Taking and Sending Pregnancy Loss and Live Patient Samples for Genetic Testing

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Information Sheet 2: Taking and Sending Pregnancy Loss and Live Patient Samples for Genetic Testing

Tel: 0117 414 6150
E-Mail: swglhprenatal@nbt.nhs.uk

Suitable samples:

Suitable samples for genetic testing of pregnancy loss are biopsies of skin, cord or placenta.  Samples may be refrigerated (4oC) overnight.  DO NOT freeze any samples.

NOTE: A sample of fresh placental tissue may be sent in addition to/instead of fetal tissue.

Container:

All samples should be put in a sterile container, such as a plastic universal containing tissue biopsy medium, if available, or sterile normal saline.  
Plastic universals containing skin biopsy medium are available, on request, from the laboratory.  If stored frozen (-20oC) the media has a shelf life of 3 months.  Media is likely to arrive defrosted, this is not an issue so please do not discard it.  Please re-freeze until day of use.  Please ensure tissue biopsy medium is completely defrosted prior to use and that the media is clear when held up to the light.  Non-sterile containers and those contaminated with formalin or formal saline are not suitable.  Please do not send pregnancy loss samples in CVS media, the skin biopsy media has additional reagents that will protect the pregnancy loss samples from a wider range of infections.
 

Transport:

Send by post or hospital transport to the address below, including an appropriately completed referral form which can be downloaded on the Bristol Genetics Laboratory (BGL) page.

Bristol Genetics Laboratory, Severn Pathology, Southmead Hospital, Westbury-on-Trym, Bristol, BS10 5NB

In the event of anticipated postal delay, (e.g. bank holidays) samples may be sent by courier, as long as arrival is within working hours.  Please inform the laboratory of the expected time of arrival. The majority of samples received by the laboratory within 3 days of being taken produce a result.

Skin biopsy from fetus/stillbirth

  • The biopsy is usually taken from the upper outer thigh within the area normally covered by the nappy
  • Rinse the limbs thoroughly with sterile normal saline
  • Using sterile instruments, cut an ellipse of skin 1-1.5cm in length (Fig. 1) to a depth which includes the full thickness of the skin and a small amount of underlying subcutaneous fat, and place in a sterile container of skin biopsy medium or sterile saline. 
  • For samples requiring fibroblast culture for storage or metabolic testing please send the sample in skin biopsy medium and as soon as possible after death to increase the likelihood of cell growth in culture

The ellipse should leave the fetus with minimal damage which can be easily repaired by clinicians or at post mortem (Fig. 2)

Fig 1 - An ellipse of skin taken at Post Mortem

 

 

 

 

 

 

 

 

Fig 1: An ellipse of skin taken at Post Mortem for genetic testing (please do not take smaller biopsies than the size shown.

Fig 2 - Site of biopsy after removal of sample

 

 

 

 

 

 

 

Fig 2: Site of biopsy after removal of sample sent for genetic testing.

Skin biopsy from live patient: 

  • The biopsy is usually taken from the inside of forearms, the upper thigh or (in babies) the iliac crest.  A local anaesthetic may be used if required.
  • Clean the skin surface with ether/alcohol and allow to dry
  • Hold the piece of skin in fine forceps, placed horizontally to skin surface so a hump of skin 5-10mm long, 1-2mm wide and 1-2mm high projects above the edge of the shafts.
  • Exert gentle pressure for 30 seconds, until the skin becomes pale and translucent.
  • Remove the protruding skin with a sterile scalpel.  Place in skin biopsy medium.
  • These samples should be sent by hospital transport or first class post as delays reduce the chance of culture success
  • Please use skin biopsy medium to increase the chance of culture success.

NOTE:  The biopsy should be deep enough to include at some point the whole thickness of the epidermis and adjacent connective tissue.

Fig 3 - A section of cord sent for genetic testing

 

 

 

 

 

 

 

 

Fig. 3: A section of cord sent for genetic testing (approximate length 2cm, diameter 1cm)

 Cord biopsy from fetus/stillbirth: 

Cord samples are a good alternative to skin and can be taken without damaging the fetus.  Cord samples can be used for routine genetic testing, although DNA quantity may be low. If possible please send a cross section of the cord (Fig. 3) of at least 2cm length (longer if the cord is from a loss at an early gestation as it is the total amount of material available that is important).  Please send following the instructions outlined in the skin biopsy section.

Placental biopsy from fetus/stillbirth:

Fresh placental tissue is suitable for DNA extraction and testing, or cell culture instead of/in addition to fetal tissue where available (Fig’s 4 & 5).  Please send a sample of chorionic villi as shown in the image below.  Please do not send:


•    large ERPCs
•    Whole fetuses unless from a very early gestation (first trimester only) as we do not have the equipment or resources to handle them

Large ERPCs or whole fetuses from a later gestation will be returned unprocessed for an appropriate sample to be obtained and sent for testing.  If the resources to take an appropriate sample are not available to the referring department, we recommend contacting a pathology laboratory at the referring Hospital for a biopsy to be taken and forwarded to BGL.
 

Fig 4 - Whole placenta with cord attached

 

 

 

 

 

 

 

 

Fig. 4: Whole placenta with cord attached. Image shows placental villous biopsy being taken from beneath the fetal surface

Fig 5 - Placental biopsy taken for genetic testing

 

 

 

 

 

 

 

 

Fig 5: Placental biopsy taken for genetic testing (please do not send smaller biopsies than the one illustrated).

Cultured cell storage and DNA extraction:

DNA extraction and storage is carried out for all samples of an appropriate size.  Cultured cell storage is carried out if specifically requested, for samples from live patients and sudden infant death samples.  Informed consent must be obtained from patient/parents for storage of DNA or cultured cells. 

Please note that the responsibility for gaining informed consent for testing and/or storage of material lies with the referring clinician. Upon receipt of samples the laboratory assumes that this consent has been obtained.

Disposal of samples

Excess skin and foetal tissue will be sent for witnessed disposal.  Placenta, cord and membrane will be sent for routine clinical disposal.

Bristol Genetics Laboratory | Owner: Helena Hennessey | Approver: Catherine Delmege
Title: Information 2 - Procedure for taking solid tissue specimens.
Active Date Of This Version: 14/10/20223 | Version 21

Badger Notes at NBT

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Badger Notes logo

Badger Notes is now being used at NBT!

We’ve introduced a new system that offers a better experience for our Maternity Service Users.

Both North Bristol NHS Trust (NBT) and University Hospitals Bristol and Weston NHS Foundation Trust (UHBW) jointly started using Badger Notes from 26 September 2023. In particular, Badger Notes has replaced the yellow notes folder with an app that provides access to a digital version of your records.


How does Badger Notes work?

Badger Notes allows you to:

  • See a week-by-week timeline of your pregnancy.
  • Access reading recommended by your Midwife.
  • View your hospital’s full library of maternity leaflets.
  • View booked appointments and information direct from your medical record.

Additionally, as you build a personalised care plan with your Midwife, Badger Notes gives you a place to record thoughts and questions about your antenatal care, birth plan, and postnatal care for your Midwife to review with you.

For care purposes, and once they've been granted access to Badger Notes by you, healthcare professionals such as GPs will also have 24-hour access to information.

The 2-minute video below offers a quick and simple introduction to Badger Notes at NBT and UHBW.

 

Why are we introducing Badger Notes?

Besides improved access to information, we’re doing this to deliver a better - and safer - care experience. Badger Notes is already in use at other NHS Trusts around the country including here in the South West.


How can I find out more?

