Petechiae in Children: Tom Waterfield at DFTB19

Cite this article as:
Team DFTB. Petechiae in Children: Tom Waterfield at DFTB19, Don't Forget the Bubbles, 2019. Available at:
https://doi.org/10.31440/DFTB.21206

 

Perhaps it was the story of Ezra and his mum, Sorina, who Tom had treated as a PICU registrar that fuelled his interest in research? But what he recognized, when he went to work in the ED, is that despite having seen the worst possible outcome s is that not all children with a petechial illness have meningo-coccaemia.  Our current practice guidelines are based on data from a time before vaccination.

 

You can take a look at the study protocol for PiC here.

 

 

 

 

 

This talk was recorded live at DFTB19 in London, England. With the theme of  “The Journey” we wanted to consider the journeys our patients and their families go on, both metaphorical and literal. DFTB20 will be held in Brisbane, Australia.

If you want our podcasts delivered straight to your listening device then subscribe to our iTunes feed or check out the RSS feed. If you are more a fan of the visual medium then subscribe to our YouTube channel. Please embrace the spirit of FOAMed and spread the word.

iTunes Button
 

 

A wrinkle in time: Kerry Woolfall at DFTB19

Cite this article as:
Team DFTB. A wrinkle in time: Kerry Woolfall at DFTB19, Don't Forget the Bubbles, 2019. Available at:
https://doi.org/10.31440/DFTB.21185

Kerry Woolfall is a social scientist and senior lecturer at the University of Liverpool. This talk, our second from the PERUKI track, she talks about doing research without prior parent and patient consent.  Following legislative changes in 2008 it is now possible (in the UK at least) to enter a child into a trial of potentially life-saving treatment then seek consent after the fact. But how would parents react to this? How would clinicians? What would happen if a child died during the trial, as may understandably occur if we are looking at potentially life-saving interventions?

This talk is not just about a researchers point of view but also details Kerry’s experience from the other side of the clipboard as a NICU parent.

The research embodies a core principle of engagement.

 

You can read some of the research here.

 

Woolfall K, Young B, Frith L, Appleton R, Iyer A, Messahel S, Hickey H, Gamble C. Doing challenging research studies in a patient-centred way: a qualitative study to inform a randomised controlled trial in the paediatric emergency care setting. BMJ open. 2014 May 1;4(5):e005045.

Woolfall K, Frith L, Gamble C, Gilbert R, Mok Q, Young B. How parents and practitioners experience research without prior consent (deferred consent) for emergency research involving children with life threatening conditions: a mixed method study. BMJ open. 2015 Sep 1;5(9):e008522.

 

You can follow Kerry on Twitter here.

 

 

#DoodleMed below by @char_durand

 

This talk was recorded live at DFTB19 in London, England. With the theme of  “The Journey” we wanted to consider the journeys our patients and their families go on, both metaphorical and literal. DFTB20 will be held in Brisbane, Australia.

If you want our podcasts delivered straight to your listening device then subscribe to our iTunes feed or check out the RSS feed. If you are more a fan of the visual medium then subscribe to our YouTube channel. Please embrace the spirit of FOAMed and spread the word.

iTunes Button
 

 

Peri-orbital cellulitis: Meriel Tolhurst-Cleaver at DFTB19

Cite this article as:
Team DFTB. Peri-orbital cellulitis: Meriel Tolhurst-Cleaver at DFTB19, Don't Forget the Bubbles, 2019. Available at:
https://doi.org/10.31440/DFTB.21102

In this first session from the PERUKI track Meriel Tolhurst-Cleaver spoke about her research into peri-orbital cellulitis. As a self-confessed non-academic she led the first trainee-led PERUKI study and reminds us that we can all get involved in research. She talks about some of the challenges in undertaking her study but most importantly she releases some of the results.

Change against the grain: Shweta Gidwani at DFTB19

Cite this article as:
Team DFTB. Change against the grain: Shweta Gidwani at DFTB19, Don't Forget the Bubbles, 2019. Available at:
https://doi.org/10.31440/DFTB.20875

Shweta Gidwani graduated from Seth G.S. Medical College, Mumbai, India in 2002. S. She has been involved in the development of emergency care service delivery and training programs in India for several years and was invited to join the International Emergency Medicine section at George Washington University as Adjunct Asst Professor in 2013 where she works on the India programs.

