The North Bristol NHS Trust stroke and TIA service is provided to both local residents and from the wider region.

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For more information on TIA services locally and to make a referral visit the Remedy page.

Useful Links

National clinical guidelines for stroke - The third edition updated 2008 encompasses the whole of the stroke pathway from acute care through to longer-term rehabilitation and secondary prevention. It informs health professionals about what should be delivered to stroke patients and how this should be organised, with the aim of improving the quality of care delivered for everyone who has a stroke, regardless of age, gender, type of stroke, or location. The recommendations have been completely revised to include the most up-to-date evidence published since the last edition in 2004. Please visit www.rcplondon.ac.uk

National Institute of Clinical Excellence (NICE). Diagnosis and initial management of acute stroke and transient ischaemic attack (TIA).

The advice in the NICE guideline covers:

• How healthcare professionals should recognise the symptoms of a stroke or transient ischaemic attack (TIA) and make a diagnosis quickly
• When people should have a brain scan and other types of scan
• Specialist care for people in the first 2 weeks after a stroke
• Drug treatments for people who have had a stroke
• Surgery for people who have had a stroke

For more information, visit www.nice.org.uk.

The neuropsychologist will often assess thinking (cognitive) abilities. If difficulties are apparent they would then typically provide advice and instruction in how to make use of strategies and techniques for minimising the consequences of these difficulties.

The neuropsychologist will often assess the more emotional side of the consequences of brain injury as well as looking at any changes in behaviour that may have occurred. It is not uncommon for people to experience feelings of:

• Unhappiness
• Depression
• Increases in feelings of tiredness and fatigue
• Irritability

The neuropsychologist may provide psychotherapy to help with these symptoms.

The work of the neuropsychologist is undertaken through individual sessions with people, within group sessions and, frequently, in conjunction with other therapists within the rehabilitation team. We offer group based interventions for help with fatigue, memory and irritability / frustration problems following brain injury.

Our Speech & Language Therapists focus on minimising the impact of functional communication and swallowing difficulties one might experience following a brain injury.

Communication can be affected by having difficulties with:

• Finding words,
• Understanding what has been said,
• Reading,
• Writing,
• Articulating / pronunciation,
• Voice
• Following a conversation,
• Eye contact,
• Saying things appropriately,
• Organising what is said,
• Understanding humour

Difficulty with functional communication can impact on independent living, inter-personal relationships with friends and/or family, consumer activities, academics, and/or work.

Sometimes people experience difficulty swallowing food and/or fluid following a brain injury. Coughing, choking, or taking longer to eat can greatly affect someone’s life.

Therapeutic intervention can occur individually or in a group, at HITU, home, or in the community.

Each patient is assessed as part of the overall assessment.

The initial assessment includes using:

• The Canadian Occupational Performance Measure
• The Chessington Occupational Therapy Neurological assessment Battery
• A functional assessment carried out in the home environment.

Measurable goals are then planned in conjunction with the client and the interdisciplinary team.

Occupational Therapy at HITU may include:

• Devising strategies to help with cognitive, perceptual and physical deficits in everyday life and supporting clients to implement these in their homes, workplace or in the community.
• Worksite assessments, planning and implementing graded return to work programmes and regular monitoring.
• Liaison with employers, job centres and other community agencies.
• Investigation into voluntary work.
• Introduction of community activities such as leisure or educational training.
• Provision of equipment to enable independence at home
• Upper limb rehabilitation
• Group work.

The Physiotherapy Team at HITU consists of 2 Physiotherapists.

Their role involves assessing clients with a wide range of physical difficulties as part of the overall interdisciplinary assessment.

From the assessment clients may be provided with an appropriate, client centred rehabilitation program based on measurable goals.

Physiotherapy sessions may take place at HITU, in local community facilities, for example leisure centres, or in the clients own home.

Respiratory "Hot" Clinic

Monday to Friday 10am-4pm in AEC. Seen same day or next day for patients threatening admission from GPs with respiratory problem. 

