This week we are joined by Neonatologist, Dr Don Sharkey to discuss innovation, research and technology within neonatal care.
Dr Sharkey is Clinical Associate Professor of Neonatal Medicine at the University of Nottingham and Neonatal Intensivist at Nottingham University Hospitals NHS Trust in the UK.
Don is an academic neonatologist with a broad research portfolio aimed at reducing major morbidities in newborn infants.
Don’s main research focus is in healthcare technologies for babies and children, focused on neonatal resuscitation, neonatal monitoring and diagnostics, and computer vision and machine learning techniques.
This was a very powerful and thought provoking conversation and we hope you take as much from it as we did.
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Theme Music - ‘Mountain’
copyright Lisa Fitzgibbon 2000
Written & performed by Lisa Fitzgibbon,
Violin Jane Griffiths
Podcast editing - Right Royal Audio
Podcast artwork thanks to The Podcast Design Experts
How would people feel about entering a very sick child in an intensive care setting into a clinical trial, particularly when many of the things that we do don't benefit that child at that time. But actually, I found parents in particular, were really open and receptive to being part of it, they saw that actually, there was something to be had for the future. And what I often say to parents when I talk to them is around your child today is being cared for on the background of a huge amount of research that parents have signed up to before. You know, the reason I know how to ventilate your baby. Now today is because of what we've learned before from other research studies, from medical studies that this treatment works better. And what we want to do is keep making that better.David:
Welcome back, everybody. This is Episode Three of the third season of the not mini adults, podcast pioneers for children's health care and wellbeing. My name is David Cole. And once again, I'm joined by my wife Hannah, and we are the cofounders of UK children's charity Thinking of Oscar. This week, we are joined by Dr. Don Sharkey, and we're going to be discussing Innovation Research and Technology within neonatal care. Dr. Sharkey is clinical Associate Professor of neonatal Medicine at the University of Nottingham, and neonatal intensivist, at Nottingham University Hospital NHS Trust in the UK. Dawn is an academic neonatologist with a broad research portfolio aimed at reducing Major morbidities in newborn infants. Don's main research focuses in healthcare technology for babies and children focused on neonatal resuscitation, neonatal monitoring and diagnostics, and also computer vision and machine learning techniques. We also discussed the sometimes difficult conversation of research within Child Health and neonatal care. We have a truly powerful conversation with Don. And we hope that you take as much from it as we did. Don, Hi, thank you so much for joining us on the not mini adults podcast.Don:
Hi David good morning. Thank you for inviting me.David:
Absolute pleasure. I think as I was saying beforehand, you're our first conversation around neonatology. So really, really looking forward to kind of delving into some of the things that you have been doing and your career. And with that, I guess, where we tend to start in in a lot of our conversations is just talking a little bit about you, if you don't mind and kind of how you got to you know what you're doing today.Don:
I guess I combined unusual route. I kind of left school with minimal qualifications, which many people don't really realise. I went straight into electronics and engineering. My apprenticeship, was doing that for a few years and then really got into into Computing and Engineering through a variety of companies. And then eventually realised that my calling was greater than what I was achieving at that time. And being a young teenager and set out went back to do my way A levels at college before deciding, somebody convinced me that I should probably consider medicine because I had the attributes for it. So at the age of 21, I entered into planning that and managed. I was lucky enough to get a place at University of Nottingham grew from there and I guess it was during my paediatrics attachment at the University of Nottingham as an undergraduate. I was lucky enough to be based in Darpshire Children's Hospital, where at the time there were and still are a couple of very inspirational paediatricians who really got me thinking about paediatrics. I never really considered it. When I went in I think like many students, and especially I was going to be maybe an orthopaedic surgeon or something like that, without realising what orthopaedic surgery was, and then got into paediatrics and realised it was for me it covered everything you thought about the whole family, the child, the kind of setting things up for the child for the future. And that's how I really got into paediatrics. And it was really cemented when I did my house officer jobs in adult medicine and I struggle to treat patients who were doing harm to themselves through their lifestyle choices. They come in, I'd fix them in hospital for a short period, they go home, do the same thing again, usually around smoking or drinking, come back to me and I really struggle dealing with those sorts of patients. And what I really wanted and what appealed to me about paediatrics was setting children up for the kind of, you know, the lifestyle that they deserved. If we could get things right early in life, then naturally that would be known for the rest of their life. So that's really where it all came from. And particularly neonatology. So that's how I eventually got into neonatology because of all this kind of specialties in paediatrics, if you get things right in in neonatology, actually, you know, the twizzle of the ventilator knob in the right direction at the right time, really can make a big difference for that child and for the rest of their life. And, of course, that child's well being fulfils the whole family's well being and sets them all up for a good life. So that's really how I got into it in space of two minutes.David:
