D. Pérez-Troncoso, D. Epstein, A. Davies, A. Thapar
BACKGROUND Medical therapy for stroke prevention has improved significantly over the past 30 years. Recent analyses of medically treated cohorts have suggested that early rates of stroke may have reduced, and reports of the safety of carotid surgery have also shown improvements. Since the effectiveness of carotid surgery versus medical therapy was established in the 1990s, there is an urgent need to evaluate whether surgery remains cost-effective in the UK. METHODS A decision model was developed to estimate the lifetime costs and utilities of modern medical therapy with and without carotid endarterectomy in patients with symptomatic stenosis from the perspective of the UK National Health Service. The base-case population consisted of adults aged 70 years with 70-99 per cent stenosis. Model data were obtained from clinical studies and wider literature. Univariate and probabilistic sensitivity analyses were carried out. RESULTS In the base-case scenario, the 5-year absolute risk reduction with carotid endarterectomy was 5 per cent, and the incremental cost-effectiveness ratio was €12 021 (exchange rate £1 GBP = €1.1125 (Tuesday 1 January 2019)) per quality-adjusted life-year. Surgery was more cost-effective if performed rapidly after presentation. In patients with 50-69 per cent carotid stenosis, surgery appeared less clinically effective. However, there was considerable uncertainty. CONCLUSION Surgery may not now be clinically effective and cost-effective in those with moderate carotid stenosis. However, these results are uncertain because of the limited data on modern medical therapy and an RCT may be justified.
{"title":"Cost-effectiveness of carotid endarterectomy in symptomatic patients.","authors":"D. Pérez-Troncoso, D. Epstein, A. Davies, A. Thapar","doi":"10.1093/bjs/znac247.126","DOIUrl":"https://doi.org/10.1093/bjs/znac247.126","url":null,"abstract":"BACKGROUND\u0000Medical therapy for stroke prevention has improved significantly over the past 30 years. Recent analyses of medically treated cohorts have suggested that early rates of stroke may have reduced, and reports of the safety of carotid surgery have also shown improvements. Since the effectiveness of carotid surgery versus medical therapy was established in the 1990s, there is an urgent need to evaluate whether surgery remains cost-effective in the UK.\u0000\u0000\u0000METHODS\u0000A decision model was developed to estimate the lifetime costs and utilities of modern medical therapy with and without carotid endarterectomy in patients with symptomatic stenosis from the perspective of the UK National Health Service. The base-case population consisted of adults aged 70 years with 70-99 per cent stenosis. Model data were obtained from clinical studies and wider literature. Univariate and probabilistic sensitivity analyses were carried out.\u0000\u0000\u0000RESULTS\u0000In the base-case scenario, the 5-year absolute risk reduction with carotid endarterectomy was 5 per cent, and the incremental cost-effectiveness ratio was €12 021 (exchange rate £1 GBP = €1.1125 (Tuesday 1 January 2019)) per quality-adjusted life-year. Surgery was more cost-effective if performed rapidly after presentation. In patients with 50-69 per cent carotid stenosis, surgery appeared less clinically effective. However, there was considerable uncertainty.\u0000\u0000\u0000CONCLUSION\u0000Surgery may not now be clinically effective and cost-effective in those with moderate carotid stenosis. However, these results are uncertain because of the limited data on modern medical therapy and an RCT may be justified.","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75219429","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}
Victoria J Roberts, Vinay Mandagere, G. Crisp, S. Biggs, J. Shabbir
Abstract Reversal of Hartmann's procedure is performed to restore intestinal continuity. There is conflicting literature on the best time for reversal, with little evidence suggesting waiting longer than a year is beneficial. We assessed the experience of our patients. Patients were identified from the local Enhanced Recovery After Surgery (ERAS) database over a 9-year period (2012–2021) at a University Hospital. Data was collected from digitalised hospital notes on patient demographics; timings to reversal of Hartmann's; defunctioning stoma; reasons for delay; length of stay; and complications. Forty-three patients underwent reversal of Hartmann's procedure. Median age was 57 (38–83) years; 19 (44%) of patients were female. Surgery was performed laparoscopically in 18 (42%); laparoscopic converted to open 6 (14%); open in 19 (44%) patients. Average length of stay was 6 days. Indications for primary Hartmann's procedure were diverticular disease (67%), malignancy (21%), and other causes (14%). Median time from the index operation to reversal of Hartmann's was 85.2 weeks (range 19.9–312.4 weeks). Only 9 (21%) patients underwent reversal Hartmann's within 1 year of primary surgery. Of the reasons known for the delay in reversal; 15 (35%) were due to patient complications, 6 (14%) were due to administrative reasons, 2 (5%) were due to COVID-19 associated delays and 1 (2%) patient choice. This retrospective analysis highlights the varied patient experience within just one centre, further research incorporating detailed patient experience is needed. It also highlights a paucity of national evidence-based consensus on optimal timing for challenging revisional surgery.
