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Hi Kevin

RE: Train of thought - August 2003.

Firstly your statistics make for disappointing reading and may indicate a lack of interest by a large proportion of Society members, or it might indicate that only a small proportion of members find the time to log onto the Web-site. I guess if you did an on-line survey of people who log-on regularly you would get a better reflection of members who might have replied. But it is very easy to get lost in the statistics.

Your musings about a vision for the Society led me to revisit the "About the Society" section (of the Web-site) and to consider the 5 aims of the Society that are clearly stated there. I wonder how many members can state these 5 aims, and beyond that how many members believe that the ANZSRS successfully achieves these aims on an on-going basis. I believe there is value in having a clearly stated shared vision that is realistic and achievable and is supported by the aims of the Society.

Are we a Society or an Association? I used to be a member of the Association for Respiratory Technology and Physiology (ART&P) in the UK, and I remember similar trains of thought being voiced all those years ago... "so few doing so much for so many - is it worth it?" Well I guess the answer to that question lies in the question what are we doing this all for?

Interestingly the Collins Concise Thesaurus notes Society as a synonym for Association and vice-versa. For me this means that the value is not inherent in the chosen word, be it Society or Association, but is in the actions of the members. We will be measured by those actions and whether our actions matched up with the aims of our Society.

To move the Society towards professional status is another journey the ART&P was going through when I was a member, and here we are moving towards professional status. Then as now an overriding question was what did the term "Professional Status" mean.

Well, I feel like I am rambling on a little but, getting back to a vision. Surely the vision for the ANZSRS is for us to attain professional status through advancement of our Society and each member by following and applying the aims of the Society. We must all open our eyes to our potential as individuals and as a Society in order to reach the goal of what ever vision we set for ourselves.

If this does not make sense in its entirity that is Ok. By building on the musings of each other we will build a Society to be proud of.

David Robiony-Rogers

7-Sep-2003

Dear Editor,

If I can drive Kevin's rhetorical "Train of Thought" (August, 2003) on a bit it would be to suggest that an Association and Society is functionally one and the same thing, at least in terms of our aims. But your point is very well taken that there is a need for the Society to develop a 'Vision' and for its members to take on a more proactive role in the affairs, governance and future direction of our Society. To do this we need (as Kevin says) to move from an association of individuals to a Society where we all pull together.

We should always be aiming for the highest level of professionalism and excellence. This will never be achieved by mediocrity, by just doing enough or through brief spurts of enthusiasm. It requires a sustained effort from each and every member. The Society would be greatly served by a Vision that amongst other things identifies all of the steps we will need to climb "collectively" in order to get there. I used the word "collectively' because unless all ANZSRS members are willing and able to become involved, we will cease to evolve into a professional organization that is able to meet future challenges and this will have a negative impact on our capacity to influence our future development and that of our profession, generally. And, of course, all this reflects on our credibility.

I agree with Kevin that the achievements of the ANZSRS, which we all benefit from, are to a very large extent due to the huge efforts of very few members. The Society should reflect the collective will (etc) of all its members and not just those of a few. It is disappointing that there are many senior ANZSRS members who contribute very little yet have the capacity and resources to do far more. In several ways the ANZSRS membership may be compared to a bimodal distribution where the doers sit some distance to the right of the main group. We need strategies to bring these groups together otherwise the divide between them may widen making it difficult for the Society to cater to the needs of all its members. The last thing we want is for members to breakaway in an effort to move on. Thus, a critical aim and challenge for the Society is to develop strategies to move the less experienced and poorly motivated members into the doers group. For this to occur we all need to become more dynamic, Society focused and importantly, motivated and proactive. We must become proactive and productive in our search for ways to improve our skills, identify problems and weaknesses, and seek solutions. We should all be involved in this and must not rely on other societies and state and government departments to do it for us or to take the initiative otherwise we are in danger or losing (or never gaining) leadership, and ownership in our own profession. Above all the Society needs to identify and be able to clearly articulate the technical, scientific and administrative skills we need to use in the performance of our work. Only then can these skills be recognised and acknowledged beyond the membership.