This talk, the opening talk proper after Mary set the scene, is a stark reminder of just how the world really works.

 

©Ian Summers

 

 

This talk was recorded live at DFTB19 in London, England. With the theme of  “The Journey” we wanted to consider the journeys our patients and their families go on, both metaphorical and literal. DFTB20 will be held in Brisbane, Australia.

If you want our podcasts delivered straight to your listening device then subscribe to our iTunes feed or check out the RSS feed. If you are more a fan of the visual medium then subscribe to our YouTube channel. Please embrace the spirit of FOAMed and spread the word.

iTunes Button
 

 

Blowing the whistle: Kim Holt at DFTB19

Cite this article as:
Team DFTB. Blowing the whistle: Kim Holt at DFTB19, Don't Forget the Bubbles, 2019. Available at:
https://doi.org/10.31440/DFTB.20736

You may recall the headlines surrounding the case of Baby P. Back in 2007 a 17 month old boy died as a result of injuries suffered over months of abuse. During that ordeal he had been seen by the London Borough of Haringey Children’s services and multiple concerns were raised. But nothing happened. Not until it was too late. Eight years earlier the same council had failed to intervene possibly leading to the death of eight year old Victoria Climbie.

Compassion to the Core: Mary Freer at DFTB19

Cite this article as:
Team DFTB. Compassion to the Core: Mary Freer at DFTB19, Don't Forget the Bubbles, 2019. Available at:
https://doi.org/10.31440/DFTB.20653

Mary Freer has been with us from the start. After a heartfelt keynote at our first conference we knew we had to keep in touch. In London we set her a challenge. We asked her to set the intention for the day for us, to frame our conversations around care.

Bubble Wrap Live 2019 – Article List

Cite this article as:
Team DFTB. Bubble Wrap Live 2019 – Article List, Don't Forget the Bubbles, 2019. Available at:
https://doi.org/10.31440/DFTB.20064

At DFTB19, we had three great talks during the Bubble Wrap Live session. Whilst the videos and podcasts from these talks are still in the works, here’s the list of articles referenced for you to check out ahead of time.

5 Paediatric Emergency Papers

Edward Snelson @sailordoctor

PREDICT: Head Injury and Delayed Presentations to ED

Borland ML, et al. Delayed Presentations to Emergency Departments of Children With Head Injury: A PREDICT Study. Annals of Emergency Medicine, 2018;75 (1):1-10

Oral Prednisolone for preschool viral induced wheeze

Foster SJ, et al. Oral prednisolone in preschool children with virus-associated wheeze: a prospective, randomised, double-blind, placebo-controlled trial. The Lancet Respiratory Medicine. 2018;6(2):97-106

Clinical Prediction Rule for Febrile Infants under 60 days

Kupperman N, et al. A Clinical Prediction Rule to Identify Febrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections. JAMA Pediatr.2019;173(4):342-351. doi:10.1001/jamapediatrics.2018.5501

Whole body CT for children with Trauma

Abe T, et al. Is Whole-Body CT Associated With Reduced In-Hospital Mortality in Children With Trauma? A Nationwide Study. Pediatr Crit Care Med. 2019 Jun;20(6):e245-e250. doi: 10.1097/PCC.0000000000001898.

ECLIPSE study

Lyttle MD, et al. Levetiracetam versus phenytoin for second-line treatment of paediatric convulsive status epilepticus (EcLiPSE). The Lancet . 2019;393(10186):2125-2134

 

5 General Paediatrics Papers

Susie Piper @chookiemama

Probiotics and Gastroenteritis

Freedman SB, et al. Multicenter Trial of a Combination Probiotic for Children with Gastroenteritis. N Engl J Med 2018; 379:2015-2026 DOI: 10.1056/NEJMoa1802597

Acetaminophen and Febrile Seizure Recurrence

Murata S, et al. Acetaminophen and Febrile Seizure Recurrences During the Same Fever Episode. Pediatrics 2018; 142(5): pii: e20181009. doi: 10.1542/peds.2018-1009. Epub 2018 Oct 8.

