Neutralising antibodies after COVID-19 vaccination in UK haemodialysis patients

Vaccination against COVID-19 induces highly protective immune responses in most people. As some countries switch from suppression to acceptance of transmission of SARS-CoV-2 within a largely vaccinated adult population, vulnerable patient groups that have not mounted adequate immune responses to vaccination might experience significant morbidity and mortality. There is an urgent need to identify such patient groups and to optimise medical advice and vaccination strategies for them

Protecting or enabling? A review of medical practitioner tribunals involving sexual misconduct

• Sexual misconduct perpetrated by doctors is a significant and serious issue that requires a robust framework for investigation and punishment.• The disciplinary process against doctors involves an over-reliance on subjective evidence, which can lead to inconsistent sanctions for similar offences.• Nearly a quarter (24%) of MPTS sanction outcomes were less severe than those recommended by the General Medical Council.• Given the complex nature and high incidence of sexual assault allegations (over 50% of cases analysed), MPTS panel members require enhanced and specialised training to adequately address cases involving sexual misconduct against patients, colleagues and children.• The tribunal process can be re-traumatising for victim-survivors of sexual misconduct, underscoring a critical need for significantly better support, including consistent provision of legal advice and dedicated witness advocates.• The existing regulatory framework is fundamentally unsuited to managing the unique and nuanced elements of sexual misconduct, necessitating urgent and major reform to establish a competent and safe system for patients, professionals and the public

Causes of Prolonged Cold Ischemia Time After Arrival of Deceased Donor Kidney at Implanting Center: Results From a Prospective Audit

\ua9 2025 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. Background: Deceased donor kidney transplants often face delays, leading to prolonged cold ischemia time (CIT), yet data on post-allograft arrival delays are scarce. Objectives: This audit aims to identify and characterize the delays contributing to CIT prolongation after allograft arrival at the implanting center. Design: Data was collected prospectively from 14 UK centers between February and September 2022. Timelines from allograft arrival to the implanting center to implantation were recorded for adult deceased donor kidney-only transplants. Results: The median CIT for all 446 allografts [(donation after cardiac death (DCD), 48.2% and donation after brain death (DBD), 51.6%)] was 11:08 h (interquartile range (IQR): 08:15–15:12). A total of 42% of DCD and 15% of DBD allografts exceeded the national recommended duration of 12 and 18 h, respectively. CIT was prolonged in centers with dedicated transplant theaters, with a median CIT of 13:41 (IQR: 08:11–15:13) compared to a median CIT of 09:43 (IQR: 07:36–12:29) hours (p < 0.005, 95% CI: −4.40, −2.60) in centers without dedicated transplant theaters. Compared to full cross-match (FXM) results, a higher proportion of Virtual cross-match (VXM) results (75.2% vs. 89.4%, Odds Ratio (OR): 2.79, CI: 1.57–5.0, p < 0.005) were available before the allograft arrived at the implanting center. The proportion of crossmatch results available before the recipient\u27s arrival at the implanting center was 31.7% (46.6% for VXM vs. 4.9% for FXM, OR: 16.76, CI: 7.50, 44.17, p < 0.005). However, no difference was found in CIT between the VXM (median: 11:06, IQR: 08:14–15:20) and FXM (median: 11:00, IQR: 08:34–14:56) groups (p = 0.75, CI: −0.75, 1.02). Qualitative analysis identified theater and staff unavailability as common reasons for delay. Conclusion: Internal center practices have a significant impact on CIT, necessitating intervention to optimize transplant outcomes

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population.The aim of this study was to inform vaccination prioritization by modelling the impact of vaccination on elective inpatient surgery. The study found that patients aged at least 70 years needing elective surgery should be prioritized alongside other high-risk groups during early vaccination programmes. Once vaccines are rolled out to younger populations, prioritizing surgical patients is advantageous

SARS-CoV-2 infection and venous thromboembolism after surgery: an international prospective cohort study

SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1–6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS- CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS- CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1–2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2–3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9–3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality (5.4 (95%CI 4.3–6.7)). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly

Determination of the Infection Risks Posed by the Use of Mobile Technology in Healthcare Settings

