AnnualReportofthe

AssociationofPaediatricAnaesthetistsofGreatBritainandIreland

2016

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Contents:Page3 President’sreportPage9 HonorarySecretary’sreportPage12 HonoraryTreasurer’sreportPage15 ProfessionalStandardsCommitteereportPage17 EducationandTrainingCommitteereportPage19 ScienceCommitteereportPage22 MeetingsCommitteePage24 TraineerepresentativesreportPage26 ACSAreportPage27 GuidelinesandPatientInformationPage28 QIreportPage30 WebsiteandSocialmediareportPage31 LayRepresentative’sreportPage33 LinkmanreportPage34 Reportsfromassociatedorganisations:AAGBI,PICS.Page37 NationalReportsPage41 EquipmentandISOupdate

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President’sreport

ThecurrentCouncil2016comprises:

ProfessorAndrewWolf(PresidentandChair)

ElectedandHonorarymembers

Dr.CharlesStack(PresidentElect)Dr.BobBingham(ImmediatepastPresident,ChairProfessionalStandards)Dr.ChrisGildersleve(HonorarySecretary)Dr.AlistairCranston(HonoraryTreasurer)Dr.MarkThomas(ChairEducationandtrainingcommittee)Dr.JonSmith(ChairMeetingsCommittee)Dr.SimonCourtman(Webmaster,websitelead)Dr.StephanieBew(Electedmember)Dr.ColinDryden(Leadguidelinesandpatientinformation)Dr.ElinJones(Traineerepresentative)ProfessorWalidHabre(ElectedOverseasRepresentative)Co-optedMembers

Dr.KarenBartholomew(Linkmanlead)Dr.LiamClaffey(Irelandrepresentative)Dr.KeithBaillie(NorthernIrelandrepresentative)Dr.CarolynSmith(Scotlandrepresentative)Dr.SallyWilmshurst(Co-optedmemberforQI)Ms.SaraPayne(LayRepresentative)Dr.SuellenWalker(ChairScienceCommittee)Dr.RichardMarks(RCoARepresentative,VicePresidentRCoA)Dr.UpmaMisra(AAGBIRepresentative,AAGBICouncil)Dr.YamunaThiru(PICSRepresentative,PICSCouncil)

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ChangestoCouncilTherehavebeenalargenumberofchangestoCouncilin2015/16.Dr.KathyWilkinsonleftAPACouncilin2015afterbeingadrivingforcebehindtheAPAformanyyears.Sheismuchmissedasthefontofallknowledgeinthingspaediatric,buthascontinuedinteractionthroughnumerousnationalrolesinthecareofchildren.WalidHabrefromGenevareplacesFrancisVeyckemansastheElectedOverseasRepresentative.BotharecloselyinvolvedintheEuropeanCollaborativeResearchStudies(Apricot,Nectarineandperhapsinthefutureotherassortedfruitthemes)andtheroleofOverseasRepresentativeismoreimportantthanevertomaintainavitalliaison.ManythankstoFrancisforhissupporttotheworkofAPA.Wehavecontinuedtoworkmorecloselywithalliedanaestheticandpaediatricorganisationsandhavethreenewco-optedmembers:Dr.RichardMarks(Vice-PresidentRCoAwhoreplacesLiamBrennan,UpmaMisrawhoreplacesIsabeauWalker,andYamunaThiruwhoreplacesOllieBagshaw.ThankstoareduetoLiam,IsabeauandOlliefortheirsupportacrosstheorganisations.WhilewehavelostLiamfromAPACouncilwealsocelebratehisappointmentasPresidentofRCoA.HavingaPaediatricAnaesthetistinthisroleisIthinkafirst,andwehavealreadyhadseveralmeetingswithRCoAandotherbodiestohelpfocusoureffortsinthingspaediatric.KeyEventsMay2015/2016Therehasbeenincreasingconcernfrombothpaediatricandsurgicaldisciplinesaboutmaintainingpaediatricskillsandbeingconfidenttoundertakesuitablepaediatricemergencycasesinnon-specialisedhospitals.ThishasledtotimesensitiveproceduressuchastheacutescrotumbeingdelayedandincreasingcallsfortransferofcasesthathavepreviouslybeenundertakeninDGHsetting.ThisissuehasnowreachednationalrecognitionwithRoyalCollegesofAnaesthetists,Surgeons,nursingPaediatricsandChildHealthallexpressingconcern.ImetwithDr.JackieCornish(NationalClinicalDirectorforChildren’sServices)andtherewillbeameetingofallstakeholdersinAugusttotrytofindsomesolutions.InthemeanwhileKarenBartholomewhascollectedreportsthroughthelinkmanschemeofourconcernsaboutdeskillinginthenetworks,andthesehavebeensenttoDr.Cornishtoprovidesomenarrativedocumentation.ThemainpushfromtheclinicalproviderswillbetostrengthentheNetworkswithaproperlyorganizedsupportstructure.ItdoeslooklikeatlastthishasreachedapointwheretheNHShasrecognizedaproblem.Recently,theyhaveissuedadirectivetotheeffectthatinthecaseoftheacutescrotum,peripheralhospitalswillneedtoprovidesurgicalservicesandthatdelay/transferwiththerisktothetestisisunacceptable.IthinkthatthiswiderissueofintegratedanaestheticprovisionthroughappropriatelyorganizednetworksofperioperativeandsurgicalcareisoneofthemajorissuesthattheAPAneedstoengagewithinthenextyear.Wewillkeepyouinformedofdevelopmentsthroughthenewsletterandwebsiteastheydevelop.Formanyyears,theAPAprovidedpeerreviewofpaediatricanaestheticpracticeattherequestofanaesthesiadepartmentsinordertoevaluateallaspectsofpaediatrcanaesthesiaanditsadjacencieswithaviewtohelpthelocalteamimprovetheirpractice.TheRCoAisnowrollingoutaschemeofquality

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improvementthroughpeerreviewthatcanbeapplieduniversallytoallhospitals.ThisprocessofAnaesthesiaClinicalServicesAccreditation(ACSA)hasdrawnmuchfromourownexperienceofpeerreviewandSimonCourtmanhasputahugeamountofworkwiththeRCoAinestablishingappropriatepaediatricneedswithinthecoredomainsoftheACSAprocess.AnothercurrentactivecollaborationisajointprojectwiththeRCoAledbyAlistairCranstonandKathyWilkinsontodevelopamicrositeforSafeguardingLevel3trainingforanaesthetists.Finally,AlistairCranston,ChrisGildersleveandKarenBartholomewareco-authorsforthenextiterationofGuidancefortheProvisionofPaediatricAnaesthesiaservices,whichwillbepublishedbytheRCoAinJanuary2017.ThesecollaborativeprojectsallbodewellforcloseintegratedworkingacrosstheAnaestheticorganisationswiththeAPAprovidingacentraltouchstoneforspecialistadviceandinputinpaediatricanaesthesia.

APACouncilhasgivensomeattentiontotheissueofaffiliatemembershipstoalliedorganisations,specificallyESPAandAAGBI.ThiswastriggeredwhenwewereaskedbyESPAtoconsiderofferingaffiliatemembershipasanadditionalpartofthecurrentAPAannualsubscriptionwithanupliftof£5-£10.ThebenefittotheAPAmembershipwouldbeaccesstoESPAwebsitefacilitiesincludingalltheireducationalresources.ThebenefittoESPAwouldbeasubstantialupliftintheirmembershipbase.However,manymembersintheAPAarealreadyfullpaidupmembersofESPAandbenefitstoESPAcouldbemarginal.IhavewrittenbacktotheESPASecretariatandwearestillawaitingmoreinformationonhowthiswouldworkinpractice.

ItisnoticeablethatinrecentyearstherehasbeenafallinapplicationstoworkonAPACouncil.Whilewearefullyrepresentedatpresentitremainsreallyimportantasthespecialistsocietyforpaediatricanaesthesiathatwecontinuetosupporttheneedsofthespecialtythrougheducation,researchandmaintenanceofstandards.ThisisparticularlyrelevantastheAPAcontinuestodevelopawiderbasethatreflectstrainees,specialistsandnon-specialistsalike.Weareawarethatnon-clinicalSPAtimeisbeingsqueezedbutinorderforCounciltobeeffectiveinthefutureweneednewideasandenthusiasms.TherewillbefutureelectionsinAutumn2016whichwillbeadvertisedthroughmembershippostsone-mailandalsothewebsiteanditisimportantthatifyouthinkyoucouldmakeacontribution,youapply.

SomeclarificationoftheissueofAnaesthesiaandthepotentialeffectsonthedevelopingbrainhasbeenachievedwiththefirstdevelopmentalfollowupofinfantsreceivinganaesthesiafromtheGASstudy.ThiswaspublishedrecentlyinTheLancetandgoessomewaytoreassuringthemedicalcommunityandparentsthatnecessarysurgeryshouldbecarriedoutandthatatthistimethereisevidencethatsingleexposureanaesthesiadoesnotconfermajoridentifiableharmstotheyounginfant.TheAPAwebsitehasupdatedourguidanceonanaesthesiainthedevelopingbrainwhichwehopeprovidesapragmaticandbalancedopinionbasedonknownevidence.