Besides the video above, we’ve listed some Badger Notes questions and answers below to help.

Don't forget that your Midwife should also be able to answer any questions you may have. To find out how to get in touch, please refer to our Maternity Services contacts page.

Smartphone showing Badger Notes App

How can I access Badger Notes?

With the following options, please be aware that you can’t access your notes until you receive a ‘security phrase’ from your Midwife.

a. Using a mobile phone

iPhone - Please search for the Badger Notes app in iTunes and download. Once done, tap the icon on your home screen to open.

Android - please search for the Badger Notes app in the Google Play store and download. Once done, tap the icon on your home screen to open.


b. Using a PC or tablet
You can log in to the Badger Notes website by clicking this link: badgernotes.net

For more information, please see Badger Notes help.

If you're registered with a GP in England, you can also create an account using NHS login.

The video below shows you how to log in, and explains the various Badger Notes features.

How secure is Badger Notes?

All information is held securely and cannot be accessed without the correct login details (similar to when you use internet banking).

Can anyone else I request (family, friend, partner, doula) access my information on the app?

No – the only person who can access your information is you. For care purposes, healthcare professionals such as GPs will also have 24-hour access to information - but only once they've been granted access to Badger Notes by you.

What languages is Badger Notes available in?

It is configured to the 11 most common languages as held on/used by the Badger Notes app, as follows: English, Welsh, Polish, Punjabi, Bengali, Spanish, Portuguese, Romanian, Lithuanian, Somali, and Maori. There is also a translate function on the desktop version.

What happens if I don’t have a smartphone?

You can access Badger Notes on a home device (e.g. desktop or laptop computer, tablet) via the internet. If you do not have internet access, please speak to your Midwife.

What happens if I move Trust and my new provider doesn’t use Badger Notes?

If this is the case, a copy of your notes will be sent on to the new hospital.

 

Having a problem with logging into Badger Notes?

Have you tried these things?

  • If you registered using your NHS login details you must use the blue NHS login button to access your account: Image removed.
  • If your current details do not match your NHS login details you will need to change them via the NHS app
  • It may be helpful to try to log into the website via a web browser and not the app.
  • If your password is not recognised click on the ‘forgotten password’ button to reset it. 
  • Further help can be found at Badger Notes - Help & FAQ

 

If you are still having problems, then please call our dedicated Badger Notes helpline on 0117 3429301 or email badgernotessupport@uhbw.nhs.uk. You will be asked to quote your NHS number so please ensure you have this to hand. This is a non-urgent telephone line and is monitored 10-4 Monday to Friday and 11-3 at weekends by administrative staff. If you need to speak to a midwife, you should call your local hospital as normal.  

Pregnancy

Clinical Research Strategy 2022/27

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North Bristol NHS Trust (NBT) is proud to provide hospital and community healthcare that supports our local populations across Bristol, North Somerset and South Gloucester and those we serve as part of our regional and national specialised services.

"Research forms an integral part of the Trust’s strategic aims and the delivery of the Trust’s ambitions. Encouraging a research-positive culture in healthcare is important to give patients wider access to clinical research, improving treatment outcomes, patient care and experience." Maria Kane, Chief Executive

 

Our VISION

To improve peoples’ health and care through the development and delivery of world-class research.

Our MISSION

To improve the health and wellbeing of our patients and local populations through excellence developed and delivered by a highly skilled, committed workforce; while conscious of inclusivity and minimising environmental impact.

Our STRATEGY REPORT

Research Strategy 22-27

Founding Principles

The last five years has seen substantial changes in societal attitudes and responsibilities in two significant spheres. COVID-19 and the Black Lives Matter movement have both highlighted the lack of progress healthcare and research has made in ensuring inclusivity and representation from all our communities and the consequential health and wellbeing inequalities. During the same period the NHS and NBT have declared a climate emergency in recognition of the impact on health and wellbeing that environmental factors are causing. As a result two overarching principles have been included in the new strategy.

Principle One: In everything we do we will seek true equality and inclusivity.

Principle Two: In everything we do we will seek to minimise the negative environmental impact of our actions.

 

Our Aims

Aim 1: Engage and empower patients and public as partners in our world-class research

What we will do: 

  • Enable more people to engage in public and patient involvement (PPI) and co-production of research
  • Provide research opportunities that reflect our patients’ experiences
  • Improve patient safety and experience by demonstrating and implementing research results

How we will do it:

  • We will seek to understand the logistical, cultural and language barriers which inhibit equitable and inclusive PPI with all the communities we serve. This knowledge will allow us to develop guidance to support, engage and empower underserved communities. Disseminating our learning with our healthcare partners will support best practice that is implemented system-wide.
  • We will maximise opportunities in research, that reflect the needs of our patients and communities, by raising awareness and demystifying research through the effective use of different media platforms. Research campaigns and engagement events will maximise the use of environmentally sensitive approaches. Through cross-organisational collaborations we will ensure opportunities to participate in research across the region.
  • We will work with our research and PPI partners to ensure research outcomes are disseminated to study participants in appropriate and timely ways. We will work with our colleagues across NBT and the region to implement the outcomes of research to improve health outcomes, whilst avoiding and reducing the environmental costs of repeating unnecessary research studies.
  • We will actively use our experience from previous studies to improve the design, deliverability, and efficiency of studies to ensure effective implementation, whilst reducing the negative environmental cost of research and healthcare.

What success will look like

  • The demographic profile of staff, patients and public involved in research will better reflect our local community.
  • The results of our research will be implemented into clinical care efficiently and within pre-defined timelines.

Aim 2: Support our workforce to develop and enhance their knowledge and skills to deliver world-class research

What we will do:

  • Build upon the skills of our workforce and volunteers
  • Develop the future workforce
  • Develop improved career pathways for all our research staff

How we will do it:

  • We will promote research as a dynamic career option, co-designing a suite of training programmes, supporting new starters, optimising delivery expertise, developing new and more effective ways of working and supporting courageous and compassionate leadership through training which is both inclusive and environmentally sensitive.
  • We will develop comprehensive career pathways to empower and support emerging talent to help individuals to pursue and access funding, mentorship, and coaching (academic or NHS) to realise their career and research ambitions.
  • We will promote opportunities to develop as leaders and lead researchers investing in the researchers of the future to address current issues with innovative solutions and strategies.
  • We will seek opportunities to enhance our quality improvement cycles and embed the lessons learned which includes adapting study design and delivery, providing state-of-the art research facilities and using technology proactively.

What success will look like

  • Improve our current internationally recognised “Investors in People” accreditation.
  • An increased number of non-medical researchers acting as lead researchers.

Aim 3: Ensure research is a core principle underpinning the day-to-day business of the Trust

What we will do:

  • Increase awareness of research and its impact on clinical care
  • Deliver research that improves healthcare and patient experience
  • Embed research in the care pathway of all NBT services

How we will do it:

  • We will promote the rights of patients to engage in research, and for staff to understand their opportunities and responsibilities to offer and support appropriate research, irrespective of profession, background, or characteristics. We will ensure patients and staff are supported to engage with research and the research information is easily accessible. All internal funding opportunities will be widely available, and access will be equitable, inclusive, and promoted through multiple media channels
  • We will actively engage with clinical divisions and healthcare education programmes to demystify research and promote research as everyone’s right and responsibility. This will enable current and future clinicians to address clinical questions that improve the health and experience of our patients and communities.
  • We will work with clinical and leadership teams to focus and embed research within clinical pathways and staff job plans, ensuring results are disseminated through departments and divisions in a timely manner. We will ensure the time our staff invest in our research is recognised and appreciated, helping to raise awareness of the value and contribution research makes in clinical practice.
  • We will co-design an adoption process with the Trust Transformation team to facilitate the implementation of research findings at NBT, agreeing targets for implementing research findings and demonstrate the value of evidence-informed and value-based practice across all clinical areas.

