https://www.picolo.org/blog daily 0.75 2023-01-10 https://www.picolo.org/blog/what-is-post-intensive-care-syndrome monthly 0.5 2021-04-23 https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/1618971541355-0AMJ83GIVBE0OKLZEYTH/GettyImages-10145647.jpg Blogs - What is PICS-p? - The PICS-p framework also recognises that parents, siblings and other family members, too, can experience emotional and social health issues after a child has been admitted to PICU. The way different members of the family are feeling, including the child, can all impact on the child’s long-term recovery and quality of life. https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/1618971599107-K8BAPB3PZJ95XRH5RK3E/GettyImages-87877130.jpg Blogs - What is PICS-p? - These problems have been described as Post-Intensive Care Syndrome in paediatrics (PICS-p). Childhood and adolescence are important times of brain development, and children who are experiencing such problems without receiving support may have ongoing problems in their schooling, friendships, mental health, family functioning and quality of life. https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/1618971154678-MYZADX9VK1HYQ7901HEP/GettyImages-637968486.jpg Blogs - What is PICS-p? - Being treated in the Paediatric Intensive Care Unit (PICU) can be physically and emotionally difficult for children. Some children may recover from their illness or injury, and their treatment in PICU, with little or no developmental impact. Others may struggle with physical, social, emotional, and/or cognitive (or ‘thinking’) skills and development after an admission to PICU. https://www.picolo.org/blog/64gnaselvqd1xbw61jaj5dp49q4lc0 monthly 0.5 2021-04-25 https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/1618982584578-J6BFJ71Y2ZY5WGLEWF0I/GettyImages-137432715.jpg Blogs - How common is PICS-p and what should you be aware of? - Headaches and pain Sleep problems Issues with muscle tone, weakness and coordination Tiredness (fatigue) Behavioural problems or changes Medical fears Anxiety and distress Depression Lower self-esteem Changes in friendships Difficulty concentrating or paying attention Trouble remembering things Trouble settling back into school https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/1618981899479-1XTPX80V85BD7JAEID26/GettyImages-669959148.jpg Blogs - How common is PICS-p and what should you be aware of? - It is difficult to know how many children will experience problems with physical, social, emotional and cognitive health after PICU. PICU patients are all different – patients range in age from infants to adolescents, some children have a one-off injury, others have complex, long-term health challenges. Some children experience difficulties in these areas before they are admitted to PICU. https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/1618982898297-UIFGEQJ0M8WO1Z48S6P4/GettyImages-560330831.jpg Blogs - How common is PICS-p and what should you be aware of? - Act more clingy, whingy, and fussy Act irritable, seek attention or act aggressive Have intense temper tantrums Have increased nightmares (may not remember what the nightmares are about and/or nightmares might appear unrelated to being in PICU) Develop new fears (e.g. monsters, animals, the dark) Act younger, or stop doing things they used to be able to do (e.g. wet their pants; say fewer words, more dependent on caregivers) Complain of stomach aches or headaches Act out their experiences or fears in play (with dolls, teddies and/or other children) Talk about hospital or PICU a lot https://www.picolo.org/blog/looking-after-yourself-as-a-parent-caregiver monthly 0.5 2021-05-28 https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/1618885850187-4M2L9I3C92HCNTRNFAG2/GettyImages-1217384593.jpg Blogs - Looking after yourself as a parent/caregiver - In PICU, you may be additionally challenged by seeing your child undergoing invasive procedures, hooked up to machines, or acting strangely due to medications or episodes of delirium. The parent’s role of caring for your child has been taken over or shared by health professionals, and parents can often feel helpless. https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/1620617344436-NVW0XZGNRY3K9HSNJ04E/GettyImages-1271249376.jpg Blogs - Looking after yourself as a parent/caregiver - You can do that best when you are feeling healthier, calmer, and like you still have some “petrol in your tank”! Eating healthy foods, exercising, taking some time out for yourself, talking to friends, or engaging in activities that you enjoy are some ways that you can care for yourself if you are feeling overwhelmed. Seek support for yourself by seeing your GP or a psychologist if you find that you are really struggling with your own