Objectives: Endoscopy teaching practice is variable, which inevitably affects the training provided. There is only one Train the Paediatric Colonoscopy Trainer (TPCT) course in the UK. Informal feedback has been positive, but its practical value has never been formally assessed. We aim to assess the practical value of the TPCT course and how attendees perceive their teaching practice compared to nonattendees.Methods: A questionnaire based on the TPCT course learning aims and objectives was distributed to two groups of consultant paediatric gastroenterologists who teach colonoscopy in the UK; those who had attended the course (participants) and those who had not (controls).Results: The 41 completed responses were received. Overall, responses indicated participants of the TPCT course rated their confidence and knowledge in teaching practices as higher than controls (4.27 vs. 3.56 p = < 0.001). There was a statistically significant difference in all areas: set (4.21 vs. 3.71 p = 0.011), dialogue (4.29 vs. 3.55 p = < 0.001) and closure (4.37 vs. 3.6 p = < 0.001) with those who attended the TPCT course giving higher ratings. There was evidence of increased understanding of key concepts such as using standardised language, conscious competence, dual task interference and performance enhancing feedback.Conclusion: Attending a TPCT course results in a higher perceived level of knowledge in fundamental teaching principles and confidence in colonoscopy teaching skills.

What is Known Botulinum toxin (BoNT) causes muscle relaxation by inhibiting acetylcholine release from presynaptic motor neurons at the neuromuscular junction.What is New In children with achalasia, BoNT can be considered only in patients in whom rapid weight gain is important to improve surgical outcomes. BoNT has been suggested for treating cricopharyngeal achalasia and delayed gastric emptying. Anal achalasia and constipation after Hirschsprung disease corrective surgery are very promising indications for BoNT use. In selected children with resistant type of functional constipation and chronic anal fissure, BoNT is a viable option for treating.

ObjectivesPriority Setting Partnerships (PSP's) using the James Lind Alliance (JLA) methodology, bring together health professionals, patients and parents/carers to identify and prioritise unanswered questions that can be addressed by future research projects. To identify and prioritise the top 10 unanswered research priorities in digital technology for adolescents and young people (AYP) with inflammatory bowel disease (IBD).MethodsA steering group (SG) consisting of AYP with IBD, their parents/carers, representatives from two charities (Crohn's & Colitis UK, Crohn's in Childhood Research Association), patient information forum and paediatric and adult and primary care healthcare professionals was established in 2021. The SG agreed the protocol, and scope of the PSP and oversaw all aspects. SG meetings were chaired by a JLA advisor and followed the established JLA methodology.ResultsThe initial survey generated 414 in-scope questions from 156 respondents, thematically categorised into 10 themes and consolidated into 92 summary questions by the SG. A comprehensive literature review followed by SG deliberation narrowed the unanswered summary questions to 45, for the interim prioritising survey. One hundred and two respondents ranked their top 10 research questions. Outputs generated top 18 research priorities presented at a final virtual prioritisation workshop, facilitated by JLA advisors and attended by key stakeholders, ranked into top 10 research priorities.DiscussionThe top 10 research priorities will encourage researchers to undertake research that addresses these areas of unmet need for AYP living with IBD, their parents/carers and their healthcare professionals, thereby facilitating improved patient care. image The top 10 research priorities determined by this Priority Setting Partnerships on Digital Technology for Adolescents and Young Persons with IBD, will encourage researchers to undertake research that addresses these areas of unmet need thereby facilitating improved patient care.What is Known?Priority Setting Partnerships using the James Lind Alliance methodology, bring together health professionals, patients and parents/carers to identify and prioritise unanswered questions that can be addressed by future research projects.Yet, the development of digital technological tools in delivering inflammatory bowel disease (IBD) clinical care, has so far been largely driven by clinical teams and developers.

