bluuebunny/crossref_metadata_2025_split huggingface dataset:
1384 Managing Peri-Orbital and Orbital Cellulitis: A New Multi-Specialty Care Pathway
Authors: Karim S , Halliday C , Patel K , Acharya V 
Published: October 2021

Abstract

Aim
1) To review current practice in the diagnosis and management of peri-orbital and orbital cellulitis in children at a London University Teaching Hospital. 2) To design and implement a streamlined, multi-specialty care pathway to improve the quality of care.

Background
Clinical differentiation between peri-orbital cellulitis and orbital cellulitis is often difficult, especially in young children. Early recognition and aggressive, multi-specialty treatment are required in order to prevent any vision and life-threatening sequelae.

Method
A retrospective case note analysis was performed for all paediatric patients with suspected peri-orbital or orbital cellulitis over a nineteen-month period. Extensive literature review was undertaken to ascertain current best practice in diagnosis and management. A streamlined, multi-specialty care pathway was developed, ratified by specialist departments, and introduced to optimise safety and quality of care.

Results
The results correlate with trends found in recent literature. 94.3% of patients had a blood culture taken with only 9.1% being positive. There were inadequate eye (37.1%) and endonasal (17.1%) cultures. Wide variation was noted in the criteria for imaging and in the antibiotic regimen used. 25.7% of patients received any nasal treatment. Suboptimal specialist review was identified in both orbital (60%) and peri-orbital (50.0%) cellulitis.

Conclusions
The new care pathway clearly informs investigation and empiric treatment based on initial risk stratification. The paediatric team is now the main, named care provider responsible for coordinating specialist input.
1426 Assessing the Impact Of COVID-19 On ENT Referrals at A West London General Practice
Authors: Jegatheeswaran L , Choi B , Rocha M F , Green A 
Published: October 2021

Abstract

Aim
The COVID-19 pandemic has resulted in initial GP consultations being conducted via telephone. This quality improvement initiative quantified this impact on ENT referrals conducted at a West London GP, using education to improve awareness of the relevant NICE guidance to reduce inappropriate referrals.

Method
An initial retrospective audit comparing number and urgency of ENT referrals and the appropriateness of ENT referrals (using NICE guidance) during the face to face (F2F) period (August 2019 – February 2020) and telephone period (March – September 2020) was performed. Results were presented locally to GPs, with education measures on relevant NICE guidance implemented. Further PDSA cycles occurred during October and November 2020.

Results
In total, 16 ENT referrals were made during the F2F period (routine n = 15; urgent n = 1); 3 were inappropriate. 31 referrals were made between March and September 2020 (routine n = 27, urgent n = 2, 2WW n = 2); 4 were inappropriate. Further cycles in October 2020, and November 2020 identified 13 referrals (routine n = 10, 2WW n = 3), and 2 referrals (routine n = 2) respectively. 1 inappropriate referral was made during October and none in November.

Conclusions
Locally, it appears that the number of routine referrals has increased since the advent of the initial lockdown. This may be partially explained by the practice losing the ability to perform some ENT services, such as ear wax micro-suctioning. Education to increase awareness of relevant guidance has been shown to reduce the number of inappropriate referrals to ENT services.
1452 How Did We Nose? COVID Adaptation of Our Nasal Fracture Service
Authors: Kumaresan K , Jones H 
Published: October 2021

Abstract

Introduction
Nasal fractures are a common ENT emergency that present to ED typically with a history of trauma. They can leave behind functional problems with breathing and can be cosmetically very deforming. For this reason, they need to be managed appropriately by the specialist team. In UHS, Southampton Hospital these patients were initially followed up by Care UK but during COVID, in order to minimise patient contact we came up with a modified patient initiated follow up pathway. (PIFU)

Method
Based on commonly agreed departmental guidelines:
We looked at the statistics from 2019 and compared it with data from August – October 2020 and reviewed all patients who presented via ED and GP to us with nasal fractures visa image and telephone review and face to face meetings over a 3-month period.

