BSPGHAN Updated Shielding Guidance and Advice on Returning to School for Children with Gastrointestinal, Liver and Nutritional problems

BSPGHAN Updated Shielding Guidance and Advice on Returning to School for Children with Gastrointestinal, Liver and Nutritional problems

Dear members,  

Please find:

1. BSPGHAN Updated shielding guidance and advice on returning to school for children with gastrointestinal, liver and nutritional problems and

2. BSPGHAN IBD Working Group – Coronavirus (SARS-CoV-2) and COVID-19 in children with IBD- Position Statement: Guidance for Returning to School 


Best wishes Sue Protheroe 

BSPGHAN President 

28th May 2020 

BSPGHAN Updated Shielding Guidance and Advice on Returning to School for Children with Gastrointestinal, Liver and Nutritional problems

President Update 17th May 2020:
1. BSPGHAN Award
2. Return to school -RCPCHadvice
3. ESPGHAN Parental advice
4. JAG accreditation and endoscopy recovery

BSPGHAN award
I am delighted to announce that Kwang Yang Lee has been awarded a BSPGHAN award for innovation in recognition of his significant achievements. You will be aware that Kwang Yang has redeveloped the BSPGHAN web site to offer a professional appearance, high quality illustrations and ease of navigation, giving the site the refreshment that was due. The award was also given for appreciation of the Covid Information Hub, helping members stay informed during the pandemic and for organising the regular BSPGHAN endorsed Zoom teaching for trainees. I am sure you will wish to congratulate him on this award. Please also get in touch if you can offer remote teaching e-mail webmaster@bspghan.org.uk
Thank you.

 

Principles to help paediatricians talk to children and families about returning to school.  https://www.rcpch.ac.uk/resources/covid-19-talking-children-families-about-returning-school-guiding-principles
BSPGHAN has been working in partnership with the RCPCH on Speciality specific advice to help describe those patients who may be extremely vulnerable. This advice is being coordinated with all stakeholders including NHS, Gov.uk and charitable partners.

 

ESPGHAN COVID-19 parental advice guide.

This short guide provides information and guidance for parents on gut, liver and nutritional conditions in children during the COVID-19 pandemic. Please find the parental advice guide by clicking here.

http://www.espghan.org/education/covid-19-advice-guide/

JAG accreditation: Supplementary environment guidance following the COVID-19 pandemic
This guidance provides a framework to assist endoscopy services to adapt their environment following the COVID-19 pandemic. It can be used by all endoscopy services in the UK and will be referred to during accreditation assessments. Restoration of services will vary significantly and so this guidance provides practical points for consideration locally and BSPGHAN Endoscopy Working Group is working on paediatric specific support for recovery of endoscopy services

I hope this bulletin finds you and your families in continuing good health. Looking after your mental wellbeing has never been so important.  Please don’t hesitate to get in touch if you need support during these challenging times and we can signpost you resources to support you.
Best wishes
Sue Protheroe, e-mail President@bspghan.org.uk
BSPGHAN President May 17th 2020

 

President Update 10th May 2020 Presidents update – BSPGHAN consensus statements on paediatric endoscopy recovery and EoE; Responses from Survey; • Thanks from BSPGHAN to charitable partners • Advocacy for trainees •Articles of interest

BSPGHAN is working to support recovery and restoration plans.

We are revising the list of conditions for children who should be shielded in line with what we know about the risks associated with COVID-19. This work, with the RCPCH, should provide the basis for advice on who should continue to shield once schools return. It emphasises the need for identification to be led by paediatricians/MDTs for those instances beyond a small core list of severe conditions.   

