In our second episode of ‘The Three Muskapeers’ Drs Damian Roland, Alasdair Munro and Ian Lewins have a chat about what’s new in the literature about COVID-19, including current challenges and controversies in Paediatrics. Contains scenes of rib-tickling.


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Helen Bevan is the Director of Service Transformation for the National Health Service Institute for Innovation and Improvement. The NHS is one of the biggest employers in the world. When it was established in 1948 the average life expectancy for men was 66 and 71 for women. As science has advanced and the population becomes more medically complex so the challenges of meeting increased demand have become more apparent.

As Chief Change Office Helen talks about the clash between old and new power and the ability of super-connectors to drive change.

In this week’s COVID Catch, up a spotlight on the communication challenges that are emerging during COVID and some further detail on a new potential emergency inflammatory condition. Also a heads up to a handy “team timeout’ tool for use at handover.

Taj Hassan is the immediate past president of the Royal College of Emergency Medicine. With consultant posts unfilled and more and more patients presenting to the emergency department what does the future look like for the specialty? Can we avoid the vision of smoking spires and desolate wastes?

In this weeks COVID Catch up the challenge of “unrequited stress’ is discussed. We’ve moved from a phase of decision drowsiness (fatigue from the unrelating demands of busy clinical shifts) into one of engagement exhaustion. Constant (often virtual) meetings with no obvious end in sight until the pandemic abates.

Erica Donovan rounded out our session on paediatric oncology with this talk about the late effects of paediatric cancers. When we think of cancer we think about making the diagnosis, the chemotherapy, the radiotherapy, the operations. Very rarely do we think of the impact of an essentially chronic disease that has taken a chunk of someone’s childhood away from them.

In her job as a paediatric oncology nurse, she has asked many, many patients exactly what matters to them. She introduces us to Te Whare Tapa Wha (the four-sided house) as a framework for considering the long term needs of her patients.

In this week’s COVID Catch two great blogs are highlighted; one from Critical Care Consultant Laura Rock on not answering “Feelings with Facts” and why this is relevant during the pandemic and one from PICU Consultant Miriam Fine-Goulden exploring how its important to hold onto the positives of COVID as well as the negatives.

Shaarna Shangamudavadivel is the HeadSmart fellow and currently doing her Ph.D. in how we can reduce diagnostic delays in the field of paediatric oncology. Paediatric cancers are rare but we’ll never pick them up if we are not aware of our unconscious biases, if we do not actively look for the zebras.

In this week’s COVID Catch up the issue of communication in resuscitation situations when all team members are in full PPE is explored, and carrying on the PPE theme, the importance of not mixing messages is highlighted.
If the wrong advice is given staff members may start using up the very PPE you are running short of. Concern is increasing about collateral damage from late presentations as a result of parent anxiety about coming to hospital and a recent paper reviews the health economics of High Flow Humidified oxygen (relevant to reducing its use where it is deemed to be an Aerosol generating procedure – AGP).
Finally the importance of designating (or not) chest compressions as an AGP discussed.

Dan Yeomanson is a paediatric oncologist dealing with teenagers and young people with cancer. Whilst the future ability to become a parent is not something that immediately springs to mind when a new diagnosis of cancer is made, you can be sure it is on the mind of the parents and the patient in front of you.

Of the ten patients that are diagnosed with cancer on any given day in England, eight will survive and one will be rendered infertile by their treatment.

COVID has brought with it a reduced flow in paediatrics for now. And many paediatricians are feeling guilt or worry about not being able to contribute in the way our Adult colleagues are currently. Damian explores this, and also how we deal with those who do present to ED during the pandemic.