Authors: Teh LS et al
Source: Rheumatology (Oxford, England) [Rheumatology (Oxford)] 2022 Jun 29. Date of Electronic Publication: 2022 Jun 29.
Abstract:
Objectives: Hydroxychloroquine (HCQ) and azathioprine (AZA) are used to control disease activity and reduce risk of flare during pregnancy in patients with SLE. The aim of this study was to determine outcomes of children born to mothers with SLE exposed to HCQ or AZA during pregnancy and breast-feeding.
Methods: Women attending UK specialist lupus clinics with children ≤17 years old, born after SLE diagnosis, were recruited to this retrospective study. Data were collected using questionnaires and from clinical record review. Factors associated with the outcomes of low birth weight and childhood infection were determined using multivariable mixed effects logistic regression models.
Results: We analysed 284 live births of 199 mothers from 10 UK centres. The first pregnancies of 147/199 (73.9%) mothers was captured in the study. 150/248 (60.4%) and 87 (31.1%) children were exposed to HCQ and AZA respectively. There were no significant differences in the frequency of congenital malformations or intrauterine growth restriction (IUGR) between children exposed or not to HCQ or AZA. AZA use was increased in women with a history of hypertension or renal disease. Although AZA was associated with low birth weight in univariate models, there was no significant association in multivariable models. In adjusted models, exposure to AZA was associated with increased reports of childhood infection requiring hospital management (OR 2.283 [1.003, 5.198], p= 0.049).
Conclusions: There were no significant negative outcomes in children exposed to HCQ in pregnancy. AZA use was associated with increased reporting of childhood infection which warrants further study.

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Authors: Ono M; Hara H; Gao C et al.
Source: Heart (British Cardiac Society) [Heart] 2022 Jun 22. Date of Electronic Publication: 2022 Jun 22.
Abstract:
Objective: We sought to investigate whether long-term clinical outcomes differ following percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in patients with three-vessel disease (3VD) and lesions in the proximal left anterior descending artery (P-LAD).
Methods: This post-hoc analysis of the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) Extended Survival study included patients with 3VD who were classified according to the presence or absence of lesions located in the P-LAD. Ten-year all-cause death and 5-year major adverse cardiac or cerebrovascular events (MACCE) were assessed.
Results: Among 1088 patients with 3VD, 559 (51.4%) had involvement of P-LAD and their 10-year mortality was numerically higher following PCI versus CABG (28.9% vs 21.9%; HR: 1.39, 95% CI 0.99 to 1.95). Although patients without P-LAD lesions had significantly higher 10-year mortality following PCI compared with CABG, there was no evidence of a treatment-by-subgroup interaction (28.8% vs 20.2%; HR: 1.47, 95% CI 1.03 to 2.09, p interaction =0.837). The incidence of MACCE at 5 years was significantly higher with PCI than CABG, irrespective of involvement of P-LAD (with P-LAD: HR: 1.86, 95% CI 1.36 to 2.55; without P-LAD: HR: 1.54, 95% CI 1.11 to 2.12; p interaction =0.408). Individualised assessment using the SYNTAX Score II 2020 established that a quarter of patients with P-LAD lesions had significantly higher mortality with PCI than CABG, whereas in the remaining three-quarters CABG had similar mortality.
Conclusions: Among patients with 3VD, the presence or absence of a P-LAD lesion was not associated with any treatment effect on long-term outcomes following PCI or CABG.

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Authors: Taib, Adnan; Killick, Rebecca; Hussain, Kamran et al.
Source: In HPB November 2021 23(11):1732-1743
Abstract:
Background Gallstone related pathology (GRP) accounts for a significant proportion of general surgery admissions. The aim of this study is to investigate if seasonal variation for GRP admissions exist in England allowing improved resource allocation and planning.
Results A total of 396 879 GRP related admissions were recorded during the specified period, accounting for 1.44% of all emergency admissions. Our study suggests a significant seasonal peak in Summer (n = 102 620) based cumulative admissions per season and a linear regression model (p < 0.001), followed by Autumn (n = 102 267), then Spring (n = 97 807) and finally Winter (n = 94 185). Spectral analysis confirmed there is seasonality in the emergency GRP admissions every 12 months. A forecasting model was shown to be reliable; all observed admissions for 2019 were within the 95% prediction intervals for each month for the proportion of emergency GRP admissions.
Conclusion Resource allocation towards the Summer months to target seasonal peaks in GRP should be considered.