If our Vision is to include the highest possible level of professionalism and excellence then we need to plan now and put into place the steps we need to take to get there. We all need to move out of our comfort zone and have the resolve and motivation to take on difficult challenges. Addressing just two possible steps:

  1. Are We a Profession?: ANZSRS members come under a wide range of awards. Does this mean we are not a recognised profession. If you are a physiotherapist then you are paid as such and your job description reflects this. A member of our profession is referred to as variably as scientist, technologist, technician, nurse, technical officer and professional officer. Job descriptions, even for the very same work and level of responsibility, vary greatly between states and between New Zealand and Australia. This diversity adds to the difficulties we all face when recruiting suitably qualified staff and does very little in terms of providing a career path. It would be a major advance if this was sorted out but I fear a long and difficult road ahead, and some may feel this to be beyond the aims of the Society.

    But should it be? We include the word "Science" in our Society name and all who pass the Society exam are entitled to use the designation "Certified Respiratory Function Scientist". One might ask "what is in a name" and to some extent I would agree. But if we are a recognised profession then surely we should have a recognisable title (eg Respiratory Scientist) on an even footing. I do realise that it is more complex than this as not all members have a science degree, etc. However, most do, but their position title and the award they are under do not necessarily reflect this. As mentioned above, a good start might be for the Society to clearly identify the technical, scientific and administrative skills needed by members (at various levels of seniority) in the performance of their work. This would certainly help in defining a career path.

  2. Publication Rate: I firmly believe that research and development should play an important role in our Society. Research is highly regarded and to some extent it is an indicator of excellence and professionalism. We desperately need to improve the conversion rate of abstracts to papers. My perception is that historically the conversion rate has been generally very low despite the high quality of the research presentations at the ANZSRS ASM (it would be interesting to compile statistics on this). I believe members who undertake non-preliminary research have a moral obligation to publish their work because an important aim is to communicate your new findings so that others can learn from it. This means that the considerable scientific and technical expertise of the ANZSRS is seldom seen and is therefore of little consequence beyond the membership. A common excuse for failing to publish (and I have used it myself) is "I am too busy" but this is rather limp and one has to ask why the research was done in the first place. It is more plausible that the poor conversion rate is due to a combination of lack of experience, lack of confidence, lack of support, poor writing skills, poor motivation and the significant effort required to write a scientific paper. This is very understandable as it is certainly a tough task to publish your work but the rewards are well worth it. Another factor that probably plays a role is that some consider their research complete once it has been presented at the ASM. I would argue that people engaged in research have a moral obligation to publish, as only then is the work complete and useful. The Society can play an important role here by not only strongly encouraging members to publish but providing educational workshops and mentors (preferably only those with a publication record). Fortunately, Kevin has been proactive in establishing up on the Web-site a list of members willing to act as mentors.

    I believe there are many members who would like to be involved in research but lack of opportunity, support, experience and confidence to do so and, in particular, find it difficult to think of a good research question. Again, the Society can certainly help here. For example, it may be useful to develop a page on the ANZSRS Web-site dedicated to research. It could post a list of research questions, potential mentors, researchers and members seeking collaboration, links to articles with information about how to conduct research, analyse data and prepare papers for publication, etc.

In conclusion, the ANZSRS is currently well regarded by its peer societies and associations and is beginning to attract the attention (but often via other societies) of government and regulatory bodies. Now is the time to develop a Vision and the means to achieve it so we evolve into a truly independent and highly regarded Professional Society that is always the first point of contact on matters relating to our profession. With your help it can be done.

Yours sincerely,
David P. Johns
University of Tasmania

7-Sep-2003

Dear Kevin,

In response to your question are we a society or an association? According to dictionary definition a society is a group bound together by common interest and standards. An association is a group in the act or process of organization or of being organized. I feel I am mostly in the second definition, trying to organize myself, while the first definition is also applicable as I aspire to common standards.

We as a society are certainly bound together by common interest, but have begun to be more organized since someone with a passion for the cause has taken the time to help us communicate better. As with most causes in life, the need for change and growth is apparent, but the labourers are few. Generally it takes only one to pick up the vision and run with it in order to inspire others. Although time poor, I am inspired by your attempts to raise the standard of our communication between each other and have become more organized in order to make time for communication.