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Committees:MeetingsJonSmithandtheMeetingsCommittee,alongwiththeextensivesupportfromthelocalteamdeliveredamemorableASMinAberdeeninMay2015.ThiswasajointmeetingwiththeAmericanSocietyofPediatricAnesthesiaandwhilewehadsomeexcellentqualitylecturesandparticipantsfrominvitedSPAspeakers,thenumbersofSPAmembersattendingsimplyasdelegateswerelimited.However,overallregistrationforthemeetingwasasexpectedandfeedbackfromthemeetingwasverygood.Themeetingmadeaminimalloss,butwaswithintheCouncilstrategyofensuringthattherolling5yearfinancialplanofmeetings(somemoreexpensivetorunthanothers)remainwithinapositivefinancialbasis,whiletryingtoprovidethebestqualityofscienceandeducationforallmembers.TheAutumnLinkmanmeetingshavebecomemorepopularagaininrecentyearswiththeemphasisontopicalissuesforthenetworks.Onceagain,KarenBartholomewandteamdeliveredaqualitymeeting,thisyearinManchesterwithgoodattendance.ScienceTheScienceCommitteehaselectedthreenewmembers,DavidMasonfromOxford,GuruswamyVelupandianfromLeeds,andPeterBrookesfromChelseaandWestminster.In2015/16wehavebeensuccessfulintwoGrantroundsattheNIAA,andwewereabletofundbothduetoimprovementsintheAPAfinancialbalance.ThefundedprojectsweretoBirminghamforastudyonplateletfunctionandbleedingaftersurgeryininfancy,andforsupportofthePan-EuropeanNectarinestudyonoutcomesfromneonatalanaesthesiaandsurgery.SallyWilmshurstourQIleadhasbeentaskedwithprovidingablueprintforindividualsandDepartmentswhowishtoundertakeQualityImprovementProjectswithintheirhospital.Wehopethiswillbeplacedonthewebsitesoon.TherehasbeenaninitiativefromtheNationalInstituteforAcademicAnaesthesia(NIAA)totrytopoolfundsfromalltheindividualsourcesavailabletotheNIAAincludingtheAPAintolargerprojectsorprogrammesofwork.ClearlytherewouldhavetobeapaediatriccomponentforsuchaprojectinorderfortheAPAtoputfundsforward.Wearestillawaitingclarification,butiftheproject/programmehadidentifiablecomponentsthatcouldhavebenefitforchildren,Councilwouldconsiderthiswithintheagreedlimitsforresearchfunding.Thisyearsawthepublicationofthe“painathome”studyinPediatricAnesthesia.ThiswasafirstinthatthiswasaresearchstudyconceivedandcommissionedbytheAPACouncil,thenfundedandfinallycompletedandpublished.Itishopedthatthisisafirststepinanewprocesstoidentifyanissue,supportateamtoundertakeanappropriateprojectandultimatelyadvancepractice.EducationandTrainingMarkThomas,ChairofE&ThasnegotiatedfortheproceedingsoftheASMinBelfasttoberecorded.Thiswillallowcorelecturestobemadeavailableviathewebsite.Thiswillneedtobedonewithsomecareasfreelyavailablelectureswithoutpasswordprotectionmaybesubjecttocopyrightissues.Thiscametoaheadthisyearwithcontactfromcompaniesaskingforfundsretrospectivelyfor

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theuseofcopyrightmaterialonourwebsitefrompreviousmeetings.TheagreedsolutionisthatimportantcorelecturesthathaveuniversaleducationalcontentwillbemadefreelyavailableaftertheBelfastmeeting,butslideswillbecarefullyvettedforconfidentialityandcopyright.Othertalksmaybemadeavailablebutwillneedtobeprotectedbehindmembershippasswords.Inadditionpodcastsofsomeselectedlectureswillberecordedduringthemeetingforuploadingonthewebsite.GuidelinerevisionandcommissionhasbecomeproblematicnotonlyintheUKbutworldwide.Afullevidencebasedguidelineorevenrevisionisaverylargepieceofworkandlargetopicsarebecomingtoobigtotakeasawhole.APACouncilhasbeenincontactwiththeEditorofPediatricAnesthesiawhoconfirmedtheuniversalproblemwiththisissue.Ithasbeenproposedthatevidencebasedmonographswithcommentarymaybeawayforward,butthisisstillunderdiscussion.ProfessionalstandardsAsmentionedabovetheAPAPeerReviewprocesscontinuesbutwiththeadditionoftheACSAprocessdrivenbytheRCoA.Alargenumberofconsultationsandstandardsdocumentshavebeenreviewedbyprofessionalstandardsinthelastyear.Thishasincludedreviewof“QualitystandardsfortheCareofcriticallyillandinjuredchildren”(PICS)andStandardsfornon-specialistemergencysurgicalcareofchildren(RCS/CSF).Theserequiredsignificantmodificationafterconsultationreflectingconcernsfromthenon-specialisthospitalsthatprovidingthequalitystandardsrequiredwerehardtoachievewiththecurrentavailabilityofpersonnelandresources.FulllistingsoftheconsultationsundertakenbytheAPAin2015/16areprovidedinAppendix1AnewroundoftheACCEAhasrecentlyopened.Thiswillprobablybethelastinthecurrentformat.BobBinghamwillreceiveapplicationsandwillbereviewedintheusualfashion.Thedeadlineisshort.PATRN:PaediatricAnaesthesiaTraineeResearchNetworkThisyearsawthebringingtogetheroftraineestoformacollectiveresearchnetworkledbyDr.ElinHugheswhoistheTraineeRepresentativeonCouncil,incollaborationwithDrsZoeHarclerodeandAnnaBarrow.Theyhavealreadybegunworkonprojectsandhavesetupajournalwatchgroup.Contactshavebeenmadewiththesurgicaltraineeresearchnetworkwiththehopethatcollaborativestudiescanbeundertakeninthenextcoupleofyears.

MeetingswithotherOrganisationsWehavemetwithalliedgroupsoftenseveraltimesintheyeartodiscussareasofmutualinterestorconcern.ThesehaveincludedRoyalCollegeofAnaesthetists,BritishAssociationofPaediatricSurgeons,RoyalCollegeofPaediatricsandChildHealth,RoyalCollegeofNursingandtheChildren’sSurgicalForum.ThesearediscussedinthereportfromProfessionalStandardsCommittee.Therehasbeencontinueddiscussiononhowbesttosupportpaediatricanaesthesiainthedevelopingworld.WehaverenewedoursupportforapaediatricfellowshipinNairobiin2016/7atacosttotheAPAof£2,500andhavebeenincontactwithIsabeauWalkerattheWFSAtoidentifyasuitable

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individualwhocouldbesupportedtoattendafutureAPAmeeting.Thiscouldalsobetiedinwithanattachmentataspecializedchildren’shospital.AdministrativeIssuesLastyearattheAGMinAberdeenwebroughtforwardaproposalthatAffiliatemembersshouldbeabletovoteonAPAissues.Thisproposalwasapprovedbyvoteatthatmeeting.FollowingthatweagreedthentodrawupadiscussionpaperandthatthatcouldbepresentedtotheAGMforaformalvote.WehaveenclosedthediscussionpaperintheAnnualreportandplantotakeafinaldiscussionandvoteonthismotionattheBelfastAGM.ThisyearIwroteindividuallytopastpresidents,honorarymembersandotherindividualswhousuallyreceiveapostedChristmascardfromtheAPACouncil.Asidefromwishingtheusualseasonalgreetings,Iaskediftheywouldformallyapprovethesendingofe-mailgreetingsinfutureyearsandthattheAPAwouldmakeadonationtoasuitablecharityinplaceofthecostofcardsandpostage.Thiswasmetwithaveryactivepositiveapproval.Iwouldproposethatthischangeiscontinued.Finally,IhopethatasyourAPAGBICouncilwearecoveringtheneedsofthechildrenunderourcareundergoinganaesthesiaandtheneedsofthemembershiptoprovidethoseservicesinallaspectsofourprofession.Ifyoudohavecommentsandneeds,pleasedosharethemwithusandwewilltrytohelpasbestaswecan.

ProfessorAndrewRWolfPresidentAssociationofPaediatricAnaesthetistsofGreatBritainandIrelandMarch2016

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HonorarySecretary’sReportMembershipWehavebeenreportingamembershiptotalofover1200during2015howeverduringauditingitbecameclearthatnearly300lapsedmembershadaccruedduring2014and2015andthesehadnotbeenfactoredintoourdatabaseofmembers.FollowingadatabasecleansingexerciseatAAGBIandchaseremailsbeingsenttolapsedmembersthemostrecent(29.02.2016)breakdownofthemembershipis: Members Outstanding Full 580 76 Trainee 226 81 Overseas 51 37 Retired 81 0 Honorary 47 0 Affiliate 18 4 1003 198 ThemajorityofrenewalstakeplaceduringMarchandAprilsoaverbalendofyearmembershipbreakdownwillbereportedtoCouncilandtheAGMinMay.Astrategytochaseupthefinallapseeswillthentakeplacewithchaseremails,telephonecallsandformallettersgoingoutoverMay,JuneandJuly.Ifafter3monthstherehasbeennoresponsethenon-responderswillberemovedfromthedatabase.Anaccuratedatabaseofmembersisimportantasthemembershipincomehelpstoinformtheactivitieswecansupportandweneedtobeabletostructureourfinancessuchthatcostsarecoveredbymembershipincome.GuidanceontheProvisionofPaediatricAnaesthesiaServicesDrsKathyWilkinson,LiamBrennanandAnna-MariaRollin,GPASauthorsforanumberofyearshavecompletedtheirfinaledition,the2016version,andthisisavailableontheRCoAwebsite.Ourthanksmustgotothesethreestalwartswhohaveprovidedanimmenselyimportantandvaluablestandardsdocument,whichisthespecialty’sreferencepointforqualityandsafetyinserviceprovision.DoctorsBartholomew,CranstonandGildersleveandJaneLockie(London)arethenew4strongauthorgroupforthedevelopmentofthenextiterationofGPAS.

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TheRCoAareseekingrecognitionfromNICEforallGPASdocumentsandsothisnewversionwillbedevelopedusingNICEnomenclature.Thisprocesshasnotbeeneasy,astheliteraturereviewhasyieldedlittlehighqualityevidencethusfar.ThenextAuthorsgroupmeetingisinmid-MayandtheexpectedpublicationdateisJanuary2017.APAmembersurveyThe2016MemberSurveyhasbeenrunningduringFebruaryandMarch2016.Theclosingdateis15thApril,preliminaryresultswillbeavailableforMayCouncilandafullreport,togetherwithCouncil’sresponsewillbemadeavailableonthewebsiteonceavailable.Membersarethankedfortheirparticipationinthisbiennialsurvey;itisavitalpartofourcommunicationstrategyandtheinformationgleanedfromthesesurveyshelpstodirectCouncilpriorities.ElectiontoCouncilDr.KarenBartholomewwaselectedunopposedtoCouncilinNovember2015.HertermstartsinMay2016andasshemovesfromherLinkmanroletoaFullMemberofCouncilDr.NirmalaSoundararaganwillmoveintotheroleofLinkmanCoordinator.TheelectionforLinkmanpositionalsoreceivedonlyonenominationandwhilewearedelightedthatKarenwillnowbeafullmemberofCouncilafterherexcellentworkintheLinkmanpositionthepaucityofnominationsforthesetwopositionsonCouncildoesraiseconcerns.Whilepeaksandtroughsofinterestdooccur,weareanAssociationofourmembersandcannotfunctionassuchwithoutmembershipengagementsoitisimportantthatwetakenoteofthisandconsiderourapproachtomemberengagementintherunuptoourflagshipevent,Belfast2016ASM.ThenextelectiontoCouncilwilltakeplaceintheautumnof2016.OneHomememberpositionwillbeavailable,togetherwiththepositionofNationalAdvisorforScotland.IftheHomeMemberelectiondoesnotresultinScottishrepresentationonCouncilthenwewouldproceedtoelectaNationalAdvisorforScotlandwhowouldbeco-optedtoCouncil.TheelectionswillberunasusualbytheERSandthisyearwillbebybothpostalandelectronicballotwithaviewtousingsolelyanelectronicprocessin2017.TenuresofCouncilmembersDr.ColinDrydencompleteshistermonCouncilthisyear.ColinhasprovidedexcellentleadershipontheGuidelinesandParent/ChildInformationportfolioandhashelpedtoimproveouronlineinformationplatformwithsomenotablesuccesses.HehasbeenavaluablememberofCouncilandwewillmisshisinputtoCouncilactivity.Wewishhimwellforthefuture,thoughthiswillbefarfromrelaxedasheslipsintoLeadorganiserrolefortheAnnualScientificMeetinginLiverpoolin2018.DrsJonandCarolynSmithcoincidentlybothcompletetheirtenuresin2017.AcallfornominationsfortheirreplacementswilltakeplaceinOctober2016.Dr.ElinJonesisalsoreachingtheendofhersuccessfultenure,asTraineeRepresentativeandwewillbeseekingtoelectareplacementforherduringthesummer.Thisyearhasseenthereplacementofallthreeco-optedrepresentativesfromourprincipalalliedorganisations.IwishtoechothethanksofProfessorWolfto