Hi flow vs CPAP in SCN (HUNTER trial)

Manley BJ, et al. Nasal High‐Flow for Early Respiratory Support of Newborn Infants in Australian Non‐Tertiary Special Care Nurseries (The Hunter Trial): A Multicentre, Randomised, Non‐Inferiority Trial. J Paediatr Child Health. 2018;54:4-4. doi:10.1111/jpc.13882_4

Rudeness and Medical Performance

Riskin A, et al. The Impact of Rudeness on Medical Team Performance: A Randomized Trial. Pediatrics. 2015;136:487-495.

Katz D, et al. Exposure to incivility hinders clinical performance in a simulated operative crisis.

LEGO and poo!

Tagg A, et al. Everything is awesome: Don’t forget the Lego.  2018 Nov 22. doi: 10.1111/jpc.14309. [Epub ahead of print]

 

Paediatric Surgery Papers

Craig McBride @paedsurg

Tissue Paper: Paediatric Burn Wound Care

Brown E.A, et al. Impact of Parental Acute Psychological Distress on Young Child Pain-Related Behavior Through Differences in Parenting Behavior During Pediatric Burn Wound Care. J Clin Psychol Med Settings (2019). https://doi.org/10.1007/s10880-018-9596-1

Brown NJ, et al. Play and heal: Randomized controlled trial of Ditto™ intervention efficacy on improving re-epithelialization in pediatric burns. Burns. 2014;40:204–13.

Paper Planes: Telehealth in Paediatrc Surgery

Brownlee GL, et al. Telehealth in paediatric surgery: Accuracy of clinical decisions made by videoconference. J Paediatr Child Health. 2017;53(12)

Rees CM, et al. Probiotics for the prevention of surgical necrotising enterocolitis: systematic review and meta-analysis.

Sandpaper: Bullying & Discrimination in Surgery

Crebbin, W. , Campbell, G. , Hillis, D. A. and Watters, D. A. (2015), BDSH in surgery in Australasia. ANZ J Surg, 85: 905-909. doi:10.1111/ans.13363

Watters, D. A. (2015), Apology for discrimination, bullying and sexual harassment by the President of the Royal Australasian College of Surgeons. ANZ J Surg, 85: 895-895. doi:10.1111/ans.13362

 

 

DFTB20 will be held in Brisbane, Australia. If you want our podcasts delivered straight to your listening device then subscribe to our iTunes feed or check out the RSS feed. If you are more a fan of the visual medium then subscribe to our YouTube channel. Please embrace the spirit of FOAMed and spread the word.

iTunes Button
 

 

What it meant: Tessa Davis and Shoni Nagel at DFTB19

Cite this article as:
Team DFTB. What it meant: Tessa Davis and Shoni Nagel at DFTB19, Don't Forget the Bubbles, 2019. Available at:
https://doi.org/10.31440/DFTB.20037
This is a story of friendship and families. It’s a story about one little girl, Libby, and the impact she has had on the world. If you have been friends of DFTB for some time you may have heard parts of her story. As healthcare providers it can be hard to know what to do when a friend or family member comes to us for medical advice. And if the diagnosis is life-changing then it is near-impossible.
Whilst Tessa and Shoni stood on stage in front of more than 450 people Libby hid outside, waiting for just the right moment to run in. She kept her chaperone (Andy) under control by challenging him to a press-up competition. You can guess who won…
This talk was recorded live at DFTB19 in London, England. With the theme of  “The Journey” we wanted to consider the journeys our patients and their families go on, both metaphorical and literal. If you want our podcasts delivered straight to your listening device then subscribe to our iTunes feed or check out the RSS feed. If you are more a fan of the visual medium then subscribe to our YouTube channel. Please embrace the spirit of FOAMed and spread the word.
iTunes Button

The missing component of clinical practice

Cite this article as:
Damian Roland. The missing component of clinical practice, Don't Forget the Bubbles, 2019. Available at:
https://doi.org/10.31440/DFTB.19685

This is an extract of the talk I gave at #DFTB19 highlighting an important research ethos – the full talk will be released via the Don’t Forget the Bubbles at a later date.

The Doctor” is a painting by Luke Fildes and was first exhibited in 1891.

The Doctor exhibited 1891 Sir Luke Fildes 1843-1927 Presented by Sir Henry Tate 1894 https://www.tate.org.uk/art/work/N01522

The artist had lost his son Philip at the age of one and the scenes reflects the admiration that he had had for the doctor who had looked out for him. 

For some the painting may represent a stereotypical view of medicine in the past – the doctor rubbing his chin in a wise fashion, the child prostrate on a make-shift bed. And there is a parent figure in the background, watching on anxiously. 

