Pot-pourri eBulletin 18 October 2019
Last month, on 19 September, the RACP hosted an Early Childhood Health roundtable at Parliament House, Canberra. I had the honour of attending along with 40 other delegates including Minister for Health Greg Hunt MP, Shadow Minister Chris Bowen MP and our two Parliamentary Paediatric Fellows (Katie Allen and Mike Freelander). The purpose of the day was to look at how we might implement the National Action Plan for the Health of Children and Young People 2020-2030 and what the priorities are. There were a number of Fellows present including paediatricians: Professor Sharon Goldfeld, Professor Harriet Hiscock, Associate Professor John Eastwood, Associate Professor Gehan Roberts and Dr Vanessa Sarkozy. You can read more about the roundtable later in this edition.
Yesterday was the United Nations Day for the Eradication of Poverty. In Australia there are an estimated three million people living below the poverty line, or one in eight Australians. We will not be surprised by the shocking statistic that more than one in six children are living in poverty. We know that poverty is the most substantial risk factor causing early childhood disparities in health as well as multiple lifelong effects, and that inequities in health have high costs to society. We must continue to advocate for the most vulnerable and call upon the Federal government to make change to prioritise the needs of children. You can read more on what the College is doing for Inequities in Child Health and access tools to assist you with your own advocacy.
It was a pleasure to attend the New Zealand PCHD Committee meeting last month and gain further insight into the health needs of New Zealand children and matters affecting New Zealand members. They have been busy on numerous fronts including developing a child health report card around key metrics that will be important in highlighting the health needs of children in New Zealand. Congratulations on this useful work and I look forward to continuing to work with and being inspired by my New Zealand colleagues in their endeavors to advance child health.
Dr Wendy Hunter, Dr David Newman, Dr Nicola Austin, Dr Danny de Lore, Dr Jessica Allen, Professor Paul Colditz (President), Dr Tim Jelleyman, Dr Pat Tuohy, Dr Genevieve Ostring and Dr Hamish McCay (Chair). Dr Lauren Weaver attended via zoom.
Planning for RACP Congress 2020 has begun and there will be some changes to the Best Poster Prize in Paediatrics. From 2020, abstract submissions will be accepted from all Paediatric Fellows and trainees, thus widening the eligibility. The best few will be chosen for oral presentation at Congress and where merit is demonstrated, a Best Fellow and Best Trainee winner will be selected. The Congress program is coming together with PCHD speakers to be announced shortly. Do plan to come along – dates are Monday, 4 to Wednesday, 6 May 2020 at the Melbourne Convention and Exhibition Centre.
Following on from Mental Health Week, I would like to remind members of the importance of taking care of our own health and wellbeing, of having a mentor, and checking in with a colleague. The College has a number of useful resources on its website. Don’t forget it’s everyone’s business.
Professor Paul Colditz
President, Paediatrics & Child Health Division
The RACP’s Paediatrics & Child Health Division held an Early Childhood Health roundtable at Parliament House, Canberra on 19 September 2019. The event attracted about 40 delegates including MPs, key NGOs and leading paediatricians including our two Parliamentary Paediatric Fellows (Katie Allen and Mike Freelander). The roundtable built on the recently announced National Action Plan for the Health of Children and Young People 2020-2030 and RACP position statements on Early Childhood and Inequities in Child Health, as well as a survey of paediatricians. It follows on from our successful 2018 child health forum at which the development of the Action Plan was first announced by the Minister for Health.
Minister for Health Greg Hunt MP, and Shadow Minister Chris Bowen MP, both spoke at the event and expressed their commitment to implementing the Action Plan, and appreciation of the engagement and advice from the group of experts the College had brought together.
The outcome of the roundtable will be to provide a clear statement to the Australian Government identifying the critical priority areas and suggested program focus for early childhood health over the next 10 years. Key themes included parental mental health, parenting support, and strengthening universal access to services that are more integrated and family-centred. College staff will continue to work with key paediatric Fellows in the coming months on directions for this work.
Shadow Health Minister Chris Bowen MP, Professor Paul Colditz, Professor Sharon Goldfeld, Dr Mike Freelander MP, Professor Valsamma Eapen RANZCP, Health Minister Greg Hunt MP
Professor Sharon Goldfeld, Dr Katie Allen MP, Professor Paul Colditz, Dr Mike Freelander MP, Associate Professor Mark Lane
Professor Sharon Goldfeld addressing roundtable attendees
Join your colleagues at RACP Congress 2020, from Monday, 4 to Wednesday, 6 May 2020 at the Melbourne Convention and Exhibition Centre in Melbourne, Australia.