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LiamBrennan,IsabeauWalkerandOllieBagshawfortheirimmensecontributiontoCounciloveranumberofyears.Dr.RichardMarks,Dr.UpmaMisraandDr.YamunaThirunowrepresentRCoA,AAGBIandPICSrespectivelyandwewelcomethemtoCouncil.MotionforchangeinAffiliateMembervotingrightsandreviewofArticlesofAssociationandStandingOrdersFollowingdiscussionsregardingthevotingrightsofbothTraineeandAffiliateMembersatthe2015AGMapaperproposingthatAffiliateMembersbeallowedtovoteattheAGMandothergeneralmeetingsoftheAssociationwillbepresentedtotheAGM.ThisisincludedintheAGMpaperwork.IfthemotioniscarriedthiswillnecessitateachangeintheArticlesandStandingOrders.Theseareduefortheirbiennialreviewin2017soanychangeinvotingwillbeincorporatedintothisreview.ConsultationsTheAPAhascontributedto30consultationsduring2015/6andthisisacoreelementofCouncilactivityandrequiresacohesiveandsometimesquitetime-limitedresponsebyCouncilonarangeofimportanttopics.NotablecontributionsbyCouncilbothcollectivelyandasindividualsrepresentingtheinterestsofCouncilinclude:1.NICEGuideline:Intravenousfluidsinchildrenandyoungpeopleinhospital.2.CSFStandardsfornon-specialistemergencysurgicalcareofchildren.3.PICS5thQualityStandardsforthecareofcriticallyillandinjuredchildren.AcompletelistofconsultationsmaybefoundinAppendix1.MeetingswithotherorganisationsIhaverepresentedtheAPAGBIatrangeofmeetingswithorganisationswithwhomweshareacommoninterestoverthepastyear.ThemostsignificantoftheseistheJointLiaisonmeetingheldatRCPCHtwiceannually.ThisprovidesaforumfordiscussionbetweenAPAGBI,RCPCH,CSFandBAPSandisahighlyproductivemeetingforallparties.OthermeetingsofsignificancearecoveredinthePresident’sreport.ChrisGildersleveHonorarySecretaryApril2016

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HonoraryTreasurer’sreportIampleasedtoreportthatthefinancialstateoftheAssociationcontinuestobeahealthyone.Overthe2015financialyearwehavecontinuedtocontainourrunningcostsbothintermsofsecretarialandCouncilexpenditure,bothasaresultofthe2012reviewofourcontractwithAAGBIbutalsobycontinuingtostreamlinethewaythatCouncilandsub-committeemeetingsareorganizedwithgreateruseofonlineandtelephonemeetings.However,incomefromsubscriptionswas£2000lessthanin2014,largelyasaresultofresignationsandsomeongoingproblemswithmaintainingandaccuratemembershiplist.The2015ASMinAberdeen,asexpected,madeasmalllossof£1600.The2previousASMsinCambridgeandLeedsgeneratedsignificantsurpluses,morethanoffsettingthe2015loss.ThismeansthattheaccountsfortheAssociationatyear-end2015remaininasatisfactorystate,andgivesustheopportunitytopursuetheactivitiessetoutpreviouslyasprioritiesfortheAssociation.Theoverallpicturefor2015isadeficitof£21,00ofexpenditureoverincome,largelyasaresultofsignificantresearchandothergrantsawardedduringtheyear.Currentlywehaveassetsofover£445,000andweremainon-trackfortheoverallfiveyearplanofmaintainingsufficientfundstopayforameetingthatiscancelledforreasonsbeyondourcontrol,yetstillbeingabletosupportandexpandourcoreactivitiesofeducation,website,research,peerreviewandguidelines.TheAssociation’sgeneralactivitieshavebeenrunwithinourincomefromannualsubscriptions,aswasthecaselastyear.ThedeficitfortheAberdeenASMwas£1,617.ItwasalwaysgoingtobeachallengetobreakevenonthismeetingbecauseofthegeographicallocationandthefactthattherewerealargenumberofUSspeakers,themeetingbeingheldinassociationwiththeSPA.IhavetothankthelocalAberdeenandAAGBIconferenceorganisersforalltheireffortsinmakingthemeetingagreatsuccess.TheLinkmanmeetinginNovembermadeamodestsurplusof£300,despiteareductionindelegatefees.HoldingthemeetingoutsideofLondonreducedcostsconsiderablyandweproposetore-investtokeepdelegatecostsforthe2016meeting(inBirmingham)toaminimum.

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Theincomefromsubscriptionshasreducedby£2000whencomparedwith2014andtheAssociation’scharitybondsandaccountshaveyieldedamodestamountininterest.ThecostsforrunningtheAssociationhavecontinuedtobecontainedwellforthethirdyearrunning.Wehavestreamlinedmanyofthesub-committeemeetingsandincreaseduseofteleconferencesandareductioninthenumberofface-to-facemeetingshavehelped.SecretarialandotherAAGBIcostshavebeenmaintainedatlevelssignificantlylowerthanthoseintheyears2011to13.AlthoughweanticipateasmallincreaseintheAAGBIcostforadministrationandsecretarialsupportin2016,wehavebeenabletoruntheAssociation’scorebusinessontheincomefromtheannualsubscription,aswedidlastyear.During2015wehavecontributed£19,500towardsaNIAAapprovedresearchprojectinBirminghamandapprovedanotherNIAAgrantof£27,000tosupporttheNECTARINEproject.WehavealsobeenabletomakeaneducationalgranttotheRoyalCollegeofAnaesthetiststosupportonlineeducationalmaterials,aswellasanothergranttowardsanonlinevideopresentationaimedatchildren.ThankstoaproposalbyourLinkmancoordinatorwehavealsohelpedtosupportanumberofUKregionalupdatemeetingsbymeetingtravelcostsforout-of-regionspeakers.WehavealsocontinuedtosupporttheWFSApaediatricanaesthesiatrainingschemeinEastAfrica.Therewillbenoincreaseintheannualsubscription,atpresent£90forfullmembersand£60fortrainees,for2016.Retiredmemberspaynosubscription,providedthattheyinformustheyhaveretired!Wecontinuetohavealowersubscriptionfeethanthatofmanysimilarspecialistsocieties.Proposedfinancialplansfor2016:EducationandTraining.IncreasedfundingfornewinitiativesbytheE/TCommittee.ContinuedsupportforRegionalUpdateMeetings:APAGBIwillconsiderrequestsforfundingforspecialistspeakersandsupportforatraineeprizeatregionalmeetingsinGBandIreland.VideofilmingandeditingofASMlecturestoallowthesetobeviewedviatheAPAwebsiteafterthemeeting.Wehaveagreedatwo-yearcontractwithaprovidertocommenceatthe2016BelfastASM.Anannualcostof£12,000hasbeenagreedbutadditionalcostswillbeexpectedtoincreasewebsitefunctionality.ResearchHavingmadegrantcommitmentsof£47,000viatheNIAA2015rounds,Councilhasagreedtodeferfurthercontributionsuntilthe2017round.Audit/QISupportforaNationalPaediatricLaparotomyAudit,alongthelinesoftheNELAprojectisunderconsiderationaswellasanumberofsmallerprojects.

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WebsiteUpdatestoincreasefunctionalitywithimproveinteractivefunctions.Thiswillenhanceeducationandtrainingmaterialsandallowvideopresentations.LinkmanMeetingThesurplusgeneratedfromthe2015meetingwillbeallocatedtowardsvenuecostsforthe2016meetinginBirminghamandwewillkeepdelegatefeestoaminimum.GlobalHealth/CharityFollowingexcellentreportsofthesuccessoftheinitiative,APAGBICouncilhasagreedanextensiontothegranttotheWFSAEastAfricaprojectforafurthertwoyears.InvestmentsInlinewithnewfinancialcompensationarrangements,Iwillreducetheamountweholdininterestbearingaccountsto£75,000foreachaccounttoprotectourassets.Asindicatedatthe2015ASMIhavepursuedoptionstoinvestsomeofourfundsinamanagedportfoliofund,ratherthanholdingmoreinlowinterestinvestments.FollowingapprovalattheJanuary2016Councilmeeting,Iwillbeinvesting£50,000inamanagedportfoliofundprovidedviatheCharitiesAidFoundation.Thiswillbeadefensive(low-risk)fund,butonethatshouldaffordbetterreturnsthantheexceptionallylowrateswearegettingfromourdepositbondsandaccounts.ExpensesforAPAGBIrelatedactivitiesTravelandsubsistencecostsformembersengagedinAPAGBIactivitieswillremainatcurrentlevels.The2015unauditedaccountsareavailableonthewebsitetobeviewedpriortotheAnnualGeneralMeeting.Iwillpresentthesalientpointsatthemeetingandaskthattheaccountsareapproved,buthardcopieswillnotbeavailable.IwouldliketorecordourthankstoBusolaAdesanya-YusufandtheSpecialistSocietiesteamattheAAGBIfortheircontinuedsupportandhelp.BusolahasrecentlylefttheAAGBIandIhopethatourassociationwithhersuccessor,RebeccaBatson,willbeasharmonious.IfyouchangebankaccountsorwishtoresignfromtheAssociationpleasenotifytheadministratorpromptlyasthissavesusagreatdealoftimeandmoney!AlistairCranstonHonoraryTreasurerMarch2016

