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The clinical objectives of this prospective, random, convenience series were: 1. Compare a novel fibre-optic pH test device (NGPOD) to gastric aspirate and pH testing for nasogastric tube (NGT) confirmation. 2. Determine if the new device reduces the need for chest radiography (chest X-ray, CXR). Methods: Recruitment of patients over the age of 18, requiring NGT feeding.Exclusion criteria: oesophageal gastrointestinal surgery within 3 months; all those with partial or total gastrectomy; bleeding gastric and duodenal ulcers; gastric cancer; those with oesophageal varices; those considered to be inappropriate.The index test, NGPOD, comprises a fine, flexible fibre-optic sensor passed down the NGT, then connected to an electronic device. A green light indicates pH ≤5.5, and a red light if pH is >5.5.The reference test is withdrawal of gastric aspirate and testing with universal pH indicator strips then comparison to a colour chart. Second-line testing is establishing NGT position by CXR or subjective clinical assessment (SCA) in intensive care unit (ICU). Results: The analysed data set contained 174 subjects who had undergone 496 tests, 96 initial and 400 repeat NGT checks.For all patients, NGPOD can reduce the need for CXR or SCA by 21.2%.In ICU, NGPOD can reduce the need for CXR or SCA by 24.5%.When performing initial tests, immediately after tube placement, NGPOD can reduce the need for CXR or SCA in 61% of patients.With repeat testing, NGPOD can reduce the need to progress to CXR or SCA in 16% of tests. Conclusions: The objective, yes-no result delivered by NGPOD, eliminates the subjective reading of a pH strip colour change, reducing the subjective element. The index test has the opportunity to reduce risk, improve safety and decrease the numbers of patients requiring X-ray. It, therefore, has the potential to reduce never events associated with NGT misplacement.

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OBJECTIVE: To appraise critically the published randomized controlled trials (RCTs) comparing carbon dioxide (CO2) with normal saline (NS) as distension medium for diagnostic hysteroscopy. DESIGN: Systematic review and meta-analysis of RCTs. SETTING: Outpatient and inpatient hysteroscopy clinics. PATIENT(S): Women undergoing diagnostic hysteroscopy. REFVENTION(S): CO2 or NS as distension medium for diagnostic hysteroscopy. MAIN OUTCOME MEASURE(S): Procedural and shoulder pain, side effects, satisfaction, quality of view, duration of procedure. RESULT(S): Ten RCTs involving 1,839 women (905 in the CO2 group, 934 in the NS group) were systematically analyzed. There was significant heterogeneity among the included trials. Compared with NS, CO2 was associated with greater procedural pain, more occurrences of shoulder pain and side effects, less satisfaction, less quality of view, and greater duration of procedure. CONCLUSION(S): A meta-analysis from the available moderate quality trials suggests that NS might be superior to CO2 for use in diagnostic hysteroscopy. Owing to problems of clinical diversity, statistical heterogeneity, and risk of bias, it is clear that additional pragmatic multicenter RCTs are needed to corroborate these findings before firm evidence-based guidelines can be given.

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PURPOSE: The performance of NHS U.K. hospitals is under continuous scrutiny as they are constantly under pressure to perform well. A recent document published by an independent body has recommended a host of clinical indicators to assess non-financial performance of hospitals. This study aims to critically analyse the performance of a single U.K. hospital against several of these recommended indicators. DESIGN/METHODOLOGY/APPROACH: Data presented to the Hospital Trust Board for 12 months were used for this study. Previous years' data were used wherever available. FINDINGS: Based on data analysis, this hospital's performance is extremely difficult to calculate. The indicators use complex ratios and due to lack of standardisation, the hospital performance could be interpreted as better, worse or indifferent. RESEARCH LIMITATIONS/IMPLICATIONS: This study analyses most of the recommended indicators. Literature review did not reveal a similar analysis of another hospital against these indicators which precludes comparison. PRACTICAL IMPLICATIONS: This study highlights the difficulty in comparing the performance of hospitals due to the inherent lack of consistency. Therefore it is apparent that any reward-rebuke system linked to performance should interpret the data with caution. It is therefore suggested that easy to control single value activities and standardised routine activities could be used to measure hospital performance. Alternatively, the hospital could compare with its own statistics from previous years. ORIGINALITY/VALUE: Literature acknowledges the difficulties in measuring clinical performance. This paper elucidates these difficulties applied to the NHS and suggests alternatives.

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A 46-year-old woman of Asian origin presented with heavy intermenstrual and postcoital bleeding caused by the rare entity of primary non-Hodgkin's lymphoma of the cervix uteri, with no evidence of disease elsewhere. Prompt diagnosis by biopsy avoided unnecessary surgery, and instead appropriate treatment with chemoradiotherapy was administered.

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All-trans-retinoic acid (ATRA) has been proved to be an effective treatment for acute promyelocytic leukemia (APL), inducing remission in more than 90% of cases. Treatment of APL in pregnancy is controversial as the use of ATRA has been questioned due to the teratogenic effect of retinoids. We report a case of pregnancy in a woman exposed to ATRA during the first trimester. The baby was born healthy, without any anomalies. Review of all reported cases of the use of ATRA in pregnancy revealed no serious adverse outcomes or congenital anomalies although only very few cases had exposure in the first trimester.

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