What will success look like?

  • An increase in research awareness and engagement amongst patients and staff.
  • An increase in the number of research findings being implemented at NBT.

Aim 4: Further develop our expertise in research design, management, and delivery to make NBT a national exemplar for cross-system research and innovation

What we will do:

  • Build on our reputation for cross-system research and innovation to make us the collaborator and centre of choice
  • Identify our strengths, clinical priorities, and opportunities to develop and deliver world-leading research
  • Ensure efficient resource utilisation for the delivery of NBT and cross-system research

How we will do it:

  • We will develop and maintain with our regional partners, a suite of best practice guidance, policies, and agreements to enhance efficient and seamless processes. These will maximise research productivity and income in regionally strategic areas which will also promote inclusivity and be environmentally sensitive.
  • We will continue to explore and deploy new research methodologies suitable to pragmatic health and social care research, including working with NBT Information Governance, and Digital Services and Technology to implement and deliver big data projects efficiently and effectively. New approaches will allow us to broaden and diversify our research portfolio focusing on under-represented professions, specialities, and communities.
  • We will embed quality improvement in everyday practice to enhance the design and delivery of the research led and delivered by NBT. We will work with regional partners to develop and share best practice, facilities, training, and infrastructure. This will, in turn, improve our efficiency in the way we deliver research thus enabling further investment in our teams and facilities.

What will success look like?

  • A comprehensive suite of guidance which supports cross regional research.
  • We will lead and implement adaptive pragmatic solutions to delivery challenges.

Review of our Research 2017-2022

Research at North Bristol NHS Trust (2017-2022)

Helen Lewis-White, Deputy Director Research & Development

We are delighted at how much we have achieved as a research community over the last five years. NBT has offered increasing opportunities for our communities to become involved in research, doubling recruitment into clinical research between 2017-2022.

NBT’s grant success over the last 5 years has been firmly based on high quality Patient & Public Involvement (PPI), ensuring we are seeking the answers to questions most relevant to our patients and the clinical services we deliver. During that time nearly 250 PPI meetings supporting 20+ research groups have worked together to define and refine research ideas, approaches and interventions, and to monitor the progress of studies as members of trial management groups.

During the same five year period, the number of departments offering research grew from 45 to 55 resulting in research taking place across every division of the Trust. In addition 8000 participants were directly recruited at North Bristol NHS Trust. We currently lead over 30 multi-centre studies across 100 Trusts throughout England and the devolved nations, offering new opportunities for patients and participants to engage in research.

The primary role of everyone within the Trust’s research infrastructure is to enable patients and the public to engage in relevant research opportunities, helping to shape healthcare for the future. For some, research may offer a new or additional treatment option, but for many people who participate in research the benefit for them is knowing they are contributing to improving care and outcomes for others.

“It’s clear that the medical community are continually trying to answer new questions, but they can only do this with the help of patients. As a lay member of the public, we don’t understand fancy medical vocabulary, so we have to dream up new ways of describing medical terms. We also have to think of ways to make our research programme interesting and to encourage as many people as possible to sign up.” Public & Patient Involvement Member.

“I know my Alzheimer’s is not going to get better. I decided to take part in research because it might just help people with this disease in the future” Research Participant

The NBT Research & Development team supports all aspects of research activities supporting the different developmental stages of research. From exploration of ideas, through qualitative ‘question finding’, through to the dissemination and implementation of findings from these clinical trials into real world practice for population health benefit.

Research at NBT is a multi-disciplinary and multi-specialist activity incorporating patient and members of the public, whose specialist lived experience provides our teams with essential and unique perspectives. This allows the research teams to work closely with Patient and Public Involvement (PPI) representatives, to co-develop and shape the important research questions, design the most appropriate study format, and to then monitor the progress of studies through to completion. Finally, the teams will then support the wider public dissemination of study findings and appropriate implementation, leading to an improvement in, or a change to, the delivery of clinical services.

NBT currently manages £28 million in research grants with an annual grant income of approximately £2.5 million. During the last five years the breadth and scope of the grants supported and awarded has grown significantly and we are currently leading 60 research grants and partnering on a further 59 externally led grants.

To enable the increase in patient opportunities to participate across the research landscape the NBT research infrastructure has grown from 115 staff members to over 140 individuals. We have also continued our commitment to invest in and develop our team members. In 2019 R&I was awarded an Investors in People Silver accreditation in recognition of the programme of work the R&I infrastructure has undertaken supporting, and improving how we work as individuals, teams and as a department, and developing our leaders now and for the future.

Collaborations with North Bristol NHS Trust

NBT prides itself on the strength of its research collaborations across a wide range of academic affiliations, healthcare settings, and industry partners.

Academic Health Science Centre (AHSC) which focuses on close collaborative system-working across the Bristol, North Somerset, and South Gloucestershire (BNSSG) Integrated Care System (ICS). The partnership enables the best use of the regional academic research infrastructure, combined with the implementation and evaluation expertise and activities led by the West of England Academic Health Science Network, directly informing the work of the BNSSG ICS.

We now aspire to build upon the previous NBT research strategies and our experiences throughout the COVID-19 pandemic, which has driven and shaped how research is now conceived, developed, and delivered.

Our academic links with globally recognised academic research institutions including the University of Bristol, University of Bath, and University of the West of England (UWE) have contributed significantly to our success. Through these collaborations NBT ensures the research we lead is patient centred, clinically important, and pragmatically delivered.

Throughout the last five years, and particularly the last two years during the COVID-19 pandemic, our collaborations have driven our continued strength and growth. Through these collaborations and mutual support NBT helped lead the regional COVID-19 vaccine research response, supporting other Trusts to recruit to COVID-19 pandemic vaccine trials across the West of England region. NBT continues to support and lead the NIHR Comprehensive Research Network: West of England (CRN:WE) and to work with partner Trusts across the region to develop novel quality improvement programmes, innovation in research delivery, and to share best practice.

NBT also benefits from being a leading and founder member of the vibrant and ambitious strategic health research and innovation partnership, Bristol Health Partners

“Generating a research culture requires innovation, creativity, engagement and skill. Here at NBT we are instilling a collaborative research culture across all areas of the Trust to ensure research stays at the heart of what we do.”

Dr Tim Whittlestone, Chief Medical Officer

2017-2022 Highlighted Achievements

Below are a few examples of the research achievements at NBT from across the lifespan of our patient population, realised through close collaborative working with our patients and partners.

STAR Programme

The STAR Programme developed and tested a care pathway for the one in five patients who will experience chronic pain three months after knee replacement surgery. STAR identified underlying causes of chronic pain and enabled onward referral for targeted treatment through screening, assessment with an extended scope practitioner, and telephone follow-up over 12 months. STAR demonstrated clinically important improvements in pain and recovery, and is good value for money, reducing hospital admissions and length of stay.

The STAR care pathway was implemented at NBT within six months of the final report to the NIHR, and is now being rolled out nationally, with the potential to improve pain and recovery for over 20,000 patients each year alongside annual NHS cost savings of over £14 million.

