Pot-pourri eBulletin 19 October 2018

President's Message 

I would like to highlight National Children’s week in Australia, which begins today until 28 October. This year’s theme is informed by Article 12 of the UN Convention on the Rights of the Child – “Children's views and opinions are respected. They have the right to express those views freely in all matters affecting the child and the right to be heard.” Activities are planned around Australia to support, promote and celebrate children and this is an opportune time to further advocate for the rights of children, including particularly those on Nauru. 

Last month the RACP signed on to the #KidsOffNauru campaign, urging the Australian Parliament to act on their duty of care and immediately transfer all refugee and asylum seeker children and their families from Nauru to Australia. On 11 October Médecins Sans Frontières (Doctors Without Borders) was forced to stop providing care on the island, potentially seriously jeopardising the health and wellbeing of refugees still present. This has prompted a strongly worded statement from the College expressing grave concerns for refugee children and their families on Nauru (see media release here).

Registrations for RACP Congress 2019 open next month and it will be held in Auckland, New Zealand. The theme for next year is ‘Impacting health along the life course’. With sessions focusing on the first 1000 days, obesity and mental health and addiction, I am sure paediatricians will find great value in the program and take away new ideas and opportunities to optimise practice from the wide range of speakers.

As part of Congress, the RACP has opened applications for awards including the Rue Wright Memorial Award to a Fellow or trainee who demonstrates excellence in hypothesis, scientific merit and relevance to community child health in an oral presentation at the RACP Congress. The Best Poster Prize in Paediatrics & Child Health is awarded to a Fellow or trainee who demonstrates excellence of hypothesis, scientific merit and oral presentation for a poster presentation at Congress. I encourage members to apply. Presenting at Congress is a great opportunity to showcase your research and exchange ideas with colleagues.

Professor Paul Colditz
President, Paediatrics & Child Health Division

Member Profile Series:  Dr Niroshini Kennedy

We hope this will be the first in a series of profile pieces showcasing what it means to be a RACP Paediatric Fellow/trainee. What inspires members to become a physician; what do they love and find most interesting about their work; what are their biggest challenges, and what are their hopes for the future? We are starting with Dr Niroshini Kennedy, a PCHD Fellow currently serving on PCHD Council. If you are interested in submitting a profile piece, or have a suggestion for this series, please contact Paed@racp.edu.au.

Dr Niroshini Kennedy
Victorian Aboriginal Health Service and Royal Children’s Hospital, Melbourne.

Areas of special paediatric interest?

  • Community Child Health
  • Child protection/ children in out-of-home care
  • Aboriginal Child Health

Why did you choose to specialise in Paediatrics?
Paediatrics for me was by far the most optimistic specialty that I encountered in medicine. I think working with children, who have their lives ahead of them, has an intrinsic sense of hope about it. This can help on those days when the challenges and inequities that my patients face can seem overwhelming.

What do you find most interesting/ inspiring about your job?
I am constantly in awe of the resilience of the little people I see, particularly those who are in out-of-home care.  I am energized by the way that children adapt their behaviour to their environments, seek out relationships, and thrive when given the right environment. I love seeing their passions and interests emerge and I get a buzz when they share their proud moments with me: an award at school, a story they have written, or, as recently, a book of intricately drawn maps by a budding cartographer.

What are the biggest challenges you face in your job?
The inequities in the opportunities that some children have, the inequities in access to appropriate care are real challenges that we see every day as paediatricians. I am proud of the leadership that the RACP has taken in highlighting these issues, and the positive steps that have resulted from the launch of the Inequities in Child Health policy paper. I am sure that this work will only be strengthened by the Early Childhood position paper and the RACP’s focus on the First 1000 days.

What are your hopes for the future of your specialty?
I really hope that community child health explores more integrated models of care to deliver services to our patients. So many of the children we see have complex developmental, behavioural or psychosocial situations, and their care needs to be more than just an office visit with a doctor: it needs to include other disciplines (eg. speech pathology, OT, psychology, social work) that can work collaboratively towards the patients’ needs and goals.

What else would you like readers to know about you?
I’m Sri Lankan, of ethnic Tamil heritage, and spent my childhood in Jaffna, England and Papua New Guinea before moving to Australia. My father is a physician, and a Fellow of the RACP, in the Adult Medicine Division.

Paediatric research resources

The Australian Paediatric Research Network (APRN) is a network of Australian paediatricians who are keen to contribute to new research that is relevant to both public and private practice. Over time, this network has developed a variety of valuable resources to help trainees and Fellows conduct research. The resources are available free to all interested parties via their website at www.aprn.org.au. Resources include:

APRN Measures Library
The APRN Measure Library catalogues around 100 commonly used measures (e.g. for surveys) in child and parent research to help paediatricians, other clinicians, researchers and students find the right measure/s for their research or clinical practice.

How to conduct research
A catalogue of online resources on how to develop and run a research project, from the beginning to end.

Translation Toolkit
How to facilitate translation planning from the start of a research project.

Links to past and current projects

For more information on APRN resources and/or membership, please contact aprn.paeds@rch.org.au.

