by Chris Course, Chair WREN
The Welsh Research and Eduction Network (WREN) Spring Study Day took place at the Princess of Wales Hospital, Bridgend on 11th May 2018. Once again, attendance was well supported by doctors from across the training grades (and an Advanced Neonatal Nurse Practitioner!), as well as Dr Huma Mazhar (from Singleton Hospital), Dr Naomi Simmons (from Glan Clwyd Hospital) and Dr Judith van der Voort (Head of School) joining us for the day to learn more about how the network is getting on and our current activities.
Our educational programme was once again diverse, with talks from Dr Phil Connor and Rhian Thomas-Turner about the new Children and Young Adult’s Research Unit at Noah’s Ark Children’s Hospital for Wales and their plans for increasing junior doctor involvement. Dr Ian Morris then gave an excellent strategy for rapid-fire critical appraisal, with an emphasis on the START assessment (slides available on our website, or on request). Dr Gethin Pugh from the Quality Improvement Skills Team at the Wales Deanery also gave us an introductory workshop to Quality Improvement, as well as teaching us the basics of the Plan, Do, Act, Study model and signposting the further QI training opportunities available.
The WREN Blog continues to go from strength to strength and now receives over 500 hits a month on our articles, under the editorial leadership of Dr Rebecca Broomfield and Dr Annabel Greenwood. They are looking for contributors too, so if you have something to share or a topic you’d love to write about, please get in touch.
Four new projects are being undertaken via the network, three of which are starting now. Details of the WREN projects and their project leads are below. Project leads can be contacted on the Current Project Portfolio page. We will be disseminating these projects amongst the units, but if you would like to get involved in any of the projects in WREN’s current portfolio, please contact the project leads (details below). If you have an idea for a project you would like to develop with WREN’s help, please contact either myself or Siwan Lloyd via our website, or using the details at the top of this newsletter.
The next WREN study day is planned for November 2018 (confirmed date to follow), and we hope that you will be able to join us for another stimulating and thought-provoking study day, building on from the success of the last!
Newly Launched Projects
Project Title: ‘The Impact of the Meningococcal B Vaccination on Septic Screens’
Project Leads: Dr Ele Jones (ST5) and Dr Rebecca Towler (ST5)
Description: Pyrexia is a common adverse effect of the Meningocccal B vaccination. NICE guidelines exist for the management of fever <3 months of age and recommends investigations for sepsis for pyrexial infants but does not make comment of post-vaccination infants. This project aims to retrospectively assess how infants are managed in paediatric and neonatal units who are presenting with fever post-Meningococcal B vaccination over a 12-month period.
Project Title: ‘Aiming to improve paediatric trainees confidence with ECG interpretation’
Project Leads: Dr Ankita Jain (ST6)
Description: The Paediatric Cardiology department at UHW gets several referrals a month from various hospitals to provide their opinion on ECGs done on children for various clinical indications. We would like to help improve confidence in paediatric ECG interpretation, and have developed a structured online educational module. Using a pre- and post-quiz on ECG interpretation it is hoped to show how skills can be improved. The link for the quiz is https://goo.gl/forms/2Qj8NBZHBdOYL33d2
Project Title: ‘Can a resus drug App help improve accuracy and reduce stress in time-critical scenarios?’
Project Lead: Dr Jordan Evans (ST5)
Description: Accurate calculation of WETFLAG resus drugs is critical, but can be affected by stress and the time-critical nature of emergency scenarios. This project aims to assess whether a smartphone app can help to improve prescribing accuracy and reduce doctor stress levels in resus situations. A pilot study has shown an App to be effective, and this project aims to assess larger numbers of doctors and nurses using the technology in simulated scenarios.
Project Title: ‘Head injuries on the postnatal wards’
Project Lead: Siwan Lloyd, ST3
Description: A pilot study at UHW has demonstrated that infants being accidentally dropped on the postnatal ward is not an uncommon occurrence, however their management and level of investigation following injury was very variable. Following on from this, an all Wales study is underway to determine the incidence, risk factors and management used, with the aim of producing a best practice guideline for these infants and their parents.
Project Title: ‘Re-audit of the Management of Respiratory Distress Syndrome in Preterm Infants’
Project Lead: Chris Course, ST4
Description: Following the initial audit in 2014/2015 by WREN, a Wales Neonatal Network guideline was introduced for the Management of RDS in Preterm Infants in June 2016. The re-audit has commenced March 2018 and is running for six months to assess how the new national guideline has affected patient care.
Project Title: ‘Management of feverish illness in infants <3 months old’
Project Lead: Blanche Lumb, ST1
Description: Do we consistently meet the NICE standards set in the investigation of sepsis in <3 month old infants? This project aims to assess that the appropriate investigations occur in a timely manner, and that appropriate empirical treatment is commenced across paediatric assessment units in Wales. Where we chose to deviate from the guidance, are we documenting this appropriately?
Upcoming Projects (Planned Start September 2018)
Project Title: ‘Evaluating the impact of the introduction of the SEREN program on Type 1 Diabetes Management in Children’
Project Lead: Matthew Ryan, ST6
Description: SEREN is a structured education package for children newly diagnosed with T1DM. This project will assess SEREN’s impact by using Quality of Life questionnaires, serial HbA1c measurements and number of DKA admissions for children diagnosed with T1DM in the years pre and post introduction.
Dr Annabel Greenwood
As Trainee Representative for Paediatric and Neonatal Organ Donation for Cardiff and the Vale Health Board, I was very much looking forward to this opportunity to spread the word and raise awareness about organ donation.
The concept of organ donation in paediatric practice is relatively new but currently very topical, and a recent article in the March edition of Archives of Disease in Childhood highlighted the fact that despite recent attempts to promote organ donation, donation rates remain fairly static, particularly in the neonatal intensive care setting.
The knowledge and experience of paediatric organ donation amongst healthcare professionals is limited, and it was therefore of no surprise that when we enquired at the beginning of the simulation day whether participants had ever been involved in a case of organ donation, only two had previous experience, one of which was in adult medicine.
The paediatric simulation day was the first of its kind in Wales, and it was fantastic to see such a wide variety of the multidisciplinary team in attendance, all enthusiastic to learn more about organ donation and the processes involved.
The day began with a case presentation from Gail Melvin, one of the brilliant ‘SNODs’ (Specialist Nurse in Organ Donation). She recalled one of her experiences of neonatal organ donation and it provided a great insight into the referral process from the consideration of organ donation, right through to harvesting in theatre.
