Your sling can gradually be removed as your pain improves. There are various sling options and you may need to experiment to find what works best for you. Please contact the Plaster Room on 0117 414 8606 if you are struggling with your sling.  

Some options include:

A full arm sling or ‘Polysling’

This may be most comfortable in the early stages and if correctly applied and tightened regularly can provide good support for the broken bone. It can however be difficult to put this sling on and off by yourself.  And it can make it too difficult to use your arm and look after yourself. 

A collar and cuff 

This sling can be easily adjusted for comfort and is easier to put on and off yourself. 
Try to position it so it is supporting the weight of your arm well as pictured. 

Walking aids

If you use a walking aid such as a frame you may not need your sling on as the frame will provide the support your arms needs.

Pillows

You can support your arm on pillows instead of the sling when you are sitting down. This will give your neck a rest from the sling. 

• Your injured arm is likely to be very painful initially. It’s important that you keep the pain under control as much as possible. Please ensure you take regular painkillers as recommended by your doctor. Speak to your doctor if your pain remains poorly controlled.  
• Constipation is a common side effect of painkillers and reduced activity. Please try to stay well hydrated and take laxatives if required. It is important to seek advice from a health professional if you remain constipated. 
   

If the bone fragment (where it is broken) is sharp and prominent it can occasionally cause problems with your skin directly above the break. You are likely to have been advised if this is a concern for your break, but occasionally this only becomes apparent after your injury was assessed. 

If this is the case, you will need someone (a family member or carers) to closely monitor the skin. If you have any signs of the skin breaking down or infection you must contact the Fracture Clinic for review on 0117 414 1260. 

Signs of problems may include:

• Heat, redness, and increased swelling after the initial bruising and swelling goes down. 
• Small area of blistering or ulcer type appearance over the bone fragment.

There is an increased risk of developing a chest infection while you are recovering. You are likely to be less mobile than normal and you may also find it hurts when you breathe deeply. 

Taking deep breaths can reduce the risk of chest infections by keeping your lower airway working well, and by reducing the build- up of secretions. To help reduce this risk:

• Breath in slowly through your nose, imagine the base of your lungs expanding fully.
• Slowly exhale through your mouth.
• Do this 2 to 3 times in a row.

Try to do this every half hour if you can. You could set a timer, ask a family member or carer to remind you; or if you are watching television, use the adverts as a prompt. 

Please consider that it may be some weeks before you feel comfortable to use your arm effectively.  

You may need some help to eat and drink initially especially if you have injured your dominant arm.

• Eating ‘finger foods’ such as sandwiches can be easier than food that needs to be cut up.
• There are adaptations such as a ‘plate guard’ (pictured below) or wide handled cutlery that can make it easier to eat. These items are widely available to purchase if required.                                      
• Please ask a health professional if you are struggling and unsure what to do. 

Gradually increase the use of your arm as your confidence increases and the pain settles. Trying to use your arm to eat, drink and care for yourself gives you the best chance of a successful recovery. 

• Practicing with an empty cup will build your confidence for meal times if you’re struggling to begin with. 
• Practice washing your face with your injured arm while sat at the sink. You can use the other hand to help if needed. 

Keep your fingers and wrist moving – make a tight fist and open your hand fully throughout the day.

Remove your sling and gently extend your arm.
Now bend you elbow and try to bring your hand up towards your shoulder.

Getting your shoulder moving from about 3 weeks after your injury 

The following exercises are suggestions. The important thing is to gradually get your shoulder moving in whatever way you feel able to. 
You might need help for the following exercises. Please speak to your community therapy team if they are involved in your care to help you with exercises.

Place your hand under the elbow of the injured arm.  Lift gently until you feel a stretch at your shoulder.
Start to gradually increase how far you can move your shoulder. 

Place your hands on a table. Slide your hands along the table as far as you can without lifting your shoulders. 

Bones contain living tissue that is constantly being broken down and rebuilt. We call this process ‘bone turnover’.  
As we get older, the process of making new bone is slower than the process of breaking down of old bone, and so the amount of bone tissue we have reduces, and bones can start to lose some of their strength and structure and become weaker. This may lead to a condition called osteoporosis.   

A fracture that has happened easily after a minor injury such as a trip or fall is known as a fragility fracture. It is often the first sign that bones have lost some of their overall strength and structure. 

