Before your surgery at North Bristol Trust, you need to complete an online health questionnaire. 

Please go to Synopsis Home to complete your questionnaire. 

You can ask a family member or friend to help you if you have trouble accessing the internet. If you cannot complete the questionnaire at home, you should come to the pre-operative clinic 15 minutes before your appointment time so you can complete it there.

What you need ready before you start:

• Your height and weight.
• Any dates for previous operations (if applicable).
• A list of your current medications (if applicable).
• Your NHS number or hospital number.

When you have answered all the questions, click the share button.

When sharing with the hospital, you will need to: 

• Begin to type North Bristol NHS Trust in the Hospital Box.
• You will need your North Bristol Hospital number which is usually at the top of your appointment letter.
• When you have completed the form please click the green agree and share button. 

Here are some things you can do to help prepare yourself for your operation. For further information visit:

Fitter Better Sooner – general information | The Royal College of Anaesthetists (rcoa.ac.uk)

• Stop smoking: This reduces the risk of breathing problems and makes anaesthetic safer.
• Have paracetamol and ibuprofen ready at home: For pain relief when you are discharged (if you are able to take them).
• Lose weight if you are overweight: This reduces many of the risks of having an anaesthetic and surgery.
• Speak to your dentist: If you have any loose teeth or crowns, treatment from your dentist may reduce the risks of damage to your teeth from equipment used during anaesthesia.
• Speak to us: If you are pregnant or breastfeeding so we can make an appropriate plan for your surgery.
• Speak to your GP: If you have any long-standing medical problems such as diabetes, asthma or bronchitis, thyroid problems, heart problems, or high blood pressure (hypertension) you should ask your GP if you need a check-up, and bring any test results with you.
• Know your regular medications: You will be advised what medication to continue and what to stop before you come into hospital. You must bring a complete, up to date list of your medication with you to all hospital appointments and on admission (a printed prescription or letter from your GP).

If you feel unwell (including fever, productive cough, diarrhoea, vomiting, or a skin infection over the proposed site of surgery) during the 72 hours before you are due to come into hospital, please phone us on 0117 414 0637. 

We may phone you in the week before your surgery to check that you still want to have your operation on the planned date and that there have been no changes in your general health since your preoperative assessment.

• A warm dressing gown and slippers with a non-slip sole.
• Day clothes and underwear.
• A list of any medications you are currently taking.
• Please bring all your belongings in a bag which is no bigger than 40cm high by 25cm wide and 85cm deep, so that it will fit in a patient locker whilst you are having your operation.

Valuables

You are strongly advised not to bring valuables into the hospital.

The Trust can offer limited safe keeping of valuables until arrangements can be made for them to be taken home or until they are returned to you on discharge. A written record will be made of the items to be held in storage and then the items will be stored in a sealed security bag and put into a locked unit. The valuables can be accessed during your stay only in an emergency.

We cannot accept responsibility or liability for cash, valuables or personal property brought into the premises unless they are handed in for safe keeping under circumstances as specified within Trust policy.

What is MRSA?

MRSA is a common bacteria which has developed resistance to methicillin (a type of penicillin), and some other antibiotics that are used to treat infections. 

MRSA is carried harmlessly on the skin and in the noses of many people, without causing an infection. However in hospital, particularly in patients undergoing invasive procedures, it can cause serious infections and can spread easily from one person to another by touch, via hands. Screening for MRSA

Who is screened for MRSA?

• Patients who are going to have certain procedures.
• Other high risk patients including those previously found to have MRSA. 

Swabs are taken from several areas of the body including the nose, any wounds, and urine if a catheter is in place. 

This will not hurt and takes only a few minutes. If you are coming into hospital for an operation this will be done before your operation or procedure.

• If you are found to be carrying MRSA you will be contacted and given treatment.
• If MRSA is not found you will not be contacted.

Treatment 

Treatment is an antibacterial liquid soap for washing skin and hair, and an ointment for application inside the nose.

This treatment can be done at home.

It must be started 5 full days before admission. If your surgery is delayed you will be contacted with further advice.

If you develop an MRSA infection whilst you are in hospital, you may be given antibiotics through an intravenous line (drip).

You can help yourself and other patients:

• Always wash and dry your hands after visiting the toilet, and before you eat.
• Don’t touch your wound or any device that is in your arm, leg, bladder, or body cavity (e.g. a drip, drain or catheter).
• Don’t expose your wound to show your visitors.
• Keep the space around your bed tidy and uncluttered so that the cleaning staff can clean all surfaces easily.
• Tell your nurse if you notice any unclean or dusty areas.
• Shower/wash daily if you can.
• Ask your visitors not to come in large groups, or visit if you are unwell.
• Ask visitors not to sit on your bed or use the patient toilets. n Do not share your possessions or equipment with other patients unless they are cleaned between uses.
• Remind staff about hand washing and drying if they forget – they won’t be offended.

