Northern Territory - May 2019

A message from the Northern Territory Committee Chair

It is my pleasure to share with you this edition of the NT eBulletin. Let me start by wishing all our RACP candidates well for the upcoming Clinical Exams. I would also like you to join me in congratulating former RACP NT Chair Christine Connors on receiving an OAM Award. Christine has been a pillar in the NT medical community for over 28 years and is being recognised for her service to medicine through a range of roles. This is a fantastic and well-deserved achievement for a dedicated individual.

The committee has contributed to several policy statements and position statements including; Inquiry into Sleep Health Awareness in Australia, Antibiotic Awareness, Pill Testing and Australian Institute of Health and Welfare National Primary Health Care Data Asset Consultation.  The RACP NT embraced the Northern Territory Alcohol Reform Policy. We have hit a significant milestone as a state after the NT government released an update on the NT Alcohol Harm Minimisation Action Plan. As the leading state in alcohol assumption, it is vital that we do more to combat the consequences of alcohol and push for the Government to implement the Alcohol Review’s recommendations. The minimum floor price for alcohol will reduce the availability of cheap alcohol and reduce alcohol consumption as well as problematic drinking patterns. This is a fantastic commitment from the NT Government and I hope we continue to see a decrease in emergency department presentations and assaults across the territory and Alice Springs. Read our full media release.

In the last few months, various training and educational events were held across the territory.  The NT Basic Trainee Physician Training Orientation was attended by a number of basic trainees, and for many, this served as their first introduction to the College. I had the pleasure of speaking alongside Professor Bart Currie, Dr Emma Spencer and Professor Peter Morris. I would like to take this opportunity again to extend a warm welcome to all our new Basic Trainees both to the College and to this wonderful state we call home.

We are looking forward to more chances to reconnect at the upcoming training and educational events across the territory in 2019 including the New Fellows Forum in September, please keep an eye out on your emails for further information. Both the RACP Foundation Research Awards and the Trainee Research Awards open soon, in May and July respectively. These are tremendous opportunities for both Fellows and trainees to be recognised for their research efforts and to gain some exposure to the rest of the College community. For more information please refer to the end of this bulletin.

In this issue we will read about the ‘Top End Pulmonary Hypertension Study’ written by Dr Pyi Naing which brings to light the issues surrounding Pulmonary Hypertension and the chance to collaborate with the National Echo Database Australia. Additionally, Dr Megan Brown from Alice Springs Hospital shares her heart-warming experience working in the Renal Medicine Team as part of a full multidisciplinary team and how her colleagues became like family.

The NT Regional Committee work plan for the Regional committee has been finalised and we will strive to meet our targets over the next two years and to increase the value and relevance of membership to Fellows and trainees in NT.  Please write to us at RACPNT@racp.edu.au and let us know the issues you wish the committee to address in 2019.  We look forward to hearing from you.

Dr Rob Tait
Chair, 
NT Regional Committee

NT Basic Physician Training – Orientation

NT Basic Physician Training Orientation Session was held at the Menzies School of Health on Monday, 18 February.  For many, it was their first introduction to the College and the opportunity to meet other basic trainees.

The audience had the opportunity to listen to a range of guest speakers including Chair of the RACP NT Regional Committee, Dr Robert Tait, Professor Bart Currie, along with DPE’s Dr Emma Spencer and Professor Peter Morris.

Professor Bart Currie was thoroughly enjoyable with his talk on what makes the Northern Territory different … and the difference was evident. With the small group, Professor Bart Currie was able to interact with every attendee on a personal level, providing attendees the platform to tell the audience where they come from and how they ended up in the top end. For many, Darwin wasn’t their first choice, but it is now somewhere they call home.

Following a presentation on the College requirements of the Basic Training program, Ben Watson of the NT Trainee Committee provided the audience with information on approaches to training, hospital-based learning and what to do and not to do. At the end of the presentations, trainees were able to network over canapés and refreshments.


