Working Party Research Articles

Patient-Reported Indicator Surveys (PaRIS): measuring patient reported experiences and outcomes across populations and health systems

Abstract We aimed to develop and test the performance of a questionnaire for adults (aged 45 or older) with one or more chronic conditions who use primary/ambulatory care across populations and health systems in multiple countries. Candidate scales and items were identified through a systematic process supported by international stakeholders (PaRIS Patient Advisory Panel, Technical Advisory Community and Working Party members of participating countries). Four instruments for each domain, covering patient reported outcome measures (PROMs), patient reported experience measures (PREMs), health behaviours, and health and health care capabilities, were shortlisted using predefined criteria and evaluated using the EMPRO method. A modified Delphi supported selecting a core instrument for each domain and additional relevant scales/items. Consultations took place with the stakeholders to confirm the suitability of the proposed questionnaire. The questionnaire was evaluated through cognitive testing and further modified accordingly. The survey was piloted in a Field Trial. Psychometric evaluation was conducted with data from a Field trial on an item level and scale level. Out of 217 instruments, the Delphi resulted in consensus on a core instrument for each main domain and additional questions to ensure comprehensiveness. The cognitive testing of the draft survey (17 languages, 20 countries) confirmed that most questions were interpreted as intended. The version of the survey developed for the field trial included 118 questions. The field trial psychometric evaluation was based on 10,145 patients, across 18 countries. The questionnaire performed well at item level and at scale level. Performance in terms of structure and validity was good overall. A revised version of the patient questionnaire was created with 115 items. A comprehensive questionnaire has been constructed based on the PaRIS survey framework for people living with chronic conditions and following an inclusive approach.

International review of blood donation screening for anti-HBc and occult hepatitis B virus infection.

Hepatitis B core antibody (anti-HBc) screening has been implemented in many blood establishments to help prevent transmission of hepatitis B virus (HBV), including from donors with occult HBV infection (OBI). We review HBV screening algorithms across blood establishments globally and their potential effectiveness in reducing transmission risk. A questionnaire on HBV screening and follow-up strategies was distributed to members of the International Society of Blood Transfusion working party on transfusion-transmitted infectious diseases. Screening data from 2022 were assimilated and analyzed. A total of 30 unique responses were received from 25 countries. Sixteen respondents screened all donations for anti-HBc, with 14 also screening all donations for HBV DNA. Anti-HBc prevalence was 0.42% in all blood donors and 1.19% in new donors in low-endemic countries; however, only 44% of respondents performed additional anti-HBc testing to exclude false reactivity. 0.68% of anti-HBc positive, HBsAg-negative donors had detectable HBV DNA. Ten respondents did universal HBV DNA screening without anti-HBc, whereas four respondents did not screen for either. Deferral strategies for anti-HBc positive donors were highly variable. One transfusion-transmission from an anti-HBc negative donor was reported. Anti-HBc screening identifies donors with OBI but also results in the unnecessary deferral of a significant number of donors with resolved HBV infection and donors with false-reactive anti-HBc results. Whilst confirmation of anti-HBc results could be improved to reduce donor deferral, transmission risks associated with anti-HBc negative OBI donors must be considered. In high-endemic areas, highly sensitive HBV DNA testing is required to identify infectious donors.

Impact of China’s Accession Protocol on its Participation in the Dispute Settlement Mechanism (DSM): An Analysis of Eleven Protocol-related Cases

It has been twenty-three years since China acceded to the WTO. Since then, China has participated in high-profile disputes through the WTO’s DSM. During this period, China has evolved from being a silent observer to a sophisticated participant in the DSM. This has provided a valuable opportunity to observe China’s participation in the DSM and to analyse the factors affecting China’s performance. This article examines China’s engagement in the DSM relating to cases concerning China’s Accession Protocol in which China was involved as a respondent. Based on an in-depth analysis of eleven Protocol-related cases settled among all cases pertaining to China's Accession Protocol, I conclude that both the Accession Protocol itself and the interpretive approach adopted by the DSB have made it challenging for China to defend against allegations of violating its obligations under China’s Accession Protocol and the associated commitments outlined in China's Working Party Report. WTO Members can consequently without difficulty resort to certain provisions under the Accession Protocol to bring cases against China.