Objective To explore Young Persons (YP) and healthcare professionals (HCP) experiences of virtual consultations (VC) and establish whether developmentally appropriate healthcare can be delivered virtually. Method YP and HCP questionnaire surveys were designed and piloted. Electronic questionnaire links were sent by post, email or text message January–April 2021 to YP aged 13–25 years old, with predefined chronic gastrointestinal conditions, attending a gastroenterology/hepatology VC. HCP undertaking VC were invited to complete staff questionnaire. Results were anonymous and collated using Excel version 2302. Results Five UK hospital trusts participated, with 35 HCP responses. Of the 100 YP completing the survey 66% were female and 34% male aged between 13 years and 25 years (median: 18 years). 13% were new appointments and 87% follow ups, 29% were by video, 69% by phone and 2% gave no response. 80% of HCP spoke to YP directly but not privately (69%). 87% of YP and 88% HCP found VC useful. 83% of YP want VC again, although 20% preferred face to face. 43% of HCP required improved phone/internet connection. 77% of YP required hospital appointments for tests following VC. Conclusions Overall respondents were satisfied with VC, finding them useful, convenient and time saving. Successful VC rely on appropriate patient selection and availability of reliable technology. Patient preference is key which may alter with time.

Upskilling in ileocolonoscopy is an important aspect of pediatric endoscopic practice as it enables endoscopists to learn additional skills through education and training to improve outcomes. With the advent of technologies, endoscopy is continuously evolving. Many devices can be applied to improve endoscopy quality and ergonomics. In addition, techniques such as dynamic position change can be employed to increase procedural efficiency and completeness. Key to upskilling is enhancing endoscopists’ cognitive, technical and nontechnical skills and the concept of “training the trainer” to ensure trainers have the requisite skills to teach endoscopy effectively. This chapter details aspects of upskilling pediatric ileocolonoscopy.

Crohn disease (CD) is often complicated by bowel strictures that can lead to obstructive symptoms, resistant inflammation, and penetrating complications. Endoscopic balloon dilatation of CD strictures has emerged as a safe and effective technique for relieving these strictures, which may obviate the need for surgical intervention in the short and medium term. This technique appears to be underutilized in pediatric CD. This position paper of the Endoscopy Special Interest Group of European Society for Pediatric Gastroenterology, Hepatology and Nutrition describes the potential applications, appropriate evaluation, practical technique, and management of complications of this important procedure. The aim being to better integrate this therapeutic strategy in pediatric CD management.

Endoscopy teaching practice is variable, significantly affecting training provided. Endoscopy specific train the trainer courses are commonplace in adults, and in the UK are now mandatory. There is only one paediatric train the colonoscopy trainer course (PTCTC) in the UK and although informal feedback has been positive, its practical value has never been formally assessed. A small cohort of studies demonstrated a benefit with these courses but highlighted the need for further research, especially in paediatrics. We aim to assess the practical value of the PTCTC and how attendees perceive their teaching practice compared to non-attendees. A questionnaire based on the PTCTC learning objectives and aims was distributed to two groups of Consultant Paediatric Gastroenterologists who teach colonoscopy in the UK; those who had attended the course and those who had not attended the course (controls). 41 completed responses were received. 25 attended a PTCTC, 3 attended an adult course and 13 had not attended any course. Overall responses indicated participants of the PTCTC rated their confidence and knowledge in teaching practices as higher than controls (4.27 vs 3.56 P = <.001). There was a statistically significant difference in all areas: set (4.21 vs 3.71 P = .011), dialogue (4.29 vs 3.55 P = <.001) and closure (4.37 vs 3.6 P = <.001) with those who attended the PTCTC giving higher ratings. There was evidence of increased understanding of key concepts such as using standardised language, conscious competence, dual task interference and performance enhancing feedback. Overall, this study demonstrates a higher perceived level of knowledge in fundamental teaching principles and confidence in colonoscopy teaching skills in those who attended a PTCTC. The study was limited by the sample size, but the results support the need for these courses and for ongoing research into their importance. References Mehta T, Dowler K, McKaig BC, et al. Development and roll out of the JETS e-portfolio: a web based electronic portfolio for endoscopists. Frontline Gastroenterol 2010;2:35–42. Anderson JT. Assessments and skills improvement for endoscopists. Best Pract Res Clin Gastroenterol 2016;30:453–71.