This set the scene perfectly for the simulation scenario, as the aim was to work through a case from presentation to the emergency department, to withdrawal of life-sustaining treatment, prior to organ donation. The scenario was broken down into sections, with a debriefing session after each section to optimise the opportunity for discussion. Actors played the role of the child’s parents, allowing candidates to practice the often difficult and sensitive encounters with families regarding the withdrawal of life-sustaining treatment.
The afternoon session consisted of workshop sessions, covering brainstem death testing and communication skills stations relevant to organ donation. There was also a brief session outlining a quality improvement project I am currently undertaking aiming to raise awareness of paediatric and neonatal organ donation at a trainee level.
The day was brought to a close with a parents’ account of their personal experiences of organ donation. This really hit home the huge impact organ donation can have not only on those receiving a donation, but also on the families of the donor. It was incredible to hear the strength the family were able to take in the face of extreme adversity and despair, in the knowledge that their child was able to help save the life of others through the donation of their organs.
The organ donation team received excellent feedback regarding the simulation day, and following its success, we hope to build upon our education programme, extending similar opportunities to healthcare professionals across Wales. A date for the diary is an upcoming organ donation deanery study day in August…final details to be confirmed!
If you have any queries about paediatric organ donation or would like to get involved, please feel free to contact me.
For more information on organ donation please visit:
Dr Rebecca Broomfield
Photo credits to Dr Sara Long, Dr Kathryn James, Dr Laura Potts
Leadership course run in MIT Boston USA
As Clinical Leadership Fellows we were privileged to have the opportunity to attend a Leadership Course at Massachusetts Institute of Technology. 5 of us hopped on a plane at the end of March and flew over to Boston in order to attend
Applied Neuroscience: Unleashing Brain Power for You and Your People
We flew in the day before the course and in true tourist fashion made the most of the first day getting over jet lag before the course began. None of us had been to Boston before and despite venturing out to an Irish bar with live music on our arrival we were all up bright and early on the Monday morning. (Thanks jet lag!) We grabbed our lonely planet guides and re-embraced our travelling student identities to explore a fantastic city.
We spent the day following the Freedom Trail - Boston has a very limited history but what it does have it exploits amazingly! The trail lead us through the start of the American Independence and British invasion. We stopped off in the harbour at lunch time and took a (freezing cold!) boat trip too see all the islands. We continued our trail and then extended it to include a viewing of the bronze duck statues in the main park. We watched the sunset in the tallest building in Boston with cocktails that were stronger than they tasted!
The course was facilitated by Dr Tara Swart (@TaraSwart) She holds a BSc in Biomedical Science and PhD in Neuropharmacology from Kings college London. She read Medicine at Oxford University gaining a BM BcH qualification. She is an executive coach and is passionate about disseminating simple, pragmatic neuroscience-based messages that change the way people work.
This course was not aimed at medics, and I do feel that we would have benefited from a slightly more rigorous focus on the scientific evidence for some of the science taught on the course, however, this was not it's aim and in fact may have alienated some of the audience who were present. Having looked into the evidence presented since the course, there is a significant scientific knowledge base behind the methods taught.
There has never been a room where, as a medic, Imposter Syndrome has a more appropriate setting. The course was full of chief executives and people who have multi-million pound contracts in their back pockets and more staff working underneath them imagined possible! However, the problems encountered and the neuroscience to increase behaviors and lead change were relevant to both the medical and the commercial setting. The insight which mixing with leaders from completely different worlds to our own has allowed us to gain was worth attending the course alone.
Right from the word go this course was structured differently to the majority. We sat on circular tables with 4-5 other delegates but at the back of the room were juggling balls, skipping ropes and standing desks. There were refreshments available through the whole day (although, caffeine was removed at 14:00 - it reduces your sleep quality after this time) and at the start we were actively encouraged to access refreshment as needed and walk around the classroom freely. While the skipping only occurred in the breaks some people did take advantage of the juggling balls and juggled at points throughout the teaching. While we learnt on the course that social safety is the area of culture in the workplace and wellbeing which has the biggest impact on the brain the next biggest area is physical activity. By standing up and engaging in a physical activity such as skipping or juggling we were actively engaging our brains and increasing our neuroplasticity, which is the brain's ability to reorganize itself by forming new neural connections throughout life.
Brains tend to hold onto old pathways, in order to create new pathways you need to rest, fuel, hydrate and oxygenate your brain. by exercising you increase the release of brain derived neurotrophic factors (BDNF) which helps with the formation of new pathways.
Neuroplasticity is an important concern when thinking about the neuroscience of leadership. We do not unlearn habits or behaviour, this is not possible but we are able to overwrite these pathways. Translated for use in leadership this could be as simple as giving people an alternative option rather than simply managing an undesirable or ineffective behaviour by saying "don't do that". Making new neural connections for behaviour is tough, but it is the first time which requires the most effort. As you repeat the same pattern of behaviour you strengthen this pathway and therefore make it more automatic.
There are 2 areas of the brain involved with learning new behaviours; the cortex - which is learning by instruction and the limbic system which is learning by experience. Knowledge/organisation of reality happens in the pre-frontal cortex but feeling and managing anxiety is under the control of the limbic system. A brain stem reflex is often change preventing within behaviour modification. Logic is not enough in order to modify behaviour and promote change you need to connect the 2 systems.
How can we use neuroscience to our advantage in the workplace?
The top 7 emotional drivers within the workplace are:
Communication is one key area where neuroscience can give us the edge over others. Using your limbic system to promote bonding and enhance the emotions above can give you an edge in leadership. Trust is the number 1 emotion but trust uses more resources than mistrust, and is therefore more difficult to employ.
Can you use neuroscience to create a better bond and increase trust? Yes, and it's as simple as eye contact. When you next communicate face to face with somebody try actively looking with your right eye into their left eye. This will activate their right limbic system which has been shown to create a strong bond. A bond enables colleges to feel more valued and creates a better working culture and environment. I've been trying this out since I returned and I feel that it has enabled me to shortcut some relationship building and create a quicker more valuable relationship. As far as I know, nobody has thought I've been looking at them strangely or even been aware that I am trying out this technique so even if it initially feels awkward for you it's worth a try! Face to face communication is always better, so make the effort to do this when possible.
The role of stress ....
The right ventral lateral pre frontal cortex is active in stress and has a role in regulating emotions. This area responds to pain - notably physical pain causes the release of natural painkillers whereas psychological pain does not, it also contains cortisol receptors. Cortisol is a fight or flight response hormone. It has a natural morning spike and then maintains low levels throughout the day accept in crisis or when there is a threat to survival. Having too much cortisol can lead to physical manifestations from yourself or the team which you are leading. These include poor sleep, irritability and craving chocolate/caffeine. The physical symptoms can detract from your brain power and demand attention, too much cortisol can also decrease your immunity and increase your abdominal fat thus impacting your physical health. Emotion biases all decisions and stress/fear biases decisions to the emotional system through the cortisol pathways. Interestingly some studies have shown that cortisol levels can be transmitted to others in a similar way to pheromones. Therefore a leader who has high levels of cortisone has the potential to expose others to them as well as themselves.
