WELCOME TO THE BRITISH ASSOCIATION FOR THE STUDY OF THE LIVER
Visit the News section of the website to read the President’s Message and for guidance for healthcare professionals in Gastroenterology and Hepatology and for guidance to patients with a liver transplant and chronic liver disease.
BASL2020 ANNUAL MEETING
8th - 11TH September, PLYMOUTH
Save the Date - BASL2020 Annual Meeting - The Guildhall Plymouth. The BASL programme runs from Wednesday 9th September to lunchtime on Friday 11th, with the BLNA Nurses Day meeting running on Wednesday 9th PM & Thursday 10th. The BLTG programme runs from Tuesday 8th to lunchtime on Wednesday 9th September.
More details will follow when available.
BASL ANNUAL MEETING
BASL AND BASL SUB-GROUPS
The British Association for the Study of the Liver is a multi-disciplinary society with around 900 members composed of interested individuals from clinical medicine, clinical and basic research and allied professions.
British Liver Nurse Association is a professional nursing organisation aiming to develop knowledge and understanding of liver disease, in order to improve the quality of patient care.
The British Viral Hepatitis aims to improve the management and study of patients with chronic viral liver disease, bringing together UK hepatologists, gastroenterologists, infectious disease physicians, virologists and interested epidemiologists.
The BLTG (British Liver Transplant Group) was launched in 2014 to represent the professional interests of liver transplantation in the UK and promote strategic and academic development. The BLTG will foster close relationships with BTS (British Transplant Society) and LICAGE (Liver Intensive Care Group of Europe) and will build on the role of the UK and Ireland Annual Meeting by delivering structure and authority to the group.
Is a professional pharmacy organisation aiming to develop knowledge and understanding of liver disorders including viral hepatitis, in order to improve the quality of patient care, through medicines optimisation, collaborative and multi-disciplinary working and promoting patient-focused research.
HCC UK is a multi-disciplinary organisation aiming to promote collaboration in research, education and clinical service development for primary liver cancer. We bring together leading oncologists, liver surgeons, hepatologists, basic scientists, radiologists, pathologists and specialist nurses to lead improvement in the quality of patient care.
Job Advert - Clinical Research Fellow in Hepatology - PortsmouthRead more
NHS Jobs advert: https://www.jobs.nhs.uk/xi/vacancy/916009530
This is for a Clinical Research Fellow in Hepatology to be supervised by Dr Richard Aspinall in Portsmouth. The post is for an initial 12 months with the expectation to extend to 2 or 3 years.
In addition to helping deliver NIHR portfolio studies, the research fellow will be supported to develop an investigator led project subject to their interests and register for a higher degree. Potential projects are negotiable but existing opportunities include projects in alcohol related illness, NAFLD/NASH, portal hypertension, renal dysfunction in cirrhosis and ongoing collaborations with public health colleagues.
Informal enquiries are welcomed. Please contact Dr Richard Aspinall, NIHR Wessex Research Network Lead for Hepatology by email firstname.lastname@example.org or telephone 02392 28 6255.
Closing date 30th April 2020.
COVID-19 and Shielding through Self-isolationRead more
On 22nd March, the British Government announced that 1.4 million people identified by their doctors would be shielded through self-isolation for 12 weeks (https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19). Recent government announcements have indicated that the liver patients to be included in the ‘shielding group’ should be those receiving immunosuppression for a liver transplant or for autoimmune hepatitis. Self-isolated patients’ clinical care should continue safely, some may also need additional support from social services (https://www.gov.uk/government/publications/covid-19-residential-care-supported-living-and-home-care-guidance/covid-19-guidance-on-home-care-provision).
All liver transplant patients will be contacted using the NHS Blood and Transplant register with information. As no central register exists for patients with autoimmune hepatitis on immunosuppressive medications, individual hospitals need to identify these patients, therefore, please prioritise writing to these patients (a draft letter template 'letter to AIH patients on Immunosuppression' can be downloaded from the website 'members area' under 'All Resources' or by request to email@example.com ). Letters sent to the patients should also be copied to GPs to permit primary care coding as COVID-19 AT RISK. Proactive day care unit therapeutic paracentesis service, tele-clinics and helplines are vital for continuing care of these patients. Reducing hospital visits and admissions for non-COVID-19 illness can reduce further spread of infection.
Thriving amidst this, Hepatology registrars at the Translational Gastroenterology Unit in Oxford have set up a registry to capture clinical outcomes of COVID-19 in patents with liver disease or transplantation (https://covid-hep.net/). Learning should continue even in crisis and conflicts.
Professor Guruprasad P. Aithal
BSG/BASL COVID-19 Advice on Hepatology patient risk groupsRead more
Important update from the BSG VP Hepatology and the BASL and BSG Presidents
During the COVID-19 outbreak the NHS is doing everything it can to keep patients with liver disease safe. However, risks relate not just to the infection itself, but also to the significant disruption of routine care due to the pandemic. Information from China and Italy suggest that hospital admissions for non-COVID-19 illness can lead to further spread of infection. Changes in routine care are now required to keep vulnerable patients with liver disease out of hospital as much as possible. However, changes to the way care is delivered for patients with liver disease must be balanced against the risks of undertreating them.