Content of todays bulletin

NEW BSPGHAN consensus statements on endoscopy recovery and management of EoE (attached and will be added to Covid Information Hub)
Survey feedback (attached)
Thanks from BSPGHAN to charitable partners
Advocacy for traineesArticles of interest
NEW Check out the BSPGHAN Covid Information Hub https://bspghan.org.uk/news/covid-information-and-guidance-information

BSPGHAN consensus statement on Paediatric endoscopy recovery and restoration during the Covid-19 pandemic May 10th 2020

  1. BSPGHAN endorses the British Society of Gastroenterology (BSG) position paper with some paediatric-specific amendments.

https://www.bsg.org.uk/covid-19-advice/bsg-guidance-on-recommencing-gi-endoscopy-in-the-deceleration-early-recovery-phases-of-the-covid-19-pandemic/

  1. The risks of transmission of SARS-CoV-2 to staff (especially those handling and cleaning the scopes) as a consequence of undertaking endoscopy are still unknown. Paediatric endoscopy takes place in a high-risk area; an anaesthetic is given by general anaesthetic (GA) or by total intravenous anaesthetic (TIVA) with laryngeal mask (LMA) which are both aerosol-generating procedures. We advise that upper and lower GI endoscopy under GA or TIVA be undertaken with level 2 PPE (FFP3 masks or respirators) until risk of transmission from faeces becomes clear. The BSG guidance acknowledges that there are other circumstances to be considered when deciding on PPE and states “It is important that consideration is given to other elements of endoscopy as well as the procedure itself. These might include but not be restricted to: use of nitrous oxide, oxygen gas (Entonox), use of nasal oxygen, administration of throat spray or enemas”
  2. Careful consideration needs to be given to the risk of exposing children and their families to a high-risk environment vs. the benefit of performing diagnostic endoscopy. The risk for staff also needs to be evaluated particularly in light of the evidence of increased risk amongst BAME colleagues. Chief Executive of NHSE, Sir Simon Stevens suggests that: “regarding people from BAME backgrounds … we recommend employers should risk assess staff at potentially greater risk and make more appropriate arrangements accordingly. Organisations should continue to assess staff who may be at increased risk including older colleagues, pregnant women, and those with underlying health conditions and make adjustments including working remotely or in a lower risk area”.
  3. BSPGHAN supports units trying to re-establish diagnostic endoscopy for suspected new IBD presentations where possible and to continue emergency endoscopy provision.
  4. Centres should adhere to the same COVID-19 screening protocols developed by their co-located adult colleagues in gastroenterology and/or the pathways developed for paediatric surgical patients undergoing urgent and elective procedures.
  5. Where possible paediatric endoscopy pathway should be in COVID-19-free areas of the hospital
  6. Please refer to Gov.uk guidance on PPE (Appendix 1)

BSPGHAN Eosinophilic Esophagitis (EoE) Working Group
Position Statement: Management of paediatric EoE during the Coronavirus outbreak.  28th April 2020

Survey Feedback: Thank you very much for your responses; the majority within the first few hours. It’s  a helpful snapshot of views while planning recovery, restoration of paused services and supporting families as the lock down eases.

Heartfelt thanks to charitable partners
BSPGHAN sent sincere thanks from all our members to the teams at CCUK, CICRA, and CLDF for their work in championing the needs of families.  They are facing a serious funding crisis at a time when we are relying on them more than ever. They work tirelessly in partnership with us to provide invaluable support and tailored family information that we have struggled to offer. They also make a massive contribution to the working life of professionals, by taking on communication strategies and campaigns. We offered a small token of financial support to thank them and show how much we appreciate their work.

Advocacy for trainees:  https://www.rcpch.ac.uk/news-events/news/advocacy-trainees-over-covid-19-pandemic

Articles of interest :
1.Challenges in chronic paediatric disease during the COVID-19 pandemic: diagnosis and management of inflammatory bowel disease in children.  https://adc.bmj.com/content/early/2020/05/07/archdischild-2020-319482 
2.COVID-19 and the gastrointestinal tract: emerging clinical data

a) 10.1% of a cohort with coronavirus–infected pneumonia presented with diarrhoea and nausea, preceding fever and respiratory symptoms by 1–2 days
b) Endoscopy – SARS-CoV-2 was detected in the oesophagus, stomach, duodenum and rectum of the two most severe patients and also in the duodenum. The implication is uncertain but raise the issue of gastrointestinal involvement and potential faeco-oral transmission,
c) Uneventful course in patients with IBD during SARS-CoV 2020 in Northern Italy – awaiting data from Espghan Porto and SECURE-IBD database.
d)The clinical importance of continued presence of RNA in the stool is uncertain and further work is required to determine risk
e) Risk of surgery during incubation period in some does start to ask the question as to whether testing prior to surgery should become routine
https://fg.bmj.com/content/early/2020/04/27/flgastro-2020-101507