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Authors: Wynne, Matthew David; Shah, Manu
Source: Nephrology Nursing Journal (NEPHROL NURS J), May/Jun2022; 49(3): 277-278. (3p)
Abstract:
Basal cell carcinoma is the most common type of skin cancer, and patients receiving hemodialysis are at increased risk of developing them. This article describes a case of a patient with a basal cell carcinoma in which the diagnosis was delayed due to the lesion masquerading as granulation tissue at the site of a previous tunnelled hemodialysis catheter. Early detection of basal cell carcinomas is important because delayed detection increases the risk of local invasion and the requirement for more complex surgical management.

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Authors: Atwal A; Snowsill T; Dandy MC et al.
Source: International journal of cancer [Int J Cancer] 2022 Jun 15. Date of Electronic Publication: 2022 Jun 15.
Abstract:
Ovarian cancer (OC) is the least survivable gynecological malignancy and presents late. Five-year survival for OC is around 45% increasing the need for innovative treatments. Checkpoint inhibitors have shown significant clinical efficacy in mismatch repair deficient (MMRd) cancers and could be a powerful treatment in OC. However, their application in OC is limited due to the lack of data on the prevalence of MMRd. The aim of our study was to conduct a systematic review of the literature and meta-analysis to provide an accurate estimate of the prevalence of MMRd in OC.

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Authors: Matthew L Costa , Juul Achten, Alexander Ooms et al.
Source: Health Technology Assessment, Vol 26, Iss 11 (2022)
Abstract:
Patients with a displaced fracture of the distal radius are frequently offered surgical fixation. Manipulation of the fracture and moulded plaster casting is an alternative treatment that avoids metal implants, but evidence of its effectiveness is lacking. Objective: To compare functional outcomes, quality-of-life outcomes, complications and resource use among patients with a dorsally displaced fracture of the distal radius treated with manipulation and surgical fixation with Kirschner wires (K-wires) and those treated with manipulation and moulded cast.

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Authors: Hamer, Oliver; Lowther, Hayley; Harrison, Helen; Hill, James
Source:  British Journal of Neuroscience Nursing (BR J NEUROSCI NURS), Jun2022; 18(3): 142-145. (4p)
Abstract:
Stroke remains one of the leading causes of death worldwide. To tackle the negative impacts of stroke, a high standard of clinical practice and a commitment to continuous quality improvement is needed across the stroke care pathway. One approach to quality improvement is the formation and implementation of quality improvement collaboratives. However, there are several barriers to the implementation of a quality improvement collaborative for stroke care which may impact on its success. This article critically appraises a systematic review that assessed the effectiveness of quality improvement collaboratives for driving improvements in stroke care and explored the barriers to implementing a quality improvement collaborative to improve care.

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Authors: Demain LAM;  Metcalfe K;  Boetje E; E et al.
Source: Reproductive biomedicine online [Reprod Biomed Online] 2022 May 13. Date of Electronic Publication: 2022 May 13.
Abstract:
Research Question: Does a genetic condition underlie the diagnosis of primary ovarian insufficiency (POI) in a 13-year-old girl with primary amenorrhoea?
Design: A case report of a next-generation sequencing panel of 24 genes associated with syndromal and non-syndromal POI was conducted.
Results: A homozygous missense variant c.1076C>T, p.(Pro359Leu) in BMP15 was identified.

