An aboriginal perspective of teen pregnancy: Cally Jetta at DFTB18

Cite this article as:
Team DFTB. An aboriginal perspective of teen pregnancy: Cally Jetta at DFTB18, Don't Forget the Bubbles, 2019. Available at:
https://doi.org/10.31440/DFTB.18537

Aboriginal and Torres Strait Island teenagers have a fertility rate four times higher than the general population (57/1000). This disparity is even higher in Western Australia where, in 2014, there were 88 births per 1000 in the Aboriginal and Torreds Strait Islander population compared to just 15 per 1000 in the general population.

Cally Jetta administers the Blackfella Revolution Facebook page – an Aboriginal activism and educational forum that encourages and supports education and understanding.  In this talk she shares her experience and the voices of some brave young women.

 

 

 

This talk was recorded live at DFTB18 in Melbourne, Australia. With the theme of ‘Science and Story‘ we pushed our speakers to step out of their comfort zones and consider why we do what we do. Caring for children is not just about acquiring the scientific knowhow but also about taking a look beyond a diagnosis or clinical conundrum at the patient and their families. Tickets for DFTB19, which will be held in London, UK, are now on sale from www.dftb19.com.

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

 

Braithwaite J, Hibbert PD, Jaffe A, White L, Cowell CT, Harris MF, Runciman WB, Hallahan AR, Wheaton G, Williams HM, Murphy E. Quality of health care for children in Australia, 2012-2013. Jama. 2018 Mar 20;319(11):1113-24.

McGlynn EA, Asch SM, Adams J, Keesey J, Hicks J, DeCristofaro A, Kerr EA. The quality of health care delivered to adults in the United States. New England journal of medicine. 2003 Jun 26;348(26):2635-45.

Nolan T, Resar R, Haraden C, Griffin F, Gordon A. Improving the Reliability of Health Care. Institute for Healthcare Improvement 2004.

O’Brien M. Leading Reliability Improvement for Safer Healthcare. The Cognitive Institute, 2015.

 

Married to the Mob: Clare Dimer at DFTB18

Cite this article as:
Team DFTB. Married to the Mob: Clare Dimer at DFTB18, Don't Forget the Bubbles, 2019. Available at:
https://doi.org/10.31440/DFTB.18327

Clare Dimer is a senior social worker in WA’s Department of Health. In this talk she talks of the challenges faced by indigenous Australians today.

At the beginning of the 18th century there were over 250 languages spoken in Australia. By the start of this century only 150 are in daily use.  Language and culture pay a huge part in healthcare and an understanding of this should helps inform how we – as doctors, nurses, social workers – can help our indigenous patients.

 

This talk was recorded live at DFTB18 in Melbourne, Australia. With the theme of ‘Science and Story’ we pushed our speakers to step out of their comfort zones and consider why we do what we do. Caring for children is not just about acquiring the scientific knowhow but also about taking a look beyond a diagnosis or clinical conundrum at the patient and their families. Tickets for DFTB19, which will be held in London, UK, are now on sale from www.dftb19.com.

 

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

 

Braithwaite J, Hibbert PD, Jaffe A, White L, Cowell CT, Harris MF, Runciman WB, Hallahan AR, Wheaton G, Williams HM, Murphy E. Quality of health care for children in Australia, 2012-2013. Jama. 2018 Mar 20;319(11):1113-24.

McGlynn EA, Asch SM, Adams J, Keesey J, Hicks J, DeCristofaro A, Kerr EA. The quality of health care delivered to adults in the United States. New England journal of medicine. 2003 Jun 26;348(26):2635-45.

Nolan T, Resar R, Haraden C, Griffin F, Gordon A. Improving the Reliability of Health Care. Institute for Healthcare Improvement 2004.

O’Brien M. Leading Reliability Improvement for Safer Healthcare. The Cognitive Institute, 2015.

 

DFTB go to SMACC

Cite this article as:
Andrew Tagg. DFTB go to SMACC, Don't Forget the Bubbles, 2019. Available at:
https://doi.org/10.31440/DFTB.18334

Without SMACC there would be no Don’t Forget the Bubbles. But little did Tessa and I know that despite being at the same conference it would be another four years before we actually met in person at DFTB17 in Brisbane.

Nobody knew what to expect at that first SMACC as we sat in the dark waiting for the conference to begin.  I had just signed up with Twitter and was just excited to be in the company of people who thought the same as me, who were excited to learn, and were using this new thing called #FOAMed. As I am the shy retiring type I barely said hello to people that now, a lifetime later, I would be proud to call friends. Instead, I just sat in the audience and absorbed all the knowledge and positivity that flooded my way.

