Stroke Thrombectomy Service

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Thrombectomy is a revolutionary treatment that can be used to treat strokes that are caused by a blockage of the largest arteries of the brain by blood clots; this is around 1 in 8 strokes. In 2019-20 North Bristol Trust, based at Southmead Hospital, performed the third highest number of thrombectomies for strokes of any stroke centre in England. We currently take referrals for thrombectomy 7 days a week.

We provide a thrombectomy service to the following hospitals 24 hours a day:

Gloucestershire Hospitals Foundation Trust

Great Western Hospitals Foundation Trust

North Bristol NHS Trust

Royal United Hospitals Bath

Taunton & Somerset NHS Foundation Trust

University Hospitals Bristol and Weston NHS Foundation Trust Bristol

Yeovil District Hospital NHS Foundation Trust

Thrombectomy at Southmead Hospital is carried out by interventional neuroradiologists, supported by stroke specialist consultants, advanced nurse practitioners, anaesthetists and a large team of other professionals using state of the art equipment.

We also provide a service to the south and western regions of Wales 7 days a week from 6am. Patients must be at the hospital by 10pm.

HKAT - Development of a speech analysis algorithm

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Background to the project:

Speech sound disorder (SSD) is one of the common problems that children face in their childhoods.  According to research, between 2% and 25% of children aged 5 and 7 years old have SSD (Law et al, 2000). When children learn to say new words, most children make some speech errors, which should diminish as they get older. SSD occurs when these errors continue beyond the age when we expect a child to have mastered specific speech sounds.  Most speech errors occur when the speech sounds are substituted, omitted or distorted.  The errors may affect how well a child is understood and can potentially limit his/her interactions with other people and negatively impact on the child's social and emotional development.

SSD is usually diagnosed by speech and language therapists using formal articulation tests and oral mechanism assessments.  As children make age-appropriate and age-inappropriate mistakes during their development, it can be difficult for parents or teachers to identify if there is a problem. Therefore, a request may be made for a formal assessment by a speech and language therapist to determine if a problem with speech exists.  This can lead to delays in accessing intervention.

Not all children need a formal articulation assessment. Some can be assessed using a screening tool which can be used to identify those children who need a more complete and thorough assessment from those who need advice only. The purpose of a screening tool is to quickly identify those children whose speech is within normal limits and those who may have SSD. People identified as falling outside normal limits can be seen or referred for complete formal evaluation in a timely fashion.

In recent years, computerised digital sound analysers have started to be widely used in speech sound analysis in detecting voice disorders, speech and audio-signal processing, etc.  Ms Ng Wing Yee (Chief investigator of this study) has recently developed a Cantonese speech sound analyser in order to make speech screening more accessible to parents and teachers in Hong Kong.  The speech sound analyser is a computer algorithm which carries out acoustic analysis of speech sounds. Now this analyser has been developed in Cantonese, we want to assess its application in an English speaking population.

Thus, the primary purpose of this study is to determine:
1) If a test which has been developed to screen children’s speech is accurate enough to be used as a screening tool to identify children with speech sound disorder.
2) How accurate the algorithm which has been developed to analyse speech sounds is when compared to a speech and language therapist.

Data collection is under way. The research team at the Bristol Speech and Language Therapy Research Unit (BSLTRU) are phonetically transcribing the speech of 200 native English speaking children aged 3 to 6 years old. At the end of the data collection, the transcriptions and audio recordings will be sent to the Chinese University of Hong Kong for analysis in order to answer the research questions above.

Within this study, there is also a unique opportunity to investigate how intelligibility varies in children with typically developing and impaired speech and how it might be perceived differently by parents and teachers. Intelligibility is often the reason for referral to speech and language therapy services and there is sometimes a mismatch between what parents and teachers consider reason for concern. The ‘Intelligibility in Context Scale’ is a seven-item parent reported measure which has been validated and provides information on how frequently a child is perceived to be understood by a range of communicative partners. In this study, we will also be collecting and comparing data on the Intelligibility in Context Scale when completed by teachers and parents. 