I was very encouraged to read the letter from Philip Quanjer with his generous offer of free access to his work, very helpful and much appreciated as I drag myself through the process for lab accreditation. I am looking forward to the day that I can also make contributions for the good of the society and I am sure I am not the only one that has noticed the improvements to our organization that is bringing us closer as a society.

Yours Sincerely
Alison Boynton

7-Sep-2003

Dear Kevin,

Firstly many thanks for your "Train of Thought - Visions" edition last month. Yours, and the contributions of Maureen in the past, Brenton, and David in the Executive Report are much needed by our Society. I am glad that the Executive is currently addressing this issue.

I have the sense that we as a Society are doing well, since we are taking the time to look at ourselves in perspective. This can only make for a healthy situation. It's something that all of us should do, from time to time, in all aspects of our lives. Two things come to mind for me - a few years ago I ended my long membership of Amnesty International Australia, and recently my family and I changed Churches. No, not going Charismatic - just a more family friendly Anglican Church. We have not really lost anything. Rather we have gained overall.

Can I bring you back to my surf report last month, when talking about Society membership? There, I wrote about the students who were proactive, those that were peripheral and those parsimonious. These students could also have been our members. Despite the existence of the later group, the Society (educational institution) still survives. Some members do cooperate and contribute more than others, which appears to be unfair. BUT, the whole looks probably quite good. Those that do all the work increase in self-worth, fulfilment, knowledge, leadership and a few others I'm sure!

However, all is not the same as it was in 1982 when I first joined. The senior membership and the constitution have grown older together. Currently, our future does belong in our hands, for the sake of those currently studying or entering into our profession. What I want to see is a flatter structure, where the work of the Executive is shared amongst a team of Leaders. Maureen's model has great merit. I have not come up with anything to improve on it. On the issue of having to have a NZ Director on the Board, that sounds like the NZ Constitution, where at least two Senators must be Maori. Is this the Pakeha pay back? All members should be created equally!

Also to promote professionalism, I would like our Society to be in a position where we can influence Government policy. We do not want to see the Tech credential thing rolled out again, and SA does need it's degreed scientists payed accordingly. Not as Techs. Also let's all lobby our State/ Territory and National Govts to recognise the CRFS qualification just as is now done in Victoria with a 4% of base pay increase. I'm not saying that we should be come an Industrial Association, but we should make a stand on employment issues. Currently our Constitution prevents this.

Finally I do see ourselves as still a Society. The ARTP is an Association. I'm not sure why they do not consider themselves as a Society first. Is it their greater interplay with manufacturers and industry? To their credit they did have an ear with Tony Blair last year. He recognised their contribution to health care (as individuals). More can be read about this at their web-site.

I hope this is of some help. I look forward to a continuing prosperous Society, where I am proud to say that I am a member.

Cheers,
Andrew
Andrew Coates MAppSc CRFS

7-Sep-2003

Respiratory Function Laboratory
Department of Respiratory Medicine
Princess Margaret Hospital
GPO Box D184, Perth WA 6840
Telephone: (08) 9340 8830
Facsimile: (08) 9340 8181

2003 ANZSRS Annual scientific meeting Best Presentation Award.

Presentation: Short-term repeatability of the forced oscillation technique in children aged four to seven years.

I was honoured to be awarded the 2003 Best Presentation award at the annual scientific meeting in Adelaide. The work presented was the collective input of a number of people and represents a portion of the research the Department of Respiratory Medicine at Princess Margaret Hospital is conducting in the area of forced oscillation measurements in pre-school children.

I would like to acknowledge the generous sponsorship of Technipro of the 2003 Best Presentation award at the annual scientific meeting in Adelaide. The continuing support of industry of the scientific activities of the Society will ensure that the performance and presentation of high quality research is promoted throughout the Society in future years. This award will allow be to attend and present my data at the 2003 annual scientific meeting of the European Respiratory Society.

The objective measurement of lung function is the mainstay of the management of respiratory disease. Spirometry requires the active cooperation of patients and may be unreliable in young children below seven years of age. The forced oscillation technique (FOT) requires minimal patient cooperation and can be used in children as young as three years. We aimed to assess the repeatability of the FOT in a group of young children aged 4-7 years over a period of 15 minutes.

