1. PLT: Child Health Update Tower Hamlets Tuesday 8th November 2016
THE ROYAL LONDON HOSPITAL
Stewart Cleeve

3. Contents Department Knowledge Practical tips Improving the service
Questions – for me
Questions – from me

4. Department

5. Royal London Hospital 5 Consultants (DM, SP, AJ, SC, PC)
4 Specialist Registrars
3 Clinical Fellows
1 Associate Specialists
2 Clinical Nurse Specialists

6. Consultants Mr Devesh Misra – general and urology
Mr Simon Phelps – general and upper GI
Miss Ashwini Joshi – general and urology
Mr Stewart Cleeve – general and lower GI
Mr Paul Charlesworth – general and upper GI

7. Infrastructure Neonatal Intensive Care Unit (36 – 105% bed occupancy)
Paediatric Intensive Care Unit
Wards – 7D, 7E, 7F, 7C
4 Paediatric Theatres

8. Generalists

9. A&E activity by year

10. % Admitted patients by type of admission

11. Common Conditions Inguinal hernia Umbilical hernia Undescended testis
Prepuce
Tongue tie

12. Prepuce Most avoidable referrals

13. Prepuce
Balanitis Xerotica Obliterans
Only over 5 years of age

14. “itchy, red foreskin…”
Do not retract : causes fissures – chemical irritation/inflammation
Soak in bath twice daily for 1 week
Explain natural history of preputial retraction
“Ballooning” - normal
Trimovate – daily for a month for symptomatic relief

15. Tongue Tie
Worth dividing in first week of life to allow breast feeding
Breast feeding project
Drop in – Tuesdays E
Not thought to impact on speech

16. What colour is the next slide?

18. Which colour represents bile in neonatal vomit?

22. Paediatric Surgery Registrar deck phone
Paediatric Surgery Registrar
deck phone

23. Practical Tips

24. Paediatric Surgery Registrar deck phone
Paediatric Surgery Registrar
deck phone

25. Clinics
Monday/Tuesday/Wednesday/Friday

26. Theatre Emergency list every afternoon
Elective lists Mon/Tue/Wed/Friday

27. Improving the Service

28. 72% success

29. 78% success

30. Success 84%

32. GMC – green outlier

33. Presentations Immature ganglion cells Colorectal trauma
HD – does length of resected ganglion segment effect outcome
Adolescent ward – “A teenage dream”
Penetrating chest trauma
Magnet ingestion
Tissue for research
Perinanal Abscess – systematic review
Training
OA – level of trainee involvement
Curriculum based teaching

36. Health Foundation Project
Eleni Athanasakos – paediatric lower GI physiologist
CNS
Gastroenterologist
Psychologist
Playspecialist
Surgeon
Weekly MDT
Radiology
Safe guarding
Transition – Prof Knowles

37. Health Foundation Project
Education – patient, parent, family members, schools
Talking therapies – counselling, cognitive behaviour therapy, hypnotherapy, psychoeducation, family therapy
Bowel retraining (biofeedback)
Neuromodulation – transcutaneous electrical stimulation, posterior tibial nerve stimulation, sacral nerve stimulation
Transanal irrigation (Peristeen or Qufora)
Surgery – examination under anaesthetic, rectal biopsy, manual evacuation of faeces, intersphincteric injection of botulinum toxin, antegrade continence enema (ACE), distal ACE, Chait caecostomy, resection of megarectum, colostomy, ileostomy

39. A Trauma Service for Children: from Prevention to Rehabilitation
Gap analysis of current service and ideal service
Elective and emergency vascular and trauma experience
Paediatric surgery
October 2016 – October 2017

40. Summary Department Knowledge Practical tips Improving the service
Questions – for me
Questions – from me

41. Take Home Messages

42. Questions?

43. Questions to you… How often do you interact with paediatric surgery?
Problems with the service?
How can service be improved?