Listen to what Lead Fellow, Professor Don Campbell has to say about RACP Congress 2020: Balancing medical science with humanity.
In this rapidly changing world, RACP Congress 2020 will equip you to deliver healthcare, provide leadership and respond to need. Congress 2020 Lead Fellow, Professor Don Campbell, encourages Fellows, trainees and stakeholders to attend Congress 2020.
“Be a part of something bigger, contribute to the conversation. Congress 2020 will broaden your horizons, challenge your thinking and inform your practise.”
With the theme of ‘Balancing medical science with humanity’, RACP Congress 2020 will look at a range of topics, exploring how the profession is transforming.
Read the program and register
The Paediatrics & Child Health Division Research Committee recently came together to produce a video guide to pursuing a career in paediatric academic research. This webinar is a complement to the Paediatric Academic Pathways document that was launched at this year’s RACP Congress.
The webinar builds on this research by informally engaging with a number of paediatric researchers at various points in their career, from Basic Trainee through to established paediatricians and stages in between. It also provides Australian and New Zealand perspectives. The video gives helpful advice on common issues like time management as well as specific contact details to help explore your research career options.
To access the webinar go to the Paediatric Resources page of the RACP website, or Zoom.
If you have any questions or feedback, please contact Paed@racp.edu.au.
Prof Harriet Hiscock
Chair, PCHD Research Committee
The Paediatrics & Child Health Division is proud to offer the 2020 Indigenous Australian and Māori Health Scholarship for Paediatrics and Child Health as part of the RACP Indigenous Health Scholarship Program.
The Program aims to support medical graduates and current RACP trainees 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 New Zealand.
There are several other scholarships available for 2020, including:
- College Indigenous Australian and Māori Health Scholarship
- Aboriginal and Torres Strait Islander Health Scholarship
- Aotearoa New Zealand Māori Health Scholarship.
Applications close Saturday, 30 November 2019.
Further details are available on the RACP Foundation webpage.
Have your say on the proposed common standards for all 38 Advanced Training curricula.
Find out more
The dates for the Divisional Written Examination and Divisional Clinical Examinations in 2020 are now available on the website.
If you're preparing to sit either exam, or you’re a DPE or supervisor, please check the dates and mark them in your calendar.
Eligible written exam candidates will receive an email closer to the opening date with details of how to apply.
If you have any queries about either exam please contact email@example.com.
Registrations are now open for the Tri-nation Alliance International Medical Symposium (IMS), 20 March 2020, Amora Hotel Sydney, Australia.
Now in its ninth year, IMS is an annual event that reinforces the strong historical relationship between medical professions from Canada, New Zealand and Australia. Cementing these ties, a formal agreement between the Royal College of Physicians and Surgeons of Canada, The Royal Australasian College of Physicians, The Royal Australasian College of Surgeons, The Australian and New Zealand College of Anaesthetists and the Royal Australasian College of Psychiatrists created the Tri-Nations Alliance.
The IMS 2020 theme 'Providing care to underserved populations' is relevant to health professionals from all member countries. With a focus on higher medical education, delegates will explore how specialist training can support and enhance access to health care for critical populations experiencing difficulties in accessing healthcare, potentially due to location or isolation, social determinants or other specific issues.
The Medevac Legislation, introduced in February 2019, has improved access to appropriate healthcare for refugees and asylum seekers being held offshore. It allows medical experts to make decisions about healthcare for seriously ill individuals and ensure that they receive the medical treatment that they need in a clinically appropriate timeframe. Previous delays and failures to transfer ill asylum seekers resulted in preventable suffering. The RACP is proud to have been a key part of the campaign to establish Medevac, and we are now continuing this by leading medical college opposition to its repeal.
Last weekend the RACP released an unprecedented statement
with 10 other medical colleges calling on the Australian Parliament to maintain the Medevac legislation and the Independent Health Advice Panel (IHAP) process.
To continue keeping up pressure on the Parliament in the lead up to the Senate voting on this legislation in mid-November, we encourage all doctors to take part in our social media campaign to save Medevac. Show the Parliament that doctors say #SAVEMEDEVAC by retweeting with comment our kick-off campaign tweet
featuring Professor Paul Colditz, RACP President, Paediatrics & Child Health Division
with your own selfie with the sign and #SAVEMEDEVAC.
You can also engage with our existing tweets (tweet #1
, tweet #2
) and Facebook
posts to support momentum for this cause.
Download sign #SAVEMEDEVAC
The RACP were proud conference partners at this year’s AIDA Conference held in Darwin from 2 to 4 October 2019. A number of RACP Fellows, trainees were present at the conference, including RACP President Associate Professor Mark Lane, Associate Professor Tamara Mackean, Dr Dennis Bonney and Dr Angie dos Santos. Staff included Director of Education Robyn Burley and Director of Policy and Advocacy Patrick Tobin.