3.Gastrointestinal endoscopy during COVID-19: when less is more  https://fg.bmj.com/content/early/2020/04/15/flgastro-2020-101492

Please check out the BSPGHAN website for the new Covid Information.  https://bspghan.org.uk/news/covid-information-and-guidance-information

Thanks to Carla and our webmaster Kwang Yang Lee for their amazing work.
Best wishes to you all; please stay well and in continuing good health. 

Sue Protheroe 
BSPGHAN President May 10th 2020e-mail: President@bspghan.org.uk

Consultants in Paediatric Hepatology

Closing Date: 04/06/2020

Employer: Leeds Children’s Hospital

We are looking for individuals to fill two replacement posts within the Paediatric Hepatology Department at the Leeds Children’s Hospital. One post will be available from September and the other from 1st December 2020, depending on availability of appointee. 

The Paediatric Hepatology Department in Leeds is a National Specialist Service for the assessment, diagnosis, treatment and follow-up of children who have a wide range of acute and chronic liver disease, portal hypertension, or intrahepatic lesions. 

For more information, see: https://www.jobs.nhs.uk/xi/vacancy/916041319 .

President Update 3rd May 2020

President Update 3rd May 2020

I hope this email finds you in continuing good health. 

We are taking stock while coming through a “peak ” of hospitalisations and set to enter the second phase in the NHS’s response to Covid-19
On April 29th we heard from the NHS CE and CEO about:-

  • ​Increased Covid-19 testing capacity – a pilot followed by roll out of regular testing to asymptomatic staff, guided by PHE and clinical advice.  
  • NHS to step up non-Covid19 urgent services as soon as possible with attention to infection prevention and control and start of some routine non-urgent elective care. 
  • Provisional plans to factor-in the availability of associated medicines, PPE, blood, consumables, equipment and other needed supplies.
  • Expanded winter flu vaccination campaign alongside a school immunisation ‘catch up programme’.

Now more than ever a safety and learning culture is vital. BSPGHAN has been working with the RCPCH, PHE and  NHS E this week to:- 
1. identify which patients should be recommended to still  “shield” (or stay at home with stringent social distancing) once lockdown restrictions are lifted and 
2. understand more about the impact of delayed presentations to healthcare or delayed delivery of care within our speciality
3. consider recovery and restoration plans of our routine activity for children and young people.

I would like to hear from members about these issues and what your current concerns are.  I will email out a survey monkey very soon. It should only take a few minutes to complete and I would be very grateful if you would return it straight away if possible and by Tuesday May 6th at the latest please. Thank you.

NICE Covid-19 rapid guideline: children and young people who are immunocompromised- published May 1st 2020 NICE guideline [NG174] https://www.nice.org.uk/guidance/NG174
This guideline is designed to be used alongside our professional guidance.  It aims to maximise the safety of children, protect staff from infection and enable services to make best use of resources during the pandemic. It can be updated as necessary. 

Children with a systemic inflammatory response – be aware and notify https://www.rcpch.ac.uk/sites/default/files/2020-05/COVID-19-Paediatric-multisystem-%20inflammatory%20syndrome-20200501.pdf
Most children are asymptomatic or exhibit mild symptoms from COVID-19 infection. However in the last two months a small number of children have been identified who develop a significant systemic inflammatory response which may be associated with COVID-19.

COVID-19 and the gastrointestinal tract: emerging clinical data https://fg.bmj.com/content/early/2020/04/27/flgastro-2020-101507
– prevalence of virus in the stool is important, impacting on endoscopy provision. 
​- clinical importance of continued presence of RNA in the stool is uncertain.
– the likelihood of faeco-oral transmission is low. 
– data on outcomes of adult patients undergoing surgeries during the incubation period of COVID-19 infection​ –  should  testing prior to surgery become routine?