It is a fantastic story. So thank you. Thank you for sharing and I guess since you've found your calling as it were, and, you know, now working in this space. So, you know, some of the things that we're going to talk about are some of the projects that you've been working on. And, and I guess now we can see the correlation between kind of a passion from a technological perspective. And also, you know, I guess, as you call it, a calling, which, yes, in some respects, we feel the same way kind of Oscars giving us that calling to try and do what we're doing from from a charitable perspective, but if you could kind of talk to us a little bit about the work that you're now doing in the role that you are and bringing those kind of two elements together,Don:
I've always been fascinated in intensive care. So I really enjoyed my time, both in neonatal intensive care and paediatric intensive care. And I think it was the technology side of things that really excited me, I reached a fork in my career path where I had to decide on one of the intensive care specialties. And I like the ability to follow patients and see them long term which you get in neonatology, you know, to see, I guess, the outcome of the care that you delivered. So that was the era embarked on and then eventually started to forge an academic career. And, again, doing most of my research in Nottingham, I was lucky enough to work with a number of different groups, from fundamental scientists through to engineers. And I was quite an early year registrar. So that's kind of a middle grade trainee, in paediatrics, and was doing my PHD. And just came across a lecture once from a colleague now who was an engineer who came over to our department to do a seminar. And he just happened to mention in his kind of summing up phrase, he mentioned that they developed a system where you could monitor the heart rate and temperature of miners underground, through wearing their their safety hat. So miners underground are exposed to extremes of stress. And the deeper they go, the more they're exposed to these stresses. So they needed some way of monitoring needs. So I guess this was, I mean, this was probably more than 15 years ago now. And what they really wanted to do was look at wearable technology for these miners. And it got me thinking at the time in 2000, I think this was there was a real problem around neonatal resuscitation and how we monitor babies in the delivery room, no one really knew the best way to do it. And we were trying all sorts of different things. People were putting on all sorts of limiters that were designed for adults or ECG machines that were designed for adults, but they would never, you know, the problems came, you know, you put an ECG on a baby, and it would fall off because the baby's got wet skin. So it was never designed for wet skin, or it would strip the skin of a very premature baby, the pulse oximeters they didn't respond to good perfusion, babies are always blue when they're born. So their saturations are always low. So they're not really optimised for that transition period. And I just, it just got me thinking, actually, if we could monitor the heart rate using something that was perhaps built into a cap, because we always put caps on our very small babies just to maintain that temperature. And then we just had had a small conversation after the seminar with my generic colleague, Professor Crowe. And it was there that we really kind of kicked off my research interest in in technologies. And we got together with a group of those with engineers, and with research and as I was working with at the time, and we put in an application to actually medical research, you were one of the kind of main charitable funders of paediatric research at the time. And we were lucky enough they funded us and that kind of kicked off quite a journey, in fact, because we then went on and subsequently developed commercialised products for newborn resuscitation, it was created a company on the back of it that's had, you know, significant investment, millions of pounds, millions of pounds of research funding, and it's growing further. And I guess that was really the very first point in which I got involved in technologies. And through that, just sitting and listening to colleagues who are really working at the fundamental science level, discovering new things be it a new polymer, a new way of designing or developing something or a new engineering technique, and just being able to translate what we're discovering into something that might actually work in the clinic. And for me, that that's been an area of immense interest. And somewhere I specialised. There are people obviously focus on on bigger populations in adults, but very few who look at it in neonatology. And so it's an area that I've kind of grown a reputation for and will be very excited about and I've got many different projects running now, all in parallel. And at times, I felt overwhelmed of being at capacity and felt this desire to try and get all of these technologies into neonatology and wish there were more people coming through. So one of my other passions are around technologies is kind of growing future leaders in this domain as well. So I have a number of students, PhD students in particular, across a variety of different specialties, which I think is unusual for an academic clinician, where, you know, I certainly in the last year, I've had two PhD students, one from computer science, one from engineering who have graduated with their PhDs. I've had two clinical fellows, who both graduated with their PhDs in technology related aspects, again in the last year, so all of these things is about growing as people get people interested in them and seeing that, actually, just because we adopt all of these things from adult technologies, it doesn't mean that they necessarily give us the right information or work in the right way. And that actually, we need to work with those fundamental scientists to develop things that are specific for children and particularly for babies.Hannah:
what you've just landed on is a question that's been bubbling in my mind for a few minutes. Now, I was interested in your take on we called the podcast, not just mini adults, not mini adults, in fact I have got it wrong, classic, and it's not limited to the devices but this idea of intervention versus adaptation, and that so many solutions that exist in paediatrics, including neonates have been derived from a solution from healthcare for adults. And so what's your point of view of adaptation versus invention? When? When is it the right time to invent and when is it better to adapt?Don:
I guess as paediatricians, it's one of the first things that we're all taught as soon as we embark on a career in paediatrics is that children aren't small adults, even adolescents are not necessarily small adults, they have different things that need to be addressed differently. And I think as you go down the ages, it becomes more apparent. And there are certainly technologies that can be adapted from adults. And I guess things around, you know, imaging is probably a good example is that imaging modalities, you can adapt usually the software quite straightforwardly to accommodate with that. And I guess, when it comes to other technologies, you need to start to think about the disease processes that are slightly different in children. And it's well described things like this particular diseases in children movements relate to orphan diseases that they're often called, whether they're extremely rare, they occur usually from birth, or usually within first months of life. And they're very rare. And actually, sadly, most children who have these, the most severe end of these, they don't survive. And partly that is because I think previously, people have not invested in trying to come up with solutions or treatments or management plans for those particular children. Because there's such a small population. And I think it was probably about 10 or 15 years ago, certainly in the EU, there was a big switch to try and to address this, I think that really kicked off in pharmaceuticals to begin with, where they realise you just couldn't just chop and change something to suit these particular children. And I think that's really where it's grown, that people are recognised that those children need specific treatments and need investment in it. But the end of the day people are is that there are a very small population, and there isn't a huge amount of guests or shareholder money to be made. And so we've had to come up with novel ways tempting people in to study these particular groups. And I think we're starting to see some of that now migrating to what we've seen in innovation, because you call it in technologies for children and particularly for babies. Realising that 100 kilo adults in their 60s who's got Heart disease is very different to a 500 gram baby he's just been born. He's got a respiratory problem that is unique to the newborn who's got the risk of a brain injury that's unique to the newborn, all of those things are things that we need to tackle differently. And I think that's where I've been coming at things from is trying to come up more from the event, and it's specifically for that population rather than adapting it. Now, some of the technologies will be the kind of platform will be an adaption. But it will be you know, just making some subtle changes to the design will make it more suitable for that population. And I think often that's where people have been falling in that territory, because it's much easier to do that. But now we're seeing more and more of a push for devices in particular to be designed for children. And typically for babies that actually there's more investment in those. And I think that's been recognised by funders. Again, we've seen it in the UK in particular, and even across in the States, probably 10, at least 10 years ago, they realised that there were real issues here. And they set up multiple institutions that had these paediatric medical device expertise, so that they could fast track and develop new technologies for children. And specifically looking at, you know, how do we do clinical trials using these new devices and development for children? I think there was a report five or six years ago that looked at 20, maybe 25, high risk medical devices that were licenced for use in children and babies. And when they look back at the regulatory aspects, those, I think, 85% of them that had no clinical trials in children at all. So they were designed for adults and tested in adults, but they developed and they got to licenced for use in children. And that was without knowing that they had any, any use in children or there were other problems. And I think a good example is probably the ECG, we all got to using ECG in the delivery room. And it's very good. But as we've got more used to using ECG monitoring, we find that it does have some limitations, children who have a slow heart rate, which is basically obviously higher at 60. But it may be that the ECG shows the rate of 60. But there's no adequate heart rate outputs is not, the heart isn't beating well enough. So you can be misled by that. And the same is true of pulse oximeter. So we just adopted pulse oximeters from adults, but actually, in the first few minutes of life, they've been shown to be inaccurate. And that's because the diffusion issues that just don't pick up the signal well enough. So there are areas where we just need to be careful that you just can't adopt these things. And that's why I've tried to focus on coming at the angle from the innovation rather than pure adaption,David:
You make a fascinating point, I have to pick up on it, because I've literally just been reading about kind of orphan drugs and orphan conditions, need to do a bit more research into it. But actually, you know, a lot of what we talk about, and I have conversations all the time at various different levels around, you know, the need for more investment, more concentration around paediatric care, neonatal care, but you know, in that spectrum. But then the the negative aspects of it is that actually the return on investment is not necessarily there, the pool of you know, patients, the size is not relative to the the amount investment that we need to go into it to make a difference. But actually, there's some studies being done, especially around orphan drugs, that a lot of or a vast proportion, a much larger proportion than you would anticipate, of profits that are made by Big Pharma have come from often very small, very kind of challenging, I guess, therapeutics that have needed to happen for certain cases. And I think there's some work there, or some thoughts that maybe need to go into looking at that and trying to translate that into, you know, the potential for paediatric care as well. And to try and rebuff the criticism or the thought process that, you know, it's just not, it's just not worth investing in. Slight tangent, sorry, but I've literally just been reading about that this morning. So it was a, it was in my mind as it were. Coming back to some of the areas that you're working in, and you talked about the company that you've formed, which is Surepost Medical, and using the cap, and I guess, you know, people can find information on that and the opportunity for that. And we'll put a link on that. But on the on the web as it were, but you're also doing quite a lot around neonatal transportation and trying to, I guess, move babies from the delivery ward to intensive care or wherever it might be. But talk to us a little bit about that, because you've spent quite a lot of time looking at that.Don:
I guess for over 20 years, many parts of the world, particularly in America and Australia, they had this centralised system where the highest risk infants would go to these big centres it often in big cities, because it would, it would improve the outcomes for these children. But in order to do that, obviously, in a geographical area, you have many births occurring all over. And so you need to be able to move the babies into those centres. And it was back in 2003, the UK decided to go for centralization of intensive care for newborns. And so they set up probably in the late 2000s, a number of transport teams, dedicated transport teams for newborns that would move babies from areas where they were born, I guess in the wrong place into these intensive care centres. So in the UK, we have about 190 maternity birthing centres and about 50 to 60. it fluctuates, a little bit of neonatal intensive care centres, but actually, you know, more than half of the births occur outside of an intensive care centre. And if your baby is extremely preterm or is born with a congenital anomaly or with birth related problems, and they need to go to these intensive care centres, and so, geographically, the UK is very small and most centres are within one to two hours of a major Intensive Care Centre. But it still means moving the baby and actually, what we do in the back of the ambulance is we take in effect a complete intensive care cot space with a dedicated nurse, dedicated trained professional and that's usually in the form of a doctor or an advanced nurse practitioner who goes out to retrieve the child from their birthing hospital and bring them into Intensive Care Centre. Now my area of interest is having ridden in the back of many ambulances with many sick babies is actually watching them bounce around in the back of an ambulance in an incubator isn't a nice thing to observe, it's good for them in that it will improve their mortality that by going to the centre they're more likely to survive. But actually, although we've seen improvements in mortality, it's been less impressive with other important outcomes such as brain injury in these children. And I guess that's what got me interested, you know, is the environment that there are being transported Then, is it optimal? Or could we improve that to improve their outcomes. And then there's been a number of studies, including some recent UK data that was really powerful that showed babies who were transported in this way were at greater risk of having a severe brain injury, so that more than would survive, but more of them would survive with severe brain injury. And although it's still a very rare event, it's an important event for that child and that family. And so my focus has been trying to tackle that and see if there are ways that we can understand what what the mechanisms are, and what we can then do to address it, particularly from a technological approach. So I've