For most patients and hospital staff MRSA poses no threat to their health.

Do

• Do have a bath or shower. This will clean your clean your skin and reduce the risk of infection.
• Do wash your hair. If you are having an operation on your head or neck.
• Do remove nail varnish.
• Do remove jewellery. If you cannot remove your jewellery, it will be covered with tape to prevent damage to the jewellery or to your skin.
• Do wear warm clothing.
• Do take your medications. Unless you have been advised otherwise, and bring your medications with you in their original labelled containers.
• Do leave plenty of time to get to your appointment.

Don't 

• Don’t smoke. This will help avoid breathing problems during your anaesthetic.
• Don’t shave anywhere near the site of surgery.
• Don’t wear make-up or body lotions. This makes sure any heart monitor pads, and dressings can stick to your skin.

Nothing to eat or drink (fasting/‘nil by mouth’). 

It is important you follow these instructions because if there is food or liquid in your stomach during your anaesthetic it could come up to the back of your throat and damage your lungs.

At the appropriate time you will be taken into a mediroom to prepare for surgery:

• You will change into a hospital gown (and your own dressing gown) and a pair of elastic stockings (TEDS). You will be asked to remove any contact lenses. You can keep your pants on as long as they won’t get in the way of the operation.
• Anaesthetists are doctors with specialist training who assess your health and are responsible for giving your anaesthetic and maintaining your safety throughout your surgery.
• You may be visited by the anaesthetist and surgeon to confirm your plan for surgery. Nothing will happen to you until you understand and agree. Please ask any questions you have.
• Premedication (‘premed’) are drugs which are given before some anaesthetics to help with pain relief, indigestion, and occasionally relaxation (but only when the benefits of relaxation outweigh the risks of being drowsy after your operation). A needle may be used to start your anaesthetic. If this worries you, please let us know.
• One person is allowed in the mediroom with you before your procedure. We ask that you and your relative/companion are respectful of other patients. The safety and privacy of all our patients is important to us.

When it is time for your operation a member of staff will go with you to the theatre.

• You may be asked to walk to the operating theatre but this will depend on your general health and whether you have had a premedication. If you are walking, you will need your dressing gown and slippers.
• Theatre staff will check your identification bracelet, your name and date of birth and will ask you about other details in your medical records as a final check that you are having the right operation.
• The theatre may look and feel quite different from other hospital departments – more cold and clinical and will be brightly lit. The theatre staff normally wear coloured ‘pyjamas’ and hats (scrubs).
• You will be asked to remove your glasses and dentures. These will be returned to you immediately after your operation.
• The anaesthetist or anaesthetic assistant will then attach machines which measure your heart rate, blood pressure and oxygen levels.

General anaesthetics 

There are two ways of starting a general anaesthetic:

• Anaesthetic drugs are usually injected into a vein through the cannula (tube in your hand).
• Occasionally you can breathe anaesthetic gases and oxygen through a mask, which you may hold if you prefer. 

Once you are unconscious, an anaesthetist stays with you at all times and continues to give you drugs to keep you anaesthetised. As soon as the operation is finished, the drugs will be stopped or reversed so that you wake up.

Regional (spinal, epidural or nerve blocks) and local anaesthetics

A regional anaesthetic or “block” is an injection of local anaesthetic to make part of your body numb. They are a type anaesthesia and pain relief that can be used with, or sometimes instead of, a general anaesthetic. They are used to enhance your recovery by reducing pain and some side effects that can occur with general anaesthesia and other types of pain relief. 

The local anaesthetic is injected very carefully and may be guided by an ultrasound machine or sometimes a nerve stimulator, which you may feel as gentle twitching. Blocks are usually performed with you awake or sedated if you prefer. If you are having a general anaesthetic they may sometimes be performed after you are asleep. The “blocked” area of your body will become warm, heavy and numb and may last several hours – so after surgery you’ll be advised how to protect yourself until normal sensation returns. You’ll also be reminded to take regular painkillers around this time so you remain comfortable when the numbness wears off. 

Regional and local anaesthetic techniques are generally safe and effective although risks may occasionally include an incomplete block, bruising around the injection site, or damage to veins, arteries or nerves. Other serious complications such as seizures or heart problems are rare and your anaesthetic team are trained to deal with these. 

Your anaesthetist will explain everything that is involved in a regional anaesthetic, including how any benefits and risks relate to you and your operation. 

For more information “Nerve Blocks: An Information Video for Patients” can be found at: 
Patient information leaflets and video resources | The Royal College of Anaesthetists (rcoa.ac.uk)

Blood carries oxygen around the body and a lack of red blood cells is called anaemia. In some cases anaemia can be treated with medicines; in others, a blood transfusion may be the best treatment. You can reduce the need for a blood transfusion by eating foods containing iron before your operation.

