Abstract Covid-19 infections correlate with peripheral neuropathy. Correlations extend to vaccination, with reports of polyradiculoneuropathy. We report a case of a 59-year-old right-hand dominant female presenting with bilateral carpal tunnel syndrome (CTS) nineteen days after AZD1222. BSSH diploma-qualified hand surgeon assessment identified increasing median nerve (MN) paraesthesia and upper limb pain. Symptoms occurred post-AZD1222 second dose administered 12-weeks after the first. Past medical history was unremarkable, and she had not contracted Covid-19. Examination found severe CTS-signs: thenar weakness, positive provocative tests (Phalen's and Tinel's) and 8mm MN static 2-point discrimination. Electrophysiology confirmed very severe wrist bilateral median neuropathies, with no evidence of widespread peripheral neuropathy. Left carpal tunnel decompression found a swollen MN bulging through the transverse carpal ligament. The patient reported symptom improvement 2 weeks post-operatively. This was reported using MHRA “yellow card” protocols as symptoms occurred within the period of neuropathic side effects. Proposed neuropathy mechanisms in Covid-19 include vasa nervorum microangiopathy. Post-vaccine effects could be connected to such changes in microcirculation implicated in CTS. Vaccines containing SARS-CoV-2 antigens enhance autoimmunity and may cause antibody-mediated effects on the synovial sheath, worsening symptoms in pre-existing CTS. Though we do not claim causality, emerging post-vaccination effects may include exacerbation. It is not uncommon for clinicians to diagnose CTS in patients with symptoms overlooked until an inciting event. With Covid-19 ‘boosters' the long-term strategy, vaccinations may increase neuropathy contribution. Increasing caseloads may present future challenges to hand surgeons managing CTS. Recording correlations may provide a basis for investigating CTS pathophysiology post AZD1222.
{"title":"551 Bilateral Carpal Tunnel Syndrome Following AstraZeneca (AZD1222) COVID-19 Vaccination: A Case Report","authors":"S. Tullie, A. Michell, A. Reid","doi":"10.1093/bjs/znac269.138","DOIUrl":"https://doi.org/10.1093/bjs/znac269.138","url":null,"abstract":"Abstract Covid-19 infections correlate with peripheral neuropathy. Correlations extend to vaccination, with reports of polyradiculoneuropathy. We report a case of a 59-year-old right-hand dominant female presenting with bilateral carpal tunnel syndrome (CTS) nineteen days after AZD1222. BSSH diploma-qualified hand surgeon assessment identified increasing median nerve (MN) paraesthesia and upper limb pain. Symptoms occurred post-AZD1222 second dose administered 12-weeks after the first. Past medical history was unremarkable, and she had not contracted Covid-19. Examination found severe CTS-signs: thenar weakness, positive provocative tests (Phalen's and Tinel's) and 8mm MN static 2-point discrimination. Electrophysiology confirmed very severe wrist bilateral median neuropathies, with no evidence of widespread peripheral neuropathy. Left carpal tunnel decompression found a swollen MN bulging through the transverse carpal ligament. The patient reported symptom improvement 2 weeks post-operatively. This was reported using MHRA “yellow card” protocols as symptoms occurred within the period of neuropathic side effects. Proposed neuropathy mechanisms in Covid-19 include vasa nervorum microangiopathy. Post-vaccine effects could be connected to such changes in microcirculation implicated in CTS. Vaccines containing SARS-CoV-2 antigens enhance autoimmunity and may cause antibody-mediated effects on the synovial sheath, worsening symptoms in pre-existing CTS. Though we do not claim causality, emerging post-vaccination effects may include exacerbation. It is not uncommon for clinicians to diagnose CTS in patients with symptoms overlooked until an inciting event. With Covid-19 ‘boosters' the long-term strategy, vaccinations may increase neuropathy contribution. Increasing caseloads may present future challenges to hand surgeons managing CTS. Recording correlations may provide a basis for investigating CTS pathophysiology post AZD1222.","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81071763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Aim Lack of communication and incomplete handover leads to errors and patient harm. Staffing challenges caused by Covid-19 highlights the necessity for high-quality handover. Our aim was to assess the quality of T&O weekend ward handover and evaluate the implementation of a formal handover document to improve the process. Method Junior doctors completed a survey to measure the efficacy and safety of current handover. A formalised written handover document in line with RCS Safe Handover recommendations was created and included in the doctors’ inductions. Evaluation was after 5 weeks with post-intervention questionnaires and new doctor rotation feedback. Results Prior to introduction of the handover document, 78% stated they were unable to formally handover. 77% experienced incomplete or unclear handover when working on the weekend. Lack of a standard handover process was deemed ineffective and unsafe. All respondents reported more efficient working with the new process. The perceived safety rating significantly increased from 2.33 out of 5 to 4.23 (p<0.0001). The new cohort of junior doctors rated the safety of handover to be 3.54, showing there is still scope for improvement in patient safety. Conclusions The use of standardized handover tools had a positive impact, improving the safety and quality of weekend handover. Workload was prioritized appropriately with improved transfer of information between teams. Covid-19 creates numerous challenges for safe clinical care. Working in unfamiliar environments and last-minute rota changes need to be mitigated by robust handover processes.
