My RCPCH 2016- Day 3

Day 3

The Plenary

The overarching themes of Day 3 of the conference encompassed research, innovation and quality improvement. The plenary session started with an inspiring talk by Professor Janet Stocks on engaging children in research, excellently illustrated by the SLIC study, which looked at lung function in school children from various ethnic groups living in London (https://www.ucl.ac.uk/slic). The majority of data collection took place in the schools themselves by a dedicated and

hardworking research team. The feedback from the children and head teacher of one school was incredibly positive, and served to remind us that public trust in paediatric research is crucial to constantly forward our understanding of child health.

This was followed by an update on the BPSU survey of Kawasaki disease to ascertain whether severity of coronary artery disease can be predicted by the clinical features on presentation. The results challenged conventional belief, and found that mucosal involvement (conjunctivae, lips) was associated with a lower risk of coronary artery aneurysms, and extremity involvement (peeling of fingers and toes) was associated with a higher risk of aneurysms. Plus, the incidence of Kawasaki appears to be rising in the UK, possibly because of under-diagnosis or under-treatment. Perhaps we should be looking out more for Kawasaki disease!

The next two talks centred on very little people. A study looking at the effect of modified TPN on head growth and neurodevelopmental outcomes suggested that parenteral nutrition with more protein and calories compared to standard TPN improved early head growth with possible improvement in language and cognitive outcomes. Another study from Cardiff University attempted to identify biomarkers in meconium, placenta, maternal hair, maternal blood and maternal urine in prenatal alcohol exposure to identify children at risk from Fetal Alcohol Spectrum Disease. However, due to inconsistency in sensitivity and specificity of the tests, there wasn’t enough evidence to identify a single, or group of, valid tests for this important condition.

The final talk of the plenary by Professor Andrew Hattersley looked at the diagnosis of monogenic diabetes/MODY and was truly enlightening, with many paediatricians leaving the lecture theatre swearing to change their practice! Did you know that the commonest cause of incidental hyperglycaemia in children was due to a glucokinase mutation, not Type 1 diabetes? Glucokinase is a glucose sensor, and contributes to the regulation of blood glucose. In the mutation, individuals run a higher baseline blood glucose which follows the same variations as normoglycaemic individuals. However- and here’s the clincher- Glucokinase MODY patients do not benefit from treatment, in that their HbA1c is unchanged with subcutaneous insulin, and they do not have any significant microvascular complications. Read more at www.diabetesgenes.org on diagnosing and treating MODY, and have a go at using the MODY probability calculator!

The morning workshop

Re-fuelled by coffee and a sweet snack, I headed to the “Writing for Education and Practice edition of Archives in Disease and Childhood” workshop, led by the charismatic duo of Ian Wacogne and Mark Tighe, with ADC editor in chief Mark Beattie intermittently throwing in pearls of wisdom. It was a great workshop and I learnt a lot about how to (and how not to) write an article. The key message I took away was to write for the person who doesn’t have time to read and has far too many daily distractions- namely all doctors!- hence making your writing fun, interesting, and to the point.

The afternoon symposium

After a rather tasty (and carb-heavy) lunch, again featuring the famous RCPCH cupcakes, I spent most of the afternoon in the Quality Improvement centred trainee session. The session kicked off with recently retired paediatrician Dr Peter Lachman giving a thought-provoking talk on incorporating quality improvement in all aspects of your daily clinical work, being mindful of keeping our patients safe and ensuring we as professionals are always learning. His slides on theory and frameworks were punctuated by “buzz sessions”, encouraging us to share our thoughts with the person sat next to us, and heartfelt personal stories of patient care. I certainly felt his suggested framework for safety and reliability, consisting of 6 questions to ask our team on a daily basis, was a real learning point on how we can keep reminding ourselves of what we do well as a team, and what we can keep doing to keep our patients safe. http://www.isqua.org/

In between trainee presentations of various interesting and innovative QI projects, Dr David Evans, RCPCH Vice President for Training and Assessment (and a thoroughly nice consultant neonatologist) stepped in at short notice and delivered an insightful, and dare I say, entertaining talk on the General Paediatric curriculum. He emphasised that, contrary to popular belief, every last competency of the curriculum does not have to be completed (phew!), and that future plans for the curriculum will be capability based rather than competency based. Additionally, he highlighted the plight of the current e-portfolio system, likening it to “starting potty training… There’s a bit of poo everywhere.” Definitely my favourite quote of the day!

Alas, I too had to nip out before the end of the session to catch my pre-booked train, so missed the last few trainee talks. To follow on from a point Katy mentioned from the 2nd day’s events about the AGM debate regarding college sponsorship from baby feed companies, I’m pleased to say that one of our trainees who seconded the motion won it! So a noble and hard-earned victory, but one which should have far-reaching positive effects. Hooray for trainees!

Dr Darshana Bhattarcharjee