Event Report


Pan-London Regional BAPEN Meeting 31st March 2011 • St. Mark’s Hospital SARAH ZERASCHI


Nutrition Pharmacist, Basildon and Thurrock University Hospitals NHS Foundation Trust, North Thames Regional BAPEN Committee Member, BPNG Committee Member and BANS Committee Member


The delegates were welcomed to the meeting at St Mark’s Hospital by Jeremy Nightingale, Consultant Gastroenterologist and Regional BAPEN Representative.


Andrea Cartwright, Nutrition Nurse Specialist at Basildon Hospital, started with a very informative presentation on the placement of gastrostomy tubes in patients with head and neck cancer. Due to the risk of tumour seeding with conventional endoscopic methods, and lack of access to interventional radiologists being prohibitive for RIG placement in many areas, she posed the question: “Do we need an alternative technique for placement?” Sarah Tarff, Liver Nurse Specialist at Basildon Hospital, talked us through the NICE guidance on treatment of alcohol detoxication, and why early nutritional intervention is so important in this patient group. A team of dietitians (Lucy Diamond, Alexis


Prince and Rick Wilson) from King’s College Hospital then presented a number of gastrostomy cases they had come across. In all cases there were lessons we could learn – inappropriate referrals, early discharges despite very high re-feeding risk, etc. They asked the question – is gastrostomy always in the patient’s best interest? A discussion about what King’s have done to improve their situation was interesting to hear.


Following a buffet lunch, Dr Simon Gabe, Consultant Gastroenterologist and BAPEN Treasurer, gave us an update on what the current position is with HIFNET (Home Intestinal Failure Network). There have been some changes made


to the initial framework and set-up, but the plan is that HIFNET will be in place by April 2012. Next came the regional update, where the regional committee members informed the delagates on a number of current issues involving nutrition. The AGM heard that Jeremy Nightingale and Sheena Visram would be stepping down from the committee, and others were invited to nominate themselves for election in the near future. The committee now comprises a doctor, nurse and pharmacist, so we’d especially like to hear from interested dietitians! Dr Penny Neild, Consultant Gastroenterologist and member of the BSG Small Bowel and Nutrition Committee, explained what is being done to address the often inadequate training doctors receive in nutrition. Surveys have shown that at the end of medical training 25% were not even confident to carry out a basic nutritional assessment. Thankfully, the GMC is now setting minimum standards for under and post graduate training, and there is explicit reference to nutrition at all levels.


Dr Tim Bowling, Consultant Gastroenterolist and BAPEN Chair elect presented on MARSIPAN. This is the Management of Really Sick Patients with Anorexia Nervosa – a niche speciality in a niche illness. He explained how this is a particularly difficult patient group to manage, and fatalities have been recognised. There is a


lack of Specialist Eating Disorder Units (SEDU’s), and they are generally unable to manage medically unstable patients. Also there is a lack of psychological specialist support in acute trusts when patients need medical treatment. Currently MARSIPAN is not compulsory, but the future aim is for it to become a requirement, e.g. by CQC. Dr Yoram Inspector, Consultant Psychiatrist


at St Mark’s Hospital, gave us an insight into the psychological aspects of patients with eating disorders. Using a number of case studies, he explained the current classification of eating disorders, and the treatment options available. Although there are a number of core traits apparent in every patient with an eating disorder, the different prevalence of each trait in an individual means that treatment needs to be individualised. To end the day, Kathryn Waller, Bariatric Dietitian at the UCLH Centre for Weight Loss, Metabolic and Endocrine Surgery presented a patient who underwent successful bariatric surgery. He had a BMI of only 37.4kg/m2


, but was


eligible for treatment under NICE guidance due to his diabetes. They described the three different surgical options available, and that their heaviest patient to date weighed 271kg. Finally, I’d like to thank our sponsors, Fresenius Kabi (Enteral and Parenteral Nutrition), Calea, Baxter, Vygon, GBUK, Rosemont Pharmaceuticals and 3M.


Gothenburg welcomes you in 2011


33rd ESPEN Congress • Gothenburg, Sweden • 3-6 September, 2011 For further details visit:www.espen.org


13 BAPEN In Touch No.61 May 2011


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