People who have had a fragility fracture have a higher chance of having another fracture compared to someone who hasn’t had a fracture.   

You may be contacted by the Fracture Liaison Service who will arrange to complete a ‘fracture risk assessment’ to see how likely you are to have further broken bones (fragility fractures). This may also be carried out by the team looking after you in hospital, or your own doctor at the GP surgery. 

The fracture risk assessment can help to guide whether you should have some further tests or investigations for osteoporosis. If it indicates that you have a high chance (risk) of having fractures, it may be recommended that you start taking some medication to help slow down the bone turnover process and improve your bone strength. This will help reduce the chances of having significant fractures like a hip fracture or a compression fracture of one of the spinal bones.   

A healthy lifestyle is important to reduce your risk of developing osteoporosis and having fractures, but if your risk for having fractures is high then it might not be enough on its own to reduce your chances of having further fractures.   

Exercise is good for bone strength - even if you have osteoporosis, a combination of good balance, coordination, and reflexes can help to reduce your risk of having a slip, trip, or fall.  

You may find it beneficial to do some strength and balance training to help reduce the chances of falls and further broken bones in the future. You may have this offered as part of your care support after your injury. If not there are classes and groups in the community you may wish to join, such as the Staying Steady classes  but if you have had one or more falls, or if you remain worried about falling, ask your GP to refer you to the specialist Falls Service. 

You can also help your bones by not smoking and by not drinking too much alcohol. Smoking, and/or regularly drinking more than the recommended weekly amount of alcohol has a harmful effect on bones, reducing the body’s ability to absorb calcium and changing how bone-building cells work, and can slow down the healing of fractures. 

Drinking more alcohol than the recommended safe amounts can also cause people to become unsteady on their feet and increase their chances of having falls and fractures. 

You should also make sure you have enough calcium and vitamin D, either from a healthy balanced diet and safe exposure of your skin to sunlight during the spring and summer, or by taking calcium and/or vitamin D supplements.   

For further information, you may wish to visit the website of the Royal Osteoporosis Society: Better Bone Health for Everybody (theros.org.uk) or contact their specialist nurse helpline on 0808 800 0035.

This is a good position to give your neck a rest from the sling. 

It’s important that you don’t allow sores to develop under your arm, so you or your carer need to:

• Wash your injured arm carefully every day and make sure your under arm is really dry. 
• Do not wear rings or jewellery for 6 weeks to reduce the risk of complications from swelling.  
• Massage your hand and arm regularly with any moisturiser. This may help a little with swelling and it can also reduce any fear you may have about touching your arm. 

There is an increased risk of developing a chest infection while you are recovering. You are likely to be less mobile than normal and you may also find your arm hurts when you breathe deeply. 

Taking deep breaths can reduce the risk of chest infections by keeping your lower airway working well and by reducing the build-up of secretions. To help reduce this risk:

• Breathe in slowly through your nose; imagine the base of your lungs expanding fully.
• Slowly exhale through your mouth.
• Do this 2 to 3 times in a row.
• Try to do this every half hour if you can. You could set a timer, ask a family member or carer to remind you, or if you are watching television, use the adverts as a prompt. 

• The injured arm is likely to be very painful at first. It’s important that you keep the pain under control as much as possible. Please ensure you take regular painkillers as recommended by your doctor.
• It can be difficult to manage your medication with one hand. Practice and tell someone as soon as possible if you cannot manage. Community teams (for example hospital discharge teams and district nurses) cannot usually help with medications so you might need a plan for this before you leave hospital. 
• It is quite common with this type of injury for the pain to increase in the first 1-2 weeks. This is due to swelling and inflammation as much as the injury itself. 
• It is possible your whole arm may swell and bruise including your hand and fingers.  It can help to know what is normal and that it will get better in time. But if you are worried or have new numbness please speak to a health professional. 
• Constipation is a common side effect of painkillers and reduced activity. Please try to stay well hydrated and take laxatives if required. It is important to seek advice from a health professional if you remain constipated.
• A simple collar and cuff (see picture on front page) will help to support your arm and reduce the pain when you are moving. If you are having any issues with your sling please contact the Plaster Room on 0117 414 8606.

