Background Iron deficiency anaemia in pregnancy is common and is a major cause of maternal and neonatal morbidity worldwide. Serum ferritin is the current gold standard test for identifying iron depletion, with a cut-off value of 30 µg/L. Recent studies in low- and middle-income countries have identified mean cell haemoglobin concentration as a surrogate marker for the prediction of iron depletion. Methods We studied values from 786 antenatal blood results from 2018 in Oxford, UK, and correlated the red cell indices with serum ferritin measurements. Results Haemoglobin, mean cell volume, mean cell haemoglobin and mean cell haemoglobin concentration have low specificity and sensitivity for the identification of iron depletion. Conclusions We found that haemoglobin, mean cell volume, mean cell haemoglobin and mean cell haemoglobin concentration do not have sufficient predictive value in this population to be used as a screening test for non-anaemic iron depletion.

Hospital medicine in the UK is under unprecedented pressure, with increasing demand on physicians as well as challenges in recruiting new doctors into the physicianly specialties. We sought to assess the prevalence of the afternoon ward round and its effect on those undertaking them. We sampled each hospital within our postgraduate region, surveying junior doctors working on inpatient medical wards. We surveyed roughly two-thirds of eligible doctors, fi nding that 30% of juniors had some commitment, of varying frequency, to ward rounds beginning after 1.00pm. Of the doctors involved in afternoon ward rounds, the majority felt they contributed to late fi nishes, delayed discharge of patients, reduced team effi ciency and reduced job satisfaction. Just under 80% felt they were less likely to consider a career in hospital medicine as a result The afternoon ward round lives on, and we should not underestimate its effect. Low junior doctor morale coupled with high work intensity can lead to burnout as well as impairing the effectiveness of the clinical service. Clinical leaders should consider leaving this practice in the past so we can cope with the challenges of the future.

The wealth of trial data, complex trial design, and variation in treatment standards in advanced stage classical Hodgkin lymphoma can be difficult to navigate when deciding on the best treatment for patients. In this review, we appraise and synthesise this evidence, in order to explain our suggested treatment approach.Since the 1960s, cures have been achieved in advanced stage classical Hodgkin lymphoma (cHL) through the use of multi-agent chemotherapy regimens often with addition of radiotherapy. Since then, treatment has been improved through a process of rigorous testing in clinical trials, such that progression free survival (PFS) and overall survival rates (OS) are now excellent, especially in younger patients. More recently there has been a shift in focus towards minimizing toxicity (both short and long term) without compromising efficacy. Recent trials have tried to achieve this by risk-stratifying patients, both at baseline and according to response to treatment, so as to guide escalation or de-escalation of therapy. Uncertainty as to where this equipoise between efficacy and toxicity lies has also led to two international standards for treatment of cHL: ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) and escalated BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisolone). It has also influenced decisions on combined modality treatment with radiotherapy.The wealth of trial data, complex trial design, and variation in treatment standards can be difficult to navigate when deciding on the best treatment for our patients. In this article, we aim to provide a possible pathway through this maze.

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