How to manage your diabetes when unwell

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If you are under the care of NBT diabetes team and become unwell for any reason, it is important that you follow the ‘sick day rules’. 

TREND UK: Type 1 diabetes: what to do when you are ill

TREND UK: Type 2 diabetes: what to do when you are ill 

What should I do if I take an SGLT2-inhibitor  - Forxiga (dapagliflozin), Invokana (canagliflozin), Jardiance (empagliflozin), Steglatro (ertugliflozin)?

If you are still unsure how to manage your diabetes despite looking at the above links, then please do not hesitate to contact the Southmead Diabetes Team on 0117 414 6427 for advice. We are extremely busy at the current time but will get back to you as soon as possible.

If you are not under the care of NBT diabetes please contact your GP or usual care provider

Endometriosis Information for Clinicians

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Information for clinicians 

There are 6 specialist endometriosis clinics per month. Our endometriosis specialist nurse also runs a separate clinic twice a month.

Referral criteria

Inclusion criteria:
• Women with diagnosis of severe endometriosis (defined as endometriosis affecting bowel, bladder, ureter)
• Endometrioma
• Extra pelvic endometriosis e.g. thoracic endometriosis
• Non severe endometriosis refractory to treatment

Exclusion criteria:
• Women with pelvic pain and no endometriosis
• Non-severe endometriosis responding to treatment

Patient pathway

 

 

Useful guidelines

NICE guideline [NG73] Endometriosis: diagnosis and management September 2017

ESHRE guideline Management of women with endometriosis September 2013

What happens at our clinic?

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What happens at our clinic?

On arrival you will be asked to complete a symptom questionnaire.

You will then see a member of the team to discuss these symptoms. You may be asked specific questions about your periods and sex life. The consultation will cover previous investigations and treatments you may have tried, and the effect of your symptoms on your day-to-day life.

Your gynaecologist may ask to examine your abdomen and pelvic area (this involves an internal examination), with the support of a nurse chaperone. There is always privacy to undress and dress. An ultrasound may be recommended; this is often completed transvaginally, via a thin probe inserted into the vagina.

The effect of endometriosis varies hugely between women. Individualised recommendations will then be discussed with you including the risks and benefits of each approach. You will have the opportunity to ask questions.

Below are examples of possible plans of care. One or more may take place in sequence or in parallel.

Investigations

Further investigations may be suggested. This could include blood tests, vaginal swabs to look for infection, biopsies from the womb lining or an MRI (Magnetic Resonance Imaging) scan. More specialist tests may be necessary involving the bladder (e.g. cystoscopy) and/or bowel (e.g. sigmoidoscopy), meaning additional appointments having to be arranged.

Medical Treatments

Medical treatments for endometriosis may be offered. This can involve taking extra hormones or treatments that result in lower hormone levels.

Surgical Treatments

Surgical investigation and treatment may be offered.

Mild to moderate endometriosis can sometimes be treated if discovered at the time of surgery.

Surgery for moderate and severe endometriosis may require a longer operation time, additional surgical support and different pre operative planning, in which case the endometriosis is often treated at a second procedure. This usually involves an overnight stay on our Cotswold ward.

Multi-Disciplinary Meeting (MDM)

When factors make endometriosis surgery complex or high risk, we discuss cases at our Endometriosis MDM. This is a full review of your history, examination findings and the results of any investigations (or previous surgery) with the whole team. We use this to ensure we are recommending the best plan of care and to discuss surgery if proposed.

This meeting also helps us review and guide improvements to our service.

How can I prepare for my appointment?

Some women find it helpful to bring a family member, friend or partner along with them for support. You may find it useful to write down your symptoms or any questions you may have beforehand and take your notes along to the appointment with you.

Endometriosis information for patients

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About endometriosis

Endometriosis is a chronic inflammatory condition driven by the hormones oestrogen and progesterone.

In women with endometriosis, cells similar to those of the womb lining (the endometrium) are found in other parts of the body, most commonly in the pelvis (e.g. on the lining of the wall of the pelvis, in the ovaries, fallopian tubes, bladder, bowel or ligaments supporting the womb). 