ASSIST

The ASSIST trial has tested a new device for assisted vaginal births and is the first potential device for assisted birth since the introduction of the ventouse suction cup, in the 1960s. For this trial a major success has been the use of alternative patient information methods. The study team developed videos to explain the study, demonstrating how the device works on a mannequin doll and including answers to common questions. Women and partners were able to watch the video at their leisure and given another opportunity to ask questions. The use of a freely accessible video combined with both a brief and detailed patient information leaflet was commended by the Research Ethics Committee (REC) for facilitating parents understanding of the study during emotive and challenging times.

CERA: COVID-19 Emergency Response Assessment

In collaboration with the University of Bath the CERA study explored the emotional impact of the COVID-19 pandemic on frontline Emergency Room and Intensive Care Unit medics. It demonstrated the significant psychological toll the COVID-19 pandemic was exerting and helped highlight the need for greater focus on mental health and wellbeing. It was particularly useful in highlighting the challenges medics feel in seeking assistance, and the fear and shame they experience when they admitted their emotional wellbeing is being affected by their role.

AERATOR

Aerator, a collaboration with the University of Bristol, tested the aerolisation of procedures during COVID-19 pandemic in multiple clinical settings. The study design enabled rapid assessment and dissemination. The results of the Aerator study were used extensively to inform the levels of personal protective equipment policy nationally and internationally. This both protected staff and patients but also enabled an evidence base for reducing unnecessary infection control procedures and enabling clinics to increase their capacity and begin to address patient backlogs.

Aerator also made use of innovative mechanisms for engaging clinicians and the public with the results of the study, using a comic strip to explain the issue and the results, ensuring the results were more accessible. https://artibiotics.com/blog/aerator

Looking Forward

Developing the new NBT research strategy (2022-2027)

This new research strategy outlines our ambitions for the next five years. It complements and supports the Trust’s values and underpins the behaviour and principles of every member of staff.

Our strategy will describe what we plan to achieve, the objectives we will need to meet them, and the additional steps we will be undertaking to further embed research within patient pathways and our community. At the same time, it is essential we remain agile to changing priorities as they arise, through constant monitoring of our research portfolio and how it informs and is shaped by health and care delivery across the BNSSG ICS.

While this strategy is specific to clinical research, we recognise a culture of innovation is a key element of ensuring research is converted to clinical change and patient benefit which forms the bedrock of the research cycle.

With empowerment as a core principle of our strategy, we aim to:

  • Empower patients and public as co-producers of research
  • Empower clinical staff to address questions they believe will improve patient care
  • Empower researchers with the skills and knowledge to best deliver the research they undertake and lead on
  • Ensure patients and the public are key contributors and collaborators within our research environment
  • Empower all our communities to hold us to account and create equity of access and inclusivity whilst ensuring our research is environmentally responsible.

Since 2016 each review of the strategy has been shaped through stakeholders’ consultation exercises, questionnaires, meetings, and conferences. These include the researchers who generate our research, the teams who deliver the strategy and our regional strategic partners and stakeholders. Each year we monitor our progress and report to the Trust Board. In 2020 our primary focus shifted to helping answer critical questions about the spread, prevention, and treatment of COVID-19, noting that the epidemic disrupted many of our other research activities resulting in some objectives not being completed, whilst other key activities became more urgent.

Whilst the Trust and R&I department has achieved so much against the delivery plans for the 2017-2022 strategy, changes to health and social care priorities, technologies and wider social change means the Trust now requires a new strategy to take it through the next five years. To develop the new strategy, we consulted widely with internal and external stakeholders undertaking the following engagement activities:

  • A survey distributed across the research teams, research active clinical staff, managers and all NBT Trust email address recipients to ask whether the Vision, Mission and Aims represented the aspirations and commitments of our teams, partners, and stakeholders.
  • A series of meetings were held in early 2022 to better understand the objectives, aspirations, and ambitions which we should endeavour to pursue through our strategy.
  • The comments and feedback were collated and contributed to the formulation of the Vision, Mission, Aims and Objectives, which were then disseminated for further and wider consultation with internal and external stakeholders.

The last five years has seen substantial changes in societal attitudes and responsibilities in two significant spheres. COVID-19 and the Black Lives Matter movement have both highlighted the lack of progress healthcare and research has made in ensuring inclusivity and representation from all our communities, and the consequential health and wellbeing inequalities. During the same period the NHS and NBT have declared a climate emergency in recognition of the impact on health and wellbeing that environmental factors are causing.

Founding Principles

Following the above consultation and engagement activities, two overarching principles have been included in the new strategy as we seek to embed these attitudes and behaviours in the research developed, supported, and delivered at NBT:

Principle One

In everything we do we will seek true equality and inclusivity.

Principle Two

In everything we do we will seek to minimise the negative environmental impact of our actions.

Stakeholders we engaged with

Internal Stakeholders

  • The research infrastructure
  • Research Leads
  • Research Innovation Group
  • Divisional Clinical Directors
  • Divisional Directors
  • The Trust Equality and Inclusivity forums
  • NBT PPI groups
  • Southmead Hospital Charity
  • The Staff of NBT

External Stakeholders

  • University Hospitals Bristol and Weston NHS
  • Foundation Trust
  • Avon and Wiltshire Mental Health Partnership
  • NHS Trust
  • University of Bristol
  • University of Bath
  • University of the West of England
  • NIHR Bristol Biomedical Research Centre
  • NIHR West of England Clinical Research Network
  • NIHR Applied Research Collaboration West
  • Bristol Health Partners Academic Health Science Centre
  • West of England Academic Health Science Network
  • Healthier Together BNSSG Integrated Care System

A PDF version of this Strategy Report is available

Please email researchcommunications@nbt.nhs.uk

Our Research

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North Bristol NHS Trust is committed to research that can improve the outcome of its patients and their experience of its services.

Working collaboratively with care providers across the geographical area, we seek to ensure that everyone we meet has equal access to research. With patients and the public at the heart of all we do, our four main aims are; to empower patients in research, support and nurture our workforce, make research visible in day to day activity, and work with our regional partners to improve healthcare.

This commitment has enabled us to deliver research both on time and to target, which ultimately leads to the highest quality outcomes and improved care for our patients.

Every year 12,000 participants take part in research at our Trust. Watch a video with few of their stories, alongside those of dedicated research staff.

Why we do research video screenshot

 

Take Part in Research

Patient & Doctor viewing an x-ray

Become one of the thousands of people taking part in research every day within the NHS.

Meet the Research & Development Team

Research Nurses at NBT

Want to find out more about our research? Simply get in touch with a member of our team here.

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

R&I Our Research Banner.png

Patient Feedback Volunteer

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Purpose 

We are looking for volunteers to improve the patient and carer experience through gathering and encouraging feedback from our patients and/or people who look after them at home (carers).

This could involve using the Friends and Family Test (FFT), short local surveys, or other feedback tools such as hearing patient stories or asking patients pre-set questions. You may have to pass on concerns, complaints, or issues raised by the people you speak with to staff, so that they can be dealt with. 

We are looking for volunteers who enjoy meeting new people, have excellent listening skills, and a friendly and open manner. In return you will meet new people and contribute to improving the wellbeing of our patients. You will also gain practical volunteer experience and learn about the healthcare environment gaining experience that may be transferable to paid employment.