Access to this service is via a faxed referral form: [attachments]

Please complete all details in block capitals and provide as much information as possible on the reason for referral.

Referrals should be faxed to 0117 4149451. Referrals received by 12 noon where the patient is able to arrive before 1pm will be seen on the same day, otherwise they will be seen the next day. A Respiratory Consultant is available to discuss referrals or offer advice Monday to Friday 10am–5pm.

Please ensure the patient's contact telephone number is included in the referral form. We will contact them by phone to give them an appointment time.

Pleural Clinic

Monday to Friday 2pm-3pm on MDCU. Seen same or next day for patients with new effusions or known pleural disease threatening admission. 

Referrals should be discussed with the Pleural SpR on 07894 803088 then email the referral to pleural-referrals@nbt.nhs.uk 

2 Week Wait

For patients with possible lung cancer.  

Referrals should be emailed to sarah.smith@nbt.nhs.uk and deborah.walton@nbt.nhs.uk  with patient details and give patient contact details of nurses.

Referral Criteria for ARAS
Referrals accepted from the in-patient nursing and medical teams and via respiratory out-patients for patients attending HOT clinic (Please refer on ICE).

The patient must have / be:

• Alert & orientated
• Be purely a respiratory admission with COPD
• Able to take their own medications or cope with their normal level of help
• Satisfactory respiratory function
• Good social support
• Able to undertake their normal activities of daily living or have adequate support in place.

Respiratory Specialist Team
Referral options for in-patients received from nursing and medical teams via ICE.

• Asthmatics
• Home oxygen assessments
• TB screening support, ie. Mantoux testing
• Advice and support for complex respiratory patients
• Inhaler device teaching and assessment
• Nebuliser advice
• Smoking cessation

Referral options for out-patients, received from Respiratory out-patients and other medical specialities. All new referrals received from primary care will be via the Respiratory consultants.

• Asthma management & treatment
• Home oxygen assessments
• TB screening
• Nebuliser assessments

Nurse led Clinics:

• Monday am alternate weeks – ARAS follow-up
• Tuesday pm – Asthma
• Thursday am – Long term oxygen therapy (LTOT) assessments
• Thursday pm – Support to the Pulmonary Fibrosis clinic
• Friday am - Long term oxygen therapy (LTOT) assessment
• Friday am – Asthma specialist treatment

Community Support
Patients receive support in their own homes under the following services. The Respiratory team work closely with primary care in providing long term support to patients through regular communication with GP’s, Community Matrons and community nursing teams along with other multidisciplinary services.

ARAS
Patients receiving home oxygen therapy – Home visits are offered when patients are commenced on long-term oxygen therapy (LTOT) and at annual follow-up for further support and monitoring. Patients receiving palliative oxygen therapy will be visited as needed but the majority of this support is provided in conjunction with primary care.
Patients receiving short burst oxygen therapy and generally only followed up by telephone except under exceptional circumstances.

These guidelines cover Mr Iain Packham, Mr Mark Crowther, Mr Neil Blewitt & Mr Phil Mc Cann

These guidelines cover the most common shoulder surgery undertaken:

• Sub-acromial Decompression +/- ACJ excision
• Rotator Cuff Repair – standard
• Rotator Cuff Repair – complex
• Shoulder Replacement (TSR, Hemi Arthroplasty, Humeral Head Resurfacing)
• Reverse Geometry Total Shoulder Replacement
• Anterior Shoulder stabilisation
• SLAP repair
• ACJ stabilisation
• ORIF Clavicle Fracture

These guidelines form a staged rehabilitation programme. They are general guidelines and any specific instructions in the post operative notes must take precedence. They are not a substitute for sound clinical reasoning and good communication with the consultant team.

Please be aware that these guidelines have been updated June 2015 – ensure you are using the most recent version.

Download:[attachments]

If you have any queries with regards the patients please contact the Shoulder Physiotherapy Team at Therapies Department, Brunel building, Southmead Hospital or the appropriate consultant

The Medicines Information Service has been established for over 20 years.