To prevent the joints from becoming stiff you should:

Allow your injured arm to hang straight at the elbow at least twice a day – more often if possible. 
Standing with your arm hanging as pictured can be a good position to clean under your arm and to put your arm into clothing when dressing.  
If you are not safe to stand, try to hang your arm straight from a seated position if you can safely and carefully do so. You may need help from a family member or carer to do this. 

Keep your fingers and wrist moving – make a tight fist and open your hand fully throughout the day.

Once your pain has settled a bit it’s time to get your elbow moving.  Remove your sling and gently extend your arm. Now bend your elbow and try to bring your hand up towards your shoulder.

It will be some weeks before you feel comfortable to use your arm effectively.  

Gradually increase the use of your arm as your confidence increases and the pain settles. Trying to use your arm to eat, drink, and care for yourself gives you the best chance of a successful recovery 

You may need some help to eat and drink at first especially if you have injured your dominant arm.

• Eating ‘finger foods’ such as sandwiches can be easier than food that needs to be cut up using a knife and fork.
• There are adaptations such as a ‘plate guard’ (pictured below) or wide handled cutlery that can make it easier to eat. These items are widely available to purchase if required.                                     
• Please ask a health professional if you are struggling and unsure what to do. 

If you normally use a walking aid with your injured arm it is likely to be too painful to use this initially. You may need support from a physiotherapist or occupational therapist to explore alternatives to keep you mobile. 

Once you are comfortable, you can use your arm normally to care for yourself– including putting weight through your arm to use walking aids if required. 

You may find your arm is still very swollen down to your hand. This is normal and usually improves once you are using your arm more. If you remain worried please see the advice at the end of the leaflet.

If you’re not already using your arm much, now is a good time to start trying a bit more. 

• Practicing with an empty cup will build your confidence for meal times if you struggle to begin with.  
• Practice washing your face with your injured arm while sat at the sink. You can use the other hand to help if needed. 

You can start to gradually use the sling less over a few days if you feel ready. You may find it useful to continue to wear it if you are out and about in a busy environment, or standing for a long period of time. 

Keep your hand supported when you are sitting and lying down to reduce swelling – try not to let it hang down by your side for extended periods of time. 

The following exercises are suggestions. The important thing is to gradually get your shoulder moving in whatever way you feel able to. 

You might need help for the following exercises. Please speak to your community therapy team if they are involved in your care to help you with exercises. 

Place your hand under the elbow of the injured arm. Lift gently until you feel a stretch at your shoulder. Start to gradually increase how far you can move your shoulder. 

Place your hands on a table. Slide your hands along the table as far as you can without lifting your shoulders.

If you find you need more practical support than anticipated when you get home then please contact Sirona who provide community based assessments through the Single Point of Access on 0300 125 6789 

• If you have worsening pain that doesn’t settle within 48 hours.
• If you notice any new change to the feeling in your hand or a new loss of movement in your hand or wrist at any stage after your injury.
• If you notice a new swelling.

If you are still significantly struggling with basic exercises or function after 6 weeks and have not been referred to outpatient physiotherapy, please contact the Frailty Trauma Practitioner to discuss referral. This is not an emergency service and calls may not be returned same day. 

If you feel you need urgent medical advice please contact a relevant health care professional such as 111 or your GP. 

Bones contain living tissue that is constantly being broken down and rebuilt. We call this process ‘bone turnover’.  

As we get older, the process of making new bone is slower than the process of breaking down of old bone, and so the amount of bone tissue we have reduces,and bones can start to lose some of their strength and structure and become weaker. This may lead to a condition called osteoporosis.   

A fracture that has happened easily after a minor injury such as a trip or fall is known as a fragility fracture. It is often the first sign that bones have lost some of their overall strength and structure. 

People who have had a fragility fracture have a higher chance of having another fracture compared to someone who hasn’t had a fracture.   

You may be contacted by the Fracture Liaison Service who will arrange to complete a ‘fracture risk assessment’ to see how likely you are to have further broken bones (fragility fractures). This may also be carried out by the team looking after you in hospital, or your own doctor at the GP surgery. 

The fracture risk assessment can help to guide whether you should have some further tests or investigations for osteoporosis. If it indicates that you have a high chance (risk) of having fractures, it may be recommended that you start taking some medication to help slow down the bone turnover process and improve your bone strength. This will help reduce the chances of having significant fractures like a hip fracture or a compression fracture of one of the spinal bones.   

