Acute pancreatitis is a common problem seen in the United Kingdom, with an incidence of 56.6 per 100,000 population.[1,2,3] Optimising management has been shown to reduce mortality and morbidity, and the British Society of Gastroenterology (BSG) published revised guidelines in 2005 to standardise treatment for this potentially life threatening condition.[4]The aim of this quality improvement project was to investigate and improve the initial management of acute pancreatitis in patients presenting to the Great Western Hospital (GWH) in Swindon between November 2012 and July 2013.Patients presenting to the surgical team during this time with a diagnosis of acute pancreatitis were identified for the initial data collection. Notes were prospectively reviewed and data collected allowing a comparison between management in GWH against BSG guidelines. Following this stage, a pro forma based on the 2005 guidelines was created and implemented, with the aim of raising awareness and standardising care among surgical staff. Following implementation of the pro forma, data collection was repeated between May and June 2013 to assess the impact of the intervention.Results revealed an improvement from 93% to 100% of patients receiving the correct diagnosis within 24 hours of presentation. Severity stratification within 48 hours of diagnosis improved from 75% to 88% and identification of aetiology also improved from 64% to 74%.The implementation of an acute pancreatitis management protocol and education of junior surgical staff has been shown to improve compliance with BSG guidelines at the GWH, and ultimately aims to improves patient care and outcomes.

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Methods A paediatric near-peer teaching (PNPT) group was set up to design, develop and deliver monthly virtual teaching sessions. This was based on the RCPCH Progress Level 1 curriculum. All ST1-2 trainees in the Wales School of Paediatrics were invited to attend these sessions. More senior paediatric trainees delivered both general paediatric and neonatal topics (including practical procedures). Results Forty-seven trainees from North and South Wales attended the sessions during the last academic year (2020)(2021). Feedback for the sessions has been extremely positive. Trainees feel that these virtual sessions are more relevant at their level and enjoyed teaching via peers. They opined the need for NPT and the emphasis on matching it to the RCPCH Level 1 Progress curriculum. Suggested areas for improvement included communication and study leave provision. Conclusion PNPT has benefited both attendees and facilitators. We hope this will foster interest in the academic pathway and equip trainees with transferable skills as future educators. Trainee feedback will be used to improve future PNPT sessions. In addition, we hope to share the barriers to attendance at these sessions with paediatricians across Wales.

Objective: To assess agreement between transcutaneous carbon dioxide (TcCO2) monitoring and blood gas analysis in neonates. Study Design: This was a prospective observational study performed in a tertiary neonatal intensive care unit. 19 infants with a mean postmenstrual age of 35+3 weeks were included. Agreement was assessed by Bland-Altman analysis and concordance correlation coefficient. End-user feedback was collected from staff and infants were assessed for evidence of skin damage. Results: Overall bias from 698 paired samples was -0.30 (SD 1.21, p<0.0001) with good concordance (CCC 0.80). 69% (95% CI 65%-72%, p=0.0003) of samples fell within the predefined clinically acceptable difference of 1kPa. Agreement was more favorable for non-invasively ventilated infants (bias -0.11, CCC 0.91). Staff feedback was positive, and no infants suffered skin damage. Conclusion: TcCO2 monitoring is a reliable assessment tool for both invasively and non-invasively ventilated neonates. It can be used as an adjunct to blood gas analysis, reducing the frequency of invasive blood tests.

Background: Children with Bronchopulmonary dysplasia (BPD) have increased incidence of respiratory illness, often necessitating Pediatric ICU admission. Little is known about the outcome of these admissions. Aim: This study aimed to determine clinical and demographic data of this cohort and determine factors affecting mortality and length of ICU stay. Oxygen requirement following a year after ICU admission was determined. Methods: Retrospective case-note review was performed. Patients with congenital cardiac abnormalities or chronic respiratory conditions like cystic fibrosis were excluded. Data were presented as descriptive statistics. Predictors of death and LOS were determined using Fisher’s exact test and univariate regression analyses. Results: Small numbers of deaths prohibited strong conclusions. Inotrope use (p<0.001), blood transfusion (p<0.001), use of inhaled nitric oxide (p=0.003) and a diagnosis of sepsis (p=0.004) were related to mortality. Age at admission, gestational age at birth, weight, oxygen requirement prior to admission or length of stay did not increase the odds of mortality. Inotrope usage (p=0.027), transfusion requirements (p=0.044) and a sepsis diagnosis (p=0.005) were significantly associated with length of ICU stay >7 days. More than half the patients, who were followed up, had an oxygen requirement at 6-month and 12-month follow up. Conclusion: Patients admitted with chronic lung disease to PICU with pulmonary hypertension and sepsis has long ICU stay and more odds of dying. More than half of the children who survive to 6-month and 12-month follow up have ongoing oxygen requirement. Studies in larger populations of children with BPD will help in more accurate prognostication following PICU admission.