These cells undergo cyclical changes (related to the menstrual cycle), where patches of endometriosis thicken and shed but with no way for them to leave the body. This causes inflammation and scar tissue to form, which can lead to pain and discomfort.

Endometriosis is not an infection and it is not contagious. Endometriosis is not cancer.

How common is endometriosis?

Endometriosis affects as many as one in ten women of reproductive age, many of whom will have no symptoms. This is an estimated two million women in the UK. It can affect women from every social group and ethnicity.

What are the symptoms?

• Pelvic pain which is cyclical (related to the menstrual cycle) or non-cyclical (unrelated)
• Excessive pain before/during/after periods
• Pain during sex
• Fertility problems
• Persistent tiredness
• Pain when urinating
• Abnormal bleeding
• Pain with bowel movements

Endometriosis can vary in severity. Some women experience few or no symptoms; other women suffer with many effects. It can affect many aspects of a woman’s life including her general physical health, emotional wellbeing and daily routine.

Types of endometriosis

There are three types of endometriosis:

1. Ovarian endometriosis: This causes ovarian cysts called endometrioma. The cyst is filled with old blood and because of the colour, the cysts are often referred to as ‘chocolate cysts’.

2. Deep endometriosis: The nodules of endometriosis implant at least 5mm below the peritoneum. Structures affected can include the uterosacral ligaments (ligaments supporting the womb), bowel, bladder and ureters.

3. Superficial peritoneal endometriosis: The lesions involve the peritoneum, which is a thin film that cloaks the inner surfaces of the pelvis. The lesions are flat and shallow and do not invade into the spaces underlying the peritoneum.

Some patients have more than one type of disease present in their pelvis.

How is endometriosis diagnosed?

Endometriosis can be diagnosed by having a diagnostic laparoscopy (key hole surgery). This involves passing a thin telescope through a small cut in your umbilicus (navel). It is connected to a video camera and television so that the inside of the pelvis can be examined. This procedure requires a general anaesthetic.

Some types of endometriosis can be diagnosed through ultrasound or other imaging such as an MRI scan.

How is endometriosis treated?

Endometriosis is treated by medical or surgical methods.

Medical therapies include:

1. Painkillers (paracetamol, ibuprofen)
2. Hormones such as the oral conceptive pill, Depo-Provera ™ injection, Nexplanon™ implant and Mirena™ coil or types that cause a temporary and false menopause state (Zoladex™)

Surgery involves removing the deposits. This is mostly completed laparoscopically

ReMemBr Group Research

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Our main branches of research concern:

  • predicting who will develop memory problems such as Mild Cognitive Impairment and Alzheimer's Disease;
  • treating memory problems and neurodegenerative diseases;
  • understanding how different types of memories are stored, and which brain regions underlie this.

We use several techniques for this including:

  • clinical trials and drug studies
  • sleep studies, including polysomnography
  • Magnetic Resonance Imaging (MRI)
  • studies with patients with diseases
  • computational modelling

For more information on the University of Bristol Dementia Research Group visit
www.bristol.ac.uk/translational-health-sciences/research/neurosciences/…

 

Dr Ankur Srivastava - Gastroenterology & Hepatology

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GMC number: 6145675

Dr Ankur Srivastava

Year of first qualification: 2006, University of Bristol

Specialty: Gastroenterology, Hepatology, Endoscopy

Clinical interest: Hepatology, General Gastroenterology including Functional and Inflammatory Bowel Disease, Endoscopy

Secretary: Joanne Hartry

Tel: 0117 4146499

Dr Ankur Srivastava graduated from the University of Bristol in 2006 and completed his specialist training in London. He participated in doctoral (PhD) studies at the University College London, with whom he maintains an affiliation, and the Royal Free liver transplant unit with a focus on earlier detection of chronic liver disease.

Dr Srivastava is a GMC registered gastroenterologist and hepatologist with interests in inflammatory bowel disease, liver transplant medicine and advanced hepatology. Dr Srivastava returned to Bristol as a consultant in 2018. He is a general gastroenterologist, hepatologist and endoscopist working in a large multi-disciplinary team. He has a sub-specialist interest in non-alcoholic fatty liver disease (NAFLD) and alcoholic liver disease. He is a member of the BASL NAFLD special interest group (SIG). The department has developed close links with Kings College London liver transplant unit with the majority of pre- and post- transplant care conducted in North Bristol.