The conference began with a Welcome to Country delivered by Dr Aleeta Fejo, the first locally-trained Northern Territory GP. Keynote speakers included AIDA President Dr Kristopher Rallah-Baker, Northern Land Council CEO Ms Marion Scrymgour, Danila Dilba Health Service CEO Ms Olga Havnen and Australian Medical Association Federal President Dr Anthony Bartone. In her address, Ms Scrymgour emphasised “let's not forget the importance of Aboriginal health practitioners who are the cultural brokers within our communities". Ms Scrymgour also drew attention to leadership and to the role of Treaty as vital to improving the health of Indigenous peoples.
The RACP held a workshop on ‘Community collaboration as a basis for specialist outreach services and innovative change’. Dr Josh Francis facilitated a powerful conversation with Indigenous patients, community leaders, and doctors on the synergistic power of Indigenous community leadership and specialist physician care to tackle Rheumatic Heart Disease in Maningrida, a community of 2,400 people 500km from Darwin.
RACP President Mark Lane spoke at the ‘Growing our Fellows’ workshop, which was an opportunity for medical students and interns to interact with Indigenous members and leaders of Australia’s specialist medical colleges, ask questions and discuss career pathways through medicine.
A special congratulations to Dr Jaquelyne Hughes FRACP who was awarded Indigenous Doctor of the Year 2019. Dr Hughes is an inspirational leader in the field of kidney health, and advocate for Aboriginal and Torres Strait Islander doctors and patients.
Folic acid is an essential B vitamin important for the healthy development of babies early in pregnancy. There is overwhelming evidence that consuming sufficient folic acid before conception and during early pregnancy can prevent many cases of neural tube defects such as spina bifida.
The RACP is developing a submission to Ministry for Primary Industries (MPI) on folic acid fortification. There are three approaches being considered by the Government:
- continue with the current voluntary approach of fortifying up to 50% of packaged sliced bread
- ask industry to enhance the voluntary approach to fortify 80% of packaged sliced bread, or
- introduce mandatory fortification of bread, bread-making wheat flour, or all wheat flour.
Documents supporting folic acid fortification of food and the consultation papers are available from MPI.
If you would like to contribute to the RACP’s submission, please send feedback to firstname.lastname@example.org by Monday, 4 November 2019.
Well Child Tamariki Ora is a universal child health, development and wellbeing program, offered universally to children aged zero to five years in Aotearoa New Zealand. Although it is a well-regarded program with high coverage, it is being reviewed by the Ministry of Health to identify areas for improvement.
The Aotearoa New Zealand Paediatrics and Child Health Division Committee agreed to collaborate with the Māori Health Committee and Aotearoa New Zealand Policy and Advocacy Committee and were able to draw on the expertise of highly-skilled paediatricians Dr Pat Tuohy, Dr Russell Wills and Dr Peter McIlroy in crafting our submission. Aotearoa New Zealand President Dr Jeff Brown described the final version as extensive and well thought out, and noted he enjoyed reading it. The RACP looks forward to further engagement with the Ministry of Health on recommendations made in our submission.
RACP Quarterly is the RACP's member magazine.
Articles in the September/October 2019 edition include:
- Dr Marion Mateos gaining international recognition for her work in acute lymphoblastic leukaemia (pages 34 to 35 )
- Medical needs of adolescent refugees resettling in Western Australia – interview with RACP Fellow Dr Kajal Hirani (pages 40 to 41)
Access previous editions of RACP Quarterly on the RACP website.
As evidence and clinical practice advances, Evolve and Choosing Wisely recommendations will reflect these changes. The previous iteration of the Society of Obstetric Medicine of Australia and New Zealand ‘Top-Five’ recommendations included:
Do not perform a D-Dimer test for the exclusion of venous thromboembolism during any trimester of pregnancy.
Recent studies have shown that using a D-Dimer along with a clinical algorithm can increase the reliability of D-Dimer testing in ruling out DVT and PE in pregnancy.
Furthermore, the alternative to D-Dimer tests for these purposes is the use of imaging tests, which have their own set of risks from radiation exposure. Where previous evidence which suggested D-Dimer testing was highly unreliable would have tipped the scales towards discouraging D-Dimer testing, the new evidence suggests the results of D-Dimer testing can be made more reliable. Thus, it is no longer apparent there would be strong benefits from discouraging the use of D-Dimer testing in these settings. Due to this change in evidence and physician support, this recommendation was officially removed in August 2019. A fifth recommendation has not been identified yet.