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Authors: Kent S;  Adatia A;  James P et al.
Source: Oral and maxillofacial surgery [Oral Maxillofac Surg] 2022 Jul 05. Date of Electronic Publication: 2022 Jul 05.
Abstract:
Introduction: Complications following mandibular fractures occur in 9-23% of patients. Identifying those at risk is key to prevention. Previous studies highlighted smoking, age and time from injury to presentation as risk factors but rarely recorded other possible confounders. In this paper, we use a collaborative snapshot audit to document novel risk factors and confirm established risks for complications following the treatment of mandibular fractures.
Methods: The audit was carried out by 122 OMFS trainees across the UK and Ireland (49 centres) over 6 months, coordinated by the Maxillofacial Surgery Trainees Research Collaborative. Variables recorded included basic demography, medical and social history, injury mechanism and type, management and 30-day outcome.
Results: Nine hundred and forty-seven (947) patients with fractured mandibles were recorded. Surgical management was carried out in 76.3%. Complications at 30 days occurred 65 (9%) of those who were managed surgically. Risk factors for complications included male sex, increasing age, any medical history, increasing number of cigarettes smoked per week, increasing alcohol use per week, worse oral hygiene and increased time from injury to presentation.
Discussion: We have used a large prospective snapshot audit to confirm established risk factors and identify novel risk factors. We demonstrate that time from injury to presentation is confounded by other indicators of poor health behaviour. These results are important in designing trial protocols for management of mandibular fractures and in targeting health interventions to patients at highest risk of complications.

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Authors: Su F;  Gao C; D Liu J et al.
Source: JAMA network open [JAMA Netw Open] 2022 May 02; Vol. 5 (5), pp. e2214594. Date of Electronic Publication: 2022 May 02
Abstract:
Importance: Left atrial appendage occlusion (LAAO) has emerged as an alternative to anticoagulation for patients with atrial fibrillation. However, the performance of LAAO among East Asian patients is unknown.
Objective: To document the procedural success rate and configurations, major adverse event rates, and antithrombotic medication regimens during and after LAAO procedures among patients in China.

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Authors: Hedayat F;  Jerry Htwe KK;  Vassiliou LV et al.
Source:Source: The British journal of oral & maxillofacial surgery [Br J Oral Maxillofac Surg] 2022 May; Vol. 60 (4), pp. 430-436. Date of Electronic Publication: 2021 Nov 27.
Abstract:
The lip-split mandibulotomy (LSMA) is an access procedure that has been used in head and neck (H&N) surgery as an aid to surgical resection of inaccessible tumours of the postertior oral cavity and oropharynx. Anecdotal evidence suggests that it has significant morbidity. Voices of concern within the H&N surgical community suggest that it has been abandoned in favour of technological advances such as robotic surgery. We report here the first (to our knowledge) registered systematic review of its kind, documenting the safety and efficiency of LSMA in H&N surgery. We performed a PRISMA-guided systematic review (PROSPERO-registered) and identified reports using a search algorithm in MEDLINE/EMBASE. LSMA-related surgical complications were recorded using the Clavien-Dindo classification. Secondary outcomes included swallowing dysfunction, facial cosmesis, and patient satisfaction recorded in health-related quality of life questionnaires (HRQoL). From 125 studies identified, 54 met the inclusion criteria (3872 patients). The LSMA mortality rate was 0%; we did not identify a single case of perioperative death. The median rate of osteoradionecrosis was 5.4%, whereas fistula formation was 5.7%. Malunion was noted in 4.9%. Other complications (surgical site infection, plate exposure) were around 5%. There was significant between-study variation with regards to swallowing assessment tools, but overall there was no significant difference in outcomes. This was also the case for the HRQoL questionairres. LSMA is a safe procedure with an acceptable rate of complications, and should definitely remain in the armamentarium of H&N surgery.