You may have a blood sample taken in pre-op assessment before your operation to see if you are anaemic. A second sample of blood is required within 7 days of the operation and is often taken on admission.

If you have previously been given a card which states that you need to have blood of a specific type, please show it as soon as possible to your doctor, nurse or midwife and ask them to tell the hospital transfusion laboratory.

Blood transfusion is only needed for a small number of patients during or after surgery. Sometimes it is possible to recycle your own blood during the operation. A blood transfusion is usually given through a tiny tube directly into a vein, and you will be observed before, during, and after.

You do have the right to refuse a blood transfusion, but you need to fully understand the consequences of this. If you have any concerns you should discuss these with your doctor, nurse. or midwife.

• After the operation, you will be taken back to a mediroom. Recovery staff will be with you at all times and will continue to monitor your blood pressure, heart rate and oxygen levels.
• Oxygen will be given through a lightweight clear plastic mask, which covers your mouth and nose. Depending on the operation you have had, you may have a urinary catheter. This is a soft tube put temporarily into the bladder to drain it.
• If you are going home on the same day, once you have had something to drink/eat and are considered “ready for discharge”, you may be taken to a seated recovery area to wait for collection or transport.
• Whilst we make every effort to reunite you with your relative/companion following your procedure the nurses will assess this on an individual basis. Your relatives /companions are welcome to ask at the reception desk about your progress.

Good pain relief is important and some people need more pain relief than others.

If you can breathe deeply and cough easily and you can move around freely after your operation, you are less likely to develop a chest infection or blood clots.

Occasionally, pain is a warning sign that all is not well, so you should ask for help when you feel pain.

Here are some ways of giving pain relief:

• Pills, tablets or liquids to swallow: You will need to be able to eat, drink and not feel sick for these drugs to work. They take at least half an hour to work.
• Injections: These may be given through a needle in your vein or muscle and take up to 30 minutes to work.
• Suppositories: These waxy pellets are put into your back passage (rectum). They are useful if you cannot swallow or if you might vomit.
• Patient controlled analgesia (PCA): This is a method using a machine that allows you to control your pain relief yourself.
• Local anaesthetics and regional blocks.

How you feel afterwards will depend on the procedure and anaesthesia you’ve had - please speak to us if you feel uncomfortable.

Very common (more than 1 in 10)

• Nausea (feeling sick).
• Shivering.
• Thirst.
• Sore throat.
• Bruising.
• Temporary memory loss (mainly in over 60s). 

Common (between 1 in 10 and 1 in 100)

• Pain at the injection site.
• Minor lip or tongue injury.

Uncommon (between 1 in 100 and 1 in 1000)

• Minor nerve injury.

Rare (between 1 in 1000 and 1 in 10,000)

• Permanent peripheral nerve damage (1 in 1000).
• Corneal abrasion (scratch on the eye) (1 in 2800).
• Damage to the teeth that needs treatment (1 in 4500).
• Anaphylaxis/severe allergic reaction (1 in 10,000).

Very rare (between 1 in 10,000 and 10,000 or more) 

• Awareness during anaesthesia (1 in 20,000).
• Loss of vision (1 in 100,000).
• Death as a direct result of anaesthesia (1 in 100,000).

The risks to you will depend on:

• Your age and whether you have any other illness.
• Factors such as smoking or being overweight.
• Surgery which is complicated, long, or done in an emergency. 

For more information about risks visit:

Risk leaflets | The Royal College of Anaesthetists (rcoa.ac.uk)

DVT: Deep Vein Thrombosis

A blood clot that forms in a vein

Pulmonary Embolus

A blood clot that has travelled to the lungs.

Venus Thromboembolism

A term to describe both DVT and PE.

Causes

Sometimes a DVT happens for no apparent reason. Some people inherit or develop an increased risk of DVT. Being unwell and having reduced mobility (for example, when recovering from an operation) can lead to changes in the blood and sluggish blood flow through the leg veins. These events make blood more likely to clot and form a DVT.

The highest risk is associated with major joint operations such as those for joint (hip or knee) replacement or hip fracture, major trauma or major spinal surgery, especially if someone has multiple risk factors for DVT.

Possible symptoms

• Skin warmth.
• Swelling.
• Redness.
• Tenderness.
• Breathing difficulties.
• Chest pain. 

How to reduce the risk

On admission to hospital or at your pre-operative assessment, you will have an assessment of your risk of DVT and any reason not to use preventative treatments. The assessment will decide the recommended preventative measures (known as thromboprophylaxis) to be used in hospital and what is recommended after leaving hospital. 

These may include:

• Avoiding dehydration.
• Getting up and moving early and frequently.
• Use of elastic support (anti-embolic) stockings.
• Injections of heparin (an anticoagulant or “blood thinner”).
• Intermittent compression boots (to gently squeeze the legs) may be recommended.
• Occasionally the use of tablet anticoagulation medication (e.g. warfarin, dabigatran or rivaroxaban).
• Vena Cava Filter (an umbrella shaped device inserted into a large vein to stop blood clots moving towards the lungs).