Commitment level

2-4 hours, weekly or fortnightly for a minimum of 6 months

Shifts available 7 days a week, timings can be discussed upon application 

Summary of duties

  • The nursing staff will sign post you to patients/carers to conduct the survey and who will be being discharged soon. Alternatively, you may be asked to approach patients/carers in waiting areas or from a list with contact details.
  • The patients/carers who will be selected to be surveyed will be assessed to ensure that they are appropriate for volunteers to contact. Exceptions to this may be where you are undertaking surveys in a waiting area and patients/carers can not be pre-selected. You will receive safeguarding training as part of your induction to assist with this and have an identified supervisor should you have concerns about the person you are speaking with.
  • Introduce yourself as a volunteer and confirm the patient/carer is happy to take part in the survey.
  • Follow the role procedure to let the patient/carer know further information about the survey, such as what it is being used for, confidentiality, and where the results will go.
  • You will talk through the survey questions and record the answers. This is likely to be on an iPad provided by the ward/area. Or if you are undertaking patient conversations, see handbook.
  • If the patient/carer has any clinical questions, always escalate these to an appropriate staff member.
  • Any concerns must be reported to a staff member immediately.
  • The patient/carer is able to stop the survey at any time and withdraw.
  • Inform the nurse in charge/manger that you have completed the survey when you have surveyed all available patients/carers.
  • It is important to follow compliance with all infection control procedures and guidelines shared with you.

Skills, experience, attitudes, and qualities needed

Essential

  • Comfortable communicating confidently
  • Excellent listening skills and a non-judgmental attitude
  • A friendly and open manner
  • To feel comfortable in an acute hospital environment
  • To adhere to the Trust values of treating others with respect at all times
  • Understand the importance to stay within the boundaries of the role description

Desirable

•    Experience working with people with cognitive impairments or dementia
•    Experience working with people with autism or a learning disability 

Training and information provided

•    Volunteer mandatory training programme (please find further information on our FAQs page)
•    Department orientation and induction
•    Specialist training if required, such as Dementia Level 2
•    Shadowing induction sessions with an existing volunteer or staff member demonstrating the role.
•    Ongoing supervision and support 
•    Ongoing updates and information

Challenges of the position

•    Coming into hospital can be an anxious time for patients and their relatives. Sometimes this may make people less tolerant than they might usually be and they may come across as impolite. It is important that the volunteer remains calm and listens politely and seeks staff support immediately if required.
•    Potentially supporting patients with cognitive impairments or dementia (around 25% of inpatients at NBT have dementia), additional training and support will be provided. 

Boundaries of the position

Volunteering within the NHS has clear boundaries to ensure that we are keeping our patients and volunteers safe. Please download the detailed role description below for further details. 

Reimbursement of expenses

•    Travel expenses to and from the hospital can be reimbursed
•    Meal vouchers for use in the staff Vu restaurant are offered if volunteering for over 4 consecutive hours in one day

Benefits of volunteering

•    Gain practical volunteer experience and learn about the healthcare environment 
•    Develop skills and experience that may be transferable to paid employment, such as working as a part of a team
•    Opportunity to help/support patients during a difficult time provide facilitating meaningful feedback
•    References can be provided on completion of three months volunteering, if required
•    Ongoing support and supervision sessions
•    Making friends with other volunteers and meeting new people
•    Awards in recognition of volunteering contribution
•    Free parking

Recruitment information

You will be asked to provide two independent references from people who have known you for more than three years (this cannot be a family member).

You will also need to have a standard Disclosure and Barring Service (DBS) check for this role, which will be paid for by the Trust.

How to apply

If you would like to apply for this volunteer opportunity, please click the link below to be taken to the application portal, where you will be able to apply online: 

Current Vacancies

If you would like an alternative method to apply, such as a paper application form, please get in touch with us directly on: 

Telephone Number: 0117 414 0110

Email: Volunteer.services@nbt.nhs.uk

Postal Address: Volunteer Services, North Bristol NHS Trust, Brunel building, Level 1, Gate 18, Southmead Hospital, Bristol, BS10 5NB

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Eating well on haemodialysis - information for kidney patients

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Introduction

This information will help you choose foods to keep you well on dialysis. You may also be given some extra information if needed. Your dietitian may change the advice in the future if your health, blood tests or appetite changes.

Contents

  • Protein foods
  • Fluid
  • Salt
  • Potassium
  • Phosphate
  • Small appetite
  • Vitamins

You will be able to talk to your dietitian regularly about your eating. You can contact your dietitian at any time. See the bottom of the page for contact details.

What can I eat? 

Beans, lentils, fish, eggs, meat and other protein foods

These are high protein foods. They are essential:

  • For strong muscles
  • To fight off infections
  • For healthy skin and blood

Before starting dialysis, you may have been advised to eat smaller portions of protein foods. Now your body is losing some protein during dialysis. You need to eat extra protein foods to replace what you are losing.

High protein foods and their recommended portions

  • Meat, chicken and turkey - palm size portion
  • Fish - hand size portion
  • Eggs - 2 eggs
  • Beans, lentils - half a tin or 6 tablespoons
  • Quorn, tofu, tempeh, soya, protein - palm size portion

Try to eat protein foods at two meals every day. Speak to your dietitian if you are struggling to manage these.

Dairy or dairy alternatives (such as soya drinks and yoghurts)

Milk, cheese, yoghurt and fortified soya milk are great sources of protein and calcium. They also contain a lot of phosphate.

Phosphate levels in the blood may be high when the kidneys are not working properly; this can increase your risk of heart disease, cause weak bones and itching. Your dietitian will advise if you need to limit these foods to lower phosphate levels in the blood. See phosphate section below for more information.

Potatoes, yams, cassava, plantain, bread, rice, pasta, cereals and other starchy carbohydrates

These foods give us energy.

Try to include one serving at every meal.

Wholegrain varieties are high in fibre. Fibre helps to keep your bowels healthy and prevent constipation. Constipation can prevent your dialysis from working well.

Try to choose these wholegrain foods:

  • Wholemeal or granary bread
  • Wholegrain cereals such as shredded wheat or Weetabix
  • Wholewheat pasta
  • Brown rice

You may have been advised to always boil potatoes, yam, cassava and plantain; this reduces the potassium. Your dietitian will advise you if you still need to do this.

Fruit and vegetables

Eat at least five portions of a variety of fruit and vegetables per day.

You may have been advised not to eat some fruit and vegetables because your potassium levels in the blood have been high. Your dietitian will advise you if you still need to do this.

Fatty and sugary foods

Foods high in fat and/or sugar include pastry, fried foods, cakes, biscuits and chocolate.

If your appetite is good and you want to manage your weight and eat to keep your heart healthy, you could:

  • Eat smaller portions of high fat/high sugar foods.
  • Choose low fat options where possible such as lean meats.
  • Choose lower fat dairy foods such as milks, yoghurts and cheeses.
  • Use smaller amounts of unsaturated fats and oils such as vegetable oil and olive oil spread.

Fluid

Fluid mainly comes from liquids you drink.

When most people start dialysis, they are still passing urine. Fluid is removed from the body by dialysis and by passing urine.

Many people find that after a while on dialysis they pass less urine; they begin to rely on dialysis to remove most of the fluid.

If you are drinking more fluid than can be removed, you will become fluid overloaded (oedema). The extra fluid puts a strain on your heart and lungs. It is often difficult to remove extra fluid by dialysis.

Signs you are overloaded are:

  • Rapid weight gain
  • Swollen ankles
  • Feeling breathless
  • Higher blood pressure

You will weigh yourself before and after dialysis sessions. The change in weight from the end of one session to the beginning of the next is mainly fluid. Your doctor, dialysis nurse or dietitian can advise you on your ideal maximum weight gain between dialysis sessions.

If you are gaining too much fluid your doctor, dialysis nurse or dietitian may advise you to limit the fluid you drink.