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Authors: Puglia FA; Chiu GA; 
Source: The British journal of oral & maxillofacial surgery [Br J Oral Maxillofac Surg] 2022 May; Vol. 60 (4), pp. 465-469. Date of Electronic Publication: 2021 Aug 30.
Abstract:
The incidence and management of maxillofacial trauma was compared between the first and third lockdowns in the United Kingdom due to the COVID-19 pandemic. From 6 January, 2021 to 8 March 2021, the units that had participated in the collection of data during the first lockdown were asked to update their information into the same database for the third. Nine units participated with 929 entries. Compared to the first lockdown, the number of patients whose treatment had been changed due to the pandemic reduced from 7.6% to 0.4% in the third lockdown. In the UK during the third lockdown there were higher numbers infected with COVID-19 and admitted to hospital than in the first lockdown. Despite this OMFS units that participated in the second study were able to continue the management of maxillofacial trauma without the pandemic affecting care.

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Authors: Long L;  Douglas J;  Morton M et al.
Source: The British journal of oral & maxillofacial surgery [Br J Oral Maxillofac Surg] 2022 May; Vol. 60 (4), pp. 470-474. Date of Electronic Publication: 2021 Sep 20.
Abstract:
Traditionally, surgical management of zygomaticomaxillary complex (ZMC) and orbital fractures occurs within two to three weeks of the injury, followed by an overnight admission to allow for extended eye observations. This is due to the risk of postoperative retrobulbar haemorrhage (RBH) or orbital compartment syndrome (OCS), a rapidly progressive and sight threatening emergency that requires immediate intervention. In September 2016 the oral and maxillofacial surgery (OMFS) department at Leeds Teaching Hospitals redesigned their trauma service with a full-time trauma consultant, a dedicated clinic, and a weekly morning elective trauma theatre list. This allowed for standardisation of the management of patients with OMFS injuries. Furthermore, a formal day-case ZMC and orbital fracture pathway was developed to allow patients to undergo surgical management of such fractures with a same-day discharge. This has since been identified as an area of excellence by the Getting It Right First Time (GIRFT) programme, and is in line with the addition of ZMC and orbital fractures to the procedural list written by the British Association of Day Case Surgery (BADS). Unbeknown to the unit, the volume of day-case procedures was the highest within the UK, demonstrating the importance of GIRFT in highlighting areas of good or unique practice. The aim of this study was to determine the impact of our day-case pathway and designated OMFS trauma service on compliance with recent recommendations by GIRFT and BADS. Secondly, it was to determine the safety of same-day discharge with regards to postoperative complications.

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Authors: Wilding JPH;  Evans M;  Fernando K; 
Source: Diabetes therapy : research, treatment and education of diabetes and related disorders [Diabetes Ther] 2022 May; Vol. 13 (5), pp. 847-872. Date of Electronic Publication: 2022 Mar 20.
Abstract:
Over recent years, the expanding evidence base for sodium-glucose cotransporter-2 inhibitor (SGLT2i) therapies has revealed benefits beyond their glucose-lowering efficacy in the treatment of Type 2 diabetes mellitus (T2DM), resulting in their recognition as cardiorenal medicines. While SGLT2is continue to be recommended among the second-line therapies for the treatment of hyperglycaemia, their true value now extends to the prevention of debilitating and costly cardiovascular and renal events for high-risk individuals, with particular benefit shown in reducing major adverse cardiac events and heart failure (HF) and slowing the progression of chronic kidney disease. However, SGLT2i usage is still suboptimal among groups considered to be at greatest risk of cardiorenal complications. The ongoing coronavirus disease 2019 (COVID-19) pandemic has intensified financial pressures on healthcare systems, which may hamper further investment in newer effective medicines. Emerging evidence indicates that glycaemic control should be prioritised for people with T2DM in the era of COVID-19 and practical advice on the use of T2DM medications during periods of acute illness remains important, particularly for healthcare professionals working in primary care who face multiple competing priorities. This article provides the latest update from the Improving Diabetes Steering Committee, including perspectives on the value of SGLT2is as cost-effective therapies within the T2DM treatment paradigm, with particular focus on the latest published evidence relating to the prevention or slowing of cardiorenal complications. The implications for ongoing and future approaches to diabetes care are considered in the light of the continuing coronavirus pandemic, and relevant aspects of international treatment guidelines are highlighted with practical advice on the appropriate use of SGLT2is in commonly occurring T2DM clinical scenarios. The 'SGLT2i Prescribing Tool for T2DM Management', previously published by the Steering Committee, has been updated to reflect the latest evidence and is provided in the Supplementary Materials to help support clinicians delivering T2DM care.