What happens if a VTE does develop?

An assessment is made by the medical team, and a scan can be done. If the test results are positive, anticoagulation treatment is given to prevent further clot formation and allow the DVT or PE to breakdown.

If you are having an operation and you are taking a drug that thins your blood (e.g. aspirin, warfarin, dabigatran, rivaroxaban, clopidogrel) your healthcare team should assess the risks and benefits of stopping this drug temporarily in the week before your operation with or without different treatment in its place.

For 24 hours after a general anaesthetic

You should:

• Have a responsible adult with you.
• Drink plenty of fluids.
• Take thinks gently including having time off work until you feel fully recovered. 

You should not:

• Make any important legal or financial decisions or sign any such documents.
• Be left alone caring for children.
• Drive.
• Cook, boil a kettle, or operate machinery.
• Drink alcohol or take sleeping tablets. 

If you stay in hospital longer than is necessary you are at far greater risk of losing your independence or developing complications such as infections or DVT. 

• From the day you are admitted to hospital the staff involved in your care will work together with you and your relatives/carers to assess your needs in preparation for leaving hospital.
• On the first day of your stay you will receive an estimated date of discharge (EDD) which may change as your care progresses.
• As part of your treatment it may be necessary for you to move to another ward, sometimes at short notice but you and your relatives/carers will be given as much information as possible.
• Where possible you will be able to vacate your hospital bed by 10am on your day of discharge, but you may need to wait in the hospital discharge lounge until transport arrives.
• Before you leave hospital you will be given a limited supply of any medication that you need and any changes that have been made will be explained to you.
• You will be given a written discharge summary which includes details of your medication and any changes. Please also take a copy of this to your next GP appointment.

Discharge arrangements may include any of the following options

• Returning to where you usually live with no additional support.
• Returning home with either short term or long term support services in place. Please let us know as soon as possible if you already have support services in place.
• Moving to a short term rehabilitation or intermediate care setting as close to your home as possible.
• Moving to alternative housing or care home.

Preparation

When your discharge date is identified you and your relatives/ carers will need to make the necessary arrangements which may include:

• Transport home: Where possible you will be expected to arrange your own transport to arrive by 10am on the day of your discharge.
• Suitable clothing and footwear.
• Access to a key to your property.
• Reinstate any private care arrangements.
• A suitable supply of food, and adequate heating in your home.

Southmead Hospital preadmission unit 0117 414 0637

The Royal College of Anaesthetists 
Churchill House 
35 Red Lion Square 
London 
WC1R 4SG 
Phone: 020 7092 1500 
E-mail: info@rcoa.ac.uk 
Website: Homepage | The Royal College of Anaesthetists (rcoa.ac.uk) 
Patient information and videos available at: For patients | The Royal College of Anaesthetists (rcoa.ac.uk)
The organisation is responsible for keeping up standards in anaesthesia, critical care and pain management throughout the UK.

Association of Anaesthetists of Great Britain and Ireland 
21 Portland Place 
London 
W1B 1PY 
Phone: 020 7631 1650 
E-mail: info@anaesthetists.org 
Website: Home | Association of Anaesthetists
This organisation works to promote the development of anaesthesia and the welfare of anaesthetists and their patients in Great Britain and Ireland.

NHS Constitution. Information on your rights and responsibilities available at: 
NHS Constitution for England - GOV.UK (www.gov.uk)

NHS information on MRSA available at: 
MRSA - NHS (www.nhs.uk)

NICE guidance on venous thromboembolism available at: 
Overview | Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism | Guidance | NICE

1 Information about blood transfusion available at: 
Blood transfusion - NHS (www.nhs.uk)

Researchers assessed whether Delta SARS-CoV-2 infection resulted in worse patient outcomes than Omicron SARS-CoV-2 infection, in hospitalised patients

The study, published in The Lancet Regional Health – Europe, aimed to provide more detailed data on patient outcomes, such as the need for respiratory support.

The research demonstrated that Omicron infection resulted in less serious outcomes than Delta in hospitalised patients. Compared to Delta, Omicron-related SARS-CoV-2 hospitalisations were 58% less likely to need a high level of oxygen support, 67% less likely to need ventilatory support (such as a ventilator) or more critical care, and 16% less likely to have a hospital admission which lasted for more than three days.

Dr Catherine Hyams, Post-Doctoral Clinical Research Fellow, Principal Investigator for the AvonCAP study and one of the study’s lead authors at the University of Bristol, said: "By finding out the reduced requirement of increased oxygen support and total positive pressure support, including non-invasive ventilation, our analysis should contribute to future hospital care and service planning assessments. 

