This training session will give you an introduction into modelling AAC.                 

You may be very familiar with AAC, or very new. You may be using a high-tech device, or something paper-based. Either way, we hope you will learn something new from this training. 

This training session will cover:

• What is modelling?
• The basics to get you started.

Resources

For further resources to help you, see AAC implementation resources in: 

• Adults with aphasia 
• Resources for alphabet users (child or adult) 
• Symbol users (child or adult)

As of 1 April, 2022, North Bristol NHS Trust has been designated as one of nine Specialised NHS England Complex Mesh Centres, supporting patients with mesh complications linked to urinary incontinence and vaginal prolapse in the South West.

These centres provide management of urinary incontinence and vaginal prolapse mesh complications, with the engagement of the multi-disciplinary team (MDT), which includes surgeons, physicians, imaging specialists, nurses, pain specialists, physiotherapists, and clinical psychologists in line with the published service specification.

The MDT of specialist clinicians is led by Professor Hashim, Consultant Urological Surgeon, and Mr. Madhu, Consultant Urogynaecologist.

Referrals:

Referrals to the North Bristol NHS Trust Mesh Complications Specialist Service MDT will be from hospital trusts and GPs in the South West, as listed below.

Patient mesh complications referrals will be triaged by the Clinical Lead(s), and invited to an outpatient appointment. They will be referred to selected members of the MDT as required, and each patient will be discussed at the monthly MDT meeting. An outpatient appointment will then be arranged with the patient to discuss and agree their treatment plan.

The region covered includes:

Hospital Trusts:

• Royal Cornwall Hospitals NHS Trust
• University Hospitals Plymouth NHS Trust
• Royal Devon and Exeter NHS Foundation Trust
• Northern Devon Healthcare NHS Trust
• Torbay and South Devon NHS Foundation Trust
• Somerset NHS Foundation Trust
• Yeovil District Hospital NHS Foundation Trust
• University Hospitals Bristol and Weston NHS Foundation Trust
• Royal United Hospitals Bath NHS Foundation Trust
• Great Western Hospitals NHS Foundation Trust
• Gloucestershire Hospitals NHS Foundation Trust.

GPs within the following Integrated Care Partnerships:

• Cornwall and the Isles of Scilly
• Devon
• Somerset
• Bristol, North Somerset, and South Gloucestershire 
• Bath and North East Somerset, Swindon, and Wiltshire 
• Gloucestershire

To refer:

• Hospitals: Please complete the MDT referral form below and email to: bristolmeshservice@nbt.nhs.uk

• GPs: Please refer via the Referral Assessment Service in eRS:
  • Speciality: Urology
    • Clinic types: Urology - (In)Continence, or Not otherwise specified
  • Speciality: Gynaecology
    • Clinic types: Urogynaecology /  prolapse, or Not otherwise specified

To contact us:

Telephone: Lynda Bishop, MDT coordinator for the Bristol Mesh Specialist Service: 0117 414 0899

Email: bristolmeshserviceadmin@nbt.nhs.uk

Further information

Patient information and decision aids are available from the British Society of Urogynaecology

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

The Trust Board meets in public at 10am.

•  Thursday 25 May 2023
• Thursday 27 July 2023
• Thursday 28 September 2023
• Thursday 30 November 2023
• Thursday 25 January 2024
• Thursday 28 March 2024

Download Integrated Performance Reports (IPR):

Download Meeting Papers:

The Bristol Mesh Complications Specialist Service, at North Bristol NHS Trust, was set up in April 2022, and is one of the nine designated specialist Mesh Complication Centres in England, supporting patients with mesh complications linked to urinary incontinence and vaginal prolapse.

These centres provide specialist and holistic care in the treatment of urinary continence and vaginal prolapse mesh complications, by a multi-disciplinary team (MDT). The MDT includes surgeons, physicians, imaging specialists, nurses, pain specialists, physiotherapists, and clinical psychologists in line with the published service specification.

The MDT of specialist clinicians is led by Professor Hashim, Consultant Urological Surgeon, and Mr. Madhu, Consultant Urogynaecologist.

The Bristol Mesh Complications Specialist Service will assess referrals from the South West region. Your GP or Consultant can refer you to the service.

Contact details

Phone: 0117 414 0899

Email: bristolmeshserviceadmin@nbt.nhs.uk    

Opening times: Monday to Friday 8:00 to 16:00

The British Association of Urological Surgeons has more information on vaginal mesh complications.

This information is based on the latest research and aims to help you deal with your back pain and speed up your recovery. It is aimed at patients who are receiving conservative treatment only.