Paired FOT measurements were performed in 47 children approximately 15 minutes apart Five measurements were recorded on each occasion and stored for later analysis. The mean resistance (R) and reactance (X) between 2-24 Hz is reported. Measurements were excluded if evidence of swallowing, mouth movement, talking or leak was noted. A measurement set was retained if a minimum of three (out of five) measurements could be analysed.

Technically acceptable paired data were obtained in 42 children (89%). Forced oscillatory data was reproducible without significant difference between successive tests over a time period similar to that used in bronchodilator testing. We conclude the FOT may provide helpful lung function information in young children unable to perform spirometry and a change of 1.75 hPa.s/L in average resistance would indicate an alteration in lung function exceeding normal variation over time.

Graham Hall PhD
Respiratory Medicine
Princess Margaret Hospital

7-Sep-2003

5th August, 2003

Kevin Gain
Website Editor
ANZSRS

Dear Editor,

It was with great pleasure that I was able to accept the award at this year's ANZSRS for the best poster presentation. I would like to extend my thanks to the sponsor of the prize, Paul Guy from Eastern Respiratory Service.

My presentation was on the "Reproducibility of the multiple breath nitrogen washout as a measure of airway heterogeneity". We have established this technique in our laboratory with the help of our collaborator, Dr Sylvia Verbanck, who is based in Brussels, Belgium. Our study evolved as part of the small airways project through the CRC for Asthma ( www.asthma.crc.org.au ). The advantage of this technique is that we can now measure heterogeneity arising from the small airways and the large airways. It was first important to test the reproducibility of this test from day to day on a group of normal subjects, as this had not been done before on our Multiple Breath Nitrogen Washout technique.

We plan to publish this work in the future once we have also tested the reproducibility of the Multiple Breath Nitrogen Washout technique in asthmatics. I have also started recruiting for a study of small airways disease in asthma patients over a wide range of severity, in which I am also looking at the effects of treatment.

Regards,

Sue Downie

6-Aug-2003

Dear Michelle

My name is Jeanann Colman and the president of LAM Australia. Our web-site is http://www.LAM.org.au. Lymphangioleimyomatosis (LAM) is a rare and life threatening lung disease that affects only women. As well as being the president of LAM I also have LAM.

The goals of LAM Australia are support for women and research and education into this life threatening disease. As LAM is so rare it is important that sufferers of this disease can contact others with LAM.

Every March LAM Australia has a LAM lunch and our last one was held in Melbourne with 9 LAM ladies attending, travelling from Brisbane, Sydney, Maitland, Narrandera and Melbourne. We also have get togethers where we meet and have a cuppa, or fund raising activities.

We are currently having brochures printed about LAM and will be sending them out to Doctors and hospitals etc. As support is important to us all, if you have any patients, can you please forward my name and the LAM web-site onto them.

Thank you Michelle

Yours faithfully
Jeanann Colman

7-Jul-2003

Dear colleague,

Roaming across the internet I came across your very complete and well-done site. To my knowledge lung function tests are still frequently carried out by people who have received little training, and many of them do not have access to vital information relating to quality assurance and the like.

I have recently been responsible, with Dr Paul Enright, for the quality control in a worldwide clinical trial and, alas, it was obvious that in many laboratories the quality of spirometry was not up to standards. I have been very much engaged in the field of promoting good quality of spirometric tests, and am the first author of an extensively used and cited report issued by the European Respiratory Society. I have also contributed to reports by the ATS. With prof. Tammeling I am also the author of "Contours of Breathing", which was distributed by Boehringer Ingelheim. I believe these volumes are still used for educational purposes.

Arising from this maybe you are interested to know that I have started a site (http://www.spirxpert.com) where I provide extensive information about spirometry, the (patho)physiologiological backgrounds, how to perform tests, bronchodilatation, interpretation of test results, etc. It also includes the paediatric age range. If you wish you can provide a link on your site.(This link has been added to the links page. KG.) I have no commercial interests, the site is accessible to anyone for free.