emotions. https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/1620617170801-67M2OZ7T3OZYDFFLKHST/GettyImages-1261460854.jpg Blogs - Looking after yourself as a parent/caregiver - It is very important that during and after your child’s PICU admission, you remember to look after yourself. This is important for both your and your child’s recovery. Children, particularly young children, are dependent on their caregivers to help them feel safe, secure, and manage their own physical feelings (e.g. pain), and emotions. https://www.picolo.org/blog/saving-brains-while-children-are-unwell monthly 0.5 2021-06-21 https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/1624247491318-FECUSCV8C5FM4MJ39KG1/GettyImages-807903342.jpg Blogs - Saving brains while children are unwell - Person-centred care is not just a word for us but has been filled with our own experiences as humans, sisters, brothers, mothers, fathers, friends and loved ones as part of “our villages” in so many contexts. We learn how we can let these reflections make us better clinicians, nor let our own experiences or personalities overshadow what the child and family are going through while showing compassion in a professional and inclusive way, sharing some of our insight gleaned from “consumers of healthcare” or being part of learning in the personal and professional context. https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/1624247181213-ZBRYAZZWB6JQAMQ8NIQF/GettyImages-636715618.jpg Blogs - Saving brains while children are unwell - My professional passion is neurocritical care. I focus my and our teams’ efforts on saving brains while children are unwell. The brain is a very special organ that holds so many things that make us unique. Connections between the cells, different parts of the brain and the brain, spine, nerves, and muscle including all vital organs, are intricate and myriad, much more complex in number and connectivity than the stars in our galaxy. https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/1624247329514-JKZ5SMPMI8MOZIPM5POV/GettyImages-1271628401.jpg Blogs - Saving brains while children are unwell - To learn more about how we can protect this vital organ and partner with the child and their family while they are unwell, help us work out what to prioritise in our Research, Education and Training and how we might create resources for children and families. As these resources grow, we would love to continue to partner with universities, organisations, research institutes, and most importantly, our patients and families and co-design this program. https://www.picolo.org/blog/rehabilitation-from-the-beginning-of-the-picu-journey monthly 0.5 2021-08-12 https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/1628726231678-YSKZ8Y69VB32R6C3QRZT/GettyImages-672136720.jpg Blogs - Rehabilitation From the Beginning of the PICU Journey - The more we learn about the journey for children through critical illness, the more we realise that rehabilitation must start from the beginning of that journey, not just once a patient has passed the critical illness phase. Critical illness often means a child’s usual physical strength and ability is affected due to the multi-organ nature of critical illness and trauma. We are learning from longer-term studies that some of the problems that can develop during critical illness may last for a long time after the PICU admission; this is part of the impact of PICS-p. Physical strength and movement skills like sitting, crawling or walking can all be impacted by critical illness. If the child is immobile for a prolonged period, this can contribute further to significant physical weakness and function. https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/1628726617465-C1Z1S4JN2ZOZZQYMDN8A/GettyImages-1084372348.jpg Blogs - Rehabilitation From the Beginning of the PICU Journey - The whole PICU team is involved in supporting early rehabilitation, the doctors, nurses and allied health staff work together to ensure that every day each patient has mobility goals and planned activities, which we work towards achieving as a team with family input. It is important to remember that rehabilitation in PICU may be as simple as moving the child’s limbs for them with gentle stretches to maintain muscle and joint function or sitting them up in bed. https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/1628726919677-PROJBZ5XKQQHU3ZP1UEQ/GettyImages-1306575526.jpg Blogs - Rehabilitation From the Beginning of the PICU Journey - Activities for each child are individualised so that they are safe and monitored throughout. We really try to involve families as much as possible in any activities as we recognise families may feel they have limited ability to be involved in the PICU environment. This is something they definitely can help with. Our aim is that this program helps empower families