BSPGHAN NEWSLETTER

 

REPORTS FOR THE AGM JANUARY 2004

PRESIDENT’S REPORT

The Society has had a good year. The establishment of working groups continues to develop and this has enabled Council to easily defend decisions taken in relation to our speciality because they have been considered by the appropriate groups of people. Over the last three years, the new groups that were established (the Associate Members Group and the Trainees Group) have continued to flourish. In my last report, I indicated that we would develop a forum for paediatricians with an interest in gastroenterology. I am delighted that this is coming to fruition. An interim Chairman, Stuart Nicholls, has started this process with the establishment of regular meetings. A constitution is being developed; and the possibility of a new Council member representing this group will be discussed at the AGM.

During the course of the year there has been successful scientific meetings both in Dublin (the Winter Meeting) and in York with the RCPCH. The Associate Group has had a successful meeting in Leicester and these meetings will continue into the future.

Finally, I would like to thank every member for their hard work during the course of the year. This is my final report as President. I have taken unity of purpose as the theme that I have tried to adopt. I have been very encouraged by the way our members have worked together harmoniously for the improvement of our sub-speciality in the last three years.

Ian Sanderson

Jan 2004

SECRETARY’S REPORT 2003

This has been a busy year for the BSPGHAN starting with the highly successful winter meeting in Dublin . Council has met 3 times since the last AGM. We now have 205 full members and an increasing and active associate members group. Council members representing specific areas/groups and subgroups will report at the AGM.

I am pleased to report that the Guidelines for Purchasers of tertiary paediatric services updates report is now complete and on the web. I would like to thank Rob Heuschkel, Mike Thomson and Ian Sanderson in particular but also the many members who contributed to the production of this report. I hope that this report will help members with local commissioning. The wider challenge of the response to the National Services Framework has been dealt with by the same group with a shortened version of the report been submitted to the college for inclusion in the college guidance on tertiary service provision which is due to be published soon. I am grateful to members for completing the workforce survey which has helped inform the whole process but also enabled us to show that the numbers of paediatric gastroenterologists in the UK needs to be expanded considerably in order to provide care in line with National recommendations and establish managed clinic network to deliver care. Primary Care and district services will be partners in the development of these networks. Stuart Nicholls has led on the establishment of the DGH sub group of the BSPGHAN, which I hope, if the society agrees will have the lead as a member of council. I have been very keen on this as much of our speciality lies within general paediatrics and occurs outside specialist centres and strong district service representation will help us in the decision making about service provision.

Highlights of the year have included the successful joint British Italian Meeting in Lucca in May and thanks to the organisers of that. We need to look for a host centre for the next meeting due here in 2006. There was also the very successful joint meeting with Faculty of History of Medicine at the Apothecaries in November organised by John Walker-Smith and Ian Sanderson with book being planned based upon the meeting.

I hope everyone will manage to get to York . 47 abstracts were submitted. 1 plenary has been accepted and 15 for presentation at our session. Tony Williams from St George’s will be our guest speaker and address the important issue of helping infants breast feed. Dinner supported by Mead Johnson will be on the Monday night before the BSPGHAN session on the Tuesday.

I would like to thank Steven Murphy, John Puntis and Mike Thomson for their work on council over the last 3 years.

Finally thanks to Ian Sanderson who soon completes his highly successful term as president.

Members asked to keep the secretary up to date with E Mail and postal addresses and access the web regularly for new information.

Mark Beattie

Jan 2004

 

TREASURER’S REPORT

The society’s financial situation remains buoyant. Our balance at the end of November 2003 was £27890. Over the last financial year expenditure has been a little more than income. Our biggest is the I.B.D. working group and I, like many of you, look forward to their evidence based guidelines for management, with interest. Over the last year I have been trying very hard to get members and associates to pay their subscriptions. This is not an easy task particularly with the associates as when they were set up founder associates paid 3 years subscription in one go; we then increased their subscriptions and because of the domestic situations of many of them (their direct debits are often in partner’s names) deciding who has paid can be difficult.