Stress is just one of the recognised threats to your brain power in work, others include uncertainty and uncontrollability. As a leader you do have the power to influence these for your team. Can you adapt your leadership in order to make your team feel more in control of the tasks which they are performing? You can definitely reduce uncertainty.
We did a good exercise on the course which focused on re-framing our responses. As a leader when a suggestion is made by a member of your team the automatic response is to say "No". In order to say yes it requires more mental energy as a leader but improving your ability to this can increase the level of control which your team feel they have and promote the positive emotional drivers outlined above. We were tasked in pairs of making a suggestion to overcome a problem to our partner. Initially they had to respond with "No" Then we had to re-ask the question and they had to a respond with "Yes, but .." thus entertaining the idea but outlining the potential barriers stopping this from happening. As the questioner we than had to once again make the same suggestion but our partner needed to respond with "Yes, and..." Using "Yes, and .." reduces the social isolation of your team and increases the attachment and bonding created. Oxytocin, which is released when creating a good bond, shapes the neutral circuitry of trust adaption. Reward and attachment emotions regulate emotion and improve decision making. Thus by utilising this type of leadership within your team you can promote good decision making and reduce stress. There is lots to gain
A 10% improvement in performance is equivalent to an extra 23 working days annually.
Other key points from day 1
During the course all food was provided and the menu was created to promote healthy eating and ensure that the nutrients provided promoted brain agility. It was followed up with an evening reception - I'm not sure where the wine fits into a healthy lifestyle but it was definitely welcome after all the information provided during the course.
Our thanks also have to go to Mr William Fleming, a fellow course participant who took us out to sample the local seafood in the evening, but also allowed us to pick his corporate brain with ideas that could benefit our leadership styles and leadership within the NHS. (I think/hope he learnt a little bit from us too!)
During day 1 we were taught that people are 15% more productive on the days that they do 30 minutes of aerobic exercise in the morning. While i'm not sure this counts as aerobic exercise, we took this on board and as a group of Clinical Fellows all attended the precourse early morning yoga session. The picture above is the view from the glass walled classroom we were practicing in, this rivals the morning session of beach yoga I took part in while travelling for the most breathtaking yoga view. It was a calming start to the day, followed by a breakfast of foods, as yesterday specifically selected to enhance wellbeing and increase brain agility.
We were more focused on day 2 on our own strengths and weaknesses and what we can do to improve our leadership while increasing our own resilience and mental toughness. If we can maintain our mental toughness and resilience as leaders then we promote a culture within our organisation that it is important to do the same.
"Nobody would get into a car without filling it up or maintaining it - Why do we not do this with ourselves?"
Maximise your potential
Prior to the course we completed a Neurozone questionnaire. This is a detailed questionnaire which enables you to focus on small changes you can make to maximise your own potential and therefore improve your leadership. Two of my areas for focus are improving my sleep and increasing the diversity of my exercise. Both of these require a small change but have the potential to have a big impact on my reserves.
Culture and patterns of behaviour and beliefs frequently impact perception, cognition and actions. You have a responsibility as a leader to use your skills to create a culture where your team members thrive. Your actions as a leader speak louder than the word which you use.
My take home messages ...
What am I doing differently since the course?
Further reading: “Neuroscience for Leadership: Harnessing the Brain Gain Advantage” Tara Swart, Kitty Chisholm & Paul Brown
We had a day to play with before flying home, part of my year is focusing on simulation and medical education. Therefore I took advantage of being in Boston to visit the 'Centre for Medical Simulation' which has a worldwide reputation. There was a course going on that day and so I got to see their sim suite in action and speak to their faculty. It was very interesting to note that they are also focusing on the educational value of simulation and how we can evidence this. Their facilities are excellent and it was exciting to be able to spend a short time there.
The afternoon was spent at the Boston Tea Party museum learning about leaders who promoted a change by making a stand - very relevant to the topics which we had been covering, and yet another leadership perspective.
Boston was fantastic, I would recommend it as a city break. The course was an amazing opportunity to understand some of the rational behind current leadership techniques and put a neuroscience basis to their implementation. I have a lot of areas to work on to maximise my own leadership potential and am looking forward to trialling these out over the coming years.
Dr Rebecca Broomfield
Photo credits to Dr Sara Long
Please read this blog with Nickelback "What are you waiting for?" playing in the background. It encapsulates the mood i'm aiming for! https://youtu.be/w-Ng5muAAcg
Nestled somewhere near the middle of Wales, with very limited phone signal and Wi-Fi that intermittently functions is Elan Valley. Its a stunning location to explore for people who love outdoor adventures and the location for a fantastic 3 day team building residential which was facilitated by Academi Wales as a part of the Pg Cert qualification I am enrolled in during my year as a Clinical Leadership Fellow. It is an amazing place to focus on team-working and your role within that team.
During the residential course we studied the Belbin Team Roles, how they interact together and our personal preferences. My team was facilitated by Phil Davies, who is an ex Wales international player and currently the Head coach at the Nambian national Rugby union side. As a head coach of an international team, Phil offered a different perspective on team working from the traditional NHS viewpoint. (And I've stolen the Nickelback song from him - Thanks Phil!)
Team-working is something which often doesn't get enough time within the NHS. By being aware of its importance and how you function within a team you should be able to more readily achieve your goals.
Belbin Team Roles
What is Belbin?
A team role as defined by Dr Meredith Belbin is "A tendency to behave, contribute and interrelate with others in a particular way" He has grouped these roles into 9 clusters of behaviour. When you take the Belbin self reported questionnaire you get a break down of your personal team preferences. The outline of the roles is described in the picture below. You don't need a person for each role to create a good team but you should try to consider all perspectives. It may be also useful to look at a team which isn't functioning to its best, does everybody within that team have the same preference and therefore the same perspective on a problem. Having the same preference can be a source of conflict as well as preventing the team achieving its goal.
My primary preference was the 'Shaper' role with my secondary preference being 'Resource Investigator' As a group of Leadership fellows we had surprisingly diverse results, reinforcing that no type is better or worse in a leadership role.
The report was slightly different from the other personality or preference reports we have completed this year. Instead of looking at areas to develop we were encouraged to focus on developing our strengths rather improving on our weaknesses.
