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The UK prison system offers a medical treatment pathway for people suffering from problematic sexual arousal (PSA) who have committed a sexual offence(s). The two main medications are Anti-androgens (AAs) and Selective-Serotonin Reuptake Inhibitors (SSRIs). Currently, evidence of the effectiveness of SSRIs is not sufficiently robust for them to be licensed in the UK for that purpose. Instead, SSRIs are prescribed 'off-label', and physicians must adhere to additional obligations in prescribing them. Yet SSRIs have fewer side effects than AAs and may be a better treatment option for many patients. The present study examined the effectiveness of AAs and SSRIs in incarcerated individuals with PSA (n = 77); the unmedicated comparison group (n = 58) resided at the same prison which houses people convicted of a sexual offence. Both medicated groups demonstrated reduced levels of PSA 3 months post-baseline; the comparison group did not. The findings provide evidence for the effectiveness of SSRIs in reducing PSA. The authors argue a randomised control trial is required to underpin the use of SSRIs in treating PSA and (potentially) its subsequent licensing. The latter would enable wider prescription in prison and community and make a substantive contribution to the prevention of sexual abuse. [ABSTRACT FROM AUTHOR]

Secondary trauma arises through indirect exposure to trauma through engaging with first-hand accounts and narratives of traumatic events. While a significant amount of research has explored secondary trauma experienced by professionals who work with survivors of trauma, such as clinicians and front-line service providers, there is little research exploring the experiences of secondary trauma among violence researchers who routinely engage with traumatic first-hand accounts through their work. This study qualitatively explored violence researcher's professional experiences of secondary trauma and their perceptions of what enables and constrains their own coping and resilience. Participants were recruited using purposive sampling methods. Semi-structured interviews were conducted online with seven female violence researchers from the United Kingdom. Questions explored participant's experiences of secondary trauma symptoms related to their research, perceptions of their own coping and resilience, and experiences of organizational support that have enabled or constrained their resilience. Data were analyzed thematically using a coding framework applied reflexively across interview transcripts. All participants reported experiencing symptoms of secondary trauma from their work including cognitive disturbances; altered beliefs of themselves, others or the world; and challenges connecting with others. Participants' assessment of their own expertise in violence research did not generally impact their perception of their own resilience. Organizational support for violence researchers was rarely provided and participants felt generally unsupported—left to manage any resultant distress alone. Research organizations and universities should implement trauma-informed policies which positively transform workplace culture, provide peer support spaces, and conduct effective training in order to mitigate psychological harm and promote resilience among violence researchers. Support should be tailored to the requirements of violence researchers, and institutions should develop policies that are specifically attentive to the needs of researchers who also have lived experience of violence and abuse. [ABSTRACT FROM AUTHOR]

We test whether the reaction of international stock markets to oil shocks can be justified by current and future changes in real cash flows and/or changes in expected returns. We find that in the postwar period, the reaction of United States and Canadian stock prices to oil shocks can be completely accounted for by the impact of these shocks on real cash flows alone. In contrast, in both the United Kingdom and Japan, innovations in oil prices appear to cause larger changes in stock prices than can be justified by subsequent changes in real cash flows or by changing expected returns. [ABSTRACT FROM AUTHOR]

The Edwardian years saw a range of dominion and colonial issues brought to the forefront of public attention by the British press, with the doyens of Fleet Street taking an active part in shaping the popular debate. This paper analyses the agency of the press in the imperial dramas involving the Indian empire, focusing upon leading aspects of the Viceroyalty of Lord Curzon. It provides, for the first time, an in-depth study of the national press coverage and its role in the controversy surrounding the downfall and resignation of Curzon in 1905, thereby shedding new light on media perceptions within the metropolis, and detailing the engagement of officials in press manipulation and propaganda. It is contended that it was the domestic context, and the consequences of attacking Curzon in public at Home, along with his failure to mount a successful defence, that were instrumental, though often overlooked, factors in determining his fate. [ABSTRACT FROM AUTHOR]