Asia Pacific Pediatric Association (APPA) Congress

RACP Paediatric & Child Health Division (PCHD) President-Elect Clinical Professor Catherine Choong spoke at the recent Asia Pacific Pediatric Association (APPA) Congress.  The APPA is a significant regional event for Paediatrics drawing specialists from across Asia, India and the Pacific in Bali. On this occasion it was held in conjunction with the 9th Annual Scientific Meeting of Indonesian Pediatric Society (ASMIPS/PIT-IKA) and 6th Asia Pacific Congress of Pediatric Nursing (APCPN). 

The Congress theme was 'Sustainable Development Goals (SDG’s) and Reducing Inequalities: How Far Have We Come?’ 

Echoing the PCHD’s position at the recent inequities in Child Health forum at Australian Parliament House on 15 August 2018 Clinical Professor Choong spoke at the session entitled 'Injury: you cannot always protect your child from it'. Clinical Professor Choong discussed the endocrine and developmental consequences of Traumatic Brain injury. This was part of a session dealing with non-communicable disease among children and the specific target of the World Health Organization SDG 3 “By 2020, halve the number of global deaths and injuries from road traffic accidents”.

Clinical Professor Choong spoke at a second session entitled 'Pediatrician to practice across Asia: is it possible?' Her talk titled 'Knowledge knows no borders' advanced the idea that harmonisation of the training curricula for paediatricians across different jurisdictions would improve aspects of child health in Asia. Clinical Professor Choong shared the RACP program of medical education, assessment, accreditation and assessment of overseas trained physicians. Clinical Professor Choong’s contribution to the Congress as the PCHD representative was supported by the College’s ongoing commitment to the international fellowship of paediatrians. The PCHD President, Professor Colditz and President-Elect Clinical Professor Choong are now working closely with the RACP International Strategy team on next steps.

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.

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.

Newborn Screening Program - Information for NSW Clinicians

Key points for clinicians:

  • Spinal Muscular Atrophy (SMA) and some Primary Immunodeficiencies (PID) will now be included in the Newborn Screening Program as part of a two-year pilot
  • Diagnosis of SMA and PID before symptoms present provides opportunity for earlier and more effective treatment
  • Nusinersen has been approved by the Pharmaceutical Benefits Advisory Committee for the treatment of SMA in children
  • Sydney Children’s Hospitals Network is participating in an international clinical trial evaluating a novel gene replacement therapy to help prevent the onset and progression of SMA

Summary:
SMA is an autosomal recessive neuromuscular disorder and occurs in one in 10,000 births. It is the leading genetic cause of infant death, causing progressive muscle weakness and in severe cases leads to paralysis and respiratory insufficiency. Although SMA cannot be cured, treatment options are available to improve quality of life and survival.

Nusinersen has been approved by the Pharmaceutical Benefits Advisory Committee (PBAC) for the treatment of SMA in children and although significant improvements in motor function can be made, earlier diagnosis pre-symptom onset has the potential to further improve prognosis.

Primary immunodeficiencies (PID) include severe combined immunodeficiency (SCID) and B cell deficiencies. SCID occurs in one in 40,000 births and results in a weakened immune system. It is usually fatal in the first two years of life from infection without intervention but can be cured with stem cell transplant if detected early. Similar to SMA, prognosis is improved if the child is diagnosed before symptoms present.

Related to the Newborn Screening Program changes, Sydney Children’s Hospitals Network is participating in a new international clinical trial (AVXS-101-CL-304 SPR1NT) to evaluate the efficacy of a gene replacement therapy as an alternative therapeutic pathway for patients with pre-symptomatic SMA.

The two-year pilot will support evaluation as to whether SMA and PID should be added to the screening program in the long term.

Further Information and resources:          

  • Sydney Children’s Hospital Network website
  • Factsheets available on the NSW Newborn Screening Program pages

Dr Kerry Chant PSM                                                                                                 
Chief Health Officer and Deputy Secretary
Population and Public Health

Graduate Certificate in Autism Diagnosis – The University of Western Australia (UWA)

Applications for the Graduate Certificate in Autism Diagnosis (GCAD) at UWA in 2018 are open and will close on 31 October 2018.

The GCAD is the first course of its kind and provides graduates trained in psychology, speech pathology, occupational therapy, paediatrics, or psychiatry with the specialist knowledge and clinical skills required to participate in team-based diagnosis of Autism Spectrum Disorder (ASD). The course is run in an online format supplemented by workshops so can be managed around work. As part of the course, you will obtain detailed training on how to conduct diagnostic ASD assessments and will receive qualification to use the Autism Diagnostic Observation Schedule (ADOS).

If you, or anyone you know, are interested please visit here. To view a short interview with one of our students, visit here

Please email Emma Miller if you would like more information.

 

RACP Survey of Fellow 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 Fellow 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, and Fellows are strongly encouraged to complete this brief online survey.

Start here to begin the online brief survey until 30 November 2018.

Any questions may be sent to racpconsult@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 the RACP 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 Mark Lane include the GESA Evolve recommendation in a difficult conversation with a patient here.  

Kids of Nauru Campaign 

The RACP has signed onto 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 it 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

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”.

Expressions of interest

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