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APAGBIProfessionalStandardsCommitteereportGuidelinesPublicationofAAGBI’supdateontheirbloodtransfusionguidelinesisimminent,itwillincorporateashortsectiononpaediatrics,whichPhillipArnoldhasproducedbasedonhissuccinctsummingupofthetransfusion‘HotTopic’information.AAGBIareproducingarevampedseriesofemergencyinformationforanaesthetistsinasimple,easytoaccessformthateasilyupdatedbasedonanAmericansystemcalledAriadne.ColinDrydenhasbeenmonitoringprogressonthisinitiative.The5yearlyILCORprocessforproducingupdatedresuscitationguidelineshasbeencompletedandthenewpaediatricguidelineswerereleasedonthe15thOctoberandpublishedinResuscitationandCirculation.TheEPLSmanualhasalsobeenupdatedandIhavebeenliaisingwithRC(UK)onresuscitationtopics.TheNICEfluidguidelineshavebeenreleasedandwerepublishedintheBMJinNovember.APAGBIhadstrongrepresentationbyChrisGildersleveonthisgroup,whichwaschairedbyPeterCrean.InformationInformationforbothprofessionalsandfamiliesonanaesthesiaandthedevelopingbrainhasbeenupdatedbySuellenWalkerandisavailableonthewebsite.TheGASstudyinterimresultshaveprovidedusefulandreassuringevidence.GPAS(GuidelinesfortheProvisionofAnaestheticServices)ThemechanismfordevelopingtheGPASdocumenthasbeenchangedandisnowutilisinga‘NICEstyle’evidencereview.ChrisGildersleve,KarenBartholomewandAlistairCranstonareleadingtheworkingpartyforthepaediatricsection.ACSA(AnaestheticClinicalServicesAccreditation)SimonCourtmanhasputinmanyhoursofworkonthepaediatricsideofthis.Inparticular,hehasmanagedtopersuadeRCoAthatpaediatricsshouldnotberegardedasaDomain5add-on,butasintegraltoDomain1-4forallhospitals.

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Hehasnowrefinedapproximately45paediatricstandards,togetherwithcirca40adultstandardsthatnowhaveapaediatriccomponent.Peerreview(PR)OurPeerReviewleadsareDebbieMarshandPeteStoddart.ThereappearstobeanewleaseoflifeforPR,especiallyforspecialisthospitalsafteruncertainperiodduetotheACSAlaunch.PRisstillregardedasvaluableprocesseitherstandaloneorasACSApreparation,especiallysincethedevelopmentsinACSAoutlinedabove.LinkmanschemeKarenandStephanieputtogetheraveryinterestingprogramfortheLinkmanmeetinginManchesteronthe9thNovemberandthiswaswellattendedandreviewed.SadlyKarenisreachingtheendofhertermandwillhavetodemitfromherverysuccessfultermasLinkmanLead.Happilythough,shewillremainonCouncilasaHomeMember.Wehave,howeveridentifiedanewLinkmanlead-NirmalaSoundararajan-shewilltakeoverfromKarenaftertheAGM.OtherorganisationsCSF–TheCSFStandardsforEmergencySurgerydocumenthasbeenpublishedandisavailableontheCSFsectionoftheRCSEngwebsite.ItisacompaniondocumenttotheStandardsforElectiveSurgeryandprovidesusefulinformationonemergencycare.PICSstandardsWehavefedbacksomeconcernsaboutthisdocument–inparticular,wefeltsomeofthestandardswereaspirationalandoverambitious.PICSarenotaskingusto‘badge’thedocumenthowever,soourinfluenceislimited.CQCTheCQChadaskedforcommentsontheirextremelylongandcomplex‘CYPcoreserviceinspectionframework’document.OurcommentswerereturnedviaRCoA.ACCEATheresultsfromthe2015roundarenowavailable.The2016roundisopenandclosesonthe16thMay.AnemailtoallmemberswascirculatedaskingthoseseekingAPAGBIsupportforthe2016roundtosubmitaCVQbythe15thApriltoallowtimeforrankingandcollatingofsupportingcitations.BobBinghamChair:ProfessionalStandardsCommitteeMarch2016

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APAGBIEducationandtrainingcommitteereportChair:MarkThomas

Members:MarkThomas,TeresaDorman,NargisAhmad,SumitDas,AndyBlevin,MaryLane,ElinJones

Wehaveenjoyedanotherbusyperiodwithlotsofoutput.WemeetonceayearinJanandotherwiseconverseelectronically.

ElinJones,ourtraineerepresentativehasbeenverybusyorganisingatraineeresearchnetwork,whichIamsureshewillcoverinherreportinmoredetail.Thisisallowingtraineesfromdifferenttrustsandevenacrossdifferentregionstocollaborateonresearchprojectsandtapintothewealthofexpertiseandwisdomofoursciencecommittee.AnotherareaElinandothershavebeenworkingonistheArticlewatchfeatureofthewebsite.Todate,twoquarterlysummariesofrelevantarticleshavebeencondensedintoaninformedcommentaryandthisisarealcredittoallinvolved.ItisanideathatcamefromSPANZAoriginally,butsincetheirfeatureseemstohavedwindledalittleoflate,wehavetakenupthebaton.Bothresourcesareworthcheckingoutif,likeme,youhavedifficultykeepingupwithallthejournals!

Hottopics

Thesehaveprovedpopularwithmorethan150responsespertopic.Whilsttheyarenotintendedtoreplaceformalquestionnaires,theyseemtobeachievingtheirgoalofstimulatingmoreinformedcoffeeroomdiscussionsatleast.Itisalsoenvisagedthattheymightalsoformthebasisofideasfordepartmentaltalks.Thelearnedcommentariesthataccompanythefinalpollresultsarewellwortharead.Recenttopicscoveredincludeclearfluidfasting,preoperative

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carbohydratedrinks,cuffedETtubesandpremedication.Topicsuggestionsareverywelcome.

ASM

IhavebeeninvolvedintheplanningoftheASMforBelfastandBristolandIhopeyoufindtheplannedschedulesinterestingandthoughtprovoking.Wehavesomeexcellentspeakersandtopicslinesup.

Videoresources

Wehaveatwo-yearcontracttovideotheASM,startinginBelfast.Theideaisthatthesevideoswillbeavailabletomemberswhomaymissparallelstreamtalksorwhowanttousethetalksfordepartmentalmeetings.ThoseofyouwhomaybefamiliarwiththeESPAwebsitewillknowhowvaluableavideolibrarytheyhavebuiltupovertheyearsandwearelookingtocomplementthatresourceusingthesameplatform.

WebresourcesandApps

Thesepagesareconstantlymonitoredfornewerresourcesandupdatesarepostedontherelevantpages.Ifanylinksarenotworkingoryoucomeacrossanynewexcitingstuffpleaseletmeknow.

Revalidation

TeresaDormanisworkinghardonupdatingtheseresourcesinlightofthedevelopmentssincemostofushavebeenthoughtthefirstroundofthe5-yearrevalidationcycle.

Invitation

Ifanyonewantstocontributetoourgroupandorjoinourmerrybandpleasedogetintouch.

MarkThomas

March2016

mark.thomas@gosh.nhs.uk

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APAGBISCIENTIFICCOMMITTEEANNUALREPORT1.NewMembersTheAPAGBIScientificCommitteeaskedmembersinterestedinjoiningtheCommitteetosubmitanExpressionofInterestandCV.Wewelcomethefollowingnewmembers:

PeterBrooks Chelsea&Westminster,London DavidMason JohnRadcliffeHospital,Oxford VeluGuruswamyLeedsTeachingHospitalNHSTrust2.ResearchGrantsTheAPAGBIprovided£50,000forresearchgrantfundingin2015,and2awardsweremade:

Round1:£19,556wasawardedtoDrsDannieSeddon,SteveWatson,PaulHarrisonandAlistairCranstonfromBirminghamChildren’sHospitalandBirminghamUniversityfortheprojectentitled“PlateletfunctioninpaediatriccardiacpatientsaftercardiopulmonarybypassandExtra-CorporealLifeSupport(ECLS)”.

Round2:£27,619wasawardedtoSuellenWalker,TomEngelhardt,NargisAhmadandNadineDobbyatGreatOrmondStHospitalandAberdeentosupportUKdatacollectionfor"NECTARINE:NEonate-ChildrenaudiTofAnaesthesiapRacticeINEurope:UKparticipationinaEuropeanprospectivemulticentreauditofpractice"

3.NECTARINE Twentycentresenrolled(3inScotland;1inNorthernIreland;16inEngland)withrecruitmentstartdatesofApril1st-May1st.AcrossEurope,recruitmentdelayedfrom1stMarchto1stApril.

APAGBIFundingwillsupportcentralcollectionandentryof90-dayfollow-updatabySomersClinicalResearchFacilitystaffatGreatOrmondStHospital.

Ethicssubmissionapproved,withHealthResearchAuthorityapprovalforsitesinEngland(SSIformsforScotlandandBelfastsites).

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ThestudyhasbeenadoptedintotheNIHRClinicalResearchNetworkPortfolio,solocalInvestigators/CentresarealsoeligibleforsupportfromLocalClinicalResearchNetworks.

TheNationalCo-ordinatorsandAPAGBIScientificCommitteeacknowledgethesignificantamountofworkrequiredateachparticipatingcentreforsettingupthestudy,andgainingnecessaryR&Dapprovals.WewishtothankallLocalInvestigators,ConsultantsandSpRswhoareassistingwithdatacollectionandentry.

WelookforwardtoreportingresultsbacktomembersatafutureASM.4.Surveys,AuditsandQI Surveys:Difficultiesobtainingfeedbackandresultsfromauthorscontinue.Numberofsubmissionshavedecreasedinrecentyears.DavidMasonhasagreedtoassistwithSurveys.

VeluGuruswamywillactasSciComlinkwithQILeadSallyWilmshurst(QI&Audits)

PainatHome:resultspublished.WilliamsG,BellG,BuysJ,MoriartyT,PatelA,SunderlandR,ShepherdL,BrooksP,PolhillS.Theprevalenceofpainathomeanditsconsequencesinchildrenfollowingtwotypesofshortstaysurgery:amulticenterobservationalcohortstudy.PaediatrAnaesth.2015Dec;25(12):1254-63

5.AnaesthesiaanddevelopingbrainAnupdatedConsensusStatementwaspostedontheAPAGBIwebsiteJuly2015.APAGBIreviewedbutdidnotendorseSmartTotsstatement.

GASstudy:Resultsofinitial2-yearfollow-upreportedinLancet.CongratulationstoUKco-authors.