There are more mobile phones in the world than there are people, and numbers are increasing. Immediate access to technology has completely permeated everyday life, and for many people their mobile devices are an indispensable accessory that accompanies them everywhere, including the bathroom. Mobile devices can harbour pathogenic microorganisms on their surfaces, that can survive for days, before potentially being transferred onto hands or other objects that they come into contact with. These devices are also rarely decontaminated. Whilst these microorganisms are generally not of concern to the healthy adult, they may be to the very young, the elderly, and those with reduced immunity. This study determined if mobile devices can be used in the healthcare setting and not be an infection risk. A six-stage mixed methodology approach was employed, with laboratory investigations into the contamination on mobile devices, the efficiency of transfer from them, and the effectiveness of decontamination methods. Analysis of existing NHS mobile device policy and application of the Hazard Analysis Critical Control Point process to perioperative practice provided real-world perspective. The findings from this study identified that current literature is under-reporting the contamination on mobile devices, and determined that the bacterial presence is transient, not constant. Transfer efficiency of up to 79% was recorded for Staphylococcus aureus from a device onto a wet gloved hand, and observation of perioperative practice identified five hazards specific to the presence of a device, that could become a risk to patient safety, but could be managed through application of Critical Control Points. This study also found that over 40% of NHS organisations in mainland UK do not have a mobile device policy, and only 11% make any reference to their infection prevention and control. Testing of decontamination methods determined that a two-stage process of wiping with a dry lint-free cloth, followed by exposure to UV-C, was the only approach that effectively reduced contamination levels without contradicting manufacturers’ guidance and thus voiding the device warranty. Optimum criteria for mobile device policy, and suggestions for in-context application, are proposed

The Compatibility of the Access to Essential Generic Medicines with Human Rights: An Analysis of the In-Transit Seizure of Essential Generic Medicines from India by the European Union

The Covid-19 pandemic has sensitised the global community on the importance of the access to essential medicines. The nations of the world have engaged in a fierce battle over the lifesaving Covid-19 vaccines, in which developed nations have come out successfully. The access to essential medicines has long been promoted by the United Nations and other international human rights organisations. This research will also study the case in which a consignment of essential generic medicines from India designated to Brazil was seized, in-transit, by Dutch customs due to a suspected Intellectual Property infringement. Following this incident both India and Brazil filed requests with the World Trade Organization’s Appellate Body to hold consultations with the European Union on the issue of seizure of in transit generic pharmaceuticals by Dutch custom officials. Against this backdrop, this work intends to examine whether the seizure of essential generic medicines from India by the EU is compatible with the standards employed by international human rights law. It will also investigate the impact that European Council Regulation 1383/2003 has on in transit medicine which, by default, was never intended to enter the domestic market of the EU in the first place. In this regard, it is worth noting that both Brussels and New Delhi seems to have much in common, including that they happen to be large democracies with India being the largest in the world. Both adhere to the rule of law, the promotion of human rights and have large economies. New Delhi was also among the first to establish bilateral relations with the European Economic Community in 1963. In recent times, both unions have engaged in negotiations over a bilateral Free Trade Agreement, which has been put on hold. This work endeavours to reflect on the aspect of international trade agreements of the EU. More precisely, it will address the higher IPRs (“TRIPS plus”) standards that seem to be part and parcel of both bilateral and multilateral trade agreements of the EU. It shall also consider both FTA’s and Economic Partnership Agreements of the EU with LDC and developing nations. In addition, it will examine whether the IPRs that are applied by the Brussels could potentially obstruct the full enjoyment of human rights. Finally, the overarching research question of this PhD project is whether the seizure of essential generic medicines from India by the European Union, designated to developing countries, is compatible with the right to health. More precisely, it will further examine whether the access to essential generic medicines could be classified as falling under the category of the right to health (human right) and consequently whether the seizure and subsequent detention of the in-transit cargo of these medicines would qualify as a violation of international human rights law. In this context, it would be relevant to examine whether international human rights law should supersede intellectual property law in cases in which a norm conflict arises. More importantly, this work will assess whether the right to health, in the form of access to medicines, should take precedence over IP law in case of a conflict between both norms. Another issue that will be investigated is whether Brussels’ utilisation of IPRs protection, and the subsequent seizure as well as detention of generic medicines from India, could, potentially, have created a barrier to international trade in the field of generic medicines