Author(s) Gray W.K.; Day J.; Morton M.
Source British Journal of Oral and Maxillofacial Surgery; 2020

When patients attend the emergency department with facial fractures that require surgery and are immediately admitted, surgery can be delayed as theatre time is prioritised for other more urgent patients. One solution is to send the patient home and admit them as an elective patient at a later date. The aim of this study was to investigate the outcomes of patients admitted directly and those seen as elective patients following fracture of the mandible or zygomatic complex. Data were taken from the hospital episodes statistics (HES) dataset for 2011-2018, and all hospital admissions for mandibular and zygomatic complex fractures within the National Health Service (NHS) in England were extracted. Patients were categorised as those admitted on attendance at the emergency department and given definitive treatment during the admission, and those not admitted on attendance at the emergency department but discharged home and seen as elective admissions within 30 days of attendance. Data were available for 39 606 patients. For both types of fracture there was substantial variation between NHS trusts in the proportion of patients admitted electively and the proportion admitted directly as emergencies. Elective admission was independently associated with shorter overall stay and lower emergency readmission rates. We found no evidence that delays to definitive surgery through elective admission had a negative impact on emergency readmission rates. Patients admitted electively had a significantly shorter hospital stay.Copyright © 2020

Author(s) Halim U.A.; Elbayouk A.; Javed S.; Ali A.M.; Cullen C.M.
Source The bone & joint journal; Sep 2020 ; p. 1-11

AIMS: Gender bias and sexual discrimination (GBSD) have been widely recognized across a range of fields and are now part of the wider social consciousness. Such conduct can occur in the medical workplace, with detrimental effects on recipients. The aim of this review was to identify the prevalence and impact of GBSD in orthopaedic surgery, and to investigate interventions countering such behaviours. 

Author(s) Jun E.J.; Yuan S.L.; Shin E.-S.; Garg S.
Source Cardiology Journal; 2020; vol. 27 (no. 4); p. 429-430

• Available in full text at Cardiology Journal from EBSCO (MEDLINE Complete)

Author(s) Jabbar T.; Mills S.; Simpson R.; Jones A.; Campbell I. et al.
Source Journal of Endoluminal Endourology; 2020; vol. 3 (no. 3)

Aims The principal aim of this multicentre, international cohort study is to explore the safety concerns of clinicians when performing urodynamic studies (UDS) during the COVID-19 pandemic. This study will also assess provider preference on personal protective equipment (PPE) during UDS and awareness of relevant international guidelines. The outcome is to offer a practical means of reducing the risk of aerosol transmission during UDS, to include a protocol for screening patients, and to consider safer methods of inducing urethral leak-point pressure. 

• Available in full text at Journal of Endoluminal Endourology from Unpaywall

Author(s) Eden J.K.; Borgen R.
Source The British journal of radiology; Sep 2020 ; p. 20200423

OBJECTIVE: The study aims to explore the perceptions of Advanced Practice Radiographers (APRs) currently giving benign biopsy results to extend their role to deliver NHS Breast Screening Programme (NHSBSP) malignant outcomes. In the UK, APRs are appropriately trained to deliver results, yet traditionally have been cultured not to. Increasing pressures on NHSBSP units are a key driver for APR evolvement. A significant lack of published research provides the rationale for the study, combined with an identified service need. 

• Available in full text at The British journal of radiology from Wiley Online Library Medicine and Nursing Collection 2019 - NHS

Author(s) Rimmer L.; Heyward-Chaplin J.; South M.; Bashir M.; Gouda M.
Source Journal of Cardiac Surgery; 2020
Background: Type A acute aortic dissection (TAAD) during pregnancy is a life-threatening event for both the mother and the unborn baby. Pregnancy has been recognized as an independent risk factor for TAAD, postulated to be due to physiological changes that cause hyperdynamic circulation. This review seeks to outline the current controversies around this unique group. 

• Available in full text at Journal of cardiac surgery from Wiley Online Library Medicine and Nursing Collection 2019 - NHS

Author(s) Langton S.; Cousin G.C.S.; Pluddemann A.; Bankhead C.R.
Source British Journal of Oral and Maxillofacial Surgery; Oct 2020; vol. 58 (no. 8); p. 898-917

Oral cancer is referred to specialists by both general practitioners (GPs) and dentists, with varying proportions reported in different studies. However, some have noted that dentists more commonly refer oral cancer in the absence of patient-perceived symptoms and may refer at an earlier stage. Unfortunately, approximately half the UK adult population do not receive regular dental care. We have conducted a systematic review of studies that compare GPs and dentists in the referral of oral cancer and have focused on three aspects: the proportion of diagnosed oral cancers, stage on presentation, and delay. Searches of the databases Medline, Embase, Scopus, Google Scholar, Web of Science, and CINAHL, together with additional searches of reference lists, authors, and conference proceedings, found 22 studies from 10 countries, which included a total of 4953 oral cancers. The percentage of medical referrals ranged from 13% to 86%; dental referrals ranged from 15% to 80%. Random-effects meta-analysis indicated a combined relative risk of medical referral to dental referral of 1.36 (95% CI: 0.99 to 1.86). For UK-based studies, the relative risk was also 1.36 (95% CI: 1.05 to 1.76). There was considerable heterogeneity for all studies and for a subgroup of UK studies: I296.4% (95% CI 95.4 to 97.1) and 81.0% (95% CI 63.3 to 90.1), respectively. Several studies showed a lower stage for dentally-referred cancers; the combined risk for dentists and GPs referring early (stages 1 and 2) disease was 1.37 (95% CI: 1.17 to 1.60), and one cause may be the much higher number of cases referred by dentists in the absence of symptoms. No studies showed a significant difference in delay. Oral cancer is referred by both GPs and dentists, typically about 50% and 40%, respectively, although there is a wide range, probably depending on local circumstances. Both groups require skills in oral examination, recognition of lesions, and knowledge of the risk factors. Effectively, regular dental attenders are a select group that is regularly screened for oral cancer, and it is likely that screening is not delivered to those with the highest risk. We suggest that further work is required on how to access high-risk individuals both for possible screening and preventive interventions.Copyright © 2020 The British Association of Oral and Maxillofacial Surgeons