Flash forward a few years and those friendships, forged online, have grown as Twitter avatars are replaced with real people. No longer am I as shy to go up to someone I have never met in real life and I’m glad others have taken up the challenge too (Andrew and Sarah,  I am looking at you).

Tessa and I feel very privileged to have played some small part in the success of SMACC as we run the very final SMACCmini paediatric workshop. If you couldn’t come along then here are some of the things you missed.

 

Sweet Child O’ Mine (A neonates journey) – Trish Woods

Trish is no stranger to the DFTB ethos and as a neonatologist stopped to make us reflect on one of our basic assumptions – just who is the patient.  Just because our tiniest patients lie in their cribs, helpless, requiring help with all of their daily cares, does not mean that we should not consider them as people. It might be an alien thought to some – that the patient in front of us hears what we say, and how we say it, but they are not just a disease or a problem to be dealt with or the one in pod 3. They are a person with a name.

Seeing the team through the eyes and ears of the patient, Trish helps us enter the sensory (and often-overstimulating) world of the NICU.

Why not take a look at this paper on some of the ways we can start treating the patient and not the disease.

Roué JM, Kuhn P, Maestro ML, Maastrup RA, Mitanchez D, Westrup B, Sizun J. Eight principles for patient-centred and family-centred care for newborns in the neonatal intensive care unit. Archives of Disease in Childhood-Fetal and Neonatal Edition. 2017 Jul 1;102(4):F364-8.

I Want Candy (neonatal pain relief) – Justin Morgenstern

Justin Morgenstern, one of everyones favourite Canadians, has recently relocated to our side of the world and is practicing in New Zealand. Knowing that he is such a fan of evidence based medicine we set him the task of finding out if sucrose is as good as we think it is as an analgesic in neonates.

Here, for your delectation, is his take on analgesia for kids.

I don’t want to spoil his conclusion but this slide might give you just a little clue…

He started by challenging a fundamental assumption – that we can accurately tell whether a neonate is in pain or not. Or, more accurately, he challenged our assumption that we could tell when a medication worked.  We know the limitations of the traditional Wong-Baker Faces scale in older children and most of us probably use some combination of our clinical gestalt and the FLACC (Face/Legs/Arms/Cry/Consolation) score in neonates. But is it some sort of surrogate marker for distress, rather than pain? If fMRIs show no difference in an infants brain when they receive sucrose does that mean it does nothing for pain?

Of course there are a lot of things we can do that we know do work:-

  • Limit painful procedures
    • If venipuncture is less painful than a heelprick why not use it.
  • Let nurses treat the pain
    • Nurses are amazing (full stop) but they are also so much better at giving analgesia by the clock than any doctor
  • Address the underlying issues
    • Splint the obviously broken arm  before x-ray rather than waiting for them to get some imaging and then feeling guilty about it.
  • Consider non-pharmacological adjuncts
    • Dogs, clowns and bubbles are all powerful distractors.

 

Straight Up (bilious babies) – Camille Wu

Camille Wu last spoke for us at DFTB17 on testicular tribulations so it was a pleasure to welcome her back to join us to talk about surgical causes of bilious vomiting.

Rather than put words in a parents mouth she suggested asking exactly what colour was the vomit. If they answer Pantone 2565C then you are in trouble. Green vomit suggests a higher up obstruction that might require surgical intervention and certainly requires surgical assessment. Likewise rather than asking if the vomit was projectile, it is better to ask “How far did it go?

Whilst it is important to remember that there are a number of significant medical causes of bilious vomit (such as sepsis and CPAP belly) we really need to be concerned about surgical causes. Camille broke these down into mechanical causes and functional causes.

Mechanical causes

Intrinsic

  • Duodenal atresia
  • Small bowel atresia
  • Ano-rectal malformation

Extrinsic

  • Malrotation/volvulus
  • Congenital bands
  • Intestinal duplication

Functional causes

  • Hirschsprung disease
  • Meconium ileus/plug
  • Necrotising enterocolitis

The more proximal the obstruction the less bubbles of gas you will see on initial imaging. Camille reminded us that early imaging and intervention can make all the difference. If in doubt, pick up the phone, no matter the time of day or night.

