Volume 8, Number 4

Simon Noble MRCP Dip Pall Med PGCE Specialist Registrar, Palliative Medicine, Velindre Hospital, Whitchurch, Cardiff

Patients with cancer are at high risk of venous thromboembolism (VTE) and the prothrombotic risk increases with disease progression. The prevalence of clinically apparent VTE in cancer patients is up to 15%.1 The actual incidence is much higher, with post-mortem studies demonstrating VTE in up to 50% of cancer patients.2,3

Fran Pressley EN(G), RGN, MISM, Cert/Ed Anticoagulant Nurse Specialist, Royal Gwent Hospital, Cardiff Road, Newport, Gwent

Plans have been initialised to change practice in the Royal Gwent Hospital (part of the Gwent Healthcare Trust) for the management of inpatients receiving warfarin therapy. At present, the anticoagulant nurse service (ACNS) has taken over the warfarin management and adjustment of five acute medical wards, with plans to eventually offer this service to the whole of the adult hospital population. This article discusses how the service has been implemented thus far.

Peter Rose, Editor

Infection with Escherichia coli 0157:H7 may result in haemorrhagic colitis, but for a small number of patients the disease progresses to the haemolytic uraemic syndrome (HUS). This syndrome is associated with a micro-angiopathic haemolytic anaemia, thrombocytopenia and renal failure. The disease represents the most common cause of acute renal failure in children and, while the clinical effects are often reversible, it can result in long-term morbidity.

Christopher Newdick BA, CNAA, LLM (London) Barrister, Reader in Health Law, University of Reading; Consultant to Reading PCT and Member of the Berkshire Priorities Committee

New drugs are often extremely effective, but they are also expensive. How does the law balance individual patients’ interests with the interests of the community as a whole? What legal framework governs the introduction of new drugs into the NHS?

Raj K Patel MRCP MRCPath Consultant Haematologist; Roopen Arya FRCP PhD Consultant Haematologist, Department of Haematological Medicine, King’s College Hospital, London

In populations of European origin, the epidemiology and risk factors for venous thromboembolism (VTE) are well characterised but such data are scanty for other ethnic groups. Traditionally, venous thrombosis has been recognised as a condition confined to the populations of Europe, this has been strengthened by the lack of diagnostic services in developing countries and the low incidence of known hereditary prothrombotic mutations in non-Europeans.