Genital Art in the 21st Century: Piercings and Tattoos. The EAU YAU Reconstructive Urology Working Party Point of View.

Genital Art in the 21st Century: Piercings and Tattoos. The EAU YAU Reconstructive Urology Working Party Point of View.

Recommendations for Upper Limb Motor Recovery: An Overview of the UK and European Rehabilitation after Stroke Guidelines (2023).

Upper limb impairment is common after stroke, with a significant impact on the stroke survivor's function, social participation and quality of life. Clinical guidelines are needed to inform clinical practise, tailor interventions to improve outcomes and address unresolved research questions. This review contributes to the evidence guiding clinical practise for upper limb motor recovery after stroke by summarising the recommendations from the UK rehabilitation guidelines (National Institute for Health and Care Excellence (NICE) and the Intercollegiate Stroke Working Party (ISWP)) and the European Stroke Organisation (ESO) guidelines, all published in 2023. All three guidelines target researchers, clinical practitioners, stroke survivors and their social networks. An important feature in all three guidelines was therapeutic intensity, with all guidelines recommending increased therapeutic intensity. Unlike the ESO, the NICE and ISWP additionally include specific research recommendations. While the NICE guidelines seem more holistic and target a wider audience, the three guidelines are complimentary. We recommend that a future consensus statement should be developed in partnership between all three organisations, agreeing on scope and using the same terminology, on recommendations to improve stroke rehabilitation in the UK and Europe.

Antithrombotic Therapy in Cancer Patients with Cardiovascular Diseases: Daily Practice Recommendations by the Hemostasis Working Party of the German Society of Hematology and Medical Oncology (DGHO) and the Society for Thrombosis and Hemostasis Research (GTH e.V.).

Active cancer by itself but also chemotherapy is associated with an increased risk of cardiovascular disease (CVD) and especially coronary artery disease (CAD) and atrial fibrillation (AF). The frequency of CVD, CAD, and AF varies depending on comorbidities (particularly in older patients), cancer type, and stage, as well as the anticancer therapeutic being taken. Many reports exist for anticancer drugs being associated with CVD, CAD, and AF, but robust data are often lacking. Because of this, each patient needs an individual structured approach concerning thromboembolic and bleeding risk, drug-drug interactions, as well as patient preferences to evaluate the need for anticoagulation therapy and targeting optimal symptom control. Interruption of specific cancer therapy should be avoided to reduce the potential risk of cancer progression. Nevertheless, additional factors like thrombocytopenia and anticoagulation in the elderly and frail patient with cancer cause additional challenges which need to be addressed in daily clinical management. Therefore, the aim of these recommendations is to summarize the available scientific data on antithrombotic therapy (both antiplatelet and anticoagulant therapy) in cancer patients with CVD and in cases of missing data providing guidance for optimal careful decision-making in daily routine.

Correlation of Maternal Vitamin D Status in Early Pregnancy and Vitamin D Supplementation during Pregnancy with Atopic Dermatitis in Infants: A Prospective Birth Cohort Study.