to support each child to participate in the optimal level of rehabilitation that they can; every child, every day. https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/1628726441978-2DWYRCG73BFECCZD2142/GettyImages-615806368.jpg Blogs - Rehabilitation From the Beginning of the PICU Journey - We start day 1 in PICU and provide a safe and age-appropriate Early Mobilisation rehabilitation program for all our patients led by the PICU physiotherapy team. Part of this program involves getting to know each child via their parents and carers to learn what stage of physical development their child had attained before their critical illness. https://www.picolo.org/blog/wellness-coaching-for-paediatric-intensive-care-workers monthly 0.5 2021-09-06 https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/1630640701936-XBOVGQ7TA15VR4OEQ4FI/GettyImages-1227322150.jpg Blogs - Wellness Coaching For Paediatric Intensive Care Unit Workers - If you’d like to know more, reach out to us. We'd love to learn how we can help you! We look forward to hearing from you soon. https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/1630640011004-KXVYRTHYT0QJJBK814HB/GettyImages-1271460776.jpg Blogs - Wellness Coaching For Paediatric Intensive Care Unit Workers - We often feel stuck in a rut. Sometimes we lack clarity on what we want or confidence when trying something new, and it's easier to not try than risk failure again. If you have been struggling with gaining clarity on your wellness goals and creating a set of achievable steps towards achieving this goal, don't lose hope; a Wellness Coach can help. https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/1630639522224-105KIYZNKVUUAFDDO05T/GettyImages-1296654337.jpg Blogs - Wellness Coaching For Paediatric Intensive Care Unit Workers - When it comes to optimising our well-being, there is a lot of valuable health-related information available. We know that strategies such as listening to music, healthy eating, and exercising work well. Despite having access to all this information, many of us don't do much with it, do we? We know that healthy eating and exercising is important, yet when we start or try something new to improve our health, our motivation quickly fades away; then the cycle of quitting begins again. We feel frustrated and think that there's no way out. https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/1630640508226-6XA5IL5L7QRRHYLRH68E/GettyImages-1221198119+%281%29.jpg Blogs - Wellness Coaching For Paediatric Intensive Care Unit Workers - As the world faces a pandemic, it is important that those who are working in healthcare take care of their mental and physical health. If you work in paediatric intensive care, then this blog post is for you! In this blog, I will talk about how wellness coaching can help you during stressful times like the covid-19 pandemic. https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/1630639728376-7K2CD9TJZ0D592VUGVF0/GettyImages-1291368677.jpg Blogs - Wellness Coaching For Paediatric Intensive Care Unit Workers - Wellness coaching uses a set of tools that are very effective in helping people stick to their commitments and eventually become healthy. A Wellness Coach will give you specific guidance that is customised to meet each individual's needs so they can take action every day until it becomes an integrated part of how they live life permanently. This process often includes discovering new ways to manage stressors (e.g.: mindfulness) or incorporating more movement into our days through activities like walking instead of driving when possible, as just one example among many others possibilities available today! https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/1630640401923-Z9HYVZBXU32EHQQLJ8WC/GettyImages-1255590828.jpg Blogs - Wellness Coaching For Paediatric Intensive Care Unit Workers - It's not just about being physically fit or exercising regularly; it's also about having mental health (feeling good emotionally); social well-being (having satisfying relationships with your family, friends and community), spiritual well-being (believing there’s meaning in life) and financial stability. Even though all those things sound great in theory, they aren't easy to put into practice when we're stressed out most of the time because our lives seem so full of activities already. https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/1630640099590-536M2B3UAY3HE17DL2TP/GettyImages-529400803.jpg Blogs - Wellness Coaching For Paediatric Intensive Care Unit Workers - Supporting PICU staff's wellbeing during the COVID-19 pandemic is critical . Wellness coaching is a well-established intervention that can help not only staff members but also Managers with retaining their workforce and improving job satisfaction. https://www.picolo.org/blog/sepsis