An additional concern with regards to speech development in children today is the anecdotal evidence from teachers that children are starting school with weaker speech and language skills than twenty years ago, and that this is having an impact on their developing literacy skills. The data collected in this study will also be compared with that collected in a previous community population study and will enable us to investigate whether this is indeed the case. We will therefore need to explore:

3) How parent report of children’s intelligibility compares to that of teachers’ for children aged 3 years to 6 years, 11 months.
4) How parents and teachers reports of intelligibility correlate with measures of speech production collected during assessment by a speech and language therapist.
5) What patterns of speech production are observed in a sample of children aged 3 years to 6 years, 11 months today and how this compares with the speech of child participants in the Avon Longitudinal Study of Parents and Children (ALSPAC) in the 1990s.

 

 

 

Pregnancy Scans

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Ultrasound scans are very important during your pregnancy and can tell us a lot of information about your baby.  Ultrasound is used to check that your baby is growing and developing as expected.  Having a scan can be very exciting; if everything is OK you get to see your baby!  But it’s not just for fun it is a medical screening test.

Please note"NBT is no longer able to accept cash payments. We continue to accept all bank and credit cards. 

If you have a specific reason why you are unable to pay via a card, then please let the Antenatal Team know at your appointment so that alternative arrangements can be made. 

We apologise for any inconvenience. "

What is an ultrasound scan?

Scans are performed by specially trained staff in ultrasound known as sonographers.  The sonographer usually puts some gel on your tummy and moves a small, hand-held probe (a transducer) over your skin to get views of your baby.  High frequency sound waves are used to transmit images of your baby onto a computer screen.

Why can it be difficult to scan some women with a raised BMI?

The sonographer likes to be able to see all of your baby’s organs and physical structure.  Scanning the unborn baby of a woman with a BMI over 25 can be more difficult as some of the power of the ultrasound waves can be absorbed by the mother’s tummy before they reach the baby. The quality of these images may therefore be poor and so the sonographer has a reduced ability to detect problems and there is a greater chance that an abnormality can be missed.  This means that not all abnormalities may be seen by scanning, especially at the 20 weeks scan.

Additional scans may also be necessary later on in your pregnancy to check your baby’s growth or position as increased fatty tissue can reduce the ability to see that the baby is growing as expected.

We understand that some patients may find it difficult or embarrassing to talk about their weight.  Please be reassured that all health professionals will be sensitive towards you and your own situation.

How is the ultrasound scan done?

The first scan is usually best performed with a comfortably full bladder but the anomaly and any scans afterwards would you’re your bladder to be empty but the sonographer may need to press on your tummy to get the best views of the baby.  Sometimes the sonographer will have to apply a firm pressure in order to improve the quality of the ultrasound beam to be able to visualise our baby clearly.  This may be more so when there is excess tummy fat.  If you find this uncomfortable, let the sonographer know.

The quality of the image produced will also affect the quality of any photos of our baby which you want to purchase.  Therefore please bear this in mind if you choose to purchase any scan photos of your baby.

When can I find out the sex of my baby?

We are unable to tell the baby’s gender at the dating (first) scan.  However, if you wish to know your baby’s sex at the 20 week scan please ask the sonographer at the start of this scan.  Please note that the sex of your baby is not always correctly identified and is not  guaranteed, therefore is not recorded or written down.

Can I bring someone into the scanning room with me?

The sonographer will need to concentrate on your baby during the scan.  Therefore we advise that you do not bring more than one person with you or your children to this scan. Your scan is an important medical examination and it is essential that our sonographers are allowed to concentrate fully without the distraction of filming or noise within the room.  The use of mobile phone cameras, videos and other photographic equipment is not allowed during your ultrasound scan.  Thank you for your co-operation and understanding.

If there are any complications after the scan what should I do?

The sonographer will inform you at the end of the scan of any problems they may have detected or concerns they may have although they may not be able to explain what this will mean going forward.  If this is the case, you will be given the opportunity to ask any questions and have further follow up by a consultant obstetrician who will discuss any further testing required.

Cell Salvage

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Cell salvage is a method of collecting blood that you may lose during an operation. The blood collected is filtered and washed to remove contaminants. If needed, it can be given back to you through a small tube into a vein. Your blood will only ever be given to you and cannot be used for someone else.

Cell salvage is a technique that is well established in many types of surgery and is used regularly at Southmead Hospital.

Why might I need a blood transfusion?

It is normal when having a caesarean section, to lose some blood during the procedure. Most of the time, the blood lost can be replaced with other fluids. Your body will make new red blood cells over the next few weeks.

However, it may be necessary to replace the blood by giving a blood transfusion. Blood used for these transfusions can be:

  • A supply of donor blood from volunteers
  • Your own blood using the cell salvage method
  • Both donor blood and your own blood

What are the benefits of cell salvage?

