• Check that your posture is returning to normal, from stooped to upright.
• Check that your shoulder movements are returning to pre-op’ range of motion.
• Recover the tone and strength in your tummy muscles.
• Abdominal muscle strength helps to keep your back healthy.
• Tummy muscles can be ‘switched off’ by pain.

Good Posture – Stand Tall
Imagine a piece of string Is attached to the crown of your head and is lifting you up.

Good Posture – Sit tall, avoid slumping or overstretching

Shoulder Movements

• Sideways and up
• Forwards and up  
• Behind your neck
• Behind your back
• Across to your  opposite shoulder

1. Switch on Your Tummy Muscles

• Lie on your back, hands on tummy, knees bent, feet resting on floor, legs hip width apart.
• ‘Long’ neck and back but keep the natural curve in your low back.
• Breathe in slowly and deeply.
• Breathing out, let your tummy button sink towards your spine without flattening or changing the position of your low back.
• Gently tighten your muscles below your tummy button, hold the tension for five seconds and continue breathing.
• Aim for 5-10 of these contractions several times a day.
• Concentrate on contracting the muscles below your belly button during each breath out.

2. Tummy Toning Exercises

• Lie on your back, knees bent, feet on floor, arms by your side.
•  Tighten your tummy muscles as in exercise1.
•  Press the small of your back against the floor.
•  Hold the position for 5 seconds, let go.

3. Heel slide

• Lie on the floor with knees bent, arms by your sides.
• Hold your tummy in, as in exercise 1.
• Keep one leg stationary.
• Slowly slide the opposite leg out until it’s straight with the floor.
• Slide it back in to the starting position.
• Alternate, extending the other leg out and then back. 
• Keep the natural curve of your spine without flattening your back.
• Contracting your abdominal muscles helps to keep your pelvis still whilst your leg moves and your lower tummy muscles work.
• This helps train your tummy muscles to support your spine.

4. Single leg extension

• Lie on the floor with knees bent and arms at your sides.
• Tighten your tummy in as in exercise 1.
• Raise one leg to ‘table top’ position (knees bent in line with hip, shin parallel to the floor).
• Slowly stretch the lifted leg out without arching your back.
• Return your leg to table top position.
• Bring your foot back down to the starting position.
• Switch sides.
• Progress with this until you can extend the leg out and hover it about 2-3 inches above the floor
• Work up to five repetitions on each side without stopping.
• Build to 20 "hovering" repetitions or more on each side without allowing your back or spine to move.

5. Heel Taps

• Lie on the floor, tighten your tummy muscles as in exercise 1. and bring your legs up one at a time to ‘table top’ position 
  (knees bent and over hips, shins parallel to floor).
• Keep one leg stationary, slowly lower other foot down to the floor (keeping knee bent) and back up to table top.
• Keep your low back and spine still throughout.
• Repeat on the opposite side.

6. Knee Rolling

• On your back, knees bent, feet on the floor.
• Roll your knees down to on one side, followed by your pelvis, keep your shoulders on the floor if possible.
• Take a deep breath in and out to stretch, return to the starting point.
• Alternate 8 to 10 times.  

7. Bridging

• Lie flat on the floor, hands resting by your sides. Feet flat on the floor, shoulder width apart, knees bent.
• Contract your abdominals, low back, glutes and slowly lift from tailbone up to form a straight line from your knees, through your hips to your shoulders.
• Hold this position for a few seconds, then slowly lower. The whole cycle of lift, hold and lower  takes at least ten seconds.

8. Stretch

• Lie on the floor face down. Put your hands at your sides at shoulder level.
• Keep your back relaxed hips on the floor, push shoulders up, to rest on your forearms.
• Exhale when you reach the top, let your mid back sag as you exhale.
• Slowly lower yourself to the starting position.
• Push only to the point of tension, maintain your hips on the floor.
• Don’t push into pain, bounce, or force the movement.
• You should have a gentle curve in your back as you push up,
• No severe curvatures in one location.

These exercises have been developed in partnership with Keeping Abreast. 

The ReMemBr Group is made up of a diverse group of researchers and clinicians.

Dr Elizabeth Coulthard, Consultant Senior Lecturer in Dementia Neurology

Dr Margaret Newson, Clinical Neuropsychologist and Dementia Research Neuropsychologist

Elena Bellavia, Research Administrator

Dr Hilary Archer, Academic Clinical Lecturer in Dementia Neurology

Ms Hanna Isotalus, PhD Student

Ms Louise Gethin, Research Nurse

Ms Natalie Rosewell, Research Nurse

Dr Gary Christopher, Senior Lecturer in Cognition and Ageing

Dr Marta Swirski, PhD, Postdoctoral Research Associate

Dr James Selwood, Clinical Research Fellow

Saba Meky, Research Assistant, Assistant Psychologist

Memories of Memory: Investigating how functional cognitive disorder affects personal judgements of memory and visual ability

We all make judgements about how good or bad our memory is. Some people may misjudge their memory - experiencing memory symptoms despite doing well on memory tests.  ​

This may be due to a condition called Functional Cognitive Disorder.