{"title":"TH3.3 “Closing the loop”: what is the delay in Reversal of Hartmann's procedure?","authors":"Victoria J Roberts, Vinay Mandagere, G. Crisp, S. Biggs, J. Shabbir","doi":"10.1093/bjs/znac248.209","DOIUrl":"https://doi.org/10.1093/bjs/znac248.209","url":null,"abstract":"Abstract Reversal of Hartmann's procedure is performed to restore intestinal continuity. There is conflicting literature on the best time for reversal, with little evidence suggesting waiting longer than a year is beneficial. We assessed the experience of our patients. Patients were identified from the local Enhanced Recovery After Surgery (ERAS) database over a 9-year period (2012–2021) at a University Hospital. Data was collected from digitalised hospital notes on patient demographics; timings to reversal of Hartmann's; defunctioning stoma; reasons for delay; length of stay; and complications. Forty-three patients underwent reversal of Hartmann's procedure. Median age was 57 (38–83) years; 19 (44%) of patients were female. Surgery was performed laparoscopically in 18 (42%); laparoscopic converted to open 6 (14%); open in 19 (44%) patients. Average length of stay was 6 days. Indications for primary Hartmann's procedure were diverticular disease (67%), malignancy (21%), and other causes (14%). Median time from the index operation to reversal of Hartmann's was 85.2 weeks (range 19.9–312.4 weeks). Only 9 (21%) patients underwent reversal Hartmann's within 1 year of primary surgery. Of the reasons known for the delay in reversal; 15 (35%) were due to patient complications, 6 (14%) were due to administrative reasons, 2 (5%) were due to COVID-19 associated delays and 1 (2%) patient choice. This retrospective analysis highlights the varied patient experience within just one centre, further research incorporating detailed patient experience is needed. It also highlights a paucity of national evidence-based consensus on optimal timing for challenging revisional surgery.","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74412483","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 Aims To explore how the COVID19 pandemic has impacted surgical training To establish how this might impact trainees moving forwards To establish ways to mitigate these effects, aside from increased theatre time Methods An online survey consisting of 10 questions was sent to general surgical trainees, at different stages of training. Results All respondents felt that training has been adversely affected by COVID19. Aside from reduced operating, 96% of respondents felt that training has been adversely affected in other ways including more ward cover, less exposure to clinic and elective work and less availability of teaching. All trainees reported that teaching had moved online; 56% felt that this was less effective. Half of respondents felt that they are likely to require more time in training as a result of the pandemic. When asked what can be done moving forwards to help catch up, responses included increasing access to wet labs and waiting list initiatives. Pre pandemic, 48% of respondents felt that was a lack of cadaver teaching and 20% reported issues accessing mandatory courses. Conclusion Surgical training has been adversely affected by COVID19, not only due to less elective operating but also lack of teaching, courses, simulation and increased stress. With half of respondents feeling that they will need additional time, finding ways to address lost training opportunities is of paramount importance to surgical trainees and should be done not only in theatre, but also through wet labs, simulation and teaching.