Expenses are paid in line with the RCPCH regulations i.e. second-class rail fare. I would stress that it is “our” money and the use of budget airline fares and discounted rail fares is appreciated.

I would like to remind trainees and associates, in particular, that the society will pay a grant (up to £500) towards expenses when presenting at overseas meetings if employers/grant awarding bodies will not finance them.

Finally, I would like to thank Mead Johnson Nutritionals for supporting the society by paying council members’ expenses when attending council meetings.

 

Steve Hodges

December 2003

 

NUTRITION REPORT

Over the past year there have been significant developments in relation to training in nutrition, including the first Nutrition Diploma Course organised through the RCPCH by Tony Williams. This pilot course was judged highly successful by participants, and will be repeated in 2004 for a larger number of registrants. The course itself is likely to be validated by the University of Southampton and could then contribute towards a higher qualification. Lawrence Weaver has also produced a core curriculum for nutrition training of SpRs working in gastroenterology, hepatology and clinical nutrition. The College Diploma would complement this hospital based training for SpRs, but will also have a broader appeal to non-gastroenterology trainees with an interest in clinical nutrition.

The British Intestinal Failure survey was commissioned by the BSPGHAN in 1999 when it was acknowledged that we had very little information on the epidemiology of intestinal failure in infants and children in the UK . A working party was set up under the chairmanship of Ian Booth. Streets Heaver Healthcare Computing, the company who run the British Artificial Nutrition survey, agreed to manage the BIFS survey. It was anticipated that this would involve a monthly invitation to members of both the BSPGHAN and BAPS asking them for details of any patient receiving parenteral nutrition for more than 27 days. Until recently there have been no funds to take this project further. There have now been two offers of financial support from industry which should allow the survey to run over a two year period, starting this spring.

As an associate organisation of the British Society for Parenteral and Enteral Nutrition (BAPEN), the BSPGHAN has a seat on BAPEN Council. Our representative until recently was Peter Milla, who chaired the Paediatric Advisory Group (PAG) within BAPEN. Currently I sit on BAPEN Council. As a Society we need to decide if this role would best be filled by whoever holds the nutrition brief on BSPGHAN Council (and also sits on the RCPCH Nutrition Committee), and whether the PAG (currently non-functioning) should be reconstituted.

The European Society for Parenteral and Enteral Nutrition (ESPEN) held its 25 th congress in Cannes during September 2003. Joint sessions with ESPGHAN ensured that there was a much higher than average paediatric content. A joint ESPGHAN/ESPEN working group is currently developing guidelines for parenteral nutrition across the paediatric age range and a number of BSPGHAN members are actively contributing to this process.

 

John Puntis

December 2003

 

ASSOCIATE MEMBERS REPORT

2003 has been another busy year for the Associate Members. There are now a total of 109 members, 52 dietitians, 45 nurses and 12 others (including pharmacists, speech therapists and psychologists). We continue to accept new members on a regular basis.

This year has seen a change in committee with myself taking over from Clare Burnett as chair. We congratulate her and her husband on the birth of their new son Henry in June.

 

New members to the Committee are:

 

Our Annual Conference in Leicester was attended by 50 delegates from across the country, evaluation was positive on all counts. Topics included; ‘ Management of Gastro-oesophageal Reflux’, Liver Disease and Cystic Fibrosis’, and ‘Obesity Management’ . Four Abstract submissions were accepted and orally presented.

Again this year Associate Members were involved in the Post Graduate Programme for Nurses and Dietitians at ESPGHAN, which was held in Prague . Members participated as Speakers and Chairs. This year saw a dedicated dietitians and nurses poster session alongside the main meeting with good representations from the UK .

The members are actively involved in the programme for the World congress in Paris 2004. The Postgraduate Programme has been expanded to 1½ days with separate nurse and Dietitian Poster Sessions to be held during the main meeting.

We continue to be supported by SHS International which has enabled funding for Associate Members to attend BSPGHAN and ESPGHAN meetings. We are also grateful to them for very generously supporting our own Annual conference, and the Committee Meetings throughout the year. Please contact myself or Liz McLean for information on how to obtain sponsorship.