Non-invasive ventilation (NIV) is a clinically proven, cost-effective intervention for acidotic exacerbations of COPD that is recommended by UK national guidelines. This study examines the extent to which these recommendations are being followed in the UK. Between August and October 2003 a national audit of COPD exacerbations was conducted by the Royal College of Physicians and the British Thoracic Society. 233 (94%) UK hospitals submitted data for 7,529 prospectively recruited acute COPD admissions, documenting process of care and outcomes from a retrospective case note audit. They also completed a resources and organisation of care proforma. Nineteen hospitals (8%) reported they did not offer NIV. There was no access to NIV in 92 (39%) intensive care units in 88 (36%), high-dependency units or on general wards of 85 (34%) hospitals. In 74 (30%) NIV was available on all 3 sites. A low pH (<7.35) was noted at some time during admission for 26% (1714/6544) of patients and NIV was administered to 31%. Patients receiving NIV were more often admitted under a respiratory physician, or seen at some stage by a respiratory specialist and had more severe disease (higher PaCO2 (median 9.8 v 7.8 kPa), lower oxygen tension (median 8.8 v 9.8 kPa), higher incidence of peripheral oedema (48% v 39%), of pneumonia (27% v 16%), higher in-hospital mortality (26% v 14%) and at 90 days (37% v 24%) and longer hospital stays (median 9 v 7 days) than those not receiving NIV. Hospitals with least usage of NIV had similar mortality rates to those using NIV more often. A comprehensive NIV service is not available in many hospitals admitting patients with acute respiratory failure secondary to COPD. Access to acute NIV is inadequate and does not conform with NICE and BTS guidelines. These observational audit data do not demonstrate benefits of NIV on survival when compared to conventional management, contrary to results from randomised trials. Reasons for this are unclear but unmeasured confounding factors and poor patient selection for NIV are likely explanations. [ABSTRACT FROM AUTHOR]

This article will examine the involvement of the Empire Press Union, including prominent early members like Lord Northcliffe and its founder Sir Harry Brittain, in the development of imperial air services as part of a larger ongoing study involving India, Australia and New Zealand. The main focus will be on the first three decades of the organization (1909-39) and on its regular conference activity which correspond with the pioneering period of aviation in Britain and in the antipodes. The press, as will be shown, had a commercial stake in the pioneer aviation story, while the Empire Press Union, for reasons to be outlined below, had a strong interest in Imperial Airways' plans to develop the 'longest air route in the world' to that time. The focus of this analysis is inevitably limited: it does not, for example, deal with the ambitious British airship experiment which competed for funds and publicity with aviation, albeit with tragic outcomes. In contrast with the triumphalism of traditional communication and press narratives, it uncovers a complex faltering set of developments in which the Empire Press Union, both for altruistic and self-interested motives, played its part. In general terms, this involvement also serves to confirm that the Empire Press Union and its elaborate conferences paid increasing attention to new and emerging technologies like aviation and broadcasting in the interwar years. Moreover, this interest was not solely a response to the commercial challenges which such inventions posed to newspapers and print journalism; rather it reflected the willingness of the Press Union leadership, both in Britain and elsewhere, to harness such developments in the interests of speedier and cheaper imperial communications. [ABSTRACT FROM AUTHOR]

This article examines the portrayal of Indian Independence in the British media with particular attention to the orchestration of official publicity by Lord Mountbatten and his press attache, Alan Campbell-Johnson. The British press was able to portray Independence as a British achievement, arising almost organically out of its long-term policy and vindicating British rule. The article also explores press portrayal of Indian leaders, the Princely States, the role of the Commonwealth and communal violence. [ABSTRACT FROM AUTHOR]

Arnold Lodge Regional Secure Unit has provided medium secure psychiatric care for the Trent Regional Health Authority since July 1983. We examined a series of 504 first admissions to Arnold Lodge in order to explore trends in demographic and service utilization characteristics over 16 years. We found an increase in the admission of more serious offenders; a reduction in the length of stay; a decline in the proportion of psychopathically disordered patients; and a sixfold increase in the ratio of men to women. [ABSTRACT FROM AUTHOR]

Presents several letters to the editor in the periodical 'British Medical Journal, as of July 1992. Prevalence of potential pathogens in the cervical canal; Treatment for allergy; Association of cardiac arrest with flumazenil.