{"title":"510 Improving Trauma & Orthopaedic Handover During a Pandemic: Keeping Patients Safe - A Closed Loop QIP","authors":"S. Tse, C. Busby, D. Bryson","doi":"10.1093/bjs/znac269.347","DOIUrl":"https://doi.org/10.1093/bjs/znac269.347","url":null,"abstract":"Abstract Aim Lack of communication and incomplete handover leads to errors and patient harm. Staffing challenges caused by Covid-19 highlights the necessity for high-quality handover. Our aim was to assess the quality of T&O weekend ward handover and evaluate the implementation of a formal handover document to improve the process. Method Junior doctors completed a survey to measure the efficacy and safety of current handover. A formalised written handover document in line with RCS Safe Handover recommendations was created and included in the doctors’ inductions. Evaluation was after 5 weeks with post-intervention questionnaires and new doctor rotation feedback. Results Prior to introduction of the handover document, 78% stated they were unable to formally handover. 77% experienced incomplete or unclear handover when working on the weekend. Lack of a standard handover process was deemed ineffective and unsafe. All respondents reported more efficient working with the new process. The perceived safety rating significantly increased from 2.33 out of 5 to 4.23 (p<0.0001). The new cohort of junior doctors rated the safety of handover to be 3.54, showing there is still scope for improvement in patient safety. Conclusions The use of standardized handover tools had a positive impact, improving the safety and quality of weekend handover. Workload was prioritized appropriately with improved transfer of information between teams. Covid-19 creates numerous challenges for safe clinical care. Working in unfamiliar environments and last-minute rota changes need to be mitigated by robust handover processes.","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87628084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Aim Surgical currency refers to the operating time required per year before a surgeon's skill fade could negatively affect patient outcomes. Increased surgical experience and volume of operating hours directly improves patient outcomes. There is no clear guidance from the NHS or Defence Medical Services on amount of experience needed to maintain current. This paper highlights the importance of surgical currency, investigates if skill fade occurs faster than knowledge, and looks to ensure surgeons are not deployed beyond the point of currency. It explores methods to prevent skill fade and reintegrate surgeons following absence. Method A thorough literature search was performed. Currency protocols across Royal Colleges, healthcare systems and other industries were studied, including systems installed to mitigate skill fade during COVID-19. Results An average deployment for a military surgeon will be three months, but pre-deployment training can make this six. The AMRC states an absence over three months affects medical knowledge. Skill fade occurs more rapidly than knowledge, but research remains limited for how long a well-practiced skill is retained. The aviation industry clearly stipulates a pilot's currency, and simulator training is provided following absence. US surgical simulator training proved effective in maintaining skills during the pandemic. Health Education England and Royal College of Surgeons Edinburgh provides return programs for trainees but not consultants. Conclusions Careful consideration should be given before extending surgical deployments. Surgical simulation could be used while deployed to maintain currency. Return-to-work programs should be available to consultants. Further research should be done on currency and prevention of skill fade.
