Pot-pourri eBulletin 13 November 2020

President's Message

Those of you who follow AFL will have noted the 2020 grand final between Richmond and Geelong attracted a huge TV audience. Many of these were children and adolescents. During this prime time, there were a number of gambling and alcohol advertisements. There is evidence that minors and young adults engaged in gambling are at risk of developing gambling related problems. The impact of advertising on children is well known, and has been demonstrated for junk food, alcohol and tobacco. The College advocates very strongly on alcohol and tobacco advertising in sports, but we are yet to see government interest in working hard on tackling the harms of gambling. We cannot forget that children and young people are susceptible to what they see of their favourite sport stars and other television content despite potential adverse effects on their psychological health and wellbeing.

In Australia, NAIDOC Week celebrates the history, culture and achievements of Aboriginal and Torres Strait Islander peoples. The theme for 2020 is ‘Always Was, Always Will Be’, acknowledging that First Nations people of Australia have occupied and cared for this continent for over 65,000 years. It is now acknowledged that, despite their remarkable strength and resilience, colonisation and systemic racism have created deep inequities in health outcomes between Indigenous and non-Indigenous Australians. It is incumbent on us, as physicians, to do our best to address such inequities. A PCHD working group is soon to finalise a statement on Indigenous child health, which will be supported by an advocacy strategy incorporating the work of existing statements on child health and early childhood. We will keep members updated on this important work. Meanwhile, to find out how you can be involved in this important week’s events, see the NAIDOC Week 2020 website.

The PCHD Council had a very productive meeting on 21 October 2020, the main focus of which was to approve the PCHD Policy & Advocacy Committee (PPAC) workplan for 2021-2022, and to recommend the PCHD Council’s 2021-2022 workplan for Board approval. I am pleased to advise our Council resolved to approve both these important pieces of work. Council members also received updates on the College’s ongoing training and curriculum priorities, as well as very informative presentations on the training curricula, exams and developments in CPD. I’d like to thank our Council members and College staff for their ongoing commitment to delivering on these areas of priority.

It is exciting to see that Congress 2021 has now launched, with the theme of ‘Transformation: Adapting for the Future’. I am very excited to be attending my local Congress session in Perth and encourage you all to do the same. I know that the PCHD sessions are well underway with further details of these to be released shortly.

I also draw your attention to some work that has been achieved by the South Australian Commissioner for Children and Young People. Consultations were held with children and young people asking a range of questions, in particular what their thoughts were on health services and what they needed to be supported. The outcomes have been published.  

Lastly, if you are involved in a research initiative and would like to share this with the membership, please email paed@racp.edu.au and we can review and see if we can promote via this newsletter. It is great to see the amazing work happening across Australia and Aotearoa New Zealand and the Pot-Pourri is a simple and effective communication tool available to you.

Clinical Professor Catherine Choong
PCHD President

The introduction of the new accreditation program will commence from 1 January 2021

As part of the Accreditation Renewal initiative, the RACP will be introducing the new Training Provider Standards and accreditation requirements in Australia and Aotearoa New Zealand effective from 1 January 2021.

The new Training Provider Standards and Adult Internal Medicine and Paediatrics & Child Health Basic Training Accreditation Requirements are available on the RACP website.

Please note that changes to the programs and requirements only impact Training Settings involved in Basic Training.

If you would like more information, please email the RACP accreditation team.

RACP Congress 2021

RACP Congress 2021, coming to you, wherever you are

The location for the 2021 RACP Congress has been unveiled and it is…everywhere.

Spread over six cities, two countries and streaming live, it has never been easier to attend.

Under the theme of ‘Transformation, adapting for the future’, RACP Congress 2021 will explore diverse topics that address ideas of transforming the way we deliver healthcare, how we look after ourselves in a connected age, and what we need to know to prepare ourselves and our practice to remain relevant.

Register now

Call for abstracts for the 2021 RACP Congress

Abstract submissions are now being welcomed for the 2021 RACP Congress series. Submissions must be received for review no later than Wednesday, 23 December 2020. Accepted abstracts will be published in the Internal Medicine Journal/Journal of Paediatrics and Child Health journals supplements so don’t miss this opportunity.

Find out more

RACP endorses Australian Research Alliance for Children and Youth (ARACY) campaign for universal free early childhood services

Following strong support from PCHD Fellows, the RACP has endorsed a new ARACY campaign which calls on the Government to invest in a universally accessible, high‐quality early learning and childcare system, delivered by a skilled and supported workforce. The open letter at the centre of the campaign outlines how investment in a universally accessible childcare system will support the important role played by families and set Australia up for an equitable and sustainable future in the COVID-19 pandemic recovery.

