ࡱ>  ىbjbj 2rrfX  rr& 8P\ fn0F\\\ ; G .e0e0e0e0e0e0e$wh)kTerN%" % %Terr\\ied...&r\r\.e.%.e..2&`d\ῡ)a.ee< fak+k\dkdXO d!."}#`O O O TeTe.XO O O f%%%%kO O O O O O O O O  8: INDUCTION DOCUMENT FOR RESPIRATORY MEDICINE AT NGH Contents Work practice within the Department Respiratory medicine staff Respiratory wards and bed allocation Timetables for ward rounds, clinics and departmental meetings Useful contacts in associated departments Appendix A HOOF forms and O2 ordering WORK PRACTICE WITHIN THE DEPARTMENT Welcome to Respiratory medicine. We hope that you will work hard, learn and enjoy this attachment. Please speak to your supervising consultant or Jennifer Hill, Clinical Director if you have personal or clinical concerns. Junior Staffing at NGH We have moved to a ward based system with juniors on each ward working together to cover the ward and any outliers belonging to the consultants on the base ward. You will be allocated a consultant for clinical/educational supervision and will work for their team most of the time, but will be expected to work with and for the other team on the base ward. To ensure safe inpatient care during times of annual /study leave, on call and sickness, the Junior Drs Coordinator may need to move you between wards and teams. Where possible such moves will be restricted to SHO grade juniors, but all grades of staff may be required to cross cover other teams. It is essential that all juniors advise Nicola Burden, the Junior Drs co-ordinator, of any planned or unplanned absence. The rota has been designed to ensure that there are at least 2 juniors on each ward every day with at least one being more senior than an FY1. Holidays are allocated centrally with each junior Dr given 9 days of leave. Swops may be accommodated but may be denied if there is insufficient cover across the respiratory unit. If you are on leave or working on a bank holiday you will be entitled to an extra day of leave and this can be taken whenever you wish, as long as your ward teams are covered and it is agreed in advance. To allow advanced planning each team should sit down at the start of the attachment to arrange study leave and request any swops. A template will be produced weekly to show who is on the wards and who is expected to cross cover other teams. Please check your e mails regularly for these timetable adjustments and let Nicola know of any problems with what is suggested. On occasions junior Drs will be expected to cover colleagues on M2, the pulmonary hypertension ward, at RHH. Board rounds We operate a policy of multidisciplinary board rounds between nursing staff, therapists and Drs at 9am every weekday. These board rounds are expected to be quick and concise diagnosis, medically fit, social issues. The mornings work should be prioritised using the information from these meetings - see sick patients requiring urgent review first, followed by those who can go home, and then the rest of the patients. TTOs should be done immediately for patients going home that day.  EMBED PowerPoint.Slide.8  Ward rounds Please ensure that all patients under your care are seen every day of the working week. If a patient is on the ward but has not yet been seen on the post-take ward round their notes should still be reviewed and summarised, and any investigations chased /ordered in advance of the post take round. Please document in the notes as per the SOAP guidance (see below). Subjectively eg, chest pain persists Objectively eg, SpO2 98% on air, BP 97/45 Assessment eg. Pneumonia resolving Plan eg. Repeat CXR, check CRP Acute Respiratory admissions There has been a Speciality Respiratory take at NGH since December 2010. There is a Respiratory consultant of the week from 10am to 7pm Monday-Friday. One of the other Respiratory consultants will do an early post take ward round daily between 8 and 10am seeing 6-8 patients who are next to be seen on the electronic post take list (likely those admitted after 6pm on the preceding evening). Please ensure that the initials of the consultant who sees these patients is put on to the electronic take sheet after the ward round. An acute medicine F1 is allocated to the 8-10am respiratory post take ward round and works from 8.15am-4.15pm. If the acute F1 is absent you may be expected to attend the Respiratory post take ward round and will be warned of this beforehand. The Respiratory SHO/F1 who is allocated to cover MAU on the rota will work with the Respiratory consultant of the week and acute registrar to look after patients on MAU 1-3 and patients admitted on the take. They will work from 10-6pm meeting the team at 10am in the Doctors room on MAU 1 each day. Juniors on base wards are not expected to see patients under their consultant who remain on MAU 1-3 as they are the responsibility of the acute Respiratory team. Time (weekdays)8-10 10 -1616-1818-1919 -overnightConsultant on-call by phoneRota via switchboard Respiratory Consultant of the weekRota via switchboardEarly PTWR Respiratory ConsultantEarly PTWRAcute Med FY1 (8.15am-4.15pm)8.15am - Early PTWR Joins MAU ward round until 4.15pm Respiratory Consultant of the weekMAU & PTWR ward round and reviewing new admissions Acute Resp SpRMAU ward round 10-18pm Respiratory referrals Respiratory SHO/FY1MAU ward round 10-18pm Criteria for triage to respiratory medicine are - Asthma/COPD Suspected PE CF Suspected TB Interstitial lung disease Bronchiectasis Pneumonia Unusual respiratory infection Suspected lung cancer Pneumothorax Pleural effusion Haemoptysis Respiratory failure Triage decisions are made by A and E staff initially but can be reviewed by medical SHOs or registrars with the help of the on call Respiratory consultant and patients can be moved between speciality take lists where appropriate. Please note that heart failure patients should be admitted under Diabetes and Endocrinology. Care of the Elderly may be more appropriate for elderly patients with advanced frailty or dementia presenting with aspiration pneumonia please discuss with the Respiratory consultant if unsure. Admissions to RSU The RSU is a 4-bedded unit delivering NIV to COPD patients with acidotic type 2 respiratory failure. During office hours admission is through Dr Hughes or his registrar. Out of hours admission must be agreed by the Respiratory on call consultant (available through switchboard). Emergency admissions to the CF Ward The CF ward is covered by Drs Edenborough and Wildman who provide continuous on-call cover. CF patients will only be admitted via the CF team, usually via the CF out patient clinic. Any CF patient presenting out of hours will be notified to the CF consultant and admitted via the MAUs in the usual way pending review. Respiratory Referrals The Acute Respiratory Registrar is available via a dedicated LRP (via switchboard) to see Respiratory referrals and can discuss these patients with the acute respiratory physician of the day as necessary. There is a secondary rota for the other Respiratory registrars to cover the MAUs and see referrals when the the acute SpR is on annual leave /study leave /in clinic. The acute / referrals registrar is also expected to act as pleural / thoracoscopy liaison. The BTS guidelines are clear on the