Please read this information carefully before coming in for your actigraphy test. 

What is an actigraphy? 

Actigraphy is a non-invasive way to find out your sleep patterns by monitoring your rest and activity cycles over 1 or 2 weeks. 

Why have an actigraphy?

If you are having problems with your sleep such as irregular sleep and wake times or excessive sleepiness, you may be referred for an actigraphy test. 

What happens during an actigraphy?

Actigraphy monitors movement over days or weeks in real life situations. It involves wearing a device like a watch which has an accelerometer that detects movements.

You will wear the watch on your wrist at all times for around 2 weeks and complete a diary sheet of your daily activities and sleep times. You must only remove the watch when you shower, bathe, or wash and then log this on the diary sheet. It is important that you remember to re-attach the watch after this.

You will press a button on the watch when you go to bed and when you wake up. This will be fully explained to you by the clinical neurophysiologist at your initial appointment. During this appointment, you will be given some diary sheets to write down your daily activities whilst wearing the watch.

After you have completed your period of actigraphy you must return the watch in person at the time specified in your letter. These watches are in high demand for use by other patients and failure to return at the specified time may result in the cancellation of other patients’ appointments.

Preparing for the test

• You can eat and drink as normal before the test.
• Please follow the guidance provided by your consultant neuropsychiatrist about reducing or stopping medications before coming for the test. This information should be in the clinic letter following your appointment. Please call 0117 414 1048 or 0117 414 0452 if you have any concerns or questions.
• You will be asked if you understand this information and whether you consent to the test before we start. You are welcome to ask the neurophysiologist doing the test to give you any further information or to explain more about the procedure.
• Your appointment should take about 10-15 minutes.

How long until I get my results?

The results will be sent to your GP/consultant. You will not receive any results during the test. Your consultant may send you a letter with the results or see you again for a follow-up appointment. Please note, results are not sent directly to you. 

Contact details

This information is intended as a guideline only. If you have any further questions about your test (excluding about results) please contact the department on 0117 414 1048 or 0117 414 1052 and a member of staff will be happy to help.

Your responsibility as a patient

Outpatient services at North Bristol NHS Trust are in great demand. Even so, every week an average of 600 patients fail to attend, which wastes appointments. Please tell us with as much notice as possible if you no longer need your appointment and we can allocate this to another patient. 

What if I am unwell or need to change my appointment?

If you have an infectious condition, such as COVID-19, measles, mumps, chickenpox, flu, stomach upset, have head lice, or are unable to attend your appointment for any other reason, please let us know with as much notice as possible so that your appointment can be rescheduled and offered to someone else.

If you want to change the appointment for a second time, we cannot offer you another date unless there are exceptional circumstances.

What if I don’t attend?

We will assume that you no longer require your appointment, and we will not offer you another one. We will write to the consultant/doctor who referred you and inform them that you did not attend.

© North Bristol NHS Trust. This edition published December 2024. Review due December 2027. NBT003735

How dupilumab may affect your eyes

Dupilumab is an effective treatment for severe asthma, but it has been linked to side effects of the eyes in some people. Most of the side effects are mild, but some can become serious if they are not managed properly.

Mild side effects which you can often manage yourself:

• Dry eyes: dryness, burning, or grittiness in the eyes.
• Conjunctivitis: red, itchy, watery eyes with possible discharge.

Uncommon side effects which require advice from a healthcare professional: 

• Blepharitis (eyelid inflammation): redness and swelling around the eyelids, often with crusting.
• Keratitis (corneal inflammation): eye pain, blurred vision, light sensitivity, or feeling like something is in your eye.

Managing mild eye side effects

If you have eye symptoms while on dupilumab, try these steps:

• Use artificial tears: over-the-counter lubricating eye drops (for example sodium hyaluronate) can help with dryness and irritation. Use preservative-free drops if needed. Speak to your community pharmacist for advice on eye drops.
• Warm compresses: apply a warm, moist compress to your eyelids for a few minutes to relieve discomfort.
• Maintain eye hygiene: clean your eyelids daily with a warm cloth or mild eyelid scrub.
• Limit contact lens use: wear glasses more often than contact lenses if you have symptoms of conjunctivitis or dry eyes.
• Avoid touching or rubbing your eyes: this can make symptoms worse and cause infections.
• Protect your eyes from irritants: avoid smoke, dust, and strong wind. Sunglasses can help.