The Safety Dance – Linda Durojaiye

Linda Durojaiye is a staff specialist at Sydney’s Children’s Hospital at Randwick. In her talk on leadership and patient safety she owned up to mistakes that have been made and shared some lessons from her department on how they have created a safer environment where everyone is accountable. Given that we have no control over who comes in we need to take ownership of what happens to them once they pass through our doors.

Linda and her team created a culture of safety – starting with regular team huddles to identify potential threats to safety. Using a strong leadership team they created a model of care that engaged both medical and nursing staff as well as the patient/parent consumer. She highlighted the resources freely available on the Institute for Healthcare Improvement website.

If you want to know more about the Clinical Emergency Response System then you can find it here.

 

One Vision (VR in paediatrics procedures) – Andy Weatherall

If your idea of virtual reality is still stuck in the last century and The Lawnmower Man (a poor 34% on Rotten Tomatoes) then you might not be aware of some of the advances that are putting the technology in the hands of normal people. Andrew Weatherall is the co-chair of paediatric anaesthesia at the Children’s Hospital at Westmead and has been looking at the role virtual reality may play as an adjunct to standard anaesthesia techniques.

He has written about his experiences here. Whether as a means to reduce anxiety before a procedure or as a distraction from the procedure itself virtual reality is no longer priced out of possibility. With Google Cardboard costing just a few bucks and lots of open source software available it won’t be long before we see more departments trying it out. We hope to hear more from Andrew and his team in the near future to see how they are going.

The Model (3D printing in paeds) – Jasamine Coles-Black

Carrying in on with technological advancements in paediatrics Jas Coles-Black from the 3D lab at the Austin in Melbourne made the audience realise just how affordable 3D printing can be. A technology that once cost six figures is now cheaper than the average consultants coffee habit. After a quick jaunt through the various methods of printing she went through some of applications relevant to paediatric practice. With printable task trainers costing just a couple of dollars (after the capital expenditure) we could all have our own paediatric can’t intubate – can’t oxygenate model. Or perhaps you want your trainees to learn how to ultrasound the neonatal spine to improve their success at lumbar puncture – a task trainee is yours for less than a latte.

3D printing can also be used to help patients understand complex ideas and a number of cardio-thoracic surgeons have used 3D printed models of congenital heart defects to help explain complex anatomy. We are looking forward to hearing more from Jas about this exciting technology and how it can benefit all of us. And, if people are interested, we could create our very own DFTB 3D printing workshop at a future conference.

Jas' favourite 80s movie

https://www.youtube.com/watch?v=1g3_CFmnU7k

(Yes – I know it was 1977 – Ed)

Sound and Vision (Critical care ultrasound) – Tom Rozen

SMACCmini was competing against the very practical paediatric ultrasound workshop but we couldn’t make it through without mentioning it at least once. Tom Rozen, intensivist at the Royal Children’s Hospital, used the example of René-Théophile-Hyacinthe Laennec’s (yes, really!) most famous invention, the stethoscope, to demonstrate how medical fashion has changed. A device that once took up an entire room can now fit in your pocket and with ultra-cheap, ultra-portable devices entering the market it will not be long before clinicians can have a device of their very own.

If you want to know what all the fuss is about then why not sign up for one of our pre-DFTB19 workshops.

Too Shy (20 minutes of bottom jokes) – Ross Fisher

Mr Fisher was set the challenge of making talking about constipation interesting and he succeeded. From his opening Limahl tribute to the crowd singalong he soon had us tapping our toes to the 1983 Kajagoogoo classic. He began by asking us to turn to the person sitting next to us and take a bowel history. After a round of sniggers a fair percentage of the delegates were unable to complete the task. Fortunately I was sitting next to Tessa and we know each others bowel habits intimately. If we are too shy shy to ask a grown up about what they get up to in the toilet no wonder we are pretty awful at asking children. Most children are all smell, noise and little substance in the bathroom so the only way to really find out what they are up to is to ask them, in their own language.

Constipation and its consequences can be stigmatising to a child and so the mindful clinician should sit and listen to the parent and their concerns, without judgement. Treatment can be a long and drawn out affair taking as long to fix as the child has had the problem for.  Take a look at our series on constipation here.

Faith (It takes a team) – Bec Nogajski

The final talk of the morning, by Bec Nogajski, brought it all together and reminded us of the importance of teaming. We’ve all been a part of dysfunctional teams and Bec challenged us to look at our role in the team, not as a passive sheep to be lead around, but as an integral unit with worth. There are many ways of finding out how you might fit in the team – Belbin’s team roles, DISC, Myers-Briggs (INTJ in case you were wondering) – but it is worth considering  that there is no perfect recipe for an effective team.