Outcomes of COVID-19 in 79 patients with IBD in Italy: an IG-IBD study. https://gut.bmj.com/content/early/2020/04/30/gutjnl-2020-321411
– Active IBD, old age and comorbidities were associated with a negative COVID-19 outcome, whereas IBD treatments were not. 
– Preventing acute IBD flares in patients with IBD is important.

BSG Guiding principles on restoration of endoscopy services.   https://mailchi.mp/fb3ebe293ed0/welcome-to-the-august-edition-of-the-bsg-e-newsletter-12317385?e=12419cdbd5
– Consensus opinion and review of the available evidence.
– Some data is not yet available; some data is inconclusive: in this guidance, therefore, the safety and wellbeing of patients and staff is taken as paramount​. 

The pressure will remain in these uncertain times. Look after each other and be aware that enhanced and active support from your NHS employer is there to ensure your wellbeing and safety.

Please take a few minutes to report back in the anonymised survey. It asks about your concerns about your personal wellbeing and that of your patients as well as your answers to the questions above (1). THANK YOU. 

Best wishes
Sue
BSPGHAN President May 3rd 2020  e-mail President@bspghan.org.uk

COVID 19 Grid Trainees – Update from CSAC 26th April 2020

I hope everyone is staying safe and keeping well during these unprecedented times when we are all having to think, work and function in very different ways – very stressful and very tiring, including the challenge of trying to practice Paediatric Gastroenterology with only limited access to endoscopy.

I wanted to update you with regard to training and our trainees many of whom have effectively had their training suspended partly because of the need to cross cover other areas but also as a consequence of the secondary impact of the endemic on our specialty.

I have been in touch with them regularly.

There are a number of issues which are general to all trainees and some specific to our specialty. These include uncertainty regarding training, progression, assessments and rotations.

David Evans has done a helpful update – see link  appended which is being regularly updated

There will be a modified ARCP process and we are awaiting the specifics and timeline and will facilitate CSAC progression forms once that is clear. The modified process will mean that the impact of COVID on training can be factored in.  The trainees will be concerned about clinical exposure, team meetings and endoscopy. There will be particular anxieties about exposure and training in endoscopy  with most services on hold at the moment, uncertainty about when they will resume and there being a likely need for significant catch up when that occurs.

We have had to cancel the face to face trainees meeting in May but have set up a virtual meeting and the potential for 1 to 1 discussions via Microsoft teams – I guess we are all getting used to this new way of working.

In the meantime – if possible – please continue to meet with your trainees regularly and facilitate training a much as possible so they we can offer them as much support as we can.  

All the best

Stay safe and keep well

https://www.rcpch.ac.uk/resources/covid-19-rcpch-trainee-progression-uk-through-2020#annual-review-of-competence-progression-arcp

Mark
Professor RM Beattie
Consultant Paediatric Gastroenterologist
Honorary Professor of Paediatric Gastroenterology and Nutrition
Chair of the Royal College of Paediatric and Child Health (RCPCH) College Specialty Advisory Committee (CSAC) for Paediatric Gastroenterology, Hepatology and Nutrition e- mail csac@bspghan.org.uk

President Update 23 April 2020- 1. NICE Guidance gastro and liver conditions 2. CCUK Decision tree for children 3. Vulnerable children guidance 4. Zoom teaching for trainees

Dear members,

I hope this message finds you well. BSPGHAN has been working with key stakeholders on rapid guidance. Please have a look at the following links- 


1. COVID-19 rapid guideline on gastrointestinal and liver conditions https://www.nice.org.uk/covid-19

2. CCUK decision tree for children- isolation/ social distancing and shieldingApplicability of “shielding” is complex for children as the evidence for risk of serious illness / mortality from Covid-19 amongst children who are immune suppressed is very limited. This decision tree for families is welcome. 

crohnsandcolitis.org.uk/news/advice-for-people-with-crohns-and-colitis-self-isolation-social-distancing#child-risk

If you’d like to share via social media there is also a short link crohnsandcolitis.org.uk/decision-tree-children
See also RCPCH Shielding list .

3. Vulnerable children guidance

There are unintended consequence of lockdown on some vulnerable families (i.e. those known to CAMHS, social services and those with education, health and care plans.) see PHE Vulnerable children guidance. Bspghan is linking up with the Rcpch and the children’s team at NHS England to consider which groups should continue shielding once the lockdown restrictions are lifted. 