B Introduction: b "Watch-and-Wait" is an organ preserving method of treating rectal cancer non-operatively post long-course chemoradiotherapy, gaining interest worldwide. Overall survival amongst "Watch-and-Wait" patients' was 85.7% with a median overall survival of 1103[717-1484] days. B Conclusion: b 27% of WW patients in this real world cohort developed recurrence and 5/17 failed distantly - highlighting the need for personalised decision-making and further understanding and identification of risk factors associated with increased recurrences. [Extracted from the article]

The article discusses various published reports within the issue, including one by Codell and Kaul that examine the role of the British press, one by Wills that explores the relationship between the Irish press and political culture and one by Shoesmith and Long that examines the newspaper "Dawn."

The NHSCSP 2004 guideline recommends that the best practice for the follow up of post-treatment squamous intraepithelial neoplasia (SIL) is by cytological surveillance in the treatment centre or alternatively, in the primary care sector as a minimum standard. We undertook this study to test this recommendation. In a colposcopy clinic of a district general hospital of UK. Retrospective analysis of 418 patients treated for squamous intraepithelial neoplasia whose post treatment cytological surveillance was followed up for 18 months after treatment. A prospective patient preference questionnaire was also undertaken in 50 randomly chosen patients having treatment to elicit their preferences for the place of follow up. At 8 months 66.4% had their first smear in the primary care sector as compared to 88.6% in the treatment centre. The post-treatment follow up smear performance graph seems to be different for the primary care sector compared to treatment centre. In 12 months nearly 90% of the patients had at least one smear and by 18 months 96.9% of the treated patients had a follow up smear in the community which would detect residual disease. There was no statistically significant difference in the detection of residual disease in the community compared to the treatment centre during the follow up period. A total of 76% of patients preferred to have their follow up smears in the primary care. Targets set by the NHSCSP of UK were not met either by the primary care sector or the treatment centre in the 8 months but was satisfactorily achieved by both in 12 months. These preliminary results indicate a need for a larger multi centre randomised trial to establish if the primary sector is truly a satisfactory alternative for patient follow up. Cytological surveillance is best carried out in the place desired by the patients to allow good compliance with the monitoring process. [ABSTRACT FROM AUTHOR]

The United Kingdom (UK) was one of the first countries to pioneer heart transplantation from donation after circulatory death (DCD) donors. To facilitate equity of access to DCD hearts by all UK heart transplant centers and expand the retrieval zone nationwide, a Joint Innovation Fund (JIF) pilot was provided by NHS Blood and Transplant (NHSBT) and NHS England (NHSE). The activity and outcomes of this national DCD heart pilot program are reported. This is a national multi-center, retrospective cohort study examining early outcomes of DCD heart transplants performed across 7 heart transplant centers, adult and pediatric, throughout the UK. Hearts were retrieved using the direct procurement and perfusion (DPP) technique by 3 specialist retrieval teams trained in ex-situ normothermic machine perfusion. Outcomes were compared against DCD heart transplants before the national pilot era and against contemporaneous donation after brain death (DBD) heart transplants, and analyzed using Kaplan-Meier analysis, chi-square test, and Wilcoxon's rank-sum. From September 7, 2020 to February 28, 2022, 215 potential DCD hearts were offered of which 98 (46%) were accepted and attended. There were 77 potential donors (36%) which proceeded to death within 2 hours, with 57 (27%) donor hearts successfully retrieved and perfused ex situ and 50 (23%) DCD hearts going on to be transplanted. During this same period, 179 DBD hearts were transplanted. Overall, there was no difference in the 30-day survival rate between DCD and DBD (94% vs 93%) or 90 day survival (90% vs 90%) respectively. There was a higher rate of ECMO use post-DCD heart transplants compared to DBD (40% vs 16%, p = 0.0006), and DCD hearts in the pre pilot era, (17%, p = 0.002). There was no difference in length of ICU stay (9 DCD vs 8 days DBD, p = 0.13) nor hospital stay (28 DCD vs 27 DBD days, p = 0.46). During this pilot study, 3 specialist retrieval teams were able to retrieve DCD hearts nationally for all 7 UK heart transplant centers. DCD donors increased overall heart transplantation in the UK by 28% with equivalent early posttransplant survival compared with DBD donors. [ABSTRACT FROM AUTHOR]

Focuses on the research assessing the physical condition of the patients after undergoing a general surgery in Great Britain. Risks of complications; Improvement on the quality of life; Response of the immune system from the treatment.

