When will I be seen by the Community Midwifery Team?

When you come home from hospital with your baby a midwife will visit you the next day to assess and plan your postnatal care.

We are unable to give you a time as we do not know how many visits we will have or where they are. If you have not been seen by a midwife by 3pm please call the Hospital where you birthed and they will contact a Midwife for you. 

Your next appointment is usually day three - four to weight the baby and then on day five - seven to perform the neonatal screening test if you have consented to this procedure.

These appointments are held in a clinic and will be performed by a Maternity Care Assistant. You will be asked to come to a local clinic if you and your baby are well.

Your discharge appointment with the midwife will be between days ten - 14 and ideally at your own Health Centre. Along with yourself and your baby, please bring your maternity notes (yellow book) and your baby’s Child Health Record red book to every appointment.

If for any medical reason you cannot attend the clinics please speak to a member of the midwifery team.

Your plan of care

1st visit - Midwife usually from your team.

Day three - four - Maternity Care Assistant from your team to weigh baby.

Day five - eight - Maternity Care Assistant from your team to perform the neonatal screening test with your consent.

Day ten - 14 - Midwife discharge appointment ideally at the place where you have been seeing your Midwife antenatally with a member from your team.

If you have any baby weighing issues or breastfeeding problems we may ask you to attend a clinic or breastfeeding support group between 9am and 5pm Monday to Friday. On a Saturday and Sunday some GP surgeries are closed so we may ask you to come to Southmead Hospital or Cossham Birth Centre.

For more information on health visiting visit www.sirona-cic.org.uk

If you are not going to be at home for us to visit you please phone the ward you have been discharged from or phone the number on your red sticker.

Do I need a postnatal GP appointment?

You will need to make an appointment with your GP for a check-up for you and your baby at six-eight weeks following the birth. In the event of some complications, you or your baby may also have a follow-up appointment with a doctor at the maternity unit; this will be sent to you in the post.

You will also need to register your baby as a patient with your GP practice. To do this you will need to have your baby’s NHS number which is issued following the birth and can be found in your baby’s Child Health Record red book.

We are developing our EIA service in line with NICE and BSR guidelines and around our patients’ needs. 

All referrals are triaged by the consultants and we aim to see suspected early inflammatory arthritis cases within 3 weeks from receipt of referral.  Referrals should be submitted with a completed proforma. 

Please refer patients with suspected persistent joint inflammation of 4 weeks or more AND any one of the following:

1. Swelling of 3 or more joints
2. Swelling of the small joints of hands or feet
3. Positive MCPJ or MTPJ “Squeeze test” (i.e. pain produced by squeezing across the metacarpophalangeal/etatarsophalangeal joints)
4. Early morning joint stiffness (EMS) >30mins

Please note the diagnosis of Early Inflammatory Arthritis is not excluded by normal inflammatory markers and / or a negative rheumatoid factor and/or normal Xrays.

We aim to make a diagnosis and start disease-modifying drugs within 6 weeks from time of referral or discharge patients back if not EIA.

People diagnosed with EIA have regular clinical reviews by the multidisciplinary team for education, self-management, monitoring of disease activity, therapeutic benefit and treatment safety.

Referrals will only be accepted with a completed Referral pathway to the Early Inflammatory Arthritis Service (EIA Service) - 3 week wait attached to the eReferral.

Patients not meeting these criteria should be referred to general rheumatology clinics.

Please refrain from using steroids until the patient has been seen in clinic as this makes assessment very difficult.

2017 course dates

There are five main levels of adverse events to be aware of when running any research study at North Bristol NHS Trust.

• Adverse Events (AEs) are any unfavourable and unintended signs, including abnormal laboratory results, symptoms or a disease associated with treatment. These must always be recorded on a Case Report Form (CRF) and in the patient's medical notes unless the protocol states otherwise.
• Adverse Reactions (ARs) are adverse events but causally related to investigational medicinal products.
• Serious Adverse Events (SAEs) are defined as any untoward medical occurrence(s) that at any dose results in death, hospitalisation or prolongation of existing hospitalisation, persistent or significant disability/incapacity or a congenital anomaly or birth defect. These events must be reported immediately to the sponsor. 
• Suspected Serious Adverse reactions (SSARs) are any ARs considered consistent with information available about an Investigational medicinal Product (IMP). They must be reviewed at regular intervals to see if the profile of any IMP has changed and a record made of this.
• Suspected Unexpected Serious Adverse Reactions (SUSARs) are any events suspected to be caused by an IMP, but which are not consistent with information about the IMP (these are the most serious of events and are subject to expedited reporting procedures).

When a clinical study involves emergency treatment or incapacitated participants, it is possible to gain consent where:

• A participant meets the emergency conditions and is obviously in a life-threatening position
• Nothing further can be accomplished with currently available treatment.
• There is a fair possibility that the life-threatening risk to the participant can be avoided if the investigational device or medicinal product is used.
• Anticipated benefits outweigh the risks of using the investigational device or clinical trial of an investigational medicinal product (ctIMP).
• If a legal representative cannot be easily reached and informed.