Each role has it's own strengths and weaknesses, knowing the preference of your team member allows you to distribute workload to their strengths, thus improving the efficiency of your team. For example, I had a low score for the 'Completer Finisher' role therefore, as a leader, I need to identify a person on my team who has strengths in this role in order to ensure my team actually completes their tasks!
Once we had learnt the theory and our own preferences we were split into teams in order to put this into practice. The teams were selected in order to ensure that the majority of the roles were covered in within team.
The details of what exactly happened in Elan Valley will forever stay amongst the team who attended. (Trust is an important part of creating a functioning efficient team environment!) But we participated in a variety of tasks that allowed us to explore our own role and communicating and motivating the other team members.
The morning focused on goal based tasks. Each task started had a time limit and started with a printed instruction. Each task had rules which could not be broken and a goal which needed to be achieved. An example of one of the tasks we undertook was a maze task. A maze was laid out out of sight from the team and we were put into a large square laid out on the ground unable to see the maze. Our team was only allowed to communicate within the box, only 1 team member was able to leave the box at any one time and all members had to successfully navigate their way across the maze to complete the task. There was of course a time limit on this. Our first team member returned to tell us the structure of the maze, we had to work out, remember and communicate a pattern of boxes which we could step on to get across to the other side of the maze. This task acutely demonstrated to me the importance of others perspectives and the importance of communication. People like to be communicated with differently depending on their thought processes. (Just in case you were wondering we managed to get all of our team members across within the time limit and only received one penalty!)
The afternoon was structured slightly differently. The whole cohort was brought back together and we were to function as subsections of an overarching team. The team goal was to earn 'money'. The money would then be spend on unlocking clues which would give us the location of a prize which we were aiming to achieve. We could earn money by completing a variety of tasks. Tasks were diverse and each has a value attached to it. We split into our sub-groups and decided which tasks we wanted to complete in order to earn money and then spend the afternoon working through these tasks. Again, of course there was a time limit set on this. All the subgroups had to come back together to decide how this money was spent.
Some of the afternoon tasks were more adventurous and required taking team work to a whole other level. My personal favorite task was the "leap of faith". This involved climbing up a tiny rope ladder onto a small triangle platform which was positioned high into the trees and then jumping off. You were harnessed and your team members were in control of the ropes. In order to work your way up the ladder you needed to trust your team members not to let you fall with the ropes, you needed a team member to anchor your ladder to stop it flapping about in the wind and enable you to climb straight and you needed encouragement from the team when halfway up you suddenly realised that it was a long way down! Despite ripping a pair of jeans I managed to get to the top and jump. It was a good exercise in overcoming barriers and how important support and trust were within a team. (Just for completeness we earned enough money and managed to get a well earned box of chocolates!)
Take home messages ....
I learnt a surprising amount about myself and team roles from participating in the residential course. However, the most important of these was
The role of communication in good team-working cannot be underestimated. It is vitally important especially when you've realised that people don't all think like you or have the same perspective as you do. Obviously this covers the face-to-face communication when outlining a task but also the importance when managing a large busy team in communicating the overarching vision of the team which you want all members to progress towards. It is very difficult to motivate and drive forward a team when you do not all have a shared vision as to what you want to achieve. I would suggest reflecting on how you manage a team and the actions you use to motivate other members. How many conflicts or mistakes have been due to poor communication?
Other than communication the importance of looking at things from others perspectives was emphasised to me throughout these personally challenging activities. When faced with a problem, taking on a different viewpoint or consulting a member of your team who you know has a different role preference to you can fundamentally change how you choose to tackle it. As a part of this it is also important to remember the importance of your role within your team, you may have a perspective which nobody else has considered.
Do you need to work on
Listening is a vital part of communication.
However, it's importance can often get overlooked when concerned about getting your opinion heard and shouting loud enough to have your say in a team activity. How many times do you have a conversation where you are already planning your answer? the next point your want to make? or even thinking about what you are having for dinner that evening.
(Unsurprisingly) communication works best when you actually listen to the people in your team. When you honestly reflect on this can you say that you always do this? Most people don't. Next time you are communicating with a college try giving them all of your attention, focusing in on what they say and responding to this rather than your previously planned out structure of how you want the conversation to go. Since trying this out after the residential I have noticed a significant improvement in my communications and my ability to influence change.
Things I am currently working on developing are:
Dr Rebecca Broomfield
What is it?
TALK has been developed to give a framework to debriefing. The aim of the entire project is to promote a supportive culture of learning and patient safety in clinical settings. Reflection is a vital part of healthcare and the tool promotes guided reflection enabling teams to work together in order to improve and maintain patient safety, create a supportive workplace culture and increase efficiency.
The project has some important values which also function to promote a positive workplace and enhance staff well being.
Reflection is encouraged to be constructive, non judgemental, and can be initiated by any member of the team.
It would be worth having a discussion within your workplace about debriefing. Do you debrief as a whole team? Is TALK a tool which could enhance the way your team work together? When getting started and initial discussion should take place in order to identify and agree potential situations which will prompt its use, focusing on positive events as well as negative. Once established then TALK can easily be adapted to different situations so don't let this initial discussion limit you!
I attended a workshop in order to facilitate using the TALK debriefing tool. I personally think that this tool is useful and needs to become embedded in the culture as much as the 'ABCD' algorithm for assessing a patient. It is initially a bit clunky to use, because it is unfamiliar but once practiced would easily facilitate difficult discussions. It could be argued that we already debrief and therefore why do we need a tool?
There are several advantages which I can see:
For more information
Follow @TALKdebriefing on twitter for up to date news
Guest blog post by Dr Kimberley Hallam
I’m an ST2 in paediatrics and unfortunately did not have the chance to attend the RCPCH conference last year. So, this year I was very excited when I realised, not only would I be able to attend for all 3 days, but it was also in Glasgow…a city which I love and where my twin sister lives.
Getting up to Glasgow itself was challenging! I travelled up after work on the Wirral on Monday night. Soon after leaving, there was an announcement that there were trespassers on the line. Unfortunately, this meant I didn’t arrive at Glasgow Central Station until 00:45! Luckily, I was staying with my sister so didn’t have the hassle of a late night check in.
Day one of the conference was entitled the ‘Science and Research’ day. Because of my late arrival to Glasgow, I didn’t attend the 8am ‘Personal Practice Sessions’, but started at 9am with a welcome from the (now ex-) President of the RCPCH, Neena Modi. During the course of the conference, she relinquished her presidential title to Russell Viner. She gave an eloquent opening talk which was followed by a presentation by the RCPCH & Us Network. This is a group of young people who work with the RCPCH to ensure that young people’s views are listened to in all matters within the RCPCH organisation. They spoke incredibly well and are clearly a group of passionate, intelligent young people who are forward thinking, keen to bring about change and ensure their voices are heard.