Objectives Background CQC recommendations for the trust following a visit, included a trust wide consistent and robust approach to assessment and planning of transitional care and a consistent approach to completion and storage of transition medical records. A ‘live’ transition plan was created in 2018 in the electronic eDMS patient notes. This enabled health professionals to document a summary of transitional discussions addressing key areas and creating a clear timeline, which could then be shared by the transferring team with the receiving adult team. It also ensured that when a young person was under multiple specialities, all involved professionals could rapidly access transitional discussions and plans made. Objectives To audit the use of the live transition plan against standards based on completion of key information in the live plan and whether the plans were transferred to adult specialities during transition of care. Methods Retrospective case note review of the eDMS live transition plan updated in the month of July 2021, for young people with chronic long term conditions that required transition of care to adult services. Results 210 live transition plans were updated between 1st and 31st July 2021. 55% (n=94) of the plans had an identified key worker1 documented. In 21%(n=45) a user error was noted because teams were creating duplicate plans instead of updating the existing transition plan, which meant a clear timeline of discussion would not be available at transfer. All plans had completed an answer to the mental capacity act question but professionals had documented uncertainty over this. Documentation indicated that 10 young people had a life-limiting condition and two included documentation of an advance care plan. There was limited use of the snapshot function to share the transition plan with adult services at transition. 17 of the young people had safeguarding alerts in their electronic notes but only 3 had a safeguarding concern documented in the transition plan. 23 different specialities completed the transition plan and 18 of these were within medicine care group. 80% (n=168) of the entries were completed by specialist nurses, 10% (n=20) by consultants and the rest by other healthcare professionals. 75% (n=158) of the entries had the intended adult team/hospital destination identified. Conclusions This first review highlighted variability in the completion of the ‘live’ transition plan in patient notes and the need for further education and training promoting use with all members of the multi-disciplinary team. Training to address this is now included in the mandatory trust transition training. This audit also enabled a review of the question on mental capacity act to make it clear and signpost professionals to trust resources. A ‘top tips’ document was created to share key themes and messages with all health professionals in the trust. Reference National Institute for Health and Care Excellence. (2016). Transition from children’s to adults’ services for young people using health or social care services.

Objectives: Ileo-colonoscopy (IC) can be technically challenging because of unpredictable colonoscope loop formation. Aims of this study were to assess the risk of loop formation and to attempt to understand which factors were likely to predispose to which subtype of loop. Methods: Prospective study conducted on children referred for an IC at Sheffield Children's Hospital. Presence and type of loop was objectively assessed using the magnetic endoscope imaging tool. Results: Three hundred procedures were prospectively evaluated. Only 9% of paediatric ICs were loop-free. Alpha loops were the most common loop in children older than 5, whereas reverse alpha loops and a wider variety of complex and repetitive loops were observed in younger patients. Once a specific type of loop has formed, the risk of re-looping in a different way or in a different position of the colon is reduced. Left lateral starting position was found to increase the risk of reverse alpha loops and re-looping. Challenging loops, such as reverse alpha, were more frequent in males. Higher body mass index (BMI) was associated with an increased risk of alpha and deep transverse loops formation, while lower BMI with a higher incidence of reverse alpha and N loop. Loop formation did not prevent 100% ileal intubation. Conclusions: This study represents the first attempt to describe loop formation according to patient characteristics in a large paediatric series. Further studies are needed in order to establish if these findings could be helpful in simplifying the execution of IC procedures in children and facilitate the learning curve during endoscopy training programs.

