COVID-19 Recovery (RS) Study

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RECOVERY (Respiratory Support) is a national clinical trial that has been identified by the Government as an urgent public health priority.

Over 30,000 people are taking part in a range of NIHR-supported COVID-19 research studies across the UK, including RECOVERY (RS).

The study was set up to compare three possible NHS treatments used to control oxygen levels, with the goal being to find out which is most effective at keeping oxygen levels high, and which is best at preventing a patient needing further medical assistance with their breathing.

Here, Dr James Dodd talks further about the RECOVERY (RS) study at North Bristol NHS Trust:

Video Transcript

Hello, my name is James Dodd, I'm a Consultant Respiratory Physician here at Southmead Hospital in Bristol, and I'm the Principal Investigator for the RECOVERY Respiratory Support study.

This is a national clinical trial that's been identified by the Government as being of urgent public health priority.

It's designed to be undertaken in adults admitted to hospital with confirmed or suspected COVID-19, and it's designed to determine what might be the best strategy of improving oxygen levels and helping to prevent patients from deteriorating and requiring more support with their breathing.

It compares three treatments that are already available in the NHS. One is CPAP (Continuous Positive Airway Pressure), whereby an awake patient will have a tight-fitting mask fitted where continuous pressure is applied and delivers oxygen to keep the airways open and clear.

The second is High-Flow Nasal Oxygen, whereby humidified or moistened oxygen is delivered at speed through tubes up the nose to improve oxygen levels. And finally it is to compare the standard treatment of oxygen masks or tubes up the nose.

Nobody's currently clear as to which of these strategies is more effective. This study is designed to answer that question, and the data will be reviewed regularly to identify if there is any treatment that is more effective and can be made available at speed to patients across the NHS.

We have a dedicated team working seven days a week at Southmead Hospital made up of nurses, physiotherapists and doctors working the emergency respiratory and critical care areas to recruit to this important study.


Study Results:

RECOVERY-RS Results

Over 13 months, between April 2020 and May 2021, a total of 1,272 hospitalised COVID-19 patients with acute respiratory failure, aged over the age of 18, were recruited to the study and randomly allocated to receive one of three respiratory support interventions as part of their hospital care.

380 (29.9%) participants received CPAP; 417 (32.8%) participants received HFNO; and 475 (37.3%) received conventional oxygen therapy.

The primary outcomes assessed through the trial were whether the patient went on to require tracheal intubation (invasive mechanical ventilation) or died within 30-days of beginning treatment through the trial.

In the comparison of CPAP and conventional oxygen therapy, the likelihood of patients going on to require invasive mechanical ventilation or die within 30-days of treatment was significantly lower in those who were treated with CPAP, than those who received standard care. In the CPAP group, 137 of 377 participants (36.3%) either needed mechanical ventilation or died within 30 days, compared with 158 of 356 participants (44.4%) in the conventional oxygen therapy group.

There was no difference in primary outcomes between patients in the HFNO and conventional oxygen therapy groups. In the HFNO group, 184 of 414 participants (44.4%) went on to require mechanical ventilation or die, compared with 166 of 368 participants (45.1%) in the conventional oxygen therapy group.

Based on these results, 1 person would avoid needing invasive ventilation within intensive care units (ICU) for every 12 people treated with CPAP instead of standard oxygen therapy.

Dr James Dodd, Respiratory Specialist and Principal Investigator of RECOVERY-RS here at North Bristol NHS Trust said: 

“The RECOVERY-RS trial has provided much needed evidence about the most effective ways of supporting some of the most seriously ill patients with COVID-19 requiring additional oxygen. These preliminary data suggests that CPAP, a form of non-invasive respiratory support delivered outside of critical care, can reduce the need for invasive ventilation and reduce the pressure on intensive care beds. It also suggests that high-flow nasal oxygen which uses lots of oxygen did not improve outcomes.