When to contact a healthcare professional

Phone the Severe Asthma team on 0117 414 2030 if you have:

• Eye discomfort that won’t go away or is getting worse.
• Vision changes, like blurred vision or light sensitivity.
• Severe redness or swelling of the eyes.
• Symptoms that don’t improve with over-the-counter treatments.

When to go to A&E at the Bristol Eye Hospital

If you have any of the following eye symptoms go to Bristol Eye Hospital A&E for urgent care.

• Sensitivity to light.
• Significant pain.
• Sudden changes in vision.
• Severe itching.

Please inform the Severe Asthma team if you have gone to the eye hospital A&E when possible. Contact us on 0117 414 2030.

Eye care tips while on dupilumab

• Regular eye exams: schedule eye exams to detect changes early.
• Report new symptoms: inform the severe asthma team about any new or worsening symptoms.
• Follow treatment instructions: stick to your treatment plan to minimise side effects and get the full benefit of dupilumab.

Summary

Eye issues can be a side effect of dupilumab but can often be managed with the right steps. Knowing the symptoms, how to manage them, and when to seek help will help you continue to benefit from dupilumab while protecting your eye health.

For any concerns or questions, contact the severe asthma team on 0117 414 2030.

© North Bristol NHS Trust. This edition published December 2024. Review due December 2027. NBT003755

What is a CPEX test?

A Cardiopulmonary Exercise Test (CPEX, also known as CPET) is a safe exercise test used to measure your fitness. It is the best test to measure how your heart and lungs will cope with surgery. It is a short exercise test on a static bicycle (like exercise bikes you see in gyms). Many hospitals offer it as part of your pre-operative assessment and planning for surgery.

Why do I need to have this test? 

We do this test to find out how you are likely to react to surgery. This will inform surgeons and anaesthetists how best to look after you. This may reduce your risk of complications, and it will also provide useful information about your potential recovery time following the operation.

What happens during the test?

Before your test begins, staff will fully explain what will happen and answer any questions you may have. The test usually lasts between 5 and 12 minutes. Staff will ask you to tell them if you feel any discomfort or pain during the test. You are free to stop if you feel fatigued (tired) or uncomfortable; but the longer you can go, the better the information we will get.

Whilst cycling your breath will be analysed and your heart and blood pressure monitored. You will have some simple medical equipment attached to you so that we can take these readings. A specialised mask will measure the oxygen and carbon dioxide in your breath.

A health professional will be with you at all times. We may ask you to stop if we see you look fatigued or there are changes to your heart rate or blood pressure.

The test begins gently, with a low intensity cycle; you will feel no resistance as you pedal. Gradually you will feel increased resistance when pedaling. Most people do enough of the test for us to get the medical information we need. After the test, you rest on the bike until you are ready to sit down and discuss the results.

Occasionally, with your permission, we may include your anonymised results in research to improve patient care.

Important information

• Please continue to take all your medications as normal – or how you have been instructed by your doctor.
• Please do not wear nail varnish to your appointment.

Will I experience any discomfort or side effects?

There are no known side effects. CPEX testing is very safe. Rarely patients experience problems with abnormal blood pressure, irregular heart rates, or chest pain.

Complications happening during the test is actually a good thing. This identifies patients who will potentially have problems during surgery and minimises the risk of surgery that you are exposed to.

Every effort will be made to minimise any risk by evaluation of your medical information before the test, and careful observation during the test.

Is there a different test I could have?

There is no other test that provides this information about your heart and lung ‘fitness’.

When will I be told the results of my test?

You will be told of the results on the same day by the doctors performing the test. The information will also be shared with the doctor or surgeon who requested the test.

What if it tells me I cannot have my operation?

Sometimes the information will tell us that your body will find the stresses and strains of the operation too much. We will discuss the risks and benefits of the surgery with you and your surgeon.

I have bad joints and am worried about riding the bike? 

Unless you have very severe joint pain, most people are able to ride the bike for the duration of the test.

How ‘fit’ do I have to be to perform the test?

People of all levels of ability, ages and fitness are able to perform the test.