This campaign aligns with the PCHD position statement on Early childhood: the importance of the early years position statement which notes that there is ample research supporting the benefits of early childhood education on child development. It recommends that the Australian Government:

  • commits to long-term, sustainable funding of the National Partnership on Universal Access to Early Childhood Education beyond 2020–21 for all Australian children and expands it to starting at three years old
  • continues to fund early childhood education through the Child Care Subsidy program.

RACP Indigenous Health Scholarships

The Paediatric & Child Health Division is proud to offer the 2021 Indigenous Australian and Māori Health Scholarship for Paediatrics & Child Health as part of the RACP Indigenous Health Scholarship Program.

The program aims to support medical graduates and current trainees of the RACP who identify as Aboriginal, Torres Strait Islander or Māori on their chosen career path to becoming a physician. The scholarships provide a funded pathway through Basic, Advanced, Faculty or Chapter training in Australia and/or Aotearoa New Zealand.

Several other scholarships are available for 2021, including:

  • College Indigenous Australian and Māori Health Scholarship
  • Aboriginal and Torres Strait Islander Health Scholarship
  • Aotearoa New Zealand Māori Health Scholarship
  • Aotearoa New Zealand Pacific Islander Health Scholarship

Applications close Monday, 30 November 2020.

Further details are available on the RACP Foundation webpage.

RACP President's Indigenous Congress Prize

The RACP President's Indigenous Congress Prize is open to medical students, junior medical officers and RACP trainees who identify as Aboriginal, Torres Strait Islander or Māori. The selected applicant will receive support to attend the RACP Congress 2021 to gain educational and networking opportunities and exposure to career pathways within the College.

Please encourage anyone you know who is eligible to apply before the deadline on Monday, 1 February 2021.

Share your views on climate change and health: George Mason University and World Health Organization survey

We invite you to participate in a survey on climate change and health being run by George Mason University in collaboration with the World Health Organization and the Global Climate and Health Alliance.

This survey is open to all RACP Paediatrics & Child Health Division and Chapter members and paediatric members of the Australasian Faculty of Rehabilitation Medicine based in Australia.

The survey is being sent to health professionals in numerous countries to assess their:

  • views on climate change as a human health issue
  • awareness of and support for the international #HealthyRecovery initiative.

The survey is confidential, administered online and open until Monday, 30 November 2020. The survey is short and should take approximately 10 minutes to complete.

If you have any questions, please contact the RACP Policy & Advocacy team at racpconsult@racp.edu.au

Seeking Evolve case study volunteers for online learning course

To support the implementation of Evolve recommendations in clinical practice, we have launched a series of case studies exploring a clinical scenario based on one of the Evolve recommendations on low-value care. The aim of the case studies is to support Fellows and trainees to build an understanding of low-value care within their specialty and act as a tool for clinical educators and supervisors. We have had approval to turn some of our case studies into an RACP Q-stream. Q-streams are an interactive learning platform, which disseminates case studies via email at spaced intervals. To support this, we are seeking enthusiastic Fellows and trainees to lead the development of case studies.

Outlined below is a list of Evolve recommendations we think would be appropriate. If you would like to be involved, email Gemma Altinger, Program Implementation Lead at evolve@racp.edu.au to receive more information on the case study development process.

 Specialty  Recommendation/s
Rehabilitation medicine (AFRM)

Recommendation 3: Do not use Mini Mental State Examination as the only tool to assess cognitive deficit in acquired brain injury.

Geriatric medicine (ANZSGM)

Recommendation 1: Do not use antipsychotics as the first choice to treat behavioural and psychological symptoms of dementia.

Recommendation 2: Do not prescribe benzodiazepines or other sedative-hypnotics to older adults as first choice for insomnia, agitation or delirium.

Recommendation 4: Do not prescribe medication without conducting a drug regimen review or IMSANZ Recommendation 1: Avoid medication-related harm in older patients (>65 years) receiving five or more regularly used medicines by performing a complete medication review and deprescribing whenever appropriate or combined.

Addiction medicine (AChAM) Recommendation 1: Do not undertake elective withdrawal management in the absence of a post-withdrawal treatment plan agreed with the patient that addresses their substance use and related health issues.