management on the place of thoracoscopy in the patient with an undiagnosed exudative effusion. Once exudate is confirmed and empyema outruled with a diagnostic US guided aspirate, and a CT scan performed, please discuss thoracoscopy with LL, JH1 or SR1 and list the patient for the Tuesday pm thoracoscopy list via the MDT co-ordinators on 66318. The thoracoscopy patient information leaflet and protocol are available via the MDT co-ordinator. These patients need to have the procedure explained, have the relevant investigations (including G and S), premedication and consent, which is the responsibility of the acute Respiratory registrar. All patients are transferred to Brearley 2 after the procedure for after-care and for a 2 night stay. Bed allocation beyond the base wards (see accompanying table) There are no internal outliers within the medical wards ie. if a diabetes patient is inadvertently admitted to Brearley 2 the patient will automatically be taken over by SKS/ JH1 unless the admitting team specifically requests to keep that patient under their care. The following wards are keep your own areas after admission under a Respiratory consultant ITU / HDU Chesterman 2 Huntsman 2-7 SAC TAU During busy periods (outliers > 50 for 3 consecutive days) an escalation policy may come into effect to cohort outliers to be looked after according to geographical areas. In this situation we would take all medical outliers in Chesterman wards - Chesterman 1 OMP / SB4 Chesterman 3 MW2 or FE1/ JH1 Chesterman 4 RJH / SKS Length of stay (LoS) LOS can be improved considerably by good discharge planning. Estimated date of discharge (EDD) should be recorded at admission (box on PTWR proforma) and be used on ward boards and in the notes. Data from other hospitals demonstrates that this reduces LoS. Planned discharge dates should mean that TTOs are done in advance allowing patients to be discharged earlier in the day, via the discharge lounge if possible. Late completion of TTOs is an unacceptable but common cause of delayed discharge. The 9am board rounds are aiming to identify unwell patients or those for discharge that day who should be seen FIRST on the ward round. TTOs should be completed immediately for patients who are medically fit with no social issues to allow immediate transfer to the discharge lounge. Coding Accurate and complete coding is essential if the Trust is to be fully reimbursed for the work that it does. The diagnoses in e-discharge summaries must include A Primary Diagnosis All Secondary Diagnoses - active problems that contributed to the length of stay. ? or possible diagnoses are not acceptable and these terms should not be used. Probable diagnoses are acceptable All procedures (including catheterisation) A coding guide and Coding sheets are included (see appendix). Patient Results At the end of each day please view and file all the results on ICE for your consultants patients please do not file abnormal results that you do not understand unless you have discussed them with a senior colleague. Discharge Summaries Dictated discharge summaries have been replaced by the ICE based e-Discharge template which will amalgamate the previous flimsy TTO and the dictated and typed discharge summary. Please start these on patients as soon as they reach the base wards and include as much of the vital details which impact on coding (see below) as possible. A copy is given to the patients on discharge so please ensure that DNAR decisions and serious diagnoses have been discussed with the patient. At discharge Please review the patient notes and read through your e-discharge summary to ensure it tells GP the salient points about the patients admission. Would you understand what has happened to the patient this admission from the TTO? Review all results on ICE for this patient episode and ensure they have been acted on and are filed. Do not file abnormal results that you do not understand and have not discussed with a senior Dr. Check whether the patient needs a repeat CXR in recovery (consolidation on CXR usually requires repeat at 6-8 weeks by GP) Comment on the TTO if bloods have been abnormal and advise the GP if/when repeat blood test are required (this should be a rare occurrence and should be agreed with a registrar or consultant). If a patient requires a repeat CT eg to follow up a lung nodule please request the CT stating on the request the month in which the repeat scan is required. Compare the discharge medication list to the list from admission comment on any changes to medication in the appropriate box and ensure no medication has been missed off inadvertently. Ensure that all home oxygen is documented (including short burst, ambulatory and LTOT) particularly when it has been newly started. Please ensure that the e-discharge is copied to the oxygen nurses for them to follow the patient up. Confirm whether the patient requires hospital clinic follow and state - -the consultant who will see the patient and their clinic code if known eg OMP TB clinic -the time interval eg 3 months -list any pulmonary function tests required at clinic as these are pre-booked for the patient eg with Spiro, TLCO -any other details eg CXR on arrival Please note that Early Supported Discharge Scheme for COPD should be recorded in the community follow-up section. Oxygen prescription The National Patient safety agency and BTS require that Oxygen is regarded as a drug and prescribed as such. This should now be done on the STH prescription chart and must be filled for ALL patients receiving oxygen. Write up the initial flow rate and device and a target saturation (88-92% for patients in/prone to type 2 respiratory failure and 94-98% for rest even if they have a diagnosis of COPD). HOOF (home oxygen order form) These must be filled in accurately and promptly to prevent discharge being delayed (see later filled example). Do NOT fill as an emergency order unless your consultant explicitly requests this and countersigns the form (this is extremely expensive). Please send copies of e-Discharge letters of all patients newly commenced on home oxygen to the oxygen nurses who will follow the patients up in their clinic. Any patients now sent home on LTOT who have one or more storeys to their property will need to have an additional comment from the prescriber (in box 11 of HOOF A) along the lines of: will require oxygen upstairs and down. The engineer will then either offer piping-in or install two concentrators. Thromboprophylaxis A thromboprophylaxis risk assessment must be completed within 24 hours of admission for all patients and dalteparin prescribed as appropriate. There is a significant financial penalty for failing to adhere to this. There is a pre-printed dalteparin prescription on the drug chart to act as reminder. The risk assessment forms have now been incorporated into the admissions clerking proforma. Please check that these are filled in and ensure that elective and direct to base ward emergency admissions have risk assessments done. Dementia The dementia screening tool should all be filled for all patients within 72 hours of admission and is in the clerking proforma. Outpatient outcome forms These will be on the front of patients notes