The team sets the behaviour, what is tolerated and what is not. As David Morrison said, “The standard you walk past is the standard you accept.” So do you check your mobile phone during clinical handover, and allow others to do the same or is this type of behaviour below the line?

 

 

Our eternal thanks, as always, to the SMACC OC throughout the years, especially, Chris, Roger and Oli who made such an impact on four aspiring paediatricians that they decided that they could run their own conference. If you want to see what all the fuss is about then there are still a handful of tickets left for www.dftb19.com in London, this June.

Inequalities in Healthcare : Andrew McDonald at DFTB18

Cite this article as:
Team DFTB. Inequalities in Healthcare : Andrew McDonald at DFTB18, Don't Forget the Bubbles, 2019. Available at:
https://doi.org/10.31440/DFTB.18304

Dr Andrew McDonald worked as a paediatrician for many years before entering the world of politics. In his years as Shadow Minister for Health he continued to practice one day a week. In both roles he saw the impact that socio-economic status has on health and continues to do what he can to make difference. Why should those that need access to excellent health care not be afforded more healthcare resources? If you can afford to pay you can get in to see a private paediatrician in a week but if you are relying on the public system it is a matter of months. Andrew McDonald challenges the audience to think on this, and who they are really helping.

It can be hard to stand up to the status quo but if you are serious about helping people you must.

 

This talk was recorded live at DFTB18 in Melbourne, Australia. With the theme of ‘Science and Story’ we pushed our speakers to step out of their comfort zones and consider why we do what we do. Caring for children is not just about acquiring the scientific knowhow but also about taking a look beyond a diagnosis or clinical conundrum at the patient and their families. Tickets for DFTB19, which will be held in London, UK, are now on sale from www.dftb19.com.

 

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

 

Braithwaite J, Hibbert PD, Jaffe A, White L, Cowell CT, Harris MF, Runciman WB, Hallahan AR, Wheaton G, Williams HM, Murphy E. Quality of health care for children in Australia, 2012-2013. Jama. 2018 Mar 20;319(11):1113-24.

McGlynn EA, Asch SM, Adams J, Keesey J, Hicks J, DeCristofaro A, Kerr EA. The quality of health care delivered to adults in the United States. New England journal of medicine. 2003 Jun 26;348(26):2635-45.

Nolan T, Resar R, Haraden C, Griffin F, Gordon A. Improving the Reliability of Health Care. Institute for Healthcare Improvement 2004.

O’Brien M. Leading Reliability Improvement for Safer Healthcare. The Cognitive Institute, 2015.

 

Cutting edge burns management: Fiona Wood at DFTB18

Cite this article as:
Team DFTB. Cutting edge burns management: Fiona Wood at DFTB18, Don't Forget the Bubbles, 2019. Available at:
https://doi.org/10.31440/DFTB.18295

Professor Fiona Wood, AM, is one of the worlds leading burns surgeons.  Having qualified from St Thomas’ in London she decided to do what so many of us do and move down under. Since the early days of her career, she has recognized that to improve the outcomes of burns victims involves not just scarless skin but also healing in mind and spirit. Along with Marie Stoner, she pioneered the use of ‘spray-on skin’ and is well known for the care she provided to the victims of the Bali bombings back in October 2002.

In this talk, she talks about the past, the present and the future of burns care whilst championing the roles of women in medicine and surgery. As a mother of six children, she reminds us all that there is nothing that cannot be achieved if you ask for it.

 

This talk was recorded live at DFTB18 in Melbourne, Australia. With the theme of ‘Science and Story’ we pushed our speakers to step out of their comfort zones and consider why we do what we do. Caring for children is not just about acquiring the scientific knowhow but also about taking a look beyond a diagnosis or clinical conundrum at the patient and their families.

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 future towards zero: Warwick Teague at DFTB18

Cite this article as:
Team DFTB. A future towards zero: Warwick Teague at DFTB18, Don't Forget the Bubbles, 2019. Available at:
https://doi.org/10.31440/DFTB.18203

This talk was recorded live at DFTB18 in Melbourne, Australia. With the theme of ‘Science and Story’ we pushed our speakers to step out of their comfort zones and consider why we do what we do. Caring for children is not just about acquiring the scientific knowhow but also about taking a look beyond a diagnosis or clinical conundrum at the patient and their families. Tickets for DFTB19, which will be held in London, UK, are now on sale from www.dftb19.com.