Once the participant has regained consciousness, or as soon as they are able to understand, the research team should explain the study to the participant and allow them time to consider whether they wish to continue within it. This process must be clearly documented in the participant’s medical notes.

Everyone involved in research is responsible for knowing and following the law and principles of good practice relating to ethics, science, information, health and safety and finance.

All those involved in research also have a duty to ensure that they and those they manage are appropriately qualified, both by education and experience, for the role they play in relation to any research. They must be aware of, and have ready access to, sources of information and support in undertaking that role.

All information regarding the laws and principles of good research practice can be found in the UK Policy Framework for Health & Social Care.

Chief Investigators (CI) & Principal Investigators (PI)

Researchers & Research Nurses

NHS Trusts & Healthcare Providers

The Sponsor

This is an operation for achalasia of the cardia, a condition in which the muscle in the lower oesophagus fails to relax and therefore hinders the passage of food and fluid into the stomach. Treatment with Botox injections or balloon dilatation of the affected part of the oesophagus can be attempted but are often short-lived and surgery is frequently required as a more lasting solution.

Under general anaesthesia, 5 small keyhole incisions are made on the abdomen and laparoscopic instruments are introduced. The lower oesophagus is approached and a lengthwise cut is made in the muscle layer of the lower oesophagus. Care is taken to cut only the muscle layer, leaving the inner lining of the oesophagus intact. As this procedure is often complicated by acid reflux after the operation, a partial or complete fundoplication is also performed at the same time to minimise this.

Intake of food should become more comfortable soon after surgery and a near-normal diet can be maintained.

The spleen is part of the blood filtering process and is involved in both production and destruction of certain types of blood cells. Removal of the spleen is sometimes necessary for certain blood disorders involving red blood cells or platelets, intrinsic problems of the spleen, traumatic injury or if the spleen is enlarged from infective/inflammatory processes.

Splenectomy is often done laparoscopically but may sometimes have to be performed as an open operation. The size of the spleen can be an important factor in this decision which can be made either before the operation or during the procedure. In the laparoscopic approach, you are put under general anaesthesia and 3-4 small cuts on the tummy are used to introduce instruments into the abdomen and release the spleen from its attachments before removing it from the body.

As the spleen is important in fighting infection, not having a spleen might affect immunity and predispose you to certain bacterial infections. To help prevent this, vaccinations are provided a few weeks prior to the operation. Some patients may also need to be on a lifelong prescription of antibiotics following the procedure.

Laparoscopic fundoplication is a keyhole procedure performed for patients with severe acid reflux, Barrett’s oesophagus and symptomatic hiatus hernias that no longer respond to medication. It is done to prevent acid from the stomach travelling the wrong way into the oesophagus. The operation is predominantly laparoscopic although very occasionally, conversion to open surgery may be necessary.

The procedure involves narrowing the defect through which the oesophagus passes into the stomach (called the hiatus) as well as wrapping the upper part of the stomach around the lower oesophagus (the wrap) to recreate the valve at the lower end of the oesophagus. The wrap itself may be complete or partial depending on the circumstances. The operation takes about 1.5 to 2 hours and is carried out under general anaesthesia.

Overnight hospital stay is to be expected, although some patients can go home on the same day. There are restrictions to food intake for the first few weeks after the operation. Sloppy and pureed food is advised for 6 weeks following the operation. Bread and meat are likely to cause the most trouble and are to be avoided. Dietary advice will be provided before you go home. Anti acid medication can be stopped immediately after the procedure.

Laparoscopic bile duct exploration is usually performed at the same time as a laparoscopic cholecystectomy in a certain group of patients. The bile duct is a hollow tube running from the liver to the small bowel and provides a passage for the flow of bile. Stones slipping out of the gall bladder and into the bile duct can cause obstruction and jaundice – a yellowing of the skin and eyes as well as acute pancreatitis. Stones within the bile duct may be detected by investigations performed before the operation or alternatively, with an ultrasound scan performed as part of a laparoscopic cholecystectomy.

The aim of the operation is to remove stones lodged in the common bile duct by making a small cut and passing a camera up and down the duct to visualise the stones before removing them. The opening in the duct is then closed using sutures. A drainage tube is left inside the abdomen at the end of the operation.

As with all laparoscopic procedures, there is a chance this may need to be converted to an open procedure,I if there are technical problems or scar tissue makes the operation difficult.

This operation requires overnight hospital stay for monitoring. Most patients go home the next day although occasionally there can be a small leakage of bile in the drain which settles in a few days. The recovery period is usually the same as that for a cholecystectomy.

An alternative to bile duct exploration is ERCP (Endoscopic retrograde cholangiopancreatography).This is not an operation but involves passing a camera through the mouth and into the small intestine to remove the stones. Sometimes a small cut is made in the muscle of the bile duct to allow the stones to pass, or a plastic tube (stent) is left in place to allow the bile to flow freely. You will be sedated for this, but not fully asleep, and can usually go home on the same day.