in the clinic and should be competed for all patients, to include follow up plans, current status of investigations and treatment and any tests performed in clinic. From April 2014 we will monitored by the CCG against a target of all clinic letters leaving the trust within 48 hours and containing the following information - - diagnosis - reason for follow up - changes to medication - GP actions required The secretaries will be asked to type letters with this information in a template but I would just ask you to ensure that you dictate letters within the clinic session and do not delay with the intention of getting back to them later in the week. Clinical supervision and educational opportunities Foundation Drs have an educational and clinical supervisor for each attachment. CMT Drs have an educational supervisor for the whole year within STH (the first consultant with whom they work) and a clinical supervisor who is the consultant they are working with in each attachment. Please arrange an early, mid and end attachment meeting with your supervising consultant. You will be expected to have drafted a personal development plan and to sign off on this and your learning agreement at the first meeting. Please try to request work based assessments at regular intervals during your attachment rather than leaving these to the end of the post when time may be short. You can request remote access to the library facilities to allow you to perform literature searches or personal study away from the work place. The British Thoracic Society has an excellent (and free) website with a number of useful guidelines available for reference. Study leave will be granted as much as possible but must be requested in writing (or e mail) at least 4 weeks ahead of time. Please inform Nicola Burden of any planned leave. Registrars should have received a list from the Deanery of important and funded study leave courses and conferences and should contact Lynne Laver at RHH to access funds. Attendance at conferences will be first allocated to those who are presenting their own work, and then by rotation according to previous conference attendance. Please discuss study leave early during the attachment with your consultant. In the past trainees, having secured themselves a place on deanery courses, have failed subsequently to attend or provide timely advice to organisers such that the place can be released to other trainees. This is considered highly unprofessional and in breach of standards laid down by GMC in terms of professionalism and good medical practice. Please endeavour to attend (or cancel) booked study courses. SHO Education Days There are 3 days per 4 month block allocated when you may undertake educational activities as you are not included in the ward numbers. The activities you choose to undertake should be decided in conjunction with your educational supervisor and depend on your training needs. It is expected you will use this time to meet the requirement for you to attend clinics. A timetable for clinics and procedural sessions available for you to attend can be found below. Please email the consultant in advance when you wish to attend their clinic to ensure that you can be accommodated on the day in question. This is a good opportunity to obtain MiniCEX or CBD. For those who have been on TAKE the day before an education day please try to clerk respiratory admissions and attend the early PTWR at 8am on your education day to present your patients on the PTWR. This is a good opportunity to get feedback from your take days and obtain an ACAT. Pulmonary Function Testing occurs 5 days a week and you should discuss with Cheryl Roberts if there are specific more complicated tests such as CPET or Mannitol challenge that you wish to see. You do not have to spend the whole session in one activity. For example you could present on the post take ward round, watch a bronchoscopy, and watch a pulmonary function test in the same morning. However you should arrange to attend sufficient clinics to meet your training requirements during these days. If you are not otherwise engaged on an educational day (eg the clinic finishes early) then you should return to work on your base ward. Sick leave If you are unwell and cannot attend work you are obliged to contact medical personnel and Nicola Burden, on ext 66318. Nicola can liaise with Joanne Nettleton if you will be missing an on call shift. After returning to work you must contact Nicola Burden and arrange a back to work interview with Dr Jennifer Hill, Clinical Director of Respiratory Medicine. Acute Medicine Clinical Coding Key Co-morbidities to Document in Case Notes/e-Discharge CO-MORBIDITYAny kind of cancer identify locationAny kind of infection identify locationRespiratory Failure (acute or chronic)BronchiectasisCachexiaHeart Failure (CCF, LV dysfunction, diastolic, Cor pul)Diabetes (IDDM or NIDDM)Ulcer of Lower LimbFaecal IncontinenceGastritisArthritis (OA, RA)Depressive EpisodeSenility (cognitive decline) or Dementia (formal Dx)Difficulty in Walking (uses walking aid)Dependence on a Wheelchair Problem lists Record a problem list where possible in the notes Primary diagnosis Current co- morbidities on treatment Active problems influencing care Primary diagnosis - a working diagnosis is acceptable; ?PE ?LRTI ?CVA with queries is not. Multiple problems can be recorded e.g. Pneumonia, NSTEMI, hyperkalemia but be specific record acute coronary syndrome not cardiac /chest pain Current comorbidities on treatment see above Are listed on the laminated sheets found on all respiratory wards as an aide memoire Record Obesity (BMI>25), include Smoker advised to stop Active problems influencing care these are the softer, more socially aware issues, found at the end of the laminated sheet. Examples include Depression +/- anxiety (on treatment or active), poor mobility (uses a stick or walking aid), poor vision (registered blind or poor vision contributed to their admission) Record all procedures done include CT scan, pleural procedures, CT Biopsy 2. Respiratory medicine staff Consultants (NGH) Specialist interests Dr C Barber (CB2) Occupational Lung Disease, lung cancer Dr S Bianchi (SB4) Interstitial Lung Disease, sleep Dr F P Edenborough (FE1) Cystic Fibrosis Prof D Fishwick (DF1) Occupational Lung Disease Dr J M Hill (JH1) Lung Cancer Dr R J Hughes (RJH) Sleep, non-invasive ventilation Dr J Hurdman (JAH) COPD, pulmonary hypertension Dr Rod Lawson (RAL) COPD (community based) Dr L Lewis (LL) Pleural disease Dr O M Pirzada (OMP) TB, bronchiectasis Dr S Saha (SKS) Lung Cancer, asthma Dr M J Wildman (MW2) Cystic Fibrosis Consultants Ext. Sec Bleep/Mobile Dr S Bianchi 52086 11740 Mobile/LRP Dr F P Edenborough 66270 14770 2190/Mobile Dr J M Hill 14680 66432 LRP/Mobile Dr J Hurdman Dr R J Hughes 66313 14646 2373/LRP Dr R A Lawson 15537 14278 Mobile Dr L Lewis Dr O M Pirzada 14681 14278/14646 LRP/Mobile Dr S Saha 14678 14661 2323/LRP Dr M Wildman 15212 15283 2303/Mobile Consultants (RHH)* Dr R Condliffe (RAC) Pulmonary Hypertension Dr C Elliott (CAE) Pulmonary Hypertension Dr D Kiely (DGK) Pulmonary Hypertension Prof S Renshaw (SR2) Pleural disease / ILD Prof I Sabroe (IS1) Asthma, Pulmonary Hypertension *see RHH induction document for junior Drs rotating to RHH Clinical Director Dr Jennifer Hill Service Manager Chris Hayden Assistant service managers Claire Walker Michael Fordyce Matrons Ruth Marrison Jane Sendel Lung Cancer MDT Coordinators Julie Key (Lung Pathway Co-ordinator) ) Nicola Burden (MDT co-ordinator/ Junior Medical Staff Co-ordinator) )66318 Sara Shaw (Clerical Officer) ) Chief of Pulmonary Physiology Cheryl Roberts Consultants and Secretaries Offices All consultants and secretaries are in the Brearley outpatients (below Brearley wards) Chest Clinic Ext. Fax. Outpatient Reception 66494 15745 Pulmonary Function Unit 14768/14784 66389 Specialist Nurses Asthma specialist nurse, Clare Daniel 66308 COPD/Oxygen specialist nurses 66388 Bleep 2526 Lung Cancer specialist nurses, Anne Clegg/ Sarah Field / Helena Stanley 66956/bleep 2937 Cystic fibrosis specialist nurses 66281 fax 66280 Respiratory nurse specialist, Dawn Weston 69758 3. Respiratory Wards and bed allocation Brearley 1 (28) 14 JAH 14 FE1/MW2 Brearley 2 (28) 14 JH1 14 SKS Brearley 3 (28) 14 SB4 14 OMP Brearley 4 (24) 10 RJH* 14 LL CF Ward (12) CF and elective respiratory patients NGH Junior Staffing TeamRegSHOF1MW2/FE1*Br 1 14 beds1 per ward1 1JAHBr 1 14 beds12SKSBr 2 14 beds1 per ward1 1JH1Br 2 14 beds1 1 OMPBr 3 14 beds1 per ward1 1 SB4Br 3 14 beds1 1 RJHBr 4 10 beds1 per ward2 1 LLBr 4 14 beds11AcuteMAU1-31 To be rostered on fortnightly basisCF*14 BEDS11 1 *MW2 and FE1 rotate 2 monthly between CF and general respiratory medicine Designated wards TB Br 3 (RH1/RH2 for ve pressure rooms) Lung cancer Br 2 (CF ward for elective admissions) COPD/NIV and acute PE Br 4 Cystic Fibrosis CF ward Sleep Br 3, 4 (CF ward for elective sleep studies) asthma Br 1 Ward telephone Nos Br 1Br 2Br 3Br 4 CFWMAU1MAU2MAU3RH1RH2Ch 1Ch 3Ch 4Ward Clerk150891432615096150926658014140694351587415084669616907769077Fax1509066812150971433352137691905214815289669126612966129Drs Office 691556991666966Ward Nos6930915093A 15960521451587315085693531451814335698536136352137B 140965214615872143201441914337C 14097521471587166120D 15113 E 66094 HB 66361 4. Timetables for ward rounds, clinics and departmental meetings Weekly ward rounds SB4 Monday 9am & Thursday 9am Brearley 3 FE1 Monday 9am & Thursday 2 pm Brearley 1 JH1 Monday 9am & Thursday 9am Brearley 2 RJH Monday am & Thursday am Brearley 4 OMP Monday pm & Thursday am Brearley 3 SKS Monday 9am Brearley1/2, Thursday 9am Brearley 1/2, MW2 Monday 9am & Thursday 2 pm Brearley 1 CF Team Monday 9.00am (full), Wednesday 11.00 (part), Thursday 2.00 (part) (on CF Ward) Consultants will visit the ward most days to discuss sick or new patients and do a board round. Outpatient clinics (SpRs are expected to attend those marked*) SB Monday (Gen) pm*, Wednesday (sleep) pm*, Friday (ILD) am* FE1 Tuesday pm* (alt. weeks) CB2 Tues pm lung cancer (JH1 Reg attends every week) JH1 Monday pm general Respiratory alternate weeks* Tuesday pm lung cancer (alternate weeks), Wednesday am lung cancer (SKS Reg alternates weekly between SKS and JH1 list); RJH Tuesday am (Gen)*, Friday am (Sleep)*, RAL Wednesday pm and Thursday am (COPD) OMP Monday (TB) pm*, Tuesday pm (alt. weeks), Thursday (TB) pm* SKS Tuesday* pm lung cancer alternate weeks and Wednesday am* (reg alternates weekly between SKS and JH1 list) Thursday pm* MW Tuesday pm* (alt. weeks) CF Team Monday AM (CF SpR)*, Wednesday PM# (CF Outpatient Unit) Attachment nameWardsClinicsBronchAsthma/COPDJAH/FE/MW2Brearley 1FE/MWRM tues pmSB4SLP wed amOMPRM thurs pmFri amLung cancerSKS/JH1Brearley 2JH1/SKSLC weds AM SKSRM thurs pmJH1RM mon PM (alt weeks)Tues amBronchiectasis/TBOMP/SB4Brearley 3OMPRM mon pmMKWILD Fri amRJHRM- Tue AMThur pmNIV/pleuralRJH/LLBrearley 4LL-LC tues PMRJHSLP Fri AMSB4RM- Mon PMPPHPPHCFCFCF Mon AM CF Weds PMacute (cross city)Specialist/referralsEDUCATIONAL OPPORTUNITIESFOR ACUTE AND SPECIALIST POSTSAMPMMondayOLDNGHTuesdayPE clinicRHHDifficult asthmaNGHComm COPD (alt)MargetsonRheum/RespRHHThoracoscopyNGHBronchiectasis NGHWednesdayThursdayOLDNGHDifficult asthmaNGHComm COPDParkEBUSNGHFridayILDNGHComm DiagnosticDovercourtEBUSNGH Clinic letters Letters have to leave the trust within 48 hours of the clinic, so please ensure that you dictate them at the end of each clinic session. We are mandated by the CCG to include the following information in all clinic correspondence (and will be financially penalised for not doing so). diagnosis reason for follow up eg. to monitor ILD GP action Change of medication Bronchoscopy lists* Tuesday 9.00am bronchoscopy list SB/ MW/FE1 Thursday 1.30pm bronchoscopy / EBUS list RJH/ JH1 Friday 9.00am bronchoscopy / EBUS list OMP / SKS *book procedure with lung cancer MDT co-ordinator on 66318 Nicola Burden will ensure that bronchoscopy lists are allocated to registrars on the rota to ensure that educational opportunities are not lost. Registrars must be supervised at all times when performing bronchoscopy unless they have completed CCT when they can bronchoscope independently. After discussion between consultant and registrar, SpRs within 6 months of CCT may bronchoscope independently if the consultant supervising that list is available in the hospital and can attend within 5 mins. Thoracoscopy list Tuesday 2.00pm thoracoscopy list JH1/SR /LL *book procedure with lung cancer MDT co-ordinator on 66318 Departmental educational and other meetings departmental educational meeting - Monday 1.00 2.00 pm (lunch usually provided), Change Room between Brearley 3 and 4. Timetable will be circulated by SKS Lung cancer MDT meeting - Tuesday 8.15 -10.30am - Lecture Theatre, Vickers Corridor Clinical Radiological Conference - Tuesday 1-2 pm Seminar Room, X-ray Department Service improvement CHANGE meeting Wed 2-3pm CHANGE room between Brearley 3 and 4 F1 Teaching - Thursday lunchtime 12.30 2.00 pm (lunch provided), Medical Education Centre Occupational respiratory radiology meeting Thursday 1-2pm - Seminar room-x-ray department ILD radiology meeting Friday 8.15-9am Seminar room-x-ray department Chest drain teaching There is an official trust chest drain teaching course for SpRs which should be completed (with sign off) before drains should be inserted within the trust please contact Dr Steve Renshaw to enrol. See STH chest drain policy on Intranet. 