by BSPGHAN | Jun 7, 2020 | News
Dear members
This week there is has been much to watch. We are uncertain what releasing of lockdown means in terms of keeping our patients and ourselves safe; what antibody testing of NHS staff may mean, if contact tracing, and wearing of surgical masks in public, and quarantine for travellers, may contain a second wave of Covid-19. We are watching out for the new paediatric multi system inflammatory syndrome, vaccine development , and the scramble for Covid-19 trial outcomes. What does seem certain is that harnessing new ways of working, planning the recovery of services and maintaining social distancing will be important to maintain for many months as we move out of lockdown and start to resume paused activity.
Please do take the time to respond to the request the questions in the survey so that Bspghan can support members in capturing beneficial clinical changes
Update to RCPCH advice – Shielding children
BSPGHAN continues to work with colleagues in the RCPCH to produce guidance on which children remain more at risk of COVID-19 related disease. It hasn’t been straightforward to produce the update with the uncertainty of what the releasing of lockdown/ school return will mean at this stage of the pandemic. Publication of the document is expected this week. The delay will allow engagement with colleagues in primary care, and more widely across the UK through the CMOs, thereby maximising the benefits of the update into a wider policy around shielding.
Resetting, restoring and recovering services
The ability of PGHAN services to deliver care during the pandemic has also been tested. Now we are moving forward re-starting services. The need for ‘COVID- safe’ practice with social distancing, will be a reality for the medium to long term and challenge our ability to manage the backlog of clinics and endoscopy cases.
A robust system of documenting patients waiting, and triaging is important.
The RCPCH has set out principles for recovery here:-
https://www.rcpch.ac.uk/sites/default/files/2020-05/reset-restore-recover-rcpch-principles-for-recovery-2020-05-20.pdf
- Planning children’s health services should be reset and underpinned by data and evidence so that innovation and new models of care that meet the needs of children and young people are maintained.
- Delivery of children’s health services should be restored so that all children and young people receive high-quality, safe and effective care in every setting, ensuring timely diagnosis with a particular focus on supporting community services. There should be no diminution in facilities and adherence to current standards must be maintained.
- The paediatric workforce should be recovered, bringing paediatricians back to children’s services and their training pathway, including sharing new ways of working with a focus on wellbeing.
Capturing beneficial clinical changes in the NHS – please check the NHS E survey questions in the link and please respond to enable Bspghan to share innovative ways of working with members.
In response to the challenges of delivering care during the pandemic, new and innovative ways of working have been rapidly developed across the NHS.
As we move into the next phase of NHS recovery, NHSEI wants to ensure beneficial changes to care are embedded in our services so that patients benefit over the next 12 months and beyond.
BSPGHAN will send in a response, to be populated by your returns.
I am keen to hear from everyone (not just from those in England), what beneficial clinical changes/ innovations have occurred within our speciality to share with members.
Please think of examples of what you’ve seen working well that should be captured and sustained, and what is needed the sustain the change.
It would be handy to describe the impact of these innovations in terms of patient’s outcomes , safety, productivity and how the benefits are measured.
Please do take the time to :-
- a) email me at President@Bspghan.org.uk with your examples and
- b) open the short survey questions in this link – members in England can of course respond and share your thoughts too.
Impact of pandemic on Training
Training have been disrupted with a loss of the usual learning opportunities, particularly where endoscopy procedures and clinics have not taken place.
As clinical services begin to be restored, the urgency to deliver on the backlog of elective care, and the need to limit face-to-face clinics will continue to compromise training opportunities.
BSPGHAN Trainees have found ways to interact and learn with weekly Zoom teaching to make up for lack of opportunities to meet the curricular requirements in the expected way.
BSPGHAN will support these sessions and endorse these as we hear that for around 50% of trainees, formal weekly teaching has not been restored.
Trainees have been advised by CSACthat changes have been made to ARCP outcomes; see https://www.copmed.org.uk/publications/covid-20 to enable as many doctors in training as possible to progress. PGHAN supervisors are asked to focus on delivering high quality supervision and teaching with clear plans to address the shortfall in experience that has resulted from the loss of training opportunities during the pandemic.
Interesting read
Epidemiology, Clinical Features, and Disease Severity in Patients with Coronavirus Disease 2019 (COVID-19) in a Children’s Hospital in New York City, New York
https://jamanetwork.com/journals/jamapediatrics/fullarticle/2766920?utm_source=undefined&utm_campaign=content-shareicons&utm_content=article_engagement&utm_medium=social&utm_term=060320#.XtgWQRKCuQM.email
Key findings from a case series of 50 children and adolescents 21 years and younger hospitalized with COVID-19 infection.
- Respiratory symptoms, while common, were not always present.
- Children commonly had comorbidities (immunosuppression including solid organ transplant * neurological disease, asthma, genetic and cardiac disease etc)
- Infants and immunocompromised patients were not at increased risk of severe disease.
- Obesity was significantly associated with disease severity.
- Elevated inflammatory markers were seen in those with severe disease.
*including hepatitis in one patient who received a liver transplant for whom the donor was found to be SARS-CoV-2–positive posttransplant
I hope that these updates are of interest and that you and your family and friends continue in good health.
As always, I welcome your feedback via email President@Bspghan.org.uk
Sue Protheroe
BSPGHAN President
7th June 2020
by BSPGHAN | May 17, 2020 | News
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
by BSPGHAN | May 10, 2020 | News
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
- 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/
- 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”
- 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”.
- BSPGHAN supports units trying to re-establish diagnostic endoscopy for suspected new IBD presentations where possible and to continue emergency endoscopy provision.
- 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.
- Where possible paediatric endoscopy pathway should be in COVID-19-free areas of the hospital
- 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
