This large audit of otolaryngology practice identifies a large degree of error in coding on discharge. This leads to significant loss of departmental revenue, and given that the same data is used for benchmarking and for making decisions about resource allocation, it distorts the picture of clinical practice. These can be rectified through implementing a cost-effective clinician-coder double-reading multidisciplinary team as part of a data-assurance clinical governance framework which we recommend should be established in hospitals.

We need to recognize and to convince policymakers that excessive dependence on contingent appointments is detrimental to undergraduate learning, and especially so for the "at-risk" students, unable Ernst BenjaminThe authors of this volume agree that contingent faculty provide a substantial and increasing proportion of undergraduate instruction. They do not agree in their assessment of the implications of these facts. Their disagreements, however, are not as great as may initially appear. This is particularly true insofar as the assessment rests, as this volume intends, on the issue of the contribution of contingent faculty to student learning.First, none of the authors seriously questions the qualifications of contingent faculty as undergraduate, especially lower-division, instructors-though I am about to do so. Second, those authors who focus on part-time instructors share similar concerns about the out-of-classroom involvement of these faculty in student learning, and attribute these deficiencies to lack of time and inadequate terms of employment and professional support. Third, several of the authors note larger concerns that indirectly affect student learning. These include the increased dependence on a declining number of full-time faculty for out-of-class involvement in student learning, the breakdown of collegial cooperation, and the longer-term impact on faculty quality that will come with deterioration in the terms and conditions of their employment opportunities.In the discussion that follows I offer a reappraisal of each of these three issues: qualifications, contribution to student learning, and larger effects. My reappraisal takes account of the differences between the three main types of contingent instructional staff: part-time faculty, full-time nontenure-track faculty, and graduate assistants. I do not aim at synthesis. Rather, I reframe the issues in the light of additional evidence to emphasize

There is increasing evidence that PDE-5 inhibitors may induce sensorineural hearing loss via plausible physiological mechanisms. There needs to be more awareness of this disabling side effect among healthcare professionals responsible for prescribing this drug.

Helicobacter pylori is an accepted cause of chronic active gastritis and has a major causative role in peptic ulceration. It is a gastric carcinogen. Its role in non-ulcer dyspepsia (NUD) is less clear; yet 50 per cent of patients with NUD are infected with H pylori. H pylori has been investigated in several other organ systems, but has not been investigated extensively in squamous cell carcinoma of the upper aerodigestive tract, a region which could be directly exposed to the bacterium by gastro-oesophageal re ux (GOR).In this study 61 patients with severe laryngeal dysplasia or frank carcinoma of the head and neck are striated by age, investigated for the presence of antibodies to H pylori and compared to age and sex matched controls.In the age group of 46-61 years, the presence of H pylori antibodies was marginally greater in the experimental (63.0 per cent) than the control group (40.7 per cent) (Pearson Chi square p.=.0.055, Fisher 2-sided exact test p.=.0.066). When combining this age group with the younger age group and thereby creating two roughly equal groups (n.=.31 and n.=.30) there was also a statistical trend towards increased positivity in the experimental group. These ndings are discussed in the light of other studies with gastrooesophageal re ux disease (GORD).

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