This study aimed to investigate the association of maternal first-trimester vitamin D levels and vitamin D supplementation during pregnancy with infant atopic dermatitis (AD) and to determine the effect of variables such as mode of conception on the association. This study was based on the Shanghai sub-cohort of the International Birth Cohort of China. A total of 4051 woman-infant pairs with singleton pregnancies were recruited. Vitamin D deficiency and insufficiency were defined as serum 25-hydroxyvitamin D concentrations of 25 and 50 nmol/L, respectively. AD in infants was assessed during the first six months using a standardized questionnaire based on the British Working Party criteria. Modified Poisson regression estimated the association between maternal vitamin D status and infant AD. The risk of AD in infants was higher in women with deficient 25-hydroxyvitamin D levels in the first trimester (RR: 1.77, 95% CI: 1.41-2.23). This increased risk was seen in naturally conceived pregnancies, but not in those conceived using assisted reproductive technology (ART). The incidence of AD decreased in infants of mothers who took multi-vitamin (RR: 0.79, 95% CI: 0.67-1.98) and vitamin D supplements (RR: 0.51, 95% CI: 0.37-0.71) compared to those whose mothers did not take any supplements. Maternal vitamin D deficiency had varying effects on AD risk based on passive smoking exposure and breastfeeding patterns. Our findings highlight the importance of monitoring and supplementing vitamin D during pregnancy, especially in specific maternal populations, to reduce the risk of AD in offspring.

Emollient application from birth to prevent eczema in high-risk children: the BEEP RCT.

Atopic eczema is a common childhood skin problem linked with asthma, food allergy and allergic rhinitis that impairs quality of life. To determine whether advising parents to apply daily emollients in the first year can prevent eczema and/or other atopic diseases in high-risk children. A United Kingdom, multicentre, pragmatic, two-arm, parallel-group randomised controlled prevention trial with follow-up to 5 years. Twelve secondary and four primary care centres. Healthy infants (at least 37 weeks' gestation) at high risk of developing eczema, screened and consented during the third trimester or post delivery. Infants were randomised (1 : 1) within 21 days of birth to apply emollient (Doublebase Gel®; Dermal Laboratories Ltd, Hitchin, UK or Diprobase Cream®) daily to the whole body (excluding scalp) for the first year, plus standard skin-care advice (emollient group) or standard skin-care advice only (control group). Families were not blinded to allocation. Primary outcome was eczema diagnosis in the last year at age 2 years, as defined by the UK Working Party refinement of the Hanifin and Rajka diagnostic criteria, assessed by research nurses blinded to allocation. Secondary outcomes up to age 2 years included other eczema definitions, time to onset and severity of eczema, allergic rhinitis, wheezing, allergic sensitisation, food allergy, safety (skin infections and slippages) and cost-effectiveness. One thousand three hundred and ninety-four newborns were randomised between November 2014 and November 2016; 693 emollient and 701 control. Adherence in the emollient group was 88% (466/532), 82% (427/519) and 74% (375/506) at 3, 6 and 12 months. At 2 years, eczema was present in 139/598 (23%) in the emollient group and 150/612 (25%) in controls (adjusted relative risk 0.95, 95% confidence interval 0.78 to 1.16; p = 0.61 and adjusted risk difference -1.2%, 95% confidence interval -5.9% to 3.6%). Other eczema definitions supported the primary analysis. Food allergy (milk, egg, peanut) was present in 41/547 (7.5%) in the emollient group versus 29/568 (5.1%) in controls (adjusted relative risk 1.47, 95% confidence interval 0.93 to 2.33). Mean number of skin infections per child in the first year was 0.23 (standard deviation 0.68) in the emollient group versus 0.15 (standard deviation 0.46) in controls; adjusted incidence rate ratio 1.55, 95% confidence interval 1.15 to 2.09. The adjusted incremental cost per percentage decrease in risk of eczema at 2 years was £5337 (£7281 unadjusted). No difference between the groups in eczema or other atopic diseases was observed during follow-up to age 5 years via parental questionnaires. Two emollient types were used which could have had different effects. The median time for starting emollients was 11 days after birth. Some contamination occurred in the control group (< 20%). Participating families were unblinded and reported on some outcomes. We found no evidence that daily emollient during the first year of life prevents eczema in high-risk children. Emollient use was associated with a higher risk of skin infections and a possible increase in food allergy. Emollient use is unlikely to be considered cost-effective in this context. To pool similar studies in an individual patient data meta-analysis. This trial is registered as ISRCTN21528841. This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 12/67/12) and is published in full in Health Technology Assessment; Vol. 28, No. 29. See the NIHR Funding and Awards website for further award information.

