Paediatrician, parent, oxygen-lover, child health researcher, implementation scientist, critical optimist | @MCRI_for_kids @RCHMelbourne @unimelb
Melbourne, Victoria
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Conduct of clinical trials is grossly inequitable:
👉Only 10% of trials included children.
👉Only 9% were conducted in low-income and middle-income countries (LMICs), 1% in low-income countries
thelancet.com/journals/langl…
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Oxygen targeting was better for all neonates in automated oxygen control compared to manual control. The improvement mostly came from less time in hyperoxaemia (too much oxygen) - but frequency and duration of hypoxaemia was also better or the same.
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Could automating oxygen delivery to neonates on CPAP improve safety? Fresh results from the Oxymate study published in @LancetGH - showing higher time in SpO2 target range (88% vs 30%) and excellent safety. thelancet.com/journals/langl… 1/x
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Patients with low blood oxygen levels were 5x higher odds of death than those without low blood oxygen levels. 3/x
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Hypoxaemia was most common in patients admitted with respiratory conditions (e.g. pneumonia, asthma, COVID-19, preterm respiratory distress), but was also common in patients with severe systemic disease, including meningitis, sepsis, trauma, and encephalopathy. 2/x
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Thanks @AyobamiABakare for sitting down to talk about #pneumonia in #Nigeria for our World Pneumonia Day event. @MelbourneGlobal @Stop_Pneumonia #WPD24 youtu.be/JgF5JkFKuIg?feature…
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A hugely important session on #OxygenAccess at #WHS2024 revealing key findings from the forthcoming @LancetGH #OxygenCommission.
Watch here: youtube.com/watch?v=nryJ4vMa…
@WHO @UNICEF @MelbourneGlobal @AfricaCDC @Stop_Pneumonia
Missed the #OxygenAccess session at the @WorldHealthSmt #WHS2024?
Fear not, you can watch it here👉
youtube.com/channel/UCrzTy8W…
#InvestinOxygen #EveryBreathCounts #GlobalOxygenAlliance
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But it wasn't easy and we learnt some important practical lessons for the future. Multidisciplinary teams are essential. Equipment does fail. Reliable power is tricky. Culture and leadership matters. Users need support. (7/10)
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After 5 years we found that pulse oximetry and oxygen practices WERE sustained. Remarkable given that oximetry was barely practiced at baseline and despite all the project oximeters needing to be replaced (by the hospitals themselves). (5/10)
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We worked with 12 hospitals in Southwest Nigeria to make pulse oximetry routine practice, improve oxygen supplies, and support healthcare workers and biomedical technicans. And we saw encouraging change. (3/10) academic.oup.com/inthealth/a…
gh.bmj.com/content/3/3/e0008…
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20 years since #Tampa rescued Afghan asylum seekers stranded at sea, Howard's "children overboard" lies and the start of Australia's inhumane mandatory detention policies aje.io/psnph2
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4. Minimum functional requirements for oxygen sources must be assessed, as oxygen concentrators and cylinders may be present without being in working order.
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3. Oxygen, and pulse oximeter, availability must be assessed at the point-of-care in all major service delivery areas, as intrafacility oxygen distribution is highly inequitable.
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2. Pulse oximetry use is a critical indicator for the quality of oxygen services and may be a reasonable reflection of oxygen coverage to patients with hypoxaemia.
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Current methods of measuring #OxygenAccess massively underestimate the problem. Here are some suggestions to do it better 👇
gh.bmj.com/content/6/8/e0060…
@CHAI_health @PATHtweets @Stop_Pneumonia @UNICEF @WHO #InvestInOxygen @MCRI_for_kids
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#5 What we do differently now - more fully integrate oxygen systems improvements into broader clinical education, supervision, mentoring, and team-work activities.
@MCRI_for_kids @CHAI_health @Oxygen4life1 @Stop_Pneumonia
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#2 - the major change in quality of care was related to how oxygen was used. Better identification of low blood oxygen. Better provision of oxygen to patients. Saved lives. #OxygenAccess
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Progress on #genderequality - but too little, too slow. Compelling data in the #GH5050 2021 report. #decolonizeglobalhealth
youtube.com/watch?v=adPYG8sY…
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Happy recycling day! I loved seeing these #RecyclingHeroes in Ibadan, Nigeria. 👏
@AJEnglish aje.io/xbrqr
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Global gaps in #OxygenAccess causes ~1 million preventable deaths every year. If something good can come from #COVID19, then perhaps this is it. #OxygenForAll
@macfound #100andChange @MCRI_for_kids @CHAI_health
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Yet this is exactly why #OxygenAccess is so important, and why #InvestInOxygen can have such broad positive effects.
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Special call out from @joy_phumaphi on the role of #solar technology. We have growing experience with #solar oxygen in PNG, Nigeria, Uganda - and recognise that #solar energy has a huge role to play in sustainable energy and health care globally.
doi.org/10.5588/ijtld.16.021…
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The time to #InvestInOxygen is now. The need is enormous, we have the technology, people, partners, and policy momentum and #COVID19 presents a unique opportunity. We must act now! #OxygenForAll
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@joy_phumaphi golden insights into the neglect of #OxygenAccess globally!