been working with some small transport companies, I lead as the research lead for the UK neonatal transport group, which are all 15 of the neonatal transport teams across the UK, we collect data, and we plan about how we can improve these transport pathways. And I've had a number of research fellows who have helped study this, thanks to funding from the likes of de Machar in particular, working with my engineering colleagues, we've been able to explore it more, with a view to adapting the transport system that we use to make it safer. So lots of people don't know. But it's quite a common thing for babies to move around the country, so much so that there are about 16,000, newborn transfers by ambulance between hospitals every year in the UK. So they're huge numbers, and often for many, many miles. So families, I think about 40% of them that our transit is over a over 100 kilometres of return journey to and from their house. So so they're big distances that these babies are going and that there's a period that does expose them to these additional environmental stresses. Now, unfortunately, the risk of having a severe brain bleed in these very preterm infants is often in the first day or two of life, and that is the time that you transfer them. So they're born in the wrong sense, they need to go to the centre so we're moving them at a time, that's the greatest risk. And so we've been studying the mechanisms there, and some of the stresses that they are exposed to. So just to give you an example, when we measured it, the kind of head exposure that newborn's head is exposed to in terms of its vibration. It's far above what is being legal and legal safe limit of vibration for a normal adult in their day to day work. So if you're a truck driver, you're expected to fall below a certain threshold of vibration. If you don't by law, there are laws that protect you that say your employments do something about it, reduce that exposure, because you're more likely to get musculoskeletal problems, backache, headaches, be off work chronically sick, but there's no such levels in terms of transporting babies. So we've looked at all that. And we've defined what the levels of vibration that these babies are exposed to. And it's often two or three times what an adult would be allowed to be exposed to. And so we've been trying to tackle that from an engineering perspective and trying to reduce the amount of exposure that they have both from noise from vibration, temperature fluctuations and really studying that. We've done that from a technological perspective. But also we've used UK wide data to explore, you know, where are the problems in these patients in terms of their movement, can we get more babies move in utero, so the mom is moved rather than before she's born before the baby's born rather than afterwards, because that's the safe environment. That's the ultimate transport incubator in effect, but there are challenges there from a midwifery and obstetric colleagues that needs to be addressed. And it was probably five years ago, nearly Jeremy Hunt as the health Secretary the time threw down the gauntlet for us to reduce brain injury in these babies by 50% by the year 2025, so we are only three and a bit years away from that. And that's a huge undertaking, and that's going to be that's going to require multiple ways of tackling it both removing more babies in utero to tackling the postnatal environment making that safer. And, you know, we've been looking at safety so that babies do have accidents in ambulances when they're being transported there is well documented cases there. And the restraints we use that the only requirement is that after an accident, if an ambulance were to turn to its side that the baby remains in the same position, it was at the start of the accident, and at the end, and the restraints are very good at doing that they can hold the baby in place. But sadly, many of the babies when we've modelled it would probably die from their restraining injuries. And so we need to think differently. And it's not just a case of putting a seatbelt on a baby or strapping a baby in with with a harness, you need to think about how you access it. And so we've been working with around Human Factors with engineers trying to develop those material scientists, what are the best mattress configurations that you can come up with? And thankfully, we went to the NHR, you know, it takes more than a million pounds to raise a child with cerebral palsy. So our argument at the end of our presentation was for the first we wanted a billion pounds to try and start this research into the first child's brain it saves froma severe a brain injury would have paid for itself. It's that easy. And I think they were switched on to that. And they Sally Davis, who was the previous Chief Medical Officer, she made a point of it in her 2012 report. We've got to tackle the the issues around prematurity around brain injury, because these are lifelong, that child gets a brain injury, it's with them for life. And if that child lives for 50 to 100 years, that's a lot of healthcare, a lot of resources that goes into that. So that's really how I got into that. And we're pushing forward on that. And hopefully, in the next maybe five years or so we'll have something that will make this a much safer system for the babies.David:
Is there anything that you can kind of discuss now in terms of some of the advancements that you're seeing, you know, some of the things that are most exciting,Don:
I guess the things we've been looking at really are reducing vibration, what we needed to do was to, to look at ways we could perhaps modify current systems rather than producing a completely new system, partly because all of these systems, they have to be a 10 year life, and we couldn't see everybody just overnight replacing their system. So how can we adapt what people are using at the moment and just put in some new components. So we've been exploring that. And we found some really, really nice, useful data from that, that hopefully, we can, we can roll out, we've been looking at how we might reduce the noise. So there are there are quite a number of times when the back of an ambulance, the noise is so loud, it exceeds the noise that you probably get with a chainsaw going up next to your ear. And if you're a highly fragile baby, you know, on multiple blood pressure, multiple ventilator support, having that noise going off next to your ear, for however long your journey is, this isn't a good thing. We know it causes fluctuations in brain blood flow. So we've explored some ways about how we can reduce the noise exposure that they have. And, you know, it's not as easy as thinking you can just miniaturise, people have tried that, and they don't work. So we've been coming up with some some nice new ways of trying to do that, again, with our engineering colleagues. But as you might expect, there are some ideas around IP and things in there that I just need to be careful about talking too much about.David:
Now, of course, of course, thank you what I mean, the project sounds like it could be, as you say, you know that the numbers speak for themselves if you can, if you can save one patient. So it's an amazing project. And you know, we've seen a few things where others are looking to do something similar. And so you know, we wish you every every every luck with that. Absolutely. Just a couple of other things that I think would be really interesting to talk about. One is that I guess you you started your career in Nottingham, I'm assuming that and you've stayed there, I'm assuming that that has been all encapsulating opportunity for you. But one of the interesting things happening in Nottingham, I think, is this centre for health technologies, which you mentioned to me when when we first started having a discussion and I, again, through our discussions and doing some research, there seems to be some really interesting things going on there. So anything that you can talk to us about just in terms of the centre, but also, you know, some of the projects that you've seen there as well?Don:
Yeah, I guess it kind of went back to what I mentioned earlier about this, the interface between getting fundamental science engineering people to talk to the clinical people to say, you know, what are the problems you've got? And, you know, are there any other solutions that we have that can can address that, and that that was a real issue for us, because I was working closely with engineers, and computer scientists, with fundamental scientists, about six years ago, with some engineering colleagues, we decided that we would put in a case to the university that actually we should create something that pulls us all together, stops us working in our silos. And I think that's the only way you can you can forge forward now I think we've researched and the university was very supportive. They were excellent. They saw the strengths, they saw the importance of healthcare technologies. It's a growing area that the future of medicine where things were going. And so we got together as a group, and we formed the Centre for healthcare technologies. One of the unique things is that there's a nice partnership between the university and one of the largest trusts in the UK that Nottingham University Hospitals. And it's quite nice, because both of them, what we call our, where our engineering and our science bases on the university is literally joined by a bridge that crosses over and one of the ring roads that goes through Nottingham to the hospital. So we have we are in such close proximity, but it really just pulled us together made us think, and I was one of the founding clinicians who helped launch that. And we've got it going still. And we The aim is that, as I say, it pulls all of those interested parties together. We have things we organise things like speed dating, so we get scientists, engineers, you know, we go out for a bite to eat and a beer maybe and we sit down with clinicians from a particular specialty. And we just speak date for five minutes you grab your beer you move on to the next person. You just chat about what they're doing. And we've had a number of really great and fruitful collaborations grow from that, that's allowed us just to develop new ideas, you know how we can take what somebody in engineering and developed around, you know, a new MRI technique, for example, and how we can apply it in the clinic. And it's allowed us to get the funding in to prove that the concept works to then go on to clinical trials. And that's how many of my collaborations have grown. And we've done that. And what we're doing now is we're working on our external partners, bringing in commercial industry partners, bringing in other institutions in order that we can try and work together. It's still in its early years, but actually, it's grown quite nicely. And we've had some really great successes from it. And I've enjoyed being part of it. I met colleague there recently, well, two or three years ago, who's created some really nice new polymers that are materials that you can coat pretty much any plastic or silicone with and for my population where infections in neonates cause huge morbidity, huge mortality, I just thought, Well, we've got to take these and put them onto some of our medical devices. And, you know, we've got some some nice funding to get that going some