We are all meeting again at the Winter Meeting in Crieff and I encourage associate members to attend what looks to be a very good meeting.

Thanks to all associate members for their contribution and support over the past four years.

 

Jackie Falconer

Chair – Associate Members BSPGHAN

 

TRAINEES IN PAEDIATRIC GASTROENTEROLOGY HEPATOLOGY & NUTRITION (TiPGHAN)

2003 has been another landmark year for the trainees’ section of BSPGHAN. We started with a trainees’ meeting and AGM at the Winter Meeting in Dublin . Professor Ian Sanderson joined us to speak about the introduction of the National Grid for Specialist Registrar training in Paediatric Gastroenterology, Hepatology and Nutrition. This proved to be a very productive session with much interaction from the trainees’.

Our TiPGHAN committee met again in May and December when the main agenda topics were the successful introduction of the Grid and dedicated log books for training in Gastroenterology and Hepatology and the planning of the first ever Postgraduate Day at the forthcoming 2004 BSPGHAN Winter Meeting at Crieff.

The introduction of the National Grid has been an exciting development for trainees. Seven SpRs were appointed during the first round of applications and took up their positions on rotations in London , Cardiff , Bristol , Manchester , Liverpool and Birmingham in 2003. All have been formally welcomed into TiPGHAN and I’m sure will make valuable contributions to our forum.

Now that the Grid is in place, a priority for trainees and BSPGHAN Council alike will be to ensure consistent high quality teaching and training across the regions. We are delighted to have a Postgraduate Day included in the Winter Meeting for the first time in 2004. This will be open to all BSPGHAN members with priority for trainees. We are hopeful of a good attendance and the meeting promises to be extremely educational and also sociable, with an evening of wining and dining!

Our goals in 2004 will be in further improving communication between trainees, not only for those presently in training but also for those SHOs and Core SpRs wishing to train in our specialities. To this end, I would ask that if anyone becomes aware of a trainee in this position, please encourage them to contact myself or one of the committee, who will be delighted to welcome them to TiPGHAN and give advice about training. Our website planning continues to progress and we hope to have an updated and fully functional section of this website up and running early in 2004. Finally, we are keen to further explore the creation of national training days for trainees. These will be vitally important for both education and for establishing links with people around the country.

Lastly, we look forward to seeing as many of you as possible at Crieff in January but please be warned that we intend to win the traditional annual consultants versus trainees football match this year!!

Helen Evans – Secretary TiPGHAN helen.evans@blueyonder.co.uk

Committee members:

Nikhil Thapar (Chairman) thaparn@doctors.org.uk

Richard Russell (CSAC Rep) richardkrussell71@hotmail.com

Helen Evans (Secretary) Helen.evans@blueyonder.co.uk

Diana Flynn flynndiana@hotmail.com

Sian Kirkham sian@siark.com

 

 

WEBSITE REPORT

The BSPGHAN website has continued to function reasonably well over the last 12 months. The design and feel of the site are essentially unchanged over the last year. We continue to use email as the main source for disseminating information about changes on the website. With each mailing however there are at least 20 returns, meaning that we don’t have the correct Email address for all members. I know our secretary is working very hard to try and keep the list updated and ultimately it is your responsibility to inform us of any changes in address.

The vacancy page has been used increasing over the last year to advertise medical, nursing, scientific and dietetic posts. In October 2003 this page on the website had 226 hits. The next most popular page with 223 hits was the page outlining future meetings and third behind that was the training page which gives information about higher training in paediatric gastroenterology and nutrition. Overall the website is having about 600-700 hits per day and so far there have been over 20,000 hits between January and November 2003.

In order to work well the website needs to be continually updated. A simple entry and change to the site takes about 20 minutes to do and a more complex entry can take up to an hour. It is therefore very helpful if entries can be sent to me either as Word or Acrobat files. In addition entries relating to meetings should be laid out in the same format as other entries presently displayed on the meeting page.