5. USEFUL CONTACTS IN ASSOCIATED DEPARTMENTS Thoracic Surgeons Mr J G Edwards 69279 Bleep 826/ Mobile Mr J Rao 15390 Mobile Ms L Socci Oncologists Clinical Dr Trish Fisher 65248 Medical Prof Penella Woll 65060/ 65206 Dr Sarah Danson 65704 Thoracic Radiologists Dr Sue Matthews 66344 Dr Matthew Bull 14822 Dr Catherine Hill 14271 Dr Aki Kamil Pathologists Dr Kim Suvarna 14862 Dr Yota Kitsanta 14850 Dr Jonathan Bury Contacts for : PACS registration/induction (including SMART cards) 66347 Computer login access / passwords / digital dictation 69040 Appendix A Home Oxygen Order Form (HOOF) correctly filled in Part A (Before Oxygen Assessment Non-Specialist or Temporary Order) All fields marked with a * are mandatory and the HOOF will be rejected if not completed1. Patient Details1.1 NHS Number*11111111111.7 Permanent address*1.9 Tel no. 0114 22255221.2 TitleMr67 Disney Way Sheffield 1.10 Mobile no.1.3 Surname*Mouse2. Carer Details (if applicable)1.4 First name*Michael2.1 Name1.5 DoB*01/05/19512.2 Tel no.1.6 GenderX Male( Female1.8 Postcode* S5 7AU2.3 Mobile no.3. Clinical Details4. Patients Registered GP Information3.1 Clinical Code(s)014.1 Main Practice name:* De Ath Surgery3.2 Patient on NIV/CPAP( Yes( No4.2 Practice address: Sick Road , Sheffield3.3 Paediatric Order( Yes( No4.3 Postcode* S66 6MB4.4 Telephone no. 08445 1111115. Assessment Service (Hospital or Clinical Service)6. Ward Details (if applicable)5.1 Hospital or Clinic Name: Northern General Hospital6.1 Name: Ward 15.2 Address Herries Road Sheffield 6.2 Tel no.: 0114 22222226.3 Discharge date: 22 / 01 / 20135.3 Postcode:S5 7AU5.4 Tel no:7. Order*8. Equipment* For more than 2 hours/day it is advisable to select a static concentrator9. Consumables* (select one for each equipment type)Litres / Min Hours / DayTypeQuantityNasal CanulaeMask % and Type2158.1 Static Concentrator Back up static cylinder(s) will be supplied as appropriate1yes8.2 Static Cylinder(s) A single cylinder will last for approximately 8hrs at 4l/min10. Delivery Details*10.1 Standard (3 Business Days) (10.2 Next (Calendar) Day X10.3 Urgent (4 Hours) (11. Additional Patient Information12. Clinical Contact (if applicable)If patient has ambulatory oxygen already please put following statement Please leave ambulatory oxygen in situ12.1 Name: Dr Consultant12.2 Tel no.12.3 Mobile no.13. Declaration*I declare that the information given on this form for NHS treatment is correct and complete. I understand that if I knowingly provide false information, I may be liable to prosecution or civil proceedings. I confirm that I am the registered healthcare professional responsible for the information provided. I also confirm that the patient has read and signed the Home Oxygen Consent Form. Aide Memoire to completing HOOF All sections marked with * are mandatory A static concentrator is sufficient for delivering LTOT. Static cylinders weigh 18kg when full and are not ambulatory. Next day delivery should be appropriate for hospital discharges. Engineer will need to have access to property. Emergency (4hr) installation requires Consultant signature and is rarely necessary. Discuss with O2 nurses. If patients already have ambulatory O2 please state leave ambulatory supply in situ in box 11. If patients already have some form of O2 at home they will need to have a HOOF form B filled in by the O2 nurses (which cannot be done by junior Drs) please contact the O2 nurses New ambulatory O2 cannot be ordered on Part A HOOF. This is done via the oxygen assessment service post discharge. Ensure a contact number is provided in case of query. If the patient lives alone this will need to be a family member who can access their property to allow O2 delivery Fax copy to O2 service (14511) Any queries contact O2 nurses      FILENAME induction document for Respiratory updated June 2014 JAH (3) Need to add JAH and LL 4=1 2 3 V 7 8 P Q @ D Y k   * + # & Z [ \ %&KκݭxxxlhV OJQJ^JaJhrOJQJ^JaJhV OJQJ^Jh!hV 5OJQJ^JaJh!hV OJQJ^JaJh!hV OJQJ^J&h!hV 5CJOJQJ\^JaJh!hV OJQJ^JaJh!hV 5CJOJQJ^J#h!hV 5CJ OJQJ^JaJ $34=a| 1 2 3 X Y 7 8 P Q [ \ KL$a$gdV  & FgdV gdV gdV $ & F a$gdV $a$gdV $a$gdV KLZBC^_abcdp01UVv,=STxԹԦԑԑԃԃvԃԑԑlԑhV OJQJ^JhrhV OJQJ^JhrhV 5OJQJ^Jhr OJQJ^JhV 5OJQJ^J$jWGhT h!hV OJQJU^J!jh!hV OJQJU^JhrOJQJ^Jh!hV OJQJ^Jh!hV 5OJQJ^Jh!hV CJOJQJ\^J*LZBbcdp0Uvwfglw|} $IfgdV $a$gdV $a$gdV gdV gdV x}fg9:IYZc\enuw+.5fj| !""νuugh!hV 5OJQJ^Jh!hV CJOJQJ\^Jhr OJQJ^Jhr OJPJQJ^JaJh4uuOJPJQJ^JaJ# *h!hV OJPJQJ^JaJ h!hV OJPJQJ^JaJ!h!hV B*OJQJ^JphhrOJQJ^Jh!hV OJQJ^JhV OJQJ^J! $IfgdV kdHM$$Iflֈ/ % R t0%44 lap<ytV   $IfgdV    0' $IfgdV kd?N$$Ifl\/ %  t0%44 lag&p(ytV   /:; $IfgdV vkd:O$$Ifl%%  t 0%44 lap ytV ;<ZoSJJJJ $IfgdV kdO$$IflF/ %  t0%    44 lapytV /&&& $IfgdV kdP$$Ifl\/ % J  t(6_0%44 lap(6_ytV ,kdQ$$Ifl\/ %  t0%44 lap(ytV $IfgdV ,- $IfgdV -.BCZ/&&& $IfgdV kdR$$Ifl\/ %j  t(6_0%44 lap(6_ytV Z[\]&$a$gdV kdS$$Ifl\/ %j  t(6_0%44 lap(6_ytV $IfgdV ]  ->J^_ij| !!!"gdV gdV $a$gdV $ & Fa$gdV gdV "##&&-'8(9(((((((())))**(*+8-9-A--gdV gdV $a$gdV "#$$&'-')))))****(*9-A-,/2J2P2๩tjjj`hV OJQJ^JhrOJQJ^Jh!hV CJOJQJ\^J%jh!hV 0JOJQJU^J"h!hV 5>*OJQJ^JaJh!hV 5OJQJ^JaJh!hV OJQJ^JaJh!hV 5OJQJ^Jhr OJQJ^Jh!hV OJQJ^J$h!hV OJQJ^JaJnH tH "--J...+/,/*OJQJ^JaJ#sVVV1WWnXoXXXXXXY@YwYYYY(ZYZZZZZ[gdV  gdV gdV  8^8`gdV ^gdV [[o[[[[\*\5\k\\\\\\+]U]]]]]]^^^'^4^5^gdV gdV 5^P^_^p^q^y^^^^^^*_O_P_n_~_____`<`g`h`{```>axagdV gdV __``h`{`aaOdFeZe3gtgugghxiiiUlVlnll˽˰}˰o_H,h!hV CJOJPJQJ^JaJnHtHh!hV H*OJQJ^JaJh!hV >*OJQJ^J)h!hV 5>*CJOJQJ\^JaJh!hV 5CJOJQJ^Jh!hV 5OJQJ^Jh!hV OJQJ^Jh!hV OJQJ\^Jh!hV OJQJ^JaJ#h!hV CJOJQJ\^JaJ&h!hV 5CJOJQJ\^JaJxaaaaabo@oBo& $IfgdV kdy$$Ifl֞a08A4F'''<''E''CF644 la]pFytr BoDoFoHoJoLo $IfgdV LoMoOoQo& $IfgdV kd$$Ifl֞a08A4F'''<''E''CF644 la]pFytr QoSoUoWoYo[o $IfgdV [o\odofo& $IfgdV kdϗ$$Ifl֞a08A4F'''<''E''CF644 la]pFytr fohorovoxozo $IfgdV zo{o}oo& $IfgdV kd$$Ifl֞a08A4F'''<''E''CF644 la]pFytr oooooo $IfgdV oooo& $IfgdV kd%$$Ifl֞a08A4F'''<''E''CF644 la]pFytr oooooo $IfgdV oooo& $IfgdV kdP$$Ifl֞a08A4F'''<''E''CF644 la]pFytr oooooo $IfgdV oooo& $IfgdV kd{$$Ifl֞a08A4F'''<''E''CF644 la]pFytr oooppp $IfgdV pppp& $IfgdV kd$$Ifl֞a08A4F'''<''E''CF644 la]pFytr pppppp $IfgdV ppp!p& $IfgdV kdў$$Ifl֞a08A4F'''<''E''CF644 la]pFytr !p#p%p'p)p+p $IfgdV +p,p.p0p& $IfgdV kd$$Ifl֞a08A4F'''<''E''CF644 la]pFytr 0p2p4p6p8p:p $IfgdV :p;p=p?p& $IfgdV kd'$$Ifl֞a08A4F'''<''E''CF644 la]pFytr ?pApCpEpGpIp $IfgdV IpJpLpNp& $IfgdV kdR$$Ifl֞a08A4F'''<''E''CF644 la]pFytr NpPpRpTpVpXp $IfgdV XpYpbpdp& $IfgdV kd}$$Ifl֞a08A4F'''<''E''CF644 la]pFytr dpfpjpnppp $IfgdV pppp& $IfgdV kd$$Ifl֞a08A4F'''<''E''CF644 la]pFytr pppppp $IfgdV pppp& $IfgdV kdӥ$$Ifl֞a08A4F'''<''E''CF644 la]pFytr pppppp $IfgdV pppp& $IfgdV kd$$Ifl֞a08A4F'''<''E''CF644 la]pFytr pppppp $IfgdV pppp& $IfgdV kd)$$Ifl֞a08A4F'''<''E''CF644 la]pFytr pppppp $IfgdV pppp& $IfgdV kdT$$Ifl֞a08A4F'''<''E''CF644 la]pFytr pppppp $IfgdV ppqq& $IfgdV kd$$Ifl֞a08A4F'''<''E''CF644 la]pFytr qq qqqq $IfgdV qqqq& $IfgdV kd$$Ifl֞a08A4F'''<''E''CF644 la]pFytr qqqqq!q $IfgdV !q"q#q2q&!!gdV kdլ$$Ifl֞a08A4F'''<''E''CF644 la]pFytr 1q2qrrrrruuvv&v-v.v/vPvRvgvhvvvvvvv wʷʧʕwkkk[Lkhr hV OJQJ^JaJhr hr >*OJQJ^JaJhr OJQJ^JaJh!hr OJQJ^JaJhr CJOJQJ\^JaJ#h!hV CJOJQJ\^JaJh!hV >*OJQJ^JaJ$h!hV CJOJQJ^JnH tH h!hV OJQJ^JaJh!hS6OJQJ^JaJhS6OJQJ^JaJhV OJQJ^JaJ2qqNrXrrrrrrrrrsRssst tuuuuvvv/vgdV  9r gdV h^hgdS6 & FgdS6gdV /vv!wtww)xxxxxyyyzzz=zTz_z`zmzzzzzzz{gdV  & Fgdr  & FgdV  w!wAwDwswwww6xBxxxxxxyyyyyyzzzz`zkzzz<{J{{{||ӵӗąxhxhxXXXXXhh!hV 5OJQJ^JaJh!hV 5CJOJQJ^Jh!hV OJQJ^J"h!hV 5>*OJQJ^JaJh!hr OJQJ^JaJhr 5>*OJQJ^JaJhr hr OJQJ^JaJh!hV OJQJ^JaJhr OJQJ^JaJhr hV OJQJ^JaJ"hr hr 5>*OJQJ^JaJ"{.{;{<{J{_{v{{{{{||||Q||| ($IfgdV $IfgdV gdV gdV |||:|P|Q||}}!}D}P}Q}_}v}x}}}}}}}¨{ff{f{fUD h!hV CJOJQJ^JaJ h!hV CJOJQJ^JaJ(h!hV 5B*CJOJQJ^Jphh!hV OJQJ^J#h!hV 5CJOJQJ^JaJh!hV 5OJQJ^J2h!hV 5CJ(OJQJ^JaJ(mHnHtH u#h!hV 5CJOJQJ^JaJ8jh!hV CJOJQJU^JaJmHnHtH uh!hV OJQJ^JaJ||} $IfgdV ikd$$IfTV )0*00*44 VaytV T}}}!}8}Q}}}}} $IfgdV ykd$$IfTV)0*  00*44 Vap ytV TQ}R}\}_}m}x}}\SSSSS $IfgdV kd[$$IfTV \ )'9 00*44 VaytV T}}}}}}[RRRI $IfgdV $IfgdV kde$$IfTV4 \ )'9 00*44 VaytV T}}}}}}}}}}}~~~~~+~-~3~4~~~~~~~~~~~~~~)*/0457ELMîîќчuîuччîччî#h!hV 5CJOJQJ^JaJ) jh!hV 5CJOJQJ^JaJ#h!hV 5CJOJQJ^JaJ(h!hV 5B*CJOJQJ^Jphh!hV 5OJQJ^Jh!hV OJQJ^J h!hV CJOJQJ^JaJ h!hV CJOJQJ^JaJ.