Examines the patients satisfaction with pre-operative analgesia in acute trauma in Great Britain. Assessment of patient's level pain and perception relief from admission; Percentage rate of patients with severe pain; Necessity of analgesia in the pre-operative period following acute admission.

Since 2014, the Transplant Practitioner (TP) has been an established member of the National Organ Retrieval Service (NORS) at one of the UK's transplant centres. The TP is a registered nurse who is competent in perfusion and preservation of retrieved cardiothoracic organs. With the advent of novel technology such as the Organ Care System (OCS) following Donation after Circulatory Death (DCD) the need to expand the role of a senior TP to include Organ Care Practitioner (OCP) has emerged and offered solution to the skills shortfall. The OCS is a portable ex-vivo organ perfusion system which can preserve a donor heart in a near-normothermic beating state from retrieval until it is disconnected for transplant. Various methods of training were launched to extend the TP's role of practice. External training to OCS headquarters in Boston, Massachusetts was undertaken in order to develop skills and expertise on how to operate this innovative technology effectively and safely. In-house teaching sessions were also initiated by other competent members of the NORS team. Moreover, further peri-operative exposure was provided to the trainees during retrievals to develop confidence and competence with the specialist equipment as well as maintain skills. TP is deemed competent upon successful completion of a DCD heart competency pack. This advanced competency to the role of the TP has allowed role progression and increased expertise responsibilities for non-medical nursing staff. Having this additional skill has allowed our centre to be fit for purpose prior to the introduction of the National DCD Retrieval Service in September 2020. Nineteen machine perfused hearts out of twenty-three organ retrievals that were operated by a TP were successfully transplanted. The expanded role of the TP as both organ preservation and Organ Care Practitioner continues to be successfully expanded within NORS which ensures that a NORS team maintains resilience. [ABSTRACT FROM AUTHOR]

In September 2020 the UK Joint Innovation Fund commissioned a pilot in order that the UK transplant community could assess the feasibility of formally commissioning a National DCD heart transplant programme. The pilot is scheduled to finish in May/June 2022. Three transplant centres provide organ procurement support for this initiative with one centre (Centre A) providing 50% of the cover and two centres providing 25% each (Centres B and C). Centre A utilises its nursing staff to operate the organ perfusion device whilst the rest of the teams use their medical staff or perfusionists. This nurse led element is unique to Centre A and has been a great success in advancing the extended role element of our nurses. Centre C was unable to continue to support the pilot due to local workforce pressures. The nursing team from Centre A proposed that they increase their oncall activity and a plan was put in place to introduce a "Hybrid" team. A 'Hybrid' team was introduced with surgeons from Centre B attending DCD heart retrievals and all of the nursing team consisting of the perfusion practitioner, organ preservation practitioner and scrub nurse attending from Centre A during the week every month where historically Centre C would have covered the pilot. This resulted in increased activity for both remaining centres, a new and collaborative way of working between two different transplant centres and also resulted in minimising the risk of the pilot failing. The "hybrid era" has ensured that 9 patients in the UK have been transplant who otherwise might not have been due to the lack of an available procurement team. The table below shows some of the benefits of this new way of working. Inter Organisational collaboration instigated and implemented at short notice by the nursing staff at one of the UK Transplant Centres has ensured that the National pilot continued and that many patients received a transplant that otherwise might not have. [ABSTRACT FROM AUTHOR]

