we implemented an equivocal reference range?

Reversion and conversion of low positive (TB-NIL: 0.35 – 0.7) and high negative (TB-NIL: 0.2 – 0.34) Q-TB results on repeat testing is a well-recognised phenomenon. To address this issue, multiple European centres have proposed an equivocal range of 0.2 – 0.7 IU/mL [1-7]; conversion to true positive results have been shown to occur most frequently when the first Q-TB result is between 0.2 – 0.35 IU/mL, and reversions to a true negative result have been shown to occur more frequently when the initial result is between 0.35 – 0.7 IU/mL [5].

The Royal Free hospital in London has implemented this equivocal range in line with other low-incidence TB European settings [6].  Data from the Royal Free lends support to the use of the equivocal range for the reporting of Q-TB results; ~1/5th of their results that fell just below the 0.35 cut-off were positive when repeated on a fresh blood sample, and half of those just above the 0.35 threshold were negative when repeated on a fresh blood sample. This data strongly implies that relying on results within the equivocal range could result in either over-treatment or under-treatment of patients.

1. Torres Costa J, Silva R, Sa R, et al. Serial testing with the interferon-gamma release assay in Portuguese healthcare workers. Int Arch Occup Environ Health 2011; 84: 461–469.
2. Schablon A, Harling M, Diel R, et al. Serial testing with an interferon-gamma release assay in German healthcare workers. GMS Krankenhhyg Interdiszip 2010; 5: Doc05.
3. Schablon A, Diel R, Diner G, et al. Specificity of a whole blood IGRA in German nursing students. BMC Infect Dis 2011; 11: 245.
4. Ringshausen FC, Schablon A, Nienhaus A. Interferon-gamma release assays for the tuberculosis serial testing of health care workers: a systematic review. J Occup Med Toxicol 2012; 7: 6
5. Nienhaus A, Ringshausen FC, Costa JT, et al. IFN-gamma release assay versus tuberculin skin test for monitoring TB infection in healthcare workers. Expert Rev Anti Infect Ther 2013; 11: 37–48.
6. Brown J, Kumar K, Reading J, et al. Frequency and significance of indeterminate and borderline Quantiferon Gold TB IGRA results. Eur Respir J 2017; 50: 1701267
7. Hermansen TS, Lillebaek T, Langholz Kristensen K, et al. Prognostic value of interferon-gamma release assays, a population-based study from a TB low-incidence country. Thorax 2016; 71: 652–658.

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

If you have been offered an appointment with us, it is because your local speech and language therapist has referred you. 

What to expect  

Appointments 

Your appointment may take place at your home, your school/college, your day centre/hospice/care setting or at one of our outpatient service buildings. 

Your appointments will usually last around 2 hours but may take longer. We will offer you regular breaks and can split the assessment over two appointments if needed.  

Who will be there? 

• Your local speech and language therapist. 
• An AAC WEST speech and language therapist. 
• An AAC WEST occupational therapist.  
• An AAC WEST assistant practitioner. 
• Your school, college or day centre staff. 
• Your family, carers or support staff. 

There may be lots of people at your appointment, please let us know if there is any way we can make it more comfortable for you.  

Appointment pathway 

1. Referral – your referral is made by your local speech and language therapist.  
2. Initial assessment – we will assess your communication access needs (how you select what you want to say). 
3. Equipment provision – an AAC device is loaned to you and we will set your goals together.  
4. Review/final review – your AAC and goals will be reviewed. At the final review we hand your care back over to the local team.  

What will happen in my initial assessment?

What will happen in my equipment provision appointment?

What will happen in my review?

What will happen in my final review?

What is an Emergency Appointment?

What is a mounting appointment?

© North Bristol NHS Trust. This edition published December 2026. Review due December 2029. NBT003829.