AFOEM eBulletin – 19 October 2018

Urgent call to screen and manage aggressive artificial stone lung disease affecting young tradies

AFOEM and the Thoracic Society of Australia and New Zealand (TSANZ) are calling for urgent action by regulators to address a public health crisis impacting workers in the artificial stone benchtop industry.

In response to a recent outbreak of the life-threatening lung disease accelerated silicosis, the organisations are calling for immediate action to include:

  • respiratory health assessments of all workers (past and present) in the industry
  • an urgent review of the dust control measures used in the industry, including independent monitoring of dust levels
  • comprehensive enforcement of hazardous substances regulations related to silica dust exposure
  • enforcement of an immediate prohibition on dry cutting techniques
  • a national occupationally acquired respiratory disease surveillance and registry program.

“Silicosis is a lung condition that has historically occurred in the mining industry when airborne silica-containing dust isn’t adequately controlled. It can take up to 40 years for workers to develop chronic silicosis,” said Dr Graeme Edwards, FAFOEM.

“We are now seeing an increasing number of people who work with artificial stone materials used for kitchen, bathroom and laundry benchtops, diagnosed with accelerated silicosis after only three to 10 years.

Silicosis is caused by inhalation of silica dust. Unlike natural stone such as granite, which comprise approximately 30 per cent silica, artificial stone materials typically contain over 90 per cent silica, leading to an accelerated form of silicosis.

Recent health surveillance of workers in the artificial stone benchtop industry in Queensland has revealed alarmingly high rates of accelerated silicosis with approximately one in three workers in the industry being diagnosed. Both RACP and TSANZ expect these rates to be the same across Australia.  

TSANZ spokesperson Dr Ryan Hoy said “Accelerated silicosis is normally rare, so there is much to learn about how to best treat it. Early identification, even before symptoms have developed, and avoidance of further exposure to silica dust are crucial.

“Many of these workers have already developed a silicosis complication known as Progressive Massive Fibrosis (PMF). Both silicosis and PMF are life-shortening illnesses, for which the only treatment at present is lung transplantation.

“Urgent clinical trials are required to assess the potential effectiveness of some new drugs being used for a different lung scarring condition.

“Our members have been reporting cases of silicosis in this industry for the last few years. We are eagerly awaiting a positive response to our call for a national respiratory health surveillance and registry program to drive an evidence-based approach to this burgeoning public health crisis.

“Australian workers deserve a safe workplace, and early intervention and treatment when problems arise. The current situation is simply unacceptable. Prevention is the best strategy, but we need to know the scale and to act now,” said Dr Hoy.  

Further information on the prevention, diagnosis and management of accelerated silicosis can be found on the RACP website.

TSANZ will be hosting a workshop on 'Understanding the Silicosis Problem' in Brisbane on Saturday, 27 October 2018.  Please visit the TSANZ website for further details.

A message from your President

Occupational Medicine in Action:  Accelerated Silicosis the new ‘Asbestosis’

By now all members of AFOEM will have received the alert about the crisis Australia is facing with regard to Accelerated Silicosis, and the information sheet of Frequently Asked Questions

These documents are essential reading and they provide clinical advice on assessing workers who are currently or have been exposed to silica dust as stonemasons working with engineered/man made stone tops used in kitchens, bathrooms and laundries. They set out the requirements for appropriate health surveillance, workplace monitoring and a call for the urgent establishment of a national registry for cases. 

They have been prepared as a result of a swiftly facilitated collaboration between AFOEM Policy & Advocacy Committee, Senior College Policy & Advocacy staff and The Thoracic Society of Australia and New Zealand (TSANZ).  

Dr Graeme Edwards is our AFOEM Lead Fellow in Queensland and together with AFOEM trainee Dr Rosemarie Knight, identified the magnitude of the problem after conducting health surveillance for silicosis in two worksites. 

Graeme has been working tirelessly and I suspect around the clock on this issue identifying and treating cases, advocating for change, being interviewed on ABC’s 7.30 and preparing webinars on the topic. 

As stated in the lead article RACP/AFOEM are calling on state and federal governments to put in place appropriate measures to identify, control and manage the situation and to establish a national register of occupationally acquired respiratory diseases.

The Federal Health Minister Greg Hunt announced he would raise the issue of the health risks of working with artificial stone benchtops at the meeting of Council of Australian Governments (COAG) Health Ministers on 12 October 2018. At this meeting the COAG Health Ministers made a commitment to a review of standards governing the artificial stone benchtop industry and examining the establishment of a national dust disease register for workers.

TSANZ is holding a workshop on 27 October 2018, entitled ‘Silicosis – update for frontline clinicians and creating the clinical pathway’, at the Mater Hospital, Brisbane. Please visit the TSANZ website to RSVP.