Another highlight from the morning included a talk by Prof. David Archard regarding children and parental rights. He took examples from recent high profile cases and presented ethical considerations regarding parental rights. He focussed on a public slogan taken from the Charlie Gard Case: ‘My Child, My Choice.’ After a fascinating discussion, he concluded that ‘disagreements [between medical staff and parents] will continue and [will] probably proliferate. Parents’ feelings and views count but they are not decisive.’ He closed the session with the remark that ‘we live in a time of post-truth and populism.’
Next came an interesting presentation from Dr Cherry Alviani and was entitled ‘Sleep for your own health: A Pan-UK Survey on Paediatricians Experience of Sleep Around Shift Work.’ She talked about a survey she completed which showed a lot of trainees do not have training on how to manage sleep around night shifts and that many hospitals do not provide somewhere for trainees to sleep on night shift and/or do not support them doing so. Given lack of sleep affects judgement and clinical performance, these are important issues to address. As an aside, the BMJ have recently published a brilliant article which gives general advice on how to survive night shifts and which I have personally found quite useful:
After the plenary session, I attended a workshop entitled ‘Press, Politics and Paediatricians; Campaigning for Child Health Across the UK.’ This was an interactive workshop and even had some role play where members of the audience acted as news reporters and grilled (a pretend) Jeremy Corbyn and Jeremy Hunt. Suffice to say, this became a little heated! Overall, the session introduced the idea that it is our duty as paediatricians to be advocates for child health. This may include being politically active (e.g lobbying government) or may involve speaking out on behalf of paediatricians/children in the press. The RCPCH have opportunities for members to become involved in such work on their Press and Parliamentary Panels (they include free training).
I’ve put this link here so you can have a wee look if you’re interested: https://www.rcpch.ac.uk/news/membership-benefit-month-media-and-parliamentary-training
The last session of the day I went to was run by the British Association of Paediatricians of Indian Origin (BAPIO) and covered ‘Hot topics in paediatric subspecialties.’ They had a number of insightful and interesting talks including ‘When do you need a gut specialist?’, ‘Chronic cough: when is it a cause for concern?’ and ‘Changing landscapes in paediatric epilepsy.’ They also had talks from Neena Modi and Russell Viner (who got a bit of a kind-hearted grilling from the audience after his talk ‘Paediatric services: fit for the future’.
I chose not to go to the meal out on the first night. Instead, I went to a fabulous place in Glasgow called Stravaigin with my sister and a Mersey trainee. It comes highly recommended!
Day two of the conference was the ‘Global Child Health Day’ and, I have to admit, the day I was most looking forward to. It did not disappoint.
The day kicked off at 8am with a session on how to include global health in your career which was delivered by a diverse group of trainees who all had experiences of working in global health during their training years. They introduced the variety of ways a trainee can take part in global health work. These include clinical work, teaching, quality improvement projects, research and public health. The session covered considerations such as the stage of training you should aim to do such work, what support you might receive and where you can do the work. They also talked about the courses you can go on to help prepare. For example, ETAT, CHILS, GIC and the Diploma of Tropical Medicine and Hygiene. I left this session feeling very inspired and excited about my potential future opportunities.
Next up was the plenary with the first person to speak Prof Anthony Costello (Director of the Department of Maternal, Child and Adolescent Health, World Health Organisation). He gave a keynote speech on ‘Global governance for child health and sustainable development.’ As his title suggests, he came across as a very inspirational person. He questioned ‘is everything getting better?’ He stated that, globally, child mortality is improving rapidly and maternal mortality is improving but not to the same extent. As currently projected, low income countries will not catch up with higher income countries for a great number of years. Globally, we are still falling short in harder to reach areas and there are still basic health needs which are not being met. For example, lack of access to clean water and sanitation.
Five key problems which act as a barrier to improving child health are as follows:
1. Fragmentation of global child health strategies undermines programming and limits impact
2. Child health goals will not be met without adequate funding and delivery to marginalised populations
3. Evidence is not systematically generated and integrated into policy and programs
4. Strategies are insufficiently tailored to country context, and tools need improved end-user design
5. Lack of accountability, clear targets and strong monitoring
He then went on to describe five key areas for WHO and UNICEF to address.
The next talk was regarding child refugee health and is something I have been interested in for a long time and passionate about since attending the Royal Society of Medicine’s study day ‘Child Refugee Health: Everyone’s Responsibility.’ Dr Marylyn Emedo presented data on ‘Adverse experiences of Unaccompanied Asylum Seeking children (UASC) and the impact on their emotional wellbeing and mental health needs.’ As a bit of background, there were 3290 unaccompanied asylum seeking children in the UK in 2016. Children from Afghanistan, Albania and Eritrea formed 48% of all UASC in 2016. Her study was a retrospective review of records of all UASC referred to a clinic run by a local authority in London between 1st January to 31st August, 2016. The study focussed on adverse experiences the children went through on their journey to the UK. It found that 51% of children experienced trauma on route to the UK including detention, beating, torture and sexual assault. All the children in the study were screened for mental health needs. Of these, 75% reported at least one symptom suggestive of PTSD, anxiety or depression and 43% accepted a referral to CAMHS. Her recommendations were for timely review in line with statutory guidelines and initiation of early support by mental health services.
Next, the workshop I chose to attend was ‘What should RCPCH’s global health priorities be?’ This started with a talk outlining some stark facts: 98 of every 100 children who die <5 years, die in developing countries, mainly from avoidable/treatable causes. There has also been a shift of mortality from communicable to non-communicable diseases. There followed a discussion surround how to address these issues as we work towards the Sustainable Development Goals (SDPs) set by the UN (http://www.un.org/sustainabledevelopment/sustainable-development-goals/). There was participation from the audience and good engagement from the RCPCH. I was particularly happy to hear that the RCPCH are launching a global health professional development framework to run alongside paediatric training in order to engage trainees in global health work.
I continued the global health theme by attending the International Child Health Group’s afternoon session. This took part in the main Clyde auditorium and was mainly delivered by people who had conducted projects related to international health.
The first talk was delivered by Dr Jonson and was entitled ‘The validation of transcutaneous bilirubin as a method to monitor newborn jaundice in a low income country.’ She had recognised there were significant problems with babies developing kernicterus as a result of untreated jaundice in Haiti. Despite having a reasonably small data set, her study suggested that transcutaneous bilirubin monitoring was a safe way of measuring bilirubin in a low income country. The unit she was working on had a lower incidence of kernicterus following the trial. However, she suggested a larger data set would be required to fully validate her findings.
