ELHT Evidence Hub
  • Home
  • Meet the Team
  • Library Facilities
  • Education, Research and Innovation
Picture

Can elective surgery for mandibular and zygomatic complex fractures reduce overall hospital stay without compromising outcomes? Analysis of administrative datasets by the GIRFT programme

27/11/2020

0 Comments

 
Author(s) Gray W.K.; Day J.; Morton M.
Source British Journal of Oral and Maxillofacial Surgery; Nov 2020; vol. 58 (no. 9); p. 1151-1157
Language English
Publication Date Nov 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
0 Comments

Can elective surgery for mandibular and zygomatic complex fractures reduce overall hospital stay without compromising outcomes? Analysis of administrative datasets by the GIRFT programme

12/10/2020

0 Comments

 
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
0 Comments

Comparison of primary care doctors and dentists in the referral of oral cancer: a systematic review

12/10/2020

0 Comments

 
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
0 Comments

Orbital floor and wall as a biological "crumple zone"

28/2/2020

0 Comments

 
​Author(s) Hasan A.; De Gea Rico A.; Cousin G.
Source British Journal of Oral and Maxillofacial Surgery; Feb 2020; vol. 58 (no. 2); p. 245
0 Comments

5 year Longitudinal Surgical performance in excisions of non melanoma head and neck skin cancer (NMHNSC)

20/12/2019

0 Comments

 
Author(s) Chandran A.; Bhanji A.; Rao J.
Source British Journal of Oral and Maxillofacial Surgery; Dec 2019; vol. 57 (no. 10)
Introduction/Aims A surgeon's experience undertaking larger case volumes is often linked to better performance. The aim was to assess a single surgeons performance in NMHNSC excisions over five years. We analysed time and case number to reach a consistent competency with regards to excision margins. Materials/Methods Skin pathology data sets were collected retrospectively from 2014 to 2018 The data collected involved a single surgeon operating in multiple hospitals and settings. Information regarding patient demographics, histological features of NMHNSC and excision margins were collected from pathology reports for each operation.

Results/Statistics The results showed from January 2014 to April 2014 there was a 6.8% involved margin rate and a 11.4% close margin rate. This improved with further case volume over the five years. By September2018 to December 2018it was noted that the involved margin rate had reduced to 3.8% and the close margin rate had increased slightly to 13.4%. We present the longitudinal statistics.

​Conclusions/Clinical relevance This study has shown that there appears to be improvement in performance of excisions of NMHNSC as the surgeon gains experience over time to reach a consistent performance. There was a clear initial learning curve to achieve this which took several cases. This likely differs from numbers presented in the literature believed to achieve competency in other bodily surgical procedures.Copyright © 2019
0 Comments

Custom titanium guides in mandibular 3D sculpting

20/12/2019

0 Comments

 
Author(s) Markose G.; Corsar K.; Graham R.M.
Source British Journal of Oral and Maxillofacial Surgery; Dec 2019; vol. 57 (no. 10)
With advances in CT scanning and 3D printing facilities the use of surgical models / stents in maxillofacial surgical planning for implants and oncological work is fairly routine. We present a case where the use of custom cutting guides aided 3D sculpting of a rather overgrown mandible in a young girl with a central giant cell granuloma. En bloc resection can be challenging due to the variable size and location of the tumours and their proximity to surrounding vital tissues. To overcome the challenge of precise resection, computer-aided models were used to assess vital structures, the extent of the affected area and plan surgery.

​The models were able to accurately identify the course of the mandibular canal. A mirror image of the normal side of the mandible was superimposed on the overgrown mandible and patient-specific guiding templates for resection were fabricated which allowed significant recontouring of the mandible with relative ease. The guiding templates provide significant advantages by guiding surgery, leading to more precise resection of the bone with less blood loss, shorter operation time and avoiding damage to the inferior alveolar nerve. We discuss the pre-operative and operative steps in the surgery and review the results.Copyright © 2019
0 Comments
    The following databases were searched:
    EMBASE,  MEDLINE, PsycINFO, BNI, CINAHL, 
    to find  ELHT staff publications

    Specialties

    All
    ANAESTHETICS
    CARDIOLOGY
    COVID 19
    DERMATOLOGY
    DIABETES
    DIETETICS
    EMERGENCY CARE
    GYNAECOLOGY
    MAXILLOFACIAL
    NEONATOLOGY
    OBSTETRICS
    ONCOLOGY
    ORTHOPAEDICS
    PAEDIATRICS
    PAIN
    PHARMACY
    RADIOLOGY
    RESPIRATORY
    SURGERY
    UROLOGY
    VASCULAR SURGERY

    RSS Feed

    Archives - past 2 years

    December 2020
    November 2020
    October 2020
    September 2020
    July 2020
    June 2020
    May 2020
    April 2020
    March 2020
    February 2020
    January 2020
    December 2019
    November 2019
    October 2019
    September 2019
    August 2019
    January 2019
    December 2018

Learning Centre Library
Royal Blackburn Teaching Hospital
library.blackburn@elht.nhs.uk
01254 734312 or Ext 84312

​Find us

Staffed Opening Hours
Mon      08:30-16:30
Tue       08:30-16:30
Wed     08:30-16:30
Thu      08:30-16:30
Fri         08:30-16:00
Mackenzie Library
Burnley General Teaching Hospital
library.burnley@elht.nhs.uk
01282 803114 or Ext. 13114

Find us

Staffed Opening Hours
Mon      08:30-16:00
Tue       08:30-16:00
Wed     08:30-16:00
Thu       08:30-16:00
Fri         Unstaffed

FAQS
​Library Catalogue
Library @lerts
​Your Specialty or Professional Group
Membership Terms & Conditions
Privacy Policy
Our Performance
​Your Feedback
​Specialty Journals

Picture
Picture
24/7 access to the library is available - please see library staff
Picture
  • Home
  • Meet the Team
  • Library Facilities
  • Education, Research and Innovation