monthly 0.5 2021-11-05 https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/ba9fe860-0663-4137-823d-bd47507d53d9/GettyImages-893472936.jpg Blogs - Sepsis - Did you know that Sepsis is one of the leading causes of death and disability in Australian children? More recently, research has been focussed on learning more about Sepsis in kids so we can better design treatment and care. Our team here in Queensland have been working hard to find ways to identify Sepsis early and initiate rapid treatment to improve survival. Results from their research have shown a growing increase in survivorship which has now opened a new unknown area around these surviving children. https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/1616810723303-DGVKDAK6OIO45DHJV3BV/Lotus+%283%29.png Blogs - Sepsis - The LOTUS study has been developed to incorporate elements we currently known are important in generalised critical illness which we refer to as Post Intensive Care Syndrome – pediatrics (PICS-p). E Exploring the cognitive, physical, emotional and social areas of these children and their families through caregiver completed questionnaires, we hope to grow a better understanding. It is anticipated much like other PICOLO research projects, that from this study we can better understand and shape future care for vulnerable children and their families surviving sepsis into the future. https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/e0fb91e9-3f5b-4de6-8bb0-4a94f327f364/GettyImages-1084372348.jpg Blogs - Sepsis - The advancement of knowledge has seen a remarkable increase in child survival, opening a new phenomena and interest related to these children and their long-term outcomes. Due to the fact improvements in treatment and survival of children with Sepsis is so new, we currently don’t know what long-term outcomes these children and their caregivers will experience in time. It is this idea that has led us to better understand this vulnerable cohort through the development of the Long-Term Outcomes after Pediatric Sepsis (LOTUS) Study. https://www.picolo.org/blog/collaborating-with-your-gp-post-picu-admission monthly 0.5 2021-11-25 https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/98ec3de7-a868-41a1-81f0-bbe68ccc6227/GettyImages-928328326.jpg Blogs - Collaborating with your GP post PICU admission - The post PICU admission child seeing their GP is competing with all the other preventative care measures the GP is trying to get their head across in a busy day. This is where the parents and carers can help. As a GP, it is very much appreciated when a patient’s needs are presented to me on a platter, especially if it is a situation I may not have that much experience in dealing with, and for most GPs a post PICU admission child does not come across their cross-hairs that often. https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/34de7783-47aa-4387-a61d-88eb325730b0/GettyImages-1353222558.jpg Blogs - Collaborating with your GP post PICU admission - A satirical article published for the British Medical Journal in 2018 suggested that if general practitioners did all the preventive care they were expected to do that the average day for the GP would need to be extended by approximately 6 hours. Clearly, GPs have a job that is impossible to do perfectly! https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/132f137e-3ee0-4193-98fd-655f893c25ed/GettyImages-1098041806.jpg Blogs - Collaborating with your GP post PICU admission - Recently, I have been involved with the PICOLO project in an advisory capacity, suggesting ways that children with a PICU admission can be followed up in the community, in particular using GPs. Driving this is despite the now high survival rate of PICU admissions that there is also a high rate of new or emerging morbidities post PICU admission that should be identified and addressed as soon as possible to reduce their burden. Given that nearly everyone has access to a GP, and GPs are the only near-universal preventive care access point in the health system, it makes sense that this is where these concerns are identified. https://www.picolo.org/blog/picu-liberation monthly 0.5 2022-02-07 https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/82017945-00ae-4c31-a56e-849bfacedc54/GettyImages-1285290797.jpg Blogs - PICU Liberation - Every day the PICU team work with the family towards achieving targeted goals to ensure each child’s care is tailored to maximise their comfort, calmness and readiness for rehabilitation. While PICU Liberation care is focussed on maximising the patient’s comfort and calmness; this is often a balance between pain relief, sedation, breathing support, exercise rehabilitation, nutrition and family support. https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/d5fb5610-64c0-4fdf-a7ed-b3638e31f9f7/GettyImages-478259193.jpg