The North Bristol Lung Centre runs a number of general respiratory and specialist respiratory outpatient clinics. These include clinics run by doctors, specialist nurses, pharmacists, physiotherapists and other healthcare professionals.  The clinics take place at:

• The Brunel building, Southmead Hospital 
• Cossham Memorial Hospital Clinic
• Thornbury Hospital Clinic

Contact details

For outpatient appointments  : 0300 555 0103

Respiratory secretaries: 0117 414 2016

AAC WEST has a range of products, developed by the centre’s experienced specialists.

The Frenchay Screening Tool for AAC
This tool has been designed for use by professionals working with people with communication disorders who wish to assess their clients’ suitability for using AAC.

This simple and easy to use tool brings together a range of specific assessment areas in one simple tool. This robust and meaningful tool allows the administrator to look at areas such as the patient's physical access, visual acuity, visual processing, symbol versus written word identification, categorisation etc. The results from this screen can be used to ensure appropriate onward referrals are made to specialist AAC assessment centres. The Screening Tool costs £100 +VAT and P&P (£15.00 p&p for 1, please ask for p&p quote if ordering more then 1x screening tool). The Frenchay Screening Tool can be purchased by contacting the AAC WEST Service on 0117 4145850.

Frenchay Alphabet Board (F.A.B)

This is a positive finger location spelling board suitable for anyone who wants a simple, low tech communication aid that can be taken anywhere. As this device contains no batteries it will act as an ideal back up for anyone who uses a high tech text based communication aid. The FAB will be useful for any person who is literate but unable to speak. This may include people who have vocal cord damage, tracheostomy, stroke or those who are ventilated. The positive finger guard location means that the F.A.B is the only alphabet chart on the market that will allow people with progressive neurological diseases such as Parkinson’s disease, Multiple Sclerosis or early Motor Neurone Disease to access this form of low tech device as the guards aid access to individual keys.

The FAB has been designed to be compliant with infection control standards and is therefore ideal for use on hospital wards or in nursing homes as it is fully washable and MRSA and E Coli resistant

FAB has been developed in conjunction with E2L products. Visit www.e2l.uk.com/FAB/index.html to watch a video. FAB can be purchased from Logan technologies www.logan-technologies.co.uk  or Ability World www.ability-world.com.

E-Tran (Frenchay Eye Transfer Frame)
This is a simple but effective low tech eye pointing system of communication designed for those who are no longer able to access AAC devices via traditional means. In cases of progressive illness, it ensures that avenues of communication with family, friends and care staff remain open, despite other physical deterioration.

The system displays the alphabet which is divided into groups, and colour coded within these. A letter is identified by first looking at the group containing the letter, and then clarifying by looking at its colour. Words and sentences can be built up in this way. This is a low tech eyepointing system of communication, which can also be used as a backup to any electronic device which might be recommended.

The E-Tran frame is available to be purchased on-line from a number of different suppliers. 

E-Tran (Frenchay Eye Transfer Frame), can be bought from ROMPA or Winslow Resources.

The Stroke Association - Charitable organisation providing free Information for Individuals & Families www.stroke.org.uk

South Gloucester Council - A directory of useful services. Search 'stroke' to access their directory www.southglos.gov.uk

Bristol Area Stroke Foundation www.stroke-bristol.org

Living (dlc) - Formerly the Disabled Living Centre www.thisisliving.org.uk

Home from Hospital service - (British Red Cross) www.redcross.org.uk

Purple Pages www.thecareforum.org

What is Stroke Rehabilitation?
Stroke rehabilitation is the process of adjusting to the damage caused by a stroke and finding ways to keep as much independence as possible. This may mean re-learning lost skills, finding alternative ways of doing things, or adapting your situation.

Common areas that are considered are:

• Balance
• Limb movement and strength
• Communication
• Swallowing
• Thinking skills
• Bladder /bowel control

Rehabilitation cannot be done for you. Your body needs to recover and you have to be motivated. It is often hard work and it takes practise and time. Being ill and in hospital leads to a loss of your fitness, and your treatment needs to be paced for you. Stroke can affect your mood and confidence. Setting goals to work for can help to keep you motivated.

Progress depends on the severity and type of stroke you have had, but also your previous health, your ability to engage with the rehabilitation process and your own determination. It is an individual process.

Unfortunately, it is not always possible to regain your independence. Progress can be restricted if you have had a large stroke, if you become unwell or due to side effects of a stroke such as fatigue.

You may need specialist equipment to help you, or adaptations to your environment. The therapists will advise on this.

How can my family be involved?
We encourage your family to be involved. Your family can play an important role helping your awareness of your usual life. You may like them to bring photographs from home, keep you-up-to date with news at home and tell us about your lifestyle.

They are invited to progress meetings so they can support you, help plan your discharge and for your future. 

They are welcome to attend some of your therapy sessions. It can help them understand how the stroke has affected you.

How long will I need to stay in hospital?
Your individual discharge plan will depend on how independent you become and your own social circumstances. Everyone is different.

Preparing for discharge begins as soon as you arrive. We use our expertise to predict the likely course of your progress and your future requirements. It is usually possible to make this judgement based on the severity of a person’s illness. However, plans may alter to reflect changes in conditions.