Background Digital healthcare (DHC) is a rapidly expanding area of healthcare and offers significant opportunities to transform Inflammatory Bowel Disease (IBD) care. DHC cover a wide range of technologies, including and not exclusive to apps, podcasts, websites, social media and patient controlled electronic medical platforms. Application digital technology (DT) in clinical practice should be supported by research evidence. A Priority Setting Partnership (PSP) was set up in collaboration with the James Lind Alliance (JLA), a non-profit organisation, to prioritise research topics that young people with IBD, their carers, and their clinicians consider important for evidence-based implementation of DT in IBD. Aim To create a survey designed to identify the unanswered questions or evidence uncertainties in the use of DT for adolescents and young persons with IBD. Methods PSP meetings were attended by key stakeholders as a Steering Group (SG): paediatric and adult gastroenterologists with an interest in adolescent and young person care from BSPGHAN and BSG respectively, IBD clinical nurse specialists, representatives from the IBD charities CICRA and CCUK and patient and parent representatives. The survey was designed through an iterative process at a series of meetings. The survey was considered complete when there was saturation of changes and the approval by all stakeholders. Readability was assessed by the Flesch-Kincaid Reading Ease test (a measure of average sentence length average number of syllables per word) and Flesch-Kincaid Grade Level test on Microsoft Word. Methods of dissemination were discussed and agreed. Results The final survey consists of three sections. The first captures roles and connection of IBD to the individual completing the survey. The second invites participants to submit questions about DT in two areas: DT to support their condition and improve IBD care, and DT to improve communication with the healthcare team. Questions are open-ended to allow participants to elaborate on their answers. Due to the vast range of DT and potential questions, examples were provided to assist individuals with answering, including the example of a mobile app for recording symptoms and disease activity. The final section for demographic data is optional and will not be linked to responses in sections 1 or 2. Finally, participants are invited to be involved after the survey closes to help with further stages in the prioritisation process. The final survey is shown in figure 1. The Reading ease test score is 61 (good scores 60 to 70) and Flesch-kinaid grade level is 8.1 (optimal scores 7.0 to 8.0). The survey was approved by the patients within the SG. Conclusion A SG with wide representation for a PSP on DT in IBD was created. As a first step to identify unanswered questions or uncertainties, a readable survey was developed. Research priorities will be identified using the JLA methodology and these will galvanise research on DT to improve disease outcomes and quality of life. DIGITAL TECHNOLOGY FOR ADOLESCENTS AND YOUNG PERSONS WITH INFLAMMATORY BOWEL DISEASE A Priority Setting Partnership (PSP) in collaboration with the British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN), British Society of Gastroenterology (BSG) and the James Lind Alliance (JLA) WHO ARE WE? We are a group of patients, carers, healthcare professionals and researchers who are passionate about improving the care and quality of life of people living with inflammatory bowel diseases (IBD) such as ulcerative colitis and Crohn's disease. Together, we are collaborating on a project called a Priority Setting Partnership (PSP), to identify the top 10 research priorities for digital technology in adolescents and young persons with IBD. WHAT ARE WE DOING? There are huge opportunities to transform IBD care with digital technologies, but we need to understand the impact that technologies will have and how to best use them. Digital technologies may include apps, podcasts, websites, social media and patient controlled electronic medical platforms. We are asking people up to and including the age of 25 who are affected by IBD; their families, carers and friends; health and social care professionals to help us identify the top 10 questions that need to be answered by research in this area. WHY DO WE NEED YOUR HELP? We would like to hear from you if you are: an adolescent or young person up to and including the age of 25 with IBD a parent, carer or friend supporting an adolescent or young person with IBD a health or social professional involved in the care of IBD patients Your views will ensure that we focus on the needs of adolescents and young persons living with the condition and guide future research. WHAT DO I HAVE TO DO? We are asking you to complete a short 10-minute survey. You don't have to be an expert in technology to take part. Ask us questions about the use of digital technologies based on your experience of living with IBD or supporting someone with the condition. WHAT HAPPENS AFTER THE SURVEY? We will look at all the questions that have been asked in the survey and check that they align with this project. For the questions that have not been answered already by research, we would welcome you would help to put these into order of priority. Please leave your contact details at the end if you wish to be involved in this part. Finally, we will come up with a list of the top 10 research priorities which will be publicised to researchers and organisations that fund IBD research. WHAT WILL HAPPEN WITH MY INFORMATION? By taking part in this survey, you give us consent to use your anonymized answers and publish these in our project report. We take your privacy seriously so we will not be able to personally identify you. You may also leave contact details at the end if you would like to continue to help with this project (optional). Personal contact details will be kept confidential. THERE ARE THREE SECTIONS TO THIS SURVEY Section 1: This asks about who you are to help us understand your role and how you're connected with IBD. Section 2: We would like you to ask questions about the use of digital technology in 2 broad areas. You may wish to focus on just one area or both: Questions about digital technologies to support your condition and have the potential to improve IBD care. These technologies help your healthcare team with making decisions about diagnosis, treatment, and clinical care. They may also help you self-manage IBD, promote healthier ways of living and monitor your progress. Examples include mobile apps for recording your symptoms and disease activity or provide information. Questions about the use of digital technologies to improve communication with your healthcare team. These technologies help to improve the two-way communication between you and the health professionals who look after you. Examples included instant messaging portals and video consultations that link you to healthcare teams. Section 3 (optional): This asks for additional background information about you to help us understand who you are and to ensure that we have captured a range of different experiences. These answers will not be linked to your responses in section 1 and 2. SECTION 1: ABOUT YOU It is important to know who you are, the person filling in the form, and how you are connected to IBD. Which of the following describes you best? □I am an adolescent or young person with IBD □I am a parent or have experience as a carer of an adolescent or young person with IBD □I am a family member of an adolescent or young person with IBD □I am a friend of an adolescent or young person with IBD □I am a healthcare professional who looks after adolescents or young persons with IBD □I am a member of an organisation or charity representing persons with IBD □Other – please state…………….. SECTION 2: YOUR QUESTIONS Write down 3 questions that you would like to see answered about the use digital technology in inflammatory bowel disease. This can be in the form of a sentence or a question. You do not have to fill in all of the sections if you don't want to. My first question/comment My second question/comment My third question/comment Please write down any other questions/concerns in the box below if you'd like to SECTION 3: ADDITIONAL INFORMATION ABOUT YOU (OPTIONAL) This optional but it is important to understand who is filling out the form to ensure that we have collected views from a range of people with varied experiences. 1. What is your age? □ <16 □ 16–25 □ 26–39 □ 40–59 □ 60–79 □ 80+ □ I prefer not to say 2. Which of the following best describes your gender? □ Boy/man □ Girl/woman □ Non-binary □ I prefer not to say □ I prefer to self-describe, please state………. 3. What is your ethnic group? Asian or Asian British □ Bangladeshi □ Chinese □ Indian □ Pakistani □ Any other Asian background, please describe………….. Black/African/Caribbean/Black British □ African □ Caribbean □ Any other Black/African/Caribbean background, please describe…… Mixed/Multiple ethnic groups □ Asian and White □ Black Caribbean and White □ Black African and White □ Any other mixed/Multiple ethnic background, please describe………. White □ English/Welsh/Scottish/Northern Irish/British □ Gypsy or Irish Traveller □ Irish □ Any other White background, please describe…….. Any other ethnic group □ Arab □ Any other ethnic group, please describe………… □ Prefer not to say 4. Where do you live? □ England □ Wales □ Scotland □ Northern Ireland □ I prefer not to say WOULD YOU LIKE TO HELP US WITH THE NEXT STEP? Once the survey has closed, we would like to get back in touch with the people who completed this survey for help with collating research questions into order of importance or urgency. If you would like to take part in this stage, please add your contact details below. Thank you for completing the survey. If you have any questions or would like any further information, please contact:………………………………