{"title":"EP-468 Impact of COVID19 on surgical training","authors":"Katherine Fox, Benjamin Parkin","doi":"10.1093/bjs/znac245.110","DOIUrl":"https://doi.org/10.1093/bjs/znac245.110","url":null,"abstract":"Abstract Aims To explore how the COVID19 pandemic has impacted surgical training To establish how this might impact trainees moving forwards To establish ways to mitigate these effects, aside from increased theatre time Methods An online survey consisting of 10 questions was sent to general surgical trainees, at different stages of training. Results All respondents felt that training has been adversely affected by COVID19. Aside from reduced operating, 96% of respondents felt that training has been adversely affected in other ways including more ward cover, less exposure to clinic and elective work and less availability of teaching. All trainees reported that teaching had moved online; 56% felt that this was less effective. Half of respondents felt that they are likely to require more time in training as a result of the pandemic. When asked what can be done moving forwards to help catch up, responses included increasing access to wet labs and waiting list initiatives. Pre pandemic, 48% of respondents felt that was a lack of cadaver teaching and 20% reported issues accessing mandatory courses. Conclusion Surgical training has been adversely affected by COVID19, not only due to less elective operating but also lack of teaching, courses, simulation and increased stress. With half of respondents feeling that they will need additional time, finding ways to address lost training opportunities is of paramount importance to surgical trainees and should be done not only in theatre, but also through wet labs, simulation and teaching.","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84450733","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 A 5-year-old boy was referred acutely to the on-call ENT doctor following multiple remote consultations with his general practitioner with 2 months history of worsening left-sided foul-smelling nasal discharge and bleeding. He underwent examination under anaesthesia and removal of nasal foreign body which was subsequently identified as a button battery (intra-operative as well as imaging pictures included). This case highlights the challenges posed to clinicians during the COVID-19 pandemic but also serves as a reminder to keep a high index of suspicion and low threshold for clinical examination in suspected cases of nasal foreign body. It also highlights that since COVID19 omicron variant has emerged it is more than significant to evaluate cases that are assessed remotely with increased care to avoid any further misses or mistakes.
{"title":"EP-244 A “missed” nasal button battery in a child during the COVID-19 pandemic","authors":"S. Anastasiadou, Jacqueline Chan, Ah Janjua","doi":"10.1093/bjs/znac245.063","DOIUrl":"https://doi.org/10.1093/bjs/znac245.063","url":null,"abstract":"Abstract A 5-year-old boy was referred acutely to the on-call ENT doctor following multiple remote consultations with his general practitioner with 2 months history of worsening left-sided foul-smelling nasal discharge and bleeding. He underwent examination under anaesthesia and removal of nasal foreign body which was subsequently identified as a button battery (intra-operative as well as imaging pictures included). This case highlights the challenges posed to clinicians during the COVID-19 pandemic but also serves as a reminder to keep a high index of suspicion and low threshold for clinical examination in suspected cases of nasal foreign body. It also highlights that since COVID19 omicron variant has emerged it is more than significant to evaluate cases that are assessed remotely with increased care to avoid any further misses or mistakes.","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"44 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86622032","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}
C. Leiberman, Georgis Kizis, Anna-Marie Leipner, Julianne Hendry
Abstract Aim Surgery is currently the recommended treatment for acute cholecystitis and the Association of Upper Gastrointestinal Surgeons (AUGIS) recommends that laparoscopic cholecystectomy be performed within 72 hours of admission. However, given the impact of the COVID-19 pandemic on healthcare delivery, this is not always possible. So, what happens to those who are managed conservatively? We observed the long-term impact of conservative management of patients admitted with acute cholecystitis over the course of one year. Methods Twenty-eight patients were admitted with acute cholecystitis to a large tertiary hospital in November 2020; twenty-three were discharged without having had a cholecystectomy. These patients were followed up for one year and observed for the development of any gallstone-related admissions and surgical procedures. Results Of the 23 patients observed, 30% (n=7) were admitted for gallstone-related complications. Biliary colic was responsible for 43% of these admissions with pancreatitis (14%), cholangitis (14%), choledocholithiasis (14%), and cholecystitis (14%) causing the rest. Only 9% (n=2) received a laparoscopic cholecystectomy. In both cases, it was in an emergency setting during admission for biliary colic. Conclusion Long-term observation of conservatively managed acute cholecystitis was possible in around two-thirds of patients as no gallstone-related hospital admissions were observed. Biliary colic was the most common cause of gallstone-related admissions. Longer observation is required to assess the feasibility of long-term non-operative management in acute cholecystitis.
