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AimsTransition within Community Child Health can be a challenge. Various examples of good transition arrangements exist in conditions such as diabetes due to well developed, funded pathways. Such models may not be appropriate for young people with complex co-morbidities along with learning disabilities. Often, availability of parallel integrated adult services, who can continue to provide care for these young adults, is lacking.The Young People’s Charter, a local focus group of families, created a summary of the practices that make for a good transition experience. These practices align with national best practice recommendations as specified by NICE and the Ready Steady Go programme.MethodsAn audit was undertaken looking at transition within the Community Child Health population focusing on young people attending a specialist educational provision and those with a diagnosis of attention deficit hyperactivity disorder (ADHD). At the time of this audit, there was no established transition models used within the setting for these groups.A data collection proforma was created based on the NICE quality standards from the NG43 Transition guideline, the Young People’s Charter summary and Ready Steady Go best practice recommendations. The data collection proforma was reviewed by the local Transition Steering Group prior to data collection. Data was collected retrospectively between January 2019 and December 2020. The audit included any patient who turned 18 during this time attending either a specialist educational provision school clinic or an ADHD clinic in the community setting.ResultsA total of 53 patients were identified with their diagnoses seen in table 1.Just under half (46%) of patients were transitioned to the care of the GP, 27% transitioned to the local adult learning disability service and 11% to adult neurology. None of the patients had a named transition worker to coordinate care and provide support and 68% had not met the adult team prior to transition.For those who transitioned to the care of the GP, a detailed medical discharge summary with background information and safeguarding issues was not done in any case. The annual health review offered to all young people over the age of 14 with a diagnosis of LD was mentioned in 41% of cases.Only 15% of patients had a transition medical summary and 94% did not have a health or hospital passport. Of those with a diagnosis of LD, 95% had an alert on their hospital electronic record.ConclusionWork in progressAlthough these results are far from desirable, it has highlighted the need of better pathways for these young people. A transition key worker across the specialist educational provisions has been appointed and dedicated multidisciplinary transition clinics involving adult teams have been set up. Representation at the local Transition Steering Group now includes colleagues working with these young people. Conclusions: It is paramount that both adult and paediatric commissioners recognise that this is an important area for improving health outcomes of individuals, to reduce the feeling of abandonment of patients and their families.

BackgroundThere are an estimated 1.5 million people in the UK with a learning disability (LD), of which 351,000 are children (2.5% of total childhood population).1 It is recognised that for people with LDs to have the best life chance, early diagnosis and appropriate intervention in childhood is key.2 However, a formal diagnosis of LD may never be made despite a continuing acknowledgement of a child’s global development delay as they progress towards adulthood.3 Of those that are diagnosed, many do not receive recommended interventions, with only 55% of those registered as having an LD receiving their annual health check in primary care.4 ObjectivesTo survey practice regarding diagnosing LD within community paediatrics.MethodsA questionnaire was designed by the authors and distributed amongst community paediatric departments in the West Midlands via a lead trainee. Responses were requested from community paediatric consultants and speciality doctors. It was open for responses between 7th January and 25th February 2020. The questionnaire addressed areas such as confidence in diagnosing LD, methods used in clinical practice to diagnose LD, and other conditions where you would consider giving a diagnosis of LD.All responses were voluntary and anonymous. Both quantitative and qualitative data were obtained from the responses.Results40 responses were obtained, of which 29 (72.5%) were from consultant community paediatricians. Only 2 (5%) were completely confident in diagnosing LD. 13 (32.5%) were fairly confident, 19 (47.5%) somewhat confident, 4 (10%) slightly confident and 2 (5%) lacked confidence in making the diagnosis. Clinicians used a range of tools and methods to assist with making a diagnosis including school reports, educational psychology reports, functional skills histories, IQ/WISC (The Wechsler Intelligence Scale for Children). A lack of access to educational psychology reports was felt to be a barrier to making a diagnosis with 17 clinicians (42.5%) stating access to their reports would help them make a diagnosis.ConclusionsConfidence in diagnosing LD varies amongst clinicians. We call for the development of standardised pathways in diagnosing LDs. We hope that this would empower community paediatricians to confidently diagnose LDs, enable children and young people to access the health care and support services available to them, and subsequently reduce their future physical and mental health complications.An additional survey of practice following these results is currently being undertaken to explore the diagnosis of LD amongst Educational Psychologists within the region.ReferencesResearch and statistics. Mencap. [cited 2021 Jan 21]. Available from: https://www.mencap.org.uk/learning-disability-explained/research-and-statisticsHorridge K. Learning disabilities matter. Dev Med Child Neurol. 2020 Oct;62(10):1112.Kenten C, et al. To flag or not to flag: identification of children and young people with learning disabilities in English hospitals. JARID. 2019 May;32(5):1176–1183Health and Care of People with Learning Disabilities, Experimental Statistics: 2017 to 2018 [PAS] - NHS Digital