Results
Despite lower attendances in ED during months of lockdown we still had 48 patients in 3 months i.e., nearly 4 patients every week. 50% did not initiate follow up. Of the patients who initiated follow up a third required MUA of which one was under general anaesthesia. All patients were treated within 21 days.

Conclusions
Our modified management pathway is compliant with the guidelines despite some consultations via telephone calls and image reviews.
1477 Epistaxis Management During The COVID-19 Pandemic First Wave- Do We Need to Admit Patients with Rapid Rhinos? A Complete Loop Audit
Authors: McCrossan S , O'Doherty K , Adair R 
Published: October 2021

Abstract

Introduction
Epistaxis is a common ENT emergency, which if management requires nasal-packing, usually results in an inpatient admission. We audited our management of nasal-packing practices in the pre- and intra-pandemic era.

Method
Review of medical notes including patient demographics, reason for admission, time of admission, bed-day numbers, management plan and 30-day mortality and morbidity (M&M). 1st-cycle- January 2020, 2nd-cycle during the 1st-wave of the COVID-19 pandemic April-June 2020. Change implemented- patients were sent home with their nasal-pack in-situ.

Results
Pre-pandemic we admitted 100% (n = 15) of patients requiring rapid-rhino (RR) insertion compared to 7% (n = 1) of patients during the 1st-wave with an average age of 69 and 74-years respectively. 67% of patients in each group were on an antiplatelet or anticoagulant. Most common co-morbidities were hypertension (67%v40%), atrial-fibrillation (27%v53%) and cognitive impairment (13%v20%). 60% of patients attended in the out-of-hours period (5pm-8am). There was no difference in M&M. Bed-day average was 3.9-days and 2-days in the first and second groups. In the first group 5 patients (33%) needed arterial ligation with only one (7%) patient in the second group requiring ligation.

Conclusions
RR insertion and discharge with outpatient follow up is safe with no difference in M&M. Total bed-days were 57v4 bed-days in group one compared to group two, with £222/bed-day (NICE costings statement) the total-price was £12654v£888. We hope that the traditional approach of admitting every patient with RR may be reconsidered as the standard and only required when necessary.
1578 Advances in Facial Nerve Monitoring Parameters During Vestibular Schwannoma Surgery
Authors: Aladham Y 
Published: October 2021

Abstract

Aim
To evaluate the effectiveness of multi-channel electromyographic monitoring of the facial nerve in improving the detection of mechanically elicited EMG activity and providing new predictive criteria for post-operative facial nerve function.

Method
The Study was conducted on 20 patients undergoing vestibular schwannoma resection in a tertiary referral cerntre. All patients were subjected to facial nerve monitoring during the surgery by a 5-channel setup monitoring the frontalis, O.oculi, nasalis, O.oris, and mentalis muscle. Mechanically elicited EMG activities of the monitored facial muscles were recorded for analysis. After tumour removal, the facial nerve was stimulated proximal to the tumour site using two different types of probes: Prass and flush-tip. Post-operative facial nerve function was assessed using House-Brackmann scale immediately post-operatively and after six months and correlated to the study tested parameters.

Results
The use of 5-channel montage led to significantly higher sensitivity in detecting mechanically elicited EMG activity than would have been possible with the ordinary 2-channel one. Mentalis muscle showed significantly higher number and amplitude of spontaneous EMG activities than other facial muscles. Positive correlation was found between the proximal threshold and the post-operative facial nerve outcome. The Prass stimulator showed significantly lower threshold than the ball-tip probe.

Conclusions
The use of multi-channel facial nerve monitoring allowed earlier and more efficient monitoring of the facial nerve. The use of the Prass stimulator is more accurate and correlates more with the real threshold needed for post-resection stimulation of the facial nerve than the ball-tip.
1603 A Google Trends Analysis of Interest in Ear, Nose and Throat Surgery During The COVID-19 Pandemic
Authors: Williams C Y K , Ferreira A F , Townson A T , Pace A 
Published: October 2021

Abstract

Aim
The COVID-19 pandemic has had wide-ranging effects on healthcare, society and everyday life. As the public’s health priorities shift, we sought to investigate the resulting impact of COVID-19 on global interest in Ear, Nose and Throat (ENT) surgery.