I am worried or anxious about completing the test

We understand that many patients find the idea of this test worrying for many reasons. We have excellent staff at hand to reassure and support you through the process. Feel free to answer ask questions on the day. We will do our best to make you feel safe and well-cared for during your appointment.

What should I wear for my test?

You should wear normal comfortable clothing and flat shoes (ideally trainers) suitable for cycling in.

© North Bristol NHS Trust. This edition published October 2024. Review due October 2027. NBT002669

The department of Clinical Biochemistry provide the Newborn Bloodspot Screening service for a large part of the South West Region. Testing is undertaken on filter paper bloodspots which are collected from babies between 5 and 8 days of age. Our UKAS accredited laboratory currently screens approximately 42,000 babies each year for nine conditions:

• Sickle cell disease (SCD)
• Cystic Fibrosis (CF)
• Congenital Hypothyroidism (CHT)
• Inherited Metabolic Diseases:
  • Phenylketonuria (PKU)
  • Medium-chain acyl-CoA dehydrogenase deficiency (MCADD)
  • Maple syrup urine disease (MSUD)
  • Isovaleric acidaemia (IVA)
  • Glutaric aciduria type 1 (GA1)
  • Homocystinuria (pyridoxine unresponsive) (HCU)

Early detection through screening and prompt treatment significantly reduces the morbidity and mortality associated with these conditions.
The newborn screening bloodspot programme is provided in close collaboration with health care professionals throughout the region.

Information for public and professionals regarding the SCID evaluation.

Screening for SCD is provided with the department of Haematology at North Bristol NHS Trust (NBT) and Cystic Fibrosis with the Bristol Genetics Laboratory

The screening laboratory works very closely with the South West Regional Metabolic Biochemistry laboratory which provides diagnostic testing to support the newborn screening programmes and monitoring of patients identified though the Inherited Metabolic Disease screening programmes. Bloodspot testing for PKU, hypothyroidism (TSH) and a monitoring service for Congenital Adrenal Hyperplasia (17-OHP) is also available.

In early 2014 we began uploading all of our results to the Newborn Blood Spot Failsafe Solution (NBSFS). This is a national web-based solution which allows maternity units, child health record departments, and screening laboratories to verify the screening status of any baby registered in England. It enables easy early identification of those babies who have had no blood spot card received in the laboratory, making it less likely that any babies will miss screening, and also promotes timeliness of repeat sampling.

Laboratory Visits

We offer half-day training sessions to midwives, health visitors, dieticians, nurses, doctors and other healthcare professionals involved in the collection of bloodspots. Please contact us to arrange a visit.

Please see below for responses to our most recent user survey

Key Contacts

Dr Helena Kemp
Director of Newborn Screening & Consultant Chemical Pathologist
Telephone: 0117 4148425

Maryam Khan
Principal Clinical Scientist
Telephone: 0117 4148418

Emma Smith-Thomas
Senior Clinical Scientist
Telephone: 0117 4148427

Dr Sophie Otton
Consultant Haematologist
Telephone: 0117 4148359

Grace VanDerMee
Lead Biomedical Scientist - Haematology
Telephone: 0117 4148356

Rebecca Whittington
Principal Clinical Scientist - Genetics
Telephone: 0117 4146175

Clare Le Masurier
Senior Biomedical Scientist
Telephone: 0117 4148430

Bryony Wright
Senior Biomedical Scientist
Telephone: 0117 4148346

This information is for patients referred to the the Adult Hydrocephalus team at North Bristol NHS Trust as a brain scan has shown features of Normal-Pressure Hydrocephalus. 

What is Normal-Pressure Hydrocephalus (NPH)?

Cerebrospinal Fluid (CSF) is produced continually in the ventricles (cavities of the brain). Normally CSF circulates through the brain acting as a protective cushion and providing nutrients. NPH affects people aged over 60 and happens when the fluid becomes poorly absorbed, causing an abnormal amount of CSF to build up in the ventricles. This does not cause high pressure in the brain, but it does affect its function, and a person’s quality of life. 

What are the symptoms? 

Mobility and balance

• Difficulty taking large steps, and shuffling when walking.
• Unable to turn quickly due to losing balance.
• Falling backwards, sometimes when getting out of a chair.
• A general feeling of unsteadiness when walking.

