The PaedsHub Pod – Details, episodes & analysis

In this episode Dr Lorna Hack speaks to Dr Anirban Majumdar about Spinal Muscular Atrophy, and the remarkable advances made in managing this condition in the twenty-first century.

Dr Majumdar is a Consultant Paediatric Neurologist at the Bristol Royal Hospital for Children, and delivers the regional Neuromuscular Service.

We discuss: the genetic basis of SMA, the targets of disease modifying treatments, the pros and cons that guide treatment choice, and monitoring of treatment efficacy.

Article: https://adc.bmj.com/content/108/Suppl_2/A199

Dr Majumdar’s book recommendations: ‘Yellowface’ by R. F. Kuang and ‘The Spanish Civil War’ by Antony Beevor.

In this episode, Dr Felicity Cooksey talks with Dr Marie Monaghan about idiopathic intracranial hypertension. Dr Monaghan is a general paediatric consultant with a specialist interest in epilepsy, based at Bristol Royal Hospital for Children. She co-authored a paper titled ‘Consensus recommendations for the assessment and management of idiopathic intracranial hypertension in children and young people’, which was published in Archives of Disease in Childhood.

Dr Monaghan discusses her experiences of working abroad, why cases of idiopathic intracranial hypertension are predicted to rise and how to approach a suspected case.

Link to the full article: ⁠Consensus recommendations for the assessment and management of idiopathic intracranial hypertension in children and young people | Archives of Disease in Childhood (bmj.com)⁠

This month Dr Tabitha Campbell, GP trainee, joins Dr Paulina Connolly to talk through the 15-minute Consultation paper: “What do paediatricians need to know about child refugee and migrant health needs?” by Dr Aoife Ryan & Dr Alison Kelly from the Online First section of ADC Education & Practice: https://ep.bmj.com/content/early/2023/01/26/archdischild-2022-324836

Dr Campbell originally found the 3-D assessment on Paediatric FOAMed:  “The 3-D Assessment for Refugee, Asylum-Seeking or Trafficked Children”, an excellent article by Dr Laura C. Wood: https://www.paediatricfoam.com/2018/03/refugee-asylum-seeking-trafficked-children/

Another extremely useful resource by the RCPCH - Refugee and asylum seeking children and young people - guidance for paediatricians:  https://www.rcpch.ac.uk/resources/refugee-asylum-seeking-children-young-people-guidance-paediatricians 

WHO estimates of Tuberculosis incidence are easiest to find on the Gov.uk website: https://www.gov.uk/government/publications/tuberculosis-tb-by-country-rates-per-100000-people/who-estimates-of-tuberculosis-incidence-by-country-and-territory-2020-accessible-text-version

But for more comprehensive data on TB you can read the WHO yearly global report: https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2022/tb-disease-burden/2-1-tb-incidence

And there’s also advice on testing for infection in their guidelines: https://www.who.int/publications/i/item/9789240056084

The landing page for RCPCH resources for FGM including links to government guidance:  https://www.rcpch.ac.uk/resources/female-genital-mutilation-resources

And free online learning: https://www.rcpch.ac.uk/resources/female-genital-mutilation-online-learning

The Refugee council website has a wealth of information. Below is the page discussing Mental health support for refugees, and also a link at the bottom of the page: https://www.refugeecouncil.org.uk/our-work/mental-health-support-for-refugees-and-asylum-seekers/

Dr Campbell’s recommended book was: “Where the Crawdad’s Sing” by Delia Owens, and her recommended Podcast was the “Off Menu” by comedians Ed Gamble and James Acaster.

This episode was recorded in front of a live audience at the 2023 RCPCH Annual Conference, Glasgow. Dr Felicity Cooksey and Dr Leila Ellis were joined by an expert panel to discuss: What could the role of the general paediatric ward be in caring for a young person with a mental health presentation?