‘Social distancing’ and ‘self-isolation’ are measures to reduce spread within a population and to protect high risk groups. The impact of immunosuppression on the severity of COVID-19 disease remains unclear. Factors associated with more severe disease are older age and presence of other medical conditions. These are also an understandable source of anxiety for patients with liver disease. Government guidance in this area is dynamic and all people in the UK should follow up to date recommendations from the government.
The government recommends social distancing for all in the UK, but this guidance defines a ‘high-risk’ group of patients with liver disease who are advised to take additional measures and go into self-isolation for 12 weeks.
Patients with liver disease in high risk group*:
`Shielded group` Advise mandatory self – isolation:
1) Patients having undergone liver transplantation and taking immunosuppression and
2) Patients with autoimmune hepatitis taking immunosuppression
The consensus view in our specialty acknowledges the higher risk for patients with decompensated cirrhosis, who are not included in the shielding cohort. We recommend that these patients with decompensated cirrhosis should be advised to adhere strictly to social distancing measures in order to protect themselves. Clinicians will not, however, have to identify this group to their GPs for coding as COVID at RISK.
*There may be others not in the above groups felt by the treating physician to also be at higher risk and these should be assessed on a case-case basis.
President's Message - COVID-19 GuidanceRead more
As a community responding to the COVID-19, you would have had a number of messages from within and outside the institutions that you work in regarding this issue. We should recognise and acknowledge there is uncertainty regarding the impact of this on individuals and groups. Accordingly, locally and nationally balanced judgements will inform regular guidance and advice. BASL has worked together with organisations that share common interest in our patients and services to provide information and advice based in the current context.
Please see news items to follow for guidance for healthcare professionals in Gastroenterology and Hepatology and for guidance to patients with a liver transplant and chronic liver disease.
Professor Guruprasad Aithal
BSG/BASL COVID-19 advice for healthcare professionals in Gastroenterology and HepatologyRead more
• All healthcare professionals have a responsibility to safeguard patients, colleagues and themselves from the COVID 19 virus.
• We wish to emphasise the importance of following current guidance and advice from Public Health England, Health Protection Scotland, Public Health Wales and Public Health Agency Northern Ireland.
• You will find any updates to this document on the BSG website.
Potential Impact on Gastroenterology and Hepatology Services
• Based on developments over the last few days, it is likely that the NHS will have to manage increasing numbers of patients with COVID 19. There is a shared understanding that if COVID 19 becomes a significant epidemic in the UK, clinical services will be stretched and that this will be exacerbated by staff shortages due to sickness, imposed isolation and caring responsibilities.
• It is likely that there will be increasing requirements for healthcare professionals in gastroenterology and hepatology to support NHS Healthcare providers in managing the care of acutely ill patients. This will likely result in disruption or cancellation of clinics and endoscopy lists and other specialist activities.
Redeployment of Staff to Managing Acutely Unwell Patients
• In the event of a significant outbreak, healthcare professionals in gastroenterology and hepatology will be asked to support broader patient and population needs.
• It is important that these activities are considered in the context of patient safety. Healthcare professionals should not undertake any activity beyond their level of competence.
• Healthcare professionals should avail themselves of training opportunities to equip them to undertake specific tasks in looking after acutely unwell patients either with suspected or confirmed COVID 19 infection.
Advice for patients with Inflammatory Bowel Disease on immunosuppression
• The following advice is from Public Health England and is well summarised by Crohn’s and Colitis UK and the International Organisation for IBD (IOIBD).
• People taking immunosuppressants for their Crohn’s Disease or Ulcerative Colitis are not at increased risk of catching novel coronavirus, however they may be at extra risk of complications from the virus if they are infected.
• People on immunosuppressants should seek advice by telephone if they develop symptoms of either seasonal Influenza or novel coronavirus.
• For the majority of patients, it is advisable to continue with immunosuppressive treatment and other treatments for their inflammatory bowel disease.
• Patients are advised to take precautions to avoid infection through good personal hygiene and avoiding unnecessary close contact with people who are unwell.
• If patients stop taking immunosuppressive medicine, they may have a flare which will increase the risk of complications if infected with coronavirus.
• If patients still have concerns about continuing the medication, they should speak to the medical team.
• If patients are at an increased risk of infection, for example, if they have been in direct contact with an infected individual, have travelled to a high infectivity area, or have another serious comorbidity that increases the risk further, they should seek advice from their medical team by telephone before making any changes to their medication.
Telephone and Virtual Clinics
• In order to maintain social distancing and reduce the risk of transmission of COVID-19, we encourage telephone consultations with patients or virtual clinics to avoid patients having to attend the clinic in person.
• We suggest that in such circumstances, a clause is added to the clinics letter that the patient has not been examined and that part of the assessment is therefore limited but has been only omitted due to exceptional circumstances.