DavidsonAJ,DismaN,deGraaffJC,WithingtonDE,DorrisL,BellG,StargattR,BellingerDC,SchusterT,ArnupSJ,HardyP,HuntRW,TakagiMJ,GiribaldiG,HartmannPL,SalvoI,MortonNS,vonUngernSternbergBS,LocatelliBG,WiltonN,LynnA,ThomasJJ,PolanerD,BagshawO,SzmukP,AbsalomAR,FrawleyG,BerdeC,OrmondGD,MarmorJ,McCannME;GASconsortium.Neurodevelopmentaloutcomeat2yearsofageaftergeneralanaesthesiaandawake-regionalanaesthesiaininfancy(GAS):aninternationalmulticentrerandomisedcontrolledtrial.Lancet.2016Jan16;387(10015):239-50

6.AnnualScientificMeeting i)Belfast2016:abstractsubmission/revisionprocesses Abstractsreviewedandhighestrankingselectedfororalpresentationand posterprizesessions.DifficultiesnotedwithAAGBIsoftwareforabstract submission/notification.

ii)Bristol2017 Speakersuggestionsincludedinpreliminaryprogramanddiscussedwith MeetingsCommittee.

7.PaediatricAnaesthesiaTraineeResearchNetwork

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TraineeRep:ElinJonesTheScientificCommitteewishestoacknowledgesuccessofPATRNandworkbymemberstoconductprojects.PeterBrookswillactastheScientificCommitteeLiaisonwiththeTraineeNetwork,andbethefirstportofcallfordiscussions/advicerepotentialprojects.

SuellenWalker6-4-2016

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APAGBIMeetingscommitteereportMeetingsareusuallybytelephone,whichworkswellinconsideringtheprogrammeforameeting.Thenextface-to-facemeetingscommitteewillbeonthe9thofJune2016inLondon.

1. Belfasta. Programme:oneortwospeakerdetailsneedtobeconfirmedbut

thisisinhand.WearetryingtogetthedetailsoftheJRLtitlefromBrianKavanagh.

b. SocialprogrammeissortedandwehavearrangedacharitabledonationatMcHughesontheWednesdayevening.

c. CouncilmeetingwillbeintheHiltonontheWednesdaymorningthroughuntillunch.

d. Trade:Thishaspickedupandasofthetimeorwritingweshouldhave>10exhibitorsandmostofthesewillbeatfullprice.Wewillcontinuetopushthisbetweennowandthemeeting.

e. Abstracts:TheAAGBIsystemhasnotworkedwell.Thesubmissionwasworkablebutclunkybutthenotificationwasterrible.Myrecommendation(andScicom)isthatwedonotusethisagainandseekanappropriatealternativefortheBristolmeeting.ItisnotclearhowmuchoftheproblemistheAAGBIusersandhowmuchistheplatform.

2. SeptemberAAGBImeetinga. SpeakersandtopicsorganisedthroughCG.

3. Bristola. Programme,planningquiteadvanced.Oneortwofurthertelcons

andtheJunemeetingshouldenableustoissuethepreliminaryinvitationstospeakersbeforethelongHoliday.ThemeetingwillbeintheColstonhallontheThursdayandFriday,intheArnolfiniontheWednesday.

b. Social:thiswillbetheSSGreatBritainontheWednesdayandtheMuseumontheThursday.

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c. Trade:JudithandRachelwillgetoneoftheirgrouptotakechargeoftrade.

d. Abstracts:seeabove.4. Liverpool

a. Venuechosen,asarethesocialvenues.b. Meetingssecretaryforthisandsubsequentmeetingsneedstobe

chosen.ItistimeforthevenuesinSheffieldtobevisitedwiththeirlocalorganisers.

c. TheMeetingssecretaryforthiswillneedtopulltheprogrammetogetherstartinginJanuary2017.

JonSmith30thMarch2016

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TraineeRepresentative’sReportThepastyearhasseenseveralnewinitiativesaimedattheAPAtraineemembershipcometofruition.PaediatricAnaesthesiaTraineeResearchNetwork(PATRN)Thenewpaediatricanaesthesiatraineeresearchnetwork(PATRN)hasbeenformallyestablished.PATRNisrunbyacommitteeofthreeAPATraineemembers,includingmyself.Therearecurrentlyover50APAtraineememberscoveringmostareasoftheUKwhohaveeitherregisteredaninterestorhelpedcollectdatatowardthefirstprojects.FromthehospitalswithPATRNtraineerepresentationwecontactedlocalauditleadstoinformthemofournetworkandinviteanyquestions.Todate,twoprojectshavebeencompleted:apost-tonsillectomyanalgesiasurveyandasurveyonanaesthesiaforidiopathicscoliosissurgery.Wewelcomeprojectideasfromallourmembers,andallparticipantsworkisrecognisedwithevidencefortheirRCoAportfolio.WearecommunicatingwiththeResearchandAuditFederationofTrainees(RAFT)inordertoco-ordinateourworkwiththemandothertraineeresearchnetworks.AttheASMinBelfast,wewillusepartoftheEducationandTrainingtableattheexhibitionfairtopromotethepotentialofthisnetworkandhopefullyrecruitmoretrainees.ArticleWatchWebsiteFeatureAlongsidetheEducationandTraineecommittee,Ihavebeenresponsibleforthenewwebsitefeature‘ArticleWatch’whichaimstopublishasummaryofrecentarticlesrelevanttopaediatricanaesthesia.Thefeaturerunsquarterlyandincludesapickofaroundtenarticlesofnotableinteresttohelpprovideaquickoverviewofrecentpublications.Theaimistoincludenotonlythosewhicharehighlyrelevant,butothersofinteresttuckedawayinjournalsthatourmembersmaynotsubscribeto.Alinktothearticlewillbeincludedwiththesummaryforease.Severaltraineeshaveexpressedaninterestinhelpingtowritethecontent.ExamQuestionWritingGroupAnexamquestion-writinggrouphasbeenestablishedwithanumberofAPAtraineemembers.ThegroupaimsaretoimprovethecontentofthetraineeFRCAsectionofthewebsite,andkeepFRCAresourcesuptodate.Anumberofquestionshavebeenwritten,andwillbereadytouploadtothewebsitesoon.CorrespondencefromtraineesTheestablishmentofPATRNledtoasurgeincorrespondencefrominterestedtrainees.Asidefromthis,anumberoftraineescontactedmetocommentonthehelpfulnessoftheCVreviewingofferedtotieinwiththe‘CareerDevelopment’

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tableatASMexhibitionfairinAberdeen.IwouldliketothanktheconsultantswhohelpedreviewtheCVsandofferedfeedback.IhavebeencontactedforadviceregardingfellowshipapplicationsandfindtheAPAtraineehandbookausefulresourceforassistingAPAtraineememberswiththeseenquiries.TherehavebeenexpressionsofinterestintheroleofAPAtraineerepresentative.IwillhavecompletedtwoyearsastraineerepresentativeinMay.Wewillbelookingatholdinganelectionformyreplacementlateronintheyear.ElinJonesMarch2016

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ReportonRCoAAnaesthesiaClinicalServicesAccreditation(ACSA)forChildrenIhaveattendedtheACSAcommitteemeetingsattheRCOAtodiscussthebeststrategyforaccreditingdepartmentsprovidingchildren’sanaestheticservices.TheinitialproposalfromtheRCOAACSAteamhadbeentohaveaspecialistACSAsetofpaediatricstandards(calledadomain5ACSA)basedonGPAS(GuidelinesfortheProvisionofAnaestheticservices),whichcouldbecompleted,byhospitalswhilstundergoingthegeneralbroadACSAprocess(domain1-4).However,aftersomediscussion,theRCOAACSAteamrecognisedthatchildren’sservicesareprovidedinalmosteveryhospitalintheUKandthatthechildren’sstandardswouldinfactbebestpositionedwithinthemainACSAprocess(domain1-4).WeseethisasaverypositivestepbytheRCOAinrecognisingtheprovisionofanaestheticservicesforchildrenasanessentialpartofeveryanaestheticdepartment.Subsequently,wehavebeenworkingtointegratetheexistingstandardsintothemainACSA1-4document.Thishasrequiredseveralreviewsandrefinementsandafinaldraftisnownearcompletionandwillbepilotedinthecomingyear.Itisdesignedtobeapplicabletoallcentres,fromspecialistcentresthoughtosmallDGHs,whowouldallbeexpectedtomeetthestandardswithinGPAS.SimonCourtmanMarch2016

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GuidelinesDVTprophylaxishasbeenalongtimeingestation,butJudithMorganhasbeenworkinghardwiththeothermembersofthegrouptobringtheworktofruition.Judithreportssignificantprogressandisoptimisticthatcompletionisnotfaroff.Thishasbeenasignificantundertaking,whichshouldbewellworththeeffortofJudith,buildingonthefoundationslaidbyMatthewChecketts,andtheothermembersofthegroup.PONVguidanceisdueforrevision.AlisonCarrhashandedovertheleadroleforthisguidelinetoSimonMartin.Simonreportsthatheisworkingtoupdatetheformat,referencesandrecommendationsandisexpectingtohavetherevisedversionsubmittedtoCouncilverysoon.Consentforimagingunderanaesthesiaismakingprogresstowardsarecommendationforbestpractice.ContactshavebeenestablishedwiththeRCPCHandtheRoyalCollegeofRadiologistswiththeintentionofproducingarecommendationandtemplatefortheconsentprocessinchildrenpresentingforMRIscanningunderanaesthesia.Theaimistoproducedocumentedevidenceofasatisfactorydiscussionwithparents/patientscoveringbenefitsandrisks,therebyallowinganinformedchoicetoproceed.