This evidence will help clinicians at North Bristol NHS Trust and across the world caring for patients with severe COVID-19 and respiratory failure. We would like to thank our patients and extended research team working across respiratory medicine, emergency and critical care in delivering this study in the early phases of the pandemic.”


Thank you to all of our research teams who are making such a different to people’s lives, and also to Southmead Hospital Charity which is raising much-needed funds for COVID-19 research.

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.

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 Recovery RS.jpg

COVID-19 ReMap CAP Study

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The purpose of the ReMap CAP study is to compare a combination of antibiotics for patients who have been admitted to ICU. This is in order to determine which combination is the best at improving survival and recovery for patients with pneumonia.

ReMap CAP is part of the international effort to fight COVID-19, currently running in 13 countries worldwide. In the UK specifically, over 30,000 people are taking part in a range of NIHR-supported COVID-19 research studies, including ReMap CAP.

Dr Matt Thomas talks about the ReMap CAP study at North Bristol NHS Trust:

Video Transcript

Hello, Matt Thomas is my name and I'm a Consultant in Intensive Care here at Southmead Hospital, and I'm the Principal Investigator for the ReMap CAP study, which is currently recruiting patients in the Intensive Care Unit.

ReMap CAP is a really exciting study that's now running in 13 countries worldwide, from North America, through Europe, down into Australia and New Zealand. And the reason it's exciting for us is the trial design is very new. It's called an adaptive trial and that means that we can test multiple different interventions simultaneously, and retain a lot of flexibility about the interventions that are available for patients here at Southmead, and those that they might be able to benefit from.

So the study is designed so that the interventions that look beneficial are selected out and patients have a greater chance of receiving them, and interventions that are maybe not so beneficial tend to be lost from the study early.

So we have a number running here. We have antiviral interventions, we have those that modify the immune system, we have anticoagulation and we have steroids. And one that is coming in the UK, but we are not participating in, is the immunoglobulin domain.

So as of today we have ten patients recruited and I think that's a reflection of the very hard work that the COVID research team are doing, communicating with patients and their families to make sure we get as many patients recruited as possible to this important work.

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.

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 ReMap CAP.png

Mindfulness 4

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This page contains all of the course materials you need to support you once you have attended Session Four of the North Bristol NHS Trust Mindfulness course.

Course materials

Session 4 recordings to practice at home:

This week we suggest you continue alternating what you do each day: aim to do a movement practice of your choice (see week 3) one day and the “sitting” breath awareness practice the other.  Remember you can do this in sitting, lying or standing. It can be worth experimenting with how you do it.

25 minute “Sitting” practice – can be done in lying or standing as well as sitting:

https://soundcloud.com/fiona-mckechnie108681984/sitting-practice-25-mins/s-DgF59SMNVHe

We suggest you also practice a 3 step pause or breathing space, regularly and also when you feel you need it:

https://soundcloud.com/fiona-mckechnie108681984/3-minute-pause/s-T9yMnZ8Cq2d

You can click on the links below to download the written materials which support the course. We have made each handout available as a Word document or a pdf. The Word document is likely to be more useful if you want to write comments on your own handout and store them on your own computer.

 

Mindfulness 3

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This page contains all of the course materials you need to support you once you have attended Session Three of the North Bristol NHS Trust Mindfulness course.

Course materials

Session 3 recordings to practice at home:

A typical mindfulness course yoga-based movement practice. Do listen to this and make sure you are happy with it before going ahead: https://soundcloud.com/mindful-health/sets/mindful-yoga-with-taravajara

Fiona has made a lying sequence that is less strenuous: 

Mindful walking can also be an option: https://www.bangor.ac.uk/mindfulness/audio/cd1/04Track04.mp3

There is also a video Pete has made to guide you through some mindful movements:

Workbooks and handouts

You can click on the links to download the written materials which support the course. We have made each one available as a Word document or a pdf as we know that some people prefer one or another. The Word document is likely to be more useful if you want to write comments on your own copy and store them on your own computer.

Workbooks outline the practice and other activities for the week and have the option of recording and reflecting on what you are learning (you will need to use this one).