Tips if you need to have less fluid:

  • Try to have fewer drinks and spread your fluid throughout the day.
  • Use a small cup or glass for drinks.
  • If eating sloppy or liquid foods such as such as soup, custard, yoghurt, ice-cream, reduce how much you drink.
  • Spicy and salty foods can make you thirsty so try to reduce these foods.
  • Try using plastic ice-cubes in drinks to save extra fluid.
  • Rinsing your mouth, gargling with mouthwash and brushing your teeth can help freshen your mouth.
  • You can quench your thirst with slices of lemon, orange, frozen grapes, pineapple cubes, boiled sweets, sugar free mints and chewing gum.
  • If you have a dry mouth, artificial saliva sprays may help such as Glandosane (available on prescription).
  • Keep a record of all liquids you are having including all drinks, soups, gravies, jelly, yoghurts, and ice-cream.

Your dietitian can give you more ideas to help.

Salt

Eating less salt can help you to feel better. Reducing salt helps your dialysis remove fluid, can improve your blood pressure and make you feel less thirsty.

Most of the salt we eat comes from processed and ready prepared foods.

Tips to reduce salt:

  • Have more home cooked foods. Cook from scratch where you can.
  • Try to reduce processed foods. Sausages, bacon, ham, ready meals, jars of mustard, sauces, pickles, and table sauces are salty.
  • When shopping, check food labels. Aim to eat mainly foods which have less than 0.3g salt per 100g or with a green traffic light symbol for salt. If you are choosing ready meals, aim for less than 1.8g per portion.
  • Consider having higher salt foods (more than 0.3g salt per serving, or amber or red traffic light) less often and in smaller amounts.
  • Free apps such as FoodSwitch or NHS Food Scanner can help.
  • Flavour your food with herbs, spices, lemon, garlic, vinegar, dry mustard powder.
  • Try to avoid using salt in cooking. Taste food first as you may not need it.
  • Try not to add any salt at the table.
  • Avoid salt that has ‘low in sodium’ written on the label as these contain potassium. This includes LoSalt, Solo, Saxa So-low.

Your dietitian can give you more help to reduce the salt you eat.

Potassium

Potassium is a mineral found in many foods. It helps our nerves, muscles and heart to work properly. Our kidneys usually control the level of potassium in the blood. Extra potassium is passed out in the urine.

Dialysis removes potassium but levels can build up between sessions, especially if you start to pass less urine. Your levels of potassium in your blood will be checked regularly.

The target range for potassium in your blood is 3.5 – 5.9mmol/l. A high level of potassium can be dangerous, as it can affect your muscles and heart.

Your dietitian will advise if you need to eat less potassium to keep your blood levels safe.

These are foods and drinks higher in potassium:

  • Some fruits such as apricots, avocado, bananas and dried fruit.
  • Some vegetables such as mushrooms, parsnips, spinach and tomatoes.
  • Potatoes which have not been boiled such as chips and jacket potatoes.
  • Snacks such as potato crisps, nuts, chocolate and liquorice.
  • Drinks such as coffee, malted milk drinks and fruit juices.
  • Alcoholic drinks such as cider and strong ales.
  • Soups containing tomatoes and vegetables.
  • Salt substitutes such as Losalt, Saxa So low and Solo.

Only limit high potassium foods if you have been advised to.

If you have diabetes, you may have been recommended to eat more fruit, vegetables and nuts. Your dietitian can advise you on appropriate quantities and help you choose lower potassium options.

Phosphate

Phosphate levels in the blood can be high when the kidneys are not working properly; this can increase your risk of heart disease, weaken your bones and cause itching.

Dialysis is poor at removing phosphate from the blood. Your levels of phosphate in your blood will be checked regularly.

The target range for phosphate in your blood is 0.8 – 1.5mmol/l. If your levels are high, eating less phosphate can protect your bones and heart, and help you feel less itchy.

High phosphate food and drinks include:

  • Cola drinks and other dark coloured fizzy drinks which contain phosphoric acid.
  • Processed foods containing phosphate additives such as ready meals, processed meats and cake mixes. Check the ingredients label for additives with ‘phosphate’ in the name such as diphosphates, triphosphates, sodium phosphate.
  • Nuts and chocolate.
  • Products with raising agents such as muffins and scones.
  • Malted milk drinks, drinking chocolate and cocoa.
  • Evaporated and condensed milk.
  • Fish with edible bones such as sardines, pilchards and whitebait.
  • Shellfish such as fresh crab and scampi.
  • Offal products such as liver, liver sausage and pate.

Other high phosphate foods such as dairy products, milk, fish and meat are good sources of protein and other nutrients. Some recommended portion sizes are below.

Your dietitian can guide you on how many portions to have per day or per week. For most people 2 servings per day of dairy foods and up to 6 eggs per week will limit the amount of phosphate you’re eating.

High phosphate foods recommended portions

  • Milk - 200ml
  • Yoghurt - 1 small pot
  • Cheese - 1 small matchbox size portion
  • Eggs - 6 per week

If you are already following a low phosphate diet your dietitian will advise if you need to continue. Only limit high phosphate foods if you have been advised to.

To help control phosphate levels, some people may be prescribed tablets called phosphate binders. Your dietitian will advise on the best way to take these to make sure they work well.

Small appetite?

If yes, the following information may help.

  • Eat little and often throughout the day. Try three meals and 2 - 3 snacks every day.
  • Eat small nourishing snacks between meals such as cereal and milk, cheese and biscuits, cakes, biscuits, desserts, pastries.
  • Have a snack, sandwich or a milky drink if you cannot manage your normal meal.
  • Try easy to prepare high protein meals such as cheese, scrambled egg, poached egg on toast or omelette.
  • Use full fat and full sugar versions of foods and drinks such as full fat milk, full fat yoghurt instead of diet or low fat ones.
  • Try to eat more on days or at times you feel better.
  • Spread butter, margarine, honey, jam and marmalade thickly on bread, croissants, and crumpets.
  • Add honey or sugar to cereals and puddings.

Eating well is important to help you feel better and cope with dialysis.

Some of these foods are high in salt, sugar, phosphate and potassium which may not be in line with the diet you have previously been advised to follow. If you have diabetes or you are limiting potassium or phosphate, speak to your dietitian for more information.

Vitamins

Water soluble vitamins are lost during the dialysis process.

Your GP can prescribe a multivitamin tablet (Renavit) suitable for people with kidney disease; this helps to replace the vitamins lost during dialysis.

Renavit contains a beef product so if you are unable to take this, we can recommend an alternative.

You will need to take Renavit after your dialysis session (three times a week for most people).

You are recommended to discuss any other vitamin, mineral, herbal or fish oil supplements with your dietitian or doctor before taking; some can be harmful for kidney patients.

Can I eat during dialysis?

Some people find it more difficult to eat well on dialysis days. This can be due to lack of time and being away from home.

Many people take a packed lunch or snack with them to dialysis. This can be particularly helpful if you have diabetes, or if your appetite is poor.

Eating during your dialysis session can help you get nourishing food even on busier dialysis days.

  • Try to include high protein foods such as a sandwich with a meat or fish filling.
  • If you normally choose low potassium or low phosphate foods, you should continue to choose these for meals and snacks during dialysis.
  • If you experience nausea or low blood pressure whilst on dialysis, consider eating smaller amounts more often during your session.

How can I eat more sustainably?

Many people want to eat food that is more environmentally friendly. Below are some ideas you could consider.