This painting has had a revival recently despite being over 100 years old. It highlights the triad of care we all know exists in paediatrics – the child, the parents and carers, and ourselves.

This triad has received increased attention recently. The need for child centered care in respect of their engagement and involvement in their care. The need for positive communication with families; we remember the cases where parents haven’t acted as their child’s advocates but forget the vast majority of cases when they have. We so often let parents down when we should have been, not just listening to them, but honestly hearing what they were saying. And most recently the doctors themselves. An understanding of the importance of wellbeing and the shackles of rudeness. 

There is a fourth component, as well. One which perhaps will never get the attention it deserves because it isn’t a visceral part of our clinical care. It’s something we know exists but are quite willing to ignore. It’s something that perhaps has more impact on our practice than we would like to admit. It’s the variability in the actual care or treatment we provide or the fact that it might not be necessary at all.

When I became chair of PERUKI, Paediatric Emergency Research United Kingdom and Ireland, the international sibling of PREDICT and daughter of PERN I’d a personal vision that I would drive the organization forward in delivering ground-breaking new research highlighting novel interventions that would really make a difference to patients. What actually occurred is that I have realised that perhaps PERUKI has an even more important roll. One that does obviously include the need to develop, innovate and implement but one also that highlights where we could, and should do, better. It’s some examples of variation and the need for no treatment I would like to share. 

So this is an original selection of PERUKI members and those who helped us get PERUKI off the ground. I’d like a chance to pay particular tribute to Mark Lyttle at this point who has worked tirelessly at the outset to drive forward many early projects and is consistently named checked by our research partners for his ceaseless enthusiasm at collaborating and engaging. PERUKI took part in a prioritisation process published in 2015 with members putting forward their preferred research agendas and PERUKI publishing the top 20 via a Delphi process.

Number 4 on this list was: what is the best IV medication for Acute Asthma. PERUKI started on this work with essentially a two phase examination of the management of wheeze in March 2013. In the first phase a written questionnaire was undertaken. PERUKI sites responded as departments and 183 consultants responded individually on their wheeze management.

In study 99 (54.1%) use salbutamol as first-line intravenous therapy, 52(28.4%) magnesium sulfate and 27 (14.8%) aminophylline; 87 (47.5%) give these sequentially depending on response and 30 (16.4%) give them concurrently. Overall, 146 (79.8%) continue inhaled bronchodilators while on intravenous therapy.

When commencing on intravenous bronchodilators there were 10 different infusion rates with over 10-fold variation between the lowest and highest.

Everyone tends to have their little foibles about which treatment they prefer. And given the range of phenotypes and genotypes that exist in our wheezy cohort in can’t be the case that there is only going to be one best fit treatment for all patients. But a 10-fold difference probably pushes the bounds of flexibility.

What makes this more interesting is the second study. Also completed at the time (March 2013) was a prospective observational study. Data was screened from all patients presenting with wheeze and a detailed proforma completed for those who received intravenous therapies.Of 3238 children, 101 received intravenous therapies. Intravenous magnesium sulfate (MgSO4) was used in 67 (60.9%), salbutamol in 61 (55.5%) and aminophylline in 52 (47.3%) of cases. 

In 35 cases (31.8%), two drugs were used together, and in 18 cases (16.4%), all three drugs were administered.

More than half used salbutamol as the first-line intravenous agent, while fewer preferred magnesium sulfate or aminophylline, suggesting equipoise regarding which is most efficacious. To investigate this, participants were asked whether they would enrol patients to a randomised controlled trial allocating salbutamol, aminophylline or magnesium sulfate as the first-line intravenous agent, to which 148 (80.9%) responded positively. Asking clinicians who are regularly prescribing acute medications is vital for study design and subsequent implementation of study findings. With all due respect to respiratory paediatricians the question that they may be interested in, or want to explore, may well be completely out of keeping with the practice habits of emergency and acute paediatricians. PERUKI have welcomed increased engagement with our specialty colleagues in the last year and we hope we will reap the benefits of this. 

So a clear example of variation. I feel uncomfortable. Is there any reason to believe this variation has improved 6 years on? We have a challenge as the evidence base is not as strong as we would like. We look to Simon Craig and his work on developing asthma outcomes here – a PERN study I am very proud that PERUKI is part of. 