PhD students, and again, we're starting to explore that. So he was focused on adults. And clearly, that's a big population. But for me, it was about getting over to the him actually, you know, it might cause a big problem in adults, so from having urine infections on from a catheter, but in babies, it causes death and lifelong disability when they get an infection. So that's an area that we really need to target. And when we talking, we talk about quality of life quality adjusted years, depending on how you measure these things, actually, when you start to talk about neonates and children, it's an easy story to sell. Although we are a small population, we're dealing with those quality of life years are there to be had. So that's really where it all came from. And it's an exciting thing. We don't just look at engineering and chemistry, we don't just look at biology, new imaging techniques, but I working with computer scientists as well. And we've been developing a number of AI approaches, which have been, you know, have been really successful and things that we hopefully we can we can keep pushing forward for.Hannah:
And moving on from that, what's your experience of kind of the practical pragmatic experience to implementing some of the ideas that you've been working on over the years, and from my background, where I was coming from was, so much of what you're involved with now has got data involved with it. So even if you're talking about a device, often you'll be collecting data about a very small baby in order to make decisions soon, or improve the decision making process, for example. But with that comes challenges of like, where the data sits and integrating with hospital systems. But actually, the question is wider than that, because you've made me think about other areas to consider whether it's the IP considerations that you mentioned, or whether it has to do with risk and the role of clinical trials, but how do you go for it, because for me, it just feels like it could be very difficult to to have a brilliant idea. And then but then be able to turn that into something that hospital organisations are happy to have implemented.Don:
I think in my field, in particular, the two barriers, I always I always felt that would be the thing that would hold our research back. The first was around technology adoption and how you move through it and how you move the technology through its adopted stages. And for me, that's always been the major hindrance. So you're often at the early stages, you come up with a great idea, you know, you've got a new sensor or a new using that example I had before a new polymer that you can, you can code to prevent code device infection, you come up with that, and then it's then getting it into those early clinical trials. And there's always a dip, you know, you get your data, you have to wait, you put in your applications, your funding, you get bounced The first time you put it in again. So there's an inherent lag of, you know, 18 months. So it really slows you down as a researcher that slows down this adoption, to get in it to the patients that really need it, you know, you then get your next round of funding and then prove in a preclinical or clinical small clinical trial that it works. And then you have to wait and put that data in for the next application. So, you know, you then do the big trial, and then eventually, you know, you get the funding for that. And then there's a lag, getting that one finished and getting the data out and people then adopting it going through all the regulatory aspects. So that still is and always will be, I think, a major hindrance. I think lots of the funders now switched on to that and they're now trying to fund a bigger, more balls programmes rather than individuals short projects that that will stop and start in that way. They want to try and fund a really brilliant idea all the way through. The other one that I thought might be a hindrance was that I guess kind of what you're alluding to was around how would people feel about it? Entering a very sick child in an intensive care setting into a clinical trial, particularly when many of the things that we do don't benefit that child at that time. But actually, I found parents in particular, were really open and receptive to being part of it, they saw that actually, there was something to be had for the future. And, and what I often say to parents, when I talk to them is around your child today is being cared for, on the background of a huge amount of research that parents have signed up to before. You know, the reason I know how to ventilate your baby now today is because of what we've learned before from other research studies, from, you know, medical studies that this treatment works better. And what we want to do is keep making that better. And I thought that might be hindrance, but actually, it's surprising how many parents even at the time of extreme worry, anxiety for them, when they're babies at their sickest they will agree to participate in the research because they can see the benefits for that. And I guess on the back of that, it's been reflected in how hospitals and how ethics bodies, for example, they see this research, and they, I think are more open to that now, they realise that some of this really is at a time when children can be at their most vulnerable. And sadly, I've had children who've been in my medical device studies that haven't survived, because of the nature I work in intensive care. And it's not, it's not related to the study they were doing, they would they would die of other causes. And, you know, it's a horrendous privilege for a clinician researcher, to be able to say, you know, to, with