Remember:

• Half of all people experience back pain at some point in their lives. It usually gets better quickly with minimal rest and continued activity.
• Stay active.
• Stay at work or return to work as soon as possible.
• Do not be afraid of the pain it is unusual for it to indicate serious damage.

Your back

Your back is strong and stable. The bones or vertebrae are held together by discs and the whole spine is strengthened both front and back by strong ligaments. It is surrounded by powerful muscles which help to protect it. It is surprisingly difficult to damage your back.

Causes of back pain

Most people with back pain do not have any damage in their spine and so it is not always possible to pinpoint the exact source of the pain.

Serious causes are very rare. If you have back pain and suddenly develop any of these symptoms you should see a doctor immediately:

• Difficulty passing or controlling urine or bowel motions.
• Numbness around your back passage (bottom) or genitals.
• Numbness, pins and needles or weakness in both legs.
• Unsteadiness on your feet.
• High fever.
• A sudden change in the shape of your spine.

Most X-ray/MRI findings in your back are normal changes with age. Just as we get grey hair at different times as we get older, our backs age at different times too. Even people without back pain have changes in their spine so scans can cause fear that influences behaviour, making the problem worse.

You may find it frustrating not to know exactly what is wrong but this is good news because it means there is nothing serious.

The first 2 - 3 days

Take painkillers and/or anti-inflammatories. These will reduce pain and help you to move and keep active (make sure you read the instructions carefully).

Try to keep moving. You might want to rest for short periods in positions that are comfortable. These positions may help:

• Lie on your front with or without a pillow under your tummy.
• Lie on your side with a pillow between your knees and, if comfortable, a small pillow or towel under your waist.
• Lie on your back with your hips and knees bent and your legs supported on a stool.

Good ideas to help you stay active

• Ice - try putting a bag of frozen peas wrapped in a damp towel on the painful area for 20 minutes.
• Heat - this can help reduce the pain of muscle spasm. Try using a hot water bottle wrapped in a towel over the painful area for 20 minutes.
• Ice and heat do have a risk of causing burns unless you are cautious when using them.
• During the first few days it is important to start gentle activity.
• You may feel a temporary increase in pain during or after the activity but this is normal and does not mean that you are causing harm.
• Exercises such as walking, cycling and swimming can help to ease pain and improve fitness.
• Choose a chair that supports your lower back.
• Do not sit for too long get up regularly, stretch and walk about. This includes driving.
• Stay relaxed whilst driving and take regular breaks.
• Avoid remaining in one position for too long.
• When you bend down try to bend your knees and hips to make your position more powerful.
• When reaching, pushing or carrying, keep items close to your body and use work surfaces at a comfortable height.
• If items are heavy get some help and do not rush.

Sleeping

• Find a comfortable bed for you and avoid one that sags or is too hard.
• If your bed is too hard put a thick duvet or sleeping bag between the mattress and the sheet.
• You do not need to worry – sex will not damage your back although you may need to try different positions.

Relax yourself

• Stress, tension and worry can tighten the muscles and cause more pain.
• Try to do things that make you feel calm like focusing on relaxed breathing, going for a walk, listening to music or having a warm bath.
• Try to do things which stop you feeling low. Be positive!

Active ongoing back care

Although a physiotherapist may help you to manage your pain what you do is the most important thing.

Stay active

• Carrying out your normal everyday activities and daily responsibilities will help your back recover. Remember not using your back does more harm than good.
• Try to do a little more each day, aiming for a steady return to work and domestic tasks.
• Don’t fear twisting and bending – it is essential to keep moving. Gradually increase how much you are doing, and stay on the go.

Pace yourself

• It is normal to have good and bad days. Keep doing your normal activities little and often throughout the day break down big jobs into smaller, more manageable tasks. This will keep your joints moving and your muscles strong and help speed up your recovery.

Tablets

• Painkillers and anti-inflammatories can help you control the pain. Easing the pain helps to make you more comfortable as you gradually get back to your usual activities.

Stay positive

Expect to get better! Remember back pain is very common and rarely serious.

Talk about any fears you may have with your doctor or physiotherapist.

Improve or keep fit

Back pain shouldn’t stop you enjoying exercise or regular activities. In fact, studies found that continuing with these can help you get better sooner.

Activities like the gym, cycling, swimming and walking are very useful ways of managing back pain problems.

Other activities that may help include tai chi, yoga, pilates.

Complimentary therapies

As well as being active some people find they also get relief from activities such as:

• Massage
• Acupuncture

What if it happens again?

• If you do get back pain again, remember, it will go away like it did last time. Just because it comes back it is still not serious.
• Remember in the early days it is important to keep active.
• The most important steps are the things you do to help yourself.
• You have a better chance of having a healthy back if you get a bit fitter being fitter will help you to look after your back.