Any members keen to help with the development or running of the website should feel free to contact me at michael.bisset@arh.grampi a n.scot.nhs.uk

 

Michael Bisset

November 2003

 

DGH SUBGROUP OF THE BSPGHAN

The inaugural meeting of this new sub-group was held at the RCPCH in London on 27 th October 2003, and was attended by paediatricians from most corners of the UK . Attendees were from a varied background including DGH paediatricians with an interest in gastroenterology, to paediatric gastroenterologists from smaller/ newer teaching centres and a spread between the two. It was agreed that membership of the group would not be exclusively limited to those from a strict DGH background, as others felt that their interests could be better represented in a group such as this. A number of issues were discussed including what the function of the group could/should be in the context of the BSPGHAN remit, a survey of practice for non-tertiary gastroenterologists, establishing a reliable database, training opportunities in non-tertiary centres for those wishing to become a DGH paediatrician with an interest, DGH – tertiary links, development of standards of care, and research and audit opportunities. An election for the posts of Chair (who will, subject to Council approval, sit on Council) and Secretary will be held in 2004. We will be meeting again at Crieff where all paediatricians with an interest in gastroenterology or paediatric gastroenterologists who feel that they would benefit from membership of this group will be welcome to join us.

 

Stuart Nicholls

December 2003

 

ENDOSCOPY STEERING GROUP

Areas of Interest

With respect to Paediatric Endoscopy issues this last year has focussed on the place or otherwise of sedation versus general anaesthetic for these procedures. Clearly, therapeutic procedures are GA-orientated, but the place of diagnostic procedures under sedation has met with differing viewpoints. This process has not been helped by the SIGN Group who produced a document suggesting GA occur for all procedures of this nature under the age of eight, because the evidence cited was of low grade, and hence the available evidence-base was somewhat unproven. A survey of all the referral units in the UK and Ireland represented by members of the BSPGHAN and a number of the larger DGH Units occurred. This showed all units (31 responses) except one performing all diagnostic procedures under the age of eight under general anaesthetic and some units performing 10-20% diagnostic procedures between the ages of 8 and 16 under general anaesthetic. Further discussions are required to determine the next step on the road to producing a position statement of the BSPGHAN. It was agreed to invite members of the Society to provide any comments in regard to this issue.

The other major issue which is evolving is the that of training. Points for continuing debate which are likely to be soon resolved include:

Training Unit Assessment associated possibly with CSAC-associated visits; basic endoscopy courses; hands-on courses; trainers going on ‘training the trainer’ courses; place of log books (and whether they are being used); specific end points for specific trainees with a goal of eventual specific endosopic CCST, specific for paediatric endoscopy training, but this is some way off; and finally the place of new training initiatives such as virtual model training, practical scope handling learning, net-based training for legion recognition.

Steady progress is being made to proposals for resolution of each of the above issues. Comments are very welcome as always. It should be pointed out that a new Joint Advisory Group on endoscopy training (JAG) document is available at the web page: www.thejag.org.uk . This has had paediatric input all along and has included the consensus statements agreed to by the BSPGHAN Membership over the last eight years.

The other point is that the World Congress in Paris occurring as you will know in the summer will have a postgraduate endoscopy course preceding it.

 

Mike Thomson

December 2003

 

 

IBD WORKING GROUP REPORT

The IBD Working Group was established in September 2000 and includes a broad mix of BSPGHAN members and associate members from across the UK . The group has worked closely with the RCPCH to develop evidence based guidelines for the management of paediatric IBD. A systematic review of the paediatric literature has been completed and has demonstrated a lack of high quality studies in children. In view of the lack of evidence it has been decided to proceed with the development of consensus based guidelines using a Delphi style consensus process. Further details will be circulated in the New Year.

The systematic review has emphasised the need for adequately powered paediatric studies and the group will be happy to consider any proposals from members of the BSPGHAN or elsewhere. A long-term multicentre study of enteral nutrition v steroids which will also address the role of azathioprine is being planned. For further details please contact Stephen Murphy.