A healthy lifestyle is important to reduce your risk of developing osteoporosis and having fractures, but if your risk for having fractures is high then it might not be enough on its own to reduce your chances of having further fractures.   

Exercise is good for bone strength - even if you have osteoporosis, a combination of good balance, coordination, and reflexes can help to reduce your risk of having a slip, trip, or fall.  

You may find it beneficial to do some strength and balance training to help reduce the chances of falls and further broken bones in the future.

You may have this offered as part of your care support after your injury. If not there are classes and groups in the community you may wish to join, such as the Staying Steady classes  but if you have had one or more falls, or if you remain worried about falling, ask your GP to refer you to the specialist Falls Service. 

You can also help your bones by not smoking and by not drinking too much alcohol. Smoking, and/or regularly drinking more than the recommended weekly amount of alcohol has a harmful effect on bones, reducing the body’s ability to absorb calcium and changing how bone-building cells work, and can slow down the healing of fractures. 

Drinking more alcohol than the recommended safe amounts can also cause people to become unsteady on their feet and increase their chances of having falls and fractures. 

You should also make sure you have enough calcium and vitamin D, either from a healthy balanced diet and safe exposure of your skin to sunlight during the spring and summer, or by taking calcium and/or vitamin D supplements.   

For further information, you may wish to visit the website of the Royal Osteoporosis Society at www.theros.org.uk or contact their specialist nurse helpline on 0808 800 0035.

• You must not eat for 4 hours before the test, but you may have clear drinks for up to 2 hours beforehand.
• Because you will be having sedation, it is vital that you arrange transport to and from the hospital and that someone is with you overnight.
• If you are unable to keep your appointment, please phone the Endoscopy Booking Department as soon as possible on 0117 414 5054. This will enable the staff to give your appointment to someone else and they will be able to arrange another date and time for you.
• This procedure requires your formal consent. You will be asked to sign the consent form in the presence of the doctor. 
• If you need an interpreter please contact the department before your appointment on 0117 414 5054. 

• Your normal medication should be taken.
• If you are diabetic and take insulin or tablets for this, please note the advice later on in this page. Please ensure the Endoscopy Booking Department is aware that you are diabetic so that the appointment can be made at the beginning of the list. 
• Blood thinning medication – your hospital doctor will have advised you whether and when to stop your blood thinning medication if you are on warfarin, clexane, clopidogrel, DOACS (rivaroxaban, dabigatran, apixaban, and endoxaban). If you are unsure or you have not been told, please phone your consultant’s secretary. 
• Allergies: Please phone the department for information if you have a latex allergy.

• You will have a brief medical assessment by a nurse to confirm that you are sufficiently fit to undergo the bronchoscopy.
• The nurse will also confirm the phone number of the person picking you up so that they can contact them when you are ready for discharge.
• A doctor will then come to talk to you about the procedure and ask you to sign the consent form if you are happy to proceed.

• A cannula (narrow plastic tube) will be inserted in the back of your hand or your elbow crease to allow us to give you intravenous sedation
• The doctor performing the procedure will spray the back of your throat and nose with anaesthetic throat spray that will make your throat numb. 
• Sedation will be given to make you slightly drowsy but not unconscious. You will still be able to hear the doctor and nurse talking to you. This state is called co-operative sedation. 
• Please note that if you are having sedation you are not permitted to drive, take alcohol, operate heavy machinery, or sign any legally binding documents for 24 hours following the procedure and you will need someone to accompany you home. We advise you to have sedation to help you to relax during the procedure.

• During the bronchoscopy you may feel some slight discomfort as the bronchoscope is passed through your nose or mouth. 
• You may cough when the local anaesthetic is administered to your vocal cords and air passages. As the anaesthetic takes effect your throat will relax and you will be able to breathe normally. 
• The procedure will take between 10 - 30 minutes

• Endo-bronchial biopsy: A small sample is taken from the inside lining of the air tubes.
• Bronchial brushings: The doctor passes a small brush over the inside lining of the air tubes.
• Bronchial washings: A small amount of fluid is put into the air tubes and sucked back through the bronchoscope into a specimen jar.
• Broncho-alveolar lavage: Fluid (about 1 cupful) is put into a single small air tube in the lung then sucked back up into a specimen jar. This collects cells from the air sacs of the lung.