Handouts explain more about the background theory (this one is optional).

 

 

Mindfulness

Mindfulness 2

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This page contains all of the course materials you need to support you once you have attended Session Two of the North Bristol NHS Trust Mindfulness course. Each week of the course has it's own page where  you will find the specific practice recordings for that week plus some additional written and sometimes video information.

Course materials

Session 2 recordings to practice at home:

15 minute body scan: https://soundcloud.com/fiona-mckechnie108681984/15-min-body-scan-fiona-wright/s-OcfX3

30 minute body scan: https://soundcloud.com/fiona-mckechnie108681984/half-hour-body-scan-fiona-wright/s-1NJPz

Landing/anchoring 10 minutes: https://soundcloud.com/fiona-mckechnie108681984/arrivallanding-practice-10-mins/s-hW1hz8wClD4
 

Workbooks and handouts

You can click on the links to download the written materials which support the course. We have made each one available as a Word document or a pdf as we know that some people prefer one or another. The Word document is likely to be more useful if you want to write comments on your own copy and store them on your own computer.

Workbooks outline the practice and other activities for the week and have the option of recording and reflecting on what you are learning (you will need to use this one).

Handouts explain more about the background theory (this one is optional).

Mindfulness

Repeat Samples & Limitations of Testing

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Updated on 20/10/21

Key factors which are known to affect performance of the screening tests.

Working in conjunction with midwives and other health professionals we aim to reduce the number of 'avoidable repeats' as far as possible. Patient safety is our utmost concern, and if we request a repeat sample, it is to ensure we get the correct result, on the right baby, so each baby who has one of the diseases we screen for, can access appropriate treatment in a timely manner.

Avoidable repeats: Key factors known to affect performance of the screening tests.

1. Problems arising before sample collection:

  • Baby too young (e.g. day 4)
  • Expired card
  • Details missing or inaccurate:
    • No NHS number / Date of birth / Date of sample

TIP: Ask the parents to check the card (if necessary make amendments to the label and/or card).

 

2. Problems arising during sample collection:

  • Insufficient - blood spots too small
  • Insufficient - Inappropriate application of blood e.g. not soaked through, applied both sides or multi-spotted.
  • Compression of sample
  • Contamination of sample (e.g. with faeces).
 

TIPS:

You can ask for the baby to be held in a different position to make it easier for you to take a good quality sample.
Prick the heel and wait for the blood to flow.

Fill each circle on the card with a single drop of blood - check the blood has soaked through to the back of the card.

Take your time - If the baby is not bleeding it may be necessary to prick the heel again. Do not squeeze.
 

3. Problems arising after sample collection:

  • Sample contamination (e.g. with faeces)
  • Water damage
  • Arrival in laboratory >14 days after collection
  • Analytical problem / Unsatisfactory analysis.
 

TIP: Samples sent by courier arrive in the lab more quickly.

 

Resources

 

Unavoidable repeats

Occasionally, we will contact the midwife and ask for a repeat sample for one of the following reasons. In these cases, the original sample was collected correctly, but the results for one or more of the tests was borderline or inconclusive.

  • Slightly raised TSH result - Repeat should be collected 7 -10 days after the initial sample.
  • Inconclusive CF screen - Repeat should be collected between 21 - 24 days of age.
 

Other factors known to affect the reliability of the screening tests

  • Thalassaemia trait is not excluded.
  • The Sickle Cell Screen is only valid if baby not transfused.
  • IRT is not always abnormal in CF patients with meconium ileus; therefore the screening result may be falsely normal.
  • IRT is an unreliable indicator of CF in babies >8 weeks of age. Therefore the test will not be performed in samples collected in this age group.
  • Some babies with MCADD, MSUD or IVA may become symptomatic in the first few days of life, before the screening test has been carried out. In this case the clinician looking after the baby should send clinical samples to their usual diagnostic laboratory. 
  • CHT screening tests for raised TSH only; therefore if hypothyroidism occurs secondary to pituitary disease, the screening result may be falsely normal.
  • Newborn bloodspot screening is only offered to babies up to 1 year of age. In older babies, other tests are available to doctors through clinical pathways for babies/children with suggestive symptoms.