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Authors: Woodward W; Dockerill C; McCourt A et al.
Source: European heart journal. Cardiovascular Imaging [Eur Heart J Cardiovasc Imaging] 2022 Apr 18; Vol. 23 (5), pp. 689-698.
Abstract:
Aims: Stress echocardiography is widely used to identify obstructive coronary artery disease (CAD). High accuracy is reported in expert hands but is dependent on operator training and image quality. The EVAREST study provides UK-wide data to evaluate real-world performance and accuracy of stress echocardiography.
Methods and Results: Participants undergoing stress echocardiography for CAD were recruited from 31 hospitals. Participants were followed up through health records which underwent expert adjudication. Cardiac outcome was defined as anatomically or functionally significant stenosis on angiography, revascularization, medical management of ischaemia, acute coronary syndrome, or cardiac-related death within 6 months. A total of 5131 patients (55% male) participated with a median age of 65 years (interquartile range 57-74). 72.9% of studies used dobutamine and 68.5% were contrast studies. Inducible ischaemia was present in 19.3% of scans. Sensitivity and specificity for prediction of a cardiac outcome were 95.4% and 96.0%, respectively, with an accuracy of 95.9%. Sub-group analysis revealed high levels of predictive accuracy across a wide range of patient and protocol sub-groups, with the presence of a resting regional wall motion abnormalitiy significantly reducing the performance of both dobutamine (P < 0.01) and exercise (P < 0.05) stress echocardiography. Overall accuracy remained consistently high across all participating hospitals.
Conclusion: Stress echocardiography has high accuracy across UK-based hospitals and thus indicates stress echocardiography is being delivered effectively in real-world practice, reinforcing its role as a first-line investigation in the assessment of patients with stable chest pain.

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Authors: Shugaba A; Lambert JE;  Bampouras TM et al.
Source: Journal of Gastrointestinal Surgery, Jul2022; 26(7): 1520-1530. 11p.
Abstract: Surgeons are among the most at risk of work-related musculoskeletal health decline because of the physical demands of surgery, which is also associated with cognitive fatigue. Minimally invasive surgery offers excellent benefits to patients but the impact of robotic or laparoscopic surgery on surgeon well-being is less well understood. This work examined the musculoskeletal and cognitive demands of robot-assisted versus standard laparoscopic surgery.
Methods: Medline, Embase and Cochrane databases were systematically searched for 'Muscle strain' AND 'musculoskeletal fatigue' AND 'occupational diseases' OR 'cognitive fatigue' AND 'mental fatigue' OR 'standard laparoscopic surgery' AND 'robot-assisted laparoscopic surgery'. Primary outcomes measured were electromyographic (EMG) activity for musculoskeletal fatigue and questionnaires (NASA-TLX, SMEQ, or Borg CR-10) for cognitive fatigue. A systematic review was conducted in accordance with the Synthesis Without Meta-analysis (SWiM) Guidelines. The study was preregistered on Prospero ID: CRD42020184881.