{"title":"1060 Surgical Currency - the Link Between Skill Fade and Safe Practice","authors":"L. S. St John, A. Sandhu, J. Baden","doi":"10.1093/bjs/znac269.387","DOIUrl":"https://doi.org/10.1093/bjs/znac269.387","url":null,"abstract":"Abstract Aim Surgical currency refers to the operating time required per year before a surgeon's skill fade could negatively affect patient outcomes. Increased surgical experience and volume of operating hours directly improves patient outcomes. There is no clear guidance from the NHS or Defence Medical Services on amount of experience needed to maintain current. This paper highlights the importance of surgical currency, investigates if skill fade occurs faster than knowledge, and looks to ensure surgeons are not deployed beyond the point of currency. It explores methods to prevent skill fade and reintegrate surgeons following absence. Method A thorough literature search was performed. Currency protocols across Royal Colleges, healthcare systems and other industries were studied, including systems installed to mitigate skill fade during COVID-19. Results An average deployment for a military surgeon will be three months, but pre-deployment training can make this six. The AMRC states an absence over three months affects medical knowledge. Skill fade occurs more rapidly than knowledge, but research remains limited for how long a well-practiced skill is retained. The aviation industry clearly stipulates a pilot's currency, and simulator training is provided following absence. US surgical simulator training proved effective in maintaining skills during the pandemic. Health Education England and Royal College of Surgeons Edinburgh provides return programs for trainees but not consultants. Conclusions Careful consideration should be given before extending surgical deployments. Surgical simulation could be used while deployed to maintain currency. Return-to-work programs should be available to consultants. Further research should be done on currency and prevention of skill fade.","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"51 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74253922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Z. Yasen, Saad Islam, Adil Hasnain, Shahanoor Ali, H. Raja, Konstantinos Tsitskaris
Abstract Aim Achilles tendon ruptures are known to be prevalent in the ‘weekend warrior’, individuals who are intermittently active on a background of sedentary behaviour. There is minimal literature that looks at whether this impacts the incidence of rupture of other tendons. In the spring of 2020, a ‘lockdown’ was announced in the UK in response to the COVID-19 pandemic. In this study we aim to assess whether the incidence of lower limb tendon rupture had increased compared to other years, and whether the incidence changed as exercise allowance was increased. Method A retrospective study was performed at a London district general hospital assessing the incidence of Achilles, patellar and quadricep tendon rupture presenting during the lockdown period, and the corresponding periods in 2019 and 2021. Results In 2020 there was a significant increase in incidence of Achilles (2021: 16, 2020: 14, 2019: 8) and patellar (2021: 2, 2020: 7, 2019: 1) tendon ruptures, whereas quadricep (2021: 0, 2020: 2, 2019: 0) tendon ruptures did not differ significantly. There was an increase in the incidence of Achilles tendon rupture as exercise allowance was increased. Conclusions This study reinforces the necessity of stepwise return to play protocol for deconditioned athletes as well as the advantages of an active lifestyle for the general population. The results also indicate that patellar rupture may be influenced by the same lifestyle factors as Achilles rupture and should prompt larger studies across multiple sites to confirm this.