This list is not exhaustive and it is important to remember that these tests are screening tests; no screening test is 100% reliable. Further information about the limitations of newborn screening tests can be found in the following laboratory handbooks:

 

Updated 23/04/2020

Contact Newborn Screening

Newborn Screening Laboratory (Bristol)
PO Box 407
Bristol
BS9 0EA

Email: newbornscreening@nbt.nhs.uk
Telephone: 0117 414 8412
 

Opening times: 9am - 5pm Monday - Friday excluding bank holidays.

Clinical advice & interpretation is available during working hours.

Access the NHS Blood Spot Screening Programme Centre

Repeat Samples & Limitations of Testing

Blood Spot Sampling & Transport

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Reviewed on 20/10/21

Labelling the blood spot card

Points to remember:

  • It is ESSENTIAL that the blood spot card is completed correctly with all the details of the baby whose blood is collected (including the NHS number). Samples received without an NHS number will not be processed.
  • These details must be filled in BEFORE the heel prick is carried out, to make sure there is no chance of a mix-up.
  • If there is an indication that any incorrect information may have been provided on a bloodspot card, you must inform the laboratory immediately.
  • Do not assume that printed labels in the baby's child health record are accurate, it is important to check the details each time you use them.
  • There is no need to indicate whether the baby is breastfeeding or bottle-feeding.

Information for parents

The NHS Newborn Blood Spot Test website includes information about each condition, FAQ's and links to further information.

The Screening Tests for You and Your Baby leaflet contains information about the blood spot screening test and the conditions it screens for. It is available in other languages.

Find out what happens to your baby's blood spot card.

Collecting the sample

A full guideline and quick reference guide are available here.

e-Learning for Healthcare has developed an e-learning module to support midwives and other sample takes in obtaining good quality newborn blood spot samples: https://www.e-lfh.org.uk/programmes/nhs-screening-programmes/

 

 of an acceptable quality sample, with correctly completed details. 

Transportation

The blood spots should be allowed to air-dry thoroughly, away from direct sunlight before placing in the transparent paper (Glassine) envelope provided (not plastic as this may cause the specimen to 'sweat') and sent, by first class post or courier on the day of collection, in a sturdy envelope.  If not possible, despatch within 24 hours of taking the sample. Despatch should not be delayed in order to batch cards together for postage.

Contact Newborn Screening

Newborn Screening Laboratory (Bristol)
PO Box 407
Bristol
BS9 0EA

Email: newbornscreening@nbt.nhs.uk
Telephone: 0117 414 8412
 

Opening times: 9am - 5pm Monday - Friday excluding bank holidays.

Clinical advice & interpretation is available during working hours.

Access the NHS Blood Spot Screening Programme Centre

Blood Spot Sampling & Transport

Introduction to Pain Management

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We normally invite patients to attend the Introduction to Pain Management Meeting at Southmead or Cossham hospital. This would be a group meeting,  to provide you with enough information to make an informed choice about how to proceed with your Pain Management referral.


We are currently unable to offer groups because of the Covid-19 restrictions, so we have made this presentation available online. We would encourage you to listen to this in your own time and then contact us if you wish to proceed with your Pain Management referral by email or phone:


Email: painmanagementcentre@nbt.nhs.uk
Telephone: 0117 4147357


We will then be able to offer you an assessment appointment, at a mutually convenient time. At present, because of the Covid-19 restrictions we are offering telephone assessments.

Pain management information video 

 

Contact Pain Management Service

For all appointment enquiries, please contact:

Pain Management
Gloucester House
Southmead Hospital
Telephone: 0117 414 7357
email: painmanagementcentre@nbt.nhs.uk

Please note that we are not a crisis service and we may not be able to answer your call but you are more than welcome to leave us a voice message and we will get back to you within 2-3 working days. 

