Heavy menstrual bleeding poses an important health problem, which can be managed, besides other treatments, with endometrial ablation. Nowadays, the bipolar radio frequency device (NovaSure) is the most commonly used device for endometrial ablation, followed by the thermal balloon device (ThermaChoice III). Thus far, studies looking at treatment outcomes have mainly been done comparing NovaSure with the older ThermaChoice (I-II) devices. The aim of this study is to compare the effectiveness of the improved ThermaChoice III with NovaSure. Patients treated with ThermaChoice III at the Ziekenhuisgroep Twente hospital and NovaSure at the Medisch Spectrum Twente hospital were included in the study. The primary outcome measure was patient satisfaction after treatment, measured by the conditionspecific menorrhagia multi-attribute scale (MMAS). The secondary outcome measure was effectiveness of the treatment, measured by the amenorrhea rate and the hysterectomy rate. Five hundred fourteen patients were included in this study; of these, 216 patients were treated with ThermaChoice III and 289 patients with NovaSure. The score on the conditionspecific MMAS was high for both groups, without a significant difference between the groups (88.8 vs 86.5, p=0.183). The amenorrhea rate was significantly higher in the NovaSure group (45 vs 27 %, p=0.001). The hysterectomy rate was slightly higher in the ThermaChoice III group, without a significant difference between the groups (19 compared to 13 %, p=0.066). Patient satisfaction is comparable in patients treated with ThermaChoice III or NovaSure. However, NovaSure endometrial ablation leads to a significantly higher amenorrhea rate.

The introduction of pressurised metered dose inhalers (MDIs) in the mid-1950s completely transformed respiratory treatment. Despite decades of availability and healthcare support and development of teaching aids and devices to promote better use, poor pMDI user technique remains a persistent issue. The main pMDI user aid is the spacer/valved holding chamber (VHC) device. Spacer/chamber features (size, shape, configuration, construction material, and hygiene considerations) can vie with clinical effectiveness (to deliver the same dose as a correctly used pMDI), user convenience, cost, and accessibility. Unsurprisingly, improvised, low-cost alternatives (plastic drink bottles, paper cups, and paper towel rolls) have been pressed into seemingly effective service. A UK law change permitting schools to hold emergency inhalers and spacers has prompted a development project to design a low-cost, user-friendly, disposable, and recyclable spacer. This paper spacer requires neither preuse priming nor washing, and has demonstrated reproducible lung delivery of salbutamol sulphate pMDI, comparable to an industry-standard VHC, an alternative paperboard VHC, and pMDI alone. This new device appears to perform better than these other VHC devices at the low flow rates thought achievable by paediatric patients. The data suggest that this disposable spacer may have a place in the single-use emergency setting.

No abstract

Airway assessment by a SALT team was performed in 4 patients within 48 h of admission. None of the patients underwent video fluoroscopy. An initial dietetic review within 72 h of admission was observed in 6 patients (18%). Median hospital stay was 8 days and in hospital mortality was 41%. Conclusion The study demonstrates a significant inconsistency in the initial management of patients hospitalised with AP. The lack of early intervention by SALT and dietetic services and routine video fluoroscopy use in the majority of patients is of concern. A specific guideline with an evidence based diagnostic pathwayand managementis needed for patients at high risk for AP.

Introduction A simple training device (In-Check Flo-Tone®) has been developed to teach pMDI users when and how to actuate their inhaler via the sounding of an inspiratory flow whistle. Samples of the device plus instructions were made available to UK healthcare professionals who were invited, from April 2013, to take part in a short questionnaire survey. The objective was to assess the effect of the Flo-Tone device on pMDI technique. Method Patient details (age, sex, asthma/COPD diagnosis and spacer use) were recorded. Four assessments were made by the healthcare professionals concerning the patients' ability to: Q1 -generate an appropriate flow rate; Q2 -press the can during the early part of the inspiration; Q3 -maintain adequate inspiratory flow after pressing the can; and Q4 -an overall assessment of pMDI technique. Ability was graded Poor, Average or Good on each occasion. Assessments were made before and after Flo-Tone training, and changes in technique were determined from the responses. A sign-test for improvement was carried out on those not already assessed as Good. Results To date, 27 assessments of pMDI users have been received: 15 male and 12 female, age range 11-90 years (mean 51 years) with recorded diagnoses of asthma (n = 17) and COPD (n = 7). Four were spacer-users. The shift table (Table 1) shows the categorical changes before and after training. Following training, 19 users had improved their overall technique and 7 remained at the pre-training level (Q4); 20 had improved their ability to maintain an adequate flow and 6 remained at the pretraining level (Q3). Data for Q1 and Q2 were 15 and 12, and 8 and 18 users, respectively. The single loss of technique was an 83 year-old combined asthma/COPD patient. Analysis of those users not already rated as Good showed statistically significant improvements (P < 0.05) for Questions 1, 3 and 4. Conclusion The data indicate that the Flo-Tone device may be a positive addition to the training tools available for pMDI users, and may be particularly useful for improving overall technique and the ability to generate and to maintain an adequate inspiratory flow.Abstract P227 Table 1. AFTER TRAINING PoorAverage Good Poor