{"title":"EP-603 What a difference a year makes: Long-term follow-up of non-operative management in acute cholecystitis","authors":"C. Leiberman, Georgis Kizis, Anna-Marie Leipner, Julianne Hendry","doi":"10.1093/bjs/znac245.152","DOIUrl":"https://doi.org/10.1093/bjs/znac245.152","url":null,"abstract":"Abstract Aim Surgery is currently the recommended treatment for acute cholecystitis and the Association of Upper Gastrointestinal Surgeons (AUGIS) recommends that laparoscopic cholecystectomy be performed within 72 hours of admission. However, given the impact of the COVID-19 pandemic on healthcare delivery, this is not always possible. So, what happens to those who are managed conservatively? We observed the long-term impact of conservative management of patients admitted with acute cholecystitis over the course of one year. Methods Twenty-eight patients were admitted with acute cholecystitis to a large tertiary hospital in November 2020; twenty-three were discharged without having had a cholecystectomy. These patients were followed up for one year and observed for the development of any gallstone-related admissions and surgical procedures. Results Of the 23 patients observed, 30% (n=7) were admitted for gallstone-related complications. Biliary colic was responsible for 43% of these admissions with pancreatitis (14%), cholangitis (14%), choledocholithiasis (14%), and cholecystitis (14%) causing the rest. Only 9% (n=2) received a laparoscopic cholecystectomy. In both cases, it was in an emergency setting during admission for biliary colic. Conclusion Long-term observation of conservatively managed acute cholecystitis was possible in around two-thirds of patients as no gallstone-related hospital admissions were observed. Biliary colic was the most common cause of gallstone-related admissions. Longer observation is required to assess the feasibility of long-term non-operative management in acute cholecystitis.","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86666712","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}
V. Butnari, A. Mansuri, S. Kaul, Joseph Huang, Rajendran Nirooshun
Abstract Aim To present our learning-curve data for patients that underwent robotic-assisted colorectal surgery (RCRS) at a large NE London DGH. Methods We report our data from 50 initial colorectal cancer resections, performed by two surgeons. We report the gender, age, histopathology, surgery performed, surgical time, conversion, post-operative complications, and hospital stay. Results The first 50 patients who underwent RCRS between February 2020 and December 2021 for malignancy were included. Twenty-one were right hemicolectomies, 16 high anterior resection, 6 extended right hemicolectomies, 4 low anterior resections (including a planned robotic boari flap in 1 case by a trained urologist), 3 abdominoperineal excisions of rectum. The male to female ratio was 1:1 and the mean age was 65 (range: 22–85) years. The ASA class distribution was 4% ASA I, 64% ASA II, 32% ASA III. The median surgical time was 263 minutes (120–620) with median console time 136 minutes (50–540), the median hospital stay 5 days (range: 2–35) and a conversion rate of 6% (3/50 patients). The most common post-operative complications were ileus 4% (4/50), wound infection 6% (3/50), anastomotic leak 6% (3/50), and abscess formation 2% (1/50). 1 mortality occurred in a patient with an operated leak who contracted COVID-19. All patients underwent confirmed R0 resections with a negative CRM. Conclusion We report our first 50 robotic cases for colorectal malignancy, showing that robotic-assisted surgery can be performed with low rates of conversion 3 cases (6%) and low rates of post-operative complications despite a challenging patient demographic and a sharp learning curve.