Method
We used Google Trends to examine worldwide search interest in the following core ENT operations following the onset of the COVID-19 pandemic: Tonsillectomy, Adenoidectomy, Thyroidectomy, Rhinoplasty, Septoplasty, Functional Endoscopic Sinus Surgery, Mastoidectomy, and Tympanoplasty. Bayesian structural time-series models were used to generate counterfactual time series, and relative differences between observed and expected search interest were calculated. Causal effects were subsequently determined, along with 95% CIs and posterior probabilities. R version 4.0.3 was used for analyses.

Results
Search interest in all measured ENT procedures was significantly reduced at the onset of the COVID-19 pandemic. Interest in Rhinoplasty recovered after 8 weeks and continued to rise to a peak of 27% greater than expected, with a cumulative Relative effect of + 11% [95% CI: 3.9%, 20%]. In contrast, significantly reduced search interest was observed for all other procedures analysed (Relative effect, range: -16% to -36%, all p values &lt; 0.05).

Conclusions
Our findings suggest divergent changes in public interest in common ENT procedures. While all other ENT operations investigated were less frequently searched following the pandemic onset, interest in Rhinoplasty at times increased to over 25% greater than expected. This could represent a shift in patient attitudes to disorders of the Ear, Nose and Throat and warrants further investigation at the individual-level.
1611 Significant Epistaxis Secondary To COVID-19 Nasopharyngeal Swab
Authors: Laycock J , Ahmed O , Wasson J 
Published: October 2021

Abstract

Aim
This case highlights the need for appropriate training when adopting new techniques, even for relatively simple procedures.

Method
we report a rare complication of the innovative COVID-19 nasopharyngeal swab which is a new skill for many healthcare professionals and frequently performed with little or no training.

Results
We describe a case of iatrogenic epistaxis after a diagnostic nasopharyngeal swab was taken during the COVID-19 pandemic. The epistaxis was significant, causing haemodynamic and respiratory compromise. In a frail patient who is susceptible to epistaxis, the potenial for further harm is significant. After initially presenting with shortness of breath, this patient (who had no previous nasal pathology) underwent routine naso- and oro- pharyngeal swabbing to test for COVID-19. He felt immediate discomfort in his nasopharynx and epistaxis ensued. The bleeding persisted for several hours; bilateral anterior and posterior nasal packing was required to eventually cease the bleed. He was compromised with a falling haemoglobin, and aspiration of blood compounded his shortness of breath.

Conclusions
Epistaxis is a potentially serious side effect of nasopharyngeal swabbing; a procedural skill dramatically increasing in prevalence during the COVID-19 pandemic. We advocate for formal training of this procedure for all healthcare staff required to undertake it. Presenting such a case report can help us in understanding the complications of this procedure, and better thus inform the patient consenting process.
1648 Is Telephone Triage Here to Stay? An Audit of The Impact of COVID 19 On A Head and Neck Cancer Clinic
Authors: Osuji J , Srinivasan V 
Published: October 2021

Abstract
Due to the COVID19 pandemic, NHS reported a 60% drop in suspected cancer referrals and a delay in treatment initiation. In a pandemic, cancer waiting time (WT) targets can prove difficult to achieve. ENT UK and NHS England recommended a senior-led telephone triage system to be put in place in response to the pandemic.
Aim of this audit was to assess the impact of the pandemic and evaluate the efficacy of tele-consults on the Head & Neck Cancer (H&N) Service at a District General Hospital.
A retrospective audit of patients referred to the H&N clinic from April - June 2020, comparing patients managed by teleconsultations to patients seen F2F. Medical records were analysed to assess compliance with NHS Cancer WT targets.
2020 saw a 1.4% drop in referrals compared to 2019. Of the 224 referrals received from April - June 2020, 96.9% were seen within 14 days. 98.7% were initially reviewed by telephone, 37% of which were triaged to a F2F appointment, 39% were followed up by telephone and 24% were discharged or given routine appointments. 11.2% were diagnosed with cancer. Comparing cancer patients managed by telephone to patients seen F2F, 80% v 57% received a diagnosis by 28 days from the referral, and 100% v 17% started treatment by 62 days.
The department did not have a significant drop in referrals due to the COVID pandemic. Cancer patients managed by telephone were more likely to start treatment within 62 days. Telephone consults should be a permanent feature of cancer clinics beyond the pandemic.
1597 Navigating the Morality of Postponing Urgent Cancer Surgery in The Covid-19 Pandemic
Authors: Tucker S 
Published: October 2021