Variation in clinical presentation of pediatric-onset and adult-onset atopic dermatitis: a retrospective, single-center, chart review of adults with atopic dermatitis from the United States.

Atopic dermatitis (AD) is a chronic skin condition that can manifest in childhood and persist into adulthood or can present de novo in adults. The clinical presentation of adults with AD may differ among those with pediatric-onset versus adult-onset disease and potential differences between both groups remain to be better characterized. These atypical features might not be encompassed as part of current diagnostic criteria for AD, such as the Hanifin-Rajka (H-R) and the U.K. Working Party (UKWP) criteria. We conducted a retrospective chart review of the electronic medical records of a large, single, academic center to compare the clinical characteristics between adult-onset and pediatric onset AD and examine the proportion of patients who meet the H-R and/or UKWP criteria. Our single-center retrospective chart review included adults (≥ 18 years of age) with any AD-related ICD-10 codes, ≥ 2 AD-related visits, and a recorded physician-confirmed AD diagnosis. Descriptive statistics were used to compare adults with pediatric-onset (< 18 years of age) and adult-onset (≥ 18 years of age) AD. Logistic regression and x2 test were used to compare groups. We found that, compared to pediatric-onset AD, adults with adult-onset AD had less flexural involvement, flexural lichenification and a personal and family history of other atopic diseases. Compared to adults with pediatric-onset AD, adults with adult-onset AD had greater involvement of the extensor surfaces and more nummular eczema compared to pediatric-onset AD. In our cohort, adults with adult-onset AD were less likely to meet H-R and UKWP criteria compared to pediatric-onset AD. Adults with adult-onset AD may present with a clinical presentation that is different from those with pediatric-onset AD, which may not be completely captured by current AD criteria such as the H-R and UWKP criteria. This can lead to possibly mis- or underdiagnosing AD in adults. Thus, understanding the differences and working towards modifying criteria for adult-onset AD has the potential to improve accurate diagnosis of adults with AD.

Impacts of habitat alteration on macroinvertebrates in large shallow lakes: An application of a macroinvertebrate-based multimetric index.

Habitat plays a crucial role in shaping the macroinvertebrate community structure in large shallow lakes. In the pursuit of improving the health of freshwater ecosystems, it is imperative to consider their habitat characteristics. To evaluate the impact of habitat variations on lake ecological health, we developed a macroinvertebrate-based multimetric index(MMI) for both the pelagic and littoral zones of Lake Hongze. Additionally, we employed structural equation models to explore the influence of utilization or phytoplankton biomass on ecological health. Historical data served as reference conditions for the pelagic. Seven key attributes were selected for the pelagic MMI, that is, Biological Monitoring Working Party (BMWP), the percentage of Mollusca taxa, the percentage of filter-collector taxa, the percentage of predator taxa, the percentage of gather-collector taxa, and the percentage of sensitive taxa and functional dispersion. The least minimally disturbed conditions and the best attainable conditions were used to develop the littoral. Four key metrics, that is, the percentage of scraper abundance, Mollusca taxa, Biological Pollution Index, and BMWP, were integrated into the littoral MMI. The assessment based on MMI revealed a "poor" health status for the pelagic zone and a "fair" health status for the littoral zone. These findings underscore the high applicability and efficacy of MMIs in assessing and monitoring ecological health in Lake Hongze. Notably, functional feeding groups exhibited heightened sensitivity to disturbance in both zones. Moreover, sediment organic matter strongly influenced the pelagic ecological health, while chlorophyll a and transparency emerged as primary factors influencing the littoral zone, attributable to varying littoral zone utilization. Integr Environ Assess Manag 2024;20:2245-2255. © 2024 SETAC.

Treatment satisfaction in adults with atopic dermatitis: a cross-sectional, population-based study examining patient and physician perspectives in the US.

