Experiences of completed and withdrawn unspecified kidney donor candidates in the UK : an inductive thematic analysis from the BOUnD study

Objectives: This study sheds light on some controversial aspects of unspecified kidney donation (UKD) as well as the ways in which potential donors are screened and prepared for the donation experience and its aftermath. The aim of this study was to qualitatively investigate the experiences of individuals involved in the United Kingdom (UK) UKD scheme, including those who complete the donation, are eventually medically withdrawn, or self-withdraw. Better insight into the different experiences of these groups will provide useful guidance to clinical teams on how to better address the differing psychological needs of completed donors as well as those who do not proceed to donation. Methods: A purposive sample was recruited through the Barriers and Outcomes in Unspecified Donation (BOUnD) study covering twenty-three transplant centres in the UK. Semi-structured interviews were audio-recorded and transcribed verbatim and subjected to inductive thematic analysis. Results: Participants consisted of 15 individuals who had donated, 11 who had been withdrawn by the transplant team and 9 who had self-withdrawn. The analysis resulted in 6 themes and 14 subthemes. The major themes were maximising and sharing benefits; risk-to-motivation analysis; support; self-actualisation / finding meaning; the donor as patient; and relationship with the transplant team. Conclusions: The data demonstrates that, although all donors enter the process with a similar level of commitment, those who did not proceed to donation expressed dissatisfaction and lingering emotional consequences linked to lack of follow-up from transplant teams. The implication for the UKD programme is that from the beginning there needs to be a strategic and consistent approach to managing expectations in order to prepare those who embark on the donation process for all possible outcomes and their associated emotional consequences

Autochthonous West Nile virus infection in Germany: Increasing numbers and a rare encephalitis case in a kidney transplant recipient.

West Nile Virus (WNV) infections are increasingly detected in birds and horses in central Europe, with the first mosquito-borne autochthonous human infection detected in Germany in 2019. Human infections are typically asymptomatic, with occasional severe neurological disease. Because of a low number of cases in central Europe, awareness regarding potential cases is low and WNV diagnostic testing is not routine. We tested cerebrospinal fluid (CSF) samples from unsolved encephalitis and meningitis cases from Berlin from 2019 to 2020, and describe a WNV-encephalitis case in a 33-year-old kidney transplant recipient. The infectious course was resolved by serology, RT-PCR and sequencing of stored samples. Phylogenetic sequence analysis revealed a close relationship of the patient's WNV strain to German sequences from 2019 and 2020. A lack of travel history and patient self-isolation during the SARS-CoV-2 pandemic suggest the infection was acquired in the patient's home or garden. Serological tests of four people sharing the living space were negative. Retrospective RT-PCR and WNV-IgM testing of 671 CSF samples from unsolved encephalitis and meningitis cases from Berlin detected no additional infections. The recent increase of WNV cases illustrates the importance of considering WNV in cases of meningoencephalitis, especially in immunocompromised patients, as described here. Proper education and communication and a revised diagnostic strategy will help to raise awareness and to detect future WNV infections

Hughes et al. (2020) 'I feel cancer patients have been neglected'.

Purpose This study aimed to explore the experience of the COVID-19 pandemic including Government-enforced restrictions, on women diagnosed with oestrogen receptor positive breast cancer in the UK using a mixed-methods approach. Methods Depression (PHQ-2), anxiety (GAD-7), optimism (LOT-R) and perceived risk of recurrence (IPQ-BCS) were measured pre-COVID-19 outbreak and perceived vulnerability, severity and impact of COVID-19 were measured during the UK lockdown period of 23rd March-13th May 2020. Free text responses provided qualitative data. Descriptive statistics regarding COVID-19-specific behaviours and correlations between pre-COVID-19 psychosocial factors and COVID-19 outcomes were conducted. Thematic analysis was conducted on qualitative responses. Quantitative and qualitative data are presented together. Results 253 responses were received during the UK lockdown period. Twenty-six percent of the sample were shielding and 15% felt at higher risk of contracting COVID-19. Higher pre-COVID-19 depression and anxiety and lower optimism were associated with higher perceived vulnerability to and severity of COVID-19 and lower confidence in protecting oneself. There were positive and negative effects of lockdown on exercise and relationships and 42% reported negative impacts on anxiety. Participants reported fear of COVID-19, difficulties with adapting to isolation and using technology, and anxiety about the impact of delayed cancer treatment on their cancer recovery and recurrence. Conclusions Negative effects of lockdown, particularly for delayed cancer treatment should be considered to manage ongoing anxiety. Screening of state depression and anxiety is suggested for intervention prioritisation, but more longitudinal research is needed to understand the long-term effects of the COVID-19 pandemic on breast cancer survivors