So what about where we think there is only a small amount of variation (a nationally agreed algorithm for example). DO we need to improve practice and CAN we improve practice? The EcLIPSE study was published a mere month ago and I am proud of the Don’t Forget the Bubbles team  for being part of the process of sharing this information widely. The Eclipse study compared levetiracetam and phenytoin in the treatment of status epilepticus. It was published on exactly the same day as the ConSEPT trial a similar study from our PREDICT friends. The EcLIPSE paper is available open access and there is a Don’t Forget the Bubbles summary. I also recommend the reviews by Justin Morgenstein and Casey Parker 

The primary outcome was time from randomisation to cessation of all visible signs of convulsive activity, defined as cessation of all continuous rhythmic clonic activity, as judged by the treating clinician.

Much debate has centred on what EcLIPSE and ConSEPT showed and at the heart of this is the difference between superiority and non-inferiority.

If these studies do nothing else it will to be to have spread the word about this construct. Because it is really important that people don’t glaze over or think because this terminology is used it’s someones else’s problem to analyse. I think this undue deference to academics probably perpetuates variation in care. I am not saying the theory is easy but neither is managing a sick neonate with congenital heart disease and we completely commit ourselves to doing that. 

Superiority trials aim to demonstrate that one intervention is better than other. The statistics, by convention, dictate that a difference between the interventions needs to be defined. In the case of EcLIPSE because phenytoin stopped status 60% of time and it was felt Levetiracetam may terminate seizures at a 75% rate the statistics calculated that 140 patients would be needed in each group. IF a difference exists this difference is likely to be a difference that is real and not by chance alone.

If they had wanted to show that levetiracetam was only 1% better then 1000s of patients would probably have been needed as if there was no difference by chance it would easily be possible that levetiracetam happened to be 1% better in that cohort of patients. 

A few interesting facts come out of EcLIPSE.

The first is that the while this wasn’t a perfect observational study – i.e not all patients presenting were recruited across a wide range of hospitals over 1400 patients were screened. This is a good cohort of children with seizures. About 10% of those who needed second line treatment for status were first presentations of afebrile convulsions and 5% were as a result of CNS infection.

Median time from randomisation to start of infusion was 11 min (IQR 8–15) for levetiracetam and 12 min (8–17) for phenytoin

But median time from randomisation to seizure cessation was 35 min (IQR 20 to not assessable) in the levetiracetam group and 45 min (IQR 24 to not assessable) in the phenytoin group.

These interventions take time! 

In EcLIPSE convulsive status epilepticus was terminated by levetiracetam in 106 (70%) participants, and by phenytoin in 86 (64%) participants. Therefore by the statistics LEVETIRACETAM is NOT better

Because the results are broadly the same it doesn’t mean they are equal – a non-inferiority study looks at two drugs and aims to calculate what is the minimum number of patients needed to be recruited into each intervention arm to demonstrate that one drug is not more than a certain % worse than another. By convention that number is normally 10%. The reason why 10% is important is that in EcLIPSE while it appears levetiracetam may have passed this test if the study had been designed as a non-inferiority in the ConSEPT study levetiracetam only terminated seizures (albeit as different end point) 50% of time; 10% worse than phenytoin. We don’t know yet what the meta-analysis may show us but this is planned.

A further suggestion is should we consider adding in levetiracetam with phenytoin; we could but that might delay some RSI intervention even further without overall benefit in seizure termination further. This is messy area where the complexity of clinical practice hints the required precision of research head on.

It might well be that you are happy for others to research novel drugs and techniques. You may well be content in supporting research through signposting or perhaps recruiting patients yourself. I would ask though that research itself is not scary. There is false divide between the ivory tower academic and jobbing clinician. Both these terms probably tribal and derogatory in their own way. We should all care about how effective our treatments are and where variability in practice is not in the patient’s interest. It is no more or less important than the three figures in Luke Fildes picture but perhaps it is less visible. 

Through PERUKI I’d like to champion this cause to make research feel more accessible. We are not doing research because we like to, we are doing it because we have to. 

Mirror Mirror

Cite this article as:
Andrew Tagg. Mirror Mirror, Don't Forget the Bubbles, 2019. Available at:
https://doi.org/10.31440/DFTB.19303

This blog post complements the talk I gave in the closing session of DFTB19. It has been recorded and will be released as FOAMed later in the year.