More information will be published on this evolving issue.

On behalf of the Faculty I also express our sympathy for the workers and their families now caught up in this distressing development.

Early October has been busy. On 4 October I attended the first College Council meeting since the new skills-based Board was appointed. There are 43 representatives from RACP Faculties, Divisions, Councils, Committees and Specialty Societies. The College Council was established four years ago. It considers matters referred to it by the Board or those the Council considers may be relevant to the Board. If agreed by a majority of Council members it makes recommendations to the Board on the issues raised by those matters. The College Council’s purpose and governance continues to evolve over time.  Some of the topics discussed were communication within the College and between members, education, policy & advocacy and workforce planning.

On 5 October, at the College Ceremony in Melbourne Town Hall I had the immense pleasure of welcoming two new Fellows into our Faculty, Dr Csongor Oltvolgyi and Dr Yasmin Khan.

From 7 to 10 October I attended the ANZSOM Annual Scientific Meeting in Melbourne that also marked ANZSOM’s 50th Birthday.  Associate Professor Peter Connaughton and I presented the President Ms Melinda Miller with a gift, a framed photograph of the signing of the Model of Collaboration, in Perth in 2017.  

While in Melbourne I met with a number of local Fellows and trainees and we discussed a range of issues including education, communication and the relationship between AFOEM and RACP.

To the trainees sitting the Clinical Exams in November, I wish you all the best for a successful outcome.   

Cara Loftus the AFOEM Executive Officer leaves us on Friday 19 October. After two years in Australia she is returning home to California. On behalf of the Faculty I would like to thank Cara for her support and hard work during what has been a very busy and productive time for AFOEM.  We wish you success in your future endeavours. 

For any faculty relating matters, please continue to email AFOEM@racp.edu.au, as this inbox will continuously be monitored.  AFOEM will be supported by Faculties Manager, Phillipa Warnes, Stacey Barabash (AFRM EO) and Rachel Smith (AFPHM EO) until the new AFOEM EO is finalised.

Dr Kevin Sleigh

It is with a heavy heart that I inform you of the passing of Dr Kevin Sleigh, on Thursday, 11 October 2018.  Kevin was a highly regarded colleague and friend in our Faculty. He was an active contributor to and leader in occupational medicine, an educator and mentor, a gentle man, approachable and with a sense of humour. Through his leadership and involvement within and outside the Faculty, with the wellbeing of the worker central to his approach, he has left a legacy that will live on in the Faculty, industry, organisations and the community. He will be remembered with fondness and respect.  An obituary for Kevin will be published in next month’s eBulletin. Vale

Dr Beata M Byok
AFOEM President

AFOEM trainee’s experience on the QLD Coal Mine Dust Disease Panel

The 2018 Queensland Mining Industry Health & Safety Conference was held on the Gold Coast from August 19 to 22. The aim of the conference was to inspire delegates and foster proactive health and safety management techniques in the Queensland mining sector. AFOEM trainee, Dr David Cleveland, was invited to be a panel member on the Coal Mine Dust Disease Panel to discuss disease prevention in the workplace.  Below is Dr Cleveland’s feedback from the experience. AFOEM thanks Dr Cleveland for his contribution to the panel and great representation of the Faculty’s work.

"When I was invited to be a panel member of the 'Coal Mine Dust Disease Panel' at the Queensland Mining Industry Health & Safety Conference 2018 held on the Gold Coast I was surprised, excited and concerned.  

The conference attracted over 600 members of the Queensland Mining Safety community and the Dust Disease Panel was to include Dr Robert Cohen and Mr Stephen Smyth (CFMEU President), so this session was going to be well attended. I had never met any of the panel members in person.  Providentially the organising committee had arranged for us all to share lunch together which provided an excellent forum to get to know each other and discuss agendas. I would definitely recommend this strategy if I were to be involved in something like this again.  

I had never presented to more than about 10 people, so to be handed a microphone to answer a question from experienced ABC presenter Kelly Higgins-Devine under the ‘spotlight’ was daunting to say the least.  

Fortunately, prior to the session I had been very ably supported and advised by experienced AFOEM colleagues in regards to how to handle a situation like this and my special thanks goes out to Dr Graeme Edwards, Dr Clare Wood, Dr Chris Cunneen, Associate Professor Peter Connaughton, President Dr Beata Byok and President-elect Professor Malcolm Sim. Their readily given advice on strategy, how to convey a message and how to be a panel member confidently whilst avoiding common pitfalls was invaluable. For anyone approaching this situation I cannot overstate the importance of preparation in terms of understanding the subject and practising your answers to likely questions. 
 