The use of cell salvage can reduce the need for a blood transfusion of donor blood.

Although risks associated with receiving a blood transfusion from a donor are low, there are still very small risks of infection being passed on. Having your own blood returned to you removes these risks and may decrease your length of hospital stay.

Donor blood is stored before transfusion and this can affects its properties: for instance, stored blood does not carry oxygen as well. Having your own blood returned to you straight away eliminates these problems.

The cell salvage technique is sometimes seen as an acceptable alternative for those who will not accept a transfusion using donated blood as cell salvage is a continuous circuit.

What are the risks of cell salvage and how can they be prevented?

1. Amniotic Fluid Embolism

There is a theoretical risk that the fluid that surrounds the baby, amniotic fluid, could be returned to the mother. This could potentially cause a condition called amniotic fluid embolism that can cause harm through an allergic reaction.

However, the washing and filtering mechanisms of the machine are very effective in removing amniotic fluid. Cell salvage has been used in caesarean section for many years and there is no evidence of this happening.

2. Antibody formation

There is a risk that the baby’s blood can get into your bloodstream. This may cause antibodies to develop that can harm the baby in future pregnancies. The most common blood group where this happens is if you are RhD negative and your baby is RhD positive.

There is always risk of mixing mother and baby’s blood during a caesarean section or delivery, even when cell salvage is not used. Therefore, to prevent antibodies forming, all mothers who have Rhesus negative blood group have a blood test after the operation. A drug called Anti-D Immunoglobulin is given to mothers whose baby has Rhesus positive blood group to prevent problems in future pregnancies. This is given irrespective of whether cell salvage has been used and can be given up to 72 hours after the operation.

What does this mean for you?

This information will help you make an informed decision on receiving your own blood back (cell salvage) during surgery. If you have any questions about cell salvage, which are not answered by the leaflet, please discuss them with your Anaesthetist.

Further information

For further information about cell salvage visit: www.transfusionguidelines.org

The use of cell salvage in caesarean sections has been endorsed by: 

  • National Institute for Health and Clinical Excellence (NICE)
  • Confidential Enquiry into Maternal and Child Health (CEMACH)
  • Obstetric Anaesthetists Association (OAA)
  • Association of Anaesthetists of Great Britain and Ireland (AAGBI)

Dr Andrew Bamber - Pathology

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GMC Number: 7016946

Year of first qualification: 2008, University of Cambridge

Speciality: Paediatric & Perinatal Pathology

Clinical interests: Paediatric autopsy pathology, Perinatal autopsy

pathology, Placental pathology, Cardiac pathology, Adult autopsy pathology

Secretary: Perinatal Pathology Secretaries

Telephone: 0117 414 9890

Dr Bamber works as a Consultant in Paediatric and Perinatal Pathology and is
based at Southmead Hospital and in the mortuary at St Michael's Hospital,
Bristol.

His routine practice includes general paediatric surgical pathology
(including non-CNS tumours), placental pathology, perinatal pathology, and
paediatric/adolescent autopsy. His main specialist interests relate to
autopsy pathology and he is an experienced adult, paediatric and perinatal
autopsy pathologist.

Dr Bamber is a member of the British Association in Forensic Medicine, the
Pathological Society of Great Britain and Ireland, the European Society of
Pathology, The British and Irish Paediatric Pathology Association, and the
Paediatric Pathology Society.

 

Bamber

Identifying & Supporting Children's Early Language

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Public Health England (PHE) has commissioned Speech and Language Sciences at the University of Newcastle to develop and evaluate a new process for early identification of children at risk of developing speech and language disorders, in collaboration with Bristol Speech and Language Therapy Research Unit and the Institute of Health Visiting.

Why is this important?

Speech and language are critical to children’s development, and speech, language and communication needs (SLCN) can affect their educational attainment, social and emotional development and opportunities later in life. It is therefore essential that children with SLCN are identified early to ensure they receive the right support and reduce the risk of problems in the long term.

However, the Bercow 10 Years On Report published in 2018 found that “more than half of young children in school are not having their needs identified, often due to insufficient knowledge and skills in the workforce” (p30). The report also showed that the screening tools which are currently used do not feature important ‘red flags’, which could provide early signs of SLCN.

How will the project work?