"When an issues is cross-cutting it is underappreciated... no champion... falls in the cracks"
Yet this cross-cutting is actually why it is so important for so many patients!
@BillClinton argues that #OxygenAccess should not be expensive or difficult. We have the technology, the partnerships and growing political will.
"How can we not do this?"
Watch: bit.ly/3vh29eI
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@BillClinton confesses to being unaware of the global #OxygenAccess gap before #COVID19 resulted in a dear friend being hospitalized and dying while hospitals in the US faced unprecedented oxygen shortages.
"I am ashamed to admit, but its true"
Watch: bit.ly/3vh29eI
@joy_phumaphi drawing on her experience as Minister of Health #Botswana to envision sustainable oxygen systems that reach all.
Watch: bit.ly/3vh29eI
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@JNkengasong outlines a vision for sustainable financing for #OxygenAccess - for #COVID19 and long-term.
Watch more: bit.ly/3vh29eI
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@joy_phumaphi captures the #OxygenAccess challenge beautifully.
"Low blood oxygen is common and deadly... pneumonia, malaria, meningitis... yet 80% of hypoxaemic patients are undiagnosed."
More: bit.ly/3vh29eI
@JNkengasong head of @AfricaCDC on #OxygenAccess in #Africa.
"Longstanding oxygen challenges - issues of underfunding and inefficiencies, supplies don’t arrive... with fatal consequences.. But within challenges are opportunities..."
Watch more: bit.ly/3vh29eI
#DrFauci on the lack of awareness that has plagued oxygen for too long.
"We take oxygen for granted... despite decades of being on the frontline of outbreak response... Ebola, COVID... I hadn't realised the lack of #OxygenAccess globally..."
More: bit.ly/3vh29eI
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I had goosebumps hearing @BillClinton lay out the challenge and opportunity in #OxygenAccess globally.
"Requires a systems approach - clinical, policy, markets, financing..." So true!!
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TOMORROW: #InvestInOxygen webinar with @BillClinton @FauciFan @JNkengasong @joy_phumaphi. Thanks for sharing your passion and wisdom!
Streaming 11 March 11am EST: bit.ly/3e9QjwB
(And 1000hrs AEST for AU/Asia : facebook.com/MurdochChildren…)
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Last night I dreamt that Dr Fauci called to ask about #OxygenAccess. Then I woke up and got this email 👇
@FauciFan @macfound #100andChange @MCRI_for_kids @CHAI_health @Stop_Pneumonia #InvestInOxygen
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Add your voice to the call to #InvestInOxygen - for #COVID19 and beyond! #OxygenSavesLives
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@macfound #100andChange @Stop_Pneumonia @MCRI_for_kids @CHAI_health
youtu.be/TKXgdCSnOyo
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Lesotho opens first oxygen plant - a great step towards #OxygenAccess for all. #COVID19 #BuildBackBetter.
Great work #Lesotho!
@health_lesotho @PIH @Stop_Pneumonia #InvestInOxygen
youtu.be/NIsz2SUuAmA via @YouTube
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I am super excited to share this glimpse into our work in improve #OxygenAccess globally (though a bit of a cringe watching myself). Big thanks to everyone involved!
@MCRI_for_kids @CHAI_health @Stop_Pneumonia
@macfound #100andChange #InvestInOxygen
youtube.com/watch?v=8rGzClHa…
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9/ Thanks for your support! And to all the other partners and collaborators contributing to the vision of oxygen for every patient, no exceptions.
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7/ This means we don’t have a one-size-fits-all approach to #OxygenAccess. From equipment selection, financing mechanisms, maintenance systems, to clinical training, we work collaboratively to build on what exists, bringing our unique skill sets and experience to the table.
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3/ For example, in #Nigeria @CHAI_health @MCRI_for_kids supported @Fmohnigeria to develop the National Oxygen Policy and National Strategy for the Scale-Up of Medical Oxygen (2017-2022) and revise related clinical guidelines, essential medicines lists, and policies.
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7) But improving #oxygen systems effectively did require strong clinical and technical support - and the team-based quality improvement strategies were key.
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6) Results also showed that improved #oxygen systems significantly reduced the need for referral - i.e. families avoided the risk of trekking (and boating) through the mountains with a severely sick child to the closest hospital. (#KokodaTrail)
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3) This new program extended #oxygen systems to 38 remote health facilities using solar-powered oxygen concentrator systems, healthcare worker and technician education, and group problem solving activities to identify context-appropriate solutions to oxygen systems challenges.
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1) Stunning results from #PapuaNewGuinea #OxygenAccess program - 40% reduction in risk of death for children admitted to remote health facilities following oxygen quality improvement program!
#InvestInOxygen @MCRI_for_kids @1health3 @gatesfoundation
dx.doi.org/10.1136/archdisch…
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Save the date: @RCHMelbourne 🫁 World Pneumonia Day Grand Round on 4 Nov: #OxygenAccess #COVID and more...