"However, the impact of lower severity Omicron-related hospitalisation must be balanced with increased transmissibility and overall higher numbers of infections with this variant."

The research team suggest there should be ongoing evaluation of the severity of new variants of SARS-CoV-2, along with careful planning of healthcare resource to avoid healthcare systems being overwhelmed.

Dr Leon Danon, Associate Professor in Infectious Disease Modelling and Data Analytics, in the Department of Engineering Mathematics and one of the study's lead authors, added: "These results have been published at a time when China is experiencing a resurgence of COVID-19 and may be useful in helping to understand what is happening there."

This research, published in The Lancet Regional Health – Europe, provides the first estimates of two- or three-dose Pfizer-BioNTech COVID vaccine effectiveness against hospital admission for more than three days and against respiratory difficulty requiring oxygen or ventilatory support.

Many studies have reported the effectiveness of the COVID-19 mRNA vaccines against hospitalisation, but few have assessed the effectiveness against clinically relevant measures of COVID-19 severity. Using detailed clinical data from Bristol’s two acute hospital Trusts, NBT and UHBW, researchers estimate the effectiveness of two- or three-doses of the (original/monovalent) Pfizer-BioNTech vaccine against hospitalisation for infection with either Delta or Omicron SARS-CoV-2 variants.

The study showed that receipt of two-doses of Pfizer-BioNTech vaccine may result in an 83% reduction in the rate of hospitalisation due to Delta SARS-CoV-2 infection, compared to the unvaccinated. Two doses also prevented severe in-hospital outcomes due to Delta SARS-CoV-2 infection, reducing the likelihood of a hospital admission lasting more than three days by 63%.  The researchers also found that two doses of this vaccine reduced the risk of a patient needing increased oxygen or ventilatory support by 52% and 59%, respectively.

Receipt of three-doses of Pfizer-BioNTech vaccine was also found to be effective in reducing Omicron infection severity, compared to the unvaccinated, including in older adults, reducing the risk of hospitalisation for more than three days with Omicron SARS-CoV-2 by 56%, and decreasing the risk of needing high-level oxygen or ventilatory support by 42% and 59%, respectively. This is additional evidence that Pfizer-BioNTech vaccine is effective in reducing hospital admissions due to Delta and Omicron SARS-CoV-2 infection.

Dr Anastasia Chatzilena, Postdoctoral Research Associate in the Department of Engineering Mathematics, and a lead author of the study, said: "Our research has shown the Pfizer-BioNTech vaccine provides effective protection against hospitalisation from Delta and Omicron infection and has significant benefits in terms of preventing severe disease, including critical care admission and respiratory failure.

"However, the benefit provided by vaccination decreases over time which appears to be more pronounced in older adults, so careful ongoing monitoring of vaccine effectiveness and SARS-CoV-2 disease severity for emerging variants remain important."

An increase in the number of non-COVID-19 respiratory infections should be expected this winter, say scientists. The warning comes following the results of a new study, published in The Lancet Regional Health – Europe, which found that over 55% of respiratory disease hospitalisations during the pandemic’s peak were caused by non-SARS-CoV-2 infections.

The study is the first to compare the number of hospitalisations from respiratory disease infections caused by COVID-19 and non-SARS-CoV-2 infections.  

Using data from 135,014 hospitalisations from two large hospitals in Bristol between August 2020 and November 2021, researchers identified 12,557 admissions attributable to acute Lower Respiratory Tract Disease (aLRTD) with patients admitted with signs or symptoms of respiratory infections including cough, fever, pleurisy, or a clinical or radiological aLRTD diagnosis. Of these, 12,248 (98%) patients, comprising mainly older adults, consented to participate in the study.

Following further analysis, the team show that of the 12,248 aLRTD hospitalisations, 55% (6,909) were due to infection with no evidence of SARS-CoV-2, while confirmed SARS-CoV-2 infection only accounted for 26% (3,178) of respiratory infections. The remaining 17% (2,161) were due to infection with no infective cause.

The Generation Study is a national research study that will sequence the genomes of 100,000 newborn babies to test for more than 200 rare and treatable genetic conditions. 

Identifying these conditions shortly after a baby is born, rather than when symptoms might appear later in childhood, means families can receive support, monitoring, and treatment much earlier. Early, effective intervention can help to prevent longer term health problems associated with certain conditions, keeping children out of hospital, and helping them live healthier lives. 

The Generation Study, led by Genomics England in partnership with NHS England, will see parents offered whole genome sequencing using blood samples taken from the umbilical cord shortly after birth.

In Bristol, Southmead Hospital (North Bristol NHS Trust) and St Michael’s Hospital (University Hospitals Bristol and Weston NHS Foundation Trust) are among more than 20 hospitals nationally taking part.