We are investigating how personal judgements of memory are affected by different conditions.

Who can take part?

We are looking for:

• people with a diagnosis of Functional Cognitive Disorder (also called Functional Memory Disorder)
• adults without memory problems.

What does the study involve?

The study involves pen and paper and computer tests of memory and vision, and questionnaires.
If you wish to take part in the study, please contact us
Telephone: 0117 414 8238
Email: research.volunteer@nbt.nhs.uk

Severn Major Trauma Network Policies 

Major Paediatric Trauma Radiology Guidance

Link to major Paediatric Trauma Radiology Guidance on the Royal College of Radiologists website (opens in same window) 

National Major Trauma Rehabilitation Guidelines

National Major Trauma Rehabilitation Guidelines on the Centre for Trauma Sciences website (opens in same window) 

Trauma triage tool launch 2025

Accessing Trauma Service

Quality Indicators for Major Trauma (T-Quins)

Severn Network Raptriation Policy - Jan 2023

Severn Trauma Adult Guideline (STAG) Manual 2022 

 

Content list of STAG Manual 2022

Severn Major Trauma Network 

• About Severn Major Trauma Network
• Major Trauma Automatic Acceptance Policy
• Mass Casualty and Major Incident
• Network Repatriation 

 

Pre-Hospital 

• Inter-Hospital Transfer of Major Trauma Patients
• Pre-Hospital Blood
• Pre-Hospital Handover
• Registration of Patients with Uncertain Details

 

The Emergency Department 

• The Trauma Team
• Emergency Department and Critical Care Drug Bags
• Death and Breaking Bad News in the Emergency Department

 

Airway and Anaesthesia

• Emergency Anaesthesia for Major Trauma
• Emergency Surgical Airway
• Oral and Maxillofacial Injuries

 

Thoracic Injuries

• Chest Injuries in Major Trauma
• Management of Fractured Ribs and Flail Chest
• Management of Cardiac Injuries
• Overview of Chest Drain Insertion and Management
• Resuscitative Thoracotomy
• Traumatic Cardiac Arrest

 

Major Haemorrhage & Vascular Injuries 

• Major Haemorrhage
• TXA Use in Trauma Patients
• Traumatic Vascular Injury

 

Traumatic Brain Injury & Spinal Injury 

• Traumatic Brain Injury
• Spinal Injury

 

Abdomen & Pelvis

• Assessment and Management of Major Abdominal Trauma
• AAST Organ Injury Grades
• Pelvic and Acetabular Fracture Management

 

Extremities

• Open Fractures
• Compartment Syndrome
• Tertiary Survey

 

Radiology

• Whole Body CT Imaging Protocol
• Interventional Radiology
• Southmead Radiology Department

 

Rehabilitation

• Specialist Dietetic Management and Nutritional Support
• Amputee Referral Pathway
• Referral Guidelines To Rehabilitation Services

Imaging plays an important role in the diagnosis of soft tissue sarcomas. 

Ultrasound:

• Identify the lesion
• Solid or Cystic
• Well circumscribed or irregular
• Uniform echogenicity or heterogeneous Size
• Superficial or deep to the fascia

MRI:

• Location, adjacent anatomy – vessels, muscle and bone involvement
• Size
• Tissue type

MRI Protocol Axial T1, Axial PDFS, Coronal T1, Coronal STIR (Sagittal T1, Sagittal STIR – depended on location.)

For patients who have under gone an excision of a lesion and have obtained a diagnosis of sarcoma as an addition we perform pre and post sequence with gadolinium. (Axial T1FS Pre and Post).

Ultrasound screening of soft tissue masses in the trunk and extremity

Ultrasound screening of soft tissue masses in the trunk and extremity (This document is located on REMEDY  BNSSG referral pathways and Joint Formulary).

SWAG region lipomatous tumour Pathway This document is located on REMEDY BNSSG referral pathways and Joint Formulary).

To contact the Enhanced Recovery team telephone 0117 4143610 or 0117 4143611.

