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Background The BioDriveAFS trial aims to investigate whether a biomarker-based antifungal stewardship strategy is superior to a prophylactic antifungal strategy, including existing standard of care, in reducing antifungal therapy use in patients with acute leukaemia, without impacting health-related quality of life at 12 months. The trial will be commencing in the UK in 2022 and aims to recruit 500 patients across 40 sites. We hypothesized that a biomarker-led monitoring approach would be non-inferior to the standard of care approach utilizing antifungal prophylaxis. Patients and methods Patients diagnosed with acute leukaemia who are planned to have intensive chemotherapy will be randomly allocated to one of two arms. The biomarker arm will consist of twice-weekly galactomannan and β-d-glucan until the end of intensive chemotherapy; positive biomarker results, neutropenic fever non-responsive to broad-spectrum antibacterials, or clinical suspicion will lead to investigation for potential invasive fungal infection as per international guidelines. Patients with proven or probable invasive fungal infection (IFI), as per the consensus definitions, will receive therapeutic antifungals, whereas those with possible or no IFI will have antifungals withheld. The control arm consists of local standard-of-care antifungal prophylaxis, including mould-active, without regular biomarker monitoring. Results Primary outcome measures are exposure to therapeutic antifungal therapy and patient quality of life at 12 months versus baseline. Secondary outcome measures include total antifungal exposure, adverse events and complications, proven and probable IFI and treatment outcome, overall survival, all-cause mortality and IFI-related mortality. Resource use to determine cost-effectiveness and antifungal resistance in fungi will also be measured. Funding The trial is funded by the National Institute for Health Research Health Technological Assessment Programme (NIHR132674) and supported by BSAC.

Background Multi-agency working to safeguard children is increasing in the UK. Nurses encounter children who are at risk of, or subject to, abuse and neglect. They are required to be able to recognise indicators that suggest a child may have been abused or neglected and know what actions to take in response as part of their role. Without support to manage the negative effects of their involvement in safeguarding children, nurses can become stressed, and prolonged stress can lead to difficulty engaging in future cases. Aim To explore the experience of nurses involved in safeguarding children and to identify the systems they access to support them with the emotional effects of this work. Method This was a phenomenological study that involved semi-structured interviews. The eight study participants were hospital-based nurses who worked in children's areas and were involved in safeguarding children work. Thematic analysis was undertaken to identify themes from the data. Findings The study identified some of the emotional effects of safeguarding children work experienced by nurses, which can be long lasting. It found that these nurses access various support systems in relation to their safeguarding work, such as case discussion, team support, child supervision and training. Conclusion It is important that managers understand the potential effects of safeguarding children work, so that they can ensure nurses have access to appropriate support. Managers should also promote access to support systems and address barriers that prevent nurses from accessing them.

This article considers the inclusion of mental health service users’ experiences and perspectives in professional education classrooms. After brief introductions to the authors’ backgrounds, the ar...