Basic Trainees listening to Presentations 1
Basic Trainees at the orientation session

Basic Trainees listening to Presentations 2
Enjoying learning and networking at the presentation

Professor Peter Morris and Professor Bart Currie
Professor Peter Morris and Professor Bart Currie

Northern Territory Trainees Committee members 2
Northern Territory Regional Chair, Dr Rob Tait with NT Trainees Committee members Dr Emma Hack, Dr Martin Hansen, Dr Madeleine Venables, Dr Rosie Rock and Dr Ben Watson

New Trainees enjoying a social catch-up
New trainees enjoying a social catch-up after the presentations

Regional Committee Chair Rob Tait
Regional Committee Chair Dr Rob Tait, Dr Rosie Rock, Dr Madeleine Venables and SA/NT Senior Exectutive Office Ms Nell Sproule

Top End Pulmonary Hypertension Study

red-blood-cells-in-vein-641133986_3647x2735Pulmonary hypertension (PH) is a debilitating and fatal condition where there is an abnormally high blood pressure in the pulmonary circulation, traditionally defined as mean pulmonary artery pressure ≥25mmHg at rest, measured by right heart catheterisation (RHC) (1, 2). PH is not a single disease but an end phenotype of multiple underlying aetiologies such as left heart diseases, pulmonary vascular diseases, lung diseases, genetics, certain infections such as HIV, and connective tissue diseases. PH can be classified into five groups clinically based on the aetiology (2). Regardless of underlying aetiology, untreated PH will lead to progressive right heart failure causing distressing symptoms and untimely death.

PH is under-recognised, poorly understood and its epidemiology is not well defined. The treatment and prognosis of different types of PH vary greatly depending on the underlying aetiologies. The effective medical therapies for Pulmonary Arterial Hypertension (Group 1 PH as per the WHO classification (2)) are available nowadays but expensive and only effective for PAH (3, 4). Early identification and correct classification of PH are necessary to improve the outcomes for PH patients. Better understanding of PH epidemiology will also improve the outcomes of PH patients by better planning and management of health resources.

A comprehensive study of epidemiology of PH is currently underway at the Top End of Australia. We have identified 2072 patients whose echocardiograms are consistent with PH (estimated pulmonary artery systolic pressure of 40mmHg and above) by querying our echo database from January 2015 to December 2015. This equates to 1142 PH patients per 100,000 population (one per cent of the Top End population of 181,418 from 2016 census) and three times higher than the prevalence from Armadale echo study, a commonly cited study in PH literatures (5). It was also higher than the prevalence of PH in Central Australia (6). We are collecting corresponding clinical information including biometrics, risk factors, treatment and mortality data from electronic health records after obtaining full ethical clearance from Human Research Ethics Committee of NT Department of Health and Menzies School of Health Research.

There is also an exciting opportunity to collaborate with NEDA (National Echo Database Australia) which will help our project by enabling us to link the clinical information and the echo data together for further analyses (7). A potential benefit of this linkage is the development of an echocardiographic marker which can be used as a surrogate of RHC to differentiate PH physiologies non-invasively and help in the diagnosis process (8).

Please, contact the co-principal investigator, Dr Pyi Naing at Pyi.Naing@nt.gov.au for more information on the study.

References:

  1. Galie N, Humbert M, Vachiery JL, Gibbs S, Lang I, Torbicki A, et al. 2015 ESC/ERS Guidelines for the Diagnosis and Treatment of Pulmonary Hypertension. Rev Esp Cardiol (Engl Ed). 2016;69(2):177.
  2. Simonneau G, Montani D, Celermajer DS, Denton CP, Gatzoulis MA, Krowka M, et al. Haemodynamic definitions and updated clinical classification of pulmonary hypertension. European Respiratory Journal. 2018:1801913.
  3. Galie N, Corris PA, Frost A, Girgis RE, Granton J, Jing ZC, et al. [Updated treatment algorithm of pulmonary arterial hypertension]. Turk Kardiyol Dern Ars. 2014;42 Suppl 1:78-94.
  4. Taichman DB, Ornelas J, Chung L, Klinger JR, Lewis S, Mandel J, et al. Pharmacologic therapy for pulmonary arterial hypertension in adults: CHEST guideline and expert panel report. Chest. 2014;146(2):449-75.
  5. Strange G, Playford D, Stewart S, Deague JA, Nelson H, Kent A, et al. Pulmonary hypertension: prevalence and mortality in the Armadale echocardiography cohort. Heart. 2012;98(24):1805-11.
  6. Haji K, Wong CX, Chandra N, Truong H, Corkill W, Kaethner A, et al. Pulmonary Hypertension in Central Australia: A Community-Based Cohort Study. Heart, Lung and Circulation.
  7. Strange G, Celermajer DS, Marwick T, Prior D, Ilton M, Codde J, et al. The National Echocardiography Database Australia (NEDA): Rationale and methodology. American Heart Journal. 2018;204:186-9.
  8. Naing P, Kuppusamy H, Scalia G, Hillis GS, Playford D. Non-Invasive Assessment of Pulmonary Vascular Resistance in Pulmonary Hypertension: Current Knowledge and Future Direction. Heart Lung Circ. 2017;26(4):323-30.

Fellow in Focus: Dr Megan Brown

Dr Megan BrownDoctor Megan Brown began working at Alice Springs Hospital in February 2017. Originally from Gippsland, Dr Brown completed her basic training and the first two years of her nephrology advanced training in Victoria. Completing her final year of advanced training in Alice Springs, she has stayed on with the Renal Medicine team at Alice Springs post-fellowship. She now works with six other nephrologists and a full multidisciplinary team to deliver comprehensive renal care to patients across Central Australia.

The RACP NT team caught up with Dr Megan Brown to learn more about her work.

What is the most rewarding aspect of your role?
Working with the Renal Medicine team in Central Australia is really a dream job for me. When I was in medical school I always wanted to work in rural and remote communities. Inspired by some amazing General Physicians who also did procedural work in a rural centre I thought being a physician with procedural skills would be a good fit for me. At the time I was told by some that ‘those sorts of physicians don’t really exist anymore’. However, in the last two years I have discovered first hand that they absolutely exist, and you can find them in the Northern Territory. I now have the great privilege to be one of them. The work we do includes complex medical care, acute renal medicine, integrating with and empowering primary care providers, procedural work (including line placement, fistulograms and fistuloplasties), remote outreach, telehealth and much more. The care we provide is truly wholistic and the biopsychosocial and spiritual elements of care are often at the forefront making the ‘art’ of medicine a constant challenge.

On top of loving the work I do I also have the incredible opportunity to work with some of the most culturally rich individuals I have ever met, and I am regularly floored by their resilience and humbled by how much I still have to learn.

What is it about your work that makes you want to get out of bed each morning?
In short, I love my job, I love my team and I love those I have the honour of serving.

For me, like many others, moving to the Territory meant leaving my biological extended family. However, this has meant that those I work with and share life with here have become like family. Alice Springs has some of the best camaraderie between health providers I have ever experienced. This means that each day I feel like I get to contribute to something bigger than myself. There are shared victories, shared challenges, shared vision and shared passions.

What does a typical day at work look like for you?
Currently I am heading up our telehealth service so a typical day for me means getting into work by 8am and connecting with each of the remote communities I will be working with that day. Then as the appointments start, I work from my clinic in Alice Springs to see patients from across Central Australia usually with the assistance of some amazing remote community nurses or medical practitioners. After I finish my clinic, I take the time to catch up on letters, emails, assist remote medical practitioners who often email or call me to discuss complex patients, and I am doing some project work looking at how to improve our telehealth service.