• Good IT support is necessary to support telephone or virtual clinics, for example use of Skype.
• Acute services can be helped by reducing acute admissions where possible by setting up alternative routes of care as in the case of day-case unit paracenteses services to prevent emergency admissions for paracentesis (these can be about 100/100,000 population).
• Patients suitable for telephone and virtual clinics include those with stable cirrhosis and those long-term after transplant.
• Patients post-transplant, those with AIH on second line immunosuppression, and those with decompensated cirrhosis and/or alcoholic hepatitis patients are considered high risk for COVID 19.
• Patients with compensated cirrhosis are considered to be in the intermediate risk group for COVID 19.
Advice for Patients with Liver, or Small Bowel Transplants
• We recommend that healthcare professionals looking after such patients refer to the guidance from the British Transplantation Society.
Endoscopy and COVID19
• Endoscopy Teams are advised to follow both national guidance for reducing transmission of infection with COVID19 (websites above) but also agree their own local protocols and policies in collaboration with senior management, Infectious Disease or Infection Control teams. There are both general measure that should be followed and specific measures around personal protective equipment (PPE).
• General measures include checking patient’s travel history at admission, providing a COVID19 information sheet about symptoms to report and checking patients temperatures upon arrival. Where there is concern, elective procedures should be postponed and rebooked as soon as possible once the patient no longer poses a risk. Units should develop standard operating procedures (SOP) for COVID19 control measures and share these widely among staff groups.
• PPE for endoscopy procedures – advice is that standard infection control measures should be followed except for aerosol generating procedures (AGP) in patients at high risk of or with confirmed COVID19 infection. AGP in this context means upper GI procedures and for patients who fall into this category, enhanced PPE is recommended including FFP3 masks. Endoscopy teams should also consider enhanced PPE for emergency and out-of-hours procedures and also consider arrangements for the most appropriate location to perform these within their hospital. Units are encouraged to ensure staff know how to be fitted for the appropriate size of FFP3 mask and how to put on PPE correctly.
• Official advice is that enhanced PPE is not currently felt to be necessary for upper endoscopy in patients at low risk or for lower GI procedures. Concerns have been raised that the virus may be faecally transmitted but there is presently insufficient evidence to recommend the use of enhanced PPE measures for lower GI procedures. Stocks of FFP3 masks are also limited and their use needs to be carefully prioritised. This is, however, a rapidly changing situation and teams should check regularly for updates to both local and national guidance
• Units should discuss locally and consider whether or not to suspend some endoscopic activity e.g. low-risk surveillance scopes (non-dysplastic Barrett’s, polyp follow-up, IBD etc) for a period to help reduce or delay virus spread but also as it is likely there will be staff shortages through illness, absence to care for others or redeployment.
Individual hospital trusts and health boards will be looking to implement local guidance based on national and international best practice. For reasons mentioned above, we encourage telephone or virtual clinics. This guidance aligns with the current data available but as the situation changes further guidance may be required. Individual treatment decisions about patient care will be between the patient and the treating physician.
Dr Tony Tham
Clinical Services & Standards Committee Chair
Announcement - due to the increasing concerns regarding the COVID-19 outbreak, the BLNA Committee has agreed to postpone the BLNA Meeting due to be held in Birmingham on the 24th April 2020. This was a very difficult decision, however, we recognise the immense pressure that all Healthcare Professionals will be under due to the current climate, and in light of this we feel that this is the right thing to do at this time.
If you are registered to attend the meeting you will receive a notification email shortly.
A new date for the meeting will be advised once known.
05/05/20 - 07/05/20
The Royal Free Sheila Sherlock Hepatology Postgraduate Course, to be held at the Royal Free Hospital, London, on 5th-7th May 2020 has been postponed.
Due to the ongoing uncertainty, a rescheduled date for the course has not yet been confirmed.
13/05/20 - 15/05/20
The last few days have seen an unprecedented health crisis evolving in the UK. We are now, along with the rest of the world, facing the enormous problems of the COVID-19 pandemic.
Protecting the health and safety of all those attending our conference must be the paramount consideration, therefore AMMF’s board has decided that the 2020 CCA Conference, 13-15 May, must be postponed until 2021.
For more information vist the AMMF conference website page here: https://ammf.org.uk/ammf-conference-2020/.
21/05/20 - 22/05/20
The 8th Annual Liver Course due to run on Thursday 21 - Friday 22 May 2020 has been postponed until Thursday 27- Friday 28 May 2021.
Registration is closed, please contact the Events Team if you have a query on firstname.lastname@example.org .
The British Hepatology Pharmacy Group has decided to postpone the Educational Meeting planned for 21st May due to the global concern regarding COVID-19.
This was a very difficult decision, however, there is no greater importance than the health and safety of our delegates.
We are sorry to disappoint those who are already registered to attend, but safety and wellbeing has to come first. We are currently working with the venue to establish a revised date which will be added to the website once confirmed.
If you have already registered for the meeting we will be in touch, and should you have any questions please do not hesitate to contact email@example.com .