BAPEN Conference


Micronutrients Under the Microscope The theme of micronutrients was continued in


the symposium organised by the BPNG chaired by Tony Murphy, University College London. The stability of vitamins and trace elements in PN feeds was examined by Professor Mike Allwood of Derby, together with a presentation on the monitoring of micronutrients in patients on long-term PN support by Ken Newton who


success story On Monday 1st November, the day before Conference, BAPEN Medical and the growing paediatric group in BAPEN held highly successful teaching days attracting 125 and 57 delegates respectively. BAPEN Medical covered Nutrition and Cancer, with subject matter ranging from the science of cancer cachexia


also covered guidelines on decision making on dose modification.


Specific presentations on aluminium exposure and hypovitaminosis D in long-term PN patients were provided by Dr Mary Fewtrell from the Institute of Child Health, London and from C Tee from St Mark’s Intestinal Failure Unit, London.


Pre-Conference Teaching Days – A


through complications of cancer treatment to the reasons why far fewer patients with cancer have HPN in the UK than in Italy. The Paediatric teaching day covered the NCEPOD report and its implications for paediatric practice, the role of lipids in intravenous nutrition and nutritional screening.


HIFNET: Building a Seamless Parenteral


Nutrition Service for Patients A well-respected group of BAPEN members met at the Baxter sponsored symposium to discuss the principles and practicalities behind implementing the HIFNET framework. The session was run in a ‘Question Time’ format – chaired by Professor Jeremy Powell- Tuck – with a blend of predetermined questions put to a ‘virtual nutrition team,’ along with the opportunity for the audience to put the team on the spot with supplementary questions. The current state of flux in which the NHS finds itself means that HIFNET has been delayed until 2012. It was encouraging to learn from Andrew Bibby that progress is being made in the way specialist services will be commissioned in the future, and that services for intestinal failure will now be commissioned by a single national body, rather than the original ten specialised commissioning groups, which should make implementation easier. A key theme, which was revisited a number of times throughout the session, was the question regarding whether HIFNET implementation would be by a nationally driven strategy, or a scheme where regional solutions would be sought. Interestingly, the model of cancer care was suggested as a model of change which had been profound, owing much of its success to a rather strictly implemented top down approach which established a challenging set of standards and protocols to which adherence was required. Dermot Burke, Consultant Surgeon from Leeds, pointed out that despite this being a painful process, it had turned out to be a highly effective one now that the dust has settled.


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The sectoring of hospitals, and how patients should be referred between them, was also an area of concern for the audience, including how these would be designated and monitored. It is clear a minimum standard will be essential and that funding and, in the mind of Andrew Bibby, remuneration is likely to depend on this. Patient representation within the networks was seen as particularly important to ensure that patients’ needs are properly met. Homecare services for patients were also of particular interest, with discussions around ensuring that any changes should deliver a continued high level of support for patients and improvements in the contracting of services - currently very complicated and time consuming. It was noted, however, that principles and practice here can differ and Carolyn Wheatley reserved a healthy scepticism regarding how well this will translate into practice.


The audience voiced particular concern around the area of service management, whether it should be dictated nationally or by the regional network and saw standard setting as an important aspect of ensuring a seamless standard of care for patients across the network.


The final word should go to Alison Young who summarised the view of the panel: “This is an opportunity to embrace what we’ve got already, and to learn and develop new skills with the support of a network which will be providing standards of care and a quality service.”


Tuesday evening saw a successful new development at the conference, focused chaired poster rounds. Organised by the Research and Science Committee, posters were put into 6 themed clusters. Each poster was visited by a 'Chair' such as Professor Elia pictured here who led discussion after a brief presentation to the group.Wine and juice lifted the occasion further! Presenters of oral communications in the research symposia also produced posters; this was well received as an opportunity to continue and spark discussion. Next year, abstract authors will be asked to choose their theme upon submission.


‘MUST’ and Management of Malnutrition


Nutricia organised another successful Breakfast Briefing meeting focused on malnutrition. Chaired by Dr Rebecca Stratton, who also presented the timeline of ‘MUST’s development, Andrea Ralph introduced innovations in screening with 'MUST' and Dr Abbie Cawood presented on behalf of Emily Walters (Southampton University Hospitals NHS trust) outlining practical experiences of implementing ‘MUST’. 40 delegates attended who enjoyed breakfast as well as the presentations.


Dispelling the Myths


surrounding IBD Dr Simon Lal chaired a full and focused session on IBD nutritional assessment and management which can be complex and confusing both for healthcare professionals and patients alike. Topics included dietary and nutritional considerations, nutrition as primary therapy and nutritional management.


Richard Driscoll, Chief Executive of the patient association of the National Association for Crohn’s and Colitis, presented on patients’ perspectives. Patients stated that the important factors for them are the attitudes of professional staff who should show respect and support for the choices they make about their care in the context of their whole life rather than just from a medical focus. Support and information to patients to ensure a clear understanding of IBD is also an absolute necessity.


Richard shared perspectives from patients on travel advice, lack of specific support and on-going dietary advice to reduce confusion over general healthy eating messages. Some patients also revealed that they need special help to make their families understand their diagnosis and the impact it has on lifestyle and choices.


“My family do not understand my dietary


requirements and they think that I am being difficult,” said one patient with others saying that they feel unable to enjoy food and are essentially scared of a resource that, at the end of the day, helps them to survive.


BAPEN In Touch No.59 December 2010


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