How do you manage work-life-balance?
Perhaps in this season of my life more than ever work-life-balance is at the forefront. I have a one-year old son so have taken the opportunity to work part-time. I currently work 11 hours a week while my husband looks after our son and spend the rest of the week being a mum. I love that I can still do meaningful work and contribute to the team without having to miss out on these special early family years.

I love being outdoors and in nature, so Alice Springs is the perfect place to be as I can walk for just minutes from my home and be out in the Central Australian desert, there is amazing rock climbing nearby and incredible cycling tracks. What better place to live and raise a family?

Are there any patient success stories that you can share?
So much of patient care in our environment comes down to trust and relationship. There are many patients who are initially terrified when they first meet any of us in the renal team. As time goes on and we build trust, these patients often become a key part of the ‘renal family’. I had the privilege recently to be involved with the ‘Catching Some Air- Asserting Indigenous Information Rights in Renal Disease’ project, it was amazing to see many of these same patients taking on roles as key advocates for renal health.

EOI – Vacancies on the Northern Territory Trainees’ Committee

We are seeking paediatric, adult medicine, rehabilitation, occupational medicine and public health trainees to join the Northern Territory Trainees’ Committee. This is a fantastic opportunity to get involved with post-graduate medical education and College representation.

Meeting five times per year, the committee is responsible for addressing educational and well-being issues that affect trainees across the Territory.  We organise several annual educational events for trainees and are always looking for new ways to support and assist trainees.

This is not a time-consuming commitment and is very manageable while you are preparing for exams. There is also the opportunity to extend your involvement to the National level on various working-groups and committees. No prior experience is required and we welcome applicants from all stages of training.

For further information about the role please contact one of the Co-Chairs of the NT Trainees’ Committee Dr Rosie Rock rosie.rock@nt.gov.au or Dr Madeleine Venables madeleine.venables@nt.gov.au

To apply to the Committee, please email RACPNT@racp.edu.au.

Upcoming events

 

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Applications for RACP Foundation Research Awards 2020

Applications for Research funding for 2020 offered through the RACP Foundation opened Wednesday, 1 May 2019. Upwards of 50 awards with a total value of $2.5M are available across the different categories: 

Most awards are open to Fellows and trainees across Australia and New Zealand. Please refer to the RACP Foundation website for information on specific eligibility requirements for each award.

Do you want to be kept updated about awards? Email the RACP Foundation to sign up for updates.

Trainee Research Awards

The Trainee Research Awards provide a wonderful opportunity for trainees to do an oral presentation of their research at a regional event. Trainees selected at each regional event will have the opportunity to present at the 2020 RACP Congress.

Last year’s selected Northern Territory representatives will present at the Research and Innovation Showcase at the upcoming 2019 RACP Congress in Auckland, New Zealand (6-8 May 2019):
Dr Johanna Birrell
Topic: Neurosyphilis in the Northern Territory

Dr Martin Hansen
Topic: Maternal and childhood anaemia in remote Aboriginal communities

Applications for this year’s Trainee Research Awards are open from Monday, 1 July to Friday, 30 August 2019. Please send your abstract submissions or enquiries by email to RACPNT@racp.edu.au

RACP Ethics e-Learning Resources

The RACP has developed a suite of e-learning resources available to members covering a range of topics related to ethical behaviour and decision making in a professional context.

Topics covered include:

The learning package is structured to provide a comprehensive overview of both conceptual and applied Ethics in a real-world context which will assist members in their daily practice both in the public and private sectors.
 
The modules include:

  • Introduction to ethics
  • Ethics in professional practice
  • Ethical Issues in Health Care: Decision making capacity and consent. Legalities of consent.
  • Continuous engagement with ethics

Additional resources related to both professional and clinical ethics are provided throughout the learning package and are available through the RACP Curated Collection. In addition to being a valuable reference resource the e-learning module is eligible for CPD points, with a certificate of completion available.

For any queries on Ethics related issues please contact: ethics@racp.edu.au

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