PatientInformationTobyhasananaesthetichttps://youtu.be/Qgf0kFPrYV0isananimatedvideoproducedbyLauraMcLellandwiththesupportoftheAPA,whichisaimedtohelpprepareyoungerchildrenforahospitalvisitforsurgery.ThevideosharesitsaimswiththeReesBearandDavytheDetectiveleafletsproducedafewyearsagofortheAPAandRCoAbyJudithShortandJosieBrown.WearecurrentlyexploringthepossibilityofusingLaura'sanimationexperiencetoproduceafreeappfeaturingReesBear.ColinDrydenGuidelinesandPatientInformationLead

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QualityImprovementThisyeartheAPAappointedaQualityimprovement(QI)LeadwiththeaimofhelpingmembersundertakesuccessfulandusefulQIprojectsattheirhomeorganisationsaswellasinformingAPAguidelinesandinitiatives.Theintentionistoachievethisthroughtrainingandeducation;peersupportandcollaborationswithotherinstitutions.Training&EducationAPAGBIScientificMeeting,Aberdeen2015DrSuellenWalkerchairedawell-receivedsessiononQIinitiativesatthelastAPAmeeting.DrDeanKurthgaveaninspiringtalkaboutthewayinwhichhisorganisation(CincinnatiChildren’sHospital)undertooktheculturalchangerequiredtobecomealeadcentreinNorthAmericaforpaediatricQI.IgaveatalkaboutQIatamorepersonallevel,withtheaimofencouragingandengagingmemberstoundertaketheirownQIprojectsinareasofmostinteresttothem.DrMikeSurytalkedabouttherelevantfindingsofNAP5,accidentalawarenessinchildren.APAGBIScientificMeeting,Southampton2017PlansareunderwaytoholdanotherQIsessionduringthismeeting,toincludeabdominalsurgeryinchildren,NAP6andotherQIprojects.OnlinetrainingAblueprintforanexampleQIprojectisindevelopment.TheaimisthatmemberscanusetheblueprinttorunaQIprojectinasimilarwaytootherorganisations,whilstbeingabletoretainindividuallocaldifferences.QIstudydayWeareplanningaQIworkshopstudydaytocoversomeofthebasicprinciples,suchasmeasurementforimprovementandPDSAcycles.OtherItishopedthataQIabstract/presentation/prizesectioncanbeincorporatedintofuturemeetingstoencouragememberstofollowQImethodologyintheirwork.PeersupportThereisaQIemailaddress–QI@apagbi.org.ukwhichwillbedisseminatedwiththeblueprint.

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CollaborationIattendedameetingwithDrRamaniMoonesinghe,DirectoroftheHealthSciencesResearchCentre(HSRC)attheRoyalCollegeofAnaesthetistsinFeb2016todiscusspaediatricinvolvementinthePerioperativeQualityImprovementProgramme(PQIP)andotherresearchinitiatives.Itwasidentifiedthatperioperativeriskstratificationinchildrenisrarelyused,makinginvolvementinPQIPdifficult,howeverthishighlightedanareaforfurtherresearch.AQIprojectfromManchesteronemergencylaparotomyinchildrenwaspresentedbyDrRussellPerkinsanditwasfeltthishadpotentialasanationalQIproject.SallyWilmshurstApril2016

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ReportontheAPAGBIWebsiteandSocialMedia Thewebsite(www.apagbi.org.uk)hascontinuedtobeapopularpointofreferralforinformationandeducationandhashada20%increaseinitsusageoverthelastyearwithabout3000visitspermonthandover8000pagesviewed.Thisincreaseseemstobeattributabletotheregularupdatesonguidelinesandmeetings,andtheeducationalcontent.Thenewinteractivepollonthefrontpagehasbecomeparticularlypopulararoundtheglobe.WearehopingthisyearaftertheASMinBelfasttoprovidevideostreamingofthelecturesviathewebsiteasthiswasoneoftherequestedfacilitiesfromthemembershipinrecentquestionnaires.Thesoftwarewhichcreatesthewebsiteisdueforanupgradesoonandthismayalsoallowsomeincreaseininteractivefacilitieswhichwillbeusefulforfurthereducationalcontentandresources.TheTwitterandFacebookdataalsoshowsanincreaseintrafficwithTwitterfollowersincreasingfrom50toover200followersandFacebooklikesclimbingtoover2000.Twitter(@apagbi)hasbecomeaverypowerfulwayoflinkingnetworksandorganisationsaroundtheUKandtheworldandallowsrapidsharingofinformationsuchasnews,meetingsdetailsandinterestingarticles.SimonCourtmanAPAWebmasterMarch2016

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APAGBILayRepresentative’sAnnualReportI have had another very enjoyable and rewarding year as the laymember onCouncil at the APAGBI, looking out for the interests of children experiencinganaesthesia,andtheirfamiliesandcarers.

1. Children’s Surgical Forum – I continue to be a participant of thisimportant forum that provides guidance on standards for children’ssurgeryandgetsmanyofthosewhomakeupsurgicalteams–includingsurgeons, anaesthetists, nurses – together to debate important issuesaround children’s surgery. Standards for emergency non-specialistsurgery for children were developed by the group and published thisyear.

2. Commissioning–IremainamemberoftheSpecialisedChildren’sSurgery

E-02 Clinical Reference Group (CRG) as a lay representative from theAPAGBI.OurworkiscurrentlyonholdwhilstthecommissioninggroupsarerestructuredbytheNHS.

3. Safeguarding–IhaveworkedwithKathyWilkinsonandotherpaediatric

anaesthetists on the development of a joint APAGBI/RCoA initiative todevelopamicrosite,includingatrainingfilm,onsafeguarding.

4. Patient Information – The APAGBI produced a very clear piece of

guidanceforparentsonanaesthesiaintheveryyoung,inparttorespondto a potentially quite alarming publication from elsewhere. There havealso been some interesting discussions on other types of patientinformationsuchasappsandananimationproject,introducedbyColin.

5. PeerReview–ItookpartinthePeerReviewattheHampshireHospitals

FoundationTrust(BasingstokeandWinchester)withDeborahMarshandotherson18/19May.

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6. ACCEA – I was invited to consider this year’s applications with KathyWilkinsonandothersonCouncilinJune2015.

SaraPayneAPAGBILayRepresentative30March2016

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APAGBILinkmanReportAnothergoodyearfortheAPALinkmanScheme!YetanothersuccessfulLinkmanmeetingwasheldinManchesterlastNovember2015,asopposedtoLondon,forachange.Themeetingwaswellattendedinspacioussurroundings,no“floorseating”wasnecessary,discussionflowedandthedelegatefeedbackwasextremelypositive.Inresponsetothepositivevibethat“OutofLondonmeetings”sendoutastrongmessageofinclusivity,wehavedecidedtoholdthe2016meetinginBirmingham,onMon7thNovember2016.Atthe2015LinkmanMeeting,aparticularlyimportantissuewasraised;thatofthecontinuedandongoing“deskilling”inpaediatricanaesthesia,inthedistricthospitalsetting,foravarietyofreasons,andalsotrainingandconfidenceissuesinnewlyqualifiedconsultants,wrtpaediatricanaesthesiawerehighlighted.AsadirectresultoftheLinkmanmeeting,AndyWolfhasescalatedthisissueinperson,toJackieCornish,theUKMedicalDirectorforPaediatricServices.Thankyoutothoseofyouwhohavesentinadditionalanddetailedinformationwrtyourownsituations.Thisisinvaluableandgreatlyappreciated.TherecentlyinductedAPAsupportschemeforregionalmeetingshasbenefittedthefournetworks,whichhaveappliedsofar,andisopentoallwhoapplyforsupportforvisitingspeakersandtraineeprizes.Pleaseapply,astheAPAwantstosupportyourmeeting!YoucanaccesstheinformationandformsyourequirefromourLinkmanpages:http://www.apagbi.org.uk/professionals/apa-linkman-schemeIndividualscanmakeadifference.JustonemessagefromanAPALinkmancansparkadiscussion,soifyouhaveanissuetoraise,pleasedoso.KarenBartholomewApril2016

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Report to APAGBI Council May 2016 Author: Upma Misra (Co-opted AAGBI Council Member & Managing editor Anaesthesia News)

Working parties on guidelines

• Guidelines for the use of blood components and their alternatives 2016 were approved by the AAGBI Board in March.

• WP on the use of controlled drugs in Perioperative care has just had its first meeting on 11th April. The aim is to update the 2006 document and incorporate the new regulations from the DOH. This has representation from the home office, CQC and allied health professionals.

Conferences

• Badged APAGBI sessions planned for future annual congress and WSM. Steve Yentis (Chair of education committee) leading.

Safety

• The safety and standards committee is due to meet in April.

• The AAGBI and RCoA have agreed on a joint statement for a revised scope of practice for the PAAs. This was shared with the Association of Physician Anaesthetic Assistants. The college will hold a voluntary register for all PAAs. This will be at no cost to them. All members of AAGBI and fellows of the college will be advised to work only with people with their names on this register. Please note this is not a regulatory role. A joint statement from the presidents of AAGBI and the RCoA is to be released in the new future. Anaesthesia News is looking for new contributions and would like to encourage members of the board to submit material that they might deem to be of interest to our members.

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PICSAnnualreportPICScouncilcontinuedundertheleadershipofPresidentPeterWilson.OtherOfficerpositionsareunchangedfromlastyear.Peter-MarcFortunecontinuesasMedicalVice-President,OliverBagshawcontinuesasTreasurerandJeffPerringcontinuesasSecretary.FionaLynchistheNon-MedicalVicePresident,buthasbeenonmaternityleavethispastyear.ThisisallgoingtochangeinSeptember,whenthePresident,SecretaryandTreasurerallchange.PICSwillalsohavetoappointanewrepresentativetotheAPA.ThemajorchangetoPICSisthatfollowingourmovetobecomeacharity,wehavenowtakenthisonestepfurtherandon1stAprilbecameaCharitableIncorporatedOrganisation(CIO)andnowhaveanewconstitutiontoreflectthis.Thisdoesnotchangetheday-to-dayrunningoftheorganisation,butgivenourpreviousfinancialdifficulties,thisnowremovesmostofthefinancialresponsibilityfromtheTrustees.FormerPresident,KevinMorris,wastheChairaWorkingGrouptaskedwithupdatingthePICSStandardsdocument.ThiswasundertakeninconjunctionwiththeWestMidlandsQualityReviewService.Version5oftheStandardswaspublishedinFebruary2016.Aspreviously,thesearecorestandardsandmorespecificguidanceincertainareasmayneedtobeagreedbyCouncil.TraininginPaediatricIntensiveCarehaschanged,withthedisbandingofICTPICMandtheformationofanewtrainingbody,PICMICSAC.ItwillincluderepresentationfromtheRCPCH,PICS,FICM,andtheRCoA.Infuture,anaesthetistswhowishtohavetheirtraininginPICUaccreditedwillhavetoentertrainingthroughFICM.AnyundertakingGridtrainingwillnothavetheirtimeaccreditedbytheRCoAandwillhavetobeconsideredforequivalenceatthetimeofapplyingforaPICConsultantpost.Membershipcontinuestogrowandwenowhavenearly700members.Emphasisthisyearhasbeenonhowtoincreasethenumberofnursingmembers,astheyareahuge,untappedresource.