Recommendation 3: Do not deprescribe or stop opioid treatment in a patient with concurrent chronic pain and opioid dependence without considering the impact on morbidity and mortality from discontinuation of opioid medications.

Occupational and environmental medicine (AFOEM)

Recommendation 2: Do not request X-rays or other imaging for acute non-specific low back pain, unless there are red flags or other clinical reasons to suspect serious spinal pathology.

Immunology and allergy (ASCIA)

Recommendation 1: Do not use antihistamines to treat anaphylaxis – prompt administration of adrenaline (epinephrine) is the only treatment for anaphylaxis.

Neurologists (ANZAN)

Recommendation 1: Do not perform imaging of the carotid arteries for simple faints   

Recommendation 5: Do not routinely recommend surgery for a narrowing carotid artery (>50% stenosis) that has not caused symptoms.

Dermatological Society (NZDS) Recommendation 5: Do not routinely use topical antibiotics on a surgical wound.
Paediatrics (PCHD)

Recommendation 3: Do not routinely order chest X-rays for the diagnosis of asthma in children.

Recommendation 5: Do not routinely order abdominal X-rays for the diagnosis of non-specific abdominal pain in children.

Sexual health medicine (AChSHM)  Recommendation 5: Do not prescribe testosterone therapy to older men except in confirmed cases of hypogonadism.

Quality and safety online course

Quality and safety are central to the delivery of healthcare in Australia and Aotearoa New Zealand. Our Quality and Safety online course has been designed to help you identify and overcome common quality and safety challenges. Don’t have time to complete the whole course? That’s no problem. Our courses are designed to enable you to dip in and out, or just do the parts that are relevant to you.

We understand you’re busy, so we’ve made sure RACP Online Learning resources are accessible anywhere and optimised for mobile on-the-go learning.

Pomegranate Health podcast Ep64: Big pharma and the people’s vaccine

This is part two in our series on global public health and focuses on the impact of intellectual property (IP) laws on the development and distribution of pharmaceuticals. The COVID-19 pandemic has stimulated a frenzy of vaccine development never seen before, but also examples of hoarding, price hikes and vaccine nationalism. The crisis has brought together scores of governments, manufactures and philanthropic organisations to pool research outcomes and patents, but the response from big pharma has been mixed.

In this podcast, we’ll discuss where the IP rules have come from and where exceptions are sometimes made for public health emergencies. We also discuss how pooled procurement mechanisms and advanced market commitments can help get drugs and vaccines to populations in developing countries and whether COVID-19 can prompt a permanent change to the existing IP regime.

Guests

  • Dr Owain Williams (University of Leeds)
  • Associate Professor Peter Hill AFPHM (University of Queensland)
  • Dr Deborah Gleeson (La Trobe University)

Fellows of the RACP can claim CPD credits via MyCPD for listening to this episode and reading the resources at the website. Subscribe to Pomegranate Health in Apple PodcastsSpotify, any Android podcasting app or our email alerts list.

Indigenous child health, children’s rights and the law medico-legal seminar

This online medico-legal seminar is being offered by the Royal Children’s Hospital (RCH) alumni in conjunction with Children’s Rights International, and will feature presentations from Dr Niroshini Kennedy, Magistrate Jennifer Bowles and Justin Mohamed, Victorian Commissioner for Aboriginal Children and Young People.

The seminar will be held on Thursday, 26 November 2020, 5.30pm to 7.30pm (AEDT), 7.30pm to 9.30pm (NZDT).

Register for the seminar

The number of participants is strictly limited to 100. Places will be allocated on a first-in, first-served basis. A link to view the recording of the meeting will also be available on request for four weeks from Dr Garry Warne, Honorary Secretary, RCH Alumni, please email rch.alumni@rch.org.au

Journal of Paediatrics and Child Health

An early view of future articles is now available.

ANZCA FPM Procedures in Pain Medicine Clinical Care Standard

The Faculty of Pain Medicine (FPM) of the Australian and New Zealand College of Anaesthetists (ANZCA) is responsible for the training and examination of specialist pain medicine physicians, and for the standards of clinical practice in Aotearoa New Zealand and Australia. The College’s mission is to serve the community by fostering safety and high-quality patient care in anaesthesia, perioperative medicine and pain medicine.