Find out more
Evolve is a flagship initiative that aims to support physicians to safely and responsibly phase out low-value tests, treatments and procedures where appropriate, provide high-value care to patients based on evidence and expertise, and influence the best use of health resources, reducing wasted expenditure. The RACP Fellows and trainees have recently shaped the next Evolve Strategy for 2019-21.
From 1 to 31 July 2019 the draft strategy was circulated through Divisions, Faculties and Chapters, Specialty Societies and through the Presidents eBulletins. We received 27 responses to the survey, one email response and also undertook a face-to-face consultation with the Paediatrics & Child Health Division.
We received a lot of positive feedback and constructive criticisms. We value all feedback and have made changes to the strategy accordingly and are looking at how we can incorporate it in the implementation of the strategy to ensure Evolve is better meeting the needs of our members. We are pleased to share the updated Evolve Strategy 2019-21 and a summary of the consultation feedback.
Get involved in shaping and implementing Evolve by emailing email@example.com.
In the previous episode we talked about the science of pain, opioid analgesia and dependence. Now we look at the influence of culture, regulation and marketing on opioid prescribing for chronic non-cancer pain. First, we ask which are the prescription opioids most commonly leading to dependence and why are they prescribed? Then we discuss the mixed messages that prescribers are getting from guidelines and pharmaceutical regulation. Ever-relaxing indications for pharmaceutical subsidies can nudge prescribing behaviour in the wrong direction.
Tasmania was for many years the worst performer on measures of opioid use and harm, but this all began to turn around from 2006. Addiction medicine specialist Associate Professor Adrian Reynolds explains how education, regulation and real-time prescription monitoring were brought together in that state.
Finally, an undeniable influencer of prescribing behaviour are the promotional campaigns organised by pharmaceutical companies. Pain medicine specialist Dr Chris Hayes explains that those within the medical profession should not be surprised by this, but should be wary so their professional judgement isn’t compromised. A couple of case studies provide context for the RACP’s Guidelines for ethical relationships between health professionals and industry.
- Dr Christopher Hayes FFPMANZCA (Director Hunter Integrated Pain Service)
- Clinical Associate Professor Adrian Reynolds FAChAM (Clinical Director Alcohol and Drug Service, Tasmania)
Fellows of the RACP can claim CPD credits via MyCPD for listening to this episode.
Subscribe to Pomegranate Health in Apple iTunes, Spotify or any Android podcasting app
The dramatic headlines about the opioid crisis are all-too familiar by now. Australia and New Zealand have followed the lead of the US, and seen a fourfold increase in opioid use over the last thirty years. Most of this prescribing has been for chronic non-cancer pain, but systematic reviews will tell you that that there are no decent trials that would warrant use for this indication.
Learn more about the opioid crisis at the RACP South Australian Annual Scientific Meeting on Saturday, 30 November at the Adelaide Convention Centre. The session will be led by Dr Victoria Cock, the clinical unit head of the Drug and Alcohol Services of South Australia inpatient withdrawal unit.
If you'd like to learn more about opioids before you attend the ASM, check out the Pomegranate podcasts today.
Curated Collections are learning guides based on the contributions and peer review of RACP Fellows and other industry experts. Each guide presents key readings, online courses, webcasts and other tools for physicians’ continuing professional development.
Discover more today
The early view of the next issue of the Journal of Paediatrics and Child Health is now available on the JPC Wiley page
Earlier in the year the College joined the Obesity Collective, a group of individuals and organisations from across Australia working to take on the obesity challenge together, with empathy and from a whole-of-society perspective.
Since then, the Collective has been active across a range of initiatives, including the launch of the Weight Issues Network (WIN). WIN is a growing organisation that represents the perspectives and needs of people living with overweight and obesity and those who care. The WIN hosted its first workshop at Westmead, where over 40 new members discussed the need for a strong lived experience voice, advocacy priorities and the power of personal stories.
The challenge of obesity is widely discussed in the media, reports and strategic plans. The framing of the challenge influences the public’s perception and weight stigma. It is a goal of the Collective to have a more unified, consistent and balanced narrative around obesity. These key messages and concepts have been developed for Collective members to consider, use and adapt when referring to obesity, including in clinical settings and in discussions with patients. We invite you to review and comment on these messages by sending us an email at firstname.lastname@example.org. You might also be interested in the Collective’s Tiffany Petrie talking to the ABC about the dangers of fat shaming.