Memory and thinking

• Slowness in thinking, and problems with attention.
• Memory difficulties.
• Changes in behaviour, loss of motivation.
• Worsening mood, depression, and anxiety.

Urinary incontinence

• Increased urgency to pass urine (go to the toilet).
• Sudden leakage of urine.
• Not making it to the toilet in time.

Why am I being referred to the Adult Hydrocephalus team? 

You were referred by a specialist doctor or GP following a brain scan which may have shown features of NPH. We are a team of skilled nurses, doctors, advanced clinical practitioners, physiotherapists, and neuropsychologists. We will do multiple assessments (walking and memory tests) to see if you would benefit from further assessment and treatment by our team. 

Physiotherapy-led prehab service

Before being seen in the Hydrocephalus Clinic, we offer patients the opportunity to discuss the diagnosis with a Specialist Physiotherapist. We will phone you once your referral has been accepted and can advise you on lifestyle choices you can make to optimise your health while waiting for your face-to-face review.

If you feel you need further advice, you can phone the hydrocephalus advice line on 0117 414 6613. This is for non-urgent queries.

How is it diagnosed? 

You have been  directed to this page as we suspect you have NPH but the diagnosis has not been confirmed.

NPH is a clinical diagnosis that cannot be confirmed with brain imaging (scans) alone. We need to do other tests to confirm the diagnosis.

Lumbar drain

A lumbar drain is a procedure that allows us to see if your symptoms are improved by temporarily removing cerebrospinal fluid (CSF) from your brain. 

The lumbar drain is a piece of flexible tubing that is inserted into the lower part of the spinal canal. The tubing is connected to a drain which allows us to control how much CSF is drained. If you benefit from the drain, you may be considered for a permanent shunt. 

Not everyone is suitable for a lumbar drain, we will review your brain imaging, and if this is the case we will discuss alternative options with you. 

 

 

CSF shunting

A tube is inserted that diverts fluid from the ventricles of the brain to the abdomen through a small valve. This is connected to another tube passed under the skin to the abdomen. This valve can be adjusted to control the flow of the fluid from your brain. 

We will the reassess your symptoms through various tests to confirm if the procedure has been beneficial. At this stage we will be able to confirm the NPH diagnosis. 

Follow-up

If you do have a CSF shunt inserted you will be followed up regularly to assess your progress and make sure your symptoms are improved.

During these appointments we complete walking and memory tests to monitor for changes in your symptoms.

What can I do whilst on the waiting list for assessment? 

Due to the symptoms of NPH, you may find it more challenging to do your day-to-day activities such as going to the shops, going on walk, engaging in hobbies, and social activities. However there are certain things you can do to help maintain your physical health during this time. 

Physical activity

Incontinence

Memory and cognitive impairment

Family and friends

We recommend including your family and friends in this process, showing them this page may help them understand the condition and how the symptoms affect your life.

If you have any further questions or concerns at any stage in the process, please contact the Adult Hydrocephalus team on the details below. If it is out of hours, please contact your GP or local Emergency Department.

How to contact us

© North Bristol NHS Trust. This edition published November 2024. Review due November 2027. NBT003702

This information is for patients who have been referred for a FEES examination. This page explains the process. 

What is FEES? 

FEES (Fibreoptic Endoscopic Evaluation of Swallowing) is an examination that looks at how you swallow. It aims to find out how your muscles work when you swallow and what might be causing you any difficulties.

How will this help?

We use FEES to understand and help with swallowing problems. It allows us to see whether:

• Food, drink, or saliva is going down the wrong way (into your airway).
• Some food and drink consistencies are easier for you to swallow than others and why.
• Your swallowing difficulties can be helped by altering the position of your head or body.
• There are any other changes we can recommend that may help you.

How is this done?

Two Speech and Language Therapists (SLT) will do the procedure while you are sitting down. A small, lubricated, flexible camera will be placed into one nostril. When the end of the camera is passed just beyond the back of the nose, we get a clear view of your throat. You will be able to see the images if you choose.

We make a recording of the images so we can analyse it afterwards.

You may be given some food and drink. This is dyed with blue/green food colouring to help us see it. This is usually: 

• Milky water.
• Fruit puree.
• Cake.
• Biscuit.
• Thickened drink.