Dr Srivastava is leading the trusts accreditation in the Royal College of Physicians ‘Improving Quality in Liver Services” process. This is a national quality improvement project to document and improve all aspects of patient care including leadership and operational delivery, clinical effectiveness and involving patients in service development. He has also helped develop a rapid access clinic for patients suffering significant flares of their inflammatory bowel disease.

Dr Srivastava is the research lead for Gastroenterology at the trust with an expanding and diverse research portfolio. Dr Srivastava is principle investigator at the trust for a commercial drug trial for patients with NAFLD. He is sub-investigator for a number of trials in inflammatory bowel disease, liver disease and endoscopy and has published over 5 peer reviewed journal articles in the past few years.

Srivastava

SNAHPer Resources

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Suitable for all members of the SNAHPer Group, here you will find links to useful training and software that may aid you in your role.

SNAHPer logo

Please note, our software suggestions are not supported by NBT, and should not be loaded onto NBT computers. They are recommended for personal use only. Software provided by your Higher Education Institution (HEI) should also be used if you have access to it.

External Training Opportunities

NIHR Applied Research Collaboration West offers a range of training opportunities over the year including:

  • Writing for a lay audience.
  • How to win at Twitter.
  • Introduction to service evaluation.
  • Basic statistics and interpretation.

You can apply for this via the ARC West website. This site also has links to short training courses that local universities offer.

Free Online Training

Open University – Succeeding at postgraduate study

Open University – Postgraduate study skills in science, technology or mathematics

AcoRD – Attributing the costs of health and social care Research and Development

Future Learn – Online courses covering a range of topics

Researcher Academy – Access to countless e-learning resources designed to support researchers on every step of their research journey  

Students 4 Best Evidence (S4BE) – A growing network of students from around the world, from school age to university, who are interested in learning more about evidence-based health care (EBH) 

Speechbite – Rating research quality (offers a concise training tool to start you thinking about undertaking quality appraisal of papers)

Free Software

Endnote Reference Management

PSPP – A free, open source version of SPSS

Computer Assisted Qualitative Data Analysis Software (CAQDAS) – A list of open source options

Open Office  A free, full office suite including Word Processing, Spreadsheet and Presentation programmes.

Rayyan – A leading provider of collaboration and research tools that power the global research community in pursuit of accelerated scientific discovery

JASP An open-source statistics program that is free, friendly, and flexible. Designed to be easy to use, and familiar to users of SPSS.

JANE (Journal/Author Name Estimator) – Comparison tool to find the best matching journals, authors or articles on PubMed.

View Our Research

Doctor conducting research at NBT

Explore the ground-breaking research currently taking place at North Bristol NHS Trust.

About Research & Development

NBT Researcher

Find out more about our research and how we're working to improve patient care.

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

SNAHPer Workshops

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SNAHPer offer regular support sessions, providing opportunities for its members to discuss any number of topics they may need advice on.

SNAHPer logo

Peer support sessions are held fortnightly in the Café area of Vu (Brunel Building), where Senior Research Associate Dr Sam Harding and other SNAHPer’s will be available to discuss the likes of project ideas, signposting different routes to career development, and how to disseminate any work that’s already been undertaken.

In addition, the group runs a series of workshops to introduce its members to different research methods and skills. Development of these sessions will be dependent on the engagement from SNAHPers and their identification of need.

Research Workshops are in ongoing development and will be available to book as they confirmed via LINK.

Library Workshops

In addition to the workshops directly organised by R&I SNAHPers, a series of workshops co-led by the Library, Audit and Quality Improvement departments will also be made available to group members. Geared at staff who may be new to areas of investigation, these sessions aim to help move ‘Ideas into practice: Navigating your way into improved patient care’. 

These workshops are currently being reformatted. Please get in touch with the Library Team via southmead.library@nbt.nhs.uk if you have any requests about what you would like to have featured in these workshops.

View Our Research

Doctor conducting research at NBT

Explore the ground-breaking research currently taking place at North Bristol NHS Trust.

About Research & Development

NBT Researcher

Find out more about our research and how we're working to improve patient care.

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