  • Try some plant food sources of protein such as beans, lentils, soya mince, Quorn, tofu.
  • When buying fish look for the Marine Stewardship Council or Aquaculture Stewardship Council symbols.
  • Try calcium fortified plant milk such as soya or oat instead of cow’s milk.
  • Opt for wholemeal breads and wholegrain versions of pasta and cereals.
  • Choose local and seasonal produce.
  • Avoid chopped, ready prepared and packaged fresh fruit, veg and salads if you can.
  • Reduce food waste, especially of fresh fruit and veg, by choosing tinned and frozen alongside seasonal fresh produce.

Further information

Patients Know Best

An easy-to-use online service that allows you to monitor your own blood test results. You can find out more and register to use it at https://patientsknowbest.com/register/

Websites

Information on kidney disease and food written by the kidney dietitians at North Bristol NHS Trust

Education videos on how to eat less salt presented by the kidney dietitians at North Bristol NHS Trust

Kidney Care UK diet and lifestyle information including recipe books to download

Kidney Patient Guide diet information including menus and recipe books to download

Website of the Edinburgh Renal Unit and contains useful dietary information

Webinar on importance of protein for people on haemodialysis

Kidney Care UK practical advice to help you reduce your weekly food shopping bill while maintaining a nutritious and kidney friendly diet

Contact your dietitian if you need further help. 

© North Bristol NHS Trust. This edition published March 2023. Review due March 2026. NBT003498.

Contact Nutrition & Dietetics

Kendon House
Kendon Way
Southmead Hospital
Bristol

Telephone:  0117 414 5428 or 0117 414 5429

Rapid Eye Movement (REM) Sleep Behaviour Disorder

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What is REM sleep?

Sleep is split up into different “stages” through the night. Rapid Eye Movement (REM) sleep is a stage which first occurs around 90 minutes after you fall asleep. The first period of REM normally lasts around 10 minutes, and as sleep continues there tends to be more REM in the second half of the night.

It is called ‘rapid eye movement’ sleep because your eyes will move more rapidly behind closed eyelids.

During REM, dreams may be much more vivid. This is due to the fact that the brain is more active during this stage.

REM sleep is important and is associated with many aspects of health and brain function. Therefore it is important to get enough REM sleep to be better able to function during the day.

The image below shows the stages of sleep we move through in a typical night. Non REM stage 1 is light sleep and Non REM stage 3 is deep sleep.

What are parasomnias?

Parasomnia is a word used to describe unusual behaviours that occur during sleep. There are many different forms, with sleepwalking being the classic example. Sleepwalking and sleep terrors are Non REM parasomnias (occurring from Non REM Stage 3 - “deep sleep”). They are common during childhood but occur more rarely in adults.

When abnormal events occur during REM sleep, then they are known as REM parasomnias.

REM-related parasomnias include:

REM sleep behaviour disorder

People begin “acting out their dreams” by vocalizing or moving their arms and legs during REM sleep. They may recall dream content associated with the behaviour if they wake up - such as calling for help, trying to hit something or trying to defend themselves.

It is caused by a failure of the normal mechanism which keeps people still during dreams. It can cause poor sleep quality and unintended injuries to yourself or your partner.

Recurrent isolated sleep paralysis

People with this condition wake up but are unable to speak or move their body at all for several seconds. Around half of people will experience this once, but frequent episodes can cause anxious feelings about going to sleep.

Nightmare disorder

This condition describes those who have recurrent, vivid dreams, usually about threats to survival or safety. It may lead to poor sleep quality, fatigue, distress even during the day, and other psychological symptoms.

Non-REM and REM parasomnias

Non-REM parasomnias REM parasomnias
Sleeping walking REM sleep behaviour disorder
Sleep terrors Recurrent isolated sleep paralysis
Confusional arousals Nightmare disorder
Sleep-related eating disorder  
Abnormal sexual behaviours during sleep  

Why is this happening to me?

REM sleep disorders are usually caused by a problem with the part of the brain that sends information down the spine to the muscles. During normal REM sleep, these cells keep your muscles still so you don’t act on your dreams. However, with this problem, it means the body is able to act out behaviours associated with dreams during the night.

There are some risk factors which may make someone more likely to develop a REM parasomnia, and these include:

  • Being male
  • Being aged over 50
  • Having other neurological disorders such as Parkinson’s Disease
  • Having other sleep disorders such as narcolepsy
  • Taking certain medications such as antidepressants, or the use or withdrawal of alcohol and/or other illicit drugs
  • Having post traumatic stress disorder

There may be no particular reason in which people develop these sleep disorders. However, in a lot of cases, people subsequently go on to develop certain types of neurodegenerative disorders such as Parkinson’s and Lewy body dementia. This may be several decades later. REM sleep disorders can sometimes be the first symptoms that present in these conditions. This is why it is important that you discuss any symptoms or concerns that you may have with your doctor.

How are REM parasomnias diagnosed?

Person lying in a bed with sleep testing equipment attached to his head and face.

A detailed sleep history is sometimes enough on its own to make a diagnosis of an REM sleep behaviour disorder, especially if there is already a diagnosis of an associated condition such as Parkinson’s Disease.

A one or two night inpatient sleep study may be needed. This is known as “Polysomnography” (which means taking multiple measurements during sleep).

Polysomnography involves the use of a number of wires which are stuck to the patient, which are used to take various measurements of the body during sleep. The important thing we look for in REM behaviour disorder is muscle tension during REM sleep. 

Image credit: File:Polysomnography model.jpg - Wikimedia Commons

How are REM parasomnias treated?

Management of REM sleep behaviour disorder includes providing physical safeguards in your sleep environments, and some medications which may be offered to help with the condition.

Physical safeguards

Some examples of adjustments that may be suggested to keep you and your bed partner safe include:

  • Padding near the bed
  • Soft barriers at the side of the bed
  • Moving clutter and sharp-edged furniture away from the bed
  • Some partners put a large pillow between them during the night

Other factors

Stress and poor quality sleep can make REM sleep behaviour
disorder worse.

Sleep hygiene is a term used to describe a healthy approach to the management of sleep and wakefulness. This can often improve not just the quality of sleep but also help with sleep disorder symptoms. Examples of sleep hygiene measures are listed below.

Sleep hygiene measures

  • Regular waking times and bedtimes
  • Avoid caffeine in the afternoon and keeping the amount low in the morning
  • Avoiding stimulating activity in the hours before bed
  • Psychological relaxation techniques prior to sleep
  • A comfortable, quiet sleeping environment at the right temperature
  • Trying to sleep enough so as not to need an alarm clock to wake in the morning
  • Avoiding alcohol or other sedatives before sleep

Medications

Medication is not always needed, but may be used if the condition is severe, distressing or causing injuries. The most common medications that may be offered are:

Clonazepam

This acts as a sedative in order to help reduce arousal during the night. However there may be side effects such as daytime tiredness, impaired balance and slower breathing during the night.

Melatonin

This is a hormone that exists naturally in the brain, which can be supplemented. It can help reduce the severity and frequency of REM parasomnia. It has fewer side effects than clonazepam.

Stopping other medications

Some medications can cause or worsen REM sleep behaviours, and should be discussed at your initial appointment. Some examples of medications that might be having an effect include:

  • Antidepressants
  • Beta blockers
  • Alzheimer’s medications

Where to find more information

If you are seeking any further information that was not covered on this page, here are some free resources.

American Academy of Sleep Medicine

www.sleepeducation.org/sleep-disorders/rem-sleep-behavior-disorder

The Sleep Foundation

https://bit.ly/3QHV0OD

How to contact us

Rosa Burden Centre

Southmead Hospital

Westbury-on-Trym

Bristol

BS10 5NB

Telephone: 0117 414 0450

If you or the individual you are caring for need support reading this information please ask a member of staff for advice.