A retrospective audit of infliximab has been completed (preliminary results presented at ESPGHAN) and a prospective audit is being planned. For further details please contact Sally Mitton or Tony Akobeng.

Elections for a new chairperson (currently Adrian Thomas) and secretary (currently David Wilson) will take place in the New Year. Members of the group are expected to be actively involved and will be replaced if they don’t attend three consecutive meetings. Please contact David Wilson if you are interested in joining the group.

 

Adrian Thomas

December 2003

 

CHILDHOOD CONSTIPATION WORKING GROUP

The group met 4 times this year. The original remit of the group was to produce national guidelines for the management of childhood constipation. This has not been possible due to lack of research to support ‘best practice’. The group organised a consultative workshop in March to get a clearer remit for the future direction of the group. The feedback from the day can be divided into three key areas and gives the group a clear remit for the coming year:

Research

·  To design a Research Map –this would give us an idea of where we are now and where we need to go! It would foster multi team working and collaboration.

·  Researchable questions – gaps in research, what do we want /need to know?

·  Register of Studies/ research ideas – what has been done, who is doing projects etc.

Members of the group had put in unsuccessful bids for the HTA call for projects. The group felt HTA were not asking right questions and the group need to pursue the issue of what is happening to this funding. The group will write to HTA asking for background of call for bids and what they were actually looking for. Also put committee forward as advisors if money still available and offer to refine question.

 

 

Guidelines

 

Education

• Design a Modular Course for health professionals. This will support best practice. ? advanced level
• Distance Learning Pack/ Web based learning

Need to access funding for research fellow to take forward Framework and this would feed into research map

Three members of the original committee have had to resign due to personal commitments. In order to maintain the group diversity a number of specialist advisors have been invited to comment on work or proposals for work as required. The group would like to approach other people who have an interest in joining the group, which would increase the ability of the group to move projects forward and spread the workload.

The group is planning a committee web page on BSPGHAN Website, which will outline work completed to date and give members opportunity to feed into group. Please send any information or comments to Jenny Gordon.(js.gordon@napier.ac.uk)

A second study day is planned for Nottingham in October 2004. The proposed date is 15 th October.

 

Jenny Gordon

December 2003

 

COELIAC WORKING GROUP

The following is the outline of the group activity for Jan 2003 to Dec 2003

1. National questionnaire audit for the management of coeliac disease: this study is just completed, the preliminary findings showed discrepancy between units on issues such as screening of siblings and children at risk, patients follow-up, and the need and the timing for gluten challenge. The study highlighted the need for national guidelines which the working group will to address.

2. Established links with diabetologists (Prof Dunger team), this will help us in sharing and disseminating evidence base practice for screen timing etc for children with IDDM and to establish a collaboration for research studies.

3. Coeliac group has been involved in drafting national prescribing

guidelines for primary care.

4. The group recently met with the chief executive of Coeliac UK . It was agreed for establishing close collaboration on a number of issues including, raising disease awareness, patients (children) education which is lacking at present, national audit and involvement of some two members the coeliac group on the associate MAC for Coeliac UK

 

Muftah Eltumi

December 2003

 

 

SERVICE PROVISION WORKING GROUP

Mark Beattie

Rob Heuschkel

Ian Sanderson

Mike Thomson

 

Guidelines for Purchasers

Following many useful comments over the last 12 months, the group met and incorporated many of these into the document that had been posted on the website after last year’s annual meeting.

In addition to refining this longer document, our specialty, along with all other sub-specialties, was asked by RCPCH to provide a 2-page document to inform the NSF College Working Group. The document was requested at short notice, and was to highlight the strengths and weaknesses of our current service provision, whilst making recommendations about how best to deal with existing and future pressures.

A shortened document has been produced and circulated amongst council members before being forwarded to the college. It included concerns about the impact of the EWTD and the trend to a more consultant-delivered service.

As the document has not been finally ratified, it is available electronically for those interested by request and will be circulated to the full membership in due course

 

R Heuschkel

December 2003

 

THE REGISTER OF PAEDIATRIC INFLAMMATORY BOWEL DISEASES.