It provides evaluated information and advice regarding all aspects of medicine use to doctors, nurses, pharmacists and other healthcare professionals. Information is also supplied to patients and members of the public where it is relating to specific treatments prescribed by North Bristol NHS Trust. 

Examples of enquiries handled by the Medicines Information Service include;

• Treatment Choice
• Adverse Reactions to Medicines
• Interactions between Medicines
• Administration and Compatibilities of IV solutions
• Medicines Dosing and Administration
• Safety of Medicines in Pregnancy or Lactating Mothers
• Safety of Medicines in Impaired Renal (kidney) or Hepatic (liver) Function
• Identification of Foreign Medicines
• Policies around the Best use of Medicines.

Medicines Information makes the most of on-line resources and other new information technology, operating under the guidance of UKMi (http://www.ukmi.nhs.uk/ ) its national body setting high standards for advice supplied.

Laparoscopy

What is laparoscopy?
Laparoscopy is a way of doing surgery using small incisions (cuts). It is different from ‘open’ surgery where the incision on the skin can be several inches long. It is also called ‘key hole surgery’.

How is laparoscopic surgery done?
Laparoscopic surgery uses a special instrument called a laparoscope. This is long thin telescope that is inserted into the abdomen through a small incision. It has a camera attached to it that allows the abdominal and pelvic organs to be examined, projected onto an electronic screen. Depending on the treatment required additional small incisions are made to pass other instruments into the abdomen.

What are the benefits of laparoscopy?
There are many benefits. It is associated with lower infection rates, less pain, shorter hospital stay and quicker recovery. The smaller scars allow you to heal faster.

What are the risks associated with laparoscopy?
Problems that occur with laparoscopy include the following:
• Bleeding or hernia (bulge) at the incision site
• Internal bleeding
• Infection
• Damage to a blood vessel or other organ, such as the bowel, bladder or ureters
There is a chance of needing to convert to an open operation. Sometimes complications do not appear right away but occur a few days to a few weeks after surgery.

Why do I need to have a laparoscopy?
Laparoscopy can be used to look for the cause of pelvic pain, infertility or a pelvic mass and provide treatments such as tubal sterilisation and hysterectomy.
It can be used to diagnose and treat the following conditions: endometriosis, fibroids, ovarian cyst, ectopic pregnancy, pelvic floor disorders and some types of cancer.

What pain relief will I have?
A laparoscopy is usually performed under general anaesthetic. This means that you will be asleep for the procedure. Local anaesthetic is also put into the small incisions.

What happens during laparoscopy?
Once you are asleep a small incision is made in or below your navel (belly button) or another area of your abdomen. The telescope is inserted through this small cut. The abdomen is then filled with gas to allow the pelvic organs to be seen more clearly. The camera attached to the telescope projects the pelvic organs on a screen. Other small incisions may be made in the abdomen for surgical instruments. Another instrument, called a uterine manipulator, may be inserted through the vagina and cervix into the uterus. This instrument is used to move the pelvic organs into view.

After the procedure, the instruments and most of the gas are removed. The small incisions are closed. Stitches are usually dissolvable and take between 7-10 days to dissolve.

What happens after laparoscopy?
Some women are able to go home the same day. For complex procedures, such as laparoscopic hysterectomy, an overnight stay in the hospital may be recommended. Your doctor will advise you.

What should I expect during recovery?
For a few days after the operation you may feel tired and have discomfort. You may be sore around the incisions made in your abdomen and navel. The tube put in your throat to help you breathe during the surgery may give you a sore throat. You may feel pain in your shoulder or back. This is from the small amount of gas used during the procedure that remains in your abdomen. It goes away on its own within a few hours or days.

Your doctor will let you know when you can return to your normal activities with recovery normally taking about 7-14 days. For more complex procedures it can take longer. You may be advised to avoid heavy lifting or exercise.