INTRODUCTION:There is increasing international recognition of the impact of variability in endoscopy facilities on procedural quality and outcomes. There is also growing precedent for assessing the quality of endoscopy facilities at regional and national levels by using standardized rating scales to identify opportunities for improvement. METHODS:With support from the North American and European Societies of Pediatric Gastroenterology Hepatology and Nutrition (NASPGHAN and ESPGHAN), an international working group of the Pediatric Endoscopy Quality Improvement Network (PEnQuIN) used the methodological strategy of the Appraisal of Guidelines for REsearch and Evaluation (AGREE) II instrument to develop standards and indicators relevant for assessing the quality of facilities where endoscopic care is provided to children. Consensus was reached via an iterative online Delphi process and subsequent in-person meeting. The quality of evidence and strength of recommendations were rated according to the GRADE (Grading of Recommendation Assessment, Development and Evaluation) approach. RESULTS:The PEnQuIN working group achieved consensus on 27 standards for facilities supporting pediatric endoscopy, as well 10 indicators that can be used to identify high-quality endoscopic care in children. These standards were subcategorized into three subdomains: Quality of Clinical Operations (15 standards, 5 indicators); Patient and Caregiver Experience (9 standards, 5 indicators); and Workforce (3 standards). DISCUSSION:The rigorous PEnQuIN process successfully yielded standards and indicators that can be used to universally guide and measure high-quality facilities for procedures around the world where endoscopy is performed in children. It also underscores the current paucity of evidence for pediatric endoscopic care processes, and the need for research into this clinical area.