Studies examining the real-world treatment satisfaction in adults with atopic dermatitis (AD) and the physicians who treat adults with AD are scarce. We sought to characterize treatment satisfaction of adults with AD and physicians' perceived patient satisfaction with AD treatment. We performed a cross-sectional study of adults > = 18 years of age (modified AD UK Working Party Criteria, age onset < = 18 [N = 767]) with AD and a parallel-physician survey among allergists/immunologists [N = 148], dermatologists [N = 149] and primary care medicine [N = 104]. Logistic regression models were used to examine factors associated with patient treatment satisfaction (PTS) or physician-perceived patient treatment satisfaction (pPTS). Factors associated with increased PTS included female, older age, and receiving a written eczema action plan (EAP). Severe AD, itch, pain, and insomnia, greater impact on partner relationships, feeling not adequately informed about AD causes, and being separated, never married, or living with a partner was associated with less PTS. From the physician's perspective, mild AD and development of EAP was associated with increase pPTS, whereas being in practice longer was associated with less pPTS. Limitations include the potential for misclassification of AD and the inability to match AD patients to individual physicians. Recognizing which factors are associated with treatment satisfaction can help inform counseling and decision-making strategies, including the use of an eczema action plan, and support patient-physician outcomes alignment.

P23 The influence of maternal inflammatory status on the risk of atopic eczema in offspring during infancy

Abstract Introduction and aims Maternal influences on infantile atopic eczema are complex, with emerging evidence for a protective role for maternal T helper (Th)1 inflammation during pregnancy. Substantial literature on characterization of a proinflammatory dietary pattern, led us to hypothesize that analyses of maternal diet and markers of inflammation might help identify mechanisms influencing the risk of infantile atopic eczema. The aim of this study was to examine the associations between energy-adjusted dietary inflammatory index (eDII) scores indicative of a proinflammatory diet pattern, maternal serum neopterin levels (a biomarker elevated in Th1 immune activation which counteracts Th2 inflammation seen in atopic eczema), and infantile risk of atopic eczema. Methods Within the UK Southampton Women’s Survey, scores for the eDII were derived from mothers’ diets (questionnaires at preconception, early and late pregnancy). Atopic eczema was ascertained at age 6 and 12 months using the UK Working Party Diagnostic Criteria (n = 262 and 270, respectively). Late pregnancy maternal serum neopterin levels were measured in a subsample (n = 497). Directed acyclic graphs were used to determine covariates to be included in linear regression analyses. Results A higher eDII score in late pregnancy was associated with a reduced risk of atopic eczema at age 6 months [odd ratios (OR) 0.89, 95% CI confidence interval (CI) 0.81–0.98; P = 0.02], with a similar trend at age 12 months (OR 0.91, 95% CI 0.83–1.00; P = 0.06). Consistent with this, and adjusting for maternal body mass index, education, smoking during pregnancy, and recent eczema, and infant filaggrin single-nucleotide polymorphism rs7512552, breastfeeding duration and sex, higher maternal serum concentrations of neopterin were associated with lower risks of infant eczema at age 6 months (OR 0.72, 95% CI 0.51–1.01; P = 0.05) and 12 months (OR 0.71, 95% CI 0.53–0.96; P = 0.03). Conclusions These findings suggest that a proinflammatory maternal diet that promotes a Th1 predominant environment protects the developing infant from Th2 inflammation and reduces the risk of atopic eczema.

Airway management in patients with suspected or confirmed cervical spine injury: Guidelines from the Difficult Airway Society (DAS), Association of Anaesthetists (AoA), British Society of Orthopaedic Anaesthetists (BSOA), Intensive Care Society (ICS), Neuro Anaesthesia and Critical Care Society (NACCS), Faculty of Prehospital Care and Royal College of Emergency Medicine (RCEM).