Dawn Gane

 

 

 

 

 

 

 

 

 

Jodie Rogers

 

 

 

 

 

 

 

 

 

 

Engela Otto

 

 

 

 

 

 

 

 

 

 

 

The aim of Breast Reconstruction Enhanced Recovery Surgery is to get you back to full health as quickly as possible after your operation. There may be circumstances where the programme will not be appropriate for some patients and if this is the case, you will be fully informed.

Research indicates that after surgery your recovery will be quicker with fewer complications the earlier we get you out of bed, exercising, eating and drinking. In order to achieve this we need to work together to enhance your recovery.

Before surgery

The specialist breast care nurse will have already discussed appropriate lifestyle behaviour. It is important that you understand what you need to do in order to ensure you are fit and safely prepared for surgery. It is important to keep as active as you can before your operation. The nurse will discuss diet and exercise with you and returning to normal activities.

 

You will be given a choice of special nourishing supplement drinks called ‘fortijuce’ and ‘fortisip’, in a variety of flavours. These are nutritional supplements containing protein (to aid healing) and vitamins (to support your immune system). Regardless of your weight or appetite, you will be given some of these drinks to take home with you. Take them at the time discussed.

As you are likely to be in hospital for 4-5 days, it is important that you remember to bring a few things in with you, or get a family member to bring them in for you. Things you will need:-

• Night wear with buttons down the front
• Slippers/dressing gown
• Sports bra/support bra
• Support pants [Large enough to cover abdominal scar]
• Toiletries [Including dry shampoo]
• Comfortable clothes to wear in the ward and home
• IPod, MP3 magazines and books

Support/Sports bra will be fitted once your breast drains have been removed, you need to wear it for 4-6 weeks following surgery. After Diep surgery, whilst in hospital you will need to try and wear support [spanks] pants to help support your abdomen and reduce some of the abdominal swelling, for at least 4 weeks.

 

If you were told to take Preop drinks, take them at the time discussed. These drinks are a clear liquid ‘breakfast’ to ensure your body has fuel to work with whilst you are not eating. If you are diabetic we will not give you these as they can cause your blood sugars to rise.

Once you arrive for surgery

Upon arrival, a member of the surgical team looking after you will check that you are fully aware of your surgery.

In order to help prevent blood clots you will be required to wear special support stockings (TEDS). The nurse will need to measure your legs to obtain the correct size.

After your surgery

You will return to the ward after your operation. You will need to stay in bed for the first 24 hours positioned with your knees bent/flexed to help your abdomen relax. For the first 24-72 hours you will be closely monitored to ensure that your new breast[s] is healing and that you are recovering from the anaesthetic.

Following this progression chart will help improve your recovery. The nurses on the ward will assist you or if you have any questions.

Day of Surgery, after your operation	Day 1 after your operation	Day 2 after your operation	Day 3 after your operation	Day 4 after your operation	Day 5 after your operation
Drink freely as tolerated	Eat and drink freely as tolerated	Eat and drink as tolerated	Eat and drink normally	Eat and drink normally	You will only be in hospital if your drains have not yet been removed
Drink Fortijuce/Fortisip	Drink 3 Fortisip/ Fortijuce	Drink 3 Fortisip/ Fortijuce	Drink 3 Fortisip/ Fortijuce	Drink 3 Fortisip/ Fortijuce	Eat and drink normally
Eat a light diet as tolerated as otherwise advised	You can sit up, between 45 and 60 degrees – a nurse will help you with this after you have seen your doctor	Try to get dressed into your day clothes	Get dressed into your day clothes	Get dressed into your day clothes	Drink 3 Fortisip/Fortijuce
Remain on bed rest	Start breathing exercises (the nurse & Physio will advise you)	Aim to sit out and mobilise as soon as you have seen your doctor – the nursing staff can help you	Mobilise normally – aim for 4 walks a day Maintain a slightly stooped position	Mobilise normally – aim for 4 walks a day Maintain a slightly stooped position	Continue to mobilise
		Continue breathing exercises	Ask for laxatives if your bowels have not opened	Ask for laxatives if your bowels have not opened	Practice stairs with physio
		have you opened your bowels? if not inform your nurse	Fitting of a sports bra	Ensure you are wearing your sports bra
		Start planning for discharge home	Plan for going home tomorrow	Discharge home today of your drains are out

You should try and be as mobile as you can once you are home. You will find that you will also need to take regular rests at intervals which may mean you have to go back to bed for a couple of hours each day. This surgery can be very tiring for the first couple of weeks and then improve slowly. The Physiotherapist will give you exercises to do once your are home, it is important to continue with the advice given to ensure you recover quickly and with full movement. We advise
no heavy lifting, washing clothes etc. for at least three to four weeks after surgery. This allows all wounds and scars to heal without any added stress to the area.

