Acute otitis externa is common and provides a heavy workload for general practitioners. We aim to determine the first-line treatment used by general practitioners in the management of otitis externa and subsequent second-line treatment in a hospital ENT clinic. In addition, this study aims to ascertain whether local and national guidelines are being followed appropriately. A prospective observational study on the management of otitis externa in consecutive patients referred to an ENT emergency clinic was undertaken. Data were collected and analysed on symptoms, initial management by general practitioners, findings and treatment in the ENT clinic. A total of 106 patients were studied. The mean duration of symptoms before presentation to clinic was 13 days; 42% of patients received no treatment by their GP prior to referral to the ENT emergency clinic. Only 14% of patients received topical antibiotics alone, whilst 44% received oral antibiotics, either alone or in conjunction with topical antibiotics by their GP. Of the 106 patients, 86% received topical antibiotics in the ENT emergency clinic and oral antibiotics were reserved for those presenting with complicated acute otitis externa. Topical antibiotics are associated with a decrease in disease persistence, whilst oral antibiotics are associated with an increase. However, general practitioners are prescribing oral antibiotics more often than required. There are few regional guidelines and no explicit national guidelines on the management of acute otitis externa for GPs to refer to. We suggest the implementation of national guidelines to aid clinical practice.

The objective of the study was to assess phlebotomy loss in renal medical in-patients in order to minimise an iatrogenic cause of anaemia. Phlebotomy has been shown to be a significant cause of iatrogenic blood loss in critical care. However, there has been limited research in patients with renal disease, at risk from anaemia. A prospective observational study was conducted of 70 consecutive patients admitted to an acute renal medicine ward in a tertiary care hospital over a period of four months. Inclusion criteria included adult patients with acute or chronic renal failure. Patients actively bleeding were excluded. Blood loss due to phlebotomy was determined from the patient's computerised records. The mean patient age was 61.5 +/- 16.5 years; the mean length of hospital stay was 23.1 +/- 19.8 days. The mean admission Hb was 9.8 +/- 2.0 g dL(-1) and 9.5 +/- 1.5 g dL(-1) on discharge. The total mean blood loss from phlebotomy during hospitalisation was 215.8 +/- 166 mL with a mean weekly blood loss of 55.7 +/- 11.23 mL. Losses were highest in the first week (mean of 76.8 mL), declining in subsequent weeks. Samples were taken for biochemistry (38%), FBC (36%), transfusion (13%) and others (13%). 46% of patients were transfused (mean 4.8 +/- 3.6 units). Blood loss was lower than in previous studies conducted in intensive care and general medicine but clinical staff should be aware of the cumulative blood loss from phlebotomy. Losses should be managed by optimising the frequency and volume of blood drawn for diagnostic laboratory tests.

This review describes the Institute's methodology, examines guidance relevant to otolaryngology and presents more recent research to update the evidence.