Women planning to give birth at home may also take part in the study. Expectant parents will be informed about the Generation study during pregnancy, and if interested, a research midwife will have a detailed conversation with them to decide if they want to take part. Taking part is voluntary and free. Soon after birth, an NHS doctor, nurse, or midwife will check with parents that they are still happy for their baby to be tested, and a blood sample will be taken and sent to a laboratory for whole genome sequencing.    

Results are then reviewed by NHS genomic scientists. The aim is to share results with parents within 28 days if a condition is suspected, or within a few months if no conditions are suspected. 

If a newborn baby is identified as having a treatable childhood condition through the genome sequencing, families and carers will be provided with further NHS testing to confirm a diagnosis and will receive ongoing support and treatment from the NHS. 

The study will also gather genomic data for wider research purposes, allowing a better understanding of rare genetic conditions. It will also potentially pave the way for new diagnostic tools and treatments and improvements in existing therapies.

In addition, the Generation Study will explore the risks and benefits of storing an individual’s genome over their lifetime. This could allow it to be reanalysed later in life if needed, enabling access to new developments in genomics.

For further information on the Generation Study, visit: www.generationstudy.co.uk

Principal Investigator – Dr Christy Burden 

Planned end date – Currently 31/03/2025.

Local Ref – 5527

 Digital Imaging versus Opthalmology for congenital cataract screening

About 1 in 3,000 babies are affected by cloudiness of the lens of the eye (cataract) and, in the majority of cases, both eyes are affected. Since a baby’s first months are a critical time for vision and brain development, early surgery is needed to prevent permanent visual impairment. For this reason, cataract is the most common cause of preventable child blindness worldwide. All babies born in the UK are examined (screened) for cataract twice: first, within 3 days of birth in the maternity unit, and then again at the 6-8 week check by their GP. Despite this, late diagnosis of cataract continues to be a problem, causing avoidable visual impairment in some affected children. In the standard examination test, midwives or doctors shine a bright white light torch (an ophthalmoscope) into the eye to assess the reddish reflected light (red-reflex), similar to “red eye” seen in flash photos. Cataract blocks the light reflection causing an absent or dim red-reflex. The test can be difficult to perform because the bright light causes the pupils to constrict and the babies to shut their eyes. The assessment is particularly difficult in babies with dark eyes since eye pigmentation affects the colour and brightness of the red-reflex. Recently, a handheld, non-contact camera, called Neocam, has been developed which takes a picture of the eyes using both infrared and green light. Previous small-scale studies have shown that this technique, called photoscreening, can make childhood cataract detection easier.  In this study, we want to find out if photoscreening is more accurate than the standard test for detecting cataracts in newborn babies.

Visit Divo website to complete the self-enrolment form.

Project Details

Principal Investigator: Dr Daniela Vieten-Kay

Planned end date: 30/6/2024

Local Ref: 5426 

A team of researchers and clinician are conducting a study of the use of a medication called Pravastatin by pregnant women who have been identified as being at higher risk of their babies being born too early (preterm birth).

Preterm birth is birth that happens before 37 weeks of pregnancy. It affects around seven out of every 100 babies born in the UK. We do not fully understand why some babies are born too early and at present there are few effective treatments to prevent this from happening. Research shows it is likely that early labour may occur in some pregnancies because of inflammation in the mother’s body. Taking a medication that reduces inflammation, such as Pravastatin, could therefore reduce the number of babies being born too early. Pravastatin is a statin, and statins are a group of medicines which are commonly taken to help lower the risk of heart disease and stroke. Statins work by protecting blood vessels and lowering inflammation in the body.

During the past couple of decades, Pravastatin has been used during pregnancy in studies which have investigated whether Pravastatin prevents or treats other problems/complications of pregnancy. In total 1,303 pregnant women took part in these studies, which showed that there were no safety concerns or problems regarding the baby’s development.

In fact, these studies suggested benefits to the baby, as they found evidence that Pravastatin reduced the number of babies born early. This is what PIONEER will now test. Based on this information, we are interested to find out whether treatment with Pravastatin reduces the chance that a woman will give birth early by: 

• extending the length of pregnancy
• reducing the risks associated with babies being born too soon. 

We would also like to find out how Pravastatin might work to reduce early birth by looking at blood samples, vaginal swabs, and stool samples taken from pregnant women who take part in the study.

Everyone who takes part in PIONEER will be randomised into one of two groups: one group will take Pravastatin and the other group will take a placebo (a dummy tablet which looks like Pravastatin but does not contain Pravastatin, only an inactive substance). An equal number of pregnant women will be placed in each group. The aim is to have two groups that are as similar as possible at the start of the study, so that the only thing that differs between the groups is whether they receive the Pravastatin or the placebo. This then allows a fair comparison between the two groups to see if there are differences between the groups in the number of babies born early.

For more information, please visit the study website www.bristol.ac.uk/pioneer

Principal Investigator – Dr Sherif Abdel-Fattah

Planned end date – 31/03/2027.