Abstract

Introduction
The Covid-19 pandemic presents challenges of unparalleled magnitude to healthcare resource allocation. Many cancer operations have been postponed due to reduced staff, bed and ICU availability, potentially allowing incurable disease progression. The five-year survival rate for stage 1 bowel cancer is 91%; stage 2, 84%1, yet some studies suggest the mortality rate of ventilated Covid-19 patients is 50-88%2,3,4,5. Many ethical documents attempt to guide just resource allocation for ICU, however, Covid-19 presents a greater conundrum. If resource allocation occurs on the basis of acute medical need it is preferential to Covid-19 care, and at what cost is this to those with potentially curable cancer? How can we navigate pandemic pressures to be as just as we can?

Method
Literature review and application of ethical theories including utilitarianism, deontology and a Rawlsian approach.

Results
Utilitarianism argues that allocating scarce resources to those likely to gain minimal benefit, whilst removing benefit from those with a higher likelihood of survival would not be for the greater good. Doctors, however, tend to practise in a more deontological way; that is in the best interests of the patient in front of them. Rawl’s thought experiment allows us to wear a ‘veil of ignorance’ to consider the fairest decision for any undefined individual.

Conclusions
Covid-19 has forced unprecedented moral dilemmas; these do not just extend to patients requiring ventilators, but those in need of curative surgery. An understanding of ethical principles and a multidisciplinary approach to decision-making should encompass the consideration of outcomes of oncological surgical intervention.
1556 Does Surgical Intervention Improve Quality of Life for Patients with Chronic Ear Disease in Nepal?
Authors: Ahmed F , de Cates C , Bahadur Bohara R , Youngs R 
Published: October 2021

Abstract

Aim
To assess change in quality of life (QoL) pre- and post-surgery for patients with chronic ear disease (CED) in Nepal. Hearing loss is the fourth leading cause of disability world-wide with 90% of those affected living in low and middle-income countries. A huge yet treatable contributor to this is chronic suppurative otitis media (CSOM). The Chronic Ear Survey is a sensitive and disease specific QoL measurement tool in patients with CSOM exploring activity restriction, symptoms and utilisation of medical services.

Method
This study was conducted at the Brinos Ear Care Centre in Nepalgunj, Nepal. A modified Chronic Ear Survey (mCES) was translated into Nepali and administered to patients before surgery and at post-operative follow up by community ear care assistants. The Mann-Whitney U test was used for statistical analysis.

Results
The mCES was administered to 64 patients pre-operatively and 28 patients post-operatively. Disease specific QOL in patients with CSOM was demonstrated to be better overall in patients post-surgery and specifically in the domains of activity limitation and symptoms. No significant change was demonstrated in utilisation of medical services (p &lt; 0.1)

Conclusions
Surgical intervention for patients with CSOM in Nepal improves ear specific QOL. This manifests specifically in a reduction in severity of symptoms and fewer restrictions on activity. Surgery in this population does not significantly change healthcare seeking behaviour and this must be explored further in the context of access to surgery and attitudes towards healthcare in this population.
173 Long Term Analysis of The Evolution of Practice and Results of Abdominal Wall Reconstruction by A Single Surgeon
Authors: Woffenden H , Vijayan D , Stevens E , Ghini F , Cunha M , Suggett N 
Published: October 2021

Abstract

Background
It is estimated that at least 12-15% of abdominal operations lead to incisional hernias, and Worldwide, evidence shows high rates of recurrence after surgical repair ranging from 12.7% in the Danish hernia registry to 23% in the Swedish registry.

Method
This is a retrospective analysis of the practice of a single surgeon at a tertiary centre. An electronic database provided all hernia surgeries done by the surgeon. A total of 185 patients with complete data were included who had open hernia repair. Electronic patient records were analysed to collect the data.

