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The cargo cult of diabetes care: An illustrative dilemma of non-transformative, resource-intensive therapies

Current medical practice is appropriately centred around notions of patient-centred care and personalised medicine. These laudable practices are occurring against a background increasing patient empowerment and disruptive patterns of knowledge transfer. Health care consumers are now interconnected and highly aware of biotechnological advances. Both health care providers and consumers want the latest and “best” in therapies, however all too frequently these therapies are both expensive and non-transformative.

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Paediatric patient safety in Switzerland

It was during his fellowship at RCH PICU in the mid-90s, that Bernhard Frey first encountered patient safety initiatives such as critical incident reporting and evidence based medicine. Back home, he tried to implement these concepts in Switzerland and complemented them in the following years by issues such as allocation of care, organizing PICU, technical measures, avoiding overtreatment and the importance of the prevailing culture. In this Grand Round, Bernhard Frey will discuss a practical approach for safe medicine, based on his experience and the current literature.

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“This is the first time I have felt like I fit in and not different than everyone else.” 70 years of diabetes camps at RCH – an odyssey in 4 parts

The RCH diabetes camps program is 70 years old this year and one of the oldest such programs in the world. Diabetes camp experiences are profound and are seen internationally as an integral part of paediatric diabetes clinical care. This program speaks to and of what is the soul of the RCH: a holistic patient and family centred approach that goes beyond clinical therapy within the walls of the hospital.

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“The times they are a-changin” Paediatrics in Geelong and reflections on the role of RCH in children’s health in Victoria

This Grand Round will present the evolution of Paediatrics in Geelong and the Barwon Region, as well as discussing the evolution of General Paediatrics as a specialty. We will discuss the importance of the relationship between The Royal Children’s Hospital and Barwon Health and its role in helping to deliver high quality medical and health care to children of our region. We will also discuss ways in which the relationship will continue to be important as Paediatrics in Geelong develops further in the years ahead. This relationship is a good case study of the role that RCH can take throughout Victoria.

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Biologics: the good, the bad and the oh so expensive

Biologics are therapeutics that target specific components of the immune system. They are characterised by unpronounceable generic names (alemtuzumab, eculizumab, blinotumomab, pembrolizumab). These medications have revolutionised the treatment of several immune-mediated disorders: including rheumatoid arthritis, inflammatory bowel diseases, psoriasis, lymphoma, lung, breast, ovarian and other cancers, and macular degeneration, and are widely used in a range of clinical disciplines.

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Is it ethical to sterilise an adolescent with an intellectual disability?

In a recent case in the US, a mother requested a vasectomy for her 13 year old son. He has autism and intellectual disability, and functions at the level of 4-5 year old. He had starting talking about getting married and having children, and she was concerned to make sure that he could never father a child. We will discuss this case, in the context of the wider ethical debate about sterilisation of children and young people, mostly young women, with intellectual disability. Concepts of bodily integrity, dignity and human rights meet with the practicalities of life for a young person with ID and their parents and carers.

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New blood management guidelines for neonatal and paediatric patients

The decision on whether to transfuse a neonate or child can be complex. You need to carefully consider specific patient circumstances, clinical condition, response to previous transfusion and the full range of other available treatments, balancing the evidence for efficacy and improved clinical outcome against the potential risk. There are new guidelines for blood transfusions.

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Bone density and chronic conditions of childhood

Bone health is an important consideration in many chronic health conditions in childhood. Issues of immobility, nutrition, pubertal delay and medication usage may adversely impact bone mass accrual, leading to potentially short and/or long term skeletal fragility, with high attendant morbidity.

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Tripping the light fantastic: 25 years of music therapy at RCH

Research into the role of music therapy in the care of hospitalised children provides evidence for reducing anxiety and agitation, and providing pain relief that enhances quality of life for children and their families. The music therapy team at RCH has contributed to this evidence-based research in children with cancer, cardiac problems, those undergoing rehabilitation or with complex chronic conditions

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