Introduction Evolution of digital technologies (DT) offers significant opportunities to transform inflammatory bowel disease (IBD) care. A James Lind Alliance (JLA) Priority Setting Partnership (PSP) aims to identify research priorities for DT in IBD. A survey was designed to identify unanswered questions or evidence uncertainties in the use of DT for adolescents and young persons with IBD. Methods PSP meetings were held with key stakeholders within a Steering Group (SG) consisting of: paediatric and adult gastroenterologists with an interest in adolescent and young person care from BSPGHAN and BSG respectively; IBD specialist nurses; representatives from Crohn's in Childhood Research Association (CICRA) and Crohn's and Colitis UK (CCUK) charities; patient and parent representatives. The survey was designed through an iterative process, considered complete when there was saturation of changes and approved by all stakeholders. A pilot survey with a feedback questionnaire resulted in additional minor changes to the structure and content and provided examples of research priorities to guide participants. Results A final survey consisting of three sections was approved by the SG. The first captures the respondent's role and connection with IBD. The second invites them to submit questions about DT in two areas: DT to support their condition and improve IBD care, and DT to improve communication with the healthcare team. Open-ended questions are used to allow elaboration of answers with examples generated from the pilot survey to assist respondents articulate research questions. An optional last section captures demographic information not linked to responses in previous sections. Conclusions A survey (Figure 1) was developed and piloted as a first step to identify unanswered questions. Research priorities will be identified using the JLA methodology to galvanise DT research that may translate into improved disease outcomes and quality of life.

Objectives Digital personal health records (DPHR) have great potential to empower and equip young people (YP) to effectively manage their health condition. This study aimed to understand the views, requirements and concerns of YP with Inflammatory Bowel Disease (IBD) and their parents/carers regarding a developmentally appropriate and user-friendly DPHR. Design Sheffield Children's NHS Foundation Trust, NIHR Children and Young People MedTech Co-operative and Crohn's in Childhood Research Association (CICRA) collaborated to develop and circulate YP and parent/carer versions of the survey to all YP and parents registered with CICRA. Survey respondents were given the options of 'yes, no or maybe' in answer to the questions, with the opportunity of commenting on each question in the free text sections. Questions included were 'Do you think it would be helpful if the app had alerts to remind you about your hospital appointments?' and 'What is your opinion of the app? 0=dislike, 100=like'. Responses were collected between January and February 2021. Results 25 YP (9–25 years (median 14); 64% female) and 93 parents/carers (44% female) across the UK completed the survey. Both YP and parents/carers rated the idea of the DPHR highly (YP: n=25, median 90(51–100)%; parents: n=86, median 100(4–100)%). YP and parents/carers would like easy access to information on IBD (YP:80%, parents/carers:89%) for themselves and to share with friends, family and teachers. Information about the transition process (YP:88%, parents/carers:97%), and information and contact details for the paediatric (YP:88%, parents/carers:95%) and adult (YP:88%, parents/carers:97%) clinical teams were felt to be helpful in supporting YP during this important period. The majority of YP and parents/carers would like access to their personal clinical records (YP:96%, parents/carers:89%), medication lists (YP:96%, parents/carers:95%), clinical laboratory results (YP: 84%, parents/carers:89%), endoscopy reports (YP:84%, parents/carers:84%), radiology reports (YP:76%, parents/carers: 84%) and hospital appointments (YP:96%, parents/carers:99%). They would also like information on emotional wellbeing (YP:80%; parents:92%), nutrition and diet (YP:60%; parents:87%), preparation for endoscopic procedures (YP:76%; parents:80%), medications and treatments (YP:84%; parents:86%), travel information (YP:84%; parents:93%) and research opportunities (YP:52%; parents:66%). YP and parents/carers would like interactive features such as symptom tracking function and disease activity indices (YP:84%; parents:88%). Most of the participants would also like the app to provide alerts and notifications for hospital appointments (YP:80%; parents:90%) and blood monitoring appointments (YP:80%; parents:82%). From the general comments made on a proposed DHPR, YP and parents/carers viewed knowledge on IBD positively and felt that it would be a useful tool to encourage YP involvement in their own care. Some parents/carers would like the ability to regulate the information accessed by their child to ensure that the information and functions are age-appropriate. Conclusion A DPHR would be welcomed by the majority of YP with IBD and their parents/carers. Further co-design with YP, parents/carers, and clinical teams is needed to understand the exact requirements of the app and its design, and to explore potential concerns.