Results
185 patients, with a median age of 57 years (IQR 68 – 49), and BMI of 31.14 (IQR 36.02 – 27.52), had a hernia recurrence rate of 15.6% (29/185). More than 80% of the cases were complex hernias with a European Hernia classification of M3 and/ or W3, with dense intestinal adhesions and multiple previous repairs. Variability in techniques and mesh evolved over this period, from anterior component separation to transversus abdominis release to achieve closure of the abdomen. Polypropylene meshes were used for non-contaminated or less complex cases. The use of biologics in the early years has been superseded by biosynthetic.

Conclusions
The creation of the abdominal wall unit and subsequent MDT at this centre resulted in a rise of total procedures, complexity of cases and patients with significant co-morbidities. Specialised abdominal wall surgeons are associated with better results when performing complex abdominal wall reconstructions.
516 Does the Use of Adjuvant Chemotherapy Increase Incisional Hernia Rates in Colorectal Cancer Patients – A Retrospective Single Centre Cohort Study
Authors: Singh N , Gupta K , Khan T , Rahman E , Singh-Ranger D 
Published: October 2021

Abstract

Aim
Incisional hernias (IH) are a known complication of any major abdominal surgery. It is known that chemotherapy impairs healing processes via delayed inflammation, impaired collagen synthesis and reduced fibrin deposition and wound contraction. There are currently, to our knowledge, no trials examining the effect of adjuvant chemotherapy on incidence of IH in patients with colorectal cancer. This study aims to assess the same by comparing IH rates between chemotherapy and non-chemotherapy patient groups.

Method
All the patients who had major surgery for colorectal cancer between January 2009 and January 2014 were divided into two groups of chemotherapy (A) and non-chemotherapy (B). Records of first 160 patients from each group were retrospectively analysed.

Results
There were non-significant differences between groups for sex, tumour location, primary operation, and type of procedure (emergency or elective). Significant differences were observed for age (more elder patients in group B, p = 0.000011), method of access (more open procedures in group B and more laparoscopic procedures in group A, p = 0.0007) and Charlson co-morbidity scores (more advanced score in group B, p = 0.029). We found that 21/120 (21.21%) patients in the chemotherapy group and 12/99 (13.79%) patients in non-chemotherapy group developed Incisional hernias. Although there was a higher rate of IH in the chemotherapy group, this was not statistically significant (p = 0.27).

Conclusions
Although this study fails to demonstrate any statistically significant difference in IH incidence between two groups, but this study can act as a pilot in order to fuel further high-quality research to draw more valid conclusions.
832 Groin Hernia Should Remain A Clinical Diagnosis -- An Evidence-Based Study
Authors: Abu Elgasim M , Conroy A , Cartland M R , Sridhar P 
Published: October 2021

Abstract

Introduction
British Hernia Society (BHS) 2013 guidelines1 suggest that groin hernia diagnostic investigation should not be done at the primary care level. Nevertheless, General Practitioners refer patients with a positive ultrasound finding of groin hernia to secondary care. As a result, patients have false hopes that their symptoms would resolve if the ultrasound finding is addressed. The study aims to find the positive predictive value (PPV) for groin ultrasound for hernia and should the primary care physicians request the scan before referral to secondary care.

Method
A retrospective audit of outcome of patients referred to a general surgical department for groin hernia treatment. The study looked at elective groin hernia referrals for the period between June and August 2019.

Results
127 patients were electively treated for groin hernia in secondary care. 40% of the patients had ultrasounds before treatment. The GP requested 78% of the ultrasounds. A positive finding was the reason for the referral. Two patients (5%) in this group had negative operative findings. 24 herniograms over 57 months for patients referred with positive ultrasound and negative clinical findings showed only 2 had positive findings (8%). None of the negative patients returned to the same hospital for groin hernia treatment until date.

Conclusions
It is recommended that the diagnostic tests for groin hernia be requested by the operating surgeon as per the BHS guidelines. Patients should not be subjected to hernia operations based on ultrasound findings as the PPV for this investigation is very low for patients who have negative clinical findings.2