4. Zoom teaching for Bspghan member trainees

I am grateful to our webmaster who has arranged weekly national teaching. The session yesterday was a success with 40 participants. There is uncertainty over training opportunities, progression, rotations, CCT and access to training. PGHAN Csac is actively linking up and supporting trainees. 


5. Strategy 

BSPGHAN has set out a new strategic focus while some initiatives are paused. We continue to contribute to national guidance to keep our patients and colleagues well and as safe as possible. Thinking ahead, we are tackling how best we will support recovery of services, training needs and ensure that children’s best interests are considered when lockdown restrictions start to ease. 

If you wish to highlight issues or signpost to resources, please do get in touch. Please have a look at the website, which is currently being reorganised so that you can find information more easily. Personal thanks to Carla and Kwang Yang Lee our administrator and webmaster for their expertise and to Council for coming together today for an extraordinary meeting. 

With very best wishes 

Sue 

BSPGHAN President

23 April 2020

President Update:  Sunday 19th April 2020   1. BSPGHAN IBD WG Position statement 2. BSG IBD Covid WG Guidance 3. RCPCH Guidance on shielding 4. Non Covid publication

President Update: Sunday 19th April 2020 1. BSPGHAN IBD WG Position statement 2. BSG IBD Covid WG Guidance 3. RCPCH Guidance on shielding 4. Non Covid publication

Dear Members

“For all those people who are finding it difficult at the moment: the sun will shine on you again and the clouds will go away.”

Captain Tom Moore has to date raised more than £25m for NHS Charities Together https://www.nhscharitiestogether.co.uk/ His words have embodied the outpouring of gratitude for Britain’s doctors, nurses and other healthcare workers on the front line.

Captain Tom got it right. He focused on the sacrifices made by health service workers and the efforts of everyone, who has been isolating since March 23. “You’ve all got to remember that we will get through it in the end, it will all be right, it might take time,” “At the end of the day we shall all be ok again.”​

We are humbled by his efforts and appreciation of the amazing work that frontline professionals are maintaining despite extraordinary pressures. The NHS has moved quickly and effectively to convert conference centres into Nightingale Hospitals. Professionals need the protection equipment to make them feel safe. Please make best use of supplies so that those working in high risk sectors are not short of adequate PPE and exposed to risk.

BSPGHAN has engaged with key organisations this week, NICE, RCPCH, BSG as well as our charitable partners. I will signpost you when the Covid-19 NICE Rapid guidance is published on Gastrointestinal and Liver conditions this week and guidance regarding Children who are immunosuppressed shortly after.

Please remind yourself below of the –

1.Bspghan IBD WG advice, and see new guidance that BSPGHAN has contributed towards from-

  1. The BSG,
  2. The RCPCH and
  3. A great non Covid article of importance to the well being of our patients

Also

  1. See considerations for use of PPE, and

Most excitingly,

  1. Trainees please note. Exciting plans to support national teaching by Zoom for BSPGHAN trainee members from trainers, starting off this week live from Birmingham. A national virtual meeting of interest to members may follow.
  1.  https://bspghan.org.uk/wp-content/uploads/2020/04/COVID_IBDWG_HCP.pdf

British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) Coronavirus (SARS-CoV-2) and COVID-19 in children with IBD

Position Statement: Management of PIBD during the SARS-CoV-2 pandemic​ IBD Working Group

  1. https://gut.bmj.com/content/early/2020/04/17/gutjnl-2020-321244

The British Society of Gastroenterology (BSG) COVID-19 IBD Working Group has published service provision, medical and surgical therapy, endoscopy, imaging and clinical trials.​​ The best available data and expert opinion has generated a risk grid for adults that groups patients into highest, moderate and lowest risk categories.

3. https://www.rcpch.ac.uk/resources/covid-19-guidance-paediatric-services

BSPGHAN has contributed towards the new RCPCH guidance.