Best wishes,
Philip Quanjer

7-Jul-2003

Dear Kevin,

I was reading with interest your letter "Keeping the Science in Scientist" (October2002). There is no disagreeing that the information and knowledge we gain from our years of learning and experience must be shared with the people we work with, people in the same professional field and others who show an interest. The real power of knowledge is not in its attainment for personal gain but rather in the sharing of knowledge for the greater good. It is incumbent upon those of us with knowledge and experience to give this knowledge to our colleagues and develop their experience so that in our absence our colleagues do not falter in performing their tasks.

I fully support your comments about knowing the equipment, the science and physics behind the 'black box', and being in-tune with the equipment. The first should be provided as part of the education our scientists have prior to performing pulmonary function testing, the second comes with long-term experience. However, just as important as being well grounded in the physics of pulmonary function testing is the need to have a clear knowledge and understanding of human physiology, especially respiratory physiology. When there is a lack of understanding of the individual lung volumes being measured and the interrelation of dynamic and static lung volumes, knowledge of the 'black box' physics will not aid in the diagnosis of the cause of inaccurate measurements.

Much has been said and published over the years about empowering people in their work by providing them with information and opportunity so that they can develop their knowledge. I believe it is incumbent upon all of us, regardless of our position or job description, to make it a part of our daily routine to make available the knowledge and experience we have to those who wish learn and develop in our professional environment.

Understanding what we are measuring is the starting point from which we can identify errors in results. Only then will we be at a position where we can apply scientific method to solve our (perceived) problems.

David I Robiony-Rogers.
Pulmonary Function Unit
Division of Respiratory Medicine
Riyadh Armed Forces Hospital, Saudi Arabia.
Email: robionyrogers@nzoomail.com

10-Feb-2003

Dear Kevin,Chris, and David,

The results are coming in from our syringe survey, and we will bring them to you formerly at the Adelaide ASM. If you havn't received your survey or are having trouble sending it, drop me an email.

Comparing two syringes is fine David, but a certified syringe is supposed to be within 0.5% of of the expected volume. ie 15ml in 3L, according to the ATS Standards for spirometry. This is despite our equipment being allowed to be within +/-3% (+/-90ml). If you compare two syringes they should be within 30ml (2x15ml). I'd like to think that my precision is within 10ml, but that would have to be at the same flow profile. Commercial linearization may not be as good as we would like it to be. I don't think there is any on our Vmax Legacy mass flow sensors.

My point is there will always be systematic measurement errors dispite how precise and accurate we try to be, and we will never know how far we are from the exact truth which might be as far as 105ml away (90+15ml) at worst assuming we have had our syringe verified. I think that the Hans Rudloph approach is what we should all go for if we can afford it, but prehaps there is a niche here for the ANZSRS or a local company to provide a revalidation service. I for one am uncertain of the syringes I have. Interested to hear further from others. There must be more opinions out there? Come on..

Merry Christmas and Happy Holidays to all!
Cheers

Andrew Coates
ancoates@mater.org.au

23-Dec-2002

-----Original Message-----
From: Chris McLachlan [mailto:ChrisMcLachlan@healthotago.co.nz]
Sent: Friday, 13 December 2002 9:42
To: kevin.gain@health.wa.gov.au
Subject: FW: calibration syringe

As Hans Rudolph suggest the re certification of calibration syringes, I emailed them with Davids question. I am forwarding their reply.

I would be interested in assessing the accuracy of a certified syringe over time and will keep watch for further communication on this topic.

Chris

-----Original Message-----
From: Gilbert Snedden [mailto:gilbert@rudolphkc.com]
Sent: Friday, 13 December 2002 10:48 a.m.
To: Chris McLachlan
Cc: hri@rudolphkc.com
Subject: calibration syringe

Christene McLachlan
Dunedin Hospital
New Zealand

Dear Christene, I have attached a MS-Word document to this e-mail, I hope that you can open it. I also copied the contents of that letter below, just in case.

Please let me know if this addresses question #1) What method do you use for re certification/? calibration?

As far as question #2) Is there any evidence that calibration syringes change their performance over time?

Unless a component that is critical to the function of the syringe changes, the performance of the syringe should be steady over time. Provided that there are no drastic changes in room temperature, etc., and the syringe has not suffered from a severe drop of some kind.

