Objective  To examine the cost implications of outpatient versus daycase hysteroscopy to the National Health Service, the patient and their employer. Design and interventions  Randomised controlled trial. Setting  The gynaecology clinic of a large teaching hospital. Participants  Ninety‐seven women with abnormal uterine bleeding requiring investigation. Methods  Women were randomly allocated to either outpatient or daycase hysteroscopy. They were asked to complete diaries recording expenses and time off work. The National Health Service costs were calculated for a standard outpatient and daycase hysteroscopy. Main outcome measures  Costs to the National Health Service, costs to the employer, loss of income, childcare costs and travel expenses. Results  The outpatient group required significantly less time off work compared with the daycase group (0.8 days vs 3.3 days), P < 0.001. Of those women who lost income due to the hysteroscopy, the average loss of income was twice as much in the daycase group (£20.40 in the outpatient group vs£50.60 in the daycase group). The average cost of childcare required to cover the time spent in hospital undergoing the hysteroscopy was similar in both groups, however, the number of women requiring childcare was small. Travel costs incurred by the women were 74% more in the daycase group compared with the outpatient group—with an average cost of £3.46 in the outpatient group and £6.02 in the daycase group. Daycase hysteroscopy costs the National Health Service approximately £53.88 more per patient, than performing an outpatient hysteroscopy. Purchasing the hysteroscopes necessary to perform an outpatient hysteroscopy is a more expensive outlay than those required for daycase hysteroscopy. However, there are so many other savings that only 38 patients need to undergo outpatient hysteroscopy (even with a 4% failure rate) rather than daycase hysteroscopy in order to recoup the extra money required to set up an outpatient hysteroscopy service. Conclusion  Outpatient hysteroscopy offers many benefits over its traditional counterpart including faster recovery, less time away from work and home and cost savings to the woman and her employer and the National Health Service. Resources need to be made available to rapidly develop this service across the UK in order to better serve both patient and taxpayer.

One of the most common gynaecological causes of chronic pelvic pain is endometriosis. A lack of correlation between laparoscopic findings and pelvic pain has been reported. As endometriotic lesions are under hormonal influence, the effects of the gonadotrophin-releasing hormone (GnRH) analogues cause shrinkage of the deposits, reducing symptoms caused by them. We carried out a longitudinal, interventional pilot study, examining the effect of leuprorelin acetate 3.75 mg (Prostap SR, Wyeth) on pelvic pain prospectively. Preliminary data shows a decrease in pain scores from before to after treatment which is statistically significant (P<0.0001) as well as a general improvement in other symptoms. Laparoscopy showed that symptom intensity is not always related to severity of endometriosis and the worst symptoms may not necessarily be due to pathology. Therefore, it is beneficial to treat women with CPP with GnRH analogues as first-line management to relieve painful symptoms, avoid surgical risks and save money.

The implementation of ESL courses at universities and colleges has been based on the assumption that a threshold level of English proficiency is necessary for students to succeed at their academic work. The correlation, however, between English language proficiency and academic success has not been clearly established. This paper describes a study undertaken at Brock University which correlates performance of students in ESL courses in spoken and written English with achievement in their other academic courses. The grades received in the ESL courses were correlated with the overall academic average and the major average for the whole group and for each of three degree groups-students completing B.A, RSc., and B.RE. degrees. Analysis of the data revealed a modest positive correlation between performance in written English and the overall and major averages in all groups except the B.RE., in which there was no significant correlation. The grades for the spoken English course failed to correlate significantly with either the overall average or the major average in any of the groups. Pedagogical implications of these surprisingly low correlations are discussed, and suggestions are offered for making skills learned in ESL courses more relevant to the academic needs of students.

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