As part of my ongoing professional development I decided to volunteer for an experiment the Australasian College for Emergency Medicine were running. As a consultant it is really hard to get feedback on how you are doing, both clinically and professionally. You could ask your colleagues face-to-face but how honest an answer are you really going to get? So I enrolled in a pilot multi-source feedback program. Unlike traditional peer feedback and yearly assessments where you receive one-on-one feedback from the head of department, this was was something different.

I had to nominate 15 colleagues to complete an online survey about my professional behaviours. Anonymized to makes sure that things would not be seen as personal. I chose colleagues from all levels of my work life – from interns, registrars, peers, my immediate bosses and the Chief Medical Officer of the hospital. I chose doctors from specialities that I refer to on a regular basis and I chose non-clinical staff too. And in order to increase the actual worth of the project I included some people that I feel that I don’t get on with as well as I could (yes, they do exist!).

The findings were…interesting. There were the usual comments about drinking less coffee and learning to say no, both of which I fail at miserably on a regular basis. And then there was this one.

Now clearly this says more about the author than it does about me, but it did get me thinking about the impact we have in the workplace.

Emotional contagion

Human beings are social animals. We thrive in groups and, despite having had language for approximately 100,000 years, we rely on non-verbal communications to let members of our tribe know how we are feeling.

Charles Darwin, in his three-quel to The Origin of the Species, wrote that, despite their fleeting nature, our emotions are written large on our faces and this process is far beyond our control. But what is more fascinating is what happens when someone witnesses that unbidden display of emotions. Watch someone smile, genuinely smile, a mirror neurons light up in your brain. In a series of fMRI studies Rizzolatti et al. showed that the same are of the brain fires up when you witness an emotional display as if you had experienced it yourself. This reflexive, sub-thalamic response is emotional contagion.

Whilst our emotions influence our physiological state the reverse is also true. If I smile (more on that later) I feel happier. If I frown I feel more sad. And if I cannot frown – perhaps I have succumbed and finally got some botox to rid me of these troublesome wrinkles – then I will actually feel happier. Well, that is what some scientists have found.

Negative states

The problem is that negative states – fear, anger, boredom – are much more readily transmitted than positive ones – kindness, compassion, calm. Perhaps because they often come unbidden and out-of-control they are more likely to leak out before they can be contained.

This can cause major problems in the workplace as a doctor infects all those around them.

The work we do has a high level of emotional labour, moving from high intensity states such as dealing with life-affecting resuscitations to low intensity states of chronic constipation, without pause.

Some people are more susceptible to emotional contagion than others. Take a look at Docherty’s 15 part emotional contagion susceptibility scale and see where you might fall.

Doherty, R. W. (1997). The Emotional contagion scale: A measure of individual differences. Journal of Nonverbal Behavior, 21, pp. 131-154

And if you are the sort of person that finds themselves crying at the movies then you are not alone. I’ve left a little something for you on our YouTube channel for the next time you want to cut loose.

There are some highly infectious people that we can find in any department.

We’ve all met the MAVERICK – the hot shot doctor that thinks they know everything. They don’t need to follow the guidelines because they know better. They can send home the febrile 28 day old because they look fine to them. They can make the half-baked referrals because it’s the end of their shift and they have to get to their beach volleyball game. Besides the team will sort it out.

They make us fearful, nervous, a little afraid. Their arrogance spreads as they achieve more success, until…. They make a mistake. And they will.

So how can we help them? How can we protect ourselves and the department from their contagion? They need to be reminded, gently, that even Tom Cruise wears a safety harness. Guidelines are there for a reason. It’s okay not to agree with them but you have to be able to defend your actions. If you want to go your own way you need the evidence to back you up. Rather than ignore the MAVERICK and allow the worry to fester it’s important to head them off (whilst allowing them to save face). You set the tone!

What about the MOANER? You only have to go into the staff room of an y department in the hospital to spot one of these creatures. They are the ones drawing everyone into their spiral of doom as they complain about so-and-so from X (insert particular out-group here). Before long the rest of the group has been infected but their particular brand of emotional catharsis and everyone begins to moan.

It’s easier to not become one of them than it is to change their mind. This is the time for herd immunity. The more positive people there are in the room the better. Rather than joining in it is time to point out the dangers of stereotypes and labels. And should the opportunity to moan about your lot at work arise then it is time to take the higher ground. Remember, you set the tone!