In the end, the session went much better than I expected and has led to some more collaborations which would have been unlikely if I had not taken the opportunity. A great piece of advice I was given was that you've been asked to be there for a reason and your opinion is valued, so don’t doubt yourself or your contributions. Also, confidence-wise it seems like a major hurdle/initiation has been passed which feels great, just don’t ask me to do it again in the near future."

Dr David Cleveland is an AFOEM trainee and sits on AFOEM Council as the Trainee Representative.

Conferences and events

The Royal Australasian College of Physicians publishes notices of events and courses as a service to members. Such publication does not constitute endorsement or mandating of any such events or courses.  View all occupational and environmental health medicine events.

Go to the events list at any time to see what events are coming up.

Indigenous Health Scholarship for occupational and environmental medicine – applications now open

The scholarship provides a funded pathway for Faculty training in Australia and New Zealand covering:

  • RACP training fees 
  • examination fees 
  • attendance at RACP Congress (or relevant Annual Scientific Meeting) each year (return economy air fare, registration, three nights accommodation)
  • $2,500 cash assistance at the beginning of the scholarship.

For further information about the RACP Indigenous Health Scholarship Program and all the Indigenous Health Scholarships being offered for 2019, please visit the RACP Foundation website

AFOEM Regional Committee casual vacancies

There are various casual vacancies on AFOEM Regional Committees to be filled by way of expressions of interest.

New South Wales

  • one position open for Trainee Representative of AFOEM NSW Regional Committee.

Queensland/Northern Territory

  • one position open for the Chair of AFOEM QLD/NT Regional Committee
  • one position open for Deputy Chair of AFOEM QLD/NT Regional Committee.

South Australia

  • one position open for Deputy Chair of AFOEM SA Regional Committee. 

Western Australia

  • one position open for Chair of AFOEM WA Regional Committee
  • one position open for AFOEM Trainee Representative of AFOEM WA Regional Committee.

Before nominating for the role, candidates must familiarise themselves with the following documents:

To nominate, submit a completed Expression of Interest Form and your resume by email to AFOEM@racp.edu.au.

Evolve Updates 

Handle antibiotics with care
As part of World Antibiotic Awareness Week (12 to 18 November 2018), RACP Evolve is inviting trainees and Fellows to become Evolve Clinical Champions by pledging their support to reduce unnecessary prescribing of antibiotics. Find out how you can pledge your support by contacting evolve@racp.edu.au. You can also visit the Evolve website for more information.

Research
Are you currently planning to undertake research as part of your Advanced Training? The Evolve recommendations offer an opportunity to undertake research in low-value care in specific health priority topics, such as bronchiolitis, antimicrobial stewardship, polypharmacy, high-risk medications and deprescribing.

Bronchiolitis clinical initiative
NSW Health and the Agency for Clinical Innovation (ACI) are currently undertaking a program that aims to address clinical variation in inpatient and emergency department management of bronchiolitis in NSW. It also aims to improve adherence to clinical guidelines and reduce potential harm from unnecessary testing and treatment.

Find out more about the Bronchiolitis Clinical Initiative and other low-value care research opportunities in your specialty by contacting evolve@racp.edu.au or go to the Evolve website.

Conference opportunities
The RACP has presented on Evolve at:

  • RACP Congress
  • Choosing Wisely Australia National Meeting
  • National Medicines Symposium
  • Australian and New Zealand Society of Geriatric Medicine (ANZSGM),
  • Society of Obstetric Medicine of Australia and New Zealand (SOMANZ)
  • Gastroenterological Society of Australia (GESA) Australian Gastroenterology Week (AGW).

In November, we are looking forward to attending the Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists (ASCEPT) in Adelaide. 

All Specialty Societies can request for the RACP to attend their conference to present on Evolve and low-value care and/or host an exhibition booth. For more information and to express interest in RACP attending your conference in 2019, contact evolve@racp.edu.au.  

Managing GORD with PPIs
RACP Evolve supports the NPS MedicineWise education program, which aims to reduce or stop Proton Pump Inhibitor (PPI) treatment when Gastro-oesophageal reflux disease (GORD) symptoms are well controlled. Find out more by visiting the NPS MedicineWise website.

How can you raise the reduction of PPI treatment with a patient? Watch RACP President Associate Professor Mark Lane include the GESA Evolve recommendation in a difficult conversation with a patient on the RACP YouTube channel.  

Kids off Nauru Campaign 

The RACP has signed on to the Kids Off Nauru campaign, urging the Australian Parliament to support the immediate transfer of all refugee and asylum seeker children and their families from Nauru to Australia for health reasons. Children and their families need an urgent assessment in a specialist tertiary level child health facility, where their medical, developmental and social-emotional (psychiatric) health can be assessed and treated in accordance with specialist recommendations. 