Remember:

• Back pain is common but is rarely due to any serious disease.
• Staying active will help you get better quicker.
• Resting in bed for more than a day or two is usually bad for your back.
• The sooner you get going, the sooner you will get better!
• Hurt does not mean harm.

Acknowledgments

This information was produced from collaborative work by the BNSSG physiotherapy working group.

© North Bristol NHS Trust.  This edition published April 2024. Review due April 2027. NBT002023.
 

You have been directed to this webpage because you have been identified by our senior nurse as appropriate for streaming to the NBT ED 111 phone booths.

Why?

It may seem strange that you have been asked to phone 111 when you have come to the emergency department; but please bear with us. We are all trying to work together to get you seen in the right place at the right time.

In the current climate waiting times in Emergency Departments can be very long and for many people an Emergency Department is not the best place for them to be seen. It can often seem difficult to navigate the wide range of healthcare services especially as the different options expand and 111 can help with this.

The Senior Nursing Streaming Team have identified that your condition may not need to be seen in the Emergency Department. By phoning 111 straight after streaming you may well prevent a long wait, and be seen more appropriately by another healthcare/pharmacy service.

How?

After booking in and having a brief chat to the Streaming Team you will have been directed to a phonebooth area to call 111. When you speak to 111 they will use validated pathways to work with you and decide where and when you should be seen; this may include the following non exhaustive options:

• Your GP
• An emergency dentist
• A prescribing pharmacist.
• A minor injuries unit
• Selfcare – with their advice.

When?

After phoning 111 if they have made arrangements for you to be seen somewhere other than the Emergency Department you are free to leave and you do not need to tell anyone you are going.

If 111 has decided that the Emergency Department is the right place for you please tell the reception team and we will put you back into the queue at the time you initially booked in.

Thank you for your co-operation with this new change to how our Emergency Department is working.

© North Bristol NHS Trust. This edition published April 2024. Review due April 2027. NBT003439.

GMC Number: 6103076

Year & location of first qualification: 2004, University College London

Specialty: Medical Microbiology and Infectious Diseases

Clinical interests: Clinical microbiology, particularly in austere environments. Infection Control and outbreak management. Tropical infections in travellers.

Secretary: Joanne Cook

Telephone number: 0117 414 6215

Dr Jason Biswas is a Consultant in Medical Microbiology and Infectious Diseases at Severn Pathology. His higher specialist training was across London teaching hospitals, obtaining FRCPath and MRCP, as well as the Diploma in Tropical Medicine and Hygiene. He commenced his post in Bristol in 2021, and is lead for surveillance of mandatory reporting organisms (Staphylococcus aureus, Clostridioides difficile).

Dr Biswas is also a Consultant in the Royal Army Medical Corps, and has extensive experience of operational service in the Middle East, Eastern and Southern Africa, and South East Asia (amongst others). His research is around screening of travellers (military or civilian) after visits abroad.

Email address: jason.biswas@nbt.nhs.uk

GMC Number: 6147753

Year & location of first qualification: 2006, Barts and The London, UK

Specialty: Microbiology and Infectious Diseases

Clinical interests: Clinical Microbiology and Infectious Diseases, Infection Prevention and Control and Antimicrobial Stewardship.

Secretary: Josephine Poad (Microbiology) and Lynne Brown (ID)

Telephone number: 0117 414 6264

Dr Colston is a Member of the Royal College of Physicians, a Fellow of the Royal College of Pathologists and is a member of a number of infection societies, including the British Infection Association, the British Antimicrobial Chemotherapy Society and the Hospital Infection Society.

This webpage is about persistent (chronic) cough, and explains more about causes and treatment.

If you have any further questions or concerns, or you have a persistent cough and a diagnosis of lung disease, please speak to your respiratory doctor or respiratory physiotherapist for specialist advice.

What is chronic cough?

Chronic cough is a persistent cough lasting eight weeks or more. Many report it to be a dry cough with an irritation or tickling sensation; this is quite common but can be distressing. The cough can be triggered by talking, laughing, certain strong smells/irritants and/or changes in temperature.

Chronic cough can lead to other problems including poor sleep, headaches, disordered breathing, exhaustion, depression, stress incontinence, and fear of being out in public.

What causes chronic cough?

The following are some of the common conditions associated with chronic cough. In many cases, there may be more than one cause.

Gastro-oesophageal reflux disease (GORD) and laryngopharyngeal reflux (LPR): Acid from your stomach rises up the oesophagus and tips over onto the vocal cords irritating the back of the throat.

Post-nasal drip: Excess mucous from your nose/sinuses drips down the back of your throat.

Asthma: Cough variant asthma can present with cough as the main symptom.