Specific support requested by trainees to facilitate research involvement included supervisory and methodological support.Table 1 Results from thematic analysis of responses to motivators and barriers around research Motivators/benefits to research Example quotes Clinical care ‘I feel it can benefit so many more children than I am able to see clinically on an individual basis. The TRN recognises the positive impact of signposting all trainees to relevant support systems when developing research or quality improvement studies.3 Without appropriate exposure to high-quality research while in training, we risk compromising evidence-based care. Contributors Survey review, analysis of data, drafting and review of article—TR, HM, FM, LP, ELW, CWC, CJ and the RCPCH Trainee Research Network Working Group.

There are an estimated 1.5 million people in the UK with a learning disability, of which 351 000 are children (2.5% of total childhood population). It is recognised that for people with learning disabilities to have the best life chance, early identification and appropriate intervention in childhood is key. However, learning disabilities often go undiagnosed. We present a structured practical approach to assessing the school-aged child who presents with a possible learning disability.

Retrospective virtual application of the National Institute for Health and Care Excellence (NICE) guidelines for neonatal infection 2021 compared with Kaiser Permanente Sepsis Risk Calculator (KP-SRC) and previous NICE guidelines 2012. NICE 2021 may reduce this to 4.4% and KP-SRC may reduce it to 2.7%, treating those recommended both culture and antibiotics.Table 1 Estimated percentages of live births >34 weeks receiving antibiotics in postnatal settings, following virtual application of NICE 2021 guidelines and KP-SRC Live births total January–February 2020 Current practice Abx NICE 2012 applied* KP-SRC 2/1000 Abx indicated plus NICE 2012* KP-SRC 2/1000 Abx and culture indicated plus NICE 2012* NICE 2021* KP-SRC 2/1000 Abx indicated plus NICE 2021* KP-SRC 2/1000 Abx and culture indicated plus NICE 2021* n 7833 624 572 118 306 346 103 209 % 8.0 7.3 1.5 3.9 4.4 1.3 2.7 NICE 2012: LM (1), SS (2), TvH (2), NM (2), AKE (2,3), PS (1), Paediatric Research Across the Midlands (PRAM) Network: (1) Birmingham Heartlands Hospital, (2) Birmingham Women’s and Children’s NHS Foundation Trust, (3) Institute of Metabolism and Systems Research, University of Birmingham.

Research is vital to paediatrics; however, many trainees feel there is a deficit in their opportunities, experience and exposure in this area. Three training regions in the UK, the West Midlands, Wales and Peninsula, have recently started region-wide, trainee-led research and governance collaboratives aimed at improving trainee access and education in research, undertaking good quality, multicentre audit, quality improvement and pilot projects in collaboration across the regions and implementing change. We report on the experiences, benefits and challenges of these trainee collaboratives (Paediatric Research Across the Midlands, Wales Research and Education Network and Peninsula Trainee Research Audit and Innovation Network) including a trainee survey looking at how these initiatives have improved skills in conducting multicentre prospective studies, team working skills, leadership, understanding of statistics and manuscripts and presentation skills. We also describe how collaboration with colleagues and participation in projects can benefit trainees in a wider sense of purpose and help to encourage morale, as well as what can be learnt as paediatric training moves forward.