Limited availability of suitable donor hearts remains a challenge to pediatric heart transplantation, contributing to waitlist mortality. Controlled donation after circulatory death (DCD) has demonstrated success in adults. Early series of pediatric DCD heart transplantation using cold storage alone reported significant early mortality. We report a collaboration between 2 centers in the United Kingdom, combining expertise in adult DCD organ retrieval and pediatric transplantation. This retrospective series comprises 6 children (4 male, all >20 kg) undergoing DCD heart transplantation at Great Ormond Street Hospital between 1 February and 30 September 2020, following retrieval with direct procurement and perfusion using portable normothermic machine perfusion by the Royal Papworth Hospital service. Baseline characteristics and 1-year follow-up were compared to 9 children who underwent donation after brain death (DBD) transplants contemporaneously. Mean DCD donor age was 24.67 years and mean DCD recipient age was 13.83 years. Mean functional warm ischemic time was 28.5 minutes and ex-situ heart perfusion time was 280 minutes. Median ICU and hospital stay were 9 and 17 days, respectively. All children survived to 1-year post-transplant. Survival and ICU and hospital stay were similar between the DCD and DBD cohorts. Performing DCD transplants resulted in a 66.7% increase in transplants for children >20 kg at GOSH during the study. This series demonstrates that DCD heart transplant can be performed safely with excellent short-term survival in children. Although the cohort is small, there was no significant difference in major outcomes compared to a DBD cohort. [ABSTRACT FROM AUTHOR]

• Individuals remain poorly predictable from population-level analyses of the brain. • The fidelity limits data scale, compute, and model flexibility impose are unknown. • We quantify these limits in multimodal, multitarget analyses across 23810 people. • We show a radical change in modelling regimes is needed for individual prediction. Our knowledge of the organisation of the human brain at the population-level is yet to translate into power to predict functional differences at the individual-level, limiting clinical applications and casting doubt on the generalisability of inferred mechanisms. It remains unknown whether the difficulty arises from the absence of individuating biological patterns within the brain, or from limited power to access them with the models and compute at our disposal. Here we comprehensively investigate the resolvability of such patterns with data and compute at unprecedented scale. Across 23 810 unique participants from UK Biobank, we systematically evaluate the predictability of 25 individual biological characteristics, from all available combinations of structural and functional neuroimaging data. Over 4526 GPU*hours of computation, we train, optimize, and evaluate out-of-sample 700 individual predictive models, including fully-connected feed-forward neural networks of demographic, psychological, serological, chronic disease, and functional connectivity characteristics, and both uni- and multi-modal 3D convolutional neural network models of macro- and micro-structural brain imaging. We find a marked discrepancy between the high predictability of sex (balanced accuracy 99.7%), age (mean absolute error 2.048 years, R2 0.859), and weight (mean absolute error 2.609Kg, R2 0.625), for which we set new state-of-the-art performance, and the surprisingly low predictability of other characteristics. Neither structural nor functional imaging predicted an individual's psychology better than the coincidence of common chronic disease (p < 0.05). Serology predicted chronic disease (p < 0.05) and was best predicted by it (p < 0.001), followed by structural neuroimaging (p < 0.05). Our findings suggest either more informative imaging or more powerful models will be needed to decipher individual level characteristics from the human brain. We make our models and code openly available. [ABSTRACT FROM AUTHOR]

In an effort to address the increasing demand for heart transplantation within the United Kingdom (UK), we established a clinical program of heart transplantation from donation after circulatory-determined death (DCD) donors in 2015. After 5 years, we report the clinical early outcomes and impact of the program. This is a single-center, retrospective, matched, observational cohort study comparing outcomes of hearts transplanted from DCD donors from March 1, 2015 to February 29, 2020 with those from matched donation after brain death (DBD) donors at Royal Papworth Hospital (RPH) (Cambridge, UK). DCD hearts were either retrieved using thoracoabdominal normothermic regional perfusion or the direct procurement and perfusion technique. All DBD hearts were procured using standard cold static storage. The primary outcomes were recipient 30-day and 1-year survival. During the 5-year study, DCD heart donation increased overall heart transplant activity by 48% (79 for DCD and 164 for DBD). There was no difference in survival at 30 days (97% for DCD vs 99% for DBD, p = 1.00) or 1 year (91% for DCD vs 89% for DBD, p = 0.72). There was no difference in the length of stay in the intensive care unit (7 for DCD vs 6 for DBD days, p = 0.24) or in the hospital (24 for DCD vs 25 for DBD days, p = 0.84). DCD heart donation increased overall heart transplant activity at RPH by 48%, with no difference in 30-day or 1-year survival in comparison with conventional DBD heart transplantations. DCD heart donation is set to make a dramatic difference in the number of patients who can benefit from heart transplantation. [ABSTRACT FROM AUTHOR]