Amongst the remainder of the afternoon talks, the one which stood out for me was given by Dr Christopher Hands and entitled ‘Delivering nurse-led emergency paediatric care in Sierra Leonean Hospitals: The effect on quality of care and mortality.’ This nurse-led care involved the introduction of triage systems, stream-lining the patient journey at the point of care and training nurses in ETAT. These basic interventions had resulted in a very impressive reduction in mortality. Anecdotally, nurses now recognised they had the skills to save the lives of individuals presenting with symptoms they previously thought they could do nothing for. For example, hypoglycaemia and seizures.
Other talks included ‘Neonatal outcomes from FGM/cutting in the Gambia; results from a multicentre prospective study’, ‘The use of satellite clinics in W Uganda to remove barriers to seeking care’ and ‘Identification of the health burden for street children and service provision available in Kismu, Kenya, through Focus Group Discussions.’
At the end of the second day, I was exhausted. However, thanks to this day and the enthusiastic way in which the RCPCH approach global health, I now have a renewed determination to pursue a career in this area.
Day three was entitled the ‘Health Services for Children day.’ The plenary in the auditorium started with a keynote speech from Prof. Jason Leitch, the National Clinical Director from Scottish Government. He was a very entertaining and enthusiastic speaker and it really was a pleasure to listen to him in his home city of Glasgow. He talked about the state of child health inequality in Scotland. He described how children living in Glasgow within a few miles of each other have a very different life expectancy (a phenomenon which is termed the ‘Glasgow Effect’). He then went on to talk about various local programmes which had been set up. For example, a programme in which fathers in prison are given intensive parenting classes and have their children visit the prison regularly. This even involved the inmates performing a play of the Gruffalo for the children and has the benefit of decreasing their chance of reoffending. There have also been programmes which involve intensive health visitor input. He ended with the following picture.
After the plenary and a short refreshment break, it was time for the final workshop session. As I seemed to be developing a political interest as the conference went on, I decided to attend the session ‘Child Health Policy Development: Why, What and How?’ This started with a presentation regarding the RCPCH health policy strategic direction for 2018. This states that the RCPCH wants to achieve the following:
1. To prioritise the health needs of infants, children and young people
2. To prevent ill health and promote health and wellbeing
3. To ensure continuous improvement in the quality of healthcare services
4. To reduce child health inequalities
They plan to achieve these aims in the following way:
1. Developing robust, evidence-based policy
2. Prioritisation and horizon scanning
3. Understanding the environment we work in
4. Influencing the right decision makers, at the right time
5. Having a tailored approach so the right messages reach decision makers across the UK
After the presentation, there was a discussion with audience participation and engagement from the new president. We discussed why and how the RCPCH develops policy, its impact and the role of paediatricians in influencing decision makers. We concluded that, as paediatricians, we have a duty to advocate on behalf of children and young people and part of that involves lobbying to push child health up the political agenda.
Following the workshop and lunch, I decided to start the first part of the afternoon with the ‘Children’s Ethics and Law Special Interest Group’ (CHELSIG). After an introduction to CHELSIG, there was a presentation ‘Children’s rights, UK healthcare and Brexit: Could things get worse for young people?’ This session discussed the UN rights of the child, including Article 16 (the views of the child), Article 24 (health and health services) and Article 16 (young people have the right to a private life). According to a study completed by the NIHR, 57% of children felt they were not involved or only involved a little in their care. This session encouraged paediatricians to involve children in decisions about their care and consider facilitating groups where children and young people can provide input into the running of paediatric services.
The next session was called ‘Moral distress, trauma and burnout in staff in relation to changes in PICU outcomes, challenging cases and media involvement in disagreements about end of life care.’ This session was led by Gillian Coleville who had studied the impact of the above in Great Ormond Street staff following the Charlie Gard case. The staff highlighted their main sources of distress are being accused of not caring, public condemnation without the right to reply, fears for their own safety, witnessing a child’s suffering, protracted legal proceedings, impact on other families and constant changes to care plan. 15% of staff had features of clinically significant post-traumatic stress syndrome. I was quite surprised at how high this was and also found it distressing to hear how the case had impacted upon their private lives.
The final session I went to on day 3 was one run by the Association of Paediatric Emergency Medicine. This was an afternoon focussing on the Manchester Arena bombing on 22nd May, 2017. We heard from Allan Courdwell, Head of Group Emergency Planning with the Northern Care Alliance who talked us through what happened on the day and how the trust managed the major incident. This was followed by an insightful talk by Fiona Murphy MBE, Associate Director of Nursing who covered the bereavement response after the bombing. She gave a moving description of how the bereavement officers supported those who suffered the death of a loved one. Her commitment to providing dignified support to the families was exceptional. She described various ways in which she co-ordinated and delivered the bereavement support. This included putting families up in a hotel together, having 24-hour access to a bereavement officer and finding out information regarding the victims so they could, for example, play their favourite music when families were viewing their bodies. She also arranged for the families to visit the arena (when safe to do so) where they had lit a candle where each of the victims was found so the families could further understand and come to terms with what had happened. This talk moved me and many others to tears and I was so overwhelmed by the dedication she and her team showed to support the families in the aftermath of the bombings.
So, that concluded my first attendance at an RCPCH conference and I really enjoyed the experience. It was great to see how proactive the college came across in providing advocacy for children and addressing global child health. It was also fabulous to catch up with old friends and be inspired by projects which other paediatric trainees are undertaking throughout the country. I’ll definitely aim to go again next year!
Care in the Community: Integrated Case Community Management of Childhood Illness in remote coastal Madagascar
Guest Post by Dr Emily Clark
The Sustainable Development Goals, launched in 2015, are ambitious.
"By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births”
This is a tough challenge we have set ourselves. Current global neonatal mortality (NMR) stands at 19/1000 live births, with under-5 mortality (U5M) at 41/1000 live births. In Madagascar, the NMR is 19/1000 live births, and the U5M 46/1000 live births (1). Note that these figures are all averages, which hides variation between regions, between rich and poor, between the educated and the illiterate (Hans Rosling has an excellent talk on this). I worked in a remote coastal region of southwest Madagascar, where there are no local data available for neonatal or child mortality as many births, and deaths, are not registered. I imagine that the statistics here would be worse than the average as communities are subject to the inverse care law: the paradox that those with the greatest need for health care have the least access.
