Summary Randomized controlled trials of good quality are a recognized means to robustly assess the efficacy of interventions in clinical practice. A systematic identification and appraisal of all randomized trials involving fresh frozen plasma (FFP) has been undertaken in parallel to the drafting of the updated British Committee for Standards in Haematology guidelines on the use of FFP. A total of 57 trials met the criteria for inclusion in the review. Most clinical uses of FFP, currently recommended by practice guidelines, are not supported by evidence from randomized trials. In particular, there is little evidence for the effectiveness of the prophylactic use of FFP. Many published trials on the use of FFP have enrolled small numbers of patients, and provided inadequate information on the ability of the trial to detect meaningful differences in outcomes between the two patient groups. Other concerns about the design of the trials include the dose of FFP used, and the potential for bias. No studies have taken adequate account of the extent to which adverse effects might negate the clinical benefits of treatment with FFP. There is a need to consider how best to develop new trials to determine the efficacy of FFP in different clinical scenarios to provide the evidence base to support national guidelines for transfusion practice. Trials of modified FFP (e.g. pathogen inactivated) are of questionable value when there is little evidence that the standard product is an effective treatment.

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reprovision programmes in Britain, provided that these are well planned and well resourced. ConclusionOur findings dispel some of the common concerns and myths associated with "care in the community" patients and provide robust evidence that community care has worked well for the former patients of psychiatric hospitals, most of whom are currently living in the community and posing minimal risk to themselves and the public. In light of this, a change towards institutional care is not a rational policy.We thank the research workers who have contributed to the collection of the data, the patients, and the hospital and community staff. This paper is designated the TAPS project 45.Contributors: NT participated in data collection, analysis, interpretation, and drafting the paper. JL conceived and designed the Team for the Assessment of Psychiatric Services (TAPS) project and has been the director of the research team for the past 13 years. He helped to draft and edit this paper. GG participated in the analysis and interpretation of the mortality data. He also computerised the assessment tools used by TAPS. NT and JL will act as guarantors for the paper.Funding: The Team for the Assessment of Psychiatric Services (TAPS) is funded by the Department of Health, North Thames Regional Health Authority, and the Gatsby Foundation. It is administered through the Department of Psychiatry and Behavioural Sciences, Royal Free and University College Medical School, London.Competing interests: The TAPS project was largely funded by the Department of Health. This, and previous TAPS papers, were sent for comments to the Department of Health before submission. However, all papers, including this one, were drafted without administrative intervention or scrutiny of any kind. The opinions expressed do not necessarily reflect the policy of the Department of Health. AbstractObjective To receive and collate reports of death or major complications of transfusion of blood or components.

Transfusion of stored leukodepleted red cells to euvolemic, anemic, critically ill patients has no clinically significant adverse effects on gastric tonometry or global indexes of tissue oxygenation. These findings do not support the use of fresh red cells in critically ill patients.