Developing pain medicine training in standards and training for procedural interventions is a key goal of the ANZCA and FPM 2018-2022 Strategic Plan. The Procedures in Pain Medicine project commenced in 2018 to deliver this strategic goal in line with the faculty’s 2019 position statement on procedures in pain medicine, including:

  1. Development of a clinical care standard relating to procedures in pain medicine.
  2. Development of a program to deliver training in and endorsement of procedural skills.
  3. Development of a post-fellowship strategy for FPM endorsement in pain medicine procedures.

The FPM Board recently approved for promulgation and use the Procedures in Pain Medicine Clinical Care Standard document. This professional document has been developed to articulate what is considered to be the appropriate and safe use of procedures in the practice of pain medicine. It seeks to reduce unwarranted variation that contributes to poorer outcomes and resource utilisation, while allowing the appropriate variability in practice required to match variations in individual patient needs. Stakeholder and public consultation processes were conducted before finalisation of the document for use by FPM ANZCA, its fellows and trainees.

The Procedures in Pain Medicine Clinical Care Standard is available on the ANZCA website.

The faculty has also developed the Procedures Endorsement Program to provide training in and endorsement of procedural skills. The Procedures Endorsement Program pilot will launch in early 2021, with full roll-out expected in 2022. Further information is available on the FPM webpage.

Open Access (free) book: Functional Somatic Symptoms in Children and Adolescents

Kozlowska, K., Scher, S., & Helgeland, H. (2020). Functional Somatic Symptoms in Children and Adolescents: The Stress-System Approach to Assessment and Treatment. London, Palgrave Macmillan. 

Building upon three decades of major scientific advances, this Open Access book sets out the stress-system model for functional somatic symptoms in children and adolescents. This approach provides both a new understanding of how such symptoms emerge – typically, through a history of recurrent or chronic stress, either physical or psychological – and points the way to effective assessment, management and treatment. In addition to chapters on the emerging science of functional disorders, the book gives central attention to the role of the clinician. The book begins by exploring the initial encounter between the paediatrician, child and family, moves through the assessment process with the mental health clinician, including the formulation and the treatment contract, and then describes the various forms of treatment that are designed to settle the child’s dysregulated stress system. The book’s aim is to give trainees and practicing clinicians, including paediatricians, neurologists, psychologists, and psychiatrists, a framework for understanding functional somatic symptoms and how the stress-system approach leads to clinical interventions that put the child (and family) back on the road to health and wellbeing. 

Story of interest: Global polio eradication in sight, but new challenges emerge

The global effort to eradicate polio has achieved great success, with two of the three poliovirus strains eradicated in the last five years and Africa was recently declared polio-free. Australia continues to contribute to the global polio eradication effort via the Paediatric Active Enhanced Disease Surveillance Network (PAEDS) and the Australian Paediatric Surveillance Unit (APSU). These networks aim to detect cases of acute flaccid paralysis (AFP) in children, which is the key clinical feature of polio. While it now seems plausible that the world will be free of polio, non-polio enteroviruses (NPEV) causing paralytic disease that looks like polio are emerging, particularly among children.

A review article recently published in the Journal of Paediatrics and Child Health highlights that the emergence of NPEV such as enterovirusesA71 (EV-A71) and enteroviruses D68 (EV-D68) in countries that are free of polio is concerning and pose a challenge to scientists, clinicians and public health authorities alike. An outbreak of EV-A71 causing some cases of AFP occurred in Sydney in 2013, and recently a cluster of possible EV-D68 AFP have been detected and further sporadic cases have occurred over the last 15 years.

This paper provides advice to clinicians that they should be on the lookout for these NPEV and should request stool samples in suspected cases of AFP.

New advocacy resource on minimum unit pricing for alcohol 

As part of the ongoing campaign to reduce the many harms of alcohol, the RACP has produced an advocacy resource on minimum unit pricing (MUP) for alcohol. MUP sets a floor price below which a fixed volume of alcohol cannot be sold to the public. MUP is designed to increase the price of the cheapest alcohol; since heavier alcohol users typically consume cheaper products, the policy effectively targets price increases at heavier users. As the heavy use of the cheap, high-alcohol products drives health inequalities, MUP is also likely to be an effective mechanism for reducing these inequalities. 

The new information sheet on MUP shows there is a robust evidence base supporting its effectiveness at reducing alcohol consumption and harm. Growing evidence from Scotland, Russia and the Northern Territory (NT) has shown that MUP can be effective across diverse settings. The success of the RACP-supported (reference 1reference 2) measure in the NT, recently corroborated by an independent evaluation, further underlines its appeal to other jurisdictions in Australia.  