This campaign was the most successful social media campaign the RACP has conducted, the hash tag trended on twitter and reached over 200,000 people across social media channels. This is based on RACP posts alone and doesn’t include other medical colleges.

Your voice is being heard, physicians are respected members of the community and governments listen to your messages – keep the campaign going and get active on social media. Use the social media kit and poster to join the RACP's calls for #doctorsforasylumseekers. Please also sign the doctors make change petition.

We are encouraging members to write to or meet with your local Member of Parliament (MP) to advocate on this issue. Please use the template letter and Refugee and Asylum Seeker Health Position Statement when writing to your MP. The Tips for meeting with MPs and RACP Advocacy Framework can assist with productive meetings. If you do meet with your local MP, please let us know at policy@racp.edu.au.

Strengthening CPD

Following the recent release of the Medical Board of Australia’s Professional Performance Framework, a new 2019 MyCPD Framework comes into effect in November 2018.

The simplified Framework strengthens CPD by engaging Fellows in a range of CPD activities from three categories:

  • Educational activities
  • Reviewing performance
  • Measuring outcomes

It is likely you are already completing formal or informal activities that can be claimed in these categories.

To help you understand the changes, we’ve put together a list of common questions and answers, that explain what the changes mean for you and why they’ve been made. You can also download the 2019 Framework online.

Read more

Rebooting CPD podcasts out now

The origins of regulatory changes on the CPD horizon and Fellows first-hand experience of the 'strengthened CPD' approach are the focus of two new Pomegranate Health episodes.

Listen now

Expressions of Interest to the RACP Clinical Ethics Support Working Party

Expressions of Interest are currently being sought for two members (including one trainee member) to join the new Clinical Ethics Support Working Party. The Working Party will also comprise a consumer member and six members of the College Ethics Committee.

Please complete the EOI form and forward with your CV to ethics@racp.edu.au by Thursday, 1 November 2018.

For more information please visit the EOI webpage.

If you have any enquiries about the Clinical Ethics Support Working Party, please email ethics@racp.edu.au.

Alliance strengthened

A new Memorandum of Understanding (MoU) signed between medical colleges in Australia, New Zealand and Canada is taking their collaborative relationship to the next level by formalising a vision, mission and objectives for future engagement.

Representatives from the Tri-nation Alliance – which comprises of the RACP, Royal College of Physicians and Surgeons of Canada, Royal Australian and New Zealand College of Psychiatrists, Royal Australasian College of Surgeons and Australian and New Zealand College of Anaesthetists – signed the MoU in Canada on Tuesday, 16 October.

Read more

RACP survey of Fellows' experience with Health Care Homes 

Stage one of the Australian Government Health Care Homes (HCH) trial commenced in 2017 and will continue until November 2019.

If you work in one of the trial Primary Health Networks of the Department of Health you may receive an invitation shortly from the College to complete this survey. However, any Fellows with experience of or patients in a Health Care Home may respond. This is part of the College’s high profile work on Integrated Care, developing a Model of Integrated Care for patients with multiple chronic conditions. Fellows are strongly encouraged to complete this brief online survey.

The brief online survey will be open until 30 November 2018.

Any questions may be sent to racpconsult@racp.edu.au

Career opportunities

New South Wales
Physicians for Private Practice 

View all positions vacant

Find a consultant page on RACP website

Just a reminder to all AFOEM Fellows and trainees, AFOEM is the only Faculty, Chapter or Division that has created a dedicated page on the RACP website that lists contact details for AFOEM Fellows by state. It is an incredible resource that can be used by all members of the Faculty.

The list is located on the find a consultant page on the RACP website. If you are included in the current listing and your details have changed or you would like to be included on the webiste, please email the AFOEM Executive Officer at afoem@racp.edu.au with the details you would like included on the page (name, address, contact number and preferred email address).

This page is also a useful resource for finding contact details for colleagues in your state and for regional committees to reach out to other Fellows that may want to be included in the various state-based activities. 

AFOEM contact details

AFOEM Faculty enquiries (including Council and committees):
AFOEM Executive Officer
Phone: +61 2 8076 6351
Email: afoem@racp.edu.au

AFOEM Education and Training enquiries:
Molly Davies, Education Officer
Phone: +61 2 8247 6268
Email: occenvmed@racp.edu.au

AFOEM Examination enquiries:
Examination Coordinator, Assessment and Selection Unit
Email: examinations@racp.edu.au

AFOEM training site accreditation inquiries:
Site Accreditation Unit
Email: accreditation@racp.edu.au

AFOEM CPD enquiries:
Email: mycpd@racp.edu.au
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