However, the syringe is a dynamic device, and the seal will wear, the lubricant will become dirty, and there may be other intervening factors that will affect the performance of the syringe. So it is a good practice to have it checked at regular intervals. This is why we completely rebuild the syringe at recalibration. Although we do not replace the critical components, with the exception of the lubricant, we do examine these prior to testing and completing the recalibration or recertification service.

Best regards,

Gilbert Snedden

Quality Assurance Manager
Hans Rudolph, inc.
gilbert@rudolphkc.com

Hans Rudolph, inc., Volume Calibration Syringe and NIST Traceability

Dear Customer,

When you purchase a Hans Rudolph, inc. (HRI) syringe, it comes with a Certificate of Calibration, which shows the actual volume of the serialized syringe at the various calibration points. The calibration of that syringe was compared to the in-house transfer standard, whose volume is traceable to NIST (National Institute of Standards and Technology) by means of the ASTM (American Society of Testing and Materials) designation E 542 Standard Practice for "Calibration of Laboratory Volumetric Apparatus". This NIST traceable volume has a 0.1% full-scale accuracy. The syringes for purchase have a 0.5% full-scale accuracy.

Hans Rudolph, inc. uses a proprietary calibration method for ensuring the accuracy of each syringe sold. The method of calibration is verified daily with the NIST in-house transfer standard, once it has been verified, we can rely on the calibration results for the other syringes. For the larger 5530, 5570, and 4900 Series Syringes, we collect the output volume and employ an encoder (which has been characterized for this purpose) for the position, or the calculated volume. We then compare it to the setting, and accuracy, and record the volume output. This is provided to you on the Certificate of Calibration. For the smaller 5520, 5510, 5550, and 5540 Series Syringes, the method we use is similar, except that, we do not collect the volume output. In order to maintain the same accuracy, we accurately measure the cross-sectional area of the bore, and measure the length of the stroke.

Once the syringe has been calibrated, we certify that calibration for a full year, under normal laboratory conditions and usage. For newly purchased syringes, the calibration of the syringe is good for one year after your date of installation; (you may have to make changes to your calibration label accordingly).

The syringe is a mechanical device and, unless any critical to function parts are worn or damaged, should provide the customer with many years of service. HRI recommends that the customers recalibrate their syringe on a yearly basis, HRI could perform this service for them and provide them with a new Certificate of Calibration. Our service technicians examine the syringe for wear, and damages (if parts are worn/damaged, these will be quoted at that time), and completely rebuild and re-lubricate the syringe. Once the syringe is serviced, it then is leak-tested, and certified for accuracy, prior to delivery to the customer. This service and the new Certificate of Calibration are under warranty for a full year.

Please refer to the HRI catalog, and/or Syringe Data Sheet (P/N 691058) for the sizes, ordering information and the instructions for obtaining service for any HRI Product.

Best Regards,

Gilbert Snedden

Quality Assurance Manager

13-Dec-2002

Dear Chris

Do you have (or know of) any evidence that a calibration syringe will change its performance over time? For many years I have assumed that if a well cared-for syringe operates smoothly and remains airtight (over its entire sweep) there is little need to have it serviced and re-certified. Of course this assumes that the adjustable 'calibration slide' (if present) on the piston arm is correctly positioned and has not moved (easy enough to check, usually). Has anyone measured the accuracy of their certified syringe? If so, how? Perhaps an easier experiment would be to compare two or more syringes? Has anyone done this? I for one accept that a certified 3 litre syringe is accurate but it would be interesting to test this. Anyone interested?

David P. Johns

43 Collins St, Hobart, Tasmania 7001
Phone:03 6226 4801
fax: 03 6226 4894
david.johns@utas.edu.au
12-Dec-2002

Hi All

We have just gone through the process of having our calibration syringes calibrated by Hans Rudolph and received excellent service from them. Unfortunately the cost of freight to and from the states has our managers jumping up and down.

I wondered what others were doing and if anyone knows of another geographically closer source for this service.

Regards

Chris McLachlan

Respiratory Laboratory,
Dunedin Hospital
Dunedin, New Zealand.
chrismclachlan@healthotago.co.nz
5-Dec-2002

 

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