The handy information sheet is being launched in support of the College’s Queensland election statement. It will be used to bolster a continuing push to introduce MUP in all Australian jurisdictions. We also urge members to use the resource in their own advocacy efforts.

Changes to the Authorised Prescriber Scheme

On 24 July 2020, the Therapeutic Goods Administration (TGA) implemented a change to the Authorised Prescriber Scheme to streamline the application process for medicines considered to have an established history of use in Australia. The application form and process have been updated for medical practitioners to apply under the new arrangements.

This change removes the requirement for Human Research Ethics Committee (HREC) approval or specialist college endorsement to be submitted to the TGA in circumstances where the medical practitioner is applying to become an Authorised Prescriber of medicines specified in subregulation 12B(1B) of the Therapeutic Goods Regulations 1990. A printable version is available on the TGA website of list of medicines with an established history of use. HREC or institutional approval may still be required to use certain ‘unapproved’ therapeutic goods within an institution, such as a hospital. Medical practitioners will need to liaise with the relevant institution to confirm the requirements.

A medical practitioner will also still need to obtain prior HREC approval or specialist college endorsement for products that are not included in subregulation 12B(1B) of the Therapeutic Goods Regulations 1990. Further details on applying for approval/endorsement are available in the guidance document ‘Authorised Prescriber Scheme – Guidance for Medical Practitioners, Human Research Ethics Committees, Specialist Colleges and Sponsors’.

Information and access to the Special Access Scheme & Authorised Prescriber Online System to submit applications is available on the Authorised Prescribers webpage.

Expressions of Interest

Apply to be part of the Regional and Rural Physician Working Group. Your clinical leadership will contribute significantly in developing a medical workforce strategy to guide long-term equitable health outcomes across Australia and Aotearoa New Zealand.

Check the Expressions of Interest page at any time, to find out if there are any opportunities that are of benefit to you.

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.

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

Career opportunities 

New South Wales

Staff Specialist/Visiting Medical Officer Paediatrics: Armidale Hospital, Regional NSW/Tamworth and North West NSW
Reference number: REQ196038
Closing date: Friday, 27 November 2020, 11.59pm (AEDT)

Please see the College website to view all medical positions vacant.

New member benefit: discounted Microsoft Surface devices and accessories

ASI Solutions has created an exclusive portal for our Australian members to purchase Microsoft Surface devices and accessories at group discount pricing. 

Log in to MYRACP and click through to the ASI portal. You will need to set up an account with ASI Solutions to access the offer.

If you have any questions please contact ASI Solutions.

Why Surface?

The business range of Surface devices is uniquely placed to support you in your everyday work and professional learning.

Coupled with your choice of the right software and cloud services to meet your unique needs, the beautifully-engineered Surface devices deliver secure access to information and allow deep communication and collaboration wherever you are. 

Please note the RACP is publishing this offer as a service to members. Such publication does not constitute endorsement. 

*Offers only available to current RACP members that are Australian residents. 
ASI Solutions respects your privacy. Please read their online Privacy Statement.

Australian members – save on electronics with JB HiFi Solutions

Save on computers, phones, TVs and more with exclusive offer at the JB Hi-Fi Corporate Benefits program. Australia’s largest retailer of consumer electronics, the portal never sleeps and provides you access to great offers 24 hours, seven days a week.

Start shopping for Christmas presents or prepare for the summer sports season with these November specials.

  • Samsung Series 4 HW-T450 200W 2.1 Channel Soundbar, (433961) – Now $285.00
  • Hisense 55S8 Series 8 55' 4K UHD Smart TV [2020] (444439) – Now $884.00
  • Dell Inspiron 3505 15.6' Full HD Laptop (512GB) (475758) – Now $982.00
  • Apple Airpods with Charging Case (2nd Gen) (381102) – Now $220.00

Visit your Member Advantage benefits platform to find these offers and more.

Terms and conditions apply to JB HiFi Solutions products, Member Advantage members only. Promotion Offer pricing valid until 30 November 2020.

Pot-pourri submissions welcome

To submit an article for publishing in Pot-pourri, please email paed@racp.edu.au. The article should be no more than 350 words. If you would like to submit an image with your article, it would be assumed that you have received appropriate permission to use the photo and it needs to be of high resolution, above 300 dpi. Please note that articles may need to be edited by the RACP Communications Team.

Update your details with the College

Did you know that you can now update your address details online? Simply Login to MyRACP and go to 'Edit my details'.
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