#DFTBLive comes to Norwich

After the roaring success of DFTB19 in London, the stage was set for another fantastic DFTB Conference in Brisbane. However, some sort of minor setback in the way of global pandemia got a little in the way of that. So, the team at DFTB did what they usually do, adapted, improvised and overcame to deliver the conference virtually. So, for 10 hours, I was Live and Connected to clinicians and colleagues around the globe in a wonderful celebration of paediatric knowledge and achievement. Here are my thoughts from the day.

Morning Keynote: Re-ignition

Tessa Davis on Where are we heading?

• Take home: The launch of the awaited Skin Deep project was of great excitement to all. It instantly tackles two problems for me head on: namely the lack of diversity when it comes to pictures of dermatology conditions online, and my own personal knowledge gap when it comes to dermatology. With a wide-ranging team of specialists involved in the project, this is one to keep an eye on

Brad Sobolewski on Fixing a broken system to care for kids

• Take home: Confronting your own biases is a central tenet of providing good care in the ED. Access to medicine is difficult for those IN the system to navigate, imagine how difficult it is for a single mother of three at 2am. So, before talking about an inappropriate ED attendance, ask yourself “Why are they really there?”

Damian Roland on When evidence reshapes our world

• Take home: The COVID-19 pandemic has proved an enormous challenge to evidence-based medicine. The speed at which information became available, and was disseminated outstripped the normal filter mechanism to separate good science from bad. It also exposed a huge issue in the way that evidence is communicated between medical professionals and the public, especially when the medical professionals don’t agree with each other.

Sarah McNabb on New research challenges

• Take home: Even when you have a big problem in front of you, you don’t have to start big. Starting can be as little as finding a friendly colleague to help you set up a network of researchers, and slowly but surely, inch your way to changing the world.
• Bonus take home: Learning to say “no” is as key as learning to say “yes” at the right time to the right project, something we almost all are guilty of in some way

Keynote #2: We’re all connected now

Mo Akindolie on Granular ambulatory paediatrics

• Take home: Guidelines and policies are excellent for standardising care. But on occasion, their inflexibility is a roadblock to truly providing the right care for the right child.

Liz Crowe and Nicole Taylor on Scouring the lid of Pandora’s box

• An absolutely fascinating interview with the writers of the acclaimed drama “Three Girls”, about the Rochdale child sex abuse ring. They explored loads of different issues, from the compassion fatigue felt from interviewing victims, to the drive beyond the TV world in giving these children a voice, and being an agent to promote debate and change in society

Becky Platt with Carly and Tom Irving on Parenting with distressed teens

• Take home: “The effective professionals involved in her care were the ones that took time to build a relationship”. There is a feeling of helplessness attached to treating distressed teenagers. Moving past the medicine, and towards building a relationship, as much as you can, with the distressed young person is vital to practicing the best medicine for them

Keynote #3: Causation and correlation

Alyssa Courtney on Nasogastric Feeds in Bronchiolitis

• Take home: Research doesn’t have to be complex or earth-shattering, it’s about little by little, making every day things better. Bolus NG feeding in bronchiolitis is safe, and effective, and may well be kinder

Tom Waterfield on Petechiae in Children

• Take home: Almost all of our research into meningococcal disease was done prior to widespread vaccination against the disease. All CDRs published currently were 100% sensitive in the PIC study, but widely overtreated petechial rash.
• Bonus take home: Understanding, evaluating and communicating risk and uncertainty to parents is one of the most difficult, but also most critical concepts to get right.

Franz Babl on Imaging decisions in grey-area patient

• Take home: Planned observation is safely associated with lower CT rates in “grey area” head injury patients. The elephant in the room here is that the younger you are, the risk of harmful carcinogenic effects of ionising radiation are exponentially higher

Keynote #4: The labyrinth

Mary Freer with Rob Delaney on A conversation about Eternity

• Take home: In one of the most moving interviews I’ve seen, Mary and Rob explored the journey and lasting impact that NHS care had on his family when his young son Henry fell ill with cancer. “The currency of love is focussed attention” will stick with me for a long time.
• Bonus take home: There is no kindness in trying to shield parents from bad news by delivering half truths. Your news will hurt them, and it will hurt them more if you are not up front with all of the bad news.