Blogs - PICU Liberation - Liberation by definition means “to free somebody from something that limits their control over and pleasure in their own life”.... Let’s look at how this concept of Liberation can be applied to the care we provide in the Paediatric Intensive Care Unit. We know that the impacts on children from critical illness (for example sleep disturbance, post traumatic stress and physical muscle weakness) can persist long after recovery from the illness itself. This is why we have implemented a new and research based care strategy called PICU Liberation to help reduce the impact of a PICU admission, and optimise every child’s recovery for better outcomes after a critical illness. https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/de337ee7-f465-48c3-b11a-ca6d3721c0f7/GettyImages-184342500.jpg Blogs - PICU Liberation - Non-pharmacological settling techniques (for example the use of music, cuddles, touch, warmth, smell and comforters) are also very important in the PICU Liberation strategy. We like to “de-intensify” the PICU environment as much as possible, so we aim to simulate the child’s home environment by establishing a daily routine for each child, and having family members as involved in caring for their child as possible. During the day we aim to have the children as awake and mobile and as possible, so that we can optimise rehabilitation therapy and family time, while at night we aim to protect children’s restorative sleep by dimming the lights, lowering noise levels and utilising soft musical nightlights. PICU Liberation is a strategy for every child, every day. Each therapy can be adapted to even our most critically unwell children. While once upon a time critically ill children were deeply sedated and immobile in bed, these days we know that the sooner we can have our patients more awake, interactive and moving, the more optimal their recovery will be. Time to Liberate!! https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/027b8f87-dd77-4d2f-8056-09683b26c438/GettyImages-1167824413.jpg Blogs - PICU Liberation - PICU Liberation is a holistic care approach which was developed by the Society of Critical Care Medicine and has been running in the Paediatric Intensive Care Unit (PICU) at Queensland Children’s Hospital for the last 2 years. There are multiple elements to PICU Liberation but the key to this innovative and caring approach is teamwork!! PICU Liberation care is centered around the child and family at the bedside, and involves the whole medical, nursing, and allied health team (including physiotherapists, occupational therapists, social workers, pharmacists, music therapists, dieticians, speech therapists, psychologists) working collaboratively. https://www.picolo.org/blog/compassion-fatigue-my-experience monthly 0.5 2023-01-10 https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/42579ddc-d3b9-4eb7-882f-a980f1e2aaae/IMG_4127.jpg Blogs - Compassion Fatigue - my experience - If you had asked me that question five years ago the answer would have been an emphatic NO. You see, I had been a paediatric intensive care nurse for over ten years, looking after the sick of the sick and I loved my job! Each day I looked forward to going into work, anxious to see who I could help and make a difference in the lives of children and families who were living their worst day…and then one day I didn’t. Ten years of nursing on the frontline had led to compassion fatigue. Compassion fatigue is defined as the natural consequence of stress resulting from caring for and helping traumatised or suffering people and it is something that can affect anyone. You could be a nurse working on the frontline or the parent sitting by the bedside of a chronically ill child, and both have compassion fatigue. https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/ad00c60b-7eff-4564-afb5-a118dfa22400/1645757885414.jpeg Blogs - Compassion Fatigue - my experience - All these steps eventually helped to improve my mental health and enabled me to dive back into nursing, but with a different focus. Having compassion fatigue helped me to realise that while frontline PICU nursing is a valuable and essential service, what happens outside the PICU’s four walls once you arrive home can be just as important and valuable. Working in PICU I only saw patients and families on their worst day. I would not see how a critical illness requiring PICU affected the patient and families after they discharged from the unit and arrived back home. Increasingly, research is demonstrating that critical illness can have long term detrimental impacts for children and their families, especially related to neurodevelopmental milestones and quality of life. https://www.picolo.org/blog/tag/%23recovery monthly 0.5 https://www.picolo.org/blog/tag/%23wellness