If you have any food allergies or strong food dislikes, please tell your Speech and Language Therapist. You may bring in alternative food if you choose to. This part of the appointment will take up to 30 minutes.

Is the procedure safe? 

The procedure is safe with a low risk of complications or side effects.

Is it uncomfortable? 

Passing the camera through the nose can sometimes cause mild to moderate discomfort. The Speech and Language Therapist will reassure you through throughout the procedure. Local anaesthetic will not be used as this will affect your swallow. 

What happens next?

The Speech and Language Therapists will analyse the images whilst you wait in the waiting area. This could take up to to 30 minutes. You will then be invited back in to discuss what we have seen. 

We will also speak with you about what the results mean for your swallowing. You will leave with a summary of this information and a plan for follow-up if needed.

You can go home immediately after the appointment. The procedure should not affect your ability to drive.

How long does it take?

The whole appointment (including assessment and advice) should take no more than 90 minutes. Please be patient if there are any delays, we will keep you informed if this is it the case. 

Can I eat before my appointment?

Unless you have been advised otherwise, you can eat and drink a light meal before your appointment. If you are currently feeding through a tube, you can take your feeds as normal.

What happens after I leave?

Detailed results will be sent to all relevant healthcare professionals involved in your care. 

What do you do with the recordings? 

The images are saved electronically and kept securely for 8 years. 

Where can I find more information? 

If you have any questions, please contact your Speech and Language Therapist. 

When and where is the appointment?

Your appointment will be at:

Gate 36 (Pink Zone)
Brunel building
Southmead Hospital

You will receive a letter/email with the time and date.

Cancelling an appointment

Please tell us as soon as possible if you need to cancel your appointment by phoning the Speech and Language Therapy Department on 0117 414 5130.

© North Bristol NHS Trust. This edition published December 2024. Review due December 2027. NBT003751

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

Video Transcript

Interested in taking part?

If you are around 50-52 years of age and have just had your first screening mammogram, you may be able to take part in DYAMOND. 

Please first read the patient information leaflet and then sign the consent form on the FAST MRI DYAMOND Electronic Patient Consenting site.

The Research Development & Grants Team can provide you with a range of support at every stage of your grant application/project development.

Please contact ResearchGrants@nbt.nhs.uk at the earliest opportunity. 

Grant development support includes:

• Advising on the most appropriate funder/funding stream
• Deciding which institution will Host and Sponsor your grant
• Advising on and facilitating Public and Patient Involvement & Engagement
• Signposting to wider support services
• Supporting collaborations
• Liaising with external organisations/companies and obtaining external costs
• Providing a full grant costing for non-commercial and investigator-led projects. This includes NHS site costs (and supporting your SoECAT submission, where applicable). 
• Critical, pre-submission reviews
• Feasibility sense checks
• Support statements
• Intellectual Property advice
• Proof reading
• Online application form entry

It takes time to fully develop a research project and to cost a grant accurately. All requests to NBT to cost a research grant application must be made well in advance of the funder’s submission deadline. The time required to achieve a high-quality submission can depend greatly on the type of funder and project.

We recommend that you contact the Research Development & Grants Team at ResearchGrants@nbt.nhs.uk, at the earliest opportunity – as soon as you begin to develop a research project – so that we can provide you with the most comprehensive support. 

Once your project is funded, our team can support you with grant set-up and management. This includes: contracting, financial management, protecting Intellectual Property, reports and external communications.

The Research & Development Office administer a number of internal funding opportunities. 

These are available to all NBT staff with a research idea that they want to develop into a project. 

We frequently make awards for small research projects, as well as personal awards for those wanting to pursue a career including research. Below are some of the funding options currently available. 

To apply, or for more information, contact: ResearchGrants@nbt.nhs.uk.

Rolling Schemes – Apply throughout the year

Available to all Medics, Nurses, Midwives and AHP’s keen to develop a research project.

Early Research Career and Concept Funding (EC&C Funding)

Research Grant Development Funding

Research Grant Development - Extension Funding

Research Grant Development - Follow-on Funding

Pre-award PPIE Funding

One-off/Annual Schemes

Nurse, Midwife, AHP Research “Taster” Grant - Application deadline 11th June 2025

Springboard Research Fund - Summer 2025

Research Career Pathway Awards - Summer 2025

Research Development Personnel Funding - Autumn 2025