Morning Appointments

Insulin treated patients:

• You should have nothing to eat after midnight but may have water until 6am.
• Have a suitable drink equivalent to 20g carbohydrates between 6 and 7 am to avoid the risk of hypoglycaemia.
• Omit normal morning dose of insulin prior to the procedure unless taking lantus or levemir.
• Tell the nurse immediately if you have any symptoms of hypoglycaemia. As soon as it is considered safe you will be allowed to eat and drink.
• Only tea and biscuits are available for patients in the endoscopy department. Please, bring your insulin with you. You should be aware that blood sugar levels may be disturbed by the change in your routine but should return to normal within 24 – 48 hours. 

Tablet treated patients:

• Hypoglycaemia (low blood sugar) is unlikely to be a problem for patients treated with sulphonylurea tablets e.g. gliclazide, glibenclamide except if fasting is prolonged.
• Omit morning diabetes tablets.
• Take your morning tablets as soon as you can eat and drink safely after the procedure followed by breakfast.

Afternoon Appointments

Insulin treated patients:

• You should have nothing to eat at least 4 hours before your appointment, but you can have clear fluids up to 2 hours before.
• Have a suitable drink equivalent to 20g carbohydrates to avoid the risk of hypoglycaemia between 10:30 and 11am.
• Have half the morning dose of insulin with a light breakfast at 8am
• Tell the nurse immediately if you feel any symptoms of hypoglycaemia.
• You should be aware that blood sugar levels may be disturbed by the change in your routine but should return to normal with 24 - 48 hours. 

Tablet treated patients:

• You should have nothing to eat at least 4 hours before your appointment, but you can have clear fluids up to 2 hours before.
• Do not take diabetes tablets before the procedure. You may resume normal medication after the procedure when you are able to eat and drink safely.
• Be aware that blood sugar levels may be disturbed by the change in your routine but should return to normal within 
  24 - 48 hours.

There are some risks and complications with this procedure.

They include but are not limited to the following:

• Specific risks:
• Low oxygen levels (hypoxemia): during the test your oxygen levels are measured and you may be given oxygen.
• Narrowing of vocal cords (laryngospasm): this is usually temporary and rarely a problem.
• Hoarse voice (this usually settles after a few days).
• Asthma like reactions: the air tubes can be narrowed due to irritation by the procedure. This is usually treated with asthma drugs.
• Damage to dental crowns and teeth – this is very rare. You will be wearing a mouth guard during the procedure to protect your teeth from damage but also to protect the bronchoscope from your teeth.
• Rarely, you may get a chest infection
• Fever: this may happen after broncho-alveolar lavage and is treated with paracetamol (Panadol).
• Bleeding: this can happen after biopsies. Normally it is minor and settles quickly. If the bronchoscope is passed through the nose then bleeding from the nose may occur. Severe bleeding is rare and is more common after trans-bronchial biopsies. Bleeding is more common if you have been taking warfarin, aspirin, DOACs, clopidogrel or drugs for arthritis or back pain (NSAIDS). Your doctor should have advised you about this by now, if you have not had any advice regarding this you should ask your doctor.
• Collapsed lung (pneumothorax): a small hole in the surface of the lung can happen after a transbronchial lung biopsy for up to 1 in 20 people. Air then leaks from the lung, causing the lung to collapse. The lung may come back up itself, but for 1 in 2 people who get a collapsed lung, a tube has to be put through the skin, into the chest. This removes the air from around the lung and may need a longer hospital stay. Rarely this can happen up to 24 hours after trans-bronchial biopsy.
• Heart problems: bronchoscopy may put a brief minor strain on the heart. This can cause abnormal beating of the heart. It rarely causes fluid to collect in the lungs, a heart attack, or the heart may stop beating.
• Reactions to sedation or local anaesthetic: can include vomiting and rare allergic reactions.
• Death is extremely rare - about 1 in 2,500.

The best way to access MMR is through the link provided on email registration. You can also access MMR by searching ‘North Bristol My Medical Record’ on Google or by scanning the QR code below.

You can reset your password on MMR by clicking on the ‘Forgot Password?’ link on the sign in page.

We can create an account for your family member or carer to use on your behalf. 

Please provide the cancer team with the best contact email for this family member or carer. 

The account details will then be sent to their email account.

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Please check the MMR website to understand your monitoring plan and find your test results. 

If your test results are abnormal, a member of the cancer team will contact you directly to discuss in further detail.