that family to sit down and say, you know, what we've learned from this has been amazing, it's been a real privilege to have you, you know being a part of it. And, you know, it's extremely sad that their child has died. And I don't know what they feel when they when they talk about that to lose a child. But actually, the number of families that said to me that they feel as though they've contributed in some way that they're, although they lost their child that it's had some weight will have a benefit for the children. And I think that's one of the things that drives us all on is conditions, particularly in those settings where not every child does survive. And actually I think, you know, many of the systems we have now around ethics and hospitals, are geared up for, they recognise that's a really tricky environment to go in. And you know, they'd be very supportive of us now, there is a lack of joined up, you know, collecting data, for example, just routine data has been very tricky previously. And the number of hoops you have to jump through in order to collect that in order to learn about your patients and study things in an offline way, can be very difficult. But again, they are becoming more open to that. And I think, you know, there are steps going forward about making everybody's data more available in an anonymized way that you can pull together. And we can look at that. And we've done lots of research, looking at those big databases as well, and utilising those, and I guess, part of that's built into some of the machine learning the artificial intelligence work that we've been developing.David:
Don, thank you, we could talk to you for hours, I think a lot of what you're doing is really, really inspirational. So it's been fantastic learning more about it. One of the things I will certainly take from the conversation, front least what we just discussed, and I think that's, you know, really, I guess, personally, a lot of things that we tried to do as well, but also the way that you're working, you know, between yourselves and the university. Anecdotally, I kind of use an example of one that actually has spurred us on quite a lot of Atlanta Children's Hospital and Georgia Tech coming together and doing very similar things. And a friend of ours and a friend of the not mini adults of podcast, Sherry Ferrugia. was, you know, the the kind of catalyst for that. And and I'm, I'm glad to say that we have, you know, I guess a similar instance in the UK that we can discuss, as well. The final question, though, which we kind of ask all of our guests is, if you could change anything within paediatric healthcare, what would it be?Don:
There are lots of things I think I've talked about lots of positives that have happened over certainly over the 15 years I've been I've been studying device technology development in this field. I think for me, it really would be not just from a funding perspective, or from the traditional funders in the UK, but from industry, as well would be to recognise, although there may not be huge amounts of money to be earned from developing these things, actually, the quality of life and the buying in to, you know, a child's future is really important. You know, Paul Dimitris head of the children's and young peoples medtech that I'm part of, we have this saying about, you know, the children may be a small part of the population, but they are the future. And that's true and if we can improve the lives of children, by rapidly developing new ideas and translating them into new things that will improve their health. their well being and ultimately their life chances that actually that's a good thing. And I think the funders in the UK, certainly from the government side of things have recognised that now, what I'd really like to do is to see, there are there are good examples out there. And I'm not applying this to everybody. But for the big pharma and big medical device companies to start to invest more in them realising that, although it's a small population, there may not be much money to have, but actually, there are big gains to be had. It's important, I think, you know, that we can help extend lives and keep them well. But I see huge amounts of money going into extending somebody's life by four months, you know, at the end of their life from a cancer treatment, but very little going into into preventing a brain injury in a aby. And I think that's perhaps here we need to think ifferently. And as it's not a uge population, it doesn't equire huge amounts of nvestment, but it just needs hat right investment with the ight teams to really accelerate t. And every day that that's eld back, you know, there's nother child who suddenly will ave a brain injury for the next 0 to 100 years of their life.David:
Don thank you so much. t's been a real privilege talkin to you, and delighted to hear a out all the work that you're d ing good luck with it all.Don:
Thank you, David.David:
Thank you so much to Dr. Sharkey for joining us on the not mini adults podcast, and I'm sure that you would agree a pretty powerful conversation that we had. And it's interesting because we're seeing a lot of innovation within neonatal care at this point in time, which is I think, you know, wonderful to see. Next week, we will be joined by paediatric neurosurgeon, Dr. Jayamohan. And who is going to be coming and talking to us about empathy, and the importance of having that connection with not only the patient, but also those around them. When looking after a child in hospital. We really hope that you can join us then please do subscribe to the podcast. And if you're enjoying it, please do leave us a review as well. We hope you'll join us again next week.