However, in terms of mortality rates, we have come a long way already. At the start of the Millennium Development Goals (MDGs) in 1990, the global NMR was 37/1000 live births (40/1000 in Madagascar), and the U5M was 93/1000 live births (160/1000 in Madagascar) (1). The Millennium Development Goals report states:
“The dramatic decline in preventable child deaths over the past quarter of a century is one of the most significant achievements in human history”
So what works, and what do we need to do?
We know that most childhood illnesses are managed at home. This is memorably described in the case of malaria as the “ears of the hippo” – where only the minority of children are seen in a health facility.
‘‘The Ears of the Hippopotamus’’ where malaria patients are managed . . . and die. (2)
How do we get children from home to the hospital? And how do we do so within a timely manner? The three delays model was devised in 1994 by Thaddeus and Maine (3). It states that the delay in a sick person receiving appropriate medical care can be broken down as follows:
1. The delay in recognition that medical help is required
2. The delay in arriving at a location where appropriate medical help can be given
3. The delay in receiving appropriate help at this location
Rather than making the sick travel to the health centre, bringing health workers into the communities has demonstrated a reduction in childhood mortality. This initiative, known as Integrated Case Community Management (ICCM), targets the top causes of childhood deaths: diarrhoea, malaria, and pneumonia. If implemented globally, early treatment in the community of pneumonia in under-fives could reduce mortality by more than two-thirds. Similarly, community-based treatment of malaria could halve malaria-related mortality. Three-quarters of deaths from diarrhoea could be prevented by administration of oral rehydration solution (4). ICCM also promotes identification and treatment of malnutrition, which is observed in one-third to one-half of childhood deaths.
I volunteered with Blue Ventures, a marine conservation NGO, working in remote coastal southwest Madagascar. I worked with their community health team, Safidy, which means “choice” in Malagasy. Here, it is all too easy to understand how receiving timely and appropriate medical intervention was a challenge. Health literacy was poor, transport infrastructure was sparse (relying on zebu carts, fishing pirogues, and ad hoc cars and lorries). The roads were sandy tracks, and driving to the city takes 7 hours to cover the 200km on a good day – and that was in a 4x4. Sadly, this is unaffordable to most. Poverty underlies life here. There is no money available for medicines, transport; many can simply not afford not to work for a day.
As part of the Safidy programme, each village in the Blue Ventures service area has one agent communautaire (AC). These ACs, already respected women within their communities, were invited by the ICCM programme to an intensive eight-day residential training course. The training was centred around the use of a fiche, a paper-based form containing a series of questions which guide the ACs through key symptoms to aid diagnosis, and the “danger signs” of serious illness. These danger signs should prompt immediate treatment, as specified by the fiche, and referral to a health centre. The fiche guides ACs in providing safety net advice and follow up arrangements. The ACs also educate communities regarding public health measures, such as promotion of exclusive breastfeeding, and immunisations.
ACs are provided with key items of equipment, such as rapid diagnostic tests for malaria, a measuring strip for mid-upper arm circumference for assessment of malnutrition, and a one-minute timer for measuring respiratory rate. Essential medicines are also provided, including oral rehydration solution and zinc, antibiotics for pneumonia, and anti-malarials.
When a child falls ill, it is easy for the family to ask the AC within their own village for advice. The AC is able to assess and triage the child, and decide, using the fiche, what treatment is required. For example, a child presenting with a cough may well have pneumonia; the AC should then check for fever, and measure the respiratory rate. If the respiratory rate is raised, this should prompt antibiotic treatment and referral to a health centre. If there are no danger signs present, then the AC can provide a course of antibiotics and appropriate follow up advice.
All the ACs are literate, however, they have had very limited education at school. Yet, these women perform the same job that we do, as a multi-disciplinary team, in the Children’s Assessment Unit. They are simply phenomenal. It is a lot to learn, and so, together with a local ICCM trainer, the Safidy team arranged for two study days for the newly-trained ACs. The focus was on role play rather than theory. Many of the ACs had brought their children along to the training and so they made for excellent “patients”, and so we witnessed some Oscar-worthy performances! Each AC received feedback on their performance: what went well, what could be improved next time.
The ACs will now spend time working under direct supervision from nurses and midwives at local health facilities, before being approved to work independently within their communities. We hope that the success of ICCM in other countries can be replicated in this little corner of Madagascar.
One AC measures a young actor’s respiratory rate using a specially-designed timer
A trainer demonstrates assessment for pedal oedema; a danger sign that should prompt referral to a health centre
For more reading on the Sustainable Development Goals: http://www.un.org/sustainabledevelopment/sustainable-development-goals/
The WHO have produced a report on the evidence for ICCM, available here: http://www.who.int/maternal_child_adolescent/documents/iccm_service_access/en/
To see data being brought to life, I would advise watching Hans Rosling – starting here: https://www.ted.com/talks/hans_rosling_shows_the_best_stats_you_ve_ever_seen
ICCM complements the WHO programme Integrated Management of Childhood Illness (IMCI) which aims to improve the quality of care available to patients at health facilities. A recent Multi-Country Evaluation has demonstrated that quality of care is improved, resulting in a reduced childhood mortality. It has demonstrated cost-effectiveness, as earlier and correct treatment saves money. http://www.who.int/maternal_child_adolescent/topics/child/imci/en/
For more information regarding Blue Ventures’ community health programme, Safidy: https://blueventures.org/conservation/community-health/
(1) All data from the World Bank, http://www.worldbank.org/ Accessed 20.03.2018
(2) The Intolerable Burden of Malaria: A New Look at the Numbers: Supplement to Volume 64(1) of the American Journal of Tropical Medicine and Hygiene. Breman JG, Egan A, Keusch GT, editors. Northbrook (IL): American Society of Tropical Medicine and Hygiene; 2001 Jan.
(3) Thaddeus S, Maine D. Too far to walk: maternal mortality in context. Soc Sci Med. 1994 Apr;38(8):1091–110. http://dx.doi.org/10.1016/0277-9536(94)90226-7 pmid: 8042057
(4) WHO/UNICEF JOINT STATEMENT Integrated Community Case Management (iCCM). United Nations Children’s Fund. 2012
Guest blog by Dr Jemma Wright
I was delighted to attend the first day of the RCPCH annual conference this year and here is a brief summary of my day.
The day started early with a personal practice session about the new PROGRESS curriculum. Hopefully you are all aware of this new curriculum as it is going to be introduced this August. The session was an introduction to the new curriculum and it does seem like the college is trying to make it easier to engage with the new, much shorter curriculum. There is lots of information available on www.rcpch.ac.uk/progress including details of the mandatory 'key capabilities' we need to achieve and 'illustrations'/examples of how to evidence this on Kaizen. The main tip was to engage with this curriculum early as you can start producing evidence on your eportfolio now so it is already there to link to the new curriculum when it becomes live on 1st August 2018.
