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Introduction: Varicose veins are common in the UK and though relatively few people develop serious complications they are a chronic condition with implications for quality of life. Treatment is predominantly conservative and, in this context, varicose veins and their effect on quality of life is important to inform the provision of clinical care.One method of understanding the issues faced by these patients is through the use of patientreported outcome measures (PROMs) which should be validated and relevant to the experience of the patient group. The identification and synthesis of existing qualitative research describing the impact of varicose veins can also be used to ensure the relevance of new and existing PROMs. Aim:The primary aim of this qualitative evidence synthesis was to examine the symptoms and quality of life domains that are important from the perspective of patients with varicose veins.Methods: Multiple electronic databases were searched including MEDLINE and CINAHL to identify reports of qualitative research of the experience of adults with varicose veins. Following study selection, data extraction and quality assessment a thematic analysis was conducted based on initial themes identified from PROMs used in this population. An inductive approach was used and emergent themes were identified. The final stage in the thematic analysis involved the development of new interpretations.Results: Three studies met the inclusion criteria for the review; the quality of the studies was high. T s of living with varicose veins were varied. Five overarching themes were identified; physical impact of varicose veins, psychological impact, social impact, adapting to VV and reasons for seeking treatment. Within these main themes further sub-themes were identified. The key theme to emerge was adaptation, as there was evidence that patients attempted to adapt to the physical, psychological and social impact of varicose veins. Conclusion:The use of PROMS to gather information about HRQoL and symptoms is well established, but PROMs currently used with patients with VV may not capture the full extent of the VV Q L The findings of this review can be used in the development of new PROMs and also in facilitating the interpretation of the results of existing PROMs in current clinical practice and future research.

SummaryTo avoid potentially fatal wrong‐route neuraxial drug errors, international standard ISO 80369‐6 specifying a non‐Luer neuraxial connector design was published in 2016. We describe usability studies used in development of the design. Thirty‐eight doctors and 17 nurses performed simulated procedures on manikins, using devices fitted with Luer connectors or draft ISO 80369‐6 ‘non‐Luer’ connectors. The procedures included spinal anaesthesia; intrathecal chemotherapy; lumbar puncture, cerebrospinal fluid collection and pressure measurement; epidural catheter placement with bolus injection and critical care use. Participants attempted cross connection between neuraxial connectors and a range of other medical device connectors, including those from the ISO 80369 small‐bore connector series. Video recording analysis was used for all assessments. Participants subjectively assessed performance of the draft non‐Luer connector, including suitability for routine clinical use. Participants performed 198 procedures. The connector achieved easy, leak‐free connections. The willingness of participants to use the non‐Luer connectors were: spinal anaesthesia 100%; intrathecal chemotherapy 88%; lumbar puncture, cerebrospinal fluid collection and pressure measurement 93%; epidural catheter placement with bolus injection 78%; critical care use 100%. Concerns raised were generally device related, rather than connector related. Most cross‐connection attempts failed, even using above clinical forces and, when successful, were judged of low clinical risk potential; the exception was a malaligned connection between the non‐Luer slip and female Luer connectors. This led to revision of the dimensional tolerances of the non‐Luer connector to reduce this risk, before publication of the final specification in 2016. We conclude that the ISO 80369‐6 neuraxial non‐Luer connector is suitable for clinical use.