No, previous test results will not be visible on MMR. 

You will only be able to view test results that happen after your MMR account is set up.

Scans or procedure results will be available to view after they have been reviewed by a member of the cancer support team. 

Blood test results will show as soon as they have been processed. 

This may mean the dates shown on MMR, may be slightly different to the date of the test. 

Please do not worry if they do not line up exactly, and continue following your monitoring plan. 

If there are significant differences, or you think your monitoring plan is wrong, please do get in touch.

Please contact your GP or other community healthcare service to arrange your blood tests. 

Any other imaging tests or hospital procedures will be arranged by the cancer nurse team. 

You will receive an appointment letter from the relevant department. 

If you have not received an appointment, please contact your cancer team.

The messaging tool is for non-urgent queries. 

The cancer support team will aim to respond to messages within 2 working days. 

If you have any urgent queries relating to your cancer, please contact your cancer support team directly.

If you would no longer like to access MMR, please tell a member of the cancer support team. This can either be through the ‘Message’ function, or by contacting your cancer support team directly by telephone or email. You will then receive results by paper letter or telephone call for the remaining period of follow up.

If your tests have remained within expected levels for the surveillance period, and you have had no concerning symptoms, you will be discharged back to the care of your GP. 

Your GP will guide you on any further follow up tests.

Primary Sclerosing Cholangitis (PSC), a condition characterised by progressive inflammation, obstruction and fibrosis of the intra- and extra-hepatic bile ducts of the liver, presents typically in the fourth or fifth decades leading often to cirrhosis, end stage liver disease and a need for liver transplantation. 

The PSC Genetics Study began in 2008, with the aim of sourcing DNA from over 3000 patients with Primary Sclerosing Cholangitis. To date over 1800 patients have participated in the study. This is a significant step towards our goal of identifying genes of potential significance in the pathogenesis of this condition.

Chief Investigator – Dr Gideon Hirschfield 

Principle Investigator - Dr Robert Przemioslo

R&I no: 2145 

The PBC Genetics Study is a national effort to establish a PBC DNA collection consisting of DNA samples from approximately 5000 patients with PBC. The DNA collection has already been used for a genome-wide association study (GWAS) of PBC. The next major analysis will be a genome wide association study of response to Ursodeoxycholic acid (UDCA).

Chief Investigator - Dr Richard Sandford

Principle Investigator – Dr Robert Przemioslo

R&I no: 2030

The The Promise study is: A PROspective randomised double-blind parallel group placebo-controlled multicentre trial of faecal MIcrobiota tranSplantation to improve the primary outcomE (first hospitalisation due to infection) in patients with cirrhosis over 24 months.

End-stage chronic liver disease, known as cirrhosis (irreversible scarring of the liver), is the third biggest cause of mortality and loss of working life in the UK. The human body contains trillions of bacteria, but people with cirrhosis have an increased number of ‘bad’ bacteria in the bowel which makes them highly susceptible to a host of infections. Over-prescribing antibiotics means they are becoming less effective to treat these infections, and the bowel can become infected with ‘super-bugs’. Replacing the unfriendly bowel bacteria in patients with cirrhosis with healthy bacteria donated from healthy volunteers (Faecal Microbiota Transplantation) could be highly beneficial and reduce antibiotic usage.

Project Details
Chief Investigator - Deborah Shawcross
Local PI – Dr Zeino Zeino 
R&D 5230

Palliative Long-term Abdominal Drains Versus Repeated Drainage in Untreatable Ascites Due to Advanced Cirrhosis: A Randomised Controlled Trial (REDUCe 2 Study)

Our aim is to see if palliative long-term abdominal drains (LTADs) result in better quality of life in patients with fluid in the belly due to liver scarring (cirrhosis), compared with current standard of care. The liver can be damaged by excessive alcohol and viral infections. If liver damage continues this scarring leads to permanent damage. It causes a painful buildup of fluid in the abdomen (ascites). Drugs can treat this, but may stop working, leading to untreatable ascites. A liver transplant is then the best option. However, many do not receive a transplant due to concerns about their alcohol use or lack of donors. Life expectancy is on average six months and palliative care is needed. Current palliative care for untreatable ascites involves coming into hospital for 1-2 days, putting a thin tube into the abdomen for a few hours and draining the fluid. This reduces pain from ascites. However, as the ascites builds up quickly, hospital visits are needed every 10-14 days. For people with untreatable ascites due to cancer, palliative care involves placing another tube, an LTAD, into their abdomen. This tube is fitted in hospital but stays in place for months. Nurses/carers then drain smaller amounts of fluid regularly in the community. LTADs avoid frequent hospital visits and can improve quality of life. LTADs are not routinely offered to people with cirrhosis. We conducted a feasibility study where half the participants received LTADs and half continued with standard hospital drainage. The study went well, with no major issues. We now need a larger study to understand the risks/benefits of palliative LTADs in people with cirrhosis. In this larger study we will measure quality of life for both the participants and their carers. The study has been designed with help of the patients/caregivers who are part of the research team.

