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BACKGROUND: Malignant bowel obstruction is experienced by 15% of people with advanced cancer, preventing them from eating and drinking and causing pain, nausea and vomiting. Surgery is not always appropriate. Management options include tube or stent drainage of intestinal contents and symptom control using medication. Published literature describing palliative interventions uses a broad range of outcome measures, few of which are patient-relevant. This hinders evidence synthesis, and fails to consider the perspectives of people undergoing treatment. AIMS: To develop a Core Outcome Set for the assessment of inoperable malignant bowel obstruction with clinician, patient and caregiver involvement, using COMET methodology (Core Outcome Measures in Effectiveness Trials). METHODS: A systematic review of clinical trials and observational studies, a rapid review of the qualitative literature and in-depth patient and clinician interviews were conducted to identify a comprehensive list of outcomes. Outcomes were compared and consolidated by the study Steering Group and Patient and Public Involvement contributors, and presented to an international clinical Expert Panel for review. Outcomes from the finalised list were rated for importance in a three-round international Delphi process: results of two survey rounds were circulated to respondents, and two separate consensus meetings were conducted with clinicians and with patients and caregivers via virtual conferencing, using live polling to reach agreement on a Core Outcome Set. RESULTS: 130 unique outcomes were identified. Following the independent Expert Panel review, 82 outcomes were taken into round 1 of the Delphi survey; 24 outcomes reached criteria for critical importance across all stakeholder groups and none reached criteria for dropping. All outcomes rated critically important were taken forward for re-rating in round 2 and all other outcomes dropped. In round 2, all outcomes were voted critically important by at leas

Background: Even though antithrombotic therapy has probably little or even negative effects on the well-being of people with cancer during their last year of life, deprescribing antithrombotic therapy at the end of life is rare in practice. It is often continued until death, possibly resulting in excess bleeding, an increased disease burden and higher healthcare costs. Methods: The SERENITY consortium comprises researchers and clinicians from eight European countries with specialties in different clinical fields, epidemiology and psychology. SERENITY will use a comprehensive approach combining a realist review, flash mob research, epidemiological studies, and qualitative interviews. The results of these studies will be used in a Delphi process to reach a consensus on the optimal design of the shared decision support tool. Next, the shared decision support tool will be tested in a randomised controlled trial. A targeted implementation and dissemination plan will be developed to enable the use of the SERENITY tool across Europe, as well as its incorporation in clinical guidelines and policies. The entire project is funded by Horizon Europe. Results: SERENITY will develop an information-driven shared decision support tool that will facilitate treatment decisions regarding the appropriate use of antithrombotic therapy in people with cancer at the end of life. Conclusions: We aim to develop an intervention that guides the appropriate use of antithrombotic therapy, prevents bleeding complications, and saves healthcare costs. Hopefully, usage of the tool leads to enhanced empowerment and improved quality of life and treatment satisfaction of people with advanced cancer and their care givers.

BACKGROUND: Bispectral index (BIS) monitoring uses electroencephalographic data as an indicator of patients' consciousness level. This technology might be a useful adjunct to clinical observation when titrating sedative medications for palliative care patients. However, the use of BIS in palliative care generally, and in the UK in particular, is under-researched. A key area is this technology's acceptability for palliative care service users. Ahead of trialling BIS in practice, and in order to ascertain whether such a trial would be reasonable, we conducted a study to explore UK palliative care patients' and relatives' perceptions of the technology, including whether they thought its use in palliative care practice would be acceptable. METHODS: A qualitative exploration was undertaken. Participants were recruited through a UK hospice. Focus groups and semi-structured interviews were conducted with separate groups of palliative care patients, relatives of current patients, and bereaved relatives. We explored their views on acceptability of using BIS with palliative care patients, and analysed their responses following the five key stages of the Framework method. RESULTS: We recruited 25 participants. There were ten current hospice patients in three focus groups, four relatives of current patients in one focus group and one individual interview, and eleven bereaved relatives in three focus groups and two individual interviews. Our study participants considered BIS acceptable for monitoring palliative care patients' consciousness levels, and that it might be of use in end-of-life care, provided that it was additional to (rather than a replacement of) usual care, and patients and/or family members were involved in decisions about its use. Participants also noted that BIS, while possibly obtrusive, is not invasive, with some seeing it as equivalent to wearable technological devices such as activity watches. CONCLUSIONS: Participants considered BIS technology might be of