{"title":"TU4.2 Robotic surgery for colorectal cancer: a single-center experience","authors":"V. Butnari, A. Mansuri, S. Kaul, Joseph Huang, Rajendran Nirooshun","doi":"10.1093/bjs/znac248.034","DOIUrl":"https://doi.org/10.1093/bjs/znac248.034","url":null,"abstract":"Abstract Aim To present our learning-curve data for patients that underwent robotic-assisted colorectal surgery (RCRS) at a large NE London DGH. Methods We report our data from 50 initial colorectal cancer resections, performed by two surgeons. We report the gender, age, histopathology, surgery performed, surgical time, conversion, post-operative complications, and hospital stay. Results The first 50 patients who underwent RCRS between February 2020 and December 2021 for malignancy were included. Twenty-one were right hemicolectomies, 16 high anterior resection, 6 extended right hemicolectomies, 4 low anterior resections (including a planned robotic boari flap in 1 case by a trained urologist), 3 abdominoperineal excisions of rectum. The male to female ratio was 1:1 and the mean age was 65 (range: 22–85) years. The ASA class distribution was 4% ASA I, 64% ASA II, 32% ASA III. The median surgical time was 263 minutes (120–620) with median console time 136 minutes (50–540), the median hospital stay 5 days (range: 2–35) and a conversion rate of 6% (3/50 patients). The most common post-operative complications were ileus 4% (4/50), wound infection 6% (3/50), anastomotic leak 6% (3/50), and abscess formation 2% (1/50). 1 mortality occurred in a patient with an operated leak who contracted COVID-19. All patients underwent confirmed R0 resections with a negative CRM. Conclusion We report our first 50 robotic cases for colorectal malignancy, showing that robotic-assisted surgery can be performed with low rates of conversion 3 cases (6%) and low rates of post-operative complications despite a challenging patient demographic and a sharp learning curve.","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84928874","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 A career in surgery requires dedication and commitment from medical school onwards. Having a mentor is proven to help facilitate career progression and improve self-confidence as well as providing supportive, non-biased, non-judgemental career advice. Mentors report increased job satisfaction and self-esteem when mentoring junior colleagues. Method The senior author, along with the local medical school's surgical society, launched a pilot scheme for medical students and volunteering consultant surgeons in April 2021. 46 students were recruited, and 28 consultant surgeon mentors. Mentees were then paired with mentors, with some mentors taking on multiple mentees. Results Feedback forms were sent out 6 months later to establish perceptions on progress and any suggestions for improvement. We had a low return rate of the feedback forms with 19 returns from mentees, 13 of which had met their mentors. 8 forms were returned by mentors, 5 of whom had met their mentees. 82.35% of mentees who returned the form said the pilot scheme had either ‘met or exceeded their expectations’. Conclusion This pilot scheme was launched just as Covid-19 pandemic recovery work started, with surgical specialities trying to clear the back log, which may be the reason of the meetings not taking place or the feedback forms not being completed. In the future, we hope to recruit surgical trainees to help with the mentorship programme and by time constraining the programme, trying to ensure that all mentees get the benefit of limited number of mentors.