monthly 0.5 https://www.picolo.org/blog/tag/%23children monthly 0.5 https://www.picolo.org/blog/tag/%23healthcare monthly 0.5 https://www.picolo.org/blog/tag/%23mentalhealth monthly 0.5 https://www.picolo.org/blog/tag/%23healthcareprofessional monthly 0.5 https://www.picolo.org/blog/tag/%23doctors monthly 0.5 https://www.picolo.org/blog/tag/%23depression monthly 0.5 https://www.picolo.org/blog/tag/%23nurses monthly 0.5 https://www.picolo.org/blog/tag/%23pics monthly 0.5 https://www.picolo.org/blog/tag/%23intensivecare monthly 0.5 https://www.picolo.org/blog/tag/%23picu monthly 0.5 https://www.picolo.org/our-team daily 0.75 2024-06-14 https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/1619148714375-E8H7WMZMK0RXK912F2U2/Belinda%2BDow.jpg https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/1619148668702-81OF6OD5VLGAHPKWLLFK/Deb%2BLong.jpg https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/1619148790366-MD01OEBRMN7O3YEJ07VH/P4230979%2Bcopy.jpg Our Team - Jessicah Minogue Nurse/Midwife, MPhil Candidate https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/1619148587590-CRIRWMVBXV7TDB8GS6XW/Lori_profile.jpg Our Team - Lori Anthony Tobias Keene, D.D.S. Hailing from Richmond, Virginia, Dr. Tobias Keene brings a bit of unabashed Southern hospitality to all his patients. He moved to Washington, D.C. over thirty years ago as a freshman at Ivy College. Right after graduation, he attended World University’s School of Dentistry. Before opening Keene Dental in 1994, he worked for free clinics and some of the finest practices in the District. He is part of the 123 Dental Association and stays up-to-date on the latest dental discoveries. When not striving to keep his patients happy and healthy, he’s enjoys hiking with his family in Rock Creek Park. https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/1619148762399-XY814AI6JSEYPQ4PV1EC/Kristen%2BGibbons.jpg Our Team - Kristen Gibbons Biostatistician, Senior Epidemiologist https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/1619148737502-XVT8YQNWHHH5KV17T103/Sam%2BBora.jpg Our Team - Samudragupta Bora Tobias Keene, D.D.S. Hailing from Richmond, Virginia, Dr. Tobias Keene brings a bit of unabashed Southern hospitality to all his patients. He moved to Washington, D.C. over thirty years ago as a freshman at Ivy College. Right after graduation, he attended World University’s School of Dentistry. Before opening Keene Dental in 1994, he worked for free clinics and some of the finest practices in the District. He is part of the 123 Dental Association and stays up-to-date on the latest dental discoveries. When not striving to keep his patients happy and healthy, he’s enjoys hiking with his family in Rock Creek Park. https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/1619148887345-IDHUG6MDGPPBE3W6PXK0/Zeph%2BTyack.jpg Our Team - Zephanie Tyack Occupational Therapist, Implementation Scientist https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/1619148862810-HAOCYW3GGWRJBAIQCUJD/Christian%2BStocker.jpg Our Team - Christian Stocker PICU Specialist, Chair, QPCCP https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/1619148617497-KLM6PVUQU5ILNPZPTLZ6/Helen%2BLiley.jpg Our Team - Helen Liley Tobias Keene, D.D.S. Hailing from Richmond, Virginia, Dr. Tobias Keene brings a bit of unabashed Southern hospitality to all his patients. He moved to Washington, D.C. over thirty years ago as a freshman at Ivy College. Right after graduation, he attended World University’s School of Dentistry. Before opening Keene Dental in 1994, he worked for free clinics and some of the finest practices in the District. He is part of the 123 Dental Association and stays up-to-date on the latest dental discoveries. When not striving to keep his patients happy and healthy, he’s enjoys hiking with his family in Rock Creek Park. https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/1619148913966-JCMU18LTYAMO75GKX7QC/James%2BBest.jpg Our Team - James Best General Practitioner https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/1616812176304-U6NAGE93OSXVNWB8N43F/Kerri+Webb.png Our Team - Kerri-Lyn Webb Tobias Keene, D.D.S. Hailing from Richmond, Virginia, Dr. Tobias Keene brings a bit of unabashed Southern hospitality to all his patients. He moved to Washington, D.C. over thirty years ago as a freshman at Ivy College. Right after graduation, he attended World University’s School of Dentistry. Before opening Keene Dental in 1994, he worked for free clinics and some of the finest practices in the District. He is part of the 123 Dental Association and stays up-to-date on the latest dental discoveries. When not striving to keep his patients happy and healthy, he’s enjoys hiking with his family in Rock Creek Park. https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/4b06766b-c956-4125-8f34-5b53ed5fea42/bzmoO2bq_400x400.jpg