For discharge from hospital you will need to be medically well enough to be safe and have reached a point when you don’t require inpatient treatment.

What Will Happen After Hospital?
Change after a stroke can take a long time and you may have goals that still require therapy after you leave hospital. If you need personal help at home or you require a care home, your Social Worker will plan this with you and your family. Services available after leaving hospital will be explained at your meetings and planned before discharge.

Your GP will be responsible for your medical care after discharge and will receive a letter from the hospital. You will get a new prescription.  It is important that you continue to take your prescribed medications and follow any advice you have been given.

Information packs
You will be given a stroke information pack at your progress meeting. It has useful information about stroke and useful contacts following discharge. We are always happy to for you to call us for advice.

If you need to stay in hospital beyond a few days, you may move from the Hyper Acute Stroke Unit (HASU) to the Acute Stroke Unit. Here, an assessment will be carried out by our expert team of therapists and other stroke specialists to determine any ongoing needs you may have for ongoing rehabilitation, care and support. This assessment will be provided to our community partners, including the Integrated Community Stroke Service (ICSS) and the Stroke Sub-Acute Rehab Units (SSARUs) , who will decide how these needs can be met outside the acute hospital.

We and our partners will aim to support you to leave the acute hospital as soon as possible, so that your care can continue in the most appropriate and supportive setting. Throughout this process you will be supported by our Integrate Discharge Service, who will work with clinicians to provide you with information about what to expect on leaving hospital.

If your needs cannot be met by community service straight away, you will continue to receive care and, if this will be beneficial, intensive specialist rehabilitation until you can be provided with what you need outside the acute hospital. This may be because you need further inpatient specialist medical and nursing care, for example.”

Therapy
Dependng on how your stroke has affected you, you might need to be treated by any combination of our therapists, depending on how your stroke has affected you. Rehabilitation is a 24 hour process, not just when you are seeing the therapists, and the nurses will encourage you to practise your activities on the ward and to do what you can for yourself.

• You will have named therapists who will treat you.
• You will have an individual plan for your needs.
• Your treatment plan will progress as you improve.
• If you are well enough, you will have a therapy timetable.
• Therapy sessions might be at the bedside or in the therapy rooms/gym.
• You might have individual or group sessions.

Colorectal Consultant led clinics occur on a weekly basis at Southmead Hospital Bristol.

Procedures performed in the Outpatients Clinic include:

• Rigid sigmoidoscopy,
• Rubber band ligation of haemorrhoids,
• Endoanal ultrasound.

Endoscopy services occur on both trusts sites weekly, this is supported by a full range of radiology services.

Conditions Treated:

• Colorectal diseases
• Colon and rectal cancer,
• Inflammatory bowel disease (colitis and Crohns disease),
• Diverticular disease,
• Colostomies and ileostomies,
• Anorectal disorders (haemorrhoids, fissure, fistula, rectal prolapse, faecal incontinence).
• Hernias.

Colorectal Nurse Specialist Service

The service encompasses support, advice and empowering patients and their families to make decisions with regard to the different treatment options. This support is offered from diagnosis throughout the patient’s disease trajectory.

The aim of the Colorectal Nurse Specialist team is to provide support and information to patients and their families at the point of suspected and confirmed diagnosis of colorectal cancer throughout their care. The Colorectal Nurse Specialists also provide nurse-led follow up for patients who have been diagnosed with colorectal cancer at North Bristol NHS Trust. 

How is ME/CFS diagnosed?

There are no specific tests to diagnose ME/CFS but there are clear guidelines to help with making a diagnosis. These guidelines include:

• Blood tests – these will be done by your GP and are used to screen out other health conditions that can cause fatigue and related symptoms, for example, anaemia, or an underactive thyroid. A diagnosis of ME/CFS can be considered if the blood test results don’t suggest other causes for the fatigue.
• Medical history – this will involve asking you about when your symptoms started and whether there were any specific triggers leading up to the onset of your illness such as an infection, stress, surgery, a trauma or perhaps a gradual decline in your health.
• Symptoms – these are descriptions of how you are feeling, and the clinician will also ask how the symptoms impact on your daily activities, work and social life, and sleep. ME/CFS is characterised by a wide range of symptoms, not just fatigue, and in order to make a diagnosis of ME/CFS a certain number of these symptoms also need to be present.

It is important to note that ME/CFS is not a condition that is diagnosed just by a ‘process of elimination’ when another medical reason for the fatigue/illness cannot be identified or explained. M.E. is a very specific syndrome with a clearly defined range of symptoms and associated problems. There are also instances where people may be unwell with an unexplained cause but where ME/CFS can be ruled out by a ME/CFS specialist.

Who might I see in the Bristol M.E. Service?

Having ME/CFS can affect many areas of everyday life such as work, activities, sleep and relationships. Managing ME/CFS effectively needs a wide range of skills. This is why we have different types of therapists in our team, including physiotherapists, occupational therapists and psychologists. Each clinician can work in partnership with people living with ME/CFS to improve their self-management skills, reduce the suffering caused by ME/CFS, increase wellbeing and improve quality of life.  Although the clinicians are specialists in each of their chosen areas, they have a high level of knowledge of the other specialties and there is significant overlap in the areas covered by each clinician.