Panelists included:

• Dr Anna Kyle, Consultant General Paediatrician and Clinical Lead for mental health and eating disorders in Musgrove Park Hospital, Somerset NHS Foundation Trust;
• Dr Elaine Lockhart, Chair of the RCPsych Child and Adolescent Faculty with over 20 years’ experience working as a Consultant in Paediatric Liaison Psychiatry     
• Dr Lee Hudson, Clinical Associate Professor, Honorary Consultant General Paediatrician and Principal Investigator for the MAPS study.

During the live session, we read a poem by Anna Perkins ‘An NG Feed’ which is available to read in the NHS Paediatric restrictive practices and nasogastric feeding guidance (https://ngt-restrictive-practice.nhs.uk/)

Resources

• RCPCH Child mental health webpages (https://www.rcpch.ac.uk/key-topics/child-mental-health)
• RCPsych Medical emergencies in eating disorders (MEED) Guidance on recognition and management. CR233. 2022
• RCEM The ABC of self-harm in young people: A psychiatric approach to resuscitation. Sabel E. 2019
• NICE Self-harm: Assessment, management and preventing recurrence. NG225. 2022        NHS Paediatric restrictive practices and nasogastric feeding guidance (https://ngt-restrictive-practice.nhs.uk/)

Book recommendations

• Dr Anna Kyle: The Shock of the Fall by Nathan Filer
• Dr Elaine Lockhart: The Body Keeps the Score by  Bessel van der Kolk
• Dr Lee Hudson: Wolf Hall by Hilary Mantel

In this episode Dr Paulina Connolly discusses recent articles looking at the neonatal microbiome, dysbiosis and interventions intended to manipulate the microbiome & improve neonatal outcomes:

Manipulating the neonatal gut microbiome: current understanding and future perspectives | ADC Fetal & Neonatal Edition (bmj.com)

Impact of intrapartum antibiotics on the infant gastrointestinal microbiome: a narrative review | Archives of Disease in Childhood (bmj.com)

Effect of prophylactic dextrose gel on the neonatal gut microbiome | ADC Fetal & Neonatal Edition (bmj.com)

Necrotising enterocolitis, late-onset sepsis and mortality after routine probiotic introduction in the UK | ADC Fetal & Neonatal Edition (bmj.com)

This month Dr Simon Parke, Paediatric Oncologist, joins Dr Paulina Connolly to discuss the research paper: "Can I go home now? The safety and efficacy of a new UK paediatric febrile neutropaenia protocol for risk-stratified early discharge on oral antibiotics" by Dr Jackson et al from the March 2023 edition of Archives of Disease in Childhood (https://adc.bmj.com/content/108/3/192). Dr Parke's film recommendation is "The Princess Bride", and his book recommendation "Love in the Time of Cholera" by the author Gabriel García Márquez.

In this episode, Dr Rebecca Treleaven discusses the complexities of the clinician parent exchange and how to improve our communication skills through the review article: “Vulnerabilities in clinician–parent exchanges and the cascade of communication traps: a review”

https://adc.bmj.com/content/108/2/86.

In this episode, Dr Felicity Cooksey has a conversation with Dr Helen Leveret about child poverty and how paediatricians can advocate for reducing health inequalities. They discuss the article Child poverty and health inequalities in the UK: a guide for paediatricians | Archives of Disease in Childhood (bmj.com).

Resources:

https://bmjpaedsopen.bmj.com/content/6/1/e001631- Dr Singh & Dr Uthayakumar-Cumarasamy review on the Cost of living crisis: a UK crisis with global implications – A call to action for Paediatricians.

https://www.rcpch.ac.uk/key-topics/child-health-inequalities- the RCPCH child health inequalities toolkit to assist anyone interested in developing their knowledge, improving their communication with families, starting QI projects & advocating for change on a local and national level.