Our Team - Jed Duff Nurse, Implementation Scientist, Problem-solver https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/1619149007304-TKIO1JHWSFXFJRDI9L8X/Luregn-Schlapbach.jpg Our Team - Luregn Schlapbach PICU Specialist https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/1619149031224-7MDNFVAF12V4T2UOK4AX/Deb%2BThoms.jpg Our Team - Debra Thoms Nurse, Consultant, Federal Nursing and Midwifery Chief Officer 2017-2019 https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/1619478033358-FHJY90W7RN58K9579VDF/17_0265_Waak%2C+Michaela+foto.jpg Our Team - Michaela Waak PICU Specialist, Paediatrician, Paediatric Neurologist, https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/1619477986633-LM1VZ11HTHKZBPVIKFRW/Jessica+Schults_smile.jpg Our Team - Jessica Schults Nurse, Senior Research Fellow https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/3711a014-c34a-4251-a969-0171fa3f472d/VA+photo+2018.jpg Our Team - Vicki Anderson Head, Psychology Service, The Royal Children’s Hospital, Theme Director, Clinical Sciences Research at Murdoch Children’s Research Institute https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/2f9e28c5-16e4-4aad-8c18-aefd83b49095/Profile.jpg Our Team - Kim-Huong Nguyen Research Fellow, Health economist https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/c9a70450-f03c-42f5-bda3-51bb2dc7a477/20210811_134802.jpg Our Team - Alexandra (Ali) Ferguson Tobias Keene, D.D.S. Hailing from Richmond, Virginia, Dr. Tobias Keene brings a bit of unabashed Southern hospitality to all his patients. He moved to Washington, D.C. over thirty years ago as a freshman at Ivy College. Right after graduation, he attended World University’s School of Dentistry. Before opening Keene Dental in 1994, he worked for free clinics and some of the finest practices in the District. He is part of the 123 Dental Association and stays up-to-date on the latest dental discoveries. When not striving to keep his patients happy and healthy, he’s enjoys hiking with his family in Rock Creek Park. https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/02e718e2-54b4-4db0-98a2-f37c50cc02c1/4B95AA3A-C16C-427F-956D-4628866678F7_1_105_c.jpg Our Team - Dr Vishal Kapoor Senior Specialist Paediatrician, Senior Lecturer https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/b831d910-eb8e-43ab-8fea-6023c984c789/IMG_4127.jpg Our Team - Karina Charles Tobias Keene, D.D.S. Hailing from Richmond, Virginia, Dr. Tobias Keene brings a bit of unabashed Southern hospitality to all his patients. He moved to Washington, D.C. over thirty years ago as a freshman at Ivy College. Right after graduation, he attended World University’s School of Dentistry. Before opening Keene Dental in 1994, he worked for free clinics and some of the finest practices in the District. He is part of the 123 Dental Association and stays up-to-date on the latest dental discoveries. When not striving to keep his patients happy and healthy, he’s enjoys hiking with his family in Rock Creek Park. https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/c71c7b1a-b6a9-40d6-be3f-12830b0283f8/Jane+H.jpg Our Team - Jane Harnischfeger Nurse, Nurse Educator https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/0af16a3f-069d-422d-8e92-ab26ba7e4cd2/Amanda.jpg Our Team - Amanda Clayton Tobias Keene, D.D.S. Hailing from Richmond, Virginia, Dr. Tobias Keene brings a bit of unabashed Southern hospitality to all his patients. He moved to Washington, D.C. over thirty years ago as a freshman at Ivy College. Right after graduation, he attended World University’s School of Dentistry. Before opening Keene Dental in 1994, he worked for free clinics and some of the finest practices in the District. He is part of the 123 Dental Association and stays up-to-date on the latest dental discoveries. When not striving to keep his patients happy and healthy, he’s enjoys hiking with his family in Rock Creek Park. https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/76dd59ed-29b2-4592-9ed3-9b9ced94c946/Sophie+2.jpg Our Team - Sophie Clayton Ex-PICU Patient, Total Legend https://www.picolo.org/presentations daily 0.75 2023-01-10 https://www.picolo.org/contact daily 0.75 2021-04-16 https://images.squarespace-cdn.com/content/v1/5ce435d6bea1ed00016ba287/1558964652247-5MWXNMFZVOPGE4TY6U2Q/MHeiderich_ReflexionenZwei-05-copy.jpg Contact https://www.picolo.org/about daily 1.0 2023-08-09 https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/1689218710311-3S0ELWXN2OVIJJM68E2P/the-impact-of-nutritional-part-1.jpg About Us Our Research https://images.squarespace-cdn.com/content/v1/605d8a8e8b6ab570050ea538/1689218792151-J0QZWK5EMNQ6BY738ISE/pexels-bruno-bueno-5365887.jpg About Us Parent Resources 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