Local Ref - 5406

Children of the 90s is a group of around 14,500 children born in the Avon area in 1991 and 1992. Scientists have been studying them ever since and are constantly making discoveries that make a difference to lives around the world.

Some now have children of their own, and we want to follow these pregnancies, births and babies. We call this Children of the Children of the 90s, or COCO90s for short. This is the only project we know of that provides scientists with information on three generations, allowing them to study important social and health issues.

If you or your partner are in Children of the 90s and are about to become or are already a parent, we'd love you, your partner and all your children to take part in COCO90s. It doesn’t matter how much or how little you have been involved in Children of the 90s in the past -- this is a new opportunity to be involved in ground-breaking research.

For more information about this study, visit the CoCo90s website.

Project Details
Principal Investigator: Ms Mary Alvarez
Planned end date: Ongoing
Local Ref: 2801

Aim: The DOLFIN trial is a research study looking at whether giving a specially developed nutritional supplement via breast or formula milk for the first year of life helps with brain development. If your baby was born less than 28 weeks old or is receiving cooling therapy, you may be approached about the study.

Recruitment: 30 babies born at less than 28 weeks or receiving cooling therapy.

A small UK study has been carried out and the results were promising, but we need to find out more.  About 500 babies nationally will take part in the study so that we can find out whether the supplement improves neurological child development. Half will receive the nutrient supplement and half will a get a dummy (placebo). You will not know which treatment your baby will receive.  Joining the study involves you giving the supplement daily to your baby until the date they would have turned one.

For more information, please visit the DOLFIN trial website.

Project Details
Principal Investigator: Dr Amiel Billietop
Planned end date: 31/05/2024
Local Ref: 5131

Aim: This research project compares two ways we may adjust a commonly used treatment, called positive end-expiratory pressure (or PEEP), to help premature babies’ lungs in the first few minutes after birth.  

Recruitment:  80 babies born before 29 weeks of pregnancy.

The POLAR Trial is a large clinical trial, being conducted in 25 hospitals around the world, including Australia, Europe, the United Kingdom and the USA.​

​This trial will establish how to best support the fragile lungs of very premature babies born between 23 and 28 weeks of pregnancy immediately after birth.​

We are comparing two approaches to PEEP levels given to preterm babies’ lungs at birth. We will put your baby into one of two groups, static or dynamic PEEP.  

All the babies in the same group receive the same treatment.  The results are later compared to see if one is better. 

For more information, please visit the POLAR study website.                                                                                          

Project Details
Principal Investigator: Dr Charles Roeher
Planned end date: 30/06/2026
Local Ref: 5152

Aim: To investigate whether in late preterm and early term infants with respiratory distress the early use of surfactant versus expectant management results in a shorter duration of hospital stay and fewer infants who fail to respond to treatment.

Recruiting: Infants born between 34+0- and 28+6-weeks’ gestation admitted to a Neonatal Unit (NNU) with respiratory distress and for whom a clinical decision has been made to provide non-invasive respiratory support.

For more information, please visit the SurfOn website.

Project Details
Principal Investigator: Dr Amiel Billietop
Planned end date: 28/02/2025
Local Ref: 4949

Aim: The WHEAT International trial will compare two different approaches, feeding babies or not feeding babies during blood transfusions, to work out which one is better. 

Recruitment: We are including all babies that are born before 30 weeks of pregnancy. The WHEAT study is an opt-out study.  This means that all babies will take part unless you let a member of the neonatal team that you do not wish your baby to participate. 

Both approaches are standard practice in the UK but we don’t how best to feed babies during blood transfusions – some hospitals and doctors stop feeds while other don’t. 

Some babies who are born early can develop a bowel disease called necrotising enterocolitis (NEC) which can be serious and can have long-term effects on how babies grow and develop. We want to know if feeding babies or not feeding babies while they have a blood transfusion changes the number of babies that get NEC.

WHEAT is taking places in neonatal units across the UK and Canada and will involve about 4,500 babies.

Project Details
Principal Investigator: Dr Daniela Vieten-Kay
Planned end date: 31/12/2025
Local Ref: 5236

Aim: The neoGASTRIC study is looking at whether routinely measuring gastric residual volumes (checking what is in the stomach before feeding) helps babies safely get to full feeds more quickly. We are comparing two ways of caring for babies having tube feeds, both ways are standard care commonly used in neonatal units across the UK.

Recruitment: We are including all babies born 6 or more weeks early (before 34 weeks of pregnancy) who require tube feeding unless there is another medical reason why they should not take part. All babies will be in the study unless you let a member of the neonatal team know that you do not wish your baby to take part.

