​BackgroundThe clinical severity of disease in neurofibromatosis type 2 (NF2) is variable. Patients affected with a constitutional truncating NF2 mutation have severe disease, while missense mutations or mosaic mutations present with a milder attenuated phenotype. Genotype-derived natural history data are important to inform discussions on prognosis and management.MethodsWe have assessed NF2 clinical phenotype in 142 patients in relation to the UK NF2 Genetic Severity Score to validate its use as a clinical and research tool.ResultsThe Genetic Severity Score showed significant correlations across 10 measures, including mean age at diagnosis, proportion of patients with bilateral vestibular schwannomas, presence of intracranial meningioma, spinal meningioma and spinal schwannoma, NF2 eye features, hearing grade, age at first radiotherapy, age at first surgery and age starting bevacizumab. In addition there was moderate but significant correlation with age at loss of useful hearing, and weak but significant correlations for mean age at death, quality of life, last optimum Speech Discrimination Score and total number of major interventions. Patients with severe disease presented at a younger age had a higher disease burden and greater requirement of intervention than patients with mild and moderate disease.ConclusionsThis study validates the UK NF2 Genetic Severity Score to stratify patients with NF2 for both clinical use and natural history studies.

Ann R Coll Surg Engl 2007; 89: 298-300 298Medical handover is 'the transfer of professional responsibility and accountability for some or all aspects of care for a patient, or group of patients, to another person or professional group on a temporary or permanent basis'.1 The implementation of the New Deal and the European Working Time Directive has meant that junior doctors are increasingly working in shifts and that handover of clinical information is taking place more frequently. There is reduced continuity of care with patients often being looked after by more than one group of doctors on any given day.3 In many instances, doctors have no day-to-day contact with patients for whom they are responsible in the outof-hours period.2 There are many published examples of cases where poor communication between doctors has had serious consequences for patients; 3 for these reasons, it is now well recognised that accurate handover of clinical information is of great importance to patient safety. 1There are currently many different handover methods being used in clinical practice. 4 Often, a verbal handover is conducted, either by telephone or in person, where the recipient of the handover may or may not take notes to refer to over the course of his shift. Some groups arrange for a handover book or folder to be used so that teams can leave messages about patients of particular concern. In this case, there may be no verbal contact at all. Increasingly, more formal pre-prepared handover sheets are being used which contain information about all of the patients belonging to that particular team.5 This can be typed on a computer and printed out for the on-call doctor for his reference. However, this process inevitably takes more time and effort.Despite this variation in clinical practice, there is very little prospective experimental evidence in the literature investigating optimal methods of handover. The British Medical Association, in conjunction with the General Medical Council, NHS Modernisation agency, National Patient Safety Agency and the Junior Doctors Committee have recently published guidelines 4 for safe handover, but these are based largely on expert opinion. We designed a study to assess the differences in information retention for different handover styles. The styles examined included a purely verbal style, a verbal with note-taking style and a handover using a pre-prepared sheet.

The heat produced by some endoscopes is sufficiently great to cause thermal injury to tissues. Awareness of the temperatures produced by these endoscopes should prompt clinicians to actively cool their endoscopes during a procedure, before any thermal injury is caused.