BACKGROUND: Malignant bowel obstruction occurs in up to 50% of people with advanced ovarian and 15% of people with gastrointestinal cancers. Evaluation and comparison of interventions to manage symptoms are hampered by inconsistent evaluations of efficacy and lack of agreed core outcomes. The patient perspective is rarely incorporated. AIM: To synthesise the qualitative data regarding patient, caregiver and healthcare professionals' views and experience of malignant bowel obstruction to inform the development of a core outcome set for the evaluation of malignant bowel obstruction. DESIGN: A qualitative systematic review was conducted, with narrative synthesis. The review protocol was registered prospectively (https://www.crd.york.ac.uk/prospero, CRD42020176393). DATA SOURCES: MEDLINE, EMBASE, CINAHL, PsycINFO and Scopus databases were searched for studies published between 2010 and 2021. Reference lists were screened for further relevant publications, and citation tracking was performed. RESULTS: Nine papers were included, reporting on seven studies which described the views and experiences of malignant bowel obstruction through the perspectives of 75 patients, 13 caregivers and 62 healthcare professionals. Themes across the papers included symptom burden, diverse experiences of interventions, impact on patient quality of life, implications and trajectory of malignant bowel obstruction, mixed experience of communication and the importance of realistic goals of care. CONCLUSION: Some of the most devastating sequelae of malignant bowel obstruction, such as pain and psychological distress, are not included routinely in its clinical or research evaluation. These data will contribute to a wider body of work to ensure the patient and caregiver perspective is recognised in the development of a core outcome set.

BACKGROUND: Malignant bowel obstruction, a complication of certain advanced cancers, causes severe symptoms which profoundly affect quality of life. Clinical management remains complex, and outcome assessment is inconsistent. AIM: To identify outcomes evaluating palliative treatment for inoperable malignant bowel obstruction, as part of a four-phase study developing a core outcome set. DESIGN: The review is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA); PROSPERO (ID: CRD42019150648). Eligible studies included at least one subgroup with obstruction below the ligament of Treitz undergoing palliative treatment for inoperable malignant bowel obstruction. Study quality was not assessed because the review does not evaluate efficacy. DATA SOURCES: Medline, Embase, the Cochrane Database, CINAHL, PSYCinfo Caresearch, Open Grey and BASE were searched for trials and observational studies in October 2021. RESULTS: A total of 4769 studies were screened, 290 full texts retrieved and 80 (13,898 participants) included in a narrative synthesis; 343 outcomes were extracted verbatim and pooled into 90 unique terms across six domains: physiological, nutrition, life impact, resource use, mortality and survival. Prevalent outcomes included adverse events (78% of studies), survival (54%), symptom control (39%) and mortality (31%). Key individual symptoms assessed were vomiting (41% of studies), nausea (34%) and pain (33%); 19% of studies assessed quality of life. CONCLUSIONS: Assessment focuses on survival, complications and overall symptom control. There is a need for definitions of treatment 'success' that are meaningful to patients, a more consistent approach to symptom assessment, and greater consideration of how to measure wellbeing in this population.

INTRODUCTION:Studies regarding the management of malignant bowel obstruction (MBO) report conflicting findings. This is partly due to different outcome measures being used to evaluate severity of MBO and the response to treatments. Furthermore, current outcome measures focus mainly on measurable physiological parameters which may not correlate strongly with patient-defined quality of life. The development of core outcome sets allows a consistent approach to evaluating clinical conditions taking into consideration patient, healthcare professional and researcher viewpoints. It follows an internationally recognised standard methodology. We present a protocol for the development of a core outcome set for Research and Assessment of MBO (RAMBO). METHODS:RAMBO is a multicentre study, comprising of four phases: a systematic review to examine current scope of outcome measures associated with MBO (phase I). Interviews with patients, companions and healthcare professionals will explore priorities and preferences for care and outcomes (phase II). An expert panel meeting will collate the findings into a set of outcomes (phase III), refined by consensus through a Delphi survey with key stakeholders (phase IV). The final set of outcomes will be ratified at a consensus meeting. Each step will actively include patient partners. Thematic analysis and descriptive statistics will be used to analyse qualitative and quantitative data, respectively. ETHICS AND DISSEMINATION:Ethical approval was obtained (Wales REC 5, REF: 19/LO/1876). Study participants and relevant stakeholders will be updated with newsletters and a lay summary at the end of the study. Abstracts will be submitted to national and international conferences, result papers will be submitted to peer-reviewed, open access journals. TRIAL AND PROSPERO REGISTRATION NUMBERS:Core Outcome Measures in Effectiveness Trials (1402); Systematic Literature Review (CRD42019150648); Rapid Review (CRD42020176393).

