Who should donate blood? Policy decisions on donor deferral criteria should protect recipients and be fair to donors

An important element in the development of voluntary blood donation schemes throughout the world has been the attention given to minimising the risk to recipients of donated blood, primarily the risk of transfusion transmitted infections. In response to the appearance of human immunodeficiency virus (HIV) in the 1980s a range of national policies emerged that excluded populations at high risk of contracting HIV from donating blood, with a particular focus on men who have sex with men (MSM), the primary reason being the protection of recipients of donated blood. Recently some countries, including the UK, have revised their policies, informed by advances in screening tests, epidemiological evidence of transmission rates and an increasing concern about unfair discrimination of specific groups in society. Policy makers face a difficult task of balancing safety of recipients; an adequate blood supply for those who require transfusion; and societal/legal obligations to treat everyone fairly. Given that no transfusion is risk free, the question is what degree of risk is acceptable in order to meet the needs of recipients and society. Decisions about acceptance of risk are complex and policy makers who set acceptable risk levels must provide ethically justifiable reasons for their decisions. We suggest it is possible to provide a set of reasons that stakeholders could agree are relevant based on careful evaluation of the evidence of all relevant risks and explicit acknowledgement of other morally relevant values. We describe using such a process in the Safety of Blood Tissue and Organs (SaBTO) review of donor deferral criteria related to sexual behaviour.     

Post marathon cardiac troponin T is associated with relative exercise intensity

Objectives

This study aimed to investigate whether measures of cardiopulmonary fitness and relative exercise intensity were associated with high sensitivity cardiac troponin T (cTnT) rise after a road marathon.

Are black nurses an endangered species?

In the late 1980s it was feared that black nurses in Britain were a dying species. There was a belief that young people of minority ethnic descent were being deterred from choosing nursing as a career owing to the discrimination, disadvantage and harassment experienced by their parents as health service workers. Anecdotal evidence and limited statistical evidence suggested that the number of black applicants to preregistration training in nursing and midwifery was lower than would be expected when compared with the representation of the minority ethnic groups in the population as a whole. Nevertheless, the evidential base has, to date, been limited. Using the most comprehensive data set available, this paper presents an analysis of the national pattern of applications from members of minority ethnic groups to preregistration nursing and midwifery training. The evidence indicates complex patterns of under- and, in some cases, over-representation of black and Asian minority ethnic groups.     

Risk-factor assessment for falls: from a written checklist to the penless clinic

OBJECTIVE: to audit risk-factor identification of fallers before and after an education programme and the insertion of a written checklist in medical notes. Risk-factor identification in a dedicated, computerized falls clinic was then examined. METHODS: documentation of risk factors for falls was studied on wards and a self-auditing 'penless' clinic for fallers subsequently set up to generate reports for medical notes and letters for general practitioners. RESULTS: risk-factor identification improved after the insertion of the checklist but remained relatively poor. A dedicated clinic allowed almost complete identification of risk factors. Of the first 112 patients (median age 82) seen in the clinic, 75 (67%) were housebound. Remediable risk factors--e.g. inappropriate medication (67%), unsatisfactory footwear (59%) and postural hypotension (17%)--were found in most. Thirty-three patients (29%) had difficulty with alarm raising. CONCLUSION: ward-based intervention showed limited capacity to identify risk factors for falls: a dedicated clinic was more successful. The use of a portable computer with a programme to screen fallers for risk factors is worthy of consideration.