@MelbourneGlobal @MCRI_for_kids #EveryBreathCounts #InvestInOxygen
rch.org.au/grandrounds/calen…
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5/ Beyond oxygen, the bigger picture need is for better recognition and support for our biomedical engineering and technician workforce within health services generally.
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3/ Our experience shows that low-level technicians can very effectively install and maintain basic hospital oxygen services – so long as they have training and adequate access to technical support and spare parts.
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9/ This is what is so exciting about the @macfound #100andChange opportunity – working with governments to take what we know works to scale, and leaving communities with sustainable solutions that solve the #Oxygen gap once and for all.
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8/ And this returns us to where we started: good care for every patient when they need it, no exceptions.
#OxygenAccess #InvestInOxygen #EveryBreathCounts
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...plus all the people and processes involved in distribution to facilities, to wards, and ultimately to patients.
But we are lucky to have more and more resources to help navigate this - and inspirational evidence from country teams tackling these challenges systematically!
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Oxygen is essential-yet often not available for sick patients globally 🫁
With colleagues from #Nigeria #Uganda and #Kenya we share practical strategies to help hospitals improve oxygen systems - simple yet life-saving🙏Please share! #InvestInOxygen
doi.org/10.9745/GHSP-D-20-00…
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#A4 6/x Tip 5 – With all that in mind, some types of oxygen sources will be more appropriate for your setting than others.
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Today I got to share a cake with these two delicious humans (and their supermum). I hope your day was as fully sweet as mine!
#HappyBirthdayMe
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Ooh, this is good.
#Privilege - the door keeper who opens the door for some, closes it for others... Difficult to see (until the door unexpectedly closes in my face). Losing privilege, gaining connection... Tnx @TEDTalks
youtu.be/dJepOq6J5kk
I've had a beaut #FathersDay. Sending love to all the other dads, grandad, dads-to-be, and special love if you're finding fathers day difficult (or if dad stuff for you just sucks). 💐
ALT Fathers day letter from daughter. Includes plenty of poo jokes.
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Happy Spring everyone!
We've been enjoying some rare #Melbourne sunshine and looking forward to a gentle emergence from lockdown. Stay safe, stay positive, be kind 🌱🌷🐝
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I found these eggs tucked under our roof. I assume they are duck eggs. What should I do with them?
A. Eat them (my brother's advice)
B. Wait and see what hatches (wife)
C. Open them and release a dinosaur (daughter)
D. Let the kids climb the ladder to see (other daughter)
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Great to see @AlyceNWilson featured with PNG colleagues in @ranzcog magazine. Keep up the excellent work!
@BurnetInstitute @HMHB_Burnet
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Hypoxaemia the strongest predictor of children with pneumonia requiring major medical intervention.
This paper adds more evidence to support rapid expansion of access to pulse oximeters globally.
#EveryBreathCounts
doi.org/10.1097/pec.00000000…
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Updated #oxygen resources for #LMIC hospitals. #COVID19. Free to use, adapt, and share 🫁 👩⚕️🚑🏥
🔹installing cylinders & concentrators with tubing to beds
🔹DIY oxygen flow-splitter
🔹oxygen and oximetry protocols & training
🔹more...
bit.ly/O2resources
#EveryBreathCounts
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BREAKING: Special issue on #pneumonia in #Nigeria in Pediatric Pulmonology. Read on for insights into why pneumonia kills >140,000 Nigerian children annually - and how to #StopPneumonia. bit.ly/PneumNig
Kudos @save_children @ucl @MCRI_for_kids @UniIbadan @CHAI_health 1/7
ALT Mother caring for child with pneumonia in Nigerian hospital while she receives oxygen therapy
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No one should die for lack of #oxygen. It’s an #EssentialMedicine. But there is a critical shortage in the poorest countries. I'm part of the #EveryBreathCounts coalition - and call on leaders to make oxygen central to #COVID19 bit.ly/2SMVW8s
#StopPneumonia
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Teamed up with @UNICEF to make our #oxygen resources more widely available. Please keep sharing with colleagues in #LMIC - getting great feedback from those involved in #COVID19 response, thank you!
bit.ly/OxygenResources
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A strategic framework to ease community-wide #COVID19 suppression measures ... #openaccess #preprint ... "phased progression from ‘suppress’ to ‘release’ & ‘restore’ stages" mja.com.au/journal/2020/stra… #MedTwitter
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Great to see #oxygen supplies getting to hospitals. Please use and share our updated installation guide: bit.ly/O2install.
- installing concentrators & cylinders
- simple tubing & flowplitter to multiple patients
- #COVID19 wards (and infection control)
@UNICEF @WHO
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*NEW* installation guide for low-cost #oxygen systems in low-resource settings. Includes #COVID19 isolation ward specs, tips on simple tubing to beds, and DIY flowmeter stand. Free to use and adapt. Please share.
@WHO @UNICEF @Stop_Pneumonia
drive.google.com/open?id=1m6…
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Local teams are working to address #oxygen for #COVID19 in #Nigeria #Africa. We have simple solutions but need support to scale.
@Oxygen4life1 @hewa_tele
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