And finally there is the MAGNET. Years of bad experience has led to a degree of learned helplessness. The more times they have been crushed by the chaos of the system the more they feel it is pointless to do something about it. At the mention of the Q word – the-word-that-should-not-be-named – they predict an apocalypse worse than any Private Frazer could dream up. Equipment will fail, stock will be missing or fall apart and there will be nobody around to help at the critical juncture – all because you said the word q.u.i.e.t.(shhhhh!)

So what can you do? It is time to role model the desired behaviour. You cannot control what is happening outside of your department but you can claw back a little control from the chaos within. At the beginning of every shift I check the key equipment that I might need to make sure it is working, I make sure that nothing is missing and I make sure roles have been allocated before the inevitable happens. I set the tone!

Manipulation?

All of this behaviour, including the examples I give in my talk, could be seen as manipulative, perhaps even a little sly? Teams that have a happier outlook, with members that embrace positive emotional contagion are safer and more efficient. Whereas when experimental psychologists have planted a MOANER as a confederate they found that teams became much less efficient.

Which sort of team would you rather work in?

Selected References

Doherty, R. W. (1997). The Emotional contagion scale: A measure of individual differences. Journal of Nonverbal Behavior, 21, pp. 131-154.

Don’t Forget The Poetry

Cite this article as:
Team DFTB. Don’t Forget The Poetry, Don't Forget the Bubbles, 2019. Available at:
https://doi.org/10.31440/DFTB.19547

We wanted to kick off DFTB19 with something just a little different and were blessed to have Erin Bolens, poet, open our London conference.

 

We’ve only just begun…

Cite this article as:
Andrew Tagg. We’ve only just begun…, Don't Forget the Bubbles, 2019. Available at:
https://doi.org/10.31440/DFTB.19490

As we prepare for the opening of #DFTB19 and meeting friends from all over the world it’s great to see everyone getting stuck into the workshops.

The Compassion Lab

Mary Freer is the Fairy Godmother of the DFTB conferences. Since she spoke at DFTB17 we have been awed at her passion for compassion. This year she ran a boutique Compassion Lab to help bring a little more kindness to our workplace.

In our time poor, resource poor workplaces it can be a challenge to be kind, both to ourselves, each other, and our patients.

If you couldn’t make it over to London then there are still some tickets left for her Compassion Revolution in Melbourne.

Presentation skills 2.0

We like to challenge our speakers to step out from behind the lectern and bring their ‘A’ game. This can be quite confronting when you are used to watching the usual ‘death-by-powerpoint’ type of talk. To make it easier for our speakers Grace Leo and Ross Fisher have, once again, acted as speaker coaches. But we didn’t want only just our speakers to benefit from their wisdom.

Over the course of the day they took delegates from the basics of the P3 methodology to the next level of presenting. We are really looking forward to hearing their pitches for next year.

The Power of POCUS

Ultrasound is the way forward in paediatric imaging and for our two workshops Cian McDermott and Russ Horowitz had an amazing team to help them. With the support of GE Healthcare and Jon Robinson delegates were rotated around a variety of stations to test their ultrasound chops.

They were joined by Resa Lewiss, Mike Griksaitis, Avi Sarfatti and Toni Hargadon-Lowe.

We were lucky to have some very patient paediatric models to tell our ultrascoundrels if they were pushing too hard or putting the probe in the wrong place. We even managed to come up with a new US sign – let’s hope the Toast sign of a full bladder catches on.

Let’s Play Make Believe

A crack team of simulationistas led by Ian Summers ran two sessions on Sunday. Starting with a simulation design workshop and ably abetted by Sandra Viggers, Camille Sorensen, Morten Lindkvist, Damian Roland and LifeCast the group were set the task of designing in situ simulation scenarios with the child in mind.

The afternoon session was led by Walter Eppich who took the delegates through the power of debriefing. He is a man who has spent a lot of time thinking about debriefing.

Bajaj K, Meguerdichian M, Thoma B, Huang S, Eppich W, Cheng A. The PEARLS Healthcare Debriefing Tool. Acad Med. 2018, 93(2), 336.

The day ended with another storytelling evening. Old friends and new gathered at the Sway Bay in central London to share tears and laughter.

What happens at Storytelling stays at Storytelling!