{"title":"EP-295 Mentoring Scheme for Medical Students Interested in a Career in Surgery","authors":"Kathryn Bowerman, Reena Agarwal","doi":"10.1093/bjs/znac245.079","DOIUrl":"https://doi.org/10.1093/bjs/znac245.079","url":null,"abstract":"Abstract Aim A career in surgery requires dedication and commitment from medical school onwards. Having a mentor is proven to help facilitate career progression and improve self-confidence as well as providing supportive, non-biased, non-judgemental career advice. Mentors report increased job satisfaction and self-esteem when mentoring junior colleagues. Method The senior author, along with the local medical school's surgical society, launched a pilot scheme for medical students and volunteering consultant surgeons in April 2021. 46 students were recruited, and 28 consultant surgeon mentors. Mentees were then paired with mentors, with some mentors taking on multiple mentees. Results Feedback forms were sent out 6 months later to establish perceptions on progress and any suggestions for improvement. We had a low return rate of the feedback forms with 19 returns from mentees, 13 of which had met their mentors. 8 forms were returned by mentors, 5 of whom had met their mentees. 82.35% of mentees who returned the form said the pilot scheme had either ‘met or exceeded their expectations’. Conclusion This pilot scheme was launched just as Covid-19 pandemic recovery work started, with surgical specialities trying to clear the back log, which may be the reason of the meetings not taking place or the feedback forms not being completed. In the future, we hope to recruit surgical trainees to help with the mentorship programme and by time constraining the programme, trying to ensure that all mentees get the benefit of limited number of mentors.","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91010213","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 Introduction There is a drive within the National Health Service towards a more personalised approach to healthcare. Patient-centred care gives individuals more control over their mental and physical health. We have implemented a patient-initiated follow-up (PIFU) system, within our trust. This provides patients with autonomy for arranging follow-up appointments when needed and saves unnecessary routine reviews. Methods Two consultant surgeons have offered a ‘PIFU style’ follow-up. Selected patients seen in clinic were discharged but provided with a PIFU card. Patients returned this card if they needed to be seen again in clinic for the same complaint. Results During the study period 149 patients were discharged with a PIFU card. There were 1370 appointments (New and Follow-up) over the same period. Only 17% of PIFU patients (twenty-six) returned within six months. One hundred and twenty-three patients (83%) sought no further appointments. This reduced unnecessary, routine follow-up visits. If a greater proportion of patients were discharged in a timely fashion and offered a PIFU card, then outpatient clinic efficiency would be further improved. Conclusion The potential benefits of a PIFU system include: financial savings, patient autonomy, more clinic availability and fewer wasted GP appointments for re-referrals. Adopting a PIFU based system, helps to reduce service waiting times. PIFU is an important tool both for improving outpatient clinic efficiency and increasing patient autonomy. PIFU should be used widely, to help recovery after COVID-19.
{"title":"SP7.12 Patient Initiated Follow-Up (PIFU)","authors":"F. Dholoo, Emily Moore, A. Dinneen, M. Solan","doi":"10.1093/bjs/znac247.085","DOIUrl":"https://doi.org/10.1093/bjs/znac247.085","url":null,"abstract":"Abstract Introduction There is a drive within the National Health Service towards a more personalised approach to healthcare. Patient-centred care gives individuals more control over their mental and physical health. We have implemented a patient-initiated follow-up (PIFU) system, within our trust. This provides patients with autonomy for arranging follow-up appointments when needed and saves unnecessary routine reviews. Methods Two consultant surgeons have offered a ‘PIFU style’ follow-up. Selected patients seen in clinic were discharged but provided with a PIFU card. Patients returned this card if they needed to be seen again in clinic for the same complaint. Results During the study period 149 patients were discharged with a PIFU card. There were 1370 appointments (New and Follow-up) over the same period. Only 17% of PIFU patients (twenty-six) returned within six months. One hundred and twenty-three patients (83%) sought no further appointments. This reduced unnecessary, routine follow-up visits. If a greater proportion of patients were discharged in a timely fashion and offered a PIFU card, then outpatient clinic efficiency would be further improved. Conclusion The potential benefits of a PIFU system include: financial savings, patient autonomy, more clinic availability and fewer wasted GP appointments for re-referrals. Adopting a PIFU based system, helps to reduce service waiting times. PIFU is an important tool both for improving outpatient clinic efficiency and increasing patient autonomy. PIFU should be used widely, to help recovery after COVID-19.","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"57 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86561331","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}