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Authors: Hunt N;  Rao C;  Logan R; 
Source: BMJ open [BMJ Open] 2022 Apr 13; Vol. 12 (4), pp. e059940. Date of Electronic Publication: 2022 Apr 13.
Abstract:
Objectives: We sought to investigate if duplicate faecal immunochemical testing (FIT) sampling improves the negative and positive predictive value of patients thought to be at risk of colorectal cancer (CRC). Specifically, we aimed to investigate whether the proportion of FIT-negative CRC missed by a single FIT test in symptomatic patients could be reduced by duplicate FIT testing.
Design: A retrospective service evaluation cohort study of the diagnostic accuracy of duplicate FIT testing.
Setting: Patients referred from primary care with suspected CRC to four secondary care trusts in North-West England.
Participants: 28 622 patients over 18-years-old with lower gastrointestinal symptoms suggestive of CRC who completed two FIT samples.
Primary and Secondary Outcome Measures: The performance of duplicate FIT for detecting CRC at a threshold of 10 µgHb/g.
Results: The sensitivity if either test was >10 µgHb/g was 0.978 (0.955-0.989), specificity was 0.662 (0.657-0.668), positive predictive value 0.031 (0.028-0.035) and negative predictive value 1.00 (0.999-1.00). Despite two-thirds of patients (18952) being negative following two tests, at this threshold only seven CRC were missed over a 26-month period. All seven patients had other high-risk features which should have prompted investigation.
Conclusions: This study suggests that in routine NHS practice, a duplicate FIT sample strategy together with clinical evaluation for evidence of anaemia and weight loss is superior to a single FIT sample alone and would allow symptomatic patients to be managed in primary care without the need for urgent referral to secondary care for urgent colonic imaging.

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Author(s): Garg S. et al
Source: Frontiers in cardiovascular medicine [Front Cardiovasc Med] 2022 Apr 13; Vol. 9, pp. 821380. Date of Electronic Publication: 2022 Apr 13 (Print Publication: 2022).
Abstract: The safety and efficacy of drug-coated balloon (DCB) treatment for de novo coronary chronic total occlusion (CTO) remain uncertain. The aim of this study was to evaluate the outcomes of DCB only treatment for de novo CTO.
Methods: In this retrospective study, 101 vessels with de novo CTO lesions dilated by balloon angioplasty with thrombolysis in myocardial infarction flow grade 3 were included. Among them, 93 vessels successfully treated with DCB only treatment were analyzed. The study endpoint was major adverse cardiac events (MACE) at 2 years, a composite of cardiac death, non-fatal myocardial infarction (MI), target vessel revascularization (TVR), and target vessel thrombosis. The secondary endpoint was late lumen loss (LLL) on follow-up coronary angiography.

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Author(s): Garg S. et al.
Source: American heart journal [Am Heart J] 2022 Apr; Vol. 246, pp. 32-43. Date of Electronic Publication: 2022 Jan 03.
Abstract: Current ESC guidelines recommend the use of intra-coronary pressure guidewires for functional assessment of intermediate-grade coronary stenoses. Angiography-derived quantitative flow ratio (QFR) is a novel method of assessing these stenoses, and guiding percutaneous coronary intervention (PCI). The PIONEER IV trial is a prospective, all-comers, multi-center trial, which will randomize 2,540 patients in a 1:1 ratio to PCI guided by angiography-derived physiology or usual care, with unrestricted use in both arms of the Healing-Targeted Supreme sirolimus-eluting stent (HT Supreme). 

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Authors: Lamb R;  Kahlon A;  Sukumar S;  Layton B; 
Source: Clinical radiology [Clin Radiol] 2022 Apr; Vol. 77 (4), pp. 264-273. Date of Electronic Publication: 2022 Jan 07.
Abstract: Diverticula of the small bowel can be categorised as true, with Meckel's being the only example, or false. False small bowel diverticula (SBD) are acquired through herniation of the internal layers of the bowel wall through the muscularis propria. Peri-ampullary duodenal diverticula are a well-recognised example; however, the importance of more distal SBD in the jejunum and ileum is underappreciated, and they are under-reported on cross-sectional imaging. SBD are a known cause of anaemia, malabsorption, and diarrhoea, and there are myriad complications of SBD and Meckel's diverticula, which range in severity from inflammation and perforation to haemorrhage, tumour formation, and obstruction. Before the advent of computed tomography (CT), SBD were readily diagnosed on fluoroscopic oral contrast studies; however, radiologists are less comfortable with their cross-sectional imaging appearances. This imaging review combines our experience of multiple proven cases, with illustrative diagrams and radiological images of SBD to provide distinct imaging characteristics, allowing for confident diagnosis of SBD and their numerous complications. We discuss the importance of SBD as a cause of benign, non-surgical pneumoperitoneum. We additionally provide important pitfalls to be aware of such as SBD masquerading as other abnormalities.