Background Transitional healthcare is increasingly recognised as a priority for young people with chronic medical conditions. NICE quality standards for Transition were developed in 2016 to enable services to identify areas for improvement.1 We performed a trust-wide audit examining compliance with the NICE quality standards in 2017, implemented new measures, and repeated the audit in 2019. The new measures were led by a central transition team and included a transition section in electronic notes, electronic ‘live’ transition plan, learning from complaints and incidents, identifying transition champions, addressing organisation-wide barriers to transition, developing clear pathways for accessing support for patients with complex transitional needs, and obtaining feedback on transitional experience. Objectives Objectives were To assess compliance with NICE Transition Quality Standards To assess whether measures implemented after the 2017 audit resulted in a change to compliance with NICE Transition Quality Standards To review subgroups of patients, including complex patients requiring transition under three or more specialties, to assess whether more input is required in these particular patient groups. Methods We reviewed two weeks of inpatient data (30th Sept - 13th Oct 2019) to identify patients with long-term medical conditions requiring transition, and assessed their transitional care against the NICE quality standards. The methodology was identical in 2017 and 2019. Did discussions around transition begin by age 14 (or at diagnosis, if later)? Was there an annual meeting where transition was discussed? Was there evidence of a named transition worker? Did they meet a practitioner from adult services before transferring? [partially assessed as most patients had not yet had their care transferred] Results We identified 43 transition episodes in 2017 and 90 in 2019. Overall, transitional discussions had started in 70% of patients, an improvement from 2017 (58%). Most patients still had not started transition planning early (36% 2017, 24% 2019) but more had an annual review (44% 2017, 73% 2019) and a named worker (20% 2017, 48% 2019). We identified three patients who had transferred to adult care without meeting an adult care provider. The transitional care of complex patients (under 3+ specialties) had significantly improved across all criteria between the two audits with 100% having started transition vs 66% in 2017. Conclusions The 2019 audit demonstrated improvement overall, but identified areas requiring ongoing development particularly with early transitional planning. Next steps include age-based transition prompts in electronic notes, embedding links to transitional information in clinic letters, and arranging virtual visits to adult services. References National Institute for Health and Care Excellence. (2016). Transition from children’s to adults’ services for young people using health or social care services (NICE Guideline NG43)