If you’re an overseas visitor, you may need to pay for your treatment or you could face fraud or bribery charges, so please contact the overseas office: Tel: 0117 414 3764 Email: overseas.patients@nbt.nhs.uk

The Major Trauma Practitioners and Hyper-Acute Rehabilitation Team (HART)

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Anna Greene, Major Trauma Nurser Practitioner

Major Trauma Nurse Practitioner

Anna Greene

Qualified as a nurse from Leeds University in 2010, Anna has always had a keen interest in Major Trauma. 

Starting her career in Oxford John Radcliffe hospital Trauma ward, and subsequently moved to work in several London hospitals in their Emergency Departments. 

Since 2017, she has been working as a Major Trauma practitioner, initially at St George's Hospital, London, before relocating to the Southwest and Southmead Hospital in 2021. 

Anna has a keen interest in Education and now has an extended role as the Severn Major Trauma Network Nursing Education Lead.

beezy

Physiotherapy - Major Trauma Practitioner

Beezy Wakefield

BSc (Hons), MCSP, HCPC

Beezy graduated from Southampton University in 2004. 

After seven years of completing her core training at North Bristol NHS Trust, she specialised in Trauma and Orthopaedics,  and spent nine years leading and developing the trauma physiotherapy service. 

In 2021 she secured a post in the Major Trauma Team as a practitioner with a special interest in pelvic and lower limb trauma and in November 2022 she became lead AHP for the HART team.

Physiotherapy - Major Trauma and Hyper-Acute Rehabilitation Team (HART) Practitioner

Beth Douglass

Occupational Therapist - Hyper-Acute Rehabilitation Team (HART) Practitioner

Claire Campbell

Physiotherapy - Major Trauma and Hyper-Acute Rehabilitation Team (HART) Practitioner

Cora Deegan

SMTN

Physiotherapy - Major Trauma Practitioner

Denise Axelsen

Denise Axelsen qualified as a physiotherapist in 2010 from University of the West of England. Having gained experience from working in the fields of intensive care, neurosurgery and Major Trauma, she has been working as a Major Trauma Practitioner since 2018. 

She supports the Network as Allied Health Professional Lead, with the goal of uniting the delivery of rehabilitation across our region and throughout our Trauma Units.

SMTN

Speech and Language Therapist - Hyper-Acute Rehabilitation Team (HART) Practitioner

Hannah Austin

Hannah qualified from Plymouth Marjon University as a Speech and Language Therapist in 2019. Hannah began working in community rehabilitation in South Gloucestershire, working with patients with progressive neurological diseases, long term conditions, stroke and frailty. 

Since joining NBT, Hannah has worked across areas including hyper-acute stroke, facilitating aphasia conversation groups, neurosurgery and complex care pathways. 

In 2022, Hannah joined the Major Trauma Service, contributing to the development of the Hyper-Acute Rehabilitation Team, combined with her Major Trauma keyworker role. 

She has particular interest in Traumatic Brain Injury, complex dysphagia management and neurorehabilitation.

SMTN

Occupational Therapist - Hyper-Acute Rehabilitation Team (HART) Practitioner

Hannah Stroud

Hannah studied Occupational Therapy at Plymouth University and graduated in 2015. She spent the first two years of her career as a rotational member of staff, before becoming a static within stroke. 

Hannah then accepted a post on the Neurosciences rotation at North Bristol Trust. It was whilst working on the Neurosurgery ward that she developed a special interest in Major Trauma and complex rehabilitation.  

In June 2022, she joined the Major Trauma Team as an Occupational Therapist, supporting the development of the Hyper-Acute Rehabilitation Team.

Laura Crowle, Major Nurse Practitioner

Major Trauma Nurse Practitioner

Laura Crowle

Laura qualified from the University of Leeds as a nurse in 2002 and has worked in a variety of surgical wards, including General Surgery, Urology and Plastic Surgery. 

Her interest in trauma started whilst looking after complex trauma patients undergoing plastic surgery and Laura has been working for the Major Trauma Service since 2013. 

Laura is a member of the National Major Trauma Nursing Group, which aims to represent and develop national standards for trauma nursing from the point of injury through to rehabilitation.  She is the lead nurse for governance at the Major Trauma Centre and has a keen interest in patient and staff wellbeing. 

Laura has undertaken Advanced Practice modules, including Patient Assessment and Clinical Reasoning, Pathophysiology and Diagnostic Reasoning for Advancing Practice, and Non-medical prescribing.

SMTN

Occupational Therapist - Hyper-Acute Rehabilitation Team (HART) Practitioner

Lucy Thomas

Lucy graduated from Cardiff University as an Occupational Therapist in 2009. She began her career in brain injury at the Bath Neuro Rehab Service before joining the general rotation at the Bristol Royal Infirmary where she worked for eight years. It was here that she gained experience across multiple clinical specialities including Stroke, Oncology and Haematology, Trauma and Orthopaedics and Surgery.

In 2019, Lucy joined the Neurosciences rotation at Southmead Hospital, working in Stroke and Neurosurgery. 

Lucy’s specialist interest in brain and spinal injury led to her joining the Major Trauma Team in 2022 as Highly Specialist Occupational Therapist and Major Trauma Practitioner.

SMTN

Physiotherapy - Major Trauma Practitioner

Nicholas Crease

Nick trained as a physiotherapist at the University of the West of England, Bristol, qualifying in 2009. Following roles treating patients at several acute Hospital Trusts across England and Wales, and a period of travel, he returned to work in Bristol at Southmead Major Trauma Centre as a Senior physiotherapist in 2015. 

In 2018, after three years of treating complex orthopaedic, respiratory and spinal injured patients, he stepped into the role of Major Trauma Practitioner, assisting in the management of those most injured patients attending the Trauma Centre. 

Nick has interest in complex pelvic and spinal trauma, older persons trauma and injury prevention,  supporting national projects, alongside community and local government initiatives in this area.

Major Trauma Practitioners and the Hyper-Acute Rehabilitation Team (HART)

SMTN Rehabilitation Prescription

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Rehabilitation Prescription

Patients with rehabilitation needs at Southmead MTC can expect the creation and delivery of a bespoke patient Rehabilitation Prescription (RP). This document supports transitions of care and documentation of rehabilitation needs / expectations advocated by a number of national clinical reference groups and best practice guidance (NICE, BOAST and BSPRM guidelines). The RP can sometimes be referred to as a Rehabilitation Plan. The Southmead MTC RP provides a platform for explaining the injuries, management and rehabilitation trajectory for patients after Major Trauma. It also aids continuity of care when patients are transferred home or to their local hospitals or rehabilitation facilities, sharing clinical and rehabilitation information and supporting provision of a handover of care.

 

Rehabilitation Consultants

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Shigong

Consultant in Rehabilitation Medicine and Clinical Specialty Lead for the Bristol Centre for Enablement

Dr Shigong Guo

LLM MSc(Orth Eng) MRCS 

 

Shigong Guo is a Consultant in Rehabilitation Medicine specialising in trauma, vascular and amputee rehabilitation. He is also Clinical Specialty Lead for the Bristol Centre for Enablement. With an academic background in bioengineering and medical law, as well as previous higher surgical training in trauma & orthopaedics, Dr Guo has a keen interest in the biomechanical and medico-legal aspects of musculoskeletal trauma and amputations, and their effects on clinical practice and rehabilitation.