Elizabeth Stokoe on The modern handshake

• Take home: Being in person doesn’t guarantee quality. As the world is forced to shift hard into digital communication, this was a timely reminder of how we have largely ignored communication science, which is vital to staying connected and disseminating information effectively

Jane Munro with Ronx Ikharia on Life of the Edge

• Take home: “Don’t let your backwards steps define you” was the resounding message from an upbeat and inspiration chat with Dr Ronx, covering the issue of racism in healthcare, and how to be a role model for the people around you

Keynote #5: Bubble Wrap Live

I’ll make no qualms with admitting that this was my favourite session at DFTB19, and remains my favourite section of DFTB. 5 speakers presenting a variety of papers with the theme of “Trying to do everyday things better”

• Favourite paper: Alison Boast presenting Tran. et al on blood culture volume. As Ian Lewins so aptly put in the Corridor Consult, I love it when a paper confirms my biases. Proper blood culture taking is essential to cutting down on false positives AND false negative. This paper suggested that taking 2 blood cultures prior to starting antibiotics vastly improved decision making around sepsis in children. Question is, has anyone ever taken two blood cultures sequentially from a child before in their practice? (I certainly haven’t, but maybe I will now…)

• Paper that most confirmed that we were all sort of making it up as we went along: Simon Craig presenting his Cochrane overview into escalation therapy for asthma. The question as to what is the best second line therapy for asthma is an age old question, and as ever, the less evidence that exists to point to a clear winner, the stronger the feelings exist that your horse is the fastest. Well, finally, we have an answer, which is…..we still don’t know. EBM giveth, and EBM taketh away, but it is reassuring to know that, regardless of the specific instructions by the consultant, your second line therapy is probably effective, and probably no more effective than the therapies he/she is trashing

• Paper with the most interesting concept: Dani Hall on Fast MRI vs CT head in children with head injury. Extremely interesting concept, though given my difficulty getting slow MRI, it might be difficult in practice. The brilliant question it raised is: given the lack of ionising radiation, how does that shift the risk profile of not scanning “grey area” head injury patients? One to keep an eye on for sure

• Paper that told me most about how the other half lives: Ben Wachira on SCREEN triage tool in South Africa. Twitter has done wonders in revealing the fascinating world of medicine in LMI countries. Their differences, and similarities, in approach to issues affecting their healthcare systems is truly eye opening. This paper, looking at their approach to triaging sick children was an interesting read, and reveals a great amount about healthcare behaviour in LMI countries compared to our own.

Keynote #6: Rewiring to be better

Gaj Panagoda on Rediscovering old tools for the complex patient

• Take home: In caring for the complex patient, there are three top tips. Firstly, be curious. Secondly, find the network. Finally, invest in personal relationships, and value other viewpoints

Nate Kuppermann on DKA and cerebral injury

• Take home: Be respectfully skeptical of evidence, even that which is entrenched in practice. FEAST and fluid boluses, rapid fluids and cerebral oedema in DKA are two great examples of mountains built on glass. The evidence base for cautious, slow fluids in paediatric DKA was a case series of 9 patients from the 1960s, and it has taken incremental work over a long period of time to undo that firmly entrenched belief. Is hypoperfusion/reperfusion the physiological model of cerebral oedema in children with DKA?

Kath Evans on Learning from the patients to improve the system

• Take home: If we only take one thing we should take home from Kath’s talk, it would be to watch this film from The Fixers, and reflect on our practice

Final Keynote: Superconnected

Henry Goldstein on Internal Capsule

• Take home: Henry introduced me to the Cynefin system of decision making, with it’s four distinct domains Clear, Complicated, Complex and Chaotic. It’s application to medicine is fascinating, and took me down another regular rabbit hole about decision making in stressful situations. Additionally, cynefin is a Welsh word, which makes it instantly 1000 times cooler, and this fact is in no way related to this blog post author’s ties to the country.

Komal Bajaj on Galvanising uncertainty

• Take home: Reacting and improving services during/after a pandemic requires a structured approach, and a “triage” of ideas as to what will have maximal impact, when. Komal referenced this Must Do/Will Do/Might Do matrix in her talk, which I think is a fantastic framework for looking at improvement in the future

Ross Fisher on Tomorrow: Being better

• Take home: The idea that we must improve in order to be better tomorrow robs us of the idea that we are good enough today. Why is it that we excuse others, and demand perfection from ourselves? Reflecting on the one negative comment, and ignoring the 100 positive comments is self-flagellation, not self-improvement. It’s not about tomorrow being better, it’s about today being you.

And with that, my first virtual conference was over! Thanks to all that I interacted with, those I spoke to in the Corridor Consults (once I plucked up the courage to actually get involved), and everyone on Twitter sharing the work around the world. Next year, Brisbane for DFTB21!