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Objectives: To determine whether FloSeal as a haemostatic agent in tonsillectomy is associated with less postoperative pain than conventional haemostasis with ligatures. Design: Randomised, controlled, single-blinded pilot study. Setting: James Cook University Hospital, Middlesbrough, Cleveland, UK. Participants: Thirty patients over 16 years of age undergoing tonsillectomy for recurrent tonsillitis were recruited for the study. At surgery both tonsils were removed by cold steel dissection. Following randomisation one tonsil fossa had FloSeal applied and the other ligatures for haemostasis. Main outcome measures: The primary outcome measure was postoperative pain following tonsillectomy measured on a visual analogue scale. Pain was recorded three times a day for the first 10 days following surgery. Haemorrhage rates were also recorded as a secondary outcome. Results: Complete data was analysed for 26 patients (87%). The data was grouped into distinct time periods: 0–2, 3–6 and 7–10 days. The sum of the visual linear analogue scale over the time periods for each patient was calculated. Using Wilcoxon Signed Ranks Test, the data was analysed and it was found that there was no statistically significant difference in postoperative pain scores between the control and treatment side at any time. There was a postoperative reactionary haemorrhage rate of 6.7% on the FloSeal side. Conclusion: In our pilot study there was no reduction in pain on the FloSeal side in the first 10 days following tonsillectomy which contrasts with previous findings in the literature. [ABSTRACT FROM AUTHOR]

There is a limited evidence base for self-testing and -management for oral anticoagulation management. Available data suggest that these are credible models for a significant minority of patients if underpinned by structured training and follow-up. The guidelines presented are necessarily consensual and outline procedures for patient selection, training, product procurement, product maintenance, quality assurance procedures, dosage adjustment and clinical supervision. The cost-effectiveness of these models remains to be elucidated within the UK. Further data on both health economic and clinical outcomes are required from UK based studies before widespread implementation of self-testing and management can be recommended on a wider scale. [ABSTRACT FROM AUTHOR]

Aims To examine the adequacy of instructions to monitor for haematological adverse drug reactions in the Summary of Product Characteristics. Methods We searched the United Kingdom eMedicines Compendium to identify instructions to monitor for haematological adverse drug reactions, and selected 84 Summaries of Product Characteristics for nonhaematological drugs, which were then scored independently by five clinicians, using a scale we devised, the Systematic Instructions for Monitoring (SIM) score. A subset of comparable summaries from Australian and United States summaries was also examined. Results The SIM scores for the five clinicians agreed well: Kendall's coefficient of concordance = 0.937, P < 0.0001. The median SIM score for the 84 UK summaries was 13 [95% confidence interval (CI) for median 12, 15] out of a possible 31. Over 40% fell below a hypothetical minimally acceptable score of 12/31. SIM scores were on average 2.0 (95% CI 0.4, 3.8) higher for Australian summaries; US summaries had intermediate scores that did not significantly differ from those in Australia or the UK. Conclusions Instructions on monitoring for adverse drug reactions are often inadequate. Pharmaceutical companies and regulatory agencies should produce clear guidance on monitoring, and the data to support it. [ABSTRACT FROM AUTHOR]

A significant proportion of patients who present for plastic surgical procedures take aspirin or other antiplatelet agents (clopidogrel or nonsteroidal anti-inflammatory drugs) or are on anticoagulants (e.g. warfarin). Although there have been several reports in the literature regarding the perioperative management of patients presenting for dermatologic surgery, there have been no such reports pertaining to the wider scope of plastic surgical practice. In the absence of clear guidelines for the perioperative management of these patients presenting for plastic surgical practice, we have undertaken a pilot survey of the current practices of consultant plastic surgeons in the UK. The aims of this study were to determine whether there was uniformity of practice, and whether the modes of practice differed from those outlined in the literature for other related specialities. A postal survey of 235 plastic surgical consultants was conducted. The response rate was 48%. Overall, most respondents (84%) stated that their practice was primarily based on personal preference, and only 28% stated that it was based on the local Unit policy. Only 23% of the Consultants based their practice on evidence-based medicine. There appeared to be significant variations in current practice amongst plastic surgeons. Some aspects of practice were found to vary from those recommended in the literature for other related specialities. We hope that the findings of this study will highlight the significant non-uniformity of practice within this speciality and that this may form the basis for the development of clear guidelines of the entire spectrum of plastic surgery for the preoperative management of this group of patients in the future. [ABSTRACT FROM AUTHOR]

To investigate whether knowledge and perceptions of antithrombotic therapy differ between ethnic groups in the UK, we conducted a cross-sectional questionnaire survey of patients attending anticoagulation clinics in three Birmingham teaching hospitals. 180 consecutive patients were recruited—135 white European, 29 Indo-Asian, 16 Afro-Caribbean. The average knowledge score was 5.5 out of 9, with no significant differences between the groups. Indo-Asians were significantly less likely than the other groups to know the name of the anticoagulant they were taking (warfarin) and Afro-Caribbeans to know the condition for which they were being anticoagulated. Few patients of any group were able to specify more than one side-effect of warfarin or the dose they were on. In logistic regression analysis the factors associated with a low score were age >61 years, having been born outside the UK, and the perception of difficulty in comprehension. Nearly half the Indo-Asians felt unable to understand what was said to them in the clinic, and 62% expressed a preference for a doctor of the same ethnic group. Although there were no significant between-group differences, this study points to gaps in the knowledge of patients from ethnic minorities and to deficiencies in the provision of information. In patient education, these groups should receive special attention. [ABSTRACT FROM AUTHOR]

This article reports that in a continuing series of drug and therapeutics updates, Charlotte Nicholls and Mojgan Sani consider the enduring role of anticoagulants in the treatment of thromboembolic diseases. Anticoagulants were discovered in 1924 when a new haemorrhagic disorder was discovered in cattle that had been fed on spoiled sweet clover silage. It was found that prothrombin (the precursor to thrombin, involved in the coagulation of blood) in the plasma of the cattle had been reduced and the anticoagulant diacumarol was the causative substance. Anticoagulants are still the mainstay of treatment in the prevention of clotting of blood, primarily in thromboembolic diseases involving the formation of fibrin. Nicoumalone and phenidone are licensed for use but are rarely used.