For further information:

• www.nhs.uk/conditions/enhanced-recovery

The aim of Urology Enhanced Recovery Surgery is to get you back to full health as quickly as possible after your operation.

Research indicates that after surgery your recovery will be quicker with fewer complcations the earlier we get you out of bed, exercising, eating and drinking. In order to achieve this we need to work together to enhance your recovery.

Before surgery

It is important to keep as active as you can before your operation and if you are a smoker you should stop now. Stopping smoking helps reduce breathing problems after surgery. You can see your GP or pharmacist for advice to help you stop smoking.

Outpatients

Before you come into hospital for your surgery, your Consultant will see you in the outpatients department to explain your operation. Following this you will be sent a date to attend the pre-operative assessment clinic, where we will carry out routine tests to ensure you are fit and safely prepared for surgery. All patients are routinely screened for potential infections at this time.

Pre-operative assessment clinic

The specialist Enhanced Recovery Nurse will see you at the pre-operative assessment clinic and will explain the programme to you.                 

You will be given a choice of special nourishing supplement drinks called ‘fortijuce’ and ‘fortisip’, in a variety of flavours. These are nutrional supplements containing protein (to aid healing) and vitamins (to support your immune system). Regardless of your weight or appetite, you will be given some of these drinks to take home with you. Take them at the time discussed.

You will be provided with written information and given the opportunity to ask questions. If you have concerns about your appetite or diet before coming in for your operation please speak to the nurses at your pre-assessment visit.
If required, you will be referred to the anaesthetist and pharmacist.

If you were told to take Preop drinks, take them at the time discussed. These drinks are a clear liquid ‘breakfast’ to ensure your body has fuel to work with whilst you are not eating. If you are diabetic we will not give you these as they can cause your blood sugars to rise.

After your surgery

Mobilizing and exercising
Following your surgery, when you wake up, it is important that you do deep breathing exercises (as prevention against chest infection). You will need to do 5 deep breathing exercises every hour as follows:

• Start in a comfortable position, ideally sitting upright in the bed or chair with your shoulders relaxed.
• Take a long, slow deep breath in, as much as possible. Hold this breath for 3 seconds.
• Slowly breath out.
• Take 3 more deep breaths in the same way. Then return to breathing normally.

For further information:

• www.nhs.uk/conditions/enhanced-recovery

The aim of Vascular Enhanced Recovery Surgery is to get you back to full health as quickly as possible after your operation.

Research indicates that after surgery your recovery will be quicker with fewer complcations the earlier we get you out of bed, exercising, eating and drinking. In order to achieve this we need to work together to enhance your recovery.

Before surgery

It is important to keep as active as you can before your operation and if you are a smoker you should stop now. Stopping smoking helps reduce breathing problems after surgery. You can see your GP or pharmacist for advice to help you stop smoking.

Outpatients

Before you come into hospital for your surgery, your Consultant will see you in the outpatients department to explain your operation. Following this you will be sent a date to attend the pre-operative assessment clinic, where we will carry out routine tests to ensure you are fit and safely prepared for surgery. All patients are routinely screened for potential infections at this time.

Pre-operative assessment clinic

The specialist Enhanced Recovery Nurse will see you at the pre-operative assessment clinic and will explain the programme to you.                 

What you eat is important, as good nutrition now will help you recover faster from your operation.

You will be given a choice of special nourishing supplement drinks called ‘fortijuce’ and ‘fortisip’, in a variety of flavours. These are nutrional supplements containing protein (to aid healing) and vitamins (to support your immune system ). Regardless of your weight or appetite, you will be given some of these drinks to take home with you. Take them at the time discussed.

You will be provided with written information and given the opportunity to ask questions. If you have concerns about your appetite or diet before coming in for your operation please speak to the nurses at your pre-assessment visit.
If required, you will be referred to the anaesthetist and pharmacist.

If you were told to take Preop drinks, take them at the time discussed. These drinks are a clear liquid ‘breakfast’ to ensure your body has fuel to work with whilst you are not eating. If you are diabetic we will not give you these as they can cause your blood sugars to rise.

After your surgery

Mobilizing and exercising
Following your surgery, when you wake up, it is important that you do deep breathing exercises (as prevention against chest infection). You will need to do 5 deep breathing exercises every hour as follows:

• Start in a comfortable position, ideally sitting upright in the bed or chair with your shoulders relaxed.
• Take a long, slow deep breath in, as much as possible. Hold this breath for 3 seconds.
• Slowly breath out.
• Take 3 more deep breaths in the same way. Then return to breathing normally.

 

For further information:

• Vascular network
• www.nhs.uk/conditions/enhanced-recovery
• www.vascularsociety.org.uk