Chapter 6 Recertification and revalidation as concepts in pediatric endoscopy Priya Narula, Search for more papers by this authorMike Thomson, Search for more papers by this author Priya Narula, Search for more papers by this authorMike Thomson, Search for more papers by this author Book Editor(s):George Gershman, Professor of Pediatrics, David Geffen School of Medicine Chief, Division of Pediatrics Gastroenterology, Hepatology and Nutrition Harbor-UCLA Medical Center, Torrance, California, USASearch for more papers by this authorMike Thomson, Professor of Paediatric Gastroenterology and Interventional Endoscopy Director of the International Academy for Paediatric Endoscopy Training Centre for Paediatric Gastroenterology, Nutrition and Haepatology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK Portland Hospital for Women and Children, London, UKSearch for more papers by this author First published: 05 March 2021 https://doi.org/10.1002/9781119423492.ch6 AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat Summary Revalidation and/or recertification are processes whereby doctors demonstrate on a regular basis that they are up to date and fit to practice with the help of a portfolio of evidence or supporting information that can include continuous professional development, peer and patient feedback, quality improvement or audit and significant events. Revalidation and recertification schemes seek to improve patient care by the ongoing review of individual medical practice. Whilst these schemes are more generic, there are currently no established revalidation or recertification schemes for pediatric endoscopists. The goals of recredentialing or recertification in GI endoscopy are to ensure continued clinical competency, promote continuous quality improvement, and maintain patient safety. Ensuring ongoing competency in GI endoscopy in adults requires monitoring of key performance indicators, reviewing outcome data and adverse event rates and evidence of engagement in educational and clinical activities with a focus on continuous quality improvement. Practical Pediatric Gastrointestinal Endoscopy, Third Edition RelatedInformation

ABSTRACT Background: The European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) position paper from 2015 on percutaneous endoscopic gastrostomy (PEG) required updating in the light of recent clinical knowledge and data published in medical journals since 2014. Methods: A systematic review of medical literature from 2014 to 2020 was carried out. Consensus on the content of the manuscript, including recommendations, was achieved by the authors through electronic and virtual means. The expert opinion of the authors is also expressed in the manuscript when there was a lack of good scientific evidence regarding PEGs in children in the literature. Results: The authors recommend that the indication for a PEG be individualized, and that the decision for PEG insertion is arrived at by a multidisciplinary team (MDT) having considered all appropriate circumstances. Well timed enteral nutrition is optimal to treat faltering growth to avoid complications of malnutrition and body composition. Timing, device choice and method of insertion is dependent on the local expertise and after due consideration with the MDT and family. Major complications such as inadvertent bowel perforation should be avoided by attention to good technique and by ensuring the appropriate experience of the operating team. Feeding can be initiated as early as 3 hours after tube placement in a stable child with iso-osmolar feeds of standard polymeric formula. Low-profile devices can be inserted initially using the single-stage procedure or after 2–3 months by replacing a standard PEG tube, in those requiring longer-term feeding. Having had a period of non-use and reliance upon oral intake for growth and weight gain—typically 8–12 weeks—a PEG may then safely be removed after due consultation. In the event of non-closure of the fistula the most successful method for closing it, to date, has been a surgical procedure, but the Over-The-Scope-Clip (OTSC) has recently been used with considerable success in this scenario. Conclusions: A multidisciplinary approach is mandatory for the best possible treatment of children with PEGs. Morbidity and mortality are minimized through team decisions on indications for insertion, adequate planning and preparation before the procedure, subsequent monitoring of patients, timing of the change to low-profile devices, management of any complications, and optimal timing of removal of the PEG.

Objectives: Patients with paediatric inflammatory bowel disease (IBD) constitute one of the largest cohorts requiring transition from paediatric to adult services. Standardised transition care improves short and long-term patient outcomes. This study aimed to detail the current state of transition services for !BD in the United Kingdom (UK). Methods: We performed a nationwide study to ascertain current practice, facilities and resources for children and young people with IBD. Specialist paediatric IBD centres were invited to contribute data on: timing of transition/transfer of care; transition resources available including clinics, staff and patient information; planning for future improvement. Results: Twenty of 21 (95%) of invited centres responded. Over 90% of centres began the transition process below 16 years of age and all had completed transfer to adult care at 18 years of age. The proportion of patients in the transition process at individual centres varied from 10% to 50%. Joint clinics were held in every centre, with a mean of 12.9 clinics per year. Adult and paediatric gastroenterologists attended at all sites. Availability of additional team members was patchy across the UK, with dietetic, psychological and surgical attendance available in <50% centres. A structured transition tool was used in 75% of centres. Sexual health, contraception and pregnancy were discussed by <60% of teams. Conclusions: This study provides real-world clinical data on UK-wide transition services. These data can be used to develop a national strategy to complement current transition guidelines, focused on standardising services whilst allowing for local implementation.