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TheSociety’swebsiteandlogohavebeenupdatedtogoodeffect.Wearenowemployingaprivatecompanytoundertakethemaintenanceandupdatingofthewebsite.TheAnnualScientificMeetingwasheldinBirminghaminSeptember2015.Itwasanextremelysuccessfulandwell-attendedmeeting,undertakeninconjunctionwithaFacultyfromToronto.Itturnedinasubstantialprofit.Itwasthefirstorganisedbyournewconferenceorganiser,IndexCommunications.The2016ASMisbeingheldinSouthampton.OliverBagshawHonoraryTreasurerandAPARepresentativeApril2016

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Nationalreports

AnnualReportfromScotlandDr.CarolynSmithEdinburghAPAMeeting:The2015APAannualgeneralmeetingwasheldinAberdeeninMay.ThelocalorganisingcommitteefromAberdeenChildren’sHospitalprovidedaninterestingprogrammeincludingsessionsfromtheCongenitalCardiacAnaesthesiaNetworkandtheCongenitalCardiacAnaesthesiasocietyontheprecedingday.Themeetingwaswellattendedandprovidedsomeunusualworkshops;bagpipeplaying,aswellasthemoretraditionalonesofhumanfactors,neonatalresuscitationetc.AvariedsocialprogrammewiththehighlightbeingtheannualdinnerheldintheArtDecoBeachBallroom.SPAN:AsomewhattruncatedAGMwasheldoverlunchattheAPAmeeting.Theeducationday,intheTeacherBuildinginGlasgow,washeldinNovember.Thisonceagainprovedpopularasithadagoodmixofsessionsforthenon-specialistpaediatricanaesthetists.Thetopicofthemeetingwas“CriticalCareUpdate”.Theusualformatoflecturesinthemorningsessionfollowedbyworkshopsintheafternoonprovidedaninterestingandinstructiveday.The2016AGMwillbeheldinGlasgowintheTeachersBuildingonthe13thofMay.Theprogrammewillbeavailableonthewebsitesoonbutisrumouredtofeatureanupdateonfluidguidelines;atraineepostersection;neonatalpresentationattheA&EandM&Mcasesfordebate.Forfurtherinformation:www.span.scot.nhs.ukAPRICOT:ScotlandhashadafantasticrecruitmentrateintotheAPRICOTstudy,largelyasaresultofthethrivingSPANnetwork.Retirement:2015sawtheretirementofoneofPaediatricAnaesthesianotablefigureheads–NeilMorton.TheRoyalhospitalforChildren:ThenewstateofthearthospitalopenedinGlasgowinMayofthisyearwithafondfarewellbeingsaidtotheoldYorkhill.ForthoseinterestedthereisaU-Tubeshortfilmwithalltheusualsuspectssayinggoodbye.EdinburghRoyalHospitalforChildren:BuildingisnowwellunderwayattheLittleFrancesitewiththeplannedopeninginSeptember/October2017.SCCCSS:TheSLWGonpaediatricsurgeryhasbeenongoingandduetobepresentedinSpring2016.Mr.FraserMunro(ConsultantPaediatricSurgeon)tookoverthemantleofchairoftheSCCCSS.Scotstar:

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InitialteethingproblemsdelayedtheimplementationofthesinglepaediatricretrievalserviceononesiteatitsnewbasenexttoGlasgowairport.Thisshouldnowbefullyfunctionalfromthe1stofApril2016.PICU:AlthoughtherehasbeenanoverallincreaseinthenumberofPICUbeds,demandseemstobeeverincreasing.Dr.CarolynSmithAPAGBIScottishNationalAdvisorMarch2016AnnualReportfromWalesDr.ChrisGildersleveCardiff

ProtonBeamtherapycentreNewscomestousfromarathercircuitousroutethatthecompany,“ProtonPartnersInternationalCentre”hasopenedaprivatelyfundedcancertreatmentcentrejustoutsideNewportinS.Wales.TheyplantotreatNHS,privateandself-fundedpatientsinitiallywithchemotherapyinearly2016,followedbyPETCTandRadiotherapylaterintheyear.ThiswillbefollowedbyProtonBeamtherapyin2017,andthiswillbethefirstsuchcentreintheUK.Naturally,beingthefirstfacilityintheUKtoofferProtonBeamtherapy,thiswillattractreferralsofchildren,(predominatelyNHSreferralsIwouldimagine),fromallovertheUKfortreatment,manyrequiringaGA.JudgedsolelyonthelimitedemailcorrespondencethusfarIgettheimpressionthatthishasnotbeenfullythoughtout,andtheimplicationsofgeneralanaesthesiainanisolatedcentre,withnoinpatientfacilitiestospeakof,withouttheintegratedcareortransportteamaccessthatisneededforsomereallysickchildren,Ifearthataseriousrealitycheckwillberequired.AmemberofthemanagementteamisduetomeetCardiffandValeHealthBoardrepresentativesinearlyApril2016.TheonlyrealisticsolutionwouldbeaformalSLAwiththisnewfacilitythatmirrorsthearrangementwithourlocal,(andseparate)Radiotherapyhospital.Weawaiteventswithsomeconcern.SCBUclosureandSurgicalDeaneryvisitTheSCBUinCardiffwasclosedtonewadmissionsfornearly6monthsfromAugust2015asaresultofendemicAcinetobacter.AsaconsequencewewereunabletorunaneonatalsurgicalserviceforSCBUbasedbabies.ThiscoincidedwiththeSurgeryDeaneryvisitandthepaediatricsurgicaltraineeswererelocateduntilsuchtimeasneonatalsurgicalthroughputimproved.Atertiarycentrenotdoingitsprimaryactivityisanuncomfortableplacetobe,withdecayinskillsofthewholepaediatricteamanobviousconcern.FortunatelyarelocatedSCBUreopenedinFebruary2016andsurgicalthroughputhasbeenrestored.Howeverconcernsremainwithrespecttoalackofsuccession

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planningonthepaediatricsurgicalsidefollowingtheretirementofthetwoseniorsurgeons,andthesurgicaltraineeshaveyettoreturn.PAGWandMEPAFCThe2015AnnualScientificMeetingtookplaceinNovemberinLlandrindodWells.OneoftherecurrentthemesfromrecentPAGWmeetingshasbeenthedesireforDGHconsultantstohaveaccesstorefresheropportunitiesinCardiffandforupdatesinresuscitation.Wehaveofferedtheformerforanumberofyears,thoughtheuptakehasbeenpoorrecently.AttheLlandrindodWellsapresentationonMEPAFCwasverywellreceivedandconsequentlythefirst(Welsh)MEPAFCcoursetookplaceinearly2016withsupportfromPAGW.Thesecondofthesecourseswilltakeplacelaterintheyear.DemandappearstobehighandthisIfeelreflectsthegrowinguneasewithinmanysmallerunitsattheprospectofresuscitationoftheoccasionalsmallchildthatmayturnupinA&Eatanytime.The2016PAGWmeetingwilltakeplaceinN.Wales,withareturntoBetws-y-coed,onthe10th-11thNovember.PlanningisinitsearlystagesanddetailswillbepostedontheAPAandPAGWwebsitesinduecourse.ThecommitteehasundergonequiteanoverhaulthisyearwithbothSecretaryandPresidentreachingtheendoftheirtermsofoffice.WeareallverygratefulforthevisionandthehardworkofGillDunnandSimonWhittakeroverthepasttwo(+)years.TheincomingofficersMaggieCollingbourneandFelicityHowardhaveaconsiderablein-traywithcommitmentstore-launchthewebsiteandhaveagreater,andmoreformalcommitmenttoLinkmanandNetworkactivity.PICUtransportserviceThejointlycommissionedSWalesandSWesttransportteamforchildren(WATCh)startedworkinSeptember2015.Avastgeographicalareaiscoveredbythisteam,fromtheextremeSWestofEnglanduptoAberystwythonthemid-Walescoast.TheHQislocatednearBristolthoughtheteamisjointlystaffedwithcliniciansandnursingmembersfrombothCardiffandBristol,assuaginginitialfearsthattherewouldbeBristoldominancetotheservice.ACSACardiffhadageneral,(Domains1-4),ACSAvisitover2daysinOctober2015.ItwasinterestingtocomparetheprocesswithAPAPeerReview.WeremainavolunteersiteforPaediatricACSAasandwhenthisisreadyforroll-out.PreoperativepreparationvideoDr.LauraMcClellandwastherecipientofanAPAnon-researchgrantin2015.Hercompletedanimationproject,“Tobyhasananaesthetic”,hasreceivedravereviewsandmaybefoundontheAPAwebsiteat:http://www.apagbi.org.uk/children-and-young-people/videos-childrenThevideomayalsobeviewedonYouTubeandtheNoah’sarkChildren’sHospitalforWaleswebsites.ItisalsoavailableasadownloadableappformatforiPadandiPhoneandiscalled“soundasleep.”(fullstopincluded!),intheAppstore.

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Dr.IsabelAguileraIsabel,aclosefriendandcolleagueinCardiffandawonderfulhumanbeing,passedawayinNovember2015afterashortillness.SheisandwillbesorelymissedbyallinCardiff,herfamilyinSpainandfriendsandpatientswhoselivesshehastouchedthroughouthercareerintheNHSandinherworkwithORBIS.AmemorialservicewasheldinCardiffinFebruary2016.SalutandrestinpeaceIzzy.ChrisGildersleveCardiffApril2016

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ISOandequipmentreportDr.HarveyLivingstoneReportfromtheinterimmeetingoftheInternationalStandardsCommitteeTC121/SC2HostedbyIntersurgicalattheirheadquartersinWokingham,UK.1st-3rdDecember2015In recently attended the interim meeting of the International StandardsOrganization (ISO) committee TC/121, sub-committee 2 (SC2). The committeeoverseesstandardsrelatingto“anaestheticandrespiratoryequipment"andIsitas a clinical expert and representative of theAAGBI andAPAGBI. ThemeetingwashostedbyIntersurgicalUKattheirheadofficeinWokinghamduetoalackofavailableroomspaceattheBritishStandardsbuildinginLondonthatweek.Themeeting was well attended with representation from the UK, USA, Germany,Ireland and Italy amongst others and I was one of three clinical anaestheticexpertspresent.ISO/TC121/SC1 BreathingattachmentsandanaestheticmachinesISO/TC121/SC2 AirwaysandrelatedequipmentISO/TC121/SC3 LungventilatorsandrelatedequipmentISO/TC121/SC4 TerminologyandsemanticsISO/TC121/SC6 MedicalgassystemsISO/TC121/SC8 SuctiondevicesforhospitalandemergencycareuseTheSC2overseesthefollowingstandards:ISO5361:2012 Anaestheticandrespiratoryequipment--TrachealtubesandconnectorsISO5362:2006 AnaestheticreservoirbagsISO5364:2008 Anaestheticandrespiratoryequipment--OropharyngealairwaysISO5366-1:2000 Anaestheticandrespiratoryequipment--Tracheostomytubes

Part1:TubesandconnectorsforuseinadultsISO5366-3:2001 Anaestheticandrespiratoryequipment--Tracheostomytubes