If you need urgent medical support or advice you will need to contact your GP, or phone 111 or 999

If you feel you need emotional support urgently, please contact your GP, or phone 111.

If you wish to speak to to the Pain Clinic, please visit the Pain Clinic page

Pain Management

Mindfulness 1

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This page contains all of the course materials you need to support you once you have attended Session One of the North Bristol NHS Trust Mindfulness course. Each week of the course has it's own page where  you will find the specific practice recordings for that week plus some additional written and sometimes video information. This course has been adapted for people who are living with fatigue and pain, and we are grateful for the time and care which our patients have offered to improve this course.

Course materials

Session 1 recordings to practice at home:

15 minute body scan: https://soundcloud.com/fiona-mckechnie108681984/15-min-body-scan-fiona-wright/s-OcfX3

30 minute body scan: https://soundcloud.com/fiona-mckechnie108681984/half-hour-body-scan-fiona-wright/s-1NJPz

Workbooks and handouts

You can click on the links to download the written materials which support the course. We have made each one available as a Word document or a pdf as we know that some people prefer one or another. The Word document is likely to be more useful if you want to write comments on your own copy and store them on your own computer.

Workbooks outline the practice and other activities for the week and have the option of recording and reflecting on what you are learning (you will need to use this one).

Handouts explain more about the background theory (this one is optional).

Mindfulness

Pain Management Helpful Resources

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We have added several resources in sections below. Just click on each section and it will open up to show the different resources.

Understanding pain & self-management

Information for participants of pain management programmes: what are they? What do they cover? How to get on one? https://www.britishpainsociety.org/static/uploads/resources/files/book_pmp2013_participant.pdf 


Pain Concern provides information and support for pain sufferers, those who care for them and about them, free factsheets and leaflets to help you manage your pain. www.painconcern.org.uk


VIDEO: Understanding Pain in less than 5 minutes, and what to do about it! https://www.youtube.com/watch?v=C_3phB93rvI

VIDEO: Pain and Me: Tamar Pincus talks about chronic pain, acceptance and commitment. https://www.youtube.com/watch?v=ZUXPqphwp2U
 

VIDEO: Tame the beast: It’s time to rethink persistent pain. https://www.tamethebeast.org/#tame-the-beast

Free self-management courses providing tools and techniques to help you to take control of your health and manage your condition better on a daily basis. The majority of the courses are delivered by trained tutors who have experience of living with a long-term health condition. selfmanagementuk.org

Arthritis

Versus Arthritis: Two major UK arthritis charities have now joined forces to offer information on current research, treatments, developments, news and opportunities to get involved. https://www.versusarthritis.org/

Back Pain

BackCare is a registered charity that aims to reduce the burden of back pain by providing information and support, promoting good practice and funding research. The charity acts as the hub between patients, (healthcare) professionals, employers, policy makers, researchers and all others with an interest in back pain. www.backcare.org.uk


VIDEO: ‘Back pain – separating fact from fiction’. https://youtu.be/dlSQLUE4brQ

Employment and pain management

The Equality Act aims to prevent employers from discriminating on the grounds of long-term ill health or disability and to make reasonable adjustments to support people in work. https://www.equalityhumanrights.com/en/equality-act-2010/what-equality-act

Access to Work provides advice to employees and employers, assessing for equipment, environmental adaptations and support.
If you require additional advice with your employer you can contact:
• the Advisory, Conciliation and Arbitration Service ACAS on 0300 123 1100
• your trade union, if you are a member.

If you need support in getting  a job, you can find information here: https://www.gov.uk/looking-for-work-if-disabled

 

Fibromyalgia

Fibromyalgia Association UK is a registered charity administered by unpaid volunteers. FMA UK was established in order to provide information and support to sufferers and their families. In addition, the Association provides medical information for professionals and operates a national helpline. www.fibromyalgia-associationuk.org


VIDEO from the BBC: Fibromyalgia: 'Like red hot lava radiating through my body': https://www.bbc.co.uk/news/topics/c2qlz4pepkmt/fibromyalgia

Therapeutic activity and exercise

Many activities and exercise forms can support the longer-term wellbeing of people living with pain.

