See our recommendation on arranging supplier visits on How AAC WEST work with independent professionals, suppliers and charities
Mounting and switches
Accessibility settings on mainstream devices can be changed and may support someone to use direct touch.
Styluses are available from a number of suppliers including these:
Developing eye gaze skills
These resources are designed for people who will use the alphabet to spell messages to support their communication.
For the alphabet charts you need to convert to PDF before printing. This will make sure background colours print correctly. (How to: Once editing done 'Save as' and change the file type to PDF OR Print and select 'Print to PDF'. Open the PDF and then print).
These documents are for you to download, edit, and print. Remember to save as PDF before printing.
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These documents are for you to download, edit, and print. Remember to save as PDF before printing.
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For other alphabet charts you can explore the Ace Centre Resources:
These documents are for you to download, edit, and print.
| Name | Information | Preview | Resource |
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| Simple scanning communication chart | A simple communication chart for users to scan and respond yes or no to various options. | 
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| Pragmatic PAS chart (adapted) | This chart is adapted from the work of Linda J Burkhart and from the version available on Ace Centre. The communication chart is designed to be read aloud by the communication partner. When the person who is using the chart to communicate hears the option they want to communicate, they indicate “yes” in some way. Try and read aloud the options in a neutral voice. When an option is selected, you could repeat the word or phrase selected in a livelier voice. You will see examples of this in the videos below. Begin by personalising the vocabulary on the chart. You will find it easier if you keep to the structure provided, but anything can be changed. Consider laminating the chart, ideally using a matt laminate pouch. Or you could print the chart on tearproof/waterproof paper or use card. The chart references a spelling chart. You can download a wide range of alphabet charts from Ace Centre. You can view videos of communication books based around similar principles as this chart being used on the Ace Centre’s YouTube page Ace Centre - YouTube. | 
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PAS Chart (5 categories).docx29.56 KB
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These resources are for supporting people with aphasia to use AAC within a total communication approach with communication partner support.
Here is some information about what to do for some common issues with AAC devices.
Please only contact AAC WEST about devices that we are responsible for.
Our contact details are at the bottom of this page.
Contact AAC WEST Tech Team (see details at the bottom of the page).
Contact AAC WEST Tech Team (see details at the bottom of the page).
Check your device for the company name. Suppliers can support with a range of issues. If you give them consent they can have remote access to your device to provide support.
Please contact us if the above do not resolve your device issue.
For admin, appointments, and referral queries.
For hardware issues like faulty batteries, broken screens, missing equipment, and frozen iPads.
Support for software issues like missing grid sets/cells, Dropbox/account issues, and connectivity.
© North Bristol NHS Trust. This edition published October 2025. Review due October 2028. NBT003817.
The laboratory provides a comprehensive service in the investigation of Leukaemia and Non-Hodgkin Lymphoma. Immunophenotyping provides additional information to morphology and cytogenetics in the diagnosis, classification and monitoring of these disorders.
HIV Monitoring
Immunophenotyping is used serially to monitor CD4 levels.
Investigation of Cellular Immunodeficiency Disease
Wrong choice of tests, especially in the paediatric setting, can mean rare cases of immunodeficiency are missed. Vital information includes type and site of infections, family history, other pathology results, X-rays and clinical features. Please refer to the Clinical Immunologists: ward or clinic referral is the ideal.
These assays are technically complex and require prior discussion with the laboratory. Abnormalities are rare, most commonly due to poor sample quality, testing during drug therapy or intercurrent infection. Abnormal findings should always be confirmed on a second sample. True abnormalities may need further, more specialised tests to specify the disorder.
The QuantiFERON-TB test is an interferon gamma release assay (IGRA) used for the diagnosis of latent Tuberculosis (TB). The assay requires special blood tubes and has specific sample handling requirements. The laboratory can issue guidance and sample tubes to requestors. Interpretation of the result needs to be in the context of clinical history and other laboratory and clinical investigations. The antigens used in the test are absent from all BCG vaccine strains of TB and from most known non-tuberculoid mycobacteria, it is possible to have a reactions to M. kansasii, M. szulgai and M. marinarum. If such infections are suspected, alternative testing should be sought.
The QuantiFERON-TB test (and other TB IGRAs) may give false negative results in immunosuppressed patients. The laboratory provides a positive control tube for all tests to ensure the validity of results. Where the positive control fails (indeterminate result) the laboratory may suggest alternative testing. Please see guide below for interpreting indeterminate results.
Guide to interpretation
• Negative: A negative result indicates that latent infection with M. tuberculosis is NOT likely. This result does NOT exclude active TB infection. The investigation of suspected active TB requires clinical, radiological and microbiological assessment.
• Positive: A positive result is consistent with latent or active TB. This result may be due to exposure to M.tuberculosis complex (except M. bovis BCG), M. kansasii, M. szulgai or M. marinarum. IGRA should not be used for the investigation of suspected active TB. The investigation of suspected active TB requires clinical, radiological, and microbiological assessment.