Chief Investigator – Prof Sumita Verma
Local PI – Dr Ankur Srivastava 
R&D - 5300

Beta Blockers or placebo for primary prophylaxis of oesophageal varices (BOPPP Trial). A blinded, multi-centre, clinical effectiveness and cost-effectiveness randomised controlled trial

Cirrhosis or liver scarring is an important healthcare problem in the United Kingdom. There are 60,000 patients living with this disease and about 11,000 people die every year due to complications of cirrhosis. Bleeding from the oesophagus or stomach is one of these complications. Cirrhosis causes pressure changes inside the abdomen and swelling of veins in the oesophagus (called “varices”) which can cause fatal bleeding. Research has proven that large varices can be treated with beta-blockers (a type of anti-hypertensive medication) to reduce the pressure in the veins. The management of small varices is still uncertain. This study aims to discover if beta blockers can be used in this setting. We hypothesize that beta blockers will reduce the risk of bleeding from small varices from 20% to 10% over a period of 3 years, resulting in significant cost savings to the NHS from better patient outcomes. The study will be opened in approximately 25 centres nationally. Patients with small volume varices, identified by routine endoscopy, will be randomised to receive either beta-blockers or a placebo. They will be followed up 6 monthly for a period of 3 years. We will assess for complications of cirrhosis (including bleeding) and medicine related side effects. The varices will be monitored annually by endoscope for the duration of the study. General practitioners will be involved in monitoring patients and adjusting doses. As part of our analysis we will assess the impact of treatment on mortality and quality of life using a combined measure, the Quality Adjusted Life-Year (QALY). We will use a mathematical prediction model to estimate the impact of treatment on costs, mortality and quality of life over a patient’s lifetime; identifying if any increased costs are justified by better outcomes for patients and represent good value for money for the NHS budget.

Chief Investigator – Vishal Patel
Local PI – Dr Zeino Zeino 
R&D - 4499

STopping Aminosalicylate Therapy in Inactive Crohn’s Disease (STATIC) Study: A Randomized, Open-label, Non-inferiority Trial

Aminosalicylate (5-ASA) agents have proven effective for inducing and maintaining remission in mild to moderate ulcerative colitis (UC) and thus are commonly used as first-line agents for patients with Crohn's disease (CD) in remission. However, there is uncertainty regarding their effectiveness for CD. In this open-label (where both the researchers and participants know which treatment is being administered), randomized study, participants with CD in remission will be allocated to either continue their 5-ASA therapy or withdraw their 5-ASA. The purpose is to investigate if withdrawal of 5-ASA therapy is not unacceptably less effective than continuing on 5-ASA in maintaining CD remission over a 24-month period. There will be a 2 year follow up period to see if participants develop any flares or complications of their CD, to monitor their quality of life and assess the impact on the cost associated with their assigned treatment. The results of the study may help to improve evidence based treatment guidelines and the approach to patient care. Participants will be randomly assigned by a computer to one of two groups: 1. Group 1: Continuation of 5-ASA treatment 2. Group 2: Discontinuation of 5-ASA treatment At the end of the study, half of the participants will be in Group 1 and half of the participants in Group 2. After participants have been assigned to one of these two study groups, they will continue in that group for the duration of their time in the study. Approximately 1580 participants will be taking part in this study. Participants will be asked to attend hospital visits for a total of 5 times over a two-year period, where they will undergo the following procedures at most or all study visits: Blood taking, Physical Exam(only at first visit), vital signs, medication review, side effects review, urine sample, questionnaires and stool samples.

Chief investigator – Dr Gordon Moran
Local PI – Dr Melanie Lockett 
R&D – 4472