PHE have developed a programme to improve identification of SLCN, including training health visitors, providing better guidance to local authorities and provision of an early assessment tool. The University of Newcastle has been selected to create this tool, led by Professor James Law in collaboration with Dr. Cristina McKean.

The new screening tool will be conducted alongside the Ages and Stages Questionnaire (ASQ), which is commonly employed by health visitors and early years practitioners at children’s 2-year developmental checks. The screening tool will be tested and evaluated by health visiting teams in five areas around England, working with a total of 1280 preschool children. The project will also develop resources to foster understanding of SLCN among health visiting teams and parents, and to help them to support children with their speech and language.

How are BSLTRU involved?

There are four strands to the project:
1)      Development of the early assessment tool
2)      Public and Patient Involvement (PPI) Groups
3)      Evaluation and Feedback
4)      Co-Design

The team at BSLTRU, led by Professor Sue Roulstone in collaboration with Caitlin Holme, are responsible for evaluation and feedback. They will gather parent and professional perspectives of the new process and contribute this insight to the development of the tool, with the objective of ensuring acceptability for those who will be using and receiving the assessment in future.

Evaluation of the parent and professional perspective will comprise a parent survey, completed by all parents whose children have been assessed via the new process, as well as telephone interviews with parents and focus groups with health visitors and speech and language therapy teams.

BSLTRU are also involved in running the PPI groups and co-design elements of the project, which aim to include parents and professionals in the design of the assessment tool and further resources.

How can I find out more?
If you are interested in learning more about the project please visit the project website here: https://research.ncl.ac.uk/slcn/, or email caitlin.holme@nbt.nhs.uk for more information.

Dr Scott Grier - Anaesthetics

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GMC Number: 6163881

Year of first qualification: 2007, Imperial College, London

Speciality: Intensive Care Medicine & Anaesthesia

Clinical interests: Inter- and intra-hospital transfer of critically ill patients, pre-hospital critical care

Secretary: Anaesthetic secretaries

Telephone: 0117 414 2641

Dr Scott Grier (MBBS, BSc, FRCA, FFICM, FIMC RCSEd) is a consultant in Intensive Care Medicine and Anaesthesia.

He has a strong interest in the inter- and intra-hospital transfer of critically ill patients and is Co-Chair of the South West Critical Care Network Transfer Group. In addition, he is a Critical Care Doctor for Great Western Air Ambulance and SWIFT Medics.

Grier

Mr Mario Teo - Neurosurgery

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GMC: 6079773

Year of first qualification: 2003, University of Sheffield

Speciality: Neurosurgery

Clinical interests: Cranial and spinal microsurgery, Minimally invasive keyhole & endoscopic surgery Complex brain tumours Cerebrovascular neurosurgery Neurocutaneous disorders (Neurofibromatosis)

Secretary: Nikki Jesson / Sheila Birch

Mario Teo is a Consultant Neurosurgeon and Honorary Senior Clinical Lecturer at Bristol Institute of Clinical Neuroscience, North Bristol University Hospital, having completed a Cerebrovascular and Skull Base fellowship at Stanford University, California, USA. He qualified in medicine from the University of Sheffield, also gaining an intercalated research honours
degree- BMedSci. He then trained in Neurosurgery at Glasgow, Cambridge and London. He has a special interest in minimally invasive cranial and spine surgery, is a firm believer in personalized health care, surgery with less tissue injury, leading to minimal scar and quicker recovery.

His clinical focus includes management of complex brain tumours (schwannoma, meningioma, craniopharyngioma, skull base tumours, neurocutaneous disorders) and cerebrovascular pathologies (moyamoya disease, cerebral aneurysm, arteriovenous malformation, cavernoma, haemangioblastoma), incorporating various surgical techniques (keyhole surgery, endoscopic endonasal approaches, cerebral revascularizations) and technological advancement (3D reconstruction, fibre tracking, virtual reality, intraoperative neuromonitoring).

Academically, he has authored numerous peer-reviewed publications, editorials, book chapters, and is also an advocate of collaborative clinical and scientific research, at local, national and international level.

Professional memberships
World Federation of Neurosurgical Societies (WFNS) European Association of Neurosurgical Societies (EANS) Society of British Neurological Surgeons (SBNS) American Association of Neurological Surgeons (AANS) Congress of Neurological Surgeons (CNS) British Neurovascular Group (BNVG) British Skull Base Society (BSBS) British Medical Association (BMA)
 

www.iwantgreatcare.org/doctors/mr-mario-teo

Teo