The overall theme of the conference was ‘Children First – Ethics, Morality and Advocacy in Childhood’ and the main plenary had a strong theme on ethics.
The first keynote speech was about “Putting the Child First” and was an extremely topical philosophical exploration of the interaction between best interests and parental rights. There has been some significant media attention in the last year on multiple cases of disagreement between the medical teams and the parents. He alluded to these cases including the common protest of ‘my child, my choice’, and put a spin on this statement by highlighting that a parent does not necessary have the right to choose anything for their child – his example being that parents have the right to choose what to feed their child but they cannot choose to feed them poison. Overall it was an interesting discussion concluding that the child must always come first.
This was followed by three project presentations:
The first was on the impact of austerity on families with disabled children across Europe. The conclusion of the project survey was that cuts since 2008 have resulted in worsening quality and access of services to disabled children with a significant negative impact on families in the UK, especially those in severe poverty.
The second was about delays in seeking legal judgements in cases of withdrawal of care, collecting data of 15 cases across the England over the last 5 years. They recommended considering alternative methods to avoid these delays such as mediation/dispute resolution, which have high success rates in avoiding litigation, and tend to have higher satisfaction rates.
The last project was about a UK survey on paediatricians experience of sleep education. It was found that around 75% of paediatric trainees have not received any teaching on sleep during their training. Interestingly they recommended that we should all be taking a 15 min nap during our night shifts to reduce fatigue and that this should be supported by our workplaces. For more information, they have recently published articles in ADC and BMJ to promote more awareness about how to approach sleep during shift work.
The plenary concluded with Professor Neena Modi talking about “Children in the 21st century’ focussing on the historical progression of a child’s role in society from possession, to protection, to partnership. She also talked about the increasing importance of non-communicable diseases in children especially childhood obesity and the interaction between child health and adult health. There is a whole section about these issues in the State of Child Health section on the RCPCH website.
Next up, I chose to go to a workshop about navigating academic training pathways. As a non-academic trainee, it was interesting to hear that the college is keen to support paediatricians interested in developing an academic element to their job. I found out about a research funding opportunities database on the RCPCH website (https://www.rcpch.ac.uk/research_funding_opportunities) and the new academic toolkit (http://apatoolkit.eastface.co.uk).
After lunch, I headed to the BPAIIG speciality group session.
We had a presentation from an epidemiologist at PHE taking about paediatric antimicrobial resistance followed by a talk by a paediatric ID consultant about balancing antimicrobial stewardship since the new NICE sepsis guidelines. The key learning point when prescribing antibiotics was to be mindful of antibiotic resistance and always ‘Start Smart then Focus‘.
There was a good representation from Wales in this session. I was asked to present my project about the epidemiology/microbiology of candidaemia over the last 15 years at Alder Hey Children’s Hospital followed by an excellent presentation by a Cardiff medical student looking at the risk of laceration when using an adrenaline auto-injector. There were also two further presentations about the impact of PCV on pneumococcal meningitis rates and two cases of INF a/b receptor 2 deficiency associated with immunodeficiency.
Finally there were two further talks by paediatric ID consultants about the use of biomarkers to guide length of antibiotic course and the novel use of old antibiotics or new antibiotic combinations to treat multi-resistant bacteria. Excitingly there is a new national trial entitled BATCH (biomarker guided duration of antibiotic treatment in children hospitalised with confirmed or suspected bacterial infection), which is being coordinated by the Centre for Trials Research in Cardiff and may guide further developments in this area.
Overall I had an excellent thought provoking day and enjoyed the excuse to visit Glasgow, my old FY2 home.
The regular visitors to the site will have noticed an extra tab at the top of the page.
The Welsh Paediatric Simulation Group (WPSG) provides paediatric simulation training throughout Wales covering a wide range of topics. Because WREN is linked to WPSG through education provision we thought it would be beneficial to have a one stop shop for access to educational opportunities so nobody misses out. The aim is that we will publish the dates of courses and contact details to book them on the WREN website as well as providing access to all the precourse reading materials.
It’s a work in progress so please bear with us while we update this over the coming months.
Also let us know what would be most useful to see on these pages and we can edit them to make they are adding value and making things a little bit easier.
Welcome to the WREN pages WPSG
Course PRUDIC Study Day
Date 2nd March 2018
Princess of Wales Hospital (Paediatrics)
Dr Dana Beasley
Course Paediatric Trauma Course
Date 18th May 2018
University Hospital of Wales
Dr Hannah Murch via Liz Williams
Course Step up to Registrar/Shift Leader
Date 21st May 2018
University Hospital of Wales
Dr Sally Richards
Date June 2018
Princess of Wales Hospital (Paediatrics)
Dr. Emily Payne
Community GRID trainee
Course Paediatrics 2
Date 2nd July 2018
University Hospital of Wales
Dr Sally Richards
Course Step up to Registrar/Shift Leader
Date 10th September 2018
University Hospital of Wales
Dr Sally Richards
Course Paediatrics 1
Date 31st October 2018
Venue Merthyr Tydfil
Prince Charles Hospital
Dr David Deekollu
As more course dates become available we will update the WPSG page of the WREN website
‘Eculizumab in Shiga-Toxin producing E. Coli Haemolytic Uraemic Syndrome: A Randomised, Double-Blind, Placebo-Controlled Trial’
This is a trial currently recruiting on the Paediatric Nephrology Unit at UHW
Aim of trial:
To assess whether Eculizumab reduces the severity of Shiga-toxin producing Ecoli Haemolytic Uraemic Syndrome (STEC HUS) in children and young people
What is Eculizumab?
Primary Research Objective:
To determine whether the severity of STEC HUS is less in those given Ecu compared with those given placebo, in children aged 6m-18 years
-Clinical Severity Score assigned at day 60
i)To assess the safety of Ecu in STEC HUS
ii)To determine whether the incidence of CKD following STEC HUS is less in those receiving Ecu compared with those receiving placebo
iii)To evaluate the cost-effectiveness of administration of Ecu in STEC HUS from the perspective of the NHS
Active arm: Standard therapy + 1st dose Ecu Day 1, & 2nd dose Ecu Day 8
Control arm: Standard therapy + 1st dose placebo Day 1, & 2nd dose placebo Day 8
NB: The trial contains an internal pilot phase of 18m (12m recruitment, 6m follow-up), the purpose of which is to determine whether the substantive trial will continue.
For further information please contact:
Jennifer Muller, Paediatric Research Specialist Nurse (CYARU)