The register is continuing to collect consented data on newly diagnosed children with inflammatory bowel disease. To date we have 271 Crohn’s, 135 Ulcerative Colitis, 48 Indeterminate Colitis, 1 Orofacial Granulomatosis and 6 Crohn’s Disease & Orofacial Granulomatosis thus totalling 461 consenting patients. Many of you will have seen the invited editorial in Archives which pulled together the experience of the register so far (Issues & experience around the paediatric register of inflammatory bowel disease. Arch Dis Child 2003;88:891-893. Taylor ,L., Casson,D., Platt,M.J.) The difficult learning curve, which has taken considerable time, has reached its peak. Judging from the way submissions are being received it is apparent that the registering process has become firmly established and widely accepted.

Funding is secure for another year due to astute financial management of the original kind support by CICRA and a further commitment from SHS and from Nestle. In addition SHS have made a substantial contribution to the subsequent 2 years.

There are various planned research projects which will, I trust, demonstrate what potential the register has for providing epidemiological data, qualitative data and cohorts appropriate to any given research trial.

The personnel involved in the register recognise that it is beholden on them to provide the initial research projects. Subsequently it is to be hoped that others will consider applying for use of this resource.

I am grateful for the continued commitment of colleagues to this initiative and would urge all to continue. Despite an apparent lack of output, in the big world of registers we are still ahead of the game and useful outputs will be forthcoming.

We are once again at full staffing levels. Lucy Taylor has returned following maternity leave and will resume her post as research assistant looking at the development of incidence measures. In her absence Carla Roberts was employed and has carried through many changes with great efficiency. We have achieved the funding necessary to continue employing her. Her remit will be to support the various projects as well as ensuring the smooth day-to-day running of the register.

A project assessing relapse rates is presently being piloted at the Royal Liverpool Children’s Hospital and will be appropriately taken over by the register once the pilot appraisal is finished.

Please note our contact details below. We are happy to discuss any issues.

Mrs Lucy Taylor – E-mail: lbtaylor@liv.ac.uk

Mrs Carla Roberts – E-mail: robertsc@liv.ac.uk Tel: 0151 293 3566

Dr David Casson – E-mail: David.Casson@RLCH-TR,NWEST.NHS.UK Tel: 0151 228 4811 ext 2714

 

REPORT FROM THE SPECIALIST ADVISORY COMMITTEE ON PAEDIATRIC GASTROENTEROLOGY, HEPATOLOGY & NUTRITION

In last year’s report, I mentioned the two objectives for CSAC. One was to develop a modular training programme in gastroenterology, hepatology and nutrition. The other was to develop a national grid for gastroenterology and hepatology. In addition, the Regional Training Advisors, Dr Anil Dhawan and Professor Peter Milla have been active visiting centres.

A modular form of training has been agreed for both hepatology and gastroenterology. Hepatologists and gastroenterologists will do two years in their primary speciality with six months in their minor sub-speciality with six months nutrition spread over the three years.

The main developments in the modular training programme have been to establish nutrition more formally. A six month nutrition syllabus has been approved for those training in hepatology or gastroenterology. Two more developments are envisaged. The first is to develop a two year training programme in nutrition. This will also require six months in gastroenterology or hepatology and six months in another sub-speciality. The second is to develop a six month module in nutrition in nutrition training centres to offer to other CSACs, particularly to neonatology, metabolic disease and endocrinology. Discussions on this module will take place with the Royal College of Paediatrics and Child Health. We have established a third training advisor in nutrition. Centres that have a primary nutrition interest now have the choice of being visited by a gastroenterologist and a nutrition representative.

A National Grid was started in 2003. Interviews took place in March. Seven new paediatric gastroenterologists entered the Grid. They received their log books and were encouraged to join the Society. Their names were also passed to the trainee’s representative so that communication was enhanced.

 

Ian Sanderson Jan 2004

 

THANKS TO MEMBERS FOR SUBMITTING REPORTS. APOLOGIES FOR ANY ERRORS OMMISSIONS 

MARK BEATTIE - JANUARY 2004

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