Having ME/CFS means that people aren’t able to do as much as before. We offer support to people in managing activities to get the best quality of life possible despite having ME/CFS. This might involve looking at ways to level out activities, and we can offer support with slowly increasing activities. We can also offer specialist advice regarding issues relating to work (both paid and voluntary work) and study. ME/CFS affects fitness, stamina and mobility, and may affect balance and co-ordination. We consider the person as a whole, and we can offer individually tailored exercise and physical activity programs to maintain general health and mobility, and these programs can lead to improved mobility for some people living with ME/CFS. We can also support people in making changes to their sleep patterns, which can take some time to improve. 

Living with ME/CFS can understandably lead to increased stress levels, feelings of helplessness or a sense of loss of control, as well as lower mood. Often people notice strong emotions such as fear, anger, frustration, and guilt. It is also common for people who have been feeling unwell for a long time to develop set ways of coping that are unhelpful, such as self-criticism. We know that ME/CFS isn’t ‘all in the mind’, however self-critical patterns of thinking can complicate the management of ME/CFS. The routines and habits that we develop throughout our lives can be difficult for anyone to change but we can help with this. We offer support in developing self-management strategies for ME/CFS and use a range of methods and techniques including a specialist form of Cognitive Behavioural Therapy (CBT) to support coping, relaxation training and also an approach known as Mindfulness which we have adapted for people living with ME/CFS.

Do special diets for people with ME/CFS help?

The British Dietetic Association produce a useful guide to dietary issues and ME/CFS that you can download from here: https://www.bda.uk.com/resource/chronic-fatigue-syndrome-diet.html
This guide is based on the best available evidence relating to ME/CFS and diet.

A significant number of people with ME/CFS also have Irritable Bowel Syndrome (IBS), which can be helped by specific diets. You can find out more information about diet and IBS from the British Dietetic Association website: https://www.bda.uk.com/resource/irritable-bowel-syndrome-diet.html
 

We aim to help patients and their doctors to identify the condition, and then offer support to manage it as effectively as possible.

We can help to reduce some of the symptoms using medication and other approaches, but many people face the challenge of living with these ongoing symptoms for some time. We know that ME/CFS can gradually improve in many people, and the support that we offer can increase the likelihood of progress. We also know that learning ways to manage the condition can help people to make improvements in quality of life. For example, many patients experience a delayed increase in symptoms a day or two after an increase in activity levels. This is known medically as “post-exertional malaise” but it is known to many of our patients as “payback”. This delayed response can make the illness particularly difficult to manage. Through learning self-management skills, people can reduce the likelihood and severity of this “payback”. This can provide a more stable situation which allows some patients to slowly build up important activities.

What happens when you first visit the Bristol M.E. service?

We accept referrals from GPs and hospital specialists. Once we have checked the appropriate tests have been completed by your GP, you will be sent some questionnaires to fill in: these form the basis of the initial assessment. We send them to you so that you have a chance to think about the questions before the appointment, so hopefully the appointment is not so demanding. The appointment will be with one of the team: a psychologist, physiotherapist or occupational therapist who will discuss your symptoms and the impact of your symptoms on your day to day to life. During this appointment we may diagnose ME/CFS, but sometimes it is necessary to make a second appointment.

Following diagnosis, a management plan is agreed: often this can include a further individual appointment or taking part in one of our multidisciplinary therapy groups. Our Service offers a multidisciplinary approach, in line with the NICE guidelines. We regularly monitor newly published research into ME/CFS, but at present there are a limited number of evidence-based treatments for ME/CFS. Three guides to therapies have been produced by the British Association of Clinicians in ME/CFS (BACME). There is a guide to symptom management, a guide to therapy and also a guide offering advice for people who are severely affected by ME/CFS To find out more about these guides, visit https://bacme.info/

We often see people who have developed M.E./CFS following an infection, such as glandular fever. Other people can identify a period of stress leading up to the start of their illness. A combination of infection and stress is also common. Occasionally, it starts without an obvious trigger.

Researchers are gradually developing insights into how the condition develops and the changes which take place in the body as a result of illness. However, this picture is far from complete at present.

A more detailed summary of the current evidence can be found at the Centers for Disease Control and Prevention website www.cdc.gov/me-cfs/about/possible-causes.html

There is been a gradual increase in research into M.E./CFS over the years, especially in the past decade. Some of this research was looking for a single "broken part", as is common with medical research. It's a bit like taking your car to the garage: you expect them to find out what's wrong, take the broken part out and fix it. This approach has led to some insights but more recently researchers have been looking at the behaviour of systems in the body and finding that they don't behave normally, particularly after an exercise challenge. This shift of focus in the research is likely to be more helpful. It's more like having a problem with a modern car, taking it to the garage, and finding that they identify a problem with the software which is stopping it from running smoothly. You can find a webinar delivered by the British Association for Clinicians in M.E. (BACME) which puts together a lot of these ideas in this Youtube video.