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International audience; BackgroundNeuromuscular blocking agents (NMBAs) are among the leading cause of perioperative anaphylaxis, and most of these reactions are IgE mediated. Allergic sensitisation induced by environmental exposure to other quaternary ammonium-containing compounds, such as pholcodine, has been suggested. The aim of this study was to assess the relationship between pholcodine exposure and NMBA-related anaphylaxis.MethodsALPHO was a multicentre case-control study, comparing pholcodine exposure within a year before anaesthesia between patients with NMBA-related perioperative anaphylaxis (cases) and control patients with uneventful anaesthesia in France. Each case was matched to two controls by age, sex, type of NMBA, geographic area, and season. Pholcodine exposure was assessed by a self-administered questionnaire and pharmaceutical history retrieved from pharmacy records. The diagnostic values of anti-pholcodine and anti-quaternary ammonium specific IgE (sIgE) were also evaluated.ResultsOverall, 167 cases were matched with 334 controls. NMBA-related anaphylaxis was significantly associated with pholcodine consumption (odds ratio 4.2; 95% confidence interval 2.3–7.0) and occupational exposure to quaternary ammonium compounds (odds ratio 6.1; 95% confidence interval 2.7–13.6), suggesting that apart from pholcodine, other environmental factors can also lead to sensitisation to NMBAs. Pholcodine and quaternary ammonium sIgEs had a high negative predictive value (99.9%) but a very low positive predictive value (

Maternal morbidity & mortality has been a major World Health Organization concern over the years, especially in developing countries like India. Uterine Rupture during pregnancy is a rare situation. The diagnosis is not always obvious & morbidity & maternal & fetal mortality is still high. Early clinical diagnosis is paramount to maternal survival. This paper reports uterine rupture with severe hypovolemic shock managed at Sunshine Global Hospital Manjalpur, Vadodara. This is an Exceptional case that we observe for the first time.

Background Volunteers contribute to patient care directly and indirectly, including the needs of carers, families and friends. There was a need to transform volunteering to make sure volunteering is safe, sustainable and transformational whilst supporting palliative care at the hospice. A new structure was developed to enable: Improved communication to and for volunteers A direct contact person for volunteers to go to with any concerns New processes and procedures to be put into place Promote volunteering opportunities for all departments Volunteers from all areas to be trained and supported Enhance diversity within LOROS Increase the knowledge of and respect for the charity within the community Creation of ‘Volunteer Voice’: a support group that has membership from the senior management team and volunteers. Volunteering was categorised into different areas/services e.g. clinical, snack bar, fundraising, shops. Role descriptions for each area were created. This enabled: Clear expectations for each role Identification of training requirements Additional support and clinical training for those directly supporting patients on the ward and within home visiting. Looking at other specialist roles for volunteer. Data Management ensured correct volunteer details, benefits included: GDPR compliance Progression of training Improve communication Better reporting mechanisms to Management Efficient rota Effective governance. Volunteering within LOROS sits within the strategic aims of the organisation in order to support its service offer and financial sustainability. Whilst maintaining a positive reputation with an associated high public profile, volunteering continues to grow: we now have 1481 volunteers (increased by over 300 in one year). Volunteering is also working on a number of initiatives transforming palliative care into the community: Telephone be–friending service LOROS Local, a mobile resources in the community [See abstract #164] Supporting LOROS @ home service. With all of the above now in place we have a sustainable volunteering model for the hospice.

Background LOROS decided to develop the scope of volunteering roles within the inpatient unit to allow volunteers to become ‘Ward Companions’. This change was implemented following patient feedback that suggested greater volunteer involvement would be beneficial to patients’ experience of hospice care. Aims Ward companions aim to enhance the patient’s stay by providing practical and emotional support and importantly, a sense of normality. Companions engage with patients in many ways; by playing games, through reading, assisting at meal times, or just ‘being there’ as a reassuring presence in times of need. Depending on the volunteer’s own qualifications and interests, they may also provide assistance with patient care, hairdressing, nail and beauty services. Companions have also supported patients to draft their last wishes and create memory boxes for loved ones. Companions have supported patients that do not have family or friends. Methods The Clinical Volunteer Coordinator has been instrumental in devising role descriptions and encouraging volunteers to contribute their skills in this area. All volunteers are required to complete a thorough training programme to ensure they are sufficiently equipped to support patients. All volunteers report to a ward team leader who briefs them on individual patient requirements and requests. Conclusion There are currently 32 volunteers enrolled as ward companions for LOROS and their contribution to inpatients has been invaluable, as evidenced by numerous ‘thank you’ cards and LOROS ‘Have Your Say’ feedback cards. The Ward Companions initiative has been shared via BBC News and Facebook, highlighting the impact the role has had and the potential for hospices to adopt this approach in the future. It’s ‘the little things’ in life that often mean so much and the attention, care, compassion, trust and empathy afforded by volunteer ward companions has significantly improved patients’ experience of LOROS.