Nagy Rizkalla, A. Khalid, J. Merrit, Abdual Khaliq, H. Khaira
Abstract Background In 2020 we assessed changes in delivery of emergency surgeries due to the pandemic in a local district general hospital. Significant delays in emergency theatre utilisation were partly abrogated with the early introduction of a second emergency theatre so that Covidpositive, negative and unknown cases could be operated in series (and occasionally in parallel) with minimal disruption. Aims We aimed to re-audit emergency theatre utilisation later on during the pandemic to assess the effects of having more established protocols and following recommendations from our first audit. Methods Retrospective study of all emergency theatre cases performed during the month of July 2021 compared with previously presented November 2020. Parameters of theatre utilisation included: sending times, anaesthetic times, operating times, recovery time in theatre and total recovery time Results The mean time taken to send for patients from wards decreased by 27% in late pandemic versus early (n=110 vs 111, p=1.25*10–7); this was also an improvement on pre-pandemic figures by 17%. Anaesthetic time decreased by 31% (p=0.0001, n=110 vs 111). Recovery time required in theatre decreased by 26% (p = 0.06, n=110 vs 111). Total recovery time however increased by 19% (p=0.097, n=110 vs 111). Conclusion Improved Covid testing and testing protocols have most likely had a positive impact on theatre utilisation by reducing sending times, anaesthetic times and recovery times in theatre. Increases in total recovery time are likely a by-product of increased elective work.
背景:2020年，我们评估了当地一家区级综合医院因大流行而急诊手术交付的变化。早期引入第二个急诊室，部分消除了急诊室使用的严重延误，从而可以在尽量减少干扰的情况下，连续(偶尔并行)处理新冠病毒阳性、阴性和未知病例。我们的目标是在大流行期间对急诊室的使用情况进行重新审计，以评估建立更完善的方案和遵循第一次审计建议的效果。方法回顾性研究2021年7月与之前报告的2020年11月进行比较的所有急诊病例。医院使用参数包括:送院次数、麻醉次数、手术次数、住院恢复时间和总恢复时间。结果大流行晚期患者从病房送院的平均时间比早期患者减少27% (n=110 vs 111, p=1.25* 10-7);这也比大流行前的数字提高了17%。麻醉时间减少31% (p=0.0001, n=110 vs 111)。住院所需恢复时间减少26% (p = 0.06, n=110 vs 111)。然而，总恢复时间增加了19% (p=0.097, n=110 vs 111)。改进的新冠病毒检测和检测方案很可能通过减少发送时间、麻醉时间和手术室恢复时间，对手术室的利用率产生积极影响。总恢复时间的增加可能是选择性工作增加的副产品。
{"title":"TU3.4 A relook into the effects of Covid-19 on emergency theatre utilisation","authors":"Nagy Rizkalla, A. Khalid, J. Merrit, Abdual Khaliq, H. Khaira","doi":"10.1093/bjs/znac248.028","DOIUrl":"https://doi.org/10.1093/bjs/znac248.028","url":null,"abstract":"Abstract Background In 2020 we assessed changes in delivery of emergency surgeries due to the pandemic in a local district general hospital. Significant delays in emergency theatre utilisation were partly abrogated with the early introduction of a second emergency theatre so that Covidpositive, negative and unknown cases could be operated in series (and occasionally in parallel) with minimal disruption. Aims We aimed to re-audit emergency theatre utilisation later on during the pandemic to assess the effects of having more established protocols and following recommendations from our first audit. Methods Retrospective study of all emergency theatre cases performed during the month of July 2021 compared with previously presented November 2020. Parameters of theatre utilisation included: sending times, anaesthetic times, operating times, recovery time in theatre and total recovery time Results The mean time taken to send for patients from wards decreased by 27% in late pandemic versus early (n=110 vs 111, p=1.25*10–7); this was also an improvement on pre-pandemic figures by 17%. Anaesthetic time decreased by 31% (p=0.0001, n=110 vs 111). Recovery time required in theatre decreased by 26% (p = 0.06, n=110 vs 111). Total recovery time however increased by 19% (p=0.097, n=110 vs 111). Conclusion Improved Covid testing and testing protocols have most likely had a positive impact on theatre utilisation by reducing sending times, anaesthetic times and recovery times in theatre. Increases in total recovery time are likely a by-product of increased elective work.","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86134958","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 