The donation after circulatory death (DCD) pathway is an emerging contributor to heart transplantation. Selected UK centres started their adult programs in 2015, followed by a centrally funded national pilot commencing September 2020. The purpose of this study is to review the activity and outcomes of the UK National DCD heart transplant program during this pilot. Data on DCD heart transplants between September 2020 to August 2021 were extracted from the UK Transplant Registry, held by National Health Service Blood and Transplant. The Registry contains data on all offered organs from potential donors, proceeding donations and organ recipients. Additional data were collected on the DCD Heart travel document. The DCD hearts were procured by 3 specialist retrieval teams, with national organ allocation to all 7 adult and paediatric heart transplant centres. The hearts of 143 potential DCD donors were referred for offering during this 12-month period, from all areas of the UK. This resulted in 77 acceptance, 60 retrievals, 33 hearts retrieved and 30 transplants. Direct procurement and machine perfusion was the technique used for all DCD heart retrievals with 2 hearts retrieved during abdominal normothermic regional perfusion. Six procurements were performed by a hybrid team consisting of members from 2 retrieval teams, and 21 were transplanted by a different centre to that of the retrieval team. Median donor and recipient age was 33 (range: 12-50) and 46 (range: 13-62), respectively. Seven recipients were super-urgent and 13 were urgent; with a median wait time of 20 days (range: 1-320). In the same period there were 105 adult and 18 paediatric donation after brain death (DBD) heart transplants; DCDs representing 19% and 22% of the programs, respectively. Two patients died within 30 days, making the 30-day survival rate 93.3% (95% CI: 76-98), similar to the DBD cohort. Extracorporeal membrane oxygenation in the first 30 days was required for 15 out of 30 transplants. In the 12-month pilot, DCD heart transplantation was 20% of the total heart transplant activity. This UK wide program was underpinned by unprecedented collaboration between UK cardiothoracic teams, and with abdominal teams, improving communication and shared learning. High volume, specialised procurement teams are key to a successful DCD heart sharing program to overcome challenges from the learning curve. [ABSTRACT FROM AUTHOR]

The 2020 ISHLT consensus statement recommends coronary angiography in potential heart donors with risk factors for coronary disease (CAD), including those aged >40 yrs. Angiography is not commonly available for donors in the UK. At retrieval, donor hearts without palpable CAD are offered for transplantation. The accuracy of this in detecting underlying CAD is unreliable. We examined the incidence of occult donor transmitted (dt) CAD and its impact on long term survival in our heart transplant (HTx) recipients. All adult patients undergoing HTx Jan'08 - Dec'18, who had early coronary angiography post HTx by left heart catheterization or computed tomography included. Angiograms were retrospectively graded by 2 observers, according to ISHLT classification of CAV. Significant dtCAD was defined as evidence of CAV grade 2 or 3 or a focal lesion >50% in a main artery at first angiographic assessment. Over the 11-year period 389 HTx performed, 302 met inclusion criteria. Mean recipient age 48.8 yrs, 77.8% male, donor age 38.2 yrs, 64.6% male, BMI 26.6 kg/m2. 28 recipients (9%) had evidence of dtCAD. This was associated with a significant reduction in long term survival (Figure 1, p=0.002). No significant difference in dtCAD in hearts from donors >40 yrs vs donors ≤ 40 yrs (10.3 % vs 8.3%, p=0.99). In donors >40 yrs, neither a history of smoking (p=0.18), diabetes (p=0.36) or hypertension (p=0.55) were associated with significant CAD in isolation. The presence of 2 or more of the aforementioned risk factors in those > 40 yrs was associated with a higher incidence of dtCAD (25.0% vs 8.0% p=0.05). In this single centre cohort, dtCAD was associated with a reduction in long-term conditional survival following HTx. Donor age of >40 yrs alone was not predictive of significant dtCAD.Donor age >40 along with a history of 2 or more of hypertension, smoking or diabetes was found to be predictive of a higher risk of dtCAD. In such donors, surgical palpation alone may be insufficient to exclude significant CAD. [ABSTRACT FROM AUTHOR]