{"title":"523 Effect of the COVID-19 UK Lockdown on Lower Limb Tendon Ruptures","authors":"Z. Yasen, Saad Islam, Adil Hasnain, Shahanoor Ali, H. Raja, Konstantinos Tsitskaris","doi":"10.1093/bjs/znac269.466","DOIUrl":"https://doi.org/10.1093/bjs/znac269.466","url":null,"abstract":"Abstract Aim Achilles tendon ruptures are known to be prevalent in the ‘weekend warrior’, individuals who are intermittently active on a background of sedentary behaviour. There is minimal literature that looks at whether this impacts the incidence of rupture of other tendons. In the spring of 2020, a ‘lockdown’ was announced in the UK in response to the COVID-19 pandemic. In this study we aim to assess whether the incidence of lower limb tendon rupture had increased compared to other years, and whether the incidence changed as exercise allowance was increased. Method A retrospective study was performed at a London district general hospital assessing the incidence of Achilles, patellar and quadricep tendon rupture presenting during the lockdown period, and the corresponding periods in 2019 and 2021. Results In 2020 there was a significant increase in incidence of Achilles (2021: 16, 2020: 14, 2019: 8) and patellar (2021: 2, 2020: 7, 2019: 1) tendon ruptures, whereas quadricep (2021: 0, 2020: 2, 2019: 0) tendon ruptures did not differ significantly. There was an increase in the incidence of Achilles tendon rupture as exercise allowance was increased. Conclusions This study reinforces the necessity of stepwise return to play protocol for deconditioned athletes as well as the advantages of an active lifestyle for the general population. The results also indicate that patellar rupture may be influenced by the same lifestyle factors as Achilles rupture and should prompt larger studies across multiple sites to confirm this.","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"92 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80416638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Charuvila, O. Olaitan, A. Srinivasan, V. Mepani, O. Putt, A. See, M. Dhingra
Abstract Background During the covid-19 pandemic, the East Midlands South Deanery ran virtual peer-MRCS OSCE teaching. We analysed two surveys to understand the impact of peer-MRCS teaching on surgical trainees in this region. Method One survey was completed by peer-MRCS teachers who delivered sessions in 2020–2021. The second survey was completed by prospective MRCS OSCE candidates. Responses were anonymised. Results 7 / 8 peer teachers and 13/17 prospective learners completed the surveys. 6/7 peer-teachers had previous experience and prior teacher-training ranged from day courses to university degrees. All peer-teachers felt that peer-MRCS teaching enabled them to refresh their anatomy knowledge. 0/7 peer-teachers preferred to deliver practical-skills teaching. Passion for teaching was identified as a motivating factor by all peer teachers. This was further supported by the general consensus (5/7) for peer teachers preferring feedback that is focused on self-development rather than conveying appreciation. Majority (12/13) of peer learners also preferred to give feedback focused on teacher development and felt they were more likely (7/13) to provide accurate feedback for peer-sessions when compared to formal teaching sessions run by the deanery. Majority of participating prospective MRCS OSCE candidates (12/13) expressed an interest in peer-MRCS teaching. Low stress environment and cost effectiveness were the top reasons why prospective peer learners preferred virtual peer MRCS teaching. Conclusions Overall peer-MRCS teaching in this cohort suggests advantages to both peer-teachers and learners with the potential to improve teaching skills and clinical knowledge among surgical trainees.
{"title":"538 Peer MRCS Teaching Among Surgical Trainees in the East Midlands Deanery, UK","authors":"S. Charuvila, O. Olaitan, A. Srinivasan, V. Mepani, O. Putt, A. See, M. Dhingra","doi":"10.1093/bjs/znac269.401","DOIUrl":"https://doi.org/10.1093/bjs/znac269.401","url":null,"abstract":"Abstract Background During the covid-19 pandemic, the East Midlands South Deanery ran virtual peer-MRCS OSCE teaching. We analysed two surveys to understand the impact of peer-MRCS teaching on surgical trainees in this region. Method One survey was completed by peer-MRCS teachers who delivered sessions in 2020–2021. The second survey was completed by prospective MRCS OSCE candidates. Responses were anonymised. Results 7 / 8 peer teachers and 13/17 prospective learners completed the surveys. 6/7 peer-teachers had previous experience and prior teacher-training ranged from day courses to university degrees. All peer-teachers felt that peer-MRCS teaching enabled them to refresh their anatomy knowledge. 