Breast cancer-related lymphoedema (BCRL) affects 24-42% of patients following treatment for breast cancer. The gold standard method of measuring hand swelling associated with BCRL is to use water displacement (volumeter). This is not always possible in the clinical setting and the figure-of-eight method, which involves wrapping a simple measuring tape around the hand in a specific way, may be an alternative. The aim of the study was to examine the reliability and validity of the figure-of-eight method of measuring hand size in women with BCRL. Twenty-four patients with hand swelling associated with BCRL participated. Two novice testers performed three 'blinded' figure-of-eight measurements and three volumetric measurements of each hand. In terms of intertester (between-tester) and intratester (within-tester) reliability, the intraclass correlation coefficients were all greater than 0.8 indicating high intra- and intertester reliability for the figure-of-eight method. For validity, a Pearson's moment correlation computed between the figure-of-eight and volumetric methods highlighted a statistically significant correlation of 0.7 between the methods for both testers. The figure-of-eight method was found to be a valid and reliable method of measuring hand swelling in this population.

Breast cancer related lymphoedema (BCRL) affects 24-42% of patients after treatment for breast cancer. The gold standard method to measure the hand swelling associated with BCRL is to submerge the hand/arm into water and measure the amount of water displaced. This method is not always possible clinically and the fi gure of eight method, which involves wrapping a simple measuring tape around the hand in a specifi c way, may be an alternative method of measurement. The aim of the study was to examine the reliability and validity of the fi gure-of-eight method of measuring hand size in women with BCRL. Methods 24 people with BCRL had their affected hand measured by both the water displacement and tape measure methods by two novice therapists (testers). The fi gure of eight measurements were taken using a blank tape which was then measured against a meter stick by the recorder. For the water displacement method, subjects were asked to submerge their hand into the water fi lled volumeter. The volume of the water displaced was measured and recorded by the recorder. The therapists were therefore blind to the results. Each method was repeated three times and the order of testing was randomised between subjects and testers.Results 24 full sets of data were available for analysis. In terms of intertester reliability the ICC values ranged form 0.825 to 0.854. For intratester reliability ICCs were 0.889 for tester 1 and 0.919 for tester 2. For validity Pearson's -moment correlation was 0.700 for tester 1 and 0.752 for tester 2 (both p<0

mainstreaming a proactive approach, later spread to the wider Notts Integrated Care System/ICS population. Local hospices are working in partnership with community, third sector and acute sector organisations to lead development and expand capacity and flexibility of the service. The partners led on advance care planning, Respect implementation, a new ICS end of life strategy, a co-designed care-co-ordination service and regular interdisciplinary training for all care providers. Progress in population-based end-of-life care was assessed using robust comparative audits of digital record-sharing (EPaCCS) data against whole-system GSF end-of-life care metrics.Results Nottinghamshire data shows (trend 2019-2021). Earlier patient identification (0.22-0.66%).. Earlier and increased advance care planning (ACP) discussions and improving quality Respect forms (audited). . Those on register attaining preferred place of care/death (54.7-67%). . Reduced hospitalisation and system resource savings (10% Quipp). . Better outcomes for individuals (commendations, fewer complaints). . Nottinghamshire's use of GSF and ACP laid the foundations for a later robust, generalist-led response to the COVID-19 pandemic.