An extension is presented of a model developed by Pirouz and Williams (2007) for non-segregating thickened tailings beach slope prediction. The model was modified based on visual observations and experimental data from tilting flume tests at three mine sites, the Peak Au mine in New South Wales, Australia, the Sunrise Dam Au mine in Western Australia and the Chuquicamata Cu mine in Chile. The structure of the model is similar to that of the original and is based on the theory that, on a large scale, the slope of the overall tailings beach is determined by the slope of self-formed tailings channels. A modified Hedstrom number is introduced in the model, and the experimental data showed that there is a strong correlation between the Reynolds number and the Hedstrom number for the flow conditions at the equilibrium slope. The relationship between the two dimensionless numbers defines the condition of flow in the self-formed channel and can be used to define the minimum required velocity, or minimum Reynolds number, to achieve the total transport condition in channel flow. A modified model for the shape of the self-formed channel based on the stability of individual particles on the bank of the channel is also presented. The validity of the available friction factor for the calculation of head loss in a non-Newtonian fluid was investigated for the open-channel flow of thickened tailings, and a friction factor defined which is applicable over a wide range of Reynolds number in the range 120-10 000 and Hedstrom number in the range 630-45 500. A minimum required velocity for total transport in channel flow was also defined as a function of Reynolds number at equilibrium slope., An extension is presented of a model developed by Pirouz and Williams (2007) for non-segregating thickened tailings beach slope prediction. The model was modified based on visual observations and experimental data from tilting flume tests at three mine sites, the Peak Au mine in New South Wales, Australia, the Sunrise Dam Au mine in Western Australia and the Chuquicamata Cu mine in Chile. The structure of the model is similar to that of the original and is based on the theory that, on a large scale, the slope of the overall tailings beach is determined by the slope of self-formed tailings channels. A modified Hedstrom number is introduced in the model, and the experimental data showed that there is a strong correlation between the Reynolds number and the Hedstrom number for the flow conditions at the equilibrium slope. The relationship between the two dimensionless numbers defines the condition of flow in the self-formed channel and can be used to define the minimum required velocity, or minimum Reynolds number, to achieve the total transport condition in channel flow. A modified model for the shape of the self-formed channel based on the stability of individual particles on the bank of the channel is also presented. The validity of the available friction factor for the calculation of head loss in a non-Newtonian fluid was investigated for the open-channel flow of thickened tailings, and a friction factor defined which is applicable over a wide range of Reynolds number in the range 120-10 000 and Hedstrom number in the range 630-45 500. A minimum required velocity for total transport in channel flow was also defined as a function of Reynolds number at equilibrium slope.

The open cast copper-gold mine, in Queensland, lies in an area of moderate but variable rainfall. A 115 km long pipeline has been constructed to provide a secure process water supply of 5 000 000 000 l/a. A thickener is included in the process circuit to maximise internal water recycling. The site water management system includes site run-off, groundwater, seepage from waste dumps, bleed and run-off from the tailings dam, and rainfall and run-off from the retention/evaporation pond system. These ponds have been sized as a "low probability of release" system, to retain a specified 1 in 10 year design rainfall event. There is no recycle from these dams, but the proposed staged development, combined with ongoing water quality monitoring, will provide the opportunity to modify the system during operation if water suitable for discharge is identified from any source., The open cast copper-gold mine, in Queensland, lies in an area of moderate but variable rainfall. A 115 km long pipeline has been constructed to provide a secure process water supply of 5 000 000 000 l/a. A thickener is included in the process circuit to maximise internal water recycling. The site water management system includes site run-off, groundwater, seepage from waste dumps, bleed and run-off from the tailings dam, and rainfall and run-off from the retention/evaporation pond system. These ponds have been sized as a "low probability of release" system, to retain a specified 1 in 10 year design rainfall event. There is no recycle from these dams, but the proposed staged development, combined with ongoing water quality monitoring, will provide the opportunity to modify the system during operation if water suitable for discharge is identified from any source.