0/7 peer-teachers preferred to deliver practical-skills teaching. Passion for teaching was identified as a motivating factor by all peer teachers. This was further supported by the general consensus (5/7) for peer teachers preferring feedback that is focused on self-development rather than conveying appreciation. Majority (12/13) of peer learners also preferred to give feedback focused on teacher development and felt they were more likely (7/13) to provide accurate feedback for peer-sessions when compared to formal teaching sessions run by the deanery. Majority of participating prospective MRCS OSCE candidates (12/13) expressed an interest in peer-MRCS teaching. Low stress environment and cost effectiveness were the top reasons why prospective peer learners preferred virtual peer MRCS teaching. Conclusions Overall peer-MRCS teaching in this cohort suggests advantages to both peer-teachers and learners with the potential to improve teaching skills and clinical knowledge among surgical trainees.","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"106 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88069168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract The covid-19 pandemic and associated social distancing restrictions had a significant impact on medical education and clinical learning opportunities for not only medical students, but for all those involved in the healthcare system. Given that up to 15% of general practitioner appointments and more than 25% of acute surgical referrals are urology related, adequate teaching is pertinent to ensure medical staff have the confidence and competence to manage urological concerns in a clinical setting. This quality improvement project aimed to design and develop an international educational series of virtual teaching sessions by the collaboration of senior urological trainees from various trusts across the United Kingdom. We designed a once-weekly urology teaching series that targeted all healthcare workers (medical students, junior doctors, nurses, ANPs, PAs…etc). The series continued for 12 consecutive weeks, with each session discussing a different aspect of clinical urology and delivered by different senior urology trainees with varying experiences across the UK. Pre-session surveys and post-session feedback were collected to evaluate levels of confidence in said topics before and after session delivery. Session attendance averaged 250 individuals per session, of multiple healthcare backgrounds and from varying countries across the world (UK, Asia, Middle East, Australia, New Zealand…etc). Overall confidence improved on average from 2/5 to 4/5 across all 12 sessions. An average of 4.5/5 agreed that the content of the sessions was beneficial, and 4.5/5 would recommend future sessions to colleagues. Virtual learning can thus be a useful tool to aid in improving medical education, even on an international level.
{"title":"1027 Urology Teaching - Improving Hesitancy by Live-Streaming!","authors":"ZW Shkoukani","doi":"10.1093/bjs/znac269.416","DOIUrl":"https://doi.org/10.1093/bjs/znac269.416","url":null,"abstract":"Abstract The covid-19 pandemic and associated social distancing restrictions had a significant impact on medical education and clinical learning opportunities for not only medical students, but for all those involved in the healthcare system. Given that up to 15% of general practitioner appointments and more than 25% of acute surgical referrals are urology related, adequate teaching is pertinent to ensure medical staff have the confidence and competence to manage urological concerns in a clinical setting. This quality improvement project aimed to design and develop an international educational series of virtual teaching sessions by the collaboration of senior urological trainees from various trusts across the United Kingdom. We designed a once-weekly urology teaching series that targeted all healthcare workers (medical students, junior doctors, nurses, ANPs, PAs…etc). The series continued for 12 consecutive weeks, with each session discussing a different aspect of clinical urology and delivered by different senior urology trainees with varying experiences across the UK. Pre-session surveys and post-session feedback were collected to evaluate levels of confidence in said topics before and after session delivery. Session attendance averaged 250 individuals per session, of multiple healthcare backgrounds and from varying countries across the world (UK, Asia, Middle East, Australia, New Zealand…etc). Overall confidence improved on average from 2/5 to 4/5 across all 12 sessions. An average of 4.5/5 agreed that the content of the sessions was beneficial, and 4.5/5 would recommend future sessions to colleagues. Virtual learning can thus be a useful tool to aid in improving medical education, even on an international level.","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"607 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74725239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T. Pasha, C. Okorọcha, C. Okafor, S. Manoharan, J. Roszpopa, S. Shahid
Abstract Aim To determine excision rates for squamous cell carcinoma (SCC) both before and during the COVID 19 pandemic. Method Between April 2020 to March 2021, a retrospective cohort study of patients undergoing SCC surgery in Cambridge University Hospitals (CUH) was undertaken. Data was collected from the hospital patient record system (EPIC) and included preoperative diagnosis, excision margins, histological subtype, and operative technique. Results 287 primary SCCs were excised during this period. 70% of SCC patients were male, with the commonest site being the head and neck (72%). The rate of incompletely excised SSCs doubled from 5.5% in 2018–19 to 11.3% in 2020–21. Of these, most incomplete excisions were due to inadequate deep margins (9.8%). The majority of incomplete excisions were performed by registrars (14.8%) followed by consultants (9.1%). Conclusions Whilst diagnostic accuracy remains high, we report a decline in complete excision rates. Deferral of non-urgent visits due to the COVID-19 pandemic may have resulted in delayed diagnosis of SCCs, resulting in larger and deeper cancers. The more invasive SCCs may have then resulted in a higher rate of inadequate excision. A potential solution is the use of templates in operative notes, in order to ensure an accurate record of deep and peripheral margins is made.