Supporting child health fighting poverty | Wellbeing and Health Action Movement (whamproject.co.uk) – A movement to inform, empower and unite clinicians who fight child poverty and health inequality.

https://www.rcpch.ac.uk/news-events/news/child-health-inequalities-podcast-1-talking-families - this edition of the RCPCH podcast discusses how to have meaningful & approachable conversations with families around living in poverty.

In this episode, Dr Felicity Cooksey & Dr Leila Ellis have a conversation with Katie Heard, a Specialist Pharmacist with an interest in antimicrobials and infectious diseases, about Group A Strep & looking at the interim clinical guidance from the UK HSA.  They discuss signs of Streptococcal infections and Scarlet fever, local statistics, the FeverPAIN score & the recent changes to it, testing and prescribing advice taking into consideration current supply issues.

Resources discussed:

UK HSA Interim Clinical Guidance & Safety netting advice: 

• https://www.england.nhs.uk/publication/group-a-streptococcus-communications-to-clinicians/#:~:text=Interim%20clinical%20guidance%20update%20aimed,released%20on%202%20December%202022
• https://www.what0-18.nhs.uk/professionals/gp-primary-care-staff/safety-netting-documents-parents/strep-and-scarlet-fever

Resources for learning more about rashes in a range of skin tones:

• https://dftbskindeep.com/about/
• https://www.blackandbrownskin.co.uk/mindthegap

The Kidzmed prescribing project:

• https://qicentral.rcpch.ac.uk/medsiq/patient-support/creating-a-pill-school-the-kidzmed-project/
• https://adc.bmj.com/content/105/11/1105

In this episode, Dr Felicity Cooksey has a conversation with Dr Anna Baverstock, a paediatric consultant and Senior Doctor Wellbeing Lead for Somerset NHS Foundation Trust. They discuss having brave conversations, enabling authentic inclusion and why Dr Baverstock believes we can change workplace culture one conversation at a time.

Together they explore Dr Baverstock’s recent article on kindness and inclusion (BACCH News September 2022 | British Association for Community Child Health) and a systematic review on the impact of unacceptable behaviours between healthcare workers by Dr Linda Guo and her colleagues (Impact of unacceptable behaviour between healthcare workers on clinical performance and patient outcomes: a systematic review | BMJ Quality & Safety). 

Dr Baverstock’s book recommendations were:

· The Good Ally - Nova Reid

· The Keeper of Stories - by Sally Page

Dr Baverstock’s recommended resources are:

Books

· The fearless organization - Amy Edmondson

· Atlas of the Heart – Brené Brown

· Listen – Kathryn Mannix

· Black British Lives Matter – Lenny Henry & Marcus Ryder

· Why I’m No Longer Talking to White People About Race – Reni Eddo-Lodge

· Against White Feminism – Rafia Zakaria

· The Transgender Issue – Shon Faye

· Inclusion on Purpose – Ruchika Tulshyan

· Demystifying Disability – Emily Ladau Disability Visibility – Alice Wong

Videos and Websites

· https://sloanreview.mit.edu/article/leading-in-an-age-of-employeeactivism/

· https://www.welldoctors.org/post/can-we-combine-clarity-andkindness-in-our-communication

Other resources discussed included:

· Compassionomics: The Revolutionary Scientific Evidence That Caring Makes a Difference -  Stephen Trzekiak and Anthony Mazzarelli

· Radical Candor - Kim Scott

· Civility Saves Lives Campaign. Available at: https://www.civilitysaveslives.com/[Accessed: November 2022]

· Ethics Unwrapped- Beyond Business Ethics. McCombs School of Business Texas University. Available at: https://ethicsunwrapped.utexas.edu/[Accessed: November 2022]

· Hickson GB, Pichert JW, Webb LE, Gabbe SG. A complementary approach to promoting professionalism: identifying, measuring, and addressing unprofessional behaviors. Acad Med. 2007;82(11):1040-8.

· Riskin A, Erez A, Foulk TA et al. The Impact of Rudeness on Medical Team Performance: A Randomized Trial. Pediatrics. 2015 Sep;136(3):487-95.