There are concerns that airway management in patients with suspected or confirmed cervical spine injury may exacerbate an existing neurological deficit, cause a new spinal cord injury or be hazardous due to precautions to avoid neurological injury. However, there are no evidence-based guidelines for practicing clinicians to support safe and effective airway management in this setting. An expert multidisciplinary, multi-society working party conducted a systematic review of contemporary literature (January 2012-June 2022), followed by a three-round Delphi process to produce guidelines to improve airway management for patients with suspected or confirmed cervical spine injury. We included 67 articles in the systematic review, and successfully agreed 23 recommendations. Evidence supporting recommendations was generally modest, and only one moderate and two strong recommendations were made. Overall, recommendations highlight key principles and techniques for pre-oxygenation and facemask ventilation; supraglottic airway device use; tracheal intubation; adjuncts during tracheal intubation; cricoid force and external laryngeal manipulation; emergency front-of-neck airway access; awake tracheal intubation; and cervical spine immobilisation. We also signpost to recommendations on pre-hospital care, military settings and principles in human factors. It is hoped that the pragmatic approach to airway management made within these guidelines will improve the safety and efficacy of airway management in adult patients with suspected or confirmed cervical spine injury.

The river health of Alista River based on macroinvertebrates communities at Selorejo Village Dau Subdistrict Malang Regency

The Alista River is one of the rivers in the upstream Brantas watershed which has relatively natural conditions, but currently there are agricultural activities on the riverbank. The aim of this study was to analyze the health status in Alista River based on the macroinvertebrate communities. This study uses a survey method. Sampling was carried out at 5 stations based on different land use. Sampling of macroinvertebrates used the kicking technique with a hand net with a mesh size of 500 μm in a 10 meter long riffle area. Data analysis used the value of BMWP index (Biological Monitoring Working Party) and the ASPT (Average Score Per Taxon). The results of the identification of macroinvertebrates found were 38 families for instance Glossossomatidae, Lepidosmatidae, and Richardsonianidae. The families belong to 10 orders and 3 classes. The lowest family is 11 families at station 5 (citrus and bamboo gardens). The highest families are 29 families at station 3 (citrus gardens and forests). The results show BMWP-ASPT score ranged from 6.3–4.3 indicating excellent to moderately poor health status. Stations with excellent categories, namely stations 1,2,3,4. Station land use 1,2,3 secondary forest before tourism was discovered including Glossosomatidae. Station 4′s land use is in the form of a tourism location and Lumbriculidae has been found. Stations in the moderately poor category, namely station 5 which is located after tourism sites (citrus gardens and settlements) were found Richardsonianidae.

An international review of the characteristics of viral nucleic acid-amplification testing (NAT) reveals a trend towards the use of smaller pool sizes and individual donation NAT.

Nucleic acid-amplification testing (NAT) is used for screening blood donations/donors for blood-borne viruses. We reviewed global viral NAT characteristics and NAT-yield confirmatory testing used by blood operators. NAT characteristics and NAT-yield confirmatory testing used during 2019 was surveyed internationally by the International Society of Blood Transfusion Working Party Transfusion-Transmitted Infectious Diseases. Reported characteristics are presented herein. NAT was mainly performed under government mandate. Human immunodeficiency virus (HIV), hepatitis C virus (HCV) and hepatitis B virus (HBV) NAT was performed on all donors and donation types, while selective testing was reported for West Nile virus, hepatitis E virus (HEV), and Zika virus. Individual donation NAT was used for HIV, HCV and HBV by ~50% of responders, while HEV was screened in mini-pools by 83% of responders performing HEV NAT. Confirmatory testing for NAT-yield samples was generally performed by NAT on a sample from the same donation or by NAT and serology on samples from the same donation and a follow-up sample. In the last decade, there has been a trend towards use of smaller pool sizes or individual donation NAT. We captured characteristics of NAT internationally in 2019 and provide insights into confirmatory testing approaches used for NAT-yields, potentially benefitting blood operators seeking to implement NAT.

International review of blood donation nucleic acid amplification testing.