Finally, we invite you to fill in a survey from the National Association of Clinical Obesity Services (NACOS). The NACOS represents organisations providing clinical obesity services in Australia. The NACOS is committed to driving improvements to access to clinical obesity services and raising standards in clinical obesity care. The team are working with stakeholders to develop a framework for clinical obesity services and are asking for input from clinicians and people with lived experience of obesity.
To learn more about the Collective and participate in its work, visit the website or contact the organisation.
The Department of Health (the Department) is undertaking a review of antibiotic listings on the Pharmaceutical Benefits Scheme (PBS).
In 2018-19, the Department commenced a review of antibiotic listings on the Pharmaceutical Benefits Scheme (PBS) that currently include a repeat when prescribed. The review is part of the Australian Government’s broader ongoing strategy to support best practice prescribing in Australia, as outlined in Australia’s First National Antimicrobial Resistance Strategy 2015-2019.
The review is being undertaken in stages with the first stage focussing on the top five antibiotics with repeats prescribed (by volume) on the PBS, being:
- Amoxicillin + Clavulanic Acid
The department’s review proposed changes to some of the PBS listings for antibiotics listed above.
The Pharmaceutical Benefits Advisory Committee (PBAC) considered the proposed changes to the listing of certain antibiotics to encourage antimicrobial stewardship at its August 2019 Intracycle Meeting.
The PBAC recommended the removal of repeat options for a range of listings where no repeats were deemed necessary as per the Therapeutic Guidelines. The PBAC also recommended aligning the listings for specific indications to the Therapeutic Guidelines where increased quantities are clinically indicated. The PBAC considered that the recommended changes, aligned as best possible with the current version of the Therapeutic Guidelines (version 16), would support antimicrobial stewardship and quality use of medicines as well as assist in the reduction of antimicrobial resistance.
An implementation date for the changes has not yet been established. More information on the specific PBS listings considered, changes recommended and implementation timeframes will be provided in the near future.
If you have any questions, please contact the Department at email@example.com.
A range of resources to help in the diagnosis and management of iron deficiency and/or anaemia in children have been developed by the Australian Red Cross Blood Service (ARCBS). These resources include an iron assessment and treatment flowchart and oral iron choices guide for both health professionals, children and caregivers.
Your input is vital in helping the ARCBS develop innovative resources to benefit your clinical practice. The ARCBS would greatly appreciate it if you could download the tools and complete the online feedback form.
The survey should take less than five minutes to complete and submitted by Friday, 29 November 2019. The ARCBS hopes that these resources prove to be of value to paediatricians – and thanks you for your support.
Download resources and take the ARCBS survey
Are you undertaking Advanced Training to further your career? Consider applying for a $10,000 grant through MIGA’s Doctors in Training Grants Program! There are many eligible training types including post graduate study, specialised fellowships, volunteer placements and more. Applications for the 2019 Program are open until Friday, 1 November 2019.
Find out more and apply
The Department of Health has issued a statement from the Chief Medical Officer and State and Territory Chief Health Officers about e-cigarettes and an emerging link between their use and lung disease.
Read media release
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.
NSW PSIG Hot Topic - Improving Critical Care
The Australian College of Critical Care Nurses (ACCCN) warmly invites you to an evening of networking, discussion and presentations centred around improving patient outcomes in the Paediatric Critical Care setting. The ACCCN NSW/ACT Branch is delighted to host Dr Martha Curley speaking on the topic 'Surviving paediatric critical illness – opportunities to improve long-term outcomes'.
Wednesday, 23 October 2019
5.30pm to 9.30pm
Westmead Children’s Hospital
Lorimer Dods Lecture Theatre, Level 4, 170 Hawkesbury Rd, Westmead NSW 2145
Australian Digital Health Agency – My Health Record in Specialist Practice Information and Networking Session
The Australian Digital Health Agency invites you to an information and networking session focussing on how to improve clinical outcomes for patients and streamline business processes.
Tuesday, 12 November 2019, 6pm to 9pm
Rydges World Square Hotel, 389 Pitt Street, Sydney
Wednesday, 13 November 2019
6pm to 9pm
Pullman King George Square, Corner Ann and Roma Street, Brisbane
A significant proportion of healthcare providers across Australia are embracing complementary and evolving digital health technologies to improve care coordination for their patients. The evening will include:
- An overview on My Health Record and its benefits for specialist clinical practice
- Expert panel discussion exploring practical strategies and medico legal advice for embedding its use
- Opportunity to initiate next steps for My Health Record registration
- Networking opportunity with your peers
Go to the events listing at any time to see what other events are coming up.
To submit an article for publishing in Pot-pourri, please email firstname.lastname@example.org
. 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.
Did you know that you can now update your address details online?
Simply Login to MyRACP
and go to 'Edit my details'.