Infections: A cough can remain even after other symptoms of a cold, throat infection or chest infection have gone.

Medications: Angiotensin-converting enzyme (ACE) inhibitors are commonly prescribed for high blood pressure and heart failure and can cause a chronic cough as a side effect in some people.

In some cases, there is no obvious cause. Some people have a very sensitive cough reflex which does not easily respond to treatment of accompanying conditions.

What happens when you cough?

When you cough, your vocal cords are struck together forcefully. The vocal cords may become irritated and this can cause more coughing. This can lead to the increased production of mucus which can trigger even more coughing, in a cycle which can be difficult to break. The habit of coughing in response to minor throat irritation may worsen over time.

How to control your cough?

The first step is to identify any sensations that come from the throat right before the episode starts. It may be a tickle or scratchy sensation.

As soon as you experience the sensation above, try the ‘hold, blow, sip, swallow’ technique:

• Hold your breath for the count of 5.
• Blow the air out of your mouth through pursed lips (as if blowing out candles).
• Sip some water.
• Swallow whilst your chin is tucked down towards your chest.

Other strategies you could try: 

• Sniff in twice in quick succession, short and sharp (so you hear noisy air) then blow out gently through tightly pursed lips, with your shoulders relaxed. Don’t push or strain from the throat..
• Tongue press – press the sides of your tongue to your top teeth holding for 3-5 seconds.

The following strategies may decrease the sensitivity and irritation that has built up in your throat due to prolonged coughing.

• Sip water frequently throughout the day, sipping every 15 minutes to keep your throat moist. Aim to drink about 2 litres of water each day. 
• Avoid caffeine and alcohol (which can dry the throat out).
• Try steam inhalation for 10-15 minutes (or as long as you can tolerate) every day. Place your head over a bowl of steaming water from the kettle, put a towel over your head and breathe in and out through your nose.
• Practice breathing in through your nose. Nasal breathing reduces the irritating effect of dry cold air on the throat.
• Avoid medicated cough lozenges as they can dry your throat out. Try sucking on non-medicated lozenges, chewing gum or honey which increase swallow frequency and can have a soothing effect.

It is important to recognise there is no ‘quick fix’. You will need to practice the techniques that work best for you regularly when you are not coughing, little and often, so you are ready to use them when you feel a cough coming on. In time you will learn to control the cough before it starts.

© North Bristol NHS Trust. This edition published October 2024. Review due October 2027. NBT003406

Diet and Irritable Bowel Syndrome (IBS)

Irritable Bowel Syndrome (IBS) is a common illness. It affects around 1 in 5 adults.  

We do not know the cause of IBS, but some things can make it worse such as:

• Emotions.
• Nerves.
• The link between the gut and the brain.
• Microbes/bacteria that live in your bowel.
• The immune response to gastric infections.

This page also explains some of the things you can do to help your IBS symptoms.

There is also a very helpful webinar at:

Webinars on Irritable Bowel Syndrome - patientwebinars.co.uk

Summary

• Eat regular meals.
• Do more exercise.
• Have 6-8 drinks every day.
• Drink less caffeine.
• Cut down on fatty foods if you get pain after meals.
• Do not eat spicy foods if you get pain after eating them.
• Drink less alcohol.
• If you are constipated, eat more fibre.
• Linseeds can help.
• Try taking probiotics.
• Do not have chewing gum or sugar free sweets.
• Peppermint oil can help.
• Try ways to help you cope with stress.
• CBT, hypnotherapy, and yoga can help even more than diet.
• The low FODMAP diet can help but is not right for everyone. There is more information about this below. 

Healthy eating habits 

Your bowel is linked to your body clock. It is more active at times when you usually eat. Eating and drinking can also make it more active.

• Have three regular meals each day.
• Do not miss meals.
• Take time to eat slowly in a calm place.
• Chew food well.
• Do not eat ‘on the run’ – try to sit down to eat.
• Try to relax at meal times.

Peppermint oil

Stress and anxiety

Other treatments

Physical activity

Drinks

Caffeine

Artificial sweeteners - Polyols

Lactose (this is the sugar found in milk)

Fatty foods

Spicy foods

Probiotics

Fibre

Linseeds (also known as flaxseeds)

Alcohol

The low FODMAP diet

Your symptoms and what advice to try

Depending on your symptoms, some of the advice in this page may help you, but some of it won’t.

Your clinician may recommend specific pieces of advice based on your symptoms. They may also ask you to complete a questionnaire called a Functional Gastrointestinal Disorders Symptom Evaluation. 

Managing your eating habits, physical activity, stress levels and fibre intake will help with the majority of IBS symptoms.

© North Bristol NHS Trust. This edition published August 2023. Review due August 2026. NBT003265