Nucleic acid amplification testing (NAT), in blood services context, is used for the detection of viral and parasite nucleic acids to reduce transfusion-transmitted infections. This project reviewed NAT for screening blood donations globally. A survey on NAT usage, developed by the International Society of Blood Transfusion Working Party on Transfusion-transmitted Infectious Diseases (ISBT WP-TTID), was distributed through ISBT WP-TTID members. Data were analysed using descriptive statistics. Forty-three responses were received from 32 countries. Increased adoption of blood donation viral screening by NAT was observed over the past decade. NAT-positive donations were detected for all viruses tested in 2019 (proportion of donations positive by NAT were 0.0099% for human immunodeficiency virus [HIV], 0.0063% for hepatitis C virus [HCV], 0.0247% for hepatitis B virus [HBV], 0.0323% for hepatitis E virus [HEV], 0.0014% for West Nile virus [WNV] and 0.00005% for Zika virus [ZIKV]). Globally, over 3100 NAT-positive donations were identified as NAT yield or solely by NAT in 2019 and over 22,000 since the introduction of NAT, with HBV accounting for over half. NAT-positivity rate was higher in first-time donors for all viruses tested except WNV. During 2019, a small number of participants performed NAT for parasites (Trypanosoma cruzi, Babesia spp., Plasmodium spp.). This survey captures current use of blood donation NAT globally. There has been increased NAT usage over the last decade. It is clear that NAT contributes to improving blood transfusion safety globally; however, there is a need to overcome economic barriers for regions/countries not performing NAT.

Comparison of different macroinvertebrates bioassessment indices in a large near-natural watershed under the context of metacommunity theory.

The metacommunity theory proposes that community structure and biodiversity are influenced by both local processes (such as environmental filtering)and regional processes (such as dispersal). Despite the extensive use of traditional bioassessments based on species-environment relationships, the impact of dispersal processes on these assessments has been largely overlooked. This study aims to compare correlations between various bioassessment indices, including Shannon Weiner (H'), Biological Monitoring Working Party (BMWP), average score per taxon (ASPT), biotic index (BI), and EPT taxa index (EPT), based on macroinvertebrates collected from 147 sampling sites in a subtropical Chinese near-natural catchment. Modified indices were calculated by removing species strongly influenced by dispersal processes to address the influence of dispersal processes. Their relationship with environmental factors was then compared to the original indices. The study employed random forest regression (RFR) to compare the explanatory power of environmental factors using the two sets of indices. The spearman rank correlation analysis was conducted to examine the correlation between indices and environmental factors. The river health assessment was performed based on both modified and original indices. The results reveal significant differences between original and modified indices (especially H' and BI) providing a more accurate reflection of environmental conditions. Furthermore, the sensitivity of the different indices to various environmental factors varied, leading to differences in the bioassessment results between the modified and the original indices. Notably, original H', BMWP, and ASPT overestimated the bioassessment results, whereas the original BI underestimated them. These findings offer valuable insights into bioassessment and river health assessment evaluation within the catchment and other interconnected freshwater ecosystems, such as lakes, reservoirs, and wetlands. Our study underscores the importance of assessing and mitigating the impact of dispersal processes on bioassessment to obtain a more precise representation of the status of freshwater ecosystems.

A Community Project to Supplement Social Care Services

Solva in West Wales, UK, is a small community with about 700 people on the electoral roll. In 2013, Solva Community Council faced the fact that things were not going well for the elderly in our village. Many had to leave home and go “into care.” They didn’t want to go and we didn’t want to lose them. A community councillor at that time, author Mollie Roach, did some research and decided that the village could look after its own. A small working party including first author Frances Barker was set up to plan the way forward. The original idea was not a volunteer service. We wanted to set up a local domiciliary care service, where the carers would live locally and not have to spend their precious time travelling between wide-spread destinations. We soon found that there were several administrative and monetary barriers in the way of setting up such a scheme, especially for a small community. Registration needed money and qualified people. and the “rules” were such as to prevent rather than encourage individual response to individual circumstances. However, we could see that there was a need for a local volunteer service. It is disturbing when you discover you cannot go up a ladder and change a light bulb. It is devastating when you are told you cannot drive anymore because of an eye problem. It is worrying when you cannot take the dog for a good walk or collect your prescription because of arthritis. All these problems are under the radar of statutory services. This is a gap that can be alleviated by a local community-based volunteer scheme. Solva Care evolved with a paid co-ordinator to mediate between volunteers and those needing help. We are now getting closer to the original idea, doing our best to integrate domiciliary and social care, working with agencies, private carers, families, and individuals, as well as continuing to run the volunteer service.

