SummaryBackgroundLimits on the frequency of whole blood donation exist primarily to safeguard donor health. However, there is substantial variation across blood services in the maximum frequency of donations allowed. We compared standard practice in the UK with shorter inter-donation intervals used in other countries.MethodsIn this parallel group, pragmatic, randomised trial, we recruited whole blood donors aged 18 years or older from 25 centres across England, UK. By use of a computer-based algorithm, men were randomly assigned (1:1:1) to 12-week (standard) versus 10-week versus 8-week inter-donation intervals, and women were randomly assigned (1:1:1) to 16-week (standard) versus 14-week versus 12-week intervals. Participants were not masked to their allocated intervention group. The primary outcome was the number of donations over 2 years. Secondary outcomes related to safety were quality of life, symptoms potentially related to donation, physical activity, cognitive function, haemoglobin and ferritin concentrations, and deferrals because of low haemoglobin. This trial is registered with ISRCTN, number ISRCTN24760606, and is ongoing but no longer recruiting participants.Findings45 263 whole blood donors (22 466 men, 22 797 women) were recruited between June 11, 2012, and June 15, 2014. Data were analysed for 45 042 (99·5%) participants. Men were randomly assigned to the 12-week (n=7452) versus 10-week (n=7449) versus 8-week (n=7456) groups; and women to the 16-week (n=7550) versus 14-week (n=7567) versus 12-week (n=7568) groups. In men, compared with the 12-week group, the mean amount of blood collected per donor over 2 years increased by 1·69 units (95% CI 1·59–1·80; approximately 795 mL) in the 8-week group and by 0·79 units (0·69–0·88; approximately 370 mL) in the 10-week group (p<0·0001 for both). In women, compared with the 16-week group, it increased by 0·84 units (95% CI 0·76–0·91; approximately 395 mL) in the 12-week group and by 0·46 units (0·39–0·53; approximately 215 mL) in the 14-week group (p<0·0001 for both). No significant differences were observed in quality of life, physical activity, or cognitive function across randomised groups. However, more frequent donation resulted in more donation-related symptoms (eg, tiredness, breathlessness, feeling faint, dizziness, and restless legs, especially among men [for all listed symptoms]), lower mean haemoglobin and ferritin concentrations, and more deferrals for low haemoglobin (p<0·0001 for each) than those observed in the standard frequency groups.InterpretationOver 2 years, more frequent donation than is standard practice in the UK collected substantially more blood without having a major effect on donors' quality of life, physical activity, or cognitive function, but resulted in more donation-related symptoms, deferrals, and iron deficiency.FundingNHS Blood and Transplant, National Institute for Health Research, UK Medical Research Council, and British Heart Foundation.

Background The measurement of body temperature has become commonplace in the current COVID-19 pandemic. Body temperature can be measured using thermal infrared imaging, a safe, non-contact method that relies on the emissivity of the skin being known to provide accurate readings. Skin pigmentation affects the absorption of visible light and enables us to see variations in skin colour. Pigmentation may also affect the absorption of infrared radiation and thus affect thermal imaging. Human skin has an accepted emissivity of 0.98 but the effect of different skin pigmentation on this value is not known. In this study, we investigated the influence of different skin pigmentation on thermal emissivity in 65 adult volunteers. Methods A reference object of known emissivity (electrical tape) was applied to participant’s skin on the inner upper arm. Tape and arm were imaged simultaneously using a thermal infrared camera. The emissivity was set on the camera to the known value for electrical tape. The emissivity was altered manually until the skin temperature using thermal imaging software was equal to the initial tape temperature. This provided the calculated emissivity value of the skin. Participants were grouped according to skin pigmentation, quantified using the Fitzpatrick skin phototyping scale and reflectance spectrophotometry. Differences in emissivity values between skin pigmentation groups were assessed by one-way ANOVA. Results The mean calculated emissivity for the 65 participants was 0.972 (range 0.96–0.99). No significant differences in emissivity were observed between participants when grouped by skin pigmentation according to the Fitzpatrick scale (p = 0.859) or reflectance spectrophotometry (p = 0.346). Conclusion These data suggest that skin pigmentation does not affect thermal emissivity measurement of skin temperature using thermal infrared imaging. This study will aid further research into the application of thermal infrared imaging as a screening or bedside diagnostic tool in clinical practice.

The standard of care for men with a suspected malignant testicular tumour and normal contralateral testis is radical orchidectomy, testicular tumour markers and computed tomography scan staging. If the definitive orchidectomy histopathology is benign, young men are potentially exposed to unnecessary radiation. We sought to establish the rate of benign pathology returned from radical orchidectomy at our local urology multidisciplinary team (MDT) and if there were any preoperative factors suggestive of benign lesions. We included patients discussed at our local MDT meeting regarding testicular tumours with histology following radical orchidectomy between 1 January 2016 and 31 December 2018. A total of 113 patients were included, with benign histology following radical orchidectomy in seven (6.2%) patients. The benign histology included one adenomatoid tumour, and the remainder showed features of either infarction or inflammation. Metastases were detected on staging imaging in 21% of patients. Of these, 64% had normal preoperative tumour markers. Neither tumour size nor number of preoperative ultrasounds correlated with a risk of benign histology. One patient had chemotherapy prior to orchidectomy. It was reassuring that just 6.2% of patients had benign histology with no significant factors predictive of benign histology. This supports pre-orchidectomy staging imaging and the current MDT pathway for suspected testicular cancers. Level of evidence: Level 2C.

Introduction Neo-adjuvant chemotherapy may be considered for suspected testicular malignancy if widespread life-threatening metastases are identified on computed tomography (CT) imaging. Staging preoperatively enables this and may prevent delays in ongoing oncological care. This project aimed to increase the proportion of staging scans performed preoperatively in the University Hospitals of Leicester NHS trust. Method All referrals between 01/01/2016 and 31/12/2018 to the urology multidisciplinary team for suspected testicular cancer were reviewed. Exclusion criteria were applied prior to collecting treatment pathway data for each patient. Based on initial audit findings, clinicians were advised to request staging CT scans at the first urology clinic appointment. Re-audit was between 01/01/2019 and 31/12/2019. Results Initial audit included 95 patients and re-audit included 23 patients. The proportion of preoperative scans increased from 28.4% to 82.6% following intervention. Median time from first ultrasound to CT was reduced from 44 days to 17 days without affecting median time to orchidectomy (27 to 23 days) or oncology appointment (61 days). Conclusions Requesting a staging CT scan as part of the first clinic assessment improved the proportion of preoperative scans without affecting time to surgery or oncology appointment.