• Indeterminate: The likelihood of the patient having M. tuberculosis infection cannot be determined from the blood sample provided. Please see the guide to interpreting indeterminate results below.
An indeterminate result from the QuantiFERON-TB assay means that the likelihood of the patient having M. tuberculosis infection cannot be determined from the blood sample provided.
The majority of indeterminate results are caused by a low T lymphocyte response to mitogen stimulation (reported as mitogen tube failure).
This can be caused by:
• An insufficient number of T lymphocytes in the blood sample. Is the patient immunosuppressed?
• A functional inability of the patient’s lymphocytes to generate Interferon-gamma (IFN-γ) in response to mitogenic stimulation, for example if they are taking drugs that supress their immune system.
• Reduced lymphocyte function due to improper sample handling.
Ideally repeat the QuantiFERON-TB test once with a fresh blood sample. If a mitogen tube failure is reported a second time, there is no value in repeating the QuantiFERON-TB test again until the underlying cause has been identified and resolved.
Rarely a high background in the negative control (Nil) tube generates an indeterminate result.
This can be caused by:
• Excessive levels of circulating IFN-γ or the presence of heterophile antibodies in the sample. Stimulating the cells further as part of the QuantiFERON-TB test does not produce a further IFN-γ response.
Ideally repeat the QuantiFERON-TB test once with a fresh blood sample. If a high background is reported a second time, there is no value in repeating the QuantiFERON-TB test again until the underlying cause has been identified and resolved.
Other causes of indeterminate results can include:
• Incorrect filling/mixing of the Lithium Heparin or QuantiFERON-TB tubes.
• If the time between venepuncture and sample incubation in the laboratory is greater than 16 hours.
These indeterminate samples should be repeated using the correct sampling and handling procedures.
For further information please see:
An equivocal reference range of 0.2 – 0.7 IU/mL is now applied to the Q-TB results generated when subtracting the negative control tube value (NIL) from the TB1 and TB2 tube results: TB1-NIL and TB2-NIL.
Where both TB1-NIL and TB2-NIL results are within the equivocal range (0.2 – 0.7), or where one result is equivocal (0.2 – 0.7) and one is true negative (<0.2) the Q-TB results will be reported as EQUIVOCAL with the following interpretation applied:
The significance of this result is uncertain. The risk of progression to active TB disease is likely to be different when compared to patients with clear positive (>0.7) or clear negative (<0.2) results. Suggest repeat testing if clinically indicated; approximately one third of patients with equivocal results will revert to either a clear positive or clear negative result when a fresh blood sample is analysed within six months. We would recommend repeat testing again in 4-8 weeks where practical. Where this is not practical, we would recommend a repeat test in weeks rather than days.
Why have we implemented an equivocal reference range?
Reversion and conversion of low positive (TB-NIL: 0.35 – 0.7) and high negative (TB-NIL: 0.2 – 0.34) Q-TB results on repeat testing is a well-recognised phenomenon. To address this issue, multiple European centres have proposed an equivocal range of 0.2 – 0.7 IU/mL [1-7]; conversion to true positive results have been shown to occur most frequently when the first Q-TB result is between 0.2 – 0.35 IU/mL, and reversions to a true negative result have been shown to occur more frequently when the initial result is between 0.35 – 0.7 IU/mL [5].
The Royal Free hospital in London has implemented this equivocal range in line with other low-incidence TB European settings [6]. Data from the Royal Free lends support to the use of the equivocal range for the reporting of Q-TB results; ~1/5th of their results that fell just below the 0.35 cut-off were positive when repeated on a fresh blood sample, and half of those just above the 0.35 threshold were negative when repeated on a fresh blood sample. This data strongly implies that relying on results within the equivocal range could result in either over-treatment or under-treatment of patients.
Includes details of sample types, volumes, special precautions, turnaround times & reference ranges.
North Bristol NHS Trust (NBT) has introduced supported self-management and remote monitoring. This is done using a website called My Medical Record (MMR). This can be used to manage your follow-up care securely.
Regular follow-up appointments can involve organising travel and time off work, which can be costly and inconvenient. Although some people find these appointments useful and reassuring, some find them unnecessary unless they have something specific to discuss.
If individuals report symptoms and concerns as they occur, rather than waiting for a routine appointment, this can help address concerns more quickly.
Following breast cancer treatment, you will be followed up for a period of time (usually 5 years) when you can contact your Breast Care Team directly if you have any queries or concerns.
The main aim is to enable you to develop the skills and knowledge to:
Depending on the type of treatment you have had, you may have a plan of regular mammograms or other imaging.
At NBT we use MMR to provide you with your monitoring plan, test results, and useful resources.
You can use it to message your cancer support team securely with non-urgent queries.
After finishing treatment, a Breast Clinical Nurse Specialist will discuss your monitoring plan and how self-supported management works.
Once introduced to MMR, you will be offered access to the website. You can access the website from your smart phone, tablet, or computer at any time.
Here is a short film about MMR:
After watching this video, if you would like to use MMR, you will be provided with login details. You can also choose not to use MMR, your monitoring will continue with routine telephone appointments.