It is also important to recognise that during this current pandemic, children who are unwell remain more likely to be unwell due to a non-COVID-19 condition than to COVID-19 itself; this includes those with the conditions described in this guidance. However, some children may remain more at risk of COVID-19 related disease, and these children should be protected as far as is possible from infection by ‘shielding’.

  1. https://adc.bmj.com/content/early/2020/04/16/archdischild-2019-318713

It is good to see an important publication from one of our trainee with the Oxford team entitled “hypoglycaemia: a hidden risk in paediatric colonoscopy,” and this sounds an important topic to audit when electives lists are back up and running.

  1. https://www.gov.uk/government/collections/coronavirus-covid-19-personal-protective-equipment-ppe

You will have seen in reports there is now a real concern at national level regarding the shortage of PPE gowns. Yesterday (Friday 17 April), Public Health England issued emergency advice on the use of gowns in clinical areas should shortages arise. It is important to emphasise that everyone should organise care to make best use of stock. The safety of teams is our priority and access to the appropriate PPE.

Stay safe, and if you have news from your region or updates or guidance to share, please get in touch.

Best wishes
Sue
BSPGHAN President April 18th 2020

President Easter Message to BSPGHAN members

President Easter Message to BSPGHAN members

Dear all

I  hope this finds you all well and spending time to rest and restore your batteries over the long weekend. 

The anticipation of working in different ways and the pressure of making new judgements for patient care has been stressful. 

The calmness of the NHS and other frontline carers and their leaders has been remarkable in the face of constant change and education. Their anxiety about risks, protecting themselves and their loved ones at home is real. We hope that increasing knowledge of the virus, on keeping a safe distance and being as well protected as possible, gives them some of the peace of mind that they need.   

It is truly touching to see the tributes for key workers and the acknowledgement of the vital roles that all workers play. 

Keep cascading the message to parents that we are open for “business as usual” as per the RCPCH recent campaign (see link) and keep good records of those who need to be seen later on. 

https://issuu.com/joballrcpch/docs/covid19_advice_for_parents_when_child_unwell_or_in

I am personally grateful to all the Bspghan members who have been so supportive and working hard to contribute to national initiatives and to make new guidance rapidly. A few examples are – 

  • Messages we sent to  NHS leaders and RCPCH that we are worried about routine areas of care for children have been heard and received by government. 
  • We have helped the NHS identify and reach out to our most vulnerable patients.
  • We have written tailored guidance for families and and IBD registry 
  • We have contributed towards rapid NICE guidance. 
  • We have suggested key conditions and timelines for recovery plans when routine services start opening. 
  • We have collaborated with stakeholders and charitable partners such as the BSG, BASL, CICRA,CCUK and CLDF who have have been supportive at achieving a common goal to advise, support and protect our families and staff.  

The qualities that health professionals signed up to – sacrifice, patience, and tolerance have always been present but are clear in the acts of kindness and putting others first. Please give a particular thought to all ward based staff this weekend who are now “masked up” all day. My masked working this weekend has been in short bursts and uncomfortably hot. The ward nurses no doubt feel the same all day, but without complaint and they deserve a huge thanks. 

This crisis has shown us that we can collaborate rapidly and work together, adapt, and break out of the silos that have existed in the NHS. Please also say a thanks to the IT crowds who have worked hard to bring in remote working and conferencing overnight. 

Our thoughts go out to new staff as young medics have been hastily graduated and the retired staff who have returned. Our prayers are with them to stay strong and safe as their offers to support the NHS are not just token efforts. 

We don’t know when this will be over. We hope that Covid testing and a vaccine will bring about change. The knocks and impact on sections of society will be enormous.  Keep the connections and interactions  going. Resolutions to be mindful of the legacies are not self righteous (in my mind); if we can maintain the current emphasis on social and cultural values, and the ability to learn and respond to change when the pressures is on us, things will be different and a bit better.​

Reach out to those in your networks and beyond who may be in smaller teams. Again, a personal thanks to the friends who have helped me each in keeping you informed and connected. They are all leaders and I am enormously grateful. 

Do get in touch if you have ideas, suggestions to share with others, or if you just need a chat. 

Best wishes 

Sue 
BSPGHAN President April 12th 2020

 

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