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Johnson R.J.,DoNation | Johnson R.J.,Kidney Advisory Group of NHS Blood and Transplant | Fuggle S.V.,DoNation | Fuggle S.V.,Oxford Transplant Center | And 4 more authors.
Transplantation | Year: 2010

Introduction: In 2004, it was agreed that a new allocation scheme for kidneys from deceased heart-beating donors was required in the United Kingdom to address observed inequities in access to transplant. The 2006 National Kidney Allocation Scheme (2006 NKAS) was developed to meet agreed objectives and preparatory work included a review of the criteria for human leukocyte antigen (HLA) matching and simulation evidence about the effectiveness of alternative schemes. ALGORITHM FOR 2006 NKAS: The 2006 NKAS gives absolute priority to all 000 HLA-A, -B, -DR-mismatched patients and well-matched pediatric patients (<18 years), and then a points score defines priorities for allocation with waiting time being most influential. Points for age and HLA mismatch are linked in a novel approach to ensure well-matched transplants for younger patients while recognizing that HLA matching is less important for older patients as retransplantation is less likely to be required. To improve equity for difficult to match patients, rare HLA specificities were defaulted to more common, related specificities. IMPACT OF 2006 NKAS: After 3 years, the scheme is already making good progress in achieving its objectives, with overall Results similar to those observed in the simulations. There has been a significant benefit for patients waiting more than 5 years for transplant. A number of other advantages of the scheme are also apparent with equity of access improving in many respects, including the achievement of equity of access to transplant for HLA-DR homozygous patients, but geographical inequity of access will take a number of years to address fully. Copyright © 2010 by Lippincott Williams & Wilkins. Source


Levy L.B.,Wellington House
Proceedings of the Nutrition Society | Year: 2013

Diet-related chronic diseases are major public health concerns in England and the associated costs to the National Health Service and society are considerable. Poor diet and other lifestyle factors are estimated to account for about one-third of all deaths from CVD in England. UK dietary recommendations were set by the Committee on Medical Aspects of Food Policy and are now set by the Scientific Advisory Committee on Nutrition. For cardiovascular health, dietary recommendations are set for nutrients (saturated fat, trans-fat and carbohydrates), foods (fruits, vegetables and oily fish) and salt. The National Diet and Nutrition Survey demonstrates that the majority of the UK population have poor diets. Average intakes of saturated fat and salt are above recommendations while fruit, vegetables, fibre and oily fish are below recommendations. The Department of Health in England is committed to working to improve diet and lifestyle. Current work includes the Public Health Responsibility Deal, under which organisations pledge to increase fruits and vegetables and reduce levels of salt, trans-fat and energy in manufactured foods and menus, the provision of information to help improve food choice through better food labels and provision of information, including a NHS Choices website and the social marketing campaign Change4Life. Copyright © The Author 2013. Source


Roe M.,UK Institute of Food Research | Pinchen H.,UK Institute of Food Research | Church S.,Susan Church | Elahi S.,LGC Ltd. | And 4 more authors.
Food Chemistry | Year: 2013

A survey to determine the trans fatty acid content of a range of processed foods was carried out in response to recent reformulation work by the food industry to lower the artificial trans fatty acid content of processed products. Sixty two composite samples, made up of between 5 and 12 sub-samples, were collected in 2010 and were analysed for fatty acids, and a range of nutrients. The foods analysed included pizza, garlic bread, breakfast cereals, quiche, fat spreads, a range of fish and meat products, chips, savoury snacks, confectionery and ice cream. Levels of trans fatty acids were reduced considerably compared with previous UK analyses of similar foods where comparisons are possible. Concentrations of trans elaidic acid (t9-C18:1) from hydrogenated oils in all samples were <0.2 g/100 g food. These results confirm information provided by the food industry in 2007 on the levels of trans fats in key processed food sectors. © 2013 Elsevier Ltd. All rights reserved. Source


Infection is different from other aspects of medical care and clinical practice because it spreads. That is the defining characteristic of infection and it means that for every infected patient who needs treatment for their illness, there are two further questions - where has the infection come from, and where (to whom) may it have spread? The study of infection is a fascinating biological interaction between microbial populations and human populations with a variety of influencing factors linked to human behaviour. This includes the behaviour of patients, their relatives and, importantly, their healthcare attendants, particularly doctors and nurses. These factors have critical importance in relation to healthcare-associated infections. These infections are complications of a patient's underlying, primary illness or of the treatment they have received for that illness. They used to be called 'hospital infections' but they know no boundaries across health and social care because the bacteria move with people (both patients and staff) and these infections affect all health and social care settings. Therefore, responsibility for infection prevention and control lies across the whole health and social care community. Source


Fuggle S.V.,NHS Blood and Transplant | Fuggle S.V.,University of Oxford | Johnson R.J.,NHS Blood and Transplant | Bradley J.A.,University of Cambridge | Rudge C.J.,Wellington House
Transplantation | Year: 2010

Introduction: National and regional strategies for allocating deceased heartbeating (DHB) donor kidneys to patients awaiting transplant are of great importance and have major implications for patients and healthcare systems. We describe the rationale for the 1998 National Kidney Allocation Scheme (1998 NKAS) and its impact on renal transplantation in the United Kingdom over 5 years. Methods: The 1998 NKAS was based on three tiers of patients defined by human leukocyte antigen (HLA) mismatch. This involved national allocation of well-matched kidneys in tiers 1 and 2, with regional allocation for less well-matched patients in tier 3. Pediatric patients (younger than 18 years) and regional patients were prioritized in tiers 1 and 2, with a points score based on six factors determining the specific priority order for allocation. Results: The 1998 NKAS allocated approximately half the kidneys from DHB donors to the national transplant list and resulted in significantly improved HLA matching, more than doubling the proportion of transplants that were 000 HLA-A, -B, and -DR mismatched from 7% to 16% for adults. Pediatric patients achieved comparable levels of HLA matching to adult patients for the first time in the United Kingdom through improved access to adult donor organs. The scheme also benefited highly sensitized patients and improved equity with regard to patient blood group, rareness of HLA type, and HLA homozygosity. Conclusion: The 1998 NKAS represented a significant advance for the allocation of DHB donor kidneys in the United Kingdom and, while not addressing inequities in access to transplant, it did largely achieve the principal goal of improving HLA matching. Copyright © 2010 by Lippincott Williams & Wilkins. Source

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