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Authors: Al-Tawil M; Chikhal R; Abdelhaliem A; 
Source: Journal of cardiac surgery [J Card Surg] 2022 Apr; Vol. 37 (4), pp. 1002-1003. Date of Electronic Publication: 2021 Dec 27.
Abstract: Uncomplicated Type B aortic dissection (un-TBAD) is still managed conservatively with optimal medical therapy (OMT) despite evidence in favour of thoracic endovascular aortic repair (TEVAR) for un-TBAD. OMT aims to regulate heart rate and blood pressure and patients require long-term follow-up to evaluate the extent of dissection, however, many un-TBAD patients are lost to follow-up. Several trials and observational studies evaluated the use of TEVAR in combination with OMT in un-TBAD and proved the safety, effectiveness, and comparability of TEVAR relative to OMT alone. What remains in question is the optimal time window to intervene with TEVAR. This was recently addressed in a fascinating review by Jubouri et al. AIMS: This commentary aims to discuss the recent review by Jubouri et al. which further proved that TEVAR is safe and effective in un-TABD and investigated the optimal timing of TEVAR in un-TBAD.

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Authors: Kumar, D., Dawoud, B.E.S.; Kent, S.; MTReC; Kyzas, P.
Source: British Journal of Oral & Maxillofacial Surgery; Apr2022, Vol. 60 Issue 3, p291-294, 4p
Abstract: Non-condylar mandibular fractures are consdered 'open' fractures and as such are thought to require prophylactic antibiotics. There is no overall consensus on the optimal regimen or choice of antibiotic in the preoperative and postoperative periods due to a lack of high-quality evidence. We therefore set out to ascertain the current UK-wide practice of antibiotic prescribing for non-condylar mandibular fractures. We used a web-based online survey (Google Forms) that was disseminated via email and social media platforms to oral and maxillofacial surgery (OMFS) consultants and trainees of all grades. The questions focused on usual antibiotic practices and typical clinical management of non-condylar mandibular fractures. We gathered information on preoperative antibiotics, and on perioperative and postoperative periods. We collected data from 50 different UK OMFS units representing a broad snapshot of national practice. The majority of responders were speciality trainees (36%) followed by dental core trainees (34%). A total of 45/50 centres routinely admitted patients, and preoperative intravenous antibiotics were commenced on admission by 77/89 respondents, intravenous being the chosen route in all cases. In the preoperative period 81% prescribe co-amoxiclav. In 91% of cases, open reduction and internal fixation (ORIF) was on general emergency (CEPOD) operating lists, whilst dedicated OMFS trauma lists accounted for 9%. With respect to timing, 49% aimed to carry out ORIF within 24 hours from the time of admission, 44% aimed for surgery within 24 - 48 hours, and 6% aimed for surgery on a semielective basis (48 hours or more). Postoperative antibiotics were prescribed routinely by 88% of responders. Preoperative intravenous prophylactic antibiotics are commonplace in non-condylar mandibular fractures. This UK-wide survey demonstrated significant variability in antibiotic prescribing practices, especially in the postoperative period. Most units still rely on CEPOD emergency theatres to provide the capacity for ORIF in this patient group

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Authors: Kyzas P
Source: Plastic and reconstructive surgery [Plast Reconstr Surg] 2022 Feb 01; Vol. 149 (2), pp. 359e-361e.

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Author(s): Michael Scott , Anton Krige , Michael P W Grocott 
Source: Anesthesiol Clin 2022 Mar;40(1):xv-xvi. doi: 10.1016/j.anclin.2021.11.013.

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Authors: Adam D; Kyzas P; Vassiliou L; 
Source: The British journal of oral & maxillofacial surgery [Br J Oral Maxillofac Surg] 2022 Jun; Vol. 60 (5), pp. 664-665. Date of Electronic Publication: 2021 Oct 20.

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