Some doctors and nurses routinely measure gastric residual volumes because they think it might help tell if the baby is coping with their feeds, and may help identify signs of a serious but rare gut disease called necrotising enterocolitis (NEC). Other doctors and nurses think that routinely measuring gastric residual volumes may not be a good idea because it can be inaccurate and we do not know if it does help to identify necrotising enterocolitis (NEC). It also increases the amount of procedures each baby has, and may be uncomfortable for them. Routinely measuring gastric residual volumes may also lead to feeds being reduced or even stopped, this will delay the time it takes for the baby to reach full feeds and might affect how well they grow. It will also mean a baby will need intravenous nutrition for longer which can lead to potential problems like infections.

In the UK about half of doctors and nurses routinely measure gastric residual volumes and about half don’t – so both approaches are standard treatment. 

The study is being run in more than 30 hospitals in the UK and Australia for about 3 to 4 years. We hope to include over 7000 babies in the study (UK and Australia combined).

Project Details
Principal Investigator: Paula Brock
Planned end date: 31/06/2026
Local Ref: 5298

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We offer dedicated multi-disciplinary clinics with physiotherapy and specialist nurses.

A well established number of patients are on Biologic Therapy

Find out more information about AS and different treatments.

NASS Bristol (National Ankylosing Spondylitis Society) has been running groups from Southmead Hospital since 1998. Since March 2020, we moved to online stretch sessions due to COVID-19.

We run physiotherapist-led online stretch sessions every Monday afternoon at 1pm and on Wednesday evening at 6:30pm.

If you’re interested in joining in, we ask you to email and we will send you a medical questionnaire for you to complete before starting the session.

Find out more on the Nass Bristol website. 

There are dedicated clinics at Southmead Hospital Bristol for new and follow up patients. The service is run by Dr Harsha Gunawardena, Dr Sam Patel and Dr John Pauling, supported by a specialist nurse and pharmacist.

We have experience in management of all autoimmune connective tissues diseases such as:

• SLE (systemic lupus erythematosus).
• Scleroderma (systemic sclerosis).
• Inflammatory muscle diseases (Myositis).
• Sjogren's Syndrome.
• Vasculitis.
• Behcet’s Disease.

We take referrals from GPs and other hospital doctors (tertiary referral) for the more complex cases requiring high level expertise, such as inflammatory muscle disease, systemic sclerosis, and vasculitis.

We prescribe advanced therapies only available at a specialist centre including cyclophosophamide and Rituximab on Medical Day Care. 

For more information on drug treatment in rheumatology please visit the Versus Arthritis website.

Combined clinics with other specialist centres and specialties including Respiratory medicine (interstitial lung disease) and Royal Free Scleroderma service for complex conditions.

Respiratory CTD Lung ILD Combined Clinic

Week 1 and 3: Dr Adamali and Dr Barratt and Dr Harsha Gunawardena for patients with lung disease secondary to autoimmune connective tissue disease or vasculitis.

Royal Free North Bristol systemic sclerosis outreach clinic

Held every 6 months with Professor Chris Denton and Dr Voon Ong of the Royal Free Hospital, London and Dr Harsha Gunawardena for patients with complicated systemic sclerosis (scleroderma).

Combined Rheumatology and Neurology neuromuscular metabolic bone disease clinic

Held every three months with Dr Emma Clark and Dr Andria Merrison

We hold a specialised osteoporosis and metabolic bone disease clinic at Southmead Hospital Bristol with Professor Tobias and Dr Emma Clark.

We have a DEXA scanner (to measure bone density) at Southmead Hospital Bristol. We often do an additional scan as part of standard DXA scans to look at the spine for vertebral fractures (VFA). We have good links with our radiology colleagues and can offer vertebroplasty if it is required.

We also have two dedicated osteoporosis specialist nurses.

Specialist therapies such as Denosumab injections are administered within the nurse clinic and Zoledronic acid infusions are administered on the medical day care unit.

The Royal Osteoporosis Society has up to date information on understanding osteoporosis, the treatments available, information on exercise diet and lifestyle, and local support in your area, please visit the Royal Osteoporosis Society website.

We have close ties with the physiotherapists, elderly care services and the falls services.

Our fracture liaison service is led by Dr Katherine Walsh and Dr Bailey, who are orthogeriatricians assisted by a fracture liaison nurse. The service is designed to identify new patients of 50 years and over who have sustained low trauma fractures injuries (equivalent to fall from head height or less). 

The nurse offers telephone follow up to patients with a high risk of future fracture to assess adherence and tolerability of bone protection medication. Where patients have not started treatment or there are medication issues they will be contacting patients to help resolve any issues.

Further information can be found on the Versus Arthritis Website.

We have a Rapid Access “Hot” Clinic for people suspected to have giant cell arteritis (GCA) with referrals from GPs and also within secondary care.

You will have an urgent appointment arranged and a temporal artery ultrasound carried out.  A further follow up will be planned if Giant Cell Arteritis is diagnosed.

Further information can be found on the Versus Arthritis Website.