}}}}*!! $IfgdV kdi$$IfTV4 \ )'9  (00*44 Vap(ytV T}}}}}}}~Rkdβ$$IfTV4 \ )'9 00*44 VaytV T $IfgdV ~~~~~4~C~[RRRRR $IfgdV kdҳ$$IfTV4 \ )'9 00*44 VaytV TC~D~X~~I@@ $IfgdV kdִ$$IfTV r )'89 00*44 VaytV T~~~~~h___ $IfgdV kd$$IfTV0 )?  00*44 VapytV T~~~~~offff $IfgdV kd˶$$IfTV F` )00*    44 VaytV T)/45[RRRR $IfgdV kd$$IfTV4 \`$ )`00*44 VaytV T567Ml[RRR $IfgdV kdi$$IfTV4 \`$ )00*44 VaytV Tlmoff $IfgdV kdQ$$IfTV F 3)? J 00*    44 VaytV T h__ $IfgdV kd?$$IfTV0)R 00*44 VapytV T CQ^_axĀ CDA\łݿݿݭМЅkZ h!hV CJOJQJ^JaJ2 jh!hV 5B*CJOJQJ^JaJph,h!hV 5B*CJOJQJ^JaJph h!hV CJ OJQJ^JaJ #h!hV 5CJ OJQJ^JaJ h!hV CJOJQJ^JaJh!hV OJQJ^Jh!hV 5OJQJ^J(h!hV 5B*CJOJQJ^Jph &C_wwn $IfgdV ($IfgdV |kd$$IfTV 0)R00*44 VaytV T_`axx $IfgdV ~kdĻ$$IfTV4 0)`R00*44 VaytV Txxx $IfgdV ~kd$$IfTV4 0)R00*44 VaytV TĀCoffZfZ $$Ifa$gdV $IfgdV kd$$IfTV F@ )  00*    44 VaytV TCDQ^clJ???1$($Ifa$gdV ($IfgdV kdt$$IfTV F$ j)z Fp  00*    44 VapytV Tlz(kdu$$IfTV ֈ$ j#)f00*44 VaytV T$($Ifa$gdV  $IfgdV ($IfgdV 6++ ($IfgdV kdU$$IfTV ֈ$ j#)f00*44 VaytV TABCD ($IfgdV $IfgdV DE[6- $IfgdV kd5$$IfTV ֈ$ j#)f00*44 VaytV T[\ǂzzz $$Ifa$gdV ykd$$IfTV)0*  00*44 Vap ytV TłƂǂYQStdefgijlmoprs}~̻̬}y}y}y}yfWGjhr CJOJQJUaJhz`hr CJOJQJaJ%jhz`hr CJOJQJUaJhjhUhV h!hV CJOJQJ^JaJ#h!hV 5CJOJQJ^JaJh!hV OJQJ^JaJ!h!hV B*OJQJ^Jphh!hV OJQJ^J h!hV CJOJQJ^JaJ) jh!hV 5CJOJQJ^JaJǂȂoff $IfgdV kd$$IfTV F )00*    44 VaytV TYh\\\ $$Ifa$gdV kdh$$IfTV 0)L 00*44 VapytV Tuuu $$Ifa$gdV ~kdE$$IfTV4 0)L00*44 VaytV Tʃne $IfgdV kd$$IfTV4 F)  00*    44 VaytV Tʃ˃P{ ($IfgdV ykd$$IfTV)0*  00*44 Vap ytV TPQRSstT }&E}}}}}}}}} $ & Fa$gdV $a$gdV gdV ikd$$IfTV )0*00*44 VaytV TEefhiklnoqr׉؉ىgdV gdV ~׉؉ىǽǹhV jhr 0JUhhr hr CJOJQJaJ%jhz`hr CJOJQJUaJ!hr CJOJQJaJmHnHu /1h0A .!"#$% F2"@@HX Μ18JFIFC     C  v$" }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz w!1AQaq"2B #3Rbr $4%&'()*56789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz ?(l(N/1 _<7+ybvyUx \'˖mwkZ-wgeX 7+^&ޯ__ GOhhg8 _G ? }GWCC<xm? p+3MV;wu[hS$ncL`q6}q]\-caU^2JX<=⌳$(X~Z'6Ş/t='C.oQ28xsqf9*Ovܻ/fa0[y|E~4?w?!?i6M|WE%G/?~6_zSO>-sYH}@" d\+WTxS|t]vo_Z"EH팁9Ue6kHCq;e2^N)$[j<hg8 GCC<xm?<?K_?m`W~gv]wRL,qv?wvvֱW.#|& v*1$c[>' җGxMQhk REVhij͎'z=('k#Ş<KZUwMm03$NQ8*pÂ9x%JX |4i3ⳮθzq>'5vfK_M|?4 ]Ų '!EWy_o¯A?`q=Ig{A]- ,-\  2O@+i_/ßmͤFo"6enE2Db;ײdTt(F#tUpXxoބwG>/ K5f(̬Q{RWF>l|D_c er~RE\l*;OOTWGf3 WBN/;0?6q~F<:{w=J7ᛥA '?k*_Zr~; kUWE=j1+( œxڵ(J_7h('5LrQ|cyjt R5?Qgsnڷ_.-C_ bY &83^ g + ͵o m9-aH OՍ~ ?eY7aX^QM0||'8E|>i/{{yzS\zGQ_!EH.̃2]ȶ{_m~<,%x@H#̚kr$[e]jO6xƂzR_9^Oh(H5iO_VĦ}*B .f\؅a7wh_9{/I9h TAƾ_L-A۩'Ed_NR_Gq#m[-<%϶k>)?O񇍼CeZ|&kGPXaVgbc)F*ퟳJQ\쑥E|A_>r>G^&*sEQ #pLי/~++ oo?+==cξqn& pv&߄p2n_SG]/91n>Ъ}%Ĺ|&jq_ Poe̓~ٳ>>G3~^>Ɨk ٛ|o"\_$Ms;J]brXI5#i 8Zkgyvi$:l\=,\ZM۱Wg,f]"1KޗU:AZ( iY?+<ѿd/|j~+=oAW83a_Ӝo DP 7¡ x̶7$d Y3_u;gpNGWcĵIm_,Gle ĥ_}H%=Kdb]3L\pk/70#Wvi?Q5Iik?#D?+KZ6ʉlHKVY_kx[+/7P+ m?8W٧ ”E?M;|2ϨqL{,i:][hd -Aowv }IW_ 4Qil\!S8흹ki-?n Ko e SD~5$Jq؜& =m%|rqX'mK[+x[Rf*a5˳`,qv$+o+_SOo'˞@:M,%V?@Oj-KQGy1Gَ.8 \Le/6=]gyƁ~ ,\heL 6mQJ+JqYW%ɹ?%} dA_r#ڿ¿ m7Co 6v]5_MS/>!|i'xŪxr&)CIhpI$YH}o&KK.%jo^\lAճ%Qm9{G_F% Gs35|!|Q#_=,鲢Mp3@ I'+ޫѥ*Mz#¥֫qKG?_ L_ ~=-mgnMĹ[> 6qXۦR5 11u1rr~ᡃS 蕀¿8?'_MȒZĪJ >kMU,I_I4~$Ǜ+bA+0>?kJpd_aR'I)FX X%l.5;}_P?JZx S[V;6< {ʤ[&~ {{8[A_rŏ鶟 VSR7";ˈZ(Vó`~ׇ¿kiBsuZ i낻IxxpHwp~iɸ3ӋwiJl|&V$fWJݻ6tW?[n/|8Ğ>CunP`㓽B1N#k3: g-?zɸWtqt .V5dEvEcĞ" Zǯ׷cj-XD؀$*(ܥ'vοV>_oh6YPNB(צywAZOo˫\-bH3CE~W?D_^{_*zG-JV6?Xbد 1W\]N?p$ __qGj|3a".$Eoqu;1?(:cs?ſ(_sAk.,1>xIJZS͵6|Nj8߫h'I|~~?~|\MyxrfݓGqkU|y]?g]N3sWWvk{)(QB=M~qfWX*VJM24} f=7v}~)|%ZuK/!ađHb+~W!?5"z֟!e*VPe~=>> iple?־ l cu(x}c&֔?/t~[iknmO\ҿGk37;2[hڄ-biPo4G>+ YIw&4$#!dHqvڑF#~ץ;\QSҔ"nGF /֬/8f@W'3KEhHW-Z3FQEp_/Ⱦ ;$A,Gj@1<\73#wcI޿/?1 qYNpv@>n}Ex=9-|SZԝQ_&Q]o-o> 2'&m2}-ѽ-Vc>2U':\1i<BPwJu)MiOFa8Ui֩(e*G־rW]ơO60'O ݗtV++c%-Fsp,ƃM~?3vh2'Ûӭ _iK\[@:ȅA_v)GPA ?_Lo #bXw;8eq!^DGº/5s:Cw D>:bR<溊E%ZRU&m^8RAY$FO|Wc?k>9VEҮ/F' kk/gW%έOyq#ZIdgb5 ]~)¦x|Lb4OX|7-HW_5X)(u]G1y\" \}iN~@<)k{w1xvg="";:W.}Cwe0to>W>9| &k SHՙ3Jq^?Y_a&u_zo=Ok`$S^~']_q/LɧXbU^Em_5~_/ k. DR.L[_flo/I䭟qX8ż6-Uyc5qK/ZX#W_ wƚЭ4:q\19|SsՕ`_P¯I7?S_o?4̀xk3ɵŲ}2"Ԛ5|DG^/&_ˎ]Ʃ;K=,һd%k<؜^1`m?1ܸl. ?o_Sۏ7_XwUG,0m̱WU^{"s|*3|/LF"+=PGyXq^_qF;KXJrv_G3.87jl+ kf<'>#]xsZ ۭB!ܤmg?οA|mt[x}<%ij!n&g|D1{tN*RWNx>#fu*2qbvjy&x= 5G]?7G= 5G]?7_9_ҿC@\lX3 %gџ($7V4{-oZxV_&$@tӫybbrpw&_|,|4/i#n3:kؙ k0V[PNshUҾQs,ڽ\Ey)Iv3hp3_?s?&?\v# }   aEd)= |g_\ ,%;j3'_UKʿģQE}q'Y_#O|xjXH';d_X__o%х )kF?}:+8k#ϡˍ?KJdISRWq_˼_^?~ڷYҥ.mֲ h#FA|j_omƖ:~h#e.;x9.5sXO[͵gzV~G,&XÖq'uZt]¸ U+xBz^2VEvYR&w8d+hթBjAQiGեN)Sdk{fiƕ}gxOA]/k=C H 5ÑFOGXUVɳ iAZ+YNBBoc(^neKwƟ n?1_A|(of˫b&? ZB\|׈!o5saէMcr(>'=5x'Dd/$4VpE~1=|KY_ᅵx/dR~Iv`}?F_`{gyy?wֱ#6D~ZΣԸ>WuUJJ?sO+whս7om(P3h(+ uP|.u8<kෝ(i}a\f |< !5 gD$I>¿Q_ [\o+j tBDs"kZ)[r lGfY\*%۳1|K|}&'DB?_pBͨV~C y?ڏ|i|VyY_U,|`h+_Dk_c& #/nGX^)[n]6)ɿ ~>(xᇇioE[iU@Oݓ+o] ᷇ Xmj ,H1)p 5uk?V֪M>l/bqxzn=ӳ瓽ע[;v?'~1|/mH c̠Uak."h']J:0=Ap~)fNne:TP𭤬yV`fRa5~~_k\^?`ǂ>^x3T5+a%Į}?Iv?gE߲HC?U~cZ56Vt5͆PW7/I%'aĹoIv-ů.% ~.?'ŧ[xkbU]9%];)*%d%v6NN5qE~9"eŵIl//ն~Ñxˣ'ʵmݿ?@9>4i㏌4liY^HM~>~Z/m^ؿZv-׍u9G=# 8a :kqyK &E^ldq2~MAwZ}ۿ$~dK,Jؖf9$(- iAZ+̭Vz? Kᇅe1Ow܆\1{`>W; ' Zĝ -:;k8VX("(eWy(pRQ4[++Y>~m\>cUBb$}k窻?j, u=y-`,]XT'.GGhF1_*e)}}__ |a܋ @̇w)5Q]iB)SdkzUjPvZiQV_zO<5@1]L$DW]s|+_54i\w~H@wB͵@Q IhIYq*u)e/8mҋ VWck~PzWo? OESDJT?uxR W&j??/<ms[x;Ö:jWCs&=9)Z6gڼa7Mzug!^7J<(:k?&_%}u,+(@[U~߱fiڅh62I9#P8'ֳ.'pn*$"m-rwzu?'x/K9ũ:|ӒI&MGKkCAT?tU4O$~K?/@c" %_?_>;Lۭ5Mz6e=o4q )۹Op)peyԔ?WI-[r]GTX)<{\'DŽt?rK `1:èOx6  Gr?~=3'>4|K7F KŌv}J*|S[(>-^PGM&;fQ+o}C8(m[_Ԧ$˨kZS9>#:|¤Գ DaмK>g3/ N]h6~Dzč*[\7ʼ3 Fxؓɞyf{ZI$rHK3h2>ʸw |9WVvKG9fE6wkdWd~oaEWx_@+E /}7W[ '!EWyEPEPEPEPEPEPEPEPEPEPEPEPEPEPEPEPEP_@+EW[ 'HMDd 20  # A"L8bV 8oLD@=L8bV 8op EV4fLx} xy s ֘;~p[7۪19*À;7eN7l@lCmͤCoDy7ecel88WNK31u&zZmR{ ^} -t!q_sh+4qttߧ9 tWo:w>,X޶iyWL\L|wne#pc\VG#Tې/Z\Dvuͺݻ[}-Rb{Lw`^,XT9/PFwu푆E5.TaWtꮟ yۘv6tĺ7v.{Iq]^_%8^6cVl}葨tB& dHbb1ac&}h 9vvjWǨ,3M5V q;QoUP_ِXTS11f|wfff5yo2nfOz raKEFGE}0u2B(Iwˋ#g-s,R?rPͳe˾wOM4n{%Yn^(8_[vwc ~_un P1kR$Cbw ;lFFSQ=>V*<-*Ri9y~նGSj |W{ݘ\ܚ5v_>FL&m+lvbK|E.!~2ʻk=P<:+9.[lsp;,ŋsw[ÊvToOSœ SL6h>Ǐ/o,5XumHMbU.! -Z*$1_n.OS~MgQR`Ry+o '_؎ᏆG4UՕWrwD=_}h-ڥKDfmjʻF|sR<љCNZH8%9Ǝm<:8F=Z U{V][Vs:A m;r0,mSBx u49Hz. tpǶ sO86epՈijf;xjv־0-ơ807%r'5~:'ekäGw4*3b* EV:~zyp,5ЩF^?v>ɱ0IR+<>9@n}Ҥʆ\_D:B""O\a2KCP0*Thɽ+Rm6Kazk>-e6lX׼[Ck>)Qx!k_{]ŇISp.^^'5~X4PIM6SIߖlgq plyBjgHKt}+# Ỏ.;ϮLkߜdp?r>keQ^r<:6q=k[ь[XLn,uJXCM ɕŸ5zSik #W 9-dPV(IzN9Ǭ"Yϣ}.hݳ{O,/3 Wp~mאX,!7XCh:/Np6KQ2_ֻժϭ4RX{aPh}[`{Y-0$ ‚sƾ"$v|nzg7n^D?WFK_1M-.h:jk簪 6%#F[% iNvW~VGGv[uycY7a’*G"w C~#^c&F>K6unyrt#`a,ͮ[Odp8HN+Fǻ4g&k褴yvx>wHQHGORH ޭ+0&Ԫ{`DQ彏`klq~u/'kBjZ,yCKV%}ṙhy~K[mpqL6eu2sz;}3K6>fpJڎVo ^UTwE C >Yis[$}sJJ#__ѭ[,Yhx>-QtNi'틶fN-[yTu활K uܮ K=; xƌfwT[v5̈́$|s*,v"sm,|ݮn4˯ %U ռX[,{jGU{zOG:<I ]P[⒱`y=7_P8%j& 1MȪ{YFUD%oeKkz]yOy™R:>hrwMK҆ᣋhpf Yn~|iɤ !{+Mm8VrnaIZ&8#OzF>M,\0qZ%@3[НK<K =./\Ԙ1*bپ󚶇uk\a+7t Fod =[%bwnb۬rO%D_u4oRB} `g}F#˽}ܗRZy,)oÂɢvo}gs-gX;}޵au A3oٻue2[alױa/?xSᏕ=l2s2M^j9nٙ&=;b9ȫ/EUrNu[Lݥ/5tw"V&C%8Ǔ'KمB?p{kߖ}n>Ly5fxC 7W[y}v`Z wxdv-4o0,|ak 'o(^z<«h9ptТӥ̷k&.HN=k[kduY[kN(+e3%fD(GpgFC%L FqõҼU>ŞItY$A':8+zEwFEe*0wZPPp-,y؊IòD%/``ةzow3) }m_'{> "pUZޯUl>X Z$+Wryw=LمK%7o ;/jr3 [ĖtRnoR>r'@Qw|O~O\Q־>u{܎bsJnTXN& 5h-Lh,މVA:#P\U*CjޗhHq+횼w+lj_XEpM 3(-#[mZ\fI55IoKVحwT. p-1:KWm7[&yl\Jc;.Yh_MW"T q+xniXڕr'kGǓUf;X/mEbqP'.6/4rJ! IVw;Rs|'4ԆM޶32mk;;?[HFCۻk$3]R$0wk7;vU>0,fl(軉z;6oUP/V~'Gƪ wh |8Fs]  +ZeBôiML\`8tU_Kw4V;)kٱz Uy].?aryEU\p'Tpև!hu:G _3}dn~X(FqO5PB^q{Vaa,׬X;|Q>ߴUOʟ|TnDogP0;Zsx:!:(FR`9D:nڣsչq\wFZG*͗@x&aJV:rqJy>痌 tVVNjo4i(lQo-w&ރn?dwzvQ֞~ԉP&-sqy~)\g!