Part3:PaediatrictracheostomytubesISO5366-3:2001 Cor1:2003ISO5367:2014 Anaestheticandrespiratoryequipment--BreathingsetsandconnectorsISO7376:2009 Anaestheticandrespiratoryequipment--LaryngoscopesfortrachealintubationISO8836:2014 SuctioncathetersforuseintherespiratorytractISO11712:2009 Anaestheticandrespiratoryequipment--SupralaryngealairwaysandconnectorsISO/TR11991:1995Guidanceonairwaymanagementduringlasersurgeryofupperairway

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ISO14408:2005 Trachealtubesdesignedforlasersurgery--Requirementsformarkingandaccompanyinginformation

ISO16628:2008 Tracheobronchialtubes--SizingandmarkingISO27427:2013 Anaestheticandrespiratoryequipment--NebulizingsystemsandcomponentsStandardsunderdevelopment:ISO/FDIS5361 Anaestheticandrespiratoryequipment--TrachealtubesandconnectorsISO/FDIS5364 Anaestheticandrespiratoryequipment--OropharyngealairwaysISO/DIS5366 Anaestheticandrespiratoryequipment--TracheostomytubesISO/FDIS14408 Trachealtubesdesignedforlasersurgery--Requirements

formarkingandaccompanyinginformationISO/DIS17256* Anaestheticandrespiratoryequipment--Respiratorytherapytubingandconnectors ISO/DIS18190 Anaestheticandrespiratoryequipment--General

requirementsforairwaysandrelatedequipment*ISO/DIS17256isintheprocessofbeingcancelledduetotheformalwithdrawalofISODIS80369-2The meeting began with a roll call of delegates, appointment of the draftingcommittee and a report from the secretariat. We then received a number ofliaisonreports fromothercommitteeswhosestandardshavean impactonourwork.UpdateregardingSmallboreconnectors(ISO80369)IthasbeendeterminedthatR1respiratorygasconnector(forgassamplinglinesetc) can mis-connecter with 11 other connectors and is therefore not fit forpurpose.Ithasbeenredesignedandaprototypewasshowntothecommittee.

Due to delay in producing a standard for this connector the standard forrespiratorytherapytubing(ISO17256)willbecancelledasitreferencestheR1andR2connector.Problemswerealsoreportedduetothefactthattheinternal

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dimensions for15mmcones&socket connectorhasneverbeendefined in therelevantstandardandthisalsogivesthepotentialformis-connection. Thestandardforthecommonnippleandcone(fir-tree)connectoriscurrentlyaEuropeanstandard,EN13544-2,andweaimtoreplaceitwithISO17256whenitisre-introduced.Asummaryofwhichconnectorsarepermissibleandwhereinthesystemwaspresentedtothecommittee,themostpertinentpartsofwhichIhaveincludedbelow:

The standard for tracheal tubes for laser surgery is progressing well andenteringitsfinalstagebutunfortunatelyISO5364(oropharyngealairways)and5361 (tracheal tubes) has been rejected by theEuropean standards bodyCENduetotheirannexZA’sbeingunacceptable.TheannexZAisadeclarationinthestandard which states how the device complies with the EU directive89/106/EEC, which gives general requirements for medical devices whichconfersapresumptionof fitnessofpurposefortheproducts fortheir intendeduse which maintaining the voluntary status of the standard. Mr LongmanexplainedthatthesecretarywilldiscussthecommentswiththeappropriateCENconsultant.

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LaryngoscopybladesandhandlesISO7376InmypreviousreportsIdocumentedaconcernthathadneedraisedregardingtheuseof blades requiring a3v supplywithhandlesproviding6vwhichhavecome to the market for use with LED type blades. Dr David Scott hasinvestigated this further and now suspects that the risk may well have beenoverstated as the internal resistance of the battery prevents a large currentflowingandthefilamentinthebulbactsasafuse-makingexplosionofthebulbunlikely.Some further investigationswillbedoneand ISO7376maywellgo tosystematicreviewratherthananewworkitemaswaspreviouslysuggested.AnaestheticreservoirbagsISO5362Thisstandardhaspasseditsfinalstageandwillbepublished.ItwasnotedthatthisstandardreplicatestheEuropeanstandardEN1820andweshouldconsiderharmonisingthesestandards.TracheostomyTubesISO5366Thestandardfor(adult)tracheostomytubesisatthedraftinternationalstandard(DIS)stageandtherewereanumberofcommentsonthedrafttoconsiderwhichtookthegreaterpartofafullday.Whilemuch(oftencircular)debatetookplaceovervariouspointsthehighlightswere:

• Sometracheostomytubeshaveasuctionchannelorotheradditionalfeature,whichprotrudesfromthewall,increasingtheoverallexternalsizeofthetubeandhowthisshouldbedeclaredtotheuser.Itwasdecidedthattheoutsidediameter(OD)wouldbemeasuredexcludinganysuch“PROTUBERENCES”butthemaximumoutsidemeasurementwouldbedeclaredintheinstructionsforuse(IFU).

• Aspreviouslymentioned,a15mmconecanadmitanumberofothersmallboreconnectors.Themanufacturerswillberequiredtocarryoutariskassessmentontheproductwithregardtothis.

• Arecommendationaddedsuchthatthepresenceofaninnertubecanbeeasilyidentifiedwithouthavingtodisconnectthebreathingsystemtube.

• Adiscussionaroundthetestmethodologyforleakagepastthecuff(ifpresent).Itwasfeltthatthecurrenttestmethodhadlittlevalueorclinicalrelevancesohasbeenremovedandabetteronewillbedevelopedintime.

• Thestandardreferstocertainpartsoftheproductsbeingfreefromsharpedgesbutitwasunclearhowasharpedgeisdefinedandtestedfor.Anumberoftestmethodsweresuggestedinvolvingapplicationofthedevicetoasensitivehumanbodypartoritsabilitytodamageladieshosieryandeventuallyconsensuswasreachedbyarequirementtocarryoutariskassessment.

FireSafetyValvesISO12911Thisisanewstandardfordevicesthatautomaticallyarresttheflowofoxygeninrespiratorytherapytubinginthepresenceoffireandiscurrentlynofurtherthanaworkingdraft.Thesedevicesarecurrentlyusedpredominantlyinthedomiciliarysettingtopreventtherapidspreadoffireinoxygen-enrichedenvironments.

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Thediscussionsfocusedonthebasicwordingofthestandardandensuringitisscientificallycorrectwithrespecttothephysicsandchemistryoffireanditwillbegintoprogresstoitsfirstcommitteedraftatwhichpointitwillbecirculatedforcommentbythememberorganizations.

Photographofanexampleofafire-breakdevice(arrow)inrespiratorytherapy

tubingandnasalcannula.GeneralrequirementsforairwaysandrelatedequipmentISO18190Thisisanewstandardwhichtakesclausesthatareusedintwoormoreotherstandardsandbringsthemtogetherintoageneralstandardwhichcanbereferredbyotherrelatedstandardstososimplifyingthepreparationofthestandardsforspecificdevices.Thekeypointsdiscussedandresolvedincluded:

• Definitionsarounduseinamagneticfield• Phthalates–theirpresencemustbedeclaredandjustified(cf.

simplydeclared)• Latex–thiswasagaindiscussedandIhavedescribedinmy

previousreportsthattheFDAdoesnotrecommendtheuseofa“latexfree”symbol,asthisinrealityisvirtuallyimpossibletoguarantee.Theclinicalperspectivegenerallywasfelttobethatsomesortofsymbolsuggestingtheproductislatexfreeismorereassuringthanthelackofasymbolindicatingthepresenceoflatex.Ourcommitteesecretary(CindyEngelhardt)hassincediscoveredthatthestandardISO15223-1maywellallowsuchasymbolsoacompromisemaywellbepossible.

• Thetestmethodologyforradioopacityofairwaydevices(ifdeclaredasbeingafeature)wasdefined.

On the final day we were given the opportunity to tour the Intersugicalproductionfacilitywhichwasnotonlyfascinatingbutalsorequiredthedonningofsomeveryfetchingprotectiveequipmentforthosewithbeards.ManythankstoPeteratIntersugicalfortheinterestingopportunity.

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Themeetingconcludedwithareviewoftheresolutionsandthankstothechair,Working group conveners, secretariat and hosts. The next TC121meetingwilltakeplaceinChicago,USA16th-20thMay2016,whichIwillaimtoattendwithanationalmeetingattheBSIscheduledforApril.

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Appendix1ListofConsultationsinvolvingAPAGBICouncilduring2015/6:NICEGuideline:IVfluidsinchildrenandyoungpeopleinhospitalCSFStandardsfornon-specialistemergencysurgicalcareofchildrenRCoAGuidanceonProvisionofPaediatricAnaesthesiaServices(authors)PICS5thQualityStandardsforthecareofcriticallyillandinjuredchildrenRCPCHShortlistofoutcomemeasuresforacutegeneralpaediatricsNICEGuidelineCG132CaesarianSectionNICEGuidelineCG144Venousthrombi-embolicdiseasesSIVA/AAGBIGuidelinesonbestpracticeinintravenousanaesthesiaandTIVA-inprogressNHSEnglandConsultationonproposedchangestoClinicalreferencegroups(Paediatricspecialistservices)NICEqualitystandards-IVfluidsinchildrenNICEqualitystandards-DiabetesinchildrenandyoungpeopleRCoAAdviceonstandardsfordeliveryofpaediatricservicesingeographicallyremotesites/ITCsAAGBISafevascularaccessRCUKEmergencycaretreatmentplan(Advancedirectivesetc.)NHSEnglandCommissioningobesitysurgeryinchildrenwithseverecomplexobesitySSCSubmissionsonspecialistsurgerycommissioningNHSEnglandtopicengagement-ProcurementprocessforPET/CTservicesCQCChildrenandyoungpeople-FrameworkforinspectionsRCPCHStandardsfordevelopmentofclinicalguidelinesinpaediatricandchildhealthNICEGuidelineTransitionfromchildren'stoadultservicesNICEGuidelineMajortraumaandinitialmanagementNHSEnglandCRGcommissioningservicesE20aspecialisedchildren'ssurgery,anaesthesiaandacutepainservicesNECTARINEEndorsementNICEguidelineDevelopmentalfollowupofpre-termbabiesRoyalCollegeofEmergencyMedicine-EmergencycaredatasetRCPCHSedationinMRISmartTotsStatementAnaesthesiaandthedevelopingbrainCQCSafeguardingpolicy(viaCSF)GASStudyPressreleaseCQCAligningstandardsandguidancedocumentsforchildren'ssurgeryintheindependentsector