{"title":"401 Squamous Cell Carcinoma Surgery During a Global Pandemic – a Single UK Tertiary Centre Experience","authors":"T. Pasha, C. Okorọcha, C. Okafor, S. Manoharan, J. Roszpopa, S. Shahid","doi":"10.1093/bjs/znac269.083","DOIUrl":"https://doi.org/10.1093/bjs/znac269.083","url":null,"abstract":"Abstract Aim To determine excision rates for squamous cell carcinoma (SCC) both before and during the COVID 19 pandemic. Method Between April 2020 to March 2021, a retrospective cohort study of patients undergoing SCC surgery in Cambridge University Hospitals (CUH) was undertaken. Data was collected from the hospital patient record system (EPIC) and included preoperative diagnosis, excision margins, histological subtype, and operative technique. Results 287 primary SCCs were excised during this period. 70% of SCC patients were male, with the commonest site being the head and neck (72%). The rate of incompletely excised SSCs doubled from 5.5% in 2018–19 to 11.3% in 2020–21. Of these, most incomplete excisions were due to inadequate deep margins (9.8%). The majority of incomplete excisions were performed by registrars (14.8%) followed by consultants (9.1%). Conclusions Whilst diagnostic accuracy remains high, we report a decline in complete excision rates. Deferral of non-urgent visits due to the COVID-19 pandemic may have resulted in delayed diagnosis of SCCs, resulting in larger and deeper cancers. The more invasive SCCs may have then resulted in a higher rate of inadequate excision. A potential solution is the use of templates in operative notes, in order to ensure an accurate record of deep and peripheral margins is made.","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74783061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Aim Extramedullary plasmacytoma are rare neoplasms, which mainly occur in the head and neck, the most common site being the nasal cavity or septum. Patients may present with epistaxis, nasal obstruction, or rhinorrhoea. Extension into the orbit is rare but can lead to visual disturbances. Method This case report pertains to a 69-year-old female patient who initially presented with a 6-week history of recurrent sinusitis, with left sided cheek pain and diplopia. Results A CT and MRI scan was performed, which showed opacification of the left maxillary, ethmoid and sphenoid sinuses with bony destruction of the medial and anterior maxillary walls and into the anterior soft tissues. The mass was completely obstructing the left nasal cavity extending into the inferomedial orbit. Staging CT scans also showed nodal disease in the neck. Biopsy with histology was positive for CD138, with diffuse proliferation of plasma cells of varying maturity and atypia. Additionally, mono IgG kappa was also positive as was CD45 suggestive of a lymphoid neoplasm. Bone marrow biopsy and PET scan confirmed there was no systemic involvement. Radiotherapy was initiated after the patient recovered from COVID -19. A repeat MRI scan 6 weeks post radiotherapy showed a partial response with reduction in the size of the tumour, resolution of the intra-orbital extension and disappearance of paraprotein. Conclusions This case report illustrates need for earlier consideration of EMP diagnostically to reduce the risk of conversion of the plasmacytoma to multiple myeloma, which is a known possibility and to ensure minimal delay in the commencement of treatment.