P09 Lancashire and South Cumbria Critical Care Network Vancomycin Project

Abstract Background This project was a collaborative piece of work across a critical care network that included specialist advice from colleagues including aseptic/technically trained pharmacists and microbiology to optimize care for critical care patients in Lancashire and South Cumbria. We used several members of our workforce including pharmacists, nursing staff, microbiologists, rotational doctors and consultants to work towards a harmonized guideline. Methods During our initial meeting, we identified that different centres were using different glycopeptides and administering them differently: East Lancashire Hospitals (ELHT)—continuous vancomycin infusion; Blackpool Cardiac and Blackpool General—continuous vancomycin infusion, with no formal guideline in place but adopted from ELHT; Lancashire Teaching Hospitals—intermittent vancomycin infusions; and University Hospitals Morecambe Bay—teicoplanin is glycopeptide of choice. Our consultant microbiologist discussed the use of glycopeptides and what infections they are used for in critical care. The pharmacokinetics of vancomycin and the benefit of using a continuous infusion was also discussed. We decided to undertake a clinical audit of our vancomycin guidelines at ELHT to ensure that we had an evidence base to implement our guideline and provide assurance to the working group. We agreed to reconvene the working group after this audit was completed and after the concerns of colleagues had been addressed. Results and conclusions We presented the results of our audit and highlighted the opportunities harmonizing this guideline would provide. We discussed various scenarios such as stepping up from a ward protocol to a continuous infusion and the different methods of calculating creatinine clearance and if this would influence the first 24 h of the infusion. One comment was concerning the administration of vancomycin and the number of times nurses will be changing bags for patients requiring higher doses, i.e. the majority of patients would usually be on 3 g/day or more depending on concentrations. This would mean changing the bag more than twice a day; as much as there is a therapeutic benefit to continuous vancomycin infusions, considering the max. concentration for peripheral and central lines allows for larger volumes, it would be beneficial (except in fluid restricted cases) to have a slightly larger volume to reduce the number of bag changes and plastic consumption. We considered this comment and discussed it with our aseptic services lead pharmacist. We attended a meeting of the ICS Aseptics Working Party across Lancashire and South Cumbria. WE discussed the proposed guideline and requested that aseptic units across Lancashire and South Cumbria developed worksheets to manufacture 5 g in 600 mL or 10 g in 1.2 L for central use to stop breaking the line when changing a bag and reducing plastic consumption. We also met with critical care practice educators across the network to discuss how we can promote this guideline and ensure nursing staff and prescribers are aware of how to prescribe and administer continuous vancomycin infusions. One of our units noted that they have had a few incidents with incorrect concentrations of vancomycin being made up for patients. We developed an e-learning package to educate our workforce.

UK Asbestos Working Party Update 2020

Abstract The Institute and Faculty of Actuaries UK Asbestos Working Party update 2020 sets out the methodology and assumptions used to estimate the potential cost of asbestos-related claims to the UK Employers’ Liability Insurance Market. The Working Party has estimated the UK EL Insurance Market cost for the following asbestos-related disease types: mesothelioma, lung cancer, asbestosis and pleural thickening, and pleural plaques. For each disease type the Working Party has constructed a range of scenarios to highlight the uncertainty of these estimates. The Working Party reminds practitioners that use the Working Party scenarios that they should always consider the experience and trends that have occurred since the scenarios were published, adjusting the scenarios to take into account new information.