Imaging appointments will be arranged by the Radiology Administrative Team.
You will receive an appointment to attend the hospital typically 1 year from when you had your surgery, and yearly afterwards for the monitoring period.
Your mammograms will be carried out by the Radiology department at the Breast Care Centre during your period of follow-up.
MMR will show when future tests are due.
Information resources including websites, leaflets and videos are available on MMR. These cover topics such as:
If there is no answer, please leave a message and we will get back to you as soon as possible. We will aim to get back to you within 48 hours.
© North Bristol NHS Trust. This edition published February 2026. Review due February 2029. NBT003691
If you have been offered an appointment with us, it is because your local speech and language therapist has referred you.
This video will tell you what to expect from your AAC WEST assessment.
Your appointment may take place at your home, your school/college, your day centre/hospice/care setting or at one of our outpatient service buildings.
Your appointments will usually last around 2 hours but may take longer. We will offer you regular breaks and can split the assessment over two appointments if needed.
There may be lots of people at your appointment, please let us know if there is any way we can make it more comfortable for you.
In this appointment we may:
In this appointment we may:
Sometimes we can combine the initial assessment and the equipment provision appointment.
In this appointment we may:
Some people will just need one review – this will be their ‘final review’. See below.
We will discuss similar points as above under ‘Review’.
If we are able to loan AAC long term, we will:
If we are not able to loan AAC long term:
Emergency appointments are for people whose condition is getting worse quickly, like Motor Neurone Disease (MND). They need to be seen urgently.
AAC WEST schedules on average two emergency assessments a month, and they are scheduled for people who meet the following criteria:
Referrals for emergency appointments are made by the local speech and language therapist. After this a series of 3 appointments will be made:
Emergency appointments are usually done by an AAC WEST occupational therapist and assistant practitioner.
In this appointment we may:
© North Bristol NHS Trust. This edition published December 2026. Review due December 2029. NBT003829.
This page will tell you about Exclusive Enteral Nutrition (EEN). It will answer some questions you may have about it.
Crohn’s disease can affect any part of your gut. It causes inflammation, ulcers, swelling and soreness on the lining of your gut.
When symptoms are under control, it is known as remission. When symptoms are more active, it’s called a flare-up.
Crohn's disease is a lifelong illness. It currently has no known cure. However, medications, surgery, or a mix of the two can help you stay well.
It is a liquid only diet. The aim is to put your Crohn’s into remission or to reduce your symptoms. The diet is followed for a short time of 6-8 weeks.
It replaces all food and most drinks with prescribed drinks. These drinks will provide all you need to stay healthy. These drinks come in a range of flavours. Your dietitian will tell you how many drinks you need.
We don’t fully know how it works. One idea is that it helps the gut ‘rest’. Some studies have shown it works for 45-75% of patients.
Sometimes you will need to follow it if you have a narrowing in your gut called a stricture. Your doctor will tell you if you have this.
| Name of Nutrition drink(s) | Number of drinks per day |
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| E.g. Fortisip | 6 |
Contact your dietitian if you can’t finish all your drinks.
The treatment goal includes:
We can use The Harvey-Bradshaw Index to see if the diet is working.
This table is at the back of the sheet for you to fill out. Please fill it out before, during, and after your diet.
If you have an appointment with a dietitian, please take this completed with you.
After following EEN for a minimum of 6 weeks, you can slowly reintroduce food over 5 days. This is an example based on a total based on total 2400kcal.
There is no specific diet you need to follow when your Crohn’s is in remission. No diet has been proven to help keep you in remission. Also, no foods can cause flare-ups. Some foods may trigger symptoms, but they can’t cause a flare-up. If that happens, use the food and symptom diary at the back of this booklet. It may help you spot trigger foods when you are in remission.
Always talk to your GP, IBD team, or dietitian before making major changes to your diet.
Please fill out this form on day 1 of starting the EEN diet. It is useful to bring this completed if you are due to see a Dietitian. If you are unsure what each section means, please speak to your clinician.
| Week | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 |
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| Your general wellbeing (for previous day) 0 = very well 1 = slightly below par 2 = poor 3 = very poor 4 = terrible | ||||||||
| Abdominal pain (for previous day) 0 = none 1 = mild 2 = moderate 3 = severe | ||||||||
| Number of liquid stools per day (for previous day) Score 1 per movement | ||||||||
| Abdominal mass 0 = none 1 = dubious 2 = definite 3 = definite and tender | ||||||||
Complications (score 1 per item)
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| Total: Remission: less than 5 Mild disease: 5-7 Moderate disease: 8-16 Severe disease: more than 16 |
Use this template for any day of the week.
| Day: | Food | Symptoms | Time of day and how long symptoms lasted |
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| Breakfast | |||
| Mid-morning snack | |||
| Lunch | |||
| Mid-afternoon snack | |||
| Dinner | |||
| Notes |
© North Bristol NHS Trust. This edition published February 2026. Review due February 2029. NBT003821