{"title":"464 Local Extension of a Solitary Extra Medullary Nasal Plasmacytoma into the Orbit","authors":"P. Sandhar, C. Gill, A. Khanna","doi":"10.1093/bjs/znac269.191","DOIUrl":"https://doi.org/10.1093/bjs/znac269.191","url":null,"abstract":"Abstract Aim Extramedullary plasmacytoma are rare neoplasms, which mainly occur in the head and neck, the most common site being the nasal cavity or septum. Patients may present with epistaxis, nasal obstruction, or rhinorrhoea. Extension into the orbit is rare but can lead to visual disturbances. Method This case report pertains to a 69-year-old female patient who initially presented with a 6-week history of recurrent sinusitis, with left sided cheek pain and diplopia. Results A CT and MRI scan was performed, which showed opacification of the left maxillary, ethmoid and sphenoid sinuses with bony destruction of the medial and anterior maxillary walls and into the anterior soft tissues. The mass was completely obstructing the left nasal cavity extending into the inferomedial orbit. Staging CT scans also showed nodal disease in the neck. Biopsy with histology was positive for CD138, with diffuse proliferation of plasma cells of varying maturity and atypia. Additionally, mono IgG kappa was also positive as was CD45 suggestive of a lymphoid neoplasm. Bone marrow biopsy and PET scan confirmed there was no systemic involvement. Radiotherapy was initiated after the patient recovered from COVID -19. A repeat MRI scan 6 weeks post radiotherapy showed a partial response with reduction in the size of the tumour, resolution of the intra-orbital extension and disappearance of paraprotein. Conclusions This case report illustrates need for earlier consideration of EMP diagnostically to reduce the risk of conversion of the plasmacytoma to multiple myeloma, which is a known possibility and to ensure minimal delay in the commencement of treatment.","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88086396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tarak Agrebi Moumni Chouari, Sarah Zhao, G. Rizkallah, N. Yang, S. Vig, Nikheel Patel, Akriti Nanda
Abstract Introduction We are faced with long waiting lists coupled with a loss of training opportunities for surgical trainees as a result of COVID-19. It is imperative to ensure training opportunities are optimised and trainees are encouraged to contribute to the service recovery efforts we are faced with. Methods A pilot ‘the hernia fest’ was undertaken with the aim of training core trainees, supporting senior trainees as independent practitioners coupled with supporting the delivery of high volume, low complexity (HVLC) care. Parallel bespoke theatre lists with the grouping of specific cases (hernias), have been run with a consultant surgeon overseeing 2–3 lists. Each list includes a selected senior trainee who is suitable to train colleagues. Cases were screened prior to booking. All theatre staff were briefed on the purpose of the lists. All patients, trainees and theatre staff completed a questionnaire. Results 50 hernia training cases were carried out over 15 sessions. 100% of patients were confident with their treatment and would recommend the service. 100% of trainees felt they had progressed in their operative competence and skill acquisition. 100% of trainees were satisfied. Senior trainees enjoyed the responsibility of running an independent list. 100% of theatre staff felt they would participate in future lists. Conclusion This model cultivates a learning environment whilst addressing waiting lists. The grouping of operations together allows for repetitive practice and may encourage rapid skill acquisition. We discuss lessons learnt and a proposed framework & checklist which can be applied to the future planning of such lists.
{"title":"SP1.2.4 A pilot study: Developing bespoke high volume low complexity (HVLC) theatre lists with a focus on training, in order to address the impact of COVID-19 on training and elective waiting lists","authors":"Tarak Agrebi Moumni Chouari, Sarah Zhao, G. Rizkallah, N. Yang, S. Vig, Nikheel Patel, Akriti Nanda","doi":"10.1093/bjs/znac247.008","DOIUrl":"https://doi.org/10.1093/bjs/znac247.008","url":null,"abstract":"Abstract Introduction We are faced with long waiting lists coupled with a loss of training opportunities for surgical trainees as a result of COVID-19. It is imperative to ensure training opportunities are optimised and trainees are encouraged to contribute to the service recovery efforts we are faced with. Methods A pilot ‘the hernia fest’ was undertaken with the aim of training core trainees, supporting senior trainees as independent practitioners coupled with supporting the delivery of high volume, low complexity (HVLC) care. Parallel bespoke theatre lists with the grouping of specific cases (hernias), have been run with a consultant surgeon overseeing 2–3 lists. Each list includes a selected senior trainee who is suitable to train colleagues. Cases were screened prior to booking. All theatre staff were briefed on the purpose of the lists. All patients, trainees and theatre staff completed a questionnaire. Results 50 hernia training cases were carried out over 15 sessions. 