The Taoist Tai Chi Society of GB is a registered charity that teaches tai chi to the community to help people improve their health and wellbeing: www.taoist.org/uk


The University of the Third Age (U3A) are self-help, self-managed lifelong learning co-operatives for older people no longer in full time work, providing opportunities for their members to share learning experiences in a wide range of interest groups and to pursue learning not for qualifications, but for fun: www.u3a.org.uk


A Bristol-based Index of social groups and clubs in Bristol listed by interest group: https://www.bristolindex.co.uk/community/clubs.asp

Mindfulness-based approaches

Mindfulness based or informed approaches have become well known in the management of pain and other symptoms.

 
“Mindfulness means  ‘awareness’, yet surely when any of us are suffering from searing physical pain… we seem to be too aware of our suffering .

How on earth can learning to become even more aware possibly help?” (Mark Williams' foreword to Mindfulness for Health by Vidyamala Burch and Danny Penman).


The awareness we are cultivating in mindfulness is wise and kind.  We find this enables people to have increased awareness of how subtle processes of mind can turn up the volume on pain.  This body-mind approach sees the individual  as possessing the  resources they need to manage their health  and mindfulness supports the recognition and cultivation of these resources.


There are some links below to more information and practices you may wish to try. Please be aware that the increased awareness developed by these practices is not always easy and most people need support in using them to gain the most benefit.  The pain management service can support you in learning mindfulness as part of your self-management. 
The Frantic World the website of the finding peace and living well with health and illness: http://franticworld.com/   (Danny Penman, Mark Williams and Vidyamal Burch)

Some free mindfulness downloads: http://www.freemindfulness.org/download

https://www.mindful.org/meditation/mindfulness-getting-started/

The UK listing has qualified and accredited practitioners: https://www.ukmindfulnessnetwork.co.uk/uk-listing/
 

Self-help books

This list of books have been suggested by our patients and clinicians. There are many books available, and we have selected a few that we think are well-written and helpful. However, we also know that some people prefer different styles of writing and different approaches.
We have written a summary of each book to give you an idea of the content.
You should be able to request these books from your local library.

Overcoming chronic pain: A self help guide by using cognitive behavioural techniques by Frances Cole, Helen Macdonald, Catherine Carus, Hazel Howden – Leach.
Practical ways to improve sleep, relaxation, relationships, fitness and pacing of activities.

Manage your pain by Michael Nicholas, Alan Molloy, Lois Tonkin and Lee Beeston.
Easy to dip in and out of. All-round coverage of Pain Management methods, including an ordered approach to a pain management programme.

Coping Successfully with pain by Neville Shone.
Personal description of his chronic pain experiences including using the methods from a pain management programme to improve his life. A fairly easy read.

Living with fibromyalgia by Christine Craggs-Hilton 
An easy read with practical tips written in a caring way. Gives sensitive tips on how to cope physically, mentally and emotionally.

Painful Yarns by Lorimer Moseley.

Explains what message pain is sending you about your body. Practical stories explaining pain mechanisms in simple terms.

Fibromyalgia: Understanding and getting relief from pain that won’t go away. By Don L Goldenberg. 
Has a personal perspective. Works through some complex material in an easy to understand way. Does use some jargon.

Manage your mind by Gillian Butler and Tony Hope.
Self-help for low mood an anxiety. Several tools to try. Practical approaches to help solve common difficulties.

Living Well with Pain and Illness: The Mindful Way to Free Yourself from Suffering by Vidyamala Burch.
An inspiring and practical book. Good for anyone wishing to begin meditating and practicing mindfulness. Contains practical exercises.

The Mindful Way through Depression by Mark Williams, Jon Teasdale, Jon Kabat Zinn and Zindel Segal.
Free of Jargon. Offers everyday coping mechanisms that are easy to introduce.