_U|P XeIoj(̭k#\Q2v.CŨl38ABhFwў+EjG#Fq򧏨8;c yeܕӳI2ɗ(@K2*1uX]. =F:0(Z=Z;AgW&@цg:ݛˋ$U٩Rp6DdZW 0r) WbG"{-L)9~ƒ-պ*ziB + (!*Mk*;+=Z.?I4EmҸ:RY7F\swNj,|}/Eb-?%frEAY}<~ɤPDYЊ-W 5Z޽ =gޑ"R1@{-/]nDd|BčRrxm9k Ǽk3-z~vPln#Dۮ춡sCd`EJ}X`6YXm˗85YMU5b W=h ?/~{ctEmGm,{(|^y^"=߲Y%t5(&I\Ygn sH.pdF9g\E־|T}2l){E%=Oq'6A>SLvfчdKz3#͌56mDӺ몖pJ+j!,*4aJ0eOW[n$Kf]lC§WmͱXd6]#˿z#GA-ouM V;P6+ pʁ!3+|ל_f *#GIh>O lߐ<_=kde:蚾NuN[[cݯ :UB brUbƘ;*S_Vi>0}RM,09s?O\OדLY[]lYăO=3bw//9ghwz@y7ڻBU/x^ï.yD'={m'b㻾ޘ7wW5ƉW돔gh"{mlZy~0EIyre ƺ\"aƍcDC&؅.t9wl{sk\kNh ja[g'cڪ"g&u򆍅>s~w~}V)KB_V2er+Ig{gu}Nh_$eь]!øsYWVylH"cx5Xe^\ޢ}B};뾪Ň6 =q+ab0Uc_ަ`|ݩRPR2AsknЧD01^ G/^Wl֌]&n*7*2VɈu^Pͪ]G_,˃$oFK56|7g/V-\"6MzJ/7Qƒ,|;.x\\'W <[3.{]-V UΰM8S Y6<].~ۂkf6|돤Sn|8ewϾ"ox+fSY/7MtV8* фT x[fʊFw[eQwa |vw&t\WPC;+uGjs}rʜRKk|Ͳ;6-(rcv,n8`ڋG2{-ߘr4*I<6!L#c&ʒj;m kywnBԛ*jkb\ PQRӍz2QHcѬG#L׌ejß9%z>KbTL\ImY"no.Q_ߴS8E^ي͗lasՊyg{t}P1[&rI'|lUon'4Qœӷoulr}hL,~kxXvd4d,lI^{}{dbSU<'W-ґJ.]Sc}Up3<m̲ӮLFGim|vGGw ^k.x$a7mG292ֿMY R'e _^JX+n#T>X' u{|gw^83quCv:Wh;׷v^/Yf%couJqqj>+}>Y!7pյ&ewvxhE1xnA 6eӏח8qXp&;jLc?\{"so:a,;сKk>bqi{RMuG\<x-[|ݦJ%_GF _ o] :.֞6we'C[SnRnՑ0ˣveGD7Wx>n&;!%&v|gsX#k˂ N՞ kϻAOrx$jX AZyw!xW#z*ڙ円Uє}r?I3)fp n Ѧnղ|:ggJ]fdѽ|=RuB,QBCQ%h_޶'+\!j|Z=.r4:jc[gb{j,==OU #xv9>doaۿTh3qGr͊7qh%.P[`u]_g[--zZ[* G0a.uڝ GE/0:)ÈnzHO68o ƋkC7ke,`oLsQõ0XGx;Ka ֞?xa[|W@enҸO5+F%ainۓ K?ui ֪Ds8SG fI-IO5U{7w*I>L!rim(ZxZe| o::R0'=t =pyɆ:EXǍ,aϼI?j6z1M׶;j((g=ʧ5}E># JH1 ZTAٴk&Pk.?VAo6̳]DN}@B܀ (i;&g&{2A"QEN< sd>#N'09]I/Po*I)!3vDRĩw."|#G B@i tӳ*!*yIziSgߪYJIYY%oIoBV%ȋwǘx @^1m/1I=Lbq\K[@uXBS7G=PB6bb U- bH υ_ϬU Txa0GPnLocaڪFf_4F| #Ԫ9gom-aGkmg?֪kk! [Oi4w%VAP7/vS0=AolG-%6I,vr#c(Y[;cQe;91Fi tD 8 c%Y+ zH=k&VU$a%c涆y:o&/ ( _H34y&! ՘ w1j[#S c-`,qEs#j@sµ`.XbW s4'5 ΅_ϰ0**9=WSBDG̱@;!a Q7.ømU7׳&4xY 413x&k-ٸ65'7-g$ x1&)im掑'x~9R751p.\[hOuS&aN1, pUU٫pyk{<V:7"mS۸Z|6ʆHR%M}:< a[8 ܢ a~ `>P!T ~^b[,FBX~M̀# U4FIH6< @w1p9쵀o/ Q uZ{Ib֪p7O[s\(/`!P1LUuڊD;|@I^^qL3ᝀ93Ն䩠a͉ӆwxyrʵaksi`q$Q;`Ya1S~i䔧/gك^`(g\٪JKhn a~=?-&g)DMW2 ZL9 |&=s}0ͅ9> sa~Zh'aAtђ`N`h3AAۿD;uC,AVOtEK0ant)>+T"y)^cS/lHS|>%5N~F{?{ؖU*CRԞhmۉOxќ\T*4+ѽ`:DK&d. OH n El90+<~J+hh$qIiɡ}`)Y:lY,/ ?SE H0 !^`ҳCTx-)~VQfMbT~wb_{WSݜk՞M1Pt]1;NZ7S^H0fz{0#6Eh{eY=MWUr4=Xx"p`X'IQm&:`_# a:$E-`dXI.WЋ0(hKC8g0#3p"lc3ꪛL+vk"#l rAn׼fói^E+,]n @błا5 %,G7n` bUMv4E+܍e ӛ z0ȊdYfiN: c̣PfAt$Q 3avS}=+h,P'wzfz0*P8 k,q)\@Fs((G^ ;$Ef2$##6`a>EJnZ^fY=l^(4̳Nh)##0?Oc8St`ikO&Fw6>Xg ĤD ׀g(3ӣDw𬇌g@+R 3ډ@8Ci QQj5+GK@ x=(0^ATxfH3&ϦY|<4YN:(h?$KM_NBPtπ=Kga^ ŀER b`>EQ99 e!͛hW^=r,s.*FO&XFsm BxKώg0oĶgDWDoPIp`il&fG t/ډd<R(H;x,;$s!H+)ڃhi d: صg\H1@6 &S ؁3IQH6 , UfJyI"ϙOЖ %qX?5Kg@Zc ك' E9?I4OQ/Fk|mڄSiy}P*lFFKXшCiP +DzHy/)(@){Y)>CX.M)*Dو ( hK!OqMŠ&h($sIϒʤ0LYLB4s`p6)X*u01x^r4h1g<-c{S3S;3/vǴ~[kL[]}0aFi>A;,o<~G{<#U{:صmb Qخ'C#{Q/X'NZY\3j߃0A}N=` 1boyڳ=@dP: gjA|6Y2(Ghdlx"UШ#M `vٓd+D+󐕒ay@,c/4Xe0ZHy} {~χldlU)߉65yw VHpFzVjМ&$8jXO-Z k &f!n0 O ؃;p} }iO gk;N;|Ş I>z0Ln,h  (@ Ht.!~m&;Gіc`t2I3 h$zO=b ~g6Zy@!ˁp=> -.I+ xMb `>ca42 Ydۡc=~)KSha 8K<IL{N8C+e가9) ,Q6 6(}BxDaB*wd+POG7 z76 ғFНzg)MIi(!7π#]q=9/A?g)ʘ=)gM'F=DB(Ͷ)K>jB;ókx:1Q63d,@nnk8z/5L³ٖxثA=,PϨg(>[_c;(t3g1ЙZu=="E+64kw ƚoG]:քBsR%K y3ԷzmG"Iލ&\gEX'=E^ˆ xۋAV@ͦWzgOr泋I)*&_DÁ#_}͏I %e-qЈ 3gdzQoˍ)#SvŮ\;&ԴM|S\-96Œ?fҿ٪2Բu5[ߞ}wONy~(ZRP).Dބ2碼Ŧjrֶxnn ΁߈ ?ͅgM?jz'@/SZ /E7慪?9>d s|6ͅ|&LͼI_1pnfr:- |@Вۀ<{~'!OyČ~[#Ϧ vWCn3 r!g0"m(^f5oYpFAT]\V0X.$} W7F#̤p]S$i] h!?3Dܡ+BR 22Kxds'v 2Vq[$[_$kGq5%KTk,o15s( pYd918'-;$J4FN|49 e_>q 򛇆Z)T:xT %A$~Q2ܡ^8 9iҠ|g_=ȐCx]:T"m筑-@)yf@2ETB0a196̉\|X(cw!~J6@~߉>c(\ t3!t)xX#4 AH6'F,=mDMIBTd^%Gj]oJ~_čʛv\?薻du A `/O`p ɛ̕V8 yUy– ${3*>`OllBwMοir@)>O@e Ⱦo& g CP6"MJ ?_sX.$R b(=AZ@5Ok 8ǻ 3%1rmBdIpkaT~]_k'?'O>/۲Dd7?[t3mmPd?weL3ao& : {i+EAZ4TN)w3PdҢm4 S@.B\EK QV!LU@͠5)i,3WeF.-#@Mß. aA0CJ{8,'џ~t x.8 R_ ~ ߥ?i ӟt%џq (9!W%z?BHҟd']Ig?/Jz`-i?`HՏHyߧ?I8@HkY9+M6 N*3o3l@c?/(ySO.H(S|@)EBܿMYƟ!߷ϐ)a)+_ 0+f0/_}u{1]:(_SKyy™LOO Ů.ڻC DfW4yݘ8iHߍ$9 EfBZuA>E^ f,k̖Ak(W)~*5qDA<Snx.fBPtge,?ߚ7t?{LF+ocߚ7>1)D y!xO L+(kzNCڐ46^+^ʹް\Y7Js$}C$Iߌ`,r3NiWb"MUCE3c-RtV K97&9]p o -VE6Q"*k.~@JC1*Y"Ëm?ߌ=8 vſ)ki}D_*@ k=W)בߝS>y~i&| U-Rgނjo1$$If!vh#v#v#v #v#vR#v:V l t0%555 55R5p<ytV $$If!vh#v#v#v#v:V l  t0%5555g&p(ytV $$If!vh#v%:V l  t 0%5%p ytV $$If!vh#v#v#v:V l  t0%555pytV $$If!vh#v#v#v #vJ :V l  t(6_0%555 5J p(6_ytV $$If!vh#v#v#v#v:V l  t0%5555p(ytV $$If!vh#v#v#v#vj :V l  t(6_0%5555j p(6_ytV $$If!vh#v#v#v#vj :V l  t(6_0%5555j p(6_ytV $$If!vh#vJ!:V l t065J!p ytV $$If!vh#vJ!:V l t065J!p ytV $$If!vh#vJ!:V l t065J!p ytV $$If!vh#vJ!:V l t065J!p ytV $$If!vh#vJ!:V l t065J!p ytV $$If!vh#vJ!:V l t065J!p ytV $$If!vh#vJ!:V l t065J!p ytV $$If!vh#vJ!:V l t065J!p ytV $$If!vh#vJ!:V l t065J!p ytV $$If!vh#vJ!:V l t065J!p ytV $$If!vh#vJ!:V l t065J!p ytV $$If!vh#vJ!:V l t065J!p ytV $$If!vh#vJ!:V l t065J!p ytV $$If!vh#vJ!:V l t065J!p ytV $$If!vh#vJ!:V l t065J!p ytV $$If!vh#vJ!:V l t065J!p ytV $$If!vh#vJ!:V l t065J!p ytV $$If!vh#vJ!:V l t065J!p ytV $$If!vh#vJ!:V l t065J!p ytV $$If!vh#v #v<#v#vx#v:V l0(5 5<55x5ytV $$If!vh#v #v<#v#vx#v:V l0(5 5<55x5ytV $$If!vh#v #v<#v#vx#v:V l0(5 5<55x5ytV $$If!vh#v #v<#v#vx#v:V l0(5 5<55x5ytV $$If!vh#v #v<#v#vx#v:V l0(5 5<55x5ytV $$If!vh#v #v<#v#vx#v:V l0(5 5<55x5ytV $$If!vh#v #v<#v#vx#v:V l0(5 5<55x5ytV $$If!vh#v #v<#v#vx#v:V l0(5 5<55x5ytV $$If!vh#v #v<#v#vx#v:V l0(5 5<55x5ytV $$If!vh#v #v<#v#vx#v:V l0(5 5<55x5ytV $$If!vh#v #v<#v#vx#v:V l0(5 5<55x5ytV ~$$If!vh#v#v<:V l t0 -65ytV kdie$$Ifl8# _ O#?&{), t0 -6888844 laytV ~$$If!vh#v#v<:V l t0 -65ytV kdh$$Ifl8# _ O#?&{), t0 -6888844 laytV ~$$If!vh#v#v<:V l t0 -65ytV kdk$$Ifl8# _ O#?&{), t0 -6888844 laytV ~$$If!vh#v#v<:V l t0 -65ytV kd/o$$Ifl8# _ O#?&{), t0 -6888844 laytV ~$$If!vh#v#v<:V l t0 -65ytV kdqr$$Ifl8# _ O#?&{), t0 -6888844 laytV ~$$If!vh#v#v<:V l t0 -65ytV kdu$$Ifl8# _ O#?&{), t0 -6888844 laytV ~$$If!vh#v#v<:V l t0 -65ytV kdx$$Ifl8# _ O#?&{), t0 -6888844 laytV ~$$If!vh#v#v<:V l t0 -65ytV kd7|$$Ifl8# _ O#?&{), t0 -6888844 laytV -$$If]!vh#v#v#v<#v{(#v:V l 2CF6,555<5{(59/ /  / a]p2ytr S$$If]!vh#v#v#v<#v#vE#v#v:V l CF6,555<55E559/ / / /  a]pFytr S$$If]!vh#v#v#v<#v#vE#v#v:V l ̙CF6,555<55E559/ / / /  a]pF̙ytr S$$If]!vh#v#v#v<#v#vE#v#v:V l CF6,555<55E559/ / / /  a]pFytr S$$If]!vh#v#v#v<#v#vE#v#v:V l `CF6,555<55E559/ / / /  a]pFytr )$$If]!vh#v#v#v<#v#vE#v#v:V lCF6,555<55E559/ / / /  a]pFytr )$$If]!vh#v#v#v<#v#vE#v#v:V lCF6,555<55E559/ / / /  a]pFytr S$$If]!vh#v#v#v<#v#vE#v#v:V l ``CF6,555<55E559/ / / /  a]pFytr )$$If]!vh#v#v#v<#v#vE#v#v:V lCF6,555<55E559/ / / /  a]pFytr ;$$If]!vh#v#v#v<#v#vE#v#v:V l  ̙CF6,555<55E559/ / / /  a]pF̙ytr )$$If]!vh#v#v#v<#v#vE#v#v:V lCF6,555<55E559/ / / /  a]pFytr ;$$If]!vh#v#v#v<#v#vE#v#v:V l  ̙CF6,555<55E559/ / / /  a]pF̙ytr )$$If]!vh#v#v#v<#v#vE#v#v:V lCF6,555<55E559/ / / /  a]pFytr )$$If]!vh#v#v#v<#v#vE#v#v:V lCF6,555<55E559/ / / /  a]pFytr )$$If]!vh#v#v#v<#v#vE#v#v:V l;CF6,555<55E559/ / / /  a]pFytr )$$If]!vh#v#v#v<#v#vE#v#v:V lCF6,555<55E559/ / / /  a]pFytr )$$If]!vh#v#v#v<#v#vE#v#v:V lCF6,555<55E559/ / / /  a]pFytr )$$If]!vh#v#v#v<#v#vE#v#v:V lCF6,555<55E559/ / / /  a]pFytr )$$If]!vh#v#v#v<#v#vE#v#v:V lCF6,555<55E559/ / / /  a]pFytr )$$If]!vh#v#v#v<#v#vE#v#v:V lCF6,555<55E559/ / / /  a]pFytr )$$If]!vh#v#v#v<#v#vE#v#v:V lCF6,555<55E559/ / / /  a]pFytr )$$If]!vh#v#v#v<#v#vE#v#v:V lCF6,555<55E559/ / / /  a]pFytr )$$If]!vh#v#v#v<#v#vE#v#v:V lCF6,555<55E559/ / / /  a]pFytr )$$If]!vh#v#v#v<#v#vE#v#v:V lCF6,555<55E559/ / / /  a]pFytr )$$If]!vh#v#v#v<#v#vE#v#v:V lCF6,555<55E559/ / / /  a]pFytr )$$If]!vh#v#v#v<#v#vE#v#v:V lCF6,555<55E559/ / / /  a]pFytr )$$If]!vh#v#v#v<#v#vE#v#v:V lCF6,555<55E559/ / / /  a]pFytr )$$If]!vh#v#v#v<#v#vE#v#v:V lCF6,555<55E559/ / / /  a]pFytr )$$If]!vh#v#v#v<#v#vE#v#v:V lCF6,555<55E559/ / / /  a]pFytr )$$If]!vh#v#v#v<#v#vE#v#v:V lCF6,555<55E559/ / / /  a]pFytr )$$If]!vh#v#v#v<#v#vE#v#v:V lCF6,555<55E559/ / / /  a]pFytr )$$If]!vh#v#v#v<#v#vE#v#v:V lCF6,555<55E559/ / / /  a]pFytr )$$If]!vh#v#v#v<#v#vE#v#v:V lCF6,555<55E559/ / / /  a]pFytr )$$If]!vh#v#v#v<#v#vE#v#v:V lCF6,555<55E559/ / / /  a]pFytr )$$If]!vh#v#v#v<#v#vE#v#v:V lCF6,555<55E559/ / / /  a]pFytr )$$If]!vh#v#v#v<#v#vE#v#v:V lCF6,555<55E559/ / / /  a]pFytr )$$If]!vh#v#v#v<#v#vE#v#v:V lCF6,555<55E559/ / / /  a]pFytr )$$If]!vh#v#v#v<#v#vE#v#v:V lCF6,555<55E559/ / / /  a]pFytr )$$If]!vh#v#v#v<#v#vE#v#v:V lCF6,555<55E559/ / / /  a]pFytr $$If!vh#v0*:V V 00*50*/  / 44 VytV T$$If!vh#v0*:V V  00*,50*/ 44 Vp ytV T$$If!vh#v'#v#v#v9 :V V 00*,5'5559 / / / / / / 44 VytV T$$If!vh#v'#v#v#v9 :V V4 00*+,5'5559 / / / / / 44 VytV Tc$$If!vh#v'#v#v#v9 :V V4  (00*+,5'5559 / / / / / 44 Vp(ytV T$$If!vh#v'#v#v#v9 :V V4 00*+,5'5559 / / / / / 44 VytV T$$If!vh#v'#v#v#v9 :V V4 00*+,5'5559 / / / / / 44 VytV T$$If!vh#v'#v8#v#v#v9 :V V 00*,5'585559 / / / / / / 44 VytV T$$If!vh#v? #v:V V 00*,5? 5/ 44 VpytV T$$If!vh#v#v#v:V V 00*,555/ 44 VytV T$$If!vh#v#v#v#v:V V4 00*+,5555/ /  / 44 VytV T$$If!vh#v#v#v#v:V V4 00*+,5555/ / /  44 VytV T$$If!vh#v? #vJ #v:V V 00*,5? 5J 5/ / / / / 44 VytV T$$If!vh#vR#v:V V 00*,5R5/ 44 VpytV T$$If!vh#vR#v:V V 00*,5R5/ 44 VytV T$$If!vh#vR#v:V V4 00*+,5R5/ / / / / 44 VytV T$$If!vh#vR#v:V V4 00*+,5R5/ / / / 44 VytV T$$If!vh#v #v #v:V V 00*,5 5 5/ / / / / 44 VytV T$$If!vh#vz #vF#vp :V V  00*,5z 5F5p / 44 VpytV T$$If!vh#v#v#vf#v#v#v:V V 00*,555f555/ 44 VytV T$$If!vh#v#v#vf#v#v#v:V V 00*,555f555/ 44 VytV T$$If!vh#v#v#vf#v#v#v:V V 00*,555f555/ 44 VytV T$$If!vh#v0*:V V  00*,50*/ 44 Vp ytV T$$If!vh#v:V V 00*,5/ 44 VytV T$$If!vh#v#vL:V V  00*,55L/ 44 VpytV T$$If!vh#v#vL:V V4 00*+,55L/ / / / 44 VytV T$$If!vh#v#v #v :V V4 00*+,55 5 / / / / 44 VytV T$$If!vh#v0*:V V  00*,50*/ 44 Vp ytV T$$If!vh#v0*:V V 00*,50*/ 44 VytV Tb 2 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~PJ_HmH nH sH tH L`L V Normal$CJOJPJQJ_HaJmH sH tH F@F V Heading 1$@&5CJOJQJ\L@L V Heading 2$$@&a$5CJOJQJ\V@V V Heading 3$l@&^`l5CJOJQJ\T@T V Heading 6$@& 5OJQJ\^JaJjj&DA D Default Paragraph FontRi@R  Table Normal4 l4a (k (No List HP@H V Body Text 2$a$OJQJ\^J4@4 V Header  9r H@H V Balloon TextCJOJQJ^JaJ2B@"2 V Body Textx4 @24 V Footer  9r FOBF V Centered$a$CJOJQJmH sH B'`QB V Comment ReferenceCJaJ<@b< V Comment TextCJaJRoqR V Comment Text CharOJQJ_HmH sH tH @j@ab@ V Comment Subject5\^o^ V Comment Subject Char5OJQJ\_HmH sH tH ZY@Z .`| Document Map-D M CJOJQJ^JaJPK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭V$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3N)cbJ uV4(Tn 7_?m-ٛ{UBwznʜ"Z xJZp; {/<P;,)''KQk5qpN8KGbe Sd̛\17 pa>SR! 3K4'+rzQ TTIIvt]Kc⫲K#v5+|D~O@%\w_nN[L9KqgVhn R!y+Un;*&/HrT >>\ t=.Tġ S; Z~!P9giCڧ!# B,;X=ۻ,I2UWV9$lk=Aj;{AP79|s*Y;̠[MCۿhf]o{oY=1kyVV5E8Vk+֜\80X4D)!!?*|fv u"xA@T_q64)kڬuV7 t '%;i9s9x,ڎ-45xd8?ǘd/Y|t &LILJ`& -Gt/PK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 0_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!0C)theme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] &Hurdman, Judith (Respiratory Medicine)"فHJ(MBW#'ف WWWZKx"P2=U_l1q w|}ł~ىEGIWY[ptL  ;-Z]"-b6APESpSrSSSSSS T"T7TBTVTXTlTTTTsV[5^xabbbc:c_czccccdde9ffgug~lllllOmPmmmmmn nnn8n9nGn]nfninunnnnnnnnnnooo$o.o3o=oBoLoQo[ofozooooooooppp!p+p0p:p?pIpNpXpdppppppppppppqqq!q2q/v{|}Q}}}}~C~~~5l _ClD[ǂʃPEىFHJKLMNOPQRSTUVXZ\]^_`abcdefghijklmnoqrsuvwxyz{|}~B ^ ` ف: TZl,R$"@@HX Μ1821@ (    S BA? "Picture 1NHS RGB#" ?B S  ?tف%*t@ RANGE!A1:G39ndځ}dځ\j]j^j_j`jajbjcjdjejfjgjhjijjjkjljmjnjojpjqjrjsjtjyJKK!T!T6r6rMrMr_u_umuvv wwww x x8xLLځ     JKK'T'T*urn:schemas-microsoft-com:office:smarttags PersonName9*urn:schemas-microsoft-com:office:smarttagsplace;*urn:schemas-microsoft-com:office:smarttagsaddress: *urn:schemas-microsoft-com:office:smarttagsStreet8*urn:schemas-microsoft-com:office:smarttagsCity=*urn:schemas-microsoft-com:office:smarttags PlaceName=*urn:schemas-microsoft-com:office:smarttags PlaceType @     BW!h"h   = ? \ ^ KNUX ,*6dpeg#"&"""$#'#)-+-//00n0p0005555+65666@7H7R8Z8EEHHKKKKLLN)NRR5TkTUUZZ[[{\}\V]Y]g^j^aa4b7bbbccBdEddddddd%e*e4e7e{e~eeeeegggggggghhhhhhmjojll|mmmmmmq"qbsfsuuvvx xryyyffhiiklnoqrׁځ.4<ik!!y$|$..<2D2889999::MM>PFPRRS.SESnS5TjT#W)WWXXXhYwY`ZgZ#`%```bbccXj^jjj/n;nss56fhiklnoqrځ333333333333333333333333333334 3YYZ 2 hig<Zo.]_%%&&<'(((-((+C,E,-KKKKKmLLL*MMZ[[\O\`\\\6]3_nd.eGe_fvfffff"iNjXjjjjjqrtvvvwmwwwwxDyyyyEz{{{S}t}W~~~~EeffhiiklnoqrځffhiiklnoqrځfZ<i!D+z ,:zxR$G5"8k~*4$ <v(R(-:dj,jBZ_fLT9E%8^G-k=Iǐf/] I0o\~5o0`4[GqXICtȸx9G|$h^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohp^p`OJQJo(hHh@ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohP^P`OJQJo(hH^`o(. ^`hH. pLp^p`LhH. @ @ ^@ `hH. ^`hH. L^`LhH. ^`hH. ^`hH. PLP^P`LhH.^`o(. ^`hH. pL^p`LhH. @ ^@ `hH. ^`hH. L^`LhH. ^`hH. ^`hH. PL^P`LhH.^`OJPJQJ^Jo(-^`OJQJ^Jo(hHopp^p`OJQJo(hH@ @ ^@ `OJQJo(hH^`OJQJ^Jo(hHo^`OJQJo(hH^`OJQJo(hH^`OJQJ^Jo(hHoPP^P`OJQJo(hHh ^`OJQJo(h ^`OJQJo(oh pp^p`OJQJo(h @ @ ^@ `OJQJo(h ^`OJQJo(oh ^`OJQJo(h ^`OJQJo(h ^`OJQJo(oh PP^P`OJQJo(h ^`OJQJo(^`OJPJQJ^Jo(-h pp^p`OJQJo(h @ @ ^@ `OJQJo(h ^`OJQJo(oh ^`OJQJo(h ^`OJQJo(h ^`OJQJo(oh PP^P`OJQJo(h ^`OJQJo(h ^`OJQJo(oh pp^p`OJQJo(h @ @ ^@ `OJQJo(h ^`OJQJo(oh ^`OJQJo(h ^`OJQJo(h ^`OJQJo(oh PP^P`OJQJo(h ^`hH.h ^`hH.h pLp^p`LhH.h @ @ ^@ `hH.h ^`hH.h L^`LhH.h ^`hH.h ^`hH.h PLP^P`LhH.h808^8`0o(. ^`hH. pLp^p`LhH. @ @ ^@ `hH. ^`hH. L^`LhH. ^`hH. ^`hH. PLP^P`LhH.h ^`hH.h ^`hH.h pLp^p`LhH.h @ @ ^@ `hH.h ^`hH.h L^`LhH.h ^`hH.h ^`hH.h PLP^P`LhH.^`o(.h^`OJQJo(hH pLp^p`LhH. @ @ ^@ `hH. ^`hH. L^`LhH. ^`hH. ^`hH. PLP^P`LhH.h ^`OJQJo(h ^`OJQJo(oh pp^p`OJQJo(h @ @ ^@ `OJQJo(h ^`OJQJo(oh ^`OJQJo(h ^`OJQJo(h ^`OJQJo(oh PP^P`OJQJo( hh^h`OJQJo(h hh^h`hH.h 88^8`hH.h L^`LhH.h   ^ `hH.h   ^ `hH.h xLx^x`LhH.h HH^H`hH.h ^`hH.h L^`LhH.^`5CJ^Jo(. ^`hH. pLp^p`LhH. @ @ ^@ `hH. ^`hH. L^`LhH. ^`hH. ^`hH. PLP^P`LhH.^`OJQJo(hH^`OJQJ^Jo(hHopp^p`OJQJo(hH@ @ ^@ `OJQJo(hH^`OJQJ^Jo(hHo^`OJQJo(hH^`OJQJo(hH^`OJQJ^Jo(hHoPP^P`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hHh ^`OJQJo(h ^`OJQJo(oh pp^p`OJQJo(h @ @ ^@ `OJQJo(h ^`OJQJo(oh ^`OJQJo(h ^`OJQJo(h ^`OJQJo(oh PP^P`OJQJo(v(*4$9G|D+f/]R([GqT9EjBk=IfG5",8^G-:I0o5oCt<                                    Z                  _                >                                            ܯ h                                   r(r V .S6f4uujCw.`|tS\'fh@ -  ف@Unknown&Hurdman, Judith (Respiratory Medicine) G*Ax Times New Roman5Symbol3. *Cx Arial7.@ CalibriG=  jMS Mincho-3 fg;WingdingsCNComic Sans MS5. .[`)Tahoma?= *Cx Courier NewACambria Math"1h''PnBPnB!24$$ 3qHP ?V 2! xx 2INDUCTION DOCUMENT FOR RESPIRATORY MEDICINE AT NGHhilljLithgow, Jim (Research)\               Oh+'0px   , 8 DPX`h4INDUCTION DOCUMENT FOR RESPIRATORY MEDICINE AT NGHhillj 22DA5631Lithgow, Jim (Research)2Microsoft Office Word@F#@lڿ@lڿPn՜.+,0L hp  +4Sheffield NHS Teaching Hospitals Foundation TrustB$ 3INDUCTION DOCUMENT FOR RESPIRATORY MEDICINE AT NGH Title  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~      !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}Root Entry FῡData Z1Table~KlWordDocument2SummaryInformation(DocumentSummaryInformation8CompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q