100% of patients were confident with their treatment and would recommend the service. 100% of trainees felt they had progressed in their operative competence and skill acquisition. 100% of trainees were satisfied. Senior trainees enjoyed the responsibility of running an independent list. 100% of theatre staff felt they would participate in future lists. Conclusion This model cultivates a learning environment whilst addressing waiting lists. The grouping of operations together allows for repetitive practice and may encourage rapid skill acquisition. We discuss lessons learnt and a proposed framework & checklist which can be applied to the future planning of such lists.","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82848167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sabina Catana, C. Burford, Anang Pangemi, A. Shrestha
Abstract Aims Paediatric inflammatory multisystem syndrome– temporally associated with SARS-CoV-2 (PIMS-TS) is a novel hyperinflammatory condition that most commonly presents with an acute abdomen. Here we present a case of PIMS-TS mimicking appendicitis and a review of the literature with a proposed protocol for managing abdominal pain in patients with recent SARS-CoV-2 infection. Results An 8-year old girl presented with suspected appendicitis. She underwent a day case open appendicectomy with normal appendix confirmed on histology. Unfortunately, she re-presented the following day with persistently high fever and was investigated for post-appendicectomy complication. She was started on intravenous antibiotics. MRI of abdomen and pelvis showed no collection but evidence of lymphadenopathy. On post-operative day four she was transferred to the tertiary centre PICU for specialist management of suspected severe PIMS-TS. Common abdominal radiological findings in PIMS-TS include ascites, bowel wall thickening and mesenteric inflammation. In addition, CRP and ferritin have been found to be significantly higher in PIMS-TS. White cells may be raised with neutrophilia and lymphopaenia. In addition, highly deranged inflammatory markers in the context of a normal abdominal imaging are more consistent with PIMS-TS than appendicitis. We propose anyone with these findings is considered as having PIMS-TS and requires urgent imaging including combined senior surgical and paediatrician review. Conclusion PIMS-TS may present mimicking acute appendicitis and given the severe cardiac compromise that can develop in patients with PIMS-TS is it important to avoid unnecessary general anaesthetic and abdominal surgery where possible. Our proposed protocol could help reduce unnecessary abdominal surgery in these patients.
{"title":"WE8.6 Paediatric inflammatory multisystem syndrome presenting as acute appendicitis: a case report and literature review","authors":"Sabina Catana, C. Burford, Anang Pangemi, A. Shrestha","doi":"10.1093/bjs/znac248.173","DOIUrl":"https://doi.org/10.1093/bjs/znac248.173","url":null,"abstract":"Abstract Aims Paediatric inflammatory multisystem syndrome– temporally associated with SARS-CoV-2 (PIMS-TS) is a novel hyperinflammatory condition that most commonly presents with an acute abdomen. Here we present a case of PIMS-TS mimicking appendicitis and a review of the literature with a proposed protocol for managing abdominal pain in patients with recent SARS-CoV-2 infection. Results An 8-year old girl presented with suspected appendicitis. She underwent a day case open appendicectomy with normal appendix confirmed on histology. Unfortunately, she re-presented the following day with persistently high fever and was investigated for post-appendicectomy complication. She was started on intravenous antibiotics. MRI of abdomen and pelvis showed no collection but evidence of lymphadenopathy. On post-operative day four she was transferred to the tertiary centre PICU for specialist management of suspected severe PIMS-TS. Common abdominal radiological findings in PIMS-TS include ascites, bowel wall thickening and mesenteric inflammation. In addition, CRP and ferritin have been found to be significantly higher in PIMS-TS. White cells may be raised with neutrophilia and lymphopaenia. In addition, highly deranged inflammatory markers in the context of a normal abdominal imaging are more consistent with PIMS-TS than appendicitis. We propose anyone with these findings is considered as having PIMS-TS and requires urgent imaging including combined senior surgical and paediatrician review. Conclusion PIMS-TS may present mimicking acute appendicitis and given the severe cardiac compromise that can develop in patients with PIMS-TS is it important to avoid unnecessary general anaesthetic and abdominal surgery where possible. Our proposed protocol could help reduce unnecessary abdominal surgery in these patients.","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86632970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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