Introduction COVID-19 drastically disrupted medical education, with large proportions of teaching now delivered virtually. It is often challenging to replace face-to-face clinical placements, reducing student exposure to different specialities. The Surgical Specialty Series was created to provide a holistic understanding of various sub-specialties while restrictions to surgical placements existed. This study aimed to investigate the efficacy of our series in improving exposure and interest to surgical careers during the pandemic. Methods The series was delivered between October-May 2020/21, covering seven surgical specialties. Each month, three webinars were delivered by surgeons (varying grades), focussing on career pathways, post-graduate teaching and undergraduate revision. All sessions were advertised using social media and delivered via Zoom using online teaching tools (polls, screen-sharing, surgical videos). A feedback form was distributed for data analysis. Results The series saw 1124 total attendees (38–107 per webinar): 29.2% were from the home university, 25.9% were from other UK-based institutions and 44.8% were from overseas. Overall, a 21.6% increase was observed in student interest to pursue a surgical career. Although 24.2% of attendees were unsure beforehand, 13.4% developed a surgical interest after. Interactive polls and videos were reported most useful and enjoyable in student learning. Conclusion The virtual series was an effective alternative to in-person clinical attachments in raising awareness and undergraduate interest in surgery, despite COVID-19. It was beneficial in widening access to quality medical education, particularly to students overseas. Successes of this series should be considered when shaping the future of undergraduate surgical education in the ongoing pandemic. Take-home message The online webinar series was an effective alternative to in-person clinical attachments, through increasing surgical interest amongst medical students. Successes of this series should be considered when shaping the future of undergraduate surgical education in the ongoing pandemic.
{"title":"O017 The virtual surgical specialty series: a platform for undergraduate surgical exposure during the pandemic","authors":"Z. Hinchcliffe, R. Remsudeen","doi":"10.1093/bjs/znac242.017","DOIUrl":"https://doi.org/10.1093/bjs/znac242.017","url":null,"abstract":"Abstract Introduction COVID-19 drastically disrupted medical education, with large proportions of teaching now delivered virtually. It is often challenging to replace face-to-face clinical placements, reducing student exposure to different specialities. The Surgical Specialty Series was created to provide a holistic understanding of various sub-specialties while restrictions to surgical placements existed. This study aimed to investigate the efficacy of our series in improving exposure and interest to surgical careers during the pandemic. Methods The series was delivered between October-May 2020/21, covering seven surgical specialties. Each month, three webinars were delivered by surgeons (varying grades), focussing on career pathways, post-graduate teaching and undergraduate revision. All sessions were advertised using social media and delivered via Zoom using online teaching tools (polls, screen-sharing, surgical videos). A feedback form was distributed for data analysis. Results The series saw 1124 total attendees (38–107 per webinar): 29.2% were from the home university, 25.9% were from other UK-based institutions and 44.8% were from overseas. Overall, a 21.6% increase was observed in student interest to pursue a surgical career. Although 24.2% of attendees were unsure beforehand, 13.4% developed a surgical interest after. Interactive polls and videos were reported most useful and enjoyable in student learning. Conclusion The virtual series was an effective alternative to in-person clinical attachments in raising awareness and undergraduate interest in surgery, despite COVID-19. It was beneficial in widening access to quality medical education, particularly to students overseas. Successes of this series should be considered when shaping the future of undergraduate surgical education in the ongoing pandemic. Take-home message The online webinar series was an effective alternative to in-person clinical attachments, through increasing surgical interest amongst medical students. Successes of this series should be considered when shaping the future of undergraduate surgical education in the ongoing pandemic.","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84709533","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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