Purpose The demand for heart transplantation has increased by 162% in the United Kingdom over the last decade. In an attempt to address both wait list mortality and prolonged waiting times, a programme of DCD heart transplantation was implemented at Royal Papworth Hospital in March 2015. We report the early outcomes of the first 50 DCD heart transplants and compare them to a matched cohort of donation after brain death (DBD) heart transplants. Methods DCD hearts were retrieved either by; Normothermic Regional Perfusion followed by ex-situ heart perfusion (NRP-ESHP), NRP followed by cold storage (NRP-CS) or Direct Procurement and Perfusion using ESHP alone (DPP-ESHP). During NRP, perfusion was restored to the arrested heart within the donor with the exclusion of the cerebral circulation whilst DPP hearts were removed directly. A retrospective cohort of DBD heart transplants, matched for donor and recipient characteristics was used as a comparison group. All DBD hearts were transported using static cold storage. Outcome measures for this study included 30 day survival as well post transplant inotrope dependence, mechanical support, initial cardiac performance, ventilator duration, intensive care duration and length of hospital stay. Results From 1st March 1 2015 to 10th October 50 DCD heart transplants were performed at our institute. Sixteen DCD hearts were transplanted following (NRP-ESHP), 32 hearts following (DPP-ESHP) and 2 hearts following (NRP-CS). The 30-day survival post transplant was 100% in both DCD and DBD groups. All other outcome variables were comparable between groups with the exception of Dopamine reliance post transplant, table 1. Values are median (IQR) or n (%) Conclusion After 50 DCD heart transplants, the results continue to show that DCD heart transplantation can be performed safely with comparable early outcomes to those achieved with DBD heart transplantation. [ABSTRACT FROM AUTHOR]

Background: Biologics are now key drugs in the management of immune-mediated inflammatory diseases. However, the increasingly complex biologics environment and growing cost pressures in the UK have led to variability in drug commissioning and inequity of patient access across regions., Objectives: Our objectives were to provide consensus recommendations for enhancing the current situation in biologic prescribing in the UK by balancing clinical freedom with equitable distribution of biologics given the limited availability of resources., Methods: A modified Delphi approach was used to reach integrated, cross-specialty consensus among dermatologists, rheumatologists and gastroenterologists practising within the English National Health Service (NHS)., Results: We describe the concepts of clinical freedom and clinical judgement and demonstrate how, together with patient choice, they can be exercised in the context of biologic prescribing in the NHS. We highlight that in England, local variations occur that are at odds with National Institute for Health and Care Excellence (NICE) guidance; these variably limit the degree to which clinicians can exercise clinical freedom and impact on equity of patient access to treatments. We define factors encompassing a drug's value and identify challenges to the measurement and interpretation of this concept, which can raise barriers to the freedom of clinical choice and appropriate prescribing decisions allowing practices of holistic and personalised medicine. Cross-specialty consensus recommendations on ensuring equitable access to biologics in the NHS while protecting appropriate and individualised drug selection for patients are provided. We have also provided strategies for improving physician-commissioner communication to harmonise equity of patient access to biologics across England and improve patient outcomes. Commentary from patient advisory groups indicates that they welcome our exploration that value does not equal cost and agree that there should be an emphasis on shared decision making, which requires the clinician to practice clinical freedom by aligning the patient's needs and preferences with available treatment choices., Conclusions: This consensus highlights the need to strike a balance between clinical freedom and short-term cost restrictions to support equitable resource distribution within the English NHS. Consideration of these recommendations may help to harmonise local, regional and national services and balance equity of patient access to biologic treatments with excellence in the NHS.